HomeMy WebLinkAboutMCKINLEY VIEW ESTATES BLK 2 LT 10
Municipality of Anchorage Page
Development Services Department
Building Safety Department
On-Site Water and Wastewater Program, 4700 $. Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.cLancflorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW000327 PID Number: 05:1-792-14
Name:
Linda Longnecker Wastewater System: New [;~ Upgrade
P.O. Box 877270 Wasilla, AK 99687 ABSORPTION FIELD
688-:1236 Three (3) aO.~T~.~ aS~,T,.~ n..
LEGAL DESCRIPTION .8 c~o~e 8
2 10 McKinley View Estates 7 ~. 1
.5 ~. 100
w.,,: [] New [].pgrade 5 ..
Class A .. F,.575 r~ ASTM D3034 PVC
F,.MM&M Contracting: 9/30-10/4/2000
¥.: c,~l e.,,,, s..: ..i c.~, .,~.,o.. c,..~:,~ TANK
SEPARATION DISTANCES Ig sepuc n Holding n S.T.E.P. r-I Other:.
SepUc AbsorpUon Lift Holding ~bllc/Pflvate ~ac~e~:
Tank Field Stafio~ Tank S~,~U~ Anchorage Tank 1,000
w., >:100 >100 N/A N/A >100' Steel Two
~w... >100' >100' N/A N/A ~ / LIFT STATION
~. >5' >:10' N/A N/A/~ ~": o.,.
.,.,~o. >5'. >10' N/A N/A ~,. ~,. .
c~,,~. None Noted ~"~"~'"~
"'""~: BENCH MARK
t. XlStlng beptlc lank Removed ~rom ~ite. Lot is
c ..... ,~ =,, owc,n ~ 2!0~97. &--xl'~r'~'J& 'T"n,,,~ Concrete Stoop at Base of Steps
Engineer's Stamp
Inspections performed by: MEA Dates: 1" 9/30/00
2"~ :10/4/00 .... - · .'-~-'~.~,,
Department of.. ,/ .~ Health and Human.,,~ ~,_Services approv
· .....
Municipality of Anchorage Page 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DMSION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW000327 PID No. 051-792-14
A
Sl 25.6 25.8
S2 30.9 30.5
C3 59.1 40.1
M1 37.2 58.2
M2 68.1 54.7
C4 37~ 58.2
C5 68.1 54.7
LEGEND
S - Septic Vent
C - Cleanout
M - Monitor Tube
SV : - Splitter Valve'
$1
c:
PLAN AS-BUILT
SCALE 1" = 40'
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAl. SERVICES DMSION
P.O. Box 196650 - Anchorage, AK 99519-6650. 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 3 of 3
Permit Number SW000327
PID No. 051-792.14
16'
93.t
Drainfield
92.0
99.1
Geotextile · ' ~abr~c .... ' ' ·
PROFILE AS-BUILT
1" = 10'
q;¢;;.;~ ..... ,;;~ ~ ·
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage. AK 99519-6650
(907) 343-4744
IO- ®
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 24, 2000
Expiration Date: Aug 24, 2001
Permtt Number: SW000327
Legal Description: MCKINLEY VIEW ESTATES BLK 2 LT 10
Design Engineer: 0014 Anderson Engineering
Owner Name: Country Realty
Owner Address: PO Box 670495
Chugiak, AK 99567-
Parcel ID: 051-792-14
Site Address: 022519 CENTURION DR
Lot Size: 20087 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify 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: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date: - 24- O0
FAX MEMO
TO:
WITH:
FROM:
DATE:
SUBJECT:
Dan Roth
DHHS
Mike Anderson
September 29, 2000
Lot 10, Block 2, McKinley View Subdivision
Septic System Design
MESSAGE:
The groundwater .level .In the test hole for this Job is at 12.5' below the ground
· surface. This is a more accurate reading than shown on our test hole log
because that reading was taken after heavy rains and the looseness of the test
hole soil.pro, bably attracted the mols. ture from the heavy rains the entir6 week of
the momtorlng period. The level is now stabilized and appears to be more
accurate as we are approaching the normal high ground water period for the year.
