HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 5 LT 14APro
p¢ct
Heights
Block 5
Lot 14A
#015-091-46
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 r~J~N EW
MAI ~N G ADDR ESS.~
LEGAL DESCRIPTION
LOC~TION . ~
' f ~ I NO. OF BEDROOMS
I ~' We~l~ ~ ~io~ area DweUing~.~
~ No. of~m~r~nts
~ ~ ~ D~STANCE TO: Dwelling PERMIT NO,
~ ~ ~ Manufacturer ~ ~
~ -- ~ Material Liquid capacity in gaUons
~ ~ TopoftiJe~fin,shgraJde ~,,.e Tot~?~fnnes Tu~ch~idth Distance between lines
MaterJ~b~e~th the / Total effective absorption area
~ Length Width Depth
~ PERMIT
~ ~ Type of crib Crib diameter
~ ~ Crib depth To~ area
~ DIStAnCE TO: Well B ~earest lot line
~ Class Depth ~ ~ler Distance to lot bne PERMIT
~ DISTANCE TOt~ ~g foundation Sewer Uno Septic tank Absorption area(s)
OTHER
PiPE MATER JALS
SOl L TEST ~AT_[NG [
'~M~s , . ~ ~
~,~ , . ~~ . .~_
~ , ,~. ~,~,~
APPROVED DATE LEGAL ~
'7-~/-~¢ Lot I~ , fN~A~ ~ ~'~,~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
8:)5 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
~" &'-. ~
/10
DATE PERFORMED:
T~f'z ~) ~'3~
SITE PLAN
h
'L.
5-7-
Reading Date
3
PERCOLATION RATE ,~'~--
TEST RUN BETWEEN ~'
Gross Net
Time Time
'~-~ t
¥oi IO
¥1~
Depth to
Water
~ o
SO
-
/*O O O
(minutes/inch~
FI AND ff/~ FT
.,g'/o2'¢ ,J'~'" ~,~¢' O~,,~ CERTIF[EDBY:
Net
Drop
POUL.., 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-411 i
TONY KNOWLES.
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit 9: 840907
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 14A Block 5 Prospect Heights Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office' for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
~~Ba~d~t ,~or
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
.. 1,1: ,,
~ SOILS LOG ~
]IUNICIPALITYOF ANCHORAGE ' " i ~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~/~PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720 TEST
SOILS LOG - PERCOLATION TEST 7/_~0 c/~)?
SLO'~E SITE PLAN
1
2
3
4
5
6
7
9
10
11
12
13-
14
15
16
17
19
20
ENCOUNTERED?.~ ~ SL -
IF YES, AT'WHAT ~ ~'
DEPTH?
Reading Date Gross Net Depth to Net
Time Time h Water Drop
~/,n ,~/-? 3:,3o
, 9 3:~/o /~ ~.,; .~,~ .i?
· COMMENTS
72-008
P-~Rco LATION RATE
iN
CERTIFIEI~ B
~utes/inch)
1201 Famona St. 99515 ~kNC~ORA~F~ ALASKA
SIX INCH WATER WELL DRILLED .......... OUT TO THE DEPTH OF
DRILLED AT THE RATE OF. !'23.00
PROPERTY OWNER Mr. ,Tim Gorton
LOCATION OF WELL SITF
DRILLER ~ernie Claus
PER FOOT.
3~6-2127
Lt. ~lk. Sub
276-1942
of Pempart Erilling Works.
360 feet.
Charge for 130 feet.
Initial Mater Well deepened from 230 to 360 feet.
230 - 360' Bedrock. A sedimentary roc~ material. New water yield from
cracks ~ fissures after 300' ~ out to 360'. The total new water production
will probably be 60 gph with somewhat greater yield in the spring of the
year. ~ow the water yiela is 50 gallons per hour. Water recovery is back
up to within 90 feet of surface.
