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Home My WebLink AboutSHENANDOAH HILLS LT 1Sh nondooh Hills Lot 1 #015-212-38 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 · TelePhone: 343-4744 On-Site Wastewater Disposal System and/or Well InsPection Report iJ J Namo: ~ ~ N~"=;'Y ~ ;'~-.P~-c'~E. OiA~ ~ ~ Wastewater SYstem: U New : ~ Upgrade Address: I'Z i~ ~A~J~ ~-C,~~ ABSORPTIONFIELD Phone: . ~ INo. of Bedrooms: ~Trench DShallowTredch DBed D'Mound ...... LE-GAL DESCRIPTION SoilRat'in,= % . Lot: Blgck: Subdiv~ion: Deplh lo p~pe bottom from orlgl~ Gravel d~pt~th pipe Township: , I Range: / J Section: ) Fill added above 0riglnal~r~de: ~ngth: "-%~1' g New g Upgrad~ Gravel width: / Number of I~Oistance belweenllnes', CIasmf,catlon (P~C): Toml~ Cased To: Total absorptio~ Pipe materlah Driller: ~ Date Drilled: Static Wats; Level: ~ Date Installed: ~ Ft. , Yield: ~ Pump Set at: Casing ~Ground: TANK SEPARATION DISTANCES ~ s~¢o ~o~n~ ~ S.T.~.~. TO 8eptlc Absorption Lift Holding ~ubllc/Prive[e Manufacturer: Capacity In gallons: Sudaco ~ / Water -*~*, ~oc, LIFT STATION Lot . ~ Y Size in gallone: Foundation . ,,'.~ ~ P~Modeq ~mal 'ts~otl°ns 'erf°rmed bY: Remarks: 14,'% ~,0~% ~.~. BENCH MARK Location and Description: ~¢-- :~d~~, Assumed Elevation: nspection performed gates: 2nd ~ . Department of Healt~ Hu ~W~ Reviewed and approved bY~ Date: . 72-0t3 (Rev. g/91 ) MOA 25 SEPTIC UPGRADE~ PREPARED FBR~ PREPARED DATE' 9/4'/96 AS-BUILT DRAWING ~ A ibc = ir:, / \ ........ ~EW 4000 GAL,~ ~f~;?~j / ....... ~/ PRBPERT~ ?!;~;~ ~ EXI,:TING FB[JNDAT~DN CURTAIN DRAIN ~ WELL ~-- SUMP LOT 1, SHENANDOAH HILLS ERNIE 8, IRENE CHMIEL ALASKA WATER & WASTEWATER SERVICES MUNICIPALITY OF ANCHOR3kGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGI~ADE) PERMIT PERMIT NUMBER:SW960257 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:CHMIEL ERNEST G & IRENE OWNER ADDRESS:12151 SHENANDOAH RD AIqCHOI~AGE, AK 99516 PAGE 1 OF DATE ISSUED: 8/20/96 EXPIRATION DATE: 8/20/97 PARCEL ID:0i521238 LEGAL DESCRIPTION: SHENANDOAH HILLS LT LOT SIZE: 48332 (SQ. FT.) NI3MBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS pERMIT IS FOR THE CONSTRUCTION OF: HOLDING 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 (iSAACS0) · 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 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. DATE: DATE :~/.~/ PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960257 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:CHMIEL ERNEST G & IRENE OWNER ADDRESS:12151 SHENANDOAH RD ANCHORAGE, AK 99516 PARCEL ID:01521238 1 OF DATE ISSUED: 8/20/96 EXPIRATION DATE: 8/20/97 LEGAL DESCRIPTION: SHENANDOAH HILLS LT LOT SIZE: 48332 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: HOLDING 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 (18AACS0) . 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 SP~ECIAL ,~OVISIONS. SPECIAL PROVISIONS/: ~4/I ISSUED BY: /-~J/~/~ '~Z/~~'''~ ) ~"~'~'"'"'~'~, 8471 Brookridge Drive ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers August 10, 1996 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ret Sewer Permit for Lot 1, Shenandoah S/D. To whom it may concern: The subject 4 bedroom house is served by a private well & septic system. The drainfield was installed in 1979, and failed in 1981 due to encroaching groundwater. A curtain drain was installed in 1982, and since then, the septic system has functioned adequately for the homeowner; however, based upon recent groundwater monitoring data, it is apparent that it still encroaches into the seasonal high groundwater. Groundwater monitoring was initially performed by Toben Spurkland, P.E., however, the homeowners have no written report of his findings. I noted water at a depth of 6.5 feet in Mr. Spurkland's monitoring tube on 7/29/96. Additional test holes (several feet deep) were dug by Ted Johnson, P.E. (summer 95). Per the homeowners, Jim Cross, P.E. (DHHS, Program Manager, Onsite Services) inspected these shallow test holes and encountered water at less than 2 feet. Given the fact that there was not 2 feet of unsaturated accepting soil, Mr~ Cross determined that a holding tank is the only viable option. In order for me to reverify this data it would be necessary to monitor groundwater through the spring of 1997. Due to the fact that the property owners want to sell the house this fall, they don't have time to wait for additional monitoring; consequently, they have resigned to installing a holding tank. We are proposing to install a 2500 gallon holding tank at the location shown on the attached plan. There are no surface waters within 100 feet of the proposed location. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems, tf you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you. Sincerely, [arness, P.E., M.S. Chmiell .wps /-----SEPTICAREA--~ LSEPTIC AREA7 LOT 8, SHENANDOAH PRIVATE WELL & SYSTEM, SAND FILTER LOT 7, SHENANDOAH PRIVATE WELL SEPTIC, SHENANDOAH PLACE HOLDING TANK AREA~ NEW 81500 GAL, HOLDING TANK,--~ HOUSE LOT 9~ HILLS, PRIVATE WEI AND HOLI]INO TANK, LOT 8, SHENAN])OAH PRIVATE WELL & SEPTIC, LOT 6, )]K I ,LLA, HDLDINO SEPTIC, LOT 7, BK 8 VALHALLA PRIVATE WELL AND SEPTIC, NDTE~ THE ONLY SURFACE WATERS NOTED ON 8/9/96 WERE: NEAR THE SOUTHWEST CORNER DF THE PROPERTY WHERE THE CURTAIN DRAIN SUMP PUMP DAYLIGHTS. TIlE SEPARATION DISTANCE TO THE NEW HOLDING TANK IS GREATER THAN 100 FEET, SEPTIC UPGRADE, LOT 1, SHENANDOAH HILLS PREPARED FOR' ERNIE & IRENE CHMIEL PREPARED BYI ALASKA ~/A'FER & ~/ASTE~/ATER SERVICES DATE~ 8~9~96 DRAWN, GARNEgS [ SCALE], 1" = 100' EXISTING TRENCH C/O TO BE CAPPED BELOW G -- <I~ CURTAIN DRAIN ALASKA ENVIRONI~"~TAL . -- CONTROL S£RVlCE., INC. .1220 West 25th Avenue &NC HORAGE, ALASKA 99503 Phone 276.1361 SHEET NC CALCULATED DY CHECKED BY , :,'DATE_ $~ 2 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Gentlemen; Upgrade permit for Septic System Lot 1 SHENANDOAH A July 19, 1995 The existing system for this lot is not performing satisfactory and must be replaced. Most of the surrounding properties are se~wed by holding tanks due to high groundwater and tight soils. ERES (Lou Butera) installed an Orenco Sand Filter on Lot 8 in 1993. During breakup water is flowing at the interface between the peat layer and the silt. Under non breakup conditions the groundwater is at4 feet. The silt percs at 60 minutes per inch. A percolation test on the peat resulted in a rate of 15 min. per inch. Discharge of the effluent to the peatlayer should be considered. Both nitrogen and viral removal will be enhanced by discharge to the peat layer. The submitted design shows the final discharge to the underlaying silt, with a sand filter layer to obtain the required separation to groundwater. Please review and comment. Yours 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 SHENANDOAH HILLS EARNEST CHMIEL Groundwater at 2.5 f. Durh~g Break Up Groundwater at 4 feet in July Use BioCycle Treatment Plant Soil Rating. From test July 6, 1995 60 Min per inch Use 2 gal per sq.ft/day, Polished Effluent No. of Bedrooms 4 Required Area per Bedroom: 150/2 = 75 sq.ft.. Total area required: 4 x 75 - 300 sq. ft. Use 5-Wide trench Length of Trench 300/5 = 60 [FT.] Inv. Elev. of Foundation Clean Out: 94.5 +- Tank Inlet 2 feet below ground Surface Maximum Ground Elev. At Tank 96.0 Ground Elev. at Trench 97+ Use Low Head Effluent Pump SYSTEM CONFIGURATION BIOCYCLE TREATMENT PLANT 5-WIDE STANDARD TRENCH TOTAL LENGTH 60 FT. TOTAL WIDTH 5 FT. TOTAL DEPTH 2.5 FT. LAKE OTIS GRAVEL 2 FT ROCK DEPTH .5 FT. COVER 3 FT. The installation of this septic system will not prevent wells fi'om be installed on the adjacent lots. There are no developed or natural surface / sub surface drahmge courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. pg.1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PE. PORMED PO.: C HHIE L LEGAL DESCRIPTION: 2 3 7 8 ~o B L~ 11 12 17 18 20 (ENGINEER'S SEAL) Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT <.~ y~,,,.. OL DEPTH? p Oeplh lo Waler AfterV Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop Y,J'i¢ =." ~,~ ,~-o. k /:; d %,/,i r q ~ I,~;~1~ PERCOLATION RATE ~ ~) Im,nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ,'~ FT AND 3 ~//"Z. FT COMMENTS ~ERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) L~T 9 ® I~ ® TA/N DRAZN Lt~? L Ll~f 5 850 300 LI~T $ i T-- L~UT 7 TOBBEN SPURKLAND P.E. II 205 W 15TH, AVENUE ANCH. AK. 99501 (907/ 279-~916 LOT I SItENANDOAfl EARNES? CH~IIEL 12151 SHENANDOAH ROAD SEPTIC SYSTEM DESIGN DATE: JULY 7, 1995 SHEET: I/3 GRID: 2736 *~7.Z,'. 