HomeMy WebLinkAboutTHOMAS L BOYLE BLK 1 LT 13AThomas L
Boyle
Block 1
Lot 13A
#015-283-03
Municipality of Anchorage
Department of Health and Human Services
UMOS,
I
•
Building Safety Division • ; ;
•
On -Site Water and Wastewater Program. 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650 Pagel Of S
www.d.anchorage.ek.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL
INSPECTION REPORT
Permit Number: SWSW 20405 PID Number: 15-283-03
Nwne
—Clint P, Pn Wastewater System: ❑ New ®
Upgrade
yam w,.
St. 9"OIR ABSORPTION FIELD
Timbw a ee"awm:
O Deep Trwc ❑Shan..Tw.h 0SWWUMW13ODow
LEGAL DESCRIPTION SoRawp kwaaft:
tlbck: teat: sum: Depn b Ftoe boaorn aam wlpin,t pada: Pipe:Toemnq.
Boyle
___U!2mas
R'�'Swaan:
F■,ddad,Owe^t4� Onde:
' n / ' it
Well: ❑New ❑Upgrade
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in
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wmSow:
A+ Home Svcs
10/27/2002
c.wn, t+aaxaee.. C+wna:
`P"l in Ft
TANK
SEPARATION DISTANCES
❑ Septic ❑ Hddng ❑ S.T.E.P. ❑�
To Septic
P Absorption LIR
Holding
g�
Man,xwn,•r
From Tank Field Station
Tank Se»ertne
�,.
Existin
Wall
105
150
118
75
;Z
tw.oewa4;_.1:
s. "Ww"w
100+
100+
100+
LIFT STATION
LdLk*
45
10.7
45
Se'
Existin ca
Fow.de 70 21.2 75.8
Pwp ow W'w at: 7..mar r..t.t. ktgn..kw
curtain Drain 100+ 100+ 100+
in
wro Make s Mod.- b Elec95M k"vwswn yartwm.d w b.
Remwka:
1 2"RI id Insulation over field. Mil 2' of sand under
BENCH MARK
bed to gain water separation. 3) Verified tank & Lift
Garage Finish Floor
Station for leakage - none found.
,k,a, ad E,, itw
102.5 Ft
Engineer's Stamp
.�OF \
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Inspections performed by: Pannone Eng. Svc Dates: 1"10126/2002
:; Ii0
; 49TH
2nO10/27/2002
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Department of Health and Human Services approval
•Pannoner
Reviewed and approved by: �l-1�.
tR«. n av Date: C�
t'_A
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I No. CE 8149.
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PERMIT NOs SW020405
E ST'G
S PTIC
REA
=XIST'G
SEPTIC
AREA
RECORD DRAWING P.I.D. NO, 015-283-03
WASTEWATER DISPOSAL SYSTEM SWING TIES
LOT 13A, BLOCK 1 BOYLE S/D Co A B C
LS 76.8 75.8
/ DVI 85A 76.9 1
EXIST'G
SEPTIC
AREA
E IST'G BED
I FAILURE.
TO E REUSED
NEW REPL
30'x67'r
EXIST'G
SEPTIC
AREA
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11700 Wagner Street
Anchorage, AK 99516
345-3134
250-7538
86.4 77.7
ml 24.5 42.9
16 ml
N2 36.8 27.7
M3 87.7 98.4
N4 89.9 90.3
'G
f�XIS
NSTALLED (2) 1 1/4' YF�
RTEI
rl,ALVE BETWE DS
'G LIFT STAT
BE REUSED
XIST'G 1269� /
ONC. SE-P'TTC TANK
Ili
T E REUSED
IU
L 1% I
T'
° WEL
—T
Z
GARAGE •r WELL
DESIGN,
PERC RATE= 40 MIN/INCH
500 SF/BR, 4 BR HOUSE
2000 SF REQUIRED
BED DRAINFIELD SYS, 0.5' EFF.
67 LFx 30', 2' TOTAL DEPTH
TOTAL AREA=2000 SF
REUSE EXIST'G
CONC. SEPTIC TANK 6 L.S.
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
ATE, 11-4-0—SCA2 RECORD
LE, 1'=60'
PERMIT NOt SWO20405 RECORD DRAWING DETAILS P.I.D. Nos 015-283-03
WASTEWATER ABSORPTION SYSTEM
LOT 13A, BLOCK I BOYLE S/D
NOTEi
1) ALLWORK SHALL BE PERFORMED
IN ACCORDANCE WITH, S ALL METERIALS
SHALL CONFORM TO AMC15.65.
2) SEE GENERAL NOTES ON SHEET 1.
3) VERIFY INTEGRITY OF TANK. INSTALL
NEW DEEP BURIAL TANK IF EXISTING
TANK IS LEAKING.
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Pannone Eng. Svc., LLC
Clint R Clair Falkenhagen P. O. BOX 102954
11700 Wagner Street ANCHORAGE,
Anchorage, AK 99516 ALASKA 99510
345-3134 272-8216 PHONE 8 FAX
250-7538 DAT 1 11-4-02 RECORD
PANNONE ENOINEERINO SERVICES
P.O. BOX 101954
ANCHORAGE, AX 99510
MM 271-8118
PERFORMED POR Clint FaDaslhown DATE PERFORMED 10-6.02
LEGAL DE9CRVnON-Iat 13A. Block I Honk 8/D
TSSI' NOrt A r--�
1
Z
4
3
7
6
9
10
11
11
13
14
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on
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IO -6-02 1920
61/4•
--
1930
l0
4'
21/4•
1930
—
6'
19-40
10
3 3/4•
2 1/4'
19-40
--
61/8'
--
1930
10
3 E/0•
2 1/4•
PEROLAnON RAZE 4.Sfmin/loch) PMi
IM RUN BEWTZM( Z.S FT and 3.5 FT
COMMENTS: Test hole excavated by A4 Home Sic. Test Hole vm otesoaked before oar best
Reoola DMt Oar
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MOLT
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10-6-02 1420
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PANNONE ENOINEERINO SERVICES
TH
y
P.O. BOX 102954
: 9LH♦♦j
T
ANCHORAGE, AK 99510
10
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MM 471-8218
Steven R. Pannonel
PERFORMED FOR:
C71nt FsliorabsEm
♦1 No. Cf� 814,!
