HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 13 LT 4AOnsite File
#017-391-59
---- MUNICIPALITY OF ANCHORAGE
�N___
On-Site Water&Wastewater Program `, S�^
t �,,� PO Box 196650 4700 Elmore Road .
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 ,- r
httpa/www.muni.org/onsite
�.. ,= Department
R�CX OR N6``
On-Site Water System Permit
Permit Number: OSP191243 Effective Date: 6/20/2019
Work Type: Well Initial Expiration Date: 6/19/2020
Tax Code Number: 01739159000
Site Legal Address: MOUNTAIN PARK ESTATES BLK 13 LT 4A G:2838
Site Mailing Address: 13001 ALPINE DR, Anchorage
Owner: APPERSON DEBORAH B TRUST Lot Size in Sq Ft: 21434
Design Engineer: Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy Ii Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
1. If existing well is to be taken out of service, as defined by AMC 15.55, it shall be decommissioned.
2. To close out this permit, please submit the following:
a) Well log
b) Pump install log
c)Water sample results for total coliform, nitrates and arsenic
d) Decommissioning log for existing well, if required.
or
Received By: 4 ,1- `6,7,c--t- Date: 6 . 2c, - %
Issued By: fi.) f1 &Aiterff Date: 6 20 1?
MUNICIPALITY OF ANCHORAGE
• fry l
Development Services Department �� Phone: 91 J-7904
On-Site Water & Wastewater Section F.��, I. 44 7
RIM*
a
JUN 19 2019
ON-SITE SEPTIC/WELL PERMIT APPLICATION • i
Parcel I.D.
( 7. 37 59' o0 0 zi0ig8Lgc;\
Property owner(s) f`} p P- c se" e:A.k A .1Y/✓ Day phone Hyl
Mailing address P0 ! $ ( I 2-2. JC7t f}- IC (`ajc 4-(c. c( ? S l I
Site address 1 '3 0 0 ( l4'L 0 I ✓t-e bd`t`V e 4 Jc-ko d):11- ,mac 4 q S7 A
Legal description (Sub'd., Block & Lot) /'moo t"• •1 f-,---,,-,) Pc,t(G C s7 f- g 4 ic- 13 -7- 1g
Legal description (Township, Range & Section)
Lot Size 2 1, 11 3 c/ Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(Z all that apply)
Absorption Field E Initial P§ Single Family (SF) 4
(w/wo ADU)
Septic Tank ❑ Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal E.
M • .4 - Iings ❑
Privy El �u -no Vr P .
Private Well RUSH! .),o
Water Storage ❑ a JUN 1 9 2019 1.
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: c ii ti
0[ c,h
6 8 Di - ce:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
-A- ° -7---------- 6i , / ? - ( 9
(Signature of property owner o authorized agent)
Permit/Rush Fees: e3,U,V Waiver Fees:
Date of Payment: 6/9,409 Date of Payment:
Receipt Number: 2X4 £ 57o Receipt Number:
Permit No. OSP/6?/9.0 Waiver No.
G.\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
e- Q re /'1.4 Se. C 4-4V1, -S U r Cafe-eti C O'\ G di 4'Cei/L/ A i €t (iri, li l h
Imo ' c9 01—4F _D ,..,-e,E( 1,4 ( i'4-9H
.L we ( Y
,S 26 k �� corwt' S. 4 on A•er1 i�/v l I
0 I 3A i
s4� 0 6,9,ed-o•4
A61 ,,
-14-19 ._,, J, i
11.0•
10.0'
L_,' ) N86° 45' 21" 98.40' S82° 45, 39"
' o DECK j ai��%/ may 59.1' db.-,
8 3
,
o '.r•:: 2' CANT. % �2 lit STORY = STAIRS
l
z • • . SEPTIC ' % NFRAME HOUSE 2' CANT,
. STAND PIPES GInumitt 40 o
STAIRS _
L� I 6' CHAINLINK I---
l �' FENCE I z
I �'�. • L D T 4A • `•.•�(Y• L1 I
M •
:�< d • •�tv �~ /°WELL oS" I w w
fir ,:.•' �.. • �2• —�� co!i 30.0/ 9�� 110.3 0
Z
S 85° 54' 06" E 7' 1='v'
198.54'
i
! IT S
Location of house was established byas built
0�
� ,
completed by Frantz Hildonen on 3- 18-86. S..--11P
No property corners were set or found this survey.
I herby certify the following described property,LOT 4A.
BLK 13. Mountain Park Estates BLS
�p� Anchorage Recording Precinct, Alaska; has been
� surveyed by me, or at my direction, and that the
�^ OF AZ, improvements situated thereon t are within the
_, •if-- property lines and do not overlap or encroach on the ASSOC.
�,� • 8 I property lying adjacent thereto. That no improvements
* .11-31•4' 7* # on the property lying adjacent thereto encroach on the P.O. BOX 0084
' ,.,,� ` premises in question and that there are no roadways,
• :H transmission lines, or other visible easements on said ANCHORAGE, AK 99523
aP property, except as indicated hereon. Tele. (907) 526-6050
��a BOB;�F.SBU'R TT .0?if The information hereon is for the use of lending ins- Fax (907) 562-6040
F. S. titutions specifically to show any conflicts between
`'t; DATE:
existing structures and platted lot lines or easements 1 1-1-94 j
���ss[ohXL��-•' structures ucand �tur ss oor fent to celines, Easemente used for s of Other SCALE: j" - 40' i
additional
• �N''-®"s:w- than those shown on the recorded plat, are not
shown hereon. GRID: 2838
Municipality of Anchorage Page ! of ~--
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5;t.d qG, O'~iq, PID Number: OI7- ~'-11 -~"1
Name: "~k~ ~t~J Wastewater System: ~ New D Upgrade
Address:
'P.o. g~ 'lli~q~ ~c~. ,~ ~1 ABSORPTION FIELD
Phone: ~~.~ INo. of Be~oms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
O-H ~ GPO/Sq Ft.
Lot: ~ Bl~k:l~ ~N~T~I~Su~ivAi°~g~ ~. ~pthtopi~bo~om f~modginalgmde:~.~. Ft. Gm~ldepth beneath pipejo
Township: I Range: Is~fion: Fill added a~ve.oHginal g~de: Gmvellength: ~ ~
Gravel width: Numar of lines: ~ DisUse ~n lin~:
WELL: E~l~New D Upgrade / ~.~ Ft I
Cla~ifi~tion (Private. A.B,C): Total Depth: ~To: Total abso~tion area: Pipe material:
'%~ Date Drilled:Ft..,ng Height$~ticWate' L.el:~ve G~und:Ft.Ft' 'ns~llenA' FU'~,~ TANKDate Installed:
SEPARATION DISTANCES ~Se~t~c ~ Ho~ ~
TO Septic Ab~tion L~ Holding PubliSH.re Manuf=cture~ ~paci~ln gallons:
Matedal:~ ~ ~ Number of CompaAmen~:
Surface
Water I~tf ~eot~ -- __ -- LIFT STATION
Remarks: ~ ~T Lt~ ~U~ BENCH MARK
Lo~tion and D~cription:
I~um~ JO0.0 fi,
Elevation:
Inspections pedormed by: ~ ~ S ~Ne~N~N~ Dates: 1st ~-]~- 9~~' ......
Depadment of Heal.and Human Se~lces ap~
~oviowed and approved By: ~ ~ ~ Dato://-/-~
~2-013 (Rev. 9~91) MOA 25
Permit No.
