HomeMy WebLinkAboutJENKINS LT 2Jenkins
Lot 2
#015-281-73
tKev uo/uzn u/
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP201093
PID Number: 015-281-73
Dwelling: ffil Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New R Upgrade
Name
Boyd & Sandra Cummings
ABSORPTION FIELD
❑ Deep Trench El Wide Trench ❑Bed El Mound
Site Address
4050 E Klatt Rd
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision
Block Lot
Jenkins
2
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
( Field
Lift Station
! Tank
Line
Ftz
Ft.
Well
100'+
25'+
TANK ❑ Septic Fm� S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1500 Gal.
Surface Water
100'+
Material
Number of compartments
Lot Line
51+
I
NA
HDPE
2
Foundation
10'+
(
LIFT STATION
Manufacturer
Capacity
I
Remarks
Orenco
250 Gal.
Alarm location
Garage
Electrical installed by
Capstone
PIPE MATERIAL House to tank Tank to 3034
Installer
drainfield
A+ Home Services
Drainfield CO/MT3034
inspector Pannone Engineering
BENCH MARK (Assumed elevation) ~400 it
Inspdection v, 6/1/2020
6/1/2020
Location and description
3rd 8/13/2020
2nd
4th
Back Door Threshold
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
0.
Conditional Approval:
Date
�
�co. -
9
.. TH ........�
Leven R.
CE a;ag
Septic System��.
Approved 1,,QU (I/�
C� ( Date
Note: this approval does not include well permit requirements.'���'��`
tKev uo/uzn u/
Municipality
~ �,�u^ °�� Anchorage
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On -Site Water and Wastewater Program
PD.Box 19055U 470OElmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
Review Comments
Engineer: PANNONEENGINEERING SERVICES
Legal Description: EPLANSJENK|NSLT 2
Parcel ID: 01528173000
Permit: OSP201093 SeptioTank
Report Type: As Built Review
2/Q/202i
Completed By: R.Carroll
The application has been reviewed and the following comments have been generated. These are to be satisfactorily
addressed prior to MOA approval:
1.Please provide acurrent as -built survey.
2.{}nthe inspection report, tank type ieselected asseptic. Elsewhere itioidentified aaoSTEP. Please address.
3. Please confirm the controls for the lift station provide time dosing (required as a condition of approval for the IDSF
field).
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PANNONE
ENG SVCLLC C.I. 1088)
P.O. BOX 1807 PALER, AK 9645
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REVISIONS
DATE
11/17/2020
RECORD DRAWING
PHONE (907) 745-8200 FAX 907 745-8201
SCALE
JENKINS L2
BOYD & SANDRA CUMMINGS-
4050E KLATT ROAD
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MUNICIPALITY OFA CHO GE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
Permit Number: OSP201093
Work Type: SepticTank Upgrade
Tax Code Number: 01528173000
Site Legal Address: JENKINS LT 2 G:2735
Site Mailing Address: 4050 E KLATT RD, Anchorage
Owner: CUMMINGS BOYD J & SANDRA C
Design Engineer: PANNONE ENGINEERING SERVICES
Effective Date:
LIEL233MEM
5/6/2020
MA10041-VAi
49512
13 Disposal Field 0 Septic Tank El Holding Tank El Privy F1 Private Well El Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: One of the existing drainfields is an IDSF, designed and approved with timed dosing from
the lift station. The controls for the new STEP tank shall provide timed dosing.
Received By: Date:
77
Issued By: Date: 511'1�6'90
/ I
EI
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201093, Rebecca Carroll, 05/06/20
,, Municipality of Anchorage Page I 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
Permit Number: ~;' u,J c~'7 0~ PID Number: O I~' ~ ~ ~ / '-~
Name: ~ ~ ~. ~~ ~~ Wastewater System: D New ~Upgrade
Address: ~*~ ~~ ABSORPTION FIELD
Phone: ~ -- '~O~ ~ ~No. o~drooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION ~oi,.~,i.~: '~ GPD/Sq. Ft. ~' [
Block: Subdiv~ion: Depth to pipe bosom from original grade: Gravel depth beneath pipe
Township: Ran Se Fill added abo~e original grade~ Gravel length:
~ ~ New ~ Upgr~~:Gravelwidth: '~ ,+ INumb~flines: Distance between lines:
Classification (Pri~: ~ Cased To: Total absorption area: Pipe material:
Driller: ~ Date Driged=% Static Water Level:Ft.,Installer=~¢ ~' '~0""~* ' , Dateinsta ~d =1 *~
y~ Pump Set at: C~Ab~e Ground:
SEPARATION DISTANCES u Septic ~E.P.
From Tank Field Station Tank Sewer Lines
WelP 't) ~O'~ /~O/~ CA /0¢(~ Ma~ Number of Compa~ments: ~
Water ¢ LIFT STATION
Lot ~ ~,~ 4~~ ~(~ Size in gallons: Manufacturer:
Line ~ ~ ~' ~
' ~ "Pump on" level at: "Pump off" level at: High water alarm at:
Foundation ~ ~'+ ~ T~ T{~ ~"
Cu~ainDrain ~[~ ~ ~ ~ ~~ Pump~oMake & Model Electrical Inspections~. ~'Ped°rmed by:
Remarks: ~ ~c~ '~ BENCH MARK
~ ~ ~ ~V~ D~ Locatfon and Description: "~P ~ ~
~.speotio.spedormedby' ~ ~uu~S ~' Dates'lst ~i ¢ ~:, , ~,
Department of Hea~ an~ ~uman ~e~ices approval ~.~, .~ ........ ,~:.
· ~, ~ ,,~- .~..~:,.
Reviewed and approved by: d~ Date: /2 -2 -¢7 ~' ...... :
72-013 (Rev. 9/91) MOA 25
NE~ 1,~5 INCH PVC~ ~AST TH MT
A TO 81 : 23 '
B TO S1 = 17.5 PID ~. 015-281-73
A TO ~2 : 29.7 S~970358
B TO ~2 = 25.3
A TD CO1 : 35,3
B TD CO1 = 39,5
A TO MH : 36.7
B TO MH = 40,6
A TO MT1 =
~ TO MT1 = 56.0
A TO MT2 = 68.5
~ TO MT2 : 73,5
A TO MT3 = 45,0
~ TO MT3 = 60.5
A TO MT4 = 63.0
B TO MT4:77.7
THE AIR LINE IS A 3/8 INCH I,D. AIR HOSE. INSULATED
WITH 1/8 INCH FOAM PIPE WRAP (R3 VALUE)
INSIDE A 2 INCH ~CH, 40 PVC JACKET. -
THE LI~E I~ BURIED TO A ~INIWU~ DEPTH OF 3 FEET,
........ .
A~-~UILT OF ~EPTIC UPGRADE, LOT ~ OE~I~S S/D ~f3.:..[~ ..............
"..
