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HomeMy WebLinkAboutLAKE HILL ACRES #1 LT 24  MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME(" / // PHO' ' LOCATION NO, OF BEDROOM~ DISTANCE TO: WW~: / ~ [Absorpti~re~k Pwallin~ ~l: PERM ITNO. W~tf~ - ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~--~O~ Manufacturer ~ / ),~ Material Liquid capacity in gallons '~ ~0~ Fou~/~ N,~,~ PERMIT NO. zo: ~! ~ No. of lines 1 Length~in~ Total I~i~ Trench,3 ', ~ inches ~: :~ Top of tile to fi~ g~d~ ~e~i~l bene~ti~ ~ ~ /~ Total effect~e absorption area Length Width Depth PERMIT NO. ~ N Type of crib Crib diam Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ J Class ~.~ D~ .Driller Distance to lot line PERMITNO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SO~LTEST~AT~NG __ . ~ //~ / A~R DATE LEGAU~;? , , ~.. -.' .... DEPRRTMENT u., HEALTH RNa., ENVIRONMENTRL ,. 3TECTION 825 "L" STREET., HNL. HURFIJE., FIK. 99501 264-4?20 L.-~_ ~'4--S I TE SEI,IEi:;~-.' F'ERI""I I T ( 820960 ) PERMIT NO. RPPLICRNT LOCRTION LEGRL SCHMtDT BROS CONST L24 LRKEHILL 8CRES #t 28~ MULDOON BOX G RNCH LOT SIZE 999999 SQURRE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH MRXlMUM NUMBER OF BEDROOMS SOIL RRTING THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: [-~EPTH= 7. 5 LEt'-IGTH= 55 l]l~:Fl%."El DEF'TH= 4. 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN THE OUTFRLL PIPE BND THE BOTTOM OF THE EXCBVBTION (IN FEET). RE[) SEPT I C: TI--It%IF~] S I ,-~. E= ±£-~0~3 ~]RLLC~f-~S PERMIT RPPLICBNT HRS THE RESPONSIBILITY TO INFORM THIS DEPBRTMENT DURING THE INSTBLLRTION INSPECTIONS OF BNY WELLS BDJ8CENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THBT THE WELL WILL SERVE. T~.~6~ (;?) I ~-tSPEC:TIC~r-~S RRE REC4t_II ~:E[) BRCKFILLING OF RNY SYSTEM WITHOUT FINBL INSPECTION RND BPPROVRL BY THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL 8ND RNY ON-SITE SEWRGE DISPOSBL SYSTEM IS t00 FEET FOR 8 PRIVBTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTBNCE FROM R PRIVBTE WELL TO B PRIVBTE SEWER LINE IS 25 FEET RND TO B COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY BPPLY. SPECIFICRTIONS BND CONSTRUCTION DIBGRRMS BRE BVRILBBLE TO INSURE PROPER INSTRLLBTION. F"FF-:I"] 'ir T E::-=:P I RES [)E£:Ef-IE:ER ];i.- -'l -=~. 82 I CERTIFY THRT i: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS BND WELLS RS SET FORTH BY THE MUNICIPBLIT9 OF BNCHORRGE. 2: I WILL INSTRLL THE SgSTEM IN BCCORDRNCE WITH THE CODES. Russell Oyster 694-2774 O & E ENG~!EERING & DEVELC¢'-~AENT CO. Performed for: Name: Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Legal Description: Earl Ellis 688-2280 Tel. No. ('~ ~ (~ -jL/~ 4- Mailing Address:· '~ ~' Depth if eat) Soil Characteristics 1 2__ 3 4__ 5 6 7 8 9 10 11 12 13 14 15__ 16__ Gr~Jnd Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No [// If yes, what depth Drain Field PLOT PLAN PERC. TEST )/ - Date: ,, / Performed by: .~ ~f~/~././~ -s_ PEF.'.H ]: T NO. DEF'F'~F.'.THENT ! HERLTH FIND ENVIRONMENTFIL OTECTION 825 "'L.' STREET., RNCHORRGE., 264-4728 11.4 EL L_ ,:.' 82.1t2.a0 :.', PtF P L I _HNT LOCRT I ON L~EGRL ,, HI.,I-,~, .1.1: L"I L24- L. AKE HILL FIE:RES; 3:800 PRTRICIR LOT 9L:c::~_Q..~'._~ SC-.¢..IRRE FEET MIN!I'qUH DISTFINC:E BETklEEN R HELL RND RN"r' ON-SITE SEWREiE DISPOSFIL S?S'TEM IS i00 FEET FOR B PRIVRTE WELL OR 150 TO 200 FEET FROM B F'UBLIC WEL.L [."EPEN[:'ING UPON THE TYPE OF F'USLIC WELL MINIMIJM DISTBNCE FROM R PRI',,.'BTE WELL TO R F'RI"/I~TE SEWER LINE IS ;.25 FEE]' FIN[) TO R COMMUNITY SEWER LINE IS 75 FEET. WELL. LOGS RRE REQUIRE[:, RN[:, MUST BE RETURNED TO THE [:,EPFIRTMENT WITHIN _.Y:O OF THE WELL C:Oi"IPLETION. OTHER REQUIREHENTS MR'¢ RPPL"r'. SPECIFIC'ATIOI',IS RN[:' CONSTRUCTION [.'.',IRGRRMS ARE R',/RILRBI_E TO INSURE PROPER iNSTRLLRTION. I CERTIF"r' THRT :L: I FII"I Ft~j"I;[L. ZRF::~,.IITH THE REQUtF.:EMENTS FOF:: ON-SITE SEWERS FINE:' WELLS FI::'; SET FOK:TH E:'T' 'lq~.: P1UNI1XtlF'FILIT'¢ OF RNC:HOF::RGE. 2: I WILl.. IF='TFILL. ,HE S'¢STEM IN FtCCOR[:,RNCE WITH THE CCIDES. RF'F'L I CRNT ',/RN-E:LI I LT E, UI L[ I SSLIED ~, ¥/:. ..... ".4.--: ........................ .,'¢'"'~-~'~": ........... r=. ...... .=:=~-'-- %,'4.. 0 Municipality of Anchorage Development Services DePartment Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ~ ~ _/".~' .~, ,"' www.ci.anchorage.ak.us ~','.L~ ~~,~/.;, (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. c~.~ IOSZ/~ · ;.[.. :.'-'.- -!. '.... '1., GENERAL INFORMATION ~.i' C0i~pi~'t6 legal description '~'· ".Location (site addi'ess or dire~ions) Expiration Date: :'." ~urrent Property owner(s) ~'a~-~. ~,, ~- ~//~7'~,~4 b. ~Jl-~J/='- Day phone ". .Mailingaddress Iq'77 M. ~-/JZA,~_~-"-r'A -~,.' c_..,q,~,~,y;o~. '97o~5'Zgq~ Lending agency Day phone Mailing address Real Estate Agent Dayphone ~/- Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2.' ';NUMBER OF BEDROOMS: ~'~ TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community· Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site ' [-1 Public Sewer [--I The Municipality of Anchorage Development Services Department (DSD) ISsues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. , ,,: ,; HEALTH AuTHORI~ APPROVAL ~CH'ECKLIST Legal~Description::~L3KE. ttr~c 4cee-~ gl Lot ~ ~,~ ' Parcel ID: O A. WELL DATA W6ll,type PgrV ~ate Completed . l°]3o/¢g casing height (above groupd) ' :: : ~ Date of test Static Water level Well production ft. g.p.m. WATER SAMPLE RESULTS:' Coliform (~ colonies/100 mi. Nitrate4' o. ! mg./I. Arsenic: mg. I. i : Date of sample: /7Z. ' ft.: g.p.m. Other bacteria 0 ./colonies/lOO'ml. '. Collected by: ~/'~T'5 t,,J'~~; B. HOLDING TANK DATA Tank Type/Material :i ,,...: Ta'nk~',si~e 1,6i.)lSP g~l. .,! Number of Compartments Foundation cleanout (Y! ~ AJ .: Depression over tank (Y~(~) A.) High water alarm (Y/N) Date of pumping &~/~/Z~4 ; Pumper ~¢' ~ P C, ABSORPTION FIELD DATA ~' ' Date in~talled ~/ZT/~Z .S°il rating (g.p.d./ft~,~ Total depth ~ ft.. Eft. absorption area ~75 ft2 Monitoring tube Dat~. .';°f!adequacy test. , . ~ . t[ Results (Pass/Fail) PA 5 Fluid,depth in absorption field before test ~ in. water added E apsed Time: tqqO min. : Final fluid depth ~ in. Absorption rate >= AnY',rejuvenation 'treat nt (pasl 12 mo.)(WN ~ type) : Dat~ installed ff/Z 7/'¢ 2_ :; C,eanouts~U) . y' : System type 'T/~C.'~J(..t/- : !:;" Gravel below pipe t.../ I,: ft. Depression over field: !~: '~ , ! ,I For -~' bedro~ms New depth'ZT,5~n. ,! I.p.d. If yes, give date · // / / ./ EASEmeNTS OF REC~Df~'OTHF~ THA~ THOSE ~HOWN ON THE RECORDED PLAT', ARE NOT SHOWN HEREON. .0 I hereby ce~y that I have ~o~'a Mo~agee'a ~- s~ction of ~e toHow~g des=i~d prope~y: Lake H~ls Acres Subd. Lot 2h " The information hereon is for the use'of lendi~ institutions showing the relationship of exist~ structures and platted easements and lot lines. It is not to be used for positioning additional structures or fencelines. t Anchorage Recording Precinct, Alaska, and that the improve. mentm situated thereon are within the property lines and .do ~not overlap or encroach on the property lying adjacent there- to, that no Lmprovementa on property lying adjacent thereto en~oach on the pre?mis?, in question and that there are no ro.a.aways, transmisswn ones or other visible easements on s,,,a property except as Indicated hereon. Dated at Anchorage, Alaska · thit 22 day nf June - ,o 88 688-4566 SEWARD & ASSOCIATES LAND SURVEYING MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-052-18 HAA # ~ ~C~c~ 1. GENERAL INFORMATION Complete legal des(~iption Lot 24, Lake Hill Acres #1 S/D Location (site address or directions) 22704 Miller Road Property owner Linda Hiemer Mailing address PO Box 670717, Chugiak, AK 99567 Day phone272-0980 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well ×xx Community well Public water MAR 3 'i 1999 ~L~NI(..I~ALI JY O[' ANCMOP, AGE dNVIRONMENI:AL S~RVICES DIVISION NOTE: If community well system, provide written confirmation from State ADEC attest- ' lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site NOTE: Holding tank Community on-site Public sewer · If community wastewater systemj provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 121 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 co .......... Phone Address 17034 Eagl~ River Loop Road No. Eagle / Engineer's signature ~?,_~,~r ~_~- ~,./~..,,,,~__._ Date DHHS SIGNATURE / Approved for Disapproved. Conditional 'approval for bedrooms. ...... bedrooms, with the following stipulations: Additional Comments By: ~'~--'~-'P'"/-"~~ C' /~~ Date 'f4[lll;flj The Municipalib/of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cedificates based only upon the representations given in paragraph § above by an independent professional ~ngineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH8 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. 72q725 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MAR ~ 1 190 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501. SERVICES DIVISION Health Authority Approval Checklist Legal Description: £o F A. WELL DATA Well type Log present ~)N) Total depth --~ ~ oO Sanitary seal (~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed io / 3~ / ~.:~.-.- o~,~,~,,.~,o A o ' ~ t~/~ ~ ) Cased to ~ 0 ' ~ Casing height (above ground) Wires properly protected ~N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform o Date of sample: 7/~°/~/~ ~ B. SEPTIC/HOLDING TANK DATA Date installed ti-[ ~-:~/~2 Tanksize 0 Foundation cleanout (Y/~). Date of Pumping ~/J~/~ rq Nitrate ©. G / ~ Other bacteria 0 S & S ENGI~N~EERING Collected by: ~703,.i EagL River Loop Road No. 204 Eagle River, Alaska 99577 / ~, t; o Number of Compartments. 2 Cleanouts ((~/N) ,Yg-~ Depression (Y~.~'~ /¢ ,9 High water alarm (Y/~. /v ¢~ Pumper ~ ~ J C. ABSORPTION FIELD DATA Date installed ~ / 3 ~/ Length .~- ~ Width Effective absorption area Soil rating (g.p.d./ft2 or~ / ~'~' System type T~f''~ '/>' Gravel thickness below pipe ~ ~/>-' Total depth ? '/~ ~; ~V~onitoring Tube present (~IN) ¥¢J' Depression over field (Y~) Date of adequaoy test ~/IW/ ~? Results P~/Fail) /~-'+~ For 3 bedrooms Fluid depth in absorption field before test (in.); ~1 ~/~ "Immediately after ~° gal, water added (in,): ~/~ Fluid depth 3~ ~/~' (ins) Minutes later: ~ ~ Absorption rate = ~0 ~ .g.p.d. Peroxide treatment (past 12 months) (YIN) ~ ~ ~ ~ ~ ~ If yes, give date ~ 72-026 (Rev. 3/96)* F o~,v a i" o ~ ~]~ ~ . D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles~ste~ E. SEPARATION DISTANCES Size in gallons ~ ........ "Pump on" level at* ~ level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ,)oo +- On adjacent lots On adjacent lots Public sewer manhole/cleanout f Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation l0 -¢~ Property line I o ¢' Absorption field Water main/service line )o 4- Surfacewater/drainage /0o .-~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: './__ Property line / o Building foundation ol .~' z../_ Water main/service line f Surface water I o o 4-- Driveway, parking/vehicle storage area Curtain drain r, ~ ~ ~.. ,,~ o ~,/~,-~ Wells on adjacent lots ) o o 4- ENGINEER'S CERTIFICATION I ;edify that I have determined thru field inspections and review of Municipal record~[¢th¢¢cCb, C,,C.C. sy~cns are in conformance with MOA HAA euidelines in effect on this date S gnature ' Date 3 / 7 ~ "~O HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~ ' ~ . MUNICIPALITY OF ANCHORAGE M~IPALI~' OF ANCHORAGE ~)~ ~:pivision of Environmental Se~ices ~ - ~ ' - On-Site Se~ices Section ~AY 0 5 1997 P.O, Box 196650 Anchorage, Alaska 99519-6650 R E C E IV E D CERTIFICATE OF HEALTH AUTHORITY .... ' ' . ' ' APPROVAL FORASINGLE FAMILY DWELLING ' ' Parcel I.D.~ ~/--0~ ~ HAA~ ~,--~.,- x- ----_ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address ~--~_ ~.~.~ ~._~ ~:L.~ o,,,"~.-- Lending agency Mailing address f ' Agent {x.j Address ~'J Day phone Day phone~ Day phone /'J ~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: "~ TYPE OF WATER SUPPLY: Individual well Community'well NOTE: RECEIVED MAY 0 5 1997 Municipality of Anchorage Dept,'Health & Human Services Public water - If community well system, provide Written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Community on-site Public sewer ' 'NOTE If communitY waStewater system, provide written Confirmation from:State ADEC attesting to the legalitY and Stat~s Of sYStem~ _~. ,-, . ' ' 72~)25 (Rev. 1/91) Fronl MOA#21 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 Munici pality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Munici pal'and State codes, ordinances, and regulations in effect on the date Alaska Wat6r & Nam e of Firm Wastewater Services 8471 Brgo~idge.,B~. / Add ress ,/'~.nct}//f/~ 99,~4 ~, ,/~ Engineer's signature ~/~~/~K ,this inspection. Phone ~ Date DHHS SIGNATURE ~/ Approved for Disapproved. __- Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional COmments By: Date E - ff '- ¢,7 The Muni¢ipsli'~' of Anchorage Department of Health 8nd Human Service8 (DHHS) i~sues Health Authori~ Approval OerUfi¢ste$ based only upon the representations given in paragraph $ above by an independeat professional engineer registered in the State of AlaSka. The DHH8 does this as a ¢ou ~esy to purchasers of home8 and ~heir lending institutions in order to 8~fisfy ce~ain federal and state requirements, Employees of DHH$ do not ¢onduot inspeoUons or analyze dina before a oerUficme is imsued. The Munioipa!i~y of Anohomge i$ not responsible for errors or omissions in the professional engineer's work. 724~25 (Rev. 1/91) Back MOA #21 Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) ~MUNICIPALITY OF ,ANCHo~ Mun,clpahty of Anchorage · ' ' H MAN SERVI'~ DEPARTMENT OF HEALTH & U Environmental Services Division ~A¥ 05 1997 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 RECEIVED Health Authority Approval Checklist E_.~ /--/IL/~ Parcel I,D.: O~'-/--O~'~ ~/~ ~/~. If A, B, or C, attach ADEC letter. ADEC water system number / Date of test Static water level ~O / Well production WATER SAMPLE RESULTS: Coliform ~ ' 1 Date of sample: ~i/-/i~¢'/¢/'::~-- Cased to I (~ / Casing height (above ground) FROM WELL LOG Wires properly protected (Y/N) l.I Nitrate AT INSPECTION B. SEPTIC/HOLDING TANK DATA Date installed c~,/~,~ Tank size / o~0 Foundation cleanout (Y/N) t'Jl~ Depression (Y/N) Date of Pumping ~r'/' ~r-/~ Pumper .~.~ ~ ~ Number of Compartments ~ Cleanouts (Y/N). ~/~EJ: High water alarm (Y/N) /AJ/~ C. ABSORPTION FIELD DATA Date installed c:~/~,~ Soilrating.JFj,p~rytt~-orff=/bdrm). //~ Systemtype "7 / ::2.o ~-/ // Length -~-- Width Gravel thickness below pipe -,~'"¢r" Total depth Effective absorption area ,z~ ~'~:~t' Monitoring Tube present (Y/N) X/' Depression over field (Y/N) ¢ O Date of adequacy test '¢{'-/1~r-/¢/'7 Results (Pass/Fail) -P/~ % For ~ bedrooms Fluid depth in absorption field before test (in.); ,~.c~ ~'/4-" Immediately after~'10 gal. water added (in.): Fluid depth ~/o~/Z~'u (ins) Minutes later: ~ ~-- Absorption rate = ~ ~-"'0 .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~,~¢- ~,,~CL,..,cJ If yes, give date /"J ~ 72-026 (Rev. 3/96)* High water alarm level at* ~ *Datum C E i V E D E. SEPARATION DISTANCES Municipality of Anchorage Dept. Health & Human 8ervice~ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot c:t (o ~ ~:~ '-~ Public sewer main tkd ~ Sewer/septic service line On adjacent lots ¢~--~u~--~"r4~n adjacent lots Public sewer manhole/¢leanout Lift station s/p..~ t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ { ~''~' Property line l ,.~ t+ · - ~ Absorption field / i /' Water main/service line ~ IQ Surface water/drainage 2" Ioo Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ! Surface water Curtain drain Water main/service line ''~ (O/ / Driveway, parking/vehicle storage area ~ -+ Wells on adjacent lots ~ IOO ENGINEER'S CERTIFICATION I certify that I have_~.deter~n~ed thruf~inspections and review of Municipal re E n gi n e e r ,s N a m'"-~////.~.~O..¢-~----~- Date _~/~%/~ '~-- Waiver Fee $ Date of Payment Receipt N umber~~¢~ Rick Mystrom, Mayor Munic p W of Anchorage Department of Health and Human Services 825 %" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 Jud~ 3, 1997 Jeff Garness, P.E. Alaska Water & Wastewater 8471Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 24 Lake Hills Acres Subdivision #1 Waiver Request #WR970019, PID #051052-18, HA970173 Dear Mr. Garness: Your request for waiver(s) of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distance(s) are the private well on Lot 24 to the drainfi~ld on Lot 24 of 95 feet and the private well on Lot 24 to the drainfield on Lot 33 of 95 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services Program ljm:#6 Coburn MUNICIPALITY OF ANCHORAGE Department of Health and Human Services WR9 970019 PID# Date Received: 05/05/97 On-site Services Section Waiver Review Worksheet HA# 970173 Permit Legal Description: Lot 24 Lake Hills Acres #1 Engineer: Alaska Water & Wastewater/Jeff Garness Applicant: Mark & Sally Coburn Waiver Requested: Waiver of separation distance from private well on Lot 24, Lake Hills Acres #1 to drainfield on same lot and ~rmlnfleld on Lot 33 Lake Hills Acres #1. Criteria: e 1. Geology: Ao Water Table B. Soil Sorption Co Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: Points: 3o Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: %~ ,~r/~/w~-~9 Rec #: 02660 Amount: $ 920.00 Name of Reviewer Date Paid: 05/05/97 OF $¢u~R R~cI( R-roTP-L p~.~rk( o/c ~ FF-~z-O£~P. l'N~ 7.4 4./ /.2 Water & Wastewater 8471 Brookridge Drive ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers May 2, 1997 Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On-Site Services Section P.O Box 196650 3mchorage, Alaska 99519-6650 Attn: Dan Roth Subject: Waiver of separation distance from private well on Lot 24, Lake Hills Acres #1 to drainfield on same lot, and drainfield on Lot 33, Lake Hills Acres #1. Dear Dan: The subject property has a 3 bedroom house, served by a private well and septic system. The drainfield was installed in 9/82 and the well was drilled later on 10/30/82. The distance from the drainfield sump, to the well is approximately 98 feet. Since the trench is 30 inches wide, it is reasonable to assume that the edge of the rock is only about 96.5 feet from the well. To be conservative, I am going to assume the separation distance is 95 feet. In addition to this encroachment, the well is also only 98.5 feet from the septic c/o on Lot 33, Lake Hills Acres. This measurement was performed using DHHS's surveying instrument (Dan Roth was present), The location of the remaining portion of the trench on Lot 33 is unlamwn. Again, I am going to assume a separation distance of 95 feet. Justification for this waiver is summarized as follows: GENERAL: Given the fact that the house on Lot 33 has a daylight basement, it is highly unlikely that the drainfield will ever overflow onto the ground surface, since in order for this to occur, the basement (home on Lot 33) would have to flood (several feet deep) with s~ewage...The subject well is uphill from the septic system on Lot 24, consequently, it is not possible for overflowing sewage to run towards the well. The only feasible path of contamination would be subsurface migration of the wastewater from the drainfields towards the well. Analysis °fthe contamination potential will be evaluated based upon the ADEC point system. ADEC WAIVER, POINT SYSTEM EVALUATION: Geological: According to the well log, the water table is approximately 160 feet below the ground surface. On the day of my inspection (4/19/97) the water was 178 feet below the top of the casing. Bedrock was not encountered, therefore, the bedrock profile is not a consideration. a. Distance from the bottom of the drainfiled to groundwater (160 foot static level in well): The bottom of the trench (Lot 24) is approximately 8 feet below grade. The separation distance from the bottom of the trench to the static water in the well is approximately 150 feet. This corresponds to 7.26 points. b. Soil sorption below the trench: According to the well log, the soils (down to the water table) are primarily a mix of sand & gravel, with occasional boulders, and some hardpan. To be conservative I am going to assume a value that is the average of clean gravel (0 points) and clean sand (1.5 points), which corresponds to .75 points. c. Soil permeabilify below the trench: I am going to treat the entire soils profile as a sandy gravel, which corresponds to a point value of.9 cl. Water table gradient: When performing the well adequacy test (pumping at a rate of 5.01 gpm for 102 minutes) there was no drawdown. In short, the hydraulic gradient is 0%. This corresponds to 2.9 points. e. Horizontal separation from well to septic tank: Given a 96 foot separation distance, the point value is 2.8. Total Points: 14.6 According to the ADEC waiver guidelines, a point value 12-16 indicates no bacterial contamination is possible, and that chemical pollution (from household sources) is unlikely. Recent water sampling/analysis (4/14/97) found no bacteria, and nitrate levels of .723 mg/l. In short, after almost 14.5 years, the water quality has yet to be effected by this encroachment. Copies of the lab results were submitted with the Health Certificate package. Given the facts presented, it is my opinion that there is minimal risk in granting the requested waiver (95 feet from well to septic systems on Lot 24, and Lot 33). If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you for your assistance. Sincerely, ~ /( ' Jeffr/~3/A[JGarness, P.E., M.S. Principal c.c. Mark & Sally Cobum ../97 THU 07:40 FAX 907 562 0824 AWWU ENGINEERING E~SEMA~,NTS OF RECORD', OTHER THAN THOSE SHOWN ON THE RECORDED PLAT', .ARE NOT SHOW.~ HEREON. The information hereon is for the use 'of lendin 'institutions showln, g the relationship of existi str, uctures and platted easements and lot lines. It is not to be used for'positioning additional structures or fencelines. AS BUIET' No ac Lake Hills Acres Sub~t~ A.nchoralle P~cording praeinct.:.A]. ~s.,ka, ancl~ ments situated thereon ara Within ~ne prop~r~y ~no~ overlap or encroach on the property ly|ng adjacent: to, that no improvements on proPerty 12i4g ad)acent ~ncroach on tha premises in question i[:rl.d...t~.'at there roadways, tmansmi~ion llne, s or other *.'l$1Dl~ said property except as indicated h~or... Da~ed at Anchorage, Al~aska ' 88 , 22 , June ' . 68 -k 65 JO 24508 27 .,/ r /' 26 2~A23 i2~,449?~~ 227O6 GRACE 5 t 2~,414 i22434,,'/ ~ 22 ,,=6 6 TLR 22526 ~528 225O8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Legal Description (incJude lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name /~-/'~-~ /?~~ Telepho_ne: Home ~ ~/4/'~//-//,?'-¢ Business ~/~"' .z//,:~ (b) ApplicantAddres~s ~¢-~////.~/'~'~- ~-~~~ ~ (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other/[~ (explain)~ (d) Lending Institution ~------~'~ ~' '-~"~'-- ~-~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Famiiy% Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual We[l~[" Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite/[~/ Public [] Community [] Holding Tank [] Note: If'lcommunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Paoe 1 of 2 5. · ENGI~IEERING 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 my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ..... ~ ~-~zc~E~,~-~ Telephone Address Date DHEP APPROVAL Approved for ~' Approved k Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. · P~n~P(~f 2 MUNICIPALITY OF ANCHORAGE (MuA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: NIcI?ALIi'Y OF ANCHORAG2 DEPT. O? HEAL~'¥1 8~ WELL DATA Well Classification ~ t/&~i~z~ Well Log Present (~N). Total Depth / ~'/ Cased to Static Water Level ~2. O / Casing Height Above Ground Electrical Wiring in Conduit ~'q) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed t' ~'~ ~ Yield /~-~'/~ Depth of Grouting Pump Set At ¢'~(--) Sanitary Seal on Casing (~N) Depression Around Wellhead (Y/(~ /o¢ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results / ; On Adjoining Lots /¢¢ ¢' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~'~ ; Date /dj - ~ - ~'~ ~ Comments B. SEPTIC/HOL-OIN'G TANK DATA Date Installed I~'~ ~ Size IOO~ 2 No. of Compartments ~ Standpipes (~N) Air-tight Caps ~/N) Foundation Cleanout (Y/~ Depression over Tank (Y/(~ Date Last Pumped /¢ - "~- ~ Pumping/Maintenance Contract on File (Y/N) · for To Property Line To Water Main/Service Line Course Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: lo To Water-Supply Well '~/ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /c7(,~, ,~ Width of Field ~.~O" Square Feet of Absorption Area Depression over Field (Y/(~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~)~ To Building Foundation Lot To Water Main/Service Line ~ ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design _ ~--/~ Length of Field ,3 / Depth of Field 7/''~ // Gravel Bed Thickness O Standpipes Present ~/N) Date of Last Adequacy Test / To Property Line ~-- To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /-.2//~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ... ,~ ,.. ¢~¢~.~-~it4~ Receipt No. *5~:%~-~;~ ...... Date of Payment /~ I~ Amount: $ Z~ ~¢e~ Date /O//~./,¢ .¢' MOA No. ~J~c~¢ ~ Page 2 of 2 72-026 (11/84) i': AP,PLIC -"NT.FILLS OUT UPPER HAL "ONLY Property Owner kl~_~b.~~ ~3~,~ X~>~'( ~ ~ "4C,~ Phone Buyer Address Zip Code RealtyCo.&A~nt K ~z ~ .,),9~ Phone Address ~ ~ (,~.q,.. ~ , Zip Code Type of Resi~nce ~  Single Family ~x Multiplo Family ~ Othor Water Supply ~lndividual ~ ~ P~ ~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~'Community ~ ~ For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ ~' ~ Individual ~2~Q~ ~ ~'~&'~' Year Individual Installed: ~ ( Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: DFPT OF ENVIR'3iq?,t,~h; ,~ ...... O, E~TION !' 0'V ~ 9 198;~ RECEIVED ( ) CONDITIONAL APPROVAL* DATE -- ~ , - BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size ALASKA erlUIROIqmerlTAL COrlTROL $eRUICeS, IrlC. ~nqineerJn§ $ ~nuJronmental Studies December 1, 1982 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On November 29,1982 our company collected a water sample from the house located on Lake Hill--R~--,-~e Lot 24. The water contained no coliform bacteria. ~YiL~.5 The well was located over 100 feet from the septic tank. The electrical wires are encased in conduit annd the well seal was adequate. The well casing stands are 1 foot above the ground. Due to the late installation of the well, the wires were not buried. This will be done as soon as the ground is thawed. Ail cleanout pipes had caps. A copy of the report is attached. Sincerely, Daniel L. MacFarlane Soil Scientist ~o OJest ~,5th Auenue · Ancho~'ac~e. Alaska 99503 * [907) 276-1361