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Home My WebLink AboutPARK PLACE #1 BLK 1 LT 1Par'k Place Block ! Lot ! #020-092-70 , 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 PHONE []NEW E~UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well . DISTANCE TO: I ~ ~ Z Manufacturer I m Liq. capacity in gallon~ ) ~ ~ Man ufacturer ~ m ~ ~o. of lines[ ~en~th~of each~line . ~ ~ .~__ ' ~ ~ Top of tile to finish Length Nidth ~ ~ Type of crib Crib diameter w Well ~ DISTANCE TO: Class Depth ~ Building foundation DISTANCE TO: OTHER PiPE MATERIALS Inside length Dwelling IWidth , Dwelling Material Foundation~D.lf_.- ~ I~ /I Nearest '~ ' ~-fi~--I°t IL~.e rotal length of lines ~ Trenchz~__~ ~nches ~ Ce-~~ v]aterial beneath tile Depth NO. OF BEDROOMS PEBMIT NO. No, of co~artments Liquid PERMit NO. Liquid capacity in gallons P E~MJ.T NO. Distance between lines Total effective absorption area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO, Sewer line SOIL TEST RATING INSTALLER REMARKS Septic tank Absorption area(s) DATE LEGAL APPROVED 72-013 fRev. 3/78) DEPARTHENT 6 HEALTH FIND EN'v'IRZNMENTAL ~ 3TEC:TION ,~ L-]'25 '"[:'" "STREET., BNCFIORFIGE., FIPPL I CFINT SUN CONSTRUC:T I 01N I N ": SRFI E:OX 4742 RNL-:H. RLFtSKR _--.':45-±F.~:=:,a L 0 F':A T I 0 N - - - LEGFIL LFiT ± BI_l<: :L FMRI-... PLFICE SUE: LOT SIZE '~.9'-m.D?.'9 SLqI..IRRE FEET T'Y'F'E OF SOIL FIBSOF.:F'T'FOi'.,I '-'"- .... , ",'r,=, JEll I2;' TF.:ENIE:H MRi:':,'IMUM .klI..IMBER OF BEE:,F--:OOM2; = 4 Si]IL RFtTING (SQ Fl',.' "EF.'" ...... - ;=:?Pi- THE P-'E..-.~J'I'F. iED SIZE OF THE E:. E F" TH= :L ,i-~ [_ E] f-~ () T[-~= 7 7 uS E-: F~ %.~ E L [:, E F" T ~-~ =:: ,~] THE L. ENGTH DIMENSION IS THE LENGTH (IN FEET.':, OF THE TRENCH CE' DRBINFIEL[:,. THE DEPTH OF B TRENC:H OR PIT IS THE [:,I9TBNC:E BETHEEN THE SUE'FBE:E OF THE ~qR'] ND Bf',l[:, THE E:OTTFM ~]F THF ..... F'- ' .... ~ ....... ~,",-.H~HTILN (IN FEET). THERE ZS NO SET 14ZDTH FOR TRENCHES. THE GRAVEL DEPTH Z2; THE MINIMUM DEF'TH OF GRAVEL BETI.qEEN THE OUTFRLL PIPE RND THE E~OTTOM OF THE EXCR',/RTZON ,::ZN FEET::,. F-:EC.,U Z E-:El:::, :'_=;E:F'T Z C: 'T~l.-!~'-,t~-::: S Z ZE= .:.:L25(~ PEFd'"iIT IaPF'LTC:FiNT HAS THE RESF'ONSIE:ZLITY TO INFORM THIS DEF'RRTMENT DUF,'ING THE If'.bTHL_idTIUi'-,I INSPECTIONS OF FII'-,tY HELL'---; RDJFICENT TO THIS PROPERTY FIND THE NUME,'EF.: OF RESIDENCES THFIT THE HELL HILL SERVE. T tI..,-~ i~]~ ,:.:" ;-2 ::,, I i'-,!l ::'-'; F" E C: T' 1: C~ ~'-.i S R E-: E F-: E ,]:-.~ L~ I: F.: E E:, BFtC:I<FILLING OF Ftt'.,IY S","STEM HITHOUT FINFtL iNSPEC:TIFiN FINE:, FIF'PF.:O',,,'FfL E:"r' THIS [:'EF'FIF.:TMENT H ILL E:E SUE:..TECT TI]i F'E" _9-':,EL. LIT" I UN.- MINIHUM E:'ISTFINCE 8ETHEEN Ft HELL FIN[:, FtN'T' ON-':'SITE SEF.IFIGE DISF'OSFIL SYSTEM IS ::LE'~C~ FEET FOR Fl F'RI',,,'FITE HELL OF.: ':L5C'~ TO 2E~C'i FEET FROM FI PUBLIC.HELL [:'EF'ENDI!"4L-i LIF"L-~N THE TYF'E OF PUBL I"' HELL MINIMUh'I DISTFII",IC:E FROM Ft PR I ',,,:RTE HELL TO FI PRIVFITE SEWER LIIqE T'--, ':.=25 FEET RN[:, TO FI 130HMUNI-F'-F' SEHEF.: LiNE IS 75 FEET. HELL LOG2; FIRE REQUIRED FIN_F:, MUST BE RETURNED TO THE F:,EPFtF.."FMENT WITHIN 2:C'~ DRYS F~F THE HELL COMF'LETTON. OTHER REQUIF.:Ei'"IENTS MFIY t'3PPL"r'. .=,FE..TFIL. PtTIFH'-,I'--;'- ' F' .... _. _ FIND C:ONSTRUCTION r':,TFIGRFfMS .FIRE FI'v'FtILFIBLE TO INSUF.:E FR_u-ER' 'F-' ' iNSTFILLRTION. I CERTTFY THAT i: I RM FBMILIBF< HITH THE REC~~IREMENTS FnR ON-SiTE SEHERS BND 1.4ELL~ fl~ SET FORTH E~'T' THE MUNICIF'RLITY OF RNCHORRGE. 2: I HILL ZNSTRLL THE SYSTEM IN RC:C:CIRDRNCE HITH THE CODES. 3:: Z UNE:,ER$TRND THRT THE ON-SITE SEHER SYSTEM I'"IRY RE;~IJIRE ENLRRGEMENT IF THE RESIE:,ENI]E I$ REI'"IOD~LEE:~O iNCLUDE MORE THRN 4 BEDROOP'IS. ~'~).~INT; ~'~ ~:ONSTRLIC:TIOIN INC. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~/ 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: ~" /(~ LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10- 11 12 13 14 15 16 17, 18- 19- 20- COMMENTS ~.~O ~/bc[c~ PERFORMED BY: /'~o.~.- SLOPE SITE PLAN WAS GROUND WATER S ENCOUNTERED? , /}O L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time (~i~,~ Water Drop ~1 ~1,) P.~o 8-,8 ~z',fl _ _ _ Z ~ o~:ee lO i-5 I PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch} OATE: 72-008 (6/79) ]BOX 1~9, STA. R I~.OUTE A ANCHORAGE~ ALASKA oo DRILLED AT THE RATE OF PER FOOT. ' PROPERTY oWNER ' LOCATION OF WELL SITF, DRILLER WELL LOG: 0 .....16' 16 .... 37' 37--i-48' 48---225' Bed.,wcL, Sed,~~ ~oc..L, 140--144' 186--189' 217--221' 180 ¢z.L~ pet Aoet Co~Z o~ Ba~Ll~¢: ~4500.00 COST iNCLUDES ALL LABOR' AND MATERIAL FOR COMPLETION Of SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~4~00.00 THANK YOU VERY MUCH. DATE BERNIE CLAUS OF R.~M. PART DRILLIN~ WORKS · .081 ,/ I ~ {~"~ 7e.b 'lZUh l Municipality of Anchorage Development Services Department Building Safety Dlvlslo~ On-Sita Water & Wastewater Progmn~ 4700 ,South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650. www.cLsnchorage.ak, us (507) 343-7~04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-092-70 1. GENERAL INFORMA~ON Explmtlon Date: CompletelegaldescrlPflon PARK PLACE ~I.LOT 1, BLOCK 1, · Location (site ad(~essordiractions) ..... 16801 Be.~JEAN ., :; ,currer~t ProPerty ownei~s) Lending agen~'.: .';,? -'-..,= Maili.ng eddr~s Mailing address · MATr &*JUi. IE SIEVERT' "' "'i" .*~ ;.Day. p.t~.ne.~ 564-1669. .. .... 16801 BLI uJEAN '- '~. Dl~y phone ' · KRIS ABEGG,/PARAGON PROPERTIES ;' Dayp.hone: - · 349-1200 311~ 'C' ST. SUITE 115 ' ' ' Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3. 'i~'PE OF WATER SUPPLY: Individual Well * ' ~ Individual Water Storage Community Class Well ~___ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site '-' IndMdual Holding tank Community On-site Public Sewer The Municipality of A~chor~ge Development Sen/ices Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional oMI engineer registered In the State of Alaska. Certificates of Health Authority Approval am ..mqulrad for the..fl~, nsfer of title (except between spouses) for properties served by a single family on-site wastewater disposal aha/or water supply system. 'DSD also Issues HAAs upon request to homeowners, codJflcak~s of Health Authority Approval are valid for 90 days from the date of Issue for pmpertiee served by a private or Class C wall 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 );ear for properties served by Class A or B wells or a public water s-~,stem; The Municipality of,anchorage is not responsible for errors or 0mis~t .ons !n the pmfesslonal engineer's work. Note:Alaska Water and Wastewater Consultants, Inc~ shall be paid $1258.75 et, or prlor to dosing for the engineering sawices provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my saal affixed hereto andes of the validation date shown below, I ve~ that my inves~gation, based on procedures outlined in the Health Au~ Approval Guidelines for this application, shows that the on-site water supply and/or wastswater disposal system Is(are) safe, func~onal end adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal NameofFirm ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone 337-6179 Address 690;I DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. CARNES$. P.E. D~te / Engineer's Comments: .................... ' In conduc~ng ffils evaluaUon, AR4&'C, inc. ettempted ~o ~ a ffx~gh, ...... consden~us englnewing analysis of rite system In accordance ~ ADEC and MOA DSD Guldellra~s & Regulaffons. The mpotted resufts descdbed lhe peffonnance of ff~e ....... · Ystem unde~ th, e conditfons encountemd at ~he grne