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Home My WebLink AboutELMORE #1 BLK 6 LT 10Elmore Block 6 Lot 10 #018-172-16 Permit Number: OSP111161 Tax Code Number: 01817216000 Work Type: Septic Permit Effective Dates: July 15, 2011 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 Upgrade to July 14, 2012 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: ELMORE #1 Site Legal Address: ELMORE #1 BLK 6 LT 10 G:3036 Owner/Address: PERKINS ROBERT T 4861 RIVERTON AVE ANCHORAGE AK 995163659 Site Mailing Address: 4861 RIVERTON AVE, Anchorage Lot Size in Sq Ft: 41917 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. Received By: Issued By: UNICIPALITY Community Development Department Development Services Division OmSite Water & Wastewater Program OF ANCHORAGE ~ili:.: ~" Phone: 907-343-7904 Fax: 907~343-7997 Mayor Dan Sullivan ~, RUSH! ON-SITE SEWERNVELL PERMIT APPLICATION ' FOR A SINGLE FAMILY DWELLING Property owner(s) "l- ~4-~ ¢)~/-~,,,~ ~. Day phone · Mailing address Site address Legal description (Sub'd., Block & Lot) ~ I Legal description (Township, Range & Section) Lot Size /--~1:), ¢¢0 Sq. Ft. THIS APPLICATION IS FOR: (~ all that apply) Absorption Field [] Septic Tank [~ Holding Tank [] Privy [] Private Well [] .,, Number of Bedrooms THIS APPLICATION IS AN: Initial [] Upgrade Renewal [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ( 'g ature of property ortner br'aOtth'~rized,~.a,a~ent) ~ Permit/Rush F, ees~ %OO~-v~ l ? 0 ~'+~6;~*-"Waiver Fees: Date of PaCm/e/n~.'// ~,,/.~ ~ Date of Payment: Receipt Number: i~ ~ CJ (¢....3,. Receipt Number: Permit No. 0% ¥o [\ I / (,._¢' i Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 July 13, 2011 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Elmore #1 Subd. Blk 6, Lot 10 To Whom it may concern: I ~ ~ 0 This is a request for a tank replacement permit on the above/referenced lot. The attached site plan has the existing layout for the installation of a new gravity flow,,l.0~ gallon tank. The existing tank has started to fail and needs to be replaced. None of the neighboring properties will be impacted by this upgrade. Please call me if you have any questions. Since~ Michael N. Anderson, P.E. DESIGN CRITERIA: NON-UFT SEPTIC TANK DESIGN, ,~ BEDROOM, 1,~e-GALLON MAX ..... - S_H 0 S_IH _0 N~I A V E - I ..... / II , II J I I ....... r-----1 F-~ - I , '11 ,// "'/\ // / \ \ -- / / , \ ___\_ ,, - NATRO NA AVE ~--- , _ _ / I / / \ \l I I \ \ ' I I -I I II <1 / \ ~/~ ~..// E AND REPLACE EXISTING n-u / \ '~"<'4~GALLLON TANK, EXISTING I t 7-%, /--TO BE PUMP, CRUSHED AND __ L_ ~ L '~/ /FILLED PER MOA CODE \ / - .... /' PROPER'Pi' LINE ~-/T ~ EXISTING DRAINFIELD ~ / No MODInCA~,ONS, I--I VACA~rr I'W ~L)! · - RIVE RTO N /""AVE- ..... ~\, '~/-x./_~.-'/ ~x-~E---'~ I ~ / /x x /I \ II I I x / VACA~ ~ / I I \ / I "-- LOT'.LI ~ -EXISTING WELL I J--~ loG' RAmUS I I ....... L _ _~/__ VACANT ........ LOT _ ~ I .................... [ Septic Design Prepored for TATE PERKINS ~: ~ ~..." ~ "...~', iOT O ^nch°ra e,^'a*a · ........... ~.~MICHAEL N. ANDERSON.:',~'~ Michoel N. Anderson P.E. DATe ~/~3/~0~1 .~,: : . ' :~','~.". No.(~EC9469 : .~,~ 4661 NATRONA AVE. DRAWN: DJR ~;~..¢./..~..~.././. ....... ANCHORAGE, ALASKA 99516 I · I I II '',' ~ ~LLLON T~K ~TO BE PUMP, CRUSI FILLED PER ~OA CO ~I~NG D~IN] // NO MODIRCA~O \ ............... ELMORE #1 ....... PROPERLY LINE--~ 10' UTILrIY EASEMENT .. BLOCK 6, LOT 5 10' UTILITY EASEMENT "I ~ I -'~ ........ / ' I I I ......... ... l,z ~-o \ SEPTIC TANK TO REMOVED & ~1 REPel.ACE PER MOA CODE~ II Ix ~ ,,,,x~ DOUBLE CO--x ~ Lief"/I ~.. 1-~?" .......... l / ', ,/ l-Z~_~'":-~/ ~ ~ '~. i r::~~_ _. __ .,.,: ',, / ,,, B J '~ ~7' / ~xl~-'"~ "RUsE / iI i ..:' ...'.-. .. ! '- .. ..". .."~ , ~ : '.'.---'~ ~ '"-:~' " ' ' ' '" ' '..'. ' / ~ . '%' '('~. '.'.~'..'-"~ ~'i"" "'~ \ / ~ EX~SmNO S.ED I I · ": ~ ../ / "' ' ' % / --.. ELMORE #1 ,,-fi,~ ~ I ~ ................ 7~: ....................... ..L2,,......L........2.,~. ..... ',. / --~ BLOCK 6 LOT 10 I I .~ /':,' .\ ,-. .~ ,. · ............................................................................ , ......................... /,- ........................................................................... z ........................... -, / / .......... ",, ~--PROPERTY LINE i.~i~ ~,~ .... / / ...................................................................................... // ~"~ .... \ \\ ...... '~.~. / // \ .~' .............. '~ "' "- ... ~/// ',,//' ~"~ ~' \ \ / '--~ ,~ ( \\ _ //_ ~ " ~'R~ V E RTO N AVE- Septic Design Prepared for TATE PERKINS ,,- -,..