HomeMy WebLinkAboutFAIRMOUNT LT 14MUNICIPALITY 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
http://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP211038
Work Type: WellSeptic Upgrade
Tax Code Number: 01711106000
Site Legal Address: FAIRMOUNT LT 14 G:3137
Site Mailing Address: 5500 RABBIT CREEK RD, Anchorage
Owner: HORTON ADAM &
Design Engineer: ARC TERRA CONSULTING INC
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
�1„cnt
t�C�YlI'IIttC•nC
3/5/2021
3/5/2022
33600
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q 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
Special Provisions:
1. Well professional shall ensure the well is at least 50 ft from the creek prior to drilling.
4
2. Prior to final approval of inspection report, the barn and chicken coop shall be demolished or moved to provide
code required separations to the well.
U
Received By: Date:
Issued By: _lvllqcew Date:
ON-SITE SEPTICIWELL PERMIT APPLICATION
Parcel 1. D. 017-111-06
Property owner(s) Adam Horton & Lindsay Nielsen
Mailing address 5500 Rabbit Creek Rd. Ancorage, AK
Site address 5500 Rabbit Creek Rd. Ancorage, AK
Day phone
Legal description (Sub'd., Block & Lot) Fairmount Lot 14
Legal description (Township, Range & Section)
Lot Size 33,600 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank
Upgrade M
(D)
❑
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
In
Water Storage
❑
THIS APPLICATION INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Dea Duffus
(Signature of property owner or authorized agent)
Permit/Rush Fees: $820 Waiver Fees:
Date of Payment: 2/18/21
Receipt Number: 0309OG
Permit No. OS P211038
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Com 1
July 6, 2021
C E11RA
CONSULTING, INC
20441 Ptarmigan Bld, Eagle River, AK 99577
Office (907) 696-6111, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Upgrade Permit OSP211038 —
Fairmount Lot 14 — Septic Design Change
In the process of installing the new septic system we excavated approximately 8'
below grade to install the STEP tank. No water was encountered during this work.
Subsequently when getting ready to install the field we observed that the water in
the testhole monitoring tube had risen to approximately 5' below grade. Although
no water was encountered during the installation of the septic tank, we feel that
changing the design from a shallow trench to a raised bed design would be
prudent based on the testhole observation.
We are proposing that the shallow trench system should be modified to a
mounded bed with 4 lines measuring 20' wide by 60' long. The 20 -foot -wide trench
is being proposed as the most efficient under the circumstances as previously
discussed.
All other separation distances and criteria will remain the same as the previously
applied for permit. This includes insuring that the adjacent developed lots which
are served by private water well are more than 100' from the proposed septic
system, that there is no surface water within 100' of the proposed septic system
and that the new septic system will be outside any protective well radii.
As mentioned in our prior letter we do not expect there to be any adverse effect on
adjacent lots by the development of this septic system. If you have any questions,
please contact me at 696-6111 /FAX 868-3793.
Respectfully submitted,
ArcTerr C isulting, Inc.
e Duffus, P.E.
At unents: On
Well and Sewer Application
Wastewater Absorption System Details/Site Plan (3)
Soil Test Hole Log
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
N�CTE
I I P
February 17, 2021
AtzcTF', U R A
CONSULTING, INC
20441 Ptarmigan 131d, Eagle River, AK 99577
Office (907) 696-6111, Fax (907) 868-3793
Municipality of Anchorage
Development Services Department
Or] -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Municipality of Ardmage
On-site Water and Wastewater
REAMED FOR CODE COMPUAN(
OSP211038, Rebecca Carroll, 03/05
Subject: Septic and Well Upgrade Permit — Failnl---t Lot 14
The owner has requested we proceed forward to obtain a well and septic permit
lot. The owners are plannin, to
10 Upgrade and move both systems on the Subject Ot
0
construct a new garage building which will be connected to water a tic but
will not have any living rid septic 11mg space. A new soil test hole was dUg ill the
the lower
system and
licipal codes. The -septic system will consist
well will be decommissioned per mul The existing septic
portion of the lot near Rabbit Creek to the south Proposed
septic area and is attached for review. The well. will be re -drilled in
of a 1500 gallon STEP tank- and two shallow trenches measuring 5' wide by 68t
long. The Proposed upgrade will serve the existing 4 -bedroom house. All
livestock have been removed as well as the chicken coop and pens.
The adjacent lots are developed and arss�.rved by private water wells that are
more than 100' franc the proposed septicystem. There is no Surface water withill
100' of the proposed septic system. - The new Septic system will be outside any
Protective well radii. We do not expect there to be any adverse effect on adjacent
Tats by the development of this tank. If YOU have al,
me at 696-6111 /FAX 868-3793. ly questions/ please contact
Respectfully submitted,
ArcTerra Consulting, Inc.
.,A
Kenneth
M. Du- 'us, P.E.
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/site plan
Soil Test Hole Log
20441 PTARMIGAN BLVD * EAGLE RIVER, AK 99577-8736 - PH (907) 868-3791 - FAX (907) 868-3793
r
WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
FAIRM❑UNT LOT 14 PID# 017-111-06
FLAG PROPERTY LINES
WELL RADII & EASEMENTS
PRI❑R TO C❑NSTRUCTI❑N
NO PUBLIC WELLS WITHIN 200' OF
0 PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 100' OF
y PROPOSED SYSTEM EXCEPT AS NOTED,
i NO SEPTIC SYSTEMS WITHIN 2OD' OF
PROPOSED WELL EXCEPT AS NOTED.
TH
KENNETH M. D S
CE 7116
kESSI011�
�j
Scale: 1'= 50'
V CONTOUR INTERVALS
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/0.5 GPD PER SQ, FT,= 1200 SQ. FT
(1200 / 20') = 60 FT, TRENCH
USE 1 BED WITH 4 LINES] 60' (L) X 20' (W) X 0.5' (D)
Total depth of system is 0' max from original grade.
