HomeMy WebLinkAboutSUN VALLEY HEIGHTS BLK 3 LT 1Sun Valley
Heights...
Block
Lot 1
#017-062-39
DON LC)I.IVE:F~
&40 :t. DIZ AI::~HC)LJh{
~'ff,H::)l-[E)F4.'('ffBEil ~,
2'/6"' J,::!!;:2;
PERFORMED FOR:
LEGAL DESCRIPTION:
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BF. ,E, EPPS & PO'TS
ENGINEERING, PLANNING, SURVE-YING
SOILS LOG -- PERCOLATION TEST
DON LDUVdF< -OVVNEIZ.
~uN VA L/-~y
(,r','~L) p~',~ SILT
wi 'TF-ACE' oF ~AlVP ANP
SliT L.,J/TF-.AC.E'
OF
Township, Range, Section:
SLOPE:
WAS GROUND WATER NO
SITE PLAN
'T'EST HoLE
ENCOUNTERED? , SE
IF YES, AT WHAT --- O
DEPTH? _ __ ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
:Z .0" Z[I Z ~:IE 0:0o ~r'- 8.8:' o
3.0"/3,5' . 4:00 O:~5 4'-9" .~,,
2,9" . ~:50 1:3~ ~'-~,9" .~'
Z,~a ~/'l~ 3:1~ 0:00 ~- 2.2" 0
2.7" " 3:40 0:15 ~'-a,q" ,5"
3.0. ,, ~:00 O:45 6'-3" , ,5,'
5.~,,/1.7,' ,, 4:15 I ~o0 %'- z,2' .~,,
2,~" ,' 4:40 I '.Z~ 8'-~,%" .5"
2,'5" ,, 4:50 1:3~ ~'- 2.~" , I"
COMMENTS
F~O~ 5G 7'0 &O m/td PEP. INCH. A~.<~O,~P'T'IONI FIE&.D ~FFECTIU~ BELOW
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OATE.
PERCOLATION RATE ~) ' '
(mmutes~mchl PERC HOLE DIAMETER
TEST RUN 13ETWEEN ~) FT AND -- <~ _FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
°ATE.
RE. ,R ANCHORAGE AREA BO[ .GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
·
D,STANCE . //~,r ~t'-/'"~':~ ,.,,.~/ ,o/,,~>,,'.~, :"/ ~ 4 NUMBER OE
FROM WELL/'~4'¢~ MANUFACTURE~[! :~ .' '/ MATERIAL ,/'7~'/-.-~' ._~ COMPARTMENTS~____
INSIDE LENGTH_ INSIDE WIDTH LIQUID DEPTH LIQUID CAPAC:ITY~/~)_ GALLONS.
TILE [)RAIN FIELD:
TOTAL LENGTI
O,ST^NCE FROM WELL POUNDAT,ON~-? NEAREST LOT L,NE 2~ /"/' OF L.,NES
NUMBER OF LINES ~- DISTANCE BETWEEN LINES .... 'FRENCH WIDTFI-~'~IN. TOTAL EFFECTIVE
A~SORPT,ON AREA_~ ~ '~ S~. FT. LENG~, OF EACH L,NE
DEPTH: TOP OF TILE TO FINISH GRADE*~g2 I! [DEPTH OF FILTER
MATERIAL BENEATFI TILF/~ ~2 .IN. ABOVE TILE ~' IN.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL ._
APPROVED _
CONST RUCTION
NEAREST NEAREST
LOT LINE SEWER LINE
OTIIER SOU RCES __
DISAPPROVED ____REMARKS
DEPTH __
SEPTIC SEEPAGE
TANK____ SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY:~
SEWER LINE DEPTH:
PIPE MATERIAL.
LOT SLOPE:
REMARKS:
Form EQ-032
DIAGRAM OF SYSTEM
GRE~ ;R ANCHORAGE AREA BO[ JGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "DII STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4551
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.-
[NSTALL~ATION LOCATION
,¢/,,'z:'/A,'/<, ?.z¢.'-,, ,/
7]'
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT DRAIN FIELD
TYPE AND SIZE OF FACILITY TO BE SERVED
FINA'~CEO TNROUG" .'
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION bY THE
DEPARTMENT OF ENVIRONMENTAl-. QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIt , DRA~N FIELD
/ ~ ~ f~ ~ f ~,~ ~ ~-e./~
SEPTIC TANK TO SEEPAge PIT WALL/~ ~l~ ~'
SEPTIC TANK __, SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC 'raNk
DRAIN FIELD-~Z~
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, ~.?' ~, SEEPAGE PiT
TO RIVER, LAKE, STREAM.
SEEPAGE PIt
SEEPAGE AREA SIZE
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPT[C: TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHt REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
DIAGRAM OF' SYSTE~
I CERTIFY THAT I AM FAMILIAR With THE REQUIREMENTS OF GREATER ANCHORAGE A~ "-A BOP UGH ORDINANCE
.~ NO. 28-68 AND THAT THE ABOVE
', ~ r ~ ,~ - ,:"'//'
T.H. No, 1
5-13-75
0.0~
SILTY SAND ,,.;/Some Gravel
SILTY SAND w/Trace Gravel
SILT, Trace to Some Sand
(~m)
7.0~
9.0 '
SILTY SANDS w/Trace Grave].
13.0'
SILT, Trace to Some Sand (ML)
No water Table
20.0' T.D.
NOTE: Test hole extended with auger-
type drilling unit.
Log Represents
Lot 1 Block 3
Sun Valley Heights Subdivision
f% Engineerin~.l 8, Geological Consultants Inc.
'~ ANCHORA(~E FAIRDANK$ ALASKA JUNEAU
Sebring Builders
Log of Test Boring
Anchorage, Alaska
TEST ON_
Insitu Material
LABORA'TORY TEST REPORT
PROJECT NO.
SAMPLED FROM
Lot
SOURCE.
PROJECT NAME_ Sebring Builders
Test Hole NO. 1 _SUBMITTED BY Jackson
Block 3 Sun Valley Heights Subdivision
LOCATION
GRAIN SIZE DISTRIBUTION
SIEVE
#G
DELETERIOUS MATERIAL
Anchorage, Alaska
% +1o
% GRAVEL
°/e SAND
o/o SILT
%CLAY
FGV
LE
PL
CLASS
DEPTH. 5-7' ,, DATE SAMPLED 5-13-75
CLASSIFICATION
UNIFIED AASHO
SM
REMARKS
Classification
Based on
Gradation
FAA
STATIC IMMERSION
'COARSE SPEC FINE SPEC
ORGANIC COLOR
R~M PROJECT NO, 562023
LAB NO 75A-755
FIELD NO,--1
DATE REPORTED 5-~5-75
5-13-75
DATE RECEIVED
COMPACTION
F~ Englne~dng (,~ (3~ologlcol
May 15, 1975
RaM No. 562023
Sebring Builders
Box 1540 C Star Rt. A
Anchorage, Alaska
RE: Test Hole and Soil Log Report for Sanitary System
Lot 1, Block 3, Sun Valley }{eights Sutxlivision
Dear Mr. Sebring:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This
inw~shigation was performed in accordance with your request of May 12,
1975, and those procedures outlined in a letter dated December ].9, 1974,
by ~,~. Itolf Strlckland of the Greater ~mchorage !~ea Borough Department
of Environmental Quality.
