HomeMy WebLinkAboutEAGLEBROOK #1 BLK 2 LT 6Eagl
brook
Block 2
Lot 6
#017-121-58
- Municipality of Anchorage ..:'. ..
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program. 4700 S. Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650 Page
www.cLanchorage.ak.u$ (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: $t4/ ~1o¥78 PID Number:
""" ~"'o~,') /~tt~n (.y WastewaterSystem: [] New ~ Upgrade
'~"' disco /tncfo~ C, ccl~ ~ ~/95-,~' ABSORPTION FIELD
LEGAL DESCRIPTION t,~
Well: E~t$ ~' [] New [] Upgrade ~.J,- F,. II ~
SEPARATION DISTANCES ~Septic DHolding ~S.T.E.P. ~Other
~ Septic Abso~tion Lift HoMing 3uM~ate E ~ ¢ (~
Tank Fie~d Station Tank s~r Une ~ I~
s~.~w.,.,~t~, >~' >t~' _ ~/ LIFT STATION
"'"~' BENCH MARK
Engineers Stamp
Inspections pedormed by: F~ ~cA.~c. Dat. s: 1" ~/lZ/~Z
2"~ ~/~3 /~
Developme~ Se~ices Depa~ment Approval , .~
/,[.
Reviewed and approved by: ~- ~ ~ Date: ~ ~ ~..~.~m~o~ C~-3589 ~' u~
PERMIT NO: SW010478 --"'""~AGE 2 Of 3 .... '"
PID NO: 017-121-58 ,,,,,,"
T.,. ~ ~.2,*b~ SC,ED. 40 PVC \ \
"E" ~ 1.25" DIA. SCHED. 40 ~C
TBM
SOILABS. D~INFIELD ~ ,~ ~,~ l ......
R~AINED FOR FUTURE
.~co..~c~.o.
~,,~... ~} ..~
"BIOCYCLE" AEROBIC
TR~TME~ UNIT
SWING TIES: ,'~?,~,:t.". CE- 353g .~'~
FROM: COR.'A' COR."B" COR."C"
TO:
"BIOCYCLE" "D" 66' ~.5' LOT
TRENCH M.T. "E" 5~' ~' t~' SEPTIC SYSTEM UPG~DE
TRENCH M.T. "F" 88' 79' ~ AS-BUILT INSPECTION REPORT
F~OP TECt~ICAE
14~30 ECIIO ST~ D~WN BY TFM
ANCHO~G~ A~S~ ~515 JULY, 2~2
PERMIT NO: SW010478 PAGE 3 OF 3
PID NO: 017-121-58
TOP BAFFLE
ELEV. 90.9
GROUND
ELEV. 95.$'
~A. 13-3034
INFLUENT LINE
FROM HOUSE
DISCHARGE
PUMP
"BIOCYCLE"
TREATMENT UNIT
LEGEND:
G PRIMARY S~- I ILING CHAMBER
O AERATION CHAMBER
Q CLARIFICATION CHAMBER
Q DISCHARGE CHAMBER
MONITOR
TUBE
2' SOIL
ORIG. GROUND
BIOCYCLE COVER
:HEDULE 40 PVC
LINE TO SOIL
ASSORPTION TRENCH
FOAM INSULATION ON
EXTERIOR OF BIOCYCLE
~ANK ELEV. 85.3'
-- 2' BLUE BOARD INSULATION
CROSS~ECTION
NOT TO SCALE
FILTER
FABRIC
2" RIGID
INSULATION
1.25" DIA. PVC
W. 1/8" HOLES
SPACED 30"
INV. 96.$"
1/2" - 2 1/2"
5.0' EFFECTIVE
BOT. TRENCH
ELEV. 91.5'
RESIDUAL
DISPOSAL
TRENCH
LOT 6, BLOCK 2, ~GLEBROOK SID ~1
SEPTIC SYSTEM UPG~DE
AS-BUILT PROFILE
F~OP TECIINICAL SEEVICES NOT TO S~LE
14~30 ECIIO STRE~ D~WN BY TFM
ANCtIO~G~ A~S~ ~516 JULY, 2~2
~ . ,ns~ect,vn_ Report ..~ . / . :..,:../;,..
· , - Munleipallty Of Anchorage,.Building Safety DIvisl0n
4700 South Bragaw,,";
' ' ,' ~, ' :' ' ; :'2 .'
':, ~ .; : ' ~'' ~.r., ' [ '., '.·'L. 7 ';' ~ . : [..'
'. , INSPEC~ON: VOICE 343-5300 INSPE~ZON:'F~ CgO7)/4g-7777 ; 'INFO: 343-5211~
~L(~. ". '" .. .: Permit 02:7932 ~'~
Name· ' Bill /~,~1(~ ' '" ;"
~dr~ 61SOANDOVERCIR ... '.'x: ..-...- ,... ....~one ~ ~,
.... ' ' '" : ' Z~tlon D~e 6/13/2002
Legal, gK 2 LT 6. - ~
Commentlor, Dir~tlon~ .. ...... : .. ~.~ .:, .~, .. . *.. , . ~
· , -: ~ ~* ',SeptcSystemExm~to -~terAHPease~-Ineedtoswngbackbywlth-
~' ' .... ~ ..... ': : 'a ground bushing-Than~,. ?' :" . .
- . ~, . ~.~ . ::, . , . . · . '~,
~'nspector
MUNICIPALITY OF ANCHORAGE
Development Services Department
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
Upgrade
Date Issued: Dec 05, 2001
Expiration Date: Dec 05, 2002
Permit Number: SW010478
Legal Description: EAGLEBROOK#1 BLK 2 LT 6
Design Engineer: 0019 Flattop Technical Services
Owner Name: David & Bonnie Swanson
Owner Address: 6150 ANDOVER CIRCLE
ANCHORAGE, AK 99516-4349
Parcel ID: 017-121-58
Site Address: 006150 ANDOVER ClR
Lot Size: 50588 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] DisposalField [] 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 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.
Issued By: ~~~"- Date: /~--/'~//~/
.t
Municipality of Anchorage
Development Services Dep. artment
Budding Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904 '
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Permit Number SWi0 10470
Property owner(s) /~,..,,~'
Mailing address (1) O'"'tS-~
Mailing address (2)
Legal description (Lot, Block &
Legal description (Section, Township & Range)
Lot Size
Day phone
· Zip Code 9'2..4-/~"
~'~,~ le ~, rc~,~-' ,;~'/
5'~) ~"~'" AcresO Number of Bedrooms
"' THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool ·
Therapy Pool
[] Well Only []
[] Water Storage []
I-] Jacuzzi []
[] Water Softening Unit []
[]
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.
(Signature of properly owner or authorized agent)
~' ~ Waiver Fees:
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/0o)
t l /~-~] /~00,/ Date of Payment:
, 1 0 '~ ~ 0 ~'~ Receipt Number;
THEODORE F. MOORE, P.E.
PH: (907)
,~ ,, ~-.,....~ ,.~ ..... ~/,~,~,'~ ~- ,,,. y~ ..... · ,~ . .~,-~,.-~ .
.~.-.~.~:...~. - ,.__. ~'~ ~-~..~, ~--.~-.~_,~.~ ~
, ,...--,-. -- .-.-.
~ & £~ON~.~ £N~££~ · ~£~¥ ~ON~£~¥~N &
14530 ECHO ST.
November 25, 2001 ANCHORAGE, ALASKA 99516
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support ot' our application for
a permit to upgrade the wastew/~ter disposal facilities on Lot 6, Block 2, Eaglebrook S/D #1, located at
6150 Andover Circle. The present drainfield is no longer able to accept water at an adequate rate for
issuance ora HAA certificate. Soils logs, pert test results, a site plan, design drawings and
specifications are enclosed for your review.
In the interest ofprolonging the longevity ofthe system, the buyer desires the proposed upgrade to
include a"Bioeycle" aerobic pretreatment tank that discharges effluent into an oversized residual
absorption trench. Because the seller's obligation stops at construction ora lesser-cost conventional
septic tank and gravity absorption system, the site plan shows both options. This should enable
comparative bids to be secured and the appropriate amount of money escrowed to cover construction in
the spring. The following detailed plans and specifications pertain to the "Bioeycle" option.
