HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 8 LT 10Mountain Park
sta
Block 8
Lot
10
#017-391-32
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Municipality of Anchorage Page ._.~._/of
DEPARTMENT OF HEALTH AND. HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:.
7~,b-/5"$1 I N°"~'~:
LEGAL DESCRIPTION
Township:
WELL:
r.,ta~silication (Private. A,E.C):
Subdivision:
· I Total Deptl~; Cased To:
Ft. Ft.
Date Orillech Slavic Water Level:
Ft.
Pump Set at.` Ca~ing Heign! Above Ground:
GPM F. Ft.
Driller:
Yiel~
SEPARATION DISTANCES
Well
SudaCe
Water
Lot
Line
Foundation
Curtain
Drain
PID Number: O~?3~II~Z'"
Wastewater System: 0 New J~,Upgrade
ABSORPTION FIELD
~ Deep Trenct~
SOil Rating: , t/.~" OPD/Sqf Ftc,
Fill addaa i~ove orlgi~ grade: Ftr
;Grovel wide;
To~l ab~fion
Ins~llec
Shallow Trench O Bed O Mound o Other
Total Oepm from original gr~le:
_ /Z, ~'~ 13,0
Gravel depti~ beneath_pipe
Grovel length;
~ Number of IIn~; D~ ~ lin~
Pipe mamdah AS~
TANK
Manufacturer. in gallons:
Materl~: Number o! Compartments:
LIFT STATION
in gallonS:
"Pump on" legal at:
Pump Make & Mod~ Electrical Inspections p
Hig~ water alarm aU
iotionan~ BENCH MARK
Dascdption:
Inspections performed by: /~:,4 Dates: 1st
~ 2nd
Department of Healt~h/~d Hu~a~n~S~/rvices approval
· ,iewed and approved by://~~ ~-i?~ ~//,('~'~' ~---Date:
Permit Number:.
Municipality of Anchorage Paga Z. 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
,,
.j
PLAN AS-BUILT
SCALE 1" = 20'
A
'7/£
cc·
~: ~ ~" .~-?
Municipality of Anchorage Page '~ ,,of
DEPARTMENT OF HEALTH AND. HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4?44
On-Site Wastewater Disposal System.and/or Well Ins, pection Report
Permit Number: ~,~/c),~, O ~L~ . PID Number: OI7~)I~Z'"
mz~
MEMORANDUM
DATE: October 21, 1996
TO:
On Site Services Engineer, MOA- DHHS
FROM: Mike Anderson, P.E.
SUBJECT:
Lot 10, Block 8, Mountain Park Estates Subdivision
Pern-fit No. SW960348
Test hole Depth to Prove Lack of Impermeable Layer
The contractor on this project, A Plus Home Services, was unable to deepen the test hole to
a depth of 20' due to the type and size of equipment he operates. I have therefore included
the test hole log completed by R & M Engineering placed on the lot in 1978. This log
shows permeable soils to a depth of 20'. Tiffs log should be verification that no
impermeable layer is closer than 6' below the bottom of the new trench.
In addition, the well log for the lot indicates permeable soils to more significant depths.
The information contained on the well log and the R & M test hole provide verification of
the lack of an impermeable layer within 6' of the bottom of the absorption trench.
MUNICIPALITY OF ANCHORAGE ~_~,-j~
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502 \~--~-~
ANCHORAGE, ALASKA 99519-6650 \~
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT ~O' \~X~
PERMIT NUMBER:SW960348
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:SAGAN JEAN S
OWNER ADDRESS:6066 BRISTOL DR
ANCHORAGE, AK. 99516
PARCEL ID:01739132
DATE ISSUED:10/ll/96
EXPIRATION DATE:10/ll/97
LEGAL DESCRIPTION:
MOUNTAIN PARK ESTATES BLK
8 LT 10
LOT SIZE: 32800 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
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:
DURING CONSTRUCTION EXCAVATE TEST HOLE TO A DEPTH OF
6FT. BELOW BOTTOM OF PROPOSED DRAINFIELD, LOG THE SOIL
STRATA AND SUBMIT SOIL LOG WITH ASBUILT/INSPECTION REPORT.
ISSUED BY: . l~~I~ '
October 1, 1996
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 10, Block 8, Mountain Park Estates Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The absorption trench on the subject lot failed a recent adequacy test and must
be replaced. The area on the lot available for a replacement system is very
limited as shown on the attached drawings. We are proposing to place the new
absorption trench at the location indicated with a flow diverter at the old
absorption trench for future use if required. The limited area available results
in the layout shown on the site plan. It will not be possible to maintain the
minimum separation distance required between the new trench and the abandoned
trench at all locations. Substantial benefit is gained, however, by leaving the old
trench in place due to the limited area available on the lot for septic systems.
Should the new trench ever fail, the old trench can be put back in service. We
therefore request the separation distance between the old and new trench be
waived in this case.
A percolation test completed by S & S Engineers in 1985 indicated an absorption
rate of 27 minutes per inch. We were unable to duplicate this rate with our test
and have designed the trench based on a slower rate of 40 minutes per inch. A
test completed by R & M Engineers in 1978 indicated a rate of 9 minutes per
inch. Their testhole was completed to 20' below the surface and indicated no
impervious layer or bedrock. We are relying on their test to satisfy the
requirement for 6' from the bottom of the trench to bedrock. None of the
testholes encountered groundwater nor is any anticipated.
