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HomeMy WebLinkAboutHOKAMA HEIGHTS LT 2BHokoma H ight Lot #017-34! -24 Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11217 O1734124OOO Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: August 29, 2011 to August 28, 2012 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: HOKAMA HEIGHTS Site Legal Address: HOKAMA HEIGHTS LT 2B G:2937 Owner/Address: PASTORINO ALEXIS R & RAYMOND C 5250 DE ARMOUN ROAD ANCHORAGE AK 995163626 Site Mailing Address: 5250 DE ARMOUN RD, Anchorage Lot Size in Sq Ft: 92320 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On-Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907- 343-7997 Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 017-341-24 Property owner(s) RAY & ALEXIS PASTORINO Day phone 351-9787 Mailing address 5250 DEARMOUN ROAD * ANCHORAGE, AK * 99516 Site address 5250 DEARMOUN ROAD * ANCHORAGE, AK * 99516 Legal description (Sub'd, Block & Lot ) HOKAMA HEIGHTS S/D; LOT 2B Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: ( [] all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A 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. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) ~sh Fees: _~ (~, Waiver Fees: ~'" Date of Payment: ~' ~'~' ~ ~ Date of Payment: - Receipt Number: ~)~ ~1~ ~l,y Receipt Number: PermitNo. (~,~1~ ~,t\~\""~ WaiverNo. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS August 15, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for Hokama Heights Subdivision; Lot 2B, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The drainfield is in a state of failure and must be upgraded. We are proposing to install a new 500 gallon lift station (after the existing tank) and a deep trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. TRENCH DESIGN: See attached design drawing for drainfield specifications 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY AND WAIVER REQUEST: The average topography in the area of the proposed drainfield is 15-20%. However, the proposed trench will be approximately 37' uphill from a slope exceeding 25%. Attached is a profile drawing showing the slopes within 50' of the drainfield. We request you waive the distance to excessive slopes to 37'. We are unaware of any adverse impacts this waiver would have on adjacent wells, septic systems or surface water. We are unaware of/ you have  ly, Presid adverse impacts this installation would have on adjacent wells or septic systems. If please contact us at 337-6179. Thank you for your assistance. .E., M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com ' I 10' TeLeco~ ~ Elec E~ J e ,0, TeLeco~ & ~- GARN'ESS ENGINEE]RIN'G~ GR. OU'P, Ltd. ~..' * 7 6179 F~ 907 3~ 32~ * WE~ wwwg glnee~ngc~ ~ ......~r~ 3701 E. ~R RO~, SU~ 101 ~CHO~, ~ 99507 * PHONE (907)33 - * ( ) - : · ' · RAY PASTORINO I 907-351-9787 I ~ OF 3 ~Oh.~' ~ness.. ' ~.~o. wo.x: 9AT~: SITE PLAN 8/9/2011 (Rev, 01/05) DESIGN CRITERIA: ' LETTERGEG' ~d.THATHASpERTAiNsA 7 PAGETo SPECIFICATIONTHiS DESIGN. / NOTE: CONTRACTOR SHALL"' HAVE ALL NUMBER OF BEDROOMS: 4- TO OBTAIN A COPY OF THE LETTER 100' WELL RADII FLAGGED BY A GALLONS PER DAY (GPD): 600 CONTACT GEG. BY PROCEEDING FORWARD REGISTERED PROFESSIONAL LAND PERCOLATION RATE/S: 15 MIN/IN WITH THIS INSTALLATION, THE ENGINEER, SURVEYOR PRIOR TO CONSTRUCTION. PROPOSED APPLICATION RATE: 0.8 WELL DRILLER, CONTRACTOR AND MINIMUM DRAINFIELD SQ.FT.: 750 PROPERTY OWNER AGREE THAT THEY ~ HAVE READ THESE SPECIFICATIONS AND DRAINFIELD DESIGN: AGREE CONDITIoNsTO ACCEPT OUTLINED.THE TERMS AND ~ WIDTH: 2.5' M.O.A. APPROVED SAND FILTER: N/A / EFFECTIVE: 7' ~ REDUCTION FACTOR: N/A /~,'~,~0~ AeTUA~ so Fr; ~4¢ SLO~-'A~/ / /_~---~,.,~. / ~. o '~, ~4/v, co ? / ~ /~f ////. /~ '"7~ ,7,'/ I ,oo, WELL RAD,US -/ o. o.,ww^ ~ / / \ '//N TO BE ABANDONED \ PROPOSED DRAINFIELD / 1.25" PRESSURIZED LINE ~/~N~~ ~+/'.P~/~, ~ ~ / / (CONVERT TO 4 INCH / / / Y ~ "'.