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HomeMy WebLinkAboutT15N R2W SEC 25 LT 85T15N R2W EC25 Lot 85 #051-282-23 GAAB HD6I GRIrA7R ANCHORAGE AREA BOROUP_ _ - ' HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 ' • INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING SSS$ 11-38 NAME AUUKt]D LOCATION 0a, v1 LEGAL DESCRIPTION 6&T657 �� % s� l5N 2- L L SEPTIC TANK: S� NUMBER OF DISTANCE FROM WELL So MATERIAL S tCrL COMPARTMENTS LIQUID CAPACITY /0-10 GALLONS. INSIDE LENGTH $TE C F INSIDE W DTH DEOPTM SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH , LENGTH • DEPTH p i No LINING MATERIAL CL'l1L NP tt VFW . DISTANCE FROM WELL ,, BUILDING FOUNDATION NEAREST LOT LINE ion TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) V y L/ SO. FT. TILE DRAIN FIELD: AA TAL LENGTH DISTANCE FROM/.vELL ,FOUND PION ,NEAR L LINE , O LINES_ NUMBER OF LINtS , f DISTANCE BETWE4N LINES �� TREN4H WIDTH ABSORPTION AREA SO. FT. DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: �fT,$((P l 70rDISTANCE FROM lrj WATER TYPE (+t DEPTH , BUILDING FOUNDATION. SAMPLE , NEAREST NEAREST SEPTIC r,1T SEEPAGE jeo J OTHER LOT LINE , SEWER LINE ,TANK 7U , SYSTEM , CESSPOOL �, SOURCES_ DIAGRAM OF SYSTEM DISTANCES: 73 DATE GAAB-1.10-2. ~ GREATER�NCHORAGE AREA C`ROUGH Case No.171, IIEALTII DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT %«���J MAILING ADD RESIDENCE ADORES S,+- -�•�l`� LOCATION OF LEGAL DESCRIPTION PDQ ,CL I �v RESS J�7PSHHOONE NO�� INSTAL I ATION - C , APPLICATION TO INSTALL: SEPTIC TAN /_ 2�,'UEPAGE PIT DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH TO BE INSTALLED PERCOLATION TEST RESULTS�a > ` , ANTICIPATED BATE 0 OMPLETION ' l�✓ '7 BELOW TO BE FILLED OUT BY.HEALTH'DEPARTMENT ` THIS IS TO SERVE AS -�e C� PERMIT TO INSTALL A �Cc=�'�`FZ `tel _. AS DESCRIBED BELOW//.// SIZE OF UNIT TO,BE SERVED - r SEPTIC TANK SIZE n`2c) 10 -TYPE r>l SEEPAGE AREA -3/ TYPE DIAGRAM OF SYSTEM DISTANCES: Health Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE ��`� - e" APPLICANTS SIGNATOR1,7 �� �� "*(z r'--REATER ANCHORAGE AREA BOROUCH� } HEALTH DEPARTMENT CASE d 176 y 327 EAGLE STREET 11, r ANCHORAGE, ALASKA 99501 Owner - Lealies Performed For James Polyefko Date Performed May ll, 1970 Legal Description: Lot Block Sub ivision This Form Reports a: S01ls Log _X ercolation Test Depth ro^r Soil Characteristics Location Sketch 2 4 6 8 10 11 _ P � s Was Ground Water Encountered? No A e If Yes, At khat Depth Reading :ole Grocs Time Net Time Depth To H2O Net Drop Brown gravelly silt (GM) �F Fine to coarse gravel with sand (GM) Well graded sand and _gravel (SW) f�w �—.- 1 t i _ P � s Was Ground Water Encountered? No A e If Yes, At khat Depth Reading :ole Grocs Time Net Time Depth To H2O Net Drop i i ereo at ion a-1: I^7- 141nute Fropased Instal anion: Seepage Pi Depth Of Inlet De, COMMENTS: The neccecsgry riroin�nn �,,, Test Performed By: R. E. Carlisle Data Certified By: Date: Drain Field It Or Trench N WATER WELL DRILLERS IAO DO NOT FILL IN DRILLING CO. 6 & O DgT[.r.TNC 00. USG NO.SB/S-1-�5/iDhC /— 9 AREA %kE DRnUR Lb6 H. GOM is S/ /.4 PZLO o f ' ♦ v er TF USE OF WELL --Hua - 14ELL Location(adress oft Township, Range, & Section, if known; or distance from Main Road ]BIRCsxwv Luvr SIZE OF CASING 6" DEPTH OF HOLE�O F�T CASED TO�r _SET STATIC LATER LEVEL r FEET ( (Bafyj) LAND SURFACE. FINISH OF VM1 02 ) OPEN END ( ): SCREEN ( ): PERFORATED (3m). CHECK DESCRIBE SCREEN OR PERFORATIONS 15 — k".pgILMATION BOTWU FIV` SBFT (HOUR) ( )FOR 1_HOURS '7ITH,23_ 'BELL PMTING TEST AST_Lp GALLONS P:Ii FEET OF D -Lu- m FROL t. STATIC LEVEL.. REMARKS_ details of formations penetrated, size of material, co' Depth in feet from round surface Give colors and hardness. p to 10 SOIL ORAVL�I. AND ROCKS 10 to 15 SAID & GBACBL 15 to 25 SILT 25 to 30 CL:S & GRANGE, SSBPACB 30 to 60 STV. :9 GRAT (SOFT) to to to to to to to WATER HELL DRILIER.a IOG DO NOT FILL IN DRILLING CO. o & a DaI imm ao. �NO- %rS AT-A-RS4D.4C /-9 DRILLER ISE B. Om AREA F -/)PC -LAKE' • VELL OWNER (P.KP i USE of mmra. ymm, Locitioh(adress oft Township, Range, & Section, if ]mown; or distance from Road EMWOOD LOOP RMD, SEC 25 Let ES. R2w.yi SN , SAA ,6 kku„(L..cw4h£Y•Sg'�IngSte, NS —44 fyy3g6 ,,Ojp - SIZE OF CASINO 6" DEPTH OF HOLE_Q_FEET CASED TO FEET STATIC =4ATER LEM 2rL FEET (/ (BE M) LAND SURFACE. FINISH OF HELI, • t CHECK ONS) OPEN MM ( ): SCREEN ( ): PERFORATED (mO . S, DEa SCRIBE SCREEN OR PERFORATIONS 15 - L' PERZORATION BoTrm Ym TEST 7ELL PULPING TEST JV_Idp OALLONS P -R (HOUR) ) FOR 1_HOURS '7M ?J— FEET OF DcZA'YD M FRM: STATIC LEW.1.. G Depth in feet from Give details of to BARD & Mk= ' 1 Bear CL!Y & OSA ILS SECPAaa ` aRa7c (3m) GRA: BT=jo (JB) penetrated, size of material, coj 0 to 10 20 to 15 15 to 25 25 to 30 30 to 60 60 to 70 to to to to to to to BARD & Mk= ' 1 Bear CL!Y & OSA ILS SECPAaa ` aRa7c (3m) GRA: BT=jo (JB) penetrated, size of material, coj Municipality of Anchorage .. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 r CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 13>571 2SZ Z3 HAA # lL-4 D5LI Expiration Date: - Z'/o S�- 1. GENERAL INFORMATION ` Complefe,h?gal description Tl�; til RZrn/ S 'L 25" cor �s Location (site addressordirections) t`��2`I S1tin1S 5/ Current Property owner(s) LOA -G5 Day phone Mailing address pD R ok 77o7012— 6�44<6E G.1 1E Z AK 99S 77 Lending agency Day phone Mailing address Real Estate Agent �A� Qh H�4mi/%C� /ZC K Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:TYPE OF WASTEWATER DISPOSAL: Individual Well 01114 Individual On-site LTJ Individual Water Storage 13 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 sample results. (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 engineers work. 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 Municipalityrof Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewate' sal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regula n in effect at the time of installation. Name of Firm _/.9 Phone Sy' Sl 9 S Address IOLf> i ✓rW R�.l- Skr--i.-- 20 l €R .4/c 79s77 Engineer's Printed Name Woo D 5. DSD SIGNATURE Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: I'll to (Rw. 01N2) Municipality of Anchorage •�, Development Services Department e Budding Safety Division On -Site Water & Wastewater Program 4700 South BradaW St. P.O. Box 196650 An horage, AK 995194650 www.d.errchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ge-TAZ Sse AS .re.