HomeMy WebLinkAboutPROSPECT HEIGHTS #4 BLK 1 LT 2Pro
H
pect
ights
Block
Lot 2
#015-
091-53
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anctlornge, AK 99519-6650
www.ci.anchorage.ak.us
(907) ~3-7904
Parcel I.D. 015-091-55
1, GENERAL INFORMATION
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAHILY DWELLING
Expiration Date:
Completelegaldescription ~PROSPECT HEIGHTS SUBDMSION ~14; LOT 2, BLOCK 1
Location (site address or directions) 9701 SlDOEOF LANE: * ANCHORAGE~ AK 99516
Currant Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PETER VAN BORSSUU Dayphone 546-:5345
9701 SIDOROF LANE * ANCHORAGE. AK 99516
Day phone
Day phone
Unless othetwlse requested, HAA will be held by DSD for plckup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (H/SA) 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 lz'ansfer
of title (except between spouses) for properties served by a slngle 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 privata or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the
professional engineer's work.
Note:Alaska Water and Wastewater Consullants, Inc. shall be paid $1,110. OO at, or prior I
to closing for the engineering services provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/orwastewater disposal system is(am) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the
information obtained from the Municipality of Anchorage f/les and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Pdnted Name JEFFR-EY A. GARNESS. P.E.
Date II/7'"(~/51
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in ecco~ance with ADEC and MOA
DSD Guidelines & Regulations. The reported results desclfbed the performance of the
system under the conditions encountered at the time of the test, and aeparation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate dudng the year. and the water usage cf the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarentee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provfde
any warranty or future esb'mate of how long the system will conb'nue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other pemon or pat~y is not authorized, nor wfll it confer any legal #ght whatsoever.
5. DSD SIGNATURE
t/'"' Approved for ~-~
bedrooms.
Disapproved.
Conditional approval for __
bedrooms, with the fllowing sUpulaUons' .,[{{{(l~'~"~f,',',.
0 ..
~ , ,A~A~W~,~,,: :
Attachments:
HAA Checklist
SepUc System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
(Rev. 12,90)
Original Certificate Date: ,} ~. -/-7/- - O I
De
CJ
Municipality of Anchorage
Development Services Department
BuMIng 6a;'e;-y DM~on
On.,~ta Water & Wastwmt~r Program
4700 8outh Bmgaw et.
P.O. ~ 196650 Nlchaage, AK 99519-6650
www.cLanchomge~lcus
HEALTH AUTHORITY APPROVAL CHECKLIST
WELL DATA
Well type PRIVATI~ IfA, B, ore provide PWSID~ N/^
Date completed I 0/10/1988 Sanltery ~eal (Y/N) YES
Total depfft 120 fL · Cased to 11 TO BEDROCK It.
Wen Log (Y/N), Y~S
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ .in.
FROM WELL LOG
Cate of test 10/10/1988
Static water level 12 fL
Well preduction 15 g.p.m.
WATER SAMPLE RESULTS:
Coliform .(~ colonies/100 rnL
Date of nample: 11/20/2001
SEPTIC/HOLDING TANK DATA
AT INSPECTION
11/20/2001
17 fL
6,9 .g.p.m.
Other bec~erla
AWWC, INC.
ABSORPTION FIELD DATA
Date Installed I
Leng~ 12 fL
Tank Type/Material STEEL
Tankslze 1250 gal. Number of Compertmenta 2
Foundation deanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 11/20/2001 Pumper
colonies/lO0 mi.
Date Installed 1989
Cleanouta (Y/N) YES
Hlgh water alarm (Y/N) N/A
A+
Soil rating ~ ~/txtrm) .88 System type MOUND
~ 56.5 fL Gravel below pipe O.5 fL
Totaldeplh 3.5 ft. Eff. al~onama 678 tt= Monltedngtube YES Oepresslonoverflald NO
Date of adequacy test 11/20/2001 Results(Pass/Fall) PASS For 3 bedrooms
Ruld depth in abeorpflon tiald before test 0 In. Wateredded 720 gal. Nowdepth 0 in.
Elapsed Time: 0 rain. Final tiuld depth0 itl Absorption rate >= ¢50+ g.p.d.
