HomeMy WebLinkAboutT12N R3W SEC 33 LT 45B Municipality of Anchorage
•
• Community Development Department Page 1 of 3
On-Site Water&Wastewater Program
4700 Elmore St. •P.O. Box 196650 Anchorage,AK 99519-6650 •http://www.muni.org/onsite•(907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181018 PID Number: 018-192-05 ❑ New II Upgrade
Name:
PAGET PLUNK ABSORPTION FIELD
Address: • Deep Trench ❑ Shallow Trench 0 Bed 0 Mound
14250 SABINE STREET*ANCHORAGE, AK 99516 0 Other
Phone: No.of Bedrooms: soil Rating: Total Depth from original grade:
687-5323 3 **0.6 GPasq.Ft. 10(MAX.) Ft.
Depth to pipe invert from original grade: Gravel depth beneath pipe:
LEGAL DESCRIPTION SEE DWG. 7Ft. F,
Subdivision: Block: Lot: Fill added above original grade: Gravel length:
45B SEE DWG. Ft. 55 Ft.
Township: T12N Range: R3W Section: 33 Gravel width: Beds Number of lines: Distance between lines:
2.5 Ft. - - Ft.
SEPARATION DISTANCESTotal absorption area: Number of trenches: Dist.between trenches:
To Septic Absorption Lift Holding Public/Private
From Tank Field Station Tank Sewer Lines 770 8t].Ft. 1 Ft.
Well •65'+ 100'+ - - 25'+ TANK IN Septic 0 S.T.E.P. ❑Holding 0 Other
. Manufacturer: Capacity:
Surface Water 100'+ 100'+ - - GREER 1250 Gal.
Material: Number of compartments:
Lot Line 5+ 10'+ - - N/A
. HDPE 2
Foundation 5'+ 10'+ LIFT STATION
Curtain Drain NONE KNOWN Manufacturer:
I
Gal.
Remarks: PER CONTRACTOR,OLD TANK DECOMMISSIONED PER UPC "Pump on'level at: 'Pump off level at: (High water alarm at:
•WR#OSV181003
Pump Make&Mode• Electrical Inspections performed by:
'TER ROGER J.SHAFER,P.E.1992 TESTHOLE
PIPE MATERIAL EXISTING/
House to tank EXISTING Tank to D3034
drainfield
Installer
WILCO EXCAVATION Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
100.00 Ft.
Inspection
Dates: 1st 2nd Location and Description:
2/26/2018 2/26/2018
3rd 2/27/2018 4th - BOTTOM OF TRIM @ NW HOUSE CORNER
ENGINEER'S SEAL
Community Development Department Approval ..••`s '
- ' i44!
*41, ...it 4
iot
Conditional approval: Date: �''•• Y•
�,
4 '* 1•
•
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,��p): C 7 53 '• z
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3. 13—cg
Approv-.• tn, — _ /" Date: LICEN,4. Ess` :
#AECC884 1,IIIISIL**•
Inspection Report_1-1-12.doc
/ PERMIT NUMBER: PARCEL ID NUMBER:
OSP181018 RECORD DRAWING 018-192-05
/
A B C 7
I FC01 16.7 24.0 62.7 / / SOUTH&WEST LOT LINES,AND \ \
FCO2 27.5 41.9 98.4 ALL WELL RADII FLAGGED BY \
ST1 36.4 45.4 51.0 / / SHANE HOLT,P.L.S.PRIOR TO \
ST2 41.1 49.1 50.5 CONSTRUCTION
STMT 41.0 46.7 47.5 / \
I DBL1 42.7 50.9 50.4
DBL2 43.5 51.7 50.4T12N R3W SECTION 33 LOT 45D-1
CO3 48.8 60.7 56.7 / /
/ FD 76.4 97.4 89.7 RpOWg
MT1 101.1 126.4 119.2 Lt
CO1 97.0 124.0 119.8 I / APPROX1MAtE 100 WE
/ MT2 127.0 140.9 116.5 \
CO2 127.0 140.1 115.085 FOO WAIVER --
L (WR# SV181003) /
/
/ / N k I
\ \ / / , s,_____,
s /
\ \ I !SHED
/' O`r L`C 9
7cP 0 /
/
1
\ J
100'WELL RADIUS / /
DRAINFIELD
EXISTING 1992 \`NEW H E TANK 11250 GALLON it____
B /
APPROXIMATE 1992 TESTHOLE n
LOCATION PER MOA RECORDS BY . \ : '
ROGER J.SHAFER,P.E. ' DBL1 t P L2 ^ / :•:4•:..:.1:7, .1% ;.• ••� !.:ti•:
0 0� FCO7 • •• •• �DRIVEWAY�•:•, ;��,•
r
GO A EXISTING 3 W` II /
ti
BEDROOM HOUSE SEE ATTACHED EMAIL
k\ FROM ARM SERVICES
Z FD \ FCO 7
tu
2 11 \ = /
y v ASSUMED LOCATION OF SEWER LINE /
c (SEE ATTACHED EMAIL FROM ARM SERVICES)
�4 14'+ ASSUMED LOCATION OF SEWER LINE;CONNECTED
j GO › IN THE MIDDLE OF THE TRENCH PER CONTRACTOR /
�� - - � /
NEW DRAINFIELD
BOTTOM OF TRENCH AND TOP OF TANK T12N R3W SECTION 33;LOT 52
INSPECTED BY MOA ONSITE EMPLOYEE
TIM ECKLUND ON 2/26-27/2018
S ALE:
li
1"=40'
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GARNESS ENGINEERING GROUP, Ltd • iI. •
CIVIL&ENVIRONMENTAL ENGINEERS •
•
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507'PHONE(907)337-6179'FAX(907)338-3246•WEBSITE:www.garnessengineenng.com ••
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ,O :, :ff ey Ga ss =
PAGET PLUNK 687-5323 2 OF 3 ��J,'•I C1-7153 '_�
PROJECT/LEGAL DESCRIPTION: DRAWN BY: .. '• �jt ' $ �
T12N, R3W, SECTION 33, LOT 45B L.K.B. ��1�•(7110FESS��P��•
TYPE OF WORK: DATE: LICENSE 1111"\\\�4 /
RECORD DRAWING 3/2/2018 #AECC884
iPERMIT NUMBER: PARCEL ID NUMBER:
