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HomeMy WebLinkAboutLEACH LT 3OI511.t k CUSA Checklist L E L .10j T 33 j Parcel ID.- 015-I i -237 13-trusture, --s-enjeod -bly t, Pr-ovi.d-e -S,-. P-ara.-ta sfi.e, A A. WELL DATA #N Well [og is filed with Onsita (or attached) Date drilled 902 Total dicapth 190 ft a e d '11 -AD 0, �c,-i iry s e �i i Is Tun d.- J Uri� 1 r -i n y �A1ires are properly prt-ected -C--,i_qinn height (above ground" 18+ in. T 0 -19/2024 j A I �� 7/ Da'7(e o' 'lo-vij test �' " C,01 -3A Well production at time of test , 3--; _�gjyn 500 NJ11ater s'�i-orasge ii-ank VOILH11-e gallons Well dissinfected f?�:)r coliform test? F&I lYes 0 U01I i -T1 bacteria . . - I OrM bacteria is 1\ 11 Iegaive Nitrate 2.1"o Tri /L 1 -3!- is 'ess th in NI RL (ND) 81 r� I C ug/L OU Arse n i Collected by GEGJ LTD. / At6F"3' Z _'ta"Jc water �Iavel at beginning of test -138.6 -f-t. Date 7/22/2024 & 8/9/2024 ) L ?e vel 'BLADDER TANK IN CIAWLSPACE'--fANK S1.7 -,E IS PER OWNER. TANK BYPASSED FOR WELL FLOIA! TEST. 1`10TEH: PER AVVPS, WELL WAS DISINFECTED PRIOR TO NEW COLIFORM SAMPLE TAKEN. B. TANK DATA a T STATION *51 `equi� Mea Dred operating ifluid in septi; 7�-,e q u, ire e n n� 'Z�­ completp" (L)ate of pumping 8' tation i r s Age of lift S -r� VYI.S.0"i .41 station impt,t`al Reauired ma,ntenar,07:_.­ -coL-, i'pkz�ts C o rn rn e n t;s" "AN ST2/ 15)3" IN ST1 D. ABSORPTION FIELD DATA r -'O' V -/w �w— I fZ)-dN Xf1lhich system tested (date inst-allac - 2/17/1 995 [� ALL standpipes present, per® record, drawing Total measurs-rul depth ir-rom grade *16.4/ (max) MeaSUred depth to pipe invert from grade ""6.2/ ft (mj,,j) N/A - pressurized field. *3.0 Per record drawings, field is insulated. F Monitor tUbes go to bottorn of effective. ' It not, state depth'im!n.e-ive El Presoaked required i -I" (Required if hOLISe V3Cqb1i or field net used for more than 30 days prior to date of test) Gallons introduced gallons date Arlt' rejuvenation treatmenit (past -1 A2, Mori UIS) If yes, enter date Cornments/Deficienciess: � Adequacy test date 8/14/2024 Results g Pas'-'-,) Fluid depth prior to test ',IiAlater adder -1 48 2 gal a _"59.25 1'-Iuid dept -hire Elapsed time 253 mill n -7 I flijld gJepth in Absorptiori rat( g p d 45 + FIELD STATUS - POST RECOVERY Effective depth (per record drawings) 108 in Effective depth used "51.71 in Effective depth remaining *"'56.25 in NEW MT (MTI) INSTALLED IN EAST TRENCH TO BOTTOM OF THIS TRENCH. EFFECTIVE WAS MEASURED IN N11T2 (WEST TRENCH). -TESTED IAIEST TRENCH ONLY. POST RECORVEY READING BASED UPON -ELEVATIONS. NOTE: A MAJORITY OF THE WEST TRENCH HAS 3+ FEET OF COVER. NO FREEZING ISSUE PER OWNERS STATEMENT. I— COSA Chad-dist—JUne 2022 ii 7- F_ Pijival_i°lc,. (Please enter distances ifltess -Li-han required or if cornt-nunity well on lot') �D ,o�nL Lo - L Z)eptic Tank/Lift Station on Lot > 1,00' 4- Community Sewer lVianhole/CleanOUt > 100' 9 Yes i f N o Yes if N o Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Lin-E-.� > 2' Yrvas if No et 7 xt Holdi k > 100' Yes if No Absorption Field n Lot o > 1 00' Yes if No ng Tanis yt 1:: �4 0 Na i ghboring Absorption Fields > 100' Animal Containment > L 0 Yes if No ff F Y es i N- 0 Manure/Anirnal Excnnta ZS'tcra qe,> 100 C I ornm unity Sewer Main> 75' [E`des if No ft. [0] Yes if No D N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances i'lless than required) Building Foundations > 10' ■Yes if No ft Surface Water > 1003 Yes if No fi Tank to Property Line > 5' Yes H, No ft Wells on Adjacent Lots: Field to Property Line > 10' LJ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' [01 Yes if No E Community Wells > 200' Yes iy' No ft _S) > Water ervice Line -10' Yes ;"l" No 0i -f tank or field is under driveway comment below -WE tl f7_11 IEF - Eu R-,� 9 T �! P., fl E N T. S "REQUESTHK,k3 � ELL WAIVER AND LC1T LINE WALIVER. SEE ATTA-01-IED LETTER. T 0 A r5­11FIA /VW7A,,Tr1M X_1% "I CATI T ST I IV 11 1F INS'PECT-l"N BY EN"NEER kX CERrlrt_r k, "iN AC A I IL 11-JiN I ".r 3 1" D tyl r, As certified by mv 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, indicates that the on-site water SUPIDly and/or wastewater disposal system appears to comply kqith applicable Municippl and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. � I f'prnpss -Ento4-iiaering -GrnUp, .1 TD.1-GE-r-1) %.A I Engineer's Pi -int -ed Name Jeffrey A. Garness PC�41P hx_A_11W�w .9 ft ) 7 - 3.3 7 - 6 1. 