HomeMy WebLinkAboutOLSON HEIGHTS BLK 2 LT 8Onsite File
Olson Hei !9 hts
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
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP191176
Work Type: Septic Upgrade
Tax Code Number: 01823110000
Site Legal Address: OLSON HEIGHTS BLK 2 LT 8 G:2936
Site Mailing Address: 4550 E 135TH AVE, Anchorage
Owner: KENWORTHY JAMES N LIV TRUST &
Design Engineer: C & M Engineering
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
Department
40414
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
Special Provisions:
1) An insulated, 20" diameter (minimum) manway riser is required on the first compartment of the septic tank, in
accordance with 15.65.205F.1.
2) The inspection report and record drawings shall document both the new and existing sections of drainfield
(since the existing section was modified).
3) A test hole is required for the reserve drainfield, in the location shown on the site plan. The test hole shall
confirm percolation rate and separations to seasonal high groundwater and impermeables. Please submit
results with the inspection report. If results require a design change to the reserve drainfield, this shall be
reflected on the record drawings.
4) A test hole was provided for the new section of drainfield prior to construction to confirm percolation rate and
separations to seasonal high groundwater and impermeables. Construction can proceed at your own risk prior to
the 7 -day groundwater reading, which shall be added to the test hole prior to inspection report approval.
1 On the record drawing, the reserve field shall be located a distance equal to twice the effective depth of the
existing drainfield.
CO # 1(61lgI15) : move .
Received By: Date: Lm
Issued By: �� Date:
Municipali
of Anchorage
P.O. Box 196650 e 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 e Fax (907) 343-7997
http://www.muni.org/Ons-ite
Development Services Department
On -Site Water and Wastewater Section
�c
i
Department
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV191039 COSA#: Permit#:OSP191176
PID#: 018-231-10
Legal Description: Olson Heights Block 2 Lot 8
Engineer: C&M Engineering
Applicant: James Kenworthy & Patricia HackleV
Your request for a waiver of the requirement that an absorption field be installed parallel to the
contours of the slope has been approved. This waiver is granted based on the drainfield being
installed per the engineer's profile drawing.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
. r r r r .. r r r r r. r r r. r r r r r. r r r. r r r r r r r r r r r r r r r r r r r. 2 r r r r r r r r r r r r r r r r r r r r r r r r r r r r r i
Waiver is Granted: X Waiver is not Granted:
Date: f� Approved by: cous
Name of Reviewer
■■ r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r �
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY
Development Services Department 1� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 018-231-10
Property owner(s) JAMES KENWORTHY PATRICIA HACKLEY Day phone
Mailing address 4550 E 135TH
Site address 4550 E 135TH
Legal description (Sub'd., Block & Lot) Olson Heights Block 2 Lot 8
Legal description (Township, Range & Section)
Lot Size 40,414 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
X❑
Initial ❑
Single Family (SF) ❑
(w/wo ADU)
Septic Tank
El
Upgrade
(D) ❑
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
s�Pe Cnt�% Distance: N R
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
C&M ENGINEERING
(Signature of property owner or authorized agent)
Permit/Rush Fees: �U"T-r376 Waiver Fees: � do 5
Date of Payment: J 11Ja%��%�(>LIVZlg Date of Payment: �O 2
Receipt Number: 60 d 100MReceipt Number: n7y 1-b
Permit No. 05'0/c? Waiver No. _05 V 1110-39
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
W I
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System replacement for Olson Heights Block2 Lot 8
Dear Reviewer,
We are requesting an additional change order to the permit for the above referenced property. We are
submitting a revised site plan which shows a revised location for the new trench system, reserve site, and
construction test hole. The new trench and reserve site are shifted to more favorable locations on the lot.
Adjustments have also been made to the plan showing updated test hole locatioins.
The new trench will be installed cross -slope to accommodate existing landscaping and garden features.
As shown in the attached cross section, this will not have a negative impact due to the small change in
slope and the soil strata. Placement of fill will be required, however it will not significantly impact drainage.
