HomeMy WebLinkAboutLANG LT 3Long
Lot 3
#051-273-58
Municipality of Anchorage Page [ of ~-~--
DEPARTMENT OF HEALTH AND HUMAN SERVICI:S
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
N.~: ~t~ ~' Wastewater System: ~New ~ Upgrade
Phone: ~_~ No.o~edrooms: ~DeepTrench DShallowTrenoh DBed DUound ~Other
Total Depth~rom original graCe:
LEGAL DESCRIPTION Soil Rating:
BlockU Subdiv~ion: Depth to pipe boltom from ori~nal grade: Gravel depth beneath pipe
WELL: ~New D Upgrade Gravel widt~ [+Ft. Number~of lines: Distancel~be~een Jines:~ Ft,
Classification (Private, A,B,C): Total Depth: Cased Tg: Total absorption are~: Pipe material:
Date~Dreed: Static Water Levek Installer',
l Pump Set at: Casing Height Above Ground:
SEPARATION DISTANCES ~'s~.tio u ,o~i.~ ~ s.~.~...
TO Septic Absorption Lilt Holding 'ubllc/Private Ma.~fsoturer:
From Tank Field Station Tank Sewer Lines ~,
Well- /¢~ [~O~ ¢i* ~k ~ O~% Materia':~· Number of Compa"ments:
su,.c~ ~ ~ LIFT STATION
Water I00t~ /00 ~ 100~
C;:~n ~ > Pu~ I ~ctr'~ I~°ns Pad°rrna' bY:~
Remarks: ~~T 50~U¢. BENCH MARK
~SJ¢~ ~ e~ ~ Location and Descdption:
Assumed Elevation:
Depadment of Health and Human Se~ices ap . ¢¢., %, ,,- ~ -
Reviewed
and
approved
72-013 (Rev. 9/91) MOA 25
IS`C970090
PID, 015-273-58
LE`C 'CELL
A TI: S1 := 24.5
B TI S1 = 21,3
^ TO S2 = 31,1
BTU 22 = 21.8
^ TI: FS = 43
3 TO FS = 24,0
^ I'U CO1 = 55,2
B TB CB1 = 28.0
]~ TD NTI = 4t,5
C TO MT1 = 4t,2
B TD CD2 = 45.6
C lB CD2 = 37.3
~ TD CD3 = 42.7
9 TD CD3 = 15,2
C TD CB4 = 25,8
9 TU HT2 = 32,8
C TB HT2 = 28,8
~ESrRVE
DOUBLE C/O
NDTE~ IN DRDER TD UTILIZE THE RESERVE SITE,
A LIFT STATIBN WILL BE REQUIREB,
AS-BUILT DRAWING'
PREPARED FUR~
PREPARED
DATE~ 5/31/98
LUT 3, LANG S/D
GRAHAM FLUMES
ALASKA WATER & WASTEWATER
DRAWN: GARNESS SCA[_E~ 1' = 30'
SW970090
PID~i 015-273-58
LINE FROM HOUSE TO
TOP OF TANK : 9&.38
AS-BUILT DRAWING
z. GROUN)] OVER TANK = 9B,3+
NIN COVER = 8 FEET.
NEW 1850 GALLON SEPTIC
TANK, INLET INVERT =
95,73, OUTLET INVERT :
95,56,
OH )]IA, PVC LINE FROM
HI]USE, INVERT AT FOUNDATION C/O
= 96,18 DROP FROM HOUSE
TO TANK = ,29 FT. SLOPE = 1,OX
GROUN]B ELEV OVER THE EAST
TRENCH = 9B,8 TO 99,5, MIN,
COVER = 3,4 FEET, THE GROUND
ELEV, OVER THE WEST TRENCH
= 97.5 TD 98,7, MIN COVER =
3,0 FEET, ~
THE CONTRACTOR ONLY PROVIDED 10
FEET BETWEEN THE TWO TRENCHES
RATHER THAN 18,5 FEET,
--FILTER
FOR LOCATION DF M,T's SEE PLAN DRAWING
FABRIC OVER )]RAINRDCK
4 INCH DIA., ASTM FBi0, PERFORATED PIPE
EAST TRENCH,
A, INVERT OF DRAINPIPE = 95,06
3, BOTTOM [IF TRENCH = 8B,9
C, NO GROUNDWATER TO DEPTH OF 16 FEET,
D, TRENCH LENGTH = 40+ FEET
E, TOTAL ADSORPTION AREA = 496+ SQ, FI.
