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Home My WebLink AboutT12N R3W SEC 33 LT 45C-1 Municipality of Anchorage Page t of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~--~,~ t~/~7~0~''~ PID Number:_ ~1~ '~'~1 Nam;:- --' ~ ~ Wast~yste~: ~ New ~pgrade ~~ q~ I ABSORPTION FIELD ISoil Rating: Tolal Depth from original grade: LEGAL DESCRIPTION . GPD/Sq. Ft. GraVel depth beneath pipe Depth to pipe bogota from original grade: Lot: f Blocg: Subdivision: [.~'C ¢?'~ ~:~ I F,. ~,. Townsl,~J;~ j ~. ~ Ran g e:.~,.~ ~ Section: ¢'D Ii"al grade: Ft. Ft. WELL: D New B Upgrade Sraveldepth: Ft. Numberoflines: Bistancebetweenlines:Ft I =DateT°tdDrilled:Depth: Ft. Cased To: Ft. Total absorpti, SQ. Ft. Pipe material: Driller: Static Water Leveh Yield: GPM IPump Set at: Ft, ICasing Height Ab°ye Ground:Ft. TANK SEPARATION DISTANCES ~ Holding [] S.T.E.P. Capacity in gallons: Absorption Herding . Material: ~ ~/-~ Number of Compartments: su~O~w~t~ [~& ~ LIFT STATION / Line "Pump on" level at: at: ~High water alarm at: Foundation Curtain [lectrical Inspections performed by: Drain Remarks: BENCH IVlARK n and Description: ~..~_/~_.. 'I~Z'..r~. kl'~' ~'.,N6,~ Assumed Elevation: Inspections performed by: '/~ 4¢'~ 'i~1,~1~ i~¢--~---.{ t-J~t Dates: 1 st. 2nd ~'~ -~¢'' r''~'l Department o, Healt~l~d ~H/,~,l~r~/app~"oYal Reviewed and approved by: ~"¢.,~(/.~'~Date: ~/~.~,/~ 72-013 (1/91) MOA 25 Permit No. ~l~--{C~ l O ~-~'~/'~ __ Page ~ of '~- Municipality of Anchorage BEPARTMENT 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 LegalDescription: ,~'~d~, ~'~:"[-1'2.,F,J~"~..,,.-~: ~:~J'~, PIDNo.: ~71~:~1~,1 N [AL 72-013 A (2/91) MOA 25 PAGE 1 OF 1 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 (UPGRADE) PERMIT PERMIT NUMBER:SW910269 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:BIESEMEYER DAVID PAUL OWNER ADDRESS:il500 HAWKINS ANCHORAGE, AK 99506 DATE ISSUED: 9/04/91 EXPIRATION DATE: 9/04/92 PARCEL ID:01819221 LEGAL DESCRIPTION: T12N R3W SEC 33 LT 45C-1 LOT SIZE: 24757 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY: DATE: DATE: August 29, 1991 ROBERTSHAFER, P.E. ROGERSHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL iNSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Mu~ipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stre~ P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: 45 C-l, Sec. 33, TI2N, R3W, S.M. Request you issue a p~,it to replace a septic tank to s~rve the referenced prop~r~y. A~tached is a site plan with supplement~ information in~uding Depart~e~ of Enviro~ent~ Conservation (DEC) correspondence. The existin~ septic tank was found to be of exploratory excavation work for documentation. i~t~ed under a separation distance w~iver of well. poor integrity during The new tank will be 86 ft. to a Class 'C' If you haue any questions or require addition~ information for your review, please con,act us. Sincerely, ROGER J. SHAFER, P.E. RJS/gm ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 August 27,1991 WALTEI~ J. HICKEL, G~OVEt~NOR (90'7) 563-6775 Roger J. Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Lot 45 C-1; Section 33, T. 12 N., R.3W., S.M., Anchorage, Alaska, Waiver Request, ADEC Project Number 9221-WA~003; Partial Approval Dear Mr. Shafer: In response to the additional information provided in your August 1, 1991 letter on the referenced property, I offer the following comments: The Department is granting a waiver to 86 feet between the Class C well and a new proposed water tight septic tank serving Lot 45 C-1 as in accordance with 18 ACC 72.032. However, at any time that an upgrade of the leaching system is required, this waiver shall become null and void and the entire system (including the septic tank) shall be placed outside the protective distances required by regulation at the time of the upgrade. The Department is unable however to grant a certificate to operate the Class 'C' well do to the close proximity of a possible cesspool or lift station on Lot B. We are presently working with the Municipality of Anchorage, DHHS in an.attempt to resolve this issue. It should be further noted that the justification provided in your let[er of August 1, 1991, specifically noting another approval dated June 23, 1989 is inappropriate in this case. Current approved reference documents would indicate that the flow rate would need to be 8 gpm per unit, not total. We will however accept the systems flow rate based on the existing production rate and storage capacity available from a 220 gallon pressure tank and the past satisfactory performance of the system for the two dwellings presently connected to it. RogerJ. Shafer, P.E. Page 2 August27,1991 Should you have any questions, please do not hesitate to contact me. Sincerely, Bill H. Lamoreaux, PRE. Anchorage District Manager CC: John Smith, DHHS David Besmear BHL/pf August 1, 1991 ROBERTSHAFER, P.E. ROGERSHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694.1211 HEALTH AUTHONIT¥ APPROVALS SEWER & WATER MAIN EXTENSIONS ENGINEERING STUDIES AND REPORTS WELL INSPECT[ON & I=LOW TEST SITE PLANS ROAD OESIGN SOIL TEST PERCOLATION TEST Kevin K. Kleweno State of Alaska DEPARTMENT OF ENVIRONMENTAL CONSERVATION 3601 C Street Suite 322 Anchorage, Alaska 99503 REFERENCE: Lot 45C-1, Sec. 33, TIP/q, R3W, SM Anchorage, Alaska ADEC Project #9221-WA-003 Dear Mr. Kleweno: As per your July 22, 1991 letter on the referenced property, we are submitting additional information for you to continue your review of the referenced project. Attached is a soils log performed on the referenced property during the exploratory excavation of the septic system. Also attached is a soils log and percolation test for a nearby lot performed on September 24, 1990o From this soils info,nation, we see the soils are silty sandy gravels. This type of soil with a high silt content provides excellent wastewater treatment and filtration which would further justify the issuance of a separation distance waiver. Also attached is the adequacy test data sheet for the referenced septic system. In regards to the existing Class C P~lic Water System, we've addressed each item listed in your July 22, 1991 letter: The type of pump within the well is unknown due to its age. However, from the flow test we performed on July 1, 1991, we see the pump is capable of suppling up to 8°5 CPM. All indications show the well is capable of producing this amount; however, due to flow variations arising from varying pressures within the pressure tank, we've listed the well production capability at a minimum of 7.7 GPM. The existing water system has served the two houses for several years with no known complaints or deficiencies in either quantity or quality. As a result of a previous submittal to your office on a separate property in 1989, %ge were informed by Cindy Thomas of your office in a letter dated June 23, 1989 that an acceptable instantaneous flow rate for a duplex (two residences) is 8.0 GPM. We feel this water system is capable of supplying this amount of water. Page Two Lot 45C-1; ADEC Project August 1, 1991 2. Listed are the elevations of the