HomeMy WebLinkAboutT15N R2W SEC 25 LT 92ction 25
Lot 92
#051 - 283-11
~, MUNICIPALITY OF ANCHORAGE
DEl ;TMENT OF HEALTH AND HUMAN SER~
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na.,e DISTANCES
WELL
Add ....FROM~ TANK FIELD
LEGAL DESCRIPTION LOT LINE ~" /0 /
Township, Range. Sectior~
TANKS
~ SEPTIC ~ HOLDING
Mstedal NO. of Compa~ments
4?~ SQFT ~ FT
WELLS
~ PRIVATE ~ OTHER (Identilv)
I ~~ cedify Ihat this inspection was peflormed according to all ~ '~; Louis ,-,,
Health Depadment Approval: ~ ~ ~--~ Date: ~--/o-~
72-013 (3/85)
~2~,27~
N 00° 10' 00' E
I ~ 100' R
c~
~ ~
I
SffPTIC SITE PLA~
EAGLE RIVER ENGINEERING SERVICES
EAGLE RIVER, AK, 99577
~3.~.'h L.. c:~. r.c.l=. ~ , ANCHOF:;~AGE~ ~-. .... 9950
264'- 4 ? ~2 ()
[::Y?c> ')54 ENG ! r,.IE:ERE. J) )DES I GN
0 z.] / :!. 6187
AF:'PI... :[ CAh] I :~
M ]:LTON HA,k:ENSC)N
F:'. 0~. BOX 770617
E. AGL.E~ F:-.' :[ VER ~, AK
694-2,776
9957'7
FL OCt'::': NA
the r'eqktir'emer"d:.s fen" cin'"si'L(.:~! !:~c.)t~er's arid t,,!e:l.:L!':~ a!~-~ set
c:,;i..~l.~O,,) :t:f~ ......... ,Al ......,' ]:N Ahl AREA COVERED ;..Iy MOA BUIL.DING r"ODF:'S.,
!. ~.b~ ~ ~.-,.~,J..,_L.!l~.!,~..d .........d,.. I AND .[14,.~1 L.,I .~ .~ . ,.dJc:~. ~:.~. OBTAINED~ ( .... A~:y-.OLLI.~..Ic~
~]J:],_t.... "'"~" '" '""'"'" '-
~.~.,~N RIEF'ORT :; AND (:~;) 'FHE
i~,~ I::.i:: ~.~ ['Fd..,.JI:D [,'JI]'HC)LJ'F AN EI...EC;'!F;,:!CAL INSF:'EC'I''''''~.
F:' ............. E:I':T'F~i'I:AI [~[.~l'.t'... i'IL~.::~i ,.,~.~:~'::' Dl,'h::: Bf ~.-.~ ~_.i.C,::I,,c:~,.:.,.~ E:.l....c.J,ll~ ..... [A.f.
SPEOIFIOATZONS FOR ON-SITE SEPTIO SYSTEM
LEGAL: Lot 92; TISN, R2W, Section 25
GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of
Health and State Department Of Environmental Oonservation require-
merits.
4, All coil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
All exoavatioRs and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anohora9e, Department of Environmental Oonservation requirements.
It is the responsibility of the owner to obtain ail necessary permits
or easements and to locate any adjacent multi-family wells.
7. The excavation is Co be exactly in the area shown on the site plan,
any deviation requires engineer approval.
It is always recommended that a surveyoF locate the nearest lot line
position and the location of any easements..
DRAINFIELD
The drainfield is to follow the natural land contour to maintain
uniform total depth of the bed bottom.
Tine bottom of the bed shall be level, plus or minus 1.5".
The total depth of the trench excavation is not to exceed 4' at any
point.
The sewer line is to replace the existing sewer line that leads to the
existing seepage pit.
The bed gravel is to be covered with typar fabric material.
Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the drainfield.
The area over the bed is to be finish graded to prevent ponding of
surface water' runoff.
The septic tank and leaohfield must not be closer than lO0' bo any
existing private well, 150' to any Class "C" well, or 20¢ feet to any
community well.
REOOMMENDED LEAOHFZELD DIMENSIONS
TOTAL DEPTH = 4' GRAVEL DEPTH
Soil Rating = 100
Bedroom Capacity = 5
Septic Tank Size = lO00
BED LENGTH = 022' BED WIDTH
SAND FILTER NOT REQUIRED DUE TO PRESENOE OF GM LAYER AT 6' DEPTH.
