HomeMy WebLinkAboutGOLDEN HILLS BLK 1 LT 5Gold n Hill
Block I
Lot 5
#015-122-31
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 Page I of
www. ci.anchorage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ~'L4.~ O"~ C~a'/'7~ PIDNumber: OI,5-- I'~-_- '~1
"'~' ~-../~r4~'f ~ C"o.r'O[ ~'ro..c/p,y, WastewaterSystem: [] New [] Upgrade
7fO0 ~-otc-.f~ b/tt(~ L~n~' 995'1d' ABSORPTION FIELD
LEGAL DESCRIPTION o.,t~- ~ t.
I ~ .. ~ld~ H,l~ ~.3-
Well: ~l~ ~ New ~ Upgrade ~'~
Cmss,f,~t,~ (Pnvam. ~ B. C) Tolal Oepm: Cas~ to: T~ ~ area P,pe Mateda
· ,.,. ~.~ s.,.~ I c..~ ~<.,=~.~ TAN K
SEPARATION DISTANCES a septic D Holding ~ S.T.E.P. ~ Other:
T~ Septic Abso~tion' Lift Holding Publi~atl M~ec
Tank Field Station Tank Sewer Line ~n C~O~
.... · ~tt ~n"dt~er~c ~o[o~ BENCH MARK
En~ine~r'~ 8tam~
Inspections pe~ormed by: FlaA~ff ~a~ ~c. Dates: 1" I~/tl[O
2 :?m.... ....
Developmenl Semices Depa~ment Approval ,~.~~
Reviewed and approved by: ~ Date:
GOLDEN t41LLS
~ R 100'
~ NEW ~.5'-LONG SOILABSORPTION TRENCH
~ 9.~ EFFECTIVE G~VEL BELOW PIPE
"BULL RUN" VALV[
G
EXISTING TRENCH '-~
NEW 1250-GALLON
SEPTIC TANK
T.H. #1 ~
%
%
%
NEW ',
--FDN C.O. '
DRIVE
SWING TIES:
PLAN VIEW
SCALE: 1" = 30'
FROM: COR. "A" COR. "B"
TO:
S.T.C.O. "C" 51' 33.5'
S.T.C.O. "D" 57' 39'
DBL C.O. "E" 59.5' 41.5'
VALVE "F" 60,5' 43'
TR. C.O. "G" 67' 71.5'
TR. M.T. "H" 78' 52.5'
TR. C.O. "1" 88' 45'
'ION
4'+ SOIL COVER
INV.
93.7~ SEPTIC TANK
INV.
93.9'
EFF. GRAVEL
BOTTOM TRENCH
ELEV. 82.9'
BOTTOM TEST HOLE #1 ELEV. 76.8'
WATER @ 77.8' 11/27/02
CROSS-SECTION
NOT TO SCALE
LOT 5, BLOCK 1, GOLDEN HILLS SID
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLA'I'I'OP TECHNICAL SERVICES
14530 ECIIO STREET
ANCHORAGE, ALASKA 99516
ISCALE: AS NOTED
DRAWN BY TFM
JANUARY. 2003
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Sile 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 06, 2002
Expiration Date: Dec 06, 2003
Permit Number: SW020478
Design Engineer: 0019 Flattop Technical Services
Owner Name: RICHARD CROSBY
Owner Address: 7100 GOLDEN HILLS LANE
ANCHORAGE, AK 99516-6835
Parcel ID; 015-122-31
'Site Address: 007100 GOLDEN HILLS LN
Lot Size: 43960 SQ. FT.
Total Bedrooms: 4 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. Ail 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.
Received By: ~'-~ ~ Date:
!
Issued By:
Date: / ~_/~ /~2.-
/
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.a k.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ~ I~- - I ET. -~ /
Permit Number SWOZO,~ 7~
Property owner(s)
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.) ~o~
Legal description (Section, Township & Range)
Day phone '3 f/~'- ~-~,~'
Zip Code ? 9,~'o '7
Lot Size
THIS
THIS
4 ~' q~;O Acre~ Number of Bedrooms
APPLICATION IS FOR:
Sewer Only [] Well Only []
Sewer and Well [] Water Storage []
Sewer Upgrade []
PROPERTY CONTAINS:
Hot Tub [] Jacuzzi []
Swimming Pool [] Water Softening Unit []
Therapy Pool []
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: ~E,'O
Date of Payment: t'Z/?. /o~,
Receipt Number:
(Rev. 12/'00)
Waiver Fees:
Date of Payment:
Receipt Number:
~ .'..:," .' ~, :""x ,.': .,"~' .", .... ~':'--."~
, ' ~..~ ,~,~,~:~ ','~:.52.rJ'~:, ..... ,,. ..... ,.~Z' ~ ~.. :~-:~,'-.
CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS
TItEODORE F. MOORE, P.E.
PH: (907) 345-1355
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
December 2, 2002
14530 ECHO ST.
ANCHORAGE, AIASKA 99516
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for
a permit to upgrade the wastewater disposal facilities on Lot 5, Block 1, Golden Hills S/D, located at
7100 Golden Hills Lane. The existing soil absorption trench is no longer able to accept the waste~vater
load generated in the residence. We are also requesting a lot line waiver allowing the system to be
installed xvithin 1' ofthe north property line. Soils logs, perc 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 2 and 11 feet below ground level is a silty gravel with a measured pere
rate of 32 minutes per inch. The material between 11 and 18.25 feet below ground level is a slightly
silty gravelly sand with a measured perc rate of 1 minute per inch. The proposed upgrade trench is
designed to have effective gravel bet~veen 3.5' and 13 feet below ground level. Using the soil
application rate of 0.45 gpd/sq, ft. for the gravel between 3.5' and 11' yields 6.75 gpd/lineal foot. Using
1.2 gpd/sq, ft. for the portion ofthe trench between 11' and 13' yields 4.8 gpd/l.f, for a total of I 1.55
gpd/l.f. This 4-bedroom residence has a design demand of 600 gpd. The proposed 55-foot long trene.13
design has a total absorption area of 1045 square feet, and a design capacity of 635 gallons per day.
The topography of the lot in the area ofproposed construction slopes do~ towards the north at
approximately 10%. The lot line waiver down to 1 foot from the north property line is necessary in
order to maximize the separation between the proposed and the existing trenches. Since this property'
line abuts on a road R.O.W. granting the requested ~vaiver will not have any impact on existing or
potential nearby soil absorption systems.
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.
; i'
SEPTIC oo ~ , m, /~
o SYSTEM o I~!,~ .!~ ..... ~o /l
LOT 1, BLOCK 3 ', .-' ' '~X. i /
~',, Go~u~ ~ ~ ~ - "'-.. . .-'"" ",,
~ ~ ~ ~ N~ 55' LONG TRENCH ~ ~
~,R 100'
t
100'
w. 9.5'
#1 ', INSTALL NEW
ELL co
e- - - 12' SEPTIC TANK ~ ,,
C.O. ~O ,,'
EXISTING TRENCH- R 10 0 ,
'BULL RUN"
SEPTIC TANK '
DRIVE .." ,, '-..
LOT 4, BLOCK 1 ~
"~ R 100' ~ -.
GOLDEN HILLS S/D ,,
WELL
~ -. ~ LOT 5, BLOCK 1, GOLDEN HILLS SID
% .. CE- 35~? ..' WELL AND SEPTIC SYSTEM
SITE PLAN
~' .... '"'" I INCH = 50 FEET
~'-=~-~" ' o FLATrOP TECIlNICAL SERVICES
SEPTIC 14530 ECllO STREET DRAWN BY TFM
SYSTEM o ANCHORAGE, ALASKA 99515 NOVEMBER, 2002
NOTE: THIS IS NOTA SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
4" DIA. F'810 /
¢ PERF. PIPE ~_ 57 MONITOR TUBE I
C.O. .~
TO ORIGINAL __ CONSTRUCT 55-FOOT LONG SOIL ABS. TRENCH
ABS. TRENCH -- BETWEEN 3.5' & 13' B.G.L
PLAN VIEW
SCALE: 1" = 10'
CLEANOUT
INSTALL NEW 1250-GALLON
SEPTIC TANK
-- NEW WASTE LINE FROM HOUSE
-- INSTALL NEW FDN, C,O,
CLEANOUT
MONITOR TUBE
12"
GROUNE
-- FILTER FABRIC
13
-- 4" DIA F-810 PERF. DIST. PiPE
21/2" SEWER GRAVEL
-- BOTTOM OF EXCAVATION
CROSS-SECTION "A - A"
SCALE: 1" = 5'
LOT 5, BLOCK l, GOLDEN HILLS S/D
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECI INICAL SERVICES
14530 ECtlO STREET
ANCHORAGE, AK, 99516
SCALE: AS StlOWN
DRAWN BY: TFM
DECEMBER. 2002
TEST HOLE ft ] I
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH Pt.