Included with this letter is a revised plan and cross section.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini(@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
6/13/19
"CHARLES G BALZARINI
CE13854AW
����li�pROFESSI�1kt_;; AW
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System replacement for Olson Heights Block2 Lot 8
Dear Reviewer,
We recently applied for and received a permit to replace the septic tank at the above referenced property.
Upon replacing the tank, it was determined that the system did not have sufficient drop to the leach field,
despite the more favorable conditions created by the new longer tank. It is anticipated that the drain field
distribution pipe will need to be lowered six inches or less to create sufficient drop across its length. The
existing drainfield also requires a new cleanout and monitor tube.
We are requesting a change order to the permit to perform the above repairs and to upgrade the capacity
of the system to 5 bedrooms. The owner would like to add an additional supplemental drainfield to ease
the loading on the existing trench and to upgrade the total capacity to a 5 bedroom system.
A new deep trench will be installed. The new trench will be sized for 2.5 bedrooms. A flow splitter will
divert the flow equally between the new trench and the existing trench. Each trench will handle effluent for
2.5 bedrooms for a total capacity of 5 bedrooms.
The existing trench will be oversized and will have a significantly increased life span.
Should repair of the existing trench reveal that it18 full to over 50% of'it's total depth, the 5 bedroom
reserve site may be developed in leu of the, combined trenches.
A testhole will be excavated and a percolation test performed during construction.
The new trench will be installed cross -slope to accommodate existing landscaping and garden features.
As shown in the attached cross section, this will not have a negative impact due to the small change in
slope and the soil strata. Placement of fill will be required, however it will not significantly impact drainage.
Included with this letter is a permit application and design package, including plans, specifications, and
calculations.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini(o)gmail. com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
6/10/19
go-_-Or.A - kj
CHARLES G BALZARINI'
CE13854 �4�
C&M ENGINEERING SERVICES
907-854-5558
Septic Design Calculations
Residence: OLSON HTS B2 L8
.
RESIDENCE, 7 T IN'F,O
�. �. ..0
number of bedrooms 2.5 br for new trench
Water usage/bedroom 150 gpd/br
Water Usage 375 gpd
system type: CONVENTIONAL
type: TRENCH
Application Rate 1.2 gpd/sqft
required absorption area 312.5 sqft
trench width (W) 3 ft
gravel depth (D) 7 1 ft below distribution pipe
Min Required Length
Total Excavation Depth:
Cover:
Insulation:
Effluent Pipe:
22.3214286 ft
11 ft
4 ft
2" blueboard
4" ASTM 3034
Calc By: CGB Date: 6/5/2019
CHARLES G BALZARINF
CE13854
AM-
���,-"ROFESS\61 -�
C&M ENGINEERING SERVICES
907-854-5558
Septic Design Calculations
Residence: OLSON HTS B2 L8
_.
:RESIDENGEfLOT1NF0
number of bedrooms 5 br RESERVE TRENCH
Water usage/bedroom 150 gpd/br
Water Usage 750 gpd
system type: CONVENTIONAL
type: TRENCH
Application Rate 1.2
gpd/sgft
required absorption area 625
sgft
trench width (W) 3
ft
gravel depth (D) 7
ft below distribution pipe
Min Required Length: 44.6428571 ft
Total Excavation Depth: 11 ft
Cover: 4 ft
Insulation: 2" blueboard
Effluent Pipe: 4" ASTM 3034
Calc By: CGB Date: 6/5/2019
CHARLES G BALZARINI�
CE13854`4`�
iti°
\ / e 135TH \
l�
49 TM
'�� ' IHARLES G BALZARlUt , �F��•,. CE -13854 .,•4���
���Ilk- FESSIONP
® MONITOR TUBE
® TEST HOLE
0,5X\ SLOPE INDICATOR
I \
I
I �
LOT 7
LOT 8
DRIVEWAY
100' WELL \ �----- ----�� /
RADII 4 BR HOME
NEW 1500 GAL
INFILTRATOR TANK.
