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Home My WebLink AboutMOORE LT 43B-1 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: ~°cO 0 ~' -C' PID Number: (~'~ ~ ~ -- ~'~-- Name: Wastewater System: [] New ~' Upgrade Address: /~ z~ ~~L ~w~, ~ ~ ~ ABSORPTION FIELD Phone: ~ ~/~ . No. or,Bedrooms: ~Deep Trench D Shallow Trench D Bed ~ Mound D Other Soil Rating: Totsl Depth from original grade: LEGAL DESCRIPTION ~. ~ ~s~. ~. //, ~ Lot: Block: Subdiv~ion: Depth to pipe boEom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: WELL:~ New ~ U~ Gravel width:~{ Ft. Number of[ lines: Distance.be~een lines:Ft. Classification (Private. A.B.C): ~th: Cased To: Total absorption area: Pipe mate/iai: ~ Ft. Ft. /0~'~ SO. Ft. ~lO /3~ Driller: _. //%~ I~ Date DriUed: StaticWater Level: installer: Date in.ailed: Ft. ~ ~%~ ~//~/~ ~ GPMIPump Set at: Ft. ~ Casing Height Ab°ye Gr°u~: TANK SEPARATION DISTANCES ~Septic B Holding ~ S.T.E.P. To Septic Absorption Lift Holding 3ublic/Pdvate Manufacturer: Capscity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ ~ SudaCewaterWel~ ~'~/~ ~LineL°t /~ ~ /OO~ J ~ ~ ~~I Material: Size in gallons:Manufacturer~ ~/~LIFT, STATION, Number of Compa~ments: Foundation ~l ~1~ ~ "~ump on" I~vel at: ~~1 at: ~i~h wator alarm at: CudainDrain ~/~ ~I~ . ~ I~ct~ I~ti~sped°rmedby: BENCH MARK Remarks: ~r~ ~ ¢~¢~¢~~ Location and Description: I Elevation: Assume~ ~ ENGI~.~ SEAL Inspections pedormed by: ~-~A~¢~,p.~ Dates: 1st ~¢/~ ~~,~ .... .................. Department of Hep th an Iint;l~l Se~ices approval %°~2%¢~ ~ ~' -%~o~ss~o~%~ Reviewed and approved by: ~[ ~ ~q~ Date: ~g/go~'~ ~.'~e~,..,.", 72-013 (Rev. 9/91) MOA 25 R-BUILT WASTEWA ABSORPTION SYSTEM EX:~T, j ~/E L ~z NEW ~'~-- ~- ~ 74,3[ SWING-T] 134,5' 66,8' i 42,4' 72,2' i 68,0' 100,8' 93,9' 120,3' 136,6' 155,5' o u p~§ 98,7' _-~ NrlTES~ 1) EXISTING BE]) WAS 0,9' HIGHER THAN TANK, T~,_~_ r~--C~T~T.[r~,, ~'I[';~TEM A]~ANI]ONE]] IN PLACE, HT ~-' ~11~ ]~raJn Pipe ~ 97,5 MUNICIPALITY OF ANCHORAGE ~- ~ DEPARTMENT Or EA TN NUT SE IC P.O. BOX 196650, 825 "L" STREET, ROOM ANCHORAGE, ALAS BLA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970095 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NA_ME:EGGERT JOHN THOMAS & OWNER ADDRESS:14251 BRANDL ST ANCHORAGE, AK. 99516 DATE ISSUED: 5/16/97 EXPIRATION DATE: 5/16/98 PARCEL ID:01819241 LEGAL DESCRIPTION: MOORE LT 43B LOT SIZE: 49326 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18/LAC72) AND DRINKING WATER REGULATIONS {18/LAC80). 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 SA24E DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY DATE: Steven R. Pannone, P.E. Consulting Engineer (907) 272-8218 P.O. Box 142025 Anchorage, Alaska, 99514 (907)272-8218 Fax May ll, 1997 ATTN: James Cross, P.E. Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 43B Moore Subd. Septic Upgrade Permit FAILED SYSTEM RECEIVED MAY 1 2 1997 Municipality of Anchorage Dept. Health & Human Dear Mr. Cross: My finn was contacted to conduct an investigation of a failed system on this lot. The existing system on this lot is in failure. The bed has 12 inches of standing water, and the liquid level in the tank is 70 inches deep. There are signs that the liquid levels have been higher in the stand pipes. I performed a single test hole on May 9, 1997. The soils report and percolation test result is attached. Ground water is currently being monitored. Lot 43B has water monitoring data from I983. There was no water encountered to a depth of sixteen feet nor after seven days of monitoring. Lot 43A soils information indicates there is no water at a depth of