~'~,. ~ ~ SOILS LOG
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
DATE PERFORMED;
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
SLOPE
SITE PLAN
10-
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
WAS GROUND WATER ~(~2 S
ENCOUNTERED7 L
O
P
IF YES, AT WHAT )~,~;~,r~ E
DEPTH? ~ ~'~'~' .
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE / ~ (minutes/inch)
~ '/~ FT AND ? .v~. FT
TEST RUN BETWEEN
PERFORMED BY:
72-008 (6/79)
P. 0. BOX 773294
Eagle River, AK 99577
694-5195
CERTIFIED BY:
( erlifieh rilling
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND /O'~/4. '~"O .,J
LEGALDESCRI~ION ~ 5~
DATE-Started ~/~ Ended
~T ~u~./ ~
KIND OF FORMATION:
From O Ft. to /<~0 Ft
From/~r, t~
From
DEl'TH OF ~,'ELL ~ 0 0
STATIC LEVEL OF WATER Fr.
DR.&%' DOWN FT.
G,~,~s. PER HR 0 t
~)OFCASlr~G ( ~00
/~</.C7- i..xl ¢ ~_J ~L~. From
Ft. to ~ ~"" Ft.
Ft. to__Ft. ,-),'~ C ~4*oCz'~ From__
From~ 6ff Ft. to ,~co
From __Ft. to
From ?. ~o Ft. to '3"7 / Ft.
From.--?7/ Ft. to~,~'~ Ft.
From __ Ft. to Ft.
From ??.? Ft. to ~:~ O0 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 Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Fl. to Ft.
Ft. to Ft
Ft. to.__ Ft.
From __Ft. fo.__Ft.
~ 7'O'°-~From__ Ft. to Ft.
From__.Ft. to Ft.
From Ft. to Ft
From Ft. ~ Ft.
UNICIPAIiTy OF ANCH~e~,~
From_ Ft. tq~[J~ '~ ~E
eNVIRoN~ ..... ~EALTH &
From Ft. to "~c~[~L PROTE~to~
From Ft. ,o Id0~tl 9 ~n~.
From Ft. to~~
to I VED
MISCL. INFORMATION:
DRILLER'S NAME
SUBJECT
ME~SAIJE
RETURN TO
REPLY
I'~Gd~ 4S 472
SIGNED
SEND PARTS 1 AND 3 INTACT -
carlzanless POL¥ PAK (50 SETS) 4P472
GAAB-HD-I
G I~,T~E R
ANCHORAGE AREA BOROV-~;~,
" HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS
LOCATION ~ ~& ~ - , r '~ LEGAL DESCRIPTION T ~' ~'~
SEPTIC TANK:
PHONE.
DISTANCE FROM WELl '."~"~ /
LIQUID CAPACITY r~/~ ~'(~ GALLONS.
COMPARTMENTS
MATERIAL
INSIDE LENGTH ~ INSIDE W~DTH
1
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
/ /7'
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH , LENGTH
LINING MATERIAl /k ~ ~" ~,? . DISTANCE FROM WELl BUILDING FOUNDATION
NEAREST LOT LINE ~ (~: TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ ~' SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL ~ FOUNDAEION , NEAREST LOT LINE , OF LINES
ABSORPT O~ AREA SQ. FT. LENGIH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: /VM' ~/~,; ~ ~' ~ DISTANCE FROM (,r~.~/?) /~ / WATER '
TYPE , DEPTH ., BUILDING FOUNDATION ,h SAMPLE /dd NEAREST
~ ~ NEAREST SEPTIC ~ ~m / ~ , CESSPOOL .... SOURCES
DISTANCES:
DATE
DIAGRAM OF SYSTEM
GREATE kNCHORAGE AREA
ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Case No. / 7~
RESIDENCE ADDRESS LOCATION OF INSTALLATION ~ f~"o~-,- -i~-'~--' '~'~'"~'
PERCOLATION TEST RESULTS ANTICIPATED DATE'OF COMPLETION.
