HomeMy WebLinkAboutALPINE TERRACE BLK 3 LT 80
\A
C�eveiopnent Services Department
Building Safety Divisicn
On -Sita Wcter &Wastewater program
4700 Sragaw Street
0t n;
?.0 Bax 196650
Mark 6egich
Anchorage,,Al" 99519-6650
Mayor www muni.arn/ansiTE
(907)243-7904
pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue: _
Parcel Identification Number:_
Legal Description Property Owner Name & Address:
/-A L P1146 T e R (SIG_ '� ,✓llr�u�zL
G-3 _s�?
pump Installation Date:
pump Intake Depth Below Tap of Well Casing: e/Ofeet
pump Manufacturer's Name: �2 j< J- ,,j
Pump Model: 7 'FL11V7 505 oZ3
Pump Size hp
Pitless Adapter Burial Depth: 8' feet nn
Pitless Adapter Manufacturer's Name: ✓:�'b tis
Pitiess Adapter Installer: n) ✓+
',Veil Disinfected Upoa Completian?'�es No
Method of Disinfection: C L, L J . 1 0
Comments: [�
Pump Installer Name: �� �1�Laf Y\
All
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installaticm.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 015 -243-11
Certificate of On -Site Systems Approval
OSC261003
Expiration Date: 12/2/2026
Legal description ALPINE TERRACE BLK 3 LT 8
Site address 11830 CIRCLE DR
Current property owner(s) MITCHELL MARK J & ROSLYN M
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
LN
Original Certificate Date: 1/8/2026
This Ce icate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sys m(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
evelopment Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory
Other __
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D, 015-243-11
Complete legal description ALPINE TERRACE; BLOCK 3, LOT 8
Location (site address) 1183t) CIRCLE DRIVE, ANCHORAGE, AK
Current property owner(s) MARK MITCHELL Day phone 907-250-3077
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: � Private Well serving # dwelling units
R Other Non-public well as regulated by MOA F-1 Water Storage
El Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: FRil Private Septic ❑ Private Septic serving 2 dwelling units
D Holding Tank [I Community Septic or Public Sewer
5. SEPTIC TANK: F1 Steel 1771 Plastic RN Concrete R Fiberglass
Age 60 -See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: MAWWTS 177IBed FjDeep Trench F]Wide Trench FEJSeepage Pit
Waiver request for:
Expedited review requested: F-1
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 45 5_0- C'O Waiver Fee $
Date of Payment
COSA#
Date of Payment
Waiver #
COSA Application_Apr2025.doc
COSA Checklist
Legal Description: ALPINE TERRACE; BLOCK 3 LOT
U1�-�43-1�
ParcelQ0:
If more than 1well and/or septic system on lot, provide separate checklist. Structure served by this system__
A. WELL DATA
0 Well log isfiled with Onsite (or attached)
Date drilled 1966 |ked Total depth °45 1t
Cased to ~45 ft
[�
,�Ganitory seal is functioning correctly
��Wires are properly protected
��
W�pmd����e���_�_gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? Yeo nNo
X Coliform bacteria inNegative
Nibate 7.64 my/L F7Nitrate less than MRL (ND)
Casing height (above gmun__18+ �)n. Amwnicug/L RN Arsenic less than MRL (NO)
Date offlow test for CD8A 1282/2025 Collected by 8ARNESQEN8|NEER|NG
Static water level atbeginning oftest 35.9 w. Date 12/2/2025
Comments
*PER AVVPSCAMERA |NSEPCT|ONOFWELL (SEE ATTACHED REPORT).
B. TANK DATA to"�T STATION
M�mma o��ingflu��v�ine�U �nk"�" MRequ
Date of pumpi
ng 5/20/2025
Age oflift station
FlRequired maintenance completed, if/VyNNTS Lift stationpMdGall�'-
BOTHST1ANOGT2
Comments: *IN '
*NOTE: PER PREVIOUS HAA AND ENGINEERING REPORTS, TANK IS MADE OF CONCRETE AND IS 1250 GALLONS.
