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HomeMy WebLinkAboutBRUIN PARK BLK 1 LT 3Bruin Park Block 1 Lot 3 #016-101-10 \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264A720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW O Cool< 3yy. frOFfo ❑UPGRADE MAILINGADD7.0 lea II� rr LEGAL DESCRIPTION Lai 3 2 2 LOCATION f NO. OF BEDROOMS 3 O N o ta A q D F- i= Oil -ALL Well Absorption area Dwelling PERMIT NO. DISTANCE TO: Uy H 2 Manufacturer Material No. of compartments WQ to f Lid. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth dOy DISTANCE TO: Well Dwelling PERMIT NO. O Q Manufacturer Material Liquid capacity in gallons 2 F p Well Foundation Nearest lot line PERMIT NO. = DISTANCE TO: Lu W ti Z No. of lines Length of each line Total length of lines Trench width Distance between lines 2 W Inches G F Top of tile to finish grade Material beneath the Total effective absorption area O inches Length Width Depth PERMIT NO. W ds- Type of crib Crib diameter Crib depth Total effective absorption area W W Well Building foundation Nearest lot line th OISTANCETO: Class T13 Depth Drillek Distance lot line PE I NQ u e-5, W s: Building found�tulo Sewer line N Septic tank Absorption area(s) DISTANCE TO: �4 OTHER PIPE MATERIALS SOIL TEST RATING S INSTALLER REMARKS r t,; ••y l 2225-E JUNE 25.1971 : a, r. L APPROVED DATE LEGAL oft/ L3, 6i 62um 'a42K A 72-013 (Rev. 3/78) 01 I<k LOCATION OF WELL (Pleas• Complete either la, 10 or IC.) la. Borough Buadlylelan Let 6�104,� to. t/.stn• Ankh ruin Parc 31 1 1 _er_ef_ot �1 DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. Seatlea No. Township NO Range a 0 EQ Meridian s. OWNER OF WELLS Bradford Ge Cook Address! Street Address and Area of Wall Location Feat Blow 4. WELI_,QJPTH: (11..1) 6. DATE OF COM►LETIQ% 2. WELL LOG surface �7ty/ Ft (� �'t Material Type Top Bolton bra silt 20 11 6. ❑Cable fool )GRotory QDriven ❑Dug ra silt Cla 25 8 ❑Auger Odetted Oeerod 0other I sandy grave he B2m T.u$00 Domestic ❑ Public Bepply O industry ❑ Irrigation ❑ Meharge ❑ commerical ❑ Tell wall ❑ other: S. CASING, ❑ Threaded Welded dl.m._!5"� In. tosQ_ft. Depth weight les./ft. dlom, In. to_fl. Depth stickup et. _ 6. FINISH of WELL Diameter, To r tlel/Meeh sire: Length: Bet b.tw•.n it. end ft. Backfilling Gravel pock 1 �L 10. STATIC WATER LEVEL! tl. ---' ❑ Abon .r ® Below load sorfooe Dare _ E401PMoet eaed: -- 11. PUMPING LEVEL below land $110099 and �Y1µ0 -- 1t. aff•r—Ars. pumPingiLG_g.P.m• ft. offer hra. pumping __a.P.m. 12.6ROUTING Well Grouted: ❑ Y•$ t] No Material: ❑ Neat Cement ❑ OtheH Is. Pump, (If available) NP ;L Length of Drop Pip• rt. aapacHy 9.p -m- -- — W Subm. ❑ jet ❑ Centrllital ❑ Other 14. REMARKS! 16. WATER WELL CONTRACTOR'S CERTIFICATION: 16. Wa1er Temp•relur• -e This wall was drilled under my lu,lsdictlaa gad this report 1s Irmo to the best of my knowl•ag• .red belief; Alaska--Nosq-xrell-ver j -s -.Drilling & Ent. AA 3327 H•Ontered Business Noma Contract Llaenee Number ,,,-,,,12241 Avion St. SRA Bos 1560 Anchorages Alaska 99516 Llga•e: -- — — -- Date: '-c1-y—P y Form 02-WWR (11/e1) Copy Distribution: WHITE -Stale DGGB PINK -Driller, CANARY-Cu/Ismer ■ ❑ C MUNICIPALITY OF ANCHORAGE Department �: Health and Environmental. rotection 825 Street, Anchorage, AK. )501 264-4720 * * * HANDWRITTEN PERMIT Permit # QQ WELL PERMIT /�� pp Applicant: /�%l %'ey i- �� Mailing Address: y. Location: / GG�� Phone Number: �y �- 98 6 Legal Description: l�-� � /� ��,-4S qft Size: ffl', �c� Type of Soil Absorption System Is: Trench: /Drainfield: " _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' DEPTH 14 LENGTH. GRAVEL DEPTH -4�A- WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the -bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO M INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 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 in accordance with codes. (3) I understand that the on-site sewer system ma4re re enlargement if the residence is remodeled to include more thdr oms. Signed: Issued by: ppli ant S Date: SWP/024 (1/81) • MUnicipa it3, of Anchorage January 8, 1988 P.O. 8196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 D mxx=x= Tom Fink, MAYOR DEPARTMENT OF HEALTH 6 HUMAN SERVICES Doug Sopko 10900 Lake Otis Parkway Anchorage, Alaska 99516 Subject: Lot 3 Block 1 Bruin Park Subdivision Permit #870053, On-site Well Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re -applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit PERMIT NO: DATE ISSUED: P'1Uhl I C I f AFL I F Y 01= AVA C3.:(`iCGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 CIN—E3 I !FU=WELL F~1=FTP1 I W 870057, 04/16/87 APPLICANT: DOUG'SOPKO ADDRESS: 10900 LAKE OTIS PKWY. ANCHORAGE, AK 99516 CONTACT PHONE: 345-3875 LEGAL DESCRIP: SUBDIVISION: BRUIN PARK LOT: 3 BLOCK: 1 SECTION: 20 TOWNSHIP: 12N RANGE: 3W LOP SIZE: 15000 (SOX1 . OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. T will adhere to all MOA and State of Alaska requirements for the set back: distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. SIGNED APPLICANT: DOUG SOPKO DATE: ISSUED BY/%Yf DATE: QK=�%.�✓ -- /'-v.