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HomeMy WebLinkAboutHOLLY HILL BLK 2 LT 6AHolly Hill Lot 6A Block 2 #014-081-09 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor www.mumi.orq/onsit (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: _ Parcel Identification Number: Legal Descriptionlie Owner Name & Address: N o L L ILLTOy Ft&,fAjaEQ4i Y ia 14FekD Rani Ce hoto61 n X Pump Installation Date: 1- l9 -1S Pump Intake Depth Below Top of Well Casing: 0 feet 775 i Pump Manufacturer's Name: Af Pa "4 % Pump Model: 75-F-3/1 _)V'S Pump Size 314 hp Pitless Adapter Burial Depth: i O feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: 1 Well Disinfected Upon Completion? [Yes ❑ No Method of Disinfection: Comments: C LO gjni In ,5 Pump Installer Name: 4 n 04 Ot Aq E t' -OV, d" Petr S Attention: The pump installer shall provide a pump installatiln log to the DSD within 30 days of pump installation. 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 SW000390 \PID No. 014-081-09 1 t� A- B ` C _. _ S1 73.0 50.0 S2 ' .78.7 535 DV .80.7 54.75 C4 47.2 69.8 M1 30.33 48.6 " CS 28.25 33.25 t� To House 93.4 LEGEND i1,000 Gallon Sep. Taff S Septic Tank Vent C Cleanout DV Zabel Flow Diverter Valve M Monitor Tube TH Test Hole E Geotextile Drainfield 27' PROFILE AS -BUILT Rock 86.8 80.0± 23' Pa L v 3 MUNICIPALITY OF ANCHORAGE Department 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 Permit Number: SW000390 Legal Description: HOLLY HILL BLK 2 LT 6A /0--2-00 <' 3'3o Date Issued: Sep 21, 2000 Expiration Date: Sep 21, 2001 L" 7aIIs ilES1Y.5Q0:. Design Engineer: 0014 Anderson Engineering Site Address: 003641 72ND AVE E Owner Name: Dallas Johnson Lot Size: 18700 SQ. FT. Owner Address: PO Box 112313 Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99511 - This permit is for the construction of: ❑? Disposal Field ❑ Septic Tank Holding Tank ❑ Privy [I 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. Received By: Issued By: Date: n� Date: 9- 2 / -D� September 9, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 6A, Block 2, Holly Hills Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on Lot 6A, Block 2, Holly Hills Subdivision has failed and 'must be replaced so a Certificate of Health Authority Approval can be obtained on the property. We are therefore applying for a permit to reconstruct the septic system on the lot to serve the three bedroom home. The attached Site Plan and backup documentation identify the location and configuration of the new and existing septic system and the parameters used in the design. It also shows the location of the well on the lot and the 100' protective radius. The subdivision to the east of this property is served by the Municipal water and sewer systems so conflicts with surrounding wells is not an issue. A test hole was placed on the lot in the area of the new absorption trench and revealed silty sand and gravel with a percolation rate between 9 and 15 minutes per inch. No groundwater was encountered in the test hole and none accumulated during the ` monitoring period. We have therefore designed a deep absorption trench system with 6' of gravel beneath the distribution pipe. The total length of the trench will be 50'. The distribution pipe in the trench will be placed 4' beneath the existing ground surface.' Total depth of the trench from original grade will be 10'. The