HomeMy WebLinkAboutCLEARVIEW LT 2Onsite File
Clearview
Lot 2
#015-242-41
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MUMCPALITY OF ANCHORAGE
—0
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ry.
Community Development Department ` Phone: 907-343-7904 s
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-242-41
Property owner(s) Wayne & Margaret Broste Day phone
Mailing address
Site address 7900 Alatna Ave Anchorage, AK
Legal description (Sub'd., Block & Lot) Clearview Lot 2
Legal description (Township, Range & Section)
Lot Size 49,950 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field X❑ Initial ❑ Single Family (SF) Q
Septic Tank NUpgrade ❑X (w/wo AD U)
Holding Tank ❑ Renewal ❑ Duplex (D) ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: # 5? 5 Waiver Fees:
Date of Payment: V? -g A- I Date of Payment:
Receipt Number: DSI 1 SCS G Receipt Number:
Permit No. 0 5 Pot % 1,35 9 Waiver No.
Permit App_-'-:- ._..:c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211359, Rebecca Carroll, 09/01/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211359, Rebecca Carroll, 09/01/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211359, Rebecca Carroll, 09/01/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211359, Rebecca Carroll, 09/01/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211359, Rebecca Carroll, 09/01/21
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/~ 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/~I~
WELL
INSPECTION
REPORT
NAME C UPGRADE
LEGAL DESCRIPTION /
~ DISTANCE TO: W~I,~v~ ,~ IAbs°rpti°narea,~ Dwelling/,~, '~ PERMIT NO~/p
~ Z Manufacturer ~~ Material ~~ No. of comoartments
L q. capac ty in gallons Inside length Width Liquid depth
/~ IF HOMEMADE:
~ ~ DISTANCE TO: ~ Dwelling ~~ PERMIT NO.
~_~O ~ ~ Manu~--~ Material ~ ~quid capacity in gallons
~ DISTANCE TO: We~ Foun~ Nearest lot lin~ PERMIT NO.
~.~ ~o. ofli,es ] ken~thof~,~ Tota'l~o~s Trench~,dth~ ,nChe, Dist,nc. Bet~eenlin,s
S[~ Top of tile to finish grade--~ .~E I ~ ' Materi~ berth tile ~ [~ ~ Total effective~/2absorptionr~¢par~
Length Width ~ Depth~' PERMIT NO.
~ ~ Tgpe Crib d[amet Crib depth
~ Total effective absorption
~ ~ell Buildin~ foun~on ~earest lot line
~ 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 , /
DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
APPLICANT CHUCK HRDDY
LOCRTION RLRTNR RVBE
LEGRL LOT 2 CLERRVIEW SUB
r.lljrd II]: I~;,~-~iLIT'T' iDF F~r~C:H~-'-~RI--IGE
I~EF'RRTMENT k HEBLTH RND ENVIRONMENTRL OTECTION
825 'L" STREET, RNCHORRGE, RK. 99501
264-4?20
I.WELL Rr-JD ~]r-J--SITE SELLER
( 8±0750 )
F'O BCIX 10-1314
LOT SIZE
TYPE OF c. nIL RBc. ORPTI ]N _ ~_.TEM IS TRENCH
r,!R).~Ir, tUM NUMBER OF BEE:,ROOMS = 4
SI_] I L RI=IT I NG (SQ. FT/BR ) = t25
THE REQLIIRED SIZE OF THE SCIIL ABSORPTION SYSTEM IS '
[:,EF'TH= :l. 2 L EI'-.I~] T H = -~--:'2 I] R F! '...' E L [-',EF' TH = 8
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE E~CBVBTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
REI=-!..I_I I I;?E[:. 'r~EPT I r: T~--~NF4.=-~- I ZE= t 25~-3 GALLI2,1'-4S
F'ERMIT RPPLICRNT HI=IS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTRLLRTION INSPECTIONS OF ANY WELLS RDJRCENT TO THIc, PRCPEF..T~ RND THE
NI_IMBER OF RESIDENCES THAT THE WELL WILL SERVE.
