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HomeMy WebLinkAboutT12N R3W SEC 15 LT 119A MtINICIPALITY OF ANCI.IOHAGE DEPARTMENT OF HEAl. TH & ENVIRONMENTAl. PROTEC'IION FNVIRQNMFNTAI. ENGINEERING DIVISION 825 [. Street- Anchorage, Alasl(~ 99501 Telephrme 2g4-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELl_ INSPECTION REPORT LEGAl_ DESCRIPTION L~C~nSN DISTANCE 'ED: DISTANCE TO; / ~ ,'c'_,,- I) i Absorption area Di lolling Material Well Dwelling DISTANCE TO: J ~" 3'' Length gidth Totallen th of Jines Material I)eneath tile NO. OF BEDROOM[; PERMIT NO. L.iquid depth PERMIT NO. NM[~terlal ~Eiquid capacity in gallons Trench width Distance between lines Tota~ effective absorption area PERMIT NO. Total effective absorption ama Sewer line Septic tank ~Absorp~on~[ea(s) / OTHER PIPE MATI:RIALS ,., SOIL TEST RATING /f't', * "~ INSTALLER REMARKS 72-013 (Rev. ~'178) LEGAL PERMIT NO. [:,EPFIF::TMENT 0f HEFtLTH RND ENVIRCINMENTFIL F'q'I"EC:'FION ',B25 "'L .STFIEET., FFINCHOFIROE., FIK. '9'"-.'~L .. Ci ~"-,I -- :% :lE -[' E .~;; ES i-,,! E I"~:: F" i F~: i'"l 2[ 'T ( S0050Z FIPPL. ,I Cal,4"r I.,,OC:i::i'T' i O1'.4 I_EGFIL t-IRFIOL[:, KI:~FIN SRFI BOX ::L7~0 :20::t. 2; T RVE, LOT SIZE 2`4,:1.-Z.026 2,2607 S6!URFIE FEET 'TYF'E OF SOIL FIBSOFIF'TION S'¢STEM IS: TRENCH MRNII"IUM NUMBEFI OF' BEDROOM'":: = 2` SOIL F'~R'I"ING (SI.,q FT,,"BR)= :1.50 "['HE FIEQUIRE[:, 5;I2~'E: ElF THE SOIL FIBSOI~:F'TION S'¢STEM IS: THE LENG'f'I-~ DIMENSION IS THE LENGTH (IN FEET.'.' OF TFIE TRENCH OR DRRINFIELI). 'I'HE DEFTH OF Iq TRENCH OR PIT IS THE DISTFINC.'E DET~4EEN 'FI-.llE SUFIFFICE OF THE GROUND RND THE BOTTOM OF THE EXC:RVFI'I"ION (IN FEET),. THERE IS NO SET P.IIDTN FOR TRENCHES. 'I"HE (~RFt',/EL DEPTH IS THE MINIMUM DEPTH OF GRFI',/EL BETI,.IEEN THE OLITFFILL F'IF'IE FIND THE BOTTOM OF THE EXCRVRTION (;IN FEET;,. PERMIT RF'F:'LICRNT HRS THE RESPONSIBILITY TO INF. ORM THIS DEPFIRTMENT DURING THE INS'I"FILLFITION INSF'ECT'IONS OF' FINV 1.4ELLS FIDJRCENT TO THIS PROF'ERT'¢ FIND TNE NIJME:ER OF RESIDENCES; THRT THE PIELL P.IILL SERVE. BFtCI.(FILLING OF FIN"? S;'¢STEM NZTHOUT F'ZNI'-IL ZNSPECTION FIND FIF'PROVFIL DV 'rFlIS DEF:'f-~FITMENT P.IZI_L BE SLIELTECT TO PROSECUTION. MINIMUM DISTFINC:E EE1HEEN R 14EI_L FIND FIN¥ 04 ..,ZI'E ,.,EMP-~E £.,I_,FO_,FIL ~:,'r=,lEtl IS ~OO FEET FOR FI PRIVFITE I,.IELL OFI ~L50 TO 21~l~l FEET FFIOM FI F'UBLIC. I,IELL DEF'ENDINI3 UF'ON THE T'.?F'E OF F'LIE~LIC: I,~ELL, f,'IZNIMUM E)ZSTFINCE FROM FI F'FIZVFITE MELL TO FI PRIVFITE S, EI.,.IER LINE IS 25 FEET FIND 'FO FI COMMUNZ'f'"r' S[EI4ER LINE ZS '75 FEET. OTHER FIF£L,'4UIREI'dENTS MFIV FIF'PL"?. SF'EC:IFICRTIONS FIND CONSTRUCTION DIFIGRFIMS FIRE R',,,'FIILFIE~LE TO INSUFIE F'ROPEFI INSTFILLFIT~ON. I CERTIFY ]'HRT ±: I RH FRHILIFIR FORTH B'¢ T'HE MUNICIPRLIT"r' OF' RNCHORFIGE. 2: I I.,.IILL INSTRLL. THE SYSTEM IN RCCORDFINCE 14ITH 'THE CODES. 2:: I UNDEI;:STFIN[:' THRT THE ON-SITE SENER S"r'STEM i'"lFi¥ REC..!UIRE ENLRRGEMENT IF FIESI[:'ENCE I2~'F,:EMO[:'ELE[~-?TO INCL. J~I[:,I~ MORE THFIN _'Z'.'. E~EI)ROOMS. 13F'r-',LIF:FIN~ HFIf~:OL[:, tO':IFIN ,,....,.,,.,. ........ .......... ....... NITH TNE FIEC.~UIREMENTS FOR ON-SITE SEI4ERS FIND NELLS RS SET THE V4.. 0 ,.~ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 ~76-222~' SOILS LOG -- PERCOLATION 'I'EST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: I 3 4 5 6- 7- 8 9 10 11 12 13 14 15- 16- 17- 18- 19- 20 SLOPE COMMENTS PERFORMED BY: No. 2251.E 72-008 (7/76) DATE PERFORMED: SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? E Gross Net Depth to Net Reading Date Time Time Water Drop ERCOLATION RATE (minutes/inch) RUN BETWEEN FT AND FT CERTIFIED"Y: /-, '~':---- / DATE:.