1450
DATE PffitFOR10ID• 10•-6-02
144*,,,�-•-.••��+�
tS�
LEGAL D88(4tlPliox Lot 13A Hlodc 1 Bode B/D
Ttter HOIZ 4
ifaR
1
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GRAVOa
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4
IE
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WASGROUND WATER
sot
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13
IF YE& AT WHAT
16
DEPTH? -&
17
DEPTH TO WATER AFISR
M[OxI1ORiNO1 -2
Is
DATE: 1a15-0Q
19
90
PSROIATION RATE 4.5
PWC HOLE DG MCM 6 hbeba
TIM RUN BEW188N 1.5 PT and 3.5 PT
COHIEM'8: Tat Lore cmmated by A+ Horne Svc. Tat Hae was Daesoaked before DEM
tit
PERFORMED BY: Stevm R. Pannone. P.S. I CERTIFY THAT THIS TEST WAS FWMRHSD IN ACCORDANCE
WfIH AIL STATE AND HOMCIPAL GUMIR EB IN EFFECT ON THE DATE OF?Hffi TEST.
Reoola DMt Oar
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FROM : PSE ENG SVC PHONE NO. : 272 8218 Nov. 06 2002 03:44RN P2
Municipality of Anchorage
Development Services Department
Building Safcty Division
On -Site Water and Wastewater Program
4700 Bragaw Strect
P.O. Box 196650 Anchorage, AK 99519.6630
www.d.anchorage.ak.us
(907) 343-7904
PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE Op AN ON-STTE
WASTEWATER DISPOSAL SYSTEM
This agreement, dated \\ - ID - is made between the Municipality of Anchorage
Development Services Department (DSD) and the property owner(s) of:
3ff bg I i�Oy(e S/0 II'100
This agreement is made for the purpose of maintaining an on-site wastewater disposal system on�
the subject property.
The property owners agree to the following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation
statement from a registered professional engineer. This inspection and operation statement shall
verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any
def iciencics have been repaired and that the system is functioning as designed.
(Printed Name) ( rimed Name)
.The Foregoin Instrument was acknowledged before me by
^^^/P b , r+.0'�'gnthis �_day of
A
OFFICIAL SEALWitne smyhandandseal. STATEof ALASKA
t
\ � _ —IV AF c' NOTARY PUBLIC
v� No Public (Signature) KAREN Y. RIC11
(Notary's printed name)
My Commission Expires
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 10, 2002
Expiration Date: Oct 10, 2003
Permit Number: SW020405 Parcel ID: 015-283-03
Legal Description: THOMAS L BOYLE BLK 1 LT 13A
Design Engineer: 0062 Pannone Engineering Services Site Address: 011700 WAGNER ST
Owner Name: CLINT & CLAIR FALKENHAGEN Lot Size: 49500 SQ. FT.
Owner Address: 11700 WAGNER ST Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516-2019
This permit is for the construction of:
[✓i 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 fora 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.
AT THE TIME OF CONSTRUCTION THE SEPTIC TANK AND THE LIFT STATION SHALL BE CHECKED FOR
SIGNS OF CORROSION AND LEAKAGE AND REPLACED IF NECESSARY.
Received By:
Issued By:
Date: /U �/ Z
Date: 1 G AO 0Z
\\ Municipality of Anchorage
�1 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.ci.anchorage.sk.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015.283-03 Permit Number SW 02040>
Property owner(s)_Clint & Claire Falkenhagen Day phone 345.3134
Mailing address (1)11700 Wagner Drive
Mailing address (2) Anchorage, AK Zip Code 99516
Legal description (Lot, Block & Sub'd.) Lot 13A. Block 1jhmU-_ THOMAS L. BOYL r Sino
Legal description (Section, Township & Range)
Lot Size 49,500 Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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 Fees: 416o
q �f� Waiver Fees:
Date of Payment: I a� /� "- Date of Payment:
Receipt Number. 21 53U4 -Receipt Number:
(Rev. 12/00)
Pannone Engineering Services, LLC P.O. Box 102954
Consulting Engineers Anchorage, Alaska, 99510
(907) 272-8218 (907) 272-8218 Fax
September 25, 2002
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bmgaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 13A, Block 1 Boyle S/D
Septic System Upgrade Permit Request
Gentlemen:
My firm was contacted to perform a health Authority Investigation at the above referenced
property for a pending sale of the property. The existing bed was discovered to be in failure. The
Owner authorized me to upgrade the existing septic system serving this lot. Two test holes were
excavated on September 15, 2002 on the lot. The soils reports and a percolation test result are
attached. Ground water was monitored for seven days. No bedrock or ground water was
encountered in the test hole. However, past experience has shown that ground water is present
in this subdivision at a depth of approximately nine feet. This will be used for the ground water
design depth. The proposed upgrade and reserve area are located greater than 100 feet from any
surface water.
The lot is approximately 49,500 square feet in size. Lot 13A slopes to the west at approximately
1 percent in the area of the test holes. The existing septic tank will be reused. It is constructed of
concrete and will be inspected for leaks. The proposed upgrade will be located on the northern
portion of the lot. A diverter valve will be installed to distribute the flow between the two beds.
The lot is served by a private well. The proposed upgrade is greater than 100 feet away from
existing & neighboring wells and 25 feet from the water service lines. The surrounding wells are
located greater than 100 feet from the proposed installation. The proposed installation will not
affect the future development of the surrounding or existing lots. See the attached design.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
`Steven Wainnone., P.E.
Civil Engineer
Attachments:
C:\Work\Letters\ 13A-1 Boyle.00 Ldoc
EJ,PERMIT NO, SW02
ST'G
TIC
REA
TO
DESIGN DRAWING
WASTEWATER DISPOSAL SYSTEM
LOT 13A, BLOCK 1 BOYLE S/D
EXIST'G 1
SEPTIC
AREA
MG BED
FAILURE.