Cost of drilling:-f23.00 per ft. x 130 ft: $2,990.00
~o set-up cost. Mo mobilization or demob cost.
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OP $2 ~ 990.00
THANK YOU VERY MUCH. ~--~~ O~
BERNIE CLAUS WORKS
DATF .Tull; 12, 1991
SERVICE CHARGEOF 1~% PER MONTH WILL S£ ASSF..SSED ON PAST DU~'ACCOUNTS.
Date Drille~L
Static Water: Level
105
Dr-aw Down N/A
.Type M~%tsri~i, Drilled:
0 feet .. to
WELL LOG
fee t
Callons Per Minute
_ feet
Total Feet of ~asing
55 Cl~v/~ravpl
95 Grave].
1 to 1.4
226
_95 __ to 226 Bedrock
.(ca.~ed to 98 f~et~
to
to
Hefty Drillin~
S.R.Ao Box 1553 H
Anchora~e,^laska
99507
Z o'/ /
•
• TGE 8(i
Municipality of Anchorage •;47 '+
On-Site Water and Wastewater Program "
(907) 343-7904 SAFETY
Certificate of On-Site Systems Approval
Parcel I.D. 015-091-46 Expiration Date: 7- S-1- le
1. GENERAL INFORMATION:
Complete legal description Prospect Heights#1; Block 5, Lot 14A
Location (site address) 9651 Buddy Werner Drive*Anchorage,AK 99507
Current Property owner(s) Matt&Ann Waldron Day phone 947-4801
Mailing address
Real Estate Agent Dar Walden Day phone 865-6406
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by:fi Date:frii
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ ‘j .2Ap _ Waiver Fee $
Date of Payment 1+-1"-i Date of Payment
Receipt Number 0 GV) 00 G) Receipt Number_
COSA# OSC \� 11'0/ Waiver#
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,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage 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 and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 3/36/ g
00000pO.
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o ' OF Air
in accordance with the guidelines and regulations established by the Municipality of Anchorage and "'
industry practices. The reported results describe the condition of the system/s on the date/s of the O •
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or • �''�
encroachments may exist that were not identified during the evaluation. The operational life of all wells 4 TH G �• *OD�
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 / VA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and /....
/
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the f ' '�` r A. Corn_ss: o
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of (/q C -!,: �• GI
the well or septic system. GEG makes no representation whether an alternative well or septic system VQ •s • .(PO
can be installed on the property in the event either of the current systems fail to perform adequately in �� e,. '� 2. (.R.•f r� cc°'p
the future. The content of this report is for the sole benefit of the person/party that retained GEG to �14°'professtonoao
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right P. � �
whatsoever. •
J�G\eCC
ON-Sii G)
6. DSD SIGNATUREWATER AND rt
System #1 Approved for S bedrooms -rn WASTEWATER Z
PROGRAM o
System #2 Approved for bedrooms
Disapproved 4''�M 4PR\I\C5'c\
Conditional approval for bedrooms, with the following stipulations:
1 �
K. e�rr '
4 i1sd'' � I ► �c al 4 S. cc 1 s. .ef • t'S a° ye:LvE 01_12
/
gy; rt / Original Certificate Date: LL,-6
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: r...COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory ____ Other
COSA blue sheet_10-10-12.doc
• If more than 1 septic system is on the lot:
COSA Checklist# of_
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Prospect Heights #1; Block 5, Lot 14A Parcel ID: 015-091-46
*Well deepened to 360 feet. Per Aarow Pump & Well
A. WELL DATA inspection on 3/23/2012, the well is only 223' deep.
Well type Private If A, B, or C provide PWSID# N/A Well Log (Y/N) Yes
7/28/1983
Date completed *7/12/1991 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes
Total depth 360 ft. Cased to101 (Bedrock)ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/28/1983 & *7/12/1991 3/19/2018
Static water level 98 & *90 ft. 159.2 ft.
