HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 18ULC 212018
Municipality of Anchorage
Community Development Department Page 1 of 2
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181293 PID Number: 020-411-26 ❑ New ❑✓ Upgrade
Name:
KEN YAZAKI
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
6501 ITALY CIRCLE
✓❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
6 GPD/SF
1.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
0.5 Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
PARADISE VALLEY 4 18
Fill added above original grade
3.0 Ft.
Gravel length
20 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
100 Ft2
1
Ft.
Well
100.5
106.7
109.5
N/A
69.2
TANK ❑ Septic ❑' S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1500Gal.
Surface Water
100+
100+
100+
N/A
Material
Number of compartments
Lot Line
29.2
12.5
25.6
N/A
STEEL
2
NA
Foundation
38.2
47.9
46.9
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
50+
50+
N/A
ORENCO
500 Gal.
Remarks
Pump on level at
TIMED in.
Pump off level at
in.
High water alarm at
45in.
Pump make and model
P2005
Electrical Inspections performed by
MOA BUILDING SAETY
Installer
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
A+ HOME SERVICES
Drainfield 3034 CO/MT 3034
Inspector PANNONE ENGINEERING SERVICES
BENCH MARK (Assumed elevation) 104.0 ft
Inspection si
dates: 11/1/18 2nd 11/2/18
Location and description
p
3'd 11/2/18 4"' 12/18/18
NW BOTTOM TRIM
COMMUNITY DEVELOOMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: DatN.
e
`:.
:'.`.yj
teven "06W6ne
.
CE 81496
�.W-fiJAZo
Approved�®
Pp Date °o� %
� �
t�'���s�•"
7Gt io i s in cl Uan 7e Aw W -r S
DESIGN PARAMETERS t
PRIMARY/RESERVE SEPTIC SYSTEM /
NO. BEDROOM: 3 (450 gpd) 4 /
TANK SIZE: 1,500g ADVANTEX / /
W/ AX20 POD &AUX PUMP VAULT 13
PERC RATE: <1 MPI
SOIL RATING: 6 GPD/ SF 20LF x INSTALLED DRAIN FIELD \N
5.0'W x 0.5 ED x 1.OTD ,/'"�
AREA ROD: 75 SF INSTALLED MONITOR TUBE AT EACH END / LIMIT OF MO/UND FILL
SYS. TYPE: WIDE TRENCH — 0.5'ED INSTALLED 1.25"0 DISTRIBUTION PIPE
VJ/ a HOLES DRILLED 18" O.C. M
MIN LENGTH: 15 LF
USED:20
TOTAL AREA: 500. DF 1 ' TD jX EPS
U CO
W I � TH-1
NO TRACE OF BED WAS FOUND
IN THE TEST HOLE. IF ANY PART
IS FOUND IT SHALL BE REMOVED R MOV D EXISTING f
W/I 10' OF THE DRAIN FIELD HOLDING TANK PER MOA C
/ INSTALLED 1500 ADVAN
W/ AX 20 POD AND AUXILLARY PUMP
{ VAULT /
19/ \�
Ov O O
WELL E
LOT UNDEVELOPED /
NO WELLS OR SEPTICS LOCATED
fIt
! t 1 c>
A
B
CO
32.8
54.6
T1
42.1
61.0
T2
48.0
65.5
LS
49.2
66.3
AUX
PUMP
53.8
69.6
M1
50.2
81.9
M2
67.0
86.9
U CO
W I � TH-1
NO TRACE OF BED WAS FOUND
IN THE TEST HOLE. IF ANY PART
IS FOUND IT SHALL BE REMOVED R MOV D EXISTING f
W/I 10' OF THE DRAIN FIELD HOLDING TANK PER MOA C
/ INSTALLED 1500 ADVAN
W/ AX 20 POD AND AUXILLARY PUMP
{ VAULT /
19/ \�
Ov O O
WELL E
LOT UNDEVELOPED /
NO WELLS OR SEPTICS LOCATED
fIt
! t 1 c>
1500g ADVANTEX I "PROFILE
TANK SCALE: NTS
NOTES: PAMONE ENG WC, C, LLC
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
DRAWN: ACP PARADISE VALLEY, BLOCK 4, LOT 18
KEN YAZAKI
6501 ITALY CIRCLE
PLAN ANCHORAGE, AK 99516
AXE
S
3BR
HOUSE
LOT 18
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-"51/188018
1500g ADVANTEX I "PROFILE
TANK SCALE: NTS
NOTES: PAMONE ENG WC, C, LLC
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
DRAWN: ACP PARADISE VALLEY, BLOCK 4, LOT 18
KEN YAZAKI
6501 ITALY CIRCLE
PLAN ANCHORAGE, AK 99516
AXE
S
3BR
HOUSE
LOT 18
(0
�0)
SAUNAI
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-"51/188018
DATE PERFORMED. 0I11EfXHe
OF ALgsl�t
'c-
' •Steven 'f2. •F'annorie•
�F CE 8149 F�/
�tcsTF�:
��1FNPROFESSMO' .�
Dote
12/19/18
Scole
1 40'
2+-0. NO
020-411-26
PERMIT NO.
OSP181293
Sheet
2 OF 2
0
w
,o
ASBUILT SEED & ASSOCIATES LAND SURVEYING 694-0828
I HEREBY CERTIFY -THAT 1 HAVE SURVEYED THE SCALE:��
FOLLOWING DESCRIBED PROPERTY= QF A 4�n
DATE
Ar
AND THAT NO FNCROACHMEIM EXIST CEPT As
INDICATED. IT IS THE RESPONSIBILITY OF THE � �=
H
OWNER TO DETERMINE THE E)OSTENCE OF ANY GRIT?:
EASEMENTS COVENANTS., OR REe3-RICTIONS
WHICH DO NOT APPEAR ON THE RECORDS? SUBDI®FS, �4� � o e Metz S�.
VISION PLAT UNDER NO CIRCUMSTANCES SiOI.IIeO / yy 'I-
LS - 5,913
,
ANY DATA HEREON BE USED FOR CMN rR JC f'I ON
OF FENCE LIKES, OR FOR ESTABLISHING BOUND-
ARY LINES.
DRAWN:
I
MUNICIPALITY OF ANCHORAGE
ment
^~` On-Site Water&Wastewater Program Allic\o 'PO Box 196650 4700 Elmore Road .
