HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 2 LT 14Homp 'on Hill
Block 2
Lot 14
#015-134-65
Municipality of Anchorage ."!~
Developmen! Sen/ices Depadment "~ .~l.'~:
Building Safety Division '~ ~"
On-Site Water and Wast~ter P~ram. 47~ S. Bragaw
P.O. Box196650 Ancho[age.~ 99519-6650 Page ~
~.cl.anchorage.=k. us {907) 343-7904
ON-SI~E WAS~EWA~ER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ~0~0 0~? PID Number:
"-- EIsa; 5 ~0~ Wastewater System: D New ~ Upgrade
I~l H~mp~ ~;vE ~I,~r~e~ ~1~- 1~7 ABSORPTION FIELD
Well: ~New DUpgrade ~ ~,. ~ ~
SEPARATION DISTANCES D sepllc ~ HoUlng ~ S.T.E.P. ~ Othe~
Tank Field Station Tank S~ t~e ~ p~ ~ ~
103' I0 ' ;5;
.~,, BENCH MARK
Develbpme~t Se~lces Department Approval ~ c~-sso~
,~.~ ~.~ ~,,~o~ ~: ~/.~ ~. ~ ~: ~ -~ q '~ ~"~..'. ~'''''',''''..: .........
PER~flT NO. SW020054
PAGE 2 OF 3
Municip. oLi~c oF Anchor'oge
DEPARTMENT OF HEA~_TH
AND HUMAN
SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box ~96650 ~Ancho~ge, AJask~ 99519-6650 · TeJephone: 343-4744
ON-SITE WASTEWATER DISPOSAl SYSTEH AND/OR WELL INSPECTION REPORT
LECAL LOT 14, BLOCK 2, HAMPTON HILLS #1 P.I.D. I~0. 015--134-65
I I
, I
8 I I
/~ I ~ ,,
,.._..-"/..~.~ ............
PER.MIT NO. SW020054
PAGE 5 OF 5
Municip. o~Li't oF' Anchoro. ge
DEPARTMENT OF HEA~TH
AND HUHAN
SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 $Anchopage, AJaska 99519-6650e TeJeghone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LECAL LOT 14. BLOCK 2, HAMPTON HILLS #1 Pig. NO. 015-154-65
FINAL GRADEy
FINAL GRADE
MT1 =91.3' /
ST 1 STOl 9 6.3'
NEW 1250 '""-91.8'
GALLON S.T.E.P,
SYSTEM
/MTI=103.3'
DIST.
PIPE=g?.3'
·
NO WATER FOUND
85.3' B.O.H.
A B
FCO 17.0' 12.0'
ST1 $2.5' 56.0'
~T2 57.0' 41.5'
MH 58.5' 45.0'
DV1 40.0' 45.5'
)V2 40.5' 45,5'
MT1 55,0' 50.4'
04/19/2002 13:49 F.l-I 9078686770
Services, Inc. ~001
~,.-*~ lr&x - DDclr&xl
&/10/02 5:~2 PAOE 17/20
LOT:. 14 Rr-,'K~.. 2
CALl. TO MI~T
.0 7549
.~,d~x~. d,'tg/'02 ..
~f/., 272-4S91 ~'
$ ~t;~/ON.- 14Aldr~O~ HILLS #t
Find
MUNICIPALITY OF ANGHORAGE
Deve/opmen! Se/vices Deparfment
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 10, 2002
Expiration Date: Apr 10, 2003
Permit Number: SW020054
Legal Description: HAMPTON HILLS #1 BLK 2 LT 14
Design Engineer: 0003 S & S Engineering
Owner Name: Chris Cromer
Owner Address: 10001 HAMPTON DRIVE
ANCHORAGE, AK 99516-1127
Parcel ID: 015-134-65
Site Address: 010001 HAMPTON DR
Lot Size: 49108 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date:
Date:
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.cl,anchorage ,ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SwOZO0,~'-4
Properly owner(s) ~ ~ t S C/~/~9/t.d C~ Day phone
Mailing address (1) JOOO!
Mailing address (2)
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size /3[ 9,~ I/'~_"~_. Acres/Sq.Ft.
THIS A~
Sewer Only []
Sewer and Well []
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Zip Code
Number of Bedrooms ''~
Well Only []
Water Storage []
Jacuzzi .
[~ Water Softemng Unit
I-'1'
I certify that the above Information is correct. I further certify that this application Is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
'~ & S ENGINEERING
17034 Eagle River Loep Road No,
,v 'z
(Signature of property owner or authorized agenl)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 1 ?JO0)
Waiver Fees:
Date of Payment:
~. i ReceiptNumber:
April 3, 2002
ROBERT C. COWANo P.E:.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCtlORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 14, Block 2, Hampton Hills Subdivision #1
It is requested that you issue a permit to upgrade a septic system to serve the existing
three bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test performed on 3/29/02. The approximate
location ofthe test hole is located on the attached site plan. At the time of excavation, no
water was found. Ground water was monitored and after seven days water was not found
as shown on the attached soils logs.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage pauems by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, p!ease contact us.