A single test hole was put dov~ within the Lot 1 area for the purpose
of defining genera[[ subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with an auger type drilling rig
and the test hole was extended to a total depth of 20.0 feet below
ground surface. One sample was recovered from the test hole and retained{
for grain size analysis. The results of this sa~le are enclosed. The
final log prepared for the test hole has been included in Drawing A-01.
Ground water was not encou~ltered in tile test hole.
We appreciate being giveu this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate -to contact us.
Very tru[Ly yours,
R & M CONSULTANTS, INC.
Vice-President
m~R/sc
Encl.
~e; GAAt~
February 23, 1987
Mr. Steve Morris
Department of Health and
Environmental Protection
825 "L" Street
Anchorage, AK 99501
MUNIcIp/~LIrI' O~ /.tvf,~O~,AG~
P'£CEIVED
Re: Septic System Expansion
Sun Valley Heights, Lot 1, Block 3
Dear Mr. Morris:
Per our telephone discussion, attached is a revised permit
application reflecting the use of the adjusted soils rating
and definition of the replacement site.
Several safety factors are now incorporated into ~le design.
The adjusted soils rating contains a 50% safety factor. The
existing field has 50 square feet of additional area over that
required for the original three-bedroom design. The first
1 1/2 feet of sidewall area below the perforated pipe is not
considered effective in the design even though some absorption
can be expected. In addition to these factors, the existing
system accepted 450 gallons of water in less than 3 hours.
The evaluation of replacement site requirements was made easy
by the fact that the lot is over 60,000 square feet. The
attached copy of the plot plan shows the area (3,000 SF x 4
bedrooms) set aside for the on-site disposal of wastewater.
This should allow for issuing of the construction permit.
Very truly yours,
, PE
smh
Attachments
ENGINEERING, PLANNING, SURVEYING
2220 E. 88th Ave,/Anchorage, Alaska 99507/Telephone 907-349-6451/344-1352
"Providing a quality personalized service to those building Alaska's future"
0
"OETAIL"
S
J I
ORIGINAL ASI~ILT 15 JUL 75
HUB & TACK {HT) [] FOUND JSET
SPIKE or PK (SP-PK ~FOUND XSET
~OD FENCE ~
GLOB AL ENTERPEISES
PO BOX 112207
ANCHORAGE~ ALASKA 99518
(907) 349- 5552
RON PIPE (IP) · FOUND ~SETIbRASS CAP
IRON REBAR (IR) IOFCXJND eSET-J~UMINUM CAP(AC) I(:~FOUND.~_... ,~--(~'~
~'~'~ RVEY TYPE
I .LOC.I '
GRID Z~NING ~ ~'~ ..... i ~'~'~ ~['"
~o I "~ I I , ....
J'HEREBY CERTIFY THAT THE PROPERTY D~SCRIBED HEREON HAS BEEN
SURVEYED BY HE, OR AT ~Y DIRECTION, AND THAT THE IHPROVE~ENTS
SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT OVER-
LAP OR ENCROACH ON THE PROPERTY LYING ADJACENT THERETO UNLESS
OTHERWISE SHOHN, THAT NO IHPROVE~ENTS ON THE PROPERTY LYING
ADJACENT THERETO ENCROACH ON THE PREMISES IN QUESTION AND THAT
THERE ARE NO ROADNAYS TRAN~ISSION LINES OR OTHER EASEHENT$
~klg PROPERTY EXCEPT AS SHOWN,
T IS THE RESPONSIBILITY OF THE OWNER OR BUlmER, PRIOR TO
CONSTRUCTION~ TO VERIFY PROPOSED BUI~IN6 GRADE RELATIVE TO
FINISH GR~ AND UTILITY CONNECTIONS AND TO DETERHINE THE EXIS-
TENCE OF ANY EASEHENTS, COVENANTS, OR RESTRICTIONS,WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION P~T,
LISTED DISTAHCES PREVAIL OVER SCALING, REPRODUCTION ~Y CAUSE
DISTORTION,
DEEP TRENCH DESIGN
TRENCH DIMENSIONS REQUIRED: WIDE
SCREENED ROCK DEPTH
LENGTH
PROPOSED TRENCH DIMENSIONS: WIDE
SCREENED ROCK DEPTH '~J~
LENGTH -- '~./~-~ -~- '~ ;h:~,~ ~ .... ,~
COVFR - ~L~i ~::~ ~"-/~,~-/
EFFEC'rWE AREA OF PROPOSED TRENCH; ~ ~F:
COVER
OTAI.
DEPTH
TRENCH SECTION:
4' PVC WITH
BARRIER
4" DRAINFIELD PIPE
- SCREENED ROCK
STANDPIPE DETAIL:
STANDPIPES TOTAL
i
TO BE CONNECTED
AS SHOWN ON LEFT
NOT TO BE CONNECTED AS
SHOWN IN TRENCH SECTION
PER M.O.A. HEALTH DEPT. STANDARDS
0RD. 15.65
\ Municipality of Anchorage
• Development Services Department ,•'��
Building Safely Division
On -Site Water and Wastewater Program '
4700 South Bragaw St. `
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Rg15svE
Parcel I.D. O 17 — O 62 - 3 q HAA # OS OG -7S-"
Expiration Date: 1 O — % $ — 0.5'
1. GENERAL INFORMATION
Complete legal description !- 1, 3 31 Sun (/a ll f '4e rQ h fr S/6
Location (site address or directions) Xy,4t Doe e - " / 13 321 Etc, e-0 / Lome
Current Property owner(s)f'[o�yn Dayphone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
i4et. 4/
Individual Water Storage
Dayphone 2S7 -o°/34,
!lo 1v
3b f" Ave-
7F 15�
AncAonyf. ht-_ 99.s'03
Unless otherwise requested, HAA wX be held by DSD for pickup. P f ewe cell Ria (/cr@ 2s -o y30
2. NUMBER OF BEDROOMS: I,r WA"[n 1411-/} r[naCs�cr/ i/ r®nary
—f— tjf"�
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site Q
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances,
and regulations In effect at the time of Installation. Alecu u,,,& >+-rrf r --I .11r ;�ru � ,
rccarpf �.rr,d�d J&� f0?ecvcr/.