PREPARED BY' ALASKA ~ATER
· -~~ ~ 18' x BO' BFITTDMLESS ISF
ND LINER DN BOTTOM,
NT1 /-AIR LINE
/ 8 TOTAL 3/4 INCH PVC
/ /-LATERALS ~/ITH 1/8 INCH
1.25 iNCH PVC__ ~, / /HOLES PER DRENCD DESIGN
HEADER, -~
LINE FRBM THE
, i ~ i ~FLU HING VALVE
, , , t ~~= q7n Apppny
~MTB ~ ~10' APPRDX,,
ORIGINAL GRADE VARIED FROM
96,7 FEET TD 97,3 ~ 6 ~ LAYER DF 3/~" PEA GRAVEL
/ ~ITH THE PVC LATERALS BURIED
FINAL GRADE = 98,B~ / MID~AY IN THE STRATUM,
COVER ~,8+~ //
/ /
~- / / ~ AIR LINE INSTALLED
x
< ~ ~8~ BELD~ THE TDP
~ DF SAND,
~ DEPTH DF SAND BELD~ THE AIR LINE VARIES
~FRDM 1.4 FEET TD B,3 FEET. THE AVERAGE
TOP DF SAND = 95,00 ~DEPTH DF THE SAND BELD~ THE AIR LINE
INVERT DF DRAINPIPE = 95,~9 APPROXIMATELY 1,7 FEET, THE AIR LINE IS AT
BOTTOM DF EXCAVATION VARIED ELEVATION = 93,4 APPRDX,
FROM 91,~ TD 9B,1,
DATE: 11/16/97
P~RNIT~ SW970358
P~LD.# 015-2B1-73
AS-BUILT DRAWING
GROUND OVER LIFT STATION
IS 96.8 FEET, MIN. COVER =
DF TANK = 91,8
GALLON
LIFT STA, DIA. PVC FROM
INLET INV. EXISTING 1250 GALLON SEPTIC TANK
=91,3
LIT STATION SET LEVEL
DUAL 1.25 INCH PRESSURE LINES, ONE GOES TO OLD
BED AND THE OTHER GOES TO THE NEW BOTTOMLESS
ISF. FLOW CAN BE DIVERTED BY S~/ITCHING VALVES
IN THE LIFT STATION,
SEPTIC AS-3UILT' LOT 8~ JENKINS S/D
PREPARED FOR: PHIL AND }~RENDA LARSON
ALASKA ~/ATER & /dASTE~/ATER
DATE: 11/17/97 D~/N, GARNESS
ISCALE~
NTS
- H'~'~"O-~'-~a_,a? TO~ lt:~S~ CZ~' -- CHUGt~C o~c~ ,~-~sset~,~e ~.
""
IN8PE~H= VO~E
LOT .
[~]GO NON¢OMPi. iANGIe OBSERVED
ORRF. CTION,S £~.~ENTIAI, A~ EXPLAINED BELOW
[ ] tNILL F~-~,A~E AT NEXT IN~PEGTION [ 1 DO NOT GONGEAL UN'rIL REIN~PECT~D
COMMENTS: (FOR IN,~PEC"TOR USE ONLY)
INSPEGTOR
rd~r k HCr~ser~, P.E. 90T
0 7587, P.~MER,~S~& 99645 (90~) 74~t7~1
FAX (907) 746.-472~
Qqality Sand and Gravel
P,O: Box 1466
PalPer, AK 99645
Subject: Sieve Analysis of Aggregates
Ge~ltleme~:
Tho following is the sieve analysis of th~,~ aggregate sampled 9/25/97:
Sample Identification: South of wash plant
Sieve Percent Passing
Spec.
Special sand
3/8" . 100 100
#4 100 7O- lOC
~'~8 61 0; 35
¢30 7 0 - 5
#50 3
#100 1
#200 0.6 0 ~ 1
Fil~eness Modulus 4.07'
If you'have any questions, please do ncr hesitate to call.
Sincerely,,~/
Mark Hansen
P.O~
Sept.. 25, 1997
Project 9717
PAGE 1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMiLN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
i~NCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970358
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NAME:LARSEN PHILLIP R JR & BRENDA C
OWNER ADDRESS:4050 KLATT RD
ANCHORAGE, ALASKA 99516
DATE ISSUED:10/08/97
EXPIRATION DATE:10/08/98
PARCEL ID:01528173
LEGAL DESCRIPTION:
JENKINS LT 2
LOT SIZE: 49512 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18A3~C72} 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 SANE DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
ISSUED BY: ~
8471 Brookridge Drive ~ Anchorage ~ Alaska 99804
(907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
October 1, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Sewer Upgrade for Lot 2, Jenkins S/D
To whom it may concern:
The existing 4 bedroom house is served by a private onsite septic system and well. The drainfield
will not pass an adequacy test (surcharged) at this time, and must be upgraded prior to the sale of
the house. Comments regarding the proposed upgrade are summarized as follows:
1. SOH,S: Two soils tests were done, one to the west of the bed, and the other to the east of the
bed. Copies of the soils logs are attached. The test hole to the west had unsuitable soils. Two
perk tests were done in the east test hole, and the percolation rates varied from 53-60 minutes per
inch. In short, the soils are marginal. No standing water was encountered after monitoring.
Rather than install an extremely large bed, or trench system, we are proposing to install a
bottomless Intermittent Sand Filter (ISF). The specifics of the design are summarized as follows:
2. TRENCH DESIGN: Bottomless Intermittent Sand Filter (ISF)
a. Percolation Rate: 53-60 minutes/inch
b. Allowable Application Rate for BSF: 2 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 300 ft2
f. Effective Depth: .5 feet of pea gravel with piping at mid point of stratum
g. Width: 18 feet
h. Length: 20 feet.
i. Effective absorption area = 360 ft2 (>300 ft2 OK)
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: Central Paving Products "Winter Road Sand", or approved equal
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 maximum depth of 4 feet, place 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.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system. ~ccto
4. TOPOGRAP}tY: The lot is gently sloping, downhill from east to west at less than °/~ and
from north to south at less than 5%. In short, there are no slope concems.
5. ALTERNATOR VALVE: The lift station shall be furnished with two outlets, and a valve
configuration, so that flow can be diverted periodically to the old bed system, allowing the ISF
time to completely recover. This should make the proposed design fairy conservative.
6. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the
construction practices will comply with DHHS' "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 (Sth floor, 9th & L St.).
7. CLOSING: Given the marginal soil conditions, I think the ISF is the most viable option for
this lot. 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 (there are none within 200 feet) or septic systems. If you have any questions,
please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your
assistance. ~
Sincer~~M
LilT 1~ JENKINS S/II
LUTH~AN CHURCH,
NE~ 3DTTDMLEgS IS
THE LAND TO THE SOUTH OF JENKINS S/D
IS UNDEVELOPE~,
SEPTIC SYSTEM UPGRADE~ LOT 2, JENKINS S/D ' , .
......... · ~ ....
.............
PREPARED FDR~ PHIL AND BRENDA JOHNSON k
PREPARED BY~ ALASKA ~ATER & ~ASTE~ATER SERVICES uh~ '-, .,' -~
DATE: 10/1/97 DRAWN: GARNESS SCALE~ 1' = 100'
'~1 RADIUS
~ _ ] \ AIR CONPRESS TO lIE INSTALLED
~ / --IN THE GARAGE, VIA THE CRAWL
! ~ / SPACE, PROVIDE PRESSURE
NEW ~OUBLE C/% / / ~ GAUGE (O-lO PSI).
j ~ EXISTING C/~ ~ ~/ ~XI~TIN6 1850 GALLON ~EPTIC TANK
~ % / -~/ NE~ 500 GALLON LIFT STATION WITH
NE~ 1~5 INCH PVCJ
NE~ ~BTTBWLESS IFS,~
NOTE: THE LIFT STATION SHALL BE EQUIPPED WITH DUAL OUTLETS,
AND PLUM~ED SO THAT FLOW CAN BE MANUALLY ALTERNATED BETWEEN
THE NEW I~F, AN~ THE BL~ ~ED SYSTEM. THE ALARM PANEL SHALL
BE IN THE GARAGE.
