HomeMy WebLinkAboutSEA TURN BLK 2 LT 9
Municipality of Anchorage Page _
r)EPARTMENT OF HEALTH 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
Permit Number: --~bJ~?)m"f~>J PIDNumber:_ OI7--' IZ/
Name: ~¢&T A~O 3~ 6 &e~,~ Wastewaler System: QNew
Address: ~ ~
~ho.~: ~_~, J No. of ~oom~: ~ Deep Trench ~ Shallow Trench ~ Mound ~her'
LEGAL DESCRIPTION so, Rating: ~W. icA~lo~ ~ Total Depth from original grade:
Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: I Range: Section: Fill added above original grade: i Gravel length: I
WELL: U New ~ Upgrade 3ravelwidth: I Numberoflines: b~stance between lines:
Classification (Private, A,B,C): Total Deptl~ ~o: Total absorption area: Pipe material: ~
Briller: / Date Drgled: Stalic Water Level: i lnstaller; Date installed:
~ield: Pump 8et at: I Ccsing Height Above Ground: ~ ~
TA
N
K
I
SEPARATION ~ISTANCES I ~ Septic ~ Holding
To Septic Absorption Lilt Holding =ublic/Pdv~ie Manufacturer: CspAcity in gagons:
From Tank Field Station Tank Sewer Lines ~0~ ~ ~ ~[~
Number of Compartments:
Surface
' Pump off" level ah High water 81arm at:
Remarks: ~ V~ A¢~vh~ ~ff y~,d~ BENCH MARK
L Assumed i~evation:
Department of Health and Human Services approval ~"~,' '''~, -"-'~
72-013 (Rev, 9/91) MOA 25
P~R,.,,, N...ER: AS BUILT DRAWING
SW980431 " 017-121-33
~ ~NEW BOTTOMLESS INTER~I'~AN~,
~ /,DOSING SAND FILTER (20 x 20
~ [ USEO ~fi A RESER~ SITE / / ~N ~ _-/- /
~ ~ A B C /
~ MT'I - 26 0 35.'1
SEATURN ~UBDIVI~ION, LOT g, BLOCK 2, ,
AS-BUILT OF SEPTIC SYSTEM ~ ~ ...
CURT AND JERI BIDINGER 345-945~ '0~¢~'.~ eE~7~53 ..."~
PERMIT NUMBER:
PARCEL ID NUMBER:
SWB~O~, AS-BUILT DRAWING o4~-.~ 24-~ I
~- N~W 2000 ~.bON
PI~ ~ ~ ~f~ Mr2
~S[A WAT~ AND WASTEWA~R CONS~TA~S, ~C.
7320 E. CHE~'ER HEIOH~
'T .... l'
WPE OF WORK:
PROFILE AS-BUILT Of SEPTIC SYSTEM (I.S.F. UPORABE)
CURT ANB JERI BIBINGER 345-"451
]ATE:I 2/2/98 DroWN m: SCALE: PAGE:
J.I_.M. N.T.S.
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99~04
17, 1998
Municipality of Anchorage
Depsrt~ of Health & Human Services
Division of Environmental Services
On-S~ Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
R C[IV D
M~micipality ot AnOno ~0~
Attn: Jim Cross & Dan Roth
Reft ISF Installation at%~t 7Ar-Ble2~, VEil Vuu ;;2 ,g~D: Sand Filter Material.
Dear Mr. Cross and Roth:
Attached are copies of two (2) sieve analysis that were performed on the sand used for the subject
ISF. The materlah were purchased by Wood & Sons Excavating from Quality Sand & Oravel
(John Watters, 1-800-478-5213). It can be seen that the percentage passing the #100 sieve
varies from 1.6% to 3.0%. The percentage passing the #200 sieve 0.9% to 1.8%. The MOA
specifications require less than 2% passing the #100 and less than 1% passing the #200. In short,
the smd provided by QS&O, although close, does not meet the MOA specification. Based upon
my conven~ations with QS&G and Central Paving Products (Sam Gian~lva, 563-3654) neither
plant produces a product that will consistently meet the MOA spec. John Waters said it would be
poss~le only if the material is washed, and that he wouldn't have his indoor washplant operational
for several months.
I contacted Orenco System, Inc. (11/18/98), the developers of the ISF packages approved by the
MOA, and talked to Eric Ball (1-800-348-9843). He indicated that the State of Oregon requires
less than 4% passing the #100 sieve for ISF sand material, but indicated Orenco would prefer 0-2
percent passing the #I00 and 0% to 1% passing the #200. He stated that the percentage of fines
in the aforementioned samples (3% passing the #100) should not materially diminish the
performance of the ISF. Based upon Mr. Ball's conmaents, and the subsequent vertnd approval
of Dan Roth, the excavator utilized the sand provided by Q. allty Sand & Gravel.
It is our intent to use the same material for the ISF installation currently trades,ray at Seaturn, Lot
9, Bk 2. Alter this installation we are going to postpone the installation of any additional ISF
systems until the quality contwl issue is resolved to your departments sati.Cmction~
FROM RLRSKR WATER & WASTEWRTER PHONE NO. : 90?3383246 Now. 06 1998 OS:14PM P2
FOR TIIE MAJlNTENANCE OF AN
ON-SITE WASTEWATER DISPOSAL
SYSTEM~
Anchorage D~part~nt of Health mi Human Servic/s,.0DHHS) and the property ,-.
This agreement is made for be purpose of maintaining au.on-site wu.stewa~ flislmsal
s.ys7 on the ,ubject property.
The property owner? agree to ~e following:
Submit ~o the MunicipalLy of Anchorage, on an annual b~is, m~ insl~:fion ~
operation smmne~ f~om a reghtcred professio~l e~. ,/~ncer. This inspection and ..
opcradon statement shall veri~y ~at the engineer lms in.~pected ~ effluent and alt
pumps, timers, m~d alarms, an~ that any defici~n~ie-s have b~en repaired ~nd tlmt the
syst_am is fu~'fimzing as designed.