7 QW Date I In conducting this elvaluation, GEG provided an engineering e-valuat-ion of thewe-1land/or septic system in accordance with the guidelines and regulations establi-sherd-by the Municipality of Anchorage and industnt practices. The reported results describe the condition of the s� sleni/s on the date./s of the evaluation. Separation distances we -re miteasuread to readily identifiablis features. Hidden defects or encroachrneants mmay exist ihair. �.klere_ not identified during the evaluation. The operational liffe of all viiefls arid sepVc systems depea-Ind upon a varier; -of variables, including (but not limited to) soil conditions, grounduvrater levels (thatmayfluctuaie during the year) I U I Ta zing quaiity of (materials and warknianship', and the water usage of the " rnily utili the system/s. These Q.cmditioins canvaqry, and arr_- n_Wi�--Jda thea Qo.Wrol cif GIE-G, do not guc-Arantes- future performance of the system/s,; therefore, GEG malkes no kvarnanty (express or implied) regan'Jing the future pen"Drrriance.of the kkie!l or septic systern. GEG rn.aak-es no -represent-a-tior, whether an alternative v�lell oi- s ep Ito sOvstem ca n be in stalled on, th e pi-operty p1r. 1he e -v -1 mith er ble, CU, �Brjt systen-4s fail I'm adequately M tile future. The content of this re -port is for th-.31, sole, benefit c.)f the person/party that retairled GGEG I in this report by any other person or party to perform ev­lu'atiom Reliance upon thy, infotination provided (including subsequient property purChasers) is not authorized, nor will it confer any legal right whic"Asoever- -------------- C-'.0SA Checklist_.June 2022 (�.�v1 I �� �� z �' L 4 Certificate of On -Site Systems Approval Parcel I.D. 015-112-37 Legal description LEACH LT 3 Site address 10651 ELMORE RD Expiration Date: Current property owner(s) ANDERSON ERIC HOWARD 7/22/2025 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By:Original Certificate Date: 8/21 /2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other Waiver - See attached COSA ApprovMjune 2022 MUNICIPAL[ty OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Wal.--,, & Wastewater Section Fax: 907-343-79197 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-112-37 Complete legal description LEACH; LOT 3 Location (site address) 10651 ELMORE ROAD; ANCHORAGE, AK I ERIC ANDERSON 907-250-2803 Current property owners) phone 3 V,. r �G 2. ON-SITE SYSTEMS SIZED FOR BEDROOMS NOTE: SEPTIC SYSTEM SIZED FOR 3 -BEDROOMS 3. TYPE OF WATER SUPPLY: � Private Well Fj Private Well serving 2 dwelling units R Private Well serving 3+ dwelling units E] Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: FE� Private Septic F71 Private Septic serving 2 dwelling units t7 Holding Tank JI Community Septic or Public Sewer 5. SEPTIC TANK: lik Steel Fj Plastic ❑ Concrete F-1 Fiberglass Age 29 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: Fj AWWTS 1771 Bed RN Deep Trench R Wide Trench R Seepage Pit Waiver request for: WELL WAIVER TO TANK & DRAINFIELD & LOT LINE TO DRAINFIELD Distance: 95'/ 97'/ 8' Expedited review requested: RE By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ IS7 1�10 Date of Payment COSA # 0�C'?, Y/ 3 03 Waiver Fee $ Date of Payment Waiver #_ 2- COSA Applicationjune 2022 MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT I All'"�� 907-343-7904 On -Site Water and Wastewater Section �� #� ��� Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241309 Subdivision: Leach Block: , Lot: 3 The septic tank for this property is 29 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Municipality ® 0'` ` S Dopaitt (.nt r P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW Waiver#: OSV241038 COSA#:OSC241309 Permit#: PID#: 015-112-37 Legal Description: Leach Lot 3 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distance to the field is 97 feet and to the tank is 95 feet. In addition, the field is approved to be 8 feet from the property line. This waiver approval applies to the existing absorption field and 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: Date: wz_ y Approved by: /11,.G_X �45- Name of Revievt **** VARIAN C E/WAIVER REVIEW **** GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING August 15, 2024 Municipality of Anchorage ,r ��.�F•A�gs1�� Development Service Department On -Site Water & Wastewater Program .. • 9 • 4700 Elmore Road , , ........ Anchorage, AK 99507 9• , ei(r CE-7A. ness Ref: Well Waiver and Lot Line Waiver Request for Leach; Lot 3 To whom it may concern: '?1 I b/ Zf WELL WAIVER REQUEST: The existing 2 -bedroom house is served by a private well and septic. We recently performed a well and septic test on the subject property for the purpose of obtaining a COSA. Based upon the current asbuilt survey, the well encroaches upon the septic system. It appears the closest cleanout for the septic tank is —98 feet from the well and the closest cleanout for the drainfield is —99 feet from the well. We are requesting that a 95 -feet waiver from the well to the septic tank and a 97 -feet waiver from the well to drainfield be granted. Justification for these waivers are as follows: • Attached is the MOA contour map for the property with a sketch of the well and septic system on the map. As can be seen on the sketch and based upon our field observations during our tests, the septic system is downhill from the well and it would be impossible for any surfacing effluent for the tank or drainfield to flow towards the well head. In short, the travel path is greater than 100 - feet. • Recent water samples indicated a Nitrate/Nitrite level of 2.15 mg/L. Initially the water tested positive for Total Coliform and Negative for E -Coli. The water tested negative for bacteria after the well was chlorinated/flushed by Anchorage Well & Pump Service. • The subject encroachment has existed for over 29 -years. Based upon these facts, it appears there is minimal risk with granting these waivers. LOT LINE WAIVER REQUEST: Based upon the recent as -built survey, the west trench cleanout closest to the south lot line is approximately —9 feet from the property line. We are requesting an 8 -foot waiver be granted. The septic system on the neighboring property is 20+ feet from the shared lot line, so there should be no adverse impact associated with this encroachment. If you have any #estions, please contact us at 337-6179. Thank you for your assistance. P. E., M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Sona Blewett From: Eric Anderson <mlitel7@msn,com> Sent: Friday, August 16, 2024 10:52 AM To: Sonja Blewett Subject: RE: Leach; Lot 3 - 10651 Elmore Road For 24 years I have not had any freeze problems with the septic system ar 10651 Elmore Road Anchorage AK 99507 (Leach Lot 3. Eric Anderson (907)-250-2803 Sent from my Galaxy -------- Original message -------- From: Sonja Blewett <Sonja@garnessengineering.com> Date: 8/16/24 10:15 AM (GMT -09:00) To: Eric Anderson <mlitel 7@msn.com> Subject: Leach; Lot 3 - 10651 Elmore Road Good morning! We witt need an email statement from you that you have not had any issues with freezing for the septic system. The east trench is good on cover and a majority of the west trench has 3+ feet of cover, but the Last 5 -feet on the north end of this east trench has only 2.7 feet of cover. Please send me an email statement that you have not had any freezing issues so we can submit it with the COSA. Thanks! Sincerely, Sonja Blewett Corporate Secretary/Treasurer Gamess En(lineering Group, Ltd. 3701 E. Tudor Road. Suite 1011 Anchorage. Alaska 99507 Phone. (907) 337-6179 )7-6179 Fax: (907) 338-33246 Website: xNANiv.(-);ariiesseiiqiiieeriii�,.com —SwIff-W vft.'U�' GARNESS ENGINEERIM; 6ROUP, Ltd fra 7= S1X'3r' 1=4's XERXESS CORPORATION kaCwtd AWA4 DMWV opa"Ics A� s, as �1f - 3 ; w k C) LlNt"0 0.j 0f*-.CY) 00 *'00 B� SJ .� Fa 100.00 .. k. A� s, as �1f - 3 ; w k Municipality of Anchorage Page __ of ___ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O..Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: __~.~J~__0.~07 PID Number: ¢2/~//Z Name: ~Upgrade .. ~¢.~ ~ ~ ~/~ ~ Z n~An.~/~ Wastewater System: ~ New Address: /o~/ ~o~ ~F ~. ABSORPTION FIELD _ Phone: ~C~¢~ ~ INc. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench Q Bed ~ Mound ~ Other I LEGAL DESCRIPTI ON so, Bating: Total Depth from origina~ade: ¢, ~ 6PD/Sq. FL /2. ' Lot: Block: Subdiv~ion: Depth lo ¢ipe bottom from original grade: Gravel depth beneath pipe Township: Range: ~ Section~ ~ Fill added above original grade: Gravel length: ~ Ft. WELL: ~ New ~ U pg fade Gr~vel width: Number of lines: Distance behveen lines: Classification (Private, A,B,C): ~/~, Total Depth: Cased To: Total absorption area: Pipe material: ~ ~/O Driller: Date Drilled: Slatic Water Level: installer: Date installed: Yield: Pomp Set at: Casing Height Above Ground: ~ ~ .u/~ ~,. z/ ~ ~. TANK SEPARATION DISTANCES ~Septic g Holding g S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines .~ ~¢ ~ ~ Material: Number of Compartments: su~ce ,, ,, LIFT STATION// Water /~ /~ ~ ~ _ Lot ~' I .... Size in gallons: jManufacturer: ~ Line I ~' ~ ~ "Pump on" level ~ off" level at: High water alarm at: Foundation Curtain Electrical Inspections performed by: Drain Remarks: B~NCH MARK Location and Description: Assumed Elevation: ,I;'~.'' ..,.I'....~..~:,'~ Inspections performed by: E,¢, Rlve~. Alaska 995~ Dates: 1st Z -P -~ (,.,~¢ (, (~ r- c ' ....... Department of Health ag~ HumCp,' es approval ' ''~,.''-''''. .... . . ...".-'?.... .< ?.. /_ :~ '~, ", "*-~.,.r'~..' .. by://%¢- ~a,e~- . '~,~,~.~...~- ' ~.,~,.