HomeMy WebLinkAboutRACHEL LT 1
-~,. DEPT. OF HEALTH &
( ~ . -" MUNICIPALITY OF ANCHORAGE 7~: ENVIRONMENTAL PROTECTION
! o,. DE; "ITMENT OF HEALTH AND HUMAN SER! S
· ', Environmental Health Division ~0V
'" 825 "L" Street, Anchorage, Alaska 99502, Telephone 2~-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECT~~TE
Name DiST~I v L
SEPTIC ABSORPTION WELL
A~me~ F ~ ~a x / ~ ~ ~ ~ ~ TANK FIELD
JPerm,, No. J.o o, .~,oom~ WELL /~[
~G*~o[sc.,.T,o.J ~ LOT LINE / ~ /~
~o~, J~,~ su~,.,.,o~
Township. flange. ~t~on
5 ~ 4 ~ ~ TI Z ~ ~ ~ ~ AS-BUILT DIAGRAM IShow Iocaho, Ol well. sephc system, pfope~y hnes.
driveway, water bod~. etc.}
TANKS ~ ~j~u~, d ~;rJ~'r~o~ ~ :~ ~ N
~ SEPTIC ~ HOLDING ~
Manu,actu,er CapaoW ,n ga,,ons
Material NO. of Compadments
· ~ ~ h t
I
V.E OF SYSTEM '1 J
~plh tO p,pe ~ttom hom FT lotal Oepth I*om original graau / ~
~ FT ~ FT / /
//
~ ~ SQ FT ~ FT
I [~ SQFT C~ ~3e3y F~to o ,,-
WELLS~
~ PRIVATE ~ OTHER fldentifv) X
REMARKS:
F~do~ 4~ ~y ~ 6~e~ d.,'/~ .. )/Z~ ~ S+,r~:~
Inspecbons Pedormed by:
~ ~~/~ cedily that this Inspeflion was pedormed amrdiflg lo all
HealthDepa.mentApprova,: ~~-- ~ · ~7~ Dam: ~--~--~ '..
V
72-013 (3/85)
PERMIT NO:
DATE ISSUED:
MIJNI CI~'~AL I TY OF . #iIgCI-~RAGF
DEPARTMENT ( ~ HEALTH AND ENVIRONMENTAL~ ROTECTION
825 L STREET, ANCHORAGE~ AK 99501
264-4720
ON--S ITE
860419
11/09/86
APPLICANT:
ADDRESS:
CONTACT PHONE:
PAUL G. JOHNSON
P.O. BOX 100797
ANCHORAGE, AK 99510
549-2551 ·
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
SUBDIVISION: RACHEL
SECTION: 21 TOWNSHIP: 12N
.75A (SQ.FT. OR ACRES)
4
LOT: 1
RANGE: 5W
BLOC;{: NA
Listed beIow are the options available to you in designing your septic
system. Choose the option that best ¢its your site.
DEF'TH T'O F'IPE BOTTOM (FT.
GRAVE[_ DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL WIDTH (FT,)
GRAVEL LENGTH (FT,)
GRAVE[_ VOLUME ' (CU. YDS.)
TANK SIZE (GALS)
SOIL RATING (SQ. FT./DR)
TREblCH I~ED tg. D RAI~I
4.0 4.0 4.0
9.0 0.5 5.5
13.0 4.5 7.5
2.5 20.0' 5.0
28.0. 58.0 54.0
24.7 28.2 40.0
1,250.0 ** 1,250.0 ** 1,250.0
125 125 125
** ~ANK MUST HAVE AT LEAST TWO COMPARTMENTS
I cepti{y that:
1. I am familiar with the requirements ~or on-site sewers and wells as set
~orth by the' Municipality ~ Anchorage (MOA) and the State o~ Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria ~ this permit.
3. I will adhere.to all MOA and State o~ Alaska requirements ~op the set back
distances ~rom any existing well, wastewater disposal system op public
sowerage system on this or any adjacent or nearby lot.
4. I understand that this pepmi[ is valid ~or a maximum o~ 4 bedrooms and
any enlargement will requi~e an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES.,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST~ BE~I~O, NE ~Y A LICENSED ELECTRICIAN.
AF'PLICAN'I': PAUL G. JOHNSON
ALASKA ,,JIRODmlZDTAL CODTROL SeI.,, tC S,
~n§in¢¢rin§ 8- ~nuironmentol Studies
177-
Novcmb(::i' 3, ] 986
InC.