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.orgionsite •
nctmynt
fHppP�
On-Site Wastewater Disposal System Permit
Permit Number: OSP181293 Effective Date: 9/21/2018
Work Type: Septic Upgrade Expiration Date: 9/21/2019
Tax Code Number: 02041126000
Site Legal Address: PARADISE VALLEY BLK 4 LT 18 G:3538
Site Mailing Address: 6501 ITALY CIR, Anchorage
Owner: YAZAKI KEN & Lot Size in Sq Ft: 16302
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
•
1
Received By: —;��ili - ...a.,,411111NENIL Date: Q t9 9
Issued By: J � (N Date: q Ar
EPLh&4
MUNICIPALITY OF ANCHORAGE
Community Development Department \. Phone: 907-343-7904
Development Services Division ` Fax: 907-343-7997
On-Site Water&Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 020-411-26
Property owner(s) Ken Yazaki & Miyuki Sato-Yazaki Day phone
Mailing address 6501 Italy Circle, Anchorage, AK 99516
Site address 6501 Italy Circle
Legal description (Sub'd., Block & Lot) Paradise Valley, Block 4, Lot 18
Legal description (Township, Range & Section)
Lot Size 16,302 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field 0 Initial ❑ Single Family(SF) 0
(w/wo ADU)
Septic Tank Q Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
lg ture of ppe ivaMer or authorized agent)
Permit/Rush Fees: �j�9 Waiver Fees:
Date of Payment: •g/g3h2 i2 Date of Payment:
Receipt Number: 0.//25 7-.7 Receipt Number:
Permit No. 63P12 I 943 Waiver No.
Permit App_2- c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181293, Deb Wockenfuss, 09/21/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181293, Deb Wockenfuss, 09/21/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181293, Deb Wockenfuss, 09/21/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181293, Deb Wockenfuss, 09/21/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181293, Deb Wockenfuss, 09/21/18
T
W UNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGRE EMENT
!*HIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREE-Xi4ENT" made and
entered into as of this "A Day of
Sukk�,J/!�''of 20 by and between
_kAL
re
he' in the"OWNER,"aid the Municipality of 1 U "
Anchorage, herein the "MUNWIPALITY7- in accordance writh Anchorage Municipal Code
(AMC) 15.065.365. In consideration of the mutual covenants contained herein, the parties to this
Aent ageasfollows:
,-m
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
0xvner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as A 4 YA_-7AK'
located at (legal description) e- � j T -c- Vr,4 (C, y, 6l . �, K �) L- - l I F
(Owner is required to read. understandand Initial each section'
�_ks Throughout the term of this Agreement. the Owner shall enter into a service agreement
,Mth an AWAVTS sere -ice and maintenance provider appro-ved by the Nfunicipality or the
manuf
acturerls representative. TheAWIATTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
<; It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs., and inspection costs. This
includes an annual maintenance fee (typically $4GO to $1600).
0t,vnlr agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to time system.
I
Owner acknowledges that regular maintenance of an AWWTS reduces the potential Z:�
failure of the system, which could include sewage backup and costly repairs or drainfield
replacennent.
(rev. 05/18/2018) Page 1 of 3
(YN Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
Z:)
assessed in accordance with AMC 14.60-0310.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS_ The -.Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS, vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred_
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality- Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
(signature)
Uli Z Cprint name)
STATE OF AAS )
) ss.
THIRD JUDICIAL DISTRICT }
Bate:
The foregoing instrument was acknowledged beffore me this Li4'" play of
20bySt,-\,3
M �(,\
NOTARY PUBLIC FOR ALASKA
My Commission expires:
?YMI ICIPALITY-
By: (sibnatnre)
Oe b aJoca ,e e75 (print name)
J
(rev. 05/18/2018)
00���191dBBB`i
do
U1300 N'
OF
lBlB 1111 t�
Date: g pzg
Title:
Page 3 of 3
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name;
~-~cu~,,~(~~ ¢ '~~.~¢~/*-/3~ ' ' Wastewater System: D New ~Upgrade
Address:
~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION ~o~, Rating: Total Depth from original grade:
GPD/Sq.
WELL: ~ New D Upgrade Grsvel depth: Number of lines: ~ Distance between lines:
Classification [Private, A,8,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. SQ, FL
Driller: Cate Drilled: StadcWater Level: Installer: Date installed:
Ft.
Yield: Pump Set at: Ft. Casing Height Above Ground:
SEPARATION
DISTANCES
Septic ~olding ~ S.T.E.P.
TO Seplic Absorption Lift Holding Uublic/Pdvat~ Manufacturer:
~rom Tank Field S,,,ion Tank Sewer Lines AR~.~ '~FA.~ t ~ ,
Material: 7 '
Co~padments:
Surface ,
Water LIFT STATION
Lot Size in gallons: Manufacturer:
Line
Foundation 'Pump on" level at: "Pump off" level at: High water alarm at:
CurtainDrain >ump Make & Model Electrical Inspections performed by:
Remarks: BENCH MARK
~ ~ / ~ ~j~ Assumed Eld ation:
Department of Health~Hu~erv~ces approval '~:,:?,~ ,
(1/91) MOA 25
HE1LJgI/V TANK
[XI£T 3Ez9
0
NDTES
SCALD 1' = SO FT,
TDBBEN SPURKLAND P.E,
203 ld 15TH, AVENUE
ANCH, AK, 99501
(9117) R79-1~916
SEC II TIiN R3F/
~,$01 ITALY £f1~£1F
SUPFACED~
1, PUMP A3SD/~PTIQN 3ED
2. BE P/CEPANEz9 ?O PUMP
EXCA VA T]DN FD~
HDL~ZN5 TANK
3, MINIMUM S FT, DF
CDVE~ DVER [~N~
SEPTIC SYSTEH AS~U~LT
9ATE, N~ ~ 19~1
SHEET, 2/3 ~R~,3538
IN
L / 1' X 10' CflN~UIT
RAIN CAP TYPICA 1' GAL VANIZED LB
- PUMP ACCESS / ~--- 5 ~T, Z7F COVER OVER TANK
,,,,,,,,,,, ,,, ,, ,,,..,,, ,,, ~,~_,,,~ ,,E?;, ~
-~--...~,,,~,,,~ ~ ~ ~ ~
...... ~ ~1 I ~Z
~ CAULgER CDUPLIN, ~TYPiCAL FD ALARM PANEL
~GH ~TER ALARM
MERC~Y S~TCH ~ T
~-- DIRECT £U~IAL ~/I~E
l' PVC CUNDUIT
5.33
1£, 17
£TANDA£9 ?000 6AL, HOL~]Nd TANK
ANCHORAGE TANK
TDBBEN SPURKLAND P.E.
203 W JSTH P, VE
ANCH. AK, 99501
LOT 18 9LDCK 4 PARASISE VALLEY
SECTION 11 TllN RSW
NED GRUB£
])ATE, NOV, 6 1991
_ SHEET, 3/3 GRID ~530
PAGE 1 OF 1
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:SW910335
DESIGN ENGINEER:TOBBEN SPURKLAND,
OWNER NAME:GRUBB EDWARD B
OWNER ADDRESS:6501 ITALY CIR.
ANCHORAGE, AK 99516
PoE.
