HomeMy WebLinkAboutMANN BLK 1 LT 2Onsite File
Mann
Block 1
Lot 2
#020-041-20
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
N,�Mlz
PHONE pijqcr,
-ONVV
UPGRADE
MAILING ADDRESS
c2'1071�� zi�/_V.
LEGAL DESCRIPTION
kot'2' 9/oai� I P&Ivyy 7_141 S�rD-
LOCATION
S,
NO. OF BEDROOMS
LJ �4
DISTANCE TO:
—
Well.
Absorption area
D
PERMIT NO
86 -0303
1- 2
a. <
Manufacturer
No. of compartments
Licl. capac in gallons
IF HMEM"ADE:
- Inside length
Width
Liquid depth
6 �4
DISTANCE TO:
PERMIT NO.
10 2
0 �:
X
Manufacturer -M—aterial—_
Liquid capacity in gallons
DISTANCE To:
—lines
Well
Foundation
Nearest lot line
PERMIT NO.
w
No. of
Length of each line
Total length of lines
Trench width
Distance between lines
CFC
____UFaterjaI
inches
C�2(
Top of tile to finish grade
—I)eneatil tile
Total effective absorption area
0 __
inches
Lengt
�_5_
Width
Depth
PERMIT NO.
a's,-
I L9-520,1(23
<
r. 11
Type of Crib AJI&
Crib dia
Crib depth Aj/4
Total effective absorption area
uj
U1
U)
DISTANCE TO:
Well
Building foundation
Peo <�q s4_
Nearest lot line
/145- 1—
Class
Depth
Driller `
Distance to lot line
LU
DISTANCE TO:
Building foundation
Sewer line
Septic tank
!s)
OTHER
PIPE MATERIALS
CA6+-
SOILTEST ATING
INSTALLER
2
REMARKS
FIT
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43'
APPROVED DATE
LEGAL
�-v I, �Muv. 0!/0)
WELL LOG
Date Drilleds 5-30-8a'
Static Water Levelo feet
Draw Down N/A feet
TyE2 Material Drilledt
0 feet to 2 Peat
2 feet to 19 Gravel w/water
19 feet to 129 Bedrock
to
to
to
Hefty Drilling
S.R.A. Box 1553 H
Anchorage OA laska
9950?
L,., 2 Blk. I
Mafln Subd.
Gallons Per Minute 40
Total Feet of Nksing_ �22
0
0
0
-po 0
PERMIT NO:
DATEll IGS"),IF. D:
APPLICANT:
AD�REgS:
���fi I "h 0 JL IE K
:4 ll����
DEPARTMENT Lx
HEALTH
AND ENVIRONMENTAL �OTECTION ^^
825 L
STREET,
ANCHORAGE,l AK 99501
264~4720
��-11. 11-11-
�k, �, p EE �,
F �ll,-. 11
\ ��
A50303 ENGINEER2D
DESI8N
'
06/14/85
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIzE:
NORTH BANK CONTRACT,
2726 TELEQUANA
ANCHORAGE -9 AK 99503
268~6850
�UBDIVISION: MANN LQT: 2
SECTION. 2 TOWNSHIP: 11N RANGE: 3W
87120 (SU.FT" OR HCRUS>
I certify that:
1" I am f'amiliar with the requirements f'or on-site sewers and wells as set
forth by the oA, Anchorage (MOA) aQd the State of' Alaska.
2" I will inst�ll the systexo in accord�nc� with all M0A codes and regulations,
and in compliance with the design criteria of' this permit.
3. I will adhere to all MOA and State o Alaska requirntiii for the i7i;et back
distancesi� f,rom any elxisting we1l, Wilk stewater diSir.:)os�Al sy5tCM) or public
seweragc-1 system on this or aOy adjacent or nearby lot"
711i: A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN CO AN ELECTRICAL PERMIT BE OBTAINED; (2) AS.BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INGPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST D ELECTRICIAN.
SIGNED
;nr�----------�-~�-~~-�~��~�~~ --�-~-~
APPLICAN O
ISSUED B DATE:
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JOB
ALASKA ENVIROV 'ENTAL SHEET NO.
0 F
CONTROL SERVlk,�S, INC.