~ ..... : ..... Reviewed and approved 72~013 (Rev. 9/91)MOA 25 Permit No,sw950007 Page _ 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,O. Box 196650 · Anchorage, Alaska 995t 9-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description.LOT .3, LEACH COt CO2 NEW 1000 GAL SEPTIC TANK ~ A B FCO 4.8 26.1 CO1 39.3 dO2 45.2 57.7 403 49.7 62,[ q04 49.3 67,~ dO6 69.6 8?.7 MTi 49.1 66.1 MT2 69.9 87.[ 100' WELL RADIUS SUBDIVISION GBADE--~ (CO3& C04) PIDNo.: o151 87'4~k (COS& C06) .~¢~') 5 4'- A 69.4~ NO WATER FOUND 237 SCAL~ NEW TRENCHES t" = 40' 1000 GAL.iSEPT[C TANK RO2[RT C, COWAN CE ~ ~JSO } · ,;,(,-/,? ........ ,'..-,.,;/ 72-013 A (1t93) ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMA~ SERVICES P.O. BOX 196650, 825 "L~' STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950007 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:ZOBOROSKIE DALE J & NORA J OWNER ADDRESS:10651 ABBOTT LOOP RD ANCHORAGE, AK 99516 DATE ISSUED: 1/25/95 EXPIRATION DATE: 1/25/96 PARCEL ID:01511237 LEGAL DESCRIPTION: LEACH LT 3 LOT SIZE: 29704 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVI S I 0~.:-~-:~ DEPT. OF ENVIRONMENTAL CONSERVA~ ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 Munic.~ .... ANCHORAGE, ALASKA 99515 Dept, Hea~tb (907) 349-7755 TONYKNOWLE~ GOVERNOR January 13, 1995 Mr. Robert Cowan, P.E. S&S Engineering 17034 North Eagle River Loop Suite 204 Eagle River, AK 99577 RE: Lot 2, Block 1, Leach Subdivision; Horizontal Separation Distance Waiver to Class "C" Public Water System Source Well. ADEC Project No. 9521-WV-362-023. Dear Mr. Cowan: This letter is in response to the materials received in this office December 28, 1994, regarding a request for a waiver of the required horizontal separation distance between a replacement on-site septic system located on lot 3, to the Class "C" well located on the above referenced lot. The Department has completed its review of the submitted materials which included a cover letter, site plan, statement of non-objection from the well owner and water sample analysis. Based upon this review, a variance from the required separation distance (18 AAC 80.030 and 18 AAC 72.015) of '150 feet to a proposed 116 feet between a Class "C" well and a neighboring on-site septic system is granted subject to the following comments: This Department regards the issuance of waivers very highly and must evaluate the potential adverse impact to the environment and public health. The absence of a well Icg for the Class "C" well in question for which the waiver is requested hinders the review process. However, based upon an engineering analysis of the materials submitted and information on file including a neighboring well 10g, it appears that the subsurface soils and topography in this area are amenable to allowing a lesser horizontal separation distances with minimal potential for contamination to the subject well. The water sample analysis collected from the well were satisfactory indicating that the existing separation distances which is less than the required distance has had minimal impact on the well. This approval does not grant additional authorizations, nor does it obligate any other state, federal, or local regulatory body to grant required authorizations. Mr. Robert Cowan, P.E 2 January 6,1995 Thank you for your cooperation with this Department, if there are any questions regarding the above please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineer ML/cf ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERfNG STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCfURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN December 27, 1994 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human S~rvices P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 3; Block I; Leach Subdivision Requ~t you issue a p~rmit to upgrade the septic system s~rvin~ the th,~ee bedroom hou,6e o~ the. ~te~e,tene.,ed p~ope,'v~. An adequacy test performed on the existing system for H~h Authority Approval purposed found the absorption capacity of the system to be inadequate. A t~st hole was excavated and a percolation test performed. The approximate location of the t~st hole is located on the attached site plan. The mo~oring tube within the test hole has been check and found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. A waiver request has been sent to the State of Alaska, Dept. of Environmental Conservation for the Class "C" well located on the adjacent property (Lot 2). This will be forwarded upon receipt. If you require additional information please do not hesitate to contact us. Sincerely, ROBERT C. COWAN, RCC/gk ENCLOSURE 17034 NORTH EAGLE RIVER LOOP , SUITE 204 · EAGLE RIVER, ALASKA 99577 © / / 30WJOdFI ,og =: ,,I, -llVI3C]/NOIIO3~-X ~3¥0S 'S'±'N Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 1 3 4 7 8 10 12 13 17 8 19- 20- DATE Township, Range, Section: WAS GROUND WATER ~.