99,I ~ ~ell CURTAIN DWAIN BUT FALL N £~ 50 75 \SCALE; 1" = 50 FL ~YWTAIND~AIN NCN £~PTt£ TANK EXIS L 100, 4 BENCH BZI T ?Z71~ SIDING ASSUME]~ ELEV I00,00 FT I I TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE AK. 99501 LOT I SHENANDOAH EARNEST CHMIEL 1215~ SHENANDOAH ROAD SEPTIC SYSTEM DESIGN DATE: ,IOD~4Y7, 1995 SHEET: 2/3 GRID: 6O ABSORPTION TR£NCH Dis/ribution Pipe l/4-inch holes ~ 24" SECTION A-A 4" Hal/pips 6" LONG 1-I/4 PVC Holes PolnBng Up ~ 5 Ft. of Cover oi1~ 1-1/4" Discharge 1 kfirafi 140 ~ 2¥" Lake Otis Grave/ B/OCYCLE PLANT BENCH MARKL: TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ~gNCH AK. 99501 07.)' 279-5916 BIOCYCL£' AERATED TREATMENT PLANT LOT I SHENANDOAH HILLS S/D 1215! SHENANDOAH ROAD SEPTIC SYSTEM DESIGN DATE: JULY 18, 1995 SHEET; 5/5 GRID: 2756 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 EW ~AME MAI LING ADDR E/9'~ ~ ,~ LEGAL,DESCRIPTION _ Coq- ( LOCATION DISTANCE TO: ManufacturerG ~;~ C.~.~~'~,'~ .~ ~ Absorption a~ i/ IF Inside length Liq, HOMEMADE: ~Dwel DISTANCE TO: Well ng Dwelling.~// Width Manufacturer DISTANCE TO: No. of lines Length of each .' Top of tile tolinish grJ:e Length Type of crib Width Crib diameter Material NO. OF BEDROOMS No. of ~.~artments Liquid depth PERMIT NO. Liquid capacity in gallons Foundatio),]~/,~ t~ Nearest Iot~/~ /, PERMIT inches Distance ~...~/e~,~ I i nes Total effective a~)sorption area PERMIT NO. Total effective absorption area Material b~neath tile Depth Crib depth Well Building foundation DISTANCE TO: Class Depth Driller DISTANCE TO: Building foundation Sewer line OTHER Neare~ lot line Distance to lot line PERMIT NO. Septic tank Absorption' ~-rea(s) PIPE MATERIAL~ 7- SOIL TEST RATING REMARKS DATE ~.~._.... /JGAL /',NC!t(} :/<: ~Permi. t II: 810981(Extended thru 1982) January 31, 1983 TO: Permit Applicant Subject: Lot 1 Shenandoah Hills Subdivision A permit issued by this department fer an individual well and/or on-site sewer system has expired as ef December 31, 1982. Permits are issued on a calendar year basis, as stated on ~he permit, by authority of Hunicipal Ordinance. If yeu have drilled the well, a well log needs te be sent to this departmenh fer documentation of the installatien date and to close the permit. If a private engineer inspected the installatien ef eh-site sewer system, please have them send us the as--bull, ts for our files and documentation. If there are any further questions, please call this effice at 264~4720. Sincerel~.~ Rebert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy ef Permit SWP/057 'THE LENGTH [::, ;[ i"tEN~]; :[ ON ]: :B 'THE LENG*FH ,:.' ]:!",! I::'E;ETI" .':, OF THE 'TF<E:t'.,!CH OF;: I;;:,I:;:iF::I]; i'.,IF:']; E:L..D. THE E:,EF'TH OF' F:t "FRENCH OR F'IT :lIE; "f'hlE D i[ZTI:::II",ICE E',Ei:"I"t,.IE:EE!",I THE :BLII:;i'.F'RC'E OF:' "I'!..IE I:;.iI:;i:ER..I!'qE:, Ri'.,I[::, THE E:OTTOI"I OF' THE Ei:.:iE:FI'v'FITION '.'1 Lr.N FEET>. 'THEiI:~:E: ;[:!~ NO :.'+.';lET H:[[::,TH FOR TREt'.,IE:HF2E;. THE: E'iIr;;'.I:::!VEL. DEI::'TH ]::F~; THE h'IINIPIUI'"I E:,E;I::'TH OF GF. iF:t',,¢!:'~;I.... E:E"I'I4EE;N THE: OL.ITF'FIL.L.. FIN[> THE; E',OTT(}hl OF "r'HE E:i:.:iCFI'v'FIT:[OI'.,I ,::):N FEET::,. F:'E.:!:;;:i-,'I :[ '1" I-.I- I- I [(.':FINT HFI'..~; THE; F~'E:":;F'ON:-':'; 3: E: ;[ L. :[ 'T"¢ '1"O ;[ NF'OF?.M 'T'H ;!: :ii; DE:PI:::ff¥'t"htEI'.,!T I:>I..IF..: ]: NEi THE ]:N:5"I"FIt...L.I:¥!'3:;t.I :[I'.,t:R;F'EC'f']:L"3N:~i; OF F:INY HEI....L.:i.?, I::IE:,..:rI::IE:E~;Nqr' TO "I'Ht'Z, I-F....FEI, I' R!'.,fD 'T'H.::j' . RE:.::, .I. [::,ENCE:ii!; THFIT THE. I.,.tEI...L_ H ;.r, LL ..... :'P'F,"r,:. '~...'::' I",!L.Ih'IE:E,:;~: F F ,"'"" ...... J3FIE:KF ;f. L..!.... 3: NG qF' !:::IN¥ .'-;;' %'T'EI'q H .[ THOIJT F :[ ?',I!::IL ]; ['.:i~ F'/:.;" T Ij Ot",! I:4N[::' IqF'PF.:O'v'F'II.... E','¢ TH Z !;:,EF:'FIf;i:"I'TqEI",IT H ]: L.L t:~:E ZI...IE:.jrEC'T TEt F'I:;i:EE!;E(%.rT ]: PI :[ N 3: }"!Ul'q 1:.':, I :!;TFINCE BE:I"I.,.IEE:N F:I HEL. L. F:II",IE:, F:IN'.? O1'.,t..