REUSED
30'x67'x0. ' BED
0' TOTAL DEPTH
:XIsTY2, OF FILTE SAND -
SEPTIC
AREA2.
TH1
INSTALL I
TUBES
CORNER
EXIST'G
SEPTIC
AREA
4L .,,.., 'wr . *
IIT❑R
EACH
TYP;
XIST'G
2
P.I.D. NO, 015-283-03
rEXIS 'G
ISTALL 1 1/4' DIVER�fl&
ALVE BETWEEN ATFL DS
'G LIFT STATII
BE REUSED
-----1% XIST'G 1269 %
❑NC. SEP- C TANK
T E REUSED
WEL
1%
6 .5
GARAGE
R.-Ponnonef
� Clint & Clnir Fnikenhngen
CE 8149 '�� 11700 Wagner Street
iao�•'��� Anchorage, AK 99516
345-3134
250-7538
WELL
DESIGN,
PERC RATE= 40 MIN/INCH
500 SF/BR, 4 BR HOUSE
2000 SF REQUIRED
BED DRAINFIELD SYS, 0.5' EFF.
67 LFx 30', 2' TOTAL DEPTH
TOTAL AREA=2000 SF
RE -USE EXIST'G
CONC. SEPTIC TANK & L.S.
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P. 272-8218 Fax
RECORD
PERMIT NO, SW02 DESIGN DRAWING DETAILS
WASTEWATER ABSORPTI❑N SYSTEM
LOT 13A, BLOCK 1 BOYLE S/D
NOTE,
1) ALLWORK SHALL BE PERFORMED �v
IN ACCORDANCE WITH, & ALL METERIALS
SHALL CONFORM TO AMC15.65.
2) SEE GENERAL NOTES ON SHEET 1. o
3) VERIFY INTEGRITY OF TANK. INSTALL c lna NV37
NEW DEEP BURIAL TANK IF EXISTING o
TANK IS LEAKING/
VV
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P.I.D. NO, 015-283-03
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11700 Wagner Street
Anchorage, AK 99516
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P. O. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218, PHONE & FAX
ATE, 9-25-02 RECORD
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Revised 10/9/02
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PREPARED FOR:
R. Pannone: N
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Clint & Clair Falkenhagen
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11700 Wagner Street
Anchorage, AK 99516
4"'IN
345-3134
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250-7538
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Pannone Eng. Svc., LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218, PHONE & FAX
ATE, 9-25-02 RECORD
T A
coma Exe - i n&'m0ff
PANNONE ENGINEERING SERVICES
P.O. BOX 102954
ANCHORAGE, AK 99510
(907) 272-8218
PERFORMED FOR: Chat Falkenhagm DATE PERFORMED: 9-15-02
I EGAL DESCRrmoN: Lot 13A, Block 1 Hoyle S/D
TgeT HOLE 1
—Z -R-7 Organic -
ye"
1
2
3
3
6
7
S
9
10
11
12
13
14
IS
16
17
18
19
20
BOH
Brown Silty SAND
to SILT
Stley Sand
80�®
WAS GROUND WATER
ENCOUNTERED? No
IF YES, AT WHAT
DEPTH? _ c;l
DEFIH TO WATER AFTER
MONITORING? .O'
k I
DATE: 4-24.60
/ods/
READtKO DATE
DROSS
NET
I
DEPTH OF
NFC
I
TOR
NATER
DROP
9-13-02
1917
6 3/4'
----
19,37
30
6'
3/4'
1937
----
61/8,
----
20-07
30
5 3/8'
3/4'
20,07
----
6 I/4'
----
20,37
30
51/2'
3/4'
PEROLATION RATE 40 ftnin/inch) FERC HOLE DIAMETER 6 Inches
TEST RUN BEWTEEN 3 Fr ark! 4 FT
COMMENTS: Test hole excavated by A+ Home Svc. Test Hole was presoaked before pert test.
♦♦♦♦♦♦
DROP
Iaffia IIoa - 732WILMOR
1920
.•�P�E,�.......
6 1/1'
PANNONE ENGINEERING SERVICES
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10
P.O. BOX 102954
2 1/1•
: 49TM 2
I9�30
----
6•
�.....i. .. ...................ti.....♦
0
ANCHORAGE, AK 99510
10
3 3/1•
2 1//'
(907) 272-8218
1910
.... ...... ................... ..
j♦I. Steven R. Pcnnonei i
6 1/B'
----
♦ No. CE 814
♦♦ ..
10
3 S/e•
2 1/1•
♦ 'Q.00....=.•
?
PERFORMED FOR.
R
Clint Falkenhagen DATE PERFORMED: 9-15-02
V
►s...♦
LEGAL DESCRumoN: Lot 13A. Block 1 Boyle S/D
TEST HOLE 2
,
BLOP6
PLAtI
1
OR
Man
Root
7
Poorly
3 OP/GM
paled
GRAVEL W/
same sit
N
4fr====
-_ l
W
L
6
TEST H LE _- -_'i
(�/1
6
TH
Of
L.1
T
z
7— sM
804r SAND
s
9-
10—
10BOH
BOH
'
11
L
12—
13
WAS GROUND WATER
KOM
14
ENCOUNTERED? No
TEST HOLZ
IS
IF YES, AT WHAT
`
16
DEPTH?
DEPTH TO WATER AFTER 4(
17
MONITORING? -lam•
Is
DATE: 4)_- E
19
RFADRW DATE
OR089
1161' D6PIH OF m171¢
I=
201-1
PEROLA71ON RATE 4.5 min inch FERC HOLE DIAMETER 6 incim
TEST RUN BEWCEEN 2.5 FT and 3.5 FT
COMMENTS: Test
hole excavated by A+ Home Svc. Test Hole was presoaked
before
perc test.
PERFORMED BY: Steven R. Pannone, P.E.1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
WA7YR
DROP
7-27-02
1920
6 1/1'
---
19�30
10
1•
2 1/1•
I9�30
----
6•
---
19��0
10
3 3/1•
2 1//'
1910
----
6 1/B'
----
19�50
10
3 S/e•
2 1/1•
MUNICIPALITY OF ANCHORAGE /
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME c
/ "� F? -P /2-
PHONE
YS ----7199
❑NEW
k'CUPGRADE
MAILING ADDRESS
5 A AC4 4t 99FO
LEGAL DESCRIPTION J /3 �Y S I 13 J` le 5�6 d".
