HomeMy WebLinkAboutLAKE HILL ACRES #3 LT 21-AMunicipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151004 PID Number: 015-122-22 Dwelling: W Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade Name: Steve Hulsey ABSORPTION FIELD [:]Deep Trench [-]Shallow Trench ❑ Bed ❑ Mound ❑ Other Address 22369 Mirror Lake Dr. Chugiak, AK 99567 Phone Number of Bedrooms Soil Rating Total depth from original grade 907-223-2553 2 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Lake Hill Acres #3, Block 1, Lot 22 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Ff Number of trenches I Dist. between trenches I Ft. Well >75r TANK ❑ Septic ❑ S.T.E.P. X Holding ❑ Other Manufacturer Modified by Resident Capacity 2,000 Gal. Surface Water _65' Material Number of compartments Lot Line >10' NA Steel 1 Foundation 11 LIFT STATION Manufacturer Capacity Curtain Drain Gal. Remarks Only one site inspection due to owner Pump on level at in. Pump off level at in. High water alarm at in. installed new tank when old one failed. Therefore, the Work was Complete. Pump make and model Electrical Inspections performed by Installer Steve Hulsey to PIPE MATERIAL House to tank ABS Tdmi nnfield ld Drainfield CO/MT Inspector Robert L Walden BENCH MARK (Assumed elevation) ft Inspection 1" 12/26/14 2"a Location and description 3itl 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ....:.. tM Mof q�'�n �{P.• 8,� s � 40M .... l '..ROBERT L. WALDEN Na 13874 r Approve Date Inspection Repo _-1-12.doc ' It �. 9 1 E P 3 �1RRe 00 M ` 6 X 3 M1 " m 1 r`.t ti p 12 r� 2 /I /! I 10 M) 9 26.491t fFl 7g°03`1 5. E. y7.00 S. ' I t � w o, 0 .aI 3 3 Z' LOT 21 --R - CK 4.5 ft. /7 3 16 /9 15 /B 5,397 sq. ft. 19 20 2/ 30a E. 9B � 22 MEANDERS I P'2/3 Along a well defined bank, I It. high, at the line of ordinary high water. 1. N. 48°31'38" E., 1.41 It. 2. N. 42°02'26" E_ 11.40 1t, 3. N. 32°51'41" E., 17.72 ft. 4. N. 10°56'03" W., 14.51 ft. 5. N. 7°21'46" E., 6.26 ft. 6. N. 30°11'26" W., 16.75 ft. 7. N. 29°52'25" W., 10.74 ft. S. N. 58°59'54" W., 8.85 11, 9. N. 31°22'03" E.. 34.66 it. 10. S. 86°23'24" E., 15.35 fl. 11. N. I8°28'28" E., 17,38 ft. 12. N. 67°04'16" E., 35.40 /1. 13. N. 79°54'00" E., 6.77 It, 14. S. 41°11'19" E., 6.98 ft. 3 15. N. 74°00'12' E.. 10.39 ft. 16. N. 32°24'19" E.. 12.30 If. l7. S. 67°43'18" E., 10.98 ft, 18. S. 12°21'05" W., 35.59 ft. 0 M1 19. S. 48°05'33" W., 15.82 ft, v h 20. S. 35°39'48" E.. 16.05 ft, e V 21. S. 76°34'49" E.. 16.53 ft. 7 W LL Fn d. l"pipe 522, S, I6°59'58" E.. 10.00 ft. 2 % 6' s at of N 5 Tops of strings Is 320.74Datif. 1972 Datum. ^ 4 �--_ 23.98 ft - 3 1 _ 7 IN. PILING 2 f o • m • 7.FOUNPATION 1 y "40.0 ft . a i65 Hold�nrd. I 1 - 1 i 1 i I � i LOT Z2 28,420 sq. ft.(M) r I 1 I I f � I 3 i W I to ro 1 o i f J 1 1 W 1 1 � r I � r 2 � I � r r f '( l0 FT. UTILITY EASEMENT - _______ ft2.00 ft (Rj _T 111.33 i7. (M) f76. yv n E. BASIS OF BEARING Fnd. I" pipe ASBUILT J A66 I4`.11c A't,sr it 2 P,o&A ftralyw-gip 127.90 Jf.(F) 415.41 ft, m! 417.90 ftR) For (Af.lmi6eSLky s /avuk ,Ly tf.SF, o,1iy. Fnd, Rebar SCALE: 1"=$0' OF 4Jw'Wtv j n I• A . ............ ! � �ROBERT L. WALDEN N�`�,:. No.M3874 .'1 3 to LOT 23 h G CO 0 0 O 2 P,o&A ftralyw-gip 127.90 Jf.(F) 415.41 ft, m! 417.90 ftR) For (Af.lmi6eSLky s /avuk ,Ly tf.SF, o,1iy. Fnd, Rebar SCALE: 1"=$0' OF 4Jw'Wtv j n I• A . ............ ! � �ROBERT L. WALDEN N�`�,:. No.M3874 .'1 l K cE 1.1.5 gctcEs - 3 Lc,+ 22 eaSPlSlool • 6 t2� �{aMe. FCo. was" G,o. 6.5 cwec - 11 �qP.•'' '•.�, I/ .t; ............... • • ROBERT L. JVYALDEN r �+AM SPS. 35502 P On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151004 Tax Code Number: 05112222000 Work Type: SepticTank Upgrade Permit Effective Dates: February 17, 2015 to February 17, 2016 Design Engineer: Walden Construction Consulting and Engineering Subdivision: LAKE HILL ACRES #3 Site Legal Address: LAKE HILL ACRES #3 LT 22 G:1562 Owner/Address: HULSEY STEVEN M 22369 MIRROR LAKE DR CHUGIAK AK 995675701 Site Mailing Address: 22369 MIRROR LAKE DR, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 29600 Total Bedrooms: 2 N Privy N Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Spedial PravisipPoWperinstalled the holding tank withouta permit. This permit is gein used as a means to document the systemt Receive Issued Municipality of Anchorage Development Services Division Onsite Water and Wastewater Program An S �� � G� L n N 4eMpartmeR **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP151005 COSA#: Permit#:OSP161004 PID#:051-122-22 Legal Description: Lake Hill Acres #3. Lot 22 Engineer: Robert Walden Applicant: Steve Hulsey Your request for a waiver of the required 100 feet horizontal separation from the holding tank to the surface water has been approved. The approved separation distance is 65.0 feet. This waiver approval applies to the existing holding 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. Theaffected adjacent property owner(s) have been given a 7 day notice regarding this waiver. Q Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. waiver iss Granted: X Waiver is not Grunted: Date: Approved by: ame of Reviewer ............... ........................`..... ................■■....■....... MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 0&1_ 12-2,—_Z-_L- 22,—ZZProperty owner(s) t' 1 Property Mailing address �%Z3%� /1� tr" Z66vk— Day phone Cl1v. Site address _ 22369 W\. rcoc Loke, tViy e—Ia a Aj( Legal description (Sub'd., Block & Lot) _ L6 -DRQ. W %�t.f 5 *3 Lo 12. Legal description (Township, Range & Section) Lot Size j. 2-o Sq. Ft. Number of Bedrooms 21 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 9 Septic Tank ❑ Upgrade (w/wo ADU) Holding Tank Renewal F-1 Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: f ie i d or +&-A n,1 c� e (` Distance: - SQ_ I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/RushFees: 2<f Waiver Fees: tsC1 Date of Payment: ! 