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Municipality of Anch6rage
Department of Health and Human Services
Division of Environmental Services
O~-Site Services Se~on 825 'L' Street Room 502
P.O. Box 19~650 A~ct~o~age, AN 99519-6650 Page of
www. d.anct~:xage.ak, us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ~ ~_~I~")~,...,~O.~Q) . PID Number:. ~__0~'0 - SZl-/-/3
Name:
~l~ ~o, Ve~' WastewaterSystem: [] New [] Upgrade
,~.~t,l°/tO, lb'~ .Auc. i A,=h., Ag: ~/C~ ABSORPTION FIELD
LEGAL DESCRIPTION ~"*~
/.// ,. ~, ,,.
~ ,. .55'. :; ,,.
Well: [~New [] Upgrade e,,~ ,,~:
Su~c,v.~w :s/2.~/c~ I~'"w'"'~'': '--'
/~ ~m ~ n.I Z ~, TANK
SEPA~TION DISTANCES ~p~c ~ ~u~ ~ S.T.~.P. ~ ~ec
Sep~c ~ ~ ~dlng ~ ~
Tank ~ld ~ Tank ~
='~' ~/'~ ~ / O~=~H BENCH MARK
Inspe=ions peffo=ed by: ~a WV~,e(/,~ Dates: 1' ~ f..~.~.-~..-......'""'.-.~..&
AS-BUILT SYSTEM DETAILS/SITE PLAN PERMIT#SVgGOe95
TIMBER RIDGE LOT 11, BLK 3 PID#O50-3el-4e
: .',v.::. .-'.~ ,
~es~[~ B-D-106.~' X":~' ~ ~_~ ~, x~ ~ ~. -~ .~
e · I , ...
.................................................................................................................. ......................................
B-E:36.1'
B-F:28.5' B
A-O=95.6' ~ ~ ~ ~ FINAL 6RADE
C-0:3~.2' ~ ~
~ ~1250 GAL
D-G:22.1' ~ /~ SEPTIC ~ [B~.4~
C-H:?O.~' ~"~ $~~ sclc. ~oc~
~ ~ ~; ~ 4~ scAct, N~S
~ .......................... ~4~ PREPARED FOR:
.... ANCHORAOE, AK. 99503
~ ~L~]NC ~ K~D 20441 PTARMIGAN BLVD.
[ .....~...~...`~...~........~.~.~..~..~.....~.~..~.......~.~..~......~..~...~.~...~.....~.~.~....~.....~.~.~.~.~.~.~.~.~...~.~
NW255
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Klaus Mayer
Project:
Timber Ridge Lot 11
TEST HOLE # 00-1
Ie --
2-
3-
4-
5-
6-
7-
8-
9-
10-
11o
12-
13-
14---
15-
16-
17-
18-
Depth
~eet)
Org/SM -brown silty soil
w/org
GM -mixed silt & sand gravel
lenses w/cobbles to 2'
B.O.H.
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
was Ground water encountered? NO
Depth to water after monitoring? NO
What depth? NA
Date? 4/18/00
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 4/10/00 2:00 7"
2 2'.30 30min 412/16" 2 4/16"
3 * 2:31 7'
4 3:01 30rain 412/16" 2 4/16"
5 * 3:02 7"
6 3:32 30 rain 4 12/16" 2 4/16"
· Water Added
19-
20-
Percolation Rate 13.3 (m/in) Perc Hole Diameter 6"
Test Run Between ,~ feet and ~ feet
L Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
by
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2769
O~A~NER OF LAND ~ ~ ~_~'
ADDRESS
LEGAL DESCRIPTION Z,T /_/ ~.~_ :~
Is well located at approved permit location?
Method of Drilling: J~;~tary
Depth of well: ~,~ O
PERMIT NUMBER ~bOO~ Date
TAX INDENTIFICATION NUMBER O ~"O - _"'~
~ ~3No
[~ cable tool
Casing Type .~T..~Wall Thickness
Diameter ~O /'' inches, depth
Liner Type: ~t~ t ,-,J~'
Casing Stickup Above Ground: ~
inches
,"~ f~' feet
feet
Static Water Level (from ground level): / q (~ feet
Pumping level: feet after__hrs, pumping gpm
Recover Rate: ! O qpm
Method of Testing: ~ I ~'-
Well Intake Opening Type: [~ Open End ~ Hole
O Screened; Start feet Stopped feet
Perforations
Start
~'udme L~/3-0 z.~ ~'.
..feceS.Stop, ed feet
· GroutType:~.~T~T_F. C
Depth: from L~ feet, to "--"- feet
Pump Intake Depth: f~et
Pump Size hp Brand Name
Well Disinfected Upon Completion? ~ O No
Method of Disinfection:
Comments:
BORE HOLE DATA
DEPTH
KELI'IVEU
APR 1 7 2000
Municipality ut Ancnorag®
Driller's Name ~
ATTENTION: It is th~ responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Mar 23, 2000
Expiration Date: Mar 23, 2001
Permit Number: SW000036
Legal Description: TIMBER RIDGE #1 BLK 3 LT 11
Design Engineer: 0070 KND Engineering
Owner Name: Dennis & Mercy Elliott
Owner Address: 1010 W. 10th Ave.
Anchorage, AK 99501-3312
Parcel ID: 050-321-42
Site Address: 019949 MEADOW CANYON DR
Lot Size: 225802 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
r~ Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastawater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
Date:
PAGE I OF I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASK~ 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM P~RMiT
PERMIT NUMBER: SW960295
DESIGN ENGINEER: KND ENGINEERING
OWNEP NAME:DENNIS MERCY A & ELLIOTT T
OWNER ADDRESS:1010 W 10TH AY.
ANCHORAGE, AK 99501
DATE ISSUED: 9/11/96
EXPIRA~ION DATE: 9/~1!97
PARCEL ID:05032~42
LEGAL DESCRIP. TION:
TIMBER RIDGE #1BLK
3 LT 11
LOT SIZE: 225802 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THI§ PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH~
THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE I,IUNICIPAL CODE CHAPTERS
~5.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (ISAAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PKOVI~IONS:
EAGLE RIVER, AK 99577-8736
(907)696-61 {{/F;~X (90,")696-8111
August 20, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject:. ~,ot 11, Block 3, Timber Ridge Subdivision
On June 5, 1996, two testholes were excavated on the above lot. The results are
attached. We have designed a single deep trench to serve the proposed 3 bedroom
dwelling. There is also adequate space for the reserve area which is indicated on the
proposed site plan.
This lot is served by individual well. There are no sewer systems that will encroach
into the proposed well site and there are no public or private wells within 200' of
the proposed septic site. There are also no known curtain drains within 50' or any
surface water within 100'. The installation will have no adverse effect on
neighboring lots. The lot has slopes in excess of 25% from north to south with the
approximate toe of slope indicated on the site plan. From the toe of slope to the
south property line the slope varies from approximately 7 to 10% with some areas
being fla.~er. There is no standing water or drainage problems in the area.
We have designed the system utilizing the top soils strata. Computations for soil
absorption was based on the rate of 10 minutes an inch. Based on the above we are
requesting that a permit be issued for the sewer system and well.
If you have any questions about this application, please contact me at 696-6III/FAX
696-8111.
Respectfully submitted,
~f ~-~ .~b) Engineering
Kenneth M. Duffu% P.E.
attachments;
On-Site Well and Sewer Application
Wastewater Absorption System Details/Sit~ Plan
Soils Logs (2)
~/ASTE~/ATER DISPOSAL SYSTEM DETAILS/SITE PLAN
LOT Il, BLOCK 3, TIMBER RIDGE S/D
CANYON VIEW DRIVE
LOT IO-D i i LOT SIZE, ea5,eoa
TINDER RIDGE i ~ LESS HOUSE FO[]TPRZNT~ a,O00
: ~ LESS PROPOSED SYSTEM, ~,000
TOTAL AREA AVAIL.m 22l,B02
LDT ii
~ ~ ~ VACANT
VACANT ) ~ ~ LOT 7
~ [~ HILDRETH
CANYflN DRIVE
VACANT
LESLIE ~ KLAUS ~AYER EAGLE RIVER, AK,
~~ ANCHORAGE, AK 99503 ~TZa/~/~/~ ~/~ IDRAVINO
Mun;cipably o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
t~25 'L" $[reet. Anchorage. Alaska 99502-0~50
SOILS LOG ~ PERCOLATION TEST
6
7
8
9
10-
12-
~3 ~-~:
1,1
19¸
20-
SLOPE
SITE PLAN
WAS GROUNO WATER
ENCOU,~iTER ?'0;~ ~P~ ,
bo~4
IF,,I
./.
i I
PERCOLATION RATE .~-~, ;m,~uleu,o<;nl PERC HOLE DIAMETER
TEST RUN ~ETWEEN (/ FTA~O ~
DEPARTMENT OF HEALTH & HUMAN SERVICEs
SOILS LOG -- PERCOLATION TEST
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
9-
'! I -
12.
15
16.
17
19
2'0.
-- CERTh~y 'lv~A~' Th~$ ~E$I ~v,~; P~.RFORMED IN
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Sita Services Section 825 'L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Timber .ldo oak 3. Lot 11
Meadow Canyon Drive: Eagle River: Ale~ke
Current Property owner(s) Kleus Mayer Day phone
Mailing address 619 West 18TH Ave.; Anehore_ae: AK 99;fl:3
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class '
Public Water System
Well
TYPE OF WASTE'WATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) 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 State of Alaska. Certificates of Health Authority
Approval are required for the transfer of title (except between spouses) on properties served by a single family
on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home
owners. 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 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 wonk.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the vaiidati°n date shown below, I verify that my
Investigation based on procedures outlined In the Health Authority Approval Guidelines for 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 typo of structure indicated herein. I
further verify that based on the information obtained from the Municipality of Anchorage files and from
my Investigation and inspoction, the on-site water supply and/or wastewater disposal system Is in
compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the
time of installation.
Name of Firm KND En_~Ineerln_.q
Address 20441 Ptarmigen' Eaale Rlver~ AK g§577
Engineer's Printed Name Kenneth M. Duffu~
Phone 696-611t
Date
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
Attachments:
· I-IAA Checldist
Septic System Advisory
Well Flow Advisory
X
Expiration Date: ~ . ~...~ 4 eo
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Reissue Date:
RECEIVED
Municipality of Anchorage ~
Department of Health and Human Service~V 2 7 Z000 ,
Division of Environmental Services
On-Srle Services Section 825 'L' Street Room &n2 ......
· ' ~ur~t[;IP'ALl]y OF ANCHORAGE
P.O. Box 196650 Anchorage, AK 99519-6L~'1~
www.ci.anchorage.ak.us ~uwM~:NTAL SEEVICES DIVISION
(907) 343~1744
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type private
Date completed 3123100
Total depth 220 ff
Timber Rldoe. Block 3. Lot 11
If A, B, or C provide PWSlD # ~
Sanitary seal Y
Cased to 38 tt
FROM WELL LOG
Date of test 3123/00
Static water level 140
Well production 10
WATER SAMPLE RESULTS:
Coliform 0 coloniesll00 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Stgel
Date installed 411812000 Tank size
Cleanouts 3( Foundation cleanout y
Date of pumping
C. ABSORPTION FIELD DATA
Date Installed 4/20100
Parcel I.D.: 050-321-42
Well Leg Y
Wires properly protected Y
Casing height (above ground) 24
AT INSPECTION
It It
g.p.m g.p.m
Jrt.
Nitrate 0.752 mg/I
Collected by: KND
Other bacteria 0 coloniesll00 mi
1250 gal Number of Compartments 2
Depression over tank D High water alarm pa
Pumper
Soil rating (g.p.d.l~ or It=/bdrm) 0.8 System type Trench
Length 55.5 ft Width .2
Total depth 9.3 fl Effective absorption area
Date of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test ~ln
Elapsed Time: __rain Final fluid depth ~ in
Any rejuvenation treatment (past 12 mo.) (YIN & type)
(paw. 11/99)
Gravel below pipe 6 It
Monitoring tube y Depression over field L
For_ bedrooms
Water added__ gal. New depthm in.
Absorption rate >= ~ g.p.d.
If yes, give date
LIFT STATION~' ='?~
Date installed
'Pump on', level at i.,
Datum
Size in gallons
in '~, 'Pump off' level at
Cycles tested
Building foundation
Water main '10'+
Drainage
In
Manhole/Access
High water alarm level at __
Meets alarm & cimuit requirements?
On adjacent lots
On adjacent lots
Public sewer manholelcleanout
Holding tank
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'~'
Absorption field on lot 100'+
Public sewer main ,
Sewer/septic service line ~0'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
$'+ Property line 10'+
Water service line
Wells on adjacent lots 10D'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I0'+ Building foundation 10'+
Water Service line 10'+ Surface water '100'+
Curtain drain 100'+ Walls on adjacent lots 100'+
F. COMMENTS
Go ENGINEER'S CERTIFICATION
I certify that I h~ve determined through field inspecUons and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Kenneth M. Duffus
Date 11127100
in
100'+
Absorption field 10'+
Surface water
Water main 10'+
Driveway. parking/vehicle storage 25'+
Waiver Fee $
Date of Payment
Receipt Number