LOCATION
NO. OF BEDROO S
U
DISTANCE TO:
Well
Absorption area
Dwelling
PERT NOO
EY
QManufacturer
W f..
Material
No. of compartments
w
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
d Y
JDZ
DISTANCE TO:
Well
Dwelling
PERMIT NO.
D?Q
= F„
Manufacturer
Material
Liquid ca
q pacify in gallons
w=
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
LL Z
�Zw
No. of lines
Length of each line
Total length of lines
Trench width
inches
Distance between lines
Q F¢-
Top of tile to finish grade
Material beneath the
inches
Total elfc/ iRabq Lon area
W
a
Length
Width
Depth
PERMIT NO.
<I-
W a'
Type of crib
Crib diameter
Crib depth
tal effective absorption area
DISTANCE TO:
Well
Building foundation
arest lot line
J
J
Class
Depth
Driller
tance to lot line
[Septic
PERMIT NO.
W
DISTANCE TO:
Building foundation
Sewer line
tank
Absorption area(s)
OTHER
tat
/
PIPE MATERIA
ffi�
/
SOIL TEST RATING
It/AA
., .
INSTA LER 1
REMARKS113 C/ /
orc S. t. �.�
1I7a /M
K 7 /et+ a d htrO.f4r d>r[.,�Ar.
I-2. to u
.
L--Jn
se
JILL—
-11
APPROVED. DATE LEGAL /
/Z-2 9-8� Zv � 13 A QoY% Sjc/m .
72-013 IRev. 3/78)
ALASKA ENVIROrNTAL
i. CONTROL SERVICLO, INC.
1220 West 25th Avenue
I. ANCHORAGE, ALASKA 99503
Phone 276-1361
SHEET NO.
OF
CALCULATED BY
DATE
CHECKED BY DATE
SCALE
-OF
0W.
J,
223 1 -E I • 4�:o' Alo le j
&
45 il
_Tf A tll� 5�a
I.-7
Ile, o?;Fe,1j
14
.I_. -_.I-. A
ri. i
1.SA1in1 NCB! 4.4r.M 11110
ALASKA ENVIRON NTAL
CONTROL SERVICLS, INC.
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
JOB
SHEET NO. OF
CALCULATED BY DATE
CHECKED BY DATE
SCALE
A......
. . .. . ......
- - - - - - - - - - - -
FINaYRtwl -
roi
r�1
ALASKA CnuimnWTAL COnTROL SMICCS, Inc.
Enginccring 6 Enuironmental Studies
SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER
TREATMENT SYSTEM— LOT 13A, BLOCK 1r BOYLE SUBDIVISION
1.0 GENERAL
1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL PROTECTION PERMIT.
2.0 THE LIFT STATION
2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER
GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT,
CAPABLE OF BURIAL TO 10 FT.
2.2 THE 24" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED
WATER TIGHT BOTTOM OF THE SAME THICKNESS AND
COMPOSITION AS THE CULVERT.
2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED
AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG.
WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC
RICH PAINT OR COATED WITH BITUMASTIC.
2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED
WITH SCREWS.
2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT
STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT
SERVICE.
2.6 THERE SHALL BE A HIGH LEVEL ALARM,PEABODY BARNES 6147
OR EQUAL SET AT THE LEVEL OF THE SOIL PIPE FROM THE
SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE
ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED BY
THE HOMEOWNER.
2.7 THE SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT
A HEAD OF 20 FEET.
2.8 THE SUMP PUMP SHALL BE SUSPENDED NOT LESS THAN 6 INCHES
OFF THE BOTTOM OF THE LIFT STATION WITH A CHAIN OR
NYLON LINE.
3.0 SEEPAGE BED
3.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES
INDICATED.
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXAVATION. THE BOTTOM ELEVATION SHALL
BE PLUS OR MINUS 2".
4.0 PRESSURE SEWER
4.1 THE PRESSURE SEWER SHALL BE 1 1/4 INCH POLYETHYLENE
PIPE BURIED TO THE DEPTH OF 5 FEET FROM THE EXISTING
SUMP TO THE CENTER OF THE SEEPAGE BED.
5.0 ALTERNATE LIFT STATION
5.1 A COMMERCIAL PACCKAGE CONSISTING OF 1/2 HP EXPERT
CHRONE FLUIDS PUMP OR EQUAL AND SIMPLEX 30 GALLON
TANK MAY BE USED.
5.2 THE 36" CULVERT STOCK SHALL MEETT THE REQUIREMENTS OR
PARAGRAPH 2 AS APPROPRIATE.
=. West 25th Aucnuc • Anchorage, Alaska 99503 • (907) 276-1361
GREA'"'R ANCHORAGE AREA BORE -IGH
V00Department of Environmental Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME e2lll/kAl �/�� /✓�.CnF3�
LOCATION /�f/�q,(�f,�_ P�
MAILING ADDRESS X64 Q' -/'1j 214_"
LEGAL DESCRIPTION 11"13.4
ps1E4
PHONE,�-/3�!�" ('�� l/
/ //l/�/.OSr�XIS'/f syz
�/Zk
SEPTIC TANK:
DISTANCE �cr//Az103/
'l�� NUMBER OF
FROM WELL`V//G=s-sMANUFACTURER IZ121`1'eh417L MATERIAL���//� /�'�� COMPARTMENTS—
INSIDE
INSIDE LENGTH INSIDE WIDTH Z/� LIQUID DEPTH y 7 I (QUID CAPACITY GALLONS.
SEEPAGE PIT:
NUMBER OF PITS Z. DIAMETER-- OR WIDTH--LIf LENGTH °Z DEPTH
pX 6x % I� &e///,: /UO
LINING MATERIAL �� CRIB SIZE: DIAMETERLDEPTHP DISTANCE FROM: WELL //Q= 06'
TOTAL EFFECTIVE // LL�
BUILDING FOUNDATION, NEAREST LOT LINE d3 ABSORPTION AREA (WALL AREA) _L2O�SQ. FT.
