HomeMy WebLinkAboutT12N R3W SEC 23 PARCEL 26COnsite File
T12N R3W
Section 23
Parcel 26C
#015-331-04
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211347 PID Number: 015-331-04
Dwelling: RE Single Family (SF) R with ADU R Duplex (D) EJ Two Single Family Project: EJ New X Upgrade
Name
LONGLY JOSEPH
ABSORPTION FIELD
RE Deep Trench El Wide Trench R Bed R Mound
Site Address
11331 RidQecrest Dr
El Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-240-5462
13
1.2 GPD/SF
12 Ft,
LEGAL DESCRIPTION
Depth to pipe invert from original grade
6 FLI
Gravel depth beneath pipe
6 Ft.
Subdivision Block Lot
T12N R3W SEC 23 PARCEL 26C
Fill added above original grade
0 Ft.
JGrav I length
32 Ft
Township Range Section
Gravel width
3 Ft.
Beds: Number of Lines
Distance between lines
FL
SEPARATION DISTANCES
TO Septic
Absorption Lift Station
Holding Sewer
Total absorption area
Number of trenches
Dist between trenches
From Tank
Field
I Tank Line
384 Ft2
1
Ft.
Well 95'+
100'+ na
na na
TANK 01 Septic C3 S.T.E.P. [03 Holding El Other
Manufacturer
Ferguson
Capacity
1000 Gal.
Surface Water 100'+
100'+ na
na
Material
Plastic
Number of compartments
III
Lot Line 10'+
51+ na
na NA
na
Foundation 10'+
10'+ na
LIFT STATION
Manufacturer
Capacity
Remarks Request Well Waiver
Gal,
Alarm location
Electrical installed by
PIPE MATERIA[. Tank to
House to tank D3034 drainfield 43034
Installer
Homeowner Install
Drainfield D3034 COIMT D3034
Inspector NorthRim Eng.
BENCH MARK (Assumed elevation) 100 It
Ins peates: ction 1-18/30/21 9/8/21
Location and description
d 2rd
Landing
Sol 41f'
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
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Conditional Approval: Date
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Note: this does include
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R.O.W. EASEMENT /
20' C.E.A. EASEMENT
(BK. 541, PC. 725)
/ Parcel 26D
IEAST 180'
IWER LINES
Parcel 26C
I 18,000 S.F.
PIPES
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11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
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11500 Daryl Avenue, Anchorage, Alaska 99515-3049
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Lot 4
Lot 5
PLOT PLAN ___ AS BUILT _X_ SCALE _1= __ 30__
GRID _ SW 2639__ Project
No. _
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Lang & Associates, inc.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
(907) 522-4625 Fax
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I hereby certify that I have surveyed the following described property: ��~'—�(
PARCEL 26C, SECTION 23, T12N, R3W, SEWARD MERIDIAN, ALASKA o * 49THitrv*
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that O
no improvements on the property lying adjacent thereto encroach on the surveyed Q
premises and that there are no roadways, transmission lines or other visible QO c KENNr FI LAN ..• o
easements on said property except as Indicated hereon O s�F'.jb1-5 z ,•' �
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Dated this the ____ Day of ___�'' t <h m __ - _ at Anchorage, Alaska O�a
RZR_ pOF
QfSSIONAL_oo
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
t
Municipality of Anchorage
P.O. Box 196650 i 4700 Elmore Road
Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997
hftp://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
Waiver#: OSV211077 COSA#:OSC211646
PID#: 015-331-04
Legal Description: T12N RM Section 23 Parcel 26C
Engineer: North Rim Engineering
Applicant: Joseph & Christine Longly
Permit#: OSP211347
n,cn[ s
D pertinent
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 1.0 feet. In addition,
your request for a waiver of the required 100 feet horizontal separation from the septic tank to
the private well has been approved. The approved separation distance is 95.0 feet. See
engineer's waiver request for justifications. Additional justifications for granted the septic tank
to well waiver include low nitrate levels in the area and recent favorable water sample results for
the well on property.
This waiver approval applies to the absorption field and septic tank installed under Permit
OSP211347 only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
®■moe®■ao®■■■am®aeneooeaoaa■■eaaeoaae�eeae�maoaoeneom�maova�eo�n�m000eooraneee�
Waiver is Granted: X Waiver is not Granted:
3
11 Z 02 A&6m azzeZI Date: � Approved by:
Name of Reviewer
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SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 10/30/21 Number of Pages: 1
To: MOA On-Site Services
Subject: T12N R3W SEC 23 PARCEL 26C
Well to Septic Tank Waiver Request
In 1981 the original septic system was installed for the subject property. A 1981 MOA
Inspection Report approval includes the well to septic tank approval @ 80-feet.
In 1988 a new trench was installed, but utilizing the original septic tank. The 1988 MOA
Inspection Report approval includes the well to septic tank approval @ 80-feet.
In 1993 engineer Ted Moore requested a separation waiver of 80-feet for the well to septic tank
separation. This separation distance waiver was approved in the follow-on MOA Health
Authority Approval Checklist. Arguments in favor of the well waiver included favorable slope
away from the well, large distance to water table, favorable soils, favorable water table gradient,
and favorable water sample results.
Permit OSP211347 was obtained for a new septic system in 2021. The homeowner opted to
install the septic system at a challenging site for construction. The installation location of the
septic tank was completed under the required 100-foot well separation. The actual separation was
discovered to be 95-feet, after construction. To attempt relocation of the tank would likely
damage it.
The previous site conditions that allowed the waiver to be approved @ 80-feet are still valid. The
new plastic septic tank is bedded on a sand liner. The tank will not corrode & should be water-
tight. We request that the waiver distance of 95-feet should be granted. If there is need for
additional information or clarification please give me a call.
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: OSP211347
Work Type: Septic Upgrade
Tax Code Number: 01533104000
Site Legal Address: T12N R3W SEC 23 PARCEL 26C G:2639
Site Mailing Address: 11331 RIDGECREST DR, Anchorage
Owner: LONGLY JOSEPH P & CHRISTINE L
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
��Z1CIl(
`p ,
G �r'
r.
Department
8/20/2021
8/20/2022
18800
0 Disposal Field Q 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
�� 1 ; I���,e►^ �,v-GJ.X�,SIJ�' 4-cle -iv re dw_eA
Received By:
Issued By: ��af
A+Vcf \'�t cite -4.
