HomeMy WebLinkAboutTONJESS ESTATES BLK 1 LT 4Tonjess
Estates
Block 1
Lot 4
#051-831-14
Municipality of Anchorage Page / of .7—
DEPARTMENT
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: —Ste./ovD a's 3' PID Number: /l rS-/ — 7-9r
Name:
" , r
Wastewater System: O New O Upgrade
Address:
ABSORPTION FIELD
Phone: No. of Bedrooms:
7
O Deep Trench O Shallow Trench O Bed O Mound 00 r
LEGAL DESCRIPTION
Soil Rating:
Total Depth fromOrigin ride:
GPD/S Ft.
Lot: Block: Subdivlelon:
Depth to pipe bosom from original grade:
Gravel dept neath pipe
Township: Range:Section:
Fill added above original grade:
Uwell length:
WELL: O New p Upgrade
Gravel depth:Number
Ft.
of lines: Distance between lines
Ft.
Ft.
Classification (Private. A.B.C): Total Depth: Cased T '
Total absorption a:
Pipe material:
FL
SO. Ff.
Driller. nlled: Static water L"'.
Instal
Date Installed:
Ft.
Yield:
Pump Set at:
Casing Height Above Ground:
GPM
Ft.
Ft.
TANK
SEPARATION DISTANCES
p'Septic C1 Holding 0S.T.E.P.
To
From
S"tic
Abwpllon un Holding btic/Private
Manufacturer.
Cspecify In gallons:
Tank
Field Station Tank Sower unaa
r
wellMaterial:
Number of Compartments:
wateB
>ivo'
LIFT STATION
Lot
Line
fS
Size In gallons:
Manufacturer.
—
Foundation"Pump
on" level at:
'Pump oil'• lav
High water alarm at:
unai
ODail rla
i3o
Pump Make & M
Electrical Inspections performed by
Remarks: +' Novi
BENCH MARK
Location and Description:
P.-A .r .iii '
r.e•'7 F ri
Assumed Elevation:
ENG EAL
Inspections performed by: -e*7-f-r S. Dates: ist 4114 tl
2nd
t Rw000 J
Department of Health and Human Services approval
'•• CE:ME
Reviewed and approved by:4" — 1L ,+� �2 Date: YlB[a/
Wore mm� una x
Permit No. SW040338
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: TONJESS ESTATES, BLK 1. LT 4 PID No.: 051-831-14
SWING TIES
C 1 26.3' 7.4'
a
l
C
SCALE 1' - 60'
®
— TEST HOLE
•
— MONITOR TUBE
a
— SEWER CLEAN OUT
fi
— WELL
— EASEMENT
— — —
— LEACH FIELD
0
— DRIVEWAY
ELEVATIONS
(NOT TO SCALE)
/l BOTTOM Or VERTICAL TRIM
V ASSUMED ELEV •100.0'
N64,
Q
z
Z
N89'59'52V 249.97'
SEPTIC TANK REPLACEMENT ONLY
4'
NEW 1,000 94.2
GAL TANK
8/23/04
ENGINEER'S SEAL
A���04
..........., q`s4p0
�•
............. .. Y.Y.L
CHRISTOPHER WOOD
CE -10387
��n :; _ ..... '0
MUNICIPALITY OFANCHORAGE ! "
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO40338
Legal Description:.TONJESS ESTATES BLK 1 LT 4'
Design Engineer: 0848 Eagle River Engineering Services
Owner Name: BRIGGHAM & SARA CHILDRESS
Owner Address: 24996 SCHAFF DRIVE
CHUGIAK , AK 99567 -
Date Issued: Aug 12, 2004
Expiration Date: Aug 12, 2005
Parcel ID: 051-831-14
Site Address: 024996 SCHAFF DR
Lot Size: 47828 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
the septic tank must be located no less than the separation distances required by 18 AAC 72 from water supply wells.
Received
Y Date:
09/03/03 11:27 FAX 9073439437 NOA LAND•USE ENFORCEMENT
Municipality of Anchorage
• -� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.d.anchoragemk.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
121 001
Parcel I.D. 1004 t951 13 114 Permit Number SW
Propertyowners) 13IM96:14AM 4- S!&RA GH CDMESS Dayphone
Mailing address (1) 2 g496 5'a4i r" aR.
Mailing address (2) G K tt &rA4 ALK R9 " j zip Code `185'6 �
Legal description (Lot, Block & SuWd.) TLWJ' 5S i'S/- BI L 4
Legal description (Section, Township & Range) mc—e-
Lot Size 14y; $n A 16Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only, ❑
Sewer and Well Water Storage ❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑, Water Softening Unit Q/
Therapy Pool ❑
1 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: 'q&0
Waiver Fees:
Date of Payment Date of Payment:
,ppttNumber. 5W3Pte') Receipt Number
Eagle River Engineering Services
Christopher R. Wood, PX.
10421 VFW Road Suite 201 (907) 694-5195 tel
Eagle River, AK 99577 (907) 6943297 fax
August 12, 2004
Dan Roth
Manager, On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Tonjess Estates Lot 4 Block 1
Narrative & Permit Application
Dear Mr. Roth:
The septic tank on the above lot has collapsed and is creating an imminent public health risk.
Please expedite review and approval of this permit.
The proposed septic tank replacement will have very limited impact on adjacent properties for
the following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance, and wells +100'.
3. This permit is for replacement of the septic tank only.
4. Drainage will not be affected and is not a major consideration in our design.
The existing septic tank has collapsed and needs to be replaced immediately. A new foundation
cleanout and double alter -tank cleanouts will be installed.
This work will not affect the reserve area on adjacent lots. If you have any questions please call
our office at 694-5195.
Sincerely,
EAGLE RIVER ENGINEE� YG ERVICES
Christopher R. Wood, P.E.
Principal
M03\04-076SEPTICNARRATI VE.DOC
: EAGLE RIVER ENGINEERING -
10421 VFW Rd., Suite 201
Eagle River, Alaska 99577
(907) 694-5195
Fax (907) 694.3297
of 3 i.
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M#CSTOPlIERRWOOD
CE-1M OA4414
i ss�oN►L '
Eagle River Engineering ,Services
Christopher R. Wood, P.
10421 VFW Rd. Suite 201 (907) 694-5195 tel
Eagle River, AK 99577 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC TANK
LEGAL: Tonjess Estates Block 1 Lot 4
August 12, 2004
A. GENERAL
1. The septic plan is for a 3 bedroom single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of health and State Department
of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi -family wells and to verify that all well separation distances have been met.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. Any remaining open test hole excavations shall be filled and monitor tube removed.