SW960518 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:LOT 4A, BLOCK 15, MOUNTAIN PARK ESTATES PIDNo.: 017-391-59
EXISTI~ 'G CRIB--,~
~s~u.~' I EXISTING
/ SEPTIC TANK I
~ ~ ' NSU~D ~DER DR~ ~Y j ~WE~ I
FCO 15.0' 13.0'
CO1 [7.0' 50.0'
SI1 fi7.0' 52.0' ~c~ t' ~o'
S12 ~0.0'
DSL2 70.0' 58.5'
FD 71.0' 59.5'
MT1 93.6' 72.0'
MT2 96.0' 86.6'
C02 99.0' 91.6'
C02 92.2'
~94.5 ST2 COS
0'~ NEW ~ : .
r2 ~ 77.8~
NO WAT]',R FOUND
71.8' B.O.H.
72-013 A (Re~. 9/91 ) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES ~ ~P~
P.O. BOX 196650, 825 "L" STREET, ROOM 502 %~_\_~
ANCHORAGE, ALASKA 99519-6650 ~ ~.~ ~
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960318
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HSIEH DEREK C & HELEN A
OWNER ADDRESS:13001 ALPINE DR
ANCHORAGE, ALASKA 99516
4A
PARCEL ID:01739159
LEGAL DESCRIPTION:
MOUNTAIN PARK ESTATES BLK 13 LT
LOT SIZE: 21434 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
DATE ISSUED: 9/26/96
EXPIRATION DATE: 9/26/97
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED By: ~ ~ ~'-~-
DATE.', ?- 2 7- fig
ROBERT C. COWAN. RE.
ROBERTA. SHAFER. RE.
September 9, 1996
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
H~J.TH AUTHORITY
APPROV.~
SEWER&WATER
MNN EXTENSIONS
SEWER&WATER
INSPECTION
ENC~NEERING STUDIES
AND REFORT$
W~LL INSPECTION
& FLOWTEST
SITE PLANS
ROAD DESIGN
SOILTEST
I~RCOLATION
TEST
STRUCTURAL &
MEC~iANICAL
INSPECTIONS
ON SITE
WASTEWATER
DGPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 4A, Block 13, Mountain Park Estates
Request you issue a permit to upgrade the septic system
serving the existing four bedroom house on the referenced
property. Also, request you issue a t foot waiver from the
proposed trench to the west property line.
A test hole was excavated and percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
At the time of excavation no water was encountered in the
test hole and after seven day ground water monitoring, the
monitoring tube was found to be dry.
Attached is the proposed upgrade design
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
The proposed 1250 gallon septic tank is to be placed
outside the well protective radius. Attached is the site
plan which depicts the location of the proposed tank.
If you require additional information, please contact us.
Sincerely,
Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RNER LOOP * SUITE204 · EAGLE RIVER, ALASKA 99577
,' ' l'" = 50'
SITE PLAN
JDESIGN
ALPINE DRIVE
ASPHALT
DRIVE
_
10' UTIL. ESMT.
r-
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: (-~1' ~ )~' ~t
LEGAL DESCRIPTION:/~1~' ,Y,gt~/ ~/~t~ ~- 3"74~'lJ''
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13-
14-
15-
16-
17
18
19
2O
COMMENTS
SLOPE
WAS GROUNDWATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Monitoring? b~.y Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
0~ ~ ~,~ G ~ ,/~,,
PERCOLATION RATE . ,3 '~ (m,nutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '7 FT AND ~ FT
:$ & S ENGINEERING .~///~..,l//
PERFORMED By,~,.,,,,~4 .--J- .~., ~_ ...J ~ ~ I ~/~ ~-~ CERTIFY ~HAT THIS
,~ ~ ~ ......... ~ .......... /- - v - · . . TEST WAS PERFORMED IN
ACCORDANCE ~AN~ ~IPAL GUIDELINES IN EFFECT ON THIS DATE. DAt~ , x /OC
72~8 (R~. 4/85)
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
SEWER&WATER
~AIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
S~TE PLANS
ROAD DESIGN
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
W~TEWATER
~SPO~AL SYSTEM
I~cSIGN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
ClVlL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE= Lot 4A, Block 13, Mountain Park Estates
September 9, 1996
GENERAL:
1.
The scope of this project includes the installation of
1250 gallon septic tank and a leachfeild trench to
serve the four bedroom residence located on the
referenced property. The existing septic tank is to
be excavated, pumped, crushed, and abandoned in place;
and a new 1250 gallon septic tank is to be installed.
The existing crib is to be abandoned as such that it
may be used in the future.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
4e
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
Se
Contractors installing wast.water disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
me
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577
Page Two
Lot 4A, Block 13, Mountain Park Estates
September 9, 1996
e
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent ¢leanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INST~.~TION:
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 4A, Block 13, Mountain Park Estates
September 9, 1996
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the %200 sieve.
e
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements, which ever applies.
Page Four
Lot 4A, Block 13, Mountain Park Estates
September 9, 1996
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 4A, Block 13, Mountain Park Estates
September 9, 1996
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons perforating work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
,-'" G?-'~.TER ANCHORAGE AREA BORO~'"~
,~ -t HEALTH DEPARTMENT
.~.__.. 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
'N9 904 ',
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK: ' 7'~-~~ ;,,~'¢?'~c/f
DISTANCE FROM WELL ~ " MATERIAJ C6~~ ~- COMPARTMENIsNUMBER OF
LIQUID CAPACITY / ~ ~ ~ GALLONS. INSIDE LENGTH / ( ' ,INSIDE WIDTH 9'
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
TOTAL EFFECTIVE ABSORPIION AREA ('WALL AREA)
TILE DRAIN FIELD:
DISTANCE FROM WELL
ABSORPlION AREA
OR WIDTH / ~' .. LENGTH '~' ~ . DEPTH
°,STANCE FROM BU,LD,NG FOUNDA,,ON
¢' ~ ~' SQ. ~.
SQ. FI. LENGTH OF EACH LINE
TOTAL LENGTH
. OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE.
,DEPTH OF FILLER MATERIAL BENEATH TILE
.IN. ABOVE TILE
WELL: ~/' t~/C9~ ('?~'/ DISTANCE FROM WATER
TYPE ' ~ DI OUNDATION.. AMPLE. ,. NEAREST
NEAREST OTHER
LOT LINE ., SEWER , SOURCES
DISTANCES:
,~6 z z¢'~"
AC'-
A,0=3v'
DIAGRAM OF SYSTEM
GrEATEr ANCHORAGE ArEa BOROUgh
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATIOH AHD PERMIT
PERM,T.O. /~//')cv
INSTALLATION LOCATION
INSTALLATION DF: SEPTIC TANK .
TYPE AND SIZE OF FACILITY TO BE :SERVED
FINANCED THROUGH ,
PHONE
SEEPAGE PIT ~ , DRAIN FIELD . OTHER ·
TO ~e INSTALLED BY _~~ ~A~
COMPLETION DATE ANTICIPATED
x"?
NOTE~ THIS PERMIT IS NOT VALID WITHOUT ~OIL TEST
FINAL INSPECTION= 24 HOUR NOTICE: REQUIRED. BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION BY THE:
HEALTH DEPARTMENT AUTHORITY WILL BE BUBJEGT TO PROSECUTION,
MINIMUM DISTANCES, REQUIREMENT5
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PiT ~7 . DRAIN FIELD ·
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK ~ SEEPAGE PIT
, DRAIN FIELD
~.--r~,-'"-
DIAGRAM OF SYSTEM
TO NEAREST LOT LINE.
WATER MAIN TO SEPTIC TANK
SEEPAGE FIT _//.~,"~ '
ALSO CONSIDER AREA WEL~S.
. SEEPAGE PIT /'~'~ /
DRAIN FIELD
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP DF
EXCAVATION ~ FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
I ,CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-OB AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
II;
· '. ' ., '.3--,-,. '<' FGREATI3R 'AffCHORAGE AREA BOROUG~ ' ..