Total depth of gravel below dlstrlbutlon pipe Is 0,5'
Total excavation of system is 2' max from original grade.
Contractor to excavate 2' & backfill with 2' of sand.
NOTES:
1. INSTALL 1500. GAL. TANK & INSULATE TANK IF <4' COVER,
2. INSULATE BED WITH 2' HD BURIAL FOAM IF < 3' OF FILL,
MIN, 2' FILL WITH INSULATI❑N, >3' COVER NO INSUL REQ,
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK,
4, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC,,,
5, RESERVED SEPTIC AREA WILL REQUIRE AN ADVANTEX SYSTEM
WITH 200 SQ, FT, OF MINIMUM SEPTIC AREA,
6, CONTRACTOR WILL ENSURE NO SOILS COMPRESSION IN FIELD AREA
DURING C❑NSTRUCTI❑N, PAGE 1 OF 3
PREPARED FOR: E AA
ADAM H❑RT❑N
5500 RABBIT CREEK RD,
ANCHORAGE, AK 99507 m�
A 1�'•
FIELD BOOKS COMPUTED: i
� x
90UNDARY: N A DRAWN: KSQ z o \
STAaNc: N A CHECKED: KMD a n�
Aseu'LT: LANG DATE: 6/30/21 ���9"' q?
owD. FILE: MD: SW3137
ACAD FILE: FILE JOB N°'` 20123 R/`FR, $ UL I NG � 6
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00'
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FLAG PROPERTY LINES
WELL RADII & EASEMENTS
PRI❑R TO C❑NSTRUCTI❑N
NO PUBLIC WELLS WITHIN 200' OF
0 PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 100' OF
y PROPOSED SYSTEM EXCEPT AS NOTED,
i NO SEPTIC SYSTEMS WITHIN 2OD' OF
PROPOSED WELL EXCEPT AS NOTED.
TH
KENNETH M. D S
CE 7116
kESSI011�
�j
Scale: 1'= 50'
V CONTOUR INTERVALS
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/0.5 GPD PER SQ, FT,= 1200 SQ. FT
(1200 / 20') = 60 FT, TRENCH
USE 1 BED WITH 4 LINES] 60' (L) X 20' (W) X 0.5' (D)
Total depth of system is 0' max from original grade.
Total depth of gravel below dlstrlbutlon pipe Is 0,5'
Total excavation of system is 2' max from original grade.
Contractor to excavate 2' & backfill with 2' of sand.
NOTES:
1. INSTALL 1500. GAL. TANK & INSULATE TANK IF <4' COVER,
2. INSULATE BED WITH 2' HD BURIAL FOAM IF < 3' OF FILL,
MIN, 2' FILL WITH INSULATI❑N, >3' COVER NO INSUL REQ,
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK,
4, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC,,,
5, RESERVED SEPTIC AREA WILL REQUIRE AN ADVANTEX SYSTEM
WITH 200 SQ, FT, OF MINIMUM SEPTIC AREA,
6, CONTRACTOR WILL ENSURE NO SOILS COMPRESSION IN FIELD AREA
DURING C❑NSTRUCTI❑N, PAGE 1 OF 3
PREPARED FOR: E AA
ADAM H❑RT❑N
5500 RABBIT CREEK RD,
ANCHORAGE, AK 99507 m�
A 1�'•
FIELD BOOKS COMPUTED: i
� x
90UNDARY: N A DRAWN: KSQ z o \
STAaNc: N A CHECKED: KMD a n�
Aseu'LT: LANG DATE: 6/30/21 ���9"' q?
owD. FILE: MD: SW3137
ACAD FILE: FILE JOB N°'` 20123 R/`FR, $ UL I NG � 6
C'o* l
WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
FAIRMOUNT LOT 14 PID# 017-111-06
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1' CONTOUR INTERVALS
PAGE 2 OF 3
PREPARED FOR:
Aor
c E1�
<. . OF.` <Q� ADAM HORT❑N
` 5500 RABBIT CREEK RD. '
4 TH ANCHORAGE, AK 99507
I - x
Z
FIELD BOOKS COMPIUTED:
KENNETH 'FU5
C' w� BOUNDARY: N A oRAym: KSD h
s CHECKED
KMD
ASBUILT: DATE, �F�p��rj/S \'•�19���
N'E5Si4��� LANG6 30 21 !LF ULTI NG6
'
DWG. RLE GRID: SW3137 R AK. 99577`
ACAo FILE FILE aoe No-: 20123
cm
WASTEWATER ABSORPTION SYSTEM DESIGN DETAILS
FAIRM❑UNT LOT 14
w w
Of
C3 O
FINISHED GRADE (ADD UNCLASSIFIED FILL) o
FINAL T❑PS❑IL & SEEDED / VEGETATED GREATER TAN °
3.1
�N
INSULATI❑N �N
FILTER FABRIC AND INSUL
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0 W Cl W
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MIN, '2 0'+ :SAND: -FJ LTER •",F❑R .:S;EPAR-ATIDN v-rIL
1500 GAL
S,T,E,P,
SCALE1 NTS
1 1/4' PVC FRf
1 1/4' PVC FOf
J
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PAGE 3 OF 3
��rr
PREPARED F❑RI
OF AZ ADAM HORT❑N
�< 't}' 5500 RABBIT CREEK RD.RCE�
'ANCHORAGE, AK 99507
.'
,'4 THS
FIELD BOOKS COMPUTED:LID
A o
i
.. s . BOUNDARY: _ DRAHN: KSD 4
z
CE— .1� STAKING — CHECKED: KMD \
,4 ASBUILT. — DATE 6/30/21 : • �.