existing 1,000 gallon concrete septic tank will be exposed and inspected for continued use. If it is damaged, it will be replaced with a new tank outside the 1 00'well radius. A flow diverter valve will also be placed to keep the existing absorption system in line for future use if necessary. The ground surface on the lot is basically flat in all directions. < The new trench will be constructed parallel to the contours of the surface in conformance with Municipal requirements. Grading will be accomplished to assure surface drainage is away from the new trench. The new trench will be placed as far from the existing trench as possible to maintain the required separation distance. If the system is constructed in accordance with our design the following statements apply 1. 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. i Lr Septic System LOT 6A, BLOCK 2, HOLLY HILLS SUBDIVISION Performed For: Dallas Johnson Date Performed: Legal Description: Lot 6A Block 2 Holly Hill Subdivision SLOPE SITE PLAN 1 F-1 OG/01- GM/SM G/OL Perc. Zone i 11 12 13 14 15 1 GM/SM TESTHOLE N0.1 Bottom of Hole See Site Plan Was Groundwater Encountered? No If Yes, What Depth? Depth to Water After Monitoring None Date: 9/9/00 yvI "g 4�` }'A— Reading Date Gross Time Net Time Depth To Water Municipality of Anchorage 3a Department of Health & Human Services `# 825 L Street, Anchorage, AK 99502-0650 — ` SOILS LOG - PERCOLATION TEST 3, Performed For: Dallas Johnson Date Performed: Legal Description: Lot 6A Block 2 Holly Hill Subdivision SLOPE SITE PLAN 1 F-1 OG/01- GM/SM G/OL Perc. Zone i 11 12 13 14 15 1 GM/SM TESTHOLE N0.1 Bottom of Hole See Site Plan Was Groundwater Encountered? No If Yes, What Depth? Depth to Water After Monitoring None Date: 9/9/00 yvI "g 4�` }'A— Reading Date Gross Time Net Time Depth To Water Net Drop 1 1 -Sep 9:10 1.75" 2 9:40 30 5.25" 3.5" 3 9:41 2" 4 10:11 30 5.125" 3.125" 5 10:12 2" 6 10:42 30 5.125" 1 3.125" E E — Perc. Rate: 9.6 Min./Inch Perc. Hole Diameter: 6" 21 Test Run Between 4 Ft. and 5 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Mike Anderson. I, Michael E Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 9/9/00 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 6A, BLOCK 2, HOLLY HILLS SUBDIVISION GENERAL: The scope of this project includes the exposing and inspection of the existing 1,000 gallon concrete septic tank and the verification that it is sound for continued use. Work also includes the construction of a new 50' long X 3' wide X 6' effective depth absorption trench at the location shown. The distribution line in the trench will be placed at 4' below the existing ground surface. Total depth of the trench will be 10' below the existing ground surface. A Zabel Flow Diversion Valve must be placed after the septic tank and the existing absorption system tied in for future use. If a new septic tank is required it must be placed outside the 100' protective radius of the septic tank. 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. 3. 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. 4. 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. 5. 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 1,000 gallon septic tank must be be procured from an approved source and installed outside the 100' protective radius of the well if the existing tank is found unacceptable for continued use. 2. 