�.r------------- - ---- �. PIA —war/r'1 LAKE' OT/S vJE�c Z �-- TANK 5 �S� of it! 400 05) GR("R ANCHORAGE AREA BO""'IGH , Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME u%tL/Rm F p� MAILING ADDRESS 6-4 ,Be,- //3 PACm Ert PHONE 227 -3q-rl LOCATION oL-RW 1611nAiL5/ LEGAL DESCRIPTION Lo7-3 Bt Oc/c SEPTIC TANK: DISTANCE Ir NUMBER OF C Sr�L COMPARTMENTS FROM WELL � MANUFACTURER '7,eeE� MATERIAL INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. T,0ewe-g TILE DRAIN F TOTAL LENGTH 611 DISTANCE FROM WELL 90 FOUNDATION NEAREST LOT LINE—;5--L—OF LINES NUMBER OF LINES Z' DISTANCE BETWEEN LINES NA TRENCH WIDTHky-4+"P - TOTAL EFFECTIVE ABSORPTION AREA 4,1041 /cO SQ. FT. LENGTH OF EACH LINE $/ DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE _s? 'iF:. ABOVE TILE IN. WELL: �- �-o j TYPE �uFi - •_���� CONSTRUCTION 7 D 1.. DEPTH /'� DISTANCE FROM: BUILDING NEAREST NEAREST FOUNDATION , LOT LINE . SEWER LINE_ CESSPOOL X ^0 APPROVED ` •" , OTHER SOURCES DISAPPROVE REMARKS DISTANCES: A-8 s /is,, Q -F3 - q0/ INSTALLED BY; SEWER LINE DEPTH: PIPE MATERIAL: Ogsr- /,Pei AS �2Dy �PFYF. PLAztrL LOT SLOPE: �, I REMARKS �S�"/O TXWG.M 14)107-74 7V DATE CCr,CW C) Sf i L rCS-r 7 r ai &)-r— ' A ". Form EQ -032 SEPTIC /f. SEEPAGE, TANK '� SYSTEM 90 DIAGRAM OF SYSTEM�� 1 I 1 1 APPROVED a f1a�m 5 O fl - j c "t08 'AA U G.A.A.B. u C= NAME OF APPLICANT a GREr\R ANCHORAGE AREA BO^��GH ^ '.�� No- DEPARTMENT OF ENVIRONMENTAL QUALITY 3550 ••C•• STREET ANCHORAGE, ALASKA 99505 TELEPHONE 274-4561 !?'1 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT ^ w INSTALLATION LOCATION ,GoT a' LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED MAILING SEEPAGE PIT I I 4 PHONE DRAIN FIELD OTHER O R FINANCED THROUGH TO EINSTALLED BY "- -- V NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST SOIL TEST RESULTS T —�� COMPLETION DATE ANTICIPATED NOTICEFINAL INSPECTION: 24 HOUR WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROS CUTION /000 6- reef SPS ~ SEPTIC TANK SIZE. TYPE SEEPAGE AREA 512E YPE DIAGRAM OF SYSTEM MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT DRAIN FIELD D I TO NEAREST LOT LINE. / am to-cG� �_ WELL TO SEPTIC TANK SEEPAGE PIT . DRAIN FIELD ALSO CONSIDER AR A W LS. WATER MAIN TO SEPTIC TANK 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 OF EXCAVATION S FEET INTO UNDISTURBED SOIL. • INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. a.A.A.s. OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER DESCRIBED SY�^STEM IS IN ACCORDANCE WITH SAID CODE. (7/� DATE �✓"-�� APPLICANT'S SIGNATURE FORM NO. EO'61 S AREA BOROUGH ORDINANCE NO. 2B•68 AND THAT THE ABOVE e-- Per{oc 9 Sept. 75�- Legal 1laecript:qn: l.e 3 -Tl:c Bruin. Park ----- Thin Fo. Aepartn e- yoib.a Lo?__xx__— Depth Feet SOIL nP+v crrRIS?I.'? top The sediments were very loose) soil with amoderate water content. 3 There were some erratic Ow j bodies but these accounted -;-� for les than 5% of the total 1 1 stratigraphy. I Sw Was Crccad Water Tncount-red? No it Tet, At What Depth? LOCATIOt'. SKETCH De(ttl of In COUDiM S : tepth TC F.oc :r._'. rit 'J: I rencn_1Lo iR— Teet Per!oraed 6y: Pe co Data Certtlr..+ r••• i D..te_ 9 Sept 75__ —J.. rerforacc to William F. Pattie—__�_,_._ dace Ye:farvec-wept, 7S ;._N I'•"parts nt Sala LeF_X$r__r .—_^Pe:eo..eUx, :rxi�_ q rt` SOIL�ILtSiCCEP.251I,S / LOCATION SUTCil 3 5 8 a Crcand Water Tnzcuat•fed7 :t acs, At least Depth?!I I z back -I As the profile indicates the. P 1 I analysis was done on a back-)--'- { & Pilled area. All sediment top contacts were relatively soil distinct with the exception of those.disturbed when this) - r ea was originally excavated f Z� Gw a sediments were fairly D ! with the exception of �' S ' 7;�Sr �— the bottom Ow layer. Gm- - - { --- T•r :1 "•r'ak:" I'S[ __ Drain Gw a Crcand Water Tnzcuat•fed7 :t acs, At least Depth?!I I z :.t 'niet i -- --2 ni �_ ft Gm_at 22$_s_gft/bdrm� __._ 1L:, P y! a By._Percco - -_— \- i;,te2 SeQt_7 _ _- � O J 3 C/- 4/ 7;�Sr T•r :1 "•r'ak:" I'S[ __ Drain :.t 'niet i -- --2 ni �_ ft Gm_at 22$_s_gft/bdrm� __._ 1L:, P y! a By._Percco - -_— \- i;,te2 SeQt_7 _ _- � O J 3 C/- 4/ Municipality of Anchorage Development Services Department Building Safety Division • On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 v www.ci.anchorage.ak.us ft']JJ w (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 016-101-10 1. GENERAL INFORMATION pf - t<� HAA# � f}03o 105 1 Expiration Date: C L2 r, kI Complete legal description tirturryrARn ��o� . �. ,• --• - --- Location (site address or directions) 10841 FOREST DRIVE • ANCHORAGE AK �I TODD KELSEY Day phone 743-9313 Current Property owner(s) I Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone Day phone ' 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 iv Individual On-site 9 Individual Water Storage ❑ Individual Holding tank a Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer I I 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 samples. (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 engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid S at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal axed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health AuthorityApproval 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 Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DESARR ROAD, SUITE 2B • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can !herefore not provide any warranty or future estimate of how long the system 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 whatsoever. 