~. ............. Yw. ELMORE #1 BLOCK 6, LOT 10 ' .." N. ~,.~:~: MICHAEL N. ANDERSON.",~- Michael, ,n_erson, DATE: 7/13/2011 . ,_,, '.. ~,:-q{"o,".. No. C,,E 9,,,,4-69 ,AWN: ANCHORAGE, ALASKA 99516'~.~ ""/..'..-~..'.¢.' ~;.~%~..,.,._,....,...,-_,~,.,\,,~.~,~cc,\~,,~ · 345-5377 / FAX: ,345-1391 SCALE: 1"=30' .. - .... .,~ 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 NAME [--IUPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Well~j,&,j{Iv1° I Absorpt,on area IF HOMEMADE: Inside length Well Dwelling Dwelling Materia~ / Width No. of lines ~f each line th of lines NO. OFBEDROOMS Trench ~d~ inches PERM NO. Liquid depth PERMIT NO. DISTANCE TO: Manufacturer Material Liquid capacity in gaUon$ Well Foundation Nearest lot hne PERMIT NO. DISTANCE TO: I ~'/ O / ~; 7' Distance bet en lines Tap of tile to finish grade ~ Material ben tile I Tot~effect~s~r~tio. a,ea Width I PERMIT NO. I Length Type of crib :rib diameter Crib depth Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller O~stance to lot hne I PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank I Absorption area(s) OTHER PiPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 724313 (Rev. 3/78) PERMIT NO. ~MUNICI~ ALITY OF ArqCH~.~RAGE DEPARTMENT OF HERLTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, RNCHORRGE, PK. 2~4-4720 tWELL ~YW~ O~W~ [ TE ~EtW~R PE~r~ [ T APPLICANT HANNI CONST. CO. SRA BOX l~B, ANCH. LOCATION RIVERTON AVE. LEGAL L10 86 ELMORE #1S?D LOT SIZE ~44-0170 40000 SQUARE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: DRRINFIELD MRXIMUM NUMBER OF BEDROOMS SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 5 LENGTH= 5~<~ GRR~'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE AROUND AND THE BOTTOM OF THE E×CAVRTION (IN FEET). THE TREe, CH ~IDTH IS 5. 000 FEET. THE GRAVEL DEPTH IS THE MINIMUH DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE ~ND THE BOTTOM OF THE E×CAVATION (IN FEET>. REQ;-J I RED SEPT I ~ TAr~( S I ZE= IOOO G~:~LLOr~S 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 THBT THE WELL WILL SERVE. T%40 ( 2 ) I NSPEOT I OHS 8RE REQU I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUH DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYFE OF PUBLIC WELL. MINIMUM DISTANCE FROH A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUWITY SEWER LINE IS ?5 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERM I T E×P I RES DECEr~BER 31, l-'~- 81 I CERTIFY THRT l: I AM FRHILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPRLITY OF ANCHORAGE. 2: I WILL INSTRLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.~(~' ,/~J~ SIGNED ISSUED CON T. ............ t 'V _. ......................... --- 5 ,v4. o S- ¸%. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 I.. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~/~01LS L~G [] PERCOLATION TEST DATEPERFORMED: ~-- (,..0-- ~'~ ~ LEGAL DESCRIPTION: ~ C'/"~ ~0 "~3 \ ~.. ~.~ ~--~ v~ ~ ~ ~.,. SLOPE 1 2 3 4 .------5 6 7 8 9 10- 11 13- 14- 15- 16- 17- 18- 19- 20- SITE PLAN WAS GROUND WATER S ENCOUNTERED? .~ E IF YES. AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND FT DATE: 72-008 (6/79) DALLY DRILLING LOG $¥REN BROS. DRILLIN$,/NC. 2701 £egle Street Anchor~e. Ahskl 99503 274-6437 ADDRESS ............................................................... : ....... Rtverton LotJ/I Blk. 6 Llmore Lub. :;' .~ ave. w~-~r~ ............ .,~ ............................................................................ D AT E--~ TA RT£D.._.I.Q..-..1./..~.:..8..1 ...................................... [ DAT~--~£D .......... !.9.=..":.~:..8..~ ............................................................... rao.~ ........ _0. ............... FT. TO........8. ............... ~r-..~.!. :~.....:.,.... g~ -v..~1 water, %-. ~OM.._.....8.. ............. IT. TO........1.._2. ............ Fr_.cl~y....~..gr.a~,el dry cla reo~, ......... !.~ ........... FT. TO--..~Z ............ rr...,<..~r.a~e{ .......... brown clay FROM ........ 3.2. ........... F~. TO.......~.3 ............. FT....?' ..6rnyel ........... d ,'u~ p Drown rnO.~ ........ .?il .......... FT. TO.......gQ .......... rT....C ~M..., · ..,%r av.e 1. ~ waterTno ~tatic £ROM ........ .9...0.. ........... FT. TO..._.l..0.2 ......... FRoM ......... 1.0.5 ........ l~r. TO.._.i.I,..Q ........ l~r ...g .r..g.y.~ ],....::.~.....w.~ .1; e r FROM .......................... FT. TO ....................... FT ...................................... FRO.~! ......................... FT. TO ........................ Imf ....................................... FRO,'*{ .......................... FT. TO .......................... FT ........................................ FROM ............... ~ .......... FT. TO ........................ FT ....................................... FROM .......................... FT, TO .......................... FT ........................................ MISCL. INFORMATION: D£~r. or w~,,.__llL.'. ................................................................... STATIC LEVEL Or WAT£R rr.....,{!q.'.....f..r...q:,t£r...q..u...n..!!...!.e.X.e.1 ~w no~ ~ .......................................................................................... GALS. PER ~X ~m~ o~ c~sma ........ ~:Z&..~.~.~....~....~.~.~! ......................... FR0Yl .......................... FT. TO .......................... ri' ...................................... FROM ......................... FT. TO ......................... FT ...................................... FROM .......................... FT. TO .......................... FT ........................................ FROM .......................... FT. TO .......................... FT ......................................... MU~C~PALITY OF ANCHORAGE FROM ........................ FT. TO F'~.?F'~...'- H~AL~ ~',, ... FRO?,! .......................... Fl'. TO .......................... Fl' ........................................ FROM ......................... FT. TO ......................... .~ ......................................... FROM .......................... FT. TO ............... .R.:EC E.i.V.ED ................. FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO .......................... FT ......................................... FROM .......................... FT. TO ......................... FT ........................................ :,et pun..-, clone to botto,! of well. Do not punp over 7 gallona per minute. ~heck ~-tattc level prior to !)unp Installation. DRILLER'S NAME ............. ~ ~..e..p...h...e..I..l.....D......._ ~.~/..r....e...n. ................................ 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 SYSTEHS ,PPROVAL FOR .6, SINGLE FAHILY DWELLING Parcel I.D. 1. GENERAL INFORMATION cosA Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ELIdORE SUBDMSION #1~ LOT 10, BLOCK 6, 4861 RIVERTON DRIVE * ANCHORAGE~ AK 99516 MATfHEW & NANCY COLLINS Day phone 4861 RIVERTON AVENUE * ANCHORAGE AK~ 9951 Day phone 632-3861 JULIE JEWEL w/DYNAMIC PROPERTIES Day phone 3111 'C' ST. * ANCHORAGE~ AK 99503 223-3211 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site [] Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] 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-Sita Systems Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEI~R As certified by my seal affixed hereto and as of the validation dale shown below; I vedfy 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 vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/o? 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. Phone 337-6179 Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, end the water usage of the family being served by the system. These conditions ara outside the control of the eva/uator of the system. Satisfactory test results do not guarantee future performance of the system, horde they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system wilt continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of tho owner listed above. Any reliance upon or use of this report by any other person or pariy is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V'~ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Cedificate Date: 5- ~:) ~- O 7 Municipality of Anchorage Development Services Department Building Safety DIvision On-Site Water & Wastevmter Program 4700 Bragaw Street P.O. Box 196650 An~orege, AK 99519-6650 (S07) 343-7g04 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST EUvlORE 1~1 SUBDMSION, LOT 10, BLOCK 6, Parce O:O/_ -/72- Legal Description: A, WELL DATA Well type ;lavA1[ If A, B, or C provide PWSID~ N/A Date completed 10/16/1981 Sanltely seal (Y/N) YES Totaldepth 111 fl. Casedfo 110 ft. FROM WELL LOG Date of test 10/14/1981 Static water level 40 ft. Wall produc~on 7 g.p.m. WATER SAMPLE RESULTS: Wall Log (Y/N) Wires propedy protected (Y/N) Casing height (above ground) AT INSPECTION 5/3/2007 62 6.54 g.p.m. YES 12 in. Depression over field__ New depth Absorption rate >= 600+ NONE KNOWN If yes, give date TRENCH 1.5 .ft. NO For 4 bedrooms 8 in. g.p.d. Coliform 0 colonies/100 mi. Nitrate 0.25 mg.lL. Other bacteria 0 .colonies/100 