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Home My WebLink AboutT12N R3W SEC 24 NE4SW4SE4NW4 PTN Municipality oll Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201170 PID Number: 015.-163-15 Dwelling: ,I Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: [j New Upgrade Name John Staser ABSORPTION FIELD ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address �' 11400 Snowline Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-317-3917 3 1.2 GPD/SF 4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.37 Ft. Gravel depth beneath pipe 1.63 Ft_ Subdivision Block Lot Fill added above original grade 0.99-1.55 Ft. Gravel length 59 Ft. Township Range Section T12N R3W NE4SW4SE4NW4 24 Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To! Septic AbsorptionI Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From , Tank Field I Tank Line 375 Ft I Ft. Well $(j'* I f* _ j TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other I I Manufacturer Capacity Surface Water j 73''` ifl0'+ 1 Greer 1000 Gal. Material Number of compartments f i I Lot Line 151+NA i Plastic 2 Foundation i 5'+ I 10'+ LIFT STATION Manufacturer Capacity Remarks *-WA1VJ:,12# VVit940019 Allowed for tank to surface Gal. Seater of 70' and tank to well of 851. ** Well to field Alarm location Electrical installed by waiver requested on 8/11/20 for 95'. Installer PIPE MATERIAL House to tankTank to D3034 drainfield D3034 Dean Costruction _ Drainfield F810 CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 it Inspectes 7/14/20 2oa 7/15/20 Location and description 3`1 7/15/20 4'h 71l6/20 SE Douse corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp t Ail Conditional Approval: Date" ,. �A Tf+itF[d,Jial�ijA�[^1{i1yT11.R(�..(3��Y/i. _ ['�},}•i�� Septic System Approved pp Date Note: this appro does not include well permit requirements.:,- ,3 A "M orI C O� -m 0 m ON (U AS -BUILT SYSTEM DETAILS/SITE PLAN Permit [ISP201170 T12N, R3W, SEC 24, NE 1/4, SW 1/4, SE 1/4, NW 1/4 PID# 015-163-15 4D=16x 59' SCALE, 1' = 30' v d`=2� �__` AW �� OF ALA,�X /* T KENNE D US V5 c `xoFES510T3EJ' DECK cu 0i HWY BmRWAI B BNRp NC N CD OEp( Q CD \ F / M W W a 3 ti M � w U u _y 0 Y 0 CD ON Cree N z 0� (LJ N ('') v 4-1 ca SCALE, 1' = 50' is .76 56,13 s� FINAL GRADE ias a� £ ` 2'. MRF FAMIC SEWER ROCK sols 6/9/20 to VATEP_ — 59• 37 .ovH SCALENTS PREPARED FORT JOHN STASER 11400 SNOWLINE DR. ANCHORAGE, AK 99507 907-317-3917 FIELD BOOKS cwpui : MUMMY:N A DMm: KSD s WING: N A CNECKm: KMD A UILT: DATE: 8/07 DM. Fly: calm SW26z 18 CD 20146 \ (lJ CD ll`��11�11 4 CD CD L7 A—E=31.9' B-E=53.3A-F=36.7'w 81.61 B -F=58.1 Vn C -G=46.4' D -G=50.8' f C -H=48.0' D -H=52,4' C -I=63.3' 1000 GAL D -I=42.8' SEPTIC C -J=63.4' v TANK D -J=44.2' �__` AW �� OF ALA,�X /* T KENNE D US V5 c `xoFES510T3EJ' DECK cu 0i HWY BmRWAI B BNRp NC N CD OEp( Q CD \ F / M W W a 3 ti M � w U u _y 0 Y 0 CD ON Cree N z 0� (LJ N ('') v 4-1 ca SCALE, 1' = 50' is .76 56,13 s� FINAL GRADE ias a� £ ` 2'. MRF FAMIC SEWER ROCK sols 6/9/20 to VATEP_ — 59• 37 .ovH SCALENTS PREPARED FORT JOHN STASER 11400 SNOWLINE DR. ANCHORAGE, AK 99507 907-317-3917 FIELD BOOKS cwpui : MUMMY:N A DMm: KSD s WING: N A CNECKm: KMD A UILT: DATE: 8/07 DM. Fly: calm SW26z ACA° n' FILE 'CCB NO' 20146 ll`��11�11 Municipality of Anchorage \ � Ue pnrtment P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 a Fax (907) 343-7997 http://wwW.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program x x x x VARIANCE/WAIVER REVIEW x x x x Waiver#: OSV201049 PID#: 015-063-15 COSA#:OSC201370 Permit#:OSP201170 Legal Description: T12N R3W SEC 24 NE4SW4SE4NW4 PTN Engineer: ArcTerra Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 95.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ...................................................... 0 M R M 0 a 0 M M 0 Z M ...... 0. 0 0.. 1 Waiver is Granted: X Waiver is not Granted: Date: 5 Approved by: Name of Reviev er **** VARIAN C EMAIVE R REVIEW **** oti �FtCTERRH , n - August 11, 2020 A»cTERIUZA CONSULTING, INC 20441 Ptarmigan Bld, Eagle River, AK 99577 Office (907) 696-6111, Fax (907).868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic System Waiver Well to Septic Leach Field— T12NR3W Sec 24 NE4SW4SE4NW4 PTN2 This letter is to request a well to leachfield waiver due to the recent septic upgrade on this property. There is an approved waiver (WR940019) for the new tank to well due to limited area. Topo was picked up in the area of the drain field and shows slopes of 15-22% across the corral and drainfield area and estimated slopes of 10- 