OSP181018 RECORD DRAWING 018-192-05
FINAL GRADE=98.70-98.90
2"INSULATION ST1 ST2
PER CONTRACTOR — —
TOP OF TANK @ INLET=95.34 TOP OF TANK @ OUTLET=95.26
P777trizziriiz, 'iri
r
INVERT OF BUNG @ INLET=94.39 NEW 1250
GALLON H.D.P.E. INVERT OF BUNG @ OUTLET=94.06
SEPTIC TANK
BOTTOM OF TRENCH AND TOP OF TANK
INSPECTED BY MOA ONSITE EMPLOYEE
TIM ECKLUND ON 2/26-27/2018
1992 ROGER J.SHAFER,P.E.
TESTHOLE MT CO
B ORIGINAL GRADE @ — = FINAL GRADE
HIGHEST POINT=77.78 =78.43 78.68
4.I1F
FABRIC
— :;::.. .::::•::: : .:::...:.::.:::::::..•::; ��-'"'QAC
dr
i..
A::<:
;% INVERT OF PIPE=74.78
g 'nIIIj:.
7.0 FEET Ns
BOTTOM OF TRENCH=67.78
ti
og
RELATIVE ELEVATION @ BOTTOM OF T.H.=61.78
(T.H.DRY ON 3/17/1992)
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GARNESS ENGINEERING GROUP — * •
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CIVIL& ENVIRONMENTAL ENGINEERS 0 0
3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507•PHONE(907)337-6179•FAX(907)338-3246•WEBSITE:www.garnessengineering.com " • ;
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ..�• J�- re�A_S�rness :
PAGET PLUNK 687-5323 3 OF 3 �.�I ;••r CE179 3 :/���
PROJECT/LEGAL DESCRIPTION: DRAWN BY: 6♦ t) f •/7 30r24•(`::
T12N, R3W, SECTION 33, LOT 45B L.K.B. ,,,�pRa• ... • .���.
TYPE OF WORK: DATE: LICENSE 1..1v"`sillo.l.
RECORD DRAWING 3/2/2018 #AECC884 J
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cs,,,,,.!!______p.i.„re, MUNICIPALITY OF ANCHORAGE went �,On-Site Water&Wastewater Program \O .„PO Box 196650 4700 Elmore Road mac'Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.orglonsite II I1 'Department
On-Site Wastewater Disposal System Permit
Permit Number: OSP181018 Effective Date: 2/9/2018
Work Type: Septic Upgrade Expiration Date: 2/9/2019
Tax Code Number: 01819205000
Site Legal Address: T12N R3W SEC 33 LT 45B G:3034
Site Mailing Address: 14250 SABINE ST, Anchorage
Owner: ESTATE OF LANDERS AURORA A Lot Size in Sq Ft: 45015
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3
This permit is for the construction of:
Q Disposal Field El Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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
40111
Received By: Ar
Date: Jia /"
Issued By: 0. `�� Date: 9 1 c�
Municipality of Anchorage
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 e (907) 343-7904 • Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV181003 COSA#: Permit#: OSP181018
PID#: 018-192-05
Legal Description:T12N R3W Section 33 Lot 45B
Engineer: Garness Engineering Group
Applicant: Paget Plunk
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to
private wells has been approved. The approved separation distance is 65.0 feet to the well on
T12N R3W Section 33 Lot 45B and 85.0 feet to the well on T12N R3W Section 33 Lot 45C-1.
See engineer's waiver request for justifications.
This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
Waiver is Granted: X Waiver is not Granted:
Date: �/ / eaNte#� �� Approved by: fa21)60,64 Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
c � 8 9 /0
MUNICIPALITY OF ANCHO•
�Community Development Department � shone: 907-343-7•�
Development Services — `` fax`7- 343-79'.'7
On-Site Water & Wastewater Program
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 018-192-05
Property owner(s) PAGET PLUNK Day phone 687-5323
Mailing address 14250 SABINE STREET *ANCHORAGE, AK 99516
Site address 14250 SABINE STREET *ANCHORAGE, AK 99516
Legal description (Sub'd, Block& Lot) T12N R3W SECTION 33 LOT 45B
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(MiI that apply) Initial ❑ Single Family (SF)
Absorption Field ® ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D) ❑
Renewal ❑
Holding Tank ❑ Multiple Dwellings ❑
❑ (SF and/or D)
Privy
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
WELL TO SEPTIC TANK Distance: 65 FEET
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5-6 1 Waiver Fees: 1122
Date of Payment: 2/q112 Date of Payment: „2/1"11
Receipt Number: 09 YO( 6) Receipt Number: 09 Dq6
Permit No. G�PIWC)iV Waiver No. 05VIVV0O
(Rev. 01/11)
Quanics
GARNESS ENGINEERING GROUP, Ltd Advanced Treatment
`System
CIVIL&ENVIRONMENTAL ENGINEERS m.�-r Dealer
January 31, 2018
Municipality of Anchorage
Development Service Department
On-Site Water&Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for T12N R3W Section 33 Lot 45B
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The drainfield is in a state of
failure and needs to be upgraded. We are proposing to install a new 1250 gallon HDPE septic tank and
deep trench type drainfield. We are proposing to utilize the existing 1992 testhole by Robert J. Shafer,
P.E. in MOA records. Comments regarding the design are summarized as follows:
1. SOILS: See the attached 1992 soil log by Robert J. Shafer, P.E. which show the soil classifications,
groundwater monitoring, and the percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: See the attached topography drawing from the MOA GIS mapping. As can be seen
on the attached topography drawing, there are no down-gradient slopes greater than 25% within 50 feet
of the drainfield.
5. WAIVERS: We are requesting that your department issue a variance from the required separation
distance of 100 feet from well to septic tank down to 65 feet for the subject lot, we are also requesting a
waiver from well to septic tank down to 85 feet for the lot to the north (T12N R3W Section 33 Lot 45C-1).
Justification for granting this waiver are as follows:
• The existing tank has encroached on the well for approximately 26 years
• The existing tank is steel; we are proposing to utilize a HDPE tank. In short, it will be an
improvement on the existing condition.
• Water samples were pulled on 1/30/2018 and the nitrate levels were 0.356 mg/L
• Per MOA records, the nitrate levels in 1991 were 0.32 mg/L and 0.452 mg/L in 2016 for Lot 45C-1
• The septic tank is located downhill from the well.
• The home is located between the well and proposed tank
We are unaware of any adverse impacts this installation or waivers would have on adjacent wells or
septic systems. I you have any questions, please contact us at 337-6179. Thank you for your
assistance.
Sncer0y,
I
Jeffrey', . - n s, .E., M.S.
Presi.-.n
3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
I
T12N R3W SECTION 33 LOT 19
T12N R3W SECTION 33 LOT 20 S264' T12N R3W SECTION 33 LOT 21
---
142nd
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/ \ T12N R3W SECTION 33 -1 SEPTICCO
/ \ LOT 450-1 _ AREEb
- ` UJ45D-1
\\ /// T12N R3W SECTION 33
/ Z
IAPPROXIMATE - I OPTIC// \\
100'WELL RADIUS AR m
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APPROXIMATE I \ '`^ /
/ I // 101'WELL RAQIQR."--1 \ ^/ \
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100'WEA RADIUS I ' /
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100'WELLIMATE RAOIU I
T12N R3W SECTION 33 LOT 46 1 = .11L I I
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CaPTIC
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T12N R3W SECTION
33;LOT 53
T12N R3W SECTION 33 LOT 51 T12N R3W SECTION 33;LOT 52
VACANT
NO CONCERN PER INSPECTION NO CONCERN;WELL ON SOUTH 1/2
REPORT;WELL ON SOUTH SIDE OF LOT OF LOT PER GEG FIELD INSPECTION S ALE:
1"=100'
441,16
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GARNESS ENGINEERING GROUP, Ltd ill14...°P..04. ••• = sCIVIL&ENVIRONMENTAL ENGINEERS r
3701 E.TUDOR ROAD,SURE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3246•WEBSITE:www.gamessenglneeAn9.com ■
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: i ,: A. Ga -ss
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PAGET PLUNK 907-687-5323 1 OF 2 �• ,°,•• C•
PROJECT/LEGAL DESCRIPTION: DRAWN BY: �� � � �
T12N R3W SECTION 33 LOT 45B D.J.G. •<p�0••���''•,.,.�...•••. .41.
TYPE OF WORK: DATE: LICENSE X11' l ESS i
SEPTIC SYSTEM DESIGN SITE PLAN 2/1/2018 #AECC884 ����� J
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DESIGN CRITERIA: GEG,Ltd.HAS A 8 PAGE SPECIFICATION
NUMBER OF BEDROOMS:3 LETTER THAT PERTAINS TO THIS DESIGN.TO
GALLONS PER DAY 450 OBTAIN A COPY OF THE LETTER CONTACT NOTE:THE CONTRACTOR SHALL HAVE THE
GALLONS PER DAY(GPD):'20 GEG.BY PROCEEDING FORWARD WITH THIS SOUTH&WEST LOT LINES,AND ALL WELL
PROPOSEDPERCAPPLICATION RATE:MIN/INCH GPD/FP / INSTALLATION,THE ENGINEER,WELL DRILLER, RADII FLAGGED BY A REGISTERED LAND
CONTRACTOR AND PROPERTY OWNER AGREE
MINIMUM DRAINFIELD SO FT.:750 FTS / THAT THEY HAVE READ THESE SURVEYOR PRIOR TO CONSTRUCTION.
'PER ROGER J.SHAFER,P.E.1992 T.H. SPECIFICATIONS AND AGREE TO ACCEPT THE \
DRAINFIELD DESIGN: / TERMS AND CONDITIONS OUTLINED.
MAXIMUM DEPTH:10 FEET / \
WIDTH:2.5 FEET PRIVATE WELL BELIEVED TO SERVE LOT
45D-1 AND 45C-1;PREVIOUSLY CLASS"C" T12N R3W SECTION 33 LOT 450-1
LENGTH:55 FEET /
EFFECTIVE:7 FEET PER MOA RECORDS.NOW BELIEVED TO BE \'
PRIVATE,ASSUMED 100'PROTECTIV
ACTUAL SQ.FT.:770 FEET' ( RADIUS j L`� S
r I /
p%U
I pPPROXIOCE 1(13 WE N
/ I 85 FOOT WAIVER REQUEST / I I \
/ I-4 I
\/ • / // PROPOSED 1250 GALLON HDPE SEPTIC�K; I
\ INSTALL DOUBLE CLEANOUTS AFTER THE TANK.