7 /S [{Z'') Date of Payment: 1�7�/S C- t(Z7.7 Receipt Number: «f Receipt Number: /fit /r�y Permit No. 05P/57 0014 Waiver No. (Y>P1 J_/60 6 PermRApp_.:; :L.:c WALDEN Construction Consulting and Engineering, LLC 2422W James T Cir, Wasilla, AK 99654 Subject: Waiver Request to update #WR960043, holding tank to surface water To Whom it may concern, I have been hired by the new property owner, Steve Hulsey, to get his property back into good standing with the Municipality. Few things have changed since the previous owner Gary Evans sold the property to Steve in 2003. Steve was the previous owner of lot 20 and current owner of 21 also. In June of 2005 Steve was given Corp permit #POA -2003-1 108-4 to fill in the surface water and swamp area on lot 21. He has been preparing for a shop/float plane hangar on that lot. He intends to combine lot 21 with 22 and make one large parcel in summer of 2015. In 2008 Steve exposed the old tank to see its condition. It had small holes forming on the top of the tank and he tried to weld patches over them and the entire top of the tank fell in. Not given any paperwork from the previous owner and not understanding the permit process he installed a new holding tank without a permit. He simply got another same sized tank and installed it in the same location figuring it was already permitted. In review of the old permits from #051-122-22, 1 learned and shared with him the waiver variance to surface water and language stating the owner needing to re -apply for this waiver with any upgrades to the tank. The surface water separation distance has improved to 65 feet since the old surface water on lot 21 has been filled in and there still exists a surface water drainage between lot line 22 and 23 that is from an existing cross pipe from Mirror Lake Drive drainage. This separation could not get any further by moving it to the south or closer to Mirror lake drive since the surface water runs parallel to the lot lines. Once Steve applies and creates one big lot 22, 1 will show a future holding tank location 100 feet away from the surface water for the next generation of holding tank installation. The currently topography of the lot has an approximate 2% drainage running toward the lake not the surface water, attached google map profile showing slope of the lot. The holding tank is wired and operational with an audible and visual alarms. Steve is also accustom to sticking his tank bi-weekly to also check the levels and has Denali Pumping Service on speed dial. I have performed a buoyancy calculation on the asbuilt tank by Steve and it is adequate in the worst case scenario. The integrity of the new tank was evaluated by S&S Engineering in October 22, 2008, attached. I also agree this tank is structural sound built with 3/8" thick walls and paint treated with Devoe Bar -Rust 235. Page 1 WALDEN Construction Consulting and Engineering, LLC Attached google site map, buoyancy calculations, and #051-122-22 for reference. Please contact me for any additional information. Sincerely, A.016•�• �iCOt7eaPC� W Robed L Walden, PE •� : ROBERT L. WALDEN ND I�CE4 r?.�Walden Construction Consulting and Engineering LLC L s bob11wolden@yahoo.com Cell #907-354-6661 Page 2 Buoyancy Calculations Location/Legal: 22369 Mirror Lake Drive Chugiak, Alaska 99567 Lot 22, Lake Hill Acres #3 Fb=0.134VtxFS Vt Y FS Nb= Fb-Tw-soil over the tank 21,740 lbs 2,000.00 gallons 62.4 Ib/ftA3 1.3 Date: 12/19/14 Project #: 14-022 V 2,055 gallons d 5 f L 14 ft Th 0.0313 ft bury depth 4 ft 10,043 lbs Tw=P*Th 3,297 lbs P 15.7 ft Moist not sat Ws 8,400.00 lbs GW 30 Ibs/ftA3 Added eco blocks 2 ea 6,000 lbs L 10 ft W 1.5 ft Wb 12,000.00 lbs H 3 ft Wsb 5,400.00 lbs Amount 2 ea Nb-Wb-Wsb (negative will hold the tank down) -7,357 lbs OK Tie down straps Tds 2 ea d 5/8" c 6,800 lbs Cable strength= Nb-(#Tds*capacity) negative will hold down the tank Cs -3,557 lbs OK OI A�V�4 'c 49 TH ..� ............................... •• ROBERT L. WALDEN� 4��'• No. CE13 74 - _�� 4� P O?f!��o PQ��o Diameter Wire Rope Ib Chain G8 Ib 1/4" 30 deg 1,100 5/16" 30 deg 1,700 3/8" 30 deg 2,400 7,100 7/16" 30 deg 3,400 1/2" 30 deg 4,400 12,000 9/16" 30 deg 5,500 5/8" 30 deg 6,800 18,100 3/4" 30 deg 9,700 7/8" 30 deg 13,000 Calculated by: Robert L Walden Walden Construction Consulting and Engineering LLC Maximizing your Profit and Reducing your Risk V ^ L.V' OO w 0 p 6w e • W Y n'Trio , HFALTHAUTHORIT APPROVALS SEWER&WATER M4?NEXTENSIONS SEWER& WATER INSPECTION ENGM ERINGSTLUES AND REPORTS WEUINSPECTION & FLOW TEST SITEPLANS ROADOESIGN SOILTEST PERCOLATION TEST STRUCTURP A IJECHANICAL INSPECTIONS ON SITE WASTEWATER DSPOSAL SYSTEM DESIGN S& October 22, 2008 Steve Hulsey 22411 Mirror Lake Dr. Chugiak, AK 99567 REFERENCE: Lot 22; Lake Hill Acres #3 22369 -Mirror Lake Dr_ -- Dear Mr. Hulsey, ROBERT C. COWAN CIVIL ENGINEERING PH: 907-694-2979 FAX: 907.694.1211 As you requested, we visited the referenced property to determine the integrity of the existing septic holding tank. Per the M. O. A. files, this tank has been previously excavated and visually inspected. The tank is assumed to be in groundwater. We took measurements on October 20, 2008 and again on October 21, 2008. Water levels had not changed, therefore the tank is not leaking and the integrity of the tank is sound. Due to the absence of a house on the property at the time of this inspection, the high water alarm system was not in place. A high water alarm will need to be installed once the house is completed. If you require additional information please contact us. Sincerely, �Z ✓ /� j/_Vn_ — Robert C. Cowan, P.E. RCClts 7 0E f�Jr, DOCK 8X34.5 ft. " 6 5 \R¢0R 4 3 O O 0) Q) �D (�D N N 3 pq Z Z LOT 21 ) 78.00 -f -f 694 ff.( /6 /2 /7 /6 --!-J O 5,397 sq. It. 9ftt(� ) 19 00 20 S, 2/ 9q.1 zt? s3300F 9g7 22 00 e WELL Fnd. I" pipe Elev. of Tops of pilings is 320.74 ft. 1972 Datum. MEANDERS Along a well defined bank, I ft. high, at the line of ordinary high water. I. N. 48031'38" E., 1.41 ft. 2. N. 42002'26" E., 11.40 ft. 3. N. 32°51'41" E., 17.72 ft. 4. N. 10°56'03" W.. 14.51 ft. 5. N. 7°21'46" E.. 8.26 ft. 6. N. 30011'26" W., 16.75 ft. 7. N. 29652'25" W., 10.74 ft. 8. N. 58'59'54" W., 8.85 ft. 9. N. 31"22'03" E., 34.66 ft. 10. S. 86023'24" E., 15.35 ft. 11. N. I8°28'28" E.. 17.38 ft. 12. N. 67004'16" E., 35.40 ft. 13. N. 79054'00" E., 6.77 ft. 14. S. 41°11'19" E., 6.98 ft. 3 I5. N. 74000'12" E.. 10.39 ft. 16. N. 32024'19" E., 12.30 ft. v 17. S. 67043'18" E.. 10.98 ft. 1n 18. S. 12921'05" W.. 35.59 ft. oa t, 19. S. 48905'33" W., 15.82 ft. It to 20. S. 35039'48" E., 16.05 ft. e p 21. S. 76934'49" E.. 16.53 ft. 22. S. 16059'58" E.'