\VEST TRENCH,
A. INVERT OF )]RAINPIPE = 94.1
)], BOTTOM OF TRENCH = 8%9
C. NO GROUNDWATER TO ~)EPTH DF 16 FEET,
TRENCH LENGTH = 40+ FEET
E, TOTAL ABSORPTION AREA = 496-',- SO, FI,
]BENCHMARK IS PATH] DOOR THRESHOLD
ASSUMED ELEVATION = 101,11
AS-BUILT DRAWING~ LOT 3, LANG S/D,
PREPARED FOR~ GRAHAM HOMES
ALASKA WATER & WASTEWATER
DATE, 5/31/98 I DWN~ GARNESS I
SCALE~ NTS
FROH : GRAHAI1 HOIqES
LOOATION OF WELL
LOCATION/SKETCH~
PHONE NO. : 90? ~"~'~ a65~:
STATE' OF ALASKA
DEPARTMENT OF I~IATIJRAL RESCJURCE$
DIVISION OF MINING & WATER MGM]
WATBR WELL R~CORD
TOW~HIP
W~LL
DEPTHS MFJ,~SURED FROM;%~,casirl~l rep []gr,~und surlaeJ
Depth
From To
WELL D~;PTH:
Depth of ~as~ng, / ,~'/ --'~ t
DRPT~g, STATIC W~TER L~EL
'Depth~ of openinq~ . tc ~t
~CREON TYPE: Clam: in.
$1oti~e8h 8~ze: Length:
used; ~ gegth ~o top;
~ROuT TYPR:
Dep~: from ft to ft
DEVELOPMENT MfT~0D: / ," ,¢,,
L~EL, AND WELD:
- .. pumping__~2gpm
Dept, Health PUMP INTAKE DEPTH: ..... f~ Horsepower:
J W~LL D 8 NFECTED UPON COMPLY'ION? '~_4..~y. E8 ~ NO
CONTRACTDR INFO~ATION: REMARKS,
/ i~. _ '~ ,.~ .,~.
~I~.X~%~/,~ ~~,,~% ~ .. . PLEASE MAIL WHITE COPY OF LOG TO:
S~7~E~res~ .... ~ ~ DNR/DIVISlON 0F MININ[~ & WATER
8601 C St, Sult~ 800
ANCHORAGE AK
Fhona {907J76~,2538, Fax (907)562.1384
LOT 5
fiNAL b'"KRU"LqlJRE. AS-BUiLT
A.qCHt:~AO~ R~O~OI#G DI~"RICT A~A~KA
TOTAL P, B5
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 AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970090
DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES
OWNER NA/~E:LANG HERBERT C & JANET LEE
OWNER ADDRESS:4050 JANET LEE CIRCLE
ANCHOP~AGE, ALASKA 99508
DATE ISSUED: 5/14/97
EXPIRATION DATE: 5/14/98
PARCEL ID:01527358
LEGAL DESCRIPTION:
LANG LT 3
LOT SIZE: 52844 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TA/~K / 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 (18AACS0) .
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 SkME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~
/ ,
ISSUED BY:r~Z~_~~
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
December 11, 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
Attn: Laura Montgomery
Subject: Status of Well & Septic System documentation for Lots 2 & 3, Lang S/I).
Permits were issued to Install the subject wells and septic systems. Lot 2 is SW970230 and Lot 3
is SW970090. Both lots were undeveloped and new homes are being built. The septic systems
have been installed, however there are deficiencies with the Lot 3 installation that have yet to be
corrected. The wells have yet to be drilled, and the developer has yet to order the as-built
surveys. After the deficiencies have been corrected on Lot 3, the wells are drilled (and I can
verify the separation distances to the septic systems), and the as-built surveys are completed (so I
can determine separation distances to the lot line) I will complete the as-built packages and submit
them to DHHS for review and approval. If you have any questions, please contact me at
337-6179, or 244-9612. Th~ ~k you for your assistance.
/
Sincerely, //~/ /~//
, , IRONMENrI'^L SERVICI:$ DIVI$1C,.