Deal' Robb J ~:~:
agpl.i, ed Eot' a~ ;gerJnJi: 'Lo build an ot]-site sept:lc SySi:(~fll bill:
area fop serlio [Ws~:em~; ci.~] to ~:he t]Bt'opi.l~a~e io(:ai;i, on of the
~?he,.'~ Elm so:il t(?sL waa oP:[guinally dmte, I noi::ice(i Lhe
J. Jke th:is, Lee always has us ('U[l oul' pecco]at:lo~ ter:;[s J!l Lhe wo~'sl.
asm]ped oJ' last:J, ng' ].onge:c. So Jn this case,
b~[-,weell 3 aB.d 3.5 feel: whel'e i:h[~ soJ] WaS ~ s;'t.[:y
poz'co]ai:ion p~vt:e of !50 square feet. pez~ bedroom,
I{owcvet', Sllch i~ cu'Cing t,am]d illea~i LhaL 1500 ~quape fee'L pep bedroom
:¢urfaoe area would be needed, according l.o your JnLe?pretat:iou of khe
t:hepe J_si].'t 6000 aquat'e feet of t'eserve apea on LhJs lot. So I deoJded
feet pet'. bedroom. Ave:caging these l:wo soils test gives e~ [;oils ratin~: o¢
I:18 sqdare feei: pe.P bedr'oom, buL t ~Jom[d fee] more comfo:eLable pat:'in2~ i~:
at 125 8qqare feet per bedr'oom since there is mm'e s~lEy so. nd than oleaa
sa~d.
Th(,'-.cefo:pe, i:l~(; :;oils apo lltOpC, aociliN;.L(:ly de=,;cz'ib~)d here am :!25
['eel pep heel:caere. Such a ao:[13 ,ai::[n~, accol'diu~ i:o kite ordinance,
pe(l(~:[~fes o[!1.~* I000 aqua:cc feel p(~'p bed:coon] Pc~s(~]:'ve a~'ea
septic sysLem. Thez'e is actually 4000 square feet of reserve area on
this lot, which is partially obtained by waiving the tot lines, The
sep~:ic ayskem itself ~,~:[].l by no means be built c]osec t. han
i:he lei: J:i~es. IL Js o~]y a. waiver o6 i:l)e d:[sLance [:o Jot: liBes
lpr~o [[l~s~ .ssP8 Au~nue ~uit¢ B o Anchox~Qe. Alaska 99503 *f907] 561-5040
Apppoved by:
Sincere.l.¥,
Eng:i. rme~:Lng Geo] og:i '3t
l, eroy C. Reid, .?~i'., Phi),
ALASKA ENVIRONMENTAL
CONTROL SERVIC' , INC.
1200,Wcst 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JOB
SHEET NO,
CALCULATED
CHECKED BY
SCALE,
ALASKA ENVIRONMENTAL
CONTROL SERVIC , INC.
1200 West 33rd Avenue Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO.
CALCULATED BY
CHECKED BY.
SCALE !:
OF
DATE --
..... 'DEPARTMENT OF HEALTH & HUMAN.~t~_"ES
' '825'L" Strut Anchorage, Alaska ~ ~% ~
SOILS LOG -- PERCO~TI~,,
LEGAL DE~RIPTION: ~'~'1 ~ / ' Township,
1
2
3
4-
5
6
7
8
11
.12
13
14
17
18"
19
20
SLOPE SITE PLAN
' ENCOUNTERED?
IF YES, AT WHAT
DEPTH7
$
L
E
Gross "Net Depth to Net
Reading Data Time Time Water Drop
l~q 5' ob q
,' 1119 ~o 'Z~ '~
PE, RCOLATION RATE ~' ~''''' II,~m,n,.~e~.',.c~) PERG HOLE Dl~E~En ~"
TEST RUN BE;WEEN FI AND ,
PERFORMED
IN
MUNICIPAL GUIDELINES IN EFFECT/I<THIS DATE. DALE.
ACCORDANCE WI'TH ALL STATE AND
72-008 ERe'. 4,85,
ALASKA EF"!Ronm~[1TAL COIITROL SEg[' rES, I[1C.
CLIENT
ADDRESS
PERCOLATION TEST DATA SHEET
ZIP CODE
LEGAL LOCATION
TOTAL DEPTH OF HOLE
ZONE TESTED ~ ft TO
ft.
C~ '"c~ ft
TH # / TEST HOLE DIAMETER
READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in)
DATUM
FINAL PERCOLATION RATE
~ SQUARE FOOT/BEDROOM
PERFORMED BY f~g'CS~
MOA ST8~-024
.(min/in)
825 "L" STREET
ANCHORAGE, ALASKA 9950!
