HomeMy WebLinkAboutFASSLER LT 4F
sler
Lot 4
#051-531-35
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: ~c,o~'~l~ PID Number: CPS-1
Name: Wastewater System: ~ New ~ Upgrade
Addre,8: ~S ~SS~ C~. ~ ABSORPTION FIELD
LEGAL DESCRIPTION so~, Rating: o . ~ GPO/Sq. Ft. Tote, Depth from ~°riginal' grade:
Lot: ~ Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: Range: I Section: Fill added above original grade: Gravel length:
pgra._/~ Gravel width: i Number of lines: Distance between lines:
WELL:
New
U
~ Ft. ~ ]O Ft.
Classification (Private, A,B,C): Tota~ Cased To: Total absorption area: Pipe material:
Driller:~~ Date Drilled: StaticWaterLevel:Ft. Installer:~H~E~ ~ Date installed:
Yield: / I Pump Set at: Casing Height Above Ground; TANK
/ GPM[ Ft. Ft.
SEPARATION DISTANCES ~s,ptic ~ Holding ~ S.T.~.P.
To Septic Absorption Lift Holding >ublic/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines A~4H~AAU~ ~ /~
Well- /~ [~ I~1 ~ ~ ~ O~t¢ Material: ~'~ Number of Compartments:
Surface , ~ ~
Water lOC ~ ~OO~ ~ ~ LIFT STATION
LineL°t ~1 / 0/ ~ ~ ~ Size in gallons: Manufacturer:
~ ~ ~ ~ ~ ~ ~ "Pump on' level at:~level at: High water alarm at:
Foundation
Curtain ~ ~ o~E F ~O ~ ~ Pum~ Electrical inspections performed by:
Drain
Remarks: ~ ~ ~p ~~,~ BENCHMARK
Location and Description:
, I Assumed Elevation:
~ ........ E~le River, Alaska ¢95~ ' ._
Department of Healt~,~nd Hu~.Serwces approval
72-013 (Rev. 9/91 ) MOA 25
Permit No.SW950316 Page 2 of
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
LOT 4, FASSLER SUBD. 05153135
Legal Description: PID No.:
ST1 98.8' 3T2
~ FINAL GR/DE ia W. C04 .5'
~ INSUI~I ION
.... ~ ~N~E~ r,~. ~ INSU~TION~
~! 4 94.4~
~ ~ 5 .;EPTIC TANK
sc*m t":~o' ~ /~NEW, TRENCHES
72-013 A (Rev. 9/91) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950316
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:FASSLER RUTH E
OWNER ADDRESS:24838 FASSLER CIR
CHUGIAK, AK 99567
PARCEL ID:05153135
PAGE 1 OF
DATE ISSUED:10/05/95
EXPIRATION DATE:10/05/96
LEGAL DESCRIPTION:
FASSLER LT 4
LOT SIZE: 30381 (SQ. FT.)
NUMBER 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:
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 ) (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.
SPECIAL PROVISIONS
RECEIVED BY: ~--~
ISSUED B Y://~l{['~k '~ ~.~/~~ ~w
DATE:
DATE:
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
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
WASTEWATER
DISPOSAL SYSTEM
DESIGN
September 21, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 4 Fassler Suubdivision
Request you issue a permit to upgrade the septic system
serving the four bedroom house on the referenced property.
A test hole was excavated and a percolation test performed
in the area of the proposed upgrade. The approximate
location of the test hole is located on the attached site
plan.
At the time of excavation no water was encountered in the
test hole and after seven day ground water monitoring,
water was found at twelve feet.
Attached is the proposed upgrade design.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCO/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
SITE PLAN
_UPGRADE__ -
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
6
7
8
9-
10-
11
12
13
14
15
16
17
18
19
2O
DATE '
Township, ~ange, Section:
SLOPE SITE PLAN
WAS GROUND WATER [
ENCOUNTERED?~'~
S
iF YES, AT WHAT
DEPTH? /~ p
E
Depth Io Water Aller. ~ &
Monitorin§? t/,.- Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE I 0 {minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN q FT AND ¢ FT
COMMENTS
S & S ENGINEERING ~.~,~,~
PERFORMED BY: ._J- n~ .... t ..-.._=_n..a.._..~d --~0~ A,~O~J~. CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 ,,.-. ........... r-
ACCORDANCE WITHE~I~'~'~I~AI~?~I~,~-------- GUIDELINES iN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, P.E.
