Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
ROBERT AUBREY LT 11A
Rob rt Aubr Y Lot 11A #051 - 102-75 ..~xMUNICIPALITY OF ANCHORAGE.~.h Department of Health and' Environmenta. Frotection Pouch 6-650, Anchorage, AK 99502 264-4720 Permit No: _~~A~~ ~-~ r/Wa t e r Permit HANDWRITTEN Date Issued: Applicant: J~ ~ ~l~- Address: ~'~ Legal Description: S/D: Section: ~ Township: Lot: t/~,¢t'7--' Block: Range Lot Size: l~ (Sq. Ft. or Acres) Lot Location: Max Bedrooms: Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. Depth to pipe bottom(ft. Gravel depth (ft.) Total depth (ft.) Gravel width (ft.) Gravel length (ft.) Tank size (gal.) Soil rating (sq. ft./br) TRENCH BED Wo DRAIN ** Gravel length 75 feet requires multiple runs (not exceeding 75 feet each) ** Tank must have at least two compartments I certify that: 1. I am familiar with the requirements for on-s te sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well~ wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximum number of bedrooms stated above, and any enlargement or modification will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL/F~IT AND INSPECTION MUST BE OBTAINED; ~ (2) AS-BUILTS WILL NOT BE APPROVED//WITHO~ AN ELECTRICAL INSPECTION REPORT; AND (3) THE E LECTRICAL~M~~ONE BY ~ENSED ELECTRICIAN. SIGNED: ~X ~ DATE: ~ Z = --~'~ Ap p 1 i c an~---~/J ~ ~ ISSUED BY: .~/~ .... ~- ~..~-~ DATE: ~.---'7.-~--g'& (/ L..E)T~ :1. I ,&: :i. 2 BL.E)E;I-:::= 0 t~(-- '~t.~,:. · ,/ COMPUTATION SHEET DATE: SHEET IOF PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14-- 15 16 17 18 19 2O Township, Range, Section:.?[~.~` ~_.t~ ,~ ~,,~_~ SI~E PLAN ~¢:~ SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh to Waler Alter Monitoring? Dale: % Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN q FT AND ~ FT COMMENTS~,o ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUtDELI~IN ~FECT ON THIS DATE. DATE: /~ 7~ ~ I ~ ,,, MUNICIPALITY OF ANCHORAGE . ~ DE tTMENT OF HEALTH AND HUMAN SER'* ~ ~S - ~ Environmental Health Division ~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES TANK FIELD WELL Phonets)L0 d~ ("'~ ~ '"~-'~ t-~ C~IIl Permit~ooNo ~% NO. of Bedrooms% WELL L O~ * + LILAC O~SCRIPTION LOT LIN E ~ t ~ Township, Range, Section ~ O AS-BUILT DIAGRAM (Show location of well, septic system, property hnes, foundabon, driveway, water bodfes, etc.) ~SEPTIC ~ HOLDING Material NO. of Compa~ments ~ v ~ TYPE OF SYSTEM C TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to p~pe bottom from Total depth from original grade original grade ~ /FT /01 FT Gravel depth beneath pipe r / FSI added abo .... ig,nal grade ~ F~ ~ ~ ~/~ Gravel length Gravel width Number of lines Soil rating Pipe material ~/ / ~ ~ ~ ~[ )~5 ~ Installer Dale installed ~ WELLS ~'--T ~ PRIVATE ~ OTHER fldenlilv) ,~' Classification (A,B,C/ 'Total Depth Cased to ~l L ~ ~ i FT Insta[lel Date Installed: I SRB 19~x . cedily lhat Ihis inspection was pedormcd according lo all Municipal and State gui~e'lines in effect on this date: ~-- 2 ¢ Health Depadment Approval: ~' Date: ~ SUBDIVISION: ROBERT AUBREY SEC'!" ! CIN: 9 'I"OWNSIq I F:' ~" :L 5N :1.500C~ (SQ~ F"F~ OR ACRE.E~) 3 LOT: . I1 & 12 RANF]E: :I.W BLOCK: NA DEF::"TH 'T'O I=' :[ F:'E B(:]"i""I"C)i"I (F'T'.) GF;~AVE:L. :(:)[~i:l:::'"J"!'"l (J:::'"i",,) TOTAL :OE,'-::']"H (F:'T.,) GRAVE]... WIDTH (Fl",,) GF~AVEL. I_E~:N(:~}TI'"i (F:"I".) GRAVEL VOL. U!"~E ((%1,, YDS~ TANK S:[ZE: ((:']ALS) SQiL.. RATING (S[;!.F'T. /BR ....... TAb. l!< .... ,.(.. 2,, I W:i..~.]. :i. ns't:.a:L1 " ' ........................... ' 3,, I k-.~:L I I ,:s. dl~:¢~.e..~ t.o a~ I MOA and..,c .~,..,=,.,...: {::)f' -. ,.,:: M..,:: pequ:i, r'emer'rLs 'f'or:' the set ~-,..,a~_l.. any e)r'~].ar'gc.:, e'~".. ~z,~J.:t.]. r'-e)(:ju~.r'(;;, an acJcJ:i.t:Lor'~al pePm:Lt,, (ger/ifieh Drilling Eog by [DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2758 OWNER OF LAND '~:' ~" -:5 /'~ ..... ,~ /c.,'¥,~w~/4~.,t~ ~,:>~.~.: v ..... DEPTH OF WELL ADDRESS ~'?;~ .'~ t.,. c~ ~b .,~ t~. ~ ,. ~ e/~.t ~./~t~ ~c'~. STATIC LEVEL OF WATER F'F. LEGAL DESCRI~ION ,', //, ~: / ~ ~'~ ...... ~ .... ' ..... '~ , . ~:..6~:',.~ ~ /:i,. O~?i'F' ' ~dZ~J DRAW DOWN FT. DATE- Started - / g;~:~/~" C~ Ended ~ =+ / ;~i /d;~. GALS. PER HR PERMIT NUMBER '~'-' r,/- '~ KIND OF CASING ~ '~' d) ,,~' KIND OF FORMATION: From ~ / Ft. to o-:, Ft. From ". Ft. to/-:f'? Ft. Ft. to ~:~ Ft From f; From__ Ft. to Ft From A" '. Ft. to / . ~ Ft. From ~ ;?'.;~ Ft. to f,~"c~ . Et From Ft. to Ft. From :' ~ Ft. to '?o..~[. Ft. From Ft. to _Ft From~Ft. to Ft From Ft. to From Ft. to From Ft. to From Ft. to~ From Ft. to From Ft. to From Ft. Ft Ft Ft _Ft Ft. .F.t Ft.' FI. to Ft Ft. to_ __Ft. Ft. to From FI. lo From FI. to__ From_ Ft. to Ft. From Ft. to_ Ft._ From Ft. to__Ft. From Ft. to Ft From_ Ft. to_ Ft. From FI. to _ Ft, From Ft. to Ft. From Ft. to Ft. From Ft. to Ft · MISCL. INFORMATION: NAME DATE: SHEET BY OF 7"'// z-O Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-102-75 1. GENERAL INFORMATION Complete legal description Robert Aubrey, Lot llA Expiration Date: ~-//J O//~ ~ Location (site address) 23008 Tundra Rose Ave, Chugiak, AK 99567 Current Property owner(s) Card, Aaron & Krysta Day phone 688-1098 Mailing address same Lending agency Day phone Mailing address Real Estate/~eot ~: ? Hope Russo Mail~g Address ~ ~ '' . ~ ~Keller-Wdhams, Ea.qle River Unles~s ~thetWis.,e're(?'u. ested, C,OSA will be held by DSD for pickup. NUMBER!OF ,BLaDRooMs: 3 TYPE OF~WATER,,SUP'PEY: Individual'Well ~ ,3 ;'~ [] Individual Water Storage [] Community Class Well [] Public Water System Day phone 301-0701 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class' C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 11/7/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, and the lre changes inland use, local soil characteristics, groundwater levels that may fluctuate during the water usage of the family being served by the system. The operational life of all well and subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. bedrooms. bedrooms, with the following~s~ip~l~Ii0ns: ~ATER AND ~ ~ WASTEWATER ~ ~ ~ J~v ...... ~. . · ~ -~. ' .....' DSD SIGNATURE ~/'/ Approved for -,~ Disapproved. Conditional approval for X Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 11/05) Original CertifiCate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Robert Aubrey, Lot 11A WELL DATA - Public Water Well type na If A, B, or C provide PWSID # ~ Date. complete~ n_~a Total depth na ft. na ft. Well Log (Y/N) n~a Sanitary seal (Y/N) n_~a Cased to FROM WELL LOG na Date of test Static water level na Well production na WATER SAMPLE RESULTS: Coliform na colonies/100mL Nitrate Arsenic: na mg/I Date of sample: na SEPTIC/HOLDING TANK DATA g.p.m. na mg/L __Collected by: n~a Parcel ID: 051-102-75 Wires properly protected (Y/N) n_~a Casing height (above ground) na in. AT INSPECTION na g.p.m. Any rejuvenation treatment (past 12 mo.) (Y/N & type) unknown If yes, give date --- Results (Pass/Fail) Pass For 3 bedrooms 0 in. Water added 450 gal. New depth 2 in. 0 in. Absorption rate > 450 g.p.d. Date of adequacy test 11/1/11 Fluid depth in absorption field before test Elapsed Time: 60 min. Final fluid depth ~ Monitoring tube _Y Depression over field __N (g.p.d./ft2 or ft2/bdrm) 0.8 System type Trench (2) Gravel below pipe 4/5 ft. Total depth 10 ft. C; "ABSORPTION FIELD DATA Date installed 7/03 Soil rating Length 69 ft. Width --3 ft. Eft. absorption area 616 ft2 Tank Type/Material Septic/Steel Date installed 7/03 Tank size 1_000 gal. Number of c0rn~artments _2 cleanouts (Y/N) Y_. Foundation cleanout (Y/N) Y_ Depression over tank (Y/N) _N_ High waferalarm (Y/N) N Date of pumping 7/13/11 Pumper lR's D. LIFT STATION Date installed na "Pump on" level at na in. Datum na E. SEPARATION DISTANCES Size in gallons na "Pump off" level at na in. Cycles tested na Manhole/Access (Y/N) na High water alarm level at na in. Meets alarm & circuit requirements? na SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot na Absorption field on lot na Public sewer main NA Sewer/septic service line na Animal containment areas ~ta SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole/cleanout NA Holding tank na Manure/animal excrete storage areas ~ta Building foundation 5'+ Water main 10'+ Wells on adjacent lots 100'+ Property line 10'+ Absorption field 5'+ Water service line 1-0'+ Surface water 1_00'+ SEPARATION DISTANCE F~_?M ABSORPTION FIELD ON LOT TO: Property line ~ ~ / Building foundation 1-0'+ Water main 1-0'+ Driveway, parking/vehicle storage Surface water lO0'+ Wells on adjacent lots 100'+ Water Service line Curtain drain COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steve 1R. ng Date 11/7/2011 COSA Fee $490.00 Date of Payment Receipt Number (Rev. 11/05) 5ooC. Waiver Fee $ Date of Payment Receipt Number Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Sragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.orglonsite (907) 343-7904 GENERAL INFORMATION Complete legal description .L-,e~P.J~obertAubrey Location (site address) 23oos Tundra Rose Ave, Cugiak, Ak Current Property owner(s) c~if~ & Mary So~'enso~ Mailing address same Lending agency CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Day phone 622.4125 Day phone Mailing address Real Estate Agent Katie Rut~egde Day phone .~s2.o4~s Mailing Address Unless otherwise requested, CO,SA w#l be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3. '~'PE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates cf On-Site Systems Approval (COSA)'based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska, Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certitied by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipalib/of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all appliceble Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s & s Engineering Phone 694-2979 Address 15861 Birchwood I.~o. Rd.-Chugiak. Ak~ 99567 Engineer's Prfnted Name Rob~t A. Shat'er ...................................... Da-t~- ~.26-07 .................................. 5. DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Orfginal Certificate Date: c'~/Z/f~7 Municipality of Anchorage Development Services Department Building Safely Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: x... O'I' ~ ~ ~; I~_.Ot~'l~l' ~ln~g~' I./ Parcel ID: DATA'"'~L3 ~/,.j, ~_ A, WELL Well type If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly~ Total depth __ft. Cased to .ft. Casing h~above ground) Date of test FROM WELL LOG ~*~~NSPECTION Static water level ~. ff. Well production / g.p.m, g.p.m. WATER ._ Coliform ~,"~olonies/100 mL Nitrate mg/L Other bacteria .__ · Ar~ ug/L date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA ~ ~"~ l ~ Date installed Tank Type/Material Tank size I~-~ 0 gal. Num r of Compartments ~ Cleanouts (~.~N) Foundation c~eanout ~N)y~ W Depression over tank (Ygi ,4"~ H~gh water a~arm (Y/N) ~/-4 Date of pumping Pumper ,7 C. ABSORPTION FIELD DATA Date installed ~,/'~-~/$~ Soil rating (g.p.d./ft~ ~ 'Z "z.~- System type Length Total depth /0 ff. Date of adequacy test Fluid depth in absorption field before test '7- in. Elapsed Time:'~.~_ rain. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y~ type) in. colonies/100 mL ft.. Width "~' ~ fl. Gravel below pipe ~ I ft. Eft. absorption area ~q~ Monitoring tube ,~?- ~' 7/-z'4[o7 Results (~>~/Fail)~ Water added [~1 gat. Absorption rate >= If yes, give date in. Depression over field For 7 bedrooms New depth ~/,z~ in. ~; '5? g.p.d. D. LIFT STATION Date installed. Size in gallons 'Pump on' lev~h water alarm level ~ in. Datum Cycles tested * Meets alarm & circuit requirements? E. SEPARATION DISTANCES ~'~J~/.-IC ~-'/~/P-. ~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldlift station on lot On a Absorption field on lot ~...~adjacent lots Public sewer main ~ Public sewer manholelcleanout Sewer Iseptic~ Holding tank ~~mment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/t'~I=~3~TANK ON LOT TO: Building foundation .-~ ~'/- Property line "~,~ './-- Absorption field ¢ I ' Water main /'~ ~- Water service line /,~ /-F- Surface water /,~O ')~ Wells on adjacent lots /~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ Building foundation I ~" Water main Water Service line /~ I ~' Surface water /~O "L Driveway, parking/vehicle storage Wells on adjacent lots / ~) ''f' Curtain drain F. COMMENTS I ced,~ that l have dete~in~mugh field inspections and review of Mun~ipa/ recordK thatl/he above s~ms ~e in confo~ance with MOA COS~ gui~lines/in ~e~t ~ this ~ate. Date of Payment *~/~ ~,/O ~ Receipt Number ~) ~ _~ ~t0/~ (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number ROBERT C. COWAN · CIVIL ENGINEERING PH: 907-694-2979 FAX: 907-694-1211 MUNICIPALITY OF ANCHORAGE Department of tleahh and lluman Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot I IA; Robert Aubrey Subdivision The septic diverter valve on the above referenced property has been switched to the old field. In order to test the old system, we visited the property on July 23 and pre-so~kcd the field with 600 gallons. We returned on July 24, 2007 and loaded the system with 1000 gallons in order to test the full effective depth of 6 feet. Based on this test the field currently absorbs 637 gallons per day, which is well over the required amount for 3 bedrooms. Reques~ the C.O.S.A. immediately so the owners can proceed with closing. 15861 S. Blrchwood Loop Road - C. huglak, Alaska 99567 AUG. 1.2007 I:ITPM · ASBUILT I H~EEBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DF-.~CEIBED PROPERTY: INDICA~. IT IS THE RES~NSJglLITY OF THE ~ TO D~ERMINE THE ~iSTENCE OF ANY E~ENTS~'COVENA~S~ OR RESTRICTIONS WHI~ DO N~ ~PEAR ON THE RE~D~ VISION P~T. UND~ NO CIRCUMSTANCES ~ DATA H~EON BE US~ FOR CONSTRUCTION O~ ~NCE LIN~, OR ~R EST~LISHING ARY LINES. e~ N0. 7598 P. 2 Municipality' of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewaler Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A $1N'G'[.~ 'FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency Day phone Day phone Mailing. sddress Real Estate Agent Mailing Address Day phone· e Un/ess otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: , TYPE OF WATER SUPPLY: · Individual Well [] Individual Water Storage [] community Class .__ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services'Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the. representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample resul[s. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further'verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in eff, e. ct at the time of installation. ' - J~i gle P-Jver I~nt~ineezin~ ~~ Name of Firm' P.O. Box ,7~'32o~, Na~_e ~_AK .e~t._.~'._._~ Phone Address Approved for .~ Disapproved. Conditional approval'for ~".~.~... - -- ,,~.~ '~.~ Louis A. B~era bedrooms, with the follo~ng stipulations: Additional Comments Attachments: ' HAA Checklist · Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 01/02) Original Certificate Date:_ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci .anchorage.ak .us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well.type ~ Date completed ~ Total depth ~ If A. B. or C provide PWSID # ,/ Sani seal (Y/N)7 ft. Cased to FROM WELL LO~ Date of test Static water level / ft. Well production ~ g.p.m. WATER SA~:~ RESULTS: .C~ colonies/100 mi. Nitrate mg./I. Arsenic: mg./l. Date of sample: Parcel ID: Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION in. fto g.p.m. Other bacteria Collected by: colonies/100 mi. Bo SEPTIC/HOLDING TANK DATA Tank Type/Material .~'7/'~ ~/ Tank size /z~P/) . gal. Number of Compartmentsc~q- /,~,, 3~ ~',..,,,-~ ... Foundation cleanout (Y/N) f/ Depression over tank (Y/N) Date of pumping ,,~"' .~ e, J' Pumper Date installed .~0'~0~ Cleanouts (Y/N) High water alarm (Y/N) ABSORPTION FIELD DATA Date installed '~/¢,.7 Soil rating Length ,~'~ / Total depth /g) ft. Date of adequacy test (g.p.d./ft2 or ft2/bdrm) ~tg ft. Width Eft. absorption area~ ,n//,,~ ~,, ¢,,,~ Fluid depth in absorption field before test System type 7-/--~--,,~,~ ,4, ~ ff. gravel below pipe z~",~'/5-" ft. z5"/4; ft2 Monitoring tube y Depression over field ~ Results (Pass/Fail) .,~¢;~-/ For ~=' bedrooms ~ in. WateLad4~,--~gai~ New d~ Ek3ps~d Tin-,e; ..m!m Finnl fltiid depth in, Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date '~- D. LIFT STATION Date installo~ "~n" level at.~atum , ' in, Size in gallons C_.¢les tested Manhole/Access (Y/N)..' High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line "~'~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank ,'/"//',~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation L~ / Water main -J--/o Wells on adjacent lots Property line ,~M Water service line Absorption field Surface water ,,~ SEPARATION DISTANCE FROM ABSORPTION FIELD' ON LOT TO: Property line /g) Water Service line Curtain drain Building foundation /~" Surface water ~-//~" Wells on adjacent lots f/~,~ / Water main Driveway. parking/vehicle storage. -.'- COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ,~--~,~ ,,~ ,~, ~ ~-~ Date /4;~ /~,'--,d ..~ iQ. HAA Fee $ ~ "~'S". Date of Payment lb~ Receipt Number 4V'.,T'/~' (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number / Municipality of AnchorageI Page / of DEPARTMENT OF HEALTH AND HUM/~N SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -~ ~ o 3' o ~ ~ ~ PID Number: Name:Wastewater System: ~New D Upgrade Address: ~ z~,~ F,~- ~,~ ~ ABSORPTION FIELD Phone: ~ No. or, Bedrooms: ~Deep Trench D Shallow Trench D Bed D Mound ~ Other LE GAL D ES CR I PTI O N so, Rating: Total Depth from original g~ade: ' ~ ' ~ GPD/Sq. Ft. /~ ~ ' LOt: Block: Subdivisi¥: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: [ Range:/ ~ I Section~ Film added above original grade: Gravel length: WELL: F/~ D New D Upgrade Gravelwidth: Number of lines: IDistance~tween,nes: Classification ~rivate, A,B,C): Total Depth: Cased To: Total absorption area: ~ 16 Pipe material: Ft. Ft. ~/= ~W~ T~=~o SQ. Ft. 'Driller: ~~p ~ate Ddlled: Static Water revel: In,tal,er: . i ~ate.in~talled: ~ Yield: GPM 1~Set at: Fi,Il Oasing Height Above Ground:FL TANK SEPARATION DISTANCES ~Septic m Holding m S.T.E.P. To Septic Absorption Lilt Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~C ~ ~¢~ ~.~ Well ~ Material:~&~ / Number~ of Compartments: Su,ac~ ~ ~' LIFT STATION Water ~/~ ~/~~ . . LineL°t ~ / / ~ / /~ / Size in gall~ J Manufacturer: Gurtain Pump ~ake $ ~odel [ file~l In,pection~ pedormed Drain ~ Remarks: ~//~ ~,~-~;~ ~-/~e BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Inspections performed by: ~,~/c ~,~ ~,~e~-,~Dates:lst 7/// ~*~49~~ Department of .ealth and Human Services approval Reviewed and approved by: Date: I,l~r/~J AUG 0 1' 2003 Permit No. SW030232 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 11A, ROBERT AUBREY SUBDIVISION PID No.: O51-102-75 SWING TIES lC I *.°'1".~'1 I I) I ~7'1'1 I E I ~.s' I~"-~" I TUNDRA ROSE AVENUE ~ 89'52'20' W 80.01' 10° [LECTRI¢ & ~¢OMta~NICAT~Ot4$ ~E)JF. NT LOT I fAI ~ - TE~ HO~ * - MONITOR o - S~ER C~ OUT N~ ~CH S 89'52'20' W IO0.O0' ELEVATIBNS (NRT TI] SCALE) ~ T[]P riff S[Y, JTHEAST LOT CDRN£R ~ ASSUH£D ELEV = tO0.O0' TRI-TRENCH It TR~'TRENCH #~ 7/18/05 ENGINEER'S SEAL ,e..~ ." ,~-,,[1~ ".'r' 0 ~.-" 4-9 TH, ~ "-.?~ ~, ~)n ~ ;. LOUIS A. 'I~U+~'I~' :'"L~,' ;~ ,,~,:,:'~;;... ....'~.~,~ MUNICIPALITY OF ANCHORA GE Development Services Department On-Site Water & Wastewater Program 4700 South Brogaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 02, 2003 Expiration Date: Jul 01, 2004 Permit Number: SW030232 Legal Description: ~~~ Design Engineer: 0024 Eagle River Engineering Services Owner Name: Donald Glenn Owner Address: PO BOX 671308 CHUGIAK, AK 99567-1308 Parcel ID: 051-102-75 Site Address: 023008 TUNDRA ROSE AVE Lot Size: 14914 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [~ Disposal Field r~ Septic Tank D 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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_,: . . . _. Issued By: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 19665b Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR ASINGLE FAMILY DWELLING Parcel I.D. - 7.4' Permit Number SW Property owner(s) Mailing address (1) Mailing address (2) ~L-C tJ/J Day phone Zip Code ,c~ ?S ~ 7 Legaldescription (Lot, Block & Sub'd.) ~:OI~PT At/t'~g? ~ LoT' Legal description (Section, Township & Range) ~J &' ~/u, 5£~T~o&) ?~ Lot Size.)/~, .~/L/ Acres/Sq. Ft. Number of Bedrooms 'V l ,, R THIS THIS APPLICATION IS FOR: Sewer Only [] Sewer and Well [] Sewer Upgrade ,J~ PROPERTY CONTAINS: Hot Tub [] Swimming Pool r"'] Therapy Pool [] Well Only BI Water Storage [] -. Jacuzzi I-'] · Water Softening Unit r'-I i certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is Tn accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (R~v. 12,'00) Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June 30, 2003 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re.' Robert Aubrey L11-A Narrative & Permit Application Dear Mr. Cross: The proposed septic system will have very limited impact on adjacent properties for the following reasons: The surrounding lots to the north and west are connected to a public water system, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. This is an upgrade, with the original system kept online as a reserve with a Bull Run type diversion valve. 4. Drainage will not be affected and is not a major consideration in our design. This septic system placement will not affect the development of any other lots surrounding this unit. Due to limited space, and drainage constraints, the trenches are of different depths to maximize the absorption capacity of the system. If you have any questions please call our office at 694-5195. Christopher R. Wood, P.E. k2002\03-017 SEPTICNARRATIVE.DOC 30' SEPTIC +30' TUNDRA ROSE A VENUE $ 89'52'20' W 80.01' 80.01' LOT ! !A EXISTIN~ HOUSE E~I~T1NG INTERIOR CLF..N,I 10' PUBUC WAT~ S[PTIC +30' a - DIVERSION VALVE [] - TEST HOLE · - MONITOR TUBE o - SEWER CLEAN OUT + - WELL EASEMENT PROPOSED LEACH FIELD - - EXISTING LEACH FIELD ~ ...... '~ ~- DRIVEWAY NO SURFACE WATER NO KNOWN CURTAIN DRNNS NOTE: LOT 1 lA IS SERVED BY PUBLIC WATER INSTALL DI~RS~ ID(I~F1NO fiELD 10' ELECTRIC &: TELECOMMUNICATIONS EASEMENT S 8g'52'20" W 100.O0' SD:trio +~o' ~ +1oo' WELL/SEPTIC SITE PLAN LEGAL: LOT 11A, ROBERT AUBREY SUBDIVISION OWNER: DON GLENN 'CONTRACTOR: N/A JOB#03-O17WS I DATE: 6/30./0.3 I SCALE 1"=30' EAGLE RIVER ENGINEERING SERVICES A P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5196 FAX: (907) 694-3297 Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER LEGAL: Rober~ Aubrey, Lll-A June 30, 2003 A. GENERAL 1. The well and septic plan is for a 3 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to tile design and are to be verified or modified in tile field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the o~vner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK 1. Existing septic tank to be pumped, exposed at the outlet side manhole, and then inspected by Engineer. If determined to be structurally sound, the existing septic tank is to be utilized. If the existing septic tank is determined to be unusable due to corrosion or any other deficiency, it is to be removed and a new one installed in the same location. Engineer shall be solely responsible for the determination. 