HomeMy WebLinkAboutTANAINA HILLS LT 11
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage Page
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: ~_'~J~:~!d~ RID Number: oil'-
Name:
~%3 ~ Wastewater System: '~'New U Upgrade
~ Address: ~ ~
~ ~¢~ ~.. ~;~D ~¢~y,~ ABSORPTION FIELD
Phone~¢~ _~ ~No. of Be~oms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION S°il Rating:/. ~ GPD/Sq. Ft. lt.5¢
Lot: ~ ~ Block: ·'~(~Subdiv~i°n: ~'lJ~ Depth to p~pe bottom~oe?°m 9dginal grade: Ft. Gravel de~th beneath pipe Ft.
Township: ~ Range: Section~ Fill added aboveo ~'°riginal~ ¢'grade: Ft, Gravel length: ~ ~ Ft.
WELL: ~New B Upgrade Gravel width: ~/Ft. Number of lines:~ Distance betweenlines:~ Ft.
Classification (Private, A,B,C): Total Depth: Oased TO: Total absorption area: Pi e material:
D Date Drilled: Date ~nstalled:
Static War ~ Level: > '
Pure et ~t: Oasing Height Above Ground:
TA K
SEPARATION DISTANCES ds~.tio u Holding ~ S.T.E.P.
TO Septic Absorption Lif~ Holding Public/Pdvae Manuf ctur r~ .~/~ Cap8cityin gagons:
From Tank Field Station Tsnk Sewer L,nes -~ ¢ i~¢
WelP ~¢,~ ~¢,,~ ,~ -- ~ {~ Material: ~ ~i Number of ~padments:
Sudace
w~te, I¢'~ i~"~ ~ ~ '-- LIFT STATION
Line 70/ Size in gallons: Manufacturer:
Foundatio~ ~'i~ ~0'*~ .... "Pump on" level~~ff" level at:
Drain
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
I~ ' ~,
S & S ENGINEERING ~.............
Eagle River, Alaska 99577 2nd '~-15 "'/6 .~ ~.~¢ , *O~*T.. C.,..COW,~,:4. ,/,,'-'r: ~.
Department of Health and Human Services apprEv~'- ~' '""'
Reviewed and approved by: ~ Date:/~ -/~- ~ -* '~-
/
72-013 (Rev. 9/91) MOA 25
SW960158 2 2
Permit No. Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
LOT 11, 'rANAINA HILLS SUBDIVISION 011-051-27
Legal Description: PID No.:
~, B C
FCO .0' ___36.0 69.5'
ST1 1 .5' 48.0 71.5'
$T2 2[ .0' 56.0 77.5'
r~R~ 1 9: ~' ~9.~ Bfl.~'
DBL2 3( .~ 61.5 82.5~___ ~ALT' SITE
C01 5( .5' 72.0 106.5'
/
MT1 4~ .0' 7~.~ 10~.0' /
C02 6' .5' 98.5 95.5'
:MT2 6(,0' 9~-.~ 98.0'
ST1 ~ ST
0, : ,,
MT1 CO1
M'~S - 9G.4' ' ' CO2 90.0' '
78.o' B.o.n. ~ ~
72-013 A (Rev. 9/91) MOA 25 ~
M-W DRILLING, Iflc.
(e0?)
ANCHORAGE, ALASKA 9951
WeU Owner INNOYATI~ff~--O~.QNSIRUCTION
DRILLINO LOG
.... Uoe of Well?ONEsT I C
Loeatton (addre~ ot: Township, Range, ,~N~tion, Ii known; or dislance main road__-~
_LOT I1, TANAINA HILLS SUBD!V_ISIO._N.~_N ..........
