HomeMy WebLinkAboutT12N R3W SEC 24 N2NE4SE4NE4NW4T12N R3W
SEC 24
N2 NE4 SE4 NE4 NW4
#015-472-19
Municipality of Anchorage.ti `uuw i u Gc;a
Community Development Department Page 1 of 3
DEC
On-Site Water Wastewater Program 2 2 - ..
and
4700 Elmore St. • P.O. Boz 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151230 PID Number: 015-472-19 ❑ New 2 Upgrade
Name:
Leland &Beverly Glenn
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
11000 Trails End Rd.
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4 -
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision - Block Lot
N2NE4SE4NE4NW4
Fill added above original grade ,
Ft.
Gravel length
Ft.
Township Range Section
T1 2N R3W 24
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES I
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
Ftp
Ft.
Well
71.5`
N/A
N/A
N/A
63.1
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1,250Ga1.
Surface Water
100+
100+
N/A
N/A
Material
Steel
Number of compartments
2
Lot Line
48.9
N/A
N/A
N/A
NA'
Foundation
8.7
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
N/A
N/A
N/A
N/A
-
Pump on level at
Pump off level at
High water alarm at
Remarks *Waiver on File WR86-035
in.
in.
in.
Pump make and model
Electrical Inspections performed by
-
PIPE MATERIAL House to tank 3034 raankto
drainfield 3034
Installer
Isaacs Excavating Services
Draineeld 3034 CO/MT 3034
Inspector Pannone Engineering Services LLC.
BENCH MARK (Assumed elevation) 100ft-
Inspection1., 8/1 /2615 a
Location and description
dates :
a
Finished Floor
30
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
`�,OF.....1 �l1110
Conditional Approval: Date
•��even •rt..�annOtAe•/
AW
/.%
Approved ��{ A t a1X Date I l a Xo l l
alt jgaPy`
,pgp
Inspection Report_1-1-12.doc
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION WAS 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: INSTALLED NEW 1,250g SEPTIC TANK.
52.4- 1250 GAL
TANK NEW
w�u
I
L -
ALLED 125og
SEPTIC TANK
DCO AND DV
4 BR
HOUSE
D
s
A
B
T1
9.70
11.70 '
T2
18.00
12.10
DC
20.60
13.40
DV
22-80
14.90
C 1
22-60
15,30
C2
26.00 I
16.00
4 BR
HOUSE
D
s
T12N R3W SEC24 N2 NE4 SE4 NE4 N
DRAWN ENJC LELAND & BEVERLY GLENN
11000 TRAILS END ROAD
PLAN ANCHORAGE, AN 99507
�n Pani
CE 8149
1 12/22/2015
Scale
P.LD. NO
-_472-1_
ie j PERMIT N0.
r/
OSP 151230
r
Sheet
2 O 2
ABBREVIATIONS
,TH
TEST HOLE
(P)
PROPOSED
-�
(E)
EXISTING
DESIGN PARAMETERS
CO
CLEAN OUT N0.
. PRIMARY SEPTIC SYSTEM
!MT
MONITOR TUBE NO.
NO. BEDROOM. 4 (600 gpd)
r' TYP
TYPICAL
TANK SIZE. 1,250g
NOTES:
PANNONE ENG SVC,
P.O. BOX 100217 ANCHORAGE, AK
PHONE (907) 272-8218 FAX (907)
LLC
99510
272-8211
RECORD DRAWING
T12N R3W SEC24 N2 NE4 SE4 NE4 N
DRAWN ENJC LELAND & BEVERLY GLENN
11000 TRAILS END ROAD
PLAN ANCHORAGE, AN 99507
�n Pani
CE 8149
1 12/22/2015
Scale
P.LD. NO
-_472-1_
ie j PERMIT N0.