The existing septic tank will be exposed and checked for any leaking. It will be
reused if it is found to be structurally sound. It will be replaced if any
imperfections are noted or any leakage is found.
Lot 10, Block 8, Mountain Park Estates
October 1, 1996
Page Two
If the system is constructed as designed the following statements can be made:
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.
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.
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
drainage patterns in the area. The current
maintained.
have no adverse impact on
drainage pattern will be
Sincerely,
Michael E. Anderson, P.E.
Attachments
. AI..P~IE
AREA MAP
SCALE 1" -- 100'
SITE PLAN
SCALE 1" = 30'
SYSTEM PLAN
NO SCALE
SCOPE OF WORK:
2.
3.
4.
5.
Expose the Existing Tank and Verify its Integrity for Continued Use.
Intercept Existing Line Out of Tank and Place Double Cleanout.
Place Zabel Flow Diverter at Existing Line and Close Flow.
Place New Distribution Line As Shown.
Maintain 12' Separation From Existing Trench.
LOT 8, BI. OCK 10, MTN. PARK ESTATES
SUB.
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home
Perc. Rate: 50 Min./Inch
Application Rate: .45 GPD/SF
Deep Trench System
Verify Existing Septic Tank
9' Gravel Beneath Dist. Line
3 Bedrooms X 150 GPD -- 450 Gallons Per Day
450 GPD/.45 GPD/SF = 1,000 SF / 18 SF/LF = 56 LF Total Length
Therefore: Construct a Deep Trench System With One Lateral a Total
Length of 56'. Lateral to Be Placed at 3' Below Ground Surface.
NOTE:
TYPICAL DEEP TRENCH SECTION
Bottom of Trench to be 4' Above Groundwater.
Minimum 3' Cover Over Trench.
Grade
Area
Over
Trench
to
Drain
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
~(ENGINEER's SEAL)
· ¥,,-;Vi,..''~, . ..... ,
DATE PERFORMh~i~~~
LEGAL DESCRIPTION: ~O~ /~, ~/~Ot.~- ~.~. /~'r/d. Township, Range, Section: '
7~Af'&~.=. ~,~ SLOPE SITE PLAN
WAS GROUND WATER~'JO
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oepmt~ Water Atter/ . _.
Monitoring? /%/dM~ Bit~ / I
Gro.~ Net Depth to Net
Reeding Date Time Time Water Drop
10-
11
12
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS -'7'~.~J--~O/-~
PERCOLATION RATE 4/~) (m~nutes/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND '~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: DATE:
72,008 (Rev. 4t85)
IN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Lot 10, Block 8, Mtn. Park Estates Subdivision
GENERAL:
1. The scope of this project includes exposing the existing
septic tank and verifying its integrity for continued use. A
new tank will be required if any leaking or other damage is
noted. Work also includes abandoning the existing
absorption trench by placing a diverter valve and
constructing a new 60' long absorption trench with an
effective gravel depth of 9'.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all
underground utility locates and for the layout of the septic
system and verification of the location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be procured from an
approved source and installed at the location shown on the
Site Plan if the existing tank is found to be unsound.
Lot 8, Block 10, Mtn. Park Estates Subdivision
October 1, 1996
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5. Tanks installed without 4' of cover shall have a minimum of
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trench shall be within 2"
of level.
2. Distribution piping must be placed level with perforations
down atop alevel bed of drainfield rock. Rock should then
be placed over the pipe to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
Lot 8, Block 10, Mtn. Park Estates Subdivision
October 1, 1996
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the
drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated, but
not solid) and ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
Lot 8, Block 10, Mtn. Park Estates Subdivision
October 1, 1996
Page Four
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. 'The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide acopy of all field survey layout and
construction notes for use in preparing the certified as-built
of the completed system.
MUNICIPALITY OF ANCHORAGE
DE :iTMFNI' OF HI=ALTH AND HUMAN SER KS
Environmental Health Division
825 "1_" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
TANKS
TYPE OF SYSTEM
~k:TRENCH [] BED [] W, DRAIN ~ OTHER
WELLS
~PRIVATE [] OTHER fldentifv)
FT
REMARKS:
DISTANCES
SEPTIC
TANK
ABSORPTION
FIELD
WELL
WELL I '7-.~ ' ._h I I ~> ~-
LOT LINE I o~+ t~' ~r /
FOUNDATION ,E~~ '-z.~. ' ~
AS-BUILT DIAGRAM ~Show Iocabon el well. sepllc system, property I[aes, Ioundahon,
driveway, waler bodies, eW j
Scale: ~.~ ,q%. ~,,
Inspections_~ao by
Dale
Municipal and $1sle guideli~:iir~iigt:6n this dale:
HealW Departmenl Approval:
__ cedily II]at this inspeclJon was perlormed according Io
72-013 ¢;85)
D~te Drill~dt
10-29=85
Lot ~ Blko 8
Mt..ark Estates
Static Water Level 197
feet
Draw Down ~ feet
Gallons Per Minute 3
Total Feet of Casing_~ 220
T_j~.Material D~illed:
25 feet to 39 Sand silt Gr v
_f'k,L.~L~_ _ to=2.gsc_~L~
9-~~to ~o12~
l~0.feet to 200 Da~op Gravel. toD_9~L_(]rave1
200 feet to 220 Si~_~Y__T_~9/u'p_Gravel w/water
Hefty Drilli~
Box 1553 H
Anchorage ,Alaska
99507
.... /~.,~, /~ ~ --~.. ..,,
,..~%~'~' ~1 IC Jc
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION: ~"T" IC~
10
11
12
13
14
15
16
17
18
19
2O
No, 1457-E ;
COMMENTS
DATE PERFORMED:
SLOPE
SITE PLAN
WASGROUNDWATER , \ S
ENCOUNTERED? ·~ ~
P
IF YES, ATWHAT E
DEPTH7
Reading Date Gross Net Depth to Net
Time Time Water' Drop
PERCOLATION RATE ~'7 (minutes/inch)
TEST RUN BETWEEN /'¢ FT AND ~ FT
PERFORMED BY:
_CERTIFIED BY:
DATE:
72-008 (6/79)
Dece]~3er 29, 1978
~t780236
Robert Charles
1234 R Street
Anchorages Alaska
99501
Subject~ Lot 10 Block 8 Mountain Park '~"
Estaees Subdivision
A permit issued by this department for well and/or
sewer sys'ten~ has expired° '
Permits are issued on a calend, ar year bas±s~ as stated
on the permitt by authority of tn~lczpa.[ ordinance.
