HomeMy WebLinkAboutCABIN BY THE CREEK #2 LT 2Cabin by th
Creek
Lot
#015-521-43
; Municipality of Anchorage Page
· 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: ,-~I"~°~(~L"[ i'"-~ PID Number: ~)~ ,.-~_ ~_c.)~\_,L[
Name:- ~ ~ ~.~,, ~ ~ ,~ Wastewater System: ~ew D Upgrade
Address:p~ ~ ~~ ~ [~ ~'~' ~ABSORPTION FIELD
i ,~
Phone:
j No.~ed;ms: ~epTrench ~ Shallow Trench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
'~ GPD/Sq. Ft. ~ ~ /~ '
Lot: Block: ~ Subdivision: Depth to pipe bottom [rom original grade: Gravel ~epth beneath pipe
Township: ~ Range: ~ Section: Fill added above original grade: Gravel length:
I
I
. ~ Ft. /~ ~' ~ ~.
WELL: ~ew D Upgrade Grave~ width: Number of lines: ~Distance betweenlines:
Classification (~rivate, A,B.C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller:~ -- ~ ~~ Date Drilled: Static Water Level:Ft. Installer:~~ ~ ~ Date?~instatled:~ ~
~Pump Set at: ~ Casing Height Above Ground:'
~"'": /~ ~"~1 /¢~ "'-I ~ ,,. TANK
SEPARATION DISTANCES ~p~ic c Ho~ing ~ S.T.E.~.
TO ~ptic Absorption Lift Holding ~;~2~Private Manufacturer: Capacity in gallons:
. Material~ Number of Compa~ments:
Sudace
~at~' ~/~' > /~' / / > /~ LIFT STATION
FouqdationL°t 7 /~ / / __~ Size in gallons: ~
Line ~' ~ ~'~' / /
t I / "Pump on" level at: " ater alarm at:
Cu~ain Drain ~/~ ~ ~ ~ ~ ~umo MaS~ $ ~ ~al In~oct,on~ p~rform~ ~y:
Remarks: ¢~./,.:~ ¢¢~ p¢~,/¢ .... ,,.~ BENCH MARK
/ / Location and Description:
/ /
I
Assumed
Elevation:
Inspections pedormed by: _ Dates: 1st ~ '~';~:~::;;~;~;
~'% 4381 - E
Department of Hea~ HUman Se~ices approval ~ *-,~. ,.,,,',,~,
Reviewed and approved by: ~~ ' Date: fl -2~ - ~ '~.,....~,~,~' ~-,-"'
T2-013 (Rev. 9/91) MOA 25
Permit No. ~
Page of
· 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: , PID No.:
................................................................. i ............................. ; ................................... ! i ............. ; ..................... i ......................... ! ...................... :' .......... ! ............ ' ........... : .........
Permit No.
" Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box "196650 · Anchorage, Alaska 995"19-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
__Legal Description: , PID No.:
..... ~ .......... ~ .... ~ ~.~
........... ~ ......... [ .................[ J
M-W DRILLING, Inc.
P.O. Box 110378 · 10330 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner ~ .... ~ r.. ~. ,- ..... ~' ~-~ Us~ of Well
Location (address of: Township, Range, Section, if known; o? distance m~/n road
Lot: 2 Cabin Creek Subd., Anchorage
Domestic
Size of casinf 6" nepth of Hole 162 feet Cased to ] g,O~ ~ 9 feet
Static water level /=3 ft. ~ . (below) land surface. Finish of well (check one)
~creen ( ); Perforated ( ~ },
Describe screen or perforatio- :lq/A
u
Well pum~ng test at 15 gallo'ns pe~ of drawdown from static level.
Date of completion
Depth h~ feet from
ground surface
open end ( X );
JanuarY,4,,',l,?94
,.. .~ '
(minute) for ~ hours with ~; ft.
Note: Well dry grout sealed w/1 sk
bentonite granuals
WELL LOG
Give details' of formations penetrated, size of material, color and hardness
0 TO 2
2 ~O 8
8 12
~O
12 42
.TO
42 50
~O
50 TO 70
70 TO, 95
95 1!9
TO
119 TO130
130 143
~O.