~ \ ~ ~ , / CONNECTED AS RESERVE SITE~ ~.;::.::'-.:,~ ~ ~ EXISTNG 1250 GAL .. = ~. .'-.~ :.. ,, '......;. ...~-..'. - GARNESS G'ROUP, oLtq. ~:'4¢ ~~ coasuk~au~s ~ o;aaaaak coa,aacvoas fid' '~ ' :'/ ..... ~' ~' ~ PREPARED FOR: IPHONE NUMBER: PAGE NUMBER: ~.-j:~'~ ..... ~',... ..... RAY PASTORINO I 907-~51-9787 2 OF ~ ~f.J~ffr~ A. Ge~ess..' ..~. ~.sc.,.=,ON: ' ' ~RAw..~: VO2~J 7-~;/'~ =~" '" )~ ~PE OF WORK: : DESIGN OF PROPOSED SEPTIC UPGRADE 8/9/2011 (Rev, 01/05) PROPOSED TRENCH i 137' WAIVERI 50' .~ I " IREQUESTEDI 2.5 ~ ~ ~ ~ ~ 20~ SLOp~ Ltd. GARNESS ENGINEERING GROUP, CONSULTANTS & GENERAL CONTRACTORS PREPAREB FOR: PHONE NUMBER: I PAGE NUMBER: .;..: ........ \"¢_ '~. ,s..' # / OF 5 ~y Ak~Garn( HOKAMA HEIGHTS S/D; LOT 2B I A.J.G. - ......... ;'-, PROFILE DRAWING Of PROPOSED SLOPE WAIVER 9/ 1 (Rev. 01105) ORGANICS LOAMY SM GM SP SOILS LOGGED BY: TEST HOLE #1 UPPER BENCH SOIL CLASSIFICATIONS GW ~ ORG GP ML GM CL GC OL SW MH SP CH SP'I OH SC DEPTH TO DATE GROUNDWATER DRY 8/8/20,'11 SCALE: 1" = 100' DATE READING CLOCK NET TINE WATER LEVEL NET DROP TIME (NINUTES) READING (INCHES) 8/9/2011 1 9:00 - 6- _ 2 9:08 8 O" 6" 3 9:08 - 6- _ 4 9:18 10 12/16" 5 4/16" 5 9:18 - 6- _ 6 9:28 10 1 2/16" 4 14/16" 7 9:28 - 6,, _ 8 9:,:58 10 1 12/16" 4 4/16" 9 9:58 - 6- _ 10 9:48 10 1 12/16" 4 4/16" 11 9:48 - 6- _ 12 9:58 10 1 12/16" 4 4/16" PERCOLATION RATE 2.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 2.0 FT. AND 3.0 FT. A FOUR HOUR PRESOAK WAS PERFORMED: ' YES ["-~NO ANDREW GRAY PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PJERF(~RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: GARNESS ENGINEERING GROUP, Ltd. ISOIL LOG - PERCOLATION TESTI ' ~ LEGAL DESCRIPTION: HOKAMA HEIGHTS S/D; LOT 2B ~*"~'e~:'.",~/ PERFORMED FOR: RAYMOND PASTORINO DATE: 8/8/2011 ' ~'-.. ..-' .~:¢ff ORGANICS TEST HOLE #1 LOWER BENCH ~ 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK. 99507 * PHONE: (907);~7-6179 * FAX: (907)538-324-6 * WEBSIIE: gameeaengineering.com LOAMY SM GM SP SOILS LOGGED BY: SOIL CLASSIFICATIONS GW ~ ORG GP ML GM CL GC OL SW NH SP CH SM OH SC DEPTH TO GROUNDWATER DATE DRY 8/8/2011 J J / / / / / / TH#I / I ~ I I SCALE: 1" 100' DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIhlE (MINUTES) READING (INCHES) 8/9/2011 1 9:01 - 6- _ 2 9:51 50 5 15/16" 2 1/16" 3 9:51 - 6,, _ 4 10:01 50 4" 2" 5 10:01 - 6- _ 6 10:51 50 4" 2" PERCOLATION RATE 15 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 7.0 FT. A FOUR HOUR PRESOAK WAS PERFORHED: · YES [] NO ANDREW GRAY PERCOLATION TEST PERFORMED BY: ANDREW GRAY COHHENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASi pEI~FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~VJ°l~"O0,Iz'' PID Number: O/7-5~/-I-- Z¢ Name: j~/~ ~1,~ ~ ~1~ Wastewater System: ~ New ~ Upgrade Address: 7~ ~,~ ~~ ABSORPTION FIELD I No. of Bedrooms: Phone: Z~- ~ 175 ~OO ~ Q Deep Trench ~Shallow Trench ~ Bed Q Mound Q Other LEGAL DESCRIPTION so, Rating: Total Depth from original grade: · +~ G~/sq.