Sincerely,
Robert C. Cowan, P.E.
ecctojj
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577
B.J.J. R.C.C. 4-10-02 1 OF' 1 /, ~. ..
,,'.-¢ ~..,-/,;% v.
~rin~DESIGN CRITERIA: c°"'"'~'°~ ,~ ,,o,,~o ,o ~.....~. z ........... -,.,.:.
3 BDRM = 450 GPD wOR~. ~',~X ~O~CCOW~
SOILS = 1.2 GPD/SO.FT. ~ ~t~/~, CE.SSOI
= SQ.rT. ,[e'D. .........
tAXi (907)694-t211 10' TELECOM · ELECTRIC EASEMENT
DRAINFIELD CRITERIA: ~r----.'~o------~~--- 1
10.0 DEEP . t ~ //~~~' ~'~/Us I ~,T, ~ss ~,,A~ 3.~' o~
6.0' EFFECTIVE / [ /~ /~ ~/ I
' ~ I'~ 7 I I
2.5 WIDE ~ ~ . ~ I I
~ ~ I I LOT
I I
LOT I / ~ /~/./ / /~ - / I I
' '
~ / I ~T~ /~ ~ ~LyF_~q'" I ~
/ ~ I~ ~' ,oo' o. e~.o~[o I ~1 ~"
DISTRIBUTION SYSTEM:
1 ~TERAL ~ 31' LONG = 30
/ ~o .OLDS .~. ~, 0.o' D.C.) I
I .~ ~ 50 HOLES TOTAL = I.O OPM/HOLE I U
I 3/16' DIA. HOLES FACED DOWNWARD
/ 10' UTILITY EASEMENT THC [NCIN[ER MAY VA~'
F
Municipality of Anchorage
Development Services Department
P O BOX 1~6~ ~ge, ~ 99519-~
SOILS Log - Percolation Test
PedDled Fo~ ~
4-
o
7-
8-
9-
10.
11,
12-
13-
14:
15-
16-
17-
18-
19-
20-
COMMENTS
Site Plan /
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT DEPTH? '. ~" L
O
Depth to Water A~ter
Monitoring? ~ E
Dale'
Reading Date Gross TimeNet Time Depth to Water Net Drop
, , io / o ?~/4'
o /o 9X4'
I 0 /0 9 ~4' ~ '/4"
PERCOLATION RATE ~ (n~,nute**,~ch) PERC HOLE DIAMETER ~
TEST RUN BETWEEN ~?L. FT AND ~ ri'
PERFORMED BY: ~/~_.. ~. I CERTIFY THAT THIS TES'I,~WA,.'~
PERFORMED IN ACCOJ~DANCE W1TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: q j' ff/'~ '?-'-
ROBERT C. COWANo P.E;.
CMLENGINEERS
(907) 694-2979
FAX (907) 694-121 !
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 14, Block 2, Hampton Hills Subdivision # 1
April 3, 2002
GENERAL:
The scope of this project includes the installation of a pressurized drainfield
and an HDPE S.T.E.P. tank to serve the existing three bedroom residence
located on the referenced property.
Construction shall be in accordance with the approved site plan and 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 any necessary
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing
their own systems must also receive prior approval from the Municipal
Health Department. ,
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septi~ tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches
· above final grade.
17034 NORTH EAGLE RNER LOOP · SUITE 204 · EAGLE RNER, ALASKA 99577
P~e 2
Lot 14. ~lock 2. i-I~n~o~ H~s ~uIxl'~'~sion # 1
A~3.2~02
Septic tanks installed with less than 4 ft. ofcover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation.
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer
rock) placement.
Once the gravel is installed, the distribution pipe is to be installed level with the holes
faced downward. The distribution piping is to be ofPVC (ASTM D3034 or equal).
All joints are to be solvent cemented. Gravel is then to be placed over the distribution
pipe to provide a minimum of 2 inches ofcover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent
to the effective depth of the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
L~ 14, Skx~ 2, H~ Hi~ ~d'n,'~ #1
Ap~3.2~
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipally
approved septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caul&r, Femco,
or equal).
A permeable nontoxic silt barrier ¢rypar 3401, Mirafi ! 40N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened grovel with less than 3%
passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever specifications applies.
