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Ofd >9 y 0 Ln �wx EO E 3 -,+ w m 3 A Ila A Iro +l :I z 0 A 'd a s >,oo," z0)] 1-400m +l to .gym 1119m� O W O O 0)N m A a 9 �z2 0 C H x to E>+ W 0) �'d A t4 0 h A a •,4 a m t3lb +l 9 0) (d v w 1T F+ l~ D E+ W 2 HzW N i to V v U •o 9 ro 0 -H > +l it 0 u 1.4 0+� .i +l a a of 00)E9C En 0>4crd UH 741 s0) ro a � ++s0) roma -1 s0) � �$1�,: � FA H z- 10 9 u 0 - 0) o w .+ m.0) a]O >OAro 4 0 0 aro+l +f r2 P. ON S C.D F I L �Vk DD Cir' r W LU 's o NNI I =uF 31 x H I =asEv h H (� i a {7Z n �Vt37f I C�3ke€F J I _ IPO AN (il >_ N CD L1 o r r r M W c= _ o C� m U-1 0o �Q D 0. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Heallh Division 0 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N.,~..Z~/~ ~ ~ /~ ~.~ / ~? . DISTANCES A~ /0/~ ~/ ~ar~ ~ ~'~7~ TANK FIELD WELL Phone(s) Permil No. Bedrooms WELL - ,~/~t~ ~ .2 FOUNDATION Township, Range, Section AS-BUILT DIAGRAM (Show location of Well, septic system, properly lines, foundation, '~/ ~/~ /~ ]/d ~ ~/ -- driveway, water bodies, etc.) TANKS - U SEPTIC ~ HOLDING ~ Capacity in gallons /~ Manulacturer Material NO, el Compadments TYPE OF SYSTEM / ~TRENCH ~ BED ~ W. ~ OTHER Depth to pipe bottom Item T~al~th from original grade original grade F~/ FT . Fill added above original grade ~Gravel depth benealh pipe Gravel length Gravel width ET FT Total absorption area Distance between lines ., ,1 / S0 FT Insteller ~ Date installed WELLS ~ PRIVATE ~ OTHER fldentifv) ~ / ENGINEER'S SEAL inspections Pedormed by: Municipal and ,tale guidelines in ellec, on~s date: 72-01;3 (3/85) . ,;:~ -~!~ · "- ...... , , . · . WATER WELL RECORD . : : · , · >:~-~ .... ~.,,,~. ..... : ......... .~..,.-_,:- -.,. ,.~ .... - ,., · .- .,,, :.DEPARTMENT OF NATURAL RESOURES.~' .r..~.: LOCATION~'OF,:WEL'E' ~ (PI~;~ ' ' ' I~:~b ;~ 'lc~ ) ~;:'"'~ ;~';:~';':'~'~';'::::'~'': ........ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Menufacturer~, )"¢ ~ Inside length IF HOMEMADE: ...... Well Dwelling DISTANCE TO: Manufacturer Liq. cape( F o u ndat io~ 0~' Well DISTANCE TO: No. of lines / Length of eacl~ line._, / Total length of linis' Material benea~ftile Depth Dwelling/~ O/~ i'~, Material~'F&& / W dth ...... Material Nearest let line 4 t Trenc~ widt~ inches inches PHONE ~¢b~ 0 ~ 7o [~]NEW [~)UPGRADE NO. OF BEDROOMS PERMIT NO. , , , /-/~,, d~r, #eh No. of compartments ~ Liquid depth PERMIT NO. Liquid capacity in gallons Top of tile to finish grade,~_ / _ ~ i Length Width Crib diameter Well DISTANCE TO: Depth Building foundation PERMIT N~O, . , ~ Distance between lines,(~.. Total effective absorption area 3 '7 q ,£/~ PERMIT NO, Type of crib Crib depth Total effective absorption area Building foundation Nearest lot line Class Driller Distance to lot line PERMIT NO. DISTANCE TO: Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALSp V C: SOIL TEST RATING 12 ~- INSTALLER APPROVED DATE LEGAL ./ 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE ? Health and Environmenta ~ Street, Anchorage, AK. Department 7rotection 825 ~9501 264-4720 * * * HANDWRITTEN PERMIT * ~ ~ Permit ~(~,~}~./rC~ WELL AND~J~ ON-SITE SEWER PERMIT Applicant: ,,. ~/-~/' ()/?/~/~'-~3,~// Mailing Address: Phone Number: ~L~-~3J Location: Legal Description: ~,~--) .