HomeMy WebLinkAboutMILE HI BLK 4 LT 3Mile H*I
Block 4
Lot 3
#050-201-20
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP161043
Tax Code Number: 05020120000
Work Type: Septic Upgrade
Permit Effective Dates: March 18, 2016 to March 18, 2017
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: MILE HI
Site Legal Address: MILE HI BLK 4 LT 3 G:0058
OwnerfAddress: DICK KRISTINA J & SAMUEL
21836 WILLSON WAY EAGLE RIVER AK 995779581
Site Mailing Address: 21836 WILLSON WAY, Eagle River Lot Size in Sq Ft: 45738
Total Bedrooms: 4
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: The 1986 well waiver allowing 90 feet separation between the private on-site
well and septic tank does not limit the waiver to the then existing septic tank. As such, the
proposed septic tank is allowed to use the same waiver.
Receive
Issued
A L
MUNICIPALITY OF ANCH®RA ITT
MAR 1,q 2016
6 Gretchgp gJt<u115f
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-201-20
Property owner(s) Samuel & Kristina Dick Day phone
Mailing address 21836 Willson Way, Eagle River, AK 99577
Site address 21836 Willson
Legal description (Sub'd., Block & Lot) Mile Hi, Block 4, Lot 3
Legal description (Township, Range & Section)
Lot Size 45,738 S q. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
Q
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 4
APPLICATION IS AN:
TYPE OF DWELLING:
Date of Payment: 311WI(p
Initial ❑
Single Family (SF)
❑X
Permit No. ft i0f(L 3
(`N/wo ADU)
Upgrade
Duplex (D)
El❑
Renewal
Multiple Dwellings
❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Dis tante:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
property owner or authorized
Permit/Rush Fees:
Waiver Fees:
Date of Payment: 311WI(p
Date of Payment:
Receipt Number: to2Vs�ffa
Receipt Number:
Permit No. ft i0f(L 3
Waiver No.
Permit App_, :-:�.�c.
Pannone Engineering ServiceS uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveCdpanengak.com
March 10, 2016
Subject: Mile Hi, Block 4, Lot 3
Septic Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 1250g sptic tank to be issued for this property.
The existing tank is collapsing. It will be decommissioned per code. Currently the lot is developed. The
proposed system will utilize a replacement 1250 septic tank that will be connected to the existing drain
field. This lot is served by a private well located 90 feet from the existing tank. See WR86-093. The new
tank will maintain this separation distance. The remaining surrounding wells are private. There are no
wells within 100 feet of this system.
1. Upgrade Tank Design.
a. See Sheet 1 of the design package.
2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed
septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: . The existing topography slopes from north to south in the vicinity of the system.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no surrounding wells within 100 feet of the proposed septic location.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272=8218 FAX: (907) 272-8211
SPECIAL PROVISIONS TO SPECIFICATIONS
ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER, DISPOSAL SYSTEMS.
2. SCOPE OF WORK: INSTALL NEW 1,2509 SEPTIC TANK AND DECOMMISSION EXISTING TANK PER CODE.
ol
'\WE\E)\
.0 4BR\GTi��rY
HOUSE
(E) \
\ I
0
WELL/ Wim_ W\N Y
SEPTIC
AREA (E)
200'+
4%4_
DRAIN FIELD (E)
COLLAPSING 12509 SEPTIC TANK (E)
DECOMMISSION PER CODE
INSTALL 12509 SEPTIC TANK (P)
WITH DOUBLE CLEAN OUT BEFORE
AND AFTER TANK .
DESIGN PARAMETERS
INSTALL NEW TANK _
NO. BEDROOM: 4
TANK SIZE: 1,250g
USE:
NEW 1,250g SEPTIC TANK
NOTES:
TANK REPLACE
DRAWN BY:
DRM
PLAN
SS
SEPTIC AREA
(QEF
NC'9N'_M
ABBREVIATIONS
LEGEND FC FOUNDATION CLEAN OUT
WATERLINE/ Tn TANK CLEAN OUT NO.