r/
OSP 151230
r
Sheet
2 O 2
Development Services Department
Property Owner Name & Address:
troaiqKu 6, M 07
Building Safety Division
On -Site Water & Wastewater Program
a
4700 Elmore Road
a
P.O. Box 196650
Mark Begich Anchorage, AK 99507
s A > E TV
Mayor www.munixrylonsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue: _
Parcel Identification Number:: q-7 Z- Of
Legal Description
5�k a � m
Property Owner Name & Address:
troaiqKu 6, M 07
Pump Installation Date: 73 _15_(G
Pump Intake Depth Below Top of Well Casing: gofeet
Pump, Manufacturer's Name: /� Ay _AA 14
Pump Model: Z 3 v5 0 V 3 L8
Pump Size i)2 hp
Pitless Adapter Burial Depth: /0 feet
Pitless Adapter Manufacturer's Name: IIIA
Pitless Adapter Installer: Vy/G
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection:
Comments:
Pump Installer Name: Y i/ h Ger w�CrP%el7
ANCHORAGE WELL & PUMP SERV.
330 EAST 76TM AVENUE
-
ANCHORAGE, AK 99518 -
- AWPS.COM
PHONE: 907-243-0740
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
On -Site Water and/or Wastewater 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: OSP151230
Tax Code Number: 01547219000
Work Type: SepticTank Upgrade
Permit Effective Dates: July 17, 2015 to July 16, 2016
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: T12N R3W SEC 24
Site Legal Address: T12N R3W SEC 24 N2NE4SE4NE4NW4 G:2640
Owner/Address: GLENN LELAND & BEVERLY
JOINT REVOCABLE TRUST GLENN L P & B R TR 11000 TRAILS END ROAD ANCHORAGE AK 99507001
Site Mailing Address: 11000 TRAIL'S END RD, Anchorage
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank
All construction must be in accordance with:
Lot Size in Sq Ft: 53375
Total Bedrooms: 4
N Privy N Private Well N Water Storage
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:
mss_
The tank is to be placed as far from the well as possible but still maintain 100 wa
from surface ter.
Received
Issued By:
Date: —111-7 1201S
Date: % 7�S
it
'
MUNICIPALITY OF ANCHORAGE
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. 015-472-19
Property owner(s) Leland & Beverly Glenn Day phone
Mailing address 11000 Trails End Road, Anchorage, AK 99507
Site address 11000 Trails End Road, Anchorage, AK 99507
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T12N, R3W, SEC24 N2 NE4 SE4 NE4 NW4
Lot Size 53375 Sci. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(® all that apply)
Absorption Field ❑
Septic Tank
❑X
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF)
(w/wo ADU)
Upgrade FADuplex (D) F-1Renewal ❑ Multiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Permit/Rush Fees: p� �`J Waiver Fees:
Date of Payment: I') Date of Payment:
Receipt Number: O tg sq(A Receipt Number:
Permit No. 0-5150I S I230 Waiver No.
Permit App_: :'.;c:
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@oaneneak.com
16 July 2015
Subject: T12N R3W SEC24 N2 NE4 SE4 NE4 NW4
EMERGENCY TANK REPLACEMENT
Design Narrative
Ladies and Gentlemen:
I am writing to request a permit to install an upgrade septic system be issued for this property. The
proposed system will serve an existing four (4) bedroom house. Currently the lot is developed. The
existing tank is in failure and is backing up into the home. This lot is served by a private well. The
surrounding lots are served by private wells. There are no wells within 100 feet of this system.
1. System 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 and drain
field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
3. Topography: The existing topography slopes from west to east at approximately 10% in the area
of the septic area thereafter increasing to an approximately 30% slope.
4. Waiver Request: No additional waivers are required. A separation distance waiver for the well to
the existing tank and absorption field was approved by the MOA Onsite Services on 18 March 1986
(Waiver Request, WR86-035). The work relating to this request increases the distance from the tank to
the well from the approved waived distance of 65' to 70'±. No work is being conducted on the existing
absorption field.
S. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots.
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
1. 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 1250g SEPTIC TANK.
