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Home My WebLink AboutATELIER #1 BLK 2 LT 7A 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: c~-~C,i/./~ PID Number:.'O~/I -~,St - ~ ~ ~ ~'C~ Wastewater System: D New ~Upgrade ~ ~o~ / ~o~ ABSORPTION FIELD ~--~5~ ~D~pTrench O ShallowTmnch O Bed O Mound O Other Soil Rating: Total Depth f~m original g~de: LEGAL DESCRIPTION ~. 8 ~.o~ ~ ~' LOt: ~ Bi.k: ~ ~ ~Su~iv~i°n:~/~ ~ ~ ~h to pi~ ~.~. ~fr°m ofigi~l g~de: Ft Grovel depth ~neath~ pi~ Ft. T~nship: I Range: I ~tion: Fill idd~ I~e o~ginal grade: Gm~l bngth: WELL: O New ~ Upgrade ~ ~ rt ! GPM Ft. Ft. TAN K SEPARATION DISTANCES ~ Septic ~ Holding = S.T.E.P. s~,==, ~ LI~ STATION Foundation ~Oi ~O.~ I ( ~ "Pump on' level at: ~ Hig~ water al.~ it: Remarks:~ ~A,u~o~ ~ ~ ~6~ BENCH MARK Depadment of Health and Human Se~ices approval ~'~ ~.8~4~: Reviewed andapproved by: ~ Date: ~'/~ g ~~~ AS-BUILT WASTEWATER ABSORPTION SYSTEM · , ~ Log; 7, Block 2 A~eUer Subd, NOTES, 1) EXISTING TRENCH SYSTEM HAS FAILEI). SEVAGE LEVEL IN THE SUMP VAS 12 INCHES ])ELI1V SURFACE IN 5/26/97. 2) VERIFIED INTEGRITY DF EXIST. 1250g SEPTIC TANK, IT VAS FnUN9 COMPETENT / ~...~_iO..~EV SEPTIC SYSTEM. DEEP TRENCH, 70 LF, 5.5' EFF. 9.5' TOTAL DEPTH. w ])r ~wlng O\Vork\7-2A?LR.I]VG VELL r! r2 43.4, 67.7' .11 54,2' 78.8'_ Ir2 9g.1' 124.2' DV DC 4~?,7' 7~.P'_ 73.6' 92.7' ~T~g21a' lla.4-T 6.5' ~ 2 70 ])ESIGN' Pert Rm~e = 11 MZn/Inc~ Soils= 188 sF/br 4 ])edroom House 750 SF Rqd Design, 5,5' E?Fec~lve 9.5' Tot~[ 8' Wide, 70' Long' To~( Absorption = z~70 PREPARED FOR, Mike O'Conner 7141Mon~:nge])rlve Anchorage, AK 99507 (907) 863-7000 P:nnone Eng. Svc;, P. 0. BOX 148025 · ANCHDRAGE~ ALASKA c'99514 272-8218, PHDNE &',FAX )ATE, 6-30-97 I AS.-I)UILT 1~,o.w~0 C~\~ork\7-2ATLR 11VG AS-BUILT DETAILS WASTEWAT£R ABSBRPTIDN SYSTEM PLAN VIEW Z PREPARED FDR~ Nike O'Conner 7141Hon~ngeDplve Anchorage, AK 99507 (907) 263-7000 i,i P~innone Eng.? Svc. , p. rl. BOX 142025- '-- ANCHORAGE;: ALASKA ~' .99514 272-8218~ PHONE 8.-FAX DATE' 6,-30-97' I lOT TO SCALEI AS-I~UILT PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND NU~ SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970145 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:O'CONNOR MICHAEL R & KATHY A OWNER ADDRESS:7141 MONTAGNE CIR. ANCHORAGE, AK. 99507 DATE ISSUED: 6/20/97 EXPIRATION DATE: 6/20/98 PARCEL ID:04103143 LEGAL DESCRIPTION: ATELIER #1 BLK 2 LT 7A LOT SIZE: 58370 {SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION 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 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: Steven R. Pannone, P.E. Consulting Engin~' {907) 272-$2 ! 8 P.O. Box 142025 Anchorage, Alaska, 99514 {907)272-8218 Fax $~e1,1997 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subj~t: Lot 7, Block 2 Atelier Subdivision Septic Upgrade Permit FAILED SYSTEM Gentlemen: My fa'm was contacted to conduct a Health Authority Investigate of the well and septic s3~tem serving this lot for a pending sale. The ~-xisting system was completely inundated with liquid. The fluid lex, els ~s~e approximately 12 inches belmv thc ground level, or 24 inches above the lateral pipe. I informed thc ox~ers that thc system was in failure. The owners requested my fu'm investigate the possibility of installing a