(feet)
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG - PERCOLATION TEST
Lot 5,_Blpck 1, Golden_H_i~l!s_S _/D
November.20.2002
Richard and Carol Crosby
SLOPE
SM Sandyloam
GM/ML Brown silty gravel
Damp, lenses of ML, SM
Depth to Groundwater Date
J~I~-G roundwater seen 11/20/02
W~te~'@17,2' - - --t 1/22/02-
~ateF'_~ ;1'?.3' 11/27102--
SITE P~N
GOLDF-N~
~LOI
17-
SP Slightly silty
Gravelly sand
Date Reading Clock Net Time Percometer Net Drop
Time (minutes) Reading (inches)
'11/22 ~2~.[_5-~al._)_presoak 12:-37:-30 '27_0/_16
#1 12.:38:.-30 1 25_1/2 · 1_1/2
#2 12;39;30 1 24_1/4 1-1/4
#3 12:_40:_30 I 23_!/8 I 1/8
#4 12:41:30 I .21.3/4 1'~3/8
#5 12;_42;,30 I 19._5/8 2_1!8
f~. 12:43:30 1 18.1/4 ~ 1 3/8
~ I
PERCOLATION RATE 1 (minutes/inch) PERC HOLE DIAMETER 8"
TEST RUN BETWEEN 11.5_FTAND 12.0 FT
COMMENTS: Per_c_tests_c0n_ducted.pp 11/20/_02_helen 7.5_a.n_d__8,_0_fe~t_er)coun~ter~._a.pa[ticularl~v_si!ty_po.rtio_n._0f the_st~atu~a~d pe_rced.
_a~_s!ower_th_a_n._60_m_in. per inch. A follow-upj3e_r~_tes~_co~uc!pd~n 11/22/_02_betw=_5~25'__&_5.75' (see T.H. #1a)_see~s ~mor_e_rep~se~n.tativ_e.-
PERFORMED BY FLATTOP TECHNICAL SERVICES. I~ ~'-..~.~'~. CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / '7.. / ~. / ~, ~.
TEST HOLE# la
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
18.25'
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG - PERCOLATION TEST
Lot 5,_Block_l,_Golden Hills S/D
Novembe~_20~2002
Richard and Carol Crosby
Pt.
SM Sandy loam
SLOPE
GM/ML Brown silty gravel
Damp, lenses of ML, SM
Depth to Groundwater Date
SP Slightly silty
Gravelly sand
Date Reading Clock Net Time Percometer Net Drop
Time (minutes) Reading (inches)
LL/22 i2" presoak 27~3/8
S~_'_-- .... 2;.13 23 5/16
#1 2;_43 30 22 3/8 ' 15~6"
Add_water 2:_43:_! 5 23 5/16
#2 3:_!3L15 30 22'_3/8 15/1'~6"
Add_water 3:14:30 23 112
#3 3:_4-~i30 3Q ~ 22~/2 t 1"
PERCOLATION RATE 32__ (minutes/inch) PERC HOLE DIAMETER 5"
TEST RUN BETWEEN._~,25__ FT AND__5~75 FT
COUMENTS:._Eadier_pe[c_tests_~con_ducted_oD 11.__~O/J32_between 7~-an-d-8~-~-feet~e~c~u-nteCed~-pa~icu~ar`~y~si!ty-p~rti~n~f~th~e-stratu~m~-~d
__perced at slower than 60 min. per inch. This follow-up perc test seems more representative of the stratum as a whole.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / 'Z.. / ~ ~.
~Ffattop q'ec/inicaf Sendces
14530 ~cfto Strett, .~nc~ora~e, ~ 99516
~P~on~ (907) 345-;I$55
Lot 5, Block 1, Golden Hills S/D
7100 Golden Hills Lane
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope ofthe project consists ofabandoning an existing septic tank and installing a new
1250-gallon septic tank that discharges effluent into a new 55-foot long soil absorption trench with an
effective gravel depth of 9.5 feet.
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.
Ali 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. A lot line waiver is being requested allowing the system to be 1 foot from the north
property line.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to xvork around
any buried utilities.
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 gqth a x~tertight 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.