. 10.00 ft. i 23.98 ft. 71NLIN GTF N 1 40.0 ft. �I 24.5 ft, 1 I I I 3ARAGE � HOLDING TO 8E a TANK 1 EMOVED o N 0.75 ft. I I I I I 1 1 I LOT 22 28,420 sq. ff.(M) I I I I 1 I 3 1 _ W Q3 1 > I 1 � I m 1 O I ti I J I I W 1 I � 1 I � I 1 (a 1 1 1 I 1 1 1 10 FT. UTILITY EASEMENT 'fit. l7 N. 82°45150° E. Fnd. I" pipe BASIS OF BEARING ASBUILT 415.41 ft 417.90 " Dated: Anchorage. Alaska November 11, 2008 1 hereby certify that I have surveyed the following described property. Lot 22, LAKEHILL ACRES ADDITION j3, Anchorage Recording district, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroaches the premises in question and that there are no visible on easements on said property except as indicated hereon. It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction of fence lines, or for establishing boundary lines. Drawn by: J.A.P. John A. Pax LS -9686 Phone: (907) 688-1329 Z LOT 23 _ 127.90 ft.(R) 127.14 ft -(M) Fnd. Rebar (M) (R) SCALE: 1"=401 OF i *:' 49TH ,p, •, John A. Per f dr rV 0, •- LS -9686 `tee 40 1,97 3 � y I 1 � o m a1 i 11 i I i I i I I I 7 0E f�Jr, DOCK 8X34.5 ft. " 6 5 \R¢0R 4 3 O O 0) Q) �D (�D N N 3 pq Z Z LOT 21 ) 78.00 -f -f 694 ff.( /6 /2 /7 /6 --!-J O 5,397 sq. It. 9ftt(� ) 19 00 20 S, 2/ 9q.1 zt? s3300F 9g7 22 00 e WELL Fnd. I" pipe Elev. of Tops of pilings is 320.74 ft. 1972 Datum. MEANDERS Along a well defined bank, I ft. high, at the line of ordinary high water. I. N. 48031'38" E., 1.41 ft. 2. N. 42002'26" E., 11.40 ft. 3. N. 32°51'41" E., 17.72 ft. 4. N. 10°56'03" W.. 14.51 ft. 5. N. 7°21'46" E.. 8.26 ft. 6. N. 30011'26" W., 16.75 ft. 7. N. 29652'25" W., 10.74 ft. 8. N. 58'59'54" W., 8.85 ft. 9. N. 31"22'03" E., 34.66 ft. 10. S. 86023'24" E., 15.35 ft. 11. N. I8°28'28" E.. 17.38 ft. 12. N. 67004'16" E., 35.40 ft. 13. N. 79054'00" E., 6.77 ft. 14. S. 41°11'19" E., 6.98 ft. 3 I5. N. 74000'12" E.. 10.39 ft. 16. N. 32024'19" E., 12.30 ft. v 17. S. 67043'18" E.. 10.98 ft. 1n 18. S. 12921'05" W.. 35.59 ft. oa t, 19. S. 48905'33" W., 15.82 ft. It to 20. S. 35039'48" E., 16.05 ft. e p 21. S. 76934'49" E.. 16.53 ft. 22. S. 16059'58" E.'. 10.00 ft. i 23.98 ft. 71NLIN GTF N 1 40.0 ft. �I 24.5 ft, 1 I I I 3ARAGE � HOLDING TO 8E a TANK 1 EMOVED o N 0.75 ft. I I I I I 1 1 I LOT 22 28,420 sq. ff.(M) I I I I 1 I 3 1 _ W Q3 1 > I 1 � I m 1 O I ti I J I I W 1 I � 1 I � I 1 (a 1 1 1 I 1 1 1 10 FT. UTILITY EASEMENT 'fit. l7 N. 82°45150° E. Fnd. I" pipe BASIS OF BEARING ASBUILT 415.41 ft 417.90 " Dated: Anchorage. Alaska November 11, 2008 1 hereby certify that I have surveyed the following described property. Lot 22, LAKEHILL ACRES ADDITION j3, Anchorage Recording district, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroaches the premises in question and that there are no visible on easements on said property except as indicated hereon. It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction of fence lines, or for establishing boundary lines. Drawn by: J.A.P. John A. Pax LS -9686 Phone: (907) 688-1329 Z LOT 23 _ 127.90 ft.(R) 127.14 ft -(M) Fnd. Rebar (M) (R) SCALE: 1"=401 OF i *:' 49TH ,p, •, John A. Per f dr rV 0, •- LS -9686 `tee 40 M -W DRILLING, Inc. .. �w 86-154' 'P.O. Box 110378. 10330 Old Seward Highway - - - - (907),-349-!3535 - - - -- - - - - ANCHORAGE,ALASKA 9951.1-.. -. - - -- bRILLING LOG Well Owner EVANS:- GARRY Use of yVetr Test Hole Location (address of: Township; Range, Section, if known; or distance main road L©t 22, Lake Hills Acres Subd. #3. Size of casing 6Depth of Hal 30 eet Cased to__20 - -feet static water leve N At. :(abo ow) land surface. Finish of weH (check one) open end ( ); Screen perforated J Describescreen, or. perfolti Well pumping test a —` } (minute) for—= ---hours with of drawdown from static Date of,completio rc 1 WELL LOG _ Depth in feet from t g ground surface rmations penetrated, size of material; color and hardness 0 TO 2 ctcu 2 TO ' 7 7 TCL— 15 Rklaval __TO 16 16 To_ 12 -k9pM . 22 TO" 33 kx- �x 5. 3 TO ate 1 ! TO Must e a an one in accordance with Alaska -TO- Drin ink-vttater xekul`ationS. Title 18. shay. : U, �O 18AAC80,020. (Fill csb. with concrete is R� TO adequate.) (✓ �%�'✓ �J TO TO- NWWA Certified on 814 & 973 TO Oeytilb'ste No's. 2 --STATE RET'URN .TO: Division. of Geological and GqA&ysIcaT Surveys (OGGS1 - 3001 Porcupine Drive (Tele : 2776615) Anchorage, Alaska 99501 - W A T E R W E L L R E C 0 R 0 Drilling Company Nems Ma&Tluson Drilling LOCATION OF WELL - Please complete either Ia, lb, or It. U.S.G.S. Local No. Drilling Permit No. A.O.L. No. STATE OF UE.J DEPARTMENT OF NATURAL RESOURCES 1 Ia. . Borough " Anch Subdivision Lake .TRi.lZ Lot P2 I Block Ib. Fraction / / /. Section No. Township a N/S. Range Meridian lc. Distance and Direction from Road Intersections Acres Sub. 1"3 - - Street Address and Area of Well Location 3. OWNER OF WELLi tr. Dale belmonte Add rnss: CLu ;iakf Ak. 2. WELL LOG - Feet Balm - Surface Material Type TOP I Sutton, 4. WELL DEPTH: (completed) ft. Surface Elevation Date of - Completion U. LL. "t:u 0 20 S. ❑Cable tool `❑Roury [3 Driven ❑Dug ❑Auger C1 Jetted 13 Bored ❑Other: v 2'a V 20 Z 5 6. USE: QOomestle ❑Public. Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commercial ❑ Test Well ❑Other: - - - - - 7. -CASING: ❑Threaded ❑Welded f in. to 1,0 ft. Depth Weight .:.'