Date: CTA3 / -a I
Date: I&/'ov
3
MUNICIPALITY OF ANCHORAGE
0�1.�( & 4
Development Services Department ;r.., Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICIWELL PERMIT APPLICATION
Parcel I.D. 015-331-04
Property owner(s) LONGLY JOSEPH
Mailing address 11331 RidgeCrest Dr
Site address same
Day phone 907-240-5462
Legal description (Sub's., Block & Lot) T1 2N R3W SEC 23 PARCEL 26C
Legal description (Township, Range & Section)
Lot Size 18,800 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
Fx�
Initial ❑
Single Family (SF) ❑
(w/wo AD U)
Septic Tank
El
Upgrade 0
Duplex (D) 171
Holding Tank
F-1Renewal
ElMultiple
Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: ((( 1
-v0 Distance: - COQ \
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: _� 59 S
Date of Payment: 027370
Receipt Number: S 1174z )
Permit No. 05 P 2 113 L -Q
Waiver Fees: 4 � 25
Date of Payment: `� Y 020.71
Receipt Number: 6'Tb
Waiver No. 0 S a A 10`11
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 8/17/21 Number of Pages:
To: MOA On-Site Services
Subject: T12N R3W SEC 23 PARCEL 26C
Septic System Upgrade
During a COSA inspection it was discovered that all the drain-field cleanouts had standing water,
indicating failure. A new design is submitted to mitigate this damage. Previous soil tests reveal
sandy soil and no groundwater; no bedrock at depth. The design calls for a new trench and a new
septic tank. Slopes and easements are depicted on the drawing. The terrain is generally a low slope
at the trench site, and the remainder of the area. The system design size is at 3 bedrooms.
The existing system trench to be connected via diverter valve.
Please review the wastewater system design for the existing home. I have included design plans &
specs, design guidelines, & soil test. If there is need for additional information or clarification
please give me a call.
Thanks-Steve
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211347, Rebecca Carroll, 08/20/21
A
F� GINEERING
SteveEng.COM T12N R3W SEC 23 PARCEL 26C
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3 -bedroom home. This is a developed
subdivision. This lot has several easements in the front. A new trench is planned + new
1000 gallon septic tank. The existing trench to be connected via diverter valve. The
existing tank to be decommissioned per UPC. No adverse impacts are expected from
trench/tank, upgrade. No conflicts to the other lots will take place by this septic system
construction upgrade. Two previous soil tests reveals favorable sandy soil. An application
rate of 1.2 GPD/FT 2. Trench Length = 375 FTI/6'x 2 = 31.25'trench, 6' effective. Depth
of trench @ 12'. Decommission old tank per UPC. Water wells & slopes per drawing. A
lot line waiver is requested to 1', due to the very limited area; no impacts from lot line
waiver to neighbor lots. Septic system on north lot over 12' from Parcel 26C trench.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• Two compartment, New 1000 gallon septic tank. Install Double Cleanouts.
Decommission old tank per UPC. MOA -Spec Material Under Tank.
• 5' minimum between the tank- trench, 10' tank- house. 10' to property lines,
• 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation
can substitute for F cover.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1 ' to 4' from foundation
wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two
adjacent opposing cleanouts between the tank and the absorption field, not more than
10' from the tank positioned to provide cleanout access towards the tank and towards
the absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain -
rock.
• Drain rock to be '/2 inch to 2 inch screened. Drain rock to be distributed uniformly
throughout the trench.
• Perforated pipe to be installed level with perforations down.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared trench sides must be raked or scarified before drain rock placement.
• The finish grade must be mounded to promote drainage away from trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
0 Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
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30' R.O.W. EASEMENT /
oo.
20' C.E.A. EASEMENTO9a
(BK. 541, PO. 725) rc^cr
/ Parcel 26D
� cs
IEAST 180'
`.GRAVEL POWER LINES` I Parcel 26C
18,000 S.F. C4
J WELL)
70.2' 24.2'
4J' .
1'x2' BOX ----0 £ f 1.4' CAM
O.� SPIPES / \ 2.0' CANT p p
10.2'02.2' SHED
PORCH
O lql. 4SP DO x5.3'
Z ORNAtT NLA CANT
'. :. 2.0 CAM 5.0'x12.2' \` j
` 24'2 WOOD SHED—� V
. N DECK 46.7'
ASPHALTI \1 1.3' CANT
. GppVEL ������ 7� 1.3'x3.8' CANT
Lot 4
Lot 5
PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2639 Project No. 21-517/A2
Daryl Avenue, Anchorage, Alaska99515-3049Lang & Associates, inc. (907)
(907) 522-6476 Phone
(907) 522-4625 Fax o Q F q X04
Professional Land Surveyors kenOlongsurvey.com o fl
jonathonOlongsurvey.com OGP`''••••.••,
1 hereby certify that I have surveyed the following described property:
PARCEL 26C, SECTION 23, T12N, R3W, SEWARD MERIDIAN, ALASKA
Anchorage Recording District, Alaska, and that the improvements situated thereon are "" """LAN within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyedpremises and that there are no roadways, transmission lines or other visible QO p�0
easements on said property except as Indicated hereon. Q O t412�p
i o
r ' .1LS-5202..' gJpO
Dated this the Day of h��-� at Anchorage, Alaska 04 o NOo
404R��SSIONAE �o
It is the responsibility of the owner to determine the existence of any easements, �pODOo�o
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
MUNICIPALITY OF ANCHORAGE
Ar
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Se tic System Owner -installer Agreement
The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner
to perform work on an on-site wastewater disposal system to serve that individual's owner -
occupied, single-family or duplex home if the homeowner meets and agrees to the following
requirements:
1. The property owner and excavation equipment operator may perform work on no more
than one owner -installation project in a 12 -month period.
l
2. Owner's projected active involvement with the installation:
Owner will be installing himself with the assistance of a friend working as a laborer on the ground.
to
Owner has extensive experience in septic system installs.
The name of the excavation equipment operator: Joe Longly
4. 1 agree that there will be no monetary compensation for installation services rendered.
5. The name of the inspecting engineer: Steve Eng
6. 1 agree to discuss the following items with the inspecting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.070.
c. Advance notice given to the On-site Water & Wastewater Section for all required
municipal inspections (AMC 15.65.070A).
7. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will
obtain additional installation instructions and approval from the equipment distributor.
