HomeMy WebLinkAboutSPRING FOREST BLK 2 LT 10ring Foresf
Block 2
Lot 10
#015-321-20
Uunicipalily oi Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Sile Waslewaler Disposal System and/or Well Inspection Reporl
Peri'nil Nutnber: ~"~ ~)O ~ I ~ PID Number:
LEGAL DESCRIPTION s°" """'~:
SEPARATION DISTANCES ~,c ~ r~o~.~ u S.T.~.~.
Water [~ I~ FT STATION
Remarks: t~,~r,.~ r~r,c W~K P~ BENCH MARK
Inspections performed by:~~JL Dates: ls~-~
Reviewed and approved by ~, ~ Dale: l-] O-~!
PER,lIT NO SW00021 5 PAGE 2 OF'
Municip. oti'l: o'F' .A.n~h.o.m g g?..
DEPARTMENT OF HEA~THAINU HUMAIN SERVICES
ENVlRONIVlENTAL SERVICES DIVISION
P.g. Box 196650 ·Ancho~'<lge, Atask(l 995tg-665O·Telephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 10, BLOCK 2, SPRING FOREST S/D P.I.D. NO.
015-321--20
LOT
Ill
I,I
ROSERT C. COWAN
CE-8801
PERMIT NO. SWO00215 PAGE 3 OF 5
D ........ I'4 u Q ic ip g_li t:. y_o. ? Anchoracle
bI~AN/MbN/ L)P HbAL/H AND HUI~AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
· P.O. Box 196650 ~_Anchorage, ~aska 99519-6650 · Te.?~ohone: 343-4744
ON-SITE WASTEWATER UISPOSAL :SYSTEM AND/OR WELL INSPECTION REPORT
LECAL LOT 10, BLOCK 2, SPRING FOREST S/D
P.I.D. NO. 015-521-20
92"3'J ~ ~-92.0'
FINAL GRA~E-/~
MT1 =81.3'J
MT2=81.3'
C01=96.4'
0~=93.3'
',
&
~VATER FOUND
75.3' B.O.H.
75.8'
A B
FCO 33.5' 21.0'
ST1 35.0' 73.0'
ST2 37.5' 76.0'
DBL1 40.0' 78.5'
DBL2 40.5' 79.5'
C01 59.0' 88.5'
MT1 40.5' 89.5'
C02 102.0' 132,0'
MT2 100.5' 151,5'
WR#: 000074 PID~: 01532120
Date Received: 8-21-00
Legal Description: Lot 10 BIk 2 Spring Forest
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Servica$
On-Site Services
Waiver Review Worksheet
HAft: Permit~: ~w~000215
Engineer. S & S Enalneertna
Applicant: Rebecca Alexander
Waiver Requested: Weetewater dlel=oaal field to lot tine of t foot
Cdteda: 1.
2. Special Conditions:
3. Other.
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
Total:
Waiver is Granted: ~
List Conditions or Reasons for above:
Waiver is not Granted:
Date: I-
Rec~: 6267
Amount: $115.00
Date Paid: 0-15-00
Municipality ,of Anchorage
~g Safely D~vmion
I'.O. l~}x 19(}(~-~0 * 4700 S. Bmgaw Street
Anchorage, Alaslm (`)0519-CW~0 * ((.)07) 3~3-8301
h I t l)://www.cl.anc hor,~g¢.nk.us
PubItc Works
S & S Engineering
ATTN: Robert Cowan, PE
17034 Eagle River Loop Rd, #204
Eagle River, AK 9957%
January 10, 2001
Subject: Waiver Request forSPRING FOREST BLK 2 LT l0
Waiver # WR000074 Lot Line Request for Parcel ID 015-321-20
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 1 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
3434744.
Sincerely,
Jeff Poet
Engineering Technician III
On-Site Water Quality Program
ROBERT C. COWAN, P.E.
January4,2001
CML ENGINEERS
(007) 694-29?9
FAX (907) 694-1211
solt. TE'ST
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
PO Box 196650
Anchorage, AK 99519-6650
Attention: JeffPoet
Reference: Lot 10, Block 2, Spring Forest Subdivision
Dear Mr. Poet,
On the above referenced property, the soils from one end of the trench to the other
are at least as permeable as the soils test performed on 6/9/00 (60 minutes per
inch). It appeared that in some areas ofthe trench, the percolation rate is most
likely even less than 60 minutes per inch. This was evidenced by lower silt content
and higher sand and gravel content in a few areas along the trench.