The proposed residual disposal trench will be constructed in the vicinity oftest hole # 1. As can be
seen from the soil logs, the native material between 1.5 and 3.5 feet below ground level is sandy gravel
with a measured pert rate of 3 minutes per inch. While your guidelines for Category II advanced
treatment effluent allow a soil application rate of 4 gpd/sq, ft. for this stratum, we have used a more
conservative rate of 3 gpd/sq.ft, in this design. Thus, each lineal foot of trench in that stratum will have
a design application rate of(2x2'x3) -- 12 gpd. The proposed effective gravel depth orS.0 feet also
includes 3 feet of depth in the underlying silty gravel stratum with a measured pete rate of 23 minutes
per inch. DSD guidelines allow an application rate of 2.0 gpd/sq, ft., however we have a design
application rate of 1.5 gpd/sq, ft. for this stratum. Thus, each lineal foot of trench in this stratum has a
design application rate of(2x 3'xl.5) = 9.0. for a total of 21 gpd/l.f. Thus, the total needed length of
trench with 5 feet of effective gravel is 600/21=29 lineal feet. The proposed trench length is 50 feet.
The design of the conventional trench alternative is based on a conservative soil application rate of
0.6 gpcttsq, ft., leading to a requirement for (4x150)/0.6 = 1000sci.ft. This is achieved by 100 i.f. of
trench with an effective gravel depth 0£5.0 feet.
The natural topography of the lot in the area of proposed construction slopes downwards towards the
west at approximately 10%. The proposed project will have no known significant impact on present or
future water supply and wastewater disposal systems serwng adjacent propemes, nor will it have any
significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at
345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
" i CONSTRUCT 50-FOOT LONG [
, , -- SOIL ABSORPTION TRENCH ... -~ ......
, iX,W-5-0'O VE BELOWP'PE.-'"I- \ '"-... /
S~ TURN S~ , · .
', . 3/16" HOLES ~ 2,0'
: ~ ~)~1.25" DI~ SCHED. 40 PVC X
,~3 ',> ,~ :~ ~~" ~ ~ ~ '
LOT 11, BLOCK 1 ; 95' LONG x 5'
(NOWELLW/I~ 100') : / ',. ~ / ~ ~ ,,
, : ~ ",.k F ~ ~"
, ~ '~ _~c...-'"~
', : ?~" ~. ~;~* · · ~;;' ~ ~ "~ LOT 6, BLOCK 2, ~GLEBROOK S~, ADDN.
, · .* ~ ~. ¢ '-."~" ~', SEP~C SYSTEM UPG~DE
~ ,~ % mt~o~i F. ~E ~ ~ ~ 14530 tCllO S~ D~WN BY TFM
, ;. ~... CE-358~ ~' ~$- ~ClIO~E,~S~516 NO~MBER 2001
' ,~.-~?~. ~.~ NOTE:
, , ,,. ~.. ~.. ALL LOCATIONS SHOWN ~E APPROXIMATE.
, , CONSTRUCT 50-FOOT LONG
', ~ SOIL ABSORPTION TRENCH .
,, ' x '"--.. /
LOT 10, BLOCK 1 , X ~, ·
S~ TURN S~
(NO WELL W/IN, 100') : T. , ,, ,
' ~t~ 1.25" DI~ SCHED. 40 PVC ~ ~ ~ ~',
, : ~W. ~16" HOLES ~ 2.0'
', ', ~l.25"DI~SCHED. 40PVC ~ ~ X~ ~ ',
,TH
, , ~ ~ ~', ~
~OCYCL~ ~ ~ ~'X', ~~~ ..~R~VE X 'V-. ,"~
_
T~. W. 5 EFF. G~V
LOT ' 1, BLOCK 1S~ TURN S~ ~ SOIL ABS. D~INFIELD ~ ~ ~ ~ ~ ,,'~
(.OWE~W~I~ ~oo') ,, / .,. ~ ~ ~ ~ ,,
', ~ ", k F ~ ~"
: : LOT 5 ....
' ' ~G OY ~ ~ LOT 6, BLOCK 2, ~GLEBROOK S~, ADDN.
, , ~ , · T.~ODO.~ ~. ~ ~ ~ 14530 ECIIO S~ET D~WN BY TFM
, , ; , :~.... ..' ~'~
, , ~ ~ ... · ....... %w.~- NOTE: THIS IS NOT A SURV~ED P~T.
1.25" DIA. PVC DIST. PIPE
W. 3/16" HOLES SPACED 24" ~ 50' M.T.-~
t '"'" ~'~-,,, ~!
,,,,.T.--~. ............... -~ ........................... _-'d
22 ...L so,.,,.s ·
A Z. W. 5.0' GRAVEL BELOW DIST. PIPE
// SOIL ABSORPTION TRENCH
2ND DISCHARGE LINE TO
"BIOCYCLE" p R E S E ~NT~..~%~'~ E .U~_ ~,), PLAN VIEW
TREATMENT UNIT ,~"':.4 .~.,, ,U,., ~ ~
~...- :;m£ODO~.r- ~.. UOO~ .- ~ FILTER 3
,.: ,,~;~. ....... · ~.~;..e ~-'~"& LU _.J I
4" D A. D-3034 ,..~ ;_...~ ,' ;....~ ~,~,,, v,~."~'
INFLUENTUNE / --BIOCYCLECOVER"'"f.'.,~..'.~2,h~?'e'~ 'Y[! 3~---i~- I
I.,~ / / . 'm"D~A~PVC /1:: I I I
.'~ / DIST. PIPE W.
~ SPACED 24"
;' L \,,,4"SC.ED.,oPvo B~ER~V' /
I I 2~ ~__SAND BACKFiLL EXCAVATION
' pD~MCpHAR ~ SAND LEVELING CROSS-SECTION "A- A"
"BIOCYCLE"
LEGEND: TREATMENT UNIT
Q PRIMARY SETTLING CHAMBER
Q AERATION CHAMBER
Q CLARIFICATION CHAMBER
Q DISCHARGE CHAMBER
LOT 6, BLOCK 2, EAGLEBROOK S/D #1
PROPOSED SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FL~TTOPTECI[N~CALS~V[CES [ SCALE: 1"-5'-0"
14530 ECIIO STREET I DRAWN BY: TFM
ANCIIOP, AGE. AK, 99516 NOVEMBER, 2001
q:~ttop rl'edinica£Services
14530 ~oeKo Street, .~Inctlorage, ~I1(.99516
cP~one (907) 345-1355
Lot 6, Block 2, Eaglebrook S/D, Addition #1
6150 Andover Circle
Wastewater disposal system upgrade
Specifications
1.0 General:
1.1 The scope of the project consists of installation of a "Biocycle" aerobic treatment unit that
discharges effluent into a 50-foot long soil absorption trench containing 5.3 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement oftopsoil and reseeding all areas disturbed by the
construction.
2.0 "Biocycle" Aerobic Treatment Unit
2.1 Thenew 1500 gallon"Biocycle" aerobic treatment unit shallbe manufactured, furnished and
equipped by Pegasus Engineering in accordance with the Municipal and State approved design. The
existing septic tank shall be properly abandoned by pumping, removing its top and backfilling with soil.
2.2 The contractor shall be prepare a suitable site for the "Biocycle" unit and install it as follows:
The depth ofthe excavation for the "Biocycle" treatment unit shall be sufficient to allow connection to
the 4" waste line leaving the house at a minimum slope of %" per foot, but no deeper than 10' - 2" below
finish grade in the vicinity of the unit. A cleanout shall be installed within 5 feet of the building
foundation. All pipe connections to the"Biocycle" shallbe equipped withwaterproofmechanical
couplings. The bottom of the excavation for the "Biocycle" treatment unit shall be carefully leveled and
smoothed by the placement ora layer ofclean sand. Two inches of rigid, burial type, insulation with a
minimum compressive strength of 30 psi shall be placed on the sand prior to installation of the
"Biocycle" treatment unit. The space between the sidewalls of the excavation and the "Biocycle" unit
shall be carefully backfilled with sand. The top of the manhole riser shall extend 4" above finish grade,
and the final ground surface graded as necessary to provide surface drainage away from the "Biocycle
unit.
2.3 The contractor shall be responsible to obtain the necessary electrical permit and inspections and
shall provide a copy of the electrical inspection report to the engineer.
2.4 The control and alarm floats shall be set and their proper operation verified by the "Biocycle"
supplier. The high level alarm shall be installed inside the residence at a location selected by the owner.
2.5 The discharge line from the "Biocycle" treatment unit to the soil absorption system shall be
1.25" dia. Sched 40 PVC. The "Biocycle" unit shall also be equipped with a second discharge line
allowing effluent to be switched into the present soil absorption drainfield(s), as desired. All pipe
connections in the distribution system shall be glued, and the ends of all pipes capped.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 50-foot long trench to a depth of
6.5 feet below ground elevation in the vicinity of test hole #1. The long axis of the trench shall parallel
a natural contour of the ground.