% lbs/ft. in. to - ft. Depth - 8. FINISH OF WELL: ' TYpe: Cp en 1;Gle Diameter: �tt Slot/Mesh Size: Length: - - Set between ft. and ft.. Fittings: - _ - - 9. STATIC WATER LEVEL: ft.. _ stes_ar. E] Above ❑Below land surface „ell Type of Measurement: - - 10. PUMPING LEVEL below land surface - ft. after 'firs. Pumping g.p.m. - ft. after - hrs. pumping g.p.m. - - - .. .11. WELL HEAD COMPLETION ❑ In Approved Pit : ❑ Pltless Adapter Inches above grade - - 12. GROUTING: Well Grouted: ❑ Yes ❑ No Material: ❑Neat Cement ❑ Other: 13. PUMP: (if available) HP - Length of Drop Pipe ft. capacity g.p. "Type: ❑ Submersible ❑ Reciprocating - ❑ Jet ❑ Other. _- 14.REMARKS: -c .50 "JUS Gil', 15. WATER WELL CONTRACTOR'S CERTIFICATION: - - This well wes drilled under my Jurisdiction -and this .report Is true to the best of my knowledge and belief: Ma nucon Drilling ,A 5385 Registered Business Name - Contract License um er Address:F..O. Box 504 River. Ak, - - - -- /E/FIrZe Signed: - -rxi /G_ // -y--to� Authorized Representative' Form 02-WWR Copy Distribution: WHITE - State DOGS, PINK to: Oct. 14, 1981 - - Driller, CANARY - Customer - 0 M -W DRILLING, Inc. P. O. Box 4.1224 • 1310C International Airport Road _ - (907) 2744611 NW 15<01-44, a S_ I ANCHORAGE, ALASKA 99509 1 r DRILLING LOG Dale Belmonte Dom. Well Owner Use of Well Location (address of: Township, Range, Section, if known; or distance main road Lot `22 Lake i ll Subdivis&nn 38. Size of casing ! " nepth of Hole9 feet Cased to---4g-;1I feet Static water level -2 ' ft. (above) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated-(-" Describe screen or perforation N/A Well pumping test at 10 gallons per (WMY) (minute) for 1 hours with 1007 _ of drawdown from static level. p C� Date of completion_ Cn ID' WELL LOG N Z Depth in feet from rn ground surface Give details of formations penetrated, size of material, color and hardness -z- o TO x p 2 ✓' TO-�y� �8 33 33 3q —TO- O -TO- TO 0- O -TO- TO -TO- -TO- TOTO NO- .TO %J v M -1 W' Cr1 �1 (l. NWWA Certified Contractor Nos. 2 - STATE MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICESLITY OFANCHORAGE E Division of Environmental Services ALSERVICES DIVISION On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 JUL 2 6 7996 343-4744 RECEIVED CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# OSS—%ZZ—Z2 HAA# 1�r24S7DCZAZQ 1. GENERAL INFORMATION // dl Complete legal description l� 22� (,A- VJ--- R I UL AC(z—S S/r 3 'i Location (site address or directions) ZZ 3 4� 9 M terzoj2- LA -_-e _DQI VE Property owner Day phone Mailing address Lending agency P� I' 1 1TCs' Day phone Mailing address G -4,j Agent `Do .t M l�F��E' �Srct'r t Day phone Address (,A - Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:-PIS-IJ4 Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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. 72-025 Rev. 11911 From MOA n21 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Alaska Water & / Phone -4"33 7-� %% tl utast nato7 SBi7i.s Address Engineer's signature 6. DHHS SIGNATURE Approved for �� bedrooms. By: Disapproved. Date •0 nOFESSt�":�� Conditional approval for bedrooms, with the following stipulations: Additional Comments NIITfC The Municipality 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 orderto 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. 72-026 (Rev. Y.'9p f�cs MCA11 � �AM1NrEY�A7,tf¢ �.4R7Ekt ' Municipality of Anchorage Itll;ol �,, ZVI E DEPARTMENT OF HEALTH & HUMAN SERVICES JULEnvironmental Services Division 19 L 2 825'L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 RECEIVED Health Authority Approval Checklist Loi Z2) Cc�ttf 1-11LL- Legal Description: AtRf--- S S /0 Parcel I.D.: U s� A. WELL DATA Well type P V' t' If A, B. or C, attach ADEC letter. ADEC water system number N A Log present (Y/N) NeDate completed 1!e712 2/-7 it Total depth 4 I Cased to 4-0 Casing height (above ground) >l2 Sanitary seal (Y/N) Wires properly protected (Y/N) Y F—S , Ss=� pwcrmc FROM/ WELL LOG Date of test (� /2'y( %9 Static water level f}IL-N1-SIA1') Well production 10 g.p.m. A INSPECTION 6 '2 3.Sr Pl;ww -m? of CASWt -- > 4,o4- g.p.m. WATER SAMPLE RESULTS: Coliform '7�2z/96 Nitrate •423 r- c46 Other bacteria -7[2 79� Date of sample: 7[z 7-/R 6 { /� �/9� Collected by: u �S B. $Bir MOLDING TANK DATA aS Date installed Pniq 9' Tank size ZZt Number of Compartments Cleanouts (Y/N) �)✓S Foundation cleanout (Y/N) �Y 1_S Depression (YIN) U High water alarm (Y/N) YJP-J r Date of Pumping Pumper �• 5 C. AlwkQi Date in Length FIELD DATA Effective absorption area Date of adequacy test Soil rating (g.p.d./ft2 or ft2/bdrm) Fluid depth in absorption field before Fluid depth ts.) Minutes Gravel thickness below pipe Results treatment (past 12 months) (Y/N) Tube present(Y/N) System type Total depth )e ter ssie ver field (YIN) For bedrooms _ gal. water added (in.): Absorption rate = If yes, give date D. LIFT STAPIA� Date installed \ Manhole/Access (Yft) High water alarm lev c es tested E. SEPARATION DISTANCES Size in gallons *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: r 4"Ot/holding tank on lot// 9 t3 ; On adjacent lots Absorption field on lot /J /4 ; On adjacent lots Public sewer main Sewer /septic service line NJA > 2S/ "Pump off' level at* 7S/ Public sewer manhole/cleanout .'/IA - Lift station SEPARATION DISTANCES FROM 91L`/HOLDING TANK ON LOT TO: Building foundation 3S t� Property line `�S r4- Absorption field t,1 Ifo Water main/service line t0 Surface water/drainage S—Wells on adjacent lots 75 / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ry (p, Water mainfservice line Surface water N IA - Curtain drain Worse y-A-XowFj Driveway, parking/vehicle storage area N �A Wells on adjacent lots (-J fA- Property line F. ENGINEER'S CERTIFICATION certify that I have deer fined th i Id inspections and review of Municipal in conforma Un A ide nes in effect on this date. Signature Engineer's Name A. 6�'�SS Date 2� 6 HAA Fee Date of Payi Receipt Nur Rev. 8/95 OSS: haa.wk.doc CE -7953 Waiver Fee $ � �Q//__ Date of Payment �Y / S0 Receipt Number $ 9073383246 08/15/96 18:01 P.01 Alaska Water & Wastewater 8171 Brookridge Drive — Anchorage — Alaska 99304 Phone (907) 337-6179 — Fax (907) 33$-3M Consulting Engineers August 15, 1996 Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On -Site Services Section P.O Box 196650 Anchorage, Alaska 99519-6650 Attn: Jim Williams Ref.' Waiver, Holding Tank to Surface Water, Lot 22, Lake Hills Acres S/D N3, Dear Jim: Per the request of your department T have prepared this summarization of the mitigating factors regarding the subject waiver. In my letter, dated 7/25/96, I addressed the structural integrity of the holding tank, and the fact that there is an alarm to notify the residents of a high water condition. Further mitigating factors are as follows: A. If the holding tank c/o cap is on tight, water will back-up into the house, rather than overflow onto the ground. Undoubtedly, this will