B. SEPTIC TANK
1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade maximum — 1% minimum
and insulated with 2" of burial foam if shallower than 3 ft., with 2 fl. minimum.
2. Septic Tank shall be a minimum of 1,000 gallon tank of MOA approved construction, insulated, or
place with 4' of soil cover, min.
3. A new foundation cleanout and two opposing aflcr tank cicanouts shall be installed.
Twenty-four (24) hours notice required for all inspections.
1\Ercs\DOCS\WPDOCS12004W4-074tankonly- spcc.doc
n MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
y ENVIRONMENTAL ENGINEERING DIVISION
\ 825 L Street. Anchorage, Alaska 99501 Telephone 2644720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
H N
u ^� it694r-Y4
NEW
❑UPGRADE
MAILINGiADDRESS
P.O. Ciox 8 A -F t
LEGAL DESCRIPTION
LY R t -rvN act- fes Slims
r.,s
LOCATION
NO. OF BEDROOMS
DIt
Well
DISTANCE TO: IOC Atisorpuonar`O
OweWnp6
PERMITTNO.
13 Z !3$
2
�F
w
Manulxtur•r
Gtwe `r
MstMials
No. of compartments ,L
LW. capacity In Gallons
O r+0
IF HOMEMADE:
Inside length
.--�
Width
Liquidde pt -
6p
DISTANCE TO:
VII
Dwelling
PERMIT NO.
Y z H
Manulxtunr
Material
Liquid Capacity in pal Ions
D
w=
DISTANCETO:
Visit
? Ito
oundalton
($'
Nearest lot line s
PERMIT N
„Ws w Z
No, of Innes
7
Length or each Un•
7
Total length of lines
Trench width
Z I1
Despots betvw•n lion
t=z ¢
3
'A7
3 p Incites
Ir H
U
opo lila to wish grade
terra beneath tile
(f8
oil ell Ktiveabwrpt�on area
Inches
42-9 6 in
W
Length
Width
Depth
PEHMIT NO.
b
`s
W
Type of crib
Cribdtamtttr
Gib depth
Total eflectrre absorption area
w
DISTANCETO:
VII
Building foundation
Nearest lot fine
Class
Depth
Driller
Distance to lot line
PEHMIT Na
.Jin
$
Building foundation
Sewer line
Septic
DISTANCE TO: I
tank
Absorptionaruld
OTHER
PIPE MATERIALS
I'
G C
SOIL TEST RATING
INSTALLER
O
S u o ILT Co N
/
REMARKS
CI
N
e
r
O
•
3
'
r
APPHOVEO DATE LEGAL
/L•3'$L LS�a 6 (� ToA+Jess FSlre..�cs Sip
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS e 3 SOIL RATING CSO FT/BR)= 90
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 8 L_ENC3TH= 34 IMRFI'wEL OEPTH� 4
THE LENGTH DIMENSION IS THE LENGTH CIN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
FZECMUIREO SEPTIC TFat.IK SIZES :1-000 ORL-L_ONS
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 <2> I NSPECT I ONS FIRE REGU I ME:D -----
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY OF4-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.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMU14ITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F ->MMM I T EXP I RES D>ECEMEER x..982
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS A14D WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED
O INCLUDC•MORE THAN 3 BEDROOMS.
SIGNED:
ISSUED
T SHORT CONST
e,z§�,
V4. 0
IIIS[
MUN I C I 1 aL_ I TY OF= ANCH^RFiGE
c7ti. 11' i &.
•
DEPARTMENT OF HEALTH
AND ENVIRONMENTAL PROTECTION
L
•
y 825 'L' STREET.
ANCHORAGE, AK. 99501
•
264-4720
11:00
OPV-s=TE
SELdER PERMIT
nim- waa•F
PERMIT NO.
C 821138 >
K
RPPLICANT
SHORT CONST
PO BOX 8 -AE 99503
694-4994
•OCRTION
:EGAL
L4B1 TONJESS
LOT SIZE 999999
SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS e 3 SOIL RATING CSO FT/BR)= 90
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 8 L_ENC3TH= 34 IMRFI'wEL OEPTH� 4
THE LENGTH DIMENSION IS THE LENGTH CIN FEET> OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
FZECMUIREO SEPTIC TFat.IK SIZES :1-000 ORL-L_ONS
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 <2> I NSPECT I ONS FIRE REGU I ME:D -----
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY OF4-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.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMU14ITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F ->MMM I T EXP I RES D>ECEMEER x..982
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS A14D WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED
O INCLUDC•MORE THAN 3 BEDROOMS.
SIGNED:
ISSUED
T SHORT CONST
e,z§�,
V4. 0
i ' @ SOILS LOG
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION IO PERCOLATION
825 L. Street. Amhara". Alaska 99501 2644T20 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �Gr l ( nd ko df -ch DATE PERFORMED: /O—.2r-62
LEGAL
Pt
2mMH
►-0�
-IRRJ G11
9 lar er fobIl-f
10
11
12
13
14
SLOPE
9
13o f1'
7fedrCCIWASGROUNDWATER _ N�
ENCOUNTERED?
Fil
5
IF YES. AT WHAT
DEPTH?
ii •�fi.'ir a.i{II Nn�e ��u�
11
1i
y
Reading
Date
. •r
15
Depth to
Water
�d�'
tH20
^���NSMjOIId
16
r
2.1�roM •�aI
i.,r
17
r� .Pial 7 Aae1
r
/0-25*
fi',•'
•w•.• ...N. e1
° ..•.. • 0o
is
Tcl6bi x,
to -2r
4:45
Fil
5
IF YES. AT WHAT
DEPTH?
ii •�fi.'ir a.i{II Nn�e ��u�
11
1i
y
Reading
Date
Gross
Time
Not
Time
Depth to
Water
Net
Drop
tH20
10-25'
1
/0-25*
4:44
gnlPn
dr
tH2O
to -2r
4:45
6„
-
2
/o -2f
4:5-4.3'
qj-2-
f/r
611
/v -25-
t- PERCOLATIONRATE 1,3 (minutet/kmh)
TEST RUN BETWEEN. .2' 4 FT AND FT
r2& 0 }�70 d'�.d-O
PERFORMEOBY: Par ROtI, CERTIFIED
2=-003 46/79)
' DATE -401:2: O -m
MUNICIPALITY OF ANCHORAGE
t_ Department Health and Environmenta"?rotection
825 '.. Street, Anchorage, AK. '.o9501
264-4720
Permit # AofALI * * * HANDWRITTEN PERMIT "
WELL AMWOR-el-SITE sEweR P u`•iIT
Applicant: , inh m Mailing Address: I'D t9ay .F 49 F gIFS
Location: Phone Numbberr:� 3
7�
3S-�sss-
Legal Description: L Q rness ZfIICL' of Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bedt holding Tank:
Maximum Number of Bedrooms: L Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH NGTH GRAVEL D WIDTH
The length dimension is the length(in feet) of the trench or drain£ield. The
depth of a trench or pit is the distance between the surface of the ground an
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 SIZEepartmentGALLONS
?ermit applicant has the responsibility to inf is dng.the
Installation inspections of any wells adjacent to this property and the number
)f residences that the well will serve. '
* * . * TWO W INSPECTIONS ARE REQUIRED
3ackfilling of any system without final inspection.and approval by this departm
will be subject to prosecution.