\ \ / SHED APPROXIMATE LOCATION OF EXISTING
TOP OF BLUFF PROFESSIONALLY 1250 GALLON STEEL SEPTIC TANK TO / \
SURVEY BY SHANE HOLT,PLS \ \ ' / BE DECOMMISSIONED PER
PC. /
APPROXIMATE LOCATION OF 1992 DRAINFIELDINSTALL FCO IF ONE IS 1
PER CLEANOUT LOCATIONS PROFESSIONALLY \ I I 100'WELL RADIUS /
SURVEYED IN BY SHANE HOLT,PLS.DRAINFIELD \ NOT PRESENT
TO REMAIN IN PLACE FOR FUTURE USE I N 6g WELL VVa
APPROXIMATE 1992 TESTHOLE \ ~_ P / REQUEST''R '
LOCATION PER MOA RECORDS BY Tq, 111 • , ,•1,•: . , , ,i .. 1r,. .../�: Y, •,
ROGER J.SHAFER,P.E. ` B : . . r ,s.•, ,• : a .l• .-
�`, DRIVEWAY ..,
PROPOSED DRAINFIELD .'• �•�
' C�` ��..••• / EXI EXISTING 3 ••
M \\:„...---- \ / BEDROOM HOUSE /
1-•
/
z \ d \
w /w /
gQai ASSUMED LOCATION OF SEWER LINE /
PER TANK AND DRAINFIELD LOCATION
\
>4,+
\
jP PROPOSED FLOW DIVERTER
— -----
'SLOPES
'SLOPES<25%WITHIN 50'DOWNGRADIENT OF THE
PROPOSED DRAINFIELD.SLOPE INFORMATION N
OBTAINED FROM MOA ARC GIS MAPPING
T12N R3W SECTION 33;LOT 52
SCALE:
1"_40'
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3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AK 99507•PHONE(907)337-6179'FAX(907)338.3246'WEBSITE:www.gamessenOneeing.com 7 •
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: '/J- ey A.. -1a ess
PAGET PLUNK 687-5323 2 OF 2 ���• CE 795 ,'
PROJECT/LEGAL DESCRIPTION: DRAWN BY: -I ••,, 1111 aG� •
T12N R3W SEC33 L45B D.J.G. �1ep••••z •,� J.
TYPE OF WORK: DATE: LICENSE ,,11'"``��♦♦
SEPTIC SYSTEM DESIGN UPGRADE 2/9/2018 #AECC884 I
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- PRELIMINARY -
SGS Ref.# 1180422001
Client Name Garness Engineering Group,Ltd Printed Date/Time 01/31/2018 13:57
Project Name/# 14250 Sabine Street Collected Date/Time 01/30/2018 13:00
Client Sample ID 14250 Sabine Street Received Date/Time 01/30/2018 14:00
Matrix Drinking Water Technical Director Stephen C.Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Waters Department
Total Nitrate/Nitrite-N 0.356 0.100 mg/L SM21 4500NO3-F B (<10) 01/31/18 DMM
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Municipality of Anchorage �. S'...G;
♦ t �. DEPARTMENT OF HEALTH&HUMAN SERVICES II"5; •G
{1 825"L"Street, Alaska 99502-0650 "' r;
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LOT 52 i OS
AS—BUILT SURVEY 1 " = 30 '
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 45B, SECTION 33, T 12 N. R 3 W. S.M. , PLAT 66-154
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
ITHE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
Municipality of Anchorage Page I of
DEPARTMENT OF HEALTH AN[::) HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: _ ~,~-~-~-'~:~---~
Address:
Phone: -~2~;~f~ --~'~..~, ~.j, ~ rNo. of Sedrooms:
LFGAL DESCRiPTiON
Lot: ~ Block: Subdivision:
WELL: [] New [] Upgrade
~f~n (Private, A,8~'~)~
GPM I Pump Set at:
PID Number: ~:)1 ~) lg:~ ~
Wastewater System: [] New ~'Upgrade
ABSORPTION FIELD
Z~)eep Trench [] Shallow Trench [] Bed [] Mound O Other
Soil Bating:~, .~ G,~O/Sq. Ft I ~.~/g
Total Depth from original rode:
Depth to pipe botlom from original grade: Grave depth beneath p pe
Fill added above original grade: Gravel length:
Gravel~p~h~ ~./J, & 't~-:>T~ ~ ! Number of lines:
Total Depth: Cased To: Total absorption are~:
Ft. Ft
Date Drilled: Static Waler Level: Installer
Ft.'
i Casing Heighl Above Ground:
Ft Ft.
Pipe material:'
¢,~-r r,-t
Date installed:
TANK
To
From
SEPARATION DISTANCES
Septic Lift
S~ation
Well
Surface
Ws, ter
Line
Curtain
Drain
[] Holding [] S.T.E.
Material:
Capacity in gallons:
Number of Compartments:
LIFT STATION
on" level at:
M~ke & Model
"Pump oft" le~'~..~LHigh water alarm at:
Electrical Inspections performed by:
BENCH MARK
~cation and Description:
Assumed Elevation:
Inspections performed by ~k~:~*3 ~, ,'~l,t¢"-~ ~.~
Department of Health and Human Services approval
Reviewed a nd ap p r eyed by://~L~.~z~,~...~. ~)~.¢obvo~ ¢- Date: _¢7~_~//¢.~
72-013 {I/91) MOA25
8ttAFER
No. 3215
Permit No. '~
Page ~ of '~
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: '"T'-I"~-N.~'~ ~1~ )! ~--__~.,, -?---~,-~-~, L..T ,44:::~ PiD No.:
SEAL
81tAFEI~
No, 215
72~013 A (2/91 } MOA 25
/47./
R O. BOX 190708 * 2921 INTERNATIOi~AL A~R,F~ORT ROAD. ANCHORAGE!, ALASKA 99519-0708
TELE[~HO~E, 243.2455
Customer's ~
Order No. ~ ~-,, Date
ALL Claims~
PAST DUE ~
bill
MONTH.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920050
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:LOUDON ZETHINA L 50% &
OWNER ADDRESS:14250 SABINE ST
ANCHORAGE, ALASKA 99511-2313
DATE ISSUED: 4/06/92
EXPIRATION DATE: 4/06/93
PARCEL ID:01819205
LEGAL DESCRIPTION: T12N R3W SEC 33 LT 45B
1
LOT SIZE: 45015 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
Tom Fink,
Mayor
N unicipality ,Ar chorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
April 6, 1992
Roger A. Shafer, P. E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for T12N R3W Section 33 Lot
Waiver Request #WR920013, PID %018-192-05,
45B
SW920050
Dear Mr. Shafer:
Your request for waiver of the required 100 foot horizontal
separation of a septic system to a private well has been approved.
