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Home My WebLink AboutWOODBOURNE BLK 2 LT 9Woodbour'ne Block Lot 9 #015-351-29 ) Municipality of Anchorage ..:,.~ :-%, Development Services Department :-_-~ =- :~ ..... On-Site Water & Wastewater Program, 4700 South Bragaw SL P.O. Box 196850 Anchorage, AK 99519-6650 www.cLanchorage.alLus (907) 343-7904 Page I of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW010512 PID Number.. 01§-3§1-29 Nome:ri I IrN LASH Wastewater System: · New rq Upgrade A~dr,,: ABSORPTION FIELD 11641 WOODBOURNE DRIVE No. of Bedrooms: eh°ne:(907) .345--9697 4 m Deep Trench 13 Shetlot Trench · Bed rtMound · Other LEGAL DESCRIPTION 2.0 9 2 WOODBOURNE SEE DWG - - - SEE DWG WELL: [] New [] Upgrade 12 ~t 5I 2.4 .~' FL FL 360 s~. FL D 3054/ F-810/ SCH 40 PVC FL DENAU 8/31/01 SEPARATION DISTANCES .s..uc a.o~.g .S.T.r."...~- m0~er To .S~ pflc Ab ,F~el~d~ o nLift Holding S~'~' ~,.~_~_: ~ Tank Station Tank Well -- 100'+ -- -- s.,a¢, Water - '~00'+ - - - LIFT ST~TJON-'-"'-"'"'~ Lot Une - 10'+ -- -- -- ~'z'~~-'''[~G Foundation - 10'+ - - - TIMER TIMER Curtoln Dmln - N(~NE KNOW ·I N/A Remarks: IN!~'TALLED NEW LIFT STATION CONTROL ~--. ~--~.:-, BENCH MARK NORTH END OF GARAGE SLAB. p^NFL FOR ISF TIMED DOSAGES. EXISTING STEP TANK INSPECTED FOR STRUCTURAL :-'-': Inspections performed by: AWWC, INC. ~ Y. CO;?' dr~:~[' I '":.'7,~ ~ ........ ~4.~.. 1~ ........... .... !: Dates: 1st 8/51/o~ 3rd 9/4/01 5th 9/6/01 [ ':'"', 2nd 8/.31/01 4th 9/5/01 Department of Health and Human Services approval i~,% ....:~- :.~...~',~ R~vlewed and approved by:.~ Dote'~° ~..~c~l. ~;,"°~,~,~o~e.~o~ AS- BUILT DRAWING 5W010312 015-351-29 / / I / I / I I ~;2/~ I ~- I ~ I "· ;~ .~... · ~ - ~?:~ ~ ~ ~UR , ~" .... "~"""-"'"" ~ I I I I g I ~ 178.2 I ~ ,~., ,,.~ I ~ I I '~;_'~.~ ..... ~ro f esslo~ A B · T1 85.6 57.0 S32 90,8 63.5 MH 92.1 65.4 VALI 93.8 69.1 VAL2 94.6 69,1 MTI 148.9 161.2 MT2 1~0.0 157.5 MT3 178.2 188.3 UT4 1B0,1 185.5 B.S.O. ALASKA WATER & WASTEWATER ~ ' CONSULTANTS, INC. 1" = 40' ELLEN LASH (907) 345-9697 2 OF 3 WOODBOURNE SUBDIVISION; LOT 9, BLOCK 2 AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE (ISF) AS BUILT DRAWING P[R~n' NOU~R: __ 015-~51-29 SW010512 = 103.2+ ~ // ' ?' 'V ' k BOSOM Of BED = 1+/-~ ~ ~ BELOW ORIO~ G~E. / ~ .' ..... REMO~D ~E OR--lC ~YER. ~ ~n~ n~ ~n ~NR UNE 98.8+/- ,/~/tom ..y ~~ ~VATER & ~VASTEWATER ~ CONSULTANTS. lNG ........ ~ ~.~..jl .............. ELLEN ~SH (907) 345-9697 ~ D~R~N: wooD.ou..E SU.D~WS~O.: LOT S. ~LOCK =, ~;, '".g.~ ..... ".~'~ A" ~e .... ~'~ ~ ~Pr o~°x AS-BUILT OF BO~OMLESS INTERMI~ENT SAND FILTER (ISF) MUNICIPALITY OF ANCHORAGE Development Services Depadment On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTE~NATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 10, 2001 Expiration Date: Aug 10, 2002 Permit Number: SW010312 =Legal Description: WOODBOURNE BLK 2 LT 9 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Ellen Lash Owner Address: 11641 WOODBOURNE DRIVE Total Bedrooms: 3 ANCHORAGE, AK 99516-1279 Parcel ID: 015-351-29 Site Address: 011641 WOODBOURNE DR Lot Size: 101166 SQ. FT. Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: ^. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Municipality of Anchorage Development Sewices Department Building Se~u~: DMsion On-Site Water & Wastewater program 4700 South Bragaw SL p.o. Box 196650 Anchorage, AK 99519-6660 www.d.anchon~.ak.us (907) 343-7904 Pan:el I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 01,5-351-29 Permit Number 5 Property owner(s) Mailing address (1) Mailing address (2) FLLFN LASH 11641 WOODI3OURNE ORIVF' * ANCHORAGE. AK Day phone ;~45-9697 Zip Code 99516 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size /Lg//b(~ A~ THIS APPUCATION IS FOR: Sewer Only [~ Sewer and Well Sewer Upgrade [] LOT 9. BLOCK 2: WOODBOURNE SUBDIVISION Number of Bedrooms Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Jacm-/l ~ Water Softenlng Unit I certify that the above Information is correcL I further certify that this application Is being made for a Single Family Dwelling and Is In accordance with applicable Municipal codes. ALASKA WATER & WASTE'WATER CONSULTANTSf INC. Permit Fees: ,,~ Date of Payment: Receipt Numbe~ Waiver Fees; Date of Payment:. Receipt Number. PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated /~ cl~.