143 162
~O
.TO
.TO
TO
TO
CSG Stickup
0r~anics
Si!Cy'. Gravel i damp
silty. Gravel; clayey, dry
I~L~L~ ¥ u
MAR 1 1994
Municipality ot A.ohu,
Dept. Health a Human Serwces
A/A,' wet
~ravel; saml.1, dry sil~y
ciay; silty, 9ompact
Gravel; sil~y/clayey, damp, dirty
Gravelly Hardpan
Gravel; sandy/silty, wet
Water Gravel; medium, clean, slighty sandy
NWWA Certified Contractor
Certi/ica~ Nv'~. 314 & .~;3
3 -- CONTRACTOR
Municipality of Anc ora e
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
March 24, 1994
Michael E. Anderson, P.E.
Anderson Engineering
PO Box 240773
Anchorage, Alaska 99524
Subject:
Waiver Request for Lot 2 Cabin by the Creek Subdivision
Waiver Request #WR940011, PID #015-521-19, HA940146
Dear Mr. Anderson:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 3.5 feet from the southern lot line to the
absorption field.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
ljw#7
WR# WR940011 PID# 015-521-19
Date Received: March 18~ 1994
-- MUNICIPALITY OF ANCHORAG~
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
HA# HA940146 Permit # SW930417
Legal Description: Lot 2 Cabin by the Creek Subdivision
Engineer: Michael E. Anderson, P.E., Anderson Enqineering
PO Box 2403~, Anchoraqe, Alaska 99524
Applicant: John E. Fenske
Waiver Requested: Lot line waiver of 3.5 feet of the souther lot line
to the absorption area.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above: L.~&f Zo~f / ~
Date:
By: ~.~---~-~-
Na'~Reviewer
Rec #: 25740/3315 Amount: $ 115.00 Date Paid: 3-18-94
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
March 17, 1994
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 2, Cabin By The Creek Subdivision
Lot Line Waiver
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
~,R 1 8 1994
RECEIVED
Dear Onsite Services Engineer: (~B ~__~/
During construction of the drainfield for the septic system propose~-
for the subject lot we discovered unsatisfactory soils near the
primary site. Further exploration revealed suitable soils on the south
side of the house near the south property line. We discussed moving
the drainfield with Ms. Susan Oswalt of your office and decided
placement in this area would be acceptable. Because of the
placement of the house we were forced to crowd the lot line to obtain
as much separation distance as possible. The drainfield now
encroaches to within 3.5' of the line.
The placement of the system at this location will have no adverse
affect on the adjacent lot as the well is located more than 300' away.
It will also have no affect on either the primary or alternate septic
sites planned for the adjacent lot. We, therefore, request a lot line
waiver be issued allowing placement of the system to within 3.5' of
the southern lot line.
Sincerely,
Michael E. Anderson, P.E.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
RECEIV£D
March 18, 1994
MAR 1 B 1994
Municipality of Anchorage
Dept, Health & Human Services
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 2, Cabin By The Creek Subdivision
Health Authority Approval Certification
Dear Onsite Services Engineer:
Transmitted is the Health Authority Approval Certification and the
As-Built of the septic system and well for Lot 2, Cabin By The Creek
Subdivision. Please note the location of the system was changed
early in the project because unsuitable soils were found near the
location of the original site. In addition, the builder relocated the
driveway serving the house across a portion of the area designated
for the system.
The relocation of the system was discussed with Susan Oswalt at the
time the problems were encountered. Testholes placed on the south
side of the house revealed soils with percolation rates less than 30
minutes per inch as opposed to rates in excess of 50 minutes per
inch on the north side. The system, however, was constructed based
on the higher rates and is substantially larger than required by
Municipal Ordinance. A lot line waiver is required for placement on
the south side of the house. The waiver request is included with this
package. The system as constructed is superior to that originally
designed because of the better soil conditions encountered on the
south side of the house.
Sincerely,
Michael E. Anderson, P.E.
i~A f~o ~ ~ K 5T'R
f
· Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PEI
LEGAL DESCRIPTION:
7-/'/'~" Township, Range, Section:
12
13
14
15
16
17
18
19
20
COMMENTS
WAS GROUND WATER
/v
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth te Water After
Monitoring? /~ Date:
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
I
PERCOLATION RATE /~ (minutes/inch) PERC HOLE DIAMETER 7
TEST RUN BETWEEN ~__/(~ FT AND ~ / / FT
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
/,/5,
10
11
12
13
14
15
16
17
18
19
,~> , .(~E~!~ ~[_,N.EER'S SEAL)
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
s
L
IF YES, AT WHAT -~' O
DEPTH? P
E
Depth to Water Alter
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
20
PERCOLATION RATE Z~._~__ (minutes/inch) PERC HOLE DIAMETER '~'-7
TEST RUN BETWEEN'"' ~ FT AND ~ ~) FT
COMMENTS
.~~ I ~ ~-~I~'-~HAT T, HIS TF..ST WAS PERFORMED IN
72-008 (Rev. 4/85)
. Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
,,~ ': (ENGINEER'S SEAL)
~.. , · :
DATE PER
LEGAL DESCRIPTION:
2
5
6
7
8
9
Township, Range, Section:
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER V
/
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
Depth to Water Alter ~
Monitoring7 f Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
,..'
