HomeMy WebLinkAboutT15N R2W SEC 25 LT 150ATISN R2W
c. 25
Lot :[50A
#051-316-14
Municipality of Anchorage
Development Services Department ~'~ ~?-',
Building S~fety DMslon ;~ ~-~_.'-=- '
On. ire W8ter & W~stew~ter Program. 4700 ,South Bmg~w SL
P.O. Box 196650 AncJ~mge. AK 99519-6650
www.d.anchomge.ak.us (907) 343-7904 Page 1 of
On-~lte Wastewater Disposal System and/or Well Inspection Report
Permit Numbe~ SW010025 PID Number:. 051-516-14
Nome:
HARVEY GREENWOOD WastewaterSystem: n New · Upgrade
12607 IRIS WAY * EAGLE RIVER, AK 99577 ABSORPTION FIELD
(907) 694-4041 *2 ~Deep Trlnch DShdilol Trench IBed nMound eeeelOU~er
LEGAL DESCRIPTION ~' ~ 2.0 ~/~ ~ 3.0-6.0
150A - - 0.65-5.65 rL 0.58
Township: 15N row*: 2W S*cUon: 25 n. ~ .~, -~ ...: .,.~ ~ ~
0.5-5.5 rL 24 n
WELL: [] New r'l Upgrade 10 r~ 5 2 n
f ,~ rL 240 s~. hq. 0-.t034/ F-Sl0/SCH. 40
rL EAGLE MTN. EXC. 5/9-12/2001
~ ~ ~ TANK
SEPARATION DISTANCES .s.,,~ a.~di.g .$.T.~,. ~o~.,
To Sepflo AbeorptJon Uft Holding Pul~c/Pdva~ ~act~m. C_.__~ In ~
~,om ton~ ~= St~on ton~ s~ u~ ANCHORACE TANK 12§0
Well **70'+ **75' -- -- 25'+ ~ STEEL "'**' ~ ~ 2
su,o¢, wote~ ~oo'+ ~oo'+ - - - LIFT STATION
Lot Uno 5'4- e**7,+ -- ~ze In ~ I
- - 1250~ANCHORAGE TANK/ORENCO SYSTEMS
Foundation 5'+ 10'+ - - - TIMER TIMER 45'
Curtoln Omln N~Nr' KN0~ ~20 OBI 05 HHF CARCEL ELECTRIC
~=arks: .sEP~C sYs~ S~ZED tar ~ eEDROO~$, BENCH MARK
· *SEE WANER 4we0100~2 TOP OF DECK IN FRONT OF PATIO DOOR
· **WAIVER CRANTED WITH I$~;~)AN(~F' OF pERMIT,
· ***THIS IS A BOTI'0ULESS INTE:RMrI"rENT SAND FILTER (ISF) 100.00
2 FEET OF M.O.A. APPROVED SAND FILTER ADDED TO TOTAL DEPTH.
THE EXISTING SEPTIC TANK AND CRIB WERE COMPLELTELY ABANDONED IN PLACE. ~.."~C~"~"[* 7't~.~..[~h.
Inspections performed by-* AWWC, INC. DBtes: ]s~ 3/9/2001 , ~r I.~ ~
...... ";
5th 3/12/2001 /~3 Vt¥~ieYl · Camess..: ~,'
Department of Health^./...-~-~-and Human Services approval, v~ ~.~?._.:...Ic£~ .......... ,7~5~ "_":'.~_~'~
· (~v.~'~t~.~/ ~.~/. ~--~//..¢/~ ~ttXL"e~ ' · · -
Reviewed and approved bY:~7~ Date: ~ ;/O -O/ ~o?.e~.=~'~
P~ AS BUILT DRAWING ~'
SW010025 - 051-516-14
NOTE: THE 100 FOOT SETBACK FROM THE POND, THE
70 FOOT SETBACK FROM THE WELL AND THE SOUTH A B C
PROPERTY UNE WERE FLAGGED AND STAKED BY A FCO 8.75 26.71 --
REGISTERED LAND SURVEYOR. ST1 10.80 39.09 -
~ ST2 12.55 ~ ,35.55 --
MH 13.39 ; ,32.68
.~ \ MT1 62.0,3 , ,34.43 46.7`3,
MT2 70..37 42.64 54.49
\ MT3 68.90 ,34.34 41.12
MT4 76.72 42.70 49.93
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ALASKA WATER & WASTEWATER J.LM.
CONSULTANTS, INC.~ ~
6901 Ir)ESteR RON), ~UITE ~ · ~(NO~G~, ~1( ~5~ · ~ ~7~37~r7~ · F~ ~907~-3Z~6 1 w ~ ~0s
PR~ FOR: PHONE NUMBS: P~E NUMBS;
HARV~. GREENWOOD (907) 694-4041 2 OF 3
LOT 150A; SECTION 25, T15N, R2W
AS-BUILT OF SEPTIC SYSTEM UPORADE (BO~OMLESS ISF)
A B C
FCO 8.7`3 26.71 --
ST1 10.80 ,39.09 -
ST2 12.55 `35.55 -
MH 13.39 32.68 --
MT1 62.03 ,34.43 46.73
biT2 70.`37 42.64 54.49
UT,3 68.90 34.34 41.12
UT4 76.72 42.70 49.93.