WELL RADIUS Cn CLEAN OUT N0.
DCO DOUBLE CLEAN OUT
OG ORIGINAL GRADE
•-- NEW SEPTIC- E EXISTING
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
MILE HI, BLOCK 4, LOT 3
SAMUEL AND KRISTINA DICK
31836 WILLSON WAY
EAGLE RIVER, AK 99577
3/10/2016
r05510-:201-2:0)
NOIT N0.
CE 8149 ,•.�
UKILIN
i MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION i✓d.-_
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 �°!�� 7
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
C'�"�/JL, - , �✓ L �'JL�G='��—
PHONE
��l�/��
®'6JEW
❑ UPGRADE
MAILING ADDRESS
�ci,�5—l>
LEGAL DESCRIPTION �y
LOCATION /
NO. OF BEAD 0OMS
U
DISTANCE TO:
WellP'/ /
�^/
Absorption area
/ o ,
Dwelling f c /
/
PERMIT NO.
IT
y
F- Z
LIJ
Manufacturer
Materials
No. of cc m artments
In
Lie. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
y
DISTANCE TO: Well
Dwelling
PERMIT NO.
J0Z
OZF
Manufacturer
Material
Liquid capacity in gallons
O
DISTANCE TO:
Well /
I&V7
Foundation /
Nearest lot line i
i�
PERMIT NO.
w=
W LL U
w
No. of lines
Length of e ch line
Total length f lines
Trench width
Distance between lines
Fz
/
3 inches
R F
finish
Material beneath tile
Total effective absorption area
Top of tile to grade /
C
inches
Length
Width
Depth
PERMIT NO.
Lu
0
F
Type of crib
Crib diameter
Crib depth
Total effective absorption area
a
Wa
W
w
Well
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
PIPE MATERIALS
Cr� - v�
SOILTESTRATING ^^��PRy1/
--
INSTALLER,---
(
REMARKS
f
OF 44
yAe
'� 8000®BB0BB0�
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easoa..Bea B•eae.B Boo oB •�B A
® on Russell L. Oyster o tV
a
APPROVED DATE LEGAL
—' .y ? �
t 14— 1
72-013 (Rev. 3178)
Trr t tie Odtfing T,. g
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588
OWNER OF LAND r` ,-:> _ r ,P DEPTH OF WELL L3<<>
ADDRESS /'` S STATIC LEVEL OF WATER FT.
LEGAL DESCRIPTIO^' ;— 'M " `� DRAW DOWN FT.'
.r ,1 i if i•.['x fu
DATE - Started Ended _ `%! £4' GALS. PER HR
r
PERMIT NUMBER �f F ' = _,' KIND OF CASING_
KIND OF FORMATION:
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MISCL. INFORMATION:
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DRILLER'S NAME
r- I IJ " I ®e I & -r #-e r_-9 F=- F:l r ti Y H r —R F-1 0E:
DEPARTMENT OV --HEALTH AND ENVIRONMENTAL F,,,ITECTION
825 'L' STREET, ANCHORAGE, AK 99501
264-4720
"f/c
4/f /� k �
C_jN—!E-. I -rE-- E: W FEE F;? F=' E F;:.4 M I -r
PERMIT NO. C 780430 '
APPLICANT GENE NEEDLES BOX 8 NEEDLES RD CHUG IAK 688-2419
LOCATION LOWER CANYON DRIVE
LEGAL L 3 8 4 MILE HIGH SUB LOT SIZE 44000 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FTe'BR)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
ED. F= Fm- -v :i- -i L_ E: r-4 im -r = n!- ts 13 F;,: t::o %..# F=- i r> E.: F- -v t- a
THE LENGTH DIMENSION 15 THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GROVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
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.