7 �, 'g/'.'
p"Ot1 DM FILE GRID: SW3137 �9c�F r�
S. ?/D `1SUI TING gj�b
ACRD FILE.'FILE JOB No.: 20123 FR AK -99!377
/Volumes/AreTerta Shared/Storage/WELL k SEPrnC — Filed by Legal/Fairmount/Lot 14/20123 Septic Design 7:6:21 Bad.dwg
J
WATER MONITOR
60' BED
ON 6/29/21 GRADE
PRESllSURIZED
DISTRIBUTION SYSTEM HOLE
SPACING
DESIGN
1.
RESIDUAL HEAD = 5'
2,
HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE @ 30
PSI
3.
30 GALS (PUMP DELIVERY)/1,00 GALS./HOLE = 30 HOLES
BOH 16.0'
4.
216 LF LATERAL/30 HOLES = 7.2' SPACING PER
HOLE — USE
7' SPACING
5.
ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS,
KT, 2,5'(typ)—\ CAP ENDS OF
PIPE--\
M.T.
PAGE 3 OF 3
��rr
PREPARED F❑RI
OF AZ ADAM HORT❑N
�< 't}' 5500 RABBIT CREEK RD.RCE�
'ANCHORAGE, AK 99507
.'
,'4 THS
FIELD BOOKS COMPUTED:LID
A o
i
.. s . BOUNDARY: _ DRAHN: KSD 4
z
CE— .1� STAKING — CHECKED: KMD \
,4 ASBUILT. — DATE 6/30/21 : • �.
7 �, 'g/'.'
p"Ot1 DM FILE GRID: SW3137 �9c�F r�
S. ?/D `1SUI TING gj�b
ACRD FILE.'FILE JOB No.: 20123 FR AK -99!377
/Volumes/AreTerta Shared/Storage/WELL k SEPrnC — Filed by Legal/Fairmount/Lot 14/20123 Septic Design 7:6:21 Bad.dwg
oy �-cTER,eh OFAr
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s C®NSUI,TING, INC
¢ Of
20441 Ptarmigan, Eagle River,AK 99577 4
0' Office (907) 696-6111, Fax (907) 868-3793
• AK O'35IT-�' r
KENNETH n F %S
.16
ref j��'r d t;� .
SOILS PERCOLATION TEST
Performed for: Adam Neilsen _ _ Date Performed:_ 0728/2020
Project: Fairmount Lot 14 ,. PERC #1 TEST HOLE # ,.TH_20-1�
Depth
17-
ORG
GM
— PERC BENCH # 1 @4'
SM SILT
Cobbles to 6" — 12"
Date
Depth to H2O
8/3/20
710"
9/12/20
71011
10/17/20
710"
11/14/20
712"
12/19/20
712"
3/2/21
713"
6/29/21
5'0"
B.O.H. 16'
18 -
HOLE PRESOAKED
19- PRIOR TO TESTING
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? NO What depth?
Depth to water after monitoring? 7' Date 8/3/20
(Depth below grade)
Reading,
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
7/28/20
1:55
-
9 1/16"
-
2
2:25
30 min
5 6/16"
3 11/16"
3
*
2:55
-
8 2/16"
-
4
3:25
30 min
6 0/16"
2 2/16"
5
*
3:56
-
8 2/16"
-
6
4:26
30 min
6 1/16"
2 1/16"
7
*
4:27
-
8 2/16"
-
8
5:57
30 min
6 1/16"
2 1/16"
9
10
11
12
*
Water
Added
Percolation Rate 14.55 (min/in) Perc Hole Diameter 6"
Test Run Between 4.0 feet and 5.0 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~(,,[i~[{~)~,-/D I PIDNumber: DI"~III~
Name: gU pg rede
~l~ ~L~. ~t~l~~ Wastewater System: D New
Address: HOI ~, ~0~ ABSORPTION FIELD
7 · ~ No. of ms: ~ Deep Trench ~hallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION soi,,.~i.~: I .~GPD/Sq. Ft. Total Depth from origin~a~e:
Lot: ~ Block: ~d~v~ Depth to pipe bottom ,rom original grade: Gravel depth beneath pi~
Township~ J ~ R ange:~ Section: ~ Fill added above original grade: Ft. Gravel length:
Gravel~:~ I ~ t Number of lines: I Distance betweep lines:
WELL: D New ~ Upgrade ~ Ft. ~ ~ I [~ ' Et'
Yield: Pump Set at: Casing Height Above Ground:
~,M ~. ~. TANK
SEPARATION DISTANCES ~Septic ~ Holding ~ S,T.E.P.
To Septic Absorption Lift Holding Public/Private M~nufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Line8 ~~ ~ ~- I~O
Surf~c~ LIFT STATION
w~t~r J0~'~i lO0'+ ~ ~
Lot I~ ~ ~ . ·
Line ~ J~t~ __ -- Size in gallons: Manufacturer:
~ou.d~t,on I~'elo'+ ~ ~ ~ ".~m.o.",~ve,~,: ~ "~.
CurtainDrain ~ ,~ ~ ~ ~ ~ Pump Make &~[Electrical Inspections performed by:
Remarks: ~1~1~ ~~ ~ BENCH MARK
Location and Description:
Inspections performed by: ~ ~ ~t~Y~ates: 1st 1~.~-~ ~'~" ~'~
Department of Health and Human Services approval ',-'~'.
Reviewed and approved by: ~ Date: /d -~-~
~'2-013 (1/91) MOA 25 ;
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES'
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
:49!H
/
//
72-013 A (2/91} MOA 25
,. I;HAFER, P.E.
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: '~1 {~-- ~H~O L( IL.~
PID NO.:
I,;HAFER, P,E.
