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HomeMy WebLinkAboutALPENBLICK LT 1Ap puomv,**l b e A *C) n sow C) � A M.. f)L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ,7 Environmental Health Division _ O/ —04 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name /�� C�f?r lie e f� DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address l�C b Te.,,, Phone(s)Permit No. No. of Bedrooms A7-ITI`.3 9 � 3 WELL /5-6 LOT LINE LEGAL DESCRIPTION Lot Block -' Subdivision / e.t FOUNDATION 90 Township, Range, Section T!aN)e 3Ao s -z-j- AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system, property lines, foundation, TANKS ❑ SEPTIC ❑ HOL � f ' 3 — —� N i'Co � -41,f r' I III Fie Id Manufacturer Ca n gallons Material No. of Compartments TYPE OF SYSTEM ❑ TRENCH ❑ BED W. DRAIN ❑ OTHER + Depth to pipe bottom from origin original de FT Total depth from original grade f��/e!teNd FT Fill added above original grade 3 FT Gravel depth beneath pipe o`7' S ^ FT Gravel length a 8 FT Gravel width s / FT t os- Total absorption area v� g SO FT Distance between lines N119 FT C, Number of lines Soil rating SQ FT Pipe material 2 3� Installer Dwher Date Installed 7 3/ - Sr/i �9ya WELLS ❑ PRIVATE ❑ OTHER v) Classification (A,B,C) Total D FT Cased to FT Installer Date Installed: REMARKS: 4- Scale: Inspections Date: Performed Lr eo, by: el ENGUYEEws SEAL G/�K J tf�d. h�L�d/y had NZ/u ever roman 11;17 j l n -o I a C de, d, Jt certify that this inspection was performed according to all Municipal and State guidelines in effect thi date: �0 Health Department Approval: Date: 72-013 (3/85) MUNICIPALITY OF ANCHORAG� Department o{ Health & Human Services 625 L S�reet, Anchorage, Alaska 99501 343-4720 ON-SIlE SEWE PERMIT �'ermzt Nuo�er: �oo�/� upgraoean co oaie >ssued: 0//31/90 Lngineer Uesigned Uwner Name: L�RL REED Day Phone: Owner �ddress: HC69, BOX 178 279-5553 SPRING CITY, TN 99999 Parce1 Id: 017-014-04 !ot Leqal: 5ubdivision: ALPENBLlCk Lot: 1A Block: NA �ection: 25 Tuwnship: 12N Range: 3W Lot Sjze 44541 �sq.,t. or acres) ;ax 8e�rooms: 7his Perm1t: 3 Tota1 Capacity: 3 �LF'||`� lAM�: Minimum toLa] septic tank capaczty: 1 V00 gallons. E�ch sepi c |an� must�ave atleast 2 compartmen�s. Uepth to top o� septzc tank(s/ '� 4.[/ �e�t requzres insula��on over tank(s). F`EkM]l EXPIRES DF[.EMBER 31, i9�0. n�RM|l ]S�UED lO MOV[ PURTION [/F lRENCH 8ACK ONlO PROP�RTY. �N�'T(.LL ACC.'RUlNQ /U ENSlNEE�'S DESlGN. A EC ALASKA RUIROWnTAL COnTROL SCRUICCS, InC. a Enqineeriaq & Enuironmental Studies SPECIFICATIONS FOR A FIVE -WIDE WASTEWATER TREATMENT SYSTEM LEGAL DESCRIPTION: LOT 1A, ALPENBLICK SUBDIVISION. 1.0 GENERAL 1.1 The Drawings, sheets 1 thru 4, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory and are to be verified or modified in the field by a DHHS approved inspector. 1.4 It is the responsibility of the property owner or installer to adhere to approved designs for installation, to maintain the specified separation distances, and to have the appropriate inspections. 1.5 It is the responsibility of the property owner or in"staller to report to the engineer any observed conditions which would put the system in violation of state or Municipal regulations. 1.6 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC SYSTEM 2.1 The existing septic tank may be used, if it meets the capacity requirements for the residence and the approval of DHHS. Older systems may need tank integrity verified. If not, then specifications 2.2 through 2.6 apply. 