~® GREATER ANCHORAGE AREA BOROU~' bepartment of Environmental Q~ ty 3330 "C" Street Anchorage, Alaska 99503 ' ~ PEROLATION It,S oOIL~ Depth 1 - 3- 6~ 8- 9- lO~ S ?o,oo Was ground water encountered? .__~Y'I.~. ...... If yes, at wi~at depth? Reading Date Gross Ti me Net 'rime Depth to Water' Net Drop Proposed installation: Seepaqe PitDrain Field bepth Of Inlet -, DeptTi--ti)--6-o~'t~)~l~o'Fi)it or t, rench COI.lJ!EHTS: p[~rformed ~y:'___ . ~Ce'rti fied By: ..................... bale: ....... 040 (6/74) 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 DWELL, lNG 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailin. g address Agent Address [)ay [:)hone I:;)ay phone. · Day phone Unless otherwise requested, HAA will be held for pickup. NUMSER 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site /v... 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. (Rev, ~/gl) 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 8isposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Nameof Firr~ ,. ~/'~,~-~:~,~Or~ ~/~ ¢~-'. Phone ~,;~./~? , · ~ ' ~ / ~' Date. DHHS SIGNATURE ~ Approved for '7-/L1/~ E/~'' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: AdditioneJ Comments By: 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 en gineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ~E~EIVEU municipality of Anchorage i JUl, 1 2.. 19~ DEPARTMENT OF t'{EALTH & HUMAN SFRVICES ~4UNICIP^LITY ©F^Nw Environmental Services Division ENVIRONMENT^LSERVI(:{~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (,(;)07) 343..4744 Health Authority Approwd Checklist A. WELLDATA /,J~/~,~,~ ',x--/¢J) J~ /~C,~L~' ~r;, J~5~,~2?~f/'7c- ©~ic~ Well type /~P~¢ ~ ~ ~-~ if A, B. or C, attach ADEC letter. ADEC water system number Date completed Log present (Y/N) ~ _ Total depth __ ,~"~/'-- Cased to Sanitary seal (Y/N) 7 Date of test Casing [,eight ihl~ove ground) Wires properly protected (Y/N) _ FROM WELL LOG AT INSPECTION Static water level '~'~ ~ g.p.m, Well production g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate ~ ~ '~ Other bacteria Date of sample: _~ / ~ ,~ / ¢ ~:~ Collected by: .~ ~ ~ '~¢~ B. SEPTIC/HOLDING TANK DATA ~0 Date installed ~~_ Tank size ~ ~O~ . Number of C~rnpa~ments ~ Oteanouts ~/N> Foundation cieanout (Y/N) _ ~ Depression ~/N) ~' _ High water alarm ~/N) C. ABSORPTION FIELD L .¢h Width _ Gr w th ckn. . pip 7 _Tet .pth. / Effective absorption area ~ _Monitoring Tube present ~/N) ~ Depression over field ~) Date of adequaoy test '~'-~'-?¢...Results(Pass/Fail). ~f~ For. "~ bedrooms Fluid depth in abso~tion field before test (in.); ~ Immediately after ~a water added (in.):_ Fluid depth ~ (ins) Minutes later: ~-~ h ~, Absorptio~rate = ~ ~ g.p.d. Peroxide treatment (past i2 months) (Y~) N % If yes, g~ve dam 72-026 (Rev. 3/96)* D. LIFT STATION Date installed '%, Size in gallons Manhole/Access (Y/N) ~-..,_...~._.~ "Pum~__-- "Pump off" level at* High water alarm level at* ~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELLON LOT TO: Septic/holding tank on lot ,¢~ t _,% [ Absorption field on lot / Public sewer main /tV///~ Public sewer manhole/cleanout Sew~,~e~tic se ~,ce line ~ ~ ~/~ ~ffstation SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~_ ~ Prope~ line ~l (~ ~ Absorption field W. er / On adjacent lots / On adjacent lots %/¢(2 on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line [ 4¢~ [ / Building foundation /C~(~) Water main/service line Surface water ~> ] E) ¢2 ~' ,/?