l:f you have drilled the well, a well log should be
sent to this department to document the ±nstallation
date.
ITl there are any fur%her questions, please contact
this office at 264~4720o
Stncerely~
Les No Buchholz~
~%en~or Anv~ronmental Specmalmst
LNB/ljw
enc: copy of per,nit
April 6, 1978 R&M No. 851109
Mr. Robert Charles
1234 R Street
Anchorage, Alaska 99501
Subject: Soil Investigation for Sanitary Sewer System, Lot 10,
Mountain Park Subdivision, Anchorage, Alaska
Dear Mr. Charles:
Block 8,
At your request of April 4, 1978, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the subject
lot. The investigation complied with those procedures required by the
Municipality of Anchorage Department of Health and Environmental Protection.
This investigation, which was accomplished on April 5, 1978, consisted of a
test hole drilled to a depth of 20 feet below the existing ground surface.
The test hole was sited according to your instructions and its location is
shown in attached Drawing A-01. Drilling was accomplished with a rotary
drill rig using continuous flight solid-stem auger with an outside diameter
of 6 inches. A sample was taken at the depths shown on the soils log in
Drawing A-OI. The sample will be held in storage at our lab for approxi-
mately six months. In addition, all material brought to the surface by the
augers was continuously monitored by an experienced engineering geologist.
The topography at the drilling site is generally horizontal. At the time of
the investigation the site had original vegetation consisting of birch,
willow, alder and spruce. The top of the test hole was located at original
ground surface.
The soils encountered in the bore hole are shown in the test hole log in
Drawing A-01. The symbols used in Drawing A-01 are explained in Drawings
B-01 and B-02. This log displays specific conditions encountered at the
test location. However, subsurface conditions may vary in other parts of the
lot without any apparent surficial evidence of the change. Groundwater was
not encountered. Bedrock was not encountered. At the time the hole was
drilled seasonal frost was present from the surface to a depth of 8 inches
Permafrost was not encountered. '
A percolation test was performed within the bore hole at the depth shown in
the attached Table 1. All depths were measured from the top of the hole.
The data in Table 1 show average infiltration from the depths indicated to
the bottom of the hole. The measured percolation rate was 9.1 minutes per
inch.
April 6, 1978
Mr. Robert Charles
Page -2-
We appreciated this opportunity to be of service to you. Please contact us
if you have any questions concerning this letter or if we can be of addi-
tional service.
Very truly yours,
R&M CONSULTANTS, INC.
Lynne Kosikowski
Staff Geologist
JMB: LK/kah
Jim McCaslin Brown, Ph.D.
Head, Earth Science Department
Attachments: Drawings A-01, B-01, B-02, Table 1
BORING NUMBER 3. Date Completed:
SOIL DESCRIPTION
All Samples A
PEAT
Reddish-brow~l
GRAVEL 1.0 '
Small, Rounded to Subangular, Dry
2.0'
SAND W/SOME GRAVEL
Light Bro~%, Dry, Medimn Dense
Fine to Medi%un Grained GP
6.5'
SILTY SAND W/SOME GRAVEL
Brown to gray, Dry to Slightly
Moist,
Median Dense SM
LOCATION
SKETCH
ALPINE
No Scale
NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE
NOT BEEN MEASURED BY SURVEYING METHODS·
15.0'
S~qDY GRAVEL W/SOME SILT
GM
Brown, Slightly Moist,
Medium Dense
- 20' rD.
No Water Table Encountered
:. s-eeWbo-~.{... SOILS LOG Jl
EXPLANATION
~_ ORGANIC MATERIAL
Liftle Visible Ice 0:-I0' Vx
~ A,8. "--/CE' DE'SCRIPT/ON
(~'Ss, 72,5Z ~%, 85,9 pcf
! ~--' DRY O~NSITY
~ ~ ~WATER CONTFNT
~BLOWS/FOOT
BEOROC~
TY~lO~L SO~L~ UOO ~ A.~-AFT~ BORING
~AMPLER TYPE SYMBOLS~
ORGANIC
~'~ S/LT ~ BEDROCK
SAND ~ /C~, MASSIVE
ROBERT CHARLES ~B. ,
BORE HOLE LOG GRID.
