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HomeMy WebLinkAboutASPEN HIGHLANDS #3 BLK 3 LT 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address/V~ ~ J'~./~~ IL.L_ ~ ~ I~ ~~ SEPTIC TANK ABSORPTION FIELD WELL LEGAL DESCRIPTION LOT LINE ~ ~ ' 14' /ff ' Lot I Block I ~ubdivlsion [~ ,~ ~~ ~l~ ~M~ FOUN~ATION , ,~ow..hi., .~n~e, S~c~o. / O AS-BUILT DIAGRAM (Show Iocahoe of well, septic system, property hnes, foundahon, driveway, water bodies, etc.) Material nts TYPE OF SYSTEM ~TREUCU ~ ~9 ~ W.~A~U U OTUE~ -b~ t~ ~,~e bottom lrom Total depth from orig,nal grade Fill adde~above ~gJnal grade Grave~'~epth beneath pipe ~_~'~ FT ~" ET ~ ~¢. ~ ~o/ Grave~ length Gravel width ~ ~ ~ ~ FT ~O~~ FT J Total absorpt,on area FTj Distance between hnes ~~ q 77 s0 6' ' Number ol lines j Sod rating P~pe material ~ j J I WELLS ~) ~J~ ~ · , PRIVATE ~ OTHER Ildentifv) ~o '~ ms:emro, Date installed: ~ /, Scale: ~ 'T~ a~ ~EAL ~ I~spections Pe~firmed by: I ' as pedormed according 1o ,'1 . " ,~, :. ~;.~ Municipal a.fl ,late guidelines J. efJ,c, o. this date: Health Depadmen, Approval: _ , , Date: /'"/- ---- 72-013 (3/85) H U N I (] I I:::' A L. I T Y ('.',) F::' A N C,) H CI R A (3 E!'. Dt~par. tmer~t of' Hc~al'Lh ~,. Human ,c...~ervic:e:~ ~i~i*:'~i:',;:?i I .... ~:~¢..~',~.:.:~.:.:.:¢..~ A~nc:hor'a'~(..'le:.~,, ~la~.i~.l.::a 97.501 Pe:.r, m :i. t tquml:)e~.r :: EIEt() 1() ?! Da'L~.:e I s~Lu:.~d ~: 06/3;0 Up g r ,::':~ d e Er"~¢;; i heel~ .Oe?.¢ i gnecl · .:H:::.I.,. I 1 (,., '!":':~1',11< :: Ivl i r't i mum 'Lot a 1 s; ~.=. l::) 'L i c: 't, an t< (:: al:)a(:: i 'L y ~ 1 ~, ()OC) (:: a 1 1 or'~ sl ,, E::a(:::h :'-':.r,~l:)'L i (::: 'Lank mus~t I"Jave., ~,. l(,~a~_~t,. ''' c:omp~r, tm~nt~ Depth to 'Lop of' ~:~f:~pt. :i, c:: 'Lank (.~) < Zl-,() fc-:,~e'L r'~..:.:;,C.lLtir'f~.~ :i, rt~Ltlatic)rl c)v,c.,,?~~ 'Lank (s),, IIq~!:~'T'~.~l.,..l_.~ PIER lii::Nl3IN[:ZI]i:l:;,'!i:~ ][)E:~BII3N, A BE][} 'T'YF'E: ABSE]RF"'T'iON SY~"I"E:I~I, I...I.:.'!:NC.:.FI"Hr, Z~:l., O' ~I WID"I"H~ 2.4.,, () ' ~I E~I::~A~V[!~L DEF'TH~ 6", MAXlHUI~ DE~F:'TH 8" ;.:~il~()' Cfi"= I:::'IL.'TE.':I:~. [~Ahl]) TO }31E f::'LAC'.E:D BELOW THE;: ,:~ llqbL. E F::AM T I..Y I'vE.,:) .I. DI:=NC.,I:= ONLY F~IqD NOT I FY [)I-'IH[.~ 1:::'1:~ 1' OR 'TO EACH I NSF:'EC'I" I [)N,, ~ ........ I C]E:I::~T I f='Y 'I"HPFT': 1, I am fam'.Lliar-, k~:i. th 'Lhe r'equJ, m'e~nents t'c)l- on.....s~ite s;ew(.z,,rs and I:'or{l"~ by the lqL~nic:ipality of' f:~rlchopage (MOA) and the E~:.atc~ of' ,?., I ~:i.].1 :ki"~stall t.l"~e~ ~sysH:.em i1-1 a(:::c:ordar)(:f~ with all MOA cc)de:,s ar3d ar'id itl compliaric:e)wit, l') the de, sign c:r':i, tep:La of' this :]~;,, ]J ~i].]. adh(:~P(a to a].l HC)~ ar'id [~¢..a~t. f2 of' ~a~tl.::a~ r'cequ~rem(¢~rrl:.~ for' disvLanc:f:~s~ [r'om alqy ~x:i.[tl:.ir'tg we].1, m~t.~at~er cJ:i. Bl:iO~a]' ~]~:~14¢~:'[~¢~(]f:.z, ~fy~t'..~}~l~l Olq thi~ or, ¢~'~1-1y ~c..~(::~n~: oP i"J~a~Pby ].c3t, Z L(rtc:tcer.~T..arld that 'Lh~ p~)pmit J.[r, vaJl. J.d for. a max :L mi.uli of' :3 ~a].sio L.lr/ch.~l-St..&lrld that the c:apac::ity of 'Lh(~) total syst(.zem :i.~ '.3 SYSTEM LOCATION PLAN 3ECTION / TOWNSHIP/RANG[ PEOPERTY CORNERS, ~ELL3, AH0 SEPTIC TAPE A~O PERFORMED FOR: AC.,~c'?-/~------------------~ Municipality o! Anchorage ~' ~ DEP^RTMENT O~ HE^LT. & HUM^N S~R~ SOILS LOG -- PERCOLATION TE~ ~," 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O ~oo-r,.