-.:;5 .T. TE ::LEiEi FLEET F'OF: F:! f:'F:~'.I'Vi::iTE HEL..L. ElF: ::LtSEi 'TO ;2EH~3 F'EET FF.:OI'q FI F::'L.IE:L. ]: E: i.,.IE:LI... D!EF'EI'.,IDJ:NG L.IF'OI'.,! 'T'HE 'I""r'F'E: OF' F:'UE:L]:C HEL.t .... M:[NII'qL.Ih'! [:' :[ :~STF!NCE F'ROf'I F:I F'I:;;:];'v'FITE: HELL. TO I:::1 F'F(:]:VR"FE %EP.IEI:;i: I....]:I",IE Z:~; 2~::; FEET FIND 'T'O R COI"II'qUN];TY :E;EHER L.]:NE ]::E; '?'~:~; FE:ET. O"I"HER F;;'.E6]U :[ FREFIE:NT:E; t'"lf:l"r' Fll;::'F'I,,.'¢. :E;F'EC :[ F' :[ E:!':~"[' :1: Efl',IZ I::lt'.,t[::, COI'.,]%'T'RUCT :[ Ot'.,! D ]: I::I(3F~:F!I'"I:~; F::II:;?E T'", ;}; (:;:EFYf' 3: F"r' T!"'IF:IT 3: FIM F¥::Ihl:[L..ZFI~E: I.,.!I'I"H THE PI='':~ '[F'F'hffEENT% F'OF:r F~N-"':~E;]:TE; E;E:I.,J!ER:~; I::INE:' HELLZ I::IZ rE;ET ............. FOI:;¥f'H EW "I"HE MUN:[C:EF'FII....:['I""r' OF FINCHORF:tGE. 2: Z H:[LL. ;[N:STF:ILL 'T'HE Z'¢STEPI :IN RE:E:E~RDFtNCE HITH THE COI:::'ES. :;if:: ]; IJN[::'ERSTF!NE:' THFIT THEE ON-:E;~:TEE SE;HER E;'¢:E~TEhl P!R"r' FE:E:QLIZI:;;'.E ENL. RRGE:PiEENT ]:F:' THE I:RE:5:[DE:NCE Z:5 F:'.f.~:?IODEL. EE:' TO ;!:NCI-.LIDE MORE: THFIN Applicant: Location: Department "UNICIPALITY OF ANCHORAGE Health and Environmental £otection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * ~/OR ON-SITE SEWER PERMIT C~_~ ~' ~/ Mailing Address: Phone Number: Legal Description: LO~- I ~~ ~o~ /~r/~Lot Size: ~ ~ Type of Soil Absorption System Is: Trench: Drainfield: ~<~ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ./ Soil Rating(sq.ft/br) /~-~ ~~~R~ed S~e~f t~ ~lD~rpt~n/ystemwi~: A DEPTH ' ~ h .... ~ .... The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). - * * ~EQUIRED SE~IIC(HOLDING) lANK $[Z5 TM SAhh0NS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * lW0~(2) INSPECTIONS AR5 REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-sJ, te sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedroo~s~ Applicant Date, .~ --- /[ SWP/024(1/81) }'t!:':',;:':; IZ .'j . i'. i",!l .lj"l~:~:Ei:l;;: E f;' ;:.,'i;~; ~- '. ;)')."1'{! ..... :! '!: ~;'! i'I :;;'!:::! i [ i",!!;! '; ::i i. !:: !' :":!::ii;' ;:' : i'j il:i: j:ii:j::~!];¢..i ;i; !;;:lEi;:' llii; T ;::'1;:' Eft::' 'i'F!Ei; ::_'i;E! 'i; t.. !:::IF '::;t'if,~:l::"j' ;!; ()H ' ",': ;' '! Ti :i ':_:; i"I'~E; i;;:'l~!:::'"I'!"i (;F' !:::1 'F:4'F'~:J'" .... .t OF;: i:'];T ;';.7:, 'i"l"il~:;; F:'¢'::;'I"¢:![",h':F: }:~'d'~: i'[,!h;!~;hl 'liqF:' ':::t }l:;;'~ ::!:::q ':i:: Gi;;;C~L!iqE:' F:ii",]i;) 'i'!!i: !.~',I[)T'i"OHOF:' :!"k!~: !~];;:':[E:i:::¢,,,'I::FF);!;d",I ,' i;~',! !:qJ",iE:' 'I'FJE :::: 'qTr' "q', t'-i.:;' Fi.iF:; H:::.:h';;:!::!',,,'fx?J' 'f; ~;;d'.,! ,:; i' i'.,J F:'rE '.'; :::'~:'~;;'i'i T 'F F:IF't'::'!. ;~; E:l:::!i'.,Fr' lq!'::i;;~; ' 't ~:' F;' ':"::; ::'t"thi':~; ]( ~: (I T T ' . ~ ,. '" . ............ ........ 'ii"l ! !,h"i. iF;~:~"i !'~ iT':~; i" :i:': ~' "4 ::' ~,ii:::'i i i ~"u':'::; ..~.~' ~;~'~:l]:!i..i i'l:;?l~:'f) ,:':",i.-, i'iLi;Z;T F:',i':!: RE:i-i.!l:~:i',!~%' I'(:) F!'iE I'" l:::' ::' ~::: :':' !'h ::~J'i' h J::!i]]:~::l :~:! .l::'l[~',! .E: ]"(1 '[ ~'!:~ i,. ~;[:,.~:' j::'¢:,;:!])[::q :[I;;: ]' .",!':::;'J']::!¢ .I .~'::1'!' T I' i~::: :", ,F:::':' ,:~::;;~"..i~ ,:" ...... '~ "5~ ¢::.::.,~" ' "~:,.. -"',~ ~'-'"' )~:] .!:: ;::" ................ ~.::_:~ .:::: i'-', ;¢::::7 ¢ '"-i~:: ::' [~',,'~ ~ :::~ ~:: :' ~:::" '~:~:: ::?¢ .... --,..i: :::~.' ~' i" :' ::;"F T F:'"i" : );::'i'i, : . .. [',E:PRRTMENT r'[ :ERL'FH FIN[) EH',,,'IF'::i'.~MEH'Ff~L F 7'EC'FION F'ERf'I~ T NO. ( ) FtPPLIURNT ~ ~' ) SQLIRRE FEET TYPE OF SOIL RE',SORBTION SYSTEM ZS' MFI,.~IP1UM iqt.IMBER OF E:E:DRC~Cffd'.S = ~-~r/ SOIl. RlaT I NG THE RE}_IRED SIZE OF THE '.:.;OIL FtD'.SCdTF'TIC~N S¥S]'EM IS: THE LENGTH DIMENSION IS THE LENGTH ,:.iN FEET) OF Tt4E TRENCt4 OR DRF~INFIE[_[:,. THE DEF'TH OF FI TREHC:H OR F'IT IS Tt%:. DISTRNE:E BETNEEN TI4E SURFIaC:E OF TIlE GROLIND RND Tt4E BOl"FOH OF 'I'H[ EXCR',,,'R': ~()H ,. IN FEET). THERE IS NO SET k4I[:,TH FOR TRENCHES. THE GRff,,,'EL DEPTH IS THE PiIN:[MLIM I::,EPTFI OF GRFI'v'EI. 8ETI,IEEN TI4E OUTFFILL PIF'E' RND THE BOTTOM OF' THE ENCR',,,'RTION (IN FEET.'.,. PERM I T RPF'L.I C:I-]NT HFI.