7
PTESTHOLE 1
NEW 24' LG DEEP TRENCH
WITH 7' EFFECTIVE
47s,
0 15 30 10' UTILITY EASEMENT
rd
n
OF Al...
co
49 TH
V / ' CHARLES G BALZARINI
�� FFG,•,•. CE -13854 •.�`��,��
PR0FESSI�NP�
I
II
EW AFTER MULBERRY TR. 61
ANK COs NO DOCUMENTED
WELL OR SEPTIC
I SP ITTER WITHIN 100' OF
PROPOSED SYSTEM
- EXISTING DRAINFIELD
WITH 12' EFFECTIVE
TO REMAIN. LOWER
DISTRIBUTION PIPE 6" TO
MAKE DROP FROM
TANK TO FIELD
RESERVE SITE:3'X45' DEEP TRENCH
WITH 7' EFFECTIVE
TE THOLE TO BE EXCAVATED DURING
CO STRUCTION TO 17' MIN DEPTH
INSTALL NEW CLEANOUT AND
ONITOR TUBE
OA CONTOURS SEPARATION DISTANCE NOTES:
THE PROPOSED SEPTIC IS GREATER THAN:
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
100' FROM ANY SURFACE WATER
TO ANY PROPERTY LINE OR FOUNDATION
LEGAL DESCRIPTION: OLSON HEIGHTS BLOCK 2 LOT 8
C&M ENGINEERING SERVICES OWNER: KENWORTHY DATE: 6/13/19
907-854-5558
SITE PLAN
A
co -
49 TH
T;HARLESGBALZARINI—��
R
CE -13854 *Ai-'AiV'
(� 1 r- A N I t-\ I IT
FILTER FABRIC
TOP OF ROCK
17' TESTHOLE DEPTH
SCALE: 1" = 5'
1
BOTTOM
OF ROCK
C&M ENGINEERING SERVICES
907 -854-5558
LEGAL DESCRIPTION: OLSON HEIGHTS BLOCK 2 LOT 8
OWNER: KENWORTHY DATE: 6/6/19 1 REV. I DRAWN: CB J REF. -
PROFILE
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Section
y� 4700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
TESTHOLE-1
Soils Log - Percolation Test
Performed For: KENWORTHY
Legal Description: OLSON HEIGHTS BLOCK 2 LOT 8
Depth
(Feet
2-
3-
4-
5-
6
TOPSOIL
BROWN GM
GRAY SAND/GRAVEL
7- SLIGHTLY SILTY GW/SW
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
9-
10-
11-
12-
13-
1415-
16-
17- - --- BOH
18-
19-
20-
49 TM .
.. ....
CHARLES G BALZARINI .
CE/13854 ����
PR0FESSIONP�
Date Performed: 06/11/19
Township, Range, Section:
Site Plan
WAS GROUND WATER
Date
ENCOUNTERED? NO
Net Time
Depth to Water
S
IF YES, AT WHAT DEPTH?
L
Depth to Water After
P
P
Monitoring?
E
Date:
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1
6/12/19
9:32
0
0-0/16"
0"
2
9:42
10
2-3/16"
2-3/16"
3
9:43
0
0-0/16"
0"
4
9:53
10
2-4/16"
2-4/16"
5
9:54
0
0-0/16"
0"
6
10:04
10
2-3/16"
2-3/16"
PERCOLATION RATE 4.5 (minutes/inch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS LAST 6 READINGS SHOWN. PERFORMED FOR 1 HOUR.
PERFORMED BY: CHARLES BALZARINI I CHARLES BALZARINI CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 06/12/19
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
05/10/2019
RE: Proposed Septic System Modification for Olson Heights Block 2 Lot 8
Dear Reviewer,
The above referenced property is currently served by an older 4 bedroom septic system. The 1250 gallon
tank has failed and is in need of immediate replacement.
We are proposing that the existing tank be replaced with a new 1250 gallon (minimum) tank constructed
and installed in accordance with MOA requirements, including the new requirements effective 5/1/2019.
As shown on the plan, the tank will be greater than 10’ from the house foundation.
The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover.
The repair shall be performed by a moa certified installer in accordance with MOA requirements.
The engineer will inspect the tank before backfilling.
