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HomeMy WebLinkAboutBLUEBERRY HILL BLK 1 LT 3Onsite File #050-202-21 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201078 PID Number: 050-202-21 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name RAYMOND NUTT ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 21732 SHEPPARD DRIVE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. BLUEBERRY HILL 1 3 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 73'+ -- 25'+ TANK ® Septic [IS.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer � RS Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 15c 5/12/2020Location 5/13/2020 and description dates: 2nd 3'd 4`" BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date Aw *: 4 . TM ....�:�``. l� �•; Curtis Huffman ; Septic System Approved - h^Date �'�'Z� F�, •. CE 128991 ���'pF . 7/10/2020. •' K§N. lti �PROFESSICO Note: this approval does not include well permit requirements. (Rev 05/02/18) PID: 050-202-21 PERMIT: OSP201078 NEW 1000 -GAL HDPE SEPTIC TANK WITH NEW DFCO & DCO. A—C=76.5' B—C=69,5' A—D=82.3' B—D=75,1' Edge Of poled R00d Sb e -pp a SCALE: 1' = 30 SEPTIC SECTION BLUEBERRY HILL BLOCK 1, LOT 3 PREPARED FOR: RAYMOND & SARAH NUTT 21732 SHEPPARD DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmail.com FS DATE: 7/10/2020 SURVEY: THD 2020 DRAWN: FWCS SCALE: 1" = 30' SCALE, NTS 1 -111111 OF AL`s 9 TH ,rr rtis Huffman , I XCE 128991 �r�, 7/10/2020 e F,rsl Water C 0 N S U L T i N G 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 10, 2020 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: OSP201078 WAIVERS - BLUEBERRY HILL BLOCK 1, LOT 3 The above referenced permit had the continuation of the 1986 waivers of well to tank and field at 75' and 94' respectively. During observations at construction and per the attached recently completed as -built survey, we respectfully request waiver modifications to 73' between tank and well and 90' between the existing field and well. Granting this waiver is warranted due to the improved tank (HDPE), slopes that flow downhill and away from the well that would direct any potential effluent influence away from the well, low nitrate results and additional well protection due to the fact the well is within the foundation. Granting of these waivers will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, (NA6 VI N_ Curtis Huffman, P.E. Attachments: COSA Submittal MOA Waiver Fee As -Built Survey N'paull ;!' s 4111s a Tom H Dreyer, P.L.S. 124 E 7th Avenue Anchorage, Alaska 99501 (907) 306-8104 mail@S4AK.com Survey Certification: I hereby certify that a Mortgagee's Inspection was performed on the described property. Notes: It is the owner's responsibility to determine the existence of any easements, covenants, or restriction which are not on the recorded subdivision plat. This asbuilt shall not be used for construction or for establishing property lines, Checked by: THD Job 2020-44 Scale 1" = 30' Plat 66-84 Drawn by: BH Field Book: 137/42 Grid NW0058 Date: 6/30/2020 Legal Description: Lot 3, Block 1, Blueberry Mill Subdivision Septic Detail Not to Scale ....................... 4" PVC rO S S Vnnhnie 4' PV(' OF AL�"o© cl) " T :Benjamin Holmstrom. LS -11 jR7708 G Q4�pAr f7d 6 � a essiona\ 4 of 4 Legend: Rebar with Cap O AL. Monument Rebar Monument Well Septic QS Gravel Overhang Wood Deck Concrete` Fence — 0_ - 5/5/2020 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com April 27, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: BLUEBERRY HILL BLOCK 1, LOT 3 PHYSICAL: 21732 SHEPPARD DRIVE, EAGLE RIVER, AK 99577 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank in the same location as the existing tank to serve the existing 3-bedroom residence. We respectfully request continuation of the existing 77& separation waiver from the well to tank. Continuation and granting this waiver is warranted due to the improved tank (HDPE) and due to slopes any potential effluent influence would flow downhill and away from the well. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201078, Rebecca Carroll, 05/04/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201078, Rebecca Carroll, 05/04/20  MUNICIPALITY OF ANCHORAGE ~'~"/°7'~ "7, ~ 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 "MAI LING ADDR ESS LOCATION ~~0 OF BEDROOMS J~. I Absorpt'~ .ea Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ ~ Manufacturer ~ ~ ~~__~ Material No. of com~tments Liq/~y in ga~ons IF HOME.DE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling ~0~ PERMIT NO. 0 ~ ~ Manufacturer ~ -- ~ Material Liquid capacity in gallons Q Well ~ ~ ~undation Nearest lot line PERMIT NO. ~ ~ ~ 'No. of lines ~ Z Length of each line ~ Total I - ~ ~ ~e ~ ~of lines Trench width Distance between lines - inches ~ ~ ~ Top oft to finish grad~ Material beneath tile Total effective absorption area Length Width Depth ~ PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOl L TEST RATING ~ ~:~ Russell L. Oyster : ~ APPROVED DATE LEGAL 72-013 (Rev. 3178) DRILLING, INC. Well Owner Michael Fannan DRILLING LOG Use of Well Dom. Location (address of: Township, Range, Section, if known; or distance main road Lot 3 Block 1 Blueberry Hill Subdivision, Eagle River Size of casing 6" Depth of Hole 170 feet Cased to 43 feet Static water level 40 ft. (~:~ (below) land surface. Finish of well (check one) open end ( x Screen ( ); Perforated ( ). Describe screen or perforation M/A Well pumping test at 5 gallons per ~ of drawdown from static level. (minute) for t hours with 1007o Date of completion 7/6/78 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 .TO 2 Casing stickup 2 .TO. 41 41 .TO 170 .TO TO TO TO. TO ~O ~O. ~O. .TO __.TO. .TQ TO. ); Sandy silty gravel Bedrockl water seeps in sporadic fractures throughout Cert/ficate No's. 814 & 973 1 -- CUSTOMER PERM I T f-lO. WUl'-,I :1: C: 'ri, ,~,, "r T"r' ,_-iF- FII'-.i,_-:H DEPflRTMENT OF HEflLTH fiND ENVIRONMEI',,ITRL F'~',OTEC'T'ION 825 "L" STREET., ANCHORAGE., RI':::. 995E1:i 264-4728 &4ELL Rl"..,Ir:, S--~l"4--~__--; I Ti Sil..,.Iii.: F'Ei~-~"I"'I ][ T' ( 78854:1. ) HI= F L I L. MNT LOCFIT I ON LEGRL I'~ICHREL FRNNON =,HEPPHRD DR L2: 8± 8LUEBERF..v HILL =,F.. :1.4".¢2..¢. ERGLE RIVER LAT SIZE 694 296:9 SQLIARE FEET TYPE OF=,0 '=- I L ABSORBT I ON c:=,,.r,,---=,TEM I S: TRENCH MH,.-, I MUM NUMBER OF BEDROOMS = 3 SCi I L RI=IT I NG (SQ FT/BR ::, = ~- ~ ~-.TEM I S THE REAU I R.E[:, S I ZE OF THE :,U I L ABSORPT 101",1 '~' ''= ' [:,EF'-rH= 7. 5 LEI'-.IGTH= 54 m]RA%-"EL E:,E:F"TH= ':.'::. 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEL. D. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESFON-~IBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS FRJPERT~ RN[:, THE NUMBER AF RES I[:,ENCES THAT THE WELL WILL SERVE. TI,lO (2':: :) I I'-,,I_-'~,PEC:T I OI"-.IS ARE RE~.~LI I F~:E[:, .=,.r_,TEM WITHOUT FII'.,IAL INSPEf":TIAN AND I...II=FR_,,AL THIS E:AC:I<:F ILL I NG OF ANY '-' ''=' ' - ' ' 0',' BY DEPARTMENT WILL BE SUBJEC:T TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 1.00 FEET FOR A PRIVATE WELL~ OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WEL. L WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE AVAILABLE TO INSURE PROPER INSTALLATION. F"ERr'I I: -r E::-:P :1: RES C-.ELi:EMBER :_~ ::L.. I CERTIFY THAT t: I AM FAMILI8R WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SE'[' FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. --R'PPL I CANT M I CHREL FRNNON OEtE GEC 'LJHNICAL Et DEVEL :~ MENT CO. Box 90, Davis St., Eagle River, Alaska 99E77 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG s.s-22so Soils Et Foundations Land Development Performed for: Legal Depth Nmme: ///~ *'f~/a/.~z_ /~',~4/~J Tel. NO. Description:, ..