of ~he taet, and sepera~fon results do not guarantoe future ~ oHhe systsm, nor do ~y guarantee lhat 5. DSD SIGHATURE ~ 'Approved for Disapproved. Conditional appmva! for ~ bedrooms, with the fllowlng stipulations: "'Attachments: ~ '. ..... HAA Checldlst . : Septic System Advisory · Well Flow Advisory Manltenance Agreements Supplemental Engineer's Reor~ original Certificate Date:' Municipality of Anchorage Development Services Department Building Safel~ Olvt~on On-S~ Water & Wastewater Program 4700 ~ Bmgaw St. P.O. Box 196650 Ancta3rage, AK 99519-6650 w,d~homge~cu~ Legal Dascrl~on: WELL DATA Well ~ m~VA~ Date completed Total depth 69' Be Ce HEALTH AUTHORITY APPROVAL CHECKLIST LOT 1r BLOCK 1 PARK PLACE ~1 Pan.lID: 020-092-70 Date of test Static wa~r level 42' Well production 8 WATER SAMPLE RESULTS: Collfonn 0 colonies/100 nd. Date of sample: 5-16-01 SEPTIC/HOLDING TANK DATA If A, B, or C provide PWSID~ N/A 8-31-83 Sanltery seal (Y/N) YES It. Cased to 40'+ ft. FROM WELL LOG 8-3-85 ,lt. .g.p.m. Nitrate 2.25 mgJl.. 2 Dapmssion over tenk (Y/N) NO Pumper Soil rating ~ ~rndm~) 25O Well Log (Y/N) YES Wires propedy p,~=ted (Y/N) YES Casing height (above ground) 13" in. AT INSPECTION 5-16-01 42' ft. 5.25 .g.p.m. Tank Type/Material STEEL Tank size 1250 gal. Number of Compartments Foundation deanout (Y/N) YES Date of pumping 5-9-01 ABSORPTION FIELD DATA Length 78 ~ Other bacte~a AWWCt INC. 0 colonies/100 mi. System type DEEP TRENCH Gravel below pipe 6.0 lt. Depression over field NO For 4 bedrooms New depth 66 in. 450 g.p.d. NONE KNOWN If ye~, give da~ - Width 3.5 It. Totaldepth 12.8 ft. Eff. absorption area 936 ftt Monltedngtube YES Date of adequacy test 5-9-01 Results(Pass/Fall) PASS Fluid depth in L__h___~_ onflaldbetoretest 51 In. Wateradded 703 gal. Elapsed Time: 164. ndn. Final fluid depth 62.5 In. Absorption ra[e >- Any mjuvanation treatment (past 12 mo.) (Y/N & type) Date Installed 8-1-85 aeanouts (Y/N) YES High water ,,latin (y/N) NORTHLAND D. UFT STATION Date Installed S~r.e in gallons ~.~t~es~,~-~-~ ~ · Pump on* level at in. "Pump n. High water alarm level at in. ~ · Cycles tested Meets alarm & circuit requtmmente? E. SEPARATION DI~TANCE~ * TO SEPTIC TANK ON SEPARATION DISTANCES FROM WElL ON LOT TO: Septic tank/lift station on lot. 100'+ Absorption field on lot. 100'+ Public sewer main N/A Sewer/septic service line 25'+ LOT 2, BLOCK 1 PARK PLACE On adjacent lots. * 98'+ On adjacent lots 100'+ Public sewer manhole/cleenout 75'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bullcling foundation 5'+ Property line 5'+ Water main N/A Water eewice line, 25'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorplfon field. 5'+ Surface water. 100'+ Bulidlng foundation 10'+ Surface water 100'+ Wells on adjacent lots. 100'+ Property line 10'+ Water sendne line 25'+ Curtain drain NONE KNOWN F. COMMENTS Water main N/A Driveway, partdng/vehlde storage *o *TRENCH TERMINATES AT EDGE OF DRIVEWAY O. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspec~ons and review of Munldpal records that the above systems ere/n conformance ~ MOA HAA guidelines In effect on thla date. Englneer'a ~ NaFte Date .~.~//o / JEFFREY A, GARNESS HAA Fee $ ,. 00 · Date of Payment Numar Walwr Fee $ Date of Payment Receipt Number. Municipality o.f Anchorage DeVelopment Services DePartment Building S~fcty Division On-Site Water and Wastewater Program 4700 Bragaw Street P,O. Box 196650 Anchorage, AK 99519-6650 www. ei.