1200 West 33rd Avenue, Suite B CALCULATED BY— DATE
ANCHORAGE, ALASKA 99503 CHECKED BY DATE
(907) 561-5040 /1 ,
SCALE . .. I
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41-1
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ALASKA ENVIROt' 7NTAL SHEET NO. OF 41
CONTROL SERVIL�j, INC. CALCULATED BY— w� t
1200 West 33rd Avenue, Suite B DATE
ANCHORAGE, ALASKA 99503 CHECKED BY DATE
(907) 561-5040 r
SCALE
PROW 20�1 CAI�tb
W 1,�. G,�o M. 01471
JOB 4- -/ �� 4- / "2 /;
ALASKA ENVIROP' ':NTAL SHEET NO. - 3 OF
CONTROL SERVIGri, INC. CALCVLATED BY- 12
1200 West 33rd Avenue, Suite B — - 42/� DATE
ANCHORAGE, ALASKA 99503 CHECKED BY DATE
(907) 561-5040 c
SCALE-- - 1V7 �
PRM ml lk wm M'. 01411
ALASKA ENVIRONMENTAL
CONTROL SEM S, INC.
1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
Phone 561-5040
v;
SHEET NO. - < /
OF
CALCULATED BY ---Z
DATE
CHECKED BY DATE
SCALE
PRWM ml 1� G'M� M� mv!
ALASKA RIUMPTAL COnTROL
�nqineerinq & Cnuironmenlal Studies
SeRUIUS, InC
SPECIFICATIONS FOR ELEVATED BED—DRAINFIELD SYSTEM
— LOT 2 BLK 1, MANN SUBDIVISION
1.0 GENERAL
1.1 THE DRAWINGS SHEETS I THRU 4 SHALL BE A PART OF
THIS SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, THE
CONDITIONS OF THE PERMIT, AND ALL APPLICABLE RULES
AND REGULATIONS CURRENTLY IN EFFECT.
1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE
VERIFIED OR MODIFIED IN THE FIELD BY THE CONTRACTOR.
1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR INSTALLER TO
OBTAIN ALL NECESSARY PERMITS, EASEMENTS, OR WAIVERS
REQUIRED FOR INSTALLATION OF THE SYSTEM.
2.0 SEPTIC SYSTEM
2.1 THE SEPTIC TANK SHALL BE A UPC APPROVED TWO COMPARTMENT
TANK, SET LEVEL, AND INSULATED WITH AN OVERLYING
LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE. THE SEPTIC
TANK SHALL REST ON UNDISTURBED SOIL.
2.2 INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER—
TIGHT CALDER COUPLINGS. PIPING SHALL BE 4 INCH SOLID
PVC SLOPED A MINIMUM OF 1/4 INCH PER FOOT, WITH A
MINIMUM OF 4 FEET OF COVER. IF LESS THAN 4 FEET, USE
I INCH OF POLYSTYRENE FOR EACH FOOT OF COVER LESS THAN
4 FEET.
2.3 CLEANOUTS SHALL BE INSTALLED WITH CALDER COUPLINGS,
CAPPED WITH AIR—TIGHT JIM—CAPS (OR EQUIVALENT), AND
EXTEND A MINIMUM OF 3 FEET ABOVE GROUND LEVEL.
2.4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE
HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE
DRAINFIELD.
3.0 ABSORPTION AREA
3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO
2.5 INCH AND FREE FROM SILT OR SAND.
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION
SHALL BE PLUS OR MINUS 2 INCHES WITHIN LEVEL.
3.3 THE NSF SAND FILL SHALL HAVE AN EFFECTIVE SIZE OF 0.4
TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE
THAN 4.
3.4 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR
1200 West 33rd Avenue, Suoe B * Anchoraqe, Alasko 99503 * (907) 561-5040
POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL.
3.5 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE
DRAWINGS. IT SHALL BE RIGID PVC, ASTM D-3034.
THE SECTION BELOW GROUND LEVEL MAY BE EITHER DRILLED
0.5 INCH HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF
THE PIPE OR A REGULAR SECTION OF PERFORATED
DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION
WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER
RAIN -CAP (JIM -CAP OR EQUAL) SHALL BE PLACED ON THE
TOP OF THE PIPE.
3.6 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED
BUILDING PAPER OR A NONWOVEN FABRIC (SUCH AS MIRAFAR
FIBRETEX 200 GRADE, POLY -FILTER X, OR EQUAL.)