DEC I I 1997
RECEIVED
8471 Brookridge Drive ~ Anchorage - Alaska 99504
(907) 337-6179 ~ Fax (907) 338-3246
Consnlting Engineers
April 25, 1997
Municipality of Anchorage
Department of Health & Human Se~wices
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Well & Septic System for Lot 3, Lang S/D.
To whom it may concern:
The subject property is currently undeveloped. Graham Homes is proposing to build a 4 bedroom
house on the site, which will require the installation of a well and a septic system. Comments
regarding the proposed systems are summarized as follows:
1. SOILS: Attached is a copy of the soils logs prepared by Anderson Engineering (Mike
Anderson, P.E.). The soils on this lot perked from 9.2 minutes/inch to 40 minutes per inch. The
primary and reserve systems fit within the 30 foot radius of TH #3, which perked at 9.2 minutes
per inch. To account for possible variations, I am proposing to use an average of the two
application rates ((.45 gpd/fl2 + .8 gpd/fl2))/2 = ,625 gpd/ft2), .625 gpd/ft2. There was no water
in the test holes on 7/31/96, 8/7/96, and 4/22/97.
2. TRENCH DESIGN:
a. Percolation Rate: 9.2 minutes/inch.
b. Allowable Application Rate: .625 gallons/day/ft2
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 960 ft2
£ Effective Depth: 6.0 feet
g. Reduction Factor = N/A
h. Width: 2 feet minimum
i Minimum Length: 80 feet
j Effective absorption area = 960 ft2
$. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPltY: The lot is generally flat from north to south, and slopes downward, less
than 5%, from east to west. In short, there are no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or on my digital pager at
1-800-481-1162. Thank you for your assistance.
Sincerely, ,/~
Princil3/tl
OMALLEY ROAD
LOT 2, LANG S/D. UNDEVELOPED
TH RADIUS
PROPOSED WELL
o
PROPOSED 4
BEDROOM HOUSE
LOT 4, LAND S/D,
IJNDEVELOPED.
TH RADIUS
LOT lA, SECTION 81, TiSN, R3W, S,M,
COUNTRYSIDE CONDOMINIUMS, THERE
IS ND WELL ON THIS LOT, ALL UF
THE STRUCTURES ARE SERVED BY COM-
MUNITY SEPTIC SYSTEMS. THE SEPTIC
SYSTEMS ARE GREATER THAN 40 FEET
FROM THE WEST PROPERTY LINE, IN
SHORT, THERE ARE NO ENCROACHMENT
CONCERNS,
CLASS 'A' WELL SERVING LOTS iA,
ID, SECTII]N 8J, TJ~N, R3W, S,M. 10936
ELMORE ROAD, COUNTRYSIDE CONDO-
MINIUMS. REQUEST TO ADEC
FOR CLASSIFICATION AS CLASS
WELl_ WAS APPROVED 1/11/95.
NOTE~ THIS IS NUT A SURVEY. THE LOCATION OF ALL WELLS, SEPTIC SYSTEMS,
AND STRUCTtJRES IS APPROXIMATE, THE CONTRACTOR SHALL VERIFY THE SEPARATION
DISTANCE PROM THE SEPTIC SYSTEM UPGRADE TO ALL WELLS ON ADJACENT LOTS.
WELL & SEPTIC SYSTEM:
PREPARE]] FOR:
PREPARE]]] DY:
DATE:
LOT 3, LANG S/D,
GRAHAM HOMES
ALASKA WATER & WASTEWATER
i DRAWN: GARNESS
4/25/97
ISCALE: 1' = 100'
PRDPUSED \CELL
PROPDSED 4
BEDRUOM HUUSE
HOLE
FDUN~AT]DN
NEW 1250 GALLON SEPTIC
~OU~LE
-TE~T H~LE fl
C/O
C/D C/B I C/U
CIO
IY TRI
ZABEL' FLB~ SPLIT'IER
E~ERVE TRENCHES
O' LUNG EACH,
SHES, 40' LUNG EACH,
~/ELL & SEPTIC SYSTEM:
PREPARED FOR:
PREPARED 3Y~
DATE:
L[]T 3, LANG
GRAHAM HDMES
ALASKA VA]'ER & ~ASTE~ATER
4/~5/97 DRAWN: GARNESS SCALE: 1" = 30'
TOTAL TI:~ENCH LENGTH
= 60 FEET.