Name of Firm F la flLn TOcAA, r 1 Sucr Phone 3H.5-- /? 6-r
Address I `yam fO rch? -57A Arc ha'-=
Engineer's Printed Name Ttiaa e4o-r• F. LfcQ•r Date JL k Zoo
00
��TH �'S J iyr.2r
5. DSD SIGNATURE v " -"""
sq ;n�eo�e F. uooae
i •. CE -3599
le-111Approvedfor � bedrooms. "t11•*a'�,..'•., -�/os_.•''.
Disapproved.,; ;ry
Conditional approval for bedrooms, with the following
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: QZ& ✓ [.t/. Original Certificate Date: % -
(Rw.,mo)
07-13-05;07:21 ; ;507 561 5301 a 4/ 6
SGSICT3E ENVIRONMENTAL SERVICES.
Drinking Water Analysis Report for Total Coliform Bacteria
READ INSTRUCTIONS ON Rran3a SINE BEFORE COU.ECMG SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER
❑ PUBUC WATER SYSTEM 09
gJ PRIVATE WATER SYSftM
® SwW R..Ma
❑ Send MNOY..
�F/.riT6
ft red
;
IMN Fw.t.1
3 YS- t3 s
Y IY.N1
3Ys'- rJS
r�c, t%
MMOUVO LINA) RESULTS:
ID&tsfflrw--
ANC FBK JUN
SAMPLE COLLECTION:
N �.. w..\ ......+N►+w >•.n M.nM. X11...
Dau: O 7 09. 0
01w AJ Y. '
Collector.
❑ SSW Rwas
SAMPLE TYPE: .
Trwpolud ,l ' 7 .\
td Lab BY• D Same as collector Other
TO BE COMPLETED BY LABORATORY ,
Samolt Receiving' �.�•
Date: Z�S-`�� ❑samP.ew]o11aVHva;
Rruas rnty W uusatoN
Time: -173;
Temp: 9--1P ❑ae
Derivery Method: CA
Received By
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tet: 9177.582.2343
Fax: 907-5815301
..« —...
101511''311f�IlIy�Iy��(I1''976
1�41�IWIWI�l�l4t�
astnd Involot
® Routine ❑ Treated Water
C3 Repeat Sample 12 Untreated Water
(refer to lab.no 1
❑ Special Purpose
❑ RUSH SAMPLE
Phone t
Fax t
Comntn4OF
.....................................................................................:....................................:...................
Bacteriological Water An0IXjls RocoM
30M IDACEe:
MMOUVO LINA) RESULTS:
ID&tsfflrw--
ANC FBK JUN
Andytit Btaan: i/ /� ?*AD _
Tow Coiarm:
�.F --
Analyst
E.CoR
Sam to Client
AnaryUcal MtlTod:
MEMBRANE FILTER RESULTS:
Phoned Q Faxed EJ
DWGcount caimwaloamL
Dstarll nu:
9= Membrane Filter
Yorvr+Cae ��7 ��
Spoke NM:
MMO•MUG (PIA)
,..rr..
LTB
LeGalet
sfactory
p Unsatisfactory
1MC.TN M..rww NCwMI
/J
Reported By "
\Waell
Deteriune• 7�"� �• �
�3 % w
form i F4P-0053 17/17103
07-13-05:07:21 ; ;607 561 5301 # 2/ 6
SCS RcfJt 1053976001 All Datunimes are Alaska Standard Tlmo
Client Name Flattop Technical Srv. Printed Datelrlme 07/122005 12:29
ProjeetNameN Various CollectedDate/ilme 07/052005 11:10
Client Sample ID Lot 1, Blo6k 3, Sun Valley Flts Received Darelrime 07/052005 13:12
Matrix Drinking Water Teehalcal Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
hametcr ResWiz PQL Units MOW Container ID Limtu Date Date Wt
Waters Department
NitotcN 1.44 0.100 mWI EPA 300.0 B (�Io) 07/07/05 JrM
Microbiology Laboratory
Total Coliform 0
coV100mL SM2092228
A (<- 1) 07/05/05 TLF
JU1.=11-2005 07:54A FROM:A+ HOME SERVICES, IN 907-868-6770
ThwOMin NLlS CUSTLY'yrMw4r,NMtf IwWWOA/ Ntw .c N,wwµn NYM:. w,�wp wn
TO
NORTHLAND PUMPING SERVICE, INC.
Your Professional Septic Pumping Service Company
7501 E. 140th Avenue
ANCHORAGE, ALASKA 99516
(907) 3447146 FAX (907) 868-6770
Charles I.a imce
do Re/Max Properties
KMS
Fax
6104
Tart
70:3451355 P:1'1
M 4. 4 newM
July 7, 2005
THANK YOU
INVOICE',;
•
$100.00
Municipality of Anchorage
-- Development Services Department
Building Safety Division
On -Site Water and Wastewater Program ; • •„
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL.
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0I-4-0(4;1-39 HAA# t5
Expiration Date: L -30-0E
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) % t33t11 1pyop- (, 1.A�
Current Property owner(s) GcorAa Norko,% Day phone SSZ - 9113
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
C4,arku LnwocencQ Day phone 2S':�-04AO
Unless otherwise requested, HAA will be held by DSD for pickup. ,
2. NUMBER OF BEDROOMS:
LII,
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal afraed hereto and as of the.validation date shown below. I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm SQwiL,and �ncintert..s
Address Z03 w I Silk 2o3�A-c►.ore+T Ak 99501
Engineer's Printed Name Tob6 S xacl and
5. DSD SIGNATURE
Approved for �_ bedrooms.
Disapproved.
Phone 279-391fo '
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
oe
By: Original Certificate Date: 3 — 3 0- Q
(Rev. QIM2)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 9951946650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L 1 B 3 Sw. \14hi. N i S Parcel ID: 011-047--3q
A. WELL DATA
Well type YL'LgAc If A. B, or C provide PWSID #= Well Log (Y/N)
Date completed -M.5; Sanitary seal (Y/N) Y Wires properly protected (Y/N) y
Total depth 191 fL Cased to > y0 ft. Casing height (above ground) :3 n.
FROM WELL LOG AT INSPECTION
Date of test — 1 1 li 1 -zoos
Static water level ft. 191 ft.
Well production —' 9.p -m. 5 9 -P.M.