~-/~ ~ ,2004, is made between the Municipality of Anchorage Depa~;,iient of H~Ith and Human Servtces (DHHS) and the property owner(s) of This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property, Thc property owner(s) agree to thc following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall bc corrected and the engineer's statement that the system is functioning as designed shall be filed annually with the DHHS. Property Owner r~ame Property Owner Name (Notarize Here) NOTARY Judicial District ~ SS, public, ~ly.sp~: wi~M ~t ~d ae~owl~g~ ~at h¢lshel~ey ex~uted ~e s~e for ~e pu~s ~ereM contused. Ai ASI WATER & WASTEWATER CONSULTANTS, INC. ~ August 6, 2001 Municipality of Anchomge Development Services Department On-Site Water & Wastewater Program P.O. Box 196650, Anchorage, Alaska 99519-6650 Reft Septic System Upgrade Design for Lot 9, Block 2, Woodboume Subdivision To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septie system consists of a 1500 gallon S.T.E.P. tank and a pressurized bed type drainfield. The drainfield is in a state of failure and must be upgraded. We are proposing that the existing 1500 gallon S.T.E.P. tank be excavated and the integrity be verified. If the tank is of good integrity, the existing controls are to be replaced with the I.S.F. controls and dosing timers. If the tank is found to be of poor integrity, then the tank is to be replaced with a new 1500 gallon S.T.E.P. tank with the dosing timers and with dual outlets. We are also proposing that a Bottomless Intermittent Sand Filter (ISF) drainfield be installed. Comments regarding the design are summarized as follows: 1. GENERAL: Two test holes were excavated west of the existing septic system to determine an area suitable for a septic system upgrade. Due to the high groundwater in the area, only one test hole was found to be suitable for an on-site septic system. Given the limited area around the test hole and the setbacks from the existing septic system, it is our opinion that a Bottomless ISF system is the most viable option. 2. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, a application rate of 2.0 gallons/day/ft2 should be used.. 3. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: 1.17, 17.1, & 120 minutes/inch b. Allowable Application Rate for ISF: 2.0 gallons/day/ft2 c. Number of Bedrooms: 3 bedrooms; but design is for 4 bedrooms d. Design Flow: 600 gallons per day 2 e. Minimum Absorption Area: 300 ft f. Effective Depth below pressure pipes: 2.5+ inches g. Width: 12 feet 6901 Debarr Road. Suite 2B * Anchorage, AK 99504 Ph: {907) 337-6179 * Fax: {907) 338-3246 * Website: akww¢.com h. Length: 30 feet. i. Effective absorption area = 360 ft2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". k. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank". 1. Sand Material: In accordance with M.O.A. latest standards m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 1.0 feet (maximum - remove all organics), place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 4. SURFACE WATERS: There is no surface water within a 100 foot of the proposed septic system upgrade. 5. TOPOGRAPHY: As can be seen on the attached topography site plan, there are no slope concerns. 6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with M.O.A.'s "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (4700 South Bragraw). 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at ~337_6179. Th~ou for your ~sistance. Je~t~y ~.{ ame'~ .E., M.S. Pr~idefit ~ 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com i I ~ I I WOOl)BOURNE S/ID; I LOT 10. BI_~K 2. I WOOl)BOURNE S/D; , I LOT 3. BLOCK 1. ,I I / I \ / \ / I ~ t pROPO~[D S[PfiC UPGRAD[.--~ . \',,\ \ , Y \'~~, ii II111 WODBOU..[ S/D; \ ',-~ \ \ ~-~--. \ 4 BEDROOM I \ \~ \ ' tiS'ds[- , \"x \ ! ~~--~ ............... / ~ //- _~ ~.------ '~ II T // / --~ ,' -c-fi-- WOOOBOURNr S/D; / /' / ,/ \X I LOt~.~OCK,. / ,/ / / // / '", ,"! \ ,/ I , / ................ ...oo, ALASKA WATER & WASTEWATER CONSULTANTS. INC. . ............... · r ............. , ~ -, ,<.~ .~: '~ ""~"~ ~,~ ......... g... N...$ E~N ~SH 545-9697 1 OF WOODBOURNE SUBDIVISION; LOT 9, BLOCK 2, SITE P~N FOR SEPTIC SYSTEM UPGRADE PROPOSED BOTTOMLESS INTERMr~TENT ~lO F~LTER (ISF} SYSTEM. EXCAVA'~E 1.25 INCH HDPE UNE. A BED I~AT IS 1.0 ~ DEeP -- BURIED 3 FEET DI~P REMO~ ALL ORGANICS ~Y 12 ~ MINIMUM AND SLOPED MD[ ~Y ~O I~T LONG. AOD 2+ tLLt BACK TO ~1[~ TANK oF M.o. ~ ~..,~.ANo ED. o~ / I i.~. O.S F~T or PI* o.*w~ I$~z '/ p,,~£ :5 OF ,3 FOR CONSTRUC'~ON / ,~i~ . ,~, ~,~.........~ I ...... ~ ]. ,-..,. ~... . ~ U~ ~_ ~. ~_ ~ ~ING ~M~ ~D D~ 0~. ~ ~' ~ ~0~ IND~ ~~ ~ NOTE: THE CO~OR IS TO CO,ACT ~~ / T.~ HO~EOW.ER TO D~SCUSS ~O~N~ ~9~.~/~.~ , ~ ~ ~ THE AIR · PRESSURE UNES TO ~E ~ ~ ~ I.S.F. ~EM. A MINI-~VATOR OR 40"~"~K'~".'~ UN~ S~ ~ I ~ ~ A D~CH-W~CH WILL BE REQUIRED FOR ~m~ ~ A ~lNl~U~ ~ O~ ~ ~t. I ~ ~ ~ pn~lnN ~F ~F INfO, ON TO 3.) ~ ~ ~I~I~I~-'~DS~ING DAMAGE. T~K I ', ~ //~ ~Nx~ I r~H ~SH (907) ~45-9697 2 OF WOODBOURNB SUBDIVISION; LOT 9, BLOCK 2, DESIGN OF PROPOSED SEPTIC SYSTEM UPORADES (BO~OU~SS ISF) '~AA~ ~----12' x :,~' BO1TOMLESS ISF. / NO UNER ON BOTTOM. PRESSURE i.~-AJR UNE COIL SPAOED AT ~3/4' DIA. SCH. 40 ~ LAll:RAL~ / PIPING DESIGNED BY ORENCO AND ~ APPROX. 1,5 ttJt.[. ORENCO / (HOLES, SHIELDS, AND FLUSHING / SUPPUED BY ANCHOARGE TANK ~ "WAS1T. R..OW' 1YPE pROViDED / VALV[S pER ORENCO DESIGN) /_ ~r- ......... tl i '; ', ; ; ; : : : ,.o] I I I \ , , , , , , , , , ,_ o,, ~ I .... , , , I I : : ~ ~ ~ I ~ ~ I ~ ~ ~ I : : './01 i~.~'-~ , : , , , , , , , , ~- ~'~ 4' DIA. MON~I'ORING TUBE AT EACH PLYWOOD BARRIER INO VALVES END. PERFORATED BLrI~N TOP AROUND pERIMETER ~ PR01[C'~ COVID~ ) OF' SAND AND DIb~IBU110N PiPE (EXTEND ABCNE GRADE} INV--. (DRILL 1/4' D~A. HOLES) PlaN VIEW 3/4' PVC LA~LS 0'YP'5) 7.,r /U/ ybloNrrORINC TUBE CrfP.) wrrH THE PVC LA'~:RN..S BURIED ! / / ......... / I / AROUND pERIMElrr..R MIDWAY IN 11'1E :STRA~t.M;.--~-~ I ~ I'ILII~ r,~:~rq'~,'~ I / (GRAV'LL BELOW PiPE - ,I'+) \/ ~-'~T--~'/~ ~ ORIGINAL GRADE .~E..=.oANo ~ I I II I~/- ~TAN'"°'~"~D7C \ I'"'"'F~"I/ / , /'~._ AIR LINE 18 BELOW TO, oF ~.o ..,~--- PROFILE VIEW . t ~ ................. ].;... o~..4 °~ '"...."L,~ J.LM. ALAS~ WATER & ~VASTEWATER ~ CONSULTANTS, INC. N.T.S. ELLEN LASH (907) 345-9697 5 OF ~ WOODBOURNE SUBDIVISION; LOT 9, BLOCK 2, DETAIL OF BOTTOMLESS INTERMITTENT SAND FILTER (ISF) , CONSULTANTS. INC. · ISOIL LOG - PERCOLATION TESTI LEGAL DESCRIPTION: LOT 9, BLOCK 2 WOODBOURNE SUBDMSION PERFORMED FOR: ELLEN LASH DATE: 7/12,/2OOl ORGANICS SANDY OM ITEST HOLE (P^OE 1 OF 2) I I GP ML GM CL GC OL SW MH SP CH SM OH SC GM/ML DEPTH TO GROUNDWATER SEEP 0 3' 6' DATE 7/12/01 7/16/Ol 7/2o/o DATE READING CLOCK NET TIME WATER LEVEL~ NET DROP TIME (MINUTES) READING (INCHES) 7/16/2001 1 2:19 - 6- - 2 2:49 .30 4 1/4' I 3/4' .3 2:49 - 6' _ 4 3:19 30 4 1/4' I 3/4' 5 3:19 - 6' - 6 3:49 30 4 1/4' 1 3/4' PERCOLATION RATE 17,1 (MIN./INCH) PERC. HOLE DIA. 6' (INCHES) TEST RUN BETWEEN 1.5 FT. AND 2.0 IT. COMMENTS: MATERIAL 3-10 IS EXTREMLY WET - *WEEP ON NORTH WALL PROBABLY FROM SWAMPY AREA T~) THE NORq'H. PERCOLATION TI'ST PERFORMED BY JOE MARCH~ u. PERFORMED BY ALASKA WATER &: WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS/P~RFORMED I IN ACCORDANCE WITH ALL STATE AND MUNICIPAL OUIOEUNES IN £F,£CT ON THIS DATE: (:~/Z-/~' ALASKA WATER & WASTEWATER 4 CONSULTANTS. INC. . .......... ~. ~ ........... [SOIL LOG - PERCO~TION TESTI ~i~ U~ ~. :'" ~ D~CE~ON: LOT 9, BL~K 2 WOODBOUENE SUBDMSION ~ ~F~ ITEST HOLE f~l 1 (PAGE 2 OF 2) 2- I~ Cw ~ ORe I ~ ~ ~~ CL Z iGH 4-- ~~ GC OL ~ SW HH ~ SP 5-- ~ SM OH ~ sc SEE PAGE 1 OF 2 7-- ~ DEPTH TO D~TE GRO~DWATER 0 9-- 10-- ~ DATE RE. lNG CLOCK NET TIHE WATER LEVEL NET DROP 11 -- TIHE (HINGES) RE. lNG (INCHES) 0 7/~ 6/01 ~ 2n 8 - 6' _ 12 2 2:48 50 5-5/4' 1/4' 15 ~ ~ ~ 2:48 - 6- - 14~ ~ 5 5:18 - 6' - ~ 6 3:48 30 5-5/4' 1/4' 15~ 16~ 17-- 18-- 19-- ~RC~TION ~TE 120 (H~N./INCH) PERC. H~ DIA.. 6' (INCHES) 4.0 ~. ~D 4.5 TEST R~ BET~EN 20--~ COHHE~S: ~R~ 3-10 IS ~EMLY W~ -- ~EEP ON NO~ W~ PRO~LY ~OM T~ ~E NO~. PERCO~ON ~ PERFORMED ~ JOE ~CH~. PERFORM~ ~ A~ WAT~ · W~ATER I, JE~ ~ G~N~S, CER~ T~T ~HIS W~ERFORMED IN ACCORD~CE W~ A~ ~A~ ~D MUNICIP~ GUlDEUNES IN EFF[CT ON ~IS DA~. ALASKA WAT R & STEWATER CONSULTANTS, IN,C,. ISOIL LOG - PERCOLATION TEST LEGAL DESCRiPllON: LOT 9, BLOCK 2 WOODBOURNE SUBDMSION PERFORMED FOR: ELI_tN LASH DATE: 7//12/2001 ORC. AN~CS GM SU/UL (W~) ITEST HOLE #2I PA¢£ 1 OF 2 GP ML GM CL GC OL SW MH SP CH SH OH SC DEPTH TO GROUNDWATER DATE 10' 7/12/01 10' 7/16/01 9' 7/20/01 ~ ~?ro ~o~e' ~' DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 7/16/2001 1 2:18 - 6- - 2 2:48 30 5-3/4' 1/4' 3 2:48 - 6' - 4 3:1s 30 5-3/4' 1/4' 5 3:18 - 6' - 6 ,.3:48 30 5-3/4' 1/4' · 'T-~-c~'-r' P(o~. = [~/~ PERCOLATION RATE TEST RL~I BETWEEN 120 (MIN./INCH) PERC. HOLE DIA. 6' (INCHES) 4.0 FT. AND 4.5 FT. COMMENTS: PERCOLATION TEST PERFORMED BY JOE MARCHEI'rl. PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. OARNESS, CERTIFY THAT THIS W~S/{SERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EPtLCT ON THIS DATE: ALASKA WATER & WASTEWATER , JSOIL LOG - PERCOLATION TESTI ~.....~J,,,J.v.l.~....l,...l lEGAL DESCRIPTION: LOT g, BLOCK 2 WOODBOURNE SUBDMSION PE, ro,,ED FOR: .ATE: ..... (f~*P~! JTEST HOLE #2J 1 (PAGE 2 OF 2) I I 2-- I~ GW ~ ORG I ~ GP rnTrm HL Z ~ GM ~ CL 4-- _o 'GC OL ~ SW ' MH C~ SP CH ~-- ~- SM ~OH ~ sc SEE PA~E 1 OF 7-- 0 DEPTH TO DATE GROUNDWATER 8-- .-I ~ o~~ g- O 10-- h C~I DATE READING CLOCK NET TIHE WATER LEVEL NET DROP 11 -- TIHE (HINUTES) READING (INCHES) h 0 8/~/01 1 8:3~ - 10- - 12 ~- 2 8:40 9 O' 10" 1'3-- Ld '3 8:40 - 10" - <~ 4 8:49 9 0" 10" 14~ 13_ 5 8:50 - 10" - W 6 9:00 10 O" 10" 15~ W 7 9:01 -- 6" - 8 9:07 6 O" 6" 16 ~ 9 9:08 - 6" - 17~ 10 9:15 7 O" 6" 11 9:15 - 6" - 18-- 12 9:22 7 O' 6" 19~ PERCOLATION RATE. 1.17 .(HIN./INCH) PERC. HOLE DIA. 6.__~._" (INCHES) TEST RUN BETWEEN. 1.0 FT. AND 1.5 FT. COP1MENTS: PERCOLATION TEST PERFORMED BY JOE: MARCHETI1. PERFORMED BY ALASKA WATER & WA~ATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS W~; ,~ERFORMED IN ACCORDANCE WffH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS Municipality of Anchorage Page DEPARTMENT OF HE-'ALTH 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: .-~-,/ ~ O;~.~ t~ PID Number: _~1~ Name: ~ Ell~ ~ 'WastewaterSystem: ow UUpgrade L · t l 6ql ~¢~oo~ ~e ABSORPTION FIELD LEGAL DESCRIPTION so,,.,..: e~ GPD/Sq. Ft. Lot: Block: Subdivision: 3epth to pipe bo[tom from original grade: Gravel depth beneath pipe Township:~,.~ [Rang'o~¢ [Section~ Filladdedaboveoriginalgrade:[.¢ ~ ~ Ft. Gravellength: ¢ O Ft WELL: ~ New ~ Upgrade Gravel~ ~ Ft. :Number clones: [Oistancebetween[ines:~ I Ft. ~lasslficatlon (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe materiat Driller; Date Drilled; ~tatic W~ter Level: Installer; ~ Da e ns aged: Yield: Pump Set a: Casing Height Above Ground; SEPARATION DIS'rANCES u Septic U Holding ~S.T.E.P. TO Septic Absorption Lilt Holding Public/PHvate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines A~ ~ Well I I ~ I~¢ I ~ Material:g ~ N"mber of Comp.rtments: Surface w~t~r ~/~ ~/~ ~ LIFT STATION Foundation ~ ~O I ~ ~ Remarks: BENCH MARK Location and Description: LNG NEg~'S SEAL Inspections performed by: Dates: 1st 2 -~t~ Department of Heal u rvices app oval Reviewed and approved by', Date: ~-~ X~ x3 · ....... / 72-013 (1/91) MOA 25 N SCALE~ I00 1,25 150 I 1' = 50 FT, 'rol~t~gN SPURKLANI) P,E, 6751 ~/, I)IHDNI~ BLVI:), ANCH, AK, 99502-3904 J J LOT 9 BLLTCK £ P/DDDBOURNE LEO & ELLEN LASH ,JANUARY £B~ 199£ -T E' PVC TO STEP TANK IlVSTALL ~ATIDN ~£4N ~ ~TAIN ~AIN ALllN~ EAST ANti l~ NOT RET~VE L~ ~E$1ROY E~$TI~ ~ WATER ~lt~ T~ ~2T~L ~Lfl~ ~ ~AT~ ~1~ TUEL'2 ALONE ~ ~ ~ ~D, N[/,1~'4L E ~A$15 DF EL.CVATIllN' TOBBEN SPURI<LAND P,E, J J 203 ~/15~h, Avenue ANCH, AK 99501 LOT 9 ~LllCK R VOO~BllURNE LEO & £~L~ LASH 831 ~ PLACE' II SEPTIC SYSTEM AS BUILT DATE, JANUA£Y E~ 19~.£ SHEET, 3/3 GRII)I £741 RECEIVED Muni¢i ality o~ Anchorage , ~?RACTOR ZN~JA~eJ~h &Human Smvtce,, ~i~ered Businea8 Name' ..... Inature of Autho~ized~epre~entative USE 01;' WI,JLT.,: ~dome3ti~] []irri(]ation F]l~Onitoz []~ubl~c .supply []othg~: CASING: Stick-,up ~ f~, Diam: ~ WILL INTAKE: ~ open end ~o~eoned pei; rotated ~ogen hole Depths of o[e %.