motivate the homeowners to take corrective action. B. 1t is the intent to construct a small berm (12 inches high and 18 inches wide) from the garage to the house, and from the south end of the garage to a spot approximately 10 feet to the south of the garage (along the driveway), so as to eliminate a direct path from the holding tank c/o to the lake/stream. Ideally, any overflow will pond on the uphill side of the berth, immediately notifying the homeowners of a problem. Another concern expressed by your department was the buoyancy forces on the empty tank. I did not analyze these forces, but assume that, since the tank has been there for over 21 years, there is not a problem. As noted during our (Jeff Garness, Jim Williams, Dan Roth, Elaine Elledge) site visit, there is not possible to relocate the holding tank, and and achieve the required 100 foot separation distance to surface waters. The greatest separation distance we could achieve is approximately 50 feet. Given the costs associated with moving the tank, and the minimal increase It 9073383246 08/15/96 18:02 P.02 in the separation distance (from 35 feet to 50 feet), it hardly seems justified. if you have any questions, please contact me at 337-6179, or on my pager at 1-800481-1162. Thank you for your assistance. Sincerely, Garness, P.F., M.S. Gary &vans2.wps Alaska Water & Wastewater 8471 Brookridge Drive — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers July 25, 1996 Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On -Site Services Section RO Box 196650 Anchorage, Alaska 99519-6650 Ref HAA for Lot 22, Lake Hills Acres S/D #3. To whom it may concern: The subject lot is served by a private well and holding tank. I tested the well and inspected the holding tank 6/28/96. The results are summarized as follows: WELL TEST: The static water level in the well was 3.5 feet below the top of the casing (approximately I foot below ground elevation). Water was pumped at a rate of 4.04 gpm for a total of 112.5 minutes (455 gallons). The water level dropped several feet during the test, and recovered completely in less than 30 minutes. Based upon this data, it was determined that the well is adequate for a 3 bedroom house (450 gpd). WATER ANAYLYIS: The water tested positive for bacteria on 6/29/96 (1 OB, w/o coli), and 0.42 mg/1 for nitrates (10 mg/l is the allowable limit). The well was chlorinated, and resampled on 7/22/96. It tested negative for all bacteria. In short, the water quality is acceptable in regards to the bacteria and nitrate parameters. INTEGRITY OF HOLDING TANK: The holding tank was pumped on 6/20/96 (J.R's Pumping), 8 days prior to my site visit (6/28/96). The house has been occupied by 3 people since 6/21/96, and the tank has yet to be pumped, as of 7/25/96 ( 35 days). According to DHHS, the tank capacity is 2200 gallons. Given the aforementioned facts, it is reasonable to assume that the tank was less than 20% full on the day of my inspection (6/28/96). Given the elevation of the nearby lake, it is clear that the holding tank is in groundwater. I could not hear any water trickling into the tank, nor did the level in the tank appear to be abnormally high, given the fact that it had been recently pumped. In short, it did not appear that groundwater was intruding into the tank. Based upon this limited investigation, it appears that the tank is water tight. The only way to be absolutely certain would be to physically expose the tank and visually look at it. Prior to my initial site visit, Richard Shafer, Tweed Excavating, repaired a leaking c/o coupling on the tank, which required exposing the lid of the tank. I contacted him regarding the repair, and according to him, the lid appeared to be in good shape. He did indicate that the soil surrounding the c/o was saturated (high groundwater). According to DHHS records, the tank was installed prior to 1975, making it at least 21 years old. Most steel tanks of this age are approaching the end of their useful life. Alaska Water & Wastewater makes no warrantee regarding the fixture life of the holding tank. HOLDING TANK FROZE -UP DURING THE WINTER OF 1995-1996: When I contacted J.R's Pumping, regarding the pumping history, they indicated that the tank was pumped on December 2nd, and June 20th. During that period, the house was occupied by only 1 person, who was only there on an occasional basis. Nevertheless, this equates to a pumping of only one time in 6.5 months. J.R's then informed me that, according to their records, the tank had froze this winter. I assume it could not be used again until it thawed in the spring. Whether the tank froze because of the minimal use, or because it is buried under a driveway (improperly insulated?) is unknown. OLD HOLDING TANK AND WELL ABANDONED: According to the records at DHHS, there were two holding tanks and two wells on this lot. Per the owner, Gary Evans, one of the wells, and one of the holding tanks (1800 gallon unit) have been abandoned. There is an old holding tank sitting on the lot ( see photograph), and the upper part of the abandoned well casing. The well was supposedly abandoned by Tweed Excavating. Attached is a copy of the recent as -built survey. Note that only one well & septic c/o are shown. SEPARATION DISTANCE FROM HOLDING TANK TO SURFACE WATER: According to the 1984 HAA issued for this property, the separation distance from the holding tank to surface water was 100 feet. Based upon my field measurements, the separation distance from the tank c/o to the lake is only 49 feet (see the attached photographs). Depending upon the orientation of the tank, and the location of the c/o on top of the tank (end or middle?) the actual separation distance from the tank to the lake could be closer to 45 feet. This separation distance is moot since the closest surface water is a creek, which runs along the west property line. Based upon the assumed location for the end of the tank, the creek is probably only about 35 feet away. Attached is a copy of a drawing done by AECS (Leroy Reid, RE) in 1984. The general location of Mirror Lake in relation to the holding tank is correct. However, it should be noted that the house