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 4tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. Lot 6A, Block 2, Holly Hills Subdivision September 9, 2000 Page 2 of 3 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. 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. 2. 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. 5. 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. 6. 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. 8. 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 Hl or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 6A, Block 2, Holly Hills Subdivision September 9, 2000 Page 3 of 3 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: Municipal Ordinance requires a minimum of two inspections. 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. 3 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage AK 99519-6650 +, }� www.ci.anchorage.ak.us ` ei(907) 343-7904 keF/ R�U t -b CERTIFICATE OF HEALTH AUTHORITY APPROVAL a' .., FOR A SINGLE FAMILY DWELLING R HAA # b602 3 l Expiration Date: 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) Awnemw F&06 All-/ Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise ieguested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone TYPE OF WASTEWATER DISPOSAL: 19 .Individual On-site 0 ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 this application, shows that the on- site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Eagle River Engineering Services 1u421 VI -W Rd., Suite 201 Address Eagle River, AK 99R Engineer's Printed Name �t/2/ITOPNr� �. riIODD 5. DSD SIGNATURE Approved for _3 bedrooms. Disapproved. Phone _ 6f?4-5-/95' Date Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: - l Le�/1_^, (�(/, Original Certificate Date: G - G - U_6� (Rw OV02) Municipality of Anchorage I.' Development Services Department Building Safety Division On -Site Water & Wastewater Program ' •' ` ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:�t2x.GG, loaf Parcel ID: Oyy OPy 09 A. WELL DATA OO Well typer/ 4-2�-_ If A. B, or C provide PWSID # _ Well Log (' N t� Date completed Dji1i 1971 Sanitary seal 01N) V¢- Wires properly protected 6?N) o Total depth '4�0+ ft. Cased to -71ft. Casing height (above ground) Z Z in. Date of test Static water level Well production FROM WELL LOG %1n1K u 1J k- ft. twIC g.p.m. WATER SAMPLE RESULTS: Coliform _,colonies/100 ml. Arsenic: 6& mg./I. B.aEEWHOLDING TANK DATA Tank Typ ati _§6.cZ Number of Compartments -:7- Tank size gal Nitrate D. 961 mg.A. Date of sample: 6ii! oS AT INSPECTION Foundation cleanoutlpN)15 Depression over tank (YO _A10— S/--ojo S S (` ft. 3.7- g.p.m. Other bacteria 0 colonies/100 ml. Collected by: Dateinstalled WZ4�00 CleanoutsON) N/ES High water alarm (Y© MO Date of pumping V/7106% Pumper 0C_b ri1�G �pr✓%IL() C. ABSORPTION FIELD { �DATA Date installed / / 1 / VO Soil rating d./ft� or ftZ/bdrm) System type %ictitG� Length SOTQft. Width a.2— ft. Gravel below pipe Total depth _((_ ft. Eff. absorption area (QD ftp Monitoring tube tis Depression over field cI Date of adequacy test S S Results {Fail) T�8f-- For,5 bedrooms Fluid depth in absorption field before test 16 in. Water addedlwgal(D New depth 3 6 in. Elapsed Time: min. Final fluid depth in. Absorption rate >= ;& g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) in 0 ^ If yes, give date I a D. LIFT STATION Date installed Size in gallons Manhole/Access 'Pump on' level at_ in. 