The proposed repair of the septic system will not negatively impact adjacent lots.
Upon completion of the installation, a record drawing will be submitted showing the location of the new
tank, leachfield, well, and other applicable features.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE (05/10/19)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191176, Rebecca Carroll, 05/16/19
LEGEND
o CLEANOUT
• MONITOR TUBE
Z TEST HOLE
0.5%\ SLOPE INDICATOR
I \
I
LOT 7
LOT 8Am� CD
DRIVEWAY
100' WELL
RADII 4 BR HOME
REPLACE EXIST TANK
WITH NEW 1250
GAL TANK. DEMOLISH
OLD TANK PER MOA
REQUIREMENTS. VERIFY
BURIAL DEPTH PRIOR TO
ORDERING TANK.
EXISTING DRAINFIELD
TO REMAIN
E
SEPARATION DISTANCE NOTES:
THE PROPOSED SEPTIC TANK IS GREATER THAN:
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
100' FROM ANY SURFACE WATER
10' TO ANY PROPERTY LINE OR FOUNDATION
SP191176, Reb4
/*: 49T .*
.. ....
CHARLE
N �... ...........
r • S G BALZARINI
�r+�'c��,•. CE -13854 .•��
pROFESSI�NP
EXIST FOUNDATION
CLEANOUT. INSPECT
PIPE FOR DAMAGE
REPLACE IF NEEDED
NEW AFTER
TANK COs
MULBERRY TR. B1
NO DOCUMENTED
WELL OR SEPTIC
WITHIN 100' OF
PROPOSED SYSTEM
NOTE: NEW SEPTIC TANK
REGULATIONS IN EFFECT
AS OF 5/l/2019. ENSURE
NEW TANK IS APPROVED
FOR MOA USE.
LEGAL DESCRIPTION: OLSON HEIGHTS BLOCK 2 LOT 8
C&M ENGINEERING SERVICES OWNER: KENWORTHY DATE: 5/10/19 1 REV: 11
907-854-5558
SITE PLAN
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
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Liq. capacity ]n
DISTANCE TO:
Inside length
Material
Width
IF HOMEMADE:
Well Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
DISTANCE TO: o~
No. of lines I Length I~n~
Top of tile to finish grade /,~ ~
F°undati°~ b I
TM°att:Ir :~ln b~[: e~----"?t~nt: se
Nearest lot line
T re nch .w~dJJ~' f(
c~) (.~,~) inches
inches
Depth
Length Width
NO. OF BEDROOMS
No, of compartme~.s~:.
Liquid depth
_ /' 70,
Dis ta nee bet ween I,/~,¢(~//~ .
Total e[fectiv(~b~.~,on area
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption erea
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line ] PERMIT NO.
Building foundation Sewer line Septic tank /~s,s~o~ area(s)
DISTANCE
TO:
J
OTHER
PIP,~ MATERIALS
SOIL TEST R^~
INSTALLER
REMARKS
DATE LEGAl_
WELL LOG
FOSS DRILLING ASSOCIATED
909 CHUGACH DR. #3?
ANCHORAGE, ALASKA 99503
WELL OWNER Frank O. Bethard
USE OF WELL Domestic
WELL LOCATION Lot 8 Block 2 Olson Heights Subdivo
SIZE OF CASING6"
STATIC WATER LEVEL
REMARKS
DEPTH OF HOLE ll~21_FTo
113 FT. G. Po Mo 15
CASED TO '1~1 FT,
WITH 25 FT. OF DRAWDOWN°
DATE COMPLETED 8/30/79
PUMP TO BE SET AT 140'
o__to
..6,5 to 75_
.7_~5 to 1 3___5
j35to 1
~to~
Till; grey color~ hard
Alluvium~ light grey color~ medium hardness
Alluvium~ blue-~rey color~ medium hardness
Alluvium~ light grey color~ with water ~
Sand and ~ravel~ ~rey color~ with wa~er
~to
to
to
to
to
to
~to
to
to
to
to
PERHIT NO.