(Sig~mm~e)
(Priuted Name)
~m~t Name)
-~- ....................... ~oKarizs ~ere .... -
~ e~~ ~ '-~,~ o~ personally appsared befor~ me,
~ho 2~ pe~sona~ly known to me
'~ ~hose 2dent~ty ~ proved on the bas~
~-- ~hose 2dent2zy I proved on the ~ath/
he/she acknowledged that he/she
FRO['I : RLRSI~R bJRI~-I~ ~-~ L.JHoTE,JHT~:t~
F'HOI*IE I'10. : 9073383246
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver
D~te Received: i'~ ,% ~a~
Legal Description: l~[ % ~%~(~
Review Worksheet
Permit
Criteria: 1. Geology:
A. Water Takle
B. Soil Sorption
C. Permeability
D. Water Table Gradient
Points:
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted:
List Conditions or Reasons
Waiver
for above:
zs NOT Granted:
Date:
Rec
By:
Na~/~F Revfewer '
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99fi04
Phone (907) 337-6179 ~ Fax (907) 338=3246
Consulting Engineers
November 17, 1998
Municipality of Anchorage
Departmem of Health & Human Services
Division of Envkonmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
DEC 1998
MUNICIPALIIY OF ANCHORAI3E
ENVIRONMENTAL,SI~RVICE8 DIVISION
Ref: Septic System Installation at Lot 9, Bk 2, Seatum S/D. SW980431. Waiver of Separation
Distance to Lot Line.
To whom it may concern:
After the pre-construction survey work was done (lot line flagged by registered land surveyor), it
became apparent thet the proposed ISF should be located closer to the test hole (to fit in the 30
foot radius) md moved slightly to north. We are requesting you verbally approve the relocation
of the ISF bed to within 5 feet of the north lot line. I am utmware of any adverse impact
associated with this encroachment. We will submit the $115.00 waiver fee with the as-built
package. If you have any uestions, please call me a 337-6170. Thank you for your
cousidemtion of this matter. /
President ~ ~)~f~5
MUNICIPALITY OF ANCHORAGE
Department of Health end Human Serv/ces
On-Site Services Program
825 L Street, Room 502
P,O. Box 196650, Anchorage, AK 995'19-6650
(907) 343-4744
ON-S ITE WABTEWATER DISPOSAL SYSTEIV1 PERMIT ~f"F~_ L~ ~.~
Upgrade
Date Issued: Nov 06, 1998
E-'xpiretion Date: Nov 06, 1999
Permit Number: SW98043'1
Legal Description: SEA TURN BLK 2 LT 9
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Curt & Jeri Bidinger
Owner Address: 15100 Platinum Circle
Anchorage, AK 99516-4333
Parcel ID: 017..121-33
Site Address: 015100 PLATINUM CIR
Lot Size: 49918 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] Disposal Field ~ Septic'rank ~ Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 end 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AACS0 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
A notorized maintenance agreement shall be part of the As-built package.
'f'his permit is for a bottomless intermittant dosing sand filter system.
Received By:
Issued By:
Date:
Date:
Alaska Water & Wastewater Consultants, Inc'oc l°ss
7320 East Chester Heights Circle ~ Anchorage N Alaska 99504 ................ ~,~,~-
(907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
October 26, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref. Sewer Upgrade for Lot 9, Block 2, Seaturn Subdivision
To whom it may concern:
The existing 5 bedroom house is served by an onsite septic system, and a private well. Our client
would like to upgraded his system. Comments regarding the proposed upgrade are summarized
as follows:
1. GENERAL: Four test holes were excavated on the property. The soils in TH#1 and TH#2
were found to be unsuitable for on-site septic. The soils in TH#3 and TH#4 were found to have
acceptable percolation rate for on-site septic system. Criven the site restrictions, there is limited
space on the lot to put the new drainfield (a conventional bed or drainfield); therefore, we are
proposing to install a bottomless, Intermittent Sand Filter (ISF).
2. SOILS: The soils in ~I~I#3 below the organics is a ML/SM material to a depth of 12 feet
(bottom of test hole). The soils in TH#4 below the organics is a SW/SM material to a depth of 4.5
feet and than transition to a ML (silt) material to a depth of 15 feet. A percolation test was
performed in TH#3 between the depths of 4.5 to 5.0 feet. A percolation test was performed in
TH#4 between the depths of 6.0 to 6.5 feet. The percolation rates were found to 26 and 26.7
minutes/inch. The proposed ISF system is to be installed around a 30 feet radius of TH#4 m~d a
30 feet radius around TH#3 is for an alternate trench site.
3. BED DESIGN: Bottomless Intermittent Sand Filter (ISF)
a. Percolation Rate: 26 & 26.7 minutes/inch (TH#3 and TH#4)
b. Allowable Application Rate for ISF: 2 gallons/day/ft2
e. Number of Bedrooms: 5
d. Design Flow: 750 gallons per day,
e. Mi~fimum Absorption Area: 375 ft2
f Effective Depth below pressure pipes: 3+ inches
g. Width: 20 feet
h. Length: 20 feet.
i. Effective absorption area = 400 ft2 (>375 fi2 OK)
j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
k. Air Supply Line: "Wasteflow' emitterline, 1/2 inch I.D, "Anchorage Tank".
1. Sand Material: M.O.A. approved sand filter
m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
We are proposing to excavate down to a depth of 5 feet (maximum), place a minimum of 6
inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand,
we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We
will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that
flow can be intermittently dosed to the ISF.
4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
5. TOI['OGRAPHY: As can be seen on the attached topography site plan, the lot runs from
approximately east/northeast to west/southwest at a grade of 10-20 percent. Also as can be seen
on the topography site plan, the proposed ISF system is to be placed in an area where the slope is
fairly flat. In short, there are no slope concerns.
