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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 F /V Conditional Approval: Date .9 4W C-:) aL* A Septic System !YZ�Cm AS Steve Eng 04 00 I Approved Date ala CE -6256 ,k N& 4s"w Note: this does include 4 11'/-3 2 approval not well permit requirements. Kev uwuzi Its) V L --ID ;Zu D --A tj FF1 Frl :C D V) -A F9 F7l � iC7 H D iCJ n F9 F- 0� n NJ W � n 0 C R C ;;u d Fog o.. b CA.) 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EASEMENT / 20' C.E.A. EASEMENT (BK. 541, PC. 725) / Parcel 26D IEAST 180' IWER LINES Parcel 26C I 18,000 S.F. PIPES Q II_ °PwgY £ 1.4' CANT 0 21=5171A2____ Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone A 'x12.2' IR.A.P. _ _ DRIVEWAY �, GRAyE1.. I O Z _ I� O��•' A 'st�h. m m I £ 1.4' CANT 0 21=5171A2____ Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone A 'x12.2' F A p�4 N mN APORCHN kenOlongsurvey.com iN 2.0x5.3' O Z CA10.2 NT O��•' A 'st�h. m m 2.0' CANT Parcel 26B WELL 5.0x12.2' WOOD SHED 46.7' .3' CANT .3'x3.8' CANT Lot 4 Lot 5 PLOT PLAN ___ AS BUILT _X_ SCALE _1= __ 30__ GRID _ SW 2639__ Project No. _ 21=5171A2____ Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone (907) 522-4625 Fax 0000OpO� oo F A p�4 Professional Land Surveyors kenOlongsurvey.com c 9 4 jonothanOlongsurvey.com O��•' A 'st�h. 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 ,•' � 0 9F —5202.•' SAO 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 as®®■o®®®aoann■a®■■a®®■■■m®■■mmama■m a a®®■s®o®®mao■ea®e®man®a®®eeeeanaa®o®®a®®� IIt l� R 7C 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) a L U N Z � N U CL U U (n O CO UaO N U cs EU H =3 C O E�a-CL o - C: .0 C C U -0 o M J F- OU) p L M O N N C L U> O V QL-] U) 0) o(nLEa) z N 41 L U N N i p U (n:3 (n J U O- ~ rl- F°cnoo 0 3Li Wim �CiKi4L6cor-� 3 m cu n a z O O a � U H O F— Q L N, pq Ul � j �d rY n o � �o U 3 Q C p CL � J gu, \ p d -Y Oy Z � n�ry xL �-- OU QLD of��� Imo- 122- a o -- U =o -- U u O x: a a _ -f-' O -P Ar r v _ 4� rn: n q-UWS3�MDN ,0c — � Z o � � co 0 ZWUfl0o v� UQ gsa,4Da6jolNLLJ I�W kQ Un Z 4) 0 ZW� am p W � V V O L� c 006 -P d C-1 > U Q1 LL - N > W O) > U -' .}' Ul N 2: W -P i sz o d � Li i S d � L -P A LL. 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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