___ -rw"- < > I " * Fr FE 0 _r 1 1-_i "!F. "F' EF FZ'_ E=_ 0 (1 1 F-0 FEE E:--.
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 15
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:=a DE FR N I -T EE X 1=" I Fz C--* 17F C_ FEE M FS: F= F, FIs , -1 !F4 77 E�
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED :' - - - f — __________
APPLICANT GENE NEEDLES
r 7'�
7% 2
_6z -
ISSUED BY -- ------
r 7'�
V
0 £t E GEOV'CHNICAL & DEVELLr?MENT CO.
o Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Soils Et Foundations �) Land Development
Performed for: Name: Tel. No.�
Mailing Address: 04.T�-o"�--
Legal Description: Lerr- `a -a w ✓�T« ��esw
Death (feet) Soil Characteristics
1 /ne, - 'S l � 3 A)
2
3 i, P, ( M - � r.,=:r�e
4
5
6
9.
10
12
13
14
15
26 /i
Ground Water Encountered: Yes No If yes, what depth
Proposed
Instal-llaattion:
Seepage Pit
Drain
Field /---
---Comments:
Comments:
< �(<<. —
�vz 5441�--IeFcn�
-�s
l ,? 0 "')
Performed by:sy2qw-- Date: .�✓�ln� ��r�
676-
!Jr
Municipality of Anchorage
-% Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. -05a?4�•ao •so COSA #- 00`109SA
Expiration Date: 3 — a9 •- / O
1. GENERAL INFORMATION N�
Complete legal description Mile Mgh SID, Block 4, Lot 3
Location (site address) 21836 Wilson Way, Eagle River, AK 99577
Current Property owner(s) Motliloo Houck Forbes Day phone 917.871-1954
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Audrey Mason, ReMax of Eagle River Day phone 622.3344
Mailing Address 11525 Old Glenn Highway. Eagle River, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
IZI
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 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 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 Douglas T. Kenley, P.E.
Address 9606 Northstar Drive, Palmer, Alaska 99645
Phone (907) 746.1073
Engineer's Printed Name Douglas T. KenleyP•E• Date
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fc
_ ....,4.L��t�
ON-SITE
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: l/ � Original Certificate Date:
(Rev 1185)
I... ._..
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Mile.NrQN SID, Block 4. Lot 3 Parcel ID: 050.201.20
A. WELL DATA
Well type Private
If A, 8, or C provide PWSID #
Date completed 4M/78
Sanitary seal (YIN) Y
Total depth 200 ft.
Casedto 30 ft.
I
FROM WELL LOG
Date of test
4129n8
Static water level
48 ft.
Well production
2 g.p.In.
WATER SAMPLE RESULTS:
Coliform o colonies/100
mL Nitrate 0.42 mg/L
Arsenic: ND mg/l
Date of sample: 11123/09
iW34iIL 2141up 12"LT:I37_wi
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) 28 in.
AT INSPECTION
12/12/09
523 ft.
16 9—
p.m-
Other bacteria o colonies/100 mL
Collected by: F. Kenley
Tank Type/Material Septic/Steel Date installed 6n0n8
Tank size 1250 gal. - Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) r Depression over tank (YIN) N High water alarm (YIN) NIA
Date of pumping 3/16/09 Pumper JRs Purnpers
C. ABSORPTION FIELD DATA
Date installed s10178 Soil rating (g p.d./ft2 or felbdrm) 125 System type trench
Length 41 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth 71 ft. Eft. absorption area 574 ftZ Monitoring tube Y" Depression over field N
Date of adequacy test 12114109••' Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 9-374 in. Water added 1000 gal. New depth 24.114 in.
Elapsed Time: 163 min. Final fluid depth 11-314 in. Absorption rate >,= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & 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 igtt-W-aer alarm level at in.
Dal Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 90
On adjacent lots 100+ ft.
Absorption field on lot 108 ft.
On adjacent lots 1DO+ft.
Public sewer main NIA
Public sewer manhole/cleanout N/A
Sewer /septic service line 25+ ft.
Holding tank N/A
Animal containment areas 50+ ft.
Manure/animal excrete storage areas 100+ It.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 19 ft. Property line18 ft•
Absorption field 10 rt.