TOTAL ABSORPTION AI~EA
= 960 SQUARE FEET (MIN.).
BACKFILL WITH NATIVE SOIL AND MOUND.
FABRIC SILT BARRIER.
2 INCHES OF BOARD iNSULATION IF SOIL
COVER IS LESS THAN 3 FEET. INSULATION SHALL
COVER THE ENTIRE WITH OF THE TRENCH.
2 FEET MIN,
TRENCH DETAIL: LOT 3, LANG BiD.
PREPARED FOR: GRAHAM HOMES
ALASKA WATER & WASTEWA TER SERVICES
DA TE: 4/25/97
NO TE:
4 INCH DiA. PERFORATED PIPE, WITH HOLES
DOWN. SHALL BE LEVEL WITHIN .01 FEET.
PLACE 2 INCHES OF ORAINROCK OVER TOP
OF PIPE. TOP OF DRA/NRODK SHALL BE AT
THE SAME EI. EVATION OVER THE ENTIRE
TRENCH WIDTH.
TUBE (TYP).
PERFORA TED IN DRAINROCK.
D WN: GARNESS SCALE:
1. TRENCHES SHALL RUN PARALLEL TO THE
SLOPE CONTOURS.
2. FOR LOOATION OF MONITORING TUBE,
SEE SITE PLAN.
3. OONBTRUCTION PRACTICES, AND MATERIAL
SPECIFICATIONS SHALL COMPLL Y WITH
ANCHORAGE MUNICIPAL OODE 15.65, "WASTE-
WATER DISPOSAL REGULATIONS".
4. INSTALLATION SHALL COMPLY WITH SPECIAL
PROVISIONS AS NOTED ON THE SEWER PERMIT.
5. SMEARED BOTTOM AND SIDEWALLS SHALL
SE RAKED.
6. DRAINROCK SHALL BE SCREENED PER M.O.A.
SPECIFICATIONS. DIRTY DRAINROCK WILL BE
REJECTED.
NTB
Municipality ol Anchorage ' '
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
PERFORMED FOR: ~__R~/~,~ {..}/~/y~ /L.J~/~ ~-..~
LEGAL DESCRIPTION: L~3-' ~/ ~-/,~, ~J~.
(ENGINEER'S SEAL)
DATE PERFORME
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20
COMMENTS
'p'l-/0 t...
WAS GROUND WATER
ENCOUNTERED7
S
IF YES, AT WHAT ~
DEPTH? P
E
Depth to Water AltF ~/7/~
~lonitoring? /V'/'J G" Oale:
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ I ~J~l"ll, /; /~ /="
~ $ 't-H~,O I: ,t~ //~N-"
PERCOLATION RATE--~ ~) {m~nute$/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~" FT AND ~ ~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES I
72-008 (Rev. 4/85)
Municipality of Anchorage ' ·
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ,~/'~¢~ ~/*V"~ ~/'O/'V1 ~"~
LEGAL DESCRIPTION: LOT' ~,~, L~,J~,,~ ~U[~,
DATE PERFORM[
Township, Range, Section:
(ENGINEER'S SEAL)
1
2
3
4
§
6
7
8
9
10
11
12
13
14
15
16
17-
18-
19
20
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~3
DEPTH? P
E
Depth to Water N~r J?Jeu
Monitoring? /~4 ~, ~ gale:
SITE PLAN
Gross Nat Depth to Net
Reading Date Time Time Water Drop
r~ ~/~l~U I:IZ IZ."
=cz.. /,,~' ~0 /L,'/~" 4'/~"
PERCOLATION RATE (~" ~' [minutes/tach) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~' ET AND . /'~ --FT
72-008 (Rev. 4/85)
· . :. CERTIFICATE. HEAL:TH AUTHORI'I:.Y '
. Complete I~al desm'~pfion LOT 3, I.~0 SUBDIVISION
Location (site address or directions) 405'0 '~ANET LEE,CIRCLE~' A~CHORAGE: - ,- ',
Current Property owner(s)
Mailing address
',L~nding age. ncy
Mailing address
Real Estate Agent
Mailing address
JERRY'~ CAROL;RANDECKER
4050 JANET LEE ClR: 99516
Day'phone.' ''522;7741
· - uavonone., '. ·
Day phone
Unless o~herwise requested, HAA wi#be he/d by DSD forplckup.
