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HomeMy WebLinkAboutTHOMAS L BOYLE BLK 2 LT 12BThomas L. Boyle Block Lot 2 126 #015-283-14 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page of 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: SW 9%0lafo PID Number:— 015-?$3-ly Name/ T GooFR� Wastewater System: ❑ New Wtty V�lJpgrade Address: C, Sr, Accu Ak 9951(p ABSORPTION FIELD Phone:No. 3y5 - qco-7 of Bedrooms: ❑Deep Trench ❑Shallow Trench X Bed XMound ❑Other LEGAL DESCRIPTION Sal Rating: ^ tJe7 GPD/S FI Total Depth from c?1nal grade: S5 Lot:�^ Block: Subdivision: Depthropipebott lro1 ogmelgrade: 'j' Gravel depth beneath Sipe 01 :) L Ft is Ft Township: ` Range: Section: Fill added ab veto=lgpinat grade: Gravel length: ' I �� �-f ``7T S Ft Ft WELL: Ejcr�rsA7>: New ❑ Upgr Gravel width: 1st Number of lines: Do uKe beteeen Noes Ft 5 FI Classification (Private, A,B,C): To pth: Cased To: Total absorption Brea: Pipe material: SIH yo T - Ft. Ft. S SO FI 46T 80,94 - V C Dnller. Date Drilled: Static water Level: Ft. matt it 1 l iv 1—a elrC- . Date installed: :o -as- `1 Yield: Pump Set at: Casing Height Above Ground. TAN K GPM Ft. Ft. SEPARATION DISTANCES ❑Septic ❑Holding ps.T.E.P. To Septic Abaorphon Uh HM,ng PubiwiPrivati, Mantuner. u18 _1A Capacity In gallons: From Tank Field Station Tank s~unee Oliz f -930 Well, I00t+- , loo} love} C+ 05'4- 05 Material: -rEEL Number of Compartments: p( Surface Water 100'4 loo'+ 100'1 LIFT STATION Lot Line I OI+ , %O f l to'l-4 Size In gallons: 0510 Mery� facturer, A&r_)4 • TA.JK /OV C—ADCO SN6TL'MS Foundation ,51` ID t+ [• ,r V "Pump ion" level et: 4A "Pump off" bvli at: 3a High water alarrrspt: 4N Curtain Drain ONE L N W1J Pump Make d Model C7Sr o5Nr1 Electrical Inspections performed by: I Remarks: BENCH MARK Location and Description: 700 0)a bit c K A+'AvC SL-1904&6 C. LA f1 000 e Assumed Elevation: rov F. EN L OF 4 �% Inspections performed by: S a 5 ENGINEERING Dates: 1St G'r23 S 7 17034 le River Loop Road, N0.2_04 2nd 6 19 7 RIs r,Alasks "r 9'7 3 G >' ROSERT C COWAN �? c�4 CE • 8801 Department of H alth and Hu aha Services appr a r rf� V 114 Reviewed and approved b . PP y' ! Date: rPnrJ (Kft "I) MOA 25 PERMIT NO. SW970126 91.0• PAGE 2 OF 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephoner 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 12B, BLOCK 2, BOYLE S/D P.I.D. NO. 015-283-14 ALL SWING TIES WERE TAKEN / FROM AN AS -BUILT SURVEY PERFORMED BY WILLIAM D. FLEMING ON 6-27-97 NEW 1250 GAL. S.T.E.P. TANK A 8 s NEW PRESSURISED BED graYi•f Sl LOT 12B Q Mr qR ll ME > ll! y .�W A Yf2�• / \`\ Y ST1 ECA V �' N O \� \•. Z m� o ra N M = EXISTING ` h Yfl X WELL \ / DRIVEWAY FE-01 „ro 8 STI CO 97.2' �ppI 97.0' FINAL CRADE III tiff 1250 C S.T.E.PAL . 91.1' SYSTEM 101.1' �M.f2 101.7' 1 M 1 FINAL GRADE \\\ SCALE 1' - 40' INSULATION ORIGINAL*� GRADE D • EP }^; ROBERT C. COWAN 'cam CE 8801 15' WIDE ` WATER rOUND 92.4• ,11CpZ�OFESS�� �• WPERYNBI[ LAM 92.4• 89.4' B.O.N. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 k k'.La-- PAGE 1 OF 1 tC• ON—SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970126 DESIGN ENGINEERS 6 S ENGINEERING OWNER NAME:GODFREY TIMOTHY W OWNER ADDRESS • 12210 GANG6 ST % 2.;11Q ��c, ru v ANCHORAGE, ALASKA 99516 PARCEL ID:01528319 LEGAL DESCRIPTION: BOYLE BLK 2 LT 12B LOT SIZE: 99500 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/11/97 EXPIRATION DATE: 6/11/98 c�r�nnc�lcs(' ar�,cG�eM 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 393-9799 ( 29 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 9. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: X,7 ISSUED BY: (iGLLG)� • DATE: S& May 22, 1997 ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. CML ENGINEERS (907)694.2979 FAX(907)694-1211 IEAETHAUTHORITY RECEIVED APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 MAY 23 1997 SEWER&WATER Anchorage, AR. 99519 Municipals of Anchorage LWNEXTENSIOM DePt. Health & Human Services REFERENCE: Lot 12B, Block 2, Boyle Subdivision SEWER&WATER Request you issue a permit to upgrade the septic system 14PECTION serving the three bedroom house on the referenced property. A test hole was excavated and a percolation test performed. ENGINEERINGSTUDIES