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DELUCIA LT 37
I, ucia Lot 37 0§1 - 141 -24 Gpr~A. TER ANCHORAGE AREA BOROI~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N.° 433 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING P H 0 N E ~J/'~"':, ~ SEPTIC TANK: DISTANCE FROM WELL ~-~/'~ ' LIQUID CAPACITY .///--; ~;~; GALLONS. NUMBER OF / .MATERIAL ~~ ~'.~'/-.~-~zk-'/---- COMPARTMENTS INSIDE LENGTH '~'"~INSIDE WIDTH ~ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH , LENGTH .//~',:3 , DEPTH LINING MATERIAL ~ zj, ...-:~ ¥ DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT LINE -~"~'~-- TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) '-~ ~ ~/'' SQ. FT. ~ TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES~'~'/''//~'- A B SO R PT..I~'~.I AREA DEPTH: lOP OF IILE TO FINISH GRADE .,~--'""~ , FOUNDATION. NEA LINE. DISTANCE BETWEEN LINES TRENC/H WIDTH SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE WELL: TYPE ~:r. ~.,;~,./~.z ~-~,~,~ DEPTH ,,::~ / DISTANCE FROM . · , BUILDING FOUNDATION LOT LINE /~, .'~.~,~ NEAREST / SEPTIC -~,/z~ SEEPAGE " SEWER LINE ., TANK .~ SYSTEM , CESSPOOL DIAGRAM OF SYSTEM NEAREST OTHER , SOURCES~ DISTANCES: ,x,,.b APPROVED H ~'ALTH AUTHORITY GAAB-HD-2 GREATEI 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 )ROUGH 279-2511 Case N o. ~ --~// SEWAGE DISPOSAL SYSTEM APPLICATION & PERMIT APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS RESIDENCE ADDRESS LOCATION OF INSTALLATION ,-~'7~ c?/'~ _,f~.-,~gcs'-:fl- ~/ , SEEPAGE PIT >/~ DRAIN FIELD , OTHER TO BE INSTALLED BY ~,. ' ;'/~' '. ~' ',~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE ./~ TYPE ,J~7¢~'~ SEEPAGE AREA ~'~" TYPE DIAGRAM OF SYSTEM DISTANCES: Health Authority ! ! certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE ~ ,..' ~ "~ APPLICANTS SIGNATURE ....... r **. * ......... P'O' BO~'196650' '*Anchorage, Alaska'~' 99519-6650 -'~' -* ~' ': '= .... "~*= ~ ~ .... CERTIFICATE OF H~LTH AUTHORI~ . . APPROVAL FOR A SINGLE FAMILY DWELLIN~ Par~lI.D.~ ,O~/ - /~/-~ ~ '- ,_ ~ ,~ ,~ omplete al escr on LO~ iT; ~~ . r . "MUNlCIPALITYOFANCHORAGE : ~='-= DEPARTMENTOF HEALTH. & HUMAN SERVICES:-=.: Loc (sit es ecti ) - ation eaddr s ordir ons - 22840 =~7~:: ~':2~;'~:?~2~.~,:;,;- ' - ~'~'~ . ~ '; :<', .... ...' '----- ' ~'-- , ~ ,!i?'-.' ;i:-. Mailing P.O. Box 671522 C ~uqx~zk,.- AK 99567 Lending agency LOF_ BEDROOMS.~ .:~ ~ 5.~ :~ : :~?' :~ NOTE::~?~f c°mmuni~: well system;:-provid& wri en.con rmat on attesting to the legality and status of system. 72-025 (Rev. 1/91) Fror4 MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER .~ ..... "* b"'m seal affiXe~l' h~ret(~ and a~ 'bf the 'validatic~n'~iate shown below,, I venfy ~h.a,.~my As certified y Y ...... .. .,,._ , · ..... ;~2__,;__,=....-ohowsthat the 0n-sitewater is Health Authori~ Approval ~pp~u~a',,-,- o .......... · .... g . · ' · d uate for the number and/or wastewater d~sposal system ~s ~fe, functional and a ~ and ~pe of structure indi~t~ herein. I fu~her'~eri~, that bas~ on the information obtain~,.~,~rfrOm the Municipali~ of Anchorage files and from my inve~ation and ins~tion, the on-site ~upply and/or watt,war~r di~p°~1 ~t~m i~ ificom~lianC~ with all Municipal and Stat~ ordinances, and rqulatio~sin eff~ on the date'~f this'rinsP~i°n- ~ Addre~ Date ~ ~ --. ~gin~s signatum ?~:"::~'*, ..... .. ' . - 5 above by'an independent Approval. Certificates based onlY upon fl'10~.[epmsentati°ns given"in paragraph · ' r in the State of Alaska- The DHHS does this as a courtesy to purchasers of homes ~. :rofessionalengmeereg~ste ed , : ., ..... ' ents:Em loyeesofDHHSdo~n°t,/ P nd their lending institutions in order to sat~sry certain federal and state requlrem fore a 'c~tificate is i~ued. The Municipality,of Anchorage is not .. ·" ' ections or analyze data be ...... .·, .......... , .... . .... ~,:,.~,?j.,.,,~.,,~-~:;.-.-tg-g~.~:,; ~-~:.~-~.'~: ..... .... -'"; ............ '~' .... ions in the rofess~onal eng~neer's~.~ork. ,,, - . ,. ;j...,.~:~ :.;:.~;:., ~ .:;~ ...~.-... respons~ble for~errors or ormss ._,.p~:..:_-: ~..:/r?2;~;,?,!:.~ :_ ..:!. ~.:..,[~ :,.? ~_~ ~ .: ..::!~.~..:~.,,,,?~. 72.025 (Rev. 1/91) ~ MOAII21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type ~J~c~_ _ Log present .(Y/~ ~ Total depth ?-- ~ ~' Sanitary seal~l) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ..-,.. / c/? ~ Driller Cased to ~ ~ ~ +' Casing height Wires properly protected (~N) ~/ FROM WELL LOG Date of test Static water level Well flow Pump level1 AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot :~.-~ ~:~ ~ Public sewer main ~ / ~, Sewer service line ~ ~ WATER SAMPLE RESULTS: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Coliform ~ Nitrate \ . ~t~ Date of sample: '~ t~ --~1~" Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~ ~-'/c> Tank size ~ c>o c:~ Compartments Cleanouts~l) ,../ Foundation cleanout (Y(~ ~ Depressio.n (;~ High water alarm (Y~ ~ Alarm tested (Y/N) Date of pumping ~--~.._c_~-~ Pumper -~'~._,~. ~..~.~,~c.- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot -~ ~"7 ~ To property line I c~t Sudace water/drainage 72-026 (3/93)* Front On adjacent lots Absorption field \~' Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (¥/N)~ ~ SEPARAT~E FROM LIFT STATION TO: W~I on lot On adjacent lots Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed \ c~ '2 c~ Length lc:~ ~ Width Total absorption area -z-/q ~ Date of adequacy test ~'~\ ~ Water level in absorption field before test Peroxide treatment (past 12 months) ('~--? Soil rating (GPD/Ft2) t ~c:~ ~/~/..-. System type d_.~ ~ Gravel thickness b'~ Total depth I ~ I Cleanout present'N) ~ Depression over field ('~ ~ Resultsd;;;[~ff, ail) ~-~-~ for '~ Bedrooms '~ ~1" After test ~- I" ~,~ ri ~, g--j~ If yes, give date ,..L\~. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -~,~- ~ To building foundation On adjacent lots '~:~ Sudace water \ Cu~ain drain On adjacent lots ~A- Property line ~ ~ To existing or abandoned system on lot Cutbank ~/.~ Water main/service line E. ENGINEER'S CERTIFICATION Driveway, parking/Vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines/n effe6!~.~...;~la~.~.~t.~/nspection. /.. .'? -~;: ,,:.-' ',.,..t ,~ Signature Engineer's Name ,~ ..... : - ~.~ ~, ..- ~...~- >/ z! ' Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Mayor Mtmicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 April 3, 1995 Mr. Robert W. Cowan S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Subject: Waiver Request for: Lot 37, Delucia Subdivision Waiver Approval: # WR95004d" Dear Mr. Cowan: l..~':~-¢:I ~ .0 ~, Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are: Well to crib 81 feet This waiver approval applies to the existing septic system to well separations only. Any future upgrades will require all separation distances be met or another approval be obtained from this department. --~ob~rt W. Robinson Civil Engineer On-Site Services kb MUNICIPALITY OF ANCHORAG~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR% WR950011 PID% 051-141-24 HA# ~ Permit Date Received: 3-23-95 Legal Description: Engineer: Lot 37, Delucia Subdivision S & S Engineering 17034 North Eagle River Loop, Suite 204 Eagle River, AK 99577 Applicant: Roger & Janice Katula Waiver Requested: Well to crib - 81 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other: Waiver is Granted: /~ Waiver is NOT Granted: List Conditions or Reasons for above: /;~ z~9~C/~w~/~?t)~/, Date: /Name of Reviewer Rec #: 00761 (1364) Amount: $ 920.00 Date Paid: 3-25-9~ HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL iNSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ;tnee t nq March 22, 1995 Municipality of Anchorage ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. C_~VIL ENGINEERS (~)7:[.694-2979 I:~X~I07) 694-1211 DEPARTMENT OF HEALT~ AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 37 Delucia Subdivision Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the well and the crib serving this property at 81 feet. The mitigating factors involved which support the issuance of the waivers are as follows: Reference the site plan/topo, surface effluent would not flow toward the well. e There is no area available outside the 100 ft. radius to upgrade the septic system. e The house is located between the well and septic on the referenced property. e Nitrate sample taken from the well located on the referenced property indicated 1.97 mg/1. In our opinion, the separation distance requirement prescribed by ISAAC.021 is not necessary in this case. If we may be of further service please contact us. Sincerely, Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~¥-1d q.LI ,Og - I U.$.&.I. Lee~l ~. , , ,,. , ,, #t111~11 IMIitl III. , , . ,~. ,,P .,'~ .:. , , · ..... ,, ., ~11 ........ ~'~,~ '~ ........... ~- 7. " " ......... ' lllcl~l " ' '" ' ' '- T~ tf ~tl I Ill. I ........ ,~ .... ,, ' " '"" ' ' ' ' ~IWIII: ~t C ' . .... ~ t t~; C~troet Ltc~N ~r ~ :-:~_ · , _-:"' _: _-_ _ _ ___ .. __ D. R. DAYTON, P.E., R.L.S. 20210 Donalat Street November 16, 1992 Legal Descriptions ~ot 38, Delucia subdivision Date o£ Test: November 13, 1992 Well Depth='165 Et. Static Wate~ Levels 154 Requirements: 450 gallons pet day lot 3 bedrooms. Test~ The well was pumped at varying tares until the d~aw down stablized. Pun~ing was then continued foe a total of 4 hrs. 56 min. Results~ The well produced 1.5 gallons pet minute with a draw down o£ Conclusions The well is cu~£ently functioning a~equately £ot r3 bedroom home, 03×16×95 16:22 COMMERCIAL TESTING ~ 90?6941211 N0.965 ~02 CT&E Environmental Services Inc. Laboratory Division CT&B R~f.% 95.097.5-1 Matrix WATER ¢11¢n~ Sample ID L37 DELUCIA 8/D Laboratory Analysis Report Client Name S & B ENGINEERING WORK Order 13240 Ordered By R.J.S. Printed Date 03/16/95 ~ 14,07 hrs. Project ~a~e Collected Date 03/14/95 · 14:00 hrs. ?reject# Received Date 03/14/95 ~ ~6:15 hr~, PW~ID UA Technical Director 8TSPH~N C. EDE Remarks: ROUTIN~ SAHgLE COLLECTED BY: RAY, QC Allowable Ext. ~arameter Results Qual Un~t; Method Limits Date Date Init Nitrate-N 1.97 D mg/b EPA 353.~ 10. 03/1~/95 See Sampl~ Remark~ ~ove NA ~ Not Analyzed Undete~te4, Rspo~t~4 value &~ ~he practical ~antifi~ati~n limit. LT - ~;~ Than Seconda~ dilutiu~. ~T - ~r%a=~r Than 2~ W. Potter Drive, Anchorage, AK 99618-1605 --Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA 03×~0×~5 14:43 COMMERCIAL TESTING CT&E Environmental Services~ Inc. t/ Drinking Water Analysis Report for Total Coliform Bacteria ~oo w. ~o:~, o~,~ ~nchorage. ~K $~5184 ~05 RE..tD I:'~TTRUCTION$ ON ~KE~E E~E ~EFO~ COLLECTDYG SAMPLE Tel: {907) 562-2343 MIJST BE .cO~rPLETEI~B Y WA'lEK SU?PL!ER PUBLIC WATER$~STE~t I.D. # PRIVATE WATER SYSTESI ., Send guultJ Send Invoicg SAM-PLE DATE: SAMPLE TYPE; S &',I]PL [, LOCATiO~ Lo-r-37 Month Day Year Routine Repeat Sample (for routine samp[e with lab r~f. I10. ) Special Purpose Treated Water 0 Untreated Water ' Time Collected Collecled By i:ax: (907) 561.5301 TO BE COMPLETED BY L&BOK.a. TORY Ana[ysls ,hows this Water SAMPLE to be: S~tisfacto~ Un:ati~f~cto~; 0 Sample owr 30 hours old. result~ may be unreliable S~mpl~ mo lm~g in traasi;; samp[* should not bc over 4~ hours old ~t examination to indicate reliabls results. Please send new sample via special deli]e~ mail. Da[~ Received _ 7//g Analysis Began Analytical ~[e:hod: ~ Membrane Filter 0 *{MO-MUG Number of c0[onies/100 mi. Lab Ref. No. Result* r 95_0975 -7. S,:nt