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HomeMy WebLinkAboutEARL RAY BLK 3 LT 23 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241346 Work Type: Septic Upgrade Tax Code Number: 05111331000 Site Legal Address: EARL RAY BLK 3 LT 23 G:1360 Site Mailing Address: 20903 CHICKADEE ST, Chugiak Owner: DEES L V & JACQUELINE S Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 10/21 /2024 10/21 /2025 86364 R1 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 3 I isReceived By: �=-� j r` t Date: Issued By: Date: Z t %' On -Site Water & Wastewater Program r. -Y ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-113-31 Property owner(s) Jacqueline & L Dees Day phone Mailing address PO Box 670267, Chugiak, AK 99567 Site address 20903 Chickadee St, Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) Earl Ray Block 3 Lot 23 Legal description (Township, Range & Section) Lot Size - 86,364 _Sq. Ft. Number of Bedrooms Three(3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field RX Initial EJ Single Family (SF) RX (w/wo AD U) Septic Tank 0 RX❑Upgrade Duplex ❑ (D) Holding Tank R Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: q -1—D Date of Payment: Receipt Number: 03� q -Z 0 Permit No. osp2Lil3qe Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App_'-'- '- c - October 9, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Earl Ray Block 3 Lot 23 – 20903 Chickadee St Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic system that has reached end of life. The existing tank is leaking and the trench failed an adequacy test. We are submitting this permit application for the construction of a new septic system to serve the existing 3-bedroom home. The attached site plan identifies the location of the home as well as the proposed septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot is generally flat, with a mild slope toward the southwest corner. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached test hole log, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241346, Curtis Townsend, 10/21/24 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=40' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO TH#1 EARL RAY, BLOCK 3 LOT 23 FEET 0 40 90 SEPTIC PLAN 10/8/24 3-BDRM HOME BARN GARAGE (2) 45' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH ABSORPTION TRENCHES W/ 2' SAND FILTER NEW 1250-GAL SEPTIC TANK W/ 20" MANWAY DECOMMISSION EXISTING PLASTIC SEPTIC TANK 2CO DV SUMP CO MT MT MT MT CO CO CO CO VERIFY INTEGRITY OF INCOMING SEWER LINE EXISTING WELL W/ 100' RADIUS 1 0' UTIL ITY EA SEMENT GRAVEL DRIVEWAY FS ≥20' 400 395 395 390 400 405 410 415 420 395 400 405 ≥6' REPLACE EXISTING CO WITH NEW 2CO NEIGHBORING 100' WELL RADIUS OUTSIDE VIEWPORT NEIGHBORING 100' WELL RADIUS OUTSIDE VIEWPORT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241346, Curtis Townsend, 10/21/24 EARL RAY, BLOCK 3 LOT 23 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 4' DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: <1 MIN/IN APPLICATION RATE: 1.0 GPD/SF 5-WIDE TRENCH SYSTEM 1250-GAL SEPTIC TANK BOTTOM OF SAND: 7' BELOW GRADE BOTTOM OF TRENCH: 5' BELOW GRADE FLOW LINE ELEVATION: 4'6"' BELOW GRADE 450 GPD / 1.0 GPD/SF / 5' WIDE * 1.0 RED FACTOR [0.5 DEEP] = 90 LF TRENCH REQUIRED (2x 45 LF SPECIFIED) GEOTEXTILE FABRIC 6" 10/8/24 PROVIDE ADDITIONAL FILL TO ACCOUNT FOR SETTLEMENT 5' 6" 2' MOA APPROVED SAND Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241346, Curtis Townsend, 10/21/24 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING START TIME NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? 0.4 9/19/24 1 2 3 4 5 6 GP (POORLY GRADED GRAVEL LESS COBBLES MORE SILT) Professional Engineers Stamp: NO Earl Ray Block 3 Lot 23 9/18/24 051-113-31 Nevie Batucan 8:25 1 0 16 8:27 8:29 8:31 8:34 8:36 1' OB 1:22 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER PERC TEST LOCATION TECHNICIAN: M. Jakubisin 7 0 16 - DRY 9/26/24 COMMENTS: SITE PLAN 6 0 16 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED 10/1/24 ..\..\cosas\forge logo.jpg GP (POORLY GRADED GRAVEL W/ LARGE COBBLES) 1 0 161:53 7 0 16 6 0 16 1 0 161:47 7 0 16 6 0 16 1 0 162:03 7 0 16 6 0 16 1 0 162:06 7 0 16 6 0 16 1 0 162:18 7 0 16 6 0 16 7 8:39 1 0 162:23 7 0 16 6 0 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241346, Curtis Townsend, 10/21/24 k� I11i111PA S �So28,2 p E 2�0 36, _E�OR EVI EI W YY / FENCE /(CZF LOT 23 95,724 sq. ft. LOT 24 M 120.71 \ 2 SEE BUILDING DETAIL SEPTIC STANDPIPES II I° II I° O � I� w o� CV crj r N N I< N WELL Imo _ w I o_ ? 5 G) Lo A O $ Iw Lo OO o m I o0 24 5 41.6' O O i I � O a Z c, I N 0�� O N tiQ02�o --J REBAR� _ _ — 10 UTILITY EASEMENT ���--- 008,30„W 319.48' �s�os�'pp„ S8�135'42" E 319.04 (M� 63 04, w N LOT 35 BUILDING DETAIL LOT 36 coNC 2-STORY 31'4 FRAME HOUSE N GRAVEL 48.01 31.0, DRIVEWAY DECK I ill =30' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (64-78) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. 10.3' NOTE REBAR N W/CAP UTILITY POLE H THE MEASURED (M) POSITION OF THE SOUTH EAST MOST CORNER OF THIS PROPERTY WAS FOUND TO BE SIGNIFICANTLY DIFFERENT THAN THE RECORD POSITION. 0 30' 60' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 23, BLOCK 3, EARL RAY SUBDIVISION ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 22nd DAY OF AUGUST, 2024, ATANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services WWW.FIXEDHEIGHT.COM 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 JOB # 24188 1 NO CORNERS SET THIS DATE I SCALE 1" = 60' QGREA ,~R ANCHORAGE AREA BORL, uGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION d'~' C ,/~' W~ J "t"~ MAILING ADDRESS ~/2/9 /¢P /~'/ V ~-- LEGAL DESCRIPTION SEPTIC TANK: D,STANCE //7 FROM WELL INSIDE LENGTH NUMBER OF MANUFACTURER OCw'/t"$"t"~"-~'~//¢¥'''77C MATERIALiSt's" 5;;;:///~'-~c' COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~ GALLONS. SEEPAGE PiT: NUMBER OF PITS / DIAMETER oR WIDTH 3 LENGTH /~'A"~ DEPTH JO / LINING MATERIAL(~//~'¢ 6 CRIB SIZE: DIAMETERJ~ ,DEPTH (~ DISTANCE FROM: TOTAL EFFECTIVE BUILDING FOUNDATION__ NEAREST LOT LINE ~ ~' WELL / 2~) ~' ABSORPTION AREA (WALL AREA) SQ. FT, ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEWER LINE SEPTIC//¢ TANK ¢'/, SEEPAGE SYSTEM REMARKS DISTANCES: INSTALLED BY: '~'// PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE ~,p.A.A.B. GRE ANCHORAGE AREA BOR Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 h !i INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING AD~I~RESS 4/~/'q /~'~- ~(~/~ /.)/~ PHONE~ I LEGAL DESCRIPTION ~rp~ ~/*¢/~ --~ ~ ~<~, ~t~/)~ '~:~- SEPTIC TANK: DISTANCE //? FROM WELL INSIDE LENGTH NUMBER OF MANUFACTURER S¢'~'$<:~'/~/'~''<~-~'~ MATERIAI~b~' ~:~'/'~¢'~<' COMPARTMENTS R INSIDE WIDTH LIQUID DEPTH ..LIQUID CAPACITY //~-'O GALLONS, SEEPAGE PIT: NUMBER OF PITS t DIAMETER ' LINING MAT ERIALC~/~'c' [ CRIB SIZE: ORWIDTH ~' , LENGT"/4~'~''''DEPTH /0 DEPTH DISTANCE FROM: WELL BUILDING FOUNDATION ADDITIONAL ABSORPTION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA1 SQ. FT. WELL: TYPE D~ ;Ifc BUILDING FOUNDATION -- CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST" LOT LINE SEWER LINE OTHER SOURCES- .~ DISAPPROVED REMARKS DEPTH SEPTIC//~' ., TANK DISTANCE FROM: SEEPAGE / SYSTEM ! 