HomeMy WebLinkAboutPENNINGTON PARK BLK 1 LT 3Pennington
Pork
Block
Lot 3
#020-181 - 35
Municipality of Anchorage :~;,~..".,~g~.",
Development Services Department
Building Safety Division
On-Site Water and Wastewater Pro(jram, 4700 S. Bra(jaw SL
P.O. Box 196650 Anchorage, AK 99519-6650 Page
vcmv.ci, anchora(je.ak, us (907} 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 5 (,'~)0~ 0 Z_~<~7/~ PID Number: 0 '~ 0 ~ [ ~/~ 5~
D~ + Dct~ ~ WastewaterSystem: ~New ~Upgrade
~'~ ~~ ~e~ ,~Y~ ~ ~ 1~ ABSORPTION FIELD
Township:
LEGAL DESCRIPTION
Well: [] New [] Upgrade
Classification (Private, A, B, C): Total Dep~ Cased to:
__ ,..<-?, r, ¢ a ~ Fb
~ Ft.
Y~eld: ~l Pump Set at: Casing Height
SEPARATION DISTANCES
TFrom'~ Septic Absorption LiE
Tank Field Station
we,, 11'7' 15i' II7'
o,s-Ft.
To~I ~¢tion ~e~ Pi e Material:
TANK
[] Septic [] Holding I~S.T.E.P.
BI Other:
Number of Compartments:
LIFT STATION
Make & Model Ei~m~ ~spec OhS peffo~ed b~ a~ ~ ~
BENCH MARK
,,,~,,~ '~ ' ,.¢ ....... ¢,,-
~ ~ :-" /5
S l S ENGINEERING ~ / ~
lnspections pedormed ~' 170~4 Eagle River Loop ,oaS, No. 204 1't j~_ ~-0~ ~- --~,,~,.w..¢..~....,.,.:
t~~o. --~ ~ ~ ~ ROBERT C COWAN
Development Se~ices Depa~ment ARproval ~ ~. x CE-880]
PERMIT NO. SW020486 PAGE 2 OF 3
Municip. cLil o~ Anchorage
DEPARTIVlENT OF HE~_THAND HUNAN SERVICES
ENVIRONMENTAL SERVICES DI¥1$1ON
P,O. Box 196650 ~Ancho~ge, ALcsk~ 99519-6650 ~TeLephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 5, BLOCK 1, PENNINGTON PARK S/D
&T
NEW 1.30.0. G. ALLON
HDPE S.TE P TANK
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P.I.D. NO. 020-181-,55
LOT
IBM
TRENCHES
6A
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LOT 4
ROBERT C. COWAN
CF.. - 8801
PERMIT NO. SW020486 PAGE $ OF 3
Nlunicip. c4i-tv Olc Anc½orcee
DEPARTMENT OF HEALTH AND HUMAN SER¥1CE$
EN¥1RONMENTAL SERVICES DIVISION
P,g. Box 196650 ·Ancho~'age, Alaska 99519-6650·Telephone~ 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEC, AL LOT 5, BLOCK 1, PENNINGTON PARK S/D P.I.D. NO. 020--181--35
ST1 MH /- 99.5'
FINAL GRADE ~z/-z INbULA/ION
96..,..., POLYETHYLENE "-- 95.7
SEPTIC TANK
MT1 =103.3' iV!T1
MT2=103.3'-x~-_
~...rFINAL GRADE
M_T3 M_T4 MT3=104.4'
~ ~¢~- MT4=i 04.4'
·
NO WATER FOUND
94.6' B.0.H.
DISTRIBUTION SYSTEM:
PUMP = BLASTER 20EB05 (~$OGPM)
2 LATERALS ~ 51' LONG EACH = 15 GPM/LAT.
15 HOLES PER LAT. (5.6' O.C.)
30 HOLES TOTAL = 1.0 GPM/HOLE
3/16"¢ HOLES FACED BOWNWARD
1-1/4"¢ LATERALS
1-1/4"¢ SOLID MANIFOLD A
FCO 8.5'
ST1 18.0'
MH 20.5'
TMT 22.5'
DV1 54.0'
DV2 34.0'
MT1 45.0'
MT2 -
MT3 63.5'
MT4 -
B C
4.5' -
23.0' -
26.5' -
28.5' -
- 37.0'
- 36.0'
- 42.5'
65.5' 45.0'
- 53.5'
81.5' 62.5'
02.0'
MUNICIPALITY OF ANCHORAGE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Dec 17, 2002
Expiration Date: Dec 17, 2003
Permit Number: SW020486
Legal Description: PENNINGTON PARK BLK 1 LT 3
Design Engineer: 0003 S & S Engineering
Owner Name: Brian & Susan Bergt
Owner Address: 17335 BETTIJEAN STREET
ANCHORAGE, AK 99516-5610
Parcel ID: 020-181-35
Site Address: 017335 BETTIJEAN ST
Lot Size: 41699 SQ. FT.
Total Bedrooms: 2 Permit Bedrooms: 2
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
Wastewater 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.
Parcel t.O.
Mttttlclpaiity of Anchorage
Development Services Depar mei
BUilding sa!e{y Division
on-Site Waier and Wasf[eWater Program
4700 South bragaw St.
P.O. Box ~g6650 Anchorage, Ak: 995t9-6650
wwW'cl'anCb°~age'ak'us
(907) 343-7904
ON-SiTE SEWER/WELL?ERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
r~¢O '-- I ~ I - 3~.3' Permit Number
Property owner(s)
Mailing address (1)
Maillng address (2)
Legal description (Lot, Block &
Legal description (Section, ToWnship & Range)
Lot Size ~ ~. ~ ~ 3 ~
THIS APPLICATION IS FOR:
Day phone
Zip Code
Number of Bedrooms ~.,
Sewer Only E] Well Only []
Sewer and Well [] Water Storage []
Sewer Upgrade ~[
THIS PROPERTY CONTAINS:
Hot Tub [] JacUzzi []
SWimming Pool [] Water Softening Unit []
Therapy PooJ []
I certify that the above tntormatlon is correct. I further certify that this application is being made for a
Single Fatuity DweJjing and is in accordance with applicable Municipal Codes.
~Z ~r7,~'3,.,---.~ S & $ ENGiNEERiNG
17034 Eagle River Loop Road, No. 204
(signa{ure of properly owner or authorized agent) Eagle River, Alaska 99577
Date pt Paymenic I~/i6/~ "~ Date o{~ Payment:
Recelp{ NUmber: 0 ~ o/i ~" (2 '~,~ Receipt Number:
(Rev. 12/00)
HEALTH ,NJT HORITY
APF~IOVALS
December 13, 2002
ROBERT C. COWAN, P.E.