'~"~ AS BUILT DRAWING
SWO10025 - 051-316-14
NEW 1250 GALLON
~o~ ~ S.T.E.P. TANK
~, ~ - 95.78
96.1- ~6.4 ~ (HIGH~ ~1~
~ 92.78
HARV~ GREENWOOD (907) 694-4041 5 OF 5
LOT 150Al SECTION 25, T15N, R2W
PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE (BO~OMLESS ISF)
;:' -."" Rising Son Electric,Inc.
. I\.~i~ '.;'~ ~t.' ·
· ~l., ,"c,,~2~t,.~ · ,'
· .~ '~.~,- )~ .%':.
~.~x~:?..V~.~ P.O. BOx 670687
~~ Chugiak AK, 99567
(907) 622-6777
Nov. 16, 2000
Re: Lift Station et 15239 Belsey Way, Eagle River, AK 99577
To Whom It May Concern:
This letter is to certify that Rising Son Electric~Tnc. Electricnl Administrator
license number 1284, Contractor license number 27285 has successfully corr, pleted
the electrical connections in accordance with the N.E.C. for the lift station et the
above referenced property.
Should you have any questions, please do not hesitate to call me.
Thank you.
Kevin S. Hornbuckle
Adrninistrator/Pres.
KSH/cmh
MUNICIPALITY OF ANCHORAGE
Development Services Deparlment
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage. AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Feb 27, 2001
Expiration Date: Feb 27, 2002
Permit Number: SW010025
Legal D e s cr ip tio n ~R2W-S-~-~-5"~'~ 5~-"-'
Design Engineer: 0041 AK Water & Wastewater Consultant
Owner Name: HARVEY GREENWOOD
Owner Address: 12607 IRIS WAY
EAGLE RIVER, AK 99577-7625
Parcel ID: 051-316-14
Site Address: 015239 BELSEY ST
Lot Size: 31510 SQ. FT.
Total Bedrooms: 2 Permit Bedrooms: 2
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of AJaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ),
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
THE TOTAL DEPTH OF THE PROPOSED INTERMITTENT DOSING SAND FILTER SHALL NOT EXCEED 6 FEET
BELOW ORIGINAL GROUND SURFACE.
Received By:
Issued By:
Date:
Date: ,2 -27-0/
Municipality of Anchorage
Development Se~ices Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak, us
(9o?) 343-79o4
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0,51-31 §- 1 '~ Permit Number.
Property owner(s) HARVEY GREENWOOD
Dayphone~l
Mailing address (1)
Mailing address (2)
12607 IRIS WAY FAOLE RIVER. AK.
N/A I.f"2.~f 8t'/,$~r~' /~0,
Zip Code cJ9577
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size 312~ ~
~'~o
THIS APPUCATION IS FOR.'
Sewer Only ~
Sewer and Well
Sewer Upgrade []
T15N R2W SEC. 25 LOT 150A
Number of Bedrooms
2
Well Only ~]
Water Storage
THIS PROPERTY CONTAINS.'
Hot Tub
Swimming Pool
Therapy Pool
D[~]
Water softening Unit
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.
A.W.W.C., INC.
(Signature of property owner or author[zed agent)
Permit Fees: ~ ~c:~ ~) ?
Date of Payment:
Waiver Fees:
Date of Payment:
Receipt Number.
ALASKA WATER & WASTEWATER
CONSULTANTS,
(Revised Letter)
February 14, 2001
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Septic System Upgrade and Waiver Request for Lot 150A; Section 25, TI5N, R2W
GENERAL: The existing 2 bedroom house is served by a private well and septic system. The
existing septic system consists of a 1000 gallon septic tank and a seepage pit type drainfield. The
existing drainfield is surcharged and must be upgraded prior to the sale of the house. As can be
seen on the attached site plan and design drawings, there are several separation distance
concerns. The only area available for a septic upgrade will require a 70 to 75 foot well waiver.
It is our opinion that this is the only option for this property; short of installing a holding tank.
The following items will address the waiver/s and the proposed septic upgrade.
WELL WAIVER REQUEST: We request that you allow for a 70 feet separation distance from
the well on the referenced property to the proposed S.T.E.P. tank and a 75 feet separation to the
proposed bottomless ISF drainfield. The well that serves the subject property was drilled on
June 13, 1973. The following items are justification for the waivers:
· Attached is the well logs for this property and two neighboring properties. As can be seen on
the well logs, bedrock was encountered between 2 to 20 feet. All three wells were cased to
bedrock. The test hole that was excavated as part of the soils evaluation was 18 feet deep,
and no bedrock was encountered. Typically, the presence of shallow bedrock would not be
conducive to the granting of a waiver. However, The existing septic tank is 73+/- feet from
the well and the existing drainfield is 83+/- feet from the well. This encroachment has existed
for over 25 years. Water samples were taken and analyzed for nitrates and bacteria. In the
initial two tests, other bacteria were present, but there as no coliform bacteria. The well was
chlorinated and the final sample indicated no bacteria and non-detectable nitrate levels. This
is evidence that the aquifer has not been adversely impacted by the existing septic system
encroachment and is perhaps the most solid justification for the requested waivers.
· As can be seen on the attached topography information dra~ving, the house and the proposed
septic upgrade are on a hill which drops offboth to the east and west. The overall topography
runs from north to south. Our conclusion is that if any effluent was to surface, the effluent
would not flow towards the well head.
· The location of the septic system is in a very visible area so that if any effluent was to
surface, it would be noticed and the problem corrected.