6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the
construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation &
Maintenance Manual". The contractor should read this document prior to construction. Copies
are available at the Municipal Onsite Services office (5th floor, 9th & L St.).
7. CLOSING: Given the site restriction, I think the ISF is the most viable option for this lot,
short of install a Reeirculating Upflow Filter, which would be more expensive. I am open to any
suggestions from your department, which would be an improvement to the proposed design. I am
unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questio~ please contact me at 337-6179. Thank you for your assistance.
Sincerely, / / A f
LOI 4A, BLOCK
SEA TURN S/D
?
/
I
I / /
\ /
\ /
\ /
\ / /
t_O¥ 5. BLOCK 1,
SEA TBRN B/D
LOT 11, BROCK 2,
SE& IURN
LOi 12, BLOCK 2,
SEA TURN S/O
SEA TURN S/D /
/ /
/ /
/ /
TRACT A, S/W 1/4, BEOBON 35, T12N, RSW
S
ALASKA WATER AND WASq[~W.ATEIt CONSULTAIWf , INC.
7520 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK ggfO4
PHONE: (907) 337-6179/FAX: (907) 33B-324B
.EGAL DESCRIPTION:
SEATURN SUBDIVISION, LOT 9, BLOCK 2,
FYPE OF WORK:
SITE PLAN
:'REPARED FOR: PHONE NUMBER:
CIJRT AND JERI BIDINGER 34,5-9451
OATE: 10/26/g8 IBRA','/N BY: ISOALE: JPABE:
J.L.~. 1 = 100' 1 OF ,]
1.25 INCll IIDPE lINE SLOPEr) HACK TO
UFT STATION FOR DRAtNAGE OF LINE, 00
INS[JLATEO
(BEE NOTE) ~.
\\
\\ .
4.' DEEP BY 5' WIDE t ~
EXIBI'INO SEPI1C TANK TO BE
ABANDONED COM ~f~
BO1TOMI ESS INTERMI'I IEN'I
!'lAND FILTER (ISF). ERCAVATE 20' WIDE
BY 2D' LONG AND 5 FEEl' DEEP (MAX).
ADB 2 FEEl' OF M.O.A, APPROVEI) SAND
FII_I'ER AND 5 INCHES OF PFJ~ GNAVEL
ABOVE AND BEtQ¥I 1lie BISTRIBLFFION I.INE,
(SEE DETAIL AND PROIqLE, PAGE 3 OF 5)
~'""~ W Et t
1. Thl£ CONTRACTOR I% REQUII'~I!D Fo HAVF'
Tile NORTtl PROPERTY I.INE FbqO0? BY A
I REGtSTERED tAN[) SURVEYOR PRIOF, ~0
[CONSTRUCTION.
/
/
THE AIR COMPRESSOR SHALL ~E I.BOATEG WITHIN THE CRAWL-
~PACE I]R THE GARAGE, THE CONTRACTOR SBALL PROVIDE A
AI.ASKA WATER AND WASTEWATER CONSULTANTS, INC.
7320 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504. ,,, ......
PHONE: (907) ~7-6179/FAX: (907) .338-3246
SEATURN SUBDIVISION, LOT 9, BLOCK 2,
[YPE OF WORK;
DESIGN OF SEPTIC SYSTEM
PREPARED FOR:
CURT AND JERI BIDINGER
OA1E: BY:
UPGRADE (I.S.r.) \.
PHONE NUMBER:
345-g451 -7953 ..'
SCALE: PAGE:
J,L.M, 1 = 40' 2 OF 3
'WAS~PI.E~' ?YPB P~OVI~P/ V~5 P~ ~k~O ~516N)
Ifl~ 5~ Plbfe~
AI.AS~ WA~R. ~ WAS~WA~lk CONS~,TANTS, INC.
PHONE: (007) fi37-6~Tg / F~: (aCT) 338-3246
', .~" r '"~
BOTTOMLESS SAND FILTER (ISF) DETAIL ~'
PREPARED FOR: PHONE NUMBER:
OATE:I 0/26/98 Dr~WN BY:j.L.Mi SeAr'E: N.T.S. ;~ OF 3
ALASKA '~FATER & WASTE~FATER CONSULTANTS,
7320 E. CHESTER HTS. CIRCLE * ANCHORAOE, AK. 99504
PHONE (907) 337-.6179 * FAX (907) 338-.3246
I SOIL LOG - PERCOLATION TEST I
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE PERFORMED:
ORG
SEATURN SUBDIVISION, LOT 9, BLOCK 2,
CURT AND JERI BIDINGER
10/6/98
I TE:ST HOLE
'.JAMES P. WILLIAMS:
" NO. 9605 ."
~.~,'.... C.G......',.~
ML
W/ LIGHT GRAVEL
SM/ML
SATURATED
B.O.H.
SOIL CLASSIFICATIONS
ORG
SC
DEPTH TO DATE
GROUNDWATER
H~w SEEP o ~o/6/.~
10', LIGHT @ 5'
s.s' ~li4?~B
DATE READING CLOCKTIME
10/7/98
NEff' TIME WATER L[-'_VEL NET DROP
(MINUTES) READING (INCHES)
1:56 ,
2:26 30
2:~ ,~o
~:5~ ~0
6" (INCHES)
PERCOLATION RATE 240 (MIN,/INCH) PERC. HOLE DIA. __-
TEST RUN BETWEEN 4,0 FT, AND 4,5 Fl'.
COMMENTS: PE:RC. HOLE WAS PRESOAKED 4+ HOURS ~IOR TO I'E,~IO. .