Any rejuvenation lreatment (past 12 mo.) (Y/N & type) NONE KNOWN if yes, give date -
LegalOesCrlpflon:PROSPECT HEIGHTS SUBDMSION ~4i LOT 2, BLOCK 1 PeroellD: 015-091-53
D. UFT STATION
Date installed
Size in gallons
"Pump on" level et in. ~~,
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se~c tank/lift station on lot ~ 00'+
Absorption field on lot. 100'+
Public sewer main N/A
Sewer/sepUc sewlce line 25%
High water alarm level at in.
Meets alarm & dmult requirements?.
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/oleanout
Holding tank N/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5% Pmbedy line 5'+
Water main N/A Water service line. 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field. 5'+
Surface Wetar. 1 o0'+
Property line 10'+
Water se~ce line 10'+
Curtain drain NONE: KNOWN
F. COMMENTS
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots. 100'+
Water main 'N/A
Driveway, paddng/vehlcle storage 10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on fids date.
Englnsefa Pdn/tad Name
Date
JEFFREY A. C-ARNE:$$
Date of Payment
Receipt Number
p~v. 12mo)
~~~17953 ..." ·
Waiver Fee $
Date of Payment
Receipt Number.
Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: g<~l~)/~,~_. PID Number: i~/..~'
Name: ~ ~ ~ ~r~ Wastewater System: D New ~ Upgrade
Address:~7~/ ~'/'~~~ ~O~ ~ ABSORPTION FIELD
'Phone:~~ / ~No. of~rooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other
Soil Rating-
'/
LEGAL DESCRIPTI ON l~O GP~ ~T°tal Depth from~origina~ 9rede:
Lot: ~ Block: j ~ Subdiv~ion: --
Fr~~ ~ De~htopipebo.omfromorigin~lgr~
~ ~vel depth beneath pipe
Township: I Range:- I ~ection: Fill a~d abov~r~ina, grade: Ft. ~avel length~ , ~, Ft.
WELL: ~,,~: New ~ UpgrAde · G~w,dth:/~, Number of lines: Di~ance~,~en,ines:
Clarification Crivate, A,B,C): Total Depth: Cased To: Total absorptioAarea: ~ ~ ~ipe material: ~
Driller:. Date Drilled: Static Water Levek 'n~t,l~er:l '
Yield: I Pu~Set at: - ~ Casing Height Above Ground:
/~ ~,~/ unk ,,. ,~,~,, + ~,. TANK
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer: Capaci~ in gallons:
Fro~ Tank Field Station Tank SewerLine. ~ ~ ' /~+~f~mP~nq
weft l~ ~ lOC~ n/~ n/~ ~ i+ Material:~ Number of ~omp~,me~ts:~
Sudace
wa~.~ !lO0~ 1~0+ - - - % LIFT STATION /
Line ~ ~ l~ ~ -- --
Foundation ~ '+ JO+i -- -- __ "Pump on" level a~el at: J High water alarm at:
Cu~ainDrain ~O~,~ ~., ~ Pum~ I Electdca, lnspection~edby:
Remarks:~///n~r~D~n ~ ~- BENCH MARK
~ . · Location and Descripti~:
. .,
I~ pe~ormed by: ~sd4ant$. ~. Dates: ~st ~t- J ~l / ~'~/
Depadment of Health and Human Se~ices approval ~ -:,'.~- ~ .'
Reviewed and approved by~ // ~ ~ Date: ?-2~'?~ ~¢{~ESS~--'
72-013 (Rev. 9/91) MOA 25
/','~/ BDRM HOUSE /~ ~ !
~S~ WA~ A~ WAS~WA~ CONS~TA~S, ~C.
7320
CHE~ER
HEIGHTS
LEOAL
DESCRIPTION:
PROSPECT HEIGHTS SUBDIVISION, LOT 2, BLOCK 1 .:~..
SITE P~N
DON AND BETTY ~ARTZ $46-2361
A.C.G. 1 = 60' 2 OF 3 rofesslo
· View A
J
vi~w~
~ :'-~ ....... , VIEW A
~,,~% ~r , II iI
BENOHMARK: TOP OF WELL H~
~-¢,,,~a ASSUMED EL~ATION- 100.00
ALAS~ WA~R AND WAS~WA~R
~a~o E. C,E~, .~0,~ C~,C~. mC,0~O~.