DATE ISSUED:10/22/91
EXPIRATION DATE:10/22/92
PARCEL ID:02041126
LEGAL DESCRIPTION: PARADISE VALLEY BLK 4 LT 18
SEC 11, T12N, R3W, SM
LOT SIZE: 16302 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
HOLDING TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ELECTRICAL INSPECTION MAY BE NECESSARY,
BUILDING SAFETY PRIOR TO INSTALLATION.
RECEIVED BY:
VARIFY WITH
(907) 27~-~916
LIlT
SEPTIC S¥.SFFE~I DESIGN
1~ BLOCt( 4 P~q~R6~} I S E V~LLE¥
NED GRUBB
L.J~;~:9 Hell d :i. I]1..] T,-'TH"I k
MUNICIPALITY OF ANCHORAGF.
ENVIRONMENTAL SERVICES DIVISION
oct 1 1991
RECEIVED
Sc~p'l:.j.c tank Out;:le'L: 4' be].o~,~ gr't~und
bal,'.:ulce up]:l.Ft: Use 110
h= 62.4x6/].~0 = 3.5 ~t
Numbof c)'F ~)E)drc;)c)llH:4
450 gal
466 gall.
SYSTEH I: [! I~1F Z I] U R/i T ] Il l~t
2000 GAL. HSLDING TANK
LEAVE E×ISTING TANK AND
LIFT STATION IN PLACE
The ins'/a:Llatil:)n c:rF this holding tank :Ls necess:Lta'ked by the
'FL~:i. lLIr'~, O~ the ex:i.s'LJ, ng absc3rp'l:.ic:~rl system ancJ caused by tlqe
imperv:i(::~usness o.F thcs, sc)J. ].~ at thJ. s lcH:.,, Ext~nsive sc]i :L ~ nvesti-
g~':cl::;i, c:,11!.~ J]~Av(.E, '{: f'~:J, ]. ~,d '?,c] -F ;L iqd sc:ii ]. s 5LLJ. '~:~/[;):[ ~2 '~ CH'" ~?lz~'~l'ld~ir"d ~BiDJ. ].
abs~grp'kicu'-, systems. J-.loll. ding t~'::tf'lk Cil" a ~r3f]c;lv~]tiv(:~ !~ystc~ffl~ il]t~?l .....
ITiJ,'[t'~]f:)l]'J] s*':ti]d 'F :i, ]. 'l:'. el"' ~ at"l? the C)l"l].y prac'lz:i, ca} sciiutions a'l:, th:i.s
t :i, m e ,,
Sc!ptic: System Des:L~;In
l..c~t lO, Bll::)ck 4 F'ar'ad:[se Valley
I:i g
q
\
13
2~
.50 0 50 100 150 200 £50 SO0
0
27
26
TnBBEN SPURKLANI] P,F.
R03 b/ 15TH, AVENUE
ANCH, AK, 99501
.(9o7) R79-5~916
SEC Ii TUN
6501 ITALY £IREI
SEPTIC SYS1TM DESIGN
BATE~ DC[, ~°0~ 199!
0 ~
0
0 ~..,~-~- EX]ST.
SURFACE
N
SO 0
SUP SURVACE DBAIN
SCALEr F = 4et~FL
C~-2225
i. PUMP ABSQRPTIflN DED
~ z?E PREPAREfl Tfl PUMP
EXCA VA TI£N FDA
HflLDING TANK
3. MINIMUM S FT. DF
CDVE~ £VER TANK.
TBBBEN SPURKLAND P.E,
203 ~/ 15TH, AVENUE
ANCH, AK, 99501
SEC Il TIJN f~3h/
t~Sfll fTAI Y
SEPTIC SYSTEM DESIGN
DATE, BC~ ~ I991
SHEET,~/2 GRID, 3538
1N
RAIN CAP TYPICAL
PUMP ACCESS
GAL VANIZED LB,
S FT. DF CDVER DVE, e lANK
CAULDE£ CDUPLING
TYPICAL
TD ALABM PANEL
DIRECT £URIAL ~/IRE
]" PVC CDMgU]T
1~,17
£[ANY?A~y? ~000 ~AL, Hi]L~?IN~ TANK
5.33
GREE£ DR ANCHDRAGE TANK
T~]BBEN SPURKLAND P,E,
203 W 15TH AVE
ANCH, AK, 99501
LDT 18 z2L£CK 4 PARADISE VALLEY
$£CTION 11 [lin 1~3~t
NED G£U~B
SEPTIC SYSTEM DESIGN
DATE, D£~, ~ I~91
SHEET, -'~3/3 GP4D,35~q8
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alasl(a 99501 Telephone 204-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
/~ 14o
LEGAL DESCRIPTION
LOCATION
ILk. capacity in ga OhS
/000 IF HOMEMADE:
OISTANCE TO: Well
~8 '~-~ [] UPGRADE
DISTANCE TO: I Well
No, of lines Le 9th ofeacl line
NO, OF BEDROOMS
Absorption area
Inside length Width
Dwelling
Dwelling ~O PERMIT NO. ~,.~6 3~ J
Material
No. of compartments
Liquid depth
PERMIT NO.
Manufacturer Material Liquid capacity in gallons
Foundation3~z ,~re~ ~2,0. Nearest lot line/O PERMIT NO~ ,~O ~ ~'
Total length of lines I Trench width
~ ~ ] ~' ~ inches
Material beneath tile
inches
Length Width Depth PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
DISTANCE TO: Well Building foundation Nearest lot line
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
Distance b e t we e n~,L~/~,2._
Total effective abs6rption area
OTHER
PIPE MATERIALS
C ~
SOIL TEST RATING
lool;1 '
INSTALLER ~'t ~--~,169
/-I,ils,'~ db,~.'~.,'/,,~, £7. ~,J-' 287.
REMARKS
APPROVED
DATE
8
72 013 (Rev. 3/78)
Date Drllled~
Static Water Level 220
Draw Down N/A
Tyne Material Drilled:
feet
feet
WELL LOG
Gallons Per Minute
Total Feet of Casin~
.0., feet to
to
tN f~-hrn~n rl~F ~ur~vP1
,3q ft
?_m
140 ft.
to 330bed rock fractures fro~ 285~-330
,, to
Hefty Drilling
Anchorage ,Alaska
AF:'I::'t. I CAN 1::
COIfl'I'ACT I::'l-JOIql!:
I.I!:GAI. /)t..,:N:.L ,,
I.J]T ,~.I ;2, t
· [l:l..]).llb ]..L(. ~ ,, I Afd~]l.)t,:~l:: VAI,Jl..EY 1...[}"['.'.' 18
:il (~(:~ (::)' (")[ I Il II=F'' OR Al'bb.':: )
E L.OCI<',", Zl
:1: c c'~, p 'I: :i. f' y t Ii a'L:
£1:)r'tl'l k)y 'Ll'16_~ I~lL~ri:i.l::j.l::la~J. ty I:)f Al'lc:hol',agl') (J',ll](~,) arid '(:.~"~.;) Sta'L¢} c)f A].aska.