CERTI~
THAT
THIS WAS PERFORMED I~ ACCORDANCE WITH ALL ~ATE AND MtJNICII AL G~IDELINES IN EFFECT ON THIS
DATE. DATE: IOl~ ~ V
AI.ASKA WATER t~; WASTEWATER CONSUUI'ANTS, INC. ~.~(. ~ .O..F.~../...<,~h~
7320 E. CHESIER~$. CIRCLE * ANCHOraGE, AK, 99504
I SOIL LOG - PERCOLATION TEST1 ql 4g
LEGAL DESCRIPTION: ~SEATURN SUBDIVISION, LOT 9, BLOCK 2,
PERFORMED FOR:_ CURT AND JERI BIDiNGER - 'L.
-
DATE PERFORMED: 10/6/98
(~0~ .. C.E. ...,~
~ ~:7: TEST HOLE ~2
2---~ ~ I S~SSIFICATIONS
~I' ~ W/ SOME SM -
LENSES
oo:, SM/SP 55' m)~4i~8 , ,,, / C.~%-----L/
, ~tt¢¢, SATU~ATEO k I" =J~ // / / ,,'
10~ ¢o,
1~ -- "'*" B.O.H. DATE ~EADING CLOCK NET TIHE WATER LEVEL NET DROP
TIHE (HINUTES) READING (INCHES)
10/7/98 1 3~32
13~
14~
16~
17~
18~
19~ PERCOLATION ~TE 120 (HIN./INCH) PERG. HOLE DIA. 6" (INCHES)
TEST RUN BETWEEN 4.0 FT. AND 4.5 FT.
20-- ~-
COHHENTS: PERC. HOLE WAS, PRESOAKED ~+ HOURS F dOR TO T~INB.
PERFOMED BY ALASKA WATER ~ WASTEWATER I, . ~ / //(/J~ , OERTI~ THAT
THIS WAS PERFORMED I~ ACCORDANCE WITH ALL ST~E~ AND MUNICIPAL GUIDELINES IN E~hECT ON THIS
DATE. DATE: IO~ %~ g
DEPTH TO DATE
2ROUNDWATER
7' ~0/6/9B
5,5' 10/14/98
ALASKA WA3~R & WASTEWATER CONSULTANTS, INC.
7320 E. CHESTER HTS. CIRCLE * ANCHORAGE, AK. 99504
PHONE (§07) 537-8179 * FAX (9(]7) 53a-3248
[SOLE LOG - PERCOLATION TEST]
LEGAL DESCRIPTION: SEATURN SUBDIVISION, LOT 9, BLOCK 2,
PERFORMED FOR: CURT AND JERI BIDINGER
DATE PERFORMED:
lo/6/98 _
I TEST HOLE
ME/SM
B.O.H.
SOIL CLASSIFICATIONS
ORG
ML
CL
OL
MH
CH
OH
SC
DEPTH TO DATE
3ROUNDWATER
DRY 10/6/98
O' 10/14/§B
DATE READING CLOCK NET TIME WATER LF-VEL NET DROP
TIME (MINUTES) READING (INCHES)
B~*
10/7/98, 1 . 1:56 , --- , ,
2 . 2:26 50 6 .3/4"
3 2:56 --- 5 1/2"
I 6"
5 5:26 I ---,,
1 1/4?
PERCOLATION RATE 26 (MIN,/INCH) PERC. HOLE [)lA. 6" (INCHES)
TEST RUN BETWEEN 4.5~_FT. AND 5.._.~0.FT.
COMMENTS: PERC. HOLE WAS PRESOAKEB 4-+ HOJRS PR,O~i TC~ -l'?~l~G..~k~,~_, ~,~1 '.
PERFOMED BY A~SKA WATER ~ WASTEWATER XA~I~ ~W~X~ ,
OERTI~
THAT
THIS WAS PERFORMED~ IN ACCORDANCE WITH AL ~%TE AND M~NIClf¢~°*' CAL GUIDELINES IN EFFECT ON THIS
DATE, DATE: [o~ ~
ALASKA WATER & WASTEWA'IZR CONSULTANTg, IN'C..
7520 E, CHESTER HTS, CIRCLE * ANOHORAGE, AK, 99504
PHONE (907) 337-617§ * FAX (907) ,338-3246
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE PERFORMED:
[SOIL LOG - PERCOLATION
SEATURN SUBDIVISION, LOT 9, BLOCK 2,
CURT AND JER[ BIDINGER
ORG
SW/SM
ML-SILT
B.O.H.
10/19/98 -
PERCOLATION RATE. 26.7
TEST RUN BETWEEN 6.0
DEPTH TO DATE
;ROUNDWATER
DRY 10/19/98
DRY 10/26/98
DATE READING CLOCK NE3' TIME WATFR LEVEL NET DROP
TIME: (MINUTES) READING (INCHES)
10/20/98 1 2:58 , --- , 6 1/2"
T 2 ~:2~ so 5 ~/B" ~ !/~"
~ 3:2B :-- 5 ~/B"
,~ ~:5~ ~ 4 1,,/~"~ !/~"
:68 I--I I
J j ~ 4:28 ~0 4 7/B" 1 1/8"
(MIN./INCH) PERC, HOLE DIA. 6" (INCHES)
FT. AND 6.5 FT.
COMMENTS: PERC. ,HOLE WAS PRESOAKED 4+ HOURS IPRIOR TO TnESTINO. ,
THIS WAS PERFORMEB IN ,ACCORDANCE WITH ALL S~ AND MUNICTP~L~ GUIDELINES
OATE. DATE: ~
, CERTIFY THAI'
IN EFFFCT ON THIS
_S.~O I L CLASSIFICATIONS
ORG
ML
CL
OL
NH
CH
OH
SC
NAME
M[JNICIPALI'rY OF ANCHORAGE
DEPARTMENT OF HEAl, TH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 I.. Street- Anchorage, Ah~sl(a 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
E4"N EW
~UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Well Absorption area
I DISTANCE TO: I ~, (~r~/ [
Manufacturer
~'L~all°ns IF IIOMEMADE Inside length
x,.~ o I- :' ' I .-
_ ! _ __;7_o__
Top of tile to finish gr~ ~,~ Material berleath tile
~D-- TypelSTANCE of crib-- TO: ......... WelICrib diameter- ---- Crib Building d e p~l~'"-- foundation
"]- ' tClass Deptb Drill~er~
~ Building foundation Sewer line
N~. OF BEO.~OMS
PERMIT O.
