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Home My WebLink AboutHUNDRED HILLS BLK 3 LT 3Hundred Hills Block Lo? 3 #078-181-05 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519.-6650 www.ci.anchorage ak, us (907) 343-7904 Permit Number: LEGAL DESCRIPTION O Page I of '~ ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT .5 ~ ~::)~ o .3'~ g; PID Number: ~::~ 7~ - I~'/ -05"' Wastewater System: [] New ~'Upgrade Well: E~,'£7' [] New [] Upgrade SEPARATION DISTANCES T~ To Septic Absorption Lift Holding Tank Field Station Tank w,,, , 37' I~' -- ABSORPTION FIELD n. ~'. I 5" ,,. t TANK ri Other: LIFT STATION IJ.A-. BENCH ~ARK Engineer'a Stamp Inspechonspedormedby: ~(~'~op 7'~c/) .~"*'c Dates: 1" 2"' Development Se~ices Depa~ment Approval ~*-~,~'"'"'?"~ Reviewed and approved by: ~ Date: PERMIT NO: SW020308 PID NO: 078-181-05 WELl;-- FROM: COR. "A" PT. "B" COR"X" TO: TR. C.O. "C" 56' 40' 98' TR. M.T. "D" 77' 39' 74' TR. C.O. "E" 100' 50.5' $0' VALVE "F" 104.6' 54.5' 46' DBL C.O. "G" 106 56' 44.5' S.T.C.O. "H" 112' 60' 40.5' S.T.C.O. "1" 122' 67.5' 33' ORIGINAL TRENCH 90' "C" T.H.#1 PAGE 2 OF 3 LOT 3, BLOCK 3 HUNDRED HILLS SID R 10(7 WELL ~ DRIVE "1" EXISTING HOUSE NEW1250-GALLON SEPTIC TANK DIV. VALVE NEW 49-FOOT LONG w. 6.1' EFF. GRAVEL POINT ON SOUTH PROPERTY LINE LOT 3, BLOCK 3, HUNDRED HILLS S/D SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT - PLAN FLATTOP TFCIINIC^L S£P, VIC£S SCALE: 1' = 30' 14530 ECIIO STREET DRAWN BY TFM ANCIIOP, AGF~ ALASKA 99516 OCTOBER. 2002 PERMIT NO: SW020308 PAGE 3 OF 3 PID NO: 078-181-05 TRENCH CLEANOUTS 3'+ SOIL COVER /~~DIVERTER VALVE DOUBLE CLEANOUT OUTS 4'+ SOIL COVER FROM , , 49-FOOT LONG SOIL ABS. ~x, .. BO.rrOUOF~XC^V^TIONEL~.?a.1,_,~ INV ! 250~:~ALLON INV. SEPTIC TANK 80.2° 80.0 BOTTOM T.H. #1 MONITOR TUBE ~ ELEV. 65.T - M.T. DRY 8/22/02 LOT 3, BLOCK 3, HUNDRED HILLS SlD SEPTIC SYSTEM UPGRADE ~SoBUlLT INSPECTION REPORT - PROFILE FI.ATrOP TECI {NICAL SERVICES 14530 ECIIO STREET ANCIIORAG -E, ALASKA 99516 NOT TO SCALE DRAWN BY TFM OCTOBER. 2002 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 90519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 21,2002 Expiration Date: Aug 21,2003 Permit Number: SW020308 Legal Description: HUNDRED HILLS BLK 3 LT 3 Design Engineer: 0019 Flattop Technical Services Owner Name: Kirk Sherwood Owner Address: 940 Wolf Way EAGLE RIVER, AK 99577-9401 Total Bedrooms: 4 Parcel ID: 078-181-05 Site Address: 000940 WOLF DR Lot Size: 136169 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewatar Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~"'~ ~ Date: Issued By: ~~ ~, ~ Date: ~/~-. J/~)~ 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 ON-SITE SEWEPJWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLI'NG Parcel I.D. ~"'1 ~'-I ?; I Permit Number SW OZO.~08 Property owner(s) Mailingaddress (1) Mailing address (2) 9'1o t~ o ~ ~c Co'o,/ Legal description (Lot, Block & Sub'd.) /...o/" Legal description (Section, Township & Range) LotSize /'~o I~q Acresl q~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone '2'71 - ~'o~' {- · Zip Code Number of Bedrooms 9P$77 -?