HomeMy WebLinkAboutSOUTHPARK #2 BLK 3 LT 33Onsite File
~ ~ Municipality of Anchorage Page / ,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Sits Wastewater Disposal System and/or Well Inspection Report
Permit Number: .~v.J ~'* .~O PID Number: OZ-D- O~'7..-
LEGAL DESCRIPTION
Range:
/ELL: 0 New
pnvale. A,8.C1:
GPM
Yastewater System: 0 New O Upgrade
ABSORPTION FIELD
Deep Trencl~ ~lJ~Shallow Trench O Sad O Mound rq Other
Total Oeotn from original gm,~a:
Upgrade
~Ofillea: :WaterL.~*e): Installer. /~
Ft. "%
SEPARATION DISTANCES
) ID~
Wetl ~Z.OO'
Surface
water
~t ./0
undation
Drain
Remarks:
I10
~ Ft.
~/~
TANK-
r'i Septic O Holding m $.T.E.P.
LIFT STATION
'Pump on" level ac
e &Ma~e
"Pum[C
BENCH MARK
Location anti Description:
ENGINEER'S SEAL
Inspections performed by: _
· Dates: 1st
?.nd
Department of Healt~l~,l~d, Hu/m~ Se~ices approvxai
.. , / ~ ~,,~/,~'/~., Date:
Reviewed and approv~ oY:/~
per~it N'o.._5 ~Jc) 5'0 ~ ~ page ~'
Municipality of Anchorage
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
Legal Description:
PID No.: OZ.O
Permit No. $~} c)~0530 Pege ~ of ~
Municipality of Anchorage
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
Legal Description: ~'
PID No.: OZ.O - 0 5'~ - ~Z..
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950330
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:SCEMIDT GALEN H & MARILYN H
OWNER ADDRESS:15721 STANWOOD CIR
ANCHORAGE, AK 99516
DATE ISSUED:10/09/95
EXPIRATION DATE:10/09/96
PARCEL ID:02005242
LEGAL DESCRIPTION:
SOUTHPARK ADDN 2 BLK
3 LT 33
LOT SIZE: 25030 (SQo FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
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 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 PROVISIONS:
DATE:
DATE:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
October 9, 1995
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 33, Block 3, Southpark Subdivision, Addn. No. 2
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The absorption trench on the subject lot ~il! not pass an adequacy test
and must be replaced before Health Authority Certification can be issued.
We hereby request a permit to upgrade the system in accordance with the
attached design. A testhole placed on the lot revealed poorly graded
gravel with a percolation rate of 27 minutes per inch. We are proposing to
place a wide drainfield with 4' of drainage rock beneath the laterals. A
total of 100' of trench will be required. A Zabel Flow Splitter will be
placed to assure effluent from the tank is evenly distributed to the
trenches. A portion of the existing trench may require removal to obtain
the required separation distance of 10' from abandoned systems. The lot
is served by a community water system so setbacks from private wells
are not an issue.
The topography of the lot slopes from north to south from 2% to 5%. It
also slopes from west to east at a rate of 5%.. No groundwater was found
in the testhole at depths over 14'. The bottom of the trench has been
designed for a maximum elevation of 10' below the ground surface. No
bedrock is known to exist in the area. If the absorption trench is placed in
the location shown the following statements can be made:
The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
Lot 33, Block 3, Southpark Subdivision, Addition No. 2
October 9, 1995
Page Two
The system, if constructed as designed, will have no adverse impact
on reserved space, either surface or subsurface, on any lots located
in the area.
The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
LOT 33, BLOCK 3, SOUTHWOOD ADDITION
NO. 2
SITE PLAN
SCALE 1" = 30'
LOT 33, BLOCK 3, SOUTHPARK ADDITION NO. 2
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home Shallow Trench System
Perc. Rate: 28 Min./In. 1,500 Gallon Tank (Existing)
Application Rate: .6 GPD/SF 4' Gravel Beneath Dist. Pipe
Reduction Factor: .5
4 Bdrms. X 150 GPD / .6 GPD/SF = 1,000 SF of Absorption Area
1,000 SF / 5 LF X .5 (Red. Factor) = 100 LF Total Absorption Trench
Therefore: Construct a Shallow Wide Absorption Trench System With a
Total Length of 100 L.F. Distribution Pipe Placed at 6' Below Ground
Surface.
NOTE:
F
TYPICAL WIDE TRENCH SYSTEM
(NO SCALE)
1. Bottom of Trench to be 4' Above Groundwater.
2. Grade Area Over Trench to Drain
3. Maintain 10' Separation from Existing
Absorption Trench.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG --- PERCOLATION TEST
LEGAL DESCRIPTION: ~03' ~, ~t,~e. JL ~ Township, Range, Section:
~OU'P~'~i'~-t~,. ~bt~]1'lO,e4_ ND, ~ SLOPE
9
10
11
12
13-
,
14
15
16
17
18
19-
20-
COMMENTS
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Dep'A to Water AUsr
Monitoring? ,~/~ ~ ~"
pERCOLATION RATE .~ 7 {minutes/inch) PERC HOLE DIAMETER .