VERIFIED CONCRETE CONSTRUCTION VIA CAMERA INSPECTION. SEE ATTACHED REPORT.
D.DISPOSAL FIELD DATA
Which system tested (date installed) ^1965
FlALL standpipes present per record drawing
Total measured depth 6 1D
from .2 ft (max)
Measured depth hopipe invert from grade °*3.5 ft (min)
FlN/A — pressurized field. -----
El Per record drawings, field is insulated.
[�Monitor tubes gotobottom ofeffective.
Ifnot, state depth into effective
FlPresoaked required if
(Required ifhouse vacant orfield not used for more
than 3Odays prior hodate oftest)
Gallons introduced _gallons date
Any rejuvenation bNONEaodm�nt(paot1�montho)
If yes, enter date
12/2/2025A�q������_____
Results [�Paoo
o
Fluid depth prior botest 51
in
Water added 644 ga(
New fluid depth 65in<--NOTE: LAST 500 GALLONS
2.5" RISE.
1O5 �
Elapsed time m|n ONLY CAUSED A2
Final fluid depth 59 in
Absorption45O+rote gpd
FIELD STATUS—POST RECOVERY
Effective depth (per ��rem�rddn�w|ngo) in
Effective6Ddepthueed in
1nwSSVME o)
Effective depth remaining m
: *CONCRETE BLOCK SEEPAGE PIT (CONFIRMED VIA CAMERA INSEpCTKzm)INSTALLED |m1uo5PER
2002 HAA AND 1983 ADEQUACY TEST REPORT. NO RECORD DRAWINGS COULD BE FOUND FOR SEPTIC SYSTEM. MOA APPROVALS ow
SEPTIC SYSTEM HAVE BEEN ISSUED IN PAST. -MEASURED TO TOP (UNDERSIDE)OF CONCRETE SEEPAGE PIT. -MEASURED
IFROM BOTTOM OpCONCRETE LID TOBOTTOM OpSEEPAGE PIT.
f. -w
? q ^ ,S
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100'
85+/-
Sewer Manhole/Cleanout > 100'
Q Yes
if No ft
0 Yes
if No
ft
Neighboring Tank > 100' ❑✓ Yes
if No
ft
Sewer Service/Septic Line > 25'Q Yes
if No ft
Disposal Field on Lot> 100' QYes
if No
ft
Holding Tank > 100' Q✓ Yes
if No ft
Neighboring Disposal Fields > 100'
Animal Containment > 50' ❑✓ Yes
if No ft
�✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Sewer Line/Main > 100' [j] Yes
if No
ft
� Yes
if No ft
N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10' Q Yes if No ft Surface Water > 100' R Yes if No ft
Field to Foundation > 10' Q✓ Yes if No ft
Tank to Property Line > 5' ❑✓ Yes if No ft
Field to Property Line > 10' [DYes if No ft
Water Main/Service Line > 10' 0 Yes if No ft
Wells on Adjacent Lots:
Wells > 100'
Community Wells > 200'
❑ Yes if No **93 ft
R] Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
'ONLY REQUIRED 50' SEPARATION AT TIME OF INSTALL (1965). "WAIVER GRANTED FROM WELL (LOT 1, BLK 3) TO SEEPAGE PIT.
- SEE WAIVER #WR030084. NOTE: THE SEPTIC TANK IS UNDER THE DRIVEWAY. TANK HAS ONLY 1.6-1.8 FEET OF COVER.
SEE EMAIL FROM OWNER REGARDING NO FREEZING ISSUES.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Gayness, P.E. Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments
may exist that were not identified during the evaluation. The operational life of all wells and septic systems
depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that
may fluctuate during the year), quality of construction (materials and workmanship), and the water usage
of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG.
Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no
warranty (express or implied) regarding the future performance of the well or septic system. GEG makes
no representation whether an alternative well or septic system can be installed on the property in the event
either of the current systems fail to perform adequately in the future. The content of this report is for the
sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the
information provided in this report by any other person or party (including subsequent property purchasers)
is not authorized, nor will it confer any legal right whatsoever.
