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HomeMy WebLinkAboutT12N R3W SEC 22 LT 22 N2S2  ~ 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 ' ~ Dwelling PERMIT NO. ~ ~ DISTANCE TO~I~O ' I Absorption area ~//O ~ '~ ~ ~ Manufacturer ~ Material No. of compartments Liq. capacity in gallons I Inside length Width Liquid depth I~O IF HOMEMADE: , ~ Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in ~allons ~ Well Foundation Neares~ot I~e PERMIT NO. ~ DISTANCE TO: ~ ~ Top of tile to finish o~ad~g ~aterial Beneath t,le -- 9 ~ inches ~0 ~Q ~ P Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~ ~ SOIL TEST RATING R EMAR KS APPROVED DATE LEGAL 72-013 (Rev. 3/78) . ":-2.'.;- _...- ...... '.. '- ; .......... ';5 , :,FPR~'T}IF~.,!T ~ ~F HEFt[ TH F~ .,![':, El-, ,¢ I RC~Nf"!EN7 HL !-. r,:.UTEL: F Z ON ~ / ~-. '' "~ , ' ::~;:% "'L'" ST'REET., flNE:H~:~?FIGE., F!K. 9950:i. ~L~ F~F'Pt...ZCI~HT GLENN Ci[:,EGRRRD ]',:~3~; !4ESTHOOD - ~-~'~ / 24.3-6886 LOCFFr'zoN :Lt~, PRTRO ' L.EGRL. , L~ ~2)SEE:. 22:TZ2N R2:W LOT SIZE ~4C~:~;~t. IFIRE FEET 'TYPE OF' SO~L RE~SORP"I"~ON S'YS'TEM ~S; TRENCFt MP,~'CEMUi'd NUHBE3~: OF BEC4?OOHS = 4 SOIL RRTtNG ,::SC..! F'T,-'"6'R)TM ±50 THE REQUIRED SIZE OF' THE SOIL.. RBSORPTION SYSTEM IS: THE LENGTH [:'IMENS!ON IS 'THE LENGTH (iN FEET) OF ]'PIE TRENCH CiE: DRFtII",IFIELD. ]'FIE DEF'TH OF' Ft TRENCH OR PIT IS THE [:,ISTRNE:E BETHEEN THE SURFFICE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTIOH (IN FEET). THERE IS NO SET WtE:,TH FOR TRENCHES. THE GRRVEL [:,EF'TH IS THE M~NZM!JM DEPTH OF GRFi',,,'EL 8ETHEEN THE OUTFRLL F'~PE RND THE BOTTOM OF THE ENCR',/RTiON <IN FEET>. PERM:(T RPF'L.!CRNT HF!S THE RESF'ONS:,IE:IL!T'¢ 'TO iNFORM THIS DEF'F!RTHENT DURING ]"FIE: INS"I"FILLRT!ON INSPECTIONS OF RNY HELL. S R[:,JRCENT "FO THIS PROF'ERT'¢ FINE:, THE IqUMF3ER OF RESIDENCES 'THRT THE HELL HILL SERYE. E~F!CKF'ILL!NG OF' RN"r' S'?'STEM HITHOUT FINFIL INSPECT!ON RND FIPPRO',.,'RL. [.:2',-' THIS DEF'FIRTHENT HILL BE SUBJECT TO PROSECL~TI'ON. MINIMLIM [:,!STRNC:E BETHEEN R HEL. L RN[:, RNY ON-SITE SEH!aGE DiSPOSRL SYSTEM IS !00 FEET FOR Fl PRtVRTE HELL OR ±50 TO 20D FEET FROH R PUBLIC HELL [:,EPEN[:,ING UF'C~N THE T?PE OF F'UE:LIC HELL M!NIMUN [:,ISTRNCE FROM R PR!VFITE WELL -['0 F4 F'RIVFITE SE!4ER LINE IS 25 FEET FI!'.,iD TO R C:OMMUNZT'Y SEHER LINE IS 75 FEET. OTHER REQUIREMENTS MR'Y RF'PL.'Y. SPECIFICRTZONS RND CONSTRUCTION DIRGRRF'IS 8RE RVRIL.FIBL. E TO INSURE PROPER tNSTRLLRTiON. I CERTiF"r' THFFf' t: i RM FRHIL. IRR t.,.IITH THE REQUIREMENTS FOP:: ON-SITE SEWERS F~N[.', HELLS RS SET FORTH 8'¢ THE HUNICIPFtLIT'¢ OF FtNCHOF~RGE. 2: I WILL INSTFtLL. THE S'T'STEM IN F3C:CORDRNE:E 1.4iTH -rilE CO[:,ES. 2;: ! UNDERS]"RND THRT THE O!'.,I-SITE SEWER '_:;'.¢STE!'d l','!R'.? REL-]UIRE ENLRRGEMENT IF THE RESIDENCE I5] REMODEL.E[:, "FO INCLUDE MORE ]"HFIN 4 BEDROOMS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 254-4720 SOILS LOG - PERCOLATION TEST SLOPE 2 3 -.--~4 5 6- 7- 8- 9- ~SOiLS LOG - ,~ [] PERCOLATION TEST DATE PERPORMEO: SITE PLAN ~,~.~ ~ 11 .~.12 13- ,14- 15- 16- 17- .~.18 ,. 19- 20- COMMIE iTS PERFORMED BY: WAS GRO.ND WATER t,) 0 ~ ENCOUNTERED? - pO E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~(minutes/inch) 'EST RUN BETWEEN FT AND , FT DATE: 72-008 (6/79) • 7(1. 557t'�;... Municipality of Anchorage/„. On-Site Water&Wastewater Program /0'' 4,;^,�y� ; ®t ' (907)343-7904 .0 7 ),-, K_> t CERTIFICATE OF ON-SITE SYSTEMS APPROVAL-- Parcel PPROVALParcel I.D. ! 