(9()7) 2G4.4111
~,~O~:GE ~ SULL~VA~.
,",fA YDR
DE;',',:;ItlE:';I (ii HEAL] ti AN[) [N%'It'{ONR~ENI/~L ['ItO]'EC[ION
January 4, 1982
Paul Johnson
Box 797
Anchorage, AK
99510
Permit ~ 810974
Subject: Lot 1 Rachel S/D
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
pL;oSgNr;mB~hnha~le~:'
Sewer and Water Program
Enclosure: Copy of Permit
I.~ELL
PERMIT NO. ( 810974
I C I F'RL I T'~ CIF Rr-~CHORRGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 "'L" STREET, ANCHORAGE, RI':.'.. 99501
264-4720
or4--S I TE SEi4EF." PFR£.I T T
APPLICANT F'RUL JOHNSON
LOCATION OHIO RD
LEGAL ~LOT i RACHEL
BOX ?9? ANCH ~S-~
~44-2756
LOT SIZE 29530 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEbl IS:
DEPTH= :1.2 L E I',.! i"3~ T H-- ~8 GRR%,'EL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETHEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
THERE IS NO SET HIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUH DEPTH OF GRAVEL BETHEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
RED SEPT I C TRf-4F( S I ----" E= :L250 6RLLOt4S
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY HELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE HELL HILL SERVE.
TI-~O ~: 2 ) I t4SPECT I Of 4S RF;E RFC~.IJ I F~:FD
BACKFILLING OF ANY SYSTEM HITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT HILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETHEEN R HELL AND ANY ON-SITE SEHRGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE HELL OR 158 TO 208 FEET FROM A PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC HELL
HINIHUM DISTANCE FROM A PRIVATE HELL TO A PRIVATE SEHER LINE IS 25 FEET AND
TO A COMHUNITY SEHER LINE IS 75 FEET.
14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT HITHIN ~0 DAYS
OF THE HELL COMPLETION.
OTHER REQUIREHENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRr;I~ ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEF-:r.1 I T E~4P I RFS DFOFr4BER ---~-~-..
I CERTIFY THAT
1: I AM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEHERS AND HELLS RS SET
FORTH BY THE MUNICIF'RLITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN ACCORDANCE HITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEHER SYSTEM MFIY REQUIRE ENLARGEMENT IF THE
RESIDENCE I5 REr'lODELED TO INCLUDE HORE THAN 4 BEDROOMS.
RPPLICRNT F~RUL %OHNSON
ISSUED BY_ ....... DATE_. V4. 0
PERFORMED FOR:,
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6
7
8
9
10
11
14
15
18
19
20
' MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage. Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
~OILS LOG
COMMENTS
PERFORMED BY:
SLOPE
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
SITE PLAN ,' :
l zz ~-lq ,..:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutetlinch}
TEST RUN BETWEEN , FTAND ~ FT ..
72-008 (6/79)
•
• 1 8 0 1p
<o
•; �. Municipality of Anch i , j
On-Site Water and Wastewater P ;:ati
i
(907) 343-7904 „' ��; 4 SAFETY
MAY 15 2018
Certificate of On-Site System . d •proval w
A
Parcel I.D. 015-273-37 Expira !1, ',.L Sed 0 0 g`
1. GENERAL INFORMATION
Complete legal description Rachel L1
Location (site address) 11120 Great Dane Cir
Current Property owner(s) Reid E. Pomraning & Debra Y. Lovaas Day phone 907-440-2831
Mailing address 11120 Great Dane Circle, Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
.11
Received by: ?yap", Date: 670Z-A
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 6 2,(o Waiver Fee $
Date of Payment Jr jt(2 i« Date of Payment
Receipt Number (')5z1 D Receipt Number
COSA# d�C-Igl gOS Waiver#
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,
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 Forge Engineering Phone (907) 522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, PE Date 5/15/18
�6 OF AtgSIk
*;<49 TH
6. DSD SIGNATURE
System#1 Approved for I bedrooms /0,
f`•..•Michael E.1381 AndersonE. ••���%
System#2 Approved for bedrooms � sel;•5:oiis ` �=
Disapproved
�l`�\\\. �4~
Conditional approval for bedrooms, with the following stipulations:
SO'
OF ANcy°'11
P�-S1TE %
O \
WAC�\NAER o
PRIG
T Cc
°'l rr ct-O\'�
By: Wi A ea,uce,\J' (i m Ec(.0 l kr,d Original Certificate Date: J u_n e 8 0o18
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory. ,
Septic System Advisory X (16nk 0`cP Arsenic Advisory'
Well Flow Advisory Other
COSA blue sheet S .. c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Rachel L1 Parcel ID:015-273-37
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 9/24/82 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 220 ft. Cased to *220 ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test 9/24/82 9/26/18
Static water level Unknown ft. 129.3 ft.