WATER SAMPLE RESULTS:
Coliform __I( colonies/100 ml. Nitrate 1.116 mg n. Other bacteria _ colonies/100 mi.
c
Arsenic: 5 m1g/1' Date of sample: /i 2ao5 Collected by. Lars
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SW I 6ria. Date installed Y19.18-4.
Tank size 1250 gal. Number of Compartments 2 Cleanouls (YM) v
Foundation cleanout (YIN) Depression over tank (Y/N) Ivt High water alarm (YIN)
Date of pumping 412 5*4 Pumper /1/A(,)
C. ABSORPTION FIELD DATA
1,134-15
Date installed i4al, Soil rating (g.p.d.M2 or felbdrm) 0_45 System type Dftp -rm
Length 40 + ly 35.5 ft. Width 2411 ft. Gravel below pipe to i 4.S ft.
7�0+ z
Total depth 14.S ft. Eff. absorption area Sib fi Monitoring tube Depression over field �L
Date of adequacy test I'll-tiloas I'll—tiResults (Pass/Fail) PAs s For -y— bedrooms
Fluid depth in absorption field before test (6_. Water added gal. New depth added -(PD 56. in.
65,
Elapsed Time: IgDQ_ min. Final fluid depth,_ In. Absorption rate >= 6k0 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) /1% If yes, give date —"
D. LIFT STATION
Dateinstalled Size in gallons00� Manhole/Access (YIN)
`Pump on- to at _ in. 'Pump 011' level _ In. High water alarm lev in.
Detu Cycles Meets alarm 8 ' uft requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot t too,
Absorption field on lot I III
Public sewer main NIA
Sewer /septic service line 7 so
On adjacent lots '>1 50 1
On adjacent lots
? ISO,
Public sewer manhole/cleanout NJA
Holding tank dA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
t
Building foundation 19 r Properly line 710 r Absorption field 22
Water main A11A Water service line >50 , Surface water Nr o
Wells on adjacent lots � 150 r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 710 Budding foundation 4(o Water main /—VIA
r
Water Service line '150 Surface water N/0 Driveway. parkirglvehicle storage ')'10 r
Curtain drain N. 0. Wells on adjacent lots % Ipp t
F. COMMENTS
* x 99,41, r.. meacesi oui6ae, ec,.
G. ENGINEER'S CERTIFICATION
k C.O.
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineers Printed Name To66a.. ��}yrRAend
Date 3-i- DS
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12101)
Waiver Fee 5
Date of Payment
Receipt Number
...
.f�
i!
�.lrwrt te+wi 'v1�
4�
rrzna..,
01 -OF -05 C4:34PU FROU-CTIE ESI, SCS EIV SERVICES BCTS615201
SGSICT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform Bacteria
READ Nsmucri Na CN REVERSE am EII'm Co"EcTmo $Mau
MUST BE COMPLETED BY WATER SUPPLIER
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ANCHORAGE, ALASKA 09618
Tel: 907-M-2343
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TO BE COMPLETED BY LABORATORY
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Reported By:
sw +•
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£JO £ 05ed
Kotula by ICY/KS 01119,05 0129105 SCL
Arsenic
3.00 U 5.00 uWL EP200.0
Wates Dopartnunt
1.60 0.100 mt/L. EPA 300.0 13 («10) 01/1Y05 )CIN
N were -`J
tfiarobiology Laboratory 011111/03 DKC
Total Coliform
0 mUl001nL SM2092228 A (<"1)
02-07-05
C4:34PU FR0l4CTtE ESI, SCS EOV SERVICES
BUT5615301 T-034
P.02/06 F-31`4
SGSL
All Dgleeffbner are A4eta Standard Time
SCS Ret#
1050322001
Printed DateRtme
02/07/2005 1438
Client Name
Tobben SpurYland P.E.
Collected Da
01/17/2005 17:00
Project Name'#
Lt I H3 Sun Valley HIS
D ITIxicmme
5 1e
Client Sample 1D
Lt 1 H3 Slat Valley Hu _
Technic Director
TaeYnkdDinetcr
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i
Allowable Piet) Amlysu nit
pawnder
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Arsenic
3.00 U 5.00 uWL EP200.0
Wates Dopartnunt
1.60 0.100 mt/L. EPA 300.0 13 («10) 01/1Y05 )CIN
N were -`J
tfiarobiology Laboratory 011111/03 DKC
Total Coliform
0 mUl001nL SM2092228 A (<"1)
Municipality of Anchorage �.•
L` P.O. Ik)x 196650 ° Anchorage, Alaska 99.519.6650 ° Telcphonc (907) 343.8301 ° Fax M) 3338200
4700 aragaw Street e Anchorage, Alaska 99.507 '
Mayor Mark Begich "w-muni
.org
Building Safcty Division
March 30, 2005
Tobben Spurkland
Tobben Spurkland Engineering
203 W 15th Ave, Suite 203
Anchorage, AK 99501
Subject: Waiver Request for Sun Valley Heights Block 3 Lot 1
Waiver Request #WR 050015
Parcel ID # 017-062-39
HAA050075 —
Dear Tobben Spurkland:
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to private well has been approved. The approved separation distance is 97.0
feet
This waiver approval applies to the existing septic tank to private well separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
givil
lgineer
On -Site Water & Wastewater Program
-• Conlnuality, Security, Prosperity
Municipality of Anchorage
Development Services Department
• " Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:050015 PID#:O17-062-39 HA/Permit# haa050O75
Date Received: March 30, 2005
Legal Description: Sun Valley Heights Block 3 Lot 1
Engineer:
Tobben Spurkland
Tobben Spurkland Engineering
203 W 15th Ave, Suite 203
Anchorage, AK 99501
Applicant: George Horton
Waiver Requested: 97 foot horizontal separation from well to septic tank
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
-?. y7-
3 -C,
3•ti 1
2.15'
7-tJ
74B
Waiver Is Granted: L/ Waiver is not Granted:
List Conditions or Reasons for above:
Date: 7ho JOE By: ,:rtaE
—Name of Reviewer
Rec#: 153351 Amount $= Date Paid: 313012005
State of Alaska:
Separation Distance Waiver Guidelines for S.C.R.O.
(State of Alaska Memorandum to District Office Engineers dated January 3, 1985)
Waiver Request for. Sun Valley Heights Block 3 Lot 1
Parcel I D#: 017-062-39
Waiver Request Number. 050015
Waiver Requested: 97 foot horizontal separation from well to septic tank
IIAA050075
Seatic Tank
The septic trench and tank were originally installed in 1975 and then in 1987 the tank was
replaced with a new 1250 gallon septic tank and the trench was upgraded with some
additional length. The septic system configuration with the respect to the well hasn't
changed since 1975 with the exception that the tank was installed too close to the existing
well. the tank installed in 1987 was installed with an encroachment to the well of 97 feet.