72-013 A (2/91) MOA 25
Lynn Billington
401 N. Forest
Bellmgham, WA 98225
OCT
' Li i I' )~ h~'] O~ Anchorage
w, ,,.,.:~ !,,~, & Human Services
L)ept, ~u3 -,
Date: Septembe 30, 1992
Attn: Onsite Services
Municipality of Anchorage
Dept. of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Dear Madam/Sir:
There was some misunderstanding on the approval requirements for the septic system that was installed
last October of 1991. The septic work was completed (Permit SW910261) according to the approved plan
and inspected by S&S Engineering. I received the mumcipality forms for the septic upgrade and design
from S&S Engineering, however they should have been sent to you. Therefore these forms are enclosed.
Please process the approval at your earliest convenience. If you have any questions please call me at work
(206) 384-8277 or home (206) 734-3236.
illington (~
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910261
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:BILLINGTO~ LYNN MARIE
OWNER ADDRESS:711 E. HOLLY ST. #323
BELLINGHAM, WA 98225
PARCEL ID:01711106
DATE ISSUED: 8/30/91
EXPIRATION DATE: 8/30/92
LEGAL DESCRIPTION: FAIRMOUNT LT 14
SEC 34, T12N, R3W, SM
LOT SIZE: 33600 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST 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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVI S I~ON~l
/~9.~-q/ t~06E~" ~,q4FER ~Li.&l; ~0~.~, 4~P /~.~ rff~7 ~,,~L
~/ . ~ I~ ,
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SO~LTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
October 31, 1991
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
ECE \/ED
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERkNCE: Lot 14; Fairmount Subdivision;
P~rmit # SW910261
Request you issue an approval to the design change of the septic system
serving the referenced property.
During a pre-construction me~ing with the property owner we found the
creek adjace~ to this property cuts farther into the property than
depicted in our original design dated August 25, 1991. The original
design loc~tion is actuary within thc 100 ft. s~tback to the creek.
A new soils test was performed and a re-design performed on-site so the
contractor could continue with the septic upgrade work. Th~ d~sign
change was r~layed to your office along with the inspection
notifications by telephone. This is also an owner installed system.
The system is installed by the owner and a couple of her friends
experienced with septic installations in Fairbanks. I notified the
owner of the requirement to be approved by your Department prior to
installation. She contacted your office and was told of no special
requirements for her to install h~r own system. [ t~lephoned your
office to verify her ~laim and was told virtually the same information.
If you have any questions or require additional information for your
review please contact us.
Sincerely,
ROGER J. " '~"""~"'
RJS/gm
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
lO
11
12
13
14
15
16
17
18
19
2O
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
,'~. ~ .1~'~ I
'~ '~'.. ~ .'~ I
Township, Range, Section:
SLOPE SITE PLAN
ENCOUNTERED?
S
IF YES, AT WHAT ~ L
DEPT.~ I O .O
E
Oeplh to Water Alter,
Moniloring? [~:~ . Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE '~'°~"~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN__~ FTAND '~ FT
COMMENTS
PERFORMED BY: I CER'TiFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE, DATE:
72-008 (Rev. 4/85)
August 26, 1991
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
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
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 14; F~rmount Subdivision;
Request you issue a perm~ to upgrade the septic system s~rving the
referenced property.
An adequacy test was performed on the existing system for financing
purposes on August 2, 1991. We found the absorption rate to be
inadequate for a 3 bedroom house. A sox test performed August 18,
1991 found the existing system to be encroaching groundwater.
Due to the location of the w~ll and Little Rabbit Creek there is
l~ited ar~a on the property for a septic upgrade, (SEE THE SITE PLAN
ATTACHED)·
We do not anticipate any adverse effects on n~ighboring properties by
the installation of the proposed upgrade.
If you have any question or require additional information for your
r~iv~w, please conta~us.
Sincerely,
ROGE~ j~'
· SH~FER, P.E.
RJS/gm
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
5
6
7
8
9
10.
11
12
13-
14-
15-
16-
17-
18-
19-
20-
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
~ L
IF YES, AT WHAT
DEPTH? ~ O
P
E
Depth to Water After ~:~
Monitoring? Date:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ¢'~' '~ (m~nuteslinch) PERC HOLE DIAMETER
TEST RUN BETWEEN__~ FTAND --~' FT
COMMENTS
PERFORMED BY: 17034 Eagle Ri,e]' L.II Read Ne, ~_. ~ ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
6agle River, Alaska ~t~ - ~ [ ~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~ I
72-008 (Rev. 4/85)
08. 20. 91 08:02 AM *TOTEM RLTY. 2749616 PO3
WATEE WELL RECORO
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologl¢ol 8, OeophyiIcOI Surveyl
LOC&TION Ol~ WELL (RIlOil ¢OmplE~fl either leo lb e# lc,) &,D,L, Na,
._ ,. 8urfoel 4, WE~L OE~TH~ (final)
~}em ~ F _In, IO~ ft.
I~ GROUTING Well Grouted:
M=~eri=l~ ~ Neat Cement
MUNICIPALITY OF ANCHORAGE
Development Services Department \ � Phone: 907-343-7904
On-Site Water & Wastewater Section - Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 017-111-06 Expiration Date: Q -2 3 -r T
1. GENERAL INFORMATION
Complete legal description FAIRMOUNT LT 14
Location (site address) 5500 RABBIT CREEK RD, ANCH AK
Current property owner(s) DANIELSON, AUSTIN Day phone
Mailing address SAME
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: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ SCO. (X) C1et'tt" 1OI 12 Waiver Fee $
Date of Payment OC/17'161 Date of Payment
Receipt Number 23—K31 Receipt Number
COSA# O1'C 191 l� l 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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 5-17-19
SOFA
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6. DSD SIGNATURE ,• `IGJ,A D
K.- System #1 Approved for 3 bedrooms A MICHAEL N. ANDERSON ;�
System #2 Approved for bedrooms r1 ff•• CE 9469 .:\`mss
Disapproved 1190 p• f,` �..
%\ ROFESS10� .
Conditional approval for bedrooms, with the following stipulatio�l�W� %""~
L Sr
`fit 4.
it
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By: ..