PERCOLATION RATE ~"~" (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN'" .~ ET AND '"" ~'~ ET
//
7
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER: SW930417
OWNER ADDRESS'.. '~ .v. ''~
LEGAL DESCRIPTION: CABIN BY THE CREEK LT 2
DATE ISSUED: 10/07/93
EXPIRATION DATE:10/07/94
LOT SIZE: 59763 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
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).
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
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
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
September 23, 1993
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 2, Cabin by the Creek Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The subject lot is crossed by Little Campbell Creek with the topography on
either side of the creek sloping toward the creek. The septic system is
placed more than 100' from the creek. Soils encountered were dense silty
sand with no groundwater. A deep trench system should function
adequately on this lot.
If the system is constructed in accordance with the attached design the
following statements can be made:
The system, if constructed as designed, will have no adverse impact on
the wells currently in use or those to be constructed in the future.
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.
o
The system, if constructed as designed, will have no adverse impact on
reserved space, either surface or subsurface, on any lots located in the
area.
The system, if constructed as designed, will have no adverse impact on
drainage patterns in the area.
Sincerely,
Michael E. Anderson, P.E.
SHEET NO. OF
CHECKED BY DATE
= JO0
SCALE
4381
P~(~0UCT 204-1 ,,S~le S~eesl L~5-t (Pa~ll ~ ~ I~,. 6~, ~ Ct ~?~ To 0i'~ ~ TOLL F~Er !
JOB
SHEET NO,
CALCU!_ATED BY
CHECKED B~
SCALE
OF
DATE
1"=5-D '
LOT 2, Cabin by the Creek
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Percolation Rate: 50 Min./Inch 1250 Gallon Septic Tank
Application Rate: .45 GPD/SF 6.5' Gravel Below Pipe
(4 Bdrms. X 150 GPD) / .45 GPD/SF = 1,334 SF
1,334 SF / 13 Ft. of Absorption Area = 102.6 LF of Trench
Therefore: Construct Two Deep Trenches each 52 LF with 6.5' of
Gravel Beneath Distribution Pipe.
I
PERFORMED FOR:
LEGAL DESCRIPTION:
DEPARTMENT OF H .F-..ALTH'.& HUMAN SERVICES '
825 'L" S~eal. An~ Alaska 99502-0650 ~.', · ,I-".,, ...... , ....... u .........
so,Ls LoG
..
c,,t,e/~/BY 7'/-/z' <c~,a',~/~TownsniP. Range, Secti°n: ..~
17
18
~oel E. Anderson
4381 - E o'
T/-/,Z
2O
SLOPE SITE PLAN
WAS GAOUNO WATER
IF YF..~ AT WHAT
S
L
o
E
PEJ~GOI~TION AATE ~r'O tnlmU~men! PERC HOLE, DIAMETER ~' '
Tr=.~'mm eE'rWEEN -,~,, rr ~o ,~'. ~ rr
SOILS LOG --- PERCOLATION TEST
2
:1
?
8
10
11
1:2
13
tS
16 : ....
17
1~, Li
w~s GROUNO WAT'cR
ENCOUNTTR E0I
St.OPE SITE
IF Y~E.,~ AT WHAT
0F.J~T14~
I I I I I
,II
724~ iAe,~ ~6t
· Parcel I.D.
1.
Municipality of Anchorage
Development Services Department
· Building Safety Division
On-Site' W~ter & Wa~tew~t~r Program"
4700 South Bragaw St.
P.O. Box 196650 Anchorage,~AK99519-6650
www.ci.anchorage.ak.us
(907) 343-7904 .
CERTIFI CATE .oF HE'AEq:H,' AUTHORITY' AP, PRoVAL,:
FoR A:-SI GEE?FAHIEY.'.DWE EINGi ' ""' ' ': '
.: .. :,. ': · ..:,. · .:-,-., :. . ',i~. :.'~ ...--,':..
