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HomeMy WebLinkAboutTONJESS ESTATES BLK 2 LT 12Ton jess
Estates
Block 2
Lot 12
#051-832-19
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141304 PID Number 051-832-19
0 New ✓❑ Upgrade
Name:
Aron Crowell & Dee Hunt
Address
25145 Schaff Drive Chugiak, AK 99567
Phone
Number of Bedrooms
3
ABSORPTION FIELD
❑✓ Deep Trench 0 Shallow Trench ❑ Bed ❑ Mound
❑ Other
Soil Rating
1.2 GPD/SF
Total depth from original grade
LEGAL DESCRIPTION
Subdivision Block Lot
,Tonjess Estates 2 12
Depth to pipe invert from original grade
1.9 R.
9.9 Ft.
Gravel depth beneath pipe
8 Ft.
Township
Range Section
Fill added above original grade
0-1 Ft.
Gravel length
25 Ft.
SEPARATION DISTANCES
Gravel width
3 Ft.
Beds: Number of Lines
From
To
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
400 Ft2
Number of trenches
One
Well
>100'
>100'
N/A N/A
>25'
Distance between lines
Ft.
Dist. between trenches
Ft.
TANK E Septic 0 S.T.E.P. 0 Holding 0 Other
Surface Water
>100'
>100'
N/A
N/A
Lot Line
>5'
>10'
N/A
N/A
Foundation
>5'
>10'
N/A
N/A
Curtain Drain
None
Noted
NA
Manufacturer
Anchorage Tank
Capacity
1,000GaI.
Material
Steel
Number of compartments
Two
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Flow Diverter Valve Installed and Existing
Absorption Bed Tied in for Future Use. Existing
Septic Tank Decommissioned in Accordance with
Municipal Code.
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
G & R Excavating
Inspector A Harala
Inspection
dates:
15` 9/3/14
2m 9/4/14
e 9/5/14 4"
PIPE MATERIAL
House to tank
DTank to
3034 D3034
draingeltl
Drainfield F810 CO/MT D3034
BENCH MARK (Assumed elevation) 100.0f
Location and description
Garage Slab.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval:
Date
Approve� '� // Date
Inspection Re T1-1-12.doc
�0' 1'941
,`Q:•• 9►i
•
e
s'* 491a•
MICHAEL E. ANDERSON . <r ®'
,• CE -4381
0'D • Z. S ./S -••4c"`
►al PRO rEssv30\:i.e
ktnnt
,p�
Municipality of Anchorage
Permit Number: OSP141304 DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
N
TONJESS ESTATES SUBDIVISION
LOT 12, BLOCK 2 , Qn
31,453 SF N1O
NOTE:
Existing Septic Tank
Decommissioned in
Accordance With Municipal
Code.
A B
12.7'
17.9
28.7
29.2
C5 39.5' 50.5'
S1
S2
C4
M1
16.9'
15.3'
25.1'
26.2'
tp
Lot 9 Well\
100' Radius
TH 1®
C5
Existing Absorption
Location Unknow
Bed Located in
Trench Vents, H
and Robert Joh
:-d. Exact
Unknown.
M1
4
51
1
7
1
LEGEND:
C4 — Clean Ou
TH — Test Hole
M1 Monitor T be
FSV — Flow Sp$tter Valve
81 — Septic Vent
Vents in
R ation to New
se Corner
son Survey.
Page 2 of 3
PID NO.: 051-832-19
Existing_
Well
NOTE:
Drawing Not Completed
From Surveyed As Built.
Locations are Not Exact.
5•
Rp
ialcV
4j�9—tfh),4
04%MICi E. c
0 N CE -4381
.04
73 PLAN AS BUILT
SCALE 1" = 30'
Miinicipality__ofAnchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP141304 PID No. 051-832-19
N
U
U
Finished Grade
W
94.0 >
N NM 0
co 00 LL
Existing Finished
Ground
.....IIIL
000 Gallon
Septic Tank
89.6
87.5
9.4
90.1
8
Existing Grade
85.6
Geotextile Fabric
Drainfield Rock
77.6
71.5
No Groundwater
8-21-2014
25' (Trench Length)
PROFILE AS -BUILT
No Scale
85.6
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141304
Tax Code Number: 05183219000
Work Type: Septic Upgrade
Permit Effective Dates: September 03, 2014 to
Design Engineer: ANDERSON ENGINEERING
Subdivision: TONJESS ESTATES
Site Legal Address: TONJESS ESTATES BLK 2 LT 12 G:1462
September 03, 2015
Owner/Address:
CROWELL ARON L &
HUNT DEE C 25145 SCHAFF DRIVE CHUGIAKAK 995675721
Lot Size in Sq Ft: 31453
Total Bedrooms: 3
Site Mailing Address: 25145 SCHAFF DR, Chugiak
Vr;ay 2:y0
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date: q��—/y
9 3 /Il
Issued By: �� .or Date:
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-832-19
Property owner(s) Aron Crowell and Dee Hunt
Mailing address 25145 Schaff Drive Chugiak, AK 99567
Site address
7-343-7904
BMITTAL
AUG 5 2014
Same
Legal description (Sub'd., Block & Lot) Tonjess Estates, Block 2, Lot 12
Legal description (Township, Range & Section)
Lot Size 31,453 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR:
(& all that apply)
APPLICATION IS AN: TYPE OF DWELLING:
Absorption Field Initial
Septic Tank Upgrade
Holding Tank ❑ Renewal
Privy ❑
Private Well ❑
Water Storage ❑
❑ Single Family (SF)
❑ (w/wo ADU)
Duplex (D)
Multiple Dwellings
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
*Ltd E Com,
(Signature of property owner or authorized agent)
Permit/Rush Fees: 60 — Waiver Fees:
O
Date of Payment: D/514 Date of Payment:
Receipt Number: /�©Q3 Receipt Number:
Permit No. LJSP(6fq Waiver No.
