HomeMy WebLinkAboutTERI #2 LT 7
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Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-751-11
Legal description TERI #2 LOT 7
Site address 4164 Mariah Dr Eagle River
Current property owner(s) Joseph and Bobbi Bloom
Expiration Date: / y 2v 2 3
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: Z y ?rJ Z 3
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
COSA Approval_June 2022
IUMMPAUTY OF ANCHORAGE
Development Services Department -343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-751-11
Complete legal description TERI #2 LOT 7
Location (site address) 4164 MARIAH DRIVE, EAGLE RIVER, AK 99577
Current property owner(s) JOSEPH & BOBBI BLOOM Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 25 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 15-5-6
Date of Payment 'I3 / a�a3
COSA # 650 a5 ION
IF q03 673
Waiver Fee $
Date of Payment
Waiver #
COSA Application.doc
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic 'dank Advisory
Certificate of On -Site Systems Approval # OSC231018
Subdivision: Teri #2 Block: , Lot: 7
907-343-7904
Fax: 343-7997
The septic tank for this property is 25 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
z
Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni or
g
13021 Montego Circle, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
February 10, 2023
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: TERI #2 LOT 7 - WELL TO FIELD WAIVER
Per the attached as-built survey by Land & Associates, Inc. dated February 10, 2023, and measurements
based on the inspection report in the MOA on-site file —the closest edge of the septic absorption field was
measured at approximately 94.2’ to the subject property’s well. We are therefore requesting a waiver to 92’
between the referenced well and field be granted at this time.
Granting of this waiver is justified in the fact that the well is upgradient some 20’ of the field with no
physical chance of surface effluent reaching the well. There have been no known issues or influence over
the past few decades from this encroachment and recent nitrate and bacteria results are non-detectable per
the attached CAN water samples. Granting of this waiver will not impact any of the neighboring properties.
Please contact us if you have any questions.
Respectfully,
Curtis Huffman, P.E.
Attachments: As-Built Survey & COSA Docs
Municipality of Anchorage
y
_ - Department
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 a (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV231004 COSA OSC231018 Permit#:
PID#: 050-751-11
Legal Description: Teri #2 Lot 7
Engineer: Curtis Huffman
Applicant: Curtis Huffman
Your request for a waiver of the required 100' feet horizontal separation from the water well to
the septic field has been approved. The approved separation distance is 92'.
This waiver approval applies to the existing septic 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
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
.................................... a E M N 0 E ..... ■ ............... 0. X 0 0. 0X.0..0. ■ 1
Waiver is Granted: X Waiver is not Gran d:
Date: y ZoZ Approved by:
Name of Reviewer
............... n K E 0 N a .......................... ■ ...... 0.. 0 0 0 ............. t 0 K 0 1
**** VARIAN C E/WAIVE R REVIEW ****
COSA Checklist.docx
COSA Checklist
Legal Description: TERRI #2 LOT 7 Parcel ID: 050-751-11
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 6/19/1998 Total depth 220 ft
Cased to 155 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 2/1/2023
Static water level at beginning of test 165 ft.
Well production at time of test 2.0 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date 2/1/2023 - RUSH CAN
Comments WELL TO FIELD WAIVER SUBMITTAL 0F 92’ SEPARATION WITH THIS COSA
B. TANK DATA
Measured operating fluid level in septic tank 49”
Date of pumping 1/31/2023
Required maintenance completed, if AWWTS
Comments: 25-YR S.T. – SEE MOA ADVISORY
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/22/1998
ALL standpipes present per record drawing
Total measured depth from grade 3.3 ft (max)
Measured depth to pipe invert from grade 3 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective 1.06+ ED / IR IS 1’ED
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 1200 gallons 1/31/23 date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 2/1/23
Results Pass
Fluid depth prior to test 0 in
Water added 450 gal
New fluid depth <1 in
Elapsed time <25 min
Final fluid depth 0 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 12 in
Effective depth used 0 in
Effective depth remaining 12 in
Comments/Deficiencies: Presoaked up to lateral & volume per AMC15.65.060 B5aii/iii and tested 21 hours later.
No known frost issues per owner. Wintertime conditions and measurements show 1.06’+ ED.
COSA Checklist.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 ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No *92+ 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 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 ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
* WELL TO FIELD WAIVER SUBMITTAL 0F 92’ SEPARATION WITH THIS COSA
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 2/10/2023
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 &
2/10/2023
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Lot 8
HOUSE DETAIL
Scale: 1"=30'
0 20 50 100 200
SCALE: 1"=50'
Tract A4113
\
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10' UTILITY
EASEMENTS
Lot 6A
15' UTILITY
EASEMENT
Municipality of Anchorage Page / of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
15.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: /K/f,/ ,¢,¢',¢/.~ PlO Number: ~.¢'0 '~g'l//
~"~:~ ~/o~ Wastewater System: ~New ~ Upgrade
Address:
~z~/ ~,,',m ~,~/~ ~,'~ /h ¢¢~ ABSORPTION FIELD
Phone: ~ NO, O~ Be~ooms:
~ ¢~2-- ~ ~-///~ - ~ Deep Trench ~ShallowTrench UBed O Mound OOther
focal Depth from original grade:
LEGAL DESCRIPTION so,,,~,,~: /. ~. ~,o,s~ ~,. ~.¢~ ~z.¢/
--Township ~ Range: ~ Section: Fdl~/~_added above/,~, original grade: Ft Gravel length: ~-- Ft.
Onlten Date Drilled: St tlc Water Level: Installer' Dale installed: ~
SEPARATION DISTANCES ~eptic ~ Holding ~ S,T,E.P.
Maleriah Num~r~oI Compartments:
SurfaCewater */O~' +/¢0' J ~/V~ LIFT STATION
Line ~r'' I ~?' ~ /
Foundation ~/ I 2~' ~ "Pump on" level at: ~r~el al: High water alarm at:
Remarks: BENCH ~ARK
-- ENGINEER'S SEAL
Inspections performed by: ~ Dates: lst_~-/?-2?
Department ol Health and Human Services approval
Reviewed and approved by: J~~ /~_~¢00 Date: IZ-~'¢¢_
Permit No. SW980150 Page 2
Municipolity of Anchoroge
DEPARTMFNT OF HEALTH AND HUMAN SERVICES
ENVIRONMENI'AL SERVICES DIVISION
P.O. Box 196650 · Anchoroge, Aloska 99519-6650 Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
ef 2
Legol Description: Teri Lot 7
Undeveloped
No Wells/Septic
wi|hin 200'
SWINC TIES
A-C = 59.8'
A-D = 125,2'
EXI5TING WELL
9al
5ep|ic ]ank
No Wells/Septic
~ wi|hin 200' [~TH2
~]TH5
Lot 7
PID No.: 05075111
No Wdb/Seplic / ~
~ilhin 200' '~-~\~ '
I\
No Wells/5eplic
within 200'
ELEVATIONS ~;) TOP OF WELL CASINO
(NOT TO SCALE) ASSUUE0 ELEV = 200.00
1~.4~ I I '196.2 ~17~-I U~17'1174.1,
TEST HOLE
MONITOR TUBE
o SEWER CLEANOUT
+ WELL
LEACHFIELD
EASEMENT
SCALE 1"=100'
11/4/98
ENGINEER'S SEAL
49m z '"W
Vh ,-~'. Louis A. Bu[ero '/.~(
November 4, 1998 12;04 PM
From: .Joe Bloom Faxfh 907-696..1'116
~NCHOR~3E, AK ~511-0378
~5-~ F~X ~5-32~
Page 1 of 1
RECEI'¥ED
~'.4 ih'l iCI
~WWA CertiJied Co~ttacto~;
C~e,~.,Ei. eate ~o'a. 8~,~ & 913
MUNICIPALITY OF ANCHORAGE
Deparlment of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box '~96650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 04, 1998
Expiration Date: Jun 04, 1999
Permit Number: SW980150
Design Engineer: 0024 Eagle River I=ngineering Services
Owner Name: William & Elsie Lester
Owner Address: PO Box 253
Eagle River, AK 99577-
Parcel iD: 050-75t-11
Legal Description: TERI #2 LT 7
Site Address:
Lot Size: 207738 SQ. FT,
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
E¢~ Disposal Field [¢~ Septic Tank
[~ Privy !, Private Well
Holding Tank
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 ( 18AAC8g ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April t5, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered. sealed, and heated te prevent freezing.
5. The following special provisions.
Received By: ,
Date: ~/'
Data:
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
May 11, 1998
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Teri Addn #2 Lot 7
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic system will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
A variance is requested to allow this system to be placed on a 33% slope. Fill will be added to
maintain minimum burial depth, and a visqueen layer will be placed on the downhill side of the
trench to prevent effluent seepage to the surface. A profile view of the proposed system is
attached for further details.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\I997\98-028-NAR.DOC
Undeveloped
,
No ~ells/Septic
~ithin ~00'
Lot 6
~ TEST ~OLE
· MONITOR TUBE
~ SEWER Ck~NOUT
~ WELL
EASEMEN~
NO SURFACE WATER P~OPOSED L~C~FIELD
NO ~NOWN CURTAIN DRAINS ,~-- EXISTING L~CHFIEL~
WELL_/SEPT~C SITE PLAN
LEGAL: TERI Addn ~2 LOT 7
CLIENT: BLOOM
CONTRACTOR:N~A ~* ~gg~Q ....
EAGLE RIVER ENGINEERING SERVICES
EAGLE RIVER, A~. ~577
(~07) G~4-5~ FAX: (~07) G~4-~7
EAG LI.' RIVER
ENGINEERING SERVICES
P,O. Box 773294
EAGLE RIVER, AK 99577
(907) 694.5195
SHEET NO.. OF
CALCULATED BY. DATE --
CHECKED BY, DATE
Wa//
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Teri Addition #2 Lot 7
5/11/98
A. GENERAL
1. The well and septic plaa are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmaaship shall meet the Anchorage Department of Health and State
Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavatioos and depths are advisory and are to be verified in the field by the contractor to ~neet
Municipality of Anchorage, Department of Eoviromnental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, aay deviatioo requires engineer
approval.
8. It is always recommended that a snrveyor locate the nearest lot line position and the location of any
easenlents.
9. Any remaining open test hole excaw~tioos shall be filled.
B. SEPTIC TANK
1. Septic tank shall have a minimum capacity of 1000 gallons and be of MOA approved design.
C. TRENCH
1. The trench is to follow the oatural laad coatour to maintain uniform total depth of the treach bottmn.
2. The bottom of the trench shall be level, plus m' minas 1.5".
3. The total depth of the trench excavation is not to exceed 3' on the nphill side at auy point.
4. The effiaent line within the trench shall be laid level withiu 0.03'.
5. The trench gravel is to be covered with typar fabric ~naterial.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or eqaivalent is to be placed
over the leachfield. Fill will be added on the downhill side of the trench to maintain this cover.
7. A visqaeen barrier will be placed oo the downhill wall of the trench extending to the bottom of the
sewer rock.
8. The area over the trench is to be finish graded at a 1% slope to prevent ponding of surface water
ruooff, and is to be covered with topsoil and seeded for erosion control..
9. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any com~nunity well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 3', uphill side GRAVEL DEPTH = 1'
TRENCH LENGTH = 75' TRENCH WIDTH = 5'
SOIL RATING = 1.2 GPD/ft5 BEDROOM CAPAC1TY = 3
SEPTIC TANK - 1000 gallons
under pipe, 2" over pipe
Twenty-font (24) hours notice reqnired for all inspections.
\1997\98-028-spc.doc
EAGLF RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 98-028
Calculated By: LB
Date: 5/8/98
Legal: TERI Addn #2 LO'[' 7
Single Family 3 Bedroom Dwelling
TEST HOLES 4&§
Shallow Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 450 gallons
Percolation rate = 2.1 minutes per inch
Wastewater application rate = 1.2 gallons per day per square foot
Required absorption area = 375 square feet
Trench width (W) = 5 feet
Gravel depth (D) = 1 feet
P, equired length = Shallow trench factor * Required absorption area / W
Shallow trench factor = 1.0, no sidewall credit