Kinimum distance between a well and any on-site sewage disposal system is 100 f
Ear a private well or 150 to 200 feet from a public well depending upon the typ
Df 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.
Dther requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
.. * * * PERMIT EXPIRES DECEMBER 3L 19 3 3
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 may require enlargement if
the reside ce is
Todeled to include more that 3 edrooms.
Signe3: .� �J2c.e� Issued by: rip 711 eo
Apwllicant
77// Date:=/:�__e?3
SWP/024(1/81)
Doc Co. du
SUIXIVAN WATER WELLS
P•O.BOX 272•CHUOIAK•ALASKA B9567 • TELEPHONE $88-2759
OWNER OF LAND 'J6 04 J S�Jc•.e,
ADDRESS
LEGAL DESCRIPTION L 4 /i4rr / 7% (.-J r'ST
DATE -Started 11 l.y/t•t Ended �! / �� -;t-•
PERMIT NUMBER
KIND OF FORMATION:
From Ft.to FL _- iJ
From Ft. to 7.7 FL o. #4 i .•r.e...:a
DEPTH OF WELL 7d'
STATIC LEVEL OF WATER FT. y s I
DRAW DOWN FT.
GALS. PER HR /5"00
KIND OF CASING ' r i- 00
From Ft. to Ft.
From Ft. to Ft.
From
FL to Ft.
From
Ft. to
Ft.
From
�Ft. to `• Ft.
r- From
Ft. to
Ft
From
Ft. toFL`��~
"�J /^'�`'
r c- From
Ft. to
FI
From
FL to FL
% r �' •' -' <'
From
Ft. to
Ft.
From
FL to Ft.
From
Ft. to
Ft.
From
Ft. to FL
From
Ft. to
Ft.
From
Ft. to Ft
From
Ft. to
Ft.
From
Ft. to FL
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From
FL to Ft.
From
Ft. to
Ft.
From
FL to FL
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From
Ft. to Ft.
From
Ft. to
Ft.
From
FL to Ft.
From
Ft. to
Ft
MISCL. INFORMATION:
DRILLER'S NAME
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 e a r e T* ry
Certificate of On -Site Systems Approval
Parcel I.D. 051-831-14 Expiration Date:
1. GENERAL INFORMATION
Complete legal description TonjeSS Estates, Block 1, Lot 4
Location (site address) 24996 Schaff Drive Chugiak, AK 99567
Current Property owner(s) John & Anna Timmer Day phone
Mailing address
Real Estate Agent
326 North 5th Street Grover Beach, CA 93433
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Fx I
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
WaiverNariance request for:,
Received by:
COSA to be relea:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
❑
Holding Tank
❑
Community
❑
Public Sewer
❑
unless otherwise requested by the engineer.
e ,
Date:_.
COSA Fee $ L16b �y Waiver Fee $
Date of Payment 101 Date of Payment
Receipt Number c25J("o rr Receipt Number
COSA# �Ll5�5 Waiver#
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 Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, All 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Phone
522-7773
Date 1012012013
�`�p6i yp0E4B6Eeae � v�®
00 p
49SN
6. DSD SIGNATURE 09M N"�
sFK) E:=Js)?:s0% o
=System #1 Approved for bedrooms pE CE -4381
System #2 Approved for bedrooms*
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: IL
By: '
The nici ity ncliorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 py an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X
Septic System Advisory -
Well Flow Advisory
COSA blue sheet_f
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Tonjess Estates, Block 1, Lot 4
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 11/14/002 Sanitary seal (Y/N) Y
Total depth 78 ft. Cased to 78 ft.
Date of test
FROM WELL LOG
11/14
Parcel ID: 051-831-14
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
10/7/13
Static water level 45 ft 44.4 ft
Well production 25 g.p.m. 10 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 12/ND mg/L
Arsenic N/D ug/L Date of sample: 7/19/13 Collected by: Anderson Engrg.
Raw Water from Well 12 mg/1 Nitrate. Treated Water at Kitchen Sink N/D.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/18/04
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) _
Date of pumping 10/7/13
Y
C. ABSORPTION FIELD DATA
Depression over tank (Y/N) N High water alarm (Y/N)
Pumper JRs Pumping
R
Date installed 12/3/82 Soil rating (g.p.d./ft2 or ft2/bdrm) 90 SF/BDRM System type Deep Trench
Length 37 ft. Width 2.5 ft. Gravel below pipe 4 ft.
Total depth 7-8 ft. Eff. absorption area 296 ft2 Monitoring tube Y Depression over Feld N
Date of adequacy test 9/26/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 25.5 in.
Water added
454 gal. New depth
43 in.
Elapsed Time: 1,440 min. Final fluid depth
25.5 in.
Absorption rate >= 450
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at in.
"Pump off' level at
in. High water alarm level at in.
Datum
Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
>100'
Septic tank/lift station on lot
>100'
On adjacent lots
Absorption field on lot
>100'
>100'
On adjacent lots
N/A
Public sewer manhole/cleanout NIA
Public sewer main
NIA
Sewer /septic service line
>25'Holding
tank
>100'
>50'
Manure/animal excrete storage areas
Animal containment areas
SEPTIC/HOLDING TANK ON LOT TO:
>5
Property line >51
Building foundation P tY
.Water main
>10' Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10'
P
Water Service line
>10' Surfacewater >100'
Curtain drain
None Noted Wells on adjacent lots >100'
Absorption field >5,
Surface water >100'
Water main N/A
Driveway, parking/vehicle storage >1 0,
F. COMMENTS
Raw Well Water Tested 12 mg/I of Nitrate Content. Treated Water at Kitchen
Sink indicated no Presence of Nitrates. 1,140 Gallon Storage Bladder in Crawlspace.