EXISTING FIELD AND CRIB INSI
f' DV AND DCO AFTER NEW TANK
'
84 /
' - NO WELLS ON SURROUNDING
LOTS W/I 100'
155.6
DESIGN PARAMETEI
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 1250g
NOTES:
EMERGENCY TANK REPLACE
DRAWN I JRL
PLAN
roc
9F
m DV AFTER TANK
7-11 m _
REMOVE'
^� TANK E BACK
W/ MOA 1`PE II
iE
P I
2P
P
4 BR
HOUSE
O 4
104 DB
r" /i6C3RCVIHI IVIVJ rc
TH - TEST HOLE
S VACANT (P) PROPOSED
(E) EXISTING
CO CLEAN OUT NO.
`�..---t----MT MONITOR TUBE NO.
TYP TYPICAL
r
Date
P o. eox�o E ANCHORAGE, AK 9ENC 9510 LC SOFA/-gslr,' m/,s/,5
PHONE (907) 272-8218 FAX (907) 272-8211 /�g�e �y►� Scale
`...... . .... / P.I.D. NO
T12N R3W SEC24 N2 NE4 SE4 NE4 NW ........... .. —t
LELAND & BEVERLY GLENN Steven R. P one w PERMIT N0.
�.. CE 8149 .•��� osPxxxxxx
11000 TRAILS END ROAD I+ ��s .. �.r
ANCHORAGE, AK 99507 �tShteOF 1
?-,MUNICIPALITY OF' ANCHORAGE,
Her- 'h and Environmental Prote, ion
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME —�e`ah U"
�I`Q-V\ h
MAILING ADDRESS 51QA7
�o`,C 5 l0
PHONE
LOCATION V(_akkS
G:0D
LEGAL DESCRIPTION, _C(�),fj
)�3vJ 5a`
-Y I-A"P,aB(9-
SEPTIC TANK:
DISTANCENUMBER OF
FROM WELL c�C> I - MANUFACTURER rE�IC' —MATERIAL STe�'� COMPARTMENTS
INSIDE LENGTH Ala WIDTH n -,a LIQUID DEPTHN LIQUID CAPACITY-. GALLONS.
TILE DRAIN FIELD:
TOTAL LENGTHq 1
DISTANCE FROM WELL FOUNDATION JOE% NEAREST LOT LINE-. 0 ' /—OF LINE
I 4
# of Lines -� DISTANCE BETWEEN LINES 1�TRENCH WIDTH IS IN. TOTAL EFFECTIVE
ABSORPTION AREA Co SQ. FT. LENGTH OF EACH LINEu t�C
DEPTH OF FILTER /'(�
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ' 0 IN. ABOVE TILE IN.
SEEPAGE PIT: V Xl5TIh1(� GeSS�a� (— L-ttlky)bL" .I
DIAMETEROR WIDTH_ LENGTH_, DEPTH
Log Crib - Rings_ Crib Size: DIAMETER --DEPTH— DISTANCE FROM: WELL .
-- TOTAL EFFECTIVE
BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
well
ClassDepth: Up)VyA0
Well Distance TO: Lot Line 2.�!
Bldg: lot- Sewer Line: rjp{-
Pipe Materials: moi, t p12��ic.
# of Bedrooms: c- GA c.
Installer: t leu_)TC)"
Remarks:
DATE.3 - L APPROVED _'�
�
I
I
l
!
_
-,
I
_
, Vit_
-
T
DATE.3 - L APPROVED _'�
` .
TRENCH
OR
PIT IS THE DlSTHNCE BETWEEN THE
SURFACE [.-'IF THE
GRDUND AND THE
BOTTOM
OF
~ ^ DEPARTMENT OF
^
HEALH HND
ENVIRONMENTHL
PROTECTION
825 /L'
STREET� HNCHORHGE/
HK�
99501 /
IS THE
264-4720
DEPTH OF GRHVEL 8ETW1EEN
(
C-�_����
OF THE
E`�� �
pl, J. 4
PERMIT NO. ( 78009] )
HPPLICHNT STR H BOX 56
LO:AT ION TRH!L� END
LEGHL 1:12N R]N S24 PHR28R LOT SIZE 0 SQU9RE FEET
TYPE QF SOIL HBSORBTION SYSTETRENCH
MHXIMQM NUMBER OF BEDROOMS -- 4 SOIL RHTING (SQ FT/BR)� 100
THE REQUIRE) SIZE OF THE SOIL HBSORPTI0@ SYSTEM 1.S�
�T,.. r.- L���K_
[HE LENIGTH DIMEN'SION IS THE LENQTH (IN FEL -T) OF THE TRENCH OR �RHJNFIELP
THE DEPTH OF H
TRENCH
OR
PIT IS THE DlSTHNCE BETWEEN THE
SURFACE [.-'IF THE
GRDUND AND THE
BOTTOM
OF
THE FXCHVHTlON (IN FEET).