~,%~_~_¢, jMaterial No. of compartments ~L
Width Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMITNO. ~lC) ~"~'~
Material
/. ,..~ C,~-- inches
Distance between lines
PERMITNO~"I O % ~'~l
Total effective absorption area
Nearest Jot line
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
-~EMARKS
Distance to tot line
Septic tank
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
I:::'Ef;~'.FI :[ 'T NCI.
I::IF:'F'L. ]: E: FI!",FF
L.OCFt"r I
F?. I CI..-IFIR[:, ! ....
!... ~ E~ 2 SEFiTI..IF, IN 5,,"D
PO
THE: I_..EN(3TH [;:,!' MENS ;[ 01",1 I S THE L,.EI",tG]"H ( :1: N FEE'F ) OF THE TREi'.,!C:H (][(-'. DRF'I I NFl I-i:l....[>.
THE [)I?~:t::'TH OF FI TRE:F,ICFt OR P]:T :IS THE C, ISTF'II'.,ICE E~ETNE;EI',,! THE )~;IJ[;i:f::'FIC[:Z f_'.'lF 'i~F.!E:
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]"HERE ZS t'.,!O SE:T I,.IZDTH FOR
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I:;'.[ES]:DEN(:::E; Z:E; I:;~'.E'h'IODE:I...[{D 'TO :[NC:I...UDE f, IORE THFIN ,-$ EIEDROO!',IS,
HUNICIPALITY OF ANCHORAGE
Department L Health and Environmenta2 .:rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Applicant: ~.(~,J<0~ ~ ,i ~/~ c~-,~t;t'vpl~ i Mailing Address:
Location: C r-~i Jf ~. A~-~ ~cc~x~ Phone Number:
Legal Description: _
Type of Soil kbsorption System Is:
Trench: ~ Drainfiel. d:
Maximum Number of Bedrooms: _ c~_
Lot Size:
Seepage Bedl __ Holding Tank:
Soil Rating(sq.ft/br) / ~
The Required Size of the Soil Absorption System Is:
DEPTH ~? _ LENGTH ~ ~ . GRAVEL DEPTH </ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPT IC(~;i~') TANK SIZE : /.>.S~] GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well.. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9.8 1 * * *
I certify that:
(1) I an1 familiar with 'the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that~ bedrooms.
Signe~: Issued by:
Applicant --
Date: ~,/~,/~/
SWP/024 (1/81)
LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AN[) ENVIRONMENTAL PROTECTION
82§ L, Street, Anchorage, Alaska 99501 264-4720
SOILS I.OG - PERCOLATION TEST
DATE PERFORMED:
TEST
1
2
3-
4-
5-
6-
7-
8
9
SLOPE
SITE PLAN
10-
11
12
~7
19
2O
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
P
E
Gross Net Depth to Not
Reading Date Time Time Water Drop
I Cz- ~- M.. ~ .-~ 1, 3 o
Z.. 12-,'v'¢ Io /, oY- O,
~ /'FF~ Io 0,~¢ D, I
TEST RUN BETWEEN
PERCOLAI-,ON RATE / ,~" ~ (minutes/inch)
__~"' ,¥-~. FT AND ~/" ~ FT
72-008 (6/79)
LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
[] PERCOLATION
TEST
PI:,~,OR~EOEO'~:. mrS. /~ flrL~'~r~/~
'_EGA~'ESCRIPT,ON: 2~'~ ~ /~/4"
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
18
19--
20.-
72-008 (6/79)
ENCOUNTERED? L
O
P
E
IF YES, ATWHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
00000000000
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
Parcel I.D. # __~[-~'l-1~ 21 -33 HAA #
1. GENERAL, INFORMATION
Complete legal description Lot 9; Block 2; Seaturn Subdivision
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailin. g address
Agent Beth
Address
15100 Platiuum Circle
Bid~nger Dayphone 564-5371
15100 platinum Circle Anchorage, AK 99516
Day phone
Simpson/Dynamic Properties
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
5
NOTE:
Individual well XX
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site XX
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.
72-025 (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 verifythat 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 dispos~.sys, te~.is in compliance with all Municipal and State.odes,
ordinances, and regulations in eft~;t~a~h~9 ~f this inspection. //~-~.~.-~
Wastewatol'~Co.t~ (tents, kid. _.
Name of Firm .,~1../J.// /_1/. _ i~none
Address /~ ~/~'P~F ~'°/~a ~u~ /u,~ n~ ~a~c/,'/A K )9~04 ~'~ ·
Engineer's signature ( .~/'~(~. -- Date
Alaska Water ~
Wastewater Consultants, Inc.
· Shall be PAID $_5~'~3~-~-
or prior to, closing for the
En~. infidel
~ Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: / /X/, 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 DH HS does this as a oourtesy 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 4~u,,, :/~~''~' 0d
DEPARTMENT OF HEALTH & HUMAN SER~I~,,:
Environmental Services Division '~'~/r,~l~'?,vc~. ~ '
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907)
Health Authority Approval Checklist
Legal Description:
A, WELL DATA
Well type PRIVATE
Log present (WN)
Total depth 200
Sanitary seal (Y/N',
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: _
SEATURN; LOT 9, BK 2
Parcel I.D, :.
017-121-33
If A, B, or C, attach ADEC letter. ADEC water system number
YES Date completed 8/13/81
_ Cased to /+0'+ Casing height (above ground) 19"
YES Wires propsrly protected (Y/N) YES
AT INSPECTION
FROM WELL LOG
8/13/99
40'
30 g.p.m.