T L~l ~_0 ( '--~ ~,
Z I 1'-4SPECT I ~]I'-4S I-IRE REC-!LI I RED-,
BRCKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION RND APPROVAL 8Y THIS
DEPRRTMENT WILL 8E SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVRTE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED RND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTBLLRTION
PERt-11 T E:=-::F' I I~:ES DECEr'IBER _~-:-1 .. -1 L-~- 8~L
I CERTIFY THAT
t: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF ANCHORRGE.
2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
V4. 0
11311
PO ~3'X ~e--~.3t4'
LOt '~ 1[ ,:"F.
C.,,O IL ~f (f~ (SI3 F f~:> = :t:L:~i
[=)EP 1-H ----- 'J-"-~ ! ~ £1'-JL.~ TH = _~.-2 131~,l-':I%-'EL DI~P TH ;= 8
fR_E,~i.I E i;~.ED '_=,EPT ir L---- TI~i~-4K L-.-.; [ 7___E= -J_251,,3 ,~I--~IC-L;)NS!
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
Pouch 6650, Anchorage, Alaska 99602 2762221
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
7
8
9
10
11
12
13
14
15
16
17
18
19
Earl R. Barnard
754-E
20
COMMENTS ~'~" ~::~
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Reading
3
Date
Gross
Time
Net
Time
Depth to
Water
,,.PO'
Net
Drop
PERCOLATION RATE .~. O (minutes/inch)
TEST RUN BETWEEN ~' FT AND ~'~" FT
7 2-OO8 (7/76)
.;~.:~:..~x tach WATSR WC,,U. mmJ. X~ ~D c4srm our TO T~ ~H ~ ~ 30O
*-~ ~,~,":" .... ~' ' '*'~* :**~ ...... '~* .... ** "*'* ~' :"*: '~ "4~'~,:*. ** ''~ *~-''' '~ · *" · .... * ' ::':" :' *,':' * ........
..,.-..-:. DRIED AT THE ~TE OF ~7.~ ~R =~-- .... ~<';:'*' ~ ::' * '"' ''~ ....... ~'¥"
COb-'T INCL,UDE~ AL.L. i.A, BOR AND MAT~,i:U,AL. FOR COMP~ION
' : '
.,-"'-?:,.....' . . ~ : ..... - .... . FORTH U
· "" ..... THANK YOU V MUCH. .-..-.,. ..':~';~ .--.:......~..~:.~...:',:.
'Z":- ::*:":."- -"- :-' ..-~ :- ........ :
,a..... . . -.../':'.:.-'.... . . :: -...
· ..i :~.. ~ . :.'
,' =...:Tx: ~. '. :. :,. - ,_--':~';~"=;. ' -~ ' ·..
MUNICIPALITY OF ANCHORAGE .. ~ ' .'
DEPARTMENT OF HEALTH & HUMAN. SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 'Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# ('~IZL~- ,.QL~_~-~\ HAA#
1. GENERAL INFORMATION
Complete legal description
S~J~ .
Location (site address or directions) '7c/C,0 AL~TJJA
Property owner '"t'o ~ D ~ t.. L otJ
Mailing address i'3~'~ I-I, tt..t..c~F--sT
Day phone ~.'~ 4-GG 53
/V,)¢~,ro~:~ ~,~- ~ff 5-05
Lending agency
Day phone
Mailing address
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: '~ ~
TYPE OF WATER SUPPLY:
Individual well
NOTE:
TYPE_OF WASTEWATER DISPOSAL:
:, ..... :~ Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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
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.
NameofFirm ~1 (::::::C2~L)L.'T'I/~ ~-/~.[~,lr'.3~,-~-~)Phone ~'~' f~
Address '(:>.o. l~,b~(,£., ,A-~- ~ ~1~ i l -13 <t. ~]
Engineer's signature Date '~ ·7
DHHS SIGNATURE
~/~ Approved for '~'
Disapproved.
Conditional approval for
bedrooms.
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 and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L. ~- d-I_~__~_x/I E~ v,J SuI5
Parcel I.D.
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal
If A, B, orC, attach ADEC letter. ADEC water system number Date completed h,,Jr~. I'=1f51(Z) Driller
Cased to
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
140'4
144'+
14C)' + (3)
'~oO~ ~ Casing height
Wires properly protected (Y/N) YF_
AT INSPECTION
,CZ:)
4-7
g.p.m. 0.~ ®
; On adjacent lots
14o' +O
; On adjacent lots I ~ c~' + (~
Public sewer manhole/cleanout ~/~'
Petmleumtank
WATER SAMPLE RESULTS:
Coliform ~-
Date of sample:
~_. I -~¢.~ ,~.w,,,c~ ~-c~-~5Other bacteria C>- s~- ~.~--r~ ~.~u~.~
Collected by: ~__-.~,~-u pd3~-~a$
B. SEPTIC/HOLDING TANK DATA
Date installed '7
Cleanouts (Y/N) ~E.c~ d~ ~c~£~
High water alarm (Y/N)
Date of pumping
Tank size 12. Sc::,
Foundation cleanout (Y/N)
~,~ (~) Compartments
/,.lO ~) Depression (Y/N)
Alarm tested (Y/N) '---
Pumper I ~ A~.c.-'~,
/'Jo
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot [ 40 ' + (~) On adjacent lots
To property line ~C,' ~) Absorption field
Surface water/drainage
72-026 (~)* Fret ~ ~
Foundation ~ / d;'
Water main/service line ~/~,
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed. ~_~,~, Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent(Y/N) .-~ _ _. ".Pu~
HM'~2t:a~eortl~re~ ':cVa:lcodes (y~~~
SEPARATION DIS~:
Well on lot / On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed '7-5 '~-- ~ ~ ~ Soil rating (GPD/FF) t. :Z{:~) System type
Length .~.t ~ Width u~,-~b,~'J(~) Gravelthickness ~"(:~) Totaldepth
Totalabsorptionarea ~l?--F-~~'(~) Cleanoutpresent(Y/N) ¥~%(~o~--- Depression over field (Y/N)
Date of adequacy test ~ -[ - °t '~ ® Results (pass/fail) ~'/~,c~c2 for 'dc
Water level in absorption field before test ~ ~. d) After test t~
Peroxide treatment (past 12 months) (Y/N) C~wPr~-~-- [,.~(-~'~D t,.~c~ If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot t ~-~
To building foundation
On adjacent lots
Surtace water
Curtain drain
Property line
To existing or abandoned system on lot
Cutbank ~ /~. Water main/service line
Driveway, parking/vehicle storage area tO '
E. ENGINEER'S CERTIFICATION
I certify ~~e~ecked, verified, or conformed to all MOA and HAA guidel~e of this inspection.
Engineer's Name'S-,,_. z'( /C_.~C.~ /-'/'/dx-/L ~
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
March 4, 1994
W.O. 94112
Municipality of Anchorage
Dept. of Health & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
RE: Lot Flow Test / Lot 2 Clearview Subdivision
Gentlemen:
On February 1, 1994, DHI Consulting Engineers performed a Well Flow Test on the above
mentioned lot.
The well can produce 792 gallons per day, slightly more than the required 600 gallons required
to meet DHHS standards. It should be noted that we were able to draw the water table below
the level of the pump after pumping only 380 gallons. At this time the pump was shut off and
the well was allowed to recharge. The well recharged at approximately .55 gallons per minute.
(Slightly greater than .416 gallons per minute required for a four bedroom home.) Prior to the
test the static water level was measured to be 47.1 feet from the top of the casing. Municipal
records show the well to be 300' deep and the pump to be set at approximately 285 feet. The
well casing has approximately 350 gallons of storage. The well is sufficient for the four
bedroom single family home, although the water production rate is marginal.
The water sample results are attached and meet the requirements set forth by the Municipality
of Anchorage. All the protective well radius setbacks are also in accordance with the Municipal
standards.
Very Truly Yours,
Dee Hi~h.~P__.E. '//'
Principal
cc: Gail High, DHI
K:\w951 klhiH 12eh3m.wl~5
PO Box 111349 Anchorage, Alaska 99511-1349 · (907) 345-1385/Fax 345-1386
0~/02794 11:~[2 CT&E ENUIRONMENTPL LAB SERUICES ~ 989 345 13D86 N0.849 Q02
Commercial Testing & Engineering Co.
