HomeMy WebLinkAboutKNIK VIEW ESTATES BLK 5 LT 6Knik View
Estates
Block 5
Lot 6
#051-043-46
Municipality of Anchorage Page 1 o! 3 _
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box ~96650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: iSW980370 PIDNumber: 051 -043-46
~ame: Sp±nell Hom~ Wastewater System: ~New -~ Upgrade
9210 Vanguard Drive Anch., AK ABSORPTION FIELD
Phone: ~ NO. o~ Bedrooms:
344-5678 Four Q Deep Trench ~ Shallow Trench ~ 8ed Q Mound Q Other
Lob 6 8~ock: 5 KnlK View Est.
L 3.5 ' ~. 4 ' ~.
Township: Range: Section: Fill added above original grade: G(avel [eng[h:
, ~ 5 ' ~. 50 '
Gravel width: Number of lines: 0is[ance be~n line~
WELL: Q NEW,: Q Upgrade 5 ' ~. 1 -
Cia.s A ~t. R. 500 s~.~t. AS~H D3034
i R. Soinell Homes 9/29/98
SEPARATION DISTANCES ~p~i~ ~ Holding 0 S.T.E.P.
From rank Field Stal,on Tan~ Sewer Lines Anahora aa Ta ~R 1 . 2 5 0
We, >200' i>200' N/A N/A N/A Mate,iai: ,um0~r pt Compartments:
Steel Two
S.n~ew~,e~ >100: >100': ~ N/A N/A N/A LIFT STATION - N/A
Lot > 5 ' > 10 ' N/A N/A N/A Siz~inoa,ons:
Line . ~
$ounda,on > 5 ' > 1 D ' N/A N/A N/A "pump on" ,,~.l a,: High wat,r alarm at:
Curtain Pump Make & Model ] Electrical Inspections performed
BENCH MARK
Remarks: ,
Rea~ Deck
,; ,.,
'i
; Assumed Etevation:
,, 100.0 ~.
5NGINS~R'S
Inspections
performed
2nd 9/29/~8 ~" '
Department or'Health and Human Services approval '~ 4~.~ .~
Reviewed and approvediby: Date: /2-2~-~
Permit
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
~.O. Box 196650 - Anchorage, AK 99519-6650 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
qumber SW980370
Page 2 of 3
PID No. 051-043-46
Four
Bedroom
House
C4
1,250 Gallon
Septic Tank
C5
50' Long X 5' Wide
X 4' Effective Depth
Absorption Trench
Alternate
Site
PLAN AS-BUILT
SCALE 1" = 30'
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
R.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW980370
;
Page 3 of 3
PID No. 051-043-46
/
II 45°
:93.9
1 , 250
Gallon
! ~ep. Tank
8' 3' 5
\93.7
4' 3' 12'
Drainfield Rock
~88.9
93.3
50' \'7~.o
.... ~.
PROFILE AS?~ILT ~~.~~
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box ~96650, Anchorage, AK 99519-6650
(907) 343-4744
Permit Number: 8W980370
Legal Description: KN!K VIEW ESTATES BLK 5 LT 6
Design Engineer: 00i14 Anderson Engineering
Owner Name: SPiNELL HOMES
Owner Address: 92!;0 VANGUARD DRIVE
ANCHORAGE , AK 99507-
This permit is for the construction of:
[~ Disposal Field [] Septic Tank [] Holding Tank
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Sep 18, 1998
Expiration Date: Sep 18, 1999
Parcel ID: 051-043-46
Site Address: 022517 KNIK VISTA ST
Lot Size: 21876 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
Privy
Private Well [] Water Storage
All construction must be in accordance with:
1. The attached appioved design.
2. All requirements Cpecified 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 mu~t notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: ~. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Issued By:
Date: ¢/~-//~ ~
Date: ¢- /(~-?g
September 10, 1998
Municipalit~ of Anchorage
Departmen( of Heath & Human Services
825 "L" Street
Anchorage! AK 99502-0650
Subject: i Lot 6, Block 5, Knik View Estates Subdivision
Septic System Design
i Impacts to Adjacent Properties
i
Dear Onsite Services Engineer:
We herebylapply for apermit to construct an onsite septic system on Lot
6, Block 5i Knik View Estates Subdivision. The attached site plan and
backup documentation identify the size and location of the new tank and
absorption !trench to serve the four bedroom home to be constructed on the
lot. The Cubdivision is served by a community water system and all
required s~paration distances are easily met. No conflicts exist with
other septi~ systems in the area.
