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PRATOR BLK 6 LT 1
Prator Block 6 Lot 1 #017-091-38 Municipality of Anchorage Page J of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �1 JAI��\� PID Number: Name: �setz-r GEf1zl1�at2 Wastewater System: ❑ New ❑ Upgrade Y p9 Address: 1411oI '?9AT0K- ABSORPTION FIELD Phone:5 P3 -.3237— No. of Be oo s: Deep Trench 11Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: O Total Depth from original grade : /2^ /I - GPD/Sq.Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe �j Pied7_04 . 7 — '1- ' Ft. 7Ft. Township: Range: 3 W . • , Section: :36P Fill added above original grade: Gravel length: J -P � Ft. Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number of lines: / Distancebetween lines: 1 O Ft. Ft. Classification (Private, A,B.C): f I Total Depth: Cased To: Total absorption area: Pipe material: �VG p G UN K, Ft. U N K• Ft. p SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: Date installed: 11fJ K Ur l K • I Ft. N/EcSoN 9ROS• /D 92 Yield: Pump Set at I Casing Height Above Ground: TANK 2. 3 GPM 1&0 Ft. J - S Ft. SEPARATION DISTANCES 1 'Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public Private Manufacturer: 4A1 -0N 41vX' Capacity in gallons: --C2 From Tank Field Station Tank Sewe Lines • 7 1Z .,5 Well 151P '70• /S'p'7 Material: STC C U Number of Compartments: 7— Surface Surface _ LIFT STATION Water Lot //f7� ZOO Size in gallons: Me cturer: Line Foundation f /� p� "Pump on" level at: mp off' le High water alarm at: Curtain u oke&Model Electrical Inspections performed by: Drain --^ BENCH MARK Remarks: Location and Description: Assumed Elevation: Ft ENC AL 4 � ° goo fi .� 4��H np0� 1 Inspections performed by: a�ln r� �� Dates: 1st 1011-5-�' •° °e° °00°909 0009B0909p® "0 9666 11 -ToNY W N! TIa 2nd l o EARLE V. AUSMAN e Department of HealthATid Hu Services approval ce - 1393 °Oj AV /l Reviewed and approved by: Date: / /e" 72-013 (Rev. 9191) MOA 25 polarconsult alaska, Inc. 1503 West 33rd Avenue * Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258-2419 ice, 14101 -PRA-rolz S-rv.;rm-r SHEET NO. � 7— OF CALCULATED BY DATE CHECKED BY DATE PRODUCT204 i (SinS4126 rPaMi =A-=, inc Grdm. Mg. 0147! To Ome, ME IOU FREE 14DO225M SCALE 11, 40' W W91 -L j LOT a -B uoe- K 17 (-1 Coe ............. . .......... . .......... c 243.7 ................ .............. OF At ............. ................. . ....... ........ .......... .............. ............. ............. . .... ................ .01 ...... 01 ............ ........ ..... ............. ...... . ............ .............. . ...... ........... .... ............. ............. .......... sH ........... ........ ....... sooaoo eo goo 004096 LARLE V. 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'\V ....... ...... ......... ............. ............. ............. .... ........ . ............ .............. ............. my ... ....... ............. ...... ...... . .......... ............ . ........... . .... ..... .............. .. ....... . ............. mv'A Rd 4,1 1 TaLk ............. . . . . .. ...... .. ............... . . ...... ... .. ... .......... ........... .......... . ..... . . ....... .......... ....... ...... ... .. . .... .... < . 14 C'5 Iz z p 6z �-'s ot's -T ...... ....... ............... .... ....... 000%p .... .. .. ...... E &Z' PRODUCT204 i (SinS4126 rPaMi =A-=, inc Grdm. Mg. 0147! To Ome, ME IOU FREE 14DO225M 31V0 A803NO3HO Z61 L Z1 O/ 31V0 Wil/ H (1 A8 031tllnowo ,y d0 'ON 133HS L Z1Q Z1.di c►„ I OI bl 90, 6TbZ•BSZ Q06) XBj OZIiZ-BSZ U06) E0966 VNSHIH '3E)VUGHONd OIC a}InS . anuany p1EE ISOM E091 soul 'elsele ;lnsuoaaelod _�_. ..__._ 0............. ;. _O.. ...._... ___... ......._...._._. _ ;...... __ m _.._. .. A d -..`_ ._. i. .......... .-........ ____. {v}�x, .... 'se _.... ... .... ......., ...._ �..._ o _._.. 3 .... Does s e .... °_ e mvwisnv n 3iav3 p� ebid * $. __.__ ........_...._......... .. ... .... __. _ _........ _._..._ .... .. i� i [ i ' ni Qn :N . . i ? -.. .. _.... .. .... ....... ........ lv =d m a 4 to _ U - _. 'r ........ .. ..... _ < __ _._... m d.. ._.__.. ..,........___..... ............ — . ... J—io 0 ....... z . ...... ....... _ ....... ... __ c ....... ....... . o —... pi b L o _ N ro W_ - - r (Ii- S - - ............ ._- _.... .. ........... .... __. _. Fa. 0 31tl0S 31V0 A803NO3HO Z61 L Z1 O/ 31V0 Wil/ H (1 A8 031tllnowo ,y d0 'ON 133HS L Z1Q Z1.di c►„ I OI bl 90, 6TbZ•BSZ Q06) XBj OZIiZ-BSZ U06) E0966 VNSHIH '3E)VUGHONd OIC a}InS . anuany p1EE ISOM E091 soul 'elsele ;lnsuoaaelod PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920317 DESIGN ENGINEER:POLARCONSULT OWNER NAME:GIERINGER ROBERT E & OWNER ADDRESS:14101 PRATOR ST ANCHORAGE, ALASKA 99516 PARCEL ID:01709138 LEGAL DESCRIPTION: PRATOR BLK 6 LT 1 LOT SIZE: 100624 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 9/30/92 EXPIRATION DATE: 9/30/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: AT THE TIME OF CONSTRUCTION OF THE PROPOSED ABSORPTION TRENCH THE ENGINEER SHALL PERFORM AN ADDITIONAL SOILS TEST AND MINITOR FOR GRO WATER T MUM DEPTH OF 22 FEET. A COPY OF THIS SOILS TE T WIL SUB TTED WITH THE AS -BUILT/ INSPECTION REPORT. RECEIVED BY: ISSUED BY: DATE:z-abolle DATE: polarconsult alaska, inc. ENGINEERS • SURVEYORS • ENERGY CONSULTANTS September 22, 1992 DHHS, Environmental Services, On-site Services P.O. Box 196650 Anchorage, Alaska 99519 Attn: Permit Review Officer Re: Design and Construction Approval for On-site Sewer System at 14101 Prator Drive. Lot 1, Block 6, Prator S/D. Dear Sir or Madam: The existing, un -permitted system on the above property is being replaced because of failure. A deep trench design is proposed. Please note that the well shown supplies both the apartment and house therefore falls under the DEC "Class C" water source requirements. Hence the 150' radius. The proposed replacement system does not affect the current use of the adjacent properties and will have minimum future impact. If you have any questions, please give me a call. I Ausman, CE Attachments: On-site Sewer/Well Permit Application Site Plan, Sheet 1 of 5 System Design Calculations, Section, Sheet 2 of 5 Percolation Test, Sheet 3 of 5 Percolation Test, Sheet 4 of 5 Percolation Test, Sheet 5 of 5 $200 Check for Permit Fee 1503 WEST 33RD AVENUE • SUITE 310 • ANCHORAGE, ALASKA 99503 PHONE (907) 258-2420 • TELEFAX (907) 258-2419 polarconsult alaska, Inc. 1503 West 33rd Avenue • Suite 310 ANCHORAGE, ALASKA 99503 (907) 258.2420 Fax (907) 258-2419 ,p8 14 lo ImwroR STg;r ET SHEET NO. OF CALCULATED BY 1DP. DATE CHECKED BY DATE polarconsult alaska, Inc. 1503 West 33rd Avenue • Suite 310 ANCHORAGE, ALASKA 99503 (907) 258-2420 Fax (907) 258.2419 k .JOB 1y IOI PR4PofZ :�'r_ SHEET NO. 2 OF -� CALCULATED BY DATE CHECKED BY DATE 0 ..r... PRODUCT 20410414 SWSI 261(PaMed) A s a.Int. Won. Mau. 01471. To Order PHONE TOLL FREE I QMS-M of 5 oIr R• e +.e Municipality of Anchorage opa Q H ° °I DEPARTMENT OF HEALTH & HUMAN SERVICES 825 '•L'• Street, Anchorage, Alaska 99502-0650 dos°eooeLINa° E RLE V. ASMA sooa SOILS LOG —PERCOLATION TEST W� %'. CE - 1393 PERFORMED FOR: KOF3ttRT GF_liZl r`ll� �� DATE PERFORMED: LEGAL DESCRIPTION:_oT I _ Fal-or-L/C�Pp 7�o� Township, Range, Section: j 12 i �,3y,1 I j35 rDEPTHI SLOPE SITE PLAN 1 2 3 4- 5 6- 77 8- 9- 10- 11 91011 12 13 14- 15- 16- 17- 18 415161718 EN9 19� 20 COMMENTS GM Fe 10 C WAS GROUND WATER NOENCOUNTERED? S IF YES, AT WHAT N n 0 / DEPTH? H P E Depth to Water After Monitoring? NONE Date: v;&/_ a PERCOLATION RATE Z (minutes/inch) PERC HOLE DIAMETER —20 TEST RUN BETWEEN 3 FT AND q FT PERFORMED BY: Z)Aa/ r C] �btJSM�lt� I E)A, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: e-1 1 Isl z 72-008 (Rev. 4/85) f- YZ o e Municipality of Anchorage y°°°°°° °© 00 ooy�{ta�q�20 DEPARTMENT OF HEALTH & HUMAN SERVICES 6Z �I(IZR� 825 "L" Street, e, Anchora Alaska 99502-0650 ?ea0000000000000-oao6oaUPa�� Anchorage, �. EABLE V. AUSMAN SOILS LOG — PERCOLATION TEST ,` x CE - 1393 ; PERFORMED FOR: Woss-;gT (,-Tel? 114CGEK DATE PERFORMED: LEGAL DESCRIPTION:h�ty t --1G (o $,�bo2S��ownship, Range, Section: T12N , 91 7S 5J�'J DEPTH 1� SLOPE SITE PLAN �Rcr 1 2 3 4 GW 5- 6- 7 67 8 9- 1011 10- 11 12- 13- 14- 15- 16- 17- 18-- 19 213141516171819 20 COMMENTS WAS GROUND WATER �n ENCOUNTERED? S IF YES, AT WHATNfA P �p DEPTH? Depth to Water A er Monitoring? AIZ Date: !�/Z/— n PERCOLATION RATE _4�— (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN E_ FT AND !3 FT PERFORMED BY: 4-unm tsl 1 )AQ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C1 .. 15 (7 Z 72-008 (Rev. 4/85) V_- EF419INE ° Ar b ,° 6 H e Municipality of Anchorage °°•° °° 000 0 q'22i DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ° EARLE V. AUSMAN SOILS LOG — PERCOLATION TEST ��`� CE - 1393 q PERFORMED FOR: R0ge1?-T G--2e=FF, 1 t4r grp- DATE PERFORMED: ;;--rpm . LEGAL DESCRIPTION: LoT l Fj _a(_te (o_ pKA.bORTownship, Range, Section: 712t4 t g3W � S36 r-1 SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 iron/ F�ks z,-- &-tj WAS GROUND WATER ENCOUNTERED? /Vo S IF YES, AT WHAT OL DEPTH? p � E Depth to Water After Monitoring? NONE Date: iv PERCOLATION RATE 12 (minutes/inch) PERC HOLE DIAMETER I I TEST RUN BETWEEN � FT AND 2 FT COMMENTS PERFORMED BY: A. 1 �y� r'1A-u I ' J CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Mom- PERCOLATION RATE 12 (minutes/inch) PERC HOLE DIAMETER I I TEST RUN BETWEEN � FT AND 2 FT COMMENTS PERFORMED BY: A. 1 �y� r'1A-u I ' J CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 72-013 (Rev. 3/78) ;MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEC PHOI — n L ` !