%ng~,. ....... to ft SCREEN TYPE:2~ Diam: in Slot/Mesh o~ze.~% Length: ..... ~t Set Between__ a~d ...... ft GRAVgL PACK TYPE ~... VD ],uz[/~ used:____ Depth to top: P~IPING LEVEL ~ND YIELD: ~._.~£_~ afte~.~ ..... hfs pumping ~ gpm PU~ INTAI{g DI. PTH .~ft llors~power: Date Pump Zn3talled WATER CHEMISTRy S~JPLE TAKEN? ~y~3 ~0 PLEASE MAIL WHITE COPY OF LOG WITHIN 45 DAYS TOt DGGS PO BOX 77-2116 EAGLE REVER, AK, 99577 I0~ NU $0:80 I66I'&E'd~S ~0~0 ~£ &OS 'lqI~G 3Nldq~ : UJO~ FROM:KONICA FAX TO: 24B5095 FEB 1% 1992 iI:i~AM P.02 PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUM3~N SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910268 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:LASH LEO D ~ ELLEN R OWNER ADDRESS:il641 WOODBOURNE DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 9/04/91 EXPIRATION DATE: PARCEL ID:01535129 LEGAL DESCRIPTION: WOODBOURNE BLK 2 LT 9 1 OF 9/04/92 LOT SIZE: 101166 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: DATE: 20;~ ~1 15th. f!w!nue, Suiip 206 1907) 27%5916 SEPT 1'C GYSTEH DESIGN LEO & ELLEN I.~SH BlED TOT/4L LEI~BTH 50 F'T. TOTAL WID'TH 2zt FT. BOTTOH BEg ELEV. EI4.OO TOP OF BElt ELEV. E~8.OO SEPTIC TA61K/I_IFI' ST~ll-IOhl 15OO LO~ $ /ACANT LG? lO N 0 50 100 1.50 £00 £50 300 350 £CALE; Y = IOOFT, TDBBEN SPURKLAND P,E, 6751 ~, DIMDND BLVD, ANCH, AK, 99502-3904 £E77' 9 BLgCK 2 WDDY?Y?DUR/V£ L£'~ & ELLEN LASH SEPTIC SYSTEM DESIGN DAVE, AUGUST 15~ 1991 SHEE'r,I/3 GRD, 2741 / / / / ~N TBBBEN SPURKLAND P,E, 675[ ~, DIMOND BLVD, ANCH, AK, 99502-3904 LEI~- ~ 3LZ2£K 2 ~/DZ2J3DURN£ LED & ELLEN L~$N bATE, AUGU$[ I~, 1991 2,1,00 TOBBEN SPURKLANB P.E. 203 ~/15~h, Avenue iNCH, AK 99501 LOT 9 BLDCK 8 W£DI}BIJURNE LEQ & ELLEN LASH SEPTIC SYSTEM DESIGN DATE* ALIGUSr £8 1991 SHEET, 3/3 GRII), 2741 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16- 17 18 19- 20- COMMENTS Municipality of Anchorage DEPARTMI--NT OF HFALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST L.]~o LA, f.- Township, Range, Section: SLOPE SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh to Waler Aller Moflitorinfl? Dale: Gross Net Depth to Net Reading Date Time 'rime Water Drop PERCOLATION RATE (minutes/inch} PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND -- FT PERFORMED BY: I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE DATE PEI~FORMED: /~'[ <;2~ / Township, Range, Section: ~* I~)..~./ , '~.~ ~ ~._¢_. ~-~.,~.~ SITE PLAN Oeplh to Waler ARer I'dontloriflg? Date: Reading Date Gross Net Depth to Net Time Time Water Drop :~:~s :~o ~- 12~ ~.'1~ PERCOLATION RATE _ ~'~ - (minutes/tach) PERC HOLE DIAMETER ~_~ I~ TEST RUN BETWEEN /8" FT AND FT PERFORMED BY: I CERTIFY THAT THIIS TEST WAS PERFORMED IN 72~008 (Rev. 4185) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST L.~ ~ s ~ Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~- DEPTH? pO E Depth Io Water Alter 1510nitoring? Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ~ : 5~ ~ o 7'~ - ~ ~ I '~// ~ PERCOLATION RATE _ q' (m~nutes/inch) PERC HOLE DIAMETER ~l) TEST RUN BETWEEN j I/,~' Il_ FT AND _,,~z~ II FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED iN 72-008 {Rev. 4/85} PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST L~ o L/~g P, WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTR? Deplh Io Weter AFter ~loniloriflg? Dale: 14 15 16 17 18 19 2O (ENGINEER'S SEAl.) Township, Range, SectJon: '~'/~, ~,lJ~/ SLOPE SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop : '~,~' ~O I~'~ 18~' l: O~ ~,0 igY- /~?-- PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER ~;~ l/ TESTRUNBETWEEN / '/L., FTAND_~" FT COMMENTS PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITRALLSTATEANDMUNICIPALGUIDELINESINEFFECTONTHISDATE. DATE: 72-008 (Rev. 4/651 LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SI--RVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST '(ENGINEER's SEAL) r ;! ~:~, /. - DATE- PER~01~'MED'~'~. ''; ' Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E [leplD Io Water Alter Monitoring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~o &o I~~v ~ PERCOLATION RATE /,-~ (minutes/tach) PERC HOLE DIAMETER ._ TEST RUN BETWEEN / CZ,,~ FT AND _¢~' FT PERFORMED BY: I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev, 4/85) CERIlFY THAT TNIS TEST WAS PERFORMED IN DATE: PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4- 5- 6- 7 8 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS Municipality of Anchorage [::)EPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? (ENGINEER S SEAL ~ DATE PERFORMED: Jl~ lq I Township, Range, Section: %c ~L ~.