FIPF'L..[ ...RNT FRRNK .P.,E].'HF-IRD
LOC~TION ~:-~:5TH RVE. ~' r 'F~-*~J;'~-
I_E..FJRL I_.OT ,'3 E:I..K 2 uLS3N SLiI~:,
T'¢PE OF SOIL RE,..-,UF..E,'fIUN S"r'S'l'Ef'i : TREN~.H
f'll:i~-::.T.l"ll..li"l tllJHBER ElF BE[:'ROOH'-S = 4- 5;O%t.. RF:IT.TI",IL":i ,::?2;.E.! FT,.'"E;R':
THE RE~UIF.;E.E:, S:[ZE. OF THE SOIL FIBSOF.'.F'TZON S.';'¢STEH
-' ' -" "='
TNE LENGTH fSII"IENSION IS THE LENGTH (]:hi F'EET) OF THE TRI..S. NCI-I
]''HE DEPTH OF R TRENCH OF.,' PIT IS THE [):r. STFINCE BET!-,IEEN THE SURFRCE OF' 't'~-~::'
GROUND, RND THE BO]''TOH OF' THE EXCFtVRTION ,.'.IN FEET).
]"HERE IS NO SET Flit, TH FOR TRENCHES.
THE (:iF.:RVEI.. E E.F IH .[.:, THE i"III'.,I]:HUH I)Et TH Of-- C4RR',,,%L BETP.IEIEN THE
FIND THE BOTTOrl OF THE E,s,',CRVRT.~ON (IN FEET:>.
PERMIT * ':, ~' ,' ,' ~
MFFLI_.FINT FIRS THE EE:.-,F. N::,IBIL.T.]."¢ TC :[I'.,IFORH THIS~.r',E.::'FIF:'f'HEhlTI:' r.l~;,?
~I'-,I:STF'ILLIRT.TK~N ]'I'-,I="],F'ECT][ON2'; OF FiN'¢ , ' '=, ..
!..IEI_t .... RD3RCENT TO TH.TS F'I~:'.."~P1EI-:i:T'.r' FIND
NLIr,IBER OF F.:[:z, ZE.~ENCES Tt4RT THE [,IEL..L !.,I.TLL
BRC:I.~:F'.ILLING OF: Rr.,l~r' S~.'5;TEf,i I.,.I:[THOUT FINRL INSF'ECT:[ON FINE:.., R,::'F'R"',,'F .... E:'¢ TI..!:I:S
DEF'RF.'.'f'FIENT [,J.T L[.. BE: SUE:,.~EC'F 'tO PRE SE"_': .. T Z: N,
I','I][HZHLIH E:,ZS'FRNCE BETNEEN R I,.IE[1. L RN.I].., RI,IV 0N-SITE SENI;:I(~E E:,~SPOSRL. S'¢STF:'t',~
:1.88 FEET FOR Ft PR:[VRTE NEI._L~ OR
:1.58 TO 288 F'EET FF.'.OM R F'UBLZC NELL DEPENI;.',]:N(~ UPON '¥P,E T"r'F"E 0F PUBL.:!:C I,IE'I ~
I-4ELL LOGS RRE REbqUZREE:, FIND HUST BE RETURNED TO THE DEPRRTHi:EI'.,IT f4I. TH]:H
OF' THE !-,IELI._ COI"IPL.ETION.
OTHER RE6!UZREHENTS f'lR'¢ RI:'PL'¢. SPEC:]:F,TCRTION~ RND CONSTRUCT:ION
FIVAILRBLE TO :INSURE PROPER :[NSTAL. LRT:ION.
I CERTIF'¢ THRT
±: I RI"I FRMIL. IRR !.4ITH THIS RE~?UIREHENTS FOR ON-SITE SEHERS
FORTH BY THE I"IUNICIPRLIT'¢ OF RNCHORFtGE.
2: I I.,.IILL INS'mL.L THE S'¢STEH IN RCCOR[:'RNCE !.,IITFI ].'HE CODES.
Z.':: I UNDERSTRND THRT THE ON-SITE SEI,.IER S'¢STEH MR"¢ REg!U]:RE E-]NLRR(:;iEHEI'.,IT IF
RESIDENCE IS F.'.EI"IOPELED TO INCLUDE I','IORE THRN ,'~$ BEDROOMS.
