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POLLOCK HOMESTEAD BLK A LT 4
Pollock Homestead Block A Lot 4 #017-112-51 MUNICIPALITY OF ANCHORAGE oent On-Site Water& Wastewater Program >.° . ±r,,.`5'; �,.�1 PO Box 196650 4700 Elmore RoadOA e. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 "' httpa/www.muni.org/onsite �* �• • .... i t)epai•mem. �'Ck OHAGE On-Site Wastewater Disposal System Permit Permit Number: OSP191163 Effective Date: 6/28/2019 Work Type: SepticTank Upgrade Expiration Date: 6/27/2020 Tax Code Number: 01711251000 Site Legal Address: POLLOCK HOMESTEAD BLK A LT 4 G:3137 Site Mailing Address: 15311 POLLOCK DR, Anchorage Owner: MORRIS CHARLES E & Lot Size in Sq Ft: 18253 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field CEJ Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: t, Q ?V Issued By: 7I - A & CPJuMQ(� Date: c 0 17 MUNICIPALITY OF ANCHORAGE f.Development Services Department ` _t Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-112-51 Property owner(s) CHUCK MORRIS Day phone 4/ 4 .0 "&'(5C Mailing address 15311 POLLOCK DRIVE ANCH AK Site address SAME Legal description (Sub'd., Block & Lot) POLLOCK HOMESTEAD BLK A LT 4 Legal description (Township, Range & Section) Lot Size 18,253 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field _ Initial Single Family (SF) U (w/wo ADU) Septic Tank x Upgrade Duplex (D) n Holding Tank n Renewal H Multiple Dwellin•s ❑ Privy ❑ (SF a 4..r5t, 7 8 g �� . to Private Well I Water Storage U AI/R 8 -;., ; 2019 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: 3 !/ N • z • I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. /7/14 (Signature of property owner or authorized agent) Permit/Rush Fees: I225 Waiver Fees: Date of Payment: 5/i 1/9 Date of Payment: Receipt Number: /U an Receipt Number: Permit No. 650 9//43 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc April 30, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic tank permit Legal: POLLOCK HOMESTEAD BLK A LT 4 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. A test was done on the leach field and it passed no issues, therefore we only need to replace the old steel tank. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely iy ,_, Michael N. Anderscm, P.11. 4661 Natrona Anch,Ak 99516 Ph 727-8864 a Pollock Circleto Flew-- 95 it. Biock 9 9 on Lot B, f to Tank . c0 9q t. .� on 0' 3' Block A • st (c. tk(All\.(.)0 c; °o *`. q-C' 7 \ \\ E-4,4,41-v_tcdit\ti.est � \\ 4.0 tn-ci � \ \ q . , o co \\\ Q 00 ,(� d(1�2 � fav•,-+ fadN \ ‘.t)A) \I\cialktilidvnj 1 }1 > 10`�, 47" U \ Gr 411110 Porch / Deck 1 ` 4 l i h� ��ta�.N.0at re WI I `\ !6 OF Ac X11 7 tf a .""V�•• .qs�•1ice' '\ j * • 49TH, PN� .. .::* J 3 Single Story e0 ,: ` ,• '9� u, ����jj Frame House \ \ /....... .. . �.. 04r, ��� \i, i •va. MICHAEL N. ANDERSON . , �fl� I Wi&�lF •• Li y( •`•� Deck ��'\� 1 a p - s�0�t� rad � `1 ` --- 1988 2_gdrm^ �A�� - / _. 90 ' 91 ,9 �• / 1 �I I Dog Mouee,,�C1 i ood Fence ,(..----- with r- O W!� n / Birch Trees 1 Note: Found 5/8" Rebar Property Corner I I See Separation Distance Waiver dated TBM—Assumed Jan. 24, 1994. Elev... 100.0' MUNICIPALITY OF ANCHORAGE DE, ATMENT OF HEALTH AND HUMAN SER. ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-472.0 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name — DISTANCES — G,qo��,uc 4,e/on) dCElel O \ TO SEPTIC ABSORPTION !® Address FROM TANK FIELD WELL WELLP1'e14_1n1_16_ hone(s) No. of Bedrooms 27�- 40U 3 LOT LINE LEGAL DESCPIPI'ION Lot Block Subdivigi n FOUNDATION Township, Range, Section - - ---- �-�s AS -BUILT DIAGRAM (Show location of well. septic system. property lines, loundation. _! � o 3�4 — TANKS SEPTIC ❑ HOLDING Manutactuier Capacity in gallons 4��YZ _517141 Material No. of Compartments —TYPE OF SYSTEM Gl//JGIeAO ❑ TRENCH ❑ RED W. DRAIN ❑ OTHER Depth to pipe bottom from total depth from original grade original grade / Y FT FT Fill adtletl above original grade Gravel -depth beneath pipe D. S- FT 3_, I-) FT _ Gravel lengti, _ 3s Gravel width s FT FT Total absorption area SQ FT Distance between lines /L,) FT 111I Number of lines Sod rating SQ FT Pipe material Installer Dale Ins�tJ'lied 7/// �_E e). �j ...7 —G, CJ GJ U q WELLS E)(1 _e, 7i1J 6-� __o PRIVATE ❑ OTHER (Identifv) -Classification (A, B.C) th Cased to FT FT TDC�te Inslallci lled. REMARKS: �� =rz J li..) Jc-_1. 7-/N4 51Fd rIC Tiufi✓/i k1 s doveway. water *— IE' Scale:-ENGQF.MF, SEAL /�� _ /4 71510. Inspections Feqorrnedby: T F JSP L(X.�✓ W� 74E/ Date. - AM'r°;r2• , Yrs, oll ,. Pie . ..,�h . ,,,r.•..,. .. ., S & S ENGINEERING � a ,V€tr1�7i1js 12ifi'CfhiEe 2f3�s""� certily Thal this inspection was perlortned according to all •r 7TH aE g"e I �j It Atr r :.,. 1 Municil�a'�1o5(r�CN�itleltiPa115hrAIG�Ts date: _— --- �. tai. IdBT•di r. , ,.:.to -;,1,. Health Department Approval: Date. 2-013 (3/85) S & S ENGINEERING 17034 E. R. LOOP #204 EAGLE RlVER, AK �95/7 PHONE #694-2979 ******************UN-Sl[� SEWER PERM1[ APPLICATIUN***************** DAlE: J -2J-88 APPL1CHNl: PKlMlC�KlO AU0HESS: 1345 WEST 9TH #201 ANCHOHA6E ALASKA 99501 CON[AC| PHONE: 276-2O01 LE6AL UES(�RlMlDN� LO7 4; 8L�CK A; POLLUCK SEC 34 ,T12N,R3W i8T SllE: 17500 (SQ FT UR ACRES) MA�. NUM�EH [|F BEDROOMS: 2 OF c���� SOIL RA[lNG: 151 SQ FT/BR S(/lL lE�lD�PTH: \�~(7F7 NO WATER PRESENT IN TEST HULE. E RO M TO lHE EXISTlNG SEPTlC SYS|EM __..... ... ..�_��-+___--_~.'___~__��____��~___~ SF I.C�AL CUNDlTlUNS UR lNS}RUCllONS: U1 GRAUE FRUM 1 8R. TU 3 8R. CAPACl\Y. IV s Q.- _ a�vos b2yr'iili!. yY9 reg¢�IF NF.'a.,gE��aiF �♦.�Yy� a 1• t ' i') Municipality of Anchorage'~ S f DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOO e PERCOLATION TEST „ tMIA A PERFORMED FOR: 6--) DATE PERFORMED:_ 'i"" ge LEGAL DESCRIPTION:��r1 `�/"� �t�L�(�C__1�Township, Range, Section: -:r � h����� '4 f F�Fm�CL SLOPE SITE PLAN -5 ri 2 3 6 / m r 4 �J( < 5 /o 6O<�J 7 -, o 8 9 i 10 / � /2 0 i 11 �� 12_ C 13 14- 15- 16- 17 4151617 18 19 20 COMMENTS p - �'iL-V" -�2tL;'r or- IAOVI�' WAS GROUND WATER 1 ENCOUNTERED? S IF YES, AT WHAT 0 F' DEPTH? P — E Depth to Water AI Monitoring?_ Date: Reading Date Gross Time Net Time Depth to Net Drop '2-'.1� ---'— �Water /P� ---� 72 �✓�� 0(� j , wJ ` N PERCOLATION RATE 13 (minutes/inch) PERC HOLE DIAMETER 12) TEST RUN BETWEEN €f,(tND —0�—FT PERFORMED 07034 Eagle River Loop Rodd No. 204 Engle River,ATO-51-3-99S77—I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: —z �Z% —j-4 -� MUNICIPALITY OF ANCHORAGE- DEPARTMENT OF HEAI_l'H & FNVIRONMFN T.AI. PROTT-.Gl-ION ENVIRONIVIENTAI._ ENGINEERING DIVISION \ 825 L Street. - Anchorage, Alaska 99501 Telephone 2-64-4720 \-` ON-SITE SEWAGE DISPOSAL SYSTC M ANWOR >n FIA, INSPFC; i IONI REPORT NAM E� PHONF IF.W p ..11__,, --+-_` e Consfy'V�-r Zvi ----------1� 5 1098 ❑ UPGRADE MAILINGAfDDRESS-J A c�C1 _ - 7 17 of J �B.W aT�I i.�-� C. W y LEGAL DESCRIPTION /- �y LOCATION NO. OF BEDROOMS �. Well uQ Absorption area Dwelling DISTANCE TO: '(J 10 P - IT NO.� -(j L S- t- Z N� Manufacturer Material Ayichor��� No. of Tom artments Liq. capacity in gallons If: HOMEMADE: Inside length Width Liquid depth O y DISTANCE TO: Well Dwelling PERMIT NO. JAZ z Q Manufacturer Material Liquid capacity in gallons O wT Well ^� Foundation Nearest lot lin DISTANCE TO: 1da"'1' 12-4 1''j PERMIT N,Q��� ZUT�?