CIVIL ENGINEER~
(9O7) 694-2979
FAX (907) 694-121 i
SEWER&WATER
MAIN I~TEN~ONS
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK. 99519
SEWER&WATER
INSPECTION
REFERENCE: Lot 3, Block 1, Pennington Park Subdivision
ENGINEERING STUDIES
AND REPORIS
It is requested that you issue a permit to upgrade a septic system with a 1300 gallon
HDPE septic tank with lift station & pressurized trench to serve the existing:
bedroom dwelling on the referenced property.
W~U. INSPECTION
& FLOWTEST
A test hole was excavated on 12/9/02 and 'a percolation test was performed/ The
approximate location of the test hole is located on the attached site plan. Ground water ~as
monitored as shown on the attached soils log, and after seven days of ground;water
monitoring the test hole was found to be dry.
SITEPLANS
ROADDESIGN
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
SOILTEST
PERCOLATION
TEST
Sincerely,
kCC/jhm
STRUCTURAL &
MECHANICAL
iNSPECTIONS
Enclosure
oNs[TE
WASTEWATER
O~POSAI. S~STEM
DESIGN
17034 NORTH E~GLE RIVER LOOP ~, SuffE 204 ~ EAGLE RIVER. ALASKA 99577
J.H.M.
DESIGN CRITERIA:
Z BDRM = 300 OPD
SOILS - 0.6 GPD/SQ.FT.
300/0.6 - 500 SQ.FT. REQ'D.
TRENCH CRITERIA:
LOT 3, BLOCK 1 PENNINGTON PARK
R.C.C. 12 13-02 1 OF 2
STRUCTURES, EASEMENTS, OR ENCROACHMENTS
SHOWN ON THIS SITE PLAN ARE AS SHOWN ON
AN AS-BUILT SURVEY DRAWN BY:
GERALD V. RANDALL, Jr.
IT IS THE RESPONSIBILTY OF THE CONTRACTOR
TO VERIFY EASEMENTS, REQUIRED SEPARATION
DISTANCES, AND PROPERTY LINES PRIOR TO
l' DZZS
17054 EAGLE RIVER LOOP ROAD 0.5' EFFECTIVE
EAGLE RIVER, ALASKA 99577 5' WIDE
PHONE~ (907)694-2979 1fiD' LONG (2 ~ 50' EA ~
LATERALS ~ 48' LONG EACH = 15 GPM/LAT.
g~ ~ HOLES ~R LAT. (~.40.C.)
~ 30 HOLES TOTAL = 1.0 GPM/HOLE
~ ~/16" DiA. HOLES FACED DOWNWARD
~' 1" OR 1-~/4TMDIA LATERALS
1-1/4 DIA. SOLID MANIFOLD
Z
<~
ALL PORTIONS OF SYSTEM
WITH LESS THAN 3.5' OF
COVER REQUIRE INSULATION.
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CONTRACTOR IS REQUIRED TO
OBTAIN UTILITY LOCATES
PRIOR TO ANY EXCAVATION
3A
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4
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ineerin~
'~*': LOT 3, BLOCK 1 PENNINGTON PARK
.Ltt. I,I. R.C.C. 12-13-02 2 OF 2
DESIGN CRITERIA:
SOILS = 0.6 GPD/SQ FT.
aoo/o.6 = 500 SQ.FT. REq'D.
TRENCH CRITERIA:
1' DEt~P
STRUCTURES, EASEMENTS, OR ENCROACHMENTS
SHOWN ON THIS SITE PLAN ARE AS SHOWN ON
AN AS-BUILT SURVEY DRAWN BY:
GERALD V. RANDALL, Jr.
IT IS THE RESPONSIBILTY OF THE CONTRACTOR
TO VERIFY EASBMENTS, REQ,UiRED SEPARATION
DISTANCES, AND PROPERTY LINES PRIOR TO
CONSTRUCTION.
17034 EAGLE RIVER LOOP ROAD 0.5' EFFECTIVE
DISTRIBUTION SYSTEM: / ·TH#
o~ 1" OR 1-1/4" DIA. LATERALS /
1-1/4" DI~,. SOLID MANWOLD
/ -rANKS (TO
_ / PUMPED, CRUSHED
~ / & ABANDONED)
S.T.E.P. SEPTIC TANI
.
Z
ALL PORTIONS OF SYSTEM
WITH LESS THAN 5.5' OF
COVER REQUIRE INSULATION.
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10' MIN.
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51'
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TRENCHES
4
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Performed For:
Legal Description:
Municipality of Anchorage
Devdopment Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK @9519-6650
w,,wA ci.a nchomae.ak.us
(907) 343-7904
Soils Log - Percolation Test
~.. ~/{ ~, ~,,,/ ~ ¢.. ,'~ 6./T Date Performed:
j~J.,K;, i jO~ ~ FI ~¢/'-d,~' ~,~K. Township, Range, Section:
Slope
Site Plan
Depth
¢ ~1.~
4-
5-
8-
9-
11-
~2-
~4-
15-
~6-
20-
/¢,'T".r~ (--1'/
WAS GROUND WATER
EXCOU,~T?,,E~?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
Resding Date
COMMENTS
Gross Time
O
bo
6o
pERCOLATiON PATE ~ / ~ (minuteCndn)
TEST RUN BETWEEN :~1 ~/.3~ FT AND __
Net Drop
D, '1~"
Il'
PERFORMED BYi7N4 E~ River L~p Road No. 2~ ~, . - ,' . - ' ~ T~ST WAS
IN ' ~ ~~T- AND k UNICIPAL GUID:LINES IN EFFECT ON THIS DATe DAT:' I ~//~ /0 ~
Municipality of Anchorage
Development Services Department
Building Safet~ Division
On-Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 A~chorage, AK g9519-6650
www.ci.anchoraee.ak.us
(907) 343-79O4
Soils Log - Percolation Test
~, 6'/'~ ~ 4>`/ ~ ~. ~ 6- T Date Performed:
¢~¢,~.T¢~ /3,i~.~¢( Township, Range, Section:
Slope
Site Plan
Depth
(Feet)
$-~
~2-/
~3-.//
14-
15-
16-
17-
18-
19-
20-
WAS GP,OUND WATE:.P,
~,~COU,~TEP,ED?
