The URL can be used to link to this page

Home My WebLink AboutGOLDEN HILLS BLK 1 LT 4Gold n Hill Block :1. Lot 4 #015-122-30 Municipality of Anchorage Page I of 3 Development Services Department Building Safety Division/On-Site Water and Wastewater Program 4700 Soulh Bragaw Sb'eet P,O, Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us {907) 343-7904 ON-SITE WASTEWATER DISPOSAl.. SYSTEM AND/OR WELL INSPECTION REPORT Permit Number:. SW01026_._~5 PID Number: 015-122-3~0 ,,,,-: Wastewater System: Upgrade Ken and Christina Zafren 10181 Curvi Street Anchorage~ AK 99516 ABSORPTION FIELD ~,,.. .~,, ~ a~,,: Deep Trench 346-2333 Four (4) s~ ~,.~ t~ ~,~ ~ ~,,~ ~,.~- LEGAL DESCRIPTION 1.2 1 4 Golden Hills 2 ,,. 10 2 Well: Existing 3 ~. J- ' r,. n. 540 ~e ASTM D3034 PVC I I n. ' Acreage Systems 8/1.2/01 ,~: i~,., s~.:" i c..~, ~..~ c,.~,~.TANK SEPARATION DISTANCES Septic T~ Septic Absorption Lift Holding ~bllc/Pm. ate ~,~ac~*, -- - Tank Field S=Uon Tank S...,U~ 'Anchorage Tank 1,250 w~ >100' >100' N/A N/A >25' Steel Two s~.w.,.>100' >100' N/A N/A ~ " LIFT STATION - NONE iN LOT ~u. >5' >10' N/A N/A r,.~-~.>5' >10' N/A N/A ~ c,~o~ None Noted ~ BENCH MARK 3ull Run Flow Diverfer Valve Placed and Existing Absorption Trench Tied In. Southeast Corner of First Step at East End of Existing Septic Tank Removed From Site. House. 100.0 rt ,Eng~ee~$.Stamp ,.,~. :,,,~.... · ..~ %,,., 8/1/01 Inspections performed by: Mike Anderson Dates: Ist -'~'- CE-4381 .'~ 2~ 8/2/01 ~ w..... .'x- '.. ~,. <,'~ ... .. ~: ,.,, Department of Health agd Human Services approval Reviewed and approved by: //'~'~'~J/! X ,/~ate: q" '~0--0..2. Permit No. SW010265 PID No. 015-122-30 Page 2 of 3 J Existin~ well Four/ ..I .'1 A B S1 32.1 19.0 S2 29.1 27.6 DV 30.5 32.2 C5 64.1 91.4 C6 71.3 107.2 M1 68.9 103.3 ~I'LEGEND. '~! S ~ Septic Tank V6nt ~ C - Cleanout - Monitor Tube TH - Test Hole Location O PLAN. AS-BUILT SCALE 1" = 30' I " ./ M1 I C6 49-.~ Munlclpality of Anchorage DEVELOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904 On-Site Wastewater DisPOsal System or Well Inspection RePOrt Permit Number SW010265 PID No. 015.122-30 Page 3 of 3 100.5 .oust- -7}~,~o0. nch 91tl / Drain F:eld Ro¢l 73t5 27~ \80.9 . ql ~7 PROFILE AS-BUILT 1" =10'. Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION ZEST Performed For. Ken Zafren Legal Description: Let4 I~lock 1. Golden Hil~s . SLOPE OG~T S TE PEArl 4 GWISW 10 11 12 13 14 15 17 18 19 Well Graded Sand SW Was Groundwater Encountered? No S If Yet. What Depth? L O Some Depth to Water Cobbles After Monitoring None Date: 71161nl ! Bottom of Hole Reading Date Grass ~let Depth To Net Time lime Water Drop I 7-Jul 1:05 .75' 2 1:10 5 5.75' 5" 3 1:11 .625' 4 1:16 5 5.625' 5' 5 1:17 .75' 6 1:22 5 5.75' 5' Pen:. Rate: 1 MinJlnch Perc. Hole Diameter. 6' Test Run Between 7 FL and 7.5 FL Comments: Percolation Cavity Presoaked Prior to Testing. Pen::. Rate >1 Min./inch. Performed By: Mi~<e Anderson. I, lYl[3;b~ Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 7116101 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.a nchoroge.ak.us (907) 343-7904 ON-SITE SEWEPJWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-t22-30 Permit Number SW O I O ~ Property owner(s) Ken and Christina Zafren Mailing address (1) t018t Curvi Street Anchora.qe~ AK 99507 Mailing address (2). Zip Code Legal description (Lot, Block & Sub'd.) Lot 4, Block 1, Golden Hills Subdivision Legal description (Section, Township & Range) Lot Size 53,548 Acres/Sq. Ft. Number of Bedrooms Four Day phone 346-2333 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Well Only Water Storage Jacuzzi [~ Water Softening Unit I certify that the above information is correct. I further cedify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes, (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: July 25, 2001 TO: Jim Cross, P.E. FROM: Mike Anderson, P.E.'~/~ SUBJECT: Lot 4, Block 1, Golden Hills SubdivisionSeptic System Design and Permit Application I have reviewed your comments and revised the septic system design for the subject lot accordingly. We have moved the trench further northeast to provide additional distance to the steep slopes at the end of the trench. We have also revised the effective depth to 10' and shortened the length to 25' again to provide additional distance. Fil[will .s, till be required at the southwest end of the trench to provide separation distance Trom tne steep slope. A cross section has been provided showing the slopes on both sides of the trench at the mid point. The trench location will meet the separation distance requirement of 50' from any downs ope grade greater than 25.% a.s sh.own .o..n the.c, ro.ss section. The only questionable area is at the end of the trencn where T~II will De a(3oe(3. The distance from the house and property line to the absorption trench has been added to the drawing. Finally, the permit application has been changed to reflect "Sewer Upgrade." Please let me know if additional information is required before the construction permit can be issued. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 16, 2001 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 4, Block 1, Golden Hills Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer:. The exist ng septic system on Lot 4, Block 1, Golden Hills Subdi,vision.has failed ..an.d must be replaced as soon as possible. We are therefore applying mr a permt to construct a new septic system on the lot to serve the four-bedroom home. The attached Site Plan and backup documentation identify the location and configuration of the new septic system and the parameters used in the design. Also identified on the plans is the location of the existing well an.d septic system along with the test hole. Existing dra. inage patterns are shown and w~ll not be altered by the development of the lot. The exIsting absorption trench will be tied into the system for future use with a Bull Run Flow Diverter Valve. A test holes was placed near the location of the new absorption trench. This hole indicated a well graded sand with some gravel. A percolation test in the material resulted in a rate approximating 1 minute per inch. No groundwater was found during tPhlacement of the test hole and none developed during the monitoring period. We are erefore ropos ng to p ace a deep absorption trenc.,h, withlO'of gravel beneath the distributionp pipe. The total depth of the trench w~ll be approxima, tely12'. The distribution pipe will be placed at 2' below the ground surface. The servIce line from the septic tank to the absorption trench will pass along the alignment of the existing absorption trench to avoid the newly paved driveway serving the house. The ground surface on the lot slopes as shown on the attached Site Plan with steep grades|ust northwest of the new trench. The new absorption trench will be constructed on a t'aifly flat surface near the top of the lot in conformance with Municipal requirements and parallel to ground contours where possible. If the system is constructed in accordance with our design the following statements apply: 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. · . Lot.4, Block 1, Golden Hills Jtily 16, 2001 Page Two The system, if constructed as designed, will have r{o adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve 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 · GROVER'STREET 1 0 ' Electric.~Easement Existing Well Four/ Bedr~m llTse Tank Run Diverter ~o Conflicts with Septic iystems or Wells in the Area. '1 / ./ Place ~ t to ~ ' ~ration X 3'~lde .~cttve ./ SCALE 1" = 30' .'. ; - .. /, Lot 1, Block 1, ANDERSON ENGINEERING P.O. Box 240773 ANCHORAGE, AK 99524 c~.cuu~o sY (907) 522-7773 Cell (907) 441~ ~ [__L-.