relevant known sources of contamination within 200 feet of the source well: Ground at septic on Lot 45C-1: 103~ Ground at septic on Lot 45D-1: 104~ Ground at septic on Lot 45-B: 107~ Ground at well house: 107~ Bottom of well pit: 98~ Top of well casing: 100° As can be seen, the elevation of all sources of contamination is lower than the ground at the well head. The location of the source well by longitude and latitude is: Longitude: 149° ~9,520'W Latitude: 61° 05,547'N 4. The name and phone number of the person currently responsible for the operation of the public water system is: David P. Biesmeyer 907/349-8199 If you have any questions or require additional information for your review, please contact us. Sincerely, RJS/ztc HEALTN AUTHORITY APPROVALS SEWER &WATER INSPECTION ROBERTA, SHAFER ~P__~UACY TEST FORM CIVIL ENGINEER 604-29?9 ~UMBER OF BR'$~ ~ ENGINEERING STUDIES AND REPORTS C0~MENT$ WELL tNSPECTION & FLOWTEST. ROAD DESIGN SOIL TEST ON SITE WASTEWATER DISPOSAL SYSTEM RESULT$ ~ Municipality of Anchorage DEPArtmENT OF HEALTH & HUMAN SERVICES 825L Street, ~chorage, Alaska 99502-0650 SOILS LOG PERCOLATION TEST PER FORMED FOR%~O ~~~ DATE PER Township, Range, Section: SLOPE 1 2 3 4 5 6 7 8 9 I0 11 12 13 14 15 t6 ~ ~-: 18 19- WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? p E Oeplh Io Walar,~f~r~ Monilorino? ~-'~_ Dale: ':~_~ Reading Date Gross Net Time Drop Net Depth to Time Water 20- PERCOLATION RATE (mmulos/inch) PERC HOLE DIAMETER -- -TEST RUN BEJfWEEN FT AND ___ PERFORMED BY: ~&~[~IN~[~I~ - ~~~% CER31FY THAT TbS TEST was PERFORMED IN 17034 Eagle RNer L~p Roa~ No, 2~ ~ ~ ' ~ ACCOR~ANC~ WnH ~~U~D~L~N~ iN E~[CT ON ?H~S DA~. ~ATE: D~PT. O~' ENVIRONMI[~NTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. H/Cf(EL, GOVERNOR 563-6775 Mr. Rober[A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 July 22, 1991 Subject: Lot 45 C-1; Section 33, T. 12 N., R.3 W., S.M., Anchorage, Alaska, Waiver Request, ADEC Project Numbers 9221-WA-003; Review Dear Mr. Shafer: In response to the separation distance waiver requests faxed to this office on July 18, 1991. I have reviewed the submitted information and have the following comments: Based on the information submitted to this office, I can not agree with your conclusion that the requested horizontal separation distance waivers should be granted. The submittal did not provide sufficient information to justify waivers under 18 AAC 72.035 of the State Wastewater Disposal Regulations. Information on the soils in the area and results of an adequacy test on the existing soil absorption system serving the structure on Lot 45 C-1 will need to be submitted to this office. In regards to the existing Class C Public Water System, based on the new Drinking Water Regulations, there are several items that need to be addressed before any type of operation approval can be issued. The items needed are as follows: Data showing the capability of the water system source to met minimum water consumption needs and the criteria for water demand calculations will need to be submitted to this office under the stamp of a Professional Engineer (P.E.). The location (horizontal position and elevation) of each existing wastewater disposal system, petroleum storage tank and line, or any other potential or actual source of pollution or contamination within 200 feet of the source well, regardless of property lines or ownership. The location of the source well by longitude and latitude to the nearest one thousandth of a minute of a degree. 