Envinmment~d Laboratory Services
c'rJu~ Rgi',# 94.0855-
Client Sm~ple
Matrix WATER
LABOP, ATORY ANALYSIS REPORT
Cliea-t~lqm~qe D H I CONSULTING Lq~TC'~IN'~I~ WO1LK O~ 76170
~oj~N~c Col~t~.t~e 02~ (~08:~ h~.
~j~ff ~v~i~e O~g~ ~ 10:37 hrs.
PWS~ I IA
By:
S~uple R~mgks;
RO[/TINE SAMI~Ec()I.I-SCTI~ BY: CA RI..
QC Allowable Eat, /ma[
Pan~n~er l~-sul~s qtml Uxfits Method Limits Dale Date
Nim~'-~ 0.10 U mgfL EPA 353.2/3[RL0 l0 02/2g/94
hilt
LLH
* See Spcci~d lnstrt~lioa, Above UA =[~mvmlsble
** ~e ,%mploRematksAbov¢ ~ =~t~t~al
D = S~n~ry ~[on. ~= O~er~
5633 B StreeL A~m, AK 99518-1600 -- Tel: (~7) 562-~43 Fax: (907) ~1.5301
E~IRONMENTAL F~ILmE~ IN A~8KA, COLOR~O. F~IDA, I~O~, MARY~O. N~ JERS~, OHIO, UTAH, WE~ VIRGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Bo~196650 Anchorage~ Alaska 99519-6650-
343-4744'
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description
HAA #
Location (site address or directions)
Property oWner
Mailing address 'TCtOC:
Lending agency
'Day phone
I
Day phone
Mailing address
Agent :~/3~ ~ I '7_~_~ W~D ~
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If dO'rnr~b~[i~/:well system, provide written confirmation from State ADEC attest-
. lng to the 'leg~a'lity and status of system.
4. TYpEOF WASTEW'ATER DISPOSAL:
Individual on-site ,-
Holding tank
Gommunity on, site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 {Rev. 1/91) Front MOA #21
g
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.
NameofFirm ~/-~'c;~ ~z.~.,~ ~m~..~, ~/'~/,~.,---s Phone ;;z7;z-7/~/
Engineer's signature-
Disapproved.
Conditional approval for
6. DHHS SIGNATURE
' .;>~. ApprOved for
bedrooms.
Date 4.,,. -4.-~'/ "
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragrapl~ 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: ~)3-' ~ ~-.t--E./~VIE;u~ Su~51::> Parcel I.D.
A. WELL DATA
Well type INO~V~OUP4,'(-~lf A, B, or C, attach ADEC letter.
Log present (Y/N) y, I~
Total depth ~C~l (~
Sanitary seal (Y/N) Y'~---,~ (~
Date completed
Casedto .~(~ 1 (~ Casing height
FROM WilL LOG
Date of test ~-?--~> I ,
Static water level IO(~~ ~
Well flow ~(;E;x~ ~j~t/~..~ H~ = 2,~_..~
Pump level ~_.~..~ L (,~?=J
ADEC water system number
J~dJ~t, I~>l(~ Driller~~l~(~
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot [
Public sewer main [~'
Public sewer service line
g.p.m.
;On adjacent lots
; On adjacent lots
'Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~A-~ ~ Nitrate
Date of sample:
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed '7" ~-~.~ ~.'~'1 Tank size ! ?-,SO 0~.1 ~
Cleanout~ (Y/N) ~5;:~ ~:~;~ 'F°~ndation cleanout (Y/N) ~ ~
High water alarm (Y/N) "'j~''~'.' ' Alarm tested (Y/N)
Date of pumping ~--~--'~'~ ; ~
SEPARATION DISTANCES FROM sEPTiC/HOLDING TANK TO:
Well(s) on lot t~'~ ~ On adjacent lots {00' 4 ~
Toprope~yline ~ t ~ Absorption field ~ ~ ~
Surface water/drainage M/34.
72-026 (Rev, 3/91) Front MOA 21
Compartments
Depression (Y/N) N
Foundation i~ ! (~)
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed -/,-, 2.,~ - ~:,!