PBOSPEBT HEISHTS ~USBIVlSlO~ ~4, LOT 2, BLOO~
DON AND BETTY MABTZ ~46-2~61 ~_~,,. -... ...-:~
DA-I'E:9/1/8/98 Df~WN BY: SCALE: PAGE:
A.C.G. NOT TO SCALE
-., ~:. :.~.:,.,... · . . ~ . , . . · ~ ,"," : ~
.... - .... . .,. ~ ~":%~
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: ~ :' ..-,. ... . : . : .... '.~ ~.~,~. : .~ ?.:
~., .~. . , ~ · . . . . ~
4700 ~rc~aw
A<Homgs, AK 995 ~946~0
www.mu~i
(90T) ~43-79.0~
Pump Installation Log
Well DzilIb~ Permit Number:
Dste of Issue:
parcel Identification Number:__
Leg-1 Description
p~p ~tak~ ~ep~ Below Top of~e~ Cas~:; ~
F~P S~e ~ hp
feet
Pump Lustziler Name:
The pump irmt~iler stroll provide a pump mst~/P~/on log'~o the DS]3 wi~Wn 30 d~TS of pump inaaik~iozz.
-2-
I ,yT. ~o
~,_.oo
84.~ 14-
~
....................................... ON
............. · ,.aC) ................ ON
.......................................................................................................... ~lj.¥a ............. AH 'a~ H:::)
......................................................................... .LC):3 f"H f*lg ............... "aJ.Va .......................... Alt
Tom Fink,
Mayor
Munic pality Anchorage
Department of Health and Human Services
825 "L" Street
P,O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1990
Donald Martz
30332 Via Borica
Rancho Palos Verde, California 96274
Subject: Lot 2 Block 1 Prospect Heights S/D #4
Permit #890172, PID #015-091-53
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1989.
Permits are issued on a calendar year basis by authority of the
Municipal Code of Regulations. A new permit must be obtained
from this office for an well and/or on-site wastewater system
not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as-built inspection report
(three-part form) must be sent to this office-for review,
approval and documentation.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Sincerely,
John Smith, P.E.
Program Manager
On-site Services
JW/ljm: 200
enc: Copy of Permit
"Kids Are Our Future"
F:' E: R H I T
L.,:::)'L 1..(~.:.)g a ].: S,,..d:::,d :L v :i. :~i :~. on ~: PRCJSPECT HTS. Lot ~:
L(=,'L E~J.z(.:;.:, ?;I. 5:L~ '-.!:;q,, ~"[..,, c)r'
Id;::,'.:....' fEh~:x:tlr'oom~.!::: ']"h:i.~:, Per. mi'L= ::f!; 'J"o'Lal C.s:~i:~ac::i.'Ly:
E;AND I='li.J... MUS"i' >.:-:f.:
SYEFI'I:[M 'T'E) :['::d:!!: ;l: I',IE~TAI...L. ED :[ N Ai::;CE)F;t:[),/.:$1CE!: ~,j I "I'H ENG ]: I',IEEF;t ' S DES t 8N ,,
DHHS P'!LJE;T' BE: NOTIF:'I
F:'E!F~ [~:t. :3; Ed'.ED[':;:OI:].t"I S ! !'q['}}LE: I:::P4'"I I I....Y I::;~E!:S Z DIENE;E!: OIqL..Y ~, (~ND E:XI:::' I REi:8 []I'4
:L2/:31/8c,'~,, !iqSTA~L..L.ATiON []1:::'
~q I:::' 1:::' I:;.' (:) F' !::;: ]: ,.'.:YT Iii: Eli... E:C;'I"R :[ C AI.~.