ADDITIONAL ABSORPTION
WELL: ,r9
TYPE •� �/f'0 CONSTRUCTION //N,Oee e2^1-I'lX0�0TH
DISTANCE FROM:
BUILDINGl / NEAREST /,A NEAREST //1' P SEPTIC / SEEPAGE f
FOUNDATION a LOT LINE L� SEWER LINE /y TANK /i3SYSTEM /4141
CESSPOOL OTHER SOURCES —�
1 Wt//.0 tc s�PUF .v£iu A-1
APPROVED—
APPROVED DISAPPROVED Ce=frf//i�rc1REMARKS G/t///' :/ 12V PL Sii/✓_^ fPiV//f� ,
DISTANCES: 1 C /031 o
1262 ` F,r/ / -Alo)/f
INSTALLED/BY: Cy�njjP
T.t.✓ locE c 7.�Sfel.lf/�fi.AD/,��//
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
bf
DATE,
Form PW -026
DIAGRAM OF SYSTEM
o liJ£!A A
r=
APPROVED
CX�J1/n/9
ccur e
G.A.A.B.
CAF,,A,TER ANCHORAGE AREA BOROT=uH
HEALTH DEPARTMENT f N NO 686
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME
NE274-G27,
LOCATION L(%{1Q yntz agb LEGAL DESCRIPTIONI7T/3Ay
SEPTIC TANK:
DISTANCE FROM
EpiNotn 40re"FID LIQUID
LIQUID CAPACITY 1150 GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH.
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH, LENGTH / /
�, DEPTH
$ ,
DISTANCE FROM WELL �6 BUILDING FOUNDATION 20
LINING MATERIAL C'DIUCL<C�E ?AP/
NEAREST LOT LINE, -s
`SS211(X b . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) JCom' SO. FT. Cl
TILE DRAIN FIELD:
DISTANCE FROM
TOTAL LENGTH
NEAREST LOT LINE , OF LINES
NUMBER OF LI7A_
DISTANCE BETWEEN LINES TRENCH WIDTH IN, TOTAL EFFECTIVE
ABSORPTIONSO. FT. LENGTH OF EACH LINE
- IIT
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL; I DISTANCE FROM WATER
T�YPE,/Or, IIE1� DEPTH, BUILDING FOUNDATION iJ SAMPLE 120AIE , NEAREST
LOT LINE j6LI EWERNEARESLINE ,TANK T SEPTI �70 , SYSTEMS /7G / ,r OTHER
,CESSPOOL ,SOURCES_
\ DIAGRAM OF SYSTEM
DISTANCES:
1 !-1
. `
:tw17-:11 4
-GA A,Doo3.1'
:� < ! �y:c2t% .fj'S:G7�/ Tv'�t.+CVC Is • 'M1 �., -- : z -
.... I
DATE �f r�%/ 7/ APPROVED ^ �'�>/ '✓� »tea -`r
hLALIM nOa11T
M U rJ I r" X-9�' Fi L_ I -F '-e r-1 F= Ft r•.F t_- t-' F;,- FA C3 E
DEPARTMENT HEALTH AND ENVIRONMENTAL .'R.OTECTION LUJ/;
825 'L' STREET, RAGE, AK. 99501
! l/
64-4720
ar•a—� I TE - _ PEFZM I at:�
PERMIT NO. C 811089 ) 1 L
APPLICANT CLINTON FALKENHAGEN SRA BOX 1547A QgS01 345-3199
LOCATION WAGNER ST.
LEGAL LOT 13 A ELY, 1 BOYLE SUE LOT SIZE 49500 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM FJUMBER. OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 160
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
E+EF=TH= S LEt�Ir;TH=� 5 0 ':3F_F-l%- EL E>EF'TH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR. DR.AINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION <IFJ FE T?.
THE TFZEr-a0H lJ I G+TH I �- jr F+O FEET.
THE GRAVEL DEPTH IS THE MIFJIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION <IN FEET). doc)
F?EG�U I FZEGs E3EPT I iG GFtLL_IDr F
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
FJUMBER. OF RESIDENCES THAT THE WELL !•JILL SERVE.
--- Tl -JO < :-:> > I "�r_FPECT I or-a�r_ nFtE REc,u I RELti ---
BACKFILLING OF AFJY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MIFJIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR. A PRIVATE WELL OR. 150 TO 200 FEET FROM A PUBLIC I -JELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MIFJIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AND
TO A COMMUNITY SEWER. LINE IS 75 FEET.
OTHER.. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER.. INSTALLATION.
F•EFRM I T EXF' I FZ.*E�7- E?ECEMBEF: =1s 1S451
I CERTIFY THAT
1: I AM FAMILIAR.. WITH THE REQUIREMENTS FOR, ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IFJ ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
APFLIC JT' CLINTON FFAALY.ENHAGEN /G/�t //J
ISSUED B ----� �= 7Fj----------- DATE - / ----
V4. 0
ro
r `'.'UN ICI PAL I TY OF Ar40"C3RAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHOP.AGE, AK. 99501
264-4720
W E L L P E R M I T
PERMIT NO. < 780982 >
APPLICANT CLI14T FALKENHAGEIJ SRA BOX 1547A 344 7105
LOCATION WAGNER ST.
LEGAL L 13A B 1 BOYLE SUB LOT SIZE 55000 SQUARE FEET
'MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL: OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER, REQUIREPIENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXPIRES aECEME3EFZ ?1 r 1.5+7":L=:
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR OPl-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES.
SIGNED
—&t t"—r.— -ll� ------
APPLICANT CLINT FALKENHAGEF
ISSUED S'
V3. 2
bl' GRi..1 ER ANCHORAGE AREA BO,.JUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
e I'�'f FIS
r/ 3700 TUDOR ROAD POUCH 6.650
ANCHORAGE. ALASKA 99302
IV7U rl TEL[P%Omr 270.0686
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
NAME OFAPPLICANT/1""M/ • ,,"ppP>4 MAILING ADDRESSS�4 �-x/fy7///sez
17) pNONE3
INSTALLATION LOCATION �M>!f!ElCLlf /�t,«(P ow��fllt��' lY
L 1314 r„tl� l 77Tlr4os ("w”
1-
LEGAL. DESCRIPTION
! INSTALLATION OF: SEPTIC TANK ` �/ - SEEXPAGE PIT i
A .A � DRAIN FIELD OTHER /
TYPE AND SIZE OF FACILITY TO BE SERVED
[/S
FINANCED THROUGH -- "lr.
SOIL TEST RESULTS
COMPLETION DAT! ANTICIPATED
'I
TO BE INSTALLED BY77,
NOTE, T AL4q-MII=HQ 1T &QIL TEST
FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION SY THE
HEALTH DEPARTMENT AUTHORITY WILL TIME SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE / TYPE �•�`� SEEPAGE AREA SIZE4!:741aTYPE. ((
011
MINIMUM DISTANCES, REQUIREMENTS
r1 DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT -201DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL / S—I _
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT
I�� r
SEPTIC TANK, SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION B FEET INTO UNDISTURBED SOIL.
A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
PITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL fACKPILL
CONFORM TO BOROUGH R,F"LATIONS REGARDING INSTALLATION,
HEALTH AUTHORITY
OR
LICENSED DESIGNER
1 CERTI THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28.60 AND THAT TME ABOVE
DISC S O Sr TEM 18 IN A7ZORDANCE WITH SAID CODE. � L
DAT ��• - APPLICANT'S SIGNATURE LJL_LL_JI/ y//71 n / O/ /.y_�
1
SEPTIC TANK
SEEPAGE PIT
`y DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
PO 1
SEEPAGE PIT J20 I
DRAIN FIELD
ALSO CONSIDER AREA WELLS. "
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE PIT
I�� r
SEPTIC TANK, SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION B FEET INTO UNDISTURBED SOIL.
A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
PITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL fACKPILL
CONFORM TO BOROUGH R,F"LATIONS REGARDING INSTALLATION,
HEALTH AUTHORITY
OR
LICENSED DESIGNER
1 CERTI THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28.60 AND THAT TME ABOVE
DISC S O Sr TEM 18 IN A7ZORDANCE WITH SAID CODE. � L
DAT ��• - APPLICANT'S SIGNATURE LJL_LL_JI/ y//71 n / O/ /.y_�
�•AI�
NAME OF APPLICANT
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6.670
ANCHORAGE, ALASKA 95502
TELVR9NE 279.6686
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
INSTALLATION LOCATION 10i 11fd
LEGAL DESCRIPTION lC 1I 4
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVEE
FINANCED THROUGH
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
MAILING
A ADDRESS /o W
TO BE INSTALLED BY
PERMIT NO.
DRAIN FIELD OTHER
NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
3/ �lW !/Pf/ !T
SEPTIC TANK 612E 1002all TYPE. � ��7C SEEPAGE AREA SIZE • �S TYPE
MINIMUM DISTANCES. REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT D DRAIN FIELD
SEPTIC TANK TO SEEP�IG PIT WALL
�j
SEPTIC TANK SEEPAGE PIT Zo DRAIN FIELD
TO NEAREST LOT LINE. �j '
///�
WELL TO SEPTIC TANK ✓ �SEEPAGE PIT /e/� " `- '
DRAIN FIELD ALSO CONSIDER AREA WELLS.
i
WATER MAIN TO SEPTIC TANK ,a SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFIL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTHORITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 25.68 AND THAT THE ABOVE
DESCRIBE YSTEM IS IN ACCORDANCE WITH SAID CODE.
DA E / __PLICANT'S SIGNATURE�������
fl C �
?
Oq
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
(907) 243-7893 3163 LINDEN DRIVE
KEN JOHNSON Ml;RtT#ggpbp, KA 99502
DEPT OF HEALT�f
ENVIR6A tfdR��;.6t �01v978
WATER WELL LOG HOV 21978
RECEIVED
Clint Falken haZen
Wagner Road
HOLE NUABER TWO
0'
to
13'
Med. gravel with brown silt- cobble at V
13'
to
35'
Brown silt
35'
to
55'
Clay and med. gravel
55'
to
67'
Glacial till
67'
to
68'
Same but weeps water- 30' head- sand pumps dry.
68'
to
78'
glacial till- verytight- drill6" drive 6"-
78'
Clean course sand and gravel ( water bearing )
Static 30'
Test bailed for hr. at 14 GPM
drawdown 15 ft. ( 45' )
Clean and clear- Bottom stable
Total casing 79'-4 3/4"
�e` ,"' 8 / .t -;e /YA dt.
Has Ground Hater Encountered?
If Yes, At What Depth
CASE 4
on 'lest
Locaticn CKPf Nh
Frcposcd Instal i" ion: seepage Pit !-� Drain field
Dept}. Of Inlet //' L`e;
7n-70 bottom of Fit Or Trenc
rr cf
Test Perforred By: (�� rr r• n
Data Certified 'cy:�r. �. n
Dat
AGCH07A'.E AREA L
HLALT'I D:.IAITt!E!,T
327 LA;! ' r STREET
ALA5'KA 99501
Perfarned
Le[rtl Dcscrintion:
ror
%n�--�—�----Date Per:
'
This Fcr,;,
of if Lcl, r;icn
Reports a:� Soils Lcr,
Depth
I'ect
Eoil Char teristics
_ _ Ne G.., /cid G eery
7,
/�),
LI/SII S"// S' CIGy cc
cc
.2 V ,
! rICI tarry ex-leenle/
.»e"i/u,'e
Cc.71e,If.r71)e
,j I V
SW (,UGJ Ve/� Wel/
M
_WGl.
S I
CCPlr1i�.
Has Ground Hater Encountered?