LOT 10 Blk 8 Mt. Park Estat ]PROJ. NO. 851109~
ANCHORAGE, ALAgMA /~
TIME
ELAPSED
TIME
PERCOLATION TEST
Robert Charles
R&M NO. 851109
INCHES
DROP IN INCHES
12:10 0 19.2
12:11 1 19.8
12:12 2 20.4
12:13 3 21.0
12:14 4 21.6
12:15 5 21.6
12:16 6 21.6
12:17 7 22.2
12:18 8 22.2
12:19 9 22.2
12:20 10 22.2
12:25 15 22.2
12:30 20 22.8
12:35 25 22.8
12:40 30 23.4
12:50 40 24.0
1:00 50 25.2
1:10 60 25.8
0
.6
.6
.6
.6
.0
.0
.6
.0
.0
.0
.0
.6
.0
.6
.6
1.2
.6
6.6 Total Drop (Inches)
9.1 Minutes per Inch
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017.391-32
1. GENERAL INFORMATION
Complete legal description
HAA#
Expiration Date:
Lot 10, Block 8, Mountain Park Estates Subdivision
Location (site address or directions) 6066 Bristol Drive
Current Property owner(s) Thomas & Carrie Buckmeier
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless e'~erwise requested, HAA will be held by DSD for pickup.
2, NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
6066 Bristol Drive Anchoraqe. AK 99515
Three (3)
O~ O~ 38
l-b/- o~
Day phone 244.5215
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank r'-]
Well [] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of HeaIth Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for propedies served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further veri~ 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(are) in compliance with all applicable Municipal and State codes, ord!nances,
and regulations in effect at the time of installation.
Name of Firm Anderson Enqineerinq
Address P.O. Box 240773 Anchora.qe, AK 99524
Engineer's Printed Name Michael E. Anderson. P.E.
5. DSD SIGNATURE
J Approved for
Disapproved.
bedrooms.
Phone 522-7773
Date 10117/2002
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ! 0 - ~ I - 0 ,=~
Municipality of Anchorage ,_o.
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Brag'aw St.
v
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
WELL DATA
Wall type Private
Date completed ~0/29ngs~i
Total depth 220 ft.
Lot t0, Block 8, Mountain park Estates
Date of test
Static water level
Well production 3
WATER SAMPLE RESULTS:
Coliform 0 c~donias/100 mi.
Date of sample: 10/7/2002
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Parcel ID: 017-391-32
IfA, B, or C previde PWSID # __
Sanita~ seal (Y/N) ~_
Cased to 220 lt.
FROM WELL LOG
¶0~29/1985
197 f.
g.p.m.
Wall Leg (Y/N) Y
Wiras properly protected (Y/N) Y
Casing height (above ground) >t2
AT INSPECTION
t0/3/2002
198 ft.
2.7 g.p.m.
Nitrate t.5 mgJI.
Collected by: MEA
in.
Other bacteria 0 colonies/100 mi.
Date installed 10/31/1985
Tank size t,000 gal. Number of Compartments 2_ Clearmuts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) 14 High water alarm (Y/N) Y
Date of pumping 8922/2002 Pumper Anchorage Cesspool Pumping
C. ABSORPTION FIELD DATA
Date instatled 10/16/1996 Soil rating (g.p.d./fl; or ft;/bdrm) .45 GPD/SF System type Deep Trench
Length 65 fi. W~lth 3 fl. Gravel below pipe 9
Total depth 12.5 lt. Eft. absorptk3~ area 1,110 ft2 Monitoring tube Y_ Depression over field 14
fL
Date of adequacy test 10/10/2002
Fluid depth in absorption field before test ~_~ in.
Elapsed Time: 1~140 min. Final fluid depth 64 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
Results (Pass/Fail) Pass For _3 bedrooms
Water added451 gal. New depth71.5 in.
Absorption rata >= 450 g.p.d.
If yes, give date
LIFT STATION
Date installed
'Pump on" level at __ in.
Datum
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100.
Absorption field on lot >t00.
Public sewer main N/A
Sewer/septic service line >25'
Size in gallons
'Pump off" level at
Cycles tasted
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cteanout NIA
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line 4'
Water main N/A Water service line >t0'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >t0'
Water Service line >t0' Surface water >100'
Curtain drain None Noted Wells on adjacent lots >t00'
COMMENTS
Lol Une Waiver issued 10/24/96
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 HAA guidelines in affect on this date.
Engineer's Printed Name Michael E, Anderson. P.E.
Date 10117/2002
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
-' - Oz..
Absorption field >5'
Surface water >t00'
Water main >t0'
Driveway, parking/vehicle storage >25'
in.
Wa~er Fee $
Date ~ Payment
R~ipt Number
- .':iI AN ~ ~4
' . . ·'"~., :: CHORAGE,'A 9952
~522-7773 ; ~":. :-' 522 6779 (FAX).'