I.OF
q
:.... ............ ..
Qp e frey A. GzY`rness;
53 evG
cG
LICENSE4ea Pr ° f e s
#AEcceaa �040�00`�0
Bill To: Ship To:
Mark Mitchell Mark Mitchell
11830 Circle Dr 11830 Circle Dr
Anchorage, AK 99507 Anchorage, AK 99507
20255347
SALESPERSON
YOUR NO.
SHIP VIA
COL
PPD
SHIP DATE
TERMS
DATE
PG.
RIDGWAY, TYLER S
40821
Net 30
12/12/2025
1
QTY.
ITEM NO.
DESCRIPTION
PRICE
DISC %
EXTENDED
PRICE
TX.
1
Service Call
CAMERA WELL FOR INTRUSIONS AND/OR
DAMAGE TO INTERIOR CASING AND
RECORD WELL DATA.
1
FIELD SERVICES
12/12/25 - Check system. Locate well head
and remove well seal. Camera well to procure
down hole data. No intrusions or damage
present to interior well casing, well is cased to
full depth of 45'. Reinstall well seal.
WELL DATA:
Pitless adapter depth - 8'
Static water level - 38'
Pump set depth - 44'
Depth of well - 45'
Casing depth - 45'
0.5
ST5-Tyler
Service Tech
0.5
ST19-Dennis
Service Tech
1
CAMERA
WELL CAMERA
$400.00
$400.00
SALE AMT.
$400.00
We appreciate your business. Thank you!
FREIGHT
$0,00
SALES TAX
$0.00
TOTAL AMT,
$400.00
PAID TODAY
$0.00
BALANCE DUE
$400.00
Arctic Effluent Services, LLC.
PO Box 110192
Anchorage, AK 99511 US
+19072298237
alaska.aes@gmail.com
6020
Mark Mitchell 12/10/2025
11830 Circle Dr Net 30
Anchorage, AK 99516 USA 01/09!2026
12/10/2025 Camera inspection Camera inspection of septic tank and 1 350.00 350.00
seepage pit to verify both tank and
seepage pit are made of concrete. Inlet
of septic tank drops in the top of the
tank. There is a center baffle between
the solid side and grey water side of
the septic tank with a center block
missing for effluent passage. Outlet of
the septic tank is in the Northwest
corner of the tank. It is touching the top
of the tank and leaves though a 90*
elbow.
The seepage pit is also made of
concrete, and the inlet of the pit enters
through the top of the chamber.
350.00
$0.00
9
R
I
0
TM
Sonja Blewett
From: Mark Mitchell <hotsauna2@gci.net>
Sent: Tuesday, January 6, 2026 10:52 AM
To: Jeff Garness; Sonja Blewett
Subject: Mitchell's Septic (11830 Circle Drive)
Morning Jeff and Sonja,
Roslyn and Mark Mitchell (Owners) have not had any freeze issues with our septic system with our house
. We purchased the house in November of 2002.
Thank you,
Mark Mitchell
hotsauna2@,&ci.net
907-250-3077
Payments $0.00
Pleamnnin��a�wewNma�
�^ `- ' amount
aspaid once payment ioprocessed. Thank you! Total Due: $320.00
~Weare not responsible for any damage tudriveways,
walkways, and or pavementdtosoft ground, poor
installation, orslick/icy conditions. Late Fees May be i
applicable after 3Udays past due. |
�
Invoice
~..~ -~.-~_
A'HOME SERVICES
DATE 12/10/2025
e07'345-1890
iNvorm 8955
TERMS Due Upon Receipt
roovv*zstave Suite zotDUE
DATE 12110/2025 |
Anchorage, AK995O3
--------------'-----
(yu7)y15'zogu
m/o@ap|vsax.com
BILL TO
SERVICE LOCATION
Mark Mitchell
Mark Mitchell
11830 Circle Drive
11830 Circle Drive
Anchorage AK 99516
Anchorage AK 99516
(907) 250-3077
(907) 250-3077
,JOB#, DATE POIREF#
DESCRIPTION
1079952473 12/10/2025
2000 gallons, 3 standpipes
Tank in driveway 50'from of house
Please note the gallons pumped from the septic tank (should
be 1250) and from the seepage pit separately and as
accurately as possible. This pump is being done in preparation i
for arctic effluent to perform work.
