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Home My WebLink AboutPROSPECT HEIGHTS BLK 1 LT 12 Municipality of Anchorage Page --/of ',)[PARTMENT OF HEALTH AND HUMAN SERVIC[!S ENVIRONMENTAL SERVICES DIVISION P,O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site ~'~stewater Disposal System and/or Well Inspection Report Name: ~/~ ~ Wastewater Syste~: ~ew ~ Upgrade Phone: ~~ No. of Bedrooms:~ ~ Deep Trench ~hallowTrench ~Bed~Mound ~Other LEGAL DESCRIPTION soi,.~,,..: /,Z GPD/Sq. FI. Total Depth from orig~l ~a?: Lot: Block: Subdivisi n: , Depth to pipe bottom~: ~1 grade: Gravel depth beneath pip~ Township: /Z~ ~W Section: ~ Filladdedab°ve°rigi}alz~e:__~. Gravellength: ~5 Ft. WELL: ~New ~ Upgrade Gravelwidth: ~__ZI. Numbe~lines: IDislan?~elwe"nlines:l ~ ~: Ft. Driller: Date rille Sta cWa e Leve Installer~ ~ield: ~ .~ IPump~: CasingHeightAboveGround: ---- ' SEPARATION DISTANCES ~ Septic ~ Holding ~S.T,E.P. TO Seplic Abso,plionLiFt Holding w~,, I1~' 1frS' IZ3' ~ ~ Material: ~/ NumberofCompartments: ~ Surface wa~r +~' +~' +2~~ W~ ~, LIFT STATION / I "Pump on' I vel al: "Pump olf" level at: High water alarm at: Remarks: BENCH MARK ' J Department of Healt~and ~man Services .ev,ew d pp oved .... _____ 72-013 (Rev. 9/91) MOA 25 Permit No. Z Page ol Municipality of Anchorage DEPARTNIENT OF HFAL'rH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~o,.~ ' caI l~goO $.'7': ~ ~, PID No' ,, ~¢1/-1'£,~ ' pvc J~ ~ ~ H ~ ~ ~,11 J ~':z" ~'~' ~ulJSo' Co~l ~ ~9' 72-013 A (Rev 9/91) MOA 25 // · I"'ANg ~r b1,¢'¢ $1CA"FIO,',J MUNICIPALITY OF ANCHORAGE MEMORANDUM Date.. Jan. 24, 19 95 To: File From; Dan Roth se:. Sand Filter - Lot 12 Blk 1 Prospect Heights The sand used in this absorption field does not meet D.H.H.S. specifications After consideration by Jim Cross, P.E. Program Manager and myself, it was decided to sign the as-built/inspection report with this notation. Engineer was notified of same. 91-015 (Rev, 1/81) From : fiLP]hE DRILl_ 90? ~45 0202 0ct.09. 1994 11:5S Prd POl W~LL ()HER: LOCATION OF V~J.L LOd~ATION/~K~rCH: DI?I~TIS MEASURED FROM:~InO t~ ~omund suff~e ' ~0~ DATA: Depth ~nd C~ Fr~ To W~LL DEPTH: ! DATE OF COMPLETION Death oi hole~(~:;:~ ~ ft DEPTH TO ~AY~ WA~ L~EL: DRILLk~G: ~air rotary [] cable tool METHOD OF ~] o~her ~ , U~ 0FWELL:~0me~o ~ Irdgatl~ ~ m~hor fl. Diam: Casino WELL ~AK~ O~IN~ ~PE: ~ opan end ~ ~eHola~ed ~opan ~le !~;R EEN TYPE: I~iam: in. ~(otlMost~ Size: __-- [.e~lth: It G~VEL PACK TYPE: Volume ~d; Depth to top; ' TYPE: Volume: D~th: (~om, ft ~ ft Duration: I LEVEL J~NO It alle~ PUMP INTAKE OElvrH: tt Horse. ptlwer: .-- W~LL DLS~FECT~I) UPO~I COM!PLETION7 ~ yl~ I~ ~ONYff~TOR INFORMAYION; REMAN(S: ~i~ ] I re usinoss Na~e / ~ ' OG ~,:~:~b,e o~ A~ori~e~ R~sp~s~a(ive ~ote / PO ~OX 772116 ~GEE RIVER AK 99577-2116 polarconsult alaska, inc. ENGINEERS · SURVEYORS · ENERGY CONSULTANTS April 18, 1995 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 Attn: Dan Roth Re: System Approval for On-site Sewer System, Lot 12, Block 1, Prospect Heights S/D. RECEIVED MuniCipality of Anch r Dept. Health & HUman ~S°~,~vg/cees Dear Mr. Roth, As you are aware, your office approved the above system with an attached memorandum stating that the installed sand filter came from an unapproved source, and was therefore an unapproved sand. Unfortunately, as might be predicted, the property owner's financial institution refuses to accept this for closing and their financing has been halted for the time being. Please find enclosed the letter which we have written to the contractor in an attempt to rectify the situation for the homeowner. Sincerely, Earle Ausman, PE POLARCONSULT enclosures: 4/18/95 letter 1503 WEST 33RD AVENUE · SUITE 310 ° ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 