Well production 8 g.p.m. 7 2 g.p.m.
WATER SAMPLE RESULTS:
Coliform N Q-'colonies/100 mL Nitrate NI D mg/L
S 7`1 /3v/�� Collected by: Forge Engineering
Arsenic • ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 11/12/86
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 5/10/18 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed
11/13/86 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 SF/BDRM System type Deep Trench
Length 36 ft. Width 3.0 ft. Gravel below pipe 8.0 ft.
Total depth 11 .8 ft. Eff. absorption area 576 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4/26/18 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 65 _in. Water added 604 gal. New depth 68 in.
Elapsed Time: 1440 min. Final fluid depth 46 in. Absorption rate >= 600 g p d
None
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout 100
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line >5 Absorption field >5
Water main 0>1Water service line Surface water
Wells on adjacent lots >100
ABSORPTION FIELD ON LOT TO:
Property line 10 Building foundation 10 Water main 10
>100'
Water Service line >10 Surface water Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots >100i
F. COMMENTS
G. ENGINEER'S CERTIFICATION +�..„,„,:‘\`
lk
I certify that I have determined through field inspections and �i�;Q;•'.. ��.A-4#
review of Municipal records that the above systems are in *, TH .; •1,.*�.
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Benjamin Schiller, PE ..�!... �`
Be* ' Schiller : i
Date 5/23/18 Ir�t . CE 2592 • ��
t)�,�A' •s�?g.1�f�;,e�
F�FROFES5;4h��••.
COSA brown sheet 10-10-12.doc
MUNICIPALITY O F ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ,' +� } 907-343-7904
On-Site Water and Wastewater Section Fax:343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # 0SC181205
Subdivision: Rachel, Lot: 1
The septic tank for this property is 31 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
Municipality of Anchorage
Development Services Department
BUilding Safety Division
On-Site Water and WaSteWater Program
4700 South Bragaw SL \~'~
P.O. Box 196650 Anchorage, AK 99519-6650 '
www.ci.anch0rage .ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING'
Parcel I.D. 015.273.37
1. GENERAL INFORMATION
Complete legal description
.0 o110
Expiration Date: 7- '7-'
Lot t~ Rachel Subdivislon
Location (site address or, directions) 11120 Great Dane Circle
Current Property owner(s). Reid Pomranln.q Day phone 440.283'1
Mailing address '1'1'120 Great Dane Circle Anchoraqe, AK 9§516
Lending agency
Day phone
Mailing ~ddress
Real Estate Agent
Day phone
Mailing Address
Unless dtherwi, se requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four(4)
e
TYPE OF WATER SUPPLY:
'Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF wAsTEWATER DISPOSAL:
I~ Individual On-site '[~ '-
[] Individual Holding tank · J-'l
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Depadment (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) for propedies served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
' valid for 90 days from the date of issue for propedies served by a private or Class C well and may.be reissued with
new watei' sample results less ,than 30 days old. (Certificates may be reissued for a period of up to one year. with
valid water samples.) Cedificates are valid for one year for properties served by Class A or B wells dr a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Name of Firm Anderson En_~ineerin.q
"Address 'P.O. Box 240773 Anchora.qe~ AK 99524
Engineer's Printed Name 'Michael E. Anderson, P.E.
sTATEMENT OF INspEcTION BY ENGINEER'
As' certified by my seal affixed hereto and as Of the validation date shown below, I verify that my ir{vestigation,
based on procedures outlined in the Health Authority 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.
Phone ~522-7773
DSD SIGNATURE
L~_ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with 'the following stipulations:
Additional Comments
Attachments:
HAA Checklist ..
Septic System Advisory
Well Flow Advisqry
(Rev. 12/00)
X
Maintenance Agreements
Supplemental' Engineer's Report
Other
Original Cedificate Date: /./L
Municipality 6f,Anchorage
'Develoi ment Servi ces Department
. .i,..~ i, Building Safety Division
On-~ite'Water & Wastewater Program
: !~:4700 South BJ'agaw St.
