HomeMy WebLinkAboutSUE TAWN ESTATE #2 BLK 3 LT 9Onsite File
Sue Tawn
Estates #2
Block 3
Lot 9
#051-511-35
Well located in 25ft creek maintenance easement is
“grandfathered” as long as well is 25 ft from the
creek. This has been checked with Planning and
Watershed.
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
3r,mit Number: OSP201303
eelling: 01 Single Family (SF) Fj with ADU M Duplex (D) M, T,,vo Single Family Project, F New M Upgrade
)rne
Jurrow
ABSORPTION FIELD
❑Deep Trench F-1 Wide Trench 7 Bed E] Mound
,e Address
8524 Sue Tawn Dr
0 other
loop-
Number of Bedrooms
Soil Ralihq
Total depth from original grade
27-0009
GPD)SF�
F
EGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
I F
1t)"division Bloc k Let
Lie Tawn Est #2 BK 3 LT 9
Fill added above original grade
Ft.
I Gravel length
I F
twilshiP Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
F
EPARATION
DISTANCES
TO
Septic
Absorption
Lift Station
Holding
Se%ver
Total absorpton area
Number of trenches
Dist. bet,,%jeen trenches
DM
Tank
Field
Tank
Line
Ft
Well
100'+
Iia
na
25+
TANK K Septic 0 S.T.F.P. F__J Holding � Other
lila nulactufer Icapacity
Greer
1000 &
>Urface Water
88'+
na
n a
Material
Plastic
Number of compartments
2
NA
Lot Line
10'+
Iia
na
Foundation10,+
na
na
LIFT STATION
Manufacturer
Capacity
emarks Septic' Tank Replacement-
&
E'xisting Strearn �Alaiiver
Alarm location
Electrical installed by
.................. ...................... * ...... * ....... ....
Tank to D3034
PIPEMATERIAL House to tank D30:34
Istallerq..............................
10eanDrainfietd
drainfield
murD3034
...................... .. . .... . ................
Spector NorthRim Eng.
BENCH MARK (Assumed elevation) 100 ft
Inspection9/15/20 W16, 20
Location and description,
dates_ z=Deck
-d
V AT,
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Starnp
onditional Approval, Date
OF IV
jr cl�
:49TH..
Septic Sy tem
-1 A (I %� 1) A A
Steve Eng
C, , _'�o
A CE -6256 r4l _Jff
Appl-oved Y\,
Date
Nnta- fli i 4z nnnrn%.r_-fl rinjac not i nrl i tri a wall narm it rarij i i rim m ontiz
AS -BUILT
MEASUREMENTS
A
B
T1
55
36
T1
58
39
C❑1
60
42
C❑2
65
48
No
Conflicts
Existing
Seepage Pit
1
0
C
14
14
(n
N
T
\ I
New 1000 Gallon N
Septic Tank w/DC❑'s Co flicts
Decommissioned ❑ of CD❑21
Septic Tank \ \
PER UPC T12 ° \ q
fco/J�\
NOR THf? 1M.•+��� �`r°r
ENGINEERING #�PSUE TAWN ESTATES #2
�* :49Di�
steveEnq.com * BLOCK 3 LOT 9
PO Box 770724 Str
Eagle Rlvwr Alaska 99577 • .. _ WASTEWATER
907.694.7028 /23/2° UPGRADE SEPTIC TANK
1' = 50'
RECORD
LAYOUT
3/20 12 of 3
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ASBUI�✓�-�'✓`f'�' SEWARD &ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY / -F A
DATE: ' • '�{ 4
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSi31LITY OF THE S iTH
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID ""' .. '•'°•
EASEMENTS, COVENANTSV OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB- l�•.