The approximate location of the test hole is located on the ANDREPORTS attached site plan. At the time of excavation water was encountered at 4.5 feet and after seven day ground water monitoring water was found &FLOWTesr PECTION at 5 feet. Ptcwr We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the SITE PLANS installation of the proposed septic system. If you require additional information, please contact us. ROADDESIGN Sincerely, SOIL TEST WRoerCC.4owan, P.E. RCC/mg PERCOLATIONEnclosure TEST STRUCTURAL & MECWINICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 1" = 60, {uIN � N z . i --4-0 00 2 (n DESIGN Jf SITE -PLAN s s y q �+ m ^x•De� a 319 A p'L Q N lD NcONO+ tl ANW� t7 O NW i��� 9 QO � K5A .3 o N CO �VIO A 00 rn�mmDv—-oll3 m ' m 53<53 O_O„m Z O �I Z 0 o � M IL II Or M O A n C) m_o t7 000 m mm A� vO-3 � i Dpv o y imy 9n Z N �• p v a s H N a n \ =J n OFO ZZ•�.r A o 9"jp vzis<in >Fc 3=xn.. nN'�rsnnCoa JO '� - r_Z~SN O;wVmi • O N t OOA N •o r.rZ rnm AzrnZ<_ �Nw �r�im K D zCozz 1Z>�A u�ioiDmnz mom•• W n A mw n NO 9A O Z 00n ZZ Z O O H 003?P00 WAGNER STREET � A m Oy1 � /•r A /I CI QQ =c$ i��� 9 � K5A .3 o �• �i � 53<53 O_O„m Z O �I l�ppl,yy rlbyCD ^1 0 O N N.T.S. SCALE DESIGN DETAIL � cn o ^• `t7 m u 1- 1- LLO F�o to r I OI I OI A S 9• N tl I , 7 I 1 t oR yF�N aj a i i i 1:.nn O dorm C, ,�7 i i i i m ;, y,•, V y x cz W cn tz ti En 4 I ' 'cn ' d I I p l I r N I I o I 1 0 I I FI I F N'� n 1O V cn 10 O 1 0 � 10 I � c� .� -'� 2 ►.y O e � o m ic _ s � � � N .4 F � k r � Q a N �i •J: (lA i j m ti .Q Municipality of Anchorage }�J DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 %+9t SOILS LOG — PERCOLATION TEST a 2 3 /" LoT L SILT- 4 T 4 5 61— I ML paNsE M �) 1 SIL. T 1%o I'4M/I M R.O. H- 9 10 WAS GROUND WATER )FE S ENCOUNTERED? 11 S IF YES, AT WHAT ' L DEPTH? /`2 p 12 E 13 OeA to Water Jitter r I 7 Monitoring? S Date: S'��6 A 14 15 16 17 18 19 20 COMMENTS EMEMBEEMEN NNERNMENNE ■■■Q©©■■■■ NEEKERNMEN Reading Date Gross Time Net Depth to Time Water Net Drop �Ei 8891 PERFORMED FOR: T f M c o n ;i R[ Y DATE PERFORMttp., S n1„a ..y -A LEGAL DESCRIPTION: LOT Ia 9 RLdLK A Township, Range, Section: •��...,;�;.:.- '/ DEPTH C 7 SLOPE SITE PLAN to ' c 1 (FEET) 91T � it OR(-a.v(c f 4' lei I 7 ,�y . o : if '7 10'.f2 7"-1, u 2 3 /" LoT L SILT- 4 T 4 5 61— I ML paNsE M �) 1 SIL. T 1%o I'4M/I M R.O. H- 9 10 WAS GROUND WATER )FE S ENCOUNTERED? 11 S IF YES, AT WHAT ' L DEPTH? /`2 p 12 E 13 OeA to Water Jitter r I 7 Monitoring? S Date: S'��6 A 14 15 16 17 18 19 20 COMMENTS EMEMBEEMEN NNERNMENNE ■■■Q©©■■■■ NEEKERNMEN Reading Date Gross Time Net Depth to Time Water Net Drop r4 3a 4K S n1„a ..y -A ro'oL '/ y ' C 7 G 3/ rr to ' c L �/Y J/r- 0 =a 10 4' lei I 7 ,�y . o : if '7 10'.f2 7"-1, PERCOLATION RATE (minutes/Inch) PERO HOLE DIAMETER 6a TEST RUN BETWEEN a FTAND 3 FT .l A 5 ENGINEERING/ L�G�t� CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: 17034 ftwin oa o. ACCORDANCE WITAWIEg11106 AAIfINUPASPXLGUIDELINES IN EFFECT ON THIS DATE. DATE S -//S -A47 72-008 (Rev. 4185) HEALTHAlTHORITY APPROVALS SEWER A WATER MNN D UENSIONS SEWER&WATER INSPECnoN ENG NEERINGSRIDIES AND REPORTS WELLINSPECTION &FLOW TEST SITE PLANS SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER CISPOSALSYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS :Lot 12B, Block 2, Boyle Subdivision May 22, 1997 ROBERT C. COWAN. P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 1. The scope of this project includes the installation of a 1250 gallon wastewater S.T.E.P. system (septic tank) and two pressurized drainfield trenches to serve the three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. C TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 12B, Block May 22, 1997 2, Boyle Subdivision 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. URIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the elevated mound site. 2. The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 3. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. 4. The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). 5. The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. 6. The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. 7. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Lot 12B, Block 2, May 22, 1997 Boyle Subdivision 8. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 34010 Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 38 passing the $200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 12B, Block 2, Boyle Subdivision May 22, 1997 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 12B, Block 2, Boyle Subdivision May 22, 1997 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER blr • ,- MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 'Q on ENVIRONMENTAL ENGINEERING DIVISION? -3 / 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 (� 1 LIS ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ml NAME PHONE — OADE MAILING ADDRFj� J LEGAL DESCRIPTION L LOCATION NO. OF BEDROOMS O _ Y Well DISTANCE TO: Absorption D&&Mg PERMIT NO. WQ ~ Manufacturer Material No. of compartments N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth d V Z DISTANCE TO: Well Dwelling PERMIT NO. 0 Manufacturer Material Liquid capacity in gallons O -t= W DISTANCE TO: Well Foundation f�4r Nearest lot line 1 PERMIT NO LL Z F- No.o lines a -et. Length of each li Total length of Iijles Trench wid[ inches Distance between 'nes ri O H Top of file to finish grade r Material beneath the inches Total eftective abs ration area W U Length Width Depth PERMIT NO. d H W G Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line J J W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(:) OTHER PIPE MATERIALS � • i . QJ P SOI TEST RAT NG 5 INSTALLER J <r REM RKS 6 n 1 y L� 3 T Y� (a.0 RVA O l0 PH ED DATE LEGAL L/at3 72-013 t w. 3/781 IT --e rD F n r4 c"G'^rte G E 'DEPARTMENT OF ..,EALTH AND ENVIRONMENTAL Pi—TECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 OM— I TE SEWER LJF �CiF;'-FipE FaEF r•1 I T �— PERM17 110. C 790046 Las APPLICANT -flM GODFR,EY SPA BOX 1547-8 344 9661 LOCATION WAGNER ST 6LdiDwS� 'LEGAL L12B B2 BOYLE S/D LOT SIZE 80000 SQUARE--EEfi-- TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER, OF BEDROOMS = 3 SOIL RATING CSO FTIBR)= 225 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF�•TH= 10 LEr•.iGTH= 2�? GFzl-'Fi•%rEL CsEF•TH= THE LENGTH DIMENSION IS THE LENGTH CIH 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 IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIH FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE 'INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C 2 ] AFZE F2E LI I RECD --- BACKFILLING OF ANY SYSTEM WITHOUT FINN 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 FEET FOR A PRIVATE WELL: OR. 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. 'OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. F IE FZ r'I I T E—:XF=* I FS E'S C•E(--EMECEFZ -:J- s J_ S? :'S) I CERTIFY THAT 1: I AM FAMILIAR IJITH 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS RE110DELED TO INCLUDE MORE THAN 3 EEDROOMS. S I GNED : c E APPLICANT JIM GG FR, ? ISSUED B4 V3. 2 ff x,►s4 LU lvo�� P �A pie-: i L13 �ai5r 2..i,Ne GRE)` -R ANCHORAGE AREA B0r`w1GH c��� Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM -icsy NAMET"m 6114rg MAILING ADDRESSSf-A 45-97•S PHONE-279-9y4lAI3-1 LOCATION_ SEPTIC TANK: LEGAL DESCRIPTION DISTANCE t NUMBER OF FROMWELL110 MANUFACTURER R MATERIAL.Stal COMPARTMENTS— INSIDE OMPARTMENTSINSIDE LENGTH INSIDE WIDTH LIQUID DEPTH IQUID CAPACITY 1000—GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER --OR WIDTH 29-1, LENGTH2-1 ; DEPTH /D LINING MATERIAL hy:V) CRIB SIZE: DIAMETER!`L DEPTH 6 / DISTANCE FROM: WELL /456 TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE ao f-. ABSORPTION AREA (WALL AREA) _2570-'4 SQ. FT. ADDITIONAL ABSORPTION WELL: Pl/2orcvLd -fo meA-T 6"n_z_z 8A XA—;-- Alqu u4ru.c-� a TYPE -rN[)1U CONSTRUCTION dAtLGd DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION—,LOT LINE , SEWER LINE , TANK , SYSTEM_ CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMA DISTANCES: /2S DIAGRAM OF SYSTEM APP/ 1cN 1U7 k` INSTALLED BV: d PIPE MATERIAL:5C4Jr/h4-r ulheRt, d LOT SLOPE: - "O� o�Sf(ACCDAL 0 REMARKS: 714tudcY- Sf[Lail�1 - I-reAll-eg- a{wzA W4 eLt.Af 1/`tt7'1DATE 4 /97� APPROVED G.A.A.B. Form No. E"31 w• NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION — r'— GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274.4561 q. o6�4m PERMIT NO. SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT a79_ `14161 INSTALLATION OF: SEPTIC TANK COMPLETION DATE ANTICIPATED DRAIN FIELD NOTEI THIS PERMIT 13 NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE ( TYpc� SEEPAGE AREA SIZE �> 17- MINIMUM DISTANCES. REOUIREMENTS�x /� FOUNDATION TO SEPTIC TANK �J FOUNDATION TO SEEPAGE PIT DRAIN FIELD O SEPTIC TANK TO SEEPAGEPITWALL 1J , SEPTIC TANK "'� SEEPAGE PIT P O DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK / SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK � SEEPAGE PIT /0 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 5 FEET INTO UNDISTURBED SOIL. 4 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. 1 G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBEDSYSTEMIS IN ACCORDANCE WITH SAID CODE. DATE A ED�a �� � � APPLICANT -6 SIGNATURE FORM NO. EO -614 TYPE OF SYSTEM 0 �+ C.REP.TL•R ANCNOQA^E AREAeo"O! •!t f(CALTit D£Pfi TV' ll 327 LAG.r eTREET. AXCHORAC£. ALVXA 99501 Performed Far Tii Legal Description: This rcrm Reports a: Depth root Soil Characteristics The soil conditions were fairly consistent with a high clay and silt content, with some sand and cobble. The sediments were fairly compact with a moderate moisture content. Was Ground Nater Encountered? Vo If Us. At What Depth CASE d to Perfnr*•r•_2gepty! T1,'I . es; Location Proposed Instal atr ion."seepage rit XX Drain :tel6 Dept), Of Inlet 2-3 ft De,,th To bottom.777it Lr ;rent• ll�i"1':Ct C'0M4ENTS:Gm at 22 sgt't/b rm seat rertormed By:—_pn.,nnn Dota Cartified'byt9,Qiti.i. l� %/�7� "�✓ _ .::-�--:"` 9.C42Z' 42�.� • '� Municipality of Anchorage 3 On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-283-14 _ Expiration Date: 1. GENERAL INFORMATION Complete legal description _THOMAS L BOYLE BLOCK 2, LOT 12B Location (site address) 12240 WAGNER STREET, ANCHORAGE, AK 99516 Current Property owner(s) DAVID & CYNTHIA WREGGIT Day phone Mailing address Real Estate Agent _12240 WAGNER STREET, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone JUL 2 1 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Comn 'ni+y rlBSS l 1e11 ❑ rv�mmuin iv Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless COSA Fee $ ?-gyp Date of Payment -71 2 Receipt Number CSA,5- .0l COSA# Obdq 13y,71 Date: requested by the engineer. Waiver Fee $ Date of Payment Receipt Number 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD. EAGLE RIVER AK 99577 Engineer's Printed Name _KENNETH M. DUFFUS Date 6/13/14 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen �.ff encroachments, deficiencies or discrepancies exist. Ar��v r 4gTHU 6. DSD SIGNATURE do System #1 Approved for 3 bedrooms. �, u°r,",,;'s Af System #2 Approved for bedrooms. Disapproved- Conditional approval for _ bedrooms, with the following stipulations: �- ��rtr_a61dt By Original Certificate Date: Th ni ality ,honag, Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbiuesh et 10-10-12.dm 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: THOMAS L BOYLE BLOCK 2, LOT 12B Parcel ID: 015.283.14 A. WELL DATA' Well type PRVT If A, B, or C provide PWSID # Date completed 1970 Sanitary seal (Y/N) Y Total depth 70 ft. Cased to 40+ ft. FROM WELL LOG Date of test Static water level ft. Well production 9 - p.m - WATER SAMPLE RESULTS: Coliform AIE6- colonies/100 mL Nitrate 1.2e mg/L Arsenic: J✓bug/L Date of sample: 6112114 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 5119114 Pumper A+ C. ABSORPTION FIELD DATA Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 5119114 ft. Collected by: ARCTERRA Date installed 6125/1997 Cleanouts (Y/N) Y High water alarm (YIN) Y Date installed 612511997 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.7 System type BED I MOUND Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth 3.4" ft. (Measured 15/19/14) Eff. absorption area 645 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/1912014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 460 gal. New depth 0 in. Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed 612511997 Size in gallons 1250 Manhole/Access (Y/N) Y "Pump on" level at 42 in. "Pump off' level at 42 in. High water alarm level at 44 in. Datum TANK BOTTOM Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: Meets alarm & circuit requirements? Y On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 1001+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 51+ Property line 5'+ Absorption field 54 Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 101+ Water Service line 101+ Surface water. 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 501+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS *Well data per MOA docs. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 6112114 COSA brown sheet 10-10-12.doc OF A1_ // 1AA-n TT -r 'P KENNETFTM. Dl 'Of 7 18 �`�' \ ai �FES3[OSlP .i Municipality of Anchorage Community Development Department Development Services Division 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 # 141347 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 12B of Thomas L. Boyle subdivision. This inspection revealed a nitrate concentration of 9.2 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. 04!11!2014 21::=7 507-7'45-0210'_' Al liRILLIh1G F'Hr-,E 01e'101 ARROW PUMP & WELL SERVICE, LLC RO, Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 • Fax (907) 345-0202 Eagle River: (907) 622-9335 d0 SITE No. 14217 I /, WELL) t WL r l/T'l CHLORINATED PUMP DEPTH 5ALE$PER$ON '-,QUA ITY - " ' - DESCRIPTION PRICE AMOUNT 1Cal elp' I 'Wit r A Y y �lAJ crV"�� r LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR J S ep WORK ORDERED BY TOTAL LABOR PAYTHISAMOUNT 3 Thank You SIGNATURE (I Hereby ACWtOwledge the Satlefaotory Completion of the Above Described Work and agree that If el work Is not paid for in 90 days I agree to allow Aarow Pump & Well Service, L.L.D. the right to remove unpaid for equipment and charge for labor already performed & labor tc remove unpaid for equipment) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL 6E CHARGED ON OVERDUE ACCOUNTS. Municipality of Anchorage •. �rl • Development Services Department Building Safety Division ,. On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-283-14 HAA# N/4 o .�1_ 0 9 3 1. GENERAL INFORMATION Expiration Date: 5 Complete legal description BOYLE SUBDIVISION; LOT 12B. BLOCK 2 - Location (site address or directions) 12240 WAGNER STREET t ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JACK & NICOLE FOLEY Dayphone 345-7955 Day phone RUTHANN BAKER w/ PRUDENTIAL VISTA Day phone 4241 "B" STREET • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 301-4882 TYPE OF WASTEWATER DISPOSAL: Individual On-site ■ 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 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. 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 (les 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 AKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B ■ ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Z Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines B 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. A W WC, Inc. can therefore 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 sale 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 fllowing stipulations: NOTE: THE WELL ON THIS PROPERTY MEETS EXISTING STATE AND MUNICIPAL CODES. THERE ARE NITRATES PRESENT. IT IS SUGGESTED THAT PERIODIC TESTING BE PERFORMED TO INSURE THE WELLS CONTINUED SUITABILITY. CURRENT NITRATE CONCENTRATION 1S 5.34 mg1L. EPA MAXIMUM CONCENTRATION IS 10.0 ma/L. MORE INFORMATION ON NITRATES IS AVAILABLE FROM THE ON-SITE SERVICES PROGRAM. AT 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By:� -� A�� C''� Original Certificate Date: ., - � q - o (Rev. 1201) Municipality of Anchorage Q t • Development Services Department Building Safety 0tvislon ` On -Site Water b Wastewater Program ' 4700 South Brsgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: BOYLE SUBDIVISION: LOT 128, BLOCK 2 Parcel ID: 015-283-14 A. WELL DATA *PER 1979 HAA Well type FWATE If A, B, or C provide PWSID# N/A Well Log (YIN) NO Date completed 01970 Sanitary seal (YIN) YES Wires property protected (Y/N) YES Total depth 070 ft. Cased to 40+ ft. FROM WELL LOG Date of test Static water level ft. Well production — g -p.m -WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 