October 17, 2002
Thomas and Carde Buckmeier
6066 Bristol Drive
Anchorage, AK 99515
Subject:
Lot 10, Block 8, Mountain Park Estates Subdivision
Well and Septic System Inspection, Testing and Certification
Dear Tom and Carrie:
At your request we inspected the well and septic system on the subject lot to determine if they met
the requirements for certification by the City. Prior to the inspection we inspected the Municipal
records and found the septic system was originally constructed in October of 1985 and upgraded in
October 1996 and is composed of a 1,000 gallon septic tank and 2 absorption trenches. The first
trench constructed in 1985 is approximately 67' long with 6' of gravel. The second trench
constructed in 1996 is 65' long with 9' of gravel beneath the distribution piping. A flow diverter
valve is in place to control flow to the trenches. The new trench is currently on line and was tested
for adequacy dudng our inspection. The accepting soil matedal in the absorption trenches is a
tight silty gravel with a percolation rate of 50 minutes per inch. The well was also constructed in
June of 1985 and is 220' in depth with 6" steel casing the entire depth.
We probed the monitor tube at the end of the westerly trench and found nearly 22" of' water. The
monitor tube in the approximate middle of the newer trench and found had 64" of water. We then
injected 451 gallons of. water into the post tank cleanout past the diverter valve and the water was
distributed to the trench. The water level in the monitor tube rose to 71.5". The water level was
checked approximately 24 hours later and was found to have receded to the elevation recorded
pdor to the test. We conclude from this test the trench is capable of absorbing the required 450
gallons of water per day and meets Municipal requirements for certification. It must be noted,
however, that the lifespan of' a septic system is affected by many variables and no guarantees or
warrantees as to the future life of the system are made or implied as a result of. our test.
The static water level in the well was measured at 198' below the ground surface prior to our test.
Water was allowed to run freely from the well through a hose bib and through a 5/8" hose and
measured with a volumeter. Flow was measured at an average rate of' slightly more than 2.7
gallons per minute with the static water level in the well dropping to 206.4'. Once flow from the well
was stopped the static water level returned to its original level in an hour. The well is therefore
capable of producing in excess of the required 450 gallons per day. A sample from the water
system was taken to the laboratory for analysis and found to be free of coliform and other bacteria
with only a trace of nitrate content. The well and water are therefore eligible for Municipal
certification.
Sincerely,
Michael E. Anderson, P.E.
Attachments
0
EASEMENTS.OF' I~ECORDi.OTHER THAN
THOSE 'SHOWN ON 1'HE RECORDED
PLAT, ARE NOT ,SHOWN HEREON,
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. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
017-39L132 HAA# '~:'lAe"\c'~'~" C
GENERAL INFORMATION
Complete'legal description Lot'~'l 0, Block 8,
Mountain
Park Estates
Location (site address or directions) 6066 Bristol Drive
Property owner Michael A. Cady & Lorraine Farr~phone 345-2450
6066 Bristol Drive Anchorage, AK 99516
Mailing address
Lending agency
Mailin_g address
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
Three (3) Y
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
XXX
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XXX .
Individual on-site -.: ,
Holding tank
Community on-site
Public sewer
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
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 furtherverifythatbasedontheinformationobtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm Anderson Enqineerinq
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer's signature
Phone 522-7773
Date 2/15/99
DHHS SIGNATURE
/~ Approved for 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with th-e following stipulations:
Additional Comments
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 enginee~ registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~25 (Rev. 1/91) Back MOA ~1
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICE'~
Environmental Services Division
· FEB 17 1999
825 L Street, Room 502 · Anchorage, Alaska 99501 (9,07) 343-4744 ,
Municipality ct AnChorage
Dept. Health & Human Services
Health Authority Approval Checklist
Legal Description: Lot 10 ~
A. WELL DATA
Well type Private
Block 8~ Mountain
Park Estates
Parcel I.D.: 01 ?-39-132
Log present (Y/N) Y
Total depth 220 ',
Sanitary seal (Y/N)
Date of test
Static water level
Well production
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 10/29/05
Casing height (above ground)
¥ Wires properly protected (Y/N)
Cased to
FROM WELL LOG
10/29/85
197'
3
220' 2'
AT INSPECTION
2/1.3/99
WATER SAMPLE RESULTS:
Coliform 0 Nitrate
Date of sample: .2/9/99
B, SEPTIC/HOLDING TANK DATA
Date installed · 1 0 / 1 3 / 8 5 _ Tank size 1,0 0 0
Foundation cleanout (Y/N)
Date of Pumping 9/98
C, ABSORPTION FIELD DATA
Date installed 1 0 / 1 6 / 9 6
Length 6 5 ' Width
197'
g.p.m. 3 g.p.m.
1.24 mg/L Other bacteria
Collected by: MEA
Y Depression (Y/N)
Pumper Anchorage
Number of Compartments 2
N High water alarm (Y/N)
Cesspool Pumping
Soil rating (g.p.d./ft~ or ft2/bdrm) .45
3 ' Gravel thickness below p pe
Effective absorption area 1 , 170': SF Monitoring Tube present (Y/N) Y
Date of adequacy test 2 / 13 / 99 Results (Pass/Fail) Pas s
Fluid depth in absorption field before test (in.); 3.1 '
Fluiddepth 3.1 ' (ins)Minutes later: 24 Hrs.
Peroxide treatment (past 12 months) (Y/N) ~
__ Cleanouts (Y/N) Y
N
System type Deep Trench
9 ' Total depth 12.5 '
__ Depression over field (Y/N). N
For Three bedrooms
Immediately after506 gal. water added (in.): 3 · 8 '
Absorption rate = > 450 .g.p.d.