Length ~--'(~ WidthL~iC~D,lfd~J(~)
Total absorption area
Depression over field (Y/N) t,J, (~
Results (pass/fail) ~ (~
Peroxide treatment (past 12 months) (Y/N) ]~C)
Soil rating ~w~l~z ./INCa{ (~System type ~
Gravel thickness · Total depth
Cleanouts present (Y/N) ~5 ~~
Date of adequacy test ~-~-~ I
for ~ '~' bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~C;:) 1 + (~ On adjacent lots I '~C:)' ~r (~)
To building foundation ~-,-~ {~-'' ~
On adjacent lots
Surface water N/,4.
Curtain dra n N/~'
Property line
To existing or abandoned system on lot
Cutbank k[/~a~ Water main/service line
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
Driveway, parking/vehicle storage area lC:) ~ ~
the date of this inspection.
Signature
Engineer's Name ~ ~',/-~/--
Date /-,,'
HAA Fee $ //'~- ~
Date of Payment ~- ~' ?//
Receipt Number -'~2 '~ ~- .~' ~ ~ ~
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
· Receipt Numbbr
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645
High Phukan Consulting Eng.
2702 Gambell St., Suite #103
Anchorage AK 99503
Attn: Carl Abrams
Regort Date:
o5/3z/ 1
Date Arrived= 05/24/91
Date Sampled= 05/23/91
Time Sampled= 1600
Collected By= CA
Our Lab #=
Location/Project=
Your Sample ID=
Sample Matrix=
Comments=
Al10665
S.E. Hose Bib
L2 Clearview Sub.
Water
Flag Definitions
U = Below Detection Limit
DL Stated in Result
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Method Parameter
Units
Result Flag
Date
Analyzed
EPA 300.0
EPA 352.1
Nitrate-N
Fecal Coliform
mg/1
#/100 ml
0.5 U
10 U
05/30/9l
05/24/91
Reported By~ William E. Buchan
Anchorage Operations Manager
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (inclu.de lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Owner
Mailing Address
(c) Lending Institution
Mailing Address
(d)
~,~,, 11, /q ~o~
0/6-02,9% ¢/
.'~~ ~'z~l, ! ~4 Telephone:Home
"/,~ ~a A~.. ~--~,,~
Telephone
Business ~. 71- ~'O
Real Estate Company and Agent
Address
Telephone ,_~""~ 2" 7~G' ~
(e) Mail the HAA to the followino address: or: Check here/~ if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-FamilyJ~
Number of Bedrooms
WATER SUPPLY
Individual Well ~i( 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 I of 2 72-025 IRev 8/861 Front
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 i~n~, .
Name of Firm~~ phone
Address
Date /I.~ ~ j, ~ ~¢1.¢~
DHHS APPROVAL
Approved for ~ bedrooms by
Approved i?~--- Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Autho. rity 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.
Page 2 of 2 72-0,25 IRev 8/86) Back
WELL DATA
..~ Ot ~.4'~C~'SO~UNIClPALITY OF ANCHORAGE (MOA)
.~t>'~';~.~.5~ I:IEALTH AUTHORI~ APPROVAL (HAA)
x~O~' .~ ~s ~ 264-4744 .
Well Classification '
Well L6g P~e'sent (Y/N)
Total Depth ~-~ ~,
Static Water Level
Casing Height Above Ground
Electrical Wiring in Coriduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Legal Description: LoT
Cased to ? 7'O
/@
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ,~ ~ J q ,1~ J Yield
Depth of Grouting /%,/O ,~
Pump Set At '
' ~;anitary Seal on C'~sing (Y/N)
Fr C,,/Depression Around Wellhead (Y/N)
_'~/~ O · On Adjoining Lots I ~O ~-'
i"~ ,1~ ; On Adjoining Lots I ~,~ ~
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~> ! ~
· Date ~
SEPTIC/lt~IB~IIII~ TANK DATA
I
Date Installed".IlU~ ,~/
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ..%} ~ O
TO Property Line ~g)
To Water Main/Service Line
Course
Size ! ~,- ~ No. of Compartments '7'
Air-tight Caps (Y/N) f Foundation Cleanout (Y/N)
J~ Date Last Pumped
/~/~'~ 'for
Temporary Holding Tank Permit (Y/N)
TO Building Foundation C;~
To Disposal Field ,~'
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026 [Rev 8/86) Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed "1 I) L~_/ ~
Width of Field [~l,,I JP.,,14,,
Type of System Design
Square Feet of Absorption Area ~ I
Depression over Field ~'/N) /~/
Results of Last Adequacy Test
Separation Distance from Absorptipn Field:
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Water-Supply'Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, parking Area, or Vehicle Storage Area
Comments
; On Adjoinin~ Lots ~'
To Cutbank (if present)
/
To Property Line / ~
To Existing or Abandoned System on
D. LIFT STATION
r/o/VS-
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 Cy(~les during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or e~nformed to allMOA.and HAA guidelines in effect on the date of this inspection.