Well Data
There is no well log in our records or provided by the engineer. However the are some
well logs submitted and used to estimate the depth of the well and the type of soil layers.
The well on the subject lot was tested and found to have 191 feet to static water. The
water sample results show the well to have 0 - Other Bacteria, 1.6 - Nitrates, and 0 -
Coliform
State of Alaska:
Separation Distance Waiver Guidelines for S.C.R.O.
(State of Alaska Memorandum to District Office Engineers dated January 3, 1985)
Waiver Request for. Sun Valley Heights Block 3 Lot 1
Parcel ID#: 017-062-39 j
Waiver Request Number. 050015 H:\WaNcr\Bcok2.x1s
Waiver Requested: 97 foot horizontal separation from well to septic tank
11AA050075
WaterTable
Points
18.3r
Depth of well:
191
7A293
Depth of septic system:
10
181
Distance from the bottom
Point
of the system to the highest
value
water table in feet
0
0
6
1
17
2
24
3
30
4
40
5
65
6
100
7
290
8
1000
9
10
Straight line Interpolation Is permitted between any two values
Soil Sorbtion
Points
».3r
3.911
7
0
+
18
1.5
+ 17 0
+ 81.5
Soil Type Point Value
Clean Gravel
0
191
191
191
11911
Fractured Rock
1
Course Clean Sand
1.5
45
6
+
7
0
+
73
6
+r
16
0
Sand w/ Small Amt of Clay
2.5
191
191
191
l 191,
Silt
3.5
Clay -and Sand Equal
4.5
0.00
+ 0.14
+ 0.00
+ 0.06
Clay
6
+1.41
+ 0.00
+ 2.29
+ 0.00
*Use the predominant soil type but values can be averaged for a mixture
Permeability
Soil T e
Point Valu
Clay(will channel)
0
Silt and Sandy Clay
2
Clayey Sand
3
Fine Sand
1.5
Sandy Gravel
1
Fractured Rock
0.9
Course Sand (30 grit)
0.4
Clean Gravel
0
Points «.,,
2.154
l 191 1 + 19 j .4 +I 191f 17 , 1 + (T_ 191 1.4
+( 45 91,3 191,1 +;913 +f91 i 1611
0.04 + 0.04 + 0.09 + 0.02
+0.71 + 0.04 + 1.15 + 0.08
*Use the predominant soil type but values can be averaged for a mixture
Gradient Points
2 2.0
% Slope
Point
Points Value
-60%
0
-30%
0.3
-20%
0.7
-10%
1.2
-5%
2
0%
2.9
5%
4.5
10%
6
60%
7
`If the gradient is unknown, assume the worst case
Horizontal I Points «„
97 2.88
Horizontal
Point
Separation
Value
In Feet
0•
0
25
0.7
50
1
75
2
100
3.
150
5
200
6
300
7
*Linear Interpolation between two point value Is acceptable. Horizontally means
straight line distance to the well not the contaminate travel distance to water table
which may be greater.
Conclusion: Grant Waiver . Total Points: 18.374
Municipality of Anchorage
Building Safety Division
On -Site Water & Wastewater Program
Field Audit Report
Eta
Date: 3/3y- Le r— Time: i'7o 412.7 Document Type: WAJ VF rz RE Q✓BSTT
Legal Description: Sva 1/a11eV 14eiiHm 13Lock 7 LcT
Site Address: I33yI orkVrAt- L.AA1E
Enginccr/Firm: % L_4 �, k-IdArj LJO Excavator:
Inspection Findings: 'TyY
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I
mail
Environmental Consulting and Design
ti
March 23, 2005
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw St.
Anchorage, Alaska 99516
Subject: WAVIER REQUEST
LOT 1 BLOCK 3 SUN VALLEY HEIGHTS
PID 017-062-39
Gentlemen;
We are applying for a waiver of the separation distances required between the septic tank and the well serving this
lot.
An As Built Survey shows that the separation distance between the septic tank and the well on lot 1 is approximately
97.5 feet.
t47�
The septic system and well were installed in 4@W. In 1987, the septic system was upgraded. A new 1250 gal steel
tank was installed and an additional 35.5 feet of trench was added to the system. On January 17i4 2005 the tank and
adsorption trench were inspected. During this inspection it was noted that the liquid level in the tank was 48 inches.
A soil log for Lot I Block 3 Sun Valley Heights show dense silt with trace of sand and gravel, between I and 6 feet
and silt with a trace of sand from 6 to 18 feet. The percolation rate is recorded as 60 minute/inch.
No well log is available for the well serving Sun Valley heights L I B 3. It is assumed that it was installed at the
same time as the septic system in 1975. During the well and septic test conducted January 17' , 2005 the static water
level was 191 feet below the top of the casing. A document search for well logs on the neighboring lots indicate the
following soil layers; sandy gravel, sand, sandy clay, gravely hard pan, and silty gravel.
Waiver Request: 97 feet from septic tank to well.
Attached are soil analyses for Sun Valley Heights L I B 3, neighboring well logs, and the method used to determine
the ADEC point's value.
�. 3/aslos
195 1 Jt�m
203 West 15" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gcLnet
Spurkland Engineering
Environmental Consulting and Design
REF.: "ADEC Separation distance wavier guidelines."
Water Table
Depth of well
Total depth of septic tank -10
191 feet
feet
181 feet
Soil Sorntion
Soil descriptions from well log for adjacent property (Sun Valley Heights L 2&3 B 2 South)
Sandy Gravel
0-7 feet
7 feet
Sand
7-25 feet
18 feet
Sandy Gravel
2542 feet
17 feet
Sand
42-50 feet
8 feet
Gravelly Hard Pan
50-95 feet
45 feet
Sandy Gravel
95-102 feet
7 feet
Gravelly Hard Pan
102-175 feet
73 feet
Silty Gravel
175-185 feet
10 feet
Medium Gravel
185-189 feet
4 feet
Silty Gravel
189-191 feet
2 feet
(7/191.0)+(18/191.1.5)+(17/191*0)+(81191*1.5)+(45/191•6)+(7/191*0)
+(73/191'6)+(16/191'0)
Permeability
Soil descriptions from well log for adjacent property (Sun Valley heights L 2&3 B 2 South)
Sandy Gravel
0-7 feet
7 feet
Sand
7-25 feet
I8 feet
Sandy Gravel
2542 feet
17 feet
Sand
42-50 feet
8 feet
Gravelly Hard Pan
50-95 feet
45 feet
Sandy Gravel
95-102 feet
7feet
Gravelly Ilard Pan
102-175 feet
73 feet
Silty Gravel
175-185 feet
10 feet
Medium Gravel
185-189 feet
4 feet
Silty Gravel
189-191 feet
2 feet
(7/191.1)+(18/191'0.4)+(17/191*1)+(8/191.0.4)+(45/191.3)+(7/191.1)
+(73/191*3}+(16/191.1)
Water Table Gradient
Subject property generally slopes from septic tank toward well 0-5 %
Assume -5% Slope
Points
7.4
3.9
2.2
2.0
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gei.net
Environmental Consulting and Design
*4
Horizontal Separation
97 feet between well and septic tank on subject property
0.88 = x-2
2.9
Total Points 18.4
Special Considerations:
Total coliform and other bacteria were not detected for the water sample collected from the well on the subject lot.