replacement system. A single test hole was excavated on May 26, 1997. The soils report and a pereolatiun test result is attached. Ground water was monitored for seven da)~. l'/o groundwater or bedrock was encountered in the test hole. Thc lot is approximately 1.4 acres in size. Lot 7 slopes to thc northx~st at a rate of approximately 3 to 5 percent. Thc proposed installation will be located on thc northeastern portion of the lot. The existing field ,~11 be reused. A diverter valse ~I1 be installed Ix~veen thc two fields. Thc septic tank s~ll be verified during thc installation. It w~ll be reused if found competent, and replaced outside thc well radius if found to be deteriorated. An existing waiver for thc separation distance bet~vc'n thc tank and thc ~s~ll (WR86-068) is on file. Double clean-outs ~11 be installed dex~ stream from thc tank. The proposed location is greater than 100 feet away from the existing ~sell serving this propox'y and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation xs411 not affect the future dex'elopment ofthe surrounding or existing lots. See the attached design. The o~aer is an experienced operator and contxactor. He xs411 be installing the system himself. ! gill perform additional inspections to ensta'~ the system is installed according to Municipal Guidelines. Attachments: {~:~WORI~?-2ATLR.001 If you have any questions about thc proposed installation, please contact mc at 272-$218 VALVE Dr=vino O~Vork\7-2ATLRJI~G DESIGN ~/ASTE~/ATER ABSORPTION SYSTEM Lot 7 ])Lock 2 A'tetler Subd, NOTES' 1) EXISTING TRENCH SYSTEM HAS FAILED. SE~,/AGE LEVEL IN THE SUMP VAS 1;~ INCHES IIELDV SURFACE ON 5/26/97. 2) VERIFY INTEGRITY OF EXIST. 1250g SEPTIC TANK. REPLACE TANK OUTSIDE THE 100' VELL RADIUS IF FOUND LEAKING. .~ROPOSED SEPTIC UPGRADE. ~-"'-10~DEEP TRENCH, 70 LF, 5.5° EFF, 9.5' TOTAL DEPTH. SEE DESIGN THIS SHEET. EXIST. 1250 G, SEPTIC TANK. SEE NOTE 2. DESIGN, ~,~ Pert R(xte = 11 MIn/Inc~ Soils= 1B8 s~/br 4 ]3e~roo~ House 750 SF Rq~ Design, 5.5' EFFeci:lve 9,5' To'teL Oep'th 2' ~/Ide, 70' Long To'tc~t Absorp'tlon = 770 sF PREPARED FOR, Mike O'Conner 7141MontmngeDrlve Anchorage, AK 99507 (907) 263-7000 P~nnone Eng. Svc. P. 0. BOX 142025 ANCHORAGE, ALASKA 99514 272-B~IB, PHONE & FAX ]ATE, 5-31-97 ) DESIGN I DESIGN DETAILS ~ASTE;/ATER ABSnRPTInN SYSTEM Lo% 7~;jI)~ock 2 AteUer L ~/ PRDPOSED SEPTIC UPGRAgE, ~/ DEEP TRENCH, 70 LF, 5.5' EFF. ~/9 5' TOTAL ~EPT~ SEE ~ESION :NSTA~ ~I~RT~R ~ ~UTe X~ ~ EXIST. I~50 0 ~ ~EPTI: TANK, ~ ~E~ NDTE ~, ~HEET 1. UPGRADE PLAN Mike O'Connor P. 0. BOX 142025 7141 Mon~=ngeDrlve ANCHORAGE, ALASKA 99514 Anchor=ge, AK 99507 272-821B~ PHONE ~ FAX (907) 263-7000 ~ DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG --- PERCOLATION TEST PE.EORMED POR: /1,1 LEGAL DESCRIPTION: L"~'~. i~-~'~__../I~ 4- 5 6 7 8 g 10 13- DATE PERPORME[ 14- 16- 17- 18' 19 Township, Range, Section: SLOPE I / WASGROUNDWATER ENCOUNTERED? IF YES, ATWHAT DEPTH? Dep(h to Wa~ Alter. SITE PLAN E Gross Net Depth ~ ~3', Net Reading Data Time Time Water Drop 5'/2 e, I?.~. ? ---- i'~: ~, Lf 7_ ~' ,si.. 37//. 20 PERCOLATION RATE I (' {mmutes/,nch) PERC HOLE DIAMETER TEST RUN BETWEEN Z"~'t.r~ FT AND '.,,~,~.~-FT PERFORMED BY; ~ '~)(~t~' I--~, _~ ~.ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) '-*'~ f~""~ MUNICIPALITY OF ANCHORAGE //i ~.'"