3.2 The bottom ofthe excavation shall be level. Any compacted or smeared surfaces shall be raked
to allow proper infiltration.
3.3 AtotalofS.3 feet ofwashed sewer gravel shall be placed in the bottom ofthe excavation with
the 1.25" diameter schedule 40 PVC perforated distribution pipes laid level such that the pipe inverts is
no less than 5.0 feet above the bottom of the sewer gravel. 3/16' diameter holes shall be drilled in the
bottom of the distribution pipe at 24-inch intervals. AIl PVC pipe joints shall be glued and the end of
the distribution lateral shall be capped. Sewer gravel shall be 0.$" - 2.5" washed and screened gravel,
with less than 3% passing the #200 sieve.
3.4 Monitor tubes shall be of 4" diameter and installed in the locations shown on the design
drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated.
3.5 Approved filter fabric shall be placed over the entire top surface ofthe sewer gravel and a
minimum of 2 feet ofbackfill. Ifthe backfill thickness is less than 3 feet, 2 inches of rigid insulation
shall also be placed over the surface ofthe bed.
3.6 The top surface ofthe cover material shall be raised a minimum of 6 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have
the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and
seed to promote rapid revegetation of'all areas disturbed by the construction.
4.0 Inspections:
5.1 A minimum of 4 engineering inspections will be required during the course ofthe project: (I)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the fight elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the "Biocycle" tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill
and grading is complete. The "Bioeycle" unit requires one inspection after it is set level and the piping
connected, but prior to backfill. This inspection may be incorporated with any ofthe above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
TEST HOLE ft 1
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH --
(feet) __
12-
13-
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 6~ Block 2, Eagfebrook S/D #1
November 20, 2001
David and Bonnie Swanson
Pt.
Reddish sandy loam
GP $1igh~ silty sandy gravel
GM Gray silty gravel
Many cobbies and boulders
Denser and harder digging below 8.0'
SLOPE
Depth to Greundwater Date
Seeps at 14.5' 11/20/01
"rW~(er at 14.0' 1 lr27101
#3
14-
15
16-
17-
18-
19-
20-
COMMENTS:
Date Reading Clock Net Time Pm'corneter Net J~'op
Time (minutes) Reading (inches)
11/20 12" Presoak 27 3/8
12" Resoak 2/
Start 2:42:45 23--3/4
#1 3 :_~2:"~5 30 22~J/t 6 I 9/15
Add water 3:--13 23-13/16
#2 3:43 30 22~/2 I 5116
Add water 3:~3:_45 23-:J~116
#3 4:13:45 30 22~18 1 5/16
PERCOLATION RATE 23 (mlnute~./lnch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5.5 FT AND 6.0 FT
Results of second perc test conducted in GP sffatum are shown on log for T.H. #2.
5#
PERFORMED BY FLATTOP TECHNICAL S E RVlCES. I._~".,.~._ ~'~-~-~-~.. CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS DATE. DATE:
ITESTHOLE#2
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR;
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 6~ Block 2r Eaglebrook S/D #1
November 20, 2001
David and Bonnie Swanson
DEPTH
(~'eet)
1-
2-
11
12
Pt.
SM Reddish sandy loam
GPIGM BilghUy si~ sandy gravel
GM Gray silty sandy gravel
GM/GP Somewhat silty sandy gravel
GMAML Bi, gravel
B.H.
SLOPE
Depth to Groundwater Date
Seep ~.. 7.5' 11/20/01
11/27/01
SITE PLAN
g
Data Reading Clock Net Time Percometer Net D~op
Time (minute~) Reading (Inche~)
11/20 12"Presoak 31
Resoak
Add water & start 2:_05:_30 26 718
#1 2:15:30_ 10 23 3 718
Add water 2:18:20 27
~ 2:_28:_20 10 23 4
Add water 2:31 :~20 27
#3 2:41:20 10 23 118 3 7/8
Note:
2nd parc test
~ T.H. #t
19-
20-
PERCOLATION RATE 0 (minutes/Inch) PERC HOLE DIAMETER
TESTRUN BETWEEN 2.5 FTAND 3.0 FT
COMMENTS: NO monitor tube set because seep encountered was actually aeptage originating in drainfield to east
The parc test shown on t~is log was conducted at T.H. #1.
PERFORMED BY FLATrOPTECHNICALSERWCES. I ~"-~,~ ~ CERTIFYTHATTHISTESTWASPERFORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
TEST HOLE
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR;
DEPTH ~
(feet)
8-
9-
10-
11-
12
13-
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 6~ Block 2, Eaglebrook B/D #1
November 20, 2001
David and Bonnie Swanson
Pt.
SM Reddish sandy loam
GM/GP Somewhat silty sandy gravel
Many boulders between 6' & 7.5'
GM/ML Silty gravel
Dense, hard digging
SLOPE
Depth to Groundwater Date
No_groundwater 11/20101
'~Vlon~ ~ dry 11/27101
SITE PLAN
9
Date Reading Clock Net Time Perc~meter Net Drop
Time (minutes) Reading (inches)
11/20 12' Presoak 31
IZ' resoak 31
Add water & start 3:10:15 27
# 1 3~0~5 10 24 5/8 2 318
Add water 3:21 27
#2 3:_31 10 24 11116 2 5/16
Add water 3:31:_.30 27-~78
#3 3:41;30 10 24 718 2 114
14-
15-
16-
17-
18-
19-
20-
PERCOLATION RATE $ (mlnute~lnch) PERC HOLE DIAMETER 6
TESTRUNBE~NEEN 3.25 FTAND 3.75 FT
COMMENTS: Recommend trench in GM/GP stratum be designed on basis of 0.6 gpd/sq, ff. T.H. #1 shows no bedrock to 15'~ water (~ 14'-0"
PERFORMED BY FLATrOP TECHNICAL SERVICES. I.~,,.~,~-%.'""~'~/~ ~ CERTIFY THAT'THIS TEST WAS PERFORMED IN
ACCORDANCEWITHALLSTATEANDMUNICIPALOUIDELINESlNEFFECTONTHISDATE. DATE: // J ~.~ /O/
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastcwatcr Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorag¢.ak.us
(907) 343-7904
PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE
WASTEWATER DISPOSAL SYSTEM
This agreement, dated ~ 7~ - t.[ -tO / , is made between the Municipality of Anchorage
Development Services Department (DSD) and the property owner(s) of:
This agreement is made for the purpose of maintaining an on-site wastewater disposal system on
the subject property.
The property owners agree to thc following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation
statement from a registered professional engineer. This inspection and operation statement shall
verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any
deficiencies have been repaired and that the system is functioning as designed.
(Signature)
(Printed NamcY
(Printed Name)
The Foregoing Instrument was acknowledged before me by
.~}~ ~ ~,_ ~?~. ?~,~'>-~ on this t~day of
c , 20 .
(NotarY's printed name])
My Commission Expires - " '": ' -'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HU~-tAN SERVICES
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-S~TE SEWAGE DISPOSAL SYSTEM AND/OR WELL iNSPECTiON REPORT
Name
Address TANK FIELD WELL
Phone(s)
Jownship, Range, Section
~ ~d ~ ~ AS-BUILT DIAGRA~ (Show {ocat,on of well septic system, ~,o~, I,.es, foundation,
driveway, water bodies, elc)
TANKS ~ ~,
Material No, of Compa.ments
TYPE OF SYSTE~ ~ 1,~ .....
~ TRENCH ~ BED ~ W. DRAIN
obginaiDepth to pipe bottom fromFill addedgradeabove original grade ~ FT GraveIT°tal depth from original grade ~depth beneath pipe FT ~ ~ ~ ~ ~ ~ --~ --
Gravel length Gravel width
Dislance between lines
Total absorption area ~ ~ ~ S~ FT
WELLS ~ ~ ~ _
~ PRIVATE ~ OTHER (Identify)
Classification (A,B,C) Total Depth ~ Cased to
FT FT i ..
Installer ,Date Installed:
/ Scale: ~ ENGINEER'S SEAL
Municipal and State guidelines In effect on Ihis date~ ~ ~ ~ ~ :
ANCHOF~AGE, AK c?gt'~'! 11
C'ONF IRM GROUND WAI"ER LEVELS PR];OR 'l'O E:XCAVA"f ION,, NOI"It:::'Y DHHS
]:N WR);"I"ING PRIOR TO ANY CHANGIES,, ];NS'f'ALL PER ATT'ACHED DES];GN,,
NOT]:F'Y DHHS PR]:OR "FO EACH ];NSPECTION,, THZS PELRM]:'f' I~S ;i;SSUED FOR
ON 1 ~/':31/89 ,, ~ t
{cn"'Lh by the Mun:icipal:i. ty of Anchopage (MOA) and the S'ka'Le of' A].asl,::a.