_tL~I:IORAG~,. ALASKA
Size of Casing §"
Static water level q4
F, ere en ( );
Depth of Hole I~4~ feet Cased to_~_ feet
ft. (~I(~) (b~low) land surface. Finish of well (cheek one)
Perforated ( ., ),
open end X );
Describe ucreen or perfor~tioa~.-.tt/_A.~
Well pumping test al~ 30+ ~gallons i~
of ~wdowa from ~tte
'-; ]Date of completio~ _ 17 ~UL
-
~l fe~t from
ground surface
A
..,...~L~TO 12-
12_TO. 32
(minute) for__l____Jiouro wlth . 100%
WELL LOG
Give det~il~ of formations pe.netrated, size of material, color and hardness
__.-5~.TO 8O
~-.-1.0~TO la0
~'$,,,a, HDI POWDERY,, SILTY
"'SILT:
~AY: BROWN, SILTY . . ---~.~
C ·
~LAY..GREY, ST~CKY, 'SILTY
~LAY: SILTY, DAMP_.,
123.T0. 140__ _ k~ATERBEA[LIIX. PZ_GRAVEL: SANDY
TO
-- . .TO,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960158
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:HUSA, KRIS
OWNER ADDRESS:3601 RASPBERRY RD.
ANCHORAGE, AK 99502
DATE ISSUED: 6/27/96
EXPIRATION DATE: 6/27/97
PARCEL ID:01105127
LEGAL DESCRIPTION:
TANAINA HILLS LT 11
LOT SIZE: 68466 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (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:
ROBERT C. COWAN, EE.
ROBERTA. SHAFER, RE.
SEWER&WATER
INSPECTION
ENGINEERINGSTUO]ES
AND REPORTS
WELLINSPECTION
& FLOW TEST
SITE pLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
CIVIL ENGINEERS
(907) 694-2979
June 21, 1996 FAX(907)694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 11, Tanaina Hills Subdivision
Request you issue a permit to drill a well and install a
septic system to serve the four bedroom house on the
referenced property.
A test hole was excavated and percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
At the time of excavation no water was encountered in the
test hole. The monitoring tube within the test hole has
been checked and found to be dry.
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by 'the
installation of the proposed septic system.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP. SUITE 204 · EAGLE RIVER, ALASKA 99577
= 60' SITE PLAN DESIGN
SGALE
~<r-:~
m~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATE PERFORMED:
T gO ^l~J~ 14~Iownship, Range, Section:
1
2
3
4
5-
6-
7
8-
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Monitoring? Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
~ -I%,~t,4 lo: 30 ~ ~' ' -~
/0' ~ q ~ "
~ Io' ~- ,~ J0~' ~
PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER ~c~ it
TEST RUN BETWEEN ~' _ FT AND c~ FT
PERFORMED By?& $ ENGINEERING
17034 Eagle River Loop Road NO. 204 I
ACCORDANCE ~I~,IR]~TI~'gfla,,~B~ItPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
ROBERT C. COWAN. RE.
ROBERTA. SHAFER, RE.
SEWER&WATER
INSPECTION
ENGINEERrNG STUDIES
ANDREPORTS
WELLINSPECTION
& FLOW T~ST
SITE PLANS
ROAD DESIGN
SO)LTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
REFERENCE:
~ENERAL:
1.
Bt
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
Lot 11, Tanaina Hills Subdivision
June 21, 1996
The scope of this project includes the installation of
a 1250 gallon septic tank and a five foot wide
drainfield to serve the proposed four bedroom
residence located on the referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and MunJ. cipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 11, Tanaina Hills Subdiw[sion
June 21, 1996
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
A foundation cleanout shall be installed one to four feet
from the building foundation° In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level° If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
e
Once the gravel is installed, the distribution pipe is to
be installed level with the perforatJ, ons faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
Lot 11, Tanaina Hills Subdivision
June 21, 1996
Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Type of Pipe
Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick
burial polystyrene (Dow Chemical Company
equal).
extruded direct
Styrofoam HI or
4. Septic tank inlets and outlets shall be fJ. tted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
Ail leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the ti200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 11, Tanaina Hills Subdivision
June 21, 1996
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities° Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 11, Tanaina Hills Subdivision
June 21, 1996
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or 'the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
PERliIT NO.