Page4
Lot 14. Block 2. Hampt~ H~s Subdiv~ # 1
Ap~ 3,2~02
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation ofany gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre-construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to car~' out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH&ENV RONMENTAI PROTECTION
825 LStre~t - Anchora.qe, Alaska 99501 Telephone 264-4720
P,-,ONE
MAI LING ADDRESS
LEGAl- DESCRIPTION
LOCATION
' Well '-- ~ Absorpti~ frea
/ ~Z IManafacturer ~_~ ~
' ~' / DISTANCE TO' Well ~/~ Dwellieg
~ / I WeU ~.
Foundation ~
~ / DISTANCE TO: I
~ ~ ~ ~ No. of ]ices ~ ~ Length o~h line Total length o~lines I 3-ren~.d~
~ 1%p of ti~e to fi~i~ grad. ~ ~ateria~ b.neath ti~e~ ~
ength
Vpo o f~criZ
DISTANCE 'FO:
'lc%'
DISTANCE 'TO:
Width
Depth
NO, OFBEDROOMS
*ERM,T NO. 7 ¢0t ?--5
No. of compartment%,
Liquid depth
PERMIT NO.
Liquid capacity in gallons
_To t, I e f,~t~)a b.~)t i o n area
PERMIT NO.
Crib diameter Crib depth Total effective absorption area
Well [3uilding foundation Nearest lot line
Depth Driller Distance to lot line PERMIT NO.
[3uilding foundation Sewer line Septic tank Absorpt on area(s)
OTHER
PIPE MA,,~ER IA LS
INSTALLER
REMARKS
APPROV/D DATE
LEGAL
'12-013 ('Re'v. 3/78~ '//
WELL CONSTRUCTION LOG
USGS
Date well completed
Nearest
Nell location: (add/ess &legal ,,escriDtio.)Lc '
Finish of well: (open-end, screen,~';;~ open-hole,
for ~ hours witil ~ _ft. of drawdown fram static level,
DRILLER'S NATERIAL LOG
Depth below land
snrface in feet
Give description of strata penetrated
(size of material, color, hardness of drilling, end water content)
~to.
____to
~to
--ito
--.to
CONSUL.TING GEOLOGIST
t3OX 476-M, STAR ROUTE A '~ ANCHORAGE, ALASKA 99507 " PHONE 344-7071
SOILS LOG
16
18
2O
Soil Type Water Level
Remarks
Total Depth of Excavation
Groundwater
~Not Reached
Depth, if Reached
Classification Method
/isual
( ) Sieve Analysis
()
Material at Total Depth ]k/~
Bedrock
~ot Reached
Depth, if Reached
Gary F. Player, Consulting Geologist
Municipality of Anchorage
Development Services Department
Buitding 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 AU.THORI .'1'~...A. PPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OI 5- - ) 3 '"J- 6 ~
GENERAL INFORMATION
Complete legal'description Lo'7' ) q $ ~-a c,~
Location (site .address or directions) / 0 o O I
Current Property owner(s)
HAA #
Expiration Date:
Mailing address
Lending agency
Mailing address
Real Estate .A. gent
Mailing Address
NUMBER OF BEDROOMS:
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
flue (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. Ce,,'tificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a pdvate or Class C we!l and may be reissued with
new water sample results. (Certificates may be reissued for a pedod of up to one year with valid w.=ter samples.)
Certificates are valid for one year for properties served by Class A or B wells er a public water system. The
Municipality of Anchorage is not responsible for errors or emissions in the professional engineer's work.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Wafer & Wastewater Program
4700 Souffi Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci, anchorage.ak, us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescriptton:~LoT' I~ J~-~cw ~- ///!~/~r~/O //'/~J' '~/ ParcellD:
A. WELL DATA
We, type
Total depth ! '70 ft.
FROM WELL LOG
Oate te,
Static water level
Wall production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
We Log(Y/N)
W~res property protected (Y/N).
Casing height (above ground)
If A, B, or C provide PWSID #
Sanita~/seal (Y/N)
AT INSPECTION
in.
Any mjuv~(past 12 mo.) (Y/N& ~pe) If yes, gwe date
Other bacteria O colonies/100 mi.
collected b~'& $ ~IGIt~'EEING
Date installed ~'/!
Cleanouts (Y/N)
High water alarm (Y/N)
System type */- ,q '~ ~*" ~
Monitoring tube
Gravel below pipe ~ ft.
Depression over field ~ O
bedrooms
in.
g.p.d.