Water main 25+ ft. Water service line
10+ft. Surface water 100+ ft. -
Wells on adjacent lots 100+ ft.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 18+ ft. Building foundation
31 ft. Water main N/A
Water Service line 25+ ft. Surface water 100+ ft.
Driveway, parking/vehicle storage '""5i•�°^"^"'
Curtain drain 1,1 •keOWe ort Wells on adjacent lots
100+ft.
F. COMMENTS: See attached letter.
G. ENGINEER'S CERTIFICATION 00`: '"s ;•%1
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in r
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Douglas T. Kenley �r��j• Et7L o�'+t
Date 117j�t•22
COSA Fee $ Z� Waiver Fee $
Date of Payment 1.2- -2 -3- e Dale of Payment
Receipt Number O YS 3 G Receipt Number
(Rev. 11/05)
moo.
-
O
gr `�
$e!' ti
AS -BUILT
uP1iI"
I hereby certify that I have surveyed the following
n
described property'
i],
�, T R I wl -Ir A-1
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property
.. - — ,•.1�
lines and do not overlap or encroach on the property
o rbi
lying adjacent thereto, that no improvements on prop -
�V
-< r
e ��•"" t">�
erty lying adjacent thereto encroach on the premises m
,_i �•,; �\,,.,,....,`�„ �•
question and that there are no roadways,'transmission
t
hues or other visible easements on said property except
indicated hereon.
as
<,�,up<r.��...��,e���,.,,� ••• r
Dated at Eagle River, Alaska
...fr. ,
"'•.+-
thi• //1 ay dof Pre -S Ig78
Cobert C. Jr_.
o+
�•'
ROBERT C. JOHNSON ;i'Q,
� � `;'y�>
SCALE: � Registered Land Surveyor No. 60 -LS
I" o / 00 Box 456, Eagle River, Alaska
Phone 604-2543
— sres'd -
SGS Ref.N
1096316001
Client Name
Douglas Kenlcy P.G.
Project Na me/01
09112
Client Sample ID
21836 Wilson Way Outside I lose
Matrix
Drinking Water
Printed Datelrime
12/042009 9:33
Collected Datc/rime
11232009 14:30
Receised Daterrime
11232009 16:00
Technical Director
Stephen C. Ede
Sample Remarks:
Alloxahlc
Prep Analysis
Parameter
Results
M)I.
knits
Method Container lD
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
rP200.8
C
(<10)
1124/09 12/01/09
NRR
Waters Department
Total Nitratc7Jitrite-N
0.420
0.100
mg/l,
S%1204500NO3-P
It
(<10)
12/03/09
RJT
Microbiology Laboratory
Colony Count
0
col/100mL
S\120922211
A
(<200)
1123/09
DLC
Total Coliform
0
col/100mL
SM20922213
A
(<I)
1123/09
DLC
rccal Coliform
0
col/100m1-
SM20922213
A
(<I)
1123/09
DLC
December 22, 2009
Mr. Jeff Poet
MOA On-site Services
Re: Mile High S/D, Block 4, Lot 3
Comments regarding the septic system:
*Foundation cleanout is located inside the garage in the cement floor.
"Monitoring tube that was referred to in a previous health authority certificate could not be located.
Bob Dean of Dean Construction was hired to drive a new monitoring tube into the leach field with a curb
riser because it had to be driven in the driveway.
' *JRs Pumping put 1,000 gallons of gray water into the tank to test the septic system, at which time we
could determine, with the new monitoring tube that had been driven, that the water was reaching the
leach field and rising.
• ••'A distance waiver of 90 feet from the tank to the well, dated 7/10/86, is on file with the
Municipality.
'"•' According to a surveyor's as built dated 12/11/78, the leach field was at that time beside the
driveway. The driveway was subsequently relocate4and the leach field is now under the drivewa
�G1L.t 1✓�t s '� Y! ? �r s rn leis C
/1.�t� 0� lig Si► J./?