mi. Arsenic: ND ug./L. Date of sample: 5/5/2007 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Data installed 9/18/1981 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cteanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping 5/8/:~007 Pumper MCDONALD'S; PUMPfN~ C. ABSORPTION FIELD DATA *SELOW EXISTING GR~)[ Date installed ~ Soil retJog (g.p.d,/~on~ 125 System type Length 79 ft. Width 5 fl. Gravel below pipe Total depth *5.70 ff. Eft. absorption area 506 fi= Monitoring tube YES Date of adequacy test 5/3/2007 Results (Pass/Fail) PASS Fluid depth in absorption field before test 3~5 in. Water added 720 gal. Elapsed Time: 1100 min. Final fluid depth 4 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) YES D. UFT STATION Data ins~iled .S. ize in gallons ~ ~ "Pump on level ~HIgh watar _al,n~level at in. ~ _~ Cycl se testsd. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cieanout Holding tank N/A Manure/animal excreta storage areas . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Proper~y line *8' Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS ~VR88-020 Absorption field Surface water. Water main N/A N/A 5'+ 100'+ 100'+ Driveway. parking/vehicle storage. 10'+ G, ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA CO.SA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Deta Waiver Fee $ Date of Payment Receipt Number SGS Client .Name Project Client Sample ID Matris 107192000 I Gamcss Engineering Group, Lid. Elmore #1 Lot 10 Block 6 Elmore # I Lot 10 Block 6 Drinking Water All Dates/Times are Alaska Standard Time Printed Daterrlme 05?22/2007 13:31 Collected Date]Time 05/03/2007 16:00 Receh ed Date/Time 05/04?2007 15:15 Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allow~ble Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals b~ ICP/MS Arsenic ND 5.00 ug/L EP200.$ C (<10) 05/16/07 05/1g/07 TK Waters Department Total NitratedNitrite-N 0.250 0.100 mg/L SM204$00NO3-F B (<10) 05/05/07 JDS Microbiolo~[~, Laborator~ Total Coliform 0 col/100mL SM209222B A (<1) 05/04/07 DLC Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.a nchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR ,A, SINGLE FAHILY DWELLING Parcel I.D. 018-172-16 1. GENERAL INFORMATION HAA# H/~ Expiration Date: ,~- ,,~ '"~- O ~ Complete legal description ¢' ELMORE 5UBDMSION 1~1; LOT 10, BLOCK 6, Location (site address or diractions) 4861 RIVERTON DRIVE * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOEL &: IdELAN1E HOFF Dayphone 348-7255 4861 RIVERTON DRIVE * ANCHORAGE, AK 99516 Day phone KATHI JOHNSON w/ PRUDENTIAL JACK WHITE Dayphone 762-3123 3201 'C' STREET sUrrE 200 * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ~ 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $1,750. OO at, or pdor I to closing for the engineering services provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, · shows that the on-site water supply and/or wastewater disposal system is(am) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address . 6901 DEBARR ROAD, SUffE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEI-I-I~EY A. (~ARNESS, P.E. Date 337-6179 Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the peffon'nance of the system under the conditions encountered at the time of the test, and separation · distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being sealed by the system. These conditions are outside the control of the evaluator of the system· Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encreachments. AWWC. Inc. can therefore not previde any warranty or future estimate of how long the system wfll continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other pereon or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for ..~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist septic system Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: ';,\_\l Y o,- ~ · WATER ANn : ~ Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department On. lie Water & Wastewater Program 4100 ~ Bmgaw GL P.O. Box lg6650 Anc~e, AK 99519-6650 www.ct~ncflorago.ak.us (9O7) 343-70O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well kypa i=mvA1~ If A, 8, er C provide PWSID~ Date completed 10/16/81 Sanltefysaai(Y/N) YES Total depth 111 ft. Case~l to 110 fl. Date of test Static water ~ Wall pro(luctJon WATER SAMPLE RESULTS: El. MORE SUBDMSION 1~1; lOT 10, BLOCK 6~ ParcellD: FROM WELL LOG lO/16/8 40 ft. 7 MAXIMUM g.p.m. Date of sample: 2/14/2002 Coliform .