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HomeMy WebLinkAboutTANAINA VALLEY LT 16Tanaino Valley Lot 16 #011-051 91 Municipality of Anchorage Page Department of Health and Human Services Division of Environmental Services On-Site Services Section 825"L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519~6650 www. ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: .S-/,G' 000 ~/~oz'' PID Number c:~/( - C:~o'- / -9 / Name: ~--/~'~v~ ~ ,Pcf/z~ ,~/~,,~-~c~,,) WastewaterSystem: ~New ~Upgrade Address:7~ ~ ~// ~,¢¢/~ ~C~. ~ ABSORPTION FIELD Phone: Number of Bedrooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION o.~ 6.~/Ft' ~.~ Ft. Biock Lot: Subdivision: Depth to pipe bo~om from original grade; Gravel depth beneath pipe: Towaship: Range: Section: =ill added above original grade: Gravel Length: ¢, ~ Fb ~ ~ Ft. Gravel Width: Number of Lines: Distance baleen lines: Well: ~.~. ~ New ~ Upgrade ~.[ it. t Classification (Private, A, B. C): Total Depth: Cased to: Total absorption area: Pipe Material: Driller: Date Drilled: Static Water Level: nstaller: Date Installed: ~eld:GPM: IPUmp Set at: Ft. ICasing Height Ab°ve Gr°und:Ft, TANK SEPARATION DISTANCES ~septic ~ Holding ~S.ZE.P. ~Oti~er:  Septic Absorption Lilt Holding =ublic/Private Manufacturer: GapacJty: Tank Field Station Tank Sewer Line I ~ Gal. Matedah Number of Compartments Lot Line ~ ~ I~ -- -- Gal. "Pump On" ~evel at: "Pump oW level at: ~ High water alarm at: Foundation ~ ~ ~ -- -- in. in.~ in. Cu~ain Drain .... ~ ~ Pump Make & Model: E~ectd~Hnspections pe~ormed by: 5~pb,* ryzAe~ ~F~ ~//~ BENCH MARK Lo~tion and Description ~ Assumed Elevation: Department of Health and Human Services approval Reviewed and approved by: ~~ ~/~ate: /D-2¢~ '~ o~'' '.'.:~:' 72-013 (Rev. 01/00)* PERMIT NO: SW000426 PID NO: 011-051-91 SWING TIES: FROM: COR. "A" COR. "B"/ TO: S.T.C.O. "D" 17' 30' VALVE. "E" 20' 31.5' DBL. C.O. "F" 20' 29.5' TR. M. T. "H" 77' 58' TR. C.O. "1" 63' 59.5' / / / / / / / / / / PAGE 2 OF 2 NEW 82-FOOT LONG SOIL ABS. TRENCH W. 7' EFF. GRAVEL "BULL RUN" DIV. VALVE ........ ,~., ~ , ~L,-,r~ VIEW 3089 ~ ~ ~o~ ~'~ *, "BULL RUN" DIV. VALVE 4'+ SOIL COVER FILTER FABRIC INV. 92.6' BOTH ENDS BOTTOM TRENCH ELEV. 85.6' DBL. C.O. BOTTOM T.H. #1 ELEV. 79.6' M.T. DRY 10/18/00 INV, 93.2' CROSS-SECTION NOT TO SCALE ORIGINAL 1250 GAL. SEPTIC TANK 4'+ SOIL COVER SCALE: AS NOTED DRAWN BY TFM OCTOBER, 2000 FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 LOT 16, TANAINA VALLEY SID SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L 57root, Room 502 P.O. Box ~'96650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 06, 2000 Expiration Date: Oct 06, 2001 Permit Number: SW000426 Legal Description: TANAINA VALLEY LT 16 Design Engineer: 0019 Flattop Technical Services Owner Name: Greg& Pam Toungmun Owner Address: 7023 Lowell Cir. Anchorage, AK 99502- Parcel ID: 011-051-91 Site Address: Lot Size: 39640 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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 ( 18AA072 ) and Drinking Water Regulations ( 18AACS0 ). 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. Received By: Issued By: Date: Date:/0 OP TEC HN.ICAL:-[ CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 October 5, 2000 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 16, Tanaina Valley S/D. The existing soil absorption bed is operating in a surcharge condition. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material above 6 feet is a dry, gravelly silty sand with a measured perc rate of 4 minutes per inch. The material below 6 feet is silty sand of variable consistency with a measured perc rate of 9 minutes per inch. Using a somewhat conservative soil application rate of 0.6 gpd/sq, ft for a trench primarily utilizing the lower stratum, this 4-bedroom residence requires a total absorption area of (4 x 150)/0.6 = 1000 square feet. The proposed 75-foot long trench design with an effective gravel depth of 7.0 feet has a total absorption area of 1050 square feet, which allows an extra 3 feet of trench to compensate for the corner. The topography of the lot in the area of proposed construction slopes downward towards the west at 4%. Near the west edge of the lot there is a 50% cut slope down to Lowell Circle. As illustrated on Section "A- A", a 25% line sloping down from the invert of the distribution pipe does not daylight out before the toe of the cut bank. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. #1 SOIL ADS. BED INSTALL "BULL RUN" DIVERTER VALVE o SEPTIC° AREA o o CONSTRUCT 75' LONG SOIL ADS. TRENCH W. 7.0' SEWER GVL BELOW DIST. p&PE LOT 16 4-BDRM TANAINA VALLEY HOUSE EXISTING 1250 GAL. SEPTIC TANK SEPTIC AREA LOT 15 LOT13 NOTE: LOTS IN THIS SUBDIVISION ARE SERVED BY A CLASS "A" COMMUNITY WATER SYSTEM LOT 16, TANAINA VALLEY S/D SEPTIC SYSTEM UPGRADE SITE PLAN I~I,ATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STKEET DRAWN BY TFM ANCI-IORAGE, ALASKA 99516 OCTOBER, 2000 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. 35 CONSTRUCT 75' LONG SOIL ABS. TRENCH W. 7.0' SEWER GVL BELOW DIST. PIPE 4" DIA. F-810 PERF. PIPE 4" DIA. D-3034 SLOPE @ 1% INSTALL DBL. C.O. INSTALL "BULL RUN" DIVERTER VALVE TO OLD SOIL ABS. BED PLAN VIEW SCALE: 1" = '10' RETAIN EXISTING 1250 GALLON SEPTIC TANK IF STILL IN O.K. COND. INSTALL FDN C.O.7 20+ TOP OF __ CUTBANK ~ TOE OF CUT BANK SECTION"A-A" SCALE:l"=7' DRIGIN GROUND ELEV. AT T.H. #1 -- CLEANOUT MOUND COVER MATERIAL 6" ORIGINAL GROUND :ABRIC DIA. F-810 PERF. DIST. PIPE 1/2" SEWER GRAVEL BOTTOM OF EXCAVATION LOT 16, TANAINA VALLEY S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES 14530 ECHO STI~ET ANCHORAGE, AK, 99516 SCALE: AS SHOWN DRAWN BY: TFM OCTOBER, 2000 q~fattop q'echnica£ $eroices 14530 qEcfio Street, j~nchorage, j~2( 99516 ~Pfione (907) 345-i355 Lot 16 Tanaina Valley S/l) 7023 Lowell Circle Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installation of a "Bull Run" diverter valve downstream of an existing 1250-gallon septic tank and construction of a 75-foot long soil absorption trench containing a total of 7.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. Ail separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The homeowner shall be responsible for arranging to have a surveyor locate the south property tine in the area of construction. The contractor shall be responsible to obtain any necessmy utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over ali system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank may be retained in service, only if it's structural integrity has been verified by the inspecting engineer, and if it has functional cleanout pipes with airtight caps, allowing pumping access to each compartment. Any existing septic tank or seepage pit which is not retained in service must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 If required, the new 1250-gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 Ail pipe connections to the tank shall be equipped with waterproofmechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. A "Bull mn" diversion valve shall be installed allowing future reconnection to the original soil absorption bed, if desired. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 75'foot long trench (in the approximate configuration shown on the site plan) to a depth of 12 feet below the ground elevation in the vicinity of test hole #1. The trench shall be no closer than 23 feet from the toe of the bank adjacent to Lowell Circle. If remains of old construction debris burial sites are encountered, or if it is necessary in order to achieve gravity flow from the existing septic tank, the trench configuration shall be modified accordingly. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 7.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 7.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. The discharge line from the septic tank shall be connected into the perforated distribution pipe at a point no further than 50 feet from either end. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 5.1 Aminimum of 4 engineering inspections will be required during the course ofthe project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. A new septic tank, if needed, requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. TEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH -- (feet) FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Lot 16. Tanaina Valley S/D 9/26100 Greg and Pam Youngmun SM Silty sand fill Pt. SM Reddish gravelly, sandy loam SP/SM Dry, gravelly silty sand More gravelly above 4.5' SM Silty sand Damp, clumps of ML thruout 6" lens of ML at top of stratum Lenses of SP/SM thruout SLOPE Depth to Groundwater Date No ,groundwater 9/26 Monitor tube dry 9/27 _ Monitor tube dry 10/3 SITE PLAN 50% :4%:: :: Clock Net Time Pemometer Net Drop Date Reading Time (minutes) Reading (inches) 9/26 12" Presoak 27 1/2 9/27 Resoak 27 1/2 Star[ 3:07 23 3/8 #1 3:37 30 19 1/8 4 1/4 Add water 3:38 23 3/8 #2 4:08 30 19 5/8 3 3/4 Add water 4:08:30 23 5/8 #3 4:38:30 3-0 20 3 5/8 PERCOLATION RATE 9 (minutes/inch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 7.0 FTAND 7.5 FT COMMENTS: Remains of old bury piles encountered at east and west ends of test hole. Material below 6 feet is quite variable. Perc test between 7.0' and 7.5' may have encountered material that is cleaner than typical of stratum. Recommend 0.6 gpd/sq, ft. PERFORMED BY FLATTOP TECHNICAL SERVICES. I ~"*..~.,~_'~Zo,~...~,~_ CERTIFY THAT THIS TEST WAS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: TEST HOLE LEGAL DESCRIPTION: DATE PERFORMED: PERFORMED FOR: DEPTH (feet) Lot 16, Tanaina Valley S/D 9/26/00 FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST Greg and Pam Youngrnun SM Silty sand fill Pt. SM Reddish gravelly, sandy loam SP/SM Dry, gravelly silty sand More gravelly above 4.5' SM Silty sand Damp, clumps of ML thruout 6" lens of ML at top of stratum Lenses of SP/SM thruout 50% : i : 4% SLOPE Depth to Groundwater Date No groundwater 9/26 Monitor tube dry 9~27 Monitor tube dry 10/3 Clock Net Time Peroometer Net Drop Date Reading Time (minutes) Reading (inches) -9/26 12" Presoak 31 9/27 Resoak 31 Start 3:06:30 27 #1 3:21:30 15 22 3/8 4 5/8 Add water 3:22 27 ¢Y2 3:37 15 22 5/8 4 3/8 Add water 3:39 27 #3 3:54 15 22 1/2 4 1/2 PERCOLATION RATE 4 (minutes/inch) PERC HOLE DIAMETER 7" TEST RUN BETWEEN 4.0 FTAND 4.5 FT COMMENTS: 2nd perc test conducted at T.H. #1 to assess the permeability of the shallow soils between 2.5' and 6.0'. PERFORMED BY FLATTOP TECHNICAL SERVICES. I '~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE' DATE: /~;'/,5,-- / ~'~ 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 REPOR'F Name Phone(s) Permit NO. NO. ol/B~drooms -/ Township, Range, Section 5 ¥ -/'12 £~¥W TANKS ~ SEPTIC [] HOLDING Manulacturer Capacity in gallons ~ P ~b l& I TYPE OF SYSTEM [~ BED [] W. DRAIN [] OTHER TRENCH Depth [o pipe boItom from Total depth from original grade odginalgrade ~- ~" FT Z/'-~" FT -~ FT 7 FT Z'~' FT ~d~O SCI ET Pipo material Date Installed WELLS [] PRIVATE ,~ OTHER (Identify) Total bepth FT Cased to Date Installed: Classification (A,B,C} REMARKS: DISTANCES 011~ SEPTIC ABSORPTION TANK FIELD WELL WELL //' LOT LINE FOUNDATION '~ / ~P ~' ~'OO "~' AS-BUILT DIAGRAM (Show Iocalion oi well, septic system, p~operly lines, Iound~[ion, dliveway, waler bodies, Inspeclions Performed by: . VI, A/~ )~IA~;[. ~ flt-t-t-t-t-t-EZ$ ~ urlg halthlalna)ect r d I -- - ~ ~ ' ~ -- e yl ' I Ion waspedome accordlngloag Municipal and State guidelines in film on Ihls date: _ ~--/I 5'/~ ~ Heallh Depadmenl Approval: --, ~,4~_~ ~ Date: , __ 72-013 (3/85) Municipalit~ ot Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PEF 2 3- 4- 5- § 7 8 g 10- s~ 11 13 14 15 16 17. 