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 ~vithin 5 feet downstream of the septic tank. A "Bull Run" diverter valve shall be installed
allowing effluent to be switched back to the original trench as desired by the property o~vner.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 55-foot long trench to a total
depth of 13.0 feet below ground level. The long axis of the 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 10.0 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 9.5 feet above
the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3%
passing the/t200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shoxvn 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. If the soil cover thickness is less
than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface ofthe
gravel, in addition to the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 12 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 sp6cifically agreed otherwise the homeoxvner shall be responsible for arranging to have
the site finish graded after the backfill material has stabilized, and for placement ofadequate topsoil and
seed to promote rapid revegetation ofall areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be required during the course ofthe project: (I)
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 right 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 of insulation or filter fabric, and (4) after rough backfill and
grading is complete. The septic tank requires one inspection afier it is set level and the piping
connected, but prior to backfill. This inspection may be incorporated with any of the 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.
George P. Wuerch,
Mayor
Municipality of Anchorage
Building Safety Dh~ision
Anchorage
All-America City
2002
12/9/2002
Theodore F. Moore, PE
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Golden Hills Subdivision Block 1 Lot 5
Waiver Request #WR020093
Parcel ID #015-122-31
Construction Pemfit Number SW020478
Dear Mr. Moore:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
2.0 feet.
This waiver approval applies to the existing absorption field to properly line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Daniel J. Roth
Civil Engineer
On-Site Water & Wastewater Program
P.O. Box 196650 * Anchorage, Alaslm 99519-6650 * TelePhone: (907) 343-8301 * Faro (907) 343-8200
4700 Souflx Bragaw Street * Anchorage, Alaslm 99507
http://~v.ct.anch omgc.nlc.us
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bra~aw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WR#: WR020093 PID~: 016-122-31 HA//:
Date Received: 12/2/02
Legal Description: GOLDEN HILLS SUBDIVISION BLOCK 1 LOT $
Engineer: TED MOORE. FLATTOP TECHNICAL SERVICES
14530 ECHO STREET. ANCHORAGE. ALASKA 99516
Applicant: RICHARD CROSBy
Permit~: 8W020478
Waiver Requested: ABSORPTION FIELD TO NORTH PROPERTY LINE OF 2 FEET
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: ~ Waiver is not Granted:
List Conditions or Reasons for above: ~'~_..~__. E~,,'//V~'.6'/~9 ~. ET]'&r~
Date: / 2 ~"/~9 Z
~ ' ' Name of Reviewer
Rec~: 28741 Amount: $160.00 Date Paid: 12/2/02
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OIR WELL INSPECTION REPORT
NAME
_
MAILING ADDRESS
LEGAL D ESC RI PTIOI~ ~,
LOCATION
PHONE
OF BEDROOMS
DISTANCE TO:
cturer
acity in gallons
DISTANCE TO:
Manufacturer
IFHOMEMADE:
Well
DISTANCE TO: Well
No. of lines I Length 'o~eac. h ~ine
Top of tile to finish grade
Length
Widtl~
)tion area Dwelling
Inside length Width
compartments
Liquid depth
Dwelling
I Material
Foundation Nearest lot line
Total length of lines / Trench w~h
.~:~_ I inches
Material beneath tile
Depth
PERMIT NO.
Liquid capacity in gallons
Total effective absorption area
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
-'~1 F~E~ATER IA LS
OTHER
IN~TALLcR
REMARKS
APPROVED /¢~F, ,~. ~ DATE LEGAL
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7
8
9 5
DEPT. OF ! LFi &
MUNICIPALITY OF ANCHOFIAGE ~,qVmON;,'aNT,'~L CTION
~ PEaOOLATION
DEPABT~ENT OF HEALTH AND ENVIBON~ENTAL PBOTEgTION
Pouch ~650, An~orage, Alaska 9950~ ~76-~22~ /:~P R 2 6 ,~.,
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
t8
19-
20-
PERFORMED B
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
lo't-
CE RTl F I E D B ~:~% '~, %,.'~,,.
(minutes/inch)
FT
72-008 (7/76)
TH-iQ
10-2-75
IF~-~l ORGANICS
["")
1, __ ' C ,I .: IGRAVELLY SA'.qD w/SO,'IE SILT
,. ~1 (S~l)
..:::.~
NO WATER TABLE
0.0~
1.0~
20.0' T.D.
Log represents location
of Test Hole, Golden
tlills Subdivision
Lot 5> Block 1
ALASKA
JUNEAU
DOUC DICKINSON
Goldec~ ttills Subdivision
Log of Test Hole
ANCHORAGE, A1,AS~\
] .7 - .?
g2' {7
.',. 7 /.,2
/ i/ /"1 7
MUNICIPALITY OF ANCHORAGE
DEPARTIVIENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAl- HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
GENERAL INFORMATION
(a)
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date IX(OU'~.-,'~ ~,"" 13/ (¢~0~' _
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~'~z~'O
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution ~r,¢¢' /~-¢~_~, ¢'c¢,~ ¢,~ ~[~/~ Telephone
Address ~($ ~ ~or ¢ller~ ~ ~/~ ~ ~C40~¢
(e) Real Estate Company and Agent N.A, ¢ ~e~h~(~)
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [] 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 of Environmental Conservation
attesting to the legality and status.
