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HomeMy WebLinkAboutMANN BLK 4 LT 2BMann Block 4 Lot 2B #020-041-11 Municipality of Anchorage Page -I—of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report cy Permit Number: 5W O ;3 fw PID Number: L�QL) - nLLi -� 1 Name: }� �i / M N5 Wastewater System: ❑ New K Upgrade Address: ABSORPTION FIELD Phone: N6. of Bedrooms: ❑ Deep Trench X Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/S . F J <L� Lot: �j p Block: !� Subdivision: v2_1 e –1 y-� (�i / ( Depth to pipe bottom from ori anal grade: Z ' � Ft. Gravel depth beneath ipe Ft. Township: Range: Section: Fill added above original grade:^ Gravel length: r Ft. Ft. WELL: ❑ New ❑ Upgrade Gravel width: / Number of lines: Distance between lines: Ft. I Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pi e m errii-al:)�( Ft. Ft. zz SQ. Ft. Driller: Date Drilled: Static Water Level: in Iter: �'+ r % ql (�aV Date installed: p Ft. -Ri� Yield: Pump Set at: Casing Height Above Ground: y TAN K GPM Ft. Ft. SEPARATION DISTANCES 1 ❑ Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: �— Capacity in gallons: From Tank Field Station Tank Sewer Lines Wein JQ /,// (� Material: Number of Compartments: Surface LIFT STATION Water Gv Lot�© Size in gallons: _ Manufacturer: Line Foundation "Pump on" level at: _ "Pump evel at: High water alarm at: Curtain � / Pump Make 8 Model Electrical Inspections performed by: Drain / V Remarks: 5f 251 5h(i )[©co f- rCP-) BENCH MARK Location and Description: r r (a�c(11 Vr V7 �'� i Go G •Oo%' AEv� USS 1121, �/ � � �( ��� • w � Assumed Elevation: � ! ENGINEER'S SEAL r�P�r Ce L) 1/12 �s .,:�. R', rj it 7� Inspections performed by Dates: 1st- 2nd—Jw Department of Health and Human Services approval ) Oil Reviewed and approved by: ZIL da Date: x-22- .. 72-013 (Rev. 9/91) MOA 25 SW980349 LOT 2B, BLK 4, MANN SURD. LOT 2n eo`o'a 300.00 feet ox AT 5' x 25' Wide Drainfield Effective Depth) \ Septic tic Cleanoats w •.J P (•1 N UU a v N r 3y� IJ h r /< -Well 300.00 feet 27000'0" SEPTIC ADDITION, AS BUILT PLAN -- — ----- -- "[• Yf J, a JAMES SIZEMORE & ASSOCIATES CIVIL ENGINEERS & SURVEYORS P,9. z 0 P 3 i "[• Yf J, a JAMES SIZEMORE & ASSOCIATES CIVIL ENGINEERS & SURVEYORS P,9. z 0 P 3 Permit No. S �� �✓G% 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: Z -p— �- 2-k3i �3Ll�c 4- Ma NN 5�)6 PID No.: 72-013 A (Rev. 9/91) MOA 25 -h o. c c� i cl4 6 D IL 0 D , -Z v ✓ojld L -t- grain/'?` C 1, C7 �1t �o �6 995 o� r<< 1 _ [� b,r �;'15ft Eft'LlEAL ar` � )�� "bd �•1 s , Z410F, r 'j a ear i yJi - , „ aongco a f; 1Q C UU In' q C E) � n .iq c� �. -1 :f,:1111 ft • ham' ,1 it � (i � •9 �� �� 72-013 A (Rev. 9/91) MOA 25 -h MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 11, 1998 Expiration Date: Sep 11, 1999 Permit Number: SW980349 Parcel ID: 020-041-11 Legal Description: MANN BLK 4 LT 2B Design Engineer: 0027 James Sizemore & Associates Site Address: 016235 ELIZABETH ST Owner Name: John Jewell Lot Size: 45000 SQ. FT. Owner Address: 16235 Elizabeth Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99516-5049 This permit is for the construction of: ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Z— Issued By: (/(>���L� 1 / /l/u� V Date: / (/ l LOT 2B, Blk. 4, N ANN SUBDIVISION Scope of Work An addition shall be made to the existing Drainfield on this lot to bring the absorption area of the existing field up to at least 340 sq. ft. This will require the addition of a standard section of Wide Drainfield built to current Municipality of Anchorage Specifications. The addition shall be constructed in the location shown on the Site Plan, and shall be 5'x 25' with