~--~---~ ' I Golden Hills DATE ' CROSS ~$gCTION --Horl MID TRENCH 1 "=1 0 ', '~1 "i-20' LOT 4, BLOCK 1, GOLDEN HILLS SUBDIVISION DESIGN FACTORS: Four Bedroom Home Perc. Rate: 1 Min./Inch Avg. Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gallon Septic Tank 10' Drain Field Rock 4 Bedrooms X 150 GPD 11.2 GPD/SF = 500 SF of Absorptlon Area 500 SF/20 SF/LF = 25 LF Trench Length Therefore: Construct An Absorption Trench 25' in Length by 3'_W~_d.e Wi.th_,1_0' .of D?i.n~.eld Rock Beneath the Distribution Lateral. Distribution Lateral to ue ~'lace~ z uelow ~_x~stmg Ground. Total Depth of Trench to Be 12' from Existing Surface. Mound Over Trench if Necessary to Provide Minimum Cover of :': Natural .-'.:.?;-'": · Backfill, '.. ,:'!'" Geotextile ~ · :,Fabric .. :. : · ::?/'- ...:...'. ;. "...."., .'.:: '4 "''Perforated · ' {Slots Down) NOTE: TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Well. Performed For: Ken Zafren Legal Description: Lot 4. Block 1 Golden Hills · .,..,_. Municipality of Anchorage <~'"'~ 825 L S~eet, Anchorage, AK 99502~650 ~-% '.. LO - Date Pedorm~ SLOPE SITE P~N 4 5 1 11 12 13 14 15 16 17 Ic. OG/PT GWISW Well Graded Sand See S[Ee Plan SW Some Cobbles Bottom of Hole Was Groundwater Encountered? No If Yet. What Depth? Depth to Water After Monitoring None Date: 7116/01 S l O Reading Date Gross Net Depth To Net Time Time Water Drop I 7-Jul 1:05 .75" 2 1:10 5 5.75" 5" 3 1:11 .625" 4 1:16 5 5.625" 5" 5 1:17 .75" 6 1:22 5 5.75" 5" Perc. Rate: 1 Min./Inch Perc. Hole Diameter: 6" Test Run Between 7 Ft. and 7.5 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Perc. Rate >1 Min./Inch. Performed By: Mi~:e Anderson. I, Michael F. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 7/16/01 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 4, BLOCK 1, GOLDEN HILLS SUBDIVISION GENERAL: 1. The scope of this project includes the pumping, crushing and. abandoning of the existing septic tank on the lot and the procurement and placement of a new 1,250-gallon septic tank at the location shown on the site plan. Work also includes the construction of a new 25' long X 3' wide XlO,'~ffective depth absorption trench at the location shown. The distribution line in the trench will be placed at 2' below the existing ground surface. Total depth of the trench will be 10' below the existing ground surface. A Bull Run Diverter Valve will be required and the existing absorption trench tied in to the new system. The new line from the septic tank to the new trench will run along the same alignment as the existing trench. 2. Construction sha be n. accordance with the approved site plan, design draw ngs, Municipal Permit with any special provisions or conditions, and all applicable State and Muncipal Wastewater Disposal Regulations. 3. 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. 4. Unless specifically agreed otherwise, the contractor shall be respons ble for final grading areas subseque.n, tly depressed from soil settling. Property owner shall be respons~be for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installat ons Owners installing their own syste.ms mu.st receive p~ior approval from D.H.H.S. before beginning system instal abon. SEPTIC TANK INSTALLATION 1. A new 1,250-gallon septic tank must be procured from an approved source and installed at the location shown. 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. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. · Lot 4, Block 1, Golden Hills Subdivision · July 16, 2001 Page 2 of 3 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be p aced level with perforations down atop a level bed of drainfleld rock. Rock should then be placed over the p pe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield reck and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below greund must be perforated. 