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
None on Lot
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot > 100 '
Absorption field on lot > 100 '
Public sewer main
Sewer/septic service line > 25 ' Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line > 5 '
Water main/service line > 10 ' Surface water/drainage > 100 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation > 10 '
Property line 4' ~¢*
Surface water > 100 '
Curtain drain None on Lot
F. ENGINEER'S CERTIFICATION
Lot
"Pump off" level at*
Driveway, parking/vehicle storage area
Wells on adjacent lots > 100 '
Line Waiver Issued 10/96
I certify that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name Michael E. Anderson, P.E.
Date ~/-~ '>'/~ ¢
Absorption field > 5 '
Wells on adjacent lots > 1 00 '
Water main/service line > 10 '
;~10'
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
are
On adjacent lots > 100 '
On adjacent lots > 1 00 '
Public sewer manhole/cleanout N/A
N/A
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 I.D. # 01739132
1. GENERAL INFORMATION
Complete legal description
Lot 10, Block 8 Mountain Park Estates
6066 Bristol Drive
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Jean S. Sagan
6066 Bristol Drive
Day phone 786 1531
Anchorage, AK 99516
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Three 3)
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
XXXXXX
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
Public water .. , ~ /,/
, <: ,~
If community well system, provide written confirmation from State'AD£C aftest-.,
ing to the legality and status of system. "' .:, ~, ,-, .
XXXXXX ", " < '
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~Y25 (Rev. 1/91) FrOnl MOA #21
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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein, lfurtherverifythat based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm Anderson Engineering Phone 563 .7155
Address P,O. Box 240773 Anchorage, AK 99524
Engineer's signature ~¢~-~.c,~, C C/'~1'%~~,-''---'' Date lo/19/96
DHHS SIGNATURE
Approved for -~
Disapproved.
Conditional approval for
bedrooms.
b.~orooms,
with the following stipulations:
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 engineeCs work.
72-O25 (Rev. 1/91) Back MOA
MuniciPality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Health Authority Approval Checklist
Legal Description:
A. WELL DATA
Well type P/2.1x/~T* .~'~ if A. B, or C. attach ADEC letter. ADEC ~vater system nulnber
Log present (Y/N) 'x(' Date completed
Total depth ~-~&) / Cased to
Sanitary seal (Y/N) ~1/'
OIT' Cll 3L.
Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTiON
Static water level /g ,~t t [ ~ , ~/
Well production ~ g.p.m. ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform O Nitrate /, i g,, ,~.,~ / L~ Other bacteria
Date of sample: {~9/%~/~, Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /~/~J }]~ tffTank size
Foundationcleanout (Y/N)"y'
Date of Pmnping /'/Y/J ~ / q k Pumper
C. ABSORPTION FIELD DATA
Date installed /O/'tb. [ ~] Cl~ Soil rating (g.p.d./ft2 or ft2podrm) o
Length ~ ~ i Width -~ / Gravel thickness below pipe
/~OOt9 Nulnber of Compartments Z, Cleanouts (Y/N) Y'
Depression (Y/N) ~ High water alarm (Y/N) /NJ
System type ~)iz~pT~-txl t2J.4.
Total depth l ~,' q3
Effective absorption area /t i ?0 /~, Monitoring Tube present(Y/N) ~'/ Depression over field (Y/N) ~
Date of adequacy test t~ tL-qM (,~ s"'~ Results (Pass/Fail) T'),0, .q, $ For "~/~ bedrooms
Fluid depth in absorption field before test (in.); ~ hnmediately after gal. water added (in.):
Fluid depth Minutes later:
Peroxide treatlnent (past 12 months) (Y/N)
(in.) Absorption rate =
If yes, give date
g.p.d.
Date installed ~-~.~_ Size ill galloos , ·
Manhole/Access (Y/N) ~'""~-~'-~ "Pump off level at
High xvater alarm level at* *Datum ~
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field oo lot
Public sewer main
' Oil adjacent lots
· On adjaceat dots
Public sexver manhole/cleanout
Sewer/septic service line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation
Property line >/g9 Absorption field '~
Water mai~qservice line ~>/O t
Surface water/drainage >]~)~ t
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
Water mai~ffservice line
Driveway, parkingA,ehicle storage area
Wells ou adjacent lots
P op -m7
>,,ti) '
I certify that ] have determined thrufield inspections and review are
m conformance with MOA HAA guidelines,~ effect on this date.
St' nature' '
Engineer's Name /~,Cgd~&~ ~ ~08W30,J "
Date
I ' q, '-'~" ,
Date of Payment
Receipt Number
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
October 24, 1996
Michael E. Anderson, P.E.
Anderson Engineering
PO Box 240773
Anchorage, Alaska 99524
Subject: Waiver Request for LOt 10 Block 8 Mountain Park Estates Subdivision
Waiver Request #WR960061, PI:D #017-391-32, HA960464, SW960348
Dear Mr. Anderson:
Your request for a waiver of the required 10 foot separation between an on-site
wastewater disposal system and a lot line has been approved. The waived distance is 4
feet from the absorption field to the west end of the property.
This approval applies to the existing on-site wastewater disposal system lot line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separations be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Robert W. Robinson
Civil Engineer
On-site Services Program
RWR/ljm:Sagan
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR~ WR960061 PID~ 017-391-32 HA# HA960464
Date Received: October 23, 1996
Legal Description: Lot 10 Block 8 Mountain Park Estates Subdivision
Engineer: Michael E. Anderson~ P.E., Anderson Engineering
PO Box 240773~ Anchorage~ Alaska · 99524
Applicant: Jean S. Sagan t.