5. DSD SIGNATURE Approved for _3 bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing Phone 337-6179 DateC} C ,ttttuttrrrrrrrr r��ZY OFA„Iriy.� V(V'JIIL MATER AND IM0I GYrru �' % PROGRAM : Attachments: HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By- Original Certificate Date: Za o (R. 1Z0 ) Municipality of Anchorage Development Services Department 8undingSafety Division ,. .., On-Sile Water 6 Wastewater Program 47W South 8rag8w St. P.O. Box 196650 Anchorage, AK 995196650 www.cLanchorageakus (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: BRUIN PARK SUSDMSION; LOT 3. BLOCK -1 Parcel ID: 016-101-10 A. WELL DATA wan type w If A, 8, or C provide PWSID# N/A We9 Log (YM) YES � Date completed 7/20/84 Sanitary seal (YM) YES Total depth 50 ft. Cased to 50 ft. FROM WELL LOG Date of test 7/20/1984 Static water level 25 ft. Well production 6 g,p.m. WATER SAMPLE RESULTS: Conform 0 colonies/100 ml. Nitrate 0.2 mgA. wires property protected (YIN) YES Casing height (above ground) 49 in. AT INSPECTION 3/3/2003 25 ft. 3.2 — 9 -p.m - Other bacteria 0 colonies/100 ml. Arsenic; N/A mgJL. Date of sample: 3/03/03 Collected by: AKWWC, INC. e. SEPTIC/HOLDING TANK DATA Tank Type/Matertal GREER/STEEL Date installed 9/10/75 Tank size 1000 gal. Number of Compartments 1 Cleanouts (YIN) YES Foundation cleanout (YM) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 3/03/03 Pumper CHUGACH PUMPING C. ABSORPTION FIELD DATA Date installed e/1o/7s Son rating C.p.d ft%drm)125 SF/BR System type DEEP TRENCH Length 61 ft. Width 3-8 ft. Gravel below pipe 6.5 ft. Total depth 'e it. Eft. absorption area 610 W Monitoring tube YES Depression over field NO Date of adequacy test 3/7/2003 Results (Pas3/Faiq PASS For 3 bedrooms Fluid depth in absorption field before test 6_5 In. Water added703 gaL New depth 62.5 in. Elapsed Time: 10 min. Final fluid depth 11.5 in. Absorption rate >= 450+ g,p.d. Arty rejuvenation treatment (past 12 mo.) (YM 8 type) **NONE KNOWN If yes, give date – **SUMP AND DISTRIBUTION LINE WAS JETTED ON MARCH S. 2003 BY BILL MCDONALD D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 098' Public sewer main — N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ••3' Building foundation 10'+ Water main_ N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field ins :y1 iou9 inspections and . review of Municlpal records that the above systems are /n """". • • • • • • • • • • • • • conformance with MOA HAA guidelines in effect on this date. A....... �; ... Engineer's Prints Na a JEFFREY A. GARNESS : of a _fig : Date 3 I 0 4 1A HAA Fee $ 1:T75. CA + 1500c, , w -&r Fee $ 1 n n n . Date of Payment � - Receipt Number 9 (Rsv. 12r01) Date of Payment La g .: Q n Receipt Number 3A,91('2 ♦�I�" .-e bit MUNICIPALITY OF ANCHORAGE Building Safety Division SA CTT MEMORANDUM DATE: March 27, 2003 TO: File FROM: Joe Goodall Engineer 11, On -Site Water Wastewater Program SUBJ: Bruin Park S/D Block 1 Lot 3 Bruin park block 1 lot 3 was visited by our dept to do a final inspection prior to issuing a waiver of 98' separation distance from well to septic field. several thisngs were found to be wrong with the site. 1.) the septic field clean-out on the east side was found to be broken 1 1/2' below ground surface and laying on its side. 2.) the septic field was above well in elevation which differed from waiver request submitted by AWWC, Inc. 3.) the well had 6" of standing water around the well 5 to 10' radius from well head. AWWC, Inc did the following to correct the above items: 1.) the septic field clean-out on east side was fixed and extended above ground. 2.) the waiver request letter was fixed to accurately reflect the well and septic elevations. 3.) soil was added around the well casing, 1 1/2' height around the casing, sloping 4-5' diameter around the casing. bA'nchor'a'jgee Ahlnlelpc` lity of Anehorage All-America City Bui1(liug Stifety M isioll George 1. Witerch. 2002 Mayor 3/26/2003 Jeff Gamess Alaska Water Waste Water Consultants Subject: Waiver Request for 98' well trench separation distance Waiver Request #WR030020 Parcel ID #016-101-10 Dear Gamess: 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 98 feet. This waiver approval applies to the existing absorption field to private well separation only. Any future upgrade to the on-site wastewater disposal system 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, rrigin eer On -Site Water & Wastewater Program I'.O. Ikic 1t )GR) • Anchorage, Alaska W519-6650 • Telephone: (tx)7) 343.8301 • I'as: (907) 343-82(x) 47(X) South Ilragaw Street • Anchorage, Alaska W507 1 It t p://e���e•cl.nnchornge.nk.us Municipality of Anchorage Development Services Department r Building Safety Division j e On -Site Water and Wastewater Program SA 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 030020 PID#: HAM ha030105 Permit#: Date Received: 3125103 Legal Description: Bruin Park SM -Block —1-1,90 3 Engineer. Alaska Water Waste Water Consultants Inc Applicant: Jeff Gayness Waiver Requested: 98' private well to trench separation distance Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: N•� yZ 2•'�- 29 2-1 Total: i -�- < 57 Waiver is Granted:_ Waiver is not Granted: List Conditions or Reasons for above: _( c r V d """" ZS Date: 3 By: •........ �... i....... a ....... a .....•••• Rec#: X918 Amount: $400 Date Paid: 3/28/2003 is Or Kevlewet ..ra ava rrr r^ W ft;dicA,. Re",.+ 4fk 00201',J t.)►rak- SID 61o�k 1 jai 3 L,jRiJEr.a., Roves'!' A/Vfk bei W01 WAiVE(2+Rcyvcsf' {� OM-4oT WAT��WEt.L -fo A6se�6'�:� -j-RENCt( of 96 FEET'. —Scpf. o f)04,4- ACTEuR7E ,�65°rz6 :o^l FieIcI wAS The S vb�eaf w '� eo�afa,c-kd i.v Sep./e^,,-4e2 /9�s -jl e Son t�c SyS�^^ Fns iN fS 14SANDt/ Wif� A PG2coiA'Ii°'V RATE OF Lp,.,s�/JvL�Cd /-s M;n)�:vch. T%;S soi I ryPic,�n7 Wi If -T/�c'.+T SGpf%c#lveA/1F %n/ A' SKoRT DiSiA^ • -rAr sv6.e cf. W9fez wELt is So �e�� Aeep• 7Jc /99u/"+ - AC- WELc. is ENCOUN�CR SCI /➢-7t y8 T'•Ce 4 SuPpiy�^) wnfe2 fo f IS k (ayEa, C4 (79 I 5;)1+7-I Zs 1we�f -to NS �eal TAcpc ge 10,J Ae- paound So1L-FAc-'. 7-,z S*n41G WA4F-O- Levc l %S I0*cc 2i-f'ea-f-�I�t1ti, t�+C 9rzcun.c� YY SuM1rnACE. ThiS w? iEt LSUF_ G.. I S a44loi.J Thr icjcVj.r;ed Spo1w"iICY Ga.fFna. 'jilt AS�lk'7– "OL/1c) Lf- p7ofec-4J -Poor �c svf- ACE C-PAI '�A : vR o lJ% D✓= -1,0Swt%E f 2S�rt� oi• 13/20Wilf COMiA^^)'vR L_ L/ -fo %REACfI Sl(,11 ^i7 Si1+�1 Laye2 AND Z3 Ftef °4 Einf'y unu £IeVff�ioli OF' 14c. fig%+- l4jvi�t/•t. %} � ,J -AAAI -%ISG SIEVRfieN o F f�G SePfiG SYSftMi ND Tl�AT *e ScP�:c sYsfE� '^1fJic •(o /}OvE�+-✓^lvv , �l,c ��{lutn/� TO�JAAA$ THE cVELL'. W:gTs►� nm /Vi7T✓2ATES TN�ti�rfE 7he4.0 cs i3 NefEa;w �.J. (r rr 81 c 31 — S _ `f •8 Soie- SQKBTFO4 _YS � 8z � z•39 — �/'Z b; I 8 ASs�M� f0'�SCIZ.✓kTIJ� (�/o 9B tz = '� :;js qg C2+(? 3�z5 I L6"ic�"S�oN 4C7n4"rffcl .F_b; nl TS _(•Z Z - 7:1- �•ct f -r 4-A ALASKA WATER ErWASTEwA rt:l<z CONSULTANTS, INC. Revised March 27, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request and Health Authority Approval for Lot 3, Block 1; Bruin Park Subdivision To whom it may concern: WELL WAIVER REQUESTS: The existing 3 bedroom house is served by a private well and septic system. The well was drilled on 7/20/1970. The septic system consists of 1000 gallon septic tank and a trench type drainfield that was installed on 9/10/1975. We recently performed a well flow test and a septic adequacy test on the property. All separation distances were found to be adequate except for the separation distance from the well to the drainfield. On 3/7/2003, we measured a separation distance of 99.7 feet from the edge of the well to edge of the sump for the drainfield using a Topcon total station. In the past this sloped distance had been measured with a rage tape to b 100'+. We request a 98 feet separation distance waiver be granted from the well to any portion of the drainfield. Our reasons to justify the approval of the waiver areas follows. • The contour of the land should not allow flow over the surface from the septic system directly to the wellhead if the drainfield were to overflow. The location of the sump is in a very open area, and the problem would be noticed and resolved immediately if the effluent from the septic system were to ever flow on the surface. The other path of contamination is subsurface migration wastewater. As can be seen on the attached well logs, there is approximately 30-70 feet of silty, clays soil above the aquifer that have served to inhibit the migration of untreated wastewater into the aquifer. Recent water samples from the well were taken and the results indicated non-detectable nitrate levels, and no bacteria. This separation distance encroachment has existed for approximately 19 years and as can be seen from the attached water samples, the aquifer has not been adversely affected. Based upon the aforementioned facts, it appears that there is minimal risk associated with the granting 6901 Debarr Road, Suite 2B " Anchorage, AK 99504 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: akwwc.com of this separation distance waiver. We also request that your department issue a Health Authority Approval. If you have any Oestions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com YNVY� ON 6 ^Z H Om f[�el�i>�ii4an.7Lr1.: BRUIN PARKC S/D EXISTING TRENCH THAT IS \\ 3.5 FEET WIDE BY 61 FEET LONG WITH 5.5 FEET OF EFFECTIVE \ \ J FEET WM — - (SEE WAIVER 0 w a- 0 w 0 Z LLI EC 0 M I I EXISTING ' WELL / LOT 4, BLOCK 1: I / BRUIN PARK S/D / � I � ' DATE: 3/14/2003 Qo6�0 4 •�"I' CP\-•' " •• ••• • �Op DRAWN BY: J.L.M. �:' •' 't ALASKA WATER & WASTEWATER ... 4 SCALE: CONSULTANTS,INC. 1" = 40' ""' AOM DFpAW FOA(}, SUITF 7p • ANr.0QA6F AK OOSOG • PNnNF 0 • (OOASp.516n VALE NUMBER: REPARED FOR: TODD KELSEY NU R: PHONE NUMBER: PHONE 743-9313 1 OF 1 ff OQ4°pr •' �0'�e .. •••• •..,,,,,, y . G m s: C 795 . ' A EGAL DESCRIPTION: LOT 3, BLOCK 1; BRUIN PARK SUBDIVISION .....