~ ENCOUNTERED? O S IF YES, AT WHAT ~ ~ DEPTH? p E Deplh ,o Water After ~t~¢¢ Monitoring? Dale: SLOPE SITE PLAN Reading Date ~'e~"- ~¢-'~.. '~[~" Depth to Net Time (~/¢,t= Time Water Drop ACCORDANCE ~U~~g~PAL GUIDELIN~IN EFFECT ON THIS PERCOLATION RATE ~-'f~ (m~nutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN ,~__ FT AND 6 FT CERTIFY THAT T~S TEST./~AS PERFORMED IN /'~/~ ) /~' DATE. DATE: 72-008 (Rev. 4/85) NAME~ MUNICIPALITY O1': ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl,. PROTEC'¥1ON ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WEI.I. INSPECTION REPORT _l~ro N E ~'EW MAILING ADDRESS LOCATION/] -- I DISTANCE TO: /~ ~ ~ ] Manufacturer ~ ~, ,~.~ ~ L~)~t~n gallons IF HOMEMADE: Inside length ' ~ ,. ~ D STANCE TO' Well Dwelling ~ I Manufacturer ' I ~= I D~STANOETO: I '~f~ ~ ~ ~ No. of lines / Le~]g[l~ ~eacb lin,e / Total length o] lines ~ ~ Top of tile to finish grade ~ ~ Length Widt~ Depth ~ ~ I Type of crib Crib diameter Crib depth - ~ ~ DISTANCE TO: Well I-Building foundation i c,.,, Depth ~ DISTANCB TO: Buildin9 foundation ~ Sewer line Dwelling Width Material Nea~est~o~,~Se/ Tre,~; inches NO, OFBEDROOMS P E R M I,¢T~N.O. No, O~-~_~r~.~ pa r t m e n t s Liquid depth PERMIT NO. Liquid capacity in gallons Total eff~ct~e absofl)tion area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO, Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING ¢~' I N ST..~.L E R . )i REMARI~S ' - LEGAL 72-013 (Rev. 3/78) "Fl.'fiE: i:::,iEF'"I"!-.! OF:' F! "i'F:!~:!'.,K::H OF: F':i:I' :!::S THE: !::,:(S'FF!I'.,K:::!:L:: !i{}~E:"['i,.IE~:E~:!'..! 'J'!.'!E: :i}i;L!Fi:F:'t:::K:::tS L'.'fF' 'I'HF:!: i. Jil:;i:Ot..!I'q.(::, F:'IH[:', 'fF.If_'ii: E:O'f"I"C!hl OF' '!'m~i: ~ii:;:':;CF:I'v'FIT ]: ON ':: :iN 'T'l..!.r.~:Bi~i!: .!:S; i'~!O :i~;!~:"F F!:I:D'i'H F'Oi::i: T!..IIi:;: !::il~?l:::!',/!!!i:L. [::flii:F:'"f'H :l:i!!i; THE: !','I :~ i'.,] :!:1',11...11',1 !::,!~:F'TH OF:' L:iFi:Fi',/!.:::L. ~i};!i~:"t"!,~iiii:~:!.!,.~! THIS C!LrTF:'FiL. L. FIND "!'HE: i!!',CKi"T!:)H C!F' 'FHEi: f.}i:::.::C:F!',/I:'.!T :!: C-IN ,:: :[ i'..! F'~i;:Z.{'T' ). SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchoraga, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST ~ Lm/..) 5il-t' 2 3 5 6 7 8 9 10 ~2 SLOPE 5ihI l,ei~.~, of' 5,.,# 13I 14 16 17 18 cor¥,~EN','S Rat~,,-/ ,~'/" SITE PLAN ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? r ..]~ idPJ~Z'~'~I~7~ ] ,~ tl:t ~' !O' ~n Reading Date Gross Net Depth to Net Time Time Water Drop .t. ~; ~3' Id ~m _1, ~ ! ~, 31 PERCOLATION RATE __ 5 (minutes/inch), TEST RUN BETW,~EN __~ FT AND '~---- FT , _ CERTIFIED BY ~ DATE: ~ .~' r~. 72-008 (6/79} Date Drilled: Static Water Level Draw Down WELL LOG fee t feet Gallons Per Minute Total Feet of Uasing_./¢~ ?ype Material Drilled: to Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 9950? ~UNICIPAI_ITY OF ANCHORAGE ~'i':;~ .~ 7 "'~' R£CEIVED '9 December 2. ~ 1978 I~780223 Donald Leach Box 988 Anchorager Alaska 99510 Subject: Lot 3 Leach Subdivision A permit issued by this department for well and/or sewer system has expired. Perntits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a ~¢ell log should be sent to this department to document the installation date o If there are any further questions, please contact this office at 264-4720~ Sincerely, Les No Buchholz, Senior Environmental Specialist LNB/ljw enc~ copy of permit MUNicipALiTY OF ANCHORAGE. '~:. DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete' legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O) 3- )/2- 57 HAA# Lot $? Leach Sub.vision IGAq 50o,-/I Location (site address or directions) Property owner Mailing address 10651Ab§o,C~ Loop Ane. hn~g~: AK DaZe Zaboroskie 10651 Abbott Loop Rd. Anchorage, Day phone 346-2856 AK 99516 Lending agency Mailing address Day phone Agent David Zaboroski/ POLAR REALTY Address 1101 E. 76th Ave. Suite Bi Anchoraqe~ Unless otherwise requested, HAA will be held/or pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Day phone 349-7681 e TY' NOTEi Individual on-site Holding tank : Community on-site Public sewer provide written confirmation from State ADEC attest-. ' · ;tatus of system. )SAL: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA~21 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 ~hat the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING 'i/u~4 i-~ie Kiver Loop Koa~i Ne. ~ Phone Address Eagle River, Alaska 99577 ~,' Engineer's signature ~, .... . -v . Date DHHS SIGNATURE ' ~L. Approved for 5 DiSapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date I[ The Mun~cipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above.by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025(Rev. 1/91) Back MOA#'21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~OT- ,~ /' CE,4cH ~'o)~/v/$/o.'J Parcel I.D. O/G-//Z-~ 7 A. Well Data Well type ~/~/v¢'l'E Log present (~N) yES Total depth / ~ O ' Sanitary seal(~N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to IqO' Casing height $~$ Wires properly protected ~N) ~,/~-~ FROM WELL LOG Date of test Static water level /~cl ' Well flow ..S- Pump level1 SEPARATION DISTANGES FROM WELL TO; Septic/hoMif~j tank on lot /0o' Absorption field on lot I O0 ' Public sewer main 7~' ' + Sewer service line ?_E ~ ~- AT INSPECTION g.p.m, ~ ,(~ g.p.m. ; On adjacent lots ; On adjacent lots I00' Public sewer manhole/cleanout /o0 ' -+- Z ~C Petroleum tank WATER SAMPLE RESULTS: Coliform ¢ Date of sample: 2 - Nitrate /.¢~- ,~¢/~ Other bacteria Collected by: .% ,~ .~ -~-,'.O~IAJE~P-.//d B. SEPTIC/HOEBtNGrTANK DATA Date installed Cleanouts (~N) ~/~,~ High water alarm (Y/~ Date of pumping ~/4 Tank size /000 Compartments 2- Foundation cleanout t~N) 'y'E£ Depression (Y~ /k) //Or Alarm tested (V~.~_ /,.)O /t.J//dr- /t.) Et/V ?'~A) K-- Pumper /'J [ ¢r SEPARATION DISTANCES FROM SEPTIC/HOLDhNG TANK TO: Well(s) on lot /00 / On adjacent lots /fijL) ¢.ff Foundation ~' To property line ~o' Absorption field ~" Water main/service line /0 Surface water/drainage /~0 '4- 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/A~ces~/N). Vent (Y/N) "Pump on" level at / "Pump off" Level at High water alarm level / Cycles tested Meets MOA electrical codes (Y/~.....~/ SEPARATION DISTANC~-R~OM LIFT STATION TO: Well on lot ~ On adjacent lots D. ABSORPTION FIELD DATA Sudace water Date installed Length /-I ~' ~ Width Total absorption area .7.7c/ )z( Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Soil rating (GPD/FF) ..5' ' Gravel thickness Cleanout present (~) yes Depression over field (Y(~ Results (pass/fail) ~After test System type Total depth /,~' ' Bedrooms If yes, give date Well on lot /,¢¢ To building foundation On adjacent lots /0 Sudace water /O(') C~rtain drain /dONE On adjacent lots /Od ' ~- Property line /¢ ' To existing or abandoned system on lot /O /4- Cutbank E'O' + Water main/service line /O '+ Driveway, parking/vehicle storage area / t E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe of this inspection. Signature Engineer's Name Date HA,& Fee $ Y Cd'~ ' ¢-'¢) Date of Payment Receipt Number 72-026 (3/93)* Back ~ :'~ .~ ROBERT C, COWAN ' ~' ', CE-8801 ", ~L'~ ,', ,':, ,Z :',L ,- ~-5;" Waiver Fee $ Date of payment Receipt Number 02/0S×95 15:00 COMMERCIAL TESTING * 90?6941211 client Name ordered By P~oJ,~t Name Projects PWSID CT&E Environmental Services Inc. I.aborato~y Division ~ ~- -~-J~______~J~_~_~_~_~-'-" ~_~ ...... ~_~_-__~_~._~_ _ Laboratory Analysis Report D3 LEACH 8/D WATER S & 8 ENGINEERING WORK Order RAY Pr£titsd Date Collected Date Eeosived Date UA 12433 02/06/95 02/03/95 ~ 03:4~ hfs. 0~/g3/~5 ~ ~5:~3 hrs. Technical Director STEPHEN C, ~DE Sa[nple Remarks: 8~MpLE COLLECTED By~ STACIE. QO Allowable Ext. A~al Parameter Results Dual U~ito Method Litalt~ Date Date Nitrate-N 1.05 mu/L ~PA 353.2 10. 0~/~3/95 8es Special Instructions Above UA - Ut%available See Sample Rel~arke Above NA = Not Analyzed Undetected, Repo~ted value 10 the practical ~antifioat%on ll~it. LT = Less Secondary d~on. GT = Greater Thall ~ W. Potter Drive, Aneh0rage, AK 99518.1605 -- Tei~ (907) 5G~-2343 Fax: (907) 561.5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILUNO~S, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPkLITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HFS. TH DEP~RIT~iENT OF H~TH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~_~? ' ;:~{~,d.~.~: l:~,; ::.~ Tei/e hdne ~ Itome .... ~_. ~ l'eie none - (c)Applicant is (check one) Lending Institution ~; ~mer/builder ~; Buyer ~ ; Other ~ (explain); /~:/ (d) Lending Institution Telephone A~ss (e) Rsal Estate Coo & Agent Address (f) Telephone Mail the HAA to the following address: '~' ~: ~ c: ,: ~ ,'.~..~c ~ c~ .... ~:~o ~ -' ~':~ ~'~'/' 2. T~e of Residence Single-Family~ Number of Bedrooms 3. Water Su~ Individual Well~ Multi-Family Other (describe) Community ~ Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4.. Note: If community well system, must have written confirmagion from the Staee Department of Envirormaental Conservation attesting to the legality and status. : ', {!~age 1 of 21 E~ineerin~ Firm Providin~_~spection_a~. Tests File Sear~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval show~ 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 M~nicipality of Anchorage files and from my investigation and inspection~ the on-site water supply and/or ~rastewater disposal system is in compliance ~.