5.34 mgJL. Casing height (above ground) 12+ in. AT INSPECTION 4/23/2002 46 ft. 5.72 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: N/A mgJL. Date of sample: 4/23/2002 Collected by: AWWC, INC. B. SEPTICIHOLDING TANK DATA Tank TypefMaterlal S.T.E.P. Date installed 6/25/1997 Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YM) YES Depression over tank (YIN) NO Cleanout (YIN) High water alarm (YM) YES Date of pumping 5/2/2002 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA MT1/MT2 Date installed 1/25/1997 Soil rating g.p.d fttdnn) 0_7 System type BED/MOUND Length 43 ft. Width 15 ft. Gravel below pipe 0.5 ft. Tont depth 3-3.4 ft. Eft. absorption area645 ft' Monitoring tube YES Depression over field NO Dat of adequacy test 4/23/2002 Results (PasslFall) PASS For 3 bedrooms 6.5/ Fluid depth in absorption field before test .9& in. Water added 652 gal. New depth 8 in. Elapsed Time: 10 min. Final fluid depth 9Z0- In. Absorption rate >- 450+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N S type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed 6/25/1997 Size in gallons 1250 Manhole/Access (WN) YES "Pump on" level at 42 in. "Pump off* level at 42 in. High water alarm level at 44 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 1009+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1000+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 50'+ Curtain drain NONE KNOWN Wells on adjacent lots 1000+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ale in conformance with MOA HAA guidelines in effect on this date. Engineer's Pri Deme JEFFREY A. GARNESS Date S z HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number � | D k N e02'52q 165.49' WAGNER STREET 4-29-02; 2t4ePM; ;907 e61 5301 • 2/ 3 CT&E Environmental Services Inc. C,UE Refit 1022142001 Client Name AK Water & Wastewater Consultants Inc. Project Name/# Lot I2B. B 2; Doyle SID Client Sample ID Outside Hose Bib hfatris Drinking Water Ordered By . PWSID 0 Sample Remarks All Dates/Times are Alaska Standard Time Printed D2terrime 04/29/2002 8:28 Collected Date/time 04/23/2002 14:45 Received Datelrime 04/24/2002 14:00 Technical Dir ec Released By Stephen. de �y7r, /�A Allowable Prep Analysic Parameter Results PQL Units Method Umits Date Date Init Waters Department Nitrate -N 334 0.200 mg/L EPA 300.0 (<10) 04/24/02 1DT Microbiology Laboratory Total Coliform 0 col/100mL SM1892220 (<1) 04124/02 KAP _ MUNICIPALITYANCHORAGE • DEPARTMENT OFFHEAHEALTHTH&8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. a _OI S - ;)y 3 — 1 y HAA # 1. GENERAL INFORMATION Complete legal description Lot 12B; Block 2; Boyle Subdivision Location (site address or directions) 12240 Wagner ST. Anchorage, AK PropeRp'owner Tim Godfrey Day phone 345-4607 �. Mailing address -12240 Viagner Street 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 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 wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R".1/21) Front MOA62i S. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, l 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 and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmS& S ENGINEERING C `I H _3 9 7 �T7�Eagia Rivet keep Rmd N. lad Phone Address Eagle River, Alaska 99577 Engineer's signature 6. DH�HSSSIGNATURE —k! Approved for bedrooms. Disapproved. Conditional approval for Date 'il r /97 6 A f1 ROBERT C COWAN CE -8801 �1 el �'•• - Mr�l bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that Aperiodic testing be performed to insure the wells continued suitability. Nitrate concentration is 5.64 mg/1. EPA uAximum concentrationt is 10.0 mg/1. More information on nitrates iS nnailnhio frnm rha nn—citp Spryirpc Prngrsm_ nWwC, 41-4744 Additional Comments 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 engineer registered In the State of Alaska. The DHHS does this as a courtesyto 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. 72-M m.