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAO DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
~NSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
REFERENCE: Lot 4 Fassler Subdivision
September 21, 1995
GENERAL:
1.
e
e
e
The scope of this project includes the installation of
two five foot wide drainfields and a 1250 gallon
septic tank to serve the existing four bedroom
residence on the referenced property.
Construction shall be in accordance 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.
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.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
e
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 4 Fassler Subdivision
September 21, 1995
e
e
5o
o
Ail standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
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 ft. 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.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD 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.
0
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.
e
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.
0
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. 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.
Page Three
Lot 4 Fassler Subdivision
September 21, 1995
50
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.
MINII4UI~ I~TERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
e
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the %200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.0.A. or D.E.C.
requirements.
Page Four
Lot 4 Fassler Subdivision
September 21, 1995
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:
me
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.
e
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.
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 contractors
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 contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 4 Fassler Subdivision
September 21, 1995
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
Development Services Department
Building Safety Division
On-Site Water and Waslewaler Program
4700 Soulh Bragaw St.
P.O. Box '196650 Anchorage, AK 995t9o6650
www.ct.anchoraga.ak.us
(907) 343-7g04
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
HAA #
Expiration Date: / ~-'" ~ -- O.,,~---
ParcelI.D. 0 5'l
O EN~:I~L. IN'~ORMATION
Complete legal descripti6n'
Location {site address ordir~ections} 24838 fasaler Ct., ChugS. ak, AK, 99567
Cur. rent Property owner(s)~ l~ayne t, tndsey Day phone688-6065
Mailing address .." PO Box 672552 ChugS. ak, AK 99567
[ending agency Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
~r~ Individual. Holding tank
Community On-site E]~
E] Public Sewer []
The Municipalily of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAP,) based only upon the representallons given In paragraph 5 by an independent prolessional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are requlred for Ihe transfer ot
title (except between spouses) for propedies served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Cerfil~cates of Health Authority Approval are
valid for g0 days from Ihe date of Issue for propedies served by a private or Class C well and may be reissued with
new waler sample results less than 30 days old. (Certificates may b~ reissued for a period ot up to one year with
valid water samples.) Certificates are valid ~'or one year for propeflies served by Class A or B welts or a public
water system. The Municipalily of Anchorage Is not responsible for errors or omissions In the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as et the validation date shown below, I verity Ihat my Invesllgailon.
based on procedures outlined In the Heallh Authority Approval Guldellnes for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe. functional and adequate for the number of
bedrooms and lype of structure Indicated herein. I further verify tha{ based on the information obtained from Ihe
Municipality of Anchorage files and [rom my Investigation and Inspection. file on-site water supply and/or
wastewater disposal system Is(are) In compliance iNilh all applicable Municipal and State codes, ordinances,
and regulations In effect at Ihe time al' installation,
NameofFirm S & S Engineering
Address 17034 N. earle River LooD RD, E.
Engineer's Printed NameRobert C. Cowan
5. DSD SIGNATURE
L// Approved for
Disapproved.
Conditional approval for
Phone 694-2979
bedrooms.
· AK 99577
bedrooms, wilh Ihe following stipulations:
Additional Comments
Attachments:
HAA Checklist
Sepl c Sys{em A(Jvisory
Well Flow AdvisoP/
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Cedificate Date: 4:~ ._, ~_ O~
Municipality of Anchorage
Development Services Department
Building Safety DNis~co
On-SIto Water & Wastewater Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.u$
O
A. WELL DATA
Date completed
Total depth ~_.~ff.
HEALTH AUTHORITY APPROVAL CHECKLIST
ParcellD: O Y' I .-,$'31-'~,5-
If A, B, or C provide PWSlD # Watt Log (Y/N) /~L/
san~ seal (Yin) ~' Veres propa~ protected (Y~N)
Cased to__~:.~fl. Casing height (above ground).
* FROM W~LL LOG AT INSPECTION
Static water level ft. / ~..~" ft
Well production g.p.m. ~)* ~ gp.m.
WATER SAMPLE RESULTS:
Coliform ..~___colonies/100 mL Nitrate ~..~j~rng./l.
Arsenic: "~ mg./I. Date of .mple: ~.v~/~)~/
in.
Other bacteria
Collected by:
~) colonies/100 mi,
Cleanoute (Y/N) "~
High water alarm (Y/N) J
Gravel below pipe ~ · ~' ft.