5. 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. 6. 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 trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfleld reck for a 5' wide trench. Contractor shall vedfy this condition pdor to placement of the reck. 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, Femco, or equal). · , 'Lot 4, Block 1, Golden Hills Subdivision · 'July 16, 2001 Page 3 of 3 5. A permeab e geotextile fabric (Typar Mirafi or equal) must be installed between the final drain rock layer and the native so ayer, 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. 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 fabdc, 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. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: TO: FROM: SUBJECT: April 28, 2002 Jeff Poet Mike Anderson, P.E.'~'~ Lot 4, Block 1, Golden Hills Subdivision Septic System As-Built The absorption trench for Lot 4, Block 1, Golden Hills Subdivision was placed at the only suitable location on the lot. Excess excavation from the trench was placed at the west end of the trench to provide as much flattening as possible. Our calculations indicate the ma|odty of the trench is at least 50' from any. break in grade great..e[~t,han 25%. The end'of tee trench is at least 35' from any break in grade greater than Soils encountered in the excavation for the trench were clean well graded sands with some cobbles. Effluent from the septic tank will percolate through this material at a fairly rapid rate in a vertical direction. Little, if any, effluent is expected to travel horizontally through the porous material. The chances of effluent surfacing downslope from the trench are extremely remote. We therefore request the absorption trench be approved in its current configuration. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT % u c. E .-'g 1PR°NE E3 UPGRADE NAME '~1 N G ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer /' Liq. calzaci~i~ gall o ns DISTANCE TO: IWell Manufacturer Weft DISTANCE TO: No. of lines Length of e ~ ine ~ngth Width DISTANCE TO: I~ss ~epth DISTANCE TO: Building foundation area Inside length Dwe ng iMaterial Nearest lot line · h /O Total [e n g th.of lines T r e~n.~od t h NO. OF¢.E DROOMS PERMIT NO. No. of compartments Liquid depth PERMIT NO. %iquid capacity in gallons Foundation PERMIT NO, Distance between lines Material beneai,~.til~ inches Depth Crib depth Building foundation Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Driller Distance to lot line [PERMIT NO. Sewer line Septic tank labs--; area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL PERMIT' tqO. DEPRR'f'MENT OF HERI...TH FIND ENV~RONMENTFIL. PRO'f'ECT:I:OI",t 825 "L" STREET., Fff',ICI"tORFIGE., FIK. ?'8~)488 ::, t If- F L 1C:FINT c ,: b~:¢.5~::~ ,'" LC I]:~¥~ I ON I_.lJ~,:. ,, ~:~,T~..EI:.I L.E:GFIL. L. 4 B :t EiOLDEN HILLE; ~E;I...IE~ L.OT S]:ZE T~'FE. UF :,Oil... ~aE,~':.URE, T.[Lffi ~,T:.,FErl I .... [~.E~...[I HFI::.::IMI...IM Nt.li'"ISER 13F E:E[::,RL]OI'I:F.; = RFFr ]: 1'.~13 FT,..'EIR ) = 'THE R[EE.:flJIRED SIZE: OF THE: SOIL FIBE;OF'~E .'~.':i;TE:M THE LENGTH [::,IHENE;ION IS THE L. ENOTH ,::IN FEET) OF THE TRENCH OR [:,RF~INFIELE:,. THE DEPTH OF:' FI TF'.ENCH OR PIT IE; THE [:,ISTFINCE E:IETHEEN THE S, LIRFFICIZ OF' THE GROUN[:, FIN[:, THE BOTTOH OF THE E',:.:',OF¢,?FfI'I()N ( IN FEET). THEF.'.E tS NO SET H~D'rH FOr..' TF..'ENCHE.3. THE GRFIVEL DEPTH IS THE M]:NIMUH DEPTH OF GF.'.FIVEI.. BETHEEN THE (]LITFFiLL. F'IPE FIND THE BOTTOM OF' THE ENCFIVFITION (ZN FEET). PEI;-':I"I}: ]' FIPF'L ;[ CFINT Fff~':.~ THF I::E'~;F"ON':5 ]' E: ~ l I 'T'¥ TO ]: NFORM TH I '.:~: DEF'FIR]'F~NT DUE. :[ NE:i THE I N:L::TFILLFrT' ~ ON :{NSPECT :[ ONS OF RN'¢ HELL';5 FiDJFICENT TO TH :[ S F~F.'.I]iPERT'T' t~I'.,l[) THE NUMDER OF RESIDENCES 'fliRT THE HELL. HILL ~,EF.'.',,/E. 61t...I...I-ILL].Nb OF FINh.' :. r:.'[El'l H]ETFIOI.JT FINFIL., INSPEC:TIOt",I FtNI} Hi-FF. ,HI THI'.:.; DEPFIRTMENT HILL BE SI...IDJECT TO PROSECUT]:OI'.4. i"IINIMLIN E:,I'STRNCE BETHEEN FI HELL fiN[::, RI.IV ON'.-S]:TE SIEHFIGE: [:,I:~i;POSRL. S"r'S'FEt"I '.tOO FEET FOra'. R PF.'.t',/FITE HEI..L.~ OR J. SE~ TO ;:.'(:J([l F:'EET FF.'OM Ft PIJE:L][C 14EL.I_ DEF'ENDING IJPON THE T"?f:'E OF:' I::'l..l[ilL. ]: l]:: HELl .... HIELL LOGE; FIRE RECalJ.T. RE[:, FIND [41J.~,T BE RE'FI.JRI'.~ED TO THE: [:,EPF]F.:THENT HI THIiq ]:O [:'l:::l"r"-'~; OF THE HELL.. COMPLETION. (:)'l"l'"l['E[;i'. RE'i)..-.!U .'[ REMENTS i"lFl'¢ RF'PL."r'. SPEC I F :[ CRT I ON'}; FIND CONE;TRt.ICT 1 ON D FI',,,'RZLFIBL..E TO INSURE I::'RC~F'EEF: CEf-;?.T I F'¢ THRT I::li'"l FRM ILIRR H I'rH THE REQtJIREI'IENT:E; FOR CIN-SITE SEHERS RND HEI...I_S F'~E; SEI' FOR]'H B'.? 'THE MLIN I C:.~ F'FIL .'[ TV OF FINCHORRGE. HILL INSTRL. L THE SVE;TEM IN RCE:ORDRNCE HITI4 THE CODES. UN[:,ERSTFff.I[:, THF.~T ,,Er'PIE ON-S ~ TE SEHER S,"r'E;TEM f'lFl'¢ RE(.:K.It RE ENI....FIR(3EI'I[ENT ]: F THE: F.'.E:~:.;):DENr~ZZ.Ei';C~ ]TNC:LIJ[::,E HOF::E THFIN 3." F)F3::'.,F-::OL]H'.;5.' IFD E ~t ....................... E. I't f [: .................................... ', :.i:. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch G.950, Anchorage, Alaska 99502 276-2221' SOILS LOG- PERCOLATION TEST PERFORMED FOR: F~/~/"'~- ~..~":" ~'1~-'~' -~ L~'~'-'/ ~T' LEGAL DESCRIPTION: DATE PERFORMED: SOl LS LOG PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O i.- 'Z_ %~'% I' SLOPE SITE PLAN i_ -- ? ) , - WASGRODNDWATERENcO NTERED, IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ~ ~ FT AND FT 72 008 (7/76) be. ,ira~]to-(i tlF~l::J.i th~: ]}O]].oS-;lD.g it~_',aS haVO b',~,::F~ conduit. 'i'ho :~optic tank pnm?~::d with a i:<.>ccj, ot ;;ul}mi, tb<.>'.] t:o thi::; the ..-;o..,-'>tic t?.m], and/or l¢.>achin:j aY(~.3. }~ObOUt C. Ptyi~t.i_ 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 INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant NameT~k ~U~___ Telephone:Home .~g"X~Z3 Business Applicant Address _~ Applicant is (check one): Lendin9 Institution ~; Owner/builder ~Buyer []; Other [] (explain); (d) Lending Institution /¢/2)/~ Address /~(_,.'/~ f' ~(~' ?L'!U _ (e) Real Estate Company and-Agent Address (f) Telephone Mail the HAA to theJ~,llowing address: ,7:,,, "> ~ ' /2_ TYPE OF RESIDENCE Single-Family L~Multi~Family Number of Bedrooms Other WATER SUPPLY Individual Well ~'~'Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Fnvironmental Conservation attesting to the legality and status. SEWAGE DISP_Q~AL Onsite []~ublic [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/841 ENGINEERING FIRM PROVIDh,, ~ INSPECTIONS, TESTS, FILE SEARCH, D/,,, ~ A AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hdalth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspectiqn..~ , ~ Engineer's Seal Approved (,~_~_~.7 '-_ Disapp;ov~'d Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o25 (11/84} _OF ANCHOR^GE ' ~ .I,,,~'t'~'l .~1 AUTHORITY APPROVAL (HAA) .-~ ~ ~CHECKLIST - FEBRUARY 1984 Well Classification .~ ~ (~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~, Date Completed _ ~ Total Depth ~-I _ Cased to ~-~ Depth of Grouting /~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Pump Set At ~,~ Sanitary Seal on Casing (Y/N) Lt .~ Depression Around Wellhead (Y/N) _ To Septic/Holding Tank on Lot ~('(~l ~ To Nearest Edge of Absorption Field on Lot IOO~ ~¢ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line ./~/iI~ To Nearest Public Sewer Cleanout/Manhole /~/(~Ocf.,,f~"~ To Nearest Sewer Service Line on Lo~ Water Sample Collected by ~)~ ;Date Water Sample Test. J~es,,Its _ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~/1~ Separation Distances from Septic/Holding Tank: TO Water-Supply Well To Property Line To Water Main/Service Line Course Size /,¢-,,.'