Completion Notes: 2000 pulled (1250 from tank, approx.
1700-1800 from seepage pit)
Payments $0.00
Pleamnnin��a�wewNma�
�^ `- ' amount
aspaid once payment ioprocessed. Thank you! Total Due: $320.00
~Weare not responsible for any damage tudriveways,
walkways, and or pavementdtosoft ground, poor
installation, orslick/icy conditions. Late Fees May be i
applicable after 3Udays past due. |
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT � � z"�`� A 907-343-7904
41
On -Site water and wastewater Section u ,„_ Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC261003
Subdivision: Alpine Terrace, Block: 3, Lot: 8
A water sample revealed a nitrate concentration of 7.54 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet” for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
ry
0
X
Ln
00 LJ
�V) LJ
LL-
,:,-3DaL-Lvv Mosaw To 112 5c, CHI
Ld
0
Z
Z LJ
af
Lai
60
C) 0
C)
Lli Lli
crz
0 LLJ
��Z
LliZ
LU
tum LJ U)
(10
LAJ
t a i
ry
Ljj
+E
i
r
Lli
Ln
—i
LLJ
D z
V)
I
�.,.«�
»saw
LAJ
L-Lj0
0
LLJ
LJ
LLJ
Lli
LIJ
0 -
»
CL
LLJ
u
LJ
��
Z
LLJ
Z
1
0
Z
Y<
z
W
CK
Ll-
LJ
i
0
<
(D
3
i
s
!
E
Ld
0
Z
Z LJ
af
Lai
60
C) 0
C)
Lli Lli
crz
0 LLJ
��Z
LliZ
LU
tum LJ U)
0 >—
UJ LJ 'LJ
Lj of
(10
LAJ
t a i
ry
Ljj
+E
i
r
Ln
—i
LLJ
D z
I
�.,.«�
»saw
LAJ
LJ
LLJ
Lli
Lj-
»
0 >—
UJ LJ 'LJ
Lj of
(10
LAJ
t a i
ry
Ljj
+E
i
r
Ln
—i
LLJ
D z
I
�.,.«�
LAJ
LJ
LLJ
Lli
Lj-
»
0 >—
UJ LJ 'LJ
Lj of
1
+E
u
+E
--�,
M-unicipalit-v of Anchorage
• �`
Development Services Dep�rrent
Building Sefety Division
On -Site Water enoF WastewCAter Progr2m
4700 South Br rgaw
P.O. Box 195050 Anchor -Coe, AK 99519-5550
wwwCi.cncho naae.ak.uS
(90 a!) 3-44�-7 904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel 1. D. 0 / ,S+ - 2 � 3 -- / /
1. GENERAL INFORMATION
-7 f I ;"i'
ExP1rGtion DGtts:
Complete legal descripticn
occ:tion (site Gdd-recs or dirc;Ctions)
C' lrr cell i ope(- o t,Aj r-j p r I.S
i
Lending agency (A'I k* -,,,:.,:.,,..
J .
Mailing address
t c1 ESt2te Ae n t ;., ;
4/y��e
Mailina , d dress
L
U� leS ol"3 evil e req( est'ed, I ', Al hic-ld y
2. NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY.: TYPE OF WASTEWATER DISPOSAL:
Individual Well '
ndlvidual On-'--i:_ }C.