2,, I wi;Ll :i.r'~s't.a].l the sy~FLeffl iii acc::opdanc:~;~ with all M[)A codes and
3,, I ~:i.:l:l, adhere to all MOA and State of Alaska ~'eqtlipetfteFrLs For' the set bac:k
d:i,s't, ances I:r'om any ((,~xistil'~9 ws].],~ was'(,(.~walLep d:Lsposa], fi~ys'(,f'.,:H11 o;" pLzb].ic
sewer'age system on 'Ll'l:Ls of any adjacent op near'by
4. I under'stand that 'Lhis pepmi't. :i,s valid f'op a maximum of' 4 bedpoc, ms,,
any enlap(2}emerrL wJ. ll r'equir'e an additional peg"mi'L,,
(Owner'> DAVID A,, GRENIE]:F~
ALASKA ENVIRONMENTAL
CONTROL SERVICES, ~NC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 563.-5040
CHECKED BY---- ---- DATE-.
SCALE
..... i ~.~...!.~.....[.. ~ i~.~ ! ~i' ~' ~ :~ !. ~ ..~ ... ~ ..~/~,~ .', ~ ~ ~.~: '
~ ~ ~ '-! ......... f-~ / = ~ : ~
~ ~ , ~ ~ ~ ~ / ~ ~ ~ ~ .......... ~ ~ ......~ ..... : ~ .......... ~ ........... ~ .......... .......... [ .......
.... ' ......... ' : ' ......... ' ........ '"'""'""'"'"'"', : : : : '"~'"'""~'~'"~'"'"'"": ~ · '~ ........... ?'"'": ............. ?'-"""'-"'-"- : '"-"Z'"-"?"'"'""":'";"
.......... ~ ............. ~ ..... ~~ ~~~' ~ ~ ~i "~'" ~~ ~, ....... ff ~ ~ ~ ~ ........ ~ ......... ~' .......
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEETNO, '~-- OF "~
CHECKED BY ..... DATE___
10
I1
ADDITIONA~ ~RUOTUfl~ OR
ALASKA eFIUIROnmeFITAL CONTROL SeRUICeS, IF1C.
~nqi~eeri~§ 6 ~nui~onmenM $1u&es
SPECIFICATIONS FOR A FIVE--WIDE WASTEWATER TREATMENT SYSTEM
LEGAL DESCRIPTION: LOT 6, BLOCK 2~ EAGLEBROOK SUBDIVISION
1.0
GENERAL
1.I The drawings, sheets I through 3, sha]l be a part of this
specification.
1.2
All materials and workmanship shall meet the reqaJrements of the
Municipality of Anchorage, Department of Itealth & tin.an Services,
(DIHIS), the conditions of the permit, and all applicable rules and
regu]ations currently in effect.
1.3 All elevations and depths are advisory and are to be verified or
modified in the field by a DHHS approved inspector,
It is the responsibility of the installer to adhere to approved
designs for installation, maintain the specified separation
distances, and have the appropriate inspections.
1.5
If the installation is not inspected by an AECS eagineer, AECS will
not be responsih]e for the installed system~ An engineer at AECS
should be consulted prior to construction~ to determine the number of
inspections that wi].] be required and 'to explain what these
inspections will involve.
SEPTIC SYSTEM
2.1
The existing septic tank may be used, if it meets the capacity
requirements for the residence and the approval of DHHS. Older
systems may need tank integrity verified, Il' not, then specifications
2.2 through 2,6 apply~
2.2
The septic tank shaI] be a UPC approved two compartment tank,
constructed of 12. gauge steel with bitumastic coating, set ]evel
on undisturbed soil and .insulated with overlying layer of 2 inch
burial type polystyrene.
The septic tank shall be a minimum of 5 feet from the house
foundation, and a miuimum of 5 feet from the absorption area~
2.4
The septic tank and drainfield shall be a minimum of 100 feet from
any private well or body of water, 150 feet from Class C wells, and
200 feet from Class A or B wells, unless otherwise specified. Less
than the required separation distance must have prior approval or
waiver by Alaska Department of Environmental Conservation (ADEC).
2.5
Pip-ing shall be fitted with a mechaaical watertight calder coupling
of the in]et and outlet of the septic tank Pipins shall be 4-inch
ASTM D3084 or cast iron, s].oped a minimum of 1/4 inch per foot from
the house to the tank and 1/8 inch per foot from the tank to the
trench,
2.6 Cleanouts shall he installed as designated, napped with a:ir tight
1412 W6g~ 331~b ~,V6r~U60 ~I~chopAG6, ~lAska 99503 · (907) 279-5553
2.7
rain caps {Jim caps or equivalentl, and extend a minimm~ of 2 feet
above ground leve].
If a lift station is shown on tbs draw:rigs i't shall be Anchorage
Tank or MOA approved equal. (See attached specification.~
DRAINPXELD SYSTEH
The gravel fop the dPainfietd shall he 0.~ Lo ~.5 inch, screened rock
with less than 3% passiug tbs e20O sieve. All substitutes must have
prior DtIHS approval.
3.3 The bottom and side of the excavation shall be raked with the backhoe
blade to ensure that it has not been compacted during excavation,
The bottom elevation shall be ]eve].
Honitor standpipe(s) shall be placed as shown Jn the drawings, and
shal] be rigid PVC ASTH I)8034, or 4-inch east iron. The section
shown with holes may be drilled 0.5 inet holes on the g-inch centers
on opposite sides of tbs pipe, or a regular section of perforated
sewer pipe, clamped to a solid section, w2th either a no-hub coupling
or a solvent joint~ A rubber rain cap (Jim cap or equivalent) sbal]
be placed over the top of the pipe,
3.4 The distribution pipe aha.l] be 4-inch rigid PVC with a minimum crus~
strength of 1500 tbs or equal, All distribution pipes shall be la~d
lave] ,
If the fins] grade of the drainfield is less than 4 feet above the
gravel, insulation is required using Dow extruded blue styrofoam
board or equat~ There shall be I inch of insnlation for every foot
of soil less than the required 4 feet of cover, but there mast be at
1eas't 18 inches of soil cover even though insula'tion is used. The
solid pipe extending from the septic tank or lift station to the
dra2nfiehl aha'Il a]so have 4 feet of cover or an equivalent layer of
insu]ation to prevent freezing of the line.
g,6 if insulation is nol; necessary, the gravel shall be covered with a
layer of nonwoven engineering fabric.
3.7 It is recammended that the area excavated and the area in the
vicinity of the drainfield shall be planted with a M~ite clover, red
rescue mix or Kentucky h]ue grass.
4.0 INSPECTIONS
4.1
4.2
A minimum of three inspe, ctions are reqaired for installation of tbs
treneh, The first inspection will be of the excavation to verify
that the ~.nstallation wi~! be in the proper soil,
The second inspeotion will be after placement of the gravel, monitor
staadpipe(s) and distribution pipo to verify prope, r installation
before backfill.
4.3 T~e third inspecl:ion shall b~; after the drai~ufield is backfilled and
the ~round ~raded,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICE¢
825 "L" Street, Anchorage, Alaska 99502-0650
SOLES LOG m PERCOLATION TEST
tEER'$ SEAL)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
DATE
DEPTH
(FEET)
18, %'~
19~
20-
COMMENTS .~,OI/~ /~T~ ~,'7~
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED7
IF YES, AT WHAT
DEPTH?
Depth to Water Alter
Monitoring?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE '~; ~' (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN '~ FT AND ~) FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /°~"~ '~''~ :
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO1 ECT{ON
ENVIRONMENTAL ENGINEERING DiVISiON
825 L Street - Anchorage, Alaska 99503 Telephone 264-4720
ON-SiTE SEWAGE DISPOSAL SYSTEM AND/OR WELL iNSPECTiON REPORT
I PHONE ~,~ [~NNEW
NAME 6
LEGAL DESCRIPTION
&OCATION
Well
DISTANCE TO: IVoT'
Manufacturer
Liq. capacity in gallons
Well
DISTANCE TO:
Manufacturer
DISTANCE TO:
No. of lines
/
Length
Top of tile to finish grade
Width
,~0~ 'TH ~';~
/ 0~9'] Absorption area/~ Dwellin~o
' Material
Inside length ~ Width --
Dwelling ~ (> L~
I Foundatio~ earest lot line
Length of each line Total length of lines / Trench width
Material beneath tile
Depth
Crib depth
Building foundation
Driller
Sewer line
NO, OF BEDR~S
PERMIT~O~ (~?O q ~
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO. g3 ~)0 ¢ ~
Distance between lines
Total e f feoti ve a b $~:~p3o~ rea
PERMIT NO,
Type of crib Crib diameter Total effective absorption area
Well Nearest lot line
DISTANCE TO:
Class Depth Distance to lot line
DISTANCE TO: Building foundation Septic tank
OTHER
PIPE MATERIALS
P ;
L AL
SOIL TEST RATING
iNSTALLER
REMARKS
DATE
APPROVED
PERMIT NO.