IF YES, AT WHAT DEPTH? o
Depth to Water After n ~ p
Monitoring? ~'/&/ ,. E
Reading
Date Gross Time
o
7~
~o
6o
6o
Net Time I Depth to Water
~ ~ ,.,,. ~/~/,t"
~ 5' '/~"
30 *,~,¢'¢ ~'/~"
-
Net Drop
-~/S"
~/s/'
~/~. ~'
CONIblENTS
PERCOLATION RATE
TEST RUN BE*PNEEN
(m~utes.'inc.h) PERC HOLE DIAMETF~R
Fi' AND ~. ~/'~ FT
S & S ENGINEERING I Jo. crUZ ~ CERTIFY THAT THIS YEST ~V4S ~
PERFORMED BY: ,~ ' - ' '
PERFORMED
IN
~m Kwer, Alaska ~5~
HEA~TH AUTHORITY
APPROVALS
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATEI~AL SPECIFICATIONS
ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
~ECHAN~C~
INSPECTIONS
ON SITE
WASTEWATER
DISposAL SYSTEM
REFERENCE: Lot 3: , Block 1, Pennington Park Subdivision
December 13, 2002
GENERAL:
1. The scope of this project includes the installation of two pressurized five foot wide
drainfields, and a 1300 gallon HDPE S.T.E,P. tank to serve the existing two bedroom
residence located on the referenced property.
2. Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all applicable
State and Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground utility
locates.
4. Unless specifically agreed otherwise, the property owner shall be responsible for
final grading areas subsequently depressed from soil settling.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their own
systems must also receive prior approval from the Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank.
3. All standpipes on the sePtic tank shall extend a minimum of 12 inches above final
grade.
17034 NORTH EAGLE RIVER LO0~ ~ SUITE 204 ,. EAGLE RIVER, ALASKA 99577
Page 2
Lot3~_Blockl,Pennington Park S/D
Decemberl3,2002
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building
foundation.
6. Final grading over the septic tank shall be such that a positive slope exists away
from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the sidewalls of the
excavation become smeared, they must be raked or scratched (ruffed-up) before gravel
(sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with
the holes faced downward. The distribution piping is to be ofPVC (ASTM D3034 or
equal). All joints are to be solvent cemented. Gravel is then to be placed over the
distribution pipe to provide a minimum of 2 inches of cover over the pipe.
3. A sir barrier must be installed between the final gravel layer and the native
soil backfill. Ensure the silt bani. er covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in
the locations shown on the design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending through the gravel shall be
perforated from the bottom of the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24)
inches. Insulation must be installed when the backfill depth is less than thirty-six (36)
inches. The finish grade over the trench must be mounded to prevent the formation of
a depression after settling.
Page 3
Lot 3: , Block t, Pennington Park S/D
December '13, 2002
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation 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:
Type of Pipe Perforated Solid
Cast Iron
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must
be installed between the final leachfield gravel layer and the native s0il backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with
less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, its gradation specifications
must conform to current M.O.A. or D.E.C. requirements, which ever specifications
applies.
Page 4
Lot 3., Block 1, Pennington Park S/D
December 13, 2002
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be set in
place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the silt
barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with
the installation of multiple trenches, sand filters, pressurized distribution systems, etc.
Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of
construction. If necessary, a pre-construction meeting will take place on-site. The
inspecting engineer will not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work outlined in
these specifications and plans and in accordance with the attached M.O.A. permit.
There will be no contractual arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's representative and will inspect
the work as stated above to document the contractors activities. Final acceptance of
the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project or
the fa/lure of the contractor to carry out. the work in accordance with these
construction documents. S & S Engineering's inspecting engineer will not be
responsible for the construction means, methods, techniques, sequence, procedures or
the safety precautions incident to this project.
CONTRACTOR / INSTALLER
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES ~---
Environmental Health Division 0 :~- O -- / ~'/---
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
J'1);~7,. ¢ ~/~o ~ DISTANCES
Address ~ ~O SEPTIC ABSORPTION
p~ ~. //~ ~/~ ~ ~ ~ ~ ~ ~ TANK FIELD WELL
Phone(s) ' ~ Permit No, JNo. o, Be ms WELL
LEGAL DESCRIPTION LOT LINE /
Lot ~ Block I Subdivlsio.
~ / I ~ ~ ,~, ~ ~¢~ FOUNDATION
Township, Range, Section
~//~ /~ ~ ~/O ~/~ ~ /~/~ AS-BUILT DIAGRAM (Show location of well, septic system, prope~y lines, foundation
driveway, water bodies, etc.)
Manufacturer Capacity in gallons
Material No. of Compadments
TYPE OF SYSTEM ~
Depth to pipe botto~ fro~ Total depth from original grade
original gra~e
-- FT F
Fill adde~above orig~de / Gravel depth beneath pipe
'~ravel length ~ / Gravel width
FT /~/ FT ~ ~ /
Total absorption area Distance between lines ~ '
FT
.,.e ..er,.,
~nstaller ~ -' ¢~ ~/~ Date Instated
WELL~
D PRIVATE ~ OTHER (Identify) ~, ~// ~ /
Instamler ~ Date Installed:
I 1' ~' ~ . ce.ify that this inspe.i0n was ped0rmed according t0 all J
72_01:::'::5:epadment ApprOval
i! FOOTING
, - FOUNDATION
BOND BEAM
FRAMING
INSULATION
ii .' ~' SHEETROCK
ilil: STRUCT. FINAL
OTHER
COMMENTS
L
MUNICIPALITYI~}OF J NCH
DEPT. Oi~::HEAJ. THm
ENVIRONMEN[AE
qFP~( ~oo'
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
INSPECTIONS (907) 563-3464 INFORMATION (907) 786-821
[] ELEC. TEMP..---.k_ -~ [] PLBG. UNDGR, []
[] ELEC. SERVICE.~L~'~ PLBG. ROUGH []
[] ELEC. ROUGH .~ LI GAS TEMP. []
[] ELEC. FINAL[} [] GAS []
[] OTHER [] MECHANICAL []
[] MECH. FINAL __ []
[] FIRE FINAL [] PLBG. FINAL []
[] ZONING [] OTHER []
[] CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
[] DO NOT CONCEAL UNTIL REINSPECTED
.~O NONCOMPLIANCE OBSERVED
[] WILL REEXAMINE AT NEXT INSPECTION
/// ./," INSPECTOR '~ DATE
)NHEN CORRECtiONs ARE MADE, PLEASE CALL FOR INSPECTION
'./ED
,' //
/ / I ,C .