IndividLICa1 VV2-t,'i- ,'rl!'Ji' �id- 12I Holding t2nk
Comm II ! 7lin`aty ClCr.`.w o,. o I kI! Su lily OI i sice i
Public VV2ter Sys:: m r 1 Public SE::'Ne,
T 7 - , .-y _
i ne N/11uni-iialii ,^_ n �,„r _,. -- -' _ ,- ;� S �, t�:=
FF i �.� . f--.. �; n+• r'V� ..� ►+ + � v .+ ! `1 .� ..-, f r �` to � � (ry 1i j] ` r �\ r" .-� ♦ 1 i! �(^�-' I J�JS�+
V • �T `I i !-�'.k f'Vi IL.I I Ga.. v ai { VtV V 1 ! •�... a 4 Ls . 'f vwr+ ..e5?,f i 1Lft kl (D`./ D) J v��...%4 ✓ ^ i V� 1 i.� / ♦�� ✓+f
AC;Crc-,V l (1 ►`AA.) bc� .d c ni'�` upon r'�� r�'� "� �:� "�� =" in c�rGgr h 4 GV an IriCe�`��`� �`i �(OieS` QnGl C;�t>�;
t Z.-sJk %•tea ^ .... ;•.. `�f'w, i F a ID
. t.•Vi �F � 1 v :e t
ncineC, reQlSiereo In the State of r,lGska, Ce. C':Ci ; ith Authority Approv l 3r e re;:uired for the transfer C
F
ill (-except ertitiven so0u 0S} roe �rO e IL- cc�,f�n by - _ nglc-7�1 ;1i`r' Oki- ii: v°FicS C:`��IctZ_, ui c`?.OSGI cridaCr
• r. \ i 1 i r .� j L^ r.
� IIJGiIy 4VS?e rrl. fiD 1 0 IstiuS l lAA,s UCOri reou Si C r�0r o`r'�"- ::ram, Ce 'L]i,ca' 0i I- .�.,,it i r,ut,1;Gk i -y r',DPr0 <n �
^
1fr-. id for 90 days from I, 1`�I- date r'`f issue 'Cr ►'� "F 1_ ies s � er: y = n i\i^'f (� (-^� (_' t[, �1
e.• Ld F w tie 1.J r U 1 t . f .,,,. �... L� '% `. ►., r k s c L v r V v v 4i Y Yt �w `{ 3.,,/ i `•~i I v y ::vim
R jCLi-. I-^ S+e results. ; V `e r-ffic :s\es f 1 Ia`f i ri I eiQcz- U„w � v r ,'r.+ p V i icd oI u,ram+ 1, ur!e ^ •- h � i 1 -.. vim. r'` ( ^
r, _ _�. _ _.. ,� ► �1l�: t vcll0 lJ�.�,r �.iil
../ei" ^^+- r'= I 1F0 r '7^ ^/ I ' •-\ ... J C....,.... 1' E t r" public Yv ,I�r �'�'� l=, t. i r'.•
� ii�;L.�.w�',,..a Cii, \ t (, /.-�"'r ?�I p��' r!iG �'--'� ! �+. � >~ vf^.�{ J-' ^ S ^` w �..4
(j j )''+ Y ice. t I L� ! G I ,..i ( `.� ..+. r..i i 4.., ail ... ! r... 1..) r !� r v , i ` C
I,d! I l.2 1 1 I t .' t
Ciz� ��'c c p :e
i to l� re; �.,..:� I ,c .,ny ►1 r s ��Vcrrt,
.. 1 .. ;
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my se.i (alffixed hereto and Calls of the v(alidcaticn 012-te shown bed I verify -1-h-t mv
I L d inveSztiQaL1(Dn,
based on procedures Outlined in the He2ith /uthoriti Approval aGuidelines for this applicat
ion, :shows that the on -
Site water supply and/or wastewater disposal system is(are) safe, functon-1 and adequate -c r the number 0�
Z-, 101 L I T
bedrooms and type o-F structure indicated herein. I further v;E,�,ri-I'V that bal'sed on the inform'2110111 obtr--Ined from the
Municipality of Anchorage files and from my investioation and inspection; the L on -site water Lt;r supply 2-MCl/or
wastewater disposal system isklare'� in compliance with (-:Ili applicc-3-ble Municipal and State I I L t code-,.-,-, ordinances.
and regulations in effect at 'Lhe "Lime of Installation.
dame of Firm r— �a I-0a 7_/( c
Phone
41
A d, d r e s s C.