Depression over field ~/
For g:~, bedrooms
New depth/,~in.
~ g.p.d.
If yes, give date '~--
B. SEPTIC/HOLDING TANK DATA
/
Tank Type/MateriaJ '~'~.f:~e(.. /
Tank '~e ('~ ~'"'~ gal." ' ::" ,Number of Compartments
mound~n ciea~'ut (Y/N) "~ '~Depression over tank (Y/N)
Date of pbmping :~/~,,,~ [O '~'' Pumper
C. ABSORPTION F~ELD DATA ,,
Length ~G¢.L/e,/'ir~. ft. Width ~
Fluid depth in e~oq~bon~--field loefore test ~ in. Water added ~ gal,
Elated Time: ~ min. Final fluid depth ~ in, ~o~ti<~ rate >=
Any ~juvenabon ~atment (past 12 mo.) (Y/N & ~pe)
D. LIFT STATION
Date installed ~/.~
'Pump on' level at_//__ in..
Datum
E. SEPARATION DISTANCES
Size in gallons_
'Pump off' level at
Cycles tested
in.
Manhole/Accees (Y/N)
High water alarm level at
Meet~ alarm & circuff requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenldltf.,,~a o~n on lot /(30 ~--
Absorption field on lot /~0 Iy_
Public sewer main
s er/sep c se icellne
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field
~/0 ~ S,Jr~cewater
Building foundation ;.~C- Property line .~'5~'
Water main /~J/,g~c Water service line
Wells on adjacent lots /~)0 ~
On adjacent lots ~/g:)O /4--
On adjacent lots
Public se~er manhole/clearmut ,~/,~-
Holding tank
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /0 I-/- Building foundation / C) ~. Water main
Water Service line /r~/'/"
Curtain drain/~J'~U~/~/~'I~J
Surface water ~'~0 /'~' D~my, parklng/~ehide storage
Wells on adjacent lots /~ ~.-
F. COMMENTS
O ,4-.-
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Pdnted Name J~
Date '~/3-~./ O *-z-
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Health Authority Approval # 020421
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot 4 of Fassler subdivision, the
well's productivity was determined to be 0.5 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
4-bedroom residence is 0.41 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
c~ MONRON STREET~ I
0 0
~ j
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section'
;,~'}~ '""P.O. Box 196650 "Anchora~;?,laSka ~9519'66S0
Parcel I.D. #
1. GENERAL INFORMATION
**~,-,~;,..,.,, rUOmplete legal Qescnptlon
~;~,;~;~; ..... ::'. . Z- -. ,;.L_,~:L~
--. CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location-(site ad~iress or directions)
24838 Fassler Circle
,. ,,,% Property owner 'Rgth Fassler
-., ~ P.O. Box 670181
~::?,:~' Mailing address
...... ~:~ ,- ..... ,, ~. Lending agency.' ·
' ' Day phone 688-2504 "
Chugiak, AK 99567
Day phone
Da o --''
72-025 (Rev. 1/~1) Front MOAi~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 inves.ti_,qation 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.
$ & $ ENGINEERING Phone
Name of Firm
i/u~ P. agle KIYe~
Eaclle River., AI,,ska
Engineer's signature "~' Date
Approv~ for 7 b~rooms.
Conditional approval for ~
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 ragistered 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 ~s not
responsible for errors or omissions in the professional engineer's work, .//
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: LeT Df, :~655t.~'o. Sue, O.
Parcel I.D.:
A. WELL DATA
Well type
Log present (Y/~
Total depth ,2 q I
Sanitary seal~
If A, B. or C, attach ADEC letter. ADEC water system number
rj Date completed ~,~t o ~ I ~] 7 ~'
Cased to ~ ! ~
Casing height (above ground)
Y
Wires properly protectedl~l-)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production
J~"' g.p.m.