WELL. DEPENDING
THFRE IS NO SET
WIDTM
FOR
TRE�CHES
AND CONSTRUCTION DIHUNHMS FRE
THE GRRVEL MEPTH
IS THE
MINIMUM
DEPTH OF GRHVEL 8ETW1EEN
THF OUTFALL PIPE
HND THE BOTTOM
OF THE
EXCHVHTIDN
(IN FEET).
U I r�__, F-7 C� 3,����
PERMIT 'APPLICANT HAS THE RESPONSlBILITY TO INFORM THIS DEPHRTMENT DURING THE
INSTHLLHTION INSPECTIOHS OF ANY WELLS HDJHCENT TO TH�S PROPERTY HND THE
NUMBER OF RESIDENCES THHT THE WELL WILL SERVE
�- .1 ��������p�� �F L_ 0: Z���������
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL YNSPEcTION AMU, APPROVAL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTION
MIN�MUM DISTHNCE BETWEEN H
WELL HND HNY UN -SITE
SEWHGE DI�POSHL SYSTEM IS
�S0 FEET FOR H PRIVATE
WELL/
OR
150 TO 200 F£ET FROM H
PUBLIC':
WELL. DEPENDING
UPON THE TYPE OF PUBLIC WELL
OTHER RFQy1REMENTS MHY
HPPLY
SPECIFICATIONS
AND CONSTRUCTION DIHUNHMS FRE
RVHILHBLE TO INSURF PROPER
INST8LL9TION.
�APE- ����v������� ����������� ���^
I CERTIFY THAT
1 I HM FHMI!'l8R WITH THE FOR ON-SITESEWE�S AND NELLS �S SET
'F0RTH 8Y THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES.
]� I UNDERSTHND THAT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMF��T I�
RESIDENCE lS REMODELED TO TNCLUDE MORE THHN 4 BEDROOM -S.
APPLICANT LFLHwD GLENN
lSSUED BY -__D8TE- _
e� SOILS LOG
MUNICIPALITY OF ANCHORAGE
ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
Pouch 6650, Anchorage, Alaska 99502 276-2221
SOILS LOG — PERCOLATION TEST q (7
PERFORMED FOR: Yy L']w TO (! �` yC, DATE PERFORMED:
LEGAL DESCRIPTION: Cl (L'' VI I1 R!d n
SLOPE _
DEPTH --
(FEET) ��-_� -
1
2 )
3
i
5
6 -f
8
ED—i
10
11 WAS GROUND WATER V S
ENCOUNTERED? O
P
12 rc.7n`V� IF YES, AT WHAT E
1DEPTH?
13 LA) 5 �
c ✓Yl Q 1
�G�rivzd `ir�
14-
15-
16-
17
4151617
18
19
ReadingDate
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
(minutes/inch)
�S
TEST RUN BETWEEN
L" �V erg
it
COMMENTS
C(/�Gl I 7
PFRFnRMFn Rv:
ReadingDate
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
(minutes/inch)
�S
TEST RUN BETWEEN
L" �V erg
FT AND FT
COMMENTS
C(/�Gl I 7
PFRFnRMFn Rv:
Z l(Slos�
L'�I �. C E R T I FI ED BY:
-y DATE: -
20
PERCOLATION RATE
(minutes/inch)
�S
TEST RUN BETWEEN
L" �V erg
FT AND FT
COMMENTS
C(/�Gl I 7
PFRFnRMFn Rv:
Z l(Slos�
L'�I �. C E R T I FI ED BY:
-y DATE: -
72-008 (7/76)
V
II
CTION CHECK
Field check list fo or or n -site installation inspections.