Encineer's Prated Name Date
5. D%':.Z;D SIGNATURE
ppro7)
oerrooms.
ved f7cr
D i s 2 p p 1- o v r;
Conclitl'onP1200rovad fb le dronsvvith-=_
S.lcul
osniIlan:
A t_ I Comments
o'
2 7
NJ
ALL�
H4, -t Maintenance- Alkareements
C] V I S 0 ry Suppiementca-1.1 Engineers Report
4
( I-N � f
E"
D-te: C-
n
Muni cipality of Anchorage
Development Services Department
Bu;ldlng Safety Division
On -Site 'Water & Wastewater Prog.rart
4700 South Bragaw St..
P.O. Box '196650 Anchorage, AK 99519-6650
wwvv. c i - a n c h o ra q e. a k us
(907) 3,183-7904
HEALTH AUTHORITY APPROVAL CHECKLI"
. T
Leg-1 C)ncorip t i, o n - f/1) Paroc al I D: 0C 2 Y 3
A. WELL DATA
Well type. rvk If A B. or C provide PVVS1D # V, /1.
Weli I og (YIN* __A-1
Dcatc-wl
Sanitary seal (YIN ) Y S pr,�Iperly protected ("ON) ......
Tot-c-i! depth IA -
Cased to Casina height (abc e gro ri� Z
F':�OM WELL LOG
Da te -D fl' lest
Static vva',:ar level
Well production
WATER -'E3,A'_\MPLE R,r_-_SLJLT
A i I IN S P E 10 IN
'g-P.M.
C a TO F rl coionies/i 00 mi. 1'6L":-�
y. 7�_M
tb7c 'eCLOererlr0_ colonic CDC rnl_
Arsenic-
_
rn. ./I. D_t'Z of simply: 'q
_Z3,010 2
)4.e,,-
B. SEPTIC/HOLDING TANK DATA 14
Tank Tyne/Material Sep etc 60 0"-A C I- e- Ae Date installed
Tank size Z S-0 cal, NumbeF of Cornpartments
Foundation cleanout (Y/N) N Depressicn over tank (YIN) Hqh wat-er alarr� (Y./IN",
Date Of primping Pumper v A:> R0
C. ABSORPTION FIELD DATA
./ft2 �2
D'L,e installed 19 6S Soil rating (g.p.d or L /bdrm) A
P7F
L
Length 6,( /1 I< Wi d t h ft. Gravel bek--w/ pipe 6-(1-) L--, '11
Total depth ft. Ef. absorption area t4n ft' Monitoring tLibe "*7'
DeP_res,--ion over field AJ
Date of adequacv test /0 Results 'Pass'Faik /I cc Ej-
.1 r-cr bed
, t�",
Fluid depth in absorption field before test in. Water a d d,%c-- d -7 3 Z g - j.
C14 Nel�-v depth 6'7- 1 in.
Elapsed Time-200 min. Final fluid C e;D t h 'Y 9, �5- i n. >:7
Absorrtion rate --
g. p.;j
Anv I-e uvencation trim atmen t 'past 12 mo.) 'Y/N type)
Y L L le_r) C> cic.t/_)
if y 7.0, give date Ail
t-(� 44 1 t-e /10 (:Z /),' nz Lv Cf, /0
C, m ty S ce
L.IFT STATION
installed
'Put-np on," level at in.