DO NOT REMOVE THIS NOTICE
84-002 (Rev. 11/87)
. ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO / OF '~
CHECKED BY
SCALE / ''/~ ~'~ ~*v~ ~' '~ · ~/
DATE
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO / OF
C^'CUL^TED .Y t' &~-,- W DA*E_ ~//¢/~ ~
CHECKED BY DATE
/
SCA,E / '~ /'0
/ ,
· ~ ~
~ .... ~ ~.. ....... ~ ..... '. ......
........ ..... ..~ ........................ / ~ ....... ' ....................... :'~ ' ~',~1 ~U j~: ~ ~ 6 ~:~.~2/ ......
......................................... ~..~ dc ~...~..? ~.?~'~
..... ~ r ..d~....~.d ···7. ~.?~. ~'
..........
.......................................... ~'7~'~'
PRODIICT 204-1 ~A~7 I~C.r Grotofl, Mo~ 01471.
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASI/,A 99503
(907) 561-5040
SHEET NO
CALCULATED BY
CHECKED BY
SCALE / ~---
DATE
/
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PROD~-'T ~-1 ~ Inc.. {~oto~, Ma~. 01~?1
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PERFORMED FOR:
Municipality of Anchorage
825 "L" Street, Anchorage, Alaska 99502-065~
LEGAL DESCRIPTION: ~. 3 ~ ! /~.~ ,~ -/L~.1 gr~Township, Range, Section: '.7-///~ /~:_~/--O
~- SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT - - O
DEPTH? p
E
neplh t° Waler Alter I
Monitoring? ~ ]PT Date:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
PERCOLATION RATE 7 (m,nutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN / ET AND ~' ET
CERTIFY THAT THIS TEST WAS PERFORMED IN
ALASKA eFIUIROnme[1TAL CO[1TROL
$ RUIC $,
Inc.
.,,~q-~'~ ~nqineerin§ ~ {~nuironmenlal $1udics
SPECIFICATIONS FOR BED WASTEWATER TREATMENT SYSTEM
LEGAL DESCRIPTION: LOT 3, BLOCK 1. PENNINGTON PARK SUBD.
1.0 GENERAL
1.1
The Drawings, sheets ] through 4, shall be part of
this specification.
1.2
All materials and workmanship shall meet the
requirements of the Municipality of Anchorage,
Department of Health & Human Services (DIIHS), the
conditions of the permit, and ali applicable rules and
regulations currently in effect.
1.3 All excavations and depths are advisory, and are
to be verified or modified in the field by the
Engineer or inspecting agency.
1.4
It is 'the responsibility of the property owner or
installer to adhere to approved design for the
installation, to maintain the specified separation
distances and to have the appropriate inspections.
1.5
It is the responsibility of the property owner or
installer to report to the engineer any observed
conditions which would put the system in violation
of state or Municipal regulations.
]. · 6
If the installation is not inspected by an AECS
engineer, AECS will not be responsible for the
installed system. An engineer at AECS should be
consulted prior to construction, to determine the
number of inspections that will be required and to
explain what these inspections will involve.
2.0
SEPTIC TANK
2.1
If there is an existing septic tank it may be used
if it meets the capacity requirement for the
residence. The structural integrity of the tank
must be verified.
2.2
The septic tank shall be a UPC-approved
two--compartment tank, constructed of 12 gauge
steel with bitumastic coating and set level on
undisturbed soil. If the tank is buried at a
depth of 4 feet or less, it must be insulated with
an overlying layer of 2 inch burial type
polystyrene rigid board insulation.
.... '-~,t .... n.-X 1,,.--~, ,.-, & l~-,r-hnn-,r:c Al~¢l/~, 9959~ (907) 279-5553
2.3
2.4
2.5
2.6
2.7
The septic tank shall be a minimum of 5 feet from
the house foundation, and a minimum of 5 feet from
the absorption area.
The septic tank and bed shall be a minimum of 100
feet from any private wel] or body of water, 150
feet from Class "C" wells, and 200 feet-from Class
"A" or "B" wells, unless otherwise specified.
Less than the required separation distance must
have prior approval or waiver by DHHS or Alaska
Department of Environmental Conservation (ADEC).
Piping shall be fitted with a mechanical
watertight calder coupling on the outlet and inlet
of the septic tank. Piping shall be 4 inch solid
PVC ASTM D--3034 or cast iron, sloped a minimum of
1/4 inch per ]]neat foot on the inlet side and 1/8
inch per foot on the outlet side. If the piping
is buried at a depth of 4 feet or less, it must be
insulated with an overlying layer of 2 inch burial
type polystyrene rigid board insulation.
Cleanouts shall be installed as designated and
capped with air-tight rain caps (Jim Caps or
equivalent), and extend a minimum of I foot above
ground level.
If a lift station is required it shall be a
combination lift station septic tank per Anchorage
Tank and We]ding, Inc. design. Specifications and
design drawings are on file with the municipality
and the engineer.
3.0
SEEPAGE BED
3.1
The gravel for the bed shall be 0.5 to 2.5 inch,
screened rock with less than 3 percent passing the
No. 200 sieve. Ail substitutes must have prior
DHHS approval.
3.2
The bottom of the excavation shall be level and
raked with the backhoe blade to ensure that the
bottom has not been compacted during excavation.
3.3
Sand, for leveling, shall have a size distribution
which meets the requirements of MOA code
15.65.077.
3.4
The distribation pipe shall be perforated 4 inch
rigid PVC with a minimum crush strength of 1500
3.5
3.6
3.7
3.8
pounds and shall meet the approval of DHttS for use
as drainfield pipe. Al/ pipes shall be laid
level, and spaced according to the drawings.
Monitor standpipes shall be placed as shown in the
drawings. They shall be 4 inch rigid PVC ASTM
D-3034, or cast iron. The section shown with
holes may be either drilled 0.5 inch holes on 6
inch centers on opposing sides of the pipe, or a
section of regular perforated sewer pipe may be
clamped to the solid section with a no-hub
coupling or solvent joint. The perforated section
of the monitor tube shall be located in gravel
only. The portion of pipe above the sewer rock
shall be solid. A rubber raincap (Jim Cap or
equivalent) shall be placed over the top of the
pipe.
Filter fabric is required.
The side slope of the mound shall be slope 1 foot
vertical to 3 feet horizontal.
The bed shall be planted with a white clover and
red fescue mix, or with Kentucky bluegrass.
4.0 INSPECTIONS
This bed will require a minimum of three
inspections. The first inspection will be of the
open excavation, to assure that the system is
installed in the proper soil strata, correct depth
and meet minimum specified design parameters.
4.2
The second inspection will be after placement of
gravel, monitor standpipes, and distribution pipe,
to verify proper installation and position of
pipes prior to backfill.
4.3
The third inspection will be after final backfill
grading and seeding' to ensure 'that adequate so:il
cover has been provided over the bed.
4.4
The inspection of the septic tank or lift station
installation can be incorporated with any one of
the above listed inspec'tions.
4.5
The lift station will require either an MOA
electrical inspection or certification by a
licensed electrician depending on whether the
building code applies to this part of the city.
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
NAME _ ~ tPHONE I []NEW
LEGAL DESCRIPTION
LOCAT,ON /72 d / Ve. NO.O BEDROOMSj
AbS,~i~n~a~:ea.~! Dwelling 2 7
~ DISTANCE TO: I ~Of )'PI
~1-I- =~ Manufacturer~.z/~ ~'e L° ~' Material(-~,e)! / No. of compartments 2
Liq. capacity in gallons Inside length~ Width Liquid depth
/~)~) ~) IF HOMEMADE:
~ ~,.~ DISTANCE TO: Well Dwelling PERMIT NO.
~O _ ~ Manufacturer Material Liquid capacity in gallons
~1~ m DISTANCE TO: Well ~0t /'h F°undati°n4~- ! Nearest lot line
~-~'ZO? ,.'"No. oflines ~ Length of each line,~,,_ 20~-~/' Total length of lines7 / Trenchwidth~inches Distance between lines /~ ,
~ ~-. Top of tile to finish grade Material beneath tile Total effective absorp.tjon area
Q ]' 84 inches ~,
Length Width DepOt h PERMIT NO.
<~ l- Tvpe of crib Crib diameter Crib depth Total effective absorption area
DJ Well Building foundation Nearest lot line
u~ DISTANCE TO:
, Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER / : ::;";;:; -
\ L
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta' ?rotection
825 .. Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit 9 ~A~
WELL ANI~ ON-SITE SEWER PERMIT
Applicant.~/~ .
Location: Z ~, ~~ ~P2hone Number: X
Legal Description:
Type of Soil Absorption System Is:
Trench: ~ Drainfield:
Maximum Number of Bedrooms:
Lot Size: ~/~-r-~ + _..
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) ~~
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH GRAVEL DEPTH
. W I DTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~){2,(~> GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet:
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * *
I certify that:
(1) 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 codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
SigneE~.~i .... __ ~.~.~./ Issued by
Applicant ~
Date: ~ ~ ~- ~_~
SWP/024 (1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
DE
%~C~V~\
DATE PERFORMED:,
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
ENCOUNTERED? (-~
O
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
~'.sq /.2B ,
/, Z/ '
~'H~O q" ~' ~.z.~
+ I~O ~"~-~ "~ Ut'O
PERCOT_ATION RATE
TESTRUN BETWEEN
ALASKA I1UIF OrlmE TAL COI1TI OL SEr UIC S,
InC.
Subdivision
Supplemental Soils Information.
mook I, ~Let -3
LOT ~ LOT LOT LOT
TH ~ TH TH TH
1 1 1
2 2 2
3 3 3
4 4 4
5 5 5
6 6 6
7 7 7
8 8 8
9 9 9
10 10 10
11 11 11
12 12 12
13 13 13
14 14 14
15 15 15
16 16 16
17 17 17
18 18 18
19 19 19
20 ~0 20
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
1200 gJ~sl 33rd Au~nL,¢ Suit~ ~ · Anchoraq¢, Alaska 99~03 · (9o7) 276-136t
9
10
Perfo~',med i/or Floral Palmateer !>rite ?erformed 9/2/71
This
Fcrm
pepth -------'~"'
Feet Location Sketch
1
2
3
4
5
6
7
m
~ I~1 D~rk brown silty sand (SN)
Ora, and brown sandy
gravel (OW)
w/silty sand ravel seams
Was Ground Water Encountered? f No
I)pain Fi eld
Dec, t?, Of 2r, let --. ', -
, om Pit %"enc~ - -'
180 s~ Y~f~f~ ...... · · - . --- - -- -
CO~:4E~,~T3:~~ u~-a~nage area ~s re~mredBer beoroom. ~ _ _ . _
Test Performed :3v: R.E. Carlisle
Data Certified By: National Testing Services, Inc.
Date:
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geolocjicol ~ Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL ~ (Pleose complete either lo, lb or lc.) A.D.L. No.
'~o~.lBorough Subdivision Lo, Block I-~.1 '/4qtrs. Section No. Township N[~ Range EO Meridion
: ~ " ~ ~of~of~of ~ S[--] WI-']
Ic.J~DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL:
Address: ';' ) ~'~ :
Street Address ~,d Area of Well Location
2. WELL LOG Feet Below
Surface 4. WELL DEPTH: (final) 5, DATE OF COMPLETION
Material Type Top Bottom
:/~'.: ,. : , .... , ~ 6. ~Coble tOO' ~Rolery ~ Driven ~ Dug
: ? ~ ~. ~ Auger ~detted ~ Bored ~ Other:
: r'~ '~; '~,,~ J ~ : ,: ? ,;:',~-, ;:. '~? ~' ~:;~ 7. USE: ~ Domestic ~ Public Supply ~ Industry
~ Te~t WeU ~ Other:
8. CASING: ~ Threaded ~.Welded
diam. ;~'~ in. to .~ ft. Depth Weight : ,'lbs./ff.
diam.~ in. fo ff. Depth ~tickup ft.
9. ~INI$H OF WELL:
Type: Diameter:
~lot/~esh Size: Length
Set between ft. and ft.
Backfilling Gravel pack
I0. STATIC WATER LEVEL:
~ Above or ~ Below land ~urface Date
Equipment used:
II. PUMPING LEVEL below land surface and YIELD
-':~ ~;. ft. after ~ hrm. pumpin9..,;:;,:~?' g.p.m.
~ ft. after ~hrs' pumping g.p.m,
12.GROUTING Well Grouted: ' ~ Yes ~ No
Material: ~ Neat Cement
I~, PUMP: (if available) HP '
Length of Drop Pipe ft, capacity g.p.m,
14, REMARKS:
16, WATER WELL CONTRACTOR'S CERTIFICATION',
15. Water Temperature ~o ~ F ~ C
This well was drilled under my jurisd{ction and this report is true to the best of my know~edge and belief;
Registered Business Name Contract License Number
Signed: , , ~ i :
Authorized' Re'presentaHve
Form O~-WWR (11/81) Copy Distribution; WHITE-State DGGS, PINK-Driller, CANARY-Customer
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. 020-181-35
GENERAL INFORMATION
Complete legal description t~ot 3;
Location (site address or directions)
Current Property owner(s) Susan &
Mailing address 17335
Lending agency
Mailing address
02..0
Expiration Date: _"2 - ~ ~- O~
Block 1; Pennin~ton Park Subdivision
17335 Betti~ean St.
Brian Bergt Day phone 345-5572
Bettijean St. Anchorage, AK 99516
Day phone
Real Estate Agent Grog Hamilton
Mailing Address 3705 Arctic Blvd. #1811
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: ?,
Day phone 272-3991
Anchora~;e, AK 99503
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
~ Individual On-site X_~
[] Individual Holding tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DAD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional c/vii
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. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties 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.
=
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,
based on procedures outlined in the Health Authority Apprevai 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 verify that based on the information obtained from the
Municipality of ,Anchorage flies and from my investigation and inspection, the on-sRe water suppty and/or
wastewater disposal system is(are) in compliance with ail applicable Municipal and Slate codes, ordinances,
and regulations in effect at the time of installation.
Phone 694-2979
Loop Ste. 204 EaEle River, AK 99577
C. Cowan Date
bedrooms. ~
bedrooms, with the following stipulations:
Name of Firm S & S Engineering
Address 17034 N. Eagle River
Engineer's Printed Name Robert
DSD SIGNATURE
~'""'Approved for ..~
Disapproved.
Conditional approval for
Additional Comments
By:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's P, epor~
Other
Original Certificate Date:
(Rev. 01/02)
............. ,~ .:-....:.. .... ...~:,?.~!;~C~ge;~s .",....".:: ....'~ ..
........ '.: ' .~ '. :'::: ~.'"~(9~..~,:",.'? :'..-,"..'". ~ · ':
':..-:.-,t;.~r...~::;...~ .. . . ...... - . , .
.:: .,..:,....,%...::,? · ':;. ',".: .... ,~.,.....~ . :..:'...- .,.
".: .:" ,..~';SA~,..L~'.. ..... .~].~:'.'. ':'... '...,?..' ..... ' .... -.'... ... '.:~ ..- ..'.~.' .... .' .,.' '.. '. .... ' ·. '... .
.....:: .. :..?..,~... ,L;:.,~:...~,..... ;~..,....,.:. :.?..-.~.~:,., ,...;~... ,:::. ':': ~.: ...,, ~::...; ...:,:.. ::....:.,:., ..:'.......'; .. ,: :: .... '~ ....... ~l~=mNe'.: ..'
~:...,,f .~...:::. :, .-, ,: ,..: ..
' :. :,'Svs~em ~pe.. :'.Y~ ~:G~
Do
"Pu
Dat~jm
Size in gallons / .3 0...O Manhole/Access~/N) ~"fl J-
"Pump ofF' level at ~"/,. ~T n ' High watel' alarm level ' 5~
,:~,:~w~ ,.;,,,,.,~ -i Meets alarm & circuit requ rements?
Absorption'field on lot !
Public'sewer main
Sewer/septic service line ~,. E-' /-./-
SEPAI~A:I'ION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation J 3 Property line ' 6 (~ ' Absorption field
Water'main N / /~ Water service line /o '-'/-
On adjacent lotS
Public'sewer manhole/c!eanout
Holding tank
Water.:Service JJne .... /~)
'C~ff~i~'d'r~in ~'O~rt..; t~ ~ow~' Wells on adjacent lots )c~ ~-
that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date
Engneer'sPrintedName ~Z~,£/,,.7' ~'.
Date / ~/'~ ¥//'0 2..
Receipt. Num'be~
(Rev. 12/01)
Waiver Fee S
Date of Payment
Receipt Number
,gNehicle storage ~'~z-~
11-25-D2 15:~6 FROI~-CT&E ENVIRON~NTAL SRV
.~tk CT&E E"~ir°nmental Services lac'
T-923 P.02/03 F-49F
CT&E Ref.#
Client Name
Project Namem
Client Sample
Matrix
1027976001
S & S
Penn/n~ton Pa~k LL
Permin~ton P~k L3~ ~ BI
Dfi~g Water
?WSlD 0
Sample Remarks:
Wa~erS Department
Nitrate-N
1.23
o.~OO
m~/L EPA 300.0
All Dates/Times are Alaska Standard Time
Pr4nted Date/Time 11/25/2002 9:31
Collected Date/Time 11/21/2002 12:15
Received Date/Time I 1/2i/2002 14:20
Allowable Prep Analysis
Limils D~te Dale Init
{<=10'} 11/21/02 JS
Microbiolog~ Laboratory
Tnt~ Coli~rm 0
coi/100mL SMI8 9222B
('<=1) 11/2tt02 KAP
FROM :GREG HAMILTON FAX NO. :g072720794 Nov. 2i 2~2 06:52PM Pi
ENGINEERS
PLANNERS
SURVEYORS
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
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner I~e/''~r' ~' ~y ~'~,~-o,~
Mailing address 1-7~]~5'' i~¢["¢-,j¢,~,~ _C~-. a
Lending agency
Day phone
Day phone
Mailing address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
/Jr ~ ¢e5-0'7
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEI~R
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/,~/',~f
Address /,~/~- .~{2 ~ c/~¢ ~'~L..~
Engineer's signature
DHHS SIGNATURE
~ ./~_ Approved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: .~~~~~~~ Date ¢/~,.~./~,~//
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev, 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: AC"'/' 3., ~ ('oC~ _f~ P¢~//]/~. ?AC, ParceI I.D.
A. WELL DATA
Well type J~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
Date completed
/1' o" ~ Cased to ~'/,5" '
Date of test
Static water level
Well flow
FROM WELL LOG
Pump level
ADEC water system number
0" Driller be/./V, I.A.,,,~i/-¢
Casing height '3 9"
Wires properly protected (Y/N) Y
MUNICIPALITY OF ANCHORAGE
AT INSPECTIO~NVIRONMENTAL SERVICES DIVISION
OCT 1 1 1991
g.p.m.