i
Testholes iplaced on the property revealed well graded gravels with
varying a~ounts of sand. Soils percolate at a rate approximating 3
minutes p~r inch. No groundwater was encountered during the excavation
nor was Cny found during the monitoring period. We have therefore
designed a, 5' wide shallow absorption trench with 4' of gravel beneath the
distribution piping. The trench will be 50' long with a total depth from
original grade of 8'.
The groun~ surface of the lot is gently sloping from east to west at rates
varying fi'pm 2% to 5%. It also slopes from north to south at
approximatlely 1%. Sufficient surface area exists for both the primary and
backup absorption trench. No conflicts exist with lot lines or between
other septic systems in the area.
Lot 6, B o~k 5, Knik View Estates
September~; 10, 1998
Page Two
If the system is constructed as designed the following statements apply:
1. The System, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future. The
subdiVision is currently served by a community water system.
2. 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.
3. The System if constructed as designed, will have no adverse
impabt on reserved space, either surface or subsurface, on any lots
located in the area.
4. The ~ystem if constructed as designed, will have no adverse impact
on diainage patterns in the area. The current drainage pattern will
be maintained.
NO'liE:
8
This Project
10 11
12
13
14
15
AREA MAP
SCALE 1"= 100'
Subdivision ~s seFved by a community
No conflicts with septic systems on adjacent lots.
KNIK VISTA STREET
Alternate Site
TH1
50' Lon~ X 5' Wide X 4' Effecti,Ce
Depth ADsorption Trench
TH2
1,250 Gallon
Septic Tank
Four Bedroom
Home ·
1
SITE PLAN
SCALE 1" = 20'
NOTE:
No Conflicts with
Septic Systems on
Surrounding Lots.
LOT 6, BLOCK 5, KNIK V~EW ESTATES
SUBDIVISION
DESIGN!! FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: 3 Min./Inch 1,250 Gallon Septic Tank
Applicati6n Rate: 1,2 GPD/SF 4' Drainfield Rock
4 Bedrooms~ X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area
500 SF/5 LF~ (Width) X .5 (Red. Factor) = 50 LF Trench Length
Therefore: Construct a 5' Wide Absorption Trench System With One
Lateral 50' in Length with 4' of Drainfield Rock Beneath the Lateral,
DistributiOn Pipe in Trench Placed 4' Below Original Ground. Total
Depth of i Absorption Trench 8'.
NOTE:
///
3.5'
.,,
Natural ~
Backfill I~~'~ r~'~
Geotextlle Fabric
~ /k-.~_~----Drainfield Rock
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
6
7
[ii
13
14¸
16-
17-
18-
19-
20-
Block 5, Knik
DATE PERi~'-~
Township, Range, Section:
View Estates SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oepth Io Water ~er .~ ....-- /~/~
Monitoring? ~ Oate: ~ ~
SiTE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
~.-"~ c-~,&/~..,.. ~,~,'~'o ~ ,~, ,¢.6 ..----'
.... t.'/~, ,' ,f4 /.e~ r¢'4'-- /~"; & ¢
/.', ~.'z...., .,- ¢5&
STATE AND MUNICIPAL GUIDELINES N EFFECT ON THIS DATE. DATE:
ACCORDANCE
WITH
ALL
72-008 (Rev. 4/85)
PERCOLATION RATE -'~ {minutes/inch) PERC HOLE DIAMETER °~"
TEST RUN BETWEEN -- ~'- FT AND -- ~=~ FT
/
WAS PERFORMED IN
, DEPARTMENT OF HEALTH & HUMAN SERVICES ~'~
825 "L" Street, Anchorage, Alaska 99502-0650
} SOILS LOG -- PERCO~TION TEST
PERFORMED FOR: S~pinell Homes DATE PERF
LEGAL DESCRIPTION: Lot 6 r Block 5 r Knik Township, Range, Section:
~/~ View Estates SLOPE SITE PLAN
6
?