S~:G~,~Et:.,:._ .,,.4~, ~ ....... ~ ...............................................................
................ .......................
SOILS LOG
1
2
3
5-
6
7
8
PERFORMED FOR:
o - ,
~o'
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMFNT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
Pouch 6-650, Anchorage, Ala.~ka 99502 276-2221'
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN
10
11
12
13
14
15
16
17
18
19
2o
COMMENTS
WAS GROUND WATER ~ S
ENCOUNTERED? ' ~' L ~ ' ' :
O
E
IF YES, AT WHAT . . .
DEPTH? ~ '
' ' Gross Net Depth to Net
Reading . Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
72 008 (7/76)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
7
8
~._~2
'ltl.-
17-
10--
20~
COMMENTS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTN AND ENVIRONMENTAL PROTECTION
Pouch ~-650, Anchorage, Alaska ggS02 ?..76-222'~
SOILS LOG - PERCOLATION TEST
~"--SOl LS LOG
[] PERCOLATION
TEST
DATE PERFORMED: ~ - ( Z'-'77
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE SITE PLAN
' ' ~ ! --' - 4 -- ;- & ~ ~ ......
L
0
E
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
CERTiFiED B''¢
72-008 (7/76)
MUNICIPALITY Of ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # C~\°~- ~\
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Day phone
Lending agency
Mailing address
Agent ~L~-,c-,./ b..~<.~u-~
Unless otherwise requested, H~ will be held for pickup.
Day phone
~..P J"~c'X _ Day phone
NOTE:
Public water ;.' , ,'-. '
. :,..(~ ,,, .~ ' .,.,
If community well system, provide written confirmation from State A.~EC attest- ,. ","
lng to the legality and status of system. . (.. ~q\ ,,
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-02~ (Rev. 1/91) Front MOA~I
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply.
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with ail Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
EngineeCs signature
Phone ~L"7 ~'- '& 9/~,
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
", ~ddition~.[.Comments
Date ¢//~.~/>--J ~--
The Municipality of Anchorage Department of Health and Human Services (DHH$) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH H8 does tills as a courtesy to purchasers of homes
and their lending institutions in order to ~tisfy certain f~eral and state requirements. Employees of DHH8 cio not
conduct inspections or analyze.data before a cer[ificate is issued. The Municipalib/ of Anchorage is not
responsible for errors or omissions in the p!'ofessional engineer's work.
72K)25(Rev. 1/91) Back MOA~I
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type ~
Log present (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
y Date completed ~.//~0/'7 O' Driller
Total depth J ~/ Cased to
Sanitary seal (Y/N) y
FROM WELL LOG
Date of test ~-/'/~ ¢.)
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot J ,~ ~--
Public sewer main P'(///~
Sewer service line
/ ~_/ Casing height
Wires properly protected (Y/N)
AT INSPECTION
MUNICIPALITY OF ANCHONAGE
! ~ ~ ENVIRONMENTAL SERVICES DIVISION
.g.p.m. ~ g-P.m:ui__ l? 199,5
o
R C[IVED
; On adjacent lots /.~'2 ''t~
; On adjacent lots / ~-~ T
Public sewer manhole/cleanout ~¢' ~/'~
Petroleum tank ~.1 ~ ~4 ~
WATER SAMPLE RESULTS:
Coliform ~¢/
Date of sample: o ¢/~'~
B. SEPTIC/HOLDING TANK DATA
Date installed 7/? ,~
Cleanouts (Y/N) ~'//
High water alarm (Y/N)
Date of pumping
Nitrate
~,~-- ]~ H4 ¢/ Other bacteria
Collected by: '~o ~,
Tank size / ~- -~ L~ Compartrnents
Foundation cleanout (Y/N) . 7 Depression (Y/N)
Alarm tested (Y/N) I"///~
'7/,¢//~ 5- Pumper / ,O Or_ ~,~ ¢/J~
h~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Absorption field
H !
Foundation
Water main/service line
72-026 (&'93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
o'tq
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~/'?'~
Length ~ ~
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) / ~
Width ~ Gravel thickness
c~ ~ Cleanout present (Y/N) ~'
"7/~ / ~- Results (pass/fail)
System type '~'
i ~ Total depth I
Depression over field (Y/N)
for ~ Bedr~ms
If yes, gbe date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 '5,2-
To building foundation
On adjacent lots ~.
Surface water ~' ~/(~-~
Curtain drain
On adjacent lots / 5-0 '~' Property line
To existing or abandoned system on lot
Cutbank 'J~O ~ '~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
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
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ¢~'¢,~4~ ~P~r'.e.¢4 Telephone:Home ~Y4".,,~'~ Business ~¢9-~?~)_
Applicant Address 'A'.~,:-~'LD /~ ~._~' /-/4, ~/;~.(_.) ~ //~:2/// Ol/(l;~,.~'/ /_
(c) Applicant is (check one): Lending Institution []; Owner/br-~ri~i~er [~; Buyer [']; Other [] (explain);
Lending Institution
(d) Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family(l~ 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
Onsite.~" Public [] Community E3 Holding Tank []
/
Note': If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 ot 2 72-025
FNGINEERING FIRM PROVIDINf¢ INSPECTIONS, TESTS, FILE SEARCH, DA'i ~ 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~2, '~'f,'C~'t4,~/ Telephone Z¢~7 ~ ~ '~ ~'/~/~
Address ('' ~-~
Date __ -g/, / ?
Engineer's Seal
Approved for ..;¢/"'~,,¢i~' bedrooms b c]_~Date __//-~'
Approved ~ - Disappro~g~d Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work,
Page 2 of 2
72-025 {11/84)
.,O%~'~I~UNIClPALITY OF ANCHORAGE (MOA)
,.,.~ t~',O~,~, ~c.,~I~LTH AUTHORITY APPROVAL ~HA~
~ ~>~O~ CHECKLIST- FEBRUARY 198; ~'
.~ ~, O'_,~~ ~ 264-4720
weWELLc asslflcatl°n~'DATA ~~~'~X~ ~:~ ~-7~ ~/~'1 ~ ~
' ' ' If A, B, C, D.E.C. Approved (Y/N) ~
Well Log Present (Y/N)/ Date Completed _~/~¢/~ ¢ Yield
Total Depth 1 ~"l Cased to I H I
Static Water Level t ~- u//
Casing Height Above Ground /~
Electrical Wiring in Conduit (Y/N) F
Separation Distances from Well:
To Septic/Holding Tank on Lot
Depth of Grouting ~ 0/,~ ~-~
Pump Set At __ / '~ f¢¢
Sanitary seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
II~-
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
; On Adjoining Lots
/~' ¢~- ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
7'
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) _0 N ~.;-
Depression over Tank (Y/N)
To Property Line
To Water Main/Service Line
Course
Size _ /'~-'~;¢-~ No. of Compartments '7
Air-tight Caps (Y/N) ')/ Foundation Cleanout (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 //~-
Date Last Pumped
:for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field _
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption ~trata
Date Installed yT~
Width of Field
Square Feet of Absorption Area ~
Depression over Field (Y/N) I~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well / '.~,~
To Building Foundation ~.,~-
Lot
To Water Main/Service Line
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
tP
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ~"~O "(
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION NoNe
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Elect'~ical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or co/g~ormed to all MOA.and. HAA guidelines in effect on the date of this inspection.
Signed Date !
Company MOA No.
Receipt No. / 0
Date of Payment ///~
Amount: $
Engineer's
Seal
Page 2 of 2
72-026(11/84)
'03 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
RESIDENTIAL WELL INSPECTION
LEGAL:
LOT 8, BLOCK 2, OLSEN HEIGHT
LOCATION: 4550 E135TH. AVE.
OWNER: WAYNE OGREN
TYPE OF WELL: SINGLE FAMILY ~..~;.~
WELL LOG AVAILABLE: ' YES 9
~t ~ JUNE 25. 1971 · ~,
INSTALLATION REQUIREMENTS MET: YES ~5~'. ..