The approved separation distance is 70 feet from the septic tank
to the well.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Program Ma g .
On-site Services
ljm: ~6
D~PT. O~ ENViRONM~NTAL CONSERV~TiON
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
April 6, 1992
Roger d. Shafer, P.E.
S & S Engineering
17034 Eagle River Loop, Suite 204
Eagle River, Alaska 99577
Subject:
Lot 45B; Section 33, T.12N., R.3W., Anchorage, Alaska, Waiver
Request, ADEC Project Number 9221-WV-001; Waiver Approval
Dear Mr. Shafer:
This letter is in response to your submittal dated March 3, 1992 and received on March
9, 1992 requesting a waiver for a single family, 1000 gallon septic tank, to be located 95
feet from a Class C well located on Lot 45 C-1, and 70 feet from the single family well on
Lot 45 B.
The Department is granting the waiver as requested provided the following conditions are
adhered to:
1)
2)
The septic tank shall be constructed of 10 gauge rnetal and cathodically protected.
All joints within the normal protective radii of the two subject wells shall be of
watertight de_.~
4)
Engineered As-built plans shall be submitted upon completion of installation with
a statement by the engineer verifying the system to be water tight,
The Department also recommends that the septic tank be fully insulated to increase the
overall ambient operating temperature within the tank, A higher operating temperature
is more conducive to anaerobic decomposition of so:is and could result is lower volumes
of solids being generated.
Roger Shafer 2 April 6, 1992
This waiver is valid for installations occurring within two years of the above date. If you
should have any question, please do not hesitate to contact me.
Sincerely,
Bill H. Lamoreaux, P.E.
Anchorage District Manager
BHL/cf
cc: Dan Roth, DHHS
Doug Robbins
~ ~U T3
2.7
March 19, 1992
ROBERTSHAFER, PF
RQGERSHAFER. P.E
CIVIL ENGINEERS
(907) 694 2979
FAX t-~94 !211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSLONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& Ft OW TEST
SITE PLANS
ROAD OESIGN
SO~t TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 45B, Sec. 33, T12N, R3W, S.M.
Request you issue a permit to i~tall a septic system and grant a
waiver for the horizontal separat~on distance between a private well
located on the referenced property and the proposed septic tank at a
distance of 70 ft.
As can be seen in the attached letter to the Alaska Deparlment of
Environmental Conservation (DEC) we originally applied to the DEC for
the referenced waiver. However, during a meeting at DEC on the
referenced property on March 16, 1992 we were informed the review and
approval of the separation distance waiver to the private w~ mu~t
come from your office.
Listed in the March 3, 1992 letter to the DEC are mitigating factors to
justify the requested waiver. Also attached for your review is a
recently perforated flow test for the private well. Water samples taken
from the private well by a realtor involved in the recent sale of the
property show neither nitrates nor colifo~ bacteria within the well
water. We have collected our own water s~pl~s from the well on March
17, 1992 to ensure an appropriate third party sampling. These s~ple
result~ w~l be forwarded to your office as soon as they are complete.
As a result of the March 16, 1992 meeting at D~C we have added specific
co~truction requirements to the proposed septic tank. These
requirements include:
I. The septic tank sha~ be completely sealed and constructed of
10 gauge steel. The tank shal~ have cathodic protection on
both ends.
2. All pipe connectio~ w~l be a Romex type or equivale~.
3. The tank will be bedded and backfilled with a ~lean sand to
within one foot from the surface of the ground. The engineer
will verify that any portion~ of the protective coating that
have been ac~dent~y removed from the tank are repaired prior
to backfi~ng.
ON SITE
WASTE WATER
DISPOSAL SYSTEM
OESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGt_E RIVER, ALASKA 99577
I" = 40' UPGRADE
SCALE
VACANT
SABINE STREET
N, T.S. PROFILE
SCALE
~EWER ROCK
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'fES'r
1
2
3
4
5
6
7
8
9
10
DATE PERFORk
¥ownship, Range, Section:"~l'~.l~ '~--~.~,
- SLOPE ~ SITE~ PLAN
WAS GROUND WATER
ENCOUNTERED?
11
12
13
14
15
16
17
18
19-
20-
IF YES, AT WHAT
DEPTH?
Depth Io Water A~JJ?~._~ [
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (m~nutos/~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~__FTAND_ ? FT
5 & S ENGINEEEtNG
PERFORMED BY; ]7034 Eagle RiYer Loop ~Oa~ ~0, '~{~ ~ CERTIFY 'fHA7 THIS TEST WAS PERFORMED IN
Eagle l~iver, Alaska 9¢577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~~
72 008 (Rev 4/85)
LOCATION OF WELL (Legal Description):
w~ ~'r.: ~ ~_~.
DATE DRILLING COMPLETED: ~ ~ ~
STATIC WATER LEVEL (Top of Casing): .
ROBERTA, SHAFER
CIVIL ENGINEER
694-2979
~CL~ '4~ F"'r.
DRILLER:
FT. DATE:
DATE OF TEST: __"~- ~"] ~"~'"~'
SCREEN:
CLOCK ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPING
TIME PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS
STOPPED, MIN.