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: WR010034 PID#: 020-092-67 HA~: ~,/o,~' Permit~: Date Received: 614101 Legal Description: PARK PLACE #1 SUBDIVISION BLOCK 1 LOT 2 Engineer: MICHAEL E. ANDERSON~ ANDERSON ENGINEERING P.O. BOX 240773 Applicant: MICHAEL E. ANDERSON Waiver Requested: 95 FEET FROM THE SEPTIC TANK ON PARK PLACE #1 BLOCK 1 LOT 2 TO THE WATERWELL ON PARK PLACE #1 BLOCK 1 LOT 1. Criteria: Geology Points: A. Water Table -~' ~' B. Soil Sorption ~ · -~ C. Permeability ~ 00 D. Water Table Gradient ~, O E. Horizontal Separation ~ · ~ Total: /~. ~'" Waiver is Granted: /~ Waiver is not Granted: List Conditions or Reasons for above: ,,5" EE ,~7'[l~,~ 1,4 E'I~ Date: ~ -¢ --O! By: ~:)~tJlJ Name of Reviewer Rec#: 4771 Amount: $625.00 Date Paid: 6/4/01 Municipality of Anchorage George P. Wuerch, Mayor Building Safety Division P.O. Box 196650 · 4700 S. Bragaw Strect Anchoragc, ~'daslm 99519-6650 · (907) 343-8301 http://wx~v.ci.anchoragc.ak.us 06/05/01 Michael E. Anderson, PE Anderson Engineering P.O. Box 240773 Anchorage, Alaska 99524-0773 Subject: Waiver Request for Park Place #1 Block 1 Lot 2 Waiver Request #WR010034 Parcel ID #020-092-67 Department o~ Public Works Dear Mr. Anderson: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 95.0 feet. This approved separation distance is from the water well on the subject lot to the septic tank on Park Place #1 Subdivision Block 1 Lot 2. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system wilt require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Daniel J. Roth Civil Engineer On-Site Water & Wastewater Program -5' x~.SY- 2 = May 22, 2001 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Su~e~: Lot 2, Block 1, Park Place Subdivision No. 1 Separation Distance Waiver Septic Tank to Neighboring Well Dear On Site Services Engineer: The septic tank on the subject lot was placed in December of 1995 during the reconstruction of the septic system on the lot. The design for the system required a diverter valve be placed and the existing failed absorption trench to remain in place for possible future use. The contractor failed to determine the exact separation distance from the well located on the lot to the north and stated the tank could be moved no further south and still provide suitable drop to the flow diverter. As a result the tank is now only 95' from the well to the south located on Lot 1, Block 1, Park Place Subdivision No. 1. We are therefore requesting a waiver be issued allowing the tank to remain in its current location approximately 95' from the well. The well is located approximately 10' upslope from the septic tank. The total depth of the well is approximately 69' with casing thought to extend the entire depth of the well. The static water level in the well was originally measured at 42' below the surface. Recent water samples taken from the well reveal no coliform or bacteria and an acceptable level of nitrate content. The well is obviously not being influenced by the effluent from the septic system. Soil logs from Lots 1 and 2 indicate tight silty gravel which will slow the migration of any effluent should a leak occur. No groundwater was found in the test holes. The, topography of Lot 1 slopes from north to south and from west to east. No surface drainage flows onto Lot 2 from Lot 1. Separation Distance Waiver Guidelines Water Table 30' Below Tank 4.0 Soil Type Silt, Silty Gravel 3.5 Permeability Silty Gravel 2.0 Lot 2, Block 1, Park Place No. 1 May 22, 2001 Page Two Water Table Gradient Slopes Away +5% 4.5 Horizontal Separation 95' 2.8 Total 16.8 The conclusion based on the aforementioned point totals is that almost surely no form of contamination can be expected from household sewage. It is therefore recommended the waiver be approved to allow placement of the existing absorption tank at 95' from the existing well. Enclosed is a copy of the well log from the neighboring well along with test hole information from both lots. Please review this information and let me know if additional information is required to approve this waiver. SinCerely, Michael E. Anderson, P.E. Attachments .AREA MAP sCALE 1" = 100' SHEET NO. OF DATE. · DATE. 76.15 LOT 2, BLOCK 1, PARK PLACE SUBDIVISION ADDITION NO. I Z I- · LOT 1 O~ Exist~ug Well Tank 'S/tic Removed Septic Tank (DO New Abs0r zon Trench House LOT 2 SITE PLAN SCALE 1" = 30' TEST HOLE LOT~'No. 2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEG*' DESCR,~r,o.: L/.; 151. ¢^kK ~5 ,5/P ~ow..