Daturn
H.- SEPARATION DISTANCES
l.ti i ri a a a r is it i i7`' i
"Pump off levie--! ait- HK 4 ri ai-:3rn- ievel c,---Z'
Cycles tested. a -
SEPARATION DISTANCES FROM VVELL ON f-OT
��eptfc tank/lift station on lot 11,671
Absorption field on lot to (5
Pdblic: sewer main
11-1k
,,.;n adjacent lots, *a 5
Or, adjacent leis
Plic Sewer ry"
Z,91 I ol-iding tcll
Sewer /lstept;�c, service line > an k 33EPARATION DISTANCES FROM ON LLOT
Building foundca:flon 9 Property !iF!c- 1�—,
`Ah- a r main
VVater r
-:3 Jr
Able-lis on adjacent lots 105,
SEP RATION DISTANCE FROM ASSORT--7-10N I LOT Ly
T0-
TDroptelt line Building found-tion 7VV-Itnt,
'•A/at-ear Service line wcate:
(Z
cl: s o n a d *,a Clr-z n t 1 cTcz
Cur-t `- drain LO j9/,)
('%.*OMW!ENTS
chine- e 7`-Ir-ln e 14-cn
�- r& /-n c in,,- 74r-t ---I -,
�>e J�-) -�- ' 9 f /�c,, C -e , 4 -e
C�- ENGINEER'S CERTIFICATION kle, J/n lclt(5,102
-ertfify that / have defen-nined throe-igh field inspnect 0 17 S C, 3 ri
T Municipal records
Jett
t'OvieW of that the above syste!-Ds are j,-, A4.%---
06000.000 to tr,
co-inform.-Mce 1with MOA HAA guidelines in effect (--)n this r,Pte-, !i V/
s.
Engineer's Printed Name 1 e� -10ro- AV
Date 0,- As zoo
HA.,A Fee -7
D.-7-je of Payment
. � ipt Number� i � � __
(Rev- 12/011)
Date of Paym-ent
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
Application
Date
GENERAL INFORMATION
(a)
(b)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions) . r
Applicant Name ~0.~ ~u~k5 Telephone: Home
Applicant Address
~q ff ' '715q Business
(c) Applicant is (check one): Lending Institution [] · Owner/builder []1"'Buyer []; Other [] (explain);
(d) Lending Institution LM~,>-f-~
Address ,400 L,~ -~"~'F
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(f)
Mail the HAA to the following(..~dress:
TYPE OF RESIDENCE
Single-Family [~Multi-Family
Number of Bedrooms
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 Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequ, ate
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 in~spection. . ,/,
Name of Firm O~'o~.c~, Telephone
Date 30 d?r,'l:
Enginf~er's Seal
Approved for
Approved
bedrooms by /l,
Disapprove¢
· · Condition~a;._~
Date
Terms of Conditional Approval
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 independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order 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
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MAY 0 9
Legal Descri~,~Tg,
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
.Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
1") f' ~ ~/O.~-. If A, B, C, D.E.C. Approved (Y/N)
I j~ Date Completed
Cased to
Depth of Grouting
Pump Set At ~'
Sanitary Seal on Casing (Y/N)
~ Depression Around Wellhead (Y/N)
I
· On Adjoining Lots /00 ~
! '
· On Adjoining Lots
To Nearest Public Sewer
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~//~
Cleanout/Manhole /q/~ To Nearest Sewer Service Line on Lot
Water Sample Collected by /. O(;~,r' ; Date ~(~
Water Sample Test Results ~-u,.~ ,.~;~, .Ti~_ ¢
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed / ?b$
Standpipes (Y/N) U ~
/
Depression over Tank (Y/N)
Pumping/Maintenance Cc ntract on File (Y/N)
/
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding 'Tank:
To Water-Supply Wel /~)O t
To Property Line ~
To Water Main/Service Line Course /~O ~ '/'
Size 1,~50 'P ~'~
No. of Compartments
Air-tight Caps (Y/N) y ~,~ Foundation Cleanout (Y/N)
Date Last Pumped ::5' ' I -
/N/A ;for --
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Iisll®sal Field
Te Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field LutA.
To Building Foundation
Lot .
To Water Main/Service Line
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well j ~.1
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)'
Date of Last Adequacy Test
; On Adjoining Lots
To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course . ,/OO f
To Driveway, Parking Area, or Vehicle Storage Area ~)
Comments
u
To Property Line ~0 ~'
To Existing or Abandoned System on
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 Pe~rr
I certify
Com
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
tted Be/m Rating Against HAA Request **
;ire ch~d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
¢~"'/~-'~' "~ ~' Date 30 (~Sf'~[! ~6~f¢
IN"qlCE ~ - 013 813
"/~ ~ ~~ CLEANING SERVICE
~ ~ ~"
P.O. BOX 112688
Job Address
PHONE 345-2513 ANCHORAGE, ALASKA 99511-2688
ROTOR ROOTER SERVICE CALL HRS. (~,
STEAM THAWING HRS.