2~. :1~ w:i.:l. 1 :install 'Lh~ sys'[x.:~m :i.n acccH,danc~:~ wi'Ll~ all MOA c:od~s and
atll(::J :ilq C:[:)[~JZ)].J. aFIIX6') I~J:i.'J:,h tlllc'~ I:]I=~'S:J.(.~I] (:::r':i. Ler~:Ja C)f I:,J'l:[~:~
:][;,, I [:JJ.]/I adh~.')l,i) 'l:(:~ a].]. M(]A and Sta'Le~ ~::~.[' Alaska I'JlOquir'(~)merllLS fen, '{:lb(Il)
(l:: A I..II::']' STATZON :IS INS]ALIJ::D IN AN AREA COVERED BY MOA [U.JILDING (Z)DES,
Ifil:lq ( :1 ) AN I::I.I:CTRICAL. F:'[;I-~I~II T' AND :I: IxlSI::'I~:CT ]: [IN HLJS'I' BI~: OBTAI NED ~ (2.) AS-Bt.III 'I'S
Ifl:l:[I Nf.)'l BI:: AI::'I::'ROVI~:D WZI'I. tl]UT AN I:I.J~:C]"I::~ICAI.. ZNSPE:CT]:[)N RE]::'CiF(]'~ hlxl]) (.:~;) 'IHE
I:I..I:CI'F~IC:hl. 19(:)1:~1::: MIJS'I BIS: BY ~,I.:[CI:NSE~) I:LI~:C'IRICIAN,,
S :[ GNED DA'I'E: '
AI:::'F:'t. :t.( :AN I ~', ~1
Zl: S SI JE:)~ ' ":
ALASKA ei UIRODIlleDTAL CO[1TROL SeRuICeS, IDC.
~ngi~¢~inq 8 ~nuJi'onm~nl~l Slu~Jics
SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM - PARADISE VALLEY
BLOCK 4, LOT 18
1.0 GENERAL
1.1 THE DRAWINGS SHEETS 1 THRU 8, SHALL BE PART OF THIS
SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF DEPARTMENT OF HEALTH AND HUMAN
SERVICES.
1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE
VERIFIED IN THE FIELD BY THE CONTRACTOR.
1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR CONTRACTOR
TO ADHERE TO APPROVED DESIGNS FOR INSTALLATION,
MAINTAIN THE SPECIFIED SEPARATION DISTANCES, AND TO
HAVE APPROPRIATE INSPECTIONS BY ADEC~S APPROVED
AGENCY.
2.0 SEPTIC SYSTEM
2.1
2.2
THE SEPTIC TANK SHALL BE A UPS APPROVED TWO
COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN
OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE.
THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL.
INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER-
TIGHT CAULDER OR FERNCO COUPLINGS. PIPING SHALL BE 4
INCH SOLID PVC ASTM 3034, SLOPED A MINIMUM OF 1/4 INCH
PER FOOT, WITH A MINIMUM OF 4 FEET OF COVER. IF LESS
THAN 4 FEET, USE 1 INCH OF DOW EXTRUDED BLUE
POLYSTYRENE FOR EACH FOOT OF COVER LESS THAN 4 FEET.
2.3 CLEANOUTS SHALL BE INSTALLED WITH CAULDER COUPLINGS,
CAPPED WITH AIR-TIGHT JIM-CAPS (OR EQUIVALENT), AND
EXTEND A MINIMUM OF 0.5 FEET ABOVE GROUND LEVEL.
2.4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM
THE BUILDING FOUNDATION, AND A MINIMUM OF 5 FEET FROM
THE DRAINFIELD.
2.5 THE ENTIRE SEPTIC SYSTEM MUST BE 100 FEET OR MORE AWAY
FROM ALL PRIVATE WELLS AND YEAR-ROUND WATER SOURCES,
NATURAL OR MAN MADE, AND 150 FEET FROM CLASS C WELLS,
AND 200 FEET FROM CLASS A WELLS.
3.0 SEEPAGE BED
3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES
INDICATED; 0.75 TO 2.5 INCHES (OR ADEC EQUIVALENT).
?
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION.
3.3 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. THEY SHALL BE RIGID PVC, ASTM 30303 D-3034.
THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5"
HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE
1200 LUesl 33rJ J~ucnu¢, Suil¢ E~ · ~nchorctq¢, J~lesko 99503,[907) 561-5080
OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE
CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR
SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL)
SHALL BE PLACED ON THE TOP OF THE PIPE.
3.4 INSULATION, SHALL BE DOW EXTRUDED BLUE STYROFOAM
BOARD OR EQUIVALENT (1" PER FOOT OF SOIL LESS THAN
5 FEET OVERLYING THE BED.)
3.5 THE TOP AND SIDES OF ~fHE BED SHALL BE PLANTED WITH A
WHITE CLOVER AND RED FESCUE MIX OR BLUE GRASS.
3.6 THE SEPTIC TANK OR BED MUST NOT BE CLOSER THAN 100 FT.
TO ANY EXISTING PRIVATE WELL OR BODY OF WATER AND SHALL
BE NOT CLOSER THAN 150 FEET FROM EXISTING CLASS C WELLS
OR 200 FEET FROM CLASS A OR B WELLS UNLESS OTHERWISE
SPECIFIED.
3.7 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC ASTM D
2729 OR EQUAL OR POLYETHYLENE. THE PIPES SHALL BE LAID
LEVEL.
4.0 THE LIFT STATION
4.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER
GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT,
CAPABLE OF BURIAL TO 10 FT.
4.2 THE 36" DIAMETER PIPE FOR THE LIFT STATION SHALL HAVE A
WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND
COMPOSITION AS THE CULVERT.
4.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED
AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG.
WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC
RICH PAINT OR COATED WITH BITUMASTIC.
4.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED
WITH SCREWS. A TWO INCH LAYER OF POLYURETHANE FOAM
SHALL BE BOLTED TO THE INSIDE OF THE TOP CAP.
4.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN ~{E LIFT
STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT
SERVICE.
4.6 THERE SHALL BE A HIGH LEVEL ALARM, PEABODY BARNES 6147
OR EQUAL SET AT ~{E LEVEL OF THE SOIL PIPE FROM THE
SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE
ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED
BY THE HOMEOWNER.
4.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT
A HEAD OF 20 FEET.
4.8 PROVIDE A CALDER COUPLING AT THE CONNECTION OF THE 4"
SOLID PVC INFLUENT PIPE AND 4" STEEL NIPPLE.
4.9 THE PUMP SHALL BE CONTROLLED BY A DIFFERENTIAL MERCURY
FLOAT SWITCH, ADJUSTED TO ALLOW A TWO FOOT SPAN BETWEEN
'ON' AND 'OFFI, AS SHOWN IN THE DRAWING. ALL RELAYS
AND ELECTRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE
CHAMBER TO PROTECT THEM FROM CORROSION, PREFERRABLY
IN A DRY LOCATION WITHIN THE HOME.