~, ~ ,. ~~, / , ~-~ ~~ (feet) Sot I Chmrmcte~1sti~ 0 1 2 3 ,, 5 7 f 10 12 15 16 f Ground Water Encountered: Yes__No /'If yes, whmt depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: / MUNICIPALITY OF ANCHORAGE �- Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-202-21 1. GENERAL INFORMATION Expiration Date: / C) - / q_ZD Complete legal description BLUEBERRY HILL BLOCK 1, LOT 3 Location (site address) 21732 SHEPPARD DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) RAYMOND & SARAH NUTT Day phone Mailing address Real estate agent PO BOX 773482, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Paymen 50 20Z 0 Receipt Number. 607033 COSA# 0 5Ca 01310 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/3/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to +G����� these various and dynamic characteristics and are outside the control of the evaluator of the ,(`i Cr well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P•' • • • !� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting &FWCS j * : 9 TH • • ... k (I • //! 6. DSD SIGNATURE Curtis Huffman j System #1 Approved for bedrooms �+t 9 • CE 128991 . ���.� ..7/3/2020•F� System #2 Approved for bedrooms 10�F�PROFESSiok Disapproved Conditional approval for bedrooms, with the following stipulations: WATER ANp m= WAS ' V. �gTER z _ , _r\uOhAM By: ...._ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: BLUEBERRY HILL BLOCK 1 LOT 3 Parcel ID: 050-202-21 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 7/6/1978 Total depth 170 ft Cased to 43 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/30/2020 Static water level at beginning of test 91 ft. Well production at time of test 3.3 gpm Comments B. TANK DATA Age of tank(s) 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK D. ABSORPTION FIELD DATA Structure served by this system Water storage tank volume NA gallons Well disinfected for coliform test? ® Yes ❑ No ® Coliform bacteria is Negative Nitrate 0.639 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWES Collected by & SULLIVAN Date of Sample 6/30/20 & C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Which system tested (date installed) 6/29/1978 Adequacy test date 10/3/2019 ® ALL standpipes present per record drawing Results N Pass For 3 bedrooms Total measured depth from grade 14.3 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade *8_1 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 23 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.2' INTO THE 7'ED Elapsed time 1220 min ® Code -required soil cover over field Final fluid depth 0 in ®System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced 2000 gallons *Assumed If yes, enter date Fix Comments/Deficiencies: per elevations of invert at ST DCO and MT. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 73+ ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 90+ ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance •;� �� with MOA COSA guidelines in effect on this date. .' , lli ... •'. �� • Curtis Huffman �¢ �'c�`• CE 128991 •`®'� ����s,F�. • 2/10/20200. •'���,� �kk, 2 °ROFESSIONW�'. MUNICIPALITY OF ANCHO RAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPRO~,A OF ON-SITE'SEWER AND WATER FACILITY 264-4720 ' Application Date 00.~Obe~[ 15, 1987 1. GENERAL INFORMATION - ~ .... (a) Legal Description (include lot, block, subdivision, section, township, range) Lo,~ 3 Block I Bl~b~y H~ Location (address or directions) Sh~_pard ::'"' '/,-:APplicant Name Alaska Ho~ing Telephone: Home Business 276-5599 -.":~,:~, ~ :::;~."('~)'~-A~P:Pficant is (Check one): Lending Institution D; Owner/builder ~; Buyer ~; Other ~ (explain);-'. ' P r~~ ~n~ ~71Aq( the HAA to the following address: ;' ~':;~ S & S ENGINEERING .OF RESIDENCE : :,MU t!.-,~.ami!Y [] must have State De[ · ;PubliC[] COmmunity [] : HOlding Tank [] ; '. "::;:;i''':':''':'::~:~'': '::;";': :~";' :'. :i: Note If community we!l.system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIN~ JSPECTIONS, TESTS, FILE SEARCH, DA 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 investigati(~n 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 ~ o_ _c E~GINEERING Address 17034 Eagle River Leop Road No. Eagle River, A~a~a Date :i'..;6.'" DHEP APPROVAL?'~ · ?,..' ?:..7,... 