2. NUMBEROF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL.'
Individual On-site ' ~
Individual Holding lank
Communlty On-site
Public Sewer ~[~
The Municipality of Anchorage Development Services Department (DSD) Issues CerUficates 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 sewed by a slngle family on-sita wastewater disposal and/or
water supply system. DSO also Issues HA/~ upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties sewed by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Ceraficates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties sewed by Class A or B
wells or a public water system. The Munlcipality of Anchorage Is not responsible for errors or omissions In the
professional englneer's work.
Note:Alaska Water and W. astewator Consultants, Inc. shall be pald $1OOO. OO at, or pdor
to dosing for I~ enginee~ng services provided. - .' .
4.' STATEMENT OF INSPECTION BY ENGINEER · ~ ·
As certified by my seal affixed hereto and as of the val'~ab'on date shown below, I verify that my
Investigation, based on procedures outlined In the Health Authority Appr~l GuidelineS'for this app#cab'on,
shows that the on-site water supply and/or wastewater disposal system Is(are) safe; functional and adequate
for the number of bedrooms and ~e of structure indicated herein..I further ve#~, that based on the
Information obtained from the Municipality of Anchorage files and from my Invesb'.~lation and Inspection, the
on-site water'su~)ply and/or Wastaw~ter disposal system Is(are) In compliance with all applicable Municipal
and State codes, ordiha-nces, And regulations In effect at the time of Ins.tallation.
NameofFlrm ALASKA,WATER.&: WASTE'WATER CONSULTANTS. INC.' Ph(~ne ,.357-6179
'Address. 6901 DEBARR ROAD. SUF[E 2B * ANCHORA(;E. AK 99504 .
Engineer's Printed Name JF.I-I. kEY A. OARNESS. P.E. Date I
Engineer's Comments.;
In conducting this ~alua~o~, AWWC, Inc. attempted to I~:Mde a thorough,
· consdentious eng/nearlng ana/ys/s of the systew In ocoor~ance ~ ADEC and MOA
DSD Guidelines & Regula~fons. The relx:~ted results described the perlormanco of the
system under the co~dillons encountered at the time of the tost, and separation
distances measured to readily Identifiable features. The operational lifo of all wells and
septic systems depend on the local sells condition, groundwater levels that may'
flucluate during thee'ear, and the water usage of the family being served by the system.
These conditions are ou~lde the consol of the e~aluator of the system. SatisfactoO' test
results do not guarente~ future performance of the system, nor do they guarantee that
there are no h/dden defects or encroachments. AWWC,/nc. can therefc~ not proylde
any warranty or future estimate of how long the system v, fll continua to meet the'
operatlonal requlrements of the ADEC or MOA DSD. Tho content of this report Is f~'
the solo benefit of the owner 8sted above. Any reliance upon or use of this repmf by any
other pe~'~on or party Is not auff~orized, nor wfll it confer any l~gal tfght whatseayer.
5. DSD SIGNATURE
I//- Approved for /'~ bedrooms.
Disapproved.
Conditional approval for __
Attachments: HAA Checldist
Septic System Advisory
Well ,Flow Advisory
ManItenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Bufldlno 6~;*~t*j DIvIMoo
On-Site Water & Westewater Program
4700 6ou~ Bragaw ~t.
P.O, Box 196650 Attchorage, AK g9519-6650
legal Dasedption:
WELL DATA
Weft b'Pe Pmv^'rg
Datecompleted 2/6/9e
Totaldeplh 181 It.
Date of test
Static water level
Wen preduction
WATER SAMPLE RESULTS:
HEALTH AUTHORITY APPROVAL CHECKLIST
· LOT 5t LANG SUBDMSION Parcel ID: 015-275-58
Foundation cteanout (Y/N) YES
Date of pumping 12/4/00
C, ABSORPTION FIELD DATA
Date Instafled 8/9?
Length e0'+ ft.
IfA. B, Or C provide PWSlD~
6anltefy seal (Y/N) YES
Casedto 181 it.
FROM WELL LOG
2/6/9
140 .It.
12 .g.p.m.