4.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASIC PAINT
OR TAR TO APROXIMATELY 3.5 FEET ABOVE THE BOTTOM.
4.11 THE SYSTEM SHALL BE INSPECTED BY A LICENSED
ELECTRICIAN TO INSURE THAT THE ELECTRICAL
INSTALLATION IS IN ACCORDANCE WITH APPLICABLE CODES
AND REGULATIONS.
4.i2 AT LEAST TWO INSPECTIONS WILL BE NEEDED OF THE SEPTIC
SYSTEM--FIRST, OF THE EXCAVATED BED; SECOND, OF THE
SEWER ROCK AND PIPE AND INSULATION, AND THE TANK. IF
AECS DOES NOT PERFORM THESE INSPECTIONS AECS WILL NOT
BE RESPONSIBLE FOR THE DESIGN.
ALASKA ENVIRON"'~NTAL
CONTROL SERVIC , INC.
1200 Wes~ 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) §61-§040
JOB ~Z)~.~/~.(, U~//('~ ,~,/~'¢~' ~ ~
SHEET NO OF
CALCULATED BY ~r~ DATE
CHECKED BY DATE
2.O
\
ALASKA ENVIRONMENTAL
CONTROL SERVIC' ', INC.
1200 West 33rd Avert Suite B
ANCHORAGE. ALASKA {}9503
(907) 561-5040
ALASKA ENVIRONMENTAL
CONTROL SERVICe% INC.
1200 West 33rd Aver Suite B
ANCHORAGE, ALASK~ 99503
(907) 561-5040
ALASKA ENVIRON'"ENTAL
CONTROL SERVK ,, INC.
1200 West 33rd Avenue. Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JOD P,~d,.<~ t/,~l~ l~l,~f q
SHEET NO. ~'
CALCULATED BY ~' ~
DATE_,
ALASKA ENVIRONlUI~NTAL
CONTROL SERVIC INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 56~..5040
I': 2.5' '
OF
DATE
DATE
ALASKA ENVIROI~ !NTAL
CONTROL SERVIC=5, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
Joe
8HEETNO
CALCULATED BY
CHECKED BY DATE
ALASKA ENVIRON~'-NTAL
CONTROL SERVIC, INC.
1200 Wes:~ 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
8HEST NO
CALCULATED BY D~-' ~Y DATF
CHECKED BY DATE
SCALE
1200 West 33rd Avenue Suite B
ANCHORAGE, AL/ ~, 99503
Phone 561, ~,0
SHEET NO (~[f OF
~;~' V/S~-~ D Y .-----~'~0~:~)~ DATE
CHECKED BY DATE -
L/FT STAT/ON DE'7'A/L
NEMA 4
ENCLOSURE
GALVANIZED OR PAINTED
METAL COVER '
~ ~" URETHANE FOAM
:GLUED TO COVER
I~'DIA PU/L'PIPE CONNECTED TO
ADAPTER FOR
PUMP REMOVAL
GROUND LEVEL
POWER AND PUMP
CONTROL lINES
I ~ DIA STEEL PIPE
~ " CONDUIT
FIL£ET WELD
AROUND PIPE
4'DIA SOLID PVC PIPE
FROM SEPTIC TANK
COUPLING
DIFFERENTIAL MERcuhY
FLOAT SWlTCH
/NS/DE OF PIT SHAL
BE COATED WITH
BITUMINOUS PAINT OH TAR
PUMP
PUMP
.POWER
ALARM
CORD
· PUM/
CLAMP
/T/ESS ADAPTER
· '/' '2" SOLID P
MIN /.. . TO ABSORPTION
AREA
~HE4T TAPE
GAl_VAN}ZED STEEL
A-4444-?6)
-- PUMP "OFF" LEVEL
GALVANIZED OR
PAINTED STEEl- PLAT~
Leroy C.
No. 2251-I~
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: ~"~M'-,..~ .~'~ I,' $'F
DATE PERFORMED:
SLOPE
4
6
9
10¸
11
13-
SrTE PLAN
WAS GROUND WATER
ENCOUNTERED?
~t
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
14-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch)
FT AND -- FT
MUNICIPALITY Of ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D.
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
- Cum plete legal description
Location (site address or directions) ~J-O~ _~'~l,v C,r¢l~
Property owner
Mailing address
Lending agency
Mailing address
Agent /Vo,~
Address
711/ T~I/ ~/'p~'~-~-
?~,,¢,'~ ,¢'/~-,/¢~ mo,-~-~-,¢¢4 Dayphone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well t~-
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-325 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I veri~y that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage flies and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ~'/,..¢.6p 7',, ¢.~ ., , 'c ,. / $~fv~ Phone
Address
Engineer's signature
DHHS SIGNATURE
~ Approved for '-r'/-/',~ E'~' bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a cpu rtesy to pu mhssers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Legal Description:
A, WELL DATA
Well type
Log present (Y/N)
Municipality of Anchorage AU6
SE-'RVICES
DEPARTMENT OF HEALTH & HUMAN MUNICIPALiTy OF
Environmental Services Division
825 L Street, Room 502 · Anchorage, ALaska 99501 · (907)
Health Authority Approval Checklist
If A, B, or C, attach ADEC letter. ADEC water system number
'/" Date completed
Total depth
Sanitary seal (Y/N)
Y
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 col ~/roo ,,~.~
Date of sample: ,~'/~- / ? 9
B. ~E~'tHOLDING TANK DATA
Cased to I '-/¢'
FROM WELL LOG
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
~-/.~- / ?¢
Nitrate
g.p.m. 5-;. E. g.p.m.
/, '/~- r~,.,? /-¢- Other bacteria /',/o,"¢
Collected by: ,~'/~/'/~,~ '~'~'c& .Cc, ~
Date installed tl /,5- ,/? /
Foundation cleanout (Y/N)
Date of Pumping 7/2.-~/??
C, ABSORPTION FIELD DATA
Date installed .r,/. A.
Length Width
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.);
Tank size '~ aO0,_7~_ Number of Compartments ~ Cleanouts (Y/N)
Depression (Y/N) ^/ High water alarm (Y/N)
Pumper ,4 -~
Soil rating (g,p,d./ff~or ft~/bdrm) __ __
Gravel thickness below pipe
Monitoring Tube present (y/N) .
Results (Pass/Fail)
Fluid depth (ins) Minutes ater:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
System type
Total depth
Depression over field (Y/N) __
For
Immediately after___ gal. water added (in.):
Absorption rate =
If yes, give date
g.p.d.
.bedrooms
D. LIFT STATION N. ~.
Date installed
Manhole/Access (Y/N)
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
~/holding tank on lot
Absorption field on lot ~J.
Public sewer main ~.
