HomeMy WebLinkAboutWHALEY TR 1AWhaley
Tract 1A
#051-111-70
/ 3
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • .Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. 5w9'Aoill PID Number. 051—a-170
Name: M M; -M J5cRrrn.A c7n14
Wastewater System: New ❑ Upgrade
Address:
ABSORPTION FIELD
P.D. boa. 17oqqs v IA1L '1175(7
Phone:
G3$—/Z3i.
No. of Bedrooms:
3
O D"p Trench O Shallow Trench pod O Mound D Other
DESCRIPTION
Soil Rating:
Total Depth from Original pods:
3.D
LEGAL
.4 GPG/3 Pt
Lot:Bloch: Subdivision:
Depth to pipe bottom from orpmel grace:
Gravel depth' beneath pipe
71
T/t�w LJNAL.W/
.O Ft
Ft.
/A
Township:
Range
Section:
Fill added above anginal grade:
/
Gravel length: �I
`T Ft.
Ft
(New C3Up9rade
Gravel width:
/8
Number of lines:
3
Distance betty 0 Ino
& FI.
WELL:
Ft
Classdte^a�non (Private. A.B.C): Tont Depth: Cased To:
ZOS
Total absorption area: Ploe�mAra`tenal: PVL FBIa
/� L Ft. �A
r1Z.1\I ATE ZOS Ft. Ft.
So
Dauer. Date 0p Ilea: 5tauo water Laver.
1 /5B
Installer. Date Installed:
& rrzAcn 6
SVLLNr44l 6/4G Ft.
yretd: Pump Set at 1 casing HugrltAbove Ground.
TANK
7 GPM Ft. Z Ft.
SEPARATION DISTANCES
0Septic 0Holding V;S.T.EP.
To
seam
AaferatWm
un
Hamra
bLNRweu
Manufacturer. Capacity In gallons:
manufacturer.
TAI IL /r 5,410
From
Tan
r
Fac
r
sutwn
f
Tam.
IA
ae-ertatee
,
Material, ST66L Number of Compartments:
v
Well
/Z7
>175
/L
77 5
Surfer°
�/oo'
>100'
>/OD'
141A
>/oO'
LIFT STATION
Lot !
71 18.5' I f Al/A >zo'
size in gallons: Manufacturer.
z Axjw TA44. Onolco
Line
Foundation Ste' 9$' $Z' NlQ --
'Pump on" level at 'Pump air level at High �Salanm at
'{$' '')L/r'
Curtain
�OA1E On) �7•
Pump Make a Model Electrical Inspections performed or.
OHZO EAUx- �a6C.T'%aL
Orlin
BENCH MARK
Remarks: NT /ISE A oreorl0n
�
Location and Description: Sova—_
l25r
McLI /N VL—.
C7_0er
o./CrLrb W
ora A1.
Assumed Elwatlon: //1. 9 n
SEAL .
ZZ
..' IJP� 0446iia..a.0""i`P Ee
Ee el, .aa .L
/1 �S1951
by: p 14A2ALA Wine' lst
`' r ^
nrao..ee•a: r..•e.. w.... f}
alio. f
Inspections performed
2nd
/I/Sj9S, 8 b 94
icrt t
Department of Health and Human Services approval
°
Date: -3'
---
Reviewed and approved by:
/ Permit No. S tJ 920 q11
Page Z of 3
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
Legal Description: ��nkT /� 1JOALC-Y Svcs. PID No.: 05l-//-t�v
Permit No. 5049Y04/11
Page of 3
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
Legal Description: 79—Ac.>r /A 14JNA«y S01; PID No.: OS'/-�% 7T
4
Pr
T #isror..—.
finrc. Sr�v,✓G G.3.3c
IM
i 1 t
.. ...
N.khosl E. /.nL vscn
..._ . ........._._._._. ..... _ ..._....... /f� J,•,.... .4:91 • E �
B-09-1996 8:33AM FROM EAGLE ELECTRIC INC. 907 344 0827
`r ..
EAGLE
ELECTRIC
%INCORPORATED
August 9, 1996
Anderson Engineering
Attn: Mike Anderson
P.O. Box 240773
Anchorage, Alaska 99524
Re:. Tract 1A Whaley Subdivision
'The wiring for the septic lift station has been completed, per National Electrical Code.
Please note that the underground OF cable was buried by others.. .