ANY DATA HEREON BE USED FOR CONSTRUCTION 6s�'r��..,``
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
DRAWN:
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201303
Work Type: SepticTank Upgrade
Tax Code Number: 05151135000
Site Legal Address: SUE TAWN ESTATE #2 BLK 3 LT 9 G:1060
Site Mailing Address: 18524 SUE TAWN DR, Chugiak
Owner: MURROW DAVID A & GINA L
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
i^1
Lot Size in Sq Ft:
Total Bedrooms:
went
r.
P
Depai-tment
8/14/2020
8/14/2021
65097
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By
Issued By:
3
Date:
F1'�4�0
Date: V/00/;?o
�C 17 t
-Z,3 ,
's,
0
Municipality of Anchorage
eppartment
P.O. Box 196650 * 4700 Elmore Road
Anchoracie, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
hftp://www.muni.orci/Onsite
Development Services Department
On -Site Water and Wastewater Section
**** VARIANCE/WAIVER REVIEW ****
Waiver* WRO50046 COSA#: Permit#: OSP201303
PID#: 051-511-35
Legal Description: Sue Tawn Estates #2 Block 3 Lot 9
Engineer: North Rim Engineering
Applicant: David & Gina Murrow
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to
the surface water has been approved. The approved separation distance is 88.0 feet. This is a
renewal of the waiver granted in 2005. Conditions will be improved with installation of new
tank. See engineer's waiver request from 2005 for justifications.
This waiver approval applies to the proposed septic tank only. Any future 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:
e Z,7
Date: Approved by: dtneff/
Name of Reviewer
**** VARIAN CEIWAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Development Services Department - Phone: 907-343-7904
On -Site Water & Wastewater Section -- Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-511-35
Property owner(s) MurrOW
Mailing address 18524 Sue Tawn Dr
Site address same
Day phone 227-0009
Legal description (Sub'd., Block & Lot) Sue Tawn Est #2 BLK 3 LT 9
Legal description (Township, Range & Section)
Lot Size 65,097 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
ElUpgrade
0
Duplex (D) EJHolding
Tank
ElRenewal
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
e
that the above information is � further certify that this is in accordance with
ble Munici al Codes. �
P E
(StgT�reofp
authorized
ent)
Permit/Rush Fees:A68r. 70- COulu_ Waiver Fees:
Date of Payment: 017106 Date of Payment:
Receipt Number: 065/5 D Receipt Number:
Permit No. 05p /30Z Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201303, Rebecca Carroll, 0814/20
TM
ENGINEERING
SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 8/6/20 Number of Pages:
To: MOA On -Site Services
Subject: Sue Tawn Estates #2 Block 3 Lot 9
Septic Tank Failure
The subject septic tank has failed- a new tank will replace the old one. The existing seepage pit
appears to be working OK. Please issue a permitso the tankcanbe replaced. Please review as soon
as possible. This is a large lot with no nearby neighbor conflicts.
An existing tank to stream waiver exists which we would like to continue as applicable to new
tank.
If there is need for additional information or clarification please give me a call.
Thanks -Steve
Lr7111r_T'Z1
INEERING
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201303, Rebecca Carroll, 0814120
Sue Tawn Estates #2 Block 3 Lot 9
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The current septic tank has failed- the seepage pit still
functions. This lot is overan acre. No adverse impacts are expected fromtankreplacement.
The easements are depicted on the lot. The slope is indicated in the area of the septic
system. N o conflicts to neighbor properties.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet.
• 5' minimum between the tank and trench. 5' to property lines & 10' to house.
• 4' of cover or insulation is required for tank; an equivalent of 1 " insulation for I' foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
• No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
• 4" diameter cleanouts with airtight caps are required 1 ' to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10' from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Wk' M,
OF t '49'Mai
........................
.. .........
stw.
�i '/6f20
DESIGN NOTES:
1. Existing Absorption Pit Remains In Place.
MOA—Spec For Tank—Bedding.
2. Sewer Service Line minimum 2% slope.
3. Replace Septic Tank/Decommission Old Tank Per UPC.
4. Stream To Tank Waiver @ 88'.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201303, Rebecca Carroll, 0814/20
No I o
Conflicts
c
Existing N
Seepage Pit
0
N I
Co flicts
New 1000 Gallon
Septic Tank w/DC❑'s
Decommission ❑ld
Septic Tank
PER UPC
5� s\ove
3
57 s\oPe
R100.0 --
\ ell
\
NORTHRIM ..-��.ac` SUE TAWN ESTATES #2 1' = so'
ENGINEERING�P'
°y••. DESIGN
steveEnq.com * 4sm•.•••..••.* BLOCK 3 LOT 9
Po Box 770724 WASTEWATER LAY❑UT
EaVe River, Alaska 99577 aims
907.694.7028 UPGRADE UPGRADE SEPTIC TANKI °ot8i6i20 12 of 3
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R@AEWED FOR CODE COMPLIANCE
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-9 On-site Water and Wastewater
R@AEWED FOR CODE COMPLIANCE
�8 Q1303, Rebecca Carroll, 08114120
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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/)r
PHONE
NEW
'
2 L
❑UPGRADE
MAI LI DDRE
S S 2 o `76 ?T77
' 1`76X
LEGALEtESCRIPT10N Z3 :317� u 7_2 A& 0
/G`
LOCATION
NO. OF BEDROOMS
o Y
DISTANCE TO:
Well
Q�
Absorption
Dwe g� (�
55
PERMIT,pW.,�
4F
Po
ManufacturerG�
M /
No. of compartment
wF
y
Liq. tYjp�9allgns
e CJ o
Inside length
IF HOMEMADE:
I
Width
Liquid depth
DISTANCE TO:
Well Dwelling
PERMIT NO.
JUZ
Oz FQ-
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
w=
FL z
No. of lines
LenAta of ac a
Total length of lines
Trench width
Distance between lines
F Z w
inches
¢ s-
Top of tile to finish grade
Material beneath tile
Total effective absorption area
a
inches
Length
3J
Width
2O
DepthPERMI
2
O.
�c
w
—
L 1 f oo •v
QF-
Type of crib
Crib diameter
Crib depth
Total effective abyur�ioyar
a S
W
�—
C9 CI CJ
N
DISTANCE TO:
Welt �,y;�
! iJ
Buildingati r�
Nearest lot lin*D
G`v
J
FX t t
ty./Driller
Distance to lot line
PERMIT NO.
d
/ /VBuilding
FIDISJTANCETO:
foundation
Sewer line
Septic tank
Absorption areas)
OTHER
11
PIPE MATERIALS
Ply c
SOI L TEST RATIN
INSTALLE
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FIVER ALASKA 'M71
W14 4944WQ
CHUGIAK, ALASKA �� L��1
- 688-3199
S LRILLI NG CN.
WE SERVE ALL ALASKA
POST OFFICE BOX 42 — CHUGIAK, ALASKA 99567
. L P_S Y Ct1Clri
OWNER OF LAND ......... ...peC1a1................... Y........................................................
ADDRESS .......$E ... I.... Q ...2.1:7.....11 ?. e....�a ..... ':. :�.......
L 3 Sue Tawe 'd.0
WELL — SITE.....'...:Y.................................::...`................................:........
- -3
DATE-STARTED ....................... Clc ...........................................
_ el
DATE— ENDED ................ .. 3.... ..........................................
DEPTH OF WELL
KODIAK, ALASKA
486-4826
STATIC LEVEL OF WATER FT. .... 12,L.t...... ........................
DRAW DOWN FT. ..... .UC
.................................................................................
,
GALS. PER HR...6: :� est.
..................................... .
KIND OF CASING ... d.'.....:....ie::.::.'......................................... ............
KIND OF FORMATION:
DRILLERSNAME .....`....::,:.:
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.............:............................................................:..........:....
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MISCL.INFORMATION: ,t, 4 as;t5 v Yra.'1ea ir;lis
DRILLERSNAME .....`....::,:.:
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MUNICIPALITY OF ANCHORAGE
Department,` Health and EnvironmentaJ''rotection
825 Street, Anchorage, AK. `A501
264-4720
# # # HANDWRITTEN PERMIT # # #
Permit 17 ELL AND/OR ON-SITE SEWER PERMIT
Applicant: rr f Mailing Address:/.
Location:>-���P-�hon-e/ Number: A11 Z?7�_
Legal Description: Z�j�� Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
T R qua ed iz o the Soil Absorption System Is:'
DEPTH LENGTH GRAVEL DEPTHS SOU WIDTH `'0 ^ f(-)
The length dimension is the length(in 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 SEPTIC(HOLDING) TANK SIZE _ 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
'Twill 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 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set fo by the Municipality of Anchorage.
(2) I W. i stall t ystem in accordance with codes.
(3Wndernd he on-site sewer system may require enlargement if
modeled to include more tha bedroomSigneIssued byd
Date: //�/p SWP/024 (1/81) �/9 dYi �hP 4acs ✓'� im�S� �? .G9/v�
/ x SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION T
PERFORMED FOR: / I
LEGAL DESCRIPTION: /— / e . L��'L >" �`' � & v
QEPT`H / (/
1
2
3
4
5
6
7
S
9
10
11
12
13
14
15
16
17
18
19
20
0l C
121
SLOPE
WAS GROUND WATER
,71 / ti S
ENCOUNTERED?
✓IJ L
Depth to
Water
O
P
E
IF YES, AT WHAT
DEPTH?
SITE PLAN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE i" (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: ,c,PIR ou"N CERTI FIE DATE!
72-008 (6/79)
•� i
v---e-'c l9 / C /ol l
AJ
Ac-
t �' rnvsr- ge �sa,�v Fl L
2
151 10,111CH
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section QD Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-511-35
1. GENERAL INFORMATION
Expiration Date: t/ a, �a
Complete legal description Sue Tawn Est 92 BLK 3 LT 9
Location (site address) 18524 Sue Tawn Dr
Current property owner(s)
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Murrow
[D Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or. Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Private Well
Water Storage
Community Well
Public Water System
Waiver request
Day phone 227-0009
Day phone
TYPE OF WASTEWATER DISPOSAL:
El
Private Septic
F
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless othenruise requested by the engineer.
COSA Fee $ 9)2-.9-0 CO L/10
Date of Payment R / `i' a 0 9-0
Receipt Number
COSA # 0.s C.20I 7_ 5
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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
onsite water supply andior wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. l further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the onsite water supply andfor wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted_
Name of Firm NorthRim Eng.
Address PO Box 770724, Eagle River
Engineers Printed Name Steve Eng
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 694-7028
Date 9/19/20
7W 10,
i c Steve Eng i
M-6256 ,e2 e
5/x.'9%
Conditional approval for bedrooms, with the following stipulations:
3y; Original Certificate Date: /a
rhe Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
•epresentations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
wt responsible for errors or omissions in the professionat engineer's nbrk.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic Svstem Advisory Arsenic Advisory
COSA Checklist
Legal Description: Sue Tawn Est #2 BILK 3 LT 9
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 10/24/83
Total depth 100 ft
Cased to 100 ft
❑■ Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 36 in.
Date of flow test for COSA 8/4/20
Static water level at beginning of test 94.8 ft.
Comments Well @ 25'+ from Creek
B. TANK DATA
Age of tank(s) new years
Tank type/material s P`""="
Measured operating fluid level in septic tank new
0 Standpipes/foundation cleanout per record drawing
Date of pumping new
D. ABSORPTION FIELD DATA 11/83
Which system tested (date installed) same
0 ALL standpipes present per record drawing
Total measured depth from grade 5 ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
of
Parcel ID: 051-511-35
Structure served by this system
Well production at time of test 6+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes 0 No
❑■ Coliform bacteria is Negative
Nitrate 1.81 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 8/10/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/4/20
Results Q Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 1 in
Elapsed time 30 min
0 Code -required soil cover over field
Final fluid depth
0
in
❑ System presoaked
Absorption rate
450
gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:` No Cleanout To Measure Pipe Invert- Only Monitor Tube
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private We 11 on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot 5, 100'
❑
Yes
Community Sewer ManholelCleanout 5 104'
E] Yes
4 No
ft
71 Yes
if No ft
Neighboring Tank > 104' Yes
if No
ft
Private SewerlSeptic Line �, 25' Yes
if No ft
Absorption Field on Lot 5 100' [lies
if No
ft
Holding Tank > 100'❑ Yes
if No ft
Neighboring Absorption Fields > 140`
Yes if No ft
Nater Main > 10'
Animal Containment > 50' Yes
if No ft
❑ Yes
if No
ft
Yes if No ft
Nater Service Line > 94'
El
Yes
if No
Manure/Ari lmaI Excreta Storage > 104'
If septic tank is under driveway comment below
Community Sewer Main > 75' Q lies
if No
ft
] Yes
if No ft
From SepticlHolding Tank on Lot to: (Please enter distances if less than required)
Building Foundations � 10'
❑
Yes
if No
ft
Surface Water > 100'❑
Yes if No ft
Property Line > 5`
Yes
Yes
if No
ft
dells on ,adjacent Lots:
El
Absorption Field > 5`
if No
hies
if No
ft
Private Wells > 904'
Yes if No ft
Nater Main > 10'
0
'des
if No
ft
Community Wells > 200'❑
Yes if No ft
Nater Service Line > 94'
El
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Pield on Lok to, {Please enter distances if less Chan required}
Building Foundation 5 10'
El
Yes
if No
ft
If absorptFon field is under driveway comment below
Property Line 5 10'
Me
Yes
it No
ft
Wells on Adjacent Lots:
Water Main 5 10'
El
Yes
if No
ft
Private Wells > 100' Yes if No ft
Nater Service Line > 10'
-711
lies
if No
ft
Community Wells > 200' Yes if No ft
Surface (Nater > 104'*❑
Yes
it No
ft
F. ENGINEER'S COMMENTS
IC OF Al !1..
IMF
A
* -49TH* t
G. ENGINEER'S CERTIFICATION .... ........�
f certify that f have deterrrarrred through field inspections and review Steve Eng
of Municrpal records that the above systems are rrr conformance with 1; CE -6256 �i
0A COSA gufdefrrres in effect on this date. 1
r
G
Municipality of Anchorage 7l
Development Services Department
Building Safety Division .
*D2 On -Site Water and Wastewater Program s A t ..
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 SINGLE FAMILY DWELLING
Parcel I.D. 5l- 511- 35 HAA # b-gb219
�
Expiration Date: /Df'lol_
1. GENERAL INFORMATION
sue 41.1 ry �s�afe r
#� 19/c, c. 3 Lot 9_
Compete legal description ;�
Location (site address or, directions) 1S15011( sue.'Tw..
Current Property owner(s)Day phone K�'�'�
n
Mailing address
P
Lending agency'
Mailing address
Real Estate Agent
Day phone
Day phone K'A %— ec/ 7�{
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
P
Individual Water Storage
Individual Holding tank
'❑
❑
Community Class Well
❑ Community On-site
❑
Public Water System
❑ 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 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 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 effect at the time of installation.
Name of
Address
Firm_A[6r71wr/I'• F—As. n Phone Is 9tl-7oaon
1 �a37 OPfr G k, l' er'
Engineer's Printed Name _S't� ✓e meq• Date 6��?6S
44
5. DSDSIGNATUREid40. % S1oy"Vrl
i V"PE 6256
_ Z Approved for _� bedrooms. d sF. .0.
9Fve.......•
Disapproved. �Zaz?oFfsst�
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: A L,Q . U,�\' , as Original Certificate Date:
(Rev. 01103(
Municipality of Anchorage
Development Services Department
Building Safety Division g all
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: •P `T ctf= B3 L 9 Parcel ID: CZ�i-6+11-,15
A. WELL DATA
Well type P If A. S, or C provide PWSID # _ Well Log (Y/N)
Date completed L o/zy�p3 Sanitary seal (YM) Wires Properly protected (YIN) _
Total depth 4&—ft. Cased to III—" Casing height (above ground) 34!r in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level / ft. 6 g.p.m.
Well production 9—
p.m-WATER SAMPLE RESULTS:
Coliform a colonies/100 ml. Nitrate 4X mgJl Other bacteria �_ colonies/100 ml.
Arsenic: mg./I. Date of sample:)3T—/ Collected by:
A"Etman &M
B. SEPTICIHOLDING TANK DATA
Tank Typelmaterial Gr_ e - S&P I Date installed e'
Tank size 0 d gal. Number of Compartments Z Clesnouts (YIN) _
Foundation cleanout (YIN)Depression over tank (Y/N) High water alarm (Y/N)_
Date of pumping - & Pumper T ll'
C. ABSORPTION FIELD DATA
Date installed "Y- Soil rating (g.9 d W or fewmr) System type 694 l�
Length So ft. Width ZQ ft. Gravel below pipe Q S ft.
Total depth .5 ft. Eff. absorption area 00 _fe Monitoring tube Depression over field 6
Date of adequacy test2 0-r Results (Pass/Faiq l4 -r r For S bedrooms
Fluid depth in absorption field before test 0 in. Water added�%gair New depth in.
Elapsed Time: nin. Final fluid depth 0 in. Absorption rate >_ 4e= * - g•p•d•
Any rejuvenation treatment (past 12 mo.) (YIN & type) VdA If yes, give date
D. LIFT STATION
Date installed Size in gall s Me ole/Access (YIN)
'Pump on" level at in. 'Pump o level at _ in. h water alarm I el at
in.
Datum Cycl tested Meets alarm ti' ci it requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot / 00 ",r -
Public sewer main N 4
r
Sewer /septic service line ._ SC' t
On adjacent lots /OQ f.&
On adjacent lots / o o "t
Public sewer manhole/cleanout
Holding tank /VSA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /d r0 Property line�t
1(Z Absorption field -5-
Water
Water main Aj�.9 Water service line /a '04 Surface water 8i f
Wells on adjacent sots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /O r'F Building foundation I d -A Water main ill%}
Water Service line I'd I* Surface water�� Dia Parking/vehicle a �r,
Driveway. na g/vehide :longe /
Curtain drain eA( Wells on adjacent lots /ay ''r
F. COMMENTS
G. ENGINEER'S CERTIFICATION��-%.........�qs,�t♦�
r�;' �'•�9 ll
I certify that I have determined through field inspections and
i
review of Municipal records that the above systems are in
0
conformance with MOA HAA guidelines in etfed on this date.
A
Engineer's Printed Name rN - AlAf �/ ,
°f `,n •
Date 6/� % d
f, 6,,*. PE 6256 • v i
HAA Fee E '
Date of Payment
Receipt Number
(Rev. 12/01) Hj
Waiver Fee $
Date of Payment
Receipt Number_
Client::
Hat -6u Test Lab 9077.163012 0E/24/08 26187pm P. 001
fat-su Test Lab of Alasi
Mile 3.2 Patmer-WasUla hwy
Midto,en community Business Park
PA. Box 7749
Palmer, Alaska 9964S
Phone: 715-30176 Fax: 7464MO
Drinking Water Analysis Report
Total Coliform Bacteria
PWSI
#. i
U
Jun 23 05 03:41P ()LnSK(1 RIM
(007)740-0222 P•2
40 Met4u Test Lab of Alaska
Nk�
Water Quality Testing
Pa�mar-YVmita Hwy.
Midtown Community Business Park
Phone: (907) 746.3005
Client North Rim Engineering
17237 Bear Paw Circle
Eagle River. Ak. 99577
Attn.:
Client ID: Lot 9 Blcck 3 Sue Town
PWSID p'
Source:
M.S.T.Lt: 51463
Sample fAatrix:
Comments.
Email: Sa•..rt..nx rogarsnsa.Corn
P.O. Box 2749
Palmer. A. 99045
Fax. (907) 745-3010
Date Arrived: 6112105
Report Dale: 623105
Sample Date: 6122905
Sample Time: 1130
Ccllected By: SE
Method Parameter
Urits
Resutts
MDL
Dale Prepared
Date Aralyred
k1CL
SM 4503-NO3-E Nitrate -N
mg/L
1.14
0.50
6123105
6/23/C5
100
SM 4500-NO3-E Nitrite -N
mg/L
O.E4
o 05
6123105
6/23/C5
1.0
TotalNitrale/Nitrite
mg1L
1.14
050
6123105
623/05
10.0
Legend. k!RL. Wlelhod RePod Level
4CL = Max. Conteminate Level
B e Pmwix In Mettod Blank
E • Estlma$ed V8!ue
H =Above MCL
D •Lcuto Diction
Re�By Jan Paul Campbell
Lob Manager
SUE-TAWN DRIVE. p
M
2' field
Imo•
' R=
--. - - - - -- - - dutilltY easement - -I--- -
a1
s
_CA
Septic Vents
0 set—► t
n7'.�
at.*
O
0
CNG Y
0G i 4;
."
NO9°55'00'W 7O25m a
t<
E
9 F'
ib et
t/ ml = Meander Line of Little Peters Creek.
9 = Found Re -Bar.
LOT BEARINGS 9 DISTANCES ARE RECORD,UNLESS NOTED, PLATO 76-268.
AS -BUILT 11/15/83
LAT 9 BK. 3 SUE TAWN EST.
ADDITION NO. 2
ENGINEERING B SURVEYING SERVICES
LEATHERLE.AF DRIVE, POBOX 870215
WASILLA, ALASKA 99687
,y.
jrN'ra'lNEERIn N� NG
Northitim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907.694.7028
June 27, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Waiver Request; Sue Tawn Estates #2 S/D, Block 3, Lot 9
During the course of a Health Authority Approval investigation, it was discovered that the
wastewater system is under 100 feet to Little Peters Creek. A small lobe of the stream is
as depicted on the drawing. This stream edge may have eroded to a closer location over
the past 22 years. The stream edge quickly moves outside the 100 foot distance of the
wastewater system.
The drainage pattern adjacent to the wastewater system is also depicted on the drawing.
The drainage topography moves in a northwesterly direction before heading toward the
creek. If this drainage pattern is taken into effect, the above ground distance is over 100
feet to the creek if effluent surfaced from the system.
We are requesting a separation waiver of 88 feet from the wastewater system to the
nearest portion of Little Peters Creek. The rationale being that a very short section of the
stream is within the 100 feet and the prevailing drainage pattem at the wastewater disposal
system is not directly toward the creek.
The system tested well and no evidence of surfacing effluent was observed.
Sincerel
Steve Eng, PE, P
Waiver Layout Drawing & HAA Certificate Enclosures
_V_ to
DRIVEp
_
M
18°4 4 eld
rec. 140.2�fi
S 14e 10' 00"E 102.06' R = 530 _ 41.6511(recd-�__.___
__.-..._.. 10'Wi11fY E.uw�M--••__ 42fii:Id) �' ._.-
N /
N
O
" Drainage Patter
3 Through Swales
0
0
o /
e
is
ti
N
Septic Vents __ _
`rSt>—eafn— EcIgP,
O
0
J
`P•
i�
. P
' � �e•54
NO. 2269-3
AS -BUILT 11/15/83
11
SUE TAWN ESTATES #
~� _ WAIVER
NORTHRIM�,:
ENGINEERING 1� - 40 LAY
,, OUT
1'7237 &*or Pow C7rel
£,. R1 Aleake 99377 s;..,�..= BLOCK 3, LOT 9
907.694.7028 6/27/05
Municipalit3� of Anch
�-w I rU 1. Nm 1!";-W • Anchamgc,.\heska!X691! -WN) • Telephone (!X)7) 343-KX)1 • Fax (!X)7) 84:1-KL(X)
47(X) DmWaw Sheet • Anehamgc,,\taska 1X1.707
rcww.namLury;
Mayor Mark Begich Huilding Silrety I)INisiort
7/1/2005
NorthRim Engineering
17237 Bear Paw Circle
Eagle River, Alaska 99577
Subject: Waiver Request for Sue Tawn Estates #2 Subdivision, Block 3, Lot 9
Waiver Request #WR050045
Parcel ID 4051-511-35
HAA# IIA050288
Dear Mr. Eng:
'o• a�
jam' _`■} O
\seer /
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field to the surface water has been approved. The approved separation
distance is 88.0 feet.
This waiver approval applies to the existing absorption field to surface water separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Julie Makela, P.E.
Civil Engineer
On -Site Water & Wastewater Program
Continunky, Security, Prosperity
Municipality of Anchorage
Development Services Department
�..r Building Safcty Division
Wa
I\— On-Sitc Watcr and Waetcwatcr Program
4700 Bragaw Strcct
P.O. Box 196650 Anchoragc, AK 99519.6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: WR050045 PID#:05l-511-35 HAM HA0502t18 Permit#:
Date Received: 6128/2005
Legal Description: ,Syne Tawn Estates #2 Block 3. lot 9
Engineer. NorthRim Enoineerina
+7237 Bear Paw Circle
Eagle River, Alaska 99577
Applicant: Bob Lvon
Waiver Requested: Be feet from absoortion field to surface water
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
...............................................................................
Waiver is Granted: Waiver is not Granted:
11�r P. ,itunne nr Raasens for above: _C.Jctrtl s- -rl'1� L'�0 � tQ��
Date: --dL — By:
ame of Reviewer
.............................................................................
Rec#:07 108 Amount: $1.150 Date Paid:'
i
Time
APPLIG,,VT FILLS OUT UPPER HALIIONLY
'
Proptlfty;Owner �
iJ �" !0M -57/G !-�C?lGv✓
Phone
Mailing Address Zip Code�%/�d�C�
/
Buyer �ll�
L)✓S -
Address
Zip Code
Inspector
Lending Institution
�� F r -- fv-7 G 7 e, Gr / 1�4 /V `
Phone
Address /,/) /
A111 �r'' /_5'G Zip Code
�, e-74PI�U
Realty Co. & Agent
�7! C- fg /2 /) r 'T /l ''� Y' �/f/.//J '!��`� ��j'
Phone
Address
Zip Code
'CONDITIONS OF APPROVAL
Legal Description 0 % �O c ,C� - -y7—U F- T It, 7/
( ) DISAPPROVED
Street Location"�'--
( ) CONDITIONAL APPROVAL'
1"
Type of Residence '
Ingle Family
DATEL—
BY:`i�v
❑ Multiple Family
No. of Bedroom�U
Soils Rating
❑ Other
Well To Absorption Area G�
Well Log Received l�BA
Water Sply
Individual
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal—`l
ividual
Year Individual Installed: /
. ❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
ime / Qi _^, /,
Timed—,,x6&Iti-�.
Date
Date
Date
DaIe1�/f(/l/ C/U,
Inspector
Inspector
Inspector
Inspector( ,
Field Notes:
�O
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATEL—
BY:`i�v
Soils Rating
Date Sewer Installed
Well To Absorption Area G�
Well Log Received l�BA
Septic Tank Size
,-- ����
Well to Tank y��-}
72"023(3182)
S