has been moved to the north (to a pile foundation), the north arrow direction is incorrect, and the garage is further to the south. Attached is a photograph which shows the location of the holding tank clean-out in relation to the garage. As you can see, the holding tank clean-out is near the northeast corner of the garage, and not the southeast corner of the garage as shown. In addition, there is a creek/swamp area west & southwest of the garage. The holding tank is only about 35 feet from this area. Normally, the justification for such a waiver would be based upon the topography between the tank, and the surface. However, in this case such an analysis would serve little to justify such a waiver since the ground slopes towards the surface water, and the separation distance is very minimal. The primary justification for the waiver must be based upon the fact that if the alarm is working properly, the homeowners will be notified of a high water condition before an overflow situation can occur. In addition, if an overflow situation did occur, it would be quickly identified, since the clean-out is in the driveway, and clearly visible from the front door. In short, it would be a smelly, unsightly mess. This situation will motivate most homeowners to take immediate corrective action. Short of receiving a waiver the only other solution would be to install a holding tank at the south end of the lot, which would probably require the installation of a lift station. If you would like to meet at the site I would be more than willing to accommodate your schedule. WIRING OF HIGH WATER ALARM: The homeowner installed a high water alarm. I tested the alarm to ensure that it works. The alarm wiring at the holding tank clean-out is a non -typical installation. The same goes for the wiring at the well casing. Attached is a photograph of each installation. CLOSING: If you have any questions, please contact me at 337-6179, or on my pager at 1-800-481-1162. Thank you for your assistance. Sincerely, S. c.c. Don McKenzie Real Estate, Bob Brown Gary Evans I.wps 0 r'''2411996 08: 42 9C W KLL IE RE P '-'- i i JtIC fI1 ' h i l r A5-�L'iL' I hereby certify that i have Surveyed, the folletwii r ,�, T ice_ ,•a . f:� t � 1; Anchorage Reic,rd;r:i, Precinct, Alaska, and that we -. ments aituaied the,ecin are within the property Iir.=-._ s_,. .)Veda-, or ercroai-: en. the PrOJxn_y lying adpec, titer no iairpra.cmknts f", pToperky lying adjacent It"'.m, as the rieuuser, ar , n.estinn and t a: there -n `aarIWC;y5ion lines or utLer visible e.asementc or, except as indicated hereon. Dated at Laxle Riv Ery; Alatka ROURT C. 1OHNS IN 1 KLL IE RE P '-'- i i JtIC fI1 ' h i l r A5-�L'iL' I hereby certify that i have Surveyed, the folletwii r ,�, T ice_ ,•a . f:� t � 1; Anchorage Reic,rd;r:i, Precinct, Alaska, and that we -. ments aituaied the,ecin are within the property Iir.=-._ s_,. .)Veda-, or ercroai-: en. the PrOJxn_y lying adpec, titer no iairpra.cmknts f", pToperky lying adjacent It"'.m, as the rieuuser, ar , n.estinn and t a: there -n `aarIWC;y5ion lines or utLer visible e.asementc or, except as indicated hereon. Dated at Laxle Riv Ery; Alatka ROURT C. 1OHNS IN 0*3 Munfeipality of Anehorage Department of Health and Human Services -� 825 " L' Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor August 19, 1996 Jeff Garness, P.E. Alaska Water & Wastewater 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 22 Lake Hill Acres Subdivision 42 Waiver Request #WR960043, PID #051-122-22, HA960113 Dear Mr. Gayness: Your request for a waiver of the required 100 foot horizontal separation of a holding tank to the surface water has been approved. The approved separation distance is 35 feet from the on-site holding tank to the surface water. This waiver approval applies to the existing holding tank to surface water separation only. Any future upgrade to the holding tank will require all separation distances be met or another approval from this department. Should the operation of the subject holding tank cause any contamination or degradation of the subject surface water, this waiver will become void. If there are any further questions or concerns regarding this waiver, please call our office at 343-4744. Si cerely, �n J �V1'VI.iW� v v �'lNl/tiM'�1� ames P. Williams Civil Engineer On-site Services JPW/Ijm:Evans *MUNICIPALITY OF ANCHORAGED Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR960043 PID# 051-122-22 HA# HA960313 Permit # Date Received: July 26, 1996 Legal Description: Lot 22 Lake Hill Acres Subdivision Engineer: Jeff Garness, Alaska 'dater & Wastewater Services 8471 Brookridge Drive, Anchorage, Alaska 99504 Applicant: Gary Evans Waiver Requested: Waiver of Holding tank to surface water of 35 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points: Waiver is Granted: X Waiver is NOT Granted: yp List Conditions or Reasons for above: �//m5t h2+b TEf> lyg-0 OiJ Date: 0MIl`/M By: Name &f Rev Rec #: #02113/1139 Amount: $ 625.00 Date Paid: July 26, 1996 Alaska Wal>teir & Wastewater 8471 Brookridge Drive — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers August 15, 1996 Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On -Site Services Section P.O Box 196650 Anchorage, Alaska 99519-6650 Attn: Jim Williams REC'EIM {AUG 20 Municipality of Anchorage Dept. Health & Human Services ey A, Garn"'s' CE -7953 Ref Waiver, Holding Tank to Surface Water, Lot 22, Lake Hills Acres S/D #3. Dear Jim: 1, Per the request of your department I have prepared this summarization of the mitigating factors regarding the subject waiver. In my letter, dated 7/25/96, I addressed the structural integrity of the holding tank, and the fact that there is an alarm to notify the residents of a high- water condition- Further mitigating factors are as follows: A. If the holding tank c/o cap is on tight, water will back-up into the house, rather than overflow onto the ground. Undoubtedly, this will motivate the homeowners to take corrective action. B. It is the intent to construct a small berm {12 inches high and 18 inches wide) from the garage to the house, and from the south end of the garage to a spot approximately 10 feet to