Based upon the aforementioned facts, it appears that there is minimal risk associated with the
requested waivers: 70 feet to the S.T.E.P. tank and 75 feet to the bottomless ISF drainfield.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwxvc.com
SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and
the percolation test results. It is our opinion that due to the overall appearance of the soils, an
application rate of 2.0 gallons/day/fl2 should be used for the proposed botto?less ISF.
BOTTOMLESS ISF DESIGN:
a. Percolation Rate: 15 minutes/inch
b. Allowable Application Rate: 2.0 gallons/day/ft2
c. Number of Bedrooms: 2 (Design for 3)
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 225 ft2
f. Total Depth: 9 feet (max.)
g. Effective Depth: 0.25+ feet
h. Width: See detail drawing
i. Minimum Length: See detail drawing
j. Effective absorption area -- 290 ft2
k. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
1. Air Supply Line: "Wasteflow" emitterline, 1/2 inch I.D, "Anchorage Tank".
m. Sand Material: In accordance with M.O.A. latest standards
n. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
We are proposing to excavate down to a depth of 9 feet (maximum - on uphill side), place a
minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On
top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway
in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a
programmable timer so that flow can be intermittently dosed to the ISF.
SURFACE WATERS: There is a pond to the east of the proposed septic system upgrade. The
100 feet setback will be flagged by a registered land surveyor prior to construction.
TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography
in the area of the proposed drainfield is a 5 to 10 percent running from approximately north to
south. There is no slope greater than 25 percent within feet, and directly downhill, from the
proposed drainfield. The trench is to be installed parallel to the slope contours.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. It' you ha~e any questions, please contact us at 337-6179. Thank you for your
assistance. ~ r
Jeffrl~y ~. ~ tmess,~"P.E., M.S.
Presldefit U
NOTE: Attached is a site plan drawing, a design drawing, a detail drawing, a topography
drawing, a soils log, and a 7 page construction specification letter which are all part of the
design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwxvc.com
N. FIR~' L~(£ ROAD I
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OkTe REVISED
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~SI~ ~TER & ~STE~TER ~.uu. ~:'~ t ~ ~'~
CONSULTANTS. INC. ~
HARVEY GREENWOOD (907) 694-4041 1 OF 4
~ ~c.~o.:
LOT 150A; SECTION 25, T15N, R2W '~.'".. .... "
SITE P~N FOR SEPTIC SYSTEM UPGRADE AND WAIVER REOUEST -~
NOT£,~ ~ NOTE: THE CONTRACTOR SHALL HAVE THE FOLLOWING
~ Am COVf~tg~T~ S~.L ~C U~CAT~ ~ TH~ ~ ~TEMS FLAGGED BY A REGISTERED LAND SURVEYOR
OR THC 6ARAC~ THC C~flTRACT~R SH~.L PIK~'][~ A 0-10 PSI PRIOR TO CONSTRUC~ON:
PRE$$L~E GA~ AT A I~T[[];I ~.'N]C~ ]$ I~ILY 1. THE 70 FOOT WELL RADIUS
v~ ~T ~ ~ 2. ~E 100 F~T S~CK ~OM SURFACE WA~
~. ~E SO~ PROPE~ UNE
T~ ~ ~S~ ~L ~ ~ ~ ~S ~ ~ ~E CO~OR IS R~PONSIB~ FOR LO~NG ~
r~ P~ ~ m3 V~X ~SZ~ ~ e ~ s~4o PVC ~ ~E PRO~SED SE~C ~M. ~E CO~OR ~
~T. ~ ZC~I[D~A~ ~ R~NS1B~ FOR ~ ~ES ~T ~Y NEED TO
3 F~T. ~ BE RELATED.
////
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~ ' ' IN~
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CONSULTANTS, INC.
LOT 150A; SECTION 25, T~5N, R2W 4h74 '. .... .' ~
DESIGN OF SEPTIC SYSTEM UPGRADE AND WAIVER REQUEST
NRUNr COt~ SPACED AT APPROX. 2
I~L'T. ORENCO 'WASTe'LOW* ~ $/4' D~A. SCH. 40 PVC
- ~--BOTrOMLESS INTERUIT~ SAND
PROV1DED BY ANCHORAGE TANK..7~ LATERALS (HOLES, SHIELDS. / FILTER (ISF), NO UNER ON
AND FLUSHING: VALVES pER / P~'~TTt3M. pRE:S~URIr pipinG
(~X~.ND ~ ~\ ~'.~' ./"~-T-~ : : '; :~'-.--:'-':--. -':'-'~ ' -
l'-"
I I I I I I I I I/O I D~CHARGE UNE FROM
· DI~. MONrI'ORINC ]IJB[
BETWEEN TOP OF SAND AND
DISTRIBUTION PIPE INVERT.
(DRILL 1/4 INCH DL~ HOLE:S)
PlaN VIEW
/ /~ FILTER FABRIC OVeR
.' PROFILE VIEW
?0. OF SAND
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
HARVEY GREENWOOD (907) 694-4041 .% OF 4 ~,~ '*,.d~f~e)f~A. Oarness... ~
DETAIL OF BOTTOMLESS INTERMITTENT SANF FILTER (ISF)
I
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~SI~ ~TER & ~STEWATER ~'. ~ ~/~
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HARVEY ~REENWOOD ($07) ~4-404~ ~ OF ~ ~ ~y, e~s:
LOT 150A; SECTION 25, T15N, R2W 4h?wJ'... 1~ ....'
