HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 2 LT 11
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
Nsme: Re-r-r~ -- ~ ~ ~ Wastewater System: ~ New
Address: _
Phone: /~ .o. of Bedrooms: ~
~6 ' ~ ~ ~ ~ .~ ~ ~ ~ Deep Trench ~ Shallow Trench ~ Mound
Total Depth from original grade:
Lot: Block: Subdiv~ion: ~ ~ Depth to pipe boffom from original grade: Gravel depth beneath pipe
Township: ~ ~ Range: Section: Fill added above original grade: Gravel length:
I
Number of lines: Dis~nce ~een lines:
WELL: ~ls~/~ew ~ Upgrade ~ ~ravelwidth: ~ O I Ft. I ~ ~ Ft.
Clarification (Private, A,B,C): Total Dept~ ~d TO: Total absorption area: Pipe material: ~
Driller: ~ Date Drilled: Static Water Level: h nstaller: Date installed:
Yie~GPM IPumpSetat: Ft. CasingHeightAboveGround:Ft. TANK
SEPARATION DISTANCES ~ s..t~c ~ Ho~..
TO Septic Absorption Lift Hotding Pub[ic/Prlvate Manufacturer: Capaci~in gallons:
From Tank Field Station Tank :Sewer Lin~ ~O~ ~
Number of Compa~ments:
Sudace
Water IO01+ ioo~+ i~o~ ~ ~ LIFT STATION
Lot t ~ ~1~ ~t~ ~ ~ Sizein gallons: Manufacturer:
Foundation I ~ ~ "Pump on" level at: "Pump o~' level at: High water alarm at:
Pump Make & Model Elect[ical Ins~ctions pedormed by:
Remarks: ~ ~l~ J~ ~ tN~odh~tq~ BENCH MARK
Location and Description:
/~ h A.um~ Elevation:
Inspections pedormed by: ~e~ ~~. Dates~ 1st
Depadment of Heal~ and ~u~an Se~ices approval '~;~J.-J c~'~* ..'~-
Reviewed and approved by: Date:/2 -2 2 -~g ~[ss~
79-013 (Rev. 9/91 ) MOA 25
PER..TSW980,8,NU*E* AS ' BUILT DRAWING
/ ~* / ~,~
~W 150~'
~¢,Gt~ (AVd,) ~ Mf~ Mr4
~S~ WA~R A~ WAS~WA~ CONS~TA~S, ~C.
LEOAL
DESC
RIPTION:
GBEAT~NB ESTATES SUBOIVlSION, LOT 11, BLOCK 2, ~ ~,[~..~ ..... ~ ....
PROFILE AS-BUILT OF SEPTIO SYSTEM (I.S.F. UPGBABE) ........
PREPARED FOR: PHONE NUBBER:
RETTA RAE S63-SSO0/242-1
RANBALL .... .....
11/5/98 J.L.M. N.T.S. 2 OF 5
af~an elecffioal & engfneerln9' inc.
p.o. ~x 91499
anohore, ge, aiaska
NOVEMBER 12, 1998
ALASKA WATER & WASTE CONTROL
FAX 338-32.46
CIO RPC EXCAVATING
DEAR SIRS,
THIS IS TO CERTIFY THAT WIRING WORK DONE AT RPC EXCAVATING,
LIFT STATION BY VINCE CASEY, HAS BEEN DONE TO NEC WIRING
STANDARDS,
SHOULD YOU HAVE ANY QUESTIONS, PLEASE CALL CHRIS MUES AT
ALCAN ELECTRIC AND ENGINEERING, INC. AT 907-563-3787.
THANK YOU.
dm
(go~ $63-37~
fax no, 562-6286
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(9O7) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 24, 1998
Expiration Date: Sep 24, 1999
Permit Number: SW980383
Legal Description: GREAT LAND ESTATES #3 BLK 2 LT 11
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: RETTA-RAE RANDALL
Owner Address: 23425 BIG SKY DRIVE
CHUGIAK, AK 99567-6331
Parcel ID: 051-133-13
Site Address: 023425 BIG SKY DR
Lot Size: 82764 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 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
(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.
