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HomeMy WebLinkAboutSOUTH HILLS BLK 3 LT 8M16 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. (RCv uJl uL! 1 O) Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: QSP201482 PID Number: 017-072-18 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ON Upgrade Name Ron &Patricia Miller ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench H Bed ❑ Mound Site Address 13601 Kelly Ranch Rd ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.8 GPD/SF 0.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0.0 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot South Hills 3 8 Fill added above original grade _3.5 Ft. Gravel length 40 Ft. Township Range Section Gravel width 15 Ft. Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic AbsorptionI ' Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 600 Ft2 n/a n/a Ft. Weil 100'+ 100'+ I 100'+ 25'+ TANK ❑ Septic RE S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 1001+ 100'+ Material Number of compartments Lot Line 5' 10'+ I 5'+ NA HDPE 2 FoundationI 10'+ 10'+ 10'+ LIFT STATION Manufacturer Capacity I Remarks nerlI P�5 , 50l I 1 16tj Se eo1,h A Gal. GoMO(aje�A 1`v� 5cAnnev -11 o�- 2021 Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to3034Installer drainfield A+ Home Services Drainfield 3034 co/MT3034 inspector Pannone Engineering BENCH MARK (Assumed elevation) 793 fl Inspection v 2/17/21 ectio 2/18/21 Location and description 3I 2/18/21 Znd 41h 4/1/21 Top of Deck ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional OF A� Approval: Date jk� Steven R..Pannone Septic System �Q, Approved Pp Lf% Date..}�0,— 2 ZZ- Note: this approval es not include well permit requirements. (RCv uJl uL! 1 O) -S,ciici"m v- D o�� x co c £ ➢oNpzZ0 D c �A-u-110 G) U)j C)-1 iso~ r- 0 c: CD Z z mm o z �� 0 z r -m ci mp D r -+ a 2 n cm (/3"I — — -- — — — — — — _ — —i _ _ v • X —X— X N X X �. — — —C — — — — — — — — — _. — •-i_ . I I _ I I I I I ; C � Q NOTES: PANNIONE ENG SVCWILLC (C.1. 1088) RECORD DRANG:::d P.O. BOX 1807 PALf�ER, AK 99645 PHONE 907) 745-8200 FAX (907) 745-8201 SOUTH HILLS 133 L8 DRAWN ACP RONALD & PATRICIA MILLER 13601 KELLY RANCH ROAD SITE PLAN ANCHORAGE, AK mmM (n oo cc: - K�>CA �-Iz �C Z z - FTI m rD� U) m D •P w N r-�Dr- W ZED> D �O = _ mU, (!� (0 U7 Cn N --• m n W N 'I (), v A (1t 00 O .70 < cnv, U)CKo co CD (n 0) O ('4 O) N 0:) CA co •P cO v Cn N -p i) — — -- — — — — — — _ — —i _ _ v • X —X— X N X X �. — — —C — — — — — — — — — _. — •-i_ . I I _ I I I I I ; C � Q NOTES: PANNIONE ENG SVCWILLC (C.1. 1088) RECORD DRANG:::d P.O. BOX 1807 PALf�ER, AK 99645 PHONE 907) 745-8200 FAX (907) 745-8201 SOUTH HILLS 133 L8 DRAWN ACP RONALD & PATRICIA MILLER 13601 KELLY RANCH ROAD SITE PLAN ANCHORAGE, AK mmM (n oo cc: - K�>CA �-Iz �C Z z - FTI m rD� U) m D F7 U flmR�1 Dx r-�Dr- W ZED> D �O G zcn mU, �imoZmmo�z C7 IM a D _ G7 C m co SHEET m n 0) G) N v � "O 0 � 00 �n Cb Cn 00 (A PN[D .70 < cnv, U)CKo m� �rrj r T 0 Zf - O0 N m gym{ pK xo En rim m O -i i) O C KELLY RANCH L„ D om 1 / / J lo x C � �m D➢ ZQ OE � O ➢ I mz n_ z x �I w o� 807� y I z. `n m 0 m m Z I I !z� Z1 00 I I 0Z G7 ( I I Nm ➢ x — I Im�A x D X X X I / Zwz _ I wo D Z `' — — — — a: 0 J a x Z Z co n I � / REVISIONS DATE 0F REV 1: 12/20/21 4/16/2021 - �• 9 �i SCALE •. 017-072-18 teven on '. CE -8149 ne: = PERMIT NO. s� OSP201482 SHEET ++.,..."` 2 OF 3 0 n n I 0 z -n U) F m N b N = Oo D� z m x � x N :N O DO \ Oi N A W N -• �m REV 1: .12/20/21 \ .o Wm P.I.D. NO 017-072-18 Na s PERMIT NO. OSP201482 ~\ 0 0 om ;�o \� 0 N O N O NOTES: PANNONE ENG SVC LLC (C.l. 1088) RECORD DRAWING P.O. BOX 1807 PALER, AK 99645 PHONE (907) 745-8200 FAX (907) 745-8201 SOUTH HILLS 133 L8 DRAWN AcP RONALD & PATRICIA MILLER 13601 KELLY RANCH ROAD PROFILE ANCHORAGE, AK ""`%,a, ' �F AC4sFy' """' i�•. Steven Ponnone' CE 5149 = 4t,i9�-ESSta�� r` """"`� REVISIONS UAIL REV 1: .12/20/21 SCALE16/2021 NTS P.I.D. NO 017-072-18 PERMIT NO. OSP201482 SHEET 3 OF 3 I�I 20' CANT - 1:1'x2.0' CANT- .3.5'x6.1.' DECK- WOODEN— FENCE 12.7' OUR OWN LANE \ \ rEDGE OF GRAVEL ROAD Q rWOODEN FENCE � { N 89'5705"E 152.54' N 41Oo �_ CHAIN—LINK25.6 1G' UTILITY FENCE V20.2• EASEMENTS 100' PROTECTIVEWELL RADIUS4.0' 8.1'x9.7' SHED N W C5 iv 10'x3O'CK /DECK 10.5'x7.6'1 O GREENHOUSE WOODEN FENCE Lot 8 36,601 S.F. EDGE OF GRAVEL ROAD WOODEN FENCE NOTE: THE GRAVEL DRIVEWAY, ROADS 50.0' AND OTHER FEATURES MAY BE RABBIT CREEK APPROXIMATE DUE TO SNOW L „—'�—' � &ICE COVER. (MUNI GIS) \ N 85'52'10"W 152.96' EDGE OF ASPHALT ROAD O OLD RABBIT CREEK ROAD MORTGAGE SURVEY _X_ SCALE _ 1 =50'_ GRID __SW 2940__ Project No.2L_152LR1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A s s o c i a f e sf in c. (907) 522-6476 Phone o000o O (907) 522-4625 Fax oo�o F / ppp Professional Land Surveyors kenOlangsurvey.com o jonothanOlangsurvey.com I hereby certify that I have surveyed the following described property: LOT 8, BLOCK 3, SOUTH HILLS SUBDIVISION (PLAT No. P-636) 0 >�: 49rH*•'�'* D� Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a G representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any Inaccuracies(7" KENNET G. LANG .. that a subsequent boundary survey may disclose. The information contained hereon shall c, o G not be used to establish any fence, structure, or other improvements. OQ s2F'•. •jl�L�i21 �0� �F•. S 5 02.''S�4 Dated this the _•_ Day of LY l 'i4.-�_ `" 1 _, at Anchorage, Alaska 4p oa •'O o --- ----- �4pROFFSSIONA\- Vo It is the responsibility of the owner to determine the existence of any easements, �40000�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 .