CIF.]::i:I' I F'Y THAT ::
am ~'am:i.l:i.a!" w:i.'l:.h I'..h6~ r'(.zeq.'...(:i.r.'..~m(er"~t.m for' or"v-~s:i,'L(~.~ ~sew(.z:,J"~ ar'icl w(~))].:l.~[~
for.'t:.h !:)y -Lh~:, Mu.n:[c::i. pali'Ly of f~nc:hor'ag~:, (i~[]~) and 'Lhe) S'La'LE~, o['
will :i.r'~i~M:.a!l 't:. h (;.:.) ~i~y~H'..~:m~ in ac:c::or'danc:~:, w:L'Lh all !"10~:~ c::od6)s and
wJ.:l.~ a(::lh(.):¢r'6) I:.(:; all PlOf~ arx::l Si:.a'Le of J.~].a~sl.::a Pt:.)qL~ii-(am(an'L-:; ~'or' '[.he s~(e1'., back
................... , .,/~:,~.: .............................. '~: , ~.~:~~:( .............. ~ ................................................................ .......... '.' ,..., .......
AE'
ALASKA rlul orlm rlTAL COF1TI OL $ RUIC $, Irlc.
~nqincering 8 ~nuJronmentd $1uclies
1200 LUe$1 33r'J Auellu~,. SuJ~ ~ ~.Anchuroq¢, Alaska 99,503.(907) 561-50~0
TO
SUBJECT
2.0 SEPTIC TANK
2.1
The exJstillg septic tank may be used, if it meets
the capacity requirement for the residence and the
approval o~ DHHS. If not, then specifications 2.2
through 2.6 apply.
The septic tank shall be a UPC-approved
two-compartment tank, constructed of !2 gauge
steel with bitumastic coatiug and set level on
undisturbed soil. If the tank is buried at a
depth of 4 feet or less, it must be insulated with
an overlying layer of g inch burial type
polys'tyreae rigid board insulation.
! 412 W6~ 33Pb &v6nu6 · ,~nchoPaG6. &[askg 00503
o 3
2.4
2.5
2.6
2.7
The septic ~ank shall be a minimum of 5 feet fr. on~
the house foundation and a minimum of 5 ~eet fpom
the absorption area.
The septic tank and bed shall he a minimum of 100
feet frown any private well or body of water,
feet frown Class "t" wells, and 200 feet from Class
"A' or 'B' wells, unless otherwise specified.
Less [han the required separation distance n~usL
have prior approval or waiver by DHIIS or Alaska
Departn~ent of Environmental Conservation (ADEC).
Piping shall be fi'Lhed wihh a mechanical
watertight calder coupling on the outlet and inlet
of the septic i:ank. In!eL pip[ug shall be 4 inch
solid PVC ASTM D-3024 or cast, iron, sloped
a ~ini~tum of !/4 inch per lineal foot.
piping shall not be less than 1/8 inch per foot
slope. If the piping is buried at a depth of 4
feet or !ess, it inuaE be insulated with an
overlying layer of 2 inch burial hype polyst~rene
rigid hoard insolation.
Cleanouts shall be installed as designated and
capped with air-tight rain caps (Jim Caps or
equivalent), and ex[end a minimum of 1 fooh above
ground level.
If a lifa station is required it shall be a
combination lift station septic tank per Anchorage
Tank and Welding, !nc. design. Specifications and
design drawings are on file with the Municipality
and the engineer.
$,0 SEEPAGE BED
8,i
3 2
3 8
The sand shall have an effective size of 0.4 to
0.6mm and a uniformity coefficient of not more
~han 4.
The graw;1 for [he bed shall be 0.5 to 2.5 inch,
screened rock with less than 3 percent passinff the
No. 200 sieve. Ail substitutes must have prior
DHHS apppoval .
The bo[tom of the excavation shall he level and
raked with the backhoe blade to insure that the
b o t -[ o m h a s n o t b e e 11 c o BI p a f? t e d ~ ' . e
[tl!r 1 13 ~ xcava~ioll.
Tile distribution pipe shall be perforated 4 inch
3.6
3.7
3.8
rigid PVC with a minimum crnsh strength of 1500
pounds and shall meet tile approval of DHHS for use
as draiafie!d pipe. All pipes shall be laid level,
and spaced according to the drawings.