TEST RUN BETWEEN ~' FT AND _ '~ FT
P~FORM~ BY ~ ' ~J~
' S IN EFFECT ON THIS DATE DATE'' ]D/~/?S-- ,,.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE ' ' / /
72~ (R~. 4/~)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Lot 33, Block 3, Southpark Sub., Addn. No. 2
GENERAL:
The scope of this project includes the verification of the
integrity of the existing 1,500 gallon septic tank and the
construction of a wide absorption trench with 4' of
drainfield rock beneath the distribution pipe. A total length
of 100 L.F. of trench is required with 2 laterals. A Zabel
Z200 Flow Divider will be installed to split the flow
between the laterals.
Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
The Contractor shall be responsible for obtaining all
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION/REPAIR
The existing septic tank shall be exposed and checked for
leaks on all surfaces. If leakage is detected a new septic
tank must be installed.
Lot 33, Block 3, Southpark Subdivision, Addn. No. 2
October 9, 1995
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. 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.
5. Septic tanks installed without 4' of cover shall have a
minimum of 2" of direct burial insulation.
A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts shall be
installed between the tank and the drainfield. The first
cleanout shall be located on undisturbed soil not more than
10' from the tank. The first cleanout shall be to clean
toward the drainfield. The second cleanout shall be to clean
toward the tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trench shall be within 2"
of level.
Distribution piping must be placed level with perforations
down atop a level bed of drainfield rock. Rock should then
be placed over the pipe to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
Lot 33, Block 3, Southpark Subdivision, Addn. No. 2
October 9, 1995
Page Three
Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the
drainfield rock. Contractor shall verify this condition prior
to placement of the rock. All pockets of unacceptable
materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated, but
not solid) and ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Lot 33, Block 3, Southpark Subdivision, Addn. No. 2
October 9, 1995
Page Four
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 seive.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as-built
of the completed system.
Zabel Z200 Flow Divider Zabel Z2OO D
F10w Direct0r
BRAND NEW FOR 94 - The Zabel Flow Divider replaces old fashioned distribution boxes and pipe manifolds
and The Zabel Flow Director replaces expensive, old fashioned Y-valves. They are also more effective and easier
to install. All Zabel products are manufactured from high quality injection molded PVC and carry Zabel's
Lifetime Warranty if parts fail due to manufacturer's defect in material or workmanship. The warranty does not
include replacement parts not sold by Zabel and does not include labor for removal or reinstallation.
The Flow Divide distributes effluent leaving the
septic tank by means of a patented central weir
design that insures the flow is evenly divided even
if the Flow Divider is not perfectly level.
The inlet pipe of the Flow Divider is constructed
so that effluent will flow from it and down into the
effluent into two equal portions.
Distributes flow better than D-boxes and mani-
folds that are subject to frost heave or ground
settling.
Testing shows that even with a level discrepancy
of 1/8" or more between the right, and left port, the
division of the flow was almost 50/50. A standard
D-box or manifold distorts the flow under these
same conditions.
· Manufactured from injection molded PVC.
· Always insures an even flow.
· Doesn't create solids build up.
· Will not clog.
· Lifetime Warranty.
Laboratory Test Results using
1000 ml samples @ 3 gpm
1. The Flow Director is a Flow Divider with a pat-
ented sleeve valve installed tO distribute the efflu-
ent flow to a primary, field of your choice and
allows the secondary field to rest until needed.
2. The Flow Divider automatically back flows from
the primary, to the secondary field and does not
depend on the homeowner to change the sleeve
valve in the Flow Director. A standard Y-valve is
dependent on the homeowner to change the flow
direction at the proper time. Unfortunately, this
usually does not happen and a problem develops
such as an effluent break out resulting in ground
water contamination.
3. At the time the septic tank is normally serviced,
the septic tank service company can redirect the
flow allowing the primary field the opportunity to
rest.
Level
Right Port
Left Port
1/16" Tilt
Right Port
Left Port
1/8" Tilt
Right Port
Left Port
Average
Distribution
50.03%
49.97%
50.2%
49.8%
51.3%
48.7%
-"-Q-uestions concerning Z200 Flow Divider" Zabel Z2OO-D Flow Director please call
1-800-221.5742 or Fax (502) 267-8801 for further information.
Rick Mystrom,
Mayor
Mtmic pality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
November 3, 1995
Robert C. Cowan, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Dear Mr. Cowan:
Thank you for your letter dated October 23, 1995, concerning the septic system
installation process on Lot 33, Block 3, Southpark Subdivision #2. I would like to
address your concerns one by one, in the order and number in which you stated them
in your letter.
Seven day ground water monitoring was not performed prior to permit
issuance.
