HomeMy WebLinkAboutCHRISTOPHER HEIGHTS LT 7 Municipality of Anchorage Page J 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: C)~'(::~ ~ PID Number: ~15'
Name:
~,~ ~ ~c~ll~ Ro&(~o~ Wastewater System: ~ New ~Upgrade
Address:~OO ~~/ ~'~ ~V ~ ~ ABSORPTION FIELD
Phone:
Of
Bedrooms:
~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION Sol, Rating: Total Depth from original grade:
E. ~ GPO/Sq. Ft.
Lot: ~ Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: ~ Range: Section: Fill added above original grade: Gravel length:
I
~ I Ft. l~ Ft.
WELL: ~r ~ New ~ Upgrade Gravelwidth: Number of lines: Distance between iines:
J ~ Ft. ~ ~'~ Ft.
Classification {Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. 3 ~ / SQ, Ft.
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: GPM[] Pump Set at: FL]] Casing Height Above Ground:Ft. TANK
SEPARATION DISTANCES ~ Septic ~ Holding
TO Septic Absorplion LiR Holding ~/Pdvate Manufacturer: Capacity in gallons:
From Tank Field Slalion Tank S ..... Li .... ~1~ C~ d~
Material: Number of Compartments:
Well IO~ ~OO lOB - ~ F,~e~l~
Surface
Water ~OO ~ ~ ~o - LIFT STATION
Lot Size in gallons: Manufacturer:
"Pump on" level at: "Pump off" level at: High water alarm at:
Foundation ~ ~ ~ ~ ~ -- - ~ ~ ~ ~ I/~
~ Electrical Inspections pedormed by: .
CurtainDrain ..... Pump Make & Model ~ ~. ~. ~,
R . T~ ~,~-~/ ~o~
emarKs: Con~,~r~ ~ ~,~/~ BENCH MARK
~l~t~ ~~l~l~ ~ ~{~~ Location and Description:
~ep ~C ~ ~ ~ ~~0~ ~C~~ I Assumed Elevation:
~ I~t~ ~f~O~ ~ ~I~C~ ~ ~ ~ 12' o~ ~ ENGINEER'SSEAL
~ ~a~ ~rvice
Department of He ilth an( u s approval ..............
Reviewed and approved ~~¢ Date' }t ~
PERMIT NO: SW960339
PAGE 2 OF 2
PID NO: 01523307
94.9
19' x 19'
RESIDUAL
DISPOSAL
BED
1.25" DIA.
SCHED. 40 PVC
1500 GALLON
"BIOCYCLE"
AEROBIC
TREATMENT
UNIT
ALARM
BOX
RISER RIM
ELEV. 98.6
- - - 1 "BLOC
~ AER(
/
SAMUEL COUR'I:
SWING TIES:
FROM: COR. "A"
TO:
UNIT "C" 53'
M.T. "D" 52'
WELL ~
~~ PLAN VIEW
', SCALE: 1" = 30'- 0"
. ' .: MONITOR TUBE
.--,' , FILTER FABRIC 'J~
2" RIGID INSULAT 1.0 SEWER GRAVEL __
't sw, 'OF D,S OTTOM
,~ : ~'~ ~.~.~S~.~'~'S~.~;~S~S~S~?~r~;~- - - - - -- ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: iiii~ii?:ili' ~ -'-'
fi4 ~.~ ~:i:~:~:~:i:~ :~:i:~:~:~:~:~:~:~:~:~ :~:~ :~::::::::::::: ::: ::: ::::::: ::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::: :!:~:i :~ :::::::::::::::::::::::::::::::::::::: ::: ::::: :~:::::~:::~
C_~_E_"] .... ========================= ................................. ::::
BIC ! / / 1.25" DIA. SCHED. 40 DIST PIPES
/lENTI / ' W.3/16" HOLES SPACED @ 2' O.C. --
T / / I.N, ,V,,. ELEVATION 97.8' ,,
/ 2.2 LAKE OTISGRAVEL FILTER SAND
BOTTOM ELEV. 95.0'
2" RIGID INS. (30 PSI)
U N D E R "BIOCYCLE"
..~~"/~. #1
TER @ 91.3'
SEPT, 1996
CROSS-SECTION
NOT TO SCALE
LOT 7, CHRISTOPHER HEIGHTS
SEPTIC SYSTEM UPGRADE
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, ALASKA 99516
SCALE: AS NOTED
DRAWN BY TFM
NOVEMBER, 1996
MUNICIPKLITY OF AI~CHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960339
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:ROBINSON DAVID D & MICHELLE M
OWNER ADDRESS:6800 SAMUEL CT
DATE ISSUED:10/08/96
EXPIRATION DATE:10/08/97
PARCEL ID:01523307
LEGAL DESCRIPTION:
CHRISTOPHER HEIGHTS LT
LOT SIZE: 45201 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
RECEIVED BY: ,-~
DATE:
DATE:
Rick Mystrom,
Mayor
Mun cip W of Ancl orage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
October 8, 1996
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject:
Waiver Request for Lot 7 Christopher Heights Subdivision
Waiver Request #WR960051, PID #015-233-07, SW960339
Dear Mr. Moore:
Your request for the waivers of the required 10 foot separation between an on-site
wastewater disposal system and a lot line have been approved. The waived distances are
as follows: property line from the Biocycle to be 2 feet from the west property line
abutting Lot 6 and the residual disposal bed to be within 0 feet from the north property
line abutting Samuel Court right-of-way.
This approval applies to the existing on-site wastewater disposal system lot line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separations be met or another approval from this department.
If there are any questions or concerns regarding this waiver, please call our office at 343-
4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services Program
DJR/ljm:Robinson
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# ',~~ PID# 015-233-07
Date Received: September 24, 1996
HA# Permit
Legal Description: Lot 7 Christopher Heights
Engineer: Ted Moore, P.E., Flattop Technical Services
14530 Echo Street, Anchorage, Alaska 99516
Applicant: David Robinson
Waiver Requested: Lot line waiver the Biocycle to be 2 feet from the west property
line abuttin8 Lot 6, and the residual disposal bed to be within 0 feet from the north
property line abutting Samuel Court R-O-W.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Waiver is Granted: ~ Waiver is NOT Granted:
List Conditions or Reasons for above:
Date:
Rec ~: #02333/2546
By:
Amount: $ 115.00
Name of Reviewer
Date Paid: Sept 24, 1996
CIVIL & ENVIRONMENTAL ENGINEERING *, ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
September 23, 1996
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
In my application dated 9/16/96 to upgrade the wastewater disposal system serving.the
residence on Lot 7, Christopher Heights S/D, I somehow omitted to apply for a lot line wmver.
