HomeMy WebLinkAboutSAND LAKE #2 BLK 6 LT 14Sa nd La ke # 2
Lot :[4
Block 6
#011-133-23
QGREJ..
~.R ANCHORAGE AREA BOF,
Department of Environmental Qualitv
3330 C Street
Anchorage, Alaska 99503
JGH
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
/
LOC AT ION
, ..,Ac2r--,-{'~ COMPARTMENTS
U FACTURER__~_~MATERiAL ~./ :NUMBER OF
INSIDE LENGTH ~'/iNSIDE WIDTH f/ LIQUID DEPTH /~- LIQUID CAPACIT ¢~ALLONS.
TILE DRAIN FIELD: ~roj~/$¢~) /
D,STANCE ,:ROM WELL /¢~ fFOUNDAT,ON '// _NEAREST ~O= .,.~__ ¢-/o~'OT*".,.~"~"~='~ ¢
NUMBER OF LINES__ / DISTANCE BETWEEN U.ES ff/~ TRENCH W IDTk~IN. TOTAL EFFECTIVE
ABSORPTION AREA~ ¢ Sq, FT. LENGTH OF EACH LINE __~ ~ = ~ 2
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ~ IN, ABOVE TILE IN.
TYPE _CONSTRUCTION
DEPTH _____ DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION__ LOT LINE SEWER LINE_ TANK__ SYSTEM_
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED-- REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
SEWER LiNE DEPTH: ¢~'~'
PIPE MATERIAL:
LOT SLOPE: ~ '
Form LQ-032
Fl-II!: I_[i:.lr',!(~i'tlt I) :[ I'II~:?',IE; ]: [:)I",! :t:E; I'HE I..E;F,IG~i'It ,:.il;l",t I:I!:i::'t") tgi:: 'i'lll::: 'll:;i:li:l'.,![:::[l i:)l:~:
FIll:: [)l:i:F*'l'll (:Il::.' I:::1 ']'I:;~:E:IqC:I'I I::)1:~: F:'):'I' :[:~ i't'lE: D);'~:;f'l::ff-,!C[i~ li',[!;['l,.ll:i:[!:;i~',! filE: ::i!;I. II;i:l::'l:::ll;::l:i: I::ll:::
(iil:~:Ot..ll",![::, I:::ll'"llr) "t'IIE: Ii~tl:::l'l-1'l:3FI ()1::' ~tl'll:i:: Fi::;':X::I:::I",/I:':II'):(3I'"! ':;:I;F'I
FIIlii;l:;:l!: )::ii; t"tO :i;EI I"I:([;:''IHt::'C[I:~'.
'i'ltlii: I:iff;i:[:l",/l!i:lr. l;)[!:;t::''l"[f ]:::~; TI'II!: I"l:[h!;[l"lUl'l t)E:F:''I'll I:)f::' I:~il:;i:F'l","[:i:l t:!i~l:!Yt'l'[l~:[i:i'"! '1'[IIi~: ()l.t'l'l:::!:::ll I--.
t::tl'"l[:) I'llt:ii: [':;(3'I''I'EIP'I O1::: 'i'H[i: i!;;:':X:::I':IVI:::II']:I::)hl ':;:t:t'"l
SURVEYING -- LAND AND CONSTRUCTION
ANCHORAGE~ ALASKA
PHONE (S07) 274-771!
July 15, 1976
Mr. Mark Forest 4~'~-Q~¢~-
6641 E. 8th Avenue
Anchorage, Alaska
Re: Soils Review for Individual Sanitary Systems
Dear Mark:
As per your request, I did inspect the general and specific area for deter-
mination of soils capability on the following properties.
Lots 14, 15, 6, 17 Sand Lake Subdivision
I find that the soils over the entire four lot area are generally as follows:
Surface to 1.5 ft. depth - loam and org.a.nic (dry) to 1.5 to 35 ft. and below
coarse sands and gravel.
The above determination of soils and depths was made by visual inspection
of the proposed construction site wherein the surface material had been re-
moved to a depth of approximately 2.5 to 3.0 ft. Additional depth and
classification of soils was determined by inspection of a large commercial
sand and gravel pit just south of and within 200 feet of this property, as
well as roadway excavation embankments within 300 to 500 feet north.
I hereby certify the soils as adequate for individual sanitary systems on
said lot 14, 15, 16, 17 of Sand Lake Subdivision NOo 2.
Yours truly,
L. P. S.
DRILL LOG
CASING
START
914 East 78th Avenue
ANCHORAGE, ALASKA
344-9242
COMPLETE
DATE
C 'FY .~ · ~ ' PIIONE
TIME WELL LOG DEPTH WELL LOG
STATIC LEVEL
GPM-YIELD
Parcel I.D, #_
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O, Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
011-133-23
1. GENERAL INFORMATION
Complete legal description_SAND LAKE ~2 S./D:
I.OT 14. BLOCK 6
Location (site address or directions) 8340 WILCOX STREET. ANCHORAGE AK. 99502
Property owner ROBERT FORGIT Day phone_(9._OZ) -~
Mailing address 834o WILCOX S'FREET. ANCHORAGE AK. 99502
Lending agency Day phone.
Mailing address.
Agent Day phone.
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BI-'DROOM,~;: 3
3. 'fYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If communily well system, provide written confirmation dom State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
lng to the legality and status of system.