- JF Z No. of linesLength of each line Total length of lines Trench wid/(h :k> Distance between lines P z w 1 5 1 �1 inches_ cc I- Top tile to finish Material beneath tile Total of grade 2 ��, �_ effective absorption area 75' p inches 35 U _ Length Width - Depth TT TT- PERMIT NO. w Q b Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line. J J w Class DISTANCE TO: Depth - Building foundation Driller - Sewer line Distance to lotline ^� PERMIT NO. Septic tank Absorption area(s) OTHER - � - - PIPE MATERIALS — pv�. SOIL TEST RATING 100 ti' INSTALLER --- R EMAR KS �oc) 1:7'lbdr- - — 5 vJaS moyL'J. UAd y'2c 41( heck -- -- - i APPROVED DATE LEGAL POOOLc1C Svb R(K A Lc3t 72-013 (Rev. 3/78) ��� � �������� �� ������� ����F11 di� � THE LENGTH DIMENSION IS THE LENGTH (lN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE 011,0E01 THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH MR TRENCHES. THE GRHVEL DEPTH IS THFE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHYHTION (IN FEET) TO! M Th UP J: RAO FPC f2w �P-,-A 1: �fl�;,D, P�:�-Dj �It-- R A, 9�� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HHD THE N1-11 "11.1 -:EF""! OF RESIDENCES THHT THE WELL WILL SERVE .1-1.1. I'll, ���is X iWX 10� EEO Q -T- X Q M 45 got AS? EY: Q 11101151 Ly 1: Two KH:� �~~ BHCKFILLING OF HNY MISTY HjTHOUT FINHL PPROVH1 BY THlS ��PHRTMENT WILL BE SU8JECT TO PROSECUTION. MINIMUM DISTANCE BETWEEH F1 WM. CAST) HNY ON~SITE SENIGE DISPY)SHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO R PUBLIC HE -1-L. DEPENDING UPON THE TYPE OF PUBLIC M.L. MINIMUM DISTANCE FROM H PIN IVHTE WELL TO H PRIV9TE SEWER LINE IS 25 FEET HND TO H COMMLNITY SEWER LINE IS 75 FEET. WELL �OGS HRE REQUIRED fIND MUST BE RETURNED TO THE DEPHRTMENT NITHIN ]0 DHYS OF THE k!ELL COMPLETION, OTHER RE81 HND C0NSTRUCTlON DIHGRHMS ME HVHILHETLE TO INSURE PROPER INSTHLLHTION, No"EMMWO 11 X HIM!" 1: QUM low NEE HD FEE M EER 1P.-. A',": � I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON^SITE SENERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF f1NCHORHGE. 2� I WILL EM IN HCCORDHNCE WITH THE CODES ]� I UND�R�THND THRT THE ON~SITE SEWEF! S;STEM MRY REQUIRE EN! HRGEMENT IF THE RESIDENCEK IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS. SIGNEvD HPPLICHNT CHRI� ��JE� ,'� ��u�D ���� ��� ������ `����� o `7 .0 DPHTMENT HEHLTH HND EVIROHENTH~ OTECTION ' 825 'L' 5TREET, HNCHORAGE, CA It. 99501 1)x/J � 26,;4~4720 N 4 Kin U R.. V71 Tyl T? 111 T04'-- M Y^11 �H, � 8 M M lot TWA 1, -T' | PERMIT NO. ( / 820452 ) HPPLICHNT OLD SEWHRT) HIWY ]49~6691 LOCHTION POLLOCK DR L�G�� L4�BL�CK A P�LL�CK S/D LOT QUHRE FE�T TYPE OF SOIL H8SORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF ] SOIL RHTING (SQ THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� ��� � �������� �� ������� ����F11 di� � THE LENGTH DIMENSION IS THE LENGTH (lN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE 011,0E01 THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH MR TRENCHES. THE GRHVEL DEPTH IS THFE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHYHTION (IN FEET) TO! M Th UP J: RAO FPC f2w �P-,-A 1: �fl�;,D, P�:�-Dj �It-- R A, 9�� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HHD THE N1-11 "11.1 -:EF""! OF RESIDENCES THHT THE WELL WILL SERVE .1-1.1. I'll, ���is X iWX 10� EEO Q -T- X Q M 45 got AS? EY: Q 11101151 Ly 1: Two KH:� �~~ BHCKFILLING OF HNY MISTY HjTHOUT FINHL PPROVH1 BY THlS ��PHRTMENT WILL BE SU8JECT TO PROSECUTION. MINIMUM DISTANCE BETWEEH F1 WM. CAST) HNY ON~SITE SENIGE DISPY)SHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO R PUBLIC HE -1-L. DEPENDING UPON THE TYPE OF PUBLIC M.L. MINIMUM DISTANCE FROM H PIN IVHTE WELL TO H PRIV9TE SEWER LINE IS 25 FEET HND TO H COMMLNITY SEWER LINE IS 75 FEET. WELL �OGS HRE REQUIRED fIND MUST BE RETURNED TO THE DEPHRTMENT NITHIN ]0 DHYS OF THE k!ELL COMPLETION, OTHER RE81 HND C0NSTRUCTlON DIHGRHMS ME HVHILHETLE TO INSURE PROPER INSTHLLHTION, No"EMMWO 11 X HIM!" 1: QUM low NEE HD FEE M EER 1P.-. A',": � I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON^SITE SENERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF f1NCHORHGE. 2� I WILL EM IN HCCORDHNCE WITH THE CODES ]� I UND�R�THND THRT THE ON~SITE SEWEF! S;STEM MRY REQUIRE EN! HRGEMENT IF THE RESIDENCEK IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS. SIGNEvD HPPLICHNT CHRI� ��JE� - .� ,.� s. ria 3• s ,__{ a -,t "� � � t s - r �h- { - y i --- .}L .{_V -s_ ffl .. r _. ;.15._$i •-d 7 S.._ ?_ i'+d_-11 � �-efn 1"yf `f'-' i.-�:-,,}F:;•f-}i'.i �:a`-Sf �j s.9 -. i<«t=;=s: 1,i _: i't € ,_i:- # di .;7!.• ft'i i'ix'?r} t _t'd'r [n !]'! Jwi :tit # ._ ; :fir t 1., t_: r € on QL - �.it-:�!-_}__ f-S't`•.s�t 1�.#!'•{ `_ 3. S }.� _�.r._{.}�`:Y �' F ;'`-- a ! 41 IDI r: -;t 1_�:i'�#J11� #-:trr-�'�€err f•� t,d'� 1__.11,.3 ,! rt .-_u . ri.,%'.�.E•:t_ }� i] , L'r :;' � t 1i`� € ti �.-{ f � �_.._r 3 i_ii" ri•.i'.r'r_.� 1-t�' r t { �•i { ,'�-: �- L'_• }t-tr .. 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I !stifel_ r_r'��rr�s,� d': 11.-•t_'r•,I? rra ;a?d:_•_ r 1'J-fi_ 11r$ . i I -:,;!).:i9 r'1;`s't Jam`_ -i 111 [4r F-, SLt:s:'?'It:. 1':,=i'}!:;;'1=t_:T, ji`r zt• i7i_l.= i'1#1+,._ i,i;ZC h) ,,,'t_t!!r•i; t� ifs='i='1_. I fa:;'ii d f !_:, it; i'-> ,-• = it ' e i l'dd 7frsii ,r'7= -14r r 1'J PERFORMED FOR LEGAL DESCRIPTI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 IJ SOILS LOG MUNICIPALITY OF ANCHORAGE. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST _f < 0 S �c�!/ v DATEPERFORMED: v SLOPE SITE PLAN iun S'rn.�7��J / O t- /,?�� j— COMMENTS n,5- w- P? %' WAS GROUND WATER / S ENCOUNTERED? 1 L 0 P _ E IF YES, AT WHAT DEPTH? _ Reading Date Gross Time Net Time ��` IA/ Depth to Net Water �- Drop I E/,. / L/. T? /047 "5'10-'27 /0 >7.O=3 0 O7 70 O� PERCOLATION RATE C< (minutes/inch) TEST RUN BETWEEN -.�. FT AND ' ee FT -44'. PERFORMED BY: %t. ( Kai.)IJ iciCERTIFIED BY: 72-008 (6/79) DATE:1— 5 e i� Frain : RLPIi,E DRILL 907 345 02:2 Feb.03.1995 03:08 AN 1301 STATE OF ALASKA DEPARTMENT OF INATURAL RESOURCES DIVISION Or WATER wAf&Ht WELL FWCORIi LOCATIGN OF WELL CONTRACTOR INFO TION: {� e usurersaim _. ' e f:tq,lr urr o u 7orrae esprese 6dt1V(3 Daly; REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: ONR0VISION OF WATER PO BOX 772116 FAGLE RIVER AK 99$77-Z110 MORDUO" 6U8Df%t4% N BLOCK 80"MN MRS "OT" TOWNSHIP RANGE MCMAN fLOY ISS 0 LOCATION(SKIETCH: WELL OWNER: �IrEra���a i 00"S MEASURED FROM: casing top 0ground surface WELL DEPTH: DATE OF COMPLETION ft Depth 01 Win; 11,011 WILE DATA: Depth Depth of casing It e + r - °A9+AW491 Type and Color From To DEPTH TO STATIC WATER LEVEL: -Am—ft below Rtop of ciwnp D pround surfaee P flare: '� -- f METHOD OP DRU MO. air rotary 0 cable tool ❑ Other USE OF WELL: damns* © irrigation C7 monitor s" ❑ public Rrrpply I7 Other„_ CASING STICK-UP- _it. t)iarn:6 in. to (0 ft -In. It r w (fy Casing type: to { ea+✓ WELL INTAKE OPENING TYPE: n open earl U soroened L1 peri ated9 nbole '/ r�F HiQ p ,�0 4�a T s Depths of ®ningS: ., w, 10 ft c SCREEN TYPE; Diam: in. � SlotlMesh Sita: _ LenLlth: It GRAVEL PACK TYPE: I Valume used,�� Aepth to topes 6 GROUT TYPE: � Volume: Depth: from 1t to -ft DEVELOPMENT METRO Duration: �p- PUMPING REVEL ANDY D: a �_ ft after hrs pump1ng . gpm PUMP INTAKE DEPTff: _ ft Horsepower: WELL DISINFECTED UPON COMPLETION? YES la NO CONTRACTOR INFO TION: {� e usurersaim _. ' e f:tq,lr urr o u 7orrae esprese 6dt1V(3 Daly; REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: ONR0VISION OF WATER PO BOX 772116 FAGLE RIVER AK 99$77-Z110 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950005 DESIGN ENGINEER:ROBERT W. WRIGHT, P.E. OWNER NAME:TUCHSCHERER PAULETTE K & OWNER ADDRESS:630 LIGHTHOUSE ANCHORAGE, AK 99515 PARCEL ID:01711251 LEGAL DESCRIPTION: POLLOCK BLK A LT 4 LOT SIZE: 18253 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 1/19/95 EXPIRATION DATE: 1/19/96 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT.' FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: 