We need to mo.d. lfy the design of the ab.so, rptlon trench due to the elevation of the
service line exiting the house. The ongmal septic.tank has failed a,nd must be
replaced. Unfortunately the Inlet of the tank i.s ap. proximately 6.5 below the
ground surface which means the distribution p~pe in the trench must be at 7'
below the surface. The total depth of the trench will be 8' which allows a 4.5'
buffer to ground water. Two trenches will now be required each 50' long and 5'
wide. We are unable to u.se a flow divider because.it requires a 6" d~op in grade
whlch we can't achieve in this case. Please rewew the attached design and
modify the permit accordingly. Thanks.
2 Pages B~ing Transmitted. Please call 522-7773 if there are any problems.
Z/I 'd 8~69'0N ~dlO:Z 000~ '6Z'deS.
L.e--r- lC), /~'~.
~3 ooo ~?~7
Z/Z 'd 8Z69'°N :.. ~d~O:~ 000~ '6~'deS
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX) '..
August12,2000
Municipality of Anchorage . .
Department of Health and Human Services
825"L" Street '
Anchorage, AK 99502-0650
Subject:
Lot 10, Block 2, McKinley View Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Eng~neen
The existing absorption tren(~h currently serving the three bedroom home on the subject
lot will not pass an adequacy test and cannot-be certified for a Health Authority
Approval. We are therefore applying for a permit to construct a new septic system on
the lot to serve the home. The attached Site Plan and backup documentation identify
the location and configuration of the new septic 'system and the parameters used in the
design. The subdivision is currently served by a community water system so separation
distances from the water service line are easily met, The existing septic tank will be
uncovered, inspected and vedfied for continued use. It will be replaced if it is found to
be leaking or structurally defective. .
A test hole was placed on the lot in the area of the new absorptio~ trench. Silty sand
was encountered with some gravel. The material percolated at a rate of 15 minutes per
inch. Groundwater was not encountered in the excavation but did develop at 11' below
the surface during the monitoring pedod. We have therefore designed a 5'. wide
absorption trench with 3' of gravel beneath the distribution pipe. The total length of the
trench will be 64'. The total depth of the trench from original grade will be 6.5' which will
be a minimum of 4.5' above the present level of the groundwater.
The ground surface on the lot is very fiat with only a moderate slop~ toward the east. '
The new trench will be constructed parallel to' the contours of the surface in
. conformance with Municipal requirements. Grading will be acccmplished to assure
surface drainage is away from the new trench. The existing absorption trench will be
abandoned in place as it is more than 8' in total depth from the surface and apparently
encroaching into the 4'. separation required from groundwater,
If the system is con{tructed in accordance,with our design the following statements
apply: .
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.
Lot 10, Block 2, McKinley View Estates
August 12, 2000
Page Two
2.. Th(~ system, if constructed as designed, wiil 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, wili 'hav~ no adverse impact on reserve
space,.either surface or subsurface, on any lots located in the area.
4.. The system, if constructed as designed, will have no adverse impact on drainage
pattems in the area. The current drainage pattern will be maintained.
Sincerely, .
II
'11
II
I
I
THIS P
~75.66
!
./
I /
/
./
· 13 / '
/'
./
/ / .
· ! /
AREA MAP
SCALE 1' = 100'
/.
/
/.
/
/'
/
/
/ b
SCOPE OF WORK:
1. Verify the Foundation Cleanout. Place New if Necessary.
2. Verify Existing Septic Tank for Continued Use.
3. Place New 1,000 Gallon Septic Tank if Required.
4. Place 2 Post Tank Cleanouts.
5. Construct New 64' Long X 5' Wide X 3' Effective
Depth Absorption Trench.
6. Abandon Existing Absorption Trench in Place.
7. Regrade All Disturbed Areas.
8. Revegetate Area As Required.
SITE PLAN
SCALE 1" = 40'
~ctive De'
LOT 10, BLOCK 2, MCKINLEY VIEW
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home 5' Wide Trench System
Perc. Rate: 15 Min./Inch 1,000 Gallon Septic Tank
Application Rate: .8 GPD/SF 3' Drainfield Rock
3 Bedrooms X 150 GPD 1.8 GPD/SF = 562.5 SF of Absorption Area
562.5 SFI5 LF (Width)*.57 (Red. Factor) -- 64.1 LF Trench Length
Therefore: Construct 64' Long X 5' Wide X 3' Effective Depth Al~sorpfion Trench. Flowline
Elevation in Trench to be 3.5' Below Original Ground Surface. Total Depth to be 6.5'.