'Conditional ' ' The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) I ,~j,,G_,~Vlr,~NIClPALITY OF ANCHORAGE (MO,~I i~C~.~O~\5~ALTH AUTHORITY APPROVAL (HAA) .~ O~C~ CHECKLIST- FEBRUARY 1984 ~C~. ~'~ ~ ~ ~ 264-4720 . / Well Classification ~'~ If A, B, C, D.E.C. Approved (Y/N) ~/~ Well Log Present ~N) Date Completed ~- ~'~ Yield ~*~ Total Depth I~ ' Cased to ~ ' r Depth of Grouting ~ Static Water Level ~O ~ Pump Set At (~. Casing Height Above Ground Electrical Wiring in Conduit (Y/~;) Separation Distances from Well: To Septic/Idelding Tank on Lot To Nearest Edge of Absorption Field on Lot Sanitary Seal on Casing ~)N) Depression Around Wellhead (Y/~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line . Cleanout/Manhole Water Sam pie Collected by Water Sam pie Test Results Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/J~ANK DATA Date Installed Standpipes(~/N) Air-tight Caps (~)N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) _j/. Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/P. lekH¢~ Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course / ~:~ ''~ Comments Size ~ No. of Compartments ~ Foundation Cleanout ~N) -- Date Last Pumped ~ ---- 1~:>-- ~ t'~//~'' ;for ~ Temporary Holding Tank Permit (Y/N) ' /_~. To Building Foundation '~' To Disposal Field "7 / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~=' ~ ~.--~" '~ t:~ Width of Field '22 */~")~ Type of System Design Length of Field ' ~:=~OI Depth of Field I ~ Gravel Bed Thickness "7 Standpipes Present~N) Date of Last Adequacy Test ~("-' Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test L'~,~'I~~ Separation Distance from Absorption Field: To Water-Supply Well ..~ ,¢~,~ i , To Property Line ! ~ -['" To Building Foundation 4:~ ~ To Existing or Abandoned System on Lot ~ /,6,, ; On Adjoining Lots ~ ~'~ / To Water Main/Service Line __~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ~, ~ c~ 1 To Driveway, Parking Area, or Vehicle Storage Area ~ ~ Comments .)4 ~,.).Z::~/'[~ ~ ,..5_,~-J) ~'- 7-' ~' D. LIFT STATION "Pump On" Level at~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ng Cycles during Adequacy Test. Meets MOA ** 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. Signe ............... " Date Comp~¢a4 Ea~_l~ ~i.~r L~p ~ad N~o ~A No,~,~ Receipt No. / --0 0 C.) '~ , ateof, ,,ment Amount:$ /0 /.) o ~ Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) Legal Description (include lot, b,[ocl¢, subdivision, section, township, range) Location (address or directions) . Applicant Nadne U,'~'/~'~---4 ¢--,/',-J' Telephone: Home Applicant Address Business (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer~', Other [] (d) Lending Institution ~ J . . . Pl Telephone Address (explain); (e) Real Estate Company and Agent Address Telephone (f) clV~a~l the HAA to the following address: S 8, S E~glneering TYPE OF RESIDENCE Single-Family,,~ Multi-Family [] Number of Bedrooms ,-~ Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 ENGINEERING FIRM PROVID,. J INSPECTIONS, TESTS, FILE SEARCH, L,_ A 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 ,,~ ...... Telephone . . Address Ea~lle River, Alaska 99577 APR 2 0 i9 6 Date DHEP APPROVAL Approved for Approved bedrooms by ~ "~' ~'~~ Date 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MO.'~J DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 APR 2 Legal Description: WELL DATA Total Depth /'~:;~ I Cased to Static Water Level 4//~) ' Well Classification ~t'~l~t %~r'l"l~.- If A, B, C. D.E.C. Approved (Y/N) Well Log Present~tl' Date Completed ~'~" ~,"' ?~ Yield ~/'~ I Depth of Grouting Pure p Set At Casing Height Above Ground Electrical Wiring in Conduit~"~'~ Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on Casing ~,N3 Depression Around Wellhead ; On Adjoining Lots '7'7' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Man hole '-'- Water Sample Collected by ~ Water Sai:nP[e Test Res.~[t~.'¥~ .'