•— Y���/ ❑UP RADE MAILING ADDRESS ignx 14 q LEGAL DESCRIPTION PffacK LOCATIO NO. OF BEDROOMS ,' Y � DISTANCE Well Absorption area J Dwellin IT NO. Uy TO: �1 LPE I-_ z Manufacturer /� Ma j I No, of compartm is w � rn Liq. capaGi i allons Inside length Width Liquid depth G IF HOMEMADE: DISTANCE TO: Well Dwelling PERMIT NO. Jaz = Z Manufacturer Material Liquid capacity in gallons O Well Fo nd 'o . n Nearest lot lin PE LU DISTANCETO: G l LL z No. of lir�2s Length of ea li Tot I le gth ofn Trench width, Distance between lines ? ¢ / (4 ches cc F Top of tile to finish grade Material beneath tile Total effec ' abs2 drea 0 J inches Length Width Depth PERMIT NIT. LU QE- Type of crib Crib diameter Crib depth Total effective absorption area aE: UJ y Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE M TERIALS pu. SOI L TEST Ij(,1TI 1.1c fjA-1 INS LL�R. REMARKS f k Sher ILL APPROVED DATE LEGAL - 07 f . �j�_j Cn LOP 1 72-013 (Rev. 3/78) DEPAF.TNE1,11- CIF, EFILTH AND ENdVIRONIIENdTAL P' I-ECTIONd - 2:c ' L Tf :E'E T., ANCHORAGE., AGE: AK. 995L-� 264--4720 CA 6"-,�6 - _ "IF F:_ ..7.E 6 °-611; F: 6=" �- 6 P= 6 i � -T PEP.'M I T NO. !: - I / - �J�� l APPLICANT MICHAEL. RAI'• DALL BO ; 4-47 SRFi-45-Iv:5I LOC:AT I ON LE13FIL LCAT .I BLK 6 PRATOR __LIB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION S'r''�:TEM I s : TRENCH N'1A0e; I1--lUll NUMBER OF BEDROOMS = 4 OIL RATING ( SQ FT, 'BR) = 125 THE. REQUIRED 'SIZE OF THE SOIL. ABSORPTION SYSTEM IS: -1--4- E_ EE 6=-4 I3` -m 6-6 _= d_1- Ci F = E-=-6 °°°°° EE•. 9.._ C- EE F: " .-6-. 6-6 THE LENGTH DIMENSION I S THE LENGTH I Nd FEET) OF THE TRENCH OR DRA I NdF I ELC:1. THE DEPTH H Of- A TRENCH OR PIT IS THE DISTANCE BETWEE Na THE S,L.II=:FACIE OF THE GRCiI_INdC AND THE BCIT'iON I OF' THE E<;C:FI`, AT T Oi'd M-4 N i FEET:. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E: AND THE BOTTOM OF THE EXCAVATION -'IP-d FEET;. ate.., 6= C! u 16 6=: E w _ E_7 F=`Y I C- T 6- -16 -J F-== ILE ::E E = :. L. �2o C=•i Cu F� P_ I- Co PERMIT APPLICANT HAS THE RESPONSIBILITY TO I i,.4FORN'1 THIS DEPARTVIEPIT DURING THE. INSTALLATION INSPEC:TIOhIS OF ANY WELLS, AC_AC.Eh+IT TO THIS PROPERTY AND THE NUMBER OF RESIDENdCES THAT THE WELL. WILL SERVE. -IF 6-4 Ce �2 =s 1 6-4 ° E_7- F:" E--: C- "IF ::IF CH Po F« E-= F� EE rt V=! k_a I Fe 6 ' I ---- M=-BACKFILLING BACK FILLINGOF AV -VT' SYS• T EMI WILTHOUT FINAL INSPECTION AND APPRO%JAL BY THIS. DEPARTVIENdT WIL.L. BE SUBJECT TO PROSECUTION. HIN li lUi9 DISTAN•dC:E BETWEEN A WELL AND Ahili ON-SITE SEWAGE: DISPOSAL SYSTEM I_. 100 FEET FOR H F' U VATE WELL OR 150 TO w_F� 0 FEET FROfel H PUBLIC WELL DEPENDING UPON THE TYPE OF' PUBLIC. WELL. MINdII'lUlel DISTANCE FROM A PRI'�'ATE WELL TO H PRIVATE SEWER LIN•dE IS 25 FEET AND TO H COMMUNITY SEWER LINE I S 15 FEET. OTHER REQUIREMENTS MAY APPLY. -SPECIFICATIONS ANL -1 CONd 7 TRLICT I Ohl DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. =- F.-• FR" 6-°I T 6 6 fF ` I ff;_:' w= _- ._= _L -° -1 E,.,. I CERTIFY IF'7 THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS, AND WELLS, AS SET FORTH �RTH BY THE M IN•,l I C: I PAL I TY OF ANCHORAGE. 2: 1 WILL INSTALL THE: SYSTEM U-4 A C.CiRDANdC:E WITH THE C:OGE S. I UNClEr:SI FIND THAT THE. Ohl--S.ITE SEWER SYS,TEI''I MAY REQUIRE EN.iLARGEFIENT IF THE. RESIDENCE 1S REMOC.-ELEC TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: --_._________________._---_--------------_.._-- APPLIf"FIN•-IT HICHAEL. f'ANdC:AL.L T'SSUED B`r' __ —___. — -----DATE_. /171 � r'#. 0 "F5iil OT NO s k; b ' Ft4 LCrT 1 L�LK 6 F'RATOR SUel LOT SUE 99��999 5Gt4.RRE= FEET I<":OF SOIL M•ORP T ICON SYSTEM IS. TRENCH ' MUM NLTMBEP OF BEE;fi'ODI"15 w 4 SCQLy F:AIM (SP FT/DF,,ip 125 F' C4LLIKEtr 512E OF THE SOIL ADSORPTION SYSTEM 15: (`-I� T tri=..Ir:iE*'•�` IlI�' {"€ 4E" LENG71-1 DIMENSION 15 THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. ':H DEPTH CSF Ft TRENCH CSF' F'IT I5 THE DISTANCE F�ETNECN THE SLIK'fiFiCE CIF THE WIL:IND AND THE BOTTOM CtF THE, EXC:A RTI CIN (1 14 FE E T a. DERE JS NQ SET WIDTH FOR TRENCHES, ;FIE GF;tiVFL. DEPTH IS THE HINIPiUM DFF'TH OF t3RAVEL BETWEEN THE C1U7FFiLL. F'IF'E 00 `IHE BOTTOM OF THE E.XC:AVAT ION CIN FEET >. �.�� f• _. �- 1 !�. � �.R •� � } "F E � +....* i � "7 4 `� 7���__-,• � c'��..a �"" � �'.R 5�x.e �r.o74. R [ � k� C.�• �'� .y.� '. Kj Fsf`PLICANT HAS THE kf^SPONSIBILITY YET INFORM`THIS DEPARTMENTL�l►F`It�� THE PL,IATION INSPECTIONS, CIF At4Y WELL. ADJACENT TO THIS PROPERTY AND THE .1'R, OF RESIDENCES THAT THE 14ELL WILL SERVE i..I� +:: ° .:► I "w. i ^l CCI`-1ti=-7 t=# Fr: F. f ? 