~ 5; 14y Township, Range, Section: SLOPE W^SGROUNDW^TERZ.bUZ'-- ENCOU.TE"E~? SITE PLAN S L IF YES, AT WHAT~4 ~, DEPTH? ~. rO ~J ~,/~iltrp© 5c¢ p E Depth to Wa~er A~e/ ~,, Monitoring? ~ ~ Oate: Gross Net Depth to Net Reading Date Time Time Water Drop I '~ 4: 05-- /Omi,, .0 7 ,, ~ PERCOLATION RATE TEST RUN BETWEEN FT AND ,~ ' FT 72~8 (Rev. 4/85J / unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 9, 1988 Bruce Corwin, P.E. Corwin & Associates, Inc. 1000 East Dimond Boulevard, Suite 205 Anchorage, Alaska 99515 Subject: Waiver Request for Lot 6 Block 3 Aspen Highlands Waiver Request ~WR88-052, H88-0364 Dear Mr. Corwin: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 97 feet from the well on Lot 7 Block 3 to the septic system on Lot 6 Block 3. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljw#6 MUNICIPALITY OF ANCHORAGE Corwin ENVIRONMENTAL SERVICES DIVISION & associates,inc. ~lJG .~ 1 1988 Consulting Engineers 1000 E. Dimond Blvd..Suite 205. Anchorage, Alaska 99515. (907)522-1311 R E C E IV E D August 30, 1988 Mr. Dan Bowles Municipality of Anchorage Department of Health & Human Services 825 L. Street, Fifth Floor Anchorage, Alaska 99501 SUBJECT: REQUEST FOR WAIVER OF WELL TO FIELD ON LOT 6, ASPEN HIGHLANDS SUBDIVISION BLOCK 3, Dear Mr. Bowles: We request a waiver from the 100 ft. separation distance from the sewer system installed on Lot 6, Block 3, Aspen Highlands Subdivision to the existing well on Lot 7, Block 3, Aspen Highlands Subdivision. The drainage from the septic system on Lot 6 cannot flow directly to the well on Lot 7 as there is a low spot in between. The well log for Lot 7 indicates 191 ft. of sands and gravels to bedrock. Since there is more than adequate treatment capability to the 191 ft, level and bedrock at 191 ft., there is virtually no way for contamination form Lot 6 to reach the total depth of the well at 348 ft. Further, we could not locate the septic system on Lot 6 in any other location than it is at. We respectfully request approval of this waiver request. A copy of the well log and other information is enclosed for your review. Should you have any questions, please let us know. Very ltruly yo,~rs, cQRW~.,& ASS~C/~TES, INC. ~c~ .J./CD,in, P.E. encloses BJC/cgc I William S. Smith do hereby certify that a field survey of the distance to the well located on Lot 7, Block 3, Aspen Highlands Subdivision to the new soil absorption system located on Lot 6, Block 3, Aspen Highlands is/oo,/~ ft. The survey was performed on August 29, 1988 using the following instruments and methods: ~ ~- ~pO/P~a:-~,~,o t~/ ,-b '~-- t ,7-~-~et~- r~ ~p ~o~ D/~~ M~. ~- Certified August 29, 1988 William S. Smith, R.L.S. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AU6 2 9 1988 RECEIVED ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ( ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE / ,~EW LEGAL DESCRIPTION . NO. OF BEDROOMS ~,s**,~,,o: Absorptionarea (~ , Dw~~ PERMITNO.~ . Z Man ufacturer ~ Mater~ No. of comments ~ Liq' cT~n~l°ns IF HOMEMADE: Inside length ~ Width Liquid depth ~ ~ DIST~ Well Dwelling PERMIT NO. ~ Well Foundation .~ , Nearest iot line 'PERMITNO. ~ No. oflineso~~ Length of each li~ ~l Totailengthof~' Trench widt~_~ Distanc~t~enlines ~ ~ Top of tile to finish grade ~ Materia] beneath tile ~ Total effective abso~i~a ~ ~ ~ i~s Length Width Depth PERMIT NO. ,~ ~ Type~~ ~ Crib di~~ Crib de~ ....... ~otal effective~area'/ ~ ~ISTANCE TO: ~ ~g foundation ~ares2~e , ../ ~ CI~~A - Depth Driller Distance to lot line PERMIT NO.~ ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOlE TEST RATING , - ,. REMARKS ' ~"~' '"~ APPROVED . DATE LEGAL 72-013 3/78) DEPRRTMENT 0 - PERMIT Nn ( ::;~s~,~:' ) ............ ~_c_~(_ _~ ~~ L , ~ ~ ~ A.~ ~, ~.. LOCRTION MEDORI DRIVE / MRXIMUM NUMBER OF BEDROOMS = ~ ~AIL R~ING (SC, FT,.'"BR)~' 17~ .~. / ..... J THE LENGTH D~MEN~[ON ~ THE LENGTH (~N FEET) OF THE TRENCH OR DRRINF~ELD. THE DEPTH OF R TRENCH OR F'~T ~ THE D~TRNCE ~ETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRT[ON (IN FEET). THE GRRVEL DEPTH ~ THE M~N~NUN DEPTH OF GRRVEL BETWEEN THE OUTFRLL P~F'E RND THE BOTTOM OF THE EXCRVRT~ON (~N FEET). F,~.:E ~.'!1_.1 I RE[:, SEF'T T L--: TRI'-,II-:~ ,_-T. 'Ir ,?_E= PERMIT RFPLIC. HNT HR_-, THE RE:,PON~IBILITT TO INFORM THIS [)EPRRTMENT DURING THE IN=,THLLHTIUN INSPECTIONS OF RNY WELLS RDJRCENT Tn THIS PROPERTY RN[:, THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TIE4,3 ,:: 2 ::, I 1'4$F"Ew-:T I L-tI'-.I"_.~ RI:;.'E RE,'"-). I_11 RE[':-, BHL. KF ILL I NEi OF RNY '.~' _~._TEM WITHOLIT FINRL INSPECTION 8ND 8PPROVRL BY THI~"=, DEPRRTMENT HILL BE z, UBJEE. T TA PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND 8NY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVRTE WELL OR 150 TO 280 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM 8 PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEE7' RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL. LOGS RRE REOUIRED RND MUST BE RETURNED TO THE DEPRRTMENT HITHIN 30 DRYS OF THE HELL COMPLETION. OTHER REOUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F'ERr.1 I T E::~.'P I F-.'E$ [)E£:ErlBEE: ].=:1.. I CERTIFY THRT 1: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS AS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. _, I bNED' ?? [ r / V4. 0 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERF.ORMEDFOR: L & H Construction DATE PERFORMED: November 4, 1980 LEGALDESCRIPTION: Lot Organics and organic silt, reddish brown, rounded gravel and cobbles, few boulders, soft, moist. (PT-OL) 6, Block 3, Aspen Highlands Subdivision SLOPE SITEPLAN 7 8 9 10 11 Gravelly-sand, grayi.sh- brown, poorly-graded, sub-rounded to angular particles to boulder size, medium dense, dry. (s?) Clayey-silt, gray, stiff, wet. (~) 12 13 14 15 16 17 18 19 2o COMMENTS Silty-sandy-gravel, gray, sub-rounded to angular particles to boulder size, medium dense ~ist. WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE PERFORMED BY: Patrick Stidmon HOWARD GREY & ASSOC., 72-008 (7/76) (minutes/inch) TEST RUN BETWEEN - ~N~)F---~-~-~FT . __ INC. ~~ii'.i'_i" :~ ;.~ ¢ ,,~ 0>..% ~ = .... .., ~ SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2224J SOILS LOG - PERCOLATION TEST PERCOLATION TEST L & H Construction PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: Lot 6, Block 3, Aspen Highlands Subdivision October 21, 1980 1 2 -----:.3 4 6 7 8 9 10 11 12 13 14 15 16 Organics and organic silt, reddish brown, rounded gravel and cobbles, few boulders, soft, moist. (PT-OL) SLOPE Gravelly-sand, dark gray, poorly-graded, few silts, sub-rounded to angular particles, some cobbles and boulders, medium dense, dry. (SP) Clayey-silt, gray, stiff, wet. Water seepage from immediately above this layer. Silty-sandy gravel, dark gray, sub- rounded to angular gravel SITE PLAN WAS GROUND WATER ENCOUNTERED? Yms IF YES, AT WHAT DEPTH? 