Sewer/septic service line --.....>
Property line
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
Size in gallons
"Pump on" level at*
"Pump off" level at*
HAA Fee $.
Date of Payment
Receipt Number
in conformance with MOA HAA ,~uidelines in effect on this date. ~ ,,.. ~, , ~ ~, ,~
Engineer's Name ] ~¢¢ ~o~ ~ )~o ~ ~ ¢ ~~.~ ,~~
Date ~ ~ ~ ~ /¢9~ :?.;~% CE-3589 ..~ ,~,~
Waiver Fee $.
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
SEPARATION DISTANCES FROM ~:;~;C/HOLDING TANK ON LOT TO:
Foundation ,¢o' :~ Property line ~> ! o' Absorption field /~. ,4.
Water main/service line '-~ lo' Surface water/drainage '~ /oc,, Wells on adjacent lots -~ ~ o,~ ,
SEPARATION DISTANCE FROMABSORPTION FIELD ON LOTTO: h/./). ( I-)ol~(/,~,Z 7"-c~n ~,)
Building foundation Water main/service line
Driveway, parking/vehicle storage area.
Wells on adjacent lots
On adjacent lots I~¢' '/~ _,,'z-¢P ~,~4o/~
On adjacent lots ~>/¢~'
Public sewer manhole/cleanout
Lift station N. ,~.,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. BOX 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA ~21
5. STATEMENT OF INSPECTION BY ENGINEE~
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage flies and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm %~-'~,/,.¢.5¢.¢? ~,,¢'k~,,~.¢~/??~ Phone
Address ¢~ % ~ i4
Engineer's signature ~ ~.c66-~~ Date
/
DHHS SIGNATURE
~ Approved for _..._~
__ Disapproved.
bedrooms.
__ Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage ~,
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
J- et.4~'~(~ .(~z Parcel t.D.
Legal Description: ~o ~ ~(~, fi)i( ~g3_L)-- ~J ~'~
A. WELL DATA
Well type 1
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
Cased to i L~-~
FROM WELL LOG
Date of test
Static water level ~-
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
_~ptic/holding tank on lot
Absorption field on lot
Public sewer main I~/~
Sewer service line ~'}-/~k
ADEC water system number
"-/3' ~w-[~-- Driller
Casing height
Wires properly protected (Y/N)
AT INSPECTION -~ ~'
7' q~
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate
Other bacteria
Date of sample:
Collected by:
B. SBI~TIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
Tank size ~- (-¢~*-~2 Compartments (~)
Foundation cleanout (Y/N) ~ Depression (Y/N) ~"
Alarm tested (Y/N)
t'~///& Pumper /'h///~,-
High water alarm (Y/N)
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I ~
To property line '
Surface water/drainage
On adjacent lots
Absorption field
,/-
Foundation
Water main/service line,
72-026 (Rev, 7/91) F¢ont CONTINUED ON BACK PAGE
C. LIFT STATION ~/-~
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Soil rating
Gravel thickness
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Surface water
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
System type
Total depth
Cleanouts present (Y/N)
Date of adequacy test
for
· rf yes, give date
On adjacent lots Property line
To existing or abandoned system on lot
Cutbank Water main/service line
Driveway, parking/vehicle storage area
bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91 ) Back MOA 21
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions
Property owner
Mailing address
Lending agency
Mailing address
Day phone ~¥.~- (~; 4/~/~/
Day phone
Address
.... Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well ~'
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. · .T-YPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, ~ verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage flies and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm "~ ~'-~ ~ u v'~J c~,L~ Phone
I
Address ,~O'~ be'
Engineer's signature _~--~j_, ~ Date
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 Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~25(Rev. 1/91) Back MO^~21
Legal Description:
A, WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I.D.
If A, B, or C, attach ADEC letter.
?/ Date completed
.~ 90 Cased to I
ADEC water system number
Casing height . ~2/~/I
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level ~,~ O
Well flow
Pump level
g.p.m.
AT INSPECTION
.MII1NICIPALtTY OF ANCHORAGE
~P ' V' ~ } ~:~,!v!prjNMENTAL SERVICES DIVISION
1991
SEPARATION DISTANCES FROM WELL TO:
Septic/l:mldir~-tank on lot J
Absorption field on lot
Public sewer main ~///~
Sewer service line r'Z/A
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
I¢,O 'f
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: ~'/tl/ d
B. SEPTIC/HOLDING TANK DATA
Date installed ~', 7' &.~
Cleanouts (Y/N) X
High water alarm (Y/N)
Date of pumping
. ~ ~ Other bacteria
Tank size / 1~4.~ Compartments
Foundation oleanout (Y/N) ,~,/ Depression (Y/N)
Alarm tested (Y/N)
J~ 'Z~-- ' '~1 Pumper '~
Nitrate
Collected by:
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot tO ~
To propertyline J
Surface water/drainage
On adjacent lots
Absorption field
w/,~
Foundation
Water main/service line
72-026 (Rev. 7/gl) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N) ~'/
Manufacturer /~ ' ~.~a
Manhole/Access (Y/N) ~//
'~ Cz. "Pump off" level at /~. Fz
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot I } 0 ~
On adjacent lots
Surface water /",//,~
D. ABSORPTION FIELD DATA
Width
Soil rating 104~ System type
Gravel thickness ~ ~/ Total depth
Cleanouts present (Y/N) /"h/
Date of adequacy test ~/7*'/¢/
Date installed
Length '~'¢ /'7
Total absorption area
Depression over field;(Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
for
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots l ~¢ o/ Property line
To existing or abandoned system on lot
Cutbank t'..d,~ m e_ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect'on the da'ti ~f this inspection.
Engineer s Name '~ ~.u~ ~..(~
Date
HAA Fee $ /,/~) ¢3.~
Date of Payment
Receipt Number
72-O28 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
203 N£Sl 15¥N, AVENUE StlITE 206
(~07)
S__EF'~.~C ~YSTEM ADEQUAOy ~ES]'
LEGAl-:
L..crb. 1~3,¢ B].c:~c:I.,: 4 par'~&di~e Vall6~y
LOCATION:
650% Irately Cir.
OWNER:
RESIDENCE:
WELl-:
SEPTIC SYSTEM:
Ecl El u..bb
Single) Fam:L:Ly~
..:, 13el:h" tit)ms
pr'ivate~ On Site
MLIN]][.'IF'AL RE[][]RDS: 3 Bedr'c~c)m System
TANK: Greet' Steel. 1000 (3al,, "Fwc) (]c~mparts.
ABEH]RF)TION SYSTEM: Bed
AB~iC]F~F"I"]:ON AREA: 4.76 ~Cl. I:';'t,,
SCI ]; b RAT I NG: ~. O0
:1: N E~'I" (.~ L.L Al' ]; [)N DA'T'E:
DATE OF LAST PUMPING: ]:.csa,'ac:cs Au.tgui~'b ~;~:-2 1.9c71
DATE OF TEST: Au¢. '7 1991
TEST PROCEDURE: S}y~(~t:.em ~as inspet:t, ed arid mea,;~ur6~d. Tanl<
.Found w:i. th '~' ':~ ~.:~,~:.~'E o+ (::over and wi'tih a l~.C:luid ].e:.>v~]. (:]~: 50 :Lr~c:h ....