$;., THE RESF'ONS I E:I L..... T~r T ] INFORM TH I S DEPRRTP1EN'F [:,l ~l;:Z NG THE ZNSTRLLFITION INSF'E'CT]:r)N'5 FiF RN'.r' WELL. S; FtD.Ti:ICEN']' TO Tt4IS FR_FERT~ f~NL:, THE NUMBER C~ RESIDENCES TFIRT THE HEt_I.. W~I..L ..... -f' 1.,..I C~ ,.-i ::~'t ) Z 1'-4 :E'; F' [E: C: ']-- IC] I'-,,! :iE; 1:::1 t:;-": P.,RCKF:[LL I'NG OF RN'-r' S"r'STEM !-.ii THOUT F I NRL ): NSPEC:T Z ')hi FIND DEPFIRT/dENT I,IILL BE SUBJEC:T TO PR".)SEC:UTION. MINIMLIH DISTRNCE BETHEEN R 14ELL :].Og FEET FOR R F'RI'v'RTE WELl_; OR 150 TO 200 FEET FROM R F'LIBI..ZC klELL C, EF'END~NG LIF'ON THE T'¢PE OF PUBLIC I, IEL...L. WEI_L I_OGS RRE REQUIRED RND MUST E',E RE'tURNED TO OF THE WELL COHPLETION. OTHER REQUIREMENTS IIR¥ RPPt_Y. SF'ECIFICR'I'IONS FIH[) E:ONS'rlTLICTION DIRGRRHS RRE RVI~ILFIBL. E TO INSIJRE PROPER INSTRLLFITION. I CERTIFY THRT .IL: I RM FRhIILI~aR I,IITH THE REQUIREMENTS FOR OH-SITE SEWERS fiND WEI_I_S RS :BET FORTH B'¢ THE HLIH[CIPFILZT¥ OF RNCHORRGE. 2: I WILL INSTFILL. THE SYSTEP1 If.4 i':ll[::tZ:lZiR[)Fl~.~C:[~ t4ITH THE CODES. ~:: I I_INDERST~M~f'HI~T THE OH--'S~TE SEHER S'¢S'I'EM rdF¢¢ REQI. IIRE ENLI~RGEMEHT' I F ]'tiE: PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 ~--12 13 14 15 16 17 18 19 2O COMMENTS [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221 SOILS LOG -PERCOLATION TEST SLOPE ~ PERCOLATION TEST DATE PERFORMED: SITE PLAN I ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop / Io/I~,~z,0 /z" O z- ,, ~:,~-~ ~ :- z:~4s~tz'' ~ " ~,.o~ %o /~ z'/~" PERCOLATION RATE 7 (minutes/inch) TESTRUN BETWEEN ,--,~--~ FTAND C~ FT 72-008 (7/76) DATE: LOT TH ~ 0 ? 9 10 II 14 15 16 17 ~8 ~9 2O A,E,C,S,~ INC, ]2.20 W, 2. Ill, AV~!NUE /qCtDI~AGE, INK, 99501 5upp]ern(nLu] Soi.l.c; inFoi-mation. Subdivision '6i LOT l_O1 LOl' T H Z 1 II .25 T FI ~' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 -t ....... SubdJ. v j. sj. on LOT 7 8 9 10 11 12 '13 '14 15 16 17 18 19 20 A,E,C,S,., INC, ].220 l'~, 251}1, AW_NUE AJEt-DIW:E, Al<, '1 H 1_01 [? E P 't H (FEET) 1 2 3 4 6 7 9 10 11 12 '13 14 15 16 11 18 19 20 ([ EET) 1 2 4 9 lO / 11 13 14 20- LOT I 2 3 4 5 6 7 9 10 1] 12 13 14 15 16 17 18 19 20 /. LASKA ^L~nqineerin§ $ ~nuJronmcntal ,~lurJiRs ENVhR .~ 11. St,,,,',. !;0 L- Fi ..I AUG ]. 9 I982 SPECIFICATIONS FOR CURTAIN DRAIN - StlENANDOAlt ltlI, I,S SUBDIVISION LOT 1 RECEIVED 0 GENERAL 1.1 THE DRAWINGS, SllEETS 1 TliRU 3, SHALL BE A PART OF Tills SPECIFICATION. 1~2 ALL MATERIALS AND WORKMANSHIP SttALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl, PROTECTION PERMIT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERFIED OR MODIFIED IN THE FIELD BY THE ENGINEER. 1.4 IT IS THE RESPONSIBILITY OF TIlE OWNER TO OBTAIN ALL NECESSARY PERMITS OR EASEMENTS. 2.0 2.1 2,2 2.3 2,4 2.5 CURTAIN DRAIN THE PIPE FOR TIlE CURTAIN DRAIN SllAI, L BI'] RIGIED PVC PERFORATED PIPE ASTM D 3350 LO6K2B. THE ROCK FII, L SItALL BE 1/2" -- 3 1/2" WASHEI) GRAVEl,. THE ENGINEERING FABRIC SHALL BE TYPAR~ MIRAFI OR F [BERTEX. THE SLOPE OF TIU£ DRAIN SttAI,L NOT BE LESS THAN 0,45 ET/lO0 Fl'. TtlE CURTAIN ])RAIN SiIALL NOT BE P1,ACED Ci,OSER TITAN 20 FT TO ANY SOiL ABSORPTION SYSTEM. 3.0 THE LIFT STATION 3.1 THE STOCK MATERIAL FOR TIlE LIFT STATION SHALL BE EITHER GALVANIZED STEEl, (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 3.2 THE 24" PIPE FOR TIlE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF TIlE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 3.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANEI) OF SLAG. WELDS ON GALVA}IIZED STEEL WILL BE SPRAYED WITH ZINC RICH PAINT.OR COATED WITH BITUMASTIC, 3.4 'FILE TOP CAP SI1ALL BI'] RAIN TIGItT AND SECURELY EASTENED WITH SCREWS. 3.5 Al,I, ELECTRICAl, FITTINGS AND CONNECTIONS IN TIlE LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 3.6 THERE SltALL BE A HIGH LEVEl, Al,ARM,PEABODY BARNES 6147' OR EQUAl, SET AT TIlE LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALl, BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY THE HOMEOWNER° 3.7 THE SUMP PUMP SItALL BE CAPABLE OF DELIVERING i0 GPM AT A HEAD OF 20 FEET, 3.8 THE SUMP PUMF SHALL BE SUSPENDED NO![' LESS THAN 6 INCHES OFF THE BOTTOM OF THE LIFT STATION WITH A CIIAIN OR NYLON LINE, 1220 [Ucsl 25th Aucnu¢ e And, o,,aq¢, Alosk 9,%o3 o (9o1) 276 i361 ALASKA F. NVIRONI~"qTAL CONTROl. SERVICE,, ~NC. 