—SLIT IC =. _. ,, 1 _ 24.2' / �� PIPES O '—Ii—, — .OO O `MANHOLES (:1 III/ Om' Lot 7 O CHAIN—LINK FENCE) Lot 8 36,601 S.F. EDGE OF GRAVEL ROAD WOODEN FENCE NOTE: THE GRAVEL DRIVEWAY, ROADS 50.0' AND OTHER FEATURES MAY BE RABBIT CREEK APPROXIMATE DUE TO SNOW L „—'�—' � &ICE COVER. (MUNI GIS) \ N 85'52'10"W 152.96' EDGE OF ASPHALT ROAD O OLD RABBIT CREEK ROAD MORTGAGE SURVEY _X_ SCALE _ 1 =50'_ GRID __SW 2940__ Project No.2L_152LR1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A s s o c i a f e sf in c. (907) 522-6476 Phone o000o O (907) 522-4625 Fax oo�o F / ppp Professional Land Surveyors kenOlangsurvey.com o jonothanOlangsurvey.com I hereby certify that I have surveyed the following described property: LOT 8, BLOCK 3, SOUTH HILLS SUBDIVISION (PLAT No. P-636) 0 >�: 49rH*•'�'* D� Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a G representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any Inaccuracies(7" KENNET G. LANG .. that a subsequent boundary survey may disclose. The information contained hereon shall c, o G not be used to establish any fence, structure, or other improvements. OQ s2F'•. •jl�L�i21 �0� �F•. S 5 02.''S�4 Dated this the _•_ Day of LY l 'i4.-�_ `" 1 _, at Anchorage, Alaska 4p oa •'O o --- ----- �4pROFFSSIONA\- Vo It is the responsibility of the owner to determine the existence of any easements, �40000�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE 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.org/onsite On -Site Wastewater Disposal System ,Permit Permit Number: OSP201482 Work Type: SepticTank Upgrade Tax Code Number: 01707218000 Site Legal Address: SOUTH HILLS BLK 3 LT 8 G:2940 Site Mailing Address: 13601 KELLY RANCH RD, Anchorage Owner: MILLER PATRICIA C & RONALD A Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: �1 Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: �ti�,cnl S E Departmc-nr 11/19/2020 11/19/2021 36591 ❑ 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 Received B� Issued By: Go -,�r I 1jdd a d; Slow Date: l //�/, /� �- Date: �O 3 E'W'Lcl� & ( r MUNICIPAUTY OF ANCHORAGE Community Development Department_ r. 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. 017-072-18 Property owner(s) Ronald & Patricia Miller Day phone Mailinq address 13601 Kelly Ranch Road Anchorage, AK 99516 Site address same Legal description (Sub'd., Block & Lot) South Hills 133 L8 Legal description (Township, Range & Section) Lot Size 36,591 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 91 Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank 0 Upgrade ❑X Duplex (D) ❑ Holding Tank ElRenewal El 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 authorized agent) Permit/Rush Fees: 0UIP Waiver Fees: Date of Payment:1 11 i � Oa 0 Date of Payment: Receipt Number: d) 6)- 4G Receipt Number: Permit No.._ 05P? -0N'3?— Waiver No. Permit App_:- :- :....:c 1111liq 1111q 1111111l 1111111 ��i���l�illill����ilillill���� i!• Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panenpak.com Subject: South Hills B3 L8 Septic System Permit Request Design Narrative 3 December 2020 This is a design narrative for a permit to install an upgraded septic system for the subject property. The proposed systems will serve an existing three-bedroom (3) house. Currently the lot is developed. This lot and surrounding lots are served by private wells. Currently there are no wells within 100 feet of the proposed system. A septic tank upgrade permit was obtained by PES on 11/19/2020 (OSP201482) to replace a collapsed septic tank. During preliminary excavation of the failed tank it was discovered the existing drain field was in failure. 1. Soils. A test hole was performed on this lot by Pannone Engineering on 11/23/2020, and groundwater was monitored for at least seven days. Ground water was observed to a depth of 5.5' below the surface in the test hole monitor tube, groundwater was adjusted for seasonal high to 4.5' below the ground surface per 15.65. Bedrock was not encountered in the test hole. Based on the results of the percolation tests, overall soils appearance and the selection of the proposed drain field; an application rate of 0.8 gallons/day/square feet was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography generally slopes from the north to the south in the area surrounding the septic system at approximately 0-5%. There are no steep slopes within 50' of the proposed drain field. S. 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 from MoA On -Site Department, the note will be removed and "For Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at 745-8200. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer r N/lailing: P.O.Cox I U07, Palmer, Air 99645 Telephone: (907) 745-8200 FAX: (907) 745-820.1 co I -i ul C) 0-- 2 W I --i •P C K (lt D (n � -I Z -0 co Imn2:Imn c01, ��p mDp _mom �J s �C)m >m m r�mr �z (A ��'n--opx,-m <O< x m����cnmX �o�o>--I-u I mDcn r�*rnu, C)m�zD+r��cnZ r�v�00 p 02 -1 c Z0-0 D� _CD p m.. Op m m Cn ' _ D o--Z ' rn� I mn o" C4 M ��m i ci �C�D Z (� D o Co U o w mXDo m� �� chin Lo t-0 Z r rn m ---1 T1 m r r7 0 O� o w m o o U) rn Irl Ci 0 D r T x (n f�Tl -� -{ z ° o- m C) E m O v N 0 �Ln J -� v —— —o m o om / I cnoA KELLY RANCH J ;o >0 J Xco � �X I I X I I r7l / I I m DECK < Frl J x — moD �0 I O LnLnzz (n an I I / CD o D D �' — N AZO om r m 0 / Z 00 , x I z X W V 0 0� I G� m0— CJ (7 0 v > 0 Z m o I I D oz ! (IqxN x x co I N I Dv�, �t w m _ c- y X X O I = zmm (- I I I I I / m I �! o o Z 0 I D I z x �1�n �sZ I I o 2 -11 p2_ �� L W I I Fl t II m I 'I — — — — — -- — — — — — — — — — —i 0 X— — x ,N�_ I —�z:�fz- x x x x — — — —( — -- — — — — — — — rg m n / - it J X I � �z o o �I Jrri NOTES: PANNONE ENG SVC LLC (CA. 1088) ""' ", REVISIONS DATE FOR CONSTRUCTION PHONE (907) 7455200 PALMER, (907)9745-8201 'CP(E. �F A(gS'1I REV 1: 72/t0/2020 12/3/2020 _ �..• y SCALE 40' SOUTH HILLS 133 L8 P.I.D. NO DRAWN ACP RONALD & PATRICIA MILLER••- = 017-072-18 p� St.— R. P.—ne 13601 KELLY RANCH ROAD ce-alae= PERMIT N0. 482 SITE PLAN ANCHORAGE, AK; SHEET ... 1 .OF 2 £ j0 £ 133HS 1'' ',+ iib' +13Od�IOHONd .... 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OF BEDROOMS 3 Y DISTANCE TO. Well ®:3 f Absorption areaj� Dwelling PERMITO. 