TEST RESULT: TI"JJ.~ ssysvbem 1'fl6~e:r[';~s 't.l"lce c:c:~de r..6)quir'~rl~c~lt:~s
c~...., .' -.¢~,~ ~)~[:)¢'&i,-t':f~69~]'b. (].F thee
i:h6:' I.-lec*lth and S(~c:ial .~=r
Ant q~)raqe. EXCEPT HIGH NATER ALARM
NOTE 'Thee c)pe:~r-'~a't:ic)natl :l.i.¢e o.F ,~].:1. ssep'b, ir: sy~terr,~:; c:le~pe)ndf~, c)n 'U. he;,
c~vaz].ua['.(::)r o~ 't'.h:i.s~ ~:i;Ecp'[:.:i.(::: f~yst.~:rfl. NE (::&~rl 'Eh(:)l"6,~cir'¢~
WEST 15'IH, A~ENUE ~UITE
A~CHORABE~ ALA~KAg9502-~904
(~07) 279-~918
RESIDENTIAL WEL~ INSPECTION
LEGAL:
Lot. 18~ Block 4 Parad:Lse Va].ley
LOCATION:
65'- 1 it. aly Cir.
OWNER: led Grubb
TYPE OF WELL.: Privat. e~ Single F:'ami. iy
WELL LOG AVAILABLE: Yes
INSTALLATION REQUIREMENTS ME]':Ye!~s
WELL YIELD FROM WELL LOG:
PUMP YIELD FROM TEST:
DATE OF INSPECTION:
TEST PROCEDURE: We]. 1
4. Gallons per Minute'-
5 Ga].],ons per Minute
August 7~ 1991
was pumped at
a c:;ons]FJ:ar]t rat'.e whi ]. e 'JZI]E9
~:~ pE~riod
pre)be. At. the ])(~qliFH]inc=l 0'~ t.J]e test water' level was -Found at .,~,z. 8
,J:c~et be].c]t~J t. op c)~ cas:Lng,, At a p ml:]in(]) ra~]e O'E ~ gailol]s
I/I~,I'H.i'~'.E~ th(D water' ].eve1 dr'c:)pped to 3C)1 a.ft. er" 65 mil]utes o-I:
]"h~-,~ we].l rec:overy was monitored .for 90 minutes,, During this time
[".hf~ ~elI recovered to 22S .fo:et.
TEST FOR E.COL]] AND TOTAL NITROGEN: Water was test. ed .for E.Coli
and '~:c)ta]. nitr'ogen on August 14 1991.
EE. []OIi O. To'~.aI Ni'L'.roge;"l O. 6S lag/]..
TEST RESULTS: ThJ. s we].I meets the
MLIni(::J. pal i ty o'~ Afl: ~ or'a(:lc~,
THIS.. WELt~ WILL, PRODUCE.. MOR_E_ THAN. ~ GALLON~_ ~PER ~INUTE
THAN F_QUR. NOU_R~
FOR .MORE
asqes s ~ 'r~ o'¢ the cof]d i {'.:J. Ol"t o'J: thE, we}I ]. .'~ppI i 6)~ ol-i], y to;) the
c:omqdi'L:LOl"~s as of 't'.'.lie day test. ccd,, 'l'hc~ f:Low 1" 6&'J; 6.;¢ ~lay cqang¢~ due to
aqui fc.)m"' -f~.x~:d:i. ng t. he wel i,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date June 8, 1988
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
6501 Italy Circle
(b) Property Owner Alliance Bank Telephone: Home
Denali Br., 440 E. 36th Avenue
Mailing Address
Business
786-6324
(c) Lending Institution A] 1 '~ ~n~: Bank
Mailing Address
Telephone
786-6324
(d) Real Estate Company and Agent R~ma× ~ Carl Rmi t-.h
Address _ 2600 Cordova
Telephone 2?6-2?6].
(e) Mail the HAA to the followino address: or: Check here [], if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family l[~(
Number of Bedrooms
3
WATER SUPPLY
Individual Well F~X Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite ~X 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.
Page 1 of 2
ENGINEERING FIRM PROVIDING ImSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, [ verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
NameofFirm q~.' ,~purklRnr~: P_ R. Telephone 279-3916
Address 203 W. 15th
Date May 'R1 ; 1ORR
Engineer's original stamp and
signature on file with D.H.H.S.
Engineer's Seal
DHHS APPROVAL
Approved for "Ph~¢¢ ( '4)bedrooms by
Approved ×× Disapproved
Conditional
Date 06-28-88
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services /DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2
72-025 IRev 8/86} Back
ALASKA el/UIROnmellTAL CONTROL SeBUICeS, InC.
o ~nqineerinq 6 {~nuironmenlol Studies
Jtlne 28, 1988
Department of Ilealth & Iluman Services
825 Y, Street
Anchorage, AK. 99501
Attn: Susan Oswalt
Let: 18, Block 4, Pul'adise Valley Subd:iv:ision
As of June 27, ]988 the illegal curtain drain on the ]or was disconnected, It
is no ]onge]? funel::Lena] as the pari: of Lhe drain along [tim wesL side of the
house has been removed and 'blue clay" has been packed back into the trench.
The crawl space drain :is still OOlllleci;ed Lo ~ha'k porkion of the dl'aJll Lhak
extends fpom the SW corl~ep of the house to the outfa].l. See the attached
sketch.
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
JUN 2 8 t988
RECEIVED
{200 LUes{ 3Srd Auenu¢, $ui1¢ ~eAnc{mroqe. Ahsko 99503,(907] 551-5040
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Properly Owner &~ ~ Telephone: Home
Mailing Address ~
(C) Lending Institution ~[[~
Mailing Address Y ~O ~ ~ ~ ~-¢
(d) Real Estate Company and Agent
Address
Telephone ~7~
(e) Mail the HAA to the followin~ address: or; Cheek here~ if hold for pick up,
List contact ~erson and day phone number below.
TYPE OF RESIDENCE
Single-Family~
Number of Bedrooms
WATER SUPPLY
Individual Well~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
onsite~L, Public [] Community [] Holding Tank []
/
Note: I~ community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025/Rev 8/861 Fronl
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this in~ /~
Name of Firm ~a. J' · .... f/ Telephone ~"7 ~" ~ ~ / ~
Address / ~ ~ l~--~
Engineer's Seal
6. DHHS APPROV.~
'Xx~pproved f o'r"~
'" proved /%
/
ppr(
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does th is as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data
before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
Page 2 of 2 72-025 IRev 8/86) Back
PAU'f¥ OF ANCt4(bR^G~:
MuNICi ...... ~1~,1~,~ ~LITY OF ANCHORAGE (MOA)
ENTAL ~w~o ~,--~
~NvI~ON~ HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
JUN C 198B 264-4720
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/b4+,,~,,~g Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments 'Y' '~
If A, B, C, D.E.C. Approved (Y/N)
7' ~' ~'"' Yield
Date Completed
Depth of Grouting ~ O ~.~ ~_..