First and second inspections.
Well: Well drilled yet? Where and what distance.
Neighboring wells in the area. Where and what classification
e.g., semi-public.
Sewer:t,,,Tank type and capacity.
,-Dank to well and neighboring wells.
Tank inlet and outlet caulked?
vStandpipe in place?
Tank set level?
Cast iron or approved plastic five(5) feet from tank.
All pipe types noted and sloped within 2% to 6%.
Trench to well distance including neighboring wells.
Trench length.
n� Trench depth below tank outlet.
Trench depth.
Trench sidewalls not smeared.
�V Gravel quality okay.
Type of perforated pipe.
Cleanout between trench and tank vertical. Sump in place?
Standpipe caps in place.
Check soil test for possible permit issuance error.
A
to
G¢ .- �
771
- a
Le
y. 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 -3
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
N Il N15- SE 77 NC � N '/' Sec 2Y� Trini Rau/ S,M i Pecrrel Z1
Location (address or directions)
/�vvo T/tirCr En�L Ruad
(b) Applicant Name Leland G/eo,7 Telephone: Home 3 `!6"ZO''2 Business
Applicant Address if 000 T''VerJ E^4 Ra
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution
Address'
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
3.
4.
lois cad wAeq
Single -Family ® Multi -Family ❑ Other
Number of Bedrooms
Telephone
WATER SUPPLY
Individual Well 1 Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 - - n-026(11/84)
9
5. ENGINEERING FIRM PROVIDI. , INSPECTIONS, TESTS, FILE SEARCH, L"�A 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 F/uf/o� TeCAWLCV1 Slrvcco Telephone 3 YS'- /35'15
Address 1 s3o EcA., SA A -kr 99S'/6
Date
(4 (,!/Cly-selokc Glrrissn�e w0111¢7e0e 4 Sar by bHEP 114 3/2-6/7g
iF Me,eo2 wc, vrr .ior . We oai 93
Wa-.'.tri �ta.lrcQ to 6Sf
S�/p �Sfe sM . Engineer's Seal
6. DHEP APPROVAL
Approved for 76."e
Approved
ur �
.��v4 -„
,,.......°9s®®
d ;.49TH
p
L .........................0
® . THEODORE F. MOORE :
o .• CE - 3589 0
61 0
bedrooms by Date 3—�F_�g�O
Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Muncipality of Agchorage 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 2 of 2,
72-025 (11/84)
"WFfUUIBMIUW( (OF A"XHORA I?
CUMMUNICIPALITY OF ANCHORAGE (MOA) ftMm N NT(OP )� PROT &
HEALTH AUTHORITY APPROVAL (HAA) PROs CilOry'
CHECKLIST - FEBRUARY 1984 MAK 1
264-4720 p� r
Legal Description: NV 44 C_
(ec 2K 7,12N, R 3w, s -rt, �Parce/ A�
A. WELL DATA
Well Classification QYrr+aFe If A, B, C, D.E.C. Approved (Y/N) N.A.
Well Log Present (Y/N) —N Date Completed 1Y6 0 Yield
Total Depth 63.* Cased to -7 S6 Depth of Grouting N'4
Static Water Level 2FJ' Pump Set At ,—
Casing
Casing Height Above Ground— 2 t Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N)
Separation Distances from Well: �✓�Y�
r
To Septic/Holding Tank on Lot 6s+ ; On Adjoining Lots > too'
,,sa%1w '
To Nearest Edge of Absorption Field on Lot 3' ; On Adjoining Lots I> tvo
To Nearest Public Sewer Line N/A. To Nearest Public Sewer
Cleanout/Manhole N, H• To Nearest Sewer Service Line on Lot IV4.