DRAWING FOR TOPOGRAPHY INFORMATION
PHONE (907) S37-6179 · r~ (907)
I SOIL LO0-- PERCO~TION TEST]
LEaL DESCRIPTION: TISN, R2W, SEC~5; LOT 150~
PERFORMED FOR: ~ GREENWOOD --
DATE PERFORMED: 12/29/00
OR~,CS IIESI
Gw/sw
1 I A
~GW ~ ORG
GP ML
GM CL
GC OL
SW MH
SP CH
SM OH
SC
DEPTH TO DATE
3ROUNDWATER
DRY 12/29/00
DRY 1/02/01
DRY 2/26/01
GM
DATE
1/o2/ol
1
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
,3:42 6" --
4:12 50 `3 1/2" 2 1/2'
4:12 6' --
4:42 `30 4' 2'
4:42 -- 6' --
5:12 .30 4" 2'
PERCOLATION RATE 15 .(MIN./INCH) PERC. HOLE DIA. __
TEST RUN BETWEEN 6.0 FT. AND 6.5 FT.
6' (INCHES)
COMMENTS: PERC-HOLE WAS PRE-SOAKED FOR 4+ HOURS. RECOMMEND USING A 0.6 APPUCATION RATE.
PERFORMED BY ALASKA WATER & WASTEWATER I, JEFFREY A. OARNESS, CERTIFY THAT THIS WAS PERFORMED
IN ACCORDANCE WITH ALL STATE AND MUNICIPAL OUIDEUNES IN EFFECT ON THIS DATE:~ i
ALASKA WATER & WASTEWATER CONSULTANTS, INC. ,~'~ OF
PHONE (907) 357-6179 · F~ (907)
BOIL LOG - PERCO~TION TEST]
LEGAL DESCRIPTION: TiSN, R2W, SEC 25; LOT 150~
DATE PERFORMED: 12,,/29/00 '~S~',.. (
(f~ ~ o~cs TEST HOLE ~1 ~;%-~;-, ''''~
2-- ,,0 ~.~ I I A ~.-------.. [SITE
'~ ~ I I' = I00' II
3_ ~,~'"~ GW/SW ~ ~P~w ..... OR~
HL ~ HO~E ~ / 2 B~R~U
~ ~ GH CL ~ ,o~
,~ GC OL m% / . ~NO
5--
~ ~SP CH ~ ~ ~?~ ~
7-- DEPTH TO DATE ~ m ~ -.
GROUNDWATER ~ ..... ~ ~PRO~ ~///~ I
10-- J
11-- DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
~M TINE (HINGES) READING (INCHES)
12 -- 1/02/01 I 3:42 ~ 6'
2 4:12 30 3 1/2' 2 1/2'
13-- 3 4:12 ~ 6'
4 4:42 30 4' 2'
14-- 5 4:42 ~ 6'
6 5:12 30 4' 2"
15--
16--
17--
18--
B.O.H.
19-- PERCO~TION ~TE 15 (HIN./INCH) PERC. HOLE DIA. 6' (INCHES)
20-- ~ TEST R~ BET~EN 6.0 FT. ~D 6,5 FT.
COHHENTS: PERC-HO~ W~ PRE-SO. ED FOR 4+ HOURS. RECOMMEND USING A 0.6 ~PU~ON ~T~
PERFORMED BY A~ WA~R & W~[WATER I, JE~ ~ C~NESS, CER~ ~T ~IS W~ ~ERFORMED
IN ACCORD~CE W~ ~L ~A~ AND MUNICIPAL GUlDEUNES IN E~LCT ON ~IS DATE:
DEPTH TO DATE
GROUNDWATE~
DRY 12/29/00
DRY 1/02/01
Se~t 9y: Alaska ¥~ater and ~lastawa:~r Con; ~07 338 3246; =e~-15-01 13:11; Paoe 212
PROPERTY OWNER MAINTENANCE AGKE~'MENT
ON-SITE WASTEWATER DISPOSAL SYSTEM
T'r. is agreement, dated ---'.~..e~ /.'9' ,200_, is made between the Municipality of
Ancl:orage Del~a~aent of Health and Human Services (DHHS) and the prolxrty owaer(s) of
This a~re~ment i~ made for th~ Furpose of maintaining an on-site waste-wa/er disposal system
on the subject property.
'Pae property owner(s) agree to the following:
The property owner(s) will have an annual inspection of thc system performed by a registered
professional engineer. This inspection shall verify that all effluent and air pus, ps, timers, and
alarms are functioning as designed. An)' deficiencies shall be co."recm~ and thc engineer's
statement that the system is fu~ctiening as designed shall be filed annually with the DHHS.
Property Owne/Narae
Prolx~ner Name
(Nom-ize Here)
w!thin instrumeut and aclmtr~,ledged that
cxccut~ the .sa-nc for '.he purlX~Cs ~..ere~.
conmi-e~.
In wimcss whcrco~, i hereunto set my h,~d ~d
oflki~l seal. ~ -
Nota."y Public (signature)
(Nolasy's prmtcd name)
My cornmiuaioa e~pites:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wa~tewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WR#: WR0100t2 PID~: 051-316-14 HA~:
Date Received: 2/9/01
Legal Description: T15N R2W SECTION 25 LOT 150A
Permit~: SW0100mn..~
Engineer:. JEFFREY A. GARNESSr ALASKA WATER & WASTEWATER CONSULTANTSr INC.