2� J DATE: /z/_ Com. Wright -Alaska Engineering Services • 0004 Glenkerry Dr. • Anchorage, AK 99504 January 13, 1995 W.O. 94028 Municipality of Anchorage Department of Health & Human Services On -Site Services Division P.O. Box 196650 Anchorage, AK 99519-6650 Re: Lot 4, Blk. A, Pollock Subd. Well to Field Waiver Well Permit Dear Sirs, �R�N,MNTgI o�VNcyo�G =iN l cEsp11/1s®N 0, 19 '7') ReCEI VI= With the payment of fees in the amount of $920.00 for a Well to Field Waiver and $120.00 for a Well Permit, the owners of the above noted lot request that the above waiver and permit be granted to bring their property into compliance with Municipal Regulations, and allow the sale of this property. A recent as -built survey, conducted by Lantech Surveyors has shown that the existing well for this property is sited 2.7 ft. into the Municipal Right of Way. The existing well has a waiver for Well to Field in existence, as it was thought to be 98 ft. from the field on Lot 4, and 93 ft. from the septic tank on Lot 3. A position for a new well is shown on the attached as -built drawing from Lantech, sited 5 ft. from its present position, and 2.3 ft. inside the lot line of Lot 4. Due to the positioning of the septic tank on Lot 3, and the shape of Lot 4, it is not possible to move the well such that it does not encroach on the 100 ft. offset distance to either system. The new well position, as shown on the attached as -built will place the well 97 ft. from the septic drainfield on Lot 4, and 94 ft.(field measured) from the septic tank on Lot 3. The new well location will be field staked to ensure that it is located properly by Lantech Surveyors, at the request of Mr. Dave Harper of Alpine Drilling, the well driller of record for this project. The Well Log for the existing well has been included with this submittal. A copy of the log for the new well will be submitted to the Department of Health & Human Services for inclusion in their files. The existing well will be abandoned in accordance with all Municipal and State requirements. Should you have any questions or require additional information, please feel free to contact me at the numbers listed. Sincerely, W ' ht -Alaska in ng ices Robt W. Wrig h t, Telephone 49071 338.0230 0 Fax (907) 337-5182 9 19Ox 1369, STAR IROUWE A ANCHOIt.A.GEo AI ASsA 90502 344='71714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 4� (� ,`- DRILLED AT THE RATE OF -21,22 PER FOOT. PROPERTY OWNER LOCATION OF WELL SITE Jl;f—r Sub. (K O I f lC DRILLER 3n Yr ,e GL��L� o F WELL LOG: 20'; cl a . Ir.in,d� -L. Seve,-M �rw.J.L drlr ,l doJLd. ce.nex:ted ^_patrsl i th. JedryeA o� deconi o.icd. nacl r2ateu�L .tyo 4 �.e rn cdaarn.. 200d J(7,teA �n?CiiLf�?:"? de COLLt20Aed .lie CjiLOcIG �JhOi'r",CC2.C.. a ,P.U�U 7(--c 7'.-1.20 �"1.P..'L iLOLUL OILOC.r.U.0 •} f 0f2 1).•,%�-12 -�i ,�i ,�nea 0,l' ryC t�'H 4 �C/ALC{.i(.I'.C.. AJ7. G^A•t_.'V".. na n,eur o7ate,-G I/(fid .a ,t'),e, dreamzcck. ire LOCI GG P,ee . 1/2 jhof� lsl..be ,i.nA 7J Led to ThAee ;°eeA 0•r" coed cre U. MUNICIPALITY OF ANCHORAGE DFPT C= 1'- i1 I,e. ENVIROIJfL_P,iA.. 0,60T 8 1982 RECEIVED Com,t o,' D,�,LLLin..: ?3000 Henn, 00+ 6E, ?est: "l$7n-00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 1518. 00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE ^tLl 77ta,, 9g8� '�iWQ —ANkk SERVICE CHARGE OF 1V2% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. Dox 1360P $TAR JZouTE A ANcnonAGEs ALAsuA 09502 *344-7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 66 Tee,t_ DRILLED AT THE RATE OF 123-00 PER FOOT. PROPERTY OWNER LOCATION OF WEL DRILLER 13e.4n.1e. (',lnun of, P.nmprmt .9,HZIA.in.n. WELL LOG: 0-••—.-.1,21 t,,.c.th 20"', Ctan!, AainJ.Ai:.. Szveml. An,a.Gl. bo,,,hlf"44. 22.... 59' 11vtdpon.: I remented. n utve.L tJ•i th. drdaee o/ decomtxo4exI..Ged;tocj,. R b2okea ;to<k matm od. !"rnn: 46 ,fe.et an, donor. $g---66' ,i food '9 Le;t. hom inn. deroap(74P;1. IMAILark. A.onrinn a Judd. Two �i'E?•-120 aaln nen hove. p;toditc .ion nt•1,th /0 , tontet .n.tuntliaa dn. Rn note nmtmt gWif..ia .th.e. dmd;tnck. bed.00 66 1/2 1lo;tie..Su.Gm.r;t,5J,td.r Pump nhnud.d be .to 63 .;vnt. 74-ae. !ret oNv rme-d ho tam. to ;te,ce-Jue. the. lurid. henA.Mt. a/ .the S,r,t4 `c qqT' z6, 9 - ('' MUNICIPALITY OF ANCHORAGE DFPT 01 I'='l• ! x ENVIRUhU.:S1.iA.. ;..V. ;.TION GOT 8 1982 RECEIVED Cne� o! A;tldd.ln l: 7?3..00 pe", !.uo.t X 66 feet: 1510.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF '151L'.00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE—1-1-1,11i, 17.tA, 1982 + SERVICE CHARGEOF IY�% PER MONTH WILL 13E ASSESSED ON PAST DUEACCOUNTS. Wright -Alaska Engineering Services • 0004 Glenkerry Dr. • Anchorage, AK 99504 February 15, 1995 W.O. 94028 Municipality of Anchorage Department of Health & Human Services On -Site Services Division P.O. Box 196650 Anchorage, Ak 99519-6650 Re: Lot 4, Bilk. A, Pollock Subd. Well Water Quality Test Results Well Log & Location Sketch Dear Sirs, Following this cover letter are copies of Water Quality test results for the replacement well drilled 1/31/95 by Alpine Drilling, a Well Log and a location sketch indicating the separation distances between the replacement well and adjacent septic systems. With the submittal of this package, the owner is requesting that the replacement well be covered under the Health Authority Approval issued 12/27/94. The well has been drilled as located by Lantech, and shown on sketch submitted with application for drilling permit on 1/13/95. Distances shown to adjacent septic tanks and fields on the attached Fig. 1 have been field verified by Robert W. Wright, P.E. Should you have any questions or require additional information, please feel free to contact me at the numbers listed. Sincerely, Wright -Alaska Engineering Services Robert W. Wright, P.E. RECEIVED FEB U 1995 Municipality of Anchorage Oept. Health & Human Services Telephone (907) 338.6230 0 Fax (907) 337.5102 From : FLPIhE DRILL 907 345 0202 Feh.15.1995 06:36 AN PIJ2 CME Environmental Services lric. JAL Is6orztory Divisittt rs��eree�<a�a®s aFvsra•.���s9�a�ac�+-w�rv�er;�o5��.rara ��at imlysxs Report zor �nta] Cloliiol- Bac-eria aoo w, PVF2Br Drive OLL..A"chorade, AK 94518-1605:"SIRCGTU1SUNR irfRSESITFBEFOF.C A- FM l; -FMJ907j 561-5301 eft , i BF SC]Pp>: COti1PLFTED ii7' ZV.a Ir E - TO BE CUWLETED 13Y J-.% 1'U Y l'L?1LTC ti+'ATER Sk"STEM P.T7. — Azicsis show , tts Ci r_: -r S-k)'rMME, <o bc: t'RiVA1;=WATF17SYSTEM ❑ Saa!plsover30:,oarzole,,�¢,;1•strt��. - ' un. }Wtr-�'r-,e .'-�J.oer `• 'vmr-$ h i� s DC 4vpr=S CC:: rS alu in 1:rCiC2%7:'allies:[fCSA�:$. 7�I�2c^5:'�C• ;,aw S2T P}e ra soeeial 6e1!vcrr mzii. _ 'Iime-ed f' \^b!/{^rTv1:f l:Unil (nn i[nc ^fie:a 5 nle (foe rolaive F�mplc =. LOC4iION _.. E'1'ISS !:'aT fear :- l ret red 1Va I('1' Tine Cotieelec ccdecccd 6 m... L/ J :tiP3}lil Ctil .'1Iei11 OCI: XNie-.nbr2'^. of'ecic :iali00,ql_ Lab Ref. %'� R-SL')I F-701 I V err.::o A•D_�.C. •.- F67s Ju !`_I Fant Cli_.-rc roti iee n; nnsa:is2r.,6n' rt3uls: ph0A.- Sp[.kt with :exec BACTERIOLOGICAL WATER RCCORy) lfl1O-�fi'G ii4vlc. Total Cc?iivrr.l Fil;cr: Direc; Coup.; '•c; i$ta:iar,: LT}; RG3 _.�....—_ C'GLIrI`--�'�f z+7c^;ten r,.r.,�•�«,;s C�..l r eeal Cclifarn Cq�ilm�:ipn � V� oe trs _ .___.. _ ____ ~ ._ Id, r„ier a: 7'+t ''(,.0 �.rc., ... .: �c:. �_• _ �� ro S:..v=;Ifen�c-1 From : FLPI�E DRILL 907 345 0202 ME Coviloonlenfal 9orvices Inc, r6�5Pv1s�sliY1�A4l16�m8fla.�sACrsaJswe • • 12470 - Sa hilt} a TU 15'..11 POLLACU DR 02/07/95 WA7'FR Collected Daty ALPINE FRILLING ..,,I Isy DAVE J1ARPRP D2/06/95 0, 09:56 hr,. „ UA $c¢srY, e,v sAWILR COLLECTED BY: D-1-11 Feb. 15. 