a 1' layer of sewer rock. The bottom of the trench shall be level, approximately 4 ft. below grade. Bottom elevation will be estabnlished by tying into existing drain line, and sloping the 4 in. pipe approximately 1/8" per foot to the new drainfield addition. The new drainfield addition shall be outside the 100 ft. well radius. GREA r .;R ANCHORAGE AREA BOR(_ JGH � 7 Jir ; Department of Environmental Quality =' 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME— �w14141"JA�(.:dtYMAILING ADDRESS 7A9 I/ 41�1, y+y PHONE V LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE ��__// tV �//�/� _ /r/� NUMBER OF / / FROM WELLS MANUFACTURER MATERIAL—COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH //,, LIQUID CAPACITY IX�~`GALLONS. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELLAL l f_q FOUNDATION _f NEAREST LOT LINE—M t OFLIN S7N S f TRENCH WIDTH �� IN. TOTAL EFFECTIVE NUMBER OF LINEDISTANCE BETWEEN LINES �`5 :33— ABSORPTION ARE SQ. SQ. FT. LENGTH OF EACH LINE _ 'J / DEPTH OF FILTER GRADEMATERIAL BENEATTILEAy� IN. ABOVE TILE DEPTH: TOP OF TILE TO _i!�_IN. �FINISH WELL: '•` i,t`:r".::= TYPE �j�� CONSTRUCTION' ��. DEPTH DISTANCE FROM: BUILDING NEAREST r NEAREST SEPTIC SEEPAGE Q PLOT LINE /6 SEWER LINE ,TANK V SYSTEM �� r FOUNDATION ,r, CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS —. DISTANCES INSTALLED BY: _J1�W /' r SEWER LINE DEPTH: "4 PIPE MATERIAL LOT SLOPE: u✓ �i REMARKS: Form EQ -032 DIAGRAM OF SYSTEM !0' DATE // y 7'rAPPROVED G.A.A.B. To NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION 4 GREE :R ANCHORAGE= AREA BOF JGH DEPARTMENT OF ENVIRONMENTAL QUALITY`" 30 "C" ST ET ANCHORAGE, ALASKA 99503 tdd�TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERM INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED MAILING ADDRESS Zgf' •' `i- PHONE FINANCED THROUGH - TO BE INSTALLED BY - SOIL TEST RESULTS COMPLETION DATE ANTICIPATED THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE MINIMUM DISTANCES, REQUIREMENT S FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD /V SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK. SEEPAGE PIT , DRAIN FIELD / TO NEAREST LOT LINE.. WELL TO SEPTIC TAN /�5�,�/V SEEPAGE PIT DRAIN FIELD _s��/ ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK,I—a SEEPAGE PIT DRAIN FIELD L� TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION B FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. 7 � (i c., �/�eyj -eel GRAVEL BACKFILL 2 /C� Gjra1)�e / CONFORM TO BOROUGH REGULATIONS REGARDING INSTA ATION. V i OR LICENSED DESIGNER S SIZE r I )A,1tf�-) t,'L4/4 w I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE REA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATEM I " APPLICANT'S SIGNATURE FOR NO� '016 r i / I ■ w woY i I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE REA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATEM I " APPLICANT'S SIGNATURE FOR NO� '016 M -W DRILLING, Inc. P. O. Box 4-1224 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Use of Well Location (address of: Township, Range, Section, if known; or distance main road Size of casing Depth of Hole L feet Cased to feet Static water level ft. (above) (below) land surface. Finish of well (check one) open end Screen Perforated Describe screen or perforation Well pumping test at gallons per (hour) (minute) for hours with ft. of drawdown from static level. Date of completion Depth in feet from ground surface TO 0 —T TO TO TO 7 C!, TO TO TO TO TO TO TO TO TO • V/ MIVIVA Certified Contractor Certificate No's. 814 &- 973 2 — STATE 2 AN(MOR GE ealRBaNhs CONS UL-rAN`rS, INC. Jl NEAU 249 EAST 51ST AVENUE - P. O. BOX 6087 • ANCHORAGE, ALASKA 99503 • TELEPHONE 907-279-0483 • TELEX 090-35419 August 14, 1975 Jerry Bloomfield 724 West 45th Avenue Anchorage, Alaska RE: Test Hole and Soil Log Report for Sanitary System Lot 2B Block 4, Marin Subdivision Dear Mr. Jerry Bloomfield: R & M No. 562088 We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This inves- tigation was performed in accordance with your request of 8-7-75, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environ- mental Quality. A single test hole was put down within the Lot 2B area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 8.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was encountered in the test hole at a depth of 7.0 feet. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. Jam;W. Rooney) Vice President JWR/WED/ja xc: GAAB :?P7 5 7.0' T.H.-1 8-7-75 0.0' ORGANICS SANDY GRAVES, •G� • TRACE SILT (G; 8.0' T. D. J,J�ZAll , X r, _ -� Log represents Lot 2B Block4 Mann Subdivisi.on R Engineering & Geological Consultants Inc. JERRY BLOOMFIELD PROPERTY ANCHORAGE FAIRBANKS ALASKA JUNEAU Log of Test Hole lL Anchorage, Alaska oArE 8-14-75 SCALE IIf=3' OWN BY WED CHKO BY ;y D PROJ. NO.562088 DWG NO. A-01 =m 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 DWELLINGParcel I.D. #C) _ LLA\ — \ \ HAA # _ ODA% (� , 1. GENERAL INFORMATION / Complete legal description �� 5L - IKcW 0 2. 3. U Location (site address or directions) %& Z13,15 J ( Property owner /�1�iln5•.l�hii JGV_fic // Day phone Mailing address /� 2 JJ Cl `-'2"wG"7C-I? `� lc-' Lending agency Day phone Mailing address _ Agent Day phone Address Unless otherwise requested, HAA will be held for pickup NUMBER OF BEDROOMS: �y 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 MOAN21 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 furtherverify 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. w aed J j 2� 1�2u�' C ,4 5e�C_' Name of Firm Phone 54-f Address Engineer's signature 6. DHHS SIGNATURE M Approved for E60 R bedrooms. Disapproved. Conditional approval for Additional Comments %RTIC Date B`—mac 2t� �y ra riw §his ��"0 s .7 t C ty bedrooms, with the following stipulations: Date q R 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 orderto 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. 72-025 (Rev. 1191) Back MOA M21 Municipality of Anchorage AUG 3 1 1998 / DEPARTMENT OF HEALTH & HUMAN SERVIGE£aiciPAUTY or ANCHOR Environmental Services Division "'1�NMrW sFrviCes nt 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L 2d � Ma�'If% 5 qk�� Parcel I.D.: A. WELL DATA Well type 12P dya % If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _ Y Date completed ,p ( ! Total depth r �% , Cased to 13"AI _ ? Casing height (above ground) Sanitary seal (Y/N) FROM WELL LOG Date of test A)y o ° .Z Static water level Z Well production _ g.p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) AT INSPECTION i —/� 9— p.m- Coliform /(U _rte G� Nitrate 0 ` e 0 7 Other bacteria _ Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA J Date installed %J Tank size 2 �� Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) _ Depression (Y/N) / V High water alarm (Y/N) Date of Pum in 1 q 6t, p 9 !1L_ Pumper C. ABSORPTION FIELD DATA c Q Date installedf V* J Soil rating (g.p.d./ftz or ft2/bdrm) CJ J 7`System type Length / 7* Width _ Gravel thickness below pipe Total depth 4' 62 Effective absorption area Monitoring Tube present (YM) Depression over field (Y/N) Date of adequacy test esults (Pass/Fail) Pa 5 ✓ For _ 4- bedrooms i Fluid depth in absorption field before test (in.); 1: Immediately after al. water added (in.):2-,_ Fluid depth (ins) Minutes later: 2A O Absorption rate = c.p.d. Peroxide treatment (past 12 months) (Y/N) / `� _ if yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES "Pump on” level at* *Datum "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 8 1 On adjacent lots Absorption field on lot } q1 On adjacent lots I OIC / Public sewer main Vv A Public sewer manhole/cleanout IV 14 Sewer /septic service line � U Lift station A SEPARATION DISTANCES FROM SEPTIC/HOLDING/TANK ON LOTTO: Foundation Property line CP J Absorption field Water main/service line � 5 Surface water/drainage © Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property lineBuilding foundation / C?N Water main/service line r• r Surface water Curtain drain 75 F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area `(62 Wells on adjacent lots I certify that i have determined thru field inspections and review of Municipal records that tfj� move„systems are in conformance withMOA g lies in effect on this date. 1 .y Signature61 Engineer's Name Jam�� 4 = V Date ' HAA Fee $� Date of Payment' Receipt Number. 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE A��A 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 Parcel I.D. # C: aL � "�'�Ll l - 1 \ HAA # 1-, f �\ C h L,—a" �) h. GENERAL INFORMATION Complete legal description Location (site address or directions) 16, a-555-) "E Property owner,4Vb/'_) Z C/_ -- V -V Day phone Mailing address �l�Z(�� Lending agency c_ C4 Y- ��/�' Day phone Mailing address J Agent �;' C'j^4/�'2 Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X, 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: 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 021 LZk VOW HOQB Il6/l 'ABU)990-ZL •Naom saaauibua leuoissajoid aq, ui suoissiwo ao saoaaa aoj opsuodsaa jou si aBeaogouV jo Al!Iedmiunn aql •ponssi si aleoilpoo e aaojaq elep az(leue ao suoiloodsui jonpuoo lou op SHHa 10 sa9Aojdw3 •sluawEwnbaa @leis pue leaapa; uieliao Alsiles of aapao ui suoiln1pui 5uipuel magi pue sawoq jo saasegoand of Asaunoo e se sigl saop SHH4 eql •uNSejV to alelS aql ui paaaasl5aa aaauibue leuolssa}oad luapuadapui ue Aq anoge g gdea6eaed ui uani8 suolleluasaidw agl uodn Aluo paseq soleoililJaC) JenoaddV (luoglnV glleaH sanssi (SHHa) saOinaaS uewnH pue gMeaH;o luawpedaQ abeaogouV to AlijedioiunW aql Lire] :suoilelndl}s buiMollol oql gllM 'swooapaq area m m sjuawwo0 leuoijippy ao;. lenoidde leuoljlpuo0 panoaddesla -swooapeq / JOI panoaddy �J 3unlVNJIS SHHa '9 ain}eubis s,a9aui5u3 v S� auogd? C �� waif 10 aweN •uoijoadsui siq; jo alep aql UO ;09119 ui suol�ejnbaa pue 'saoueulpao 'sapoo ajejS pue lediolunVN Ile pm aoueildwoo ul si walsAs jesodslp aa}eMalseM ao/pue Alddns JOIpm ells-uo aq; 'uolloadsui pue uoile61169nui ALU woal pue saIij 96ea0gouy 10 llijediolunW aqj woal pouielgo uolluwao;ui eqj uo paseq jegj /\jiaanaagjjnj I •uiaaaq paleoipui aanlonaisto odAl pue swooapeq jo aagwnu aqj Aol a;enbope pue leuoi}ounj'apes si walsAs Iesodsip aaleMaIseM ao/pue Alddne aaleM alis-uo aql legj smogs uolleoildde lenoaddy Allaoglny glleaH slgl Jo uoile6iIsanui Aw legl A;uan I 'MoIaq uMogs alep u011ep11en aql 10 se pue olaaaq paxl;}e leas Aw Aq pailpiao sy 833NION3 AS N01103dSNl d0 1N3W31VIS 'S •.