+. Uv1) 8� MOA R1 MUNICIPALITY OF ANCHORAGE n ENVIRONMENTAL SERVICES DIVISION a Municipality of Anchorage JUL 01 1997 DEPARTMENT OF HEALTH & HUMAN SERVICES j Environmental Services Division R (; _d`%dd V E I' 825 L Street, Room 502 Anchorage, Alaska 99501 907' 34.7 Health Authority Approval Checklist Legal Description: LOT' I a Q 13 K ;A Q o y a r S /a Parcel 1. D.: o 15 - of 8 3- /y A. WELL DATA Well type PPXU AT- It A, B, or C, attach ADEC letter. ADEC water system number t�— Log present&) IES Date completed 10 S- / -71/ i Total depth -70 Cased to 'J$ Casing height (above ground) 1 r-4 Sanitary seal O/N) Y rt s Wires properly protected J�eN) Y E S FROM WELL LOG AT INSPECTION Date of test 1C7 -S - -%� 16 a 7/ q 7 Static water level 3) 1 7 Well production g.p.m. r 7. 3 f g.p.m. t R�.srwcr<a By Pu.+/� d pi.u„AjNG WATER SAMPLE RESULTS: Coliform O Nitrate Other bacteria / Date of sarrr le: % 13 / 9 7 S t S ENGINEERING p Collected by: »ev F g1. DI -m. r -op Rood Ug.296 S. SEPTICIHOLDING TANK DATA 5.' p, 1 AO Y_ Eak Rhr, r, Als*a 99577 Date installed 626-0 Tank size /o5(D Number of Compartments a Cleanouts(&A) Ie5 Foundation cleanout�V �U S ) YCS Depression (Y� High water alarmj( YF�, �— Oats of Pumping~ . o%NPumper C. ABSORPTION FIELD DATA Dale' instatted - .�5 ^9.. Soil rating (g.p.dJW or ft'/bdrm) Q, % System type Oed d t" A30 Ler qth ` . X13' Width / r Gravel thickness below pipe O.5 ' Total depth 3, 51 Effective absorption area , Pl� — Monitoring Tube present&)�> Depression over field (Y©)JO Date of adequacy test Results (PassifFeiQ For bedrooms Fluid depth In absorption field before test (in.); � Immediately atter_ gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = - a.p.d. Permdde treatment (past 12 months) (YM) 72-026 (Rev. 3/96)• if yes, give date D. LIFT STATION Date installed " P5 "9 Size in gallons 0�5 Manhole/Access j�34) YES "Pump on" level at' qa "Pump air level at* High water alarm level at* `7y -Datum &T%oA of: I AA)K Cycies tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 10()' +- On adjacent lots I 00 +� Absorption field on lot i0O + t On adjacent lots 160 +'f - Public sewer main N �A Public sewer manhole/cleanout ^' '4 i Sewer /septic service line a S 'i Lift station 100 + SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: r Foundation 10,+ Property line io rr Absorption field fo f Water maintservics line 6 l Surface water/drainage 160'f Wells on adjacent lots Loo It SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r . Property line 14) +{ Building foundation l O 14 Water main/service line �o f Surface water 1 0o l 4 Driveway, parking/vehicle storage area Curtain drain /a/i e h AJ o 110 iJ Wells on adjacent lots 10011- F. 0Or1- F. ENGINEER'S CERTIFICATION I certify that I have determined thru Held inspections and review of Municipal records eoov� in conformancee Dui lines in effect on this date. .�P, ,"...... Signature 27 Engineers Name X,) R n t% .•4 ''' fd ::• 7 / I y ROSE" C. COWAN Date q 7 a}rI�CE • i9ol f9 .../ HAA Fee $ 3 opt /)7 Date of Payment f 77 Receipt Number. !;I �-2 El (4 72-0213 (Rev. 3198)' Waiver Fee $ Date of Payment Receipt Number are JUN -27-1997 1033 CT&E ESI ANO-IDME 9075615301 P.02/03 r %it`s' CT&E Environmental Services Inc.., �Sc. I Is CT&E Ret.X Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 973330001 S & S Engintxting Boyle SID Lot 12B Blk 2 Boyle SID Drialdug Water E Client PO# Printed Date/Tlme 06/26/97 17:45 Collected Date/Tirne 06/23/97 19:00 Received DatePCune 06/24/9717:00 Technical Director: Stephen C. Ede Released By ./j/- Jlz Rltowebte Prep anatysis Peremeter Results POL Units Fethod Limits Oett Date t, Nitratr•N 5.64 1.00 mg/L SM1E 4500•MOTf to aux ` Total Cotifonr 1 OB W/0 COLI 06/26/97 d:' SMta 92228 06/25/91 Tr,. _e , THIS SIDE FOR OFFICIAL USE ONLI INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLICUTILITY _ Connection Verified— PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: %O If Tank is homemade give dimensions: SOILS RATING ""a– TYPE OF TANK TYPE MANUFACTURER TOTAL ABSORPTION AREA MATERIAL C.,Q � Y ► „1 lq 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area betriviti, Line Neerest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [A -,APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE Gf citB1�Y\(T\Title/\ LEGAL DESCRIPTION 72-010 1Rev. 9/78) S. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE"— �E7 gk Q, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION _ WR t_ r CM/vp 826 L Street - Androropa, Alanka 98601 S. TYPE OF R IDENCE e* ❑ One ❑ Four ❑ Other SINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION ❑ MULTIPLE FAMILY fe Three ❑ Six Telephone 2644720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplw requests will not M preawpd. Place allow ten (101 days for processing. 1. PROPERTY OWNER since June 1975. For wells drilled prior to at date, give well ❑ PUBLIC UTILITY PHONE tinMAILING od If system is over two (2) years old an adequacy test Is required _-ri ADDRESS by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 5 PROPER Y RESIDNT 11 different r PHONE Lai 2. BUYER AA MAILING ADDRESS 3. LENDING INSTITUTION PHONE AK C/o l S L /QNc oF MAILING ADDRESS 56 P O _ ao o nr- .To 4. REALTOR/AGENTPHUNE RiciA kodri cee.2 Goanr) N MAILINt ADDRESS S. LEGAL DESCRIPTION - �E7 gk Q, STREET LOCATION _ WR t_ r CM/vp in S. TYPE OF R IDENCE NUMBER RBEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY fe Three ❑ Six 7. WATER SUPPLY hie' INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to at date, give well ❑ PUBLIC UTILITY depth (attach log if available.) / ( E S. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE" e�lfindividual/on-site, give installation dater , 1^UF6' If system is over two (2) years old an adequacy test Is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) 5C I VY IDFdi FROM Tim W. Godfrey Star Route A Box 1547-B Anchorage, Alaska 99507 +;SUBJECT Lot 12B Block 2 Boyle Subdivision DATE 8 /10— MESSAGE The water sample submitted to the laboratory show positive results. Please read the enclosed instructions and resample. Thank you. Sewer and Water Section :,'=Health and Environmental Protection SIGNED 825 L Street 99501 REPLY 08/29/79 nn L tt `` The well was chlorinated o>C`�9,�EWth )a second sample sent to Chem Lab several days later. I have used the well for five years and never had any problems. I believe the source of contamination to be standing water in the crawl space of the new home being built. The rground had settled around the foundation and Runoff rain water was partially draining in the crawlspace. The water line under the house from the well was temporarily hooked up with a compression fitting, to a garden hose to supply water to my mobile home. The Sitting was leaking and I feel standing water under the house was draining thru the water line and into the well. -� i R•difyrmq 4S 471 I SEND PARTS 1 AND 3 WITH CARBON INTACT • PART 3 WILL BE RETURNED WITH REPLY Poly Pak ISO RMt) 4PO71 SUBJECT FROM • DATE r &., il/J �.ICXJc. SIGNE l ' a�. ,a.r,>>, «.-. r,.. -..w. �_....a_.. ._=:+mzv-.... ..,."._.. vre^. K. .,a yc<_�tiu "►��!' •"�'��_Z.N ...,...,..<.. �/�� m�,,.�., Rsmy r. r r n e �<a SIGNED -+^sr, ..az-c=-...;a�.•...-am«..,�sr.....,.,.,,..,.,.-a.as.rw.-an»-::.m.........,.-.er;..auss..wusas-.mrsucv...,w.»nis+«:.. Rodillm a 4S 471 - SEND PARTS 1 AND 7 WITH CARBON INTACT • PART D WILL RE RETURNED WITH REPLY Poly Pak ISO EwIE14P471 DETACH AND FILE FOR FOLLOW-UP January 31, 1979 gin Godfrey Star Route A Box 1547-B Anchorage, Alaska 99507 Subjects Lot 12B Block A Boyle Subdivision Dear Mr. Godfrey: As per your request, note the attached copy of the inspection report. It indicates that the existing sewer system was permitted and designed for a two(2) bedroom trailer and not a three(3) bedroom trailer, as you had stated during our to ephone conversation on January 30, 1979. The existing septic tank(1,000 gallons) is adequate for a three(3) bedroom residence. However, the leach area is approximately one -hundred seventy-one(171) square feet of absorption area less than the requirement for a three(3) bedroom home. If there are any further questions, please contact this office at 264-4720. Sincerely, John Kennedy Principal Environmental Control Officer JK/ljw TO / F .''A • �C.ye 1 O ]� M Health &Environmental Protection (,�/JJ Environmental Sanitation Division 825 L Street, Fourth Floor West Anchorage, Alaska 99501 .... '- - -t �/��/.-..� _ .... .yam_... si ' XT I, I J `r �� S�V DATE �. MESSAGE 74- 447 liao V REPLY, � 6� t. SIGNED DATE RRdifprm e 4S 471 - SEND PARTS I AND 3 WITH CARBON INTACT - I PART 3 WILL BE RETURNED WITH nKY. DETACH AND FILE FOR FOLLOW-UP