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ROLLING HILLS ESTATES BLK B LT 4
I ol I lng Hill lock Lot 4 NO1 1-072 -15 - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES / Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~am~ ~ DISTANCES SEPT,C A,S0DPT 0, WELL Address TANK FIELD Phone(s) Permi~ No. ~ NO. oi Bedrooms Township,~~Range, Section~ ~ ~ ~~ driveway, water boOies, etc )AS'BUILT DIAGRAM (S~o~ location of well, septic system, property hnes, foundabon, TANK~ ~ ~ -' - N ~EPTIC ~ HOLDING Manutacturer Capacity in gallons ~ ~ TYPE OF SYSTEM ~RENCH ~ BED ~ W. DRAIN ~OTHER ~ Fill added above orig~nm grade Grave~epth beneath p~pe Tota~ absorphon area ~ Dislance between lines q~ SO FTi ~ FT Number o, lines Soil rating Pipe material ~ WELLS ~ ,, IVATE ~ OTHER (Identify) Classification (A,B,C) Total Depth Jo~eCto ,nstalle, Date installed: Sca,e: I ~ ~ ~ ~NGINEEEIN~ cedify that this inspection was pedormed according to all ~ ~,?.~ . , ~034 ~ele River Loop R~d No. 2~ Certified Well Locat ion....~.....0..~.7......~/~...~... Date co p ....... Depth of well... ........~.~.,L..:.: ............................................... : .......................... Size of casing .............. .~.~. .............. Distance to water....:....Z~..~, ............................................................................ Distance to water while pumping._...~.~:.~___..L[. ............................ at ~ate o~ ........ ~..~g~ ................... ,.g~n0n, pe~ no,~." Des~iptton of Fomation ~..:~ [ . from certify the ~' HiWi]H ,.-K Dri renard Roa , 'W~:'advise you to 'attach"this certificate to your-deed. SPECIFICATIONS ~OR A TRENCH-TYPE WASTEWATER DISPOSAL SYSTE~ FEB 3:'1989 LEGAL DESCRIPTION: LOT 4, BLOCK B, ROLLING HILLS ESTATES GENERAL RECEIVED t.1 The drawings, sheets 1 througb 4, shall be a part of this specification. All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. Ail elevations and depths are advisory, and are to be verified or modified in the field by the engineer or inspecting agency, 1.4 It is the responsibility of the owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed s~stem. An engineer at AECS should be consulted prior to construction to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, it may be used if it meets the capacity requirement for the residence and the approval of the MOA. 2.2 The septic tank shall be a UPC-Approved two-compartment tank, constructed of 12-gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial 'type polystyrene rigid board insulation. 2.3 The septic tank and trench shall be a minimum of 100 feet from any private well or body of water, ].50 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight calder coupling on the outlet and inlet of the septic tank. Piping shall be 4-inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation. 2.6 Cleanouts shall be instal]ed as designated and capped with air-tight rain caps (Jim caps or equivalent), and extended a minimum of 1 foot above ground level. 2.7 If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. Specifications are attached. 3.0 ABSORPTION AREA 3.1 The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than 3% passing #200 sieve residual. All substitutes must have prior DHHS approval. 3.2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level. 3.3 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D3034, or cast iron. The section shown with holes may be 0.5 inch holes drilled on 6-inch centers on opposing sides of tile pipe, or a regular section of perforated sewer pipe clamped to a solid section with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be installed over the top of the pipe. 3.4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of 1500 lbs and shall meet the approval of DHHS for use as drainfietd pipe. All distribution pipes shall be laid level. 