HomeMy WebLinkAboutDEARMOUN ESTATES TR AI eArmoun
Estates
Tract A
#017-152- 29
~ MUNICIPALITY OF ANCHORAGE
DL=~TMENT OF HEALTH AND HUMAN SER~S
· ~ Environmental Health Division
." ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
( ~,. .O~I?~II,TE~EWAG~ISP~.AL_ SYSTEM AND/OR WELL INSPECTION REPORT
-~ ~'~ ~ '~'~ ~ ~L~~' ::j~ DISTANCES
~} ~' ~Or'~ n ~0~ TANK FIELD WELL
Phone(s) Permit N~ I NO. oi B oo.~ WELL __0~--
'.GA....C.,.~,O. LOT LINE ~0' ~' --
T/~ ~ ~ W ~ AS-BUILT DIAGRAM ,Show location ol w~u, septJc sT.,e., property ,,nes. foundat,on,
TA. S
EPT C .OLm. G
TYP[ OF ~Y~TEM
~ TRENCH ~ED ~ W. DRAIN ~ OTHER
~ ET 0.~ ET .~
. IB~ 8QFT G.O FI '~
' I WELLS i ~ ~' '¢~,~ ~.
~ PRIVATE ~ OTHER,Identify) 5~~'
classHicatiOn (A,B,C} Total Deplh FT c.sea to ~ ~ _ / ,'.
Health Oepadment Appro Date:
72-013 (3/85)
MUNICI
DEPARTMENT OF
825 L
~L I ]-Y Om=~ ANCH~AGE
HEAUTH AND ENVIRONMENTAL PROTECTION
STREET, ANCHORAGE~ AK 99501
~.64-47~0
ON'--S I ]-E S~-Z~ER PERM I T
PERMIT NO: 860251
DATE ISSUED: 07/50/86
APPLICANT: ONITED BANKCGRP AK. ~ ACREAGE SYSTEMS INC
ADDRESS: 601 E. NORTHERN LIGHTS BLVD. ~165
ANCHH~AGE, AK 9 ~k
CONTACT PHONE:
LEGAL DESCRIP: ~UBDIV'ISION: DE ARM~UN ~ST. EOT~ _~~R~CK:
~E~TION: 26 YOWNSHIP: 12N RANGE: 3W
LOT SIZE: 1~25A (SQ.FT. OR ACRES)
MAX BEDROOMS: 4
N/A
Listed below are the options available to you in oesigning your septic
system. Choose the option that beet fits your site.
DEF'TH ]0 PIF'E BOTTOM (FT.) X~ 0/ /~O 4.0
GRAVEL DEPTH (FT.) ~ ~ LO.5 ~ 1 5
TOTAL DEPTH (FT.) N 6 ~- 5'~
GRAVEL WIDTH (FT.) '~ 5 29.0 5.0
GRAVEL LENGTH (PT.) ~o~. ~*~0 56.0 198.0
GRAVEL VOLUME (CU.YDS.) ~]1~' 60.~ 73.4
FANK SIZE (6AL. S) ~5(
1,'5( ~k ** 1 250.0 ** 1,
BOIL RATING (SQ.FT. /BR) ~ ~ 267 518
** GRAVEL LENGTH > 75 F'I. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** FAN~ MUST' HAVE Al LEAST TWO COMPARTMENTS
~ ..... ~~ -~ ............. ~ ~ -r ~~ ...............................
certify that:
1. I am tamiIiap with the requirements ~oP on-site sewers an~ wells as set
~ort. h b'~ the Municipality oF Anchorage (MOA) and the State o~ Alaska.
2. I will ~nsta11 the system in accopoanc8 with all MOA codes and regulations~
and ].~ compliance with the design criteria o~ this permit.
-5. I wi].i adhere to ali MOA ano State of Alaska requirements for the set back
distances ~rom an~, existing well, wastewater disposal system or public
sewer'age system on this or an~ adjacent o~ nearby lot.