I'o -LO-E-C- Q Fb'~ Da~c; ~ Time: Client notified of unsatisfactory, results: Phoned Spok~ wiIh Date: Time; BACTERIOLOGICAL wATER ANALYSIS RECORD ,Time __ E. Coti Co[onie,ll00 mi COLIFIRM M~IO-MIJG R,Jult: Total Coliform Membrane Filter: Direct Count Verification: LTB 8GB Fecal Coliform Confirmation ~' Final Membrane Filter Results ~ Analyst Coliformll00 mi [] Fuxcd [] Foxed Comments: PART ONE Member of the $;G$ Groug {$oci~t~ G~tn4rale de Su~illance} 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o51-141-24 ~ HAA # _ 1. GENERAL INFORMATION Complete'legal description Lot 37, Delucia Subdivision Location (site address or directions) 22840 Daniel Street Marcein Debusk Property owner · Mailing address PO Box 671661, Chugiak, AK 99567 Day phone 276-3090 Lending agency Mailing address. Day phone AgentGreatland/Cindy Lindblom Address ~ia]] ma c~]~n Righway, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: Day phone 694-9125 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. xxx TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 1~11) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 17G34 F. ag;e ~;ver Loop ~,oad No. -~u4 Eagle River, Alaska 99577 Phone DHHS SIGNATURE ~ Approved for Disapproved. '-~- }-//~' E' -~"bedrooms. Conditional approval for bedrooms, .......... ~,~ ~OBERT C. COWAN j.~ with the following stipulations: Additional Comments 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 pumhasers 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. /2.4325 (Rev, 1/91) ~ MOA ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. Legal Description: Health Authority Approval Checklist ID£~c/~ 5;/0 ParcelI.D.: O&~1- ]HI-;3~ A. WELL DATA Well type Log present Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed .,,, I ct' 70 Cased to ~ ~ ' '/ Casing height (above ground) Wires properly protected ~N) FROM WELL LOG Static water level I Well production _ WATER SAMPLE RE, Coliform -~ Nitrate Date of sample: /0/ B. SEPTIC/HOLDING TANK DATA Date installed it/~ [ ? O Tank size Foundation cleanout (Y/I~ ~ o .g.p.m. AT INSPECTION /o/~ ! g.p.m. Other bacteria Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska ~9577 Number of Compartments / Cleanouts ~/N) ~ Depression (Y/t~) ~ o High water alarm (Y/I~ /,~ o Date of Pumping /o /, 0/ q Y Pumper C. ABSORPTION FIELD DATA Date installed ~ / '~ ] 7 O Length ! o Width Effective absorption area ~' ~/o Date of adequacy test i o [ ¢ Soil rating (g.p.d./fF or~ ! ~ e System type r / O Gravel thickness below pipe 6 Total depth Fluid depth in absorption field before test (in.); ~ ~ Immediately after~ ~0 gal. water added (in.): Fluid depth ~c i (ins) Minutes later: ) ~ Absorption rate = /fS'd ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) /~* *'~ ~rO ~ ~ If yes, give date ~ Monitoring Tube present ~/N) 'Vl ~ Depression over field (Y/~ /'~ O Result~Fail) Pa- $$ For ~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level.~a~..--~ High water alarm level at* _.~.~atum E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~'-'/ k ~o ~'~ ~ .~ On adjacent lots Absorption field on lot ~/ ~ ((~/t ff ~co 0 ~ '~ Public sewer main ~ / 4- Sewer/septic service line ~ 3- 4 /ga -/ On adjacent lots Public sewer manhole/cleanout ,~//a Lift station ~ / ,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ ~ Property line 5" -F Absorption field ! Water main/service line / 0 '-'~ Surface water/drainage /oo ;-/- Wells on adjacent lots ! /00 4-- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ! o --/-- Building foundation ) o Water main/service line Surface water ) o ~3 ~ Driveway, parking/vehicle storage area Curtain drain ~va,v~ /<,v~,., ,,.~ Wellson adjacentlots /oo /+ ]0 ENGINEER'S CERTIFICATION I cedify that l have datelined thru field inspections and review of Municipal ,n conformance w~t~7~ gu~nes in effect on this date. Signature Y~ d~' ~~ Engineer's Name ~O~*~mr ~ ~o ~ gate t o/2q/~ ~ HAAFee $ .'~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* !. DATE RECEIVED '~ INSPECTION APPOINTMENTS TIME TIME T~ DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts oil page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE · PHONE 2. BUYER MAI El N G AD'DR ESS 3. LENDING INSTITUTION " PHONE MAILING ADDRESS / 4. REALTOR/AGENT I PHONE I 5. LEGAL DESCRIPTION STREETLOCATION "~c(t,Z,~,J' ~.,'dTt~T//'~7- ~&:~4-~J T~X//~/"~) ~/<~ jS'r ~.~'~ /D/~3 S 1' ~ 6. TYFE OF RESIDENCE NUMBER OF~BEDROOMS ~ ' ' ~ One ~ Four ~ Other__ ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY -[ 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE I~] PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: IG)~G If Tank is homemade give dimensions: PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line I --7 0 MATERIAL Septic/Holding Tank ~Abs i Are~ ewer Line Nearest Lot Line 5. COMMENTS ~ APPROVED FOR L~_ BEDROOMS ~' CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED I '~~~~ DATE ~ ~~ ~ m BY 72-010 (Rev. 6/79) EXCAVATION ROBERT A. SHAFER . WORK CIVIL ENGINEER 694-2979 D.A. Bond Company ATTENTION: Joyce Gardner Eagle River Professional Building P.O. Box 1928 Eagle River, Alaska 99577 MUNICIPALITY OF ANCHORAGE r. NVl.:, :, t , ,u E _P, ECEI_V_ED Dear Ms. Gardner, Reference: Lot 37t DeLucia Subdivision and our letter dated April 3, 1982 The sewer system adequacy test which you requested on the referenced property was performed on April 23rd and 24th, 1982. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit was charged with 1000 gallons of fresh water and after a period of 24 hours approximately 900 gallons had percolated out of the crib. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failure. The work required on the well, as specified by the Municipality, was also completed. The well wires were placed in conduit and caps were installed on the cleanouts to seal the septic system. If we may be of further service, please do not hesitate to call. sinc'er~ly, /~/~ / cc: Home Federal Savings and Loan Association Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 April 3, 1982 MUNICIPALITY OF ANCHORAGE ENVN- L'. _:!,/ . '. ,,,..) E ; .,1 Joyce Gardner ~ ~-~~ D.A. Vaughn Company Eagle River,Professional Building P,O. Box 1928 Eagle River, Alaska 99577 1982 RECEIVED Dear Ms. Gardner, Reference: Lot 37t De~ucia Subdivision A sewer system adequacy test could not be Performed on the system located on the referenced property as you requested. The clean-out for the septic tank and the absorption system were not visible and could not be located due to the excessive amount of ice and snow~ covering the ground. It is recommended that we wait until the last week in April at which time we will locate these clean-outs or excavate and re-install the clean-outs as necessary to perform the adequacy test. At' the same time we will make arrangements to piece the well wires on the well into conduit and seal the well at the top of the casing. We will file a report with you as soon as the above work has been completed. sinCer 1 .., / / -'ROBERT A. SHAF/ER, P.E. Home Federal Savi-ngs and T,oan Asso¢iati6n Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA March 30, 1992 Terence and ~ancy Cooney Box 3Pg5 }{oner, Alaska 99(503 '~ubject: Lot 37 De]uci~ Subdivision Approval for the in<~ivi~ual sewer and water f~cilities cannot be qranted until the fol!owin~ items ]~av~ been completelY: Expose.~ electrical %¢ires to the well head are in violation of the ~-~;unicipa].it¥ of Anchorage co'.~es and ~ust be ~ncased in con¢]u it. q~e water analysis report nee~s to be sub~nitted to this office fro~ the C]]e~ Lab, 5~33 ~ ~treet, for our review. The septic ta~ak pumped with a r~.ceipt sub~nitted %0 t!lis ~ epar tment · A four (4) incl~ cast iron c!eanout needs to be installe.:~ to the se?tic tanl': an~../or leaching area. An ad. equac¥ te~t nee~Ts to be perfnrrner~, on the existin~'~ leachin~ area. This test ;~il! ~eter_'~4ine if the syste?, i$ a?equate accor~r]ing to ~ationa! Standar.:~s. A listinc of private firths ,?-.erforn..in~ the test is enclose~. This red, orr nee~'~ to ]~ge sub~nitte~ to this office for our review. olease notify this (~epart,'~sen.+_ for a reinspection ~hen the. noted discrepancies have been corrected. If there are any further questions, i~le~se call this office Sincerely, Enclosure Robert C. Pratt Associate U. nvironmental S~}eci~list ~qarch 30, 1982 Joyce Gardner J_,.A. Vaughn Co. P.O. Box 1928 ~aqle River, Alaska 99577 Subject: Lot 37 Delucia Subdivision Approval for the individual sewer an,,.~, water facilities cannot be granted until the following items have been completed: Exposed electrical,.~wires to the Well head are in violation of the ~unicipality of Anchoraqe-eocles and must be encasc~. in conduit. The water analysis report needs to be sub?nitted to this office from the Chem Lab, 5633 B Street, for our review. ~%e septic tank pumped with a receipt submitted to this department. A four (4) inch cast iron cleanout needs to be installed to the septic tank and/or leaching area. An adequacy test needs to be nerformed on the existing leaching area. T!~is test will determine if the system is adequate according to ~Jational Standards. A listing of private firms performing the test is enclosed. This report needs to be subn~itted to this office for our review. Please notify this department for a reinspection when the noted discrepancies have been correcte~. If there are any further questions, D!ease call this office at 264-4720. Sincerely, Enclosure Robert C. P~att Associate Environmental Specialist ,MUNI~:IPALITY OF ANCHORAGE ~ MUNICIPALITY OF ANCHORAGE DEPT. 07 ! :'Z'.LT;-i & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~B~IRON,'"vT:;NTAL , LCTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION MAR 2 g *eleph°ne 26414720 RECEi, sD REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILI DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 4 PH~ON E Il. PRO~YOWNER , ? , MAI LI NG-ADDR ESS -1 ~ ) <' PROPERTY RESIDENT (If diTferent from above) PHONE ·,'° PHONE 2. BUYER MAILING ADDRESS / 3. LENDING INSTITUTIONm "1 PHONE 4. REALTOR/AGEN~ '~ .' ( ~//~'~. PHONE MAI LING s, lo:3o 5. LEGAL DESCRIPTION. STREET LOCATION / 1,..,~ /~,. ' J3Z 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY · ~MBER OF BEDROOMS I I One [] Four [] [] Two [] Five [~ Three [] Six Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ .... INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.),,/.-.~(' ' /'~ ,:'~'~ **If individual/on-site, give installation da~ ,,//~2 (' ................ J ..... , L_~L: ..... :.'.: I NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE I--I PUBLIC UTILITY Connection Verified I--ISeptic Tank or []Holding Tank Size: J ~)'~) If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tan k IAbs~p~n Area~' ~ JSewer Line JNearest Lot Line 5. COMMENTS [~ APPROVED FOR __~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED LEGAL DESCRIPTION IBY (Title) 72-010 (Rev. 3/78) DAVID SLENKA}.m ~94-9055 ENGINEERING I~ClL~NICAL ENClNEERS CIVIL ENGINEERS $~B 196X Eagle P~ver, Alaska 99577 ~IVIL ENGI.