3.5 Trenches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or 2 times the gravel depth (whichever is greater). 75 feet is 'the maximum allowed linear length of any trench. 3.6 If the final grade over the trench is less than 4 feet above gravel, insulation is required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3,7 If insalation is not necessary, the gravel shall be covered with a layer of nonwoven Geotextile fabric (such as Mirafai, Fibretex 200 grade, Poly Filter X or equivalent). 4.0 INSPECTIONS 4.1 A minimum of two inspections are required for the installation of the trench. The first inspection will be of the open excavation to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. 4.2 4.3 The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify proper installation and position prior to backfill, The inspection of tile septic tank installation can be incorporated with any one of the above listed inspections. PERFORMED FOR: LEGAL DESCRIPTION: Z. ~ ~'~ ~,~.,j~.'~'~_ 1. _~ ~ ~ ~. (ENGINEER'S SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI 825 "L" Street. Anchorage. Alaska 99502-06~;~,,-, so,.s .o. _ ...co...,o. 3 4. 5 6 7 8 9 10 11 12 13 14 15 16- 17- 18- 19 2O SLOPE OF ANCHORAC~ OF HEALTH & PROTECTION -'B CEIVED WAS GROUND WATER ./_ ENCOUNTERED? S IF YES, AT WHAT (~ DEPTH? p E SITE PLAN iI III1'11.1 II ~ ~ I I-'.'1 I I Deplh to Water After.~),,~ f MonitorinD? late: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN __ ~- 7~" (minutes/inch) PERC HOLE DIAMETER "~ FTAND & FT COMMENTS PERFORMED BY: A~'~ ~' ~''J I ~ ~L~/~'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~-"~/-- 72-008 (Rev. 4/85) ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO, ~ OF C^'CUL^TED SV t/' ~J~-,l DATE CHECKED BY DATE SCALE ........ i ........ ~ ~ .... i- i ...... 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L .............. i .............. i ............ .i .............. [ ............. ~ ............. ]....~.....~.....c..~,...J ......... i' ............ i i i ....... i .................. ~ ~~':' ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. ~1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CHECKED BY. DATE \ ° = %o o ~ Torn Fink, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 20, 1989 Leroy C. Reid, P.E., PhD. Alaska Environmental Control Services, Inc. 1412 West 33rd Avenue Anchorage, Alaska 99503 Subject: Request For Additional Information For Waiver WR89-002 Lot 4 Block B Rolling Hills Estates, PIN 011-072-15 Dear Mr. Reid: Before the subject waiver can be processed, the following information must be provided: 1. As-built inspection of the existing seepage pit and bed. 2. A soils log/perc test/water monitor should be provided with the inspection report. 3. To assist me with the waiver procedure a site plan delineating the as-built septic system, all wells and septic systems on surrounding lots and general slopes of the subject lot and surrounding area should be provided. If you have any questions of the above request, please contact me. Sincerely, Daniel J. Roth Civil Engineer Acting Program Manager On-Site Services Program ALASKA enUlRonmenTAL COI1TROL SeRUICeS, Inc. ~nqineerinq ~ ~nui~'onmenlaJ Studies ¢ )NM NIAL Si;-~/k i:s DIVISION J~nu~ry 5, 1989 Municipality of Anchorage Department of Health & Human Services 825 L Street, 5th Floor Anchorage, AK 99501 ATTN: Dan Roth RE: Lot 4, Block B, Rolling Hills Estates