TEST HOLE IN THIS GENERAL
AREA TURNED UP UNSUITABLE SOILS.
NOTE~ THE AIR COMPRESSOR ~HALL ~E A THOMAS INDU~TIRE~, MODEL 5070, ~2 ~UPPLIED
BY ANCHORAGE TANK, THE AIR LINE ~HALL BE 1/8 INCH DIA. ~CH. 4Q PVC, INSULATED
WITH 1/8 INCH FDAW PIPE WRAP (RS VALUE), INSIDE A 8 INCH 2CH, 40 PVC JACKET.
THE LINE SHALL BE BUBIED TO A MINI~UH DEPTH DF 3 FEET.
SEPTIC SYSTEM UPGRADE, LOT 8, JENKINS S/~ t "
PREPARED BY: ALASKA WATER & WASTEWATER 0~. '".. ' .-".x¢~
, · ............
DATE~ 10/1/97 DRAWN~ GARNES~ SCALE~ l' = 30' -~,es., ~
'. v----- 18' x EO' BOTTOMLESS
NO LINER ON BOTTOM,
1,25 INCH PVC NOTE~ DIMENSION~ OF ISF
MAY BE CHANGED TO
HEADER,
PVC AIR LINE TO ~ ' ~ ~ ~ ~
TO ~ I i ~ ~ ~ ~ ~ ~ 9Y ORENCO & ANCHORAGE
~~ ~--FLUgHING VALVE
AIR
LINE
COIL
SPACED AT APPPROX ~ ~ ~ ~ ~ ~ ~ ~ ~ / (TYP), INSTALL
B FEET, ORENCO /' ~ f ~ ~ ~, ~ ~ ~ ~ PER THE ~ORENCB'
'WASTEFLOW' TYPE ~/ .~ ~ ~ ~ ~ ~ ~ ~ ~ ~ DETAILS
ANCHORAGE TANK, ~ ~X' ;'~ ~ ~ '/ ,
~ ~BE PER ORENCO DESIGN, AND SUPPLIED
4 INCH DIA, MONITORING
BY
ANCHORAGE
TANK,
TUBE AT EACH CORNER-~
SLOTTED 4' SOLID PIPE
PROVIDE 2~ OF RIGID INSULATION
AIR LINE SHALL BE
6 ' LAYER DF 3/8' PEA F SAND SHALL
~ITH THE PVC LATERALS S '~INTER RDA~
NID~AY IN THE STRATUM. SAND', DR APPROVED EQUAL,
OTTONLESS INTERMITTENT SAND FILTER DETAIL
SEPTIC SYSTEM UPGRADE : LOT B, JENKINS S/D
PREPARED BY~ ALASKA ~ATER & ~ASTE~ATER
DATE: 10/1/97 DRAWN: GARNESg SCALE~ NTS
Municipality of Anchorage ~.'~..' ~ ..'~ ~'~
825 "L*' Street. Anchorage, Alaska 99502-0650 ,~/,/rjr//~z~. '~J~/~! ~._
SOLES LOG -- PERCOLATION TEST /~'~en~n,,~.e . ~
' z~w~ ~-~'. V , ~
LEGALDE~cmPTION: ~,0' ~ / ~,~S S/p Township, Range, Section:
7
8
9
10
11
12
13
14
15
16
17
COMMENTS
¥
PERFORMED
ACCORDANCE
72:0o8~ (~v.::~85)
SLOPE
SITE PLAN
I
~F*ES,^*WHAT (? ¢~' O
DEPTH? p.
E
Ooplht°WalerAlter'~zY Bal,' 0~/~1~
Monitoring? , ~
'~ Gross Net Depth ~ O~' Net
~, Reading Date Time Time Water Drop
~,o- %5' : ~ ~ 5I/~''
~,, ~__...~,.,/~,~..~.t4 PERCOLATION RATE /o0 ~ .~ [minutes/inch) PERC HOLE DIAMETER
r-.4~' TESTRUNBETWEEN'~C'~-~'.._~__~.~ FTAND ~{~ FT/ ~
t~ ~ W ~ I/ ~" V~~CERTIFY THAT THIS,EST WAS PERFORMED ,.
ALL STATEANDMUNIOIPALGUIDELINE~ ;EFFECT ONTHISDATE. DATE: ~/**1*~ -
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Township, Range, Section:
SITE PLAN
SLOPE
WAS GROUND WATERJ~J
ENCOUNTERED?
L
IF YES, AT WHAT
O
DEPTH? p,
E
Moniloring? . __
2o
PERGOI ATION IRATE__l°~0'k~r (m~nules/inch) PERG HOLE DIAMETER
TEST RUN BETWEEN "~f"~.l~ FTAND H'~
FT
PERFORMED BY: ~ ~ ' ~ CERTIFY THAt THp TEST WAS pERFoRmED IN
72 008 (Rev 4/85) --
Gross Net Depth Cd' ¢i¢ Net
Reading Date
Time Time Water Drop
.%
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
Permit Number: ,-.'~'(~J ~ Z'-' O~ ~] ~ PID Number: ~ ~ ~'~'~ -~
Name: ~A~ ~ 5~/O~ Wastewater System: ~New ~ Upgrade
Address: ABSORPTION FIELD
Phone:
~-- ~O~ ~No. of Bed~ms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION So, Rating:.. ~ GPD/S% Ft. Total Depth from original gr~e~/z,
Lot: ~ Block: -- Subdivision:~ I~ Depth to pipe bottom from original,grads: Ft. Gravel depth beneath pipe. ~ Ft.
Township: J Range: ~ Section: Fill added above original grade: Gravel length:
I
I
WELL: ~New ~ Upgrade Gravel width: ~ Number ~lines: Distance belween lines:
Ft. ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: -. ,,
DriVer: D2t~ i, ed: StaUc Water Level: Installer: /~/?
Yield: [ Pump Set at: Casing He[ght Above Ground:
SEPARATION DISTANCES ~Septio ~ HoUi.g ~ S.T.E.P.
TO Septic Absorption Lift Ho~ding ~ublic/Private Manufacturer: ~~ Capacityin gallons:
From Tank Field Stalion Tank S .... Lines / ~ ~
Number of Compadments:
Surface
..... LIFT STATION
Water
Lot * ~ Size in gallo~s: Manu[acturer:
Foundation / ~ I ~ ~ I -- -- ~ "Pump bn" level at: "Pump off" level at: I High water alarm at:
Curtain Pump Make & Model ~ Electrical Inspections performed by:
Drain ~ ~ ~ ~ ~
I
Remarks: ~OU~ 'PA5~ ~ ~i~: BENCH MARK
I Assumed Elevation:
ENGLN~tR'S SEAL
Inspections performed by: ~A~ ~~: Dates· 1st~~~/~/~
Department of Health and Human Services approval ~'~ %~ ' ~..~
Reviewed and approved by: ~~ Date:
/
72-013 (Rev. 9/91) MOA 25
· ~ Pern~it No.
~'t,'J ~Z. O0'~ Page Z. of.
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: L~T ~: ~'F>lKIl. l~ 5diSh. PID No.:
72-013 A (2/91) MOA 25
~/ / /
.... , / / ".