During the review process for this permit, the ground water levels were checked
on adjacent or nearby lots 31, 32, 35, and the level at the time of excavation on
lot 33. Due to the stated "urgency" of the permit request, ground water levels
were not verified after the required 7 day period until October 19 by Jim
Williams and Robby Robinson of this office. This is a standard procedure for
"urgent" permit application requests, and has been accomplished for a variety of
engineers in the past, including S & S Engineering.
2. The permit was applied for and granted on the same day.
At the time this permit application was submitted to DHHS, it was requested to
be expedited due to the fact that it involved a "failed system". We have no
record that any reference was made to surfacing effluent or collapsed tanks.
However, staff assumed that this was the case, for any system upgrade actually
involves a "failed system", and should not receive priority treatment on that
basis. The permit was assigned quickly, and reviewed and issued the same day.
This procedure has been accomplished for a variety of engineering firms in the
past, including S & S engineering, for systems that involve a health hazard.
Any misrepresentation in this matter will be dealt with by DHHS.
Robert C. Cowan, P.E. November 3, 1995
Page 2
The integrity of the existing septic t~nk was not verified.
The verification of the integrity of the existing septic tank was not required due
to the age of the tank. There is no code requirement regarding what age septic
tank requires verification, but is typically set at 5 years for coated steel
tanks.
The design does not provide 10' of separation to the existing trench.
Mike Anderson, P.E., the engineer on this project, stated that during the
installation of the new system, the portion of the existing trench which was
located less than 10 ft. from the new trench and soils effected by the trench
were excavated and backfilled.
Bedrock was not verified to be deeper than 6 feet below the bottom of
the disposal field trench.
The absence of bedrock was confirmed by a previous test hole dug in the
immediate vicinity of the system to a depth of 16 feet. Soils tests on adjacent
lots indicate no bedrock to a minimum depth of 17 feet.
The system has an adverse effect on the future upgrade space on the
lot.
As this was a replacement system on this lot, there is no code requirement to
miniroJze the impact of a design on future upgrade space. This is left to the
discretion of the engineer. DHHS does not confirm or deny that this in fact
occurred.
Did the existing trench have an effective depth of 4t as stated in the
inspection report, or 2' as was indicated by the depth of the monitoring
tube?
According to Mike Anderson, P.E., the engineer on this project, the effective
depth of the trench in the area that it was excavated was 4 ft.
What are the guidelines for trench and wide drain field designs that
include one or more 90 degree bends?
This design factor is not specifically addressed in the code, however the code
does state that the separation distance between trenches shall be 10 feet. Using
this as a directive, the effective length of a five ft. wide drain field would be the
inside wall length of the field minus 10 feet for each 90 degree bend. However,
Robert C. Cowan, P.E.
November 3, 1995 Page 3
this 10 ft. "duplication" area may be made up with excess exterior wall length
generated at the outside of the 90 degree bend. In the case ofa 5 ft. wide
drain field, the 10 ft "lost" on the inside is "gained" on the outside, so the
effective length is the length of the inside trench wall. In the case of a trench
system, tiffs calculation would be slightly different. This process could be used
for any depth of 5 ft. wide drain field, however is would be more conservative as
the trench became shallower. This procedure will be outlined in an Engineering
Bulletin at some point this winter to standardize the procedure for all
engineers.
If you have any further questions or comments on this matter, please contact me at
343-4744.
Sin~rely, ~.~
Je~nes Cross,
Program Manager
On-Site Water Quality
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
OcLober 23, 1995
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
Attn: Jim Cross
P.O. Box 196650
Anchorage, AK 99519
RECEIVED
OCT 2 4 1995
Mur~ic~p~h~y o~ Anchorage
Dept. Hea~th & Human Sertdce~
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
SEWER&WATER
INSPECT[ON
ENGINEERINGSTUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
ROAD DESIGN
SO[LTEST
PERCOLATION
TEST
STRUCTURAL&
MECHAN[CAL
INSPECTIONS
REFERENCE: Inspection of Lot 33; Block 3; Southpark Subdivision ~2
I am writing this letter at the request of Mr. Jeffrey Zeman, the
buyer of the subject property and as a result of my inspection on
10/19/95 during the installation of the septic system for this
property. The inspection was performed at the request of the buyer's
agent Ms. Donna Gunn of Vista Real Estate and was redundant to the
inspections being conducted under the direction of Mr. Michael
Anderson, P.E. I understand Mr. Jim Williams and Mr. Robbie Robinson
of Department of Health and Human Services (DHHS) also made a site
visit just prior to my arrival on 10/19/95.
The following are concerns with the subject property's septic system
which are of importance to my client (Mr. Zeman) and to the interests
of S & S Engineering:
Seven day ground water monitoring was not performed prior to
permit issuance. The test hole was excavated on 10/6/95 and the
permit was issued 3 days later on 10/9/95.
