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Hills
Block 3
Lot 14
#015-173-36
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~'7~ PID Number:
Name: ~, '~VI D , Wastewater System: ~New D Upgrade
Address: ABSORPTION FIELD
Phone: No. of B~oms: ~eep Trench D Shallow Trench D Bed ~ Mound ~ Other
LEGAL DESCRIPTION ~ SoilRating: ~ ~~GPD/Sq. Ft. Total Depth from original grade:
Lot: Block: Subdiv~ion: Depth t0 pipe bottom from original grade: Gravel depth beneath pipe
Township: Range: Section: Fill added above original grade: Gravel length:
Number of lines: Distance between lines:
WELL: ~New D Upgrade ,Gravel width: ~ Ft, ~ I ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
D~te,Drilled: Static Water Level: nsta er: Date installed:
or'"er:~L'P I~) ~ ~/~/e~ /~ .,. ' N~T~-N
Pump Set at; Casing Height Above Ground: .'
Yield: ~0 GPM '~g'rTO~ ,~. ~, ~ ,~. TANK
SEPARATION DISTANCES ~ Septic D Holding ~S;T.E,P.
To Septic Absorption Lift Holding Public/Private ;Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~H~ ~N
I a ! Material: Number of Comp~ments:
Sudace -- LIFT STATION
Water ~JO H ~
Line ~5) ~0) ~5~ /~ { Manufacturer:~
Foundation ~ ~ ~ ~ I ~ "Pump on"~level at:il "Pump off"?/leve!,, at: High water~5'falarm at:
Cu~ainDrain ~ ~ N ~ 3ump~N~oMake & Model ~ Etectrica~nspectionso~ pe~ormed by:
Remarks: BENCH MARK
Location and Description:
Assumed t~ Ft.
Elevation:
Inspections performed by: Dates: 10t ~
2nd B/5-/~
Department of HeaRb and Hu~an~e~ices approval
Reviewed and approved by: Date: ~
I /
25 LJ £5 SO 75 i00 i£5 150
.... -I SCALE; ~_~' -- SO F~
TOBBEN SPURKLAND P.E. I ILOT
205 W 15TH. AVENUE
ANCH. AK. 99501
~9o?~ 27~1~
14, BLOCK 3 HOMESTEAD HILLS S/D
MIDHELSOHN AND DAUGHTER
4550 TRAPLINE CIRCLE
SEPTIC SYSTEM AS BUILT
DATE: AUG. 19, 1996
SHEET: 2/5 GRID: 2656
Nonltor
Cleon Du'
Cleon Dui
Stondord Trenches;
50' L on9
10' Peep
7' Sewer
3' Cover
i4
MoniTor
Cleon
Foundotlon Cleon out
YS00 STEP
FLD~/ SPLI?TE£
102,5
94.5
AID SCALE
FLOW SPLITTER
105.5-+/
/VD SCALE
102.2
94.5
/SO0 5AL STEP
£ENCH MARK, eOTTO~
ASSUNEP ELEV,
TDBBEN SPURKLAND P,E,
203 Wl5th Ave
Anchor~9e Ak 99501
14,
BLOCK 3 HOMESTEAD
DA VID M SNO~/
4550 ?RAPL/ME CIR.
SEPTIC SYSTEM DESIGN
])ATD APRIL 1, 1996
SHEET, .~/~ GF?ID~
· .', ,; ~ ~ ~' ~i', ~, , ~EPARTMENTOF NATURALRI~SoURCE$
~,,,, , ~ ~ , ~ : OF MININ~ & WAYER MGMT
LOCATIONISK~CH: ' ]: WELL O~ER: . ' .', , ". ~
DEPTHS M~SURED ~OM:~casing top ~gmund ~uRaeff. WELL DEPTH: ..... ' .......... ~ DATE
Matedal Type and Color ' , F~o ~
~ , ~ , ,:'1:~,?~: ft below ~o, Of Casing D ground sudace ':
:, r" M~HOD OF DRiLLiNG: ~ air'rota~y ~ cable too~ .
~ ~ ' W~LL IN'AK PEHING t~PE~open end , ~ screened
. ~erfotS~ed ~ open hole ~
'~ep ~enings'
:: SIO[iMa~ Size,~ "... L~ngth: , it
' ' ' ~,PUMPiNG L~EL ANO ~tELb: '
,.~':" ~. ~.,, ~:.~ :;?~t after' ..../. / '. hrs pumping ~0~ opm
. ~ :.u: -:PU~P INY~R~ b[PTH~' ' It Horsepower:
' '" ...... "~:~:~"~ F L~IONf" D N0
CONTRACTOR INFORMATION:
COPY OF LOG TO:
~. DNRIDIV~ION OFMiNING~.WATER MGMT ....
· 3601 C St~ suite 800
Anchorage, Ak 99503-5935
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950378
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:SNOW DAVID M
OWNER ADDRESS:4530 TRAPLINE CIR
ANCHORAGE, ALASKA 99516
3 LT 14
PARCEL ID:01517336
LEGAL DESCRIPTION:
HOMESTEAD HILLS #1 BLK
LOT SIZE: 51429 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED:il/06/95
EXPIRATION DATE:il/06/96
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.
RECEIVED BY:
ISSUED BY ,
DATE:&--Io
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
RECEIVED
JUN 5 199G
Municipality ot Ancl~orage
Dept. Hea th & Human Services
James Cross P.E.
Municipality of Anchorage
Division of Environmental Health
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
Subject:
SW950378
Lot 14, Homestead Hills
June 5, 1996
Gentlemen;
In my professional opinion, based on the rapid rise and consequent rapid decline, of the water
observed in the GWM in the testhole excavated on 3/28/96, I believe that the observed water was
the result of melting snow mixed in the backfill of the testhole and water resulting from the thawing
of the ground. Since no water was observed anyplace else on the lot, neither in the foundation
excavation, the water line excavation or the monitor placed in October of 95, I find the possibility
that this was groundwater highly unlikely.
Yours
T. Sp
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
Daniel G. Roth
Municipality of Anchorage
Division of Environmental Health
Department of Health and Social 'Services
820 1 Street
Anchorage, Alaska 99501
Subject:
Lot 14, Block 3, Homestead Hills
Well and Septic Permit SW950378
Gentlemen:
April 19, 1996
RECEIV[D
APR 19
Munloipali'b ' :~:"'r'°~ age
Dept. Health & Human ,Survices
On March 28, 1996 additional testholes were excavated on this lot. Soil with acceptable percolation
rates were found at the north east comer of the lot. Consequently a revised septic system design is
submitted for your review. The original permit was for an intermittent, bottomless sand filter. This
proposal calls for two 50 foot trenches with a STEP tank since the residence will be located down
slope from the drainfield.
Yours
'-'m-C' , 17
T. Sphrkland P.E.
Cc Michelsohn
ToS?U Q AND
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 14, BLOCK 3 HOMESTEAD HILLS
DAVID M SNOW
No Ground Water or Impervious Layer to 16 f.
Use Standard Trench
Soil Rating.
42 min/in
Use 0.45 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 150/0.45 = 333.33 sq.ft..
Total area required: 4 x 333.33 = 1,333.3 sq. ft.
Testhole Total Depth 16 ft
Available rock depth 16 - 6 - 3 = 7 ft
Required Trench Length: 1333.3 / 14 = 95.2 ft
Use two trenches each 50 ft. long
Use STEP tank
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH 2 x 50 FT
TOTAL WIDTH 2 FT
TOTAL DEPTH 10 FT
ROCK DEPTH 7 FT
COVER 3 FT
SEPTIC TANK 1500 STEP
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
10-
11
12
13-
14
15
16
17
18
19
2O
COMMENTS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
[,eT'
' (ENGiNEER'S SEAL)
DATE EREORME,D-:,
Township, Range, Section:
'i
WAS GROUND WATER 1'"10
8! kl,~0 ENCOUNTERED?
S
,~ . "~'~" ' IF YES, AT WHAT O
DEPTH? p
Water Alters*
SLOPE SITE PLAN
I
N
Reading Date Gross Net Depth to Net
Time Time Water Drop
N~' ~;IL ~L '7° ~.~"
~'/~" ~:~ ~o 7'/y ~ YV"
PERCOLATION RATE /~) (minutes/inch) PERC HOLE DIAMETER
7Z "
TEST RUN BETWEEN ~ FTAND (~ FT
P[=RFORMED BY: ~-~ I , ~'~ '~ cERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WlTH ALL STATE AND MUNICIPAL GUiDELiNES iN EFFECT ON THiS DATE. DATE: ~r~'~,[ Ii ~ ~ c~.~
72-008 (Rev. 4/85)
PERFORMED FOR:
LEGAL DE${~RIPTION:
1
2
3
4
5
6
8
9
11
13
14
20-
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG I PERCOLATION TEST
. ;(ENGINEER'S SEAL)
DATE PERF'ORMED; '~ ~:~
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth lo Water After
Moniloring? Date:
SITE PLAN
I-
N
Reading Date Gross Net Depth to Net
Time Time Water Drop
,&o ~iz ~ , 37' ,~o'
PERCOLATION RATE '/-~-~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 7YZ~ FTAND 8 FT
COMMENTS
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE:
72-008 (Rev. 4/85)
,'--,.~,.--
£5 O £5 50 75 ]00 185
ALTERNATE SYSTEt~t
STANDARD TRENCHES
APRIL I, 1996
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
LOT 14, BLOCK 3 HOMESTEAD HILLS S/D
MICHELSOHN AND DAUGHTER
4550 TRAPLINE CIRCLE
SEPTIC SYSTEM DESIGN
DATE: OCll, 5, 1995
SHEET: 2/$ GRID: 2656
Non/for
Cleon Z~u
C~eon
£tandord Trenches;
$0' Lan9
t. 0' Oeep
3' Cover
J4
NonlSor
Cleon LYuS
ND SCALE
4' ?op:o/~
Ex/sS, 5round
Nih Co vet
Toni<
M,'r'o £/ 140
7 Pt aP £m/~/c Roof{
ND SCALE
]~00 ~AL STEP
BENCH klARK
ASSUMED ELEV, lO0, O0
TDBgEN SPURKLAND P,E,
203 WlSth Ave
Anchorage Ak 99501
14,
BLOCK 3 HOMESTEAD HILL~]
II
DAVID M SNOW
4550 TRAPL/NE O/R.
SEPTIC SYSTEH DESIGN
DATE, AP~L 1, 1996
SHEET, 4/4
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PERMIT NUMBER:SW950378
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:SNOW DAVID M
OWNER ADDRESS:4530 TRAPLINE CIR
ANCHORAGE, ALASKA 99516
PAGE 1 OF 2
PARCEL ID:01517336
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
DATE ISSUED:il/06/95
EXPIRATION DATE:il/06/96
LEGAL DESCRIPTION:
HOMESTEAD HILLS #1 BLK
3 LT 14
LOT SIZE: 51429 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
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 (iSAACS0) .
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
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
THE FOLLOWING SPECIAL PROVISIONS.
i P~M~,;[M~S~.[B,E LOCATED IN AH AREA OR
~~: S~[.~T AMBIENT ~i~ ~
~,~ .THE R~O~OSED~TERMITTENT DOSING SAND FILTER SHAL ~N
~GER IN T~E GR~6~D
ISSUED BY: ·
DATE: /2 -/-
T SPUI: LAND
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 14 BLOCK 3 HOMESTEAD HILLS
Percolation rate more than 60 minutes per inch in two of three testholes
Use bottomless sandfilter in vicinity of testholes 2
Percolation rate 10 minute per inch
Use 4 gallons per sq. Ft. per day
Required Area per Bedroom: 150/4 = 37.5 sq.ft..
No. Of Bedrooms 4
Total area required: 37.5 x 4 = 150 sq. ft.
Sandfilter bottom area: 15 x 25 = 375 sq. Ft
The installation of this septic system will not prevent wells from be installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
pg.1
Municlpalit~ of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
Township, Range, Section:
10
11
12
13
14
15
16
17
18
19
,20
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water Alter
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
~ERFORM£D BY: I CERTIFY ,THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL
7
8-
9
10
11
12
13
14
15
16
17
18-
19-
20-
COMMENTS
DATE PERFORF,
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water
Monitoring?
/ Gross Net Depth to Net
Reading Date
Time Time Water Drop
¥ ~ ~ Y ~/~
PERCOLATION RATE
TEST RUN BETWEEN
{minutes/inch) PERC HOLE DIAMETER
FTAND -~:~ ~'~FT
J~ERFORMED BY: ~ I
CERTIFY T. HAT THIS TEST WAS PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ' ~ '~ j ~ ~ ~""
72-008 (Rev. 4185) ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: E-~ ~ ~ DATE PERFOI
LEGAL DESCRIPTION= Le"~ Iq. ~ ~ '~ ~ow,~sLe~I'Ownship, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13-
14-
15-
16-
17-
18-
19-
20-
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
s
L
IF YES, AT WHAT O
DEPTH? p
Depth to Water After
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ ~ ~ ~/m ,1~
PERCOLATION RATE II ~) (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ~/'Y2-"FT
COMMENTS
~=ERFORMED BY: I CERTIFY.T~IAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '
72-008 (Rev. 4/85)
I®
I
16
%
YA£AN?
LD? 6
DEVELOPE. O
LZT? 8
/ ~ LDT 5
JUMAR ~VENUE
~ L~ \
50 O 50 200
SCALE: 1" = }00 FT,
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
LOTI4, BLOCK3HOM£ST£ADHILL$$/D]I SEPTIC SYSTEM DESIGN
MICHELSOHN AMD DAUGHTER DATE: OCI'. 5, 1995
45~0 TRAPLINE CIRCLE SHEET: l/d GRID: 2656
/~00
£0 £AIVPF/L TEE
HI]USE
~IiIiI I
0 25 50 75 .tOO I~5 150
S£ALE: 1" = 50 FT,
TOBBEN SPURKLAND P.E.
203 W 15TH. AVENUE
ANCH. AK. 99501
LOT 14, BLOCK 3 HOMESTEAD HILLS S/D
~flCHE£SOHN AND DAUGHTER
4550 TRAPLINE CIRCLE
II SEPTIC SYSTEM DESIGN
DATE: OCL 5, 1995
SHEET: 2/$ GRID: 2656
20
15
_1
3/4' AIR LINE
I/8" DRAIN HOLES
AT ALL LOW SPOTS
£ '-8. S'
From STEP lank
Loierol ond Oriifico Shield
Air Supply
Arctlc Insulo t;/on
6" Holfpipe D303,l, 6' Lon9
PVC, Holes Polnllng Up
TOP VIE~:
CENTRAL PAVING ROAD SANfl
SIDE VIE1Y
TOBBEN SPURKLAND P.E,
203 W 15TH. AVENUE
ANCH. AK. 99501
18x20 SAND FILTER
LOT 14, BLOCK 5. HOMESTEAD HILLS S/D
I J SEPTIC SYSTEM DESIGN
DATE: OCT, 17, 1995
SHEET: 3/4 GRID: 2636
T.SPURKLAND P.E.
203 W15TH. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
1.0
SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION
LOT 14, BLOCK 3, HOMESTEAD HILLS S/D
MICHELSOHN AND DAUGHTER
GENERAL
1.1 Owner is
1.2 Engineer is the person or entity hired by the Owner to inspect this project. The Engineer must be
recognized by the Municipality of Anchorage, Department of Health and Human Services.
1.3 Contractor is the person or entity hired by the Owner to install this project. The Contractor must be
recognized by the Municipality of Anchorage, Department of Health and Human Services.
1.4 The Drawings, sheets 1 through 3, shall be part of this specification.
1.5 All materials and workmanship shall meet the requirements of the Municipality of Anchorage,
Department of Health and Human Services, the conditions of the permit, and all applicable rules and regulations
currently in effect.
1.6 All excavation depths are advisory, and are to be verified and may be modified in the field by the
Engineer.
1.7 It is the responsibility of the Owner or the Contractor to adhere to the approved design, to verify that
the specified separation distances are met, and that the required inspections are performed. The Department of
Health and Human Services shall be notified at least two (2) hours in advance of each inspection. Notify DHSS
by calling 343-4744.
1.8 The Contractor or the Owner shall report to the Engineer any observed condition which would put the
septic system in violation of State or Municipal regulations.
2.0 SEPTIC TANK
2.1 If there is an existing septic tank, it may be used if it meets the capacity requirement for the residence.
The tank shall be inspected by the Engineer, and its water tightness and structural integrity shall be verified.
2.2 A new septic tank shall be one fabricated by either Anchorage Tank and Welding or by Greer Tank
The septic tank shall be a UPC-approved two-compartment tank, conslructed of 12 gauge, or better, steel with bitu-
mastic coating. The tank shall be set level on undisturbed soil. The tank shall be covered with the equivalent of
four feet of soil.
2.3 The septic tank shall be installed a minimum of five feet from the house foundation and a minimum of
five feet from the absorption area.
Specifications for septic system installation
Lot 18 Block 3 Homestead Hills S/D
pg.1
3.0
2.4 The septic tank shall be a minimum of 100 feet from any well serving a single residence; 100 feet from
any body of water, creeks or dra'mage ditches with flowing water; 150 feet from Class "C" wells, and 200 feet from
Class A or Class B wells.
2.5 All pipe connections to the tank shall be mechanical watertight couplings. Cleanouts shall be installed
as designated and capped with ak-tight rain caps. Cleanouts shall extend a minimum of 12 inches above f'mal
ground elevation. Provisions shall be made for landscaping and importation if topsoil.
2.6 Lift station shall be as manufactured by Anchorage Tank and Welding
Effluent Pump shall be OS1-05-HHF
Control Panel shall be OSI Simplex control panel with Elapsed Time Meter, Counter, Programmable
Timer, and Intrinsically Safe Control Relay.
Air Compressor shall be Thomas Industries Linear Compressor Model 5070.
Air line shall be supplied by Orenco
SAND FILTER
3.1 Gravel shall be 3/8" washed pea gravel.
3.2 Sand shall be Central Paving Road sand with less than 4 % passing the #100 sieve, and less than 2 %
passing the #200 sieve.
3.3 Pressure distribution pipe shall be Schedule 40 PVC or ABS. Effluent and air.
3.4 Solid 4-inch pipe shall be ASTM D3034.
3.5 Monitor standpipes shall be installed as shown. That section of the pipe penetrating the gravel shall be
perforated, either by drilling 0.5" holes on 6-inch centers or by joining a section of F810 perforated pile to a solid
section of pipe.
3.6 Geotextile shall be Amoco 4545.
3.7 Insulation shall be extruded direct burial polystyrene. Dow Chemical Styrofoam HI 40.
3.8 Topsoil shall be a mixture of 40-60% organic matter, 20-30% sand and more that 20% silt. All quantities
are measured by volume.
3.9 Grass seed shall be Kentucky bluegrass.
4.0
INSTALLATION
4.1 Locate all underground utilities, property lines, future driveways, existing or proposed water wells, water
ways, surface and sub surface drainage facilities, lakes, ponds, and all other facilities requiring separation distances
from the proposed septic system. Notify Owner or Engineer of any observed possible conflict.
4.2 Stake alignment of system with markers showing the protective distances from wells and water bodies.
4.3 Establish an elevation benchmark. This BM shall be easily identifiable, stable and permanent. An
Specifications for septic system installation
Lot 18 Block 3 Homestead Hills S/D
pg.2
arbitrary elevation of 100 can be assigned.
4.4 Install the tank as shown on the drawings. Record the inlet and outlet elevations of the tank. Tank shall
be placed on undisturbed native soil.
4.5 Excavate the absorption field. Bottom of excavation shall be level and scarified~ . Record elevation of
each comer and center point of bed. Construction equipment shall not operate on the floor of the excavation. Any
material compacted by the operation of the construction equipment shall removed and replaced with uncompacted
materials.
4.6 Place the sand to the depth specified. Do not contaminate sand with native materials or spoils from the
excavation. Level the sand surface (+- 1") before placing the pea gravel. Level the pea gravel before installing
the perforated pipe.
4.7 Solvent weld the joints.
4.8 Cover the distribution pipe with pea gravel, and cover the excavation with geotextile before backfilling
and placing insulation, if required.
4.9 Record the finish ground elevation at each corner and at the midpoint of the bed.
4.10 Furnish a copy of all survey notes to the Engineer.
5.0 INSPECTIONS
5.1 A minimum of five inspections are required. The first inspection will be to lay out the installation with
the proper separation distances from the adjoining wells. The second inspection will be of the open excavation.
At this time the soil conditions will be observed and compared to the design assumptions. Ground water
conditions or presence of bedrock will be verified.
The third inspection will be after the placement of the air distribution piping, the fourth inspection after
placement of pea gravel and effluent distribution piping, standpipes, tank(s) and other components as specified.
A final inspection will be conducted after placement of topsoil and cleanup. Any deficiencies will be noted and
the Contractor notified. Such deficiencies shall be corrected within ten days.
5.2 All electrical work requires either an MOA electrical inspection or certification by an licensed electrician.
Submit proof of inspection or certification to the Engineer.
5.3 Submit catalog data of all mechanical equipment.
5.4 Notify Engineer at least 24 hours in advance of beginning any work.
Specifications for septic system installation
Lot 18 Block 3 Homestead Hills S/D
pg.3
'his [~ureemct~t, da~cd .... ..__199__, is mad.: betWeell the Municipality of
" ', - ' ' andre ro e~' owner(s)
]his agreement is made for the purpo.~e of illailltainil~g all on-site wastewatcr disposal
/y~qcem or, the :;t*bjec~ prope~
The I~rUl)m'ty uwners agree tO the l'ollmvil~§:
Allow the Nit ti<: p;t ltv of Anchorage the perpetual right of en(~y to thc pr0pet~y during
normal workSog houru, to allow for effluent samplbxg or evaluating the general s[~10 Of
repai~ o[ function ot' thc syslem,
$ubmit to the MunkipaJit7 of Anchorage, on an annual basis, m~ i~specfiotl ard operation
statement from a reeiste~ed professional engineer. This ie...peetioa atld operafiOll
~tatement shall vu;5t) lhat d~e ¢nglneet ha~ inspected ~t effluent anti a~ ptnnps, umels, and
ahu n:¢, end [hat unv'defi¢'ieuci¢$ have been repaked and ~at the system is f~otiotlhlg as
(Printed Name)
.98
•
GE-
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 SAFETY
Certificate of On-Site Systems Approval
Parcel I.D. 015-173-36 Expiration Date: Nov S a0 I $
1. GENERAL INFORMATION
Complete legal description Homestead Hills #1 Block 3 Lot 14
Location (site address) 4530 Trapline Cricle
Current Property owner(s) Mark Staples Day phone
Mailing address 4530 Trapline Circle, Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING: Rvl5 Fl
❑ Single Family (w/wo ADU) 7 )/$
❑ Duplex 1 5$ fl1
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well I] Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: L/14611U/kt/7flf6771 /g
COSA to be released Date:
to the engineer,unless otherwise requested by the,engineer.
0.614
COSA Fee $ 6 + 315 = bo Waiver Fee $
Date of Payment 1-- 30 -15 Date of Payment
Receipt Number 07061IS Receipt Number
COSA# OSC 1$137 5 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems 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 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Forge Engineering Phone (907) 522-7773
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 7/30/18
6. DSD SIGNATURE % '�' •
V System#1 Approved for ��
y pp bedrooms �r BenjarrOchiller 0
¢ �/ . CE 12592 •
System#2 Approved for bedrooms fi�t`9FpPR/30118onss •;••
Disapproved ' r 'Conditional approval;fo.r.,%,:. "' bedrooms, with the following stipulations:
^itii0��
ON-SITE
WATER AND
0 WASTEWATER
PROGRAM
<-
4„,,
-
By: i t, r./e/C4 eVo o-1 Original Certificate Date: acy iS) 0201
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineerreglstereci in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's
twork. ..
j
7. ATTACHMENTS: ' - ,-
COSA Checklist X Nitrate Advisory �. , ^.�
Septic System Advisory Arsenic Advisory •
Well Flow Advisory Other Tarn X•,
COSA blue sheet r .. c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Homestead Hills #1 Block 3 Lot 14 Parcel ID: 015-173-36
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 4/26/96 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 60 ft. Cased to 60 ft. Casing height (above ground) 36 in.
FROM WELL LOG AT INSPECTION
Date of test 4/26/96 7/17/18
Static water level 18 ft. 25 ft.
Well production 20 g.p.m. 4.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 5.52 mg/L
Arsenic ND ug/L Date of sample: 7/16/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./Steel Date installed 8/05/96
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y
Pumper Northland Pumping
Date of pumping 8/2/18
C. ABSORPTION FIELD DATA
Date installed 7/25/96 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.45 GPD/SF System type Deep Trench
Length 2 x 50 ft. Width 2.0 ft. Gravel below pipe 7.0 ft.
Total depth 10-11 ft. Eff. absorption area 1333 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/20/18 Results (Pass/Fail) Pass For 4 bedrooms
13.5/25.5 1659/309 51.5/37
Fluid depth in absorption field before test in. Water added
gal. New depth in.
Elapsed Time: 1440 min. Final fluid depth 27/33.5 in. Absorption rate >= 600 g p d
None
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 8/05/96 Size in gallons 1500 Manhole/Access (Y/N) Y
"Pump on" level at 43 in. "Pump off' level at 41 in. High water alarm level at 45 in.
Datum Bottom Cycles tested Two Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100 On adjacent lots �100
Absorption field on lot 100 On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas 100
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >10' Property line >5' Absorption field >5'
Water main Water service line Surface water 100
Wells on adjacent lots 100
ABSORPTION FIELD ON LOT TO:
Property line 10 Building foundation 10 Water main >10
Water Service line 0>1Surface water 100 Driveway, parking/vehicle storage 10
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION 41-Nz`��\\
of Ag1111
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in ��)P• •• ••.'�
•
conformance with MOA COSA guidelines in effect on this date. % *;•4q 1H )\ • *
Engineer's Printed Name Benjamin Schiller, PE �,,- • • • rd
Date 8/2/18 /r • • •• •Benjamin chiller : • •,
r if'••. CE 12592 •••` �
•�k �`rI •., 8/2/18 .<c,�'��
llV".PROFESSIO ' .
COSA brown sheet 10-10-12.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT , • `t!.''''e907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC181375
Subdivision: Homestead Hills #1 Block:3, Lot: 14
The septic tank for this property is 22 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
. ., r 1 _'��MT 1_£i ',,fir
1 y ,,,,'4,,,3:,,:7,`) ,s
•.Y r'1 . �J.r. *' .,: ' Yy 7 ..5 j Rxlti `
totiK.to
T
'+ t e lig .ab ti.:::to Tia :it .^
. ...i4:-.44,4t:.,, �/.1 yam,.R J
'�f`. p „I -, w1".. R « .- S•\ ..
-4p -' —
wt f 'k r
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Y . 2418 ,
Mailing Address: P. 0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
(NJ IppI11 i�j �y r i �� �_
OCI PALOTY F F � I ICHOR; AG E
DEVELOPMENT SERVICES DEPARTMENT e ( r } 907-343-7904
On-Site Water and Wastewater Section baa Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181375
Subdivision: Homestead Hills #1, Block: 3, Lot: 14
A water sample revealed a nitrate concentration of 5.52 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
MUNICIPALITY OF ANCHORAGE
0 �� j III M-
1
IIOINMINIIIMIIIMIIPMOOMIIMIIIIMIIIMMIIIMIIOIMIIIIIMIIIIMIIII
�� =;��` Phone: 907-3�?�3 7904
Development Services Department ��` Fax: 907-343-7997
On-Site Water & Wastewater Section
Lift Station/Pump Vault
Maintenance Log
Owner • c .1 5
Street Address 'A' _ft Sr, • ' -
Phone /11, - Legal Desc.
PID - -
5e2tic Tank: /
�
•Sludge level 5� 'nches -Pumping: required ye*� no -Pumping completed67-4i-o
(u.Y;\1 p u..,p --w,ts plc)
1 t tt station;
-Pump basket cleaned -ur •Effluent filter cleaned 0S1°
-Control floats cleaned •Proper float settings confirmed 6Q
-Operation satisfactory e ''___O__, o
Allan-fix ���,;
-Dedicated electrical alarm circuit : •• •Audible and visual alarm inside dwelling �Q
-Alarm system operation c+a :.c i o - .Sftolr
Manhole Riser
-Ground water intrusion at riser to tank connection - iQ . Nee hole functional vE no
-Ground water intrusion around pipe penetrations des p
•Manhole lid: Functional (4...ag,
Insulated Properly Secured e0 riQ.
Other
•All manufacturer required inspections and maintenance completed yi
Comments,
Maintenangg Provider:
Technician
I-0. 13 L *s Date of maintenance
Company A P \, r-; t4OVYl e -S en
y A2
Signature Datef _,-- -)
Mailing Address: P. 0. Box 196650* Anchorage,Alaska 99519-6650 www.muni.org I1
1
NORTHLAND PUMPING SERVICE, INC. I N V O I C E
Your Professional Septic Pumping Service Company
7501 E.140th Avenue
28503
ANCHORAGE,ALASKA 99516 t,+
(907)344-7146 • FAX(907)868-6770 �. - .11Z—
.
DATE
Mark
TO 4530 T alpline Circle aty,
r Po.#
Anchorage.AK 99516 �(
f
TERMS:
QUANTITY UESCRIPTic?r J AMOUNT
Pump Septic & Lift 5195 00
MOA Lift Station Inspection 165.00
This Week
wQ•k eU �a seg t wl ,�.,P, ,.
". "Beginning Jan. 1,2018 AWWCU has again raised ow dump fees resulting in a rate increase
- To voice concerns regarding continued late increase contact Assemblyman John Weddleton 7'10-0685 'i
6kSe(-)k C.S ` (f55ib1 e,
07/16 1500 gallons, 2 standpipes
Tank local ed 20' E of Electric meter on E side of house in side yard 6-below ground level
(1-ek‘'Nk k I , 4' CvAAej/ ( ) tSpU G-‹. 1
V)())Gallons
-A• !
Gallons Holding Tank ❑ PROBLEM AREA-CALL FOR MORE INFORMATION
❑ NEEDS TO BE DONE AGAIN IN 6 MONTHS
X. Septic . Standpipes ❑ Good Shape ❑ Sludge buildup on bottom K1 Floater on top
Q+(�tL El Jim cap missing or E] Cut standpipe to 1'above ground ❑ Needs Septictrine
Leach Ares" `time needs replacing
TRAPLINE
CIRCLE4
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* : D AS-BUILT SURVEY O S �� RB MFRS SER IMS DOTE
Qom • o
o a SHANE A.HOLT . �� I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
�O a LS-6914 .••6c°,0'' OF THE FOLLOWING DESCRIBED PROPERTY
444aprOJes s:: o' LOT 14, BLOCK 3, HOMESTEAD HILLS NO. 1
��Dppoo�� ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
// EXIST OTHER THAN NOTED. g TH DAY OF
/ THE IHFORMATI011 HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW AHY DATED AT ATHIS
NOT TOC BE USEDE FORE POSITIONINGU ADDITIONAL STRUCTURESCTURES AND PLATTED , IMPROVEMENTS,LINES AND/OR ORE FENCELINES.MENTS; AND AUGUST ,ANCHORAGE,ALASKA
E,A
2018
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE. FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMII HOLT LAND SURVEYING
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS• 9309 DROVER DRIVE
ANY PAVING SHOWN HEREON MAY BE APPRO%IMATE DUE TO EXCESSIVE SNOW ACID/OR ICE. ANCHORAGE,AK 99507
345-5513
13996, FB 189-53
Municipality of Anchorage
Development Services Department ....
Bund ng Safety D v s 0~
On-Site Water and .Wastewate( Program
4700 SouthBragawStJ..- - ' ".
.... . .o .... i'' Z,'. "". '" ....
P.O. Box 196650 Anchorage ~,995!9-665 , . .' '~." '
· ;www.cIad~6ra~:aklb,s'., · 'i'. '~ ' ~ "" ' ';: ' ', ,'
'/"' (907)343-79.0~.~ v ,., J,:'
CERTIFICATE
OF
HFAL,TH.'AUTHORITY:/-~PPROVAL : - '
FOR A-SINGLE FArlEY DWEllinG' ..... '
Parcel I.D. 0'Z5~i73-36
GENERAL INFORMATION
"C(~mplete legaldescription Lot
H,U,#.' H,q
Expiration Date:
14, Block 3,-Homestead'Hills #1
Location (site addres~ or directions) 4530 Trapline Circle
Current ProperbJ owner(s) David Snow Day phone 561-5771
Mailing address
Lending agency
Mailing address
Real Estate Agent
' Mailing Address,
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER sUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
4530 Trapline'Circle'; Ea~{~'IRiveri~ AK 995'16.!
'Phone' "'
Day
Unless otherwise requested, HAA will be held by DSD for pickup.
3
Day phone
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 Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request lo homeowners. Certificates el 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 eld. (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 er a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. TATEMENT OF INSPECTION BYENGINEER
As ce~fified b~, 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 lype of structure indiCated herein. I further verify that based on the Information obtained from the
Municipality of Anchorage files and from my ir~vestlgation 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 In effect a~ ~ I~H~l~ltl~tion.
Name of Firm E~II. RlYer, Alaska ~$~ Phone ~q/"J-)' 9 3 ~'
Address
Engineer's Printed Name Roberl: C. Cowan~ P.E. Date' ¥//q/c, r
5. DSD SIGNATURE
, ~ Approved for ~
Disapproved.
Conditional approval for
.
bedrooms. ~ '~.. .' ~' -
bedrooms, with the following stipulations:
Additional Comments
,,e i WATER AND
· _ W~,.qTI=WATI=I~
~ 7: PROGRAM ./ .
......
Attachments:
HAA Checklist , X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: L-/c' - c,~.~z'-- 0 J
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 9951~6650
www.ci.anchorege.ak.us
(S0?) ~t3-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescripflon:].o~' )~ /51K 3 ~om~YT~*O ~/~.~z ~'/ ParcellD: 0/,t--/'73-3~
A. WELL DATA
Wall type ~',%v~ r4
Date completed
Total depth (o O
Date of test
Static water level
if A, B, or C provide PWSID #
Sanltap/seal ~1)
Casedfo ~0 ft.
FROM WELL LOG
/~' ,ft.
Wall production
WATER SAMPLE RESULTS:
Coliform . O colonies/100 mi.
Date of sample: ~//./e I
B. SEPTIC/HOLDING TANK DATA
~ o + g.p.m.
Nitrate ;~ · q mg./I.
Collected by:
Wall Log~l).
Wlrez propedy protected ~qq)
Casing height (above ground) ~ G~ in.
AT INSPECTION
ft.
g.p.m.
TankType/Mataria1 ~z~,r,c / $ r~.a ~.
Tank size I $ OD gal. Number of Compartments
Date of pumping ¥ ~ ~ ~/o I
Other bacteda O colonies/100 mi.
S & S ENGINEERING
1,q',..~.,4 rr. Nl~e myer LO~ i~o~d No.
EJgla Rlvm., Nido, gg.T'/7
Date installed ~//3 .-S'//~) '~
C~eanoots (S~}N) ¥ z J'
High water alarm(~N) ¥4~ d'
Pumper N 0,'~ 7~ L'~"~ '0
C. AeSoRFrlON FIELD DATA
Date installed *'7/~.,f'//'~ & Soil rating ~r ~fodrm)
Length A ~ ,.~0 ft. Width ~. ft.
Totaldepth ]0 ft. E~f. absorptionareal3.~)~ Monitoring tube
Date of adequacy test ~/) ~/~ ) I~)suits~Fail)
Fluid depth in absorption field before testy I~in. Water added ~'aly gal.
Elapsed Time: J I ~' min. Final fluid depth ¥ /e in. Absorption rate >=
Any rejuvenafioo treath~nt (past 12 mo.) (YIN & type) /v0,~t. g,dO ~,~
System type -rR¢ ~,c~'~ 4'
Gravel below pipe '7 ft.
Depression over field H ~
For ~ bedrooms
New depth~' ¥'~ in.
~ ~ O g.p.d.
If yes, give date --
D. LIFT STATION
Date installed 7/3. ~-/~/(~
'Pump on" level at .~' ~ "in.
Datum 'To/ e~ ~,~e.9.
Size in gallons ] .t'"O O Manhole/Access {~) Y~ .5'
'Pump off' level at {; ,3 in, High water alarm level at 5" 'f in.
Cycles tested ~ Meets alarm & cimult requirements? )~Z $
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO'
Septic tank/lift station on lot I ~ O ~ '~'
Absorption field on lot
Public sewer main N/,4
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhole/oleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation I O '+ p~line 10 ~+
Water main ~//R Water service line
Wells on adjacent lots ! ~)0 -k
Absorption field
Surface water
Water main
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ! O ~ Building foundation ! 0 ~-
Water Service line / 0 '*/' Surface water I O0
Curtain drain/U,:,v~- ,¢~0~.V "Wall~ in*adjacent lots I
F. COMMENTS ' ....
G. ENGINEER'S CERTIFICATION
I certify that I have determined through §eld inspections and
review of Municipal records that the above systems are/n
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Data
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12J00)
Driveway, partdng/vehicle storage
Waiver Fee $
Date of Payment
Receipt Number
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
:DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions
Property owner
Mailing address
Lending agency
Mailing address
.~b4C ~,'{~' '~A,,./~ ~ Day phone
Day phone
Agent
Address
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
4. TYPE OF WASTEWATER DISPOSAL:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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, 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type df structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm I o ~
Address ~
Engineer's signature
Date
DHHS SIGNATURE
/~ Approved for ~
Disapproved.
Conditional approval for
bedrooms.
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 engine, er 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
responsibJe for errors or omissions in the professional engineer's work.
72-O25 (Rev 1/91) Back MOA #21
MUNIOPAIJTY OF ANC;HORAGE
I~N¥1RONMENTAL
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICESAiiR
1996
Environmental Se~ices Division
825"L" Street, Room 502 · ~.~.o~. A,~ ~0~' ~0~) ~ E!~ED
Legal Description:
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Health Authority Approval Checklist
~40 tq.~ $~ AD 1'4 ~ L-L-;~ Parcel I.D.:
LoT t ~4 t '~ IL. 3
Y
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of samp,e:
B. SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout (Y/N)
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed
Length o~'$~/? I Width
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed /'///~[~ / q ~
Cased to ~ tS)
FROM WELL LOG
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Nitrate Other bacteria
Collected by:
Tank size /O~tg't? Number of Compartments ~ Cleanouts (Y/N) .
7 Depression (Y/N) I"{ High water alarm (Y/N)
Pumper 1'4//~
Soil rating (-g~dvff~2 or ft2podrm)
oO~ t Gravel thickness below pipe
System type
Total depth
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.);
Fluid depth ~,r (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Monitoring Tube present(Y/N) ~'/ Depression over field (Y/N) tx]
Results (Pass/Fail) ~ For ~ bedrooms
Immediately ,after ~gg~. water added (in.):
Absorption rate = 't.~ g.p.d.
If yes, give date ~
D. LII:I' STATION
Daie installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
"Pump off' level at* q [
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
/tot
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation I ~ ~ Property line /'//~ ! Absorption field
Water main/service line ~//~ t -P Surface water/drainage ~[O'O Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
Water main/service line ~' ~:~
Driveway, parking/vehicle storage area ? ~,,,...>_ t
Wells on adjacent lots '~ 10n::> ~ Property line o~O I
F. ENGINEER S CERTIFICATION
1 certify that I have determtned thrufield .... tnspecttons and revtew ofMuntcmal record~'~t~I'~,.,, ~abov~.~ste~:a~e, ..,
m con ormance wtth MO del ne t ate
' ,fi ' ~ H~gui i s 'neffectonthisd .
Date [~ ~ I ~ ~ ,.
...............................................................................
HAAFee $ ~ ~[~ W~verFee$
Date of Payment ff~/~ Date of Payment
Receipt Number ~[~ 7 ~F ~ ) Receipt Number
Rev. 8/95 OSS: haa.wk.doc
CT&E Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
CT&E Environmental Services Inc.
Laboratory Division
This is a
963920001
Tobben Spurldand P.E.
14/3 Homestead Hills
L14 B3 Homestead Hills
Dril~fing Water
0
Preliminary report
Client PO#
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
200 W. Potter Drive
Anchorage, AK 99518-1605
Tel: (907) 562-2343
Fax: (907) 561-5301
08/23/96 09:26
08/19/96 14:00
08/19/96 14:40
Released By
Sample Remarks:
ALlowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Nitrate-N 2.00 0.200 mg/L EPA 353.2 08/20/96 ESC
Total Coliform 0 0 col/lOOmL SM18 92228 08/19/96 TAV
~BQS Member of the SGS Group (Soci~tO G~n~rale de Surveillance)
bllCHEL$OHtq&~DRUGHTER CONT 522--~;76 P. 02
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF PlJBLIC WORKB
BUILDING SAFI::'I'Y DIVISION
3500 E~t Tudor Road
CERTIFICATE OF OCCUPANCY
ISSUE DATE: AUGUS'r i6,. _1.996 ,
This Certificate issued ,pursuant t,o Section 309 of the current edition of The Unifo ,r~n,, Administrative Code, ce~ifies that
at the tithe of cor~struchon, as evidence by the final inspection dates noted below, thru structure, or portion th,.reef, was
in compliance wi~h ordinances of the Municipality regulating building construction 0..r use, for the following:
Building. Permit kJo:. 95-097t (NEI~T SING~E-FAt,~t,'Z)
~'ht: 14 BIk: 3
Site Addres.s:
Street Address: I52
FINAL STR: 8.-14-96 __
FINAL ELF:C: 8.,-7-~6
Subdivision: ltOl. fl!;S'l'FJ~ *JILLS
BY:
BY:
Zip: 9951.8
Owner __. DAVID SNOg
IN'£jc~&'tATIOI~,y; ANCHORAGE State; /¢:
BY: ROI, t'~G FINAL MECH'; 8-14-96
BY: CgM~INGS FINAL FIRE. N/A
FINAL PLBG: 8-
PREPARED BY:
~-003 I Rev, 5192 i~ '
L D~G~