1995 05:36 AN P03 RUSH Ordf tr 12470 priptud Date 02/07/95 2 14;32 hl:!; Collected Daty 02/06/95 91 0Q:15 Y,r r,. R"e:jlred Date D2/06/95 0, 09:56 hr,. Technical Directord STEPLION C. EDE y4"i""a.'-w'x Relea Sed BY •..•°9 �..�"�,�'s'�$�-x2....1 C)C AJ.J.9tvable Ext. A11AI dsicter Re on 1. to - pual ljr Sl.c Method Aimits Date Date In ._.._.................. ......-_--------- ----- ... . li 0.19 U mg/L F'Tr1 l&0.7. in, 02/pG/9'i CM . ,pecial lneLYucGi@aG Abvw UA - V11AVA1Japl.e ^,Ample FwnArks Ahnvc NA , Not. Analyzed .;,leter-tod, Reportad value is the practical quantificat.i Dn limit, LT a L96a Than -_Ondary dilutlun. GT ^ Urm96mr Thin From : F -LP I hE DRILL 907 345 0202 Feb. 15. 1995 06:36 AN PE11 CT&E Environmental Services 111c, Laboratory Division «a 95.11561-1 S - -r male ID 15317. PDIaLACK Laboratory Analysis Report {TATER • Name AI,px?lE DRILLING WORIL order 125-f0 By D. HARPER Printed V t02 1 UA :.r Reniaiikc: SNIFL6 COLLELITI) 8Y: L.L_h. M e / 4/95 w 16:9] bre, CoJleetCd Date 02 WR5 a hrr.. Received Date (:2/09/Rg G' 15:4'J, hye:. Tee)IRical ll1.Ye GtVr STEPHEN C. RDE Rel.epGad &y ;ample Remarku Above KA o Not Annlyzod .'tx7ete CCf.d, Reported w3mt. is the practical. quantaficaticor ljmj.t.. VT - Leg C: TILan r.pn(idYy dilution. 01' d Gre&tor Than 200 W. potter Arive, Andlornge, AK 9961B-1605 1-a(: (907) 562-2343 FAx: (607( 561-6301 'd'+I0Nrw1FNTAt- FACILITIES IN ALASKA, CALIFORNIA, AORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. OHIO, WEST VIRGINIA QC Allowahle Ext. Anel. .: Am3t:er Reeul tr. Qual .. Unitn M&LIWO Limit Date Date 7rrit . Urinkiny Water _ _ 0.012 . .._--------- my/L >:PA 735.2 -------------..._ D. Cris 07/13/95 .....------ 02/14/95 KGE ;ample Remarku Above KA o Not Annlyzod .'tx7ete CCf.d, Reported w3mt. is the practical. quantaficaticor ljmj.t.. VT - Leg C: TILan r.pn(idYy dilution. 01' d Gre&tor Than 200 W. potter Arive, Andlornge, AK 9961B-1605 1-a(: (907) 562-2343 FAx: (607( 561-6301 'd'+I0Nrw1FNTAt- FACILITIES IN ALASKA, CALIFORNIA, AORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY. OHIO, WEST VIRGINIA � � �� Municipality of Anchorage Department of Health and Humar. Services 825 "L" Street ;Nystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 ,Mayor January 24, 1995 Mr. Robert W. Wright, P.E. Wright -Alaska Engineering Services 6004 Glenkerry Drive Anchorage, AK 99504 Subject: Waiver Request for: Lot 4, Block A, Pollock Subdivision Waiver Approval: # WR950005 Dear Mr. Wright: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a well and has been approved. The approved separation distance(s) are: Weill to Absorption Field on Lot 4 97 feet Absorption Field to Tank on Lot 3 94 feet Septic System on Lot 8, Blk B to new well on Lot 4, Blk A 95 feet This waiver approval applies to the septic system to well separation only. Any future upgrades to either will require all separation distances be met or another approval be obtained from this department. Sincere y, Robert W. Robinson Civil Engineer On -Site Services kb MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR950005 PID# 017-112-51 Date Received: 1-18-95 HA# Permit: # SW950005 Legal. Description: Lt 4, Blk A, Pollock SID Engineer: Wright-Alaka Engineering Services 6004 Glenkerry Drive -- Anchorage, AK 99504 _ Applicant: Robert W. Wright, P.E. Waiver Requested: Well to Absorption Field on Lot 4 - 97 feet _ Absorption Field to Tank on Lot 3 - 94 feet Septic System on Lt 8, Blk B to new well on Lt 4 Blk A.- 95 feet__ Criteria: 1. Geology: Points: i A. Water Table 4o 1-10 r B. Soil Sorption C. Permeability D. Water Table Gradient;; E. Horizontal Separation TOTAL: ` 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: wer Rec #: 00640 (0003) Amount: $ 1040.00 Date Paid: 1-18-95 Pollock Circle 94 it. to Tol on dot 3, �1 I I I oy o Porch A .................R4 �, ;4,, �o"e�r�F�5 StOr Single amHouA w V\ a �3gth Fr a se 3 Bdrm. R�f?ERT W. WRIGHT ti C F-II15¢ :. f Deck 9�4 PI.w1'; a1v12—Bdrm upgrade o \ 1 Dog HOuse i s Wood Fence Birch Note: Found 5/8" Rebar Property Corner See Separation Distance Waiver dated TBM—Assumed Jan. 24, 1994. Elm= 100.0' Wright—Alaska Engineering Services FIGURE 1 Lot 4 Block A CIVIL • SEPTIC + DRAFTING Telephone: (907) 338-6230 Fax. (807) 337-5182 Pollock S u b d i v i s I o n Replacement Well Location 6004 Glenkerry Dr. a Anchorage, AK 99504 'D' 94028 COMP. FILE 9402BGSP SCALE 1"- 20' DATE 2/15/95 Mr. & Mrs. Marc Tuchscherer V�-Ck7b 1wo79 Municipality of Anchorage] • -- Development Services Department •° Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-112-51 HAA # 66)q Z�3 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 4 Block A Pollock Homestead Location {site address or directions) _15311 Pollock Drive, Anchorage, AK 99516 Current Property owner(s) Cassandra & Arnold Johnson Day phone 345 8138 Mailing address 15311 Pollock Drive, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent _Jerry Dewhurst/RBMaX Day phone 257-0169 Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site El 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 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 are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. 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 sample results less than 30 days old. 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. (R. 11199 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verity that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eno Svc Phone 272-8218 Address P.O. Box 102954 Anch AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test. I attempt to provide a thorough, conscientious ��������� VAta engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. 7hc ���P�� „ .q �, reported results dcseribe the performance of the system under the conditions encountered at the time of ♦ ` , the test, and separation distances measured to readily identifiable features. 71c operational life of all = �'J,.° wells and septic systems depend on the local soil condition, ground water levels that may fluctuate = {z :,, d Q rH during the year, and the water usage of the family being served by the system 'nese conditions are • P .. . ... „......... outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden def '................... ............ or encroachments. PES can therefore not provide any warranty for future performance nor give any *.Steven R. Ponnone estimate of how long the system will continue to meet the operational requirements of the ADEC or. ���i '• No. CE 8149 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 person or parry is not authorized nor will it confer any legal right whatsoever. it 6. DSD SIGNATURE ✓ Approved for 3_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: M'. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By, f14;J / &/ Original Certificate Date: Expiration Date: Reissue Date: (R" 111x9) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorpge.ak.us .