6901 DEBARR ROAD~ SUITE 2B, ANCHORAGEr ALASKA 99504
Applicant: HARVEY GREENWOOD
Waiver Requested: ON-LOT WATER WELL TO THE PROPOSED SEPTIC TANK/LIFT STATION AND
INTERMITTENT DOSING SAND FILTER
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver Is Granted: ~ Waiver is not Granted:
List Conditions or Reesons for above: .,~" ,g ~
Date: ~- --2 7-- O / By: P'fA/
Name of Reviewer
Rec~: 0605 Amount: 920 Date Paid: 2/9101
Municipalit3. of Anchorage --
George P. ll'uerch, Mayor
Building Safety Dix slon
P.O. I~x 196650 * 4700 S. Bragaw Street
Anchorage, Alaslm .09519-6650 · (907) 32t3.8'101
02/27/01
Jeffi'ey A. Garness, PE
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504
Subject:
Waiver Request forTl5N R2W Section 25 Lot 150A
Waiver Request #WR010012
Parcel ID #051-316-14
Wastewater Disposal System Construction Permit Number SW010025
Depnrtment of
Public ~ork~
Dear Mr. Gamess:
Your request for a waiver of the required 100 feet horizontal separation from the
on-site wastewater disposal system to private well has been approved. The approved
separation distance is 70.0 feet. This approval is for the proposed Intermittent Dosing
Sand Filter treatment system.
This waiver approval applies to the existing on-sitewastewaterdisposal system to
private well separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water & Wastewater Program
I
TI~'~ g 2~v ~T~, 25' L~T I~'~t
I
I
Tom Fink,
Mayor
A unicipality of Anchorage
Department of Health and Human Services
$25 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
September 8, 1989
Lou Butera, P.E.
Eagle River.Engineering Services
P.O. Box 773294
Eagle River, Alaska 99577
Re: Lot 150A T15N R2W Sec. 25 Waiver Status
Dear Mr. Butera:
The conditions and stipulations of the separation distance
waiver which was issued by this department have not been met.
Our records indicate that quarterly sampling has not been
performed, therefore the subject waiver is no longer valid.
To obtain an approved waiver at this time, an application must
be submitted with all pertinent waiver guideline items addressed.
If you have further questions regarding this matter,
Daniel Roth at 343-4744.
S,.c?
¢~ ~ g~r ~ah~ a ~J~e r vi c e s Program
please call
cc: Daniel Roth, Civil Engineer
On-Site Services Program
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
SERVICES
Lou Butera, P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (§07) 694-5195
questions regarding
ioned on quarterly
.ished?
it require some
action?
~is ma~er, ~ease
Signed
9%015 (Rev. 1/81)
V~UNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES.
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
August 25, 1986
Nell Hawthorne, P.E.
NHawthorne-Engineering
7127 Old Seward Highway
Anchorage, Alaska 99502
Subject: T15N R1W Section 25 Lot 150A
Waiver Request, WR86-098
Dear Mr. Hawthorne:
This department has reviewed your request for a waiver of the I00~foot
separation required between the seepage pit and well on the subject
property. The seepage pit is located 80 feet from the well. Based on
supplemental information that you have provided this department is
willing to grant a conditional waiver.
As a condition of this waiver results of quarterly nitrate analysis
performed on the well water must be provided to this department. These
analyses must be performed by a laboratory certified by the State of
Alaska. The first results should be mailed ~ the department no later
than December 31, 1986. Subsequent sampling result deadlines will occur
on the last day of March, June, September and again on December 31 of
each year. Samples must be collected in accordance with accepted
procedures.
This waiver will be considered valid only as long as quarterly sample
results are provided to this department. This waiver is valid for the
existing two bedroom single family dwelling only. Any modifications
to the septic system will invalidate this waiver.
If you or your client have any questions regarding this waiver or the
conditions attached, please give me a call at 264-4761.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
N~AWT~ORNE~ENGINEE~NG
7,27 OLD SEWARD HIGHWAY
ANCHORAGE, ALASKA 99502
907-344-47 $ 1
NHAWTHORNE ENGINEERING
7127 OLD SEWARD HIGHWAY
ANCHORAGE. ALASKA 99502
907-344-47 ! 1
July 9, 1986
Mr. Stephen Morris
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, AK 99501
MUNICIPALITY OF ANCHORAG2
DEPT. OF HEALTH &
~NVIRONMENTAL PROTECHON
1 o1986.
Re: Lot 150A, S25, T15N, R2W
Dear Steve:
Apparently, a
subject property.
sketch.
separation distance waiVer is required for thei
I performed a site survey shown on the attached
A letter by the builder in your files says the septic system was
installed in 1969 and the well in 1973. Use began in 1977. From 1969
to 1973, the required distances were:
Well to septic tank = 50 feet
Welt to absorption field = 100 feet
On August 8, 1978, Robert Pratt of your office approved a 91 foot
separation between the well and the "seepage area".
I do not have a well log for the lot. No soils test is available
either, but some information is on the attached sketch from 1978. Due
to the topography, I am not concerned about ground water interference
with the seepage pit.
Let me know if I can provide further information.
NH:ck
Enclosure
August 21, 1978
R&M NO. 851581
Mr. Walt Belsey
P.O. Box 886
Eagle River, AK. 99577
Re: Adequacy Test on Existing Sanitary Sewer System; Lot 105A,
Section 25, T15N, R2W, S.M., Alaska.
Dear Mr. Belsey:
This letter is prepared as a supplement to our original report of
septic system test results on the subject property dated August 16,
1978.
Our test showed that the seepage pit dispersed liquid at a minimum
rate of 508 gallons per day. As reported at that time, this rate
is adequate for a one bedroom residence.