� Municipality of Anchorage Department of Health & Human Services + HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Z-2 t3 151- Parcel I.D. A. WELL DATA ,( Well type VI VJ / e A, 13, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 7� _ Driller '! Total depth % / �% Cased to 7 � % Casing height- Sanitary eight Sanitary seal (Y/N) _ Wires properly protected (Y/N) _ FROM WELL LOG Date of test Static water level Well flow Pump level AT INSPECTIONUNICIPALITY OF ANCHORAGE �Eh�IRONMENTAL SERVICES DIVISION �-- CCS AI' a 1 1992 g.p.m. J RmE I V E D SEPARATION DISTANCES FROM WELL TO- Septic/holding tank on lot J On adjacent lots _l0C-) Absorption field on lotj �} ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank /VC) WATER SAMPLE RESULTS: / 3 Coliform 7 Nitrate r Other bacteria Date of sample: Collected by: L©� ��oF M �C ro «he �i le s B. SEPTIC/HOLDING TANKDATAC / 1 Date installed ✓�' u � � J Tank size � Z' � Compartments / Cleanouts (Y/N) �_ Fo ndation cleanout (Y/N) � Depression (Y/N) /'� / High water alarm (Y/N) IvA,_ Alarm tested (Y/N) — Date of pumping Z_ — 7_ Pumper SEPARATION DISTANCES FPrQM SEPTIC/HOLDING TANK TO: Well(s) on lot 0 �/ On adjacent lots _ Foundation Jr / To property line Ca Absorprticm-field `� Water main/service line Surface wate /drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (YIN) "Pump High water alarm level Manufacturer Manhole/Access (YIN) "Pump off" level at Cycles tested Meets MOAelectrical es (YIN) SEPARATI DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA �l Date installed l /J oil rating D /(� stem type 5WIOZe Length L� Width Gravel thickness Total depth 7- Total absorption area Ko 4P ! Cleanouts present (YIN) Depression over field (YIN) A) Date of adequacy test Results (pass/fail) �� C5 for W-1 Peroxide treatment (past 12 months) (YIN) /V0�E/1- cice) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / �� ) / , Well on lot 1 y On adjacent lots �� / Property line To building foundation To existing or abandoned system on loth On adjacent lots - Cutbank i Water main/service line Surface water G 5 Driveway, parking/vehicle storage area l Curtain drain `V � /Ty C�uf� 69 /o 4 <7 e w� c ac of a(/1E. ENGINEER'S CERTIFICATION bedrooms I certify that 1 have checked, verified, or conformed to all MOA and NAA guidelines in effect on -the. -.date of this inspection. �.y� �� !�" 4 Signatur Engine 'sName��a� ull Oi. /J Date � � L GU HAA Fee $ Z_L0 � Date of Payment Receipt Number a� �/ ��� Gcy� 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee Date of Payment Receipt Number ,- Municipality ®f Anchorage, �_- Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 29, 1992 James Sizemore, P. E. James Sizemore & Associates 6410 Switzerland Drive Anchorage, Alaska 99516 Subject: Waiver Request for Lot 2B Block 4 Mann Subdivision Waiver Request #WR92004�, PID #020-041-11, HA920235 t-1 �- Dear Mr. Sizemore: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are from a private well to the spetic tank - 83 feet; from a private well to the leachfield - 89 feet; and from the septic system to surface water - 50 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, &ww , ✓r� Daniel J. Roth Civil Engineer On-site Services ljm:#6 Concur: Sm' h, P.E: Zohn rogram Manager On-site Services MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR920042 PID# 020-041-11 HA# HA920235 Permit Date Received: July 30, 1992 Legal Description: Lot 2B Block 4 Mann Subdivision Engineer: James Sizemore, P. E. 6410 Switzerland Drive, Anchorage, Alsaka 99516 Applicant: John F. Jewell Waiver Requested: Private well to septic tank - 83 feet; well to leachfield - 89 feet S u RfncE G_etrFk SO ifrT Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: *ire«r• Waiver is Granted: X— Waiver is NOT Granted: List Conditions or Reasons for above: SEF ,tj']/%_hQ-hFO. Date: y -?ice 92 By !/ ame o eviewer Rec #: #23900/3285 Amount: $ 590.00 Date Paid: 7-30-92 +- k/f1/j/ER l4EG'UESrFOI? 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C, IF, D SO/L. 5at? 6TloN 5014, 5 ysrcr+ regwpRork a 61?'Nvf-1 sdM� seer 2. r /I-3' 4-6'o yr �- At 7- %{ rl}QL E G R 6 tQ/ CAI r N 0!0 2 ON 7-1 L S Pa R /9 1 io,v 5'3 '/— l /?Awv ro riktL /3. % C a Argy L usl o 1v i=V cti 7-Kv4 61.1 rkeE Pp/ArTs AIDC ,rNojqr (7,Or /&/ iKF, kVOwN SCOPF OF 9E,PROC/' IS ;IIMINW Paw,vL /IgRp j=1 oma+ i, f_ c c rd p/I61dvf1tl-D, R c L l r f- M5 rre q6 9,v /u PL i9Cp_ s/.&« 971 w /Tk ,v a cc.v7'1*mI&&rt 0A) fl? F-5tN,- /ti wF�c James Sizemore & Associates Civil Engineers & Surveyors 6410 Switzerland Drive Anchorage, AK 99516 (907) 345-1572 2.3 September, 1992 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Ak. 99519 Attn. Mr. Dan Roth, Civil Engineer. Re: waiver Request for Lot 7.B Block 4, Mann Subd., Waiver Request Number lr?R920042, H.A.A. Number HA920235, P.I.D. 020-0410-11 Dear_ Mr. Roth: On Sept. 16 th, 1992 Mr. Jewell hired Alpine drillinc; to drill a test hole in an area adjacent to the leach field that I had indicated to Mr. Jewell as being an acceptable location for checking the depth of ground water. A 4 inch diameter hole was drilled to a depth of 11 ft. with a rotary air drill. An 1 1/2 inch diameter monitoring tube, with the bottom 3 ft. being perforated, was placed in the hole. The hole was dry on Sept 17, Sept. 21, and Sept. 7.2 when I checked for ground water. I talked with the driller, Mr. Dave Harper of Alpine drilling and he assured me the hole did not end in bedrock and that he was in a gravelly material when he stopped drilling at a depth of 11 ft. below the surface. It would appear that cond.ditions have been verified, as requested in your September 10, 1992 letter, that will allow the Municipality to grant this waiver request. Sincerely c ��$ James F. Sizemore P. E. .4 ®� PIPQQ{ �^p �° o°©U °V0®°soap "Q�ga}SiY C" ey ✓� €�/ a v vC o°1 �bA7,"_� J -?, ///� /moo •� �tl U9 pOwsn V" -",-Y i James F. Sizemore . W W 'o° #1517[ c O•0 9F 009AW a Vpjo N� �'ROFESSI�t Municipality of Anchorage � AHI � rAiS` Department of Health and Human Services dhr15 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 September 10, 1992 James Sizemore, P.E. James Sizemore & Associates 6410 Switzerland Drive Anchorage, Alaska 99516 Re: Waiver Request For Lot 2B Block 4 Mann Subdivision, Waiver Request Number WR920042, H.A.A. Number HA920235, P.I.D. 020-041-11 Dear Mr. Sizemore: Recent review of the file for the subject lot indicates that the absorption field serving the dwelling may potentially be encroaching on bedrock and/or groundwater. A test must be performed adjacent to the wastewater disposal system to verify that neither bedrock or groundwater encroach on the bottom of the system prior to issuance of your waiver request and H.A.A. This test should be performed to a minimum depth of 10.5 feet to verify no bedrock and monitored 7 days for groundwater. If you have any questions, please call me at 343-4329. Sincerely, ;, Daniel J. Roth Civil Engineer On -Site Services cc: John Smith, P.E., Program Manager, On -Site Services OSS156 James Sizemore & Associates Civil Engineers & Surveyors 6410 Switzerland Drive Anchorage, AK 99516 (907) 345-1572 31 August 1992 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage Ak. 99519 Attn: Mr. Dan Roth Subject: Additional Information for Waiver Request for Septic System located on L2B, Bk. 4, Mann Subcivision. Dear Mr. Roth: As discussed with you on Friday morning, Aug. 28th., I have collected additional information to support the waiver request on the subject lot. The following information is presented: 1) A Plot Plan of the lot indicating the general slope of the lot and location of the well, septic tank, leach field, & small water pond. 