Accordingly, I am now applying for a waiver allowing the "Biocycle" aerobic treatment unit to be
located within 2 feet of the west property line abutting Lot 6, and the residual disposal bed to be
located within 0 feet of the north property line abutting the Samuel Court R.O.W. These reduced
separation distances are necessary because of the many constraints limiting the available area on the
lot. Granting the requested waiver will have no significant impact on the ability to construct future
septic system upgrades on nearby lots.
Please give me a call if you have any questions. The $115 Municipal waiver fee is being
paid along with this submission.
Sincerely,
Ted Moore, P.E.
cc: David Robinson
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
SEP 2 4 1996
RECEIVED
CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSgS
THEODORE F. MOORE, P.E.
PH: (907) 345-1355
September 16, 1996
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to install a "Biocycle" aerobic treatment unit and residual disposal bed on Lot 7, Christopher
Heights S/D, located at 6800 Samuel Court. The existing soil absorption trench is operating in a
surcharged condition, and the available room on the lot for an upgrade outside the required 100 foot
setback from wells and surface water is extremely limited. Soils logs, perc test results, a site plan, design
drawings and specifications are enclosed for your review.
The proposed residual soil absorption bed will be constructed in the vicinity of test hole # 1. As can be
seen from the soil log, the native material between 5' and 9' below ground level is a slightly silty fine
sand with a measured perc rate of 2 minutes per inch. The design application rate selected for the effluent
from the "Biocycle" aerobic treatment unit is 2 gpd/sq, ft., which is provided by a 10' x 30' residual
disposal bed.
The topography of the lot in the vicinity of the proposed construction slopes downwards towards the
south at 10-15%. Although the groundwater monitoring showed a groundwater depth of slightly over 9
feet, to provide an additional factor of safety, the design of the residual disposal drainfield incorporates 2
feet of triter sand to raise the level of the bottom of the gravel to 3' below original ground level in the
vicinity of test hole #1.
The proposed project will have no significant impact on present or future water supply and wastewater
disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-
surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
LOT 2A
SEPTIC
SYSTEM
~__,
HOUSE
LOT 6
CONSTRUCT 10' x 30'
RESIDUAL DISPOSAL BED
T.H.
SEPTIC
MOUND
O O
INSTALL
1500 GAL.
O
"BIOCYCLE"
~ ------UNIT _~
100' OFFSET
FROM CREEK
o ] HOUSE
SEPTIC
SYSTEM
LOT 1
ABANDON EXISTING
1250 GAL. SEPTIC TANK
& SOIL ABS. TRENCH
SAMUEL COURT
J
.J
LOT 3
TELEMARK HILLS S/D
UNSUBDIVIDED
(VAO/~,N'r)
..R~DCKRIDGE DRIVE
LOT 8
CHRISTOPHER HEIGHTS S/I;
LOT 7, CHRISTOPHER HEIGHTS S/D
WELL AND SEPTIC SYSTEM
SITE PLAN
FLATTOP TECHNICAL SERVICES I INCH = 50 FEET
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 SEPTEMBER, 1996
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
LOT 4
TELEMARK HILLS S/D
3O
DISCHARGE LINE / 'Iv' ,,
1 ·25" DIA SCHED 40 PVC
TREATMENT DISPOSAL BED ',t W. 3/16" DIA. HOLES IN
UNIT BOTTOM, SPACED 2' D.C.
llA!!
PLAN VIEW
SCALE: 1" = 10'- 0"
INFLOW FROM
RESIDENCE
~. ~,- ..... ~ .,. ~ 2 SOIL COVER ~ 1 25 DIA
'~, ~;z %, ,' .... .' z~ ~"T~R FABR C ~ ~ SCHED 40 PVC
9" SEWER GVL'~55
0.5" DIA. SCHED. 40
LINE ORIGINAL 5
GRADE TO PROVIDE
lO
NATIVE SANDY SOIL
SECTION "A - A"
SCALE: 1" = 5' - 0"
"BIOCYCLE"
AERdB-I(~- '
:1'~ ~,:l'M e MT
UNIT
1.25" SCHED 40 PVC
DISCHARGE LINE
TO DISPOSAL BED
BACKFILL AROUND
"BIOCYCLE" WITH
CLEAN SAND
RE-PLUMB ~ __
SEWER LINE ~
THRU FDN. WALL ~
2.5' BELOW GROUND
INSTALL BLOWER
INSIDE CRAWL SPACE
2" RIGID INS. (30 PSI)
UNDER "BIOCYCLE"
LEVEL EXCAVATION
W. CLEAN SAND
LOT 7, CHRISTOPHER HEIGHTS S/D
SEPTIC SYSTEM UPGRADE
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, AK, 99516
SCALE: AS sHOWN
DRAWN BY: TFM
SEPTEMBER, 1996
Flattop Technical Services
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 7, Christopher Heights S/D
6800 Samuel Court
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of abandonment of an existing septic tank and soil absorption
trench and installation of a "Biocycle" aerobic treatment tank which discharges effluent into a 10' x 30' soil
absorption bed constructed over 2 feet of filter sand.
1.2 Construction shall be as depicted on the approved site plan and design drawings, as supplemented
by the "Biocycle" unit manufacturers specifications. Minor deviations from these drawings may be
allowed or required by the engineer conducting the inspections. All construction procedures and material
specifications shall conform with Municipal and State requirements. All separation distances shall be in
conformance with Municipal requirements, unless specifically waived.
1.3 The property owner shall enter into an on-going periodic maintenance agreement with the
"Biocycle" supplier which is acceptable to the M.O.A. Health Department.
1.4 The property owner shall enter into an analytical testing agreement with the "Biocycle" supplier if
required by the M.O.A. Health Department.
1.5 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
1.6 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.
1.7 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 Existing wastewater disposal system:
2.1 The existing 1250 gallon steel septic tank and separate lift station tank must be properly
abandoned by thoroughly pumping, removing the tops and backfilling with soil.
2.2 The existing soil absorption trench shall be abandoned in place with any standpipes removed.
3.0 "Biocycle" aerobic treatment tank:
3.1 The new 1500 gallon "Biocycle" aerobic treatment tank shall be manufactured, furnished and
equipped by Pegasus Engineering in accordance with the M.O.A. approved design.