The separation distance from well to absorption field is reported to be 82 feet from the May 18, 1985, Health Authority on file. The distance from well to crib standpipe is 101 feet. The absorption field is reported to be a log crib and a bed. The crib is 20'x 20'>~ 14' . The bed size and location are unknown. An adequacy test on December 8, 1988, shows the absorption field is working adequately for 3 bedrooms. The septic tank was exposed for inspection of integrity and found to have rust holes through the top. A new 1000 gallon tank needs to be installed at a minimum of 100 feet from the well. On December 1, 1988, a well flow test was performed. The well is 92 feet deep with a static level of 75 feet. The yield is 2.8 gpm with ~ total drawdown of ll feet to the pump intake. The well log shows an abundance of clay down to 85 feet and would be cased to the bottom. Water samples taken December 1, 1988, are satisfactory. The lot is level. We request that you grant a waiver of 82 feet for well to absorption field. If you approve this waiver, we will immediately apply for a septic tank permit. If you have any questions, please call. ACW/sr Sincerely, Alan C. Wien Senior Engineering Technician ,5 7D, cD, C) ~3 ,rio (oo'o8~ H_L~Onl} ...?o'oi CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. " FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order t 10735 Date Report Printed: DEC 5 B8 e 15:10 Cllant Sample ID:L4, BB, ROLLING HILLS EST ~WSID ;UA Collected DEC I 88 ~ 17:35 hrs. Received DEC 2 88 ~ 16:05 ks, Preserved wlth :4 DEO, C Client Name : AECS Client Acct; AKECMRP P,O.$ NONE REC'D Ordered Ry : Analysis Completed :DEC 2 88 Send Reports to: Relea. edBy : ~ii;~ C. ~.~' 2) Special Instzuct: Chemlab Ref I: 3626 Lab Smpl ID: 1 Matrix: WATER Allowable NIT~ATE-N 2.5 m~/1 EPA 353.2 iD Sample ROUTINE SAMPLE 1 Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Lese Than, GT-Greatez Than MUNICIPALITY OF ANCHORAGE MEMORANDUM January 26, 1989 TO: Accounting & Budget FROM: ESD, On-site Services/Water Quality SUBJECT: Request for Refund - 2570-9526 On January 5, 1989 a request for a waiver was applied for by Alaska Environmental Control Services, Inc. Upon an brief review it was determined the on-site disposal sYstem would need to be upgraded, therefore, distance requirements would then have to be met making the waiver request not necessary. Please make arrangements for a refund to be processed for the following: Alaska Environmental Control Services, Inc. 1412 West 33 Avenue Anchorage, Alaska 99503 Amount: $590.00 Account: 2570-9426 Legal: Lot 4 Block B Rolling Hills Estates PID $011-072-15 Thank you. Laura J. Ward On-site Services attachements Municipality of Anchorag6 ~ OSm DEPARTMENT OF HEALTH AND HUMAN SERVICES 20 876 Environmental Services Division Telephone: 343-4744 ................ ON-SITE SERVICES FEE DOCUMENTATION Date Paid: /-- s~&~ Name of Paver: (l~me on Check) -- Mailing Address: (Off of check) . ~./ i 200 6.>~B~""" ~ ~ Legal Description(s): Permit Number: TyPe of paYment: (Indicate Amount Paid) ..H.~alth AUthority: ~:"~er & Well Permit: Well Permit: Sewer Permit: Copy Request: Excavator Permit: Engineer Permit: Pumper Permit: Well Driller Permit: Tank Manufacturer: 72-034 (Rev. 10/87) WAIVERS:' Lot Line: Well to Tank: Well to Field Field to Surface Water Tank to Surface Water (Waste Treatment) DIS.TRIBUTION: WHITE--MASTER FILE CANARY--PROGRAM FILE 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. o3.:t-o72-3.~ 1. GENERAL INFORMATION Expiration Date: ,! Complete legal description Rolling Hills Estates, Block B Lot 4 Location (site address) ";2~7 West 73'rd Avenue, Anchorage, AK Current Property owner(s) Mailing address Lending agency Mailing address Robert & Evelyn Peterson 1415 Angler Drive, Kenai, AK 996zz Day phone Day phone Real Estate Agent Mary Cox/ReMax .M~iling Address un~less °therW'j~:e requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: TypE oFWATER SUPPLy: Individual Wel Individaal Water Storage Community Class Public Water System Day phone 257-o16~; .4 Well 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. DSM 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 Pannone Engineering Services, LLC Phone 2_72-8228 Address P.O. Box :too2~_7, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 81~-71~.~- Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, round water levels that may fluctuate during the year, and the water usage of the family beimz serv~ by the system .... - - - -. ' These condit~ons are outside the control of the evaluator ofth~s system. All systems eventually fad and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ~.....~...~....~ performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev, 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other '~~/~ Original Certificate Date: ~- ~2 ~-// 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: A. WELL DATA Well type _P Date completed Total depth 9= ft. Rolling Hills Estates Block B Lot 4 If A, B, or C provide PWSID # ~ Sanitary seal (Y/N) Y Date of test Static water level 7:z Well production ~o WATER SAMPLE RESULTS: Coliform'~----~olonies/100 mL Arsenic:.~, ~0ug/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size __ gal. Foundation cleanout (Y/N) __ Date of pumping C. ABSORPTION FIELD DATA Date installed Length Total depth ~ ft. Date of adequacy test ~ Cased to 9= ft. FROM WELL LOG 81', nl:t97~. g.p.m. Nitrate ~' mg/L Date of sample: 81~.?1~,o.,~. Parcel ID: ozz-o72-~5 Number of Compartments Depression over tank (Y/N) ~ Pumper Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) AT INSPECTION 81', ,~l:zo', ~. 77 ff. 6.,~+ g.p.m. Collected by: Laura Pannone Date installed Cleanouts (Y/N) High water alarm (Y/N) Soil rating (g.p.d./ft2 or ft2/bdrm) ~ ft. Width ft. Eft. absorption area ft2 Monitoring tube~ Results (Pass/Fail) Fluid depth in absorption field before test~ in. Elapsed Time: ~ min. Final fluid depth ~ Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added in. System type Gravel below pipe Depression over field For ~ bedrooms ~ gal. New depth Absorption rate >= If yes, give date in. in. g.p.d. LIFT STATION Date installed "Pump on" level at__ Datum Size in gallons in. "Pump off" level at~ in. · Cycles tested E. SEPARATION DISTANCES Fo Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots [oo+ On adjacent lots N/A / Public sewer manhole/cleanout 100+ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 8o' Absorption field on lot N/A Public sewer main 7~i+ Sewer/septic service line a=p c~ u~ Holding tank ~.oo+ Animal containment areas ~oo+ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~o Property line ~o+ Absorption field N/A Water main [o+ Water service line 2~i+ Surface water ~.oo+ Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots COMMENTS in. Public Sewer with Lift Station w/grinder due to gravity issue on house outlet. G. ENGINEERS CERTIFICATION I ce~ify that I have determined through field ~nspections and ~ TH ~ ~ I h he boy 'stems are ~n review of Mun~c~a taco,s t at L a e s~ ' conformance w~h MOA COSA guidelines in effect on this date. ~~...~ ............... . . . ~~'F~'~'~-g~'~ Engineer's Pnnted Name Steven R. Pannone, P.E. '~'~'..~ ~,~ Date 8/~7/~o~ COSA Fee $ ~13 ~ Waiver Fee $ Date of Payment~[r(~' [ [~ Date of Payment Receipt Number ~ ~ ~~ Receipt Number (Rev. 11/05) SGS Ref.# 1113841001 Client Name Pannone Eng. Srv. Printed Date/Time 08/23/2011 13:46 Project Name/# Rolling Hills Est BK BLt 4 Collected Date/Time 08/15/2011 9:00 Client Sample ID Rolling Hills Est BK BLt 4 Received Date/Time 08/15/2011 16:40 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 5.40 5.00 ug/L EP200.8 C (<10) 08/18/11 08/22/11 NRB Waters Department Total Nitrate/Nitrite-N 0.125 0.100 mg/L SM204500NO3-F B (<I0) 08/16/11 AYC Microbiolog~ Laboratory E. Coli Total Coliform Negative I 100mL SM20 9223B A 08/15/11 DLC Negative 1 100mL SM20 9223B A 08/15/11 DLC ~Vc r~! ,) -.~.ASEMENTS OF RECORD, OTHER THAN FI-lOSE SHOWN ON THE RECORDED 'q. AT ARE NOT SHOWN HEREON. I hereby certify that I have surveydd the following ~o:~,'z~_ ...~'~:~.:.:.~~. : ....... .: :.....'..'."..' '..:. Anchorage' ReCOrding Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not, overlap or encroach on the property lying adjacent thereto, that nO improvements on prop- erty lyhng adjacent 'thereto, encroach on the' premises in question and that there are no roadways, transmission lities or other visible easements on said property except as indidated hereon: Dated at Anchoralle, Alaska thi~1~t _clay of~/~ ~y ..... FRED WALATKA & ASSOCIATES Engineers and Surveyors Municipality of Anchorage P.O. Box 196650 ® 4700 Elmore Road Anchoraqe, Alaska 99519-6650 ® (907) 343-7904 · Fax (907) 343-7997 ..h..ttp:llwww.muni.or,qlOnsite Development Services Department On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** WR#: OSPl11226 HA#: OSCl11313 Permit: PID#: 011-072-15 Legal Description: Rollin.q Hills Estates, Block B, Lot 4 Engineer: PES Applicant: Robert Peterson Your request for a waiver of the required 100 feet horizontal separation from the sewer manhole or cleanout to the private water well has been approved. The approved separation distance is 80 feet from the sewer manhole (lift station) to the private water well, and 46 feet from the sewer cleanouts to the private water well. This waiver approval applies to the existing conditions only. Any furore 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: 8/26/1_~1 Approved by.'~' /'J' Name of Reviewer Rec#: 086293 Amount: $1,050.00 Date Paid: 8/26111 **** VARIANCE/WAIVER REVIEW **** Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-maih steveCCpanengak.com Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 August25,2011 Subject: Rolling Hills Estates, Block B Lot 4 Private Well to Lift Station Waiver Request Private well to Sewer Service Clean-out Ladies and Gentlemen: I am writing to request a separation distance waiver between the existing private wells serving this property and an existing sewage lift station serving this property to 80 feet and a separation waiver to a private clean-out to 46 feet. The existing lift station is a 500 gallon tank with a grinder pump that lifts the sewage into a four inch Tyseal service line that flows into an AWWU sewer main in 73rd Ave. The Tyseal pipe joints are sealed with rubber gaskets. The steel tank was installed in 1998 and was documented by AWWU. See the attached inspection Report. The well on Lot 4 was drilled in April of 1985 when the house was originally built. The well log for this lot is on file with your department. The well serving this lot is cased to 92 feet, the static water level was 72 feet below ground level, and the total depth is 92 feet. The ground water in this area typically flows from the west to the east towards the lake. The lift station and sewer clean-outs are located northeast of the well and approximately the same elevation as the well. The existing lift station tank is 80 feet from the well and the nearest clean-out is 46 feet from the well. The soils on this lots were logged to be clay and sand mix to a depth of 86 feet below ground, with till and water bearing sand and gravels to a depth of 92 feet. Page 2 of 2 As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: Distance from sewer system bottom to groundwater (60') 5.5 Soil sorption below sewage system (Clay/sand) 4.5 Soil permeability below the system (Clay/sand) 2.0 Water table gradient (Away from source ~ 5%) 4.5 Horizontal separation (80' to Lift sta, 46' to C.O.) ' 1.0 Total Points 17.5 16-25 Almost sure to be free from any form of contamination from household sewage. In my opinion, this waiver request meets the above criteria for approval and does not constitute risk to health. I hope the above information will assist you in determining that the waiver should be granted. Sincerely, ~.....~...O..~~..,.....t Steven R. P~one, P.E. O~effCivil Engineer Aaac~ents: Suite B..6~ Anchora~?~/s~ 99508 272,..S2:~.8 FAX: (907} 2i2-,821.2 MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907)564-2762 WASTEWATER CONNECT PERMIT 98-0238 DATE OF APPLICATION SCHEDULED COMPLETION DATE 01/2g/g8 12/31/98 BLOCK/LOT~CT BLK BLT 4 SUBDMSlON ROLLING HILLS ESTATES TAX COD~ 1107215 GRID 2124 AS-BUILT STREET ~ 5227 W 73RD AVE OWNER PETER-R-R-R-R-R-R-R-R~~T W & EVELYN K MAIL ADDRESS 5227 W ;31~i~X'~VE ANCHORAGE, AK 99502 SINGLE FAMILY MULTI-DWELLING No. APT$ COMMERCIAL PHONE ¢ON'F~CTOR SMIDT EXCAVATING [] Repair Existing Service [] On Pmpe~y Only [] Hydrant Only [] Main Tap - To Properly Line Only [] Main Tap & On Property Connect [] Disconnect [] E & R - Main Tap Only [] City Tap [] 50' or Longer RowNo. CONNECT SIZE 4" REIMBURSABLE NUMBER INSPECTION FEE PERMIT FEE DEPOSIT TOTAL 104.00 35.00 0.00 0.00 139.00 ASSESSMENTS [] Main Line Extension [] Have Been Levied [] To Be Levied Comments: '~"~x~ F-- _~,~__~ ,~,~',~ ~ "4't, Z__~_.C2_.-- ' wner ~ - ~ff * ~ ~ .... ~ PAID ~ CASH ~ OTHER INSPECTED BY DATE ~/5/~ REMARKS PEI~IlTTEE (Please Print) *SAME AS OWNER POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Origin= DATE SCHEDULED TIME SUBDIVISION ROLLING HILLS ESTATES INDICATE NOi SIZE MAIN: TYPE MAIN: CONNECTLOCATION: 125 / F__ c,~ ~V,{ P/c. BLOClgLOT/TRACTBLK BLT 4 AIN: COMMENTS: AT PROP. LINE: ~ ! ~0" ~F ~F_.C,L "m=,_.¼ 22,s~'A_,qquW~ ~ t ~ '-'-ii - , · ~,~ ~ ~,,,v..~ ~.~; .~' . ~~..',,.. ~ ~_:~; ~.~ . ~ ~,," . .-.. ~.;: ~ ',,. ~ , f49~,'~' .~ ~,, , ~SE~ENTS OF REOORD, OTHER THAN ~HOSE 8HO~ ON TNE REOORD~D ~l~ ~ ~' .~ 3~T ARE NOT S~OWN H~REO~.. ' .An. eho=ag4 Recording Precinct, Alaska, and that the ~mprovements situated thereon are within the property lines and do not. overlap' or encroach on the property lying adjacent theretO, that no improvements on prop- erty lying adjacent 'thereto. encroach on the'premises in question and that there are no roadways, transmission lilies or other visible easements on said property except as indicated hereon: Dated at Anchorage, Alaska this' FRED WALATI<A & ASSOCIATES t~ngineers and Surveyors hereby certify that I .have' Sulweyed the following ~,'~' ~. ... ~'~: ~.;. :.~~: : ...... ...........-.'.'..'...'.~. Parcel I.D. # MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or dire,~tions) (b) (c) (d) (e) Property owner /¢/.4 ~ Mailing Address ?o / ~.. 57'; Telephone: (home) Business.~?/-Z. 7~"4o Lending Institution Mailing Address Telephone Real Estate Company and Agent Address Telephone /?/? Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'J~ Number of bedrooms WATER SUPPLY Individual Well ~i~. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site~ 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 /'¢¢~4¢.~ Telephone Address /~/t/~.. /~ .~j~ ~ /¢-x/'~¢'. ~ Date 6. DHHS APPROVAL Approved for /7/ Approved bedrooms by Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 7/88)Back Page 2 of 2 A. WELL DATA ~ MUNICIPALITY Of ANCHORAGE (MOA) ~ [ ~.~ Health Authority Approval (HAA) MU~,~ OF ANCHO~i~cKLisT . FEBRUARY 1984 ENVIROI~M~';AL S~RV~CI~S DIVISION 343-4744 MAR ! :~ 1989 Legal Description: ,~dT'~ z/ ~'z/~ ~ RECEIVED Well Classification Well Log Present Total Depth ¢]~"' Cased to Static Water Level ? Casing Height Above,Ground Electrical Wiring in 'Conduit~N) ~£/~/,,~-~'~ If A, B, C, D.E.C. Approved (Y/N) Date Completed (~'~/~"~ ? / Yield Depth of Grouting Pump Set At '~/,~ Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~d'/A To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~'~' Water Sample Collected by ,/~z~$ /Z~ ~lZ~,~/ ; Date Water Sample Test Results ~- ~ -'~ aJ/?';E'd~/"~ Comments Z,J~/,4-~/.~J "7~'7~ /~.~/~,,'"~'. ; On Adjoining Lots /'~'~ /~,~/' · ; On Adjoining Lots /-//Z/.-$ e'~F. SEPTIC/HOLDING TANK DATA Date Installed ,,~-2--~o~'? Size Standpipes(~N) Depression over Tank (Y/~ Pumping/Maintenance Contact on File (Y/N) Holding Tank H gh~W~tet':Al'~rm (y/N) /~-5~ '"/No. of Compartments Air-tight Caps i~N) Foundation Cleanout ~/N) Date Last Pumped x/'/~ ;for Temporary Holding Tank Permit (Y/N) · ... ,,; ,,;~, , SEPARAT ON DIST,~NCES FROk, f~E~PTIC/HOLDING TANK: · , ~ '....~.- ~ ' To Water-Supply Well ;~ ,. /~;~,,,~4t;6~ To Building Foundation To Property Line lO ,/- To Disposal Field To Water Main/Service Line ' /0~.'~ To Stream. Pond, Lake or Major Drainage Course /o'0 ¢- Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /4/3 '/ Type of System Design Length of Field ~'o Depth of Field Square Feet of Absortion Area Depression over Field (Y~_I~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation /, Lot /~ 'F To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness 5/ ~ Statndpipes Present ~1) Date of Last Adequacy Test To Property Line /.ff~ To Existi/ng or Abandoned System on ; On Adjoining Lots To Cutback (if present) ! /o-o ~-- Comments D. LIFT STATION Dimensions Manhole/Access (Y/N) "Pump On" Level at -'"'~"~ "Pump Off" Level at High Water Alarm Level at ~~ Vent (Y/N) _ Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA gui~ inspection. Signed ~ ~*'~'"-- Company Date MOA No. Receipt No. ~ Date of Payment Amount: $ I'~ id~,l~,s~iD effect on the date of this ~,N~_..... ..... .~.~-~ .~...;.~...~.¢....~. ~, Engineer's Seal , Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev, 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORY BY SAMPLE for Work Order ~ i2028 Date Report Printed: NAR 9 89 8 11:04 Client Sample ID:L4, BE, ROLLING HILLS EST PWSlD :UA Collected MAN 6 89 8 16:00 h~s, Received MAR 6 89 @ 16:30 h~s. Preserved with :AS REQUIRED Client Name : A E C S Client A¢ct: AKECSRP ?.0.9 NONE REC'D Req ~ Ordezed By : LEE REID Analysis Completed :NAN $ 89 Send Reports to: Laboratory Superviso~ :STEPHEN C, EDE 1)A E C S Special Instruct: Chemlab Ref #: 4446 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N ND(O.i) mE/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY A. WIEN. 1 Yests Pezformed · See Special Instructions Above UA=Unavailable ND- None Detected ~' See Sample Remark~ Above NA- Not Analyzed LT-Lose Than, GT-Greater Than 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 Application Date GENERAL INFORMATION (a; Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ,~'~[2N"7-~1 ~;~,~,0P Telephone: Home Applicant Address ~%2~ 7 (,,)_ 7~'~~'E-d (c) Applicant is (check one): Lending institution []; Owner/builder []; Buyer/~; Other [] (explain); Business (d) Lending institution Address Telephone (e) Real Estate Company and Agent ,/'~,f.,~,~,~l~. Address ~0 ( ~. ~.~ Telephone 7R'TE/f (f) Mail the HAA to the following address: TYPE OF RESIDENCE Sin.5[e-Family~.. Multi-Family [] Number of Bedrooms ~'~ Other WATER SUPPLY Individual Well [] ~" Community [] Public [] Note: if commUnity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL ©nsit~~' Pubtic [] Community [] Holding Tank [] Ncte: If community well system, must have written confirmation from the State Department of Environmental Cc attesting to the tegality and status. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FiLE SEARCH, DATA 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 Address __ ./,~"('~0~' Date ~-- ( ~ - ~'~-' 6. DHEP APPROVAl. :;':C,~ ' Approve-for/~>/.~:~ ~.- bedrooms by Approved Disapproved Conditional ~ Terms of Conditional Approval ~ ~-~ ~'~ / ~ / /~'~ ~~ ,~~ ,.~ ~ :~ -' n ~.~. . ~ ~ ~ /~:~( >'~-~--~, ~ 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 ane 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 omissions in the professional engineer's work. WELL DATA MUNICIPALITY. OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot. To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 1985' ~t z/ D ¢~ If A, B, C, D.E.C. Approved (Y/N) . ~ Date Completed ~-t~~ ~ f Yiek Cased to. Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date Date Installed Standpipes (Y/N) Depression over Tank (Y/N) 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 Main/Service Line /~ ? .,~ Size //(~z/ No. of Compartments V' Air-tight Caps (Y/N) Y" Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation / ~ '~ To Disposal Field ~22¢ ~ To Stream, Pond, Lake, or Major Drainage Course comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Width of Field "20 Type of System Design Length of Field Depth of Field ,/~'" ~-~ Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /4./')g'_~,~¢'. ~' ~--~-/=~ ? P//~-,'"/xC/,~Ov? Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line 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~/'/~' ~'/'~'/;,'1 have checked~v, erified/.~r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~,~ Date .~'[~' ~ . Company ~e~(C E d~/~¢ MOANo. ~r~ ¢~f Receipt No. ~ '~ ~ ~ ~ Date of Payment ,~- ~O -~ Amount: $ ¢~ ~ Page 2 of 2 72-026 {11/84) ENGINEERING iNNOVATiON IN 't r~E FAR NORTH ARCTIC ENGINEERS, INC. ENGINEERING STUDIES * DESIGN * CONSTRUCTION MANAGEMENT " SURVEYING .g-~--_ / ~ _ g. A-- ARCTIC ENGINEERS, INC. ~5o6 w. 36,. AVENUE- ANC,~ORAGE, AL,mA ~9503' 9o-//~61-t~,~ 3901 PATRICIA LANE - ANCHORAGE, ALASKA 99504" 907/333-9428 (ACCOUNTING} May 14, 1985 Municipality of Anchorage Department of Health and Environmental Protection Pouch 6-650 Anchorage, Alaska 99502 ATTN: Ms. Auswald RE: L-4 B-B Rolling Hills Estates OceanTech Ms. Auswald: We drilled a 3".augered test hole on May 13, 1985, at the subject property. The hole was drilled within 10' of the existing crib sewer system, at a depth of 28.5'. Ground water was not encoun- tered at this depth; therefore, we can assume that the bottom of the crib system is at least 4' above the water table. If you have any questions, please contact me at 248-3888. Sincerely ~ OCEAN TECHNOLOGY, LTD. Patrick A. Beaugard, P.E. Engineering Manager PAB:ma MUNiCIPALiTY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED 2502 West Northern Lights Blvd./Anchorage, Alaska 99503 / Telephone 907/248-3888/248-1919