polarconsult alaska, inc. ENGINEERS * SURVI--YORS · ENERGY CONSULTANTS April 18, 1995 Michelsohn & Daughter Construction, Inc. 852 W. International Airport Road, Suite B Anchorage, Alaska 99518 Attn: Paul Michelsohn Re: Sand Filter used for Lot I2, Block 1, Prospect Heights S/D Dear Mr. Michelsohn, This letter outlines our findings regarding the above referenced septic system and is in response to your call last week regarding the financing difficulties relating to the sand filter portion of the project. It is our understanding that the contractor whom you hired for the on-site septic improvements at the above property, Harten Construction, did not provide an approved sand for the construction of the septic system in accordance with MOA requirements. The MOA requires all septic systems to be constructed in accordance with the stipulations set forth by the On-site Services branch of the Department of Health and Human Services. The department has pre-approved the materials allowed for use in the construction of such systems which includes, among other things, pipe, sewer rock, filter material, insulation, tanks, lift stations, and also filter sand. These requirements are documented and available at the On-site Services office. Knowledge of these requirements is necessary to be an MOA approved excavator/installer for such systems. As engineers, it is our responsibility to verify that the physical attributes of the system meet the general requirements of the design during construction of the system. This is performed through a series of site visits and inspections. Verification includes measurement of trench elevations, separation distances, pipe slopes, tank placement, surface grading, system layout, etc. Construction practices, methods, and use of the proper materials is the responsibility of the excavation contractor who is installing the system. It is not the responsibility of the engineer to verify that the materials used conform to MOA specifications. As with many of the materials, it cannot be casually visually determined if the filter sand meets MOA gradation requirements. In such cases, the owner must rely upon the certified excavator/installer to use the correct materials. In this particular case, not only did the contractor have available the MOA standards for choosing the correct sand but also benefited from a reminder printed directly on the design by Polarconsult. 1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE. ALASKA 99503 PHONE (907) 258-2420 · TELEFAX (907) 258-2419 polarconsult We suggest that you tell Harten Construction to rectify their mistake by either: Replacing the current sand with an MOA approved one; or Prove to the MOA that the sand originally installed meets AMC 15.65.060 (D); or Prove that the sand came from (a) Lake Otis gravel pit ("Lake Otis Gravel"), Anchorage, or (b) Central Paving Products ("DOT Road Sand"), Palmer, or (c) Quality Sand & Gravel, Wasilla, or (d) Beaver Lake Sand & Gravel, Wasilla, and meets AMC 15.65.060 (D). Sincerely, Earle Ausman, PE POLARCONSULT CC: Dr. Michael Propst Dan Roth, DHHS, On-site Services MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHOP~AGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT ~ER:SW940144 DESIGN ENGINEER:POLARCONSULT ALASKA, INC. OWNER NAME:PROPST MICHAEL T OWNER ADDRESS:P.O BOX 233332 ANCHOKAGE, AK 99523-3332 DATE ISSUED: 6/01/94 EXPIRATION DATE: 6/01/95 PARCEL ID:01509103 LEGAL DESCRIPTION: PROSPECT HEIGHTS BLK 2 1 LT 1 LOT SIZE: 97600 (SQ. FT.) ~ER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE sAND USED WITH A MAXIMUM OF 4% PASSING THE #100 OF 2% PASSING THE #200 SIEVE. // . IN THIS SYSTEM SHALL MEET DHHS SPECIFICATIONS SIEVE AND A MAXIMUM DATE: 'DATE: polarconsult alaska, inc. ENGINEERS · SURVEYORS · ENERGY CONSULTANTS July 28, 1994 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 Attn: Permit Review Officer Re: System Amendment to Approved Design Permit for Lot 12, Block 1, Prospect Heights S/D. Dear Sir or Madam: Please accept the following revision of the approved design for the above property. Because of changes made to the basement elevation of the proposed four bedroom house, a pressurized system (lift station) will be required. The only changes to the current approved design are: diameters of the delivery, manifold, and lateral lines, and replacing the standard septic tank with an Orenco tank/lift station (1,500 gallon) from Anchorage Tank. Please find attached the amended design calculations and a new plan view of the system showing hole spacing, diameters, etc. The approved profile view remains unchanged (other than the distribution line diameter). If you have any questions, please give me a call. Sincerely, ~ Matthew rorshin POLARCONSULT 1503 WEST 33RD AVENUE · SUITE 310 ° ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 ° TELEFAX (907) 258-2419 polarconsult alaska, inc. ].503 West 33rd Avenue · Suite 3].0 ANCHORAGE, ALASI<A 99503 (907) 258-2420 Fax (907) 258-243.9 CALCULATED BY ~'~//e~ DATE CHECKED BY__. DATE -- ........ _~ p£c c_... · 2 /~]41V!~.L..D 7 I¢ *~ ' ' '3.Z 71 Dlselaimei': The attached on;site septid Systeni design was developed m accordance web generally accepted engineering practmes and outran( Municipality of:Anchorage design requiremanrs. Polarconsult.,offers. n0..~varranty,, express, or implied, oeperform~co, or longevity of the system and is not responsible for damages associated with its performance or longevity. This design has been?based'on · the fesul~ of the' attached ·soils percolation tests which are'assun~ed t6 he repr~seiithtigi~ of the Sbil cohdifi0ns'in Which tho system i~ to bo built, If during construction the soils are found to bo less favorable than assumed.from, these,tests, tho system may.require redasign ornot bo able to be constructed at all. The:locations of the soils tests, monitorh~g wells; and leachfields are approximate and have been based on tlxe assumed locations Of the 10t Ift~es whibh may b'e ~ubjecf¢ to si~/fifi~aitf 8/~6r.' A's such. we re~omirnend that'th~se 10e~/ti6ns · bo verified by a registered land surveyor, prior to site planning, and..sys~em construction. Polarconsult will not be responsible for damages associated with errors relating to the location assumptions. polarconsult ala;ka, Inc; 1503 West 33rd Avenue .. Suite 310 ANCHORAGE, ALASKA 99503 (907) 259.2420 Fax (907) 258-2419 JOe SHEET NO. C[CU ~IEO "y__ ~K CHECKEO BY-- BATE __ ~lin` 15' ~ PZA,g vl¢~ oF PF~C'~_FEO CA~I'~D ~,/rr-~r Dbclaim~ ~o a~ched on.site soptio syst~ d~i~ Wa~'~6vel6p~d ~ ~6f~6e ~i~"g~mlly accepted engineering practices ~d cu~ent MunicipaliW of:~chomgo desi~ raq~mn~.....Pol~censult off~. no w~, oxpr~s, or ~plied, o~.peffo~ or longeviW of the system ~d ii not responsible for damages ~sociamd w · i~ peffO~ce or longeviW. ~is desi~ h~ been b~od on bo, built. If dung cons~ction th~ soiN ~e fo~d.~ ~o l~s: favomble.~ ~smed.ff0m.~o;tes~, ~ system may:requffo r~esi~ or=not bo able to be cons~emd at all. ~ loc~ions of tho soils tes~, monito~g wells, ~ leachfiol~ ~e approximate ~md have been b~ed 0nt~e assumed locations of the lot l~es which may ~'subj~ct t~ si~ifidint eff0L'As iii~h, we ?eeomN~nd that thoio locations be wrified' by a registered l~d s~eyor prior to site pl~ing ~d sysmm, cons~cfion. Polarconsult will not bo r~ponsible for (~ages associated wi~ e=ors relat~g to ~e location assumptions. polarconsult alaska, inc. ENGINEERS · SURVEYORS" ENERGY CONSULTAN"¢S August 23, 1993 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 