- "' Comments '~ ~"~" L~ ~'4'/~ ; on Aajoining Lots /o~ 1 ~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~ ~ t ~" B. SEPTIC/HOLDING TANK DATA Date Installed ~"~'~J" ~ Size J~ o ~ No. of Compartments ~ Standpipes~)N)' Air-tight Caps~'/,i~ Foundation Cleanout{~l~ Depression over Tank (X~ Date Last Pumped 4.//... ~.-. ZI~ Pumping/Maintenance Contract on File (Y/N) ~['~" ; for '"- Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~7~-~ i Temporary Holding Tank Permit (Y/N) To Building Foundation To Property Line To Water-Mai~Service Line Course To Disposal Field ~7 ~ To Stream, Pond, Lake, or. Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~' ~ 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-Ma~/Service Line ~ ~ ~'"' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Depth of Field Gravel Bed Thickness Standpipes Present~ Date of Last Adequacy Test Type of System Design ,'~~~ Length of Field ~ ' To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present)_ 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 $ &S Engh~erin{I Signed SRB i;6x. CompanyE~l,e Ri~r, Receipt No. ~~q Date of Payment Amount: $ ** 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. Page 2 of 2 72-026 (11/84) Date ~ ~ h ~ MOA No, ,~::~'-~;3..3 ..~ unicipal tYof Anchorage P.O. B~.,,,, 196650 ANCHORAGE. ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES May 7, 1986 Robert Shafer, P.E. S & S Engineering SRB 196X Eagle River, Alaska 99577 Subject: Lot 3 Block 1 Blueberry Hill Subdivision Waiver Request, WR86-056 Dear Mr. Shafer: Your request for waivers of the required horizontal separation between the well and septic system components on the subject lot has been granted. The well to septic tank separation has been waived to 75 feet and the well to leachfield separation has been waived to 94 feet. These waivers are valid for the existing three bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw ROBERT A. SHAFER April 20, 1986 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Susan Oswalt REFERENCE: Lot 3; Block I; Blueberry Hill Subdivision Request you approve the attached Health Authority and grant a waiver for the horizontal separation distances as shown on the attached check sheet. As you will note on the attached well log, soils in the top 41 feet are silty, sandy gravel and in accordance with the soil log are rated at approximately 150 square foot per bedroom. This soil will privide adequate filtration that will permit lesser horizontal separation distances. The water supply is collected mostly from sporadic fractures in the bedrock between 158 feet and 170 feet. At the time the septic tank and absorption trench was installed, the well was not in place. It is my understanding that when the well was drilled in 1978 that it was drilled in the only location permissible due to terrain. The horizontal distance between the well and the on-site septic system is generally flat. A coliform bacteria analysis of the water indicates satisfactory readings and a risk analysis indicated that no bacterialogical pollution would be possible. Since contamination is unlikely from bacteria it is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not necessary in this case. If we ma~ be of further service, please contact us. Sincerel~?'~, ~OBER¥ A.~ ShAFER, P.E. /RAS/ss SRB 196X EAGLE RIVER, ALASKA 99577 APPLK ,NT FILLS OUT UPPER HA ' ONLY Phon6--'h Mailing Address Zip Code Buyer Address Zip Code Lending Institution Phone Address Zip Code Street Lo, cation ~ ~- '~ ~ ~, ~ ~)9~ Typ~Residonce [1 Single Family [] Multiple Family No. eL Bedrooms' [] Other War. Supply ~ Individual ATIACH WELL LOG. A w~l log is required for all wells drilled since ,June t07§. [] Community For wells ddlled prior to that date, give well depth (attach log if available). [] Public Utility Sew_~Disposal ~1 Individual Year Individual Installed: [] Public Uttlity When Connected to Public Utility: [] 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: (~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE / -'~ 7 Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 (3182)