~/'7" Driveway, parking/vehicle storage area Curtain drain /¢0//)~-'~ /L%~O66//¢~, Wells on adjacent lots "~ /~/C.)I F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name Date HAAFee $ ~)~ *P-~ Date of Payment · 0'-~) ~ ,J~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number JUN"30~gg 08:38 FROtJ'CTE ENVIRONk4ENTAL ,~t~I~ C T&I~ Env,ronmemal Services Inc. T-305 PON03 1:-~55 CT&E Client: Name Project Name/a Client Sample ID ,'vial:rix Ordered By PWS[D 993028001 James Slzemore & AssociaTes Lo~ II9A T12N R3W Sec 15 Lot IIgA T12N R3W Sec 15 Dnnking Wa~er 0 S,~mple Remarks: Client Prinled Date/Time 06129/99 17 03 Collecl:ed Date/Time 06/25/99 16:00 Ree. eived Date/Time 06/25/99 16:45 Teehl~cal Director: Sl&ephen C. Ede 0.500 u 0,500 mg/c EPA 3130,0 10 nmz 06/~5/99 06/25/99 SCl. DEPT. OF ENVIRONMENTAL CONSERVATION / SOUTHCENTRAL REGIONAL. OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 7'elephone: (.907) Addre$.~: 274-2533 June 15, 1984 Ms. Gwen Turner Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Ms. Turner: Subject: Lot ll9A, Section 15, ~2N, R3W The separation distance of 45 ft between the well and septic tank is below current Department standards of 100 feet, and also below Department standards at the time of construction (50 ft). We have concerns about the possibili~ of leakage fr~ the septic tank into the well, due to the age of the septic system. Due to limitations on the options available to correct the presenL situation, we will reluctantly approve the present wastewater dis- posal system, subject to the following conditions: a. Testing of the static water level of the septic tank by a registered engineer under a no flow condition indicates there is no leakage from the 'tank. b..~:ah'16ri~ation unit is installed on the Water~.linei' ~'~61~Well ~nd continuous chlOriha?on~6fii:~h6~?i ~elllwater d~ring well pumping is pra~,ticed.:henc~$1 ~£o=rth;'~maintaining a free'chlorine residual, ofia?i. i:!~.~a'st"O:l'mg/l: =Th~ Chlorine appliCaiiion 6:in{- ~i~]~ib.~]i pl a'~e~" p~ior to th~ hressn~' .~ovlde for contact time in th~ tan~ In addition to these mandatory conditions, it is strongly recommended that samples for nitrate be taken on a periodic basis (suggest quarterly) to insure that waste contamination is not enterin§ the well. Sincerely, Bill H. Lamoreaux, P./~'E. District Office Coordinator BHL/msm cc: Robbie Robinson (MOA Health) 6410 Switzerland Drive (907) 345-1572 James Sitzemore & A.ssoctates Civil Engineers & SuI~eyors Anchorage, AK 99516 Municipality of Anchorage Department of Health & Human Services Environmental Services Division 825 L Street, Room 502 Anchorage, Alaska 99501 July 22, 1999 RECEIVED Municipality ol Ant Dept. Health & ffUmanhe°,,r~o Reference: HAA Application for Lot 119A, Section 15, T12N, R3W Dear Jeflq As discussed today, tile waiver granted by the State of Alaska for the well to septic tank separation had two conditions that had to be met. Dining the test I performed on the system, I checked both items. The water level in tile septic tank remained static over a 24 hour period. The house was not occupied when 1 performed tile HAA test, and I checked the water level in the tank on the weekend when no work was being performed on the house. There is a chlorination unit installed between the well and the pressure tank. It was working while I performed the flow test on the well. The unit was set to chlorinate the water at a rate of ( 1 V2 ) ppm If you have any questions, please call. Sincerely yours, ~ James F. Sizemore PE MUNICIPALITY OF ANCHORAGE Department of Health & Human Services r)IVlSION OF ENV RONMEN'r'AL SERVICES 343-4744 Parcel I.D. # CFRTIFICATE OF INSPECTION FOR HEALTN AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) T'l tq E' Yf,/ .