~ T I ,q.N, ~3 u/-./ SLOPE SITE PLAN S L IF YES, AT WHAT O DEPTH? p E Depth to Water Alter I~10nil0ring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop P, ,oo k PERCOLATION RATE ~ Immules/mch) PERC HOLE DIAMETER PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WlTR ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) rllliOIt[I Et[.VP, ALASKA 9%02.-370~i £~F'EE',I;F:ZCATtDNS FOR SEP'F:~C SY[TI'P]4 INSTALLATZCIN I_El'l' 9 ~3LOE;K 2 SEC 24 T121",1 R3W !. 0 GENIZRAL :1, ,, '?' IlI. :i % 't:h,:' r"0}%i3(:Hl!s:i t::1:( ]. :i. [:x,,' (3¢: ~':]i( []~.,,Irlcgi'" (::)r L, hE:, t.(3 ,'z(Jl/r.H'"~? '~:(:3 '?.]1~ ,,¥:)pl"(::i¥c!(t (:J(::!;J,:]ll,¢ t:(:) ~?E!{' J ~:";¢' (;ii,vt 't-J'~(a 2.0 SEF']'IC TANK Anchor'agf¢ Tank arid Wtf-!ding (:)r l::iy Greer- Tank Fi(ELD })(:i,AI (::l'l(:rlfii ,::~::X:l ill IC),, II i::} ,, :.:: ~a. o_ i~ N!B-['J~,L .l_/~l' ]~ £llxl · Municipality of Anchorage Development Services Department Building Safety Dtvtsion On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us CERTiFiCATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMilY DWELLING Parcel I.D. 015-351-29 t, GENERAL INFORMATION Expiration Date: / :2. - ~_~"- <~ ! Complete legal description ~ WOODBOURNE LOT 9, BLOCK 2 Locatlon (slte address or directions) 11641 WOODBOURNE DR. Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ELLEN LASH Dayphone 345-9697 11641WOODBOURNE DR. *ANCHORAGE AK Day phone DAWN STORM W/ PRUDENTIAL Day phone .3201 'C" ST. SUITE 200, *ANCHORAGE AK, 99503 227-9306 Un~sso~em4sereque~e~HAA~llbeheMbyDSD ~rp~kup. 2. NUMBER OFBEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL.' Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Servlces 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 tn the State of Alaska. Certificates cf Health Authority Approval are required for the l~ansfer 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. Certficates of Health Authority Approval are valid for 90 days from the date of Issue for propertes 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 propertes 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1400.00 a~ or pdor to dosing for the engineering sendces provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the va#da#on date shown below, I varify that my investigaEon, based on procedures ougined In the Health Authorib/ Appreval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, funcfonal and adequate fo~ the number of bedmoms end b/po of sb-ucture lndicated herein. I further varify that besed on the information obtained fmrn the Municipality of Anchorage files end from my invastigafion and inspection, the on-sire water supply end/or wastewnter disposal sysfem Is(are) in compliance with all applicable Municipal end State codes, ordinances, end mgula~ons in effect at the firne of insta#afion. NameofFirm ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name. JEFFREY A. GARNESS. P.E. Date 337-6179 Engineer's Comments: In condu~Jng thl~ evaluation, AWWC, Inc. a~mpted te pmvldo · thorough, conscientious enginsedng analysle of ~he ~/sfem in accon~ance with ADEC end MOA DSD Guidelines & Regulefons. The reported results described the per[onwance of the system under the ¢ondtffone onceuntemd at the time of the test, end separation distances measured to readily identifiable feature~. The operational life of eft wefts end · eptic systems depend on the local soils condition, groundwater levels that rney fluctuate during the year, and the water usage of the fom~7y being sen/ed by the syste~n. These cond/fons ere outs/de the cenbot of the eva/ualor of the sy~em. SaE~mc~y test results do not guarantee fufum perfon'nance of the system, nor do they guarantee that there am no hidden defec~ or encreachmant$. AWWC, Inc. can therefore not pmvfdo an), wan,anb/ or future estimate of how long the system will continue to meet the operational mquiremente of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any tel/once upon or use of this relx~'t by any other pe~on or party Is not authon~zed, nor ~ it confer any legal tfght whatsoever. 