Pump Set At
~,, .fl/~.z Sanitary Seal on Casing (Y/N)
'~ Depression Around Wellhead (Y/N)
~f O V ; On Adjoining Lots
/~ ~4,. ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Size /O.~¢.',~ No. of Compartments "'~-~'~*~
Air-tight Caps (Y/N) X Foundation Cleanout (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Comments
Date Last Pumpe~-"~'Z
; or
Temporary Holding Tank Permit (Y/N) ~ __
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
,,
' · :. --/,
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design
Length of Field
Depth of Field '
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of. La. st Adequacy Test
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
To Property Line I C~
To Existing or Abandoned System on
; On Adjoining Lots
~'~o-C~! present) ~ O u/ ,~
"Pump On" Level at IltI
High Water Alarm Level at ~,~)
Tested for
Electrical Codes (Y/N) y
Comments
Dimensions /"7/~ ~)'~
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Bating Against HAA Request **
I certify that I have checked, verified,~or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed '~-~ Date '~/i~/~
Company MOA No.
Receipt No. /
Date of Payment
Amount: $
Page 2 of 2
Engineer's Seal
72-026 nl/84)
CONSULTING ENGINEER TELEPHONE: (907) 279-3916
SEPTIC
SYSTEM ADEQUACY TEST
LEGAL:
~ ' : LOCATION:
-. ' OWNER:
RESIDENCE .-
WELL:
SEPTIC SYSTEM:
Lot 18, Block 4, Paradise Valley ~ OF
~,,~..' ~,, ..
6.501 Italy Circle ,¢%.
Single Family, Three Bedrooms ¢~~7~'
O~ Site, Single Family ~%
FROM MUNICIPAL RECORDS:
TANK: Greer Steel, 1000 gal. Two Comp.
ABSORPTION SYSTEM: Bed
ABSORPTION AREA: 476
SOIL RATING: 100
INSTALLATION DATE: August 1985
DATE OF LAST PUMPING: May 21, 1988. Marx
DATE OF TEST:
May 19, 1988
TEST PROCEDURE: System was inspected and measured. Tank was
found with three feet of cover and a liquid depth of 55 inches.
Two monitor tubes in bed were found 2.5 feet deep with no
standing water. Lift station was found 77" deep and with 8
inches of water. Lift station lid was not bolted down.
730 gallons of clean water were added to the lift station at a
constant ra~e of 5 gallons per minute. Pump turned on at 11
inches and off a5 6 inches. Approximately 50 ~allons were pumped
per cycle. Adding 730 gallons to tAe bed caused 3.5 inches of
water ~op be m%asured in the monitor tubes. 12 hours later the
tubes were dry, indicating that the volume of water had
been absorbed ky the sO~ ............................ ---~ ........
/0~ May<-~ the tank was exposed and it was discovered that t~
// pipe between the septic tank and the lift station had separated
[at the lift station. The tank wa's found 6 inches lower than the
~inlet to the !lft. Tank was raised, bedded in pitrun material
~und_~reconnected to the liftstat~n.
TEST RESULT: This system meeus the code requirements of
the Health and Social Services Department of the Municipality of
Anchorage.
NOTE The operational life of all septic systems depends on the
local soil conditions, groundwater levels that may fluctuate
during the year, and the water usage of the family being served
by the system. These conditions are outside the control of the
evaluator of this septic system. We can therefore~ not give any
estimate of how long this system will function satisfactory for
currenu or future occupants.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL pROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address
(b) Applicant Nam,
Applicant Add~'
(c) Applicant is
~phone: Home 15Z~ % S ~ -3- ~5 Business
; Owner/builder%~; Buyer []; Other [] (explain);
(d) Lending
Address
(e)
Telephone
Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Familyi,~ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY'
Individual Well'~ Community [] Public []
Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservauon
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ 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.
Page 1 of 2
72-025 {11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D~,,,A AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchora9e files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm _ /~ Eo~ Telephone ~ I ~o~,0
Address Iz~oo t,O :~ .~ ~z.r~ ~c~ ~ c~ ~(,9 °~
Date /,~ "/," '~ ~
Seal
DHEP APPROVAL
Approved for -¢',,.,~c. C"~2 bedrooms by ~ '~)'' "~-t~,~
Approved / Dis~ved Cond~al
Terms of Conditional Approval
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph $ above by an independe.nt professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-o25 (11;84)
MUNICIPALITY OF ANCHORAGE (MO~,
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
,JAN 5 lg86'
WELL DATA
Well Classification (C/ ~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present~_~N)~ Date Completed '7-~ ~;~'~5- Yield
Total Depth ~ ' Cased to /¢0'~
Static Water Level ,'~¢'~
Casing Height Above'Ground
Electrical Wiring in Conduit~N)
Separation Distances from Well:-
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Depth of Grouting (~/~.h'~Z.¢~-~.%
Pump Set At of~:~¢(4/~-t
Sanitary Seal on CasingS4)
Depression Around Wellhead (Y/~
; On Adjoining Lots
~ OZ~ ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
· ~T~O- t ¢-"( ; Date
-6' ,-.
2. 5
SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes
Depression over Tank (Y/I~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ',,O
To Propert~ Line
,~;W~t~r ~q n~ce Line
Size too o No. of Compartments
Air-tight Caps~N) Foundation Cleanout
Date Last Pumped
; for
'---- Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
72-026(11/84)
C. ABSORPTION FIELD DATA ·
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well J O~
To Building Foundation 5 2-
Lot -
To Water Main/Service Line \ (.3 -~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness J
Standpipes Present ~N)
Date of Last Adequacy Test
To Property Line 1 o
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at ,/~'~-
Dimensions
Manhole/Access~N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Tested for
Electrical Codes~N)~'~
** Check Permitted Bedroom Rating Against HAA Request **
I certify tha~l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Receipt No.
Date of Payment J
Amount: $ (
Page 2 of 2
72-026 (11/84)
December 9, 1985
WATT ELECTRIC
2907 W. 33rd
Anchorage, AK
248-7557
99517
To Whom It May Concern:
This is to confirm that Doug Mandevill inspected the
electrical hook ups on the lift station at Lot 18,
Block 4, Paradise Valley Subdivision.
Mr. Mandevill is an Alaska licensed journeyman elec-
trician. He stated that the connections, splices,
etc., appeared to conform to the National Electrical
Code, and any applicable local codes.
Very truly yours,
JW:cw