%/ id Location (address or directions) (b) Property owner _H- 0(- '~- Mailing Address /~//~ (c) Lending Institution Mailing Address /L/// (d) Real Estate Company and Agent _~b/2dc Address /~ /~ Telephone: (home) Business )q-/.~ Telephone (e) Telephone ~./ Mail the HAA to the following address: (or check hereFif hold for pick up.) List contact person and day phone number below: 2. TYPE OF R[-'SIDENCF Single-Family..E~ Number of bedrooms 3 3, WATER SUPPLY Individual WelI,E~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site.[2' 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 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validat~ion 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 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 c'~'~¢~,~i ~ ¢ /¢¢¢r'¢'C', Telephone Date ¢/~¢/~ Engineer's Seal Approved for ..~ bedrooms by Approved .~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health AuthorityApproval cerificated 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 M unicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 {Rev ?/88} B~ck Page 2 of 2 RECEIVED A. WELL DATA Well Classification ~_,~ ! MUNICIPALITY OF ANCHORAGE (MOA) ICIPALITY ~.e,~lr~l~At~rlly Approval (HAA) NM&Ni'AL S~,~ ' FEBRUARY 1984 ~-4744 ~ 1~89 Legal Description:-~3M Well Log Present (Y/N) ~ Total Deptl'LL~/' Cased to ~?~" Static Water Level Casing Height Above Ground / ,~ ~¢ ' Electrical Wiring in Conduit (Y/N) \/ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ ' To Nearest Edge of Absorption Field on Lot If A, B, C, D.E.C. Approved (Y/N) _ Date Completed _L_2,_kDbJ~.d ~ __ _ Yield 4 ¢:. pP/ Depth of Grouting Pump Set At (..~! Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) /00' + To Nearest Public Sewer Line ~'~//~¢ _ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by J~.*%lg)/ X~:~¢~'-~T'' 'Date / / Water Sample Test Results ; On Adjoining Lots /'Od) ; On Adjoining Lots B. SEPTIC/HOLDING TANK DATA Date Installed ~w/./E. gcw~/_Size 10¢2')~1 No. of Compartments ~/~¢_~/f,¢2.~&/ Standpipes (Y/N) F' _____Air-tight Caps (Y/N) _Y Foundation Cleanout (Y/N) ~.~ Depression over Tank (Y/N) ~/ Pumping/Maintenance Contact on File (Y/N) '.~1/~ Holding Tank High-Water Alarm (Y/N) ~,///q, Date Last Pumped Z~.J~z/8°/ ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well 4~ ~ q¢ To Property Line ~,O ' '~ To Water Main/Service Line /~ /~ To Stream, Pond, L..ake or Major Drainage Course __/~) I Comments To Building Foundation ,~--~ ' To Disposal Field °7 7 ' 72 026 (Rev 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~¢/¢~o~, m Type of System Design Length of Field ~%.5~/ Depth of Field / ,~ - ~- ' Gravel Bed Thickness 7 ' Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well f'O © To Building Foundation ./tO0 · Lot I\1 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course ~'/(.~O ' To Drivewa, y, Parking Area, or Vehicle Storage Area Comments~x~- .