THIS PERMIT ISSUED FOR THE CONSTRUCTION OF AN ALTERNATIVE INTERMITTENT DOSING SAND
FILTER WASTEWATER DISPOSAL SYSTEM. THE ATTACHED PROPERTY OWNER MAINTENANCE
AGREEMENT SHALL BECOME A PART OF THIS PERMIT PACKAGE.
Received By:
Issued By:
Date:
Alaska Water & Wastewater Consultants, Inc.
7320 East Chester Heights Circle - Anchorage ~ Alaska 99504
(907) 337-6179 N Fax (907) 338-3246
Consulting Engineers
September 23, 1998
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref.' Sewer Upgrade for Lot 11, Block 2, Greatland Estates Subdivision
To whom it may concern:
The existing 4 bedroom house is served by an onsite septic system, and a private well. The
existing trench is surcharged and must be upgraded. The existing septic system is currently
having to be pumped every 2 to 3 weeks. Comments regarding the proposed upgrade are
summarized as follows:
1. GENERAL: One test hole was excavated to the west of the existing septic system. The soils
were found to be impermeable at approximately 7.5 to 8.0 feet, limiting the design depth to 1.5
feet below grade. Because of the flat topography, and the shallow' depth (due to impermeable
soils), a lift station and shallow bed/trench type system will be necessary.
In order to limit the impacted area of construction (a concern of the homeowner) we are
proposing to install a bottomless, Intermittent Sand Filter (ISF). This will allow a field size that is
50% of the size of a conventional bed. We discussed with the homeowner the possiblitity of
digging additional test holes, with the hope of finding soil conditions that would be more
conducive to putting in a conventional trench type, however, she has opted to go with the ISF.
Not only will the ISF allow for a reduced impact to the yard, it should peform better than a
conventional system.
2. SOILS: On September 11, 1998, a test hole was excavated and a percolation test was
performed at the area of the proposed septic upgrade. As can be seen from the attached log, the
soil below the organic layer is a GM material to a depth of approximately 7.5 to 8.0 feet. From
7.5/8.0 feet, the soils transition to a GM/ML material to a depth of 16 feet (bottom of test hole).
No ground water was encountered at the time of excavation. A percolation test was performed
between 3.0 feet and 3.5 feet, and determined the rate to be at 2.4 minute/inch. Another
percolation test was attempted between the depths of 7.5 feet and 8.0 feet and the perk rate was
found to be greater than 120 minute/inch.
· ' .- 3~ TRENCH DESIGN: Bottomless Intermittent Sand Filter (ISF)
a. Percolation Rate: 2.35 minutes/inch
b. Allowable Application Rate for ISF: 2 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 300 fi2
f. Effective Depth below pressure pipes: 2.5+ inches
g. Width: 10 feet
h. Length: 36 feet.
i. Effective absorption area = 360 R2 (>300 fi2 OK)
j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank".
1. Sand Material: Central Paving Products '~inter Road Sand"
m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
We are proposing to excavate down to a depth of 3 feet (remove all organics), place a minimum
of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the
sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer.
We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so
that flow can be intermittently dosed to the ISF.
4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
5. TOPOGRAPIt~Y: The lot,is generally flat in the area of the proposed upgrade; in short, there
are no slope concerns. ./
6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the
construction practices will comply with DHHS' "Intermittent Sand Filter Design, Installation &
Maintenance Manual". The contractor should read this document prior to construction. Copies
are available at the Municipal Onsite Services office (Sth floor, 9th & L St.).
7. CLOSING: I am open to ~ifiy suggestions from your department, wi;rich would be an
improvement to the proposed design. ~ am unaWare of any adverse impacts this installation would
have on adjacent wells or septic gystems. If you have any questions, please contact me at
3SiftS/el~. Thank y~~ rout assistance.