9 Feet L Gross Net Depth to Net Reading Date Time Time Water Drop 2 10-21 10 Min. 20 Min. 40~" 1 3/4" 3 10-21 10 Min. 30 Min. 41~" 1 k " 4 10-21 10 Min. 40 Min. 424" 1 " 5 10-21 10 Min. 50 Min. 43k" 3/4" 6 10-21 10 Min. 60 Min. 44" 3/4" cobbles and boulders, dense, moist. (OM) *Average of three holes PERCOLATION RATE 1 .~ (minutes/i.ch) TEST RUN BETWEEN 4[ FT AND 7 . FT COMMENTS Water seepage most notable at north portion of trench at 9 foot depth. PERFORMED BY: Patrick Stidmon CERTIFIED BY: Richard A. Lowman, DATE: 10-21-80 HOWARD GREY & ASSOC., INC. P.E. 72-008 (7/76) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~J SOILS LOG - PERCOLATION TEST PERCOLATION TEST L & H Construction PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: Lot 6, Block 3, Aspen Highlands Subdivision October 21, 1980 1 2 3 4 5' 7 10 14 COMMENTS SLOPE SITE PLAN Organics and organic silt, reddish brown, rounded gravel and cobbles, few boulders, soft, moist. (PT-OL) Gravelly-sand, dark gray, poorly-graded, few silts, sub-rounded to angular particles, some cobbles and boulders, medium dense, dry. (sP) Clayey-silt, gray, stiff, wet. Water seepage from immediately above this layer. (~m) Silty-sandy gravel, dark gray, sub- rounded to angular gravel WAS GROUND WATER ENCOUNTERED;' IF YES, AT WHAT DEPTH? cobbles and Gross Net Depth to Net ~ Reading Date Time Time Water Drop 2 10-21 10 Min. 20 Min. 40¼" 1 3/4" 3 10-21 10 Min. 30 Min. 41~" 1 ¼ " 4 10-21 10 Min. 40 Min. 42¼" 1 " 5 10-21 10 Min. 50 Min. 43¼" 3/4" 6 10-21 10 Min. 60 Min. 44" 3/4" boulders, dense, moist. (GM) ~ '*Average of three holes ~ PERCOLATION RATE 1 ~ (minutes/inch) TESTRUNBETWEEN 4% FTAND 7 FT Water seepage most notable at north portion of trench at 9 foot depth. PERFORMED BY: Patrick Stidmon CERTIFIED BY: Richard A. Lowman, DATE: 10-21-80 HOWARD GREY & ASSOC., INC. P.E. 72-008 (7/76) Date' NG CO', .' R · John s...oad. , ,SPENARD, ALASKA we.ad*ise:~oU !t°'.aita~h' thi~ certificat'e to your deed. 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 ©F HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Ol'~ -- ((~20 NAA# GENERAL INFORMATION Complete legal description Location (site' address 'or directions) Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site 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 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 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. NameofFirm 1~'~(~(~'-'/ ~-~v~iV~'~r"~H,~. Phone ~'.'~'7- Address Engineer's signature Date  IS SIGNATURE Approved for ,v Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Hum.an 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 engineers work. 72-.025(Rev, I/91) Ba~;k MOA#'21 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: A~J~H ~i~tl~l~ ~ ~ ~/~ ,~ ParcelI.D. O['~ ~ go A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed }7_ ~/ Driller Casedto /~ >~/ff Casing height ~// Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main /~x////~ Public sewer service line /~v/'/~ Wires properly protected (Y/N) AT INSPECTION g.p.m. ; On adjacent lots ;On adjacent lots Public sewer manho e/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 1 I - 2 LO Tank size / ''~' ~- ~') ~, .,31 Compartments Cleanouts (Y/N) / - Foundation cleanout (Y/N) ~ Depression (Y/N) High water alarm (TZN) ,~ ~- ~larm testeO (Y/~) Date of pumpings. Well(s) on lot To property line SEPARATION DISTANCES FROM'SEPTIO/.HOLDING TANK TO: On adjacent lots ["/, ~1 Absorl~tion field (~ ~- Surface water/drainage 72-026 (Rev. 3/91) Front MOA 21 Foundation ~' %~ Water main/service line /[////~ / ,~/~'¢ ~ 7'>~/~C~ONTiN U ED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA ;~:., ~'~"<' '!L-"t"u ~: '~ ~'J')iA ~ ~ *~,~; /'~ ~ ' ~ /'~.,.