Waiver Requested: Lot line waiver of 4 feet from the absorption field to
west end of lot line.
Permit ~ SW960348
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: '\//i Waiver is NOT Granted:
List Conditions or R~asons for above:
Date: / ~'.~.~ By:
Name of ~eviewer
Rec 9: 02371/3096
Amount: $ 115.00
Date Paid: Oct 23, 1996
October 23, 1995
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
RECEIVED
OCT 2 3 19%
Dept. Health & Human 8ervJoes
Subject:
Lot 10, Block 8, Mountain Park Estates Subdivision
Septic System As-Built
Lot Line Waiver Request
Dear On Site Services Engineer:
Very little area is available for a septic system on this lot because of the
location of the well on the lot and on the adjacent lots. In addition, the
new absorption trench was constructed to leave the existing trench in
tact for possible future use. The west end of the absorption trench
encroaches to nearly 4' of the property line. The majority of the trench,
however, is greater than 10' from the line. A waiver to the 10' setback
requirement is necessary for the west end of the absorption trench.
No easements exist along the property line. In addition, no development on
the adjacent property is within 50' of the line. Due to the elevation
changes on the property next door the use of the adjacent area for a
replacement septic system is very unlikely.
It was necessary to crowd the lot line to avoid encroaching into the
existing system. We therefore request a waiver be issued allowing a
portion of the absorption trench to be approximately 4' from the lot line.
Please let me know if you have additional questions.
Sincerely,
Michael E. Anderson, P.E.
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
~-~- &Gl-_%5 HAA# ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
I.mt 10; B~n~.~. ~; Mnu~'(~Jn P~ Estates
Location (address or directiens)
6066 Bristol .D.ri~¢;"; 'Anchorage, Alaska
(b) Property owner' ~.~-~'~O, ~-,~2 L '~-1 ~,(~ S Telephone: (home)
Mailing Aadress
(c) Lending Institu{ion GMAO Telephone
Mailing AddreSs':- ' Ter'~.y L~. )a~/Loan Officer
FORTUNE PROPERTIES/Niel Thomas
(d) Real Estate Company and Agent
3000 A Street, Anchorage, AlasEa 99503
Address
Business.
Telephone
562-7653 '
(e) Mail the HAA to the following address: (or check here ~, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
17034 Eagl~ River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family E~ Number of bedrooms 3
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th' legality and status.
4. SEWAGE DISPOSAL
On-site 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.
72-025 (Rev. 7/88) Page 1 of 2 ·
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my sea~ affixed hereto and as of thevalidationdateshown below, J 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
S & S ENGiNEF. R|N'G
17034 Eagle River Loop Road i'~o,
· , -,:- ao~77
Eagle River, ~,~
Telephone
6. DHHS APPROVAL
Approved for. -..? bedrooms by
Approved &~_~._ Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections
or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) E~ack Page 2 of 2
A. WELL DATA
Well Classification
Well Log Present (.~¢~, N)
o MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
JCJPALFrY (~HE~,F~4~ - FEBRUARY 1984
NMEN'rAL SERVICES DW1~.~-4744
OCT ]989
RECEIVED
'¢ Date Completed
Legal Description: [.-¢__.¢r' 1~ ~ ~
If A, B, C, D.E.C, Approved (Y/N)
Casing Height Above Ground
Electrical Wiring in Conduitq~/N)
Total Depth '~'~¢-~t Cased to '~."7--c'* Depth of Grouting
Static Water Level ~ ', ~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot / '~"~ ~
Pump Set At
Sanitary Seal on Casin ((~_.~N)
Depression Around Wellhead
; On Adjoining Lots I
; On Adjoining Lots
To Nearest Edge of Absorption Field on,Lot
To Nearest Public Sewer Line r~/,~
To Nearest Sewer Service Line on Lot
Water Sample Collected by ~--~"~ ~ ~ [~,~=:¢-m¢~. ; Date
Water Sample Test Results ~¢~t.~~
To Nearest Public Sewer Cleanout/Manhole
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed I~''5~ ~¢-~'~ Size
Standpipes (C/N) ~
Depression over Tank (Y/~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
.Air-tight CapsY. C~N)
No. of Compartments
~ Foundation Cleanout4~TN)
i~ /Date Last Pumped ~!,
; for
¢&//'~ Temporary Holding Tank Permit
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-S. upply Well
To Property bins
T,o Water Main/Serve'ce Line
To Building Foundation
To Disposal Field
I ~=~t ~r
t
J
To. Stream, Pond, LaKe or Major Drainage Course
Comment~ A~'' ~o~ ~..-
72-026 (Rev. 7/88) Front Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/d~j:)
Results of Last Adequacy Test
/?~.t,¢ ~:~ Y¢~ Type of System Design'"'~. ,~/4
Length of Field
Depth of Field
Gravel Bed Thickness Lc,
~ ~:::~,¢¢_.-4~ Statndpipes Present 4::~/N)
~-~ Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot pA
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existin~ or Abandoned System on
Adjoining Lots "~ '~r~
To Cutback (if present)
t
Comments
Date Installed
'Pump On" Level
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ Pumping Cycles during Adequacy Test.