Since the house on the property has been assessed as a two bedroom
residence the expected load on the system is 300 gallons per day.
The rate established during the test indicates that the system is
also adequate for a 2 bedroom residence.
Very truly yours,
~&M CONULSTANTS, INC.
Gary ~mith
Senior Geologist
GS/dkd
Attachment
August 16, 1978
RgMNo. 851581
Mr. Walt Belsey
P.O. Box 886
Eagle River, Alaska 99577
Re: Adequacy Test on Existing Sanitary Sewer System; Lot 150A, Section 25,
T15N, R2W, S.M., Alaska
Dear Mr. Belsey:
Per your request of August 9, 1978, we conducted a test of the sanitary sewer
system on the above described property.
The septic tank was p~sped prior to the performance of the test on the
seepage pit. During the test the liquid level in the seepage pit was
measured before and after the addition of 508 gallons of water. The total
depth of the crib was 6.8 feet. Ail liquid levels were measured below the
top of the standpipe and are shown in the following table:
Initial Water Second 24 hour Total
Reading Added Reading Reading Drop
(gallons)
6.8' 508 4.6' 6.8' 2.2'
The meter used during the test was a Neptune 1~" standard water meter which
had previously been calibrated by R&MConsultants, Inc.
The water level rose 26.4 inches with the addition of 508 gallons of water,
indicating a capacity of 19.2 gallons per inch. Twenty-four hours later the
liquid level was again measured and found to be 6.8 feet. It had dropped 2.2
feet or 26.4 inches. This indicates an average effluent acceptance rate of
508 gallons per day for the surrounding soils. If the one bedroom residence
on the property is to house two people, the average load on the system can be
expected to be 150 gallons per day. We can therefore conclude that the
system is disposing of effluent at an adequate rate for a one bedroom resi-
dence.
Mr. Walt Belsey
P.O. Box 886
Eagle River, Alaska 99577
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions regarding this letter or if we can be of additional
service to you.
Very truly yours,
R&M CONSULTANTS, INC.
ynne Kosikowski
Staff Geologist
GS: LK/kah
~Gary A. Smit~/
Project Manager
Eagle River, Alaska 99577
· ~O~ 150A
Supply.
The ninety-on~(91) s~paration be%~,~een the ~II and the
are atta¢~'hed.
In t~ ~vent the ayste~ dee~ not pass the adequacy teat, an
uf~rad~ of th~ seepage area ~ill ~ requfred~ which would
inelude a on~-hundred(100) foot separation bet,~{een the well
In the event the adequa(;y fails, a soils test .~auSt be obtaiaed
If there% ~e any questions, please contact this office
at 264-4720.
sincere!y,
Sanitarian
c /lju
I-'.obert A. Hall~ Director
.qeal~h & l~;:~viron;~enta! Prote~l;ion
AUG 0 a i9'~ ~.
4
r~. ,. 0 4 !978
~ec~
HEP DIR. OFC
M-W DRILLING, inc.
P. O. Box 4-1728 · 2811 Dawson
A C 907~279-1741
ANCHOP, AGE, .~J~ASIC& 99509
DRILLING LOG
Well Owner
Walter Belsey
Use of Well Do~.
Location (address of: Township, Range, Section, if known; or distance main road
Lot I_50A_. ~,c~. Tl~'i~. R2V
'Fire Luke
Size of casing 6 Depth of Hole 175 feet Cased to 24 feet
Static water level 15 ft. (~.0~) (below) land surface. Finish of well (check one) open end (
Screen ( ); Perforated ( ).
Describe screen or perforation None
Well pumping test at ~--~ gallons per
of drawdown from static level.
(minute) for ] hours with
);
ft.
Date of completior 1% J,,~. 77
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
S/ltv Gravel
TO
_~_~//{_TO
TO
TO
]OOTO
.TO_
.TO_
.TO.
TO.
.TO.
.TO.__
.TO.
.TO_
.TO.
.TO
1 oo
Weathered Bedrock
Grey
2 -- State
Municipalityof AnChorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.a k.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY .APPROVAL
'FOR A SINGLE FAHILY DWELLING
GENERAL INFORMAIION -- "" '--':" ......
CompletelegaldescriPtion T15N R2W SE:CTION 25 LOT 150A
Location (site address or directions) .. ' 15239" BE:LS-EY
:- HARVEY CREENWOOD ............. Dayphone. (907) 694-4041
12607 IRIS,WAY E::ACLE: RIV[R, .AK-99577 ' ,'. .... r: ....
;: ,Cun'ent Property owner(s)
. ::.:~., -'Mailing address
· . "; '~.} Lehding agency...
:' ·... Mallingaddress
- Real E~tai~ Agent
Mailing address
Day phone
., · ~, ~ .:,.'. '~ :,,..;,,,~, .(.
Unless othe~vise requested, HAA will be held by DSD for pickup.
,. -. ;,:-;.
.:i;.."2. NUMBER OF BEDROOMS:
~ 3. ' TYPE OF WATER SUPPLY:"
· ". Individual Weli" '
Indiv, idual W~t~r Storage
- Community Class Well
Public Water System
TYPE OF.W.'~STEWATER DISPOSAL: ........
