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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 4 LT 14 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: ~Wc/qO$c)c) PIe Number: Name: Wastewater System: J~ New Q Upgrade Address: ABSORPTION FIELD Phc~e: ~ No. of Bedrooms: ~c~ /~v~., ~ qq~77I ~ ~ Deep Trench ~ShallowTrench ~Bed ~Mound ~Other DESCRIPTION so~, Rating: Total Depth from origin~l~ grade: LEGAL /.~ GPD/Sq. Ft. Lot:~ BIock:~ ~T ~Subdiv~i°n:~ ~ ~ ;Depth to pipe bottom from original grade:~ Ft. Gravel depth beneath p~pe ~ Ft. Township: Range: Section~ I Fill added above original grade: Gravel length: WELL: ~ New ~ Upgrade Grave~ width: ~ Ft. Number/of lines: Distance~between lines:Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES ~ s~.~i~ ~ Ho~i~g ~ Sm~.P. To Septic Absorption Lift Holding ~ublic/Pr[vate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~O~ ~ Material: Number of Compa~ments: Sudace '~ ' LIFT STATION ~' Water /0~ /00 ~ Lot ~ Sizein gallons: Manufacturer: ~ Line /~ ~ /~ ~ "Pump on" level at: ~p off" level at: High water alarm at: Foundation ~3 Electrical Inspections performed by: Cudain Drain Remarks: BENCH MARK Location and Description: I Assumed Elevation:/~ ENGI~SEAL 17034 Eagle River Loop Road, No. 2~ ~/'~: /I~-'/ Inspections performed by: Eaale River. Alaska 99577 Dates: 1st/~ -aC- ~ Department of Hea~ Mu s approval {~,,~x,..?.., ,,, ... Reviewed and approved b Date: / "~.~....,..~-" ....... 72-013 (Rev. 9/91) MOA 25 Permit No.Sw940599 Page 2 of 2 Municipality of Anchorage 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 Legal Description.BEAT LAND ESTATES#5, BLOCK 4, LOT 14 PID No.: 05115525 97.~_~ ;iCi2 ~=: GBADE~...~ MTt)~(CO4&~ MTSO ii /97.9' FINAL ................................................................................... / SEPTIC ' ' __ 89.5' ~ TANK / (~ ~T.S. ~ A B ?CO 1.6 39.(: 201 25.6::59.4 302 27.3 i 60.~ ~03- 30,7.~ 304 34.8:: 59.[ ~iT1 34.7:: 58.£ ~[T2 62.7 :.57.~c WELL SCALE f' = 40' 72-013 NEW 1000 C~AL. SEPTIC · i '.i DRAINFIEL] · er diei rilling og by ~OC Co. dba SULLIVAN WATER WELLS RECEIVED DEC 2 2 1994 P.O. BOX 670272, cHuGIAK, ALASKA 99567 * TELEPHONE 688.2759 Murii(;ipaii(y ,~?~ciGhOi age · ' . Dept/)-le~_Human Servioe$ OWNER OF LAND ,~,5.::.Ti--- ~L ADDRESS LEGAL DESCRIPTION Z- ~ '/~ ~ DRAW DOWN'FT. DATE,Started Ended [ / O/9 ~ GALS. PER HR O PE~IT NUMBER KIND OF CASING KIND OF FORMATION: From ~ Ft. to C~ From - F,.to ... Ft..F?/¢.f/AJA ,~'"m'/cj<'dP From Ft. t.)O~ gd~g?ad~ From__ From ~~ From ff~ Ft. to~O FL Fr0m_~-, r'~ Ft. to 6c/ Ft. Fromm_D c~ Ft. to Ft. From __ Ft. to Ft. From__.Ft. to Ft. From From From__,Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to "Ft From Ft. to Ft From Ft. to Ft. From__Ft. to Ft. From Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. ~JE 7- · __Ft. to Ft, Ft. to Ft . Ft. to Ft. : Ft. to Ft. From__Ft. to Ft. From Ft. to Ft. From.__Ft. to Ft. From.__Ft. to Ft. From · Ft. to__ Ft From Ft. to Ft. From Ft. to Ft From · FL to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHOP_AGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT KU3N~ER:SW940399 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DISOTELL CARL A OWNER ADDRESS:P.O. BOX 770210 EAGLE RIVER, AK 99577 DATE ISSUED:10/13/94 EXPIRATION DATE:10/13/95 PARCEL ID:05113323 LEGAL DESCRIPTION: GREAT LAND ESTATES #3 BLK LT 14 4 LOT SIZE: 87991 (SQ. FT.) ~ER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 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: ROBERT SHAFER, P.E. September 30, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 14; Block 4; Greatland Estates #3 Request you issue a permit to drill a well and install a septic system to serve the proposed thrc~cbedroo~houseonthe referenced property. Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been checked and found to be dry. Attached is the proposed design. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. The proposed 1000 gallon septic tank is to be placed outside the well protective radius. Attached is a site plan which depicts the location of the proposed tank. If you have any questions, or require additional information for your review, please contact us. Sincerely, ~ Robert C. Cowan, . . RCC/JA/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 \ ~9¥0S ROBERTSHAFER, P.E. ON-SITE WASTEWAT~ DISPOSAL SYSTEM (XANSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHAN]CAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 14; Block 4; Greatland Estates The scope of this project includes the installation of a 1000 gallon septic tank and five foot wide drainfield to serve the proposed three bedroom residence for the referenced property. o Construction shall be inaccordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA99577 Page Two Lot 14; Block 4; Greatland Estates #3 September 30, 1994 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. AS.~]~PfION TRENC~/DRAINF~.D INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. o Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MAT~{IAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Lot 14; Block 4; Greatland Estates #3 September 30, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. o When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four Lot 14; Block 4; Greatland Estates #3 September 30, 1994 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage J DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 , SOILS LOG -- PERCOLATION TEST ' LEGAL ~SC~mlIO~:~ [~ ~ Township, Rango, Soction: O~ ~~~ ~ ~ SLOPE SITE PLAN 1 3., 5 ? 8 WAS GROUND WATER 10 ENCOUNTERED? 12 ~,W,~ DEPTH? De,th to Water After Monitoring? 13 - ~ Dote: Gross Net Depth to Net Reading Date Time Time Water Drop 14- 15- 16- 17- 18- 19- PERCOLATION RATE '~'* (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~'~" FTAND FT COMMENTS PERFORMED BY: P~ ~~"~ I~-------~¢ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4185) 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGALDESOR,.T,ON=b 1 2 3 4 5 6 7 8 9 I0 11 12 13 14 15 16 17, 18- 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES DATE Township, Range, Section: WAS GROUND WATER ENCOUNTERED? DEPTH? SITE PLAN Depth to Water ~j, JIe, co J [ M0nitormfl? ~-~'"~ Date: C~-~0 ~J Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ''~' '~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~'~'~- FT AND '~"~' FT COMMENTS PER FO R M E D BY: ~"~"0'~ ~'"~'~'~'~ ~ CERTIFY THAT THIS TEST WAS PERFORMED tN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ --"~ ~ -~"? ¢ 72-008 (Rev. 4/85) Municipality of Anchorage Development Services Department Building Safety'Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMI'LY DWELLING Parcel I.D. GENERAL INFORMATION Complete legaldescription ' LeT Location (site address or ,directions) HAA#. Expiration Date: e Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless"°thetwise requested, HAA wi//be held by DSD for pickup. NUMBER OF BEDROOMS: 3-' ' TYPE OF WATER SUPPLY: Individual Well Individual Water Sto~age Community Class ~ Public Water System ' ' Day phone Day phone Day phone TYPE OF WASTEWATER.DISPOSAL: E~ Individual On-site E~ [] Individual Holding tank [] Well [] Community On-site r-i r--I -.. Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an 'independen~ professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. DeVelopment services':Department : Bbilding Safety Division ' On-SiteWater& Wastewater;Program ~ 4700 South Bragaw St.r ; ....... P.O. Box 196650 Anchorage,' AK ;99519-6650 ~ .' .:: i'..i,,i, www. 'ci'anch°rage'ak' ,Os (907) 343-7904 .... ' ~ ' i'i' ''':~ OVA cF! ..... i!i, : HEALTHAUTHORITYAPPR., L ECKLIST '"= 'i:iLegal Description: /...~ /~,,/'~k' t./, ~ ~-~z~/,.~.~t~/="'5~-.L~/:!3 ParcellD: 0~i-~1~~-' ~."~ : : : , :, .! ; i. : :; IWELL DATA , ' ' IfA, B, orCprovidePWSlD# ~ ' ~" "' l iWelltype ~--; /~' Well Log (Y/N) ' 'i '~f .~ Date completed e/~,{: '! 't "Sanitaryseal(Y/N) ~ Wires properly protected (W~) ~'.. .. taldepth ~ E. ~ ' Casedto ~ ~. Casing height (abovegrou ),, ',~ , FROM WELL LOG · AT INSPECTION Ddt6 o~ ~est Io ~:~ ~ ~/e ~ ' Static water level ~ ~ fl. .~ ~ ft. Well production I ~ g,p,m. ~ g.p.m. ~ 'WATER SAMPLE RESULTS: 'Coliform ~ coloniesll00 mi. Nitrate ~.~ mg~. Other bacteria ~ colonies/100 mi. Arsenic: ~ ~g~l. Dale of sample: ~ ~ollected by: ~ ' B.: SEPTI~/HOLDIN~ TANK ~ATA ~ ' ;, ,Tank T~e/M~teri~i ' ~. ~ ! ~.~ ' Date installed '~' I :Tank size /~ gal. Number of Compadments ~ Cleano~s (WN) ~ ~ ',. : I' ' Foundation cleanout (YIN) ~ Depression over tank ~IN) ~ High water alarm (WN) ~1 ' : .... '~ / ' ~ ;~ ; Date of pumping ~ ~ Pumper ~~a,-/ ~Er~ ":;~' .. C,: ABSORPTION FIELD DATA .~. : Date installed ~/~ Soilrating (g.p.d./E~or~Nd~):,/.~ System~e ~-~~ : ' . Length ~ ~ ff. Width ~ ~. Gravel below pipe ~ 'Total depth ~ ft. Eft. absorption area,~1 ~ ft~ Monitoring tube ~ Depression over field :'Date of adequa~ test ~e? Results (Pass/Fail) ~ For ~ bedrooms . Fluid depth in absorption field before test O in, water added ~Ogal. New depth ~ in, 'Elapsed Time: in. Final fluid depth . , , Abso~tion rate >= ~D g,p.d. ~Any rejuvenation treatment (past 12 mo.) (Y/N & t~e) '.~J If yes, give date SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1040777001 Tobben Spurkland P.E. GLE, L14, B4 GLE, Lot 14, Block 4 Drinking Water All Dates/Times are Alaska Standard Time Printed Date/Time 02/19/2004 13:51 Collected Date/Time 02/16/2004 14:00 Received Date/Time~.-- 02/16/2004 15:30 Technical Direetor~,~ ~e . Released By '~ Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate-N 3.05 0. 100 mg/L EPA 300.0 B (<= 10) 02/I 6/04 Microbiology Laboratory Total Coliform 0 col/100mL SMI89222B A (<=1) 02/16/04 DKC 19:43 FAX 002/002 ^.q. IlUILT n~s ~ku~l~ ~ ~ within th~ ~mp~y lln~Jnd ' ' ;i ,~ ' ' ", : I:::i ' , i ~,~, ,.~ F-' , 5~ .. :2[ :' ~ i !~ , ~! . ,,: ;~ DeveloPment'Se~lcesDepart.ment . ' ~//,~j~,, ~ ='~ ~ ..~ ,~ ~Bu,ld,ngSafetyDIvls,on ; '"~ h. I{~~ ~J}' ' ;:.=]. '. On-Site'Wa{er~and~astewater Program" : ~ .... ' ~~~// ~ ' ~ ~ .' ,' ' 4700 South Bragaw St. :. = ='~: ~ ~ ~ ~~ '. ~ . ~c.aqcnorage.aK.us ~ . .' ~ ~ ~kl;~lTF~,,~,~ ,.___~W~F//~,___,.,,_~. .- ------------~ ~HRMIT~AE ~OMMbN.I: SHEET Legal description: ~reot ~nd=Estotes.