3.2 The contractor shall prepare a suitable site for the "Biocycle' unit and install it as follows: The
location of the unit shall be chosen to maintain a minimum separation distance of 100 feet from all private
wells, as well as the small creek which traverses the lot on the south side of the house. The depth of the
excavation shall be sufficient to allow connection to the 4" waste line leaving the house at a minimum slope
of 1/4" per foot. To avoid the necessity of a manhole riser extension, the existing waste line leaving the
house shall be re-plumbed through the concrete block foundation, and insulated with 2 inches of rigid
insulation. The bottom of the excavation shall be carefully leveled and smoothed by the placement of a
layer of clean sand. Two inches of rigid, burial type, insulation with a minimum compressive strength of
30 psi shall be placed on the sand leveling course prior to installation of the "Biocycle" unit. The space
between the sidewalls of the excavation and the "Biocycle" unit shall be backf'flled with sand. The top of
the "Biocycle" treatment unit shall be buried no deeper than specified by the manufacturer, with the
manhole riser extending above finish grade. The final ground surface shall be graded as necessary to
provide drainage away from the "Biocycle" unit.
3.3 The contractor shall be responsible to obtain the necessary Municipal electric permit and
inspection, and shall provide a copy of the electrical inspector's report to the engineer overseeing the
construction of the wastewater disposal system.
3.4 The on, off, and alarm floats shall be set at the elevations specified by the manufacturer, and their
proper operations shall be verified by the contractor. The alarm box shall be mounted inside the residence
at a location selected by the homeowner..
3.5 The discharge line from the "Biocycle" aerobic treatment unit to the soil absorption bed shall be
1.25" dia. Sched 40 PVC.
3.6 The air blower used to aerate this "Biocycle" unit shall be installed inside the crawl-space of the
building, with a 0.5" schedule 40 PVC air line leading from it to the "Biocycle" unit. The air line shall be
carefully bedded to minimize the potential for damage as the ground settles.
4.0 Soil absorption system:
4.1 The residual soil absorption bed shall be constructed by excavating a 10' x 30' area to a depth of
5' below original ground surface at test hole #1 in the area shown on the site plan.
4.2 The bottom of the excavation shall be level. A total of 2 feet of filter sand identified as "D.O.T.
Road Sand" supplied by Central Paving Products shall be placed in the bottom of the excavation.
4.3 A total of 0.75 feet of washed sewer gravel supplied by AS&G shall be placed on top of the filter
sand with the perforated distribution pipes laid level such that the pipe inverts are no less than 0.5 feet
above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than
3% passing the #200 sieve.
4.4 The distribution pipe network shall consist of a non-perforated 1.25" dia. Sched. 40 PVC
manifold feeding 2 distribution laterals consisting of 1.25" dia. Sched. 40 PVC with 3/16" diameter holes
drilled in the bottoms spaced 2.0' O.C. All pipe connections in the distribution system shall be glued, and
the ends of all pipes capped. Monitor tubes shall be of 4" diameter and installed in the locations shown
on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
4.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum
of 2 feet of soil 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 of the gravel, in
addition to the filter fabric.
4.6 The top surface of the cover material shall be graded to smooth contours. Fill slopes shall be no
steeper than 3:1.
4.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the
site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed
to promote rapid revegetation of all areas disturbed by the construction.
5.0 Inspections:
5.1 A minimum of 5 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sand leveling and/or filter material has been placed, (4) after the sewer gravel is
in place and the distribution pipes have been laid and connected up to the "Biocycle" aerobic treatment
tank, but prior to placement of insulation or filter fabric, and (5) after rough baclcfill and grading is
complete. The installation of the "Biocycle" aerobic treatment tank requires two inspections - immediately
prior to placement in the prepared excavation and after it is set level and the piping connected, but prior to
backfill. These inspections may be incorporated with any of the above inspections, if feasible.
5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
TEST HOLE #
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH,
(feet)
1
COMMENTS:
FLA'R'OP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
Lot 7, Christopher Heights S/D
September 5, 1996
David and Michelle Robinson
Pt,
SM Fill material
Pt. Original ground
SM Sandy loam
SP/SM Somewhat silty f'me sand
Variable, some silt
SP Slightly silty fine sand
Brown, lenses of SM
Damp below 8'
Small water seep
ML Gray sandy silt
Dense, cohesive
Lenses of wet SP, SM
Several water seeps
B.II.
SLOPE
Depth to Groundwater Date
Seep at 9.5' 9/5/96
Water at 9.2' 9/12/96
SITE PLAN
SAMUEL COURT
o,
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
9/5 12" Presoak 27 5/8
Add water & start 12:22:10 23 5/8
#1 12:27:10 5 21 1/8 2 1/2
Add water 12:27:30 23 1/2
#2 12:32:30 5 21 1/16 2 7/16
Add water 12:32:45 23 3/8
#3 12:37:45 5 20 15/16 2 7/16
Add water 12:38 23 9/16
#4 12:43 5 21 2 9/16
PERCOLATION RATE 2 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 7.0 FT AND 7.5 FT
PERFORMED BY FLA'I-rOP TECHNICAL SERVICES. I ~'.~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
TEST HOLE # 2
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: L~t 7, Christopher Heights S/D
DATE PERFORMED:
PERFORMED FOR:
September 5, 1996
David and Michelle Robinson
DEPTH
(feet)
Pt.
SM Silty sand fill
Buried logs and brush
Fluid oozing in from east side of T3-I.
Soil saturated with septage
B.H.
SLOPE
SITE PLAN
SAMUEL COURT
o
T.H. ~-#1 fj!ii!::~'iii!iii/
~'~ ::::::::::::?::::::::::::::::::::::::::!i WELL--~
11
Depth to Groundwater Date
7.5' 9/5/96
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
PERCOLATION RATE
(minutes/inch} PERC HOLE DIAMETER
TEST RUN BET~NEEN FT AND FT
COMMENTS: No monitor tube set. Material unsuitable for septic system construction.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ~_~__~'~e~-,~_ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: F //~ /4~ u~
PROPERTY OWNER AGREEMENT
FOR THE MAINTENANCE OF AN
ON-SITE WASTEWATER DISPOSAL
SYSTEM
This agreement, dated O~'~C/0 199~___, is made between the Municipality of
Anchorage Department of Health and Human Services (DHHS) and the property
owner(s) of:
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject property.
The property owners agree to the following:
Allow the Municipality of Anchorage the perpetual right of entry to the property during
normal working hours, to allow for effluent sampling or evaluating the general state of
repair or function of the system.