¥o! /-/,//.r I-I Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date o! Payment: Receipt Number: TilEODORE F. MOORE, P.E. PH: (907) 345-1355 CIVIL & ENVIRONMENTAL ENGLNEERLNG * ENERGY CONSERVA'HON & ANALYSIS 14530 ECIIO ST. ANCHORAGE, ALASKA 99516 August 20, 2002 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose ofthis letter is to provide the required design narrative in support ofour application for a permit to upgrade the wastewater disposal facilities on Lot 3, Block 3, Hundred Hills S/D, located at 940 Wolf Way in Eagle River. Soils logs, pert test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 4 feet and 15 feet below ground level is a silty sandy gravel with a measured perc rate of 2 minutes per inch. Using the soil application rate ofl.2 gpd/sq, ft. specified in the wastewater ordinance, this 4-bedroom residence requires a total absorption area of(4 x 150)/1.2 = 500 square feet. The proposed 45-foot long trench design with an effective gravel depth of 6 feet has a total absorption area of 540 square feet. The topography of the lot in the area of proposed construction slopes down towards the northwest at 5-10%. Southeast of the proposed trench the land rises more steeply at approximately 50%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. \ \ \ LOT 2, BLOCK 3 HUNDRED HILLS S/D \ LOT 1, BLOCK 2 \ HUNDRED HILLS S/D , \ ', .~ '~ T~,BkO~K~ '°- .... '" ~ ........ HUNDR£D HILLS ELL R 100 ~/ ~/ ,, DRIVE R 100' ABANDON SEPTIC TANK \ \ \ \ \ \ \ \ \ LOT 4, BLOCK 3 HUNDRED HILLS S/D SEPTIC TANK CONSTRUCT NEW 45-FOOT LONG WITH 6.0' GRAVEL BELOW DIST. PIPE LOT 6, BLOCK 4 HUNDRED HILLS S/D / LOT 3, BLOCK 3, HUNDRED HILLS S/D SEPTIC SYSTEM UPGRADE SITE PLAN TRENCH 59.4' T.H. #1 / WELL FLATTOP TECI [NICAL SERVICES I INCH = 100 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99~ ]6 AUGUST, 2002 NOTE: THIS IS NOTA SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. TO ORIGINAL TRENCH CONSTRUCT 45-FOOT LONG SOIL ABSORPTION TRENCH ,, W. 6.0' EFFECTIVE GRAVEL BETWEEN 4.5' & 10' B.G.L 4'* DIA. F-810 / ~ ' "A' , PERF. PIPE PLAN VIEW SCALE: 1" = 10' INSTALL NEW 1250-GALLON , · SEPTIC TAN/(~ LE CLEANOUT "BULL RUN" DIVERSION VALVE ORIGINAL GROUNI~ FILTER FABRIC-~ 4" DIA. F-810 ,~ '"'- PERF. PIPE , SEWER GRAVEL ' BOIl'OM OF ' ' F. XCAVATION CROSS-SECTION "A - A" SCALE: 1" = $' 10.5 LOT 3, BLOCK 3, HUNDRED HILLS S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECI [NICAL SERVICES SCALE: AS SIIOWN 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK. 99516 AUGUST, 2002 ITESTHOLEit ! I FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: .__].ot. 3~ Btock~.J-lundred H[IIs DATE PERFORMED: PERFORMED FOR: July 25~2002 Kirk Sherwood (feet) 1 - SM Sandy loam 2 - GP/GM Dark gray silty sandy gravel 3- ML Gray silt 4 SLOPE 5 GP/GM Dark gray silty sandy gravel Many boulders Vadable consistency above 6' (~epth to Groundwater Date --'No groundwater 7/25/02 --__Monitor_tube_dry 8/7/02 SLOPE 51TE P~ / ~TEST HOLE ~1 I 10% Clock Net Time Date Reading Time (minutes) 15 7/25 .12". Presoak 12" Resoak ML Gray sandy silt ,add water J, start__3:39:15 16 - #1 3:49!15 10' Add water 3:50 17 S.H. #2 4:00 10 A~ter 4L00:35 18 - #3 4:10:35 10 Percometer Net Drop Reading (Inct~es) 27 5/8 27 1/2 23-3/8 17 1/2 5 718 23 -3/8 173/4 .~5.5/8 235/8' 177/8 53/~ 19- 20- PERCOLATION RATE.__ .2 TEST RUN BE~NEEN 5.5 (mlnutes/lncfl) PERC HOLE DIAMETER __ FT AND__6.0 FT 8~ COMMENTS: PERFORMED BY FLATTOP TECHNICAl. SERVICES. I.~_J ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH AiL STATE AND MUNICIPAL. GUlDEMNES IN EFFECT ON THIS DATE. DATE: ~ / ~/'O__? Pl~ttop TedinicalSm¢r__ e9 14530 ~_~I~o Strot, Ancbora~e, AK 99516 Plume (907) $45-1355 Lot 3, Block 3, Hundred llills S/I) 940 Wolf Way Eagle River, Alaska Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope ofthe project consists ofreplacement ofanexisting 1250-gallon septic tank and construction ora 45-foot long soil absorption trench containing a total of 6.