Mound Over Trench to Provide Minimum of 3' of Cover.
NOTE:
TYPICAL WIDE TRENCH SECTION ,
. (NO SCALE)
· Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: ~
Legal Description: Lot 10. Block 2. McKinley View Subdivision
3
4
5
6
7
8
9
10~
13
14
15
1E
17
18
21
OG/OL
Some
Gravel
Was Groundwater
Encountered?
If Yes, What Depth?
Depth to Water
After Monitoring
Date:'
Bottom of
Test Hole
SLOPE
North
South
No
11' '
8/7/00
,~ ~. ~'~,Jj .L~. ....... ~',,. --¥
~..~4..-1"-[' ~5: ~
y.../,~_ ..,~:~.....,~.......?.,~,~; ._:,,;.. ~ -
Date Performed: -..."'
SITE PLAN
S
0%
L
O
P
E
Reading Date Gross Net Depth To Net
Time Time Water Drop
I 7-Aug 12:30 10"
2 1:00 30 12" 2"
3 1:01 9.5"
4 1:31 30 11.5" 2"
5 1:32 10"
6 2:02 30 12" 2"
Perc. Rate: 15 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 4.5 Ft. and 5.5 Ft.
Comments: Perc. Cavity Presoaked Prior to Test.
Performed By: Tim Kimbrough, I, ~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 8/7100
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 10, BLOCK 2, MCKINLEY VIEW ESTATES SUBDIVISION
GENERAL:
The scope of this project includes the placement of a new foundation
cleanout and the verification for continued use of the existing 1,000
gallon septic tank. If the tank is found to be unsound the work will
include the procurement and placement of a new 1,000 gallon septic
tank at the location shown on the Site Plan. Work also includes the
construction of a new 64' long X 5' wide X 3' effective depth absorption
trench at the location shown. Distribution pipe will be placed at 3.5'
below the odginal ground surface. The total depth of the trench from
odginal ground will be 6.5'. Mounding over the trench may be required
to provide a minimum of 3.0' of protective cover.
Construction shall be in accordance with the approved site pla~,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
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.
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 o--f
affected areas unless specifically agreed otherwise.
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 1,000 gallon septic tank must be be procured from an approved
source and installed at the location shown on the plans if the existing
tank is found to be unfit for continued use.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include Ko 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.
· Lot 10, Block 2, McKinley View Estates
August 12, 2000
Page 2 of 3
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.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall vedfy 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.
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.
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 F810 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).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
' ' Lot 10, Block 2, McKinley View Estates
August 12, 2000
Page 3 of 3
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:
Municipal Ordinance requires a minimum of two inspections. 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 excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfllled.
The second inspection must be conducted after the placement of the
geotextile fabdc, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME /~i ~
LEGAL DESCRIPTION
LOCATION
IInside length
-EW
P~'r '~-~N~ ~E~ {.~PG RADE
NO.~_.~EDROOMS
Dwellingc~ ~_..~ /
PER-MIT_NO. __
,o. of co~ynt,
Liquid depth
IDwelling PERMIT NO.
Material
[Nearest lot ,in~_~,~ ~-
/ ~ ~-~d~ .
/ ,
Foundation%~, /
Liquid capacity in gallons
-:~~tion area
PERMIT NO.
DISTANCE TO' t we/g/'~ _
Man u factu re,r/~ ,~ J
Liq'tz~t ~al'~~ IF HOMEMADE:
~,s,..c~,o: I"~''
i~umur.r
-- Wel ~ -
~~C~TO: /
~hnes~ ~ Length ~li~e
~ [~~ Top oftile~o finish grade
~ Width'
Type of crib ~
~~TO: w~
Depth
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
Sewer line Septic tank Absorption area(s)
OTHER
PIPE M AT E R I/~.~LS
INSTALLER
APPRO~~)
~_o,~,.i,,l~,~ m~
DATE~
LEGAL
I--1 L~ tP,t
C:
DEPFtR'!'MENI" HEALTH AND FN','IF.'nNMENT~L F~TEF:TInN
8;2 ..... '"L'" STFEET, At'-,CHORFIGE., FIk'. :.~
.......... e,- CONST ,::SAL RRELLO) F'O BOX 207:1.. E.R. 99577 '69¢.~4169
HFFL [ _.HN I ~,.~.:,
L 0 E: R T i 0 N
LEGFIL LiS B2 MCKINLEY L]~. ¢ ~ ~.%~.,;,¢:*~n~c~ ............. ~ LO]" SIZE '9'~'~9'~q~ qptlRRE FEET
T'-r'E'E OF SOIL FIE:SORF'TIZN z,¥z, TEH IS: TRENCH
MRXIMLH t'IUME'ER OF EEDRCEHS = ~: SOIL.. RATING ,::SL.] FT,-"BR)=
THE REPl IF. tED SIZE OF THE :.LIL HE, z, UF..PFILN SYSTEM
THE LENGTFI DIMENSION :ES THE LENGTH ,.'.'IN FEET::, OF 'THE TRENCH OR DF:AINFIELD.