4....t I � LEE., tILLdI LN�' OF T -TN,' ' S�YSTEK WITHCIIIT FINAL INSPECTION AND FrF'F'f%GrVAL. F4' THIS e: 'FP'TPIENT 14IL.L. VE „.UBJEU TO F'f*,OSEC-LITION. — —_ V:Ltll DISTANCE BETWEEN Ft WELL RND ANY ON --511E SEWAGE DISP05FIL F-YSTEM IS FEET FOR A PRIVATE WELL OR J 51D TO 200 FEET FROM A PLiEcLIC: WELL DEPENDING THE TYPE CIF I LIFtL.IC WELJL . )�'. I4 f'rIcTANCE FROM Ft PRIVATE 14 LL. TO H PRI'vATf 'EWER LINE X5 25 FEET FINE! Cfrht UNITY SEWER' LINE 15 75 FEES', R- REQUIREMENTS MAY APPLY. SPE:C.IFICRTIONS AND CONSTRUCTION DIF16f:,AMS FIRE at161_E TO INSURE PROPER INSTALLATION. E : I • "3 E ..:_ fr r fix. ;• E" C . F-7 I I F;:: 3:1., _ J_ SA ZTIFY THAT `Tt: FAMILIAR WITH THE tLFtLtIFELdENTS FOR 014--5,ITE S•EWERF, AND WELLS AS SET I BY THE MUNICIPALITY OF ANC:HCtF'AGE. -WI-LL INSTALL THE S;SISTEVi IN AC•C'C+f;DANCE 147TO THE [CEDES. ;i,Tt•,�DER_TFtND THAT THE ON—SITE 5EI,JFR _YSIEM EMPTY �.I CaL1IF:E ELdLR�4iEL'!f L,�T IF THE RE1,10DEJLED TO INCLUDE I-JOQE THAN 4 DEE,Fa'COMS. KiI NT rtiti.HREL. RANDALL SOILS LOG MUNICIPALITY OF ANCHORAGE +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 1e.'1� Sia �..L.— DATE PERFORMED: — LEGAL DESCRIPTION: O toau£ a, l9G3 Michael Randall Sl Box 447 an6»£aye, 99507 11 Subject: t 1, Block G, Prator SLIDdiViSion i)ear: &_, all: . ?Bis @aft at is enable to apj.)-ove the -site sewer installation until Jolla Construction has obtained ager certification £o= installation from this dlepart-nient. if you have any questions please call tais office at 264-4720. Cw5&/ej/s2 Siacer l7. Cory &illlsj a, . zwtinq oewer & Mate£ Program xianwjer � \ \ A. APPROVAL TO CONSTRUCT Plans for the construction or -modification of public water system located ! -'Y �i2.-Y'4"F'< \{'1 •ev5„4 kt M1:�, L c'S)4f y� 2 ; h % �Ui r Ili.. -0 i bm ;" at.',f_4 ' l •. ( i ". "I .,-� _.,.� A L_ b„ t. >.: •,- x - _ 4t n..x^ n ra 'Alaiskka submitted in accordanah ce with 18 AAC 80.100 OF DATE I - DISTRIBUTION.' 1. WHITE- om ENGINEER (Cplete Section C) - - 2 YELLOW WATER SYSTEM FILE (COMPIete Sectlon C) - 3. PINK - ENGINEER/MUNI-BOROUGH (complete Section C r^ a > 4. GOLDENROD MUNI -BOROUGH (Complete Section A) ._ 180107(Rev. 111lKq }ss:-. "�:, d ® Mtmieipality ®f Ancliorage Department of Health and Human. Services � 825 'U' Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor 343-4744 March 3, 1997 Robert E Gieringer Gwendolyn T Gieringer 4048 Laurel Street Suite 103 Anchorage, Alaska 99508 5389 Subject: Lot 1 Block 6 Prator Subdivision Permit #SW960026, PID X1017-091-38 The subject permit, issued February 23, 1996 by this office for a single family well and/or on-site wastewater system, has expired as of February 23, 1997. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. VSiinicely,Alt Cross, P.E. m Manager On-site Services enc: Copy of Permit cc: S & S Engineering 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:SW960026 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:GIERINGER ROBERT E & OWNER ADDRESS:14101 PRATOR ST ANCHORAGE, ALASKA 99516 PARCEL ID:01709138 LEGAL DESCRIPTION: PRATOR BLK 6 LT 1 LOT SIZE: 100624 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 2/23/96 EXPIRATION DATE: 2/23/97 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 ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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. fSPECIAL PROVISIONS, IF THE CHECK VALVE DESIGNED TOBEINSTALLED ON THE WATER LI:NE'FROM THE EXISTING CLASS,C WELL IS EITHER NOT.INSTALLED' 'OR REMOVED AT A'FUTLTi� TE`; THEN THIS"WELL BECOMES A MULTI -i FAMILY WELL AND SHALL.B.R GOVERNED BY A.D.E.C.' RECEIVED BY: ISSUED BY: DATE: ti -96 -f 6, DATE: 2 -2.3 - / (O February15, 1996 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTHAUTHORITY MUNICIPALITY OF ANCHORAGE APPROVALS Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER & WATER MAIN EXTENSIONS REFERENCE: Lot 1, Block 6, Prator S/D Request you issue a permit to drill a second well on the SEWER&WATER referenced property. INSPECTION The proposed plan is to drill a second well, as shown on the attached site plan, to obtain more water for the water system. ENGINEERING STUDIES AND REPORTS We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed well. WELL INSPECTION If require additional information lease contact us. You � p OWTESTEST &FLOW Sincerely, SITE PLANS �GJ Robert C. Cowes ap P.E. RCC/gk ROAD DESIGN Enclosure SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 60' I SITE PLAN SCALE D�u(n �umFTI Dm� ym m ;Ux - 4- Oomal R am aN -aim on�oczi w:/ Am zm ozo z .M, �m� r7a o 0 N2 zm z L —J d \ A Y�JIn ON �Omr*m . > M(f)-aDm-i rrl _ �NyS�X� < 's 'ao�v -a - p3H5 Fri A ON N rri �o rrl jm �NyS�X� o 's CL -i D AN < r /oa / / m / —y1OV813S Wd381S •OO l / / y����' / / �IOb9135 Wb3b1S ,OO l i / / ' m wY3als �0 3NIla31N33 Wb3NJ.S �0 3NI12J31N3� Z -i 0 s r =SCALE- SITE PLAN DETAIL c A` r-+ 0 r D G7 � D z r O 1 I 113PA M3N W0dJ o m � � o rn � r= m ' > -j O C14 l 3M. DNIISIX3 WONT � D � �I _ N O � CA � cn _ O r m r- d < z ym z m —x co rn zx Z_ W rr rrtfn Z G -)C7 < < '� Cl) s D Z m C IV rTl N S � •µO - j> V* • 9����S 1- Municipality of Anchorage -�1 Development Services Department ,' Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street / P.O. Box 196650 �� t Anchorage, e, AK 99519-6650 650 ry www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. COSA# 096055 1. GENERAL INFORMATION Expiration Date: 11 _'2' O O P Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PRATOR BLOCK 6, LOT 1 (HOME) 14101 PRATOR STREET *ANCHORAGE, AK ROBERT GIERINGER Day phone 563-3232 14101 PRATOR STREET *ANCHORAGE. AK Day phone MIKE MCLANE W/ PRUDENTIAL Day phone 276-8507 3801 CENTERPOINT DR. SUITE 200 *ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class C Well Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSO. 