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. The homeowner is responsible for accurately marking the relevant property lines to enable achievement of the requlred separation distance. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250-gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. A "Bull Run" diversion valve shall be installed downstream of the septic tank allowing future reconnection to the original soil absorption trench. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by 45-foot long trench to a depth of 10.5 feet below ground level. The long axis ofthe excavation shall parallel an existing contour. 3.2 The bottom ofthe excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 6.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 6.0 feet above the bottom ofthe sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4' diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet ofsoil cover is to be placed over the filter fabric. Ifthe soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface ofthe cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required during the course ofthe project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the fight elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement ofinsulafion or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any ofthe above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] NEW MAI LING ADDRESS LEGAL DESCRIPTION LOCATION Well DISTANCE TO: Man ufacturer -- DISTANCE TO' [Well ' Manufacturer I Well I DISTANCE TO: I / NO. of lines Length of eachJine Top of tile to finish grade ~ I Length Width [ Type of crib Crib diameter DISTANCE TO: Well [Class Depth DISTANCE TO Building foundation Absorption area I nside length Dwe ng :oun~ti~ ~, 'otal length of lines Material beneath tile Dwelling NO. OFBEDROOMS PERMIT NO. Material ~..~,~.~.~ No. of compartments Width Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot Ii.ne Trench width .~3 inches ~O inches Depth PERMIT NO, Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO, Sewer line Septic tank Absorption area(s) Distance between lines Total effective absorption area OTHER SOIL TEST RATING INSTAL'LER REMARKS APPROVED DATE LEGAL by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694'2588 OWNER OF LAND ~/~ LEGAL DESCRIPTION ~F .~ ~Lf s~ ffi/~~ H/~AW DOWN FT. DATE-Started f~~V'~ ~ Ended /~ -~ -~ GALS. PER HR PERMIT NUMBER ~ y?~ ~ ~ KIND OF CASING DEPTH OF WELL /2/ ~' STATIC LEVEL OF WATER FT. fO / /5" . KIND OF FORMATION: From {~ Ft. to ~,~' Ft. t~ ~/~ ~/;/]~,_~* .~--/~/ From From ~ Ft. to /~ Ft.~,~~, ~~ From From--Ft. to Ft, From From ._ Ft. to Ft. From. From_. Ft. to_ Ft. From From Ft. to_ Ft. From From Ft. to Ft. Fr~m From Ft. to Ft. From From Ft. to.--Ft. From From- Ft. to. Ft From From :c, Ft. to Ft. From From Ft. to Ft. From From Ft. to. Ft. From From Ft. to Ft. From__ From Ft. to Ft. From M1SCL. INFORMATION: Ft. to Ft. Ft. to,__ Ft. Ft. to_ Ft: Ft. to Ft. Ft. to- Ft Ft. to. Ft. Ft. to Ft. _Ft. to Ft. Ft. to Ft. Ft. to Ft.. Ft. to Ft. Ft. to Ft. Ft. to Ft,. Ft. to Ft Ft. to Ft. Ft. to Ft. RECEIVED WELL AND PERMIT NO. ( 788966 ) I"IUI'-.t I.-C: I I '~tL I TY OF- P,I'-.IC:H .