3.7 IF INSULATION IS USED RATHER THAN MOUNDED BACKFILL,
THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM
BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD
OF THE REQUIRED THICKNESS (I INCH PER FOOT OF SOIL
LESS THAN 4 FEET OVERLYING THE BED).
3.8 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE
CLOVER AND RED FESCUE MIX, OR BLUEGRASS.
3.9 IT IS CRUCIAL THAT CARE BE TAKEN IN CONSTRUCTION OF
THE BED TO ENSURE PLACEMENT INTO THE PROPER SOIL
STRATUM FOR PROPER OPERATION OF THE SYSTEM.
4.0 INSPECTIONS
4.1 A MINIMUM OF THREE INSPECTIONS SHALL BE REQUIRED;
THE FIRST INSPECTION SHALL BE OF THE EXCAVATION PRIOR
TO THE PLACEMENT OF THE NSF SAND FILLER.
4.2 THE SECOND INSPECTION SHALL VERIFY THE INSTALLATION OF
THE NSF SAND FILL� BEFORE GRAVEL AND PIPES ARE
POSITIONED.
4.3 THE THIRD INSPECTION SHALL INCLUDE THE GRAVEL, PIPES
ALL CONNECTIONS AND BARRIER MATERIAL/INSULATION� PRIOR
TO BACKFILL.
4.4 IF AECS DOES NOT INSPECT THE INSTALLATION, AS DESCRIBED
IN SECTION 4.0, THEN AECS IS NOT RESPONSIBLE FOR DESIGN
OR INSTALLATION OF THE SYSTEM.
Q -'SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TE�Tr)
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: A)(2V- &11� 00014c4JOCIS DATE PERFORMED: �E5�/
L /- T 11 Pi J�'-5 wi ��, -1,
LEGAL DESCRIPTION:
5-E §:-� j
(FEETI
Lrp L
'SILT�-
440 oti S�4 t4
SLOPE
SITE PLAN
v 11 ��M
F-�o
10-
2 -
k . . N . I
3 --
PEA T
P+
M�.
ifA.1,�I. A4
e90-"7"6;6HA( C0664
-,A'r&6 A7- 125Q.2AA
-71
K4,fd. e
9
Date
Tim
Net
Time
Depth to
Water
Net
Drop
10-
11 -
12 -
13 -
14 -
15-
16 -
17 -
18-
19 -
20 -
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? -70 5--o-str
9- 1 4�- --2v - ,
oil
Reading
Date
Tim
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY: N-cf";�5 �C*
CERTIFIED BY:
72-008 (6 /79)
----(rninutes/inch)
FT AND -- FT I
DATE:
9--��OILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATZION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 1v1')y-4L �Okl com S �v
to DATEPERFORMED:
T- it V, le3 (t) 5rc.
LEGAL DESCRIPTION:. 6(0�4
SLOPE SITE PLAN
I A , � -
2:q qf'� F+
ec C
3
4
6
7
8 v
w
10
11 WAS GROUND WATER S
ENCOUNTERED? 5 L
-0
12 P
IF YES, AT WHAT E
13 DEPTH? -'5-1-3-6 5-
14
15
16
17
18
19
I I /U
0
Reading
Da te
G
N� �t
Depth to
Net
Time
Time
Water
Drop
'71
10 PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN F T A N D F T
COMMENTS ke,,�-ej )Q!j 0Zt"It? S-ro 1� 0, eq k(oc"' � 4&.( L &Z"
"I �n -2:i� 10�
j
PERFORMED BY:
7 2-008 (6/7 9)
cov CERTIFIED BY:
DATE:
Parcel l.D
020-041-20
Municipality of Anc
On -Site Water and Wastewater
(907) 343-7904
Certificate of On -Site Systems
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Mann, Block 1 1 Lot 2
16001 Elizabeth St.
JUN 0 8 20116
Expiration Date: 01-aq. I (Q
Current Property owner(s) Gregory & Janice Clayton — Day phone
Mailing address
Real Estate Agent
351 E International Airport Rd. Anchorage, AK 99518
2. TYPE OF DWELLING:
Rx Single Family (w/wo ADU)
El Duplex
R Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
FX
Individual
El
Individual Water Storage
El
Holding Tank
Community Class Well
El
Community
Public Water System
El
Public Sewer
El
WaiverNariance request for:
Received by: Date: 4�'/Q_9 L,�-01_
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ _572,6-oo Q-10
Waiver Fee $ 59
Date of Payment Date of Payment (Q Z2,5_'? //(9
Receipt Number 0 Receipt Number 0-3o? F� &-
COSA# QXe"(,ot 2d S' Waiver# OSV/6'/074
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal aPj ed.ti and as of the validation date shown below, I verify that my investigation, based on procedures outlined
11 s Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
in the CertiflcE V%
disposal system is (are) safe, , f6iiclional and adequate for the number of bedrooms and type of structure indicated herein. 4 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe 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 soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being sewed by the system. These condifibns
are outside the control of [he evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above,
Name of Firm Pannone Engineering Services LLC
Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
En . gineer's Printed Name Steven R Pannone Date 6/7/2016
6. DSD SIGNATURE .. ....
System #1 Approved for bedrooms -Sl- vein w.
CE -8149
System #2 Approved for bedrooms
AW
Disapproved
Conditional approval for bedrooms, with the following stipulations:
KA -L
By Original Certificate Date:L-2—q -16,-�.
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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbl.eshee[S - ., c
If more than I septic system is on the -lot:
COSA Checklist# '_- of
Structure smed by this systehi 1
Certificate of On -Site Systems Approval Checklist
Mann, Block 1, Lot 2 02-0--0,420 -
Legal Description., Parcel,'ID:
A. WELLDATA
Well type PrivaI;e If A, B, or C p.Fovide PWSID # Well Log (YIN) Y
5130/ 5 Y ed (Y/N) Y
198 , Sanitary seal (Y/N Wires properlyprotect
Date completed
Total'ideptfl 22 12+
ft. Cased to t Casjng height (above ground) n.
FROM WELL LOG AT INSPECTION
5/30/1985 5/17-12016
Date of test
0 Unknown*
Static water level ft.
4o,- &0+'
Well production 9 -p -m -
WATER SAMPLE RESULTS:
Coliform es/100 mL Nitrate mg/L
_��eg_coloni� ND
N D ug/L Date of s�ample: 5/1'7[2016 toile PES
Arsenic cted by:
B. SEPTICIH'OLDING TANK DATA
Tank TypefMaterialSeptic/Steel lN18/1985
Date installed
Tanksize 1,500 gal. Number of Compartments 2 Cleanouts (Y/.N) Y
Foundati6n6Ieanput(Y/N)_K_ Depression. over tank (Y/N) N. Highwater alarm (Y/N) N
Date of pumping 5/4/2016 Pumper Isaacs- Rumping -
C. ABSORPTION FISID DATA
6118/1985 5 SF/8,R -Bed
Date installed Soil rating (g.p,dM orfl:21bdrm), System Itype
Length45� 0-5
ft. Width ft._ Gravel below pipe ft.
T 4tft-,4 3 o6ion 6 re6(11'25%1 be Y Al IdN,
btal 4 Yt. tff. abs Monitoring tu Deoressiorn over flei
Oass
of ad
6 Re For bedroomS
Date equoytesi 51171,201 - i
,suits (Pass/Fel!) __ -I , I . .
�0
FI d dio'th In absfttibn field befdr6 te6t, 0 in. Water addeJL�_ gaL New dept _.In.
90 750+
Elap.s#d Time: mh�% "Final flulddepth 0' In. Absorption rate >= g.p.d.
No
Any.rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Si,ze in gallons
Manhole/Access (Y/N)
'Pump on" level at in. "Pump off" level at
in. High water alarm4evel at in.
Datum Cycles tested
Meets alarm &-circuit requirements?
E.- SEPARATION DISTANCES
WELL ON LOT Td:
Septic tank/lift station ory lot 100+
—
On adjacent lots 100+
Absorption field on lot 100+
On adjacent lots 1 004M
Public sewer me I i:n 75+'
Public sewer manhole/cleano 100+'
ut
Sewer /septic service line 25+
Holding ta, 100+ .
nk
Animal containment areas 50+
Manure/animal excrete storage areas 100+
SEPTICIHOLDING TANK ON LOT -TO:
Building-fo6ndation 5+ Property line 5+
Absorption field 5+.