07 :(4. PZ Z LU f Manufacturer GY"� Material 5-,"y .J l No. of compartments ti Liq. capacity in gallons V o,o IF HOMEMADE: Inside length Width Liquid depth O Y Jaz DISTANCE TO; Well Dwelling PERMIT NO. ❑ Z Q 2 F Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well Foundation 3®( Nearest lot lint , C..sf. — PERYY! J LL Z f Z w No. of lines Length of each li / '7 Total length of line) / 't7 Trench width inches Distance between line R1�. ❑ Top of tile to finish grade ( Z fo, f Material beneath tile inches Total effe iv a °rpt' n a lob ' ! W 0 Length Width Depth PERMIT NO. Q I– wa Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS P VC, SOIL TEST RATING 0 ` in 1A4 e INSTALLER/ 1'0!o4 REMAR to J _ �1 to •W r er �° r Uk I$ APPROVED DATE LEGAL Lod, 72-013 (Rev. 3/78) WELL LOG mate Drilled: Static Water Level_ _ feet Draw Down feet Tyne Material Drilleds z or 8 OLR 3 Sou rAe FNLLs s4Q, Gallons Per Minute 15 Total Feet of Casing �i 7 0 feet to l A6SoII r �( to L)e surf Ce bi(i14 o to 'IS- to '97 to to Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 l:_/ 0Q 6, r% ye( to i -�/ cjg lel- MUNICIPALITY OFrANCHORAG.E r7- T C' f... i ENVIR�n�U t.�A. I ,O E' D '1982 RECEIVED DEIAP'TNEP-4T HEA!. -.TF-! A19D EP! WIRONNEI-41"Al..' ;�;:,OTEC*"f'10I`-,! 825 `(." W".;-fr?EET, FIK', 9950J.. 26,el-4720 A COPY BE C-113T.A.PiED FROld THE' FILE!s, Df."ITA PnYr AVAILABLE IPJ "I"HE C.'UMPUTER ) LA 1�qop X c4 NT c /�,Ersr 9(� coc1r) ®(co 5��-U fir. � ��� � �®��',��� ��� . —r// Tec t) Awoa- AOil 13— ?2- min in ALASKA ENVIRONVWNTAL CONTROL SERVICI INC. 1220 West 25th Avenue ANCHORAGE, ALASKA 99503 Phone 276-1361 LLT SHEET NO. OF CALCULATED BY. DATE -- CHECKED DATE-- SCALE—1 El_� V=� - 251 -- IDUCT 2041 ice, GIOWm Mm 01450 ALASKA ENVIRONMENTAL CONTROL SERVIC INC. 1220 WesL' 25th Avenue ANCHORAGE, ALASKA 99503 Phone 276-1361 'As 3f 6/pan .�4hdl // I PRO � 241 1AAK—Mg) tnC,, Croton, Mass 01450 m 2 SHEET NO. OF -- CAL CUI ATED BY DATE CHECKED BY---- DATE -- SCALE Of /I"-- /I 1-0 6"r�'4twd I- e V6, 71 .7 s 7/1 +: 4, -, 71 I itr lof) to r", c f r ti o V" "�4 --c7v ALASKA ENVIR®NfNT"AL CONTROL SERVIC , INC. 1220 West 25th Avenue ANCHORAGE, ALASKA 99503 Phone 276-1361 PROWCf 7041 �tiJ Inc, Gnchn,Mam,01450 JOE SHEET NO_------- --'------'-- CE ----- —' — CALCULATED BY .�(,.t_r �, 1 �---`"1.• DATE—�­107 Z CHECKED BY—__--_.—. —---.-.—.-- DATE---------- SC ATE --- ---- SC iALL 0W -f-RNC-1� 3 g room floose R�fro 0,76 for S/wJ exIg" rmv,!2� -ate V i ' y f r 00 ff /f� i -o n r Y /. 7C> 11 t f W, i -L e /Vole. - � old wef 1 in N . cot nil s'�iorA�r% (C') bc. i ��� o w i _ti c-or3 <, re f; �: , �rpCr� Nrt F/11sc�ean _ �bpp of. Geoeodm (.5t:?o note w.g) 7o��luz'-V' 'y�' Clemravel (/. sewer oire (441'5' tu N OF p� 1 _. ler Gj a a° �"j.�„,� o •: �� �A . _. 40 - �• a a+•e • /•/•/ypQi•as•eu n•/{ (� Or�v� eXtruJpd b/ F, �: oReid, J o r A rl 0 aft ?tz7 .+• o. 2251-E �••y`* o r of f 116� ALASKA ENVIRONN!-�NTAL CONTROL SERVICL , INC. 1220 West 25th Avenue ANCHORAGE, ALASKA 99503 Phone 276-1361 [01--� S lo .3 JOB -50ilf-1 --- -- —L�L�__V SHEET NO.t - OF- Lf CALCULATED 11191r1- DATE CHECKED BY DATE . .... . .. .. I . ..... ..... ..... .. . ......leo tes..... retAldijl)e.l foamF511, fro 1) -7 P depf h , o f I/ feetI if -f fa /'c? I be ac J4 a 4 1 1/ 0� n /Yl Vm lov,,) y roilt i d wick z 0f 4 _G?j-h 41 1 p-, r t�; VJC7�ts 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 (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. D1-7 -- 0-72-- 1 F3 1. GENERAL INFORMATION HAA Expiration Date: © 3 Complete legal. description 1.._D i 12). 1�S"k '3. Sy v i H 1-4 t L -1—S Location (site address or directions) 1; 6oi tl t�- L.L--/ ��NC�-I 1ZOA Current Property owner(s) D A N i E�:e c" g is i -i Qo&P_r4 i3ai Day phone a 1-16-3 Mailing address 7 SpY v c w -c3 q Ct So �i Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. 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 ❑ Public Sewer ❑ 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. 4. 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 Health Authority 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. Name of Firm l o 4 keH -S�1DU v V- let K6 P? If- Phone Address 2.0-�, V, I Aer u, 11,-),o:!> Engineer's Printed Name l o Pk n -e L4 5�rV_la.v� a� Date e 0 0COO l ,.. �u ,0oco` 5. DSD SIGNATURE It,°� ` Q'''►```' t Qf)Q� 0`{gyp % Approved for 3 bedrooms. Disapproved.v��J� Conditional approval for bedrooms, with the following stipulations: OF AN, Cl;;'• �Z; • �,� Q1 - :r -Additional Comments ; WATER AND ; m ._ YVAbILWAILK Attachments: HAA Checklist X Septic System Advisory . Well Flow Advisory "'�/Ili U 1?►1)))�' Maintenance Agreements Supplemental Engineer's Report Other By: OIZ[N / Original Certificate Date: 7-a /- 03 (Rev. 01102) Municipality of Anchorage a, Development Services Department =?�° Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:_ 44T6, 3 S0y i B N 1 L -LS _ Parcel ID: 0 07a - /L9 A. WELL DATA Well type R - Date completed 1992- Total 992Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (YIN) Cased to -V--'7ft. FROM WELL LOG 14g 7- 0 0 ft. / g.p.m. Well Log (YIN) y Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION .2- -7k 2 --7 Z 9— p.m- WATER SAMPLE RESULTS: Coliform _colonies/100 ml. Nitrate 0.2741 mg./I. Other bacteria NL colonies/100 ml. Arsenic: mgA. Date of sample: �`!/03 Collected by: r . S �� r I,C l .10 B. SEPTIC/HOLDING 'tTANK DATA -5 Tank Type/Material -etd he e Fit Date installed 1 qi 8 2 Tank size -1d d 0 gal. Number of Compartments Cleanouts (YIN) Foundation cleanout (YIN) 4L Depression over tank (YIN) lel High water alarm (YIN) Date of pumping I -i6 -0 Pumper A R&vw_ Se y;c,-t.S C. ABSORPTION FIELD DATA Date installed 107- Soil rating (g.p.d./ft2 or ft2/bdrm) IOL System type a - I'd-le- Length 'd-leLength _1/1 ft. Width ft. Gravel below pipe 1, 5- ft. Total depth q ft. Eff. absorption area 301 ft2 Monitoring tube `)j Depression over field I"I Date of adequacy test q17,1101 Results (Pass/Fail) P T— For 3 bedrooms Fluid depth in absorption field before test -ei -in. Elapsed Time: )3 min. Final fluid depth -o - in Any rejuvenation treatment (past 12 mo.) (YIN & type) Water added7.$-Ogal. New depth in. Absorption rate >= Y 'V g.p.d. r-10 If yes, give date L_-1 D. LIFT STATION Date installed "Pump on" level at n. Datum E. SEPARATION DISTANCES / Size in gallons 'Pump o ' evel at in. C es tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 98+ Absorption field on lot _ 10-0 + Public sewer main NA, Sewer /septic service line qD Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots i" --� IO-IeD -f Public sewer manhole/cleanout Holding tank 1�/�,-- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation C? Property line 5 y Absorption field i D x Water main tl/^ _ Water service line o`Z Surface water 9� Wells on adjacent lots Joe � in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �� 'h Building foundation\ c+� Water main i Water Service lines 4 Surface water i Driveway, parking/vehicle storage 5-,g-+ 1 Curtain drain v2D Wells on adjacent lots _ l 41-0 f F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. -",),>wo7- �. p��G Uk Engineer's Printed Name 1 o hh v r I-, La V-Z�' J. 4,�, c Date HAA Fee $ �J7�" Waiver Fee $ Date of Payment -7/il-�� 3 Date of Payment Receipt Number '�3' °� `� Receipt Number (Rev. 12/01) 7/2/2003 Tobben Spurkland Subject: Waiver Request for South Hills Block 3 Lot 8 Waiver Request #WR030048 Parcel ID #017-072-18 Dear Spurkland: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to surface water has been approved. The approved separation distance is 90.0 feet. This waiver approval applies to the existing septic tank to surface water separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any finthher concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, odall it Engineer On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department �.e Building Safety Division 14 '' On -Site Water and Wastewater Program ` 4700 Bragaw Street s A e TY P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: 030048 PID#:017-072.18 HAM Permit#: Date Received: 1125/03 Legal Description: South Hills Block 3 Lot 8 Engineer: Tobben Spurkland 203 W. Ie Avenue Suite 203 Applicant: Dan Rosenberg Waiver Requested: 80 Foot Waiver between the Septic Tank & Surface Water Criteria Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: T ■rr��r��rrrrrrrrrrrrr�rrrrr�r a rrrrr�rrr a r�•■■■srrrrrrrrr•rr■ u ■ urrrrrrrrr u Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: SF_t AT -r Ec. IAEn Na 7-r— S ,M. Dater 1 e By. Name of Reviewer rrrrrYrr a r�rrrrrrrrrrrr�rrrr■•■■r u r u rrrrrrrarrrr a rrrrr�r�rrrrarrrrrrrrrrrr Rec#: 37567 Amount: $190,00 Date Paid: 6125/2003 i l Z- W #4 f uc2 IZ6j vFsT For2, t_oT 5 t3(oe k, 3 S'ou tli /4 ((S Sbo (til i1 ? VF_ rz- 12E-p UES 't- A) vr,,g E9, k)I� 03 oD WAir� Rtgt/Ec>7 fort 5407 iL TANk. 7-0 SV"CE w�TE� DF g5'Fet�. Se_rT i c Dft"t6. =_ _bufF57E W RTE, 5 YS7 !1^ ti/RS Ca.sT2Vc Tao 77Aj 3-V hon T/i� SEPTie.. TAN IL IN QUr=STft1 Wfl5 T)GY:vMc'NTPp tiS /03 aav 7`llE XPi -AS SCUM-CAOe+a17 �N� fF 7-y,e Soil rSTFt�'sI/ErzY�ar� int "TRF_ ri%16 sCo7IC_ TA k E¢'flVi-n/T q RFlA7�v�l7 s//oRT 7jiSNLE. THE SEP?it 77+NI< T+ui QuEsiy`(r►1 i5 c1Pgd2Rai6n/T To 7f l �: Su2FRcF wRT f-101-1E VE2 7-ot 'o92igplt%7 /COMTD�> wocll�i torkF_ 4 uIVQW - II19 lon f .,A-pil-N Vii- is r IORe. AAV tom' i✓1'�v+� -rAV k 'ro S U2Fr}GE (/VA IElK %5 9�7 eGt. S� i L SO��BTi �yV WWW � � y ( 2 `5- 4- S,-5- - 1 C ,� / �C4 as ..�� rnh PEa�il�rR�I ,TT` �r 35 t ��� - 0-3 WPrTF_ IZ TRB t � E,'R�4Di En/T' 2.0 0Fi9gApHy 04� �taE4 BE-FWC-F� SEPT-#'c- ,mak OiNO C19,E45K k4r/- , FtOr/ A-IoA� A-- p47-4.4 7-h,'1-7- /S "OrZE looFee� 15e�ort t-REFlc�( E� fih� UZLL14• �OIZ� pK7�9L S�cAA/u1-T iOAI 1�I ?c • zr 20l Z' P 707E A c_ %DIJL�vSiO^f 4SEI07-1 G %ANlk, Tu S vtgF6cE Lvg7"ErZ CG�Eck, OT 9� �j�ZA�rr wa�z vF2 I. T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw St. Anchorage, Alaska 99519 Subject: Waiver Request Lot 8, Block 3 South Hills S/D PID 017-072-18 Gentlemen; June 24, 2003 We are applying for a 10 foot waiver of the separation distance required between the septic tank and surface water. From the surveyed As Built of the property it appears the septic tank may be 95 feet from the high water mark of Rabbit Creek. The creek bank is eroding, and the separation distance becomes less every year. The attached site plan shows the configuration of the creek as of May 6, 2000. This information was obtained from an aerial photograph. Elevation shots of the area between the septic system and the creek show that the general surface drainage path between the septic system and the creek is more than 100 feet. We request that a waiver be granted for the following reasons: 1. At the time of installation the separation distance between the septic tank and the creek was 100 feet ,or more. 2. Due to bank erosion the creek has wandered towards the septic tank and encroached on the 100 feet separation distance. 3. The topography of the area between the septic system and the creek forces any surface discharge from the septic system to flow overland , along a path that is more than 100 feet, before it reaches the creek. Yours T. Sp and P.E. Matt .•'(E** l`YI AN '• 49th - %... ..» ....................:s.... s r ............ ....... ...... ... r TO EN SPURKLAND No, •�1'•................. Wilk OUR OWN LANE R 25 0 25 50 75 100 125 150 SCALE, i' = 50 FT. 50 TPIF LOT 7 Well I 985 I II I s 1 II I q (I 1 .0 I I � I � I II I 11 4 LOT B 1 II 1 S U f 5-vff 1 11 1 S Q 1 rano � sEPrrc rAHx Aea1�rELD I 1 I 5' — 63----1 o` � +�1 INIhI J 91.0 95.0 96.7 I ( I II I 3 w r— B NK MAY 2000 I I I xl / 94.5c D e.1 00 \ I �$19r L II v ^ I M I 1— RABYT CREEK 50 OL B RABBI T CREEK 1ROAD TOB203 W 5TH.SPURLAND AEN P.E. LOT 8, BLOCK 3 SOUTH fifMT—S 1g-- SEPTIC SYSTEM WAIVER 203 W 15TH. AVENUE ' �" ANCH. AK. 99501 DAN ROSMERG DATE: JUNE 18, 1996 (907) 2 9-3916 11 14601 KELLY RANCH ROAD SHEET: 1/1 GRID: 2940 PIN 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # l :Z- —i P° HAA # 1. GENERAL INFORMATION Complete legal description L 1", i F1 I r LL !S C li (j 7 1-4 +_1 1 i_1--` Location (site address or directions) ! 3 1 -c' ; '_= L_ \/ 12-/-- N r_ ,.4 Property owner L ! — _ = t, '? c: ; ` Day phone Mailing address - 1 5 L ( Liz Lending agency t l',(. , 1 ` = ` — Day phone Mailing add Agent v Day phone '3 Address i.t"Er Unless otherwise requested, HAA will be held for pickui v 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well O Community well Q-1 Public water NOTE: If community well system, provide written coni ing to the legality and status of system. >Q Lo 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide writtt attesting to the legality and status of system. L1 72-025 (Rey 1/91) Front MOA 021 I\ 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 furtherverify 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 i 4919 c H Si . -1,_I :f p i-= Phone' - / L- 3`r i L Address )_� �- u l I -i ( 14 Ze .x Engineer's signature C •�� C� G� �� �_ Date 6. DHHS SIGNATURE Approved for _3 bedrooms. Disapproved. Conditional approval for Additional Comments By: 4t1TIC � _1 /'-I L bedrooms, with the following stipulations: Date l - 2 4 - 9l - The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent Professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 1/91) Back MOA #21 Municipality of Anchorage .� DEPARTMENT OF HEALTH & HUMAN SERVSt- �'v DAiL Environmental Services Division 11CC 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 MAY 31 1996 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: LZ (out, 3 yr3 I So ✓ wr 14" l(,, Parcel 1. D.: 017 — O l �L - / e A. WELL DATA Well type P— If A, B, or C, attach ADEC letter. ADEC water system number N// Log present (Y/N) of Date completed J '?'0 , 'tq ;?- Total 2 Total depth 7 / Cased to jV 7 Sanitary seal (Y/N) X FROM WELL LOG Date of test 6-- �,e' ,. 0 2. Static water level c Well production / g.p.m. WATER SAMPLE RESULTS: Casing height (above ground) '30 it Wires properly protected (Y/N) AT INSPECTION .7<�2 Coliform Nitrate Q. ,� % i� Other bacteria Date of sample: ,`7 - 2 2 • 14o Collected by: -5�-s B. SEPTIC/HOLDING TANK DATA p g.p.m. Date installed / %� Q Tank size 10V0 Number of Compartments , a _ Cleanouts (Y/I)--)!� Foundation cleanout (Y/N) Depression (Y/N) Iq High water alarm (YIN) Date of Pumping y �, Pumper 4 0 e 4 a rsti2g ce ys 00 / C. ABSORPTION FIELD DATA Date installed l a )- Soil rating (g.p.d./ft2 or ft2/bdrm) /0-0 System type 5- G"'IelG Length ol °/ / gt �% 1 Width �(1 Gravel thickness below pipe /,� Total depth Effective absorption area:50/ Monitoring Tube present(Y/I)-y- Depression over field (Y/N) Date of adequacy test y/2 2l 9G Results (Pass/Fail) T For .3 bedrooms Fluid depth in absorption field before test (in.); al r.Z Immediately after 7301 gal. water added (in.): oJr� Fluid depth a'r_ !l (ins.) Minutes later: Absorption rate = i % d. �V" g.p. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIFT STATION N10 /\J Date installed Size in gallons Manhole/Access (Y/N) "Pump oil" level at* "Pump off' level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I`J l 00 Septic/holding tank on lot Jp;�E On adjacent lots I/4fa Absorption Geld on lot I ! D ; On adjacent lots Public sewer main �!� Public sewer manhole/cleanout 1-41A Sewer /septic service line 1 VZ5 I Lift station N L' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I Building foundation Q t Property line '70t Absorption field 13 Water main/service line i 9-5 II Surface water/drainage /00 I Wells on adjacent lots > I t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 Building foundation �i -121 / Water main/service line > 5t> t_ w Surface water / Driveway, parking/vehicle storage area i O Curtain drain fJ —Wells on adjacent lots_ > / / Property line a� / F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal reebp. tkdt the csbot)e-s' stekts are in conformance with MOA HAA guidelines in effect on this date. qtr; Signature _ �� s Engineer's Name bb -e, p ✓ i (/�la rt� t` ` Entgi�i ring SealHOd YI Date t / q q 6 HAA Fee $ Date of Payment Receipt Number / Rev. 8/95 OSS: haa.wk.doc D / / Waiver Fee $ Date of Payment Receipt Number WE OF m '•,Ifenneth L Dreyer, 0 9 s LS -8202 �44p........°o aA ' ac o 0fessian0\ co 50' 50' in 0 0 O W W (D 0 OUR OWN DRIVE UI 0 WELL DO 41 21.2 O� Q� N 89°57'05" E 152.54' 10' EASEMENT x ------------------------ PARKING AREA 00 20.0' o 0 4.0 o = x cD o Z V) W D O 5 24.0' 12.8 — LOT 8 25.5 I 0� `t 24.3' 25.9! Ul O —X---x--x—x---x-- x x _X _X i ITI' I ks� I y 11• x � �Tt. '. Z> Iv I I t 4� x CA I a) x I I IX—X--%----x---x—.X_—X—X--x—r-j I X < x 1 \ I 1 1 1 x I I APPROXIMATE _ CENTERLINE RABBIT _-CREEK �--X x X -- I N 85°52'10" 6N 152,96' 0 fr) LO RABBIT CREEK ROAD i • • N • 1.01 7 ORDERED ev: EXCLUSION NOTES: It is the owners' responsibility to determine the existence of any easements, covenants, or restrictions LEGEND: SET FND 5/8"RB W/CAP* 5/8" RB 0 I� I K L A YTO fJ which do not appear on the recorded subdivision plat. NOTE: 3.25" AL.MON. MONUMENT {}j With THE REALESTATE COMPANY Under no circumstances should any data hereon be used for HUB & TACK O �� construction or for establishing property lines. FENCE- —x— X — s+ .a SURVEY CERTIFICATION: LANTECH has conducted a physical survey of this property as shown on this OVERHANG - WOOD DECKS - drawing and that the improvements situated there CONCRETE - property lines and no encroach- ASPHALT- 0 - - men is exist other than noted. RAVEL- GRAVEL- - STANDPIPESO -_ A S —BUILT OF: LEGAL DESCRIPTION: AS-BUILT SEPTIC _ yA R WELL- LAND & CONSTRUC110N SURVEYORS -PLANNERS -ENGINEERS (RECERTIFIED)440 ` 1ALASKABENSON LVD LOT 8, BLOCK 