72-025 (Rev. 1/91 ) Front MOA #21 Computer Vemion
Note: Alaska Water and Wastewate. r Consultants, Inc. shall be paid $£5£$.0~) at, I
or prior to, clos;ng for the engineenng services prot4deo. I
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation data 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 inspec,t~on, the on-site water supply and/or wastewater
disposal system is in compliance with all MunicipaI,~ State codes, ordinances, and regulations in effect
on the date of this inspection..//__~_ J~ ,
Engineer's Signature l_~//v/,~v, ],,~ Date
In conducting this evaluation, AWWC, lr~. a~te. bted t~ovide a thorough, conscientious engineering analysis of the
system in accordance with ADEC and MO,~l Df /S Guidelines &' Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system. These conditions are outs/de the control of
of the system, nor dotheyguarantee tha tthere are no hidden defects or encrcachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continua to meet the operational requirements of the ADEC or MOA DHHS ........... ~~....
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or pady is not authorized, <3rn ess..'
bedrooms
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
~ Approved for J~
Disapproved
__ Conditionalapprovalfor
3mess..
'--7953 .."
bedrooms, with the following stipulations:
Additional Comments
Date .;~' - ~ - OD
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Cedificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Ataska. 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-O25 (Rev. 1/gl ) Back MOA ¢k21 Computer Version
Legal Description:_ SAND LAKE /~t2 S/D;
A. WI=LL DATA
Well Type. PRIVATE
Log present (Y/N)
Total depth 415'
Sanitary seal (Y/N)
Date of test
Static water level
<kCEIVEI)
MuniciPality of Anchorage MAY
DEPARTMENT OF.' HEALTH &, HUMAN SERVI~-r~, ~^un or ANC~
Environmenta Services Divis on ',","~,' E - c
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907)343-474~~ H~'^t. SF~tV, ~-~
Health Authority Approval Checklist
LOT 14, BLOCK 6 Parcel I,D,: 011-133-23
If A, B, or C, attach ADEC letter, ADEC water system number
YES Date completed 1977
Cased to 40'+
YES
N/A
_ Casing height (above ground)__ 12"+
Wires properly protected (Y/N) YES
FROM WELL LOG AT INSPECTION
1977 4./25/2000
205' 14-5'
5 g.p.m. 4.8+
Wall production
g.p.rn.
WATER SAMPLE RESULTS:
Coliform 0
Nitrate 0.5 mg/L Other bacteria. 10
Date of sample: _
~/25/2000
Collected by:
A.W,W.C., INC,
B, SEPTIC/HOLDING TANK DATA
Date Installed 5/26/77
Foundation cleanout (Y/N) YES Depression (Y/N) NO
Date of Pumping_ 4/25/2000 __ Pumper DENALI (O & G)
C. ABSORPTIQNFIFLD DATA
Date installed 5/26/77
Length 2.3' ".Width
Effective absorption area
Date of adequacy test_
Tank size_ 1000 _ Number of Compadments_2 Cleanouts (Y/N)
High water alarm (Y/N) N/A
[* 14.5" BELOW INqERT]'
** 1.25 ABOVE iNVERT
Soil rating (g.p.d./ft2 or ft2/bdrm) 85 "Systemltyp~;. TRENCH
3' Gravel thickness below pipe__ 6' __Total depth
264- SQ FI' Monitoring Tube present (Y/N) YES Depre,,mlon over field (Y/N)
4/25/2000 Results (Pass/Fail).. PASS For_ 5
YES
10'
NO
Bedrooms
Fluid depth in absorption field before test (in.); .51.5 Immediately after 305 gal, water added (in.):*'67.25
Fluid depth_. 60.5 (Ins) Minutes later: 200 Absorption rate = 450+
Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date .......
72-026 (Rev. 3/96)* Computer Vemlon
D. LIFT STATION
Date installed Size
Manhole/Access (Y/N) ~ level at* "Pump off' level at*
High wa~ *Datum
.~G~sted
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
94?
100'+
N/A
25'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 4.5' +/- Property line 5'+
Water main/service line 10'+ Surface water/drainage 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
On adjacent lots 96'
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Lift station N/A
Absorption field
Wells on adjacent lots
5'+
100'+
Property line
Surface water
Curtain drain
Building foundation
100'+
10'+ Water main/service line 10'+
Driveway, parking/vehicle storage area UNDER DRIVEWAY
98' TO WELL ON LOT 11,
Wells on adjacent lots B~< 7 (ABEC WAIVER 1998~
F. ENGINEER'S CER-T, IFICA~ION
of Municipal ¢cord,~ t~ll,Yne/j~b
Signature ~/I-Y I/1~ \
Engineer's Nam~//
Date ~/~0/
field inspections and review
s systems are in conformance
this date.
JEFFREY A. GARNESS
HAA Fee $
Date of Payment , .~-'" / ?.-" OO
72-026 (Rev, 3/96) ComputerVerslon
Waiver Fee $ ~,~. k~'- O~:'
Date of Payment
Rick Mystrom.
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
hltp://www ci.anchorage.ak.us
June 7, 2000
Jeffrey Gamess
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B
Anchorage, AK 99504
Subject:
Waiver Request for Sand Lake #2, Lot 14, Block 6
Waiver Request #WR000029
Parcel ID #011-133-23
HA000192
Dear Mr. Gamess:
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to private well has been approved. The approved separation distance is 94
feet from the septic tank to the private well on the subject property. Your request for a
waiver from the septic tank on the subject property to the private well on Sand Lake #2,
Lot 15, Block 6 has been approved at 97 feet.
This waiver approval applies to the existing septic tank to private well separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
WRft: WR000029 PID#: 01t.133-23
Date Received: May 15~ 2000
Legal Description: ~and Lake#2, Lot ~4~ Block~6
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Services
Waiver Review Worksheet
HAft: HA000~92
Permit&
Engineer: Alaska Water & Wastewater Consultants~ Inc.
