HomeMy WebLinkAboutTANAINA VALLEY LT 12
Municipality of Anchorage Page / o f --,~
DEPARTMI--NT OF HEALTH AND HUMAN SERVICES
FNVlRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
~me: ~ Upgrade
~0~ ~ ~ ~5~D Wastewater System: D New
Address:
~lSq ~ C~.~ ~c~ ¢¢5~ ABSORPTION FIELD
Phone: lNo. of Se~oms: ~DeepTrench ~ Shallow Trench ~Bed DMound ~Other
Total Depth ¢rom original grade:
5 Z--Block: ~'~/~S~bdivisi°n:~X Depth ,o ,~pe bo~m~o ~ origin 8, g rede; Ft. Gravel depth beneeth~pe,
WELL: Q New Q Upgrade / Gravel width: -3 Ft. I ~/~ Ft
~ ·
Classdication (Private, A,B,C): Total Depth: ~ ~ed TO: Total ~bsorption area: Pipe material:
SEPARATION DISTANCES ~.tio
-- Well ¢~ ¢~' ~2~ ~/~ +~¢0] M~' Number of Compartments:
Foundation ~ ~ ~ ~/0/ ~/~ 'Pump on" level at:,¢~" '~p elf" lave at: g :
- I
Remarks: BENCH MARK
Inspections performed by: ~¢ Dates: 1st //~ ....
Rev awed and app rove~~[~"~ - Date:
72-013 (Re~. 9/91) MOA 25 ]
PermltNo. ,~,] ~/"//P~¢ _ Page ~'~ of_
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES ..
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
PlO No.: _011-051-87
Legal Description: TANAINA VALLEY LOT 18
LFIT 12
DETAIL
10' UTILITY EASEMENT
N 89'56'10' E t37,50
Z
SCALE 1" = 40'
· - MONITOR TU8E
o - SEWER CLEANOUT
"~ - KEYBOX
~ NEW LEACHFIELO
-- --- EXISTING LEACHFIELD
ELEVATIONS ~ fop OF OAS H6TER PIPING
ENGINEER'S SEAL
· /¢" ..... x~" '~/' "~' - · ~
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE [%+ '(l{~l~ ~ ([;CLV~ffld
P.O. BOX 196650, 825 "L'~ S~REET, ROOM 502
ANCHOP~AGE , ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940434
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:RINGSTAD JOHN C & ANN T
OWNER ADDRESS:7154 LOWELL CIRCLE
ANCHORAGE, ALASKA 99502
DATE ISSUED:il/18/94
EXPIRATION DATE:il/18/95
PARCEL ID:01105187
LEGAL DESCRIPTION: TANAINA VALLEY LT 12
LOT SIZE: 33920 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACMED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AN]) THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
DATE:
Louis Butera, P.E.
Registered Civil Engineer
November 3, 1994
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re:
Tanaina Valley Lot 12
Narrative & Permit Application for Septic Upgrade
Dear Mr. Cross:
The proposed septic upgrade will have very limited impact on adjacent properties for the following
reasons:
The surrounding lots are large, allowing sufficient room for septic sites.
Surrounding lots are served by a community well or have a private well + 100 feet
distant.
Immediate neighboring septic systems are all -t-30 feet distance.
Reserve ~pace is not required for an upgrade, however there appears to be adequate
reserve area due to absorption capacity.
Drainage will not be affected and is not a major consideration in our design.
The existing field will be retained by use of a switching valve to provide possible
use of the existing field as an alternate disposal trench.
Although the perc test of 1.1 min/inch indicated an absorption rate of 1.2 gpd/ft2,
0.8 gpd/ft2 was used for our design due to the existence of in situ fin~ sand
material, and premature failure of the existing five foot wide system.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\C:\WPWIN60\WPDOCS\1994\94-084A.NAR
P.O. Box 773294 · Eagle River, Alaska 99577 , Telephone (907) 694-5195 · Fax (907) 694-3297
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Tanaina Valley Lot 12
GEMF.,IIA~
1. The septic plan is for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of l:Iealth
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
1. The trench is to follow the natural land contour to maintain uniform total depth of
the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 12' at any point.