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK~SIZE /,d ~0~/. TYPE
SEEPAGE
AREA
DIAGRAM OF SYSTEM
TYPE
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE ~ / / - 7~ ~' APPLICANTS SIGNATURE
~ '%EATER ANCHORAGE AREA BOROUGH/-~'-'~
HEALTH DEPARTMENT ~ CASE # 178
327 EAGLE STREET
ANCHORAGE~ ALASKA 99501
.... or l~mes Po[xrefko ~ ~ -~ Date Performed ~," 1970
Legal DescmiptlZn:' ~-~lock~~n ?_~5 N R 2W~
This Fomm Repom~s a: Soxls Log X
Depth
Feet
Soil Characteristics
(GM)
IBrown Silty Sand (SM)
Gray Sand, Poorly Graded
(SP)
2
4 __
6
lO
Was Ground later Encountered? No
If Yes, At ~fbat Depth.______~
"f------i~o~ 7t Time
~ea~ng i Date ~ Gross ,ime
Proposed
Installat¢on: Seepage Pit X
Location Sketch
Depth To H20
Drain Field
Net Drop
Depth Of Inlet ~ Depth To Bottom Of Pit Or Trenc~
COMMENTS: ' -- ....
Dr aina~', ',2,0,0' 'sq uar~' ',fti, per'"be droom .... qr, ,4b 0 'feet " ~
for nrooosed 2 bp~9~m dwellin~'
Test Performed BY: R.._~. a lisle ....
-
Data Certified By: Date: ......
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 FAMILY DWELLING
Parcel I.D. O51-283-11
1. GENERAL INFORMATION
Complete legal description
Expiration Date:
Lot 92~ Section 25~ T15N~ R2W, S.M.
Location (site address or directions) 15723 Husk'7 Drive Eagle River t Alaska
Cument Prope~yowner(s) William & Denise Warburton Dayphone (907) 244-8881
Mailing address
15723 Husky Drive Eagle River? Alaska 99577
Lending agency
Day phone
Mailing address
Real Estate Agent
~one 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 []
Individual Holding tank
Community On-site
[] 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 5 by an independent professional civil
engineer registered in the State of A~aska. 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 less than 30 days old. (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 MunicipaJity of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As ce~fied by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Health Authority Approval Guidelines 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 t,jpe of structure indicated herein. I ~rther 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(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations tn effect at the time of installation.
Name of Firm Pinard Engineering
PO Box 87134? Wasilla~ Alaska
Paul E. Pinard
Address
Engineer's Pdnted Name
bedrooms.
DSD SIGNATURE
t'~ Appro_v~ed four"
Disapproved.
Conditional approval for
Phone (907) 357-364'7
99687
Date
~r.o-°
bedrooms, with the following stipulations:
Additional Comments
Attachments:'
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Bu~d~g Safety Division
On-Site Water & Westewater Program
4700 South Bragaw St.
P.O. Box 196650 Anct~orage, AK 99519-6650
ww~.ci.enchorage.ak.us
(~0D a43-7~04
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescriptlon: Lot 92~ Section 2,5, TI~R, R2N, S.M. ParcellD: 0.51-283-11
A. WELL DATA
Wall type ~'tvate If A, B, or C provide PWSID # N~A Well Log (Y/N)
Date completed "//86 Sanitary seal (Y/N) ~ Wires property protected (Y/N)
Total depth 400 It. Cased to 40 ff.+ Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test ?/86 ~/22/02
Static water level 10,5 ff. 150.0 lt.
Weilproduction 21 RPh ~i~. 3.3 g.p.m.- ~'t%b .500 gal.
of tank
WATER SAMPLE RESULTS: ~%orage.
Coliform 0 colonies/100 mi.
Date of sample:
Nitrate 0. 402mg3.
Other bacteria 0 colonies/100 mi.
Colec~d~: Paul P~nned/Pina~d En~ineerine
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Sep%tc/~teel
Tank size 1000 gal.
FoundaUon cteanout (Y/N) ·
Date of pumping 5/31/02
Number of Compartments 2
Date installed 7/87
Cleanouts (Y/N)
Depression over tank (y/N) lq High water alarm (Y/N)
Pump~ 3R~ Septic Pump/ag
C. ABSORPTION FIELD DATA
Date installed
Lanam 4t lt. w th lt.