Well production 1.5 & *0.83 g.p,m, 0.58+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 ml. Nitrate 6.32 mg./L. Collected by: GEG. Ltd.
Arsenic: <5 ug./L. Date of sample: 3/19/2018
*33 year old septic tank is approaching the end of its useful life
B. SEPTIC/HOLDING TANK DATA **FCO Sc ST1 located under ground level deck (see attached photos)
Tank Type/Material Septic/Steel Date installed *7/31/1985
Tank size 1500 gal. Number of Compartments *2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N)**Yes Depression over tank (Y/N) No High water alarm (Y/N) N/A
Date of pumping 3/27/2018 Pumper Isaacs Pumping Service
C. ABSORPTION FIELD DATA *Below Existing Grade
Date installed 7/31/1985 Soil rating (g.p.d./ftzorf/bdrrr� 138 System type Trench
Length 84 ft. Width 2.5 ft. Gravel below pipe 4.5 ft.
Total depth *7.8+ ft. Eff. absorption area 756 ft2 Monitoring tube Yes Depression over field No
Date of adequacy test 3/19/2018 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test**25 in. Water added**938 gal. New depth **31 in.
Elapsed Time: **30 min. Final fluid depth **25 in. Absorption rate >_ **750+ g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) None Known If yes, give date —
**438 gallons of water were pumped from the well/storage tank over a 65 minute period causing
the liquid level in the MT to rise approximatley 6". Approximatley 165 minutes after running out of
water, the liquid level in the MT had dropped 6". A 500 gallon water haul was then used to
introduce the necessary remaining gallons into the drainfield, causing a 6" rise in MT liquid level.
The drainfield was then allowed a 30 minute recovery period resulting in another 6" drop in MT
liquid level (returned to starting liquid level).
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at •• •• wa er alarm level at in.
•- •• Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
J
t Absorption field on lot 100'+ On adjacent lots 100'+
3 Public sewer main 75 + Public sewer manhole/cleanout 100'+
2
Sewer/septic service line 25+ Holding tank 75'+
f. Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
Q
? SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation *Unk Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation **Unk Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
,} Curtain drain None Known Wells on adjacent lots 100'+
U
F. COMMENTS
*South end of septic tank (ST1) is under ground level deck (see attached photos)
**Could not confirm (see attached sketch)
G. ENGINEER'S CERTIFICATION ,.4:7'7C... F• ` `�5A
i 1\ '•'i--Op
I certify that l have determined through field inspections and Q 4 H .. *�O
review of Municipal records that the above systems are in 0
conformance with MOA COSA guidelines in effect on this '•. j
date. '/ •ff = A. arness, P
Engineer's Printed Name JEFFREY A. GARNESS ((I 0VP • •
E7795 ��.. .cl�p
) •311/8 <,Ao
Date 40oOO fess‘Oovo
O�oo
#AECC884
(Rev. 11/05)
/
/./
4 .5.4./
hr,�
Q g0004ppO�
„„
� OF At N
o � q
I ;F � o��P. o s�00
/
// \� 49 DJ %� O,
��/ o Sian,.i. ,mo o
..'_.-- fir.. m . o
`I_ in.v=tom_..... -- - '- - v SHANE A.HOLT 4
w�_ �� 444 ay LS-6914 ��000
3► � 44p`Ojesslens� �o�
77.
vSHED \ S8'lti
.° �N` �27y 3pB
Jo ASF �4
e
/77 DEC,. .
\
/
o \`
2 #' ir.
'�`� 4'
U �PN1\ Jc '
� '` r" F
F • A.
'moo /
., //
e°
'e, sl',
t ,C,
V S
8 S� `IY ;i,
• 9g .4,' ^ t4.