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for · .tttit(tl'.h/,'~,, bedrooms. ' bedrooms, wi~ ~e fll~ng sapula~ = WATER AND WASTEWATER . ~ t PROG~ ~ Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manitenanca Agreements Supplemental Engineer's Reort Other Original Ce~ficate Daie: c~ -.2. ~C'"- 0 [ Municipality of Anchorage Development Services Department On.~te Wlr& Wa~w~ler P~gram P.O. 8ox 196650 An~, AK 99519-6650 A. WELL DATA Well type Date comp;eted ~/20/91 Totel depb'l 148 I~oft~ Stet]o water level HEALTH AUTHORITY APPROVAL CHECKLIST WOODBOURNE: LOT 9~ BLOCK 2 Palcel ID: 015-351-29 ifA, B, ore pn:Mde I~ID~ ~anltary sua~ fi/N) YES Casadto 148 ft. FROM WELL LOG 9/20/91 79 It. Well produclion 9 g.p.m. WATER &N~4PLE RESULTS: Collfom~ 0 colonies/lO0 mL Nllrate 0.719 rog J1.. Date of sample: 9/0.5/01 Collected by:. 6EPTIC/tlOLDING TANK DATA Tank TYPe/Idate,al STEZL/S.T.Z.P. Tank$1ze ,150o gal. Number of C~npattments 2 Depression over ten~ (V/l~ NO Pumper Soil raUng ~ fl'/~drm) 2.0 ~ 12 R. Foundation ~teanout (YIN) Date of pumping 6/31/Ol ABSORP110N RELD DATA Date lll~ We, Log (Y/N) AT INSPE~ON 6/20/01 122 ~ 5.5 g.p.~ 12+ ~. Otherbecteds o colonle~lO0 mi. AWWCt INC. ~ IIl~t~ed 11/gl , C;e~noute (Y~O High water almm (Y/N) YES A+ ~mty~ Gravel below p~e Tot~dep~ 2.74+ ft. Elf. L_~_. ~onarea 3so ~l Monltodngtube YES Date ofadequacytest NEW SYSTEM Results (Pass/Fall) - Wateradded - gal. Any mJuvenauon treatment ~3ast 12 mo.) (Y/N & type) BED .23 ft. Dapmsslon over field NO For - bedrooms Newdepth - In. - g.p.d. ff ye~, give Cate - D. UFT ~I'ATION Oate Installed 11/91 "'Pump on" level at TIMER In. Datum BOTTOM 0F TANK E. SEPARATION DISTANCES N:wmp~n field on lot. Public sewer nm]n Sewer/8ep~ ~ervlce line SIzeln gallons,, 1500 "Pump oft" level at ~MER In. Cycle~ tested 3 SEPARATION DISTANCES FROM WELL ON LOT TO: Sepl]o tank/llft ~tetlan on lot 100'+ 100'+ Manhole/Access (Y/N) YES High water alarm level at 46 Meets alarm & dr:ua requirements? YES On adjacent lots 100'+ On adjacent lots 100'+ Public eewer rnenhole/cleeneut N/^ 25'+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO,' Building foundal~on 5'+ Property line 5'+ Absoq~on field 5% Water main N/A Water eervice llne 10'+ Surface water 100'+ Wells on adjacent lots 100'+ in. SEPAR,~TION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Bulldlng founclal]on 10'+ Water main N/A 10'+ Water eewlce line Sun'ace water. 100'.~.+, .Driveway, parMngNehlcle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100 + F. COMMENTS I cerSfy ~mt I have determined ~ough #eld Inspec~ns end retSew of Munlclpe/ records ~hat the above systems am ln conformance ~ MOA HAA guidelines In effect on this date. ;)ate / :'. ....... '. OateofPaymont ~1 1~51o~ Receipt Number / {Rw. ~,~o) Waiver Fee $ Date of Payment Receipt Number 9EP-II-01 18:19 FR01bCT&E EIIVIRON~KTAL SRV · zTk ~T. Environmental Servlcea Inc. 9075615301 T-157 P.02/03 F-263 CT&£ Ref.# 1016032001 Client PO~ Client Name A~, Water & Wastewater Consultants Inc. Printed Date/Time 09/11/2001 15:34 Project Name~ Lot 9 BL~ Woodboume Collected Date/Time 09/05/2001 11:05 Client Sample ID 11641 Woodboume Dr. Received Date/Time 09/06/2001 lO:00 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By .e ~' a -- · · PWSID 0 Released By Sample Eer~rks: Allowsble P~-p Analysis parameter Results PQL Units Method Limits Date Date Init Nstrate-N 0.719 0.500 mg/L EPA 300.0 (<10) 09/06/01 SCL i{'t czob:l, ol ogy V.aboza to:'y' Total Coli~'onn 0 eol/lOOmL SMI8 9222B (<1) 09/06/01 KAP 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 SINGLF FAMILY DWELLING Parcel I.D. # 1, GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Day phone Day phone Day phone