2) I searched through the microfilm files in your office and obtained copies of well log and soil test data that was available. Well Logs for the following are furnished: Lot 2AB4, Lot 1AB4, Lot 1BB4, Lot 4BB4, Lot 4BB3. No house is built on Lot 3A adjjacent to this lot to the South. There are also no houses on Lots 1A, 1B, and 4AB3 located across Elizabeth Street to the West of this Lot. A Request of the 100 ft. separation between the setic tank and leach fiel and the small pond is also made. The slope of the lot is such that any overflow of the septic tank or the leach field would run down hill and away from the pond. Sincerely yo ?JamsF. Sizemore P. E. James Sizemore & Associates Civil Engineers & Surveyors 6410 Switzerland Drive Anchorage, AK 99516 (907) 345-1572 24 July 1992 Gentlemen: I am requesting a waiver of the 100 ft. separation between the well & leach field and well and septic tank. The surface water that was incicated in my HAA test is a small pond on the property, & the surface level of the water is actually the same level as ground water table on the lot. This lot contains 45,000 square feet, and slopes from Fast to West. The well is located upslope of Septic Tank & Leach Field, and therefore surface pollution around the well due to a system problem is eliminated. The surrounding lots are also large, and the area is zoned for single family dwellings. Using the State of Alaska Guidelines for Separation Distance Waivers, I obtained a total point value of 14.0. I feel that granting of the waiver is justified for this lot, since the owner, Mr. John Jewell has lived in the home for over 12 years with no pollutin problems with the well. Looking thru the P40A files for homes on surrounding lots & in the general vicinity, I found no indication of polluted wells. To clarify the intent of this request, I don't feel there will be any adverse affect from granting this waiver. I am available to answer any questions that you or your staff may have concerning this request. Sincerely ours James F. Sizemore P.E. U Z Municipality of Anchorage f_ 3 Department of Health & Human Servvices r)r� z EZ Division of Environmental Services Pii N On -Site Services Sectionm o P.O. Box 196650 Anch. Ak. 99519 < 75 Z M CO h3 nn N (l Attn: Mr. John Smith 0 v Subject: Waiver Request of 100 ft. Separation between Well & o M m Septic Tank & Leach Field for system located on L2R, RK 4, Diann Subd. Gentlemen: I am requesting a waiver of the 100 ft. separation between the well & leach field and well and septic tank. The surface water that was incicated in my HAA test is a small pond on the property, & the surface level of the water is actually the same level as ground water table on the lot. This lot contains 45,000 square feet, and slopes from Fast to West. The well is located upslope of Septic Tank & Leach Field, and therefore surface pollution around the well due to a system problem is eliminated. The surrounding lots are also large, and the area is zoned for single family dwellings. Using the State of Alaska Guidelines for Separation Distance Waivers, I obtained a total point value of 14.0. I feel that granting of the waiver is justified for this lot, since the owner, Mr. John Jewell has lived in the home for over 12 years with no pollutin problems with the well. Looking thru the P40A files for homes on surrounding lots & in the general vicinity, I found no indication of polluted wells. To clarify the intent of this request, I don't feel there will be any adverse affect from granting this waiver. I am available to answer any questions that you or your staff may have concerning this request. Sincerely ours James F. Sizemore P.E. M F b NI LLI W W LLI W �. kn N N N coo fV Pqq �veie5 e+e+w 0 f�4 l 21 _ l cr y `7r geg i L � f�O)cy '1� r W. VI s�t-14 N I Fbo f Firi�9e nl Qv.