The permit was applied for and granted on the same day. Having
performed the adequacy test that established the need for the
upgrade of the septic system, I did not observe or know of any
condition that set this property apart from the several other S &
S Engineering properties waiting on the action of the D.H.H.S
during the same period of time. There was no surfacing effluent,
the septic tank showed no evidence of failure and the property was
vacant.
It appears that the integrity of the existing septic tank has not
been verified. However, the tank is only four years old and may
not need this verification.
The design, as approved and installed, does not provide 10'
separation to the existing trench. The 10' separation could have
been achieved had a deeper test hole been chosen.
The lack of existence of bedrock has not been verified to 6' below
the trench bottom. The trench bottom was designed to be at 10'
below original grade and the test hole was 14' deep.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 33; Block 3; Southpark Subdivision ~2
October 23, 1995
The system, as constructed, has an adverse effect on the future upgrade
space. The trench on the north side of the existing trench would not have
been necessary had a deep trench design been chosen as mentioned above.
This would have allowed this area to be reserved for a future upgrade.
Other areas on the lot are available for a septic upgrade but would likely
involve a lift station or the removal of extensive landscaping.
The existing trench has been determined to have an effective depth of 2'
rather than 4' as indicated by the original inspection report. Also , the
soils absorption rate provided with this application is significantly
different than the rate provided for the original permit in 1991 even though
it was p~rformed in nearly the identical locations.
The trenches were not installed according to the permitted design. The new
trench encroaches upon itself at the corners with the "U" shape. However,
it appeared the trench length was being increased to accommodate the
saturation that might be expected at the corners. The "U" shape design,
coupled with the shallow trench design, cost approximately $2000.00 more
than it would have cost had a deep trench design been selected.
After researching and discussing the turn of events with the individuals
knowledgeable with this property since I performed the adequacy test, it has
become clear the engineer involved with the permit told the seller's agent that
he could provide the quick permit and H.A.A. turnaround as indicated by the
above facts. No other engineering firms, including S & S, were able to quote
this short of time period. As a result, all the other engineering firms were
excluded from the bidding and the engineering work was awarded~the engineering
firm that has since obtained the permit.
The perception here is that serious and significant business advantage has been
granted to one engineering firm and came at the expense of all other
applications in process and represents a financial loss to S & S Engineering or
one of the other engineering bidders.
My association with the Department over the past year has always been a very
positive one. DHHS has been very helpful, courteous, professional, unbiased
and always has acted to protect the public's health and environment. This is to
the credit of each employee currently and previously working in the on-site
section. I am confident that each of the questions raised herein will be
addressed to the satisfaction of all involved parties and that this exercise
will provide beneficial information for all engineering firms practicing in this
area of expertise. This will also avoid liabilities for the buyer of this
property beyond what is normally assumed.
I would also like to emphasize that the septic system as observed during my
inspection should be expected to perform as well as o~ better than the average
system. It is not my client's or my intention that additional evaluation or
requirements be imposed which might delay the sales transaction.
Page Three
Lot 3; Block 33; Southpark Subdivision #2
October 23, 1995
Request a response to the following questions nu~ered in accordance with the
concerns above:
1. Is seven day ground water monitoring waived?
2. How can S & S Engineering obtain same day permit approval since this has not
been possible over the past year even in cases of surfacing effluent?
3. At what age should a septic tank integrity be verified?
4. Is 10' separation between the old trench and the new trenches waived or
allowed by permit approval?
5. Is 6' separation to bedrock waived?
6. Is the adverse effect on future upgrade space approved?
7. Can the previous existing trench be used for a four bedroom Health Authority
Approval should the new trench ever fail? Is an investigation of the
original installation going to be complete?
8. What criteria should be used for extra trench length or absorption area for
"L", "U", or "T" shaped trenches? How does the criteria differ between a
deep trench and a shallow (5' wide) trench?
It is requested that these questions be addressed prior to Health Authority
Approval (H.A.A.) to protect the interest of all involved. Prompt attention is
requested in order to allow closing on the sale by October 31, 1995.
Your prompt and concerned attention in this matter is greatly appreciated.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
cc Joe Fisher/Remax Properties
2600 Cordova
Anchorage, AK 99503
Donna Gunn/Vista Real Estate
4241 "B" Street
Anchorage, AK 99503
Galen Schmidt
19301 67th Ave. N.E.
Seattle, WA 98155
Jeffrey Zeman
Municipality of Anchorage Page
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: ._~A) c~ I OO ~C) PID Number: ~?~ ~UZ~/~
Name: / Wastewater System: ~New ~ Upgrade
Address:
Zx ~ ~u~/t ~/~ ABSORPTION FIELD
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
/~ GPD/Sq. Ft.
Subdivision: ~ Depth to pipe bottom from ~-grade: Gravel depth beneath pipe
Lot: ~ Block: ~ ~~ ~ ~ Ft.