B. SEPTIC/HOLDING TANK DATA
TankType/Matedal 5-~,/4;-,c. / $7'~,L
Tanksiza )~.5'1~ gal. - Number of compartments ~-
Foundation cteanout (Y/N) ¥~--f Depression over tank (Y/N) ~'O
Date of pumping Iu//I-- /u~,~,,~/ Pumper ~
c. Aeso.P=O.-ELD DATA
Lengm 3 ~-~ ~L Wd~ _3 [
Totaldedth ~ ~ It. Eff. abe~rptionama:-~/ fl2
Data of sample: ~/,~ ~,/o ~.
' Municipality of Ancho.r. age
Development serViceS D6 al-{ment
Building Safe~y Divlslon
On-Site Water and Wastewa{er Program
J,700 South l)ragaw St.
P.O. Box 196650 Anchorage, Al< 99519-6650
,,w~.cl.anchorage.a k.tJs
(907) 34;~-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parce .O. OI
1. GENERAL INFORMATION
Complete legaldescription Lot 1/*; Block 2;
Location (site address or dir~,clions) 10001 Hamnton Dr-Ire ~
Current Property owner(s) Chris Cromer
Homes Unlimited
3705 Arctic Boulevard,
Greg Hamilton
Mailing address
Lendin'~ 'agency.
Mailing address
Real Estate Agent
Mailing Address' Same As Above
Unless otherwise requested, HAA will be hem by DSD for pickup.
2, NUMBER OF BEDROOMS:. 3
Expiration Date:
Hampton Hills Subdivision, # 1
Anchorage? AK
Day phone
Day phone 727-3047
# 1811, Anchorage, AK
Day phone
99503
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site
Public Sewer []
The Municipality o! Anchorage Developmen{ Services Deparbnenl (DSD) Issues Certil~cales of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In the Stale of Alaska. Certificales of Health Authority Approval are required for the transfer ol
lille (except between, spouses) for propedies served by a single family on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certi[ica~es of Health Authority Approval are
valid for 90 days from Ihe date of issue for propeflies served by a private or Class C well and may be reissued with
new water s~.mple results less than 30 days old. (Ceflificates may be reissued [or a period of up to one year wiih
valid water samples.) Ceflific~tes are valid for one year for propedies 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 prolesslonal
engineer's work.
Monicipality of Anchorage
Development Services Department
Building Safety Division
On..Slte Water & Wastewater program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
w~w.ct.anchorage.ak.us
HEALTH AUTHORITY APPROVAL CHECKLIST
A. WELL DATA
Well type .~V~'~'~' If A, B, or C provide PWSID # ~'
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
/5-?.- , ..
~ g.p.m.
Date of sample:
c~onias/100 mi. Nitrate ~. 5I mgJL
Well Log (Y/N)
· W~''es properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
In.
Other bacteria (~ colonies/100 mi.
Length ~'~ ' ft. Width 9o ~, ~' ff. Gravel below pipe '~'"" ff-
Total dep~' I ~-, ft. Eft. abso~tion ama .~ft2 Monitoring tube y Depression over field ~
Date of adequacy test ~ Results (Pass/Fail) ~--~1//..,, For ~ bedrooms
Fluid depth in absorption field before test ~ in.~.,Wa~'~__ gal. New depth in.
Elapsed Time: , min. Final ~,,~9~ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12/1a~.) (Y/N & type) If yes, give date
Date lnstellod ~- Soil rating (g.p.dJIt2 °r~
C. ABSORPTION FIELD DATA
B. SEPTIC/H.OI~fl~3 TANK DATA
Tank Type/Material ~
TanksiZe /~ gal. Number of Compartments
Date of pumping ~ Pumper
System type
Date installed ~
Cleanouts (Y/N) ~7/
High water alarm (Y/N) /J/'~
mnq
April 9, 2002
ROBERT C. COWAN. P.E.,
CML ENGINEERS
(907} 694-2979
FAX (907) 694-12"1 !
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 14, Block 2, Hampton ttills S/D #1
A conditional llealth Authority Approval is requested for the referenced property. A
septic system upgrade is to be installed by June 15, 2002.
There is no eminent health bozard created, no obvious code violation, such as overflowing
sewage, or no adverse effect as a result of the granting of the conditional approval.
Ifyou require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/ hm
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577
t'i ..
.i
Hat. IS 2~2 12:561'11
8lEah
, ;!1;
't'~ .... ;'~"~' ~
.~4~{~:./. = ~:l ...... =.'.1'=: · :':';"
'X~6rk~e*~6rdln~ Pie~lh~l.'~alk~. arid
men~ Iltul~d thereon are the
~. thet ~c~t
~xcept u lndlca~ h~reon. ' : / ' ' '
...... J ....... ~ .I..
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.# .~\%-~ ,%Li- le..~ HAA# ~-,/0 ¢t ~ (':~3--°\
1, GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent Tor4r~?