~. - ..... ~ ~" HEALYH-DEPA~T~IENT '' ~ CASE #
· ' 327 EAGLE ~TREET
ANCHORAGE. ALASKA 99501 . "
Th~s ~o~ ~poets al Soits ~g '_ ' · . ,Percolation Tes~ , ~ , , ,
Feet Location Sketch'
m
Was Ground Water Encountered?
Yes. At What Depth _
Proposed Insta ~epage Pit ~ Or~tn Field
Depth Of_j_nlet. , ' Depth. To Bottom Oi Pit Ov T~enc~' · .
~/~ ~/~ ~ _.~,~'. ' ' -~ '-' ~,~-~ r,, * ' . .
_ · · .-,~ . '- -' ~t ~ ~ (. ~/o//~ .. ~~ ~qt'~ ' '
r,,c ~,=¢o~d ~, ~~ ¢~..,~, .., ..... , .,......... .... .....: . ·
· ' ~ ' ' . ~ ..... ~' '.' ;~i¢' .' .... '. ~' '(4, ""~ ":";3'" ......
' ' ' . · '. . : * .' ' , ' .' .0. :.~ ...r,...; .,}'.':'",%':"?.,%'~';T";~' ';.?.?". ".. ',' .... :;;
-.-' '. ,' 'n.+~'i -- e ' [~;~:'.~ ~' '-'~"".' ~ ~.~."'**,;~ .: '~ .
' . - i : · t I. ~.:' -. ". { ...'.i'.{.' . :." ~, ". . ...'. .
1
.2
3
6--
7
8
9--
10--
Performed For
Legal Description: Lot
This Form Reports Soils"l~gll~
Depth
Feet
CASE # .,
~ Date Performed IO/l~
Blo6k,i- iSubdtviston ' ,
Pe'rcolation TestiS. N,
Soll Characteristics
Was Ground Water Encountered?_~
If Yes, At What Depth?
L
Reading Date Gross Time Net Time Depth to !(20 Net Drop
Proposed Inst( Seepage Pit Drain Field
Depth Of Inl.,et Depth To Bottom Of Pit Or TrenCh
T~st rerformed'B~ ~'.~./ ' ' Pata Cerfifled By:
' r ..'�%z 'j ?. r� � . 1.. r'.^'•' �.'^. a '4^+�,. .s .w>#i...n} i :q�^ r ti ...
i.'� I. < , y"+ �t't ,. it !' .:°✓ h a i a.` ° r o3'a ,M... :w vr; < �yftt i{v!.`., `�
v ,`R .Iµ nr r. �liyi Ri �'y. R•^tai �i,�� K.I. Gi y'r'.h�aaWl'La R.- r'}itifi',wt. [n,,, f.t. r.~ ' A�!' r'to
• ii R �[ + i• .� ++ l > �' y v M. rr i 3 arYr � � Ki .'. a+�>".n/i '
. ;.. Y i�.. •'Y+ � d t:' 5 1 'g f 1+++�W 4: ` . l i � : Jr / ..Y ,�+�Nrw: � • ry tti rpt, i`hY � } l\� .nvq /•. � i'a A.
`N� V iy rr� �4 +bk4 Y r•` 11{ L+�R i< �rr.� �{ii Vsve1�A,
is it /•
!l.`.• n 1 s /? fid• f'r (ZI; �l 1 }3 {! i e a •i r i :, •. 4 (
/ _1 Y -_ l.:�S! i_.J t _1.14.{1 J�1 1 :r • � �i.iL S• Z.J��L�3.�uJ. �1..
it
Certified Well I''''- =m,
a
r:<:.. 1 i'' • For.... ! .? Y)..K..........N.4! Ll.n.f�..c 1?.e................................................................ oz'. .:r•.:,
i' :,. •'
Location .... Lrei..y.��..
\ Y Date completed ....a.pxi.�......J.�i.�l ........_..... '"• c;.
.�
1 , 4 'T
qYc :may„
Depthof well.................i.70..... .t •............................:......... _......................... 1 I
ryi Size of casing 6.........�.D�.:............................................ > : s 'sack`
Distanceto water ......... .4..l......T.............. _.._...........................................
Distance to water while pumping. ............. il ............................ at rate
of.......13A .......................gallons per hour.
kw
wez
�•'I
♦ G+ 4
I I Ai Y
• 7 1
yH
+-
i
1
y ,:SIA
Description of Formation..`;,,' .
from
to
t t25
Z
L' tLf brr :n• ' .}i I t
27
3 tP
-I ._
34
110
5 Of t
1 3
t o b be A6,n
If3
I29
-r x. r
S ,
n ij�!1,,'�_
zg
rs6
,Lr
1,cy
.}ice
_
.'•jI.
1... ra a
b
r
,. I /. _
i
1�j�t1
r�
it
I certify the ove true and correct. t+G4y�3 <lY�
L I p J
.. 1{ ti �M Zvi
`' ...
Dri..ll
+fie
DOTTEN DRILLING CO. _* -A.;
Johns Road w• c..
SPENARD, ALASKAWi
NVe advise you to attach this certificate to your deed. ta,
�'+J'. 'i..„ �r�,T,...•....j{.x ,rr. _..TS••,y,'f.".f�}� i:'�jiY'..-r'.: �,r��,.•a._•r�'•y;-rr77,��'^3�1'.'`�•�ir�r�iit��•. '�i;��ot."` :ir::.
` S.>:, ••a �yi.{i �.i'?5ir�._:g��:{i?•i r�ig.'7?L�iil�(.l..i:e+'�._:,+':i:} y... �?1t•l htia i�i/lyf.54�+^.),ill aea.. .M1 �...,.,�•...i 'i
IY� �,� grn �'..� t � r•. � i trn �•f x. . r sq -l'•-�• Ft •rn �.✓ it .> t! i S(e (CK `�'1
,/ *T;b' '11„ i >P ,.114 a 'f�tt :� J, t/•Jit � t7;J.sci .. ' . 1t'?'•�i�4, .� w it•,�ri ; ' f %+' Z `A
i> /' � "'"Y' + • y Yy:t *� • '`irii \� p { • aR" A F•.rryfi'Yiay,i A: .•.,M1+7.Rr � I yf fr. ti � J x v`
I {t' J.•lw+N� ..::,��. .� JAi.. �. �`} J ..14 >. w n i JJuhht r � Y'. JIa is ` � k J � +� : i r'G 6;
_ eifrl:t:,y._ .. ...•:...1,'•,A:. r:!�li.'m.'....... .Mw�:i[n r.....d..11...... '.' ...ITIbII::.. .....'ar� ,x.. lt�_,:.:....e.\
PERMIT N0.
IOIr ~-~LIt"'r' 13F
DEPRRTr'IENT G, HERLTH AND ENVIRONMENTRL ~,<OTECTION
825 ~L~ STREET, ANCHORAGE,
264-4 72~
L~ELi PER~.I I T
81~i15 )
8PPLICRNT
LOCRTION
LEGRL
FRRNK HOLLINGSHERD SRR BOX ~64-G RNCHORRGE 99507
L4R BiZ ~IOUNTRIN PRRK ESTRTES LOT SIZE 55000 SOURRE FEET
MINIMUm1 DISTANCE BETHEEN A HELL AND RNY ON-SITE SEWAGE DISPOSRL SYSTEM IS
lO0 FEET FOR R PRIVRTE HELL OR 15O TO 200 FEET FROM R PUBLIC NELL DEPENDING
UPON THE TYPE OF PUBLIC HELL.
MINIMUm1 DISTRNCE FROM R PRIVRTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RND
TO R COMMUNITY SEHER LINE IS 75 FEET.
HELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT HITHIN 50 DRYS
OF THE HELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
I CERTIFY THRT
l: I RM FR~tILIRR HITH THE REOUIREMENTS FOR ON-SITE SEHERS RND HELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE HITH THE CODES.