WELL YIELD FROM WELL LOG: 15 GALLONS PER
PUMP YIELD.'
6 GALLONS PER MINUTE
DATE OF INSPECTION:
OCTOBER 28, 1986
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE
DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 124 FEET
BELOW TOP OF CASING. AFTER SEVEN MINUTES OF PUMPING THE WATER
LEVEL WAS MEASURED AT 134. THE WATER LEVEL REMAINED AT 134 FEET
FOR THE DURATION OF THE TEST, 60 MORE MINUTES.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON
OCTOBER 29, 1986. TEST WAS NEGATIVE.
TEST RESULT:
THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is 150 gallons of water
per bedroom per 24 hours.This well surpasses this requirement.
The assessment of the condition of this well applies only to the
conditions as of this date. The flow rate of the well may change
due to subsurface conditions that may not be observed from the
surface, and changes in land use and other factors that may
impact the conditions of the aquifer, feeding the well.
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
SEPTIC
SYSTEM
ADEQUACY
TEST
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WELL:
SEPTIC SYSTEM:'
LOT 8, BLOCK 2, OLSEN HEIGHTS
4550 E135TH. AVE. ~q?~[~'
WAYNE OGREN ~:' 4 9~" }?~
FOU
FRIVATE, ON SITE '~ "~['. .'.>;,~
FROM MUNICIPAL RECORDS
TANK: GREER STEEL, TWO COMP. 1250 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: ~ SQ.FT.
SOIL RATING: 150
INSTALLATION DATE: JULY 1979
DATE OF PUMPING: OCTOBER 30, 1986. ISAACS
DATE OF TEST:
OCTOBER 30, 1986
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND
WITH FOUR FEET OF COVER AND 49 INCHES OF LIQUID.
CLEAN OUT TO TRENCH WAS 4 FEET DEEP AND CLEAN. SUMP WAS 15 FEET
DEEP WITH 6 FEET OF WATER. 1000 GALLONS OF CLEAN WATER WAS ADDED
TO THE TRENCH WHILE THE WATER LEVELS IN TANK AND SUMP WERE
MONITORED. THE WATER LEVEL IN THE SUMP ROSE LINEARLY 35 INCHES.
THE INFILTRATION RATE WAS MONITORED FOR 60 MINUTES. DURING THIS
TIME 66.6 GALLONS WERE ABSORBED. EXTENDING THE MEASURED
ABSORPTION RATE TO 24 HOURS A RATING IN EXCESS OF 600 GALLONS PER
DAY IS OBTAINED.
TEST RESULT:
THIS SYSTEM MEETS ~HE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater 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 septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
DATE RECEIVED
TIME TIME TIME
DATE DATE DATE
I NSP ECTOR INSPECTOR I NS P E,Gq'O R
MUNICIPALITY OF ANCHORAGE /~UNICIPA[.IT~' OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF
825 L Street - Anchorage, Alaska 99501 INWNONMENTAL I'~OTECTION
(~~ ENVIRONMENTAL SANITATION DlVlSIONTelephone 264-4720
DIRECTION$'. Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1, PROPERTY OWNER PHONE
MAILING
PRO~E~Y RESIDENT (If d~fferent from above) PHONE
2, BUYER PHONE
MAILING ADDRESS
3, L~NDINGIN~TITUTION ~ PHONE
I
MAILING ADDRESS
4, REALTOR/AGENT ~ PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RES[D'TENcE
NUMBER OF~BEDROOMS
~ SINGLE FAMILY
[] MULTIPLE FAMILY
[] One ,~ Four
[] Two [] Five
[] Three ~] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL I_OG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.]
8. SEWAGE DISPOSAL SYSTEM
~ NDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVEO
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or E~]HoldingTank
Size: I ~--~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
I TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank 1Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[~-~pp ROVE D FO R ~;;'~'~'/~ B E D ROOMS
[] CONDITIONAL APPROVAL {letter must accompany certificate)
E:] DISAPPROVED .~~
DATE BY '~__~