Signed ~r~- ~ Date ~'/~/~ '
/
Company MOA No.
Receipt No. /,t~ ,_'~ O
Date of Payment ~-"-"-///~¢~¢'''
Amoun,:$ /7 O ~
Page 2 of 2
72-026 fRev 81861 Back
Engineer's Seal
CONSULTING ENG NEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WELL:
SEPTIC SYSTEM:
SEPTZC SYST .M AD ,OUACY TEST '
¢oo
Thomas Burton t.~]. JU~[ ~S. ~9~ ..'~
Single Family, Four Bedrooms ~4~~~'~
On Site, Single Family
FROM MUNICIPAL RECORDS:
TANK: Greer Steel, Two Comp. 1250 gal.
ABSORPTION SYSTEM: Trench
ABSORPTION AREA: 512 sq. ft.
SOIL RATING: 125
INSTALLATION DATE: July 1981
DATE OF LAST PUMPING: May 7, 1988. Marx Enterprises
DATE OF TEST:
May 6, 1988
TEST PROCEDURE: System was inspected and measured.. Tank .was
found With '4.5 feet of cover and 47 inches of liquid. Sump to
trench was 14.5 feet deep and had a liquid depth of 46 inches.
400 gallons of clean water were added to the sump at a constant
rate of 7 gallons per minute. This caused the water level in the
sump to ~rise 2 inche_~, indicating that the water was being
absorbed by the ground at a fast rate.
TEST RESULT: This system meets the code requirements of
the Health and Social Services Department of the Municipality of
Anchorage.
NOTE The operational life of all septic systems depends on the
local soil conditions, groundwater levels that may fluctuate
during the year, and the water usage 0£ %he £amily being served
by the system. These conditions are outside the control of the
evaluator of this septic system. We can therefore not give any
estimate.of how long this system will function satisfactory for
current or future occupants.
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
RESIDENTIAL WELL INSPECTION
LEGAL:
LOCATION: 7900 Alatna
OWNER: ThOmas Burton.
TYPE OF WELL: Single Family
WELL LOG AVAILABLE:'
Lot 2, Clearview
'Yes
INSTALLATION REQUIREMENTS MET:Yes
WELL YIELD FROM WELL LOG:
PUMP YIELD FROM TEST:
;%.-
2 gallons per minute
7 gallons per minute
DATE OF INSPECTION:
May 6, 1988
TEST PROCEDURE: Well was pumped at a constant rate while the
drawdown was monitored with an acoustic probe. At the beginning
of the test water level was found at 71 feet below top of casing.
At a pumping rate of 7 gallons per minute the water level dropped
to 282 feet after 55 minutes of pumping. A total of 400 gallons
were pumped. The well recovery rate was monitored for 40
minutes. The well recover to 244 feet during this period, a
18%
recovery.
TEST FOR E.COLI AND TOTAL NITROGEN:
and total nitrates on MAy 9, 1988
E.Coli 0. Total Nitrates. None Detectedu~'
'Max. allowable Total Nitrates 10mg/1.
TEST RESULTS: _This .well meets the requirements of
Municipality of Anchorage.
THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE .FOR
Water was tested for E.Coli
the
MORE
THAN FOUR HOURS
The Municipal requirement for well flow is 150 gallons of water
per bedroom per' day. This well exceed this requirement. The
assessment of the condition of the well applies only to the
conditions as of the day tested. The flow rate may change due to
subsurface conditions that may not be observed from the surface,
and changes in. the land use and other factors that may impact
the aquifer feeding the well.