~ colonies/100 mi. Nitrate mgJt.. Ameni~: N/A mgJL. B. SEPTIC/HOLDING TANK DATA Tank Type/Mate~st STEEL Tank size 1250 gal. Number of Compartments Foundation cleanout (Y/N) YES Date of pumping 9/29/2001 C. ABSORPTION FIELD DATA Date installed g/la/s~ Length 79 .ft. 2 Depressk3n over tank (Y/N) NO 018-172-16 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 2/14/2002 64 .ft.' 5.7 g.p.m. YES 12+ in. Other bacteria c~, colonies/100 mi. Collected by: AWWC~ INC, Dateinstalled 9/18/81 Total depth us ft. Eft. abso[ption area 506 fi= Monitming tube YES Date of adequacy test 2/14/2002 Results (Pasa/Fall) PASS Fluid depth in absoq~tlon field before test 1 in. Water added 734. gal. Elapsed Time: 15 min. FInalfluicldepth 4 in. Abeorption rate >= Any rejuvenation tmalnlent (past 12 mo.) (Y/N & type) NONE KNOWN TRENCH 1.5 fl. Depression over field NO For *,I bedrooms 6 in. g.p.d. New depth 450+ If yes, give date Cleanoute (Y/N) High water alarm (y/N) Pumper, NORTHLAND PUMPING *SIr.~C SY~I:.~I SIZED FOR 4 BEDROOMS ~ll rating (g.p.dJTteor ([:~) 125 System type Win'th 5 f. Gravel belew pipe D. LIFT STATION Date installed Size in gatlon~ ~~-- 'Pump on' ~ High water_~ .;~.m ~evol a.t ._ in. ~ Cycles tested. Meets alarm & circuit requimmente?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septi~ tenldllft station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cteanout Holding tank N/A N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:. Property line '8'+ Building foundation 10'+ Water service line 10'+ Sun'ace water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Abseq~Jon field Surface water. G. ENGINEER'S CERTIRCATION I certify that I have determined through field inspections and review of Municipal records that the above systems are ~t conformance with MOA HAA guidelines in effect on this date. 100'+ *WAIVER IN PLACE Water main N/A Driveway, parking/vehicle storage 25'+ Engineer's P .rinted Date JEFFREY A. GARNESS HAA Fee $ Date of Payment R~i~ Numar (~. 1~01) Waiver Fee $ Date of Paymem Receipt Number . ,,,,"~--~'~ MUNICIPALITY 0= ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ('~- ~-~-\(,~ ~IPAI. IT~ OF AN(.'HO~AG~ ENVIRONMENTAL SERVICES DIVI3ICN AUG 05 1997 RECEIVED NAA# ~ ("~q"'~ ~ ~t.[.L~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Lending agency Day phone Mailing address Agent -~*/~/d "~_fOldi~.7'c'Jv Day phone ~".~-550~.. Address '.~RC~ ~'~ttlTi'~ '~.,tti_ ~,~7.~7~ j ~DJ C ~ ~.u;'E .~(~. /~/ ~?~ 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. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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, 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 ~//~-~,//:~V~*~ ,~/AJ~/~-/A)~- .--~J';~Phone Engineefssignature ~:~' { ~g~5 Date DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~.~/'~", .//]'I. ~r-z-~-.,/~/. Date The Municipality of Anchorag~ 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 courtesy to 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 resp;3nsible for errors or omissions in the professional engineer's work. Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICESi~u~c~P~U~ OF AN Environmental Services Division ENV~ON~e~AL sERwc~ai&~i;¢ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 AU(; 0 5 1997 · Health Authority Approval Checklist RECEIVED · A. WELL DATA _ we, type "~L'~i~uA'T~ Log present 0~1) Total depth Sanitary seal (Y/N) o1%-172,- I~, If A, B, or C, att&ch ADEC letter. ADEC water system number Date completed (I I' Cased tO /1/0 '1/' Casing height (above ground) - e J,l w ro. properly protected FROM WELL LOG AT INSPECTION Static water level ~'~0 ! ~ Well p~on ~ g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of Sample: B. SEPTIC/HOLDING T~.NK DATA Date Installed ~ Tank size (~ I.~; ~'/~ other ~'te.e Co,.c d Number of Cumpa~tments r~ O Foundation cleanout (~/N) V'~5 Depression (Y/l~ ~ High water alaml (Y~ C. ABSORPTION FIELD OATA Gravel thickness below pipe Total depth ~ · .~ Effective absorption ama ~ .~- Monitoring Tube pmsem (~)N)' Y~.t, Depression over field (Y/l~ Date of adequacy tast ~)'?-(~Sl~' Rasulte(~T:all) ~)f~5,~ For ~CL~ nuid depth in absomfion field before test (in.); ~Z¥ ImmediatelY after"~ gal. water added (in.): Ruid depth O (ins) Minutes later: ~O~ ~,~- At~somtion rote = ~) '~- g.p.d. Peroxide treatment (past 12 manths) (Y~ ~ o If yes, give date )L)/,PF Soil rating (g.p.d./fF or ~,'m) /,,~~--~ System type 5'J4//~-/~'~/,r~'/c/lY-/--t9 bedrooms o~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Abso~tion field on lot ! 