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HomeMy WebLinkAboutKROGSTAD LT 1Krogstad Lot 1 #015-501-03 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name r rn ��,E�fe�M�t9 DISTANCES TO FROM SEPTIC ABSORPTION WELL AddressTA //,t�� ADX "doll" 11XIed WELL S Phone(s) --// Permit No. extol O� No- of Betl oms LOT LINE LEGAL DESCRIPTION � Lot Block ,*J/-� Subdivision �^4,*3;7 D FOUNDATION � Township, Range, Section 4.,,ss r $ ( / /ter ./L / AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system, property lines, loundation, TANKS I I I I i I i i ``K SEPTIC ❑ HOLDINGS Manufacturer Capacity in gallons _ , i 14. rb Material No. of Compartments 57tyL­ Z> TYPE OF SYSTEM 'gTRE:NCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade FT ® FT Fill added above original grade Gravel depth beneath pipe -- FT �4 FT Gravel length Gravel width J FT � FT Total absorption area Distance between lines SO FT "" FT Number of lines Soil rating Pipe material �l�Ch SQ FT rf/d MO _ Installer Date Installed WELLS PRIVATE ❑ OTHER tldentity) Classification (A,B,C) Total Depth Cased to FT FT I Installer I REMARKS: A�r �. ir- I;l ate. '��-.]2S'� 1 ;l 1 Z,7-0 I— `" �� ` %' _ certifythatthis inspection was performed according to all Municipal and Slate guidelines in effect oonnLI/SL)dale: Health Department A roval: YJ� _ Date: — 72-013 (3/85) ENGINEER'S SEAL 1 15 Iza 1-11 F3 i 4 14 zi M. -W bRILLING, [no, P.0, WX 110378 0 1040 OW Smard Highway (907) 349 8339 ANCHORA(it, AUISKA 9011 DRILLING 1,00 weU Owner.. _q.it'rt _ _ " R 02 ?- . W -'.7 88-143 _---Use of wen__Q-0�nieat ic (address of: TOwnshtPp Rangcj SOMIDA, if known; or distance main road_, 17 ---Depth of HoIe__2_U-dLj0qt Cased to --L8 l_�7 Statio water 9 (abO& �13010w) 101d surface, Finish of wall (check one) open end Sow -U01) Perforated DoscribL sr -it ­n or wall PLUXIVIng ti�S't t)t f"C'�' (niltil'71o) for__ ours 01 drqw(OW11 irom static level, WELL LOG DMAI, Ixt 1toril gmi 4ttvfaee Ge d4tallg of formations penetreacd, eine of material, color I - u'c_ M.tjni62aMY Of Anchorage 5 Ow- R Depi Hea 4P -To L0tq!*!nd 'Yi V we wag w: . .1 _�r alp'LC Iw M4. �Qntactor Certuic2tt NO% 614 & 073 3 — CONTRACTOn MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Streetnchorage9 Alaska 99501 343 (31\1--S ITE SEWER & SEPTIC TANK & WELL PERMIT Permit Number: 880113 Date Issued: 07/06/88 Engineer Designed Owner Name: TOM BARTHOLOMEW Owner Address: PO BOX 231101 ANCHORA8E, AK 99523 Day Phone: 248 7423 Parcel Id: v/ ('' 5-})/-'0 --"7 Lot Legal: Subdivision: KROGGTAD Lot: 1 8lock: - Section: 15 Township: :12N Range: 3W Lot Size 1^25 A (sq.ft" or acres> Max Bedrooms: This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total 1p250 gallpns" Each septic tank must have at least Depth to top of septic tank(s) < 4,0 �eet requipes insulation over tank(s)" WELL: Log must be submitted to Munic1pality o{ Anchorage Depaptment o f Health and Human Services within 30 days of well CAMP ] St. ion" INISTALL PER ENGINEERS DESIGN, A TRENCH TYPE ABSORPTION SYSTEM~ LENGTH: 64'; GRAVEL DEPTH: 6/; MAXIMUM DEPTH: 10/. WELL TO BE DRILLED IN THE SE CORNER OF THE LOT" NOTIFY DHHS PRIOR TO EACH INSPECTION, THIS PERMIT IS ISSUED FOR A SINGLE FAMILY RESIDENCE ONLY AND EXPIRES 12/31/88" I CERTIFY THAT: 1. I am [ ami liar with the requirements for on~site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State (.)f Alaska" 