>Ionitor standpipes shall be placed as shown in the
drawings. They shall be 4 inch rigid PVC AST,',I
D-3034, or cast iron. The section shown with
ho/es may be either drilled 0.5 inch holes on 6
inch centers on opposing sides of the pipe, or a
section of regular perforated sewer pipe may be
clamped to the solid section with a no--.hub
coupling or solvent joint, Tile perforated section
of the monitor tube shall be located in gravel
only. The portion of pipe above tile sewer rock
shall be solid. A rubber ra:[ncap (Jim Cap or
equivalent) shall be placed over the top of the
pipe.
If the final grade over the bed is less than 4
feet above the gravel, insulation is required,
as.lng burial type polystyreae rigid board
insalatJon. There shall be ! inch of insulation
for every foot of soil less than the required 4
feet of cover, bat there must he at /east 24
inches of soil even though insulation is used.
The solid pipe extending from the septic tank to
the drainfield shall also have a minimam of 4 feet
of cover or an equivalent layer of insalation
combined with soil.
If insulation is not necessary, then the gravel
must be covered with a .layer of a nonwoven fabric
(such as Mirafai, Fibretex 200 grade, Poly-Filter
X, or equivalent).
The top and sides of the bed shall he plauted with
a white clover and red fescue mix, or with
Kentucky bJuegrass.
4,0 INSPECTIONS
4.1
This bed will require a minimam of 'three
inspections. Tile first inspection will be of tile
opel] excavation, to assure that the system is
iilsta!led ia tile proper soil strata, correct depth
and meet minimum specified design parameters.
4 . 2 The second inspection will be performed after sand
fill iS instal_led, but prior to placement of
,,7 3
4.5
gravel and distribution pipes. This inspection
will verify that the filter is ppoperly installed,
that it meets specifications and that it fulfills
the intention of the design.
The third inspection will be after placement of
gravel, mouJtor standpipes, and distribution pipe,
Lo verify proper installation and position of
pipes prior to backfill.
The inspection of hi-he septic tank installation can
be incorporated with any one of the above listed
inspections.
The lift station will require either an MOA
electrical inspection or certification by a
licensed electrician, depending on whether the
building code applies to this part of the city.
~INEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES~, 825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
4
5
6
7
8
9
10
11
12
13
14
15-
16
17
18
19
2O
?~57~E)~ ,/~ '~6~fTownship, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
Depth to Water After ',x o,/
Monitoring? P"~f Date:
Reading Date
PERCOLATION RATE
Gross Net
Time Time
Depth to
Water
-- (minutes/inch) PERC HOLE DIAMETER
Net
Drop
.5/
TEST RUN BETWEEN ~-~ FT AND .
COMMENTS Z'Z/<~¢'
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
'1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
S,EET .o / o~_ . 4
CHECKED BY DATE.
$CA{.F
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
'1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO. · ~ OF.. 4
SCALE
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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
1. GENERAL INFORMATION
Complete legal description .
Lot 2; Block 1; Prospect Heiqhts #4
Location (site address or directions)
9701 Siderof Lane
Anchorage, AK
Property owner
Mailing address
Don & Betty Martz
9701 Siderof Lane
Day phone
Anchorage, AK
346-2361
995:i:6
Lending agency
Mailin. g address
Day phone
Agent Mary Tutterow/Jack White Real Estate
Address
Day phone
762-3151
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 \,
TYPE OF WATER SUPPLY:
Individual well XX
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.
XX
72-025 (Rev. 1/91) Front MOA ~21
Municipality of Anchorage ,~P~ Z ~.~ /~
DEPARTMENT OF HEALTH & HUMAN SERVI~S~u~ ~ ANL~
Environmental Services Division I~NYil~Nt~ltiNt~k~l~lWl~_~§ ~1¥'1~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A, WELL DATA
Well type ~l u/'/7~-
Log present (~N)
Total depth
Health Authority Approval Checklist
~¢r&-'J~EL~/ ~-oT~! ~{ ParcelI.D.:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to // ~,~o/~d67o Casing height (above ground)
Sanitary seal ~/N)
Date of test
Static water level
Well production
FROM WELL
g.p.m.
WATER SAMPLE RESULTS:
Wires properly protected ~.~) /(/2~
AT INSPECTION
g.p.m.
Coliform /~ Nitrate
Date of sample: ~ I ~ /~ ~
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~(~ ~8~. Tanksize (~O
Other bacteria ,
Collected by: A ~J ~ ~ f ?F~/NJc,
Number of Compartments ~-~ Cleanouts~N) 2.