If Yes, At What Depth
CASE 4
on 'lest
Locaticn CKPf Nh
Frcposcd Instal i" ion: seepage Pit !-� Drain field
Dept}. Of Inlet //' L`e;
7n-70 bottom of Fit Or Trenc
rr cf
Test Perforred By: (�� rr r• n
Data Certified 'cy:�r. �. n
Dat
Municipality of Anchorage IPP
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-8850
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-283-03 HAA # H A t7 2 Q S�) 0
Expiration Date: 2 - / R - 0 3
1. GENERAL INFORMATION
Complete legal description Lot 13A Block 1 Boyle SID
Location (site address or directions) 11700 Wagner Street, Anchorage, AK 99516
Current Property owner(s) Clint & Claire Faulkenhagen Day phone 230-7538
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
11700 Wagner Street, Anchorage, AK 99516
Day phone
Audrey McKenzie fSlec per' Re-1�1l f,Day phone 3442501
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
21
Individual Holding tank
❑
Community On-site
❑
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 welts or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
(Rw.. III"
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
based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and
State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn Pannone Eng. Svc. Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date ll S[d?
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, coa cientious
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The
reported results describe the performance of the systcrn under the conditions encountsxd at the time of
the test, and separation distances measured to readily identifiable features. The operational life of all
wells and septic systems depend on the local soil condition, ground water levels that may fluctuate
during the year, and the water gage of the family being served by the system. These conditions arc
outside the control of the evaluator of this system. All systems eventually fail and satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that there arc no
hidden defexts or encroachments. PES can therefore not provide any warranty for future performance
nor give any estimate of how long the systems will continue to meet the operational requirements of the
ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party is not authorized nor will it confer any
legal right wtratsoewer.
6. DSD SIGNATURE
Approved for L' bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory
By:
Expiration Date:
(Rw. 11199(
Other
Original Certificate Date: % ) — /
Reissue Date:
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 19WW Anchorage, AK 99510.8050
www.oi.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 13A Block 1 Boyle S/D Parcel I.D.:_ 015-283-03
A. WELL DATA.
Well type P If A. B, or C provide PWSID # _ Well Log Y
Date completed 10/2011978 Sanitary seal Y
Total depth 7�ft Cased to 71 ft
FROM WELL LOG
Date of test 10/2011978
Static water level 30 ft
Well production 14 g.p.m
WATER SAMPLE RESULTS:
Coliform -&— colonies/100 ml Nitrate ! i( rw
Wires properly protected Y
Casing height (above ground) 15 n.
AT INSPECTION
t]if/fiIP�
25 ft
2.5+ g.p.m
Other bacteria T7— coloniestl00 ml
Date of sample: 1116/2002 Collected by: _Dura Pannone
B. SEPTICIHOLDING TANK DATA
Tank Type/Material _Concrete
Date installed T/1011971 Tank size 1250 gal Number of Compartments 1
Cieanouts Y Foundation cleanout Y Depression over tank N High water alarm Y
Date of pumping _0130/2002 Pumper Af Home Services
C. ABSORPTION FIELD DATA
Date installed 1012612002 Soil rating (g.p.d./62 or ft?/bdrn)11 System type _Q0
Length JV ft Width 30_ ft Gravel below pipe 0.5 ft
Total depth :U ft Effective absorption area 2010 ft2 Monitoring tube Y Depression over field h,
Date of adequacy test A&!&? Results (Pass/Faio Pass For A bedrooms
Fluid depth in absorption field before test New in Water addedSM gal. New depthNM in.
Elapsed Time: Q min Final fluid depth NM in Absorption rate >=0¢00+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
(Rev. I VW)
D. UFT STATION
Date Installed 12/28/1881 Size in gallons Unknown Manhole/Access Y
'Pump on' level at 10" In'Pump ofr level at 4: in High water alarm level at LOL, in
Datum Bottom of Vault Cycles tested 10 Meets alarm 8 circuit requirements? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 105 On adjacent lots 100+
Absorption field on lot 150 On adjacent lots _100+
Public sewer main 76+ Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 70' Property line 41V Absorption field 70'
Water main 30+ Water service line 30+ Surfacewater 100+
Drainage 100+ Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10.7' Building foundation 21.2 Water main 50'+
Water Service line 50'+ Surface water 100+ Driveway, parking/vehicle storage 15+
Curtain drain N/A Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 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.
Engineers Printed Name Steven R. Pannone. P.E.
Date 11 I SIeL
vV
HAA Fee SJc ' Waiver Fee E _
Date of Payment Z Z Date of Payment
Receipt Number 2 ego Receipt Number,
(Rev. i IM)
zr 40TH
Steven R. -Fonn,
No. CE 8149
11 -11 -OZ 11:30 FRW-CTC"- ENVIRMKN7A1. SRV
CTB! EnVltonmernan 111"on Inc.
971'.6733:1 T-693 P.OZ/03 F-13`.
is
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CTAETWA
1027542001
Pamoae bnQ. Stv.
Printed Date/Tlme
11!11!2002 11:38
COeu Nage
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Reeelyd Data'Rmt
11!06"2002 12:05
11l06ROt12 12:45
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L13A. BKl Hoyle S/D
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UNDER NO CRCUMSTANCO SHOL D AN AS -GMT K USED FCR CONSiRUC11011 OR ►OR LITA8USH10 0 BOUNDARY OR MOE UNM
THE SURVEYOR TAKES RESPONMITY
FOR THE MIAL TRANSACOON ONLY AND ASS AXES FINANCIAL UASI ITY ONLY POR THE COST Of THE SURVEY.
USTED DISTANCES PREVAIL OVER SCALING. REPROOUMION MAY CAUSE UWARS N SCALL
SOT SRnIY SURVEY TYPE
SYMBOLS
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IT IS THE RESPON-SR" TY OF THE BUILDER OR OWNER. PRIOR TO
ONLY THOU IMPROVOIE TS ABOVE GROUND AND VISIBLE WALL SE
CONSTRUCTION. TO VERIFY
PROPOSED BUILDING GRADE RELATIVE
SHOWN. FCNOO. 11EI.Lf. SCPTIC CIEANOUTIL SIDCWALY-% DRIVEWAYS.
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERIAW
ETC, ARE SMOMN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
THE DOSTENCE OF ANY EASEMENTS• COVENANTS OR RESTRICTIONS
.MAY PREVENT SOME MIPROVOICNTS FROM RENO
S@1 ANO LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARC RECORD UNLCSS OTHCRWISE NOTED.