, ,
?
/
/
~Pe~'mit No. 5~Jqz'O0~c[ Page :~ of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: ~ ~. ~"~{J~W~, ~ PID NO.:
SEAL
/~ichael E. Ande~son.~
.4381-E
72-O13 A (2/91) MOA 25
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
"PNi k.
DATE PERF(
LO'T' Z, ~"~-~_-~l~h'-~ S Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16-
17
18
19
20
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
0 --
'0'I
IF YES, AT WHAT
DEPTH?
Depth to Waler After.
Moniloring? ""~ d"J Dal~
Reading Date
Gross Net Depth to
Time Time Water
PERCOLATION RATE __
TEST RUN BETWEEN __
FTAND .
Net
Drop
(minutes/inch) PERC HOLE DIAMETER .
FT
CERTIFY THAT THIS TEST WAS PERFORMED'IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72~.x38 (Rev. 4t85}
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920094
DESIGN ENGiNEER:ANDERSON ENGINEERING
OWNER NAME:IVERSON WILLIAM D &
OWNER ADDRESS:4050 KLATT RD
ANCHORAGE, AK 99516 ~J
PARCEL ID:01528173 /~ ~_~_ ~ ~_~ .~./~
LEGAL DESCRIPTION: JENKINS LT 2
SEC 22, T12N, R3W, SM
DATE ISSUED: 5/21/92
EXPIRATION DATE:
LOT SIZE: 49512 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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.
1 OF
5/21/93
SPECIAL PROVISIONS:
DATE:
DATE:
May 17, 1992
Municipality of Anchorage
Dept. of Health & Human Services
Environmental Services Division
825 "L" Street, Room 502
Anchorage, Alaska 99501
Subject:
Lot 2, Jenkins Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer'.
I have reviewed information available on lots adjacent to the subject
property and have conducted an onsite investigation. The terrain of this lot
gently slopes as shown on the attached site plan. Soils encountered in the
testholes located on the lot were fairly consistent and excellent for an
onsite septic system. The water level in the holes was observed between
3-1/2' and 4-1/2' below the surface. This is no doubt the worst time of
year for runoff and water accumulation. Other testholes taken in the area
later in the year indicate no groundwater encountered. A month from now
the water level will be substantially lower or nonexistent. The system,
however, is designed for the worst case.
The system, if constructed as designed, will have no adverse
impacts on the wells currently in use or to be placed in the future
on lots located in the area.
The system, if constructed as designed, will have no adverse
impact on existing septic systems in the area or those to be
constructed in the future.
o
The system, if constructed as designed, will have no adverse
impact on reserved space either surface or subsurface on any lots
located in the area.
The system, if constructed as designed, will have no adverse
impact on drainage patterns in the area.
Sincerely,
Michael E. Anderson, P.E.
SHEET NO...
CALCULATED BY.__
CHECKED BY
SCALE
/.,OT $
No-rd ; /. /Z.S"O ~,4cCo~
JOB
SHEET NO..
CALCULATED BY.
CHECKED BY.
SCALE
OF
DATE
DATE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
ERFORMEO FOR:
EGAL DESCRIPTION:
1
2
3
7
DATE PERFOR
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
Monitoring?
L ,
IF YES, AT WHAT
DEPTH;' ~ O
P
Reading Dete Gross Net Depth to Net
Time Time Water Drop
z ;o~ /~ 7 %" I Y& '
Z~o '~5 ?~" / y~,,
z ~ ~ ~o /~ ~ ,, / y~ ,,
~,oo .~ . ~/~. t ,/~,,
PERCOLATION RATE , //'~ (minutes/inch} PERC HOLE DIAMETER . ~ u
TEST .UN ~TWEEN .~ /Z. ~ A.D _ $ _ ~T
[FORMED BY: ~J~l/~"~['- ~ ~r~'~O ~J I CERTIFY THAT THiS TEST WAS PERFORMED IN
;ORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
08 (Rev. 4/85}
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
ERFORMED FOR:
EGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9.
10
11
DATE'
SITE PLAN
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IFYES, AT WHAT / L
DEPTH? ~ O
P
E
Oep~ lo Waler After , ~
Monitoring? ~'q ~. Oal~ ~
I
I15 ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
~/ s-/~o /z; ~' - ~ y,_ ,, _
z. /~: ,~o /-<' 9 Yz" /"
$ /z ~ ¢$ /-<' ia ~'/,~" / Y,~"
"/ /:,~o I~ //~/~'
·
PERCOLATION RATE / ~
~ (minutes/inch) PERC HOLE DIAMETER _ ~"
TEST RUN BETWEEN ~' ~[-- FT AND _ ~ FT
MMENTS''7~'-'~'ff' ,/''/''~ L.'~''' /""'~,E' $ 0,14'/,f....,~ ~ ~ ~ ~ ~
~ORMED ~Y: ~ ~ Se ~ ~ CEm~V T~A~ ~S ~[S~ WAS PErFOrMED ~
:ORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:
O8 (Rev. 4t~)
RECEIVED
AUG 2 8 1992 STATE OE AU~S~
DEPARTMENT OF NATURAL R~SO~RCc.~
DIVISION OF WA~R
Municipality of Anchorage WATER WELL RECORD
LOCATION OF WE~ Dept. Health & Human Services
~ROUGH ~_~ O~ LOT ~[0~ ~E~ION OT~ ~CTION~
TO~I~ ~GE M~IDIAN
LOCATI~ISK~CH: ~L O~ER:
DEPT~S M~U~ FR~:~ca~ ~op ~ground su~ace W~/L D~: DA?~ OF ~P~lOt~
.... ~ofhole: ~ ~ J ft
BORENO~ DATA: ~pth Depth of ~si~9:~ ~ / ft ~/ ~ / ~ ~
Ma~rlal Type and Colo~ From To
DEPTH TO STATIC WATER L~EL:
[ -' ~ , , ~ ~ 0 ft below ~ top of ~sing ~ gm~d s~dace
CONTRACTOR INFORMATION:
~.,:~ .z..~ ,~.~ .,_ ;' ~/Z. ~ .~L r~
Regmtered I~usmess Name / ~,
'") ' '/ ..,C""
..... . :'-./'. FF.._
METHOD OF DRILL/NG: ~.~ air rotary [] cable.tool
[~ other
USE OF WELL: 'Ii domestic E] irrigation [] modto;
~ public s~p~ ~ o~r
CASING STICE-UP: ~~ft. Diam.: ~p in. t~tt
WELL INTAKE OP~G ~PE: ~ open end ~ screened
~ pedomted ~ open hole
Depths of openings: ~ 1:o ft
SCREEN T%I~ Diam:
Slot/Mesh Siz~ ~ Length:,
GRAVE~ PACK TYPE"---.~.