�. _-(`' Original Certificate Date:
S Z3 —l?
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 Arsenic Adv' A[/
Well Flow Advisory Other I ca4tt Sic). "
COSA Checklist blue sheet
COSA Checklist
Legal Description: FAIRMOUNT LT 14 Parcel ID: 017-111-06
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
X Well log is filed with Onsite (or attached) Well production at time of test 2.5+ gpm
Date drilled 8/10/88 Water storage tank volume 0 gallons
Total depth 140 ft Well disinfected for coliform test? ❑ Yes No
Cased to 28 ft Coliform bacteria is Negative
• Sanitary seal is functioning correctly Nitrate :Y/0 mg/L ❑ Nitrate less than MRL (ND)
❑■ Wires are properly protected Arsenic ug/L ®Arsenic less than MRL (ND)
Casing height (above ground) 12+ in. Collected by MNA
Date of flow test for COSA 5/16/19 Date of Sample _____
-//q
Static water level at beginning of test 30 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) Zg years ❑ Required maintenance completed
Tank type/material STEEL Age of lift station years
u
Measured operating fluid level in septic tank "�/@Lift station material
❑ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 5/13/19
D. ABSORPTION FIELD DATA
Which system tested (date installed) 11/4/91 Adequacy test date 4-16-19
▪ ALL standpipes present per record drawing Results ['Pass For 3 bedrooms
Total measured depth from grade 4.5- ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade7...sft(min) Water added 500+ gal
❑ N/A—pressurized field
New depth 0 in
❑■ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min
depth into effective
❑ Code-required soil cover over field
Final fluid depth 0 in
❑ System presoaked Absorption rate 500+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) UN
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies:
. v vw-Q-v
COSA Checklist yellow sheet
, • E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100'
0 Yes if No ft ❑✓ Yes if No ft
Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft
Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft
O Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water> 100' ❑✓ Yes if No ft
Property Line > 5' El Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells > 100' p✓ Yes if No ft
Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft
Water Service Line > 10' p Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' El Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' 0✓ Yes if No ft
Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft
Surface Water> 100' ❑ Yes if No 92* ft
F. ENGINEER'S COMMENTS
* WAIVER ON FILE.
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. o.......?l 1
G. ENGINEER'S CERTIFICATION F:\1?;�•. . .441-td
..:17
r
I certify that 1 have determined through field inspections and review e • 4TH : �,.��/
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. 0 ,4x f A
;,.--3s..MICHAEL N. ANDERSCN
i i•. CE-94 9 ..',. ..,,,17
COSA Checklist yellow sheet
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • II'-are 907-343-7904
f
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval #0SC191171
Subdivision: Fairmount Lot 14
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 29 years old. 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.
This is an example of what the metal of a 20 year old steel tank MAY look like.
iltiVIiiiiiiV. .- -'—'14- ,
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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 St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage, ak. us
(907) 343-79O4
CERTIFICATE OF HEALTH AUTHORITY APPROVe-r_
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O 1'7 - II ~ - o ~'
m
GENERAL INFORMATION
Complete legal descdpti6n Lo f
Location (site address or directions)
Expiration Date:
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
D,~,,,~ ~ Na~? '~y/o,- ,Dayph0ne $-0',,,-0"/22
5'5'oo R~,/,;/' C¢-,,~/<: /iR';, ,4od, o,-,~fe,., ~k
Day phone
A-¢c
Day phone
Mailing Address
Un/ess otherwise requested, HAA wi/I be held by DSD for pickup. P I ~'~'~' c~ ¢/
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY: '
Individual Well []
Individual Water Storage []
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 Development 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 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 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. 5',4~ ~,'¢e ~.,'~'/'- .c¢/, ar-~,/'zo,~ ~,~/~re ~,~,,-
NameofFirm f=f~/J~! 7-~c~,¢~1 _Cer~i r ~
Address I¥..C'_~d ~:c/,o ~',J'._, ,,~..~o,"-'~'~., ~
Engineer's Printed Name .'F]~o,~'o,'~ ,,c=. /.~oo,-~,
Date
DSD SIGNATURE ~
Approved for
Disapproved.
Conditional approval for
bedrooms.
· ~,., ':.. , ~ ~ ~.~
bedrooms, with the following sbputat~onsi
Additional Comments
,~.,."~?-". ......
~ .- 0N-SITE
~ :, W~ASTEWATER
Attachments:
HAA Checklist
Septic System Advisor7
Well Flow Advisory
Maintenance Agree~nents
Supplemental Engineer's Report
Other
O.dginal Certificate Date:. ,.~r"-_ / 3 - 0 -~
(Rev. 01/~2)
Municipality of Anchorage
Development Services Department
Bu~ding Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK gg519-6650
www. ci.anchorage, ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
WELL DATA
Well type P'~, ~,'¢t/-e_
Oat.e com~.eted -8/to I~ ~
Total depth /yp ff.
If A, B, or C provide PWSID #
Sanitary seal (Y/N) 'T' '
Cased to ~R ff.
Parcel ID:
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
1,5" g.p.m.
VVell Log (Y/N)
Wires properly protected (Y/N)
.~? colonies/100 mi. Nitrate ~ If t~ mg./L
Casing height (above ground)
AT INSPECTION
in..
Other bacteria Q colonies/100 mi.
Arsenic: ~ mg./L
Date of sample: y//8/O_3" - Collected by: ff(~,F/cf, 7'~¢~, ~'~'C
B. SEPTIC/HOLDING TANK DATA
TankType/Material ~'e'/~ ]'to '/
Tank size '1 (J<:~ gal. Number of Compartments
Foundation cleanout (Y/N) Y' Depression over tank (Y/N) /V
Date of pumping ~//~-~/o..~ Pumper ~- -t-
Date installed i~ / 2.~ / ?/
Cleanouts (Y/N) ~
High water alarm (Y/N) id, 4L
ABSORP*['ION FIELD DATA .