~ (2~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots '~f2 ~ To Cutback (if present) D. LIFT STATIO% ~'~ Date InstaJled% Size in Gallons "Pump On" Level at High Water Alarm Level Tested for Meets MOA Electrical Codes (Y/N% Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. , certify thatt/4/"~yh/C/~/cl~e( ke~, v~f'ified, or conformed to all MOA and inspection./ ///~,~//'// / · Signed U~;%~ /~ ~ Oo .an, Date ~/~/~ / MOA No. ~ ~ Receipt No. Date of Payment Amount: $ effect on the date of this Receipt No Engineer's Seal Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) 8ack Page 2 of 2 ~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT EY SAIdTI, E for Work Order # 14703 Date Report Printed: JUL 13 89 @ 14:40 Client Sample ID:RSW ~12N SI5 Lll9A PWSID Collected JUl, 10 89 @ ld:O0 Received JUL l0 89 @ 16:05 hrs. Client Name : CORWlN & ASSOC Client Acct : COBWINP P.O.~ NONE REC'D l~eq ~ Ordered ky : Analysis Completed :JU~ 12 89 Laboratory Super¥1;or/:~gPllglI C. EDE Released ky Send ~epo~ts to: 1)COEWIN & AS50C 2) Special Instruct: Chemlab Ref i: 6192 Lab Smpl ID: I Matrix: WATER Allowable Parameto~ Tested Result/Units Method Limits NIT~ATE-N NDCo.io) mt/1 EPA 353.2 I0 Sample ROUTINE SAMPLE Remarks: Teste Por£o~mod 300 Special Instructione Above UA-Unavailable None Detected *' Soo Sample Ren~rks Above Not Analyzed LT-Le~. ~han, GT.,Sroater T~n & associates,inc. Consulting Engineers August 15, 1989 Mr. Dan Bolles Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ^lj 1 5 lgSg RECEIVED Re: Govt. Lot llgA T12N R3W S 15 Dear Mr. Bolles: A chlorination unit was installed on the above referenced project on August 14, 1989. The unit is set up to chlorinate the water at a level of one and a half (1 1/2) ppm. The unit has been installed prior to the pressure tank to provide adequate contact time in the tank. The records indicate that a chlorine unit was installed in 1984. However, our investigations reveal no evidence that one was ever installed prior to August 14, 1989. If you have any questions, contact our office. Very truly yours, Corwin a Associates, Inc. Gerard Kress Eng~neerl g Technician GK/lb MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Qn-Si_J~9_~e_rvi(.-'~$ Transmittal ~heek TO: The for attached paperwork has been reviewed and is being the following reason(s): Discrepancy in legal description. Incomplete; needs _ ~'1'~. /'~4/~t~/ Signature missing on return~,~d Additional info needed Sewers/wells, curtain drains and streams within 200 feet not shown. Area soil/well information needed. ~_ Other/~/2a~ ~f ~_/~/.~/'~-W/;f~-~ Please supply the necessary information and re-submit your request. Your cooperstion is appreciated. Date ~/~//~-- Reviewer ~/~//z//~/~, /aen203-2 DEI[~F. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: {907) Address: 274-2533 June 15, 1984 Ms. Gwen Turner Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear i',is. Turner: Subject: Lot ll9A, Section 15, T12N, R3W The separation distance of 45 ft between the well and septic tank is below current Department standards of 100 feet, and also below Department stanoards at the time of construction (50 ft). We have concerns about 'the possibility of leakage -From the septic tank into the well, due to the age of the septic system. Due to limitations on the options available to correct the present situation, we will reluctantly approve the present wastewater dis- posal system, subject to the following conditions: Testing of the static water level of the septic tank by a registered engineer under a no flow condition indicates there is no leakage from the 'tank. bo A chlorination unit is installed on the water line from the well and continuous chlorination of the we'll water during well pumping is practiced hence- forth, maintaining a free chlorine residual of at least 0.1 m§/1. The chlorine application point should be placed prior to the pressure tank to provide for contact