~ER ~OBERT A. SHAFEK ~94-2979 Star Realty ATTN: Rick Bevins 640 W. 36th Avenue Anchorage, Alaska 99503 April 2, 1979 REF: Three bedroom residence located on Lot 37, Delucia Subdivision. An adequacy test was performed on 30 and 31 March 1979 on the sewer 'system serving the three bedroom residence located on the referenced property, The septJc tank was pumped and verified to have a capacity of 1,O00 gallons. The seepage pit was charged with 600 gallons o~ water. Measurements taken at the-end of a 24 hour period indicated a loss of 840 gallons or 28Q gallons per bedroom. It can be concluded that, as a result of the above survey and test, the sewer system is adequate; however, the standpipe for the septic tank and for the seepage pit needs to be extended and sealed with caps. CF: National Bank of Alaska ATTN: Real Estate'Branch Anchorage Municipality, Dept of Health & Environmental Prot GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED: INSPECT: TIME: REQUEST FOR APPROVAL OF INDIVI'DUAL SEWER AND WATER FACILITIES FOR APPROVAL REQUESTED BY: ADDRESS' PHONE 2 PROPERTY OWNER: ~-,]/~ 7:~,~ .. PHONE: 3, LEGAL DESCRIPTION' ,? ~ / . //",,-:.~..~/,?'~.. .,":I:-'~ ".. 4. TYPE FACILITY TO BE INSPECTED:~."~.~'"::, ~:.. /':~;::(~TREET:. - ,~.,' ~- - . NUMBER OF BEDROOMS: WELL DATA: A. TYPE B. DEPTH C. SIZE D. E. CONSTRUCTION BACTERIAL ANALYSIS SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE // ('~ 2. A G E i ? 3 MANUFACTURER ,.- 4. INSTALLER APPROVAL REQUEST FOR SEWER & WATER FACILITIES PAGE TWO B. SEEPAGE PIT 2 LINING DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B WELL TO SEEPAGE PIT / ,~, C. WELL TO SEWER LINE D. WELL TO PROPERTY LINE E. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK G. FOUNDATION TO SEEPAGE PIT H. SEEPAGE PIT TO PROPERTY LINE 8. COMMENTS: APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY Municipality of Anchorage Development Services Department Building Safety DiviSion On-Site Water and Wastewater Program ',' 4700 South Bragaw St. .' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak,us (907) 343-7904 CERTIFICATE~ OF HEALTH AUTHORITY APPROVAL FOR A SINGLE F^MII_Y DWELLING Parcel I.D. -051-141-24 GENERAL INFORMATION Complete legal description © Expiration Date: Lot 37, Delucia Subdivision Location (site address or directions) 22840 Daniel Street Current Property owner(s) Marcein Tucker Mailing address PO Box 203254 · Len. ding agency . .... Mail!ng address Real Estate Agent Dick ]~oble Mailing Address e Day phone Anchorage; Alaska Day phone 688-5777 99520 Day phone 272-1565 Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 e TYPE OF WATER SUPPLY: ' Individual Well [] · Individual Water Storage [-'1 Community Class 'Well [] Public Water System [] TYPE OF WASTEWATER DIspOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer [] The Municipality of Anchorage Developm'ent Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 INSPECTIONBY ENGINEER As certified' by my seal affixed hereto and as of the validation date shown below, ! verify that'my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water, supply and/or wastewater disposal sYstern is(are) safe, functional and adequate for the number of bedrooms ~nd 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 Pinard Engineering Address PO Box 871'3/+? 'Wa'Silla, Alaska Engineer's:Printed Name Paul" E. Pinard bedrooms. DSD SIGNATURE [/';"" Approved for DisapproVed. · Conditional approval for Phone (907) 357-3647 9%s7 " Date 6/2 ~.._.~.~/~~ ~T~w~. o o.. ~.~ bed.t.0oms, with the following ~tipulations: Additional Comments .. Attachments: HAA Checklist Septic system Advisory .Well Fiow Advisory Maintenance Agreements Supplemental Engineer's Report Other · Odginal Certificate Date: (Rev. 01/02} ~ Municipality, 0fAndhorage, uevelopment services uepar~ment i: ' Building Safety Dlws~on i On-,Site water & Wa§!~Wat~r P/0gram ! ' ~ ~ '4700South Bragaw'~st. P.O. BoX 196650 Anchoi'age, AK 99519-6650 '~:h0'rage.ak u~ www;ci.an . '(907) 343-7904' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T,ot WELL DATA Well type PriYa%e Date corn pleted'-;,1 9?0 Total depth 245 ft. Date of test Static water level ~ell pr°ducti°n, WATER SAMPLE RESULTSi i.~Coliform ' 0 colonies/100 mi: Arsenic: mg.ll.: , .., 37,1 ,Sanitary seal (Y/,N) Cased to 40+ ft. FROM' WELL LOG ' ! ' [Delucia Subdivision Parcel ID: B, or C provide PWSID # ft. g.p.m. Y Nitrate'2 · 43 ." mg./I. I , Date of sample:i 5/18/04 · 051-141-2/~ *Done ft. g.p.m. 'O Well Log (Y/N) lq' Wires p~operly protected (Y/N) Casing ~elght (above ground) ;in. AT INSPECTION :. 5/5/04 * ~66 * o!83 . Othe~ bacteria tcolonies/1 O0 m-i. C~lle~tedby: Pinard Enginee;in OATA' Ta, nklType/Material: Septic/,Steel , . i ' .7, ' Date installed . .11/11/70 ~ank'size1000,gal Number of Compa~ments I1 : li I ' : ' · t ' ' ' ! 'II:' '' 1: ,water alarm (Y/Ni N. Foundation cleanout (Y/N) N , iDepression over ta6k (Y/N) N HighI Date of pumping ,5/1 5/04 !: pumper JRs: Pumping' {by :KND ~E: [ABSORPTION FIELD DATA installed 11/11/?0 Soil'taring (g.p.d./ft: or fti, ilJdrm) 100,' System type Crib-Seepag~ Le,ngth 10. ft. 1 I, Width .,1 0 ft,: Gravel below pipe · I !',.t ~ ! I~ . : T.,- , ,', ~ ~ ; ~0taldepth 9 ft! ! Eff.'abs0rptionarea 240 fit, MonitoringtubeYes DepressiOn'Over'field "It t 'ade uac tea ' ~ !! ~::' " t ! ',' Date o[ q y t :6/24l/o4 · Results (Pass/Fail) Pass I Fo? 3 ' bedrodrris Fluid depth in absorption field before tes~ 8.4 in. Water added450/gal. Elapsed Time:110 min. Final fluid depth 20 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type): ¥~ Absorption rate per MOA I E i If yes, give date .arly.'~. >: 450: g.p.d.