(907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 4 Block A Pollock Homestead Parcel I.D.: 017-112.61 A. WELL DATA well type I! If A, B, or C provide PWSID * _ Well Log y Date completed 1131M995 Sanitary seal I Total depth -g2_ft Cased to J4 _ft FROM WELL LOG Date of test 1/31M995 Statle water level 49 It Well production 3.3 9 -p.m WATER SAMPLE RESULTS: Colfform JL_colonies/100 ml Nitrate 0.1 mg/I Date of sample: _712512005 Collected by: LRP B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel Wires property protected Y Casing height (above ground) min. AT INSPECTION 26 It 2 9 -p.m PQ,<a wo P4xs-/ass Other bactena-=a— colonies/100 ml Arsenic N/A mgA Date installed 0124M982 Tank size 1000 gal Number of Compartments a Cleanouts X Foundation cleanout y Depression over tank NI High water alarm NIA Date of pumping 712512005 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed /2 8 $ ' Soil rating (g.p.ddle or ft2Axlrm)j System type Trench � 1 D Length Pftj Width ftL Gravel below pipe ft Totaf depth ¢ R E %C11ve absorption area flr Monitoring tube Depression over field N Date of adequacy test 7125/2005 Results (Pass/Fall) Pass For ¢ bedrooms Fluid depth in absorption field before test Qa in Water added48488 , gal. New depth in. Elapsed Time: LQ min Final fluid depth gpt in Absorption rate >- 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date (Rev. 11/99) D. LIFT STATION Date installed Size in gallo Manhole/Access 'Pump on' level at _ in'Pump ofr level at in High water alarm level at _ in Datum Cycles to Meets alarm 8 dreuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 97.3 On adjacent kNs 93.5 Absorption field on lot 97 On adjacent lots 95 Public sewer main NIA Public sewer manhole/deanout NIA ( Sewer /septic service line 25+ Holding tank 100+ r 1 Dim SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 9 Property line 2 Absorption field 2' Water main 25+ Water service line 25+ Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1.15 (WMA Building foundation 17 Water main 100+ Water Service line 25+ Surface water 100+ Driveway, parkinglvehide storage 25+ Curtain drain None Observed Wells on adjacent lots 100+ F. COMMENTS ter/ WcAfbaard Z(7f-Ove-C'IM'tLnK,`rV\V- rl Qc"oj(-Ol<< G. ENGINEER'S CERTIFICATION I car* that 1 have determined through field inspections and �` review of Munk4ml records that the above systems are in conformance with MOA HAA guidelines in effect on this data r r r f�iSle,en h. G�nnc^e.�; Engineer's Printed Name Steven R. Pannone. P.E. �+,cr c� •• X,�0:0 Date • Fi _v.. HAA Fee $ V0. �D Date of Payment 8 7d,5166 - Receipt Number 7x8&3 (Rev. 11/0) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage W��' > / PA. IM)x Miri50 • Atwhomgc, A1aska!Y.I,i1J-6(;R) • Telephone (!M)7) 333.9301 * Fnz (!M)7) M—KIM / 470)13mgme Slrccl • Anchomgc, Alaska (M607 Mayor Dlark Begich w Z111nl.nrg I3ttilding Stifcty Division August 26, 2005 Steve Pannone Pannone Engineering P.O. Box 102954 Anchorage, Alaska 99510 Subject: Waiver Amendment for Pollock S/D Block A Lot 4 Waiver Amendment for WR#: WR950005 Parcel 1D # 017-112-51 HA050423 Dear Steve Pannone: This is an amendment to a waiver that was waiver of the required 100 feet horizontal separation from the well to the septic tanks and absorbtion fields has been approved. The approved separation distances are: • A 97 foot horizontal separation distance from Lot 4 Well to Lot 4 septic tank and Absorbtion field. • A 93.5 foot horizontal separation distance from Lot 4 Well to Lot 3 Septic Tank and Absorbtion field. • A 95 foot horizontal separation distance from Lot 4 Well to Block B Lot 8 Absorbtion field. This waiver approval applies to the existing septic tanks to 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, Joc Goodall Community, Security, Prosperity Municipality of Anchorage Development Services Department • ..r Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: WR950005 PID#: 017-112-51 HAtPermit# 1IA050423 Date Received: August 26, 2005 Legal Description: Pollock S/D Block A Lot 4 Engineer. Steve Pannone Pannone Engineering P.O. Box 102954 Anchorage, Alaska 99510 Applicant: Steve Pannone Waiver Requested: This is to amend the waiver done January of '95. Some portion of septic were not waived. Please see original green sheet for waiver requested and the points dated January 18, 1995. Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ......................................................................... Waiver Is Granted: X Waiver is not Granted. List Conditions or Reasons for above: Date: 18/95 By: Joe Goodall Name of Reviewer ......................................................................... Rec#: 00640(0003) Amount: $1M Date Paid: 1/16/95 POLLOCK U S 89'58'25" W , N I I O O I O I N Ct m C: = I rENCE- —x— X — LOT 3 OVERHANG— WOOD DECKS— 0 Enm rI J O Z ~ O O I I I LOT 2 LOT 4 JERRY DEWHURST with BEST REAL ESTATE 440 WEST BENSON BLVD. # 200 ANCHORAGE, ALASKA 99503 WORK ORDER NUMBER: DAM . ,. AUG. 17, 2005 s -•7'-U 20054-266A '" an CI " `"° "'A�" TSM APH 3137 20.3' N N IIIIIIIIIIIIIIIII 11111111 IIIIII EXISTING HOUSE NIL S 89'58'25" W H 139.00' LOT 5 90 25' O O O L Ln I m 25' Im NOTE: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. CO, POWER POLE EXCLUSION NOTES: It Is the owners' responsibility to determine the existence of any easements, covenants, or restrictions LEGEND: SET FND 5/e'RB w/CAPD 5/8" RBQ which do not appear on the recorded subdivision plat. NOTE: 3.25• ALMON. 0, MONUUENTA$� Under no circumstances should any data hereon be used for HUB k TACK L] construction or fa' establishing property lines. rENCE- —x— X — SURVEY CERTIFICATION: LANTECH has conducted a physical TI of this properly as shown on this OVERHANG— WOOD DECKS— 0 drawing and that the Improvements situated there, ONCRETE—o CONCRETE— jh on,, are within the property lines and no encroach— ASPHALT— ments exist other than noted. GRAVEL— A S —BUILT O F: LEGAL DESCRIPTION: SEPTIC STANDPIPES- 5 WATER SWELL NGINEERS 561-6626 562-5291 LOT 4, BLOCK A, 1-76 HOMESTEAD SUBDIVISION M.14(: POLLOCK MUNICIPALITY OF ANCHORAGE • �� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D.# 0(7-//Z - -2 1. GENERAL INFORMATION HAA # 0 19CC, _l \ Complete legal description l-c>T `I , 71�[ocr. k� �OLLoclC 5/1, Location (site address or directions) '-Drzw L--5 Propertyowner lvg�B -UTaY Dayphone SqE-clou7 Mailingaddress X5311 PotLcoc(ci�2/ A/JC4 AI, - 9 ice• Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA X21 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 -sine water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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�,A ��� ,NON c .p c� --__ Phone Address G'-o.Ci3o iclaoz� ryIG C�)95/— Engineer's signature — Date _149/F7- 6. DHHS SIGNATURE Approved for ��f�� P �� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 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 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 responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 421 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE E C I V E g Environmental Services Division 825 L Street, Room 50r! • Anchorage, Alaska 99501 • (907) % T47 41997 Health Authority Approval Checkli, Municipality of Anchorage ept. Health & Human Services Legal Description: L44 '13,g elf Parcel I.D.: o l', - i/2 — _z; I A. WELL DATA Well type rwa-�-: If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed ! - 3i - C7,5- Total sTotal depth 655 Cased to G N _ Casing height (above ground) ',7 9 Sanitary seal (Y/N) Y _ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 1 ` 31 - g s 3 /a/97 Static water level 414 z R f Well production 3, 3 g.p.m. Z ' g.p.m, WATER SAMPLE RESULTS: Coliform ' -- Nitrate ae 1 U c' Other bacteria cP Date of sample: _3�9%q� Collected by: S ,T2_ G B. SEPTIC/HOLDING TANK DATA Date installed /o/zzl o Tank size / Zso Number of Compartments _2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) `� Depression (Y/N) ✓U O High water alarm (Y/N) -U0 Date of Pumping 3 Pumper A -t µoMD- G;V6 C. ABSORPTION FIELD DATA 3%zSlBi'� � SI-rRUnac}► Date installed so Zzls3© _ Soil rating (g.p.dJf12 or ftz/bdrm) (F -S7 —System type-r2Qano ct-} _ 3s' s' s' s•s' Length 3z' _Width 'R _ Gravel thickness below pipe V' _'notal depth A' 30 Z Effective absorption area _ ?55 _ Monitoring Tube present (Y/N)_!