RECEIVED
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main N,
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Al, ,4,
h(on ,e
WATER SAMPLE RESULTS:
Coliform 47 col / I00 ,,~.~
Date of sample: 1o /7 /~/
Nitrate I, '/
'~'/"( Other bacteria O co I / too r,,.~,
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed O"/~ 7 ! ,¢ .3 Tank size /~,C,42 ~,~/
Cleanouts (Y/N) )" Foundation cleanout (Y/N)
High water alarm (Y/N) /V,,~.
Date of pumping g/7/9/
Compartments
Depression (Y/N)
Alarm tested (Y/N) /~1, P,..
by RoA,
/V
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I:~0'
To property line dO '
Surface water/drainage
On adjacent lots ;> ¢oo' Foundation
Absorption field '¢ O' Water main/service line
~oo~
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) Y'
High water alarm level
500
"Pump on" level at
Manufacturer i~hckor~/~
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 I YO On adjacent lots
D. ABSORPTION FIELD DATA
Date installed ~/t ¥/9 0 Soil rating
Length ~/5" Width 1 5'
Total absorption area ~'
Depression over field (Y/N)
Results (pass/fail) r~,~.~.~ ~e¢ ~¢ro,,,Fo/~ym¢ ~'~&o,f)for
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot I¢O' On adjacent lots I Y~" '
Surface water
~ 5'0 ~'/~c4rr,, System type
Gravel thickness /. 0
Cleanouts present (Y/N)
Date of adequacy test
If yes, give date
Total depth
Y
io17
bedrooms
Property line
To building foundation ,.5"~ ' ~Cr~p, C.O, To existing or abandoned system on lot
On adjacent lots ~. 3'~' Cutbank /~,,'~. Water main/service line
Surface water ~. too' Driveway, parking/vehicle storage area
Curtain drain No~ eG.¢~r
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines
the date of this inspection.
Signature ?.,/~~- '~' 77/~..~
Engineer's Name ~1¢,o~or~ f~, hloor~
Date fo(l~ /9/
HAA Fee $
Date of Payment
.ece pt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
ALASKA elqUIROrlmErlTAL CONTROL SeRUICe$, Inc.
~nqincmncI ~- ~nuironrn~nlcd $ludics
P. 0. Box 240668
Anchorage, AK 99524-0668
(907) 279-5553 *** FAX (907) 276-8706
October 28, 1991
Nunicipality of Anchorage
Department of Health & Human Services
825 L Street, Fifth Floor
Anchorage, AK 99501
ATTN: Dan Bolles
RE: Lot 3, Block 1, Pennington Park
Dear Dan:
OCT 2 8 1951
·
On October 23, 1991, I checked the differential level
between tile two standpipes of the bed. The level
differential was 7.5 inches.
On October 24, 1991, Bob Dean opened that part of tile
system. It appeared that the southwest corner had settled
for several reasons. There was a section of Hancor pipe
which was used to prop up the cleanout to keep it level.
This had collapsed. Also, there appeared to be come
settlement in that corner. I dug through the rock to
examine the under soil. It was wet, but not plugged.
was evidence of some sludge in the field, but it wasn't
much. The owner reported to me that he had problems with
the lift station basket floating.
bulking of the sludge.
There
This was probably due to
The corner was leveled -to the NS and EW pipes. Rock was
used to bring tile rock fill to grade over the pipe. It was
then reinsulated and backfilled.
I believe that tile system should now function properly.
cc: Peter Johnson
LCR/sr
Sincerely yours,
Phi), PE, BEE
CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 October 11, 1991 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The following is a report of adequacy tests conducted between October 7-9, 1991 on the water supply
and wastewater disposal systems serving the residence on Lot 3, Block 1, Pennington Park S/D, located at
17335 Bettijean St.
According to the driller's log, the well was completed in June of 1983 and has a total depth t~f 46 feet
and a yield of 20 gpm. On October 8 the static water level stood at 14 feet below the top of the casing.
Steady pumping of 726 gallons of water from the well at the maximum pump output of 6.6 gpm caused
the water level inside the casing to be drawn down to a maximum of 19', and the water level recovered
rapidly once the pumping was stopped. Based on this test we determined that the total yield of the well is
in excess of 6.6 gpm, which is more than adequate to meet Municipal approval for any single family
residence, and also exceeds the FHA criteria of being able to supply water at 3 gpm over a 4 horn' period.
Water samples collected on October 7 were satisfactory, showing 0 coliform or other bacteria and 1.4 mg/1
of nitrate-N.
The wastewater disposal system consists of a 1000 gallon steel septic tank installed in June of 1983
.followed by a 500 gallon Orenco lift station package installed in October of 1990 which pumps effluent
into a 15' by 45' soil absorption bed which was also installed in October of 1990. Prior to the start of our
test on October 7, 1991 we measured fluid depths in the bed's north cleanout to be 0 inches, in the center
monitoring tube to be 6 inches, and in the south cleanout to be 6". This indicates that the bed bottom is not
completely level. At no time during the course of our test did the fluid level in the bed rise to a point where
it could be observed in the north cleanout pipe.
To assess the absorption capability of the system we added a total of 918 gallons of water over a 2 day
period through the second compartment of the septic tank. The lift station pumps approximately 176
gallons of water per dose. The first dose caused the fluid level in both the center monitor tube and in the
the south cleanout to rise 1.31". After the second dose these fluid levels had increased to 2.31" and excess
fluid was observed to be siphoning back into the lift station after the pumping cycle was over. This
indicated that the fluid level in the bed had risen to the level of the pressure line from the lift station. Based
on 3 days of observations of fluid levels in the lift station and soil absorption bed, we concluded that the
surge capacity of the bed is approximately 260 gallons, and that the system is capable of absorbing 600
gallons of water per day, when the bed is filled to the level of the high point of the pressure line from the
lift station. This measured absorption rate is slightly greater than the minimum Municipal criteria for
approval of a three bedroom residence.
Sincerely,
Ted Moore, P.E.
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
~____:.: ..... __~..--.--~- --~-:--~ ~ --~ ._.--:~ _-~--~~
5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343
FAX: (907) 561-5301
~ate Eepogt ~xlnted: OCT lO 91 t 15:00
Client $a~le ID:L~ BI P~NINGTOW P~K OUY$IDg 3 HO$~ ' Client N~
F~SID :U~ Client ~oct
Collected OCT 7 91 I I~:30 h~.. ~PO S PO I NO~ ~[CgI~D
~ecetv~ ~T 7 9t ~ ~7:00 ~t. ~oq S
A~lyetm Coapleted :OC! 9 9l Send Eepoxte to:
~,l,,ed ,y : ~---/~ ~..~.~ 2)
Chemlab Re[ l: 915341 Lab ~1 ID: 1 ~{at[ix: WAYBR
Allowable
Pa~amete~ Ye{ted Re.ult Umtt. Nethod LimAte
NIT~AT~-N 1.4 m~/1 EPA ~$~.2 t0
~aple ROUTINE ~AWPLE COLLECTED BY: Y.~. ~E. ' BIB.
~emt~ Pe:~ozmed ' See Speolel Inat~uct~o~ Above ~A-Unava~lable
None Detected "~ee ~ample Ee~azk~ Above
Mot Am~l~e~ EY-~e.~ T~n. GT-G~eate~ T~n
'-',~1 ~~ Member of the SGS Group (societe Gen~rale de Surveillance)
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
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ~.,,'~-/v/~¢
Mailing Address f'. O. ~'c,,~ /! ~'
(c) Lending Institution
Mailing Address 15-C, d~
Telephone' (home) ~.6'&-~'d'¢"/ Business E~'~-'
Telephone 86-'~ -
(d) Real Estate Company and Agent N, ,~.
Address
Telephone
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Number of bedrooms
Single-Family []
3. WATER SUPPLY
Individual Well []
'3
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 ~ 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 seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
NameofFirm ~(¢[~r~ '7-~cA/~ t'~4! ..~'ur~f Telephone
Address / fi' ~'_~0 ~c~¢' -('~ /,¥,~ChOr',~¢¢~. ,,4.~
Date
6. DHHS APPROVAL
Approved for ~'
Approved '~
bed rooms by~~--~4~= .~-/~_ ate/2
Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHH$ 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. 7/88) Sack Page 2 of 2
Well Classification
Well Log Present (Y/N) ~/
Total Depth /-/-(o Cased to
/
Static Water Level 35' o~
Casing Height Above Ground
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description:
Date Completed h S
If A, B, C, D.E.C. Approved (Y/N) kJ,~,
Yielc~ ~,(o GPt't Ifl~ftS
1~-/t3/~o
Depth of Grouting ~,/3r '
IZ/~,~/?~ Pump Set At ~' ~
3 7 ' Sanitary Seal on Casing (Y/N)
Y
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot I 3'2
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ,~/oo
To Nearest Sewer Service Line on Lot
Depression Around Wellhead (Y/N) Iq
; On Adjoining Lots /
~ 172 ' ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by F~-ATTOP
Water Sample Test Results
Comments~ ~TEA~Y Pu~PIN ~
~TE~ L~L IN ~H~
B. SEPTIC/HOLDING TANK DATA
Date Installed G1~.7/'~3 Size
Standpipes (Y/N) '/' Air,tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) N
Holding Tank High-Water Alarm (Y/N) N ,~.
No. of Compartments
~/ Foundation Cleanout (Y/N)
Date Last Pumped c~Il°/cIO
;for
Temporary Holding Tank Permit (Y/N) ~J./~.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well I
To Property Line ~. (oO ~
To Water Main/Service Line
To Building Foundation
To Disposal Field ,~
To Stream, Pond, Lake or Major Drainage Course '7'/o0'
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field I$ '
15o
Square Feet of Absortion Area ~, 7 5' z=
Depression over Field (Y/N)
Results of Last Adequacy Test N,~r,
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well J '72
To Building Foundation ~.5" ' IcR0t'l
Lot ~ 2_5' ?Er~ Rs
To Water Main/Service Line ~ 80 r
To Stream, Pond, Lake, or Major Drainage Course '>./oo'
To Driveway, Parking Area, or Vehicle Storage Area
~'//8o~ ~ Type of System Design BEb
Length of Field //-5 /
!
Depth of Field 0 - 1
Gravel Bed Thickness J '
Statndpipes Present (Y/N)
Date of Last Adequacy Test
!
To Property Line I ~
To Existing or Abandoned System on
; On Adjoining Lots I 2 2./
To Cutback (if present) N,A-~
Comments
D. LIFT STATION
Date Installed c~
Size in Gallons .500
"Pump On" Level at
High Water Alarm Level at (,1~"
Tested for N,~.
Meets MOA Electrical Codes (Y/N)
Comments P'~" a~
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at ¢$"
Vent (Y/N) "//
Pumping Cycles during Adequacy Test.
I~£Po~eT iN F/
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA g..u~L~f~.~ffect on the date of this
inspection.
Signed
?-/. :....::: t:'::> ..~ '*%:~;5 . , -
Company
~:~ ..................... t; ~', ,, ;~ Engineer s Seal
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
APPLIC' NT FILLS OUT UPPER HAl "' ONLY
Property Owner F~?/~ ...~, /D~ .._. /,/' d:~ /d,,/~) ./t? ~, 4,.,,, ,/~-"* Phone
Mailing Addre~ ~ ,~ / ~ ~~~~~ ~~..~. I/~ Zip ~
Buyer ~ ~- ~ ~ / ....
Lending Institution ~ /~. /~- ' ~ ~x ~ "? 7 Phone
Realty Co. & A~nt ~.,¢/~, ,..~ ;~-~ ' ' ~-;;n; ' - -
Legal Descript~n~¢ ¢~ /2//~ ¢ /~ '~ ~' ~/~¢
Type of Resi~nce ............. ~ ....
Single Family
Multiple Family No. of Bedroo~ .~
~ Other
Water Supply
Individual A~ACH ~LL LOG. A w~l Icg is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
Individual Year IndivMual Installed: /'~ ~'.~*
Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time~'~ (~(I'/~4~'/~' Time . i
Date ~ / ~
Date Date Date ~ ~-~ ~ )~.~( . ~ ~ ~- ~( ~ ~:~
Insp~tor Insp~tor Insp~tor Insp~tor / ~
Field Notes: ~ ~.~ ~ MUNICIPALI~ OF ANCHORAGE
~_ ~. c¢¢~ cL~ ,~ ~PT. OF H~ALTH ~,
~ ~ (_,O,% ~ ENVIRONM2NTAL PROTECTION
('~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAP~OVED
( ) CONDITIONAL APPROVAL'
DATE ~-'~ ~ ~-
~ ~ O ~-~ ~ ~ ;~ Well to Tank /~ t~ Septic T~k Size ~
72-023 (3182)