'Pump o laF inU rHigh water alarm levet at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/li t-eteEioct on lot /OS On adjacent lots /.0 r Absorption field on lot /00On adjacent lots 'f 100 Public sewer main _ l0_0 Public sewer manhole/cleanout t, /o o Sewer /septic service line t2 �_ Holding tank _V1,00e; SEPARATION DISTANCES FROM EPTI TANK ON LOT TO: Building foundation SO Property line R5, f Absorption field /0 r Water main -f to, Water service line "I 10J Surface water f //ao' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line r Building foundation 30 , Water main Water Service line f IO Surface water 100 �_ Driveway, pa(king/vehicle storage is Curtain drain rVf7E Wells on adjacent lots 1 F. COMMENTS® PU-e,4* t> %JTTK 1,6e04k1- oA1 ,}Nt> Hoo Ohl- oN 5/2010r PA;A to '"T- * Dmg op wbur}1k FRa VDA ft FXLbr. 6.12.,. V614-ri G. ENGINEER'S CERTIFICATION I certify that / 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 Gf )617-OP/fE,C 4. LUX -1) Date AO ,5 HAA Fee S43ow t J175,-2-0 RUSH Date of Payment(,.L03.©'s Receipt Number o 6,9Q 3 (Rev. 12101) C Waiver Fee $ Date of Payment Receipt Number R Fpow\. • f L-5 N 89. 52 15'1E 140.00 8 g •" w AO y ELL4 I� h T In P U • Oka o = PTPr-5 2 25 0 N 8 9. 57,15"w L I EAST 72nd I LQ Abbeb 6/o2/05' I C IfarsToPIlNile 12- W006 ?! 3053Y F DMrrT S ASSOCIATES ILII 847LETT ARIVE AVCHOW.C. ALASKA 1TL0T 161.1111 N89 165.00 .E /a32 l.r VAi R.W. 120.03 O M S7' 15" W 7 -BG I l 1 r. I 1 C' UTILITY ESMTS. 516-PIEBAR TTP ID �As vxPk. M . CiA I XMIly CELTIFY THE FOLLQII!1C OESCXIBCP PXOPEATY. LOT 6 A BLOCX 9 HOLLY HILL SUED. IVICH.OXAGE REC0:91)K: DISTRICT, ALISYA, HAS Of SuRVEYCD 6Y NE, OX A7 IIY 0)REC IO.y AHD THAT lip ENCROACHIIEl1E LIST &CETT AS 1rm1CAM IT IS.THE RESPONSIGILTTY OF THE OWNER OR 3111I.M. 771OR TO CoiaTRu7701f, TO VERM 170POSED BVILD111r CCADE RELATIVC TO FIA7SCED GRADE 'ANO ELILITY CONNEc.70NS AYJ TO DETEXM)NE TILE EXISTENCE OF AAV FASPl41.7S, COVET AWS, Or RESIR)CTION WHICH Lb Par ON TILE RECORDCO SLaVIV:S10N FLAT. LIABILITY 13 LIMITED TO TME NIOUr? Of CO01►E.MSA-.IDll tECCIVC9. CO►Y OF ORIrIMAL MY CAUSE DISTORTION, LISTED VISTAMCE PREvA1L3 OVER SCALIAT.. n 05-27-05 11:50A11 FROM -CUE EOS ENV SERVICES SCS Ref.N 1052833001 ClientNamc Eagle River Engineering Project NamHM Holly Hills LISA. B2 Client Sample ID Holly Hills L6A, B2 Malls Drinking Water Sample Remarks: 9075615301 T-851 P.02104 F-138 All Dates/Times are Alaska Standard Time related DateMme 05126/2005 8:13 Collected Datemme 052012005 13:00 Received Date/Time 051202005 13:28 Tecbnical Dlrector Stepken C. Ede Allowable Prep MNlyus Parameter Results PQL Unite Mcd,od Container ID Limits Date Dae (nit Haters Department Nilmte-N 0.462 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 D (<-10) 0520105 JJO col/100mL SM209222D A (<')1 0520105 TLF Mc2onalit :s Pumping Service 5432 E. Northern Lights Blvd, Suite #466 Anchorage, Alaska 99508 (907) 338-4476 Invoice # 3 5 4 8 Sold Date: Date of Service: PhonyCWstomer P.O. Number: Cornea P C, n � Description Price Pnwit Amount Septic tank pumped Sludge in tank Leach treatment Bio -mat in leach Water level in leach Cap on Stand Pipes Other: Recommendations: Total 1.5% interest will be charged monthly on unpaid bills until paid. --E>EC;E—iP-r 0 t i 1A 'Et Municipality of Anchorage ® Department of Health and Human