15% west of the area. The drain field was placed in the existing drainage area trrench as approved, and the septic cleanouts are more than 100 feet from the well. On receiving the asbuilt survey drawing from Fred Walatka and Associates it shows the arc of the 100' protective well radius crosses over the center of the drainfield. The current water sampling results (5/11/20) show nitrate levels from the old system as 4.09 mg/L and we can expect the same results from the new leachfield. We are requesting a waiver of the well to septic drainfield to a distance of 95 feet. We do not expect there to be any adverse effect on adjacent lots or to the existing well on this property due to the topography, with the well approximately 20 feet higher than the ground level of the trench. If you have any questions, please contact me at 696- 6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc en . Duffus, P.H. 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 Z r- = D N00°02'00" 255.± M ��m U) >mif ;gym 0M Z � Z0� m ®* Cl) Z0 _ 0� —OzM M* --1 0z z = 0 z iii 0=M; M U) ;d o0 (n o mom (Z 0 ;o= z0m M Y ® _ U) -tom z � fT1 Y , W W � > m CO WCD < n � 00 -I-� Co `� —►11.2 ® w p -� 'o CA) 01 C31 0 x ® z ® 0 N m z -p T 00 ® � COO Q -COD n C) G) CD 1+ o I C) T = cc) ay D M C m �• �- 1 v 1 T:3 fl�i ® N ill W (D Cn ID CL < CD CD CD : D �0 9 1+ 4- CZ Orp 71 cD `G O W i�rU G T -s -�, � 'Q� G DM CZ � n � p C � 5. ca D�oQ 4 ,® 2H 0 _ t 34_ p�m0 n q, CDCD _ C�� -a D n OC'kCD S CD -, ? D :3 11 0 �+ u .. � o o m 07 CD CD 3 o m o� CD 0 � 30' General Public Use & Utility Easement � 3 ® �� o sv cn W — -� - ..S D Cl�� C �• SNOWLINE DRIVE 0 �_CD 0 CD o 500003'00"'W 255± T C:D ,_, CT rf, �. CD 3• CD CD N D� Q OCD u CD o m 3 fTl C37 =7- D5TC/)v. :37 O T 0- Qy C� n" ChD M C 5 �`C jrm(D z• � 'CD o �U'C W m w o - — .ZI Cn O ° c� C7 (D �- a. o- D CD Cgyp =rm o N o ;w CZ p Cr — r+ n 0 � o � � �. n (DD � �. CD =rCD CD .-t- 0 0' CD CD — GofD 0 n 1•T I Co3� 3 3 o CD CDC to CA p CD C®' ® C O � CD 0 O � � � C� CD CD � � sl � ® .� CD CD .-+ e-+: O 43 C/} -z CD. -r -a C 6- p iv N C7 ` C7 Q �- O CD Ca N Z Q) =rZ N � 1 0 cn cn CDC L -p m Co ®CD n 0 :3 <CD M -n O CL 0 x CD C C=3 � C 3. -o CD CCD N CIa Q � 11 C -,b • +t • • b \ • • o CD Cn CD ZY �cn T. CD• M me' -& Cn C2. CD .� O�? ° ''' •� • ` CD cc O 'U _ CD � 0 �' Z T p --I OZ�N Ao ® `Cr••1(.0 O _ i13 '� (p _ 000 `C o� p � �r, .• rncn CA . C5S CD v t 0 � �Oo •! �00 %Z o m ® z �N� CDnim 0 CD �,00 0 cocQ CD mr+-P-1- � CD CC �. � 00 y D caCD Q- CD i • • o CL CD CDYOR MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201170 Work Type: Septic Upgrade Tax Code Number: 01516315000 Site Legal Address: T12NR3W SEC 24 NE4SW4SE4NW4 PTN G:2640 Effective Date: Expiration Date: ,,, c 1. 0 . U Deparemenr Site Mailing Address: 11400 SNOWLINE DR, Anchorage Owner: STASER JOHN R & JULIE A Lot Size in Sq Ft: Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: This permit is for the construction of: 7/2/2020 7/2/2021 87750 R1 Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either. a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: * Prior to construction, a surveyor is to locate the creek in the southern half of the lot and flag the approve 70' separation for the tank location: If this distance can not be met; construction of thesystem will stop pending On - Site review and approval. Received B, Issued By: Date: Date: 72 t! "ell S Municipality of Anchorage > Ur �:n•rment P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Proaram x x x x VARIANCE/WAIVER REVIEW x x x x Waiver#: WR940019 COSA#: Permit#: OSP 201170 PID#: 015-163-15 Legal Description: T12N R3W SEC 24 NE4SW4SE4NW4 PTN Engineer: ArcTerra This is a reissuance of WR940019 for the proposed septic system upgrade. The allowed separations are; the tank to surface water of 70' and tank to well of 85'. This waiver approval applies to the proposed tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. e e e e■■■ e e e e e e e e e e e e IN e e e e e e e e e e e e e e e e t e t e e e e e e e■■■ IN e e e e e e e e e e e e e e e e e e e e e e e e e e e e l Waiver is Granted: X Waiver is not Granted: Date: zi z� Approved by: Gf/ 11 Name of Revi er ■■ e e e e e e e e e e e e e e e e e e e e e e e e e e e e e t e e e e e e e e e e e e e e e e e e t e e e t e 0 ■ e e e e e e e e t e e e e e e e e e I **** VARIAN C E/WAIVER REVIEW **** . i MUNICIPALITY OF ANCHORAGE A Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section —' Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 015-163-15 Property owner(s) John Staser