~,.,t,F.,,~'.//~'/9 2
Date installed II / q,/9/ Soil rating (g.p.d./l~ or ff~/bdrm) ~
Length ,S'~ f. Width 5- lt.
Total depth ~' ff. Eft. absorption ama.T?~ ~ Monitoring tube
Date of adequacy test 9~//'7 / o_7' Results (Pass/Fail)
Fluid depth in absorption field before test 9.52 in. water added/9 ~ gal.
Elapsed Time: !~ min. Final fluid depth ~¢~. ~ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)./Vc,,~e_ /,~oe.~,,,,
System type ..4'g~',~/e ,=d',~/,, ~e/cd'_f
Gravel below pipe ~: It.
Depression over field A/
For -~ bedrooms
New depth~b", y in.
~,~-z9 g.p.d.
If yes. give date A/. ,4.
D. LIFT STATION ~/. ~'.
Date installed
'Pump on" level at ~ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level at
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot I ~,O'
in.
Manhole/Access (Y/N).
High water alarm level at
Meets alarm & circuit requirements?
Absorption field on lot I~' .~ ~
Public sewer main A/./1-.
Sewer/septic service line ~>
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~ I ' Property line
Water main ~/. ~'. Water service line
Wells on adjacent lots ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~ ?- ~ ' Building foundation ~ ~J ~' '
Water Service line ~;> ¢o' Surface water ~ ¥'~'
Curtain drain ~Jo,~¢ _~'~n Wells on adjacent lots
COMMENTS
ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal reco~s that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name '--r~¢~,~-¢ ~.
Date I"/~y 1.7 ~ 'Eo ~, ~
On adjacent lots I O~' '
On adjacent lots ~, ! ~,o '
Public sewer manhole/cleanout
Holding tank. A/./f-.
Absorption field '7 ~
Surface water I ~ ~ '
Water main A/. ,~.
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Driveway, parking/vehicle storage ~' /o '
in.
Waiver Fee $
Date of Payment
Receipt Number
¥1 z,) lo3
5'
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
1. GENERAL INFORMATION
Complete legal description
Lot 14; Fairmount Subdivision
Location (site address or directions) 5500 Rabbit Creek Roadf Anchoraqef Alaska
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Lynn Billington Day phone (206) 384-8277 wk
(206) 734-3236 hm
401 North Forest, Bellinaham, Washington 48225
Day phone
SteDhanie Paszek - CENTURY 21/NEW HORIZONS Day phone-~
2213 East Tudor Road, Anchorage, Alaska 99507
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:
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
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA #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
5 & ',
17034 Eagle River Loop Road No, 204.
Phone
Engineer's signature
Eagle River, Alaska 99577
DHHS SIGNATURE
/~" Approved for~'//~'~__~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipali~ of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1191) Back MOA ~21 ~
A. WELL DATA /~,J ,~ f,~.,
Well type/'~/U~ ~'.~' If A, B, or C, attach ADEC letter. ADEC water system number
s~n~ ~ ,
Logpre~ ~) y~ ~ Date completed ~-/~--~ Priller~
Total depth ~ /~ Cased to ~I~. Casing height
~ ~ Wires properly protected~)
Sanitary seal~) /
FROM WELL LOG AT INSPECTION
Municipality of Anchorage
Department of Health & Human Services
Legal Description: ~/~ ~/~~ ~ /~ Parce .D. "~ '~/O~
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/~ tank on lot //622,
Absorption field on lot ,/~
Public sewer main
Sewer service line
/
; On adjacent lots
r
; On adjacent lots
Public sewer manhole/cleanout /0/~)
Petroleum tank ,,,,'tJ
WATER SAMPLE RESULTS:
Coliform,~',~ 7"/5'.~,4 ¢ 7',O~ ,-/ Nitrate
Date of sample:
~" ,-~,~ '~'/~'~'/~' Other bacteria
Collected by: ~'¢t~T1"O,O
B. SEPTIC/iI~ TANK DATA
Date installed ~0 -Z ~ -- ~'/ Tank size //'~;~
Cleanouts~N) /~'.5 Foundation cleanout~N) /~-' ~'
High water alarm (Y/N) /[')//'~ Alarm tested (Y/N)
Date of pumping ~'~'~',.f' 7~/~&?f2 ~t,,"~,~,~'$ ~/~ Pumper
SEPARATION DISTANCES FROM SEPTIC~ANK TO:
Well(s) on lot _,/~- / On adjacent lots //~;)O /-'/-
/
TO propertyline / (~ ~ .,~ ~
Compartments
Depression (Y~
,4,70
Surface water/drainage
Absorption field
/0o +
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
Date i~ Manufacturer ~
Size in gallons ~ _.._..__._~ Manho~
Vent(Y/N)__ ~m op ff'levelat
~i.e. electrical codes (Y/N) ~
SEPARATION DISTANCE FROM L~IPT"S-T-A-TJ~
D. ABSORPTION FIELD DATA
Date installed //" /~¢///']-'~-~2_- Soilrating
Length ~ W~th ~ Gravel thickness ~' Total depth'~l~" "r/~~
Total absorption area ~ ~'~ ~,,~-,
Depression over field (/'~ /~J o
Results (pass/fail) ~)/~
Peroxide treatment (past 12 months) (Y~____.~
Cleanouts present(~N)
Date of adequacy test ,L(~..q.¢'
for 3 bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIEL....~O:
Well on lot ./'~::)~" /
On adjacent lots //O(~)
Propertyline ~O /-~
!