Submit to the Municipality of Anchorage, on an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and
operation statement shall verify that the engineer has inspected all effluent and air
pumps, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
(Signature)
(Printed Name)
(Signature)
(Printed Name)
C. ~.,.~,.,-~._¥,~ %,~0
(Notarize Here)
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Dear Homeowner/Prospective Buyer:
The on-site wastewater disposal you are interested in purchasing is an "alternative" wastewater disposal
system. This system, known as a "Biocycle Aerated Wastewater Treatment System", is undergoing testing
within the Municipality of Anchorage under the Alternative System section of the Wastewater Disposal
Regulations (AMC 15.65). There are certain risks involved with the ownership of one of these systems:
This system has been shown to be effective in other areas. The system is currently undergoing a
two year testing period in Anchorage under the guidance of the Department of Health and Human
Services (DHHS) and the State of Alaska Department of Environmental Conservation (ADEC) to
determine its effectiveness in a subarctic environment. Testing results on systems installed in 1994
have been very encouraging. Copies of initial test results are available from the DHHS.
The Biocycle system has not been tested and approved by the National Sanitation Foundation
(NSF). Currently, Anchorage Municipal Code for Wastewater Disposal Regulations requires
proprietary equipment to have NSF approval. This approval or changes to the Wastewater
Disposal Regulations through Municipal Assembly action will be necessary prior to this system
being approved as a standard system.
if this system fails to meet the requirements set for it to become a standard, code approved
wastewater disposal system, it may have to be removed and replaced by either a holding tank or (if
possible) other wastewater disposal system that meets Municipality of Anchorage requirements.
The cost of any conversions required to meet code requirements will be the responsibility of the
homeowner at the time of conversion.
I (we) certify that I {we) have read the above statements and am (are) aware of the risks outlined.
(Purchaser Name) (Purchaser Name)
(Purchaser Signature)
(Purchaser SignatUre)
Notarizc Here
'-~ MUNICIPALITY OF ANCHORAGE
DEPARTs/lENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
' 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
IPHONE
MAILING ADDRESS
LEGAL DESCRIPTION /
LOCATION X NO. OF BEDBOOM8
~ff ~'~4/~,, ~f/ J/~v ff~-:'~ .0.8
DISTANOETO: ~ / /o' [Abs°rpti°nareasi Dwelling 9' ~ERMIT
~Z~( ~ Manufacturer~ Y ~ Material~/ No. of compartments
~ ~ Inside length Width Liquid depth
Liq. capacity in gallons
12Fd IF HOMEMADE: --
Well Dwelling PERMIT NO.
~ DISTANCE TO:
~_~ Manufacturer Material Liquid capacity in gallons
~ Nearest lot line ~ PERMIT NO.~
Q Well ~/ Foundation ~7
~[ ~,s~.c~o: //
~ ~ Z No. of lines ~ Length of each~,line ~ Total length of lineage Trench width~ inches Distance between lines
~ Top of tile to finish ,fade ¢ . M,terial Be,eath tile Total effectiue absorption area
Length Width Depth 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.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
SOIL TEST RATING t ~/ ~' I~'
/
INSTALLER~
I
REMARKS
APPROVED ~ DATE LEGAL
3-~-~z~r Lot 7 Ft~,~ I (4~,~t~p~,
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
Fe.~'~ --t~~t¥~'~--t- I 3flu[.- /~i;fi[ mU.~RADE
Well
DISTANCE TO: I
Manufacturer /~<¢~.,
]Liq. capacity in gallons
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
IAbsorption aFea
NO. OFBEDROOMS
PERMIT NO. ~,~ ~ ~1~ ~ L~
No. of compartments
Z
[ O O~~ IF HOMEMADE: I Inside length Liquid depth
DISTANCE TO: Well I Dwelling PERMIT NO.
Manufacturer Liquid capacity in gallons
Foundation
Total length of lines
Material beneath tile
Depth
Dwelling
Material
W dth
Material
Nearest lot line
I Trench~id~ inches
inches
DISTANCE TO: Well ~t%~.¥ ~
No. of lines [ Length of eachline~
Top of tile t? finish grad~:
I ~ [Length
I ~ / Ty~-~of c rib
~m~ DISTANCE TO:
I > I DISTANCE TO:
Width
PER. MIT NO.
Distance between lines
Total effective absorption area
PERMIT NO.
Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
PEF.:r,11 T NO.
~F'PLIC:ANT FEJE~ I~ ~91~ OLD ~EWARD HIGHWAY 995~2 g44-6691
LOCATION _ _ , , LOT SIZE 999999 SQUARE FEET
LEGAL
T'¢PE OF SOIL ABSORPTION ~YgTEM IS' TRENCH
r,IAXIMUH NLIhlBER OF BE[:,ROOhlS = 3 SOIL RATING ,::SQ FT,-"'BR)= t5E~
THE REQUIRED ~qIZE OF THE SOIL ABSORPTION ?~STEM
[:,EF'TH= t2 LE~-~GTH= 3:~ GF:A'--'EL [)EPTH
THE LENGTH DIMENSION Ic THE LENGTH <IN FEET> OF THE TRENCH OR [:,RAINFIEL[:,.
THE [:,EPTH OF A TRENCH OR PIT IS THE DISTANCE BETP~EEN THE SLIRFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET).
THERE I~ NO SET HIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMLIH DEPTH OF GRAVEL B~HEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITV TO INFORM THIS DEF'ARTMENT [:,LIRING THE
INSTALLATION INSPECTIONS OF ANY ~ELLS ADJACENT TO THIS PROPERTY AND THE
NUHE:ER OF RESIDENCES THAT THE HELL HILL SERVE
- E:Y THIS
E:AC:KF ILL ING OF 8N~' :,~-,TEM HI THOLIT FI NAL I NSF'ECT I ON AND AF'PRO'v'AL
DEPARTMENT HILL BE SUBJECT TO PROSECUTION-
MINIMLIM [:,ISTANCE E:ETHEEN A ~4ELL AN[:, AN'¢ ON-SITE SEHAGE DISF'OSAL S'¢STEH
tE~E~ FEET FOR ~ PRIVATE HELL OR 15E~ TO 2~E~ FEET FROM A PLIE:LIC F~ELL [:,EF'EN[:,ING
UPON THE TVPE OF PUBLIC HELL
HINIMUH DISTANCE FROM A PRIVATE F~ELL TO 8 PRI'v'ATE SEHER LINE I5 25 FEET AND
TO A COHHUNIT~' SEHER LINE IS 75 FEET.
HELL LOGS ARE REQUIRED AND HUST E:E RETLIRNED TO THE DEPARTMENT 1.4ITHIN
OF THE HELL COMF'LETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION [:,IAGRAHS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIF'T' THAT
:I.' I Al"1 FFtI',IlLIAR P.IITH THE F~:EC!I_IIF.:Er'IEI'-,ITS FOR AN-SITE SEP.IEF.:S AND HELL5 AS SET
Ff'd:;.'.TH E:'T' THE MLII"-,II_.Z,F'HLIT L-iF RNF:H¢]RAGE.