/ cJ
AS'-31;TLT SAYE` y' = 3E19 _ a
NO CORNERS SET THIS DATE /J 0'1,
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY /,^ a4'
OF THE FOLLOWING DESCRIBED PROPERTY / // rh
LCT 14 A, BLOCK S. PROSPECT HEIGHTS HO. ( PLAT 70-23; - / (
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
''' 'Pec' , / '',f
` � r
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
,
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED.
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. DATED AT ANCHORAGE,ALASKA THIS -- DAY OF
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN _ -- 2018 1
•
HEREON ( UNLESS INDICATED) '
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE
ANCHORAGE,AK 99507
345-5513
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • ` 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # 0SC181122
Subdivision: Prospect Heights #1, Block: 5, Lot: 14A
A water sample revealed a nitrate concentration of 6.32 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen,which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available,which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
E:717)
907 343 7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Well Water Advisory
Certificate of On-Site Systems Approval # 0SC181122
Subdivision: Prospect Heights #1, Block: 5, Lot: 14A
This well's productivity was determined to be .58 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 5-bedroom residence is .52
gallons per minute or 150 gallons per day per bedroom. Although the subject well
currently exceeds this minimum requirement, the production capacity can
fluctuate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
w..,..w.ci.anchora9 e.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY'APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o 15 - o '~ i - "/u
1. GENERAL INFORMATION
Complete legal description
Lot 14A. Block 7:
Expiration Date: '7 - ~ ' t~) !
Location (site address or directions) ~g51. B,ddy WPrrrr ]3r~'P
Current Propertyowner(s).Jim & Janet Gorton Day phone 762-3148
Mailingaddress 9651 Buddy Werne~Drive~ Anchorage, AK 995'JG
Lending agency Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, I tAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
[]
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the Stale of AJaska. Cer'Jficates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to hcmeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates ere valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not respcnsible for errors or omissions in the professional
engineer's work.
o
STATEMENT OF INSPECTION BY ENGINEER ..
As certitied by my seal affixed hereto and as of the validatioh date shown below, I verify that my investigation,
based on procedures outlined In the Health Authority Approval Gdidelines for this application, shows that the
on-sita v~ater supply and/or wastewater disposal system is(ara) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the
Municipality of Anchorage flies and from my investigation and inspection, the on-site ·water supply end/or
wastawatar disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
S & $ ENGINEERING
Name of Firm 17034 Eagle R;ver Loop Road No. 204
Address
Engineer's Printed Name ~obert C. Cowan, P,E,
5. DSD SIGNATURE
Disapproved.
Conditional approYa
Phone ~'7 ~- ~ '7 7'7
Da,e
bedrooms, with the following stipulations:
,Addiition ~,,,~l~o~rnt~js o .ents
lNote: ',,,e property meets ex,sting State and Municipal Codes. There are nitrates
present. It is suggested that periodic testin= be performed to instate th~ xvell~ enntintvorl q~It.hll{~.
Current nitrate concentration is 5.25 m~l. EPA maximum concentration is 10.0 mg/i. ~Iore
................... ~ ,, u...~ Ou-SiIc Sc~ ~iuc~ Frogram, at 343-7904.
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemenlal Engineer's Report
Other /~7~'~'~. /T.")~/
Original Certificate Date: z--/. - ~ - 0 /
M. nicipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastawater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchomge.ak.us
(9O7)
HEALTH AUTHORITY APPROVAL CHECKLIST
LegatDescripflon:LoT I~//t 8Lte.y' ~KoJP~c.~- ~/~,.IC..#r$ ParcelID: t~lZ}''-0=11-¥G
A. WELL DATA
Well type/aR ;'4'9 r"L
Data completed 7/t~-t e I
Total depth '~ (o O ft.
Data of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seat ~/N)
Cased t~ ~O+ft.
FROM WELL LOG
fid ft.
O, ~ g.p.m.
Wirespmpedyprotacted~/N) Y~ $
Cas~ height (above ground) I ~. + in.
AT INSPECTION
'3 /~.1/01
/JO ft.
O, ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/100 mi. Nitrate ~.. ~.t'- mgJI.
Date of sample: ~ ] 3 ~- / O / Collected by:
B. SEPTIC/HOLDING TANK DATA
TankType/Matedat oc~,n~''c /$/-+:~' ~'-
Tanksize J'.~-O@ gat.. Number of Compertments ~
Foundation ctaanout ~1) ¥, ~ Depression over lank (Y~
Other bacteria 0 colonies/100 mi.
ae~r.~t~6~) Y* s
High water alarm (Y~ ~,~ 0
Data of pumping 'A / o I Pumper
ABSORPTION FIELD DATA
'Date installed ~/ji/~,,.,r- Soilrating (O.p.dJfl~ o~
Length *~'~ ft. Width ~t '/a.. ft.
Total depth ~ fl. Eft. absorption ama'~ $
Data of edequacy test 3/eX,/O ' .esults~Fail)
Fluid depth in absorption field before test t~a'7 in. Water added ~ ~:Ogal.
Elapsed Time:~/4 min. Final fluid depth ~e~, in. Absorption rate >=
· ,~e~'4. ~c,va~,n/ If es ivedate
Any rejuvenation treatment (past 12 mo.) (Y/N & typ ) ~ y g
System type ~-.?e,,, c/V
Gravel below pipe ~ °/~- ft.
Depression over field ,~' 0
For '~' bedrooms
New depth De/' in.
'7 ,~O g.p.d.
S & S ENGINLe~em~
17014 Eagle Rlv~ I. oep Road No. 204
Eagle River, AJadm 99577
Date installed "~ / .TI J ~'5"'
D. UFT STATION
Date installed
'Pump on" level at
Datum
E.
in~ High water alarm level at
~ Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES
Fe
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllllt staticm on lot / 0 0
Absorption field on lot I ~ ~ '~.
Public sewer main
Sewer/septic sewlce Ilne
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~ ~' Propert~ line o~' '~
Water main A//,~ Water service line / O
Wells on adjacent lots ,/go ¢
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /O -/'- Building foundation. I O -~
Water Sewice line )o ~,- Sudace water J o o ·
Curtain drain ~0,v~. ~,~,0,w,~/.WelJ$oledJacentlets )co
COMMENTs.- .': ....... ,.:'
Absorption field
Surface water
!
Water main A,'/,4
Driveway, pafldng/vehicle storage
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. ~/~
During a recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot
Block ~ of ~o~c--~ ~,~ Subdivision, the well's
productivity was ~etermined to be ~.8...gallons per minute.
The minimum well productivity'required by this Department
'(~C 15.55) for a ~- bedroom residence is ~ gallons
· per minute. Although the subject~weil currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies ~f the subject'
Health Authority Approval.
' hODERI' C. COWAN.
rlOllERT A. SI IAI'Ell. I'VE.
WELL FI~OW TEST DATA
CIVIL EUGINEEris
(907) 694.2979
FAX (907) 694-12 t f
CLIENT: ~ '"*'~ -f .;t~/~4 ~ ¢,;~;?./c~,~' DATE:
WELL DEPTII: ~ ~ CASIN~ DEPTIh ~ ~ '
DATE DRILLING COMPLEIED: ~,~.~ 'I/,~/q I DRILLER: I~ ~ ~
MISC. DATA: CASING IIEIGIIT: I ~ SANITARY SEAL:
WIRES IN CONDUIT: y ~ J GRADING O.K.:
EaACTERIA AND NITRAIE SAMPLES COLLECTED (dale}:
TEST DATA:
METER PUMPING DEPIII TO
CLOCK READING RATE WATER REMARKS
TIME (GAL) (GPM) (FT)
I.'~'~,'~1 ~?107~-/7 I10 swl
I "~5' O/ d '7'3,~,2
RESULTS: WELL CURRENTLY PRODUCES O. ~' OPM WITIIA .) 3'(, ORAWDOWN
TESTED BY: ~¢ ~ C° .