_ Depression over field (Y/N) N _ Date of adequacy test 3laLq Results (Pass/Fail) �P/a ss _ For ;3 bedrooms Fluid depth in absorption field before test(in.); 1�i2 Immediately after�� gal, water added (in.): --L l2 Fluid depth -'E1ay( _ (ins) Minutes later: /&X /. _ Absorption rate = i�;-v <<S"O g.p.d. Peroxide treatment (past 12 months) (Y/N) _ �t�C� _ If yes, give date iv :.-c �Vt Fac 2c> 72-026 (Rev. 3/96)* fav=-s-c:L't- 41<! a D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES "Pu *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons _ "Pump off' level at* Ct1-.9 t- TQS -o LI193 SfLGi t"NST Septic/holding tank on lot 9�°3 ro ,o, �, Es wqw, On adjacent lots Q:3--�-oc�, 1,3 Absorption field on lot R7 Cin) On adjacent lots 440 /CC,' -4- L„3 cg Public sewer main v (eq Public sewer manhole/cleanout A Sewer /septic service line Cr �' Lift station _ / oo -r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 8 s«LD i _ Property line Z,r+ Absorption field Z ` Water main/service line '2c5-" Surface water/drainage �c,� ' Wells on adjacent lots / c;,o -f" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line a �� ,� Building foundation f Water main/service line z.Y _ Surface water ! oo Driveway, parking/vehicle storage area - 3E( _ Curtain drain oo "r Wells on adjacent lots ! c�o + R ENGINEER'S CERTIFICATION &?WOLF I(T I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name S-r-c�avc_ Date 3lgL 4 N HAA Fee $----DC% C)( ) Waiver Fee $ Date of Payment 2)- \ -9- Date of Payment Receipt Number QQ(ffLk 1 Receipt Number 72-026 (Rev. 3/96)* Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907) 272-8218 (907)2.72-8218 Fax April 1, 1997 Municipality of Anchorage Dept. of Health & :Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 4, Block A Pollock Subdivision Lot Line Waiver Modification Gentlemen: RECEIVED APR -" 1997 Municipality of Anchorage Dept. Health & I-luman 5ervk es My firm was contacted to conduct a Health Authority Investigation at the above referenced lot. I researched the records and discovered a Lot Line Waiver for the system installed in 1982 to be closer than the required ten feet from the lot line. During my investigation, I discovered the monitor tube of this system to be located on the property line and the clean-out at the extreme end of this system to be located approximately 1.5 feet from the property line. Therefore, I request that the existing Waiver be modified to reflect the above discovered information. If you have any questions about the proposed installation, please contact me at 272-8218 Sincerely, teven R. Pannone, P.E. CAWORK\4-APOLK.001 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 'MOA #21 �a f�4 NO 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 furtherverify 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 Firmer ic/G/A16E''4 iIA1'-5Phone _538-62,30 Addresscr/o1214 Engineers signature Date 1�L/6�94 ?�1 ROBERT W. WRIGHT r I4Q1�a,tso CE -8156 S1<0 `�� 6. DHHS SIGNATURE Additional Comments Municipality of Anchorage MLEM Department of Health and Human Services bm HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: GO%4, 1�OGLOGK S13,Parc el I. D. ��zzZ-s� A. Well Data Well type /�RIVA71�- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 1✓ Date completed/ 2 Driller j�2FAE 7 - Total depth Flo FT. (9) Cased to Fi Casing height 2, 5 /0 Sanitary seal (Y/N) _ 1 Wires properly protected (Y/N) i Date of test Static water level Well flow Pump levell FROM WELL LOG _Z17z82 2(;� AT INSPECTION -- 10 ® g.p.m. 3,7 TO 2-D 0 g.p.m. (p--Ir7T SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 99,cr, d ; On adjacent lots 7,r O Absorption field on lot 99er 0 ; On adjacent lots 9 TFr, 0 Public sewer main GIA Public sewer manhole/cleanout NA Sewer service line AIA Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate d / m9 lG Other bacteria D Date of sample: 11111194 Collected by:��(jyT B. SEPTIC/HOLDING TANK DATA Date installedT 9 e:2 Z Tank size 1OUD G%IL, Compartments 2 Cleanouts (Y/N) y © Foundation cleanout (Y/N) —Depression (Y/N) I High water alarm (Y/N) _6%6 Alarm tested (Y/N) Date of pumping _ /7 w Pumper Af ZYOm,�- cSEieVUAS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot qq,2:0 On adjacent lots /SOFT O Foundation %. 75 Fr O To property line Absorption field 2 er 0 Water main/service line NA Surface water/drainage IVA F/EGD O 7 -/ON 72•026(8l93)•Front �_. g20N! Df/f!S FILES CONTINUED ON BACK PAGE Q -- PE�2 oWi✓�R �n 4 � a C1 Absorption field on lot 99er 0 ; On adjacent lots 9 TFr, 0 Public sewer main GIA Public sewer manhole/cleanout NA Sewer service line AIA Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate d / m9 lG Other bacteria D Date of sample: 11111194 Collected by:��(jyT B. SEPTIC/HOLDING TANK DATA Date installedT 9 e:2 Z Tank size 1OUD G%IL, Compartments 2 Cleanouts (Y/N) y © Foundation cleanout (Y/N) —Depression (Y/N) I High water alarm (Y/N) _6%6 Alarm tested (Y/N) Date of pumping _ /7 w Pumper Af ZYOm,�- cSEieVUAS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot qq,2:0 On adjacent lots /SOFT O Foundation %. 75 Fr O To property line Absorption field 2 er 0 Water main/service line NA Surface water/drainage IVA F/EGD O 7 -/ON 72•026(8l93)•Front �_. g20N! Df/f!S FILES CONTINUED ON BACK PAGE Q -- PE�2 oWi✓�R C. LIFT STATION ( NA) Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at _ High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot —On adjacent lots Surface water D. ABSORPTION FIELD DATA LGO W Date installed 9/_4 S .4 4 Soil rating (GPD/Ftz) _ _System type Length 86F7 -(D Width 1'7_ 0 Gravel thickness s� /1�/Z�Total depth /9 S8= 4.7/ Total absorption area r7 -!Z _Cleanout present (Y/N) Y— Depression over field (Y/N) r 982 sysT. = ///14/94 Date of adequacy test 19 8 SZE'=W/a/Results (pass/ fail) —Pf}-l�S _for Bedrooms 19805YS7'. = O /98ZSYST, - d Water level in absorption field before test 1988 sysr. _ /-7! O _After test _ 9€Lg syST = Peroxide treatment (past 12 months) (Y/N) 0 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 9 2 (D On adjacent lots _.r 42O F r Q Property line 16,177 O To building foundation—/7F7- oundation_/7Fi O To existing or abandoned system on lot NA On adjacent lots /50F7' (/ _Cutbank AIA _ Water main/service line_ /1/A Surface water 61 A Driveway, parking/vehicle storage area _ 3597' 0 Curtain drain AIA�� E. ENGINEER'S CERTIFICATION I cert}'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effept:0}i citbf this inspection. �A 901 r✓ o..,,,r o .. > Signature Engineers Name WWlel6IL17, a ttdeC:Rr"CN"`tVR'tdf`#T P°. CE -&1, Date HAA Fee $ Da Waiver Fee $ – Date of Payment ` / 6 _ %Z Date of Payment Receipt Number �5_6/ 7 ( f ��T Receipt Number_ 72.026 (3/93)' Back Wright -Alaska Engineering Services • 6004 Glenkerry Dr. • Anchorage, AK 99504 December 16, 1994 W.O. 94028 Municipality of Anchorage Department of Health & Human Services On -Site Services Division P.O. Box 196650 Anchorage, Ak 99519-6650 Re: Lot 4, Blk. A, Pollock Subd. Health Authority Approval & Septic System Repair Dear Sirs, RECEIVED DEC 1 ) 1994 Mumr,,pal,.y of ,0.nchorp,�6 Dept. 110alth & I.luman 5urulces With the submittal of the following HAA paperwork, system repair record drawing package and the payment of $300.00 for Municipal Fees, Mr. & Mrs. Marc Tuchscherer request the review of the information provided for the granting of a Health Authority Approval for the above noted lot. Adequacy tests were conducted on the two