- . }Mayl ~ 4 D. LIFT STATION NA Date installed Size in gallons "Pump on" level at in. "Pump off" level at __ in. Datum Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Se ptic tank/lift station on lot 5'7' (Install'ed "; On'~djaC~ntlois'- ;i00'+ · prior .to 73) Absorption field on lot 81 ' tWaiver _~ran~;ed) On adjacent lots '100' + Public sewer main NA Public sewer manhole/cleanout · - Sewer/septic service line 25 ' + Holding tank SEPARATIbN DISTANCES FROM SEPTIC/HOLDING TANK '0N LOT TO: NA- Ge Building foundation 1 5 ' Property line ;5 ' + Water m~in :' lO, + -: ' 'water service line 10' + Wells on adjacent lots 66" (Se'e Ltr Report from END SEPARATION DISTANCE F~,o'M ABSORPTION FIELD ON LOT TO: Property line 10 ' + Water Service line 10 ' + :C'u'rtain'd~ainNone COMMENTS Building foundation Surface water Wells on a(Jj~ent'l~)t~ Absorption field Surface water Engr. ) 15' 100'+ 10'+ Watermain 10'+ 100'.+ Driveway, parking/vehiclestorage-.lO'+ 69' (See Ltr Report from KND.Engr.) PrevioUs. :Ade'quacy Test performed ~nat~on~of absorption shortly af~er,~ejuvL..,..~,,~' . field per int'ormation i-rom-MOA.This firm' had ,not b~e..~.~ i~0~-~.~.~of the ENGINEER'S CERTIFICATION procedure. Recent test ~H~f~~y~s of ,~se of the rejuvenated ~sys~ I cedify that l have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on'this dat~. '~; , Engineer's Printed Name Paul E. Pinard Da'te-".: " 6/26/04 :'. i HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt N~mber . Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory, Health Authority Approval # 040294 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 37 of Delucia subdivision, the well's productivity was determined to be 0.83 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing .cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Municipality of Anchorage Mark Bcgich, Mayor Building Safety Dix sion P.O. Box 196650 · 4700 Bragaw Street Anchorage, Alaska 99519-6650 ° (907) 343-8301o Fmx (907) 343-8200 http://xxa~av, muni.org 4/22/2004 Bob Cowan S&S Engineering 17034 North Eagle River Loop Eagle River, Alaska 99577 Subject: Waiver Request for Delucia S/D Lot 37 Waiver Request #WR040033 Parcel ID #051-141-24 Dcm' Bob Cowan: Your request for a waiver of the required 100 feet horizontal separation from the absorption field to private well has been approved. The approved separation distance is 61.0 feet. This waiver approval applies to the existing absorption field to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Civil Engineer On-Site Water & Wastewater Program PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 37, Delucia Subdivision APPLICANT: Mamein Tucker PO Box 203254 Anchorage, Alaska 99520 SEPTIC TANK TYPE/SIZE: Steel/1000 gallons, per MOA Records ABSORPTION SYSTEM: Seepage Pit, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAI./BR = 450 gallons TEST DATA JOB NUMBER: 04-128 DATE OF TEST: 6/24~04 FIELD STAFF: PJ Pinard NUMBEROF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments Rate Volume Tank P]V[ (GPM) , (GALs) (GALs) Uquid Level ' A Level Monitor A SAS Monitor 6 SAS Tube 1' Level Tube 2* Level 7: ] 5 4.7 - - 4.4' - 0.7' - Start Test- Meter ] 10030 7:30 4.7 70 70 4.4' 0.0' 1.1' 0.4' 110100 7:45 4.7 70 140 4.4' 0.0' 1.4' 0.3' 110170 8:00 4.7 70 210 4.4' 0.0' 1.6' 0.2' 110240 8:15 4.7 70 280 4.4' 0.0' 1.8' 0.2' 110310 8:30 4.0 70 350 4.4' 0.0' 1.9' 0.1' 110380 8:40 40 390 4.4 · 0.0' 1.9' 0.0' Ran out of H20 110420 8:50 4.0 0 390 4.4' 0.0' 1.8' -0.1' Used Neighbor's Well 9:05 60 450 4.4' 0.0' 1.9' 0.1' Stop Test- 110480 RECOVERY *ALL MEASUREMENTS IN FT. Date Time ST MT SAS MT 6/24 9:20 1.7'1-0.2' PM TEST: PASSED XXX FAILED ?COMMENTS: :Prior to this test, the SAS had been in use for 30+ days after the rejuvenation procedure done by others. Test data & recovery measurement showed that design dally flow could be absorbed In less than 24 hours. Reviewed by: Paul Pinarff~ Date: 6/26/04 PINARD ENGINEERING Paul E. Pinard Registered Engineer/AK & ID P.O. Box 871347, Wasilla, Ak 99687 (907) 357-ENGR(3647) Dan Roth Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Bragaw Street Anchorage, Alaska 996519-6650 May 26, 2004 RE: Lot 37, Delucia Subdivision Dear Mr. Roth: Attached is an application and supporting paperwork for a Certificate of Health Authority Approval for the referenced property. Based on records from your office, a waiver was previously granted for the existing separations between the on-lot well and the wastewater disposal system components on this property. It has also come to my attention, though the attached letter from KND Engineering, who performed the well flow test, that there is a separation distance conflict between these system components and the well on the adjacent lot. S&S Engineering has. apparently made a recent submittal which you are reviewing for a waiver for this conflict. Though KND performed the well flow test, this firm conducted the Adequacy Test on the wastewater disposal system and collected the water samples. Once the outstanding waiver issue has been resolved, request that you issue the Certificate of Health Authority Approval for this property. A copy of an As-Built Property Survey, dated March 20, 1995, has been included with the attachments. It shows the Well and the Monitor Tubes for the septic tank and crib. Although it is several years old, field measurements that I took while on the property support a finding that the Monitor Tube locations are unchanged from that shown by this survey. I hope that this will suffice in lieu ora new survey. If you have any questions, please do not hesitate to call me. Encl: (as) Sincerely, Paul E. Pinard, P.E. Parcel I.D. MuniciPality of Anchorage Development Services. D~partment'i Building Safety Division On-Site Water and Wastewater Program i 4700 South Bragaw St., P.O.' Box 196650 Anchorage :AK 99519-6650 wWW.ci.anchorage.ak.u.~ (907) :343-7904 ~.- CERTIFICATE OF HEALTH AUTHORITY App'RoVAL FOR A SINGLE FAMILY o51 -,"141 ,.2/+ Lot 37~ !Expiration' Date: T . ':; · ~; : ' i Delucxa Subdivision GENERAL INFORMATION Complete legal description Location (site addres~ or directions) 228/+0 I),~ie'!