I010o!
q ¢o T ofo r d.¢
Day phone
Day phone
Day phone
Address -/qq ~ /~ ~-~,e¢ £~,/-d (o~,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ N
TYPE OF WATER SUPPLY:
Individual well ~
Community well
Public water
If community well system, provide written confirmation from State AD£C attest-
ing to the legality and status of system,
NOTE:
TYPE OF WASTE-'WATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72-025 (Rev. 1/91) Front MOA #21
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.
Name of Firm ~=/a/-~o '7~¢ ~n/~ f ~r~;¢~ Phone ~ ~/.~" -/35-$-
Address )~,~_3o I~-~c~, ~'/'? /~r'-,,~c/~o,"~4¢ /'~'~
Engineer's signature ~"_~ ~. ~ Date
=
DHHS SIGNATURE
~ Approved for Y
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with th~ followin~ stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHH$) issues Health Authorib/
Approval Certificates based only upon the representations given in paragraph 5 above by 8n independent
professional engineer ~gistered in the State of Alaska. The DHH$ does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and st~e requirements. Employees of DHH$ do no~
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage i8 not
responsible for errors or omissions in the professional engineer's work.
72-O25(Rev. 1/91) Back MOA~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Z. /z(..~ 2. H/~MP"FoN ~rlJ..L5 Parcel I.D.
A. WELL DATA
Well type PR\ !/ATE:
Log present (Y/N)
'Total depth I '70
Sanitary seal (Y/N)
_If A, B, or C, attach ADEC letter.
Y Date completed
Cased to J '''/O
Y Wires properly protected (Y/N)
ADEC water system number N.~,
~'/Ig/7~' Driller ~/~¢N ~ I~I~ILLING
Casing height L~ ~
..o., WELL LOG AT ,.S.ECT,O.
Date of test .~'/l~/ 7~ I,2` /I
Static water level I ~' ~ I ¢¢ ~
Well flow ~ g,p.m. ~, 7
Pump level - J ~
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /o.5' 'TO C.o,
Absorption field on lot 135 / T0 C, 0.
Public sewer main ~ loc '
Sewer service line ~,SO
; On adjacent lots ~ /00'
; On adjacent lots '~ /oo
Public sewer manhole/cleanout "'?/°O /
Petroleum tank NoNE OB$~'E¥'~- b
WATER SAMPLE RESULTS:
Coliform ~ co/ /10o~
Date of sample: 12/I[~l~-
Nitrate
~..~/-L~ Other bacteria
Collected by: ~ LA'rTOP 'T-Ec/¢.
B. SEPTIC/HOLDING TANK DA'f'A
Date installed S/I&/7~
Cleanouts (Y/N) Y
High water alarm (Y/N) ~,~,
Date of pumping
Tank size _ J ooo d;/)L Compartments 2_
Foundation cleanout (Y/N) ¥ Depression (Y/N)
Alarm tested (Y/N) N,/~,
/) ;~ Pumper -~"_¢~ ~ ~:~'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s)onlot__lO$f F;get4 C.o. On adjacent lots '~./oo'
To property line ~,0! Absorption field
Surface water/drainage
Foundation 30
Water main/service line
T°
72 026 IRev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length 2~ / Width
/
Total absorption area ..~O
Depression over field (Y/N) Iq
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating 25' ¢~ System type
Gravel thickness .S Total depth
Cleanouts present (Y/N)
Date of adequacy test Iz/!
for
N¢,I~ Kdow'N t)~ If yes, give date ~, ~.
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot l,~5~
To building foundation
On adjacent lots 0.50
Surface water ~/oo
On adjacent lots >/oo Propertyline Lt?-
To existing or abandoned system on tot _ ~,/~,
Cutbank ~' Water main/service line .~0'
Driveway, parking/vehicle storage area
Curtain drain No~¢ or~$D~V£b
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ...,~.~_date of this inspection,
Signature
Engineer's Name
Date
HAA Fee $ _4/ 7
Date of Payment
Receipt Number
72-026 fRev. 3/911 Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 lB STlBEET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
i2/01/9P f, .ii;:[q hxa.
]2/OJ/g? !) ?t:S[I i~L~',
Member of the SGS Group (Soci6t~ G~n~rale de Surveillance)
COMMERCIAL TESTING & ENGINEERING CO. AK DIV
CHEMICAL & GEOLOGICAL LABORATORY
TELEPHONE (907) 562-2343 5633 B Street
Anchorage. Alaska 99518
DrinkingWater Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D. #
~' PRIVATE WATER SYSTEM
Name
~ ~53o ECHo
Mailing Address
J Ye $ 3 q$- I
Pho~e No.
State Zip Code
Mo. Day
SAMPLE TYPE:
,~/Routlne
[] Check Sample (for routine sample
with lab ref. no. .)