.10/7/99
135'
5.5 g,p.m,
Nitrate_ .5 m,q/L Other bacteria
7/26/99 Collected by:__ AWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout (Y/N)
Date of Pumping NEW
C. ABSORPTION FIELD DATA
Date installed 11/23/98
Length _ 20' Width
11/18/98 _ Tank size 2000 Number of Compartments 2 Cleanouts (Y/N), YES
YES Depression (Y/N) NO High water alarm (Y/N) YES
Purnper N/A
"THIS IS A INNOVATIVE
DOTrOMLESS INTER MITi'ENT
DOSING SANDRLTER SYS~!M,
Effective absorption area 400 SQ FI' Monitoring Tube present (Y/N) YES_ Depression over field (Y/N) ____
Date of adequacy test NEW Results (Pass/Fail) - For -
_ Soil rating (g.p.d,/fF Or fF/bdrm) ;~ System type. , BED*
(APPLICATION RATE)
20 Gravel thickness be ow p pe. .25 Tota de~'h TO TOP OF _SAND
NO
__ mmedately after - gal, water added (in.):
Absorption rate = -- .g,p,d,
If yes, give date -
Fluid depth in absorption field before test (in,);
Fluid depth - (ins) Minutes later:.
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev, 3/96i*
bedrooms
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
11/18 Size in gallons
TIMER
YES "Pump on" level at*
BOTTOM OF TANK
*Datum
2000
"Pump off" level at* TIMER
Cycles tested -
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
1OO'+
lO0'+
N/A
25'+
100'+
On adjacent lots
On adjacent lots 100'+
Public sewer manhole/cleanout
100'+
Lift station
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation 5'+ Property line 5'+ Absorption field
Water main/service line 10'+ Surface water/drainage 100'4- Wells on adjacent lots
5'+
100'+
10'4-
75'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
5'+ Building foundation 10'+
Property line
Surface water 100'+
Curtain drain NONE KNOWN
Water main/service line
Driveway, parking/vehicle storage area
100'+
Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
· I certify that
in conforma~cewi~/
Signature \
Engineer's Na~
:felines in effect on this date.
dEEF ~ARNESS
Date
:-7955
.. ..." .:,~..~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6659
http://www.ci.anchorage.ak.us
AK. Water & Wastewater Consultants, Inc.
ATTN: Jeffrey Garness, PE
6901 De Barr Road, Suite 2B
Anchorage, AK 99504-0000
August 05, 1999
Subject: Waiver Request for SEA TURN BLK 2 LT 9
Waiver # WR990009 Lot Line Request for Parcel ID 017.-121-33
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 5 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely,
Engineering Technician III
On-Site Water Quality Program
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 ~;~ -
GENI='RAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address Or directions)
(b) ,App'l?ant Name"'~"'f¢/'4'//~-~'~ ~'"'6/~/H~7~ Telephone; Home ~5/~- ~Z~¢ Business S~S~
(c) Agplicant is (check one):,Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d)
Lending Institution /~' ~'~"¢¢ Telephone
Address ~ ~'f' /' 7-'~' ~ ~'~P
Real Estate Company and Agent
Address
(e)
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family ~' Multi-Family [] Other
Number of Bedrooms ~
WATER SUPPLY
Individual Wellr'~ Community [] Public []
Note: If com m unity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite'~ Public [] Community I"] Holding Tank []
Note: If corn m unity 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 PROVIDll iNSPECTIONS, TESTS, FILE SEARCH, D, ~, 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 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 -//~--'¢- ~ Telephone ~'~'5' ? -~'--'~ 5/~
Address /2-~.7/ /,~ ~7~.~~/ /'~J .¢'~'/T&-- Z~ ,/~/../ //~d y'/¢~O~
DHEP APPROVAL x
Approved for ~ C'~> bedrooms by ~ /~' "~'~'"~'"~'
Approved ~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHFP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent 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
72-025 n ~/84)
~,~,IICIPALR'¥ Ol~ ^NcHo~I~NICIPALITY OF ANCHORAGE (MOA)
~NV,tON~ENT^L S~RVIC~ D~t~TH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MAR .5 1987 264-4720
Legal Description: /:¢/7~ ~zd, d/d ,~.
WELL DATA
REEEIVED
Well Classification
Well Log Presen N)
Total Denm .2--~z>
Static Water Level _ (~
~'~"~/¢/¢~¢'"¢' If A B, C, D.E.C. Approved (Y/N)
Date Completed '~/~ ~: / Yield
Cased to
1~ '
Casing Height Above Ground _
Electrical Wiring in Condcit~N)
Separation Distances from Well:
To Seotic/Holding Tank on Lot
Depth of Grouting _
Pump Set At ~///)
Sanitary Seal on Casing~rN)
Deoression Around Wellhead (Y~)
; On Adjoining Lots /d/~O/'~'
//o
To Nearest Edge of Absorption Cield on Lot ; On Adjoining Lots
To Nearest Public Sewer Line ,d//4 ~-o Nearest Public Sewer
Cleanout/Manhole _ ~'..~/,'"~ _ To Nearest Sewer Service Line on Lot
Water Samole Collected by ~45 /4. ~/?~p/ ; Date
Water Sample Test Results -,~i./~/'"7~/'"/fdT~/'//'
Commenls (¢¢ /¢J/=-¢~c ,,~¢~J 7~'~7~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Stanc pipes ~'~1) Air-tigm Caps~N)
Depression over Tank (Y,~/¢~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~/~4
Separation Distances from Septic/Holding Tank:
To Water-Supply We
To Prooerty Line /o"
~'-~¢¢¢/ Size t;¢~c' No. of Compartments
Foundation Cleanoutl~N)
Date Last Pumped
;,or
Temporary Holding Tank Permit (Y/N) _
To Water Main/Service Line
To Building Foundation
To Disposal Field
Course
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
7202E 11/84)
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 A~equacy Test ,
Separation Distance from Absorption Field:
To Water-Supply Well . .