As owner of (legal description) =1 Se tan 2 ce- Z 4 G
I agree that the information above is true and accurate.
Owner's printed name: Joe Longly
Owner's signature: Date: 8/251202/
4?44
Mailing Address: P. o. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Municipality of Anchorage Page / 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 WellJnspeCtiOn Report
Permit Number: '~'-I~¢'~°~ PID Number:~ ~/~'~
Nam~~F ,.~, ,'~.i~.~,.,j~L...~ Wastewater System: ~ New ~pgrade
Address:
[t~ ~,~~~~. ABSORPTION FIELD
Phone: INo. o~rooms: U DeepTronch ~ShallowTrench ~ B~UMound UOther
LEGAL DESCRIPTION so,.~,~: ~ ~pth from original grade:
GPD/Sq. Ft.
Depth to pipe bottom from original grade: Gravel depth beneath pipe
Lot: ~ Block: Subdivision:
Ft.
TO~[~ ~ I Ran~ I Section~ Fill added above ori~e: Ft. Gravel length: Ft.
Gravelwidth: ~ Numberoflines: lBistancebetweenlfnes:
WELL: ~ New ~ Upgrade ~ Ft.I Ft.
Classification (Private, A,B,C): ~ Total Depth: Cased To: Total~rption area: Pipe material:
Driller: Date Drilled: Static Water Level:FL Install¢~¢r: ~ Date insta,,ed:~ [~ {~¢
Yield: GPM IPump set at: Ft. Icasing Height AbOve Gte"nd:Ft. TANK
SEPARATION DISTANCES ~Septic/~'~ ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufacturer:~ ~ Capacity
From Tank Field Station T~nk Sewer Lines ~¢ ~
Well /~/~ /~¢ ~ ~ ~ ~ Material: ~ Number o,~artments:
Surface_ ~
LIlT
STATION
Wat~ ¢~W /~ ~ ~ ~
Lot ~ Size in gallons: ~ Manufacturer:
I
Foundation ~, ~t ~ ~ ~ "Pump on" level ~P' level at: I High water alarm at:
CurtainDrain ~, ~ /~~ Pummel I Electrical lnspections performed by;
Remarks: BENOH
LocalioR and Description:
I Assumed Elevation:
ENGINEE~'S~SEAL
. ,, 17034E~leRIverLoopR~d~No'~._: ~ Dates: ~'l 'q ¢' "~~':*
Inspechons penormoo ~y: '~: , lst~ ~
2nd ~ -
Department of Health a~d Human Services approval ~ · ,~',, :. ..... .,,-,'"
Reviewed and approved by: ~ ~~ Date: _¢-2/-¢~ ";,?., ', .. ", ~: ,.":'~..,. ,, :.', '*'-:.
72-013 (Rev 9/91) MOA 25
Permit No.
SW930279 Page _? 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
Legal Description: LOT ~6C, SEC 33, TI3N, R3W, SM, AK PIDNo' 01555104
C01
94.0
C02
FINAL GRADE
~87.2
SEPTIC TANK
FCO 8'A 41B'
CO1 32.8' 46.5'
C02 38.0' 46.3
ENGINEER'S SEAL
SCAL~ l' = 40'
30'
ESMT.
UTIL. ESMT
72-013 A (Rev. 9/91 ) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502~
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW930279
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:RAPHEL BRADLEY A &
OWNER ADDRESS:il331 RIDGECREST DR
ANCHORAGE AK 99516
PAGE 1 OF 1
(UPGRADE) PERMIT
DATE ISSUED: 8/10/93
EXPIRATION DATE: 8/10/94
PARCEL ID:01533104
LEGAL DESCRIPTION: T~2N R3W SEC 23 PARCEL 26C
LOT SIZE: 18800 (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 343-4329 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. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~"~.' DATE:
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER &WATER
iNSPECTiON
ENGINEERING STUDIES
AND REPORTS
,WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSALSYSTEM
DESIGN
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
August 6, 1993 (907) 694-2979
FAX 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 26C, Section 23, T12N, R3W, SM, AK
Request you issue a permit to replace the septic tank serving
the three bedroom house on the referenced property. TH~
EXCAVATION OF THE EXISTING TANK IS OPEN AND M~ST BE CLOSED QUICKLY FOE
~AFETY. PLEASE ISSUE THIS PERMIT WITHOUT DELAY TO PREVENT ANY HEALTH
HAZARD. ~
An adequacy test was performed in June 1993 by Flattop
Technical Services and the absorption capacity of the
existing system was found to be adequate for a three bedroom
house.
A Health Authority Approval with Waiver has been requested by
Flattop Technical Services. However, at the request of the
buyer and with the permission of the property owner the
existing tank was excavated to verify its integrity, and the
tank was found to be of poor integrity with numerous holes
along the sides and top.
The new proposed 1000 gallon septic tank is to be placed
outside the well protective radius (see attached site plan)
therefore, the requested waiver is not required.
If you require additional information for your review or have
~ny questions, please contact us.
d
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE: August 12, 1993
TO: Accounting & Budget, DHHS
FROM:
On-site Services, ESD, DHHS
SUBJECT: Request for Refunds - Account # 2570-9426
Please make the necessary arrangements for the following
refunds.
Thank you.
T12N R3W Section 23 Parcel 26C - Waiver Request
This waiver is not required due_to the fact a permit for moving
the septic tank has been applied for and issued. Therefore the
waiver application is not needed at this time.
Receipt# 24886/4500
Amount $410.00
Account # 2570-9426
Bradley Raphel
11331 Ridgecrest Driv~
Anchorage, Alaska 99516
Lot IA Kincaid Acres Subdivision - Health Authority Approval Request
The property owner has cancel~d~hhe request for the HAA and does
not require this process at this time.
Receipt $24867
Amount $170.00
Account $ 2570-9426
Tobben Spurkland, P.E.
203 West 15th Avenue $206
Anchorage, Alaska 99501
Thank You.