To building foundation //(~) -//- To existing or abandoned system on lot
On adjacent lots ~.~5) /.7~-- /t~/~ I
Cutbank Water main/service line
Surface water //~ Driveway, parking/vehicle storage area
Curtain drain /~/d)/,-r'~F
E. ENGINEER S CERTIFICATION / Cd ~O~¢H ~ ~ ~¢~ ~
certify that I have checked, verified, or conformed to ~1 MOA and HAA guidelines in ef~ct on the date of this inspection~
Signature
Engineer's Name
Date
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska ~577
HAA Fee $
,-~ OI~ ,4 -~%
Waiver Fee: $
Date of Payment
Receipt Number
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL iNSPECTION
& FLOW TEST
SITE P[ ANS
ROAD DESIGN
SO[L TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERTSHAFER. PE
ROGERSHAFER, PE
November 24, 1992
CIVIL ENGINEERS
(907) 694.2979
FAX694 1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attention: Susan Oswalt
MUNiCiPALITY OF AIqCI IOI~AGE
ENVIRONMENTAL SERVICES DIVISION
HOV 2. ,".. 1992
RECEIVED
REFERENCE: Lot 14; Fairmount Subdivision
D~ar Susan~
Request you issue the attached He~lth Authority Approval.
As you know, p~r Flattop Technical S~rvices' lett¢~ dated November
3, 1992, there are some discrepancies in the septic inspection
report for the referenced prope~y. Attached is a revised she¢~ 2
of 2 of the inspection report which ~liminat~s the discrepancies.
Flattop Technical Services' meritorio~ i~pection also revealed a
separation distance violation b~D~een a drainfield trench on the
referenced property and a w~ll on the adjacent Lot 13.
On November 18, 1992, Tweed Excavating abandoned that portion of
the drainfi~ld encroaching the w~ll by excavating and r~moving the
s¢~r rock and piping. To replace the portion abandoned, 3 fe~t of
ne~ dr~infi~ld was added to the existing system. This change is
also depicted on the revised sheet 2 of 2 attached.
If you have any questio~ or require additional information for
your review, please contact us.
Sincerely,
ROGER J. SHAFER, P.E.
RJS/tv
Attachment
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
CIVIL & EN¥1RONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
TItEODORE F. MOORE, P.E. ~ 14530 ECHO ST.
PH: (907) 345-1355 November .~, 1992 ANCHORAGE, ALASKA 99516
Stephani¢ Paszek
Century 21 - New Horizons Real Estate
2213 East Tudor Road
Anchorage, AK 99507
Dear Ms. Paszek:
Per your request on October 26, 1992 we conducted an adequacy test of the water supply system
serving the house owned by Lynn Billington on Lot 14, Fairmount S/D, located at 5500 Rabbit Creek
Road. The following is a report of our findings.
We were unable to locate a driller's log describing the original installation of the well. The driller's log
which you provided to us indicates that the original well was deepened in August of 1988 from a depth of
60 feet to a depth of 140 feet, and had a reported yield of 1.5 gpm. On the date of our test the static water
level stood at 24 feet below the top of the casing. During the course of our test we pumped a total of 252
gallons of water from the well over a 3.5 hour period. Steady pumping of 182 gallons of water from the
well at the maximum pump output of 7.5 gpm caused the water level inside the casing to be drawn down
to the pump intake at 139 feet. We then measured the actual well production over three recovery and
drawdown cycles. Based on our test data we determined that the total yield of the well is 0.34 gpm,
which is slightly in excess of the Municipal criteria for approval of a 3 bedroom residence. This well
yield would not satisfy the FHA lending criteria that a well be able to supply 720 gallons of water within a
4 hour period. Water samples collected on October 26 were satisfactory, showing 0 coliform or other
bacteria per 100 ml., and 0.33 mg/1 of nitrate-N.
According to the as-built inspection report on file at the Municipal Health Department, the wastewater
disposal system was installed in October of 1991, and consists of a 1000 gallon steel septic tank followed
by a 5' wide soil absorption drainfield. The engineer's inspection report provides conflicting information
regarding the length of the drainfield (either 53' or 55'), and the gravel depth below the horizontal
distribution pipe (either 1.8' or 2'). Because the soil absorption system is less than two years old, no
adequacy test was required or performed. To apply for a Health Authority Approval (HAA) certificate,
however, it is necessary to verify and report separation distances between applicable wells and septic
systems. Our measurements indicate that the west cleanout pipe on the mom northerly of the two trenches
is 98.5 feet from the well on Lot 13, (see our notes on copy of revised design). Since this is less than the
required 100 foot separation, it will be necessary to either obtain a waiver of the required separation
distance or to remove the portion of the drainfield which is less than 100 feet from the well on Lot 13 and
replace it in an acceptable location. The Health Department probably would grant the waiver because the
deviation is small, but the process usually takes about 4 weeks. Them would also be an extra cost of
$300 for us to prepare the necessary waiver analysis report and $590 for the Municipal waiver fee. Since
the engineer overseeing the installation of the drainfield was responsible for ensuring that the applicable
separation criteria were achieved, the property owner may wish to an'ange for that engineering firm to
obtain the waiver. Please feel free to give me a call if you have any questions on this report, and/or let me
know if you wish us to proceed with the waiver application.
Sincerely,
Ted Moore, P.E.
i II I
FLATTO~ TECII~C^I,
~. (~o7)
AI)EQ~/AGY TgSl' I~ATA SI~EET
sec "b.~,o. ' pipe w. , fluid
oe~' '-" b.C.O.,____, pipe ~.., £1ui~
se~"---'~" ~1~.o pipe ~,,' ' "':flu,id
-ee~" t.o."" "pipe ~. "~uid
Surge Capacity
Adequo~e for
TE NiCALSE
CML & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
TIiI£ODORE F. MOORE, P.E. November 3, 1992 14530 ECItO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
John Smith
M. O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
RE: Lot 14 Fairmount S/D On-Site Wastewater Disposal System Inspection Report
Dear Mr. Smith:
We were recently requested to obtain a Health Authority Approval (HAA) certificate for the subject
property. In the course of drawing information from the recently approved On-Site Wastewater Disposal
System Inspection Report to complete the HAA "yellow sheet", we encountered conflicting information
regarding the gravel length in the drainfield (53' reported on pg 1 vs. 27'+28' reported on pg 2) and the
gravel depth beneath the distribution pipe (2' reported on pg 1 vs. 1.8' reported on pg 2). Some
combinations of these numbers do not add up to the required total absorption area. We bring this to your
attention under the assumption that you will wish to contact the inspecting engineer and have him resubmit
consistent information.