Total depth .5 lt.:l: Eft. absorption ama 4.92 ~ Mon~ring tube__
Soil mUng (g.p.dJlt~ or f~fodrm) I~ ef/bd System type Seepage Bed
Date of adequacy test 5/22/02 Results (Pass/Fall) Paae
Fluid depth in absorption field before test 0 in. Water addedS00 gal.
Elapsed Time: 1 50 min. Final fluid depth I in. Absorption rate >= ~50+
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~ If yes, give date
Gravel below pipe 0..5 ft.
Depression over field N
For 3 bedrooms
New depthg- 5 in.
g.p.d.
D. UFTSTATION [~/A
.~:~ Manhole/A=ce~___~ (Y/N)
'Pump on" level at in. 'Pump off' lev~'~---'k~-.....~ water alarm level at in.
Datum Cycles tested Meets~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 10.3 t
Absorption field on lit 10/~ ~
Public sewer main l~/R
Sewer/septic service line 25 ~ +
On adjacent lots 1QI;) t +
On adjacent lots 1 O0 ~ +
Public sewer manhole/deanout
Holding tank
n/A
Building foundation ?0 e
Water main I~/A
Wells on adjacent litslO0 ~ +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Properly line 28 ~
Water service line 10 ~ +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 ~ +
Water Service line 10" +
Curtain drain
F. COMMENTS
Building foundation 8.3 ~
Surface water 100 t +
Wells on adjacent l/ts100 ' +'
Absorption field 6 ~
Surface water 100 ' +
Water main R/A
Drh, eway, paddng/v~ storage. 1 5 ~
Date of Payment ~,- ~ ,- 0.2.,
Receipt Number ~-- 0 ~ ~'~ 0
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
G. ENGINEER'S CERTIFICATION
Date 5/31/02
~ CT&E En~onmentalSe~lce$1nc.
CT&E
Ordered
PW$1D
Sample Re~rt~:
1022892001
?inard Engineermg
Lot 92 Sect 25 TISN R2W SM
Lot 92. Sect 25. T15N, R2W, SM
Drinl~g Water
0
0.4~!
ToLd Coliform 0
PQL
All D.tes/l'bnes orr Alaska Staadard Time
print,ed Date/Time 05/24/2002 12:$0
Collected Date/Time 05/22/2002 13:40
Rttel~ed Date,Time 05/211/2002 13:40
Technical Director
Rddeased By (~~
Allowable Pr~
I~U Date D.te
0.200 ml/I- EPA 300.0 (<101 05~I/(r2
~l/lOOmL $M15 9222B
Init
SDT
f<l) 0f.'21,02 ~
~AY--$I--2002 05|~6 PM ~£NI$£ WAR~URTON 98? ~96 ~9~1 Po81
~'~ Pump septic Tank w/up to 3 E~ackwashes
['-I Pump Holding Tank
i""i Extra Time / Backwashes Required
[:~ JP,'$ recommends your next pumping in ~ AUTO
W~ will call or send a reminder at that time.
[~1 Standpipe(s) needs repair; missing / crimped I broken I no caps
~ Only one standpipe on septic tank
'~= Tank appears to be//,)pr gallons / crib leach
C-I Last PumpL- .# of gallons
~ Other
Description Amount
Gallons Pure
Extra Time I Backwashes
)then
Total Amount Due:
Payment Terms: 30 days from invoice date - 1 ..5% per month late fee
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) $57-ENGR (3647)
ADEQUACY TEST
LOCATION: Lot 92, Section 28, TlSN, R2W, S.M.
