HomeMy WebLinkAboutSEQUOIA ESTATES BLK 1 LT 15Sequoia Estates
Lot 15
Block 1
#017-152-15
Municipality of Anchorage Page
DEPARTMENT 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: _~c4/~ o5'7/ PID Number: ~t 7 -t5"-~1.5,-
Name:
~,-.? ~ I'/a,-./ (c~ r-z~w,-.,,.?,,~- Wastewater System: [] New [~ Upgrade
Address:
Phone: '~/~-_ ~'~.~ IN°'°fBe/-~°°rns: F~ Deep Trench rq Shallow Trench FIBed EJMound rqOther
LEGAL DESCRIPTION ~.v ~.q~- GPO/S~.Ff. ~,o'
Lot: Block: Subdivbion: Depth to pipe bottom from edginal grade: Gravel depth beneath pipe
Township: Range: ~ Section: Fill added above original grade: Gravel length:
I
WELL: ~;~ ~ New ~ Upgrade Gravelwidth: Number of lines: D~stance~etweenlines:
~' ~ Ft. I -- Ft.
Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material: ~
Driller: Date Drilled: StsticWater Level: Installer: Date installed:
Yield: GPM ~ Pump Set at: Ft, ~ Casing Height Above Ground:Fi, TAN K ~ ~ ~/~
SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons:
Material: Number of Compa~ments:
Sudace
Water ~(~' >~o' - - LIFT STATION
Lot ~ , - Size in gallons: Manufacturer:
Line ~ ~ ~ ~
Foundation /~' ~O .... "Pump °n" level ~t: I "Pump °ff"'eve' at: I High water alarm at:
Cu~ain iPump Make & Model ~ Electrical Inspections pedormed by:
Drain -
I
Remarks: ~ ~;?,~( ~'c ~ ~ BENCH MARK
~ Location and Description:
I Ass~ed Etev~ion:
ENGINEER'S SEAL
Department of Health and Human Services approval ,: ¢, CE,.358¢
72-013 (Rev. 9/91) MOA 25
PERMIT NO: SW990371
PID NO: 017-152-15
NEW 67' LONG
SOIL ABS. TRENCH
W. 7.4' EFF. GRAVEL
SWING TIES:
FROM: COR. "A" COR. "B"
TO:
VALVE "F" 28' 44'
DBL. C.O, "G" 31' 48'
TR. C,O. "H" 21'
TR. M.T. "1" 58' 74'
TR. C.O. "J" 73' 86.5'
65'
GuNN~SON DRIVE
DRIVE
PAGE 2 OF 2
WELL --/~:~
ORIGINAL
1250 GALLON
SEPTIC TANK
LOT 15
BLOCK 1
PLAN VIEW
SCALE: 1" = 30'
EXISTING
1250 GALLON
SEPTIC TANK
PROFILE VIEW ,",
NO'r TO SCALE
/
GROUND ELEV. 96.4'--
--BOTTOM OF TRENCH ELEV, 84.4'
BOTTOM T.H. #1
ELEV. 78.4'
M.T. DRY 10/1/99
LOT 15, BLK. 1, SEQUOIA ESTATES
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALAgKA 99516
SCALE:AS NOTED
DRAWN BY TFM
OCTOBER, 1999
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P,O. Box 196650, Anchorage, AK 99519-6850
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 30, 1999
Expiration Date: Sep 29, 2000
Permit Number: SW990371
Legal Description: SEQUOIA ESTATES BLK 1 LT 15
Design Engineer: 0019 Flattop Technical Services
Owner Name: Gary & Mary Cartwright
Owner Address: 6700 GUNNISON DR
ANCHORAGE , AK 99516-3718
Parcel ID: 017-152-15
Site Address: 006700 GUNNISON DR
Lot Size: 49084 SQ, FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[¢~ Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] PrivateWell [] Water Storage
All construction must be in accordance with:
1, The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ),
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A, Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
Lot line waiver #WR9900'~6 issued for 2' from absorption field to west property line.
Received By: ~ ~ Date:
Issued By: , / Date:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Wa~iver Review Worksheet
HA% Permit
Lot 15 Block I Sequoia Estates
WR~ WR990076 PID~ 017-152-15
Date Received: Sept 21, 1999
Legal Description:
Engineer:
Applicant:
Ted Moore, PE., Flattop Technical Services
14530 Echo Street, Anchorase~ Alaska 99516
Gary & Mary Cartwright
Waiver Requested: Lot line waiver of absorption area to the west property line _
common with Lot 16 of 2 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:
List Conditions or Reasons
for
Waiver is NOT Granted:
above:
Date:
Rec #: 05294/9764
Amount:
By:
Name of Reviewer
$ 115.00 Date Paid: Sept 21~ 1999
'TOP TECHNICAL
CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
September 20, 1999
M.O.A. DH/tS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for
a permit to upgrade the wastewater disposal facilities on Lot 15, Block I, Sequoia Estates, located at
6700 Gunnison Drive. The existing soil absorption bed is operating in a surcharged condition. In
order to maximize the distance between the existing bed and the proposed trench and to preserve several
large trees, a lot line waiver is requested allowing the trench to be constructed within 2 feet of the west
property line common with Lot 16. Granting of the waiver will not significantly impact the ability to
construct future replacement systems on the adjoining lot. Soils logs, perc test results, a site plan, design
drawings and specifications are enclosed for your review.