~'~.g./]d~--~ ~7~')/~:~&~"~-~ Size: Type of Soil Absorption System Is: Trench: ;,~-' Drainfield: Maximum Number of Bedrooms: ~ Seepage Bed: Holding Tank: Soil aating(sq.ft/br) ~ The Required Size of the Soil Absorption System Is: DEPTH /? LENGTH /c/ . GRAVEL DEPTH //~ WIDTH The length dimension is the length(~n feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTtC~Ot;B~Bf~TANK SIZE = /~>C~) GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * ~ Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 S * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if to include more th.a,th bedrooms. Issued by:~~-~ Date: the. eside is emodeled X~P~ant SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: '~t_-- ~.Q:~ '- (~:~'~ LEGAL DESCRIPTION: 3 5 6 7 8 9 10 11 12 13 '~' ,.~'14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ~,'t ~:) S ENCOUNTERED? ~ P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS ~/ L% t) tN L ""~ ~'~- ~ ~ C TEST RUN BETWEEN FT AND 72-008 (6/79) CERTIFIED BY: ALASKA ENVIRONMENTAL CONTROL SERVK ', INC. 1220 West 25th Avert, Suite B ANCHORAGE, ALASKA 99503 276-~361 · 279-29~.7 ( [V~-W DRILLING, Inc. Box 10-378 * 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner CI.^J~i ,c. Tl~4f~.~,.LT,7~I,~": Use of Well Doraest:tc' Location (address of: Township, Range, Section, if known; or distance main road !~t 6 Tract 5 Siaflcer.'~:..~ Size of casing fi''' Depth of Hole Static water level Screen ( ); Perforated ( 5~ feet Cased to 53.2 feet (below) land surface. Finish of well (check one) open end ( xx ). Describe screen or perforation ~k:a'te Well pumping test at rfc gallons per ~6}: of drawdown from static level. (minute) for 1 hours with 10~'/~ Date of completion July 13; 198~ WELL LOG Depth in feet from ground surface 0 .TO. 2 Give details of formations penetrated, size of material, color and har6lness 2 .TO. 4 50 .TO. TO .TO .TO. .TO. .TO .TO .TO. TO ~TO .TO Brown clav mud Kravel NW1NA C~-ttfied C_~.~_~_--_te iMM_._ ~f ~ 3--CONTRACTOR 61 F. ' \ •- Municipality of Anchorage ti �°P= t On-Site Water and Wastewater Program o�� (907) 343-7904 a JUN 0 Iw r (.1 IAA a .may �� si Certificate of On-Site Systems Approva c : e g`AV%.\ Parcel I.D. 015-281 -48 Expiration Date: 61-2,3-/7 1. GENERAL INFORMATION Complete legal description Siefker #3 Tract 5 Lot 6 Location (site address) 3740 Cleo Avenue Current Property owner(s) Scott & Julie Duby Day phone Mailing address 3740 Cleo Avenue Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: H Single Family (w/wo ADU) ❑ Duplex n Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well H Individual H Individual Water Storage Holding Tank ❑ Community Class Well n Community n Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b1 I CS jjDate: COSA to be released to the engineer, unless otherwise requested by the en . r. COSA Fee $ 5a , Waiver Fee $ Date of Payment 4,/ -71/7 Date of Payment Receipt Number U c165-3 _ Receipt Number COSA# 3�5C / 1 aas Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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,ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system. nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 6/7/2017 '6. OFAt, ' 1 6. DSD SIGNATURE g -• -- •••• �' - 1P• • • • 0 it System #1 Approved for bedrooms %Steven R. Pannone . r CE-8149 �� System #2 Approved for bedrooms 9 ' � . Disapproved illgf \\Or-ES P • Conditional approval for bedrooms, with the following stipulations: \-C•( OF h/ • ON-SITE cG: WATER AND rt WASTEWATER • PROGRAM By / (" ' Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work 7. ATTACHMENTS: • COSA Checklist X Nitrate Advisory •Septic System Advisory Arsenic Advisory Well Flow Advisory Other • • ' ' • 3,-4 , COSA blue sheet_c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system ' Certificate of On-Site Systems Approval Checklist Legal Description Siefker #3 Tract 5 Lot 6 Parcel ID 015-281-48 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 3/6/1990 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 113 ft Cased to 113 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 3/6/1990 5/23/2017 Static water level 32 ft. 48 ft. Well production 15 g p m 5 g p m. WATER SAMPLE RESULTS. Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 5/23/201 7 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/10/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/19/2017 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 6/10/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 SF/BDRM System type Trench Length 41 ft. Width 5 ft. Gravel below pipe 3.5 ft. Total depth 8 s_i i 5 ft. Eff. absorption area 379 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/23/2017 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 450 gal. New depth DRY in. Elapsed Time: 90 min Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo ) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 86* On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ ** Driveway, parking/vehicle storage Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. *Waiver on file #WR890067. Tank has 2" of insulation over top. **Partially under driveway, trench insulated for driveway. G. ENGINEER'S CERTIFICATION ..+� OF AL.•Ak I certify that I have determined through field inspections and j�%.P �)� ...*9 ���� review of Municipal records that the above systems are in r*. 49 TH / ' •.* 9 conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone • �� Pannone: Date 6/7/2017 liars. CE-8149 . '0% +�li. Aois�icP� � COSA canary sheet_2-6-15.doc CLEO AVENUE 0 ``' b r7 ill L E, S89° 57' 40"E 84.00' Os: CV _ N. oda.. ... --• -15.9' . :. ....:.....: �1 45.2' flEXISTING HOUSE � . , � el C 45.2' O 1 s.-nii i 31#1 C O I.......,..X..,,..,..,. O 04 CA LOT 5 .— A ' x W LOT 7 OO NI- I F._ • x CONCRETE BLOCK ° RETAINING WALL O Z x to x LOT 6, TRACT 5, SIEFKER SUBDIVISION x x NO. 3 x — — J 10' UTILITY EASEMENT _ _ X --- X ' X -- -- X --- -- X f- X N89° 57'40"W 84.00' 1 -- - 44Qoaappp ,„,,:„<„,c,..............:.<11/4.5,,1111 . : V LOTS LOT B 10- e, 4 s °ao '.• 49TH i`.. %�0V g.... d.,.. .€44...., m •. STEVEN CALLA AN • o D PQO e• •'• r_L _-1 034 .•••4 Q0 '4OJr°fe•ssi•o•n0\ \''4� NOTE: "ppaa�a THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. ORDERED BY: JULIE AND SCOTT DUBY PARCEL No.015-281-45-000 SURVEY CERTIFICATION:LCG LANTECH.INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE LEGAL DESCRIPTION: ADDRESS- 3740 CLEO AVE. IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED AS-BUILT EXCLUSIONARY NOTE:IT IS THE OWNERS'RESPONSIBILITY TO DETERMINE THE LOT 6, TRACT 5, EXISTENCE OF ANY EASEMENTS,COVENANTS.RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO SIEFKER SUBDIVISION NO. 3 CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION,FOR ESTABLISHING PROPERTY LINES,OR FOR PLOT-PLAN PURPOSES. LEGEND: 25x0 H Street SEPTIC STANDPIPE 0.... ea=fen: .......... Anchorage, Alaska 99501rre Overhang Asphalt .y WATER WELLyy�d Deck.r` Concrete \ } Survey Department FENCE —X—X— - - Phone 562-5291 DRAWN DATE: 6120117 WORK ORDER: 17043 "tom~. Inc Mainline DRAWN BY: AP PLAT: 70-90 e Phone 243-8985 CHECKED BY: SC GRID: SW2735 SCALE: 1"=20' FB/PG:68/18 REF:89L266 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 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 lot, block, subdivision, section, township, range) Location (address ~r d~rectLoe~s) , ~.~: ', , .. (b) Property owner ,' h:/'/~-% ~- Mailing Address '° ' Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) 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..~ Number of bedrooms 3. WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site I~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 leAoJdd¥ leUOR!puo0 Jo sLu.,e/ leUO!t!puoo 'pe^oJddes!O //~" pe^o~dd¥ 7~/~~ /'/ /' '" ~q SLUOOJpeq ----~-- JO, pe^oJddv A. WELL DATA Well ~Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: Z'¢/ If A, B, C, D.E.C. Approved (Y/N) /4///~¢ Date Completed -~,/~.,/¢,'~ Yield /J'-,/';/¢,*-~ · //,3 Depth of Grouting ' Pump Set At //o Sanitary Seal on Casing ~/~N) Depression Around Wellhead (Y¢~' Well Log Present~"~)/N) Total Depth //.3 Cased to .... Static Water Level .~-~ ~ Casing Height Above Ground Electrical Wiring in Conduit ~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by / , Water Sample Test Results /2)0 c-'/: Comments ~-'~,,~ "/Lo f,¥-¢-/_? ; On Adjoining Lots /<2~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole / B. SEPTIC/HOLDING TANK DATA Date Installed ~//'~¢/~'~ Size /~¢¢ Standpipes ~'~N) Air-tight Capsc/~N) Depression over Tank (Y/~ Pumping/Maintenance Contact on File (Y/N) Holding Tank HighrWater Aiarti~ (Y/N) SEPARATIONO!S.TANOES:~FRbM SEPT C/HOLD NG TANK: To Water-Supply Well , < , ~-~¢'~ .. ' To Propert~ Lin~- .... No. of Compartments Foundation Cleanout Date Last Pumped ,~ --/¢ ~'~¢ ;for Temporary Holding Tank Permit (Y/N) To Water M~'i~/S'erv~e:Li"n'e '. ,' ::.; "-Z-F.'-¢ / To Stream, pbnd; ,17~k~ or Major Drainage Course .~/¢¢ Comments ~'~-~-%-, ~ /lac .~ ~c~'[ /**Jul>/z~ ~'~'~z/ ~o,.~ //~.* C/~ ~.~ 72-026 (Rev. 7/88) Fron~ Page 1 of 2 To Disposal Field / To Building Foundation /~'~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area ,~¢ Depression over Field (Y/6i' Results of Last Adequacy Test /¢¢/~? '~¢ ~-~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /'¢¢- To Building Foundation ./~) (*' Lot ~,/L J~-~.t.,~z4/6 To Water Main/Service Line ~'.J'- ',~ Type of System Design Length of Field z// / Depth of Field ¢¢"'J' --//.,)~ Gravel Bed Thickness c//Z "' Statndpipes Present (~'.~) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots //~ ~- · To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date I n S'~....._ Dimensions Size in Gallons ~ Manhole/Access (Y/N~. ~'~' "Pump On" Level at ~ ~ ~) / _ "~.m..~Of-f~evel at High Water Alarm Level at -""---~~ Vent (Y/N) _ Tested for ¢.~-'~/ %~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes ~ / 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 this Signed Company Date MOA No. Receipt No. ~ / '~ -~-~ /(~'7/d~/ Date of Payment , ,.~ '--/~-~-~,~"~'~ ' Amount: $ / /fP' eeee ee % ~ ~nglneer s ~eal Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 16, 1990 Leroy C. Reid Alaska Environmental Control Services, Inc. PO Box 240668 Anchorage, Alaska 99524-0668 Subject: Waiver Request for Lot 6 Tract 5 Siefker Subdivision #3 Waiver Request ~WR890067, PID ~015-281-48, Permit 9SW900032 Dear Mr. Reid: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 86 feet from well to septic tank on the subject lot. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services C°ncuri~ ~ On-site Services ljm:#6 Tom Fink, Mayor Department of Health and Human Services $25 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 February 9, 1990 Leroy C. Reid, P.E. Alaska Environmental Control Services, Inc. P.O. Box 240668 Anchorage, Alaska 99524-0668 Re: Waiver Application WR890067, Lot 6 Tract 5 Siefker ~13 Subdivision, P.I.N. 01528148 Dear Dr. Reid: This office has completed its evaluation of the subject waiver request. Based on our review, the waiver of the required 100 feet separation distance between the proposed well