015-141-38 Expiration Date: 1. GENERAL INFORMATION Complete legal description T12N, R3W, SECTION 22, LOT 22 N2S2 Location (site address) 4725 E. 112TH AVENUE*ANCHORAGE,AK Current Property owner(s) DEBRA&ALLEN FREUDENTHAL Day phone 444-1137 Mailing address 4725 E. 112TH AVENUE`ANCHORAGE,AK Real Estate Agent LEIGH BROMLEY • Day phone 273-7725 2. TYPE OF DWELLING: II Single Family (w/wo ADU) • ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well! ':;-`."' ■ Individual On-site Individual Water Storage' ❑ Individual Holding tank ❑ Community.:Class'=` Well ❑ Community On-site ❑ Public Water Sy`stehi ❑ Public Sewer ❑ WaiverNariance request for N/A Distance: - • Received by: � . Date: I I / L Z I 1 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52140/D v Waiver Fee $ Date of Payment t I//�o 7/2.0I(p Date of Payment Receipt Number 07 6fSDE7 Receipt Number COSA# 05CIIWaiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE,AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. • Date I /9-/ Engineer's Comments: 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 ��•C O� / 1��♦ condition of the systems on the date/softhe evaluation.Separation distances were measured to readily identifiable features. '•P, _... ,q ♦♦ Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic ,trC/�, ♦ systems depend on a varietyof variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during 'J:•• the year),quality of construction(materials and workmanship),and the water usage of family utilizing the systeMs.These ; •- conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of ■ = 4i). rr I •: I % systeMs;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 orseptic system can be installed on the property in the event either of the I'. ..,.. . , •„ current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the ♦ A r • ♦ c^ y 'Ga ess information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not ♦ Gni •, 7954 authorized.In short,GEG disavows any legal duly to anyone other than the person/par(y who paid for this report ♦♦ '> CE- r V\- 6. DSD SIGNATURE .1. PROFESS LICENSE ........... System System #1 Approved for `-f bedrooms. WAECC884 System#2 Approved for bedrooms. Disapproved. \vv1.\v. , 11 t..‘ ZY OFAA , Conditional approval for bedrooms, with the following stt$ ons: Qr, ON-SITE `vs WATER AND m WASTEWATER z • k_1 PROGRAM NTSERNA6cP• //ori ;c-kimnol Original Certificate Date: ///Z 74 The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory X Other (Rev.10112/12) • . If more than 1 septic system is on the lot: COSA Checklist# of_ Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: T12N, R3W, SECTION 22, LOT 22, N2S2 Parcel ID:_ 015-141-38 A. WELL DATA PER GEG INSPECTION **PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed UNKNOWN Sanitary seal (YIN) YES Wires properly protected (YIN) YES • Total depth *130+ ft. Cased to "40+ ft. Casing height (above ground) t2+ in. FROM WELL LOG AT INSPECTION Date of test 9/27/2016 • Static water level \I\10)-\.o0 ft. 79 ft. Well production /NO g.p.m. 0.7+ g.p.m. • WATER SAMPLE RESULTS: Coliform *0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG,Ltd./'ARROW PUMP&WELL Arsenic: 7.89 ug./L. Date of sample: 9/27/2016&*10/7/2016 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/STEEL Date installed 6/30/2003-7/1/2003 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping (i' )-o) I(.o Pumper Mc C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE NORTH/SOUTH • 6/30/2003-7/1/2003 ' Date installed 10/13/1981 Soil ratingp.d./�or /bdrm 0.8/150 System type TRENCH Length 50/50 ft. Width 2.5/2.5 ft. Gravel below pipe 7.6/6 ft. Total depth *11.8+/12 ft. Eff. absorption area 750+/600ft2 Monitoring tube YES Depression over field NO Date of adequacy test "9/27/2016 ' Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test —34.5 in. Water added "686 gal. New depth—47.5in. Elapsed Time: "1440min. Final fluid depth"34.5 in. Absorption rate >= "600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - "TESTED NORTH (2003)TRENCH ONLY, SOUTH (1981)TRENCH WAS DRY UPON INSPECTION, HOWEVER, CONDITION OF TRENCH IS UNKNOWN. INTRODUCED WATER INTO WEST MT(MT2)THROUGHOUT TEST.WEST MT WAS ABLE TO ABSORB 686 GALLONS IN 24 HOURS AND NO RISE IN LIQUID LEVEL WAS OBSERVED IN THE EAST MT(MT1). UPON INSPECTION, IT WAS NOTED THAT BOTH VALVES IN THE LIFT STATION WERE OPEN,ALLOWING AN EVEN DISTRIBUTION BETWEEN BOTH TRENCHES. UPON COMPLETION OF THE ADEQUACY TEST, BOTH VALVES WERE LEFT OPEN. D. LIFT STATION 'SECOND COMPARTMENT OF 1500 GALLON STEP TANK Date installed6/30/2003-7/1/2003 Size in gallons *500 Manhole/Access (Y/N) YES "Pump on" level at 43 in. "Pump off' level at 39 in. High water alarm level at 47 in. Datum BOTTOM OF TANK Cycles tested - 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES . SEPARATION DISTANCES FROM WELL ON LOT TO: • Septic tank/lift station on lot 100'+ On adjacent lots *1001+(WITH CAVEAT) Absorption field on lot 1001+ On adjacent lots '100'+,(WITH CAVEAT) Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25+ Holding tank 75'+ Animal containment areas 501+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001+ . SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line "5+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 101+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WAS UNABLE TO CONFIRM WELL AND SEPTIC LOCATION FOR PROPERTYTO SOUTH (T12N, R3W, SECTION 22, LOT 22,S2S2),"PRIVATE PROPERTY"SIGNS POSTED AND NO HOMEOWNER TO WALK THROUGH PROPERTY. "WR#030044 • Ncl OF A, �4� . G. ENGINEER'S CERTIFICATION ear•• •/•A--_\. I certify that 1 have determined through field inspections and 4 • review of Municipal records that the above systems are in !l ` iiia conformance with MOA COSA guidelines in effect on this I ; date. - Is r^ : :J-f ', A. Gorness w Engineer's Printed Name JEFFREY A. GARNESS - 4•10 cllt 'E-7953 ./...rte ••FP '•••!).)1 Ilft• 'Ft: Date Illi-l1(, LICENS.•0 pROFES51g#i•' • $AECC884 ,******** (Rev. 10/12/12) • • Municipality of Anchorage *' " Development Services Departmentma = Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # OSC161532 During a recent COSA on-site inspection and test of the potable water supply well on Lot 22 N2S2 of T12N R3W Sec 22 subdivision, the well's productivity was determined to be .7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4-bedroom residence is .41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. 150 Scale LOT 228 I 8445H LOT 6 S09°59'00"E 330.00 � r � 1--- - _�. ` , \ \ \I rC2� t)RIDER -.- �SeptlpeentaC DECK :int 1 I Septic tank/ I gg "1N112,5112,LOT 22 a I g HL Fire pit Section 22,T12N,R3 W,S.M.,AK c,rob wall ` LOT 2'I F3 mO on 2gg ,y5 Wood rot wall'', °2gg o�l 26 c US LOT 23 rfe «I I ,Ro Iry Iv a1 II c u u=- R` wll 11 �wln fence S o d R s 1 Conc.ratlwan Attain link . o b.CI Garden PPP` CI O itl d I TA \ \ r0 I, M10 o a /I ,A^ � Y °- I I Chain link fence/ Chicken cooN. / I - Ween fenced a_. S09°59'00"E 330.00 , ° alghbors deck encroaches Driveway continues Soununaae xvt Si.S1,Lot 22 m en2w Av°n,he rf no recon of IA E.nemem was found. 5112,5112,LOT 22 Section 22,T12N,R3W,S.M.,AK 1111LT NO CORNERS SET THIS DATE :: A ,11 herebyn 0m11 have propert eaa M°rlyapee'simpedlon 2:::%. L`�. or Cq 1 enhaELM.c9eeapr!Pe9I1 2.T1ZPThe nhtrz cru. r•r P•• '‘F4-1, Sau11r 112 of BLM Lo�22$ n 22,TITN,3JWSM.AK *�,: 49th // Anchorage Recording Precinct.Alaska,and loathe .. f ///��^VV,1�y� Improvements&tinted thereon are within the property lines r"/�)(1'ev� 4X°Mf.o- - and do notevwlap or encroach on the properly Mlnp /'+a A adjacent thereto,that nolmprovements on the property lying / . '.Fred Wolotko:y .a adjacent menloencroach en the premien,In question and j P,^s. 1255-5 .•, s That there amen rmaways,aranrmbemnmm or other visible easements on said property except as hnameted SCALE: 1"=3U' 11" 0••. hereon. THOSE SHOWN ON THE RECORDEDEASEMENTS OF RECORD,OTHER HANI 11\�O. tDote 2llhi Anchorage, day of September 2016. PLAT ARE NOT SHOWN HEREON. I FH.FB 18-10,p99 FRED WALATI(AR ASSOCIATES BE i00R218-00691 Engineers and SnrveYan MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Properly Owner ~ ~ Telephone: Home ~6~ Business Mailing Address (c) Lending Institution Telephone Mailing Address ~ -'~' ~ J'~ (d) Real Estate Company and Agent ~-~.~_.%~. ~r ~.~ ~, ~1¢~ o~ Address Telephone Mail the HAA to the followina address: or: Check here E], if hold for pick up. List contact person and day phone number below. (e) TYPE OF RESIDENCE Number of Bedrooms WATER SUPPLY Individual WellK Community [] Public [] Note: If commfunity well system, must have written confirmation from the State Department of Environmental Conservabon attesting to the legality and status. SEWAGE DISPOSAL OnsiteV Public [] Community [] HoJding Tank [] /t Note: 14 community weJl system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 IRev 81861 Front Page I of 2 'HJOM $,jeeu!J~ue leUOjSS@JoJd eql u! sue!ss!u Jo Jo sJoJJe JOj elq!suodseJ leu si e[~eJoqouv jo ,~l!lEd!o!un~ eqJ. 'penes! e! elEe!~l]J@0 E eJoJ@q eiEp az,qeue Jo suoBo@dsu! jenpuoD ~ou op SHHQ jo see~olduJ~3 'sjueLUeJjnbeJ eje}$ pue leJepeJ u!epeo Xjs!IEe el J@pJo u! suo!lnl!jsu! 5u!pueI J!EqJ pub SELUOq JO SJeSEqeJnd oi,~sepno0 E SE e!qJ seep SHHQ eq± 'E~lSelV 1o ejeiS eql u! peJejs!baJ JeaujDue leUO!SSajoJd luepuedepu! ue ,~q eAoqe ~ qde~l~eJEd u! ua^!5 suo!jEju@seJdeJ eql uodn/~lUO peseq seleo!j]peo leAoJddv /q!Joqjnv qilUaH sanssj (SHHC]) see!^JeS ueLunH pub qjleaH 1o ~ueLulJEdeQ eSEJoq3uv 1o ~lJied!o!unV~ eq.L NOIJ. n¥o leAoJddv leUOB!puoo 1o SLUJD I '9 lees s,Jeeu!6u3 .g MUNICIPALITY OF ANC ,. ENVII~ONMENTAL SERVICES DIVI$11~NICIPA)~-ITY~ OF, ANCHORAGE (MOA) ' HEALTH AUTHORITY APPROVAL (HAA) " JUL I 1988 CHECKLIST- FEBRUARY'ID84 264-4720 WELL DATA Well Log Present (Y/N) '~ Date Completed ~f~l }¢,1~¢,*~/~1 Yield Total Depth ?./'50 Casedto ~'/'"~(~' Depth of Grouting~ Static Water Level ~ ~ Pump Set At Casing Height Above Ground J ,,~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N) Separation Distances from Well: TO Septic/~Tank on Lot 7 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~ ; On Adjoining Lots To Nearest Public Sewer Line ~/*? To Nearest Public Sewer Cleanout/Manhole ' ~._~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ .~ ; Date ~/~ Water Sample Test Results ~ ~ ~¢~ [~.~./ NJ) Comments SEPTIC/HOLDING TANK DATA Date Installed ~ Size ,/ ,,~.,~" C;> No. of Compartments "T'¢,~ o Standpipes (Y/N) ~ Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) ~" Depression over Tank (Y/N) ~ Date Last Pumped qOt'/~¢~' [,,~41.--" $ Pumping/Maintenance Contract on File (Y/N) ~/~ ;for ¢¢//~,'~ Holding Tank High-Water Alarm (Y/N) 1~/7,~ Temporary Holding Tank Permit (Y/N) ~¢'~-~ -- Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ?? To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed O Width of Field ?~,.,,2.. Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line .~/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~'~ Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To E~x4et~m~or Abandoned System on ; On Adjoining Lots To Cutbank (if present) 7.¢' Comments '.FTS 'AT, O. H Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Yested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verifieC,~r conformed to &!l MOA and HAA guidelines in effect on the date of this inspection. Signed _ Date Company ~M~A No. Receipt .o. /~,~"¢ (O5 ¢¢--0'z/'~ ~') Date of Payment Amount: $ * x//O.~z~.~ Engineer's Seal INSPECTION APPOINTMENTS DATE DATE DATE © INSPECTOR INSPECTOR DEPT. OF HEALTH & ~UNICIPALITY oF ANCHOrAgE ENVIRONMENTAL P~,OTECTION ~ ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E I V D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processin~ PROPERTY RESIDENT (If~eren~ojn ~ove) ~. -- ~ ~ ~' -~ .............. . ~ ~ ~ PHONE 4~ REALTOR/AGENT MAILING ADDRESS ,,.,,~ SI NG LE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY [] One ~rFour [] Other__ [] Two ~ Five ~ Three Six * 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 J~ INDIVIDUAL/ON-SITE** [] PUBLIC UTIL(TY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION F~E MUST ACCOMPANy(.E~,C" REQUEST BEFORE PROCESSING CAN BE INITIATED. "':' ~ ( ~.~ /4, ' k' THIS SIDE FOR OFFICIAL USE ONLY 1. 'TYPE OF RESIDENCE [] SINGLE FAMILY MULTIPLE FAMILY 2, WATER SUPPLY INDIVIDUAL COMMUNITY PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~] INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified [] Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING [] OTHER TYPE OF TANK MANUFACTURER TO'rAL ABSORPTION AREA MATERIAL 4. DISTANCESWELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~PPROVEDFOR ¢'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE Tom Fink, Mayor unic p lity of Anch r ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 12, 1988 Tobben Spurkland, P.E. 203 West 15 Avenue "C", Suite 203 Anchorage, Alaska 99501 Subject: Waiver Request for T12N R3W Section 22 N½ S½ Lot 22 Waiver Request ~WR88-033, H88-0253 Dear Mr. Spurkland: 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. 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. Ro~t'h Civil Engineer On-site Services DJR/ljw#6 CONSULTING ENGINEER ~-"~ 203 w. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279 3916 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUL t 1988 Munioipality of Anchorage RECEIVED Division of Environmental Health Department of Health and Social Services 820 L Street Anchorage, Alaska 99501 June 30, Subject: REQUEST FORWAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL TO SEPTIC TANK N1/2, S1/2, LOT 22, SEC. 22, T12N, R3W 4725 Ell2TH. AVE AHFC 1988 Gentlemen; We are submitting a request for waivers distances stated in Title 18, Alaska Chapter 80.020. from the separation Administrative Code, During an Health Authority Inspectio~ on May 25, 1988 is was discovered that the distance between the tank and the septic tank was 97 feet, 3 feet less than the required 100 ft. No well log exist for this well, therefore I have used well logs from surrounding properties to evaluate the contamination potential. By going through the DEC's procedure of analyzing the potential for contamination I arrive at the following points: Ground Water (at 100 ft.+ ) 7.0 Soil Sorbtion ( Silt,Sand, Clay) 4.5 Permeability ( Silt ) 2.0 Gradient ( 0 ) 2.0 Separation ( 97 ) 3.0 Total 18.5 Conclusion: Almost contamination. sure to be free from any form of As an added safe guard. Tank is a steel tank. was used as well as water tight couplings. Please issue an waiver for this well. Cast Iron p~pe 'CONS~JLTING ENGINEER TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: N1/2, S1/2, Lot 22, Sec 22, T12N, LOCATION: 4725 E ll2th. Ave OWNER: AHFC RESIDENCE: Single Family, Four Bedrooms ,~.~ 2225-~ WELL: On Site Single Family SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: ~.'~ ~-~:,~.~-. TANK: Greer Steel 1250 Gal. Two Comp. ABSORPTION SYSTEM: Deep Trench ABSORPTION AREA: 600 sq. ft. SOIL RATING: 150 INSTALLATION DATE: Oct. 1981 DATE OF LAST PUMPING: June 1, 1988 Isaacs DATE OF TEST: June 1, 1988 TEST PROCEDURE: System was inspected and measured. Tank was found with 7 feet of cover and a liquid depth of 49 inches. Sump to trench was 18 feet deep and dad 12 inches of liquid. 1000 gallons of water were added t9 the sump in 250 gallons increments. The water level in the sump rose to 33 inches after the first 250 gallons and remained at that level. After four hours the water level had dropped 2 inches. This indicates that the sump is not perforated, or is plugged at the bottom three feet. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function ~atisfactory for current or future occupants. ANCHORAGE, ALASKA 99501 · CONSULTING ENGINEER TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: N1/2,S1/2, Lot 22, Sec. 22, T12N, LOCATION: 4725 Ell2th. Ave. OWNER. AHFC TYPE OF WELL: Private, Single Family ~...~."..---~F¢'-"'; ; .... :. WELL LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: NO. Septic tank ~aS;:~ta'5'~d too close to well in 1981. Required distance is 100 f~et, actual distance is 97 fe~t. A waiver must be requested. PUMP YIELD FROM TEST: 7.5 gallons per minute. WELL YIELD FROM TEST: 0.75 GALLONS PER MINUTE DATE OF INSPECTION: May 25, 1988 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 81 feet below top of casing. At a pumping rate of 7.5 gallons per minute the water level dropped to 129 feet after 12 minutes of pumping. At this time the well was dry and the pump was pulling ~ir. Pump was shut off and well recovery monitored for 45 minutes. During this time well recovered 48% to a water level of 106 feet. A total of 90 gallons were pumped in 12 minutes. TEST FOR E.COLI AND TOTAL NITROGEN.: Water was tested for E.Coli and total nitrates on June 1, 1988. E.Coli 0. Total Nitrates. ND (None Detected) M~x. allowable Total Nitrates 10mg/1. TEST RESULTS: Municipality of between the well This well meets the requirements of the Anchorage with the exception of the distance and the septic tank. THIS WELL WILL PRODUCE MORE THAN FOUR HOURS THAN 3 GALLONS PER MINUTE FOR MORE The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. 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