P.O, Box 196650 AnchorJ~ge, AK 99519-6650 '
~ il ~. i;w~.ci.anchor'age.ak.us ·
'i: I I~(907) 343,7904 -
"HEALTH :J U';TI-ibRITY / iPPROVAL CHECKLIST
Legal DEscription:. Lot 1, Rachel Subdivisio~ It ·
. A. ,WELL DATA ..... ~ ~' ii' ~ ,
-Well type Private'' :, ;' !" ',:ifA, B, ~i ~ p!~vicle PWS'ID
Date completed 912411982 ,4 ,: San tarySea ',(Y/N)YJ
· ' ': : . ~ ; ~ : ', . ' -l~ .': , -I
, ~ ',. , ; , .: , ~,~ ~, ~ , [ '
Total depth 220 fl. . Cased to~220
- , ~ ; :'~ · FROMWEL~iLOG
Dat~ofJest, ~ ':': -; ~91241~98~ "'
Static water level ' :unkn0w~' ~
,. Parcel ID: 015273.73
"'i, ! W;li-L g (Y/N)Y
; · Wires properly/iE?0tected (Y/N) Y
!, :Ii Casing heighi !~bOve ground). 24 ; in.
· ~ .~ AT INSPECTION-
121.8 , ft.
LIFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
Size in ga Ions -
"Pump off' level at
Cycles tested
'in.
SEPARATION DISTANCES FROM WELL'0N LOT TO:
Septic tank/lift station on lot. >100' ·
Absorption field on lot ' >100'
Public sewer main NIA
·' Manhole/Access (Y/N)
High water alarm level at
' Meets alarm & circuit requirements?
....
On adjacent lots >100; i,, ,'; -
On adjacent lots. >100'
, Public si~Wer manhole/cleanout N/A! i,, ,,,
Sewer/septic service line >25' Holding tank NIA , .,~:
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ~; ¢:'"; I!
Building foundation >5" Propertyline >5' .Absorption field >5'. ~i i'.:.
Water main >10' Water service line >10' Surface water". >100.!
t,I
Wells on adjacent lot's >100' . .......::,;. '~, ':i I!
LOT TO: : ' ii'; I ,= ,
SEPARATION DISTANCE FROM ABSORPTION FIELD ON i:! ',~ ,!,!,i~; '
Propertyline >10' Building foundation >10' Watermain. >10' ;,' i .i.
water Service line >10'
Curtain drain None Noted
COMMENTS
Surface water >100'
Wells on adjacent lots >100'.
in.
, Driveway, parkinglv~hi~Ie~'~ r e: >25'
.o, ~ .,' ~:: ¢ i'~
G.. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and .
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in, effect on this date. · ~ '"
Engineer's Printed Name Michael E. Anderson, P.E.
Date 41112004
HAAFee $ ~?~O'"
Date of paiment. ~r'/Z:/(~
Receipt Number
(Rev. i2/00)
Waiver Fee $
Date, of Payment
Receipt Number
1 "-30'
' 71-316 '
RACHEL SUBDIVISION
~' LOT 1
r. As'r
3' t, fl'~ & Row Es~r.-
I
I .
r. As~ ~o.oo*(R&.).
·- EAST 112TH AVENUE
AS-BU I LT
PROPERTY D~ ~ ~D ~T'~
~ ~O SUING ~M~ ~ ~ ~ ~."
4726 ~ 8~t A~UE D~INE ~ ~CE OF ~ ~
~HO~ ~ ggS02 ~ OR ~/~0~ ~1~ ~ ~
P~NE 2~-5454 ~P~ ON ~E RE~ S~D~I~ P~T,
UN~ NO ~RCU~ SH~ ~ ~TA
GmO ~ H~ON BE ~ FOR ~U~N ~ ~
~E RE~ ~ ~
F.B. dOB'NO. * *
03~7 ~T~ NO~: NO C~NERS SET ~HI'S DA~E,.
/.
ANDERSON ENGINEERING
P. O. Box 240773
AnchOra'ge, AK 99524
'Ph; 522-7773, FA~ 522-6779
;~SEPTIC SYSTEM ADEQUACY TEST
~' WE. LL FLOW TEST ..,
Lot 1, Rachel Subdivision Parcel I; D.: 015-273-37.
wELL Depth: L'?,,~,O' Ft. Static Level:-' l?-f.$ Ft~ · Ca~ing Depth: "~,~ Date:
TIME METER VOL -VOL. .Time_ =low ..L_.
(G) Reading gals C NET (gpm) (Well) (Chg)
Septic ~ reptic
.,.
Inspector,
FLOW RATE: I~, (,~ GPM Date:
Comments:
Michael E, Anderson