4. The sewer line is to be tied into the existing sewer line that leads to the existing
trench (see detail drawing). The diversion valve shall be a Bull Run brand,
available at Alaska Pipe & Supply. Other high quality substitutes may be
considered prior to excavation.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIFJ.D DIMENSIONS:
TOTAL DEPTH = 12' GRAVEL DEFIIt --= 6.5' under pipe, 2" over pipe
TRENCH LENGTH = 58' TRENCH WIDTH = 3'
DESIGN SOIL RATING = 0.8 GPD/ft2
TEST SOIL RATING = 1.2 GPI)/ft2
SEPTIC TANK = existing 1,250 BEDROOM CAPACITY = 4
Twenty-four (24) hours notice required for all inspections.
/--
C:\WPWIN60\WPDOCS\ 1994\94-084A.SPC
~ LOT 13 s~Pnc .~o,
/ ~T~[5' "X. ~ X ~ ~ 10 UTILITY EASEMENT
X - 5 ~o / ~ - TEST HOLE
X / X~ / · - MONITOR TUBE
~ / ~ o - SEWER CL~NOUT
~ ~FTATI / , + - K~BOX
~ ~ / NO ~JRFACF WATER +100 ~ PROPOSED L~CHFIELD
SEPTIC SI-FE PI_AN
LEGAL: TANAINA VALLEY, LOT 12 ~.. ....
OWNER: dOHN RINGS-FAD ~;~'.'
CONI'RACTOR: N/A ~7.-~9TH ~
JOB ~ 94-0841 DATE: 11/02/94] SCALE 1" = 40' ~/:~c_,_
EAGLE RIVER ENG[NEERZNG SERVICES
P.O. Bo~ 773~4
EAGLE RIVER, AK. 99~77
(907) 694-5195 FAX: (907) 694-3297
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: L~l" l~. ~/~N~N~ V/~b~.~_~'T' Township, Range, Section:
9
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
5rd.
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT ~/~ O
DEPTH? p
E
Depth to Water After I
Monitoring? I;2~..~' 1'7 "rOale: I[/'-~C~H
SITE PLAN
Gross Net Depth to Not
Reading Date Time Time Water Drop
c-oo(~. Io'~J~'~cl F-~4~n¥'t.x ~'4.1o iN
z,c,
PERCOLATION RATE /.I (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN '~__ FT AND ~ FT
IN I'/,L.L. I POc HY / Lors
PERFORMED BY: ~--"~'IF~-~'~, ~'~ -~-'~,~'~ ~'~:--~"~'
AOOORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: __//- ¢:r .- Y~/
EAGLE RIVER
ENGINEERING SERVICES
P.O, Box 773294
EAGLE RIVER, AK 99577
(907) 694-5195
~os Z.=,P /& T~,~/,~ ~7,~//~
SHEET NO I OF I
Single. Family 4 Bedroom Dwelling
(4BR) (150 gpd/BR) = ~ gpd
' Percolation rate = I.l min/inCh ~ 1.2 glxllft2
Due to fine sand, use 0.8 gpd/ftz
600gpd + 0.8 = 750fLz
Use a trench system, depth of grovel = 6.5'
..
750 + (2 x 6.5') = 57.7' lengthwith 6.5, rock underpipe
· Trench dimensions:
Length
Width-
Total depth
Grovel depth
= 12! .
= 6.5'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division 0 / / ~,3-/
¢ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N..~e DISTANCES
.OEc.5/dq/,l$ lA1 M/~OD ~T0 SEPTIC ABSORPTION
Add,.~,,.~,,, ~ TANK FIELD WELL
Phone[s)~/~ ~' ~ /~/ Permit~No. / q q ~o o~~o°ms WELL ~ ~' ¢ ~ ~O~ ' +
LEOAC .,6CRIPTIO" LOT LINE ~ ~ ' I ~
J & FOUNDATION ) ~ 5 1 ~
Township, Range, SecCon AS-BUILT OlA~RAM [Show location gl wen, septic system, properly hnes,
TANK8 ~ ---
~ SEPTIC ~ HOLDING _
Manufacturer Capacily in gallons
Material No. of Compadmenls
TYPE OF SYSTEM
~ TRENCH ~ BED W. DRAIN [~ OTHER
. %~ ~
FT
Number of hnes Soil ra,~ng Pipe materialJJ~ -- ~ ~'/~ -- __
] /~ SOFT
WELLS
-
~ PRIVATE ~ OTHER (Identify) ~ --
~UM ~T'/ [~,- FT ET~ ....