-.fiGF -, ~DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ' ' 825 'L' STREET, ANCHORAGE, BK. 9.,~81 264-472~-3 O1"4---S I TF- SEI4ER PEIE"i"I MYRNA JOHNSTON MI 8.5 HILAND RD L~ 83 HUNDRED HILLS S?D PO BOX ~34 EAGLE RIVER LOT SIZE APPLICANT LOCATION LEGAL 694 q~5~ SQUARE FEET TYPE 0F SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = SOIL RATING (SQ FT?BR>= ]"HE REQUIRED SIZE OF THE SOIL ABSORPTIBM. SYSTEM IS: [:, E P'T I-I= 2Li L ElD-lO T I-I = 3::::1- i]Ri-;~¢EI .... DEPTPt= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN ]'HE SURFACE OF ]'HE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). ]'HERE IS NO SET WIDTH FOR TRENCHES. ]'HE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REG!U I RED SEPT I C: TRNK-~ S I ~.::.E-- ~ GRLLCd"4S q-WI9 ( 2 ) I NSF'ECT I Or-IS FIRE REC4U I RED, BACKFILLING OF ANY ~.,~=,TEM WITHOUT FINAL INSPECTION AND APPROVAL BY THI=, DEPARIMENI WILL BE .llBJEtl 10 PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELD OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~8 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EF.'M I l' E×P I REc.; I.)ECEMBER 3:1. 1~, 8 I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY 'THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ISSUED BY----~~-~ ...... DATE'-~~L'OL~'-~ ..... V12 Performed For ~t~-~. ]~t4/q:~7'OAJ Legal Descri:ption: Lot '~ Block This Form Reports Soils Log_ ~ GRE.~qR ANCHORAGE AREA BOROUGY~' [JEPAR],.£NT OF ENV[RONMEtlTAL QUA[.~,Y Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 ~' Dated Per,formed % Subdivision H¢~meO 14,~.~ : Percolation Test__ Soil Tes( Must Be Logged To 4' Below Proposed Seepage System - Depth '1'~ IJ~J~lSo Feet il Characteristics Was Ground Water Encountered? kJo If Yes, At What Depth? Reading i t 'Percolation Rate I Date I Gross Time Net Time Net Dro Mi n u ,.e Proposed Installation: Seepage Pit Drain Field Depth of Inlet '5 Depth to Bottom of Pit or Trench- /.! Test Performed BY J~//V_4/~$ ~:~J&t~/~--~t,~ Date Certified BY: Date: 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 GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address ?,o. ~7o~ IO0-7~ Day phone Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well 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: 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 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 ~'/~ f-/c,f, 7-~ ¢--~ Address 1~15-3 0 ,~ ¢Ao ..C'~'./ ~,~ c/~o r,~v¢~,' Engineer's signature ~'~ ~. ~ Phone DHHS SIGNATURE ~' _ Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Heatth and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 1/91) Back MOA #21 Legal Description: Municipality of Anchorage ~i~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type t?~I~/ATE Log present (Y/N) Y Total depth 122, ' Sanitary seal (Y/N) Y if A, B, or C, attach ADEC letter. Date completed Cased to t 22 ' ADEC water system number I,~,,~, 1o/~ / 7'~ Driller /~ Casing height IR Wires properly protected (Y/N) ~' FROM WELL LOG Date of test Static water level ~'0 ' Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer mai~ :~/oo ' Sewer service ine ~ 5'o g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout z · 7/00~ Petroleum tank N0~£ O~SE~¢E/~ WATER SAMPLE RESULTS: Coliform 67 c~.l /(o~ ,,~ Date of sample: to/2~l/'~ z Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Io Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ~2~'o G.~- Compartments Foundation cleanout (Y/N) f~ ',, ,o~s~ / Depression (Y/N) Alarm tested (Y/N) ~. A' · Pumper J. ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots :> /oo ' Foundation Absorption field I~ ' Water main/service line 72-026 {Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on"level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed to[2'~ Length ~q' ~ Width ,~, Total absorption area ~O Depression over field (Y/N) bt Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ~6, Surface water E. ENGINEER'S CERTIFICATION Curtain drain On adjacent lots ~, ,'oo Property line (02 ' To existing or abandoned system on lot N.,~ Cutbank N ,/~, Water main/service line Driveway, parking/vehicle storage area "~ o~ 5~ve b bedrooms I certify that I have checked verified, or conformed to all MOA and HAA guidelines i~n~e~e~ct on the date of this inspection ·, · · Engineer's Name ~A~o~o~ F, ~o~, ~~_. · THEODORE F, ~OORE CE- 35~ HAA Fee $ / ZD' ~ Waiver Fee: $ Date of Payment //~ ~ ~ Date of Payment Receipt Number ~~~7/~.) Receipt Number To building foundation On adjacent lots >. ,.,c~ Surface water ~ ~ o9 Soil rating Ioo ~' /SD~ System type TRE,~c~I Gravel thickness _5' ~ Total depth I0 Cleanouts present (Y/N) Date of adequacy test le for K~4ouz~f If yes, give date MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range) Location (address or directions) Telephone: Home ~' _...(b) Applicant Name t'C~ r-Jo' ~'tt't~'r~c~oo¢¢' Business ~&'l- (c) Applicant is tcheck one): Lending Institution []: Owner/builder'S; Buyer []; Other [] (explain); / (d) Lending Institution ¢ f/~ Telephone Address (e) Real Estate Company and Agen! ~'~/'("¢]''~ Address Telephone TYPE OF RESIDENCE Single-Family [] Multi-Family Number of Bedrooms Other WATER SUPPLY ndividual Well I~ Community [] Pu blic [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, SEWAGE DISPOSAL Onsite [~ 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. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and nspection, 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 I--'(~-~[-/'of .7-~c/~,n~cc~( ~"~'c_c Telephone ~'~--l$~4-~-- Address IYS~Z~ ~c~ ~/ ~ ~c~o~'~ ~ ~ ~¢~ Date ~ ~/ /~ Engineer's Seal Approved for ~/~'~/.L/~ bedrooms by \ / ,~' ' Approved z2t~ Disapproved Conditional Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNIClPAUT? OF ANCHOP, AGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2 ? . ru :,iVF. D Well Classification i~rtv~ ~ Well Log Present (Y/N) Y Total Depth ~'~8~ Cased to Static Water Level ~l ~' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole N, ,4. Water Sample Collected by Water Sample Test' Results If A, B, C, D.E.C. Approved (Y/N) Date Completed fo [ 2.¢¢ ! ?~ Yield Depth of Grouting I~hA. Pump Set At "'~ ~ ~'! ' Sanitary Seal on Casing (Y/N) ~' Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments SEPTIC/HOLDING TANK DATA Size Date Installed Standpipes (Y/N) }"' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) ~ t/~ · Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well I,.q~ To Property Line ~ To Water Main/Service Line Course ~ ~OO' No. of Compartments Foundation Cleanout (Y/N) N Date Last Pumped ~ /17 /,~...~ /~.,~ ,~. ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ¥~ r To DispoSal Field I ¢ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I~' / ~ 7 / Width of Field ,.~O" Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot N,/~. Type of System Design Length of Field ¢~. r Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line N, A. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments I:',~r'~c ,,P,~' ~,~'e~¢'..