2' I I.,.ITLL INSTALL THE _-,m ..... ' IN Af":COF.:E:'ANCE HITH THE F:AE:'ES.
r OF HEPA_TH ~NO Et~[RONMEINTRL PROTECT[O~I
LOT ~J[SE
PERMIT NO.
F1LIr-J ICzIk RLI T"T' IDF FIr-JCH.JRFtGE
DEPBRTMENT OF HEBLTH 8ND ENVIRONMENTBL PROTECTION
825 'L' STREET, RNCHORRGE, WK. 99501
264-4720
L~ELL RND
( 82i154 )
,;II-d--'__-] T TE SEL4ER PERM I T
RPPLIC:RNT
LOCRTION
LEGRL
FEJES DEVELOPMENT INC
L?B1 CHRISTOPHER HEIGHTS
69t7 OLD SEWRRD HIGHWRY 99502 ~44-669±
LOT SIZE 999999 SQURRE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS
SOIL RRTING <SQ FT?BR)= 150
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[)EF'TH= i2 LEI'-JGTH= 38 GE:R'~-'EL C)EPTH= e]
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFBCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFBLL PIPE
RND THE BOTTOM OF THE EXCBVRTION (IN FEET).
REF_~I_I I RE[:, SEPT I C: T~-]~'-Jk~] $ I ZE: 1E1E1E1 GRLLI]fJ$
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
TLJO (:)) I ~-JSF'ECTI Cl~-J$ R~iE ~:E~!I_II ~:EC,
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN B WELL RND RNY ON-SITE SEWRGE DISPOSBL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 158 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO 8 PRIVBTE SEWER LINE IS 25 FEET 8ND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS WRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F'ERF1 I T E,'=-:~P I RES E:,EI_-:EI'-IE:EF-: 2:'~ .. ltV:B2
I CERTIFY THRT
i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
5: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM WRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THBN ~ BEDROOMS.
SIGNED:
RPPLICRNT
ISSUED BY-2:~--
FEJES DEVELOPMENT INC
V4. 0
SOl S LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
/,AL
DATE PERFORMED: 4~" "~ L.~ - ~ '~_.
';SLOPE
I. oT 7
SITI
!
PERFORMED BY: /%/~d- [=~' ~'.L.~ f~ ~'~
WAS GROUND WATER SL
ENCOUNTERED? , //~O O
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Ti me Time Water Drop
PERCOLATION RATE
.'(minutes/inch)
TEST RUN BETWEEN FT'AND FT
72-008 (6/79)
CERTIFIED BY:
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicol E~ Seophysicol Surveys
Drilling Permft No.
LOCATION OF WELL (Pteaee complete either la, lb or lc.) A.D.L. No.
~!l"~'l'lB°r°ugh Subdivi&ion,, Lot Block--II-'~'1 I/4qfri. Section No. T°wnehiPNl'--IgJ Range El-1 Meridian
, ,,'~:.-j-. Y~?' / --of--of--of -- SE] ' WE]
----J~ DISTANCE, AND DIRECTION~ FROM,: (~.,'ROADA~ , J, ?INTERSECTIONS :5. OWNER OF WELL:;~.T~,.,.~.
' '" ....... ,7' Address: ~' ?/ '
Street Address end Area of Well Location
2. WELL LOG Feet Below
Surface 4. WELL ~EPTH: (final) 5. DATE OF COMPLETION
Material Type Top Bottom .,~ r~-
., ~;'~ d~ ? 6. ~ Cable fool ~ Rotary ~ Driven ~Dug
' ~ ~: ..~.~...., ," /,. ~ Auger
~,~". ~.,~"?"~'~ .... ~.' ~ ,',-,~;~/~ "/ ~:~ ~A~ ~' 7. USE: ~ Oome.lic ~ Public Supply ~ Industry
..... ~ ..... ~; "' ::'" C Z: ....... ~, -:.' ~ "? ~ Irrigation ~ Rech,ro, ~ Commerical
8. CASING: ~ Threaded ',~ Welded
diam. : ~1 in. to ¢~/ ft. Depth Weight '?' , lbs./ft.
~ ~ diam. in. to~ ft, Depth Stickup :~: .
ft.
" 9. FINISH OF WELL:F
. Type:~ ,i 't" '~ ~'' "~/:~/ Diameter:
Slot/Mesh Size: Length:
/ Set between ft. and ft.
,' Backfilling Gravel pack
/
IO. STATIC WATER LEVEL .... ft.
Date
~ Above or ~ Below land surface
Equipment used:
II. PUMPING LEVEL below land surface and YIELD
,~/~:~ ft. after hrs. pumping /' ,~,_ g.p.m.
ft. after hrs. pumping g.p.m.
IZ.GROUTING Well Grouted: ~ Yes ,~ No
Material: ~ Neat Cement ~ Other:
15. PUMP: (if available) HP
Length of Drop Pipe ft. capacity g.p.m.
~ Subm. ~ dot ~ Centrifical ~ Other
14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION:
15. Water Temperature o ~ F~ ~ C
Thl:s well ~as drilled under my jurisdiction and this report is true to the best of my knowledge and belief;
,?" Registered Business Nam~ ~ Contract License Number
,'. /, · . ~,,/{ ~':~;~~"'-- <.. .~.~ ,
~: " .4 , ,' _.' . ,/,..;,._
'' "' Authorized R~esentative
Form 02-WWR {11/81) Copy Distribution; WHITE-Sf~Ie DGGS~ PiNK-Driller, CANARY-Cusfomer
MUNICIPALITY OF ANCHORAGE
Development Services Department j Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-233-07
1. GENERAL INFORMATION
Expiration Date: ' 2 7 -2 7
Complete legal description CHRISTOPHER HEIGHTS LOT 7
Location (site address) 6800 SAMUEL C, ANCH AK
Current property owner(s) PETERSEN
Mailing address
Real estate agent
SAME
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
Q
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ S-5 Waiver Fee $
Date of Payment g�gl2Z Date of Payment
Receipt Number 01(q6 -C20 Receipt Number
COSA # 0 S G 2.2 '14 27 Waiver #
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, based
on procedures outlined in the Certificate of On -Site Systems 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. t 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727$$64
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E.
6. DSD SIGNATURE
System #1 Approved for 4
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
Date 6-12-22
S., �'°' 6� •C mak. � d
owl
•
��. • 9TH4...:.....
.......-:....:
.1af
.;
�J ��•• MICHAEL N. ANDERSON • fV""
CE- 46�• • ,.� .
2.;;;
bedrooms, with the following stipulations:
.,�llll(lt(tfrrrr�,.
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: CHRISTOPHER HEIGHTS LOT 7
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1
2J
1/92
Total depth 61 ft
Cased to 61 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 21 in.