[] Special Purpose
Year
[] Treated Water
~ Untreated Water
SAMPLE
No.
41
Time
Collected
Collected
By
C He~r
TO BE COMPLETED BY LABORATORY
Analysis, shows this Water SAMPLE to be:
/~Sati~actory
[] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results, Please send
now sample via special delivery mail.
Analytical Method: Membrane FlEer
* No. of colonies/100 mi.
Lab Ref. No.Result*
I I ~
Analyst
BACTERIOLOGICAL WATER ANALYSIS
Membrane Filter: Direct Count
RECORD
~ Coliform/lO0 mi
BEFORE
COLLECTING SAMPLE
Reported By_
TNTC = Too Numerous To Count
OB = Other Bacteria
~SGE
Verification: LSB BGB
Fecal Coliform Confirmation
Final Membrane Filter Results
~ c?'~__~ ~ Date
Time:
Coliform/100 mi
PART ONE OF TWO
REMAINDER TO FOLLOW
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE C)F INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-S~TE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Business
(b) Applicant Name ._~;i~,~¥~J __ Telephone: Home b~ .
Applicant Address
(c) Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d) Lending Institution
Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone
· Mail t,t~e HAA to the following address:
TYPE OF RESIDENCE
Single~Family/[~ 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 Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~- Public [] 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,
72-025 (1 lt84)
Page 1 of 2
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA,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 Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm .~---~ ; ~)t~¢¢ AcCO Po7~_5 Telephone
Address ~,~,~,0 ~-
ApproveS'for -~ ' ~.--- _ bedrooms by
Approved ~.. ' ' Disapproved
Terms of Conditional Approval
~'~.. Date
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protect{on (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professiona[
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work,
Page 2 of 2
72-025 (1 ~/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST ~ FEBRUARY i984
264-4744
Legal Description:
MUNICIPALITY OF ANCHORAG,~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
WELL DATA
Well Classification
Well Log Present (Y/N) _ '~
Total Depth 170 Cased to
Static Water Level I'~
Casing Height Above Ground
I--lectrical Wiring in Conduit (Y/N)
Separation DiStances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
'fo Nearest Public Sewer Line _ "b/
Cleanout/Manhole 'Jo
Water Sample Collected by
If A, B, C, D.E.C. Approved (Y/N)
Date Completed _ ~'/~' ~' / ~ (~ Yield
Depth of Grouting
Pump Set At U~JJOOdt'd
Sanitary Seal ~)n' Casing (Y/N) _ ")/~"~
Depression Around Wellhead (Y/N)
~0~''.ct ; On Adjoining Lots -I"lOOl
; On Adjoining Lots 't"lOOZ
TO Nearest Public Sewer ' 4.2,~1
To Nearest Sewer Service Line on Lot
; Date. t'¢.,/ ~/~ ~
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed '/161_ G Size lO00 NO. of Compartments
Standpipes (Y/N) _ '~ Air-tight Caps (Y/N) ~,{~ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ['J¢o Date Last Pumped
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 "¢ ~'''
Course .4'
; for
Temporary Holding Tank Permit (Y/N)
!
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026fRev 886~ Fronl
C. ABSORPTION FIELD DATA
Soils Rating in ¢&bsorpti,on Strata
Dat8 Installed /J /86
Width of Field '
Square Feet of Absorption Area
Depression over Field (Y/N)
RO
Type of System Design
Length of Field ~"~'!
Depth of Field l~t
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test ~::::¢~,¢-.,r0/2~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line .-¢ ~.~. I
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
Comments '~'~" /~¢rT'~f~ (/~-:~¢tct:~/'J
/
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank r(if present) ~ P/'~I~.I~,J -r'
LIFT~TION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Co'des (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request
I certify that 1,13ave checked, verified, or conformed to all MO,A and HAA guidelines in effect on the date of this
Signed ~,~~ Date J'~"/~/~ ~' . . inspection.
Company ~ ~~ MOA No.
Date of Payment
Amount:
$
Page 2 of 2
72 026 fRev 8/861 Back
MUNICIPALITY OF ANCHORAGj
DEPT. OF HEALTFI &
ENVIRONMENTAL PROTECTION
Lu
.RECEIVED
December 8, 1986
Department of Health and
Environn~nt~% 1 Protection
825 "L" Street
Anchorage, ~< 99501
Re: Health Authority Approval
Lot 14, Block 2, Hampton Hills
Gentlemen:
Attached is application for Health Authority Approval for the
above-referenced lot for your review and approval.
The previous 1985 Health Authority Approval was approved
conditional on the fact that the reverse grade on the pipe
between the tank and the field cleanout be corrected. ~wo
weeks prior to the on-site well and septic test, DeArmoun
Excavating exposed the pipe and found real problems with the
pipe gradient. A new cleanout was installed immediately
adjacent to the tank, and the excavation was backfilled.
During the on-site testing, elevations were shot in tb~ newly
installed cleanout and the existing cleanout at the beginnning
of the field, and a positive gradient was verified.
The 1985 Health Authority Approval application indicated that
water backed up into the ~ank. This occurred during our test
also, but we feel the reason is not a reverse grade. Water
backed up into the tank because the absorption system does not
accept the amount of water that the well is capable of
providing. In this case, an increase of about 4 inches in
tank water depth dissipated within 45 minutes after the
required amount of water was placed into the system.
Ve~,j truly yours,
smh
Attachments
ENGINEERING, PLANNING, SURVEYING
2220 E. 88th Ave./Anchorage, Alaska 9950'//'['elephone 907-349-6451/,344-1352
"Providing a quality personalized service to those building Alaska's future"
Location:
BESSE, EPPS & POTTS
2220 EAST 88 AVENUE
ANCHOi{AGE, AK 99507
(907) 349-6451
WATER ~.[,L TEST
RECEIVED
Subdivision:
Lot:
Block:
Client's Na~e:
Address:
Iooo/ Pc,~t~PTot~ z~zW ~
Tester:
Initial Reading on Meter:
GALLCk',IS GALLONS W~uu
TIM~ GPM A VOLUME TOTAL VOLUM~ u~4~ L.
l~oo t.~o ~ ~ ,, '~',
l;~ 0 o ~ffS, ~ 49
~:0o . ~o I~ ~7
Production Rate: ].o~/~' GPM' 24-Hour Capacity. 2~50 Galloons
MUNZCZPALITY OF ANCHORAGE
DIVISION OF ENVIRONbiENTAL ~ALTH
DEPARI~ENT OF IDEALT]! AND ENVIRONMENTAL PROTECTION
APPLICATION FOR ['{~JTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date /~QCc ~ ~
(a) Legal Description (include lot, block, subdivision, section~ township, range)
Location (address or directions)
(b) Applicants Name~,'c~& I~s6~ Telephone - ltome Business 5~9~o~tc/
Applicants Address_~l~~~f_~3_.~~ ~,c~¢,,~4~ 4~ ~V F~ ~
(c) Applicant is (check one) Lending Institution ~ ; O~mer-Jb~r ~ ;
(d) Lending Institution ~_~a~/C~._p_~,j~_,2~ ..... ~~O_~R~_ ~
Address /~ ~~q ~ 4~a~ ?_ ~_ ~ ~0 i~ ...........
(e) Real Estate Co. & Agent ~o ~33_~J_t~__=~!q~_~_~_i~~
(f)
Telephone
Mail the HAA to the following address:
2. ~%pe of Residence
Single-Family~
Number of Bedrooms
3o Wat_~_jer Su~
Individual Wel!.~
J
Multi-Family
Other (describe)
Community~ Public.~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status~
S
Ousite ~ Public ~[ 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 1 of 2]
e
Engineerin_~Firm Providin~ections, Tests_~ File Searc_~h3. Data and Information
As certified by my seal affixed hereto and as of the validation date shown below,
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal sysgem is safa~ f~ction~ and ~aquate for
the number of bedrooms and type of structure indicated herein. I further verify
based on the% info~a~ion obtain~ from the b~nicipality of ~chorage files and from my
investigatio~ ~d inspection, the on-site ~ter supply and/or ~stewater disposal
system is in,compliance ~%ho~lth%nl%l~:lc~%dn.State codes, ordinances~ and regula~
tions in effect on the da' '
Name of Fi~~ Telephone
Approved for
Approved Disappr oved~'~' Co~dition~
CAIVf I0N
THE MIIN!CIPALiTY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES EEALTH AUTHORITY APPROV~kL CERTIFICATES BASED SOLELY UPON THE REPRESE'.~TE-
ATIONS GIVEN IN PARAGRA_PtI 5 ABOVE BY AN INDEPENDENT PROFESSIO-~-~A--~ ENGINEER REGISTERED
AS A COURTESY TO pURCHASERS OF HOMES AND
IN TIlE S rA]. OF ALASKA. %~E DHEP DOES %]tls
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. 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 LN TI~ PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY oF ANCHORAGE (MOA)