~ /~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots ::~ ~0 To Cutbank (if present) ~, ~oo ~ D. LIFT STATION N,,4, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date 3 / 2./ MOA No. Signed Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal Time Time 4e Date Date Date Inspector Inspector Inspector Comments Conditional Approval . ( ). : Z'::~al Approval~ ; , Date Sewer Installed ~~ Permit No. Septic Tank Size ~ ~ _~ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~ / ~ ~ ~ ~OH ~ Phone Lending Institution /5~ ~/~.~t0~ ~ ~ Phone Address ~0x ~i ~ ~ ~ ~ ~? Typ~f Residence ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Wat~Supply ~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June ~ Community 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utility available.) Sew~e Disposal / ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MBST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. EXCAVATION ROBERT A. SHAFER WORK June 14, 1982 CIVIL ENGINEER 694-2979 Nyrna Johnston c/o Area Commonwealth Realty P.O. Box 249 Eagle River, Alaska 99577 Dear Mrs. Johnston, Reference: Lot 37 Block 3: Hundred Hills Subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1250 gallons. The absorption trench was tested by a continuous flow of water over a period of 72 hours. An average of 458 gallons for each 24 hour period was accepted by the system without any adverse effect. It can be concluded from this test that the waste water disposal system is currently functioning adequately for the three bedroom residence located on this porperty. However, the system cannot be guaranteed against subsequent failures. If we may be of further service, please do not hesitate to call. cc: Mun~0ipal[ y of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA ~ '~ ~ - ~ ' ~U~ )ALITY OF ANCHORAGE ~' DEPT, OF H~ALTH,& ~r~T~TH & ENVIRONMENTAL PRO~ECT~IEONMENTAL P~OT~CTION 825 L Street - Anchorage, Alaska 99501 MAR 1 6 1979 ENVIRONmEnTAL ENGINEERING DIVISION Telephone 264-4720 R E C E I V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTYOWNER I PHONE MAILING ADDRESS ~. O. ~ox 334, ~gLe ~Lve~, AE 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE William E. and Myrna E. Johnston 694-9766 MAILING ADDRESS ~. O. 9ox 334, ~ag[e ~e~, A~ 99577 3. LENDING INSTITUTION ~ PHONE MAILING ADDRESS 907 W. No~the~ ~g~s 9[~d~ ~c~o~e~ A~ 99503 4. REALTOR/AGENT ~ PHONE H~ ~oh~s~o~ A~A~ [~c. ~e~[~o~s~ 694-9555 MAILING ADDRESS 2. O. ~ox 249, ~ag[e ~ve~, ~ .. 99577 5. LEGAL DESCRIPTION Hundred Hills Subd. Lot 3, Block 3 ;TREET LOCATION Mile 8.5 Hiland Road 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] [] Two [] Five :~ Three [] Six Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date,_, ~ _ ,~givewell depth (attach log if available.) 121 feet 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY If ~nd~v~dual/on-slte, give installation date Oct. 1978. If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~010(3/78) On-site septic system has prior approval for 4 bedrooms - Please re-approve for 4 bedrooms. Thanks, Myrna THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED r-]PUBLIC UTILITY Connection Verified INSTALLER []Septic_Tank or [] Holding Tank Size: ~'~-"~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank a Sewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS V APPROVED FOR ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BY (Title LEGAL DESCRIPTION 72-010 (Rev. 3/78)