SIGNED:-~¢Z~NT FgRNK "O~LINGSHERD ~ , .
.
V4. 0
'"'- '.:"~ .... "~':'"'~ :'~':~:';~ ' '"'"'" ' · ...... ~'~ '~" ":" "'."';.:.~;''*':~;.'-?"*~,".,::,'-~.. · '. ''. ~.'A4UNI~-, -".' ~ :" . ~ ~,: .-. '
· ': "~ ';': '~:tt'"'::'/':':::"'~:*:'-;~ ~.'.:"',';.' '~"~." MUNICIPALI~OFANCHOR~GE ~'~ ".;"~-'~~'0~' ..' ~.L.': ."...:: '~:'~
:".;:':;":' ; ." ~.";-/?'~;::.:: :;~ ~h . ' DEPARTME~ OF H~LTH & .UMA~ SERVICES
- ..: ' ;-,' '..:~: ::,';. "',. ' ' .' .... ~,''~ .......... , ........... ~" " ' ..~ ..... ~'1~ ........ ..' ..... '",,"
: ...,~-..~. u ; .... ~ ..... P.O. Box 1~0 Anchom e, Alaska.,9951~0~ ~,,g~c,~ ........... ~ ..........
~ ....... ?., ..... ~- ..... '. ...... , ...... APPROVAL FOR ASlNGLE FAMIE~DWELLING ..:.,..::...
'.:",::: Parcel I.D. ~ .... ~[~ ~ I~t ...... a-'~..~;;~:~:;~J
"~' ;::": ~-: .' ~:,~....;~; ?.~;L~::~-~,'L';- ~ =--~.,;:-'-., ;~ :-:-4'.: ~:; ;~ ;~::,~:'.~ ~J."~ ~
-' 't · ..... ,..7 1~.,.: ~J~[ ~,~ c? ..~,~., ~,f . .re.;, ~. ,~.~ ', ;,; ~...,.;.,=.-. ,.~ ~.,=,:¥=,,;.~
~ ..~,,-,,.~ Locabon (site address or directions) ~ .....
.. ....... 5,~,.STATEMENT:.OF INSPE~I'II3N RY- I=m~ltur=r=,', ', ~-,,~,...,* .......... · ........
~:~;.~:- - :~:~:~ ~mfl~ by my seal affix~ hereto and as of the validation date shUSh'
:... :=..: .,... · ~-::...;~ ~nv~t~gahon ~ th~s.Health Authori~ Approval applicati6n sho~'that tho ~'h
.. ~ · .... . - -..,.-~ ~--,, ,~ ~;... ..... · .~..~ .~ ~.~. .......... ~ ~ ,~,~m~u~7,:: :.~
......... ...... ,. ~.~?.¢[ ~o~[d~P0~l ~y~tom 18 ~fo, tunchonal and adoquato lot th~ numar o~ ~h~ ~: ~..
.. = i=-, .~: =: .=== . Wp of stm~ure ~i~ted hereto. I fuAherven~ that ~ on the info~ation obtain~ frnm
~" - ~ ~"~*' 'the M.,-~-;--~:~;~'~=::T~L~,~:~:~%'~='''~-':~ ~ ;~ ~'~'~:~'~"'' ".' .... "'-~' '-,': ~, · -~'.~.,',.-~-~.':--~ " "-
' '' ~"':'""} '.}~:}' ~-,~,w,,[~ u, ~.~rug~ ~ lr~ ,~yjn~lgat,gn and Ins~ion. the onZsite'water w.:'. '.:
-:?.~.,.;--, -.:: ~' ..... pp y and/or:w~ewa~r ~sp~l system ~s ~n comDhance with ~11M,ni~i~l
. . .. ._ . ordlnan~. ~d r~ulations in, eff~ on the dnt~ of th~ Ine~*=~'-:' *~'~ -*~'~";~ ...... :~"" ~'i~ '5" '
· . ...... :~.* ~ .~ ..... Name of ~ S& S~GINE~I~ ,~ -. ~*' :~/ *:, -. * * ~,,~:.--*
of, Health and Hum~
!i ~,, c /vUJN/ctPAIJIy OF ,~N(.;H~c
': ~ MunicippU~, ~ g~qhomge ~m~ s~c~s ~~
DEPAR~E~ 0~~ ~U~N SERVICES
Environmental Sewi~s Division f~A~ 0; ~996
825'L" Street, Room ,02e An~omg,, Alaska 99501e (90~ 343~7~ C E I V E D
Health Authority Approval Checklist
Legal Description: ~:~" 41k. ~s..g- ~'~
A. WELL DATA
Wdi type
Log present (~)
Total depth
s~u~ se~ ~)
Date of mst
S~atic water lvvel
Well production
If A, B, or C. attach ADEC lctmr. ADEC water system nmaber
Dam completed
Cas:d to t'7o. ~
FROM W~ J. LOG
· g.p,m.
Casing height (above ground) I t 4-
w~ p~op~y p~=d 6:tN)
AT INSPECTION
V,o g.p.m.
WATER SAMPLE RESULTS:
Coliform ~)
Dam of sample: ~- ~ o - g/a,
B. SEFTIC/HOLDING TANK DATA
Nitrate
1,2. '1
Collected by:
Other bacteria
$ & S ENGINEERING
E~gle River, Alaska 995~J'
Dat¢installed [o"'tct-'ll Tanksizc.l~ NttmberofCompanments
Foundafionclcaaom~q) ' v/ Dc'pmssion(Y,Q~
Date of Pumping. q~,-' 3'°1 ~ ~ Pumper
C. ABSORPTION FIELD DATA
Date installed ~u-\ N -q t
Length & L,, ' Width
Soil r~ting (g.p.d./ft: or fi:/bdrm) ~ System .tTpc ~ (~
'1 ~ t Gravel tlgckn~s below pipe ~ ' Total depth .,~ '
Effeclive absorption area 5"~:' ~,<,,~ Moaitoring Tube prcscnq~N) y Depression over field (Y~) ,J
Date of adequacy test . ,,9-,,,,] '~- 9 6, Resul~ail) ~' For Y bedrooms
Fluid depth in absorption field before test (in.); ~ o." Immediately a. Rcr ~/.0 gal. water addexi (in.):
Fluid depth -~, S' "(ira.) Minutes later: (,,g"' Absorption rotc .~,~:) 4-
= g.p.d,
Peroxide trcaUncnt (para 12 months) (Y(~ ~,v,,,)/~ //*~Jg~.~ ff yes, give date '~'~
D. LIFi' STATION
Date installed Size in gallons
Mm~hole/Access (Y/N) "Pump on" lev.~~~ "Pump off' Icvcl at*
High water~~alarm level *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding lank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
; On adjacent lots
; On adjacent lots
Public sewer manholedcleanout
Lift station
/oo
/o0 ' 4'-
SEPARATION DISTANCES FROM SEPTIC/HOlDING TANK ON LOT TO:
· ~'-°l/'i Absorption field
Building foundation ·: Property line /
Water main/service line lo I e' Surface water/drainage /o s /d'Wells on adjacent lots
1'4'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ' /0 ~ ~-:. Water main/service line
Surface .water, / O o I'~`' Drivew~., parking/vehicle storage area
Curtain drain /~//>- ' ~oO
Wells on adjacent lots
Properly line
ENGINI~-R'S CERTIFICATION
I certi~, that I have d~nedth~field inspections and review of Municipal
in conforman~idel~ect on this date.
Signature // .~. --~".~C. .... ~
'-~F. agie kiver, Alaska
HAA Fee $
Date
of Pavmem
Receipt Number ~ ~;/t~7~
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Parcel I.D. #
i. 'G£NERAL INFORMATION
..... ComPlete legal description
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
· .. On-Site Services Section
P.O, Box196650 Anchorage,'Alaska 995196650
3 3-4744
· CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
-.~ .,'.'" · ... ~a'ii~:.':. :,
.Lot 4A~ BLock 15~ ~{otm;t.a~ Pa~.k E6~a, te6
Location (site address or directions) 13001, A~pZ~¢ .P*J. ve
· '!7 · ;.' ' "" A~o~q% AK
. .P. roPerty owner E.~.e_. O~o/t
Mailing address , ..~0 ~]~:~ ~d~¢ ~oad
'_Lending agency ' "' .....
Mailing add[~ss '"'"
' ' Address ~600 Co~do~a
Day phone
~ VO¢~ 10509
Day phone
Unless otherwise requested, HAA will be held for pickup.
· .;:;Z-~.,,.;:-.:L~-: --: .... .,...._.; ,. ..... - ..... . -..
2. NUMBER OF BEDROOMS: 4
Day phone 276-2761
AK'99503'
3. TYPE OF WATER SUPPLY:
Individual well XXX --.
.-::)-'-':~;" ' .'"... 'Communitywell- ' ~ ...,-..9~';'""'"'""'"'
.i 77-~ ..... ' ............ Pdblicwater .......................... . ' . .~,'~%~,,,.- .......
,. ·
......... N'O'TEi "'l[communi~/ ~v~[l"SY~t-~n, pr° ~l~ written confirmation from State .A.'~, EC aff~s, tf.?)
7 ..... ingtothelegalityandstatusofsystem, ;, ~ .
' ~.;
~-PE OF WZ'ASTEWATER DISPOSAL: · ': ~;'" ~"
4.
~ /;.',..' L; ,.'.-'<
% -~.., ,, .,-. ,,0 ~ ..
Individual on-site .. ~ ',,,*?~:'Z:'. ..... ,
":'-~'.'i',:':....-'_ . Holdine~-:';~':2' .'~ ' "' :-. ' ' '"', I('L t.:" -"
.... ;.' ' tank *,:d:','. ,~':g., - - - - '-~'~ .........
':'" '"" .... "" -",., ....,,~o,dmun~,~. ,..-;gn:-~'/"~ ': "" ' '*' ' .......
· ,'.': '~: :. ?.'.-: : Public sewer :-.:~ ~.:';: ;:"r:;~ ..... ;* ~
'~,..,'U. , ',~.;:' : ; :'-" ,,' ".' * "' ' .';
- ,~-.,:. -i; NOTE: .'-If community wastewater $)/Stem, provide'written confirmation from State ADEG ..(','
;.' ~, .'i *.:, attesting to the legality and status of system.':!::'.:.~* :: ..... ;~*.,.~:;' .;~;'..: ..:, ~; :i,):7-?..::;.; *.: ,.~i*:". ~,'.i~i~--.~* ;.:
· . '~".~"~.', · ' - :7 .'. '.:.: 'L ':"~i' ",".' ..":, --" · '. ' * ' '7 ' *:
: ; ..... · '-' ":"' : '' · r'':''*." . ' ' * :;.
.'~ 72-02~.1/~1) Front MOAII21 ' . , ..:,:. :,.,:', .......... ~ : ' . ";' ' .-' ~ -- ' ',"":.,
· ~ .. . .
...................................... .:'~.:..~ ...... ; ...........
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,
ordin, a0ces, and regulations in effect on the date of this inspection.
S & S ENGINEERING ..............
Name of Firm : 7c,;4 =o~,'~ ~.:~ ~ Lc,~,p ~c;. ~"'~ Phone
CE. -
6. DHHS SIGNATURE
_~..::L ..... ;~;Approved"..:'-' :lfor.. "":' ':' ':~ ............... bedrooms."" ~':"
· · : .-.. . ; ....~._:.. :...:.~.';. '-.-; -: ':._:. ........ -.::-.-..=_.. ' .:'.:-.. :. -.: .: '"~ ..':_"A.._: ......
..... nisan~rnv~l . ... . .. ... :.
..... - -,.. .... . . , -.~.o.~ ,,:.., :' ,. -,~.~ .... .- ..
..... ..;...... .... ,.- .... . .._ __
Conditional apprOval for bedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human S~rvices (DHHS) issues Health Authority
.- '... Approval Certificates based only upon the representations given in paragraph 5 ab~,~e' b~ an indePendent
· "':~ >L pro~essional enginear rt~isiered in the State of Alaska. The DHHS do~ this ~ a eourt~/to pumlm~m of homes
:': '.:: :' '.:: "and their lending institutions in Order to satisfy certain federal and state requirements. EmploYee~'~)f DHHS do not ' ..
....,..A:,:i.i::~,:-:}*C~g'duct Inspections or' analYze d~ta' before'a :certificate is' Issued. The Muhiclpality"of' :A~c:hOm:~e Is not
-.': (:'(% [!.~.::."~' ' ,r~ponsible for e~ro'~ '0~" ~missi0n-~ tn the piOfessiOnal engineer's work..O*','.:~
'~:,.. ~ .,::~' :-_'-~':C-~'?.,<:::,:, .. -...,.L.: .' , .: .'. . '~.?,':E,'K. : ":.';.' '.""::- :'::'.:"'""":*":*'."-':' ~ ''.,"-: .~," .:-
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LoT' ~-A
A. Well Data
Well type
Log present~.Y~N) ('j/~'~
Total depth
Sanitary seelig)
/~(z:r_.~ h'~ /dou~7,q//J ~,~k;' Parcel I.D.
O/?- 3q'l -~?
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~[-/ ~[' Driller .~//~'~:-/,.3 /.~/~.fU_//',J~
.Casedto 170r " . Casing height [
.Wires proper y protected~N) ~'~' -~
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
/../~--,
Septic/hekfi~ tank on lot
Absorption field on lot [190
FROM WELL LOG AT INSPECTION
14- ' /55'
; On adiacont lots.,
; On adjacent lots
Nitrate
Public Sewer manhole/cleanout
Petroleum tank
Collected by:
Public sewer main
Sewer service line ~ ~
WATER SAMPLE RESULTS:
Coliform (~//00 ~ ..~
Date of sample: ~/~ ~'/
Other bacteria (--"//"'
B. SEPTIC/HgL-DING TANK DATA
Date installed ,.
Cleanouts(~) '(~tr~.Li' ..,
Tanksize ,/~ '~? ~,~/---
Foundation cleanout Y~)
Compartments
Depression (Y~)
High Water i~'larm (Y~)) p'O.i;
Date of pumping ¢/~'/~G- Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDff~C TANK TO:
Well(s) 0~'lot" :' ~'e;~!?' On adjacent lots [C~ l~
To prope~ line" [0' ~ Absorption tield [0 r~
Alarm tested (Y/N) ~///~,
Foundation ,~/'[-'
Water main/service line /O/'-~--
Surface water/drainage [OO r,/,
~-m6 (~3)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
;'PumP on" level at
Meets MOA electrical codes (Y/N)
Well o..~ On adjacent lots
D, ABSORPTION FIELD DATA :
Soil rating (GPD/Ft~)
M~.nufacturer
Manhole/Access (Y/N) ~
~P pu~-~off" Level at'
Date installed
Length
Surface water
Total absorption area ri~'O [='"~-. .Cleanout presen~J~l) ~,5 ' ~pre~ion over field
Date of adequa~test. ~/~/~ ' Resul~f~il) .. ~ ~ f~ ~ ~Ou~
Waterlevelinabso,tionfield beforetes, ~ + ~_ 'f~ ~ erte~t).