2. Septic Tank shall be insulated if burial depth less than 4'. Two after tank cleanouts are to be installed, with "Bull Run" diversion valve to existing system. C. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom ofthe trench shall be level, plus or minus 1.5", and'shall be located at 9' below top of ground surface as measured on the downhill edge of excavation. 3. The existing trench shall be connected to the new system with a Bull-Run type diversion valve. 4. The trench gravel shall be covered with typar fabric material. 5. Natural soil shall be placed over the trench to a depth orS' and 4', for trenches 1 and 2 respectively. 6. The area over the trench is to be finish graded to prevent ponding of surface water runoff. Care shall be taken to ensure that the required fill depth is maintained over the entire trench. 7. The septic tank and leaehfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = (NTE) 10' GRAVEL DEPTH = 4' under pipe, 2" over pipe (Trench # 1) COMBINED TRENCH GRAVEL DEPTH = 5' under pipe, 2" over pipe (Trench #2) LENGTH = 30'+ 33'= 63' TRENCH W1DTH = 3' SOIL RATING = 0.8 GPD/ft~ BEDROOM CAPACITY = 3 SEPTIC TANK = 1000 Twenty-four (24) hours notice required for all inspections. ~001 \03-017Trench- spec.doc .ERFORMED FOR; Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST DATE PERFORMED: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 '11 12 13 14 15 16 17 18 19 20 Coagt. gS TO ~b" WA, ORO~,NDWATER gO b_~¢.,~6('~I j~O~F ~-~,,.'r ENCOUNTERED? El Depth t° Waler After.2' MoAitorlnD? Date:. T~T rI°~ SITE PLAN I I 'I~I~LI I I~,1 I' I II I1,,,o'1'/I ~F'q/I I II I Gross Net Depth to Net Reading Date t~,~ q Time Time Water Drop · HERCOL;A=J'ION RATE / ~ (minute~inch} PERC HOLE DIAMETER TEST RUN BETWEEN {:~.0 FTAND 7'/-~ FT PERFORMEDBY_.~..fl~T'~,C~'~)~ ~. [,~/C)C?~ I _/~'~~~~RTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT CJN THIS DATE. 72-008 (Rev. 4185) EAGLE RIVER Joe c;,'~--OI7 l~o~SeT ,,,q ~6P£'/: L-~l ,4- ENGINEERING SERVICES s.E,..r.o or P. O. Box 773294 C A LCU LATE D B ¥,, ~J~-'-.~ EAGLE RIVER, ALASKA 99577 U^TE Phone 694-5].95 C.ECKED S¥ ~"' ,~ ! I i i i SCALE .......... '~ ............ ? ....................... ! .......................... ,~ ........... " ............. f ............ ~ ........................... 1 ......................................... t ............. ? ............. ~' ............ I ~,~,,~ .... ~.~,-./~ ~ ...... i ....... i ............ ~ ...... ~. ~ ..~ I t , ~ ; ! ~ .]"i.'"i" { { i I j { ~ i { ............................... i..~Z..i .....~ I ............ i .............. ~ ............. ~ .......................... ~ ........... 't .......... ~ ............. i ......... "~ ............. ~7 .......... i .............. { ........................... ~ ........... :'-7¢ ............. ~ ............. r , " { j' ........... ~ ............. z ............. r- ............. i .......................... J ............. J ............ ; ............. ; ............. ; ........... ¢ ............ ' ............. i ............. J ............. J. ........................... ~ ............. } ............ ~ ........................... ' ............. ~ ............. ~ .............. ~ ............. [ ..... ~ ............. ~ ............. ~ ...................... ~ ........... .......... ; .......................... ~B..~.~. .......... ;.~..~d.~.,~:.7...~ .......... ~ ............. L..>~.:.....~.o.,.~..~.~ ................ ~..z~.,...<.~_..!.o..c......¢,.E.~ ............ .~.~..~...~,~ .................. ~ ............ , ........... ~ .............. ~ ............. ' ............................ ' ............. ' ............ ~ ........... * ............ r ............ ~ .............. ~ ............. ~ ........... { ............. l ............. { ............ i .............. f ............. T ............. r ............................. ' ............................ f ............. ~ ............. ] ............ ~ ........................................................ ~ ............ ~i ........... ............. E~.¢r~.~..~. .......... : .......... i...rd~.~;.~.:......d~,~z.O......~'. ........... ~rC ~,~,,'~ ~:'[ ........... i .................................................... ~ ............. { .................................................................... I ........................................................................................................................................................................................... ~ ............. ~ ................. ~ ............ ~A.d6. ........ ~ .............. i ................................................................................................................. ......................... , ............. ~ ............. ~ ............. ~ ............ ~ ............. ;...~ ..................... ... , . ................ ~....y...,...2./o ......... , ......... ,.....~ ........... ,.~.~.~...~, .......... ~.....~ .............. ~.~......~......~,~ .... .......................................................................... ' ............. ~ ............. ' .................................................................. * , ......................................... ~ ? ........................... ' ............ ' ............. i ...................................................... " ............. ~ ........... ~ ............ *'-'"'"" ................................ I ........... i ...... ~ ~.~,~ ~ ~ ~. (i% S i~-z,~Td) ~ . ..i ....... ! ............ i ......... ! ............ t ............. t ........ t ................... { .......................... ~ ......... ! .... l ............ t ..... ............ ~ ............. ~ ............. i ............ i ............. i ............ i ............ i .................................................................... i ............ i ............. ~ ............ ~ ............ i ............ ! .................................................... ~ ............ ~ ............. ~ ............. ~ ............ ~ ............. ~ .................................................................. .......... ~ ............. , .............. .~.A:C:~ ............. .C..d..M..~.M;¢: ............ i.....:...~.......!..E~.~.~.z ~...~ .... i .......... ~ ..... ~ ~ ~ ~ ~ ' ~ ~ ~ ~ ~ .................................. ~ ................. i ....... I ...... ~ .... ! ........ l i ...~ ...... I. ..! . i ..I i i . , !, ! i ! , i ! i I I "~ i" i' '~ ......... i ....... i ...... i'~'~' i ............. i .......... :";'""'i .......... i ............ i .................... i .............. :'"'":";T:'""~ ......... i'"'"'"'~! ............ E'""T"7:FT"'"~'~" ........... i';'?r"T'"~'l ........... i ............. ! ........... i ............. i ........... i ............. ~ ............. L:.,..L:....i._~ ~ ..... t ............. , ............ ,.Y ... i:.. ~....~... ~ ~:.~..L¢.,,I ........... ! ............. ':~';~;'"'"'"r ......... T'""~'"2!: ........ i ............. ~ ........... [ ............ ~ ............ F'-';F":"~ ........... ~ ........... i ............. ~ ............ ~ ............. ~ .............. ~ ............ ~ ............. ~ .............. ~ .............. i ............. i ............ ~ ............ ~ ............ ~ ........... ~ ............. ~ ............. ........... ~ ............ ~_~.{G. ............. .I~t.~L..._3~.L.~4~...[ .......... ~ ..................................... 1 .......... ~ .............. i ............. ~ ........... ~ ........... ~ .......... ~ ............ ~ ........ ~ .... i ........ ~ .... ~ ........ , t , , I . , , · : i ' i i { j J I I ~ ~ ~ ' i ' { ~ ~ ~ '~ i { i ~ J I I i ' : ' ' F' ::: i ' i...:' :': I ~ ~ i ~ :_ ~ ~ t , ~ , ~ i ~ ~ , I I i I ......... i .... l .................................. ' ............. ' ....... ~ ............ i ........... r ............ ~ ............ ~ .......................................................................... i ............ t ....................................... ~' ........... i ............................................................................................... r ........ I , I I ~ , , , t I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot llA; Robert Aubrey Subdivision 23008 Tundra Rose, Chugiak, Alaska Location (site address ordirections) Property owner Mailing address Don Glenn P.O. Box 671308, Chugiak, Alaska Day phone 99567 265-8852 wk 688-2098 hm Lending agency Mailing address Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water :O:× If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA it21 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/orwastewaterdisposal 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. Name of Firm Address Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for 17034 Eagle River Loop Roa¢{ No, 204 - '- 2ivo. v, ;Mask~ qgCJ77 Phone Date bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Em ployees of DH HS do not conduct inspections or analyze data before a certificate is issued. Tl~e Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 {Rev. 1/91) 8ack MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT /l ~ ) l"~0~"~.7-' ~U~J?E"I" Parcel I.D. , 5//> A. WELL DATA ~-....._.. Well typ~B, or C, attach ADEC letter. ADEC water system nUmber Log preSent (Y/N) ~ riller__ Total depth ' Cased to Wires properly p r::i::;:)10" FROM WELL LOG $ ,S.t, alj~.water level ~-- ~ Pump level '"'"'""'"'"-~ _ SEPARATION DISTANCES FROM WELL TO: ::Ps:rClthi;~ifinegl~aon~,;7 lot ///J -'~""' ";On adjace? ; On a '~ Public sewer mai:n ///~' Public sewer manhole/cleanou~ Petroleum tank Sewer service line WATER S Colif~ Da~ of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~/~4-/~ Tank size /0(20 Compartments Cleanouts (~N) ¢¢'--,¢' Foundation cleanout(~N) ~E.S ~ Depression High water alarm (Y~) /~ Alarm tested (y/~)2 Date of pumpjng II/l[/qz Pumper ~'~,¢S' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /Uf[~ To property line ZO ~ Surface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots Absorption field /I¢ · ~ t~DI)/T/d/J '/'-¢ t.¢'ou$&.- Foundation ~ [ Watermain/serviceline UzJK/Jo¢~J ~"'Z~'-~0¢7' IE /--0/"¢1'T'~'.¢ 1/~ ¢~',~b¢,' ~'/~,~,'~; CONTINUED ON BACK PAGE I~~ATION Date ins~ Meets MOA electri~~~ ,S. ~~ANCE FROM LIF~ STtTION 70: ~~1~ FIELD B~A On adjacent lots Surface water Date installed ~ /Zz¢/¢(¢ Soilrating Length ~ Width ~' ~' Gravel thickness Total absorption area ~ ~''~ cd Depression over field (Y/~..~ N° Results(~)fail) Peroxide treatment (past 12 months) (Y/N) Manufacturer Manhole/Access (Y/N) ~ ".---'"'"~Pump off" level at ~es tested Cleanouts present (~N) Date of adequacy test for bedrooms If yes, give date MI/l, SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~/~ To building foundation On adjacent lots Surface water /'00 Curtain drain AYO.~'E On adjacent lots /OO/"J- Property line To existing or abandoned system on lot Cutbank AY//'4 Water main/servioe line__/O Driveway, parking/vehicle storage area ~'~E 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 $ 8, S ENGINEERING 17034 Ea.~lle River Loop Roacl No, 204 HAA Fee $ [ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number lunicipality o3 Anchorage Department of Health and Human Services Torn Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 24, 1992 S & S Engineering 17034 Eagle River Loop Road Eagle River, Alaska 99577 Attention: Roger Shafer Subject: Waiver Request for Lot llA Robert Aubrey Subdivision Waiver Request ~WR920076, PID #051-102-75, HA920792 Dear Mro Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. waived distance is 4 feet. The This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, · /'Robert W. Robinson Civil Engineer On-site Services RWR/lm HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P E. ROGER SHAFER1P.E November 19, 1992 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 11A; Robert Aubrey Subdivision Requcst you issue the attached Health Authority Approval and grant a separation distance waiver from th~ l~achfi~ld trench to the w~st property line at 4 fe~t. According to an as-bu~ survey performed by Robert C. Johnson in 1987 the end of the Icachfi~ld trench scales at approxlmat~ly 4 fe~t to the w~st property line. We fe~ the waiver may be granted for the following reasons: I. The lot line in question borders a platted roadway which is currently only minimally developed. 2. Since the w~st property line docs not abut an adjacent property, we do not anticipate any adverse effects on the development of any adjacent properties by the issuance of the waiver. If you require additional information for your review, please contact us. Sinc~rcly, ROGER J. SHAFER, P.E. RJS/tv 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 NOV- 9-92 lION 3:22 OORI~OSION ENGR FA× NO, 9072658272 P, 02 MUNICIPALITY OF ANCHORAGE DEPARYMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTiON FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lots 11/12 Robert Aubrey Subdivision Location (address or directions) (b) Applicant Name Don Glen Applicant Address Telephone: Home Business '265-8852 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Bank of the North Address 3301 C Street. Anchora[e (e) Real Estate Company and Agent Address Telephone % Debbie Ackerman 786-7323 Telephone (f) Mailthe HAAtothefollowingaddress: S & S 'Engin3e~ing TYPE OF RESIDENCE Single-Famil,~ Multi-Family [] Number of Bedrooms three(3) Other WATER SUPPLY Individual Well E~x Community [] Public [] Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~xx Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 St ENGINEERING FIRM PROVIDINL, ~NSPECTIONS, TESTS, FILE SEARCH, DA ~ND INFORMATION As certified by my seai affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 supp!y 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 Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of March 1986. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. Note: No horses or other livestock permitted within 75 feet of the well. DHEP APPROVAL Approved forThree(3) bedrooms by -~ z4)-'~'~..-,.,.~ Date June 11, Approved XXXXXXXXXX Disapproved Conditional Terms of Conditional Approval -/..~.,.~. ~. ,,.,~_.,',~,.-.~,~_ ,'~ ~~/~ ~,'~,'~ ,'~ 1986 CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representatiohs given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of OHEP 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. Page 2 of 2 ROBERTA, SHAFER June 4, 1986 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Susan Oswalt REFERENCE: Lot 11 & 12; Robert Aubrey Subdivision In March, 1986 you issued a conditional Health Authority Approval for the referenced property. Deficiencies noted in the cond~onal approval have been corrected in that the water line b~tween the new well and the house has been buried, final grading has been completed and all depressions have been filled, the old well has been properly abandoned and there is no evidence of livestock within the well protective radius. This residence is currently receiving its water supply from the Municipality of Anchorage temporary water supply project for the Peters Creek area. Therefore, the new well has not been placed in service. Request you issue a final HAA for the referenced property. if ~erely, ,e of further service, please contact SHAFER, P.E. SRB 196X EAGLE RIVER. ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Z-- Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) Applicant Name~-~'J ~__~---L_,~' ~J. Telephone: Home Business ~f~ ,~, Applicant Address Applicant is (ch~ck one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); Lending Institution4~,~W',~' ~F /,~f~ //'~/Clr'/h Telephone '~:~ ' Address .~,~0/ ~_. ,~', /Z)/~JC.~/ , - Real Estate Company and Agent Address ~ ~ AJ ~ (d) (e) Telephone (f) ,~the HAA to the following address: SRB 19Gx TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual WeftJ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,~, Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 (11/84) ~NGINEERING FIRM PROVIDIN,.. INSPECTIONS, TESTS, FILE SEARCH, DA mA AND INFORMATION 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 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. Name of Firm $ & S E.g;.eerlng Telephone Address S~B 196x E~,ql~. OJver, Alaska 99577 Date Approved for '-~ bedrooms by -~¢~: ~'' Approved Disapproved ~r-Cond!fionali CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or'(~missions in the professional engineer's ~work. Page 2 of 2 ' . -" DEPT. OF HE,~.TH & MAR 0 6 RE_ EIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MO~-,j HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: L ~_~"r' Well Classification '-~t~ t '~',~-'t'-~__ If A, B, C, D.E.C. Approved (Y/N) Date Completed ,~ ~_./~t.~ Yield Cased to ~OO -~ ~ ~ Depth of Grouting Pump Set At Sanitary Seal on Casing(~N) Depression Around Wellhead (Y/(~) Well Log Present(?)'N) , Total Depth ,~, ~:~ ~--~ Static Water Level / ~/' / Casing Height Above Ground 40 // Electrical Wiring in ConduiCY~N) Separation Distances from Well: To Septic/~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~.~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~..,~ ; Date Water Sample Test Results Comments ~ ~ ~L'~ B. SEPTIC/HOLDING TANK DATA Date Installed Z-"-~'L'[-~ &' Standpipes &l~-)~ Air-tight Caps~C.J~ Depression over Tank.,,¢¢'~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water.Math'r/Service Line Course Size f, CO ~ No. of Compartments ~ Foundation Cleanout d,~t~ , Date Last Pumped ~"~ I .,,~---- ;for f~ ~'~' Temporary Holding Tank Permit (Y/N) To Building Foundation [ 4:~ To Disposal Field IO~ ' To Stream, Pond, Lake, or Major Drainage Comments .Page1 ?~2: ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field ~--~-) Depth of Field 1~Z::~ ~ Square Feet of Absorption Area Depression over Field (,Y'~) Results of Last Adequacy Test Gravel Bed Thickness Standpipes Present ~/.~ Date of Last AOequacy 'rest Separation Distance from Absorption Field: To Water-Supply Well /. ¢) ~ I ~- To Building Foundation IO~ ~ Lot ~ ~ -,'~,~ ~ To Water-Main/Service Line ~ '~ ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~-'~ ~, ,~4, ~_.~. (~ ¢..~"Y~ ~, r,,~ (~ To Property Line 1D To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if.present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of thi'~ inspection. Signed ~, ~.- Date ~ ~ ¢ ~ ' ' Company Ea~le ~iv~, Al~a ~ MOA No. ~ ~ Receipt No. ~ '~-~ ~ ,-~ ~ Date of Payment ~ ~[~ ~ Amount: $ ~ ~ Page 2 of 2 72-026 (11/84) CHEMICAL & GE61 )GICAL LABORATORIES {,. 'ALASKA, INC. 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D, NO. (*) See h on back Water System Name Mailing Address Phone No. City State MO. Day Year SAMPLE TYPE: d_Rou.ne [] Check Sample (for routine sample with lab reL no, [] Special Purpose [] Treated Water .~t;~Unt reated Water Zip Code SAMPLE NO. Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,~3atisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: [] Fermentation Tube [~Membrane Filter I I [.ab Ref. No. Result* Analyst/' 06-1220 (b) Rev. 1983 BACTERIOLOGICAL WATER AI~ALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB BGB Final Membrane Filter Results /{.~.'~ Reported By ~i~-~ ~,~//'~ ~ D~te Time: TNTC = Too Numerous To Count Coilformll00ml Coilformll00ml a.,,,. ' unicip lityof P.O, BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES March 19, 1986 Ted Hawley Advent Engineering 3941 Twilight Lane Anchorage, Alaska 99516 Subject: Lots 11 and 12 Robert Aubrey Subdivision Waiver Request, WR86-033 Dear Mr. Hawley: This Department has denied your request for a waiver of the separation distance required between a well and 'other potential source of contamination. In this case, the potential source of contamination considered was a barn and corral located within the required 75 foot separation. A risk analysis indicated that chemical contamination of the well was a possibility. Your request was denied on this basis. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw MUNICIPALITY OF ANCHORAGE r'NVIRONMENTAL PROTECTION Advent Engineering J'.~AR ~ ~ ~j 3941 Twilight Lane Anchorage, Alaska99~16 RECFIyFD Municipality of Anchorage Department of Health and Environmental Protection 825 "L" Street Anchorage, Alaska Attention: Steve Morris Regarding: Separation distance waiver request for Lots 11 & 12, Robert Aubrey Subdivision S 9, T 15N, R 1W Dear Steve: Advent Engineers was hired by the owner, Mr. Don Glenn, to attempt to obtain a separation distance waiver for the above referenced property. The well and septic systems are newly installed, refer to the attached Permit No. 860012. Separation distances between these and surrounding systems are satisfactory. The potential problem lies in the location of the well in relation to a barn on the property. The owner recognized the potential for well contamination with the arrangement, and desired Municipal approval of the entire arrangement. The owner wishes to advertise the property for sale with the barn listed as a sales benefit. The accompanying site plan shows the location of the barn on the property. At present, 20 rabbits are the only occupants of the barn, although the barn with its attached corral allows room for 2 horses. Also attached are copies of the soils log used in obtaining the well and septic system permit, and of the well log. These documents show pertinant technical information relevant to this request. Topography on the site is such that it is possible for water from the barn/corral area to flow towards the well. Such water could occur due to washing of the barn floors, heavy rainfall, or spring runoff. Slope from the barn to the well is estimated to be no more than 1%. The well is not located in a depression, so even if a large amount of water was flowing from the barn area, it is expected that only a small portion of it would actually reach the well casing. If this did occur, pollution of the aquifer is anticipated to be a remote possibility unless direct flow along the well casing also occurred. Considering the 202 foot well depth and the number of clay layers shown on the well log, the possibility if aquifer contamination seems even more remote. To mitigate this possibility, we suggest that the well be sealed as shown in the attached sketch. This system would divert flow outward from the well casing so that it would infiltrate into the surrounding soils and thus obtain purification by biological action. If this method of sealing is employed, we would require that the system be inspected by a field engineer prior to burial. If this waiver request is granted, based upon sealing the well casing as specified, we feel that there would be no negative impacts. The property has a history of being a home for domestic animals, and this would probably continue. Positive impacts would be that the owners could enjoy having animals with a degree of assurance that they would not be endangering their water supply. We request that you review the attached information, and make a decision on whether a waiver would be acceptable to your Department. If you require further information, or have any questions, please call Ted Hawley at 243-7782. Sincgrely~ ~ /~ doc: Glenn /__d'F (0 .4P?¢2o>: Cc4~. -C' /;: ~o0' / unicipallty Anchorage P.O. B~JX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES April 7, 1986 Ted Hawley Advent Engineering 3941 Twilight Lane Anchorage, Alaska 99516 Subject: Lots 11 and 12 Robert Aubrey Subdivision Waiver Request, WR86-033 Dear Mr. Hawley: Your waiver request for the subject property has been reconsidered in light of the supplemental measures proposed to divert surface runoff away from the well casing. Your request for a waiver of the 75 foot separation distance required between the well and the barn and corral on the subject lots has been conditionally approved. The barn and corral were considered as "other potential source(s) of contamination" requiring a 75 foot separation to a private well as stipulated by 18 AAC 72-021. The conditions of this waiver are as follows: 1. The well casing must be sealed at two levels along the casing with concrete, grout or other suitable material as described in your submittal (see enclosed). Documentation that properly constructed seals have been installed must be submitted to this department for this waiver to be considered valid. 2. A simple french drain must be installed to divert surface runoff away from the well. This drain shall be installed in the location and according to the specifications in the attached plan. Documentation of proper construction must be submitted to this department. The drain system must be maintained in a functional condition for this waiver to be considered valid. Ted Hawley Advent Engineering April 7, 1986 Page 2 3. Ail manure, soiled straw and other contaminated materials must be stored a minimum of 75 feet away from the well casing. This waiver may be revoked at any time at the discretion of this department or the State Department of Environmental Conservation. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw 4-1-86 MUNI~IPA[I?¥ OF ANCHORAGE D~P~, OF H~ALTH & Advent Engineering ENVIrONMeNTAL P~OTE¢~ION 3941 Twilight Lane Anchorage, AK ~L ~ ~] 99516 RECEIVED Municipality of Anchorage Dept. of Health and Human Services Environmental Health Division 825 "L" St. Anchorage, Alaska 99502 Attention: Stephen S. Morris Regarding: Separation distance waiver request for Lots 11 & 12, Robert Aubrey Subdivision S 9, T 15 N, R 1 W, SM Waiver Request WR86-033 Dear Steve: Enclosed is supplemental information to the previous waiver request on the subject property. The supplemental information consists of a floor plan of the barn, and a berming plan which would divert runoff from the barn and corral areas away from the well casing. Please note that the timbers underlying the barn would direct all flows from the corral to the north and south, and in conjunction with the berms would keep most of the potential runoff a minimum of 20 feet from the well casing. It is proposed that these measures would be employed in addition to the previously proposed well sealing program. We request that you re-review the waiver request considering this additional information. If you require further information, please call Ted Hawley at 563-2286, ext. 60. Ted Hawley $ '~' .... °; "~ Field Engineer ~~'~5 ~ I /2 (,.---, 0___ o Vg. g gD O 7-0 f2fOf., C ii po-~-~ z~L Le '1 7-1 r~g L~ Z. ors fid/?_ ,L ,. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 LStreet-Anchorage, Alaska 99501 s 'e' 1 9 1978 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 .RECEIVED 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. PROP~ OWNER MA~L~ ~S~ / PROPERTY RESIDENT (If diffe~nt from above) ' PHONE 2, BUY~ / MAI LING AD. ESS 3, LENDING INSTITUTION ?' PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS ' /) ~ [] One [] Four [] Other~ [] Two [] Five ~L Three [] Six 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM T~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 7f2-010(3~78) THIS SIDE FOR OFFICIAL USE ONLY ',. DATE RECEIVED INSPECTION APPOINTMENTS TIME TiME TIME DATI:' DATE DATE -- INSP~TOR INSPECTOR INSPECTOR DIRECTIONS: I, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER F~] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDI VI DUAL/ON -SITE '~ATE INSTALLED E~PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size:____. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I I~learest Lot Line J WELL TO: 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) Bill % C~mi!le Davis Consultants 127 ~{~st ~.~'~,.~eed $~Ject= i~ot !! a~d 12 Robert Aubrey Subdivision Yn in~psction %-~a~ performe~, on the above subject property. ~il! nsed to be co~a?!eted. (1) Lop, ate %he ~ell and raise th~ casing t~]eive(12) inch~s twelve (1~) inche~ above grog!nd level. (3) Pt~p the septic tank to verify its siz~ and for maintenance pur?os~. (4) If the se~er systeY~ is one-hundred(!O0) feet fro~ th~ w~ nave a ~2e.~.co ..... ion t~:~st D~rfomed to d~ter~d,ne if the syst~n Is adequats for a three(3) ballroom singl~ family residence. If the sewer ~oes ' ~fastance not [~eet t~.e'"--c~-~ ~-~m~(~ v'-'~ (io0).~ ..... .....-.~ foot. ~ Bill Yates Sept~er 27~ 197~J (5} If %he septic tank is not large enough for a three(3) ~droo~ r. esidence~ it v~ilt need to be upgrade(! to meet the minimum% require~%%ents. tast~ an uPg~aJ~ ~!! be~nee~.. Prior to the u~ra,.~e a soils test must be obtainad and a permit issued by this departzdent. If there are any ~estions~ pt~ase contact this offic~ at 2~4-4720, RCP/I j w oc~ Alaska National Bank of the North i-~ort~-ge Loan Section % Sharon 3301 C Street 99503 Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~ Date Received ,.~/ Time of Inspection ~]~ Date of Inspection INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: ~~c~ ~ Mailing Address: ~0, ~ ~79 Phone: ~.-~/~-- 2. Property Owner: ~~ ?f-. /~>~c%l~ ~ ~~Phon - ~/~ Mailing Address: ~©, ~ ~ ~//~~~~ ~ 3. Legal DesCription: ~-~Z~ // ~/A c~ ~. C~ ~ 4. Location: ~ ~c~o~ ~ O_~/~o~x~m~ c~ . ~ 5. Type of facility to be inspected No. of bedrooms 6. Well Data: A. Type ~L~c~_y C. Construction Sewage Disposal System: A. Installed B. Depth D. Bacterial Analysis B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area , Sewer Lines , C. Absorption area to nearest lot line LQ-034 (1/74) Page 1 of two oaees GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO ;,_~/.,q.S~] FHA 2. Property Owner: Mai.ling Address: ~gT /~Tt~ ~RcrvDay Phone. - 3. Name of Buyer: o CONV Day Phone 3-~ -l"7/Z"/ Mailing Address: ~(J ~ E ~')fl (~[~e~/ Name of Lending Institution: .A/ ,~ ~ Mailing Address: ~ ~. ~~ ~ ~ ...... Phone Name of Realtor~A~~~ ~ ~~~ Mailing AddrO~ ~ 0 ~ X ~ Phone __~ ..... ~- ~~ 6. Legal Description: on: Locati 7. 8, Type of Facility to be inspected: No. Bdrms. Water'Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site) EQ-037 (~ / Pagq. 2,of two pages - ReL Legal Description ~t for Approval of Individual S Jr & Wate'r Facilities Comments Approved .~~. ~-~~ Disapproved Date ./ Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~-/'F/ /, Time of Inspection ~-~ ~ ~~~' Date of Ins~pection _~_i1~ ' "~OJV'iDDAL SEWER & WATER FACILITIES FOR 1. Approval requested by: 2. Property Owner: ~-~Z~,~,~/ Phone: Phone: Mailing Address: 4. Location: Type of facility to be inspected Well Data: A. Type B. Depth No. of bedrooms C. Construction D. Bacterial Analysis Sewage Disposal System.~/~~ A. Installed C. Septic Tank: 1 Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 2. Material 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line B. Foundation to septic tank , Other contamination , Absorption area C. Absorption area to nearest lot line__ FO-034 (1/74) Pame 1 of two oaQes ~ge 2 of two pages - Ret st for Approval of Individual . .er & Water Facilities I~eg~l D'es~ri'ption ~7~ /X ~~ ~~-? c~ Comments Approved Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., AnChorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: Mai-ling Address: 3. Name of Buyer: Mailing Address': 4] Name of Lending Institution: Day Phone. Day Phone CONV Mailing Address: Phone Name of Realtor or.Agent: _ Mailing Address: ~'~'~v/¥~:~ Phone 7. Type of Facility to be inspected: No. Bdrms. ~. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation EQ-037 (~/74) O?,!,jGh(,j(., ;~,[./.',,, ~A 99567 invoice Customer's Order 0 DATE SHIPPED SHIPPED VIA TERMS F.O.B. SALESMAN RedF~rm - 7s73o'Z INVOICE September 27, l POUC,~. 6-650 ANCHORAGE, ALASKA 99502 (907} 264-4111 GEORGE M. SULLIVAN, MA YOR · DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "'L" Street) Bill Yates % Camille Davis Consultants 127 West Fireweed Lane Anchoragev Alaska 99503 sUbject~ Lot 11 and 12 Robert Aubrey Subdivision An inspection was performed on the above subject property. The sewer system and well were not located. Therefore, before approval may be granted several items will need to be completed. (1) Locate the well and raise the casing twelve(i2) inches above ground level. (2) Locate the sewer system and extend the cleanouts twelve(12) inches above ground level° (3) Pump the septic tank to verify its size and for maintenance purposes. (4) If the sewer system is one-hundred(100) feet away from the well, have a percolation test perfomed to dete~tne if the system is adequate for a three(3) bedroom single family residence. If the sewer does not meet the one-hundred(100) foot distance requirement to the well, either the well or sewer will need to be relocated. Bill Yates September 27, 1978 Page Two (5) If the septic.tank is not large enoug~ for a'three(3) · bedroom residence, it will need to be upgraded to meet the minimum requirements. . In the event the sewer system does not pass the adequacy test, an upgrade will be need. Prior to the upgrade a soils test must be obtained ahd a permit issued by this department. If there are any questions, please contact this office at 264-4720. Sincerely, /~ Associate Specialist RCP /l w cc: Alaska National Bank of the North Mortgage Loan Section % Sharon 3301 C Street 99503 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ' 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 CERTIFICATE OF INSPECTION SEWER AND WATER FACILITIES 1, PROPERTY OWNER Bill Yates and Denise Boies MAI LING ADDRESS 2, LEGAL DESCRIPTION Lot 11 and' 12 Robert Aubrey Subdivision 3, TYPE DWELLING SINGLE FAMILY RESIDENCE MULTIPLE FAMILY RESIDENCE OTHER (Describe) 4. WATER SUPPLY P-~ INDIVIDUAL COMMUNITY/PUBLIC 5. SEWAGE DISPOSAL INDIVIDUAL/ON-SITE PUBLIC UTILITY r-q HOLDING TANK (Maintenance Required) E3 APPROVED FOR BEDROOMS I--] CONDITIONAL APPROVAL (See Attached). ' SEAL'- DISAPPROVED Did not comply with letter of September 27, t9~78' DATE October 72-O14 (3/78) IBY {TITLE~} LOC'A'"FED IN T H SECTION ONE' WE-,ST, SE-WA'PuD ME'P,.,IDIAN ALASKA 'BY: ~EC- PIP~, ANCHORAGE P,~ECI NCT, Anchorage, Alaska FILED FOR District Recorder ~: ...~.~.... j3.~ ~..~.,.,~.~..~.~h~ ~i~ To:...~.B.~.~}-~k ~l~e~ SCALE'' fL' 10 O' 'F"I%O'PO~ ED 30 ~O~D ANCHORAGE PRECINCT Anchorage, Alaska ~is~jct Record~ ~y=~.~=..~..~_~.~ .............. ........ ~k~.~ ........................ Grid NW 1359 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET cAsE NUMBER: S-8546 DATE RECEIVED: S~ptember 3, 1986 SUBDIVISION OR PROJECT TITLE: COMMENTS DUE BY: September 26, 1986 Lot llA Robert Aubrey Subdivision ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE - COMMENTS: /~/g:~ ~' ~'~q~ ~ -'~"' ~ ~?~'ELIMINARY PLAT APPLICATION '~"" OFFICE USE Municipality of Anchorage REC'D BY: DEPARTMENT OF COMMUNITY PLANNING P.O. BOX 6650 VERIFY OWN: Anchorage, Alaska 99502-0650 A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. 0. 1. Vacation Code Case Number (IF KNOWN) New abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). Existing abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34) full legal on back page. l l,,l tfl I,d ldyl ,:-Iokk 4. Petitioner's Name (Last- First) ill Address Phone No. 5. Petitioner's Representative ~ ~ ROBERT C. JOHNSON Address -J~ Registered Land Surveyor - 694-2543 .';~..~.,~ Box 456-- Eagle River, Alaska 99577 City __ Phone No. Bill Me __ 6. Petition Area Acreage 12. Fees B. Date: Proposed 8. Existing Number Number Lots Lots 9. Traffic Analysis Zone 10. Grid Number 11. Zone 13, Community Council I hereby certify that (I em) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it in conformance with Chapter 21 oi the Anchorage Municipal Code of Ordinances. i understand that payment of the basic subdivisio~n fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may be have to postponed by Planning Staff, Platting Board, Planning Commission, or the Assembly dueto administrative reasons. Signature 'Agents must provide written proof or authorization. Please check or fill in the following: 1. Comprehensive Plan -- Land Use Classification Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan -- Land Use Intensity Special Study Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation Marginal Land Commercial/Industrial Public Lands/institutions Alpine/Slope Affected Industrial Special Study Dwelling Units per Acre Alpine/Slope Affected Avalanche Floodplain Seismic Zone (Harding/Lawson) Please indicate below if any of these events have occurred in the last three years on the property. ~" Rezoning Case Number, Subdivision Case Number Conditional Use Case Number Zoning ~/ariance Case Number Enforcement Action For Building/Land Use Permit For Army Corp of Engineers Permit Legal description for. advertising. Checklist Waiver 30 Copies of Plat -- Reduced Copy of Plat (8'/2 x 11) Certificate to Plat Fee __ Topo Map 3 Copies Soils Report 4 Copies Aerial Photo Housing Stock Map --. Zoning Map ~ Water: Private Wells Community Well Sewer: ~ Private Septic 'community Sys. Public Utility Pu'~tic Utility Back MUNICIPALITY OF ANCHORAGE MEMORANDUM DATE: February 18, 1987 TO: Jae Winn, Community Planning Department FROM: Susan Oswalt, DHHS On-Site Services SUBJ.: S-8546, Robert Aubrey Subdivision Following passage of AO No. 86-198 on January 6, 1987, this plat conforms to requirements set out in AMC 15.65. This department has no objection to the plat provided a plat note is added which states: "No more than a three (3) bedroom dwelling may be constructed on this lot."