6901 Debarr Road~ Suite 2-B~ Anchorage, AK 99504
Applicant: Robert Forglt
Waiver Requested: Waiver of separation distance between well on Lot 14~ Block 6 and the
septic tanks on Lot 14~ Block 6 and Lot ~5~ Block 6.
Criteria: 1. Points:
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: .~'. Waiver is not Granted:
List Conditions or Reasons for abow!: _~'l~P- ~. ,/~/"r'~r (' ~ ~ .~
Data: 7- O0
Rec#: 05860 Amount: $625 0~_0
Name of Reviewer
Date Paid: May 12, 2000
= £./
ALASKA WATER & ASTEWATER
' : .... C.~ONSULTANTS, INC. ~ :. :~:~ ::-:-:-:: ......... ~
May 8, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Envh'onmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Sand Lake #2, Lot 14, Bk 6. 8340 Wilcox Drive: HAA and Waiver of Well to Septic
Tank.
To whom it may concern:
We evabated the subject well and septic system for the purpose of obtaining an MOA health
authority approval. The following is a smnmarization of our findings:
WELL: It is believed that the well was drilled in 1977 by C.H. Self Drilling. Attached is a MLS
contract that the builder, Byron McKim~ey, signed on 7/7/1977. The contract states that the well
is 400 feet deep. According to the well log by C.H Self Drilling, the well is 415 feet deep. The
MLS contract is evidence that the well was in place prior to 7/7/1977.
On the day of the well test the static water level was 145 feet below the top of the casing. Water
was pumped fi'om the well at an average rate of 4.8 gpm for 101 minutes (484 gallons). A
maximum drawdown of 23 feet occun'ed during the test. Based npon this data, it was determined
that the well production exceeds the MOA requirements for a 3 bedroom house (450 gallons per
day).
WAIVER OF SEPARATION DISTANCE BETWEEN WELL ON LOT 14, BK 6 AND
THE SEPTIC TANKS ON LOT 14, BK 6 & LOT 15, Bk 6: The Septic tank installati6n for
Lot 15, Bk 6 was approved by the MOA on 8/11/77, wlfich is at least a month after the well on
Lot 14, Bk 6 was drilled. The separation distance from the edge of the well to the edge of
clean-out onthe subject septic tank is about 97.6 feet. If it assumed that the clean-out is about 12
inches from the inlet of the tank, the separation distance fi'om the tank to the well is abont 96.5
feet. The septic tank located on lot 14, Bk 6 is approxhnately 95 feet from the subject well. This
septic tank was installed on 5/26/77, before the septic tank on Lot 15, Bk 6. To be conservative
we are requesting that a waiver be granted for a separation distance of 94 feet. Justification for
the waiver is as follows:
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
The septic tank clean-out is located in the front yard in a highly visible location. If wastewater
were to overflow it would easily be noticed by the owners of both Lots 14 & 15.
The topography is relatively flat, consequently, there would not be a tendency for overflowing
wastewater to migrate towards the well.
Recent water samples (4/25/00) taken on Lot 14, Bk 6, indicated no fecal coliform bacteria,
10 O.B., and non-detectable nitrate levels. In short, the water quality is excellent.
Attached is the well log for Lot i4, Bk 6: The well is 415 feet deep. Water was not
encountered until a depth of 410 feet and the static level was 205 feet. This is an indication
that the aquifer is confined by the overlying soil layers. Attached is logs for numerous wells in
the general vicinity. In each case you can see that the static water level is much shallower
than the total depth of the well, again, an indication that the aquifer is trapped under the
confining overlying soils. These overlying soils have served to protect the aquifer for the past
23 years.
Given the fact that the well on Lot 14, Bk 6 was in place prior to the septic tank on Lot 15,
Bk 6, the MOA waiver fee should be the responsibility of the owners of Lot 15, Bk 6.
Based upon the facts presented it is clear that theh' is minimal risk in granting the subject
waiver.
SEPTIC SYSTEM: The septic system was installed on 5/26/77. It consists of a 1000 gallon
septic tank and a trench type drainfield. The trench is 23 feet long and has an effective depth of
72 inches. On the day of the adequacy test (4/25/00), the liquid level in the trench was
approximately 14.5 inches below the drainpipe invert. Over a period of 63 minntes, 263.3
gallons was introduced into the trench, which caused the liquid level to rise 21.5 inches ( 12.2
gallons per inch), submerging the lateral by about 3 inches. The recove~3~ was monitored for 107
minutes during which tinge the liquid level dropped 8.75 inches (1.75 inches below the invert),
indicating a recovery of 107 gallons (approximately 1 gpm absorption).
Over the next 12 minutes an additional 39.4 gallons were introduced, which caused the liquid
level to rise 3 inches (13.1 gallons per inch), 1.25 inches into the lateral. The recovery was
monitored for 58 minutes, during which time the liquid level dropped 3.25 inches, indicating an
absorption of 42.6 gallons, or .74 gallons per minute. The recovery was checked again, 200
minutes afrer the system was filled, and the liquid level had dropped a total of 6.75 inches (5.5
inches below the invert of the lateral), indicating an absorption rate of .44 gallons per nfinute (633
gallons per day). Based upon this data it was determined that the drainfield meets the absorption
requirements for a 3 bedroom house (450 gallons per day).
DRAINFIELD IS TOO CLOSE TO WELL ON LOT 11, IlK 7, SAND LAKE S/D: The
separation distance fi'om the trench clean-out was measured to the well on Lot 11, Bk 7 using a
Topcon GPT-1003 total station. The separation distance was measured to be 98 feet fi'om the
edge of the well to the edge of the clean-out. A waiver was granted for the subject separation
distance (98 feet) in August of 1998. It is possible that the edge of the drainrock is closer than 98
feet from the well.