The proposed system will be constructed in the vicinity of test hole #1. As can be seen from the soil
log, the native material between 7.5' and 12.5' is a silty sand with a measured perc rate of 13 minutes
per inch. The overlying siltier sand has a measured pete rate of 32 minutes per inch. The design
wastewater load ora 4-bedroom house is 600 gallons per day. The proposed soil absorption system
design is a trench containing 6.5 feet of sewer gravel with the bottom of the perforated distribution pipe
at 5.5' below ground level and the bottom of the trench at 12' below ground level. Using the soil
application rates specified in the wastewater ordinance, the bottom 4.5 feet of sidewall area should
absorb effluent at 0.8 gpd/sq. ~., which corresponds to 7.2 gpd/1.fi The toll 2 feet of sidewall area will
absorb effluent at 0.45 gpd/sq, ft, which corresponds to 1.8 gpd/1.£ Thus, the total trench will absorb
effluent at a design rate of 9.0 gpd/l.f., which means that the minimum required trench length is 68 feet.
The topography of the lot in the area of proposed construction slopes down towards the north and
west at 0 - 5%.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have
any questions on this submittal.
Sincerely,
Ted Moore, P.E.
RECEIVED
8EP 2 1 199(
MUNICIPALITY OF ANCHORAGt~
ENVIRONMENTAl. SERVICES DIVISION
LOT 7, BLOCK 2
GUNN~
...... WELLS
'~. CONSTRUCT
_ - ....... . 67' LONG
R 100' --' SOILABS. TR.
~' W. 6.5' GVL
PAVED
DRIVE
INSTALL "BULL RUN"
DIV VALVE & DBL. C.O ~
' < :.-.-.-.-__,'
LOT 15
BLOCK
LOT 14
LOT 15, BLK. 1, SEQUOIA ESTATES
SEPTIC SYSTEM UPGRADE
SITE PLAN
FLATTOP TECHNICAL SERVICES 1 INCH =50 FEET
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 SEPTEMBER, 1999
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE,
CONSTRUCT 67-FOOT LONG
SOIL ABSORPTION TRENCH
WITH 6.5' SEWER GRAVEL
BELOW DISTRIBUTION PIPE
"A" 25
DBL.
~ C.O~
1E2X~ 0ST;N,~ ~LO N _/
SEPTIC TANK
EXISTING SOIL ABSORPTION BED
--- INSTALL "BULL RUN" DIVERSION VALVE
PLAN VIEW
SCALE: 1" = '10'
-- CLEANOUT
MONITOR TUBE
- MOUND BACKFILL 6"
GROUND
Z_R FABRIC
4" F-810 PERF PIPE
1/2" - 2 1/2" SEWER GVL
SECTION "A - A"
SCALE: 1" = 5'
OFTRENCH
LOT 15, BLK. 1, SEQUOIA ESTATES
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, AK, 99516
SCALE: AS SHOWN
DRAWN BY: TFM
SEPTEMBER, 1999
Flattop Technical Services
14530 Echo Street, Anchorage, AK 99516
Phone (907) 345-1355
Lot 15, Block 1, Sequoia Estates
6700 Guanison Drive
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of construction of a 67-foot long soil absorption trench
containing a total of 7.0 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived. The trench shall be constructed no closer than 2 feet from the West lot line.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
1.6 Prior to the start of construction, the homeowner shall arrange with a surveyor to locate the
northwest property corner and place a stake on the west lot line 25 feet south of the northwest corner.
2.0 Septic Tank:
2.1 The existing septic tank may be retained in service, only if it's structural integrity has been
verified by the inspecting engineer, and if it has functional cleanout pipes with airtight caps, allowing
pumping access to each compartment. Any existing septic tank or seepage pit which is not retained in
service must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the
waste line between the tank and the soil absorption system shall have a minimum slope of i/8" per foot.
A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be
installed within 5 feet downstream of the septic tank.
2.3 A "Bull Run" diversion valve shall be installed downstream of the septic tank allowing future
reconnection to the original soil absorption bed, if desired by the homeowner.
3.0 Soil absorption system:
3.1 The new soil absorption system shall be constructed by excavating a trench to a depth of 12.0
feet below ground level in the vicinity of Test Hole #1
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked
to allow proper infiltration.
3.3 A total of 7.0 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 6.5 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing
the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A
minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less
than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the
gravel, in addition to the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have
the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and
seed to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and
grading is complete.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
1
TEST HOLE # ] 1
LEGAL DESCRIPTION:___Lot 15~ Block 1~ Sequoia Estate_s
DATE PERFORMED: September 2,. 1999
PERFORMED FOR: Gary & Ma.l¥ Cadwdght
DEPTH
(feet) Pt.
1
SM Silty sandyloam
SM/ML Very silty sand
Lenses of ML
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
SLOPE
2%
COMMENTS:
SM Brown silty sand
Soft digging
SM/ML Very silty sand
Dense
Cobbles below12'
GP/SP Sandy Gravel
Depth to Groundwater Dste
No groundwater 9/2/99
M,T. dry 9/10/99
15%
o,
5%
Clock Net Time Percometer Net Drop
Dale Reading Time (minutes) Reading (inches)
9/2 12" Presoak 27 3/8
9/3 12" Resoak 27 3/8 __
_Add water & Start 3:43 .... 23~3/~8_ _
#1 4:13 30 21 2 3/8
Add water 4:13 23 1/2
~_2_ 4:43 30 . _ 21 1/8 2 3/8
Add water 4:43 23 5/8
#3 5;13 30 21 1/4 2 3/8
PERCOLATION RATE 13 (minutes/inch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN 8.75 FT AND 9.25 FT
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,/,..~--¢¢~ / ~'~'"'~'1 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9/17/99
ITEST HOLE # la I
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
Pt.