Laura J. Montgomery
On-site Services
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR~ WR930040 PID# 015-331-04 HA# HA930387 Permit
Date Received: July 9, 1993
Legal Description: T12N R3W Section 23 Parcel 26C
Engineer: TEd Moore, P. E., Flattop Technical Services
14530 Echo Street, Anchorage, Alaska 99516
Applicant: Bradley Raphel
Waiver Requested: Private well to septic tank - 80 feet
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
Points:
3. Other:
Waiver is Granted:
Lis~ Conditions or Reasons for above:
Waiver is NOT Granted:
Date:
Rec ~: 24886/4500 Amount:
By:
$ 410.00
Name of Reviewer
Date Paid: July 9, 1993
,~-~. MUNICIPALITY OF ANCHORAGE
DL RTMENT OF HEALTH AND HUMAN SEE ~ES
- Environmental Heallh Division
' ~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
7-~ F~.q D ~ F( P ~ ~ L. ~ SEPTIC ABSORPTION
A~,~ _ TANK FIELD WELL
Phone{s) Perm,t NO N~ Bedrooms WELL ~1~
26 C FOUNDATION /0'
AS-BUILT DIAGRAM (Show location ol well, septic system, property hnes, [oundahon,
TANKS U
TYPE OF SYSTEM
~TRENCH ~ BED ~ W. DRAIN ~ OTHER/
Depth to p~pe bottom Irom
or'ginamgrade~ ~__ ~ d FT ]'~t-O'" FI~ ~ ~ + OU'~
SQFI ~ FT ~ '" "" " ~
WELLS
~ PRIVATE ER (Identify)
Classmfication (A,B,C) FT Cased [o
~ C~ '~ ceCfy Ihal Bis in~psctJ~ was peflormed according to all
72-013 {3/85)
M U N I C I P A L I T Y 0 F A N C H 0 R A ~] E
Departmen'~. cW~ Health & Human Services
825 L St~'eet, Anchorage, Alaska 99501 34.3-4720
0 N - S I T E S E W E R F:' E R M I '¥
Per'mit Number': 880()97
Date Issued: 06/:-:'.4/88
Upgr'ade
Engineer Deeigned
Owner' Name:
Owner' Add~', ess.~
BRA[) RAPHEL
11:];3 1 R i DGECREST DR.
ANCHORAGE, AK 995 :~8
Day Ph~ne:
546-3300
F'a~-cel Id~ 0 15-3:51-04
Lot Legal: Subdivision: .... Lot: 26C Block: -
Section~ 25 Tewnship: :i.~N Range:
Lot Size 15()00 (sq. Ft. e~~ acc'es)
Max Bedrooms: ]'his Pel-mit.: 3 Tot. al Capacity:
SEPTIC TANK: Minimum tot, al septic tank
tank must have at. least ~ compaptmente~
~ee'[ ~equir~es insulation ovep t. ar~k(s)~
capacity: .1.,000 gallen!.~,, Each septic
Depth to top el' septic tank(e) < 4.0
:I:NSTALL TRENCH TYF'E ABSORF:'-I'ION SYSTEM'.' 2',9' X 8', MAXIMUM DEPTH
1 ..::. . N 0 T I F Y ..... ~ ....
..... ' DHFIS F'RI[]R TO '[ST ~ ~2 INSPECTIONS.
THIS PERMIT IS FOR A SINGLE FAMILY HIPPIE ONLY AND EXPIRES
1~ I31188.
I CERTIFY ]'HAT:
1. i am £amiliar' with the ~equil~ements ~'op en-site se~eps and ~ells as set
l:o~'~_h by the Municipality o~' Anchopage (MOA) and the State o~' Alaska.
2,, I will install the system in accopdance with all MOA cocle's and pegulations~
and in compliance with the design c~it. epia o[ this pepmit,,
:5,, I ~ill adher, e to all MOA and State o~' Alaska pequip~ments fo~~ the set back
distances ~'~om any existing well, ~aste~ate~ disposal system, o~' public
sewer"age system on this 'ep any adjacent o~~ neapby let.
4. I under~s{~ that pepmit ~s valid ~of a maximum o~
alse undo:: t, he capacity o{ tine total system is 3 bedrooms and
any enla additional Pepmit,,
S i gned:
(O~nel") ~
Issued By:
I
SEWER SYSTEM LOCATION PLAN
'"'~"~ ~' '~ '~¥' "i~'~'~'i '~' "' ', ..... ~ ~ ~ ,
~o~ 6>o~ ~l'Y I
Municipality o! Anchor'age
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502*0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
DATE PERI
4
8-
9
10
11
12
~3
16
17
19-
20-
-F/~../~ ~',~ownship, Range, Section:
SLOPE SITE PLAN
WASGROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Monitoring? "J~ ~__ ,V' Dale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~ FT AND /,'~ FT
,
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI F N THIS DATE, DATE'
72-00B (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ~..~~ PHONE
~ ~ell' ~ / Absorption~are~ Dwelling ~ ~ PER~ ~
~ IManufact"rer ¢~ I Mat~~ I '°' °' c°mP~®
% -- ~ Manufacturer Material Liquid capacity
~ ~ ~ No. of lines Lengt of e ch line Total length line Trench ' ti Distance betwe n ~
~ Top of tile to finlsh grade
~ ~ Type of crib Crib diameter Crib depth Total ef ecti e ab o pti a
m Well Building foundation Nearest lot line
~ DISTANCE TO:
d Class Depth Driller Distance to lot line PERMIT NO,
dation Septic tank Absorption area(s)
~ IDIsTANcE TO: .......... I ,J I
OTHER
REMARKS
DATE LEGAL
DEPARTMENT ~'~ HEALTH AND_,E~,'./IRONME?.TAk/-'";:OTECTIC;N ' 825 '"L'" STREET., .ANL. H~RAGE.,
APPLI CRNT 14RRREN EANDERS z,,zo
LOCRTION RIDGEVIEW
LOT SIZE ].8000 SQI~ARE FEET
L. EGRL Ti2N R~:W SEC 2~ 26 C % ~,,~
, ~ :' 2 SOIL R. RTING
MBXIMUM NUtlEEF. OF BEDROOMS .....
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM
E.-~ E F"]" H= 8 L El'-~ G'l H = 5~3 ,3 E~' R '-,-" E L_ [)EF" TI--~ = 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRC:E OF THE
GROUND AND THE BOTTOM OF THE EXCAVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
RECaLl ][ RE-P-, SEP"IF T C: T RI'-,~-:~ '_--; ;l ZE= 2L E'~E4 ~'~
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEF'RRTMENT DURING THE
INSTALLRTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
Tl4C~ (2) I ~4$PECTIC,~-~5 RRE F:E,;!LII F:E[:'
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT WILL 8E SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSAL SYSTEM IS
&..,k TO 200 FEET FROM A PUBLIC WELL DEPENDING
100 FEET FOR R F'RIVRTE WELL OR =~
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET RND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST 8E RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY RPPLY. SPECIFICRTIONS BND CONSTRUCTION DIBGRAMS ARE
AVRILRBLE TO INSURE PROPER INSTRLLRTION.