time in the tank. In addition to these mandatory conditions, it is strongly recommended that samples for nitrate be taken on a periodic basis (suggest quarterly) to insure that waste contamination is not enterin§ the well. Sincerely,. Bill H. Lamo eau , ,.. District Office Coordinator BHL/msm cc: RobDie Robinson (HOA Healtil) MUSI£CIRALITY OF ' DIViSI(~ OF ~4~ HEALRM DEPA~E~ OF I~ ~D ~I~'AL APPLICATI~ ~R ~TH ~ORI~ ~P]~AL 1. ~al Info~'r~tion ~pli~ation Date (a) ~gal ~s~iption (inclu~ lot, bl~k, su~ivisi~3, ~etJ.on, t<~;nship, Lo~tion (ad.ess o~ directions) Applicants Address (c) Applicant is (check~o__m.) L~nding Institution [---~; Owrmr/bui, lde~:~--~; (d) ~mding Institution Address t~,al Estate Co. & Agent Add. ess Other Note: If cc~mr~ni, ty v~ll si;stem, must: have w~.itt-~n confrontation ft-om the State Department of 5~viror~ngntal Conservation attesting to tha~ legality and status. Is the wall adequate fo~ the number of bacl~_oc~as specified :in this HAA~) Se wac~. DisJ~.osa] ~s the wastewate~ disposal s~stem adequate for. the mr~e~, of [Page 1 of 2] 2-15-84 _Engirm~er_j[n__q Firm Providing Inspeotions, Tests, Data and Information that I have chscked, verified, o~. conformed to all MOA [{~A (k~ick~.lir~s in Date Tele~ho__~ $ fgned by ( ENGINEER SEAL) /?O?E ;%%""., ? 6, D~!E_P_A_ppr ova 1 App~,ove d fo~ Appromd ]<~. [ DisapF~°ved C~ Terms of Conditional Approval Conditional Date %he Municipality of Anchorage Department of ~alth and Enviror~rental ]Protection does not guarantee the ~ntinued ~tisfacto~y ~rfo~man~ of 'h~ water, supply and/or the was~wate~ dis~sal system. ~]is approval indicates that, as of t~ validatio~ sh~n a~, ~d or~ t~ ~ta and infor~tion f~nished ~ an e~i~er registered the State of ~aska, ~le ~te~ supply and wastewater d:[s~sal system is safe and tional for the n~ of ~dr~rs and ty~ of struct~e indicated. ( DHEP SFAL) 7. Mail the HAA to t~ foll(~zing address: . / ~ '?~ ~.f ~, ,,~ ~.i. , ~'~,' KB2/d5/s [Page 2 of 2] 2-15-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AU~tORITY APPROVAL (HAA) CHECKLLSIP - FEBRUARY 19[].4 Legal Description: Well Log P~esent Y~) Total Depth ]7/ t Cased to Statie Water l~vel /¢~_¢~ Casing Height Above Ground /, ~/' Eleet~ical Wiring in Conduit .(y~ separation Distan(~s f~om Well: To Septic/Holding Tank on Lot If A, B, c~, C, D.E.C. Approved(Y/N) ,]ate Completed ~D" Yie ld~L% . ~ ~-~o,~ . Depth of G~outing ~/C . Pump Set At: Sanita=y Seal on Casing E~p~ession Az, ound Wellhead (~___ To ~a=est Edge of ~so=ption Field on TO ~arest ~blie ~e~ Line __,~j~ TO ~est ~blie Clean~t~a~ole ~//~ Wate~ S~le Collected By ~:, ; ~te Wate~ S~le Test ~sults SE~IC/HOLDING TA~ ~TA ~te Installed ~(A~{~p~ StandDi~s ~N) Ai~-tight Caps ~~ F~ndation Clea~out P~in~intenan~ ~n~a~ on File (Y~) .~/~ .; for 'Holding Tank High-Wate~ Ala~ Separation Distan~s ~ ~ptic~olding Tank: To Buiiding Foundation ~ / ¢ __To Disposal Field ~ ~ To Stream, Pond, I~2ke, c~ Major D~ainage C. ABSORPTION FIELD E~TA Soils Rating in Abso~ption~trata Date Installed ~/./~-~ width of Field 9/ v~ Square Feet of Absorption A~ea Depression ove~ Field (Y~) Results of Last Adequacy Test ~d~ Type of System Design Length of Field Depth of Field G~a~l ~d Thick,ss Separation Distance from Absorption Field: To Water-Supply Well / ~)(.9 ! Cz) To IMzoperty Line /~// To Building Foundation /OO / OD To Existing or Abandoned System cn Lot ~- ~O O3 ; On Adjoining Lots ~. $~), To Water Main/Service Line AJ /~q- To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Course ~ /O~) To D~iveway, Parking