~. //' Lot: ~~ BIock:~ ~O~ ~-- Subdivision:~ ~ ~ Depth to pipe bottom from original,grade: Ft. ~ Gravel depth beneath pipe~ Ft. Township: ] Range: Section: Fill added above original grade: ~ Gravel length: WELL: ~ New ~ U pg rade Gravel width: I Number of lines: ~ Distance between lines: ~ Ft. / ~ Ft. C~ification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:~ Driller: Date Drilled: Static Water Level: Installer: Date installed: ~ Pump Set at: Casing Height Above Ground: Yield:& GPM Ft.Z,~. TANK SEPARATION DISTANCES ~Septic · ~ Holding = S.T.E.P. To Septic Absorption L~ft Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines A~ ~ OJ~OC ~ ~ 1t Well >/~l >/~¢1 -- -- >~Ot Material: ~~ Number of Co~ments: Line >lOt >/~ ~ ~ >/~ I Size in gallons: M I , "Pump on" level at: ~le~water alarm at: Foundation ) ~ >/¢ ~ -- Curtain Drain ~0'¢ O~ ~P¢~ ~ I Electrical Inspeoti°ns perf°rmed bY: % Remarks: BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: ~ ~n~ Dates: 1st g/7 5g ~;;~::' ' Department of Heal~ and Human Services approval *" ..... ......... Reviewed and approved by: Date: 2 -2¢ -~ *: ...... '~" 72-.O13 (Rev. 9/91) MOA 25 Permit No. ,~vJq=Zoo~z- Page Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 ° Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~-r' Z~, /-Jot~v~A /-/~'z/.,~47'.~ PID No.: O/7- 5~/- P.ermit No. 5'vJ ?s'oo/z- Page ~ of ,~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION ' P.O. Box 196650 · Anchorage, Alaska 99519-6650 ° Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: 017- 35~) - ~.'Jr LOCAl_ ~.110N OF W~lt- STATE OF AUM;ICA DEPARTMENT OF N~YURAL RESOURG~.~ DIVISION OF MINING & WATER MGMT WATER WE~ RECORD ~ ~ IU~I~qR;~ON LOT ~N t~~-- ~ --- . -- ~o~ ~~/~ ...... __ ~ T~ a~ C~~r ~~:~~. ~~/ ~., . ..__ __ ._ ~_~~ ~/ ~_ ~ ~.ted ~ op.n ho,e ~~ , .~ ~ ~ o~.~o= ~_ __~. :,, ~ ' PUMP ~AKE DE.H: ~ It Ho~at:. CONTRACTOR INFORMAYION{~ f. ; REMARKS: '""~,;l~~".'' /~..-*'~ ~. ~"c-'-- PLEASE MAIL WHITE COPY OF LOG. To: ~ab-~t~ 7'~ ~ 360DiNOR/DSF~it.,SIO~N~O, gFeMIBNoIoNG & WA'{'. MGMT __/~ncho.~ac~er, Rk 99503-5935 AUB ?_.S '95 1:49 ~00~ 3~! IVHil ¥&SIA X'v'd 60:ZT /~0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950012 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:LOOMIS RONALD F 50% & OWNER ADDRESS:7205 FOXRIDGE CIRCLE ANCHORAGE, AK 99518=2702 PARCEL ID:01734124 DATE ISSUED: 2/07/95 EXPIRATION DATE: 2/07/96 LEGAL DESCRIPTION: HOKAMA HEIGHTS LT 2B LOT SIZE: 92320 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AZC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 563-7155 563-5389 (FAX) August 23, 1995 Municipality of Anchorage Department of Health an~l Human Services Onsite Services Section P.O. Box 196650 Anchorage, AK 99519-6650 RECEIVED AUG ,! MuniCipaq~, of uept, Health & ~ ...... ge Attention: Robbie Robinson Subject: Lot 2B, Hokama Heights Subdivision Permit No. SW 950012 Dear Robbie: The owner of Lot 2B, Hokama Heights Subdivision has decided to construct a four bedroom home on this property. The permit for the well and septic sYstem was issued for a three bedroom home. We are therefore requesting the permit be reissued for a four bedroom home. A revised site plan and trench cross section are included for your review. Soil conditions on the lot a suitable for a four bedroom system. The design remains the same with the exception the trenches now become 67' in length rather than the originally specified 50'. Please review the attached information and let me know if you have any questions or comments. Sincerely, Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 January 30, 1995 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 2B, Hokama Heights Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We hereby request a permit be issued to install a new septic system and well on the subject lot. This is a new subdivision and lots on either side of this lot are currently vacant. There are no encroachments into the 100' separation radius between the proposed systems and any wells in the area. The surface of the lot slopes rapidly from north to south and in some cases exceeds 25%. Absorption trenches will be placed parallell to the slope and will be at least 50' from the 25% grade. If the system is constructed as shown on the attached drawings the following statements can be made. The system, if constructed as designed, will have no adverse impact on the wells currently in use on adjacent lots. The minimum 100' separation distance will be maintained. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. o The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact .on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. N 89'59'47" E -- 125.13' ~o 28 Io 91 54.5 sq.ft. d ' -- 2,10 ocres S 89'56'1,5" 152.33' © GRIFFIN SITE PLAN SCALE 1" = 60' LOT 2B, 'HOKAMA ROAD HEIGHTS DRAINAO[ Lot 2B, Hokama Heights Subdivision DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Perc. Rate: 31 to 60 Min./Inch Application Rate: .45 GPD/SF Drain Rock Beneath Pipe: 4' Wide Trench System 1,250 Gal. Septic Tank Reduction Factor: .5 4 Bdrms. X 150 GPD / .45 GPD/SF = 1,333 SF of Absorption Area 1,333 SF / 5' Wide = 267' LF X .5 (Red. Factor) = 134 LF Trench Therefore: Construct a Wide Trench System With Two Laterals For a Total Length of 134'. Place 4' of Drainfieid Rock Beneath the Lateral. Place Distribution Pipe at 6' Below Ground Surface. Install Laterals Parallel to the Slope. NOTE: TYPICAL WIDE TRENCH SYSTEM (NO SCALE) Trenches to Be Installed Parallel to the Slope at Least 15' Edge to Edge. Grade Over Trench to Drain Away from Trench. Laterals to be a Minimum of 50' Upslope from a 25% Slope. PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST (ENGINEER'S SEAL) ~'U~;. Township, Range, Section: SLOPE WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Atf/~r~ ~ J,.-r. ,.~/Z..'~ MoniloriAg? / ~ ~.~4~- Date.. Reading Date / :~//"f SITE PLAN Gross I Net Time Time /0;/5- Depth to Net Water Drop PERCOLATION RATE ~'.~ (minutes/inch) PERCHOLE DIAMETER TEST RUN BETWEEN ? FT AND _, ~ FT , ~/.,.~,...~ E~.,..,./..~T,,¥ "HAT TH,S TEST '"AS "ERFORMED ,N CORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ //..~ 5- ~8 (Rev. 4/85) I -'flFQflMED FOR:., .=GAL OE$CfllPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range. Section: WAS GROUND WATER ENCOUNTERED? $ IF YES, AT WHAT L DEPTH? O P Moml~,.iag ? __ Time Time Water Droi~ ~ / ~.11 I¢~ /: zo - ~ ~ ,, _ ~ z:~ /~ ~ ~//~ ,, ~//~ ,, PE,clCOLATION RATE .'~' _ |minuleUi~.l,U PERC HOL~ DIAMETER WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: Lot 2B, Hokama GENERAL: Heights Subdivision 1. The scope of this project includes the procurement and installation of a 1,000 gallon septic tank and the construction of a wide trench drainfield to serve the proposed three bedroom home. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall also be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A 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. Lot 2B, Hokama Heights Subdivision January 30, 1995 Page Two 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 5. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts shall be installed between the tank and the drainfield. The first cleanout shall be located on undisturbed soil not more than 10' from the tank. The first cleanout shall be to clean toward the drainfield. The second cleanout shall be to clean toward the tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trenches shall be within 2" of level. Sidewalls of the trenches must be raked before gravel placement. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any water wells in the area. Lot 2B, Hokama Heights Subdivision January 30, 1995 Page Three 6. Direct bury insulation must be placed over the distribution system when less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Absorption trenches shall be placed a minimum 50' away from any 25% or greater break in grade. 