4. I under'stand that this permit is valid fpp a maximum o~ 4 bedrooms and
,Al v E)Fi~Bi"qe[~lent will 'equire an additional permit.
F A LIF'I STA! iON IS INSTALLED IN AN AREA COVERED BY MOA BUt. LDING CODES,
I"HEN (1) AN'ELEC1R].CAL PERMII AND INSPECTION MUS'I BE OBTAINED; (2) AS-BUILTS
~II..L NOI BE APPROVED WI'l"HO0[ AN ELECTRICAL INSPECTION REPORT; AND (5) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
S I GNED'
~PPL I CANl:
ISSOED k ~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99,502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
I t
LEGAL DESOR,PT,O.: ESTATS5
1
2,
3-
4-
5
6
7
8
9
10
11-
12-
132
14.
15-
16-
17
18
19
20-
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED7
SITE P~LAN
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth lo Water ,~ter ~l ~,
Moailoring? /~O/f2.(~ Dale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
I It .~'~1,/ i;:o~/~:,~' 1o - . ~b/.~"t
Z I1,'1~/:Z$ -- ,~0/.K~' .0~
¥ ,,.',5~71:'/5- - ..~ 11.~7
PERCOLATION RATE ~' "'(minutes/inch) PERC HOLE DIAMETER
Z/0 FTAND
TEST RUN BETWEEN . /~' ~ FT
72-008 (Rev. 4/85) J ~
e
TY
MUNICiPAI. I OF ANCHO~I~GE
DEFT, OF H~ALTH &
I~NVIRONMENTA[- PROTECTION
FE~ ~l ? tg88
RECEIVED
WATER WELL RECORD
DEPARTMENT OF NATURAL ~ESOURE
Division of Geological ~ GeophysicM
o '/4qlr,. Section NO. Towr~s,~lPNr'j Range Er1 Meridian
~ Auger ~ detteS ~ 8ore~
PUMPING LEVEL below lend suffac4 end YIELD
~a'~ft. citer .~ hrl. [lumping__
WELl. CONTRACTOR'S CERTIFICATION:
· DF []
~DEPAR'T'MENT OF HEAL'TH AND ENVIRONMENTAL PROFE'CTION
825 L STREET. ANCHORAGE, AK 99501
264-47~2 )
PERMIT NO= 8 .... ~
DATE ISSUED,' 02/12/87
AFFL. ICAN],
ADDRESS:
CON'TACT PHONE:
AND ENTERPRISES ALPINE DRILLING
c,.O. BOX 110496
ANCHORAGE. AK 9951]
345-0202
L..EGAL_ DESt, n,.r':
LO'F SIZE:
_ 99A (SQ. FF. [JR
I certify tha'E:
i. ] am iamiliap with Lhe reo~Jirem~n-Ls ~or on-site sewers and wells as set
~orth ~y the Munic:ipali~y o~ Anchorage (MOA) and the State o¢ Alaska-
~. I w~l]. install the ~sy'stem rn accordance wi'th all ROA codes and regulations,
and ~n compliance with the design criteria o¢ this permit.
3. I will adhere to all MOA and State o~ Alaska Pe~u~pements {or th~ se~ back
distances ~po~~ any existing well. wastewat, er disposal system or public
sewerage system on this or any adjacent op nearby lot.
ISSUED BY
......................... -
1
I
/ /. ~ ... o~..~' ~
SEWER SYSTEM LOCATION. PLAN
~.~{/t~//;~,;~ .......... L~' ' ~ NORTH
~J~'~?**.. · ~"~ ~~- ' "~' ':~OC~~~"" '" '~ fi' ~,~:~:~. ~ ~' ' - · '
':: ;:: : ','ii: ....... :.;.,.on,~-~m~ .... ,,, ::-;,, .
Aunic pa tYot
Anchorage
P.O.I 196650
ANCHORAGE, ALASKA 99519-6650
(9O7) 264-4111
TONY KNOWLES.