sixteen feet also (it was monitored in 1991). No bedrock was encountered in the test hole. I request the water monitoring requirement be waived due to the eminent health concern affecting this property and the close proximity of existing water data indicating adequate separation to ground water. There was no water in the monitor robe on Sunday May 11, 1997. The' water monitor tube will remain to verify that no water exists. The lot is approximately 1.15 acres in size. Lot 43B slopes to the south at a rate of approximately 1 percent. The proposed installation will be located on the southwestern portion of the lot. The existing field and tank will be reused. A diverter valve will be installed directly after the tank. The existing tank is located inside this lots 100 foot well radius. An existing waiver is m place for the separation distance to 98 feet. If a new tank is required, it will be installed out-side the 100 foot well radius on this and surrounding lots. Double clean-outs will be installed down stream from the diverter valve on both post-tank lines. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposcd installation shall not impact the future development of the surrounding lots. Seethe attached design. If you have any questions about the proposed installation, please contact me at 272-8218 Sincerely, ~nnone, P.~. Attachments: C:\WORK\43MOOR.001 MUNICIPALITY RECEIVED I}ESIGN WASTEWATER A]~SBRPTIBN SYSTEM Lo~c 433 Moore Subd, NOTES, l) EXISTING ]~E]] SYSTEM HAS FAILE]I SEWAF, E LEVEL IN THE TANK WAS NEASUREI) AT 70' ]~EEP ¢4E' BELOW Tnp OF C,D,), 2) VERIFY INTEGRITY BF EXIST, EAST 14end 1850g SEPTIC TANK, REPLACE .................................................... IANK/]L~T&T~F~ _TJ~$ _lQOi _ W E L L RADIUS IF FDUN~ LEAKING, 3) TEST PIT 3 WAS EXCAVATE9 ON 5/~1/83, ORIGINALS ARE ON FILE AT ~; ',', ',~. .......... EXIST, / ~ELL EXIST. SEPTIC TANK ~ ~ INSTALL ~IVERTER VALVE & ~DUBLE CLEANBUTS, PRDP[ EXIST. BE~ FIEL~ EFF, SYSTEM Drawing C,\~/ork\43MDDR,I]WG 75 LF C:>TP3 TPI ¸42' HnUSE ND WELLS DR SEPTIC WITHIN EOO' BF PRDPDSE~ INSTALLATIaN 7,~~75' EXIST, ~x.~_ 4 tledroom House 1000 SF Rqd DESIGN; 7' E??ec~clve 11' To'cai Depth 2' Wide, 75' Long Total Absorption = 1050 PREPARED FDR~ Hr, Tom Egger~ 14251Brandt Drive Anchorage, AK 99516 (907) 265-1663 Pannone Eng, Svc, P, D, BOX 142025 ANCHORAGE, ALASKA 99514 272-8218, PHONE & FAX 0ATE, 5-11-97 ~ DESIGN ~C/~LE, 1'=60' / DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM Lot 43]3 Moope Sulod, RECEIVED MAY 1 2 1997 ~ Mlmioipality of Anchorage el)t, Health & Human Service,, Z [23 W il'ID NV393 ~r~ ~OmINaW lflD NV]13 Z _J b_ O_ D~wlng C,\Wo~'k\43MDDR,lWG lno NV31D NV]lO £RDNV393 NOlIV~lflOJ PREPARED FDR~ Mr, Tom Eggert 14851Br~n~l Drive Anchorage, AK 99516 (907) 265-1663 P~mnone Eng, Svc, P, D, BOX 142025 ANCHORAGE, ALASKA 99514 878-8818~ PHDNE ~ FAX IDATE 5-11-97 INDT TO SCALE DESIGN PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? Township, Range, Section: SLOPE SITE PLAN S IF YES, AT WHAT ~) DEPTH? ~ p E Depth lo Water A~fter. _ Monitoring? '~'~" Dale: COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~ ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT PERFORMED BY: '.-'~'~'~"'~,'~j/U'O'~/t~'t~'~ I ~'"r~L~-'~),~,,u.,,~J~.,,~,/.~.