[:,EPFIF;?.THENT HEFILTH I::II'.,IE:, E]",I',,,'IR. OI",II"IEI",ffI=II .... :OTECTIOI",I
825 '"L" %TREET., FIIqCFIORFIGE., FIK.
ii.,-ii EEL.. ~ ...... ~ F,,~ [:, C:, F,,ii '-- %-=.; Z "f" E: '.S.S.; E£ lb..ii E R: P' E: R: th'ii Z T'
,:: ',E~]:OSL:5:: )
IF'I:'L T. CFINT
.O,:::R"F I OI'.,I
,EGRL
RHR"r'FI C/OHOI.,IFRE, GREY & RSSOC 7::L5 L ~; 276-5254
LOT :L::I. BL.I-':: J.. TFINFttI",IFI HILLS :SUB Lr.I--;"l'' :SIZE S~S~S";~gS~ SL.:!LII::IRE FE:ET
ii]"F'E OF' SOIL RBSOR. PTION S"/S"I-'Eli IS: TRENCH
iRXIiiUi,'l NUI,I-BE:R OF' E:E[:,ROOI,IS :,: ]:
SOIL F,:R'FIN(:~ ,::S(;! FT/BR)= E:5
¢'HE REE:!UIRED :SIZE OF TFIE SOIL. FIBSORPTZIDN :S"r'STEM IS;:
E:" EE F:" iF Fii == ::L %. L- EE ii".ii ~-F~ T IH := ;:2 r~; II.".'~i F-;: f:~ "'/IE L_ [:" E: F" T' Il-it .... ~
]'HI.U: LENGTI-i DIi"IEi"4SIOI",I I'.S 'file L. EI~'~(:'iTI"i ,::II'~ FEET) OF THE TREI",ICI-i OR [:,RFIINFIELE).
THE [)EPTH OF R TREi",ICH Oi-;~: F:'tT IS THE DISTFIi",ICE E:ETI.'.IEFN TFIE SUF.:FFICE OF THE
GROUND FINE) TI-iE E:OTTOf'I OF THE E:C:FI',,,'I::ITION ':: I I",l FEEl").
TI'iERE i'.~; i",lO SE"[' I-,.IID'T'H FOR 'fI'~:EI'C:I'iE:S.
"I'I'"IE GF;!R',,"EL I)EF'TH IS THE I"IlNII¥1LIt"I I)EPI'H OF GRFI',/EL BET.t,.IEEN THE OUTFIZII_L F'IPE
RI',I[:' THE E:OTTOI'"I OF THE EXCR',,,'RTION (II",l FEET).
F'ERMIT FIF:'F'LICFIFff HFIS "FHE RESI-:'Oi',ISIBI. LIT'T' 'FO INFORH 'I"HIS DEPRRTI'iENT DURIi'.~G THE
I i'4STI::tI_.LFIT I ON INSPECT I Ol'.,lii:.'; OF I::lt~l"r' P.IELL:S FIE:,.TFE:EI",I'~' TO TH I 5; Pf.~tOF'ERTY FIi",![.', THE
!CIIdBER OF RESIDEI"~CIZ'.:~; TFIRT THE P.IELL I.,.IILL '-:;ER',,,'E.
i:RC:I'::]:' ILi. I I',IG OF FII'¢F S'¢:"~;TEI'i 1.41THOUT F" I NFIL I I",I:'SPEC]" 101",1 Ri",I[) FIF'F'ROVFIL E:'¢ TH I:S
~EF'FII::(I-'I'"IEltT !,.!ILL BE SUE:,IECT 'TO PR. OSEC:UTION.
1II"4II¥1LII"'I D];STRI",ICE BIETI.,EE:N R t.4ELL RNI} FIN"/ OI",I-StTE SEI.qRGE DISF'OSRL SY'.STEI'd IS
00 FEET I':OR R P[~'.IVFI]'E F.IEI_.L OR '150 TO 200 FEET F'F,:Cq'"I FI F'UBI..IC !.,.lEi.i. I)IEF'EI'.,Ii)II",I~]i
F'OI'4 TIIE TYPE OF: PUBLIC FELL.