V, :~ ~ ~ o ~, (sw~) o o sra, i,.4d~r-~--l~ .~r
~'~ 5 ~', ~' _. ~ ~ ~,
15
20
,..~ ~ ~ 25 ~ ~' ~' ;~, ~
30
40
~4~ 45 ~' ~ a~.~
50
55
~'. ~ [ 60 (1 hour) ~ ~' ~' ~, O
~',~t 150 ~' ~ ~. I
~'. ~ t ~ao ~3 hours) ~ ~ ~ -~9, ~
~t~ 240 (4 hours) t ~ ~ ~, ~
.~cow.v ~~/
~',o~ t 0 ~ ~ O 0
.. ~'-~ ~ q~,' . ~1' ~
~5
20
30
Comments:
Is not Guarattteed
§ubiequent Var|ation{
Can Occur.
CHEMICAL o
c~ GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
TELEPHONE (907) 562-2343
5633 8 Street
Anchorage, Alaska 995t8
Drinking Water Analysis Rvv~,rt, for -"'- v, . ·
TO BE COMPLETED BY ~,IAT:R ...... R
[] PUBLIC WATER SYSTEM I.D. #
~'~PRIVATE WATER SYSTEM
Z,¢C~o
SANtPLE DATE:
SAMPLE TYPE:
Mo. Da), Year
Routine
Check Sample (for routine sample
with lab rot. no,
Special Purpose
~ Treated Water
[] Untreated Water
SAMPLE
No. LOCATI(;)I~ , ~
31 I
41 I
Time Collected
~,,~C°llected~'-"/:~ ~//~
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be;
',~ Satisfactory
~ Unsatisfaclory
Ui Sample too long in transit; sample should
not be over 30 hours old at examinalion
to indicate reliable results. Please send
new sample via special delivery mail,
oete.e ived
· rime ~eoe,ved
Analytical Method: Membrane Filter
' No. of colonies,q00 mi.
Lab Ret. No. Result*
q2.O-Tm
2___
Analyst
.E.C. ~C_
READ INSTRUCTIONS
BEFORE
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Fliter: Direct Count
Vorificallon: LSB
Fecal Coliform Confirmation
Corltorrrdl00 mi
BGB
COLLECTING SAMPLE Final Membrane Filter Results /1
TNTC = Too Numerous To Couni
PART ONE OF T',Wtl:
OB = Other Bacteria REMAINDER TO FOLLOW
/¢- C3 a.m.
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHOHE(907) 562.2343 FAX 19071561-5301
ANALYSIS RESULTS for INVOICE J 51420
Cheraiab [~i ~ 92.67!7 Sac?lo J i },~rlx: WATER
UA Client Acer
FEB 2~ 92 ~ iS.~O XES BFO~ :
FEB 2q 92 ~ iff:S? hrs. geqJ :
AS REQUIRED Ordered By
Anaiys~s Completed : ~'~g 26 92 Send Reports to:
o .-r,xsor ~.~?,.~., C EEC I)HZRZOG, MARTIN
:;IT?,ATE N %,: 13) P. 3, L E?A ~57,.2 1~
Sample ROUTINE SA~iPLE COLLECTED BY: MARTIN HERZOG, WITNESSED BI JEAN HERZOG.
I Tests ?eriormed See Special ln~tructlona Above UA-Unavailable
ND- None De~ected '" See Sample Re~ar~s Above
MA- Not Analyzed LT-Loa$ Tbmn, GT-Crest~r Than
~-~ Member of the SGS Group (So¢i~t~ G~firalo de Surveillance)
ROBERTSHAFER, PE
ROGER SHAFER. P.E
March 3,
1992
CIVIL ENGINEERS
(907) 694-2979
FAX 694 1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAO DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
State of Alaska
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
800 East Dimond Blvd., Suite 3-470
Anchorage, Alaska 99515
REFERENCE: Lot 45B; Sec. 33, T12N, R3W, S.M.
Request you grant waivers for the horizont~ separation distances
b~tween a proposed 1000 gallon septic tank and a Class 'C' w~ll
located on the adjacent Lot CI, and a private well located on the
referenced lot at 95 ft. and 70 ft. respectively.
The septic syst~ serving the referenced property was recently
abandoned to obtain approv~ on the Class 'C' well located on Lot CI.
As can be seen from the attached site plan there is a steep slope on
the property. To maintain a feasible pumping access to the proposed
septic tank, the tank will need to be installed within the protective
well rad~ as opposed to over the bank where the leachfi~ld is
proposed.
Mitigating factors to justify the requested lesser separation distance
are as follows:
O~y the septic tank will encroach the protective well radii.
Generally, a septic tank is not considered a continuous source
of effluent contamination as wou~d a leachfield. The proposed
tank is to be installed with water tig~ couplings on the
i~let, outlier, and both cteanout pipes.
The recent soils test on the referenced property and the
previously performed soils log on Lot 45CI show a medium soil
permeability with a fair silt content. This should provide a
high rate of effluent purification as the wastewater travels
through the soil.
Both soil logs did not d~tect groundwater. Th~£efore, the
presence of groundwater should not hinder effluent treatment
or aid in effluent migration.
Although there is no w~ll log available for edther well, a
flow test performed on the Class 'C' well in July 1991 shows a
static water lev~ within the w~ll at 85 ft. below the ground
surface. A Water Rights application for the Class 'C' w~,
filled ou~ by a previous property owner, states the w~ ~
being 191 ft. deep. We presume both w~lls are similar in
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Pag~ Two
Lot 45B; Sec. 33, TI2N, R3W, S.M.
March 3,
5.
1992
The general too~raphy of the ar~a insinuates a sub-surface flow toward
th~ west. Th~ means any effluent from the proposed septic syst~
wou~d probably travel away from the referenced wells.
Therefore, we feel the separation distances prescribed under 18 AAC72 are not
required in this case.
With the issuance of these waivers we will apply to the Municipal Depar~nent of
Health & Human Services for a permit to i~tall the septic system.
This request is on behalf of our client, th~ current property owner:
Martin H~rzog
3817 South Carson Street #428
Carson City, NV. 89701
(702) 885~0988
If you have any questions
please contact me.
Sincerely,
ROGER J. F , P.E.
RJS/~m
or require additiona~ information for your revi~o,
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEI-'RING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: {907) 561-5301
ANALYSIS RESUI, TS fez INVOICE i 51977
Chemlab ROE.# 92.1034 Sample ~ 3 ~atrix: WATEN
Client Sample ID
PWSID
Collected
DRINKING WATER L~SB SEC 33 T12N R3W SM Client Name :S & S ENGINEERING
UA Client Acct :SNSENGP
NAR 17 92 ~ 16:20 hts. BP0# :
NAR 18 92 ~ 11:50 hrs. Roq~ :
AS REQUIRED Ordered By :R. SNAFER
PO~ :NONE RECEIVED
Analysis Completed : NAR 19 92 Send RepoYt~ to:
I, abo~atory Supervisor : STEPHEN C. EDE 1)S & S E)IGINEENING
Reloa~od By : t/' ~._ ~/~ 2)
Parameter Result, Units 14athod Allowable Limits
UITRATE-N O.Ii mE/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: N.J.S.
ND~ None Detected "Soo Sample Remarks AboYe
NA- Not Analyzed LT-Less Than, GT~Oreate~ Than
Member of tile SGS Group (Soci~tb G~n~,rale ds Surveillance)
CItEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
TELEPHONE (907) 562-2343
5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Celiform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
~PRIVATE WATER SYSTEM
S & S ENGINEERING
17034 Eagle River Loop Roa~
Mailing Addles~
Mo. Day
SAMPLE TYPE:
~Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
State Zip code
Year
[] Treated Water
[] Untreated Water
SAMPLE
No, LOCATION
41
Time Collected
Collocled By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to bo:
~' Satisfactory
E] Unsatisfactory
[] Sample too long in transit; sample should
not be over 30 hours old at examination
to indicate reliable results. Piease send
new sample via special delivew mail.
Analytical Method: Membrene Filter
No. of colonies/100 mi.
Lab Ref. No.
~2,1034 4
I
Result*
Analyst
BEFORE
COLLECTING SAMPLE
READ INSTRUCTIONS Membrane Filter: Direct Count
Veriflcstion: LSB
I-'ecal Coliform Conflrmallon
Final Membrane Filter ~ults
BACTERIOLOGICAL WATER ANALYSIS RECORD
TNTC = Too Numerous To Count
OB = Other Bacteria
BGB
Date
Coliformll00 mi
Collform/100 mi
PART ONE OF TWO
REMAINDER TO FOLLOW
• • • • QP _xe`,
• _ Municipality of Anchorage owy,,,,,,,,‹"t�_�=-.?`
On-Site Water and Wastewater Program < "milI•m
(907) 343-7904 SA E.
Certificate of On-Site Systems Approval
Parcel I.D. 018-192-05 Expiration Date: 10 ---/ S -10
1. GENERAL INFORMATION:
Complete legal description T12N, R3W,Section 33, Lot 45B
Location (site address) 14250 Sabine Street*Anchorage,AK 99516
Current Property owner(s) Paget Plunk Day phone 687-5323
Mailing address
Real Estate Agent Doug Rickel Day phone 240-2152
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance requ r: I Distance:
Received by: Date: 3// //$
1
COSA to be released tot e •ng er,unless otherwise requested by the engineer.
COSA Fee $ Ace' .GD Waiver Fee $
Date of Payment 3(13(f$ Date of Payment
Receipt Number Receipt Number
COSA# (21C/71 0 PO Waiver#
•
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 3//2_,//
0000OO��
In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system o0 OF A� 004
in accordance with the guidelines and regulations established by the Municipality of Anchorage and K\� .••......• . 4 ,6
industry practices. The reported results describe the condition of the system/s on the date/s of the 4 P • • Q
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or O� ��-) . d
encroachments may exist that were not identified during the evaluation. The operational life of all wells �� .i 9 T
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0..
groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 VA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and Q. . . . -
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q '•,Je r-, •. Carnes..••
system/s;therefore, GEG makes no warranty(express or implied) regarding the future performance of On , E_ . Q�
the well or septic system. GEG makes no representation whether an alternative well or septic system Q'9's • (d •,ce4
can be installed on the property in the event either of the current systems fail to perform adequately in C4 o •'2.r1�• •� ccO
the future. The content of this report is for the sole benefit of the person/party that retained GEG to apet&
rofessio
perform the evaluation. Reliance upon the information provided in this report by any other person or �OOOo •
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved � �-�(� Dc'�iC,y
�, o
Conditional approval for bedrooms, with theAIlowboAp atior
= WATER AND 'is
m WASTEWATER -
n PROGRAM
SEPI\`-'
By: v� –E Original Certificate Date: ^13
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: �t
COSA Checklist /" Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: T12N, R3W, Section 33, Lot 45B Parcel ID: 018-192-05
A. WELL DATA
Well type Private If A, B, or C provide PWSID# N/A Well Log (Y/N) Yes
Date completed unk Sanitary seal (Y/N) Yes Wires properly protected (Y/N)
Total depth 162 ft. Cased to unk ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test unk 1/16/2018
Static water level 100 ft, 43.1 ft_
Well production 12 g.p.m. 4.8+ g.p.m.
WATER SAMPLE RESULTS:
Coliform Ne9 colonies/100 ml. Nitrate 0.356 mg./L. Collected by: GEG. Ltd.
Arsenic: <5 ug./L. Date of sample: 1/30/2018 k ( {3i /Zvl rd
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/HDPE Date installed 2/26-27/2018
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) N/A
Date of pumping New Pumper
C. ABSORPTION FIELD DATA
4/7-10/1992 0.6 Deep Trench
Date installed 2/26-27/2018 Soil rating a.p.d./Ior ft'/bdrm) 0.6 System type Deep Trench
58 3 6.5
Length 55 ft. Width 2.5 ft. Gravel below pipe 7 ft.
*11+ 754
Total depth **10.7+ ft. Eff. absorption area 770 ft2 Monitoring tube Yes Depression over field No
Date of adequacy test New Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test — in. Water added — gal. New depth — in.
Elapsed Time: - min. Final fluid depth — in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N/A _ If yes, give date —
*Below existing grade **Below final grade
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at .. wa er alarm level at in.
•- •• Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *65'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75 + Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots *85'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain None Known Wells on adjacent lots 100'+
F. COMMENTS
*WR#OSV181003
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G. ENGINEER'S CERTIFICATION o,�'> of A 4s�0
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I certify that I have determined through field inspections and 10 ` 9l H r '.Y VO
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this v _ '
date. J... ... ...�
f = A. •ame .;
Engineer's Printe Name JEFFREY A. GARNESS vA,/ CE 79 3 OO
Date 3 /2.-// e �Q "�Pa'' 1.L1r,'�F,00
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(Rev. 11/05)
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AS-BUILT SURVEY 1 " = 30 '
NO CORNERS SET THIS DATE
0oo000p I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
v1;, OF '4 L OF THE FOLLOWING DESCRIBED PROPERTY
Opl •..' ,..A., .CSS O�0 LOT 45B, SECTION 33, T 12 N, R 3 W, S.M. , PLAT 66-154
i9.:49 TH it 1t1 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
0. . �� ,�f ' 'Q VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
0 Sht"..�� /i�G°- THE INFORM4TION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
0/)7+ • '",f::'
`� CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED.
vs- SHANEA.HOLT .• i NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. DATED AT ANCHORAGE,ALASKA THIS 6 TH DAY OF
Q4 P LS-6914 O� EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN 2018
1411'V
4 0 •.• y p HEREON ( UNLESS INDICATED) MARCH ,
04p�O.e, i°naA�6c PROPERTYTE: ELINES OR POSITELINES THAT ION ADDITIONALTHIS
IMPROVEMENTS ARE
NOT TO BE USED TO DETERMNE
�p000o� ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAN) SURVEYING
1304 GROVER DRIVE
ANCHORAGE,AK 14507
13311, FB 187-1, RTK FILE,13811 RC 3-I-5513
Parcel I.D. #
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA #
~UNICIPALI~,
AUG 04
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Dayphone ~2.- ~1~1
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
,,2_.
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.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72K)25 (Rev 1191) Front MOA ~21
STATEMENT OF INSPECTION BY ENGINEER.
As certified by' my seal affixed hereto and as of'the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Munic!pal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ~ -
Address .. r-~-¢
Engineer's signature
Phone
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 DH HS 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.
72-025 (Rev, 1/91) Back MOA ¢Y21
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501· (907) 343-4~
Health Authority Approval Checklist
Legal Description:
Parcell. D.: ¢1~- l~/'2.-~ d)~
A. WELL DATA
Well type ,,"-'~'
Log present (Y/N) ~'
Total depth [~'~
Sanitary seal (Y/N)
Date completed .
Cased to I~ .'2. /
If A, B, or C, attach ADEC letter, ADEC water system number
_ Cas ng le ght (above ground)
Wires properly prote~ted (Y/N)
Dote of test
Static water level
Well production
FROM WELL LOG AT INSPECTION
g,p,m,
WATER SAMPLE RESULTS:
Coliform ¢
Date of sample: 'TIilI~I/CJ~I
Nitrate ~ ~, /~"~//~C Other bacteria
Collected by: J,1, -~,
SEPTIC/HOLDING TANK DATA
Date installed Z~10"¢~;2-- Tank size j~,~) Number of Compartments ~ Cleanouts (Y/N)
Foundation cleanout (Y/N) y Depression (Y/N) J~ High water alarm (Y/N)
Date of Pumping ~::¢/~_/'¢'~ _Pumper
C. ABSORPTION FIELD DATA
Date installed /¢ I/P .-ct %
Length. ~-,~ Width
Soil rating (g.p.d./fF or4¢/b~rn) ~ ;~, System type
Gravel thickness below pipe ~¢,~' Total depth
Effective absorption area '-~ ~ Monitoring Tube present (Y/N) _ Depression over field (Y/N) . _
Date of adequacy test 7.~. ~ ~ Results (Pass/Fail) '"~ For ~--
Fluid depth in absorption field before test (in.);
Fluid depth ¢ / (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
bedrooms
Immediately after~r_~gel, water added (in.): _ ~ ~/~.
Absorption rate = /¢/~ 7 g,p.d.
If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N) "Pump on" level at*
High water alarm level at* ~ .... *Datum
Cycles tested ~
"Pump off" level at*
E, SEPARATION DISTANCES
SEPARATION D STANCES FROM WELL ON LOT TO:
Septic/holding tank on lot "'/¢ I
Absorption field on lot
Public sewer main '~,'///~-
Sewer/septic service line ~ ,~-.~
On adjacent lots
On adjacent lots
sewer manhole/cleanout
Public
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation .~'~ Property line ) 1,OI Absorption field /_.dO"
Water main/service line ?~5" Surface wateddrainage ~] u) Wells on adjacent Pets
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
.~¢ ?~' Building foundation ~/~t
Property line
Surface water
Curtain drain
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots I ~)~ /
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records that the above .s, ystems are
in conformance with MOA HAA guidelines in effect on this date.
Signature ~.~
Date ~ L/I Iff ~
HAA Fee $ ~ ¢ ~
Receipt .mber
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number