Township: ~ ~ Range: ~/~ Section: ~ Filladded above original grade: Gravellength:
I
Gravel depth: Number of lines: 10istance be~/een lines:
WELL: Q New D Upgrade ~/~/ ~Ft. ~I ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
~/~ ~ ~ / ~(~ Ft. Ft. ~ ~ SQ. Ft.
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: GPM IPumpSet at: Ft. ICasing Height Ab°ye Gr°und:Ft. o//~ TANK
SEPARATION DISTANCES ~ptic ~ Holding U S.T.E.P.
TO Septic Absorption LiE Holding >ublic/Privste Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~ ~
Material: Number of Compadments:
Surface
LIFT STATION
Line ~ /~ ~ X~ ~/~ m~ "Pump on" level at: I water alarm at:
Remarks: BENCH MARK
Location and Description:
Elevation:
Inspections performed by: ~a V~, ~CrAb~¢~l Dates: 1si ~-2/-~/ ~
Reviewed and approved by: ~ ~/~~ Date: ¢~
72-013 (1/gl) MOA 25
Permit No. ~'~t) ~/O~) ~0 Page "~ of ,2-
Municipality of Anchorage
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
Legal Description: ~- ~c3 L~L ~,~UT)( F'A/~/~ ,A-DDt/ ~. PID No.:
72-013 A (2/91) MOA 25
Munic~gality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L' St~eeL Anc~ora§e. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PE
LEGAL OESCRIP"I'~ON: /-- 33 ~/_ ,3 ~n u'n4,~,~,~ ~.Townsi3ip. Range, secaon:
1
2
3-
4-
5
6
7
8
9-
10-
11
12
13.
14-
15-
16 --
17
COMMENT~
SLOPE
SITE PLAN
WAS GROUND WATER
IG~'°s'~ N~' 1 Oeomto N~
Date T~me T~me Wa~e~ Oreo
I I
PERCOLATION RATE [mmutes~mcat pE.Rc HOLE. DIAMETER
RUN BETWEE~I FT AND
PAGE
1 OF
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910090
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:SCHMIDT GALEN H & MARILYN H
OWNER ADDRESS:3236 SOUTH CIRCLE
ANCHORAGE, AK 99507
DATE ISSUED: 5/09/91
EXPIRATION DATE: 5/09/92
PARCEL ID:02005242
LEGAL DESCRIPTION: SOUTHPARK ADDN 2 BLK
LOT SIZE: 27000 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
3 LT 33
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THERE MUST BE TWO ADJACENT CLEANOUTS BETWEEN THE TANK AND
ABSORPTION FIELD LOCATED NO MORE THAN 10 FT. FROM THE TANK.
THE FIRST CLEANOUT MUST BE ORIENTED TOW~M~DS THE ABSORPTION
DATE.
\
\
/
hot 32
/
/
~ORTH
3~
/
/Lot
Lot 3 3
/
l: ~r~ /
!
1
Un~ubdtvtded
(vacant)
/,q 5TA LL- 5oAF
New Wate~ and Wa~tewaten Syatem'De~ign /"=~
SEPTIC SYSTEM DESIGN
LOT 33, BbOCK 3, $OUTHPARK ~2
! [
Hunlcip~llly el Anchorage ~ '~.'*~¢U ~,"C,~ ,,~ *.'~'~#
DI~PAFITMENT OF HEALTH & HUMAN SERVICES
62,5 "[," Street, A~nc:hora.~e, Ahtsklt D¢~0~,0550 ,,,"
SOILS LOG PERCOLATION TEST
'~ ,~,,
;y ......... ' '"'"'" '" '~' "'
4'
6,
9-
10,~
~3.
17
18
10-
~0,
~'~";91 11:12 REMA× PROPERTIES
.:;.~ ,
i ,
IF Y;~, AT WHAT
PI:.RFORM[D BY; .~~ I CERYIFY '~HAT THIS T~$¥ WAS PERFORMED IN
ACCOROANCJ WITH ALI, 6TAME AND MUNICIPAL OUIOELIN~[~ IN J~;F~,CT ON T~$ DA'rE, g^'tc,: . I ~ ~'~ ~'' 9 J~ ............ ...~
12 REHR× PROPERTIES P.4
Municipality Of Anchorage
DEPARTMENT O~ H~ALTH & HUMAN SERVICES
SOIL~ LOG -- ~EflCOLATION TEST
4
10,,
11
12
13
14
17
/~ichael E. Anderson
4381 - E
E
.Not
PI[RFORM~D BY: ................ i .? ~ ~ [~"~'" C[RTiFY THAT 'THIS '/(~S'I' WAS ~RFORM~,0 IN
ON SITE SYSTEM IMPACT
L33 BL 3 Southpark 4/2
Installation of an on site wastewater system for this lot should have
little if any impact on the surrounding properties due to:
The entire subdivision is served by a community water
system which eliminates the possibility of well
contamination on any one lot.