••' deo O Q� profsssTOWar' YPE OF WORK: DETAIL DRAWING OF WAIVER REQUEST 3- 7-03; 3:06PM; /l !! ME Environmental Services Inc. CT&E ReER 1031126001 Client Name AK Water & Wastewater Consultants Inc. Project Name/B Bruin Park L3 B 1 Client Sample ID Bruin Park L3 BI btatria Drinking Water Sample Remarks: :907 58,5301 0 2/ 3 All Dates/rimes are Alaska Standard Time Printed Datefrime 03/06/2003 16:45 Collected Daterrime 03/03/2003 16:00 Received Datdrime 03/03/2003 16:18 Tecbaical Director rr�// Ste Ede Ede Released BY,,,� Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 0.200 U 0,200 mg/L EPA 300.0 Microbiology Laboratory Total Coliform 0 coV100mL SM189222D P LL 03/04/03 3S 03/03/03 KAP Parcel I.D. # _ MUNICIPALITYANCHORAGE • DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services as On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING , 016-101-10 HAA# E` L)doJ 1. GENERAL INFORMATION Complete legal description tot 3; Riock 1; x ,lin Pak slhdivigion Location (site address or directions) 10841 Forest Drive Anchorage, AK Property owner Kim & Linda Cresap Day phone 349-1277 Mailing address 10841 Forest Drive Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(A..1/91) Fro MOA921 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 spection. Alaska Water & Wastawater Name of Firm Q'"9111[tsr+tAk I-4!1 Phone -337—&/7c) Address 7320 Engineer's signature ALASKA WATER & WASTEWATER, INC IS TO BE PAID#l2./•25 AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE _2L Approved for Disapproved. Conditional approval for Additional Comments By: bedrooms. UlTIr — Date I u/moi 7 v ...... i "7 .c it A"Gainesi E.7953 ftcESSO bedrooms, with the following stipulations: 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. nms Mw, V91) a•k #AOAm • Municipality of Anchorage OCT o 5 X98' DEPARTMENT OF HEALTH & HUMAN SERVICES,,,,r,%.,rAuIY OF AN Environmental Services Division ^ONMEWAL SLR 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LO/ 3 8/0c4- / A&j;1 /dfk Parcel I.D.: 0/6 -!D/ -fid A. WELL DATA Well type Pry va 1e� It A, B. or C, attach ADEC letter. ADEC water system number !! Log presantoIN) Date completed i1 Total depth t6170 Cased to 5/3 Casing height (above ground).�/o t Sanitary seal (YM) �eS Wires property protected gOjN) T— FROM WELL LOG AT INSPECTION Date of test 9B Static water level 4 25 • X 2$ , Well production % g.p.m. '� 2-10 g.p.m. #-sn/orr+whbq p.odided A4r.tAMi e,clsfrn.y 1184 t4xiI orlt'y and not WATER SAMPLE RE LTS: 41- (�; Q6is{,n9 l97 lutrad dug Ws7l• Coliform Nitrate . 14 Q Other bacteria 2 Date of sample: 913068 Collected by: kdsL &c ia, 6rrs.1464 B. SEPTIC/HOLDING TANK DATA Date installed /ZO� 75. Tank size /DOa Number of Compartments / ' Cleanouts@l N)�_ Foundation cieanotA&N) \IES Depression (Y®A_ HighAwater alarm (Y4g of A Date of Pumping 10-111-97 Pumper Pwrb -rrnte.rr 12-00 r.*,tL e-5 puA1PwO Pry Remo— t2ooTF. lL . ' C. ABSORPTION FIELD DATA 1,25- SF/ea �,, 7f¢t')G LL Date installed — /10 75 Soli rating (g.p.dJftr or ft'/bdrm)pt,o,,I System type — rl Length 18 S : L! Width S - b Gravel thickness below pipe 5 Total depth - 9 Mie" �.. 0j sump Effective absorption area %/0 5 Monitoring Tube present &N)Depression over field (Ye -ALQ_ Date of adequacy test 91!Y 98 Resulta�as /Fail) For 4h re bedrooms u Fluid depth in absorption field before test (In.); 1 •1 Immediately atter 717'sgal. water added (in.): 019 Fluid depth /A - 5 0 (Ins) Minutes later: I aOQ Absorption rate = q50 + Peroodde treatment (past 12 months) (Y& If yes, give date YI�GL 72.026 (Rev. 3186)• G lc kcl rose, o Y,," a4f4w t/(., fait 652 94110►►s rrarr� were pdbsd to tire- C posh +an K. dva ) ICQehFreld . ('rank WaS -'ulI ,r,iiouSC was otctlp" JUrrn9'tLst a Ouernw;h+) D. LIFT STATION Date installed / Size in gallons Manhole/Access (Y/N) "Pump on" leve `Pump off' level at" High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES (D Iqg`4 s 2 pre 1975 handdu.9 43cll ioultecl l+i�l�•'"- SEPARATION DISTANCES FROM WELL ONLOTTO: uVil house.- drst'nnccs aK 4ppto,1,"LtL SeptirJholding,tank on lot 1 OO t 9b 85 ± On adjacent lotsm l00 +- 1s) 100�� Absorption field on lot Q 100 t7 9S r = On adjacent lotsd I"lb i 10014 - Public sewer main Public sewer manhole/cleanout WA r Sewer /septic service line .Z rr1 4- Lit station Ali SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: JG Foundation 10 rt Propertyline 5 t Absorptionfielddt Ci 1h5ped6n report 'Water main/service line 16 + Surface wateddrainage 166,f*' Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I P.t' gui�ngfoundation 1Qr+- Water main/service line 10 f Surface water 1 nn r a' Driveway, parkingNshicle storage area I O f Curtain drain Alone— kAnwri Wells on adjacent lots _ 1 D0 r+ F. ENGINEER'S CERTIFICATION f =` tilott 4renoi7 Wlddl an InSpecildn repCt=t, ee af4aehed as- ur'14- h LLLa_n, �e-cl-► I colo that 1 d to d Inspections and review o Municipal recd Q ems are in conlo will H s in effect on this date. i OF Signature or Engineer'd Name r'�aS r IF Date / 0 A /9 � ••• •••• e C 7953 HAA Fee $ " Waiver Fee S Date of Payment /0. Date of Payment / 0 Receipt Number G-�7 ! Receipt Number r 72-026 (Rev. 3/98)' .� .