Water Sample Collected by Date
Water Sample Test Results Sec{-it.rscc
Comments Wal 40 Pt aU %anrs cua 4t a eea A0 SV' Q� 3/ ZB ! T�
Waiver low SO well /0 absorehog J-leW ceParaf*0a o i 93'
B. SEPTIC/HOLDING TANK DATA
Date Installed 17e 7 Sizel 2No. of Compartments
Standpipes (Y/N) Y Air -tight Caps (Y/N) r Foundation Cleanout (Y/N) N
Depression over Tank (Y/N) _N Date Last Pumped 3110186-
Pumping/Maintenance
!10!6!Pumping/Maintenance Contract on File (Y/N) Ah, ; for N.N.
Holding Tank High -Water Alarm (Y/N) +`A Temporary Holding Tank Permit (Y/N) N'd•
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 6sk To Building Foundation 31
To Property Line 7 30' To Disposal Field JV «
To Water Main/Service Line N<A• To Stream, Pond, Lake, or Major Drainage
Course ;;;0 (60'
Comments Tan (c —A-- wet/ �ct�ergle cvarvGeeel % 1�` 6n 3/z8/7�r
Page 1 of 2
72-026111/84)
C. ABSORPTION FIELD DATA
85 a pe- I;y rvna�f
Soils Rating in Absorption Strata IGo el- Awl Type of System Design P't
Date Installed 1? ' 00 7 4F•e^C4 - '9 Length of Field 38'
Width of Field Depth of Field 8
Gravel Bed Thickness 5�
Square Feet of Absorption Area Standpipes Present(Y/N) Y
Depression over Field (Y/N) N Date of Last Adequacy Test 3/
Results of Last Adequacy Test Sa�-4.%c41,
Separation Distance from Absorption Field
To Water -Supply Well 93� To Property Line > 30'
To Building Foundation H/ To Existing or Abandoned System on
Lot > 361 ; On Adjoining Lots > 30'
To Water Main/Service Line N. A. To Cutbank (if present) N•'+
To Stream/Pond/Lake/or Major Drainage Course 7 Eou
To Driveway, Parking Area, or Vehicle Storage Area 2' SO'
Comments uWWe� geeJe�C roo well - abs ArenC4 ,yeo ®Ctrl o&'� 93
-7-v Ac,4 zlaoe i1 Se -7 eeX fog' .r liDas ed i r oefi�w/o
SeetpaQG r' et:fo V/-;// Cbn9«Ae-e -46
D. LIFTSTATION N.A•
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
— Dimensions
Manhole/Access (Y/N)
"Pump Off' Level at
- Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed 1 � 9ft&-'-t Date 31f01-06-
Company
1f0166Company F&~AG MOA No. R.5-aS2
Receipt No. �%S4��+���
Date of Payment 3 -11 •,V(o @` OF• At
�0®
a �Giheer sn5e�•.0��®
Amount: $ •of-
�'a'• 49TH •'�*off
�.....................:...
Page 2 of 2 HEODORE F. MOORE
t'� e. • CE - 3589 �bt A
72-026 (11/84) ®�Pr �••........ QoC�
®®o•®moo
Municipality
of
Anchorage
March 18, 1986
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907)264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Theodore F. Moore, P.E.
Flattop Technical -Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: T12N R3W Section 24 Parcel 28A
Waiver Request, WR86-035
Dear Mr. Moore:
Your request for a waiver of the separation distances required between
the septic system and well on the subject lot by 18 AAC 72.021 has been
granted. The separation distance required between the well and septic
tank and the well and absorption field have been waived to 65 feet and 93
feet respectively.
These waivers are vaild for a four bedroom single family dwelling
only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
CIVIL, & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
1986
PH: (907) 345-1355 March 11, ANC 'KA 99516
ENV/ k$�Gr� - ase
FAL
M.O.A. Dept. of Health and Human Services pkQTECAjN
P.O. Box 6-650 MAR 1
Anchorage, AK 99502 1If;
Attn: Steve Morris EPE,
q
RE: Well-Absorption Trench Separation Waiver Parcel 28A, Sec
T12N, R3W, S.M.