Due to the soil type and absence of water in the test hole
monitoring tubes during breakup, the soil provides a good
condition for natural percolation.
Installation of a trench system now will allow absorption at
the 3-7 foot depth reserving the surface area for a future
bed system near grade if required.
Due to the topography of the lot and surrounding area there
should be no impact of drainage caused by constructing an
on site system(s) on this lot.
If you have any questions please contact me at 561-5829.
Yours Truly,
L. Wayne McFadden
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
WALTER J. HICKEL, GOVERNOR
563-6775
October 7, 1991
FOR: Wayne McFadden
PWSID: #213475
My review of the records on file in this office reveals that the South Park Subdivision
Class "A" Public Water System is in compliance with the provisions of 18 AAC 80.060,
State of Alaska Drinking Water Regulations.
Sincerely,
Byron Roys
Environmental Engineer
BR/cf
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
www.ci.anchorage.ak, us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.O 2-C;'-
~piration Date:
I. GENE~L INFORMATION
Compl~t; legal descHptio6
Locatio~(site~ddr~{ .or dire~ions)
Lending agefi~ ~ ~' Day phone
Day phone~
Mailing address
Real Estate Agent
Day phone
Mailing Address
Un/ess otherwisq requested, HAA will be held by DSD for pickup.
2. NUMBER OF BE'DROOMS: ~
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 (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-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 proper[les served by a pdvate or Class C we!l ,=nd may be reissued with
new water sample results. (Certificates may be reissued for a pedcd 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 responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
5. DSD SIGNATURE
~ Approved for ~
Disapproved.
Conditional approval for
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/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 flies 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 .J ~ ~?/,¢, ~ ,~ ~ ~-7~¢_ J"]¢~ ~ g/,~ Phone
Address ~ '~' [0 ~¥,[/'J,-=z~r"71 ~ ~ ~ f"~ (,f~__... _,~ //]~_~..2 ~:~/~/'~:,
Engineer's Printed Name Jc~/~?~ ~ F~ ,~'~/"-<~. Date '~
.'r. ¢.' ......
bedrooms, "~
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: /"/ - .~- 0 ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewatar Program
4700 South Bragaw SL
P.O. Sox 196650 Anchorage, AK 99519-6650
www.ci.anchorage, ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
J -'
A. WELLDATA C. /T"~/' ~r/~T'~& --
Well type IfA. B, or C provide PWSlD # Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wlres properly protected (Y/N)
Total depttt ff. Cased to ff. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ff.
Well production g.p.m, g.p.m.
WATER SAMPLE RESULTS:
Coliform __colonies/100 mi. Nitrate rng./I. Other bacteria __
colonies/100 mi.
Arsenic: mg,/L Date of sample: Collected by:
B. SEPTICJHOLDINGTANKDATA ~ '~----.%_~ ~
Tank Type/Material ~ Date installed 11~'e::~l~gr
Tank sizg~ gaJ. , Number of Compartments ~ Cleanouts (Y/N) Y
Foun¢~eall~....l~_/N, ..~:_ Depmsaion over tank (Y/N, /~ High water alarm (y/N,
~ ,~ ,.i. ---
. ..¢:¢" - ./
Total depth _L~. ff. Eft. absorption area l~C)fl2 Monitering tube
Date of ari ,a tesFV
Fluid depth in absorption fielri before test'.~.,~ in. water added/~O~gal.
Elapsed Time:[Z[~'O min. Final fluiri de¢~ ~.-~ in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
~ Depression over field /~
For ~ bedrooms
New depth~/ in.
Absorption rote >= ~ ~ g.p.d.
If yes, give date
D. LIFT STATION
.D. ate Ins _roll--Manhole/Access (YIN)
Pump on leve'~. '_Pump ~water alarm level at
Datum f~ Cycles tested Meets a~'lllT'&'eimui~uimments?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot* '/~ -~
Absorption field on lot /~/,~'
Public sewer main
Sewer/septic sewice lineJ~,~
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN/K ON LOT TO:
Building foundation ~ Property line' ~ ~'' Absorption field
Watermain · -.-~Ot-/t ") Watersorvicellne ,~'~'-,t'~ Surface water
Wells on adjacent lots /~,.//A '~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON L~T TO:
Property line 1 ~ Building foundation ~ '~"~-' Water main '7,-~! ~' ~ )
Water'Service lina~_.~ Surface water ,~)J/~ ~'~ Driveway, partdng/vehicte storage
Curtain drain/~J~)~" ~ ~ells on adJace.t lots ,/'~/~
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections end
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Pdnted Name
Date
Date of Payment
R~ipt Number
(Rev, 1~1)
Waiver Fee $
Date of Payment
Receipt Number
I
I
5'7--.
PLOTPLAN ASBUILT ~- SCALE I':'~'o'. GRID
/
Project No. _~G-'[.4-q .