~'p. Range. S~tion: I ~/~ 2 3 (ENGINEER'S SEAL) ' DATE PERFORMED: 7 8 9 10- 11- 12 13 14 15- 16- 17- 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? s I Gross Net De~th to Net Reading Date Time Time Water" Drop /.,;/~ ~,~ $,1~ ,,~1 PERCOLATION RATE ~f"~ (m,nutes/,nch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT / ~7/ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OAT~ DATE: ~/ 72~ (R~. ~) MEMORANDUM DATE: September 22, 1997 TO: Jim Cross, P.E. FROM: Mike Anderson, P.E. SUBJECT: Lot 2, Block 1, Park Place Subdivision Septic System As-Built Certification Attached is the certified as-built for the septic system constructed on Lot 2, Block 1, Park Place Subdivision along with comments from the original review by Jim Williams of your staff. I will address each of his comments in the order received. A soils log is submitted which shows soil strata to 6' below the system. A cross section which shows the west trench relative to the toe of slope along Betfijean Street is attached. Also attached is a letter to Dan Roth of your staff requesting a variance to the separation distance between the absorption field and roadway embankment. The original letter, which should be in your files, was approved by Mr. Roth before the system was constructed. All depressions over the septic area have been filled in and all jim caps are in place. The attached drawing shows the distance from the well to the north and the septic tank. The distance between the well and septic tank is 100.5'. It is true that a portion of the tank is within the 100' radius, but both the inlet and outlet of the tank are at least 100' from the well. The tank was placed at the same location as the old tank, but was moved out of the 100' radius of the well on the lot. The excavator was somewhat imprecise in the placement of the tank and thought the entire tank was outside the 100' radii of both wells. This is the only location for the tank in which the flow diverter valve will work to both the old trench and the new absorption trench. We respectfully request that a waiver between the tank and the well to the north not be required in this instance. The new absorption trenches were originally designed to be entered in the center. Because of the distance separating the two absorption trenches it is easiest to enter at the north end. My technician, Alan Harala, discussed this with you in December of 1995, as I was out of town. He received verbal authorization to enter the trenches at the north end and not as shown on the design. The system is constructed with a flow divider and both trenches receive equal amounts of effluent. We are confident the trenches will work in the configuration constructed and are hopeful the as-built can now be certified and further action is unnecessary. 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 ~t. ~"~ I) ~ '~ 0 \ ~'t g CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ,(~--,¢''~0 - I:~)0~ ,'-~ -~ LO HAA# GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone ~t~'~o"75'H ~ GSa_ y,y~.~ w/ Lending agency Mailing address Agent Address Day phone ,21~'- ~oG -8-¢ [.~ Day phone 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 AD£C 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 Yerifythat 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address ¢¢--0 Engineer's signature --~-~ ~ Date 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 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. 1/91) Back MOA Municipality of Anchorage ~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHEGKLIST LegalDescription: Ill '"~c~-~'- -~)[~'~-~'-- ParcelI.D. 0'2¢-O~- -7° A. WELL DATA Well type ~' Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well flow Pump level 7' Date completed ~:::~/;~/~ 3 Driller Cased to L~ ¢ Casing height Wires properly protected (Y/N) FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I C) 7 Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ,~ Date of sample: ~/~o/~_~ Nitrate ~'~'~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 8/1 / S ~ Cleanouts (Y/N) "~/ High water alarm (Y/N) Date of pumping Tank size ' I ~- 50 Compartments Foundation cleanout (Y/N) ~' Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot [0'7' To property line "~ ~CO Surface water/d rainage Onadjacentlots '7 l~'C:~ Foundation Absorption field I,.~ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION [%~/'/~) Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~°/l / ~ ~ Length '~ Width Total absorption area _ Depression over field (Y/N) Results (pass/fail) Soil rating ,,~,'~ System type Gravel thickness ~ ' Total depth Cleanouts present (Y/N) ~/' Date of adequacy test for ¢ bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I I ~' -~ On adjacent lots _~ 1~ Property line To building foundation ~ /~' To existing or abandoned system on lot On adjacent lots ~, /c.'~ Cutbank h,./~ v~,~ Water main/serviceline Surface water Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number '~J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ! Location (address or directions) (b) ,.~,p~lic'ant Name ~"~',~, ~'~o~'-(/~',~' Business . ,Applicant Address ' -~-7 ,.,~ ~ (c) ~Ap~licant is (~heck ~)i L~bing Institution U; Owner/builder~ Buyer ~; Other D (explain); (.d) Lending'lnsti~utio~,.~,~j ~ ~ A ~ ~ ~ d ~,~ ~. Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84} EI~GINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA ND INFORMATION As certified by my sea[ affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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, ordinancesl and regulations in effect on the date of this inspection. Name of Firm ?~_/~C '~ ~ ~ Telephone ~- ~o ~ Address (~¢¢ ~' ~'~ ~"'~ ~ (~c~'~2'~ ~¢~-¢ ~ Approved X Disapproveo-,' Terms of Conditibg?l Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~-FJ' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /~/, L~ /, '"mw ~r, JINM~'N[AL PROTECTION 231986 RECEIVED Well Log Present(~N) Total Depth ~-~5 Cased to Static Water Level / Casing Height Above Ground Electrical Wiring in Conduit~)/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole /(-'/'~ Water Sample Collected by Water Sample Test Results IfA, B, C, D.E.C. Approved (Y/N) /~.-'~. Date Completed ~;~-- ~ '- ~' --'~ Yield Depth of Grouting Pump Set At ~,~'. Sanitary Seal on Casing ~) Around Wellhead (Y/~i,/ Depression '.~_, "~ P ; On Adjoining Lots /'(.,9~ ~f ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (~N) Depression over Tank (Y ~/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septi,c/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course I~ ~ O No. of Compartments Size Air-tight Caps,) Foundation Cleanou)~) Date Last Pumped '~'J Ho di.9 Tan, ,er it To Building Foundation /t'~ F- To Disposal Field ~'¢ To Stream, Pond. Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed c~../_ ~ ,-~ Width of Field 'z¢',.'~-(~ t Square Feet of Absorption Area Depression over Field (Y~ Separation Distance from Absorption Field: /'Off' To Water-Supply Well To Building Foundation Lot ,,'~/~. To Water Main/Service Line bT ~-~ ' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Presen~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots -?~--) To Cutbank (if present) ~-~7'- ! O0" D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimenmons~~'~ Manho~C, dLess (Y/N) __ ~¢'ump cfr' beve~ at ___ Vent (Y/N) ___ Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I~have chec,~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~,~Jt _. ¢'~/'~'-"¢/~ DateI:¢ql-f¢e Company ~¢/.. ~'G_' ~¢ MOA No. ~7- ~¢~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ALASKA I UIRO[lmeI1TAL COI1TROL SeRUICeS, II1C. [~n§in¢¢rin§ f~ I~nuironrnenl~l $ludies JAN 23 1986 JIM BUMGARDNER 5740 E 172ND AVENUE ANCHORAGE ALASKA 99516 SELLER-SAME 60020 LEGAL:PAR K PLACE ADD ~/I/BLOC K 1/LOT 1 WILL PICK UP FROM OUR OF MUNICIPALITY OF ANCHORAG~z DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 2, lg86 RECEIVED ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-JAN 21 1986 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 936 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 450 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JAN 22 1986 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE-I/21/86 A FLOW TEST WAS PERFORMED ON THE WELL. 677 GALLONS OF WATER WAS PUMPED AT A RATE OF 6 GPM OVER A DURATION OF 2 HOURS. THE DRAWDOWN WAS 12 ' WITH A RECOVERY TIME OF 20 MINUTES AND THE STATIC WATER LEVEL WAS 48 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. t20o IJJ~s~ 33r(t rq~enue, Suite B o A.chora§e, Alaska 99503-(907) 561-50z10 APPLI[ NT FILLS OUT UPPER HAl *' ONLY Property CJ~¢,qer Sun Construction Phone Mailing Address Star Route A Box 474E Anchorage ZipCode 99507 Buyer Address Zip Code Lending Institution Phone Address Zip Code Realty Co. & Agent Esther Bumgardner Phone Star Route A Box 474E Anchorage 99507 345-1099 Address Zip Code Legal Description Lot 1 Block 1 Park Place Subdivision Street Locatio~ Betti Jean S~reet Type of Residence ~ingle Family [] Multiple Family No. of Bedrooms ~chree [] Other Water Supply ~ Individual ATTACH WEL~. LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give ~1 depth (attach log if available). [] Public Utility I Sewer Disposal ~ Individual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Insp~tor ]nsp~tor Insp~tor Insp~tor Field Notes: MUNiCIPALiTY O~ ANCHORAGE ~; ~) , ~ ~ ~J / ~NVIRONM:NTAL P~OT~CTION ( ~APPROVED BEDROOMS ........ ~ONDIT[ON; ) CONDIT~AL APPROVAL* Soils Rating D~te ~wer Installed Well To Absorption Area ~ 3 0 /~ / 3 Well toTank 72-023 (3182) December 5~ 1983 Sun Construction Star Route A, ~.~ox 474i~ Anchora{3e, Alaska 99507 Subject: Lot I ~lock ! Park Place [~ub~2ivision Approval ~or the individual se%~er and water facilities cannot be [~ranted until the ~ollowin%) ite~ns have been completed: o Locate and expose the cleanout to the seepa<le pit and/or leaching area for our inspection. This is to i~-~sure the ~]inir~]um distance requirements are ~et between t}~e well. and sewer syste~. Please noti~:y ti'lis Det~}artment for a reinspection %.;~en the noted ~tiscrepancies have been corrected. If there are any ~!urther q,]estions, please call this of_~ice at sincerely, JRi/a/E3 J ii'~l Roberts Assistant Environ}nental Specialist December 15~ 198~ Department of ?tealth and Environmental Protection Muncipality of Anchorage Attention: Jim Roberts Regarding Septic System on Lot 1 Block 1 Park Place Since 'the septic system installation inspection drawing and report on Lot 1 Block 1 Park Place Subdivision inadvertently omitted denoting the placement of insulation above the septic line in the driveway area~ Sun Construction Inc.~ hereby absolves the MOA of any responsibility regarding the fulfillment of this requirement. For the record~ insulation was indeed placed on top of the septic line in the driveway area° ncere~ ,~U' ~0~ ,qu'n Co%st nc~ioi~ .~nc ~reslt~enu