'' -' IS . -"1
THE DEPTH ElF R TF. EN_.FI OR PIT THE DISTAHCE E, ETI.~EE.I-,. THE SURFACE OF THE
........ "'lTM -
3Rl~ NJ':, AND THE E:RTTF~M ElF THE E,.,...HCMTIJN (IN FEET',
THERE tS NO SET WIDTH FOR TRENCFIES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OLrFFALL PIPE
AND THE E:OTTOM OF THE E',dfZ:RVFiTION ,:.'IN FEET).
t I .' ~j
PERMIT AF'F'LICRNT HAS THE F:'E_-,F_N.:,IBILIT.r TO INFORM THIS [:,EF'RRTMENT DURII',IG THE
INS'T'ALL.ATIEd'.~ INSPECTIONS OF FINY .WELLS AD TFIZENT TO THIS F'ROPERT'¢ FIND THE
NJMBER ElF RESIDENCES TFIRT ]"HE WELL WILL SER',,,'E.
BACKFILLING OF FINY S'.r'STEM WITHOUT FINAL INSF'ECTION AND RF'F'RO',,,'AL BY TFIIE;
DEPARTMENT WILL BE '.--;IIB.¥EF:T TO FRO::,EL. UT.uN.
MINIMUM DISTANCE BETWEEN A WELL FIND FtNY ON-SITE SEWAGE DISPOSAL. SYSTEM IS
100 FEET FOR A PRIVATE WELL OR t50 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF F'UBLIC WELL
MINIMUM DISTBNCE FROM B PRIVBTE WELL TO A PRIVATE SEWER LINE IS ~5 FEET BND
TO FI COMMUNITY SEWER LINE IS 75 FEET,
OTHER REQUIREMENTS MAY FIF'F'LY. SF'ECIFICATIOI'.,IS AND CO!'.,ISTF.'.LICTION [:,IRGF.'RMS ARE
R',,,'RILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THAT
::L: t AM FFIMILIFIR WITH ]"HE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPRLIT'¥' OF FINCHORRGE.
2: I WILL INSTALL THE S"r'STEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTRN[:, TF'IAT THE ON-SITE SEWER SYSTEM I"lFf¥' REQU2RE ENLFIRGEHENT IF THE
RESIDENCE IS REMODELE[:, TO IN. CLUDE MORE THAN
SIGNEr.,: .......2__'x_:£ .... ;- - ~.;"?.. ............................
AF'F'L I CANT FI&S COt'-,I:;T (';AL FIRE[ LC :,
,-,- ., ,,~ ' ::' ( "',: ': /- .
~l~ssell Oyster
694-2774
O&E
Performed for: Narne:.
ENL~,NEERING & DEVELO,
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
MENT
CO.
SOIL LOG
Tel. No._
Mailing Address:
Legal Description:
Earl Elil~
688-2280
Depth (feet)
1__
2__
3__
4__
5__
7__
8__
~10 __
11__
12____
14__
16____
Soil Characteristics
Ground Water Encountered: Yes.___
Proposed Installation: Seepage Pit
Comments:
_ No__
If yes, what depth
Drain Field__
PLOT PLAN
PERC. TEST
Performed by: Date:
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
DATE PERFOR[VIED:_O[:~' ~'~r
LlO
SLOPE
SITE PLAN
10
11 ENCOUNTERED?
1 2 IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time ¢~,i~'~ Water Drop
;~ f~ ~ ~ , .