1220 West 25th Avenue ANCtlORAGE, ALASKA 99503 Phone 276-1361 /t/~ 'L' ALASKA ENVIRONi~"'rYAL CONTROL SERVICE._, iNC. 1220 West 25th Avenue ANCHORAGE, AI_ASKA 99503 Phone' 276-~,3{i:1 CFIECKt D DY .............. DATE SCALE /iJ '? ' ' QT 1. ALASKA ENVlRONIV 'TAL CONTROL SERVICES, INC. 1220 Wes'~ 25th Avenue ANCHORAGE, ALASKA 99503 Phon,'a 270-136:1. N O'T' [}'! URE"FHAI',.IE FOAM .SHOUI..L) I',{". APPLIED 'I'C ?: DIZI~TH OF 4 FEET BELOW GROUND SURFACF. :',1 A TItlCI NI::..:,.:, OF ~ INCH, COAl' BOTTOM 2 EEET I',::~I()E WI'Tt-~ I:ITUI'~As'rlc PAINT. SEE q~>:CIF'IC/Vi"tONF, FC~, i','~.i ~'~l ~ ,'~,~' c. GROUND-. ....I'qETAI_. CAF' WITH ~_ UP, LTHAI'.iE 7(-)AM (- } . ,' ' C' .~,' · (.t I W.~-~,,, ......... , _~.,,, / 1.,,~EIVI, A -4 BO'X-.-I, / "'::II_I__ET '\,/ELD . -' .... ~ '( ALI._ /,I', .; [,~ ND" ' CH/\IN Ot-q f',iYL~)N ROPEi PUNP POWFR COFq)-- AF-IL,L ET WELD LL AROUND ._[ ..... [.. 1!4.,o coup,..l c, ~'-.1 ~'"N P-r .~- ] ~(CFIECK VALVE ---' SUNIP PUI"IP .,~ SOILS LOG PERFORMED FOR: LEGAL DESCI~IPTION: MIJNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Stroet, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PER CO LATI ON TEST "('F E~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTEF;ED? IF YES, AT WHAT DEPTH? G~oss No{ Depth to Net Reading [)ate Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) Fl' PERFORMED BY: CERTIFIED BY: DATE: 72-008 (6/79) WATER W,~LL LOG FOSS DRILLING ASSOCIATED 909 CHUGACH DR. #3? ~NCHORAGE~ ALASKA 99503 WELL OWNER. Charles Jackson USE OF WELL WELL LOCATION Lot 1 Shenandoah Hills Subdivision Domestic SIZE OF CASINGS,, . DEPTH OF HOLE 65 FT, STATIC WATER LEVEL l~ FT. G, Po M, p REMARKS CASED TO 6~ FT. WITH 5t FT. OF DRAWDOWN. DATE COMPLETED 2/2/80 PUMP TO BE SET AT 64' ,. 0to ]0 Organic: dark brown color and soft z~ato 6o 60to. 6~ to Alluvium: grey color~ medium hardness Heaving Silt: grey color and soft~ with water Sand and G~avel: grey,..with water to to to ~to~ to to to to to ~to~ to to Parcel I.D. # MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-8650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 015-212-38 1. GENERAL INFORMATION Complete legal description SHENANDOAH HILLS S./D: LOT 1 Location (site addressordirections) 12151 SHENANDOAH ROAD. ANCHORAGE. AK 99516 Property owner ST~VEN ESSLEY Day phone (907) 548-0710 Mailing address 12151 SHENANDOAH ROAD. ANCHORAGE. AK 99516 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community weft system, provide wdtten confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide wdtten confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev, 1/91 ) Front MOA ¢Y21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shaft be paid ¢zSgO~8-at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that nty 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 inspectio, n, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal a~nd/JState codes, ordinances, and regulations in effect on the date of this inspection../"-')- Name of Firm ALASKAWAT~R&/Wj¢ rEWA/TER CONSULTANTS, INC. Phone (907} 337..6179 Address 6901 DEBARR RO/AD, S/JI~/E ~J~HO~GE, ALASKA 99504 Engineer's Signature ~--//-~/~~t,v ¢---~ .- Date /~/2~ In conducting this evaluation, AWWC, Inc.~attC/'np t to pro~d~ thorough, conscientious engineering analysis of the system in accordance with ADEC and M¢AD, HH~ Guidelines & Regulations. The reported results described the performance of the system under the conditions ehcountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend ~n the ~~ca~ s~i~s conditi~n~ greund water ~eVe~s that may ~uctuate during the year~ and the water osage of the family being served by tho system. These conditions are outside the control of the evaluator ef the system. Satisfactory test results do not guarantee future performance ~.. (..~ ~/ .... .. of the system, nor do they guarantee that there are no hidden defects or encroachments. "'~];~,'?.~0^;" ' '~".... AWWC, Inc. can therefore not prot4da any warranty for future estimate of how long the system will continua to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, · . ,,¢ .. .?,~ .' ............ nor will it confer any legal right whatsoever. 