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HomeMy WebLinkAboutSILVER CREST BLK 1 LT 7Silver Crest Lot 7 Block I #015-062-29 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page DEPARTMENT OF HEALTH AN[) 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: S ~ R,.~q::~ ~ ,5"'¢ PID Number: ~~ (~ ~ .~'~ ~m~: ~y ~ A h~ ~c~ ~ .Wastewater System: D New ~ Upgrade ~"~: ABSORPTION FIELD Phone: ??~'t ~S~ ~No olB~drooms ~ Deep Trench OShallowTre~ch OBed ~Mound OOther TOwnship: IRango:~ ]Section: F,I ,dde aboveoriginalg,ade: Gravellength: WELL: e~B T D New ~ Upgrade ~~. Ft. ~ -- Ft SEPARATION DISTANCES ~s~tic u Ho~a~9 u S.T,E.P. Material: Number of Compartments: Water ~ ~ ~ ~ ~00 ~ Line ~P J IO ~ -- -- Foundation S1' lO' -- - _, pu,r,p o,¢.,eve, at: i,,Pump ofF, leve, at: ~ High water alarm at:, I Drain I BENCH MARK Remarks: ~,/~ h¢~ ~ ~l/e~ I ENGINEER'S SEAL Inspections performed by: ~(¢t-~p %~c4 ~c Dates: lst~/8~/9 3 ¢~': %~ ~A L '~¥ Department of Health and Human Services approval ~.,'~,~ '. C~-3589 PERMIT NO: SW 930354 PID NO: 01506229 -4 SWING TIES FROM: COR"A" COR"B" TO: C,O. "E' 27' 40.5' C.C. "F" 32' 44' C.O. 'T' 10.5' 68.5' M,T,"J" 34' 74' C.O."K" 57.5' 81' PAGF 2 OF 2 NEW 50~ 'LONG SOIL A.,BS. TRENCH % ~"K" iiiiiiiiii!iiii!!iiiiiiiiiiii NEW 1250 GALLON \~. ,,.,, 4 BEDF{OOM HOUSE \, i- W E E LL . 00' PLAN VlFW '. ~'.,:OOORE ,.. ~oo~,: SCALE: 1" = 30' 'o NOTE: T. FI. #1 MONITOR TURF DRY @ 80.5' 9/23/93 SOIl. ARS. TRENCH 90.45' INV GROUND @ 99.5 1250 GAL.. SEPTIC TANK ~ 84.5' CROSS-SECTION NO SCALE LOT7, BLOOKI~SILVE~CREST S/D SEPTIC SYSTEM UPGRADE AS-BUILTINSPECTION REPORT FLATTOp TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 ISCALE: AS-SHOWN DRAWN BY TFM OCTOBER, 1993 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930354 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:STRANG JERRY A & ALISA A OWNER ADDRESS:9200 GROVER DR ANCHORAGE, AK 99516 DATE ISSUED: 9/10/93 EXPIRATION DATE: 9/10/94 PARCEL ID:01506229 LEGAL DESCRIPTION SILVER CREST BLK 1 LT 7 LOT SIZE: 43098 SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ./ ~ DATE: 9 / N ,FLATTOP CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 September 1, 1993 ANCHORAGE AI~kSKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sh's: The purpose of this letter is to provide the required design nma'ative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 7, Block 1, Silvercrest S/D, located at 9200 Grover Drive. The present soil absorption trench is no longer able to accept the flow of wastewater from this 4 bedi'oom residence. Soils logs, pete test results, a site plan, design di'awings 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 8.5' and 18' below ground level is a unifol~:n sand with a measured perc rate of slightly less than 1 minute per inch. Because the native material is sand, there should be no need to import additional sand to use as filter material. Using the soil application rate of 1.2 gpd/sq, ft. specified in the wastewater ordinance for soils with a perc rate of between 1 and 5 minutes per inch, this 4 bedi'oom residence mquh'es a total absorption area of (4 x 150)/1.2 = 500 square feet. The proposed 50 foot long trench with 5.5 feet of sewer gravel has a total absmption m'ea of 550 squm'e feet. Because the sand st~'atum is encountered at a relatively deep depth, the proposed design calls for the bottom of the sewer gravel to extend to 4 feet above the bottom of the test