Services a Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. c i. anchorage. a k. us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 014-081-09 HAA# &)LCC t Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 6A, Block 2, Holly Hills Subdivision Location (site address or directions) 3641 East 72nd Avenue Current Property owner(s) Dallas Johnson q Day phone 522-9126 Mailing address Afi L�� CALCI Z� Zl-� ('l�IL� 7 (Cf'%C l(' %�,� 141 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: _Thx_e� ) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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. -2 25 lFev. Ot 001' 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 Health 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. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, Phone 522-7773 AK 99524 Engineer. sPrintedName Michael E. Anderson, P.E. Date 10/1/00 fr ' 2Y 'Ei}%GINEER'S� MP 6. DHHS SIGNATURE Approved for bedrooms. J. N Disapproved. n'r. Conditional approval for bedrooms, with the following stipulafions'' " yL Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: _/ O - q - D U Expiration Date: Reissue Date: 75025 Rev. 0100V Municipality of Anchorage • �` Department of Health and Human ServiccRE C E I V E — Division of Environmental Services On -Site Services Section 825 "L° Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 OCT Q 3 2000 www.ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 6A, Block 2, Holly Hills Subdivision Parcel I.D.: 014-081-09 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 19 7 0 Sanitary seal y Total depth 82 ft Cased to > 40 ft FROM WELL LOG Date of test Static water level ft Well Log No Wires properly protected y Casing height (above ground) > 24 in. AT INSPECTION 7/21/00 57 ft Well production 9 -p.m 3.03 9 -p -m WATER SAMPLE RESULTS: Coliform a colonies/100 ml Nitrate ` 37 mg/I Other bacteria colonies/100 ml Date of sample: 9/28/00 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material steel Date installed 9/28/00 Tank size 1 , 000 gal Number of Compartments 2 Cleanouts U Y Foundation cleanout Y Depression over tank N High water alarm N Date of pumping New Construction Pumper N/A C. ABSORPTION FIELD DATA Date installed 9/29/00 Soil rating (g.p.d./ft2 or ft2/bdrm) 8 System type Deep Trench Length 50 ft Width 2 ft Gravel below pipe 6 ft Total depth 12 ft Effective absorption area 600 ft2 Monitoring tube Y Depression over field N Date of adequacy test New const. Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in Water added gal. New depth in. Elapsed Time: min Final fluid depth in Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date 72-026 (Rev. 01/00)' D. LIFTSTATION - N/A Date installed Size in gallons "Pump on" level at in "Pump off" level at in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 10 0 ' On adjacent lots Absorption field on lot 100, On adjacent lots Manhole/Access High water alarm level at it Meets alarm & circuit requirements >100' >100' Public sewer main >100' Public sewer manhole/cleanout >100 Sewer /septic service line > 25 ' Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >51 Absorption field >51 Water main > 1 0 Water service line > 10 1 Surface water >100, Drainage > 100' Wells on adjacent lots > 1 00' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line >10' Building foundation > 10 Water main >10' Water Service line > 1 0 ' _ Surface water >1001 Driveway, parking/vehicle storage > 10' Curtain drain None Noted F. COMMENTS Well Data Taken Fx Wells on adjacent lots >100' DHHS Files. No Wel. 