0~)I~L Public sewer main Sewer/septic sewice line On adjacent lots 10(~ On adjacent lots 10(I I,~. Public sewer manhole/cleanout dA lift stefion ~k/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation S t _.~ Property line /0 t'~- Absorption field. Water main/centice line ~ 14'- Surface water/drainage ]00 ~.,L Wells on adjacent lots R SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water HAA Fee $ ~z~ , ""-- _'-----~7~ Date of 7 Building foundation /0 ~ Water .~,~cer~ce ,ne 16 g 1~<3 ~' Driveway, paddngNehicle ~m~ ~ ~ ~ Cu~n d~n ~ ~ Wells on adja~nt I~ 100 '+ ENGINEER'SCE~CA~ON ~ WA~ ON Flc~ - 72-O26(Rev. 3/g6)* Waiver Fee $ Date of Paymem Receipt Number ZI~ CT&E Environmental Services Inc. CT&E Rd.// Client Name Project Name/# Client S~mple ~D Ordered By PW$1~ Sample P.~natks: 974062001 Elmorc $/D No I,L~ 10, BI~ 6 Elmer~ 8/13 No l,Lt 10,Blk 6 Dfi~dng Water Cller~ PO// Printed Dnte/T~e 07/30/97 12:29 Colle~ed Date/Time 07/25/97 14:45 Received Datefflme 07/25/97 15:!5 Technical Director: Stephen C. Ede N;trate-N Tota! Coliform 0.136 0 PGL Unlt~ 0.100 ~/~ cot/lOO~ Attowabte Prep ,~'~aLysta Hethod L{mJta Date Date %flit ~I~ 4500-NO]F 10 ~ 07/~6/g7 JiJ ! I L$ 6885 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DiVISiON OF ENVIRONME.TAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot. block, subdivision, section, township, range) Lo'r' lO SLOC-,IC , Location (address or directions) {b) Property Owner ~11~ I~G~.AHAt11 Mailing Address Telephone: Home Business (c) Lending Institution~f"/~'~' J~'/~f'~m O~,,~P~. Telephone Mailing Address (d) Real Estate Companyand Agent. ~"i'C~_[el _~e/'~_./Y~Ct~l,/-~,~ Address (e) Telephone ~ 'TG- .ZTG I / Mail the HAA to the followino address: or;. Check here [~,if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well~l~ Community r"l Public r"l Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legaIity and status. SEWAGE DISPOSAL Onsite'~ Public 1'3 Community I~ Holding Tank i'-I Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 a'nd 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 '~:~_..~ ~'??~ ~ ~OT'I"~ Telephone ~'~-~ ~'! Address ~'~'~-~ ~' ~ A~E ) ~o~A~ Date Z~ ~ ~ Approved for .,~ bedrooms by ' Approved ' .,~ Disapproved Terms of Conditional Approval .~' ~-~--Oate .~-,~-~'8 Conditional CAUTION 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 courtesy to purchasers of homes and their lending institutions in order to satis~ certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page ;~ of 2 't~'-o~s ,Re~ e,~e~ B~ck /~ j~uNJCI~ALtT/O1: ANCHORAGE Et,,iVJ~OHM~.I~AL SERVICES DIVISION MUNICIPALITY OF' ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264..4744 Legal Description: L~T' CLmO~C WELL DATA Well Classification ~:>~t~J/~-T~ If A. B. C. D.E-C. Approved (Y/N) Well Log Present (Y/N) ~x~{~-~ Date Completed lO/~ J Yield Total Depth /1/· Cased to J I0~ Depth of Grouting Static Water Level '40'[~'E~',U'~I-Lt'C~ 5/,*-Iq~,.-/(~'rH~,3~"i" Pump Set At Casing Height Above Ground ~'~'~ Sanitary Seal on Casing (Y/N) ~,~ Electrical Wiring in Conduit (Y/N) ~'~ Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot '/"lC~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 'J'/~:~* ; On Adjoining Lots To Nearest Public Sewer Line '/"'~ ~ To Nearest Public Sawer Cleanout~Manhole ~ JOIpI Water Sample Collected by Water Sample Test Results +100/ I TO Nearest Sewer Service Line on Lot Jr- I0 Comments B. SEPTIC/HOLDING TANK DATA Size Date Installed Standpipes (Y/N) ~/~:"~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line TO Water Main/Service Line 'V--' Course "IL' I NO. of Compartments ~-' ~"-';~' Foundation Cleanout (Y/N) X/~"~ Date Last Pumped (~ -' '~-- ~ "~ ~E~4~ .¢E~'~ ~/~, . for ' Temporary Holding Tank Permit (Y/N) ' To Building Foundation To Disposal Field To Stream. Pond. Lake. or Major Drainage Comments Page I of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Installed ~" Date Width of Field- Square Feet of Absorption Area --~'~ Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well .4- lOC)/ To Building Foundation Lot 4.'10' To Water Main/Sen~ice Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field "~7 Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~'~ To Existing or Abandoned System on ; On Adjoining Lots ,cio / To Cutbank (if present) '{ "/3 t .