14
15
16
17
18
19
20
PERCOLATION RATE ~ [ r~ (minutes/inch)
TEST RUN BETWEEN . ~-- FT AND 2 '~/'~_ FT
72-008 (6179)
ALASKA
WAS GROUND WATEfl
ENCOUNTER£-D?
IF YES, AT WHA, T
DEPTH?
5
6
7
8
9
10
1/
t2
13
14.
lfi
17,
20-
'tH g
Gross Net Depth to Net
I If;adiP9 Date Time Time Water Drop
PERCOLATION RAFE ..................................... (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: ~ eer,{ GEFITIFIEt3 BY: I)ATE:
APPLI( ,NT FILLS OUT UPPER HAl ONLY
Property0wner ....~-/~.~...~/~.~._ x,~.~f~ ~/~i~,'~A ~.~ ~~ ...... Phone
Address ,~ ~ '~ ~.~ ,( ~.~ .~,~,.~. ~ ~,/~. Zip Code
Lending Institution ~ / ~ ~ // Phone
Street Locati~ A//&: '~ ' ' ' '" ' -
Type of Resi~nce
~Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ Individual Year individua[ ~nstafled:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Insp~tor Insp~tor Insp~tor
Field Notes: ~/~I]i~ICtPAI~TY OF
l)!~)~' ,- ,,
~:h[Vl:;: .), 4,', ,:: ............
, ::: :
( ) DIS~BOVED
( ) CONDITIONAL APPROVAL*
O*T~ /~. ~_ ~ ¢ Z.~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
[~ ~ Z Well to Tank Septic T~k Size
72.023
; - .,.'- . ,.*:.- ,Department of Health:and Human.Servmces :.,, .: .,-
. ,., , ~ . ., ~ .. .......~.a,~.~..a~, . ...,,.~ i , ,.. -: ...... ,~ .....
·. CERTIFICATE OF H~bTH AUTHORI~, APPROVAL ......
Cu~ent Prope o her s LlndaLongn~ker .... ,'. ','. .... Da one ~1236,
, Mailing address · P.O. Box8~270.,Wasilla,'AK99687; : .- ....... ',, '.
Mai~i~g add[ess'.' ' + J
IE"-SA" nt"' ' ' ' " "' ' ' ' "' ' ' "/'""" " ' "'"
: Un ss othe~is~ ~ ested, ~ willbe ~Id by DHHS rp kup. ~ picked up b~ ....
"OMSER OF BEDRoOMs:
3. '. TYPE OF WATER SUPPLY:
-. Individual Weli
,, . Ind!vidua_l Water S!orage..
; Community Cla~s_A-Weft
Public Water System
'th ~ (3) .... ' ' '
.TYPE oEWASTEW~TER DISISOSA~.; , - ', '.
Individual On-s -," ,
Indi~iduAl Holding t~nk,'." "' '" E]: ·
CommuntyOh-site *' , ' '- E]~': "' "'
Public Se{ver E]:
The Municipality of Anchorage Department of Healih and Human Services (DHHS) Is~;ues Certificates of Health
Authority Approval (I-IAA) based only upon the rep~:esentations given in paragraph 5 by an Indel~n. deht pr0fessk{nal, ,
civil ~ngineer registered in the State of Alaska. Certificates of Health Authority Approval are'required for th~ trar~sfer, ',
of title (except between spouses) on propedies served by a single family on-site waste~ater disposal and/or.water .
supply system.' DHHS also issues HAAs upon'request to home oy~ners: Certificates'of Health'Authority Approval",
are valid for 90 days from the date of issue for properties served by a pdvate or Class C ~/ell and may be reissued
· with new water sample results less than 30 days.old. Cedificetes 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 respons~le fo~: errors or,
, omissions in the professional engineer's work. .
'5.- STATEMENT OF INSPECTION BYENGINEER :. ;,.;-: . '~ ;,'/. ',". - · .... ",
~,~ c~--tified b~ 'mv"~:,~al ~ffi~ed h~'~t~ a~'~d'~ ;of ~ valMation date sh~ ~197 I v~ ~at,my
r ~;~ ~" '~ ~"~ '~h '~ i~t~ H~ th ~Au~ ~proval Gu~d~nes f~ th~s ~lth
· '- · - '*. ' ' ................... t ater d~s a ,s tem'~s ~fe..~ncbon~
'~h~h~ ~'~ h'U~f ~ ~hd ~ of ~cture i~d~t~ herein..~ m~,v~
nfn~t ~n* ~bta h~ fr~ t~ Mu~ c ~ ~ of ~a~ files'and from my investlg~fion pnd m~bpn. ~e
sit~'W~t~'s~olv ah~ ~te~ater'd sposal system ~s in ~mpha~e ~th all ap~ble. ~umc~pa~,~nd
Name of F~rm. ~demon Enflmeennfl.: ........ "' '" ~''' ' -'~ ~'~'; "' :. *P~5~ev'5~-~3
. r ss P..B ~ chom ,,, .:.,.
Eda nee~ PHnted Name '-. Michael E. Andem6n. P.E. "- - ~ . . Date '- ~10101
. . . .... , . . ~, . .~..~ ~~ ~~...~.y..~..,~,...~-.t...'~ . .
6. DHHS SIGNATURE , ' 4t~,:.. ....... :.~e~ '
Approvea~or, .'J- Dearooms,: ' , . , , · :.' , ~ ',..?~t~- .
· Disapproved.' ~ · : ,'. · ,,.'. ' · :' · ', ;, - .' ,
'bed ~ tip
rooms with the f611owing s utations: .r.
. Conditional approval for .....
Additional Commen~s
Attachments: HAA Checklist
Septic System Advisory
Well Flow Advisory
Expiration Date: L.~ , I I ~
(~ev. 1(~)
X
Maintena.nce Agreements
Supplemental Engineer's Report
Other
Original Ceflificate Date: /-//- //- ~ I
Reissue Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Pragmm
47OO South 81~gaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci,mx:horage.al~us
(go7) 343-?g04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal De~atplkm: Lot t0. Block ~, Uddnle/View Eot~te~
A. WELL DATA
wea type C~uA.
Talal depth --
Be
If A. e. ar C pmvlde PWSID # 211~"97
FROM W~ i LOG
Date of tes~
StaUc water ~
we~ ~r°%~an
WATER ,~IPLE RESULTS:
Cdiform calonles/100 mi.
Date of sample:
SEPTICMOLDING TANK eATA
Tank TyTm/Matmlal Steel
Ta~tk size 1,000 gal.
Date of pumping
ABSORPTION FI~,.D DATA
ft.
g.p.m.
Number of Campam'nente Z
Dalxession over tank (Yfld) N
~ mUng (g.p.dJf~ ~ ft2A:)drm) · GPO/SF
Wiclth .5 ft.
CJ
Length t00
Tc~al depth ~ ft.
Parcel ID: 051.T92.14
wea tog (Y~)
Wires.properly protected (Y~l)
casino heght (above eround)
AT INSPECTION
ft.
g.p.m.
aeanou= (Y/N) y
High water alarm (Y~I) N
System type 5' Wlde Tfendl
Gravel t~ow pipe 1
Eft. e--hs'~P-- tJon ama 575 ~ Monitoring tube Y Depression Qver field N
Re~u~ (Pas.~FaU)
Fluid depth in absorption field before test in. Wate~ 8dded gal.
Elapsed Time: min. Iqnal fluid depth in. AJ3~orpaon rate
Any rejuvenation treatment (past 12 mo.) O'/N & t~tpe) N
Far bedmams
New deplh in.
g.p.d.
If yes, give date N/A
D. MFT S'rATION
Date installed
'Pump on' level at in.
Datum
F_ SEPARATION DISTANCES
'Pump off" level et
Cycles tested
SEPARATION DISTANCES FROM WElL ON LOT TO:
Septic tank/lilt station ~n lot
N~scxption rmld on lot
Public sewer main
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & ~ n~luf~eme~ts?
On adjacent lots
On adjacent lots
Public sewer manhele/deanout
Holding tank
Property line ,>10'
Water Service line >10'
Curtain (hain None Noted
F. COMMENTS
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:.
Building f~undatlon >5' Pro~ line
Watermaln.4UA' [~'~ '~'~' Water sewlce line >10'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION F;;~ n ON LOT TO:.
Bullding foundation >t0'
Sur~ce water >100'
Wells on adjacent lots >100'
Water main >t0'
~, parta~hUe storage >25'
Waiver Fee $
Date of Payment
Receipt Number
Receipt Number
{Rev.