II'4II'iUl"l DI:::;TF~IqCE F'ROM FI F'RI',/FffE I.,.IELL TO FI F'RI',,,'FffE SEFIER LiI",IE :I::S 25 FEET FIFE:'
0 Fl COi"IHUNIT'T' 'E, EI.qER LINE ]:'E, 7'5 FEET.
ELL L. OGS RRE REL.:~UIRE[) F¢'~[:, I'IU::_";T E:E RETURNED TO THE I)EPFtRTI"IENT I.,.IITHII"4 ~:0 DFI"/S;
F." THE [,.IEI...L. CC~I'IF'L. ETiOI'i.
I'HER RE(¢~UIREi'iEI",ITS I'iR"r' RPPL'¢. SPEC:IFIC:RTION:S FII",IB' COI",ISTRLI(::I"IOI",I [)IF:IGRFIH'.S FIRE
,,'I=IILRBLE TO II",ISLIRE PROPER II'4'_:;TI'al...LFITIOI'4.
CERT ]: F'"/ THFIT
I F~I'I F:'RPIIL. IlaR I.,.!]:TI"I THE REQLIIREHEIIT'::; FOR OI",I'-S,,ITE .'SEFIERS RN[:, I,.IELL'_:; RS; SE:'['
R"FI"I B"r' THE ["11...11'.,I I C I F'RL. I'T'¢ L'IF FII",!CHORFIGE.
]: 1.4ILL tNSTRL.L TI-iE S'T'S'rEPI II'.,I RCC:ORDFII'.,tCE I.,.]:[TH THE 1:::O[:,ES;.
- ¥::,TE i',J?.[' ,r~;~..]l,.,[II;iiE EI,ILI. IL.i.~E.I lEt,Il IF' ]'FIE:
..;. Z U!.,I[)EI:4::STFd'.![:, THFff THE OI'.,t-SITE :SEI.,ER ,:; .... , - .:; ..........
FE..=; I [.,EI.,IC:E 12; F~.EHO[)EI_.E[:, 'FO I I'.,IC:LLI[:,E MORF THFIN ~: E,E[:,Fbuf,'I:,.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION
925 L Street, Anchorage, A~aska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR: Hernan Amaya DATE PERFORMED: 8-20-82
LEGAL DESCRIPTION: Block 1, Lot 11, Tanaina llills Subdivision
6
7
8
9
10
/11
12
13
14
15
16
17
18
19
2O
1
2
3
4
5
COMMENTS
design.
Organics and organic SILTS
SILT, brown, moist, some fine
sands (ML) (F-4)
275 sq. ft./bedroom
SAND to sandy GRAVEl,, brown,
moist, gravels are subrounded,
sand is generally coarse, trace
to some silt. (GW) (F-l)
85 sq. ft./bedroom
SLOPE SITE PLAN
Recommend using 85
WAS GROUND WATER S
ENCOUNTERED? NO ~
P
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND -- FT
sq. ft. /bedroom as a bas±s for on-site sewage _system
PERFORMED BY: ]]oward Grey & Associates, InC. CERTIFIED BY: A1 Zeman
DATE: 8-20-82
72-008 (6/79)
· {~ 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. #
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
Lot 11; Tanaina i~Hills Subdivision
Mailing address
Agent
Location (site address ordirections) NF~Kiliak Place
Anchoraqe, A~
Property owner ' Kris Husa/ Innovative Construction Day phone
Mailing address 3601 Raspberry Rd. Unit 4D Anchorage, AK
Lending'a~ency r' Day phone
248-8835
99502
. Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
xxx
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
xxx
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-02§(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 tl~at 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 d[sp0sal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspeqtion. , ~ .