8. A minimum 2' of accepting soil is required below the drainfield rock. Contractor shall verify this condition prior to placement of the rock. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 seive. Lot 2B, Hokama Heights Subdivision January 30, 1995 Page Four INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system. August 22, 1995 VISTA REAL ESTATE BETTER HOMES AND GARDENS® Jim Cross Department of Environmental Conservation 825 L Street Anchorage, AK 99501 Re; Permit for owner installed septic system Hokama Heights, Lot 2B Dear Mr. Cross: In 1982 and 1983 I was employed by C & G Construction in Kotzebue, Alaska. My job was to connect new construction homes into the public water and sewer system. I operated a Case and a John Deere backhoe. Although we were hooking to sewer rather than septic, the principle of run and fall ratios was the same, and the equipment was essentially identical. In June 1988 I excavated, filled and graded a 300' driveway in house subdivision in Sterling, Alaska. I operated a Caterpillar bulldozer. In 1989 I worked as laborer for Elmer Bird, an approved septic instlillation contractor, on the installation of a 2 bedroom septic system on the Radvansky property in Sterling, Alaska. In 1995 I worked with Elmer Bird as laborer/operator on the installation of a 5 bedroom septic on my property in Sterling. 'During the past two weeks I have cleared land and graded for the driveway on my Hokama Heights property. I have used a John Deere backhoe and a Case bulldozer. Also, during this period of time I closely observed the installation by Mike Anderson and A-1 Excavation of the 3 bedroom septic system at 5400 DeArmoun Road. I will be working closely with Mr. Anderson during all phases of the installation of my septic. I feel that I have the skills necessary to do a very professional job. If you have questions or wish to check on references, please see Jim Vogel who is a member of the On-Site Wastewater Technical Advisory Committee. Thank you for your assistance in this matter. Sincerely, Ron Loomis 3000 C Street, #101 · Anchorage, AK 99503 Telephone: (907) 562-6464 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 Parcel I.D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-~41-24 GENERAL INFORMATION Complete legal description Location (site address or di?ections) Current Property owner(s) Ron Ness .Mailing address Lending agency Mailing address .,,Re~i Estate Agent Gary. Kontul Mailing Address Expiration Date: Hokama Heights: Lot ~2.~0 DeA~i~oun Rd... Anchorage.. AK Unless otherwise requested, HAA will be held by DSD for pickup. 4 N~MBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System 99~16 Day phone 344-t~1:;~1 Day phone Day phone 244-1 71 7 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [~ [] Individual Holding tank ~ Well [] Community On-site r-~ [] Public Sewer [] The Municipality of Anchorage Development Services Depadment (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the 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. 4. 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 Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND ENGINEERING= Inc. Phone (907) 6;96-6111 Address 20441 Ptarmigan Blvd.= Eagle River= AK 99577 Engineer's Printed'Name Kenneth M. Duffus Date 12/1 .~/2003 o Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The dperational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. Approved for '7- Disapproved. Conditional approval for .. ~: WATERAND : ~ :. WASTE'WATER: : bedrooms. ~ : PROGRAM .-' ....................... '",~)),I))))))P~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Cedificate Date: / ~ - / "~ ' O .