Day phone Mailing address 11400 Snowline Drive Anchorage, AK 99507 Site address 11400 Snowline Drive Anchorage, AK 99507 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Sec 24 NE4 SW4 SE4 NW4 Z /ZN a3U) Lot Size 87,750 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) ! (w/wo ADU) 0 Septic Tank E Upgrade M Duplex ElHolding (D) Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: 5-'w1q iG•25- Date of Payment: 4`jl ZQa-D Receipt Number: (3 LjC(573 Permit No. 0:5 P 0 1136 Waiver Fees: Date of Payment: Receipt Number: Waiver No. i' GADevelopment Services\Building Safety\On Site Water and Wastr m \Client Forms\Permit Application.doc �."6M 9 25% DISCOUNT APPLIED Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201170, Deb Wockenfuss, 07/02/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201170, Deb Wockenfuss, 07/02/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201170, Deb Wockenfuss, 07/02/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201170, Deb Wockenfuss, 07/02/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201170, Deb Wockenfuss, 07/02/20 O O L6 m N 0 O N O O O (D IJ 8433L N89055'00"E 330± Metal fences Y O � Septic vents R=4.5 L=21.00 NE1/4,SW1/4,SE1/4,NW1/4, EXCEPTING THE SOUTH 65 FEET, SECTION 24, T12N, R3W, S.M., AK IE (a) N I LU \ I� \ I In N� IZ) ppmmmate centedine of creek \ U Ia S89055'00"W 330± EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. RLB, FB 15-13, PG 70-73 Im I� U) IF fence SCALE: _V= Note: Unable to locate all septic vents. �1%.N%%Xxx �P�� OF • q��, 49th . y 00: ;7'•�00 .Fred Wal atka. >f / tIll, "r 3255 - S ZO • ... • ' pa°yam 8433L AS -BUILT NO CORNERS SETTHIS DATE I o @� Wood fence IE (a) N I LU \ I� \ I In N� IZ) ppmmmate centedine of creek \ U Ia S89055'00"W 330± EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. RLB, FB 15-13, PG 70-73 Im I� U) IF fence SCALE: _V= Note: Unable to locate all septic vents. �1%.N%%Xxx �P�� OF • q��, 49th . y 00: ;7'•�00 .Fred Wal atka. >f / tIll, "r 3255 - S ZO • ... • ' pa°yam 8433L AS -BUILT NO CORNERS SETTHIS DATE Municipality of Anchorage Page I _of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~R~/0d[x~ PID Number: Name: , Wastewater System: [] New '~Upgrade Addres,: ABSORPTION FIELD ~A.~O~-~ .~ .t~ [3 Deep Trench [] Shallow Traneh []no,,,h~Bsd [] thor LEGAL DESCRIPTION so. ~ating: Total~ original grade: GPD/Sq. Ft. Lct:~ ~4eek~ C'; bd!':[c!~ m Depth to pipe bottom from original grade: ~vel depth beneath pipe Township: Range: Section: Fifl added above original gra~: Gravel length: Gravel width:// Ft. Number of lines: Distance betweenlines:Ft. WELL: New Upg rade Classification (Private, A,S,C): ~,~ [~To Total Depth: Cased To: Total~orption area; Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPM PumpSetat: Ft. Ft. .: TANK SEPARATION DISTANCES .~Septic ' [] Ho~ing FI SmE.P. TO Septic Absorption Lift Holding Public/Private ManufActurer: Capacity in gallons: From Tar~k Field Station Tank Sewer Lines ~j ~ CH O P--.~C--~' T/~ ~.~ ~,~. Number of Compartments: s~,aoe ~ -- LIFT STATION Lot Sizein gallons: Manufacturer: "Pump on" level at: I "pu~vel at: I High water alarm at: I CurtainDrain ~,~O/ I~- /c:::/ ID [/,J,~ ~1 Electrical Inspections performed by: e~ BENCH MARK Location and Description; I Assumed Elevation: 17034 Eagle River Leap Road~ Ne. 2{~ ?~: ~ ~ Inspections performed by: Department of Health.and H ices approval/ ,~ ? .... Reviewed and approved by Date: 72-013 (Rev, $/91) MOA 25 Permit No.2w940089 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report NE 1/4,SW 1/4,SE 1/4, NW 1/4, Legal Description:T'12N', R.SW., S.M., AK PIDNo.: 01516515 CO ~1 C02 : FINAL GI~E NEW :. 1000 GAL ~ TANK DECK EXIST. ; BDRM NEW 1000 GAL. SEPTIC PC0 8.5 21.6 201 17.5 27.0 202 22.5 32.0 2O3 26.5 37.~ ~04.. ENGli' Rick Mystrom, Mayor Mtmicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 6, 1994 Robert Shafer, P.E. S & S Engineering Suite 204 17034 Eagle River Loop Eagle River, Alaska 99577 Subject: Waiver Request for T12N R3W Sec 24 NE¼ SW¼ SE¼ NW¼ PTN Waiver Request ~WR940019, PID ~ 015-163-15, SW940088 Dear Mr. Shafer: Your request for a waiver(s) of the required 100 foot horizontal separation of a septic system to the surface water has been approved. The approved separation distance(s) are a septic tank to surface water of 60 feet. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Robert W. RObinson Acting Program Manager On-site Services ljm:#5 ROBERT SHAFER, P,E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 August 30, 1994 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & PLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage Ak 99519-6650 REFERENCE: NE 1/4, SW 1/4, SE 1/4, R3W, S.M. 11400 Snowline Drive NW 1/4, STRUCTURAL & MECHANICAL iNSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN SEC. 24, T12N, Request you issue a 60 foot separation distance waiver from the proposed 1000 gallon septic tank to the creek located on the referenced property and allow a change in the proposed location of the new 1000 gallon septic tank. We have determined the septic tank can not be installed as shown on the design. The previously proposed tank location is too far below the nearest driveable surface to allow pumping of the septic tank. A considerable threat to the creek will exist if the tank is installed in an "out of sight, out of mind" downhill location which cannot be pumped. We request you allow the tank to be installed in the driveway near the house a minimum distance of 60 feet from the creek and 70 feet from the well serving the property. This new proposed tank location will allow easy access for pumping and maintenance. A 70 foot well .to septic tank waiver was granted by the Municipality in a letter dated 4/22/94. The house will be directly between the tank and the well. The well is not threatened by this design change. ~E~R A. SHAFER, P.E. 17034 NORTH EAGLE R~VER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 3AI~(] 0 NY'Id :illsI PAGE 1 OF MUNICIPALITY OF ANCHOP~AGE DEPARTMENT 0F HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940089 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ABEL JAMES R & LORRI M OWNER ADDRESS:Il400 SNOWLINE DR ANCHORAGE, AK 99516-1154 DATE ISSUED: 4/22/94 EXPIRATION DATE: 4/22/95 PARCEL ID:01516315 LEGAL DESCRIPTION: T12N R3W SEC 24 NE4SW4SE4NW4 P TN LOT SIZE: 87750 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A.,0PENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 April 22, 1994 Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request Waiver Request for T12N R3W Section 2~ NE¼ SW¼ SE¼ NW¼ PTN ~WR940019, PID #015-163-15, SW940088 Dear Mr. Shafer: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank of 70 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. oh~n S~ith, P.E. Program Manager On-site Services Robert W. Robinso Civil Engineer On-site Services ljm:~6 MUNICIPALITY OF ANCHORAG~~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# [~q%\~%q PID# 015-163-15 HA# Date Received: April 13, 1994 Legal Description: T12N R3W Section 24 NE% SW¼ SE% NW¼ PTN Engineer: Robert Shafer, P.E., S & S Engineering 17034 Eagle River Loop Road, Suite 204, Eagle River Applicant: James Abel Permit 99577 Waiver Requested: Private well to the septic tank of 70 feet Criteria: o 1. Geology: Points: A. Water Table B. Soil Sorption ~'~ C. Permeability D. Water Table Gradient E. Horizontal Separation /~ ~- TOTAL: Special Conditions: 3. Other: Waiver is Granted: / / List Conditions or Reasons for above: //~ ~Z~,)9.~~ Date: Waiver is NOT Granted: / ' lq //d · Name/of Reviewer Rec #: ~*~%u~ /'~'~ Amount: $ (~,(D(3 Date Paid: ~~~1 April 12, 1994 ipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES HEAUHAUTRORITY 825 L Street APPROVALS PO BOX 196650 Anchorage, Alaska 99519-6650 REFERENCE: NE1/4, SW1/4, SE1/4, NWl/4, SEC. 24,T12N, R3W, S.M. SEWER & WATER MAINEXTENSIONS 11400 Snowline Drive Request you issue a septic permit to replace the existing 500 gallon septic tank with a new 1000 gallon septic tank SEWER &WATER and issue a 70 foot waiver between the well and the proposed INSPECTION septic tank on the referenced property. Due to the creek location running through the property we are requesting that you waive the horizontal separation ENGINEERINGSTUDIES distance between the well and the new 1000 gallon septic tank to a distance of 70 feet. This would allow a 100 foot separation between the creek and the proposed 1000 gallon septic tank. A waiver of the horizontal separation distance down to 70 feet should be granted for the folloWing reasons: S,TEP~S 1. The ground between the well and proposed 1000 gallon septic tank slopes downward (25-35%) from the well toward the septic tank. This slope will direct effluent migration away from the well in ROAODESIGN the event of effluent overflow from the tank. 2. The well has been in place for approximately 25 years and shows a nitrate level of 1.22 mg/1 in a sample taken on 3/3/94. No coliform or other SOl'TEST bacteria were present in the sample. 