~: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 {Rev. 4/85) i~ ,,_~/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME '~ IPHONE EW IMAILING A _D,D R F~SS LZAL DESCRIPTION LOCATION NO, OF BEDROOMS DISTANCE TO: J Weg ~,¢ / Absorption7 Dwelling¢0 PERX~O. ~ kiq. c~it~ ~jlons Inside length Width Liquid depth ~ ~ IF HOMEMADE: ~ ~ ~ Well Dwelling PERMIT DISTANCE TO: O ~ ~ Manufacturer Material L~quid capacity in gallons ~ Well Foundation Nearest lot line PERMIT ~ ~ DISTANCE TO: ~ ~ ~ No. of IMes Length of each line Total length of lines Trench width Distance between lines ~~ ~ inches ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~ inches ~ ~ Length ~/~ Width ~ 7 ~ Depth ~ / PERM~N~ ~ ~ T~e of cr,~ Crib diamete~ Crib depth ~ Total effectiue absorption area~ ~ ~ell ~ DISTANCE TO: t~0 / Building ,~/~ion Nearest lot line /~ ~ Class Depth Driller Distance to lot line PERMIT NO, Building foundation Sewe~ line Septio tank Absorption area(s) ~ DISTANCE TO: OTHER O PIPE ~ATERIALS t SOIL TEST RATING 72-01~ rv~-~/ DRILLING, Inc. P.O. Box 10-378 * 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner CHUC~ FDORE Use of Well Dormstic Location (address of: Tow. nship, Range, Section, if known; or distance main road Lot 43-B M~ore Subdivision 11 Size of casing. Static water level Screen ( ); Describe screen or perforation None Well pumping test at 10 gallons per (I~;~ of drawdown from static level. Date of completion Animist 2; 1983 _Depth of Hole ]130 feet Cased to 129 feet 90 ft. (~ (below) land surface. Finish of well (check one) open end ( xx ); Perforated ( ). (minute) for 1 hours with 100% WELL LOG Depth in feet from ground surface Give details of formations penetrated size of material, color and hardness 0 TO_ 2 Casing stickup 2 TO_ 30 30 TO 8O 80 To_~llD_ __i!0_TO ] 27 127 .TO. 130 TO. TO_ TO_ TO_ TO TO TO TO_ TO_ Br~n clay and gravel Brown cia.v and gravel ('d~p) GTav silty ~ava_l CCr~y hard ?m Waterbearing gravel NWWA Certified Canli',~cLur Certificate No's. 814 & 973 1 -- CUSTOMER ~ ~ ~ HANDWRiTTeN PERMIT - ~he bottom of ~he excavation(in leek). There i~ nO ,. ~e graVek depth is the m~ depth of gravel between the outfali . P~it ap~lican~ ha8 the ~pon~_b~l~y ~o info~ thi~ depar~nh ~ ~ *.TWO(2) INSPECTIONS ARE R~U[R~O :will be subject to prosecution. :~n4 ~x~t be ~etu~n~ to this dapa~en~ within 30 (:Other remitments ~y appZy. ~p~ifica~ions and - ~ o~rkify that: set fo~kh by ~he ~icipaii~y of .~chorage. MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmenta] ~rotectiont~_t 825 \~ Street, ~_qchorage, AK. '~501 - ~ .... ~ ~ 264-4720 ~' * * * HANDWRITTEN PERMIT * * * ~:~. ' Permit %~ WELL AND~ ON-SITE SEWER PERMIT C/ ~,~Z' / ~pplicant:c~,~/( /~~- Mailing Address: ,_p~ Legal Description: ~m ~L¢ ~.:'~ :T/2"-X~~" Lot Size: Type of Soil ~sorption SyStem Is: / Trench: . Drainfield: Seepage Bed: ~ Holding Tank e rooms: DEPTH The Required Size of the Soil Absorption System Is: ' 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~,~-L3 GALLONS * * 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. * * * TWO(2) INSPECTIONS ARE 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 31, 1 9 o° 3 * * * · I certify that: (1) I am familiar with the requirements for on-site 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 enlar/~ement if the residence is remodeled to include more tha~3 bedrooms~./ Signer: Issued by :~~(~/~-~u~.~ ............. Applicant /x :/./,~ Date: _ . · SWP/024(i/81) J 5~e('~ t o'~ 3 S[-,cetS ] ~/ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION .,~ PERCOLATION . ' TEST .825 L,'. Street; Anchorage, Alaska 99501 ,.264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: SLOPE SITE PLAN 1 2 3 4 ~0~ 11 12 13 15- 16- 17 18 19- 20- C. Reid, Jr. No. 2251-E WAS GROUND WATER L ENCOUNTERED? ~',~o o P IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop [~zq 50 .Sq · oH 8q5 ~ '8z5 .o~5 65ot ,t~ ,81 .ol5 PERCOLATION RATE > (~O (minutes/inch) ':' ~! ~TEST:RUN:BETVVEEN .... '-% · ,.:;F~T,AND ~ '/~- FT '~ 5' ~dL5 ,~,.~ ~a ® 8su'/I,~o,. s~,-~ ~ 5-'% q' o.~. ,-,~,wb. bt~ -~,- n,q -. ,~; 4-e. PERFORMED BY: CERTI FI ED BY: DATE: 72-~08 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: 5 /~-'~ / ~ LEGAL DESCRIPTION: 4' 6 7 Lo't- 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Se;~ '~ L,~- net L'oq¥;,~oo~s-- q~t '~c PERFORMED BY: ~e',/eqS WAS GROUND WATER S ENCOUNTERED? 1~o L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE minutes/inch) TEST RUN BETWEEN FT AND ~ FT CERTI FI ED BY: DATE: ,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO.NMENT,AL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~' SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 5 6 7 8 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 20- COMMENTS WAS GROUND WATER S ENCOUNTERED? ~ L 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop o,z~ - ,~O -- ~15'~ '5o .3o . zo ~[57.. ~ ,50 -- PERCOLATION RATE 2-~ (minutes/inch) TEST RUN BETWEEN "~ ¥2- FT AND ¢.5f FT PERFORMED BY: ~-,It~ ~, 3, 72-008 (6/79) CERTIFIED BY: DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~'7-- ~ z.{~ ,./'/ NAA# ////~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone A I/-- ~5 Day phone Agent ~-4~. Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: "~: ' Individual well Community well RECEIVED MAY ? 1 1997 Municipality of Anoh~Orra~ece Dept. Health & Human ~e Public water 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 Holding tsnk 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 certifiedby 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 waste~vater 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~--'~A,o,d~r~¢ oeruAocm,.,u~ CfoC,. Address EngineeYs signatu r~~:::~~ Phone Date · ~, Approved for ~;fd/'L ,. Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 fY21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Se~Jces Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3 Health Authority Approval Checklist Legal Description::/- ~3~E, t'-~oc~.- '5/-~ Parcel I.D.: A. WELL DATA Well Log present (WN) Total depth I~Jot Sanitary seal (Y/N) IfA, B, or C, attach ADEC letter. ADEC water system number Date completed ~'/~/~'._~ Cased to ~o'P Casing height (above ground) I. Wires properly protected (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: FROM WELL LOG AT INSPECTION ~l'zl~ / b g.p.m. .~. g.p.m. Coliform -- ~ ~" Nitrate ~) ~ tC~ ~) Other bacteria Date of sample: .~/1'~[ q=F Collected by: --~ ' F2'~A~ c~,,u~ B. SEPTIC/HOLDING TANK DATA Date installed /c)/~"~ Tank size /~,.~o . Number of Compartments Foundation cleanout (Y/N) "~ Date of Pumping '.5'//&/~'~ C. ABSORPTION FIELD DATA Date installed -~-//"~'~/~ =7- Length '~'~(-'~ Width Effective absorption area Date of adequacy test ,4J~. Depression (Y/N) ,,,c/c) Pumper ~ ~o,,~ ~Vc~- ~-- Cleanouts (Y/N)_ High water alarm (Y/N) Soil rating (g.p.d./ft~ or fF/bdrm) Gravel thiCkness below pipe Monitoring Tube present (Y/N) Results (Pass/Fail) ~A Fluid depth in absorption field before test (in.); ~ Fluid depth ~ (ins) Minutes later: ---' Peroxide treatment (past 12 months) (Y/N) - - 72-026 (Rev. 3/96)* O · ~ System type -t'-~2~..~,.~C/~ -~' ~ Total depth ~ /~-~,~' Depression over field (Y/N) ,,~ For z~ bedrooms Immediately after '""-- gal. water added (in.): ~ Absorption rate = -'--' .g.p.d. If yes, give date ~ D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* ~ E. SEPARATION DISTANCES Size in gallons "Pum~ "Pump off level at* *Datum RECEIVED, SEPARATION DISTANCES FROM WELL ON LOT TO' On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station Septic/holding tank on lot Absorption field on lot Public sewer main ¢t~'[¢~ Sewer/septic service line MAY ? 1 1997 Municipality of Anchorage Dept. Health & Human Services SEPAR'ATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~ q ~ Property line /'/~ Absorption field Water main/service line Surface water/drainage ! c~c~'4- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Sudace water Curtain drain Building foundation ~, ~ ~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots / .~¢¢, F. ENGINEER'S CERTIFICATION ~c~rt~y~ha~havede~erm~ed~hruf~e~d~s~ec~nsand~ev~Mu~c~a~r~c~rc~st~~:/~ in conformance w/th MOA HAA gu/de//nes /n effect on th/s date. Signatur6~ ~ Engineer's Name ~~ ~~~'~ HAA Fee $ ~ 6 Rece,pt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ,~ ,MA¥-22-1997 16:49 CT&E ESI .~t~_-~, ~CT&EEnv[r°nmen~alServiceslne' ANCHORAGE 90?5615301 P.02/03 CT&E REA'.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 972489001 Pa~none Eh§ 4SB Moore S/D Fronthoae Bib Client PO# Printed Date/Time 05t22/9'7 11:16 Collected Date/Time 05/18/97 14:00 Received Date/Time 05/19/97 10:20 Technlca! Director: Stephen C. Ede Released B~ ~' S--afiiple Remarlc~: CT&E Microbiology Drinking Water Program certification status is provisional as of 4/8/97. Parameter Results .._ p~tL Unlta , ,, Matho¢~ Nitrate-N 0.100 U 0,100 mg/L SM18 4500-N03~ Total coliform 0 eol/tOOmL $M18 92~2B 10 m~x 05/20/97 ~ 05It9/97 RMV MUN C PAUTY ^NCHOR^GE DEPARTMENt' HEALTN AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, towns_h, ip, range) Location (address or direction, s~ Applicant Name ('~C~'~.-?~ ~_,--~. Telephone: Home...~.~//-~ ~ 5,~/..,2-,, Business Applicant Address ,/¢/~_.~.-'/ /_..~/_.~~,~'_ ~__~_~_~--/, Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain); (d) (e) (f) Lending Institution ~,/~?~¢_~/_-'~.-¢~/'~</~-~/~¢--Telephone Address' Real Estate Company and,Agent ~/ ~~, ~~. Address Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms Y Other WATER SUPPLY Individual Well~ Community [] Public [] ' Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite.~)' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health' Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the 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 S ~ S ENGINEERING Telephone ~' ~"'~-~¢~ ~ ~ Address 5[~ B "~95X Date · EAGLE RIVEP,, AK 9957~' D.E. APP.OV^L Approved for,-~'~"- bedrooms by ~ ~' ~¢-~"~> Date ,,Approved ~ ', Disapproved Conditional Terms of Conditi6nal APp~oyal CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) · .H.~..A..L.T~..AUTHORITY APPROVAL (HAA) MUNICIPALITY OF DEPT. OF HEALTH & CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 ,SEP 41986 RECEIVED Well Classification Well Log Present ~i~YN) Total Depth ~,"Z~ c> t Cased to Static Water Level '¢~ O ~ Casing Height Above Ground J "L. ~ Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/~ Tank on Lot ~ '~ ~ ~ To Nearest Edge of Absorption Field on Lot \ ~:~ ! 4r To Nearest Public Sewer Line Cleanout/Manhole '"' Water Sample Collected by Water Sample Test Results Legal Description: I IfA, B, C, D.E.C. Approved (Y/N) Date Gompleted ~,''J-~ ~'~ Yield ~,~ ~'7.~ ~ Depth of Grouting Pump Set At Sanitary Seal on Casing (~N) Depression Around Wellhead (Y/~) ; On Adjoining Lots ; On Adjoining Lots ¢ I/~ To Nearest Public Sewer ,r~/~ To Nearest Sewer Service Line on Lot B. SEPTIC/14~L-DtN~ TANK DATA To Property Line To Water Main/Service Line Course Date Installed Standpipes~/N) Air-tight Caps (~I/N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N),41 Holding Tank High-Water Alarm (Y/N) I~ Separation Distances from Septic/l~ank: To Water-Supply Well ~ t No. of Compartments Foundation Cleanout (Y~. Date Last Pumpe¢ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation "~'~ ~ ! To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed \[~'~ ~ ~ ~"~'~ Width of Field "~'"~ ! Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field ~l~Gravel Bed Thickness Standpipes Present (~N) Date of Last Adequacy Test ~:~,-""Z.,[o- ~L~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha~ I~ ~'~[~1~,,~,,' or conformed to all MO~ and~A~uidelines in effect on the date of this inspection. Signeds"~ ''6x .Date ~/~ Company~6LE RIVER, AK 995~ MOA No. ~ ~ Receipt No. /~O[ OO~ ~ Date of Payment ~- ~' ~ Amount: $ ~, O~ Page 2 of 2 72-026 (11/84) Anchor e P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (90?) 264-4111 TONY KNOWL£S, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES September 9, 1986 Robert A. Shafer, P.E. S & S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot 43B Moore Subdivision Waiver Request, WR86-128 Dear Mr. Shafer: Your request for a waiver of the 100 foot separation required between the septic tank and well on the subject property has been granted. This distance has been waived to 98 feet. This waiver is valid for the existing four bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERTA. SHAFER September 4, 1986 CIVIL ENGINEER 694-2979 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Steve Morris MuNICIPALI'[Y OF ANCHORAGE DEP'[. OF HEALI'H & Ei~vIRONMENTAL PROTECTION REFERENCE: Lot 43B; Moore Subdivision Request you approve thc attached Health Authority Approval and issue a waiver for thc horizontal separation distances between the well and septic tank. The on-site inspection report performed by the Municipality of Anchorage, on October, 1983 indicated a horizontal separation distance between the well and septic tank of 99 feet, however, our field measurements indicate a distance of 98 feet, therefore, request the waiver be issued at 98 feet. Attached for your review in addition to the material provided with the HAA application are the following documents: A. Site plan showing the relationship between thc well and the septic system. B. Waiver review worksheet. It is our opinion that the horizontal separation distance prescribed by 18AAC72.021 are not required in this If we ma~?b~of further service, please contact us. SRB 196X EAGLE RIVER, ALASKA 99577 D,\TE RECEIVED: !!NG I NEER: MUNICIPALFi'¥ ,77 DEPARTMENT OF l{['lAl, l'fi A~X'D HUMAN 5i']RV' ":" WAIVER REV®..,~ %~G.~IKSttEE]' CRITERIA: 1) Geology: Votnt~: 2) 3) A. Water Table B. Soil Sorption C. Permeabll£~y D. Water Table Gradient E. ~lorizontal Separation ro-i'^l.: tq ,g WAIVER graated, with conditions listed below: not granted fo~ reasons lis~:ed below: DAI'g: · APPLIC, .__.NT FILLS OUT UPPER HAL._i. ONLY Address Zip Code Lending Institution i !,/_) i\At ~. -~ A (J ~ ~J ~.J ~ Address Type of Residence ~"~in g le Family [] Multiple Family No. of Bedrooms [] Other Zip Code Zip Code Phone Water Supply ~-4ndividual [] Community [] Public Utility ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For welds drilled prior to that date, give well depth (attach Icg if available). Sewer Disposal ¢'.~ndividual · [] Public Utility [] Holding Tank Year Individual Installed: ~ -~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE iNITIATED. Time Time Time Tim~ °ate °ate Date Inspector Inspector Inspector Inspector Field Notes: ~I~F~~rj::P:~%ROOMS 'CONDIT'ONS OF APPROVAL ( ) CONditIONAL APPRCVAL* Soils R~ting Date ~wer Installed Well To Absorption Are~ /~ ¢ Well Log Received ~% g /C ' 7--rS WelltoTank ~ ¢' SepticT~kSiz. 72-023 (3/82)