015-521-43 :' :"; ": ', . :'...":'":". :. :'..":.?]A~::: ..'
......... ; . , .... :.: ~ , .
' CABIN':BY :I'HE 'CREEK suBDivisioN '#2i'tof',.21 '.'::"- ' :::": ' ~'"' ".':::' :"'
Location (site address or directions) " 10907 ?BARONIC 'DRIVE *"ANCHORAGE, AK 9~"~6
. ".'" '"' :- :'-' "'"" ' ' '.':' i'-" '.-.',',. ", .i '-.:-. '. ~'~'~:, '. ,'..~ ~
CRAI¢ &.'CINDI ~WiI:.K'ER ',':,-':-.:::., :' :' .... :,':D~i~; phone::: ;. ~':' '' ," ',,,.'.:'.:L~::; ::" ':': ::'
GENERAL INFORMATION
Complete legal description
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
Un/ess otherwise requestedl HAA will be he/~ by DSD for pickup.
10907 BARONIC 'DRIVE *', 'ANCFIO'R~ " -'"
GEm';AK 99516 :, ,"
· ./ , :, .'.. . ::-:-: :.:- . .' .- -'' : .,.i :. :,'. ....
.' D~y phone" =" .... :-' '-:, :1 ' · ":" 'r
KEV1N TAYLOR wi. PRUDENTIAL VISTA Day phone :. ;2'73-7223 .
4241 ."B"-:STREET' *'ANCHORAOE,';AK 99503 "', .,"'; ' ' · ·
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
4
TYPE OFWASTEWATER'DISPOSAL: .i , .
Individual Well []
IndividuaIWater Storage - -- []
Community Class Well []
Public Water System []
Individual On-site [] -
l,ndividual Holding tank : []" ,~..
' Community, On-site []" : ' '
PublicSewe~' []" " :" -"
The Municipality of Anchorage Development Services Depadment (DSD) Issues Certificates of Health Auth. ority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the trahsfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or.
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may
be reissued with new wa.ter samples. (Certific.ates may be reissued, for a p~riod of up to one year with v.a. lid
water samples.) Certificates are valid for one year for propedies served by Class A orb w..ellsor a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note~ Alaska Water and Waslewater Consultants, Inc. shall be paid $'211¢.°'~ at, or prior
! to closing for the engineering services provided.
STATEMENT OF INSPECTION BY ENGINEER. r ' *' . .
AS certified by'my seal affixed hereto,'and as of the validatio~ date shown below, I verify that my
investigation, based on procedures outlined in the Health Authofity Approval Guidelines for this application,
shows that the on-site water supply and/or waslewa~ter disposal system is(are) safe, functional and adequate
for the number of bedrooms and type o.f strdcture 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/o~ waslewaler d(s. po.sa.! Sys. t~' is~ Nre) in .cofnplianbe with all applicable Municipal
and State codes, OrdinanCes, and regularities in, ~ect at th..e ~r~e of installation.
Add~'ess
'N~me of Firm ALASKA. :WATER' &: WASTE'WATER .. CONSULTANTS, INC.
6901 DEBARR :R'OAD, i'sUI~E 2B
*'ANCHORAGE;AK 99504.
Engineer's Printed Name . jEFFREY A.~ (:;ARNESS,' P.E.
Engineer's Comments: .
In conducting this evaluation, AKWWC, Inc. attempted t~ Provide a lho~ugh,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the 'time of thb test, a~.d s~aratiOn
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils conditionj groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the Control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there ere no hidden defects or encroachments. AKWVVC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC er MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance UPon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
["/"' Approved for L/L .bedrooms.
Phone 357-6179
Disapproved.
Conditionalapproval for ~
· bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenan;~,e Agreements
Supplemental Engineer's Reort
Other
(Rev. 1Z01)
Ordinal Cedificate Date:
Municipality of Anchorage
·Development Services Department
Building ~afety Division
On-Site Water & Wastewater :Program
4700 $out~ 8ragaw SL
P.O, 8ox 196650 Anchorage. AK 99519~6650
www.cLanchorege,ak.us
(S07) 343-7~04
Legal De$cflPtlOn:
A. WELL,DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
CABIN BY THE, CREEK S/D ~2; LOT 2, ParCel ID:
,015'-521 --4.3
WelHype P.P~VA~. IfA, B; orC provide PWSID~ N/A
Date complete. 1/4/lgg¢ Sanitary seat(Y/N) YES
Total depth _.162 fl:. Case~! to 160.65 fL
FROM WELL LOG
Date of test 1/4/1994.