the south- of the garage (along the driveway), so as to eliminate a direct path from the holding tank c/-0 to the lake/stream, Ideally; any overflow will pond on the uphill side of the berm, immediately notifying the homeowners of a problem. Another concern expressed by your department was the buoyancy forces on the empty tank. I did not analyze these forces, but assume that, since the tank has-been there for over 21 years; there is not a problem. As noted during our (Jeff Garness, Jim Williams, Dan Roth, Elaine Elledge) site visit, there is not possible to relocate the holding tank, and and achieve the required 100 foot separation distance to surface waters. The greatest separation distance we -could achieve is approximately 50 feet. Given the costs associated with moving the tank, and the minimal increase in the separation distance (from 35 feet to 50 feet), it -hardly seems justified. If you have any questions, please contact me at 337-6179, or on my pager at 1-800-481-1162. Thank you for your assistance. Gary Evans2.wps y p� r ,p ALASKA ENVIRONX TAL > lam^ H Ili Aertes #] qq Y I' CONTROL SERVICES, INC. 4NeEr W. a _ 1200 West 33rd Avenue Suite 6 ---- ANCHORAGE,AtASKA99503 CAICULArzeeY+ _ oArz7��u/rY Pto 2761361 crncAm ev DArz o weu— -- -- MUNICIPALITY OF ANCFIOR_4GE r DIVISION OF :riTVIROIZT TAL hPALT_H DEPARTMENT OF aEALTH A=ID ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date. F,.,. (a) Legal Description {include J.ot, block, subdivision, section, tr.–Ua)=. , range) Location (address or directions) (b) Applicants Name' o/,,r i _. �? d'<lephonc - liomc T in Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/Lu.11rI. ; Buyer ; Other (d) Tending Institution Telephone Address (e) Real Estate Co. E Agent Address telephone (f) Mail the HAA to the folio:ri.ng address: 4. Sewage Disposal Onsite Public Comm -unity i l.di.';^ Tagk r'x; Note: Iz community well system, must hav written coiifi.rma"inn from: tt:e :State Department of Environmental Conservation attesti,ig to the 1�,,%L t:y and status [Page 1 of 21 r of Residence Sing a --Family I Mu' ? i–F<. ,:l.ly—1 Ot in: (c;. s 10 Nuiaber rnr-" ?edrooms 3. Water Supl+j.y - Individual Well i Co r ".:t .t:y h r��-...._J, Public Note: If community well system, muat have mitten corfirmatiosn f'_om ;:he St9L'. Department of Environmentnl. Conoervaelon attesting to the legality status. 4. Sewage Disposal Onsite Public Comm -unity i l.di.';^ Tagk r'x; Note: Iz community well system, must hav written coiifi.rma"inn from: tt:e :State Department of Environmental Conservation attesti,ig to the 1�,,%L t:y and status [Page 1 of 21 r 5 1, -2�2. 1_4KV {-1, f t S {k r£S` is , • 0 Engineering Firm Providing Inspections, Tests, File Search. Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that ray 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 riles and from my investigation and inspection, the on-site water supply and/o=.: wastewater disposal system is in compliance with all Municipal and State coder,, ordinances, and regula- tions in effect on the date of this inspection.. Name of Firm Tel ephonef' �„j ,.S0) (O 'J” Date O (ENCINEER SEAM.) 6. DHEP Approval Approved for / % bedrooms `< Apprcved_,�_\\ Disapproved Terms of Conditional Approval. Leroy C. LAI, _ • r By�.: > aC�DYio..�_sLj Conditional CAUTION THE MUNICIPALITY OY ANGAORAGE DEPARTMENT OF HEALTH AND ENVIIONvMENTAL i OIH(_,T1:OH (DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASCP SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT P OFiES,I:ONAL LC1 IN ER REGISTERED IN TEE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY 'IO PURCYAS RS OF HOMES ANI) THEIR LENDING INSTI'1'UTIOES IN ORDER TO SATISFY CERTAIN F DF.RA ANT_i ?'ILTE REQUIRE- MENTS. EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALYZE: DATA' BEFORE A CERTIFICATE IS ISSUED, THE XUNICIPATJTY OF ANCHORAGE IS NOT RESPONSIOLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGTNEER'S WORK. (DHEP SEAT:) RR`/e�/ll18 z - % %> (Page of 2j �� ��y �C��` .ti�,P' v�'t � =v,��/ � 7 19-84 % MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classificaticcnel'+S5 'C� If A, B, or 0 D.E.C. Approved JN) Well Log Present ,e si/N) Date Completed /g/pI Yiel&zhs-, . Total De th �[S' Cased to e4 Depth of Grouting P z� P 9 [1�u Static Water Level /��2�.SdG , _ Pump Set At Casing Height Above Ground �.3� Sanitary Seal on Casing I) Electrical Wiring in Conduit &IN) Depression Around Wellhead (Y Separation Distances from T%b11: 11 To Septic Holding Ta on Lot 1?0 ion`+_ On Adjoining Lots Tt5e ` To Nearest Edge of Absorption Field on Lot 4',4 ; On Adjoining Lots >FSZ,' To Nearest Public Sewer Line x/11 To Nearest Public Sewer Cleancut/Manhole k;tA To Nearest Sewer Service Line on Lot 24A Water Sample Collected By !)M ; Date 112Sr1,44 Water Sample Test Results B. SPPTEEfHOLDING TANK DATA Date InstalleedjQedow- k I4'iS'4 size .Zwkpp+(D No. of Compartments Standpipes Air -tight Caps /N) Foundation Cleanout (Y Depression over Tank (Y Date Last Pumped fi12_gl (D Pumping/Maintenance Contract on File &); for hA F, L>.. _s r IE�eL�E� Holding Tank High -Water Alarm Oh Temporary Holding Tank Permit (Y Separation Distances fron Septic/Holding Tank: i To Water -Supply Well gt"'Wl'�Cc+© To Building Foundationt80, am To Property Lire >.2cTo Disposal Field (A To Water Main/Service Line A;JA To Stream, Pond, Lake, or Major Drainage Course 311oe'� rm&k l aka } Comments X,111 124feAJorz 0 4&a 1Ln_.,sE [Page 1 of 21 3 2-15-84 Ll �C\?C:�Jf�Jlii�`,�■�i�IiD7� IVY • L, 2z t„4L'tiEI�IIsAcpest�3 Soils Rating in Absorption Strata &V 4 Type of System Design qA Date Installed OLIIA- Length of Field A I ,,4 Width of Field " La Depth of Field 'V6 Gravel Bed Thickness N(A Square Feet of Absorption Area A4+ Standpipes Present (Y/N) ti 1R Depression over Field (Y/N) A -M Date of Last Adequacy Test req Results of Last Adequacy lost Separation Distance from Absorption Field: To Water -Supply Wbll A'& To Property Line To Building Fougdation IV44 To Existing or Abandoned System on Lot _ Fop A 7 On Adjoining Lots N(sF To Water Main/Service Line Ai 1A_ To Stream/Pond/Lake/or Major Drainage To Driveway, Parking Area, or Vehicle Storage Area i'fk