7 ~ DISTANCES: INSTALLED PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE APPROVE[ A.A.B. t:::!J:::'J:::'J,... ]i [...[]iI[i:J=JT ]i I E: ,:. t . [)tiEF::'F:IF:'.TMENT (:3~ dEFIL. TH F::INE:' EEl".]',,,' I ROhtME:NTI:::II.... F':'. ,'EC:T I CIF,! ;.'-~!:Ei:.l..6 El 'tq. 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'O ~E Russell Oyster 694-2774 Soils 8 Foundations Performed for: Legal Description: Depth (feet) 0 2 5 , 6 Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Land Development Name: Soll Characteristtc~ 10 11 12 13, 14 15 16 Drain Field Ground Water Encountered: Yes No__ Proposed Installation: Seepage Pit Comments: Performed by: If yes, what depth Date: -Z~i ~)~ 7[o erlifieh lril[ing by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTION Z. ~ 3 /~ 3 DATE-Started 3/~) .?/76, Ended PERMIT NUMBER 7~ $---~'Oc'' DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASING / gl KIND OF FORMATION: From f,~ Ft. to From 5 Ft. to From .~c~ Ft. to ~-'~ From ?,'~ Ft. to ].3° From ]20 Ft. to From Ft. to Ft. From Ft. to Ft From Ft. to Ft From FL to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft From Ft. to Ft From Ft. to Ft From Ft. to Ft. From Ft. to Ft. 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CH Z CKRDEE': Oi::F :FSI.::::[ RD F'ETE:F..:E; CR L;.:..!:::!~: EC~: EFIF.':L RFI'-r' ::-:;I.JB ',,,' :[ EI.,.t DF.': '3'~'=T.45E' 4- LOT 2~, Z ZE j.::!IEIE)EIEI E;(;!IJF~F4:E FEI'T'I" HINtHLtH D:[:E;TFINCE BETP4EEN R L4EI._L RND RN"r' ON'-$I"FE S:;EI.,.IRGE [:,:[SPOSFIL S'.F':i!;TEH IS FEET ~::'O~: Ft F'RI',,,'F:ITE P.IE. iLL. DP:: ;.:.:i:E~Cl FEET FOF~: ~ F'UBLIC: b. IELL. b}ELL LOGS; FIRE F'.Et'.-:!UiRE:[:, I'qN[::, HUS:,T E,'E R'L:.:"FUF..'.NE[:, TO THE [:,EF'FIF.:THENT 1.4]:THIN .E'-::C1 [':,R'T'S; THE [4ELL COHF:'LETION. ::SF'Ei)3 ]: F I [:I~T I E~N:":.:, F~N[." CONST~i:UCT I ON [:' :[ RGRFIP'IS; RF'.E FI',,,'FI I I_FIE':LE TO I N'.:.~UF-'.E' F'~'.OF'EIR N:.:.~;'I"I=iL..L FYI" I OIq. ]: IZ:EF.:T I F"T' THR"F =,EP.IEF.=, FIND I.,.IELL:E; Fl:i~ 'E;ET.T :L: I RH F'FtHILIFIF4: I.,.IITH THE F.:EI:.:!IJ.I:F.:EHEI'4"FE; F"F' ON-"2;ITE" F:'L"~F;:TH B'T' THE HUN .!: C I F'FtL :[ T'¢ I::IF' FIN" H" F.'FI '3E. ;2': :t: t4]:LL. IN'-:;TFIL. L THE: . ,.=TEi'I I1'-4 I=/CC[)f;::DI::INCE b.!ITH THE F.'r"iDE'E;. Parcel I.D.# 1. GENERAL INFORMATION Complete legal description MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 \ 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA#. Lot 23~ Block 3~ Earl Ray Subdivision Location (site address or direCtions) 20903 Chickadee Lane Property owner L.V. Dees (Jo~) Day phone 688-3460 ~.~.~2027 Mailing address P.O. Box 670267 Chugiak, AK 99567 Lending agency Mailing address Agent Nanc~ Kornowski/AK USA ¢.U. Day phone 4000 C~di~ U~ion Driv~ 5th floor Anchora~e~ Day phone AK Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: XXX Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #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 inves_ti_gation 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. $ & s ENGINEERING Name of Firm 17-n34 -"~ ~iver io Add ress [~agJe ~iver, Alask~ Engineer's signature ,~ Phone Date DHHS SIGNATURE .~' Approved for'~'~'~ {/'~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: /~,~,,,_.._~ {~-~ Date ~''- ~'-7'-~-~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: [,..~-r'~-% ~V.--~ ~ ~ s~ Parcel I.D: O~-/~ //$ - ~/' A. Well Data Well type ~,,J ~ Log present ~YN) ~ Total depth \ ~Z.~ Sanitary seal ~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed "7 ~ 7--'-5 ~ L, Driller ~- Cased to \ ~-~ Casing height Wires properly protected ~/N) ~/ AT INSPECTION I..~, 0 .g.p.m. ~", '-5 .g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ Absorption field on lot \ Public sewer main Sewer service line '?~'~ WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed \ c~-'l L~ Cleanouts ~1) ',~ High water alarm (Y/~ Date of pumping Collected by: Other bacteria $ & S ENGINEERING i7~,i F.=B;,, ~,;,,~, L,;,~p =c,a~ Eagle River, Alaska 99577 Tank size \ ~ ~ o Compartments Foundation cleanout (~) ~/ Depressio,n (Y~_~ Alarm tested (Y/N) "] ~ t L~ Pumper "~¢-~ ~--~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: '~ '~ ' Well(s) on lot \ o o On adjacent lots To property line ~c) t ~-- Absorption field Surface water/drainage ~ ~ 0 Foundation Water main/service line 72.026 (3/93)*Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Vent (Y/N) "Pump on" level at High water alarm level ~ed Meets MOA electrical codes (Y/N)~ ~ SE~CE FROM LIFT STATION TO: Well on lot On adjacent lots Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed \ Length /~' Total absorption area Date of adequacy test Water level in,absorption field before test Peroxide treatment (past 12 months) ('~J) ~--~ ~-- Width ~ ~ ~ ~ ---c1.$ Results_(~fail) Soil rating (GPD/FF) ~-~ ~ Gravel thickness Cleanout present ~'/N) System type Total depth Depression over field (Y~ for ~-~ Bedrooms After test 12--~-Z~ ~.~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water \ Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots ~, oo ~ ~- Property line % ~ \ ~ To existing or abandoned system on lot Cutbank ~ ~, i~. Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on t, Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back ~ of this inSPection. Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 June Application Date 5,1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 23~ Block 3~ Earl Ray T15N R1W Sec.10 Location (address or directions) Chickadee St. (b) Applicant Name L .V. Dees Telephone: Home 688-3460 Business N/A Applicant Address POB 670267~ Chugiak~ AK 99567 (c) Applicant is (check one): Lending institution []; Owner/builder []; Buyer []; Other,[] (explain); (d) Lending Institution City Mortage Address Centerfield Drive~ Eagle (e) Real Estate Company and Agent N/A Telephone 694-3503 River ~ AK 99577 Address Telephone (f) Mail the HAA to the following address: _ pickup by enKineer TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well syStem, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and Status. 4, SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If Community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84} Page 1 of 2 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 ~ealth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm "~"' ~ ~l~t~t) ?.I~.I~IlCCI~I~IR ~FRVICE$ Telephone Address EAGLE RIVER, AK 99577 __/~... P.O. BOX 773294 Date L'~/ ,'/~ ~nA c4n~ gineer's Seal DHEP APPROVAL Approved for ~-~-<bedrooms Approved ~L,/' Disapproved Terms of Conditibnal Approval Conditional) Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independept professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in erder to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCJ-JO~AGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUN Legal Description: IfA, B, C, D.E.C. Approved (Y/N) ,~:./,/x.,~ Well Classification /~'~ //,/,,4 2-./c' Well Log Present (Y/N) /Y Date Completed Total Depth /x.~. / Cased to / ~-'~2 / Static Water Level "7/4~'' ~'¢~'" /-~/~ Casing Height Above Ground ,~. Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot / To Nearesi Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Yield Depth of Grouting ~¢v'"'7 Pump Set At ~-J'~ j Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Comments ; On Adjoining Lots '¢/¢¢ / /~'-0 / ; On Adjoining Lots ¢'/~e / To Nearest Public Sewer To Nearest Sewer Service Line on Lot *'~ ~' / _/ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '""/.~ Separation Distances from Septic/Holding Tank: To Water-Supply Well /z~ .~ / To Property Line To Water Main/Service Line Course /djA /77~ Size ?,~u~ ~-~/ No. of Compartments zV Air-tight Caps (Y/N) ,~' Foundation Cleanout (Y/N) Date Last Pumped YV,/~ ; for .... Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field /¢ / To Stream, Pond, Lake, or Major Drainage Comments Page I Of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~'-~ To Building Foundation 7.~ Lot To Water Main/Service Line ~'/~' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comm.ents ~.~u 4 Y-~,- Type of System Design Length of Field ~'~- / Depth of Field /O / Gravel Bed Thickness ~' ' Standpipes Present (Y/N) Dateof Last Adequacy Test To Property Line '"'/c~ To Existing or Abandoned System on ; On Adjoining Lots ~'~,c~ / To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Receipt No. 72-026 (11/84) unicipanty of Anchorage P.O. BL)~ 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264~4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES May 5, 1986 Lou Butera, P.E. Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577 Subject: Lot 23 Block 3 Earl Ray Subdivision Waiver Request - WR86-055 Dear Mr. Butera: Your request for a waiver of the required 10 foot separation between the water and sewer line on the subject lot has been denied. Your request was for a waiver to "zero" feet because the water and sewer line share the same trench. Your waiver application did not demonstrate that a waiver of the 10 foot separation was justified in this case. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw EAGLE RIVER ENGINEERING SERVICES P.O. BOX 773294 EAGLE RIVER, AK. 99577 694-5195 April 30, 1986 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 REF: Lot 23, Block 3, Earl Ray ::I©WOHDN¥ AZl'lVal:mNnW Dear Mr. Morris: On behalf of my client, Mr. Joe Deem, I am submitting a request for wavier of water line to sewer line horizontal separation distance to O'separation for the above referenced lot. The original septic system connection served a trailer that was relocated to another area of the lot. When the new trailer was connected the water line was placed in a 12' deep trench and the sewer line was run in the same direction and shares the same trench with the waterline at 4' depth along a length of approximately 40'. The waterline is reported by Mr. Dees to be one piece (no connections) along the entire run adjacent to the sewer line. The last 10' portion of the water line that exits the ground into the crawlspace is sheathed with a PVC pipe. The existing pressure tank is being replaced by an air bladder tank which will not require the waterline bleedback. The waterline will be then be held under pressure when the pump is off. As the captive air tank was added to the system I would request verification from the owner that the bleedback on the well drop pipe was removed, thereby eliminating any draining of the waterline. As this might involve some expense I am asking for preliminary approval of the common trench as exists. If there are any questions or if additional information is required please feel free to contact me at 694-8195. Sincerely, Lou Butera, P.E. Encl: inspection report water sample