h
Name of Firm s & $ ENGINEERING P one. ~¢/
. 17034 Eagle River Loop Road No. 204
Address Eagl~. Elv, er~,A,~li~lska 99577
Engineer's signature ~"/Z .~.x~'-/.~ .. Date ';~
DHHS SIGNATURE
Approved for
bedrooms.·
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
"~'e Mu~'icip~lity'of .A~'~0'rage Department of Health and Human Services (DHHS)issues Health Authority
'A"o;~roval O~'r~ f cate~'~sed on y upon the representations given in paragraph 5 above by an independent
p rofesslonal, engln .~,~ ,r registered in the State of Alaska. The DHHS does th~s as a courtesy to purchasers of horn
and ti~eir ie~ding ini~titutions in order to satisfy Certain federal and State requirements. Employees of DHHS do not
conduct inspections or analyze data 13afore a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
MUNICh,^Un' O~
I~NVIRONM~NT^L SERVICe8
Municipality of Anchorage DEC ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division RECEIVE
825 L Street, Room 502 · Anchorage, Alaska 99501 * (907) 343-4744
Legal Description:
Health Authority Approval Checklist
'Tqc~¢,~f~o, J'J"iJJS ~/b Parcel I.D.: C)I[- O~j" ~'~
A. WELL DATA
Well type
Log present ¢~l',J)
Total depth
SanitarY seal ~j'N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. '~HOLDING TANK DATA
Date installed
Foundation cleanout ~N)
Date of Pumping.
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
FROM WELL LOG
_ Casing height (above ground)
Wires properl~ protected ~'~N) AT INspEc'~'ION
Nitrate
17034 Eagle River Loop Road No. 204
Collected by: ------[-~e~E-h-~r,
g.p.m.
Tank size 12,5'Ojg, Number of Compartments ~ 61eanouts ¢;~N) ~5
!.~ (~. Depression (Y [~.~ /{//O High water alarm (Y~J~ ~O
_ Pumper
C. ABSORPTION FIELD DATA
Date installed ~-'//1~/~
Length dr;')! Width
Effective absorption aiea
Date of adequacy test
Soil rating ~orft2/bdrm) J,, & System type T'"¢¢,qch
Gravel thickness below pipe ~, ~ Total depth /J, 5 "/,2,5
Monitoring Tube present (~) ¢~ Depression over field (Y~ .~
Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth ~ (ins) Minutes later:
Immediately after '-- gal. water added (in.):
~ Absorption rate = '-- --"--' g.p.d.
Peroxide treatment (past 12 months) (Y/N) -~ If yes, give date
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access (Y/N)
~d-'""~'~High water alarm
E. SEPARATION DISTANCES
*Datum
l S.e.~p_~olding tank on lot
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL ON LOT TO:
IOO"k
Sewer/septic service line ~'(~ ~'
On adjacent lots /OO "~'
On adjacent lots i CO I Jr"
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM~--IOLDING TANK ON LOT TO:
Foundation I~' '~ Property line ~-70 / ~ Absorptipn f!eld
Water main/service line iO1 "~
Surface water/drainage ]~ ~ 1~ Wells on adjacent lots [00' '+'
F.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
~ i '~' Building foundation -
Property line
Surface water I(~rO
Curtain drain ~,//~
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
ENGINEER'S CERTIFICATION ~.~.,-_-~.~",~'~.,~,~
I cert~ that I have thru fie/d ~nspections rev, ew Mumc~pal rec~ ab'~.~s are
in conformance with ~OA HAA .qu~elines i~effeCt on this date.
signature ~/¢~¢~ ( . ~
. ~ - ~,~(,.~./~-~
Date / % //° /~0
HAA Fee $.
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
~tk CT&E Environmental Services Inc.
CT&E Ref.#
Client Name
Project Nan]e/#
Client Sample ID
Matrix
Ordered By
PWSID
966460OO1
S & S Engineering
Ll I Tanaiim Hills
Ll I Tanai~m Hills
Drinking Water
Client PO#
Printed Date/Time 12/13/96 17:01
Collected Date/Time 12/09/96 13:25
Received Date/Time 12/09/96 14:00
Technical Director: Stephen C. Erie
Smnple Remarks:
Nitrate-N
Total Coliform
Results
PQL Units Method
0.100 U
0
9 ob w/o coli
0.100 mg/L
0 cot/lOOmL
SM18 4500-NO3F
SM18 9222B
Allowable Prep Analysis
Limits Date Date Init
10 max
12/13/96 WEP
12/09/96 WEP