WATER SAMPLE RESULTS:
Coliform
Nitrate
Date of sample: t [/~ / q ~
~OLDING TANK DATA
Date installed
Il'Q- ~%~ Tank size I~-O ~..c Number of Compartments
~', a q my/Z. Other bacteria
Collected by: F~,~
ABSORPTION FIELD DATA
Date installed Ii- 9. -q ~-
Foundation cleanout (~)
Date Of Pumping. ~/,~
Depression (Y/I~ t,/~,
Pumper
~ Cleanouts ~?q)~/~
High water alarm (Y/~ I'd e,
Soil ratin~r ft2/bdrm) 0,~
Length ~,tot -rOT'at-Width ~_.~t Gravel thickness below pipe
Effective absorption area '"/~ ~a ~ Monitoring Tube present((~) qe-~ Depression over field (Y/~)
Date of adequacy test N/A
sy a~',e,,,-. Results (Pass/Fail) For ~ bedrooms
Fluid depth in absorption field before test (in.):
Fluid depth (ius.) Minutes later:
Peroxide treaunent (past 12 months) (Y/N) ,-- --
Immediately afteC ' . gal. water added (in.):
Absorption rate = g.p.d.
If yes. give date
System type. ~-o0,~.~.o~o 'rt~m,ac/~
Total depth ~'.~' /
IZ
D. LIFT STATION ~~
Date installed Size i
Manhole/Access (Y/N) ~* "Pump off' level at*
High water alarm level at* _ ~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
c~holding tank on lot
Absorption field on lot
Public sewer main
/ ptl'Se--':c service line
Sewer
: On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO:
Building foundation -~ ~ Property line t ~ Absorption field '7
~ Wells on adjacent lots
Water main/service line lO '~ Surface water/drainage too
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water /oo
Curtain drain ! ao
Water main/service line /~ ~'
Driveway, parking/vehicle storage area
Wells on adjacent lots /oo '4
Property line
F. ENGINEER'S CERTIFICATION
in conformance u,it.h /v~f)4 ~ gu~lines in effect on this date.
~i nature ~ ~ ~ ~ [~ ~
.........................
...............................................................................
HAA Fee $ ~& ' ~ Waiver Fee $
Date of Payment / [ ~ ~ ~ Date of Payment
Receipt Number /~ ~ ~ ~ ~ Receipt Number
Rev. 8/95 OSS: haa.wk.do¢
HEALTH AUTHORiT'f APPROVAL NO.
During a recent Health Authority Approval on-site inspection and
test ~ the potable water supply well on Lot ~ Block ~
of ,,~"~L-'='/<' Subdivision, the well's productivity
was determined'to be ~ gallons per minute. The minimum we!!
productivity required by this deoartment (AMC 15.55) for
a ~ bedroom residence is Oo~/2 gallons per minute.
Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of
noncritical water uses such as washing cars and watering lawns
and gardens may be required.
This advisory must be attached to all copies of t'he subject
Health Authority Approval.
11/20/1995 18:53
9876941211 S AND S ENGINEERING
JUflN ['IAKTiII-C~T¥ ~TG (907) 263-0735
PAGE 01
J~l J~'~Babb & C~m Inc.
RECEIVED
NOV ~ 0 1995
Municipalit~ of AnChor
DepL Health ~H' - age
uman Ser~;ice~
Pamela PagI, i~A~'
Joel J. _1~,._~1~._ & (30, I110.
ROBERT C. COWAN, RE.
ROBERT A. SHAFER, RE.
HEALTH AUTHORI'Pf
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE pLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
WELL RECOVERY TEST DATA
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
CLIENT: ~
WELL LOCATION (legal):
TEST DATE: ~-7.-'J~cl.~'' TESTED BY:
WELL DEPTH: ~Z-q, t ' 'j' WELL DRILLER:
CASING DEPTH: ~o~ & DATE DRILLED:
TEST PROCEDURE: MISC DATA:
1) Draw water down to pump. Casing Height: ~Z?t
2) Shut pump off 15-60 min. Sanitary Seal? ,,~
-record time Wires in Conduit?
-record meter reading Grading O.K.?
3) Turn pump on. Drawdown. Pump Depth: I ~
4) Shut pump off, Samples Taken? N.J
-record time Date:
-record meter reading
5) Calculate gal./min, recovery,
TEST DATA: START TIME: /0; / -~,'~ STATIC WATER LEVEL: /,3~ '
TR,AL II PU P II II ETER II GAL. N.
OFF
1 ON
OFF ~,'
OFF O,'oo ~0~, ~ 5, /
2 ON
OFF
OFF O ' ~ ~ ~/~. 7
3 ON
OFF
OFF
OFF &' ~ 7
OFF
5 ON
OFF
RESULTS: WELL CURRENTLY PRODUCES: , .,~..~ ~.-Z~/'~
FLOW RATE NOT GUARANTEED-SUBSEQUENT VARIATIONS CAN OCCUR.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577