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HomeMy WebLinkAboutT15N R1W SEC 5 LT 86Onsite File
T15N RIW SEC 5
Lot 86
The 2' piped sand f ilter is to remain for all COSA
approvals.
James “Jay” Crewdson, P.E
Email: CELLC.1@outlook.com
Cell/Text: (907) 280‐9493
PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567
September 10, 2024
Municipality of Anchorage
On‐site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99519‐6650
Attention: Deb Wockenfuss
Reference: T15N R1W S15 Lot 86
Existing Crib (seepage pit)
Crib Documentation and Minimum Required Absorption Area
Crib Documentation
Liner Material: perforated steel
Liner Size:46‐inch (3.83‐feet) diameter x 72‐inch (6.0‐feet) tall
Effective Depth: 6‐feet
Total Depth: 6.8‐feet
Insulation:4‐inch thick above crib
Gravel Width: 3‐feet (outside of steel crib liner)
Outer Diameter: 3.83‐feet + (2 x 3‐feet) = 9.83‐feet
Outer Circumference: 3.14 x 9.83‐feet = 30.88‐feet
Absorption Area: 30.88 x 6 = 185‐sf
Minimum Required Absorption Area
Soils Percolation Rate: 1.5‐mpi
Application Rate: 50‐gpd/sf (BioBarrier AWWTS)
Bedrooms:4
Min. Required Area: (150x4)/50=12‐sf
Please feel free to contact me for more discussion.
Thanks
James “Jay” Crewdson, P.E.
swom"
1 1 A1
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181050 PID Number: 051-081-28
Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade
Name:
Atkins Jeppsen 20217 Trust
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
21625 Scenic Dr., Chugiak, AK 99567
❑ Other
Phone
Numb er of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
86
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
15N 1W 5
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
50+*
50+*
23**
TANK ❑■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
BioBarrier-Infiltrator Tanks
Capacity
540 and 1530 Gal.
Surface Water
50+*
50+*
Material
HDPE
Number of compartments
3
Lot Line
5+
10+
NA
Foundation5.6***
10+
LIFT STATION
Manufacturer
Capacity
Gal.
(
Curtain Drain
None
Known
Remarks *BioBarrier 0.5-N w/remote monitoring
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
** see waiver
***outside of foundation soil bearing prism
Pump make and model
Electrical Inspections performed by
Soils perc test for existing crib: 1.5-mpi
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
ARM Services
Drainfield CO/MT
Inspector Crewdson Engineering LLC
BENCH MARK (Assumed elevation) 100 ft
Inspdection 15' 6-16-18 6-29-18
Location and description
2nd
SO 411,
Bottom of siding at "A" (see record drawing)
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Lj s L S
Conditional Approval: Date
i0).-* •'� +�/
/TH* •,,pr
i* ' 4 •�
/ ames A. Crewdson•: j
C1 1527
Approved�cr1. Date a d 1
i\�PROFES
_/�
.r �
I h'i S 5 542;,1 w b e i i A-i;,xkd
ALLC # 112279
Inspection Report_9-1-12.doc L' c kiiT v-1a.J _11
�U,� rtT�L172(L�l /
fj' I11�L1 11Q�N Yec�lli,cZ1%t' /,t 11c��CV Ccc�din lJtt�fVe�s
SWING TIES (feet),
C1 C2 C3 C4 M1 M2 M3 DC DC -FM
A 29.31 13.89 14.71 23.50 17.00 11.22 8.42 23.41
B 50.96 62.93 77.52 79.86 59.38 66.59 75.81 50.21 34.66
C 3.66
WELL —
f. 25'. WELL'
RADIUS
GARAGE
8,
1 E U
I BR ADU
i I
�,�O'WELL
i RADIUS
DECK
-----------------
> 3 BR SFH
M
z
01.
M DRIVEWAY
W
M
rp+
BOTTOM OF HOUSE SIDING
ASSUME 100' ELEV
Mi C,2EG
INLET ELEV-J Infiltrator IM -540
INV 97.48' SEPTICTANK
PETERS CREEK---
1<11ETERS CREEK
0SETBACK
LOT 86
UNNAMED CREE
C1 C4 CRIB
TH1 0
M1 \---UNNAMED CREEK
ri M2 C 50' SETBACK
C C2 M
B1 5 � 'ED SF
B2 ORIENTED 45*± FROM VERTICAL
(BENCH MARK) A F STAND PIPE
ORIENTED 45*:t FROM VERTICAL
ioBarrier 0.5-N SEPTIC TREATMENT SYSTEM
USING INFILTRATOR IM -540 AND IM -1530 TANKS
50' PATENT ROW RESERVE
-PLAN
SCALE: 1"=307
M2 ELEV
/99.4' M3
FG 99.5'
TOT ELEV
(BOTH TANKS)
98.00,
0
Infiltrator IM -1530 OUTLET ELEV-/
SEPTIC TANK INV 97.31'
NOTES
1. 4" FOAM BOARD INSULATION PLACED ABOVE BOTH TANKS AND ALL.PIPES
NOT TO SCALE
T15N, R1 W, Section 5, Lot 86
Septic System Inspection Report
Record Drawing
Plan and Profil&
Civil & Environmental Engineering Prepared for: Mike Atkins Date: 10-22-18
PO Box 671389 Chugiak AK 99567 . celic.1@outlook.COM Permit: OSP181050 Page: 2 of 2
Cellfrexi: 907-280-9493 - Fax: 907-688-2295
ALL INFORMATION SHOWN 014 THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEERING, LLC AND SHALL NOT BE USED FOR
ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING. LLC
LEGEND
(E) existing
B# - blower
BR -BEDROOM
C# - cleanout
DC - double cleanout
ED - effective depth
EG - existing ground
ELEV - elevation
FIG - finish grade
FM -force main
IAW - in accordance with
INV - invert
M# - manhole
SF - sand filter
TOT - top of tank
.... .. aoaaaaaaa
. ... ...........
.
ames A. Crewdson
CI1527 �
ALLIC #112279
ALLC #112279
Municipality of Anchorage
Development Services Department yy
Building Safety Division G' is3: ri • • • ;
On -Site Water and Wastewater Program D
S 4700 Elmore Road Q : • . • • • • •
P.O. Box 196650 Anchorage, AK 99507 ®49 ,lames A. Crewdson: �Q
www.ci.anchorage.ak.us Q
(907) 343-7904 �� C11�527 ` •'��®
Soils Log - Percolation Test\��ROFESS\®NP "®
D
Performed For: M 1 j 11 Date Performed:
Legal Description: / / 5 %(J ��CS^ C�� Township, Range, Section:
Slope Site Plan
Depth
(Feet) SEE DESIGN SEE DESIGN
L), 5 '
UV w 'I� , to
3-
4-
5- so0,
6-
7-
8 -
WAS GROUND WATER
9_1 ENCOUNTERED?
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
COMMENTS
S
IF YES, AT WHAT DEPTH? L
0
Depth to Water After p
Monitoring? E
Date:
I I I SEE DESIGN I I I I
Perc hole presoaked
Reading
Date
Gross Time
(2et Ti FedDepth
to Water
Net Drop
i�
PERCOLATION RATE S (minutesrinch) PERC HOLE DIAMETER U
TEST RUN BETWEEN �FT AND j FT (� �y /�
Y A In /. /) -_ l . t r T, c _.7 n �. gin • �.. r-' : �� n �A' — R �.1 a, V4/I
PERFORMED BY: Crewdson Engineering LLC i James Crewdson CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage s ,
P.O. Box 196650 ® 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV181089 COSA#: Permit#:OSP181050
PID#: 051-081-28
Legal Description: T15N R1 W Section 5 Lot 86
Engineer: Crewdson Engineering
Applicant: Atkins Jeppsen 20217 Trust
Your request for a waiver of the required 25 feet horizontal separation from the
sewer service line to the private well has been approved. The approved separation distance is
23.0 feet. See engineer's waiver request for justifications
This waiver approval applies to the existing sewer service line only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
.......................... a 0 0 0 M M 0 a a a 0 M ......... ■ ............ a M t t t ...... a 0 M t .. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: c 0 Approved C. rUtr
pp by:
Name of Reviewer
**** VARIAN C E/WAIVER REVIEW ****
Crewdson Engineering,_ LLC
�c>
Civil & Environmental Engineering
October 22, 2018
Onsite Reviewer
Municipality of Anchorage
On-site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Reference: T15N, R1W, Section 5, Lot 86
Well to Private Sewer Line Separation
23 -Foot Waiver Request
osv . $10$ i
i� Z15 ,?R, j 10A -0c
9,",t pq 'Z 5 5 G
James "Jay" Crewdson, P.E.
Email: CELLC.1@outlook.com
Cell/Text: (907) 280-9493
Fax: (907) 688-2295
The existing private sewer line was found to be less than the required 25 -feet from the well where it exits
the building.
Mitigating factors:
1. This is an existing condition that has no known problems related to the reduced well separation
distance.
2. Topography between the well and private sewer line is such that any overflow from the private
sewer line would not flow towards the well.
3. The private sewer line was replaced/revised during the recent septic system upgrade to improve
its freeze protection and is in excellent condition.
4. The private sewer line exits the building under a slab -on -grade, near interior walls that would
make it very difficult to move.
Given the mitigating factors shown above, we believe there is minimal risk involved with the existing
23 -foot separation distance and request a waiver be granted allowing it to remain in its present
location.
Please feel free to contact m if you have any questions.
J mes "Jay" Crewdson, P.E.
OF
W000
James A. Crewdson
�� �• 011527 ••i
OW
�1 ZROFESSIONP-►�
ALLC, l I
PO Box 671389 • 18368 Amonson Road * Chugiak, Alaska 99567
LOT 78 1 LOT 77 ■ 1 LOT 76
O
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LOT 85
zo
0
0
0
0
LOT 94
0
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0
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54.1
24.3'–
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ih C9
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_24.3' ),
WEST 330.07'
LOT 86
2 SEPTIC
STANDPIPES
(4 TOTAL)
N FX�Sr•�NG .3�
32 8 &0
SF05,
ELECTRIC PEDESTAL
SEPTIC LID
SEPTIC BOX
SEPTIC LID
OSF6 1 S
°ss
ss° °ss
SS
co
N
154.3'
coo m 50' RIGHT OF WAY RESERVATION o
n `I PER MISC. BOOK 219 PAGE 11 LO
I I
WEST 330.13'
LOT 93
LOT 87
LOT 92
OF
49TH***
NOTE:
Q THIS DRAWING SHALL NOT BE MODIFIED FOR USE
AS A PLOT PLAN WITHOUT THE EXPRESSED
D '. ' "' """"' """' WRITTEN CONSENT OF LCG LANTECH.
) 9 •. STEVEN CALLAG AN
LEGEND: O L 12'3�4,/�g •' t� Q
.. Asphalt%J SJ��
SEPTIC STANDPIPE SSO d a d
WATER WELL ® Concrete �44rOfessiond\
Overhang ��O;O000�
FENCE —X—X—
Wood Deck PARCEL NO. 051-081-28-00 ADDRESS: 21625 SCENIC DRIVE, CHUGIAK, AK
250 H Street LEGAL
Anchorage, Alaska 99501 DESCRIPTION: LOT 86, SECTION 5, AS -BUILT
Survey Department TOWNSHIP 15 NORTH, SURVEY CERTIFICATION: LCGLANTECH, INC HAS CONDUCTED A PHYSICAL
-"" - Phone: 562-5291 SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES
RANGE 1 WEST, SEWARD MERIDIAN THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE
Mainline PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED.
.Inc Phone: 243-8985 DRAWN DATE: 7/3/2018 WORK ORDER: 18078 EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITYTO DETERMINE
AECC 668 THE EXISTENCE OF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR
DRAWN BY: MH PLAT: RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED
CHECKED BY: SC GRID: NW1457 SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY
ORDERED BY: MIKE ATKINS SCALE: 1" = 40' FB/PG: 809/44-45 LINES, OR FOR PLOT -PLAN PURPOSES.
+.to "�O MUNICIPALITY OF ANCHORAGE ,,»enc
On-Site Water&Wastewater Program .o 5`',,
PO Box 196650 4700 Elmore Road '�
- 11 ct
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
--irel_fai
I)cpartinent
4NcNO_RpV*"
On-Site Wastewater Disposal System Permit
Permit Number: OSP181050 Effective Date: 4/24/2018
Work Type: Septic Upgrade Expiration Date: 4/24/2019
Tax Code Number: 05108128000
Site Legal Address: T15N R1 W SEC 5 LT 86 G:1457
Site Mailing Address: 21625 SCENIC DR, Chugiak
Owner: ATKINS JEPPSEN 20217 TRUST Lot Size in Sq Ft: 108900
Design Engineer: CREWDSON ENGINEERING, LLC Total Bedrooms: 4
This permit is for the construction of:
El Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy ❑ Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Ipiew
tt Special Provisions:
1. This system is being tested for Advanced Wastewater Treatment System approval. If it does not meet
requirements, it may need to be replaced.
2. The crib is to be documented. A percolation test is required.
i
Received By: `! Date: S
Issued By: /� / •- _ Date: �
MUNICIPALITY OF ANCHORAGE
Community Development Department 4 I =
:� Phone: 907- _ •I
Development Services Division Fax: •s ••tf
On-Site Water & Wastewater Program ti ION A
ON-SITE SEWER/WELL PERMIT APPLICATION a APR 11 2018 ;
tea.
Parcel I.D. C61— O / -.,2 c.
j { 5
Property owner(s) /I;k . d 1 k►,� y�is'� . i ppb N Day phone '
Mailing address 02l t,o2C—SC vt ;c_ 4Jl^: L-fv.V x k .�k ' qq
Site address Sa.ln�
Legal description 77 CA/ R/14) 1 gZ1?
Legal description (Township, Range & Section)
Lot Size /()&g,0i) Sq. Ft. Number of Bedrooms - `i
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field Initial ❑ Single Family (SF) J
(� (w/wo ADU)
Septic Tank Y-=�, Upgrade
Duplex (D)
Holding Tank ElRenewal ❑
❑ 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, unicipal Codes.
(Signa 4e of property owner or authorized agent)
Permit/Rush Fees: '‘S-6 Waiver Fees:
Date of Payment: k-13 - • Date of Payment:
Receipt Number: Qt{ 1,0(tuG Receipt Number:
Permit No. DJb Waiver No.
Permit App_9-1-12.doc
Crewdson Engineering,_LLC
QMJames "Jay" Crewdson, P.E.
Email: CELLC.1@outlook.com
Cell/Text: (907) 280-9493
Fax: (907) 688-2295
Civil&Environmental Engineering
April 11, 2018
Onsite Reviewer
Municipality of Anchorage
On-site Water&Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Reference: T15N, R1W,Section 5, Lot 86
Septic System Upgrade
Design Narrative
The owner of the subject property would like to replace the undocumented functioning septic system.
The 4-bedroom home utilizes water saving "low flow" toilets, faucets and appliances and is eligible for a
reduced design flow in accordance with the AMC 15.65,210.D.2 Exception. As such,the design uses 125-
gpd/bedroom times 4-bedrooms (3-bedroom home, 1-bedroom ADU) for a total daily design flow of 500
gallons.
The septic system will use a BioMicrobics, Inc. BioBarrier 0.5-N Membrane BioReactor (MBR) sewage
treatment system. The effluent produced by the MBR will be discharged into the existing crib drainfield,
which will be verified for adequate size while it's exposed to attach the new effluent pipe. Soils "Test Pit
2" (attached)indicates 100-sf/bedroom soils,which for the MBR requires an application rate of 50-gpd/sf.
The required minimum drain size is calculated to be (500-gpd)/(50-gpd/sf)= 10 square feet of absorption
area.
The project also includes replacement of the force main from the garage/ADU to the septic system.
Please feel f ree to contact me if you have any questions.
James "Jay" Crewdson, P.E. „ � •s..1? I
'ames A. Crewdson .
4%� tr OFESS\IY
\\\��
— . L 114.) —
PO Box 671389 • 18368 Amonson Road • Chugiak,Alaska 99567
i \
' 11 \ \ p
i€/;?s,
11 ill I �
M I \ \
XI
PLAN
\ PETERS CREEK
rn I SCALE: 1"=30' sc.---50'SETBACK
m I D WELL 100'WELL RADIUS- I
\
m
ETERS CREEK
I •&R(E)FORCE MAIN k<1300'
00'SETBACK
APPROX.LOCATION E)CRIB,PERFORM SOILS
GARAGE& \ PERCOLATION TEST TO VERIFY \
1 BR ADU SIZE IS IAW BB 0.5-N APPROVAL,
I \ RESULTS SHALL BE SUBMITTED
WITH THE FINAL INSPECTION
DECK REMOV REPORT.
(E)ST tl
44. •
. .
I .
• 0 • P)BioBarrier 0,5-N UNNAMED CREEK
/ ili
W/SAND FILTER 50'SETBACK
I • 3 BR SFH 1
•
/ 10' P)BioBarrier
I DRIVEWAY BLOWER(2 TYP)
(E)ELECTRICAL p}BioBarrierMETERBASE CONTROL
I • • / PANELSNNAMED CREEK
/ 00'SETBACK \
/ 50'PATENT ROW RESERVE \ \
NOTES
1. All components shall be installed IAW MOA,DES and BMI
requirement's. LEGEND MBR-Membrane Bioreactor
2. Construction requires Level 1 and Level 2 DES certified contractors. (E) existing MD-Mixing Device
Level 1 contractors complete all required excavation,backfill,and (P) proposed MOA-Munic.of Anch.
placement/installation of tanks and external piping. ABO-Above Bottom Of MPI-minute per inch
Level 2 contractors install all required septic treatment equipment, ADU-accessory dwelling unit MT-monitor tube
coordinate with the electrical sub-contractor and complete the BMI AMC-Anchorage Municipal Code MWL-Maximum Water Level
required system startup procedure. BB-BioBarrier MBR OWL-Operating Water Level
3. Level 1 and Level 2 contractors shall be MOA certified installers. BGL-below ground level R&R-remove&replace
4. The septic tanks shall be installed IAW the attached BMI-BloMicrobics Inc. SF-square foot
"Infiltrator IM-Series Tank Installation Manual",and BR-bedroom SFH-single family home
"Infiltrator IM-Series Tank Buoyancy Control Guidance" CO-cleanout SNDF-Sand Filter
5. The minimum allowable drain size shall be based on a flow rate of DC-double CO ST-Septic Tank
150 gallons/day/bedroom. DES-Denali Environmental Supply TU-Treatment Unit
EG-existing ground W/-with
FC-foundation CO
FG-finish grade
GRW-groundwater
CPEP-Corrugated Polyetheylene Pipe
IAW-in accordance with
OvienkoningineetalLiC T15N, R1 W, Section 5, Lot 86 t,.XV
.di* F, Septic Upgrade Design %*.. ;� *#i
...,4•141•44
, r` jc_____71,0
s A.Crewdson .
.F s Prepared for: �� • C11527 ••�4• iv'
°"'tII`Et"`onmen'l B"�'ee"'4 Mike Atkins and Krista Jepsen Date: 4-23-18 jk,4,11:d3;/ F,;.
OBox671389ChugiakAK99567 • celic.1@outlook.com Permit: OSP181050 p Page: 1 of 2 i\‘NNs.. `�4"
Cell/Text:907-280-9493 • Fax:907-688-2295
N_L INFORMATION MOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWDSON ENGINEEREA3.LLC MD SHALL NOT SE USED FOR ALLC#112279
ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMSSSON mROUCREWDSON ENGINEERING.LLC
24"0 HDPE RISER&LIDVENT OUTLET
INSULATED(3 TYP) \ 4"0 PVC 4" PVC
\_—, OPEN END
—
1- INLET/BAFFLE EFFLUENT LINE ,_-11
I— DES SNDF
_' Ir 11- 4"0 PVC 72"MAX ABO TU / 6"0 PVC I('I—�
IIII II' h
ai!I i. I24"MIN •
INDEPENDENT Il.l�ll
II- I FLOAT STAND _ Iiiimie
• I�II
j_ I PARTITION 1 4-
ii: BB I SEE DETAIL P1 \ 1,,
! i �.II.
�l 547" SaniTEE 45" 47" BB MD \ MWL 38'• .0
I I OWL 1.
16.•�I-I 1 tsirl I Itt II .. I I
--.11—.11-11-1111—.11-11-11-11—u L a—u—u—cru—..,—.—u—n—u—u—n—a—..—n—a—u--vr��r r.l CONNECT TO
//� (E)CRIB
SETTLING ZONE TREATMENT ZONE SEE NOTE 7
Infiltrator® IM-540 TANK Infiltrator® IM-1530 TANK
NOTES TABLE 1.BioBarrier®SUBSURFACE DRAIN
1. COMPONENTS AND EQUIPMENT SHALL BE IAW THE MOA"STANDARDS AND SOIL PERCOLATION RATE DRAINAGE RATE
SPECIFICATIONS FOR COMPONENT PARTS AND MATERIALS USED IN (MIN/IN) (GPD/SF)
CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS" 1-5 50
2. COMPONENTS AND EQUIPMENT SHALL BE IAW THE MOA BioBarrier®0.5-N 6-15 23
APPROVAL REQUIREMENTS 16-30 14
3. BioMicrobics®EQUIPMENT SHALL BE INSTALLED IAW BioMicrobics® 31--60 6
INSTALLATION REQUIREMENTS 60-120 3
4. Infiltrator®COMPONENTS SHALL BE INSTALLED IAW"Infiltrator IM-Series Septic 120-240 1.7
Tank General Installation Instructions"and "Infiltrator IM-Series Tank Buoyancy NOTE
Control Guidance" 1. SIZE AND CONSTRUCT NEW DRAINFIELDS
5. THE CONTRACTOR SHALL ACQUIRE ALL BioMicrobics®, Infiltrator®AND Denali IAW AMC 15.65.010 WIDE TRENCH AND
Environmental Supply(DES)COMPONENTS DIRECTLY FROM DES UNLESS AMC 15.65.210.D2b WIDE TRENCHES USING
EXPRESS PRIOR WRITTEN APPROVAL HAS BEEN ISSUED TO THE TABLE 1 DRAINAGE RATES
CONTRACTOR
6. IF REQUIRED,THE SAND FILTER LENGTH SHALL PROVIDE 2-FEET EFFLUENT
TRAVEL DISTANCE PRIOR TO DISCHARGING TO GROUNDWATER AND 3-FEET
PRIOR TO DISCHARGING ABOVE AN IMPERMEABLE BARRIER
7. VERIFY(E)CRIB IS IAW TABLE 1 SIZE REQUIREMENTS FOR 1-5 MPI SOILS E
4"O—C
REMOVE 2"0�
HIGHLIGHTED (3 TYP) 34"38
AREA 1--36"
III
■ % 12"
DETAIL P1 SCALE:NTS
PARTITION HOLES &CUTOUTS
NOTE
1. PARTITION 1 IS MODIFIED IAW THIS DETAIL
AND PROVIDED BY DES
T15N, R1 W, Section 5, Lot 86 V\
....6.--- .F Agkkk
BioBarrier 0.5-N *" A • ' 1' .•*lel
DETAILS A
`avigu. - Prepared for: ,r#1<F' a e'C11527 Crewdson A. •���'
°�'I&g"Mtlf'"e1dEngineering Mike Atkins and Krista Jepsen Date: 4-23-18 ��lict,;_��?j:l$07_,:.'
'0 Box 671389 Chugiak AK 99567 • cellc.1©outlook.com Permit: OSP181050 Page: 2 of 2 l\���"`=��a
Cell/Text 907-280-9493 • Fax:907-688-2295
ALL INFORMATION SHOWN ON TWA DOCUMENT tS THE PROPERTY OF CREYNSON ENGINEERING LLC AND SHALL NOT BE USED FOR ALLC#112279
ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION GROGCREWDSON ENGINEERING.LLC
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
AND Krista J ,ps-ef)
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
le5" Day of 14 f ri' 1 of 20 IA ,by and between Kr1 i{Ctp p v,
herein the"OWNER,"and the Municipality of Anchorage,herein the 1'
"MUNICIPALITY." In consideration of the mutual covenants contained herein,the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS),described as
BioBarrier 0.5-N
located at(legal description).
T15N, R1W, Section 5, Lot 86
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On-Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code(hereinafter, "AMC") 15.65.These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts,components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On-Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations,Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS,the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement,the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition,it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement,and any renewals thereof, at the owner's sole expense,to pay
for any and all: (1)repair(s),(2)maintenance,(3)adjustment(s), (4)replacement
costs, and(5)inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws,regulations, rules
and orders for.the AWWTS.
C. Upon request by the Municipality,the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor,the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance,repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test andinspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On-Site Systems Approval.
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction,maintenance and repair of the
Owner's AWWTS.
I. Owner agrees to provide and maintain a telephone connection to the AWWTS as
required by the AWWTS approval.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions,nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof,or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing,executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement,the only authorized representatives of the parties
arc:
a. Owner: current owner
b. Municipality: Director.Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall he brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNET;;,:
4,6671-
By: k l 1 5--/a. J JpS-er1 (signature) Date: LI I S 1 S
15.1a jeto pS- r) (print name)
STATE OF ALASKA )
) ss.
TIIIRD JUDICIAL DISTRICT ) ,�+t
The f regoin_ instrume t was acknowledged before me this lb day of ri I,
20/b , by ir%5►, _ -e1, '
"V'_ �0 ,, _ 1 Notary Public
NO ��' PUB O' i ASKA I MATTHEW JONES
State of Alaska
My rommissiI Aires: c/o3/tZ2J l My commission Expires Feb.3,2021
MUNICIPALITY:
By: ,b ./ (signature) Date: y/v'/is
Deb ( dLke nc:A 5 (print name) Title:
t
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 0 Fax (907) 343-7997
http://www.mun i.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
mens s
r
v
Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP141166 COSA#:
PID#:051-081-28
Legal Description: T16N R1W SEC 5 LT 86
Engineer: Garness Engineering Group
Applicant: Joshua Jeppsen
Permit#: OSPI41145
Your request for a waiver of the required 100 feet horizontal separation from the absorption field
to the surface water has been approved. The approved separation distance is 70.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
varr►maA
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
................................................•.............................1
Waiver is Granted: X Waiver is not Granted:
Date: Approved b .
Name of Reviewer
..............................................................................
I..
GARNESS ENGINEERING GROUP Ltd Ad......I 7ea�sxrcx srs r» ,
.. :: CIVIL & ENVIRONMENTAL ENGINEERS. .... GROUP.) Ltd
May 30, 2014
Municipality of Anchorage F 19
Development Service Department ^ ►��
On -Site Water & Wastewater Program ""�' ° ° • of
4700 Elmore Road
Anchorage, AK 99507
Ref: Waiver Request/Amendment Drainfield to Surface Water for T15N, R1W, Sec 5,
Lot 86;
To whom it may concern:
6 5wLZ?
A septic tank permit was issued (OSP141145). During the flagging of the creek setback
it was discovered that the creek (Peters Creek) had eroded towards the drainfield.
There is already an existing waiver in place (WR#88-066) from the drainfield to the
creek for 95 feet. The property owner indicated that erosion of the creek bank has
resulted in the creek bank moving progressively closer to the septic system over the last
seven (7) years. The separation distance between the creek and the drainfield is now a
little over 70 feet. We are requesting for an amendment to the existing waiver and/or
issuance of a new waiver for a distance of 70 feet. In order to mitigate this, we are
proposing to install a berm(s) so that surfacing effluent would have a travel path of
greater than 100 feet to the creek. The drainfield is in a highly visible and vegetated
area. If effluent were ever to overflow, it would be recognized quickly and corrected.
We are unaware of any adverse impacts this waiver would have on adjacent wells or
septic systems. If you have any questions, please contact us at 337-6179. Thank you
for your assistance.
05Pt(46tS(o
413 :7. 1.4e)
QC.Z114
0175D -C)
3701 East Tudor Road, Suite 101 `Anchorage, Alaska 99507-1259
Phone: (907) 337-6179' Fax: (907) 338-3246 ` Website: www.garressengineering.com
I
EXISTING WELL
R,po
I p`�
�p0 �
NOTE: BERM TO BE AT MINIMUM
24" HIGH AND 6' AT BASE.
THE BERM IS TO BE GRADED
SO THAT THERE IS POSITIVE
DRAINAGE AND SO THAT NO
WATER CAN POND. MUST BE
TOPSOILED AND VEGETATED
AFTER CONSTRUCTION.
MT HAD 4.5" OF LIQUID `1
LEVEL ON 5/30/201`,
INSTALL DOUBLE CLEANOUTS
I OLD SEPTIC TANK TO
�
REMOVED AND REPLACED
WITH A NEW 1000 GALLON
PROPOSED SEPTIC TANK.
GARAGE
EXISTING
3 BEDROOM
HOUSE /
I
SCALE:
1 40
PROPOSED BERM-
INSI�
SO THAT IN THE EVENT
OVERFLOWING EFFLUENT, TH
TRAVEL DISTANCE FROM ANY
PORTION OF THE SEPTIC
SYSTEM IS GREATER THAN
100 FEET TO CREEK.
DDITIONAL BERMS TO BE
STALLED AS REQUIRED TO
C TE A DISTANCE GREATER
THAN 100 FEET,
APP,20X{l:TE LOCATION
,-6F PETERS CREEK
EXISTIN DRA_;IELDS
/ --- -
L%
50 FOOT PATENT ROW RESERVE
'a
30 FOOT PATENT ROW RESERVE
GARNESS ENGINEERING GROUP, Lid
CIVIL & ENVIRONMENTAL ENGINEERS
3701 E. MOOR RO'D, SVIM 101 • A HO . M 99507 • PHONE (907) 337-8179 • FM (907) 338-3245 • WE n vgomweeng[roerngso
� OE
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
KRISTA JEPPSEN 801-259-2118 1 OF 1 to
LEGAL DESCRIPTION:
T15N, RiW, SECTION 5, LOT 86
TYPE OF WORK:
WAIVER AMENDMENT
J.L.M.
4
Ell
ffffy A.—aeness.1
CE— 953
5%o f!!�•' 4aC'�
PROF!lifE'SS�ION®i��'
I'llnlwLs
Ir -E) A I A AC A/r_. 1 /lr -7-T
1,7 L/V L-/t/V/V/L-r V/ LV/ / / I -vh
f /'-j
(EAST 330 07°�
TO WNSHIP 15
NORTH
RANGE i WEST
SECTION 5
GOVERNMENT LOT 66
rXX
WELL
SEPTIC VENT
RECORD DATA
4.49-R l'
Osv
CONCRETE
b
n
s!mrc
THIS 15 A RECERTIFICATION
OF AN A5—BUILT SURVEY
PERFORMED IN JUNE 1989
(MLA JOB89-106).
W
k—
C�
TWO STORY
PRAMe HOU5E
�SHEO ------
50' PATENT RIGHT-OF-WAY RESERVE
330.
/1nI )r-C)A/A Ar-A/r / n
/ V -- -
kytL-rt/vly/L/v/ L_L/I
L
r_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _------
4.49 -RL
_____
r�•p
r •• G RY D. KOVJA%.. yS
® �5 8856(�a
s. r
tt0-- 25 50 75 100
--Piursl�`___ ,
SCALE
fcCUYV%C CK UND AS? c;t(;IvF s rA�f
11940 BUSINESS BLVD,. (11fE 205
EAGLE RIVER, ALASI:.% JIJ577
(907) 694-4199
"IELD WORK DATE: 6-15-05 PARTY CHIEF: DIA
)RAWN DATE! 6-17-05 IIRAWN BY: JC
I hereby certify that I hove, or someone under my supervision
has, inspected the property describer) as:
GOVERNMENT LOT 86, SECTION 5
TOWNSHIP 15 NORTH, FfANGE 1 WEST
SEWARD MERIDIAN, ALASKA
Anchorage Recording District
The improvements situated thereon are within the property lines
and do not encroach or overlap onto adjacent properties, nor do
any improvements from adjacent properties encroach or overlap
onto this property• except as indicated hereon.
Na lot corners have been set. The property dimensions been are tram the record
plat and are not necessarily as we may have measured. .The improvemal locotions are
approximole and have been determined only to the extent that enables as to determine
if there ore any eneroochmenle onto or off of lila lot. Orafling and reproduction
may produce graphic inconsistencies; therefore scaling should not be otteornled to
determine unshown dimensions. This drawing is not adequate far addilionol
construction or far determining the exact Incalion of property lines. Only
easements from the recorded subdivision plot noted above are shown hereon and It is
the responsibility of the owner to determine if uny other cosecants, cnvennnte. ar
restrictions exist.
0McClintock Land Associates, lac. (IAA) 2005
This doeume at is copyrighted and is authorized to be used for onereal property
transaction or praiser only. Any copy is to be considered unautho Nxed unless it
bears an original surveyor's signature (usually in blue ink) or o slump showing
recorder's office data. Copyright restrictions (but not re—use restrictions) ore
waived if this document hes been officially recar,.d. trading institutions may also
nmke additional copies for their own records. Liability to MLA is limited to fees
received far this project.
FIELD BOOK: 106-22 PLOT SCALE: 1"-50'
GRID: NW 1457 OWG NAME: A005-183 JOB NO: 05-183
Ln �
W
5f
li
,
e
e ).
4.49-R l'
Osv
CONCRETE
b
n
s!mrc
THIS 15 A RECERTIFICATION
OF AN A5—BUILT SURVEY
PERFORMED IN JUNE 1989
(MLA JOB89-106).
W
k—
C�
TWO STORY
PRAMe HOU5E
�SHEO ------
50' PATENT RIGHT-OF-WAY RESERVE
330.
/1nI )r-C)A/A Ar-A/r / n
/ V -- -
kytL-rt/vly/L/v/ L_L/I
L
r_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _------
4.49 -RL
_____
r�•p
r •• G RY D. KOVJA%.. yS
® �5 8856(�a
s. r
tt0-- 25 50 75 100
--Piursl�`___ ,
SCALE
fcCUYV%C CK UND AS? c;t(;IvF s rA�f
11940 BUSINESS BLVD,. (11fE 205
EAGLE RIVER, ALASI:.% JIJ577
(907) 694-4199
"IELD WORK DATE: 6-15-05 PARTY CHIEF: DIA
)RAWN DATE! 6-17-05 IIRAWN BY: JC
I hereby certify that I hove, or someone under my supervision
has, inspected the property describer) as:
GOVERNMENT LOT 86, SECTION 5
TOWNSHIP 15 NORTH, FfANGE 1 WEST
SEWARD MERIDIAN, ALASKA
Anchorage Recording District
The improvements situated thereon are within the property lines
and do not encroach or overlap onto adjacent properties, nor do
any improvements from adjacent properties encroach or overlap
onto this property• except as indicated hereon.
Na lot corners have been set. The property dimensions been are tram the record
plat and are not necessarily as we may have measured. .The improvemal locotions are
approximole and have been determined only to the extent that enables as to determine
if there ore any eneroochmenle onto or off of lila lot. Orafling and reproduction
may produce graphic inconsistencies; therefore scaling should not be otteornled to
determine unshown dimensions. This drawing is not adequate far addilionol
construction or far determining the exact Incalion of property lines. Only
easements from the recorded subdivision plot noted above are shown hereon and It is
the responsibility of the owner to determine if uny other cosecants, cnvennnte. ar
restrictions exist.
0McClintock Land Associates, lac. (IAA) 2005
This doeume at is copyrighted and is authorized to be used for onereal property
transaction or praiser only. Any copy is to be considered unautho Nxed unless it
bears an original surveyor's signature (usually in blue ink) or o slump showing
recorder's office data. Copyright restrictions (but not re—use restrictions) ore
waived if this document hes been officially recar,.d. trading institutions may also
nmke additional copies for their own records. Liability to MLA is limited to fees
received far this project.
FIELD BOOK: 106-22 PLOT SCALE: 1"-50'
GRID: NW 1457 OWG NAME: A005-183 JOB NO: 05-183
On -Site Water and/or Wastewater System
Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141145
Tax Code Number: 05108128000
Work Type: SepticTank Upgrade
Permit Effective Dates: May 29, 2014 to May 29, 2015
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: T15N RlW SEC 5
Site Legal Address: T15N R1 W SEC 5 LT 86 GA457
Owner/Address: JEPPSEN JOSHUA 50% &
DAHL KRISTA 50% 21625 SCENIC DR CHUGIAK AK 995670000
Site Mailing Address: 21625 SCENIC DR, Chugiak Lot Size in Sq Ft: 108900
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
MUNICIPALITY OF
Community Development Department
Development Services
On -Site Water & Wastewater Program
Parcel I.D. 051-081-28
ANCHORAGE
Phone: 907-343-7904
Fax: 907- 343-7997
Mayor Dan Sullivan
On -Site SewerMell Permit Application ? ► / < A
For A Single Family Dwelling v `'
Property owner(s) KRISTA JEPPSEN Day phone 801-259-2118
Mailing address 21625 SCENIC DRIVE *CHUGIAK, AK 99567
Site address 21625 SCENIC DRIVE *CHUGIAK, AK 99567
Legal description (Sub'd, Block & Lot) T15N, R1 W, SEC 5, LOT 86
Legal description (Township, Section & Range)
Lot Size
Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DEWELLING:
( Mall that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
Upgrade ®
(w/wo ADU)
Septic Tank
®
Renewal ❑
Duplex (D)
❑
Holding Tank
❑
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.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
PermittRush Fees: i �gqq, Waiver Fees:
Date of Payment: 51a9 f��lqDate of Payment:
Receipt Number: (JaZc2l/(Jl7 Receipt Number:
Permit No. - Q 5PARIL16 Waiver No.
(Rev. 01/11)
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS.
May 27, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic Tank Upgrade for T15N, R1 W, SECS, LOT 86;
To whom it may concern:
The existing three (3) bedroom house on the referenced property is served by a private well and septic system. Per a
pumping company and the owner the septic tank is failed and needs to be upgrades'. We are proposing to decommission
the existing septic tank per UPC and replace it with a new 1000 gallon septic tank.
We are unaware of any adverse impacts this installation may have on adjacent wells or septic systems. If you have
any questions, please contact us at 337-6179. Thank you for your assistance.
Sincerely, A
P.E., M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
C
UW, L10. MV A O PAUL JYLUNUAIIUN
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
CONTACT GEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
I CONDITIONS OUTLINED.
EXISTING
HOUSE
NOTE: THE CONTRACTOR
SHALL HAVE THE NORTH &
WEST LOT LINES, ALL WELL
RADII, & THE 100' SETBACK
FROM PETERS CREEK
FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO
r'ONCTRI ICTION
IEXISTING DRAINFIELDS
APPROXIMATE LOCATION
OF PETERS CREEK -
1111
`EXISTING DB
DBLOW SPUTTER
INSTALL L C/
0'S
/ OLD SEPTIC TANK TO BE
REMOVED AND REPLACED
WITH A NEW 1000 GALLON
- SEPTIC TANK. - -
50 FOOT PATENT ROW RESERVE
30 FOOT PATENT ROW RESERVE
GARNESS ENGINEERING GROUP, Ltd"
"
mmmx waw CIVIL & ENVIRONMENTAL ENGINEERS
W01 E. MU ROOD, SUOE 101 * lWORORgGE. PIC 99507 • R E (907) 331-81M • FM (907) 338-3948 • WEBSRE: wW pmewn Il Omg=m M .....
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: F
KRISTA JEPPSEN 801-259-2118 1 OF 1
LEGAL DESCRIPTION: DRAWN BY: •���
T15, R1W, SECS, LOT 86 PNB �1
TYPE OF WORK: DATE:
♦ SEPTIC TANK UPGRADE DESIGN 5/27/14
1�
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
825 L Street - Anchorage, Alaska 99507
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION
REPORT
NAME
-
P�7HO7�NE
KNEW
❑UPGRADE
MAILING DDR
lI L. _/w Cc, IRI'OoZ'
LEGAL DESCRIPTION
Lvv M, s4a� t'-
r
LOCATION
NO. OF BEDROOMS
W I
Absorption area
Dwelling
PERMIT 91 1197 �JZ
v
O
DISTANCE TO:
C�
Y
F Z
Manufacturer
Materia
No. of comport ents
w
Liq. capacCp gallons
))
IF HOMEMADE:
Inside length
Width
Liquid depth
❑ Y
JDZ
DISTANCE TO:
Well
Dwelling
PERMIT NO.
= z
Manufacturer
Material
Liquid capacity in gallons
❑
Well
Foundation
Nearest lot line
PERMIT NO.
w=
DISTANCE TO:
J w z
HZ w
—
No. of lines
t�
Le gth of each line
(� (,j (.3 ,
Total) n hof lines
1 (
Trench dth
inches
Distance bet!�Y�errlirrs
( 7—�
K
F
Top of rile to grade / !
Material beneath rile
Total erff5t0,—absorption area
❑
_finish
'
inches
Length,
Width
Depth
PERMIT NO.
w
C7
C( F
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
W°
w
-
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
w
Building foundation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
PIPE MATERIALS
/
SOI L TEST RATI
/66
INSTALLER
6
_
RE ARKS
'u'L
` 69/-� fad.
f
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PPRO E DATE LEGAL
-7 Ili 7
72-M3 (Rev. 3/78) -
L/ �x fl-_ I i�! ^
-DEPARTMENT 0' AEOLTH AND
925 /LSTREET H�C
,
264-472KK
~ / Al k=7 L.L,11 K! 9 E" .9—��S: _T ' 9- LE
PERMIT NO. � ( 780189 )
�+^
APPLICANT JERRY L WALKER GEN. DEL EAGLE RIVER 694 3348
LOCATION NORTH BlRCHWOOD LOOP
LEGAL L86 SECT.5 T15N R1W SW LOT SIZE 108900 SQUARE FEET
.TYPE OF SOIL HBSnRRTION SYSTEM IS: DRHINFIFL . 4/0 77e M05T ST -AY OUT
0F(pm�4.�u�*�
,1|��XI|'|UM 14UMBEF� OF BEDROOMS = ] SOIL RATING (SQFTi1�'R)�� 1'm0 p&mf� '
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: REawnawb //VSv4.4'r/4/o_
gvtTH Srl(Zopo"
cQ ������-�= �� ������������-����� 05 �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHlNFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
1 1-1 ETE 1- Fit EF A4 cl 14 01 X K117- 1-1 1: nw 25' pol fRo nza F17 E7 k=_ _T
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET)
�1EE��111:_- �101010,f _1���
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- ?1- 9411 cm �:2: -u KKEH-, FP.!E=G_uLJ:KKEElT> ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL RE SUBJECT TO PROSECUTION. ^
MINIMUM DISTHNCE BETWEEN
H WELL
AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE
WELL; DR
�
150 TO 200 FEET FROM H
PUBLIC WELL DEPENDING UPON
THE TYPE OF PUBLIC WELL
WELL LOGS ARE REQUIRED
AND MUST
BE RETURNED TO THE
DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY
APPLY.
SPECIFICATIONS AND
CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER
INSTALLATION.
T'S050-1171-
I CERTIFY THAT
1: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
5IGNED:_ ___________
||M"L1[ JERRY L WALKER
« (/
ISSUED BY_ __ DHTE_ Ze__-_ VI.2
a ATF
GREATER A14CU0RAGL AREA BOROUGH
DEPARTMENT OF ENV tRONMF11TAL QUAL TTY Case
3330 "C" Street
ANCHORAGE, ALASKA 99503
Performed For ���f- ostfj it Dated Performed
Legal Description: Lot 8(,=63-aEic na Sid#ori awn i, (5a 2_ I Jnr s•M•
This Form Reports Soils Log_ ` Percolation Test
I Soil Test Must Be Logged To 4' Below Proposed Seepage System3y
DFeetiTTc5+PSoil Characteristics UJ�G ���' �:' `U
tick o.s.•� i<. !s•., .. .,-r�3a.. C) -
•c F: K�: t�.h 'S.I;B I�rc 'rvi{P .�;i
r; ;nn•
• FRS: v 'ni- 1'0
• t'S1"
�'•v
Gross Time Net Time
�4' �p
Depth t ( FN e.�
Fr ` • l\\ �Gi:?
Y.�ack or�ac.,� �;. CSI.- -
y ,i NN17
tlf1 L brn Sd /9 PI�w San...: c',bl^1 (1-06)
•ti:—
tvdt iareded WJ!d1.5,(,Y,Iei S so.. ;A.. �'7W16%
.d.
4
Vim• ` weic✓ t -d' -c . _ _ OS' J CD A �/SZrF
--
-
-
Was Ground Water Encountered? Yes s
I �016
If Yes, At What Depth? lP F
ll
Reading Oate
Gross Time Net Time
�4' �p
Depth t ( FN e.�
Fr ` • l\\ �Gi:?
y ,i NN17
MEN
on
M■■■■■�
MIN
Reading Oate
Gross Time Net Time
�4' �p
Depth t ( FN e.�
Fr ` • l\\ �Gi:?
y ,i NN17
Percolation Rate Mi nul:n
Proposed IristallTtion: Seepage Pit Drain Field X
Depth of Inlet-- I' _ Depth to Bottom 67t—Pit or Trenc
.0014MENTS:-.�c�2! .����Ilo4, cP,z�sal �',rld r<<"„ -.r ,,. i�.;� ��,1 ..r:�,l b___h hal, U,;I„- f; E,i,' S•'+. �, .�„ �i
1'vc-( i„ Irl _2 'T,U of Ilc,..l. a1 1' - AH
Ir ,. i”
' Gwi: - /,,i 13
Test Performed BY_,0,•L)r� Ii, 1,N •� ,.•< Date Certi Picd BY:L
December 29, 1978
$780189
Jerry L. Walker
Gameral Delivery
Eagle River, Alaska 99577
Subject: T15N R1W Section 5 Lot 86
A permit issued by this department for well and/or
sewer system has expired.
Permits are issued on a calendar year basis, as stated
on the permit, by authority of Municipal ordinance.
if you have drilled the well, a well log should be
sent to this department to document the installation
date.
if there are any further questions, please contact
this office at 264-4720.
Sincerely,
Les N. Buchholz, R.S.
Senior Environmental Specialist
LNB/ljw
enc: copy of permit
EsEER"00-1— Q IR:1, ���%%1L__ ����'12�
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD-
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET).
��� ����� �� �'��� ����
THE GRAVEL DEPTH IS THEE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
HND THE BOTTOM OF THE EXCAVATION (IN FEET).
F&AE015 cowlEEK-1- X N0 TFIVAK
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
1- 00 K3 c lot :1 ����������� ��� �������E��
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL B; THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I-
100 FEET FOR H PRIVATE WELL, OR
150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 70 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THA -1
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS FET
FDRTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH TUE CODES.
I: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED
ISSUED
������� ����
��
���� ����
DEPARTMENT O'\EHLTH
AND ENVIRONMENTAL
F TECTIOm
825 /L' STREET/
ANCHORAGE,
AK 9950-L
'
264-4720
�sms EA ��
.... ... 1��
����� ����I�
PERMIT
NO. ( 780189 )
8PPLICHNTGEN.
DEL
EAGLE RIVER 694 7548
LOCATION
NORTH BIRcHWODD iO0P
FEET
LEGAL
L86 SECT.5 T15N RtW SW
LOT SIZE 108900 SQUHRE
AV re � /m� " 0-/r /00 ��^r*l
TYPE OF SOIL
HBSORBTION SYSTEM IS:
DRHINFIELD
~
, 0
MAXIMUM NyMGER
OF BEDROOMS = 7
SOIL
RATING (SQ FT/BR)- 100
THE REQUIRED
SIZE OF THE SOIL ABSORPTION
SYSTEM
_A4AR
IS:
EsEER"00-1— Q IR:1, ���%%1L__ ����'12�
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD-
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET).
��� ����� �� �'��� ����
THE GRAVEL DEPTH IS THEE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
HND THE BOTTOM OF THE EXCAVATION (IN FEET).
F&AE015 cowlEEK-1- X N0 TFIVAK
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
1- 00 K3 c lot :1 ����������� ��� �������E��
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL B; THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I-
100 FEET FOR H PRIVATE WELL, OR
150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 70 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THA -1
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS FET
FDRTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH TUE CODES.
I: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED
ISSUED
' GRLr+iER ANCHORA(?C AREA BOROU(,.'�
DEPARTI.1ENT OF ENURONMIF(ITAL QUALITY Case fl
3330 "C" Strect
ANCHORAGE, ALASKA 99503
erforrred For Rs Fr +jle��Dated Performed--a/-2_1h'
egal Description: Lot 2I hr s,M•
his Form Reports Soils Log_ Percolation Test T
- Soil Test Must Be Logged To h' Below Proposed Seepage System3y
Feet Tes'fp�� 2 Soil Characteristics VJ4e ;7jv fo -:L 1
:Fri, bl- SP
tl rSr [- 'UYM Shc9�r w $J++.; f,'h1-4
hrr, to
Usc 10L -�
Was Ground Water
If Yes, At What
Encountered?_-)___
t
Depth? l�
i�
tl
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a
a
loe
to
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a
Reading Date
Gross Time
Net Time
Depth t,,,, t�t%Ai
e`14r1 D
R+ °
1 ata i;
I
11�TP
� I
I 1
a
a
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a
Reading Date
Gross Time
Net Time
Depth t,,,, t�t%Ai
e`14r1 D
R+ °
1 ata i;
I
11�TP
,rcotacion +:ar.e Minute
Proposed Installation: Seepage Pit Drain Field
Depth of Inlet _ Depth to E3o.ttom oY Pit or Trench r'
MMENTS: ,a! .S 11a1low AsPasal { Irl Yr ✓ ..1 {his <{aai .;r:✓, I b,ii h 1 it v + �rr i1'Fr �
A r n�
st Performed BY �),,/ ,r� -
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Municipality of Anchorage
Department of Health and Human Services dh
Tom Fine, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
October 25, 1988
Lou Butera, P.E.
Eagle River Engineering Services
PO Box 773294
Eagle River, Alaska 99577
Subject: Waiver Request for T15N R1W Section 5 Lot 86
Waiver Request #WR88-066
Dear Mr. Butera:
Your request for waiver of the required 100 foot separation of
a septic leachfield to a surface water has been approved. The
approved separation distance is 95 feet.
This waiver approval applies to the existing septic system to
the surface water only. Any future upgrade to the septic
system will require all separation distances be met or another
apporval from this department.
Sincerely, �
&� )_/ % wv
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljw
EAGLE RIVER ENGINEERING SERVICES
Lou Butera, P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (907) 694-5195
September 20, 1988
Mr. Daniel J. Roth
Civil Engineer
On -Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519-6650
RE: Lot 86 T15N R1W Sec. 5
Dear Mr. Roth:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 31988
RECEIVED
On behalf of my client, Mr. Ralph Winterrowd, I am applying for a
waiver of horizontal separation distance, septic leachfield to surface
water, to 95' distance. This waiver is to allow Health Approval of
well and septic systems.
The subject septic system was installed in 1979 with inspections
by the Municipality of Anchorage. Our measurements show a distance of
95-98' to the extreme edge of a bend in Peters Creek. It appears that
the bank has eroded to create this distance. The owner is taking steps
to control erosion and it was determined that a waiver would be
preferable to adding fill to the site which would essentially
accomplish the same result. Ground slope between septic system and
creek is essentially zero or flat. There is dense vegetation and high
grass with an uneven furrowed type ground surface. Any surface leakage
of effluent would most likely be trapped in the immediate area and
percolate into the porous soil. Surface seepage would also be noticed
as the septic system is immediately adjacent to the home. Subsurface
soil characteristics of the area are gravel type soil (GW). The ground
water table is measured at 4.25' below the bottom of the septic system
or 6' below ground surface with measurements taken in April and
September. Septic and well have passed an adequacy test.
If there are any questions regarding this matter, please do not
hesitate to contact me at 694-5195.
Sincerely,
Zi��.r�
Louis Butera, P.E. ir��.�'�S -7101 3011
LAB/bjr
EAGLE RIVER
ENGINEERING SERVICES
P. 0. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
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COSA Checklist NEW.docx
COSA Checklist
Legal Description: T15N R1W SEC 5 LOT 86 Parcel ID: 051-081-28
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/2/1981 Total depth 223 ft
Cased to UNKNOWN ASSUME 40’ ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18 in.
Date of flow test for COSA 9/5/24
Static water level at beginning of test 4 ft.
Well production at time of test 5 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic 8.71 ug/L Arsenic less than MRL (ND)
Collected by Date 9/5/24
Comments Static was visible at 4’ at test & well was in a small enclosure with a light bulb for heat.
B. TANK DATA
Measured operating fluid level in septic tank *NA
Date of pumping *SEE MAINT REPORT
Required maintenance completed, if AWWTS
Comments: *MAINTENCE OF BIO BARRIER BY ARM
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments: __________________
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade 6.8 ft (max)
Measured depth to pipe invert from grade 3.7 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.*
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective *3.5’
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 9/5/2024
Results Pass
Fluid depth prior to test 21 in
Water added 600 gal
New fluid depth 28 in
Elapsed time 90 min
Final fluid depth 21 in (+ 30” ED missing)
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 72 in (MOA 6’ ED)*
Effective depth used 51 in (Missing ED + Final Fluid Depth)
Effective depth (ED) remaining 21 in
Comments/Deficiencies: Approximate total measured depths from existing grade. *Per crib documentation & ED per
elevation measurements of the bottom of crib and the cleanout invert just prior to crib with 2.5’ or 30” of ED missing – not
measurable.
COSA Checklist NEW.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No *50+ ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No *50+ ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No **23 ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ***5.6 ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No *5+ ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No *50+ ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No *50+ ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII SEPARATION DISTANCE REQUIREMENTS.
**WAIVER OSV181089 – ADU TO SEPTIC SERVICE LINE. ***Per inspection report – outside soil bearing prism.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/19/2024
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
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
09/19/24
BETI-fi r
R WATER. BETTER
DENAI,I FNVIR� ORLD.
• Chugiak, A 99567 1`IMENTAL SI_TPPL y
FIE r D jNj�p� Phone: 907-280-9493 -E-mail: cell
18368 Amonson Rd.
BioBarrierglVl CTjON &SERVIc.1@outlook.cbm
BR S REPORT
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INSTALLATION INFOR111ATInN .. -._._ _
Model No.
COMPONENT
BLOWER
Blower Brand and
Size
FUNCTION
Serial No. "-
Date of Installation
........._ . ..
..........
Z -V (93
PROCEDURE
OPERATION
:Open ONVer housing check to
confirm that blower is running (be
;sure blower is ON and sho«s ON in
the BB panel.
INTAKE FILTER iRemove wtng nut from intake
;assemble on blower, remove all
€debris from filter element. Put
CONTROL PANEL AUDIO & VISUAL ;Place control panelinto MANUAL
FUNCTION jMODE then turn the blower OFF.
;See "Manual Mode" directions in
jsenue manual for proper execution
of this task.
REACTION BEING AERATED
CHAMBER
SOLIDS
' KMON AL
koBarrier
over
system and check to be
sure vigorous boiling is ocurring
(unless panel indicates the system is
in LTRP mode).
Cheek Solids RemoN al procedure in
Whe Service, Manual.
Date of last pump -out
RESULT
. ... . . ....... ..
` Ll C&T
Cjv
Authentisign ID: DFFE63AA-1D75-EF11-991A-002246299C60
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this 17th Day of September of 2024 _, by and between
Makellie Hanofee , herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as BIO -BARRIER
located at (legal description)
T1 5N R1 W SEC 5 LOT 86
2. Maintenance. Repairs and Alterations.
M (,Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
M includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
NOwner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Pagel of 3
Authentisign ID: DFFE63AA-1D75-EF11-991A-002246299C60
M1Owner acknowledges that the Municipality may request records of maintenance and
M� repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
RAWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
MKCertificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
R guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
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Municipality of Anchorage
' Development Services Department
— Building Safety Division
On -Site Water & Wastewater Program `
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsitef"
R� � S � (907) 343-7904 ;
��I CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O51— M 1- ,'2 g COSA# n Q
1. GENERAL INFORMATION Expiration Date: _ — "! ' O 7
Complete legal description T15N R1 W SECTION 5 LOT 86
Location (site address) 21625 SCENIC DRIVE * CHUGIAK. AK 99567
Current Property owner(s) SUZAN BOWEN Day phone 688-5351
Mailing address P.O. BOX 671103 • CHUGIAK AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent LAVERNE PETTIGEN w/ DYNAMIC Day phone 622-7163
Mailing address 3111 'C' STREET * ANCHORAGE AK 99503
Unless otherwise requested, COSA will be held by DSD /or pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
ii.
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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 samples. (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 engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat 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 riles and from my investigation and able Municipal
ct the
al
on-site water supply and/or wastewater disposal system is(are) in compliance with all app P
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SURE 101 " ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily idontifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory lost
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confor any legal right whatsoever.
5. DSD SIGNATURE
V Approved for 3 bedrooms.
Phone 337-6179
Date 0
. G.. j
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations:
ON-SITE
WATER AND
WASTEWATER
PROGRAM
Attachments:
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Reort
Nitrate Advisory Other
By: (/ �,� ���� Original Certificate Date:
(RW.7LOS)
Municipality of Anchorage
Development Services Department
�J Building Safety Division
On -Site Water & Wastewater Program
4700 8ragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.orglonsfte
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: T15N. 111% SECTION 5 LOT 86 Parcel ID: 0S/ -0F/ -.Z$
A. WELL DATA
Well type MNATE If A, B, or C provide PWSID# N/A
Date completed 6/2/1981 Sanitary seal (Y/N) YES
Total depth 223 ft. Cased to 40'+ ft.
FROM WELL LOG
Date of test 6/2/1981
Static water level 50 ft.
Well production 5 g,p,m,
WATER SAMPLE RESULTS:
Coliform _0 oolonies/100 mi.
Arsenic: 10.4 ugJL.
B. SEPTICIHOLDING TANK DATA
Nitrate N4_mg./L.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12"+ in.
AT INSPECTION
10/31/2006
52 ft.
2 g.p.m.
Other bacteria 0 oolonies/100 ml.
Date of sample: 6/14/2007 Collected by: GEG Ltd.
*INSIDE CRAWLSPACE
Tank Type/Materiai -
SEPTIC/STEEL
Date installed
7/11/1979
Tank size 1000 gal.
Number of Compartments 2
Cleanouts (Y/N)
YES
Foundation deanout (Y/N) "YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 8/16/2006 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Data installed 7/11/1979 Soil rating (g•p•dJR'or t )fir 100 System type TRENCH
Length 78 ft. Width 5 ft. Gravel below pipe 0.5 ft.
Total depth *179-4.58& Eff. absorption area 300 to Monitoring tube YES Depression over field NO
Date of adequacy test 10/31/2006 Results (Pass/Fail) PASS For 3 bade
Fluid depth in absorption field before test i in. Water added 473 gal, New depth 7_5 in.
Elapsed Time: 290 min. Final fluid depth 3_5 In. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) TERRAUFTED If yes, give date9 30 2006
sy:;,4" w0.4 p1z., 0,4 */110/07
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(EAST 11A nly•1 I
TOWNSH/P 15 NORTH
RANGE 1 WEST
SECT/ON 5
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GOVERNMENT LOT 86
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05, SEPTIC VENT
XX XX) RECORD DATA
Osv
THIS IS A RECERTIFICATION
Ow OF AN AS -BUILT SURVEY
PERFORMED IN JUNE 1989
ON (MLA JOB 89-106).
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' AS—B 1TI T
••���\\ \ , has. inspectI her 01y c "edfriithetpropertyvdescrib ddasne under my aupervtaion
.,c OF A p, , •-
S
P;.••" :�$ GOVERNMENT LOT 86, SECTION 5
1 , 0 TOWNSHIP 15 NORTH, RANGE 1 WEST
4
,•, SEWARD MERIDIAN, ALASKA
wyl•� Anchorage Recording District
GARY D. KOWAL
��Bp6,-58oS:�la
0 25 50 75 100
SCALE
11CCUNhOCK LAND ASSOCIATES, JANM
11940 BUSINESS BLVD. SUITE 205
EAGLE RIVER. ALASKA 99577
(907) 694-4499
1ELD WORK DATE: 6-15-05 PARTY CHEF: OM
1RAWN DATE; 6-17-05 DRAWN BY: JC
The improverxnts situated thereon are Within the property lines
and do not encroach or overlap onto odjacent properties, nor do
any ieprovemenls from adjacent properties encroach or overlap
onto this property, except as indicated hereon.
No let oalnems haft been asp. The properly dimension,plot end he $h0en are Irc01 the record
approsisola erolhere�0 sslly 0s lgralneEOOnlrv1 e011 ssusilent Tthat irobhesnua locatelgnOro
if Ihen era ssy aacraaclwnoc anlo 01 off Of IM lot. Dropping ono reprodwilm
Idrs oo nnslhan IOirnsians-c. las this Mdrawing cls innolhOuld adequate
beoratpd[jIleft.llantl
essernlsiIr a IM for
recordeorasuba vides ply the Iacted above a,a shown here" and Itonly
Is
IM
nrirrlcllosspansi011lly al the boner 10 0410101100 It say other easseenls, covenants, or
m exist.
CIIcCIlatcca land Assaciatss. Inc. (LLA) 2005
This Oecueenl 11 cepyrighled Ind is authorised to be used to, on, net properly
transaction Of Prefect Only. Any copy Is 10 04 ceaclderod unauthorized unless It
boon an ori Incl sarveyar's signature lus"lll' In 111" Ina) ar a stamp $having
recorder's aft co data. Copyright rostrlcil I"I (but Out royale reslrlell"s) oro
"lead 11 this document has been 0111101e11y recorded. Lending Institution my alga
mate bdditla dI Copies to, Iheir den records. Liability to LLA R limited to loss
received for Ihlg project.
FIELD BOOK: 106-22 PLOT SCALE: 1-.5W
CR10: NW 1457 OWC NAME: A805-183 JOB N0: 05-183
D. LIFT STATION
Date installed
"Pump on" level at n.
E. SEPARATION DISTANCES
Size in gallons Manhole/Access�(Y/N"Pump off" leve High water alar in.
Cycles tested Meets alar & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/Ilft station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
e95'
Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
WAVIER
G. ENGINEER'S CERTIFICATION
I car* that I have determined through field inspections and fig.
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Print -d Name JEFFREY A GARNESS °q /
Date
COSA Fee c if y) •Uv 4. 175 K ()S H Waiver Fee $
Date of Payment Z� U % Date of Payment
Receipt Number l f -15 Receipt Number
(Rev. 1 V06)
Municipality of Anchorage
,..�_
Development Services Department
j Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 070227
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
86 T15N R1 W Section 5 of Subdivision. This inspection revealed an
arsenic concentration of 10.4 micrograms per liter (ug/L) for the property's
well water sample. The Environmental Protection Agency (EPA) has
established a maximum contaminant level (MCL) of 10.0 ug/L for public
drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
information on arsenic is available from the On -Site Water and Wastewater
Program website (www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
• MUNICIPALITY OF ANCHORAGE���
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section On
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# - q9 HAA# _'2Q�
1. GENERAL INFORMATION
Complete legal description
Lot 86 T15N R1W Section 5
Location (site address or directions)
21625 Scenic Drive, Chugiak
Property owner Ralph Winterrowd Day phone 269-7000
Mailing address 6901 F- rnidor, Snita 7 Anchorages AK 99507
Lending agency NSA Day phone
Mailing address
Agent NSA Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well x
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 X
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 (Rey. 1/91) From MOA 421
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 Eagle River Engineering Services Phone 694-5195
Address
P.O. Box 773294,
Engineer's signature
6. DHHS SIGNATURE
P\ Approved for
Disapproved.
Conditional approval for
Additional Comments
River, AK 99577
bedrooms.
Date ii1,31%_,_
bedrooms, with the following stipulations:
By: Date/W��7
SEEM 11110
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.
7M25(Rev. 1/91) Rack MOA921
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 407- SL 1-151-1 2/W S6G5 Parcel I.D.
A. WELL DATA
Well type P2/V11TAC If A, B, or C, attach ADEC letter. ADEC water system number N1A
Log present (Y/N) Datecompleted06-11OZ-A) Drillers W/L.LIf}Mi
Total depth 223
Casedto
7�
7 �T Casing height
Sanitary seal (Y/N)
Y6 Is
Wires properly protected (Y/N) yE5
FROM WELL LOG
AT INSPECTION
Date of test
U(o�0?�S'102/92
Static water level
U /
Q(l1T 2EL/D AQC_D
Well flow
15.0
g,p.m. 2' g.p.m.
Pump level
UNKNOWN
ON&NOW&Z
SEPARATION DISTANCES
FROM WELL TO:
Septic/hotdh"nk on lot
%DD
—;On adjacent lots /UD
Absorption field on lot
; On adjacent lots zoo /
Public sewer main
NJA Public sewer manhole/cleanout /VIA
Sewer service line
f %S
Petroleum tank NOAIC /f?A4126N7
WATER SAMPLE RESULTS: /
Coliform Nitrate D'/ L Other bacteria
Date of sample: �p�2!'122Collected by: E /J6/NEE./2
B. SEPTIC/FI860ING TANK DATA
Date installed X999 Tank size /000 Compartments 2
Cleanouts (Y/N) %/&�: S Foundation cleanout (Y/N) YES Depression (Y/N) I'VO
High water alarm (Y/N)
Alarm tested (Y/N) N1,4
Date of pumping , /off 9 2 Pumper
SEPARATION DISTANCES FROM SEPTIC/HeEMG TANK TO:
We] I(s) on lot zoo/ On adjacent lots t ZOO Foundation
To property line t /0 Absorption field
Surface water/drainage 4-
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y.
Manufacturer
Manhole/Access
SEPARATION DISTANCE FROM LIFT STATION TO:
Well
D. ABSORPTION FIELD DATA
On adjacent lots
-- "Pump off' level at
Cycles tested
Surface water _
Date installed —J�i% Soil rating /00 System type
i
Length 7tf Width s � G/'
r�avel thickness � Total depth �
Total absorption area 3 � ��d iP Cleanouts present (Y/N) y
Depression over field (Y/N)
Date of adequacy test /1/0�,/2 2 --
Results (pass/fail) zQA SS for 3
Peroxide treatment (past 12 months) (Y/N) _ U.1A If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /00 ¢
—On Property line
To building foundation
To existing or abandoned system on lot
bedrooms
7� /U v
On adjacent lots x_30 ' Cutbank N //1 Water-main/service line Z10 '
WAivIC,Q
Surface water 95
5 Driveway, parking/vehicle storage area /01
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
�en((ees'r � brR
Signature
Engineer's Name
Date
N, OFFSSIO�� ?�
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91)Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
L;'JNICif''F.LIT1' O. P.'idCF!O.^.AGE
h\I.J
MUNICIPALITY OF ANCHORAGE
• t Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES MW
343-4744
ECI IVES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # OSR 081 2 o HAA # �A 20, - C��(Ll
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 86 T15N R1W Sec.5
Location (address or directions)
Scenic St. Chu iak
(b) Property owner Ralph Winterrowd Telephone: (home) n/a Business 248-4485
Mailing Address 6311 DeBarr Rd Suite L -2B Anchorage Alaska 99504
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
nick -up by engineer 694-5195
2. TYPE OF RESIDENCE
Single -Family IR Number of bedrooms 3
3. WATER SUPPLY
Individual Welles Community Public
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site 7 Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
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A. WELL DATA
of �H alth Y OFANCHORl (H (MOA)
F HEAITHI�alfh Authority Approval (HAA) i
EN' NTA PROTCHIMKLIST -FEBRUARY 1984
343-4744
Legal Description: I of eLp T75/?
RECOVED
Well Classification 7 n la -16 If A, B, C, D.E.C. Approved (Y/N) n A
Well Log Present (Y/N) _ Date Completed iR �a �� Yield
Total Depth-�V 5 Cased to Depth of Grouting iL HCl_
Static Water Level 4-d Pump Set At ILI0 /
/
Casing Height Above Ground `%
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot 001 ; On Adjoining Lots J -/0O/
To Nearest Edge of Absorption Field on Lot 100 ; On Adjoining Lots f /00 r
To Nearest Public Sewer Line 11-1 az To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot 1i' X5'
Water Sample Collected by Date yew/ ?y
Water Sample Test Results Co/ r yo rn-, z , /1 d-rc'_L L 0' 1 M 9/&
Comment:
B. SEPTIC/HOLDING TANK DATA
Date Installed IM Size/U �_No. of Compartments
Standpipes (Y/N) �-Air-tight /Caps (Y/N) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) % Date Last Pumped . «W is
Pumping/Maintenance Contact on File (Y/N) ) ; for C( -
Holding Tank High -Water Alarm (Y/N) P -I((- Temporary Holding Tank Permit (Y/N) u -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well i()(Ji To Building Foundation
�f
To Property Line + la, To Disposal Field F1
To Water Main/Service Line /01
To Stream, Pond, Lake or Major Drainage Course 00 l
Comment:
72-026 (Rev. vae) From Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /oo 4' ,,e Type of System Design fie_ d
Date Installed /q 77 Length of Field RG r
Width of Field 3 Depth of Field ftw a2. O
Gravel Bed Thickness 6 _
Square Feet of Absortion Area 3 3 P Statndpipes Present (Y/N) Y
Depression over Field (Y/N) Al Date of Last Adequacy Test /a 788
Results of Last Adequacy Test 5'Q-k�4 p?' -0!
SEPARATION DISTANCE FROM ABSORPTION FIELD
To Water -Supply Well — /00 To Property Line -}/o r
To Building Foundation /O To Existing or Abandoned System on
Lot 730 ; On Adjoining Lots ' 30'
To Water Main/Service Line -/0 To Cutback (if present) "14
To Stream, Pond, Lake, or Major Drainage Course a;r//Xj
To Driveway, Parking Area, or Vehicle Storage Area f/O
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access(Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company
Date /�/ry F� ( Engineer's Seal
MOA No.�6S
Receipt No. p 'Y Receipt No
Date of Payment 111f > id
Amount: $ 17J. 00
Waiver Fee: $
Date of Payment
72-026 (Rm 7/66) Back Page 2 of 2
l" ICIPALITY OF ANS
DEPT. OF W,
MUNICIPALITY OF ANCHORAGE (mokViIGNM€NiAi
HEALTH AUTHORITY APPROVAL (HAA) 11 26 1985
CHECKLIST - FEBRUARY 1984
264-4720 {nom E V
Legal Description:
Sem
A. WELL DATA
v.
Well Classification Pr' I'q �-C If A, B, C, D.E.C. Approved (Y/N) NIA
Well Log Present (Y/N) !z Date Completed GL`e�&'� Yield
Total Depth a 3 Cased to iZ + Depth of Grouting 4114
Static Water Level f 3 r AAI„ `" ! Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
l
To Septic/Holding Tank on Lot
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
On Adjoining Lots
-I,-
To Nearest Edge of Absorption Field on Lot �; On Adjoining Lots �� o
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole 419 e_ To Nearest Sewer Service Line on Lot a 5 t
Water Sample Collected by J'nsi^e er Date
Water Sample Test Results Sa f'r FG -4,
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 7� 7 S Size 1pyD G" / No. of Compartments 'Z
Standpipes (Y/N) y C`e) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Al
Depression over Tank (Y/N) y Date Last Pumped 8� /Z8S'
Pumping/Maintenance Contract on File (Y/N) ; for _L//4
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) 1V14
Separation Distances from Septic/Holding Tank:
To Water -Supply Well joe
lU
To Property Line
To Building Foundation
To Disposal Field
'k/
To
To Water Main/Service Line /U * To Stream, Pond, Lake, or Major Drainage
Course 400 4e *,f, Creep
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed —,/ 2 7'i Length of Field
i
Width of Field 5 Depth of Field a /
Gravel Bed Thickness G
Square Feet of Absorption Area �9� Standpipes Present (Y/N) Yo 6e 1hr✓r,11,W
Depression over Field (Y/N) !1J %>, Foy( e,. j Date of Last Adequacy Test i9 �; 2 a i9dl
Results of Last Adequacy Test -S• f•stje��.,.,
Separation Distance from Absorption Field: J
To Water -Supply Well Zoe To Property Line
To Building Foundation i To Existing or Abandoned System on
Lot %)d On Adjoining Lots 3"-1-
To Water Main/Service Line To Cutbank (if present) llt4p e_
To Stream/Pond/Lake/or Major Drainage Course ZUv / % /e
To Driveway, Parking Area, or Vehicle Storage Area 7 -
Comments
D. LIFT STATION
N�
Date Installed
Size in Gallons
"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)
Pumping Cycles during Adequacy Test, Meets MOA
'" Check Permitted Bedroom Rating Against HAA Request "
I certify that I havvee chheecke_d,,verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
SignedY �z'��26 Date SV •7 �/f s'
Company z MOA No. _ST- r a 6S -
Receipt No.aw/�l
OF
Date of Payment
ao ' �� s�
Amount: $ Uri) Engineer's Seal
01
��,9nn.la navequ EausEav'f.a�a6v-�a•
Page 2 of 2
72-026 111/841
fnUls A. Rurf,p•'V - -
°?
6Y -6 -
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 8/21/85
1. GENERAL INFORMATION -
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ' anna Knhl Pr Telephone: Home 688-3099 Business 688-3999
Applicant Address P n Rnx 269 (hugi ak Alaska 99567
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer❑:; Other (explain);
(d) Lending Institution r;+j Mnrt,gage Telephone 694-3504
Address -i3'2 Ricar� Alaska�,77
(e) Real Estate Company and Agent M2Tiq.nna Knhl er
Address p D $fix 7FG Chllaiak Alaska A��67
Telephone SRRAgG
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family ® Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Welles Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite,a Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 01;04)
Page 1 of 2 -
FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Geri a #W fn Et(a EEauv.Ga�flVICi
G --
Telephone
F�an¢
Address EAGLE RIVER, AK 99577
Date ���a) � S- QnA RIA,
Q 0. ®OX 773294
'two water samples taken were unsatisfactory after chlorine treat-
ment of the well the 3rd
periodic check samples of
sample was satisfactory. I would suggest
in the future.
A.. Bu:era '
o ta Sb!
6. DHEP APPROVA
Approved for bedrooms byxeate
Approved
Disapproved Conditiona
Terms of Conditional Approval
CAUTION
Engineer's Seal
7®
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