1731 George Bell Circle
I Hereby certify that I have surveyed the following described property:
Lot~'~ .Block ~ , ~?'~-.1:'~-'~.~ ~u~-.~tOt4~ ~1"~0tlqc~l'4
~~ Rccor~n~ District. Alaska, and that the Improvements situated
thcrcon arc within thc property lines and do not encroach onto thc propcrty
adjacent thereto, that no improvements on thc property lying adjaccnt tbcrcto ~'-
cncrosch on th~ surveyed premises and that there nrc no roadways, transmission
~****~*
Dated ~is the ~ Day of_ ~ . 19~ . at knchorasc, Alaska
It is the responsibility of ~e owner to determine thc cxistcucc of any easements.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services ;'.._.,~ ~..;~
- ' /.' On-Site S~rvices Section
- <~,.,- - -,.:. ~ . . P.O"Box 196650 .Anchorage, Ala~k~ ;~ 99519-6650
~;?:_, ;.-- · -.. ?,~' :'~ - 3~-4744 .',':,-:-~ "'
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcell.D.~ OZO-O~-~ ~ .. HAA
1. GENERAL INFORMATION ':
C~mplete legal description ~ ~' ~;:~
[~0c~tion (site address or directions) ./~"'7~ i ~T~ t,',,JOOb
Property owner
Mailing address
Lending agency
Mailing address'
Agent
Day phone
Day phon~
:,Day phone
. ' NO~E: If community well system, prowde written confirmation from
¥ ? .... ~!i~'~.~ · lng to the legality and status of system.
72~25 (Rev. 1/91) Front MOA~21
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 of this Health Authority Approval application shows that the on-site water suppl~, ~-'
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
suppty and/or wastewater disposal system is in compliance with all Munici pal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm /~r-~',J/) ~/~.~ O~J ~--,~ 6/'"'J'~--"'~'~'"~(..,r Phone ~"~, ~- 71~'~'"
Address
Engineer's signature
6. DHHS SIGNATURE '
~' Approved for . ~ bedrooms.
D~sap 3roved.~?.,.,:.~ ,:
· __ ..Cond~!~o~al ,approval .for .bedrooms, w~th the following' stipulations: ',.~::~:~"~.~-~.
". The Munic~pahty of Anchorage Dep~rtment of Hea th and Human Serv cos (DHHS) ssuea Hea th Authority
"i-','~ .;.'~ "'App~:o~;al' Cedificates based 0nl~r Ul~:~!ih'e'i-epresefi~ations' given ih paragraph 5 al~0ve b~,
q;. ~.;~.andtheirlendn nsttut ' ' .... '" ' '' ' ' '" ' ' ' ' ' ' ,'
.~, ;. g ons~norderto~s~ce~amfederalandstaterequirements. Employ~sofDHHSdonot ,,,..
:;¢~:-~:-~::~':'conouct 'Inspections or analyze'data' ~ofor& a Ce~ificato 'i~ issued. The 'Municipali~"of Anchorage
. ~.-;.'~'~:.~,..~.., ?.~ ~nsible, for. errom or omissions in the ~rofe~ional engineers work. ',
Health Authority Approval Checklist
Legal Description: ~ .~3~ ~LO~,lc- ~. ~'0 ~'rJ+F~,q-tLIt-- Parcel I,D.:
Municipality of Anchorage
DEPARTMENT OF HEA'T, HUMAN SERVlC £ E IV E D
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
OCT 2 ~ 1995
Municipality o~ Anch..or?.e
Dept. Health & Human ~e, vmeu
A. WELL DATA
Well lype C4~$~
Log present (yfN)
Total depth
Sanitary seal (Y/N)
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
Casing height (above ground)
Wires properly protected (YIN)
AT INSPECTION
FROM WELL LOG
' g.p.m.
Nitrate Other bacteria
Collected by:
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Number of Compartments 2'-
B. SEPTIC/HOLDING TANK DATA
Date installed ~/Z-}]~t Tm~ksize [,
Foundation cleanout (Y/N) ~1/' Depression (Y/N)
DateofPumping /O/Z&~.'~ Pumper A
C, ABSORPTION FIELD DATA
Date installed ,It)/~g. L0]q ~ Soil rating (g.p.d./fi2 or fiZ/bdrm) ', ~' C~P~>
Length_ lOC) ~ Width o Gravel thickness below pipe
Effective absorption area IjOO0 FF,z' Monitoring Tube present(Y/N)
Date of adequacy test A/~i~J ~,~'E Results (Pass/Fall)
g.p.m.
Fluid depth in absorption field before test (in.);
Fluid depth ,M//~ Minutes later:
Peroxide treatment (,past 12 tnonths) (Y/N)
__ Cleanouts (Y/N) Y
High water alarm (Y/N) /x]
System type
Total depth /O I
Depression over field (Y/N) /x/
For ]~2~ oo"L bedrooms
Inunediately after O gal. water added (in.):
(in.) AbsorpUonratei:='1"~:~' ~;~0 .g.p.dl
If yes, give date ,/~/]l.
_? , Size in galloas
Mauholc/Access (Y/N) ~ level at* "Pump off~ level at*
High water alarm level at* *Dat~
Cycles tested ~
E. SEPARATIONDISTANCES ~Ot'qt~O,'.~ln-~/ [~'I..L. ~' ZOOt ~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Scl)tic/holding tank on lot
; On adjacent lots
Absorption field on lot
5 On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer/septic service line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ t Property lioe ~-~Z t Absorption field
Water mai~/service line ~>t'~ t Surface water/drainage >/0(9t Wells ou adjaceut lots
Boildiug foundation
Surfilce water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
I
~0 Water mairdservice line
~ I00 '
Driveway, parking/vehicle storage area > ~-0 '
t
Wells Oll adjacent lots ~' 7.L0O
m conJbrmance with MOA IIAA guidelines in effect on this date.
Signature ~)~e~t.~ ~ ~
Enginecr'sNalne /%~lC.~4t~L-'/... ~ ~Oa~O~J
ENGINEER'S CERTIFICATION
! certify that ! ~lave determined thrufield inspections and review of Municipal records that the above systems are
HAA Fee $ ,~('DI)_, C7..79 Waiver Fee $
Date of Paynleat .
Receipt Number
Date of Payment
Receipt Number
Rev. 8/95 OSS: baa,wk.doc
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
Parcel I.D.'# ~¢)~.,5-~ '--/z
1. GENERAL INFORMATION
Complete'legal description
Location (site address or directions)
": - 'Proi~erty owner
-;,- Ma I n~ address
' Lending agency
";~ '~-- ' ' Mailin~ address
Agent
~'? ~o 7
Day phone
Day phone
Day phone
Address
2. !. NUMBER OF BEDROOMS:
· 3. -~ TYPE OF WATER SUPPLY:
-. Community well
* . Pub ic water
Unless otherwise requested, HAA will be held for pickup..
NOTE: If community well system, provide written confirmation from State ADEC attest-
to the legahty and status of system.
.: '. ~?:!!:',' '.lng , '
' , -".4. ?YPE OF WAS~EWATER DISPOSAL:
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
-72-025 {Rev. 1/91) Front ~40A ~21
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 of this Health Authority Approvat application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequ ,ate 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.
Engineer's signature
DHHS SIGNATURE
_7~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates b&sed only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain,federal and state requirements, Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the profession¢~l engineer's work, .
Municipality of Anchorage ~i~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter.
Date completed
Cased to
Legal Description:
A, WELL DATA
Well
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Welt flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line
Parcel I.D.
ADEC water system number
Driller
Casing height
Wires properly protected (Y/N)
~uNtCtPALITY OF ANCHORAGE
iNSPECTi(~t~ONM~t~T^t, sERviCES DIVISION
AT
oCT ~ 1991
g.p.m. ~.~.m~~/~9
; On adjacent lots
; On adjacent lots.
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
S. SEPTIC/HOLDING TANK DATA
Date installed ~Z~/~/
Cleanouts (Y/N) y
High water alarm (Y/N)
Nitrate Other bacteria
Collected by:
Tank size /Z ~-o Compartments
Foundation cleanout (Y/N) y Depression (Y/N) /'J
/,//,,4' Alarm tested (Y/N)
Date of pumping ,'/~1.¢ ~"~,~$7'"~ucTI oN - o~¢upA~ c ,/ E,~f~ EC'I'EZ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Foundation.
Water main/service line
Well(s) on lot /~-¢ o~4 LO'/- On adjacent lots
To property line z/Z/ Absorption field
Surface water/drainage
72-0~6 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE
'""-(~...~IFT STATION
Size in gallons _'~-~
Vent (Y/N) '~'"1
High water alarm level ~
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
D. ABSORPTION FIELD DATA
Soil rating ! 2_ ~' System type
Gravel thickness ¢', 5-' Total depth
Cleanouts present (Y/N) ,Y
Date of adequacy test fVE'~
for /,¢-/5'- ?/
Date installed __
Length GO' ~Nidth '~'
Total absorption area
Depression over field (Y/N)
Results~fail)
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
~n 5T,~U CTtc~4
('¢) bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
We on Iot£,C~mo4/¢~/
To building foundation /¢¢
On adjacent lots 15_5'
Surface water ,~<~F_ ~lr~A~ Low
Curtain drain po~4F-
On adjacent lots X-~o' '/' Property line
To existing or abandoned system on lot
Cutbank ~'°or + Water main/service line
/e¢¢'/* Driveway, parking/vehicle storage area fi'g/
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date / o /, /~/ I
HAA Fee $ /
Date of Payment
Receipt Number
72-026 (Rev. 3/91) B~ck MOA 21
Waiver Fee: $
Date of Payment
Receipt Number