Bladder is not Connected to Well, but Used for Hauling Water for Domestic Use.
G. ENGINEER'S CERTIFICATION ` WLIk l
1 certify that I have determined through field inspections and � o®E°Aegtot--
review of Municipal records that the above systems are in 4,e f-
.70. ®®
conformance with MOA COSA guidelines in effect on this date. �� 0►TGINEE .7 0.
Michael E. Anderson, P.E. .... �* m
Engineer's Printed Name "°° "`•6
Date
10/21/2013 ® � m r e AMMSO
��+'° CE -4381
COSA brown sheet _10-10.12.doc
Municipality of Anchorage s
o
Community Development Department
Development Services Division a s
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 131545
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 4 of
Tonjess subdivision. This inspection revealed a nitrate concentration of 12.4
milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
ARCTIC PUMP & WELL INC.
Jim Sullivan
yPO Box 770197
ns,msnn.. Eagle River, AK 99577
'nt a s_rBrm - (907) 688-2510
(907) 258-2510
(907) 745-2510
avwna eci.net
Pump Installation Log
Well Drilling Permit Number: SW
Parcel Identification Number:
Date of Issue:
Arctic Pump & Well, Inc.
Page 1 of I
Legal Description:Tonjess
Property Owner Name & Address
Lot:4
Block:1
John Timmer
326 N 5`f' St
(;rnvvr Raanh Cn Qld4,
Pump Installation Date: 10-24-13
Pump Intake Depth Below Top of Well Casing: Feet
Pump Manufacturer's Name: Dempster
Pump Model:
Pump Size: hp
Pitless Adapter Burial Depth: feet
Pitless Adapter Manufacturer's Name: S-50
Pitless Adapter Installer: U/K
Well Disinfected Upon Completion? Yes
Method of Disinfection: Chlorine
Comments:
well casing 40'+ with no perforations
Ground is draining away from well
Soil is sealed tight around casing
Pump Installer Name:
Arctic Pump & Well, Inc.
Arctic Pump & Well, Inc.
Page 1 of I
Engineer:
-egal Description:
permit:
Report Type:
•
Municipality of Anchorages,
P.O Box 196550 4700 Elmore Road"'"'
Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997 v
http:/Iwww.muni.org/onsite
Planning and Development Services Department ��``r�t3ri"■T
On -Site Water and Wastewater Program
On -Site SewerMell Submittal Comment Sheet
ANDERSON ENGINEERING 10/24/2013
TONJESS ESTATES BLK 1 L 4
OSC131545 Well/Septic Completed By: J.Poet
COSA
-he attached paperwork has been reviewed and is being returned for the following reasons:
With nitrates greater than 10mg/I see 15.55.055 H - Well must have a visual inspection with a down hole camera
and an evaluation of the annular seal around well.
See the attached report from Jim Sullivan of Arctic Pump and Well Inc. The well was recently inspected and
found to be free of perforations. The annular seal was inspected and determined tight around the casing
with drainage away from the well head.
r.
SGS
SGS RcL#
1134780001
Client Name
Anderson Engineering
Project Name/#
24996 Schaff Dr.
Client Sample ID
24996 Schaff Dr.
Matrix
Drinking Water
Printed Date/Time
10/02/2013 15:21
Collected Date/Time
09/27/2013 12:35
Received Date/Time
09/27/2013 15:17
Technical Director
Stephen C. Ede
Sample Remarks:
450ONO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria (biased low). Refer to the LCS for accuracy.
Allowable Prep Analysis
Psrameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Coliform
ND 5.00
12.4 * 0.100
Negative
Negative 1
ug/L EP200.8 C (<10) 09/30/13 10/01/13 HKS
mg/L SM21450ONO3-F B (<10)
100mL SM219223B A
100mL SM219223B A
09/27/13 AYC
09/27/13 DSH I
09/27/13 DSH
des! %/e—
Municipality of Anchorage
-� Development Services Department
Building Safety Division -
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. O57 -931-1q HAA u _0501$ 1
Expiration Date: P 46 — O
1. GENERAL INFORMATION
Complete legal description Ln;"'i/ /3�ocK/ �an.jFss �'sT�ofcs
Location (site address or directions) e7.11!7 .5'&h'c /'<'Qr., e , :9 „v k If e
Current Property owner(s) w SccA G��� /�/.rss Day phone ep-9- aG yG
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
�i U r c a C ate. Day phone 6 2 2- 3 3 994e
zq2-- %%%%
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 10
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 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B welts or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
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 7` ffen/en Phone &,07)7f/G-io73
Address 99Gn e:*.
Engineer's Printed Name Dmu,*/.as 7'
f%n/e!,
Date �'
'w)
,",i:-49
7 t KEK
5. DSD SIGNATURE CE 9176
��-
_� Approved for bedrooms. i<� .•'•••••••••
Disapproved. , ������•��
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: C /v1� / /C�. Original Certificate Date: _�7—
(R•v. 0IM2)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 9951"850
www.ci.ancharage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /r / y `le e e /, 7"0 �� cSs lsfc%s Parcel ID:
A. WELL DATA
Well type AL,
.k,?k If A. B, or C provide PWSID # _
Date completed ii�rl��� Sanitary seal /N
Cased to yOf ft,
FROM WELL LOG
Date of test
Static water level ft
Well production
WATER SAMPLE RESULTS:
Coliform nles/100 ml. Nitrate rig./I.
ic: mg./i. Date of sample:
B. SEPTIC/HOLDING TANK DATA
TankType/Material SLlLt_c{ 3 %e el
Tank size // / gal. Number of Compartments
Foundation cleanout (Y/N) _.X— Depression over tank (Y/N) A/
Data of pumping n e ry 710 � K Pumper
.ar • f r oI/
C. ABSORPTION FIELD DATA
Well Log (Y/N)
Protected (YM) y
Casing height (above ground)
AT INSPECTION
ft.
9—
P.m-
Other bacteria oolonies/100 ml.
Collected by:
Date installed F// gra -Y
Cleanouts(Y/N)
High water alarm (YIN) 41Z—
Dateinstalled Soil rating (g.p.d./ft=or(j �_& Systemtype tre�7ci)
Length 3 7 ft. Width it R Gravel below pipe S' ft.
Vnr/c3 '
Total depth '7- 8 R Eft. absorption area 9 6 fe Monitoring tube _4e_ Depression over Aeld A'
Date of adequacy test 4/-/-2 - D,f' Results (Pass/Fail) �gf 55 For 3 bedrooms
Fluid depth in absorption field before test 34 ilii in. Water added s/.l gal. New depth y61 in.
Elapsed Time: V`I min. Final fluid depth 33' in. Absorption rate >= -/SO g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) iY If yes, give date
D. LIFT STATION
Date installed
'Pump on' level at _ in.
E. SEPARATION DISTANCES
Size in gallons
'Pump off"
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot /Of
Absorption field on lot Ile 7, ,
Public sewer main �Y/A
Manhole/Access (Y/N)
level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Zee/
Public sewer manhole/cleanout 1$114
Sewer /septic service line 1.4'10 / Holding tank A//1-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation .S Property line �> Absorption field
Water main W114 Water service line aSt Surface water lee t
Wells on adjacent lots /1•e* t
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 071srY Building foundation /S Water main iY14
Water Service line o?S,y� Surface water loo • Driveway, parking/veNcle storage f/cO t
/YOB e *�,)9,vn
Curtain drain ev e--yis t Wells on adjacent lots leo
F. COMMENTS T/caves//<✓i?e uf/strrnee%o/ by /.y P� is 1n eylf11o9
oof�b/ew /« /c/di:771A;k /107>YJe L'YAW/$P2eL4v,siA�
G. ENGINEER'S CERTIFICATION AW �P• '•8V�
1 certify that I have determined through field inspections and I{tg.••TM
+
review of Municipal records that the above systems are in -�• • " ''
conformance with MOA HAA guidelines in effect on this date. . 4 • • • • j
T �.
Engineer's Printed Name Do 4!3 14-1 Y' Re n le -,Z i CE 8176
Date �' ('' Oti �� •�
HAA Fee $ U-41(-)_• CID
Date of Payment
Receipt Number
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
Mayor Mark Begich
Municipality of Anchorage
CO. IMis IM671) • ,1txhoni e, alaslm M9519 -UN) • 47M Ample SINCI
Omicc: CX)7) M -SM • Fam ('X)7) 341-82M) pup://a���r.munLnryt
Developntcnt Ser%lecs Deltttrtntent
May 16, 2005
Anna Timmer
24996 Schaff Drive
Chugiak, AK 99567
RE: Encroachment: Well in Utility Easement
Block 1, Lot 4, Tonjess Estates Subdivision, Grid NW 1462
Dear Anna Timmer.
me.nt
L�
Q iJ A
Department
The Right -of -Way Division has reviewed a request for a letter of nonobjection to an existing well, which
encroaches 6' into the utility easement. On the as -built survey dated August 23, 1993, submitted with the
request, the petitioner has shown the well.
This letter of nonobjection is issued with stipulations, and by using it the petitioner is agreeing to the
following:
1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or
injury to any person as a result of the encroachments.
2. All applicable codes and regulations will be observed and maintained within the easement.
3. This letter of nonobjection will in no way preclude MOA from full use and enjoyment of its rights
within any portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or
reconstruction of MOA improvements to accommodate any or all of the encroachments shall be paid
by the property owner.
5. Obtain letters of nonobjection from the following utilities:
nchorage Water & Wastewater Utility ❑Alaska Communications Systems
Chugach Electric Association, Inc. Matanuska Telephone Association
Matanuska Electric Association, Inc. Enstar Natural Gas Company
❑Municipal Light and Power GCI Cable of Alaska
❑Eyecom (Girdwood cable TV)
All letters of nonobjection should be retained in your permanent files. Should you have any questions,
please call me at 343-8033.
Sincerely,
Jack L. Frost, Jr.
Right of Way Supervisor
Concur,
Property Owner(s)
Community, Security, Prosperity
May 03 05 06:06p Jim Sullivan 907-688-2543 p.l
ARCTIC PUMP & WELL INC.
Jim Sullivan
PO Box 770197
Eagle River, AK 99577
(907) 688-2510
May 3, 2005
Fred Kenley
R.E. L4 BI Tonjess estates 24996 Schaff Drive
I have disconnected the well at this property and there is an existing potable water
holding tank in the crawl space with an outside fill spout
Please feel free to contact me with any further questions.
Sincerely,
imli
:m Sullivan
' y
<SG•Go•
lz Xlz
4a,
s
y
S - G CAV ac
Nava Olt.
_
r
FC.94 n 0
l�t.'� e �oWO
N Y
_
Zy9-97'
4.,a �p•tn-�1 �p-oma �:cM.h.,....-'
AS -BUILT
-
I hereby certify that I have surveyed the following described''
,
property' . c. •�� To_yJ CSS STAT&Sr
—ker_y
Stl @Oki �� TtSilt_fLILI.
A14-
. •. •:.' r•..'. t:f �� ;., ?
Anchorage Recordlrtg Precinct, Alaska, and that the lmprova-
-
u`- ��';,+�•+••.,`r;; •';�•
", ��'• •`
-
mania situated thereon are within the property Imes and do
lying
' �,•; -�
•�."S„`• ,",: '' ",''+
not overlap or encroach on the property adjacent there-'
to, that no Improvements on property lying adjacent that to
•
encroach on the premises In question and that there are no
Y •
roadways, transmission lines or other visible easements on'
n`n��,o
said prgperty except as Indicated hereon.
• r t t
-
Dated At Tuygle River, Ala -,&a/
t >
/ ?
thle �- I -'=A .iay of A i/ C:•' VTI`
i • , -••
ROBE&T C. JOIMSON /
SCALE Registered Land Surveyor No. C80 -LS " -
-
l" - 50' Box 450, Eagle River, Alaska
Phone (907) 024-2543
\ Municipality of Anchorage
• -- Development Services Department
Building Safety Division �=
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.cl.anchorage.ek.us
(907) 343.7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FORA SINGLE FAMILY DWELLING
Parcell.D. f151-1911-4 HAA #dA0cPo%G'1
Expiration Date: _ 4 -.:2-- O 3
1. GENERAL INFORMATION
Complete legal description ke.—:K 6'.� /, Via: /r.SSt�1r�r�s
Location (site address or directions)
Current Property owner(s) e-iae Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
_t:y.W,4e 99s—L'1
Day phone
AvaeD>/ AJ Day phone E9yyiao
Unless otherwise requested, HAA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS:
S. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Weil
[�r
Individual On-site
191*'
Individual Water Storage
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 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) for properties served by a single family on-site wastevrater disposal andlor water
suppl�/ system. DSO also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of Issue for propertles served by a private or Class C well end may be reissued with
new water sample results less than 30 days old. (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 cr omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation.
based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated hereh 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 .Oec-,eus'T�.-J/—t"y Phone&o7*46�—/oT3
Address 99�oG, rc�✓<fi•.cJ Z7x,
Engineer's Printed Name ZZ04-1<4--Of J� A ye Ary _ Dat
S. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Adviscry
Maintenance Agreements
Supplemental Engineer's Report
Other
By. �L�1 it (L/ / —c�� Original Certificate Date:
FW rzcni
Municipality of Anchorage
Development Services Department
Bmft Safety Division .....
On Site Water 3 Wastewater Program
4700 South Bragaw SL
P.O. Box 19t M Anchmage. AK 995198 N
vvww.cimichorageA k.us
(907)341.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal peacep. zov/s Tows✓ins EjParcel ID: 0S1- 8 3 1 • I
A. WELL DATA 44vx-t%G
Wen "a .— K A, B. or C provide PWSiD i _ Well Log (YIN)
Date completed _ i Sanitary seal (YlN)-1,fV r Wtrea proPef1Y protaded (YM)
Total depth fL Cased b R Casing height (above ground) In.
FROM WELL LOG AT INSPECTION
Date of test
Static water level R ft.
Well production 9.p.m. fl•pAL
WATER SAMPLE RESULTS:
Cotifam ' f colonles/loo mI. Nitrate mg.A. Other bacteria _L:L colonkWI00 ml.
Date of sarnple: lr i Collected by:
�r
S. 3EPT=HOLDING TANK DATA
Tank Type/Materid S�rris fir^rL Date instaltaed <'2,/0/Bz-
Tank size eff f gat. Cs/.saNu
t Jam' �of a Z Clearauts (YIN) Y
Foundation deanait (YIN) -Y—. Dep0533on over lank (YIN) .V High water alarm (Y/N)
Date of purn0v 04;,/a z. Pumper Jr�.✓• Oty i�4 .//e�r[S
C. A930RPTION FIELD DATA
Date Installed Sob raft (g.p•d./A' or 9!W =) 9G System type ��rla,✓
Length d7 ft. Width X •:rte IL Gravel below pipe _ft.
Told depth 8 ft. ER. absMti0n area —Z 9 1P Monitoring tubs ,j,' Depression over field AJ
Date of adequacy test 2 </—JvX, Resutts (Pass/Fob) P«s For 3 bedrooms
Fluid depth In absorption held before test <!LL in. Water added �� gat. New dep#%:Kr In.
Elapsed Time:i6 min. Find Aub depth 'y/ in. Absorption rete >■ ys0 g.p.d.
Any rejuvenation wast hent (pest 12 mo.) (Y/N b type) A10 If yes, give date
0. LIFT STATION
Data Installed Size in gsmona ManholelAccesa (YIN)
'Pump on' level at _In. 'Plxmp otr level at _ In. High water alarm level at In.
Datum Cydes tested Wels .term t: dreun r w*wnerhs?
E. SEPARATION DISTANCES r,,PA14:! i cJ S'~00 -
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tw*M station on lot IV G Xi f •S
Abaorptlon field on lot /,f o��f' ,p ,g vv
Public sewer main ,7c
Sewer Islaptic servka line -e/' `Pf 'W
On adptcent luta f O a +rv(
On adjacent lots , / 0 "AV W
RNIC Lowe watt e/deanout AIZW -fay
Hold4tp tank _ "/4 s9L
SEPARATION DISTANCES FROM SEPTICAiOLDiNO TANK ON LOT TO:
Buddktg foundation �OfA Property Absorption Paid
Water main 'J/4 Water service line -ex*ol Surface water /e0 A<pf
Wails on adjacent lots /00 r<
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Una 24' F,' Buddktp fouWater main '`//�✓
Water Service line - i'ri-f- Surface water /mO�F� priveway.parkkgtielidestorapa •f/O'/5�
d,le.✓eA&, aV
Curtain drain Yo "vorr- Weds on adjacent kis
F. COMMENTS
O. ENGINEER'S CERTIFICATION
I cw* that I have deftm*wd Mrough held kapediorts and �0 -'•
rovlew of Munlopal records that ftabove systems are In :rt. $ TM .. r
conformance with MOA HAA quideNnes In effect ort thb dde. ....
EVheees Prk ted Name .!/o.i<s-+f T,-.e•clt 6yA CE T. 6OU
K7
Dais 3 -3-7-6:titi•' t
HAA Fee S 737f Tl o a
Date of Payment7L0.-
Receipt Number f71 sy
(Rev. 12,00)
Waiver Fee S
Date of Payment
Receipt Number
• •• J • • • ' , • • •• . • 1• •• •• • • ' ,
• . , �sy
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• • •• • •a
AS -BUILT
.'t• .•' I hereby certify that I have surveyed the following described
prowtv
.IiW k-4.—Su lens Z;' • •S"rt d
.�:r :• ' r Anchorage Ite ordkia Precinct. Alaska. and that the Improce-
-�•p�t.a•,.a•�J•�..� ��� •�� • • stents situated thereon are within the property Unes and do
.:. •.�` • , ,•.^=r: Via. Pot overlap or encroach on the properly.lying adjacent then
.r.�•f� ,•,� ,� a s • to. that to kr+ rovements on property !yids adjacent thereto
•. ! = .., encroach on the premtscs In question and that there are ao •
• roadways, tranwWWon lines or other vbible amaements on'
`'•••;j,';,�~a�j�' ►.i•�;•r:IJ• i ,. , , said property except as indicated hereon.
v :S; ns4 .�:'r'•' L Dat•:d of Thele River; Alaaka
S`•' r� 1:}:i.:e �l,r i this tf ►� day or'�4'fj�•V �"� 19<T?
. .:. 1. .•i '.
.^ ak>%:!• .,• .�'':• ".•• - .' .• ROIIET.T G JOIC:SOY 7'rz.'r
1...' y..,�•� •� SCALL
.,, • Rejiatertd Land Surveyor No. 1180•liS'
I• ,i So• Do: 434 gagle River. Alaska ,
Phone (907) 924-2343
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ROSIAT C COWAN. P.E.
CIVILLAI"t!m
March 21.2002 (n e"'2m
FAX("04.1211
MI.M. CIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 1%650
Anchorage, AK 99519
REFERENCE: Lot 4; Block I' Tonim Estates
24996 Schaff Drive
This letter is to inform )rou that the existing well on the above seferenecd property has
been disconnected and a 1000 gallon water storage tank with associated pump has been
installed in the crawispace. The new system has been inspected by us and meet. current
Municipal standards.
If you rcquirc additional information. please coniact us.
Sincerely,
a04taT G COWAN
CE -8801
=34 NORTH EAGLE RVEA LOOP • SURE 204 • CAW RNER ALASKA M 17
TOTAL P.O2
-—
MUNiCIPALITY OF ANCHORAGE Ak
• ^• DEPARTMENT OF HEALTH 6 HUMAN SERVICES AiEm
Division of Environmental Services low
On -Sita Services Section LULIW
P.O. Box 196650 Anchorage, Alaska 99519.66SO
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. N (IS1 9 Sl - IM HAA '# 1a Q S 25 Q 1; 1A
9. GENERAL INFORMATION ` • ';
Complete legal description Lot 4t'Block;.11.tonjeAe'Edtiteb
Location (site address or directions) 24996 Scha66 ViUve
Propertyowner. Sharon Dune/Au3outu PRopeLVed Day phone 688-4939
Mailing address P.O. Box 671923 Chuglak. AK 99567
Lending agency Day phone
Mailing address
Agent
Address
Dayphone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 V
3. TYPE OF WATER SUPPLY:
Individual well XXX
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 XXX
Holding tank
Community on-site
Public sewer
NOTE. If community wastewatersystem, provide written confirmation from State ADEC
attesting to the legality and status of system.
n4231M..N1) INN 00A971
5. STATEMENT OF. INSPECTION BY ENGINEER
As certified by my seat 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 furtherverify that based on the information obtained from
the Municipality of Anchorage files rom my investig
tern ation and inspection, the on-site water
supply and/or wastewater dis al s m is in compliance with all Municipal and State codes,
ordinances, and regulatio In e t on the date of this inspection.
Name of Firm
Address
Engineers signature
ING
Itivor, Alaska 99577
6. =Approved
IGNATURE
for bedrooms.
Disapproved
Phone
Date
Conditional approval for bedrooms, with the following stipulations:
Notes The well
meets exis
suggested that a Periodic testing be Perf2rmed to insure the wells
cop,r4nued suitabiAity. Nitrate concentration is 8.47 mg/1. EPA
The Municipality of Anchorage Department of Health and Human Services (OHMS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an Independent
professional engineerregistered In the State otAlaska.The DHHSdoesthis 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 ingineei's work.
MmrM "11 gra "OAm
Munldpatity of Anchorage
Aam
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Descrfption:L&< A PL* -k -Cori SFAS F.cer Parcel I.D.
A. Well Data
Well type PFJ If A. B, or C, attach ADEC letter. ADEC water system number ►�!p.
Log present &N) x Date completed 1I- JA,e)l� Driner SJ w%J kyk-t
Total depth '1 S� Cased to i -6' Casing height 1 Ztt f -
Sanitary seal &N) Wires properly protected 9N) �I
FROM WELL LOG
Date of test �A 0 2
Static water level 4S'
Wen now ZSR 0 O.P.M.
Pump lovell U �'
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
�1 -1—qS
y�o r
tart
rr
rrs
it
w
�5
rri
w
v
\F
� m
PL
Septicfiolding tank on lot l o l.' ; On adjacent lots 1 o0
Absorption field on tot \,n� ; On adjacent lots o ~
Public sewer main '1 Ve Public sewer manholelcleanout
Sewer service line '�'� Petroleum tank
WATER SAMPLE RESULTS:
Coliform 0 Nitrate '21•4*1 Otherbacteria
Date of sample: g 3 t- Collected byS A S ENGINEERING
B. SEPTICIHOLDING TANK DATA Eagle Rivet. Alaska "S"
Date installed 1 Z �'� - a Z Tank size k c Compartments Z
Cleanouts&To _Foundation cteanout (m) Depression (Y/F0 _
High water alarm (YO tl Alarm tested (Y" ')`t✓
Date of pumping y Pumper . StZ b`p a o t.
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK TO: `
Welt(s) on lot \ 04 ' On adjacent lots 1 e b Y Foundation Los
To property One t o t Absorption field 1 c C Water maln/servlce line t o t
Surface water/drainage
oes'F'� s .% GD-anJ 1.5 D eee� CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size In gallons Manhole/Access
Vent(Y/N) 'Pump W level at opt
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION
D. ABSORPTION FIELD DATA
UFT STATION TO:
adjacent lots Surface water
Date Installed 1?- /i --S'=— Soil rating (GPD/Ft2 .'_o89L System type
t . ,s
Length :7 Width 'Sa Gravel thickness A Totat depth t
Total absorption area X11. Cleanout present Depression over field (YJQ 14
Date of adequacy test q i %13 ResuI0 1j3hail) IF for 3 Bedrooms
Water levet in absorption field before test n After test ep
Peroxide treatment (past 12 months) (Y(9_ rLv � t�.s e .J ni if yes. give date d
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
% Ny� %
On adjacent lots 1 ao It a- Property rine
2S r
To building foundation
\ 'Sr 1 To existing or abandoned system on lot
1..
On adjacent lots
'S o
Cutbank A A Water main/servtce line
1 " t '-
Surface water
l o c>
Driveway. parkingtNehicle storage area '70%4,-
0 % 4—
A `D.
Curtain drain
r:tn�:.•..•.i.i a de
E. ENGINEER'S .CERTIFICATION ;` r
I eerily that t hatre checked,
Signature
orean/arrnedto all MOA and HAA guiddlnes In effect on the date of this lnspecDon.
No.204
Date /E.qb Rtnr, AIe6k6
HAA Fee $
Date of Payment — 3
Receipt Number
72-026 ("3)' Oak
Waiver Fee $
Date of Payment
Receipt Number
7! ..*
*A6 A A. sN.tr
Na t UM
n
n
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
• 260-4720
Application Date to -7-j5_00
1. GENERAL INFORMATION
(a) Legal Description (include lot block, subdivision, section, township. range)
I.,r—,r L. mac.. k f6<
Location (address or directions)
(b) Applicant Name Telephone: Home
Applicant Address -21 � r1hoK b-toj Z_-t,tveft',f,s rev.-i-tt�urr
(c) Applicant is (check one): Lending Institution 13: Owner/buildeeO Buyer (3: Other D (explain);
(d) Lending Institution
Address
Telephone
(e) Real Estate Company and Agent �re .-&D31i;�� ✓a"� K-wC,x
Address ��� ��y� '��+
Telephone «µ " �G'i
(f) Mail the HAA to the lotlowing address:
S 8 S ENGINEERING
SR S 196X
EAGLE RIVER, AK 99577
2. TYPE OF RESIDENCE
Single -Family Multi•FamilyD Other
Number of Bedrooms a
& WATER SUPPLY
Individual Well Community D Pubflc D
Note: II community well system. must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsito�K Public D Community D Holding Tank D
Note: It community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 rims 1111s"
0 lr�\ n
S. ENGINEERING FIRM PROVIDING ...;;PECTIONS, TESTS, FiLE SEARCH. DATN..ND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below. I verily 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 riles and from my Investigation and Inspection. the on-site water supply and/or
wastewater disposal system is Incompliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm 5 & 5 ENGINEERING Telephone Xy"j�= 7_97 9
59 8
Address _� 6X
Date GEt RIVER, AK 99577 .lJL I ions
6. DHEPAPPROVAL
Approved for 077 ° 3 bedrooms by lS +fit' Date
Approved x Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solety upon the representations given In paragraph S 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 engineers work.
Pape 2 of 2
trc»ouse
n M•JNIDPAUTY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (NOA) DEPT. OF HEALTH d .
ENVIRONMENTAL PROTLCrION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST • FEBRUARY IOU J U L 0 2 10
20"T"
i 0S._._Al1
•: . a—.� :.
A. WELL DATA
Well Classification !G C. It A. B. C. D.E"C1. Approved (Y/N) a IA
Well Log Presenlo/N) Vale Completed (1 .t�j =:5i- Yield n.!S '-iyM V -
Total Depth 7 Sr Cased to �? $ Depth of Grouting
Static Water Level 4<0 Pump Set At t1 rK,
Casing Height Above Ground �� Sanitary Seal on Casing (DN)
Electrical Wiring In Conduit43N) Depression Around Wellhead (YJq
Separation Distances from Well:
rh
To SeptiUifot ogfiank on Lot On Adjoining Lots - t !20
To Nearest E I
dge of Absorption Field on Lot o �' :On Adjoining Las
To Nearest Public Sewer Une t1)t To Nearest Public Sewer t
Cleanout/Manhole r')'% To Nearest Sewer Service Line on Lot
Water Sample Collected by 15 k s ; Dale
Water Sample Test Results SO'n`zEt'iZ el_ --
Comments-
Comments• b416 --5 '> Lc!ef 5td--w62 r-n_s
B. SEPTICINOLO1MG TANX DATA
Date Installed (Z3 BL Size — XZ00No. cf Compartments z"
Standpipes &N) Air -tight Caps OYN) Foundation Cleanout (Y[Q
Depression over Tank NO a Date Last Pumped
/M
Pumpingaintenance Contract on Fite (YIN) ; for
Holding Tank High -Water Alarm (Y/N) o Temporary Holding Tank Permit (WN) A
Separation Distances from SepticlHekhM Tank:
To Water -Supply Well o� r To Building Foundation 1.0
To Property Une t o 11 To Disposal Field I d I
To Water Main/Service Une
Course
Comments
Page 7 of 2
72-MI1 Uaa)
To Stream. Pond. Lake. or Major Drainage
'1
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 9b4b 64� Type of System Design A
Date Installed Length of Field 3�f
Width of Field 'si12 Depth of Field 13 r
Gravel Bed Thickness
�t
Square Feel of Absorption Area Standpipes Present ®N)
Depression over Field (Y/Q
Date of Last Adequacy Test (e Z43'e'L' e"
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well `( O,'t To Property Line 2S r
To Building Foundation
Lot -
To Existing or Abandoned System on
On Adjoining Lots --.,v I'1"
To Water Main/Service Une L o 1.4— To Cutbank(iI present) a i'
To Stream/Pond/Lake/or Major Drainage Course A
To Driveway. Parking Area, or Vehicle Storage Area Flo IX
Comments
D. LIFT STATI ON
Date Installed
Dimensions
Size in Galion
I Manhole/Access (Y/N)
'Pump On' Level at
'Pump Off" Level at
High Water Alarm Level at
Vent (Y/N)
Tested for
Pumping Cycles during Adequacy Te6L Meets MOA
Electrical Codes (Y/N)
Comments
•• Check Permitted Bedroom Rating Against HAA Request •'
I certify that I have checked• verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Sign S ENGINEERING Date J• I ms
SR 196X gr_oo3
Co `}� MOA No. �
Ree No. R 34 LE �1a5 OF.q��y�
Date of Payment `i • �'gb yip "�`S,f
Amount S
Page 2 of 2
12-M 11140
r --•i —,,
r.ouoll
APPLInNT FILLS OUT UPPER HA. ; ONLY
Proper— ar.• T I .�i
L SL v v ur
pnOne��.Z,J.
Making Address 404 ,
U e, Y Zip Code i�z"—6
6 /—y EiSrl
Buyer �•
Date
Vale
Address
Zip Code
/ D+ a
Lending InstitutionJ
�91-AS/�.4 lr/NiU,4 —CNSo�✓ j /4/,ti�.l.ld
Phone
Actino
2lp Code.
Jr
Really Co. 1 Agent
/ •
401G<</
�
Pone
-Z /
/�£�.ady ' PCode
_157-541
AddressC
c /-/o,.y4s.
Legat Description ..� 1
P
q 'eZ/f / 7 ••-J t ss Fs _1N7, -r .
Street Location
Type of Residence
F4ngle Family
O Multiple Famlly
No. of Bedrooms -�
O Other
Water Supply
CK41vidual
( .) DrSAPPROVED
ATTACH WELL 100. A welt lot Is requited for all "Is dri/ed Since.iuhe 1975.
is
O Community
For well$ drilled prior to that date, g" well depth (611801 log
It avallablO
O Public Utility
BATE q �7
Serer Isposat
WeWhIctual
'
Year Individual Installed: �'r� •
O Public Utility
When Connected to Public Utplly:
O Holdlnq Tank
s
Wen To Absorption Area
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED.
Well Log Received
r.ouoll
Time
Time
TIn
Date
Vale
Date
/ D+ a
Jr
Inspector
Inspector
Inspector Inspector
Field Notes:
( r2) APPROVED BEDROOMS
-CONDITIONS OF APPROVAL
( .) DrSAPPROVED
( ) COND=NA APPROVAL•
BATE q �7
Botts Rating
Cote Sewer Installed
Wen To Absorption Area
//o
Well Log Received
SopilcTankSW Q0
O
/1,. 3-8s
I Well to Tank* Dj<
r.ouoll