[th all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection° D ate ~ , 'x;,-~ ' % '4- (~N~ZNEE~ SEAL) .i". ,o _ //¥ .... ,-Y,.%; ................ :,.. ,(-,'~ D~E?~ //fl /q /// -- /_ .M'I / /~///.,/ bedrooms By ~~~ Approved/ Disapproved ~ ~onditional Te~s of Condigion~ Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES m~,ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT~ ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° %%IE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19 -84 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification /~r/~ ~./ Well Log P~esent .(Y/N) y~3 Total Depth / ~/d? ~7¢ Cased to Static Water Level /$1'ff ~'~ Casing Height Above Ground ~.o '~ Electrical Wiring in Conduit (Y/N) MUNICIPALITY OF ANCHOrAGe- DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION' APR Iveco If A, B, c~ C, D.E.C. Approved(Y/N) Date Cc~,gleted ~'/(?/y~Z. ~I¢. Yield ,/~ ~pth of G~outin~ ~ ~t At Sanit~y ~a1 on Casing ~ ~ession ~ound ~l~ead (Y~) Separation Distances f~om Well: To Septic/Holding Tank on Lot .. ; On Adjoining Lots To Nea~st Edge of Absorption Field on Lot/& To Nearest Public Sewer Line /y/~ To Nearest Public Sewer Cleancut/Manhole //7 To Nearest Sewer Se~vice Line on LOt water Sample Test Results" B. SEPTIC/HOLDING TANK DATA Date Installed ~/~//~ > Standpipes (Y/N) /~: Depression over Tank (.Y/N) Size /p ~ o No. of CQ%~a~tments ~'~ Air-tight Caps (Y/N) ~ ~ Foundation Cleanout (Y/N) ~z~; Date ast Pumping/Maintenance Contract on File (Y/N) f//~ ; for Holding Tank High-Wate~ Alarm (Y/N) ~//~_ Temporary Holdi~x~ Tank t%~rmit (Y/N) SeDaration Distances frc~ Septic/Holding Tank: To Water-Supply We 11 ~L ~ '/~ £~ o. :~' To Propemty Line .~ 3 o TO Watez. Main/Service Line coU~ .'..~/~ To Building Foundation To Disposal Field_ ~/ ' .~'~ To Stream, Pond, Lake, c~ Major Drainage [Page 1 of 2] Receipt ~ Date Paid Amount: 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ~//~//~z Width of Field ~ 6~" ~ Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test /~ ~ Type of System Design Length of Field ~/~ / ~<~ Depth of Field : / ~ Gravel Bed Thickness _%- / 7~ ~/~/0 ~ Standpipes P~esent (Y/N) /v~3 Date of Last Adequacy Test 9z/~/~$ Separation Distance from Absorption Field: To Water-Supply Well ~ / /~ ~-~, ~/ To P~operty Line ~> ~ ~>~ TO Building Foundation To Water Main/~rvi~ Line To St~e~ond~ke/~ Majo~ ~aina~ C~se To ~iveway, P~ki~ ~ea, ~ Vehicle St~a~ ~ea / D. LIFT STATION Date Installed Size in Gallons "Pump O~" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dirrensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles ~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA ~quest ** ~Z_ /F~T- I certify that I have checked, verified, or conforn~d to all MOA HAA Guidelines in effect on t.he date of this inspection. Signed Date MOA No. KB1/d5/s [Page 2 of 2] ENGINE.E_RS 2-15-84 50i.'TnCENfRAL REGIONAL OFFkCE 43/ "Z" ST~4IiEi', SUi!'E 200 ANCHOt~;GE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Address' 274-2533 May 30, 1984 AlasKa Environmental Control Services 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Sir: Subject: Well to Septic System Waiver, Lot 3, Block 1, Leach S/D The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the private 'well and the septic tank to 91 ft and the private well and absorption field to 92 ft. Sincerely, ~r~u~ee E~ Er±ekson Env±ronmental Engineer BEE/msm MUNICIPALITY OF ANCHORAGE DIVISION OF kl~VIRONMENTAL HF~L'il'I DEPARTMENT OF ~AL~I ~D EN~IR~NT~ PR~'ECTION APPLICATION ['~R HEAL~ ~HORITY ~PROVAL CERTIFICATE 1. ~al Infor~tion ~plication Date (a) Legal ~s~-iption (inclu~ lot, block, su~]ivision~ ~ction, tcl~ship, (b) (c) Location (aC.d~ess o~ direct, ions) Applicants Na~ Applicant is (check one) Lending institut'ion Buyer C]][' Other [7---~ (explain)? (d) /ending Institution Adok'ess ..................................................................................................... (e) Ill. al Estate Co. & Agent Adck. ess Te le phone Water Su~lff_ Individual Well 'E;!:::t Cor~a]nity FjZI ~blic Note: If c~tmity w~ll system, must have ~it:t~n confir~]tion frt~l the State ~p~nt of ~viropa~ntal Conservation attosting to t[~ legality and status. Is the ~ell adequate fo~ the n~r of ~dr~s s~cified in this ~AA~ Se__wg~e.. Disposal Onsite ~i l%,bl:i.c Fj-~.; Community E]:~-1' Ho].ding Tank Is the wastewater disposal system adequate for tine nt.unbe?z of [Page 1 of 2] 2-15--84 5. _En_qgi~_~e.~i~ Firm Providinq~_n_spections, lbsts, Data and Information I certify ti]at I have checked, verified, or ¢.~nforme~d to all MOA BAA Guide].irms in effect on the date of this inspection. Signed ~.