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
/ LOT 171 BLOCK 6
RANO LAKE #2 S/D
/f. OT 8, BLOCK 6
SAND LAKE #2 $/D
LOT 8, BLOCK 7
SAND LAKE ~2 S/C
LOT 9, BLOCK 6
SAND LAKE ~2 S/D
LOT 10, BLOCK 6
SAND LAKE #2 S/D
--L~OT 11, BLOCK 6
sam ~KE ~2 S/D
LOT 12, BLOCK 6
SAND LAKE #2 S/D
/
SAND LAKE ~2 S/D
LOT 15, 8L K 6
SANB LAKE ~ B/O / /I
-..I
THREE
/ BEOROOM H~USE
~" /\/
LOT 13, BLOCK 6
/\ / /'
/ ~, \ /
I//
LOT 11, BLOCK 7
SAND LAKE #2 $/D
LOT 12, BLOCK 7
SAND LAKE #2 S/D / / ~ / / ~ j~. SAND LAK£ #2 S/D
_1/ \ I I ~-.J ~
\
ALASIiA WATER & WASTEWATER
CONSULTANTS, INC.,
DATE:
5/4/2000
DRAWN BY:
K.D.W.
~CALE:
1" = 40'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
ROBERT FORGIT (907) 762-9261 1 OF 1
LEGAL DESCRIPTION:
SAND LAKE #2 SUBDIVISION; LOT 14, BLOCK 2
TYPE OF WORK:
SITE PLAN FOR WAIVER REQUEST
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
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
o
Property owner
Mailing address
Lending agency
Mailing address
_ Day phone
Day phone
Agent_
Address
Day phone.~7~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NO'I'E:
If community weft system, provide written confirmation from State ADEC attest..
lng to the legality and status of system.
4. TYPE OI= WASTEWATER DISPOSAL:
NO'I'E:
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.
?2-025(Rev. 1/91) Front MOA~Y~I
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 ~0f this Health Authority Approval application shows ~hat 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.
NameofFirm / ~-~ ~, Phone P--"70/~7~9/~'
/
Address r~-O~ ~ l,~'/ ~ r)~-O'~.~(.//
Engineer's signature ~ ~,~'~, Date 'l"/q ~
DHHS SIGNATURE
/Z~_.__ Approved for''~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
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, -:
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type _
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Cased to
Parcel I.D.
If A, B, or O, attach ADEC letter. ADEC water system number W/A
Date completed 1~7'7 Driller C.~. ~_.iL- -~.-;~li~-
~ I ~'-- Casing height 1.2 u
/ Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
~_¢ _~ IL~q
.-~ g.p.m. ,~, ~
Date of test
Static water level
Well flow
Pump level1 '""~
SEPARATION DISTANCES FROM WELL TO:
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
~J, ~:) Other bacteria
Collected by: '~", % ,
Date of pumping
B. SEPTIC/HOLDING TANK DATA
Date installed ~/¢2.~/7'7 Tank size ! O'-C~c_D Compartments
Cleanouts (Y/N) %/ Foundation cleanout (Y/N) ~/ Depression (Y/N)
High water alarm (Y/N) /'~ Alarm tested (Y/N)
SFPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO:
Well(s) on lot I c--o On adjacent lots
To property line .~ /O Absorption field
Surface water/drainage /'"./o H ~
Foundation
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION /"--//,/~
/ /--~-
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
"Pump on" level at
Manhole/Access (Y/N)
"Pump off" Level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surtace water
D. ABSORPTION FIELD DATA
Date installed ~'/~,/7
Length
Total absorption area
Date of adequacy test
Water level in absorption field before test .~ ~
(past 12 months) (Y/N) ~ /r~
Peroxide
treatment
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Soil rating (GPD/Ft2) r~ ~ System type '~'/c.z-,~ ¢ ~
Width -~ Gravel thickness ~:~ Total depth / L~
~ ~/ Cleanout present (Y/N) ~/ Depression over field (Y/N) ~/
/
/1~/ff ~ Results (pass/fail) '~ for ~ Bedrooms
After test ~ ~
If yes, give date
Well on lot J ~
To building foundation
On adjacent lots ~ 03
Surface water /"%'/~
Curtain drain ~",/~o
E. ENGINEER'S CERTIFICATION
On adjacent lots ! ~ Property line
To existing or abandoned system on lot
Cutbank /~ ¢ ~-/-~ Water main/service line
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effe~t,:qn~ the,date of this inspection.
,,~-,,, ,-, , :~..,
z~,_,' ~? ,,, ~.. :)., ,
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-028 (3/93)* Back
Hick Mysttom,
Mayor
Mmficipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
January 20, 1995
Mr. Tobben Spurkland
203 W. 15th Avenue, Suite 203
Anchorage, AK 99501
Subject:
Waiver Request for: Lot 14, Block 6, Sand Lake #2
Waiver Approval: # WR950002
Dear Mr. Spurkland:
Your request for waiver(s) of the required 10 foot horizontal separation of a
septic system to a lot line has been approved. The approved separation
distance(s) are:
Absorption Field to Property Line 5 feet
This waiver approval applies to the absorption field to property line separation
only. Any future upgrades to either will require all separation distances be met
or another approval be obtained from this department.
Si n c~r..e?.,¢
Robert W. Robinson
Civil Engineer
On-Site Services
kb
MUNICIPALITY OF ANCHOP~Gm
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
PID# 011-133-23 HA# HA950008
1-12-95
WR# WR950002 Permit
Date Received:
Legal Description: Lot 14, Block 6, Sand Lake ~2
Engineer: Tobben Spurkland, P.E.