10 : WAS GROUND WATER
ENCOUNTERED?
Oepm tn Waer
Monitoring'/ gat~
11 s
IF YES, AT WHAT / ~)
12 DEPTH? ~-- C, P
13
Reading Date Gross Net Depth to Net
Time Time Water Drop
I Z:~7:~/ /9,~ I~,o~ ~,;~ ...
I
I
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE:
THAT THIS TEST WAS PERFORMED IN
ON-SI'f'E WASTEWATER DISPOSAL SYSTEM
CONS'rRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 6, BLOCK 5, KNIK VIEW ESTATFS SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and
placernent of a 1,250 gallon septic tank. It also includes
the construction of a new 50' long XS' wide X4' effective
depth absorption trench at the location shown on the site
plan. The distribution piping in the trench must be placed at
4' below the original ground surface. Total depth of the
trench will be 8' from the original ground surface.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
;
3: The Contractor shall be responsible for obtaining all
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
4: Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5; Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
A new 1,250 gallon septic tank must be procured from an
approved source and installed at the location shown on the
Site Plan.
Lot 6, Block 5, Knik View Estates
ii
September 9, 1998
Page TWo
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5. Tanks installed without 4' of cover shall have a minimum of
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
;from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1! The drainfield shall be constructed to the dimensions shown
! on the design. The bottom of the trench shall be within 2"
;; of level.
2! Distribution piping must be placed level with perforations
down atop alevel bed of drainfield rock. Rock should then
be placed over the pipe to provide a minimum of 2" of cover.
3i A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
41 Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Lot 6, ~lock 5, Knik View Estates
September 9, 1998
Page Th'tee
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
:settlement or depressions.
7. Grade area surrounding the absorption trenches to drain
, away.
8. A minimum 2' of accepting soil is required below the
; drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
;septic tank manufacturer.
2. The following pipe materials are approved for use in septic
;;system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F8'I0 or H.D.P.E. (perforated,
but not solid) and ASTM D2662 or A.B.S. (perforated and
solid).
3; Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
41 Septic tank inlets and outlets shall be fitted with
;watertight couplings (Caulder, Fernco, or equal).
Lot 6, Block 5, Knik View Estates
September 9, 1998
Page FO;ur
5 A permeable geotextile fabric (Typar, Mirafi or equal)must
be installed between the final drain rock layer and the
native soil layer.
6., All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
e~Cayation of trenches, beds or pits and before the installation
of any g'avel. A septic tank may be set in place, but may not
b¢ backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
C~ntractor shall provide a copy of all field survey layout and
c~nstruction notes for use in preparing the certified as-built
of the completed system.
Municipality of Anchorage
Development Services Department
Building Safety Division
O;¥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 DWELUNG
Parcel I.D. 051-043-46
:' 'I..,G E, ERAi.' iNF'O~MATiON
~ ' Completelegaldes~ription
· Expiration Date:
Lot 6, Block 5, Knik View Estates
Location (site address or directions)
Cuffe, ntPrope?ow~er(s). Ronald a AprtZ Knight
~.. Mailing ad~re~ PO Box 670423 Chu~takt
Lending agen~
Day phone 688-0382 -
Alaska 99567 '.~ .
Day phone --
Mailing address
Real Estate Agent
Traci Barickman/Dynamic Day phone 373-2950
Mailing Address 165 'P... Parks Hiqhway,
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
Suite 201 Wasillat
Ak 99654
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class. A
Public Water System
Well
[]
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an ~ndependent professional c~vll
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except beb,veen spouses) for properties served by a sin~cle 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
englneer's work.
STATEMENT OF INSPECTION I~Y i::NGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
. ba~ed 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 Anchorage flies 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,
Phone 357-3647
and regulations in effect at the time of installation.