~ street Current Propertyiowner(s) Marcein Tucker PO Box 203254 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Dick Noble . Un/ess otherwise requested,~ HAA will be held by DSD forpic~up... 2.. NUMBER OF BEDROOMS: ' l - 3. TYPE OF WATER sUPPLY: individual Well Individual Water Storage Community. Class Public water System :i ' 'Day phone Anchb'rage ,!i:Ak 99520 · Day phone ;Day phone TYPE OFiWASTEWATER iDISPOSAL: ~ IndividUal On-site nOlVlaUal 'l~0iding tank Well ',688,5777. 27~. ~_ i 565 ~ The Municipality of Anchorage Development Services Department (DSD)' ISs'Ues Certificates of Health ~uthority Approval (HAA) based only upon the representabons g~ven~n paragraph ,4 i by an ~ndependent profesmonal civil engineer regmtered in the State of A aska. Certificates of Health uthonty Approval are requ red for the transfer of · ' '; u' ', ~ .* . ' , ,, ~. ~,~, ~ .' · ,!,~ . . ,,. ', , . . t ~, I . , , btle (except between spouses) for properties served by a smgle-fam lyon;s te wastewater disposal and/or water supply :system· DSD also issues HAAs upon request to homeowners.!Ce~lflca~es.of Health Authority Approval are vahd for 90 days from !the date of ssue for propert es served by a pr vate or Class,C well and may be remsued w~th new,water sample: results::(Cerbf cares may be re ssued for a period 'of up ~to one year with va d water sam~: ~ ) '~ ' !' ' '" [ I . ~ ,, ~ *, ,I ' ~ ! : , I, ,' ii '-'~ ..... ~ ' ' '. Cemficates are vald for. one year for propemes served:by Class[A or B~wels or a pubic water system., e Mun c pal ty of Anchorage s not respons~b e for errors or.om ss~ons ~n the profesmona englneer's work ; : ' !! ~': , r , ;' ", ; ' ' ~ t 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 outlihed in the Health :Authority Approval Guidelines for this application, sh'ows that the on- ~ site water supply and/or w::~§tewater disposal system is(are) safe, functional and adequate'f0'r~the number of bedrooms and tyPe of st~'u~iure indicated herein. I further verify that based on the information ~btained from the ~ Municipality of Anchorage ifiles and from my investigation and inspection, the on-site water supply and/or wastewater dispOsal sYst(~r~ is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm .P';nard .Ea~:i. neer-i'n~ Address ',PO BoX 871347 'Wasilla~ Ak 'Engineer's Printed Name Paul E, Pinard By: 99687 Phone (9071i 357-3647 Date ~ . .: .i ~ ".~..~.~ ~:=' . .': ~ .~ ~., .~ Approved for ; :. ....bedrooms. .'; ' ' ' - . . .'~"~-~'-it.....*~"?~,~- ~ · :. ·" ?:'" I, , Conditional a~proval for bedrooms, wi~h the following stipulations: Additional Comm~ents Attachments: I HAA Checklist i Sephc System 'Advisory Well Flow Adv~sory ' ~: '(Rev. 01/02) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ;! , Municipality of Anchorage Development ServiCes Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot :37, Delucia Subdivision Parcel ID: 051-1 41 -24 A. WELL DATA Well type Private Date completed '-',-1 970 Total depth 2/+;5 ft. IfA, B,-or C provide PWSID # Sanitary seal (Y/N} Y Casedto AO+ .ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: ft. g.p.m. Well Log (Y/N} N Wires properly protected (Y/N) Casing height (above ground) 18 AT INS{~.~TION 5/5/04 * * Done by 166 ft. 0.83 * · g.p.m. in. KND Eng Coliform ' 0 colonies/100 mi. Arsenic: mg./I. B. SEPTIC/HOLDING TANK DATA Nitrate 2 o/+3 mg./I. Other bacteria __ colonies/100 mi. Date of sample: ;5/18/O/+ Collected by: Pinard Engineerin§ Tank Type/Material Septic/Steel : Date installed 11/11/70 Tank size 1000 gal. Number of Compartments I Cleanouts (Y/N) Y Foundation cleanout (Y/N) N Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/15/O/+ Pumper ,3'Rs Pumpinl~ C. ABSORPTION FIELD DATA Date installed 11/11/70 Soil rating (g.p.d.lft2 or ft21bdrm) 100 System type Crib- Length 1 0 ft. Width 1 0 ft. Gravel below pipe Total depth 9 ft. Eft. absorption area 2/+0 ft2 Monitoring tube Yes Date of adequacy test 5/20/OZ Results (Pass/Fail) Pa$~ Fluid depth in absorption field before test 1 3 in. ** Water added/+50gal. New depth Elapsed Time: 1 '75 min. Final fluid depth 6 in. 5/21/O/+Absorption rate >= /+;50 Any rejuvenation treatment (past 12 mo.) (Y/N & type) Nn~,~ 'k',',nwn If yes, give date Seepage Pit 6 ft. Depression over field No For 3 bedrooms 53 in. g.p.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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tar;k/lift siation on lot ~?' ('l'nstal'led" ~:Ori adja~:~nt lots 10O' +' . prior to 73) Absorption field on lot 81 ' (Wamver granted) On adjacent lots 100' + Public sewer main NA . Public sewer manhole/cleanout Sewer/septic Service line 2 ~5 ~ + Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK 0NLOT TO: Building foundation 1 ;5 ' Property line 5 ' + ~ Absorptionfield water main ~ 10 ' + WMer service line 10" +., Surface water Wells onadjacentlots 66' (See' L~,r Report from KND Engr. ) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Surface water 1 O0" +- Wells on adja~enilots ~9 ' Property line 10 ' + Water Service line 10 ' + Curtaind~-ain NOne Known COMMENTS Fe 15' 100'+ Water main 10'+ Driveway,' parkingh)ehicle storage 10 ' + (Ree Ltr Report from KND Engr.) owner filled: ST' p~i.or~.~t'~,,.~Adequa6y Test. of The ST &; ~b were both pumped: At start of test there was 1.1' liquid 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 :Paul E. P'inard Date ' ' ' ~;/26/04 ~ HAA Fee $ ~ -.~ ~ ~ ~ Waiver Fee $ Date of Payment .~- ~ ~' - O ZT~ Date of Payment Receipt Number .~".