FLOW RATE NOT GUARANI'EED-SUBSEQUENT VARIATIONS CAN OCCUR.
17034 NORTI I EAGLE RIVEn LOOP * SUITE 204 * EAGLE RIvErt. At ASKA 995??
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
GENERAL INFORMATION
(a)
(b)
(c)
264-4720
Application Date~
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name 4d¢8 P. NT£1~PfCI$&.S Telephone: Home
ApplicantAddress 1:3YO, O 8¢,fWOT' WflF , /~NC/~;
Applicant is (check one):. Lending Institution []; Owner/builder []~'; Buyer []; Other [] (explain); _
Business 3 ¢.%52 7'7
(e) Real Estate Company and Agent
Telephone ~-
(f) Mail the HAA to the follgwing address:
TYPE OF RESIDENCE
Single-Family [~ 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
0nsite,,.[~ Public [] Community [] Holding Tank []
Note: If corn m. unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 .......
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hea~th
' Auth°rity Appr°val sh°ws that the on-site water supply and/or wastewater disposal systern 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 date of this inspection.
Name of Firm ~ ~C~ [/~C~ Telephone ~-~'/-
Address12o0 cd 23J i UF., t NC .
Date
Approved L ~-"~/~ Disapproved{~''~' Conditional~ -
Terms of Conditional~pproval
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.
Paee 2 nf ?
WELL DATA
MUNICIPALITY OF ANCHORAGE (MO.~)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: ~
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
APR 2 1
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit
Separation Distances from Well:
To Septic/Holding Tank on Lot
Well Classification ~-JN ~)/~//~0Uf~/ If A, B, C D.E.C Approved (Y/N)
Well Log Pres Date Completed ~/~/r~r~ ~ Yield
Total Depth ~ Cased to ~ Depth of Grouting ~/~
Pump Set At //~
/ ¢ ~ / Sanitary Seal on Casing ~/N)
Depression Around Wellhead (Y~
7~10/
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot a~;~'~--IO/tOn Adjoining Lots
To Nearest Public Sewer Line /~/t~ To Nearest Public Sewer
Cleanout/Manhole _
Water Sample Collected by
Water Sample Test Results
Comments
/15'/¢'
I/0/'f'
J~///4'r To Nearest Sewer Service Line on Lot _ ~- / (~) /
~ - ~ ~/7-C~H~/CK ;Date ('f///~/~2~·
B. SEPTIC/HOLDING TANK DATA
Date Installed '7//'~ ,/~'.%~ Size /,~- O J~ NO. of Compartments ~.
Standpipes ~N) Air-tight Caps ~N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) /~/'//~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~-~ J ~ /
To Property Line j ~ 4/¢-
To Water Main/Service Line
Course
Foundation Cleanout (~N)
Date Last Pumped .
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~ ~. ~
To Disposal Field ~' /
To Stream, Pond, Lake, or Major Drainage
Comments
I~age 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Type of System Design
Width of Field ~,~
Length of Field ~ ¢7/ /
Depth of Field (~ /'
Gravel Bed Thickness ~I/,--~ ~
Standpipes Present (~/N)
Date of Last Adequacy Test
Square Feet of Absorption Area
Depression over Field (Y~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well 2-10/
To Building Foundation 2
Lot ~///~
To Water Main/Service Line Z~/~'
756ff
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
/
To Property Line I.~'
To Existing or Abandoned System on
; On Adjoining Lots
TO Cutbank (if present) ~///;~r
/00
2-5
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Man h ole/A.~4"C~N)
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Company
Receipt No. '~)~
Date of Payment
Amount: $
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I hav. e. ch..e,cked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
ALASKA ENVIRONMENTAL
CONTROL SERVI,~'~, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO.. OF
CHECKED BY DATE
sc^~_~ / %.~O '
I
I