— a'S Parcel ID: en a / A r z j 5 A. WELL DATA Well type Zffowra If A, B, or C provide PWSID # _ Date completed ,jd6d4 Sanitary seal(ON) _Vel Total depth �_ft. Cased to 16=ft. FROM WELL LOG Date of test u�L' Static water level 9 ft. Well production 7. 3 9•P•m- WATER SAMPLE RESULTS: Well Logd9N) W.7 Casing height (above ground) XY n. AT INSPECTION /..7' g.p.m. Colfform _r,) colonies/100 ml. Nitrate • 14 mg -A. Other bacteria _Q_ coionies/100 ml. Date of sample: l v 1 AM _ Collected by: G thus L4"y>. B. SEPTIC/HOLDING TANK DATA Tank Type/Material S7aic Date installed S��D Tank size AV0 gal. Number of Compartments / Cleanouts (91) _ A3 Foundation deanout (Y©j _Aff Depression over tank (Y4V ,W High water alar (YM Date of pumping. jD- Jzcl I l Pumper 3 R' s C. ABSORPTION FIELD DATA Date installed —i•D Soil rating (g.p.dlR' or<� .5 System type iLBP4f�6 nT Length ii. ft. Width /Q+ ft. Gravel below pipe ( ft. Total depth ft. Eff. absorption area Sty IF Monitoring tube _yAz Depression over field _AP Q Date of adequacy test :. .rs .*, ResuftscFa ail) .Pwaz For _I bedrooms Fluid depth in absorption field before test _lam in. Water added Yo D gal. New depths in. Elapsed Time: 1,9 4W Final fluid depth T' in. Absorption rate >= y.SO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y60type) If yes, give date N D. LIFT STATION Date installed "Pump on" level at _ in. E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank:114eta4wi on lot S� Absorption field on lot Tb. Public sewer main _ 1-100!- Sewer "'100 r Sewer /septic service line t Z5 r Manhde/Access (YIN) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots d ele to On adjacent lots d �,S,e' Public sewer manhole/deanout -i/orf r Holding tank IL furl r in. SEPARATION DISTANCES FROM SEPTIC/1,166DINe'TANK ON LOT TO: Building foundation Property line _2r -Y' Absorption field Water main Y,w ' Water service line Surface water Y ,Cw' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 7 9 Building foundation .r Water main iV ' Water Service line 71/.0' Surface water t loo ' Driveway, parking/vehicle storage 4'Y ' Curtain drain v, zi O Wells on adjacent lots 4,100 ' .rr nJww- w AAAI . l F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name�r��revy� R L -fid.., Date , 1116Y f e �( HAA Fee $ �� �j (� `i` 7 RUS -Apiver Fee $ // SQ Date of Payment /� �7 a Date of Payment/ 0y Receipt Number 0 Receipt Number 6-Vj'7�7- �jJ,AA- (Rev. 12/00) V V M i G Y� v• �t/89m r7 �°i ASBUILT SIWAID'h ASSOCIATES LAND SURVEYING 694-082( 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: So FOLLOWING DESCRIBED PROPERTY: � OF A(� �R "ln>loTtz�zsT/sv,Pr�s�> DATE rf Sf AND THA Ifo F.NCROAlrHMENTS EXISf EXCEPT AS/��y �, ` • - : y� INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' aS-7P f�"'�,'.• LS -3918 `i•� ANY DATA HEREON BE USED FOR CONSTRUCTION _ { ^sr ' •....