Name o[ Firm Pt. nard Engineering
Address Po Box 871347 Wastllat Ak 99687
Engineer's Printed Name Paul E. Ptnardf PE
Date - 6/22/01
·
· ~li~...~_~'N E~
bedrooms, with the following stipul~fiohS~
5. DSD SIGNATURE
~ Approved for · ~ . bedrooms.
Disapproved.
'Conditional approval for
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: '7 - ~ '0 !
Municipality of Anchorage
Development Services Department
Bl~ldlng Safety Division
On-S~e Wa~ & Was~ea~r Program
4700 ~ Bragaw St.
P.O. Box 196850 Anchorage, AK 99519-6§50
www.~mmge.a~us
(~0~ 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Leg~dDescdpflon: Lot' 6t Block 5~ Knik View Est:a~:es ParcelID: 051-043-46
WELl. DATA
Well ~pe ._C-]sass
Date completed
Totel depth.
ffA~ B, or C pm~de PWSID # 218409
san~ay s~ (Y/N)
FROM WELL LOG
We, Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
Date of test
Static water level . fl-
Well production
WATER SAMPLE'RESULTS:
Coliform colonies/100 mi.
· g.p,m.
g.p.m.
Nitrate . mgJt.
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank TYpe/l~atert~.l Steel/Rn~h°rage Tank
· 'Tank sizp ~ 'gal Number of Compartments 2
· *."Foundation ;~J~tnout (Y/N) '/ DepreSsion over tank (Y/N)
Date of pumping
C. ABSCJRP1;IOI~ hELD DATA
Other bacteria __
colonies/100 mi.
N
Date installed 9129/98
Cleanouts (y/N) Y
High water alarm (Y/N) ~Z /%/
pu~q~ST inspected prior to testinq system- tank
~as clean~ havinq no measu~eable scum or
aludqe.
System type. 5' #1de Trench
Gravel below pipe 4 fl.
y Depression over field N .=
For 4 bedrooms
New depth 0 in.
600+ g.p.d.
If yes, give date
Date installed 9129/98 Soilmtthg (g.p.d./~orfffFodrm) 1.2
Length 50 * It. W'~th 5 ft.
Total depth 8 It. Eft. absorption areaS00 ft; Monitoring tube
Date of adequacy test 6/16/01 Results (Pass/Fail) Pass
Fluid depth in absorption field before test 0 in. Water added ~770gal.
~ Elapsed Time: 105 min. Final fluid depth 0 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Absorption rate >=
De
LIFT STATION
Date installed
'Pump on" level at
Datum
None on
Size in gallons
in. 'Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROMWELLON LOT TO: No #ell
Septic tenkJliff station on lot
Absorption field on lot
Public sewer main
Sawer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5" + Property line 5" + Absorption field
Water service line 25" + Surface water
On adjacent lots
On adjacent lots
Public sewer manhole/deanout
Holding tank
5"+
100"+
50'+
Water main 25" +
Wells on adjacent lots 200 ' +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 ' + Building foundation
Water Service line 2 5" + Surface water
Curtain drain None on lO~Nells on adjacent lots
F. COMMENTS
10'+ Watermain 25"+
100"+ Driveway,~ng/ve~destorage
200"+
in.
G. ENGINEER'S CERTIFICATION
Engineer'sPHn~N.e Paul S. Pi~,
H~Fee $ ~00.~ O Wa~erF~$
Date of P~ment ~ -~ ~- ~ / Data ~ Pa~ent
Re~ipt Number ~ ~ ~ R~ipt Number
(Rev. 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
051 -043246
Parcel I.D. #
1. GENERALilNFORMATION
Complete legal description
Lot 6, Block 5, Knik View Estates
Location (Site address or directions)
PropertydWner ._~pinell Homes, Inc.
9210 Vanguard Drive
Mailing acMress
Day phone 344-5678
Anchorage, Ak. 99507
Lending agency
Mailin. g address
Day phone
Agent
Address.
Day phone
Unless otberwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~'n.~ (4)
TYPE OF WATER SUPPLY:
Individual well
: Community well xx
Public water
NOTE:
community well system, provide written confirmation from State ADEC attest-
i8g to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xx
i Holding tank
Community on-site
Public sewer
NOTE: !if community wastewater system, provide written confirmation from State ADEC
~ttesting to the legality and status of system.