Area, or Vehicle Storage Area /~z~ ~: De Date Installed Size in Gallons "Pump On" Level at High k~te~ Alarm Level at Tested for Electuical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating AGainst HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA on the dat.e_.of this ,inspection. mld ls effect [Page 2 of 2] 2-15-84 DATE INSPECTOR D A T ~-~'~c--"~T~-~ INSPECTION APPOINTMENTS DAT[: DATE INSPECTOR INSPECT~ MUNICIPALI'rY OF ANCHORAGE MUNICIPALI'IY OF ANCHORAGE DEPARTMENT 0F ~EALTH & ENVIRONMENTAL PROTECTION DEPT. 825 L Street - Anchorage, Alaska 99501 ENVIrONMENTAl. ~NW.ONM~NTALSAN~TAT~ON D~V~S~ON SEP g 1980 'relephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE PHONE MAILING ADDRESS ~. LENDING INSTITUTION PHONE MAI LING ADD R ESS M~/,A4. REA~TORIAGENT . ,_~. ~ ~- PHONE E..LEGA~.J3ESCRIPTION ~ . STREET LOCATIO ~ , ~ 6, TYPE OF R~SIDENCE NUMBER OF,BEDROOMS [] One i~ Four ~ SINGLE FAMILY [3 Two [] Five ~ MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY ~, INDIVIDUAL' ~ ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled orior to that date, give well [] PUBLIC UTILITY ~epth (attacl~ IO~ if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE" /~,~/~,'~ YEAR ON-SITE SYSTEM WAS INSTALLED. E~] PUBLIC UTIL TY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQIJEST BEFORE PROCESSING CAN BE INIT)ATED. 72-010 (Rev, 6/79) ~_ ~.~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS · [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [~ TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~INDIVIDUAL/ON -SITE DATE INSTALLED E~]PU BLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: if Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA ~ATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line [ Nearest Lot Line WELLTO: Absorption Area to nearest Lot Line 5, COMMENTS [Z~'~t~PPROVEDFOR ,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79) DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCEN'FRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 RILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 June 15, 1984 Ms. Gwen Turner Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Ms. Turner: Subject: I..ot ll9A, Section 15, T12N, R3W The separation distance of 45 ft between the well and septic tank is below current Department standards of 100 feet, and also below Department stanaards at the time of construction (50 ft). We have concerns about the possibility of leakage fran the septic tank into the well, due to tile age of the septic system° Due to limitations on the options available to correct tile present situation, we will reluctantly approve the present wastewater dis- posal system, subject to the following conditions: Testing of the static water level of the septic 'tank by a registered engineer under a no 'Flow condition indicates there is no 'leakage from tile 'tank. bo A chlorination unit is installed on the water line from the well and continuous chlerination of the well water during well pumping is practiced hence- forth, maintaining a free chlorine residual of at least 0.1 rog/1. The chlorine application point should be placed prior to the pressure tank to provide 'For contact time in the tank. In addition to these mandatory conditions, it is strongly recommended that samples for n~trate be taken on a per~oe'lc bas~s (sugg st quarterly) to 'insure that waste contamination is not entering the well. Si ncerel y, Bill H. Lamoreaux, P.E. District OFfice Coordinator BHL/msm cc: Robbie Rohinson (MOA tteal th) ALASKA elIUIROBITIEI TAL CO