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 party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date 3%l0/0$ .:....• . ...... ......... '•,Je G ness:' P CE -7 3 :p �04re �jl{R�RP•. c400 edprofesslorle t Y((O(F r�/ter `\\`�4\Qp�`, .. •. • per, ' • o off: • ONSITE WATER AND WASTEWATER : PROGRAM Conditional approval for bedrooms, with the filowing stipulations:O '•,• ,•' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: Original Certificate Date: (Rev 11005( Municipality of Anchorage --°l Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PRATOR BLOCK 6, LOT 1 Parcel ID: 01:Z — DQ 1— 3 $ A. WELL DATA *CLASS C WELLS ARE NOT REGULATED BY ADEC Well type CLASS c If A, B, or C provide PWSID# *N/A Well Log (YIN) YES Date completed 6/1/1996 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 216 ft. Cased to 100 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/1/1996 10/12/2007 Static water level 88' ft. 88 ft. Well production 20 g.p.m. 6+ — 9 -p.m -WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1.67 mg./L. Other bacteria _ND_colonies/100 ml. Arsenic: ND_ug./L. Date of sample:10/12/2007 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/27/1983 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 10/12/2007 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA E Ow EXISTiNG GRAD Date Installed 9/27/1983 Soil rating (g.p.d./Worql��/bdEo 85 System type SHALLOW TRENCH Length 60 ft. Width 5 ft. Gravel below pipe 1 ft. Total depth *9 ft. Eff. absorption area 345 ft' Monitoring tube YES Depression over field NO Date of adequacy test 10/12/2007 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 1046 gal. New depth DRY In. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N 'Pump on" level at in. "Pump offleve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 150'+ On adjacent lots 150'+ Absorption field on lot 150'+ Public sewer main N/A Sewer /septic service line 75'+ Animal containment areas 50'+ On adjacent lots 150'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 59+ Absorption field 5'+ Water main N/A Water service line *t0'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line '10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER S&S ENGINEERING — uzo Ste_ S1�Jr� Lt"154 cStr-- CLOSE G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 3110 /0 8 COSA Fee q:�70 Date of Payment !:�1 w Receipt Number l43iq, (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage ° Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsile (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL r� FOR A SINGLE FAMILY DWELLING Parcel I.D. [j1 �f 'tq1' >5�'COSA#O R O 0 60 �y 1. GENERAL INFORMATION Expiration Date: - /1 — .Z o " d Complete legal description PRATOR BLOCK 6. LOT 1 (ADU) Location (site address) 14101 PRATOR STREET "ANCHORAGE. AK Current Property owner(s) ROBERT GIERINGER Day phone 563-3232 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 14101 PRATOR STREET 'ANCHORAGE. AK Day phone MIKE MCLANE W/ PRUDENTIAL Day phone 276-8507 3801 CENTERPOINT DR. SUITE 200 *ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class C Well 0 Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG. VD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily identifiablo features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V Approved for I?— bedrooms. Disapproved. Phone 337-6179 Date 2 jO oa 'ern rnass �o CE 9 3 Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory V Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Nitrate Advisory Other 13 (Rev. IMS) 02r�•,....,;•�;yo ' ON-SITE WATER AND :• WASTEWATER PROGRAM Original Certificate Date:. - 2 D –Q S/ Municipality of Anchorage C• Development Services Department ° Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PRATOR BLOCK 6, LOT 1 (ADLI) Parcel ID: A. WELL DATA *CLASS C WELLS ARE NOT REDULATED 6Y ADEC Well type CLASS c If A. B, or C provide PWSID# *N/A Well Log (Y/N) YES Date completed _6/1/1996 Sanitary seal (Y/N) YES Total depth 218 ft. Cased to 100 ft. Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/1/1996 10/12/2007 Static water level 88, ft. 88' ft. Well production 20 —9 P -m, 6+ g,p,m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.67 mg./L. Other bacteria ND colonies/100 ml. Arsenic: ND ug./L. Date of sample:10/12/2007 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 10/20/1992 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/12/2007 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 10/20/1992 Soil rating (g.p.d./Wo /bdr 0.45 System type DEEP TRENCH Length 50 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth • 11.87 ft. Eff. absorption area 700 ft= Monitoring tube YES' Depression over field NO Date of adequacy test 10/12/2007 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test 31.5 in. Water added 400 gal. New depth 41.5 in. Elapsed Time: 124 min. Final fluid depth 39.5 in. Absorption rate >= 300+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at —in. "Pump off level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot '125'+ On adjacent lots 150'+ Absorption field on lot *145'+ On adjacent lots 150'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 75'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line •'•10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Buildingfoundation 10'+ Water main N/A Water service line .."10'+ Surface water 100'+ Driveway, parking/vehicle storage "0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS **SEE ATTACHED ASBUILT SURVEY ***PER G. ENGINEER'S CERTIFICATION •. '< 9S�0o I certify that I have determined through field inspections and review of Municipal records that the above systems are in �......... conformance with MOA COSA guidelines in effect on this 0 ........ date. a mess. - Engineers Printed Name JEFFREY A. CARNESS QQ4� •• CE -7 53 Date t7 3 �%Pror.Slorlt= COSA Fee $ 3 Waiver Fee $ Date of Payment,C ! 'I'� Date of Payment Receipt Number , 2 Receipt Number (Rev. 11/05) SCS Refa 1083827001 Client Name Garness Engineering Group, Ltd. Project NamcIN Prator B6,L1 Client Sample ID Prator B6,LI Matris Drinking Water r%VSID 0 All Datcs/Fimes are Alaska Standard Time Printed Datcaime 08/1 M008 15:35 Collected Date/time 07/30/2008 14:30 Received Date/time 07/31/2008 9:10 Technical Director Stephen C. Ede Sample Remarks: Parameter Allowable PQL Units Method Comaim Limits Prep Analysis Date ID Date knit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/31/08 08/01/08 NRB Waters Department Total Nitrate/Nitrite-N 1.21 0.100 MWL SN120 4500NO3-F B (<10) 08/06/08 JDZ Microbiology Laboratory Colony Count 0 col/100mL SM20 92228 A (Q00) 07/31/08 DLC Total Coliform 0 coUl00mL SM209222B A (<l) 07/31/08 DLC Fecal Coliform 0 coUl00mL SM20922213 A (<I) 07/31/08 DLC WELL SEPTIC SYSTEM GRAINFIELD -EXISTING SEPTIC TANK \ \ PRATOR S/D. \ \ LOT 1, BLK 6ISTIN\ \ \ \ MOUSE 0 \ GARNESS ENGINEERING GROUP, Ltd. � CONSULTANTS i GENERAL CONTRACTORS • •• •• Mt •••••••• ••••••4 Al L IIAdI ApV. 91rt wl • M4MK{. IW%7 • M (•O7ivi-GSM • IN L.o.u»-.vM • R - w.. ., prr I fwn • PREPARED FOR: PHONE NUMBER: PACE NUMBER: �' ROBERT GIERINGER 907-563-3232 1 OF 1 �Q '•,J eLLf A. Car eSS.: LEGAL DESCRIPTION: DRAWN BY:Q� s CE PRATOR SUBDIVSION; LOT 1, BLOCK 6 P. 4�n�e��' 4� , OB'��Qo TYPE OF WORK: DATE: 4p0�4Op sic SITE PLAN FOR WAIVER REQUEST 2/19/2008 $WE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF WATER WASTEWATER DISCHARGE AUTHORIZATION PROGRAMS February 25, 2008 Jeffery A. Gamess. P.E., M.S. Gamess Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507-1259 555 CORDOVA ANCHORAGE, AK 99501 Phone: (907)269-7519 Fax: (907) 269-3487 http://www.state.ak.us/dec/ Re: Separation Distance Waiver for an Existing Septic Tank and Onsite Wastewater Disposal System to a Class "C" Source Well-Prator Subdivision, Block 6, Lot 1-Anchorage-ADEC Plan Tracking Number 7028 Dear Mr. Gamess: On February 22, 2008 the Department received an engineering waiver request for an existing Class "C" Source Well and the existing Municipality of Anchorage approved 1,250 gallon two compartment septic tank and an onsite wastewater disposal deep trench (effective depth 7 feet) disposal system. You are recommending two waivers based upon sampling results of the source well water of 1.67mg/l of nitrogen as nitrate, no fecal coli form or arsenic detected, the soil conditions at the site having a 17 foot layer of clay material in the upper 30 feet of the well log and a well depth of 218 feet. The following separation distances were reviewed as follows: A reduction in the separation distance from 150 feet to 125 feet from the existing class "C" source well to the existing septic tank on Lot 1, Block 6, Prator Subdivision. A reduction from 150 feet to 145 feet from the existing source well to the existing deep trench type onsite disposal system also on the above described lot. Based upon the engineers recommendations and the history of past waivers in this area providing protection for the public's health. the Department per the Wastewater Regulations 18 AAC72.060 reduces the separation distances to the existing site conditions. Should a threat to public health develop and be associated with this onsite wastewater system. all waivers may be rescinded. This approval does not imply the granting of additional authorizations nor obligate any state, federal or local regulatory body to grant required authorizations. Any person who disagrees