~. ~(~,~ Date installed .-- /~ Soil rating .... : :-'-:/ Length r~ '-~' Width "~ 0 t~ ' 'f -- ~ Gravel thickness ~ Surface water System type .~ Total depth Total absorption area Depression over field (Y/N) Results (pass/fail) "'.." Peroxide treatment (past 12 months) (Y/N) Cleanouts present (Y/N) Date of adequacy test for ! If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots~l --~ Property line To existing or abandoned system on lot Cutbank /~//~- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name ~t) ~'~~''~'' l~''~ Date ~/ /~ /~( HAA Fee $ / Date of Payment Receipt Number :..... ."* ."49 :, Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 1~: 47' MTL-AMCHORAGE 90~7 ~7~5 ........ NORTHERN TESTING LABORATORIES, INC. 2505 FAIRBANK~ STREET ANCHORAGE. AL.A~KA g9503 907-27T-/~q78 · FAX 274-964~ ~ UNIVERSITY PLAZA WEE~, ~JITE A FAIRBANKS. ALASKA ggR~ ¢J07.479-3115 - FAX 4?9-0547 Drinking Water Analysis Report for Total Coliform Bacteria" ' TO BE COMPLETED BY CUENT qJBLIC WATER SYSTEM I.D. · UVATE WATER SYSTEM ~. ~ Purchase Order No. IIPLE TYPE: {outine ill, iai Purpose ,*heck Sample (for original contaminated ' ~ample with lab reference no. ~aCure of Representative 2ip coca Treated Water: ~"'~reated Water AA~ TO BE COMPI. I~"rED BY LABORATORY Received at: .,,~ Aneh. [] Fbks. Date Received ~me Received Nex~ Sample Due COMMENTS: SATISFACTORY S ....... UNSAT!SFACTORY U RESAMPLE OTHER BACTERIA TOO NUMEROUS TO COUNT 'No. of Tocat Coliform Colonies per 100 mis. .; ., /,, ,' .. / Date ' " 'lime P. 1/2 T£STlNG LABORATOR'IES, ]NC, FAIRBANKS, ALASKA 9~?OT ;~7} ~56-3116 * FAX ANCHORAGE. ,~S~ ~9503 t.~7) 2~.83~ · FAX Kniefel Engineering 8441 Miles Cour= Anchorage AK ~9~04 Attn$ Rober~ Kniefel Our Lab $: Location/Projec~: You= Sample ID: Sample Matrix, Al12014 12941 Midori Drive Water Re~o=t Da=e= 07/19/91 Date Arrived= 07/15/91 DaCe sampled: 07/14/91 Time Sampled= 1630 Collected B¥~ SM FLag Definitions Below De~ec~ion Limit DL Stated in Result AbOVe Regulatory Max. Below Detek~cion LimLt Estimated Value SM 418C Ni=r&te-N Result Flag 0.1 0 Analyzed 07/~6/91 Reported B¥t William E. Buchan unicipality of nchora ¢ Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 22, 1991 Robert Kniefel, P. E. 8441 Miles Court Anchorage, Alaska 99504 Subject: Waiver Request for Lot 6 Block 3 Aspen Highlands ~3 Waiver Request 9WR910030, PID 9017-013-80, HA910307 Dear Mr. Kniefel: Your request for waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved° The approved separation distance is 91 feet from the well to the septic tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely~ ~ Robert W. Robinson Civil Engineer On-site Services Conc~ur: ~ /" / / , On-site Services ljm:#6 ~:IkCCI~,~,NMENIAL SkRVlc.~.$ UlVt~JQN 1991 RECEIVED ROBERT KNIEFEL, P.E. 8451 MILES COURT ANCItORAGE, ALASKA 99504 (907) 337-6560 Mr J'ohn Smith, t ruaram Mana.