Attn: Permit Review Officer Re: Design and Construction Approval for On-site Sewer System at Lot 12, Block 1, Prospect Heights S/D. Dear Sir or Madam: Please accept the following design for review and permitting. The proposed system does not affect the current use of the adjacent properties and will have minimum future impact. If you have any questions, please give me a call. David Ausman, CE POLARCONSULT Attachments: On-site Sewer/Well Permit Application Site Plan, Sheet 1 of 4 System Design Calculations, Section, Sheet 2 of 4 Percolation Test, Sheet 3 of 4 Percolation Test, Sheet 4 of 4 $320 Check for Permit Fee 1503 WEST 33RD AVENUE · SUITE 310 o ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420. TELEFAX (907) 258-2419 polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 3[0 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 SHEET NO CHECKED BY OATE__ /__dT /2~ 0 - polarconsult alaska, inc. 1503 West 33rd Avenue · Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 CHECKED BY OATE gOO F-'r~ .... : 120 /~?: o /0 ' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 1 2 3- 5- 6~ 7 8 9 ~0 12 13 17 18 20- "/"/-/,/t / DATE PERFORMED:__ SLOPE SITE PLAN "~ WAS GROUND WATER /~/ ENCOUNTERED? /'!/0 __ OEET.?'EYES'ATW"AT V/A Monitoring? /~ ~ Dale Gross Net Depth to Net Reading Date Time Time Water Drop p~,~ 7/z~ IZ:~o -- 3~" _ ~ -~/~ /~ :_zz g_ ~... 3,~/;'' ~ 7/~ j~:~3 I ~. ~Z~" ~" 5 ~/~7 /z:~ ~ ~,~, ~ ~/~" z/~" ~ '~/2~ I~:~ ~ ~,.. ~ ~J~" ~//~" ~ 7/~ /~:~ ~ ~,'~. ~ ~/~" %" e ~/~7 i~:~? I ~. 5 '~" ~" ~ ~/~v /z:?o ~ ~,.,. ~ '~" ~/~" PERCOLATION RATE__~ (mmutes/,nch) PERC HOLE DIAMETER TEST RUN RETWEEN "~ _ FT AND Z.~ FT COMMENTS PE.FO.MED. ' /"L//Z'"'" X0"'Z/'" CE.T,FYTHAT.,.,ST STW^a EaFORMEO ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 72-008 (Rev. 4/85) PERFORMED POR: LEGAL DESCRIPTION: O 1 2 3 4- 7 8 9 10 11 12 13 14- 15- I6- 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? L ,P AT W"A T v/A DEPTH? Depth to Waler Allot h~onJlorJn§? Reading Date Time Time Water Drop I ¥/2-~ 12:l~: - 0,, _ 3 7/~;~ ~-:z7 7,.,,~. ~/" z" PERCOLATION RATE ~)' ~ -- (minutes/tach) PERC HOLE DIAMETER -- TEST RUN BETWEEN '~ FT AND . Z~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE' DATE; 72-008 (Rev. 4/851 MUNICIPALITY OF ANCHORAGE DFPARTMENT 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 015-09 -03 HAA#/dR 9 % GENERAL INFORMATION Complete legal description Lot 12; Block 1; Prospect Heights Location (site address or directions) 9801 Prospect Drive Anchoraqe~ AK Property owner Mike & Sue Propst. .Mailing address __~g01 Lending agency Day phone _ Prospect Drive Anchoraqe, AK Day ~hone 346-8296 99516 Mailin. g address Agent Address Bonnie Mehner/Prudential Jack White Day phone Unless ott]erwise requested, HAA ~vill be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well xX Community well Public water NOTE-': TYPE OF wASTEWATER DISPOSAL: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. XX Individual on-site Holding tank Community on-site Public sewer NOTF: 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, 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 files and from my investigation and inspection, the on-site water supply and/or wastewater dispo~F~,il,~/~t~r~, ~m~liance with all Municipal and State codes, ordinances, and regulati~li~t~rO(~(~,~ud~nspection. Name of Firm ~ eBa ~oad~, ,~1~ 31~ Phone Engineer's signature ~ ~ Date // Alaska Water & Wastewater Consultants, Inc.