2" I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit" 3" l will adhere to all MOA and State of Alaska requiremeOts {or the set back distances Irom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4^ I understand that this permit is valid for a maaximum o[ 4 b�drooms" I also understand that the capacity o[ the total syistem is 4 bedrooms and any enl l dditional permit" Signed: DATE: ~~~ (Owner} TOM BA Issued By: DATE: A EC S ALASKA RUInOnC RTAL COnTROL HUM, InC. Q 6ngineerinq & Enuironmenlal Studies SPECIFICATIONS IVOR A TRENCH TYPE WASTWATER DISPOSAL SYST . KROGSTAO SURD [vlslON, LOT 1 1.0 GENERAL t.l The drat+lags, shoe Ls 1 through 3, shall be a part of th`,; spec ficaiinn. 1.2 All manor ials and workmanship shall meet the, requirements of ,_he Municipality of Anchorage, Department of Health & Human Services (DIIHS), the conditions of the permit, and KII applicable rules and regulations currently in effect. 1.3 Ala c1evat.ions and depths are advisory, and are to be verifier) or modified in the field by the engineer or inspecting agency. 1.4 It is the responsibility of the owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspecLed by air 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 TANK 2.1 If there is an ex.isking septic tank, it may be used if it meets the capacity requirement for the residence and the approval of the MOA. 2.2 The septic tank shall be a CPC -Approved two-compartmenttank, constructed of 12 gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch huriai- type polyvinrene rigid board insulation. 2.3 The septic tank and trench shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C sells, and 200 feet from Class A or i3 wells, unless otherwise :specified. Less than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight, es,Ilder coupling; on the outlet and inlet of the septic tank. Piping shall be 4 -inch solid PVC ASTM D3031 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, 1200 West 33rd Auenue. Suite B • Anchorage. Alaska 99503 9 (901) 561-5040 it must be insulated with an overlying layer of 2 inch burial -type, polystrene rigid board insulation. 2.6 Cleanouts shall be installed as designated and capped with air -Light rain cups (Jim caps or equivalent.), and extended a minimum of 1 foot above ground level. 2.7 If a lift ;station is required it shall be a combination lift statiolt septic tank per Anchorage Tank and Welding, inc. design. Specifications are attached. 3.0 Absorption Area 3.1 The gravei for the trench shall be 0.5 to 2.5 inch, screened rock with less than 3% passing5200 sieve residual. All substitutes must have prior DHIIS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall he level. 3.3 'Monitor standpipe(s) shall he placed as shoran in the drawings, and sii<ill be, 4 inch rigid PVC ASTM D3034, or cast iron. The section shown with holes may he 0.5 inch holes drilled on 6 -inch centers on opposing 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. A rubber rain cap (.Jim cap or equivalent) shall be installed over the top of the pipe. 3.4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of 1.500 lbs and shall meet the approval of DHHS for use as drainfield pipe. All distribution pipes shall be laid level.. 3.5 Trenches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or 2 times the gravel depth (whichever is greater). 75 feed. :is the maximum allowed linear length of any trench. 3.6 if the final grade over the trench is less than 4 feet above gravel, insulation is required, using burial type polystyrene rigid hoard insulation. There shrill be 1 inch of insulation for every Not of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 if insulation is not necessary, the gavel shall be covered with a layer of nonwoven Geotextil.e fabric (such as M.irafai, K hretex 200 grade, Poly Filter Y or equivalent). 1.0 INSPECTIONS 4.1 A minimum of two inspections are required for the installai ton of the trench. The first inspection will be of the open excavation to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. 4.2 The second inspection will be after placement of [he gravel, monitor standpipe and distribution pipe to verify proper installation and position prior to bacRfill. 4.3 The inspection of the septic tank installation can be incorporated with any one of the above listed inspections. .� 'DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION w TEST 625 L. Street, Anchorage, Alaska 99501 2G -4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:.I�.jY1- 1-�—�1 C c-lk DATE PERFORMED:'2 1' 0 2 _ LEGAL DESCRIPTION:_--j-� t,`l v�^' ��e,c,e� �L•k '25�1 - SLOPE SITE PLAN urgbnIG No,a: 1 roy5�z� t 2 3 —4' CIO r �^ 5 (Gjr11 �l�iy ,sandyl��i�Ve� I 1 1/ bblea ��roL►ghou� s � , ���i Off. � ApAr .�s�4�4 p 1 ;.• •• •..�-a••••i• !� i••6.•H•• •JE 11 �'a. • �,•• C. REID, JRyy91•(,f�OUND WATER ,I•� S �• CE -2251 •.�Nj�1NTERED? 1 \0 L 0 12 - •4 •• ®PfOfM'10 ES, AT WHAT DryC•'.-/�/(-�- iE - �6�@i1A�`- 13 � 1 ��, }��F[:�`'-•, PERCOLATION RATE /� ,M TEST RUN BETWEEN COMMENTS -i 7Y _i�`"1 %L PERFORMED BY: t '- 4 A;' CERTIFIED BY! r . 1 Net Depth to Net Time Water Drop i �- .n �•yl 3.Ilo � . •2s fic3 3.5 2 S 14 " , • " /� ti� 5 }- 9iaVf Yt Readin 9 Date Gross Time, . I OCC SIO ap .2 •i2 .1 :30 15 •' •• 10 x.33 s i�n •'� RC„ I U� IAV � i,� !'. :A /1�//''yy 4 td 11.•30• W ••.. o.a•p�t�.l n sa ♦HAD 11:43:1 °I 18 sF - 191 J 20 ��, }��F[:�`'-•, PERCOLATION RATE /� ,M TEST RUN BETWEEN COMMENTS -i 7Y _i�`"1 %L PERFORMED BY: t '- 4 A;' CERTIFIED BY! r . 1 Net Depth to Net Time Water Drop i �- .n �•yl 3.Ilo � . •2s A A �40 Ir inutes/inch) I DATE �_• fic3 3.5 2 S ,2 10 x.33 A A �40 Ir inutes/inch) I DATE �_• FRW,V �l C�--7 iz.. c,x.. u 01471. Illlf III�IIII� • • f• • • f«••• • f f • • • • • • �O O cp 0 o n O� O N rq Z D o° nH O p O a � 31 n IF o -4 r n D m a n LA m ° WE o T_ N �u 0O OC D OC x L 00 O 01\N- m a H r r A r n %or 7 1 Zr N ul " -i { O p �� O O 8 ^,z rn D F n 0�rn H z; > 0 M rn N H G o 0 0 0 E a m® n O a n� p rn H I v �D . UI . rn In c. � J z r m H z a > D �r WE o T_ N �u 0O OC D OC x L 00 O 01\N- m a H r r A r 1 bH z H O 8 ; H M > M H o n p In S3 m a > a zn H o to ri o O Htr A p a � til a MI U 14 w A O z O u C DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 May 30, 1984 Alaska Environmental Control Services 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Sir: BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 MUNICIPALITY OF ANCHORAGE DFPF OF r1A.LFH & L-'NVIRONM iVi.iL PROTECHON ECEI V ED Subject: Wastewater System, K.rogstad Subdivision, Lot 1, Block 0 (8421 -DA -328) We have reviewed the plans and specifications for the subject project. The plans are approved, conditioned on adherence to the following items: 1. screened rock back fill in deep and wide trenches (3/4" - 3"). 2. screened rock back fill in absorption bed (3/4" - 1 1/2"). 3. sufficient area plotted on as -built for replacement system. This letter constitutes the permit required by A.S. 46.03.720(a) for plan approval of sewerage systems. It should be remembered that final approval will necessitate the submission of Engineer As -built Plans to include photographs as indicated on page 13 of enclosure. This will consequently mandate that a professional engineer conduct basic inspection of this project so as to be able to sign off on as -built plans. Arrangement for this inspection work is the responsibility of the developer. Sincerely, Jams F. Hayden Env ronmenta1 Field Officer JFH/msm Enclosure cc: Robbi Robinson (MOA health) DEPHRTMENT OF HEHLTH HND [.-N;lKUNVILN|ML I`MU|t |Ium 825 'L/ TREET/ HNCHORHGE/ F:11-::.. 995� 264-4720 I] m-11���� ��4�� ������� ������ ����1� PERMIT NO. ( 8]04]6 ) DHTE OF ISSUE T- 5 87, _'DI IF' *** WHRNING - DUE TO G REQUI�EMENTS THIS PRINTOUT MHY NOT BE HNA * *** COPY OF THE ORIGIONHL PERMIT HPPLICHNT CHERI CHRISTIHNSON 9105 JEWEL TERRHCE ]]G~7688 LI'D CHTIOhl LEEG HL L1 KROGSTHD LOT SIZE 999999 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS� TRENCH MHXIMUM NUMBER OF BEDROOMS SOIL RHTING (SQ THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� ~~~^ THE LFNGTH DIMENSION IS THE LENGTH (IN F�ET) OF THE'.. TRENCH OP, DRHILNFTELD. THE DEPTH OF H TRENCH OR PIT THE DISTrqNCE Ei,ETWEEN THE SURFHCE OF THE 1-*i�01 IND HND THE BOTTOM OF THE N FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). ����L-11 _X, R, F.:.:.- E 11 H--'- U= .�4� IF" lfz-� EE C:q L-11 I���� BHCKFILL_ ING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL RND ANY 0NITE SEWAGE". DISPOSHL SYSTEM I� 100 FEET FOR H PRIVHTE WELL/ OR 150 TO 200 FEET FOR H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DIST8NCE FROM H PRIVHTE WELL TO 0 PRIVATE SEWER LINE IS 25 F�ET HND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS HRE REQUIRED FINE MUST BE RETURNED TO THE DEPHRTMENT HITHIN ]0 DA'I'S OF THE WELL COMPLETION OTHER REQUIREMENTS MHY HPPLY ~ SPEClFICHTIONS HND CONSTRUCTION DIHGRHMS 1r HVHILHBLE TO INSURE PROPER I�STHLL0T�ON ����1�� ��� ����� E_- LEE C_ 1 0 A��� I CERTIFY THHT i: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS �ND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDERSTHND THHT THE ON~SITE SEWER SYSTEM MHY REQUIR EE IF THE RESIDE DE MORE THHN ] BEDROOMS. HP C"I"IHNSON ISSUED BY. �.v~ ����DHTE....... ~-~�.� INSP��TION HI��ORY � SEWER (/ 0 SEWER 2 0 WELL INSP 0 WELL LOG DATE 0 DRILLER t� SOILS LOG MUNICIPALITY OF ANCHORAGE 99 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION1 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: r c_f � DATE PERFORMED: 9,29, 2, LEGAL DESCRIPTION:_ -1- 1 GAN MW) P -Cy 1 �: Lc)� ? s F) l / Imo�Iy+ \/� 1 t SLOPE SITE PLAN IRO ` tf - U (y1 a n 1 ('- �� 2 3 4 5 6 Cobb�E;s��rpi���Gui 10 WAS GROUND WATER lC S 11 - _ �'I'� ENCOUNTERED? L 12 ` -� E 13 14 %_��)_G�rOut.�lt71SC14 15 ` C c d'stoO'd Q'C)W .s 16 17 18 19 IF YES, AT WHAT DEPTH? �1 Reading Date Gross -L" Time Net Time ' Depth to Water Net Drop N2Gt -1 %, 2'l j2- \: " v% 'V j0 3-0 1 3. (% 1-1-120 11:3C;! 3 U) C 11 3l) �� , Ito I I : L13: 15 - . 5 zs- a 4 : S3 5 1c) �3 : -s5s" Ica i IA 2 c) I I: s 3c) '(� 3 L6 ■ t 2- ' 0-�: le:)- 3: 1 Ld 12 ; 11 Reading Date Gross -L" Time Net Time ' Depth to Water Net Drop N2Gt -1 %, 2'l j2- \: " v% 'V j0 3-0 1 3. (% 1-1-120 11:3C;! 3 U) C 11 3l) �� , Ito I I : L13: 15 - . 5 zs- a 4 : S3 5 1c) �3 : -s5s" Ica i IA 2 c) I I: s 3c) '(� 3 L6 +- H ZO t 2- ' 0-�: le:)- 3: 1 Ld 12 ; 11 .3.33 , 20 uPERCOLATION RATE / L5-- (minutes/inch) TEST RUN BETWEE9NN �� _- FT AND FT COMMENTS .L PERFORMEDBY: le'44-da e- _CERTIFIED BY: DATE: 72-008 (6/79) Municipality of Anchorage , :• : s • ®evelopment Serv�ces,De'partment •t. r �F ,. ftge1c Building Safety brvrsron.t• " A, w AMTV On Srte,Water and Wastewater Program •4700 Sout}i,Bragaw Street ur •,e'.Y.9,.•vi P.O. Box 196650 Anchors e; AK 99519-6650 � www ci ra�ge r ,r'�$(907�•3;,7904'�e t;, •^ , 5 R h y ti r N r y r h CERTIFICATE OF HEALTH AUTHORITY;APPROVAL , FOR A SINGLE'FAMILY DWELLING x Parcel LD. 015-501 -03 :. "HAA' s3p Ezprratron Dater %' nc�x3' .1. GENERAL INFORMATION Complete legal description. L61:1 Kr6asiad' "'• `,:r `°r '' Location (site address or directions) 10601 Our Road,'Anchorage, AK °; s Current Property owner(s) Timothd N61son bay. phone 346-3903 Mailing address 10601 Our Road, •Anchorage AK agency U.S.•InspectAttn Richard Sheehan' Day phone 703f-­91-1116252 P. Mailing address 3660.Conco�de Pkwv::Ste 100, Chantilly, VA•20157-1129 Real Estate Agent Day.phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup.' HRA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: 'TYPE OF WASTEWATER DISPOSAL:... Individual Well Individual On-siteIndividual 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 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 on-site wastewater disposal and/or water supply system. DSD 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 engineers work. �Y 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of.the-validf tion dare shrtv:n below, I verify that my investigaticl '< "'' based on procedures outlined in the Healfh,Authority.Appl-avai :. udelines for this Health Authority Approval application shows that the on-site,water supply and/or. nrav±seater 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 Anchoragefiles and ffoin my investigation and inspection, the on-site water supply and/or wastewater disposal system As in earn;:;fiance with all applicable Municipal and State codes, ordinances,'and regulations in effect at the time of in -taila+ion. Name of Firm Pannone Eno. Svc. Phone 272-8218 Address P.O. Box 102954, Anchr AK 98510 Engineer's Printed Name Steven R. Pannone, P.E. Date !7 (t-r,->� Engineers Comments: In conducting all I(Iocluac) tett I i. tunpl to pulvl1: a thmoa)_h•, cans, ienl lour evoinCerllla flnah.sls of the system in tux:ordance aith'vIQA IAW'Gunlciir.(, b'c'tcglll Aion., •Ihc ........... " fl)IoltCd I'CSlllls (ICsc17Ix the p(:rform uicc'ofthl tii;tem a+l.ls.r the i:ond,nons Gly{)i11t�rCU i!t th:: t!lai Uf ®40, /1 ��.••'� �•: / . ®� (tic test. and selxlriltil)n dis4vlt:es incastired to readily. 1QtR1hha1�lll 1Callta't`s. Ilf� (rpP rationaI lila of' all W ® B \sells and septic sys!ems (i jiend on'!lic load soil condilio y �:Idund \\:iter level!: . t! al ma)' Iluctuala Ar - ® / during the }cur, wind the \\'idcr nkI} c of the tinnily thein, %Lrv�d h\ Ilie tiss:(.7 1 he;e conch on; We�� outside n:r C0111101 oI'the ccahlutor o('lhis scstanl. All s}slcais rsenluallc [all u d , ):nf .tory trsl V`�,C ••...•.•`: ' w leiults do nol wiantntee luture Ixtiformance ofthe s\'ste!ll, 11(n do tllt4 L't1al 'llo al tl v'- It ,!O �a .... - em IIiddell delCc!s of e11Cl Oflcinllttlllti Ills Call Lh(.TCIUtt; Ilot l)fUl'IdC dfl\_ Rill I'fll:l\ for .:Ih: a l)U 11) naRl:i' 4® F101 I!1\'C 9II1C estimate ofhow lone the sNsleni will contillue to meet till` operaijoinal re(lla.t 1nt.I.ti Ui the 0 ,0 ADli(1 or 610A DSD. The content o: This re )olt is for the sole bene.11 of IIx! wwul .r lis: • ! -•'•• f ' l 1 '� '' ld l ln)sr. •l;:� 6 ,.{•;J� lZ_i �' �- `� 4W •ls I'ClllUpon N±1lli(k`ltf lhls 1'C )(lii by Jil\'Ut11Cr •MI:ti0ll of mlrl)'is no! i!I1L!(Irl%Qlli<if; %t ill !i Cll!L'rl fell\' �' ..• a �0 ' 1lllight 6. DSD SIGNATURE 1� Approved for —._ bedroorns. Disapproved. Conditional approval for __—_ bedrooms, with the following stipulations: Additional Comments Pz P i '.'ll • •a. Attachments ��f�/�i�iJ1 1)311'3`1 11 HAA Checklist.: X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other ' By: f Original Certificate Date: -7-03 �i Expiration Date: Reissue Date: (Rev. 11/99) . D.LIFT STATION;in"Pumlevel Y ' Date installed g s" Manhole/Access "Pump on" level at at in High water alarm level at in Datum tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/rift station on lot 920 On,adjacent..lots .100+ - Absorption field on lot 135 On adjacent lots 100+ Public'sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 30+ Holding tank ,,N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �� P Property line 49 Absorption field 7' ' Water main N/A Water service line 30+ Surface water N/O Drainage 100+ Wells on adjacent lots' 10.0+ SEPARATION` DISTANCE FROM: ABSORPTION FIELD' ON LOT TO:. , Property line 10+ Building foundation `�' f r Water main N/A i Water Service line .35+ Surface water NIO Driveway; 'parking/vehicle storage 25+ Curtain drain N/O Wells on.adjacent lots 100+ F. COMMENTS OF "- G. ENGINEER'S CERTIFICATION SCP.••• •�S1�. I certify that f have determined through field inspections and `, 49 t— �....,r review of Municipal records that the above systems are in ' ' 0 conformance with MOA HAA guidelines in effect on this date. .. Steven R. Pannone Ar Engineers Printed Name Steven R. Pannone, P.E. �I�'S: No CE 81a19 Date r-,� oU HAA Fee $ 3 5 Waiver Fee $ Date of Payment 117—/o3 Date of Payment Receipt Number 02'? K/ 6- - Receipt Number (Rev. 11199) ,a - ` e-02;12: I BSM; CTl S Lenvlranmental Services Inc. x. •r"AWMWr4rrrrArardP4W4Wrrrm CTBE Ret.# 1026471001 Client Num Pwm=e Bug, Srv. P ojwName/# Lot 1 Krogstad Client sample M Lot 1 Krogstad Aiatriz Drinking Water PwSID o Sample Remarks: Parameter Reaelte waters Departtaent NitrataN 1,1S Microbiology Laboratory Total Coliform 0 I All Dates/Times are Alaska Standard Time PrintedDate/Plme 12011&12002 15.18 Collected Date/Time 1211612002 13:45 ReceivedDate/Tlme 12116!2002 14:30 Technical Direct Staph Ede Released By Allowable Prep Analysis PQL Unita Method Lm*9 Date Dau Ink 0.200 mglL EPA 300.0 (G=10) 12/16/02 FL;r col/100m], SMIS9222S (e=1) 12/16/02 KAP w N O N 'z� 0 m 0 m m � D C D v o mR (n C c v m F < u U y n z �A z r v v ❑ N m D Z rS I ®O r- 0 N W W N 00'01'29' E 165.58'(M) S 00'00'56 W 165.25'(R) S ono W (l � N OBL 2 X L'tL 36.5 g V) MHS o mZ a o{s 165.26'(M) S 00-00'22' W I I 165.25'(8) OF BEARINGS S 00-00'22' W 330.50(R) 330.53(M)- Ct m D Z rS I 00 rnC f � I E) I I mrn • • .w.. 4 24.8 I oot o m � N OBL 2 X L'tL 36.5 g V) MHS o mZ a o{s 165.26'(M) S 00-00'22' W I I 165.25'(8) OF BEARINGS S 00-00'22' W 330.50(R) 330.53(M)- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF: HEALTH & HUMAN SERVICES Division of Environmental Services 0*:� On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # bk - (�� HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) I n Property �1 �� I2��S Day phone p Y• _ Mailing address f03/o Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: - 3. TYPE OF WATER SUPPLY: Individual well —— Community well Public water N boos e La 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 x Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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. Name of Firm / o �b�H v �- V. I a � �• 1= Phone e " 3 Q L6 Address Engineer's signature s� 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments A- ct� Date I!X3 ` R Z ;ter. bedrooms, with the following stipulations: 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 M Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �-©� gra r Parcel I.D. D11�P���r ( C' A. WELL DATA Well type R, If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 7/70/ 6 Driller Total depth o2 e %L Cased to 4- ReZ p Casing height n 1�" _ Sanitary seal (Y/N) _ Wires properly protected (Y/N) _N u D 1,&/ r FROM WELL LOG Date of test Static water level o2CoU AT INSPECTION 3/ Z' MUNICIPALITY OF ANCHORAGE �, y -7 ENVIRONMENTAL SERVICES DIVISION Well flow g.p.m. VT g.p.m. Pump level F0bo� "b -R L C E I V E D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 12-b ; On adjacent lots _ y / ( 0 _ Absorption field on lot —// I � ; On adjacent lots > /rte' Public sewer main _ N//A Public sewer manhole/cleanout N Sewer service line N WATER SAMPLE RESULTS: Petroleum tank N Coliform 05 Nitrate 0 + VJ Other bacteria Date of sample: Collected by: -S R. SEPTIC/HOLDING TANK DATA Date installed — �/ 0/Bg Tank size i ;2 .5-o Compartments Cleanouts (Y/N) 112— _ Foundation cleanout (Y/N) y Depression (Y/N) _ High water alarm (Y/N) f� 4�A Alarm tested (Y/N)�/- Date of pumping _-env' �/���� Pumper / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot— le20 —On adjacent lots >/O -O / Foundation ` � o_� l 4 To property line !2 Absorption field Surface water/drainage Water main/service line 1-440: - G "1 _ 72-026 (Rev. 7/91) Front - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) Nigh water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ Date installed 7 Z Z 4 P, Soil rating Z.:5—o System type e_�G/ Length '15 z/ Width 3 Gravel thickness Total depth Total absorption area (oyp;l Cleanouts present (Y/N) % Depression over field (Y/N) ri Date of adequacy test f Results (pass/fail) for y bedrooms Peroxide treatment (past 12 months) (Y/N) I � If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot No adjacent lots/cto Property line Z / To building foundation r l� o� / /tom/ To existing or abandoned system on lot x_616 On adjacent lots 7 30 Cutbank Water main/service line No ! ( // 1,7 Surface water r-�10 Driveway, parking/vehicle storage area tQ Vyl -e— Curtain drain t) E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 7 Engineer's Name 1 0 (�%t � �pD � ft a -Ir- � Date ' �3! Qt Z ' NAA Fee $ Ad Waiver Fee: $ Date of Payment C3'_LV)A— Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/91) Back MOA 21 2VJNBTi5TH.AYENUESUITE 206 ANCH8KAG[`ALASKAY9502^JY0N (907) 279-3916 RESIDENTIAL W[71-1-. INSPECTION LEGAL: Lot 2 Krogstad LOCATION: Our Road OWNER: TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE- Yes INSTALLATION REQUIREMENTS MET -Ye WELL YIELD FROM WELL LOG - PUMP YIELD FROM TEST: 9.4 Gallons per Minute DAJE OF INSPECTION: March 14, 1992 TEST PROCEDURE: Well was pumped at a constant rate for four hours. A total of 2256 gallons were pumped. Static water level was found at 247 feet. Total well depth and casing depth is 282 feet. TEST FOR E.C[]LI AND TOTAL NITROGEN: Water was tested for E.Coli and totalnitrogen on March 16, 1992 E.Coli 0. Total Nitrogen 0.47 mg/l. Max. �llowable Total Nitrogen 10 mg/l TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. T0,9 WELL WILL PRODUCE MORE THAN i3GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The per e day. llhis well exceed this requirement. The assessment of the condit1on of the well applies only to the conditions as of the day tested. [he flow rate may change due to subsurfaco conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquiferfeeding the well. 203U[STl5YH.AV[HU[SUITE 206 ANCH0kAB[/ALASKA 99502~JY04 (907) 279-3916 �F'T.ICSYS'TEM0.)DEQUACYTEST LEGAL: Lot J. Krogstad I-OCATIUN: Our Road [111H11,01low RESIDENCE: No Residence WELL: Private, On Site SEPTIC SYSTEM: FROM MUNICIFAL RECORDS: 4 Bedroom System TANK: Greer Steel 1250 Gal. Two Comparts. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 6443 Sq. Ft. SOIL RATING: 150 INSTALLATION DATE: 7-27~8G DATE OF LAST PUMPING: Never Used, Never Pumped DATE OF TEST: March 15, 1992 TEST PR8CE0LURE: 1240 gallons of water was added to the end of line clean out. No water was observed in the trench monitor. The addition of 1240 gallons resulted in 4 inches of water being measured in the monitor. After two hours the monitor was dry. TEST RESULT: This system meets the code requirements of the Health and Social Services Depart- ment of the Municipality of Anchorage^ NOTE The operatJ.onal life of all systems depends on the local soil conditions, groundwater levels that may fluctuate Juring Lhe year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. . CHEMICAL & CTEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL. TESTING & ENGINEERING CO. 5633 S STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 51884 Chemlab Ref.# 92.0984 Sample # i Matrix: WATER Client Sample ID L1 KRAGSTAUL Client Name :TOBBEN SPURKLAND, P.E. PWSID UA Client Acct :TOBBENS Collected MAR 15 92 @ 12:00 his. BPOV PO# :NONE RECEIVED Received NAR 16 92 @ 09:35 his. Req# Preserved with AS REQUIRED Ordered By Analysis Completed MAR 16 92 Send Reports to: Laboratory Supervisor STEPHEN C. EDE 1)TOBBEN SPURKLAND, P.E. Released By. .........,....... ... lam. ::a.-.en.ve................................,,..........,...........................,......... Parameter e� Results Units Method Allowable Limits ----------------------------------------------------------------------------------------------------------------------------------- NITRATE-N 0.47 mg/l EPA 353.2 10 Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T.S. ................o............................. 1 Tests Performed See ............................_............... ................. ...... Special Instructions Above UA -Unavailable ND- None Detected °' See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT-Gteater Than 1110�'���� Member of the SGS Group (Societe Generale de Surveillance)