Comments regarding the well:
There is a 500 gallon storage tank in the garage. Because of the low producing well, the well test was
done on 12/12/09 and the septic system test was done on 12/14/09. A four-hour well test produced 1.6
GPM
1�1 f pt
Douglas T. Kenley, P.E.
5. ENGINEERING, FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm _, &R) �-A'2rN P — ze ka r-- Telephone 344
4
Address 7 /a 7 CEJ <7 Hew
Date 7/1/616
WATER WELL NOTE: This Health Authority Approval inspection merely
certifies that the subject water well produced 150 gallons per
bedroom per day and that certified laboratory tests showed no
presence of coliform bacteria in a sample of that water. No warantee »' �aa. 'S
or certification is expressed or implied concerning the long term EJa a°••71
adequacy or safety of the water supply.
f
ON• -SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval J°°° 'ne
inspection merely certifies that the subject on-site sewage disposal
system accepted at least 150 gallons of water per bedroom per da NEIL HA% '
Y P 9 P P Y i3
as determined by methods approved by the Municipality of Anchorage ����"9.°•� CE -43G >
Department of Health and. Human Services. No warantee or �ijJfC'ia„°°•.a. ✓.
certification is expressed or implied concerning the long term ®p��1OfOSSi11` rJ
adequacy of the on-site sewage disposal system. Construction data
reported ;on buried system components is from MOA files and was
:not verified during this inspection.
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work..;:
Page 2of2
MUNICIPALITY OF ANCHORAGE (MO`A�
LTH AUTHORITY APPROVAL (HAA)
^ CHECKLIST - FEBRUARY 1984 .
264-4720
Aal Description:
A. WELL DATA 6�4� o�y\a J t 1 !JP.
is i 1A�
Well Classification If If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) VeS �'�Date Completed Yield
Total Depth OZW—' Cased to Depth of Grouting N�A
Static Water Level 54, Pump Set At aAlKAMW Al
Casing Height Above Ground 3 Sanitary Seal on Casing (Y/N) 114—S
Electrical Wiring in Conduit (Y/N) 006 y I I Depression Around Wellhead (Y/N) Ad
Separation Distances from Well: 01
To Septic/Holding Tank on Lot 940 ; On Adjoining Lots Aaa
To Nearest Edge of Absorption Field on Lot /08+ ; On Adjoining Lots
To Nearest Public Sewer Line e" To Nearest Public Sewer
Cleanout/Manhole /0 To Nearest Sewer Service Line on Lot
Water Sample Collected by ; Date G - ZG - $"rn
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed d,--10 8 Size A9.S'l> o.44 No. of Compartments Z
Standpipes (Y/N) Vee Air -tight Caps (Y/N) ye -5 Foundation Cleanout (Y/N) /V40
Depression over Tank (Y/N) AZO Date Last Pumped 6a- ZEA" 0'4
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) ✓ Temporary Holding Tank Permit (Y/N) 4'4
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 9Q To Building Foundation
To Property Line i&
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-026(11/84)
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1,2S g /
Type of System Design
Date Installed _ Jgrp �d Length of Field.- S1/41
Width of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area 575� Standpipes Present (Y/N) V&—S
Depression over Field (Y/N) &10 Date of Last Adequacy Test 30—$6
Results of Last Adequacy Test 44 CpuAT G y xo /h
Separation Distance from Absorption Field:
To Water -Supply Well /Otl To Property Line /S
To Building Foundation To Existing or Abandoned System on
Lot O G 7eA ; On Adjoining Lots /GO'
To Water Main/Service Line 46 To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area ep '
Comments /7P /P Lp ,v idCwAy
D. LIFT STATION n /
1 V IA
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted
I certify that I
Signed
Company A&J1
Receipt No.
Date of Payment _
Amount: $
Page 2 of 2
72-026 (11/84)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
m Rating Against HAA Request **
eyr ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date 7 ��
— MOA No.
�S 0 ...
"
NEIL HAWTHORNE
®2 % CE - 4369 AY
AY
�����/�/�,• a ve [[[,,,
A® AY°•e•a•e^°•��%4
Municipality
of
Anchorage
July 10, 1986
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907)264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Neil Hawthorne
NHawthorne-Engineering
7127 Old Seward Highway
Anchorage, Alaska 99502
Subject: Lot 3 BLock 4 Mile High Subdivision
Waiver Request, WR86-093
Dear Mr. Hawthorne:
You request for a waiver of the 100 foot separation distance required
between the well and septic tank on the subject lot has been approved.
This distance has been waived to 90 feet.
This waiver is valid for the existing four bedroom single family
dwelling only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
A V H A T ORNE-EN OID I V EERIN RSG
7127 OLD SEWARD HIGHWAY
ANCHORAGE, ALASKA 99502
907-344-4711
July 2, 1986
Stephen Morris
Anchorage Dept. of Health and
Human Resources
825 L Street
Anchorage, AK 99501
Re: Lot 3, Blk 4, Mile High Subdivision
Dear Steve:
Please consider this a request for a waiver of the separation
distance requirement from a septic tank to a private well. The
distance separating the two on the referenced lot is 90 feet.
A well log and soils log are enclosed. The well is uphill and
through the house from the septic tank.
Y:�yo
1
Neil Hawthorne, PE
NH:ck
Enclosures
,4
AVOW
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF "LTH & ^I
I-
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI �{'I/IRONN�ENTAL PiOI ECiION
L
825 L Street - Anchorage, Alaska 99507
AUG
ENGINEERING DIVISION r7 �
ENVIRONMENTAL
Telephone 264-4720 EF rr FF
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEFP'99LIVI
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing,,
-
1. PRO RTY OWNER
P ONE`�;)q I
MAIL G ADDR ESA ,5-1,o
PROPERTY RESIDENT Of di fere t from abo
PHONE
(n � i
�-
-
2. BU R
*ATTACH WELL LOG. Awell log is required for all wells drilled
PHONE
MAILI ADDRESS -
3. LENDING INSTITUTION
PHONE
i
_ --
MAILING ADDRESS
4. REALTO GENT
PHONE. (�
MAILING ADQREI3S
*c
U
5. LEGALrPESCRIPTION
STREE LOCATION
it
6. TYPE OF RESIDENCE -
NUMBER OF BEDROOMS
❑ One ❑ Four ED Other
�7
`V —SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Three ❑ Six
7. WATER SUPPLY
-
INDIVIDUAL*
*ATTACH WELL LOG. Awell log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
_ --
IL♦� INDIVIDUAL/ON-SITE**
**If individual/on-site, give installation date
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)
THIS SIDE FOR OFFICIAL USE ONLY, f
-
INSPECTION APPOINTMENTS
DATE RECEIVED-;�
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED r
y
INSTALLER
�tn✓1�
❑Septic Tank or ❑ Holding Tank
Size: Q s'k) If Tank is homemade
give dimensions:
SOILS RATING
DSJ
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL T Q
4. DISTANCES
WELL TO:
-Septic/Holding Tank -
Absorption AreaSewer
Line
Nearest Lot Line
Absorption Area to nearest Lot Line -
5. COMMENTS
M� tN
PPROVEDFOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter st accompa y ertificate)
($7/DISAPPROVED
DATE BY (Ti le)
LEGAL DESCRIPTION .
72-010 (Rev. 3/78)
AIN(J1G'U,GL, ALA. K/. 99501
J,
zY
August 8, 1979
Gene Needles
Post Office Box 8
Chugiak, Alaska 99567
Subject: Lot 3 Bloc} 4 Mile High.Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1) A well log is submitted to this department.
The top of the well casing sealed with a sanitary seal
so that it is water tight.
The water analysis report be delivered to this office
from Chem Lab, 5633 B Street, for our review.
Please notify this department for a re -inspection when the
noted descrepancy has been corrected. If there are any
further questions, please contact this office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Security National Bank
Mortgage Loan Department
880 H Street 99501
Audrey Mason
% Totem Realty
724 East 15th Avenue 99501