REMARKS:
~ ~ ~1~ I~ 5~=~T/C ~d~ ¢ ~ Inspections Reformed by:
I J~[~ ~ ~$ ~rO~ ceflllyJhat Ihla inspecd0n was ped0rmed according t0 all ~& ~ '% 4381-E ,; c%c,:~ '~"
/--
-- Health Depadmen, Approval: i Date:
72-013 (3185)
D6)pal"Lm~?n'l: eli' Health & Human ~,~el'vic:es
0 I',1 S I '1 E ,% E: W E R F:' E R M I 'T'
Pel'mi'L Number': ~80144
Da'~.l:? Issued: 07129188
Engineer Desic!ned
Owner' Name: I)E~BIGNE; IN WOOD
e r' Add r es!~i: '7(),~:! ',L DR :1: I':'TWE)OD LANE
ANI3HORAGE, Al< 99',518
3()ay Phone."
349 - El 0:1. 4
Pa r c e ]. I d: 0 1 J.,',..05 1,,,..87
I...o'[ Lle:~gal.~ 8ubd:i,v:i,s:i,c)r~: TANAINA VALL. EY SUBD.
Sect i c~n: 4 Townsh ip: 12N Range: 4W
I..c)'l. E~:i. xe 339E~0 (scI. t"t.. (31"
Black
E~EF:"T'IC 'FANI<:I Mirl:Lmum tat. al sept. ic 'Lank capac:ity: :1.,2.50 ga].:l.(::)n!:~. Each sept:i.c
· Lank mus'L h,',~¥e at ].east 2 c:ompar"Lmen'~.s,, Depth to top o£ sep't:i.c {ank(s) < 4,,1::)
[I',IFOI:",:M D.H,,H.!3. F'RII3R 'T'O :I, ST & 2ND II~I!3F:'I~:[;TIE)NS BY ENGINEER,
AF'I"EI::', OI:::F:r]'.CIZ I"I[)LIF:~.rL~ [;ALJ..,. Z;43-46El:I AND LEAVE A
CONSTI:~'.UCT PE:R E:NGII'dEERr:~ ATTACHED APPROVE:D
I:::'Ii!:RM ]/1' EXP I RI~iEi~
I'::'ERM :I I VAI,,,. :1: D FOIR A ~B I NJ3LI!!: FAP1 :[ LY RE:El I DEN[;E ONLY,
I F
:1: f:EI::d'IIF:Y ]HAT:
fc)rtl'i by the MLtrl:ic:ipa].i'Ly ciF Anchc)rage (MOA) and 'the State of Alaska.
2. :1: &~f.:l.:l.:i.l"~si;.all the t~Wst. 6tm irt acc::(::H"daxrlcL.:~ wi'Ll't all MOA cc)des and P6x~'B.lla'L:i. cir'ls~,
aHH::I :J.l'l comp].iaru::e YvJ. th the def~ign rzri'Ler'ia
3. I wi]:l adhere "t,o all MDA and State {::)t' A:l, aska r'f~qu:i.P(.:~l~:~TLE~ J'l:tl" th~ ~iet back
disi:ar'lces from any ex:i. st:Lng
sc,~we:,Page E~y,:~rLem Ol"l 'q:.hJ, Ei c)r' any adjacerrL or rt~)arby :Lo'L.
4. :1: under'stand %ha'L this permit is valid
also under!~d:.ar'H::l *L/~a'L 'Lh~:~ c~c:i, ty c)~' the tc)'Lal, siy!~if. 6)lll :kEi 4 bedl"~r)om~ and
any en la,'<:t~i 11 req~ an add it ior',a I I:)":~' rrr:i,'L,,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN.SERVICES
825 "L" Street, Anchorage, Alaska 995020650
SOILS LOG m PERCOLATION TEST
DATE PERFORMED:_
LEGAL DESCRIPTION:
1
4
$
IAI~ L&
?-
8-
la
11
12
14o
'18-
18
COMMENTS
Township, Range, Section:
BI.OPE SITE PI~N
WAS OROUNO WATER
ENCOUNTERED?
DEPTH?
Reading Cate Gro~4 Net Del)th to Net
Time Time Water Droo
. , /~.~, .~ 0
/ ,, .~ ~¥ I/.~."
p. ,, / o ~ /4..5' ,, /
PERCOLATION RATE __~, '~ . [m,nutesnnc~l) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND
:1
I
3
7
3~D~O ~f.