~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HOKAMA HTS.. LOT 2B A. WELL DATA Parcel D: 017-341-24 Well type Private Date completed 8/1 9/95 Total depth~ 335 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) y Cased to 335 ft. FROM WELL LOG Date of test 8 / 1 9 / 9 5 Static water level 2 8 ~ ft.. Well production I~ g.p.m WATER SAMPLE RESULTS: Well Log (Y/N) y Wires properly protected (Y/N) y Casing height (above ground) -.5' AT INSPECTION 293 ft. 5,45+ . g.p.m. Coliform 0 colonies/100 mi. Nitrate 133 rog.II. Other bacteria 5 colonies/100 mi. Arsenic: : NA mg./I. Date of sample: 1:>/8 & l:>/l:>/Z003 Collected by: KND Engineerin~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material - - ---'--- - - -: --ate Installed 9/7/1995 Number of Compartments .~. Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pun~pin(3 4/21/200:~ Pumper Alaska Sewer & Drain C. ABSORPTION FIELD DATA Date installed 9/14/95 Soil rating (g.p.d./ft2 or ft%drm) 0,45 System type .TRENCH Length. 135 ft. Width $ ft. Gravel below pipe 4 Total depth 11 ft, Eft. absorption area '1350 ft~ Monitoring tube _Y Depression over field N' Date of ade(~uacy tes~esults (Pass/Fail) PASS For 4 bedrooms Fluid depth ir~ absorption field before test 16 in. Elapsed Tim~: 15 min. Final fluid depth 15 Any rejuvenation treatment (past 12 mo.) (Y/N & type) Tank size ._~ gal. Water added 600 gal. New depth 18 .. in. Absorption rate >= 600 g.p.d. N If yes, give date in. D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at~ Cycles tested. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer/septic service line ZS'+ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? in. Building foundation 5'+ Water main 1 Wells on adjacent lots 100'+ On adjacent lots 100 ' + On adjacent lots 10 O' + Public sewer manhole/cleanout 100'+ Holding tank 100'+ Property line 5 '+ Water service line 1 O' + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field 5 ' + Surface water 1 0 0'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 0'+ Water Service line 10'+ Curtain drain 50'+ COMMENTS *See attached Service, LLC ENGINEER'S CERTIFICATION ! certify that I have determined through field/nspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on th/s date. Engineer's Printed Name, Kenneth M, Duffu$ Date 1 ;~/1 5/2003 HAA Fee $.375.00 Date of Payment 12/15/2003 Receipt Number (Rev. 12/01) Building foundation I 0'+ Water main 1 0'+ Surface water I 0 0'+ Driveway, parkingNehicle storage Wells on adjacent lots 1 0 O' + well vault (installed by 0revious owner in 1999) detail by Aarow Pump & Well Waiver Fee $ Date of Payment Receipt Number DEC-11-2012 11:04P FROM: T0:8683793 p:1/1 CT&E Environmental Services Inc. 200 W. ?o~ter Drive T,eleph°ne! (907) 562-234:; I~'aesimile: 1907) 561-5301 i ~ . . 200 W. Potter Drive 3rJnking Water AnalysisiI(eport for Total Coliform BaCteria · · ' - · Tel:'{907) 562-2343 MUST BE CO~L~D BY WA~ ~PLIER T~N CO~L~D BY L~O~TORY PUBLIC WATER SYSTEM I.D. # ~q~ PRIVATE WATER S. YSTEM ~ $end Result$ Fl . Set~ Jnvolce ~ SendRe~ultx I~ .Fen~ffnvolee ~l[~nth . Day Year SA MPLE TYPE: ")s~_ Routine gl Treated Water D R~l~e'fit S'ample (for rou~lne sai6ple ; ~i~ Untreated Water with'lab reL-lio, , ' , " ,) Special Purpose Tin3e Collected SAMPLE.LOCATIO~I Collecteil .B~ pJ~ l'tlnt Analyj;is shows this .Water SAMPLE io be: SatlsfactoW Unsati.s factory Sample over 30 hours old, results may be unreliable ~a~I~ too ~6.