72-025 (Rev. 1/9'~) Fronl MOA¢I21
STATEMENT OF INSPECTION BY ENGINEER
As certi!ied 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 typelof structure indicated herein. I fur[her verify that based on the information obtained from
,
the Mun!c pa ity of Anchorage flies and from my investigation and inspection, the on-site water
supply alqd/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 ofiF rm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineers signature ~,.
Date_ 12/22/98
DHHS S!:GNATURE
- X/ A. pproved for . Z/
Disapproved
Conditional approval for
bedrooms.
bedrooms, with th'e following stipulations:
Additionai Comments
i
Date /2 -2 ,f- -~'r:¢ _
The Municipalit~ 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 reg stered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lendinglinstitutior s 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) Back ~IOA t¢21
Legal Description:
A. WELL DATA
Well type __
II,
i[ Municipality of Anchorage R E C E iV E D ~
i DEPARTMENT OF HEALTH & HUMAN SERVICE%EC 22 1998
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (9~)~i~i.~7~z~nchorage
~ept ~lealth & Human Services
Eot
Class~ A
Health Authority Approval Checklist
B[ock 5, ~±k View Parcell.D.: 051-043-.4~
Estates
__ IfA, B, or C, attach ADEC letter. ADEC water system number 218409
Log present (Y/N).~,
Total depth
Sanitary seal
Date of test
Date completed
Cased to
FROM WELL LOG
Nitrate
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
g.p.m, g.p.m.
Static water level
Well production
WATER SAMPLE F~ESULTS:.
Coliform
Date of sample:
B, SEPTIC/HOLDING ~ANK DATA
Date installed 9 ~? 9 / 9 8
Foundation cleanest (Y/N)
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed 9 i[2 9 / 98
Length 50 '
Effective absorptio~n area 5 0 0 SF
Collected by:
Other bacteria
Number of Compartments 2 Cleanouts (Y/N). ¥
Tanksize 1,250
Y Depression (Y/N) N
Pumper Construction
Soil rating (g.p.d./fF or ftVbdrm) 1 . 2
Gravel thickness below pipe
Monitoring Tube present (Y/N) ¥
Immediately after
Absorption rate =
High water alarm (Y/N) Y
Date of adequa~ytest New Const. Results (Pass/Fail) Pass
Fluid depth in abso~tion field before test (in.);
Fluid depth i (ins) Minutes later:
Peroxide treatmenf,l(past 12 months) (WN) N/A
?~-o~ (Rev.
Systemtype 5 ' Wide
4 ' Total depth 8 '
__ Depression over field (Y/N) N
For Four
gal. water added (in.):
g.p.d.
If yes, give date
Trench
bedrooms
D. LIFT STATION -None
Date installed
Manhole/Access (Y!N)
High water alarm lo,el at*
Cycles tested
E. SEPARATION DISTANCES
on Lot
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DIS'~ANCES FROM WELLON LOl' TO: No Well on Lot.
Septic/holding 'tank 0n lot
Absorption field on 10t
Public sewer main
Sewer/septic servic.¢ line Lift station
SEPARAT ON D s'r~NCES F:IOM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ? 5 ' ! Property line _. > 5 ' Absorption field
Water main/service !!ne.
"Pump off" level at*
Community Water.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
>5'
> 2 5 ' .Surface wateddrainage > 1 0 0 ' _ Wells on adjacent lots > 2 0 0 '
SEPARATION DIS1;~NCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 1 0 Building foundation . > 1 0 '
Surface water
Curtain drain No
1:00'
Water main/service line > 25 '
Driveway, parking/vehicle storage area
ENGINEER'S CERTIFICATION
I certi~/that I have determined thru field inspections and review
in conformance w/t~ MOA HAA gu/delines, jl~ effect on this date.
Signature
Engineer's Name.
Date 12/22/i98
on Lot Wells on adjacent lots > 2 0 0 '
Date of Payment
Receipt Number
72-026 (Rev. 8/96)*
Waiver Fee $
Date of Payment
Receipt Number