4. The name and phone number of the person (s) responsible for the operation of the public water system. If you have any questions, please do not hesitate to contact me. Sincerely, Keven K. Kleweno Environmental Engineer cc: John Smith, DHHS CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS REPORT BY SABLE for WORKordar~ 35841 Data Repo~t ?tinted: JUL 5 91 ~ 13:24 FAX: (907) 561-5301 Client Sample ID:L45 'C' SEC 33 TI2N R3W S~ Client Name :S & S ENGINEERING PW$ID :UA Client Acer :SNSENGP Colleoted JUL I 91 ~ 16:30 hrs. SPO J PO ~ NONE RECEIVED Received 3un 2 91 @ Is:10 hfs, Raq ~ Preserved with :AS REQUIRED Ozdarad By :g SRAFER Analysl~ Completed :JUL 3 91 Sand Reports to: Laboratory Supo~_v~.ij_o~X!~STEPREN C. NDE I)S & S ENGINEERING Chemlab Raf 4:913166 Lab Smpl ID: 3 )fatal×: WA~ER Allowable Pa[amatar Te~ted Result Units Rethod Limits NITRATE-N 0.32 ~g/i EPA 353.2 10 Sample I~OUTINN SAMPLE COLLEC~}:D BY: I Test~ Performed S8o Special Instructions Above UA-Unavailable ND- None Detected "Soo Sample Bornark~ Above NA- Not Analyzed LT-Less Yhan, G~-Greater Than ROBERT SHAFER, P.E. ROGER SHAFER J~y $, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTIt AUTHORITY APPROVALS SEWER & WATER MAiN EXTENSIONS ENGINEERING STUDIES ANOREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS State of Alaska DEPARTMENT OF ENVIRONMENTAL CONSERVATION 3601 C St~ Suite 322 Anchorage, Alaska 99503 REFERENCE: Lot 45CI; S¢~. 33, TI2N, R3W, S.M. 2900 East 142nd Av~,nu~, Anchorag~ R~qu~st you issu~ a c~tificat~ to op~rat~ a Class 'C' w~ll and grant a waiv~ from th~ w~ll to a proposed septic tan~z a~ 86 ft. Thc w~l was dr~d when Lot 4~CI was d~v~lop~d in approximat~y 1962. At that time th~ w~ ~s used to s~rv~ o~y a singl~ f~ ~ng. In approx~at~ 1964 th~ n~h~o~n~ Lot 45DI was d~v~op~ and ~h~ w~ at ~at ~m~ s~v~d both Lot 45~I and Lot 45DI. Th~ ho~zo~ s~par~on ~s~nc~ from a C~ss 'C' w~ and a s~p~c syst~ in 1964 ~s 80 ft. Th~for~, th~ s~para~on ~s~nc~s to the ~xis~ng s~p~c ~nk and l~a~hfi~d on Lot 4~CI and th~. s~p~c tan~ on Lot 45DI ar~ "grandf~h~d". R~c~ ~x~v~on of th~ s~p~c syst~ s~rving Lot 45~I for dodecagon found th~ ex~ng st~ s~p~c ~nk to b~ of poor i~g~y. Th~for~, w~ propoS~ to r~plac~ th~ s~p~c ~nk w~h a n~ 1250 ~on ste~ s~p~c ~n~ wi~ w~ ~ coup~ngs on the i~ and ou~. Th~ l~chfi~d s~rving Lot 4~DI was upgraded ou~id~ th~ 150 ft. pro~v~ ra~us in May 1984. Th~ ~ a no do~on av~abl~ for th~ w~t~ater ~spos~ syst~ s~ving Lot 45B. Th~ is on~ s~ndpip~ visibl~ and w~ ar~ ~s~ing ~ to b~ a c~spool i~ed wh~n th~ property was d~v~op~d in 1971. T~ c~spool is lo~d o~y approx~at~y 50 f~. from the ~ng C~ss 'C' w~. Th~ s~par~on ~s~nc~ r~q~r~d in 1971 ~s 80 ft. to a s~p~e ~n~ and 120 ft. to a l~chfi~d. Th~for~, ~ sys~ was i~d in vio~on of S~t~ R~g~a~o~. So as not to ~nd~ th~ fi~n~n~ of th~ r~f~nc~d prop~ty w~ ~ t~ th~ wat~ syst~ b~ approved and a no~c~ of viola~on b~ ~su~d to th~ own~s of Lot 45B info~ing th~ of ~h~ s~para~on ~s~nc~ vio~on so they may ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 4~CI, July 5~ 1991 The existing Class 'C' wU consists of a 6" ste~l casing to a depth reportedly of 191 ft. The wU head is within a pit approximately 10 ft. d¢.ep within a w~ house. Thgre is a submersible pump within the w~ll and a ~20 gallon pr~ssur~ tan~ and pr~sur¢ switch ~so lo~ated within thc w~ll hous~ pit. There is a sa~tary s~z~ on th~. w~l h~ad with thc pump suspended off a d~.op pipe which cxtgnds through thg ¢~er of the w~l sea~. Also within thg w~ll home pit is an abandonad w~ll n~xt to tha w~ in opar~on. T~S unused w~ is ~ b~ prop~ly abandonad by f~ng th~ w~ w~ sand and i~t~ng a ~on~ p~ w~n th~ top 5 ft. of ~sin~ to furth~ s~ th~ w~. T~s abando~g~ is ~ ~g p~c~ du~ng th~ ~v~on work for th~ i~.