PEF-:~"-I }] 'f' E::-::F' ]: F~:E'_-~ [:,EC]_..Et",IE:ER .7~-- 1.~ t9,31
I CERTIFY THRT
2.: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTA 8'¢ THE MUNICIPRLI~AORAG=~
2: I WILL INS]~C~L T~?'STEM IN RCCOR[:,RNE~ WITH THE CODES.
]:: I UNDERSTR~B~HE ON-SITE SEWE~Y~TEM MRY REQUIRE ENL8RGEMENT IF THE
RES~~~Cg_IDE MORE T~N 2: BEDROOM:.. _
. q
............ / ,
' .... 7-7 ....
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264 4111
GEORGE M. SULLIVAN,
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
December 31, 1980
Warren Sanders
1425 P Street
Anchorage, Alaska
99501
Permit ~ 800605
Subject: T12N R3W Section 23 26 C Parcel 3
A permit issued by this department for well and/or sewer
system has expired as of this date.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for
our files.
If there are any further questions, please call this
office at 264-4720.
Sincerely, // ~
Senior Environmental ~p~cialist
LNB/ljw
enc: Copy of Permit
SWP/057
PERMIT NO.
DEPARTMENT O'"',HERLTH AND ENVIRONMENTAL R~OTECTION
825 "L ':STREET, ANCHORAGE., AK. 95 ~L
;264-4720
( 8006,¢~5 )
APPLICANT WARREN SANDERS
LOCATION RIDGEVIEW
LEGAL T~2N R~W SEC 22 26 C
TYPE OF SOIL ABSORPTION SYSTEM IS:
~425 P.
TRENCH
ST.
LOT SIZE
272-i260
t8000 SQUARE FEET
MA~<IMUM NUMBER OF BEDROOMS
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:.EF'TH= 8 LENL3TH= 58 GRR%.'EL DEPTH= 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F~:E L----." LI I F:E[) SEF'T I C: TR~'.-,II-{ ~ I ZE= :]L~']~]'~ETM ,_3RLLC~NS:
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
T~Cw (;2) IF~SPEC:TIO[~S ~RE RE(;~UIREC~
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR R PRIVATE WELt_ OR &50 TO 280 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL;
MINIMUM DISTANCE PROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
14ELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAMS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PEF~D1 IT E:~PI ~:E--~'~;, DEC:Er"IE~ER _.~::L~ ~L~-~8~2~
I CERTIFY THAT
~: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
R: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
RPPLICANT ,?)RRREN SANDERS
V4. 0
DOE AS A. STARK and ASSOCIATES, COi~ LTANTS
957 Westbury Drive * Anchorage, Alaska 99503 · Phone: 277-4300
October- 10, 1980
Soil Test
Parcei~ PareeI 3 or Deeds Book 373 Page 0875 (Y 150r of E 26:10'
of' S 100' of N 1780', Section 23, T12N~ NSW, SH
.Ridgeview Drive south, of O"Malley Road
Test loc'ation~ 30' sout~, 15' east: of northwest corner of lot.
Test method: A i2" backhoe hole was dug with: a shelf 8' down;.
No, groundwater was encountered. A 1~' deep post hole was
dug on the shelf and a soil sample taken'and p:e~colation
test~ made at this iocation~ 9' below originai ground. The
hole was~dug and wetted on 10-9. The test was made per
USPHS recommendations, specifically Se, on the 10th. The
hole was Ie,ft open~
Test results: The percolation rate the first 10 minutes was ~.'~
minutes per' inch,; the rate the last I0 minutes was
minutes per' inc~.
Attachments', lot map, soil gradation;
Sic'Fl
Organization . Management · Engineering · Surveying * Planning · Human Resource Development 7; ',
I
I
0
A
R�
I
0
m
>
CD
This well is producing gallons c~':~ater per hour.
DRILLING
SR BOX 668, BOGARD RD.
PALMER, ALASKA 99645
TELEPHONE 745-4071
Set pump @*~'%--- feet.
INVOICE NO
DATE
YOUR P. O, NUMBER
TERMS
SALESMAN
Lot Btk, Sub WE LL LOG
DEPTH DEPTH DEPTH CASIN FORMATION
IN FT. CASIN FORMATION ~ FT. CASI~ FORMATION IN FT.
~"66 .i 165 i 265
PLEASE PAY FROM THIS INVOICE i . pe~toot MOON?
Certificate of On -Site Systems Approval
Parcel I.D. 015-331-04
1. GENERAL INFORMATION
Expiration Dater 0 oC Ck
Complete legal description T1 2N R3W SEC 23 PARCEL 26C
Location (site address) 11331 Ridgecrest Dr
Current property owner(s) LONGLY JOSEPH
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone 907-240-5462
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
E
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: WC !� �D s pQ
h1c
l 6LI,
Distance: /
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ of
Date of Payment I 1 1 A021
Receipt Number g 5 3
COSA# oSC a 116 q (o
Date:
Waiver Fee $ 9q 5
Date of Payment r-
Receipt Number 1.�
Waiver # Qs V 2 110 2 7. 66;gsed )
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 10/30/21
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for - bedrooms
Disapproved
�P�� OF 4/ lkk4,
49a
s
j4,
Qr
Eng 4yo o
CE -62%
3
Conditional approval for bedrooms, with the following stipulations:
OF Aa((,-",
C,
O:z
P KV
rwNT SE19
By:_ t6kh �WA Original Certificate Date:
The Municipality of Anchorage Development 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. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA CtcrAlist blue �stmet
COSA Checklist
Legal Description: T12N R3W SEC 23 PARCEL 26C
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 12/80
Total depth 222 ft
Cased to 222 ft
❑■ Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) 36 in.
Date of flow test for COSA 7/20/21
Static water level at beginning of test 75.5 ft.
Comments
B. TANK DATA
Age of tank(s) new years
Tank type/material spf'stc
Measured operating fluid level in septic tank na
❑■ Standpipes/foundation cleanout per record drawing
Date of pumping new
D. ABSORPTION FIELD DATA new
Which system tested (date installed) na
❑■ ALL standpipes present per record drawing
Total measured depth from grade 12 ft (max)
Measured depth to pipe invert from grade 6 ft (min)
❑ N/A — pressurized field
❑■ Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 015-331-04
Structure served by this system
Well production at time of test 8+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
❑R Coliform bacteria is Negative
Nitrate mg/L ❑■ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 9/21/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date na
Results Q✓ Pass For 3
Fluid depth prior to test 0
Water added gal
New depth in
Elapsed time min
bedrooms
in
❑E 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) no
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
95
Yes
Community Sewer Manhole/Cleanout > 100'
E] Yes
if No
ft
0 Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No 98*
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No ft
Animal Containment > 50' ❑✓ Yes
if No ft
Yes
if No
ft
if No ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
—❑✓
Community Sewer Main > 75' Yes
if No
ft
Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No ft
Surface Water > 100'
Yes if No
Property Line > 5'
Fv�
Yes
if No ft
Wells on Adjacent Lots:
Wells on Adjacent Lots:
Absorption Field > 5'
0
Yes
if No ft
Private Wells > 100'
Yes if No.
Water Main > 10'
0
Yes
if No ft
Community Wells > 200'
Yes if No.
Water Service Line > 10'
0
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'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑
Yes
if No 5
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' B Yes if No
Water Service Line > 10'
21
Yes
if No
ft
Community Wells > 200' 0 Yes if No
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
Request well -tank waiver. Owner -Installer Misplaced Tank Location.
* 98' Well Waiver Previously Granted.
North MT Of Old Trench Missed On Survey, But Located On Record Dwg.
G. ENGINEER'S CERTIFICATION'
+�®F x %%4
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
Ar.
MOA COSA guidelines in effect on this date. TH
�* .i Steve Eng /
�AV
« CE -6256 J0 AV
COSA Checklist yellow sheet ,%o 11 '/ 3 % 2 T�
ft
ft
ft
ft
ft
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 DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions) II ~-~ / /~,cZ~ e cr~.~}- Dr''~'~ ~
=
Property owner [3r~,ff. I.~ l&,~phe I
Mailing address F.o. ~o~. ~/7.~ ?~r'~
Lending agency
Day phone (?'03) ~:~ -3'~"/y
Day phone_
Mailing address
Agent I~/ll ~m/~'~¢ ) ~oo~
Address ~6o0 ~ ~,~1;
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~' ~'
TYPE OF WATER SUPPLY:
Individual well ~'~
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site ~'
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.
72-025 (Rev. 1/91) Front MOA t~21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority App?oval 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 inves_tLgation 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 f~f~./-/~f~ 7~c~//,,'~ ( ~,,~,J~c~_/ Phone
Address /~',.¢.~0 ~'~,¢ Z','z.,, A--,-~c/~c,r-,~,~.~.. .,?~- ¢~.~ f~
Engineer's signature 1:7"~ ~ ~
DHHS SIGNATURE
Approved for
Disapproved,
Conditional approval for
bedrooms.
bedrooms, with the following stipulations;
Additional Comments
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 engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: U~'F ~-,~f~, ¢-~u~-~,~_~ ~a~ccelI.D.
A. WemmData ~0~ ~L~ ~o~
Well typeset ~ If A, B, or C, a.ach ADEC letter. AOEC water system number
Log prese~N)~/ Date completed /~/~ Driller ~ ~'~ / ~
Total dept~ ~ ~/ Cased to ~ / __Cas~g height
Sanita~ se~N)~ Wires propedy protecte~N) ~
FROM WELL LOG
g.p.m.
AT INSPECTION
; On adjacent lots
; On adjacent lots /~-~ ' ~-'
Public sewer manhole/cleanout
Petroleum tank
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot /~2:~
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample:
B. SEPTIC/t-I~I;~A~i'q'ANK DATA
Date installed 0//~//~ ~-2
High water alarm ( ~
Date of pumping /--) ~:~ ~
Other bacteria
Collected by: ~' /'=~ ~/~*~ '
Tank size /~T-~ ~"~- Compartments ~
Foundation cleanout (~/N) / Depression (Y{~ /
Alarm tested (Y/N) /,-)/~'.
"7-~q--~ ?~- Pumper /"~/,~ ·
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /D / 5
To property line '~) /
Surface wateddrainage
On adjacent lots /~ ['-~ Foundation
Absorption field ~-J~ Water main/service line
CONTINUED ON BACK PAGE
72-026 (3/93)* Front
C, LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level /..,,,,/..~Cycles
Meets MOA electrical codes (Y/N)
SEPARATION DISTAN~ON TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Length Width
Total absorption area
Cleanout present (Y/N)
Date of adequacy test Results (p~
Water level in absorption field before test
./
Peroxide treatment (past 12 months) (Y/N) .//"
SEPARATION DISTANCE FROM A/.B~PTION FIELD TO:
Well on lot /' On adjacent lots
Tc°n baU~i; 'cnegn; :;:sd~
Surface wa~
R S CERTIFICATION
Manufacturer J
Manh°l~evel at
tested
Surface water
Soil rating (GPD/Ft2) ..-""/System type
Gravelthickness ,//'/ Total depth
./' Depression over field (Y/N)
for
After test
If yes, give date
Properly line
To existing or abandoned system on lot
Cutbank Water main/service line
Driveway, parking/vehicle storage area
Bedrooms
I cert/fy that lhave checked, ver~edtoall MOA and HAA guide/ines ineffect on the date of this inspection.
Engineer's Name /
Date ~034 B~., ................. 0/~/7~
ag e River, Alaska 9g57~
H~ Fee $ Waiver Fee ~
Date of Payment
Receipt Number
Date of Payment
Receipt Number
72-026 (3/93)* Back
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: FA~C~L2~,C 5f¢ 23.'[IzN, E'3k-' Parcel I.D.
A. Well Data
Well type ~'~ v'AT£
Log present (Y/N)
Total depth 2'22
Sanitary seal (Y/N) Y
If A, B, or C, attach ADEC letter. ADEC water system number
__Date completed 1~/80 Driller Hoo~
Cased to o_ '~ ~_ Casing height 2~"
Wires properly protected (Y/N) Y'
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
~. -to C.o.
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line .
.g.p.m.
Z
AT INSPECTION
~ ~'. ~ g.p.m.
~o
; On adjacent lots ~ ' ~ ~, ~'
; On adjacent lots ~
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform 0 col /'(oo ~',~
Date of sample: G/:2 ~/~ ~
Nitrate ~. fc~ ,~,~ ('~_ Other bacteria
Collected by: ~-LA'fffo,° T£¢fI
B. SEPTIC/HOLDING TANK DATA
Date installed I
Cleanouts (Y/N) ¥
High water alarm (Y/N)
Date of pumping
Tank size IooO ~4~- Compartments ~-
Foundation cleanout (Y/N) Y Depression (Y/N)
Alarm tested (WN) ~,A.
7/~- */~ Pumper ._~_~ c~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 80~ On adjacent lots IoO'
To property line .5o Absorption field :2
£, o, Foundation
Water main/service line
Surface water/drainage
72-026 (3/93)* Front
~ /o0
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Well on lot On adjacent lots
D. ADSORPTION FIELD DATA
Date installed (~/2~J~ Soil rating (GPD/FF)
Length ~1 Width :2.5 Gravel thickness
Total absorption area 4(05' F~*- Cleanout present (Y/N)
Date of adequacy test 6,/2 q ~/~ -d-[z,~-/?.? Results (pass/fail)
Surface water
System type
Total depth
Depression over field (Y/N)
for
Bedrooms
Water level in absorption field before test
After test
Peroxide treatment (past 12 months) (Y/N) No,4c
If yes, give date N. 4-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /0~
To building foundation
On adjacent lots
Surface water >/o
On adjacent lots ~ /oo Properly line ~'/0
To existing or abandoned system on lot
Cutbank N,/~. Water main/service line ~. 5o
Driveway, parking/vehicle storage area / I '
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA ~
date of this inspection.
Signature ,~-'~
Engineer's Name
Date ~7-~., (,y 9.
HA,& Fee $ / 7¢ oo
Date of Payment 7/'? / ¢' .~
Receipt Number-'~ ~/~ ~?
72-026 (3/93)* Back
:..:~ ' REPORT of ANALYSIS
Chemlab ~ef.~ ~9~.4220-$
Client Sample ID :L26C SEC 23 TI2N; R3W
Matrix :WATER
Client Name tS & 8 ENGINE~RING
Progect Name :
Pro~ect# ~
~UA
· · '~? 5~3'B STREET
· ' '"' TEL: (907) 562-2343
WOR~ Order ''i'69851:
Report Completed t08/23/9~
Collected ~08/19/93 @ 17~10 hfs
Recefved ~08/20/93 @ 11025
Technical
Dlrec%or~ST~?~C, EDE
Released By'
Sample Remarks: ROUTINE SAMPLE COLL~CT~D BY~ J.K.~. .
OC Allowable Ext. Anal
Parameter Results Oual Units Method Limits D~te Date Init
Nitrate-N 0.10 mg/L EPA 353.2/~00.0 l0 08/20 LLH
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
CIVIL & ENVIRONMENTAL ENGINEERING " ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. July 9, 1993
PH: (907) 345-1355
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
Dear Sirs:
By means of this letter we are requesting issuance of a separation distance waiver allowing the existing
septic tank on Parcel 26C, Section 33, T12N, R3W, S.M. to be 80 feet from the well on the same lot,
instead of the normally required 100 feet. A site plan and copies of other relevant backup documents from
the DHHS files are included to assist you in your review. Please note that this same well is also 98 feet
from the septic tank on Parcel 26C, but a waiver has already been issued allowing this (WR87-033)
According to the driller's log, the well serving this lot was completed in December of 1980 and has a
total depth of 222 feet. On June 24 we conducted a yield test of this well. The initial static water level
stood at 169 feet below the top of the casing. Steady pumping of 896 gallons of water from the well at
the maximum pump output of 6.4 gpm caused the water level inside the casing to be di'awn down to 173
feet, but no further. Based on this performance, we determined that the total yield of the well is in excess
of 6.4 gpm, which is more than adequate for DHHS approval of any single family residence. Water
samples collected on June 25 were satisfactory, showing 0 colonies of coliform or other bacteria per 100
ml., and 0.1 mg/l of nitrate-N.
According to as-built inspection reports on file at DHHS, the original wastewater disposal system was
installed in January of 1981 and consisted of a 1000 gallon septic tank followed by 54 lineal feet of soil
absorption trench containing 5 feet of sewer gravel. The Municipal inspector's report noted that the septic
tank was 80 feet from the well, but no waiver was expliciily granted. In June of 1988 the original trench
was replaced with a new 31 foot long soil absorption trench containing 7.5 feet of sewer gravel. The
inspection report for this upgrade reported that the original septic tank was retained and that the distance
from it to the well was 80 feet, but no formal waiver was sought or issued.
On June 24 ~ 25, 1993 we conducted an adequacy test of the wastewater disposal system. Since the
house had been unoccupied prior to our test, we presoaked the trench with 896 gallons of water on Jtme
24, and then tested it on June 25 by adding another 644 gallons of water. The monitor tube near the
middle of the trench had 1" of mud at the start of our test, and the addition of 896 gallons of water caused
the fluid level to rise 52". This fluid had completely percolated away by the next day, and the addition of
644 gallons of water caused the fluid level to rise again to 46 inches. After the flow of water was stopped
the fluid level receded at an adequate rate for a 3 bedroom residence.
As is indicated on the site plan, the topography of the lot slopes generally towards the west, with the
result that should effluent daylight from a failing septic system, it would tend to flow away from rather
than towards the well.
The soils log prepared in 1988 at the time of the trench upgrade shows poorly graded sands down to
13 feet underlain by silty gravel. The silt content in this GM material should provide good filtration of
septic tank effluent as it makes it way down into the soil. The almost illegible well log shows about equal
proportions of clayey hardpan and mixed sand and gravel extending down to the bottom of the casing at
222 feet. The clayey hardpan should provide an effective barrier preventing locally originating
· contaminants making their way into the aquifer being drawn upon by the well. The fact that the casing
extends to 222 feet, yet the static water level is at 169 feet provides further indication that the aquifer is
confined and artesian.
The following is a breakdown of how waiver analysis points could be assigned using the 1985 D.E.C.
"Separation Distance Waiver Guidelines for SCRO".
Category
Distance to water table (222' of casing - 2' stickup - 9' depth of tank = 211')
Soil sorption (50% clay and sand mad 50% clean sand)
Permeability ( 50% clayey sand and 50% sandy gravel)
Water table gradient (assume +5% - parallel to slope of ground)
Horizontal separation (80 feet~
Total
Points
7.6
3.0
2.0
4.5
2.2
19.3
Based on this waiver point assignment it appears that the waiver can be safely granted without concern
as to contamination of the well by contaminants potentially leaking from the septic tank on this lot.
Please feel free to give me a call if you have any questions on this analysis.
Sincerely,
Ted Moore, P.E.
2O
PAR°~~ ~ ,~ .~oo
~' ( ~9~- HOUSE j
I I00,
j PARCEL 26C
0 0
PARCEL 26B
PAROEL 260, 8W 1/4, NE 1/4, 8EO 23
T12N, R3W,
WELL AND SEPTIC SYSTEM
SITE PLAN
~A~O~ ~C~[CAL S~RV[C~S 1 INCH = 40 FEET
) 0 20 40 60 80 1 O0 14530 ECHO S~ET DRAWN BY TFM
~ f ANCHO~GE, ~AS~ 99516 JULY, 1993
FEET
NOTE: THIS IS NOT A SURVEYED P~T.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
ENVIRONMENTAL LABORATORY SERVICES
Chemlab Ref. $~ :93.3017-1
Client Sample ID :PARCEL 26C SEC 23
Mat r ix : WATER
REF~RT of ANALYSIS
EAST HOSE BIB
5633 B STREET
ANCHORAGE AK99518
TEL (907) 562-2343
FAX:Ig07] 561-5301
Client Name :[~.ATTOP TECHNICAL SRV WORK Order :67614
Ordered By : Report Completed :06/29/93
Project Name : Collected :06/25/93 @ 10:00 hrs.
Project~ : Received :06/25/93 @ 12:00 hrs.
PWSID
Technical.. Director:STEPHEN~. EDE
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: CHRIS,
QC Allowsble Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate--N 0.10 mg/L E~PA 353.2/300.0 10 06/28
See Special Xnstructions Above UA = Unavailable
See Sample Remarks Above NA = Not Analyzed
Undetected, Reported value is the practical, quantification limit, LT = [,ess Than
Secondary dilution. GT = Greater Than
Member of the SGS Group (Soci~t6 G~n6rale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH. LLINOIS. OHIO. MARYLAND, WEST VIRGINIA, NEW JERSEY SOUTH CAROLINA
~ ' ~ APPLI(' "'~IT FILLS _OUT UPPER_I'IAI"mONLY
Buyer
Address -~ Zip Oode
Lending Institution ~ ~ %-}- ~. ~,~,< Phone
~ngle Family
Water Supply
~ndividual = A~ACH WELL LOG. A w~l log is required for ail wells drilled since June 1975.
~ Communily For wells drilled prior to that date, give well depth (~ttach log if available).
~ Public Utility
Sewer Disposal
~dividual Year IndivMual Inslalled: ~ ~ t
g Public ~JlJty When Connected to P~blJc UlilJly:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH ~E~EST BEFORE ~OOE881NG CAN BE INITIATED.
Time Time Time Time
Date Da ~..t~'~ Date Date
Inspector InspeClor Inspector Inspector
, APPBOVED DROOMS 'CO D.IONSOFAPRROVA'
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received
/ -- ~ \ Well tO Tank Septic Tank Size
72-023
July 13, 1982
Richard S. and Donna E.
P.O. Box 1'0-406
AnchorAge, AK 99511
Christal
Subject: Parcel 26C, Sec. 23, T12N, R3W,
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
Exposed electrical wires to the ~;e!l tea6 are in
of the f~un~elpal~.tV of Anchorage codes and mush be encased
in conduit.
~3he water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
Please notify this Department for a reinspec~.ion w'hen the
noted discrepancies have been corrected. If there are any
· ' of~_~e at 264-4720.
further ¢~uestlons, please call thzs ='
Sincere%y,
Robert C. Pratt
Associate Environmental ~pec].al3. st
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEO~vTII~I~iPALITY OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501 DEPT~ OF HEALTH &
ENVIRONMENTAL PRO fECTION
ENVIRONMENTAL ENGINEERING DIVISION
T. epho.e 264-4720 MAR 1 6 1981
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing.
, PROPERTY OWNER~
IAI LING ADDRESS
PROPERTY RESIDENT (If different from above)
BUYER
MAILING ADDRESS
PHONE
PHONE
PHONE
3, LENDING INSTITUTION
MAILING ADDRESS
4. I~A L'"'ro B/AG E NT
MAILING ADDRESS
PHONE
STREET LOCATION
6. TYPE OF RESIDENC
'~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF B~DROOMS
[] One [] Four
[] Two [~} Five
,'~[;~ Three {~} Six
[] Other
7, WAT RE~UPPLY
INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE'**
[] PUBLIC UTILITY
**if individual/on-site, give installation date \C>tc~\
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72~010(3178) ,~ ~,~:~ ~O (:F~N 0QJN
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE -- DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS: ;
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [~ THREE [] FIVE [] OTHER
E~] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI L[TY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
E~INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ' I ~/"~
Connection Verified __ INSTALLER '
[~Septic Tank or E~]Holding Tank
Size: /O00 If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area tq nearest Lot Line
· _ _ ~ ~ ~
~PROVED FOR ~ BEDROOMS
NDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
LEGAL DESCRIPTION
825 "L" STREET
GEORGE M. SULLIVAN
DEPAR1M~NT OF H,EALTH AN[) ENVIF~ONMEN'FAL PROTECTION
March 19, 1981
Warren/Eva Sanders
% Rhodi Karella
Totem Realty
724 East 15th Avenue
Anchorage, Alaska 99501
Subject: T12N R3W Section 23 Par. 26C
Approval for-the:individual sewer and water facilities
cannot be granted until the following items have been
completed:
The water facilities were not turned on at the time
of the scheduled inspection. Please call this office
for another appointment.
A well log submitted to this department for our
review.
The top of the well casing sealed with a sanitary
seal so that it is water tight. If there is a seal
there, it needs to be tightened so that it is water
tight°
Exposed electrical wires to the well head are in
violation of the Municipality of Anchorage codes and
must be encased in conduit and buried.
The exposed water line needs to be buried.
Please notify this department for a reinspection when the
noted descrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Robert C. Pratt, R.C.
Associate SpelcalJst
RCP/ljw