Foundation cleanout (Y/N) ",// Depression (Y/~ /%5~ High water alarm (Y/N)
Date of Pumping ~ll%/~%c~ i~umper ~ ~ ~~
Date installed ~ [~ Soilrating~rff~/bdrm) 0,~¢ ~¢d~ystemtype~ ~
Length ~ ~ ~ ~ % ~ ~
~ Width ~('~ Gravel thickness below pipe ~ ~¢ Total depth
Effective absorption area~ ~ Monitoring Tube present ~N)~ Depression over field
Fluid depth in absorption field before test (in.);
Fluid depth '~¢'F (ins) Minutes later:
Peroxide treatment (past 12 months) (Y~I)
72-026 (Rev. 3/96)*
Immediately after/~/;2ffgal, water added (in.):
Absorption rate = (~OO ~ g.p.d.
~ If yes, give date ~/~
bedrooms
CT&E Environmental Services Inc.
CT&E Ref.# 985044001
Client Name AK Water & Wastewater Consultants Inc.
Project Name/# Prospect Heights No4 L2 B 1
Client Sample ID Prospect Heights No4 L2 B1
Matrix Drinking Water
Ordered By
PWSID 0
Sample Remarks:
Client PO//
Printed Date/Time 09/09/98 09:23
Collected Date/Time 09/04/98 13:00
Received Date/Time 09/04/98 17:10
Technical Director: Stephen C. Ede
Released By~ ~
Resu(ts PQL Units Method
Total Coliform 0
Nitrate-N 3.03
col/lOOmL
0.100 mg/L
Allowable Prep Analysis
Limits Date Date Init
$M18 9222B 09/04/98 KAP
EPA 300.0 10 max 04/04/98 09/04/98 GCP
CT&E Environmental Services Inc.
Laboratory Division ~,~' ~ ~-a',a'~'.a'.~,e-.~'.a,.a-.~,e-.a-,a-.~:a,.e.,e,.a.jjj.
Drinking Water Analysis Report for Total Coliform Bacteria :oo w. Potter
Drive
Anchorage, AK 99518-1605
READ ItYSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tel: (907} 562-2343
Fax: (907) 561-5301
Send R~ults ~ Send Invoice
SAMPLE DATE:
~t~.:M P c E TYPE: Routine
[] Repeat Sample (for routine sample
with lab re/no. )
[] Special Purpose
Month , Year
~ Treate4Water
[] Untreated Water
SAMPLE LOCATION
ComlT, ents:
TO BE COMPLETED BY LABOP, ATORY
Analysis shows this Water SAMPLE to be:
Satisfactor,.'
[] Unsatisfactory
[] Sample over 30 hours old, results may
be unreliable
O Sample too long in transit; sample should
not be over 48 hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
-~--4,1emb fane Filter
Cl MMO-MUG
Date
Time Received
Analysis Began
Analytical Method:
esult* Analyst
985044
~em m ~-,.u,r~.~.. .-,.,,,.,, Fb~ Jun
Time Collected
CollectedBy
· ,:%,., Acc
BACTE~OLOGICAL WATER ~N'.~YSIS ~CO~
MMO-MUG Result: Total Coliform~ ~
Date; Time:
Client notified of unsatisfactory results:
Colonies/100 mi
COL[F[RM
Membrane Filter: Direct Count
Verification: LTB
Fecal Coliform Confirmation
Final Membrane Filter Results
Coliform/100 mi
Time I L~ ~(--~ h r5
Spoke with
Time:
Faxed
Faxed
7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
September 21, 1998
RECEIVED
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
SEP 2_2 1998
Municipality of Ap, chorage
Dept, Health & Human Services
Ref: Undocumented Well and Septic System for Lot 2, Bk 1, Prospect Heights #4
To whom it may concern:
The well and septic system serv/ng the subject property were permitted for installation by the
MOA in 1989. Unfortunately, the contractor did not pay the engineer who inspected the
installation (Leroy Reid, P.E.), consequently, he did not submit the as-built documentation. Upon
contacting Mr. Reid, he indicated that (he believed) all of his records were turned over to a
collection agency. In short, no records are available. We contacted the excavator that installed
the system and he provided the attached written statement. We performed field elevation
measurements, and obtained a copy of the as-built survey to prepare a pseudo as-built drawing.