- · ..... Individual On-site ........... ·
[] ~lndivi.d.ua_! Holding ta.nk
[] Community On-site []
[] - Public Sewer. []
The Municipality of Anchorage Development Services Department (DSD) rssues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval ara 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 h(~'eo~vn~s.' Certificates of Health Authority
Approval are valid for 90 days from the date cf issue for properties served by a pdvate or Class C well and may
be reissued with new water sample results less than 30 days old,.- (C~ficates may be reiss~:Jed for a period of
up to one year with valid water samples.) Certificates are valid for one y~ar for properties s, erved'by Class A or B
wells or a public water system. The Municipality of Anchorage is not responsible for'error~ 0~; o~is~ions In'[h'e
professional engineer's work. ' ' , ' ' · '~ ' ~
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my saal affixed hereta and as of the vafldation data shown below, I verffy that my
Investigation, based on procedures outlined in the Health Authodty Appmval Guidelines for this application,
shows that the on-site water supp~, and/or wastawatar disposal system Is(am) 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 Munlclpalily of Anchorage files and from my Investigation and inspection, the
on-alta watar supply and/or wastawatar disposal sYStem is(are) In compliance Wl~ all applicable Municipal
and St~ta codes, onfinances, and regulations In effect at the t~rne of instaliation.
Name of Firm , ;ALASKA WATER & WASTE'WATER CONSULTANTS, INC. . Phone 357-6179
Engineer's Printed Name JEFFREY A. GARNESS, P.E.. Date I
. ¢~oerat~nalmqulreme~tsof~eADECo~MOADSD. 77~econtentoflt~smportlsfor
. ....
"~i ON-SITE
~- WATER AND
__ . ~. wi~ ~e fll~ sflpu~a~ns~ .WAST~ATER
' ' ' ~" ~ "PROG~M
5. DSD SIGNATURE.
DisapprbVed. :
.. Co~n~.~.°..na. ! approval for
Attachments: ., . ........
HAA Ch{~:ldi~t ..... ~ ' Ma~ltenanc~ Agreements,'" '
Septic System Advisory .- Supplemental Engineers Reort.
-- ........-.--.,We"l=l''~rM-~i~'" ' "', .:-: ," Other '. -' "'
Municipality of Anchorage
Development Sen/Ices Department
Building ~afety Division
On.Site Water & Wastewater Pn3gram
4700 8ouet Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanctm3rage.ak, us
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Oescttption: T15N R2W SECTION 2,5 LOT 150A Parcel ID:
A, WELLDATA I'~N WELL HOUSE AND CONCRETE SLAEI AROUNO CASINGI
Well type PR~ATE
Oatacompleted JUNE/75
Toteldepth 175 fl.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
IfA, 6, or C provide FqNSID~ N/A
Sanlte~y seal {Y/N)YES
Cased to 4 fl.
FROM WELL LOG
JUNE/75
i5 ft.
/,~ g.p.m.
Well Log {Y/N).
Wires properly protected {Y/N)
Casing height (above ground)
AT INSPECTION
3/ g/o
46' .ft.
2.5+ g.p.m.
051-516-14
YES
,in.
Coliform ,~ colonies/100 mi.
Data of sample: .3/19/2001
B. SEPTIC/HOlDING TANK DATA
Nitrate ~ rng./L.
Collected by:
Other bactada ~ G, colonies/100 mi.
AWWC. INC.
Tank Type/Matarlal
Tank size 1250 gal.
Foundation deanout {Y/N) YES
Oata of pumping N/A
C. ABSORPTION FIElD DATA
Date installed 3/9/0 ~
Length 24
STEEL
Number of Camparlmente 2
Depression over tank {Y/N) NO
Data installed
YES
Cleanoute (Y/N)
High water alarm {Y/N) YES
Pumper N/A
pe[LOW nN~. G~.~o~ ro ~oP or s~p,
Soil ratirlg ~-'.~r ~/Ixlrm) 2.0 System type.
0.38
.~ Width 10 ff. Gravel below pipe
Total depth .4.5'+~- Eft. absorpaon area 24.0 ff~ Monitoring tube YES
Date of adequacy test NEW Results (Pass/Fall) PASS
Fluid depth in absorption field before test N/A in. Water added N/A gal.
Elapsed Time: N/A min. Final fluid depth N/A in. Absorption rata >=
Any rejuvenation treatment (pest 12 mo.) (Y/N & type) NONE KNOWN
ft*
Depression over field. NO
For 3 bedrooms
Now depth N/A in.
N/A g.p,d.
If yes, give data -
D. UFT STATION
Date installed 3/2001
"Pump on" level at TIMER in.
Datum $.O.T
E. SEPARATION DISTANCES
Size in gallons 12,50
"Pump off level atTIMER in.
Cycles tested NEW
*SEE: WAIVER i~WR010012
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank~llt station on lot
Absorption field on lot
Public sewer main N/A
Sewer leeptic se~vtce line 25'+
*70'
Manhole/Access (Y/N) YI~S
High water alarm level at 45" in.
Meets alarm & circuit requirements?. YES
On adjacent lots 100' +
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Water main N/A
Wells on adjacent lots 100'+
Pmpeffy line 5'+ Absorption field 5'+
Water ss~ce line 10'+ Sudace water 100'+
I**WAIVER GRANTED WITH ISSUANCE OF' PERMITI
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line o* 7' + Building foundation, 10' +
Water service line 10'+ Surface water 100' +
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
Water main N/A
Driveway, parking/vehicle storage
50'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems em in
conformance with MOA HAA guidelines in effect on this date.
Enginee?s Printed N~JTte
JEFFREY A. GARNESS
HAA Fee S
Date of Payment
(Ray.