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 Michael E. Anderson, P.E. Date 10/11 /00 HAA Fee $ "3 OV ` �V Date of Payment Receipt Number 72026 (Rev. 01/00)' Waiver Fee $ Date of Payment Receipt Number 1 !J1-02-00 18;10 'AL FROM -CTE ENVIRONMENTAL 5615301 ME Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total .Coliforn READ [NSTRUCTIOVS ON REVERSE SIDE EEFORE COLLEC77NC MUST BE COMPLETED 13Y WATER SUPPLIER T a PUBLIC WATER SYSTEM I.D. k q PRIVATE WATER SYSTEM ❑ Send Resula ❑ . Send Invoice anunnan ev YraN amprary ma one um a, mg m q S}� d Resxlls �. Send Invoice � G L(y.I D Isnssa C iJCirrl LC ae nn v Maemin < /L/ 1-886 N.Veluz !-_"7 200 W- Potter Drive I Bacteria Aneharage, AK 99618-1606 Tel -(907)562-2343 SAMPLE Fax: (907) 561.6301 R COMPLETED•BY LABORATORY - shows this Water SAMPLE to bet tisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be ove$ohouts old at examltlatron to indicate reliable results. Please send new sample via special deliv mail. Date Received Time Received Analysis Began . Analytical Method: R �O•MUGbrane tlter a City 1 0058IB 1 RE FL SAMPLE DATE: Month Day year SAMPLE TYPE: 4" Routine ❑ Repeat Semple (for routine sample with lab ref no- w Special Purpose SAMPLE LOCATION LLr r[A �(10 7 t 14V_� ALAS d Treated Water q . Untreated Water Time Collected Collected: By 011 LA Plcasa Phut Sent to A.D.E.C- Ancti Fbk+ Joe Fazed bale: Time: Client notified of Unsatisfactory results: Phoned Spoke with F� d Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO•MUG Remit; Total Collfor'm' �? Cori C9lenlea1100 ml Membrane Flitert Direct Cauat Verification: LTB •�.— BOB COLIFIRM Fecal Coliform Confirmation Collferml100 m6 . Final Membrane Repotted B ate Time� hts Comments: PNM' Taa Nam<ros To Couar Olt nofAer Baelerta MMemboe of the SGS Group (Saci6t& Gdndrale de Surveillance) ENvIRONMES�TROC:^i40ti^TImBU�Ct 1 1 MRIDA. ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA VE 'd 6969 -ON UM L 0002 •E '100 � 1002-00 18:10 FROM -CTE ENVIRONYFNTAL 5615301 ME Environmental Services Inc, Laboratory Division 200 W, Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref. M 1006881001. Client Name: Anderson Engineering Project Name: nla Client Sample ID: 1.00A B2 Holly Hills Matrix: Drinking Water PWSID Na Sample 1-886 N.UI/UZ F-b/b Client POM n/a Printed Daterrime: 10/02/00 17:30 Collected Date/Time: 09128/00. 12:30 Received Date rime: 09/28/OD 14:10 Technical Director: Stephen Ede Released By: A A n n Al P. A. h ceiyed Time Oct. 2, 5:IIPM E/Z 'd 6969'eN HVOC:L DON I '1�0 Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Total Coliform (MF) _ .. 0 o6I/100 ml SM9222B o9/28/00 JDT _ Nitrate _ 0.97 0.5 mg/l. EPA 300 10,0 09/28/00 SCL h ceiyed Time Oct. 2, 5:IIPM E/Z 'd 6969'eN HVOC:L DON I '1�0 K__1 MUNICIPALITY OF ANCHORAGE fJGItJEER'S SEAL Inspections Performe b i, Date. or certify that this inspection was performed according to a ��`,• JUN22?