~3, ,. Block ,4 ,.Lot, 24 - , ~ a e~ork has been revmwed and ~s being returned for the following reasons. The attached p p . ~ . . ~ ~ Original s~gnature,or stamp m ss~ng on.~., ,.. ,.'; . ~.~ ~ ~ .~ ,Calculatonerrormdes~gn ...... ,.. .... : . .. ~ ~, " ' ~ ~ , ~ I~- , ~, , ~: ~ . I ~: ~ ~ , · ,~ , . · , ~ ~ ,., :,= ~: ~,~ ~' . ~ . , : ' ~ Add'tionalsoil~information neede'd.~',:'~=~.." =' ','f "= {.: ~"' '1, I ~atermonitoring resu~[s ~na~equam.,.~.,~ ~'.. .~ ' 1. =: ; ~ D~screpancy ~n ~nformabon su~m~tt~d~'~.,~ '~.... ~ ~:.~ ~pographicinfo~mationmiSsingorinadequate. ih~: ~ : . : ~ ,~ Incomplete;.missing ' :~ ~ ' ' ~ =. ~ 1~ ~ ~: ~ Incomplete;missing ' '~ :'.; .~ ' ~'~ : ' ~ ',' ~ Additional adequacy test ~nformab0n n~eded.. ~,, ~, = .: : ~ ~Watersample;unacceptaDle.:~ ,~: : ~ . : .~ ' ~, = ' ::= ' ::. . ~.=. ~ Measured/proposed d~stan~sld~mensions ~s~ng~ : ~. ~ , ' ' I: ~1 ~ Lo~tions'of all soils, per~lat~on ana water momtor!ng te~ ~ ~ Proposed system too deep'for so~ls ~format~on submitted. ,. . ~ . g red . , . ~ i ; .. ,. . . . . Well Io requ ........ ~ ~ .... ~, ~ ~ I,,~ ~,,. ~ ,, : ' ' , ,,~ '~: ....... ~ , ,', ~ = ..... ~ ~ ~Om~ss~on~nnarmt~ye. :: , '.~ . , ' ~ ~ ~ . ~ ..:, ~ :lnsufficieht fill ~er tank or field. : '= ~ .: ~" ~ ., ~"' ;~ ~. ',~;:: ~ :~ ,:~ ,:r ~ ,~,[ . ,~ ,~ ~,- : , !~. ,:~ ~"',~[ .,-[ ~ ',~'. ~'t!;l".-~ : [~: , ~ ~:,' ~ '~ ;:'~' ~ :Other Co;Id ~t, find Monito,:tubeldumng f,eld ,nspectmn :~ ]f~ ~ ~~:: ~ , : ~ ~ ~ ' , ~ ~ ~ ~ . , ~ . ~, . . , . , . , ~ . N~meo~revlewer: ~-o-~ : ,,, .:'~',: i '. , .. , , , · -- ., i . ;:, . ~ ,I '. r~ · ~; ..., ~ ,.. ....... l,:, . ,. , . ,, . ~ 'Please ~'u~, , t~e :~ecessar~ tntormaFon iana ,"' ' .I ~ ~ , I .~ i ,,, :, ~..~'~ , , , t I-. .. , , ~I~ . ':~ ', :~' THIS~O~:t~ ' CriED TOiTH, 5~RAPERWORK., " '~ '~' ''~ = ' ' i ' ' 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, # 1. GENERAL INFORMATION Compt~(~te'iegal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) lq:q. Property owner Day phone Mailing address Lending agency Mailin. g address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 [Re~.1/91) Front MOAfF,~I 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 I ~ ~,~,~, Address Engineer's signature; DHHS SIGNATURE ~/ Approved fo;~,P~¢~ bedrooms. Date (~/~' l~ ~ Disapproved. Conditional approval for ~ / ~.~. bedrooms, with th-e following stipulations: AdditionalOomments~,'\,,i¢ ¢L¢~f'¢,¢c~/ ('~,/~{:~ ~/L~ (~¢')vl~iJ~O~,~dc~ By: The Munioipality of Anchorage Department of'Health and Human Services (DHHB) i~ue$ Health Authori~ 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. 72-02~(Rev. 1/91) Back MOA~/21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: (~-~_,~.,4 LJ £, Parcel I.D.: A. WELL DATA Well type. ~ Log present (Y/N) Total depth [/~ ~f IfA, B, or C, attach ADEC letter. ADEC water system number Date completed 1 0/9 ~.t/ Cased to ~ ~ r Casing height (above ground) Sanitary seal (Y/N) ,, ~//' ' Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed /0,2;o'. ?"/ Tank size FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION g.p.m. 7 '~ Y g.p.m. Nitrate ~,~,~¢ ~'~¢Z Other bacteria ~"[ ~ Collected by: '/~ '-~ Number of Compartments Foundation cleanout (y/N) 7 Depression (Y/N) N High water alarm (Y/N) Date of Pumping ~/¢~ Pumper C. ABSORPTION FIELD DATA Date installed le -~ - ~ ~ Length Width Effective absorption area ~'7 Date of adequacy test ~7/~'~ / ?. ~. Fluid depth in absorption field before test (in.); Fluid depth 1~ II (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g.p.d./ft~ er--ftYed~m-)-- Gravel thickness below pipe Monitoring Tube present (Y/N) y Results (Pass/Fail) '~ lO J' ~-- System type "~-" ~'<"'3'4z//~-- ~'~ / Total depth Depression over field (Y/N) For ,~ bedrooms ,..,/~ Immediately after'7~,O gal. water added (in.): Absorption rate = ~>/--/~ ~ q.p.d. If yes, give date 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) n" level at* High water alarm level at* ,/~ *Datum Cycles tested _//// E. SEPARATION DISTA CN~EES "Pump off" level at*. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ t ~ On adjacent lots ~/,~-o Absorption field on lot Public sewer main t~/~, Sewer/septic service line On adjacent lots Public sewer manhole/cleanout b////--% Lift station t',/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation (~"2 ~ Property line ~/0 Absorption field l 0 Water main/service line .>c~~ Surface water/drainage I"t/1D Wells on adjacent lots >/~..~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation ~ ~/ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION "': I certi~ that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Na Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment . Receipt Number T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 Subject: Conditional HAA Great Land Estate #3 Block 4, Lot 14 June 2, 1999 Gentlemen; On June 1, 1999 I observed that more than 2 feet of fill had been placed over the septic tank on subject lot. The condition of the HAA has therefore been satisfied. Please issue an Unconditional HAA for this property. Yours T. Sp'~ur~ Parcel I.D. # 1, 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 GENERAL INFORMATION Complete legal description Location (site address or directions) \ oko~ \~_ O'~P~ P__ Property owner Mailing address ~L.;5 ,~-,~ ~-,--,.,~,~-~. ~'~-~,,~ Day phone Lending agency Mailin. g address Day phone Agent Address Day phone Unless otherwise requested, HAA will be. held for pickup. NUMBER OF BEDROOMS: --~ TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and statu"s 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) F¢ont M'OA#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 ~..~ EngineeCs signature Phone Date ~/~/~¢ DHHS SIGNATURE Approved for Disapproved. ,'~ Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ~ --//~'-- ~¢'? · 'f;Nqll'h 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. 72-O25(Rev. 1/91) 8~ck MOA~21 : Municipality of Anchorage J~ E (~ E ! V FJ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAR 5 19 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) i~u4~-474,4 c~pa~ity of A~chorage Oept. Health & Human Services Health Authority Approval Checklist Legal Description: A. WELL DATA Well type "~ Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D.: O ~ ~ ¢ \'-5'5- ,2--% If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~, ~ Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION g.p.m. -7 g.p.m. WATER SAMPLE RESULTS: Coliform (~ Date of sample: 'Z/;~3'/~ Nitrate o.~. ~ q vv'(~/L~ Other bacteria N .L~ Collected by: I -~ B. SEPTIC/HOLDING TANK DATA Date installed lo. ?..~. Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed ~o. zo .¢J ? Length //~¢ Width Effective absorption area Date of adequacy test z/¢:5 Fluid depth in absorption field before test (in.); Fluid depth ~//t* (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Tank size lo.--o-er Number of Compartments 3_ Cleanouts (Y/N).__ Depression (Y/N) y ~' High water alarm (Y/N) Pumper ~ ~.~'~.~ P~'~'[;-~'~ ~ Soil rating (g.p.d./ft~ ~) ]~ Gravel thickness below pipe Monitoring Tube present (Y/N). ~ Results (Pass/Fail). '~ N ! ~ Depression over field (Y/N) __ For ~ Immediately after '77.c~ gal. water added (in.): Absorption rate = ~ /~Z~,~C:> g.p.d. If yes, give date 7' System type Total depth bedrooms 72-026 (Rev. 3/96)*' LIFT STATION ~-~/~. Date installed Manho e/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum __ "Pump off" level at* Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ Io-O Absorption field on lot ~ [ c-c> On adjacent lots "~ ~ ~ On adjacent lots ~ I~o Public sewer main /A Public sewer manhole/cleanout Sewer/septic service line :> IC,"O Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,:~"7 Property line /%/~ Absorption field Water main/service line ~ ~ .~ Surface water/drainage l'"~. / o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation ,'5 ~/ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~ //cD F, ENGINEER'S CERTIFICATION "_~:~.'. I certify that I have determined thru field inspections and rev/ow of Muntctpal recor, d~J that,th~'a~ove systems are in conformance with MOA HAA guidelines in effect on this date. ~-' '%t ;'-:.,'., ,, ~¢: *"' ~' .: · :,"".' ,' ' HAA Fee $ Date of Payment_ Receipt Number_ 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number MAR-Ol-99 18:28 FROM-CTE ENVIRONMENTAL ~t~ C T&E ~'"vir°nm'nmlServicesl"c %080 P.02/03 F-4)5 CT&E Ref.# gg~K)58023 Client Name Tobben Spurld~md P.E- Project Name/# nla Client S~ple ~ Great Lm~d Estate L 14 Bk 4 Matrix D~i~mg Water Ordered By PWS~ 0 Sample Remmks' Client PO~t Printed Date/Time 03/01/99 16:09 Collected Date/Time 02/23/99 12:30 Received Date/Thane 02/~3/99 15:30 Technical Director: Stephen C. Ede Released By //~// / ~ Atta~abLe Prep kimiTa Pate ~ate ToTaL CoLiform 0 ¢ot/)OOmL SM1B 9222B 02y23/99 KAP NiTraTe-N 2.89 0.100 ~/L EPA 300.0 10 ma~ 02/2~/99 0212)/~9 $£L ::: '¥~-:~:'-;~-;'~c~mpl~te legal'description ~ t 14; Block 4; GroUnd Es'~e~ ~3'??:¥.~?-J't .-.'-._-.' . >~,~~~the~ise.m ue~te~ H~.w#lbeheldforntckun~~.~.,:,~, :~-:: ~TE.~? :lf. commuot.~:~we~l: system, provtde wn~en .confi~ation. ~m State . ?:- ...... ....¢. ~- ...- If commum~ waste~ter syste~ prowde wrt~en qonfirmation:from~State:~ DEC '~STATEMENT OF INSPECTION BY, ENGINEER · ,. ~; ~...-..,.-,.,.., ?%f '~-" ......... ~.-.~..fi... ~ - - - As certified by my se*~[~ffi~ed h~t6~and'~s Of the validation date shown, below,.I verify that my nvestigat on of this Health*:A~*~h~rity~rA~3proval application shows that the ·on-site water supply and/or wastewater disposal Sy~ier~*is~'sa:~el f~u~n;:ti'0'n'ai'and adequate f0'~ i~e 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 invest, i_,qation and inspection, the on-site water supply and/or wastewater disposal s~stem is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection Name of Firm : .~ ~ ~=;,.~';'L.__k'_- 17034 Eagle Rlve~. Loop Road Address . .E~I~ ~~ :, ~ .Engin~¢ssign'atur~',v'' ~;~ ", .~ Phone · · · . . ,.-....:: ~. ~-. P_.. · . . · .,.:,:..:.; ,~*~2~;ese'ntati°hS niven inpamgrap~ 5 a60Ve'by ~n::indepe~d?~t,:: APproval Ce~ ficates DaseQ omy upu. ~-~ ~. . ~ . .... ,. : r~ ..~ :.,. .. , ': ~'' ~e~ ntheSta{~"~{A[~k~,TheDHHSdoesthisasacou~esyt°purchasem'°fh°mes;;;~':: professional engineer r~ste -. ~' ~. ' .' ' ~:: ~-~ ~"~ ~,~*~ ~a' ~6m~h~'Em I°y~s of DHHS do not andthe~r lending mstltut~onsm or0erto' ,~. ~, ,, , ... ;_ ~_.?e,~ Th~ M~icioali~ 6f Anchorage ,s not tlons 0r' ana e data oerore a cem~lca~e ,s ,~.-~..,.- .v~--: .... :. ::~...~ ...... , ~:. ,.conduct jnspec. : ...... ~, ~..~ .... ~,.,,~. ,,,,:. ~? ; -,..~.-. ,:,?-,:::~;:~?.~:;:::-.;:::,.; :-;;;;;;~.~.r,;~:c;,::~, :, .: Legal Description: A, Well Data Well type ~, Log present (;;~N) Total depth L~I ~ Cased to Sanitary seal ~N) ~ Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C, attach ADEC letter. ADEC water system number ~ 1~ Date completed ~.~ ~ Driller ~o~..~, ~...~ FROM WELL LOG Date of test \ o -~ ~ Static water level ~'5 ~ Well flow 1~, ~ Pump level1 ~ V---- ~.o%' ~ ~ Casing height Wires properly protected (~N) ~ AT INSPECTION g.p.m. J g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/hetdiflg tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots \c, c:, ',"~ ; On adjacent lots \ o c~~ ¥ Public sewer manhole/cleanout ~1~. Petroleum tank ~A~.~ WATER SAMPLE RESULTS: Coliform d.~ Nitrate Date of sample: .-~ Collected by: Other bacteria B. SEPTIC/HC, L~,:;;~ TANK DATA Date installed \o~ ?l ~ Cleanouts (~) ~ High water alarm (Y~ Date of pumping ~LI/~ Tank size \o~o c.~/>d_~ Compartments '7..- Foundation cleanout (~/N) ,,./ Depression (Y/~) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot ~'~-~'~-~' To property line \ c Surface water/drainage On adjacent lots Absorption field Foundation '~"~ I Water main/service line I ~ ~'~ 72-026 (3~)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPA~F'I' STATION TO: WelK-0n lot On adjacent lots Manufacturer Manhole/Access (Y/N) "P u..mp-eff~'~el at Sudace water D. ABSORPTION FIELD DATA Date installed t c::, ~ 7~ Length L~~ Width Total absorption area Date of adequacy test ~-~./~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ Cleanout present ,GS"N) Results (pass/fail) Soil rating (GPD/Ft Gravel thickness System type ~,¢.~ 3 ~ Total depth Depression over field (Y/~_)~ for ,~/~, Bedrooms After test ,'~ ~, If yes, give date '~/~. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots Ic~ c:, ~- Property line To existing or abandoned system on lot Cutbank ~L~,~. Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on_J~e,c~.__,e~is., inspect/on. ......... Si nature Enolneeg_ Name . Date HAA Fee $ ¢ fpcO ,- ~-J~ Waiver Fee $ Date of Payment ¢t-' ~ C.,/ -- ~ .'~- Date of Payment Receipt Number '7 ~3 ~/L~¢O ~/ Receipt Number 72-026 (3/93)° Back CT&E Environmental Services Inc. Laboratory Division ~ ~T~= Re=., 9~.1~9~-1 Laboratory Analysis Report M~trix WATER Cllenc Sample ID Client Name Ordered By Project Name F~oJect~ pw$~D UA WORK Order 13564 p~inced Date 04/03/95 ~ 13:51 h~- Collected Date 03/30/95 ~ 11;30 hr~, R~celved Date 03/39/95 Technical Director 8TEP~N C. EDE sample Remarks: $~PLE COLLEOTED E¥: ~ ~ S ENGINEERING, WITNESSED BY JACK. QC Allowable ~Xt. Anal pa~at~eter ~esul~s Q~al Ut~l~ Method Limits Date Da%e Init ............................................................. 03/31/95 CMR Nitrate-N 2.53 D I/l~/~ E~A 353,~ 10. See ~pecial In~truotione Above UA - %Taavailable 8~ Sample Rema~ Above NA ~ Not A~alyzed Undetected, Reported value ia the praotical ¢~anblfica~lOn ~imit. LT = 5e~s Than GT - Greater ~an Secondary dilucion- 200 W. Potter Drive, AnGhorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACIUYt~S IN ALASKA. CALIFORNIA, FLORIDA, ILLINOI6. MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA