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MCKINLEY HEIGHTS #2 BLK 2 LT 1
Mckinley Heights #2 Block 2 Lot 1 #051-251-69 Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211138 PID Number: 051-251-69 Dwelling: K Single Family (SF) R with ADU El Duplex (D) El Two Single Family Project: El New RE Upgrade Name Steve and Catherine Ellis ABSORPTION FIELD Rfbw,�Trench [:1 Wide Trench 171 Bed F-I Mound Site Address 17926 Hollow St Chugiak �E] Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 QD IS F: Ft, LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Subdivision Block Lot McKINLEY HEIGHTS #2 21 Pt� Ft, Fill added above original grade G h �" v� Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Dista a between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist, between ti�e hes From Tank Field Tank Tank L�ii n e Ft2 Well 96' >1 00' NA N' A TANK H Septic El S.T.E.P. [I H Iding El Other Manufacturer Capacity Surface Water >1 00' >100' NA NA greer 1250 Gal, Material Number of compartments Lot Line >10 NA NA NA plastic 2 Foundation & >10' NA NA ,W-T__STATION Manufacture � �.�� Capacity I I Remarks 2" insulation overta tank Gal. Alarm location :Electric i)led by Installer Tank to PIPE House drainfield 3034 JRs Septic Drainfield C01MT3034 Inspector Curtis Townsend BENCH MARK (Assumed "elevation) 100 ft Inspdatesection 15, 8/7/2021 2nd 10/23/2021 : Location and description 3,d 4'h_- 1h BOTTOM SIDING POINT B ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date w Pud .. ... .......... ..IV, ..curds , send R No. E01 90-1 Se System p Approved 1(� Date Note: this approval does not include well permit requirements. Pa%, r)Rtn,)Ii Q\ CANYON DR F-ILLJrv r \o o-I- SLOPE 6% It NEW SEPTIC TANK LOT 2 IS VACANT LAND, NO WELL OR SEPTIC . t- --{ N) o\s =- ar\\ .Aw\NV ehu THERE ARE NO STEEP SLOPES WITHIN 50' OF THE PROPOSED TANK. SCOPE OF WORK1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,250 GALLON TWO-COMPARTMENT SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEM. NEW TANK IS 5' AWAY FROM EXISTING FIELD. DECK SUPPORTS ARE STTEL PILINGS WHOSE BOTTOM IS BELOW THE BOTTOM OF THE SEPTIC TANK. TANK WAS PROVIDED WITH A MINIMUM 20,, DIA RISER SERVING THE FIRST COMPARTMENT. DOUBLE CLEANOUTS WERE PROVIDED UPSTREAM AND DOWNSTREAM OF THE TANK. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREIVENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. IXISTING 50' x 36" x 48" EFFECTIVE DEPTH TRENCH Septic Record Drowing Prepored for STEVEN & CATHERINE ELLIS 17926 Hollow St Chugiak, Alaska 99567 McKINLEY HEIGHTS #2 BLOCK 2LOT 1 osP21 1 1 38 EKLUTNA INGINIIR/NG, LLC 19162 N/OUNTAIN ROAD CIUGIAK, ALASKA 99567 (e07) 406- 1 058 DATE: 11412022 DRAWN: CLT SCALE: 1" = 40' PID: 051-251-69 SHEET 2 OF 3 l.EXISTING SEPTIC TANK IS 8' FROM FOUNDATION. NEW SEPTIC TANK WAS PLACED AT SAME ELEVATION AS EXISTING. IT DOES NOT PENETRATE THE FOUNDATION PRISM. DOUBLE CLEANOUTS WERE PROVIDED UPSTREAM AND DOWNSTREAM OF THE SEPTIC TANK. TANK lS A MlNlt'/UM OF 5' AWAY FROM END OF EXISTING SEPTIC FIELD. 2" RIGID INSULATION PROVIDED OVER TANK. 2. 3 4. z.z tn LlrN J-O> O>u)a EXISTING FITLD (J t7-I =: :<z=s:o EXISTING TFFTCTIVE DEPTH TRENCH NEW 1,250 G PLASTIC TANK MARK A B DCOI 9'-6"9'-6" STI I t'-o"10'-t 1" ST2 t5'-l t5'-5" DCO2 t6'-6"t6'-t t " Record Drowing Prepcred for STEVEN & CATHERINE ELLIS 17926 Hollow St Chugiak, Alaska 99567 McKINLEY HEIGHTS #2 BLOCK 2LOT 1 osP211138 EKLUTNA ING/NEIR/NG, LLC 19162 MOUNTAN ROAD CHUGIAK, ALASKA 99567(e07) 406- I ose DATE: 11412022 DRAWN: CLT SCALE: 1" = 8' PID: 051-25169 SHEET 3 OF 3 FILE NAMESHEET NUMBERSURVEY DATESTAMP:SCALECOMPANYNMICHAEL KELLER MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 1 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211138 Work Type: SepticTank Upgrade Tax Code Number: 05125169000 Site Legal Address: MCKINLEY HEIGHTS #2 BLK 2 LT 1 G:0957 Site Mailing Address: 17926 HOLLOW ST, Chugiak Owner: ELLIS STEVEN M & CATHERINE H Design Engineer: EKLUTNA ENGINEERING, LLC" This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: n,ent S �o C llepartment 5/13/2021 5/13/2022 53400 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 4 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 Aril 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 Special Provisions: Per engineer's site plan note, deck supports shall be modified to be a minimum of 5 ft from the tank if tank cannot be located 5 ft away. Received B) Issued By: / Date: 3/z=' Z Date: 5 13 b42 P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section �»cnt S c n n �t111 >r' Department * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: WR920059 COSA#: Permit#:OSP211138 PID#: 051-251-69 Legal Description: McKinley Heights #2 Block 2 Lot 1 Engineer: Eklutna Engineering Applicant: Steven & Catherine Ellis Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 96.0 feet. See engineer's waiver request for justifications. This is a re -issuance of an existing waiver originally issued in 1992. This waiver approval applies to the proposed septic tank only. Any fixture 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: 11120:2 Approved by: ! 31/ eCOL du Name of Reviewer ...................................................... a N N K M N .................. 1 **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE �� Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section -� Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-251-69 Property owner(s) STEVEN & CATHERINE ELLIS Mailing address PO Box 671252 Chugiak Site address 17926 Hollow St Chugiak AK 99567 Day phone Legal description (Sub'd., Block & Lot) MCKINLEY HEIGHTS #2 BILK Legal description (Township, Range & Section) Lot Size 53,400 Sq. Ft. Number of Bedrooms 4 2 LT 1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo AD U) Septic Tank 0 Upgrade Q Duplex (D) ElHolding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: septic tank to water well Distance: 96' I certify that the abovgg information is correct. I further certify that this is in accordance with applicable Municipal ,C�pdes. S'/ 7 / Z-0 Z r (Signature of property owner or authorized agent) Permit/Rush Fees: �ov� 5 Waiver Fees: Date of Payment: J /OCA Date of Payment: Receipt Number: d 3 0 Receipt Number: Permit No. o Sp 2111 3 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewaterr\FormsUient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211138, Rebecca Carroll, 05/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211138, Rebecca Carroll, 05/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211138, Rebecca Carroll, 05/13/21 FILE NAMESHEET NUMBERSURVEY DATESTAMP:SCALECOMPANYNMICHAEL KELLER Name: Eklutna Engineering Lab ID#: M210298 Mailing Address: 19162 Mountain Rd Date Sampled: 03/22/2021 Chugiak, AK 99657 Time Sampled: 1900 Legal Description: McKinley Heights #2 Block 2 Lot 1 Sampled By: CLT Date Received: 03/23/2021 Sample Site Location: Downstairs Bathroom Sink Time Received: 1237 Nitrate Parameter Method Result Unit MRL MCL Date Total Nitrate/Nitrite – N TNTplus 835/836 (Hach 10206) 2.92 mg/L 0.200 10.0 03/25/2021 Method Reporting Limit (MRL): the lowest concentration that can be reported reliably Maximum Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA mg/L: milligrams per liter; 1/1000th of a gram µg/L: micrograms per liter; 1/1,000,000th of a gram Absent (A): none of this type of bacteria was detected Present (P): one or more bacterial cells of this type were detected Results Reported By: _____________________________ Patience Lynch Laboratory Analyst Reviewed By: 9131 E Frontage Rd, Ste 15 Palmer, AK 99645 (907)745-3005 matsutestlab.office@gmail.com Signature: Email: Luanne Cross (Mar 29, 2021 14:55 AKDT) Luanne Cross office@matsutestlab.com v MUNICIPALITY OF ANCHORAGE / p DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION I 1,NVIRONMLNI'AL 11\161NIPL;IIING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 '— ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE13NEW ` G ��/\ a ❑ UPGRADE ' { MAILING ADDRESS X"/` ��. .. � r �!'. ��r '•.� >+ / Iia ,::: LEGAL DESCRIPTIONS 4 Lit, - LOCATION (' � 1(L ML O OF BF ROOMS r �s 1IIv l _L �1' jl '> DISTANCETO: WIT I AbsorpS tarea Dwellm r PERttaJ U _ Y MCL /' Material No. nf,,,Fompartmenoi ' f-2 <anufacturer, w� r " w Liq. Ca acit n;y Ions �� IF HOMEMADE: Inside length ._ Width - Liquid depth / ' C Y O DISTANCE TOi Well. Dwelling PERMIT NO. O? Q Manufacturer Material Liquid capec(ty in gallons `:r d w= DISTANCE TO: Well e,, ou �dat n , , ���1 4 i wrest Ig31i '�La w No. f lines Le etch line Tota line Tra v_j 2 (pn th yiyjth Distance between lines' t' (� D inches ...-• 0 h Tpq o Ile to I'' ish ode M t r'I II beneath til Totalf[�e ti absorptierl area V ��'t N Ft t1 J_J !�F % K inches ""'i LU Length Width Depth PERMIT NO. 1� O 4 f Q F Wy Type of crib Crib diameter Crib depth Total effective absorption area cf a tu DISTANCE TO: Well Building foundation „ •, ` . Nearest lot line + J Class - Depth Driller Distance to lot line PERMIT NO. ' DISTANCE TO: Building foundation Sewer line Septic tank .:.... Absorption area(s) �, - .:...• , OTHER r° PI EMAT RIALS /4 /� o� RX 1, �r 's h mrl r °s •,�t`3� L. J V I r :7 ,�� SOIL TEST RATING" 9- INSTALLER REMARKS ,a'+ „yk �,�as r +"d fi r.r.. u r) t f/4 tr{�a .} '&V i /� 011 / l� 1041 ,.., C. i ANS N a. , ;• 3� APPROVED DATE LEGAL CHUGIAK, ALASKA 688-3199 WILL14 'GRILLING COQ'�, WE SERVE ALL ALASKA POST OFFICE BOX 42 - CHUGIAK. ALASKA 99567 OWNER OF LAND .... DOM..Barnrda, . ............................... ............. ADDRESS P...O.....Box-11,41 --- EagJ-e ... Ri-v.er..Ak ...................... m. ........ DATE - STARTED .... DATE - ENDED ........8.T-7:.78.... N'D OF FORMATION: FROM ..........4.......... FT, TO ...... FROM ....... ------- - FT. TO .......2k ........ FT. Ang........................ FROM .......24......... FT. TO .....-4..6......... FT. Hardpan ...... ....... FROM ......-46......... FT. TO ......... 50......... FT. Sand, ... & ..Gray. EAl FROM - ...... 1 0 ....... ? FT, TO .......1.32...... ...... FT, Rack ............... FROM ....1, . ...... _ FT. TO ...... FT, TO ........................ . FROM _.1,33. ......... FT.TO- ..... FR Uvf ----- ................. FT. TO ........................ FROM -191 ......... FT� TO. --1.91-1-. FT . ................. FROM, -.1,91 . ...... FT. TO ...... ..Rook.. .................. FROM ....288.....-,-_1--T. TO ......289...... ..... _lrart . Unecl-Rack FROM ....289......... FT. TO- -Rock ..... FROM...................... FT. TO .... ............... FT MISCL. INFORMATION: KODIAK, ALASKA 486-4826 DEPTH OF WELL ....... STATIC LEVEL OF WATER FT, -2.7jq DRAW DOWN FT . ....... G.P.M. EST. ..................... ...... ....... GALS. PER HR... ... KIND OF CASING .... ... SC ... -. --q FROM....................... FT. TO ....................... FROM....................... FT. TO ........................ FT . .......... FROM- ............. ....... FT. TO ........................ FT........................... FROM ....................... FT, TO FROM....................... FT, TO ........................ FT . ........ FROM.......... ...... FT, TO ........................ FT . .................. FROM. ........... _- FT. TO ........................ FT................................. FR Uvf ----- ................. FT. TO ........................ FT . .................... FROM..... ................. FT. TO ........................ FT . ................. FROM FROM ...... FROM ....... -. FT. TO ........................ FT-- ................ ........... FT. TO ....................... FT. ..................... ............ FT. TO ........ FT. ............... DRILLER'S NAME - .... tTay ... W.jjjj.g;.ng ............................... E.',Av1"PAF-`.THENT 0 HEIFILTI-I AND 825 °L. W,441 F`,. 0. r3,Me", 1.1.41. EFICA11.' 1,"IVER ON RVIUIE'0014 CII`CLE I -J. F,".2 I tILEY FIE I GHT'S *2 F"ET-4, YPF, OF 14"'AY0'. Y511 M f' : TF.EhICH vitIMMUM NUMBER OF BEDROOMIE4 SOIL, RATINCi REQUIRED SI' 1`1' OF THE SOIL ArD'.5.OF*P"1'XON "IF v 0::t=-! THE DXMEN',---XOP-A TFIF.,: LFM1.-iTH r,"04 FEET) OF THE Ol,",' "THE C41"TH OF` F-) 'TF'MNCH Or PIT IS 'THE DY,`3,TF1NC'E oETtkjfz,.,EN THE SURFACL" CiF TI'll.:,," GROUND AND THE BOYTOM OF THE EXCAVA"TION (IN FEET.,). THL"Ri" IS NCI SET WIDTH FOR TF.EN1-1.HES. J+ 1� - I , F.IE �iRAVUI- DEPTI-I MPTH OF- Gf AVEI IU' I THF:' nK'-'" THE BOTTOM OF THE EXCAVATIOV-11 (IN FEET). Frc":: C 0 -fl 1, r-7,21 FE. - q, JC 1- F-1 p -A pf." PERMIT Al"I'OUCIIAN'T H1`,T-"',' THE 'TO INFOF.".11"I TH'IS THE IN!'-'-PE`TfM4S Of--' ANY WELLS ADJACENT TO TH:(S' V"F'0P`--'RTy ANI-) 'THE THAT 'THE WELL MII-L IS-ERVE. 9d > X -1- X �1t"-E. 9-J "o., 01"; 1".- V--., Bk Fl CX F I L I INI'] Ol", rlNY '-'-",'YSTEM WITHOU'r Fut-4A1.. AND Vir"PROVf-11- 11"ily DF--PAR.TVIENT WILL BE SUrBJECT 'To ITCNIMUM DISTF&ICE. U-4ETWrEN A WELL ANU.) ANY 10Fr'l FEET FOR A 1-4-ii.MITE WELLa OF-? To 2((,90 Fr'J.-j' FROVI A PUM-IC WE I-1- f..'1FF*EN1.`,1N(11i UPON THE TYPE OF PUt"I IC 1AILI-L. WELL t-O(V';'- AT -`.E P.F,(-XJIF;'.ED AND MUST BE RETURNED TO THE 1.X--111-*11'T6'lENT 1•aITI-11.1`4 34-1 T;'€ -1Y`-,' CIF WEA -L COMPLETIOP-1 OTHET-11". MAY APPLY. DfAGRf-'1MS iEf t: AViIII-ABLE TO INSURE PROPER INSTALLATION. C" r : fra I RFEE, IFL'�----" Y' CER.TIFY THFIT 1: 1 AM FT)MILIAR WITH THE' REIPUIREVIBITS FOR ON-,-!,-,4'TE AVID FC)RTH C"ily THE, MUNY.C.'IPFILITY OF 2: 1 WILL INOS-�TALL THE SYS'JEM IN ACCOf,!DANCk;.1,41TH 7I-11" XUNDLI Tf5 '� "iMAY REGAJIRE ND 'THAT THE' ON SITE SEkIER *,', -1-JI- -I R E S I C'§ E. NC E" C F".ENODELEP T0-4V-JC'1JJDE1 MORE T1•aAI!4 4 1-3-fik-B-ARF4 F4,`-'RNAR.G, -1PPLICF IF INT DONA U. rAc S C.) SUE Vs. r GEC ECHNOC L & DEVELiPMENT CO. Box 90, Davis St., Eagle {liver, Alaska 99577 694-2774 or 688-2.280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name:' ? < ° Va' Tel . No. Mailing Address:'�?�>�> Legal Descriptions Depth (feet) 0 2 3 4 Soil Gharacterigtics Mer e %' d i/ 14 15 16 Ground Mater Encountered: YL)s � No _ Xf yesp what depth Proposed Installations seepage Pit___ Drain Hold MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 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. # S s /J 6 1 '4 HAA # 1r� 0-CAIn 1. GENERAL INFORMATION Complete legal description Lo.` 1; b.O ock 2; McK..aZey Hetight5 #2 Location (site address or directions) 17926 How ocv Street Chuaiak. AK Property owner J.ir7 lyok'sky Day phone 688-1333 Mailing address P.O.Box 671826 Chugiak, AK 99687 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: n, 3. TYPE OF WATER SUPPLY: 1/1111 Individual well AAA 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: 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 x21 - • 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. Name of Firm s & S ENGINEERING Phone G 9 -7`3 17 034 raglu River L0011 KCad Mm 204 Address Eagle River, Alaska 99577 Z" Engineer's signature ��/� L-�• Date C0: ROBERT C. COWAN /W % CE-8801Ai", \ 6. DHHS SIGNATURE Z Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments auric 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 (Rw. 1/91) Back MOA a21 D.: LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: off' level at* Septic/holding tank on lotlo`� � ,qj> to 2-92 ; On adjacent lots loo`s` w "- tia605-5 Absorption field on lot 1 oa ; On adjacent lots 101:. Public sewer main oto• Public sewer manhole/cleanout Sewer /septic service line Zs 1 Lift station �1y SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S k Property line lei t + Absorption field S Water main/service line lot b- Surface water/drainage l oo t f Wells on adjacent lots 100(+- SEPARATION 00t+- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10 XA- Water main/service line 10 Surface water 100 %'1'- Driveway, parking/vehicle storage area 2S 1 k Curtain drain JIB Wells on adjacent lots 1t>t> tir Property line 10A F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of>Vfunicipal records th ms are in conformance withDLIO�A HAA guidelines in effect on this date. �r'(�„'•,••,,;4(„QS Signature '���G+✓/ ,� ••�''k'9 Engineer's Name R iB4tT C Cow'I.i e n ea` Date 7 ( Pe ROBERT C. COWAN �Q CE - 8801 aw HAA Fee $ 01�n .60 Date of Payment -7-16 _ `6o Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE M E M O R A N D U M WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. 11,4 94 0,&84 During a recent Health Authority Approval on-site inspection and test of the potable water /supply well on Lot Block & of /!%4A/q %�i-yilx Z Subdivision, the well's productivity was Bete mined to be ©.4N gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4— bedroom residence is Q,fr�_ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. S&S HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN nG CLIENT: ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS 07) 694-297 WELL RECOVERY TEST DATA FAX(907)694-1211 WELL LOCATION (legal): TEST DATE: b- 2 I, —9 �• WELL DEPTH: CASING DEPTH: Ar Z TESTED BY: I-Iw,bo. r> WELL DRILLER: zo- \Akw\ i'MS DATE DRILLED: a TEST PROCEDURE: MISC DATA: `,je 1) Draw water down to pump. Casing Height: 12. 2) Shut pump off 15-60 min. Sanitary Seal? >;S Sv�o�S.L -record time Wires in Conduit? S (yot,Z -record meter reading Grading O.K.? N. 6S 3) Turn pump on. Drawdown. Pump Depth: any' 4) Shut pump off. Samples Taken? �fr5 -record time Date: L 27 -9 L OFF -record meter reading 4 5) Calculate gal./min. recovery. (,7.o.`j TEST DATA: START TIME: gi ; c> STATIC WATER LEVEL: 5_2� TRIAL PUMP TIME METER 11GAL.�It. (L 1 OFF a t;0yl,ll 1, S ON Q aJZ v b OFF Lo,y r Sv�o�S.L 2 OFF Q4 (yot,Z ON OFF (a'. 3 OFF ON OFF 4 OFF o'.0 o (,7.o.`j ON OFF ci oS (pXCI.?i 5 OFF t�',oa G2i.Z ON OFF RESULTS: WELL CURRENTLY PRODUCES: FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 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 Parcel I.D. # n�2� -' �!-�`" In�1 HAA # H� `lL°h54 1. GENERAL INFORMATION Complete legal description LOTS'` Location (site address or directions) 1!9Z��-�"`� iA,it—, Property owner Fk�!Nx= Qaz e ' r-- Vim- — Day phone Mailing address Lending agency Day phone Mailing address Agent �czldAx�c �i✓Ciriurs /I ouygc3,! Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well X 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: Individual on-site X 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 #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 regulationyavpji % on thp� ate of this inspection. Name of Firm _ 20210 Donalar St. Phone �6 1249/7 uSta , Alaska 99567 Address C Engineer's signature 6. DHHS SIGNATURE X_ Approved for Disapproved. Conditional approval for bedrooms. Date / aL +qfj� J z • r � .Pp uc d R. Daytca pyo. 2205-C• "130FESS`QN��: bedrooms, with the following stipulations: Additional Comments Date /6 /Z � L_. 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. 72-025(Fev. 1/91) Back MOA #21 Date /6 /Z � L_. 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. 72-025(Fev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: bT L , g Parcel I.D. ma jynawY J - _.T s Z A. WELL DATA Well type ave If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ly Date completed OZ?6 Driller X✓i�� �" Total depth Cased to Casing height Sanitary seal (Y/N) Y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test $ Z%3 Zq2 - Sir uxie.Ajeato*-111 Static water level Well flow g.p.m. 0'7 g.p.m. 6 oa Pump leveler � o- m d\ y r SEPARATION DISTANCES FROM WELL TO: M a O Septic/hekfiirrg tank on lot ; On adjacent lots ® NO —a—g� m z Absorption field on lot On adjacent lots /�� '" R7 �, N ti 2 0 Public sewer main K/0 Vs� Public sewer manhole/cleanout AX/ ,r N G7 o m Sewer service line Ala IV A Petroleum tank WATER SAMPLE RESULTS: Coliform (f) Nitrate �2_ ' 6 Other bacteria U Date of sample: Z Collected by: B. SEPTIC/FI�BI#i6 TANK DATA Date installed �u ue M8 Tank size JZS® Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Al Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) Pumper S-gH 177j? y &4_P t5 Date of pumping in SEPARATION DISTANCES FROM SEPTIC/Higt&06 TANK TO: Wells) on lot .7-7 On adjacent lots i oe> •+ Foundation To property Iine G'® Absorption field Surface water/drainage ZAP `�` 1/llA-rve/t„ A-epv c` -a Pcmt- 72-026 (Rev. 7/91) Front Water main/service line i®.t" CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed X"Id& /!78 / Soil rating /0Q,5_rAsL System type IA0ev«' Length 60 Width Z/ Gravel thickness 4 " Total depth i' -- Total absorption area 4De✓ 5t Cleanouts present (Y/N) Depression over field (Y/N) /V Date of adequacy test 2'Zpte,;,>. Results (pass/fail) / for ¢ bedrooms Peroxide treatment (Past 12 months) (Y/N) Ii/OA/6-' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1,018 On adjacent lots 1019 '/--Property line /0 '"- To building foundation .. // Z d To existing or abandoned system on lot ANS On adjacent lots Cutbank :�'O Water main/service line /0 Surface water /00 ° t- Driveway, parking/vehicle storage area 30 Curtain drain 1V0ti� 1r_A&>wA) E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Pavid R. Dayton P.E. 20210 Donalar St. ;.xtlak, Alaska 99567 Signature Engineer's Name Date A G,�6_e 1%,C). 2205-E itn•• fta•••k N!•••0••`. �nrE,SS HAA Fee $ _Z 70 Waiver Fee: $ Xky 00 Date of Payment [J �� ' ��� Date of Payment AJ o) __92 - Receipt Number l 4931 Receipt Numbers.41 ��� 72-026 (Rev. 3/91) Back MOA 21 ., MUNICIPALITY OF ANCHORAGE, : Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#(►1Q9an�Dn PINI Permit # Date Received: October 2, 1992 Legal Description: Lot 1 Block 2 Mc Kinley Heights #2 Engineer: David R. Dayton, P.E. 20210 Donalar Street, Chu iak, Alaska 99567 Applicant: Frank Gerievic , Waiver Requested: Private well to septic tank 96 feet Criteria: 1. Geology: Points: A. Water Table 15, � B. Soil Sorption W, 4 C. Permeability D. Water Table Gradient U E. Horizontal Separation a.,V TOTAL: ��) 2. Special Conditions: i h� //. ✓acv /s .rk-.' 7V, 3. Other: Waiver is Granted: Waiver is NOT Granted: /Lis/t Conditions/ or Reasons for above: liJ,.,: 4 Rec #: 24116/4231 Amount: 5 410.00 Date Paid: 10-2-92 Municipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 20, 1992 David R. Dayton, P. E. 20210 Donalar Street Chugiak, Alaska 99567 A Subject: Waiver Request for Lot 1 Block 2 Mc Kinley Heights #2 Waiver Request#WR920059,- PID #051-251-69, HA920654 Dear Mr. Dayton: Your request for waiver(s) of the required 100 foot horizontal separation of aseptic system to a private well has been approved. The approved separation distance(s) are the private well to the septic tank is 96 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, Robert W. Robinson Civil Engineer On-site Services ljm:#6 Concur: 7 ohn Smith, P.E. Program Manager On-site Services Ile IWZ 1,17 - v D. R. DAYTON, P.E., R.L.S. rMINWRIMN Chugiak, Alaska 99567 (907) xMt-� 20210 Donalar Street 696-2417 September, 28, 1992 ADEQUACY TEST Legal Description: Lot 1, Block 2, McKinley Heights #2 Date of Test: September 27, 1992 Septic Tank: 1250 gallon, 2 compartment, steel tank (DHHS Records) Absorbtion system: 50" x 4' effective depth trench (DHHS Records) Soils Rating: 100 sq. ft. per bedroom (DHHS Records) Daily design flow: 4 bedrooms - 600 gallons per day (DHHS Records) Test: 776 gallons of water were injected into the absorbtion trench in an 8 hour period. Two hours of the test period were dead time between loads of water. Results: Float measurements taken at 20 minute intervals,showed a consistent 5" to 6" rise. Each time the float level returned to the original level in less than 1 minute. Conclusion: The absorbtion system is currently functioning adequately for a 4 bedroom home. bCR 14 1, y5�� 9T.°. David R. Dayton 0 NO.dw ®' �°R0gESS10N�i ngth�� Ju.ey 17, 1992 n ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS (907) 694-2979 FAX 694-1211 MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY ENVIRONMENTAL SERVICES DIVISION APPROVALS Daceene N.icoty6en RE%MAX OF EAGLE RIVER OCT 16600 Center6ietd Diti.ve SEWER &WATER Suite 201 RECEIVED Eae- sg�R.eVen, A.ea6ka 99597 MAIN EXTENSIONS REFERENCE: Lot 1; Block 2; Me K.intey He.Lght6 #2 Dean M.6. N.ieot y6 en, SEWER 8 WATER INSPECTION ,, p At gout nequat a blow tut wa6 pen6onmed on the weseAv.ing .the lt ne6eneneed property on Juty 13, 1992. The 6tatic water Levet was mea6ured in the weete at 48 6t. beeow the top ENGINEERING STUDIES o6 the weZZ casing. A meter wa.6 connected at the pne66uae tank and the AND REPORTS 6tow turned on 6uU. A6ter 6orty-six minutes the water Levet wa6 drawn dawn to the pump (302 6t.). The pump was then 6hut o66 and the water tevee wa6 allowed to recover bon approx.imatety 6.i6teen minute.6. At that time the pump way, tanned on again and the water levee drawn back WELL INSPECTION down to the pump white the water quantity wa6 metered. Thi6 pro lees B FLOW TEST ( a,6 repeated 6 evera e times with three eon6.0 tent %uu?.t4 . From this te6t we have bound the were to euAitentey produce 45 gatton6 pen hour (GPH). The 6tow rate .i6 not guaranteed to nema.in constant, subsequent vati.ation6 can occur. SITE PLANS Poon to receiving a Mun.ici pat HeaP,th Certi.6.tcate the 6ottowing worth wilt need to be accomplished: ROAD DESIGN 1. An adequacy teat on the 6epti.c 6y6tem 2. Septic tank pumped 3. Water 6ampte6 taken (Cot i.6orm baetetia 9 nitrates) SOIL TEST 4. A wa.iven .issued 6or the 6epanation di,6tance between the 6ept.ic tank and the weft. PERCOLATION TEST 16 we may be o6 Gunther 6env,ice to you, please contact w6. S.incereey, STRUCTURAL 8�\ MECHANICAL n INSPECTIONS ROGER J. SHAFE , P.E. RLS/gm ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 D. R. DAYTON, P.E., R.L.S. M57UMa i `Chugiak, Alaska 99567 (907) U19NNM 20210 Donalar Street 696-2417 October 2, 1992 Municipality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, Alaska 99519-6650 Re: Lot 1, Block 2, McKinley Heights #2 We request you issue the attached Health Authority Approval and grant a waiver for the separation distance between the well and septic tank at 96 ft. The well and septic system were installed in 1978 and approved by the Municipality of Anchorage in 1979. A risk analysis was performed using the ADEC "Separation Distance Waiver Guidelines". The analysis shows the well is "almost sure to be free from any form of contamonation from household sewage". Other factors involved which support a waiver are: 1. Only a portion of the septic tank is within the 100 ft. radius. The absorbtion trench meets the 100 ft. separation. 2. Well logs from this lot and nearby lots show relatively shallow bedrock in the area. The general area slopes are quite steep indicating that bedrock slopes are also steep. Septic tank effulent should follow the same lines. 