with this decision may request an adjudicatory hearing in accordance with 18 AAC 15.195- 18 AAC 15.340 or an informal review by the Division Director in accordance with 18 AAC 15.185. Informal review requests must be delivered to the Division Director, 555 Cordova Street, Anchorage, Alaska 99501, within 15 days of receiving the decision. Adjudicatory hearings requests must be delivered to the Commissioner of the Department of Environmental Conservation, 555 Cordova Street, Anchorage, Alaska 99501, within 30 days of the decision. If a hearing is not requested within 30 days, the right to appeal is waived. Thank you for your cooperation. If you have any questions please do not hesitate to contact me at 269-7519. Respectfully. William R. Rieth, P.E. Environmental Engineer cc: William Smyth, WW, U'- -"-is-2007 of, ?9!"i FCOM: - r ■a' 70:,,,,232-:5 p:}/1 ■ .■.aa.o. Hees evnw"asw.fa to\rig ,+o�.emr MF.a.c9�r«mw. n.t eu.e�eu ■ i ' eier.,ae♦.�a ' . ♦ J ••ire � •u��MO A+ HOME SERVICES , INC. 7501 E. 140th Avenue Anchorbge, Alaska 99516 345-1890 CUSTOMER Robert Geiringer 2751 DeBarRoad, 0320 ._ . AmrboraecTAK 99308 Block Lot INVOICE # .33168 DATE DESCRIPTION AMOUNT Pumo Seytic at 14101 Prat `� 103.00 invoice tP =cG. • .a Tankq on TOTAL REMARKS - .w Gallons t/ Septic Leach Area Holding Tank ❑ PROBLEM AREA—CALL FOR MORE INFORMATION ❑ NEEDS TO BE DONE AGA KNIN6 MONTHS ❑ Good Shape udge buildup on bottom ❑ Jim cap missing or ut Standpipe to 1' above ground needs replacing _�/_ StandpipesTime ❑ Floater on top ❑ Needs Septictrine i SCS Reto 1075487001 Client Name Gamess Engineering Group, Ltd. Project Namem Lt 1 and 2 Prator Client Sample 1D Lt ] and 2 Prator Matrix Drinking Water PN'SID 0 Sample Remarks: Pamm�er RaulU PQL Metals— by Arsenic ND . - ... 5.00 Waters Daoartmant Total Nitrit"itrite-N 1.67 0.100 MScrobiolow=ton, Total Coliform 0 Units McNod Allowable prep Ati�u Container ID Limits Date Date Nit a82 EP200.8 C (<10) 10/16/07 10/17/07 MH mgt SM20 4500NO3-F B (<l0) coVIOOmL SM209222B A (<I) 10/15/07 LCP 10/12/07 SDP A4 Dates/flmes an Alaska Standard Time PrintedDate/Time Collected Datefrime ]0/19!2007 9:54 Received Date/Time 10/122007 9:30 10/122007 14:25Stephen Technical Director C. Ede Units McNod Allowable prep Ati�u Container ID Limits Date Date Nit a82 EP200.8 C (<10) 10/16/07 10/17/07 MH mgt SM20 4500NO3-F B (<l0) coVIOOmL SM209222B A (<I) 10/15/07 LCP 10/12/07 SDP MUNICIPALITY OF ANCHORAGE �� • T Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES q4 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ti 17 0 9 ('3 F% HAA # Q n- 9 ) L—) �(n 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 1410 1 "PRN-ipP, t>P , tsc� lot2 Ate;= , ky, 95s (b) Property owner RoSERT G , 61GP Mt--C—R Telephone: (home) — Business S6,3 -3z Z Mailing Address yoya L4uREt_. Ave. SuirE /D3 /-�wcN. q95-0$ (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family K Number of bedrooms Z 3. WATER SUPPLY Individual Well ❑ Community Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 54 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 Of 2 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. 1 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 ;TnaQOLARCn.V `iiL"T Telephone Z Sc3 _ z4 ZG Address J�b3 W 3:!)_14'Z1 Ave AVG 41czR a A� `'`r��3 Date v" �9 Y'- 1V r A4 TH n„ - •••• °+0 77 O aeaa0• Engineer's Seal / z WLE V. AUSMAN o [� CE - 1393 6. DHHS APPROVAJ, Approved for—'* -bedrooms by �``�YXC Date Approved Disapproved Conditional Terms of Conditional Approval EACkTIUNe The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LU I F P3WC-K ry . PRKtoR ,' Parcel I.D. 0 1-109 1 3 A. WELL DATA Well type CLbsS 'C' If A, B, or C, attach ADEC letter. ADEC water system number Pw:sib Z- 17 9 k, Log present (Y/N) N Date completed iJVkA) c a %J Driller IN'<616'N4M Total depth /60 Cased to ;�- 4& Casing height %191 " Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION p m Date of test 7Z219Z a P. sCJ Static water level 7G, ' °' 0 m Well flow it/. A . g.p.m. Cn rn Pump level 3 D c s cD i't'I rA p IV SEPARATION DISTANCES FROM WELL TO: (D s m Septic/holding tank on lot 16c-) + ; On adjacent lots Absorption field on lot iso y ; On adjacent lots /50 ; ' Public sewer main AIA Public sewer manhole/cleanout NA Public sewer service line AjA Petroleum tank WA WATER SAMPLE RESULTS: Coliform O Nitrate O Other bacteria Date of sample: (o - 2 G' -1 ? Collected by: 6-i t=AZ I K)e*,E 12 B. SEPTIC/HOLDING TANK DATA Date installed /0/9Z Tank size /OSd & A L Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) A/ High water alarm (Y/N) Date of pumping A;A Alarm tested (Y/N) NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells on lot lSO ' 1p O On i�G.,. Foundation 4� To property line X36 ` Absorption field -Water main/service line NA Surface water/drainage AIA 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Date installed IZI />a_ Soil rating Length �50 Width Total absorption area "Pump off' level at Cycles tested Surface wa \ Gravel thickness System type Test --?,4 ck Cleanouts present(Y/N) Total depth I Z Depression over field (Y/N) Date of adequacy test /VA Results (pass/fail) iU%a for _ 2- bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date IVA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /C>�` On adjacent lots SSG' Property line To building foundation I �,� To existing or abandoned system on lot 4�6 On adjacent lots 100 .; Cutbank Surface water Curtain drain >S A E. ENGINEER'S CERTIFICATION Z Water main/service line Driveway, parking/vehicle storage area i\ -Z A 2" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effete 4ate of this inspection. �.> J ��t°� ,;LL eYtSignature .o )/ fro 0 0000 00,0..0 q UU�o O�qQ Engineer's Name s !� A,0 i `� �� 00 sr a �6 2 Z ��, V. AuSNM o Date e CE P 1393 ,�' �; 47 OQ HAA Fee $� d' ��Waiver Fee: $ Date of Payment 1 j - `} j Date of Payment Receipt Number t �� 1 _ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LcnT / .61.06k 4o I Pe/470C Parcel I.D. 0I� 5/D A. WELL DATA n� v Well type Log present(Y/N)_ _ If A, B, or C, attach ADEC letter. ADEC water system number P W 5 I b Z t -k, > I to A/ Datecompleted Q'Vkh 0W/.I Driller UM ow irJ Total depth I (D 0 Cased to 1> L/ o - Casing height Sanitary seal (Y/N) y Wires properly protected (Y/N) y Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main / 5-0 ,r, / AIA AT INSPECTIONCD Nitrate CD Other bacteria 0 2 Date of sample: In - 2 � `�] - 70 lv CD 0 °1 C) M s- Cl Z 3 spm gp410 Cn i'r1 = J ((ao :3 n o cc r" UY 0 N O N _.tCD nm m, On adjacent lots ; On adjacent lots Public sewer manhole/cleanout IVA Public sewer service line NAS Petroleum tank WATER SAMPLE RESULTS: /vA Coliform Nitrate CD Other bacteria 0 Date of sample: In - 2 � `�] - Collected by: '9099�2'T [srr=_ tz r(mc-%F Z . B. SEPTIC/HOLDING TANK DATA Date installed Tank size 126-0 Cleanouts (Y/N) %� Foundation cleanout (Y/N) — Compartments I- - Depression (Y/N) I /vim Alarm tested Y/N /I,/ - A - High water alarm (Y/N) ( ) Date of pumping , ;, /V • A ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot �5 On adjacent lots —Foundation '6l To property line �L� y Absorption field S Water main/service line N' A Surface water/drainage x/,-,OQ 72-026 (Rev. 3/91)Front Moa 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pum " level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at _ Cycles tested 4 face water _ Date installed FF Soil rating Sw System type Length 61 O Width `p 0 " Gravel thickness 12 Total depth Total absorption area 4? 2 Cleanouts present (Y/N) Y Depression over field (Y/N) _ 4/ Date of adequacy test Z Results (pass/fail) P45_5 for bedrooms Peroxide treatment (past 12 months) (Y/N) N If yes, give date A . SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1.S'0 -/- On adjacent lots /_ O ' �— Property line 9 To building foundation 2 rJ !''` To existing or abandoned system on lot 26f On adjacent lots C u t b a n k 3-7- Water main/service line M • A Surface water �°� N• 14. Driveway, parking/vehicle storage area �2- Curtain drain IV V A E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MDA and HAA guidelines in eff i'Rlats of this inspection. Signature wf °'It 9 Lt.,°pp y,• 4 'F'0 444 P40040@ @@bPRO� Engineers Name 0 g 0 , 00 ooaoa euoogoona 0 ARLE X AUShflAPd ° Date _ �°IV,°°° a .1393 ° °° ;, 1�V}V$� °0447 F]yA�00000° A�49 fti3 mf li3it� � + HAA Fee $ IC Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number T STATE OF ALASKA - DEPARTMENT OF ENVIRONMENTAL CONSERVATION. gE0ROVAL OF ONSITE RESIDENTIAL WATER AND SEWER SYSTEMS. i' °• lows R PROPERTY DESCRIPTION Lot, 81ook & subdivial __.br_tf Survey /yi0t Pra}or 'Dvivg Loj, Ii Blatt !o Pr4�ar Sub�ivitioti o ss V Liao certificate Issued for Application No: j9A4jD 'E2/i916 This approval does not constitute a guarantee of any kind, explicit or implied; as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink Ing water standards for total coliform bacteria. Title -'�.L�' 1 10-/2-92 WASTEWATER DISPOSAL The domestic wastewater system was: w ❑ inspected by the Department of Environmental Conservation and found to be in compliance with applicable' requirements of 18 AAC 72; ❑ inspected by.4. Professional Engineer who certifies that the system complies with applicable re- quirements, `1S'AAC 72; ❑ installed by a Certified Installer who certifies that the system complies with applicable requirements of 18. AAC 72 or ❑ tested by a Professional Engineer who certifies that the performance of the system is satisfactory and that the system complies with the minimum separation distances specified in 18 ARC 72. This approval is valid fora ❑ single family ❑ multi -family unit with a total of bedrooms. 18.0404 (Rev. 8185) DISTRIBUTION: WHITE—BANKILENDING INSTITUTION; CANARY—APPLICANT PINK—DEPARTMENT