�kti.wct � g�, EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON, V0RT'3A-7F TNSP�CTION • LOT SURVEY CERTIE CATION LOT 2B BLOCK 4._. SUD)J-(L rr0t" ANCHORAGE RECORDING DISTRICT ,.REPARED BY: DOWLING 8 ARSMATES In, W e- cr s� ori, ee "% to 3A ��E• 9# �.q(,q 90 i * `49 xa • , °a !•nQQQNMe•4•v es •H.•• eve•, 0 9n , James Karl Dowling 564-SA, 64-S �1��� P•rs v• vu.••✓��p SJQy I, ROFESSIONA� �P LEGEND: ®o.w�e..�v�•s ® BRASS CAP MONUMENT 0 IRON PIPE 0 STEEL PIN 13 SURVEY HUS 4 TACK I 04 #'�ST 15th Ave. Residence o0: AN�RiAGE, ALASKA 99501 %)4TE• larch 2') 107J • h I � I Diary I GRID: 323! t-Ap- g14PGO7c% s MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. O • '-AL-11-1 Pr - - 825 L Street - Anchorage, Alaska 99501 ENVIRONh– NTl;L • --1,-CTION - ENVIRONMENTAL ENGINEERING DIVISION APR i,)iq Telephone 264-4720 - REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW f.6EI1VIE'0 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNE I PHONE MAI NG Ap Ri SS – PROPERTY RESIDENT (If different from,aboove/ - - _ - PHONE ❑ Two ❑ Five 2. BUYER- - - - - - - - - PROS— �/- - - - - - - - - MAILING ADDRESS/ Q ` _ 3. LENDING IN TITUTIO PRIONE MAI LIN15 ADDRES since June 1975. For wells drilled prior to that date, give well 4. REAAITOFffAGEN - - s PHONE �7 MAII/LING ADDRE 5 41 5. LEGALL PESCRIPTION�`� STRE T OCA , � q ^i? W"�l 6. 'TYPE OF RESIDENCE P NUMBER OF BEDROOMS SINGLE FAMILY- ❑ One W Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY - - - - - - - - - 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 UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM 1 INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date--�— If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY - INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE - DATE DATE INSPECTOR INSPECTOR INSPECTOR - DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE El PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER El Septic Tank or ❑ Holding Tank Size: / D-S"� If Tank is homemade give dimensions: SOILS RATING c,A TYPE OF TAN<. MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank bsorption Area 7 Sewer Line - Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR �' BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE- BY (Title LEGAL DESCRIPTION 72-010 (Rev. 3/78) F `4:,� l ocation: ?Near 152nd Avenue & Birch Road ` Sing1e Famil 5 Type facility to be - y No bedrooms of Jnspected .of S-_ r�tl' A 3 Y{ +•i Y »�c Al 5 i -. . -, ` `,��i 6 ' Well D4'ta ,° ' , - ridividual - � p g .. I� , vt--3i ,Aa tint iE h ( a r i� -e i 71 y; ;All_ Ype B. Depth qilly ill C: "Construction'.U.f!fRJ'v`~<• D. Bacterial -Analysis s s system d e s ! I 7 Sewage Disposal System: 0n7 site7 AtInstalled B Installer; C. Septic Tank:1 „, Size 2. Manufacturer D Seepage Pitt 1: Absorption Area 2. Mater'al E.Field: Total length of.lines B Distances: A -W 11 to.' Septic tank Absorption area ii-_ Sewer Lines , Nearest lot 17ne " contamination ,.Other B. Foundation..to septic tank , Absorption area. _._ C. Absorption area to nearest 1ot'line _:. EQ -034 (1/74) Page'1 of two pages Page 2 of two pages - Rei st for Approval of Individual er & Water Facilities Legal Description Lot 2-B Block 4 Mann Subdivision Comments�yyt.6•�— Approved Disapproved �(— =4!�V Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 certify that the information contained in this request for approval to be a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date