Coliform 0 colonies/100 nd. Nib'ate .705 mg./L.
Date of sample: 4/24/01 Collected by:.
SEPTIC/HOLDING TANK DATA
Tank Type/Material ~I~EL
TanksIze 1250 gal. Number of Compartmente 2
Dapresalon over tenk (y/N) NO
Pumper.
PBD.OW FINN. GRADE:I
Son rating ~ ttYedrm) .8
wen Log (Y/N)
wires property protected (Y/N)
Casing halght (above ground)
AT INSPECTION
4/24/01
140 .It.
6.7 .g.p.m.
18'+ In.
Other bactefte 0 colonies/100 nd.
AWWCt INC.
Date Installed 6/97
(3eanoute (Y/N) YES
High water alarm (Y/N) N/A
A+
System type TRENCH
Gravel bek~v pipe 6.2
Width 2'+ .ft. ft.
9.6-10,8 WTCST
Toteldepth9.8-1o,8 gASTft. Eff. absorption area 992 ft" Monl~tube YES Da~overflald NO
Oateofedequacytest 4/24/01 Results(pas~=all) PASS For 4 bedrooms
Ruld dep~ In absorption field before test~ In. Water eclded'*818/569 gal. New depth 22.5/53.25 in.
~2OC) +
E]apeedTIme: 1410min. Finalffulddepth 1.5/45.5 In. Absorp~onmte>= ...m g.p.d.
Any mJuvenaUon treatment (past 12 mo.) (Y/N & type) NONE KNOWN If y~s, give date -
*'1145 TOTAL
D, UFT STATION
Date Installed Size in gaffons ~~ _
'Pump on' level et In. 'Pump n. Hlgh water alarm level et In.
~ Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES
8EPARATION OISTANCES FROM Wr; ~ ON LOT TO,'
Septic tank/lift station on lot, 100'+
AbampUon field on lot. 100'+
Public: ~8wer main N,/A
Sewer/septic sendce line 25'+
On adjacent lots, 1 oo'+
On adjacent Ints. lOO'+
Publlo sewer manhote/cleanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field 5'+
Surface wate£ lOO'+
Building foundation 5'+ Property line 5'+
Water main N//A Water sendce line 10'+
200'+ PUBMC
Wells on adJacent lote ~m'. PYT
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property llne 10'+
Water service line 10'+
Cutteln drain NONE KNOWN
F. COMMENTS
Building foundafion 10'+ Water main N/A
Surface water 100'+ Driveway, parking/vehicle storage
200'+ PUBUC
Wells on adjacent Ints. 100'+ PVI'
G. ENGINEER'~ CERTIFICATION
I cerUfy fiat I have determined ~hmugh field inspections end
review of Murdclpal records that the ebove systems ere In
conformance with MOA HAA guidelines In effect on ~his data.
Englnee Printe¢ Name
Date
HN Fee$
Date of Payment
Receipt Number
(Rev. 12/00)
WaKer Fee $
Date of Payment.
Receipt Number
APR-30-OI 16:dO F RolJ-
,~r~ CT&E Environmental Services Inc.
T-156 P.02/0t F-23l
CT&£ Ret'.#
Client Name
l'ro] et't Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Sample Reroadc~:
10120410O1
AK Water & Wastewater Comultants Inc.
Lan; S/D Lot 3
Lang S/D Lot 3
Ddnkiag Water
0
Results PQL Units Method
Client POg
Printed Date/Time 04/30/2001 15:17
Collected Date/Time 04/24/2001 9:00
Received Date/Time 04/24/2001 15:40
Technical Director Stephen C. Kde
Released I1~ ~
Allowable Prep Aaab-sis
Limits Date Date Init
Nit~ate-N
0.705
0.$00 mg/L EPA 300.0 10 max 04/24/01 SCL
M:Lcrob:Lology Laborat:ory
Total Coliform
0 col/100mL SMI89222B
04/'24/01 KAP
MUNICIPALITY OFANCHORAGE
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
Parcel I.D. # O / ~;' ~ ¢,1...-I,:¢ --
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
Lending agency .,~-'"
Mailing address,
Day phone.-~-~
Agent ,.~M¢,(~- L~,~u,-(~_,/ (~¢-Z~ i,b~-CC~.~qT~J2~(~-~a~y--phone '7/¢ ~- '~/c/,Z
Address / ~I g ~
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-
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-O25 (Rev, 1/91) Fronl 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 cum )liance with all Municipal and State codes,
ordinances, and regulations in effect on the date of~f
Name of Firm A!~ka Water ~ Waste/Cr~. t~
,, 7320q~t C./hCster l-,14'S~circl
Aaa ress ./A .oh ~ra6d Ala~kiVp9504
Engineer s signature (V~~
DHHS SIGNATURE
I/' Approved for
inspection.