~a~on of the, proposad s~p~c ~nk. Sincg thc n~w sgptic tanh is to s~rv¢ a singl~ f~ily dwelling, a permit to i~s~all the s~p~ ~nk w~ b~ ob~n~d ~rom the Mu~p~y of Anchorage (MOA) Dgp~a~ of H~h and H~an S~vic~ p~or to i~ng th~ ~nk and subs~qu~ to approv~ of th~ C~ss 'C' w~ and gra~ng th~ ho~zo~ s~para~on ~nc~ ~v~. At~ch¢~ for your r~vi~w are the following document: I. A w~Z1 and septic sita plan showing the r~fer~naad Class it~ prot¢.~tiva radius. ' C ' w¢~l with 2. A w~ll flow t~st data sh~ for thg Class 'C' w~ll. 3. Ba~eria and Nitrat~ water sampla r~sul~. 4. A C~rtificate of Appropriation of Wate~ issued in 1978. 5. A septic in~p~on r~por~ for Lot 45DI. 6. Photos of the w~ll house and w~l pit. ?. A vicinity map. If you hav~ any qu~tio~ or the referenced property owner: Anchorage, Alaska 99506; #349-8199. or require additional information pleasa contact us DAVID P. BIESMEYER~ II$00 flaw~in~; ROGERTA. OHAFER CIVILENGINEER WELLDEPTH: t.~ ! .FT. CAStNer, ""~?c~'~ J~ * r~' E DRILt,INO COMPLETED: ~-~~ DRILt.[fl: _ STATIC WATER LEVEL ~op of C~stng): ~ _FT. DATE: CLOCK TIUE ELAPSED TIME SINCE DEPTHIO DRAWDOWNI PUMPIN(! RUMPINO $~'ARi'EDI 8TOPP£D, MIN. WATER, FT, RECOVERY RATr~ OPM 0 I 3~ g0 / Comments: 150 18013 hours) 240 (4 hours) RECOVERY I 0 Flow I, not Guar~n~ee~l Subsequent Variations DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR 563-6775 RECEIVED Mr. Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: July 22, 1991 JUL 2 3 1991 Municipality of Anchorage Dept, Health & Human Services Lot 45 C-1; Section 33, T. 12 N., R.3 W., S,M, Anchorage, Alaska, Waiver Request, ADEC Project Numbers 9221-WA-003; Review Dear Mr. Shafer: In response to the separation distance waiver requests faxed to this office on July 18, 1991. I have reviewed the submitted information and have the following comments: Based on the information submitted to this office, I can not agree with your conclusion that the requested horizontal separation distance waivers should be granted. The submittal did not provide sufficient information to justify waivers under 18 AAC 72.035 of the State Wastewater Disposal Regulations. Information on the soils in the area and results of an adequacy test on the existing soil absorption system serving the structure on Lot 45 C-1 will need to be submitted to this office. in regards to the existing Class C Public Water System, based on the new Drinking Water Regulations, there are several items that need to be addressed before any type of operation approval can be issued. The items needed are as follows: 1. Data showing the capability of the water system source to met minimum water consumption needs and the criteria for water demand calculations will need to be submitted to this office under the stamp of a Professional Engineer (P.E.). 2. The location (horizontal position and elevation) of each existing wastewater disposal system, petroleum storage tank and line, or any other potential or actual source of pollution or contamination within 200 feet of the source well, regardless of property lines or ownership. 