8
9
I0
14
~4,0 K) ~t
T'/'. ? I' ';
13
I ''=/oo'
Municipality of Anchorage
DEPARTMENT OF HEALTH & HI. JMAN.SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORME
LEGAL DESCRIPTION:__ ~.(~ -~-
I
2
?
g
12
14
15
16
17
18
lg
20,
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? ,,
S
IF YES. AT WHAT
DEPTH? . p
E
Gro~ Net / Deoth to Net
Re~ding
Date
I
PERCOLATION RATE _ (m~nute~,ncn) PERC HOLE DIAMETER
TEST RUN BETWEEN ___ FT ANO _ FT
COMMENTS ~/I
Parcel I.D. #
1.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH ALf?HORITY
APPROVAL FOR A SINGLE FAMILY DWELL. lNG
011-051-87
GENERAL INFORMATION
Complete legal description
Tana&na Valley, Lot 12
Location (site address or directions)
7154 Lowell Circle, Anchorage
Property owner Jo~ Rinqstad
Mailing address 7154 r,r~we]] (-:~r.c_,.7~.J:~ AK
Lending agency
Mailing address
Agent
Address
Day phone 243-7464
99502
Bank of America, Oregon/Miles BeneJ__i~ay phone
21000 NW Everqreen Pkwy, Hillsboro, OR 97214
Jack White Co./Claire Ra~sey Day phone
3201 C Street, Anchorage, AK 99503
563-5500
Unless otherwise requested, HAA will be held for pickup,
2. NUMBER OF" BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
NOTE:
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual well ~ ~, ~ ~
Commumty well X r-r'l ~ ~ o
Class A ~ ~ ~-' , .....
Pub ic water -- ~ ¢/,~k\,k', ~ ;[,/'.:',,
-- O,~,.,~ ;,,' ' (2: '"
,.7 ', i I-~ .
Individua{ on-site .%~/~/.., ,. { St'
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legalitY"and 'status of system.
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 inves~ti_gation and inspect[on, 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 Eagle River Engineering Services
Address P.O. Box 77-3294, Eaale R~ver, AK
Engineer's signature
Phone 694-5195
99577
Date 12/05/94
DHHS SIGNATURE
~ Approved for _~_-__
Disapproved.
__ ! Conditional approval for
bedrooms~
bedrooms, with the following stipulations:
Additional Comments
/17 /., ,
The Municipality of Anchorag~ 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 rsgistered in the State of Alaska. The DH HS 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 omissio~s in the pr~ie~si0n~l ,engineer's work. ,i: .~, ,
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ?~.NFtlhl.4 ~'~.L.~"/ ~.-~/Z~ Parcel I.D.
A, Well Data
Well type
Log present (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Total depth Cased to Casinc
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM Wl=l
Septic/holding tank on lot ___
'O:
Wires properly protected,
AT II~
; On adjacent lots
Absorption field on lot __
· On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer service lira
Petroleum tank
WATE
Nitrate Other bacteria
of sample:
Collected by:
B, SE!PTIC/f-I~.'I~NG TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size / ~.¢(2 Compartments
Foundation cleanout (Y/N) _ J~_~, Depression (Y/N)
,,k///~ Alarm tested (Y/N)
0 ~'1 ¢'1//(~ b/ Pumper
SEPARATION DISTANCES FROM SEPTIC~-DfNG TANK TO:
Well(s) on lot /~',/~ On adjacent lots
To property line ~-'/ Absorption field
Surface water/drainage /L//}/'~
Foundation /.~ /
Water main/service line
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARAT~ STATION TO:
Well_~cmlo~ On adjacent lots
Manufacturer J
Manhole/Access (Y/N)
~' Level at
,,.~Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed ///~ ~
Length ~ ~ / Width
Total absorption area ? L~ ? ¢ Cleanout present (Y/N)
Date of adequacy test /%///¢ '- /V¢ h,.) Results (pass/iail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N) ,/'-///~
Soil rating (GPD/Ft2) /' ~"
Gravel thickness
.System type
Total depth
~/~ Depression over field (Y/N)
~ ~S for
After test /¢//l-
If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,/'//,/~
To building foundation
On adjacent lots ¢ _---~'~/
Surface water
Curtain drain /¢~/¢~
On adjacent lots ~ .¢~O / Property line
To existing or abandoned system on lot
Cutbank /¥//,~ Water main/service line
Driveway, parking/vehicle storage area ~O
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA
Signatur . ,
Engineers Nam(~
Date / ?.~/¢ '~/(~/-'/
", JAMES A. SMITH
CE-8816
HAA Fee $ ~
Date of Payment
Receipt Number
\
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description
Lot 12,
HAA #
Tanaina Valley
Subdivision
Location (site address or directions)
7154 Lowell Circle
Property owner John and Ann Ringstad Day phone
Mailing address '71~4 Lowell Circle, Anchoraqe, AK 99502
Lending agency ~ar'j'e,/ T,enn~t Day phone
243-7464
Mailing address
Agent
Address
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3 k~
NOTE:
Individual well
Community well ×x
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site x×--
Holding tank
Community on-site
Public sewer
If community wastewater system, provide wriften confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev ~/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.