18- 19- Township, Range, Section: SLOPE SITE PLaN WAS GROUND WATER ENCOUNTER ED? ~/<:~ IF YES. AT WHAT DEPTH? I PERCOLATION RATE __ (mlnute~ncl31 PERC ?IOL£ DIAMETER Tom Fink, Mayor January / unicipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 995'19-6650 8, 1990 Denali Supply, Inc. 7021 Driftwood Anchorage, Alaska 99518 Subject: Lot 16 Tanaina Valley Subdivision Permit #890016i PID #011-051-91 The subject permit, issued'by this office for a:single family well and/or on-site wastew~ter system has expired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built.inspection report (three-part form) must be sent to this office for review, approval and documentation. When applying for a new permit, the fee~ are: ~90.00 for an on-site wastewater permit;' $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" ])(::q:;il:.h ,1:.(::) Cc, l::) (::)F ,~¢~)[:)'1:. :i, (:: 'L,~:tr'll:: (~?~) 4: 4," ]:lq~iFl'P'~l.I.. I:::'I~!:F;: Fl.ldl,l, 1 t:I4!3F!]C)C}:3':/. 'f'H]:?'; F:'Ii'.'F;~I¥1:[T I~EXF':I:fi:E!:(B C:]I",I :1..:, /,.:: ,1, /1:3 ~' ,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMFNTAL PROTECTION 025 L~ Street, Anchorage, Alaska 99S01 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR:_ LEGAL DESCRIPTION: ~ ~ ~" /~ 1 2 5v/ry 3 4 5 6 7 SLOPE SITE PLAN 10 11 12 13- 14- 15 16- 17- 18- 19- 2o ~AS GROUND WATER S S IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop / " q ~ 13" /" z ~, $ ,¢ /~. /" _ PERCOLATION RATE ~'/, ~ (minutes/inch) TEST RUN BETWEEN ~ PT AND ~ -- FT COMMENTS 72-008 (6/79) 2O ~],~11 I ? 13 MichaeJ fi. Anderson 4381 -E Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Designs In Wood 7021 Driftwood Lane Anchorage, Alaska 99518 Subject: Lot 16 Tanaina Valley Subdivision Permit ~880039, PID #011-051-91 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 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. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit ~$,~11 Lf. Oo \ 7 ~bq ', 'ti'. 711 4 /V~ichae[ ~. Anderson 4381. E N K P E R M I T J.l"l de!s:i, gr'l:i.r]lT:, yOLU' Each se,::rk i c MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: L~/~ LEGAL DESCRIPTION: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / " ,/ ¢ ~" /" ~ " ,~ y /z. /" ~ ~ __ /2- '/ //, 25 ., '~ 5' PERCOLATION RATE /-/, ~'~ (minutes/inch) TEST RUN BETWEEN ~2.~ FT AND ¢~"~ , FT 72-008 (6/79) RASPBERRY ROAD T 6 20 7 16 8 14 I0 12 C-S I/~$ STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBDC WATER SYSTEIVIS APPROVAL TO CONSTRUCT Plans for lhe construction or modtflcatlon of In by approved. public water syslem located Alaska, submitted In accordance with '18 AAO 80.100 have been reviewed and are [] conditionally approved (see attached coedltlons). ~ ~ 7 · TITLE If construction has~ not started within two years of the ~pprowl date, thls certificate I~ void and new plan8 and specifications must be submitted for review ~nd approval before construction. B. APPROVED CHAHGF ORDERS Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" seclion must be completed and signed by the Department before any water ts made available to the public. Tile construction of tile ~/"~~ public we,ers e,emweseomp,e,edon __,da'e,.Tbe.s,em,sbe,eby granted Interim approval to operate for g0 days following the completion date. As-bulll plans su~d during lhe Interim approval period, or an nspect on by t ~e Department, has conlhmed Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 Parcel I.D. 1. C~fl - os-~ -? / CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: GENERAL INFORMATION Complete legal description Lo/- I~, Location (site address or directions) Current Property owner(s) i°~~', ¢~ ~-~-~? Mailing address '7 ~, Z .7 ~,~, ~ er/ Lending agency /~/~ 6. '7-a.~ ,~/,*,~ D/cz//e?, 5- 1// ~0~ /~c,c.~,~(I (er-c/e,'. Day phone Day phone Mailing address Real Estate Agent Mailing Address Day phone 4 Unless otherwise requested, HAA will be heed by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class "A" 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 (HAA) 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 between 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 Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-O25 (Rev 01 00)' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Hearth Authority Approval application show 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. DHHS SIGNATURE // Approved for J-tL- bedrooms. Disapproved· Conditional approval for ENGINEER'S STAMP bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Original Certificate Date: Reissue Date: 72 025 IRev. O1 00~' Legal Description: /--o/- A. WELL DATA Well type C/¢,-o' Date completed __ Total depth .__ Municipality of Anchorage Department of Health and Human $orvi~ C E ! V E D Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 OCT 2 4= 2000 www. ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST ft Cased to FROM WELL LOG If A, B, or C provide PWSID # ~/~' 7~ ~' Well Log Sanitary seal __ Wires properly protected __ ft Casing height (above ground) Date of test Static water level . ft Well production g.p.m WATER SAMPLE RESULTS: Coliform colonies/100 mi Nitrate Date of sample: Collected by: SEPTIC/HOLDING TANK DATA TankType/Material ..~eto/-;~ / d'~ee ! Date installed 5-//.~-/q~ Tank size Cleanouts 'd Foundation cleanout Date of pumping ~ o / /~) / oO ABSORPTION FIELD DATA AT INSPECTION mg/I Other bacteria__ in. ft g.p.m colonies/100 mi gal Number of Compartments Depression over tank N High water alarm Pumper Date installed I0//q/pc, Soil rating (g.p.d./ft2 or ft2/bdrm)~ System type Length ~ ~- ft Width ¢ ft Gravel below pipe 7. ¢ ft Total depth ~8, oft Effective absorption area I~'~ ft~ Monitoring tube__ Date of adequacy test /v'./¢. (~/,/~ Results (Pass/Fail) Fluid depth in absorption field before test ~ in Water added__ Elapsed Time: min Final fluid depth in Any rejuvenation treatment (past 12 mo.) (Y/N & type), hi '¢ Depression over field ~' For '-/ bedrooms gal. New depth in. Absorption rate >-- ~¢d,, g.p.d. If yes, give date /d.A. 72-026 (Rev. 01/00)* D. LIFT STATION ~/. ~, Date installed "Pump on" level at __ in Datum E. SEPARATION DISTANCES Size in gallons __ "Pump off" level at __ in Cycles tested SEPARATIQN DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot/v'. ,4,, Absorption field on lot /¢. 4, Public sewer main /¢. -~. Sewer/septic service line H. ,~. Manhole/Access High water alarm level at in Meets alarm & circuit requirements On adjacent lots ,U. ,4. On adjacent lots ~. ,~, Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line 13 ' Water service line > to ' Wells on adjacent lots ~. zoo , Building foundation Water main _ ~ ~¢ ' Drainage -;> ~t,~,, Absorption field :~.¢ ' Surface water '~ ¢¢~ ' Building foundation t ~" Water main ~. z¢ ' Surface water ~. zoo, Driveway, parking/vehicle storage Wells on adjacent lots ~> 7-o0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I ~ ' Water Service line > ~¢' Curtain drain OOMMENTS 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 Date HAA Fee $ ~o0~ Date of Payment ,/¢/~'¢'/~ Receipt Number ~*~'~* ~ / ~9~"~~') Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF EN¥1RONMFNTAL SERVICES 343-4'744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ('-"~11- ~';~1-°~ / HAA#_ ~'~("hf'%,\~c~'~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) Property owner Mailing Address Location (address or directions) ,Z'~ ~/c2~..Z/L~,4 / C, Telephone: (home) __ Business ,~'¢ ?- ¢ 42 /~ (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here [Ef;~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 I~'"'"'~Pu blic [] Note: If community well system, must have written confirmation 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. 72-025{Rev 7/88) Page 1 of 2 'HJOM s,Jeeu!~ue leUOiSSejoJd eLlh u! suo!es!uJo JO s JO J J8 JOJ elq!suodseJ hou s! eeeJoqouv jo,q!led!o!un~ eq.L 'pense! s! eheo!J!hJeo e eJojeq ehep ez,qeue Jo suoihoedsu! honpuoo hou op SHHC] jo sae~oldLU3 'shueLueJ!nbeJ elels pub leJepe,t u!ehJeo/(JsBes oh JepJo u! suoBnlRsu! 6u!puel Jieqi pub seuJoq jo sJeseqoJnd oh ~sehJnoo e se s!q~ seep SHHQ eqJ. 'e)tselV jo elehS eqj u! peJels!beJ Jesu!hue leUOfSSejoJd huepuedepu! ue,~q eAoqe ~; qdeJ§eJed u! ueA!b suo!lehueseJdaJ eqh uodn ,{lUO peseq p@heo!jpeo le^oJddv ,qpoqinv qhleeH senss! 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WELL DATA Well Classification _ Well Log Present (Y/N) Total Depth Cased to Static Water 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 I._ot Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIL~T - FEBRUARY 1984 lC PA 3~¥ O~ ANCH©kg~'~J Legal Description: Mf ,Y 1 5 1990 Date Completed Depth of Grouting 7'-,,¢,,v,4 //,/,4 V/~/~bE/V 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 ,¢L~¢~?,~ Size Standpipes (Y/N) __}/ Depression over Tank (Y/N) _ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ /V//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: ~,~' ,~',~ Air-tight Caps (Y/N) _ No. of Compartments /V Foundation Cleanout (Y/N) Date Last Pumped ~J£VJ ; for Temporary Holding Tank Permit (Y/N) /v/.~ To Building Foundation _ '7 ~ To Disposal Field To Water-Supply Well '7,")O To Property Line /;7' To Water Main/Service Line _ To Stream, Pond, Lake or Major Drainage Course Comments S~-)=:;~T'I (::- ~/jTE/~'/ 1.5 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~- 2_/~ ~O Width of Field ~ ~/ ~-'00 Square Feet of Absortion Area Depression over Field (Y/N) /'4 Results of Last Adequacy Test I~A 55 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 70 To Building Foundation ~- ~-' Lot nOME' Ow L~-r' To Water Main/Service Line ~ c/, To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~.~.~o~- ,P T-/~).~' Type of System Design Length of Field Depth of Field Gravel Bed Thickness /, ~" Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line ; On Adjoining Lots lO©'4- To Cutback (if present) To Existing or Abandoned System on D. L~ON Date I nst alle-'d--.. Dimensions Size in Gallons ~ Manhole/Access (Y/N) "Pump On" Level at ~_.......Q~/~ "Pump Off" Level at High Water Alarm Level at /,.,..'~'-<~...... Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and inspection. Signed ~/~, ~ E ~4..,'~ Company ,/'~ Z~ ~Tt.~ o ,,) -~/_,/MG-'~I~a6 Date ~--/z S-/~/O MOA No. ReceiptNo. ~l~,'?~¢) ) I¢''~''¢-' ReceiptNo Date of Payment ,~) ¢ l~' ¢ ~ (~ Waiver Fee: $ Amount:$ l~(~'('~) Date of Payment 72-026 [Rev. 7/88) Gack Page 2 of 2 s in effect on the date of this Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERV/kTION A I,..O~,A ...... ,T ..... D I.>T~,x~,.T Or ~' IC;:, 3o~01 C STRE,..., SUITE 322 A?ICTTOILAGE, ALAS[fA 99503 ~,a~ 15, 1990 STEVE COWPER, GOVERNOR -o775 FOR: WAYi,1E ' "' FADDE?] ~'7 o T .I, O ~ P,.,.~D. ~2147..~ According to the records on file in this office, the F, states/Tanain~/Valle¥ Subdivision Uater System is with the State of Alaska Drinking t~ater Regulations. Country Lane in compliance Sincerely, VEC:bas