Static water level , 43 ,, ff.
We. llpreductlon .... 15 , ~ g.p.m.
WATER SAMPLE RESULTS:
COliform . 0 , colonies/100 mi.
Arsenic: fl/A mgJL.
SEPTIC/HOLDING TANK .DATA
Tank Type/Matarlal .~ ..... ~ STEEL
Tank stzeJ250 gal, Number of COmpartments 2
ABSORPTION FIELD DATA
Date tnatallad:,
Length 126,5 .~ft,
Ni~ate 0.704, mga'L
Date of sample:,1/28/2003
Well Log(Y/N), YES,
Wlmspmperly protected (Y/N) _ ._ YES
Casing height (above ground) .... 2~
AT INSPECTION
1/28/2oo~
, 59 ..... fL
6~22 .
irl.
Other bactafla o colonies/10o mi.
Collected by:. AKWWC, INC.
Oateinstalied. , ,12/1--5/93
Cleanouta (Y/N) YE~
Foundalionclean0utO~/N) ~YEs Depresslon over tank (YIN) NO Hlghwateralarm(Y/N), ,, N/A
Date of:pumping. :1/28/2003 Pumper , CHUGACH PUMPINg , .
PB£L0W 'RN~ GaN)EI ee~'r~., SO. UTH~ TRE~ICH ONLY
$011 rating ~rlt~/bdrm) 0.45 System type . DEEP TRENCH
Width... 1~7 fL Grevelbelow pipe, , . 5.5 ft.
Totaldepth _*lo-~o.sfL .Eft. absorption area 1383 fta Monitoring tube YES. Oepreasion over field NO
Date of adequacy test, 1/28/2003 Results (Pass/Fall) **PASS For, 4~. bedrooms
Fluid depth in.absorption.field before test. 27 in. Water added .682. gal. New depth 56.5 in.
' . 28/ ' 56/
ElapsedTlme. ~005 min. Final fiuid depth 5~ in. Absorption rate >= .. 600-1- g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date -
D. LIFT STATION
Date installed Size in gallons M~-"--'"'-"-'"'--
"Pump on" level at in. "Pu~ High water alarm level at in.
~ ~ Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100°+
Absorption field on lot 100'+
Public sewer main N//A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Sewer/septic service line 25'+
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properb, line 5'+
Water main N/A Water service line 10'+
Absorption field
Surface water
5'+
100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *3.5'
Water service line 10'+
Building foundation 10'+ Water main N/A
Surface water 100°+ .Driveway. parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*WAIVER GRANTED. WAIVER i~WR940011
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA I-IAA guidelines in effect on this date.
Engineer's Pdnted~ame
Date :Z.//o/~
JEFFREY A. GARNESS
Date of Payment
(~v.Receipt12~Ol)Number
Waiver Fee $
Date of Payment
Receipt Number
LOT 3
A$-~T ~
1~ CORNER~ ~T ~ o&'r~ $CAL[:I" . 40'
! H~R£~Y C[RTIFY THAT I HAV~ P~Rr0R~I~ A
IM]RTGAGI~£'S IN~P~CTION or T)~ ~rrm LOVING
I~$CRI~I~ PROPERTY.
LOT ~', CA~IN ~Y ~ CR~L'K ~ NO. ~
01-31-03 11:35 FROU-CT&E ENVIRONkENTAL SRV
~1~K CTIE Environmental Services Inc.
9075;15301
T-595 P.02/03 F-$58
CT&E
Client Name
Project Name/~
Client Sample ID
Matrix
San'~le Rcma~$:
1030511001
AI~ Water & Wastewater Consultants Inc.
Cabin by the Creek #2 L2
Cabin by the Creek #2 L2
Drinking Water
All Dates/rime; are Alaska Standard Time
Printed Date/Time 01/31/2003 10:12
Collected Date/Time 01/28/2003 15:00
Reteived Date/Time 01128/2003 15:40
Technical Dlrtttor
./ Step_hen~/Kde
Allowable Prep Analysis
Parnm=ter P.~s,,lts PQL Units Method Limi~ Date Date Init
Nitrnt¢-N 0.704 0.200 mg/L EPA 300.0 (<'-10} 01/211/03
JS
M:Lcrobiolog¥' r. aborat:o=y
Total Coliform 0
coVl00mL SMI$ 9222B (<=1)
01/28103 KAP
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
1. ' :;GENEI~AL~iNFORMATION
.... Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Day phofl~ -
IMBER!OF BEDROOMS:
'~.'-~,.~3 ~.TYPE OF.WATER SUPPLY
~.,~:,,,,,.,..~ ~.-, ~ .-Ind~wdual well
,;. ~ ~ ~,~Commum~well-
; ?~ ~~;~;~:~,. Pubhc water~
.......... .. NOTE: ';'.-If community well system, provide written confirmation
1. ing to the legality and status
.-. ~. 4. ?y, PE OF WASTEWATER DISPOSAL:
Individual on-site
........ Community on-site :, ,_ , ,, ,
Public sewer "'~- '~ ~ . ' 0,?' ' ~,
NOTE: If community wastewater system, provide written confirr/IJ~/~ from State ADEC
attesting to the legality and status of system." ~"?~:'* ..... ''*'' ~:~"' ~
72-4)25 (Rev. 1/91) Front MOA
STATEMENT~;O:F*' INSPECTION BY ENGINEER
As Certified by my seal affixed heret° 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 wa~te~vater 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. -.~
_ · Engineer's signature
Phone 3' f/5"- ~ 3',~-5- ,,
Date,J/<.~-(~/) /~6"
, · . 6..~HHS SIGNATURE
Di:
;:-~:~:::~-: :."':':'; r" ,Cond~bona! approval, for i ~',-",~:~ ~7!!,! ~.l~_r.ooms,;~.~jth~:the~ follow!ng stipulations:
.......... -~,-,.Add~honal Comments
. .,~/~ . .,J.~q ..,).~.~. ~.. ,. Date-~.~ ..-~
. {.; . ~ . . . ._ ... :._.:.::., -., . _. .
· , '~_. . ~? ,' >% ,'
'~ .~,n~ ~umcJpali~ 9,~n~ho~ge ~p~ent of H~ ~d Human'~ewi~ (DHH8) i~ues Health
' Ap~pZ~.~,Oe~s~ only upon me ~n~ons gi~n in pa~graph 5 a~ve by an independent
prof~6~al en~in~r r~ister~ in the 8~te oinkm ~ DHHS d~s thi6.8 ~u~ to purcha~ of hom~
and_~h~i~.l?nding institutions in order to M~ ~n f~ and s~te r~uiremen~. Em ploy~ of DHH8 do not
conduct ins~ctions or 8nal~Sm'~fo~'a-~M~ ~ i.u~. The ~unicip81i~ of AnchoMge is not
r~ponsible for e~o~ or oral.ions in the prof~ioM engin~¢s wo~.
(Rev. 1/91) 8ack MOA #21
MUNICIPALITY OF ANCHORAGE
~.NVI~ONMENTAL SER¥1CE$ DIVISION
Municipality of Anchorage ~
DEPARTMENT OF HEALTH & HUMAN SERVICES AUI~ 01 1996
Environmental Services Division
825"L" Street, Room 502e Anchorage, Alaska 99501® (907) $45~[a~ E ! VE D
Legal Description:
A,. WELL DATA
Health Authority Approval Checklist
~ ~,~.6y - t4,,e -Cr'~.et, c.-C/D #: E Parcel I.D.:
Well type fr,"a/-e
Log present (Y/N)
Total depth Iff I'
Sanitary seal (Y/N)
Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 5'/E.? / 9 ~
Cased to I ffl' Casing height (above ground)
Y' Wires properly protected (Y/N)
FROM WELL LOG
Date of test t~ / ~-~ /9 ~
Static water level ~t9 '
Well production I 0
WATER SAMPLE RESULTS:
Coliform ~) CO/ /lO0 rn~ Nitrate
Date of sample: ?/Z.?/7~;,,
SEPTIC/HOLDING TANK DATA
Date installed 0"/~ ir [ ~ ~ Tank size
AT INSPECTION
tg, ~O ~,f,' [-~ Other bacteria NoNe
Collected by: FIc~/'/o/a 7"~(~ So'¢
Number of Compartments ~ Cleanouts (Y/N). Y
Foundation cleanout (Y/N)
Date of Pumping 7/~/¢ ,5'
C. ABSORPTION FIELD DATA
Depression (Y/N)
Pumper
/V
High water alarm (Y/N) ~/./~.