(feet)
1
2
3-
4
5-
7-
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 15. Block 1. Seq~LQia Estates
September 2, 1999
_ Gar,/&_Ma~ Cartwdght
SLOPE
SM Silty sandy loam
SM/ML Very silty sand
Lenses of ML
2%
SITE PLAN
SM Brown silty sand
Soft digging
Depth to Groundwater Date
~o groundwater 9/2/99
M.T. dry 9/10/99
15%
SM/ML Verysilty sand
Dense
Cobbles below 12'
GP/SP Sandy Gravel
Reading Clock Net Time Percometer Net Drop
Time (minutes) Reading (inches)
14" Presoak
Resoak
Start 3:43 9 1/2
#1 4:13 30 10 5/8 1 1/8
#2 4:43 30 11 5/8 1
#3 5:13 12 9/16 15/16
PERCOLATION RATE 32 (minutes/inch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN 5.25 FT AND 5.75 FT
COMMENTS: This Icg shows the results of a second perc test conducted at T.H. #1. The test hole was dug and the perc tests
conducted during a period of prolonged rain, so the results may be somewhat conservative.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,./.,.~,,¢(. /'"~o-e-~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9/17/99
MUNICIPALITY OF ANCHORAGE
[, .R'rMENT OF HEALTH AND HUMAN SE. ,ES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502. Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
ECl/SEPTIC
[] HOLDING
TYPE OF SYSTEM
[] TRENCH LI/~"'BED L~ W. DRAIN [] OTHER
-- WELLS AO~ {~
DISTANCES
~ SEPTIC ABSORPTION
TANK FIELD WELL
WELL NO~ FFN --
LOT LINE ;;2..0 ' '~C)~ -
FOUNDATION
AS-BUILT DIAGRAM {SIiow location of well, seplm system, property Lines, foundahon,
driveway wa~er bodies, etc j
[] PRIVATE [] OTHER fldentifv)
REMARKS:
~llllJcipal and State Duideiines in ellecl on this date:
__ cedi~y that this Jnspeclion ',vas padormad aceordin§ to all
72-013 (3/85)
I:::'1~!]':~ M I ['
AF"F:4... 1CAN'I: ACREAGE SYSTEMS
AL)DRES!i{~ 6():i. E NORTHERN I.,.IWHFS :EII..VD
AIxlCH[)RAGE, RK 99503
CON['AC;T PI"I[HqE:
L.EGAI.. )[)I~:SCR I I::': !.:~UBD I V Z S I(::}hl~ SEQUOIA E~'f'hTES I-OT: 15
SECT i ON: 26 T'OWNSH I F:': i:;~'.N RANGE:
LOT S 1Z E: 49084 ([~[;! ,, Fl". I]1::~ A[',RI~':S )
I.O'i I..[]CATIC]N~: GUNNISC]N DRIVE
MAX Zd]]}ROO]"IC~: 4
BLOCK
I,.:i. stc)d I::)elc)w al'i:~ the opi'..ic~ns ava:i, labl(,:? i'.o you
!F.y!~?,t.(,~m,, [7, hoosla t,h~.~ Ol::rl.:J. orl tlla't, best [its your sii:.e.
DEI::']':I-I I"0 P I i:::'E :CIOTT'OM (FT.) 4.0 4 ,, () 4 ,, 0
GRAVIii]... DI~i:F:"I'H (F:'T,,) 6.0 0,, 5 :3,, 5
]'OrAl.. DIZP'I'I.I (i~'T',, ) ](). 0 4,, 5 7.5
GFd~VE~:I. WID"I-H (I::T.) 2.5 19. () 5.0
E~RAVIEI.. I..EN[:)]H (F:T,,) 39.0 :37. () 50,, 0
[:~I::~AVEI. VOI,.UME (Cl.J. YDS,, ) :~3.5 J~6. 1 37. I
TANK S I Z E (GAL,S) 1 ~, 2.50.0 '~"~' :1,, 250 ,, 0 '~"~ 1, R50.0 '~"~'
SOIL. RA'IIN(::J (SQ.F:'T. /BR) :L15 1],5 3.:1.5
· ~.1~ i'ANK NUST HAVE AT I..E::AST 'I"WO COMPAR'I'I~IENTS
ce)rt, il'y 'Lhat:
1. I am ~','am:i.:l. iar' ~,:['l.h
Fort. l~ by 'khe MuniC:Ll::~a].it.y of Anchc~l~ag[_~ (BOA) and t, he St, ate of Alaska,,
I will :[nsf. all i'.h(,.) syst. em :i.n acco['.clarH::e v~J.t.h all MOA c:odes and
and in comp],:i, ar~ce w:i.t.h t.h~::.) c:le~J, gn c:r'iCeria oF th:i.s permit,,
I [~]:i,:l:l. aclhor, c:~ 'Lo a].]. MOA and Stai'e ot' A].aska r(~ecluir'ements t'cm the sed:, back
I..IF:-I S'I'AT'IOIq IS INSTALL..ti:D Ilxl AN AREA IZ:'.OVERI:~::O BY MOA BI.!ILDIIqG CODI~:S,
( :1 ) AN lil]_ECTRICAI.. I:::'I!~RMIT ~ND IN~;I::'ECTI[]N MUST BE OBTAINED; (2) AS...BUII/I'S
NOT BE AI:::'PI::~OVE~D WITHOLJ'I" AN I;i]_F~:CTI::~::I:C~L. IixlSI::'Ii~:CTION REF:'ORT~ AND (3) 'I].IE
PERFORMED FOR:
LEGAL DESCRIPTION;
1 OL.
2
3-
4
5
6
7
8
9
10
11
12
13
15
16
17
18
19
2O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST.
~ ATE PERFORMED'
Township, Range, Section: "T'I z,/~ ~
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh to Waler After
Monllorino? D~te:
SITE PLAN
I I~ ,~~-~
(1N' r
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER
· TEST RUN BETWEEN FT AND ~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIOELINE~IN EFFE/ON THIS DATE. DATE:
72-008 (Rev, 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TES'F
LEGAL DESCRIPTION:
1
d~
s-
6-
7
8
9
10
11
12
13
14
~5
~7
t8
2O
DATE PERFORMED:
Township, Range, Section:
SLOPE SITE PLAN
/
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? '~'
~, ii O'~..T~k gob_
I'~O
OepDI to Waler AllerI¢l'~?C([
Monitoring'7 Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER
/ ¢ I TISTRUN BETWEEN. -- F AND __FT
/ lA,,
PERFORMED BY; ~' ':,-k~,'~,',~ I ////~/~Z uERTIFY THAT T~IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE~N EFFECN THIS DATE DATE'
72-008 (Rev. 4/85)
REPLY
SIGNED DATE
I'(JE.~r-o~ 4S 4)'2 SEND PARTS 1 AND 3 INTACT -
........ PART 3 WILL BE RETURNED WiTH REPLY. cetrballle--~r~ POLY PAK (50 SETS') 4P472
DETACH AND FILE FOR FOLLOW-UP
NOTE: . ' ' ·
THE ACCURACY OF LOCATION OP EXISTING
PROPERTY coRNERS, WELLS, AND SEPTIC
SYSTEMS INDICATED IS NOT EXACT ....
DIMENSIONS INDICATED HAVE BEEN DETER-
MINED BY USE OP CLOTH TAPE AND ~
SURVEYING TECHNI UE__.~q~-.-----~
\
\
SEWER
/
./ "//
/"~// /¢~?
¢' :'.7.~ ,/,,:; c .... ' ' )
ff 7o F ¥ s~~ "'~'""., "*'~' ......... ". ", ~'
~'mfl ,c ,~- ..,r~
SYSTEM LOCATION PLAN
, NOTF: , ',
· .. 'THE ACCURACY OF LOCATI05 EXISTING
PROPERTY'CORNERS, WELLS, AND sEPTIc
, DZ~NSIONS INDICATED I~VE BEEN DET.ER~
. ~INED BY USE OF CLOTH T~E ~D N~
· · :....: ~,.., .~. ~
-' · .,?.,~.-
/
L-oT- /~
~+ ~ 3~ ~ ~ e~'o~~, t ~ ' ( ..... ~-1'~ ' ~-'
'SEWER SYSTEM LOCATION PLAN
Subd:
Prepared for:
Block:
Anchorag,e
P.O. f i 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4:~ 4?44
TONY KNOWLES.
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 9, 1987
Alpine Drilling
PO Box 110496
Anchorage, Alaska 99511
Subject: Lot 15 Block 1 'Sequoia Estates Subdivision
On-site Well Permit %860353
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1986.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system the original as-built inspection report (three part
form) must be sent to this office for review and approval, and
for documentation.
If there are any further questions, please call this office
at 264-4744.
Sincer~y,
R.W. Robinson
Program Manager
On-site Services
RWR/ljw
enc: copy of permit
F~I,..F:' ]: h!Ei: Dt:~ 1 I.,I ,. ]: N('i
~OTE:
THE ACCIq~ACY OF LOCATION C ZXISTING
PRG~ERTY CORNERS, WELLS, AND SEPTIC
SYSTEMS INDICATED IS NOT EXACT.
DIMENSIONS INDICATED HAVE BEEN DETER-
SURVEYING TECH~~ ~
LOT 15'
uo'r I~
SEWER SYSTEM LOCATION PLAN
/'
WATER WELL RECORD
STATE OF ALASKA
OEPARTMENT OF NATURAL RESOURES
Division of Geological 8~ Geophysical Surveys
Drilling Permit No.
A,O,L. NO.
t~.O' ~ I~,GROUTING Well Grouted: ~ Yes ~ NO
~gis~ Bus?~ss Name~ ~ Conlrec~Lio~ns~ Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
On-Site Services Section
P.O. [3ox 196650 Anchorage,Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
("')/"'~ - ~,/~,h.~-I~ HAA#
GENERAL INFORMATION
Complete legal description
LoT ~, 81J< I ~ J'E~VO~A
EST~IT££
Location (site address or directions)
rt C e 4 E
Property owner PATTI
Mailing address ~70o 6u~soN be. 4NCdO~A6~- ,
Lending agency NO~WE~T
Mailing address
Agent
Address ~ %of
Day phone
Al<
Day phone
~'iEHrJE~; 3-czc~C bO)~l~-E ~c~, Day phone '7~2- ~//o
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY 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.
Name of Firm FLA'fq-OP 'T,c..C~I .~v'cZ Phone 3'~5-
Address 1~£3o EC~O ST ~C~I. ~ ~q~lG
Engineer's signature ~~ ~ ~ Date
DHHS SIGNATURE
/k~ Approved fo
o
Disapproved.
bedrooms,
Conditional approval for
bedrooms, with the following stipulations:
By:
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 engineer's work.
72-025(Rev. 1/91) Back MOAt21
Municipatity of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: LoT 15', BLI< Ij $£quo~f~ ~ST, ParcelI.D.
A. Well Data
Well type ?Rt vA"rE
Log present (Y/N) Y
Total depth 2.32
Sanitary seal (Y/N) ~"
If A, B. or C, attach ADEC letter. ADEC water system number
Date completed '7/1~/3(~ Driller /~LpINE
Casedto 2 2,~ Casing height 32.
Wires properly protected (Y/N) ~'
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG AT INSPECTION
25- .g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 130
Absorption field on lot t I o
Public sewer main ~ Ioo'
Sewer service line > loc '
7' ~' g.p.m. ~: o~
; On adjacent lots >/oo/
; On adjacent lots > /oo
Public sewer manhole/cleanout > / co
Petroleum tank
WATER SAMPLE RESULTS:
Coliform 0 CoLo~/l~o
Date of sample: 7/'/
Nitrate
o.'~ ~'3 /L
Collected by:
Other bacteria
¢LATTOP
SVCS.
B. SEPTIC/HOLDING TANK DATA
Date installed S'/~/~o
Cleanouts (Y/N) "/
High water alarm (Y/N)
Date of pumping (~ [2g/~
Tank size 12 5'0 ~',~ L Compartments P-
Foundation cleanout (Y/N) c,o. ~ 6s~'r..Depression (Y/N)
,A. Alarm tested (Y/N) N, ~ '
N
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 13o T° C.o, On adjacent [ots ~ /oo
To property line $o Absorption field NoT
Sudace water/drainage ~ Ioo'
Foundation
Water main/se~iceline
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
.Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed 5/~/$~ Soil rating (GPD/FF) 1.3 Systemtype
Length ~c,' Width 13 ' Gravel thickness o. 5- Total depth
Total absorption area '72 o F+~'~ Cleanout present (Y/N) '7' Depression over field (Y/N)
Date of adequacy test 7/~z/%/ Results (pass/fail)~' P~-~ for '7'
Water level in absorption field before test ~" After test '7"
Peroxide treatment (past 12 months) (Y/N)
N
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION
Well on lot I lO On adjacent lots ">/oo Property line 2 0
To building foundation ~ 2.o' To existing or abandoned system on lot N .~.
On adjacent lots > 3o Cutbank N.,~. Water main/service line I¢'w
Surface water ~ /oo' Driveway, parking/vehicle storage area ~T/)~oe~ ?¢ ~ ' F~o~
Curtain drain NONE OI~SE~VEb
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
HAA Fee $
Date of Payment
Receipt Number
72-026 (3~93)' Sack
~.~,',. CE - 3589
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date /.Z.. -/2' -g"7
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b)
(c)
(d)
Properly Owner '~-'~/~]' '.~¢r~/"//'E~ Telephone: Home
Mailing Address ~
Lending Institution ."~. ', ~//'~¢/,,~/~"'- Telephone
Mailing Address //'~ ./
Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the followina address: or: Check here [], if hold for pick up.
List contact person and day phone number below.
2. TYPE OF RESIDENCE
Sin gle- Fa mily".~
Number of Bedrooms
WATER SUPPLY
Individual Well ~[. Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status,
SEWAGE DISPOSAL
Onsite"~' 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 Front
NOI.LNVO
'9
.g
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description:
1987
RECt IVED
WELL DATA
Well Classification
Well Log PresentON)/
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduitl~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
~)~///¢-¢--~ If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ ~/'~ ~'~' Yield
Cased to ~'~'~' Depth of Grouting
/~ / Pump Set At
~ ~ Sanitary Seal on Casin~)
Depression Around Wellhead (Y~
; On Adjoining Lots
To Nearest Public Sewer Line
Oleanout/Manhole
Water Sample Collected by
Water Sample Test Results
To Nearest Edge of Absorption Field on Lot /¢"~ ?~' ; On Adjoining Lots
A)/~ To Nearest Public Sewer
.//,4 To Nearest Sewer Service Line on Lot
./¢zvb/,~/,¢'' )).~JZZ/,~/~ ; Date /'~- ¢ -~*'7
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipe.~_~N) Air-tight Caps.)
Depression over Tank
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
~'%/~' Size / ~--~"-O No. of Compartments
Foundation Cleanout Y~'?)
Date Last Pumped (¢~ ,'~///~' ,
~J'//¢ ;for / d/
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line /O
Course , /¢'~ "'~
To Building Foundation ./~'
To Disposal Field ? ('.~'.~7-' ~
To Stream, Pond, Lake, or Major Drainage
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 (~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /¢"o ,,./-
To Building Foundation
Lot ,,~/'/.,4
To Water Main/Service Line /o
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(~4)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutbank (if present)
LIFT STATION
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
~ Vent (Y/N)
P~eq~acy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
, certify t hat I h.~.~ch.,~ed~, v,~rified, or conformed to all MOA an.d.. HAA guidelines in effect on the date of this inspection.
Signed ~ ¢ ' *~//'~"-"~ Date /"~
Company ,,'¢~'¢-5 MOA No,
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72 026 fRev 8/861 Back
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON REVERSE SIDE £EFORE COLLECTING SAMPLE
Commercial Testing & Engineering Co.
Environmental Laboratory Services
5633 B Street
Anchorage, AK 9951 8-1 600
Tek (907) 562-2343
Fax: (907) 561-5301
MUST BE CO-MPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D. # t ltllll
it~ PRIVATE WATER SYSTEM
[] Send Results [] Send fnvoice
SAMPLE DATE:
Month Day Year
SAMPLE TYPE:
~' Routine [] Treated Water
[] Repeat Sample (for routine sample, "~ Untreated Water
with lab ref. no. )
[3 Special Purpose
SAMPLE LOCATION
Time Collected
Collected By
[:3o CHRIS
TO BE COMYLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Safisfactop,.'
El Unsatisfactory.
Sample over 30 hours old, results may'
be unreliable
D Sample too long in transit; sampte should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special dglivery mail.
Date Received 7//- 7
Tin~eReceived ~ U 1 1~94
Analysis Began
Analytical Method: ~ Membrane Filter
[] MMO-MUG
* Number ofcoloines/100 mi.
Lab Ref. No. Result*
Analyst
Client notified of unsatisfactory results:
Phoned Spoke~Sth
Date: Time;
Faxed
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Coliform
Membrane Filter: Direct Count (~ Colonies/100 mi
Verification: LTB ~x). ~r · BOB
Fecal Coliform Confirmation [~9 · ~ .
Final Membrane Filter Results ~5~ Coliform/100 mi
ReportedBy'~.{pO. {~ 0 ~ 1994 Time l,-~,J~ hfs
Member of the SG
ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA
pART Olde OF TWO:
RErlAINOER- TO FOLLOW
zTL
CT&ERef,#
Client Sample I12)
Matrix
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~j.~,~:~',~j,~,~,~-,~f,~,~',~rj~'.~fjjjjjl
LABORATORY ANALYSIS REPORT
94.3412-3
L15 BLKI SEQUOIA EST
WATER
Client Name FISATrOP TECHNICAL SRV WORK Order 80162
Ordered By TED MOORE PrintedDate 07/11/94 ~11:26 hrs.
Project Name CollectedDate 07/07/94 ~13:30 hrs.
Project// Reeeived Date 07/07/94 ~ 14:00 lu's,
PWSD UA
TeclmicalDirector
STEPHEN C. EDE
Sample Remarks: ROUTINE SANIY'LE COLLECTED BY: CHIHS,
QC Allowable Em. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 0.89 mg/L EPA 353.2/300.0 10 07/08/94 CMR
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = Not Analyzed
: U = Undetected, Rep orted value is the practical quantification limit. LT= Less qthan
.~ D = Secondary d/I. ution. Gl'= Greater'l'han
5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
CHEM1CAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Reportifor 1fetal Coliform Bacteria
TO BE COMPLETEDtBY WATER SUPPLIER
'1111111
E] PUBLIC WATER SYSTEM I,B,# '
)~' PBIVATE WATER SYSTEM
/;/1~,',~, ~ ,/%, ~ Ii, ~,,, 4' £,¢~-, p?,~. ~.~
Name ~ --- /' Pho'ne No.
City
State
Day Year
?
SAMPLE TYPE:
~9' Routine
[] Check Sample (tot routine sample
with lab ref. no.
[] Special Purpose
) [] Treated Water
~2 Untreated Water
SAMPLE
NO. LOCATION
3 I J
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analy"sis shows this Water SAMPLE to be:
'~/Satisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Please send
,new sample via special delivery mail.
Date Received
Time Received
Analytical Method:
Membrane Filter
No. of colonies/100 mi.
·
Lab Ref. No. Result*
I
I
I FTq
I
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS, Membrane Filter: Direct Count
(~ Coilform/10Oml
BEFORE
COLLECTING SAMPLE
Verification: LTD
TNTC = Too Numberous To Count
OB = Other Bacteria
PART i OF 2
BGB
Coilform/lOOml
O.e_ /~.h/cC
Time: ~%~_ a,m.
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
,~/"L.~.'o~,~,~,~'"~ FEDERAL TAX ID # 92-0040440
/~tlAL%IS l~g['OI!T B? S[I.~PLE
Client EJ~r~pl iD: LT 15 gl',E I SI~OUO[A 1LS'ITCgS 12-%87
Snn!pln ~,~ec'd : I)IiC 9 87
Order'ed By : A.D.
Seiid
[fork Order Ho. : 4260
Client Account :
Bate Report Printed: OkC [[ 07 ~ 14:40
l/eleasecl B? : 2
Address ~2
PO i~O× 110496
~pe¢ia{
inskuct:
Allouable
l~aralet er Tented P, esul t/Units [,lethod Limits
NITf4A'I'I¢I] O .67 ~n¢l tO
l/nnlark:~: ANT~[,YSiS COiIPI,~,I'EB: 12-9.87
I }'nots Per¢ornted ~ See Special Inptructions Above
NB= None Detected ~ See San]plo Remarka Above
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.
Name of Firm '/:'/~/-/~,p
Address / Y.5' ~2
Engineer's signature
DHHS SIGNATURE
5"'/" Approved for b~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Depadment of Health and Human Se~ices (DHHS) issues Health Authority
Approval Ce~ificates 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 cou~esy to purchasers of homes
and their lending institutions in order to satis~ cedain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a ce~ificate 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 & 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
ParcelI,D.# g2t'7 - 15'2-- - /%
HAA# Id-/) ~ ~2 .~-~ ~/
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner ~/z %./ ~ /'~'~%. C"~,--t ~.-;,¢~/ Day phone
Lending agency
Mailing address
Agent ¢onn/(
Address '~ 2d,/
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~/
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
D, LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / ~'~'
Absorption field on lot
Public sewer main ~, /I-.
Sewer/septic service line
Size in gallons
"Pump on" level at*
Engineer's Name
Date ~'c~ ~ ~,
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
"Pump off" level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~' Property line ~ 7' Absorption field ,5-j
Water main/service line ~ lo~ Sur[ace water/drainage '~ lc, o' Wells on adjacent lots '~ too,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
,/r e 9/¢¢\
Property line d' (.._~.~.,~ ,¢',rr ..' Building foundation ¢-,¢' Water main/service line ~, lo '
Surface water > ! ~,,o ' Driveway. parking/vehicle storage area I '
Curtain drain /,/o,o~ $ ~ ~',~ Wells on adjacent lots '> I o,~ '
F. ENGINEER'S CERTIFICATION "
I certify that I have determined thru field inspections and review of Mumclpal records:that, the abo~¢ systems are
In conformance with MOA HAA guldefines in effect on this date. , < ~, ' ; ,,. ¢,. ~'
HAA Fee $ /',/, ,'~.
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 * (907) 343-4744
Legal Description: /.-.¢,/ 1,5-.
A. WELL DATA
Well type
Log present (Y/N) "f"
Total depth "~
Sanitary seal (Y/N)
Health Authority Approval Checklist
G/kc I.~ -('~.o;¢t /~'~-.('~. ParcelI.D.: O/ '~ -/.ff~-- /..5--
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
199'
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 7 /
Cased to '~- ~ ' Casing height (above ground)
Wires properly protected (Y/N)
AT iNSPECTiON
'~.,f g.p.m. '~ '7' g.p.m.
Coliform ¢) col
Date of sample: ,,5"1¢--Y/~0
B, SEPTIC/HOLDING TANK DATA
Date installed ,5-/!/B~ Tank size
Foundation cleanout (Y/N)
DateofPumping I,¢ / ~ /q¢
C, ABSORPTION FIELD DATA
Date installed I~ / ~-/¢¢
Length ff 7' Width
Effective absorption area
Nitrate /, ~.3 ~-~,¢~ /~'
Collected by:
Other bacteria
/~5-0~/~ Number of Compartments ~ Oleanouts (Y/N)__
Depression (Y/N)
Pumper
Soil rating (g.p.d./fF or ff~/bdrm)~.~ ~'. q.~ System type '7-~e-~cfi
~, .5" Gravel thickness below pipe 7, '/' Total depth
Monitoring Tube present (Y/N) Y' Depression over field (Y/N) /V
Date of adequacy test M.A.
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
Pe~'~(ide treatment (past 12 months) (Y/N)
Results (Pass/Fail) ?a.~. For ~
Immediately after gal. water added (in.):
Absorption rate = .g.p.d.
If yes, give date
bedrooms
72-026 (Rev. 3/96)*
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.
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
LeAding agency
Day phone
Day phone
Mailing address '
P~.? /.ce/I,/
Agent ~'~.'~; c ?ro~,-~.~./ ,"F~7.~' ~'~',~,~/z,~ Day phone
Address ~111 "c " _C/~..j ,,~-,~c~c,~:~.~',
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.
4. 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.
72-029 (Rev, 1191) Fronl MOA
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. [ 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 F'/~/-Yo/¢
Address /¥.~-,.~0 ~:c/4~ _C/> ,,~'/~c/~o~'~,J~ .,~ ~¢5-/~,.~
Engineer's signature
DHHS SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: ~//~ /-/C/- /~ Date //-/0~
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 engineef's work.
RECEIVED
· . OCT08 1999
MunicJpahty of Anchorage MUNICIPALITY OF ANCHOP. A~IJlJ~'~
DEPARTMENT OF HEALTH & HUMAN SERV~I~i~NMENTAL SERVICES DIV~
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A. WELL DATA
Well type DP' ~'¢ (~-
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Health Authority Approval Checklist
/..o/" 157, rJ/ocl</, ~'¢?,.,o,~ H.~½, ParcelI,D,: O/ '7 -/Z'Z -/5-
IfA, B, or C, attach ADEC letter, ADEC water system number
Date completed 7//:~/Z~d'
Cased to ~- ~ ~ ' Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
B. SEPTIC/HOLDING TANK DATA
Date of Pumping I ~/t/9¢
C. ABSORPTION FIELD DATA
Date installed I 0 ,/~, / )?
Date installed --5-///~0" Tanksize IZ~-~¢o/ Number of Compartments ~ Cleanouts(Y/N)__
Foundation cleanout ~/N) c,~, ,~ b~ ¢, Depression ~/N) N High water ala~ ~/N)
Pump.
Soil rating (g.p.d./ff2 or ff~/bd~) ~, ~, ~' q~ System ~pe.
Length ~"-z' Width '2-.,-s~ ' Gravel thickness below pipe
Effective absorption area c2¢ / ~' Monitoring Tube present (Y/N) 'r'
Date of adequacy test /v,.4, ('N~r~)__Results(Pass/Fail)
Fluid depth in absorption field before test (in,); O Immediately after
Fluid depth (ins) Minutes later:.
Peroxide treatment (past 12 months) (Y/N) M
'7, ~ ' Total depth I
Depression over field (Y/N) _ A/
For
gal water added (in.):
Absorption rate = ~ ~C.P g.p.d.
If yee, give date /,,/./4.
bedrooms
72-026 (Rev. 3/96)*
D. LIFT STATION /"J' ~'
Date installed
Manhole/Access (WN)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot I .~' '
Absorption field on lot I 1.5- '
Public sewer main /'J. ~.
Sewer/septic service line '~ ~.5-'
Size in gallons
"Pump on" level at*
*Datum
. On adjacent lots '~ !oo ·
On adjacent lots ~> r~,o '
Public sewer manhole/cleanout
Lift station
Wells on adjacent lots
"Pump off" level at*
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation I $- ' Proper'b/line ~. 7 ' Absorption field
Water main/service line ~. /o' Surface water/drainage ~ ioo '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Proper'b/line ~" Building foundation ~ ~'
Surface water '~- ~ o o '
Curtain drain ~'~ ~' 5 ¢~'~
Water main/service line
Driveway, parking/vehicle storage area /'
Wells on adjacent lots ~ /oo '
ar~
F. ENGINEER'S CERTIFICATION
I certify that I have determined
in conformance with MOA HAA guidelines in effect on this date.
Signature '~~ '~.
Engineer's Name --7"/~ co ~./o ~-~ F~. /~oo ~_
Date ~'c~/-~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
ReceiPt Number
05-30'00 13:19
FROM'CTE ENVIRONMENTAL 5615301 T-54Z P 03/03 F-Z65
CT&E Environmental Services Inc. ~~ ~O~:
Laboratory Division ~~~~
Drinking Water Analysis Report for Total Cohform Bacteria
READ INSTRUCTIONS ON REVERSE SlOE BEFORE COt. LECTIN6 ~;AMPLE
MdST BE COMPLETED BY WA~'ER SUPPLIER
PUBLIC WATER sYSTEM IDi~
PRIVATE WATER SYSTEM
- Treate~Water
.~ UntreetedWater
)
SAMPLE DATE
SAMPLE TYPE
'f, Routine
Repeal Sample
(refer to lab no,.
Special Purpose
BACTERIOLOGICAL WATER ANAY$1~
200 W. Porter Drive
Anchorage, AK 99518-160§
Tel; (907) 562-2343
Fax ~907) 561,5301
Time Recowea:
TO BE COMPLETED BY LABORATORY
£.24 .,~o
/.¢o0
MMO-MuG
LaD Ret NO
Client notified of unsatisfactory results:
RECORD
ColOr"he$1100.1{
COt. IFORM
05'30'00 13:1g FEO~CTE EHViRO[~UENT^L
~l.t~ CT&E Environmental Services Inc,
551530i T'54Z P.OZ/03 F-Z65
CT&£ Ref.# 1002467001
Cli¢at Name Flattop Tachnical
Project Name/# L ] 5, B 1 Sequoia Est
Client Sample ID L 15, BI Seqaoia Est
Matrix DrYing
Ordered By
PW$1D 0
S~pl¢
Client POn Pre. Paid Colis~i03
Printed DatefFime 05/30/2000 11;o,8
Collected Date/Time 05/24/2000 13:30
Rceeive~l Date/Time 05/24/2000 15:00
Technical Directur Stephen C. Ede
uATER$ D£PT
1.23 0.500 n~/L EPA 300.0 10 max 05/g4/OO SCL
MICRO LA8
Tota~ CoLiform 0 ¢Ol/100~T~- SM18 92228 0S/24/00 ZAP
OCT-O?-gg 1~:54 FRO~-¢TE ~NVI~ON~NTAL
5G15301 T-~O5 P 05/0~ F-27~
Zt~ CT&E Environmental Services Inc.
Laboratory Division .are
Drinkin§ Water Analysis Report for Total Coliform Bacteria
200 W. Potter Drive
READ iNSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING '~AMP~.E Anchorage. AK 9B518-1605
Tm {907) 562-2343
Fax (907} 561-5301
MUST BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM IDI~
PRIVATE WATER SYSTEM
SAMPLE DATE .L...c~ .._o..y_ _.¢_ ).
SAMPLE TYPE:
'-/ Routine Treated Water
Repeat Sample ._ LIr~tfeated Water
(refer to lab no.~ )
Special Purpoee
Locabon toilette{3 from: CollectS: Oy Onillal):
BACTE~OLOGI Ag WA ANAYsI8 RECORD
MMO-MUG Re~ull: To~al Coliform .~
Verification: LTB ~GB __ COMFOR~
Sent ~ ADEC ANC F~K JUN
Client notified of unsatisfactory results:
OCT'O?'gg 17:$4 FROM'CTE ENVIRON~NTAL
Zt~ CT&E Env,ronmenta, Services Inc,
T-T05 P OZ/O? F-2?6
CT&E Ref,# 995428001
Client Name Flattop Tectu:ucal Sty
Proj ecl Namely N/^
Clien~ Sample ID Lot 15 Blk 1 Sequoia Esl
Matrix Driaking Water
Ordered By
?WSLO 0
~ample Remarks:
Clienl PO# Pre-Paid Colis/NO3
Printed D~te/Time i0/07/99 16;03
Collee/:ed Dale/Time 10/04/99 14: Io
Received Datel'Pime 10/04/99 16:55
TechMcal Dire~'t, orj~$tephen C. Ede
0.500 mg/~ EPA 300.0
10/0~/~9
10 max
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, ALaska 99519-6650
http://www.ci anchorage.ak.us
Flattop Technical Services
ATTN: Theodore E. Moore, PE
14530 Echo Street
Anchorage, AZ( 99516-0000
September 30, 1999
Subject: Waiver Request for SEQUOIA ESTATES BLK 1 LT 15
Waiver # WR990076 Lot Line Request for Parcel ID 017-152-15
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 2 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 fi-om this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely,
Civil Engineer I
On-Site Water Quality Program
ocr a~, 9'~ 17~5d FRO~'I= TO=9345t355 P,qGE~FJ?
NORTHERN TESTING LABORATOR'IF..S, INC,
Master Bath Tub
Sequoia Estates, Lot 15, Block 1
A163909
Water
Bmee Robson, P.E.
1904 8 Sarichef Loop
Eagle River, AK 99577
Chenl FD:
Cliem Project #:
NTL Lab#:
Sample Matrix:
(907) 456-3116 · FAX 4S6.3129
1907) 3494000, FAX 3494016
[go?l 659-2145. FAX (159.2~46
Report Date: 9/28/99
Date ~vod: 9/23/99
S~ple Date: 9123199
Staple T~e: 12:50
Colle~ed By; BR
M = M~
= Ab~ MCL
D = Lo~ To
Date Date
Method Parameler Uaila Result M'RL Prepared AnalyzeSl
SM 4500 NO3 E
Nitrate. N mg/L 5.29 0,50 9/27/99
Chemistry Supervisor
N0,R?HERN TESTING LABORATORIES, INC,
i~O~ ~ ~C~0~O0~~'~ ~ n .S. nnqTn 5 TLR~%ETN U E FAIRBANKS, ALASKA 99701 t9071456-3116' FAX 456.3125
ANCHORAGE, ALASKA 99518 (907} 349-1000 ' FAX 349 1016
PRUDHOE BAY, ALASKA 99734 (907) 659 2145 * FAX 659-2146
Gary & Mary Cartwright c/o Brace Robson
6700 Gtmnison Drive
Anchorage, AK 99516
Arm:
Client ID: Master Bathtub Tap
Client Project #:
Source:
NTL Lab#:
Sample Matrix:
Comments:
Sequoia Estates, Lot 15 Block t
A162809
Water
Report Date: 8/19/99
Date Arrived: 8/13/99
Sample Date: 8/12/99
Sample Time: 18:40
Collected By: Robson
** Legend **
MRL = Method Repovi Level
MCL ~ Mac Contaminam Level
B = Present In Method Blank
E ~ Estimated Value
M = Matrix Interference
H = Above MCL
D = Lost To Dilu~on
Date Date
Method Parameter Units Result MRL Prepared Analyzed
SM 4500 NO3 E
Nitrate-N mg/L 0.82 0.50 8/17/99
Reported By: Stephanie K. Co~vling %
ChemisU'y Supervisor