~-~t ~ Sig~d W Date 2' .7 ... ~ r (ENGINEER Disapproved E~ 6. DHEP A~proval Appr ova. d foL* Terms of Conditional Approval %he Municipality of Anchorage Depa~tn~)nt of ['faalth and Envirom-~ntal Puotection dops not guarantee the continued satisfactory [~rfo]:mance of ti'~ wate~ supply and/or the wastew~.te~ d:[sposal system. This appl, oval indicates that, as of t]~ validation clnte shown gd0ove, ba~d on the ct~ta and information furnished by an engil~er registered in the State of fklaska, the v~te~ supply and wastewater disposal system is safe and func~ tional fozt the F.t~ube~.' of bedroc~s m;d type of structu'~e indicated. (D~EP SI?AL) 7. Mail the HAA to the fol].cming address: KB2/d5/s [Page 2 of 2] 2--15-84 A® Be MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Log P~esent~N) Total Depth lq D Static Water Level Casing Height Above Ground MUNICIPALITY OF ANCHOP, AOI: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION~ Legal Description: ~2/?~__ . Yield Depth of Grouting /~/~ Date Completed Cased to ;~0/ Pump Set At MAY 1984 jREC] IVED Electrical Wiring in Conduit~N) Separation Distances f~omWell: Sanitary Seal on Casing ~N) Depression A~ound Wellhead _(Y~_J To Septic/Holding Tank on Lot ~// ~ ~. ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot'.~ ~./~ ; On Adjoining To Nearest Public Sewer Line /L3/,Q~-- TO Nearest Public Sewer C leancut/Manhole To Nearest Sewe~ ServiceLi on Lot /~/i~.~Q/~-. ; Date ~-// /~'4ne water sample Collected By Water Sample Test ~Results~ ~/~i%'~L~¥~%~ ~ SEPTIC/HOLDING TANK DATA ~6~ ~ Standpipes ~N) Air-tight Caps _~N) ~u°~aN~i~oOnA~ Depression over Tank (Y~ Date Last Pumped_ Pumping/Maintenance Contract on File (Y/N) [13/fl~ ; fo~ Holding~Tank High-Water Alarm (Y/N) ldl~- Temporary Holding Tank Permit (Y/N) · Separation Distances f~tcm _~ep~tic/Holding Tank: To Water-Supply We. ll C~i' '~- ~ ~ To Building Foundation //,.~. '~ To Property Line ~ 5©' To Disposal Field /?! To Water Main/Service~Line IL)/~'~ To Stream, Pond, Iake, or Major D~ainage co. se [Page 1 olf 2] ......... ~"*LUr OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION JlJtl I984 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 4/f~ Width of Field ,~ ~- Square Feet of Absorption A~ea Depression over Field (Y~ Results of Last Adequacy Test /~--~-J/' Type of System Design Length' of Field ~'~ Depth of Field 9'~'- Gravel Bed Thickness ~/~Y'C3 ~ Standpipes P~esent Date of Last Adequacy Test /~///~ Separation Distance f~om Absc~ption~Field: To Water-Supply Well C.~_' 0~' ~ TO ~o~ty Li~ To Building Foun~tion ~~3 To Existing or ~ndo~d System Lot ~;~ ; ~ ~joining ~ts To Wate~ Main/~vi~ Line ~/,~ To ~t~(if p~e~.~t) ~,/~ To St~e~ond~ke/~ Majo~ ~aina~ C~se To ~iveway, Pa~ki~ ~ea, o~ Vehicle Sto~a~ ~ea D. LI~ STATION ~ Date Installed Size in Gallons "Pump Oa" Level at High Wate~ Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. 'Meets MOA Co~nts ** Check Permitted Bedroom Rating Against HAA t%equest I certify that I have checked, verified, or conformed to all MOA HAA on the dat Signed Company KB1/d5/s [Page 2 of 2] in effect ~of thi. s inspection. .) Date No. 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTtLAL REGIONAL OFFICe: 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 May 30, 1984 Alaska Environmental Control Services 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Dear Sir: Subject: Well to Septic System Waiver, Lot 3, Block 1, Leach S/D The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the private 'well and the septic tank to 91 ft and the private well and absorption field to 92 ft. Sincerely, tfruce E. Erickson Environmental Engineer BEE/msm APPLIC NT FILLS.OUT UPPER HAl ONLY Mailing Addre~ ~ .... ,) . . ZiP Code _ . ~.,., .,.~ (/?C~-.-II '~- Buyer / Address Zip Code Address //7~/~/; ~' ~ 7 ~';~ Zip Code Realty Co. & A~nl Phone Address ( ~.~:/-~1 ~ /~, (2 ,,~/ Zip Code '/ Street LocatlmC?~" ......./"~] ''} / [ V /:~"~0 {~. r~' ~ Type of Resi~nce / " - ~' Single Family U Multiple Family No. of Bedroo~ ~ Other Water Supply ,~ ~ Individual ~¢Lp ~ ~ ATTACH WELL LOG. A w¢l Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg tf available). ~ Public Utility Sewer Disposal ~ ~ ~uBIio Htllit~ When Gonnocto0 ~o ~uBlio Htlllty: ~ Holdino Tank ROTE: TH~ I~SP~OTIO~ ~[ M~ST ~CGOM~Y fi~GH ~fi~[Sl ~FOB~ ~OGES8~ Time Time Time Time ~.~L~.i_~ I~--( ~-~_L~\O~_9 Date Date Date '~ ~ Insp~tor Insp~tor Insp~tor ~ Insp~tor ~ .~ ~ ~_, O, MUNJC~PALtTY OF ANCHORAGE - 2~ZT Cc iJ~':r'4 . ,, RECEIVED _ ('~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' gATE ~--~ ( ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~- ~ ~ Well to Tank Septic T~k Size 72-023