SURVEY CERTIFICATION
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Pannone Engineering Services, LLC
Consulting Engineers
(907) 272-8218
November 17, 2002
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 13A, Block 1 Boyle S/D
Requested Information
Mr. Jeff Poet:
P.O. Box 102954
ge, Alaska, 995 10
You called me and requested additional information concerning the installation of the septic
system on the above referenced lot.
t-�-
The drain field needed to be(located due to the presence of high ground water. The top two feet of
the soil in test hole number one was not suitable for a soil absorption system. We performed two
additional test holes and found the soils in the top two feet of the test holes were suitable for a
soil absorption system. The ground water was monitored to be two feet below the ground
surface. The above is why the soil absorption system was moved.
The drain field has over two feet of cover over the drain pipe. The entire field is covered with two
inches of rigid insulation. There is an equivalent of four feet of cover over the drain field.
If you have any further questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
`Sre en I . arinone,P.E.
Civil Engineer
Attachments:
C:\work\Letters\ 13A-Moyle.002.doc
iAgb-10'.-1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 913 /&..'
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
L i3A 73 1 Sov/e 5/D Sal %rzN e3w
Location (address or directions)
(b) Applicant Name 01^ rt F_% I k,— =ffrhTelephone: Home 345' 3 /99 Business T- 3550
Applicant Address !/�o✓�
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder V; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution P�Zoe., n A ( .[?n 1 k ,6f Ah/ Telephone � � � c2 //,!57—
Address
/.157—Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-FamilyQ Multi -Family 13 Other
Number of Bedrooms 4
3. WATER SUPPLY
Individual Well t Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 111,841
n
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date o1 this inspection.
Name of Firm Atjt,., I t e,-„ e— F .. , „ rr r n . Telephone 3'F 4 :!47//
Address 7i .2 7 S N,.,,. fl„ .l, Ak 99 5'i N
Date _ 9/3 1AL.
WATER WELL NOTE: This Health Authority Approval inspection merely
certifies that the subject water well produced 150 gallons per
bedroom per day and that certified laboratory tests showed no
presence of coliform bacteria in a sample of that water. No warantee
or certification Is expressed or implied concerning the long term
adequacy or safety of the water supply.
ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval
inspection merely certifies that the subject on-site sewage disposal
system accepted at least 150 gallons of water per bedroom per day
as determined by methods approved by the Municipality of Anchorage
Department of Health and Human Services. No warantee or
certification is expressed or implied concerning the long term
adequacy of the on-site sewage disposal system. Construction data
reported on buried system components is from MOA files and was
not verified during this inspection.
6. DHEP APPROVAL
Approved for bedrooms by Date
�"
1
Approved Disapproved Condi o I
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) Issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
t 72-023111,84)
r____ ...
A.
MUNICIPALITY OF ANCHDRAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 L, 13A 31
Bayle s iv
$ z. �-nzN�R3LJ
Well Classification Prr✓a."fe If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (Y/N) Date Completed 10/20/'7's Yield_ 7 Q Pm
Total Depth 7R Cased to 7 F Depth of Grouting IV14
Static Water Level ?o' Pump Set At
Casing Height Above Ground /? 4- Sanitary Seal on Casing (Y )
Electrical Wiring in Conduit (Y/N) X Depress icn Around 'Kbllhead (YIN) N
Separation Distances from Well:
To Septic/Holding Tank on Lot /OD ; On Adjoining Lots toe 1
To Nearest Edge of Absorption Field on Lot 14_9t ; Or. Adjoining Lots loD'-r
To Nearest Public Sewer Line N/A To Nearest Public Sewer
Cleanout/Manhole N14 To Nearest Sewer Service Line on Lot 36 '
Water Sample Collected By A4 N.., a . ; Date /Z -) /FG
Water Sample Test Results 5
Ccnments
B. SEPTIC/HOLDING TANK DATA
7/7/�
Date Installed Sime iNo. of Compartments (
Standpipes (Y/N) Y Air -tight Caps (Y ) } Foundation Cleanout (Y/N) Y
Depression over Tank (YIN) N Date Last Pumped P,/2 7 /s
Pumping/Maintenance Contract on File (Y/N) N for
Holding Tank High -Water Alarm (Y/N) N /A Temporary Holding Tank Permit (Y/N) N IA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well _ Inc To Building Foundation 3o
To Property Line �9' To Disposal Field 3pi
To Water Main/Servics Line 3e) a- To Stream, Pond, Lake, or Major Drainage
Course N /A
Cements
(Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1&0 Type of System Design P
Date Installed Io/R r Length of Field
Width of Field .2 Depth of Field 2'
Gravel Bed Thickness
Square Feet of Absorption Area Standpipes Present (Y/N)
Depression over Field (Y/N) At Date of Last Adequacy Test RAZ7 /86
Results of Last Adequacy last 02' — 4 ak
Separation Distance from Absorption Field:
To Weter-Supply Wall 14.9 To Property Line 31�
To Building Foundation SD 4- To Existing or Abandoned System on
Lot 30 ' + ; On Adjoining Lots 3U ri-
To Water Main/Service Line SD w To Cutbank(if present) > 114
To Stream/Pond/Lake/or Major Drainage Course N /f1 _
To Driveway, Parking Area, or Vehicle Storage Area 3 6 '-1-
Convents
D. LIFT STATION
Date Installed t o /81 Dimensions 36 qY 2 4 N
Size in Gallons % Manhole/Access (Y/N) Y
"Ramp On" level at ID "Pump Off" Level at 4
High Water Alarm Level at .70 Vent (Y/N) Y
Tested for 34 &A 5.,:., Ringing Cycles during Adequacy Mast. 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 MCH HAA
on the date o i i pact on.
/_ / l i
Signed Date _�� L� w o�
Corpany c. l o - MOA No. 29 p, ;
KB1/d5/s �c:�zs N� �• 1 - 3b �G"
P ,a
(Page 2 of 21
in effect
ct'+n; rt
• • Ell HA\ViNORNE ,
CE -4259 : •,
44 1 yFrC'&Z- � w4
2-15-84