Date of flow test for COSA 8/9/22
Static water level at beginning of test 7 ft -
Comments Comments
B. TANK DATA
Age of tank(s) 25 years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 6/22/22, see maintenance log
D. ABSORPTION FIELD DATA BIO -CYCLE
Parcel ID: 015-233-07
Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 5.64 mg/L ,J Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample 8/9/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 25 years
Lift station material fiberglass
Comments: Bio -cycle
* see maintenance inspection
Which system tested (date installed) 10117/96
Adequacy test date 8122/22
❑ ALL standpipes present per record drawing
Results [✓,]Pass For 4 bedrooms
Total measured depth from grade 5 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade ft (min)
Water added 600 gal
❑ N/A — pressurized field
3
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
1440
Elapsed time min
depth into effective
❑ Cade -required soil cover over field
Final fluid depth 0 in
F1 System presoaked
Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of test)0
Gallons introduced gallons
If yes, enter date
Comments/Deficiencies: SEE ATTACHED INSPECTION REPORT
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Q
Yes
Community Sewer Manhole/Cleanout > 100'
ft
Q Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100'
Yes
if No
ft
Private Sewer/Septic Line > 25'F1 Yes
if No ft
Absorption Field on Lot > 100'✓Q
Yes
if No
ft
Holding Tank > 100' [j✓ Yes
if No ft
Neighboring Absorption Fields
> 100'
Surface Water > 100'
0
Animal Containment > 50' Yes
if No ft
ft
0 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
Q Yes
if No
ft
✓V Yes
if No ft
From Septic/Holding Tank on Lot to: (Please
enter
distances if less than required)
I
Building Foundations > 10'
Q✓ Yes
if No
ft
Surface Water > 100' 0 Yes
if No ft
Property Line > 5'
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100' Yes
if No ft
Water Main > 10'
Q Yes
if No
ft
Community Wells > 200' Yes
if No ft
Water Service Line > 10'
Yes
if No
ft
if septic tank is under driveway comment
below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓[]
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
El
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that i have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
49TH
EN
MICFI i ;N. AN1)ERSCN
�. 1 •, CE 9 69 '�
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC221427
Subdivision: Christopher Heights Lot 7
A water sample revealed a nitrate concentration of 5.64 milligrams per liter
(mg/Q. The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Ma�lmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mur`n arg
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
} Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Z I Day of A V w J of 20 22-, by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as ^r, -r, -
located at at (legal description)
S }42\S'tOP 0. Q \-Vexx�wy<> LOT T 4A=ftr-fK �LPe'T �Z ��J�O �— AQ -t>
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
-_�?_ Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
A�— Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
t Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
_ M Owner acknowledges that the fine for failing to maintain and repair an AWWTS maybe
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
1 Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial .District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:
By: �� (signature) Date: 8/-Z,3 Z'Z
aZc-� 1�2n� r -.S (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this o f day of (�S f
20 o707 , by -ra J'? brtw h111111I11l1/g/z�
M/
NOTARY PUBLIC F&R AL SKA= : NO'•;z J
• ao• = r
My Commission expires: a�Da�' _� ; ARI;.
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MUNICIPALITY:
By: (signature) Date:
name) Title:
(rev. 05/18/2018) Page 3 of 3
3705 Arctic Blvd #313
l a s ka Anchorage AK 99503
Email: crbioak@gmail.com
(907) 274-0314
2nd Quarter Inspection Report 2022
Homeowner Info
Customer Name: Jim and Stephanie Peterson
Address: 6800 Samuel Court
Tank#: 23 Install Date: Oct. 1996
Initial Inspection:
Area: O'Malley
Alarms Tested: Air 0 High Water g Battery Tested: Yes ❑ No ❑ N/A
(Please mak<-? sure alarrm is cyn "normal". iiot "mato',)
Does system have a septic tank ? No [ Yes ❑ (Recommend pumping tank every 2 years)
Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor?
Yes V Repaired ❑ Yes Z Repaired ❑ Strong ❑ Mild ❑ None g
Are all aerators functioning?
Yes R1 Replaced ❑
Any buildup of solids?
Yes [A No ❑
Pump float operating?
Yes 0 Replaced ❑
Filter cleaned?
Yes 0 N/A ❑
Alarm float functioning? Any buildup of solids?
Yes 9 Replaced ❑ Yes ❑ No 0
Discharge line condition:
Good [V] Replaced ❑
Comments: ltec(;nnri un(I pumping
Inspected By: ChrislAbi Date: 06/22/2022
Has emailing or mailing of form been requested?
{contact office to request...) Yes No C
3705 Arctic Blvd #313
6ZY LE laAnchorage AK 99503
s Email: crbioak@gmail.com
(907) 274-0314
1st Quarter Inspection Report 2022
Homeowner Info
Customer Name: Jim and Stephanie Peterson
Address: 6800 Samuel Court
Tank#: 23 Install Date: Oct. 1996
Area: O'Malley
Initial Inspection:
Alarms Tested: Air 0 High Water Battery Tested: Yes ❑ No ❑ N/A [V1
(Ploase rna)(B sure cll3rrri is c)i': "nor'rnal". not 1"Tlt.lLL' }
Does system have a septic tank ? No [ Yes ❑ (Recommend pumping tank every 2 years)
Are all aerators functioning?
Yes FV1 Replaced ❑
Clarification return system operating?
Yes FV1 Adjusted ❑
pH Reading:
(pH of 6-8 is ideal)
7,
Pump float operating?
Yes 0 Replaced ❑
Filter cleaned?
Yes [;71 N/A ❑
Dissolved Oxygen PPM
(2-5 is ideal)
,,
Alarm float functioning?
Yes [V1 Replaced ❑
Any buildup of solids?
Yes ❑ No
Any buildup of solids?
Yes ❑ No 0
Turbidity of discharge (in FTU)
(Under 35 FTU is considered compliant.)
4.01
Any buildup of solids?
Yes No[�
Discharge line condition:
Good ' Replaced ❑
Comments:
Has emailing or mailing of form been requested?
Inspected By: Chris/Abi Date: 03/28/2022 (contact office to request...} Yes1:1 No 5
3705 Arctic Blvd #313
_' Anchorage AK 99503
Email: crbioak@gmail.com
(907) 274-0314
4th Quarter Inspection Report2021
Homeowner Info
Customer Name: Jim and Stephanie Peterson Tank#: 23 Install Date: Oct. 1996
Address: 6800 Samuel Court Area O'Malley
Initial Inspection:
Alarms Tested: Air 0 High Water 0 Battery Tested: Yes ❑ No ❑ N/A
(Please rr)ake sere alarm is on "normal". not ")-n Litt-,"
Does system have a septic tank ? No [1 Yes ❑ (Recommend pumping tank every 2 years)
Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor?
Yes V Repaired ❑ Yes [A Repaired ❑ Strong ❑ Mild ❑ None 0
Inlet plumbing in working order?
Yes 0 Replaced ❑
Are all aerators functioning?
Yes [Vi Replaced ❑
Clarification return system operating?
Yes [V1 Adjusted ❑
pH Reading:
(pH of 6-8 is ideal)
7.1
Pump float operating?
Yes 0 Replaced ❑
Filter cleaned?
Yes [VI N/A ❑
System Inspection
Dissolved Oxygen PPM
(2-5 is ideal)
3, 1
Alarm float functioning?
Yes 1�1 Replaced ❑
Solids pillow normal?
Yes [V1 Requires Pumping
Any buildup of solids?
Yes ❑ No
Any buildup of solids?
Yes ❑ No V
Turbidity of discharge (in FTU)
(Under 35 FTU is considered compliant.)
7.04
Any buildup of solids?
Yes ❑ No g
Discharge line condition:
Good (�i Replaced ❑
Comments:
Chris/Abi Date: 11/02/2021 ecte
IRS d B :Has emailing or mailing of form been requested?
Inspected Y(contact office to request...) Yes No 1
3705 Arctic Blvd #313
laska Anchorage AK 99503
Email: crbioak@gmail.com
(907) 274-0314
3rd Quarter Inspection Report 2021
Homeowner Info
Customer Name: Jim and Stephanie Peterson
Address: 6800 Samuel Court
Tank #: 23 Install Date: Oct. 1996
Initial Inspection:
Area: O'Malley
Alarms Tested: Air [VI High Water A Battery Tested: Yes ❑ No ❑ N/A
(Please make sure alarm is on "normal not "mute"j
Does system have a septic tank ? No A Yes ❑ (Recommend pumping tank every 2 years)
Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor?
Yes 171 Repaired ❑ Yes Z Repaired ❑ Strong ❑ Mild ❑ None 0
Filter cleaned? Discharge line condition:
Yes [;4 N/A ❑ Good [�61- Replaced ❑
Comments:
Has emailing or mailing of form been requested?
Inspected $y: Chris/Abi Date: 09/17/2021 (contact office to request...) Yes No C
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
,~'..~ 0 7 HAA# ~
GENERAL INFORMATION
Complete legal description '
Location (site address or directions) ~',~oo _~¢/ (o,<r/
Property owner
Mailing address
Lending agency
Mailing address
6~8oo
~ I-I~cl~ell¢ I~o~J~ro,~ Day phone
Day phone
Agent Dg/-er,~ /~,l<y - '7 .S'/-~r' J~..al~ Day phone
Address
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well ~
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site ~
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 /='/~/-/o/~ T'~c,/~ £uc Phone
Address /Hs"-~ zE-C~o ~. /~,~c~,~r-~,~,~ //~/,-c ~5"/~
Engineer's signature '~7~'~ ~, ~ Date
DHHS SIGNATURE
__~ Approved for '~tL_ _
Disapproved,
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
Additional Comments
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 ANCHOI~GE
£NVIRON~ENTAL SERVICES DIVISION
Municipality of Anchorage i~0V 1 2, 199eat.~
DEPARTMENT OF HEALTH & HUMAN SERVICES J~ E C E i V
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Legal Description:
A. WELL DATA
Well type ~"~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Health Authority Approval Checklist
~'J~ r'"( ~"/9h~r ~/''f Parcel I.D.:
Y
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed I ~ / I '7 / E3 ~
6 I' Cased to d' I ' Casing height (above ground)
y' Wires properly protected (YfN)
FROM WELL LOG
I'll 17 I ,9 ~
t 2 . g.p.m.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform C7 C~ I //°O t~
AT INSPECTION
Nitrate q, O 7 mJ /-~ Other bacteria
High water alarm (YfN)
O. 0~ Total depth
Depression over field (y/N)
Date of sample: ~/?-q / 9( Collected by: [:flab~avl° T'ec/~
B. SEPTIC/HOLDING TANK DATA (_~ 'OaXc(~~
Date installed j t'/l'7/?ff Tank size 15"O0~qa t Number of Compartments q Cleanouts (y/N)
Foundation cleanout (YfN) T' Depression (y/N) N 'r'
Date of Pumping tV, ~. ~ N t,%~ Pumper H- A
C. ABSORPTION FIELD DATA
Date installed I0 / t 7 / c) t( __ Soil rating (g.p.d./ft2 or ft2/bdrm) ~,~ 'Y~_ System type
Length 1 9 Width ! ~ Gravel thickness below pipe
Effective absorption area 3 6' / t~' Monitoring Tube present(y/N) 'F
Date of adequacy test /V', 4, (_ r} e~ta} Results (Pass/Fail)
Fluid depth in absorption field before test (in.);
Fluid depth (ins.) Minutes later:
Peroxide treatment (past 12 months) (y/N)
For ¥ bedrooms
Immediately after gal. water added (in.):
Absorption rote = ~> 6'00 g.p.d.
If yes, give date b/. A,
De
LIFY STATION (._ ~,~c~,cl~-_)
Date installed I
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested to.
E. SEPARATION DISTANCES
Size in gallons i ,5-oo
"Pump on" level at* '2 g '/'~" "Pump off" level at*
*Datum ff loor of: vt,~; tt
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
; On adjacent lots Z> too '
Absorption field on lot
t ; On adjacent lots ~> too '
Public sewer main br. A. Public sewer manhole/cleanout b/. fl
Sewer/septic service line
Lift station I O~ '
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~-~' Property line ~ ' ~' Absorption field ~ ,Y '
Water main/service line ~> 2,,c' Surface water/drainage too ' Wells on adjacent lots ~> too '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 2 8' Property Line I ~ Water main/service line ~> 25-'
Sufface water ~ tOO'
Driveway, parking/vehicle storage area ~ '
Curtain drain /do,~ Seen Wells on adjacent lots ",> tO0 '
ENGINEER'S CERTIFICATION ~ ~ ... ec ~.~ ~ eo( I o t ,~ {9{
I certify that I have determined thrufield inspections and review of Municipal records that the above systems are
in conformance with MOA I-L4A guidelines in effect on this date.
Signature ~"'~,.-,~,~ ~.