~, Shall be PAID ~ ~ - or prio? to, closing for the Engineering Servicc. s Provided, DHHS SIGNATURE ~' Approved for ~/ 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 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 DH HS 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 professi(Jhal engineer's work. Kt:Ci:i Municipality of Anchorage ~JO¥ 2~'. DEPARTMEN'r OF HEALTH & HUMAN SERVIC~iCm^, n~ Environmental Services Division [NVmO~mfAgs~WCCm 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type----P~t!VATE: Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist PJ~,QSP~()T 12. BLOCK 1 _ Parcel I.D.: 015-091-03 IfA, B, or C, attach ADEC letter. ADEC water system number YES [)ate completed B/2~.i/g4 Cased tOl~2_(ZO.J3EBROGL4~ Casing height (above ground) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample: 11/16,/99 B, SEPTIC/HOLDING TANK DATA Date installed 8/18/94- Tank size Foundation cleanout (Y/N) YES Date of Pumping 7,/2/99 C. ABSORPTION FIFLD DATA Date installed 8/1 B/g4- Length 11 O' Width YFS Wires properly protected (Y/N) __ FROM WELL LOG AT INSPECTION R/29/94 7,/2/99 11 26' 2,5 .g.p.m. 1.25 N,/A 2% YES g,p.m. Nitrate 4-.25 mg,/L C)ther bacteria O A,W,W,C,, INC, Collected by: 1500 Depression (Y/N) NO Pumper A+ HOME SERVICES [EAST,/WEST] 8oil rating (g,p.d,/ft~ OF ft2/bdrm) 5' Gravel thickness below pipe Number of Compartrnents 2 Cleanouts (Y/N) YES_ High wa. ter alarm (Y/N) YES SHALLOW 1.2 System type TRENOHES 5.4? 1.05' Total depth Effective absorption area 600 SC) FT Monitoring Tube present (Y/N). YES Depression over field (Y/N) NO Date of adequacy test 7,/2,/99 Results (Pass/Fail) PASS For 4. bedrooms 466/138 Fluid depth in absorption field before test (in.); 7.25/7 Immediately after gal. water added (in.): 9/9 Fluid depth_7.25/8.25 (ins) Minutes later: 75/9(:) Absorption rate = 600+ g.p.d. Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date - 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) 8118194 YES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line High water alarm level at* Cycles tested 3+ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'.+ 100'+ N/^ 25'+ Size in gallons "Pump on" level at* 44-" *Datum R~'n'r~M (~F TANK 1500 "Pump off" level at* 40" On adjacent lots 100'.+ On adjacent lots 100'+ Public sewer manhole/cleanout Lift station 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field Water main/service line 10'+ Surface water/drainage 1OO'.+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 10'+ Property line Surface water Curtain drain N/A 5'+ 100'+ Building foundation 1 O' Water main/service line 1 O'+ 100'4 Driveway, parking/vehicle storage area 10'+ NONE KNOWN Wells on adjacent lots 100'+ F. ENGINEER'S CERTIFIOATION/I I certify that I.,~ d~e/mi/e/~/hl field inspections and review of Municipal recor~t '~...~b~ ,~ems are Signature~/~~ ~ ' .~ ~ Engineer's N: ~ ~_~ ~....:....~ Date /fl ~/~ v~UCE-7955 ...." &~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* · Waiver Fee $ ")'/ ~ "~-,'~ '--- ~¢ Date of Payment ~L¢/,,_~.._ ( ~:)/(~,,~ ~ Receipt Number 11-23-g9 )O:3T FROM-CTE ENVIRONMENTAL ~tK CT&E Eh vi ton menTal Se,vic as Ino. T-OgZ P.02/03 F-12I CT&E Ref,# Client Name Proj~T Nam eY/t Client Sample ID MaTrix Ordered By PWSlD 996342~)01 · ~ Wa~er & WasTowa~er Cons~tan[s Inc. Prospect His Lo~ 12 Bk 2 Prosp~ HB LoT 12 Bk 2 Drinking W~er Sample R~ ............... Client POt/ Printed DaTe/Time 11/23/99 08:49 Colle~ged Date/Time 11/16/99 10:15 R~eived DaTe/T/me 11/17/99 13:~ T~h~I~: ~ephen ~de Releas~ ~~~- CoLiform o coL/lOOmL SHI8 9222~ 'tO f~gx 11117/9~ KAP 11/17/~ 11/17/9g SCL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Divisi0~r0f 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 Parcel I.D.# Ol~'"-('"~l-O~ HAA# q -Ol 1, GENERAL INFORMATION · · Completelegaldescdption /~12-~ l~J ~'¢~/~r¢7~ /L/r/~)/~ Z/'~; Location (site address or directions) Property owner ,p ~:, ,,~/'k~., ~ru~ Day phone Mailing addr;ss Lending agency . Day phone Mailing address Agent Address Day phone · Unless otherwtse requested, HAA will be held 2. NUMBER OF BEDROOMS. ~-¢ '; 3. , TYPE OF WATER SUPPLY: ,'. · Individual well .Community.well,, Public water NOTE: ;, -.. · If community well system; provide written confirmation from Stat~ ADEC attest- to the legality and status of system, lng 4. TYPE OFWASTEWATER 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 stat~s of system. ' 72-025(Rev. 1/91) Front MOA#21 STATEMENT O1" INSPECTION BY ENGINEER As certified by my seal e:ffixed heret0and 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 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 ~o/~fc¢~// Phone Engineer's signature Date - ,./¢. ¥.'..2. % 6. DHHS SIGNATURE ~;~f~ ' . '~ pp fo '" ...': A roved 'r - . ' .;~ ~__ Conditional approval for ~droo'ms, with the follOwing stipulations: ,-\ Additional Comment,,~' _~~'~-- 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 DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not rssponsible for errors or omissions in the p?ofessional engineer's.work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type '/''~r-ivct Log present (Y/N) ¥ Total depth ~- ~''~' Sanitary seal (Y/N) If A, B, or C, attach ADEC letter, ADEC water system number Date completed ~/,Z'~/? ~ Driller Cased to /~ F77 Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 ' · ~- / ~ ~-~" SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot //~ /"~7-' Absorption field on lot / Z/5' /-~?-, Public sewer main Sewer service line g.p.m. ; On adjacent lots ; On adjacent lots ~r /0o ?%. Public sewer manhole/cleanout /'~'/¢'~- Petroleum tank WATER SAMPLE RESULTS: Coliform C), Date of sample: ~/o/~ Collected by: Other bacteria B, SEPTIC/HOLDING TANK DATA Date installed ~,/'~ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping D.'T. £. P. Tank size [) ~00 Foundation cleanout (Y/N) Compartments ~- .Depression (Y/N) Alarmtested (Y/N) -- Pumper -- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / / ~ F'~- On adjacent lots To property line + ~'O ~ Absorption field Surface water/drainage 'h/00 /~': Foundation // /'~7-- ~,O ~'~. Water main/service line 72-026(8/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) ~ High water alarm level _ Z/~ Meets MOA electrical codes (Y/N) ~/b/~ 5' Manufacturer ~r-~- o~ ~-~,w~--- 25'0 ~1. ~N~fanhole/Access (Y/N) "Pump on" level at /_/z./ - "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I~-~ ~'")-- On adjacent lots Sudace water__~ D. ABSORPTION FIELD DATA Date instal,ed ~//~/~ ~/ Length ~ F'7-- Width Total absorption area 7~~'0 ~?- Date of adequacy test ~'[/o ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) /' ~- /~7-. Gravel thickness Cleanout present (Y/N) '~ Results (pass/fail) ~' System type //~o~.~' ~'- ~'/~'~ ~- Total depth /, ~ ~- ~. ~ .Depression over field (Y/N) ~ for - Bedrooms After test ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: We{I on lot To building foundation On adjacent lots Sudace water ,/'~/o~- Curtain drain On adjacent lots 4-/0~2 ~7-- Propertyline To existing or abandoned system on lot Cutbank.~/c't~ Water main/service line Driveway, parking/vehicle storage area -k/~ 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, Signature Engineer's Name Date HAA Fee $ ~,~,/~ - ~ Date of Payment ,. '~/,-~//? ~ '~--'- Receipt Number ¢~:"~ ~ *d ~ ~ ~,h ,, ,, Waiver Fee $ Date of Payment Receipt Number 72-026 (3~93)' Back 03/'14x95 11:49 CDHHERCIAL TESTING ~,' 2582419 HD,959 Q02 CT&E Environmental Services Inc. LahoratotwOivi~ion Laboratory Analysis Report 200 W. Po~ar Drive, An6hora~e, AK 99518-1605 -- Tel: (.'.'.'.'.'.'.'.'.'i~?) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIE~ IN ^LABKA, CALIFO~N:A, CLQRIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY. OHIO, WEb~i- VIRGIN~