Ifyou require any further information, please contact us at 694-2979.
Sincerely,
RCC/skh
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
MUNICIPALIT~ OF ANCHORAGE
Department of Health and Human Sen/ices
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 06, 2000
Expiration Date: Jul 06, 2001
Permtt Number: SW000215
Legal Description: SPRING FOREST BLK 2 LT 10
Design Engineer: 0003 S & S Engineering
Owner Name: Rebecca Alexander
Owner Address: 6101 West Tree Dr.
Anchorage, AK 99516-6710
ParcellD: 015-321-20
Site Address: 003101 WEST TREE DR
Lot Size: 43125 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day,
B. Covered, sealed, and heated to prevent freezing.
ROBERTC. COWAN. P.E.
June 21, 2000
CML ENGINEEFLS
(907) 694-2979
FAX (907) 694-121
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 10, Block 2, Spring Forest S/D
It is requested that you issue a permit to install a septic system upgrade to serve the
existing four bedroom dwellin~ on the referenced property..q ~ s G n ~ cz.o.,t ~- ~
A test hole was excavated and a percolation test was performed. The approximate location
of the test hole is located on the attached site plan. At the time of excavation 6/9/00, water
was not found. After seven days of ground water monitoring, no water was found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
RCCCojj
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577
4 BDRM - 600 GPD ~ w RK :XCAV~O~
DR~F[ELD CRITERIA:
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: j~''
/-07-
LEGAL DESCRIPTION:. ~'
DATE PERFORM
Township. Range. Section:
2-
3-
4-
5-
6
7
8
9
I0
1!
12
13
14
15
16
17
18
19-
COMMENTS
o,~c-4,,,, c $
WAS GROUND WATER
ENCOUNTERED?
SLOPE
IF YES, AT WHAT
DEPTH? pO
E
Oep~h to W.ef N1er '
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
~0 ~0 ~ ~/~" ~/~"
~O J0~.~ ~"
PERCOLATION RATE ~O (~ (mmutes/;ncl~) PERC HOLE DIAMETER
TEST RUN BETWEEN '7 FT AND (~ FT
T "J·-~ [.:c!e River Loop Road No. 2~ I ERTIFY THAT T/HIS TI~ST WAS PERFORMED IN
PERFORMED BY; L.,:,I~ ~ver, A lika ~577
ACCORDANCE WITH ALL STATE AND MUNiCiPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ROBERT C. COWANo P.E.
CIVIL ENGINEERS
(907) B94-29~
FAX (907) 694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 10, Block 2, Spring Forest S/D
June 21, 2000
GENERAL:
Thc scope of this project includes the installation of a new 1300 gallon
Premier polyethylene septic tank, and installation of a new trench to serve
the existing four bedroom residence located on the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal pemfit with any special provisions or conditions, and
all applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
Con~a'actors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
7034 NORTH EAGLE RIVER LOOP ' SUITE 204 ~ EAGLE FdVE R, ALASKA 99577
Page 2
Lott0, Block 2, SpHng ForestS/D
June 21, 2000
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches above final
grade.
Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts
shall be located on undisturbed soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield. The second eleanout shall be
to clean toward the septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer
rock) placement.
Once the gravel is installed, the dis~ibution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt baxrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
fi'om the bottom of the trench to the invert of the distribution pipe. This is equivalent
to the effective depth of the gravel as noted on the design.
Page 3
Lot t0, Block 2, 8pflng Forest
June 21,2000
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The £mish grade over the U'ench must be mounded to prevent the formation of a
depression after sealing.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
T.vp. e of Pipe Perfomt~
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be
installed between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform
to current M.O.A. or D.E.C. requirements, which ever requirement applies.
Page 4
Lot tO, Block 2, Spring Forest
June 21, 2000
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
The f~t inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and befog the installation of any gravel. A septic tank may
be set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon fmal grading ofthe property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre-construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or conlrol in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineefing's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
NAME APP.L~ICANT N~]~: ALAN HANNON · ,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SFWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RIFPORT
PHONE
~NEW
[] UPGRADE
MAILING ADDRESS
2~O/ ~ c,~.~
LEGAL DESCRIPTION
LOCATION
70 ~"' ' / :: V' '
Well ?/~l v'AYE
I
Absorption
area
J DISTANCE TO: J I-I~ I
~ JLiq. capacity in 9aliens ~ ,= u~*E*~DE' J Inside length
J / ¢' ~'~ '- J Dwelling
~..~ DISTANCE TO' Well
~ I Manufacturer
~z~z
Dwelling 2 6, O/
Mater a ~T~' L.