Comments "ld __L- -Ge ly-s D. LIFT STATIM Date Installed +0/X Dimensions U(k Size in Gallons A) ("J, Manhole/Access (YM) 'Vfa "Pump On" Level at tjI,,,k- "Pump Off" Level at 4"(A High Water Alarm Level at 1i Vent (Y/N) vt4 Tested for (JI A Pumping Cycles during Adequacy Test. gets MOA Electrical Codes (Y/N) for Comments ** Check Permitted Bedroom Rating Against FAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed1 � Date Company CCS MOA No. q-02 KB1/d5/s (Page 2 of 21 15-84 Department of Environmental Conservation 437 E. Street 2nd Floor Anchorage, Alaska., 99501 Attn: B. Erickson. Subject: Lot 22, Lake Hills Acres #3 On June 5, 1984,, this office submitted paperwork for Health Authority Approvacl_on the subject property's existing systems. This letter is int response to your office's letter of July 3,- 1984. The subject property is essentially level in the occupied area of the lot. The highest portion is that which slopes towards the roadway, and is not involved with the disposal systems on the lot. The most compromising situation is the proximity of Mirror Lake and the imposing groundwater. The residences in this area are conventionally on holding tanks due to these conditions. The holding tanks we 1) The holding July 27, 19' 2) On July 24, trailor was gallons. re pumped to verify capacity:. tank serving the house was pumped on 34, the amount pumped was 2200 gallons. 1984, the holding tank serving the pumped and found to contain 1800 Attempted abandonment of the second well met.with problems. In order to cut the casing below ground level, and seal the casing, it was necessary to continously pump. Due to the proximity of the lake and the imposing groundwater, the soil in this is saturated. The well was sealed, welded metal plate over the casing, and backfilled. The neighboring well (south) is separated from the subject property by a swampy area. This connects the lake to a culvert under the roadway. The flow is from the culvert to the lake. A parallel measurement indicated that the neighboring well is 145-150 feet from the holding tank that serves the trailor. The conditions presented by the lake, surface and ground water restrict the residences to holding tanks. At this time there are no alternative wasterwater disposal suitable to these Auenue. $cite B Alaska 99503 B • Anchorage. Alaska 99503 561-5040 ALASKA ENVIRONMMTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276.1361 JOB Lof .22 LA H;lis Acefz#0 SHEET NO.� OF CALCULATED BY M � DATE 7/3 Q 12 - CHECKED BY DATE SCALE I 1 Vy AKI Dh ' Gob. 4 01471. BILL SHEFFIELD, GOVERNOR it 1__J DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) SOUTHCENTRAL REGIONAL OFFICE /address= 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 July 3, 1984 Alaska Environmental Control Services, Inc. 1200 W. 33rd avenue, Suite B Anchorage, Alaska 99503 Dear Sir: Subject: Lot 22, Lake Hills Acres #3, Waiver Request - On-site Water Supply & Waste Disposal Facilities Based upon review of your submittal of June 5, 1984, the following addi- tional information is required before our review can continue: (1) Site Topographic Hap (2) Holding Tank Volume (3) Specifications and abandonement plans for the unused well. (4) Determination by your office, based on review and available information, that site conditions and waiver to a lessor separation distance adequately protects the water supply. (5) Indicate 150 feet protective radius and all other sources of contamination to include a statement that none are determined to be present. Upon receipt of the above, the review can be completed. Sincerely, f' Daniel Schubert Environmental Engineer DS/msm 1 s f,. IF BILL SHEFFIELD, GOVERNOR t DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 August 1, 1984 Alaska Environmental Control Services, Inc. 1200 West 33rd Avenue, Suite B. Anchorage, Alaska 99503 SUBJECT: Waiver Request Class A Well to holding tank to 98 foot. Lot 22, Lake Hills S/D. The Department has reviewed the subject waiver request and hereby waives the horrizontal separation between the well and holding tank from 100 feet to 98 feet. Sincerely, "Bfuce E. 'Erickson District Engineer BEE/dd P. O. r Well Owner_ Dale Belmonte M -W DRILLING, Inc. 2P4 • 1310C Internanonal Airport Road (907) 274 4511 VCHORAGE, ALASKA 99509 DRILLING LOG Location (address of: Township, Range, Section, if known; or distance main Lot 22 Lake 1-1111 Subdivision DEPT. _. F. —Use of Well Dom. Size of casing_1F1 Depth of Hole_. feet Cased to_r�n ..{.__feet Static water level__+_2_.—ft. (above) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( ). Describe screen or perforation NSA Nell pumping test at----LQ—gallons per (l (minute) for_____1 _hours with100_%_ x1K of drawdown from static level. )ate of completion 1179 _ vg leptn in teet from _ 'round surface Give details of formations penetrated, size of material, color and hardness 0 _TO2_ ___1T0_-2-0-- 2 -L2.0 -TO_- 15 - -35—TO__ A L- _TO-_ TO TO -— I —CUSTOMER APPLIONT FILLS OUT UPPER HASONLY Property Owner Dgle f . R t- -eeb Time Mallirlt Address S-A +. UX G 3 koz C h Zip Code Date Buyer Date Address Ho `jl e 6- Zip Code ' Lending Institution - Phone Address i9ek l"%, R t. C -1,i+ {^o . p K- Zip Code Realty Co. & Agent Phone Address 116Af. Zip Code rvsII�22`0�.016, Legal Description LUf a a 3r4 �Q��i f ✓+r Gu Hr ��S l` -PS Street Location Type of Residence IASingle Family ) t� CONDITIONAL APP� ❑ Multiple Family No. of Bedrooms - ❑ -Other DATE JY?�' Water Supply BY: ;9C Individual ATTACH WELL LOG. A well log is required for all "wells drilled since June 1975. ❑ Community - For wells drilled prior to that date, Iva well depth/(attach log If available). ❑ Public Utility Well Log Recelved f "Ile Sewer Disposal I� Individual{ - Year Individual Installed:✓ -r �� S '❑`Public Public U lily: Utility When Connected to ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: rvsII�22`0�.016, t ( ) APPROVED BEDROOMS 'CONDITI NS OF APPROVAL (. ) DISAPPROVED f f� ) t� CONDITIONAL APP� OVAL DATE JY?�' , BY: / WO --ttal icCR� dGGrK. `r!/ 2GL�lYi1•dL 1 Soils Rating Date Sewer Installed Well To Absorption Area - Well Log Recelved Septic Tank Size Well to Tank 72029(W)