hole. The enclosed well log indicates that bedrock in this m'ea is at a depth of greater than 176 feet, and that the sand extends to a depth of approximately 50 feet. The topography of the lot slopes gently towm'ds tile east at approximately 3% No other wells or septic systems are within 100 feet of the proposed upgrade site. The proposed project will have no impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any impact on resmwed space/sm'face and subsurface, or on di'ainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. / GROVER DRIVE TRENCH-TOBE ~k?:;~ ,,, ~ 1Ir / / 27~s 20 40 60 80 170 ~,~'~,. FEET ¢ ~ '. CE- 3589 ,' ,¢ ~ .... ~ ~ ~;._. ......... ~,, LOT 7, BLOCK 1, SILVERCREST S/D WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPT. 1993 NOTE: THIs IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. SOIL ABSORPTION TRFNCH 50' PLAN VIEW 1"=10' F-810 ASTM ~ .... D-3034 t//---DOUBLE C.C. ~50 GALLON PTIC TANK 3 .KFILL FABRIC SEWER GRAVEL SECTION "A-,A" 1' =-:5~ LOT 7, BLOCK 1, SILVERCREST S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOi'TECHNICAL SERVICES SCALE: AS SHOWN 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 1993 NOTE: THIS IS NOT A SURVEYED P[J~T. ALL LOCATIONS SHOWN ARE APPROXIMATE. Flattop TechnicaI Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Lot 7, Block 1, Silvercrest S/D 9200 Grover Drive Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandonment of an existing septic tank and soil absorption treuch and installation of a new 1250 gallon septic tank followed by 50 lineal feet of soil absolption trench with 6 feet of sewer gravel. 1.2 Consu'uction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or requh'ed by tile engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in confolrnance with Municipal requirements, unless specifically waived. 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 ensm'e that propel' di'ainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to u'ees 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 m'eas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank is to be properly abandoned by thoroughly pumping, removing its top and backfilling with soil. 2.2 The new 1250 gallon septic tank shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with watmproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, mid the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" 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. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 50 foot long trench to a depth of 14 feet below the original g~'ouud level 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 6.0 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated disu'ibufion pipes laid level such that the pipe inverts are no less than 5.5 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. 3.7 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. 3.8 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading, placement of topsoil and seeding after the backfill material has stabilized. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the conn'actor 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 infiln'ative 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 filter fabric, and (4) after final backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently fat' in advance to ensm'e the availability of the engineer. TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 7, Block 1, Silvercrest S/D DATE PERFORMED: August 20, 1993 PERFORMED FOR: Jerry Strang DEPTH (toot) Pt 1 - SM I>.eddish sandy loam 2- 3- GM Tan, silty sandy gravel dry SLOPE SITE pLAN WELL SP Brown, uniform medium sand (becomes fleer with depth) Depth to Groundwater Date None 8/20193 M.T, Dry 8/2~7j93 Reading 12" Presoak Add water Slart Add waler #2 Add water #3 Add water fl4 Clock Net Time Percometer Net Drop Time (minutes) Reading (inches) 10:20 27 3/8 10:22:15 21- 10:23 27 1/4 10:24:30 23 3/8 10:25;30 1 21 1/2 1 7/8 10:26:00 23 1/2 10:27:00 1 2178 ___ I 5/~ 10:27:30 23 3/8 10:28:30 1 21 5/8 ! 3/4 10:29:00 23 5/8~ _10:~30:00 1 22- 1~ 5/8 PERCOLATION RATE < I (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ]0,5 FTAND Il.0 PT COMMENTS: PERFORMED BY FLATTOP TECHNICAL SERVICES. I ,~'~'.~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON rillS DATE. DATE: ~__~.~/_._/_?_ .~._ ............ TEST HOLE FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: DATE PERFORMED: Lot 7, Block 1, Silvercrest S/D August 20, 1993 PERFORMED FOR: Je]Ty Strang DEPTH (loot) Pt GM Tan, silty, sandy gravel GP Sandy gravel(dw) SM Gravelly, silty saad (Pockets of Si>) SLOPE WELL SITE PLAN 17 18- 19 COMMENTS: Depth to Groundwater Date None 8/20 M.T. drDL 8/27 Reading Clock Net Time Porcometer Not Drop Time (minutes) Reading (Inches) PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 'TEST RUN BETWEEN FT AND FT ~"'~¢.~ ~..¢~¢'-,,'(~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY FLA'FrOP TECNNICAL SERVICES. AOOORDANOE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~" Hea ~UNICIPALITY OF ANCHORAGE and Environmental Prote, Jn Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 ............... INs'h-ECTION REPORT ON-SITE SEWAGE DISPOSAl,, SYSYEM SEPTIC TANK: DISTANCE ~ pROM WFLL L~'~ NUMBER OF COMPARTMENTS INSIDE" ' ~ . ,VID]II__ _ ~_ LIQUID DEPTH ...... LIQUID CAPACITY--~--~mLLONS, ~'/~/,Z ,// / TOTAL LENGTH / DISTANCE FROM WELL')~[._FOUNDATION ~/ NEAREST LOT LINE_~~ ...... OF LINE ~ of Lines -- l ...... DISTANCE BETWEEN LINES ~Z~._ TRENCH WIDTH:S~IN. TOTAL EFFECTIVE / [)EPTH OF FILTER SEEPAGE PIT: DIAME'FER .... OR WlDTtt___, LENGTH DEPTH Log Crib Rings BtJtLOING FOUNDATION ..... Crib Size: DI;\tvlE'I'ER .... DEPTI4_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE_____ A£~,SORPTION ARIiA (WALL AREA) SQ. FT. Well Class:_ Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~,_~ ~t of Bedrooms: __'Z./I - Installer' ' ~ ' Remarks: ' ~ ~--~"~ -- ' M-W ,,DRILLING, DRILLING LOG Dom. Well Owner ,~i:(~.phe,~8 Ccm[~ tr11¢:ILio t ~Use o~ Well · Location (address off Township, Range, Section, if known; or distance main road Lot 7 Block ].,:~.~c.~,~,..~. Crest 6" l 7 6 Zeet , Cased. to_ l ? 5 feet ............... Size 9f casing__~__Depth of Hole - - Static water level ~JtO ft. (:lI~'~e) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at ]l'O0'Fgallons per ](}Ibllr)( of drawdown from static level. (minute) for 1 hours with 100% Date of completion :) / 2 ~: / 7 7 xx ); Depth in feet from ground surface · 0 .... TO 2 _TO 5 TO '/ 7 TO 1.5 1, 5 _TO 55 50 _TO · 55 TO_ 70 70 _TO. 89 89 .TO 100 115 _TO 1.50 __TO il 76 TO WJ~LL LOG Gi~e details of formatioue penetrated, size of material, color and hardness (aaing sti¢:kup Fi!'L O[~ganics Loooe grave]. Sandy graktel ''.. Sil ~:y ~r,avaJ ..... _Si].tV f,:r ave J. - Cl. ay and gravel, m:l.xed PISI<'.M J. T IqO. I FI~. OF .=,_ :I.L t L_CE~.E ...... I'l =,~.:., IL.II 'IP.E]qC:H iVll::~:qIl','ll.IM I'~L.II'II::,EI.. Ol': IBE])Ii~!Cu]Ii'I~E~; = 4- :,..J.l... 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M IT"I'KE":'E:; OP'I ION SLJD,:~E[::'I I'O f'I"IE F OI...L..I.31,.I 1 NEi C:OI',![) I T i ONE;: fL.. IEI'IHI:::F~'. FI CI_FIS:,S I OP. i1 N'.~t':' I::IPF'I:':'XY',,'[~]) F'I..I::IIqT I'"lF:l't' BE INSFFII-I..E[;'. FI (::(liNT :1: NI. JOIJ:::; I'flFt I i"4 FE]",IFINC:Iil; FIEif4'.EEE"MEN '1' I ';~; E.".Ei;li:!lJ I I;~'.ED. FIE:iPJ:£1:::MI:~IqI' iS; I'"lorl' I'(I.:i:F'T I]:l. Jl:;f.l~:Ei'r~'t' YOU t"'IFI'-? BE: F.:EL.:!I.JII:,.".EiD TO .b:NLIZlF,'.GE~ FIE*,'.i~OI~:I:::'I'ION 5;'t':iEFl'L-]"t F:IND,.."OF~'. MOU MFI"/ Ei:E: .'SUB,TEE:] I'O MUM D I E;'I'I:::INCE [i~[~:'I'!.,.IE~IEN F:t !.4E:L.I... FIN[:) F:II',IM ON-S I '1 [£ SE:P.IFIGIE D ]: SF:'O~;FIL :E;'~.'t~;-I'b.M I ~; I:::[!~[£~ F:OK'. I:~ F'l:;~'.]i~,,'l::]"l'l~ P~EiLI.. 0t~'. ;[:~Cllli~i FIEE'I' 14'l]ll~: FI PI. JEfl..tC b~EiI..I ..... PJEL. I_. I.(3(:!i!S FIRE: F~'.EX::!I..IiF:.'EIi:, FIND MIJSI' E;li.:. I~'.IC'I'LII:.~'.NE;D '10 "i'HIE I)EF'F:II-,.".Ti"IISN"I I.,.IITHIN SCi [:,I'::IYS i'HE: I,.I[FJ..L. I]:OMl.:t.,~i: F ~[ O i1"1[:]:~'. I.;;'.I:/(;!LI]:F.:E:ML:J",IT~E:; Ml:'"'l"r' FII-':'I':'L.'-,". :'SI::'Ii'JI::}IFiCFfI'):Cd",IS laH[) CCIN!E;'I'RIJC]'ICIN IJ:':LFIJ}iR~Fli"IE~ t'qVI::'III..F:IBLE 'I'CI II",I::::~U[;.'.[::: Pf~'.L'IF:'HJ'?. IbI'.:i:~I'FII...L[:ITll]Ii",L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATF OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner _'-I~r,r.( Mailing address ~z.c~_~ ~ ~-~/.~r~ L. ending agency Day phone .3 L~G -.2.~.% 7_. Day phone Mailin. g address Address ' Day phone AT,-A76 J Unlessotherwise ~quested, HAA willbeheldforpickup. NUMBER OFBEDROOMS: ~/ _ TYPF OF WA'rER SUPPLY: Individual well Community well Public water NOTE: If commtlnity well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. · rYPl= 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-O25(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. NameofFirm ['~¢]0~4 ~---~/~O¢'~,.LA.H.~ '~-~:, Phc~ne ~¢--'~c~ Address 0~..O~ ~ l~--/~¢1 ~,~.o_'-~ ,~-~t¢-~. /~,'~ ~-OI Engineer's signature Date DHHS SIGNATURE /"'"' Approved for Disapproved. Conditional approval for bedroon~s. bedrooms, with the following stipulations: Additional comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeYs work. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 MAR 'l ~ 2.000 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us MUNICIPALITy OF ANCHO,~AG~ (907) 343-4744 .... '>~"qMI~NTAL SEI~VICES HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ~ _ Date completed ~/¢~7 Total depth 1'7 ~' fi If A, B, or C provide PWSID # Sanitary seal Casedto _/7~)~'_ ft Date of test FROM WELL LOG Static water level * S-o Well production I WATER SAMPLE RESULTS: Coliform ~) _colonies/100 mi Date of sample: B. SEPTIC/HOLDING TANK DATA ft g.p.m Parcel I.D.: Well Log Wires properly protected '7/ Casing height (above ground) _,~ ~_ in. AT INoPECTION g.p.m Nitrate _~.~.o mg/I Other bacteria. Co,eoted by: colonies/100 mi Tank Type/Material _ ~ o Date installed ?~a/~'.'~ Tank sizef/~ .~c~ gal Cleanouts_~/ _Foundation cleanout ~2/ Date of pumping ~1~,¢/ C. ABSORPTION FIELD DATA Date installed ~'/~'///¢¢ Soilrating (g.p.d./ft2er~) Length .