The HAA "yellow sheet" also requests information regarding the separation distance between the on~
site disposal system and wells on neighboring lots. In obtaining this information we measured a distance
of 98.6' between the center of the cleanout pipe at the westerly end of the north drainfield and the center of
the insulated wellhead on Lot 13. The approximate location of this well was identified on the engineer's
revised design dated 10/31/91, but the inspection report form does not contain a designated blank for this
distance to be reported. I realize that the deviation from the required separation distance of 100' is
relatively small, but I cannot record it as being 100 feet over my engineer's seal. Thus, unless your office
is willing to process a HAA certificate with the separation distance as-is, someone will have to either apply
for a waiver or relocate a portion of the drainfield. Perhaps it would help if a future revision of the
inspection report form were to include a designated space for reporting the separation distance to the
closest well on a neighboring lot.
Please give me a call if you have any questions on the above.
Sincerely,
Ted Moore, P.E.
RECEIVED
NOV 5 1992
MuniciPahty of Anchor
Dept. Health & Human e~.a..g..e
~VICOs
THIS 81DE FOR OFFICIAL USEONLY
. ' ~ "' ...... DATE RECEIVED
INSPECTION APPOINTMENTS
TIME i 'T~ME ' TIME .....
DATE DATE
INSPECTOR · 1 ~JSPECTOR INSPECTOR
DI R ECTIONS~. ' ~
~ SINGLE FAMILY ~ ONE ~ THREE ~ FIVE
~ MULTIPLE FAMILY ~ ~O ~ FOUR SIX
T PERMIT NUMB~
~ IN~i'g~UAL ~EPTH O~ W~LL .....
~ COMMUNITY ,
~ PuB~LIc UTI LITY DATE DRILLED
Connection Verified , LO~ RECEIVED
' P~RMIT NUMBER
3, 8EWAG~DISPO~AL SYSTEM
~ IND'I'~I~/ON .SITE DaTE INSTALLED
Conn~fi.~ Verified
~ , .~ INSTALLER ......
Siz.; -~ If Tank is homemade SOI~S RATIN~
give dimensi?gs: ~
TYPE OF TA~ MANUFACTURER
TOTAL ABSORPTION AREA MATERJ~L ......
4. Dl~TANCESAb~orptl~.. Area toWELL TO:nearest Lot L,ne " ~eptl~/Holding Tank .IAb,orpt on Ar~a JSewer Line .....
6. ~cOMME'NTS
~ OONDITIONAL APPROVAL (letter must accompany certificate) .,
~ DISAPPROVED
'LEGAL DESCRI~T oN
72-010 (Rev. 3/78)
MUNIcIPALiTY OF ANCHORAQif
DEPT. OF tlEALTH &
ENVIRONMENTAL
~905 OLD SEWARD HIGHWAY
ANCHORAGE, ALASKA 99502
OFFICE: (907) 344-O313
November 7, 1978 ADC No. 78i14
Mrs. Jane Johnson
Box 10-463
Anchorage, Alaska
99511
Re: Adequacy Test of Existing Septic System, Lot 14, Fairmont
Subdivision.
Dear Mrs. Johnson:
At your request, we have performed an adequacy test on the existing
septic system located on the above referenced lot which is situated
at approximately Nile 1.7, Rabbit Creek Road. The test was per-
formed on November 3, 1978.
After confirming with the former owner that the system consisted
of a septic tank and seepage pit, we met the pumper truck at the
site. The water for the test was supplied by Isaac's Honeywagon.
Since the initial depth of wastewater in the pit was 2.7 feet
and the depth of the pit is 8.0 feet, as measured from the top
of the 4-inch diameter stand pipe, it was not considered necessary
to pump out the pit prior to filling with water.
The following table represents the depth of liquid in the seepage
pit.
Liquid Depth
Time in Bit Remarks
lO:06am 2.7'
10:12am 5.3'
10:43am 4.4'
1:47pm 4.0'
5:45pm 3.9'
6:45am (11/4/78) 3.6'
6,00pm 3.4'
Initial depth.
600-700 gallons added to pit.
= 230 to 270 gal/ft of depth
in pit.
Water visible in stand pipe
1.7-foot drop=390 to 460 gal/day
Approximately 600 to 700 gallons of water was added to the seepage
pit. The meter on the pumper's truck did not permit an accurate
estimate of the water added. The added water raised the liquid
level 2.6 feet to 5.3 feet, or 230 - 270 gallons per foot of depth
in the pit. The 5.3-foot water level in the seepage pit was within
the stand pipe, so additional water was not addea.
November 7, 1978
Mrs. Jane Johnson
Adequacy Test
Page -2-
As can be seen in the Summary of Measurements, the water level
dropped 1.7 feet to the 3.6-foot level during the 24-hour period
of the test. This would approximate 390 to.q-460 gallons per day
that your septic system is disposing of through soil absorption.
It is assumed that this three-bedroom house will house five
people, the average daily load on the disposal system~:can be
expected to be 375 gallons per day. Since this existing seepage
pit percolated 390 to 460 gallons per day, it can be concluded
that the system is performing adequately at this time°
If you have any questions concerning this test, please do not
hesitate to call our office.
Sincerely,
ALASKA DEVELOPMENT CONSULTANTS
Stephen D. Shrader, P.E.
Project Manager