APPUCANT; William & De~ise Warburton
15723 Husky Street
Eagle River, Alaska 99~'77
SEPTIC TANK TYPE/S[ZE: Stee4/1000 gallons, per MOA Records
ABSORPTION SYSTEM: Seepage Bed, per MOA Records
DAJLY FLOW:
JOB NUMBER: 02-079
DATE OF TEST: rg22/02
FIELD STAFF: P.J. Pinard
NUMBER OF BEDROOMS: 3
SCUM: 0.4' SLUDGE: 0.3'
NEEDS TO BE PUMPED: Yes XX No
3 BEDROOMS x 150 GAUBR · 4~0 gallons
TEST DATA
CURRENTLY IN USE: Yes XX No
Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments
Rate Volume Tank
]~M (GPM) (GALs) (GALs) Liquid Level * A Level Monitor /, SAS Monitor A SAS
Tube 1' Level Tube 2' Level
2:$0 3.3 4.1' 0.0' Start Test- Meter 313130
3:05 3.3 50 50 4.2' 0.1' 0.1' 0. l' 313180
3:20 3.3 50 100 4.2' 0.0' 0.2' 0.1' 313230
3:35 3.3 50 150 4.2' 0.0' 0.3' 0.1' 313280
3:50 3.3 50 200 4.2' 0.0' 0.4' 0.1' 313330
4:05 3.3 50 250 4.2' 0.0' 0.5' 0.1' 313380
4:20 3.3 50 300 4.2' 0.0' 0.6' 0.1' 313430
4:50 3.3 100 400 4.2' 0.0' 0.8' 0.2' 313530
5:20 100 500 4.2' 0.0' 0.8' 0.0' Stop Test 313630
RECOVERY *ALL MEASUREMENTS IN FT.
Date TIme ST MT1 SAS MTI
5/22 6:15 4.1¥-0.1' 0~'/-0.6'
PM
5/22 6:30 0.1¥-0.1'
PM
TEST: PASSED XXX FNLED
CO~EvlENTS: There was no measurable liquid in the SAS prior to beginning the tell With the addition
of ~ gallons to the system (more than the daily design flow), the level rose 0.8'. No backup into
the ST o~curTed. Recovery was measured and found to be rapid, with the level dropping 0.7' in 70
minutes.
Reviewed by:. Paul Pinard
Date: ~/30/02
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
WELL FLOW TEST
LOCATION: Lot 92, Sectio~ 25, Tff~/, R2W, S.M. JOB NUMBER: 02-079
DRILLER; Sullivan Water Wells DATE OF TEST: 6/22/02
DATE WELL COMPLETED: 7/86 FIELD STAFF: P.J. Plnard
WELL DEPTH: 400'
STATIC WATER LEVEL (top of cas~g): 1 SO.0'
Elapsed Sta~c Flow Cumuta*dve
Time Time Water Rate Gallons Remarks
(MimJtes) Level (,qpm) Pumped
2:40 PM - 150.0' 3.3 Start Flow- Meter 313100
2:55 15 179.2' 3.3 50 313150
3:10 30 209.1' 3.3 100 313200
3:25 45 234.7' 3.3 150 313250
3:40 60 265.3' 3.3 200 313300
3:55 75 299.1' 3.3 250 313350
4:10 90 * 3.3 300 313400
4:25 105 * 3.3 350 313450
4:40 120 * 3.3 400 313500
4:55 135 * 3.3 450 313550
5:10 150 * 3.3 500 313600
5:25 165 * 3.3 550 313650
5:40 180 * 3.3 600 313700
5:55 195 * 3.3 650 313750
6:10 210 * 3.3 700 313800
6:25 225 " 3.3 750 313850
6:40 240 * 800 Stop Flow - 313900
RECOVERY
Recovery not measured since well was refilling 500 gallon storage tank.
* Depth to static level exceeded length of well probe.
Average Flow Rate: 6.0 gpm
Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF
PRODUCING 6.}' GPM. THIS TEST DOES NOT CONSTTTUTE A
WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM
WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE.
Reviewed by:. Paul Pinard"~
Date: 5/30~02
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
GENERAL INFORMATION
Complete legal description
Sect~on 25; T15N; R2W; ~ot 92
Location (site address or directions) 15723 Husky Drive Eagle River, AK
Property owner
Mailing address
Milton and Liela Hac~e~en Day phone 696-2664
Lending agency
Mailing address
Day phone
Agent Cliff Johnson/ CRAWFORD REAL ESTATE
Address
Day phone 562-5592
2. NUMBER oF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3 ~J
NOTE:
Individual well
Community well
Public water
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
XXX
Holding tank
Community on-site
Public sewer
If community wastewatei' system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 s & ~ ~,~:~,~_ _ _ Phone
Add riss
Engineer's signature Date
DHHS SIGNATURE
~ Approved-for '7~¢¢~ _('~'.37 bedrooms.
Disapproved.