To Building Foundation
Lot ,'d~//¢
To Water Main/Service Line /~'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field /~:'
Gravel Bed Thickness //
Standpipes Present(~N)
Date of Last Adequacy Test
To Property Line _..~'C /
To Existing or Abandoned System on
; On Adjoining Lots ..;._5' "~
To Cutbank (if present) ////¢
/~, ./~
Comments
D. LIFT STATION
Date I nst alte¢...........~ A /////~
Size in Gallons
"Pump On" Level at ~-~_....,~__
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~~....~ng Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request
I certify that I hav¢~hecked.verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
Signed ~ ~L~,z.:.--~ Date ~'" F~'¢/~
Company 2¢ Z';L¢-~' ~A No.
Receipt No, //<:~E~)'/ ~'~
Date of Payment ~/¢~
Amount: $ 2~-~
Page 2 of 2
72 026 (11/84)
LABORATC'CtlES, INC. rosY :.0. #
ANCHO. O, ,
BACTERIOLOGICAL WATER ANALYSIS
DATE COLLECTED
I
~NTH ~ YEA~
I,D. HO. (PUBLIC'SYSTEMS)
~mlJ
.... ~M~ OF SYSTEM - --
SYSTEM ADDRESS
TO BE COHPLETED BY WATER SUPPLIER
TIME COLLECTEDAu TYPE OF SYSTEM
PUBLIC ~?INDIVIBUAL
CIRCLE CLASS
B c t eetial ,
TELEPHONE NUMBER
clITy STATE ZIP CODE
"COLLECTED BY: (SIGNATURE)
LOCATION WHERE SAMPLE WAS COLLE~-ED ~ 7/}7j
~YPE OF SAMPLE
(CHECK ONLY ONE THIS COLUMN)
'~DRINKING WATER
~/CUECK TREATMENT
RAW SOURCE WATER
HEW CONSTRUCTION OR REPAIRS
OTHER(Specify)-
[]]CHLORINATED
~FILTERED
~UNTREATED OR OTHER
IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE?
[3 YES ~0 PREVIOUS COLLECTION DATE
ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM)
"~END REPORT 'FO:(PRINT FULL NAIdE,ADDRESS AND ZIP CODE
ADDRESS
CITY STATE ZIP
FOR LAB USE ONLY
£] RESUBMIT SAMPLE
Sample rejected because:
CHECK ONE OR.MORE
[] Sample too long in transit.
Sample should not be over 30 hours.
[] Sample received too late in week
[] Not in proper container
[] Leaked out
[] Insufficient information provided.
Please read instructions on form.
~Other (Specify)
RECEIVED BY ,~)))~:~_4.t~
DATE ~-~-~,~,'? TIME ~F- '~'~'
ANALYTICAL METHOD:
[_~ME~BRANE FILTER
[] FERMENTATION TUBE
Date & Time Started
Date & Time
LABORATORY RESULTS
[] Other Bacteria
II Test unsuitable because:
II Confluent Growth
[3 TNTC
SATISFACTORY rQ/~)ISAT I SFACTORY
BACTERIOI.OGICAL WATER ANALYSIS RECORD
FOR LAB USE ONLY
ID E :AL COLI O S
Membrane Filter: Direct Count
Verification; LTO
Final Membrane Filter Results
Reported By
READ rdUIPLE COLLECTION INSTRENC~IONS ON BACK OF FORM
~ ~ '- Coliform/1OOml
BGB
Coliform/lOOml
Date
Time
MI~ICIPALITY OF ANCHORAGE
DIVIoION OF ENVIRON~IENTAL HEALTH
DEPARTNENT OF HEALTH AND E~IRO~NTAL PROTECTION
APPLICATION FOR ~ALTH AUTHORITY ~PROV~] CERTIFICATE
1. General Infol~ation Application Date __~-
(%) Legal Description (include lot, block, subdivisien, section, to%~shIp, range)
Location (address or directions)
'_~1:>~'~' [',-~.'~ ~l-~-,' , ~J~/~v(~. b{ ~-,O'~oc~n¢~c.,.L [{~ :.~lt:~a -~.:A. ~
- ':~t q" >:7 'Z '2."
(b) Applicants Name (-~ tC.t-tzN[:i~) ~ .¢_~(/~?'~'Telephone - Home .'.?'~¢. Busines~
Applicants Address ~ (h / ~-~ [[[ 9%.~A
(C) Applica. t~.tis Other(Check~t°~e) (explai~),Lendi'g ~.stitutio~q (; ~5; O~er/bullder
(d) I, ending Institution ~j.:, Telephone
Address
(e) Real Estate Co. & Agent_~jj_hi(;: ....
Address
Telephone
(f) Mail the }{AA to the following address:
2. T_~yjpe of Residence
e
Number of Bedrooms
Other (describe)
Water Suppil
Z dividual Well
Community
Note: If community we].l system, must have written confirmation from the State
Department of Environmental Conservation attestiag to the legality and status.
Sewage Disposal
Onsite ~I Public ~..~.[ Community [----] ttolding Tank ~___~
Note: If cemmunity well sys'tem~ must have written confirmation from the State
Department of Environmental Conservation attestieg to the legality and status.