Peroxide treatment (past 12 months) ~) - ~O~ ~ ~-~lf yes, gDe date
SEPA~TION DISTANCE FRoM ABSORPTION FIELDTO: ~ ~E ~D ~5 ~ECK/~'
Well on lot [OO I~ On adjacent lots [ O O ~ Prope~ line
To building foundation . ~O /~ To existing or abandoned system on lot
On adjacent lots ~/~ Cutbank r ~ W;ier mai~sewice line
Sudace water .//OO r,/--- Driveway, parking/vehicle storage area _. ,~"~/ '
Curtain drain '_./U~/'J(:~ '/'(-AJ OC, J/,J -
E. ENGINEER'S CERTIFICATION ~
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on t~e date of this inspection.
Date of Pa~ent
R~ipt Numar ' '
72-026 (;3/93)° Back
.......... 5¢75v
:7
WaNer F~ $.
Date of Payment '
ReceiPt Number :
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
'OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ~rCJj ~..~.~
GENERAL INFORMATION
(a) Legal Description (include lot. block, subdivision, section, township, range)
Location (address or directions)
13001 AIF;
(b) Applicant Name ~"~'~((~'- -'r~,mc~) Telephone: Home ;~ ~,5"'- Ib-,5"~. Business ~'"'~'~
ApplicantAddress .c~ ~:~,/-~ne ~/~er~t[~a ~ ~:)00 ~ ~'~.,, /~ ~o,'¢zd~'C
(C) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer I-I; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [~. Multi-Family[]
Number of Bedrooms ~
Other
3o
WATER SUPPLY
Individual Well [;~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. ·
SEWAGE DISPOSAL
Onsite I~ Public [] Community [] · Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72.025 (tt~84)
5o
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal alfixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
Address
Date ~ I~ I~
Approved for ~"~,~' ,4~ bedrooms b
Approved .~'/ Disapproved Conditional
Terms o Con~li[i~nal Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Desc.ription: L.o~
' ~.,,,~',,, ,",~,-I,
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth 17
Static Water Level I~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
MUNI¢IPN.riy OF
DEPT. OF HEALTH
EN~Ia3NMENTN.
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
If A, B, C, D.E.C. Approved (Y/N) N,~-.
Date Completed t~/~r'~l ~ I~1 Yield
Depth of Grouting I~,/I.
Pump Set At ....~' I ~'¥~
Sanitary Seal on. Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots '~.
{~" ; On Adjoining Lots ;> ~'c,~, ·
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date 3'/1~/,~,~'
To Nearest Edge of Absorption Field on Lot
Water Sample Test Results
Comments. ~/~f~- ~ff~'~
B. SEPTIC/HOLDING TANK DATA
Date Installed I&'/ /f / 7/ Size I~'~ 7~'g/ No. of Compartments
Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~' Date Last' Pumped ,,~/I-~
Pumping/Maintenance Contract on File (Y/N) N',,a,. ; for
Holding Tank High-Water Alarm (Y/N) N,,~4,
Separation Distances from Septic/Holding Tank:
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well ~,:3
To Property Line ~, [o
To Water Main/service Line
Course ~. Ioo '
To Building Foundation ~o r
To Disposal' Field ~.,~ '--~'" &~,/~,~ c.c,.~'
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata &r.~
Date Installed {g//'g/
Width of Field I~t
Square Feet of Absorption Area
Depression over Field (Y/N)
Type of System Design
Length of Field ~'
Depth of Field g' '
Grayel B~ Thickne~ ~.
Standpip~ Present (YIN)
Date of Last Ad~uacy Test
Results of Last Adequacy Test.,
Separation Distance from Absorption Field:
To Water-Supply Well I t~' '
To Building Foundation ~.'
Lot
To Water Main/service Line
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~, 3'0 '
To Cutbank (if present) N''4'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION H,A ·
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'~ ~.~ Date /'~:~/~
Company ,c~'~/~ ~--.~¢.~,,~,~/' _.~ MOA No.
Page 2 of 2 ~,~.,~ .... ...
Engineer's Seal
MUNICIPALITY OF ANCHORAGE
' DMSION OF f/gVIRONMENTAL HEALTH
DEP~ OF HEALTH AND E1~57I~ ~ON
APPLICATION FOR HEALTH ;~'fHORITY APPROVAL CRKTIFICATE
1. General Infc~ation
Applicatio~ ~te
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 4A Block 13 Mountain Park Estates Subdivision
Location (add~ess c~ directions)
(b)
Ap?lfcants Name K.F. Hollingheadr
Applicants Add~ess SRA Box 364-G
J r. Telephone
Anchorage 99507
(c) Applicant is (check one) LendinG Institution
Buyer ~-~; Other ~ (explain);
(d) LendinG'Institution Alaska Mutual Bank
~--~; Owner/builder ~-~;
Telephone
Address
(e) Beal Estate Cc. & AGent
Address
Te le phone
2. ~Type of ~sidenoe
SinGle-Family ~
Number of Bedrc~s
3. Water Supply
Individual Well
· ~nlti-Family ~-~
four
C~,~unity ~
Other (describe)
Public~
Note: If ~u,,~.,nity ~ell system, must have w~itten confirmation f~cm the State
Depa~h~ent o.f Envirc~mental' Conservation attesting to the legality and status.
Is the ~11 adequate fc~ the number of bedrooms specified in this HAA (Y/N)
Sewaqe Dispcsal
Onsite ~ Public ~-~ c._*.,,~.~nity ~-~ Holding Tank ~-~
Is the wastewater disposal system adequate fc~ the ~umber of ~edrocms (Y/N)
[Page 1 of 2]
2-15-84
Se
En~ineerin~ Firm Providirg, Inspections ~ Tests ~ ~3sta and Infc~mation
I oertify that I ha~ c~cked, ~ified, <~r oonfo~-d to all FDA HAA Guidalines in
effect on the date of this inspsction.
Signed
Nam~ of Firm
Add~ess
S i~r~d by
(ENGIN~ SEAL)
Dste
Telephc~s
This Department has received
written confirmation from the
eng~neer(Corwin & Associates)
regarding the conditional of
April 19, 1984. These conditions
have been completed and this
property is now fully approved.
· 6. DHEP Approval
Append for
Appro~d ~-~
Terms of Conditional Approval
Disappro~d ~ Conditional ~--l ~ "
The Municipality of Anchc~age Department of Health and Envirormental Protection dces
not Guarantee the continued satisfact__~ry perfGrmanoe of the wate~ supply and/c~ the
wastewater disposal-system. This approval indicates that, as of the validation date
shc~n abo%~, based o~ the data and i~fc~mation furnished by an e~3ineer registered in
the State. of Alaska, the water supply and wastewater disposal system is safe and func-
tional fc~ the rnmber of kedrecms and type of structure indicated.
(~HEP SEAL)
7. Mail the HAA to the followirg address:
KB2/d5/s
[Page 2 of 2]
2-15-84
1. General Inf,~,~mticn
(a)
(b)
~ga~, Description (include .lo.t, b~
Location (ad~ ~ di~ectic~)
subdivision, section, tcwnship, range)
Applicants Nam
Applicants Address
(c) Applicant is (check'one) Lendirg Institution [---]; ~ner/kuilder~
· Buyer ~; Other ~ (explain);
Address
(e) Real Estate Co. & AGent
Address
e
Telepharm
Type of Residence
Single-Family~
Number of Bedroa~s
~nlti-Family ~
Other (describe)
3. ~tter Supply
Individual ~11 ~=~ Oa~:~.,nity ~-~ Public [-~ ,
Note: If c~,~dnity ~11 system, must have written ccnfirm, ation frcm the State
Deparhrent cf Envtroi-m~ntal Conservation attestipr3 to t~ legality and status.
Is the w~ll adequate for the number of bedrCcms specified in this HAA (Y/N)
,'.
4. Sewage Disposal
?nsite/~ Public F~ C~,,,unity [-~ Holding Tark ~
Is the wastewater disposal system adequate for the rnml~r of b~drocms (Y/N)
[Page- 1 of 2]
2-15-84
51 Eflgineerin~. Firm Provihlr.~ Inspections, Tests, ~ta and lnfcrmation
I c~rtify that I hav~ checked, verified, c~ confo~'~,ed to all MDA HAA Guidelines in
effect on the date of this ir.~pection.
.,,"-J,
/,/~ _~. ~ , (~ S~) ~ '.
~sappro~d~
//
.6. DHEP Approval
Appro~d for
Appro~d ~
The Municipality of Anchorage Depa~;,~nt of Health and Envircrn~ntal Protection dces
ncr guarantee the continued satisfacto~f perfo=f~mnee of the water, supply and/or the
wastewater disposal system. This approval indicates that, as of '~e validation date
shc~rn above, based on the data and information furnished bi; an en(3ir~er registered in
the State of Alaska, the w~ter supply and wastew-ater disposal system is safe and func-
tional for the rnmber of bedrocms and type 'of structure indicated.
(UdEP SEAL)
7. Mail the HAA to the followir~3 address:
KB2/d5/s
[Page 2 of 2]
A. ~ELL I~TA
MUNICIPALITY OF ANC~IDRAGE (M(~)
HFALTH ;~n%IO~TY APPROVAL (BAA)
CHECKLIST - FEBRUARY 1984
Well Classification/~
Static Water [e~l //d ~
Casing Height Abo~ Ground
Pump Set At
Sanita7 Seal on Casing (~,
Electrical Wiring in Conduit (Y/N)
Separation Distan~ss f~ Well..
To septic/Holding Tank on Lot
To Near~st Edge of Absc~ption Field on Lot /~o ' ; On Adjoining Lots >/oo '
To Nearest Public sewer Line /,62 To Nearest Public se~r
Cleancut/Manhole ,4//~2 To Nearest sev~= Servi~e Lins on LOt
Water Sample Test results j'~zT~.¢~'~7~--~/
SE_z~PIC/HOLDING T3%NK ~A
Dat~ Installed / /?/
s . ims
Air-tight Caps (Y/N) ~
No. of Co~a~tmsnts
Foundation Cleanout (Y/N)
Pumping/Maintenen~ Contract on File (Y/N) ~ ; fc~
Holding Tank High-Water Ala~ (Y/N) /F',~ Temporat-y Holding Tank Permit (Y/N)
separation Distances f~ Septic/Hcldin~ Ta~3~: - ,
To Water-Supply Well ~3 / /. ~. ~ To Building Foundation 30 ' 7~ g/~
To Property Lir~ ,,% /o / ' To Disposal Field ~FL~ "~'/'~"~
To.W~/M~im,~service Line ~'ro Stream, Pond, T~ke, c~ Major D~aina~e
2r15-84
Date C~,¥letsd, ~'/-,,/ ~/ Yield
Z~,,o~-,~ Dapth of G~c~ting ~,,~"
Soils ~ating in Absc~pticn Strata
Date Installed / o/?/
Width Of Field /¢ '
Type of System Design
I~ngth of Field ~
Depth of Field ~;& p
Gravel Bed Thickness
D. LIFT STATION
Date Installed
Si~s in Gallons
"Pump On" ievel at
High Water Alarm Isvel at
Tested for
Electrical Codes(Y/N)
Mannole/access (Y/N)
"Pump Off~ Level at
Ve~t (Y/N)
l~ping cycles du~ing Adequacy Test.
** Check Permitted Bedroom Rating Against HAA Bequsst **
I certify that I have checked verified, c~ confc~msd to all MOA HAA Guidsli~es in effect
Signed
Km/d5/s
[Page 2 of 2]
2-15-84
.DEPT. OF ENVIRONMENTAL CONSERVATiON
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
/
BILL SHEFFIELD, ~OVERNOR
Telephone: [~07)
,Add'ess:
274-2533
July 12, 1984
Mr. Stand Brust
Corwtn & Associates Inc.
4321 Grape Place,* Suite 204
Anchorage, Alaska 99504
DearMr. Brust:
Subject: Private Well Radius Waiver to 90 feet (8521-WA-004)
Lot 4, Block 13, Mountain Park Estates
The Department has reviewed the subject waiver request and hereby ~Jives
Tthe 100 feet horizontal separation between the Well and septic tank to -
FgOfeet. This waiver is applicable to the existing tank on_R_q]~lcand would
'have to be upgraded to existing code when the system was to be expanded
or replaced.
Sincerely,
Eflviro~ental Engineer
BEE/msm
cc: Robbie Robinson (MOA)
COl?WIN & ASSOCIATES, INC.
CONSULTING ENGINEERS
4321 GRAPE PLACE SUITE 204 ANCHORAGE. ALASKA 99504
(907) 561-615t
April 13, 1984
Mr. Keith Bandt
Environmental Engineering Manager
Anchorage Department of Health &
Environmental Protection
Pouch 6-650
Anchorage, Alaska 99507
Re: Recommendation for waiver of separation distances,
Lot 4, Block 13, Mountain Park Estates
Dear Keith:
Enclosed are copies of the following documents, relative to this
recommendation for waiver of the 100 foot separation distance
between the well and the septic tank for the referenced property.
The Health Authority Approval application and HAA checklist were
previously submitted to you.
As-Built of septic system, dated October 19, 1971.
Drillers Well Log
Copies of Adequacy Test Log, field pumping test of well,
and analysis of the well water.
The septic system and the well system are adequate for this
dwelling. The water analysis was satisfactory. However, a
measurement was made between the well and the cleanout to the
septic tank. The distance measured was 93 feet, indicating that
the tank is approximately 90 feet from the well. A waiver of the
100 foot separation distance is therefore required.
The static water level in the well is 165 feet below ground level.
The ground slopes to the west. The soil profile appears to
consist of fine grained soils past the 22 foot level.
Mr. Keith Bandt
Page ~wo
April 13, 1984
Contamination from a possibly leaking septic tank would therefore
be filtered by about 143 feet of soil. If the contamination did
reach the ground water table, the flow would tend to be downhill,
away from the well.
Based on the foregoing, I recommend a waiver of the separation
distance.
Sincerely yours,
CORWIN & ASSOCIATES, INC.
Stanley Brust, P.E.
Associate
SB:kjh
Enclosures
Frank Hollingshead
SRA Box 364-G
Anchorage, Alaska 99507
FIELD PUMPIHG TEST
DATA SHEET
DATE DR[ LLIrlG COMPLETED: ..~f~/ DR I LLER:
STATIC wATER., LEVEL. (Top of Casing): ~ ./~ '/ ' FT
... Elapse~ Time Since
Clock .Pumping Started/ Depth to Drawdown/ Pumping Remarks ,-
Tine ..... Stopped, Him. ,Water, ft. Recover~, Rate, Ii, PM
:... 45 ,
.-" ~ '1 .-
-: '. .:1~0 (2 hours)
. RECOTERY
.~. I
· ,. : . 15 I .....
50
..... 55 ~ 7~ H
I
STANLEY BRUST & ASSOCIATES
Engineers. Planners o Surveyors
Project No.
~dequacy Test Log
Lega~ Description
No of Bedrooms
Date Time Level Readings Remarks
septic tank
//f
~./ ~
April 16,
CORWIN & ASSOCIATES, INC.
CONSULTING ENGINEERS
4321 GRAPE PLACE SUITE 204 ANCHORAGE. ALASKA 99504
(907) 561-6151
1984
Mr. Keith Bandt
Environmental Engineering Manager
Anchorage Department of Health &
Environmental Protection
Pouch 6-650
Anchorage, Alaska 99502
Re: Lot 4A, Block 13, Mountain Park Estates
Dear Keith:
This will follow up on our phone conversation on April 16, 1984,
regarding the referenced property. Enclosed is a plat showing
the change from Lot 4 to Lot 4A. This entailed a minor
adjustment in the north lot line and does not impact the water or
septic systems on the lot.