...... ~,e River Loop Road No. 204
Name of Firm
Address
Engineer's signature
DHHS SIGNATURE ~_/~
~ Approved for-/~'¢~¢~ ~' bedrooms.
Disapproved.
6~
Conditional approval for
Phone
Date
bedrooms, with the following stipulations:
Additional Comments
By:
Date
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.
Municipality of Anchorage .~'~,
Department of Health & Human Services
HEALTH AUTHORITY APPROVAl. CHECKLIST
Legal Description:
A. WELL DATA
Well type
Parcel
If A, B, or C, attach ADEC letter. ADEC water system number '~'\z~
Log present(Y/N)
Date completed Driller
Total depth
Sanitary seal (Y/N)
Cased to
Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
g.p.m.
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~ ~ ,~..,-z~ _
Cleanouts~N)
High water alarm (Y/N)
Date of pumping
Tank size [ "~ ~-c.~ Compartments
Foundation cleanout~F~N) "',( DepCb~Sion
Alarm tested (Y/N)
SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line [ C:'t ~
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacentlots
Surface water
D. ABSORPTION FIELD DATA
Date installed / C::~- ~,¢:~ ~
Length ~ Width
Total absorption area ~-~:~'C~
Depression over field (Y~ ~
Results ~faJl) ~
Peroxide treatment (past 12 months)
Soil rating
Gravel thickness
Cleanouts present)
Date of ad~_~y test
for '~
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots "~c~ ~ .~L
On adjacent lots ~.<~/:;) I j¢ Propertyline
T~ el;ing or abandoned system on lot
Cutbank Water main/service line
Surface water
Curtain drain
System type
Total depth
bedrooms
Driveway, parking/vehicle storage area ~'~::::~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 inspecti~n.
$ & $ ENGINEERING
Signature ~7~., .. :~le Rlv~ L~p, Road No.~
Eagle Rlver, tUaGRa g~$1l
HAAFee$ /~,
Waiver Fee:
Date of Payment ~ / / ~ ' / ~ Date of Paymeat
Receipt Number - ~Z (~%~/.) Receipt Number
72-02B (Rev, 3/91) Back MOA21
DEPT. OF ENVIRON MI,~.~NTAL CONSERV, ATiON
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
August17,1992
Roger Shafer
S & S Engineering
17034 Eagle River Loop Rd.
Eagle River, AK 99577
SUBJECT: Tanaina Valley Subdivision (Country Lane Estates)
Class "A" Public Water System, PWSlD #214706
Dear Mr. Shafer:
I have completed a review of this office's files concerning the status on the above-
referenced Class "A" Public Water System and found following:
Inorganic Chemical Contaminants:
Date of last samples on record:
18AAC 80.200
5/04/90
Organic Chemical Contaminants:
Date of last samples on record:
18AAC 80.200
11/16/91
Volatile Organic Chemicals (VOC's):
Date of last sample on record:
18AAC 80.400
11/16/91
Radioactive Contaminants:
Date of last sample on record:
18AAC 80.200
12/05/90
Total Coliform Bacteria:
Date of last sample on record:
18AAC 80.200
7/14/92
Final Operation Certificate:
Date Issued:
Outstanding Violations:
Country Lane Estates Well
10/29/87
No
Based on the above information, this Public Water System is in compliance with State
Drinking Water Regulations (18 AAC 80).