Dear Mr. Morris:
By means of this letter I am requesting a waiver of the well
to absortion trench separation distance down to 93 feet for the
subject property. Copies of relevant documents are enclosed for
your review.
The well and original wastewater disposal system were
constructed in 1966, but no as -built records are available. In
1978 an upgrade permit was issued for a four bedroom system. The
permit has a handwritten notation signed by "L.B." indicating
that the tank -to -well separation was waived down to 50 feet, but
it does stipulate a 100 foot separation between the well and
absorption field. The as -built inspection report prepared by the
Municipal inspector fails to indicate the actual well to
absorption distance, which I measured to be 93 feet. The actual
well to septic tank cleanout distance is 65 feet.
The as -built indicates that the soils encountered during
construction were better than those found in the test hole; thus
the 456 square feet of absorption area is actually sufficient for
a five bedroom residence. On March 10, 1986 the fluid level in
the 6 foot deep gravel filled portion of the trench was less than
a foot above the bottom, and it easily accepted water at an
adequate rate for a four bedroom residence.
The ground surface in the vicinity of the absorption trench
is approximately 12 feet lower than at the well, and it slopes
away from the well. The fluid level is 14 feet below the present
ground surface which has been built up 4 feet since the time of
construction. The soil log indicates tighter soils (fine sand
with some layered silt) underlie the receiving strata; these will
tend to slow the downward percolation, and at the same time the
topography will direct the effluent away from the well. In the
unlikely event that a failure should occur which results in
effluent surfacing, from either the tank or the absorption field,
this also will flow away from the well.
The well itself is 65 feet deep and was drilled -in 1966 by
Sunset Drilling. No log is available, but I measured the static
water level to be at 28 feet, the yield to be 1.0 gpm, and the
pump intake to be at 58 feet. A water sample taken 3/6/86 showed
no bacterial contamination.
It is my recommendation that in light of the abovementioned
mitigating circumstances, and the good performance of the
oversized soil absorption system, a waiver should be granted in
this case. No discernable improvement to the public health would
be accomplished by requiring that the well be relocated 7 feet
further away.
Please call me if you have any questions, and I shall look
forward to receiving your response.
Sincerely,
I� /' 6-
cc. Leland Glenn
Ted Moore, P.E.
CO LVa
,� $_W a,
.............�./..�.y.).�..
THEODORE F. MOOP.E ;
<'r_.' CE - 3589 _
11
Time
Time
pie
nn
Date
Date -
Date
1 04
Inspector
Inspect
Inspector
�LL
Comme is
Conditional Approval pFPT. OF HEALTH R
r, s,, pe o wr�
,-ENVIR;NPP.._f`;'A-.
—=�n`c 9
N��e-sbUa C oma^ �(� s� u�
AUG 9 198
RECEIVE 11
P w
Date Sewer Installed
Permit No.
Septic Tank Size
Holding Tank Size
Soils Rating
Well To Absorption Area
Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner c rel 9 6V CUP/ F/9? "=:'
Phone
Mailing Address �. S� Sig lin 99W7
1
Buyer
Address
Lending Institution (•���
Phone
Address
Realty Co. & Agent
Phone
Address - - -
Legal Descriptio _. - _ - _ C mac/ P ou-, a g
Street Location
Typo Residence /it
Single Family 4j A.13+
❑ Multiple Family No. of Bedrooms
❑ Other
Wate upply __
ndividual ATTACH WELL LOG. A well log is required for all wells drilled since June
❑ Community 1975. For wellg d iped prior to that date, give well depth (attach log if
El Public Utilityavailable. c7 b'
SewDisposal - /�% Q/
'age Individual Year Individual Installed: !�ti
❑ Public Utility When Connected to Public Utilit --