72-013 (Rev. 3/78)
4~
PERMIT NO.
RPF'L I CRNT
LOCRTION
LEGBL
TYPE OF SOIL RBSORF'TION S'¢STEM IS:
[:,R V I D FI ~ .... ~' '-'- '" '~
.~RENIER ~,L4..:,,' OLD SEWRR[:, HIGHWRY.:.
LE; ERGLEBRCOK ~± LOT SIZE '9'~'£¢'~'S~9 SQURRE FEET
'=]OIL R. FIT I NG
MRXIMLIM NLIMBER OF E, EDF..UOII_ = 4
THE REQUIRED =,I~E OF THE SOIL ABSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENC:H OR [:,RRINFIEL.[:,.
THE DEPTH OF R TRENCH OR F'IT IS THE DISTRNCE BETWEEN THE SLIRFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCR'¢RTtON (IN FEET).
THE GRRVEL. DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F'ERMIT ~F'PLIC:RNT HR'=; THE F..E_,FON=,IBILIT, TO INFDRII THIS DEF'RR. TMENT [.',URIN(~ THE:
INSTF~LL. RTII]N IN_,FE..TtIJN_ OF AN'¢ WELL=, ADJACENT TO 'THIS FF..LPEET~r RND THE
N.Ib16ER OF RE-,I[.ENCE:, THRT THE WELL WILL SERVE.
....... 'f' [4 C~ ':: "2 ':,
E, HL.k. FIL. LIN.~ OF RN¥ -,~-~TEM WITHOUT FINRL INSPECTION RND RPFF. L~BL THIS
DEF'RR. TMENT 1.4ILL BE =,LI6JECT TO FF..=,EL. UTIUN.
MINIMUM [.',ISTFINCE BETP.IEEN Ft WELL FiND FIN'Y ON-SITE SEWFIGE DISPOSFiL SYSTEM IlS
~00 FEET FOR Fi PRIVRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC. WELL DEPENDING
UF'ON THE TYPE OF PUBLIC 14ELL
MINIMUM DIST~NCE FROM Fi PRIVRTE WELL TO R PRIVFiTE SEWER LINE IS 25 FEET F~ND
TO Fi COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS FIRE REQUIRE[:, FIND MUST BE RETURNED TO THE DEPFiRTMENT WITHIN ]:0 DRVS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY FIPPLY. SPECIFICFiTIONS RND CONSTRUCTION DIRGRFIMS RRE
BVRILRBLE TO INSURE PROPER INSTFiLLFITION.
F~ E F-: ~'~ I T' [-] ;:-':, P :[ RES [) E C: E ~'"1 B E F-:_=,."~- .... i _, -::L_¢"= '=' .... _:=.'="
I CERTIFY THRT
±: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON--SITE SEWERS RND WELLS RS SET
FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCHORFIGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
];: I UN[:,ERSTRN[~RT ~HE ON~TE SEWER SYSTEM I'1FI'¢ REQUIRE ENLRRGEMENT IF THE
RESZDENC:E I~ F~¢E~~P~LLIE:,E MORE THRN 4 BEDROOMS. 3/' -~
............
SIGNED:
~PF'LIC~NT D~VID R GRENIER ~&
ISSUED BY_.__ ~S~ ~ .........
MUNICIPALITY OF ANCH, ORAG
DEPARTi ~TOF HEALTH AND ENVIRONMENTA ,'ROTECTION
BZ5 L Sl~.~t, Anchor~pe. Al~k~ 99501 2r>4-4720
SOILS LOG -- PERCOLATION TEST
PERCOLA¥1ON
TEST
>ERFORMEb FOR:
DATE ?ERFORMED:____,__~/2. C~ /.j~=~
PE,~T, ~'T SLOPE
2
SITE PLAN
lo
11
12
]3
15
7
?0,
17. o'
q"OTAL. DgPF~ OF
~ 0 ~:P-- I ~J G' LO.O'
WAS GROUND WATER S
ENCOUNTERED? t,/' JZ~"-~C L
}F YES, AT WHAT
DEPTH?
Reading D~le
PERCOLATION RATE
I'E£T RUN BEI~A/EEN
:MENTS ~ AF-~E~-' .J)-_ ~aJJ.J~JAJ~__ ~ -Lg~,-(~i
Time
-?
~rn;nut t~/;nch]
~/' ~S"~- FT AND
FORMED! , BY: I__CERTIFIED BY: DATE:
?"UNICIPALITY OF ANCH, OF~AGE
SOILS LOG - PERCOLATION TEST
2 YEe_y ¢4o1'5T FrOot,-1
WAS GFIOUND WATER
ENCOUNTERED?
L L
IF YES, AT WHAT
DEPTH7
',~' .... , ,' -?~:' PERCOLJ~,TION RATE __ / 2.
~'EST RUN BE'T¥¢izEN ----~--- FT AND S% 0 '
GEOTECHNICAL
ENGINEERING
AND TESTING
John ~. Lamba, P.E. 7127 Old Seward Highway ~ Anchorage, Alaska 99502 907-349-§531
7 March 1983
Triad Engineering
6937 Old Seward Hwy
Anchorage, Ak. 99502
Dear Dave,
In response to you request, Mso McCracken reviewed her
notes, regarding the location of TH4o This review indicates
that the location presented on the revised TH location map,
attached, is more correct than the location presented in our
report dated May 4, 1982. TH's 2 & 3 generally are shown ~n
the same locations on both maps. Topographic considerations
and heavy ground cover made measurements approximate without
survey methods. The locations of TH 1 on the "Revised TH
Location" map and on the map presented in our report are
within the limits of accuracy used to originally establish
the boring location. Be advised that the standpipes remain
in the borings and can , therfore be located in reference
to the newly established lot corners should any question
remain.
We trust the foregoing is sufficient for your needs~
~,,, ·~. ,,.
Very ~ ~u t~y.-yo ~r ~'i'~'
~hn
:.5
rage Esmh I
ad ~
Esmt.
( BASIS Of BEARING )
N89 ,~,,'W 4B8.03' REC.
N 89"59'56"W 489,1_2 MEAS
7
54,256 S.F.
I.Z46 AC.
578.82'
-~r tele. ~ Elec. Esmt.
N65°IE
25.00
157.
N8~
.¢
50,588 S.F.
1.161 AC.
P77-54
50,240 S.F.
1.153 AC.
N 0°15,' I9"W
?1.18
8
66,886 S.F
1.5:56 AC.
%
?
?
151,506 S.F.
;5.48 AC.
-4
ZZ
50' Public Access Em
Automatically Vacate,
Access Becomes Avail
North Of Lot 8
IO'Tele. & Elec. Esmts.
N 48" W
\O'7
$,4 "
Recovered 5/8"Reb~
i
N89° "W 489.12~ MEAS~ '
20 Tele. 8~ Elec, Esmf.
o
54,256 S.E
1.246 AC.
N 65':'1~'22"E
~9°55'0(
25.00
50,588 S.E
1.161 AC.
I0' Tele. 8, Elec. Esmts,
5
50,240
1.153 AC.
N 22'~8'C
~o. oo B L 0 C
4
85,736 S.E
l, 968 AC,
66,886 S.F
1.536 AC.
ARC = 76.12'
CHD:75.
?
/
/
?
lO~
~. 20' Drainage
~: Esmt.
Tr.
I~1,~86 S.F.
5.48 AC.
20' Drainage Esmt.
eded
)o
zz
50' Public Access Easem
Automatically Vacated
Access Becomes Availab/h
North Of Lot 8
IO'Tele. & Elec, Esmts.
x/ N 14°40'48" W
\ . 5.00'
x \07
Elec
25. \
Esmt.
\oo
cD
5 30,15 E
258.64
151,218 SoF.