6. DHHS SIGNATURE ~ Approved for L~ Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments By: /') ¢-~. _.~/.~-~/ ~'..-/, /'<:)¢-'~-'(" Date / O -;2. Q- ~z) o 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 Computer Version RECEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICEi T Environmental Services Division 825 "L" Street Rm 502 Anchorage, Alaska 99501 (907) 343-4744 ~j~'-~---'~ MUN C PALITY OF ANCH ,CT'~"~ ENVIRONMENTAL SEP, VICES DIVISION Health Authority Approval Checklist Legal Description: SHENANDOAH HILLS S/D; LOT 1 Parcel I.D.: 015-212-38 A. WELL DATA Well Type. PRIVATE Log present (Y/N) Y Date completed Total depth 65' Cased to 65' Sanitary seal (Y/N) IfA, B, or C, attach ADEC letter. ADEC water system number N/A 2/2/80 Casing height (above ground) 18'% YES Wires properly protected (Y/N) YES Date of test FROM WELL LOG 2/2/80 AT INSPECTION 10/12/00 Static water level 12' 5~ Well production 5 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform ,~ Nitrate Date of sample: 10,/19/2000 B. SEPTIC/HOLDING TANK DATA Date installed 9/4/96 Tank size Collected by: 4000 Number of Compartments Other bacteda J A.W.W.C., INC. Foundation cleanOut (Y/N). YES Depression (Y/N) NO Date of pumping 9/18/00 Pumper ISAAC'S 1 Cleanouts (Y/N) YES High water alarm (Y/N) YES C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ff2 or fl2/bdrm) System type ~ Length Width Gravel thickness below pipe ~epth Effective absorption area Monitoring Tube p~ Depression over field (Y/N). Date of adequacy test ~J~ass/Fail) FOr Bedrooms Fluid depth in absorpt~, iatal~ after, gal. watar added (in.): __ Fluid depth ,.--~~ater: Absorption rate =_ p~ (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* Computer Version D. LIFT STATION Date installed Size in gallons_ Manhole/Access (Y/N) "Pump o~ "Pump off" level at* High water alarm level at* .~~~*Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 8eptic~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 75'+ N/A 25'+ On adjacent lots 100'+ On adjacent lots 1 o0'+ Public sewer manhole/cleanout N/A__ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Absorption field N/A Walls on adjacent lots. __75% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Surface water -------"-"-"-~veway, parking/vehicle storage area ~ Wells on adjacent lots I certify that I hav,~ de~bn of Municipal records t~a~ with MOA Signature ~--~/f Engineer's Name/ v ~/ Date :1 inspections and review stems are in conformance this date. JEFFREY A. GARNESS HAA Fee $ Date of Payment Receipt Number 72-028 (Rev. 3/98)* Compuler Waiver Fee $ Date of Payment Receipt Number. 10-25-00 11:24 FROM-CTE ENVIRON~NTAL CT&E Environmental Services Inc. 5615~01 T-92§ P.01/02 F-042 1006564001 AK Water & Wastewater Consultants Inc. Shenandoah Lot 1 Shenandoah Lot 1 Drinking Water Client PO# CT&E Ref.# Printed Date/Time 10/25/2000 11:08 Client Name Collected Date/Time 10/19/2000 16:25 Project Name/# Received Date/Time 10/19/2000 17:00 Client Sample ID Technical Director Stephen C. Ede Matrix ~ Ordered By Released By PWSID 0 Sample Remarks: Attonabte Prep Anatvsis 0.589 0.500 mg/L EPA300.0 10max 10/20/00 SCL Nitrate~N ~_~io 1 Qgy Lab-°rat°r~ Total Colifm'm 0 col/100mL SM18 9222B 10/19/00 IDT MUNICIPALITY OF ANCHORAGE ,,~ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of EnvirOnmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION Complete legal description 6ol- Location (site address or directions) Property owner ~ ~ '~ -.~~-- ~.~wdh~,L. Day phone ~'¢r'~' - 5",~F,~/ Mailing address Lending agency Mailing address Agent f"-) I~ Day phone "'JA Address NJ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ MUNICIPALITY OF/M',ICHOF, AGH TYPE OF WATER SUPPLY: Individual well Community well ENVIRONMENTAL SERVICES DIVISION "19% NOV RECEIVED Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. 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. 72-025 (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. Name of Firm _~_~.4- Address ~E~'~ll-~/2~ .~//¢~)F'~¢ ~--q~H-Phone Engineer's signature t~/~'~--"'~ Date Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~- Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional eng'ineer 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. 72-025 (Rev. 1/91 ) Back MOA #21 MUNICIPALiTy OF ,~/CHc..~- ENVIRONMENTAL 8ERVI Municipality of Anchorage c~.,~/'~ DEPARTMENT OF HEALTH & HUMAN SERVICES J~0V 1 4 7~5 Environmental Services Division ' Street, Room 502. Anchorage, Alaska 99501. (907/a4~E~Ei V£ D Health Authority Approval Checklist Legal Description: A. WELL DATA Well type ~::~4 ~'' Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number "'J ~ '~ Date completed ~,/~/8' O Cased to ~ ~ Casing height (above ground) ''>'/'~'// Wires properly protected (Y/N) Date of test Static water level /_~_FROM WELL LOG AT INSPECTION / / 17_, ~r, .5' ~.~, ~ Well production WATER sAMPLE RESULTS: Coliform Date of sample: It/t Nitrate g.p.m. Collected by: ,. S~PT~C/.O'D~N~TA.~DATA ~,,~,~. ~ ~_~ Date installed q/,p,/c] ~. Tank size .~¢E) Number of Compartments I Cleanouts (Y/N) ~/,E~ Foundation cleanout (Y/N) N~--- (~ Depression (Y/N) t JO High water alarm (Y/N) ~--J2 Date of Pumping / Pumper C.~-~.PTION FIELD DATA Date inst. Soil rating (g.p.d./fF or fF/bdrm) _ System type Length '""'"'""'"'-.~idth Gravel thickness below pipe ~ Effective abso r ption area"'""'"'"--,._ Monitoring Tube present (Y~~pres~ion over field (y/N) __ Date of adequacy test ~~__ For Fluid depth in absorption field before t~cstlTn.)~tely after gali wate¢ add~ed (in.):. Fluid depth __~s later: Abso~, g.p.d. Perox~nt (past 12 months)(Y/N) If yes, give date -'~-~._"~"~ 7~. 6 (Rev. 3/96)* bedrooms Manhole/Access (Y/N) ._~-~ "Pump off" level at* High water alarm level at* ~ '*r)~t,,m ~'~.._ E, SEPARATION DISTANCES ,.9~¢'e~holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: I'~-O ~-; · On adjacent lots ! On adjacent lots Public sewer manhole/cleano~l. Lift station SEPARATION DISTANCES FROM 8E'P-T-~/HOLDING TANK ON LOTTO: Foundation II ~ '~ .~, Property line '¢¢~/~ Absorption field Water main/servicb line ~.~OI .Surface water/drainage ~' ~oo/ Wells on adjacent lots SE~CE FROM ABSOBPTION FIELD ONLOT TO: Property hne ~ -~*"--~-~'-~~e Fine Surface water ~ -~'-'~-- Drive~~sto - ay, parK~a-- ~ Wells on adjacent lots ENGINEER'S CERTIFICATION /A I certffy that lhav/e~lt~te~Y/Cinedt~.fi/~t/dfnspections an; in conformanywith ~N HA/( g~C~J~e~ in effect on this date. HAA Fee $. ~"~. ~ Date of Payment Receipt Number ,~j~/ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* CT&E Ret,# Cllent Name Project Name/# Cltent Sample ID M~trlx . Ordered' By PWS1D ,. 965891(1(11 AK Water ,qc Wastewater Services Lot 1 Sltentmndoah Drinldng Water $}'unple Remarks: ......... S~unple Collected by: ,left Client PO# Printed Date/Time 11/12/96 li:22 Collected Date/Time 11/01/96 13:50 Received I)ate/'llme 11/01/96 1~:00 Technical Director: S/el)hen C, Ede P~r~moter ~itrate. N Total eol{{orm RQOUItS 0.773 0 AlloweDlo Drop M~thod Limits O~te 0,100 ~I~/L SM18 4500'NO3F 10 max 0 co//lOOmL $M16 9222B Anolysi~ Date lr 11/04195 11/01/96 " DAXE-'~'ECEI V E D INSPECTION APPOINTMENTS ~,j~ DATE MUNICIPALITY OF ANCHORAGE ~UNICIPA DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~T OF 825 L Street - Anchorage, Alaska 99501 [NVIRONiv;~iql,':,.L ,, J'I~:CTION EUWRO E TAL SA ITAT O P V S ON [, AY 3 1980 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MAI~G ADDRESS PROPERTY RESIDE'NT (If different from above) ' ' - ~ PHONE 2. BUYER PHONE ~AILING ADDRESS 3. LENDING INSTITUTION ~ PHONE I MAI LING ADDR ESS 4. REALTOR/AGENT ~ PHONE MAILING ADDRESS TYPE OF RESIDENCE NUMBER OF,BED,.RO_~IS "~----... SI NG LE [] One .~J.~ Four [] FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six Other 7, WAT.~ER ~PPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** / ~'~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev, 6~79)~L/~ THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LO REOE,VED PERMIT NUMBER DATE INSTALLED 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL, SYSTEM [] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified. []Septic Tank or []Holding Tank Size:_] ~)- 5'O If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line INearest Lot Line 5. COMMENTS DATE ~/~APPROV ED FOR ~Z: BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)