~g in' transit; sample should ~aot b¢~ov~r~lY,~ours old'at examination ..to indicat6 reliab.l¢ r~sults. Pleas~ se~d .aewjample via sgeci.'a] deliye~.mail. Anal3~t.s Began . Anal3"tical l~loffiod: Membrane Filter · * Nmnber oi' colonies/100 ml. 1037888 Date: Time: a Fbks Cllen~ noilflgd of.unsatisfactory results:. Phbned Date: · Spoke with Time: BACTERIOLOGICAL ~VATER ANALYSIS I~ECdRD blI~O-MUG Result: Total C~liform blembr=lne Filter: Direct Count · Verification: LTB Fecal Coliform Final Pdembrane Filter Resmlts Reported By ~_ ,%~' BGB · COLIFIRM [] Faxed Faxed 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-341-24 HAA# ~ {~ C~{-~. ~ ~ GENERAL INFORMATION Complete legal description Subdivision Location (site address or directions) 5250 DeArmoun Road Property owner Mailing address Lending agency Mailing address,., Agent Address Ronald F. Loom~ 5250 DeArmoun Road Day phone ~-~n52 Anchorager AK 99516 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Four f 4 ) TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 Anr~-~r~ ~.ng'i ~e~ri ~g Address p, C) Rn~r 74~771 Ancl~or_~_ge, Engineer's signature . ~J-~.E~ ~ AT~ Phone. 522-7773 99524 Date 6/21/99 DHHS SIGNATURE Approved for ~-0 U/~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additiona~ Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional 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. 72q325 (Rev. lj91) Back MOA ~ Municipality of Anchorage E IV E D DEPARTMENT OF HEALTH & HUMAN SERVIi~--'~~'' Environmental Services Division ~/~/~ ~ ~7~,~9 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90 4 - Legal Description: A. WELL DATA Well type p~-~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of AnchOrage Health Authority Approval Check~i~)t' Health & Human Services Lot 2B: Hokama Heiqhts Parcel I.D.: 017-~41-~4 If A, B, or C, attach ADEC letter. ADEC water system number Date completed 8 ! 1 9 ! 9 5 Cased to 3 3 5' Casing height (above ground) y Wires properly protected (Y/N) FROM WELL LOG 8/19/95 Y AT INSPECTION 6/11/99 Date of test Static water level Well production 6 WATER SAMPLE RESULTS: Coliform 0 Date of sample: 6 / 1 1 / q q B. SEPTIC/HOLDING TANK DATA Date installed 9 / 7 / 9 5 Foundation cleanout (Y/N) Date of Pumping 9 / 98 C, .ABSORPTION FIELD DATA Date installed 9 / 14 / 95 Length 1 35 ' Width Effective absorption area I, 350 SF Date of adequacy test 6 / 11 / 99 288' 292.5' Y g.p.m. 5.2 g.p.m. Nitrate 1 64 mq/L Other bacteria Collected by: Tank size I, 2 5 0 Number of Compartments 2 Cleanouts (Y/N) Y Y Depression (Y/N) N High water alarm (Y/N) N Pumper Northlasnd Pl]mpj ng System type 5 ' Wide 4' Total depth 1 1 ' Depression over field (Y/N) ... Soil rating (g.p.d./fF or fF/bdrm) .... 4 5 5 ' Gravel thickness below pipe Monitoring Tube present (Y/N)~ Y Results (Pass/Fail) pas.~ Fluid depth in absorption field befOre test (in.); 1 2" Immediately after 1,0 §~!. water added (in.): Fluid depth 1 2" (ins) Minutes later:~ Absorption rate = > ~ o o q.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date ~/A 72-026 (Rev. 3/96)* Trench bedrooms 1 4" D. LIFT STATION Date installed None on Lot Size in gallons Ee Manhole/Access (Y/N) High water alarm level at* Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: >100' Septic/holding tank on lot Absorption field on lot > 1 .o o' Public sewer main N / A Sewer/septic service line > :~ 5' On adjacent lots > 1 0 0 ' On adjacent lots > 1 0 0' Public sewer manhole/cleanout Lift station N/A "Pump on" level at* *Datum "Pump off" level at* Foundation > 5 ' Property line > 5 ' Water main/service line > 2 5 ' Surface water/drainage > 1 0 0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 1 0 ' Building foundation > 1 0 ' Absorption field > 5 ' Wells on adjacent lots > 1 0 0 ' Water main/service line Surface water > 1 o n ' Driveway, parking/vehicle storage area > 2 5 ' Curtain drain Nc)n~ ~n T,nt Wells on adjacent lots > 1 0 0' F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor~d~~e~{~ve systems are in conformance with MOA HAA guidelines in effect on this date. Signature ~ ~, ~....