~'O ft Width ~ ft Gravel below pipe _ ~., jt Total depth_ /~7/.ft L:ffective absorption area ~,~oft2 Monitoring tube Date of adequacy test ~"3//o7//~¢/ Results (Pass/Fail) '7> Fluid depth in absorption field before test ~ /! in Elapsed Time: ~/~-e~ Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) Number of Cornpartments Depression over tank _~ High water alarm Pumper 1 J~ ~o~ c_ ~. System type . Depression over field I~ For_ ¢ _ bedrooms Water added 5"o~:% gal. New depth. ~ ~ in. j/__in Absorption rate >= ~oO g.p.d. ~'~ If yes, give date ~ 72-026 (Rev. 0U00)' DJ LIFT STATION Date installed "Pump on" level at Datum in E. SEPARATION DISTANCES ,,SriZe in ga,l, lons. ~........--'"'~nhole/Access Pump__--at in High water alarm level at __ in Cy, pie'~rtested Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: SePtiC tank/lift station on lot I 0 c/ Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots J 0.5 "h On adjacent lots I o.~ '1~ Public sewer manhole/cleanout Holding tank N~A- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation ! ! Water main N///A- ~ Drainage 14 J 0 Property line L,LD Water service line .~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~[~f Building foundation J E)~ Water Service line ) ~ ~ Curtain drain f'J Io Absorption field Surface water Water main ~'~//~ Surface water I,.~, [ c:~ Driveway, parking/vehicle storage Wells on adjacent lots ~. I bo F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev, 01/00)' 03-11-00 13:32 FRON!-CTE ENVI F~ON~!ENTAL CI'&E Client Name Projeet Nsm Malri~ !000942(301 Tobben Sparkland P.E. Lot 7 Bk 1 Silver C~¢sI Lot 7 Bk 1 Silver Crest Orinkkng Water Pri~/¢d D~e?£imv Collected D~tcJTime Recvived Date/Time Pre-Paid Colis.rN©3 03/10/2000 16:56 03/07/2000 13:15 03/07/2000 14:00 Ordered By Technical Dir¢~zr Stephen C. Ede 0.500 u 0.500 mo/i- EPA 300.0 C<lOb O?;j'O?/gO SOL Time DEPARTM~ 825 Date Insp 2- '-78 Monday Pr~ ~t MUNICIPALITY OF ANCHORAGr,~ OF HEALTH AND ENVIRONMEk ,L PROTECTION L Street, Anchoraae. Alaska 99501 264-4720 ~::,~Y,~ Date Received: February 22, 1978 Date .~.J-7~ ~. Date Insp :~,4 Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending InStitution Request: Mailing Address: Phone: 2. Property Owner: Stephens Construction Mailing Address: 21601 East 84th Court Phone: 349-4675 3. Legal Description: Lot 7 Block 1 Silver Crest Subdivision 4: Single Family Residence: ( ~ Number of Bedrooms: Four Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit # Construction Individual Well ~ Community/Public System ( ) Depth of Well 176' Well Log on File Bacterial Analysis 6. Sewage Disposal Permit # Septic Tank Size Absorption Area System: On-site System ( ~ Public Utility Installed Installer Manufacturer Soils Rate Material ( ) Distances: Well to septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 7 Block 1 Silver Crest Subdivision Comments: Affadavit Attached Approved: ]Disapproved: Letter Attached: ( ) Date: Department Worksheet: '" ~5~equest for Approval of Individual Sewer ana Water Facilities 2~ Name of Buyer: Mailing Address: Phone: 3. Lending Institution: Mailing Address: Phone: o ~e ._ ~k~~ Phone: Mailing Address;~_k~_~ ~-~ ~ Street Location: %, C~.> ~ t~ k m~_~L_ Single Family Residence: ( ~/~Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply:~ *Individual Well (w'~ Public/Community System ( If Individual Well, well depth ~Q~ If Co~nunity System, name of system 8. Sewage Disposal System: *~On-site System ) Public System ( ) If On-site System, date of installation: *NOTE: A well log is requJ_red on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77