components of the drainfield on 11/10 & 11/14. It was noted during the 11/10 test that no effluent was flowing into the 1982 portion of the drainfield. As the 1988 portion was only a two bedroom upgrade, a control valve to alternate fields could not be installed. To remedy the lack of adequacy of the 1988 Upgrade, it was decided to effect a repair of the system by connecting the two components, and forcing the effluent to flow through the 1982 drainfield before accessing the 1988 Upgrade. The adequacy test conducted on the 1982 drainfield showed that it has recovered at least enough absorptive capacity for a three bedroom home. The test on the 1988 Upgrade indicated that it has capacity for 1.8 bedrooms. All work to repair this system was performed by A+ Home Services, a certified septic installer. Note that waivers are in effect for the encroachment of the tank into the 100 ft. well radius, and for the 1982 drainfield being closer than 10 ft. to the south lot line. Should you have any questions or require additional information, please feel free to contact me at the numbers listed. Sincerely, Wright -Alaska Engineering Services ZQ0W/"__ / �*6911 Robert W. Wright, P.E. Telephone (907) 338.6230 • Tax (907) 337-5102 POLLOCK a U N 0 O O 0 � O r LOT 3 m z P --I O 0 C I LOT 2 S 89°58'25" W 64.00' LOT 4 N Ul EXISTING WELL 5.0 NEN! WELL �. LOCATION O0' 20.3' N N IIIIIIIIIIIIIIII�����I�1��1i1 � IIIIIIIIIIIIIu1111111ll.U.w � 28.0' IQ EXISTING HOUSE N 48.3' L; 7625 �O Ot� c� 4\+�professiono\ �o� ��D0000�� �o CK � SEPgc cL�,�r�o g8� 0) 47.6 45.5 I r CD P 0 0 O S 89°58'25" W 139.00' LOT 5 25 25 -02 POWER POLE "�4f!4+f' ,.'". , �s,t;cut>Lc•(w�swuuy-vuuvcw;t><x;[_U;(r ,., .^ (n EXCLUSION NOTES: It is the owners' responsibility to determine 0 ORDERED eY: B O B CAM P B E E L O the existence of any easements, covenants, or restrictions O_ OO CJ which do not appear on the recorded subdivision plat. NOTE: Cn 45.5 I r CD P 0 0 O S 89°58'25" W 139.00' LOT 5 25 25 -02 POWER POLE "�4f!4+f' ,.'". , �s,t;cut>Lc•(w�swuuy-vuuvcw;t><x;[_U;(r ,., .^ �..,. EXCLUSION NOTES: It is the owners' responsibility to determine LEGEND: SET FIND ORDERED eY: B O B CAM P B E E L the existence of any easements, covenants, or restrictions 5/8"RB W/CAPD 5/8" RB 0 which do not appear on the recorded subdivision plat. NOTE: 3.25" AL.MON. 1;� MONUMENT With 2001 REALTY Under no circumstances should any data hereon be used for HUB & TACK El construction or for establishing property lines. FENCE-xx— SURVEY CERTIFICATION: LANTECH has conducted a OVERHANG- _ _ physical survey of this property as shown on this WOOD DECKS- - drawing and that the improvements situated there CONCRETE- 0 -- on are within the property lines and no encroach- ASPHALT- 0 - — ments exist other than noted. GRAVEL- RAVEL-,L\XS—E3U t_T O (_ LEGAL DESCRIPTION: AS—BUILT SEPTIC STANDPIPES- LAND & CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS440 WATER wELL-®O WEST B103 ANCHORAGEEALOASKALVD.99503 (907) 562-5291 LOT 4, BLOCK A, WORK ORDER NUMBER: oA�E: JAN 13, 1995 scALE: 1"=30' (fax) 561-6626 94-L- 754A DRAWN BY: CHECKED BP GRID NUMBER BOOK/PAGE: POLLOCK HOMESTEAD SUBD DMD. t. 3137 347\29 Wood Deck I I I I 1 1 1000 Gal / Segt%O Tank I / C / \ S e Detail � \\I S Ieet I2. \ C N \ \ 100' Protective Well Radius I \ � Single Story Cut & Cap each �� \ 3—Bdrm / end of 4" PVC Frame House Service pipe. 3\ ,5 90 Wood Deck 1988 2—Bdrm Wide Trench�! Septic System Upgrade /_�� Property Line See Detail n // Location Swing—Ties \\ 1 1 2 3 \ A28.6 28.5 11.8 \\y ' B39.8An727.0 � g1 Sheet -2 Clum o \ L� Dog House Birch ees O, Existing 4" ��PVC M.T. o Wood Fence Wright—Alaska Engineering Services CIVIL • SEPTIC • DRAFTING Telephone: (907) 338-6230 Fax: (907) 337-5182 6004 Glenkerry Dr. a Anchorage, AK 99504 ° 94028 COMP. FILE 9402BAS1 ISCA11 1"= 61 JDATI 12/16/94 ® F 44th i W. WRIGHT -8156. .� See't3��t' J Q Sheet 2. DRAMONO FIGURE 1 Lot 4, Block A Pollock Subd. Septic System Repair Mr. & Mrs. Morc Tuchscherer Existing Cleanout Existing n Ground II �� II II Existing 1000 Gal. Septic Tk. 87.89' I i ------------� Remove existing Wye (or Tee) Install straight length of 4" 00110 PVC pipe Existing 1000 j //ft Gal. Septic Tk. J// I I I Ld Cut & Plug 4" PVC Service line to 1988 2—Bdrm Upgrade After—Tank After—Tank C1 Cleanout Section Cleanout Plan Scale: 1"- 4' w— Scale: 1"- 4' Existing Mon. II f+i New Cleanout Tubew .— (to Remain) I I IPI: Existing Grade p -0%��/iii Cut Existing Perf. pipe. Install 4" PVC Cleanout \i & Long Sweep 90' Bend. 00 0 0 °0 Connect to New 4" Solid 00 °pO0 PVC Service piping. Tee / ° °° bd' ° o ° oExisting 1982 3—Bdrm °o System Sewer Rock 0 0 0 00 0 0 0 0 °°$ Inv. EI.- 87.16 1982 End System Tie --In Isometric Scale: 1"- 4' Existing Ground 1988 2 Bdrm — Upgradi S — F,(— - New Cleanout Existing Cleanout I(to be Removed) I II II _ J 7 Cut & Plug Existing 4" PVC Service piping Cut Existing Perf.--' piping at beginning trench. Install 4" PVC 45' Bend & C.O. Connect to New Service piping 1988 Upgrade Tie—In Isometric scale: 1"- 4' SEC g ©GAINING Wright—Alaska Engineering Services CIVIL • SEPTIC • DRAFTING Telephone: (907) 338-6230 Fax: (907) 337-5182 6004 Glenkerry Dr. • Anchorage, AK 99504 '0' 94028 COMP. FILE 94028AS2 SCALE 1"- 4r DATE 12/16/94 FIGURE 2 Lot 4 Block A Pollock Subdivision System Repair Details Mr. & Mrs. Marc Tuchscherer MUNICIPALITY OF ANCHORAGE l_J DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date eX60/pr 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner Telephone: Home �F��"�� Business Mailing Address—. �_ i ���s C,4J.'D6'f"� — (c) Lending Institutior�� e-� ?_ - .�,_%�elephone Mailing Address (d) Real Estate Company and Agent Address �.� L�� e5t�-) Telephone 7G — r9 (e) Mail the HAA to the followino address: or: Check here if hold for pick up. List contact person and day phone number below. 8t 17034 Eagle River Loop Roacl No. 204 Eagle River, Alaska 99577 - 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms _ 3. WATER SUPPLY Individual Well [Ir 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 Ut Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fFev 81861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & 5 ENGINEERING Telephone 7� — Address Eayle River, Alaska 99577 Date 6. DHHS APPROVAL &{j 1 g Approved for 3— bedrooms by �J ( Date Approved X Disapproved Conditional Terms of Conditional Approval CAUTION -,? -3/- eg;�' 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 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 responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 Mev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Descriptio 1�1_-ems C�tf� S to A. WELL DATA Well Classification 1 t-��1 V )QL)A 'l-- If A. B, C, D.E.C. Approved (Y/N) r�'/� Well Log PresentN) Date Completed l-7 82, _ Yield a PM Total Depth Se Cased to � Depth of Grouting ` Static Water Level 2;W211 it — Pump Set At �00� — Casing Height Above Ground 2 4- Sanitary Seal on Casing(ON) �1 _ Electrical Wiring in Conduit®/N) Depression Around Wellhead (Y4D Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots I To Nearest Edge of Absorption Field on Lot On Adjoining Lots Q To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by G Z-- lam^ Date Water Sample' Test Results 0 Comments _'Z -'G -Fig B. SEPTIC/H6 P NG TANK DATA Date Installed a'"Z'I -01- Size No. of Compartments StandpipesO?N) _�)( _ Air -tight Caps 4WN) _� Foundation CleanoutQYM) Depression over Tank (y r_3 Date Last Pumped , "- 2 C' Pumping/Maintenance Contract on File (Y/N) for - I Holding Tank High -Water Alarm (Y/N) / /- Temporary