203 W. 15th Avenue, Suite 203
Anchorage, AK 99501
Applicant: __ Susan Jolly
Waiver Requested: Absorption Field to Lot Line - 5 feet
Criteria:
1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: >~ Waiver is NOT Granted:
List Conditions or Reasons for above:7~ ~/-~.,,~/(:/' '~'~ //,r'/~/,/~>/~'/M,/~
1,' . . , , ~ ~ ~ ' · /~ I× , " ~ '/
Nam~ of Rev'iew~ r
Amount: $ /~ Date Paid: /~
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
MUNICIPALI I¥ OF ANCHO~Ot::
ENVIRONMENTA~ ,SERVICE8 DIVISION
RE£EIVED
Municipality of Anchorage
Division of Environmental Health
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
January 12,1995
Subject:
HAA Lot 14, Block 6 Sand Lake #2
PID 011-133-23
Gentlemen;
We are requesting an HAA for Lot 14, Block 6 Sand Lake #2. The residence is a two bedroom
house with a three bedroom septic system. The well and septic system was installed in 1977,
inspected and approved by a Municipal Inspector.
HAA's were issued in February of 1988 and in November 1993.
All previous paper work show that the drainfield is 5 feet from the nearest lot line. The Municipal
ordinance in effect in 1977 did not address lot line separation distances. Since this system has been
approved three times with a distance of 5 feet noted to the nearest lot line, and no requirement of
lot line separation in 1977, I assume that a waiver request is not required.
The septic system was treated with Hydrogen Peroxide on June 22, 1993. A subsequent adequacy
test on November 3, 1993 showed that the system was operating satisfactory.
Since this test is less than two years old, the septic system was not tested for this HAA application.
The well test performed in 1993 was not satisfactory for the underwriter of the present loan
application. The well was therefor retested to meet FHA requirements on January 6, 1995.
Please issue an HAA for this property.
Yours
Tobben ~S~'/dand P.E. -
,JAN 'J 2 1995
Munic¢ - ,
P. ah~y al Anohorage
t~ealtl'l & Human Services
Commercial Testing & Engineering Co.
Environmental Laboratory Services
Drink2ng Water Analysis Report for Total Colifor~ Bacteria
5633 3 Street
Anchorage, AK 99518-1600
Tel: (907) 562-2343
Fax: (907) 561-5301
.MUST BE COMPLETED BY WAT'ER sLrPpL~R
PRIVATE WATER SYSTEbi
II
Month Day
SA}~LE T??E:
Routine []
Repeat Sample (for routine sample ~Iz
with lab ref. no. )
Special Purpose
Treated Water
Uutreated Water
Time Collected
SAM}~LE LO CATION Collected By
TO BE CON£P/Z,!~D BY LABO::LATORY.
An~ysis shows r2~Js Water S.~'v~P_ LE to be:
Safi~ac:ony
S~ple over 50 hom-s e!d, re~B ma}'
g Sample too long ha U-ansit; s~mple should
nor be over 48 hom-s old ar examination
to ~ndicate reliable rerju. Piece send
new smmple xba ~eci~ de}ireO' mall.
Date Received
Time Received
Analysis Began
Anal)~ical bletbod: ,D~Me..'n..brane Filter
Nmmber of ca!orbesl100
[.ab Ref. ,.No.
Sent to A.D.E.C, ~ Fbks
Jun
CUent ~]otified of unsatisfactoD' results:
Phoned Spoke ~ith
Analyst
Ti'nc:
Foxed
BACTERIOLOGICAL WATER ANA.LYSIS P, dgCORD
MMO-SfI:JG Result: 'Fora[ Coliform
blembraae Filter: Direct Count
Verification: LTB
Fecal Coliform Conf'trmadon
FiJnal Membrane Filter Results
.... '
Repo ~'ed By /' ¢~
Coil
Colonies/100 tTd
BGB COLIFERM
pA~<~ONE OF
TWO T(3 FOLLOW
Member of the SGS Group (Soci~lA G~n~rale de Surveillance)
Commercial Testing & En eering Co,
Environmental Laboratory Services ~.a,,a-~,e-.ar,~-~'.a-.a,.~.a-,~',~'~'~',a",e'~
LAB INS'PRt.]CTION~
5633 B Street
Coi.lec%ed
Received
WORK Order
Report CompLeted
Technical Director
Released By
;kient Name :TOBBEN SPURKLANO, P.E.
)rdered By :
Jroject Name :
)roject~
~WSID :UA
Anchorage, AK 99518-1600
Tel: (907) 562-2343
:01/06/95 @ ~4:30 hrs.
: 11840
:STEPHEN C. EDE
~ampke
~emarks:
SAMPLE COLLECTED BY: T.S.
CTE A]lowable QC E×~, Anal Anal
Test-Parameter Meth~J Units k, tmits Resultl Oust. Date Date Init
i 80128-Lead-Orinktn9 ~at ~A 239.2 - - - mg/k, - - 0.015- - -~ ........
80154-Nitrate-N ..... ~A 353.2 .... rog/t,-.- 10.- - - ~./o ~ _ I-~ ~
20005-Total Col iform- - SMi6 909A - - - g/t00mi ..... _ ~ . -
End of Sampi. e~ 1 k~h Instructions on ~ORKorder$ ti840 3 Tests for this Sample.
Comments: (Additional information ~ttached {Yes/No))
~ OF A[~ ~B iNSTRU~IONSWORKforo~eT~l1840
Member of the SGS Group (Seci~t~ G~n~rale de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box196650 Anchorage, Alaska 99519~6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL P'OR A SINGLE FAMILY DWELLING
Parcel I.D. # Oil- 1 5 ~, -- ¢[.