Permit App_9-1-12.cloc
ON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK99524
522-7773 677-7766 (FAX)
August 5, 2014
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: Lot 12, Block 2, Tonjess Estates Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer
The existing septic tank on Lot 12, Block 2, Tonjess Estates Subdivision has failed and
must be replaced. We are therefore requesting a permit be issued for the upgrade of
the septic system to accommodate the three-bedroom home on. The attached Site
Plan and backup documentation identify the location and configuration of the existing
and proposed septic system. The existing septic tank will be decommissioned in
accordance with Municipal Code. The existing absorption bed will be left intact and
connected to the new system with flow diverter valve for future use as needed. Also
identified on the plans are the locations of the existing well on this and adjacent lots and
adjacent septic systems. No conflicts exist between the proposed septic system and
the wells on this or adjacent lots. Protective radii are shown to the adjacent wells.
Drainage arrows are shown indicating the current drainage pattems. The drainage
patterns will be maintained after construction.
The test hole placed on the lot indicated Well Graded Gravel with Sand (GW/SW). No
groundwater was noted and none developed during the monitoring period. The
percolation rate in the soil was found to be 4 minutes per inch. We have designed the
new trench with an application rate of 1.2 gallons per day per square foot. We are
proposing to place a 24' long by 3' wide absorption trench with an 8' effective depth.
The total depth of the trench will be 10'.
The ground surface on the lot slopes from east to west in the area of the absorption
trench. The trench will be placed parallel to the slope as shown on the attached
drawings. A minimum of 100' will be maintained between all components of the septic
system and the proposed well and from any surface water in the area.
Lot 12, Block 2, Tonjess Estates
August 5, 2014
Page Two
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattem will be maintained.
Sincerely, p
n a 6L2
Michael E. Anderson, P.E.
Attachments
TONJESS ESTATES SUBDIVISION
LOT 12, BLOCK 2
31,453 SF
SCOPE OF WORK:
Decommission Existing Septic Tank
in Accordonce With Municipal Code.
Ploce New 1,000 Gallon Septic
Tank and 2 Post Tank Cleonouts.
Ploce Flow Diverter Valve and New
24' Long x 3' Wide x 8' Effective
Depth Absorption Trench.
24' Long x 3' Wide
x 8' Effective Depth
Absorption Trench.
Lot 9 Well\
100' Radius \
1
LEGEND:
TH — Test Hole
CO — Clean Ou
MT — Monitor Ire
FSV — Flow Sper Volve
SV — Septic Vint
/
CO
CO
1,000 Gallon
Septic Tank
S�
SV
2C0
7
Existing_
Well
NOTE:
No Groundwater within 100' of the
Septic System. No Excessive
Slopes within 50' of the Septic
System.
0
-�PP
i t�fl�flAh.1,h
/
49th 4-•i
irati
SPO, MICHAEL E. ANDERSON; Ent
•
#C"` •
No. CE ' ,-4391 �
SITE PLAN
SCALE 1" = 30'
LOT 12, BLOCK 2, TONJESS ESTATES SUBDIVISION
DESIGN FACTORS:
Three Bedroom Home
Perc. Rate: 1-5 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
Deep Trench System
1,000 Gallon Septic Tank
8' Drainfield Rock
3 Bedrooms * 150 GPD/Bedroom = 450 SF Absorption Area
450 SF/1.2 GPD/SF/16 SF/LF= 23.44 LF Trench Length
THEREFORE: Decommission Existing Septic Tank in Accordance with Municipal Code. Place
New 1,000 Gallon Septic Tank and Construct 24' Long x 3' Wide x 8' Effective Depth Absorption
Trench. Flowline Elevation to be 2' Below Original Ground Surface Total Trench Depth to be 10'.
Provide 3' of Cover Over Absorption Trench and 4' of Cover Over Septic Tank. Place Flow
Diverter Valve to Connect Existing Bed for Future Use.
1'6"
3'
Geotextile Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL DEEP TRENCH SECTION
,.�
(NO SCALE)
a....
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
•
41.4444s249th s -V
MICHAEL E. ANDERSON INE
♦ ��':
�. SNo. CE -4381.' r���
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Lot 12, Block 5, Tonjess Estates
PERFORMED FOR: Dee Hunt/Aron Crowell
DATE: 8/21/14 PROJECT No •
PARCEL ID#• TECHNICIAN: A Harala
2 —
3
4
5
6
7
8
9
1011
12
13
14
15
16
17
18
19
20
TEST HOLE 1
OB/OG
GW/SW
WELL GRADED GRAVEL
WITH SAND
B.O.H.
WAS GROUND WATER ENCOUNTERED?
IF YES @ WH
DEPTH OF WATER AFTER MO
DATE OF MO
SLOPE
No
444
2 49th� '•�$
el ..` 0A
1 MICHAEL E. ANDERSON ? z
Professional Engineer, Stamp:
SITE PLAN
See Site Plan
LT DEPTH?
ITORING: None 0
IITORING: 8/30/14 tC
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
8/21/14
1
11:36
.75"
2
12:06
30
8.25"
7.50"
3
12:07
.50"
4
12:37
30
8.00"
7.50"
5
12:38
.75"
6
1:08
30
8.25"
7.50"
PERCOLATION RATE: 4 0 (MIN/INCH) PERC. HOLE DIA. 12 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS. TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 8/30/14
4 .. • MUNICIPALITY OF ANCHORAGE
•
1 r \\
► (i I
` -
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
• 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAMEPHONE
N' Ca. lia_ ctn
.94 ;Soy
KNEW
❑ UPGRADE
MAILING ADDRESS
r O So)c 77Z 793E -71,_R; ve�j AK 99577
LEGAL DESCRIPTION
TOnJess g-sfu4rs J Of /Z B/0k2-
LOCATION
P.'S c.Y.e.-k--
NO. OF BEDROOMS
v Y
w1Manufacturer
N I-
DISTANCE TO:
Well
/OPj
Absorption area
'}/•
Dwelling
$'
PERMIT NO.
9Vo?$2_
6
Material .S-{ee-1
No. of compartments 2
Liq. capacity in gallons
HOMEMADE:
Inside length
Width
Liquid depth
IF
t] Y
JOX
S — <
gll
Dwelling
PERMIT NO.
DISTANCE TO:
Manufacturer
Material
Liquid capacity in gallons
TILE
GRAINFIELD
TRENCH
DISTANCE TO:
Well /yD
Foundation 3D•
Nearest lot line I �•
PERMIT NO. 8t% oy yZ
No. of linesLength
3
of each line f
2$
Tete4-leogth-effines
el Ie. Ji 31'
e.
T.rwidth
8 .17 • laeieee
Distance between lines
Top of tile to finish grader
5 Z
Materia l ber��ath tile
Ved to inches
Total effective absorption area
5Z7$f
SEEPAGE
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
3
Class vr;vecit..
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
/oB
I
wail
PIPE MATERIALS
Y"evc 69%57/1 D3 030 ee4s774D 2721
SOIL TEST RATING
•1
0
O
f
No/h,
INSTALLER
54e-ve- b k 3
a 11
REMARKS
•
F
m
aF� A /
F.I•.• 4se/as
/0
1
. ••A'°rs
' •.•••'i
b�`
a
1
L
ra ,:h#0
r •
. • d
.'TH ,'
n
11
1111
`
1\
•
16 I/. .�
C‘C /r
s ••••' -..4. d's
,
'''ESS `;�.w'•" 21it�t cor�ts
e`d,tFs•C4- ice •
Z...r
4
fes•)
A P VEDi DATE LEGAL le,18te5
//I� /2'2-88y %onus. sv.n-�zs o4 (J /ockZ
2-013 (Rev.3/
K6 U4Be.ife" v-6- //,2
LOCATION OF WELL
(Please complete •Ilh.r lo, Ib or Io.)
r,..,'\ WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological Q Geophysical Surveys
Drilling P.rmll No.
A.D.L. No.
0 Borough
Subdivision
Tonjess
Lot
(2-
Blocs
2—
Ib. 1/e Qtrs.
—of_et—of ^
Section No.
Township ND
sO
Range ED
w0
Meridian
1�. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Street Address and Area of Well Location
3. OWNER OF YELL: Mr. Kit Callahan
Address: P.O. Box 772993
Eagle River, Ak.
99577
2. WELL LOG
Feet Delow
Surface
4. WELL DEPTH: (final)
240
S. DATE CF COMPLETION
15 84
--,—
ft.
.10 - -
Material Type
Top
Bettors
band, gravel, silt
0
30
c. 0 Cable taolXX Y' a pry p Driven ❑ Dug
--Grey—rozk
.-01-15D-
0�YAuger 0Jet ed ❑Bored Other:
Grey and greenstone, water
100
120
T. UAX omeelic p Public Supply 0Industry
s0
120
LOU
0 Irrigation 0 Recharge 0 Commerical
Greenstone and water
200
210
0 Test Well 0 other:
Grey rock and greenstone
210
240
0 CASING: 0 Thr.aJ.dXXM Welded
diem. 6 In. to.3.2,_ ft. Depth Welgh117 Ibs./ ft.
Com. In. to It. Depth Stickup 11.
9. FINISH OF WELL:
MUNICIPALI FY- OF ANL.AUMGE
DEPT. OF --:EMT#
&
Type: Diameter:
ENVIRONMENTAL PROT
CTION
Slot/Mesh Stye: Length:
Set between 11. and It.
f� l.]�
JAM 2 3 iY`
i
5
Daekfillinq G,.y.l Doak
38 � 1 0 8"
R eEiv
D
10. STATIC WATER LEVEL: ff. /15/
5
L c ' V
Deft
0 Above or X Tdow land surface
Equipment used:
11. PUMPING•LEVEL below land surface and YIELD
ft, after hrs. pumping g•p•m•
ft. otter hrs.' pumping • g.p.m.
-
12.GROUTING Will Grouted:' 0 Yes 0 No
Material: 0 Neot Cement Other:
13. PUMP: (if acailobl.) HP
Length of Drop Pipe ft. capacity g. p.m.
0 Subm• 0 J.' 0 Centtrifical 0 Other
14.REMARKPrOduct10T1 of z GP'1
16. WATER WELL CCNTRACTOR'S CERTIFICATION:
15. Water Ternperolui. 0 F C
Toil. well was drilled under my jurisdicllon and the repot l is True to 1•w best o1 .my knowledge and belief;
Magnuson Dxilling ':AA 5385
Regiaered Business Hon,. Contract License Number
A'�dre:.: P•0. Box 770504 Eagle River, Ak. 99577
e�--�.— Oct. 19, 19'84
Aathorlsed Representative
Form C2•WWR (Il/el) Copy Distribution: WHITE- Slate DGGS, PINN 'Driller, CANARY -Customer
4
c
N
a:
N
0
• a
e
F1LiJ'1 a c a P a'�E_ I TY �� 441,411-IDff� Cie
DEPARTMENT OF HEALTH -AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
QN—E a TO= E tE Fi L' w1=1 _L F'8•^F ' 1 a T
PERMIT NO: 840942
DATE ISSUED: 11/09/84
APPLICANT:.
''ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
I MAX BEDROOMS:
KIT CALLAHAN
P 0 BOX 77'993
EAGLE RIVER, AK 99577
694-5102
SUBDIVISION: TONJESS ESTATES LOT: 12
SECTION: 2 .TOWNSHIP: 15N RANGE: 1W
1A (SQ.FT. OR ACRES)
BLOCK:
Listed below are the options available to you in designing your septic..
system. Choose the option that best fits your site.
DEPTH TO PIPE BOTTOM (FT.)
GRAVEL DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRAVEL LENGTH (FT.)
GRAVEL VOLUME (CU.YDS.)
TANK SIZE (GALS)
SOIL RATING (SQ.FT./BR)
IIID
5.5
0.5
6.0
17.0.
31.0,
19.6
1,000.0 **
115
w_ Drar.l
5.5
1.5
7.0
5.0
54.0
20.0
1,000.0
115
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS'
1
**
• ,I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2.. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances,from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES;
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST DE OBTAINED; (2) AS-DUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
DATE:
APPLICANT: 'KIT CALLAHAN
ISSUED BY � ` � DATE: 8- 9. eci
PERFORMED FOR:
A34,6,?e,
LEGAL DESCRIPTION:
i •4-
,..o3 •
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
S �iA5S 1 �t+i,si'rKc+IM
DEPTH
(FEET)
L"t , 1 !gid a re)-) r i t•
SLOPE
Ole 6 - Anil i
4-
C /4t /4),••••
10-
11
Sµn1.1 4 6, -Ave(
6t/G// &—Iesq/(aw-GP)
l / Jto(rnr..,
12-
13-
14 -
15
16
17-
18-
19-
20 -
COMMENTS Rec. cane- .i .6'e,!
1
a
l
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
DATE PERFORMED:
SOIILS__ LOG
gtT//09SZ2—
❑ PERCOLATION
TEST
!/Y -/V
SITE PLAN
Wr
/1
4a
�--a
Hs
roc`
1.6
5//
,
t
i
SckA
FF
O
0
V
!S•
20
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
sysie at
(minutes/inch)
FT AND
Tot -4./
rent ..4'k "a.,it .tSed a•-e.t c"r•. 13encc
PERFORMED BY: 68f -'-e a -q
72-008 (6/79)
CERTIFIED BY:
FT
De#,Vii,
,Z 7v S/yyQ
DATE: !{ eI{ v
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744 ..
CERTIFICATE OF HEALTH AUTHORITY.
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l D # O3-.'9
1. GENERAL INFORMATION "
Complete legal description • Lot- 12; Block 2;-Tonjess Estates
HAA #:• Hh. • 97L /.9'f
•
•
Location (site address or directions) 25145 Schaff
Eagle River, AK
e • Property owner
;Michael & Wanda Clancy
'Mailing address •-D•
' ,'.ending
`'Mailing address -
Box 672134
Day phone
Chugiak, AK 99567
688-6094
Day phone
Agent -Ro1f.Milton/ Partner's Real Estate
Day phone
Address
Unless otherwise -requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
'TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer •
XXX
NOTE: If community wastewatersystem, provide written confirmation from State ADEC
attesting to the legality and status of system.
72.025 (Rev.1/91) Front MORIN
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 with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & S ENGINEERING
Address
1/u34 Eagle River Loop Road Ao.
Eagle River, Alaska 99577 ,
Engineer's signature
Phone 6'1 1- -9 7
DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Date 6 /a 3/9 7
•rc�a
�►�� OF ��1�
�'C�,' • .ti c>1
I1I 441
6ROBERTLG EOYAN
lc�sr� CE -8801 ;
�lti1i 1>1Ti►SO. .4.1"w
Conditional approval for bedrooms, with the following stipulations:
Note: The well for this property meets existing State and Municipal Codes.
There are nitrates present. It is suggested that aperiodic testing be
performed to insure the wells continued suitabiliaty. Nitrate concentration
is 5.26 mg/1. EPA miximum concentrations is 10.0 mg/l. More information on
nitrates is avotl.-£rov the nn -Sire cervieeq Prngram. i1NAA, 343-4744.
Additional Comments
By: :. •
Date 6— 2 3 -
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 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 wo
rk
72-025 (Rev.1/91) Back MOA 121
Municipality of Anchorage r.
DEPARTMENT OF HEALTH & HUMAN SERKIEESE I V E D
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (I -74
Health AuthorityApproval Cheg,jnlcipality of Anchorage
pp Health & Human Services
Legal Description: Loi r X RUCK 2 7a AJ $5 t 57. • Parcel ID.: 0 S / — Y 3 A --1
A. WELL DATA
Well type Pig
Log present SYN) %E
Total depth a'to
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed / D 4" 13
Cased to 3 a 7 • 04' Casing height (above ground)
14
Sanitary seal ®1N) )' i s Wires properly protected/N) Y[ S
FROM WELL LOG AT INSPECTION
Date of test /0 //r/ sal SIig/97 '46 -
Static water level 3 8 S V. 6
Well production 0 • S g.p.m. S g.p.m.
ac rc,r /4L-li#AA+L IrNOCA s✓/EA,l.I'# 4/
WATER SAMPLE RESULTS: e4 M. A,v qi.$ ie N P.C.
Coliform 0 Nitrate S. 4, Other bacteria i
Date of sample: SIT/ 9 7 Collected by: S 7..44 7 C,Led,tr F 4 /'+ . AN44,e,..,,
B. SEPTIC/HOLDING TANK DATA
Date installed / a`• / g'1 Tank size )0(10:7 Number of Compartments a Cleanouts iygYN) )'E J
Foundation cleanoutfi/N) 7 E 5 Depression (Ye N v High water alarm (Ye N o
Date of Pumping " Y /•1 7 Pumper a' - R • P 4., r, -46-
C.
e4C. ABSORPTION FIELD DATA'
Date installed I ti / Soil rating (g.p.d./ft' orMa/bdrmj 1 i 3` System type 8E 0
Length 3I ' Width
' 7 Gravel thickness below pipe
0, S Total depth °1
Effective absorption area • Cr Monitoring Tube present etN) Yas Depression over field (Ye ^' o
Date of adequacy test b //I/9 7 Results ail) PAs 5 For bedrooms
Fluid depth in absorption field before test (in.); 0 Immediately after'r`o gal. water added (in.): q
7" 3:a
Fluid depth 3-S' (ins) Minutes later. 1-a 40 Absorption rate = `" C 3 0 g.p.d.
Peroxide treatment (past 12 months) (Y/N) ^' ° ^' 'CNC 44 ' If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at"
High water alarm level at* `Datum
Cyc
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 70 o On adjacent Tots 1 0 o 14-
Absorption field on lot / 0 0 .4- On adjacent Tots v o f
Public sewer main /'4 Public sewer manhole/cleanout "A
Sewer /septic service line a. s' + Lift station N /4
SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO:
Foundation 8 1
- Property line / 0 �+ Absorption field S �4
Water main/service line /43 t Surface water/drainage / do * Wells on adjacent lots 100
SEPARATION DISTANCE FROM ABSORPTION FIELD -ON LOT TO:
Property line / 0 + Building foundation/0 "' Water main/service line /0 '
Surface water 70 0 ' f Driveway, parking/vehicle storage area a S
Curtain drain N o' 4- K Na w Pi
F. ENGINEER'S CERTIFICATION
Wells on adjacent lots 10 0 14.
I certify that / have determined thru field inspections and review of Municipal records ' ' r_ ' s are
in conformance with..f A�IAA guidelines in effect on this date.
Signature/''M
/� •
K
Engineer's Name d j t,1 T C. C0 w 9 •v
Date `�a3/97
HAA Fee $
Date of Payment l- `c�-c,
Receipt Number 1.�a111
72-026 (Rev. 3/96)"
Waiver Fee $
Date of Payment
Receipt Number
JUN -20-97 1f::ti9 FROM=MW/DPW OFFICE ID, 563 5389 PACE 4/5
Cr iii Environmental Services Inc.
• a J'Sa
CI &E Ref./,` 972283002 • Matt PON
Client Nanta SG Technical Printed Udell -one 05/12/97 13:05
Projed Narce';l NIA CateredDate/Time 05/08/97 09:21
Mot Samp4.L 1 : L12,B2 Tonjeac Est. Bea ived Dote/raw 05/06/97 09:55
Matrix Drinking Water Ta aita1 Dtmtor: Stephen C. Ede
Orduzd By
p'VVSID 0 Bel"Sed DJ
Sample Rtrr:W.i
Cf&E Miat bin:.;; y- DrinauE Water Program certification wttut is provisional as of 4/6/97.
allowable Prep Anatysis
Parameter Rasutts POL Units Nettrod Limita Date Date snit
Nitrate -N 5.26 0.500 ap/L 3N1$ 4S00-N055S 10 ons 05/09/97 JUL
Total Calton-. i OR N/0 m J COL/IOU NL SN18 92226 05ID8/97 RAH
/'�6.� '.
-----...2.4", t r : 4,1/4_
,or.,k+t,
ss&8
"E Cinee zmq
'�aE
AIAs
FIEUTMALfiiDPor
APPROVALS
SEWER/WATER
&MTN EXTENSTOS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPOR1S
WELL INSPECTION
&FLOW TEST
SITE PL fIS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
OSPOSAL SYSTEM
DESIGN
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
ADEQUACY TEST FORM
CLIENT: t" 1 \ C-4 Ike -G. a-Aca-V'4
CIVIL ENGINEERS
(907)694.2979
FAX (907) 694-1211
DATE: (o-lLI—cj7
LEGAL DESCRIPTION:. L. t22 7_ rot1.3-` SS EST.
0 OF BEDROOMS: '1y
SEPTIC TANK/FIELD SEPERATION TO WELL:
Ot71
TYPE OF ABSORPTION SYSTEM: P2GD SEPTIC TANK SIZE: ) pop
ABSORPTION FIELD DATA: Depression over field (j; IJ
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
/oit RECEIVED
SEPTIC DATA:
LIFT STATION:
Driveway, parking/vehicle storage area:
Curtain drain:
Foundation:
ala
to f�
JUN 2 4 1997
Date of pumping: UK Pumper: M i ipality ul n,.cno aye
Foundation cleanout (Y/N): y Depression (YIN „ ].lept. Health & HUrtlall Serviol
"PUMP ON" level at:
High water alarm level:
"PUMP OFF" level at:
5s -c- p i az.,ZA•.M c , 3ALtC-
TIME
METER
READING
GALLONS
ADDED
LIQUID LEVEL
(TOTAL)
1 •OMMIENT_S__
S.T. M.T. AM.T.
Hr2"
c5" 1
1"
de -4-r1=
—
4-7"
1',30eri
o''
--
1-.ePM
+l Lin
1 "
4-1.'
•"4-',3orA
.tat L
Sop
1"
}ell"
1"
4.0
I
S
ham\ -/QJ
Q. IZIn
7"
-7,"
1'
-Z-
L'—is-011
2
1‘3or-
35-,
_ 3,s_ _y_',_.
-3.S
11" l5
OOIR-- P ..C.,o M ow-rJnA-t-
to o "
1-1fk-T'-.^- V
or
VMS E Slate 1- S3E__ 1
/JJ4 Ate.
l z_b t,3 r....
-tp.'.
c 1 _mirk 4 wt -r-1- --rZ.1
k -A -Z— ,13 S r--,7— r
P�6z t<<,b3
oM.Ig.- I
.r r--ocwDe_,
awl d,
17v-
Cr,
RESULTS: IFAIL: FP%JS
EXPLANATION: 3
TESTED BY:
THIS SYSTEM IS NOT GUARANTEE.[) AGAINST SU
10011? C. COWAN
Etir,ILu
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
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MUNICIPALITY OF ANCHORAGE
• DEPARTMENT, OF HEALTH &HUMAN SERVICES '.
`Division'ot Environmental,Services
r s On -Site Services Section;`:' t' •' ; '
P O BoO96650a Anchorage, Alaska•J 99519-6650 ,
!a -r. ,,343-4744•
' CERTIFICATE OF; HEALTH AUTHORITY .
PPROVALFORASINGLEFAMILY:DWELLING ` t
Y
I{• ,�t� L f 'Y,.l {•.+1 .
arcel l D # ��1 h: 11 .... > HAA# ..WQCli�(>�L',=
•`GENERALz INFORMATION
omplete legal description
Location (site add s
( ress or,directions)1,2 5145 ; Schaff•:Drive.;
Chuq> ak r • AK 99567
Property owner Michael Clancy Dayphone ,.688.7-6094,_(h)::,,
••. ,, ..., -( ,,•. : r .ail ,,!127978471..;,(w):',
Mailing address ' : 225145,' Schaff,.Drive;,. Chugiak'._:iAK;�:'.99567, ":':` ..
Lending'agency ' _ ; . Day phone'
Mailing address _ . •
gent .. , <'
Address
Unless otherwise requested, HAA will be held for pickup:
NUMBEFf OF BEDROOMS: .5;131 , '1 7• ,
TYPE OF WATER'SUPPLY
• ,Individual Well xxx-
Community.weli
Public water''
TE If.community wellsystem, provide written,confirmatlon from State ADEC attes
.ing'.to the legality,and'status;of;system. ;`
, TYPE,OF,WASTEWATER'DISPOSAL:;
•
Individual on-site
Holding tank
Community;on'stte'.
NOTE: ' .If community wastewatersystem, provide written confirmation from;State ADE
' attesting to the legalityIand status of system
2-025 (Rev. 1/91) Front MOA 021
•
•
w.
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 AuthorityApproval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional`andadequate for the number of bedrooms
and type of structure indicated herein: l furtherverify 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 M_ unicipal and State codes,
ordinances, and regulations in effect on the date of this inspection
S 8 S ENGINEERING -Z./� 7 9
Name'of.Firm Phone ` G 9 `f
17034 Eagle River:Loop Road No. • `
.!Address Eagle 1214e% Alailrn 9g' .
Date3 /' .: : ,
_Engineer's signature
ACV �, �k 1
i M
OF ,..2 'L• -,i.YT7 '•c•.-?"
S
, 7 •tel•.•' 4•4.ltl.
R
s
obort A. S'tdr hI
/ d '• No. 14.57-E ' ' i‘•-..1.,4".
re
• :DHHS SIGNATURE ;'. °�4k�ESSr' !re
•T
Approved for.: --bedrooms.
Disapproved:
• 6.
Conditi•on•al approval for • bedrooms, ,with, the following stipulations:
•
Additional Comments
Date
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
A .
•pproval'Certificatesbased'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 the( . r.
'r lending institutions in orderto satlsfycertainfederal and state requirements. Employees of DHHS•donot
conduct inspections or analyze data, before ‘a.certificateOs issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work
•
•
•
72425 (Rev. 1/9” Back MOA a21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1. -o -f 1 Z- g► -+LZ- �o�rF�s �5r' Parcel I.D.
A. Well Data
Well type ?tz t.l e i1 _ If A, B, or C, attach ADEC letter. ADEC water system number l'`ft,
Log presentN)
Total depth Z`tol
Sanitary seal )
Date of test
Static water level
Well flow
Pump levell
y
Date completed 1 o - 1 S - frIt
Driller I 1.Josa.l
g
0A-
Cased
tk
Cased to 32 F�.t?-• Casing height 12
FROM WELL LOG
‘t•-•%5-941-
Wires
0-%5-94
-t)
Wires properly protected (SFIN)
AT INSPECTION
-21-cl
1
D,S g.p.m. S 2 + g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
/ao'
/eit) fF
Public sewer main "J 1/4
r
Sewer service line 2 s -
; On adjacent lots
; On adjacent lots
/0o
/ 00 �-
Public sewer manhole/cleanout
Petroleum tank
` I}
2S
WATER SAMPLE RESULTS:
Coliform Nitrate 3. ag Other bacteria
Date of sample:
Collected by:
: S
B. SEPTIC/HOLDING TANK DATA
Date installed 11Y - S 1 Tank size 1 00o Compartments Z
Cleanouts PN) I Foundation cleanout0/N) y Depressign (Y
High water alarm (Yi fi Alarm tested (Y/N) ,i(A
Date of pumping 'i — / / - 91- Pumper -T/Q , Gossjo v r.,
SEPARATION DISTANCES FROM SEPTICMOLDING TANK TO:
Well(s) on lot /o' On adjacent lots / a Foundation
To property line /a / Absorption field /0 Water main/service line /0 A
Surface water/drainage /06
72.028 (3/93)' Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at 'Pump off"
High water alarm level - ested
Meets MOA electrical codes (Y/N)
SEPARATION • ' CE FROM LIFT STATION TO:
Well on lot On adjacent Tots Surface water
D. ABSORPTION FIELD DATA
Date installed 1
Soil rating (GPD/Ft2) US / System type Cie- 7
Length '> > Width \ 1 ` Gravel thickness 0,5- Total depth Z,; -
Total
,; -
Total absorption area S-7-7 Cleanout present ON)
I
Date of adequacy test 4-2-1-9 f- Result fail) /7i11%5
Water level in absorption field before test 0 - After test 0/r
(41)Peroxide treatment (past 12 months) ( AWL (A.L J J If yes, give date ,t(,_
(PIM
Depression over field (Y/) .l
for 3 Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
L
/Do
On adjacent lots
/ao
Property line /6
To building foundation /o t y To exiting or abandoned system on lot r'��
On adjacent Tots 3 0 Cutbank ��.a- Water main/service line /0
Surface water
Curtain drain
(Do rF
i/ -
Driveway, parking/vehicle storage area 2.f
E. ENGINEERS CERTIFICATION
I certify that I have checked, verified, or confo ed to all MOA and HAA guidelines in effect on the date of this inspection.
S
Engineer's Nam
SEN
•
Date Eagle River, Alaska 99577 S,3 %i/
Signature
&
IN
HM Fee $
3a V
Date of Payment
Receipt Number
72-026 (3/93)• Back
Waiver Fee $
Date of Payment
Receipt Number
SINCE '908
Commercial Testing & Engineering Co.
Environmental Laboratory Services®`rrtr.r.r.era-w-c-r►c©dzrzw-d-arznezw®crr-crs%z-..^rcrcmc
LABORATORY ANALYSIS REPORT
CT&E Ref.# 94.1661-3
Client Sample ID L12 BLK2 TONJESS EST
Matrix WATER
Client Name S & S ENGINEERING RUSH Order 77540
Ordered By RIS Printed Date 04/18/94 @ 08:47 hrs.
Project Name Collected Date 04/15/94 @ 15:00 hrs.
Project# ReceivedDate 04/16/94 @ 11:30 hrs.
PWSID UA
Technical Director STEPHEN C. EDE
Released By:
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY.
Parameter
QC Allowable Ext. Anal
Results Qual Units Method Limits Date Date Init
Nitrate -N 3.88 mg/L EPA 353.2/300.0 10 04/16/94 CMR
* See Special Instructions Above UA = Unavailable
•• See Sample Remarks Above NA=Not Analyzed
U = Undetected, Reported value is the pmctical quantification limit. LT= Less Than
D=Secondary cfilution. GT=Greater Than
5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
T,2 je Lc -4- /
Location (address or directions)
Pe-frr^s C—rw&
(b) Applicants Name K. (7,7/4, /,a„ Telephone - Home Business
Applicants Address PO -772,91'73
”5-77
(c) Applicant is (check one) Lending Institution El ; Owner/builder MI ;
Buyer f[ ; Other ` (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following. address:
Vo(' err cc -v.?
/K,/
�`ti--r2 v -�-4C 2'2577
2. Type of Residence
Single -Family Multi -Family J Other (describe)
Number of Bedrooms _ 3
3. Water Supply
Individual Well Community j Public
Note: If community well system, must have written confirmation from the State
•Department of Environmental Conservation attesting to the legality and status:
4. Sewage Disposal
Onsite
Public 11 Community
Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
i
Name of Firm Ccwit, E 4.SS0C+e,�'4,.Sa1.� Telephone
PF A4 Mi
Y .� LL'�
Address /�V9 / . /Gcl/n.- Sci , ,� •0.741,••.' 7Y,7a.ii Q
//. JJJ iii
Date %" .-3'tis a't 4 3►1 •'.*it
4EI INE ME))
1 '% , CE -52E7 I o
6. DHEP Approval L��� 4b �oF'•'
Approved for bedrooms By
Approved .X Disapproved
Terms of Conditional Approval
1
Date
Conditional
.S- /-(e/s/
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
MUNICIPAL{."
DEFT. OF
ENVIRONMENTAL F::.:Tt:•-:TICN
JAIL231985
RECEIVED
Lof /Z 13/ock2
T+•iac_s
Well Classification Pr;Va. le- If A, B. or C. D.E.C. Approved(Y/N)
Well Log Present (Y/N)
Date Completed /o -,S- 8i
Total Depth 21401 ' Cased to 32' 46 Depth of Grouting
Static Water Level s8''". Pump Sat At
Casing Height Above Ground q" Sanitary Seal cn Casing (Y/N)
Yield
Electrical Wiring in Conduit (Y/N)
Depression Around tnbllhead (Y/N) nl
Separation Distances frau Well.;
To Septic/Holding Tank az Lot • /;./91 Co Adjoining Lots
To Nearest Edge of Absorption Field cn Lot /55-' ; Co Adjoining Lots • too'
To Nearest Public Sewer Line — To Nearest Public Sewer
Cleancut/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected By ..1. oirec
Date /-Z/-e5
Water Sample Test Results 4; 541. c.Awy
Caunents #: ret fcnnLLAN.e., rl",fr. ,�.-:U.- ; we -11.i .
8. SEPTIC/HOLDING TANK DATA
Date Installed /Z -?S -S' Size /coo ya.F. No. of Compartments Z
Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) }/
Depression over Tank (Y/N) N Date Last Pumped
Pumping/Maintenance Contract cn File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) Temporary Bolding Tank Permit (Y/N)
Separation Distances frau Septic/Holding Tank:
To Water -Supply Wall /081 To Building Foundation 8'
To Property Line > iQ' To Disposal Field e.fi'
- Aj Q,rur
To Water Main/Service Line — To Stream, Pond, Lake. or Major Drainage
Course
Comments
Receipt 1 t 7 p
Date Paid:
Amount: L
(Page l of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 115 sOr Type of System Design
Date .Installed r 2 - zs - tsi Length of Field -31'
Width of Field 17' Depth of Field C
Gravel Bed Thickness 1'
Square Feet of Absorption Area Sal Standpipes Present (Y/N)
Y
Depression over Field (Y/N) /1 Date of Last Adequacy lest —
Results of Last Adequacy Zest 5,1,54.4.4., tO.�1,0
Separation Distance frau Atiscrpticn Field:
To Water Supply Well 156-' TO Property Line > i b'
To Building Foundation 30' To Existing or Abandoned System as
Lot n o„e ; On Adjoining Lots —
To Water Main/Service Line - To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, cc Vehicle Storage Area
Convents
D. LIFT STATION none
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
Maw On" Level at "Pimp Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Zest. Meets MaA
Electrical Codes(Y/N)
Contents
** Check Pew' tted droan Rating Against HAA Request **
I certify
on the da
Signed
Company
KBl /d5/s
=t
iormarr
I hadecked, verified, or conformed to all
pecticn.
[Page 2 of 2]
Date /-Z3 �S
NOA No. „ f7- -2/S
MOA HAA Guidelines in effect
40•
...... `
0 : e - J. Corrin ; ua/
t C '. • CE -5283 .. ��
rt It
a•........•.• • C., do
14. R4FFC N.41'
2-15-84