Address 2, NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev, S/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm -'~'~-/ p,,rkL, ,,cC E Phone ~,-~4/_,~¢/j~ Address ~2--O -% ~-/ l ~ ,~'~/ / DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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 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~'25 (Rev. 1/91) Back MOA Legal DeScription: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parce,,.D. Ol - A. WELL DATA Well type ~ Log present (Y/N) Total depth I L~ g Sanitary seal (Y/N) If A, El, or C, attach ADEC letter. Y Date completed Casedto I ~ ~ ADEC water system number Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test ~ ' ?~ O . 1 / ~7 ~,> ~c.. ~ Z Static water level . . r'q-i Well flow g.p.m, g.p.m.,,~ Pump level ~ ~ ~ ~ ~ o SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot I ~..~ Public sewer main Sewer service line On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ~////&' Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria I /¢-'"~ ] ~ ~ Collected by: Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Il ] ["J I~l Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping _ Tank size l ~5~t~'¢-~ Compartments _ Foundation cleanout (Y/N) y Depression (Y/N) IN// Y _ Alarm tested (Y/N) J"//,Ar Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I [.~ To property line Surface water/drainage On adjacent lots _Absorption field Foundation .Water main/service line 72-026 (Rev. 7/9~) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) '~ High water alarm level "PumD on" level at Meets MOA electrical codes (Y/N) ~ Manufacturer Manhole/Access (Y/N) "Pump off" le~)el at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot J ~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed I J/I ~ /fl Length ,~"O Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ~o ~" System type ~-~ Gravel thickness ~ ~ Total depth ! - Cleanouts present (Y/N) Date of adequacy test for ~ ~ bedrooms 1~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO; Well on lot I (¢.~ On adjacent lots ~ /0-12~ Property line To building foundation I O I To existing or abandoned system on lot On adjacent lots Surface water Curtain drain Cutbank ~' /¢~'-¢--~ Watermain/servicePine Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o? the da¢e of this inspection· HAA Fee $ /'~:) ~' Date of Payment f/~"~' ~'~:~ ~-- Receipt Number 72-026 (Re¥. 3/91} 8~ck MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL L4BORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGF, ALASKA 99518 TELEPHONE (907) 562-2343 MIAL¥SI'3 R~:SI]LTS for INVOICF, I{ 50639 Chin,lab l~.f.~ 92.0325 Sm~pl~ ~ I ~4atrlx: I'~A~R FAX: (907) 561-5301 Client Sample lid : POTAB[,F, 9/2 ~';OODBOUgIIF, P?/SID : UA Colloeto(t : JAN 27 92 0 Iz~:45 Received : JAil 27 92 ~ 16:50 AnMysls Completed : JA}I 29 92 Send gop(,rts to: t)TOgB~:N SPIJP, K[,ANO, P.E. 2) IID!P, AT~;. N 0.69 .%mplo P~OUT!~tI'; SM,,~PL~; COU,}',CTI'Ji) lt~: 8PUP, KLAND, ~olna~ks: I 'feats Pozfozrned See Special Inst[uet!ons Above tlA,~Una,~oltabJo ND- [lone Detected '* goo Sar,lplo Remarks hbovo ~1~ Member of the SGS Groop (8oci~t¢ G~n~rale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPt. ETED BY WATER SUPPLIER El PUBLIC WATER SYSTEM I.D. # I I I_ I lll PRIVATE WATER SYSTEM~.,.~~ Mo. Day Year SAMPLE TYPE: k. Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] 'Created Water /t~Untreated Water SAMPLE No. 1 2 3 4 5 Time Collected LOBATION Collected By 1 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: S¢.~ Satisfactory O Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail Date Received ~/{'t' / Time Received /,~ ,.~ Analytical Method: Membrane Filter No. of colonies/lO0 mi. Lab Ref. No, Result* 92.0466 J Analy/t A.D...C. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC = Too Numerous To Count OB = Other Bacteria BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Collformll00 mi Verification: LSB RGB Fe~al Coliform Confirmation Coliform/100 mi Final Membrane Filter Resnltaj /~ Reporled By_ /,!~ (..~ · ~/.,~ Date ¢ PAItT 0.£ nV TWO: ,-: , EEHAINDER TO FOEL W ,: