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Home My WebLink AboutT15N R1W SEC 8 LT 76TI5N .8 BLM Lot 70 #051-093-24 Municipality of Anchorage Page Department of Health and Human Services Division of Environmental Services On-Site Sen,ices Section 825 'L' Street Room 502 P.O. Box 196650 Anchorage. AK 99519-6650 w~w.cl.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL iNSPECTION REPORT Permit Number: SW000464 PID Number: 051-093-24 "~°: Wastewater System: [] New ~ Upgrade Jim Scott 20327 McKinley View Chugiakt AK 99567 ABSORPTION FIELD 688-9395 Five (5) OO..T,.,~, []S~,~,T,.~ O"~ O,~o--~ OO.~ LEGAL DESCRIPTION 1.2 c~.o~ 8.5' BLM Lot 76 6.5 v,. _2 15N lW 8 .5 n. 90 F,. Existing, ~,, n. 643 ~ ASTM D3034 PVC ~,,MM&M Contracting 8/10/2000 SEPARATION DISTANCES I~ septic t-I Holding I-I S.T.E.P. n Other:. Tank Field Station Tank S~,,U,., Anchorage Tank 1,500 w., >100' >100' N/A N/A >25' Steel Two (2) ~.~w.,. >100' >100' N/A N/A ~ / LIFT STATION wu. >5' >10' N/A N/A N/A c~ "'~"~: BENCH MARK Tank and South 16' of Trench Covered With 2" of Direct Bury Insulation, E~isting Absorption Trench Top of Front Deck Abandoned in Place, 100.0 n. Engineer's Stamp Inspections performed by: MEA Dates: 1" 11/8/2000 Department of Health and Human Services approval Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 -Anchorage, AK 99519-6650 -343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW0~00464 PID No. 051-093-24 Page 2 of 3 A B C S1 9~4 25.5 S2 19.4 33.3 C4 21.9 32.3 M1 2t.9 32.3 C5 85.3 105.5 Five Bedroom House Sl Existing Well C5 MCKINLEY VIEW AVENUE Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 -AnCho~-~g~, AK 99519-6650.34314744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW000464 Page 3 of 3 PID No. 051-093-24 5 96.0 2" Insul. ilI 1,500 Gallo~ Septic Tank l ~ 89.9 ~ 6.5' 1'1' -: : 27' 95.5 '2" Insulation Drainfield Geotexti/ 90' . abric % 81.0-* PROFILE AS-BUILT \89.1 87.0 . ' 1"=10' ... . ! .ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: TO: FROM: SUBJECT: January 19, 2001 Jeff Poet Mike Anderson, P.E.~J,'-~-~ BLM Lot 76, T15N, R1W, Section 8 Septic System As-Built Attached is a revised Plan As-Built showing the second test hole which was placed near the new absorption trench during construction. Materials found in the hole were identical to those encountered throughout the new trench area. A test hole log is also submitted for this area at your request. Please let me know if you need additional information. Municipality of Anchorage Depadment of Health & Human Services 825 L St~'eet, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: ~ Legal Description: Lot 76. T15N. R1W. Section 3 4 5 '6 1 11 12 13 14 15 16 17 18 21 OGIOL SW Well Graded Sand with Gravel Bottom of Test Hole SLOPE SITE PLAN North South Was Groundwater Encountered? No S If Yes, What Depth? L Depth to Water O After Monitoring P Date: E · · See Site Plan Reading Date Gross Net Depth To Net Time Time Water Drop Perc. Rate: 3.3 Min./Inch · Perc. Hole Diameter: 6" Test Run Between 5 Ft. and 6 Ft. Comments: Perc. Cavity Presoaked Prior to Test. Test Hole Deepened During Construction Performed By: Tim Kimbrough. I, ~ Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 12/27J00 Municipality of Anchorage DepaAment of Health & Human Se~ices 825 L S~eet, Anchorage, AK 99502~650 SOILS LOG- PERCO~TION TEST Pedormed For: ~ Date SLOPE 1 OGIOL SW Well Graded Sand with Gravel North See Site Plan So~th Was Groundwater Encountered? No S If Yes, What Depth? L 1 Depth to Water O After Monitoring P 11 , . Date: E 12 14 16 17 18 21 Bottom of Test Hole Reading Date Gross Net Depth To Net Time Ti~ne Water Drop Perc. Rate: 3.3 Min./Inch Perc. Hole Diameter: 6" Test Run Between 5 Ft. and 6 Ft. Comments: Soil Materials Encountered Are Identical to Remainder of Trench Area. Performed By: Mike Anderson. I, ~ Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 1119/01 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 3434744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 01, 2000 Expiration Date: Nov 01, 2001 Permit Number: SW000464 Legal Description: T15N RIWSEC 8LT 76 Design Engineer: 0014 Anderson Engineering Owner Name: Jim Scoff Owner Address: 20327 McKinley View Chugiak, AK 99567- Parcel ID: 051-093-24 Site Address: 020327 MC KINLEY VIEVV AVE Lot Size: 108900 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [--~ Disposal Field [~SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. '5.".The following special provistofls."~ . .... 'AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL*CONSTRUCT AN ADDITIONAL TEST HOLE A :MINIMUM OF 14.5 FEET BELOW ORIGINAL GROUND SURFACE IN THE VACINITY OF THE PR°POSED ABSORPTION FIELD. Date: Date: :ANDERSONENGINEERINGi P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 . 522-6779 (FAX) October 23, 2000 Municipality of Anchorage Department of Health and Human Services .825 "L" Street Anchorage, AK 99502-0650 Subject: BLM Lot 76, Section 8, T15N, RIW Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Eng~'neer: The existing septic system on BLM Lot 76, Section 8, T15N, RIW has failed and must be upgraded immediately to prevent a possible health hazard and damage to' private property..The owner of the property wants to upgrade the system to accommodate five bedrooms. We are therefore applying for a permit to construct a new septic system on the lot to serve a five 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, t a so shows the location of the well on the lot and the 100' protective radius. . -. . . A'test hole was placed on the lot at the location shown which indicated sandl with . ...- varying concentrations of silt and gravel. No groundwater or bedrock was encountered . in the test hole nor was any found during the monitoring period. We are therefore proposing to place a 5' wide absorption trench system with 2' of drainfied rock beneath the distribution pipe. The pipe will be placed at 6.5' below the existing ground surface and the total depth of the trench will be 8.5', The length of the trench will be 90', The new trench may conflict with the existing trench and, if so, the existing trench and all soil contamination will be removed within 10' of the new trench and buded on site a minimum of 100' from the well. The existing septic system on the lot h~s'b~en continually in *service for the past 18 years. We are confident the soils found in the location of the new absorption trench will perform similarly for that amount of time. Soils to the west of the house and below the 8' drop off were found to be very tight with extremely slow percolation rates.' In additon, groundwater was encountered within 6' of the surface.-. The best location for the new absorption trench is above the drop off and adjacent to the house as shown on the site plan. Unfortunately, the service line exists the house at a depth of nearly 6' requiring the service line of the trench to be at least 6.5' beneath the surface. The ground surface on the lot slopes as shown on the attar;bed Site Plan. The area for the new. absorption trench, .'however, 'is fairly fiat. The ground slope drops approximately 8' at a 2:1 slope 15'.to 25' from the edge of the new trench. The new .. Lot.5, Lang Subdivision · October 15, 2000 ~ , . Page Two :.. '" trench, however, will be 6.5;. below the surface so should not conflict with the existing slope. The new trench will be constructed parallel to the 'contours of the .surface in conformance with Municipal requirements..Grading will be accomplished to assu~e surface drainage is away from the new trench. . If the system is constructed in accordance with our design the following statements apply:. . ]. The system, if constructed as designed, will have no adverse im~3act on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, Will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constr~cted as designed, will have no adverse impact on reserve · space, either surface or subsurface, on'any lots located in the area. - '4. 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. '" '~.~..'~'."~' ".' ~,;'z-' ' ' "~"';'t.~,~.~ ' ' Attachments ' ~ ",;' ,,,., ..~ ~,~5 , ;~-~) . . . -: ~%%%~ .. . SCOPE OF WORK: 1. Verify the Foundation Cleanout. Place New if Necessary. 2. Remove and Dispose Existing Septic Tank. 3. Place New 1,500 Gallon Septic Tank Outside Well Radius. 4. Place 2 Post Tank Cleanouts. 5. Construct New 90' Long X 5' Wide X 2' Effective Depth Absorption Trench. 6. Remove Existing Absorption Trench and All Contaminated Soil Within 10' of New Absorption Trench. 7. Regrade Ail Disturbed Areas. 8. Revegetate Area As Required. 5% 5'% 90' Lono X 2' Eff~ Absorption T: Five Bedroom Home 30 Gallon tic Tank I ¢istin¢ ADSOr // Trenc~ MCKINLEY VIEW AVENUE Ex.i,s~$ng SITE PLAN SCALE 1" = 40' NOTE: No Conflicts With Wells or Septic Systems in the Area. -BLM LOT 76, SECTION 8, T15N, R1W DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home 5' Wide Trench System Perc. Rate: 5 Min./Inch 1,500 Gallon Septic Tank Application Rate: 1.2 GPDISF 2' Drainfield Rock 5 Bedrooms X 150 GPD 11.2 GPDISF -- 625'SF of Absorption Area 625 SFI5 LF (Width)*.7 (Red. Factor) -- 87.5 LF Trench Length Therefore: Construct 90' Long X 5' Wide X 2' Effective Depth Absorption Trench. Flowline Elevation in Trench to be 6.5' Below Original Ground Surface. Total Depth to be 8.5'. Mound Over Trench to Provide Minimum of 3' of Cover. 6! Natural Backfill 5! Geotextile Fabric 4".PVC (Holes Down) · Drainfield Rock NOTE: TYPICAL WIDE 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. Municipality of Anchorage Department of Health & Human Services 825 L S~'eet, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For:. Jim Scott Legal Description: BLM Lot 76. Section 8. T15N. RIW SLOPE OGIOL SW Well Graded Sand with Gravel Date Performed: SITE P~N See Site Plan 1 11 12 13 14 15 16 17 18 21 Bottom of Hole Was Groundwater Encountered? No S If Yes, What Depth? L Depth to Water O After Monitoring None P Date: 10/22/00 E ;{eading ;)ate Gross Net Depth To Net Time Time Water Drop I 19-Oct 5:05 2" 2 5:10 5 3.75" 1.75" 3 5:11 2" 4 5:16 5 3.5' 1.5" 5 5:17 2" 6 5:22 5 3.5' 1,5' 7 5:23 2" 8 5:28 5 3.5' 1.5' Perc. Rate: 3.3 Min./Inch Perc. Hole Diameter;. 6' Test Run Between 5 Ft. and 6 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Mike Anderson. I, ~ Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 10/23/00 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: BLM LOT 76, SECTION 8, T15N, RIW GENERAL: The scope of this project includes the removal and disposal of an existing septic tank and the procurement and placement of a new 1,500 gallon septic tank at the location shown on the site plan. Work also includes the construction of a new 90' long X 5' wide X 2' effective depth absorption trench at the location shown. The distribution line in the trench will be placed at 6.5' below the existing ground surface, Total depth of the trench will be 8.5' below the existing ground surface. Ail components of the septic system must be a minimum of 100' from the well on this and adjoining lots. The existing absorption trench and all contamination within 10' of the new trench must be removed and disposed on site at a location 100' from all wells in the area. Construction shall bb in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,500 gallon septic tank must be be procured from an approved source and installed outside the 100' protective radius of the well on the lot. 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. I~LM Lot 79, Section 8, T15N, RIW October 23, 2000 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. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior 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. 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). .BLM Lot 79, Section 8, T15N, RIW October 23, 2000 Page 3 of 3 5. A permeable geotext!le fabric (Typar, Mirafi or equal) must be installed between the final dra~n rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 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, distribu, tion 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. MUNICIPALITY OF ANCHORAGE ~ HEALTH& ENVIRONMENTAL PRO r~CTION DEPAR TivlENT OF ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, ALaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ N~OF 8EDROOMS,~ , ~ Well Dwelling P~MIT NO. O ~- ~ Manufactme( Material Liquid capacity in gallons : ~ No. oflines,/ Lengd~ch',~ Total ,~of ~,~ ' ~ Top of~ t~.f~/sh ~rad~'' ''-- .-- -- ~r.7;:,S~,re l'l b. a h tile ~Z " iht,es Total effec~ve absorption ore. Length Width Depth PERMIT NO. ~ ~ Type of crib ;rib diamete Crib depth m Well Building foundation Nearest lot line ¢ DISTANCE TO: Class ¢ ~epth Driller Distance to lot line PERMIT NO. ~' Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: INSTALLER 0 ~j F'ERMI F NO. I¥~lL.l~"-.~ ]E C: ]E I-:'FltL .I ]'"%-" CIE:' DEPRRTMEN'f' OF HERLTH RND EI"¢v'ZRONMENTF:IL. F'ROI'ECTIr~N 825 ct. STRP-ET, FINCHORflGE., IRK. 92}' t. 264-4720 L--lEE. I_ F4 f'-.~ E':, ~],t'...l--..~'; I TE ( B:~:00--'.':7 ) FIPPL I CFtNT LOCFYF t ON LEGBL JFIMES S. SCOTT LOT 76 SE(; 8 T±SN 7800 DEBRRR RD LOT SIZE 2~000 3~8-8456 SQURRE FEE]' T'¢PE OF SOIL FmBSORF'TIOI'.~ SYSTEM IS: TRENCH MRXIMLIM NLIMBER OP BEDROOMS SOIL RRTING ':]SQ FT/'BR)= ±25 THE REQUIRED SIZE OF THE SOIL RBSORPTION S¥S'FEM IS: -[:, E: P ~r F-[ = ::.t E-~ L E_:. i'-,[ C-ii T H =--= 2~-: 2 I-~ F~: Fl '.,.' E L [:, ED] F' -r' I1--] == ~; THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF ]'HE 'TRENCH OR DRFIINFIELD. THE DEF'TH OF' Fl TRENCH OR PIT IS ]'NE DISTRNCE BETWEEN THE SURFRC:E OF THE GROUND RND THE BOTTOM OF' THE FM, CRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. TFIE GRFI'¢EL DEPTH IS ]'HE MINIMUM DEPTH OF GRIgVEL BETP~EEN THE OUTFFtLL PIPE FIND THE BOTTOM OF THE E,~.:;CR'¢RTION (IN FEET). PERMIT RPPLICI=INT HI=IS THE RESPONSIBILITY 'FO INFORM TFIIS DEPF~RTF1ENT DURING THE INSTFILLRTION INSPECTIONS OF FmN9 1.4ELLS BDJRCENT TI;) THIS PROF'ERT'¢ FIN[:, THE NUMBER OF RESI[:,ENC:ES THRT THE ~4ELL 14ILL SERVE. ........ Ti.,.! C~ ,:: ;2: ) I I'-.ISF'ECT :I ON"__---., RRE F-."E:~]:.~ L~ ][ RE[: BBCKFILLING OF RN'¢ S'¢STEM HITHOUT FINRL INSPECTION RND RPPR. O'¢RL B'T' I'HIS [:'EPBRTMENT [4ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTBNCE BETWEEN R HELL FIND RN'T' ON-SITE SEI.4RGE DISPOSRL 'S'¢SI'EM IS J. 00 FEET FOR £-I F'RIVFITE 1.4ELL OR t50 TO 200 FEET FROM FI PUBLIC 1.4ELL DEPENDING IJPON THE TYPE OF F'UBLIC NELL. MINIMUM [:,ISTRNCE FROM R PRIVRTE WELL TO FI PRI'¢FITE SEHER LINE IS; 25 FEET FIND TO R E:OMMUNIT'¢ SP]4ER LINE IS 75 FEE]'. HELL LOGS BRE REQUIRED RN[:, MUST BE RETLIRNED TO THE DEPIgRTMENT NITHIN ]:0 DRYS OF ]"PIE HELL COMPLETION. OTHER. REQUIREMENTS MR'¢ FIF'PL'¢. SPECIFICRTIONS FmND CONSTRUCTION [)IRGRFIMS FIRE R'¢RII_FiBLE TO INSURE PROPER INSTFIL. LRTION. I CERTIFY THRT ::L: I tRI'"I FI-IIIILIHR HITH THE F-:EQIJIREMENTS FCF.' Uf4-.-.I]E -,ENER--. RND HEL. I_.=, FIS SET FORTH B'¢ THE I"IUNICIPFILIT¥ OF RNCNOR. RGE. 2: I HILL INSTBLL THE S'¢STEM IN RCCORB, RNCE MITH THE CODES. ]:: I UNDERSTFIND THRT THE ON-SITE SEWER SYSTEM MFI'¢ RE)..]UIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THIRN ~: BEDROCMS. V4. 0 LOt SOILS LOG PERFORMED FOR:_ LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SLOPE [] PERCOLATION TEST DATE PERFORMED: SITE PLAN 10 11 12 13 WAS GROUND WATER A/~ /vu' ENCOUNTERED? IF YES, AT WHAT DEPTH? 14 15- 16 17, 18- 19- 20- COMMENTS PERFORMED BY: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE__ /~//',/ (minutes/inch) TEST RUN BETWEEN FT AND FT ~,~ ........ ~ .~ ~ / '/ 72-008 (6/79) Municipality of_Anchorage Development Services Department --- Building Safety Division on-site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ParcelI.D. 051-093-24 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR'A SINGLE FAMILY DWELLING HAA# 0,q C) C)(~ ~ Expiration Date: 'J--/- Complete legal description T1 .~N RIW SEC. 8. LOT 76 ~ , Locatio. n (site address or directions , ' · i-curren't P.rbpertyown,eris)_James & Joyce Scott .. Mailing address 'Z.0' ~ ~.."'/ Lending agency Day phone Dayphone. Mailing address Real EstateAgent Les I~nile¥- Prudential Vista Mailing Address 1663F, Centerfield Drive: Eagle Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well .' Individual Water Storage ': 'community Class Public Water System [] Well [] Day phone _68 9- F; 4 6 4 River: AK 99~;77 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The MuniciPality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue'for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of.up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. " i i ......... i_ MuniciPalitY Of AnChorage ~ ~ i ! I!! On-Site Water & Wastewater Program . :...' !' :' : 'i . . . P.O. Box 196650. Anchor:age, AK '995i9;665~' ;' !.[.:' :i ", :; HEALTH AUTHORITY APPROVAL CHECI~I~T'! , Description: T15N RlW SEC8 LOT 76" , ParcellD:':OSl~O93-Z4 .'- : . Dat%comp!eted~: . . Samtary seal (Y/N) ¥. ' Wires 'nroned~ 3i-;4~,,,-*,~,~ ... Cohform,_,OI. colonies/100 mI.N,trate .~mg./I.Other baCt6ria!: Oi 'cblotni~'s'/li~0 rd (Y/N) ASBUILT I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: 1 HAT NO:ENCROACHMENTS EXIST EXCEPT- ,~ -' INDICATED. IT IS THE RESPONSIBILITY OF THE iOWNER TO DETERMINE THE EXISTENCE OF ANY !EASEMENTS,' COVENANTS, OR RESTRICTIONS i WHICH DO NOT APPEAR ON THE RECORDED SUBDI- ! VISION PLAT.:'UNDER NO CIRCUMSTANCES SHOULD ' ANY DATA HEREON BE USED FOR CONSTRUCTION i OF FENCE LINES,' OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & SCALE: DATE: GRID: DRAWN~ ASSOCIATES LAND SURVEYING 694-0829 , t ~'-2:3~o3; 5.- ,~ 2/ 3 SGS Ref.# 1038006001 All Dates/Times are Alaska Standard Time Client Name Klq'D Engineering Printed Date/Time 12/23/2003 9:40 Project Name/# TISN, R1W, Sec 8,Lot 76 Collected Date/Time 12/18/2003 15:10 Client Sample ID TI5N, R1W, See 8, Lot 76 Re~:eived Date/Time 12/18/2003 16:15 Matri~ Drinking Water Technical Directo~_~. ~ ~'~phe~ Erie Sample Remarks: Parameter Results PQL Units Method Coiitalner ID Allowable Prep Analysis Limits Date Date Init Waters Department Nitrate-N Microbiology Laboratory Total Coliform 0.100 U 0.100 mg/L EPA 300.0 B (<'=10) 12/18/03 JJB col/100mL SMI8 9222B A (<=1) 12/18/03 DKC 12--23-03; 5:13PM; · ; ;907 5615301 CT&E Environmental Services Inc. 200 W. Potter Drive: Anchorage, AK 99518-1605 Telephone: (907) 562-2343 Facsimile: (907) 561-5301 200 W. Potter D~ive )rinldng Water Analysis R'eport for Total Coliform Bacteria ^.cho,,o, ^~ s~*~8.~0s · ' · Tel: (907) 562-2343 · MUST BE CO1VIPLt~:t~=D BY WATBK SUPPLIER · ' TO BE COM3PLETED BY L..ABORATORY PUBLIC WATER sYsTEM I.D. PRIVATE %VATER SYSTEM ,~end Results 0 · Send lnvotce ~., ' ,Month . D:iy SAMPLE TYPE: . = Rq/~t S:a.,N; (f~r rouiihe sa~iple with'Jab <~.£-ia o; 13 Specihl Purp.ose SAMPLE LQCATIO~I Year Treated a, Vat er Untreated .Water l'i~e Collected CollecteR B~ Analy.,,;is shows this .Water SAMPLE io be: '~.' Satisfactory rl Unsati.sfactory 12 S~rnple.over ~0 hours old, re.mits may be unreliable ' re. Sam'l~16 too l~ng i~.tra~it; sample should not be,o _v~'~o .uts old'at examination to indicat~ re~ab.le results. Ple~e smd .l~e~v..sa.rnple via special delivery.mail. Date Rec'el~ed .. .Time ~. ece~ed ! 6 15 .' A.nalysi~ Began .' ' t 7 O0 Analytical ~lethod: Membrane Filter M~O-MUG 1038006' es.lt* Da:c: Time: Clien't no[ified of."nsatlsfactory resuli%.. Phbned Sp~ke with Dale:. Analyst Comments: BACTERIOLOGICAL WATER ANALYSIS ,RECORD M~O-BIUG Re~ult: Total CiJliform Membrane Filter: Direct C. ount · Verification: LTB BGB Fecal Coliform Confirma~on · COLIFIRM ~ C6lonles/l~O mi Coliform/lO0 m} Time _ i/~ hfs Faxed Foxed ~'NTc-~oo Numero.~ J'~ Count OB ' Other B~tg,'in ~~ MemberoftheSGS GrouolSoci~tSG~n~raledeSurveilia~ce) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONM~:NTAL HEALTH DEPf~RTMEN~ OF HEALTH AND ENVIRONMH~NTAL PROTECTION APPLICATION FOR ]~7~LTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Applica~ion Date __~.~_~i/~d/2.~__.__~ (a) Legal Description (include lot, block, suhdiw£sion, section, township, range) Location (address or direct±ohS) (b) Applicants Name. '~3~- -~.'-'c~'XT~-- Applicants Address ._~.' /2 f _~'3~Oi/ Tele~_oj!e '- Home Business (c) Applicant is (check one) Lending Institution [~'[ ; Owner/builder (d) Lending Institution Address (e) Real Estate Co. & Agent_ Address (f) Telephone Mall the HAA to the following address: · / 2. T.T_~. ep_._q_f Residence Sing le-Family ~ Number of Bedrooms 3. Nater Individual Well ~ Multi-Family Other (describe) Community I--~ Public L~--[ Note: If community well system, must have written confirm~ation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage p_is_~osal. Note: If community well system, must have written confirmatiou from the S~ate Department of Environmental Conservation attesting ~o the legality and stains. [Page 1 of 2] 5. E__n_gi__!neerin§ Firm Providinfi~_j~ns~e__c.t.,i_o_n~_%.~e.,ts, File 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 one-site water supply and/or wastewater disposal system ia 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 bkmicipality of fmchorage files and from my investigation and inspection, the on-site water supply and/or w~stewater disposal system is in compliance vritb all Municipal and State codes, ordinances, and regu].a-~ tions in effect on the date of this inspection. Name of Firm Telephone. .................. Address Date Approved for .--~-~---- bedrooms Approved ._~_ Disapproved __ Conditional Terms of Conditional Approval -' ~ tAUT ION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HE~[,TH A/qD ENVIRONMENTAL PROTECTION (DHEP) ISSUES J{EALTH AUTHORITY APPROVAL CERTIFICATES BASEl) ~.?_!~_L_]f_ UPON THE REPRESEN~f- ATIONS GIVEN IN PARAGP, APH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER ILEGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCtIASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTailN FEDERAL AND STATE REQUIRE'- MENTS. 'EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DA~7A BF, FORE A CERTIFICATE IS ISSUED, TIlE MUNICIPALITY OF ANCHORAGE I3 NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TIlE PROFESSIONAl, ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7~.19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Log P~esent: ~N) Total Depth /70 Cased to Static Water Level /~ Casing Height Above Ground Electrical Wiring in Conduit ~N) Separation Distanoes f~om Well: / To Septic/H~3 Tank on If A, B, o~ C, D.E..C. Approved(Y/N) ~ZO <& Depth 0% Grouting. ~ Pump Set At_ /&O Sanitary Seal on Casing Y~_~__ Depression A~ound W~llhead (Y./~)~ ___ ; On Adjoining Lots /~f) /~- / ; On Adjoining Lots To Nearest Public Sewer To Nearest Edge of Absorption Field~n Lot /~.0 TO Nearest Public Sewer Line Cleancut/Manhole ~ ~ ? ~ ...... ~_..~. To Nearest Sewer Service Line on Lot Water Sample Collect~i~kz~m,~.~i~i~?~N(~._. ; Date ~,~ Wate~ Sample Test Results_ ~.n. uu,~....gZ9 , ~ ~z _~' m:_~' SEPTIC/H~2N~ TANK DATA Date Installed ~,/~/,/~-~ Size /~d~ No. of C~a~tn~nts Standpipes~N) Air-tight Caps ~/N) . Foundation Cleanout !Y~ __ ~p~ession o~ Ta~ ~Y~ ~te ~st ,~0 ~/~/~ ~ P~ing~intenan~ ~n~a~ ~ File (Y~)'/~ ; for --~ . ~ Holding Ta~ H~gh-Wate= ala~ (Y~) ~ _ ~ra=y Holdi~ Tank ~r~t (Y~) ~ Sep~ation Distan~s ~ ~ptic~!diag Tank: To Wate~.-Supply Well _ To P~operty Line ,/~ TO Water Main/Service Line Course Corm~nts To Building Foundation /(7_) ! To Disposal Field ~-- To Stream, .Pond, Lake, o~ Major D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption S/t~ata Date Installed 3/3//83 Width of Field ' ~ Square Feet of Absorption A~ea Depression over Field Results of Last Adequacy Test ~/~- Type of System Design Length of Field ~ Depth of Field /~ / Gravel Bed Thickness 72- ~ Standpipes Present ~_~N) /~of Last Adequacy Test Separation Distance from Absorption Field: To Building Fo. undat~on ". :./~ t To Exlst~ng or ~ndo~d System To Water Maf~/~r~i~ L~~- .~ To Cut~(if pre~nt) ,~O. / To Stre~ond~k~/~ Major D~alna~ Co~se //~ . To ~iveway, P~nking ~ea, ~ Vehicle St~a~ ~ea ~ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fen Electrical Codes(Y/N) Cuu~ts Dimensions Manhole/Access (Y/N) . / /Pump Off" Level at ./~ / Vent (Y/N) /A ~ets MOA ** Check Permitted Bedroom RatingAgainst HAA 9equest I certify that I have checked, verified, or conformed to all MOA HAAGuidelines in effect on the date of this inspection. Signed' ,. .~ ~.,,, a~ ~,~-. ~ ,.,it4 f~ '"' KB1/d5/s [Pa~e 2 of 2] 2-15-84