Roger Shafer 2 August 17, 1992
If you have any questions on the above comments, please do not hesitate to contact this
office at 349-7755.
Sincerely,
Michael Lu
Environmental Eng. Asst.' II
ML/cf
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 "C" STREET, SUITE 322
ANCHORAGE, ALASKA 99503
WALTER J. HICKEL, GOVERNOR
563-6775
. November 22, 1991
FOR: S & S Engineering
PWSID # 214706
My review of the records on file in this office reveals that the Country Lane Estates
Subdivision Class "A" Public Water System, is in compliance with the routine coliform
bacteria samples requirements listed in Table C, and with the inorganic sampling listed in
Table B of 18 AAC 80.200.
Sincerely,
Byron Roys
Fnvironmental Engineer
BR/cf
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Z~:' la. 7,~,~>~/~'.~ VAL.LE~ ~ e/ 7-1Z >./ ~ ~/ ~,~
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-S~TE SEWER AND WATER FAO,UTY FO~ S~NGLE FAMILY DWELUN~
Telephone: (home)
Telephone
Location (address or directions)
(b) Property owner /)~/~/:~
Mailing Address
(c) Lending Institution
Mailing Address
Business
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here ,~ hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community ¢¢ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Nole: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status,
72-025 (Rev 7/88) Page 1 of 2
~ J.o ~ e6ed
leUO!l!puoo'
peAoJddes!Q
,~q s~uooJpeq
le^oJddv leUO!i!puoO ~.o SWJeL
-~ pe^mdd¥
~ Jot pe^oJddv
'lYAOl:tdd¥ sNNa '9
leeS's,Jeeu!Su3
tCtjhtlc~?^~-II~ or ^~ MUNICIPALITY OF ANCHORAGE (MOA)
EN¥/I~O~MEiq fAL: , S£1~'~
A, WELL DATA
Well Classification ('?c¢.,¢?/~,Y,c.~¢P'
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on t. ot
WaterSample Collected by
WaterSample Test Results
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~-_~7'-/~
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Comments
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed /¢-Z3 ~ Size 12~5~) No. of Compartments
Standpipes (Y/N) fV _Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /'J Date Last Pumped A/~(z/ COr~ 'bT;,
Pumping/Maintenance Contact on File (Y/N) /J~'V¢ r_2~¢~-, ; for
Holding Tank High-Water Alarm (Y/N) _ /t/~--4/ Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Comments _
To Building Foundation
'¥o Disposal Field
To Stream, Pond, Lake or Major Drainage Course
72-026 (Rev. 7/881 Fronl Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ..5
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ~ '
To Building Foundation
Lot t,/o,v~ oN LoT
To Water Main/Service Line ,5
Type of System Design
Length of Field
Depth of Field ~"
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line I'2-'
To Existing or Abandoned System on
; On Adjoining Lots /~'¢ '/'
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course Mo,~¢ //d 4~¢.4
To Driveway, Parking Area, or Vehicle Storage Area
Comments /1~$~o?~/2~-/~ ~./~r~¢*¢ /~
Dimensions
Size in Gallons~'~"~ Manhole/Access (Y/N)
"Pump On" Level at -"'~'~.~ "Pump Off" Level at
High Water Alarm Level at '"'~ Vent (Y/N)
Tested for ~ Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N) ~
Comments ~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA
inspection.
Signed ~/~1~ ~- ~
Company /¢/V~ &"#.Jo ¢J ~"~ f,; ~ ~ e/,~714 ~¢¢, ~-,t
MOA No.
Receipt NO. ~/ ~'2 ~'~ ~ ' '/~ (~ ~) Receipt NO
Date of Payment ~/~-~ ~ ~)/~'~. . ~ ./~ ~- Waiver Fee: $
Amount: $ .4~) Date of Payment
72 026 (Rev 7/88) Back Page 2 of 2
uidelines in effect on the date of this
Engineer's Seal
STEVE COWPER! GOVERNOR
5~3-6775
To Whom I~ May Concern:
Accordinq to the records on eile in this office, the _CooOA£~ .......
/~-z~,~_k~'~.'~5/_~a~-×,,,~_.~4~O~ater System is in compliance uith the
'qta~e oF Alaska Or~nkinq Water Requla~ions,
SincerelY,
Environmental Field OFficer