4. 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.
Page 1 of 2 72-025 (1~84)
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.
Name of Firm t='(~¢o~ ~j'ec(~i,'h caf ~ Telephone 7 ?~t3~~
........... t:~ Engineer's Seal
THEODORE I~. ~AOOi,~E ? ~
Approved for ~.~_~_~_ bedroom~ ~/' ~;_.~'--;.7~¢.,, ~ .¢ ~,.._,~_~..:.Dat
Approved ~¢%_ Disapprov~'~J~" Conditional
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 professional
engineer registered in the State of Alaska. The DI--IEP 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.
Page 2 of 2
ENVIRONMENTAL PROTECTION
RECEIVED
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~/~/'7 ~ Yield
~i~ r Depth of Grouting ~,A.
Well Classification
Well Log Present (Y/N)
Total Depth 2.1 7 ~ Cased to
Static Water Level I I I
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding 'Tank on Lot I
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line iV, fi.
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Pump Set At .~' I~.~-~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
l fl¢0 ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
?
B. SEPTIC/HOLDING TANK DATA
Date Installed ¢"'/~1 / ?¢ _ Size / ~'~'~//c4( No. of Compartments
Standpipes (Y/N) )'" Air-tight Caps (Y/N) _ ~' Foundation Cleanout (Y/N)
Depression over Tank (Y/N) t"/ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) R,/J- ; for
Holding Tank High--Water Alarm (Y/N)
Temporary Holding Tank Permit (Y/N) ~,A.
Separation Distances from Sel)tic/Holding Tank:
To Water-Supply Well
To Property Line _ ~,~' ~
To Water Main/Service Line
Course ~ (,o~, ~
To Building Foundation
L.~~
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~"/tl ?
Width of Field '~- ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation '2~
Lot N,
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line ? 8~2 ~
To Existing or Abandoned System on
; On Adjoining Lots ~ ;~ ~ ~
To Cutbank (if present) N,/I.
D. LIFT STATION N, /~-
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.
Signed '~'/~go~-~o¢'~ ~ /~'0, o~",¢' Date (I /
Company /~,/~t/:/¢,,¢ '~'~(~ -¢',/,:J' MOA No.
Receipt No. _,~¢'~ ~'0 / -- DO/' 3
Date of Payment //~ 4~
Amount: $ ¢./~--~;'~'~ (::3~_~ Engineer's Seal
Page 2 of 2
72-026 (11/84)
Time
Time
Date
)ector
Date
C;omments '~, ~S~, 'L~ /9
Inspector
Date
Conditional APproval
~i' c , - .....
Date Sewer Installed '-~
Soils Rating
PermltNo.
Well To Absorption Area
Well to Tank
Septic Tank Size
Holding Tank Size
Well Log Received
APPLICANT FILLS OUT LOWER HALF ONLY
Mailing Address -~1~')lq [~0k/ (};d- 1,1.) IO/'V~ 1. t. /)1~ (~/
J-Phone
,3¢¢
Address
Lending nstitution /)/'~'
Address
Realty Co, & Agent
Address
Legal Description
Street Location
'o, [3LOc /< /
Phone
Phone
f Residence
Single Family
[] Multiple Family
I~ Other
No. of Bedrooms
Water/Supply [] Individual
[] Community
[] Public Utility
Sewaj;~e Disposal FJ Individual
E] Public Utility
U] Holdin~-ank
ATTACH WELL LOG. A well Icg is required for all wells drilled since June
1975. For wells drilled prior to that date, give well depth (attach Icg if
available.)
Year Individual Installed: 6) / ~' ~/
When Co qnected to Publio Utility:.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN !BE INITIATED.
I' DATE{.I~ EC EIV ED
~ ' INSPECTION APPOINTMENTS
TIME TIME TIME
DATE ' "-" DATE
D[:?]' ., &
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic~ag,k, or [] Holding Tank
Size: toL'~U If Tank is homemade SOILS RATING
give dimensions: I ~'~
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line
WELL TO:
I
I
Absorption Area to nearest Lot Line
5. COMMENTS
[~:~-~ APPROVE D FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY