HomeMy WebLinkAboutLAKE HILL ACRES #6 BLK C LT 1 Onsite File
Lake Hill Acres
# 6
Block C
Lot 1
#051 - 122 - 57
The 1989 field may not be tested for a COSA .
Municipality of Anchorage _
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • littp://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181154 PID Number: 051-122-57 ❑ New ✓❑ Upgrade
Name:
JOHN & MELISSA SHAW
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench 0 Bed ❑ Mound
❑ Other
Address
22245 ANTHEM PLACE
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
0.8 GPD/SF
2.7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.2 Ft.
Gravel depth beneath pipe
0.5Ft.
Subdivision Block Lot
LAKE HILL ACRES #6 • C 1
Fill added above original grade
2.0 Ft.
Gravel length
50.0 Ft:
Township Range Section
Gravel width
15.0 Ft.
Beds: Number of Lines
3
Distance between lines
5.0 Ft.
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
750 Ft2
Number of trenches
N/A
Dist. between trenches
N/AFt.
Well
100.5
107.2
N/A
I N/A
68.2
TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1 1250Gal.
Surface Water
100+
100+
N/A
N/A
Material
Number of compartments
Lot Line
45.2
24.0
N/A
I N/A
NA
STEEL
2
Foundation
34.1
49.7
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+ (
50+
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
JR'S SEPTIC SERVICES
PIPE MATERIAL House to tank Tank to
3034 drainfield 3034
Drainfield 3034 CO/MT 3034
Inspector PANNONE ENGINEERING SERVICES
BENCH MARK (Assumed elevation) 98 ft
Inspection z,
dates: 6/26/18 god 6/27/18
Sd 6/27/18 4'h 7/25/18
Location and description
p
AT HOUSE POINT B
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
OF A� k
co
TH
4iteven . annone
8149
FD
�� PRo
ApprovedDate j ci%
.� � � C�
iop ec; tui i naPui t_ i - i - i G.uuG
I AR-�---
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 4(600 gpd)
LSTANK SIZE: 12508 \+ \_ - - -1' �- -��� �.
PERC RATE: 4.5 MPI
___..SOIL RATING: 0.8 GPD/SF - - - -\ - p "
_ --
AREA ROD: 750 SF -
"SYS. TYPE: BED 0.5'ED
MIN LENGTH: 50LF TRUE, ORTHS L i•= T
USED:
'�\50LFx15'WxO.5' E.D., 2.7' TD X200'+ NORTH
TOTAL AREA: 750 SF SURFACE WATER 91
92 i
! j !RESERVE AREA BASED
! \\ \ U ! ON AWW T S (NIC) TH-P EXTENT
OF FILL
r lir 93 CM2 of vv
M C2 �" C - M4 /� H-, / ��Q \/
\%� _
i
\C1 f- �C6`/INSTALLED ABSO PTIONLD P( )
50LFx15.O'WxO.5;E.D.,2.7'T.D.
M 1 / W/ 2.0' FILL COVER
s5` / C5
! - DCO DV \
INSTALLED 1250G SEPTIC TANK _ M3 C4 \ A B
�i W/ DCO AND DV (QUANTICS 26 _ T1
\TH CO 57.2 28.4
! TRU-FLO)AFTER TANK -97- - / � T1 62.4 35.5
( ea Co r _ % \� T2 70.8 44.1
��-
a
1 + �� j 45.2
DRIVEWAY ` / X / \ \ DCO 72.6 45.8
4BR - DV 74.0 47.3
! I SE:D mi 66.3 51.3
Q rz� C1 66.6 51.8
C2 70.0 55.6
C3 73.8 60.1
t ABANDONED SEPTIC 1 / 63.8
M2 77.2
TANK(E) PER MOA CODE I / M3 1 7.2 71,4
C4 102.3 73.6
C5 105.5 77.6
! t I WELL C6 108.2 80.8
WELL E : ` M4 109.6 82.8
o� <
-._
<o 0 0
�
?w W a F
5 �^
V V ova Fv TER FABRIC o
OC. FC.
96.0_om GRAIN ROCK 6 -ABOVE PIPE INV g u
_ 4- o ORNN PIPE FC.95.0 _ ]t wz
4 0 \ - - -- 00.93.0 in-FE5 15yv
t �
/ 1250 g SEPTIC v
sL✓ TANK
91.2 0.8
0.5' ORNN ROCK SAND IAYER. All SIA
EXCAVATED BELOW BED '7 5/26/17
DATE PERFORMED:
��T A7� �T�-+ T g 5/19/17
NOTES: PAMOyE EN SVC, C� LLC �®S'� L"®�kk Dote
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 �� �F A� 4s�1 /3 /2020
`�'`P • '� `� Scale
PHONE (907) 272-8218 FAX (907) 272-8211 Amoco • y
1„ = 50'
LAKE HILL ACRES #6 BC L1 �J. . ' • • • • • P.I.D. NO
SITE: 22245 ANTHEM PLACE FJ Steven • . •Pannone --85+--4-22-57
DRAWN ACP MELISSA & JOHN SHAW% CE 8149 ®°� PERMIT NO,
SITE PLAN C PO IBOX AK 1904
9 567 � o ljik\_ "� Sheet
�®® 2 OF 2
ANCHORAGE MUNICIPALITY OF ANCH
\ �e n t
On-Site Water&Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.orgionsite
Depart niclit
4NCMORAVE
On-Site Wastewater Disposal System Permit 6/- /q """k
Permit Number: OSP181154 Effective Date: 6/25/2018
Work Type: Septic Renewal Expiration Date: 6/25/2019
Tax Code Number: 05112257000
Site Legal Address: LAKE HILL ACRES#6 BLK C LT 1 G:1562
Site Mailing Address: 22245 ANTHEM PL, Chugiak
Owner: SHAW JOHN C & MELISSA M Lot Size in Sq Ft: 41205
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
The Inspection Report is to note that the undersized 1989 field may not be tested for a COSA.
Received By: 1/411
� Date: (42 / ZJ
Issued By: /-fes l�Cl t �wr� Date: 6/o-5-//e
MUNICIPALITY OF ANCHORAGE ��61 9 9 ' 77
,3
7. )Community Development Department Phone: -3190 ��i, 3
Development Services Division �- Fax: 4 343-7d8 ,'
On-Site Water& Wastewater Program w
h
l/ 01 6 8 L9�'
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-122-57
Property owner(s) John & Melissa Shaw Day phone
Mailing address PO Box 671904 Chugiak, AK 99567
Site address 22245 Anthem Place
Legal description (Sub'd., Block & Lot) Lake Hill Acres #6 Block C Lot 1
Legal description (Township, Range & Section)
Lot Size 41,205 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(E)all that apply)
Absorption Field El Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑ Duplex (D) ❑
Holding Tank ❑ Renewal 0 Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
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 authoriz-d agent)
Permit/Rush Fees: ILIO— /YO Waiver Fees:
Date of Payment: (o,21- ' co y/ig Date of Payment:
Receipt Number: OIa- 6G 077% eceipt Number:
Permit No. 05e e tan 0 Nom..Ca:Waiver No.
Permit App_ :: .c
Pannone Engineering Services uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
June 20, 2018
Subject: Expired On-Site Water and Wastewater Permit
Permit Renewal Request
Permit Number: OSP171110
Legal Description: Lake Hill Acres #6 Block C Lot 1
This is a request to renew the permit for the above mentioned lot. Construction is scheduled to start in
July 2018, after this permit expires. All site conditions remain the same. The construction still will not
affect the health, safety, or development of the surrounding lots.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
MUNICIPALITY OF ANCHORAGE
On-Site Water& Wastewater Program �� 5e;,
i g ,, PO Box 196650 4700 Elmore Road
r Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
epart/rich t
44:c.O N P6E
On-Site Wastewater Disposal System Permit
Permit Number: OSP171110 Effective Date: 6/23/2017
Work Type: Septic Upgrade Expiration Date: 6/23/2018
Tax Code Number: 05112257000
Site Legal Address: LAKE HILL ACRES #6 BLK C LT 1 G:1562
Site Mailing Address: 22245 ANTHEM PL, Chugiak
Owner: SHAW JOHN C & MELISSA M Lot Size in Sq Ft: 41205
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
0 Disposal Field El Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The Inspection Report is to note that the undersized 1989 field may not be tested for a
COSA.
Received By: .IA . .L �Il ,2AL L AS I Date: •
Issued By: ' Date: I -7,
MUNICIPALITY OF ANCHORAGE
(7-;:'\\
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. 051-122-57
Property owner(s) MELISSA & JOHN SHAW Day phone
Mailing address PO BOX 671904, CHUGIAK, AK 99567
Site address 22245 ANTHEM PLACE
Legal description (Sub'd., Block & Lot) LAKE HILL ACRES #6 BC L1
Legal description (Township, Range & Section)
Lot Size 41,205 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field Ni Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade 0 Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
ORIENTATION OF BED Distance:
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/Rush Fees: (01 Waiver Fees:
Date of Payment: '51 31/1-1 Date of Payment: 5131 I I i
Receipt Number: OlOB'3C1 Receipt Number: 09(01°1(1
Permit No. O`�'P1 � I lI o Waiver No. OSV n by\
Permit App_:- .:...c,
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
May 30, 2017
Subject: LAKE HILL ACRES#6 BC L1
Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade absorption field to be issued for this property.
The proposed system will serve an existing four (4) bedroom house. Currently the lot is developed. The
lots in this subdivision are served by private wells.
1. Soils. One test hole was performed by Paul in 1977 for the original system and a second test hole by
McClellan in 1989 for the replacement system. PES performed a test hole which resulted in a soil
rating of 4.5mpi. Based on the results of the percolation tests; an application rate of 0.8
gallons/day/square feet was used for a conventional wastewater system in the area of the test hole.
Groundwater was encountered after the water monitoring period at 6.7'. The proposed absorption
system provides ample vertical clearance to the determined water level.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100' of the proposed septic system. The system will
maintain 100' of separation to all surface water.
4. Topography: The existing topography generally slopes from the southwest to the northeast in the
area surrounding the septic system at approximately 5%-7%. There are no steep slopes within 50' of the
proposed drain field. The proposed drain field will maintain 50' separation all steep slopes.
5. Waivers: We are requesting a waiver for the orientation of the field due to features found in the area
of the proposed bed and minimize loss of existing vegetation. The profile of the proposed system shows
that proper clearance to groundwater can be maintained along with installation within the appropriate soil
strata.
6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site Department,
the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
-.74100,112 •
0% Steven R.Pan.ne ry�
81 •
`l SSl�ot..
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
.- Yl LLL lr 1/ - 1
JAR \ `\ � �—_
0 A 'tel
\\-- —'-'/ y
Add-I% *:** 1* \ ...._ \--- — --- —
-------------
..._.---
46'
y 0 _ �, �KEp VE _
TRUE ren, _ so `MIRROR `\ CO
\
N. .—
f • 200'+ NORTH TO....- —<.. -T—s. \ \ w
\?%)\\I-K-://sT—
SURFACE WATER mx N M.� 1 70
D INSTALL
1 �� EI ` 5OLFx15.0 WxO 5PEION2F71T D P)
I RESERV AREA BASED m W/ 2.0' FILL COVER /
I I 9 AWWTS NIC
N , � 1\
IN.TALL 125OG (SEPTIC TANK P `��` \C):\/1 , 1
W DCO AND DV QUANTICS m ` �i►*, w 1 y
TRU-FLO)AFTER TANK ��� , �� .� •
\/
*I ‘,1\11 1\V\44\ .V_ 464111 ,
..cie,
\ ,. .._ ,,,,
I ..? . ,„ ,,
,_ EF:_ _, /ALc,,,,,,,_ .
/
Ia I y 149,2 1�� ` • „ /
l � �' 98rJI �1 ,�I
r I �, 1 �i��. . \ M
I d� 101,2 4 45.3 i 1�
IDRIVEWAY f / /
J � s! SBD
.
.c'
I W a. / //q 4T
L. i ABANDON SEPTiC TANK E,--\ - -, _ \ .
- -\ • 7
8
PER MOA CODE iI
I ~� �, I'I WELL (E)/
WELL (E)/ r \,
_ DESIGN PARAMETERS
'” ' ' - a' A I •Y R A M PRIMARY SEPTIC SYSTEM
ABOVE PIPE INV EXCAVATED BELOW BED
NO. BEDROOM: 4(600 gpd)
3.0 II
re-ces -.1:- I F. . ,:�wsx TANK SIZE: 1250g
- I rsev PERC RATE: 4.5 MPI
MEEI.ulr0�1 D.G.
I ilieNeillii I „_„_ -I'it„_-, SOIL RATING: 0.8 GPD/SF
s. — -'-' AREA RQD: 750 SF
'. -j o_s}-- SYS. TYPE: BED 0.5'ED
4.0- MIN LENGTH: 5OLF
su
e.. USE:
spiv. BED PROFILE 5OLFx15'Wx0.5' E.D., 2.7' TD
-i0..
SCALE; 1•;10' TOTAL AREA: 750 SF
NOTES: LLC `,\\ \ Date-�o
FOR CONSTRUCTION PANNONE ENG SVC, LLC OF O6/dg•/2017
P.O. BOX 102954 ANCHORAGE, AK 99510 0••'
PHONE (907) 272-8218 FAX (907) 272-8211 t•'•• • �4 , Scale
LAKE HILL ACRES #6 BC L1
SITE: 22245 ANTHEM PLACE "$}evenft. •annore 051-122-57
O.
DRAWN JRL MELISSA Sc JOHN SHAW CE 8149 PERMIT 11
PO BOX 671904 ..,., OSP171110
SITE PLAN CHUGIAK, AK 99567 "1�q ,w. Sheet
1 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW 1250g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 6.7 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 6.7 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE:
ABBREVIATIONS
w w WATER LINE / TH TEST HOLE
WELL RADIUS (P) PROPOSED
(E) EXISTING
—ss ss — NEW SEPTIC CO CLEAN OUT NO.
MT MONITOR TUBE NO.
TYP TYPICAL
NOTES: PANNONE ENG SVC, LLCDate z)
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 P�G..•• 06/•(x/2017
PHONE (907) 272-8218 FAX (907) 272-8211 4q 1, Scale
*;' I. NTS
LAKE HILL ACRES #6 BC L1 P.I.D. NO
051-122-57
SITE: 22245 ANTHEM PLACE ever; -.Waage
• PERMIT NO.
DRAWN JRL MELISSA & JOHN SHAW 4•.•. CE 8149 • 05P171110
PO BOX 671904 •.... i Sheet
DESIGN NOTES CHUGIAK, AK 99567 �;;t 3 OF 3
SOILS LOG — PERCOLATION TEST
TEST HOLE 1 .
OR TOPSOIL SLOPE SITE PLAN
1111111111.11.11.
1 ML ORGANIC
SILTS
2 SM BROWN 91 /
SANDY SILTS til
9Y
4
4
DARK GRAY
5
POORLY ,t TEST 9� lik.
GRADED SAND HOLE
_
5P
6 T
7 __ 6.7' AIPA
8
FINE PACKED
9 SP/SM SAND W/ 1 '----a1
SILTS, DAMP
10
BOH
DATE PERFORMED: 19MAY2017 _ f
IEWAY
4BR
FD
A
SLOPE
WAS GROUND WATER
ENCOUNTERED? N
TH 1
IF YES, AT WHAT
DEPTH? -NA-' x
DEPTH TO WATER AFTER
MONITORING? - 6.7'-
DATE: 26MAY2017
CLOCK WATER RATE SOIL TEST RESULTS/ANALYSIS
READING DATE TIME NET TIME LEVEL NET DROP (MPI) • PERCOLATION RATE 4.5(min/inch)
READING
(Hydrologic Soils Group: HSG A)
1 19MAY17 0849 4.50" • PERC HOLE DIAMETER 6"
2 0859 10 MIN 6.71" 2.21" 4.52" • TEST RUN BETWEEN 3.5 FT AND 4.5 FT.
3 0859 4.50" • TEST RUN FOR OVER AN HOUR, LAST
THREE READINGS PROVIDED.
4 0909 10 MIN 6.70" 2.20" 4.54"
5 0910 4.50" -
6 0920 10 MIN 6.69" I 2.19" 4.57"
COMMENTS:Test hole excavated by JR'S SEPTIC.
PERFORMED BY:STEVEN PANNONE. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
PANNONE ENG SVC LLC \ , Dote
,OR CONSTRUCTION 06/06/2017
P.O. BOX 102954 ANCHORAGE, AK 99510 �' '••'•"'••.
PHONE (907) 272-8218 FAX (907) 272-8211 �• 1 Scale
j *: . .'.iiipko NTS
LAKE HILL ACRES #6 BC L1 •��� •• 051-122-57
SITE: 22245 ANTHEM PLACE ••$}even •.YSaririo�ie•
NO.
DRAWN JRL MELISSA & JOHN SHAW cE 8149 PERMIT 711
PO BOX 671904 osP171110
�;•'••.. Sheet
SOILS LOGS CHUGIAK, AK 99567 'ice 1 OF 3
OPINION OF COMPLIANCE
ANCHORAGE GENERAL PERMIT 93-10-M4/11 -M4/12-M4
File Number: POA-2017-335, Mirror Lake [GP 93-10-M4 Residential]
Municipal Reference Number: Mirror Lake 17-A
Permittee (LANDOWNER): Melissa Shaw
Expiration Date: October 31, 2020
Project Location: Lake Hills Acres #6. Block C, Lot 1, Anthem Place, Chugiak
Anchorage Wetland
Management Plan Map #: ER 25, 26
Wetland Unit #: 109
Wetlands Fill Amounts: 1430 sq ft; -194 cyds gravel
Work Description: Excavation and backfill for new septic system and field
All work will be performed in accordance with the attached plans submitted
with application dated: June 16, 2017
The permittee will perform work in waters of the U.S. (wetlands) in accordance
with the terms and conditions of the Anchorage General Permit, as specified
below:
Anchorage General Permit Conditions:
GENERAL CONDITIONS OF THESE GENERAL PERMITS
All activities identified and authorized by these GPs shall be consistent with the special
conditions listed above, as well as the general conditions listed below.The Corps can also
add site-specific special conditions to a GP verification, as applicable.
Obtain GP verification prior to activity: No work shall be done under these GPs without first
obtaining an Opinion of Compliance (OC)from the MOA Planning Division or General Permit
Verification from the Corps. A copy of the Municipal building permit application and grade/fill
permit application or Land Use permit application must be included with the GP application.
Compensatory mitigation, if required, must be acquired before proceeding with authorized
jurisdictional activities.
Time limit: Verification under these GPs is valid until October 31,2020, unless the GPs are
modified, reissued or revoked. It is incumbent upon the applicant to remain informed of
changes to the GPs.
Melissa Shaw 1
POA-2017-335; California Creek 17-A
Mitigation:The activity must be designed and constructed to avoid and minimize adverse
effects, both temporary and permanent,to waters of the U.S.to the maximum extent
practicable at the project site. Mitigation in all its forms (avoiding, minimizing, rectifying,
reducing, or compensating for resource losses) will be required to the extent necessary to
ensure that the adverse effects to the aquatic environment are minimal.
Compensatory mitigation will be required for all wetland losses greater than 0.1-acre unless
the District Commander determines in writing that either some other form of mitigation would
be more environmentally appropriate or the adverse effects of the proposed activity are
minimal,and provides a project specific waiver of this requirement.The applicant may seek
this determination by written request to the Corps.The Corps'determination on
compensatory mitigation will be returned, in writing,to the MOA Planning Division for
inclusion into the OC. If applicable,compensatory mitigation must be completed prior to
conducting work authorized under these GPs. Compensatory mitigation projects provided to
offset losses of aquatic resources must comply with the applicable provisions of 33 CFR 332.
NO MITIGATION REQUIRED—fill is less than the mitigation cut-off
Setback:Where there are wetlands along or around a stream or water body,the project shall
include and maintain a non-disturbance setback,measured horizontally from the ordinary high
water mark, as specified in Attachment A.Applicants shall contact the MOA Planning Division
or Corps to obtain or confirm delineation of the setback.The setback extends only as far as
the outer edge of the adjacent wetland boundary. Setbacks greater than 25 feet wide do not
extend into non-wetlands.
NO SETBACKS
Buffer:The project shall include and maintain a non-disturbance buffer area, as specified in
Attachment A. Applicants shall contact the MOA Planning Division or Corps to obtain or confirm
delineation of the buffer.
NA
Delineation of project boundary: Project boundaries shall be staked,flagged or otherwise
clearly delineated prior to the commencement of the authorized activity to prevent inadvertent
encroachment of adjacent wetlands.
Staff verified wetland boundary
Endangered Species: Activities authorized under these GPs must not adversely affect a
federally listed threatened or endangered species, or destroy or adversely modify its
designated critical habitat.
Historic properties: No cultural resources shall be adversely affected by activities authorized by
these GPs. If the permittee discovers any previously undiscovered archeological,
paleontological,or historic resource, while conducting activities authorized by these GPs,the
DC must be immediately notified by calling (800)478-2712. The Corps will notify the Alaska
State Historic Preservation Office of what has been have found.The Corps or the appropriate
federal land manager will initiate the Federal and State coordination required to determine if
the remains warrant a recovery effort or if the site is eligible for listing in the National Register
of Historic Places.
Inspection:The applicant shall allow the DE or their authorized representative(s)and/or a
representative from the MOA Planning Division to inspect authorized work at any time
deemed necessary to assure that on-going and completed work is in compliance with the
terms and conditions of these GPs.
Transfer of General Permit: If the applicant sells or wishes to transfers the property associated
with the authorized activity, the applicant must obtain the signature of the new property owner
Melissa Shaw 2
POA-2017-335; California Creek 17-A
or lessee in the appropriate space on the verification/OC and submit a copy of that page to the
MOA Planning Division' and/or Corps, along with appropriate documentation of the
transaction.All information must be submitted within 30 days of the property transfer to
validate the transfer of the GP authorization to the new party.
Modification by other authorization: If the work proposed under these GPs is subsequently
modified by any other Federal, State, or local governmental authorization, a modification of the
GPs, MOA Planning Division's Opinion of Compliance, and any verification by the Corps to
perform activities under these GPs may need to be obtained.
Use of multiple general permits, including Nationwide Permits:The use of more than one GP or
Nationwide Permit(NW P)for a single and complete project is prohibited, except when the
acreage loss of waters of the United States authorized by the GPs and/or NWPs does not
exceed the loss of more than one acre of wetlands.
Project site restrictions and design criteria:
1. For residential developments,the aggregate total loss of waters of the United States
authorized by GP-1993-10-M4 shall not exceed one acre. For residential
subdivisions, the aggregate total loss of waters of United States authorized by this GP
cannot exceed one acre.This includes any loss of waters of the United States
associated with development of individual subdivision lots.
2. Erosion Control: Prior to the initiation of any fill discharge authorized in accordance
with GP- 1993-10-M4,the Permittee shall install erosion control measures along the
perimeter of all work areas to prevent the displacement or erosion of fill material
outside the authorized work areas. The erosion control measures shall remain in
place and be maintained until all authorized work is completed and the work areas
are stabilized. Immediately after completion of the final grading of the land surface,
all slopes, land surfaces, and filled areas shall be stabilized using sod, degradable
mats, barriers, or a combination of similar stabilizing materials to prevent erosion.
3. Fill Material: Only clean fill material shal I be used for this project.The fill
material shall be free from items such as trash, debris, automotive parts, asphalt,
construction materials, concrete blocks with exposed reinforcement bars, and soils
contaminated with any toxic substance, in toxic amounts in accordance with
Section 307 of the Clean Water Act.
4 Within 60 days of completion of the work authorized by this permit,the Permittee shall
complete EITHER the attached"Self-Certification Statement of Compliance"form
(Attachment D),Q$the attached"As-Built Certification By Professional Engineer"form
(Attachment E), and submit it to the Corps. These are further described below.
Self-Certification Statement of Compliance: In the event that the completed work
deviates in any manner from the authorized work,the Permittee shall describe the
deviations between the work authorized by this permit and the work as constructed on
the"Self-Certification Statement of Compliance"form. The description of any
deviations on the"Self-Certification Statement of Compliance"form does not
constitute approval of any deviations by the Corps.
As-Built Certification: Within 60 days of completion of the work authorized by this
permit,the Permittee shall submit as-built drawings of the authorized work and a
completed"As-Built Certification By Professional Engineer"form to the Corps.The as-
built drawings shall be signed and sealed by a registered professional engineer and
include the following:
a. A plan view drawing of the location of the authorized work footprint, as shown on
the permit drawings, with transparent overlay of the work as constructed in the
same scale as the permit drawings on 81/2-inch by 11-inch sheets or PDF. The
Melissa Shaw 3
POA-2017-335; California Creek 17-A
plan view drawing should show all "earth disturbance," including wetland impacts
and water management structures.
b. A list of any deviations between the work authorized by this permit and the work as
constructed. In the event that the completed work deviates, in any manner,from
the authorized work, describe on the attached"As-Built Certification By
Professional Engineer" form the deviations between the work authorized by this
permit and the work as constructed. Clearly indicate on the as-built drawings any
deviations that have been listed. Please note that the depiction and/or description
of any deviations on the drawings and/or"As-Built Certification By Professional
Engineer"form does not constitute approval of any deviations by the Corps.
c. Include the Department of the Army permit number on all sheets submitted.
Project-specific conditions:
1. Time Limit. GP authorization of this project expires on: October 31, 2020. If you need more
time to complete the authorized activity,submit a request for extension under these GPs to the
Municipal Planning Department prior to the expiration date. You may not continue work beyond the
expiration date until receiving notification to that effect from the Municipal Planning Department or
the Corps Regulatory Branch.
Note: Permitee should allow at least one month for processing of extension requests.
2. Setback Where there are wetlands along or around a stream or waterbody, the project shall
include and maintain a non-disturbance setback, measured horizontally from the ordinary high
water mark.The setback extends only as far as the outer edge of the adjacent wetland boundary.
Setbacks greater than 25 feet wide do not extend into non-wetlands. For previously unplatted
residential subdivisions,the setback area shall be tracted out, rather than being included in
individual lots.
65'from streams that are neither anadromous nor headwaters, as defined above;and,
3. Other Approvals Required Before Starting Work. You must not disturb wetlands for this project
until you have obtained all applicable Municipal and State approvals required for the work. These
approvals may include, but are not limited to:
Municipality of Anchorage:
® Land Use Permit
❑ Clearing Permit
® Grading&Fill Permit
❑ Building Permit
❑ Right-of-Way Permit
❑ Flood Hazard Permit
❑ Utility Agreement(s)
❑ Rezoning Approval
❑ Preliminary Plat Approval
❑ Subdivision Agreement
❑ Stormwater Treatment Plan
❑ Parks Right-of-Entry Permit
❑ Wastewater Disposal
❑ Urban Design Commission
❑ Geotechnical Commission
Alaska Department of Environmental Conservation:
❑ Stormwater Treatment Plan
❑ Wastewater Disposal
❑ Soil Remediation Plan
If any of these—or other—approvals result in a change to the attached plans,you must provide a
description of the change and a revised plan(s)to either Municipal Planning Department Staff or
the Corps Regulatory Branch,and may not proceed with the project until the change is authorized.
Melissa Shaw 4
POA-2017-335; California Creek 17-A
4. Offset Unavoidable Impacts. To offset the unavoidable adverse impacts of the project to the
aquatic environment, the permitee:
® Mitigation not required; fill less than 0.1 acres.
5. Limits on Work Area. You must not conduct any of the following activities in wetlands or
waterbodies beyond the approved project footprint(or in any other avoidance area identified above)
during either construction or operation of the project/facility:
D Discharge of fill material (even temporarily), including stockpiles; or,
D Excavation and sidecasting/backfilling;or,
> Mechanized landclearing;or,
D Operation, parking/storage or servicing of equipment.
6. Construction Runoff. You must employ runoff control measures necessary to preclude or
minimize both erosion and the transport of sediment, pollutants, and solid waste beyond the
approved project footprint. These measures shall include,but are not limited to:
❑ Phasing of Site Preparation(to minimize the extent of exposed soil);
O Silt Fence; Place at lower edge of new fill
❑ Reroute Offsite Runoff around Disturbed Soils (e.g., dike/ditch)
❑ Mulching (e.g., wood chips,straw, grass clippings, gravel);
❑ Matting (e.g.,jute, straw, coir);
❑ Sheeting for Stockpiles, Temporarily Exposed Slopes(e.g., plastic,geotextile fabric);
❑ Check Dams in Ditches/Drainageways(e.g., hay bales, sand bags, gravel berms);
❑ Surface Roughening (to slow runoff down slope);
❑ Terracing of Slopes;
❑ Sediment Trap(s);
❑ Temporary Sediment Basin;
❑ Storm Drain Inlet Protection (e.g., hay bales,sand bags, and gravel berm)
❑ Outlet Filtering/Stabilization for Construction Dewatering;
❑ Revegetation of Fills and Disturbed Soils—basic regrade and seeding
• ❑ Onsite petroleum spill/leak response equipment and supplies and provision for their
proper disposal
7. Contaminated Soil. If contaminated soils are discovered duringconstruction,you must
immediately cease all work in the vicinity of the contamination, contact the Alaska Department of
Environmental Conservation for instructions, and defer any further activity until you receive ADEC
approval to continue.
8. Endangered Species. The activity must not jeopardize the continued existence of a threatened or
endangered species, as identified under the Endangered Species Act, nor endanger the critical
habitat of such species.
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POA-2017-335; California Creek 17-A
Special Conditions. as required by the Watershed Management Services (WMS) of the
Municipality of Anchorage:
Not reviewed by the MOA WMS section. Minor backfill only.
Special Conditions, as required by the Planning Division of the Municipality of Anchorage:
No special conditions are required by the MOA Planning Division.
Special Conditions, as required by the Corps of Engineers:
This project did not reach the threshold of a General Permit Agency Coordination (GPAC);
therefore, the Corps did not comment on this application.
Your signature below, as permittee, confirms that you accept and agree to comply with the terms
and conditions of Anchora•e General Permit 93-10-M4 as supplemented in this document.
LAPPLi W
SI N
Owner / /f �DA�T/E1 Z
r A_ - L L1 moi-!
PRINT i !
Owner DATE
Opinion of Compliance
The signature below confirms the Municipality of Anchorage's opinion that the project
described above meets the terms and conditions of Anchorage General Permit 93-10-M3.
Q---aeLZ---' 30//1
SIGN Thede Tobish, Senior Planner DATE
Tlafe - ash 6 //
PRINT Thede Tobish, Senior Planner DATE
Melissa Shaw 6
POA-2017-335; California Creek 17-A
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmenlal Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES OS--/- /
Address ' - TANK FIELD WELL
Phone(s) I IN°'°fBe>° WELL ,/0 ,,..~! /0//
Township. Range, Section ~ /
AS-BUILT DIAGRAM {Shgw location of well, septic syslem, prope~y lines, foundation.
5~'~ '~ )~ f [~/ ~/V~ driveway, water bodies, etc.)
~SEPTIC ~ HOLDING ~~2 ~
Material No. of Compa~ments
TreE OF SYSTEM
~ TRENCH ~ BED ~ W. DRAIN ~ OTHER '~
Fill added above original grade Gravel depth beneath pipe
Number o, lines Soil rating Pipe material X
Installer Date Inst?ed
~PRIVATE ~ OTHER fldentifv) ~ -~, ~A~ /~.20<;AL
/
Installer = Date Installed: '~ ~
REMARKS:
I ~Y ~~ ~~ ceflilythatlhisinspeflionwaspBdorm8~accordingtoa,I
Municipal and State guidelin~ in effect on this dat~ /~/~' ~'~'~ '¢, ~x %.
Heallh Depadment Approval: / Date: ~ ~
PROJECT:
6700 Arctic S~ur Road · Anchorage, AK 99518-1550 ° PHONE (907) 349-5148 ° FAX (907) 349-4213
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i,, ]] ~'.;.!£ii i'ami:l, iau'~ ~J. th ..ll,e r'~)quire)m,'.~;.:nt..:~ ~'- .... .~¢ ,.,1: I :~
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~El"Id 'J.l'i izomt;)].iartc:~a ~.~i'Lh 'Lh¢,~, cll~ili[~ln cPJ. t.l~i"ia! o{' tl"li~ permit.,,
3,, i will a.c!l"i~zm=, t.,::;~ ,ail- - MOA a~r'l(::t St. at.e of ~hlasl<a i ..... e. cu~., 'il~i:':')iit~:'H"lt.~5
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and that t~e impro,,ement~ ~ituated thsre~ ore
within· the pr~er~ lines and do n~ overlap or
encroach on the pr~rty lying adjacent` th~reto~
that .~ improvements, on the property lying
adjacent there¢o' encroach on the premi3es
in question and th~ there are no road-
way~'Iran~mi~sion li~3~ or other vi=ibl3
easements on eaid property except a~
indicated
AS-BUILT SURVEY
LoT I F~L.OCv- (b
Date
STAN SEARS ~ ASSOCIAT'ZS
REGISTERED LAND"' SURVEYORS
pOST OFFICE DOX '~"-"
EAGLE RIVER, ALASKA
Scat* j"Grid I Drawn b,,/ ,,,~_~ V/.O.
........ ,....,,l,,,., ,,4 ,.
SOILS LOG-~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
B25 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
1
3
4
5
6
7
8
9
10
11
12
13-
14-
15-
16
17,
18
19
20
COMMENTS
?z s
SLOPE SITE PLAN
WAS GROUND WATER S
y£5 L
ENCOUNTERED? 0
IF YES, AT WHAT
DEPTH? '~
I
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~,~J.~'~Zz:~ ~ (minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
PERFORMED BY: ,~) ,~'1,,~.~ CERTIFIED BY: DATE:
DA]LE: <::~/~,7/,~ '~ SH%:__
PREPARED BY: ,/~/~'-¢'"'¢"~"/
' SUBJECT: ~'~ .~}~'<~/C'z'' 5 ~-,,'~/~/,:~
OF__
ARCTIC SLOPE CONSULTING GROUP
Engineers Scienlists * Surveyors
PROJECT:
i j
6700 Arctic Spur Road · Anchorage, AK 99518-1550 · PHONE (907) 349-5148 '" FAX (907) 349-4213
~4
~Z
PROJEC'~
Engineers S¢ientisls Surveyors
6700 Arctic Spur Road "Anchorage, AK 99518-1550 · PHONE (907) 349-5148 "FAX (907) 349-4213
~ " ~.:MUNICIPALITY OF ANCHORAGE
He~ 'h and Environmental Prote~ ion
~ Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
iNSPECTION REPORT ON-SITE S,~WAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
~ NUMBER OF
FRO~vl WELL ""7~~''IO MANUFACTURER _ MATERIAL COMPARTMENTS
INSIDE LENGTId INSIDE WlD1H LIQUID DEPTH LIQUID CAPACITY/(-'~-¢ GALLONS.
TILE DRAIN FIELD:
/
DISTANCE FROM WELL~7('j(':'~ FOUNDATION
# of Lines DISTANCE BETWEEN LINES
ABSORPTION AREA _~/~3''~
DEPTIh TOP OF TILE TO FtlNISH GRADE
TOTAL LENGTH ~¢~'2
NEAREST LOT LINE .OF LINE
-- TRENCH WIDTH,~¢' IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
__ IN. ABOVE TILE IN,
SEEPAGE PtT:
Log Crib __.Rings
BUILDING FOUNDATION_
DIAMETER _ OR WIDTH_ , EENGTH , DEPTH
__ Crib Size: DIAMETER-__DEPTH__ DISTANCE FROIv~: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE .... ABSORPTION AREA (WALL AREA)
SQ. FT.
Well
Class: Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
Pipe Materials:
# of Bedrooms:
Installer: ~/~
Remarks:
!
! I !
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'T'F.ii:!i:!;;i:E: :l::!i; i'.4Ci :!ii;tii:'[' i.,.i;!;!:::,"i"l...! F:'EI[4:
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i:.:!['-,ii") 'iF.it::; i:::',i') i'"i'l'"d"'i i::1i:::' '1'!...II::; F:i::.:;I':;:i:::I¢,,,~i:::t'!' :i' [:]['q ,:; ;i: i'.,i F;'F::!;ii:'T'
Performed For /-/gr~v
Leoal Oescrirtion: /Lot / BloCk C,
This Form Renorts Soils LDo
"On~ t~t is worth a th~umnd opinions"
2204 Cleveland Anchorage, Alaska 99503'
' Date Performed ~
Subdivision
Percolation Test
Penth
Feet
~,'~:~ Soil Characteristics
8
10
12
14
16
18--
20
Bo//
Was Ground Water Encountered?7V_~.~_
I~ Yes, At what Denth?
I' Readinq Date Gross Time Net Time Depth to H20 Net Dron
ercolation ate )iinute
Prnvosed Installation: Seenaoe Pit Drain Field
Deoth of Inlet Depth To Bottom Of Pit Or Trench
/ /
( erlifieh rilling
by
A & L DRILLING COMPANY? ', lt¥ ?
BOx97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-258B~ , , · ,
OWNER OF LAND
LEGAL DESCRIPTION
' / ~ Ended
DATE-Started ~7/~ ~1'7
PE~IT NUMBER
I //
DEPTH OF WELL ~/
STATIC LEVEL OF WATER FT. ]
/
D~AW DOWN FT.
GALS. PER HR .~)~ o ~ ~)
KI D ov CASIN
KIND OF FORMATION:
From ~7 Ft. to d~ Ft.v~ ~Oegd ~o~eObT.,d From--
From :i> Ft. to Jr> Ft. ,~f) From~
From /0 Ft. to~Ft. ( /.~ ~'~&v//~C ~.tdC/ From~
From ,:) ~ Vt. to (,.h~ Ft. ,5~rL'~U~'O ffdV from~
From (~5~ Ft. to :7~? Ft. ~e?;d' ,~'~o0 ou~'T~ From~
From ] ? Ft. to ~ / Ft..~dg~ D (ffN'VS~g 3~- tO~,'q T~-~ From
From~Ft. to.~Ft. From
Fr0m~Ft. to.~FL From~
From Ft. to Ft. From~
From Ft. to Ft. From~
From Ft: to Ft. From~
From~Ft. to Ft._ . From
From Ft. to Ft. From~
From Ft. to Ft. From
From Ft. to Ft. From ~
From Ft. to Ft. From ~
From Ft. to Ft. From
Ft. to Ft..
Ft. to.__Ft
Ft. to Ft
Ft. to.__Ft
Ft. to Ft
Ft, to Ft,
Ft. to Ft..
Ft. to.__Ft.
.Ft. to Ft.
.Ft. to Ft.
.Ft. to__Ft
Ft. to__Ft
Ft. to Ft.
Ft. to__Ft
Ft. to Ft
Ft. to Ft.
Ft. to__Ft
MISCL. INFORMATION:
DRII.I,ER'g NAME /i;:,.. :? ~"~ '' ?
MUNICI'PALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # ~',5"'/- / Z - 2--- - '~" 7 HAA# U-~ ~--"~ ~ ~L~" E-~J(~ ¼
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
~ ~.~- / z::i'~ o ~/4 ~ /-.4/<E' /C/z_/.s ,4 c,,~'-_¢ ,4.,'0.
Location (address or directions)
(b) Property owner/~'.~'e~'-¢/z:~/~np ~'~'~' Telephone: (home) Business
Mailing Address ,ZC"~d,,4 ~,74¢2,.¢"~'<~ ~.,~K/~,/,4,~.., A,4::
(c) Lending Institution
Telephone
Mailing Address
Address
Telephone
(e) Mail the HAA to the following address: (or check here ~,if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family [~ Number of bedrooms
3. WATER SUPPLY
Individual Well ~¢' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88} Page 1 of 2
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A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: /_.O/-'- / &C'L~::7~C,~ ~_~
Well Classification
Well Log Present (Y/N) Y Date Completed 7/,~.~/77 Yield
Total Depth 8/" Cased to ~// Depth of Grouting
Static Water Level /.~ ...-.4. Pump Set At
If A, B, C, D.E.C. Approved (Y/N)
Y
Depression Around Wellhead (Y/N) /V'
Sanitary Seal on Casing (Y/N)
; On Adjoining Lots
Casing Height Above Ground :~ '~
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /~:::2..~ ·
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
To Nearest Public Sewer Cleanout/Manhole
; On Adjoining Lots
B. SEPTIC/HOLDING TANK DATA
Date Installed/Oil ~./~¢~' Size
Standpipes (Y/N) Y
No. of Compartments
Air-tight Caps (Y/N)
Depression over Tank (Y/N) ~
Pumping/Maintenance Contact on File (Y/N) /O/
Holding Tank High-Water Alarm (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line '~'~
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Foundation Cleanout (Y/N) Y t'~$~,J
72-026 (Rev. 7/88) Front
Page 1 of 2.
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~:2//
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation ,,~/
Lot /<::2 ~
TO Water Main/Service Line ~<¢2
Type of System Design
Length of Field .-~¢~ /
__ Depth of Field -/~-"- '~'~ t,
Gravel Bed Thickness // ~)._4
Statndpipes Present (Y/N)
Date of Last Adequacy Test
y,
To Property Line J~ /
To Existing or Abandoned System on
; On Adjoining Lots /,d~'',-~'
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area ~'~:~
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA;g'~'[delin~S~i%..e~ffect on the date of this
inspection.
Signed
Engineer's
Seal
MOA No.
ec ,.t No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order # 19551
Date Report Printed: FEE 2 90 @ 14:42
Client Sample ID:LI BLK C LAKE HILL ACRES ~6
PWSID :UA
Collected JAN 29 90 ~ 13:00 hfs,
Received JAN 29 90 @ 16:08
Preserved with :AS REQUIRED
Client Name : BATES HARRY
Client Acct: BATEHC
P.O,~ NONE RECEIVED
Req ~
Ordered By : H. BATES
Analysis Completed :JAN 31 90 Send Reports to:
Laboratory Supervisor :STZ~h~N C. EDE 1)BATES HARRY
Special CALL CLIE~'WHEN COMPLETED, 349-5148. HOLD FOR PICK-UP & PAY}dENT.
Instruct:
ChenLlab Ref ~: 9354 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result Units ~ethod Limits
NITRATE-N 2.6 mg/1 EPA 353.2 10
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BY H. BATES.
Tests Performed * See Special Instructions Above UA=Unavailable
None Detected *' See Sample Remarks Above
Not Analyzed LT=Less Than, CT=Greater Than
#1: Time
Date
Insp
. ~EPARTME
825
MUNICIPALITY OF ANCHCRAGB-~
OF HEALTH AND ENVIRONMEN ' PROTECTION
L Street, Anchoraa~. Alaska 99501
264-4720
Date Received: March 7r 1978
9:30 a.m. #2: Time 93: Time
3-~78 Friday
Date
Date
Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Teamster's Federal Credit Union
Mailing Address: 1200 Airport Heights Road ~430 Phone:
Property Owner: J.B. Hensen
Mailing Address: % Larry Terry, 276-1333
Phone:
Legal Description: Lot 1 Block C Lake Hill Acres Subdivision #6
4: Single Family Residence: Sx~
Multiple Family Residence: ( )
5. Well System: Individual well (x)
Permit ~
Construction
Number of Bedrooms: ?
Number of Bedrooms:
Community/Public System )
Depth of Well 85' Well Log on File
Bacterial Analysis
Sewage Disposal System:
Permit ~
Septic Tank Size
Absorption Area
On-site System (x) Public Utility ( )
Installed d~ ~ / -~'~ Installer
i~7~3~> ~ Manufacturer ~.~%_~-~
Soils Rate Material ( ~Ag~
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 1 Block C Lake Hill Acres Subdivision #6
Comments:
Affadavit Attached
Approved:
Disapproved:
Letter Attached: ( )
Date:
Date:
Department Worksheet:
~, , i, ' · MUNICIPALITY OF ANCHORAGE
'" ~ i Department of Health and Environmental Protection
//~,~,.~/ 825 L Street, ~chorage, Alaska 99501
.' 264-4720 ~
~quest for Approval of Individual Sewer and Water Facllltmes
1. Property Owner: % , ~
2~
o
Mailing Address:
Name of Buyer: ~/
Mailing Address:
Lend in g in st itut ion: ,~,f~¢~.~
Mailing Address:
Rea 1 for/Agent: ~~ ~~/~
Mailing Address:
Street Location:
Phone
Phone:
Phone:
Single Family Residence:
Multiple Family Residence:
( ) Number of Bedrooms:
( ) Number of Bedrooms:
/~ Public/Community System
Water Supply:~ *Individual Well
If Individual Well, well depth
( )
If Community System, name of system
8. Sewage Disposal System: *~n-site System
If On-site System, date of installation:
( ) Public System ( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77