TRIP CHARGE HRS.
OVERTIME CHARGE HRS,
ADDITIONAL LABOR CHARGE HRS.
PUMPING SERVICE ///~/~O1~(GAL) HRS
HYDRO-JET SERVICE HRS
PLEASE PAY FRGM THIS INVOICE
CUSTOMER ORDER #
TOTAL
TOTAL FOOTAGE CLEANED OR THAWED BLADES USED
PROBABLE CAUSE OF STOPF~AGE ~~A. (~") J~
APPLIC 'iT FILLS OUT UPPER HAL' JNLY
Prop~, tyOWn6r Authur F. & Jean M. Johnson Phone
385--0793
Mailing Address SR Box 2392, Anchorage, AK. mpCode 99507
Buyer Joseph P. & Judith H. Burroughs
Address ~ Zip Code
Lending Institution Alaska Mutual Bank (Benson Branmbl~ Phone
[~R~}l;{]~,.~r;~ 00 }l< .... z,p Code 99509 274-3561
Address
Realty Co.&Agent Associated Brokers Thc. Phone
Lof~se D. Campbell 563-3333
Address ~i.~ W ?Rt:h dl Anehnr~[~_=
Legal Description L8 B3 Alpine Terrace
Street Location ~.1830 Circle Dr['.
Typ.e of Residence
3~J[ Single Family
[] Multiple Family No. of Bedrooms
[] Other
wate, Su,p~y Well Drilled 1965
ATTACH WELL LOG. A wetl log is required for all wells drilled since June 197,5.
_.~ ~nd~v~dua~ NO log available
[] Community For wells..ddlled prior to that date, give well depth (attach log if available).
[] Pub,cUt,~ty Depth is 43fL
Sewer Disposal
~] Individual Year Individual Installed: ~-9 6 5
'~ Public Utility When Connected to Public Utility: _I~./_A_
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time '~ Time
Date Date Dat,~e Date
Inspector Inspector Inspector InspeCtor
/\
Field Note~ , DEPT.
( ) DISAPmOVED
( ) CONDITIONAL A~ROV~
w ~
Soils Rating Date ~wer Installed Well To Absorption Area /~ 0 ~ Well Log Received
/~ ~ Well to Tank /'~ '7 Septic T~k Size
72-023 (3182)
STEVEN A. JOHNSON
P. O. Box 76
Chugiak, Alaska 99567
(907) 688-3085
August 2, 1983
Arthur F. Johnson
P. O. Box 2392
Star Route
Anchorage, Alaska
99507
Re: Septic system adequacy test results
Dear Mr. Johnson:
Transmitted herein are the results of an adequacy test I performed on a
septic system serving a four-bedroom residence located on Lot 8, Block 3
of Alpine Terrace Subdivision.
Existin~ System Design
The system in service at the time of this test consisted of a 1250 gallon
concrete two compartment septic tank and a concrete ring seepage pit.
Four-inch diameter cast iron pipe was used in constructing the system.
The system was installed in 1965.
Adequacy Test Results
Adequacy testing was begun on June 19 and completed on June 20, 1983.
During the course of the test, 1600 gallons were added to the septic tank
at a rate of 4 gallons per minute. The fluid level in the septic tank
was monitored as the test volume was added.
Based on my measurements of the fluid level in the septic tank and the
rate at which water was added to the septic system, I conclude that this
septic system at the time of the adequacy test:
has an absorption rate in excess of 200 gallons per
bedroom per day;
August 2, 1983
Arthur F. Johnson
Page 2
is capable of absorbing 265 gallons in 49 minutes
which is equivalent to a short-term surge rate of 5.4
gallons per minute.
Thank you for contacting me regarding your adequacy test.
you have questions.
Please call if