+ I0o' LIFT/~TION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) : · .,Comments, "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify t haJ.,I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company~ ~ ~ MOA No. ' Receipt NO. : /~ Amount:$ / ~ ~ ~0 Page 2 of 2 Da~e:, Client's Name: Addrass: NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS. ALASKA 99709 907479.3115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907.277~378 Besse, Epps, & Ports 2220 East 88th Avenue Anchorage, Alaska 99507 Attn: Andy Ports Date Arrived: 4/19/88 Time Arrived: 1525 Date Sampled: 4/19/88 Time Sampled: 1135 Date Completed: 4/22/88 Source: LIO, B6, Elnore #1 Sample ID#: A041988-13 Parameter Units Result ADEC MCC* Carol $. Garrison, Vice-President ~ HCC = Haximum Contaminant Concentration NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907479.3115 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277~378 Quality Control Report Client: B.E.P. ID#: A041988-13 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95~ confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Standard ID# Parameter Unit QC Result Acceptable Range EPA 378-12 Nitrate-N mg/1 7.4 7.2 - 8.0 Carol J. GarP~on, Vice-President ====================================================================== Department of Health and Human Services 825 "L" Street Tom Fink. Mayor P.O. BOX 196650 Anchorage, Alaska 99519-6650 May 13, 1988 Andrew F. Potts Partner Bess, Epps & Potts 2220 East 88th Avenue Anchorage, Alaska 99507 Subject: Waiver Request For Lot 10 Block 6 Elmore Subdivision Waiver Request Number WR88-020 Dear Mr. potts: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 8 feet from the standpipe in the absorption trench on the subject property to the lot line for lot 9. The waiver was issued pursuant to the required letter of non-objection submitted to the department from the recorded owner of Lot 9 Block 6 Elmore Subdivision #1. 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 cc: Gus Andress, P.E., Manager On-Site Services/Water Quality Programs. BESSE, [' PS & POTTS May 6, 1988 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, Alaska 99501 Subject: Health Authority Approval Waiver for Lot Line to Septic Seperation, Lot 10, Block 6, El~re Subd. No. 1 Gentlemen: As shown on our Health Authority Approval Application, the end of the leach field on subject lot is 8 feet from the lot line common with Lot 9 of the same subdivision. Please accept this letter as a request for a waiver for this sep- eration distance. Attached is the origional of a state- ment from the owners of Lot 9 stating their non-objection to this situation. Also attached is the application fee for this waiver. We feel that this waiver should be granted for the following reasons: 1. The owners of the effected lot do not object to the location of the system. 2. Soils in the area are good and the location of this system (because of the 8' Lot Line separation) will not affect the location of replacement systems. 3. This is a minor encroachment into the required seperation distance. 4. This location has been public record since it was approved on 9/18/81. if you require any additional information, do not hesitate to contact me at 349-6451. Please expedite this as soon as possable as a closing is scheduled on 5/11/88. Thank you for your assistance on this matter. Andrew F. Ports Partner jwp MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION 6 1988 RECEIVED ENGINEERING, PLANNING, SURVEYING .~' ~x)L~O E. 88th Ave./Anchorage, Alaska 99507/Telephone 907.349-6451/344.1352 "Providing a quality persona#zed sen/ice to those building Alaska's future" ,. MUNICIPAUTY OF ANCHORAGE ..... ,.. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION '~. DIVISION OF ENVIRONMENTAL HEALTH " ~:- ' - CERTIFICATE OF INSPECTION FOR HEALTH AOTHORITY APPROVAL ' OF ON-SITE SEWER AND WATER FACILITY · GENERAL INFORMATION (a) (b) · . DRe..P (c) · ' : '" APplication Data Legal Description (include lot, block, subdivision, sectio,n,, to~vnship, range) ./:., :' Location (address or d~rect~ons) · '" .': Applicant Nam .,4-,a'/ '· Telephon ome '. Business Applicant Address' ' ,~,~-,~."~'~,/~,~,~/T 1.,.~¢ ,~-. ' " Applicant is (check one): Lef~din:g Institution I-]; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution kJ'.. ~ % Ic~ Telephone. Address (e) Real Estate Company and Agent Address ' Telephone (f) Mail the HAA to the Iollowing address: 2. TYPE OF RESIDENCE ' ' '· ' Siigle. TFamily]~ Multi-Family[]' Other L Number of Bedrooms ... ~ *' · 3. WATER SUPPLY .... - Indiwdual Well . Community[] ~Pubhc[] ,... ..... .,; . ........ /' : ~'-.r: ~. · , .,~,~' ',.~',-. - !Y' ';'"' ~'" ' -'*. Note: If community well system, must have written confirmation from the State DePartment of Environmental Conservation attesting ' " '" '* "'; ' ': '7;: . '* .... "' lo the legahty and status.,, '; ........... .