Shallow trench factor = 1.00
Total Excavation Depth = 3.0 feet on high side of hill
Required length = 75 feet
98-028-cal.xls 9:09 AM5/8/98
SINGLE FAMILY ON-SITE WORKSHEET
ERES PROJFCT NUMBER: 98-028 CALCUli, TED BY: LB
LEGAL DESCRIPTION: TERI Addn #2 LOT 7
NUMBER OF BEDROOMS: 3
WATER USE PER BEt)ROOM: 150 GALLONS
PERCOLATION RATE: 2.1 MINUTES PER INCH
DEPTH TO GROUNDWATER: 7 FEET
DF'PTH 'FO IMPERMEABLE LAYER: 9 FEET
ANTICIPATED DEPTH OF COVER: 2 FEET
MOUND OR BED SYSTEM
USABLE SOIL STRATA
TOTAL USABLE DEPTH: 3
USABLE[ SOIL STRATA DEPTH: 1
WASTEWATER APPLICATION RATE: 0,8
ABSORPTION AREA REQUIREMENT: 563
MINIMUM BED LENGTH
12 FEET WIDE BED 47
15 FEET WIDE BED 38
TRENCH SYSTEM
WASTEWATER APPLICATION RATE: 1.2
ABSORPTION AREA REQUIREMENT: 375
SHALLOW TRENCH OPTIONS
5 FEET WIDE TRENCH
GAL/SQ.FT
SQ.FT
FEET
FFET
GAUSQ.FT
SQ.FT
DEEP TRENCH OPTIONS
3FEETWIDETRENCH
EFFECTIVE REQUIRED TRENCH EFFECTIVE REQUIRE[) TRENCH
DEPTH (FT) ENGTH (FT) DEPTH (FT) ENGTH (FT)
1 66 4 NA
2 NA 4.5 NA
2.5 NA B NA
3 NA 5.5 NA
3.5 NA 6 NA
4 NA 7 NA
8 NA
9 NA
10 NA
DESIGN SPECIFICS
FIFLD SYSTEM:
GRAVEL DEPTH:
TRENCH OR BED WIDTH:
LENGTH:
TOTAL
EXCAVATION
DEPTH:
S (B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH)
FEET
5 FEET
75 FEET
3.0 FEET, ON HIGH SIDE OF HII. L
98-028-cal.xls 9:09 AM518198
I~unlclpallty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERPORMED POR:
LEGAL DESCRIPTION:
'T//.L.
1
2
4.
5
7
8
9
11
1.3-
14.-
15-
18-
19-
20-
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth lo Water Afler/
Moflilgrino? o. ?- Dale:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __
(m~nutes/~nch) PERC HOLE DIAMETER __
TEST RUNSETWEEN __ FTAND FT
COMMENTS %¢/*/ ~"¢~ ~*~,~'~ ~-;~',"-'~' /~- 1~¢~; ~"/,~/¢¢*' -4~/",'~ ..~/'~ T ~'~c ."~"~'/~'-,~
PERFORMED BY: ~'-~J~ I ~ .~.~---~,:,.~'Z.~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE W~TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~'~-~ //~ ~'~-
72~008 (Rev. 4/851
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PEREORMEO POR:_. 'ZOo/t4
LEGAL DESCRIPTION: '"~/'*'
1
2
3-
4-
5-
6-
7-
8-
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF: YES, AT WHAT '~ [ O
DEPTH? -) p
E
Oepth lo Waler After
Monitoring? Z,
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
__ tm~nutes/mch) PERC HOLE DIAMETER
FT AND ___-- FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE.
Municipality of ARchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG b PERCOLATION TIE[ST
LEGAL DESCRIPTION:
1
2
3
4
7
10
11
12
13
14
15
16
17
18
19
20
Township, Range, Section;
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh ID Water After~f/z
Moniloring?
SI'FE PLAN
Reading Date Gross Net Depth to Net
Time Time Water /l~rop
PERCOLATION RATE __
(minutes/tacit) PERC HOLE DIAMETER __
FT AND __ FT
PERFORMEO BY: ~,~/-~'.S' I ~'~"~'~'- CERTIFY THAT THIS TEST WAS PERPORMEO IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIOELINES IN EFFECT ON THIS OATE. DATE. _,~'~
72-008 (Rev. 4/85)
Municipality Gl Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PE.PORMED
LEGAL DESCRIPTION:
t
4-
0-
7-
8-
9~
11
13-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oeplh to Waler A~ler ,~ /
Monilodng?
Township, Range, Section:
SLOPE
SITE PLAN
14-
15-
16-
17-
18-
19-
20-
Gross Net Depth to Net
Reading Date Time Time Water Drop
I ~--(. ~,~ /,/,. ~ ZE'
~ f /v,'v~ ~"., ~/ "/~ ~ ~//~
~~ l~.'e ~ ~ ~//~
PERCOLATION RATE /' /'~ ~ (m~nules/~nch) PERC HOLE DIAMETER ~/'"
TEST RUN ~3ETWEEN '7_.. FT AND --."~> FT
COMMENTS
PERFORMED BY: ~',~ ,~%.r' I ~'~"~ ' ~-'--'- CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE W~TH ALL STATE ANO MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE, ~--~-.//--~c
72-008 (Rev. 4/~5)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
1
4-
5-
7-
8-
9-
Township, Range, Section:
SLOPE
SITE PLAN
14-
15-
16-
17-
19-
19-
20-
WAS GROUND WATER/'~-~)J
ENCOUNTERED?
S
L
IF YES, AT WHAT / _O
DEPTH? t~ /~.
E
Oeplh to Waler Afler ,,
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~' / (m~nutesnnch) PERC HOLE DIAMETER __
TEST RUN BETWEEN -- PT AND FT
COMMENTS
PERFORMED BY: /~ "~ '~*~ J- L
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 {Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE: ,.~----
Municipality of Anchorage
REQUEST FOR VOUCHER CHECK
[:ROM: Health & Human Services
(DEPARTMENT)
TO: MUNICIPAL CONTROLLER
DATE: June 5, 1998
R 82271
THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY
VOUCHER NO. PAYMEHTOT. F VENOOR NO.
/
~EFERENCE NO. E DATE INVOICE NO.
CHECK NO, CHECK DATE PREP APPR
1. REQUEST THAT A MUNICIPALITY OF ANCHORAGE CHECK BE ISSUED TO:
Name Joseph Bloom
Address 4251Mariah Drive
Eagle River, Alaska 99577
2. THIS PAYMENTIS FOR THE FOLLOWING (SUBSTANTIATION ATTACHED):
The applicant paid for an on-site well and on-site wastewater system permit. The well is
an existing well and does not requiring a permit to drill at this time. Please refund
the well portion of this permit application.
Lot 7 T~ri #%, Receipt # 03714/0664 $120.00
3. DISPOSITION OF CHECK:
(1) ]~ MAIL TO PAYEE
(2) [] MAIL TO PAYEE WITH ATTACEIMENT
(3) [] NOTIFY PAYEE TO PICK UP IN TREASURY
Phone #:
(6) []
Org. #:
AUTHORIZED USE ONLY
NOTIFY DEPARTMENT EMPLOYEE
WHEN CHECK iS READY IN FINANCE
4. ACCOUNTS TO BE CHARGED:
TEMI I ENTER ALL POSITIONS OF ACCOUNTING DISTRIBUTION
iNO' I DESCRIPTION I Org/CC I Acct/Obj I ~ask I Opt I Cost Ctr. We~Vo
5. TOTAL AMOUNT OF CHECK
Phone No.
Employee 343-474/~
INSTRUCTIONS
b.
AMOUNT
120.00
$ 120,00
Approving Authority
TO be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash.
Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7.
Retain carbon copy for your file.
IVluniclpallty of Anchorage
DEPARTMENT OF HFALTH AND HUMAN SERVICES
Environmental Services Division
']'elephone: 343-4744
ON-SITE SERVICI=S FEE DOCUMENTATION
Nan~e of Payer: (Name on Check)
Mailin~Address: (Off of check)
Legal Description(s):
OS- 03714
Permit Number:
_°beck,,..
Type of Payment: (Indicate Amount Paid)
~lealth Authority:
Sewer & Well Permit:
Well Permit: __ / ~- ~C~'C'~O
Sewer Permit: '~-~)-
Copy Request:
72-034 (Rev. 10/87)
Excavator Permit:
Engineer Permit:
Pumper Permit:
Well Driller Permit:
Tank Manufacturer:
(Waste Treatment)
DISTRIBUTION:
Lot Line:L~'L~`h~'- ,-~ '
Well to ~d~. - h~',-"~'~
Field to Sudace~ater
Tank to Sudace Water
NOTE: Application must be tilled out complelely
Property Owner Name
Mailing Address '~'~'
Legal Description
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Sewer/Well Permit Application
SINGLE FAMILY DWELLING
Parcel Ide~liJication Number
Day Phone
Zip Code qqs-??
T~r',' ~'~1,~ **2.
Subdivision
Lot Size "Z. o ~ '7~T~¢
Number of Bedrooms:
Townshfp Range
Inspections will be conducted by: RECEIVED
Approved Engineering Firm
Municipality (permit fee included)MAY 2 2 1998
Does your house contain any of the following: Hot Tub, Swimming Pool, Therapy Pool, Jacuz,~JNICIPALIT¢ OF ANCHOe~GE
· ,) liNVIRONMENTAL SERVIC~,S DIVISION
or Water Softener Unit? If yes, which one.
' ' . 'Y ' pp' ' ' be' g
and in accordance with applicable Municipal codes. 5"~"'~/ "~ ~ J;~'~ ,. -~1~