A nitrate result of 1.6 mg/I was reported for the water sample collected from the well on the subject lot. This is well
below the required standard.
A horizontal separation distance of 97 should provide adequate protection against the possibility of water
contamination due to septic system overflow.
As per ADEC waiver guideline a point value of 18.4 is almost sure to be free from any form of contamination from
household sewage.
At this time we are applying for an On Site System Approval, and request that a formal waiver be granted.
Sincerely,
Tobben Spurkland
203 West 15° Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gci.net
I'::::11:::•s, Inc.
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Size of casiar b—.Dzjlth of Hole t M1 feet Cased to 1S1 feet A'(t
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63177 ,
' L
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c0GiT10N1 go %T �Q9t v
Size of Carirg G Depth of Nolo 11t�fe_et. lased to r 4 3 �
Static water level r x.; fest (above) lar) land surface. Finish of 16a1 Sfo'CQ
(check one) Ogen and ( ): Screen ): Perforated ( ). W of!
Describo screen or perforaticns:lot) 131F7' )ePs.r`: N . "
Nell puaping test at laz allons p:rr illi) or _ ours With
yp 1 feet of drantlorn from statrc level.
Rermrks 'r^r Cr9' ia5 w t..l O•r 4'.=rrcc Or F-orr-,'
DZ:a cC-?3ctcd Allr/-yr DELL LOG
. ----
IDcptF. in £:.•.: from Circ w:tails o: formations penetrated, size of rester a ,
grct^d :•^fee: colcr, and hardness.
/ to /I ZxKs • I'� L.►_ vawJ r �gnw • it to as f4AO PAN
!11 to 1� a Coy J l/ '
135 to
to yv w: �.,a� 14A AV AOM
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4.
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ENG:N^t//SRNGf, FLAP 1i4:Na SUHVC 9JG
SOILS LOG — PERCOLATION TEST
PERFORMED AOR: CoN LDUVEK—OWiFlF1Z
Lar I 0 MIK 3
DATE RP•'�n0E0
LEGAL CESCRIMON: 50" 'VALLEY FiGj+Ts Township. Range. Section.
SLOPE SITE PLAN
T ►i.T>, Fieo�ENTOP5��/L�0�4Ar�/CS �� _ ,-
. (rilL) DOVSE SX7
W7 TRACE OF SgNDAND
57HE GRAVEL
BOULDERS TO 12 CYA.
rl 1
rdlD MOLE
C7
NASOROU"DWATER NO
ENCOUWIREOI
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DATE RP•'�n0E0
LEGAL CESCRIMON: 50" 'VALLEY FiGj+Ts Township. Range. Section.
SLOPE SITE PLAN
T ►i.T>, Fieo�ENTOP5��/L�0�4Ar�/CS �� _ ,-
. (rilL) DOVSE SX7
W7 TRACE OF SgNDAND
57HE GRAVEL
BOULDERS TO 12 CYA.
rl 1
rdlD MOLE
C7
NASOROU"DWATER NO
ENCOUWIREOI
IP YES. AT NMAT
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►ERCOLAnONRATE (00
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A:f.�np•allM••. All S•I11 Aaf•.,.,rr•�fl.•f 11 •.r :n11rRC'f. ••?..S CAT[ CAT(
;r;
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 AUTFtORITY
APPROVAL FOR A SINGLE FAMILY [:)WELLING
Parcel I,D.# 01"7- ~)~,. ,¢0.._ ~ff
HAA #
1. GENEFIAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Day phone
Address
Day phone
Day phone _¢/0 --
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Unless otherwise requested, HAA will be held for pickup.
NOTE:
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
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm "-'~ ~',~1. --~d ¢~',-~¢L~,L¢,~/
Address ~ ',~ ~ I ~ ~ ~
Phone
DHHS SIGNATURE
Approved-for ~--z~_~ ~.~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: /
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 ~,~ 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 engineeCs work.
72-025 (Rev. 1/91) B~ck MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEAl. TH AUTHORITY APPROVAL CHECKLIST
Legal Description: L¢'~
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level1
Parcel I.D. O I"~ -- ~(¢*~
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed _ ~5 Driller ~
~¢A~Cased to + ~O Casing height
FROM WELL LOG
Wires properly protected (Y/N)
AT INSPECTION
g.p.m. /'?J. '7
Y
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
g' ECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line ~
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
O q7
Collected by:
Other bacteria
lB. SEPTIC/HOLDING TANK DATA
Date installed ~/~4//~ '7
Cieanouts (Y/N) y
High water alarm (Y/N)
Date of pumping
Tank size ! ;Z {~ O Compartments
Foundation cleanout (Y/N) y Depression (Y/N)
{,,I/~ Alarm tested (Y/N)
6j oJq] Pumper
SEPARATION DISTANCES FROM SEPTIC/HOt. DING TANK TO:
Well(s) on lot
To property line
Surface wateddrainage
On adjacent lots '). I ~ Foundation
Absorption field ~ Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION '~/^
Date installed
Manufacturer
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
/3¢/'7~ Soil rating (GPD/FF)
Date installed
Length /--/~) ¢- .~5', S Width ~ y *~ Gravel thickness
Total absorption area '7~ (.. 5'~ t'~
Date of adequacy test f¢/'(~/~' ~
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Cleanout present (Y/N)
Results (pass/fail)
~/.~ .~ Total depth /
Depression over field (Y/N)
for ¢ Bedrooms
After test f¢~ /
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~.
To building foundation
On adjacent lots
Surface water N
Curtain drain
On adjacent lots '~/,~'~c.~ Property line
/1~ 7 To existing or abandoned system on lot
Cutbank ~ 0 ~4 ~ Water main/service line
Driveway, parking/vehicle storage area ~ ~'7
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff8cton the date
Engineers Name ~ ~ J¢ JO.~'l ~'~ ¢'~L[ ~.~¢~
HAA Fee $ '/70 ~
Date of Payment ~- ~. 2 ~.~_~
ReoeiptNumbe, ~. ,~,~.~)-... ('/ZS-.~'~?
of this inspection.
Waiver Fee $
Date of Payment
Receipt Number
72-026 {3/93)* Back
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVlCr-'s
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 (include lot, block, subdivision, section, township, range)
Location (address or directions)
4ol D Arzm ouN
(b)
(c) Lending Institution ~
Mailing Address ,~4-0 t~. ~T~ ~/~"
(d) Real Estate Company and Agent i~)~q~
Address
Property Owner ,.~Ol',-J J,.-O~'~,[~ Telephone: Home .
Mailing Address '~/~' /3r~ .A'~:~)~-.
Business
Telephone
Telephone
(e) Mail the HAA to the followina address: or: Check here"~ if hold for pick up.
List contact person and day phone number below. ¢ '
TYPE OF RESIDENCE
Single-Family~
Number of Bedrooms
WATER SUPPLY
Individual Well~ Community [] Public
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite"~ Public [] Community ["] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 8/861 Front
ENGINEERING FIRM PROVIDING iNSPECTIONS, TESTS, FiLE SEAFICH, 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 aad/or
Wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ~'~'~E~ ~::;~:~ ~ ~OT'[".'~ Telephone
Address
DHHS APPROVAL
Approved for "~'" ~'~.,~ bedrooms by
Approved b--'"" Disapproved Conditional
Date .-~, - ~ E~ --~' ~
Terms of Conditional Approval
CAUTION
'l'he 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 DH HS 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 7p-025 fRev 8/861 Back
MUNICIPALITY OF ANCHORAGE
I~NVIRONMENTAL SERVICES DIVI$1ONVIUNICIPALI'rY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL. (HAA)
RECeiVeD
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description: ~50l~ ~/ALt. Ey H~HT9 _
LII 1~_-3
WELL DATA
Static Water Level __ J~
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Well Classification .:~Jk~T"~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ' NO Date Completed ._~J0__f'rllfl~/~. I~"~' Yield
+ i FIEI.p
Total Depth "2.0 ~ / Cased to _40 ~EP-Jf:I~'P_ Depth of Grouting
Pump Set At 0!'4lQ'J0
4" ~.8 Sanitary Seal on Casing (Y/N)
'~ Depression Around Wellhead (Y/N)
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line __ 4"
Cleanout/Manhole + JOo~
+ ICg~
; On Adjoining Lots
; On Adjoining Lots
__ To Nearest Public Sewer
To Nearest Sewer Service Line on Lot + %~ I
Water Sample Collected by '];~' - ¢-AP4;y W)t¢~, e~7. ; Date _ ~ (Z6~ ~'7
Water Sample Test Results ~5~ISF~QXO~
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course J~O¢~
SEPTIC/HOLDING TANK DATA 0, j~L~
Date installed ?¢' ~/~7- Size I ¢-- f~(.-,) NO. of Compartments
Standpipes (Y/N) y(~ Air-tight Caps (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:
.Jo-lO0~
-+ IOO
12-
¥6-;~------~ Foundation Cleanout (Y/N) ",/E~
Date Last Pumped ~
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments ~-~ A::~t'~)YJ~--]D I~'z'~'6C~0~j r'2~-'~O~
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed r~l~EI ~IT ~' ~//~'~
Width of Field ~'~r'i~
Square Feet of Absorption Area
Depression over Field (Y/N) ('~O
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well .-PIOO !
To Building Foundation
Lot 4'- JO r
Type of System Design
Length of Field ~J~J - :~,.~'
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Properly Line
To Existing or Abandoned System on
; On Adjoining Lots
To Water Main/Service Line .~ ~, t
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area -f" ('O !
Comments ~ t""~'c;-10 f¢'~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
Signedl certify that¢.,~e~ked,,,_;~MLvwA ~verified' or conformedDate to all...~/l ~/~'TMOA and HAA guidelines in effect on the date of this inspection.
ReceiptNo. ~ ~ O O /~. O ~ 7
Date of Payment ¢ --/¢ --~ 7
Amount: $ ./~ ~ O~
Page 2 of 2
72-026 fRev 8/861 Back
LAE ORATCrtlES,
INC,
'7127 ,OLD SEWARD HIGHWAy
ANCHORAGE; ALASKA 99518
(907)344=8551
BACTERIOLOGICAL WATER ANALYSIS
TO BE COMPLETED BY WATER SUPPLIER
DATE COLLECTED TINE COLLECTED TYPE OF SYS~M
HONI'H I~Y YEAR~. ~ ~] PUBLIC~I'~NDIVIDUAL
I.D. NO. (PUBLIC'SYSTEMS) CIRCLE CLASS
I i i I i I t A B C
NAME OF SYSTEM TELEPHONE NUMBER
s /~C06E6
LOCATIONWHERE SAMPLE WAS COLLECTED
'COLLECTED DY:(S1GNATURE)
TYPE OF SAMPLE
(CHECK ONLY ONE THIS COLUMN)
[~/D~INKING WATER
~/CHECK TREATMENT
m-)CHLORINATED
[-)FILTERED
J-)UNTREATED OR OTHER
J-1 RAW SOURCE WATER
[] NEW CONSTRUCTION OR REPAIRS
[] OTHER(Specify) ~
IS TItIS SAMPLE SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE?
[]]YES E~O PREVIOUS COLLECTION DATE
ANALYSIS REQUESTED (IF'OTHER THAN TOTAL COLIFORM)
NAMESEND REPORT. TO:(PRIflT~ ~-~ FULLhL- pME,ADDRESS AND ZIP CODE
CITY STATE _/E~- _ ZIP
FOR LAB USE (~N~.Y
r-1 RESUBMIT SAMPLE
Sample rejected because:
CHECK ONE OR MORE
r-1 sample too long tn transit.
sample should not be over 30 hours.
~ Sample received too late in week
[~]Not in proper container
[] Leaked out
[] Insufficient information provided.
Please read instructions on form.
[-) Other (Specify)
RECEIVED FROM
ANALYTICAL METHOD:
~_~,MEMBRM(E FILTER
~-)FERMERTATION TUBE
Date & Time Started _.~_:1 .t~)
Date & Time Completed~;(~SrTLO
.... LABORATORY R~SULTS
~ Other Bacteria
[) Test unsuitable because:
~ Confluent Growth
~TISFACTORY ~U~SATISFACIORY
BACTERIOLOGICAL WATER MqALYSIS RECORD
FOR LAB USE ONLY
TOTAL COLIFORMS
FECAL COLIFORI~
OTHER
Membrane Filter: Direct Count
Verification: LTD
Final Membrane Filter Results
Reported By. , __
BGB
Date
Time,
Coliform/1DOml
.Coliform/100ml
.... A.M.
P.M.
READ SAMPLE COLLECTION INSTRUCTIONS O~ BACK OF FORM
Location:
BE.~SE, EPPS & POi'rS
2220 EAST 88 AVENUE
AN(~IORAGE, AK 99507
(907) 349-6451
WATER h~LL TEST
Sut~livi.,3ion:
Lot:
Block:
Client's Name:
Tester:
C'..~EYe'~
Initial Reading on Meter:
GALLONS GALL(XiS
TIME GPM A VOLUME TOTAL ¥OLUME
~0 :0~ 0.0 o 0
I0:i ~ '5, i ~-0 40
Io :;~1 .z.9 ~ '75 _
I0:45 -~. i 5'~ I'Zf~ _
II :, ol t. ~ r7
Il :. I I ~ .'7 ~'7 I1 ~ _
I: zO ~6 1+7 ~oo _
NOTES: P'~Z.4T 450 c~¢,t,. '¥c/~C,e'D ~'¢'TO E"/,~ST ~D,5OF-PTIo¢ FIELD
h~O ,SCC6¢'T~D, NeLL C',/66e'5 ~rW~SM I?,f%' AND 11~7'
Production Rate: ~.09 GPM' 24-Hour Capacity4~O Gallo~s
~, (~,~ , . .~:~.N.]a;~IPALITY OF ANCHORAGF
AND ENVI
~F~[~ Il .~.~J!~ :~., ?EALTlt RONMhN PROTECTION
~['~E~'; A' , ~ ~25.1~, ext. 224 or 225
~'~, ~ ~ ~~: ~ Da~:e Received July 12, 1977
Time .... .......................
REQUgST FOR AP~AOVAL OF I~D].V~DUAL ~EW~,R AND WATER FACZ~TIES
1., Lencling .£nstitution Request: Alaska Mutual Savings Bank % Stormy
Ma.i]Jnq Addr¢;ss: Post Office Box 1].20 99510 Phone:
274.-3561/245
Proj:ernv Owner: W. Kay Johnson Phone: 344-9661/w
Mailing Address: Star Route A Box 373A 9950'7 344-4005/h
Legal. Description: Lot 1 Block 3 Sun Valley Heights Subdivision
4: SingLe Family ResJ.dence: (x) Number of Bedrooms: Three
Mu.Lt.~pl.e Family Residence.: ( ) Number of Bedrooms:
5. Well System: 'lh~dividual woJl gx) Commun.tky/PuDlicoyo" "'Lam (
Permit Depth of Well Well Log oa .role ( )
ConsLruck:[on Bac%er J. al Analysis
Absorp'hion
Disposal System: On~.sihe~stem (x~ Pub.Lie Utility ( )
7. DisLan¢:es: Well to Septi~ Tank
L~3 SeWqg}; ]',]_n() Nearest Lo[: line
to NearesL Lot I,Jne
Absorption Az,ma
Absorption Area
Paqe Two
Depa~:tment of Health and Environmei~tal Protection
Request_ for Approval of Individual Sewer and Wa~er Facilities
Alfadavit Attached: ( ) Let'ter Athached: ( )
[)i~:approw~d: Date:
DepartmenL Worksheeh:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HIZALTH ANt} ENVIRONMENTAL.
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILII'IES
1. Type of Inspection: VA. ___FHA CONV.~×
2. Property Owner: W. Kay Johns~o_n_
Mailing Ad'dress: BAA,,'~Bo_x 373A_
Day Phone:_344-9661 wk & 344-4005 home
3. Name of Buyer: LA_I. TINEN, Laurence H.
Mailing Address: ]~__O0._Box 3503 Anch 9950:[ Day Phone:._2_79-0611 wk
4. Name of Lending Institution: Alaska Mutual Savings Bank
Mailing Address: P. O. Box 1120
__Pbone:_ 274-3561 ex: _245 attn: STORMY
5. Name of Realtor' or Agent: none
Mailing Address: Phone:.
6. Legal Description: Lbt 1, Blk 3, Sun Valley Heights Subd.
Location: ...... Anchorage
7. Type of Pacility to be Inspected:
8. Water Supply
Type of Supply: Public Utility..
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility.
If Individual, date of instailation_
.No. Bdrms.. 3
Individual
well & septic
Individual (on-site)._
72-003(3/76)
Page 2 of two pages - R~
Legal Description ~
for Approval of Individual & Water Facilities
Comments
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 274-456'1
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA FHA CONV
/ ~--. F'~ [ "
2. Property Owner: /(~_.~Z:L~,~])_~_~_~¢%_c< ~_,.
3 Name of Buyer: / f ¢ ¢:/2~¢ .~
Ma ili ng Address: ~_ D~Z
Mailing Address: --~L _..'~. t~. ~b~ . Phone
5. Name of Realtor or Agent:
Mailing Address:
Phone
6. Legal Description:
7. Type of Facility to
8. Water Supply
Type of Supply:
If Individual,
If Individual,
g. Sewage Disposal
be inspected:. No. Bdrms. -~
Public Utility Individual
number of dwellings presently served
del)th of well---~?~L "~
System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site)
Eq-037 (~/74)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quali
230 "C" Street, Anchorage, Alaska 99503
Date Received ~ - ~'~ ~
~ ~~/~ ~j Time of Inspection ~',~ ~ .
~ /~ Date of Inspection -~ ~L-~-~-.~Y
\~ / ~ IN VIDUAL SEWER & WATER FACILITIES
/ k~ FOR, ~
1. Approval requested by: ~~~~ ~. ~~
Mailing Address: ~X ~ ~2~ 0-~ %~. Phone:Gqq- ~o~
2. Property Owner: Phone:
Mailing Address:
5. Type of facility to be inspected ~o.~No._ of bedrooms
6. Well Data: ~ ,
A. Type ~ r B. Depth
C. Constructio~//~-~_~e~/~ D. Bacterial Analysis
7. Sewage Disposal System: E _~.~F.~-~.k- ~$,N~.. _~/~_~- ~ ,~..~
A, Installed ~-~o ~ S B. Installer
C. Septic Tank: 1. Size \,~ ~ ~
D. Seepage Pit: ~1. Absorption Area
E. Disposal Field: Total length of lines
2. Manufacturer ~:)~ ~,~
2. Material
Distances:
A. Well to:
Septic tankL~O~
, Absorption area
._., Sewer Lines
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages