HomeMy WebLinkAboutTIFFANY TERRACE LT 2Tiffany
Terrace
Lot 2
#015-472-22
Municipality of Anchorage
Development Services Department '
e/
Building Safety Division
On -Site Water and Wastewater Program, 4700 Bragaw St.
�.
P.O. Box 196650 Anchorage, AK 99579-6650 Page I of
www ci.anchorage ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: PID Number: _0/$- —_(_7 t — ZL
Ra "af' 0F*4%a n
Wastewater System: ❑ New ® Upgrade
Aaar"'ABSORPTION
11160 "TaFlr End nd
FIELD
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Y6 2717
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SEPARATION DISTANCES
tia Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
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BENCH MARK
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Engineer's Stamp
Inspections performed by: F�arTCCA, $''mac • Dates: '1't
2 nd
Development Services Department Approval*;
iE-�:.��1 �a
•' Oo. ••,: �_
Conditional Approval Date:
i.: 49al •�*
:THEODORE F. IfOORE ;
CE 3599
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Date:
Reviewed and approved by: f a1
t� •�/G� EA*r
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Oil
PERMIT NO: SWO60370
PID NO: 015-472-22_______________
NEW 1250-GALON "E'
SEPTIC TANK
W03
ass«
PAGE 2OF2
EXISTING SOIL ABS. TRENCH
---------------------------------------
SWING TIES:
FROM: COR. "A'
COR. "B'
TBM
TO:
N
S.T. C.O. "C' 14.5'
21'
S.T. C.O. "D' 21.5'
24.5'
DBL. C.O. "E".:_, 23.5',:29'
7
PLAN VIEW
SCALE" 1" = 30'
W SOIL COVER
OUTLET 1250 GALLON•
INV. 94.6' SEPTIC TANK
CROSS-SECTION
SCALE: 1" = 5'
94.6'
LOT 2, TIFFANY TERRACE
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MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water B Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO60370
Legal Description: TIFFANY TERRACE LT 2
Design Engineer: 0019 FLATTOP TECHNICAL SERVICES
Owner Name: PAT HOFFMAN
Owner Address: 11160 TRAILS END RD
ANCHORAGE, AK 99516-1210
Date Issued: Nov 14, 2006
Expiration Date: Nov 14, 2007
Parcel ID: 015-472-22
Site Address: 011160 TRAILS END RD
Lot Size: 53994 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3_ The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
- (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAYBE LOCATED NO LESS THAN
FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER
SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY
PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY
WELLS.
Received By: j6l�e AA,-, Date: 17175"/06
Issued By: ( 'I V
Date: lf/ux�
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
ON-SITE SEPTIC/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O 167 - Y7 2 - 'L2
Propertyowner(s) Pot F H-03" An Dayphone 3Y6-2717
Mailing address 11 1 e Til/ En a R A-^ c'4c` yt Zip Code 9-rl
Site address Sa r•+t Zip Code N
Legal description (Sub'd, Block & Lot) 1-4'P 2, 'T/ffw yr Te macre, S' Ib
Legal description (Township, Section & Range)
Lot Size 5390(1-I Sq. Ft.
THIS APPLICATION IS FOR (®all that apply)
Absorption Field
❑
Septic Tank
12
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial ❑
Upgrade ❑
Renewal ❑
Pliant EKp.d�/�
Coll a�e.r.C1 lre7Ae Taei-
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: H60 eeWaiver Fees:
Date of Payment: 11 / 13 / of� Date of Payment:
Receipt Number:5� a Receipt Number:
(Rev. 11105)
CML E ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
TED MOORE, P.E. 14530 ECHO CANYON ROAD
PH./FAX: (907)345-1355 ANCHORAGE, AK 99510
E -Mail: tgmoore@gci.net November 13, 2006
M.O.A. DSD
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application
for a permit to replace a collapsing septic tank on Lot 2 of Tiffany Terrace S/D, located at 11160 Trails
End Road. A site plan and specifications are enclosed for your review.
The replacement tank will be installed at the location shown on the site plan. The topography of
the lot is generally level in the area of the septic tank.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space -surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
T_ e Ipto-.
Ted Moore, P.E.
LOT 1, STONERIDGE S/D
WELL
; SEPTIC ;
AREA ;
�.9..;4�' LOT 2, TIFFANY TERRACE SID
j A ��' SEPTIC TANK REPLACEMENT
*• qg •� * SITE PLAN
of .................. ......
--
. FLATTOP TECI INICAL SERVICES 1 INCH = 50 FEET
--
. - --
-
-
........:.:;
' P :• THEODORE F. MOORS �: ,!� 14330 ECHO CANYON ROAD DRAWN BY TFM
CE -3589 �i �C� ANCHORAGE, ALASKA 99516 NOVEMBER, 2006
40 fe es10f1W
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIN
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LOT 1, TIFFANY TERRACE
(VACANT)
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EXISTING_SOIL ABS. TRENCH
I
ABANDON
EXISTING
FIBERGLASS ALL NEW
SEPTIC TANK 1250 -GALLON
I
4-BDRM SEPTIC TANK
O
HOUSE
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Imo„•' LOT 2, TIFFANY TERRACE
I
LOT 1, STONERIDGE S/D
WELL
; SEPTIC ;
AREA ;
�.9..;4�' LOT 2, TIFFANY TERRACE SID
j A ��' SEPTIC TANK REPLACEMENT
*• qg •� * SITE PLAN
of .................. ......
--
. FLATTOP TECI INICAL SERVICES 1 INCH = 50 FEET
--
. - --
-
-
........:.:;
' P :• THEODORE F. MOORS �: ,!� 14330 ECHO CANYON ROAD DRAWN BY TFM
CE -3589 �i �C� ANCHORAGE, ALASKA 99516 NOVEMBER, 2006
40 fe es10f1W
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIN
.riattop 7echnicafSen ices
14530 Echo Canyon T,9g.Anchorage,,XX 99516
Thom (90 7) 345-1355
Lot 2, Tiffany Terrace S/d
11160 Trails End Road
Septic Tank Replacement
Specifications
1.0 General:
1.1 The scope of the project consists of abandoning a collapsing 1250 -gallon fiberglass septic
tank and replacing it with a new 1250 -gallon septic tank
1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these
drawings may be allowed or required by the engineer conducting the inspections. All construction
procedures and material specifications shall conform to Municipal and State requirements. All
separation distances shall be in conformance with Municipal requirements, unless specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work
around any buried utilities.
1.4 Unless agreed otherwise, the contractor shall be responsible for any tree clearing and
grubbing necessary to complete the project.
1.5 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.6 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 Septic Tank:
2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the
top and backfilling with soil.
2.2 The new 1250 -gallon, 2 compartment septic tank shall be Municipally approved and shall be
set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and
a 4" cleanout.
2.3 A double cleanout shall be installed in the discharge line between the new tank and the point
of connection to the existing soil absorption trench.
3.0 Inspections:
3.1 A total of 3 engineering inspections will be required during the course of the project: (1)
initial discussion with the contractor to finalize the location of the tank and construction procedures, (2)
after the tank is set level and piping connected but prior to backfill, and (3) after rough backfill and
grading is complete.
3.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far
in advance to ensure the availability of the engineer.
GREA I ER ANCHORAGE AREA BOR. GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME �� t�R ",` MAILING ADDRESS A PHONE _:�L(ry- SSCnD
LOCATION �Rta��S"*'^ LEGAL DESCRIPTION
L" a' t ��AY�� <Pry�C2
SEPTIC TANK:
DISTANCE
NUMBER OF
I k F�(rq �$C
FROM WELL �
MANUFACTURER s� MATERIAL COMPARTMENTS^^�1
INSIDE LENGTH �- INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY aSI)GALLONS.
I E L D: �
I t TOTAL LENGTH
DISTANCE FROM WELL t00 FOUNDATION NEAREST LOT LINE OF LINES
NUMBER OF LINES ' DISTANCE BETWEEN LINES N lk TRENCH WIDTH �-';(-IN. TOTAL EFFECTIVE
ABSORPTION AREA S �® SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
i ^�
DEPTH: TOP OF TILE TO FINISH GRADE L4 MATERIAL BENEATH TILE_! ()- IN. ABOVE TILE --U—IN.
WELL:
TYPE ��O`'u ti�V-0.A CONSTRUCTION SteA DEPTH DISTANCE FROM:
BUILDING I NEAREST NEAREST
FOUNDATION 'So, LOT LINE - SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
SEPTIC I SEEPAGE t
TANK C , SYSTEM (7p
DISTANCES: DIAGRAM OF SYSTEM
/ �rnlls • t4orf{
INSTALLED BY: -
y ell, )0".q
I sF�
SEWER LINE DEPTH:
PIPE MATERIAL:CASA_ U*' ✓" II
`0.&X
LOT SLOPE:C_ R
REMARKS:
c,..... 11_ngl
5,C -T
I
F'•'9 A..9 F' -=F T C__ I F=• F : F L._ I: T °-x ° CA F= A=1 PA a "CA v F=A v:3 E=_ /t
DEPARTMENT RJ;; HEALTH AND ENV IRONMENTHL,,--�',OTECTi�iPd�j�
325 'STREET, ANCHORAGE, AK. '9. +1 t4Cf47c��
279-2511
�.9 � L_ L_ F=1 P+9 �-• A;a t5i — � T E✓ '� E= R=.! E; F� F=° E=F� 0-•'9 T: T Lvc�ll�.r s.
PERMIT NO. C77084 %VIC�Lo ACU Ti
APPLICANT EUGENE BARNHART SRA BOX 1536 34.4-5560
LOCATION TRAILS END RD
LEGAL L2 TIFFANY -TERRACE LOT SIZE 54450 SQUARE FEET
TYPE OF SOIL ABSORBTIGN SYSTEM I6: TRENCH
MAXIMUM NUMBED? OF BEDROOMS = 4 SOIL. RATING CSQ FTr/BR)= 140
THE REQUIRED SIZE OF 'THE SOIL ABSORPTION SYSTEM IS:
CSE F= -rH= • :
THE LENGTH DIMENSION IS THE LENGTH f: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 CIN 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 CIN FEET).
F= EEGRI F__F .L Fc E< FWp !S& E= F IF I C. T F F F 9 F _,_-. I .1 ,2 E-:- A,_A Y_3 F -F L_ L_ A -,A P-4 "__.
T_L4ED "_: > I: "°r.Fes' E=AW T I ADF:9F;-F Fc E CoI_ p I FZE=E:+
BACKFILLING OF ANY SYSTEM WITHOUT FINAL IP•d'_PECTION AND APPROVAL BY THIS:
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I_,
100 FEET FOR A PRIVATE WELL OR 200 FEET" FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
F=• E= Fr` 9'1 jr "T' .r f=l L__ 1E Ex F= AD FWC A=A t=4 I -E 0-0 EF_ F=F F=.' F= F _ Cl1-° p S LJ E"
I CERTIFY THAT
1: 1 HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS 'SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE':.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF' THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
APPLICANT EUGENE BARNHART
ISSUED BYz=riA-fit--- DATE_2 _ _- !
R&M CONSULTANTS. INC. 5024 CORDOVA • BOX 6087 • ANCHORAGE, ALASKA 99502 • PH. 907-Z79-0483 • TLX. 090-25360
GINEEPS
LA... R.
TS
SURVEYORS
March 14, 1977
Mr. Carl Luchsinger
SRA Box 94
Anchorage, Alaska 99507
R & M No. 751121
RE: Test Bole and Soil Log Report for Sanitary System,
Lot 2 Tiffany Terrace Subdivision, NWf, Section 24,
T12N, R3W, Anchorage, Alaska
Dear Mr. Luchsinger:
We are submitting herewiththe test boring results and our comments
regarding soil conditions encountered at the. subject site. This
investiagtion was preformed in accordance with your request of March 7,
1977 and those procedures outlined in a letter dated July 15, 1975
by Mr. Rolf Strickland of the Municipality of Anchorage, Department of
Environmental Quality.
A single test hole was put down within the subject site area for the
purpose of defining general subsurface soil conditions for the proposed
sanitary systen. Excavation was accomplished with an auger type drilling
rig and the test hole was extended to a total depth of 20 feet below
ground surface. The final log prepared for the test hole has been
included in Drawing A-01.
Groundwater was encountered in the test hole while drilling.
A percolation test was performed from a depth indicated and reflects
average infiltration from that depth to the bottom of the hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & 11 CONSULTANTS, INC.
IA
James W. Rooney
Vice President
JWR/pe
xc: Municipality of Anchorage
ANCHORAGE FAIR6ANKS IVNEAU VALOEZ WASILLA
i
M,
T.H.l
3-9-77 0.0'
ORGANIC SILT W/SOME
SAND
Brown, Very Moist
4.0'
a ?
SILTY SAND W/SOME GRAVEL
;•%;
_ Very Moist, Brom
12' W.D.
Test Hole locations are approximate
and have not been located by survey
methods.
7.0'
SAND W/SOME SILT
Brown, Very Moist
Boulder 2 9'
SILTY SAND W/SOME GRAVEL
Occasional Cobbles
aJ: 20.0' T.D.
This log represents subsurface soil
conditions within Lot 2, Tiffany
Terrace Subdivision; PI41o, Sec. 24- _
T12N-R3W, S.M., Anchorage, Alaska
OWN: CD o F.B.
JMA SANITAR`_' SEDER TEST HOLE GRID_
CKD: R&M CONSULTANTS, INC. - CARL LUCHSINGER 2640
LATE: 3-11-77 PROJ.NO 751121
ANCHORAGE, ALASKA
SCALE; - DWG.NO. A-01
TIME
12.00
12:01
12:02
12:03
12.04
12:05
12:06
12:07
12:08
12:09
12.10
12:15
12:20
12:25
12:30
12:40
12:50
1:00
i
PERCOLATION TEST
.Carl Luchsinger
-
R & M No. 751121
- -
TH, 1 March 11, 1977
-ELAPSED
TIME
INCHES -
DROP IN INCHES
73.50 -
-
1
74.25
.75
2
74.7"$
.50
3
75.50
.75
4
75.75
.25
5
76.00
.25
6
76.25
.25
7
76.50
.25
8
76.75
.25
9
77.00
.25
10
77.50
.50
15
78.00
.50
20
78.50
- .50 -.
25
79.00
.50
30
79.50
.50
40
80.50
1.00
50
81.75
1.25
60
83:00
1.25
9.50 inches total drop
6.3 min/inch All) --
G. A. A. B.
Department of Environmental Quality
Test Holes
Ti.,_fany Terrace Subdivision
June 22, 1971
`Pest Hole No. 1 401 South & 251 West N E cor. 1
0-11 Peat - Top Soil
1-21 Clay - Fine Sand.
2-51 Clay - Fine Sand - Small gravel
5-111 Course gravel - Clay
Pest Hole No. 2 601 North & 251 East of S W cor.. 2
0-11 Peat - Top Soil
1-21 Gravel - Silt
.L-10, Gravel - Clay
Open Excavation 501 North & 3011'Iest of S W cor. 2
0-11-' Peat - Top Soil
1-21 Rock - Silt
2-121 Rock - Course Gravel - Clay
tp�s
j �«ff tl j( j�� L�/ SC f/j Srfy� NFA.///✓ //Z
�.
� WATER WELL LOG 4�
FOSS DRILLING n�oU
1336 Ingra Street /l
Anchorage, Alaska 99501
WELL OWNER e'i USE OF WELL�D r'12/
LOCATION D
SIZE OF CASING 1DEPTH OF HOLE1MFT. CASED TO blo FT.
✓
STATIC WATER LEVEL cQ �7 FT. YIELD�_GAL.PER.MIN. WITH � Q
FEET OF DRAWDOWN,
DATE COMPLETED c=5- oS 9- %: PUMP TO BE SET AT `7 p /
��t o�o
L[t o l
.L&o-1--op
—t 0-
-t o—
_t 0—
_t 0-
-t 0-
-t 0-
-t o_
TUry OF AN
_t p—
EIv�rIRp� JM—Op T SF
®t 0-
__
1977
-t
_
r1
c II/co
_to_
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES"111 U1 "
Division of Environmental Services [&NTAL SERVICES DIVISIOP.
On -Site Services Section D
P.O. Box 196650 Anchorage, Alaska 99519-6650 FEB 18 1998
343-4744
CERTIFICATE OF HEALTH AUTHORITY RECEIVED
APPROVAL FOR A SINGLE FAMILY DWELLING Q
Drs y7Z 22 ') }�-{920002-O
Parcel I.D. # HAA #.
1. GENERAL INFORMATION
Complete legal description Lof 2 -r, {�an.X —IC ern c e
Location (site address or directions) 111 6-0 Trz , 1 1 nd Rd
Property owner
a= en e
d- D0ro A
y hurt Day phone
3 Yy- Z09 7
Mailing address
11Ido
Ti"atlf
End Nd• /}n�r
/+1r 9951
Lending agency
Day phone
Mailing address
Agent le "'Y Deco4urrf rie Mux Prn,O-ert1l' Day phone 2S7 -G113
Address 2GGo Cor'-/oue, h4 -c 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: y
3. TYPE OF WATER SUPPLY:
Individual well v
Community well
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 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 Flaffop TPc4n.lea/ Phone 3yS-i3ss
Address x'1530
Engineer's signature ����r�-c ��Go�� Date
6. DHHSSIGNATURE
✓/ Approved for
Disapproved.
0
�QU�L bedrooms.
Conditional approval for
a
4 4
�i
11 :gk V1_1
bedrooms, with the following stipulations:
Note: The well for this property meets existing State and Municipal Codes.
There are nitrates present. it suggested that periodic testing be
performed to insure the wells continued suitability. Current nitrate
conce .
More information on nitrates is available from the On-site Services Program,
DHHS,
Additional Comments
UITIC
Date ; 7 q O
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
W25(RevAM) Beck MOAk21
*- ENVIRONMENTAL SERVICES DIVISION
Municipality of Anchorage FEB 18 1991,
DEPARTMENT OF HEALTH & HUMAN SERy�,CrE� E I V E D
Environmental Services Division K
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: Lof 2 T,)CJ�4nIY Tie f-�crce Parcell.D.: 4/S `t 72 2Z
A. WELL DATA
Well type P v T If A, B, or C, attach ADEC letter. ADEC water system number P. /F
Log present (Y/N) Y Date completed 3 / 29
Total depth IOo ' Cased to 11;6 Casing height (above ground)
Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
FROM WELL LOG AT INSPECTION
Date of test 131 Z9 / 7 7 2 /"-- /.9"P
Static water level 28 32
Well production I g.p.m. a.8y g.p.m.
WATER SAMPLE RESULTS:
Coliform O cv/ / tcicl m -e Nitrate G ST Other bacteria Nr�e ✓LAI&''lL-a
Date of sample: 2 // 2- 98 Collected by: T •> Mia "e
B. SEPTIC/HOLDING TANK DATA
Date installed G/20/77 Tank size 12SC,7 Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) W /�-.
Date of Pumping R/0/97 Pumper
C. ABSORPTION FIELD DATA
Date installed 6 20 / 77 Soil rating (g.p.d./ft2 or ft2/bdrm) I W 5' C f System type -r,-e" cti
=l30R1`7
Length K7' Width 3 Gravel thickness below pipe 6 Total depth 1O meow 14,8 l
r/
Effective absorption area .S6W C7' Monitoring Tube present (Y/N) Y Depression over field (Y/N) N
Date of adequacy test 2/ /?-/90 Results (Pass/Fail) Pa SJ For H bedrooms
Fluid depth in absorption field before test (in.); I " Immediately after gal. water added (in.): I"
Fluid depth I" (ins) Minutes later: 30 Absorption rate = > 600 g.p.d.
Peroxide treatment (past 12 months) (Y/N) None 1-nown If yes, give date N A
72-026 (Rev. 3/96)*
D. LIFT STATION N • A.
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot > 13G
Absorption field on lot 13
On adjacent lots
On adjacent lots
"Pump off" level at*
> toot
Public sewer main W. A • Public sewer manhole/cleanout
Sewer /septic service line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 8 Property line >-5 Absorption
N.
Water main/service line > Surface water/drainage > rc�o ' Wells on adjacent lots �> ( ao '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line > (o ' Building foundation 20 Water main/service line
Surface water > e oo ' Driveway, parking/vehicle storage area
Curtain drain Non e SC� (,e Wells on adjacent lots > r oo'
F. ENGINEER'S CERTIFICATION
1 certify that I have determined thru field inspections and review of Municipal records'that the above systems are
in conformances with MOA HAA guidelines in effect on this date.
Signature ✓-,.� `� ��r���c
Engineer's Name Th eo c --6-e- F rY c,o�
Date Fm race y l8 /9 98
HAA Fee $ 3op G`
Date of Payment ill
Receipt Number Q 35— L J5 (71c5-7
11
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. UAq%Z�
During a recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot 2
Block Subdivision, the well's
productivity was determined to be 0,6' gallons per minute.
The minimum well productivity required by this Department
(AMC 15.55) for a ko0'�- bedroom residence iso {z gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
V
FEB -18-1998 07:16 CT&E ESI ANCHORAGE
ME Environmental Serviaea Inc.
CT&E Rd.N
Client Name
Project Name/q
Client Sample ID
Matrix
ordered By
PWSID
980638001
Flattop Technical Srv,
Lot 2, Tiffany Terrace
Lot 2, Tiffany Terrace
Drinking Water
0
9075615301 P.02iO3
Client Fol/
printed DatePTime 02/17/98 12:58
Collected Date/Time 02/12/98 12:30
ReceivedMtdTime 02/12/9814:00
Technical Director: Stephen C. Ede
Released BY
AILDwable Prep Analysis
Units Method Limits Date Dace Init
Parameter Results PQt �-� —
witrate-N 6.55
0.100 ma/L EPA 300.0 10 max 02/13/98 RMV
Waters Department AmtYses
vvl/100mL SMtB 92228 02/12/98 TRW
Total Coliform 0
#1: Time
--KUNICIPALITY OF ANCHORAGE/-- ,
EDEPARTMEN = HEALTH AND ENVIRONMENT, ?ROTECTION
8 Street, Anchoraaa, Alaska 99501
264-4720
Date Received: October 19, 1977
11: 0 a.m. #2: Time #3: Time
Date 10-21-77 Friday Date
Insp
Buchholz
Insp
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request:
2
3
4:
5
Mailing Address:
Phone:
Property Owner: Eugene A. Barnhart Phone: 344-5560
Mailing Address: Star Route A Box 66-B
Legal Description: Lot 2 Tiffany Terrace Subdivision
Single Family Residence: (x) Number of Bedrooms: Fo u rg 0,
Multiple Family Residence: ( )
Well System: Individual Well (x)
Number of Bedrooms:
Community/Public System ( )
Permit # % Depth of Well 100' Well Log on File
Construction OT,4n A;-Q1(1Q. Bacterial Analysis
99
6. Sewage Disposal System: On-site System (x) Public Utility ( )
Permit # 770fi6� Installed 6(17 7 Installersn '
Septic Tank Size Manufacturer
Absorption Area j_ 0 Soils Rate 1q0,0 Material
7. Distances: Well to Septic Tank 1(it% I to Absorption Area
to Sewer Line i(%t� Nearest Lot line h9' Absorption Area
to Nearest Lot Line
Pace Two "
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 2 Tiffany Terrace Subdivision
Comments:
Affadavit Attached: U) Letter Attached: ( )
Approved:
Date: lj "-,;�y_717
Disapproved: a Date:
Department Worksheet:
(�"JNICIPALITY OF ANCHORAGE���' \011 `��
Department of Health and Environmental Protectimv.; ,,/.:
® 825 L Street, Anchorage, Alaska 99501
264-4720
�- ,
equest for Approval of Individual Sewer and Water Fc,kl,ia:
1.
2.
3.
4.
5.
6.
7.
Property Owner:
\_ I�
Mailing Address: _ ��� X E �'- `-� Phone:
Name of Buyer:
Mailing Address:
Lending Institution:
Mailing Address:
Realtor/Agent:
Mailing Address:
Phone:
Phone:
Phone:
Legal Description:
AL1
Street Location: L
Single Family Residence: (Vj` Number of Bedrooms: - 'A—
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well (,rte Public/Community System ( )
If Individual Well, well depth 1< 0
If Community System, name of system
8. Sewage Disposal System: On-site System Public System ( )
If On-site System, date of installation: `\ _Q "1
*NOTE: A well log is required on ALL wells drilled since 6/75.
If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
FROM:
noINTER -OFFICE MEMORANDUM
GREA R ANCHORAGE AREA BOROUGH
Additional Soils & water Infor-
mation for Mose Plats Finalized
i���b ect to D F.q. ApPrnval.
DEPARTMENT. _ �II.ViY'onHl2'nta��-���-�� --- -�- � SUBJECF? -
INITIATED BY:DATE OF MEMO:
DATE ANSWER
TO: DEPARTMENT _ P�atln�.t�'Lj:-,�ep�p`_��t d---
_ REQUESTED: _ --_-- --- -------
RECEIVER: _--jaic -ela hftyL ----------------
REQUESTED
----n -- REQUESTED ACTION SCHEDULE
�--------
. _ —
-FOR INFORMATION ONLY PREPARE BACK INFORMATION
FOR IMMEDIATE ACTION CALL ME BEFOREE YOU ANSWER
- NEED YOUR RECOMMENDATION
FOR YOUR CONSIDERATION
OTHER
on this particular case
this
apartment with sufficient sol is
1,1DTZ_.ci4nadAMatoly po hep ved _with
indiv�dua7 sewer and water systems..
We have not recommendea any changes in lot sizes or con-
fTgur_ati4ns_ i!e nodotnen-ARry+�_as._submitted-----------__
_2opir1 i9itubsit+itzt�,226�atkSntSttbditioa �_--- - ----- ------- -- - - - - ---------------
_ ------------------------------__ _ ___ � --
The engineer
on this particular subdivision has provided this Department with suffT-
nt faTfornTation and soils iest._to__indi at that -0n" -slit , sewe�and�ater-systems'+3�
function satisfactorily on all lots in the proposal subdivision. We not recuorrmended
_
thi
at as submitted.
B. Grant Subdivision
Nn
mation to indicate that on-site water supplies will functionJLe satisfactari ii all lots.
have not recommended any changes in lot sizes or shapes. We now recommend approval