**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
Company
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
72-026 IRev. 7/88) 8ack
S & S ENGINEERING
17034 ~ag~ ,,, ................ ,,--,
~gla River~ Alaska 99577
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
ANALYSIS REPORT BY SAMPLE for Iqork Order ~ 17012
Date Report Printed: OCT i 89 ~ 13:41
Client Sample ID:LIO BB }40UNTAIN PARK S/D
PWSID :UA
Colleotod SE? 25 89 @ 15:20 hrs.
Received SEP 25 89 ~ 16:00 hrs.
Preserved with :AS REQUIRED
Client Name : 3 & 3 ENGR
Client Acct: SNSENGP
P.O.~ NONE RECEIVED
Req ~
O~de~ed ~y :
Analysis Completed :SEP 27 89 Send Reports to:
SupervI~oL:STEPHEN C. EDE 1)S & S ENGR
Laboratory
Released By : ~.~.'-~--~ ~ 2)
Special
Instruct:
Chemlab Roi ~: 7719 Lab Smpl ID: 5 ~atrix: WATER
Allowable
Parameter Tested Result/Units ~ethod Limits
NITRATE-N 0.60 mR/1 gPA 353,2 10
Samplo ShI4?LE COLLECTED BY gDJ
Remarks:
i Tests Performed See Special Instructions M)ove UA~Unavailable
ND,, None Detected '* See Sample Remarks Above
Nh= Not Analyzed LT=Less Than, GT=Greater Than
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PUBLIC WATER SYSTEM I.D.#
[] PRIVATE WATER SYSTEM
Mailing Address
City [ I ~ ' .... Stale
Mo. Day Year
Zip Code
SAMPLE TYPE:
~ Routine
Check Sample (for routine sample
with lab ref, no,
[] Special Purpose
.) [] Treated Water
[] Untreated Water
SAMPLE Time
NO. LOCATION Collected
Collected
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TO BE COMPLETED BY LABORATORY
sYatis shows this Water SAMPLE to be:
isfactory
[] Unsatisfactory
[] Sample too long in transit; sample sho.uld
not be over 30 hours old at examinatioh
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received ¢'- 4 ;~-~?
Time Received /~
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref, No, Result*
Analyst
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter: Direct Count
Verification: LTB BGB
Final Membrane Filter Results ~
Reported By'~-~J."---~ -.-~-"-~~ ~.Date
TNTC = Too Numberous To Count
OB = Other Bacteria
Time:
P2%RT ONE; OF TWO
I:~M~iNDE~R TO FOLLOW
Coliform/100ml
Collforrn/100ml
MUNICIPALITV OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONiVIENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEAI2i'FI
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date __~ \ ~
GENERAL INFORMATION
(a) Legal Doscription (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~~ ~;-~% Telephone: Home ~ "' ~ Business
Applicant Address ~ '~ ~ ~ ~-~~ -~'~/ ....
(c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent
Address
Telephone
(f) M;sil the I-tAA to the foltowing address:
TYPE OF RESIDENCE
Single-Family~C MuLti-Family
Number of Bedrooms '~
Other
WATER SUPPLY
Individual Well¢~-- Community [-~ Public
Note: If community well system, must have written confirmation from the State Department ol Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL ~
Onsite,,~C Public [~ Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72 025 {11~84)
Page 1 of 2
ENGINEERING FIRM PROVIDING..~PECTIONS, TESTS, FILESEARCH, DAT' .ND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thi~ Healtl;~
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 atl Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm . . . Telephone
Address
Date
Approved ~.~ DisapprovedU'' C°nditi°nar~'
Terms of Conditional 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 pro~-essional
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 el 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
72-025 (I ~/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APP'ROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
,MUNICIPALITY OF ANCHORAGE'
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
NOV 1919t -'
,o IV E D
WELL DATA
Well Classification
Well Log Present'(~;~N)
Total Depth ¢...'Z.,c~'
Static Water Level
Casing Height Above Ground
Electrical Wiring in ~onduit~,'.,'~N)
Separation Distances from Well:
t¢~-'Z~'~ ~¢~,-~- If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ c>~¢_.-~ ~ 'E~ Yield
Cased to
Depth of Grouting
Pump Set At
Sanitary Seal on Casing ~¢N)
Depression Around Wellhead (Y/,¢~
To Septic/14e~ Tank on Lot I '2~-~ ' 4-_ ; On Adjoining Lots
To Nearest Edge of AbsorptionField on/Lot ~ ~ ~ ~¢ ; On Adjoining Lots
To Nearest Public Sewer Line ,¢ /¢/:~ To Nearest Public Sewer
Cleanout/Manhole ~
Water Sample Collected by
Water Sample Test Results
Comments
To Nearest Sewer Service Line on Lot .~..~. 1 4-
B, SEPTIC/=H(~'~,NG TANK DATA
Date Installed tO~'~ ¢ b:~ Size t ~
Standpipesd~2/N) Air-tight Caps (~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)~.3//x,
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/.Meh~-n~Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
No. of Compartments
Foundation Cleanout(_(~/N)
/Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
'Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well / t C~
To Building Foundation
lot
To Water Main/Service Line l c:~ ~..~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area; or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Presen(~N)
~,...~ Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots "~ o~
To Cu~tbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
/~A 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 M CA and HAA guidelines in effect on the date of this inspection.
Date
MOA No. ~>'~-~--OL;) _.~
Signed
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)