Phone
Date
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.
72-025 (Rev. 1/91) Back MOA ¢ff21
Legal Description:
A. WELL DATA
Well type D¢~-~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
RECEIVED
Municipality of Anchorage ~
DEPARTMENT OF HEALTH & HUMAN SERVICES JU~I '~ 0 1998
Environmental Services Division CHO~..~_J
,9_~jN~CI~ALt~ OF AN
825 L Street, Room 502 · Anchorage, Alaska 99501 · ~ ~¢[~,~f~WCES D[WSION
Health Authority Approval Checklist
If A, B, or C, attach ADEC letter. ADEC Water system number
~ Date completed.
t ~ / Cased to / 9/~
Casing height (above ground) /'~
Wires properly protected (Y/N) "-/F.E_.C.'
FROM WELL LOG
g.p.m.
AT INSPECTION
g.p.m.
WATER SAMPLE RES~/~.TS:
Coliform
Date of sample: ~ /~/'~'~
Nitrate
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~ ~"
Foundation cleanout (Y/N)
Date of Pumping h,.! ¢.-.--,..~
C, ABSORPTION FIELD DATA
Date installed ~/~
Length ~t.l_ Width
· . '-J { [ ~,,,~-/J~, Other bacteria
Collected by:
Tank size I ~.~-'O "~ (Y/N)_.,.~
Number of Compartments --- Cleanouts
/
Depression (Y/N) ,k,/O High water alarm (Y/N) /~J lA
· ' Total depth ~]. ~'-/~. ~, (_~-~, ~
_ Depression ever field (Y/N) fi JO
Pumper
Soil rating (g.p.d./ft2 or fF/bdrm) "~'
~ (4- Gravel thickness below pipe
Effective absorption area ~c/'Z- Monitoring Tube present (Y/N) ~'
"~ Results (Pass/Fail) For bedroo~'-~
Fluid depth in absorptio~ __ Immediately after, gal, water added (in.): __
Fluid depth ____ (ins) Minutes later: __ Abs~e-~..._.~_ g.p,d,
_.~Peroxide treatment (past 12 months) (Y/N) ' ' ' ' ' If yes, give date--~_...~~
72-026 (Rev. 3/96)*
LIFT STATION
Date installed ~
Manhole/Access (Y/N) ~' level at* "Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots
/
Public sewer manhole/cleanout ~d ~
Lift station /"')//~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~' r-l- Property line .~ ~ Absorption field
/ Jool'~
Water main/service line /O -~ Surface water/drainage /'00 '/- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line / O /'~ Building foundation /0 ~"f' Water main/service line /0 /'/~
Surface water [00 rj~ Driveway, parking/vehicle storage area ~-O
'
/On -~
Curtain drain M Wells on adjacent lots '~oo/ e
F. ENGINEER'S CERTIFICATION ~
fit
I certify that l h~e d~rmin~ff~q field inspections and review of Municipal reco~¢~
in conforma~¢o ~i7~ zyoli~osinoffect on this date. '~
Signature [ PJ~ (~
Engineer's Na~ ~ ~J~ ~ ~~
//
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
CT&E
Client Name
Proj ~:t Name/#
Ord~r~ By
PWSH)
982'74-4001
AK Water & Wa~tewaer Services
Lot 3, Lang fi/D
L~t 3, La~8 ~/D
0
Client PO#
l~'Intefl Dzte/Tkne 06/0B/98 I5:55
Coll~t~dDatefrime 06109198 16:15
R~eeived DatdTime 06105/98 10:25
Technical Director: Stephen C, E,Je
ALLo~ebLe Prap An~Ly~i~
Lim~ Date Oete
I 0)/ 100 ML/ NO COLI
0.711
0,100 ~/L