5.012
Recovered 5/8 '
\ ~ [[ Recover,
N65°56i 07 W 1 f
154.52 (P78458)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Expiration Date:
Parcel I.D. ~'.3/'7 -- I 7-- / -
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ~'1,~'~ ~r,~e~,~'e," ~'~*'c/~_
Current Property owner(s)
Lending agen~ Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless 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
[]
[]
[]
[]
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 representatiens given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates cf Health Authority Approval are required fcr the transfer of
title (except be~een spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upcn request to homeowners. Certificates of Health Authority Approval are
valid fcr 90 days fram the date of issue fcr prope."[!es served by a private or Class C we!l and may be reissued with
new water sampte results less than 30 days ctd. (Ce.'"tific-~tes may be reissued for a period cf up to one year with
valid water samples.) Ce~ificates are valid for one year for properties served by Class A cr E we!Is cra public
water system. The Municipality of Anchcrage is not respcnsible fcr errcrs or cmissicns in the prcfesslonal
engineer's wcrk.
4. 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,
based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of ~nchomge files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(ere) in compliance with all applicable Municipal and St.~te codes, ordinances,
and regulati.ons in effect at the time of installation.
Name of Firm ~'lo.],'~::~/ "~'~c,~; ¢c~ [ .~'u'lc,,,./ Phone ~',/$-- ~_c'.,~'
Address / ,~ ~-.~
Engineer's Printed Name
~ o,- .%~> ~ ENGINEER'S
~. ~:; ..: .:; ~,. ,,;' A. ' "*'~ STAMP
DSD SIGNATURE ,,,
Approved for bedrooms.. ,....'
Disapproved.
x Conditional approval for 4 bedrooms, with the following stipulations:
Money to be placed in escrow for the
minimum of three certified contractors to ~erfn,'~ ~h.' ,~n~ ,-,,~,,~* to the
attached permit No. SWOIOA7~, Money {n e~rnw ~hnll ~ ho ~.l.n~.H ,,.~1 eh~
o~ice has given ~inal approval. The work shall be completed no later than 6-15-02
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
.. ... -.:.; .....
~ .... ?...
~ ~: ON-~IT: -.
.- . WASIEWAT,-= .
PEOGRA~ .~
Maintenance Agreements ~'JY,;))] J II ) I'l~ '
Supplemental Engineer's Report
Other
Original Certificate Date:
M,nicipality of Anchorage
Development Servicea Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Sauth Bmgaw St.
P.O. Box 196650 Ancharage, AK 99519-6650
www.ci.am:t~rege.ak.us
(007) 343-7g04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type
Date completed ~/~-~'/~, Sanite~seal (Y/N)
Totaldepth /9~ ft. Casedto I,~6'' 11.
FROM WELL LOG
If A, B, ar C provide PWSID # -
.,. · Well Leg (Y/N) Y
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
tt /~3/0( ,.
7. ~-~9 'P g.p.m.
Date of test
Static water level
Well production
It.
g.p.m.
Y
/~' in.
WATER SAMPLE RESULTS:
· Coliform ~:) colonias/100 mi.
Date of sample: I I / ~/0 /
Nitrate ,~0,~ mg./I. Other bacteria ~ colonias/100 mi.
B.. SEPTIC/HOLDING TANK DATA
Tank size 1'~"'0 gal. Number of Compartments
Foundation cleanout (y/N) 'r Depression over tank (Y/N)
Date of pumping ~ ~/~00/ Pumper
C. ABsoRPTIoN FIELD DATA
Date instaUed ~J,/'/y/~ ~
Cleanouts (Y/N)
High water alarm (y/N) ~/.,~.,
Length 9..~ ft. Width ~" It. Gravel below pipe ~. It.
Total depth '7 It- Eft. absorption araa,,~'~ · Monitedng tube ~ DepreSSion over field
Date of adequacy test ~l / I~ / ¢3, I Results (Pass/Fg, il) ~.e; I ~ Far t'tt bedrooms
Fluid depth in absoq)fion field before test ~.~'ifl. Water added..~.P gal. New depth'~t'). 9 in.
Elapsed Time: ~ min. Fiflal fluid depth~,7in. Abso~tion rate >2-~v~te~'tl:~ g.p.d. Ye
Any rejuvenation treatment (past 12 mo.) (Y/N & type) /ut If yes, give date ~/.
Date Installed ~'/~'/'~'~ SoU rating (g.p.d,Al~ or ~fodrm)'~r',~ System type
D. UFTSTATION tV./~'.
Data installed
Size in gallons
Manhole/Access (Y/N)
'Pump on" level at in. "Pump off' level at in. High water alarm level at
iN.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic ta~ station on lot ~05'"
Absorption field on lot I ~ Z ~
Public seWer main J~/· ~,
Sewer/septic service line ""~ '?-.,.~~ ~
On adjacent 'lots
On adjacent lots '~ ¢oO '
Public seWer manhole/cleanout .' N.
Holding tank
Property line ~
Watar ssr~ce line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field t ~ ·
· Surface watar "~ !~_..,~ ~
Building foundation ~'
Water main J~/. ~J~'
Wells on adjacent lots ~ IoO t
SEPARATION DIsTANcE FROM ABSORPTION FIELD ON LOT TO;
Building foundation I ~' ~
Watar main ~/, ~..
Driveway, pafldngNehicle storage
Property line
Watar Service line
Curtain drain
Surface water ~' t<:,tP '
Wells on adjacent lots ~, I00 '
I certify that I have determined through field inspections and
review of Municipel mc'oMa that the above systems are in
conformance with MOA HAA guidelines in effect on ~Ls date.
Engineer's Printed Name '7"~'o'~..~'~ ~.~ ~.. /~OO'~'
Date /VOU ~.~., ~OOZ
Waiver Fee $
Data of Payment
Receipt Number
NO, VoZgoOI 06:39AU Fi~T&E EN¥iI~'i~NTAt. SRV
,4~E CT&E Environmental Services Inc.
T-553 P.O~/05 F-39~
C'T&E Ref.~ 1017971002
Client Name Flanop Ttd~ical Sty.
Project Nxm~ Ea~lcbr~k
Clignt Sample ID Lot 6, Blk 2, Eaglcblook ~l
Matrix Dr~g Water
O~e~ By
PWSID 0
Sample Rgrmuk$:
Client PO~ Pfc-Paid Cohs/NO3
Printed Date/Time 11/28/2001 8:20
Collected Date/Time I 1/19/2001 13:00
Rerelved Date/Time i1/19/2001 14:10
Method
Allowabte ~ Anat~ia
Limi~ Date Date Init
~atets Depa:t2aem~
Nmatc-N
0.500 U
0.500 mg/L EPA 300.0 (<10) 11/19/01
SCL
Microbiology La~oraCory
Total Colifo,m
col/lOOmL SM18 9222B
(<I) 11119/01 KAP
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
HAA#. ~-~C~ G~C')~Q \ ho
GENERAL ~NFORMATION
Complete legal description
Location (site address or directions)
Property owner ~1,c~¢~gl ~ :~n/~, ~ /V~y6 ~ So Day phone
Lending agency ~. ~, Day phone
Mailing address
Agent I"y.n E~*J.. f~*
Address 7d o O ~,~../~ ..cb,; ,~,~c~
Unless otherwise requested, HAA will be held for pickup,
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY: ' · '
Individual well
Community well
Public water
Day phone
9'9,5-1 o
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA~/Z1
5. STATEMENT OF iNSPECTiON BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm ~'lczf-/~? 7'¢r_~c~1 £er~;¢~, Phone_ '~
Address 1~/,5~0 ~-~c4o %/~ ~cho~. ~
Engineer's signature ~ ~ ~ Date_
DNNS SIGNATURE
X Approved for '¢~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authorib/
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued° The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~725 (Rev. 1/91 ) Back MOA ~1
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~/- ~.~
A. Weft Data
Well type ? v/z
Log present (Y/N) Y'
Total depth I 9fi'
Sanitary seal (Y/N) T'
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed '3 / ad' / ~ ~ Driller
Cased to
Date of test
Static water level --
Well flow ~0
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line '-~
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform
Date of sample:
SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N) Y
(tod' lo c. o,~)
g.p.m.
t ad' ' Casing height
Wires properly protected (Y/N)
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
MuNIcIPALffY OF ANCHOt~'Ac3I~
gNV~RoNMENTAL SERVICES DIViSiON
g.p.m.
~UN ~ 5 ~995
Nitrate
Collected by:
Other bacteria 0 col//co x. 4'
Tank size f ~- 5~:) ¢y~'f
Foundation cleanout (Y/N) 'r'
Compadments ~
Depression (Y/N)
/v
High water alarm (Y/N) ~'. A,
Date of pumping ff /to / ~ ff Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ t t 0 ' On adjacent lots
To property line ~ .~-¢' Absorption field
Sudace water/drainage ~ roo,
Alarm tested (Y/N)
Foundation q' ~
Water main/service line "> ~'
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. MFT STATION IV'. 4.