_5—E 25, .19/1 Municipal andtate guidelines in effect on this date: Health Department Approval: pate: DEF rMENT OF HEALTH AND HUMAN SERVi 3 Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DAN DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address TN a 51 Phones) it No. No. of Bedrooms --�� 118 3L1Q- (014 1-5 0 70 WELL D I O q LOT LINE LEGAL DESCRIPTION Lot 13, lock sy,�qdmsipn tl1L FOUNDATION Township Range Section TI t 1 �3 G 014 AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS SEPTIC ❑ HOLDING Manulacturer AtJGu. �AND F GP VEL— Capacity In gallons I&&_0 Material Ce c Gra No. of Compartments ONE t DI TYPE OF SYSTEM ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade N FT nj FT Fo YL 4. i y Fill added above original grade FT Gravel depth beneath pipe -rj FT Gravel length FT Gravel width L% FT Total absorption area 7 (J SOFT _ Distance between lines FT ` Number of lines VNO Soil rating 150 SOFT Pipe material Til Installeer/ r / Date Install d 0 � 6 WELLS PRIVATE ❑OTHER (Identity) Classification (A,B,C) - Exis�,n%7 Total Depth FT Cased to %% FT Installer U "M4.44 Date Installed. 74-c- - ! Q7l REMARKS: fJGItJEER'S SEAL Inspections Performe b i, Date. or certify that this inspection was performed according to a ��`,• JUN22?_5—E 25, .19/1 Municipal andtate guidelines in effect on this date: Health Department Approval: pate: . , . � ` ^ DEPAATMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ' 825 L STREET, ANCHORAGE, AK 99501 OBTAINED; (2) AS-BUILTS 264-4720 \ ' PERMIT NO: 85067O ELECTRICAL ' DATE ISSUED: 10/10/85 LIC�NSED ELECTRICIAN. APPLICANT: DAN SIGNED ADDRESS: 5460 F 991-1-1 DATE: ANCHORAGE, AK 99516 CONTACT PHONE: 349-9641 _�~��� ^ ' LEGAL DE�CRIP: SUBDIVISION: HOLLY HILL � LOT: 6A BLOCK: 2 SECTION: 4 TOWNSHIP: 12N RANGE:3W LOT SIZE: 1870O (SQ" FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options ` to you in designing your septic sysILem. Choose the option � � ~ �. ..... � that best fits your site. _ ~ � _ _ � � � _ � . ~ � ~ ... � ~ ����� � ��� |� �- ������ DEPTH TO PIPE BOTTOM (FT"> 4" , 4^O 4"0 GRAVEL DEPTH (FT" 5"0~r 0.5 3"5 TOTAL DEPTH (FT,) 9"0 4"5 7"5 GRAVEL WIDTH (FT") 2"5�k 19"0 5.0 GRAVEL LENGTH (F -T. ) 45"0w�~ 36°0 49"0 GRAVEL VOLUME (CU,YDS. ) 23.0 25"4 36^3 TANK SIZE (GALS) 1,O00"O~*x' 1,O00"0 �+* 1,00O,0 ** SOIL RATING (SQ,FT"/BR) 1506� 150 150 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I ceptify that: 1^ I am familiar with the requirements for on-site sewers and wells as set forth by the Munit: ipality o[ Anchorage (MOA) and the State ca IF Alaska" 2. I will install the system in accordance with all MOA codes and regulations.� and in compliance with the design criteria of this permit" 3" I will adhere to all MOA and State of Alaska requirements for the set back distanc�s �rom any existing well, wastewater disposal systeor public sewecage system on this or any adjacent or nearby lcat. 4, I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will reqUire an'additicanal permit" IF A LIFT STATION IS INSTALLED IN AN AREA CnVERED BY MOA BUILDING CODES., THEN /(1) AN ELECTRICAL PERMIT AND INSPEUTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL ' WORK MUST BE DONE BYA LIC�NSED ELECTRICIAN. SIGNED DATE: APPLIC�NT� DAN AMOS _�~��� ISSUED, BY �� ` DATE: ,~..�~ ~. ,��` ,^ .....__..... ..... �Cts SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST � ,f� 9 / A3l PERFORMED FOR: DAN FiA�1Ca1�� DATE.PERFORMED: iC?lq=� LEGAL DESCRIPTION: LOT L A., R_,!x',4 Z-1,140Lii ("ULL q C— _T U -t4 fP SLOPE SITE PLAN ,�EP.ZJ 3 4 X14 6 7 8 9 10 11 WAS GROUND WATER *� S ENCOUNTERED? t`{ L O P 12 E IF YES, AT WHAT DEPTH? 13- 14- 15- 16- 17— , DF. 314151617F. 414 kA ��. ee e y •.A a'3i T ��> � • p�. 16s�ae •• • •A •e•.e• •• e�y €;r N 2225—E `+^a kr�ar 20�� C),• 1 2b, 1971 a .a e•� e COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop V •I �f� ,� /i ,� ^JHS y,(�''f S 3 V 3 1 PERCOLATION RATE (minutes/inch) B TEST RUN BET7 N FT AND FT F r PERFORMED BY: � z> CERTIFIED BY: 9 DATE: GAAB.HD.I GW ER ANCHORAGE AREA BOROU'' DEPARTMENT OF ENVIRONMENTAL O.UALI1 I 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ., MAILING — NAME f%�' PHONE LOCATION SEPTIC TANK: I" NUMBER OF DISTANCE FROM WELL �U MATERIAL �° �c�f/� C� Se��_CgMPARTMENTS X' LIQUID LIQUID CAPACITY Z'� 452 --GALLONS. INSIDE LENGTH INSIDE WIDTH `"�- DEPTH �— SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS_ OUTSIDE DIAMETER i/ OR WIDTH_ 7 LENGTH 7 DEPTH IX , LINING MATERIAIi e_lT DISTANCE FROM WELL ��X � � f BUILDING FOUNDATION�� � NEAREST LOT LINE �- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) �O SQ. FT TILE DRAIN FIELD: f✓Iid DISTANCE FROM W NUMBER OF LINES ABSORPTION AREA TOTAL LENGTH NEAREST LOT LINE , OF LINES_ ISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: fc?J✓/-✓'vG�✓c_- , DISTANCE FROM , WATER TYPE « � DEPTH d� BUILDING FOUNDATION. ___ZLe? f SAMPLE NEAREST NEAREST SEPTIC v SEEPAGEm OTHER LOT LINE �3 SEWER LINE__ TANK ��'�'��� �(% , SYSTEMS /CESSPOOL /y� SOURCES��®� DISTANCES: DIAGRAM OF SYSTEM ftT c' --.1-2d GREATEI .NCHORAGE AREA TROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM — APPLICATION & PERMIT Case No. v ,3. i hc„o; NAME OF APPLICANT it�iE� /�/�/1��% MAILING ADDRESS'�•'�i2 ;"yjy g PHONE RESIDENCE ADDRESS /da� �`�-s���1�� LOCATION OF INSTALLATION—L Y-2'2� LEGAL DESCRIPTION LCe7"/ rb4e 2 APPLICATION TO INSTALL: SEPTIC TANK �J, SEEPAGE PIT , DRAIN FIELD , OTHER TO SERVE THE FOLLOYYING FACILITY - FINANCED THROUG TO BE INSTALLED BY PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION. BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ,Idiz�o� 14& , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVEXdw D SEPTIC TANK SIZE TYPSEEPAGE AREA TYPE S DIAGRAM OF SYSTEM DISTANCES:" 74 A) X6AJ (�° HEALTH AUTHORITY V I I I 1 1 1 1 1 I I OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Boroughrdinanc N.o. 28-68 and that the above described s ste is in accordance with said code. % 01 Z; ! Q 1111 LLy- vZ L 7 nnTF "� � �Lt APPLICANTSSIGNATURE YREATER ANCHORAGE .AREA BOROUGH 1 _ HEALTH DEPARTMENT CASE ! 327 EAGLE STREET ANCHORAGE,; ALASKA 99501 r Date Performed m Performed For��n� iJGlk�g.,----------- /�'7 Legal Description: Lot 2, Sub ivisian o llw ��' This Form Reports a: Soils Log �ercolat on Test ep Feet Soil Characteristics 90 Y , Cl � Ttie �(�%sc�.vtee OF gRtxx0-i .3 dYs��a c�t�s art -Rtes 10 --SF 4- Cri'Yt (oc t R., Fi-, o+t-�e, PR4 (e . a YKtxI-raga, OP G94tA GtvA 5 st t� YKAe wP {-1 a vuOAP-1 x paQ+t CtL a IZ� C7YK. 7 9 Y SVVI is lest V-CrA,paJ- t4tc,wL a moe-V�'Yl+l� s t[r- G vk8 etb( da -e, -1-o r` aAk �o Owl ojp-p- so r I�r Location Sketch s ! ✓O Was Ground Water Encountered?...vy,..�..._..,.a...,...a 'o a if Yes, At What Depth w M-1 Reading Date Gross Time Net Time Depth To H2O Net Drop E mo..rvu.mw erco a ion Proposed Installat"on: Seepage Pit _ o/ Drain Fieid Depth Of Inlet..... i - .......�......._.. 3 Depth To Bottom Of Pit Or 'd'r'ench COMMENTS:S' &m -�o eo�-l.) n -2a-7 n's L-A., __ - - ...-�- Teat Performed By: Pe-P-C.t-0 Data Certified By Date. •7 - 16_7n