• r�' OFFENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. `-• �- " 10-27-04; 3:14PM: SGS ReLp 1047008001 Client Name Eagle River Engineering Project Namelm T15N. R2W, Lot 85 Client Sample 1D TON, R2W, Lot 85 Matrix Drinking Water :907 5015301 0 2/ 7 All Dates/Times are Alaska Standard Time Printed Dalenime 1027/2004 9:14 Collected Dste/fime 10/192004 1230 Received DaleMme 10202004 14:30 Technical Dir r Stephen C. Ede Relnsed HMr /r. , A l- - Sample Remarks: Nitrate was analyzed by Mat -Su Test Lab of Alaska. Allowable Prep Analysis P. Met" Results PQL Units Method Container WLimits Date Date Init Microbiology Laboratory Total Coliform 0 eol/100ml. SM209222B A (<-1) 1020/04 DKC pa07 6616301 0 4/ 7 10-27-04: 3:14PM: matessu Test Lab of Alaska Water Quality Testing Mite 3.2 Palmer-Wasllls HWY. Midtown Community Business Park Phone: (907) 745-3005 Client SGS Enviromenlal Attn.: Forest Taylor Client ID: T15N R2W Lot 85.1047008001 PWSID A: Date Prepared Source: MCL M.S.T.L.A: 20041004 Sample Matrix: 1.66 Comments: 1022/04 u 1 •.0 M P.O. Box 2749 Palmer, Ak. 99645 Fax: (907) 746-3010 Date Arrived;1021104 Report Date: 1022/04 Sample Date: 10/19104 Sample Time: 1230 Collected By: Method Parameter Urns Results MDL Date Prepared Date Analyzed MCL SM 4500-NO3-E Nitrate -N mg/L 1.66 0.50 1022/04 10/22/04 10.0 Legend: MRL - Method Report Level MCL - Max. Contaminate Level B - Present In Method Blank E - Estimated Value H -Above MCL O • Lost to Dilullon RepoCed By Jon Paul Campbell Lab Supervisor Eagle River Engineering Services Christophcr R. Wo«l, PX (907) 694-5195 tel 10421 VFW Road Suite 201 (907) 694-3297 fax Eagle River, AK 99577 November 8, 2004 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: TI 5N R2W Sec. 25 Lot 85 Waiver Request from on-site septic to on-site well Dear Mr. Roth: Eagle River Engineering Services (ERES) is applying for a waiver of separation distance to 82' (allowing for several feet from the standpipe to edge of seepage pit) from the onsite well on the above referenced property to the edge of the seepage pit installed on this same property in 1970. There is a current Health Authority Approval in the works for this lot awaiting the result of this Waiver Request. We list the following factors and characteristics in support of this waiver: Soil Characteristics: A test hole excavated in 1970 indicated that there is well graded SW -type material, gravelly sand with no near -surface groundwater in the vicinity of the seepage pit. This SW material will allow effective filtering of the leachate. Well Characteristics: The well log indicates Silt from 15-25 feet below ground surface, with clay material at 25-30 feet, and soft bedrock from 30-60 feet, and hard bedrock from 60-70 feet. The well is cased to 65 feet below ground surface. The casing is perforated in the bottom five feet only. ERES believes that the silt and clay create a barrier, filtering and/or stopping septic effluent from reaching the water supply. Surface Slope: Surface Slope is at 2%-5% perpendicular to a direct line of theoretical surfacing effluent running from the seepage pit to the on-site well. Surface runoff would now West from the seepage pit, and away from the on-site well. Other Factors: There is a 34 year history of continuing use of this well and septic system. Current water samples indicated no fecal coliform or other bacteria, and 1.66 mg/L nitrate, well below the allowable limit of 10 mg/L. M03\04.118 W AIVULEITER.DOC Thank you for your timely consideration of this Waiver Request. We have attached the well log, soils test, and septic system asbuilt. If we can provide any more information for you to expedite this waiver request, please call our office at 694-5195. Sincerely, EAGLE RIVER EN EE G SERVICES Christopher R. Wood, P.E. Principal X2003\04.118 W N V ERLETTEa.00c Municipality of Anchorage o t O t'.O. Ik,x 19GG50 • Anchorngc, plaska!)`kil?Gf•50 •Telephone (90'7)84.4&')(11 •Pax (9117) 319.8200 47W aragme Street • Anchorage, Alaska 9'.1.-07 s • i r r a�V.mtml.org Mayor Mark Begich Building Safcty Division November 9, 2004 Christopher R. Woods, P.E. Eagle River Engineering Services 10421 V.F.W Rd, Ste 201 Eagloe River, Alaska 99577 Subject: Waiver Request for T15N Rl W SEC 25 LOT 85 Waiver Request #WR040085 Parcel ID #051-282-23 HAA040587 Dear Mr. Woods: Your request for a waiver of the required 100 feet horizontal separation from the absorption field to private well has been approved. The approved separation distance is 82.0 feet. This waiver approval applies to the existing absorption field :to private well separation only. Any future upgrade to the on-site wastewater disposalsystem will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Goodall i '1 Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department .,r Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 WR#: 040085 PID#:051-282.23 Date Received: 111910a Waiver Review Worksheet HA#:040587 Permit#: Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: ............................................................................... Waiver is Granted: l.lst Conditions or Reasons for above: Waiver Is not Granted: Date: By: Name of Reviewer ............................................................................... Rec#: 80522 Amount: $JM Date Paid: 1119/204 -ra vae w PJAtVEK REQUEST FOIr, TISN RZW Sec 2S Lor 85' WAIVFK REQUEST- rUVw,q:l, OHOOS5' wftiv6rt RcQVEsr Foot UN -Lor WkTEr( WELL T -o O'V-Lor SEiOA4E 'Pzr OF 8Z FEET Sc-E,pAbE Prr LDATrf- RrF-CgE^lcE EA4t,E A?IVER� I11RI✓EZ ReQVEST- I.ETfEk ORTEO /UopEntBE.ro, e0 2oo&f. 7We SOIL. CN,Jr?/}Cj&ZrST/CS rNDICATE rHRr TNEae is 4 WELL. lfaAoED Stv-Typo; /1/�TERn4L� 4AAVCu.y SAND . THIS Sal M/1TERIHL_ WIa/- *,?"ok! EFFEcTrvE FICTFft,a/fj of LERc.r//FTIr. THE SUXFAce scope /At TNF— 04,04 /S 2 .10 .5 ;/ FLoWINf? WEST F/Cor� 5EcPs}4jE Plr' ofNO .4pV'/ FRDr%4 THE Dov- St rE k1FLL. WC -Lc. 04 -rot — THE h1FLc. Co(� /NDICA76j SraT F�to.N /S -ZS FEET /3ELow .jRovND SURFACE / W'Tq e-t.AN It^-fTERtAc- Rr ZS =3o FFET A'VP Spm 6EDI{ocl<, FROM 3o -6(U FEET AoVo IARp ?FD Ro(k FROM (o0--jO FEET. THE Wr,&C. /S CASlA TO 63- F6'fT BEGoh/ TWE C7RoufjO stJftrACE . FRES J3ELIEU;'$ THE SILT A -^/'O C( -Ay cRERTE SARAiEfl / FtCTER,Pjo AN01oP\ SrOPp/ry j SEPTtc ecFLl1E.Y1- rRo M tZpi c - Hi AJ, THE q JATE'/Z, S uPn f y . cR j)r*ATVAEAIt of c�Vl eo�l/n6YTRL CoNS62UkT/On/ R/}T10,) DISTAAJcE. WAIVE (r/IDFL'tVES. FO/L Sc.•K o. PERM,�Ar3 70 S LJPES A"JA-' FRDn.: WATE/Z q.s-o S o vacs Ar S% S F -PA aA T'/ oN IDs = B -FOTAG_ : (f • t3 Or1G1.VSt 014 qo ArJT WA rVER 1&)F}TE2 T-48LE POINTS FRoM 9911 Wr&4. DATA- :7o FFEr 7'07-41. DEPT'&( /41 FEET CA18 pEvTW WWW x S(c Faer zS1 Non 000 noo �r _re �oi� sow,�3r�oN ae a_ -17 �Q KY KY PERM,�Ar3 70 S LJPES A"JA-' FRDn.: WATE/Z q.s-o S o vacs Ar S% S F -PA aA T'/ oN IDs = B -FOTAG_ : (f • t3 Or1G1.VSt 014 qo ArJT WA rVER