JWidth
UJ
I Well ,~RtVA1E WA'tL~'
DISTANCE TO:
No. of hines /, Length of each line ,
So,o
Top of tile to finish grade ¢~,, ¢FA"
Length
Type of crib
DISTANCE TO:
Class
DISTANCE TO:
PERMIT NO.
No. of com~.artments
~,IA Liquid depth WA
PERMIT NO,
Liquid capacity in 9aliens
Material
Foundation z~ / Nearest lot line
Total e ]gth of lines Trench widt!~
~'O, O
Material beneath tile
2 ~o '1" was n ~:Add~_ 0
PERMJl NO.
ZL¢os'/~
Distance between lines
filches ~
Width Depth
Crib diameter Tx ] ];'~ J Crib depth
Well / 'x,/ F ~ J Building foundation
S'.prh Dri,ler /,,/ u
Building foundation Sewer line / ;' /'
f~-,es
Total effective absorption area
PERMIT NO.
ITotal effective absorption area
Nearest lot line
Distance to lot line
Septic tank
PERMIT NO.
Absorption area(s)
OTHER
FERIALS
L TEST RATING
INSTALLER
REMARKS
APPROVED
IPALITY OF
DEPT. OF HEALTH
RE.
LEGAL
72-013 (Rev. 3/78)
Fff:'F'L, ]: CF:tN'I"
L. OCWF t 01",1
LEGFIL.
FIL.FIN HF:II",ff'~Cff',I F'. 0. BOX ::L::Le~-473: ]i:44."";:_:'2.7'-3::
LOT :l..ta BI._K 2': .SPI:i:.T. NG F'OI:;?.ELgT LOT $]:ZE 99991a:9 '.Sg!lJrZlRE FEET
T"r'PDZ 01:: !~:';0 t L R[ii:'3nF.:P"r' ~ ON :'3',r'5;TE]"I ~ff.]: TI~:EI",IE:H
MI:::I;:.:;IMLIM I'-,tljI"ID:ER OF' E:I]EE:,I~?.OOM'-:J; = 4
::.,OIL I:~:FI"['ING ,:::-!:;g! F'T,."BR)= 225
THE REQUIRE[:, :F:';IZE 01::' THE :~1]tl.... F:iE:SORF'TION .S"r"JS-FEM IS:
THE L. ENGTH E:,IHECN':":;TOI",I I:5 "FHE LENGTH '::IN FEET) OF THE "I"REI",ICH OR [:,RFIINF]:EI...E:'.
:~HE [:,EF'TH OF I::1 "FRENCH 01:;?. F'ZT ~:.::; 'THE [:,]::E, TFINCE BETHEEI",I THE :]:.;I..II:~:FFICIE OF THE
GF.:OI...I?'~[) fiN[) THE E:EF['"['OM (]1c THE IEXE:Ft',,,'FIT I 0t",I ':: I N FEET ).
THERE ~.'; ["~(] ~E'¥ H IE:'TH FOF-'. TREIqCHES.
THE GF.':FtVEL. I}EPTFI :I:L::; ThlD] MINI I'IUM [:,EPTH OF GRFIVEL E':ETHEEN THE OUTFF:I[...L PIF'D:
I-':11~.,t[:, TH[:~.' E:OTTOM OF THE EXCFI'v'FIT I Of',l ( I t",1 FEET).
I::'ERM I T FIPF'L. I CFtNT HFIS TI-ID: RIESF'ONS I B I L t 'T'¢ TO .'[ NFOF::M TH I $ I]:,EF'I::IRTMENT DIJF..: I NG "FHE
]iI'.,I'.E;TFILLDI]"ION I t'.,t'.E:i:PECTION:~ O1::' I:::11'.,f"¢ I.,.IDiLI...E; R[:,JFtCIENT TO THI'.'~"; F:'ROF'ERT"r' F'IND THE
NIJI"IDfiER Of'": F.".E'.'".i:I[)EIqCEE: THFIT "FHE I.,.tEI...L HIL..L C, EF.:VE.
................... :'If'" I!.....1t ~C::, ~:E ;.:.Z..Z 3:,, :E ll".'.,~ .".E~!; [I::::' E~E E: T :E ~:Z".~ t'-,.~ "_--'¢ F!t F:' [~E ~: IE ll2.~ Lil Z IF;..' EEE::,
BFICKF'I LL. :t: NG OF Fff.,Ih" .S'.¢STEH ,H :1: THCIUT ;~: I 1'41~3L. I I",ISI::'EE:T '[ O1'-,t RI'.,ID RPF'RO',,,'FIL 8'¢ TH I S
I}ED'FIF..:]]"IEI",IT I.q ILL. BE SUBJECT "FEi PRO'::qECUT I OI'.,I.
M I t'.,I I MUM [::, I t!....qTIalqCE DE'I"HEEN FI 14ELL. f':lt'.,IE:, FINk" ON-'-:!; I ]"E SEI.,.IRGE [:, I ~-'_;PO2;F:IL :i.~;'.r'S;"f'EM I ~";
::.1..~!10 FEET FOF.: FI PF.:I',,,'IaTE HELL Ot::;: :].SE:l TO 21.3El FEE]' FROM la PI.JBL]:C HELL E:,EF'EN£:,ING
Ijpr3N 'T'HE T'.¢PE (:iF' F'UE:L. TC HELL.
HIi'.,tIPiUM E.,Ii];'i]::iNCD: F'I;.:OM DI F'I:;:'.:[VFtTE HELL. "FO Fi PRI',,,'FITE '_'-T, EFIER LINE ].'S 25 FEEET laND
'/"O F:l COMMLINIT'.? :E;EI.,.IER L. INE ]::.5 75 FD:ET.
O]"HER i:;.:Et..';:.!LI I REMEhlT::':q t"'lf:t"r' I::IPPL.."r'. $:]PEC I F I CFtT I Of'iS FIN[::' CONSTRUCT T ON E:' I FIGF.:I:':IMS F:II'7:E
Ft',,,'R :[. I....I:::I[::H.~E TO I N'.:~:;UF:E F'ROPEF;: I I",I'Z:;TI:'~I..LFIT 'Z O1",t.
]: CERT :[ F"r: THI::IT
::L: I FIM FFIMILIRR 1.4ITH TFIE Iq:EL::!UIREI'"IEhI"I':~] FOR ON--':E':;]:TE :?:;D.-.I.,.IERS FiND HELL:E; FI:F.; SET
FOF..'TH [:"i"r' THE MUI",I]: C I F'RL I l""r' OF' I:':thlCHOF.:FtGE.
2: I H]:LL .T. NSTFiLL. ']"PIE: :?'Ri!.:;,TEM :[1"4 FtCE:Ot:.;::DFII",ICE HITH THE CODES.
ii:: I UI'.4DERSTFINE:' -FHFIT THE Oi",t-'":E;][TE :~D:HEF.: S","~;TEH MFI"r' REL:'g..IIRE ENLFIRGEMEi",IT IF THE
RE!:;iDENCE IL=., REHOE:,ELEE:' TO :[NCLU[:'E MOI:;.'.E THI::IN ,1. E',E[:'F.:OOM::-:;,.
:[~; ]: GNE[.,: ,¢.....-.-- .............. ~
~ I~.,1'[' FtLFIhl
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~' PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ L/~a M
5
10
12
13
14
15
16
17
WAS GROUND WATER NO
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
B\k La+
PLAN
72-008 (6/79)
PERFORMED BY:
PERCOLATION RATE
Reading Date Gross Net Depth to Net
Time Ti~e Water Drop
t~zO
:u:S3~ I 0 2,qq
MUNICIPALITY OF ANCHORAGE
DEPA.TMENT OF .E^LT. AND ENWRONME.TAL P.OTECT O. D,WS ON OF
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
{b)
(c)
Location (address or directions)
Applicant Name ~_ ~,¢,.r' t¢ ~,
Applicant Address _ /c/ ~¢v~.
Telephone: Home Business
Applicant is (check one): Lending Institution []; Owner/builder.~; Buyer []; Other E] (explain);
(d) Lending Institution Telephone
Address
(e)
Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
Cc.// 3 +~ - ~,'~o~
TYPE OF RESIDENCE
Single-Family [~ Multi-Family E]
Number of Bedrooms ~¢
Other
WATER SUPPLY
Individual Well F'] CommunitC~'~?~?ublic []
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 [] Cornmunity [] 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 ¢1/84)
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 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, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm NI-IAWi't;OP, N~ . ~ii',;~;ii..!,_':~,~,NG Telephone
7]27 Old Seward Highway
Address Ancli,, AI(.99502 34~.~:~
Date //.~1 ~
"ATE" W~O~Tht~lth ~o,ity~pp,ova~inspeCJon ~rel~
certl~s ~ th~ub~ect~te. ~ prod~ 'Z~g~l~ p~
be~~ha~e~ti~d lab~toPy ~,ts~h0we~no
~~~c~la in~sample~ that~ater/No w~ntee ~-~t (~' ,ri/, '~
/adeq~cy or {afety of the water suppl~ ~'"'~
ON-SITE SEUAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval
system accepted at least 150 gallons of water per bedroom per day
as detemined by methods approved by the Municipality of Anchorage
Department of Health and Human Services, No warantee or
certification is expressed or implied concerning the long te~
adequacy of the on-site sewage disposal system, Construction data
reported on buried system components is from MOA files and was
not verified during this inspection.
DHEP APPROVAL~ ~-.~,~ ~
Approved ~or..¢__~¢, bedrooms by.
Approved ~ ' Disapproved Conditional
Terms of Conditi0~al ApprOval
Date
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 $ 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)
MUNICIPALITY OF ANCHORI~J~NICIPALITY OF ANCHORAGE (MOA)
DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA)
ENVIRONMENTAL pROTECTION CHECKLIST ' FEBRUARY 1984
264-4720
~'~0'~ I ~ '~ Legal Description:
WELL DATA
Well Classification
Well Log Present (Y/N) _
Total Depth
Static Water Level
Cased to
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield _
Depth of Grouting
Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/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
Comments ~.Y-,'¢.," / ~" ~../~4¢~-.
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) ?~ __ Air-tight Caps (Y/N)
Depression over Tank (Y/N) _ ./~,~".~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank HighLWater Alarm (Y/N) ,,~,,~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~ ,2~ ~ ~
To Property Line _ ~_-~b //'
To Water Main/Service Line ,~'~ ~ ~'
Course
Size ,/~.-5-~;~?.,,¢d._ No. of Compartments ~--
Foundation Cleanout (Y/N)
Date Last Pumped ~;'~'~//~ ~' ~"~
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field /~,~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test ,'¢~'~',,~"~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot .,'~,,'¢L'¢'~- ~---'~'~,,~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments__J(d~f/~ ~.¢__ ¢j¢
Type of System Design
Length of Field
Depth of Field /lk/',~/
Gravel Bed Thickness J~l~ ~/
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots /~:¢~/ ;'~
To Cutbank (if present) ,/¢Y',~'~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments ·
** Check Permitted Bedroom Rating Against HAA Request **
I certify that,c Y'// ,"~ / ',¢--¢_.L 'bhaw' checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed --/~ .~'r~ Date Ii
Company ,/~uJ.+¼o.c'v,.¢. MOA No.
Date of Payment ////~/~
Amou,t:
Page 2 of 2
72-026 (11/84)
DE~. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
DATE: September 18, 1986
PWS I.D.# 213564
To Whom it May Concern:
According to records on file in this office the SPRING FOREST
Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
~ ~ames C. Allen, RS
~_JRegional Sanitarian Supervisor
APPLI(, NT FILLS OUT UPPER HAl. ONLY
Property Owner
Phone
Address
Zip Code
Really Co. & Agent
Legal Descriplion
Street L.ooat[~
Phone
¢ ' / '/-- L./f./
Phone
Type of Residence [g~ Single Family
C] Multiple Family
[] Other
No, of Bedrooms__~____
Water Supply I
[] Individual
~ Community
[] Public Utility
Sewer Disposal
Individual
[] Public Utility
[] Holding Tank
ATTACH WELl. LOG. A well Icg is required for all wells drilled since June 1975.
For wells drilled prior 1o that date, give well depth (attach Icg if available),
Year Individual Installed:
When Connected to Public Utility: __
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time
Date
Inspector
Date
Inspector
Date
Inspector
Time ~ ~"
Date
Inspector
Field Notes:
I~-~7~pp ROVE D BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAl_*
'CONDITIONS OF APPROVAL
Soils Rating
72.023 (3182i
Date 8ewer lestalled
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
DEPT. OF ENVIRONMENTAL CONSERVATION
BILL SHEFFIELD, GOVERHOR
~lephone: mO?)274-2533
Address: 437 E. Street
Suite 200
Anchorage, AK
99501
To Whom It May Concern:
Our records indicate the Spring Forest Subdivision Water System to be
in compliance with the State of Alaska Drinking Water Regulation.
Sincerely,
Anchorage/Western
District Supervisor
JOA/msm