❑ Holding Tank
oo
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING JOVATEQ.f'r
M
-+
FAA! ECEIVED
.- -- INSPECTION APPOINTMENTS
- -
TIME
TIME -
TIME ,�jt�
%
L
DATE
DATE -
DATE
One Four Other
El1.�/
SINGLE FAMILY
❑ Two ❑ Five
INSPECTOR
INSPECTOR
INSPECTOR
in INDIVIDUAL*
MUNICIPALITY OF ANCHORAGE
- -
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL PROTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
1//
NOV 2 01979
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
❑ PUBLIC UTILITY
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER -
PHONE
'f e /a"
MAILING ADDRESS
PROPERTY RESIDENT (If different from above)
PHONE
S 'amu
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITLITION
PHONE
MAILING ADDRESS 47
!/✓�. / "moi G-' � ✓ !%1 �Jn
4. REALTOR/AGENT
PHONE
MAILINGADDRESS - -
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
Z ❑
One Four Other
El1.�/
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER PPPLY
in INDIVIDUAL*
* ATTACH WELL LOG. A well 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.) C S-
8. SEWAGE DISPOSAL SYSTEM
1//
ld INDIVIDUAL/ON-SITE**
// YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY -
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
INSTALLER qq
❑Septic Tank or ❑Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
CS-•�'`-
TYPE OFTANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
c - .Vr ifJC.(L ).�..-,1/ .... ..i,...) �2a•��- iii 6
4. DISTANCESSeptic/Holding
WELL TO:
Tank Absorpti n Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
Cd,—APPROVEDFOR .�— BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
BY
72-010 (Rev. 6/79)
MUNICIPALITY OF:ANCHORAGI\
DEPARTM.OF HEALTH AND ENVIRONMEh, L PROTECTION
825 _ L Street, AnchoraaP. Alaska 99501
264-4720
#1: Time 1:16 #2:
/ 1',) /1
u t
Date �-9-�� (I S
�
InsP (1)'LUDa
uuv1S
1
2
Date Received: February 24, 1978
Time `
,� 1
#3: Time
Date Date
Insp „-AULA6. Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request:
Mailing Address
Phone:
Property Owner: Leland P/Beverly R. Glenn Phone: 344-5120
Mailing Address: Star Route A Box 56 99507
3. Legal Description: T12N R3W Section 24 Parcel 28A
4: Single Family Residence: (x* Number of Bedrooms: Four
Multiple Family Residence ( ) Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System ( )
C
7
Permit #
Construction
Depth of Well
Well Log on File ( )
Bacterial Analysis
Sewage Disposal System: On-site System (x3� Public Utility ( )
Permit #
Septic Tank Size
Absorption Area
Installed 1967 Installer
Manufacturer
Soils Rate
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
Material
to Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: T12N R3W Section 24 Parcel 28A
Comments( \A �Q \ Ess t flnti��� �+} 1 h 't$
�iH4Clk
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
Date:
Disapproved: VQpyC/ Date: l� !
Department Worksheet:
20
Mfle q
MFl,
VC—D l2YC� r C2?� �� rncrl
\Q�
sovfw ' I65.0' a
W
L25 At.o
�! c
' 7 4
-1 POYL( lf. O (3•4- Moo POUNO•
e I uooSi� , —� Dlbrkl>JAr E P(kfTBn N
1sTonq N01 FOUND,
uvusE- � Sc�Tic r„E
si iQ
z,
° ~ h
NE t TIF�Drd} 1/ R RALT / Sir CNV06(v 2A„rfWKt VlSl r
�IL11., SubD, SDR• W'r I
2 STDa11 Analrlo�l _ _ �v- .
No1+�tN Ib5.0'#
o a sr
:T� 1.• I,NEGF�, ",:
I hereby certify that I have surveyed the JAMES L. SCHEFFEL, Registered Surveyor
N 1/2 NE 1/4 SE 1/4 NE 1/4 NW 1/4
of Section 24, Township 12 North, Range 3 -1 -ria 1” 50'
3 West, Seward Meridian, and that the im-
provements situated thereon are within the AS -BUILT SURVEY
property lines and do not overlap or encroac 1,N 172 NE 1/4 SE 1/4 NE of
on the property lying adjacent thereto and Section 24, Township 12 North, Range 3 Vest
that no improvements on property lying ad- Seward Meridian.
jacent thereto encroach on the premises in q estion. Anchorage Recording District