If you .have any questions or concerns regarding the above information, please do. not
hesitate to contact me @ 344-7121. Thank you for your time. '
Sincerely,
Todd Houston
President
P. 1
ELECTRICAL CON'T'RACTING
Construction • •Maintenance • Remodel • Code Upgrade Statewide Servlet • Lkensed DondedandInsured
7711 Schoon Street Suite 1 • -Anchorage. Alaska 9951&3038 • (907') 121 344-7 • FAX(907)344-0827
P.O. Iiox 871632 • Wuilty Ataske 99687-1632 • (907) 3736881
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW960102
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:M M & M CONTRACTING
OWNER ADDRESS:P.O BOX 670495
CHUGIAK, ALASKA 99567
PARCEL ID:05111170
LEGAL DESCRIPTION:
WHALEY TR 1A
LOT SIZE: 79772 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF
�nc�l
DATE ISSUED: 6/06/96
EXPIRATION DATE: 6/06/97
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 (18AAC80).
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
ISSUED BY
DATE. 1, /& 1%
DATE
1
ANDERSON ENGINEERING
P.O. Box 246773
ANCHORAGE, AIS 99524
663-7115S 6634989: (FAX)
May 16, 1996
Municipality of Anchorage
Department of Heath & Human Services
825 'L' Street
Anchorage, AK 99502-0650
Subject: Tract 1A, Whaley Subdivision
Well and Water System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The owner of Tract 1A, Whaley Subdivision originally intended to connect to a
community water system to serve the needs of the house proposed for the lot. The
community system, however, was unavailable and a well must now be drilled on
the property. The attached site plan indicates the location of the proposed well
and shows the protective radius. No conflicts with septic systems in the area are
noted.
If the well is placed in the location shown the following statements can be made:
1. The well, if constructed as designed, will have no adverse impact on other
wells in the area or those to be constructed in the future.
2. The well, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in
the future.
3. The well, if constructed as designed, will have no adverse impact on reserved
space, either surface or subsurface, on any lots located in the area.
4. The well, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
A1-
Sincerely,
r
i'
Michael E. Anderson, P.E.
Attachments
POSED WELL' _ -- ---
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ANDERSONRENOINEERING
°P.0. SOX 240773
ANCHOAAaEl AIC 99524
MEMORANDUM
DATE: June 5, 1995
TO: Jim Williams, MOA- DHHS
FROM: Mike Anderson, P.E.
SUBJECT: Tract IA, Whaley Subdivision
Attached is a drawing of the S.T.E.P. tank and absorption bed which were recently
constructed on Tract IA of Whaley Subdivison. The tank was not placed in the location
shown on the original permit because the contractor decided to move the house to the east
side of the lot. The absorption bed, however, is in the location indicated on the permit.
The proposed well will be a minimum of 100' from both the S.T.E.P. tank and the
absorption bed. The final as -built showing both the final location of the well and the
completed septic system will be submitted once the pump is placed in the lift station and
final grading is completed over and around the absorption bed.
JOB Tr:ntr ,/�, ,�,+,►�y
SHEET NO. _ Of
CALCULATED BY 'DATE
CHECKED BY DATE
7
_–'-- —--------- --SE –
PaoR co"-
FROM MMM CONTRACTING PHONE NO. : 6881238 Aug. 08 19% 06:50PM PS
Tp' ftifirb Dr 1*11ing log
00c
co.ao• '
SULLIVAN WATER FELLS
P.O. BOX 67DP72,CHUOIAK,ALASKA 99667 • TELEPHONE666.2769
)WNER OF LAND LL � DEPTH OF WELL 0 v
►DDRESS]Q)_t6f?X STATIC LEVEL OF WATER FT. o
LEGAL DESCRIPTIO. �Q DRAW DOWN FT.
DATE •Started Eadcd GALS. PER HR
PERMITNUMBER KIND OF CAS►\G .^�
From
Ft. to
OND Of FORMATION:
J"
••
_ From it•tu
From_a• Ft.to.42—rI. Jenk ►>-t /
FI.
1
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Ft.
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Ft.
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From Ft. to—ft.
From - Ft• to ' Ft
Flom Ft Io Ft.
From Ft. to Ft.
From Pt. to Ft. From Ft. to— _—.Ft —�.