3. Unfortunately there is no well log available for PERCOLATION the well on the referenced property, however TEST there is a well log for the well on the adjacent lot, lot 1 Karview S/D. This well log indicates ~e~aquifer is confined by impermeable clay and ~gr~el hardpan layer between 26 to 58 feet" below STRUCTURAL& / t~e ground surface. Such strata inhibit septic 'NSPECT'ONS / / /~ffluent migration into the aquifer. ONSITE ~/~ A. 5~, P.E. 17054 NORIH EAGLE RIVER LOOP · SUIIE 204 · EAGLE RIVER, ALASKA 99577 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 W 3AIWG NVgd 3J. ISI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE sEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N~me DISTANCES ~ddre~ TANK FIELD WELL ~ Z~ ~¢ driveway.AS'BUl[TwaterDIAGRAMbodies, etc.){Sh°w location of well, septic system, prope., lines, ,oundatio., TANKS N Material NO. of CompaRments TYPE OF SYSTEM D TRENCH ~ BED ~ W. DRAIN ~ OTHER original grade / FT ~,~ FT Fill added above o~iginal grade Gravel depth ~eath pipe Total absorptio, are~ Distsnce between lines Number of lines Soil rating Pipe material WELLS ~PRIVATE D OTHER (Identify) Clarification (A,B,C) Total Depth Cased to FT Installer Date InstaRed: j 72-013 (3/85) M U N I [.: iii F:' A L. ]] F Y Il) F: A N C H i.]i ?. A G E 025L S'i'.r'~,et~, Ai"'~(:::!"ii:)i"age, Ail. a!~i].::a 99501 ~t ) thc;:, c~p'I'.:[,:3i~ 'LhaL'. ' :i. ri d e s :i. g r'l :i in 9 y ciu r- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:. LEGAL DESCRIPTION: ~ 3 4- 5- 6- 7 8- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- (ENGINE~;EAL) DATE PERFORME~~ ~°c~7 A,/E".¢'.~/;¢'~'./ :~£ ~/]d.Y?l-ownsh p, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth te Water After Moniloring? Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE -- (m~nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND --FT COMMENTS ~O//- ~'~'?,z~/~'~-~/ ~ /~,~' · ,&/'O ~',~ PERFORMED BY: '~'*~ ~ ~"" ~/~ i' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 IRev. 4/85) C][)N'I AC}'i F:'~ IONEi x ;~ .... r~ f~.~m~ ~.~F ~"~l::.l-ii... fi! AND ENt,~!RONMENTAt l-rd~lE:.(..i .[J.I .:.~,::.~.~ ::~ i ~ '. i:::.,:::. ~ ~ ~. ~.,~ ~[~ ~. ~'~. ~ A~... :~ ~,~ ,.., J. ~-~N,._.,'~L,~ ~bc.~ AK 99503 . SECTION, 2:4 ~R;4I'JGE:' 3~4 ' .... fV]urt:fc:i (fvlOA) a':u~ca .... ~' ' ........ ..........;~4i~::..~ ~La'LE~ c)~' A.[,::~:.~::t~ ' ...... ' PE.:,~qLtiPE}h'~EHit!;~ ~'C)i ......... ,..~,,.:.~ !~(.}:~'[. ' ....... c: ~ .. ', :'I'::'i::;~["i'l' F ~.w~" ...... .t.I ~' ")~ .... c.[' .... ~ .~. ~..~'l'~Jc) I"" '~ BE ~db I ~..~; I,m:.J),'-"" '~ (2) ~...u_r "~.:,L~ J......" :' ' "I "[~::~' ,,..'~'~t'"" ~' .... ~'~ - ~ '"~ .... r [ .L :.,~.. ~ ~.~.,~..~... Rh.. -.~ ~ f~ AND ~'~ ~::, I d,. m&:: A ~.-. ~.,c. Nc:n:::,b [.I ..... ~ ]~ .~. L, .. P.,I. PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (ENGINEER'S SEAL) 1 2 3 4 5- 6- 7 8 9 10 11 12 13 14 DEPTH WAS GROUND WATER ENCOUNTERED? Township, Range, Section: ~,Z~/ 7''/-2vu /Z3'z~., ~-"~'/· SLOPE SITE PLAN Depth to Waler Alter ~ Monilodng? '~, Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~) ' ~ (minutes/inch) PERC HOLE DIAMETER ~ // 15 17- 18- 19- 20- TEST RUN BETWEEN . ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) '~/[/¢~1~- ALASKA nuIROFIm nTAL CONTROL St RUICI S, ~nqin¢¢rin9 ~- ~nuironmcnlal Studies InC. UNIFIED SYSTEM ASTM D-2487 10/16/87 CASSETTA'S LOT SAMPLE IDENTITY 1 PASSING #200 SIEVE: 17.30% PASSING # 40 SIEVE: 25.41% PASSING # 10 SIEVE: 36.87% PASSING # 4 SIEVE: 50.78% PASSING 1/2 IN SIEVE: 71.19% PASSING 3/4 IN SIEVE: 79.78% PASSING 1 INCH SIEVE: 81.97% PASSING 2 INCH SIEVE: 100.00% PASSING 3 INCH SIEVE: 100.00% RETAINED: 8.11% RETAINED: 11.46% RETAINED: 13.91% RETAINED: 20.41%. RETAINED: 8.59% RETAINED: 2.19% RETAINED: 18.03%~ RETAINED: 0.00% RETAINED: 0.00% THE LIQUID LIMIT IS UNKNOWN THE PLASTIC LIMIT IS UNKNOWN THE PLASTICITY INDEX IS UNKNOWN CU IS UNKNOWN CC IS UNKNOWN THE SOILS ARE COARSE GRAINED THE SOILS ARE GRAVEL THE SOILS ARE SILTY GRAVELS.(GM) 1200 [Ucsl 33rd Auenu¢, $ui1¢ ~;eAnchora§¢, Aldsko 99503.