10+ line
Water main Water service
10+ Surface water 100+*
Wells on adjacent lots 100+�
ABSORPTION FIELD ON -LOT TO:
Property line lot Building foundation 10+ Water main 10+
-10+ 1 OQt** '1()+
Water Service line Surface water Driveway, parldrigi.vehicle storage
50+
Curtain drain Wells on adjacent lots
100+
F. COMMENTS
-**Pond is no Ion -er
g xisting
G. ENGINEEFSPERTIFICATION
I certifyffiat I have determined through field irispections and
review of Municipal records that the, above. system�� are in,
conformance with MOA COSA guidelines in effect on this d�ite, ii
Steven Panis
Engineer's Printed Name
Date 6/7/26 16
COSA canary sheet-2-6-15.doc
V r. " .
iiioQr. �,
t
Municipality of Anchorage
P.O. Box 196650 * 4700 Elmore Road
Anchorage, Alaska 99519-6650 * (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.orglOnsite
Development Services Division
On -Site Water and Wastewater Program
t
X
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV161070
PID#: 020-041-20
COSA#: OSC1 61218 Permit#:
Legal Description: Mann, Block 1, Lot 2
Engineer: Pannone Enaineering Services
Applicant: Gregory & Janice Clayton
The following separation distances are approved.
1. 55 feet between the existing onsite septic tank and surface water.
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
7 The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver.
Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
X Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted: f
Date: /a Approved by:
....... / I oTeviewer
4 ...................................... V.a!T� .......................
Pannone Engineering ServiceS LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveC@Panengak.com
June 20, 2016
Subject: Mann S/D Block 1 Lot 2
Septic system to Surface Water Waiver Request
I am writing to request a waiver of the separation distance from the existing septic system to a newly
constructed pond on the property. When the septic system was installed in 1985, it met all the separation
distance requirements. The owners of the property constructed a small pond on the property 59 feet
away from the septic. This pond was recently mapped as a small intermittent open channel drainage by
the MoA WSM. When FES conducted our COSA investigation we searched for surface water due to the
Note on the file. This intermittent drainage was dry on May 17, 2016 as was the pond located
approximately 55 feet northeast of the drain field. The owners recently constructed a small wedge-shaped
berm between the pond and the septic tank. The berm is constructed at a 6% cross -grade towards the
tank and a 6% longitudinal grade to the west such that any spilled sewage will overland flow in excess of
100 feet before it enters the drain
channel.
1. Surface Water: There is an intermittent drainage within 100 feet of the existing septic tank (PES
measured 59 feet to the nearest point.) Using an earthen berm system (see attached picture) the existing
septic tank will maintain an overland sheet flow of at least 100 feet from all surface water and drainage.
2. Topography: The existing overall topography slopes to the west at approximately two to six
percent.
3. Waiver: We are requesting a waiver for the separation distance from the septic tank to surface water
of 55'. The surface water is approximately 59'± from the septic tank. Construction of the earthen berm
system extended the overland sheet flow distance to greater than 100' from the existing system to the
surface water.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
Approving this waiver will not affect public health nor wil I it pollute the groundwater.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
u
FLI�l NU, bb—lUb
MANN SUBDIVISION
LOT 2, BLOCK 1
95o919 S.F,
BUILDING DETAIL
SCALEb III
-20'
AS -BU I LT
I HEREBY CEFMFY THAT I HAVE $UR\'MD THE
GASTALDI LAND,
PROPERIY DEPI=D A$OVE AND THAT NO
SURVEYING, LLC
ENCROACHMENTS EXIST EXCEPT AS INDICATED,
7 IS THE RESPON$IBILITY or THE OWNER TO
JErr A. GASIALDIP R.LS.
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
2000 E� DOWUND RD,, SUIIIE 8
COVENANTS OR RESTRICTIONS WHICH DO NOT
ANCHORAOE, ALASO 99607
APPEAR ON THE RECORDED SUBDIVISION PLAT,
PHONE 248—U454
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
GRID
DATE
HEREON IRE USED FOR CONSTRUCTION OR FOR
SW323�
6/24/2010
ESTABLISHING BOUNDARY OR FIENCE UNES,
ANCHORAOt REOORDING I)IMICT, ALASM
F.131
JOB No.
MV
NOTE: NO CORNERS $E7 THI$ DATE
OF
)RIVEWAY CON71NUF$
To LOT i
miory & youtom e
"50"
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date — le) - � -y<
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, sul�clivision, section, township, range)
"7- 7, �IdALJ -5-oon' —///A) SJ PJ J Fe- 0,
Location (address or directions)
(b) Applicant Name Telephone: Home --- Business
Applicant Address 5�1-�Iw�A14 4Veell 1k. ��5—oj
(c) Applicant is (check one): Lending Institution Owner/builderX; Buyer 1:1 ; Other El (explain);
(d) Lending Institution
Telephone
Address
(0) Real Estate Company and Agent N /A
Address
Telephone
(f) Mail the HAA to the following address:
- V 1 �4 (� / L / ,, �'-' -1i 1,Y) �2 C, �� - - b 1� '�: Z
� 10 �
2. TYPE OF RESIDENCE
Single-FamilyX MUlti-Farmly Other
Number of Bedrooms
3. WATER SUPPLY
Individual WeIlX Community El Public El
Note: If communitywell system, must havewritten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
OnsiteK Public EJ Community 0 Holding Tank EJ
Note: If communitywoll system, must have written confirmation from the State Departmentof Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 0 1184)
/_ Z"61
5. ENGINEERING FIRM PROVIDIN-, iNSPECTIONS, TESTS, FILE SEARCH, 0), ANDINFORMATION e
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 insoection.
Name of Firm
Address 17 -eV 4)
Date
6,WWae-
44172-
�'4,1 r-, Telephone
ngin al %
9 10 Qp ro 00' 30r� 302,JaM
Lr)roy 1, 1 F,
NO.
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6. DHEP APPROVAL
y
Approved for bedrooms b ate
Disapprove Conditional
Approved
Terms of Conditional Approval
� r1a
CAUTION
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 DFIEP 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 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: 1-67- Z- 23eoa/
A. WELL DATA
Well Classification If A, 6, C, D.E.C. Approved (Y/N)
Well Log Present (()YN) —Date Comple�� ---Yield
Total Depth Cased to Depth of Grouting
Static Water Level 0 Pump Set At
Casing Height Above Ground -_
Electrical Wiring in Conduit&
Separation Distances from Well:
Sanitary Seal on Casing6N)
Depression Around Wellhead (Y( No
To Septic/Holding Tank on Lot //-<, --t-
On Adjoining Lots Z�71 4'r
7�
To Nearest Edge of Absorption Field on Lot On Adjoining Lots 7
To Nearest Public Sewer Line Al�,4 To Nearest Public Sewer
Cleanout/Man hole To Nearest Sewer Service Line on Lot
Wate r Sample Collected by Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size No. of Compartments
Standpipes& Air -tight Caps&N) Foundation CleanOUt 6(Y N)
Depression over Tank ( 6/N Date Last Pumped y
Pumping/Maintenance Contract on File (Y/N) for W
Temporary Holding -rank Permit (Y/N
Holding Tank High -Water Alarm (Y/N) o� L,4
Separation Distances from Septic/Holding Tank:
To Water -Supply Well To Building Foundation /_3
To Property Line e? j To Disposal Field _tr
To Water Main/Service Line — 0
Course WIA
Comments
Page 1 of 2
72-026(11/84)
To Stream, Pond, Lake, or Major Drainage
/_ �, 6 / �Wv
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed Length of Field
Width of Field Depth of Field
Square Feet of Absorption Area
Depression over Field ( )(9—
Results of Last Adequacy Test
Gravel Bed Thickness I
— Standpipes Presen 6Y N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well 5� / 5 _10
— To Property Line 0 '7� M�
To Building Foundation
Lot
; On Adjoining Lots
To Existing or Abandoned System on
__� 0 " -�-
To Water Main/Service Line wi-A To Cutbank (if present) AV -d
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Are,
Comments
D. LIFT STATION
Date rn-S�
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
** Check Permitted Bedroom Rating Against HAA Request **
Vent (Y/N)
Cycles during Adequacy Test. Meets MOA
I certify that I ch4ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
P0Pee7Z';6 -7
S1�31 l�� Y/ 11f7ee'l Date 'C',
1�bFe'.5
Company MOA No.
Receipt No. 15(o 6c)
Date of Payment .-S -<95
Amount: $ 60,C)
Page 2 of 2
72-026 (11/84)
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Hoy C. Reid, Jr. 4W,
No. 2251-H