ITROL SERuiCeS, I lC. June 21, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Attn: Keith Bandt Legal: Lot l19A Section 15 Ti2N R3W Dear Keith: A well to septic tank waiver was requested from the Alaska Department of Environmental Conservation for the above property. The waiver was conditionally granted on 15 June 1984. The two conditions were to measure static water level in the septic tank to determine its integrity and to install a chlorination unit in the water system. The water level in the septic tank remained static over a 24-hour period with no water useage. This indicates that the tank is entire and has no leaks. A Culligan chlorination unit has been installed between the well and water storage tank, allowing a sufficient contact time. The unit consists of a 20,-gallon chlorine tank leading to a feeder unit and then into the line between the pump and holding tank. The feeder unit is set to come on when the well comes on, and it can be adjusted to feed in chlorine at a rate of 0.1 to 1 mg/1. The conditions for the well waiver having been met, we are now applying for a HAA. If you have any que~tions please contact our office at 561--5040. Sincerely, ;wen Turner ;nvironmental Scientist Approved: 1200 ~¢sl 33rd Au¢ u¢. Suil¢ B, Anchorofle. Alas~o 99503 .[907) 56650ZlO ALASKA E ilUIROFIFI1E FITAL COFtTROL ~ntlinecrJltq $ ~nuJronme~lal $1udi~s $ RuICE!S, Irl£. MAY 14 1984 DAVID WYSNYNSKI 4610 E 101ST AVENUE ANCHORAGE AK SELLER - DAVID WYSNYNSKI BUYER - SUBDIVISION - SW1/4 NE1~4 OF SW1/4 SEC15 T]2N R3W SM BLOCK - LOT - i19A ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 490 SQFT, THE SYSTEM IS CAPABLE OF ACCEPTING 300 GALLONS OF WATER PER DAY. THE SURGE CAPACITY DF THE SYSTEM IS 450 GALLONS, BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 2 BEDROOM HOME, THE SEPTIC TANK WAS PUMPED ON MAY 7 1984. , FLOW TEST ON WELL THE WELL FLOW RATE WAS 4,2 GPM FOR 2 HOURS, SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 2 BEDROOM HOUSE, 1200 [Uest 33rd Auenue. Suile B oAnchoroqe. Alasko 99503.(907) 561-50/40 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 Ms. Gwen Turner Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Ms. Turn~r: June 15, 1984 Subject: Lot llgA, Section 15, Tl2N, R3l,l The separation distance of 45 ft between the well and septic tank is below current Department standards of 100 feet, and also below Department stanQards at the time of construction (50 ft). We have concerns about the possibility of 'leakage from the septic tank into the well, due to the age of the septic system. Due to limitations on the options available to correct the present situation, we will reluctantly approve the present wastewater dis.- posal system, subject to the following conditions: ae Testing of the static water level of the septic tank by a registered engineer under a no flow condition indicates there is no leakage from the 'tank. bo A chlorination unit is installed on the water line from the well and continuous chlorination of the well water during well pumping is practiced hence- forti~, maintaining a free chlorine residual of at least 0.1 mg/1. The chlorine application point should be placed prior to the pressure tank to provide for contact time in the tank. In addition to these mandatory conditions, it is strongly recommended that samples for nitrate be taken on a periodic basis (suggest quarterly) to insure that waste contamination is not entering the well. Sincerely, , Bill H. Lamoreaux, P.E. District Office Coordinator BttL/msm cc: Robbie Robinson (i,iOA Ileal th)