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 9, 1987
Alpine Drilling
PO Box 110496
Anchorage, Alaska
99511
Subject: Tract A DeArmoun Estates Subdivision
On-site Well Permit #860346
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1986.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this Department for documentation of the installation and to
close the permit.
If a private engineer inspected the installation of the on-site
sewer system the original as-built inspection report (three part
form) must be sent to this office for review and approval, and
for documentation.
If there are any further questions, please call this office
at 264-4744.
e~elyz
'R.W. Robinson
Program Manager
On-site Services
RWR/ljw
enc: copy of permit
MU~4 I C ~'~L~_ I ]'~'~' OF" ~N~ SE
DERARTME~ HEALTH AND ENVIRONMENTAL PROTECTION
8~5 L S'IREET~~NCHORAGE~ AK ~9~L~]1
264-47~0 ~
F"ERM I T NO:
I)ATE ISSUED:
860546
09 / 15/86
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
ALF'INE DRILLING
P.O. BOX 110496
ANCHORAGE, AK 99511
345-0202
~BOBI>t!V.ISION: DEAR~D EST, TR. A
SECTION: 26N TOWNSHIP: 12N
.99A (SQ.F'T. OR ACRES)
I certi~'y that:
1. I am £amiliar with the requirements £or on-site sewers and wells as set.
¢orth by the Municipalitx of Anchorage (MOA) and the State o£ Alaska.
2. I will install the system in accordance with all MOA codes and regulations~
and in compliance with the design criteria o¢ th~s permit.
~. I will adhere to all MOA and State o~ Alaska requirements ~or the set back
distances ~rom any existing well~ wastewater disposal system o~~ public
sewerage s~stem on this or any adjacent or nearby lot.
APPLICANT: ~FINE D~IN~ .............. DATE: ~___~_.~_~__,~___~_
..' / / /.-" /',./
/ ./ .,'
/
..~
SEWER SYSTEM LOCATION PLAN
~ ~ ~ S~CTION/TOWHSHIP/RANGE ~ _
~1~.~,./;':: ~ ¢~* ~ I PROPERTY CORNERS, WELLS, AND SEPTIC
*{/~,..,,,~ ' * ~' NORTH ~, 0 t-
(3.oo,£o. oo$)
-/
X67891~01
Municipality of Anchorage LiC. 416104
On-Site Water and Wastewater Program -r I AUG 0 2<; •r;LD e'aI
(907) 343-7904 !a
$ A F�
\56
Certificate of On-Site Systems Approval • or 6 8 `'^�
Parcel I.D. 017-152-29 Expiration Date: /l — —I 7
1. GENERAL INFORMATION:
Complete legal description DEARMOUN ESTATES; TRACT A
Location (site address) 13211 Alqarin Circle*Anchorage 99516
Current Property owner(s) Rebecca Johnson Day phone 907-240-8907
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by. Date: 9/ -/
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ S?'v Waiver Fee $
Date of Payment F13111 Date of Payment
Receipt Number Receipt Number
COSA# o c1i1 1339 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: eiZ //
q��oa�pp�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic systemo� •
in accordance with the guidelines and regulations established by the Municipality of Anchorage andeL: V•-QF".. .• (45-'
industry practices. The reported results describe the condition of the system/s on the date/s of the 07 -.• �4 /�—On
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or TH 1/-0 j Vn
encroachments may exist that were not identified during the evaluation. The operational life of all wells ' . 9— , , * 0
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q I
iNs
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and V,. ...� . r� Q
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the V/n1 '-,J f r A. orn Ss;
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of VO m CE/7953
the well or septic system. GEG makes no representation whether an alternative well or septic system o n9's
-.
Pd P .. c+6
can be installed on the property in the event either of the current systems fail to perform adequately in U4 e 2- �f ��o
the future. The content of this report is for the sole benefit of the person/party that retained GEG to %Q ro fCss;on
perform the evaluation. Reliance upon the information provided in this report by any other person or O�OpoQ��
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved %.\`+ UF�fVC
Conditional approval for bedrooms, with the following stip atioG�.
nON-SITE `5,
WATFR AND n
r WASTEWATER
�ROGRHI',/i
:„ _^ �c_c
B %o,.. E Original Certificate Date: L( -I 7
The Municipality of Anchorage 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.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10.12.doc
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: DEARMOUN ESTATES; TRACT A Parcel ID: 017-152-29
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (YIN) YES
Date completed 4/24/87 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 242 ft. Cased to 233 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 4/24/87 6/13/17
Static water level 215 ft. 215.3 ft.
Well production 7 g.p.m. 2 g.p.m.
WATER SAMPLE RESULTS:
Coliform ND colonies/100 ml. Nitrate 2.26 mg./L. Collected by: GEG, Ltd.
Arsenic: < 5.00 ug./L Date of sample: 6/13/17
B. SEPTIC/HOLDING TANK DATA 31 YEAR OLD STELL SEPTIC TANK IS APPROACHING "9'AWAY FROM
THE END OF IT'S USEFUL LIFE FOUNDATION
Tank Type/Material SEPTIC/STEEL Date installed 8/11/86
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) 'YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 6/12/17 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA I•BELOW EXISTING GRADE Al MII I WEST/EASTI
Date installed 8/11/86 Soil rating (g.p.d.lftzor(/bdrrr) 267 System type BED
Length 50 ft. Width 36 ft. Gravel below pipe 0.5 ft.
Total depth '4.4+ ft. Eff. absorption area 1800 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 617/17 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0/3 in. Water added 796 gal. New depth 5/4 in.
Elapsed Time. 122 min. Final fluid depth 3/3 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes. give date -
-THERE ARE TWO BED MTS THAT EXTEND 7"AND 8" BELOW THE INVERT OF THE LATERAL
-LIQUID LEVELS BEFORE TESTING SHOW THAT THERE'S NOT EVEN DISTRIBUTION IN FIELD.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(Y/N)
"Pump on" level at in. "Pump off' level at .• wa er alarm level at in.
• - Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+(ASSUMED)
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '0' Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
'WR#910032
.�,*"I 4_
. .4 , 47
.2I14
G. ENGINEER'S CERTIFICATION : •..
I certify that I have determined through field inspections and4 t IH,
review of Municipal records that the above systems are in
•
conformance with MOA COSH guidelines in effect on this • • . •• •
date. : = f Gar•ess.: Lu a
Engineer's Printed Name JEFFREY A. GARNESS 111�• : CE�793 �=
• J5
Date LICENSE.,4�%>>,5s�S 1+44
#AECC884
(Rev 10112112)
1 Lot 18, Greenbrook Subd. 8460E
I S89°58'03"E 339.65 _
I 30 CD
\
N
0
Well v TRACT A \ ,)f \ �i�p6�eL\
•
sned V�
W
J 90.0 ' ---T8---"---1'-0
XI 0 r• 23.6 1
U N 2 Story o DO
Gravel driveway Frame N
E 3.5 House
Q a h 12.0
O tri
,y
Q a 10.0 0 0
- -..-.-- 7-7
16.O 1
N
co
Of ,
(c)j N C h
h�
o �a� SCALE: 1"= 40'
y
o 4).�
Z Wire fent �o �OP�
Garden--,,e1.\-/- ° Q J.
oO
NJ/ Shed ev-
tems p /
dk------:-.7Seg d'
Chicken coop AS-BUILT NO CORNERS SET THIS DATE
r r ,„44.rVVI,r` I hereby certify that I have performed a Mortgagee's inspection
•ii° OF •A � ' / of the following described property: TRACT A.
' Chain link fence' ��'• ' • ' L; S # OeARMOUN ESTATES SUBDIVISION
•• 4 g t h * •••.9 i Anchorage Re:ording District,Alaska,and that the
ori*• •[[�� * / improvements situated thereon are within the property lines
ffi "";_,CW''' and do not overlap or encroach on the property lying
T st iadjacent thereto,that no improvements on the property lying
30 X16 adjacent thereto encroach on the premises In question and
0 / c.)-•.Fred Wdl d tko . / that there are no roadways,transmission lines or other
�p ,, 'PI. •. 3255 — S ••• at. l visible easements on said property except as indicated
1 e 4F • • • • `' — hereon.