In addition, we obtained a copy of the well log from Alpine Drilling. Based upon our field
tests/measurements, and the letter from Nielson Brothers, we have a reasonable level of
confidence that the system was installed in compliance with MOA regulations, and that it is
adequate for a 3 bedro/4 ~m house. If you have any questions, please call me at 337-6179.
NIELSEN BROS. CONTRACTING, INC
2138 East 88th Avenue, Anchorage, Alaska 99507
Phone 907-344~2029 / Fax 907-344-4750
September 12, 1998
Municipality of Anchorage
Department of health and Human Services
ATrN: Dan Roth
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 2; Block 1; Prospect heights #4
9701 Sideroff
Dear Mr. Roth,
Nielsen Brothers Construction, Inc. installed the septic system on the subject property in 1989.
The system was designed and inspected by Leroy Reid, P.E. (Alaska Environmental Control
Services, AECS). It is my understanding that the as~built documentation was never submitted
to the Municipality for your final review and approval: consequently, the subject septic system
is undocumented. It is my understanding, in talking with Jeff Garness, P.E. (Alaska Water &
Wastewater Consultants, Inc.) that Mr. Reid was unable to find any of his records regarding
installation inspections.
I have reviewed the original design drawings, and revisited the site to familiarize myself with
the installation. To the best of my recollection the system was installed exactly as shown on the
design drawings except for the following:
· The bed was rotated approximately 90 degrees so that it is parallel to the slope
contours.
If you have any questions or concerns, please contact me.
Sincerely,
Ken Nelson
Nielsen Brothers Cont.
INVOICE # 14194
CUSTOMER
7501 E. 140th Avenue
Anchorage, Alaska 99516
345- 1890
'/320 E. Ch~st~rheigb. tz Cb-de
A~'4C'HG~.AGE, AK. 99364
Block ! Lot -- ~Prmpect H~ights #4
DESCRIPTION AMOUfaT
......
REMARKS
OniOns t/ Septic __ Leach Area __ Holding Tank ~ Standpipes
NEEDS TO BE DONE AGAIN IN 6 MONTHS
~G~d Shape ~ sludge buildup on bottom ~ Floater on lop
Jim cap missing or ~ Cut standpipe to 1' above ground ~ Ne~ Sept~trlne
n~s mplacl~
/
D. LIFT STATION
Date ~J/v//dr-
Size in gallons~~
Manhole/Access (Y/N) __~t* __ "Pump off" level at*
Highway* *Datum
Cycl ested
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
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation [d cC- Property line ¢/6 '-~ Absorption field /
Water main/service line o~.~ ~7- Surface water/drainage L0c3'¢- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~d ~ Building foundation ~O (4-
Surface water lob '~
Curtain drain /~'--)O/~E~ ~/~
/
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots //OO ~
ENGINEER'S CERTIFICATION
Icortifythatlh. cv~et~¢ed/~ t inspeetionsandreview ~ OF 4~:~
of Municipal reco2~e~o¢~s are
in conformance w~H2~d ~es in effect on this date. ~' ~/2~?'~
Signature~ J~:~,~ ~ r~:~.~:~/'~ ~
Date
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the dat,e/~f this inspection.
_ Alaska Water & Wa//~bwater
~,~'~'~ ~'f hirm ~ __, _,.~ ~t, Phone
~228'~st ~,~ ~e~ ~-ItsI C~cle
Address · "~ , , ,-
Engineers signature ~?i~.~, /'~ Date
ALASKA WATER & WASTEWATER CONSULTANTS,
IS TO BE PAID $1785.00 AT CLOSING FOR
ENGINEERING SERVICES PERFORMED.
DHHS SIGNATURE
Approved for ~--/L~ t~ ~ ~bedrooms.
Disapproved.
Conditional approval for
INC
o
bedrooms, with the following stipulations:
Additional Comments
By:
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 DH HS 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.
.,?.. '.,//
.//
· /
/
3(0'