Conditional approval for
o8
bedrooms, with the following stipulations:
Additional Comments
Date ~'-
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Author!ty
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Ataska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal an¢ 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
A, Well Data
Well type ~g~-~ ~
Log present
Total depth ~ ~ [ Cased to
Sanitary seal'N) '-[
FROM WELL LOG
Date of test
Static water level \~
Well flow
Pump ~evell
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot \ ~"~
Absorption field on lot
Public sewer main
Sewer service line
If A, B, or C, attach ADEC letter. ADEC water system number
~-~ Date completed ~ ~:::>[-~ Driller
'~¢O~' ~ Casing height
Wires properly protected (~)
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed
Cieanouts ~l)
High water alarm (Y~)
Date of pumping
Nitrate ~.~ ~
Collected by:
Other bacteria
$ & $ ENGI[,~EER~NG
~ag~e River, Alaska 99577
Tank size \ oc~ ~ Compartments
Foundation cieanout ~1) ~[ Depression (,Yl~)
~ Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~. ~ "-5 ~ On adjacent lots
To property line . '~'~ ~ Absorption field Lo ~
Surface water/drainage \ ~ (~
~.c:, c:::,~''~ Foundation
Water main/service line
72-026 (3/93)* 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) ~
SEPARATION DIS~T. AN6E~ROM LIFT STATION TO:
~ On adjacent lots
Manufacturer
Manhole/Access (Y/N)
at
Surface water
D. ABSORPTION FIELD DATA
Date installed ~ ~ ~
Length ~ ~ ~ Width
Soil rating (GPD/Ft2) ~o~-~
--t Gravel thickness
System type
Total depth
Total absorption area. '¢t"~i7~ Cleanout present'N) '7/
Date of adequacy test o~ ~ \ \ _~ .~ Result~fa~il) ¢',¢,~ s
Water level in absorption field before test ,¢~ ~/,~-"
Peroxide treatment (past 12 months) ('~ ¢.-o~ ¢..__ ¢,-~o~ ~
Depression over field (Y~)
for "~
After test /~ ~
If yes, give date /~L ~
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /. ~ zN~
To building foundation
On adjacent lots "z2r~t ~- Cutbank
Surface water ~ ~ ~'~
Curtain drain ~\ !~,
~- ./~ Water main/service line
Driveway, parking/vehicle storage area \
On adjacent lots \ t.~ 6:) Property line
<~'"5' To existing or abandoned system on lot
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified,
and HAA guidelines in
Signature
17034
Eng
Date
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
09×i3/9~ 17:02 CT&E ENUIRONMENTAL LAB SERUICES ~ 9073761i87 N0.812 Q05
ENVIRONMENTAL LABORATORY SERVICEI~
~'~¢~'~ REPORT of ANALYSIS
Chemlab Ref.~ :93.4700-3
client Sample ID :L92, SEC25, T15N, R2W
Matrix :WATER
5633 B STREET
ANCHORAGE, AK 99518
TEL: (907) 562-2343
Client Name :S ~ S ENSIN~JNING
orderedBy :RAY
Project Name
ProJect~
PWSID :UA
WORK Order :70766
Report Completed :09/13/92
Collected ~09/08/93 @ 12:00 hrs.
Received :09/09/93 @ 15:45 hrs.
Technical Directo~:SY]~P~'7~ C, ED~ ,
Released By :J~~/-~'_
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY.
QC Allowable Ext. Anal
Parameter Results gual Units Method Limits Date Date Init
Nitrate-N 0.56 mg/L EPA 353.2/300.0 10 09/10 LLH
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA = No~ Analy~ed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution. ~T = Greater Than
wm'r,T, FLOW TEST DICTA
HEALTH AUTHORITY
LOCATION OF WELL (Legal Description): ~o~ ~ ~,~ ~ ~ ~
WELL DEPTH: ~ ~ CASING DEPTH: ~o~ j~ TESTED BY: ~
CLOCK DEPTH TO H?,AWDOWN pUMPZNG
TINE Wa,.,K R ~a~ (GPM)
SEWER & WATER
INSPECTION
ANO REPORTS '
MISC. DATA: CASING HEIGHT: %~t~ SANITARY SEAL?:
- -- %/ GRADING O..K.?:
WIRES IN CONDUIT?:
BACTEI~IA & NITRATE SAI~LES COLLECTED.
