HomeMy WebLinkAboutSILVER CREST BLK 2 LT 4
~b':'IICIPALIt¥ 0[: ANCl4ORA(~[
'~'iRONMENTAk 81~RVldl-"8 DIVISION
Municipality of Anchorage Page
AUG 1 6 1996 DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
DIV.I 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
- ~n'~it~astewater Dmposal System and/or Well Inspecbon Report
Permit Number: 5~ff~Sq~ PID Number:
Name: ~0 nV ~m"fh Wastewater System: D New
· d~,~,: ~B~I ~ d~le ABSORPTION FIELD
Pho.~: S~8-r~¢ JNo. ofe~room~: i~DeepTrench DShallowTronch BBoO gMound aOthe,.~
LEGAL D ESCRIPTI O N so, Rating: 'rotal Depth from original grade:
~' ~ GPO/Sq. Ft, J ~* ~--'
Subdiv~ion: 3epth Io pipe bottom Irom ori~inal grade: Gravel depth beneath pipe
LOt: ~ Block: 8 %~lve¢ Cr~t' ~' ~ Ft. 8, / Ft.
Township: J Range: J Section: Fill added above original grade: Gravel length:
I
I
0 -t Ft. q 7
Number of lines: [ Distance between lines:
WELL: ¢~ff~ ~ New ~ Upgrade G,~vo~i~th: 8,¢ ~t. /
Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material: ~
Ft. Ft. 7~ I SQ. Ft. P
Driller: Date Drilled: ;tatic Water Level: Installer: Date installed:
Yield: I P.mp S.t ~t: C~sing Height Above Ground: TANK
GPM~ Ft.
SEPARATION DISTANCES ~ Septic D Holding C S.T.E,P,
To Septic Absorption Lift He,ding ~ublic/Pdvat~ Manufacturer: Capacity in gallons:
Material: Number of Compartments:
S.rf~c~ LIFT STATION
Water ~ tO0~ ~ loct --
Lot ~ I~' Size in gallon;~anufacturer;
Line ~ 2&D ~ -- "~
F°undati°n I~ I~ -- -- _ "Pump Oh"level at.. J"Pump cfr'level at: j High water alarm at: ,__,,
Curtain Pump Make & Model J Electrical Inspections performed by;
Drain .....J
Remarks: O ~,¢/~/ ~¢~6 ~ ~ I~e~ BENCH MARK
~ ~. ~ ~ oU~ hOJ¢~¢ ~ Locatlon and Description:
-~ ~.~, ,, '~.~ ~,
Inspections performed by: F/~ ~ ~04 ~¢ Dates: 1st ~1t319~ ~ ~ "~,~-~'"',; ,"
g ~t~4
Reviewed and approved by~ ~¢ /;~,~ Date:
PERMIT NO: SW960244
PID NO: 01506235
I\
SWING TIES:
NEW 1250 GAL.
SEPTIC TANK
FROM: COR. "A" COR."B"
TO:
S,T. C.C. "C" 21.5' 21.5'
S.T.C.C. "D" 26.8' 27'
VALVE "E" 28' 29'
DB[.. C.C. "F" 28' 30'
TR, C.O."G" 12' 37.5'
TR. M.T. "H" 37.5' 51'
TR. C.C. "1" 60' 69'
PAGE 2 OF 2
EXISTING
4 BDRM HOUSE
#2
"A" ~
L:XISTING
'FRENCH
PLAN VIEW
SCALE: 1" = 30' - 0"
NEW 47' LONG
W. 8,1' SEWER GVL,
2" RIGID INSULATION
OFTR.
3'+ SOIL COVER
NEW 1250 GAL.
SEPTIC TANK INV.
93.4'
BOTTOM T.H. #1 M.T.
ELEVATION 76.8' --
DRY 8/12/96 ~,
PROFILE VIEW
NOT TO SCALE
BOTTOM TRENCH EXCAVATION ELEV. 84.9
LOT 4, BLK. 2, SILVER CREST S/D
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
SCALE: AS NOTED
DRAWN BY TFM
AUGUST, 1996
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHOR-AGE, ALASKA 99519-6650
PAGE
1 OF 1
0l Or>
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960244
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
DWNER NAME:SMITH JOHN ANTHONY
DW1WER ADDRESS:6861 LOVITT CIR
ANCHORAGE, AK. 99516
DATE ISSUED: 8/08/96
EXPIRATION DATE: 8/08/97
PARCEL ID:01506235
LEGAL DESCRIPTION:
SILVER CREST BLK
2 LT 4
LOT SIZE: 45903 (SQ. FT.)
~XIIIMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
!. THE ATTACHED APPROVED DESIGN.
2. AL/, REQUIREMENTS SPECIFIED IN ANCHORAGE MI/NICIPAL CODE CHAPTERS
15.55 AND 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 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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.
SPEOIAL PROVISIONS:
PRIOR TO RECIEVING FINAL MOA APPROVAL ON THE UPGRADE,
A PROPERTY LINE WAIVER IS REQUIRED BETWEEN THE
DLD EXISTING TRENCH AND THE SOUTH PROPERTY LINE.
DR, COMPLETELY DECOMMISSION TRENCH AND OMIT THE
BULLRUN VALVE.
RECEIVED BY:
ISSUED BY: f~gi~
DATE:
CIVIE & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
TI[EODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 July 26, 1996 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dem' 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 4, Block 2, Silver Crest S/D, located at 6861
Lovitt Ckcle. The present soil absorption trench is operating in a surchm'ged condition. Soils logs, perc
test results, a site plan, design drawings and specifications m'e enclosed for your review.
The proposed system will be constructed between test holes #1 and ~v2. As can be seen from the soil
logs, the native material below 2 feet is predominantly sand with a vm'iable silt and gravel content. Two
perc tests both demonstrated perc rates of less than one minute per inch, however no sand filter should be
necessm'y due to the fact that the native material is sand. Using a slightly conservative soil application rate
of 0.8 gpd/sq, ft., this 4 bedroom residence requh'es a total absorption m'ea of (4 x 150)/0.8 = 750 squm'e
feet. The proposed 47 foot long trench design with 8 feet of sewer gravel below the distribution pipe has a
total effgctive absorption area of 752 square feet.
The topography of the lot in the tu'ea of the proposexl construction slopes downwards the east at
approximately 5%. To minimize unnecessary tree clem'ing, the new trench will be approximately 15 feet
east of the original trench, which is greater than the sum of the two gravel depths, so there should be no
cross leakage. A "Bull Run" diverter valve will be installed to allow future reconnection to the original
trench after it has had a chance to rejuvenate.
The proposed project will have uo significaut impact on present or future water supply and wastewater
disposal systems serving adjacent properties, nor will it have any significant impact oa rese~wed space-
sm'face and subsurface, or on drainage.
Please give me a call at 345-i355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
ABBOTTROAD
LOT 4
BLOCK 2
EXISTING
BDRM HOUSE
EXISTING
1250 GAL.
SEPTIC 'rANK
(REPLACE, IF
NECESSARY)
LOT. i' ''' "'"'"
3
WELL
150'
LOT 5
CONSTRUCTNEW
TRENCH
W. 8' SEWER GVL
#~
INSTALL
DIV. VALVE
~. I SEPTIC SYSTEM UPGRADE
\] SITE PLAN
FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 JULY, 1996
NOTE: THIS IS NO'[' A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
4" DIA, F'810 ~.-..--,'A"
PERF. PIPE ~
M.T.
c.c. --+: ......... ~ ............ _~_~ ........................... ,I'
EXISTING 1250 GALLON
/, D-3034
INSTALL "BULL RUN" /
DIVERTER VALVE
CONSTRUCT 47' LONG
SOIL ABS. 'FRENCH W.
8' SEWER GVL. BELOW
HORIZ. DIST. PIPE
PLAN VIEW
SCALE: 1" = 10'- 0"
MONITOR TUBE
CLEANOUT
3
MOUND COVER MATERIAL 12"
ORIGINAL GROUND
FILTER FABRIC
4" DiA. ASTM F-810 PERF PIPE
'-21t2"SEWER GRAVEl.
SECTION "A - A"
SCALE: 1" = 5'- 0"
~OF
EXCAVATION
LOT 4, BLK, 2, SILVER CREST S/D
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECtlNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, AK, 99516
SCALE: AS SHOWN
DRAWN BY: TFM
JULY, 1996
Flattop Technical Serv~es
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 4, Block 2, Silver Crest S/D
6861 Lovitt Circle
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of consu'uction of a new 47 foot long soil absorption n'ench with
a total of 8.5 feet of sewer gravel (8.0' below the horizontal disU'ibution pipe). The existing 19 year old
1250 gallon septic tank is to be inspected and replaced if it is no longer structurally sound.