[907) 561-5040 ALASKA I1UIROIlmEI1TAL CONTROL SERVICES, I[1C. ~nc~ineerimI ~ ~nuironm~ntal $1udies October 8, 1987 Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 Re: Lou Casetta's Lot Permit # 860060 Attached is the site plan, the old permit, and 1964 site survey. A recent appraisal shows the house as still being a 3 bedroom house. Therefore, we request that instead of a 4 bedroom granted in the above mentioned permit that only a 3 bedroom system upgrade be permitted. Since the house was built before August 1965 it is probable that the system should be in the OAHD records. We were never able to find them. In 1968 the distance from a septic tank to a stream was 25 feet. This is well beyond that. If you have any questions, please let me know. Sincerely, ~200 [U~s! 33rcl ~ucnu¢. ~uit¢ ~-Anchoroc~¢, ~laska 99503*(907) 561-50z10 ALASKA b,dlI OFIITII nTAL COFITI OL IrIC. February 24, 1986 Steve Morris MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 "L" Street Anchorage, Alaska 99502 Re: On-Site Sewer and Water Supply System NE 1/4, SW 1/4, SE 1/4, NW 1/4, Section ~24 T12N R3W, S.M. Alaska; 11400 Snowline Drive Dear Steve: Enclosed find a copy of a Site Plan and Soil Log. This information has been compiled recently and is a good representation of the physical configuration of this lot. Information on the subject lot is non-existent with your department so the size of the on-site sewer system is not known at this time. The existing absorption area has failed and the owner would like to upgrade the absorption area so that it will be adequate for a 4-Bedroom house. Proposed area for placement of the system is shown on the site plan. Investigation of the septic tank shows that the tank may be larger than we prevzously excepted. U~%n~a ~at~detecto~ to,out'tine the .dimen~i0ns ~f: the:~:t~k shbW~th~Z~i~t~be~-approm~m~e~ly 1500ga~Ons. ~iT~tandpipe showJ is probably located in the second compartment. Further investigation of the tank is required to confirm the actual volume and structural integrity. ~The.~sep~¥atiOn~d~s=~iancefrom'~the tank to ,Little Campbell Cree:k:~varie'~ fromi85 to 100', Soi~l see:ms to be s~lty sandy gravel which will provide good filtration and the lot is heavily vegetated. Based on these facts we request that you waive the 100' separation requirement of the tank to the creek to 85' and the. 100~ separ~t'~on fr~m,well!'to~seP~ic!~tan~itp ~,;, This would be conditional on three things, 1) verification of septic tank structural integrity and water tightness, 2) installation of a standpipe for the first compartment, 3) determination of the volume of the tank. 1200 UJcsl 33rd A,~¢nu¢, $ui1¢ ~;*,Anchoroq¢, Alaska 99503,(907) 501-50/40 Good soll was encountered in this area. The percolation rate calculates out to about 34 square foot per bedroom and will be increased to 125 square foot per bedroom for a safety factor that we feel will give the system a good operating llfe. I would like to recommend that a 5 foot wide trench with 42 inches of sewer rock be used here. With the correction factor from the Manual of Septic Tank Practices of 0.54 the length of the trench would be 54 foot long. If you have any questions regarding this matter contact m~ at 561-5040. Sincerely, F. Cords Civil Engineer Approved By: Rid , PhD, P.E. Presid?t ALASKA ENVIRONg..NTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF_ CHECKED BY OATE / // ./.7 // \ I.. CIENEPAL� INFO RMAXION Cornpl,ete. legal descriptiort 71,2NR3W �G- E4 NIW4 Looaion (site qdfjres�s) 21 141DO Spowline Drive, ArAch0q, s.K. Gwrth-ot P-roporty ownef(s) joh'r, S-1a7gor D.ay phono tolailing. addross 11400 -soo.vAirift Or'rvn. A -K Real E_-t-,qt4e- AgeRt Djay ph(3: fi 0 2.TYPE- OF DWELLING: Single Family (wivm ADIJ) c)u.0 ley, P.%4ultiple:D-Arollinq,,,(-Si,,nqiGPai-nlyaridforDail ile.-Y-) 34 NUMBER OF BEDROOMS; 3 TYPE OF.,WAT W_A.$'T.E ER DISPOSA .. L' 4- TYPEO-FWATER SUPPLY.; -age Individual I ndividual Wefl On. -i$,ite %PhAor aact Wci-e4e*.:e�- r Pr*lugraffl Hold. -Ing Tank. Cj Individual, Water-Siorago, POT) 343-TR04 Corrimunity -Z C mity C-lasm Wo_iL PU IC Publir- "Nater �E.4ysstem CERTIMCATFE OF ON -S-ITESys-TEms APPROVj�-%.t__ Parcel I.Q. E:xpiration.. Date - I.. CIENEPAL� INFO RMAXION Cornpl,ete. legal descriptiort 71,2NR3W �G- E4 NIW4 Looaion (site qdfjres�s) 21 141DO Spowline Drive, ArAch0q, s.K. Gwrth-ot P-roporty ownef(s) joh'r, S-1a7gor D.ay phono tolailing. addross 11400 -soo.vAirift Or'rvn. A -K Real E_-t-,qt4e- AgeRt Djay ph(3: fi 0 2.TYPE- OF DWELLING: Single Family (wivm ADIJ) c)u.0 ley, P.%4ultiple:D-Arollinq,,,(-Si,,nqiGPai-nlyaridforDail ile.-Y-) 34 NUMBER OF BEDROOMS; 3 TYPE OF.,WAT W_A.$'T.E ER DISPOSA .. L' 4- TYPEO-FWATER SUPPLY.; Individual I ndividual Wefl Hold. -Ing Tank. Cj Individual, Water-Siorago, Corrimunity C mity C-lasm Wo_iL PU IC Publir- "Nater �E.4ysstem r A'afmdVartance request for bstancp Rscilv d by: COGII, (aft ruS f:Mrih '-td tr1 MC5 OiiOhWef. requoRU01-y ItIm angimror. S. S-TATEME7NTOrI.N,'c.�PeC-nOMS-Ye�NelIN8C-t�, 4 n on, A.g. certified by rtrj --eai: affix, -A. 4i�5rafo and-:ag of tM validaficyn dato sl-wwrl bei Ow, I valify tKrit- Iny iftdqt�ilekfl b on prQcpvdLt1.r&- 0Ufli.,,nk,--vJ. M .ole Ce-Tfifi?-'atu Of 0-n,�SiTta -8pyrstuwk-� Appruval Guld.elitirm fur thL5 '440cgUot-1, Shows fffaf tho 011-1Mte.. mvtut wplity andfor wauTewal-or Weposol !L�y.N-tem i% (prd) .4;;700, funcI109191 and: a-dequate for the mmnEw.r of bodroom - . -f : ha It) . Fttncl ryjv of -structure indimatod 1wrein- I rurthe-r vart -V that bag -ed D11 Ef .6rMFAq0 obtairied- fTqm Mo. Munici Wly ol: Art charmue flk✓ amid froni imy InvoApatiop. and inspecton, Um, Gri-,j, b� wator supply a.ndlor wastunvater di-spwsal SjM-te.m in CbfflPAWICP- WO :9.11 tipplica.13le Murticipol and SWO.- writ -s, utdf.nanc,fv-,, and regulaflorl�: i3i effp-d all thu Halle of irtq-T-Mlaiion. Name of Firm t-WJ�L- VRA Phonri % INC;t. �.. --l— , .11-11-1— Ad-dress. 2M "A ft I FE Z,.AK. Enginears Printa-d Name qfteere. ccYnnuarilm, -fluir'. wkq*;1qr-mpl0ed in tNt M--:D-k mgWadon-& 7he of (he Well 80 St- M. -g= klprRJ.-.% ou to 'lie wN.Ckans, *s or Ui& 68, y tWed, 'rilePY Ild abBUIPOIF! foltm IMiy chomp we to W'.L*rface 00ndmuft Oat rna..y not front Alle w-f1w, 0--o-or-S. Kam usq, lorwwwatEr WIT-i9AhAt 111W.V tKiduatD ft,irhk g ML- vduf awl IN,, vn-jlmztr rage uf 6- Nwaty bwng r—,( -std by iii�4-w.-iitorn- Tlv-- opelmik'snal fifo. mf all Vefi mul eksf�3 Ble varluw- mr,!.j MA, -Vit:iQ1 rf trlt:a tv,i'aligtbi, orlhe.%wll aii.d -s*rm-ic t"lmm. Ajr.Tema C*fn 1 h1 is y 1100 '011111 rundWl -", ligad�)Ty lr,,r Ijrrq4 ur rkiture. duj ipaM6 t t�ii hrLTA orra g Ljar-7,rt r,) Vial m umv.--Lsifl <lehrjanc--o- or dlsurupamP-H exist, 6. D91) SIGNATURE Sy-slem #-I Approved foro-om. 3 bedrs. Sy-ftm #2- Appro-edd fdr bucItem-n-is_ .. .... . .... Disappra-vee. Conditional app-R�vpjlor bnd.roonus, iMth the folipwing, Opulations: i OF A* 6r, .. . ...... ` �Q�Py''% ... .. . . ON-SITE ....... . ....... WATER AND WAST.. TgR pROGRAM . ............ .. ....... .... v 1 6 tl'% "I -�NN Grrginml Gertificate On.W.-- M.Pef L WA 94 ffi"I 7. ATTACH MENTS-r CC)SA Cfteckd�s.[: X aeptic Sygfuam Advisory 1 F I ow A d%1j so. r, A d v I s —ary Iry other COSA Checklist Legal Description: T12NR3W See 24 NE 1/4 SW 1/4 SE 1/4 NW 1/4 " Parcel ID: 015-163-15 If more than 1 septic system on lot: COSA Checklist # _of Structure served by this system 1 A. WELL DATA Adequacy test date _ ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.7 gpm Date drilled <1970* Water storage tank volumeNA gallons Total depth 113+* ft Well disinfected for coliform test? ❑ Yes ® No Cased to 40+* ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 4.09 mg/L E]Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 12 in. Collected by Areterra Consulting Date of flow test for COSA 5/11/20 Date of Sample 5/11/20 Static water level at beginning of test 58 ft. Comments *Information from 3/22/94 Cosa B. TANK DATA Age of tank(s) New years 7/15/20 Tank type/material Septic/Plastic Measured operating fluid level in septic tank_ ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) New 7/15/20 Adequacy test date _ ® ALL standpipes present per record drawing Results ❑ Pass For _ bedrooms Total measured depth from grade 5.55 ft (max) Fluid depth prior to test _ in Measured depth to pipe invert from grade 3.36 ft (min) Water added gal ❑ N/A – pressurized Feld New depth _ in ® Monitor tubes go to bottom of effective. If not, state depth into effective _ Elapsed time min — ® Code -required soil cover over field Final fluid depth _ in ❑ System presoaked Absorption rate _ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 86x ft rO Yes if No _ ft Neighboring Tank > 100' ® Yes if No _ ft Private Sewer/Septic Line > 25' Yes if No _ ft Absorption Field on Lot > 100' ❑ Yes if No 9595_* ft Holding Tank > 100' 0 Yes if No _ ft Neighboring Absorption Fields > 100' if No _ It Animal Containment > 50' 0 Yes if No It ® Yes if No ft —ft _ comment below _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No _ ft 0 Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No _ It Surface Water > 100' ❑ Yes if No 73_9* ft Property Line > 5' Yes if No _ ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No _ It Private Wells > 100' 0 Yes if No _ ft Water Main > 10' ® Yes if No _ It Community Wells > 200' 0 Yes if No _ ft Water Service Line > 10' ® Yes if No —ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No _ ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ It Wells on Adjacent Lots: Water Main > 10' ® Yes if No _ ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No _ ft Community Wells > 200' ® Yes if No _ ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS * Waiver # WR940019 "Waiver requested 8/11/10 G. ENGINEER'S CERTIFICATION / certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ..:?, .-..: .,:. i.:;APPROVALFO IAI. INFORMATION al description. [site address or directions)' address I.i~g agency - g.add~-ess' 'ess ' Oi3!~ss.'otherwise : reqUested, ::TYPE OF WATER SUPPLY: :f :'..-:'.: " ' nd wdual well :'.~ ~ .' ..:~,:. '~ Public water - : ' , -- , If Community well system,.'~.o{/ld~.:w~itten ~onfirmation from State ADEO attest- lng to the legality, and status o( s~)~t~fni )F WASTEWATER DISPOSAL: " ' '. Individual on-site · NOTE: '72-025 (Rev. 1191) Fronl MOA#21 Holding tank , ,:: . Community:On-si;~e:"i' ' ' :&:,',:.;:.: Public sewer If community was~ewater system/provide Written confirmation from State ADEC attesting t~the'?~gality!an~l.~fa:fu~'5~;Sy~t~m. 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 Appro~/al application shows that the on-site water supply ahd/or wastewater disposal system is safe, functional and adequate for the number of bedrooms' and type of structure indicated herein. I further verifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site.water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .~ .~--~-) · Phone Add ress s & s ENGINEERING17034 Eagle River L~oad/" ' / Eagle River, Alas~ 9~5~,7-~// Engineer's signature / //~.~/,.~'~"--""-~ Date ~HS SIGNATURE / Approved for --~ Disapproved. Conditional approval for bedrooms. bedrooms, with, the following stipulations: 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 ,, t pr~fessi~na~engineerregisteredintheState~fA~aska~TheDHHSd~esth~sasac~urtesyt~purchasers~fh~mes , ~, : , ' and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHFIS do not i 'l:' ;icOndUCt inspections or analyze data before a certificate is issued. The MUnicipality of Anchorage is. n0t: ~, ,.i ? p0nsible for errors or omissions in,the professional engineer's work. ,,': : ~ '?~, Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~C,/z/ A. Well Data Well ~pe ~/~ Log present Total depth Sanita~ sea~) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number. ~/~?~ Date completed ~ / q~O Driller C)/~ Cased to Z~ r.~_ Casing height Wires properly protected(~) ~"~-,~ FROM WELL LOG Date of test ~?- ~ L/~ I C~/--~' Static water level Well flow ~/~'/ '~"? g.p.m. Pump level1 //'/ [[.~ r SEPARATION DISTANCES FROM WELL TO: Septic~,c!d~ng tank on lot Absorption field on lot /0(.) f-/~ ; On adjacent lots AT INSPECTION MUNICIPALI~Y OF ANCHOIO~GI:: ~.?~IRONMENTAL SERVICES DIVISION ~;kR 2 Z 1994 g.p.m. RECEIVED ; On adjacent lots Public sewer main <7.~- [-/~ Public sewer manhole/cleanout Sewer service line ~ ~'/~- Petroleum tank WATER SAMPLE RESULTS: ~ ~K ~ /~ L~ ~ ColEorm ~/~O~ Nitrate Date of sample: ~/~ / ~ Collected by:<~~/ B. SEPTIC/H~&N~-TANK DATA Date installed ,,t-/?~'~ Tanksize~ :(~.~ ~zl~__ Compartments Cleanouts (~) ~"~ FoUn/dation cleanout (y{~ .,,L.)o Depression (Y/I~ High water alarm (Y(~) /L.JO Alarm tested (Y!N) /C////~ Date of pumping ?/i(~/~-(~'~ ~-- Pumper, /~/~/~' SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot i:Jq' TO property line Sudace water/drainage 72-026 (3,93)* Front On adjacent lots /'~O ~ Foundation /O Absorption field ~-~'7~- Water main/service line ~(~ .~L O~ ONTINUED ON BACK PAGE C. LIFT STATION N0/,,J~ Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~- SEPARATION DIST.,~N~~FT STATION TO: Wel/]Jj3~ On adjacent lots Dateinsta,,ed /ol / n rati lGPD, t') LenCh I Total absorption area Date of adequacy test Water level in absorption field before test Manufacturer ~ Manhole/Access (Y/N) / ~" Level at ....----'"~C ycles tested Surface water Width ~ ~' Gravel thickness -~ ~f ~ Cleanout preset) ~ /~ / ~ Result~ail) Peroxide treatment (past 12 months) (Y,'/N) After test yes. give date System type Total depth Depression over field (Y~ ~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot /('j)O C/~- On adjacent lots /~/--~ [7a~ Propedyline /0 / To building foundation ./('~) /-~ To existing or abandoned system on lot On adjacent lots ~ ('~ Cutbank ,/Jo/ue.'- ~¢~-,~,~ Water main/service line //(")"2"-- Surface water /~)0' Driveway, parking/vehicle storage area /C)/7~ Curtain drain /L/~/~d E. ENGINEER'S CERTIFICATION I cerWy that I have checked, verified, or conformedtoall~ and HAA guidelines in effect / Signature s & s ENGINEERiN ~-'~r~ 17034 Eagle Riverbed'No' 204 EngineeCs Name ~a_.b Date ..~ - ~_.'n..--- '¢'~:,, HAA Fee $ ..~o¢ .:'-'~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/g3)' Back