1. GENERAL INFORMATION
Complete legal description
Locati'on (site address or directions)
Property owner ~ t'~¢ [ L,.~
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SIJPPLY:
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.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site J
Holding tank
Communi'ty on-site
" Public sewer
NOTE:' If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify th'at 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.
Address
Engineer's signature
DHHS SIGNATURE
X Approved for '/¢~ bedrooms.
Phone ¢':~7'~' - Z ~/.~
Date
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:
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 ~,oove 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: 4'a'~ /~ ~'~K~,~, ..~z~,.c'z..c¢//,t~/L( Parcel I.D.
A. Well Data
Well type '~,
Log present (Y/N) y
Total depth ¢!-¢'
Sanitary seal (Y/N) J
Date of test
Static water level
Well flow
Pump level1
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed J E/'~7 Driller E,
Cased to q/,-~ Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Iq77
.g.p.m.
AT INSPECTION
MUNICIPALITY OF ANCHORAGE
...... ONM NTAL SERVICES DIVISION
g.p.m.
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: ~/z ~.-/~
Nitrate ]..~ "~/..~//. Other bacteria _ ¢
Collected by: ~-/~,,;'/~ ~* ~ ~
B. SEPTIC/HOLDING TANK DATA
Date installed b, 7 Tank size ~ t;~-¢¢--O
Cleanouts (Y/N) _ 7 Foundation cleanout (Y/N)
High water alarm (Y/N)
Date of pumping
Compartments
'"'/ Depression (Y/N)
Alarm tested (Y/N) ~/~'¥
Pumper ,A~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1¢'6a
To property line _ ~)j O
Surface wateddrainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
"Pump off" Level at
.Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length
Total absorption area
Date of adequacy test
Width
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Cleanout present (Y/N)
Results (pass/fail)
Soil rating (GPD/Ft2) ~>
Gravel thickness
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot Jt~. ''t~ On adjacent lots ) 0'~ '{'
System type
Total depth
Depression over field (Y/N)
for
After test
If yes, give date '7/"z-'o/~ .'.~
Property line
To building foundation
On adjacent lots
Surface water '~'~.
Curtain drain
To existing or abandoned system on lot
Cutbank N f.t'vc~ Water main/service line
Driveway, parking/vehicle storage area
Bedrooms
E. ENGINEER'S CERTIFICATION
certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect U~n ~h~"d~t~ ~f this inspection.
HAA Fee $ /'~)
Date of Payment
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
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 .~.
lA'% HAA# ~-1~'~ -~'- ~-\,''~-~::~
GENERAL INFORMATION
Complete legal description _ ~'¢~/
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone
Mailing address
Agent
Day phone
Address
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.
72-02§ (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 disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Address ,~;)~0'~ '¢~' I-~-/--~ /¢ ¢.~L')[.,
EngineeCs signature ~ - (~ff~
Phone
6. DHHS SIGNA'f'URE
App roved ' fo r
bedrooms.
Disapproved.
Conditional approval for '~'~-~-~3.~/ 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 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 er,gineeCs work.
?2-0'25(Rev, I/01) 8sck MOA#21
W. D1HOND BI_VD,
ANCHORAGE, ALASKA 99502-3904
(907) 279-3916
Municipali~-y of Ancherage
Divi~,ion ef Environmer~tat Health
Department of Health and Social Servia:es
820 I Street
Anchorage~ Alaska 99501
.~ubje~.t. NAA qor L.ot 14 Block 6 Sand Lake ~2
L'~en t 1 em~ n; ' /
August 5 ~ il 993
On August 4, ~993 i reinspected the s~ptiu- _~ystem on this lot. I
Found 6 inches of ~iquid in the sump. By addieg Z~OO gallons the
system the liquid level :in the sump rose 28 inches. No water
flc;wed iraEo the tank. 13 hours lahmr the water lmve] was back to
6 it~ches again,
I also located the trench for lot t5. lh~ trell£h rL~l]s in front
~¥ ~h~-~ residence~ 18 feet from the tank standpipe. One end of the
trench ~s 12 feet from the sump on lot 14, the other end is in
the driw~way. I exposed the f~rst pipe, but not the ether~ Both
pipes were located with a metal detector.
l'ohb~ ~pur kl arid F'. E.
RECEIVED
AUG 5 199
Municipality of Anchorage
Oep|, Hearth & Human Services
" MAT-SU TEST LAB
' Softs- Co.crete- Water
Field and Laboratory Testing Services
Oo !
~800 E. Parks Highway, Suite D-100, Wasilla, Alaska 99654
Pi3one (907) 376-3005 Fax (907) 373-15686
DRINKING WATER ANALYSIS FOR TOTAL COLIFORM BACTERIA'
APPLICANT INFORMATION
Mailing Ad[Iress: ~'~'~ ~0 ~,>~-/~ PWSIO No:
Sample Information
Legal Description o~ Pro,~erty:
Date Collected ~ ?,/~-.~-/~ J~ Time Collected.--/"~ '~0 Collected By:__,/~'
Sample Type: ~ Routine Repeat Sample # Treated Untreated
Fecal
REFER TO BACK SIDE FOR INSTRUCTIONS
MAT-SU TEST LAB, INC.
Soils - Concrete - Water
Field and Laboratory Testing Services
1800 East Parks Highway, Suite D-100, Wasilla, Alaska 99654
Phone (907) 376-3005 Fax (907) 373-5686
CLIENT: Gilfilian Engineering, Inc.