Date installed 6'/E ?{ 9 ~- Soil rating (g.p.d./ft2 or fl2/bdrm) ~ System type
Length I I~ ' Width ~ Gravel thickness below pipe 0"' Total depth
Effective absorption area I q/6' ~* Monitoring Tube present(Y/N) ~' Depression over field (Y/N)
Date of adequacy test 7/Z3 -712.,¢/¢d Results (Pass/Fail) Pa,'..g' For ~ bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth tq¢ */3'/~ (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N) /~
~90
Immediately after
Absorption rote =
__ gal. water added (in.):
6'00 ~' g.p.d.
If yes, give date
g.p.m, q,/~ 7' g.p.m.
D. LIFT STATION N.
Date installed
Manhole/Access (Y/N)
Size in gallons
High water alarm level at*
"Pump on" level at*
"Pump off" level at*
Cycles tested
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot I~'~ ' ~' ¢. o.
; On adjacent lots
Absorption field on lot 15~ I ~ 9~' C.O.
· On adjacent lots
Public sewer main tN. d-, Public sewer manhole/clcanout
Sewer/septic service line ~ E b- '
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation .~ Property line ~t9 ~- Absorption field ~ I O '
Water main/service line _'> tO ' Surface water/drainage > IOO' Wells on adjacent lots ~ t oo'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation fib- '
Property Line gq' ~' Water main/service line
Surface water ~> I OO' Driveway, parking/vehicle storage area I ~ '
Curtain drain 'lXlooe ~eeo Wells on adjacent lots ~> tO0 '
Signature
Engineer's Name
Date
ENGINEER'S CERTIFICATION ..... ~ ~'
I certify that ! have determined thru field inspections and review of3/Iunicipal recor~ that the"~bove ~y~te~s -art,.
in conformance with MOA HAA guidelines in effect on this date. ~'~ ~,~ : .d , , 'o'.
HAA Fee $
Date of Payment
Receipt Number
3o0
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
08×01/96 I;~:J:02
CT&E ESI ANCHORAGE ~ 90?5451355 N0.413 Q02
CT&E Environmental Services Inc.
Laboratory Division
Drinking Water Analysis Report for Total Coliform Bacteria 2oo w. ¢o,,., o,,v.
Anchorage, AK 9951 8-1 605
R~4D 13~TR6'CTION~ O~Y ~FE~E 3IDE aEFO~ COLLECTI~ 3A:~I~LE Tel: ~907) 56~-2343
,~[UST BE COMPLETED BY WATER $1JPPL1ER
~U'BLIC 'wAT[R SYSTEH I,D, #
Send Rcxults ~, $~tncl Invoice
,'4onth Day Year
SAMPLE '~'PE:
~ Roudn¢ a Tr~tated Wa[er
**'lib lab ref. no. )
~ Sped~l Purpose
S.A~{PLE LOCATIO% Co{lecled Br
Fax: Ig07) 561.5301
TO BE CO,.'v[PLETED BY LABORATORY
Analysis shows this Waler SAMPLE ~o be:
Satisfamog
b'nsadffac~o~
Sampie over ~0 hours Cd. results may
be unreliable
S~m¢le ~oo Ion~ in transit; s~mpl~ should
not be over 4g hours old ar examination
to indicate ~liable results. Ptcas~ s~nd
new ~mple via special delive~ mail.
.
Dale Received
Analysis Began
Analytical :Helhod:
ir1 MMO. MUO
' Number ofco!onics/100 mi.
Lab Ref. No. Result° Analyst
Client ~olified o¢ unsadsQctoQ' r~sulls:
Time:
Faxed
[]
Faxcd
BACTERIOLOGICAL WATER ANALYSIS RECORD
M~IO-HUG Result: Tot:l ColiForm
,~Icmbrant Filler; Dirccl Coun~
Verification: LTB
Coliform/tOO mi
CT&E Environmental Services Inc.
Laboratory Division ~'~'~'j~-.ar~-~'~,~j~'j-~'~'j'~'~r~r~'~jffjjjj~jsffjff~~
CT&E Ref.#
Client Name
Project Name///
Client Sample ID
Matrix
Ordered By
PW$ID
963135001
Flattop Technical Srv.