MISCL.INFORMATION: _ _ ` _ ,__ •,_ ._
brand fax transmlttalmemo 767t
IofpWa►
DRILLER'!'rNAME ► ,, "I
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE I`'t Il�q'gq ( ;Upp/n
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940411
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:M M & M CONTRACTING
OWNER ADDRESS:P.O. BOX 670495
CHUGIAK, ALASKA 99567
PARCEL ID:05111170
LEGAL DESCRIPTION: WHALEY TR 1A
LOT SIZE: 79772 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT:
THIS PERMIT IS FOR THE
DISPOSAL FIELD /SEPTIC
ALL CONSTRUCTION MUST
CONTRUCTION OF:
TANK SYSTEM
BE IN ACCORDANCE WITH:
DATE ISSUED:10/25/94
EXPIRATION DATE:10/25/95
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 (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
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:'
t'1:-..BOTTOM"OF BED 'EXCAVATION SHALL BE��NO" -T
DEEPERHAN'THREE--'- '
z"(3) FEET FROM GROUND SURFACE.*
r2,.-" ORIFACE PATTERN SHALL BE STAGGERED_BETWEEN�LATERALS'SO 7'
?THEY ARE NOT SIDE BE.SIDE..' /
RECEIVED BY: z � DATE: �0)r4/9y
ISSUED BY:
DATE:/0-25--74-
I
ATE:/U"2S -9¢
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
October 12, 1994
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Tract 1-A, Whaley Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
We hereby request that a permit be issued for the construction of a septic
system on the subject property. The location of the system and and the
reserve site are shown on the attached site plan. In addition, the topography
of the lot and existing drainage pattern is also illustrated on the plan. Soils
encountered during the field study indicate acceptable conditions for an
onsite sytem. The location of the system, however, requires that a S.T.E.P.
pressure system be constructed. The lot will be served by a community
water system so well construction is not required. If the system is
completed as designed the following statements can be made:
1. The system, if constructed as designed, will have no adverse impact on
the wells currently in use as the subdivision is served by a community
water system.
2. The system, if constructed as designed, will have no adverse impact on
existing septic systems in the area or those to be constructed in the
future.
3. The system, if constructed as designed, will have no adverse impact on
reserved space, either surface or subsurface, on any lots located in the
area.
4. The system, if constructed as designed, will have no adverse impact on
drainage patterns in the area. p'Al-
Sincerely, F. C1.)
tuftACC� (,,,' •T: :S. ........'+ e
��•jo Kchad E. And�rwn ::
Michael E. Anderson, P.E. �a. �f 43e1.E .:4.v
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Tract 1A, Whaley Subdivision
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom
Home
Shallow Bed
System
Perc. Rate: 27
Min./Inch
1,500 Gallon
S.T.E.P. System
Application Rate:
.4 GPD/SF
2' Percable
Soil Beneath Bed
3 Bdrms. R 150 GPD / .4 GPD/SF = 1,125 SF of Absorption Area
1,125 SF / 18 LF (Bed Width) = 63 LF (Bed Length)
Therefore: Construct a Pressure Distribution System Utilizing a
1,500 Gallon S.T.E.P. System with 3 Laterals, Each 57' In Length.
Pump Type: 20 OSI 05 HHF - 5 Stage
Three Laterals: 57' Long
Orifices per Lateral: 9 @ 633' Spacing' .
Orifice Size: .1875" Facing Downward
Lateral Diameter: it,
Manifold Diameter: 1.25"
i
_—%I �H //�\// �`\ \.�� I—iJ��/�TtJRi:�L.—BAGcFIi,(:.�!• i —r� / �\ /p�/tl��i
i 0I I O I -O I I , D¢alyrl
I I I I i I I I 1 1 I I I -1 ' r I Z 11 D,rcn
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i I I I I i I r I r y r r i I I lr I I 1 i I, 1 I I
•• d
r
t.�Twa y"_1 :,� a?
TYPICAL SHALLOW BED SY TEM "1'4�r Mahml E. a4331 Ed.mn Q Al
(No Scale) i �F •. , •• ��
NOTE: Grade Area Over Bed to Drain Away From `Area mad
Minimum of 3' Cover Required Over Bed
,O.T er /A.ALgjy
:5yniyIspo4
SHEET NO.
/
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CALCULATED BY
d
Al 9f}
DATE
CHECKED By
DATE
. SCALE
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NET DISCHARGE, GPM ZG' 31 6. P rA
ORENCOSYSTEMS,INC 2B26COLONIALROAD ROSEBURG,OR97470 (503)673-0165
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED
LEGAL DESCRIPTION:��,�
II
e5P7M.
w
2
0
5 M
3
7 4
e'
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i
5-
6
6-
7-
78
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13
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15-
16-
17-
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415161718
19
20
COMMENTS
SLOPE
I3
WAS GROUND WATER /
ENCOUNTERED?
IF YES, AT WHAT /
DEPTH?
Depth to Waer Anter
11miturinD? Dslc ro
•ichoel E. Anderwn
s 4781-E
T
�1�yF�P/�,nn.�M.
DATE PERFCHMEO:' =�t
Section:
SITtc PLAN
SI
L FFF"'
Am
®®m
II
m�
EXEMM
r•
PERCOLATION RATE Z (minuteshmh( PERC HOLE DIAMETER
TEST RUN BETWEEN 3�% FT AND SFT
;4-%Amko
PERFORMED BY: "� I 74"W TIF THAT THIST nST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:�L�`F
7208 (Rev. 4/85)
e v •Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
1 ' SOILS LOG — PERCOLATION TEST
PERFORMED
LEGAL DESC
A rG,�� „j1ErNGINEEA'S SEAL)
j E. Anderson
4381-E ,
k
DATE PERFORMEDt•?i
), Range, Section:
SLOPE SITE PLAN
10 0 }/ . WAS GROUND WATER
O ENCOUNTERED? A
tt Ufa S
�OA( IF YES, AT WHAT / L
12 DEPTH? p
E
Depth to Water Alter ,
13 Mon for nD7 Dric 1,7L4
14 4'
15-
16-
17-
18-
191
516171819
20
PERCOLATION RATE (mmuteLinch) PERC HOLE DIAMETER 7_
TEST RUN BETWEEN �•L FT AND Zi_FT
COMMENTSy -ia-> 15095
PERFORMED BY: �1 ER FY THAT Ty IS TE TT�WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /Oj/�ZL% y
72-0118 (Rev. 41115)
�i►767L"./1S"�5���
PERCOLATION RATE (mmuteLinch) PERC HOLE DIAMETER 7_
TEST RUN BETWEEN �•L FT AND Zi_FT
COMMENTSy -ia-> 15095
PERFORMED BY: �1 ER FY THAT Ty IS TE TT�WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /Oj/�ZL% y
72-0118 (Rev. 41115)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Tract 1-A, Whaley Subdivision
GENERAL:
1. The scope of this project includes the procurement and
installation of a 1,500 gallon S.T.E.P. pressure distribution
system and shallow absorption bed to serve the proposed
three bedroom home.
2. Construction shall be in accordance with ithe", approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal. Regulations.
3. The Contractor shall be responsible for obtaining all
underground utility locates.
4. Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall also be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK/LIFT STATION INSTALLATION
1. A septic tank/lift station is to be constructed by a
certified septic tank manufacturer. Construction shall
include two 4' cleanouts for pumping access and an 18'
manhole for access to the lift station.
2. The septic tank/lift station shall be sufficiently bedded to
prevent settling or shifting of the tank.
Tract 1-A, Whaley Subdivision
October 12, 1994
Page Two
3. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
4. Septic tanks/lift stations installed without 4' of cover
shall have a minimum of 2' of direct burial insulation.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. No cleanouts are required
between the tank and the drainfield in a pressure
distribution system.
6. Final grading over the septic tank/lift station shall be such
that a positive slope exists away from the septic tank.
SHALLOW ABSORPTION BED CONSTRUCTION:
1. The absorption bed shall be constructed to the dimensions
shown on the design. The bottom of the bed shall be within
2' of level. The bottom of the bed must be raked before
gravel placement.
2. Distribution piping must be placed level with perforations
down atop a level bed of drainfield rock. Rock should then
be placed over the pipe to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4' in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
5. Direct bury insulation must be placed over the distribution
system when less than 3' of backfill depth is available.
Finish grade over the trench must be mounded to prevent
settlement or depressions.
Tract 1-A, Whaley Subdivision
October 11, 1994
Page Three
MATERIAL SPECIFICATIONS:
1. Septic tank/lift station must be constructed by a
Municipally approved septic tank manufacturer. An Orenco
20 OSI 05 HHF - 5 is recommended.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated, but
not solid) and ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 seive.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
Tract 1-A, Whaley Subdivision
October 11, 1994
Page Four
standpipes, cleanouts and insulation. No backfill should be in
place at the time of the second inspection.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-11-170
1. GENERAL INFORMATION
Complete legal description Tract 1A, Whaley Subdivision
HAA#
Expiration Date:
Location (site address or directions) 24016 Ski Road
Current Property owner(s) Brett & Lucy Goode Day phone 6884099
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P.O.OBox 672449, Chugiak, Alaska 99567
FSBO
None
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup. OX FD a I0 f -G )1
2. NUMBER OF BEDROOMS: 3 \J
3. TYPE OF WATER SUPPLY:
Municipality of Anchorage
TYPE OF WASTEWATER DISPOSAL:
Development Services Department
Q
Building Safety Division
❑✓
On -Site Water and Wastewater Program
a
4700 South Bragaw St.
❑
P.O. Box 196650 Anchorage, AK 99519-6650
❑
www.muni.orglonsite
law
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-11-170
1. GENERAL INFORMATION
Complete legal description Tract 1A, Whaley Subdivision
HAA#
Expiration Date:
Location (site address or directions) 24016 Ski Road
Current Property owner(s) Brett & Lucy Goode Day phone 6884099
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P.O.OBox 672449, Chugiak, Alaska 99567
FSBO
None
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup. OX FD a I0 f -G )1
2. NUMBER OF BEDROOMS: 3 \J
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 Theta Environmental & Engineering Phone 242-0755
Address 660 Maney Dr. Wasilla, Alaska 99654
Engineer's Printed Name Ronald E. Godden
5. DSD SIGNATURE
_ Approved for _� bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineers Report
Other
By: Original Certificate Date:
Qta .01101)
Municipality of Anchorage
(/ Development Services Department `:..
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Tract Ia. Whaley Subdivision Parcel ID: 015-111-70
A. WELL DATA
Well type P-010 If A, B, or C provide PWSID #
Date completed 6/96 Sanitary seal (Y/N).YL_
Total depth 205 % Cased to205•• ft,
FROM WELL LOG
Date of test 06/96, On File, MOA
Static water level 158' ft.
Well production 7.0' 9.p -m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 1.97 mg.A.
Arsenic: ND mg.A. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Anchorage Tank, Steel.
( , Tank size 1, 00 .:gal. Number of Compartments°
Foundation cleanout (YM) Y Depression over tank (Y/N) N
Date of pumping 10/04/05 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 11/5/94' Soil rating (g.p.d.te or f:21bdrm)04..
Well Log (Y/N).Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24' in.
AT INSPECTION
10/0405
150.97 ft.
4.33
Other bacteria 0
9—
p.m-
colonies/100 ml.
Collected by: R. Godden
Date installed 11/5194
Cleanouts (Y/N) Y
High water alarm (Y/N) ►yq- Y L'e"/'ry"b
System type Shallow Bed"
Length 64.. " ft. Width 18" ft. Gravel below pipe 0.7" ft.
Total depth 4* ft. EH. absorption area 1152 ft' Monitoring tube Y_ Depression over field N
Date of adequacy test 10/04/05 Results (Pass/Fail) Pass ' '� For 3 bedrooms
Fluid depth in absorption field before test dry in. Water added t 46 gal. New depth007" in.
Elapsed Time: 5 min. Final fluid depth dry in. Absorption rate >= 648 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Unknown If yes, give date
D. LIFT STATION
Date installed 11/5/94 Size in gallons 250
'Pump on' level at Eft 5 in. 'Pump off" level at Eft 6 in.
Datum Below top of riser Cycles tested 2
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot + 100.0 ft'
Absorption field on lot +100 ft•
Public sewer main N/A
Sewer /septic service line + 25 ft"
Manhole/Access (Y/N) Y
High water alar level at 6 It 3 in.
Meets alarm & circuit requirements? Y
On adjacent lots +100.0 W
On adjacent lots + 100.o Fr
Public sewer manhole/cleanout NIA
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation + 10 Ft' Property line*10 fr Absorption field +10 ft'
Water main NIA Water service line .+ 25 ft" Surface water + 100 ft'
Wells on adjacent lots + 100 R
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line + 10 ft" Building foundation +10 Ft' Water main NA
Water Service line + 25 Ft's Surface water + 100 ft' Driveway, parking/vehicle storage +10 W
Curtain drain NIA Wells on adjacent lots + 100 ft'
F. COMMENTS
From MOA Records, Installation
G. ENGINEER'S CERTIFICATION
I certify that 1 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 Ronald E. Godden
Date (01 u} /0
HAA Fee $ 4 1— C:),00 �
Date of Payment (6/64
Receipt Number "'r:nZt D. -Al s4fYM
(Rev. 12/01)
11/5/94, 'Observed
Waiver Fee $
Date of Payment
Receipt Number
10/19/2000 09:23 9076943093 C#AT L40 REALTY PAGE 02/02
I
C*y
AS•BUMT
t hereby certify that L have etuwyed the following described
.•......,. / A'.
ty�l trlaY .5'vIn1.
Anchorage Rect rding Precinct, Alaska, and that the Improve-
ments situated titanion am within the property lines and do not
overlap or encroach on the property lying adjacent thereto, that
no Itnprovement6 on propperty Lyin adl1scont thereto encroach.
od-the premises in questJon and that there,are no roadways,
tranaml+ston Lines or other visible easements on said property
excaptas indicated hereon,
Dated at E gle Rlvef, Aluk�a
thl.
.sL" dayor0r_L'�
ROBERT C. (OHN5ON —O�Fa
SCALE: Registc d Land Surveyor No. 60 -LS
1'• a} -p' Box 77-0156, Eagle Itiver, Alaska 99577
'phone (9m) 6941513'
Municipality of Anchorage
!�� —•
Department of Health and Human Services
Division of Environmental Services 1 f
' On -Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE FAMILY DWELLING
Parcel I.D. 051-11-170 HAA" /_/Pl✓Cr5/-�-
Expiration Date:
GENERAL INFORMATION
Complete legal description Tract 1A, Whaley Subdivision
Location (site address or directions)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Ski Road at Park Drive
John Smelcer
Dayphone 688-4268
P.O. Box 328 Anchorage, AK 99508
Day phone
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Three (3)
TYPE OF WASTEWATER DISPOSAL:
® Individual On-site
Individual Water Storage ❑
Community Class Well ❑
Public Water System
u
Individual Holding Tank
Community On-site
Public Sewer
L
The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family cn-site
wastewater disposal and.'or water supply system. DHHS also issues HAAs upon request to home owners.
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
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 encineer's work.
72025 iRev 0100)'
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show 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 applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P_O- Box 240773
An ho aag, AK 99524
Engineer's Printed Name Mi ha t _
Anderson, P_F_ Date 10/12/00
ENGINEERS
:15._-•
'T�/'�°y "I' '-- ///'{1 • STAMP
:•' ✓ .rte-�4'1+2�"`-�1n.�.�.t�
6. DHHS SIGNATURE
% ''
Approved for 3 bedrooms.
Disapproved.
` ` -
r
Conditional approval for
bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: (/ i>�t/ �. d Original Certificate Date: / O -16 -o o
Expiration Date: — / (o - O / Reissue Date:
75.025 (Rey 01 00)'
n.
Municipality of Anchorag-' a
e
Department of Health and Human Service E C E I V E
Division of Environmental Services
On -Site Services Section 825 "L• Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us OCT 12 2000
(907) 343-4744
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL CHECKV=ONMENTAL SEIMCES DIVIS ON
Legal Description: Tract 1A, Whaley Subdivision Paarcel 1I.D
51-1-f71T—
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log Y
Date completed 619 Sanitary seal Y Wires properly protected Y
Total depth 205 ft Cased to 205 It Casing height (above ground) ' 12 in.
FROM WELL LOG AT INSPECTION
Date of test 6/96 10/11/00
Static water level 158 It 155 It
Well production 7 g.p.m 4.1 9 -p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml Nitrate • 5 mgll Other bacteria 0 colonies/100 ml
Date of sample: 10 / 4 / 0 0 Collected by: MEA
B. SEPTIC/HOLDING TANK DATA
TankType/Material Steel
Date installed 11/5/94 Tank size 1 , 500 gal Number of Compartments 3
Cieanouts Y Foundation cleanout Y Depression over tank N High water alarm Y
Date of pumping 5/15/00 Pumper JR's Pumping
C. ABSORPTION FIELD DATA
Date installed 11/5/94 Soil rating (g.p.d./ft2 or ft2/bdrm) • 4 System type Shallow Bed
Length _EA_ft Width 18 ft Gravel below pipe• _ ft
Total depth 4 ft Effective absorption areal ,15 A2 Monitoring tube Y Depression over field N
Date of adequacy test 10/11 /00 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in Water added 750 gal. New depth 0 in.
Elapsed Time: 0 min Final fluid depth 0 in Absorption rate >= 450 g.p.d-
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N/A
72.026 (Rev. 01/00('
D. LIFT STATION
Date installed 11/5/94 Size in gallons 2 5 0 Manhole/Access Y
"Pump on" level at 4 5 in "Pump off" level at 41 in High water alarm level at 4 5 in
Datum Bottom of Tank Cycles tested 3 Meets alarm & circuit requirements Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100,
Absorption field on lot >100, On adjacent lots >100'
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line >251 Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >51 Property line >51 Absorption field >5'
Water main N/A Water service line >10, Surface water 2 100'
Drainage >100, Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation > 10Water main N/A
Water Service line >10' Surface water > 100' Driveway, parking/vehicle storage > 25'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
Lift Station Pump Replaced 5/00. _a a:_•._
G. ENGINEER'S CERTIFICATION " PA
4�
I certify that I have determined through field inspections and R'S
review of Municipal records that the above systems are in r,• • ..... .
conformance with MOA HAA guidelines in effect on this date.;
Engineer's Printed Name Michael E. Anderson, P. E,
Date 10/12/00 `i� r• '
M ! ATE e
HAA Fee $ 3bL ! IfU Waiver Fee $ ,
Date of Payment a ��Z�UD Date of Payment
Receipt Number O'% IP CO Receipt Number
72 026 (aw. oiroo)•
10-11-00 09:12 FROWCTE ENVIRONIENTAL 5615301 T-273 P.02/05 F-143
CT14E Environmental Services Inc.
AL W.i r..M
Cr&E Ret#
1006173001
Client Name
Anderson Engineering
Projectliamem
N/A
Client Sample 1D
Tract 1A, Whaley
Matrix
Drinking Water
Ordered By
PWSID
0
Sample Rcmarks:
Client PO#
Printed Datefrime
10/10/2000 17:56
Collected Datefrime
10/04/2000 12:00
Received Datdrime
10/04/2000 15:20
Technical Director
Stephen C. Ede
Released By
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date ]nit
Waters Department
Nirratc-N 0.700 0.500 mg/L EPA 300.0
Microbiology Laboratory
Total Coliform 0 col/IOOmL SM18 9222E
i=
Received Time Oct -H. 8:14AM
10 max 10/04/00 SCL
10/p4/00 KAP
10-11-00 09:11 FROM -CTE ENVIRONMENTAL 5615301 T-273 P.04/05 F-143
" CT&E Environmental Services inc.
Laboratory Division►iiiiiaiiiiiii��������������������'�����u�����
200 W. Potter Drive
rinking Water Analysis Report for Total Coliform Bacteria Anchorage. AK 99619.1605
Tel: (907)562.2343
READ INSTRUCTIONSONREYERSESIDE BEFORE COLLECTING SAMPLE Fax: (907)561.5301
�T nov
O PUBLIC WATER SYSTEM I.D. R
O PRIVATE WATER SYSTEM
O Send RAaks C . Send fareke
....
ow o
W
0
W
C3 s(ed Rejaks Send rawke
LL..rh�oj L�4er'c-N
SAMPLE DATE. ® Me O D
Montb_ Day Year
SAMPLE TYPE:
X Routine D Treated Water
13 Repeat Sample (for routine sample G Untreated Water
with lab ret. no. )
O Special Purpose Time Collected
SAMPLE LOCATION Collected By
'J"/t4S IAS l.� at _ 1Z100 Mme'
rl.ua crit
Comments:
IFAnal sis shows this Water SAMPLE to be:
Satisfactory
Unsatisfactory
(3 Sample over 30 hours old, results may
be unreliable
O Sample too long in transit; sample should
not be ovct3lVhours old at examination
to indicate reliable results. Please send
new sample via special dfliv, mail,
Date Received
Time Recelved
Analysis Began
Analytical Method: rMembtane Filter
a MMo-MUG
I • Number of colonies/100 ml.
Lab Ref. No. Result'
1006173
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Analyst
Jun ❑
Fazed
Date: Time:
Client notified of unsatisfactory results:
13
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Date Time:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Rath: Total Collferm Jw Coli
Membrane Filter. Direct Count Colonies/100 m1
Veriticatlon: LTB
BCH
COLIFIRM
Fecal Coliform Confirmed"
Final Membrane Filter Results --fo�)
C--ollform//100 ml
Reported BY
Date Time 1 _' — brs
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ENVIRONMENTAL FARACAI VAd TIme, 6C1�I�-•U O1 UM'ILLINOM MARYLAND. MICHIGAN, MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
• y 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
051 11 170
Parcel LD.# HAA #-*IS\�
1. GENERAL INFORMATION
Complete legal description
Tract 1A. Whaley Subdivision
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Atitlroee
Park Drive & Ski road Chugiak
MM & M Contracting
P.O. Box 670495
Day phone
Chugiak, AK 99567
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well xxxxxx
Community well
Public water
Day phone
Day phone
688 1236
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:
Individual on-site xxxxxx
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(RW. 1191) Pont 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.
NameofFirm Anderson Engineering phone 563 7155
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's signature -7i1felted ZOLILC Date 8/9/96
6. DHHS SIGNATURE
Approved for - -3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By: .
bedrooms, with the following stipulations:
Date 9—j — 96
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Fealth 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 thei r 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.
72425 )FN. VYl) Back MOA 121
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES C E I V E D
Environmental Services Division
J 825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 34*ga 12 1996
Municipality of Anchorage
DOW. Health 3 Human Serviees
Health Authority Approval Checklist
Legal Description:71i/AeT //i� LJHq!E� 5U6- Parcel I.D.: /' //-/7(�
A. WELL DATA
Well type If A. B. or C. attach ADEC letter. ADEC water system number
Log present (YM) Y Date completed 1'/q6
r
Total depth Z051 Cased to 7 -PS/ Casing height (above ground) Z
Sanitary seal (YIN) Y Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test G�qL
Static water level / �$
Well production -7 g.p.m.
WATER SAMPLE RESULTS:
Coliform O Nitrate -1-U '"J I L ^ Other bacteria
A b
Date of sample: B �5 / 96 Collected by: 4AA-4 a
B. SEPTIC/HOLDING TANK DATA
g.p.m.
5T. �: I`'.
Dau installed !lb 141 Tank size /15-00 Number of Compartments Z Cleanouts (Y/N) Y
Foundation cleanout (Y/N) y Depression (Y" 4 High water alarm (YIN)
Dau of Pumping /JM1 Pumper cv j Sra t! u ton/
C. ABSORPTION FIELD DATA
Date installed 11 Soil rating (g.p.d.f a or fl$bdrm) • ` s) stem type 8 st_
Length 1,41' Width / F Gravel thickness below pipe 1 1 Total depth 3 z
Effxtive absorption area / 5"Z Fr: 'Monitoring Tube present( "-h ' Depression over field (Y/N)
Date of adequacy test Ale - J (h of 51, Results (Pass/Fad) P4 55 For %�Nit+V bedrooms
Fluid depth in absorption field before test (im.); _ 0 Immediately after_ gat. water added (in.):
Fluid depth O (ins.) Minutes later: Absorption rate - R.p.d.
Peroxide treatment (past 12 months) (Y/N) /J If yes, give date /V /A
D. LIFT STATION
Date installed abb L Size in gallons Z SD
Manhole/Access (YM) Y 'Pump on" level at* 45 "Pump off' level at*
n
High water alarm level at' y S *Damm T k 15 1
Cycles tested F -I v--*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septictholding tank on lot /27 i ; On adjacent lots i/O D r
Absorption field on lot 9/7S t ; On adjacent lots woo,
Public sewer main /" tA t W5 Public sewer manholetcleanoui t W-5,
Sewer /septic service line > 75- t Lift station
/Z7t
SEPARATION DISTANCES FROM SEP7TCIHOLDING TANK ON LOT TO:
Building foundation $Z r Property lice -711 Absorption field > 5
Water maintservice line i/0 r Surface water/age ?/DO ' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
t
Building foundation IS Water main/semce line
414
Surface water >/AO Driveway, parkbigNehicle storage area >/O t
I
Curtain drain on/ Ls OM(ar Welts on adjacent lots i /ODr Property line >/O
F. ENGINEER'S CERTIFICATION
/ cerh# that / have determined thru field inspections and review ofMunlcipal recaidt char the abow Y'w'Wms are
in conformance with MOA R4A guidelines in effect on this date. r•
$IgnatureLrrl"<Ll C. a1ti-pl� is e
Engineer's Name 4e4,'46L f I i ocRSO,.J f,
Date S�q/96 v 4'y t
�c.
HAA Fee S ,;CC� W Waiver Fee S
Date of Payment rS -\a C'AQ
Receipt Number b Q \101
Rev. 9/95 OSS: haa.wk.doc
Date of Payment
Receipt Number