3, ANCHORAGE, 99503 (907) 562-5291 WORK ORDER NUMBER: oo.tt: SCALE: M/ 28, 1996_ 1.,=40 fax 561-6626 SOU T H HILLS S U B D. A90ADPoA'hN 8f: CIIF.CKCD BY GRID NUMDER: aaoK/PAGE: 94-x- ' KLD, t. 29h0 REF 89L69 4 Mmicipality of Anchorage Department of Health and Human. Serviceshc, 825 "U Street Rick AJvstrcm. P.O. Box 196650 Anchorage, Alaska 99519-6650 Ma vor June 25, 1996 Tobben Spurkland, P.E. 203 West 15th Avenue #203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 8 Block 3 South Hills Subdivision Waiver Request #WR960028, PID #017-072018, HA960206 Dear Mr. Spurkland: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank of 95 feet for the referenced property. This waiver approval applies to the existing septic well separation only. Any future upgrade to either require all separation distances be met or another from this department. Sincerely, Daniel Roth Civil Engineer On-site Services DJR/ ljm system to will approval MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WRkj,LC 0L,b,q.S PID# 017-072-18 HA# HA960206 Permit # Date Received: June 19, 1996 Legal Description: Lot 8 Block 3 South Hills Subdivision Engineer: Tobben Spurkland, P.E. 203 West 15th Avenue, Suite 203, Anchorage, Alaska 99501 Applicant: Troy Miller Waiver Requested: Private well to the on Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: rtv septic tank of 95 feet. Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: 5_FjE , 7T19C1-/EQ Date: G-24`6 By: 124 Al Name of Reviewer Rec #: 01963/9858 Amount: $625.00 Date Paid: June 19,1996 4 lvy/vEq 1?FQuEST l�o/P Lor 8 oLk 3 Sour# ///GLS SUOP. WhIvEJ? }yJF4uEs7- NuMQER wn960028 w)givF/f R Equur Fon Sol° r/c r6AI f To WELL of 9S" PEET. 5F-prlc p6rA - THIS wlI.s rEw*Trx sYsrEm wits CovfrRoC72E0 /n/ XW.,` /9'82, $ePr/c rILtiK /,l 4uP$T/0A1 wrlf poct4mr-m,,.r6p .as (o3" 4c,,,gy rAte so! As pocu,uF,vrap on, r, -/F_ Afsu/L r /3 loo r;: r-tgc so,L r s Tugrid Tfdls rl-(EN rH,s Sorc /f v Erg r Good /A/ r/?,E,47-,A/(9 SEVI`!G K EFFLuiE,vT IV it REc,prlvE'L. Y $Haler P1S-7 --vCF-, rke SEPr/c r!#nvk JW CduEsr,o.v /s PURG,?APIkAIT roo OA, 7kF 5-*,&t4ff ,45- 7-kic sL oPt- Z%aM$. - I kL/ E L L P6 rFt 774 pwrLL,,v6 Ir LacorEO A6Zr&-EED Rorr( Tt4e t, F -LL /a/ ctLcFr rro,✓ is Q7 FcA-r are THF so/4 E,lievuA.,r, R6O RF 6R,4vEL w , rm f /L r ro ?o ' w[ rN j o,u E &�-,¢r614 7-141E A CG 4 Y L, /r/7 6^P uE� If C,v C o u,v r67,2 ED Pie v m 3e — 4',f ' F EeE % . r!-r(,f ,L- o9 Torw/41- /.r MOJ T L CSL Y IMAEAuEAWI-E AA112 CaAlr-o r JA,6 77YE CLEAR, 6RwL-�Fz- c,ilri-/ e-Aroe F&47M ¢5 - 9 7 ' F12oM l4NY fuI?#:,+c E e - v ,r)+m rA,AA-rf. u-1:LL N4 P A crrR/A !x!/!7.272- My If ,v/rl?.+rE,p: rr-lE wIr,an-rdrs /if/Y Or rr�rs sgM Z' w! -i L w FRr 39 "ty/f. T14(s A &,9o4w6 1f' o u NITIel9rr� e4No "OJT I /KEK A/D C0A-7.4a4/.,00,7,' *9 F_ RrAe-M1A,6 T/ -e S L,El. L FK o ra rl-tF Sas aeric r!¢ ^-l! /V 4/K A-.rr! vA% A. 1V)4rr--rn r4eLF- ®' FROM BOroM OF 50R9 T/a-IV 2 ?T/ 2.s t %7 S.�F" — )/. 7F t Y71 /-rv/�,zytiT,�� S�vfr�e�r/aN e iz G. AoiNrs � G n /rNp TOTAL Y7 2.3 7,0 2.8 %4. t„ Gt/L F 7-H6 oo/o-rf .Do Ivor up ra /&/ li/ r16ArIN6 FAA A!Z?J OF N / rn I9-rrf S ,o ,m vL E o,,, rirF d9t* rE 4- 7`eI7-X? o htGa + ro Al p 19--foF STNQLE / P19 A fneueraRE QfTwEeSRi 7%e F_ rcrp /r"EM1' /N OKtrsri,, ,}ICJ r74E 1.61-1- /S 'VOT Dow/V GRAN/&ivT I/ROAI rlet-- SEoT/G 7-A)$ vK ti LL /= f Y/ O A.1G l4IQlQI i1V T %/ZE /ff a t /i t� Ge Ger T/4/ f t. /¢ / v Ei�. fjLSO� jrH' L je r QuE f ev. a © 9( gra 5i „ 2a A}K S \ DA . : 1 18" 1! ! 9£ T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 Daniel Roth Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 Subject: Waiver Request Lot 8, Block 3, South Hills S/D Gentlemen; June 19, 1996 RECEIVED JUN 19 1996 Municipality of Anchorage Dept. Health & Human Services Per your request we are applying for a waiver of the separation distance required between a residential well and a septic tank on Lot 8, Block 3, South Hill S/D. We request a five foot waiver. A field measurement shows a distance of 98.5 feet between the well and the standpipe to the septic tank. A as built of the septic system record the separation distance as 103 feet. The well and septic system are separated by the residence, making a direct measurement of the separation distance difficult. The well and septic system was installed in 1982. The well log for this well and the well located on lot 7 have been used in justifying the granting of a waiver. The justifications for granting this waiver are: 1. This is a minimal encroachment. The standpipe to the septic tank is 98.5 feet from the well. The tank is a 1000 gal tank with a diameter of 5 feet. The corner of the tank, which will be closest to the well maybe 96.5 feet from the well. 2. Water samples taken in 1991 show a concentration of 0.39 mg/ml of Nitrates. A similar sample taken in 1996 shows a concentration of 0. 272 mg/1. 3. The well log for this well and for the well on lot 7 show several impervious layers between the surface and the intake of the well(s). 4. The ground surface slopes away from the well. Overland flow of surface contaminants originating at the septic system location will flow away from the well. 5. Conclusion: 1. Water quality sampling of the well shows that contamination of the well is not taking place. 2. Inspection of the well log(s) bears out that surface contamination of the well is prevented by several impervious layers. 3. Surface topography prevents any possible sewage overflow to reach the well casing. The four foot encroachment of the septic tank does not compromise the water quality of this well. Yours T. Spurkl d P.E. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION JUN 7 9 1996 1 RECEIVED w •. 49th •'��� .s..... k� T ;Aq.BBEN SPURKLAND •�� acs% NO. CE -2225 .�_Aw OUR OWN LAN E 25 0 25 50 75 100 125 150 SCALE, 1" = 50 FT 1� „ sa e11 '---7— — — — - - — — — — I I I I Pti�P 1 1 1 LOT 7 i p(�, Wel) 99,3 pR %V 1 II 1 p Lr 1 q I 98,5 PV SSP 1 11 1 i' Q LOT 8 1 J II I II I U 5 -WIDE Z I 1000 GAL SEPTIC TANK DRAINFIELD I a` .SC I 1 1 �j I1 II I II I lX I I I I APP. CREEK CE7VTER L14- 0 L D 14 -OLD RABBIT CREEK ROAD TOBBEN SPURKLAND P.E.LOT SBLOCK 3SOUTH HILL) J— SEPTIC SYSTEM WAIVER , , 203 W 15TH. AVENUE DATE: JUNE 18, 1996 ANCH. AK. 99501 TROY MILLER -- I --- -- 13601 KELLY RANCH ROAD SHEET: 1/1 GRID: 2940 CEA LAND SERVICES ID:907-762-4852 ENCROACHMENT AGREEMENT JUN 05'96 12:59 No.001 P.01 THIS AGREEMENT, made and entered into this Eighth day of May, 1984, by and between CHUGACH ELECTRIC ASSOCIATION, INC., an Alaska non-profit electric cooperative membership corporation of Anchorage, Alaska, hereinafter called "First Party, " and Fritz and Cynthia Kettenburg of Anchorage.. Alaska, hereinafter called "Second Party, " WITNESSETH THAT: WHEREAS, First Party occupies an easement on the North side of Lot Eight (8), Block Three (3), South Hills Subdivision, Anchorage Recording District, Alaska; and WHEREAS, Second. Party utilizes a well which encroaches approx- imately Four Feet (41) on the foregoing easement, NOW? THEREFORE, for and in consideration of their mutual agreements and other good and valuable consideration, the receipt of which is hereby acknowledged, First Party, for itself, its successors and assigns, waives its objections to Second Party's encroachment on the said easement for the purpose mentioned, subject to the following conditions: 1. Second Party will hold First Party harmless from liability for any injury or damage to any person or property which may result from such encroachment. 2. The said encroachment will be without prejudice to First Party's full enjoyment of any and all rights it may have,in and to such easement. 3. Any facilities or property of First Party which are damaged or destroyed as a result of such encroachment will be repaired or replaced at no cost to First party. 4. Second Party will comply with all applicable safety codes and regulations. 5. Any expenses which First Party may incur in the relocation or modification of its facilities to accommodate the said encroachment will be paid by Second Party. Sy its execution of this Agreement, Second Party agrees, for itself, its successors, and assigns, that its encroachment upon the named easement as hereinabove mentioned will be subject to the foregoing conditions. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives and agents as of the day and year first above mentioned. CHUGACH ELECTRIC ASSOCIATION, INC. (First Party) By: Thomas S. Kolasinska General Manager Post -it" Fax Note 7671 Dale 43 pag1 10 ll TO n-� i %Ca.-rc�i•7 _ From T Q. CcaInept he S+ Co. a c Phone 0 _._ Phone 4 Fax# r-.4 ;��n'a'�i.. FezN raiz 5a Fritz Kettenburg C nthia Kettenburg _ �-(Second Party) By- FtZ Kettenb rg *c-t "urgBy: a Ket 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Of _L 7 L _1 v HAA # W)S 1 191) 1. GENERAL INFORMATION I Complete legal description Location (site address or directions) 1 3 Property owner ��Cl �� � � Vibe 2 t �� Day phone3 ? - Y� il: 14 7S -its/ Mailing address Lending agency�� L��A Day phone. Mailing address ! / Agent __K't, Day phone S`i E. Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: *' \'j 3. TYPE OF WATER SUPPLY: Individual well — Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front 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 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 1��Phoneyf�� Address t? r ITukl-- J,/, wzc�'VL 0 �. Engineer's signature �-�--�-L��—C��� Date 6. DHHS SIGNATURE / Approved for Disapproved. A�Aa) bedrooms. Conditional approval for Additional Comments bedrooms, with the following stipulations: By: / G��Date MiTlr The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025�Rev.1/91) Back MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LgAal SouT41 wL c slrL Parcel I.D. OI'1_ o'YA_ /f, A. WELL DATA Well type R C-5 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) >� Date completed 5. 2es. RZ Driller "E> Ty Total depth 4 Cased to Ll 7 Casing height 3 t� Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG 2 8. 8.2- SEPARATION 2 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Wires properly protected (Y/N) AT INSPECTION g.p.m. 8 g.p.m. j3o�fo vsn On adjacent lots Absorption field on lot I I ; On adjacent lots > Public sewer main NSA Public sewer manhole/cleanout Public sewer service line tq/A Petroleum tank ?q1A WATER SAMPLE RESULTS: g, Coliform � Nitrate � =�'�/ Other bacteria Date of sample: S�i�l9i Collected by: B. SEPTIC/HOLDING TANK DATA 7-9=82. Date installed 1118 °L- Tank size I a-vo Compartments 2 Cleanouts (Y/N) O Foundation cleanout (Y/N) y Depression (Y/N) Iy High water alarm (Y/N) /j Ns�k Alarm tested (Y/N) N11A Date of pumping�``f`✓ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot V y -o On adjacent lots y ` Foundation B To property line go Absorption field 19 Water main/service line > 02.5 Surface water/drainage 72-026 (Rev. 3/91) Front MOA 21 - CONTINUED ON BACK PAGE C. LIFT STATION Date installed . Size in gallons Vent (Y/N) . NON2 High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed Q ga — Soil rating IU -u-6 System type Ulitptz 72GsNCN t Length _ y�_ Width ✓ Gravel thickness 8 �� ' Total depth Total absorption area 361 Cleanouts present (Y/N) Y Depression over field (Y/N) Date of adequacy test b I &Istl Results (pass/fail) F aa5 for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) 1-/ //-\- If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wel I on lot 1 1 .5 On adjacent lots > I OLD Property line To building foundation 3 To existing or abandoned system on lott On adjacent lots CA4D Cutbank N/,y Water main/service line 7 a Surface water . �I�� Driveway, parking/vehicle storage area 5 c� Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 1 - Engineer's Naam�e� 1 E Date —._. y•G'� 4iM 11 q Ct HAA Fee $ � c' Waiver Fee: $ Date of Payment ��� "� Date of Payment Receipt Number �� �� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTn,L HEALTH DEPARTMENT OF HEALTH AND 01VIRONMENTAL PROTECT.T.ON APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE; 1. General Information Application Date (a) Legal Des r ption,(include jot, ck, su, 'vision, section, township, range) Location (adess or digections), 1/8 �f,YV 5 :. l�2 /r'w..: ,.p—..—b `a.—/✓�.�(... LJ'a UCti. (b) Applicants Name-/ Gy//ki%-c'c lblepho�ne Applicants Address�� (c) Applicant is (check cry--) Lending Institution Owner/builder Buyer ; Other '(e.xplain); (d) Lending Institution � � % �- P �e « - �4y s �c -Te le2hone Address (e) Tbia.i Estate Co. & Agent Address Telephone 2. Type of Pesidence Single4Family .E Multi -Family Number_ of Bedrooms 3. Water Supp1V Other (describe) Individual Wbll Cormnunity Public Note: If corrrrrarrity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA (Y/N) 4. Sebe Disposal Onsite , Public Community Holding Tank Is the wastewater disposal system adequate for the number of tedrooms (Y/N) [Page 1 of 21 2-15-84 5. Engineering Firm Providing Inspections, lbsts, Data and Informa_tior, I certify tla£ I have checked, verified, or conformed to all MOA HAA Guidelines in effect on/the �- 'nspection. Sigre Date Name to Firm p Telephone Address wr s Signed by Date (ENGINEER SEAL) 6.DHEP Arproval Approved for 3 bedrooms Approved Disapproved Terms of Conditional Approval "o7 By `.,. Date Conditional The Municipality of Anchorage Department of Health and Envirorffrental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation, data shoUm above, based on the data and information furnished by an ergimer registered in the State of Alaska, the water supply and wastewater disposal system is safe and furc-- tional for the number of bedroom and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 2-15-84 MUNICIPALITY OF ANCHORAGE (MQA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL ARTA MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 2 2 10PA RECEIVE. Well Classificatio If A, B, or C, D.E.C._Approved(Y/N) /V24 Well Log Present Y Date Completed •5 ,Ztv � 0- Yield. ds'/ Total Depth ( Cased to `�'y% i Dept of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing Y Electrical Wiring in Conduit ( Depression Around TAblihead Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot Z7�; On Adjoining Lots _i' To Nearest Public Sewer Line, � � To Nearest Public Sewer (`loanrvt /RAanhnlP /C/ ��'"'T To Nearest Sewer Service Line on Lot Water Sample Collected By,53,J/2��69'��iN t: Date Water Sample Test Results 6GCG to Com ants B. SEPTIC/HOLDING TANK DATA Date Install e Size No. of Ccnpartments Standpipes Y Air-tightCaps Foundation Cleanout Y Depression over Tank Date Last Pumped Pumping/Maintenance Contract on File (Y/N)for Holding Tank High -Water Alarm (YM) �Mporary Holding Tank Permit (Y L Separation Distances from Septic/holding Tank: / ®To Water -Supply WI?11 3 ` To Building Foundation To Property Line �-7 To Disposal Field To Water Main/Service Line To Stream, Pond, Lakef cr Major Drainage Course -J-- Comments [Page 1 of 21 f2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata // 'Q Type of System Design���/ Date Installed ��% Length of Field Width of Fields C? l� Depth of Field �L Gravel Bed Thickness —y' - Square Feet of Absorption Area �C' Standpipes Present�Y�/�Q) Depression over Field Ly Date of Last Adequacy Test A'OT- 2 y 4 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply TAbll /4 % ! To Property Line 2o To Building „Foundation '30 To Existing or Abandoned System cn A Lot - Z'P^J/_e ; On Adjoining Lots 7L To Water Main/Service Line /t=' To Cutbank(if present)% To Stream/Pond/Lake/cr Major Drainage Course 11Z? 0 74 To Driveway, Parking Area, or Vehicle Storage Area l l< -J "T Comments ( /✓ IOAC G<' D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) ' Commnts ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha,r ve checked, verified, or conformed to all MOA HAA Guidelines in effect on the date,bf s on. Signed Date. 3✓�� Company �L MOA No. r� E`": P ,. KB1/d5/s snp;19C.X gyy( _99 114 (Page 2 of 21 2-15-84 APPLIC NT FILLS OUT UPPER HAL ONLY Time P,Dperty Owner - Phone 7 Mailing Address .� .`r`} ".-,�, Zip Code ��<� ��e1 Buyer / ,: n (J", Address /` 'rt. 1--. , , �•� _� >� Tj - Zip Code Date Lending Institution/ Phone Address Zip Code'.,<%71 Realty Co. & Agent :',v �`rs2'A�F'fi f;.n:! %/'�,/ � T r .�; � ��>��i �� /�.li�f.:�::✓/.r'/ Phone Address c:' ,<% "i ! �'��� Zip Code Inspector Inspector Inspector Legal Description Inspector Street Location -�` . ••°')-. f . j,E� �' _ „ r-,. -; . N Field Notes:a.�71 C�-iC __ Type of Residence C` P T (:'' I'T' TH I ENVIk f,,A_' O E' ;i J Single Family t_ -S o��cM�� X x Multiple Family No. of Bedrooms � J t9Oa.c��ti ❑ Other Water Supply K Individual ATTACH WELL LOG. A well 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 (,'J APPROVED BEDROOMS2 Sewer Disposal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ( ) CONDITIONAL APPROVAL - ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ��<� ��e1 ,: n (J", Date Date Date "-37- !_a_�rr�� Date 1—i-Y,�� x � ( Inspector Inspector Inspector Inspector L_IDL_V LITY-OF ANCHORAGE Field Notes:a.�71 C�-iC __ _ C` P T (:'' I'T' TH I ENVIk f,,A_' O E' ;i J � " t=sc,C o��cM�� X x BJP t9Oa.c��ti ( nC V *2 C RECEIVED c.t l R e Q Vag Gtaa�"eI� �'I (,'J APPROVED BEDROOMS2 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL - DATE BY: '') Soils Rating Date Sewer Installed Well To Absorption Area T Cz 3 Well Log Received //U U (-7 / — _j ,2 Well to Tank �' © Septic Tank Size 72023 (3182) r ` � a wM� A i AWD, i t I � I ^•new "r_—I I r � it � y gf 0 2 4!l i t I � I 3 I � y gf 1 •� f , 1 1 Ci (- ---- � -' _ __"� xL _I f --------- � oI 1 r i _ j 4!l o. gf 1 •� f , 1 1 Ci (- ---- � -' _ __"� xL _I f --------- f