1.2 Cons~'uction shall be as depicted on the approved site plan and design drawings. Minor
deviations from ~hese drawings may be allowed or requked by the engineer conducting the inspections.
Ali construction procedm'es and material specifications shall confolrn with Municipal and State
requirements. All separation distances shall be in confoxrnaace with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work m'ound any
buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensm'e that proper di'ainage is achieved after settlement and that there m'e no residual
depressions. Insofar as possible the conU'actor shall minimize damage to u'ees and existing lawn re'cas.
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 distm'bed by the construction.
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 ah'tight caps, allowing pumping
access to each compm'tmeot. Any existing septic tank or seepage pit which is not retained in selw~ce must
be properly abandoned by thoroughly pumping, removing the top and backfilling with soil.
2.2 If required, the new 1250 gallon, 2 compartment septic tank shall be Municipally approved and
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 bofial type, rigid insulation.
2.3 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, trod the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" pet' 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 47 foot long trench in the location
shown on the site plan to a depth of approximately 12.5 feet (8.5' below the invert of the septic tank
outlet).
3.2 The bottom of the excavation shall be level. Any compacted or smeaa'ed surfaces shall be raked to
allow proper infiltration.
3.3 A total of 8.5 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 aa'e no less than 8.0 feet above the
bottom of the sewer gravel. Sewer ga'avel shah 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
per'f orated.
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 covet' thickness is less than 3 feet,
two inches of rigid, burial type iusulation 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 12 inches higher than the
sun'ounding 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 homeowoer 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 consu'uction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be requh'ed 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. The septic tank requh'es one inspection after it is set level and the piping connected,
but prior to backfill. This inspection may be incotl>orated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently faa' in
advance to ensure the availability of the engineer.
TEST HOLE #
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
14-
15-
16-
17-
18
19-
20-
1
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 4, Block 2, Silver Crest S/D
July 18, 1996
Toey Smith
SLOPE
SITE PLAN
SM Rexldish sandy lomn
SP/SM Brown, somewhat silty gravelly seed
Many cobbles, variable silt content !~CiMNG ~/~
Becomes somewhat siltier and
gravelier below 8'
Depth to Groundwater Date
No groundwater 7/18/96
Moeitor tube dry 7t25/96
SP Coarse send
Clean, browll
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
~/18 5 gallon(ll~Ll~resoak 12:52:25 __26 1/2~
12:52:55 0.5 1_9 1/2 7
12:53:10 dry
PERCOLATION RATE <<1 (minutes/insh) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 6.5 FT AND 7.0 FT
COMMENTS; No imported filter sand should be reqeired because of tile presence of underlying SP stratam. The perc test was conducted in an
_~peciall¥ clean porfioa of the stratmn~ with somewhat slitter amterial above. To be coeservative, recommend using 0.8 gpd/sq.ft, for desiga. __
PERFORMED BY FLATI'OP TECHNICAL SERVICES. 1_~.--¢--~ '~",~",4_ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCF WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: --,7 / ~¢'~/c(ff"
TEST HOLE
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
5-
6-
7
8-
9-
FLATTOP TFCHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PEFICOLATION TEST
Lot 4, Block 2, Silver Crest S/D
__ July 18~ 1996
Tony Smith
Pt
SM Reddish sar, dy loam
SP Clenn fine sand
SLOPE
SITE PLAN
10-
SP/SM Somewhat silty
gravelly sar, d
12 - araey cobbies
Sim to T.H. #1
13-
Depth to Groundwater Date
No grouedwater 7/18/96 _
Monitor tube dry 7/25/96
COMMENTS;
SP Coarse saed
B.H.
Reading
12" Presoak
Clack
Time
Net Time
(minutes)
Porcomoter
Reading
27 3/8
Add water & start 1:36:32 23 3/8
#1
Add water
#2
Add water
1:37:52
1:38:52
1:39:12
1:40:12
--E-:~:-3~
1:41:30
20 3/4
#3
Add water
23 3/8
20 7/8
#4
PERCOLATION RATE <1
TEST RUN BETWEEN 6.75
No imported saad filter should be reqaired because the aalive material is saud.
23 3/8
20 7/8
23 1/2
21
(minutes/iach) PERC HOLE DIAMETER 5
FT AND 7.25 FT
Not Drop
(inches)
2 5/8
2 1/2
2 1/2
2 1/2
PFRFORMED BY FLATTOP TECHNICAL SERVICES. I_~j'~/ '//,,r/.o-¢.-~ CERTIFY THAT TNIS TEST WAS
PERFORMED
IN
AOOORDANOFF WITN ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: --,~ / ~-d'-//~'~
Rick Mystrom,
Mayor
Mmdcipality of Anchorage
Department of Health and Human Services
825 %" Street
P.O. Box 196650 Anchorage. Alaska 99519-6650
September 13, 1996
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject;
Waiver Request for Lot 4 Block 2 Silver Crest Subdivision
Waiver Request #WR960042, PID #015-062-35, SW960244
Deal' Mr. Moore:
Your request for a waiver of the required 10 foot separation between an on-site
wastewater disposal system and a lot line has been approved. The waived distance is 2
feet from the trench to the south property line.
This approval applies to the existing septic system lot line separation only. Any future
upgrade to the on-site wastewater disposal system will require all separations be met or
another approval from this department
If there are any concerns or questions regarding this waiver, please cai1 this office at 343-
4744.
(/~Sincerely, /7
James P. Williams
Civil Engineer
On-site Services
JPW/ljm:smith
MUNICIPALITY OF ANCHORAG~
Deparsmen5 of Health and Human Services
On-site Services Sect±on
Waiver Review Worksheet
WR~ WR960042 PID= 015-062-35
Date Received: August 16, 1996
Permit 9 SW960244
Legal Description: Lot z~ Block 2 Silver Crest Subdivision
Engineer: Ted Moore, P.E., Flattop Technical Services
14530 Echo Street, Anchorage, Alaska 99516
Applicant: John Anthony Smith
Waiver Requested: Lot line waiver of 2 feet from the trench to the south property
line.
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
Waiver is NOT Granted:
for above:
Date:
Name~k' Reviewer
Rec =: #02161/1754 Amount: S 115.00 Date Paid: August 16, 1996
HUNi[C1PAi, ITY OI" ANCHORAGN
h and Environmental Pro're: J_on
Pottrth il?IooF West
825 I, Street
Anchorage, Alaska 99501
264-4720
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I:,:'.I:i:~,:I.I::,Er,4c:IE ]:!:; I;:!IEi','IODE:L.E:I) '1'13 ]:i'.,ll::;J,,.IJl:::,t:: 1,11:::ll:~tl:: 1'1.-11-'11'.4 4,
I:::11='1:'1..'"" v ~ ~~----¢r,-.-, ~..,~ ..:[ i:~:l:,:ll,.,h~ :;:i I'I:i:I::'HIEN:~i i~::l:::li',]'.;~/I I;.:1. il::: 'i' ]: 13J'.,J
, .=.= ,::,, ................................. : .........
M-W DRILLING, INC. ,
DRILLING LOG
Well Owner .Use of Well
Location (address of: Township, Range, Section, if known; or distance main road_ Lob 4 Blk 2 ~'i' , ..... ....... ' ~ ' ' '* ·
Size of casing 6" Depth of ttole
Static water level 50 ft. (above:)
Screen ( ); Perforated (
Describe screen or perforation N/A
Well pumping test at__ O__gallons per '(t'lol:l~) (minute) for. 1 hours witk
of drawdown from static level.
].1//~/'17
Date of completion
· ti 6 LI.
6 ,., feet Cased to 4 feet
(below) land surface. Finish of well (check one)
).
open end ( ×:' );
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO 2, t,,a.u,[m., s cz(';l(.u1
2 TO 2 )',oOS (;
:1 2 TO }..5
!/J__TO 20
/,()~TO '3!)
3.[i TO (i0
60 TO (56
TO
TO
TO
TO
TO
_TO
TO
TO
2--STATE
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.# _.~ tS'-
1. GENERAL INFORMATION
Complete legal description L,,~t ~/.,
Loc~tion (site address or directions)
Propertyowner ~c.,y (; ?~l,~r- _c/--~r~j.
Lending agenoy
Mailing address
Day phone
Day phone
Agent ^/o,~ ~ Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMSER 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 OFWAS'rEWATER 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.
7~-025 (Rev. 1/91) Frc3nt MOA#21
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 F{~/-¢'~r 7-~4,~;,¢,~/ .~.~,"~,(~'_/' Phone 'Z ~/-(-- I-?~',~'
Address
Engineer's signature
So
DHHS SIGNATURE
1,/ Approved for F~/~"~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
ECEIV'Eb
Municipality of Anchorage dUN
DI=PARTMENT OF HEALTH & HUMAN SEPA~Et~LIT~
Environmental Services Division ~NVJRoN~NT^L SERVICES
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: &~,/' ~ ~/c~cl< ~, ~/h.,~r ~',~.~./' ZL.~ .Parcel I.D.:
A, WELL DATA
Well type
If A, B, or c, attach ADEC letter, ADEC water system number
Log present (Y/N) ~" Date completed
Total depth ~' ~ Cased to ~' ¥, ~/
_ Casing height (above ground) 3' ~"
Sanitary seal (Y/N)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production ~ g,p.m, ,5-, ~ 'P
g.p,m,
WATER SAMPLE RESULTS:
Coliform
Date of Sample:
Nitrate _
,,/
Collected by:
Other bacteria 3 cc,/
/:/~/-/.~? ~'~,, c4
B. SEPTIC/HOLDING TANK DATA
_ Soil rating (g.p.d./ff~ or ff~/bdrm) O. ~' System type "7'~'¢,~ C ~ _
Date installed ~ / I$ / ~ _ Tank size / ?~-0~/ Number of Compartments ~- Cleanouts (Y/N) ~'
Foundation cleanout (Y~N)~_ 'F _ Depression (Y/N) ~/ High water alarm (Y/N) ~', ,~,
~ y.r ~ / ~ ~ /r? ~ r~ ~ ~,Purnper
Date of Purpplng .:~.~-,~,~ e~-
ABSOR~T~ION FIEED DATA
Datein~'?Jed ~1 ~'~17~
Length _ I [ ~ ~ ' Width "~.,~' . Gravel thickness below pipe. ~ / ' _ Total depth
Effective absorp~tion area '7 ~" / c~' Monitoring Tube present (Y/N) ~ _ Depression over field (WN)
Date of adequacy test ~'/P/H) Results(Pass/Fail) ?~,c,~ For 5/ bedrooms
Fluid depth in absorption field before test (in.); g" immediately after,~'~2 gal. water added (in.):
Fluid depth _~ I~ ~ (ins) Minutes later:. ~ Absorption rate =. ?) &'~ g.p.d.
Peroxide treatment (pa.,~t 12 months) (Y/N) ~
Ifyea. give date
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Size n ga ons
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off" level at*
Wells on adjacent lots '> zo,~
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation I ~' Property line 'V~- ' Absorption field
Water main/service line ~ ~¢ ' Surface water/drainage ~' I°'~ '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~ ~'~, ~' y' Building foundation 1 ~'
Surface water ~ t~,~ '
Cu~aindrain ~ ~
F, ENGINEER'S CERTIFICATION
I cedi~ that I have determined thru field inspections
in conformance with MOA H~ guidelines in effect on this date.
Signature ~~ ~ ~
Engineer's Name ~h~r~ ~ ~oo~
Water main/service line ';> ~o,
Driveway, parking/vehicle storage area. '~o '
Wells on adjacent lots ~> ~ oo '
HAA Fee $ ~ O0 ~
Date of Payment ~
Receipt Number ~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment.
~.~ Receipt Number
J{!f~-15-gg t6:Zt FRO~CTE
ztr~ c'r&E Environmenlal Serviceslnc.
561~301
CT&E Ref,~t
Client Name
Project Name/#
Client Sumpl~ ID
Ordered By
PWS~
992581001
Fla~op Techaical Sty.
Lot 4, Bile 2, S~lvetcteal S/D
Lot 4, Blk 2, Silv~cresT S/D
Drinking WaTer
'0
~nple Rera~xk~:
CLient PO~ P~e-Paid Cohs/NO3
Printed Date/Time 06115/~9 11;44
Collected Date/Time 06/09/99 14:15
~elted, DMe/Time 06109199 13:25
'reclmical Dlr~aur: Stephen C. Erie
ToTal Coliform
#itraTe-N
30BIIO0 ~L, #0 COLI
~,.19
0.500
EPA ~oo.o
06109199
10 ~a~ 081091~9 0b109199
SUN-15-0g 16:ZI FRO~-CT[ ENViRON~NTAL 5615301 T-T6? P 03/03 F-050
ZI~"~ CT&E Environmental Services Inc.
2~ W Prater Dr~ve
Anchorage, AK 995t 8-1605
Drinking Water Analysis Repo~ for Total Coli. fo~ Bacteria Tel (~7) 6e2-2343
Sl~ ~FO~ COLLECTIN~ SAMPLE ~a~. ~~~
~s~PLETED BY WA 1 ~K ~,~ [ AnaPS~ snows tins Water gAMPLE to ~c
~ PUBLIC WATERSYb~EM I.D. ~ ~~ ~ S~nsfacmD
~ pKIVATE wATER SYSTEM ~~ ~ Un~nsfacm~
~ Send Info,ct ~ Sample over ~0 hours old. results may
Year
S^MPLfi [)ATE-
Mon[h
SAMPLE TYPE'
Q Treated Water
~ Roatinc
~ Repeat Sample (l'or routine ~am~le ~ Unlr~ated Water
with lab ref. no,
o Special Purpose Tlm~ Collated
SAMPLE LOCATION Collected By
Sample too long m transit; sample 5houlO
to indtc~e rdta~le results. Pkase
Tim, ~t~cd
l~al~lc~ M~b~; ~embra~ Fil~er
AnalyS~
Client notified of unsafisfacmry rt~ults:
[] __--
BACTERIOLOGICAL WATER ANALYSIS
17. Coil
MMO-MUG R~Ult: To~al Coliform ~_ . ~-
vcnficatmn: LTB ~ IIGB ~ COLIFIRM~--
F~al Culiform Cunfirmatlan
Final Membr~ g' ter
Commenl~
,.
(~ 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
....... _ CFRTIFICATE OF HEALTH AUTHOR TY. ','~,.. :,,~"., ..... '
,, , ,.,APPROVAL
FOR A SINGLE FAMILY DWELLING
1. ".:GENER, AL INFORMATION .'_" .",~ "'~ "' ....... '" '
Complete legal description '/...~,f ~ ...I~/0~ ,~,- ,,.~//v~
;, .r ,ar" Location,(site address oi' directions) ' r~'8~" J "~,bO1 t'~''. Ct~(¢ ' ':"' '
., ' "" ;"' ': ':'~Prn~n~'~wd~r" ';'~anv :~ ,~m~4 ~."".':',?~ ,'~.'~t'~:-":.' ~,'., ,~'"',, : ':
'. -''-: ." ~' '?Mad~ng address _'~.:','n~,~c ~ .: :. ::,. ~,,,~,.~,¢,,,,;.,,~, ,,
. .'.' "..: .:Lbnd n~ ~gency . : . ':' Day phone
' :,.; No3 E: If ~'omm~mty ~vast~ate'r sYstemj ~/i~ Wrttten confirmat, on from State
~.- ,. · ...: ~ , , , attesting to the legality and status of system
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of ti:is 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
Address
Engineer's signature.
Phone ~' 5'~'-'- ,',.~,'-J-
Date
DHHS SIGNATURE
~ Approved for
Disapproved.
Conditional approval for
, bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by art 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 emissions in the professional engineer's work.
MUNI(3PALII¥ OF ANCi IORAo~
eNVIRONMENTAL SERVICES DIVI$10~
AUG 1 9 199G
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES~ E C, ~ IV [ D
Environmental Se~ices Division
825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744
Legal Description:
A. WELL DATA
Well type
Log present (Y/N)
Total depth _
Sanitary seal (Y/N)
Health Authority Approwal Checklist
¢[~,ch:: ~ X',/~et' ~'r'~_~fi' ParcelI,D,:
IfA B, or C, attach ADEC letter, ADEC water system mtmber
Date completed
Cased to g ~
Date of test
Static water level 3~O ~
Well production
WATER SAMPLE RESULTS:
Coliform E9 Co Io,ate~/lO0 r~ .~ Nitrate
Date of sample: __7 / lO / 9,(
B. SEPTIC/HOLDING TANK DATA
FROM WELL LOG
ti lq / 77
It/~/77
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
_ 7 / ti / ?d
.¢3 '
¥'
~ g.p.m. ~. ,S' '/' g.p.m.
7, a~ r~/'~ __ Other bacteria No,~
Collectedby: _,c ~.~ /5",'~/o
Date installed ~/tS / ~tff Tank size I '~Y~'~'~/ . Number of Compamnents
Foundation cleanoot (Y/N) __ "f Depression {Y/N) N
Date of Pumping_N. ,~, ~ Na~} Pumper __ p/,
C. ABSORPTION FIELD DATA
___ Cleanouts (Y/N) ....
High water alarm {Y/Iq)
Date installed ~/ t3 / 9ff
Length ~ 7 ' Width
Effective absorption area 76' I O' Monitoring Tube present(Y/N) Y'
Date of adequacy test bi, A. (l~lt~) Results (Pass/Fail) t°tr~
Fluid depth itt absorption field before test (in.); ~9
Fluid depth (ins,) Minutes later:
Peroxide treatment (past 12 months) (Y/N) N
Soil rating (g.p.d./ft: or fl~/bdrm) O, ~.r-x/~System type _ 7-re. c6
"~, 6- ~ Gravel thickness below pipe _ ~, / Total depth
Immediately after
Absorption rate = ->
If yes, give date
. Depression over field {Y/lq) N
For ~'/ bedrooms
gal. water added (in.):
g.p.d,
D. L1Fr 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
Sewer/septic service line
i07.t
Size in gallons
"Pump on" level at*
"Pump off" level at*
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station t,,l, .d-.
lO0'
tOOt
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation I 0 ~ Property line
Water main/service line ~> to ' Surface water/drainage > too ~ Wells on adjacent lots ~> I oc.~ '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation I ~ ~
Suffacewater '> too '
Curtain drain No~¢ .,c~,af~ Wells on adjacent lots
ENGINEER S CERTIFICATION
.... ,? ,:: ?4. ~, ~ ~ ~'' * ~ 22' 'i!'] ~'?'.,
I crt#fy that I have determmed thrufield mspectwns and review of Municipal rec~2Pds ]h~a? the abb, ve'~i¢tein~re
m conformance wtth MOA PlAA gutdehnes m effect on thts date
Engineer s Name / ~ ~,o~r~ F. ~-- .... ,End,nearing 8eal~I~'a , ;.
Date ~uq~ p /? Iqqff -~47~:.,,~*~,.*, %;:%?
Proper~ Line ~Water main/sendce line ~> to '
Driveway, p~nWvehicle storage ~ea ~ ~ O ~
HAA Fee $
Date ofPayment
Receipt Number
Rev. 8/95 OSS: haa,wk.doc
Waiver Fee $
Date of Payment
Receipt Number
APPLIC FILLS OUT UPPER HAl. ONLY
Propcty O,W*,ler Phone
Relocation Realty (Jera~ A. Parks) Vacant
Mailing Address C/O Jack ~,.,..~...+'" ~...r'"' _'~-,n~..w C. °" ^-~'~ ..... Ak Zip Code
Buyer
Address Zip Code
Lending Institution Phone
Alaska Pacific Bank
Address Zip Code 276-0002
Realty Co. & Agent Phone
Coldwell Banker-Jack White Co. (Larry Maulden)
Addreee 3201 C. , St., Anchorage, Alaska Zip Code 99503 277-1553
Lot 4, Blk 2, Bilver Crest Sub.
Street Locatlo~ 6821 Lovttt Ct., Anehorage~ Al.aska
Type of Residence
{Slngle Family
Multiple Family No. of Bedrooms
[] Other
Water Supply
~,~lndividual ATTACH WELL LOG. A well Icg Is required for all wells drilled elnce June 1975.
~ Community For wells drilled prior to thai dale, give well depth (attach Icg if available).
~) Public Utility
Sewer Disposal
When Connected to Publ~'j~rtuw¢~
[] Public Utility
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQOEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date ~. _
Inspector Inspector Inspector Inspector
Field Notes:
~/2~~ ICUNICIPALIIY OF ANCHORAGF-
DEPT. OF HEALTH
~/..~/~, i~NVIRONM~CNTAL PROTECTION
JUl.. 1 4 ~g83
RECEIVED
~ ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) OISAPPROVED
Soils Ralln0 Date Sewer Installed Well To Absorption Area ,/~ Well Log Received ,~Z~.-
CONSULTING ENGINEER TELEPHONE: (907) 279-3916
Au§u§t 17, 1983
Larry Maulden
Coldwell-Banker/Jack White Co.
3201C Street
Anchorage, Alaska 99503
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTK)N
AUG 2
RECI:iVED
SEWER AND WATER ADEQUACY TEST
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WATER:
SEWER:
DATE OF TEST:
TESI' PROCEDURE:
Lot 4, Block 2, Silver Crest Subdivision
On Lovitt Circle
Four Bedroom, Single Family
Wire Must be installed in Conduit
From Municipal Records:
Tank Greer Steel, Two Compartments 1250 gal.
Absorption System Trench 47 feet long, 6 feet of rock.
Absorption Area 564 sq. fi:.
Soil Rating 120
Installation Date October 1977
August 16, 1983
System was inspected on August 2, 1983. The house was empty.
The Sump for the trench had 4 feet of very thick sludgein it.
This sludge was pumped out and sump stayed dry. Total volume
pumped approximately 10 gal.
On August i[6 950 gal of water was added to the tank at a
steady rate of 6 gal. per min. The liquid level in the tank and
sump were continuously onitored, but no raise in water
levels were observed. The tank level remained at 48½ inches
and the sump stayed dry.
This system accepted 950 gal of liquid in a 2 hour period
with no sogns of stress. It meets the Municipal requirements.
July 18~ 1983
i.(EiOCa t ion Realty
(,]era] A. Parks)
c/o Jack UhitE CO.
3201 C. Street
Anchorage, AK 99503
Snhje. ct: dLot 4, Block 2, Si!vet CrEst Subdivision
Apprnva] for the individual sewer and water facilities cannot
be granted nntil thn fo]low~ng ite~c; have been completed:
° The septic tank pumped with a receipt submitted to this
department ·
An adequacy test needs to bE performed on the ax:[sting
leaching area. This test will determine if the system Js
adequate according to National Standardn. A listing of
private firms performing the test :La enclosed. Th:Ts report
need~ to ha snhmitted to this office for our review.
Please notify this
noted discrepancies
furthel.' quest:ions,
please calL!, this offJ. Ee at 264-.-4720.
Sincerely,
JSK2/ej/E2
J. S. kobErts
Assl[~taat l~llVirO~lr, lenta] Specialist
Time
Da~e
Insp
'4UN~CIPALIT~ OF ANCHORAGE
DEPARTMEN] ~F HEALTH AND ENVIRONMENTA .3ROTECTION
825 L Street, Anchorage. Alaska 99501
264-4720
Date Received: March 21,
1:30 p.m. ~2: Time ~3: Time
3-22-78 Wed Date Date
Pratt Insp Insp
1978
REQUEST FOR APPROVAL OF INDIVIDUAl, SEWER AND WATER FACILITIBS
Lending Institution Request:
Mailing Address:
Phone:
Proper~y Owner: Stephens Construction
Mailing Address: Post Office Box 3-3772 ECB
Phone: 349-46'75
Legal Descript±en: Lot 4 Block 2 Silver Crest Subdivision
Single Family Residence: (x) Number of Bedrooms: Four
Multiple Family Residence: ( ) Number of Bedrooms:
Well System:
Permit
Construction
Individual well (x) Con. unity/Public System ( )
Depth of Well Well Log on File
Bacterial Analysis
(x)
Sewage Disposal
Permit
Septic Tank Size
Absorption Area
Sysmem: On-site System (x) Public Utility
Installed 1977 Installer
~D'~ Manufacturer
Soils Rate /~o Material
( )
Distances: Well mo Septic Tank to Absorption Area
to Sewer Line Neares~ Lot line Absorption Area
to Neares~ Lot Line
Page
Two
Depar~men~ of Health and Environmental Protection
Reques~ for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 4 Block 2 Silver Crest Subdivision
Comments:
Attached
Affadavit
Approved: ~ ~
Disapproved:
Letter Attached: ( )
Date:
Department Worksheet:
~ MUNICIPALITY OF ANCHORAGE
~. Department of Health and Environmenta]_ Protection
h~i:~ 825 L Street, Anchorage, Alaska 99501
'~'~ques~ ~or ~pproval of '[ndiv~duai Sewer and ~a~e~ Fac~l~es
1. Property Owner: ~,~.5~ q ~k--.k~"
Mailing Address: Phone:
Lending Institution:
Mailing Address:
Phone:
Mailing Address:
Phone:
Street Location:
Single Family Residence: (v~) Number of Bedrooms: ~
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply:~ *Individual Well ( )
If Individual Well, well depth
If Conununity System, name of system
Public/Community System ( )
Sewage Disposal System: *~n-site System
If On-site System, date of installation:
( ) Public System ( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77