Engineer's Name '7'% e_o dore
Date I I / t 5'" / ~ ff
HAA Fee $ ~ ~'0 ~
,at o aym n
Receipt Number ~---~ ~-~ ~/~ ~ ~
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL ~ALTR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Infot~mation Application Date ~ec ~ I~
(a) Legal Description (include lot, block, subdivision, section, township, range)
. C~.~,~h.-''' f-,re,-3_/~ L~'t ~- ~1o~ ~ r ~z i~ e.~ ..%.~_ z~
Location (address or directions)
(b). Applicants Name ~>~ ,"~ ~' -
a~ ~ \¢ Telephone Home Business
Applicants Address ~oo ~.~..~e ~ co~,. ~ ~.-~ ~ I~
(c) Applicaan_is (check.one) Le~i~ Institution ~ ; ~er/b~lder ~ ;
(d) Lending Institution
(e)~ddressReal gseate Co, & Age.~
(f)
Telephone
Telephone
2. Type of ~esidence
Single-FamilYF--~
Number of Bedrooms
Other (describe)
3. Water Supply
Individual Well~
CommuniCy~--~
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 sy~tem;-must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
LIT r-~ I c~,,-~,~,-~,,'~b~
5.. En~ineerin~ 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 Nuuictpality of Anchorage files and from my
inves~iga:ion and inspection, the om-si~e wa~er supply and/or wastewa~er disposal
system is in compliance with all Municipal and Sta~e codes, ordinances, and regula-
tions in effect on the date of :his inspection.
Telephone s-8~ ~'~ ~ o
Address
Date
DEEP Approval
Approved for
Approved ~
bedrooms
Disapproved
Terms of Conditional Approval
CAUTION
TEE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORII"f APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PA/~AGRAPH 5 A~OVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE D~EP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
M~NTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR A/~A/.YZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY 0F ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENCINEER'S WORK.
(DHEP SEAL)-
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
ae
Be
Well Classification
Well Log Present ~)
Legal Description: C,{,-,'~pA~..- /.~,~ ~,7~
If A, B, C~ C, D.E.C. Approved(Y/N)
Date Completed [~/7/~__ Yield
Total Depth ~ / "" Cased to
Static Water Level -~- Pump Set At
Casing Height Above Ground
Electrical Wiring in ConduitS)
Separation Distanoms frcm Well:
To Septic/Holdin(3 Tank on Lot /,
To Nearest Edge of Absc~ption Field on Lot
To Nearest Public Sewer Line
Depth of Grouting~)~ ~_~ ~
Sanitary Seal on Casing/_Y/N) Y
Depression Around Wellhead (Y~ /¥
; On Adjoining Lots
"~;~ On Adjoining Lots
To Nearest Public Sewer
Cleanout/Ma~J%ole ~z~ To Nearest Sewer Service Line on Lot
Water Sample Collected By ~t-~ ~g~)g~ ; Date /&/~
Water Sample Test Results _~-~~
' %3
SEPTIC/HOLDING TANK DATA
Date Installed ~ z~-~- Size IZ~o No. of Ccmpartments ~-
Standpipes ~/~) ~ Air-tight Caps ~/N) _% ~_FQundatioB~_C_le_a_n~out ~/N) ~
Depression over Tank (Y~ n) Date Last Pumped ~_____~_ --'~-,..~_~
Pumping/Maintenance Contract on File (Y/N) ~'3/~--; for ~J{~-
Holding Tank High-Water Alarm (Y/N) ~u'l Temporal; Holdin~ Tank Permit (Y/N)
Separation Distances frcm Septic/Holding Ta~R:
To Water-Supply Well /
To Property Line
To Water Mai~JSer~.~.ice Lir~
Course ( ~ o-+
To Buildin~ Foundation
To Disposal Field
To Stream, Pond, Lake,
Major Drainage
[Page 1 of 2]
Receipt ~
Date Paid:
Arno un t:
2-15-84
Soils Rating in Abso~pticn Strata
Date Installed 4~-~n--~-i~~
Width of Field ~"
Square Feet of Absc~ption A~ea
Depression over Field (Y~
Bssults of Last ~equacy Test
~ L7 ' Type of System Design
Length of Field 5- ~
Depth of Field /~
Gravel Bed Thickness ? ~'
Standpipes P~esent ~)
Date of Last Adequacy Test
Separation Distance f~cm Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major D~ainage Ccu~se /
To D~iveway, Parking A~ea, or Vehicle Storage A~ea
//o ~' To P~aperty Line f ~
~ / To Existing or Abandoned System cn
; On Adjoining Lots 3 ~
To Cutbank ( if present) ,,~4
D. LIFT STATION
Date
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Con~nts
Dimensions
Manhole (Y/N)
"Pump Of Level at
Vent (Y/N)
Pumping du~ing Adequacy Test. Meets MOA
/
Company ~$ /'~'~
KB1/d5/s
[Page 2 of 2]
2-15-84
DATE
A+Home .Services
15900 Francesca Drive
Anchorage, Alaska 99516
345-1890 · 276-7161
DESCRIPTION
PREVIOUS BA LANCE
'- ~,~' 'L~ ~-~:~,~.
BALANCE DUE [~
If this statement does not agree with your records p/ease notify us at once.
STATEMENT
pit. nlm~ 114
2820 "C" STREET, SUITE NO. 3
ANCHORAGE, ALASKA 99503
PHONE (907) 272-9231
LEGEND:
· 5/8 REBARSET
O 5/8 REBAR FOUND
[] 2"x 2" HUB & TACK SET
~ EXISTING ELEVS.
DATUM ASSUMED
D. ~. BY: ' i;'
CHKD:
G RID:
F . B . ~ ,~-b ., ,/-~
SCALE: il' 4
· =- /-'~
DATE: / ?,'''?~ '9D~-?
ENGINEERS
PLANNERS
SURVEYORS
tLANTECH .rtify tha, I have surveyed the pro.try shown and described hereon and that the
improvements situated thereon are within the property lines and no encroachments exist other than noted.
NOTE: It is the contractor's responsibility to check top of foundation in relation to finish grade and building setbacks in
relation to lot lines and easements.
LEGAL DESCRIPTION:
APPLIC NT FILLS OUT UPPER HAl, ONLY
Property Owner. ~r~'~. ~ - /'% I/z> / ~ ~/y Phone
Mailing Address ~/~ ~1 ~...)~~/~..~ ~ Zip Code
Lending Institution ~~ / ~A~ ~ '2~ ~ kA / Phone
Type of Resi~nce
Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
Individual Year Indiv~ual Installed: ~ ~ ~
Public ~ility When Connected to Public Uti~ty~ '~ --
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date__~D~tS c~ ~.~ -- ~'~_ '
Inspector Inspector Inspector Inspector
(~' APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAP~OVED
{ ) CONDITIONAL APPROVAL*
DATE ~ ~ ~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~
~/~ Well to Tank Septic T~k Size
72-023 (3/82)