•i o%FESsior:A' �a 9 mir Dated at Anchorage,Alaska
EASEMENTS OF RECORD,OTHER THAN / 11� �`N�� mis 24th day of JULY 20'7.
THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES
Engineers and Surveyors
PLAT ARE NOT SHOWN HEREON. PR Tech. FB 17-4,pg 51 BE
(507-24B-1666)
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
· . On-Site Services Section~:
~ P.O. Box 196650 Anchorage, Alaska 99519~6650
343-4744 ;.
CERTIFICATE OF HEAL.TH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description -j"~ c ~' /~
·
Location (site address or directions) I 3 ~/I A I~, ~r;n ~ re (~-
Property owner
Mailing address
Lending agency
Day phone '5' ~/6-- ~//
Day phone
Mailing address
Agent N ,~1 7'~o/~,.r~ For/'~n~_ ?r~?er/.;~ Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State
lng to the legality and status of system.' :-
TYPE OF WASTEWATER DISPOSAL: : ',~::
Individual
on-site
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.'
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, f[Jnctional and adequate for the number of bedrooms
and type of structure indicated herein. I furth~rverifythat 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.
~ bedrooms.
DHHS SIGNATURE
APproved for
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
, .,~.,.~ / Date /'~.
Th~ ka,~a~i~ of Anchorage Depadment of H~lth and Human Se~ices (DHHS) i~ues Health Authori~
,~A~al Cedifi~tes based only upon the mPmsentstions given ~n ~mgmph 5 above by an independent
~ro~O~ional ~n~in~r m~i,tomd in th~ S~m ct Alaska. Tho DHHS d~ thi* a~ a ~ou ~ to pu rcha~ ol hom~
and their lend ng nstitutions in order to ~tis~ cedain f~eml and state ~uirements. Employes of DHHS do not
~ondUct ins~ctions or anal~e data ~fom a ~ f ~te s ssued. The Mun c pa ~ of Anchorage s not
m~pon~lblo ~or ,~m or omi~lon~ in th~ prof~ional on~in~ work. ~ ~
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "~"r~ck /~ /~_ ~-r~,nc,~<n ~-.c~ Parcel I.D.
A, Well Data
Well type r~r~ ~; ~/-4
Log present (Y/N) ~
Total depth ~ ¥ ~-'
Sanitary seal (Y/N)
Y
if A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~//~ / &'7 Driller /)1~-~
.Cased to '~ 3' 5' Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test ~/ / ?- 5' / 6 7
Static water level ~ ~ ~"
Well flow 7
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ I ¥~ '
Absorption field on lot ~ ! ?-o'
Public sewer main /~. ,A-.
Sewer service line ;> ~-~"
g.p.m.
AT INSPECTION
~/~'
3.5'
--..> '~.1 ~ ~
; On adjacent lots > ~ oo '
; On adjacent lots ;~ t4,o '
Public sewer manhole/cleanout /~, ,~,
Petroleum tank h/o/, ~_
WATER SAMPLE RESULTS:
Coliform ~ cc,/ /'(oc,~n~_ Nitrate
Date of sample: t ~- / ~- / 9 ¥
Collected by:
Other bacteria n ~,~& *~'*~ ~',"~
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~-7 / ,~d' Tanksize I ~5"~ v?,~/ Compartments
Cleanouts (Y/N) ~ ~Foundation cleanout (Y/N) 'r' .Depression (Y/N) /V
High water alarm (Y/N) /~,, H-. Alarm tested (Y/N) ~,/I-.
Date of pumping ~ / ~? / ~ ~' Pumper /~% I~c~'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ t ¥o / On adjacent lots
To property line ~ ? ~ Absorption h~{~ ,
Sudacewater/drainage ~ [O~~
Foundation ~'d'
Water main/service line
72-026 (3~3)* Front CONTINUED ON BACK PAGE
C. LIFT STATION N, ~,
Dote installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water.
D. ABSORPTION FIELD DATA
Date il,Stalled 8 / ~'7 / ~9o~
Length ~5-O ~ Width
Total absorption ama I & oo
Date of adequacy test
Soilrating(GPD/Ft2) ?_d'7' ~3'//3'~r,~-,Systemtype G'~'
Gravel thickness O. ,.5-' Total depth ¥,~5-'
.Cleanout present (Y/N) '~ .Depression over field (Y/N)
Results (pass/fail) />~-~J' for ~
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Alter test
If yes. give date
Well on lot ~ I ~0
To building foundation
On adjacent lots '~
Sudace water ~
Cu~ain drain
On adjacent lots '~
To existing or abandoned system on lot
Cutbank ,~. ,~. Water main/service line
Driveway, parking/vehicle storage area ~-o
/V
Bedrooms
E. ENGINEER'S CERTIFICATION
I cer~[y that l have checked, vedfied, or conformed to all MOA and HAA guidelines~.?~~e~d~ate of this inspect'on.
· ·
·
Engineer's Name "/-~c¢o¢-¢ r~-. /~oo~--d ~ .t,~oDo.,~ ~, =oo,=... ~
·
:; .. ~-~; _
HAA Fee $
Date of Payment
Receipt Number
Waiv~¢ ~'$ '"
Date of Payment
Receipt Number,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
'7-r~c~¢-{- ~4) C~ Ar~o~u~ ~£ }~-J
Location (site address or directions) I-3 2- ~ ! ~r/~.~ ,~-,',~ ~'~,'-~ [~
Property owner
Mailing address
Lending agency
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well ~'~
Community well
Public water
NOTE: ' If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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-D25 (Rev. 1/91) Front MOA#21
=
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm ~(~-~'f 7~c-,~,~co,-( -C~r','~c;¢- Phone
Address /q5-_~o ~c6c~ 51~,~ ,~/~c6of-~¢7~, ~L~
Engineer's signature ,'~~ '~- ~ Date ~-/¢¢ ,/9 2_.
DHHS SIGNATURE
X
Approved for ~(~) bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following
stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a 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 engineeCs work.
72,.025 (Rev. l~1) Back MOA#21
Mu. nicipality of Anchorage
Departmento[~Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Parcel I.D.
A. WELL DATA
Well type />~h~,=<{-~.
Log present (Y/N) Y'
Total depth ~ ¥ ~
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number tV./~.
Date completed.. ~( ! ~-¥ ~ '7 ,. Driller
._, .... Casedto ~,~3~ ~.. ~ .Casing height _. ~-~ .,~.
Y Wires pr~operly protected (Y/N)
FROM WELI~
Date of test
Static water level
Well flow
Pump level ,
SEPARATION.D!STANCES FROM WEI,;L TO:
Septic/holding tank on lot ~'~ ,'
Absorptior! field onlot ~- t
Pul~li(,~,~.i~Ver .main ,~ N,
-Sewer's~e line TM ;> 5~(
WATER SAMP~.I~ESULTS
Coliform ~ 'co(-/IO~ ~.~
Date of sample: :/./.~ t / 9 ~
B. SEPTIC/HOLDING TANK DATA
Datednstalled _ ~ / IJ ! ~d'.r~
g,p~m.
' i On adjacent lots '~ ~. c, g ·
; On adjacent'lots ~> ~c,~, - r~
· Pu~'l. ic-sewer manhole/cteanClut r · ~' ~ ,- ~'' -
,. ~ Petroleum tank N~:~
Tank size '/Eo"~ ,~'~/ Compartments~ ~
Cleanouts (Y/N)' , ~' .,- Foundation cleanout (Y/N) Y'
High water alarm (Y/N) N,.4_ ,'~'~ ~ Alarm tested (Y/N)
Date of puml~'lg.~';/~.:.,,t. ;~' &s.e.. ~'~' /99~ Pumper . .'N,.,~-..
~EPARATION DISTANCES FROMSEPTtCJHQLD NG TANK TO: .-
We [(s)on : ...... 6'&"
~ On adjacent 10ts ~,. IOr=' Fourldation ~ . ,..
· To prdpei~y-lin'~"" '~' ~ '~" Ab$orptm~Wate[mem/servioe line ~. "~',~" ·
Surfacewater/drainage =, ~o~'= ,....,¥ .. , ~ ~,,. . ~ ....
72-026 (Rev. 7/91) Front
C. LIFT STATION ~,!. A,.
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
Mar~ufacturer ~-
Manhole/Access (Y/N)
.....'- '" ~Pump off" level 'at
High water alarm level
Cycles tested
Meets MOA e. tectr ca codes
SEPARATION DISTANCE FROM LIFT S'I;ATION TO:
Well on lot . On adjacent 10tS'-'
Surface water'
D. ABSORPTION FIELD DATA
Date inst~lled
Le~h~th .-b-o,,
To~t~l absorption area'
Depr. essio~' over field (Y/N)
Results (paSs/fell)
Width ~' '
Soil rating '~' 7 ~ /8~r~ S~stem type
Gravelthickness ~', ~" ' Totaldepth
Cleanouts pres, ent (Y/N)
Date of adequacy test
for 5/
q/tG - y/t?
bedrooms
Peroxide treatment (past 12 months) (Y/N) No ' If yreS, give date
SEPAI~ATION DISTANCE FROM ABSORPTION FIELD TO:
Well eh-lot. ~, i .. On adjacent lots ~ ~ '. Prope~'line
To building foundation ~ ~o To existing or abandoned system on lot N,
Onadjacentlots ~. 3~' Outbank N,&. W~termeln/se~iceline
Suflace water ' ~ I~' p~iveway, pa[~i~g/Vehicle storage area ~" "' '
E. ENGINEER'S CER~FiCA~ON '
I ~dify that I have-checked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of th'i~ ins~ction.
Date
HAA-Fee $ /~
Date qf Payment
ReceipbNumbet
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Ba=k MOA 21
Tom Fink,
Mayor
Nlunicipality of Anchorage
· Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
July 23, 1991
Ted Moore, P. E.
Flattop Technical
14530 Echo Street
Anchorage, Alaska
Services
99516
Subject: Waiver Request for Tract A. De Armoun Estates. Subdivision
Waiver Request #WR910032, PID ~017-t~2-79
Dear Mr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 0 feet abutting De Armoun Road.
The
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Concur
//ohn Smith,/p ~;.~
ljw#7
CIVIL & ENVIRONMENTAL ENGINEER~G * ENERGY CONSERVATION & ANALYS~
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 July 20, 1991 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK99519
Dear Sirs:
On behalf or the property owners, we are requesting a waiver of the normally requh'ed 10'foot
separation distance between a wastewater disposal system and a property line down to 0 feet for the
system on Tract A of DeArmoun Estates S/D. A copy of an "as-built" survey of the lot is enclosed
showing the cleanout in the south comer of the soil absorption bed to be 2.5 feet from the property line
abutting DeArmoun Road. The waiver request to 0 feet is to allow for underground projection of the
sewer gravel up to the property line.
While it appears that the excavator, Acreage Systems, and their engineer, Corwin and Associates,
made an error in reporting this system to be 50 feet from this property line, I do not see any mason why a
waiver should not be granted. Since the land on the other side of the property line is a public road fight of
way in excess of 100 feet wide, there is no possibility of existing or future water supply or wastewater
disposal systems being affected by the granting of this waiver. There are no known environmental
impacts associated with granting this waiver request~
Please give me a call if you have any questions on this request.
cc: Whitney Murdoch
P.O. Box 243222, Anchorage
Sincerely,
Ted Moore, P.E.
RECEIVED