3. The location of the source well by longitude and latitude to the nearest one thousandth of a minute of a degree. The name and phone number of the person (s) responsible for the operation of the public water system. If you have any questions, please do not hesitate to contact me. Sincerely, Keven K. Kleweno [nvironmental Fn~ineer cc: John Smith, DHHS 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 GENERAL INFORMATION Complete legal description Lot 45C-I, S6ction 33, TI2N, R3W, SM Location (site add'ress or directions) 2900 East 142 Ave. Property owner Mailing address Lending agency Mailing address David Bi~s em~yer 1.150o Haw~Jns: A~ch. rm~g¢.: AE. Day phone 349-8199 99~D~ _ Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 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 XX 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) Fronl MOA ,~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 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING 17034 Eaf)le River Loop Road N'o~ 204 Eagle River, Alas~<a 99577 Name of Firm Address Engineer's signature DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for 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. Legal Description: A, WELL DATA Well type ~ Log present (Y/4~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST if A, B, or C, attach ADEC letter. AOE¢ water system number 4 Date completed Total d~pth ~ !:(0' Cased to ~ /¢~ Sanitar~ seal ~TN) ~[ ires properly protected~) Date of test Static water level Well flow Pump level FROM WELl. LOG / SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g,p.m. AT INSPECTION MUNICIPAH'I-¥ OF ANCHORAGE' '""/~ / ~ '~VIRONMENTAb SERVICES DIVISION OCT 2 8 199i ; On adjacent lot ~. ~ '~ ; On adjacent lots Public sewer manhole/cleanout h,~)t.-~ Petroleum tank. __ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate _ ~. ~'Z- r'¢¢~1/ __ Other bacteria Collected by: ~4 ~ '~'~4~,'~;~ B. SEPTIC/HOLDING TANK DATA Date installed '¢~'t. ~' (.¢:,-'¢\ \ Clea no u ts ~(~'¢1%1) ~/ High water alarm (Y/N) Da,e of pump,ng Tank size /"'7---~'~::~ _ Compartments Foundation cleanoutd~N) "/ Depression (Y~ Alarm tested (Y/N) ' '"~Z:~C'J / L'~-~ Pumper Well(s) on lot To property line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots / ~o~ Absorption field "~ Surface water/drainage ~ ~ Ij¢- Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~ Manufacturer Size in gallons ~ Manhole/Access (Y/N) "Pump on" ~_ Vent(Y/N) ,v,v,~, ~ "Pump off" level at High water alarm level ~les testgd_ Meets MOA electrical codes (Y/N) ..... ~_ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed \O'](r~' ~ Soil rating ~'-~ ~¢'4//~ ;" ; Length L)I/-"' ~ Width L)~,~ - Gr~vel thickness ¢"'<' Total absorption area L)~.~ /5/~¢¢'¢~O: dr~/¢~*'; Cleanouts present,C~N) Depression over field (Y4'~~ ¢ Date of adequacy test Results (pass/fail) - d?/~¢.~ for Peroxide treatment (past 12 months)(V~ ~'~')~'/ ~'~)'-~)k"3~ It yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~";~ ~C~' To building foundation On adjacent lots Surface water Curtain drain On adjacent lots \ ~ 1'3~- Property line ,..~/.~ To existing or abandoned system on lot "¢~¢~/~ Cutbank ~'-~F2~- Water main/service line / C;;ZDI 4- Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date $ & 5 ENGINEERING 17034 I:*n_l. I~;wr I_~? Dnn~l E~gle ~iver, Alaslca 99577 HAA Fee $ Date of Payment Receipt Number 72-028 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number STATE OF ALASKA DEPARTMENT OF ENVlRO.NMENTAL CONSI=RVATION CONSTRUC'I-ION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS' A. APPROVAL TO CONSTRUCT public water system located , Alaska, submitted in accordance with 18 AAC 80.100 Plans for the construction or modification of by "~ ~ '-~ ~'?/L~' ' ~ ~-~--~g-~- ~ .have been reviewed and are ~ approved. ~ conditionally approved (see attached conditions). ~ ~ ~~ 8~27- I~ ~ons~ro~lion ha8 noI 8l~t~d within two ~oars of t~o ~rovfll ~to, this ~orHfi~8lo is void 8n6 now ~l~n8 B. APPROVED CHANGE ORDERS Approved by Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. water system was completed on ~ ¢'- '"" / (date), The system Is hereby granted Interim approval to operate for 90, days following the completion date. As-built plans submitted during the Interim approval period, or an Inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate, /~ DISTRIBUTION: 1, WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK * BNGINEEPJMUNI-BOROUGH (Complete Section C) DEPT. OF ENVIRONMENTAl, CONSERVATION Anchorage District Office 563-6775 3601 C Street, suite 322 Anchorage, Alaska 99503 WALTER J. HICKEL, GOVERNOR October 24, 1991 Roger J. Shafer S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Lot 45 C-1, Sec. 33, T12N, R3W, S.M. Anchorage, AK. ADEC Project # 9221-WA-003 Dear Mr. Shafer: This is in response to your letter of October 21, 1991, in support of your request for a certificate to operate the existing Class 'C' well serving this property. With the abandonment of the septic tank on Lot B, this water system is an acceptable Class 'C' system. Therefore, in accordance with 18 AAC 80, Drinking Water Regulations, this system is approved for operation. The enclosed "Construction and Operation Certificate" is the Department's approval of this water system. At this time, the Department is assigning Public Water System Identification (PWSID) Numbers to all Public Water Systems in the State. As a result the PWSID Number assigned to this Public Water System is 217437. Thank You for your cooperation with this Department. If you have any questions, please do not hesitate to contact me. Sincerely, Byron Roys Environmental Engineer Enclosures: As Stated BR/pf O~ob~r 21, 1991 ROBERT SHAFER, P.E, ROGER SHAFER, P,E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECT[ON ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST ROAO DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM State of Alaska DEPARTMENT OF ENVIRONMENTAL CONSERVATION ATTN: Bill H. Lamor~aux 3601 C S~r¢~ Suite 322 Anchorage, Alaska 99503 REFERENCE: Lot 45 C-I, Sec. 33, T12N, RSW, S.M. Anchorage, Alaska ADEC PROJECT fl 9221-WA~005 Mr. Under the separation distance waiver granted in your l~t~r of August 27, 1991 a n~ septic tank has been i~t~ed to s~rvt the singl~ family r~sidenct located on tht refcrenctd property. According to your l~tt~ a c~rtificale to operate the Class 'C' w~ll serving this property co~d not be ~rant~d du~ to the proximity of a wasteu~t~r disposal system located on the adjace~ Lot B. On Octobe~ 18, 199~ our offic~ witn~s~d the abandonment of the septic tank portion of thc wastewater disposal system s~ving Lot B. The ste~ septic tank s~rvin~ Lot B ~s excavated and the top removed. The content~ were p~ped by a septic p~mping company. Th~ tank w~ then d~troyed in plac~ and the cntir~ ~xcavation was covered with l~e to n~u~JLalize th~ s~ptic contaminant. ThC ~xcavation was then filled. At this point thc hous~ located on Lot B is vacant. PJ~or to occupancy a n~W Septic system will need to be i~talled to s~rve th~ property under a Municipal permit. With this septic syst~ abandonment th~)[e no longer ~xis~s an ~n~£oac~ment on the Class 'C' w~ll. We r~q~st yo~ issue a e~rtificate to op~e the Class 'C' w~l and a l~tt~ of compliance on the water syst~. or require additional information for your If Ecu, have any questions r~vi~w, pl~as~ contact uS. Sincerely, " ROGER J. SHAFER, P.E. RJS/gm