� AltmieipaUty of Alehorage i 1 Department of Health and Human Services 825 "L" Street Rick hlystrom. P.O. Box 196650 Anchorage, Alaska 99519.6650 Mayor hitp:?www. ci.anc horage. ak. us October 15, 1998 Jeffrey Garness, P.E. Alaska Water S Wastewater Consultants, Inc. 7320 East Chester Heights Circle Anchorage, Alaska 99504 Subject: Waiver Request for Lot 3 Block 1 Bruin Park Subdivision Waiver Request #WR980072, PID #016-101-10, RA980340 Dear Mr. Garness: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 3 feet from the absorption field to the north property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. r&lncerely, I Daniel J. Roth Civil Engineer On-site Services ljw #7 zowlaatl MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Wiiver Review Worksheet WR# 980072 PID# 016-101-10 HA# 9An34n Permit # Date Received: 10-5-98 Legal Description: Bruin Park Lot 3, Block 1 Engineer: Jeffrey Garness P.E. Alaska WAter & Wastewater Consultants, INc. 7320 East Chester Heights Circle ANchora¢e Ak 99504 Applicant: Kim 6 Linda Cresan Waiver Requested: 3 feet from the absorption field to the north nropprty lino_ Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: :[rtr EyG1Wfdre 'S G 0-e fl6R OF Tu STie�icEY rrs.� DATED p -3d —yB Date: /D — /f—yg By: 0,#Al Name of Reviewer Rec #: 04227/5891 Amount: $ 115.00 Date Paid: 10-5-98 QRSE2Uco CONC, CAP F�u�t bu1714 wEz« FLo (L. lqwwe Ay I AnPFeir c QC nr!-eA,A.fa Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 September 30, 1998 Municipality of Anchorage Department of Health & Human Services P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 3; Block 1; Bruin Park Subdivision Property line waiver request Request you issue a three foot property line waiver from the absorption field on the referenced property to the north property line. We do not anticipate any adverse effects to the neighboring property with the issuance of this waiver. The well on Lot 2 (north of the subject lot) is located on the opposite side of the lot (near the northeast property line between Lot 1 and Lot 2) If you require additiAal information, please contact us. .E., M.S. JAG/gk O9 29-19% 0:t34Fm FROM LCR14VfY 10 97-'=2=6 P.01 09 C y G• 1 SEP -30-9B 09:53 AM ROTO+ROOTER 907 347 8264 P.02 INVOICE 006? ¢200V 92 SEWER AND DRAIN 1' I M "Ally ga '% & dkaCLEANING SERVICE Veu! die [ y �"'w- P.O BC% 112E88 PHONE 345@513 ANCHORAGC. AJASKAM11.2598 (LIQ a Gr ` P -] 0:.20 IU 8` 1 For est d r LAnchPr00e AK q95/6 _j u:30 JOD ACOTSS DATE Y•.[5'.n4 0-14 97 ��ohn T w9 NDMS Gw lwwu•w '- • �.sa # 1►,, �f IGe (• R0T0-000'EA SCRVICC CALL HRS. STEAL' TT+AW NG - HPG. TPIDCHAR3C HPG 4D OVERTIVF CHAROC . HFS. ADDITIONA_ LA70R C`IATIGE HAS. 1 PUMPING SERVICE I7 hh LGAL 11RS O I-YDPO-JETSERVICE _ Hr.S. 1 -' TVCAMERAINSPCCTON HAS. ` �+ MATCRIALS &QckLQ E -r yWle -- Qo—`.1 PLEASE, MY I•HCIA,TtkI "O'CC_ TOTAL, 95. QO TOLIL FOOTAGE CLEANEOORTIIAWED 1 BLADES USED____ PRCEAB:E CAUS7- OF STOP?AGC A LINE CLEANEC„__ . _. __._......... _. ❑JOB NOT GUARANFEED FOHFOLLOWNGSEASON _ .-_...._...... WCHw,AOCFPTFOSr ••__ OCT -02-1998 15105 ME ESI EUCHORROE /1'L CT4E Environmental 9ervlces Inc. 9075e1533-1 P.OS/M CT&E Rd.1r 985681001 CBent POA Printed DatelTime 10.OZ/98 09:59 CNent Tame AK Water &Wastewater Consultants Inc. Counted pateMroe 0913OJ98 11:45 Project NamelO B uln Pari•. Lot 3 Blk 1 Received DRUM= 09/30158 12:20 Client Samplo ID B uln Patk, Lot 3. Blk 1 Technical DLretton Stephen C. Fdc Distrix Drinking Water Ordered By 0 Released By PWSW ample pcmark3,. Atlovable Prep laalytis Pa>e+eter aeAutts PM Units Nethod Limits Data Date init letet Cblltbna 2 04/170 NL, NO CCLI LN1s 92273 09/30/93 EAP Nttrata-N 0.149 0.4.00 WL EPA 737.0 10 wax 09/30/93 09/33190 CCP (1' — 34'I- Trorr. (b) Applicants Name $RADFdRP CyyK Telephone - Home Business Applicants Address -7.0. j6oy, I l o 6g. C, LAW ArY 92511 (c) Applicant is (check one) Lending Institution ; Owner/bis Buyer E__1 ; Other E:::l (explain); (d) Lending Institution A LA5r-A SANK or 4 i4L:-: 14O2T^N Telephone ,2%%- LIS 8 I Address 2501 "C" STRkF_T A44-i.f�gT�JH�tW QLD i Vl✓f (e) Real Estate Co. b Agent RF -MAA REAL?`! SE`1toR 'REF1M Address I010- .E P11 -'.ANO Telephone ;2.2- 10,7-0 (f) Mail the HAA to the following address: 2. Type of Residence Single -Family [Z] Multi -Family Number of Bedrooms 3. Water Supply - Individual Well [M Community Other Sdescribe) r Public Q 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 1:91 Public [::I - Community E= 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 21 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Date *?to 1. General Information Application (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 3 Zkl -62O1 N TIA2K SEC P..o T 12WR_57t& Location (address or directions) _ _ „� — 34'I- Trorr. (b) Applicants Name $RADFdRP CyyK Telephone - Home Business Applicants Address -7.0. j6oy, I l o 6g. C, LAW ArY 92511 (c) Applicant is (check one) Lending Institution ; Owner/bis Buyer E__1 ; Other E:::l (explain); (d) Lending Institution A LA5r-A SANK or 4 i4L:-: 14O2T^N Telephone ,2%%- LIS 8 I Address 2501 "C" STRkF_T A44-i.f�gT�JH�tW QLD i Vl✓f (e) Real Estate Co. b Agent RF -MAA REAL?`! SE`1toR 'REF1M Address I010- .E P11 -'.ANO Telephone ;2.2- 10,7-0 (f) Mail the HAA to the following address: 2. Type of Residence Single -Family [Z] Multi -Family Number of Bedrooms 3. Water Supply - Individual Well [M Community Other Sdescribe) r Public Q 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 1:91 Public [::I - Community E= 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 21 5. Engineering Firm Providing Inspections Testa 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 -sits 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 regula- tions in effect on the date of this inspection. Name of Firm ; 6- a vA SDJ fIe-1AJ4S pE TelephoneP_79-341•b Add Date 6. DHEP Approval /5!-4 Approved for : _ bedrooms (ENGINEER SEAL) By OF At %Ili �!* 40TH ••9 . tJ 2225•E 1 lE 2S, 19]1 ., . �•i ,+lD�t€ iriEaC\� 7 a 7 PY Approved 7><—' Disapproved Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF D11EP 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. (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-19-84 M WCIP^y OF ANCHORAGE • DEM.. OF HEALTH 6 EMRRONMENTAL PROTECTION MUNICIPALITY OF ANCHDRAGE (MOA) HEALTH AU!lWRITY APPROVAL (HO L 2 71,98A CHECKLIST - FEBRUARY 198¢CE C E I V E D A. WELL DATA Legal Description: �? �ff.��wl T>AfAV CCr 9!1 Well Classification Res;c%N,14'.r/ If A, B, or C, D.E.C. Well Log Present (Y/N) Y Date Completed Total Depth Cased to Approved(Y/N) n�i-• Yield Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) V Depression Around Wellhead (YM) Separation Distances from Well: To Septic/Holding Tank on Lot 14013 ; On Adjoining Lots 100 { To Nearest Edge of Absorption Field on Lot L2_1 ; on Adjoining Lots l00 To Nearest Public Sewer Line hI/Ar To Nearest Public Sewer Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot N h Water Sample Collected By i� S Date 25��1/ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 5.e 1975; size Itxsea No. of Compartmenis I Standpipes (Y/N) Y Air -tight Caps (YIN) Foundation Cleanout (Y/1N) Depression over Tank (Y/N) hi Date Last Pumped 7l/8Al4/ Pumping/Maintenance Contract on File (Y/N) N/A. for Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) WIA Separation Distances from Septic/Holding Tank: To Water -Supply Well 10 I To Building Foundation tip To Property Line .2 3 To Disposal Field 1 To Water Main/Service Line M/p To Stream, Pond, Lake, or Major Drainage Course N/A Comments [Page 1 of 21 2-15-84 r C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1:2r% Type of System Design TiQEn c 4 Date Installed 91101-7s- Length of Field g (o Width of Field (yNDepth of Field_, cs / �- g Gravel Bed Thickness 6 F Square Feet of Absorption Area ti /. p Standpipes Present (YIN) Y Depression over Field (Y/N) N Date of Last Adequacy Hest -71/ 6 /8 y Results of Last Adequacy ZBst Separation Distance from Absorption Field - To Water -Supply Viell 101 To Property Line 3 To Building Foundation ! A To Existing or Abandoned System on Lot N/A' = on Adjoining Tots -3 t7 + To Water Main/Service Line_ To Cutbank(if present) y g To Stream/Pond/fake/or Major Drainage Course j�fi4 To Driveway, Parking Area, or Vehicle Storage Area B Coments D. LIFT STATION . Date Installed Jit Dimensions Size in Gallons "Pump On" Level at Manhole/Access _(Y/N) "Rump Off" Level at High Water Alarm Level at Vent (YIN) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(YM) Coments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have chocked, verified, cc conformed to all MDA HAA Guidelines in effect on the date of this inspection. / �/ Signed . S 7 Date �1! 7 crnQanl+ S ✓k t MOA No. f i i -D t KBl/d5/s (Page 2 of 21 *: •may ..49T -t t RS r a' 2225-E L AG•,• NE 25.1971 2-15-84 W. 15th 203 4©e ° Lia SPMG3G3 ANDA P01 0 NCHORAGE,VALASKA1T99501 CONSULTING ENGINEER TELEPHONE: (907) 279.3916 SAYLOR REHM REMAX REALTY 1000 E DIMOND ANCHORAGE, ALASKA 99502 S E P T I C S Y S T E M A D E Q U A C Y - - - - - - - - - - - - - - - - - - - - LEGAL Lot 3, Block 1, Bruin Park LOCATION On Forest Drive Off O'Malley OWNER Bradford Cook RESIDENCE Single Family, Three Bedrooms JULY 19,1984 T E S T WATER SYSTEM On Site Well SEPTIC SYSTEM FROM MUNICIPAL RECORDS: TANK:1000 gal. Greer Steel ABSORPTION SYSTEM:Deep trench,61 feet long, 5 feet of rock ABSORPTION AREA:610 sq.ft. SOIL RATING: 125 INSTALLATION DATE:September 10, 1975 DATE OF TEST 7/18/84 TEST PROCEDURE Drainfield was charged with water at a steady flow of 5 gpm. A total of 450 gallons of water was added to the trench. Both the tank and the standpies were monitored. No rise in water level was observed in either tank or drainfield. Since the system had been in ordinary use up to the time of the test and since no distress was observed during the charging of the trench, this system is considered adequate for this residence.The tank was pumped on July 18 1984. F T This system meets the requirements of the ��e�•••"• QS�Ii Municipality of Anchorage as of the day the .yi system was tested. There is no quarantee that *:4 1.141 i� the system will continue to meet these requi- �• ••• •/ rements. The operational life of all septic /,•, .,.� system depends on the local soil conditions, ' - 2 "- E groundwater levels that may fluctuate during the year, and the water usage of the family �` being served by the system. P. >J—S'z— .. APPLI(`NT FILLS OUT UPPER HAS ONLY Properly Owner /�d>rp� Phone //C�k A� �n A)c 1 Zip Code 1/ j3w-w(a Mailing Address r .box (o-IDz& Date Buyer N fA r Inspector Address / U ' 21D Code /� Lending Institution QAC)j1,5)e NoRr&i(6E- Phone) ` Field Notes: 274-0005, Address Zip Code Hzo• Realty Co. d Agent /j/z r 'r h c -uL- Phone Address Zip Code /�^ Legal Description L I �"r 3 �j�fU�N M R k Street Location DATE Tyf Residence BY: SIngle Family 3 Solis Rating Multiple Family No. of Bedroom Well To Absorption Area Com, p ( ❑ Other Septic Tank Size tip 0 ' r o Water Supply Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. O Community For wells drilled prior to that date, give well depth (attach log 11 available). ❑ Public Utility Sewer Disposal Q 7 (D Y ^!U —7 S • Individual Year Individual Installed: —c /❑ Public Utility When Connected to Public Utility: 0 Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time (r 1 Time Tim Time e ✓LC � 0 Date Date Date Inspector Inspector Inspector Inspector 1S Field Notes: Ct( W°J�j NC, 4\da-% e7v. ea kKOA.C.- Hzo• h c -uL- (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' S — ff DATE BY: Solis Rating Date Sewer Installed Well To Absorption Area Com, p ( Well Lop Received Nit b- Septic Tank Size tip 0 ' r o 1? :5-/ — (C> -'?5- Well to Tank : () I C rtaza r>en -'�ELOU� M GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 10 "C" Street, Anchorage, Alaska 99503 274-4561 .Vk Date Received y= %�r Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF J�Y INDIVIDUAL SEWER & WATER FACILITIES FOR fi _ 7% rig 217 ( ll 1. Approval requested by: fLo"si 0Z -01e. W. Q"P Mailing- Address: Phone: 2. Property Owner: 1,di/1PAom t0 YNE Phone: �7Z-3tiC�s'/ Mailing Address: /� //�� 3. Legal Description: 1,/Jy S .elecA / ,BlIU�.rJ /.(/,et 4. Location: 5. Type of facility to be inspected S,'!FD No. of bedrooms 6. Well Data: (1 _ A. Type +t ►B. D th C. Construction — D: Bacterial Analysis 1 — 7. Sewage Disposal Syst — A. Installed + 9�i ° L7f B. Instal ler C. Septic Tank: 1. Size, 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material', k E. Disposal Field: Total length of lines 8. Distances: A. Well to: .Septic tank t Absorption area 9 0 Sewer Lines Nearest lot line 5 , Other contamination B. Foundation to septic tank 3 L/ Absorption area C. Absorption area to nearest lot line 5 EQ -034 (1/74) Page 1 of two pages A el X971 ,i/- : ;'•'•'.GREATER ANCHORAGE' ARE:. BOROUGH \, Dcpart^ent of Environr:ntal Ouality • +:a�'.. 3330 St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER A 'WATER FACILITIES 1. Type of Inspection: CiIRO VA xxx FHA CONV WILLIAM F. PAYNE , 2. Property Owner: c o as a Generators Mailing Address 100 E. International Airport Rd Day Phone 3. lune of Buyer: BRADFORD GABLE COOK (tailing Address: 905 Muldoon Road Day Phone 333-4955 Mogge Company.a rt 4. dame of Lending Institution: Coast . P.O. Box 1200, Anch., Ak. Phone 279-0665 Mailing Address: 5. Name of Realtor or Agent: SYNDIC REALTY 206 E. Fireweed Lane; Anch phone 274-8536 Mailing Address: Lot 3- Block 1, Bruin Park 6. Legal Description: Location: NHN Polar Drive; Anchorage, Alaska -- 7. .Type of Facility to be inspected: � Bdrms. 3 _ 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of ::all 9. Sewage Disposal -System Type.of System: Public Utility Individual (on-site) If Individual, date of installation ge 2 of•two pages - R""it for Approval of Individual '�+r & Water Facilities Legal Description C / Approved Disapproved Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM G ✓Y ��a.t• Z �, 7 �n� /��i.t d rt" k. iu r' �tI.r \ Q°V'),.- I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date Lot 3, Block 1, Bruin Park S/D August 22, 1975 Property was inspected for loan approval today. The following items were noted: o. The top of the crib in the seepage pit was exposed. Measurement showed the top of the crib to be at the 6 foot level. Cast iron pipe was leading out of the crib. The cleanout on the crib needs an air -tight cap. 2. Measurement to the well from the crib (not the pit wall) showed it to be approximately 86'. �) /3.1 The well is apparently a dug well as no casing could L/ be found. It is located in a block well house (see attached drawing). The seller indicates the depth to be 15', and that it is a flowing artesian well. No evidence could be found to verify this item. 4. A water sample was taken; the water from the tap had a definite odor. ^� 5. Inasmuch as the crib must be at the 12 foot level, a l" soil test is recommended to determine the true ground water level. The seller says the well is 15', so there is a good likelihood of a high water table. 6. The lots on either side of this property are vacant. 7. The lot slopes toward the road from the existing crib and also towards the well from the crib. There is no septic tank on the property. 9 The soil in the excavation above the crib is very silty, SEO and no evidence of gravel backfill was observed. C6��D'�K U1'1 8�'1-0 k"' r ax 1 ale m SOD' w2�e2 �q! roda-�-- ol 1 1 1 � I F-029 - 7S �07/- g lg-e� l r"� esu -auk 7� e4:A G 03 7Ae-,Z �ji 00 tom= 't4r_ / 1 'ok miA f9e JA a+/,3 0 Ne4LScp°E�-NTs Aieg io 4-6SfrNo p PC6 /; oo pm pr;o�. Fa SA&Wd C7,tt j 5 ' C 6 4Q EDGE o r �,��mcu, (f,<t J3 L 1� V-. WJD Ura l DOC) gial"