HEALTH ADTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification
Well Log P~esent~/N)
DEPT. O~ h'zAL~jt 8;
JAN 1 i '198or'
Casing H~ight Above (]round ~ -/ ,,
Electrical Wiring in Conduit
Sepa=ation Distances f~c~ Well:
If A, B, c~ C, D.E.C. Approved(Y/N)
Date Cca~leted ~5'//~/~ ~ ' YielZ~
Total Depth ,. /7(3 ~' Cased to / ~ Depth of G~out~ng/t163~
Static Water Level _ /%//~g~t~.D . Pump Set At ~o+ c~ LU~,//.,/O~ ',
~ Sanitary Se~ on Casing ~N)
Depression A~cund Wellhead (Y~
To Septic/Holding Tank on Lot /~,~-~
To Nearest Edge of /~Dso~ption Field on Lot
To Nearest Public Sewe~ Line
Cleanout/Manhole ~_ _ To Nearest Sewe~ Service Line on Lot
Water Sample Collected By ~]-~OC., ; Date
~ ; On Adjoining Lots /00 ~ (~
//~/~C73; On Adjoining Lots /~o ~ (~
To Neap. est Public Sewe~
Water Sample Test Results
B. SEPTIC/HOLDING TANK DATA
Date Installed _-~'/~/~' Size /¢~0 0 NO. of Ccmpa~tments
Standpipes ~)(~ Ai=-ti~t Caps ~) Foun~tion Cleanout ~)
~p~eSsiOn o~= Ta~ (Y~ ~te ~st P~d
P~ing~intenan~ Con~a~ ~ File (Y~) ~'/~ ; for
Holding Ta~ High'Wa'te~ ~a~ (y~) ~/j-~a~ Holdi~ Tank ~t (Y~) ~/~
Sep~ation Distan~s ~ ~ptic~olding Tank:
To Water-Supply ~11 /~ z~ To ~ilding Foundation
To ~o~ty Li~ ~.~ / ~h TO Dis~sal Field ~ /
To ~ter ~in/Se~vi~:Li~ M(~ TO St~e~, ~nd, ~e, ~ ~jor ~aina~
· ~ ~ ~ / I
C. ABSORPTION FIELD DATA
Dm
Soils Rating in Absorption Strata
Date .I~stalled ~5~ ~/~
Width of Field <~
~c~ Type of System Design~r~Z~j~
Length of Field ~ ~
Depth of Field /D ~
.-
Gravel ~Bed Thickness ~%~
Square Feet of Absorption Area ~9~ Standpipes P=esent~/N)
Depression ove~ Field (Y~ Date of Last Adequacy Test '~-47/~>~'
Results of Last Adequacy ~st ~~7~,/2-~ &~c~kw)~-<~,
Separation Distance f?cm Ab~scatptio~ Field:
To ~ate~-Supply Well //~/~ To P~operty Line ~ /
To Building Foundation ~ ~ ~ To Existing or Abandoned System cn
Lot A]//~ ; On Adjoining Lots ~.~(9 / ~
To Water Main/Service Line ~3(/~ To Cutbank(if p~esent) ~! ~
To Stream/Pond/Lake/c~ Major D~ainage Course Al [.~r
To D~tiveway, Parking Area, c~ Vehicle Storage Area ~-/~- / ~)
LIFT STATION
Date Installed
Size in Gallons
"Pump On" r~.vel at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Dimensions
Manhole/Access (Y/N) ~J(~
"Pure9 Off" Level at
Vent (Y/N)
Pumping Cycles du=ing Adequacy Test.
Meets MOA
** Check Permitted Bedrocm Rating Against HAL Request **
I certify that I have checked, verified, or confor~ed to all MOA HAA Guidelines in effect
on tl~ date of this i~,.~pecti~n.
S igned~ff.~~c~ Date '~%//~ ~'
KB1/dL/s6~! ,~ ~ . u - ~
[Page 2 of 2]
2-15-84
ALASKA B, UIRODmeDTAL COF1TROL Seh'dlC $, IFIL
~§in¢¢rinfl $ ~nuironmcnM Sluclics
n ~9 1984
KONNI SNYDER
10001 HAMPTON DRIVE
ANCHORAGE Al<
SELLER - RICHARD HENDERSON BUYER -
SUBDIVISION - HAMPTON HILLS BLOCK - 2
ADEQUACY TEST FOR SEWER SYSTEM
LOT - 14
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 290 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 680 GALLONS.
BASED UPON ~E TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON DEC 12 1984 .
A FLOW TEST WAS PREFORMED ON ~{E WELL. 680 GALLONS OF WATER WAS
PUMPED AT A RATE OF 1.56 GPM OVER A DU1LATION OF 3 HOURS.
THE DRAWDOWN WAS 13.65' WITH A RECOVERY TIME OF 30 MINUTES
AND 'OHE STATIC WATER LEVEL WAS 141.98 FEET.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
1200 UJf:sl 33rd Aucnu¢. $ui1¢ B oAnchor~§¢. Alosko 99503 ,,,(907) 561-5040