HomeMy WebLinkAboutFOX HILL BLK 3 LT 1Fox Hill
BIo.ck 3
Lot I
#051-073-02
Municipality of Anchorage Page / of
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
PermitNumber:..-',~-..~L~' I~-JO/-~Oc} PIDNumber: O~''/° OT.~'~'-~--
NAmA: Wastewater System: D New [] Upgrade
AddreSS: ABSORPTION FIELD
Phone: I NO. of.~B~edroom$: '
~,~.?. ~. ,~c,~. ~,,c'~ ~ [3 Deep Trench [3 ~hallow Trench ~ Bed ~ Mound [3 Other
LEGAL DESCRIPTION so, Rating:~. '/ GPD/$q Ft. Total Depth~.~from~ original/grade:
Block: Subdivteion: Depth to pipe bct~om from odgJnal grade: I Gravel depth beneath pipe
WELL: ~'~,'s~,',,~ New [] Upgrade irAvelwldth: /.~ Ft. ~' ~ Ft
Casing He,g~t At~,e Ground:
Ft. t,~ Ft. TANK
SEPARATION DISTANCES e Septic [3 Holding [] S.T.E.P.
MatarJAl: Number of Compartments:
Surface
W~ter ~,~ ' ,'~'~t' ,'Y/~' ,v/~ ~ LIFT STATION
Lot Size In gallons: I Manufacturer:.~ ~ '
Remarks: BENCH MARK
Depaflment of Health and Human Se~ices approval
Reviewed and approved by' ~/~/~ ~ Date:/~'~'O/ '
72-O13 (Rev. 9/91) MOA 25
Permit No.
Poge 2 of 4
Municipolity of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchoroge, AIosko 99519-6650-Telephone 343-4744
On-Site W(~stewofer Disposol System (]nd/or Well Inspecfion Reporf
Legol Description:
LOT 1, BLOCK 3, FOX HILL SUBDIVISION
PID No.:
/
/ \
/
Permit No.
Poge 3 of 4
Municipolity of Anchoroge
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchoroge, Alosko 99519-6650- Telephone 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legol Description: LOT 1, BLOCK 3, FOX HILL SUBDIVISION
PID No.:
ENGINEER'S SEAL
Permit No.
Page 4 of 4
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650. Anchorage, Alaska 99519-6650. Telephone ,$43-4744
On:Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 1, BLOCK 3, FOX HILL SUBDIVISION
PID No.:
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 01, 2001
Expiration Date: Oct 01. 2002
Permit Number: SW010409
Legal Description: FOX HILL BLK 3 LT 1
Design Engineer: 0069 Douglas T. Kenley, PE
Owner Name: Thomas Bol
Owner Address: 22339 WOODCLIFF COURT
CHUGIAK, AK 99567-5304
Parcel ID: 051-073-02
Site Address: 022339 WOODCLIFF CT
Lot Size: 40999 SQ. FT.
Total Bedrooms: 2 Permit Bedrooms: 2
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
Ail 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: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: ~
Issued By:
Date:
Date/~..L
Municipality of Anchorage
Development Services Dep. artment
Buading 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
(9O7) 343-79O4 '
ON-S TE SEWER/WELL PERMIT APP.LICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Perm t Number SWO 1040~.
Property owner(s) '~c ~-~ ~ '
Mailing address (1) ..~,,~-.;I'~F ~,r,z~.~'/_/,~".~'
Mailing address (2) c'~v',,,~',,.¢,~' ,.~x.,~',.-,~-',-~ Zip Code
Legal description (Lot, Block & Sub'&) ~,', ,.-" //,.,~"~-'~ ~"~'.-~'~, -'~ y ~ ,: z..-
Legal description (Section. Township & Range)
Lot Size ,5,///~ ,~ Acres/S._~q.~J. Ft... Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Weft
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Day phone ~'~/~ - ~,~g.~'""
Well Only []
Water Storage []
Jacuzzi []
Water Softening Unit []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner er authorized agent)
Date of Payment:
Receipt Number:
(Rev. 12/00)
Permit Fees: ~. o'~ Waiver Fees:
'~/I 7/O / Date of Payment:
19 [~) ( ~'~ Receipt Number:
Douglas T. Kenley. P.E. 9960 E. Puffin Drive, Palmer, Alaska 9'3645 (907) 746-1073
September 13, 2001
Mr. Thomas Bol, O~ncr
Lot I, Block 3, Fox Hill Subdivision
Chugiak, Alaska
PERCOLATION TEST RESULTS
AND
GENERAL SITE INVESTIGATION REPORT
On August 20, 2001, an adequacy test ~*s conducted on thc well and septic system. Thc well passed, but thc
septic system was found to be in a failed condition. Thc above-referenced 41,000 sq. ft. site was inspected in
support of this application for approval to upgrade thc on-site ~=stcwater disposal system. The inspection
consisted of soils percolation tests and an overall conditions survey of thc property.
Thc site is located at 22339 Woodcliff Court. Thc immediate area that has been selected for thc replacement
x~stc~=ter disposal s3~tem has an average slope of I to 6%, The site is sparsely treed xvith birch and spruce
but is heavily treed ~dth small alder. On-site observation and physical survey shmv that there are no water
wells nor private ~ustm~=ter disposal systems ~thin a 100' radius of the proposed system.
On August 31,2001, three test holes were dug to depths of:
Test hole # ! to 11.1'
Test hole #2 to 8.7'
Test hole #3 to 11.6'
Water seepage ~s encountered during thc digging as follows:
Test hole # 1 at 8'
Test hole #2 at 6.5'
Test hole #3, none ~x~s encountered, but a gray, silty clay layer was encountered at 5', which continued to the
bottom of' the hole.
Test holes #1 and #2 were pre-soaked on August 31. Test hole #3 x~s merely filled with ~=tcr to confirm
what x~us observed through visual inspection, i.e., that the absorption rate ~s greater than 60 minutes per
inch.
Peru tests were conducted September 1, 2001, on test holes #1 and #2, with thc following results (as shoxm on
thc attached soil logs):
Test hole # 1, 9 minutes per inch
Test hole #2, 20 minutes per inch
Water levels in thc monitoring tubes were also inspected, with ~.tcr found at thc following depths:
Test hole #1 at 5.8'
Test hole #2 at 6.5'
Test hole #3, no x~.ter
Lot 1, Block 3, Fox Hill Subdivision
Page -2-
9/17/01
Water levels in the monitoring tubes were again inspected on Septcmbcr 8, 2001, with water found at the
following depths:
Test hole # 1 at 4.9'
Test hole #2 at 6.5'
Test bole #3, some ~xater was evidenced, but could be due to xxater seeping in on top of the impervious layer
after heavy rain
With a reference taken from the bottom of the foundation clean-out, thc bottom of the replacement bed system
can bo no lower than 10' below said reference point. The top of the replacement bed system x~ll essentially be
less than 1' below the existing ground level; therefore, it may be necessary to insulate and provide additional
fill.
Because of the variations in soil conditions present on the lot, it is proposed to use a pert rate of 20 minutes
per inch.
Thc proposed system will have no measurable impact on additional reserve space, surface or sub-surface
drainage, or on drainage from adjacent lots. It appears that there is no potential for contamination of adjacent
xxatcr wells or streams from knox~ sources.
Attached please find proposed design drax~ngs for the replacement system. If thcre should be any questions
concerning the percolation rate or characteristics of the site, please call me at (907) 746-1073 or 243-5372.
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/
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BLOCK 3. FOX HILL SUBDIVISION
CHUGIAK. ALASKA
Z
m
LOT 1. BLOCK 3. FOX H~LL SUBDIVISION
SPILETER
TO EACH FIELD
4" DIA. PERFORATED PIP£
LAID LEVEL V~I HOLES
DO~i
2' INSULA'flON REQUIREC --
IF LESS THAN 3' OF COVER C0-2
SE~,~R ROCK
FABRIC
UATERIAL
Al PERIMEIER
AND SEED
GRADE
I I
OF ORGANICS
FROU SEPI~C lANK ~ BOT. 9F B.[D
~N. S~ ~ (U~ ~0 BEDS)
10' ~ NOTE: BED ~Cll~ ROIAIED gO' F~ ~ITY
~QU~D ~AT[R IS PRE.NE ~HIN ~' ~ ~HE ~ ~ -
L~AIED. C~E ~LL NEED ~0 BE PRO~D[D
~tl, ~ND LEaL ~ERE lHE BEDS R~LL NEED TO -- '
~ ~ OF ~1 I~. UAiNT~N ~E PRIER 4' ~E~CE. --UOA S~D FILTER
~ ~. .......... ~ ~ UAX. PAS~NO l~ S,~
~ ~ .~.' .-"...
~...;..~ ;~...~.~.....~..).... ~
~ ~_. SEPTIC SYSTEM SECTION DESIGN
NEW 1.000 GALLON SEPTIC
TANK IF
/-DIVERT£R
TO LEACH FIELDS
10'+
VALVE
SEPTii SYSTEM SECTION DESIGN
NTS
I I
~,;......----~;-......?~ ,~
SYSTEM
ELEVATION
SECTION
~ ......... ~ ~ N~S
PERfORMeD FOR
M~lcipalily o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" St/eel. :chorage. Alaska cJ9502.0~50
SOILS LOG PERCOLATION 'rEST
LEGAL DESCRIPTION ~X' ,~Z///..,x- Township. Range. Sechon
I
3
4
5
6
7.
0-
~8
2o
WAS GROUND WATER
ENCOUNTERED)
IF 'YES. AT wHAT
OEPTH~
TEST IqUN e£TW£SN ~///;t, FT ),NO '~ I: T
Mueicipalily ol Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Streel. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
9
10
II
13
14
15
16,
t8-
19-
20
OAT£ PERFORMEO
Township. Range. Seclion
SLOPE
WAS GROUNO WATER
ENCOUNTEREO~
IF YES, AT WHAT
oEPTH~
IA
COMMENI$ ~
Mm'ticipalil¥ o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
82.5 "L' Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMEO.
SLOPE SITE
I
2
3
4
5
6-
7-
8
9
tO
II
WAS GROUND WATER
ENCOUNTEREO) _ --
If YES, AT WHAT
DEPTHt 'E
13
1S
16-
17
18
19,
~ ' ~ _ ~ ~.. ~ _ I -- CiRTIFY THAT THIS TEST WAS pERFORME0 IN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'rAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Well i
DISTANCE TO: '~0
Manufacturer
JLJq. capacity in gallonsI IF HOMEMADE
Manufacturer
Well
DISTANCE TO: J
No. of hnes J Leng~ of each hne
Top of tde to hmsh grade
Length J Width
DISTANCE TO: " /~
/Class .-. ~epth '
DISTANCE TO: Building foundation
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
Absorption area ¢ Dwelling .-
Width ~l~¢
I
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
Inside length
Dwelling
Foundation /~//j/'~' NMea~ial
' t lot Jine
TMOatt:lr: :in: ,e hn ::~//~ Trench width
PHONE ,~/"N EW
~.......0¢//../ ~.~ ? ~ [] UPGRADE
NO. OF BEDROOMS
'I~ERMIT NO,
No. of compartments
-2.
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
inches
Total effective absorption area
inches
Depth .~.. ! ~.~-- PERMIT NO.
Crib depth
Building foundation
/17'
Driller
Sewer line
Total effective absorption area /,.~-~c;~ZZ;~ ¢
Nearest lot line
/O +
Distance to lot line PERMIT NO,
Septic tank Absorption area(si
OTHER
REMARKS
by
DOC Co. clDa
SULLIVAN WATER WELLS
P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started
PERMIT NUMBER
Ended
DEPTH OF WELL '
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR '
KIND OF CASING
KIND OF FORMATION:
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.
From__Ft. to__
From Ft. to .' Ft.
From Ft. to
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
From__Ft. to Ft.
From__Ft. to___Ft
From__Ft. to___Ft
From__Ft. to
From Ft. to
From Ft't°~lt{6~'~ ~C3.
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 Et,
From~Ft. to
MISCL. INFORMATION:
DRILLER'S NAME
MUNICIPALITY 0F ANCHORAG~
Departmen, of Health and Environment Protection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * *
Permit ~t WEI L AND/OR ON-SITE SEWER PE~JT .
/~' ~' ~ .. , ~ ~
Location: Phone Nu~er:
Legal Description: ~ g3/ ...... ~ __7l Lot Size:
Type of Soil ~sorption System Is:
Trench: Drainfield: Seepage Bed: ~ ..... Holdin9 Tank:
Maximum Number of Bedrooms: Soil Rating (sq. ft/br)
The Required Size of the Soil Absorption ,.System
DEPTH 3 LENGTH ~'~ GRAVEL DEPTH ~ WIDTH O'~'-~'~ /
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE TM /~)~F] GALLONS ~''' *
ermit applicant has the responsibility to inform this department durJ. ng the
nstallation J.nspections of any wells adjacent to this property and the number
f residences that the well will ser~e.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
ackfilling of any syshem without final inspection and approval by this departme~
ill be subject-to prosecution.
inimum distance between a well and any on-site sewage disposal system is 100 fe(
or a private well or 150 ho 200 feet from a public well depending upon the type
f public well. Minimum distance from a private well to a private sewer line
s 25 feet and to a commlunity sewer line is 75 feet. Well logs are required
nd must be returned to this department within 30 days of the well completion.
ther requirements may apply. Specifications and construction diagrams are
vailable to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8~* * *
I certify that:
l) I am .f~iliar wi. th the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
2) I wil~stall t~e system in accordance with codes.
3) I~d~rst~nd tha5 the on-site sewer system ma~equire enlargement if
' ~e reese's remodeled to include mo%.~~3~ ~rooms.
~1 icant ,~ , ~ ~,
Date: ~--' /~ --'~/~
SWP/024(1/8].)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
y PERCO~^T'O?'l°~
-t,~sfi .j. 1985'
RECEIVED
¢',,/: ::. ::
-/
SLOPE SITE PLAN
ENCOUNTERED?
IF YES, AT WHAT
,/'t°l''rDE'm-'?
COMMENTS
PERFORMED BY:____
Reading
Date
,,
Gross
Time
72-008 (6/79)
//: z.:/t
Net
Time
Depth to
Water
//
/3
13
PERCOLATION RATE: ., (minutes/inch)
TEST RUN BETWEEN --,~ FT AND ~ PT
Net
Drop
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
"" Expiration Date:
1. G~NE~L INFORMATION
Current P~-~perty ov~r(s)
' Mailingaddr~ss
Lending agency
Day phone
Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
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 ~E]
community On-site
[] Public Sewer []
The Municipality of Anchorage Deve!opment 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 AJaska. 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 Municipality of Anchorage is not responsible for errors or omissions in the professicnal
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-sita 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
wastawater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Phone
Name of Firm D~'~'? [,~ 7~. J~,,')
Address ~:~ :. ~/~. ~/~. ~
Engineers Printed Name D~,<~/~.- ~ ~/~. Date
_ ·
~ Approved for ~ bedrooms, t;u~.. ..
Disapproved.
Conditional approval for ~ bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date:
(Rev. 12,'00)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastawater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorago, AK 99519-6650
www.ci.anchorage.ak.us
(~07) 343-?g04
HEALTH AUTHORITY APPROVAL CHECKLIST
A, WELL DATA
Date ~ompleted ~/~'
Total depth /,-~'-,~ It.
If A, B, or C provide PWSID #
Sanitary seal ~) y
Cased to xf,~ f, ft.
FROM WELL LOG
Date of test
Static water level ,/~'
Wall production
fro
g.p.m.
Well Log (Y/N) ?
Wires properly protected (Y/N) ~
Casing height (above ground) ._,s~.~.__ln.
AT INSPECTION
/$~, ~' ft.
~' ~ g.p.m.
WATER SAMPLE RESULTS:
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank$ize /~Oqo gal.
Foundation cteanout (Y/N) /V
Date of pumping ,~/,~
C. ABSORPTION FIELD DATA
/. tf
Nitrate /-~' mgJI. Other bacteria __
/
~' colonies/100 mi.
Number of Compartments ~--
Depression over tank (Y/N) ,
Pumper A~'~
Date Installed
cleanouts (y/N)
High water alarm (Y/N) _ ~.,/~
Date installed /~,,~/,~/ Soil rating ~r ~/txlrm) c~.
Length ~'~'3~- ft. ~" Width ,/5" ft.
Total depth ,~-/- ft. Eft. absorption area //,,7~'~ Monitoring tube .
Date of adequacy test ~ Results (Pass/Fall)
Fluid depth in absorption field before test ~ in. Water added ~ gal.
Elapsed Time: ~ min. Final fluid depth ~ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (YiN & type)
System type ,,'~t~'~'~/
Gravel below pipe - -,~- ft.
y Depression over field .4/
For ,.Z, bedrooms
New depth '~' in.
~ g.p.d.
If yes, give date ~ -
D. UFT STATION
Date installed Size in gallons ManholeJAccess (Y/N)
'Pump on' level at~. in.
D~~ Cyolee tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/tiff station on let
Absorption field on lot
Public sewer main
Sewer/septic sewlce line
On adjacent lots
On adia~nt lots
Public sewer manhole/cieanout
Holding tank ////~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ,f/'~' Prope~y line ~'~
Wells on adjacent lots /~'~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line , ~' v Building foundation
Water Service line ,~o-,,' ' Surface water
Curtain drain ~,~ ~·'~ 7- Wells on adjacent lots
Absorption field
Sudace water
Water main ~,'a,,~ ,,' /
Driveway, paddng/vehicie storage
F. COMMENTS
HAA Fee $
Date of Payment
Receipt .umber
(Rev. 1~)
Waiver Fee $
Date of Paymeni
Receipt Number
OCToZZ-OI 07:55 FI~T&E ENVII~NI,(NTAL $91/ 9075015301 T-OZ7 P.OZ/03 F-O00
CT&E Environmental Services Inc.
Laboratory Division
200 W, Potter Drive
Anchorage. AK 90518
Tel: (907) 562-2343
Fax: (907) 561-5301
CT&E Ref. #; 1017387801
Clienl Name: Dougtas T. Ken[ey
Project Name:
Client Sample ID: Lot 1 Block 3 Fox H~II
Matrix: Drinking Water
PWSID n/a
Client PO~: n/a
Printed Date/Time: 10/22/01 07:45
Collected Date/Time: 10/19~01 11:30
Received Date/Time: 1~/19/01 12;20
Technical Director: Stephen Ede
Released By:~
sample Rereads:
Parameter Results
Total Coliform (MF) 0
Nitrate 1.99
Allowable Prep Analysis
PQL Urals Method Limits Date Date Init
col/lDO mi SM9222B 10/19~1 KAP
0.5 mg/L EPA 300 1o.n 10/19~01 SCL
.~tr~ CT&E EnvironmentalServiceslnc.
CT&E Ref.# 1015507001
Client Name Douglas Kenley P.E.
Project Name/# LI, B3 Foxhill S/D
Client Sample ID L1, B3 Foxhill S/D
Matrix Drinking Water
Ordered By
PWSID 0
Sample Remarks:
Corrected Report: Client ID
Client PO//
Printed Date/Time 08/28/'2001 8:44
Collected Date/Time 08/20/"2001 21:30
Received Date/lime 08/21/2001 I1:10
Technical Director Stephen C. ;'de
Released By~ ~
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Inlt
Nitrate-N I.:84 0.500 mg/L EPA 300.0 (<10)
08/21/01 SCL
Microbiology Laboratory
Total Coliform 7 OB, No Coli
coFI00mL SMI89222B (<1)
08/21/01 SKW
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
1. GENERAL INFORMATION
Complete legal description
Lot I; Block 3; Fozhill Subd,~vision
Location (site address or directions)
2~3, Woodc,.~t~/~ Court
Chugiak, AK
Property owner
Mailing address
Lending agency
Mailing address,
Ronald & Donna Gilson
22339 ~l~ood~L~ Court
Day phone
Chuqiak~ AK 99567
Day phone
688-5120
Agent Les Bailey/ Vista Real EstAte
AddreSs 16635 Center~ie~d Drive. Eal~le Rive%
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well X×X
Community well
Public water
Day phone
AK 99567
689-6464
MUNICIPALITY OF ANCHORAGe;
ENVIRONMENTAL ~£RVIcE$ DIVISION
06' 1996
RECEIVED
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XXX
NOTE: 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
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shews that the on-site water supply
and/or wastewater disposal system is safe, functional and ~dequate 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.
S & S EHGJNEERING '-~'~
/ Phone . ~ ~/-'~-¢,~'7 ~
17034 Eagle River-~.oop Road,No. 204
Name of Firm
Address
Engineer's signature
/ /
Date -> //Z/./4~ ~
,/ //
DHHS SIGNATURE
~- Approved for '~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does th is 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.
72-025 (Re~. 1/91) Beck MOA ~'21
Legal Description:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN 8ERV
Environmental Se~ices Division
825"L" Street, Room 502 · Anchorage, Alaska 99501e (907)
Health Authority Approval Checklist
A. WELL DATA
Well type
Log present ~N) _
Total depth ]5"~2
Sanitary seal
Date of test
Static water level
Well production ,2 ~ 0
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: 02 - g. ~ - ~ G
B. SEPTIC/HOLDING TANK DATA
Date installed ~ ~ I I - 5 4 Tank size
Foundation cleanout ~N) ~
Date of Pumping _',)' ,3. 7 - ~ ~,
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed '4" ~ ~
Cased to ]6ol, ' Casing height (above ground)
/ Wires properly protected C~;N)
FROM WELL LOG AT INSPECTION
g.p.m. ~ 6, -3 g.p.m.
Nitrate /~ ~ a9 Other bacteria 0
Collected by: S g. S ENGINEERING
I YD34 Eagle River Loop Road No. 204
Znglo River, Ala.,ika 99577
\~ t~ o Number of Compartments 7-- Clcanouts ~N)_,,//
Depression (Y~: J High water aim',n (Y~) 3IA
Pumper ~- ~O M/z~
ABSORPTION FIELD DATA
Dateiustalled "/'ll-fi4 Soilrating (g.p.d./ft2orfl2/bdrTM) ,.~b/'~ ~/~SYstemtype ;g6b
Length ~ ~ Width ~ t Gravel thickness below pipe 0,~ ' Total depth ~ t~
Effective absorption area /~ 0 '~ MonitOring Tube present~) ~ Depression over field (Y~ ~
Date of adequacy test ~ ~ 7 ~ ~ Results~Fail) fl~5 For ~ bedrooms
Fhfid depth in absorption field before test (in.); d Immediately after~ gal. water added (in.): D
Fhfid depth ~- (ins.) Minutes later: ~ Abso~tion rate = g.p.d.
Peroxide treatment (past 12 months) (Y~ ~o~& f~ If yes, give date ~
D. LIFT STATION
Date instaltcd
Maubote/Access (Y/N)
High water alarm level at*
Size itl gallous
"Pump o11" level tit*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank Oil lot /
Absorption field ou lot
Public sewer main
Server/septic service line
: On adjacent lots
: On adjacent lots
Public sewer manhole/clcanout
Lifi statiou
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water inain/service line
· Property, line :Vo ~4' Absorption field
Surface water/drainage I o~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building £oundation //7 '
Surface water
Curtain drain
Water m,%ffservice line /o ! d
Driveway, parking/vehicle storage area ,2 3-'
Wells on adjacent lots /0 0 t ~ Property line
/o /4-
F. ENGINEER'S CERTIFICATION'~-')
En ineer's ~~aflloRwer Loop Road,o.~ ,- /~ . ~ ~~ :
g ~ ~,~ ........ / //'.Ej~gin~fing Seal.Her~/
............................................................................................................ ; ;~a. _d:_k~ia;~r.~fi~ ..........
~ ~ Waiver Fees
HAA Fee $
Date of Payment
Receipt Nmnber
Date of Pay~nent
Receipt Nuinber
Rev. 8/95 OSS: haa.wk.doc
zTL
CT&Ii Ref.#
Client Sampl~ ID
Matri~
CT&E Environmental Services Inc.
Laboratory Division
Laboratory Analysis Report
Collected Date02/26/96
96064'/.4079
L1 B3 FOXHILL $/D 10647-01
Drinking Water Teclmicd Director
R~lea~ed By ~.~'
/
Sample Rem,'trks:
iqitr~te.N
1,98 ,1 mg/l
Attouabte Prep Analysis
Limits Date 0ate Init
200 W. Potter Drive, Anchorage, AK 99518.1 60_5 -- Tel: (907) 562.2343 FOx: (907) 561-5301
ENVIRONMENTAL FACIL1TIE~ IN ALASKA, CALIFORNIA, FLORIDA, ILklNOI$, MAF1YLANO, MICHIGAN, MISSOURI, N£W JERSEY, OHIO, WE$T VIFIG~NIA
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 _
GENERAL INFORk'iATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name -:7.*('~1-~'z_-)4:~f~/--'~,4',¢.~ Telephone: Home
Applicant Address --~-~]1 .(~JJ~z.,'_(~_L~-'_,/A'?.~¥}_z,,.-) "- -.~
(c) Applicant is (check one): Lending Institution []; Owner/builder,~4. Buyer []; Other F_.3 (explain); .....
(d) L.ending Institution ...... ~,) ¢ /~'J /A~
Address
_ Telephone
(o) Real Estate Company and Agent
Address
Telephone
(f) ;,Me~'- Yt~e HAA to the following address:
TYPE OF RESIDENCE
Single-Family,.~ Multi-Family L--"]
Number of Bedrooms __"~ _.
Other
WATER SUPPLY
Individual Well ¢J Community [] Public
Note: If community well system, must have written confirmation from the State Department of Envirom'nental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
· Onsiteg':Zl' Public ('~ Community [Lq Holding Tank
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
ENGINEERING FIR[VI PROVIDING INSPECTIONS, TESTS, FILE SEAFICId, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verily that my ~nvestKjation of th~s
Authority Approval shows that the on-site water supply and/or wastewater disposal system is sale, functional and adc~u~e
for the number of bedrooms and type of structure indicated herein. I fudher verify that based on the information ob!aCr~e¢
from tlqe Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect
the date of this inspection.
Name of Firm . ~_, . .,~.~,
Address .~.= ; ~ -,* · .¢ ~*:
Date
Telephone
Approved for Jff~"~ ~'" b~dC.-~.~ms~y
Approved _____:"- _..- Disap::_
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health
Approval certificates based solely upon the representations given in paragraph 5 above by an independent
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of bomes and their
institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspeclio~s 6~r
analyze data before a certificate is issued. 'rite Municipality of Anchorage is not responsible for errors or omissions ir~
professional engineer's work.
Page 2 of 2
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: L~c:...f-
Well Classification
Well Log Present~xl)
Total Depth I ~;-:~ ~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit Y~)
Separation Distances from Well:
To Septic/24et~if~g Tank on Lot
Cased to '~C)~ '~'
If A, B, c,p.E.C. Approved (Y/N)
Date Completed _ ,4-/~¢f¢j'~ Yield
Depth of Grouting
Pump Set At [.), ~
Sanitary Seal on Casing~N)
Depression Around Wellhead
Ioo '-/'
To Nearest Edge of Absorption Field on Lot /,.5~O /,j.
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots
; On Adjoining Lots __/~-'~
/.5/~ To Nearest Public Sewer
~/~ To Nearest Sewer Service Line on Lot /O /'~
B. SEPTIC/~ TANK DATA
Date Installed
Standpipest~N)
Depression over Tank (Y~J~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High--Water Alarm (Y/N)
Separation Distances from Septic/~g Tank:
To Water-Supply Well ~ ¢::~¢.~
To Property Line \,(~
To Water Main/Service Line ~ ~) 1'4-
Course
Size !~r~) No. of Compadments
Air-tight Caps(~N) Foundation Cleanout ¢'~JN)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed "~- ! ~ -- '~,/--~
Width of Field
Square Feet of Absorption Area ~'~-t~6~
Depression over Field (Y/~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ ,~ ~ '~
To Building Foundation ~ ~. ~'~ I
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field "~
Gravel Bed Thickness
Standpipes Present ~)'N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Comments
D. 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
Compa.my,~*ILF. ~IVEF~, A[.ASt(A
Receipt No.
Date of Payment
. Amount: $
** 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.
Page 2 of 2
72-026 (11/84)