Volume used: Depth to top:
GROUT TYPE: ~.. Volume:
Depth: from "- f~ to
Duration:
I=UMPiNG LEVEL AND YI~LO:
-~, .-~ ~-~__ ft after .... '-/ hrs pumpi~g/~~' gpm
PUMP iNTAKE DEPTH: "~ ft Horsepower: '~'
WELL DISINFECTED UPON COMPLETION;~ E~[. YES [] ~-O ~
REMARKS:
PLEASE f~L WHITE COPY OF LO:G TO:
PAGE 1 OF 1
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 SYSTEM PERMIT
PERMIT NUMBER:SW920271
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:MANN PHILLIP J & SHARON
OWNER ADDRESS:8230 HENRY CIRCLE
ANCHORAGE, ALASKA 99516
DATE ISSUED: 9/08/92
EXPIRATION DATE: 9/08/93
PARCEL ID:01528173
LEGAL DESCRIPTION: JENKINS LT 2
LOT SIZE: 49512 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
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
ISSUED
DATE:
DATE:
~Permit
~'~ ~-00~ Page Z.
k,lunicipaJity of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
of ~
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
PID No.:
Legal Description: ~_~__~.~
Michael E. And,
4381 E
72-O13 A (2/gl) MOA25
/
/
/I I
'/ i'i '
'
///
/.
/
Municipality of Anchorage
Development Services Department
Building Safety Division
On'Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 An~orage, AK 99519-6650
www.ct.anchorage.alcus
(9O7) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Pamel I.D. 015-281-7.3
Expiration Date:
1. GENERAL INFORMATION
Completelegaldescfiption JENKINS SUBDIVISION; LOT 2
Location (site address or directions} 4050 E. KLATT ROAD
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ANCHORAGE, AK 99516
TROY RHODES c/o REMAX PROPERTIES Day phone 257-0168
2600 CORDOVA ANCHORAGE, AK 99505
Day phone
MARY DEE FOX w/ REMAX
Day phone
2600 CORDOVA ANCHORAGE. AK 99505
257-0168
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 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 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 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
professional engineer's work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $660.00 at, er prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto end 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 type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Ancho~ge 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORACE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. e~tempted to pmvfde a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the perfon'nance of the
system under the condi~ons encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions ara outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there ara no hidden defects or encroachments. AWWC, Inc. can therefore not previde
any warranty or future estimate dhow tong the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for L~
bedrooms.
Disapproved.
Conditional approval for __
bedrooms, with the fllowing stipulations:
..
Attachments:
· HAA Checklist
Septic System Advisory
Well Flow Advisory
;. WAS'[EWAII:K: .-'
?,,-z,,, .. ..... ·
Manitenance Agreements .,./?/· ,v,c;,~ ~ ~. ,..,.
/JJ~b;,; "
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
On.,,~te Water & Westewater Program
4700 ~u~h Omgew 6L
P.O. Box lg6850 Anch~, AK 9g~1 g.~660
Legal Descdplion:
A. WELL DATA
Well Mm P~V^;
Date completed
Total depth 231
HEALTH AUTHORITY APPROVAL CHECKLIST
JENKINS LOT 2 Parcel ID:
015-281-75
If A, B, or C provkle PWSlD~ N/A Well Leg (Y/N). YES
6/1992 ~llte~/~al (Y/N) YES Wire~ properly protected (Y/N) YES
It. Casedto 231 It. Caalnghelght(abovegroond) 12+ .In.
FROM WELL LOG AT INSPECTION
9/1992 10/26/2000
170 lt. 174 [
15.0 g.p.fn. 3.2 g.p.m.
Well production
WATER SAMPLE RESULTS:
Collfon'n o colonle~lO0 mi.
Date of ~ample: 9/28/01
SEPTIC~OLDING TANK DATA
Nllrate 0.5 mgJt.
Other bacteda
AWWC~ INC.
Tank ~x~IVlaterlal
Tank ~ze 1250 gal.
Foundation cteanout (Y/N)
Oate of pumping 10/2/01
ABSORPTION FIELD DATA
D~te InStellOd 11/lgg7
Length 20 ft.
S~EEL
Number of Comperlmente 2
Depmsalon over tanR (y/N) NO
Pumper.
0 colonies/1 O0 mi.
6/1992
High water alana (Y/N)
A+ HOME SERVICES
~ro TOP OF SAND FROM RNAL GP~OE
Soil ratlng (~or ~/lxlrm) 2.~0 System type BOTrOMLESS ISF
Width 18 .ft. Gravel below pipe 3.5'
In. Al:~orp~on rote >-
NONE KNOWN
Total deplh .3.2 ft. Eft. absorpfion ama X ItI Monll~lng tube YES
Oateofadequacytest 10/26/00 Results(Pass/Fall). PASS
Fluid depth In a~ field before test 0 In. Water added 838 gal.
Elapsed Time: 0 ruth. Final fiuld depth 0
A~/mJuvenafion treatment (past 12 mo.) (Y/N & type)
Depression over field NO
For 4. bedrooms
Nowdepth 0 In.
600+ g.p.d.
D. UFT STATION
Data Inetalied 11/1/1997
'Pump on' level at T1MERIn,
Datum BOTI'OId OF TANK
E. SEPARATION DISTANCES
Stzeln g~ 5oo
'Pump off' level etTIUERn.
Cydse tastad. ~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot. 100'+
Abso~ptlon field on lot 100'+
Public sewer main N/A
Sewer/septic sen'ice line 25'+
Mmnh~4~YA~ce~ (Y~N), YES
High water alarm level at 47 In.
M~ a~ & d~ ~ulmme~? YES
On edJacent Iota. 100'+
On edjacent lots. 100'+
Publlo sewer mantx)la/claanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water sen/ice line. 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSOR.°TION FIELD ON LOT TO:
Pmpelly llne 10'+ Bulidlng foundaUon tC) ' ~'
Water sen, ice line 10'+ Su~ce ~atar 100'+
Curtain drain NONE KNOWN Wells on adjacent Iota. 100'+
F. COMMENTS
Absorption lleld.
Surface water.
5'+
HAA Fee $ '~/'3~
Data of Payment
Receipt Number
(R~. ~0)
Waiver Fee $
Data of Payment
Recelpt Number
G. ENGINEER'S CERTIFICATION
j cerl~y that I have determined through field Inspec#ons end
mWew of Municipal records that the above systems ere In
conformance with MOA HAA guidelines In effect on this date.
Engineers Pdntad Na~ne JEFFREY A. GARNESS
Water main N/A
Driveway, perldng/vehldesturage 10'+
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 A~chorage, AK 99519-6650
www.ct.anchorage.ak, us
(eO~) 34,.~7e04
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 015-281-7.3
1. GENERAL INFORMATION
Expiration Date:
Complete legal description !JENKINS SUBDMSION: LOT 2
Location (site address or diractlons) 4050 £. KLATI' ROAD ANCHORAGE, AK 99516
Current Propedy owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ERIK &: DONNA DAVIDSON Day phone 842-3705
4050 E. KLA'I'F ROAD ANCHORAGE~ AK 99516
Day phone
MARY DEE FOX W/Ri[MAX Day phone
2600 CORDOVA ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for plckup.
2. NUMBEROF BEDROOMS: 4
257-0120
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WAS I ~-WATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Sewicas 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 PJaska. Certificates of Health Authority Approval are required for the Vansfer
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 pdvate or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a pedod 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
professional engineer's work.
IN ore: Alaska Water and W. astewa~, r Consultants, Inc. shell be paid $360.00 at, or pdor
to dosing for the englneenng sen/~ces provided. "
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I ved[y that my
Invastige§on, 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 b/pe of structure indicated herein. I further varify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-sire 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.
NameofFirm ALASKA WATER x- WASTEWATER CONSULTANTS. INC. Phone
6901 DEBA~R ROAD. surrE 2B * ANCHORAGE. AK 99504
Engineer's Printed Name JEI-I-t<EY A. CARNESS. P.E.
Date
337-6179
Engineer's Comments:
DSD Guidelines & Regulations. The mpo~d msu~ deco,bed the performance of the
system under the conditions encountered at the ffme of the test. and sepem#on
distances measured to med#y Iden~flable leah'res. The operaEonal life of all wells and ~/~ ? ~ 4 ~
sapac systems depend on the local so85 condi~on, groundwater levels that may
flucfuate during the year, and the water usage of the family being sen/ed by the system.
These ¢ondi#ons am out, de the contm~ of the evalualo~ of the system. $aE~actoty test
results do not guarantee future performance of the ~/stem, nor do they guarantee that
there am no f~Idden dofects or encmachments. AWWC, In~' sen therefore not pmvfde
eny wan'~nty oc futum estimate of bow long the system wlli contlnue to meet the '~'. "'..~ .... ."
operaEonal mqu/remente of the ADEC or MOA DSD. The content of thla mpe~f la for
the s~le benefit of the owner llsted above. Any mltense upon or use of this report by any
other person or perfy la not authodznd, nor will lt confer any legal rlght whatsoever.
Disapproved. ATF..R AND ·
-~.t.I)))) j j))) H' .
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Englneefs Reort
Other
Original Certificate Date: )I,"~ _ /...// --~ /
Municipality of Anchorage
Development Services Department
On-81te Weler & Westewat~ Program
4700 ~uth Bragaw $L
P.O. Box 't06650 .,~'x:homge. N~ 9951g-6650
www. cLanchomge.ak, us
(007) 343-7904
Legal Oes~pfiem
A. WELL DATA
Weft t~e ~VA~
Date completed 6/1992
Total depth 231 It.
Date of test
Stafie water level
Weft production
WATER &a~IPLE RESULTS:
HEALTH AUTHORITY APPROVAL CHECKLIST
JENKINS S/Dj LOT 2~ Parcel ID:~ 015-281-75
IfA, O. ore r~wlde PWSlI:~
Sanlteq seal
~OM ~ k~ .
~/~2
170
15.0 g.p~
~ of ~ample: 9/28/01
wen Log (Y/N)
W~s property protected
Casing height (a~ g~)
AT INSPE~ON
10/26/2000
174
~.2
YES
YES
12+
B. SEPTIC/HOI nlNG TANK DATA
Ce
Otherbecterla ~ colonles/lOOmL
AWWC, INC.
TankNze 1250 geJ.
Foundafien cleanout (Y/N) YES
Number of Compadments 2
Depression over tank (Y/N) NO
6/1992
YES
High water alarm (Y/N)
Date of pumplng lO/2/Ol Pumper A+ HOME SERVICES
ABSORPTION FIELD DATA *TO TOP OF .SAND FROM RNAL GRADE
Oatoil~'te~od 11/1997 ~ollralJflg(~ortT¥od1111) 2.0 Sy~t~mtype BOTTOMLESS ISF
Lenglh 20 It. Widlh 18 .It. Gravel below pipe 3.5'
TotaldepUt .3.2 ft. Eff. ab~marea 360 It' Monltoringtube YES
Date of adeduacy test 10/26/00 Results(Pass/Fall). PASS
Fluid depth In ebsoq~on field before test 0 In. Water added 838 gal.
E]apeed Time: 0 min. Final fluid depth 0 In. Absorpfien rate >=
Any mJuvenatlon treatment (past 12 mo.) (Y/N & type) NONE KNOWN
N/A
Depression over field NO
For 4 bedrooms
Newdepb~ 0 In.
600+ g.p.d.
yes, give date -
D. UFT STATION
Date installed 11/1/'1997
"Pump on" level et TIMER In.
Datum BOTTOM OF TANK
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM W~ ~ ON LOT TO:
Size In gallons 500
'Pump off' level at TIMER In.
Cycles tested ~
8ept[o tanUIm station on lot10o'+
.a.~oq~on field on lot. 100'+
Public ~wer main N/A
Sewer Isep~o sewtce line 25'+
High water alarm level at 47 In.
Meets alarm & circuit requirements? YES
On adjacent lots lOO'+
On a~acent lots lO0'+
publlo ~ewer manhole/deanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundallon 5'+ Property line 5'+
Water main N/A Water aerdce line. 10'+
We~ on adjacent lots 10o'+
SEPARATION DISTANCE FROM AB$OR~'i'iON FIELD ON LOT TO.-
Ptope~y line 10'+
Water ~endce line 10'+
Cudaln drain NONE KNOWN
F. COMMENTS
BuBo'lng foundation 10'+
Surface water 100'+
Wells on adjacent lots. 10o'+
At~orp~on field 5%
Surface water 1 oo'+
Water main N/A
Driveway, parklngAmhlde storage 10'+
O. ENGINEER'S CERTIFICATION
I certify that I have determined 6~rough field In~ end
rmSew of Munic~pal records ~hat the above aysfema are In
conformance with MOA I-ARA guidelines in effect on this date.
Engineers Printed Name
//
Oa~e , /°/~//(~)// .....
JEe~EY A. OARNESS
HAA Fee $
Date of Payment.
Receipt Number,
Waiver Fee $
Date of Payment
Receipt Number
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Divts[on of Env~ronmentel Services
On-Site Services Section
P.O. Box 196650 Anchorage, AJaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
015-281-73
1. GENERAL INFORMATION
Complete legal description JENKINS SUBDIVSION: LOT ~'
Location (site address or directions) 4o5o E. t<L~n. ROAD ANCHORACE. At< 9951
Property owner ERSt< AND DONNA DAV]DSEN Dayphone WK-(9253 842-3705
Mailing address 4050 e. KLAn' ROAD ANCHORAGE. AK 99516
Lending agency, Day phone
Mailing address
Agent SHARI BOYD w/ JACK WHITE Day phone (907) 563-5500
Address ,3201 "C" ST. ANCNORACF AK 99~0~
Un/ess otherwise requested, HAA wi//be held for pickup.
NUMBER OF BEDROOMS: 4
I'YPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community well system, provide wdtten confirmation from State ADEC attest-'
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
?2-025 (Rev, 1/91 ) Front MOA #21 Compt.,ter vemion
Note: Alaska Water and Wastewater Consultants, Inc.. shall be paid $1,000.00
or prior to, closing for the engineering services provideo.
5. STATEMENT OF INSPECTION BY ENGINEER
As ce~fied by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation 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/er wastewater
disposal system is in compliance with all Municipat~and State codes, ordinances, and regulations In effect
on the date of this inspecfion.
Name of Firm ALASKA WA'T'~R &,~ ,S~/A'i!ER CONSULTANTS. INC. Phone (907)337-6179
Address 6901 DE~I~ARR R/OAD. Is~ :/2~../ANChORAGE. ALASKA 99504 , /
Engineer's Signature ~_ .~0:! ~/ ~'~ 'Date ,//~/¢0 '
In condu~ng this e~a/uation, At444/C, In¢./a~, em~ ted to 9rovide a therough, consOientious engineerin~ analysis ef the
system In accordance with ADEC and MOA DHI- ~ Guide/inee & Regulations. The reported results described the
performance of the system under the conditions encountered et the time of the test, and separation distances
measured to readily identiflabfe features. The operational life ef all wells and eeptic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system. These conditions are outs/de the control of
...... .,.,..,
~Me,- ".,. ....... ~,~
bedrooms
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provfde any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above.
reliance upon or use of this report by any other person or pady is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
Approved for
Disapproved
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 Ihe 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.
72-025 (Rev. 1~1 )Bact( MOA #21 Computer Vemion
RECEIVE
Municipality of Anchorage ~'~
DEPARTMENT OF HEALTH & HUMAN SERVICES- ~
· EnvlronmentalServlcesOMslon -NOV 0 9 ~
825 't. Street, Rm 602 Anchorage, Alaska 99501 (907) 343-4744 ~
Health Authority Approval Checldlst=n~R°~E~rrA SERV~CES-0~0N
Leg~1 Dascdl~on:
A. WELL DATA
WeB Type PRIVATE
Log present
Total depth 2~1'
JENKINS SUBDMSION; LOT 2
FROM WELL LOG
Date of mst 9/1992
Static water level 170'
Well production 15.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 Nltrate
Date of ~ampla: 10/26/2000
B, SEPTIC/HOLDING TANK DATA
Date Installed 6/'1992 Tank size 1250
Parcel I.D.:
015-281-73
If A, B. or C, attach ADEC letter. ADEC water system number N/A
YES Date completed 6/1992
Cased to Z~l' Casing height (above ground) 12"+
Y[$ Wlrss pmpe~y pmtecteq (Y/N) YES
AT INSPECTION
10/26/2000
174'
,;3.2 g.p.m.
0.500 mg/L Other bacteria. 0
Collected by:. A.W.W.C. INC.
Foundation cleanout (Y/N) YES Depression (Y/N) NO
Date of Pumping 9/8/2000 Pumper A+ HOME SERVlCI~S
Number of Compartments 2 Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
INTERMITTENT SAND fiLTER
*TO TOP OF ~O FROM FINAL GRADE.
rating {i~)or fi2/bdrm) ;~.0 System type
BoI'rOMLESS
ISF
18'+ Gravel thickness below pipe 3.5' Total depth *3.2'
C. ABSORPTION FIELD DATA
Date Installeq 11/1997
Length 20% ~
Effective absorption area
Date of adequacy test
360 SQ.FT. Monitoring Tube present (Y/N) Y[:$ Depression over field (Y/N)
10/26/2000 Results (Pas&tFall) PASSED For. 4
g" Immediately alter 838 gal. water added (In.): _
0 Absoq~on rate = 600+
NONE KNOWN If yes, ONe date -
Fluid depth in absorption field before test (in.);
Ruld depth O' (ins) Minutes later:.
Peroxide treatment (past 12 months) (Y/N)
NQ
D. UFT STATION
Date installed
High water alarm level at*
11/1/1997
47'
Size in gallons 500
"Pump on" level at* 'riMER 'Pump off' level at*
· Datum B_.O'ITOM OF TANK
TIMER
Se~c/holdlng tank on lot
Abeerpfion field on lot
Public sewer main
Sewer/septlo se~ce line
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
N/^
25'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property llne 5'+
Water maln/cewlce line 10'+ Sun'ace watel~dralnege 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Properly line 10'+ Bulldlng foundation 10'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout
Mit etatlon 100'+
Absorption field 5'+
Wells on adjacent lots 100%
Water maln/sewlce line
Sur[ace water 100'+ Driveway, parldng/Vehlcte ~tomge ama 10'+
10'+
Curteln drain NONE KNOWN Wells on
of M~ ~ ~ ~ ~ ~ms am ~ ~
Slg~m~ ~ ~
~In~s Ns~J~R~ ~ ~N~S
Da~~~
Date of Payment
Waiver Fee $
Date of Payment
Receipt Number
Parcel I.D. #
1.
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 -~-~-:
Day phone ~_~
3~--~'- 4-770
Lending agency
Mailing address
Day phone
Agent
Address
,...-
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well
NOTE:
Community well '~lZ-~
Public water
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
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 shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm A[a.~ka '¢~'~ it,' ~ ........... ~-~ Phone
Address ffncno, '' '
Engineer's signature -~~ ~~ Dato
6. DHHS SIGNATURE ..........
',~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authorit7
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.
72-025 (Rev. 1/91) B~ck MOA ~21
Legal Description:
Municipality of Anchorage m r r E:
DEPARTMENT OF HEALTH & HUMAN SERVI(i~S~ ~ IV F~ D
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907~(;i~_4~F~91.97
.... Municipality of Anchorage
Health Authority Approval ~necKli~pt Health & Human Services
~1" Z,/ J~:J~/f~l~ ~/P ParcelI.D.: O
A. WELL DATA
Well type
Log present
Total depth
Sanitary seal
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~/C]~7,.
Cased to '~ / Casing height (above ground)
It'
Wires properly protected (Y/N) ~--~'
Date of test
Static water level
FROM WELL LOG AT INSPECTION
(7 0 ! 77
/-~' g.p.m. ~' ,~
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample'. /o
Nitrate ,'1 ~/j~ Other bacteria
Collected by:
g.p,m.
B. SEPTIC/HOLDING T~NK DATA
Date installed ~o/~o~. Tank size ~/~-0 Number of Compartments ~-' Cleanouts (Y/N)
Foundation cleanout (Y/N) ~F----.~ Depression (Y/N). ,~J~ High water alarm (Y/N)
Date of Pumping 9/~ ~)/'~"12¢' Pumper C~J~
C. ABSORPTION FIELD DATA ~--O/L-- r,4~..-t/~l
Date installed t I /~ '~ Soil rating (g.p.d./ft2 orJt~ ~'~ System type
Length ,c-or+ Width /r~t'+ Gravel thickness below pipe ~:~ # Total depth
Effective absorption area ~¢oO 4- Monitoring Tube present (Y/N) V Depression over field (Y/N) /',J____~_O
Results (Pass/Fail) For' __~
Fluid depth in absorption field be~~l, water added (in.):
Fluid depth ~~~__ g.p.d.
~ast 12 months) (Y/N) If yes, give date ~-----~-~'-~
72-026 (Rev. 3/96)*
LIFT STATION
Date installed ~/I/'c~ '''~''
Manhole/Access (Y/N) ~ ~----~
High water alarm level at*
Cycles tested ~J ~
Size in gallons
"Pump on" level at* 'TI f,-I ~ "Pump off" level at*
*Datum ~ ~"~-~
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
iOO/+
tOOt4~
ioof+-
On adjacent lots
O~n adja~ lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: /"-"~
Foundation ~,~t¢¢ Property line 60 t4. 't' ~,,,.
-- Absorption field '~L3
Water main/service line [(~ ~ Surface water/drainage I00 Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~'~'
Surface water
Curtain drain
Building foundation ~"4- Water main/service line
Driveway, parking/vehicle storage area
~/-~,40~J ~U Wells on adjacent lots 200 ! 4-
ENGINEER'S CERTIFICATION/~
I certify that/have deJezcmi.~d~.l(u field inspections and r6
in conforman~' h~F~A~.~deline, in effect on this date.
Signature L~'TN~/v k -/ ---
Engineer's Name ~~
Date 11/' ~/ff~
HAA Fee $.
Date of Payment.
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Alaska Water & Wastewater
Consulting Engineers
Date:
Attention:
II/~/~C~_~.~- i iI Number of Pages Including Cover:
From: Jeffrey A. Garness, P.E., M.S.
comment(s):
Reply requested: [~ Yes [] No
7320 East Chester Heights Circle * Anchorage, Alaska 99504 * Phone: (907) 33726179 * Fax: (907) 338-3246
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
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Address
J
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TyPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
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
STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verifythat based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ,^,!~s~.t~r--~, t~ Phone
Wastew-~[er Se.~ic~Cs .q
Address 847i ~ric~eCr, /
Engineer's signature ~' ~ ~ ~'/~ ~ Date ,
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Money shall be put in
bedrooms.
bedrooms, with the following stipulations:
escrow to construct the bottomless intermittent dosing
~an6 ¢~lter purmtant to permit number SW970358. Construction shall be
completed by no later than October 31, 1997.
Mcnc7 in sgcro~.~ cha!! not be rel~ed ,n~l ~h~ ~¢¢~ h~ given final
approval.
Additional Comments
Date ,/E2 -~- ? 77
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 Anbhorage is not
responsible for errors or omissions in the professional engineer's work.
72-o25(Rev. 1/91) Back MOA#21
Legal Description: CO"T' 5/
A. WELL DATA
Municipality of Anchorage D Ii:: ('~ ! V EL D
DEPARTMENT OF HEALTH & HUMAN SERE4~ES'" '
Environmental Services Division ~_z~9474.
825 L Street, Room 502 · Anchorage, Alaska 99501 · (9~34
Municipality ot Ancr~orage
Health Authority Approval Checl~ffi~t, Health & Human Services
Well type
Log present (Y/N)
Total depth ~--.-3 ~'
Sanitary seal (Y/N)
~Ov''T'- ' If A, B, or C, attach ADEC letter. ADEC water system number
k./~_~ ~ Date completed ~/~:~o-~
Cased to -~ / Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
/70
AT INSPECTION ~,~
/-7'7
g.p.m. ~ ~
' ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: /o//4/~----~
N it rat e
· /'~///~ Other bacteria .~
Collected by: ~-~'~' '~'
B, SEPTIC/HOLDING TANK DATA
Date installed ~/~c~. Tank size
Foundation cleanout (Y/N) *'¢~-:;~ Depression (Y/N) /~JO High water alarm (Y/N)
Date of Pumping ~/i~/~,¢' Pumper
C. ABSORPTION FIELD DATA
Date installed
Length ~¢~--~ / Width
Effective absorption area
Date of adequacy test ~/ /~/~':~-
Number of Compartments ~-- Cleanouts (Y/N)YCT-~-~
Soil rating (g.p.d./fF or ffE/bdm~ ¢ ~-- System type
/
Gravel thickness below pipe
Monitoring Tube present (Y/N) "7/
Results (Pass/Fail) J~
~ t¢ Total depth '~! :~
. Depression over field (Y/N) /'*JO
For ~ bedrooms
Fluid ~diately after, gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption -<L g~2/--} g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~o,,./,¢~. If yes, give date ~
72-026 (Rev. 3/96)* .~J~P~ ~'~:::~
~UN~C~P^Lm, O,~,~Nc~o~. ~
ENVIRO/x~EN'r^I~ SE,~V~C~$ O~V~S~ON
D. U~N OCT 02 ]597
Date~installed ~ Size in gallons ~
E. SEPARATION DISTANCES
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
!
/oo
!
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation
Water main/service line
Property line ~__._~:)
S'urface water/drainage t O O/~-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '"~"~ ~ Building foundation '~-'~ ! ~-
Surface water
Curtain drain
/
Absorption field / /
Wells on adjacent lots
~Oo
Water main/service line
Driveway, parking/vehicle storage area ;2..~/~-
Wells on adjacent lots /CPO /¢'' pv"F"'
ENGINEER'S CERTIFICATION
I certify that I have de~?rmined~u field inspections and review of Municipal
Engineer's
HAA Fee $ ~.
Date of Payment /O/c~Z~
Receipt Number --~/~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-47'44
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# l~'~h~\/-'~-;--~---~ ~
1. GENERAl- INFORMATION
Complete legal description
HAA #
Location (site address or directions)
Property owner _
Mailing address
Lending agency
Mailingaddress
Agent
Ad dress
Day phone
Day phone ~'
Day phone
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Unless otherwise requested, HAA will be held for pickup.
NOTE:
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. 1/91) Front MOA #21
o
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Ar4'.~ ~-77.~'O r.) ~' ~,, ~J ~-'7~.~-1~_4/d 6 Phone ·
Address ~ 0. ~O¢; Z~'8 77~
Engineer's signature
DHHS SIGNATURE
(
Approved for ~x/¢_._ 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 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. 1191) Back MOA #21
(~ Municipality of AnchOrage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~;)-I~ Z~ ~T"~'1~t,r~l~-~ ._ Parcel I.D.
A, WELL DATA
Well type P'~t I~''r~c If A, B, or C, attach ADEC letter..ADEC water system number
Log present (Y/N) Y Date completed
Total depth ~ j Cased to
~ Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test ~ ,,
Static water level J '~0
i5~ g.p.m.
Well flow / ~
Pump level --
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
; On adjacent lots
.; On adjacent lots
· Public sewer manhole/cleanout
Petroleum tank _
.Sewer service line _
/
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: -
~ ~) Other bacteria
Collected by: '/'~' ~/'~-%'='''
B. SEPTIC/HOLDING TANK DATA
Date installed _ ~'/~5~/~ Z~ Tank size J '~ ~"~ ~A'/~ 'C°mpartments
Cieanouts (Y/N) '~ . Foundation cleanout (Y/N) Y _ Depressio/~j(~/~)
High water alarm (Y/N) ' ~/~A Alarm tested (Y/N) /
Date of pumping ~~'~/'l~J ~) xj. Pumper_ i~J A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r
i ~/~ _On adjacent lots_ ~ /~1 .Foundation
Well(s) on lot ~' / / I
To property line .~'~) .Absorption field .Water main/service line
Surface water/drainage
72-026 (Rev. 7/91) Front
/Z
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
Date installed ~'/~/~ ~-.
Length _ ~(.~ Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
On adjacent lots
Surface water
Soil rating ,,~'~ - / '- System type Gravel thickness _ ~ ~
Total depth
Cleanouts present (Y/N)
Date of adequacy test
On adjacent lots_
Surface water _ _
Curtain drain
for
Cutbank ~J¢.) ~,J
Water main/service line_
Driveway, parking/vehicle storage area
Peroxide treatment (past 12 months) (Y/N) ~
If yes, give daie __
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot_ / .~¢~' I On adjacent lots >/~.3 /
~_ ~ ! Propertyline_
To building foundation -,5
To existing or abandoned system on lot
'> /60'
bedrooms
60
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the da
· _
Engineer's Name. /~'1
inspection.
)ate of Payment. _.
teceipt Number
2-028 (Rev. 3/91) Back MOA 2~
Waiver Fee: $
Date of Payment _.
Receipt Number
September 15, 1992
Municipality of Anchorage
Department of Health & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attention: Susan Oswalt
Reference: Lot 2, Jenkins Subdivision
Subject: As Built Deficiencies
Dear Susan:
On September 14, 1992, I visited Lot 2, Jenkins Subdivision to verify that
all deficiencies noted on the as built drawing were completed. The
contractor, Harten Construction, had hauled in material to fill in low areas
around the well head and bed area. He had also completed placement of
the cteanout caps. All deficiencies have now been completed and the work
is acceptable.
Sincerely,
Michael E. Anderson, P.E.