~. c) 7 ~ ~~ Receipt Number PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 37, Delucla Subdivision APPLICANT: Marcein Tucker PO Box 203254 Anchorage, Alaska 99520 SEPTIC TANK TYPE/SIZE: Steel/1000 gallons, per MOA Records ABSORPTION SYSTEM: Seepage Pit, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAIJBR = 450 gallons TEST DATA JOB NUMBER: 04-128 DATE OF TEST: 5/20104 FIELD STAFFi PJ Pinard NUMBEROFBEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes CURRENTLY IN USE: Yes XX No XX No Time Flow Volume Cumulative Septic Tank Septic Soil Absorption System Comments Rate Volume Tank PM (GPM) (GALs) (GALs). Liquid Level * A Level Monitor A SAS .Monitor ~, SAS Tube 1' Level Tube 2* Level 3:20 6.7 4.4' 1.1' Start Test- Meter 84750 3:35 5.6 100 100 4.5' 0.1' 1.l' 0.0' 84850 4:20 250 350 4.5' 0.0' 1,8' 0.7' Pan out o£H20 85100 4:25 2.7 4.5' 0.0' 1.8' 0.0' Restart w/H20 from 85100 4:55 80 430 4.5' 0.0' 2.1' 0.3' neighbor 85180 Ran out of H20 6:10 4.0 4.4' -0.1' 1.5' -0.6' Restart w/owner well 85180 6:15 20 450 4.4' 0.0' 1.5' 0.0' Stop Test- 85200 RECOVERY *ALL MEASUREMENTS IN FT. Date Time ST MT SAS MT 5/21 1:30 0.5'/-1.0' PM TEST: PASSED XXX FAILED COMMENTS: ST & SAS had been pumped several days prior to the test but ST refilled w/some liquid reaching the SAS (1.1') Test was hampered by the fact that both the on4ot well and the neighbor's well had to be utilized for water. Recovery showed absorption of de~lg~laily flow In less than 19 hrs. Reviewed by: Paul Pinard Date: 5/24/04 GS Reft/ 1042717001 :lient Name Pinard EnElneerJflg ~roject Namd# Lot 37, De]ucia S~D :llent Sample ID Kitchen Sink iatrLx Drinkiag Water qA'SID 0 All Dates/Times are Alaska Stnndard Time Printed Date/Time 05/24/2004 14:10 Collected Date/Time 05/18/2004 14:50 Received Date/Time 05/18/2004 15:43 Technical Director _.- Stephen. ]:de Allo~bl¢ Pr.-'p Analysis nrlm.-ter R~ul~ PQL Umts Ma Centai~.'r ID [,imi~ Date ~t; Init I'at:e:o Depa2~a~tetnt lqitrate-N 2.43 0. 100 mg/L EPA 300.0 B (<"10) 05/19/04 JIB Li.c:obi. olLogy Total Coliform 0 col/lOOmL $M18 9222B A (<-1) 05t18104 DKC SGS/CT&E ENVIRONMENTAL SERVIC~=S Drinking Water Analysis R~port for Total"Coliform Ba~eria' MUST BE COMPLETED BY WATER SUPPUER · 200 w. ~OT'r~ omW Tel: ~37.562-2343. . . Fax: g07-561-6301 Li~ Ri! Ni. 1042717-l iillmlllll SAMPt. E COLLECTION: : SAMPLE TYPE: ' ' ~ .l~outl" r-i Tm-t~d Wata. · . '~ . i .~. ~ ) BE COMPLETED BY LABORATORY Sample ReceMrm: Ti~.: ~,,,/'~('3 ' · .Deli~ Method;_ ~c~eriolc)oical Wirer An. Iv'lit RecoKl:' I~ Satlsfact&y []. Unsatidacto~/ Form $ FW- 0053 12~17/03 JRs Pumping PO Box 773415. Eagle River, AK (907) 694-6454, [Billing Information Frank & Melissa Petranovlch 22840 Daniel Court Chugiak. AK 99567 (907) 688-5632 pobSite Information Melissa 22840 Daniel Court Chugiak, AK 99567 (907) 688-5632 Service Type Qty Extra Time 1 Septic Service Under 2k 1 Additional Location Comments: Last Home on your Right/Gray Home w/White Trrm g's are on the Home Pipes and Tank are in the Front Yard Job Description: 1000g P.O. Number:. Terms: Net 30 Salesrep: Kadia Map Book: Cross Streets: Ranch Road Job Comments: Service Agreement Number:. 013117 Order Date: 11-May-2004 Service Date: 15-May-2004 12:00 am Technician: Tony Job Type: Repeat Map Gdd: 36- - Last Serv Unknown New Customer MEETING W/BUCK KUHN @ 10:00 AM 31esfing Tank Pump (2) Tax Percent: 0 · Price Each .x 2 Men $85.00 No $115.00 No Diagram: UKE DRAWING Tax No No Extension Actual $85.00 $.s.oo !/,.j . Gallons Planned: 1000 Gallons Actual: ~ Hose Length: Double Tank: [] . Pump System: [], Baffles Inlet: [] , Baffles Outlet: [] . Estimated Charges: Actual Charges: , NonTaxable Total - $200.00 Taxable Total Tax Total Grand Tota'l $0.00 $0.00 $200.00 tE, O ::. Customer agrees to the terms and conditions pdnted on the back. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Representative Date Accepted by .]Rs Pumping Date Accepted For your added convenience we accept Visa and Master Card payments over the phone. (907)696-6111/FAX (907)696-8111 May 13, 2004 Marcein Tucker POB 203254 Anchorage, AK 99520 RE: On-site Water Production-- Delucia, Lot 37 Well Yield from past test: Well Yield from recent test: Well Depth: 245' 1.1 GPM (3/14/95) 0.83 GPM (5/5/04) 'Sanitary Seal: Yes Static Level: 167' Static Level: 166' Stickup: 1.5' Test Procedure & Results: The well was pumped at a constant rate while an acoustic sounder monitored the draw down and recovery. At the beginning of the test, the static water level was measured at 166' below top of casing. After drawing down the well a subsequent recovery rate of 0.83 GPM was measured. No bacteriological or nitrate water analysis samples were taken. A 500-gallon water storage bladder is located in the crawl space. The MuniCipalitY of Anchorage requirement for well flow is 150 gallons of water per bedroom per daY, which equates to 0.31 GPM for a 3-bedroom residence. This well exceeds this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. During the inspection of the referenced lot it was discovered that the well on the adjacent Lot 36 was within the 100' radius of the on-site wastewater system on Lot 37. Please see attached drawing. This well was existing prior to a 1995 waiver request to the MOA and should have been included in the subsequent 950011 waiver issued by the MOA. After discussing the issue with MOA staff, they are willin§ to include this well in the original waiver once they receive safe drinking water analysis and other additional data pertaining to the well on Lot 36. Ifyou have any questions regarding the referenced proper tY's on-site water system or testing procedUres, please contact me at 696-6111/FAX 696-8111. Respectfully, ]~l~]~ Engineering, Inc. Attaehrnont.~.' A.~ nntocl 1" - 50' flTE PLAN x ./ . ; ..' -. ;':'Lt:- :.; . . I .'.: It. , ql · - '- i "; ':""!" . .! .>. i'~ . , .. .:,, ~, t# ,, JOl ' -' - ;..- J I h(~/Nr~(fY that . .. ~';,;,: 1612 ,5