Lot 3, Cabin by the Creek S/D
Lot 3, Cabin by the Creek S/D
Drinking Water
200 W. Potter Drive
Anchorage, AK 99518-1605
Tel: (907) 562-2343
Fax: (907) 561-5301
Client PO#
Printed Date/Time 07/26/96 08:40
Collected Date/Time 07/23/96 15:00
Received Date/Time 07/23/96 15:30
Technical Director
PWSID 0 Released'By ~ ~"
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Nitrate-N 0.800 0.100 mg/L EPA 353.2 07/24/96 ESC
Total Coliform 3 OB W/O COLI SM18 92228 07/23/96 TAV
~=~S Member of the SGS Group (Soci~t6 G6n~rale de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
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
APP..ROYAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # .--,,J--,~, , , HAA#
GENERAL INFORMATION
Complete legal description ~-C~T- 7_-,
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
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
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA#21
Se
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 isin compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm //~r'A) 0 ~'P-"~J ~'~(~ / ~ ~-='L-"'/~) (~ ' Phone
Address '"~0 ~0
Date
DHHS SIGNATURE
~ Approved for Z/--
Disapproved.
Conditional approval for.
bedroomS~
bedrooms, with
Additional Comments
the following stipulations:
By:
Date, ''~ - .2. ¢- - ~
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,, certif! ,ca,te is issued. The Municipality of Anchorage is not
responsible for errors Or omissions in the p.rofess!ona! engineer's work.
72-~25(Rev. 1/91) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~T~ ~.'f~,//~/ B~ 7-//~- Parcel I.D.
A. Well Data
Well
Log present (Y/N)
Total depth /~'
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ////~v~.~4z- Driller /~'-
Cased to /~/~. ~ / Casing height
Wires properly protected (Y/N) y
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
!
~g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /o~' '
--- /~,~. '
Absorption field on lot
Public sewer main
Sewer service line
AT INSPECTION
MUNICIPALITY OF ANCHORAGE:
ENVIRONMENTAl- SERVICES DIVISION
g.Pir~R '1 8 1994
RECEIVED
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: ~.-~/..~/~0 ~
Nitrate
O. ~--/'o ,,w.,,~/,~ Other bacteria
Oo,,ec e
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /o~''I On adjacent lots '~' '~G-O
To property line .~'Z.- / Absorption field
Surface water/drainage ~ /~-~'"/
Tank size ~/ ~-~'0 ~J~/t~ Compartments
Foundation cleanout (Y/N) /~' Depression (Y/N)
/V'/..~---- Alarm tested (Y/N)
Pumper
!
Foundation 7
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
Manufacturer
High water alarm level ~ C~Cycles tested
Meets MOA electrical codes (Y/N)
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length /Cb. ~'
~ Width
Soil rating (GPD/Ft2) * ~
Gravel thickness
Total absorption area //~ ~xE'. Cleanout present (Y/N)
Date of adequacy test /V/~~ Results (pass/fail)
Water level in absorption field before test _~'""'""~
Peroxide treatment (past 12 months) (Y/N) .~'"~'
System type /'~- ~,~
Total depth ?//~ ~/~ ~'
Depression over field (Y/N) /~/
for ~
After test ~
If yes, give date ~
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Welt on lot ~
To building foundation
On adjacent lots
Surface water
Curtain drain /'//~-'"'~
On adjacent lots ,-~ Z-~ ~' / Property line
To existing or abandoned system on lot
Cutbank ,,,v~/~ Water main/service line
Driveway, parking/vehicle storage area 7
E. ENGINEER'S CERTIFICATION
I certify that I have checked, vedfied, or conformed to all MOA and HAA guidelines
Signature
Engineer's Name
Date ~'
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
CT&E Ref.#
Client Sample ID
Matrix
ClientName
Ordered By
Project Name
Project#
PWSID
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~,e-~'~'j~'~-j~r~'~'~-~',e,~'~'J~-~
LABORATORY ANALYSIS REPORT
94.0999-1
L2 CABIN BY THE CREEK SUBD. #2
WATER
ANDERSON ENGINEERING
UA
WORK Order 76429
Printed Date 03/11/94 ~ 15:38 hrs.
Collected Date 03/09/94 ~ 11:00 hrs.
Received Date 03/09/94 ~ 11:15 hrs.
Technical Director STEPHEN C. EDE
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A.H.
QC
Parameter Results Qual
Units Method
Allowable Ext. Anal
Limits Date Date Init
Nitrate-N 0.40
mg/L EPA 353.2/300.0
10 03/09/94 LLH
* See Special Instructions Above
** See Sample Remarks Above
U = Undetected, Rep orted value is the practical quantification limit.
D = Secondary dilution.
UA = Unavailable
NA =Not Analyzed
LT = Les s '[han
Gl' = 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