[Page 1 of 2]
5. Engineering Firm Providing Inspect£ons, Tests File Search. Data and Information
])HEP Ap~rpval
Approved for ~ bedrooms
Approved ..... Disapproved
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 infomnation obtained from the Municipality of ~chorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance ~th ~1 Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Address ~ > ~?'~ -> :-/ , .; <,~ , <' ,<* . /~ ' ' ~ ~_,~,,'~,~ ,.. ,' . - '
Date ..... >;. ~_~
ConditionaI
Terms of Conditional Approval
CAUTION
THE b~NICIPALITY OF ANCHORAGE DEPARTMENT OF llEALTH AND ENVIRO~.qENTAL FROTECTION
(DHEP) ISSUES I~ALTH AUTHORITY APPROVAL CERTIFICATES BASED :~.~O_iELY~ UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH fi ABOVE BY AN INDEPENDENT PROFESSIO~kL ENGINEER REGISTERED
IN THE STATE OF ALASKA. T}UC DHEP DOES THIS AS A COURTESY TO PURCiiASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-°
MENTS. Ei~PLOYEES OF DHEP DO NOT CONDUCT INSPZCTIONS OR ~NALYZE DATA BEFORE A
CERTIFICATE I$ ISSUED. TIlE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIObbkL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/Di8
[Page 2 of 2]
7--19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEAUI'H AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALT!i &
ENVIRONMEN IAL PROTECTION
WELL DATA
.Well Classification
Well T~x3 P~esent (Y/N)
Total Depth fl
,RECEIVED
If A, B, cm C, D.E.C. Approved(Y/N) N
~/ Date Completed _ ~- 1 I~ ~ I Yie ld_~9_~
. Card to ~ ~ ~r. __ ~pth of G~outing__~
Static Water ~1 %~OFr, .~ ~t At ~ ~ ~O ~T. _
Casing ~ight ~ GI~nd ~'/ Sanit~y ~al on Casing
Elec~ical Wiring in C~nduit (Y~) ~ ~p=ession ~nd ~l~ead
~p~ation Distan~s f~ ~11:
To ~ptic~ioldin~ Tank ~ ~t ~ [ { O 7~. ; ~ ~joini~g Lots > '[ CO
To ~a~st Edge of ~so~ption Field on Lot ~ L!~m; ~ Adjoining ~ts~; I
To Nemzest Public ~r Line m./A __ To ~est Public Se~r
Clean, t/Manhole ~./A To ~est ~ ~vi~ Li~ on ~t ~i./A
Wate~ Sable Collected By __~ ; ~te ~ - ~ - % ~4
Wate~ S~le Test ~sults ~~~~
B. SEPTIC/HOLDING TANK DATA
Date Installed Appg~q-~O(~,-~-~l Size tg_,~(} ~r~l No. of Compartments
Standpipes (Y/N) ~/ Air-tight Caps (__Yffi~_~ ~_ Foundation Cleanout (Y/N)
Depression ove~ Tank .(Y/N) N Date Last Pumped _ ~ ~ ~_ I ~ ~ L~
Pumping/Maintenanc~ Contract on File (Y__y~__~_; for
Holding Tank High-Water Ala~t (Y_/N) ~../~ . Temlx~ra~y Holding Tank Permit (Y/N)
Separation Distances ~cm Septic/Holding Tank:
To Building Foundation ~ I O '
To Disposal Field ~ t (~)"
To Stream, Pond, ~ake, c~ Majo~ D~ainage
[Page ] of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed .APPCA~/I~
Width of Field
Gra,~l ~d Thick.ss
S~e Feet of ~sorption ~ea
~p~ession ove~ Field (Y~)
Results of ~st ~e~a~ ~st
~paration Distan~ ~ ~sorption Field:
To ~te~-Supply ~11
To Building Foundation
Lot ~N ,/~ ; ~ ~joining ~ts ~ ~/~ .
To Wate~ Main/~vi~ Line ~./~ To ~t~(if pre~nt) ~./~
To St~e~ond~ke/~ Majo~ ~aina~ C~se ~% ,/~
To ~iveway, Pa=ki~ ~ea,
D. LIFT STATION
Date Installed ~.//~
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Cor~nts
Dimgnsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~Pumping Cycles du~ing Adequacy Test.
Meets MOA
** Check Permitted Bedroom Rating Against HAA Raquest
I certify that I have checked, verified, or conformed to all 5~)A HAA Guidelines in effect
on the date of this i~DgcTci~n. /~
Signed ........ Date
KB1/d5/s
[Page 2 of 2]
:-15-84
--=' ' DATE RECEIVED
' I NSPECTION APPOI NTM ENTS
TIME TIME TIME
DATE DATE DATE
iNSPECTOR iNSPECTOR INSPECTOR/-~
MUNICIPALITY OF ANCHORAGE
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~I~iqICIPALITY OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501 DEPT, OF HEALTH
ENVIRONMENTAL PROTECTION
ENVIRONMENTAL. SANITATION DIVISION
Telephone 264-4720 ~y
REQtJEST FOR APPROVAL OF INDIVIDUAL WATER AND D
DIRECTIONS: Complete ali parts on page 1. Incomplete requests will not be processed. Please allow ten (10) davs for processing.
MA lNG ADDRES~
~OPERTY
RESIDENT
(if
different
fro~
MAILING ADDRESS
~ LENDING INSTITUTIO~ PHONE
~AI lNG ADDR (~
C
6. SI DENSE ~,) NUMB6R OF~BEDROOMS
[] One E2 Four [] Other
~INGLE FAMILY ~ Two [] Five
~ MULTIPLE FAMILY ~]r~ Threo E2 Six
7, WATE S~UPPLY
INDIVI DUAL+ ~"~ fgz'~ ' ATTACH WELL LOG. A well Icg is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC DTILITY de~th {attach Io9 f available,}
8, SEWAGE DISPOSAL SYSTEM
/'~ INDiVIDUAL~ON-SITE** I YEAR ON-SITE SYSTFM WAS INSTALLED.
[] PUBLIC LYf LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST 5EFORE PROCESSING CAN BE INITIATED.
72-0lO(Rev. 6179) __~-.
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [~ THREE [] FIVE [~] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED f
E]PUBLIC UTILITY ~ ~ ~
/
Connection Verified
INSTALLER
[]Septic Tank or []Holding Tank
Size: ! :.~._~,~t~ If Tank is homemade
SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO; Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~ APPROVED FOR _.'~3 BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ~
72-010 (Rev. 6/79)