ADDRESS: 255 E. Fireweed,#102
Anchora.qe, AK 99503
PHONE# 277-2021
ACCOUNT #: 001
TEST(s): Nitrate
DATE: 7/1/93
COST OF TEST(s): $22.00
TAX: N/A
TOTAL: $22.00
PAYMENT: CHECK # . CASH __
REFERENCE NO: 393079
LEGAI./PROJECT NAME: Lot 14, Block 6, Sand Lake #2
PRIVATE: ,/ PUBLIC (LIST STATE ID NO.):
DATE RECEIVED: 6/22/93 TIME RECEIVED: 1630
DATE SAMPLED: 6/22/93 TIME SAMPLED: 1330
GE1#93062
SAMPLED BY GEl/KS
Analysis Performed:
Level Detected MCL
Nitrate 1.2 mg/I 10 mg/I
mg/I := milligrams per liter
ND = none detected
MCL = maximum contaminant level
NOTE: This analysis was performed by:
Mat-Su Test [.ab, Inc.
If you have any questions concerning the above results, please call me at 376-3005.
Cheryl FOdtz, Water Lab Manager Date
T.. ~PUR~L._i~-'~N~) F'- E..
205 NEST 15TH. AVENUE SUITE 206
ANCHORASE, ALASKA 99501
(90?) 279-S916
Municipality of Anchorage
Divisien ef Envire;lmentai Health
Department of Health and Social Servia:es
820 I ~treet
Anchorags~ Alaska 99501
Subject: HAA for Lot 14, Block 6, Sand Lake
PID 011-133--23
Gent 1 emen;
November 5~ 1993
NOV 4 19'3
i ~li~ o~ Anchorage
Manic P ¥ ~: '
Dept. Health & Human ,>erweee
The septic system on this lot failed an adequacy test on June 22,
1993. On July 20 the drainfield was treated ~ith Hydrogen Perox-
ide~ and a conditienal HAA was issued~ conditioned en a retest
after 90 days of continuous use.
On November 5, 1993 I tested the abserption field and concluded
that the septic system meets Municipal standards.
A liquid level of 36 inches was measured in the trench monitor
prior' to the test. 450 gallons of clean water was added to the
system at a rate of 6 gallons per minute. This caused the water
level in the trench to rise to 53 inches. 25 minutes later the
water' depth was 49.5 inches, and 2 hours and ten minutes later
the water depth was 44.75 inches.
After 6.5 hours the water depth in the monitor was 40 inches.
The lasting effects of Hydregen treatment is not known. I expect
that an opgrade will be required semetime in the ~uture.
Please issue an unconditional HAA for this property.
'l'obb~;ur lc 1 and P~. E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES ~) / J / ~
DIVISION OF ENVIRONMENTAL SERVICFS
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~::~(t~-'}" ~' ('"~'"~L~
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)
~ ,F?~' /~ ,/~-.~'
(b) Property Owner ///~'?¢ /Z'~,~,,,~, Telephone: Home
Mailing Address_ /~"~. ,Z~(.~-~"
(c) Lending lnstitution //~,~/¢~ ~/ ~ Telephone
Mailing Address_
(d) Real Estate Company and Agent
Address ~
Telephone C2~-~ ~ ¢
(e) Mail the HAA to the'followina address: or: Oheck here ~, if hold for pick up.
List contact person and day phone number ~elow.
Business
2. TYPE OF RESIDENCE
Single-Family,S]
Number of Bedrooms
WATER SUPPLY
Individual Well []' Community [] Public[-~
Note: If corem unity well system, must have written confirmation from the State Department of Environ mental Conservation
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 fRev 8/861 Fronl
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 inspection.
Name of Firm /~/-'-d..5/~-~"-.~_~ Telephone
Address /.~C' C' /3 ,'~ 2~'e~ .."¢'~- /-./~-~,,¢.-~f~ /~'/c' ~f~,.~',
Date . - / ~/ / ¢¢~
Approved ~ Disapproved _ Conditional
Terms of Conditional Approval
Date
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 ¢Rev 8/861 Sack
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORIIEY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAGE 264-4744
ENW ONMENTAL S RWCES D V S ON
Legal Description:
8 2 1988
E¢¢ IVED
Well Classification ' ~ If A, B, C, D.E.C. Approved (Y/N) /~'Jf~7~
Well Log Present~c~N) Date Completed ~¢/¢'??. Yield
Total Depth /:'.//5~ Cased to
Static Water Level
Casing Height Above Ground / /
Electrical Wiring in Conduit ~,~N)
Separation Distances from Well:
Depth of Grouting /v¢,~4
Pump Set At M.*4~
Sanitary Seal on Casing ~//'~N)
Depression Around Wellhead (Y/,~
V
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
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date °~/~cr/~ ¢
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~--/~¢'//~? Size /¢~ o No. of Compartments
Standpipes (~N) Air-tight Caps ~'~N) Foundation Cleanoutgt~/N)
Depression over Tank (Y~) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) .~./'4~ ; for ...c/'/~'
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /,,~
To Property Line . ~ "'~'
To Water Main/Servic8 Lind
Temporary Holding Tank Permit (Y/N)
/
To Building Foundation ?¢
To Disposal Field /,4~' ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026 fRev 8/861 Fronl
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ','~ ,'"'~ ,-'~¢':~ //~
To Building Foundation ~7"¢
Lot
To Water Main/Service Line /(2////
To Stream/Pond/Lake/or Major Drainage Course
Type of System Design
Length of Field ~ /
Depth of Field /g)
Gravel Bed Thickness c¢
Standpipes Present
Date of Last Adequacy Test '
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ..~ ~' ¢?