-~T~i.j,,,,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION .~"~.~. ~,~ ~? ENVIRONMENTAL ENGINEERING DIVISION ~'~ 825 L Street- Anchorage, Alaska 99501 Telephone 2~720 ~ ON~ITE SEWAGE DISPOSAL SYSTEM AND/oR WELL INSPECTION REPORT NAME ~ / ~ IPHONE I ~ UPGRADE D,ST .CE.O: I //0 DISTANCE TO IF HOMEMADE: Inside length W~dth Liquid depth Well Dwelling Well Foundation DISTANCE TO: lin ile to finish grade Material beneath tile Length Width Depth Crib depth DISTANCE TO: Depth Driller Building found~o~.~.-- Sewer llnef._. Z_ 3~ OTHER PiPE SOl L TEST RATING REMARKS PERMIT NO. gallons Nearest lot hne ~' inches PEHMIT N( , between lines PERMIT NO. O,stance to lot line PERMIT NO. Absorption area(s) Septic tank 72~)13 IR~v. 3178) ~ CHUGIAK, ALASKA 688-:3199 % I"DRILLING CO. WE SERVE ALL ALASKA POST OFFICE BOX 42 - CHUGIAKo ALASKA 99567 KUUIAi/, ALASKA 486-4826 WELL - SITE .,~.~..~.~,~.~.~'.....~...IL~....P..~.¥.....~.....~...A...~v~......~.. ........................ DATE - STARTED ....... ~..-.2.~..-..~,% .......................................................... DATE - ENDED ........... ~=2.~..-.?,[ ................................................. .: .......... DEPTI! OF WELL ........... .1,.00._~.'~ .................................................... i.. STATIC LEVEL OF WATER FT....IL0...~.'~...t,~...h.O,~o ........................ DOWN ........................................ : ........................ GALS. PER IIR ............ ,~...~a.'~ ......................................................... -KIND OF CASING .....6..£~..S~h....~.O. .......... ~. ....................................... KIND OF FOR~.IATION: FRO.~! ............. O ...... Fr. TO ............. ..~ ...... FT..~o=hum_~ ~n ...... FRO~ ............. ..q. ...... FT. TO ........~.~. ........ FT...~...a....~..cJ......&.'...~?..~.¥..o..1 FRO.~! .......... 1.~k ...... FT. TO ........2~. ........ FT..~72..~!. ....................... FROM .......... .7.~ ...... FT. TO .......q!.' ........... FT. Ff~OM ...........~ ......FT. TO .....2.2")..~. ........ FT. ?.:rD.~..r.~.~...~:...:;::.:?..~?r FUO~ ...................... Fr. TO ...................... FT .................................... FROM ...................... FT. TO ...................... FT .................................... FROM ...................... FT. TO ...................... FT .................................... FROM ...................... FT. TO ...................... FT .................................... FRO,",! ...................... FT. TO ...................... FT .................................... FROM ...................... FT. TO ...................... FT .................................... FROM ...................... FT. TO ...................... FT .................................... FRO.',! ...................... FT. TO ....................... FT ...... ~ ........................... FRO~.! ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ........ ~ ........................ FROM ....................... FT. TO ........................ FT ................................. FROM .....................FT. TO ................... ~.... FT ................................. FRO~! ...................