Waiver Fee $
Date of Payment
Receipt Number
ALASIG~ WATER & WASTEWATER
CONSULTANTS, INC. - ...... ,,
FACSIMILE TRANSMITTAL
DATE:
APR
NUMBER OF PAGES:
(INCLUDING COVER)
TO:
FROM:
Alaska Water and Wastewater Consultants, Inc.
.Jeffrey A. Garness, P.E., M.S.
COMMENTS:
6901 Debarr Road, Suite 2-B * Anchorage, AK 99504
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
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name '~-~ ~:~-~¢ Telephone: Home .~'~ ._.~"7~'0 Business ,~?_~
Applicant Address ./~'..~. ~- '~ ~. ~** ) .~,.~ .~'~ '7
(c) Applicant is (check one): Lending Institution []; Owner/builder,S]; Buyer []; Other [] (explain);
(d) Lending Institution ~ t ~ ' Telephone
Address
(e) Real Estate Company and Agent ~ I ~/~
Address
Telephone
(f)
Mail the HAA to the following address:
~,~ /I
TYPE OF RESIDENCE
Single-Famil.~J~" Multi-Family []
Number of Bedrooms. .~
WATER SUPPLY
Individual Well~'~"Community [] Public
Note: if community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite,[~"'Public [] Community [] Holding Tank []
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 {11/84)
'5.
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health'
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
NameofFirm /k.~.u.)"~<~,rj4¢- --~'~r'-, Telephone
Address 7/.~. ? ~) ~ H.,~/
Date 7/! m/~ (.
WATER WELL NOTE: This Health Authority Approval inspection merely
certifies thst the subject water well produced 150 gallons per
bedroom per day and that certified laboratory tests showed no
presence of coliform bscteria in a sample of that water, No warantee
or certification is expressed or implied concerning the long term
adequacy or safety of the water supply.
ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval
inspection merely certifies that the subject on-site sewage disposal
system accepted et least 150 gallons of water per bedroom per day
as determfned by methods spproved by th~ Municipality of Anchorage
Department of Health and Human Services. No warantee or
certification is expressed or implied concerning the long term
adequacy of the on-site sewage disposal system. Construction data
reported on buried system components is from MOA files and was
not verified during this inspection.
DHEP APPROVAL / /,
Approved for -J~' ' '.bedrooms by
Approved ~ , Disapproved
Terms of Cohditional Approve!
Date
Conditional
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 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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
--/- ~ 5'
MUNICIPAUTY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth 1'3~ / .~
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
j~¢2~! i/~..~-.~- IfA, B, C, D.E.C. Approved (Y/N)
Date Completed I 9'~'~ '~ Yield
Cased to ~),~L~ ..... Depth of Grouting ~/¢~ }¢ ~o ~ ~
Pump Set At ()'r~ l¢ ~ ~,~- ~
! ~- ~+' Sanitary Seal on Casing (Y/N)
'~ Depression Around Wellhead (Y/N)
'~ ;~ cb ; On Adjoining Lots ,'~ I ~O
~ ~ ; On Adjoining Lots 2> fO~ ·
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
To Nearest Edge of Absorption Field on 'Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed / .~..~.~ z~2 Size IO~ No. of Compartments
Standpipes (Y/N) .~ Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~/ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~ ,/_~. ; for
Holding Tank High-Water Alarm (Y/N) /*~/,z~ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well -~' ~ ~
To Property Line '~¢ +'
To Water Main/Service Line ~.~ / 4'
Course I ~2 ~/~
To Building Foundation
To Disposal Field L~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed I ~ ~ -~ :~
Width of Field (~h I< ~.o ,~.~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ O t
Type of System Design
Length of Field /...~.,n ~
Depth of Field _ ,.¢..
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Building Foundation ! ~ 4-
Lot ~/~ ~ ~. L- ~ ~¢_ ~
To Water Main/Service Line ~O ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ,'~ ;~
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) .~'O ¢/'~,,p .¢- S lo ¢ .~. I
Comments
D. LIFT STATION
Date Installed
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
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify tha~d~.v~h~¢~d, o_r conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed //---¢~, .~~ Date
Company .,~ z'~' '"~J:~J¢~4 ~_~_~ M 0 A
Baoe pt q
Date of Payment ~--~ ~r~ ~(¢c~
Amount: $ (-.~'" ~ ~'~'~
Page 2 of 2
NO.
72-026 (11/84)
MUN C PAL TY OF ANCHORAGE ' · ".' ' :' . ',' "',~)>l
DEPARTMENTOFHEALTH&ENVIRONMENTALPROTECTIOI~I': ~; ; : :~" ' ' ' '
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 ~ ' '~ ~ '~
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,
MAI LING ADDRESS
PROPERTY RESIDENT (if different from above}
2. BUYER PHONE
MAILING ADDRESS
3. LENDING INSTITUTION~ '" 1 PHONE
MAI LING ADDR ESS
4. REALTOR/AGENT I PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ One [] Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
WATER S PPLY
7. ~J~ iNDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
8. SEWAGE DISPOSAL SYSTEM
~ iNDiVi DUAL/ON_SiTE~.
[] PUBLIC UTI LITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) ~'I~
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
72-010(3/78)
NOTE: THE INSPECTION FEE MUST ACCOMpANy EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
,NSPECTOR INSPECTOR 1NSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size:. If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS :
[]~/APPROVED FOR ~'~ BEDROOMS
[] CONDITIONAL APPROVAL (Petter must accompany certificate)
[] DISAPPROV, ED
LEGAL DESCRIPTION
72-010 (Rev. 3/78)