STRUCTURAL & ~"~
MECHANICAL ~ULT~ ~.T. Ct~RR~Y PRODUCES ~ L~ J w'rTH A ~-~(,"~( Di~qWDOWN
INSPECTIONS
ON SITE
WASTE WATER
OISPOSAL SYSTEM
DESIGN
FLOW RATE NOT ~U~]t~Tj'K~]--~U~SF~U~NT VARIATIONS C_2tN O~CURI
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
ROBERT SHAFER, P.E
ROGER SHAEER. P E
CIVIL ENGINEERS
(9071694.2979
FAX 694- ! 2~ ~,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application Date Jtg_y 27, 1987
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
(b)
(c)
[Z)T 92: NE ,~ T15N~ R2W; SectAon 25
Location (address or directions)
~572~ HUSKY DRIVJ~: ]TJ~P,T,F, R~R
Applicant Name ~N ~SON Telephone: Home dgq-2ddq Business
AppllcantAddress 1572~ ~St~ O~, ~GLE ~. ~ 99577
Applicant is (check one): Lending Institution ~; Owner/builder ~ Buyer ~; Other ~ (explain);
(d) Lending Institution
Address
NA Teleohone NA
NA
,(e) HA
'- NA
NA
(f) Mail the HAA to the following address:
'HOLD ~T)R PICKUP BY F, AC~T,R RTVE, R ~TC, TT,,TR~,RTNC,
Real Estate Company and Agent
Address
Telephone
2. TYPE OF RESIDENCE
Single-Famiiy~[ Mu[ti-Family [] Other
' - Number of Bedrooms ~ '
3. WATER SUPPLY
Ind vidual Well:~ Community[] _Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite~[[: Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attestihg to the legality and status. ' ....... ......
72-025 (11184)
Page 1 of 2
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MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
MUNICIPALITY OF ANcHoP, AGE
ENVIP,.oNMENTAL SERVICES DIVISION
JUL 2 7 1987
WELL DATA
Well Classification ,*'~/,-t ~'/~- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) t,~ Date Completed ,?,,/6~&; Yield
Total Depth ~-.-./~ o Cased to ,~¢~.~,~o~,~, Depth of Grouting
Static Water Level /¢,.S- /%,,~,
Casing Height Above Ground /"~
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot /03 ?
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results ~'~,~'~'~"~
Pump Set At
Sanitary Seal on Casing (Y/N)
Comments
Depress[on Around Wellhead
· ; On Adjoining Lots
1'~/ / ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Size /~'~ No. of Compartments
Air-tight Caps (Y/N) ~ Foundation Cieanout (Y/N)
Depression over Tank (Y/N) /'-/
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well //~ ~
To Property Line '/-/o"
To Water Main/Service Line '~-/~"
Course ~'//--'~-~"
Date Last Pumped
; for "~'//"~
Temporary Holding Tank Permit (Y/N)
To Building Foundation 7~' /
To Disposal Field ~'
To Stream Pond, Lake. or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ,,/~,z./
To Building Foundation
Lot
To Water Main/Service Line ,¢--/o '/
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area /-/*¢ /
Comments '-~' ~'¢'~- ~'"~ ¢-- '¢~-z-'~-'~' //'¢~ ./~
Type of System Design .~
Length of Field ~;z/// ~-"-
Depth of Field --~ -/'~' / J2'.-~/ .,¢'~.~/~
Gravel Bed Thickness ~/'/'' 4,.,-,,-~-~,.,/.~' "' ¢J ,¢¢'~..,,~,,/¢/.~'~
Standpipes Present (Y/N) .,,9'
Date of Last Adequacy Test ,.4x~-,...., c:~.~'/'¢,-, ¢. ~'~,,~'~¢
To Property Line ./O
To Existing or Abandoned System on
; On Adjoining Lots '/--~¢¢
TO Cutbank (if present)
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~~ Date
Company ..¢~7¢.,/~ .¢- .. MOA No,
Receipt No, I-I L% (.~ ~ - o O ~ ~
Date of Payment ~r~
Amount: $ I O0°¢~ ~eer's Seal
MUNICIPALITY OF ANCHORAGE
DEPT OF I-IEALTH
ENVIRONM£NTAL PROTECfION
Page 2 of 2
'JUL 2 ? 1987
72-026 (11/84) RECEIVED