To Cutbank (if present)
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D, LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments~ ~'
Dimensions /~
Manhole/Access (Y/~N). _~'~ ~
"P~.u~mp ~f f~-Level at
;/,//~ Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have.o, becked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Sign e dC~..~,~)
Company ~¢~/~" MOA No.
Date of Payment
Amount: $ / .~~
Page 2 of 2
72-026 fRev 8/861 Back
APPLI~ 'NT FILLS ()UT UPPER HAt ONLY
Type of Resi~nce
Single Family
~Multlple Family NO. Of Bedroorns~
Water Supply
Individual ATTACH WELl. LOG. A w~l log is required for all w~lls drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal
Individual
When Connected Io Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
[)ate Date Dal~ t ( ~ ' Date
Field Notes: , .
DEPT. OF HEALTH &
~ ~ ~C~A~X ENVIRONMENTAL PROTECTION
~ 5 -~ '-)'7 Well to Tank ~/OP~(¢[ / ~Z Septic T~k Size
AIF OT C ENGINFF. I:IIS, iNC.
}~NGII,~I£EFIING~%IIJDItS e DESIGN e (.;ONSFR[JOrlON MANAGr{MENi ~¢ ~I/RVEYING
April 26, 1983
Mr. Adolph Barton
8340 wilcox
Anchorage, Alaska
99502
SEPTIC SYS_TE__M ADEQUACY TES~
LEGAL:
Lot 14, Block 6, Sand Lake #2
HOUSE:
3 bedroom, ranch style
SEPTIC
SYSTEM:
From MOA records
Tank:
Absorption
System:
Soil:
Absorption
Area:
1,000 gallon, steel, 2 compartments
23' long x 3' wide 4' deep trench
85 sq. ft. per bedroom
264 sq. ft.
DATE OF TEST: April 25, 1983
TEST
PROCEDURE:
Water was added to the leach field through a 4" stand pipe
in 100 gallon increments. The first 300 gallons were dumped
at approximately 100 gpm. After the addition of 300 gallons,
water backed up into the stand pipe. Monitoring of absorption
capacity was attempted, but the liquid level in the drainfietd
dropped too rapidly to monitor. An additional 250 gallons of
water was then added at an approximate rate of 20 gpm. The
system absorbed all of the additional water as fast as it was
1506 W, 3~]11A\/ENUE ~ ANCI-IOnAGE. ALASKA 9950,~ ' g0'//277-8593
3901 PAfRICIAI ANE ~ ANCI4ORAC;E. ALASKA99504 o 907/333-9428 (AQCOtlNTING)
Adolph Barton
Adequacy Test
April 25, 1983
-2-
added. At that time, it was determined that the system
could absorb a large amount of water at a rate of 20 gpm.
RESULTS:
The system absorbed 550 gallons of water J.n approximately
10 minutes. Initial absorption capacity was 100 gpm, and
final steady absorption capacity was approximately 20 gpm.
The system meets Municipality of Anchorage adequacy require-
#1: Time 2~
~. m. t~ 2: Time _ , ~ / ~ 3: Time
-77 Wednesday Date ~ . 3. Date
~olz Insp _ Insp
REQUEST FOR APPROVAL
'IlJNICIPALITY OF ANCHORAGE '~</cx ~, ~j
JF HEALTH AND. ENVIRONMENTA, PROTECTION 11.5~/~}F~""-_
L Street, Anchora~a, Alaska 99501
264-4720
~pu,~. ~>.~b-, Date Receiv d: October 18, 1977
/ / -- ~t- '? ~
~()~ ~ ~ A/~ -
OF INDIVIDUAL ~EW~,R AND WATER FACILITIES
1. Lending Institution Requesn: ttome Federal Savings and Loan
Mailing Address: 535 D Street Phone: 2'72-1451
2, Proper'ny Owner: Byron Mc ]Kinney Phone: 337-1935
Mailing Address: Box 3218
3, Legal Description: Lot 14 BlocR 6 Sand Lake Subdivision #2
Single Family Residence: (x)
Multiple Family Residence: ( )
Number o~ Bedrooms: Three
Number of Bedrooms:
5. Well System: Individual Well
Permit ~ Depth o~ Well
6. Sewage Disposal System: On-site System
Permit ~ 3~'~'~ Installed _/~-7~
Septic Tank Size
Absorption Area J_~ gf .
(x) 'Community/Public System (
__ Well Log on
File
(x)
Bacterial Analysis
(x) P'ublie Utility (
Installer
Manufacturer
Soils Rate I_~,._~ Material .~~ .
7. Distances: Well to Septic Tank
to Absorption Area
to Sewer Line
Neares~ Lot line
Absorphion Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 14 Block 6 Sand Lake Subdivision #2
Comments:
Affadavit Attached: ( )
Approved: ' ;~
Letter Attached: ( )
Disapproved:
Date:
Date:
Department Worksheet:
~ AUNICIPALITY OF ANCHORAGE lO I~l~A~'
{{~'~\ 825 L Street, Anchorage, Ala.~ka 99501
~equest for Approval of Individual Sewer and Water Facilities;
Name of Buyer: _~D(~/_,.PH
Mailing Address:
Lending Institutiol%:
Mailing Address:
Realtor/Agent: ~~)
Mailing Address:
, tree oc tion: c OX
single Family Residence: Q~ Number of Bedrooms:
Multiple Fami]_y Residence: ( ) Number of Bedrooms:
Water Supply: * Individual Well ~ Public/Co~m~unity System
If Individual Well, well depth
If Community System, name of system
( )
Sewage Disposal System: On-site System .~/~ Public System ( )
If On-site System, date of installation:
*NOTE:
A well log is required on ALL wells drilled since 6/75.
If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77