2.2 The septic tank shall be a UPC -approved two-compartment tank, constructed of 12 gauge steel with bitumastic coating, set level on undisturbed soil and insulated with overlying layer of 2 inch burial type polystyrene. 2.3 The septic tank shall be a minimum of 5 feet from i the house foundation, and a minimum of 5 feet from the absorption area. 2.4 The septic tank and drainfield shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class "C" wells, and 200 feet from Class "A" or "B" wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by Alaska Department of Environmental Conservation (ADEC). 2.5 Piping shall be fitted with a mechanical watertight calder coupling of the inlet and outlet of the septic tank. Piping shall be 4 inch ASTM D-3034 or cast iron, sloped a minimum of 1/4 inch per foot from the house to the tank and 1/8 inch per foot from the tank to the trench. 2.6 Cleanouts shall be installed as designated, capped with air -tight rain caps (Jim Caps or equivalent), and extend a minimum of 2 feet above ground level. 2.7 If a lift station is required, it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. using an ORENCO lift ' station design. Specifications and design drawings are on file with the Municipality and with the engineer. 3.0 DRAINFIELD 3.1 The gravel for the drainfield shall be 0.5 to 2.5 inch, screened rock with less than 3 percent passing the No. 200 sieve. All substitutes must have prior DHHS approval. 3.2 The bottom and side of the excavation shall be raked with the backhoe blade to ensure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipes(s) shall be placed as shown in the drawings, and shall be rigid PVC ASTM D-3034, or 4 inch cast iron. The section shown with holes may be drilled 0.5 inch holes on the 6 inch centers on opposite sides of the pipe, or a regular section of perforated sewer pipe, clamped to a solid section, with either a no -hub coupling or a solvent joint. The perforated section of the monitor tube shall be located in gravel only. A r SOILS LOG JJ 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: NdicN (i1 -1CY Ili DATE PERFORMED:_ 1 _ LEGAL DESCRIPTION:, PERFORMED FOR: LEGAL DESCRIPTION: 1 1 SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 1 IIII Gross Time Net Time Depth to Water 2 Nib 7 2IIJ3 3 :: GM/ SP 4 �• 5 6 �•; 7 .; •'• ; (vS 8 9 . SEEP* 10 11 12- 21314151617 13- 14- 15- 16- 17 18 19 20 tNz COMM i PERFORMED BY:LG IG M0fi 72-008 (6/79) N - OZy V DATE PERFORMED: lot SITE PLAN • MEMOMMMMEN Wo Reading Date Gross Time Net Time Depth to Water Net Drop Nib 7 2IIJ3 ly'36/orcinjq: 416. ; A111. 4tp .0(0 + zO /S v0 1&71i 7• ; (vS , C55 PFRCr)I ATIONJ RATE A� ) 23 TEST RUNBETWEEN FT AND �1 '00 C� 1'1 P 12rave/ Scvid W CERTIFIED BY: (minutes/inch) DATE: ZZ 13 MUNICIPALITY OF ANCHORAGE —' DEPARTM•=LT OF HEALTH & ENVIRONMENTAL PROTECTION E RONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4iA y SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ON-SITE PHONE NEW NAME /_ Girl 345 -33v3 UPGRADE NC1SOrI erick MAILING ADDRESS SR A �x 3Eo LEGAL DESCRIPTION 'Rik Lo+ A 0 NO. OF BEDROOMS LOCATION � ^1G�1`� i// ' De AyM0%.t J U z r We:l Absorption area Dwelling PERMIT N0830(oel DISTANCE TO. U Y Material No. of compartments F– Z Manufacturer CL Q N ~ Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth Well Dwelling PERMIT NO. 6 Z DISTANCE TO: Material Liquid capacity in gallons _ Manufacturer DISTANCE TO: Well , IC -1 Foundation / r' i L Nearest lot line „ ► PERMIT NO. (09 -1 = JLL Z No. of lines Lengt• of each lin t Total length of lines ' Trench width 0 Inches Distance between lines H Z W Q 2►' r 1 Top of rile to finish grade Z Material beneath the 30 inches Total effective absorption area r C Length Width Depth PERMIT NO. W a Q H Crib diameter Crib depth Total =effective area Type of crib as w Well Building foundation Nearest lot Zine y DISTANCE TO: Depth Driller Distance to lot line PERMIT IN Class J J 'L Building foundation Sewer line Septic tank Absorption area s �+ DISTANCE TO: OTHER PIPE MATERIALS �1G SOIL TEST RATING 2Z-4 4ff' BeJ nor - I EXBTJ — 010 g RE S ' rte: � '•,9 1 so* .: 00. 000N000 aA�*0.0}-1NO..r r•f {^ : Leroyl. Reid, Jr. • DATE LEGAL 126/85 LA 1A B1 0 72-013 (Rev. 3'781 ALASKA ENVIRONMENTAL JOB •� d /* /�°e•^ 'bl - S� 6 CONTROL SERVICES, INC. SHEET NO. OF CALCULATED BY d DATE CHECKED BY DATE N^ i o ' cr.�i F rwa w moi � tic' s'*k mr alai. e • a�e' .� I N_ : I F j- $_ _ I _ C S ° j_� 1= �-._.N r,4 #_:1-4 ""1 F° fO4 ii E DEPARTMENT T HEALTH AND ENVIRONMENTAL . A 3TEC T I ON 825 'L' E,TF`EETo ANCHORAGE, AK. 9950:1 264-4720 Cm 1-4 — :__• I -F E fn E 44 E F= F'E7 F=: t'. -f I `F APPLICANT NELSON G I t• GER I C:H SRA BOX 180 . i' 99507. 345-3303 LOCATION LEGAL L:i.A ALF`ENBL I C K'. LOT SIZE _�'�!`=�__� _�`�! SQUARE IAF'E FEET TYPE OF SOIL ABSORPTION SYSTEM I E : DRA I NF I ELLS MAXIMUM i`'di_MBER OF BEDROOMS = _ •OIL RATING (SO FT/BF')= 227 THE REQUIRED SIZE C iF THE SOIL ABSORPTION SYSTEM IS: to iL_ E r-4 (7j _i"'. f-9 = 03 EJ CA F_ FAVI EE9_._ Cx E F• lF V4 = — THE LENGTH DIMENSION I THE LENGTH (IN FEET OF THE TRENCH OR DDA I NF I ELD. THE DEPTH OF A TRENCH OR FI T IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOH OF THE EXCAVATION 0 i`•d FEET) . e "FE - " F= EoV4 CV l A 1..•-9 I C== -T_ i•• -Y IE. !f -* " e--1 x-1-1 C -D F" E= E _Y_ _ THE GRAVEL DEPTH IS THE MINIMUM LIEF`TH OF GRAVEL BETWEEN THE OUTFALL F`IF`E AND THE BOTTOM OF THE EXCAVATION I N FEET). F__- E e7.� r_A .a. F_ E CA "n E F° -i- I i_= _F I=II 4`-.i - I = E --_ -1 C-5 �1� w=1 r� 1=i L_ L r_� P .9 "=• PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM M THIS DEPARTMENT DURING THE INSTALLATION INSPEC:TICANS � iF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER C �F RESIDENCES THAT THE WELL WILL SERVE. ii . C#•-_ _ g h „g e F` E ate: -F i Cu r-4 F i F° E F= E C o i_� I F" E C=■ �. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION Hi' D APPROVAL BY THIS DEPARTMENT WILL BE S ►B _+ECT TO PROSECUTION. MINIMUM DISTNi'• CE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS :i.F= O FEET FOR A PRIVATE WELL OR 150 Ti i 21.10 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FF -'OM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET 1"'1ND TO A COMMUNITY =. EWER LINE IS 75 FEET. OTHER 1=:E :!U I REMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE F'F.OPER INSTALLATION. Flay E FT 11 I -i E F• I FR E" n CEO CI E l l E j E F? __ W.: AI... 02 03 0- 1 I CERTIF`r THAT i: I AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELL_ AS SET FORTH BY THE i'I►_ N I C: I PAL I T`r' OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE CE WITH THE CODES. S. : I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM t'1t= Y REQUIRE ENLARGEMENT IF THE RESIDENCE IS F: icIDELED Ti i INCLUDE MORE THAN BEDROOMS. SIGNED : _ __�'_v __ _____.--_- A 'F`L I CANT NELE,C1%• �a I i' GEF: I C -H //2Z _? 0 ISSUED B`r'__ ________- -------------- DATE-- PERFORMED FOR: N` ` LEGAL DESCRIPTION: 111i 1 111111 2 3 4 5 6 7 8 9 v_ EE 10 CN17. 11 12- 13 14- 15- 16- 17 4151617 18- 19- 20 81920 ITIA Z COMMENTS 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 'lO l G en be'lC0 DATE PERFORMED: rq FA PERFORMED BY: ]' e_fC` Mofi STS -- 02-q 72-008 (6/79) WAS GROUND WATER "" A %b S ENCOUNTERED? �/ L O P E IF YES, AT WHAT DEPTH? —�— R /I (A it v►��1i �,� i� ,�IP_ SITE PLAN Reading Date Gross Time Net Time Depth to Net Drop 1 /�yj M2_6 �j (, ' / /211,3 / 3 /� 41 /C�%%�/�• tWater , y�t�j s Q �f✓ +HzO ffir� / D '4. zU� D l�rr�l� tH ® 1S OU js == I � MI �� %� � PERCOLATION RATE L TEST RUN BETWEEN n i� w ra t1el 6_a') i CERTIFIED BY: 2 �-- 2 . _`> —(minutes/inch) FT AND �-= FT 2 aIn /I &A DATE: / /�� C=ATER ANCHORAGE AREA BOROP4M HEALTH DEPARTMENT N? 324 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME /Ye�S�� he��►��� ADDRESS -�� 'be 11 277-,)(7$ PHONE LOCATION L��-� LEGAL DESCRIPTION ��t �1F'Pn b�lC�< &4� SFPTIC TANK. :55 /,�� �� NUMBER OF / DISTANCE FROM WELL MATERIAL COMPARTMENTS LIQID LIQUID CAPACITY ! GALLONS. INSIDE LENGTH �,//n INSIDE WIDTH DEPTH 5 SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH // , LENGTH—/ , DEPTH 6 LINING MATERIAL L -OC DISTANCE FROM WELL ( BUILDING FOUNDATION NEAREST LOT LINE 35-1 TILE DRAIN FIELD: DISTANCF/FROM WE ER OF LINES PTION AREA EPTH: TOP OF TILE TO FINISH GRADE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) DISTAWEE BETWEEN LINES FT. LENGTH OF EACH LIN NEAREST LOT TRENCH DEPTH OF FILTER MATERIAL BENEATH TILE JCS SQ. FT. TOTAL LENGTH 'JE LINES TOTAL EFFECTIVE ABOVE TILE WELL:% DISTANCE FROM / WATER TYPE v a DEPTH .,BUILDING FOUNDATION. -32 � SAMPLE NEAREST NEAREST SEPTIC' SEEPAGE/� OTHER LOT LINE � ,SEWER LINE-, TANK�' ,SYSTEM CESSPOOL ,SOURCES DISTANCES: = 3 q' 9C,V5' DIAGRAM OF SYSTEM j �c1►� �n _ � f `� s� pP�� � cu e VA y h' �U; L DATE APPROVED'T HEALTH AUTHORITY v GAAB-HD-2 GREATE, ANCHORAGE AREA OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. NAME OF APPLICANT o "A MAILING ADDRESS e37e2 'rH ,NO:2,7-- RESIDENCE ADDRESS _ _ LOCATION OF LNSTALLATION _ LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY + o, DRAIN FIELD J , OTHER -- /"j- ; i"!1 o ,M,, FINANCED THROUGH IU DC IIVJIWLLCU 15T L PERCOLATION TEST RESULTS A ANTICIPATED DATE OF COMPLETION �% K Von BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS /��? '�+2G , PERMIT TO INSTALL A f'�'✓`��-/—_' '•'s' �-" AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED 3 � - SEPTIC TANK SIZE C'0 0 TYPE`'Z3-tLzSEEPAGE AREA TYPE DIAGRAM OF SYSTEM DISTANCES�:r, LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Are above described system is in accordance with said code. DATE APPLICANTS SIGNATURE ° m �\ ----'---�-- --�-- -- - -- - / - ' - - ----_______ ' A P CAI s _K AN" ('11 '7':�,C'L: Perfcr-ned Yor VIA Date Per`: -,r: -,led Lef,l D(, v e r (I t i �rit I c De th ee t Lorat-Licon SA'etch 1 Encountered? 1'e-', r h 'Il-stal T 0 C, 0 �T: f 1) i t renchi 2,S a Test PertFormed Bvl, D&Ila Certified Date: Describe screen or perforations: Well pum ing test at___4_gallons per (hr) infor hours with feet of drawdown from static level. Remarks WELL LOG -,A .-..--.-Depth in feet from Give details of formations penetrated, size of material, ground surface color, and hardness. < t 0 -:N ----- - WATER"9LI, DRILLERS LOG —90 NOT FILL IN C�rilling Co. 7 USGS No. to Driller —0 1. Area Well Owner Use of Well Location (address of: Township, Range, & Section (if known); distance from road: 71' 7111 60A -Z i I!. -i sl - Size of CasingL Depth of Hole feet. Cased to feet. Static water level feet (above) (–bTlo—w )-land surface. Finish of well (check one) Open end Screen Perforated Describe screen or perforations: Well pum ing test at___4_gallons per (hr) infor hours with feet of drawdown from static level. Remarks WELL LOG -,A .-..--.-Depth in feet from Give details of formations penetrated, size of material, ground surface color, and hardness. < t 0 -:N ----- - "30 t o__45 to to to :j t.. to Ll 7 117 to 'i to to to C_ MUNICIPALITY OF ANCHORAGE Qr HIP" ENVIRONMENTAL PROTECTION m 01 C" J U L 2 RECEIVED Aw: '14 jig W* Ig 4 to to to "30 t o__45 to to to :j t.. to Ll 7 117 to 'i to to to C_ MUNICIPALITY OF ANCHORAGE Qr HIP" ENVIRONMENTAL PROTECTION m 01 C" J U L 2 RECEIVED Aw: '14 jig W* Ig 4 Municipality of Anchorage i Development Services Department s` ' M ►': Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-014-04 HAA# 1. GENERAL INFORMATION Expiration Date: $ —30 — D3 Complete legal description ALPENBLICK SUBDIVISION: LOT 1A. Location (site address or directions) 13000 PATRICK ROAD * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KATHRYN ENGLE Day phone 257-0118 13000 PATRICK ROAD * ANCHORAGE. AK 99516 Day phone MARY COX w/ REMAX PROPERTIES Day phone 2600 CORDOVA STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: 257-0112 TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site N 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, inc. shall be paid S at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality ofAnchorage riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of 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. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. 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. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. 337-6179 Date �dl' t7 Y Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other WASTEWATER By: Original Certificate Date: S ' 3'D — 0 3 (R".12101) a Municipality of Anchorage ' Development Services Department Building, Safety Division " Onsite Water & Wastewater Program "' 4700 South Bragaw St. R.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.sk.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: AL.PENBUCK SUBDIVISION, LOT JA, Parcel ID: 017-014-04 A. WELL DATA Well type PRIVAIE If A. B. or C provide PWSID# N/A Date completed^,1970_ Sanitary seal (YiN) YES Total depth4g it. Cased to 48 fL FROM WELL LOG Date of test � 1970 Static water level 12 ft. Well production 6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 4.83 mgJL. Well Log (YIN) YES Wires propedy protected (YIN) YES Casing height (above ground) l Z+ In. AT INSPECTION 5/9/2003 11.8 R, 2.0 g.p.m. Other bacteria 0 colonles/100 ml. Arsenla N/A mgJL. Date of sample: 5/9/2003 Collected W AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Materfal CONCRETE Date installed 10/20/70 Tank size 015 gal. Number of Compartments1 Cleanouts (YIN) YES Foundation cleanout (YM) YES Depression over tank (YM) High water alarm (YIN) N/A Date of pumping 5/9/2003 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA• isnNG G MP $8/g/90 Date instafted 7/25/113 $o9 rating p.d r ftW4rrn) 227/135 System type SHALLOW TRENCH Length 80 ft. Width 5 ft. Gravel below pipe 2.5 ft. Total depth 04.8-6.3 ft Eff. absorption area 825 ft' Monitoring tube YES Depression over field NO Date,of adequacy test 5/9L2003 Results (Pass/Fain PASS For 3 bedrooms 14.5 14.5/ Fluld depth in absorption field before test /0 in. Water added 50D gal. New depthl;Sn. 14.5/ Elapsed Time: 240 min. Final fluid depth In. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date 'MOVED LAST 28 FEET OF ORIGINAL TRENCH ON TO PROPERTY SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 100+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 350'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION �G V r� I certify that / have determined through field inspections and * l review of Municipal records that the above systems are in conformance with MOA MAA guidelines in effect on this date. ... .. .................. Engineers Printed Nam JEFFREY A. GARNESS �4�, C 7953 e Date S�� 03 �wp�ofessWn_� HAA Fee $ 315 • Date of Payment 2S' 2O'0-3 ReoeiptNumber 3&1_9 (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number D. LIFT STATION I j Date installed Size in gallons Manhole/A i on" level at in. "Pump Off" . High water alarm level at in. L"Pump j Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanM!ft station on lot 080' On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer /septic service line 25'+ I Holding tank N/A tSEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 108+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 100+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 350'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION �G V r� I certify that / have determined through field inspections and * l review of Municipal records that the above systems are in conformance with MOA MAA guidelines in effect on this date. ... .. .................. Engineers Printed Nam JEFFREY A. GARNESS �4�, C 7953 e Date S�� 03 �wp�ofessWn_� HAA Fee $ 315 • Date of Payment 2S' 2O'0-3 ReoeiptNumber 3&1_9 (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number 05-13-03 05:32PU FROM-CTiE ENVIRONMENTAL SRV Fm SGS Ref.# 1032548001 Client Name AK Water & Wastewater Consultants fnc. Project Name/# 13000 Patrick LIA, Alpenblick Client Sample ID 13000 Patrick L1A Alpenblick Matrix Drinking Water 9075615301 T-548 P.02/03 F-438 All Dates/Times are Alaska Standard Time Printed Date rime 05/13/2003 16:05 Collected Date/rime 05/09/2003 9:18 Received Date/Time 05/09/2003 12:00 Technical Director Stephen 5.,Ed Released Sample Remarks: Allowable Prcp Analysis Parameter Results PQL Units Methal Limits Date Date Init Waters Department Nitrate -N 4.83 0.100 mg/l. EPA 300.0 («10) 05/09/03 is Microbiology Laboratory Total Coliform 0 col/I OOmL SM18 9222D L (<--I ) 05/09/03 KAP 61 M.or.rl .ON T Z 0cQg ICE z zs s ww T Z 65 .IV/ M.1f1,OZ,O N u ZOO d "AJVJZt EAMOZIM omtesz XCO AW4 86ed !11dtZ:C CO-Ce-Aell !gtZP GCC L06 !UO3 Jolumolsem Pue J81EM BMSeTV :Ag jueS 0cQg ICE z zs s ww 65 .IV/ M.1f1,OZ,O N u ZOO d "AJVJZt EAMOZIM omtesz XCO AW4 86ed !11dtZ:C CO-Ce-Aell !gtZP GCC L06 !UO3 Jolumolsem Pue J81EM BMSeTV :Ag jueS MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 0 t � � �} i 4 — �' C� HAA # 0 nCI 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 130CC) PA-T7Ri- (b) Property owner Le- Telephone: (home) Business Mailing Address � 3 y U 0 (�A-TT- i L iL 2 a 4j) (c) Lending Mailing Address (d) Real EstateCbmpaP- na�gent Address _ Telephone Telephone (e) Mail the. HAA to the following address: (or check here if hold for pick up.) List contact person and day ,phone number below: 6—k '2: -en -2_x (r 2. TYPE OF RESIDENCE Single -Family. Number of bedrooms 3y 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from.the State Department of Environmental r Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site l Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. 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. � �1 .... Name of Firm�1N e2(L.t (-Y—Telephone 3 3 Address Date A%. ©� A .....,,,� 8 oa oAs Engineer's Seal y�1 Robert E. Kniefe d o to No. 4149 • E J= j `3e0®`ate. 6. DHHS APPROVAL / p Approved for bedrooms by Approved '' Disapproved Conditional Terms of Conditional Approval 1 r, The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 orderto 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. 7/88) Back Page 2 of 2 0 O,A\' \O F �5���� MUNICIPALITY OF ANCHORAGE (MOA) \G\QQ�, V • Health Authority Approval (HAA) C) CHECKLIST - FEBRUARY 1984 a 343-4744 Legal Description: L (A ; t 5 () O t7 k iL A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed ��� Yield Total Depth+R Cased to 48 Depth of Grouting /A Static Water Level 1 Z' Pump Set At '� k Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot (1© B Sanitary Seal on Casing (Y/N) \f 0 S Depression Around Wellhead (Y/N) On Adjoining Lots tv 0 O To Nearest Edge of Absorption Field �J// on Lot ( � A- ;_ ; On Adjoining Lots i ( V 0. To Nearest Public Sewer Line A To Nearest Public Sewer Cleanout/Manhole �"t ` A To Nearest Sewer Service Line on Lot Water Sample Collected by t om— ; Date -7-21C) Water Sample Test Results N k _MA -`z= — ►•� 4 4 �(-- Comments C - y L i C! tZ C �1 B. SEPTIC/HOLDING TANK DATA Date Installed (�j P 3 Size i 0 L"I0 No. of Compartments � Standpipes (Y/N) i � Air -tight Caps (Y/N) Y65 Foundation Cleanout (Y/N) Depression over Tank (Y/N) �'C Date Last Pumped Z Q Z q0 Lime, S Pumping/Maintenance Contact on File (Y/N) /'J/ -A ; for t_� r A Holding Tank High -Water Alarm (Y/N) Lt' /A Temporary Holding Tank Permit (Y/N) �' �A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ( C To Building Foundation To Property Line 3 To Disposal Field 2 - To To Water Main/Service Line b G To Stream, Pond, Lake or Major Drainage Course 7 I Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z Z% Type of System Design w (t7 mFi_)& H Date Installed I g S 3 Length of Field a v Width of Field Depth of Field Gravel Bed Thickness Z'° Square Feet of Absortion Area X S�u 9 G I-o� Statndpipes Present (Y/N) �A S Depression over Field (Y/N) r' 0 Date of Last Adequacy Test --7 — Results of Last Adequacy Test L-N-�jtLy SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ( ( , To Property Line To Building Foundation Lot To Water Main/Service Line IM ; On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course - To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y Comments To Existing or Abandoned System on 7 t 0 To Cutback (if present) (0 � (00*_ Dimensions Manhole/Access (Y/N) "Pump Off" Level ent(Y/N) **Check Permitted Bedroom Rating Against HAA Request" N/A Pumping Cycles during Adequacy Test. I certify that I have checked, v rified, or c nformed to all MOA and HAA guidelistain effect on the date of this inspecti n. Signed. r Company Engineer's Seal Date MOA No. l, Robert E. Knief No. atas-E a Receipt No. � Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 NORTHERN TESTING LABORATORIES, INC. 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907.277-8378 • FAX 274.9645 3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 907.456.3116 • FAX 456.3125 Kniefel Engineering 3441 Miles Court Anchorage AK 99504 Attn: Robert Kniefel Report Date: 06/12/90 Date Arrived: 06/07/90 Date Sampled: 06/07/90 Time Sampled: 1235 Collected By: RK Flag Definitions U = Below Detection Limit Our Lab #: A101307 DL Stated in Result Location/Project: - B = Below Regulatory Min. Your Sample ID: 13000 Patrick H = Above Regulatory Max. Sample Matrix: Water E = Below Detection Limit Comments: Estimated Value Method Parameter Units Result Flag ------------------------------------------------------------------------ EPA 300.0 Nitrate -N mg/l 3.4 Anchorage Operations Manager HEALTH AUTHORITY RESULTS AND ANALYSIS Date of Testing: June 7, 1990 Legal Description: Lot 1A, Alpen Blick Street Address: 13000 Patrick Number of Bedrooms: Three (3) ----------------------------------------------------------------- Results of Well Flow Test: Passed Average Flow Rate: > 5 gpm ------------------------------------------------------------------ Results of Water Quality Analysis: Passed Total Coliform -- 0 colonies Nitrate -N -- 3.4 mg/l (10 mg/l allowable) Testing Laboratory: Northern Testing Laboratory ----------------------------------------------------------------- Results of Septic System Adequacy Test: Passed ----------------------------------------------------------------- Approvals: The field absorbed 690 gallons of water over a 2 1/2 hour period. The field is rated and approved for a three (3) bedroom house. The well tested satisfactory producing water at a rate exceeding five (5) gpm. The tests followed current MOA regulations. y0 A R i��n•a�.e l*ia.RW YYR• •Rse -' 3 P.obert E. <, L,•a. No. 414-E 6 �:^�*� (� AW 4�''�ii►`1iorG.�O: MOA CE 90-030 - APPLIC IT FILLS OUT UPPER HAL --'ONLY Time Prgpert.v owner Nelson. and Margaret Gingerieb Phone MA BOX 380, A1Cbora�e' , Ali%slm 99507 345-3303 Mailing Address Zip Code Date Buyer Carl and Mary Reed Date 74 Z' Address P.O. Box 10-486 Zip Code 99507 Lending Institution Frontier Alaska Federal Credit Union Phone Address i ,SkM6 99503 Zip Code 99503 Inspector 563-3766 Realty Co. & Agent Williwaw Realty Field Notes: Phone Address 502 E!aAr5Q9&1fMAncbora9e, Alaska. 99603 Zip Code 9"3 � 276-8069 Legal Description Lot 1A $lk 0 slpenbltck Street Location UpW D@Armu. off Patrick Road Ty of Residence RECEIVED Single Family ,3 `CONDITIONS OF APPROVAL El multiple Family No. of Bedrooms ❑ Other ( ) CONDITIONAL AP ROVAL' Water Supply L � Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. C`IILN ❑ Community a For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility BY: Sewer Disposal CX Individual Year Individual Installed: 3= 7/25/83 ❑ Public Utility When Connected to Public Utility: Date Sewer Installed ❑ Holding Tank Well Log Received NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF AN HORAGE DEPT. OF H`AL TH Y< � ENV IKOti%MENTAL PROTECTION J 11 L 2 5198'3' n� RECEIVED ( 5) APPROVED BEDROOMS `CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL AP ROVAL' DATE f BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72-023 (3182) ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL HEALTH CASE REVIEW WORK SHEET ❑ PLATTING BOARD El PLANNING & ZONING CASE NUMBER_ S-6103 NAME Lots 1A, 1B Alpenblick Subdivision DATE RECEIVED February 2, 1982 COMMENT TO PLANNING BY February 19, 1982 FOR MEETING OF CASE OF li�'PUBLIC WATER NOT AVAILABLE TO PETITION AREA [L4UBLIC SEWER NOT AVAILABLE TO PETITION AREA �c REVIEWER'S COMMENTS: �v ;zz Ll -3 -�,T� 71-014 (Rev. 2/78)