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
ABSORPTION FIELD DATA
Date installed (~ [ ~ [ 97
Length 92'
Total absorption area
Date of adequacy test
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
.Cycles tested
On adjacent lots
Surface water
Width 5~' Gravel thickness
6~ ¢'¥ Cleanout present (Y/N) Y
~ / 7 ,' ~ ~'- Results (pass/fail)
Water level in absorption field before test ~3" ~,* ~',,~
Peroxide treatment (past 12 months) (Y/N). ~,o~f ~,, o~.,,, o,c if yes. give date ~/.
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~.'
To building foundation
On adjacent lots ~
Surface water ~ ~ oD
Curtain drain ~
Soilrating(GPD/F¢) Ids- ~'/rj~',~ .System type 5-' ~.,.
Total depth ~c, ~-'
Depression over field (Y/N)
for 5' Bedrooms
Aftertest I~,$'* .,,* r~,,~
V
On adjacent lots -> ~(.,~, Property line
To existing or abandoned system on lot
Cutbank ~. ,4. Water main/service line
Driveway, parking/vehicle storage area
ENGINEER'S CERTiFiCATiON
I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
HAA Fee $ .~47~ oo
Date of Payment
Receil~ Number
Waiver Fee $
Date of Payment
Receipt Number
~b×l~×~b ih:OB COMMERCIAL TESTING ~ 9071451555 N0,652
Client Name FLATTOP TECHNICAL SRV WORK 0r~er
Ordered By TED MOORE Printed Da~e
~ro~ect Name CeaSe,ted ~a~
ProJe¢%~ Received Data
PWSID UA
1§288
Teehniosl Directo~ ST~P~N C, ~D~
Sample Rem~rke: SAMPLE COLLECTED BY: T.F. MOORE. *~ LAUNDRY SIN[.
~C Allo~abl~ Ext. ~al
Parameter Reeulte ~uel UnAts Me~hod Liml[~ Dale Date Init
~cr&~e-N 0.10 U m~/b ~PA ~5~.2 lO. 06/09/95 DJS
U = Undetected, Rgpor~ed val~e l~ ~ha practical quan~ification limit. LT ~ Lees Th~n
CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS
TttEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
June 9, 1995
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The following is a discussion of the adequacy test which we recently performed on the
wastewater disposal system serving the 4 bech'oom residence on Lot 6, Block 2, Eaglebrook SA).
Because of the complexity of the system I believe a more detailed explanation of the our test
procedure and data is necessary. Despite some anomalies, I interpret the measurements to indicate
that the system is still functioning adequately to qualify for issuance of a HAA certificate. A copy
of our field data sheet is enclosed for your review.
The wastewater disposal system consists of a 1250 gallon septic tank which was installed
in March of 1983 followed by two segments of 5' wide soil absorption drainfield with 2 feet of
gravel beneath the horizontal distribution pipes which were installed in June of 1989. There are 7
standpipes in the drainfield itself. The initial fluid levels in the various standpipes were a bit
difficult to interpret, as they did not completely conform to the theoretical configuration of the
system. Based on the observed perfo~rnance of the system during our recent test, I suspect that
the horizontal distribution pipe may not be entirely level, and that at least in some locations it dips
down below the top of the sewer gl'avel, somewhat nearer to the midpoint.
The monitor tube at the south end of the long (70') drainfield segment extends only 11
inches below the invert of the adjacent cleanout, whereas the monitor tube at the north end of the
short (23') drainfield segment extends 22 inches below the invert of its adjacent cleanout. To
assess the adequacy of the system we added 722 gallons of water through the cleanout immediately
downstream of the septic tank, while monitoring fluid levels in the standpipes before, during and
after the flow of water was stopped. This amount of water caused the fluid depth in the long
drainfield segment's monitor tube to increase to a maximum of 19 inches, and in the short
drainfield segment's monitor tube to increase to a maximum of 33 inches. The system was able to
accept this large surge loading without fluid backing up from the drainfield into the septic tank.
After the flow of water was stopped the fluid levels receded 2 inches in a little over one hour,
which translates to more than an adequate rate for a 4 bedroom residence.
I interpret the maximum fluid depth of 33 inches measured in the monitor tube in the short
trench segment to indicate that this short trench segment is probably constructed at a lower
elevation than the long trench segment, and therefore is subject to overfilling before the long
segment is fully utilized. Alternatively, it is possible that the monitor tube extends down into the
sand below the bottom of the sewer gravel and the adjacent cleanout is significantly below the top
of the sewer gravel. In either case, I do not think that the measured fluid depth in this monitor
tube indicates the system as a whole is on the verge of failure. In fact, given the large
demonstrated surge capacity of the combined drainfield system and the rapid reabsorption rate, I
feel the system continues to function adequately for a 4 for bedroom residence and recommend that
you issue the requested HAA certificate.
Please feel free to give me a call if you have any further questions on this adequacy test.
Sincerely,
Ted Moore
cc: Michael and Jennifer Novolio
FLATTOP TECHNICAL SERVICES
14530 Echo Sro, Anchorage, AK 99516
Pho (907) 345-1355
ADEQUACY TEST DATA SHEET
Legal Description :__~
Street Address: __~/~0
Client
Test Date:_~ /7/?~- Tested By:
Initial Conditions: ~$¢~ &~p?~¢,,~,~/~f
Float ~1 in.~ o~f~.~.rset~" b.t.o._o_" pipe w. ~5" fluid
Float ~2 inN, o~.~,~,w,~set _ b,t,o,~ pipe w. ~o" fluid
Float ~3 in~e~c~2 set "b.t~o.~" pipe w. ~ ".fluid
Float ~4 in ' set '" b.t.o~
Water added throug~~ /~o~o~m~ .~'~h'~.%L: _ fluid
ACTIO~ H20 METER NET~ WELL
TAKEN LEVEL
z:fz r~ 3~C3~o o ~
3': Z?
3-: V3
Measured Well
Unit
Yield
Absorption
FLUID LEVEL
Absorption
Average
= 1~3 P",~ = ~.9'~/~ Adequate for _~_ Bdrms
Capacity =~__~f- ~0 .~t.~ Surge Capacity
Rate = 2~.IZ~,~ ~ I,~ Adequate for ~ Bdrms
7~"
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343°4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell. D.# L~-'I- ~.~).~.~ ~ NAA# ¥1\~'~,°~°~ L_~_~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address 0n'directions)'.- ' ·
(b) Property owner ~Av'~ ~,¢,,¢~/~',~ ~'
Mailing Address- ~¢¢'~X~ /¢~o,
(c) Lending Institution ' ~ -';
Mailing Address
Telephone: (home)
Busi n ess ~'¢/¢ - ~'~''~ 7
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here'~ if hold for pick up.)
List contact person and day phone number below:
2, TYPE OF RESIDENCE
/
Single-Family~, Number of bedrooms z./z
3. WATER SUPPLY
Individual Well'l~, Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site'J~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRI~ PROVIDING ~NSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORI~AT~ON
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 end 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 ~r~¢'~ Telephone ~?~-.5'~¢.¢~f
Address /¢/,~ ~J J$~'~ ,'~v/4'¢¢/ /¢~ ¢'~-¢'¢,~
Date
6. DHHS APPROVAL
Approved for ¢ bedrooms by _
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
Date
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in ordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsibleforerrorsoromissions
in the professional engineer's work,
72°025 (Rev. 7/88) Back Page 2 of 2
1989
V ED Legal Description:
A. WELL DATA
Yield
_ Pump Set At
Sanitary Seal on CasingL~N)
Depression Around Wellhead (Y~_~
If A, B, C, D.E.C. Approved (Y/N) _w_¢/~
Well Classification __
Well Log Present .~;~)'N)~ F_/L~ Date Completed
Total Depth /¢~' Cased to ./¢/~ ~_Depth of Grouting
Static Water Level ¢~'_~_ _
Casing Height Above Ground /
Electrical Wiring in Conduit~N) __
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ....