~ . .. , · . ... ; t' ~ ~,, ;,., . ...,.. *-",.' ";' .4.' SEWAGE DISPOSAL , ., . ~ . , .... ~':.'*:.',-'..s:'?. '-r" ~..," · .,* yt '.,,~..' -'. ' *' ",r, Onslte'J~ Pubic[] Communty[] Ho d ng Tank [] , : Note: mmunity well system, must have written ~onfirmation from the State Department of E~vironmental Conservation 'to the ' ' '"'* '"" ~ '.i attesting legality and status.' ' '*:; .....'" ' ' <' '"' ':' ..... ' ' i" ' 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA'AND INFORMATION AS certified by my seal affixed h'ereto 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 froEn Ihe 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 ellect on the date o~tion. Name of Firm ~."~.,~'~'~-'.-.<~'" ~-'~'~,,~ f ,.-'""~/-'2'..~= Telephone ~'=fi'~J/~' ~///"~"/~ Address ~,~,,~-. O -- / Date Approved for L"3-C-~. bedrooms bye' Approved ~ Disapproved Terms of Conditional Approval Conditioner'~ 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 DHEP does this' a~ a courtesy to purchasers of homes and Iheir 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 72-02~ (1t/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~,, HEALTH AUTHORITY APPROVAL (HA, A) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGe. DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 2 'I 1981 Well Classification Well Log Presen(l~lN) Total Depth //",// Cased to / Static Water Level ~'5'"'~ Casing Height Above Ground -."~"~ Electrical Wiring in Conduit~N) Separation Distances from Well: /~/~,?" If A, B, C, D.E.C. Approved (Y/N) Date Completed /~.4,' -/~' --~/""' Yield Depth of Grouting Pump Set At /~"' Sanitary Seal on Casing,:~,l) Depression Around Wellhead (Y~") ./ To Septic/Holding Tank on Lot /*~'/~'* ~ ; On Adjoining Lots To Nearest Edge of Absorption Field~r~, Lot /,,.2'~ // ; On Adjoining Lots /~* ~' /~' To Nearest Public Sewer Line r/'~/''~''' To Nearest Public Sewer Cleanout/Manhole r~"~ ~',Ct /" To Nearest Sewer Service Line on Lot Water Sample Collected by ~* .,1,"~,1 ~'~-~ 'v~ ; Date ~ Water Sample Test Results Comments '~"~' ,~"/'~Hc'73 t",/A~,.. &'JE~ "7'~,~-'.~rT ; bJ~-!.J..- I..8~, : ~ r~--?~.LLT '~ B. SEPTIC/HOLDING TANK DATA Date Installed ,-~'-""'~ -~"/ Size /.~'..5'*'*~) No. of Compartments Standpip~N) Air-tight Cap~N) Foundation Cleanout~N) Depression over Tank (~ Date Last Pumped ~ -'7 Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) '~'"'-~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~,o ~ To Building Foundation d'5". ~,,,~ To Property Line .,,..z~-~,, // To Disposal Field ~'~' / To Water Main/Service Line ~' ~-- ~ To Stream, Pond, Lake, or Major Drainage Course -'f/~'--~-' ~,~"- ~ Comments ~"~'-.~"/'~V-.~ P~-.~ ~~ ) C~I~ ~ ~ Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absprption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Gravel Bed Thickness /~' Standpil:~Presen~) Date of Last Adequacy Test Type of System Design "'-"~'~-~-,~"~,,"~ Length of Field ~'~ Depth of Fie~d '"-~'~- ~' '// Separation Distance from Absorption Field: To Water-Supply Well /,.-~ To Building Foundation ,,./~,'~-d~"" To Existing or Abandoned System on Lot ,//' ," ~ ? To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course //'~'~' -'~ ~'~'~'~¢~'- ~-~'-'--"~ To Driveway, Parking Area, or Vehicle Storage Area "~"'~ ~"~ Comments ~' ,~'/T~ [ L,m9 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off'' Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request I certify tha~have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed { ~ { ~,~J~ ~ ~"J'~ Date Company /~'D'~r~ ~r~'~ MOA No. Receipt NO. Date of Payment ~' ~' ~ Amount: $ Page 2 of 2 r.,oc~ Hon: 2220 (~07) Prr~l,n:,':ion [t'~ re: /r 0 GPM 2.1-11our Capac{ ty C~l]c~s Inspector Inspector Inapector Comments ~ Conditional Approval Date Sawer Installed Permit No. Septic Tank Slze ~"1 _? [ Holding Tank Size Sells Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~ff,q/~ I ~sfr~ cY,ok d_~, Phone Address Lendin ,ns,itution fl14 l t Phone Address.~1~ E, /{/~. Z.~/~/~ ~>/V~', Realty Go. & Agent ,, Phone Address Street Location Type~ Residence ~ Single Family D Multiple Family NO. of Bedrooms Wate~upply D Individual A~ACH WELL LOG. A well log Is requlr~ for all wells drltl~ since June ~ ~mmunity 1975. For wells drilled prior to that date. give well depth (attach log If ~ Public Utility avaltablq.} Sew~ Disposal ~ Individual Year Individual Installed: ~ Public Utility When ~nnected to Public Utility: NOT~ THE INSPE~ION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.