and the existing septic tank is approved. The approval is for a separation distance of 85 feet. Because this waiver is being approved prior to completion of the well, it is understood that the following conditions must be met for this waiver to remain valid: When the new well is constructed the septic tank shall be exposed to verify tank integrity, the presence of water tight couplings, and manhole gaskets. As an alternative to exposing the septic tank, you may through the analysis of well logs from adjacent wells, provide documentation which supports the conclusion that the aquifer supplying the new well is confined and slopes away from the well towards the septic tank. The well shall be constructed with solid casing to a depth no less than 80 feet. Should either of the above conditions not be met within 120 days from the date of issuance of this waiver, the waiver will become void. This waiver approval applies only to the separation distance between the existing septic tank and the proposed well. Any future upgrade to either will require all separation distances be met or another approval from this office. Sincerely, Daniel J. Roth Civil Engineer On-Site Services Program Manager On-Site Services Municipality Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-8650 January 30, 1990 Leroy C. Reid, PhD, P.E. Alaska Environmental Control Services, Inc. P.O. Box 240668 Anchorage, Alaska 99524-0668 Subject: Request for Separation Distance Waiver Lot 6, Tract 5, Siefker No. 3 Dear Dr. Reid: This office has completed its evaluation of the subject request for waiver of the required 100 ft. separation distance between an existing septic tank and a proposed well location. The request was for a separation distance of 85 ft. The request for waiver was evaluated in accordance with the Alaska Department of Environmental. Conservation (ADEC) waiver review guidelines. Our evaluation of the supporting documentation, which accompanied the request, yielded a total of 10.9 points. In accordance with ADEC waiver guidelines, a minimum of 16 points is required for issuance of a waiver unless the presence of special construction techniques and/or mitigative factors is documented. Therefore the request for waiver is denied. Resolution of the separation distance deficiency may be pursued by any of the following three alternatives: You may prepare and submit additional supporting documentation which supports the assignment of 16 or more points in accordance with the ADEC waiver review guidelines. Kids Are Our Future Dr. Leroy Reid January 30, 1990 Page Two 2 o You may prepare an engineering report that documents special construction techniques and/or the presence of mitigative measures or factors which support the issuance of the waiver. Such a report must conclude that there is a negligible possibility or probability of the wastewater system serving as a point source of contamination to the well. This conclusion must be supported by an appropriate engineering analysis. You may relocate the offending well or wastewater system. If you have any questions, please call me at 343-4744. Sincerely, ~ PJ~ha~a~Er; On-site Services cc: Dan Roth, Civil Engineer, On-site Services I ..- eFIUIRO ITIE FITAL COFITROL S( RUIC $, Ii'lC. ~n~in¢¢rincI ~ ~nuironmcntd $1udics " P. O. Box Z40668 'G . r, %~ ~ '~, ~Anchorage,AK 99524-0668 .:~,. -J+, (907) 279-5553 *** FAX (909) 276-8706 November 14, 1989 Department of Health & Human Services ~unictpa]ity of Anchorage P. O. Box 196650 Anchorage, AK 99519-6650 RE: Lot 6, Tract 5, Siefker #3 WR 890055 Geatlemen: On February 15, 1989, a waiver request was made to allow the septic tank to remain 91 feet fram the we].l. On February 24, the waiver was issued. See the attached letter. Since then, the lending institution has decided that it will aot lend money on this house unless the well is moved to outside the utility easement. The well can be moved and not impact the ne:[ghbor's system, Lot 7, if it is moved to the location shown on the attached site p]an. This will place it exactly 100 feet from the; edge of the neighbor's septic tank (Lot 7) and 100 feet from the edge of the existing 5 feot wide drainfield, on this lot. The distance to the septic tank on this lot will be reduced from 91 feet to 85 feet. The tank is only 6 years old, so it still should be in good repair. The house has bean vacant since the Health Authority was issued on February 27, 1989. In my prefessional opinion I do not think that tthe issuance of a new distance waiver of an additional 6 feet will create a health hazard. I therefore request that you issue a new waiver. LCR/sr Sincerely yours, Leroy C. Reid, Jr. PhD, PE, DEE President MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4?44 Parcel I.D. Ct ... 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 lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address ·'Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent ~/'~'~'~'/;~' Address Telephone (e) 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 I~ Number of bedrooms --~ 3. WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. 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 legailty and status. 72-025 {Rev. 7/88) Page 1 of 2 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, Iverifythat myinvestJgation 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. NameofFirm ~'~"~-' '~' ' Telephone ¢~'~) 2 ~'~'- ,.~"'5'-5'-3 6. DHHS APPROVAL Approved for ~ bedrooms~~/C~ Approved ~ Disapproved Conditional Terms of Conditional Approval Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: Well Log ,Present Date Completed If A, B, C, D.E.C. Approved (Y/N) ~ '~-,/,~---~2'~ Yield 0-2 ~','~-/~r 4,l~'~ Total Deptti~'l '~ Cased to L~Cw Static Water Level ~ Casing Height Above Ground / ~'¢-~ Electrical Wiring in Conduit ~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~, / ' Depth of Grouting _ /,.,//(~ Pump Set At /'~"/( ~ Sanitary Seal on Casing (~) Depression Around Wellhead (Y(~_ ,..~/:¢.Y/i~.TM) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /{/o¢C/.- . , On Adjoining Lots To Nearest Public Sewer Line /t,,/~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~~ ~,~,~. ;Date C~~ ~ Water Sample Test Results ~c~ ~ ~~5 ~,~ , Comments ~1( ~1~ '~ ~'~-~ ~ ~ ~ ~.'~ B. SEPTIC/HOLDING TANK DATA Date Installed ¢'-/¢~ *>~ ze/~¢ ~a4. No. of Compartments Standpipes ~N) Air-tight Caps ~) Foundation Cleanout (Y~ Depression over Tank (Y/~) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Date Last Pumped ~_//~ ~v~ /,¢/t~C5 Temporary Holding Tank Permit (Y/N) /?//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-sUpply Well '~:~// ' ~'¢ To Property Line ~ '?'/~ z" To Water Main/Service Line ~.,.5'" ~ To Stream, Pond,, bake Or Major Drainage Course To Building Foundation To Disposal Field Comment~ 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ -{¢_.;1~ ~.-.~ Width of Field ~ Square Feet of Absortion Area ¢-~' ' Depression over Field (Y,~ Results of Last Adequacy Test /¢dd-fl..c~,¢~._- '" ' SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ,/(:~ ry.._ To Building Foundation /'C_.~ Lot L-~CkKr~ccc'rl ;On Adjoining Lots To Water Main/Service Line ~"/+'- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course /~:::~(..2" To Driveway, Parking Area, or Vehicle Storage Area ~ ¢''\~ Comments '7"-,E~c.f/ ,,,J.~ ~.'r'~ /¢~ Type of System Design Length of Field ~ / ' Depth of Field ~'. Gravel Bed Thickness Statndpipes Present (~N) Date of Last Adequacy Test k. To Existing or Abandoned System on aTION lied Size in G~ "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~,~ Vent (Y/N) ~"'"~ ~mping Cycles during Adequacy Test. **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 this inspection..4 Signed Company Date MOA No. '¢~[' Receipt No Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Page 2 of 2 Tom Fink, Mayor ' ' 'it un c pai y of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 February 24, 1989 Lee Reid, P.E. Alaska Environmental Control Services, Inc. 1412 West 33 Avenue Anchorage, Alaska 99503 Subject: Waiver Request for Lot 6 Tract 5 Siefker Subdivision ~3 Waiver Request #WR890055, HA890006 Dear Mr. Reid: Your request for waiver of the required 100 foot separation of a septic tank to a private well has been approved. The approved separation distance is 91 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sin ely, / · Civil Engineer On-site Services RWR/ljw 96 ALASKA eFIUIROI meF1TAL COFITROL SeRUlCe$, IrlC. I~n~]in~¢ria~ 6 I~nuir0nm~nld $1udies MLu") lc i i:::,a :1. i ty (::)'f: An c I'a(::~ rag e ]}el::)ar'trn~:~l"~t o'f: Hea:l.'l:h and t...lum~n Ser"vices 825 L.. S'~:reet, Su:i. te 502 Ar'u]l"~or'age, Al< 9950.t. A"FTIxl: I}an R(::)t h I:;;E:: Lot 6, Tra(:::t F:'r"om the I..lealth Autl'~or":Lty :J.l"lSl::U~c'l~imr'i, ~.~e find the separatiorl distance from well 'E:(:~ s~ptic tar)l.:: ~(:~ be 91 feei;. The t~nl.:: was :Lr'Jstal].ed ,;](..u'l(.>~ .'L()~ 19~:'.$~ ar'icj is a 1C)0C) gallon steel, c:o~Jlpart~er'Jt tal]k,, Nater tight c:oLq::)].~el"~ shoL~].d be Ol] inlet and outlet': piping:, ,) 'T'l-le well was c:lr"illed July 13, 1983. Or'l Fel::H'"uary 9, 1989, a zl. hour flow test shQwed statlc level at 46 feet, '7.2 gpm with a tc:)tal drawdown c)f :];5 feei-.,. Thls area is not known f(::)r any bedrc)ck al:)ov(~.., 1(])(]) feet, se casir'lg should extend be].o~ Ii.)..]. feet. Surface slope :i.s to the east, southeast. Water samples are satisfactory. W(.:+;, r"£.):,'.::luest that y(:)u gF"al]i] a waiver mf 9.1. fee't: fc)r well tm s e j::)t .'J.. (::: t ~t r~ k ,, I'F yi::)L.i have ai'/y C:IL(est.i.c:,I"IS, i:.)lease call. ACW / s r S i n c:: e r e 1 y Alan C. W.ier'~ Tec:hnician 1412 W6s~. 331~Ch AV61lU6 e Ancho~aqe, ~kJ&sk& 99503 · (907) 279-5553 ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CHECKED BY DATE SCALE ! ~ ii! .... .... :i ...... ~ ....... I ................ ! .......... ~ i .... i i;. ~..! ! ......... i i ...... i ........ i ' ' ' ' ' ' .i. ~ .... ~ ~ i, ' ~ i i."i'., i.i.'"' .."~.'.'"'.'.....~' APPLI( NT FILLS OUT UPPER HA[ONLY Zip Code Zip Code Phone Lending Inslitution Address / ,?" ,.,' .;'~ 'i ''q / :' Zip Code Realty Co. & Agent Address Legal Description Street Locatio~ Zip Code Phone Phone Type of Flcsidence ~-'S~'n~ le Family E~ Multiple Family [] Otber No. of Bedrooms Water S~.pply ...F%-Iffdividual [] Community [] Public Utility ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior Io that date, give well depth (attach Icg if available). Sewer D~iSposal E~¢~'ndividual [] Public Utility [] Holding Tank Year Individual Installed: .' r When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time Date Date Date Inspector Inspector Inspector Time Inspector MUNICIPALITY OF ANCHORAGi Field Notes: -- ^PPROVED BEDROOMS ) DISAPPROVED ) CONDITIOFI,¢4. ASPROVAL' DEPt. OF I'!E/",L/'il & I'=NVIRONMENi'AL PROT/CTIOh RECEIVED 'CONDITIONS OF APPROVAl. Soils Rating 72.023 (3182) Date Sewer Installed Well To Absorption Area Well to Tankl"'~,(' Well Log Received Septic Tank Size / <:¢'""~2 Torn Fink, Mayor A ur ieip lity Ar ¢lxQr e Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 February 24, 1989 Lee Reid, P.E. Alaska Environmental Control Services, Inc. 1412 West 33 Avenue Anchorage, Alaska 99503 Subject: Waiver Request for Lot 6 Tract 5 Siefker Subdivision ~3 Waiver Request #WR890055, HA890006 Dear Mr. Reid: Your request for waiver of the required 100 foot separation of a septic tank to a private well has been approved. The approved separation distance is 91 feet. This waiver approval applies to the existing septic system to w'~ll separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Civil Engineer On-site Services RWR/ljw #6 ".F ih ' ', ' ALASKA r IIUIROFImEFITAL COFII'ROL SERUICES, IFlC. o ~'~~En~ine~rincl ~' EnuJronmenlel $~udi. February 15, 1989 MLInicipality of Anchorage Department of Health and Human Services 8~ L Street, Suite 502 Anchorage, AK 99501 ATTN: Dan Roth RE: Lot 6, Tract 5, Siefker #3 From the Health Authmrity inspection, we find the separation distance from well to septic tank. to be 91 feet. The tank was installed June 10, 1983, and is a 1000 gallon steel, 2 compartment tank. Water tight couplers shQuld be on inlet and outlet piping. The well was drilled July 13, 198~. On February 9, 1989, a 4 hour flow test showed static level at 46 feet, 7.2 gpm with a total draWdown of ~O feet. This area is not known for any bedrock above-lF~F~ feet, so casing should extend below 81 feet. Surface slope is to the east, southeast. Water samples are satisfactory. ' We request that you grant a waiver of 91 feet for well to septic tank· ~. If you have any questions, please call. ACW/sr Sincerely Alan C. Wien Senior Engineering Technician 1412 ~Ve~c 331~0 ~v~riu6 · ,~ncho~,~q~. ~[,~sk& 99~03 · (907} 279-~53 A ¥~ ~_O_E EXCLU$10N rosponslblllly~lo delerrnino the existence oJ ENQINEI~I~IB, I~[,.ANNEI:II~, 440W~$T BEN$ON BbVO. ANCHORAGE, ALASKA 99503 562.5291 NOT[: It It the contra~ 0/~" I~ Iii BA fl 0 0 MONUMENT ~ ~ PK N~ll ~ IRON PIP~ (~ ~o EL,~VS,, DATUM ALASKA e lUIROFlme[1lAL CO[1TROL SeRUICeS, Itl[ Enqin~¢rin~ $ [~n~ironm~ntol Slu(~i¢$ P. O. Box 240668 Anchorage, Al( 99524-0668 (90'/) 2'/9-5558 *** FAX (90'/) 2'/6-8'/06 January 81, 1990 MEMO TO: John Smith FROM: Dr. Leroy C. Reid, Jr. SUBJECT: Well waiver, Lot 6, Tract 5, Siefker Subdivision #2 Using Darcy's equations and soil permeabilities, I have calculated the possible conditions for the waiver of 85 feet from the well to the septic tank. In addition, I used the well log from Lot '/ as a possible real case. My conclusions are as follow: 1. It will take between 1.7 and 17 years for the water to flow from a leaking tank to the first aquifer at 50 feet below ground. The literature does not support bacteria living this long in water. Also, the literature shows bacteria not being able 'to travel this far. See attachments. 2. If the new well's log was the same as the Lot 7 well, the water from the septic tank would still not reach the well. The radius of influence would be about 1 foot. It would flow vertically. Under full flow conditions (tank leaks all water) it would take 2 days for the water to flow that far. Normally, 2-3 feet of soil will remove all bacteria from a stream of water. 3. The granting of the waiver for a well to septic tank distance of 85 feet will not create a health Attachments: Table Table B.1 3 well logs