Preside
LOT 2, BLOCK 2,
GREATLAND ESTATES S/D
SERVED BY PRIVATE
WELL AND BEPTIC
LOT 3, BLOCK 2,
GREATLAND ES1ATES S/D
SERVED BY PR~ATE
WELL AND SEPTIC
PROPOSED UPGRADE SYSTEM~
(SEE DESIGN, PAGE 2 OF 3)/X
LOT 12, ESTATES S/D ~ ~
GREATLAND
LOT 4, BLOCK 2,
GREATLAND ESTATES S/O
SERVED BY PRIVATE
WELL AND SEPTIC
LOT 10, BLOCK 2,
GREATLAND ESTATES S/D
SERVED BY PRIVATE
WELL AND SEPTIC
LOT 10, BLOCK 3,
GREATLAND ESTATES S/D
ALASKA WATER AND WASTEWATI:.R CONSULTANTS, INC.
7320 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504-
PHONE: (907) 337-617g/FAX: (907) 338-3246
LEGAL DESCRIPTION:
GREATLAND ESTATES SUBDIVISION, LOT 11, BLOCK 2,
fYPE OF WORK'.
SITE PLAN
PREPARED FOR: PHONE NUMBER:
RETTA RAE RANDALL 688-6841/271-5071
OATE:9/23/98 ID~w~ m,, ]SCA~E: ]PAGE:
J.L.M. 1 = 100' 1 OF
LOT 1, BLOCK 3m
GREATI~,ND ESTATES S/D
.......... 1 O' UTILITY EASEMENT
~-- 25 NGH HDPE LINE SLOPED BACK TO
/ LIF]' STA-flON FOR DP~CNABE OF LINE. NO
/ LOW SPOTS WHICH WILL ALLOW Y/A'FER TO
J COLLECT. ALL CONNEOTONS SHALL BE
J STAINLESS STEEL WITH STAINLESS STEEL
INSULATED ! BANDS, NO HOSE CLAMPS.
AIR LINE
~ J ..~PROPOSED 1500 gALLON
\ J / S.T,E,P, TANK WITI4
~ J / DUAL OUTLETS
_ /
PROPOSED 80]TOMLESS---
IN~ERMI1TENT SAND F'IL1E(~,
ORGANICS). AOD 2 FEETr OF' ~VilNTER ROAD" \ ~
SAND FILTER (CENTRAL PAVI~PTiC 1A~IK TO BE
AND 3 INCHES OF PEA ORA~ANDO EN 0 COMPLLq'ELY
AND BELOW THE DISTRIBUTION LIND \ ............ \
· · USEe AB A RESERVE Sr~E \
SPACE l~ THE: GARAr~, THE rtrtNTRACTI~ SHALL PRBVT]I~ ~. ~",~/7).-
ALAS WAS WA E CONS T S,
PHONE: (gOT) 357-6179/F~: (907)
I~PE OF WOR~:
SITE P~N
688- ~84 ~/22g-gB87
RANDALL
DATE:9/25/98 D~WN BY: SC~.E: PAGE:
I ,
PLAN V~EW
~2" ~ IN~AqON
/ /
2' MIN, OF COVg~ /
~ PROF~ E V~EW
DESCRIP~ON:
BOTTOMLESS SAND FILTER (ISF) DETAIL
RETTA-RAE ~ANDALL
)ATEt9/23/98 D~WN BY: SCALE: PAGE:
. 7520 E. CHE~ Hm. CIRC~ * ~CHO~GE, AK. 99504
PHONE (907) 337-6179 * F~ (907) 338-32~6 ~."-//I
-
LEGAL DESCRIPTION' GR~T~ND E~ATES SUBDIVISION; LOT 11, BLOCK 2, ~ .... ~.. T[~.,~ .... [ .... : ....
i Je r~ ~ A. ~essf
~ $ ~. ...' ..&~
2~q SOIL C~SSIFICATIONS ] paoPos[o uP~[
~ ~ ~,~, ~ ~D~ ~ ~SEE DESIGN. PAGE 2 OF
7~! L!II FI II DEPTH TO DATE / .......... N ......
~i M II GROUNDWATER F3 ~,~,,N~ ~,,~,~
,, JilBI:I:I .A~E READING CLOCK NET TIME WATER LEVEL NET DROP
IIIEIIllll~ii~l T~ME (M~NUTES) READING ONCHES)
IliBllEi!l;I -~ -5:00 -~: ~ -1~-!- 4-7/8-
le~ B 0 H - 8 ~;~0 10 MIN. - -~~-- 4-1/¢"
I I .... ~-- ~=~o __' .... __ ~" ___
17~ I - 10 5:30 10 MIN. 1-3~4" 4-1/4
18~
I
~o~ TEST RUN ~ETWEEN ;.0 ~. eND ~/
COMMENTS' UPPER BENCH PRESOAKED FOR4 HOURS+~ TO//S~ERNO~TION TEST W~ A=EMPTE.
B~EEN THE BEP~ OF 7.5 FE~ TO B.O FE~. THE PE&O~TION/¢ZF~ ORE ~ER THAN 120+ MINUTES/INCH
PERFOMED BY A~SKA WATER · WASTEWATER ', [ J~ YX~' , CERT.~ THAT
THIS WAS PERFORMe IN/ACCORDANCE WITH ALL ST~¢~/~ ,,~'P~EUNES IN EFFECT ON THIS
~AT~..AT~:
DEPTH TO DATE
;ROUNDWATER
DRY g/11/gB
DRY 9/18/98
ALASKA WATER & WRSTEWATER PHONE NO, : 907338324S Sep, 18 1998 02:59PM P2
PROPERTY OWNER AGREEMI~_.NT
FOR THE MAINTENANCE OF AN
ON-SITE WASTEWATF~R DISPOSAL
SYSTEM
T~/$ agree~uen~, dat~ September 22 199__S, ~ m~de between ~e Mu~p~l{~ of
~ora~e D~¢n~ of He~ ~d H~ Se~ices ~S) ~nd ~¢ prope~
o~er(s) off
23425 Big Sky Drive, Chugiak, ~
Tbt~ agreement is made for the purpose of m~i~r~i.~g an on-site wastewarer disposal
sysz~In on thc subjec~ property,
The property owners ~ree to ~e follow~ng:
Submk w the Municipality of Anchorage, on an 9~.u~ basis, an inspection and
operation statement from a registered professional engineer. This inspection mcl
operation statement shall verify that the engineer has inspect~ all effluen~ and ak
pumps, timers, and alarms, and r/mt any deficiencies have been repaired and rimt r. he
system is funcfioniug as design~l.
($igmmr¢) (Signature)
Retta-Rae Randall
(Prinmi Name) (Primer Name)
. . . ............. Notarize Here .....
SI:ate Of Alaska On ~his _.2~a day of q~p~mher , 1998
Retta-Rae ~n4.~ _ pe=sonally appeared before me,
x ~ho is personally kno~ ~o me
-- whose ~den=ity I proved on the basis of
, a credible witness
ack~iedged ~t he/sh~ s~gned t=.
to be the signer of the aboy~ document, and he/she , .
' MUNICIPALITY OF ANCHORAGE '
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I * ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE NEW
M AILINGAD~/ c/~ ~ ~ /~'~
LOCATION ~ ~ - ~ NO. OF~ROOMS
~ ~ ~ ~ /~Xbsorp~n~rea Dwelli~/
~ ~~
Liq, cgpAci~ i~galJons Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capaciW in gallons
Leng~/~>ine Total le~ ~i~s Trench~ D~ween lines
~Z m Topof tile to finish grad~ Material beneath die
"/~.,U -- inches
Length Width Depth PERMIT NO. - -
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot Hne
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
iNSTALLE~ ~
REMARKS
/
APPROVED DATE LEGAL
tV1-W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner ~ t~'IT~LAUSEN Use of Well Donmstic
Location (address of: Township, Range, Section, if known; or distance main road Lot 11 Block 2 Greatland Estates
Size of casing Depth of Hole 199 feet Cased
Static water level 160 ft. (a]~;L~ (below) land surface. Finish of well (check one) open end ( xx );
ScreEn ( ); Perforated ( ).
Describe screen or perforation None
Well pumping test at 20 gallons per of drawdown from static level.
(minute) for 1 hours with 100%
Date of completion June 24, 1983
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO 2 Casing stickup
2 TO_ 4 Organic
4 TO. 21 .Silty. gravel
21 TO 42 'Silty_ cobbles
42 TO 80 Silty. hard pan
80 TO 84
193 TO 199 WaterbearinE ~ravel
TO.
TO~
2'0_
TO
TO
1 -- CUSTOMER
F'ERH I T NE
[.,EPFIRTHENT OF HEFtLTH RN[:, EN',/iRONMENTFIL PROTECTION
8:-:'5 '"L'" STREET., FINCHOF.':FIGE., FlK. 9~50:1.
,:: 8_---':E~566 :.',
C~ f-.i --- :i],; Z ]-E E;EIt..JJEF: F'EF:I".'~ ]: T'
FIF'F'LiCRNT KFIRL R F~LE:,HFiLiSEN PO E-X E:E:G E.R. 99577 '-q'-->~:"':'
LOF:RT i FiN /'~-:RLL 694-21]--':t FFiR i N'.:.;F'ECT I
LEGRL"-L±'IB2 GRERTLFIN[:, ESTFiTES '-" LOT SIZE 999999 SL.'i!UFIRE FEET
T'gPE OF SO I L FIE SOF.'F'T i ON S'gSTEH '- · TR. ENC:H
MRXTMUH i'-~ilJMBER OF BE[:,ROOMS = 2:
SOIL Rt:ITING ,::S6! FT,-'"BR)= '].09
THE REQUIRED SiZE CiF THE SOiL FtBS¢~RF'TION S'~'S'I'EI'"I iS:
C:.EP TH= :_~: L_E:i'-~]~"'F~-~= 4:1_ C~F:F~%.~EL [:.EF'TH= -~
THE LENGTH DiHENSION iS THE LENGTH (IN FEET) OF THE TRENCH OR [:,RFIINFIELD.
THE [.',EPTH OF R TRENCH OR PIT IS THE [:,t'_:;TRNCE BETWEEN THE SURFRCE OF THE
GROUND RN[:, THE BOTTOM OF THE E,'-'<CFIVRTION (IN FEET).
THERE iS NO SET HI[:,TH FOR TRENCHES.
THE GRFIVEL [:,EF'TH iS THE I'iiNIf'IUI"t [:,EPTH OF GRFI',,,'EL. BETWEEN THE OUTFFiLL PiPE
FiND THE BOTTOM OF THE EXCFIVRTION ,:.'tN FEET).
F'EF:I"iI'I' FtPF'LICFiNT HI=IS THE RESPONSIBILI'T"¢ TO iNFORM THIS DEPRRTMENT DUF.:ING THE
INSTFiLLFITION INSF'ECTIONS OF FIN'9 WELLS FI[:,JFICENT TO THiS PROPERTY FINE:, THE
Nt_I"iBEF.' OF RESIDENCES THFlT THE WELL HILL SER',/E.
BFICKFILLING OF Fih, l'9 '_-~'9'-:,TEM WITHGLIT FINFlL INSPECTION FIN[:, FIF'F'R.O',,,'FIL B'9 THIS
[:,EPBRTMENT WIL. L BE SUBJ'ECT TO PR. OSECLITION.
MiN!HUH DtSTFINC:E BET!.,.IEEN FI I.,.IELL RNC, FtNV ON-SITE SEWFIGE DISPOSFtL S'gSTEM IS
:.LOE~ FEET FOR Fl PRIVFITE .WELL OR ±50 .TO 200 FEET FROM R PUBLIC I.,-IELL DEPENDING
UPON THE T'T'PE OF' PUBLIC WELL
HINtHUH [:,ISTFtNCE FROM Ft PRIVFITE .WELL TO Fi PRIVFlTE SEWER LINE IS 25 FEET FiND
TO FI COMMUNIT'9 SEWER LINE IS 75 FEET.
WELL LOGS FiRE REL.-..,UIRED FiND MUST BE RETURNED TO THE DEPFlRTHENT NI]'HIN _--.':F'~
OF THE WELL COHPLETION.
OTHER REI..-.!UIREMENTS MFi'9 RPPL'9. SPECIFICRTIONS FiND CONSTRUCTION [:,tFiGRFiMS FIRE
FIVFiILFtBLE TO INSURE PROPER INSTFiLLFiTION.
i CERTIFY THFlT
:L: i FIM FFiI'"IILIRR .WITH THE REQUIREMENTS FOR ON-SITE SE.HERS FIND WELLS RS SET
FORTH B'¢ THE HUNICiF'FILIT'¢~,OF FINCHORFIGE.
2: I WiLL Ii'-,tSTFILL THE S'gS'I'EH INcFICCOF.:[:,RNE:E WITH ,T..HE CODES.
Z.:: I UNC, ERSTFIN[:, THRT THE ON-'S,~y SEWER S'¢STEH I"lFl¢ F.:E6BJIRE ENLFIRGEMENT IF THE
F.:ESi[i, ENE:E iS REMO[:,~LE[:, 'fiEf ~_:~DE MOF.:E THFlN Z-.': BE[:,ROBHS.
F-IF'F'LICFINT KRF.:L. F.'. FEL[:,HFIUSEN
"'"7~ ~ ! .~, .4' ~ ~ .... ,-'~/~' X .-~ /~:'* ':i?
....... ¢h' .......... '- -/i' ................................... ~ ..... ',/4. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
3
6
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
COMMENTS ~'~" ~
PERFORMED BY: ~',~[
72-008 (6/79)
WAS GROUND WATER S
ENCOUNTERED? ~ ~ L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
~ (minutes/inch)
'~ ~I'Z_ FT AND ~J FT
CERTIFIED BY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
0~1133 15 HAA# I~(~c'~ ~
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions),,~-~//
Property owner ~1 ~,~ ~[ ~~ Day phone
M.iHn; ddre s
Lending agency
Day phone
Mailing address
Agent ¢.o,~ ~ T~ ~",',-,~
Address ~ /4~.~o~-.~ ~.~t ~-~'/-
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA ~21
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
Address ~oo
Engineer's signature
Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: ,"~"-~"~""-' ~C.-~__¢-,~-~- Date
/
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~O25 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
. Department ofrHealth & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L. I J 1~7- ~_.~..4-1a, q~ ~:-+' Parcel I.D. ~,5' I
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
FROM WELL LOG
0"o~ ~
If A, B, or C, attach ADEC letter. ADEC water sYstem number
,,.~u ~i t~5 Driller/~A%0
Date completed :
Cased to 1 ~ Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
AbsorPtion field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform ~
Date of sample:
Nitrate
q-~l-gz~
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public seWer manhole/cleanout
Petroleum tank
Collected by:
· Other bacteria
J
B. SEPTIC/HOLDING TANK DATA
Date installed ,.~'o~ ~.
Cleanouts (Y/N) '7'
High water alarm (Y/N)
Date of pumping
Tank size Compartments
Foundation cleanout (Y/N) / Depression (Y/N)
~/A Alarm tested (Y/N) /dA
t.P 9~. - Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 4-,oo
To property line
Surface water/drainage
On adjacent lots
AbsorPtion field '
+toO/ Foundation +ZO'
4-5 ~ Water main/Service line
72-026 (Rev. 7/91) 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) ~
SEPARATION DISTANCE FR~IFT STATION TO:
Well on lot On adjacent lots
"Pump on" level at
Manufacturer
Manh~s (Y/N)
"Pump off" level at
Cycles tested
Surface water
El. ABSORPTION FIELD DATA
Date installed 3'uJ.qll 19:8~ Soil rating
Length
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Width
Peroxide treatment (past 12 months) (Y/N)
JDcJ ~;~'/J2¢-¢'¢ System type
Gravel thickness Total depth
Cleanouts present (Y/N)
Date of adequacy test $~¥'~'F'
for
bedrooms
If yes, give date "~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water 4-1 co/
Curtain drain
On adjacent lots
Property line
To existing or abandoned system on lot
Cutbank +lO°t Water main/service line
Driveway, parking/vehicle storage area
+ ~'5"
E, ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
Signature
Engineer's Name
Date
of this inspection.
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
NORTHERN TESTIN LABORATORIES, INC.
3330 [NDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 ' FAX 274-9645
Constructing Engineers
9601 Buddy Werner Drive
Anchorage AK 99516
Attn: A1 Landers
Report Date: 09/17/92
Date Arrived: 09/11/92
Date Sampled: 09/11/92
Time Sampled: 1330
Collected By: AL
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
Comments:
A120333
Greatland Estates
Lll, B2
Water
MDL = Method Detection
Limit
Flag Definitions
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Method Parameter Units Result Flag MDL Analyzed
EPA 353.3 Nitrate-N mg/1 2.2 0.5 09/16/92
Reported By: Sus~C. i e~ntal
Microbiology Supervisor
1671~ ~¢¥ Dr,
~;a~le River, Al( ~'~:~-
STATEMENT
I ?.7 ~ ~ PAe 'cy Dr.
APPLIC'-NT FILLS OUT UPPER HAI. = ONLY
Prope~yOwn~ ./~,~'i v ~, .J-~'-- _-.- ~ ~ / Phone .,
· ~ ~/~ ,/~ ' - ~,~ ?~-- v ' '-, /
Mailing Addre~ /~-/~-/:,, ..... v' -x .> ~, d..~ ~._~':~ . ,Z~..-'.~r _ x -' ~'::;./ ~ x-P~ .x/~'~/~ Zip Code ::?: '/., ., ..' ' :'/'
Buyer ~; ~< '"/ -- ~ -' ~i ~' CUqC~ {~
Address Zip Code
~ -- /p~ . x Phone
Lendiog Institution ? ;. ~ '/~.4 x -, ~.' ~ .~" <_~ x~
Address / ?'-'x '- z: ....... ~.~. ~xx.?.'t.~':_,'_. ...... ~z ~.~;. ~'. ~ ~ Zip Code -
Phone
Realty Co. & Agent
Address Zip Code
Lega
Descr
ption
Street Locati~ ~... .~x{%/ ~_~p, ~Z~,_ ,:~;[.~ ~ ~ :c/'.
Type of Residence
~ Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~¥ndividual A~ACH WELL LOG. A w~l log is required for ail wells drilled since June 1975.
'~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal ~ -
~; Individual Year Individual Installed: / / ~ ~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: //~ ~'~ "'T'. ~. I'"¢~ % o ~ l-~ I )- ~ ~r ¢-.. ¢-~ . MUNICIPALITYDEpf. oFOF
RECEIVED
(~ APPROVED BEDROOMS ~COND~TIONS OF APPROVAL
( ) DISAPPROVED
DATE JJ--
t -
Soils Rating Date ~wer Installed Well To Absorption Area /~ ~ Well Log Received
(67 ~ Z~-~3 WelltoTank / ~ Septic T~k Size
November 16~ 1983
Karl [~'e ld tnause~]
P. O. I~ox 7'7-06~36
Ea.'.jie River, AK 99577
Subject: Lot 11, Block 2, Greatland iJstates
Approval for the inGividuai sewer and water [aciiities cannot
be ~jranted until the ~ollowing items have been completed:
n v;eli log submitted to this o[~ice ~or our ~iles and
review°
~ 's as-Duiits., which ~3cen
o 'i'he~ ngineer have ~ ~'~ sub~itte'd to
this office, are nou wlt.,llll ti1.. parameters o[ tile on-site
i~:stailation permit issued by this department.
discrepancies will need to be corrected before this
department can accept the submitted engineer as-[}uilts, d
Please notify this 0epart~nent for a relnspection 'Wi~e~%
noted discrepancies nave been corrected. I~ there are any
~urther questions, please call this office at 264-472uo
Sincerely,
Acting Sewer & ~,~ater
Program :"~ana~3e r
C~.~36/ej/gl