~qer On <gite ,~crvi,'_:es ])epartment of' Health and iiuman Services Municipaiit, y o~' Ancheraee PO Box i9,,6G50 Anchorage Alaska 89519-6050 SUB,J'EC, T: WAIVER REQUEST~ LOT 6, BLOCK 3, ASPEN HIGHLANDS ])ear Mr. o°'Ia J.'th: ~ ~ ~ ],,urin.~,' the course of' perl'ormin;{ a ileai'Lh Authori-ty revJet,~ oJ the above sept :Lc system and well , t;Je deter'mi n~rCd tho wet k to tank distance is 91 feet with the t,~ell to first 'tank comL, artmeni clean----o,~t at 88 feet. The purpose r,F thts .te-I:t:e-r- Js 'tn rec~nesl. waiver for the %,~elt to tank sepa. ration dis't:an(:e to the ct i stance. Attached is our fi. old drawing of the (,,~eii, l:ank, and house locat ion. As can 'been seen, the t..le 1 ] f;o ;-::t-~pt lc ka[ik ,':' ].o.D_li ou.h J s a. pproxima%ety 93 f'oet, hie feel the waiver is .iustit'ied in this case due to the following informak:ton: iL~ The weit caslr;tS is :30" abovc~ the Sr;)und heJ a'ht. 'L'he top of MetlL caslllg is approxirao, to.ky 4 f'e~:t above the ~zr'oulld the septic tank. The ground above Lbo a. bsorpt ion bed approximately 8 feet lower 'tha. r~ the {<round a.t the ue].l least 1(.) feet lower than the top of the t,~eil casin~:'. 2. Th e 8. r o tllid be 13 wee n : h e t,~<, 1 ] ~N'L( t h e s~¢'g,Z i c 't a dot~n l:os!a.i'ds the absoJ:'pt, io~l bed ~,fi'~ich T,,fot~Ld make direct :[lLo;,r of '~', '-',- ~ f]-'9 the .... [Jct.%t. Ill . 'kartk 1:o l;he t, fel[ J IIIDO~:~S J [9 [e S. '.Ih,?- ;,~ell log sho~s -t:;,~o c'ia7 Lavers ( i[(;' 76 .... i29' depth) tgl, iich would pr,~v:ide ample SelY, lt 1. C %0 Me ][ i corl-[.afllirta% J)I'E2~.;C~I'I~i eveii t,lith l:he h%av'y I',qill;s toe Jl&Ve had. ~iLI''J.[i~::' ~}.[i(J DI' [01;' ' O 1; 11 e (; E: 2; 1. }.:,e ]' J ~.~ (]., requirement:s.~ its ~,Ji'th ~ny of' the 6Je taou. ld apprec:iate yotlr beff;t effort -t:O exlz, edite th:i':; proc6:s;3. We ~,~i 1 t be su_bm:[t't in?. tho HAA a. ppt J.c:a.t J. or~ on Tu. esd,a.!~,, ,,,~i] i be. , HAAS & ASSOCIATES Construction Services (907) 563-4921 JOb SHEET NO, OF CALCULATED BY CHECKED BY j l! / SCALE ' R E. CEIVE D ,fr~ ~,~ '~.~,,'? L 1 9 1991 Mun.i~!p.a, Iity :of Anchorage ~. DePt; i~-i~i(h '&' H'U'~an Servicett x / ~ ~ / ~.,~/' , / · .- -- or-4( ~ ~ ~:.. ~ - .... ~9 ~~~ ~ :, e,.~ e ,,. · e,.~'~,, ~ ~.- d/? o/7 ~ CERTiFiCATE OF ,NSPECT, ON ~OR HEALTH AUTHOR'TY APPROVA~ Fl~- ©,3~ d OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) (c) Location (address or directions) Property Owner I['fN~_ I L_L Mailing Address Lending Institution Mailing Address /z. q4: / Telephone: Home --'z-6.~'--.~,5-~'0 Business 'Telephone (d) Real Estate Company and Agent Address Telephone Mail the HAA to the followino address: or: Check here'S, if hold for pick up. List contact person and day phone number below. ('.~4LL :~z.z- ,/<7/I (e) TYPE OF RESIDENCE Single-Family ]~ Number of Bedrooms" ,'~ WATER SUPPLY Individual Well,j~" Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,J~ 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. Page 1 of 2 72-025 ¢Rev 8/86~ Front · ~JoM s,~eeu!Sue leUOiSSe,toJd eq~, u! SUO!SS!LUO .lO s~o~Je Jo,t elq!Suodse.l ,tou s! eee.toqouv ,to M,!led!o!unv~ eq.L 'penss! s! e~,~o!:t!pea e e.io:teq e),ep ezXleUe Jo suop, oedsu! ~,3rlpuoo ),ou op SHHQ :to seeXoldLU=l 's),ueLue.qnbe~ e~,e~,s pue le.~epe,t u!e~4eo X,ts?,es o,t .lap.lo u! suo?,n~,!~,su!eu!puel J!eq~, pue SeLUOq ,tO sJeseqoJnd o), Xsepnoo e se s!q]. seop SHH(] eq/;e~S~lV :to e~,e~S eq~, u! peJe~,s!eeJ Jeeu!eue leuo!sse,to~d ~,uepuedepu! ue Xq e^oqe ~; tlde~§e.md u! UeA!5 suop, e~,uese.~de~ eq~, uodn ~lUO peseq seJ, eaij.!i, leo teAo~dd¥ X~,poq~n¥ q~,leeH senss! (SHH(3) seo!^~eS ueLunH pue qHeeH :to ].ueLu~ledeQ eSe~oqou¥ :to M,!led!a!unR eq_L NOI.LnVO le^oJddv leUOi~,ipuo9 ,to SLUJel leuo!~,!puoo pe^oJddes!G -~ pe^oJdd¥ '9 .g WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCt-I~I~H AUTHORITY APPROVAL (HAA) ENVIRONMENTAL ,SERVICES DIVI~cKLIST ' FEBRUARY 1984 264-4744 AUG ~ ~[ ].988 Legal Description: L ,-~"T RECEIVED Well Classification P~.I Well Log Present (Y/N) Y If A, B, C, D.E.C. Approved (Y/N) Date Completed 2/~',/ Yield Cased to Depth of Grouting ~I,~ Pump Set At Sanitary Seal on Casing (Y/N) ~/' Depression Around Wellhead (Y/N) JoI~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot /~"E ~' J'~ 'Date ~/~/o Total Depth Static Water Level ! $-] ' '-~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: t. To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~//~ Water Sample Collected by J Water Sample Test Results --~TJ.fF/4c-'/"O~--V/' Comments '-~ /~)' /"/7 e~ J'~'.e-r~/ E/b'.//~b' .- '° · On Adjoining Lots 'On Adjoining Lots .~ ' 1oo B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~/,~ Separation Distances from Septic/Holding Tank: To Water-Supply Well /~--_~O ~ To Property Line ~ O ~ 4- To Water Main/Service Line ~O ¢ Course Comments ~L'~'C:::--/~ --'//'//- (~. /~- Size /~--~-~03'~ (' No. of Compartments ~// Foundation Cleanoul (y/N). Date Last Pumped · for Temporary Holding Tank Permit To Building Foundation //~ ~ To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026 (Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/I Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~77 ! Type of System Design Length of Field .~'.-~ ~ Depth of Field ~" Gravel Bed Thickness ~ ~' Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: L.'~' ~ ~'- ~' To Water-Supply Well /D I t ¢7 "4/,E'/~'/a'~c'/f//v/. ~'o Property Line To Building Foundation --~'-(~ ~ Lot 4('7 ~ -t- ' On Adjoining Lots To Water Main/Service Line ~0 ~ ~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /~//dr To Driveway, Parking Area, or Vehicle Storage Area /00 ' Comments /_)e'~.~ /r~..j ~'V3'-/~,~-~'-~$'-/~/j¢zff · S AT ON Date "Pump On" ~evel at High Water Alarm Level at ~;t~r~cfa~ rc o d es (Y/N) ~'~ Comments · * Check~itted BedFRating Against HAA Request ** Date of Payment Amount: $ / Page2 0,2 72-026 (Rev 8/86) Back ! To Existing or Abandoned System on Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA guidelines in effect on the date of this inspection. ineer's Seal I William S. Smith do hereby certify that a field survey of the distance to the well located on Lot 7, Block 3, Aspen Highlands Subdivision to the new soil absorption system located on Lot 6, Block 3, Aspen Highlands is/~o,/~ ft. The survey was performed on August 29, 1988 using the following instruments and methods: o~ ~- Certified August 29, 1988 William S. Smith, R.L.S. C:I-IEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 onlqrLE £0~ Work 0~ i~ ANAL'iSIS ~g?OR'I~ ~,Y o~, ~, Date ~epo~t P~:lnte8 AUG 17 aa ~ 16~14 Cl:Lent Sami;Je tD;L6, B$ ASPEN HIGHLANDS ~WolD Coll.~ated AUG iS 88 ~ 09:00 h'cs, Received AUG J5 Pr~erved with :~ DEG. C CLient. }lar, u : CORWtN ~ ASSOC C!iont A¢ct: CORWINP P.O.~ NONE REC'D O~dezed 5y : Labotatot:y Supe~,/i~ ',STEPHEN 5.' ~DE 1)COR~IN a lssoc ]A~S t~ttC t; Chemlab kef {; 2215 Lab Smpl ID: J. Mat~lx: WATER Allowable Paramete~ T~ted R,~sutt/Unlt~ ~thod Limlt~ NI~RATE~.N 3,8 mg/] EP~ :~53.2 lO Sample ?,OU~tNE SAI~I,E Remazks. SAMPLE COLLECTED Perform~ ~ See Special Inst~uction~ Above UA-Unavailable Detected '" 2o~ Sample Remarks Above CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER Name Phone No. City State Mo. Day Year SAMPLE TYPE: '~ZRoutine iCheck Sample (for routine 71~f ~with lab ref. no." FI · Special Purpose sample ) Zip Code [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 3 I 51 Time Collected Collected By TO BE COMPLETED BY LABORATORY Date teceived O'S~IF~~'~ Time' Received Analysis shows this Water SAMPLE to be: j~Satisfactory o [] Unsatisfactory S[mple too long in transit; sample should (it be over 30 hours old at examination indicate reliable results. Please send n ,w sample via special delivery mail. IOSD Analytical Method: Membrane Filter * No!' of colonies/lO0 mi. Lab Ref. No. Result* I ,~/r--~ I-~ lI I-~ II 7T~ I~ I I-I-1 Analyst BACTERIOLOGICAL WATER ~NALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB Final Membrane · Reported By Coilform/100ml TNTC = Too Numberous To Count OB = Other Bacteria BGB Date Time: PART I OF 2 REMAINDER TO FOLLOW Coilform/100ml APPLIC FILLS OUT UPPER HAl. ONLY Property /%f'::3Y./.:;:' ./: :?/')/"F~-" /'(:.. ~ J:i2,12X'._ 2~/ /2'(~- Phone Mailing Address / ,f.2~ '?'/~// ,, /, ,/~',:~!::~7 ,,.~"2~. Zip Code Buyer Address ~J~q/~/~ Zip Code Street Locatio~ 'J~.~Z ~r//' /,~/~'~/%;'/'-" ' ~,~' Type off.Residence L4V~Single Family ~ [] Multiple Family No. of Bedrooms . [] Other Water Supply [~,,'r~dividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal [~-th'~ividu~'l Year Individual Installed: ';.~'/ [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: 01~. ~ (..11~'%~ · OJ~ ~ ~ MLJNICtPALITY OF ANCHORAOE DEPT. OF ENViRONMFNi-AL RECEIVED (>) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( )DISAPPROVED I I CONDmONALAPPROVAL' DATE 11-- i 8 --9 --5 BY: Soils Rating Date ~wer Installed Well To Absorption Area l ~ ~ ' Well Log Received ~ ~ ~ I I -- ~'~ 0 Well to Tank 1~0 Septic T~k Size ~: DATE RECEIVED I NSP ECTI 0 N APPOI NTM E NTS TI ME TIME ~ ~"'-/,~'~ TI ME DATE DAT DATE . MUNICIPALITY OF ANCHORAGE DEPT. OF t-~AL}H & _ ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~VjEONMENTAL 825 L Street- Anchorage. Alaska 99501 F E B 9 19 81 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proc~d. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ , J PHONE MAI LI N~ AD~SS PRO~Eh~ ~ESI~ENT (If ~ifferent {rom abo ~ PHONE 2. BUYER PHONE MAI LING ADDRESS 3. LENDIN~NSTIT~ION I PHONE MAILING ADDRESS ' 4. REALTOR/AGENT I PHONE I MAI LING ADDRESS 5. LEGAL DESCRIPTION ST.- ET 'OCATrON 6.' tYPE ~I~'RESIDENCE ~ ' NUMBER OF,BEDROOMS ~~ SINGLE FAMILY [] One [] Four [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~l~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BE FORE PROCESSING CAN BE INITIATED. 7:2-0'10 {~. ~/7~) ~ ~_. THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: { ~-~ ~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELLTO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER ~ MATERIAL Septic/Holding Tank ~Absorption Area I Sewer Line Nearest Lot Line 5. COMMENTS DATE ~-[~-"~APPROVED FOR -~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)