.'.'~O ¢I¢ NO. of Compartments Air-tight Caps (Y/N) _ ~.¢,,~ Foundation Cleanout (Y/N) Date Last Pumped ,4/ .~ p,~ ~) ,/~ /~ :for --- Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ ~ "'~:)'~ Width of Field .,~ Square Feet of Absorption Area ~',~.O:~./.-IL 1 Depression over Field (Y/N) Results of Last Adequacy Test U Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation IS I- .i- Lot To Water Main/Service Line ----{J2C)f' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /'~0,¢Q.,~¢ J~er' ~JF/~..Type of system Design IU'~ Length of Field Depth of Field 8 Gravel Bed Thickness Standpipes Present iY/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /t~ LIFT STATION Date Inst la~d Dimensions Size in Gallofts.....~ Manhole/Acc~-- .~.__ "Pump On" Level at ~ ~];~" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for .// ~Pi~.ycles d~. Meets MOA ~l;Cmt rimCealr tsCOdeS (Y/N~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~LU.-t~'¢. (?zas.~.4 Date Company ~Or[~ ~~MOA No. Reoeipt No. Date of Payment ~ ) ' Amount: $ ~Q ~ , '~% Engineer's Seal Page 2 of 2 72-026 (11/84) D,., J RECEIVED ~ NSPFCTI ON APPOI NTM ENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR MUNICIPALI'rY OF ANCHORA(,~E MUNICIPALITY OF ANCHORAGE DEPT. OF WM.,LTII ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL pR~EN1AL P~OTECTION 825 L Street - Anchorage, Alaska 99501 DEC 'i 198! ENVIRONMENTAL SANITATION DIVISION Telephone 204-4720 ,RECEI.~ED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND 8EWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proeessed, Please allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) ~HONE 2, BUYER PHONE MAILING ADDRE88 . . ' ~. LENDING INSTITUTION I MAILING ADDRESS 1~~' MA~I~G ADDB[SS S. LEGAL DESCRIPTION STREET LOCATION" 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One ~-J Four J~ [] Two I-~ Five SINGLE FAMILY [] MULTIPLE FAMILY ,[~' Three [] Six I-~ Other 7. WATER SUPPLY INDIVID[JAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SI'rE** //~7~-'~ [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED__ Y~t.~' 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~.~ '--'-) 0p/ Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: /~_~J-~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ~ 4, DISTANCESwELLTO: Septic/Holding...~_[, ~'~ Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~]--~-D I SAPP R OV E D DATE BY ~ "~ ' Ul::~h OF HEALTH & '~ ~/~ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTIO%_ ..~-, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEOTION ) 825 LBtreet-Anehorage, Alaskag9!501 OCT 3 1978 ENVIRONMENTAL ENGINEERING DIVISION Te,ep,o.e, ,,*o RECE! D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAOILITIE$ DIRECTIONS: Complete all parts on page 1, Incomplete req~ts will not be p. ypceSSed. Please allow ten {10} days for processing. ,. P.oPERTV MAILING ADDRE~ / ~ ~ ~ ' -- ~ ~ PROPERTY R ESJDEN'r 3. I_ENDmG I~ITUTIONn /~ '~ // , PHONE 4. REALfOR/~GEN%~/ ¢ ...... PHONE MA LING ADDR ES~ SINGLE FAMILY MULTIPLE FAMILY 7, WATER~UPPLY 1~ INDIVIDUAL~ LJ COMMUNITY [] PUBLIC UTILITY INDIVIDUAL/ON-SITE** [] One [] Four El Other [] Two [] Five Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth {attach log if available.) ,¢ Jf individual/on-site, give instaJJation date ~//~/'~ If system is over two (2) years old an adeqd/acy tes[ is required 8, =EWAGE DISPOSAL SYSTEM [] PUBLIC U'FI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~] INDIVIDUAL/ON -SITE DATE INSTALLED ~,' E~PUBLIC UTILITY ~.o ~- ''~ Connection Verified INSTALLER []Septic.Tank Ol' [] Holding Tank Size: [c-~.~,-L3 If Tank ishomemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line ~ N~arest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [];~'APPR OV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78)