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~'~/~ ~'
Water Sample Test Results ~F~4E- T' ~
Comments ¢j'E'z~- ,,¢z,,cc,J__'~,~C f /~/~' ~¢'¢ ,
__; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole ~//~¢
; Date / ~ ?'' ~¢
B. SEPTIC/HOLDING TANK DATA
Date Installed ,~"/¢~-~¢$ Size . Z~.¢~ No. of Compartments ~
Standpipes~)'N) ...... Air-tight Caps~,~N) ~_ Foundation Cleanout CN)
Depression over Tank (Y~ Date Last Pumped /~¢~,~'¢¢ /~
P~mping/Maintenance Contact on F e (Y/N) ~ ; for ~
.olding~a'n~ ~,gh;~'9~:;~l~rm (Y/N) ~A -- Temporary Holding Tank Permit (Y/N) ~
SEPARAT ON ~ 8~'~.C~OM SEPT C/HOLD NG TANK
To:'W~ter~upplyWell ...... ~/~0¢ To Building Foundation ~
To Property bine "~=:r' ,' :~'
To Water MainCServi6e bine
To Stream,~Pond, Lake Or Major Drainage Course
To Disposal Field
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION F~ELD DATA
Soils Rating in Absorption Strata
Date Installed ~' ~ -
Width of Field ~ /
Type of System Desig~n
Length of Field ¢~'
Depth of Field
~ Gravel Bed Thickness ~-- ~
Square Feet of Absortion Area .... ~_~./~./_ ..... Statndpipes Present.N)
Depression over Field (Y~
Results of Last Adequacy Test 'gA
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water=Supply Well
To Building Foundation
Lot ~
To Water Main/Service Line
Date of Last Adequacy Test
To Property Line -~"~
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course /da 'C--
To Driveway, Parking Area, or Vehicle Storage Area /o ~'
Comments /-z-¢'~'¢' 4~¢J2>IT/¢"4/,4'z-- ,g~/c~'¢g'~'
D. L~FT STATION
Size in
"Pump On" Level at
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Vent (Y/N)
-P~-p~n-Tfi~-C3~4eA~d~._uring Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guideline.,
inspection.
Signed
Company
Date
MOA No.
Receipt No. _
Waiver Fee: $
Date of Payment
Page 2 of 2
date of this
Seal
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range) '
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Location (address or directions)
(b)
Prope~'ty owner,
Mailing Address,
Telephone: (home) Business
(c) Lendin.'g Ir~stituti~n ,:' , Telephone
Mailing Addr(~s '
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the following address: (or check here~ if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family'~[. Number of bedrooms
3. WATER SUPPLY
Individual Wel~'~ Community [] Public []
Note: If community well system must have written confirmation from the State Department of Environmental
'COnServation attesting to th legality and Status. '
4. SEWAGE DISPOSAL
On-site~l~ 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 (Rev. 7/88) Page 1 of 2
Name of Firm
Address --
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' '
As certified by my seai 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,
functiona .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.
~'~' Telephone
Date
Approved for ~ bedrooms by Date
,,~gfma, ced- .... .B4saC, preved-_ Conditional -~
Terms of Co n dition al Ap p roval -,~'~-z~xtL/x¢'~~ ~¢~.~' :~b.~¢'¢ 77~ ,'~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev, 7/88) Back Page 2 of 2
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLBST = FEBRUARY 1984
343-4744
Legal Description: ,¢.~7"
Well Classification
Well Log Present ~N) Date Completed ..,~'¢¢'-~"~ Yield
Total Depth /¢~' Cased to __/_~ ~_ Depth of Grouting
Static Water Level ¢"~' * Pump Set At
Casing Height Above Ground / '~' Sanitary Seal on Casingl~N)
..... If A, B, C, D.E.C. Approved (Y/N)
Electrical Wiring in ConduitCN)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot __
To Nearest Edge of Absorption Field on Lot ....
Depression Around Wellhead (Y~)
; On Adjoining Lots
. _ ; On Adjoining Lots
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results ~/~
Comments A/~'~.. ~¢~J '7~E~$?
To Nearest Public Sewer Cleanout/Manhole
~.5~/¢.
/¢. ~J/E'J ;Date .. /-¢-¢
B. SEPTIC/HOLDiNG TANK DATA
Date Installed -~'-/~-.~... Size
StandpipesON) ._ Air-tight Caps~l)
Depression over Tank (Y N(N~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~/,~ __
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
No. of Compartments
__ Foundation Cleanou~N)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
To Water,Supply Well
To Property Line
To Water Main/Service Line
To Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ ~/¢' ¢'~'
Width of Field ,~
/cz.-
__ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes PresentbN)
Date of Last Adequacy Test
Square Feet of Absortion Area ~0
Depression over Field (Y~
Results of Last Adequacy Test f'A/,¢¢¢¢¢4~'~'¢¢'~¢' ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /¢¢ I ¢'
To Building Foundation /4 ¢"
Lot __ ~ .......... ; On Adjoining Lots ~o
To Water Main/Service Line /o "H To Cutback (if present)
/-/¢
To Property Line
To Existing or Abandoned System on
To Stream, Pond, Lake, or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. L~FT STATION
Dimensions
Siz~ n Gallo~.~ Manhole/Access (Y/N)
"Pump On" Level at ...... ~ _ _ "Pump Off" Level at
High Water Alarm Level at -~""~._ Vent (Y/N) _
............................ ~___ Pumping Cycles during Adequacy
Tested
for
Test.
Meets MOA Electrical Codes (Y/N)
Comments __
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, veal,fled, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company __
Date
MOA No.
Receipt No. ~ Co'q-/' ~"~'/~¢,~9 "~ .)
Date of 'ayment
Amount: $ .... /~.~. O~
72-026 (Rev. 7/88) Back
Receipt
Waiver Fee: $
Date of Payment
Page 2 of 2
APPL C F LLS OUT UPPER HAL NLY
Mailing Address
Buyer
Address
Code
Zip Code
Lending Institution
Address
Realty Co. & Agent
Address
Legal Description
Straet Location
Type of Residence
~.~/81ngle Family
~ Multiple Family No, of Bedrooms
[] Olher
~/ater Supply
~,lndlvidual
EJ Community
t~ Publl8 Ut!lity
Sewer Disposal
~ Individual
BI Public Utility
[] Holding Tank
Zip Code
Zip Code
Phone
Phone
ATTACH WELL LOG. A well log Is required for alt we~ls dri~ed since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Year individual ~nstalled:
When Connected 1o Public Utility: __
NOTE: THE INSPECTION FEE'MUST AccbMP,~NY EAC;H REQUEST BEFORE PROCESSING CAN BE INFrlATED.
Time Time Time Time
Date Date Date
Inspector Inspector
Field Notes: (.~,~)~¢ f.: ~; (. (, ~ ~ ",/
Inspector
Date
Insp6ctor
(/~'-) APPROVED BEDROOMS .¢¢'
) DISAPPROVED
) CONDITIONAL ~,PPROVAL
BY:
"CONDITIONS OF APPROVAL
Soils Rating Dato Sewer Installed
Well To Absorption Area /~) { ' W_ell Log Receive~d .................
/ Well to Tank ¢ (': ( Septic Tank S~ze .... ~:% __;;___
ALASKA [ FiuliROFIITle[1TAL CO[1TROL SeRbiCeS, IrlC.
~r, qJneerinq 8 ~nuJronmer, lal Studies
January I0~ 1984
Department of Health & Environmental Protection
825 Lo Street
Anchorage, Alaska 99501
Attn: Robbie Robinson
Dear Robbie:
On January 7, 1984 our company inspected the sewer system and well
located on Lot 6, Block 2, Eagle Brook Subdivision and collected a water
sample° The water sample was satisifactory and a copy is attached°
Ail the standpipes were capped and protrude above ground level° The
finished grade looks good and surface drainage is away from the septic
system.
The well is located 106' from the system and has a sanitary sealo The
wires are encased in conduit. We recommend a approval be granted°
Sincerely,
Laura Ogar
Environmental Health Specialist
Appro
1200 UJesl 33rd Auenue, Suite [~ ~ Anchoraqe, Alaska 99503 ~ (907) 276d361
DATE:
TO:
FROM:
SUBJECT:
MEMORANDUM
April 11, 1983
Laura Crow
Health and Environmental Protection
Request for Refunds - Account # 2460
Please make the arrangements for a refund[for the following,
a private engineer has completed the inspections on the
installations of the on-site sewer systems.
Harry F. Shore
6937 Old Seward Highway
Anchorage, Alaska 99502
Permit % 830091 - Lot 3A Eaglebrook Subdivision
Receipt # 228556
Amount $30.00
Permit % 830092 - Lot 6 Eaglebrook Subdivision #1
David A. Grenier
6937 Old Seward Highway
Anchorage, Alaska 99502
Receipt # 228556
Amount $30.00
Laura J. Ward
Senior Office Assistant
Sewer and Water Program
attachements
91-010 (4/76)