I also checked out the discrepancy you pointed in the well
pumping log. I measured the levels again on April 16, 1984, and
found the static water level to be 156'-6". Thus, the figure of
166'-6" should have been 156'-6" and should be so changed on your
log.
On April 16, 1984, I learned that the old pump had failed and had
been replaced by a new one, which was placed lower down in the
casing. I ran an abbreviated pumping test to ascertain the
characteristics of the new system. Equilibrium was reached
within five minutes with a four foot drawdown at 4.92 gpm, and
the well recovered fully 10 minutes after pump shutdown.
A full four hour test was not run since the yield of the well had
been ascertained on the previous pumping test.
Sincerely yours,
CORWIN & ASSOCIATES, INC.
~--fStanley Brust, P.E.
Associate
SB:kjh
cc: Frank Hollingshead
SRA Box 364-G
Anchorage, Alaska 99507
FIELD PU:4PIHG TEST
DATA SHEET
Clock
Tine
PROJECT:
LOCATIO:~ OF t. IELL (Legal Description):
I, IELL DEPTH FT. CASI):G: .x~,~ ~,.ot~, FT
DATE DRILLIrIG COHPLETED: /~Ff~y'~.
STATIC WATER LEVEL (Top of Casing): /__~--~-'~
Eladseo Time Sincel '
Pumping Started/ [ Depth to Drawdown/
Stopped, Hin. [ t.later, ft.Recovery
i ·
. ~ -L 0
DATE OF TEST: ~ mJ~ ~
· SCREEN:
DRILLER: /~
FT
0
1
5
1¢
15
2O I
25
35
40
45
5O
55
60 (1 hour)
9O
12~-]-'[2 hours~
150
lBO (3 hours
210
240
,~ hours'
RECOVERY
0
$
10
15
25
30
45
50
Pumping
Rate, r, PM
0 Start
Remarks
CORWIN & ASSOCIATES, INC.
CONSULTING ENGINEERS
1549 E. TUDOR RD., SUITE 204 ANCHORAGE, ALASKA 99507
(907) 561..6t51
July 16, 1984
Mr. Keith Bandt
Environmental Engineering Manager
Anchorage Department of Health &
Environmental Protection
Pouch 6-650
Anchorage, Alaska 99502
Re: Lot 4A, Block 13, Mountain Park Estates
Dear Keith:
,MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PRO?£CrlON
JUL 1 7 1984
RECEIVED
In April of 1984 a test and an inspection were performed at the
referenced property for a Health Authority Approval. We had
recommended a conditional approval be granted subject to a waiver
of the separation distance, that the well have exposed wiring
placed in conduit, and that the cleanouts on the septic tank and
crib be repaired.
A reinspection was made in June of 1984 and it was found that the
cleanouts had been repaired and that the exposed wiring on the
well had been placed in conduits. The Alaska Department of
Environmental Conservation also granted a waiver of the
separation distance. A copy of their July 12, 1984 waiver is
attached.
CORWIN & ASSOCIATES, INC.
.~ley Brust,
Associate
Based on the foregoing, we recommend that an unconditional Health
Authority Approval be granted to this property.
S incer ely, ~E O..F.
,.., ~\~. ....... ..~.e~ ,,
--
SB:kjh
Attachment
CC:
Frank Hollingshead (with attachment)
SRA Box 8896
Rainbow Valley
Indian, Alaska 99540
264-4720
Susa.. Oswalt
Dept. He&l~_h & Envo Prot.
825 L Street
Anchorage, . Ak. 99501
~('~--dK-'-~--~. 4S 472 SEHD PAR'TS ! AND 3 WITH CAR~ON INT&~I'
PART 3 WILL BE RL~UIENED WITH REPLY.
DETACH AND FILE FOR FOLLOW-UP
· ' . .--' ' MUNICIPALITY OF ANCHORAGE~M...-.-..~.. ]~.
I " DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~I~IINICIPALh T "-;~' ~.~4~A
ENVIRONMENT,LL
ENVIRONMENTAL ENGINEERING DIVISION
Tel.phone 2~720 MAR20
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~ ~Ei~E
,DIRECTIONS: Complete ell pa~; ~ ~ 1. I~ompll~ r~ will n~ ~ pr~, ~eate allow ten (10) days for pr~sing.
1. PROPERTY.~NER ~ I
' MAI LING ADDRES~ '
F2. B~ PHONE
MAI LfNG ADDH ESS
M~ING ADDRESS
lld DRIVE .UM.ERO..EDROOMS
r"-I One ~ Four
~ SINGLE FAMILY I--I Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL'
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is requ'ired for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
SEWAGE DISFOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
I--I PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
' -
THIS SIDE FOR OFFICIAL USE ONLY -
DATE RECEIVED. -
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY I--1 ONE [] THREE [] FIVE I-] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED , '
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
I[] INDIViDUAL/ON -SITE , DATE INSTALLED
r-1 PUBLIC UTI LITY ~ I ~'")
Connection Verified. INSTALLER J
[]Septic Tank or I--1Holding Tank
Size: I ~ ~ If Tank is homemade SOILS RATING
give dimensions: '" '
TYPE OF TANK MANUFACTURER \
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
!5. COMMENTS
[] CONDITIONAL APPI~OVAL (letter must accompany certificate)
~-DISAPPROVED
DATE -. BY (Title)
LEGAL DESCRIPTION
72-010 {Rev. 3/78)
Preston Phillips
Totem Realty
?24 E 15th
Anchorage, Alaska 99~01
.-' Tobben Spurldand P.E.
8155 Cranberry St.
Anchorage, Alaska 99502
Phone (907) 243-5302
April 8, 1980
SEWI~R--A DE QUAC Y TEST
LOT 4, BLOCK 13, MOUNTAIN PARK ESTATE
Residence
4 bedroom, single family
Water System
Sewer System
Date of Test
Test Procedure
On site well, location not known
From Municipal Records:
1897 gal. concrete tank
Log Crib
Effective Absorption Area;
Soil rating 200
April 7,8,1980
~20 sq. ft.
Water Volume 0
System was inspected on April 1, 1980. Pit was found
dry. /~ - - - ?~
On Apr.i~. 7 the-t&-~ w~~ump~d~and water introduced into
the-pit~ '~e foli~~'gs were t~en
m~h
., 0 ~ches.
~ Apr~ 8 the depth was meas~d ~d fo~d to be
1~ ~ches
Ab~rpt ~on
~7-~? = ~/~ ~.
2~ --~---
~is System meets the M~ici~ ~qu~ements.
nicipalityAnchor ¢O
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
March 26, 1980
Preston Phillips
% Totem RealtY Inc.
724 East 15th Avenue
Anchorage, Alaska 99501
Subject: Lot 4A Block 13 Mountain Park Estates Subdivision
Earl W./~a¥.~Da~.l~_~op~rt~ ........ !~
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1)
The water analysis report be delivered to this
office from Chem Lab, 5633 B Street, for our
review.
Expose the well for our inspection to determine
proper construction, also to insure the minimum
distance requirements are met between your well
and sewer system.
(3)
Expose the standpipes to the septic tank and to
the seepage area for our inspection.
The septic tank pumped with a recept submitted
to this office.
Preston Phillips
March 26, 1980
Page Two
An adequacy test be performed on the existing leaching
area. This test will determine if the system is
adequate according to National Standards. A listing
of private firms performing the test is enclosed. This
report needs to be submitted to this department for
our review.
if there are any further questions, please contact this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: First National Bank of Anchorage
Mortgage Loan Department
Post Office Box 3128 99501