~ ~:~'~ ~ :~ ..l:. ~ .... :::. ..... ~;'~-~ '= ~' ..':' Engineer's Name Mi ~.h~l P.. _ And~_~'son: P .P.. ~/~'~~?.'~* Date 6/21/99 HAA Fee $ Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number 72-026 (Rev. 3/96)* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 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 .................... : ..... ' ................. ./ · ~'ii' :'~:' '~i'_.,.... . '" Parcel I.D. #' OI7--SSZ/--Z~/- '":'" -:.~t?f~.'~-'C~'plete legal'descriPtion ' Agent.. Day phone Pubhc water ': NOTE: ~ If community well system, provide written on f~o Ors 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 Address' 6. DHHS SIGNATURE X Approved for Phone bedrooms. ficipality of:AnchO~g? ~epartment of Health and Human Services (DHHS)iSSueS Health I, certificates b~?~'~'i~¢~pon the repreSentatiOns given in paragraph 5 abOve bY.an indePendent Pro~i0hal engineer regist~'¢~":'i~'ihb State of Alaska. The DHHS dOes this as a courteSy to PurChasers of i' :i.i?~ and their lending inStitUtions i'~ ~i-~r t~ ~tisfy certain fc~leral and state mquirements. Employ~s of DH HS do not °r anal~"'~t~ta'bef°re a Certificate is iSSued. The MUniciPalitY'of.Anchorage is not ;ii:'i ':'":'re~i~"~il~ie for errors or~omissi'on's inche Professional engineer's Work. "i i!: ':- . (Rev. 1/91) Back MOA 1¢21 -----. :; ' ' ' Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~.~EIVED 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 34 Health Authority Approval Checklist /-)o ~,~ A N mt,/,~r's Parcel I.D.: FEB 20 1996 Municipality of Anchorage Dept, Health & Human Services A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Y If A, B, or C, attach ADEC letter. ADEC water system number Date completed i Cased to Y Casing height (above ground) Wffes properly protected (Y/N) Date of test Static water level FROM WELL LOG I AT INSPECTION Well production WATER SAMPLE RESULTS: Coliform t9 Date of sample: Nitrate /- 7..'/ ~v~t//... Other bacteria Collected by: ?V~. Be SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping. Tank size /,gt:>~O Number of Compartments -'~0 Cleanouts (Y/N)~ ¥' Depression (Y/N) /X] High water alarm (Y/N) Pumper Ce ABSORPTION FIELD DATA Date installed Cl/l$-l,-//q.5" Soil rating (g.p.d./ft2 orft2fodrm) * ~.~ Length l ~" Width ~. I Gravel thickness below pipe Effective absorption area l, ~ ~'0 ~ ~'Monitoring Tube present(Y/N)...~ Date of adequacy test .A]t~-p3 ~0t4~C Results (Pass/Fail) ]>As~ Fluid depth in absorption field before test (in.); Fluid depth .(ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) Immediately after Absorption rate = If yes, give date System type ~J ~ ~ Total depth ? j i Depression over field (Y/N) For ~ b~oo~ ~ g~. water added (in.): 2 ~0 0 g.p.d. Date installed -~~"--........~__ Size in gallons Manhole/Access (Y/N) ~~ "Pump off" level at* High Water alarm level at* *Datum ~~ Cycles tested E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: > / 00 / ; On adjacent lots ~ [ t9 0 / ; On adjacent lots /V~/.~"5 Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line >10 Absorption field ! Water main/service line Surface water/drainage ~ 10~ Wells on adjacent lots '~100~ I >/o0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation > 3 0 Surface water ~> f O 0 t Curtain drain AJo~J~' o,J ~rr >/ROt Wate~ main/service line ,~' S 0 Driveway, parking/vehicle storage area F. ENGINEER'S CERTIFICATION Wells on adjacent lots Property line I certify that I have determined thrufield inspections and review fMuntctpal records .4~bi~b~n~stems are in conformance with MOA HAA guidelines in effect on this date. ~ .< ~. ~ ~ ~ ~ Fee $ ~ OO, 0~0 W~ver Fee $ Date of Payment Date of Payment R~eipt Number ~ ~ !~"7 t-~7 Receipt Number Rev. 8/95 OSS: haa. wk.doc