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ...................... FT .................................. FRO'si FT TO MUNtC~.tlTY OF ANCHO{~AOE MISCL INFORMATION: OCT 2 8 1981 RECEIVED ILLER'S NA, IE ........... u .... .., ....... i,].,],,t,a-,,,g ................................................................. .~ : PERMIT NO. APF'LICANT $IM/ALANA MC SPADDEN LOCATION L~g Z...- LEGAL B -,~ ATELIER , r.lur~ z o z PAL I t'~ OF' Ar~CHORAGE · DEPARTMENT ~"~ HEALTH AND ENVIRONMENTAL/'~;OTECTION iqEll Rr-JD Or~--:~ I TE SEIqER PERrq I t 2~97 EAST 47TH COURT ~950~ 27~-0~12 LOT SIZE 54~ SOURRE F~T TYPE Of SOIL ABSORPTION SYSTEN IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= ::1_0 LEr~IGTH= 43 GRR~.'EL DEPTH= cc: THE LENGTH DIMENSION IS THE LENGTH (IN FEET> Of THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE GROUND AND THE BOTTO~I OF THE EXCAVATION (IN FEET>. THERE IS NO SET HIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUr'! DEPTH OF GRAVEL BETHEEN THE OUTFALL PIPE AND THE BOTTOM Of THE EXCAVATION (IN FEET>. REQIJ I RED --c. EPT I C TF~Nt4 _~ I :::'E= :1.1!-_-~00 gRllOr-l_c: PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORm1 THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND 'THE NUMBER OF RESIDE~CES THAT THE HELL HILL SERVE. TtdO ~. 2 ) I r-~SPECT I rjt-.l$ ARE REQm_m I RED BACKFILLING OF ANY SYSTEP1 HITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETHEEN A HELL AND ANY ON-SITE SEHRGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL. MINIMUM DISTANCE FROM A PRIVATE HELL TO A PRIVATE SEHER LINE IS 25 FEET AND TO A COMMUNITY SEHER LINE IS 75 FEET. HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT HITHIN ~0 DAYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERI"11 T EXP I I~:E--c: DECEr'IBER 3'3:-.1.. 198-1 I CERTIFY THAT 1: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I HILL INSTALL THE SYSTEM IN ACCORDANCE HITH THE CODES. ~: I UNDERSTAHD THAT THE ON-SITE SEHER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN _~ BEDROOMS. S I GMED: .......... APPLICANT JIM?RLANR MC SPADDEN ISSUED BY .............................. V4. 0 ~,.~'"/-/ . ,-.MUNICIPALITY OF ANCHORAGE,~ · Department~ ~ Health and Environmenta~ 7rotection · . , ~'. 825 L Street, Anchorage, AK. 99501 ' .· 264-4720 ~ ~ # HANDWRITTEN PERMIT ~ # ~ WELL AND/OR ON-SITE SEWER PERMIT Applicant: J,~ ~l~m~ P~'J~%Mailing Address: ~ Location: ~)~O~ ~; I !~ ~C Phone Number: Legal Description: ~Z &7~ ~ ~.~iE~ Lot Size: Type of Soil Absorption System Is: Trench: ~,- Drainfield: Seepage Bedt Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) / The Required Size of the Soil Absorption System Is: DEPTH /0 LENGTH Z';~3' GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ~ ~ REQUIRED SEPTIC(HOLDING) TANK SIZE = /000 GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ~ ' ' TWO(2) INSPECTIONS ARE REQUIRED ~ ~ # Backfilling of any system without final inspection.and approval by this departmen' will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * * I'certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) ' I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3.bedrooms. Signe~: ~~ ~3c. ~ Issued by: Applic t Date, SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST ~'~O~LS LOG [~PERCO LATION TEST LEGAL DESCRIPTION: L ~)'~- 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS G.OUNO WATER ¢~, ~ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? · Gross Net Depth to Net Reading Date Time Time Water Drop =el~/7-~'1 i,.~-o ~* c~77 -~3. ~, t'.o~ ~ o.~ PE.COL.,T,ON RATE ?~.,~z zz.,/ ','EST RUN"E~EE. ~,F' '=T A.O S'"" ET . 72-008 (6/79) Tom Taylor _ Soils L Yes :' e r.'.. ?: .. c, nil £ h ~, r ) c t e.c.~.~_t ~.-c J ...... ,.. .Brown Sandy Gravel S{lty Gravelly Sand ;~ - 5ottom of test ho]e. >0 ~-r'Uld 'j6~er [f, couri%err°d? No I I. ,.",z t e e:r r, S S Tir.g 2i,:e i C zm, th .) · ' ', .... ./LT'..'! ........................... }Hnute .&rein Field ~ r r, rcsed . i r~ t ~,1 3 ~'t ib~: Seen~,ce Pit . . - F,'.-nth To ~(,{ts. zr, (,f Fit C,r Tr'~r,..h C.e'.'th of :~let ; - .... --2:~-.,'..~ ~,-,t,'or,,n from mimus 6" ~'o 7'. ~ .' ' c2 -]uare lfoot r~(!djred p,,r bedroom from minus 7 tO lb · /a '%~J [ . ,. . .: ....................... ~- .',. _ ,.. /,~//~=-, Ferf0rmed [0r . Tom Taylor Lenal ~escrintion: Lot 7 Glocl:;~ This form ~er, orts Soils Loo Yes Cleveland ADchorage, A]~-ska .°9503' ~%e ~erf0rmed 7-30-77 Subd~vis(0n Atelier Subdivision DEP1. GF V~ALTH & ~IRONM~NTAL rer, th reef '- Soil Characteristics --~-6"-Peat--6"-~eddish-~'l~ .__Brown Sandy Gravel Silty Gravelly Sand Brown Bottom of test hole. 18-- 20--- .I I ~as ~round ~ater Encountered? No l¢ Yes, At what Denth? -._"-Z7 .... J ......... I ' I Grnss Time Fercclatinn Rate Hinute Prn~esed Installation: Seenaoe Pit ~eoth of Inlet .................... C~p~h · ' I Grain Field To Sottom Of Pit oY-iF'~,~F ..... ;.~::' E !i I $: _.1_2_5_ s~_u_aF.?._~9o_~._.r ~equ.i.r o.d._per, bedroom..from..minus. 6 "-to--7-:.. .... -/~ .... 150 squ~ foot_r-equzrec~per_.bedroom from.minus.-$'--to--15,~.-- ............. -. ~ ~..__.. ?//~/,,'~.;... Parcel I.D. # 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 RON'M~N1AL ee.....' RECEIVED 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing ~ddress Lehding agency Day phone ~ ~' &~'-~ ~'~.,5'o Day phone Mailing address ' Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: e NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~T'P.._,,~_..~J ~-~:)A,V~C, CJ,~-- Phone "~-7_--~21~ Address '~,o .~Y.. /~"~c~,,T ~,'u~- ,,~{C ,~'c~,5'-/~ Engineer's signature-,-~5~'~ Date ~/~'/9-7 DHHS SIGNATURE .,/ 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 based 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 professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HU.M.A.N. SERVIC~ ..... Envi~o~nmental Services Division · P~-EC E I V ~ L) 825 L Street, Room 502 Anchorage, Alaska 99501 (907) 343-4.744 _ JUL 1 1997 Health Authority Approval Checldlst.. i -'i~' gl Anchorage MUnlC pal ty _ . - Dept. H~alth & Human ~erv~ces Legal Description: ~. ~- ,'~'~ ,~'-r'~. C/~ parcel I.D.: A. WELL DATA W'e, type Log present (Y/N) Total depth Sanita~/seal (Y/N) Date of test Static water level Well production IfA, B, or C, attach ADEC letter. ADEC water system number Date completed ~'['2~ [ ~ / Cased to ¥ FROM WELL LOG WATER SAMPLE RESULTS: Coliform "-- (~) ~ Nitrate Data of semple: '~/I3 Iq B. SEPTIC/HOLDING TANK DATA Data installed ~l/l&~t Tank size Foundation cleanout (Y/N) C. ABSORPTION FIELD DATA Effective abeorption ama ¸,4 Date of adequacy test ~/~ Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later. Peroxide treatment (past 12 months) (Y/N) Casing height (above ground) '~f'/ '~ Wires properiyprotected (y/N) ~ AT INSPEGTION ell .,5*' g.p.m. '5. ,5- /o Z-~ Other bacteria ~0 ~ Collected by: ~.-~..~)~ue~ ~ !~-~0 Number of Compertmente ~ Cleanoute(Y/N).__ Depression (Y/N) v~ High water alarm (y/N) "- Pumper i~i '~' Soil rating (g.p.dJfF or fff/bdrm) ~. ~ System type '~3 -1- ~ Gmval thickness below pipe ~. ~, Total depth //.-7 Monitoring Tube present (y/N) ~ Depression over field (Y/N) ~ Results (Pass/Fall) ~;=~s.5. For ~ .bedrooms Immediately after "--gal. water added (in.): ~ Absorption rate = -- g.p.d. ~ If yes, give date 72-026 (Rev. 3/g6)* Manhole/Access (Y/N) ~P~o~el at~ 'Pump off' level High water C ed E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: . Septic/holding tank on lot ~1' ~. 9 On adjacent lots Absorption field on lot / O~,~~ ~ Public sewer main Sewer/septic service line On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ O ~ Property line (e-'F ~ Absorption field Water main/service line ~40 ~ Surlace water/drainage ~4- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: / Properly line ,.~ Sudace water ! Curtain drain Building foundation ..~c~, ~ Water main/sewice line Driveway, parking/vehicle storage area ~; C~ t Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and rev/ew of Municipal recerds~ems are in conformance wl~ MOA HAA guidelines in effect on this date. Signatu~ HAA Fee $ ~ (~('~ ~ ~ Waiver Fee $ Receipt Number ~'~..~C~ c~"~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* JUL-16-199? 12:S9 CT~E ESI ANCHORAGE 907SG15301 P.03/04 CT&E Environmental Services Inc. Laboratory Divls;on Laboratory Analysis Report CT&E Ref.# Client Name Project NameJ# Client Sample l~iatrix Or~iered By I~W$1D Sample R~m~rks: 9?3813002 Pa~on~ Eng Sty. 7141 l~fo.~.~oe DnsU'S Ba~h S~ D~.g War= 0 Client Printed Date, q'ime 07/16/97 11:23 Collect~l Datedl'Ime 0'II13197 12:30 llectlved Dar e/Tlm~.~--~7/1 4/97 1 2:00 Technical Dlr~he~ C. £y y ,Jtrlel-N 1.27 0.100 I~J/L $R18 &S00*NO3F 10 max 07115197 JRJ Toter Co[Ifor~ 0 cot/100~L SN18 9222S 07/14/97 E~ " 200 W. Potter Drive, Anchorage. AK 99518.1605 -- Tel: (907) 562-2343 Fax: {907) 561-E301 3180 Pager Road. Fairbanks. AK 99709o6471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALA$ICA~ CALIFORNIA. FLORIDA. ILLINOIS. MARYL&ND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA 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 264-4720 Application Date GENERAL INFO;:MATION (a) Legal Description (include lot, block, subdivision, section, township, range) Loc.'dion (address or directions) (b) Applicant Name '~)o.c~ .; 7~, ~ Telephone: Home -"~.~_~ -;~_..z~. Business ApplicantAddres~; ,,;~7/ /~,/ 3d)"/ k S:~t31 ~,,,,L .<:).~ (c) Applicant is (check one): Lending Institution r'l; Owner/builder:~]'; Buyer n; Other I-I (&xplain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (t) Mail the HAA lo the following address: (",,, ct Page 1 of 2 TYPE OF RESIDENCE Single-Family [~ Multi-Family I-I Number of Bedrooms, ~ Other ~:'. · ~ WATER SUPPLY ~: .: Individual Well ~ Community I"1 Public I'-I .i · ! ~ No e: I! commun ty well system, must have wr tten confirmation from the State Department of Env ronmental I SEWAGE DI,.*POSAL ~/.~, ..~ .., ..... ;..~ · , Note. If commumty well system, must nave written conhrmat~on from the State Department of Environmental Consen/ati~ ,' L''" attesting to the legality and status. ~,~- " . ,... EN.GINEERING FIRM PROVIDING NSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION s certif ed by my seal alfixed 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 Ihis inspection. HATER NELL NOTE: This Xealth Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria tn a sample of that water. No warantee or certification ts expressed or implied concerning the long term adequacy or safety of the water supply. OH-SITE SENAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval Inspection merely certifies that the subject on-site sewage disposal system accepted at least 1S0 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification ts expressed or Implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on butted system components ts from HOA files and was not vettfted during this Inspection. DHEP APPROVAL Approved for '~h ~'ee- bedrooms by ~"~ Approved ~"/ Disapproved Terms of Conditional Approval /C2- '"~7,.~,~ Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based eolely 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 engineers work. Page 2 of 2 WELL DATA MUNICfPALITY OF ANCHORAGE (MO~/ HEALTH AUTHORITY APPROVAL (HAA) CHECKUST - FEBRUARY 19842644720 RECEIV...ED Legal Description: Z~.,4~' Well Classification ,/~/~',~',r'/-~ Well Log Present (Y/N) Total Depth /~;~t~ ' Cased to Static Water Level Casing Height Above Ground ~..~· Electrical Wiring in Conduit (Y/N) ~/~ If A, B, C, DiE. C. Approved (Y/N) Date Completed ~,~/_ Yield Depth of Grouting ~/~ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ¢~' ~ ; On Adjoining Lots /~::) ·~' To Nearest Edge of Absorption Field on Lot //~' · To Nearest Public Sewer Line Cleanout/Manhole ~,~/,~ Water Sample Collected by Water Sample Test Results .~' Comments ,')/S~'4,U~x~ B, SEPTIC/HOLDING TANK DATA ; On Adjoining Lots /~ · e To Nearest Public Sewer To Nearest Sewer Service Line on Lot ,5"~, · ~ ; Date ~"'~,~'~'~,, Date Installed Standpipes (Y/N) _5/~~ Depression over Tank (Y/N) .,'~,,0 Pumping/Maintenance Contract on File (Y/N) . Holding Tank High-Water Alarm (Y/N) / Separation Distances from Septic/Holding Tank: To Water-Supply Well ~' · To Property Line ~ · ~' To Water Main/service Line Cour e Size /'¢;~-~"~ ¢~/-. No. of Compartments ~" Air-tight Caps (Y/N) ~.~ Foundation Cleanout (Y/N) Date Last Pumped .'5"-.~ ~' Temporary Holding Tank Permit (Y/N) . To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-02601/84) C. ABSORPTION FIELD DATA Soils Rating in Absorpiion Strata Date Installed Width of Field ~,~-~=--J~,~ Type of System Design 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 ~'7 Lot A,¥~V~. To Water Main/Service Line ~;)' '~' Length of Field .~'~:) · Deplh of Field :: Gravel Bed Thickness Standpipes Present (Y/N) ~vz~'~5 Date 9f Last Adequacy Test .~-,,~'7 - ~ '~ To Property Line To Existing or Abandoned System on To Cut~nk (if pre~nt) To Stream/Pond/Lake/or Major Drainage Cour~ To Driveway, Parking Area, or Vehicl~ Storage A~a ~ * LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (WN) 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 thatJ h~ve.~hec~ ~erif~ conformed to all MOA and HAA guidelines in effect on the date of this inspection. Si-ned ~",'~'~-~/ /~,.~;~:;~Date ~///~/~ Company /~q~-I~r~, e--~ MOA NO. Receipt No. ~I~ Date of Payment (~- I ~ '~ Amount: $ ~ ~ O~ Page 2 of 2 :'/ unic pali Yof Anchorafle P.O. Bt.,,. 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWI. E$. MAYOR DEPARTMENT OF HEA~.TH & HUMAN SERVICES June 10, 1986 Nell llawthorne, P.E. NHawthorne-Engtneerlng 7127 Old Seward Highway Anchorage, Alaska 99502 Subject: Lot'7A Block 2 Atelier Subdivision #1 Waiver Request, WR86-068 Dear Mr. tlawthorne: This department has granted your request for a waiver of the minimum separation distance required between a well and septic tan~ for the subject lot. This distance has been waived to 96 feet. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/lJw NHAWTHORNE-ENGINEERING 7127 OLD SE~NARD HIGHWAY ANCHORAGE, AI...ASKA 99502 gO7-;~,.4-47 ! ! May 29, 1986 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUN 2 1986 Mr. Stephen S. Morris Municipality of Anchorage Department of Heal th and Human Services B25 L Street Anchorage, Alaska 99501 RECEIVED RE: Lot 7A, Block 2, Atelier #1 Dear Steve, Please consider this a request for a waiver of the separation distance requirement between the private well and the septic tank on the subject lot. This request is to reduce that required distance to 96 feet for this lot. The DHHS copy machine was broke down this morning and I'm leaving for a week so I would appreciate you taking the time to dig out the well log and septic as-built. The ground surface at the well is higher than that at the septic system. Thank you for your time. Sincerely, Nell Hawthorne ' ~' APPLIC'~T I~ILLS OUT UPPER HALr-,.ONLY Address ~ Zip ~e ~ Other ~ f Sewer~ Individ.lDISp°sal ~ ~ Ye~, ,ndiv~ua, ,nsta,,~: ~ I D Holding Tank .~ ~= / ~ Time Time Time Time Date Date Date Date Ftetd Notes: NIUNICIPALI~7 OF ANCHOP, A(3E RECEIVED (~ APPROVED BEDROOM~ *CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CO~IT~NAL APPROVAL* March 10, 1983 Jim E. and Alana McSpadden 7141 Montague Cir. Anchorage, AK 99507 Subject= Lot 7A Block 2 Atelier subd. Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: " The top of the well casing should be sealed so that it is water tight. The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. " The depression over the sewer system %~ill need to be filled so that surface water drains away from the sewer system. Please notify this Department for a reinspection When the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, JR150/p/E1 Jim Roberts Associate Environmental Specialist March 10, 1983 C-21 Heritage IIomes Janette Griggs 207 E. Northern Lts. Anchorage, AK Subject: Lot 7A Block 2 Atelier Subd. Approval for the individual sewer and water facilities cannot be granted until the following items have been completed= The top of the %:ell casing should be sealed so that it is %~ater tight. The ~{ater analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. The depression over the sewer system %~ill need to be filled so that surface water drains away from the sea;er system. Please notify this Department for a reinspection %~hen the noted discrepancies have ~men corrected. If. there are any further questions, please call this office at 264-4720. Sincerely, JR151/p/E1 Jim Roberts Associate Environmental Specialist