3. Lots in the area are quite large, therefore the septic system density is low. Attached for your review are well logs from the referenced lot and adjacent lots, site plan, water analysis for coliform and nitrate and risk Analysis. It is our opinion that the 100 ft. separation distance is not required in this case. If there are any questions, please contact us. Sincerely, m,,:.roen+ea°, % David R. Dayton .meg f^. Gavkt R. .'y1on te`�,,'� `j`J',aW P'FO. 22US^'� e 4�4.Es tl9Car �e°Deem®°°" oe�.�'gp 'rerE as'��) LOr\Rca )1G''F1T5Z t Y11a-Owc. 7.;4altv (Aa) zero ' o,.ns, PAn/�Src� t� 20 3, S a K l2IbL-r, s-OGL -701 a�coa+ • as •eNe ,f .�� r� r .y ! tiQYlii �'7�":Ofl • �� . • '1-l. •••.�OY9C v�� znZ�a GAt�lrrL t 5=c 290 T I�W,2tw1 42,r> NWic)S7 D. R. DAYTON, P.E., R.L.S. HQUOUR 218 Chugiak, Alaska 99567 (907) IMNMI 20210 Donalar Street 696-2417 October 8, 1992 Municipality of Anchorage Dept. of Health and Human Services 825 L Street Anchorage, Alaska 99519-6652 _w—o Re: Lot 1, Blk. 2, McKinley Votes #2 Attn: Mr. Robby Robinson rrEIVED OCT 0 1992 ;IWIty ;i Anchorage 0-,0 , Ha'Ith & Human Services Dear Robby, The following additional information for the Well to Septic Tank Separation Distance Waiver is as follows: Based on an assumed elevation of 100.0 ft. on top of the well head, The ground at the well is 96.6', the ground in the driveway at the garage door is 105.4'. The elevations of the ground at the septic system cleanout pipes are 108.4', 109.4', and 106.5'. I have marked the locations of the elevations aswell as sketched the slopes, ridge top area etc. on the attached well -septic site plan. I trust this will enable you to complete ytbur review. S/in�cerely, � / � D.R. Dayton G4 ccYo,v Ole" i p �• -` X5.'1 � : : i4S 2'S I ' 3�3' \ S ti0 a I o , Yl N H VI II a a V M A N I 146D6, hD PaVC".7?CIO z' Ost ice l' V � IOGr ' 1 i I j I i O ti, l l '_ i� I r i � �%• a^k� 5 ee � I �� i� i j '- e w 4o is sn°u eao e=avadae" • 1 /o/7AF Z ; /10494!! e46t-p 0 i YVF,C�G. � D.eJ✓$' �,S��G... i � ' �eF � cwaes••a •.Mgr.e�a.o°p�i ��� { i 1, 1 r, •I�� y David i{. i�rl} IM •i7 �I� ; .� i r$p tP •. N4.� i•°°• i C'��TtX$'�i jd/�OG/N ; : 3 : aiD'e @mss i 6\1tc he°.e.eaeee P FESSIO�A'� i ZH*dG�I SIC. + � C•�tK.x..my�': /`7"t3rlGi'fi5 Z. i � ' J4 �1 ii S1.% � , i Sic ea T Is M, P-1 444r> NvVg57 G�1 r 7 /2,11A 2-79 Z 5. LEGAL DESCRIPTIO N B j d MUNICIPALITY OF ANCHORAGE MUNICIOUTY DEPT, 0i l Ault & : Ii.CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC71IRINIRQNid,l-.'NI A 825 L Street - Anchorage, Alaska 99501 NUMBER OF BEDROOMS • ❑ One .❑ Four ❑ Other [ pp [] q Itd�lil\ 1 ❑ Two ❑ Five ENVIRONMENTAL ENGINEERING DIVISION e 7. WATER SUPPLY Telephone 264.4720 INDIVIDUAL* REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER 8. SEWAGE DISPOSAL SYSTEM ** If individual/on-site, installation dater d. Ld l3E PHONE n0o, If system is over two (2) years old an adequacy test is required PUBLIC UTILITY MAILING ADDRESS r1 PROPERTY RESIDENT (If different from above) PHONE 2. BUYERPHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE /°� VIA MAI LING tA � 4. REALTOR/AGENTPHONE V A _ .� � } . �� .,., L , 9/- MAILINGADDRESS k C� _ -12 Z 5. LEGAL DESCRIPTIO N B j d - - J K o- 2_C3. STREET LOCATION, 7 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ,-fn'SINGLE FAMILY ❑ One .❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ✓�T 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.) 8. SEWAGE DISPOSAL SYSTEM ** If individual/on-site, installation dater d. Ld l3E El INDIVIDUAL/ON-SITE** give 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. 72-010(3/78) J� 01; ---- 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 ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LA—`APPROVED FOR _ tl BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) s i LEGAL DESCRIPTION 72-010 (Rev. 3/78)