Holding Tank Permit (Y/N) / 71Q, Separation Distances from Septic/hvkIfh�,g_Tank: To Water -Supply Well - e) To Building Foundation To Property Line — 1. L> t A_ To Disposal Field _ i To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments A \A!:>twAL 1%1 Page 1 of 2 72-026 (Rev 8/86) Front C. ABSORPTION FIELD DATA 1 Type of System Design Soils Rating in Absorption Strata s if— �j�p g'=JPe,(I � Date Installed' ��� Length of Field S r Width of Field —� Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Presen+dNDN) t 1 Depression over Field (Y/d4p Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: ( S To Water -Supply Well — 1 4– To Property Line _ To Existing or Abandoned System on To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments — D. LIFT STATION nstalled Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments l� On Adjoining Lots To Cutbank (if present) _ 1 S_ Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at Vent(Y/N) — gijj�ng Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request *" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S ENGINEERING �acl No�@4Date* Sign �7 1703G Eagle�tid$► C� Comb oR;;ar__TAlasaca 99577 MOA No. Receipt No. Date of Payment 0 0 Amount: $ Page 2 of 2 72-026 (Rev 8.861 Back �� 0 A. A Mauch 23, 1988 ROBERT A. SHAFER CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS Mun.ie.i.patity o4 Anchorage Department ob Heat.th and Human Service6 825 L Street Anchorage, Ataska 99501 SEWER &WATER MAIN EXTENSIONS REFERENCE: Lot 4; Block A; PoUock Subdivision Request you i.66ue a permit .to upgrade the existing septic system on the reberenced tot Brom a one bedroom capacity ,to a three bedroom capacity. SEWER&WATER INSPECTION e aration distances between q you Also %equest y nan-t a waiver [or the s%� g U the wett toeated on the rebereneed property and the septic ,tank on the %e6erenced property and the septic tank on the adjoining Lot 3; Mock A. to 98 beet and 93 beet respecti.vety. Atso teques.t a tot tine waiver bor the proposed .teaehb.ie.td ,toy beet. ENGINEERING STUDIES AND REPORTS An adequacy test was perbotmed on the hepti.c system tocated on the rebereneed property on January 25, 1988. The Leswet6 ob this test .indicate that the septic system is currentty bunction,ing adequately WELL INSPECTION bar a one bedroom house. & FLOW TEST Attached ban your review ban the upgrade permit and the .tot tine waiver are the bottowing documents: SITE PLANS 1. On—sitesewer permit appp kation 2. Site plan ROAD DESIGN 3. Design criteria 4. Soits .tog The singte bami.ty wett serving the %e6erenced property was d'titted SOIL TEST in Juty, 1982. The weft goes .through a "gtavet with 20% stay blinder" Brom 0-22 beet and hardpan Brom 22-59 beet. The septic tank bot .the reberenced property was .instaP,ted and .inspected PERCOLATION TEST by Alaska Enviranmenta.t Cont of Services .in August, 1982. The septic tank serving the neighboring Lot 3; Block A; was instatted and .inspected in November, 1979. The topography ob the area i.6 generat.ty 4tat with a s light s.tope away brom .the welt to the tebetenced septic systems. STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 1 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 page two Lot 4; BCock A; Po lock Subdivision Manch 23, 1988 Attached bon, your tev.iew bon the neben.eneed waiver an.e the boeP.oWng doeumenta: 1. Site pkan showing tetative distances between the wee P. and septic d ystemd. 2. WeU tog bon .the weep serving .the nebeneneed pnopenty. 3. Septic .inspection nepont bon. ,the septic tank setv,ing the nebeaeneed pnopenty. 4. Septic inspection nepon.t bo)t the septic tank se4v.ing Lox 3; Mock A. It is our opinion that the hon..izonta2 sepakation distances pn.men.-i.bed by 18AAC72.021 ane not )cequin.ed .in this case.. Ib yo�quiAe additionae inbonmation, ptease contact Rogen/694--2979. A. SHAFER, P.E. /,56 Municipality of Anchorage Department of Health and Human Services di'1hS Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 April 7, 1988 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request For Lot 4 Block A Pollock Subdivision Waiver Request Number WR88-0.12 Dear Mr. Shafer: Your request for waiver of the required 100 foot separation of two(2) septic tanks to a private well is approved. The approved separation of the well to the septic tanks on the subject lot and on lot 3 are 98 feet and 93 feet respectively. Included in this waiver approval is the five(5) foot encroachment of the recently upgraded drainfield on the subject--lot-to the -property line for lot 5. Points supporting this approval are: 1) The septic tank on the subject lot was exposed and watertight couplings were existing on the inlet, outlet, and standpipes, 2) the water well appears to be supplied by a confined aquifer and has solid casing to this aquifer, 3) the owner of lot 5 has written a letter of non -objection for the drainfield on the subject lot encroaching upon his lot line. This approval applies to the existing septic tanks separations and drainfield to lot line encroachment future upgrade to the well or the septic system on lot will require all separations be met or another from this department. Sincerely, r;"� Daniel J. Roth Civil Engineer On -Site Services cc: Gus Andress, P.E., Manager On -Site Services/Water Quality Programs to well only. Any the subject approval ROBERT A. SHAFER CIVIL ENGINEER 7 1 694-2979 �g351`` t is system on .e bedroom capacity. .nce.5 between -'.c .tank on _- - ning Lot 3; est a tot tine Q `ed on the .this .test adequatety - it tine waivex 131 SG, PER, TES1 STRU, MECH-,. ,rL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN dna. ted zy binder" d .inspected he aseptic nd .in,s pected Etat with LV,flenenced septic systems. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 APPLIG. SIT FILLS OUT UPPER HAL ONLY Time �1 Property Owner ,"- ;, r <,- •, y ,,d. Phone Mailing Address �..f f l"1' a�-P•-!.1„ .{cam%I>1.�>s Zip CodeBuyer Date •C/ �.. �6-l'\ y ) C Address/! 1f� 1�C1 aj`f 1�. �+ 7 f' A, Zip Code - 01) Lending Institution r. / // .f= Phone Address ,,!/ r"' r:a ¢ / /� /f j" Zi 7 Code t Li ' rte, ,,, ��/.'�ikf 'I 1 - r Realty Co. & Agent Phone Address `„ �F7�, _-1 �^ ... .. Zip Code_ Legal Description Field Notes: } j G� �p �GJ s MUNICIPALITY OF HORAGE r+ DFDT C� I i?; I R. � 1_----j�--- ENVIRUII„,,:r; A .0,�:rION { �P�e''a�Frt f StreetLocation 4 8 198P Type of Residence p Single Family RECEIVED ❑ Multiple Famlly No. of Bedrooms _? ❑ Other 'CONDITIONS OF APPROVAL Water Supply /' ,P Individual � ��� a N IZ,� . Q 140,,11-0d ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community — For wells drilled prior to that date, give well depth (attach log if available). O Public Utility Soils Rating Sewer Disposal JR Individual Year Individual Installed: Well To Absorption Area /© ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank Well to NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Septic Tank Size © C5 Adna-flsLq Time L l_ �Z _ I Time �1 TimeI C]h,- <�' 4r- o Time -� t Date •C/ �.. �6-l'\ Date ^ ^Date (J' _ �-�h(�L C Date r� �1 )�� r`I 1) - A, 1.,.11_.1 - 01) Inspect o� IJ\ InspectorL(\/ Inspector Inspector �la 6 z`-�I�fr; Field Notes: } j G� �p �GJ s MUNICIPALITY OF HORAGE r+ DFDT C� I i?; I R. � 1_----j�--- ENVIRUII„,,:r; A .0,�:rION { �P�e''a�Frt f 8 198P RECEIVED ( ✓, APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL. APPROVAL' V4-11-0-03 4—II "--03 i�t DATE BY: 1-YL�1 Soils Rating Date Sewer Installed Well To Absorption Area /© Well Log Received 8— 9 L-- Well to Tank q Septic Tank Size © C5 7202] (9182)