HomeMy WebLinkAboutTHAYERMOORE HEIGHTS BLK 3 LT 4Thayermoore
He'D
ights
Block 3
Lot 4
#015-081-11
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141180 PID Number: 015-081-11
Dwelling: FNI Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade
Name:
MALCOM &ELAINE BULL
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
7220 RUSSELL CIRCLE ANCHORAGE AK 99502
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original gradeGravel
Ft.
depth beneath pipe
Ft.
Subdivision Block Lot
THAYERMORE HEIGHTS 3 4
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
TO
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
Ft'
I Ft.
well
>100'
>25'
TANK i Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1250 Gal.
Surface water
>100'
Material
STEEL
Number of compartments
2
Lot Line
>5'
NA
LIFT STATION
Foundation
>5'
Manufacturer
Capacity
Gal.
Curtain Drain
>50'
Pump on level at
Pump off level at
High water alarm at
Remarks EXISTING SEPTIC TANK ABANDONED
in.
in.
in.
PER UPC REQUIREMENTS.
MAX BURIAL DEPTH OF TANK 10'
Pump make and model
Electrical Inspections performed by
PIPEMATERIAL Housetotenk3034 Tankto3034
drainfield
Installer
JOHN'S EXCAVATING
Drainfield CO/MT3034
Inspector ANSON MOXNESS
BENCH MARK (Assumed elevation)100 ft
Inspection 1� 6/12114
Location and description
dates:
a
BACK DOOR JAM
3"'
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
IF
Conditional Approval: Date
o �P9 fit•
i
%........
i ... !+ .. . ... �
�1 E. SPURKLAND��
15
�~
�1P
Approved Date
\��H�E9s�
1�
Inspection Report 9-1-1f.doer'
CIR ABANDONED EXISTING
SEPTIC TANK PER MOA
CODE REOUIRfM£NTS I I
3 I —
I
_ 1 I
5
C A
f0' URL
NO WELL WITHIN 100' TO THE SO TH
25 0 25 50 75 100 125 150
SCALD I' = 50 FT THA YERMERE HEIGHTS SID
BLOCK 3
NOTE • THIS IS NOT A SURVEYED PLAT WELL & SEPTIC
LOCATIONS TAKfN FROM ON -517f WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION ALL LOCATIONS SHOWN ARE
APPROXIMATE.
4+ FEET COVER
DQUBLE
CLEAN["
SWING TIES
A
B
S.T. C.O. C
14'
38'
S. I. C.O. D
21.5'
45.5'
DBL. C.O. E
23'
47'
1250 GAL STEEL SEPTIC TANK
2RAINEIELD
Y//—
4' CONTOUR LINES
CON!
EXISTING BRAerrrICLu
FLIUNDATIQN
CLEANOUT
BENCH MARK DOOR JAM
ASSUMED ELEVATION 100 FEET
SPURKLAND ENGINEERING THAYERMORE HEIGHTS B3 L4 SEPTIC SYSTEM DESIGN
203 W K TH. AVENUE MALCOLM BULL DAT£t JUNE 12 2014
ANCH. AK. 99501
(907) 279-39. 7220 RUSSEL CIR ANCHURAGE AK 99516 SHEEP 1/1 GRID+ SW2439
PERMIT # USP 141180 PID # 015-081-11 ThoyernoreHelDhtsB3L4-49BBV&
MUNICIPALITY OF ANCHORAGE
e
Community Development Department Right of Way Section
Development Services Division Phone: 907-343-8240
Mayor Dan Sullivan
June 19,2014
Malcolm I. & Elaine M. Bull
7220 Russell Circle
Anchorage, AK 99507
Fax: 907-343-8250
RE: Encroachment: Septic System in Utility Easement
Thayermoore Heights Subdivision, Block 3, Lot 4, Grid SW2439, 7220 Russell Circle, Anchorage, Alaska
The Right of Way Section has reviewed a request for a letter of non -objection to an existing septic tank and the stand
pipes, which collectively encroach: 10 feet into the 10'- Utility Easement. On the as -built survey dated 6/13/14 and the
septic system design dated 6/12/14, submitted with the request, the petitioner has shown the septic tank and the stand
pipes.
This letter of non -objection is issued with stipulations, and by using it the petitioner is agreeing to the following:
1: Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or injury to any
person as a result of the encroachment's.
2. All applicable codes and regulations will be observed and maintained within the easement.
3. This letter of non -objection will in no way preclude MOA from full use and enjoyment of its rights within any
portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or reconstruction of
MOA improvements to accommodate any or all of the encroachments shall be paid by the property owner.
5. Maintain letters of non -objection from the following utilities;
E Anchorage Water & Wastewater Utility Alaska Communications Systems
E Chugach Electric Association, Inc. ❑ Mataim" Telophone Association
❑ Matanuska Electric Association, Inc. Instar Natural Gas Company
❑ Municipal Light & Power E GCI Cable of Alaska
❑ Eyecom (Girdwood Cable TV) , ❑ No letters required
All letters of non -objection should be retained in your perniatient files. If you have any questions, please call Daune
Wyatt, Right of Way Plan Reviewer at 343-8240.
Sincerely, Concur
lc
Pack L. Frost, Jr. Malcolm I. T3ull, Owner
Right of Way Supervisor
cf Tz
Elaine M. Bull, Owner
Mailing Address: P.O. Box 196650 o Anchorage, Alaska 99519-6650 • http://www.muni.org
On -Site Wastewater Disposal 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:
OSP141180
Tax Code Number:
01508111000
Work Type:
Septic Upgrade
Permit Effective Dates: June 12, 2014 to June 12, 2015
Design Engineer:
SPURKLAND ENGINEERING
Subdivision:
THAYERMOORE HEIGHTS
Site Legal Address: THAYERMOORE HEIGHTS BLK 3 LT 4 G:2439
Owner/Address: BULL MALCOLM I & ELAINE M
7220 RUSSELL CIR ANCHORAGE AK 995070000
Site Mailing Address: 7220 RUSSELL CIR, Anchorage
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy
All construction must be in accordance with:
Lot Size in Sq Ft: 26800
Total Bedrooms: 4
N Private Well N Water Storage
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.__ _
Special Provisions: The ROW letter of non -objection is to be submitted to Onsite prior to IR
approval.
Received
Issued By.
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
06
/ Parcell
ANCHORAGE
Phone:
Fax:
ON-SITE SEWER/WELL PERMIT APPLICATION
D 015-081-11
Property owner(s) MALCOLM BULL
Mailing address 7220 RUSSEL CIR ANCHORAGE AK 99516
Site address SAME
Day phone
Legal description (Sub'd., Block & Lot) THAYERMORE HEIGHTS B3 L4
Legal description (Township, Range & Section)
Lot Size Sq. Ft.
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
0
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 4
907-343-7904
907-343- 9
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) 0
Upgrade R (w/wo ADU)
Ren
s-1 -Duplex (D) ElLMu(SF Dwellings Elat ,Gj.A
(SF and/or D)
JUN 0 9 2014
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
property owner or authorized agent)
Permit/Rush Fees: D/ cL V6h Waiver Fees:
Date of Payment: I d YyDate of Payment:
Receipt Number: 61 Receipt Number:
Permit No. 0';'j9jLtjl?0 Waiver No.
PermH App_9-1-12.doc
Spurkland Engineering
Environmental Consulting and Design
June 6, 2014
Municipality of Anchorage
Development Services Department
Building Services Division
On-site Water and Wastewater Program
4700 Elmore Rd.
Anchorage, AK 99519-6650
Subject: SEPTIC TANK PERMIT APPLICATION
Thayermore Heights Block 3 Lot 4
Ladies and Gentlemen:
We are submitting an application to upgrade the septic tank for this lot. The existing tank has been
compromised and must be replaced. The submittal consists of one (1) drawing showing the present
improvements on the lot and the proposed improvements of the lot, of which only the septic tank is
subject to this permit application.
The installation of this septic tank will not prevent wells and septic systems from being installed on the
adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of
the proposed septic tank location. The proposed septic tank will not change the general slope of the area.
Ponding and/or concentration of surface runoff will not result from this installation.
If you have any questions or are in need of additional information please contact me at 279-3916.
Sincerely,�
StSp land, P.E.
203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gci.net
25 0 25 50 75 100
SCALD 1' = 50 FT
NOTE., THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
DOUBLE
CLEAN
25 150
THA KERMERE HEIGHTS S/D
BLOCK 3
4 FEET COVER
CONNECT TO
EXISTING BRAINFIELD
1250 GALLON SEPTIC TANK
FOUNDATION
CLEANOUT
ISPURKLAND ENGINEERING I I THAYERMORE HEIGHTS B3 L4 I I SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE
ANCH. AK. 99501 MALCDLM BULL DATEr JUNE 6 2014
(907) 279-3916 7220 RUSSEL CIR ANCHORAGE AK 99516 SHEET, 1/1 GRID: SW2439
PERMIT # OSP 141XXX PID # 015-081-11 ThiyermoreHeight5B3LABW6
l, f", - i Q)0- Tw-,!�- FJL� ;J'U
WALTER J. HICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE (907) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99503
RECEIVED
April 2, 1993 APR 5 1993
Munic;pahry of Anchorage
Ida Vanhouten Dept. Health & Human Services
7220 Russell Circle
Anchorage, Alaska 99516
Subject: Lot 4, Block 3, Thayermoore Heights, Anchorage, Alaska, Public Water and
Wastewater Disposal Systems, ADEC Project Numbers 9321 -DW -069 and
9321 -WW -056, Review
Dear Ms. Vanhouten:
I have reviewed your March 12, 1993 submittal regarding the upgrade of your single
family home into a Bed and Breakfast. Based on this review, I have the following
comments.
From the submitted information, it appears that the existing water system met all
regulations and guidelines when it was installed. Based on this information and the fact
that the demand on the existing water system will not be increased, it appears that the
water system will be able to meet the demand without modifications. Therefore, the
existing Class C Public Water System serving the two bedroom Bed and Breakfast and
two bedroom single family home located on the above -referenced property is approved
for the concerns of this Department. A final Operation Certificate, constituting this
approval, is enclosed.
The Department is assigning Public Water System Identification (PWSID) Numbers to all
public water systems in the state. The PWSID Number assigned to your Class C Public
Water System is 218093. This number will need to be placed on all analytical results
submitted to this Department. At this time, Class C Public Water System, in accordance
with the existing State Drinking Water Regulations, are not required to monitor the water
provided to the public. However, I recommend that you monitor for nitrate (as nitrogen)
once a year and total coliform bacteria twice a year.
It appears that the existing wastewater disposal system was also installed in accordance
with state and local regulations and guidelines at the time of installation. Also, the existing
wastewater disposal system was able to accept the necessary amount of water to pass
Ida Vanhouten
April 2, 1993
an adequacy test on October 9, 1992. The existing wastewater disposal system was
adequate to handle the volume of wastewater from a two bedroom Bed and Breakfast
and two bedroom single family residence. Thus, in accordance with the provisions of 18
AAC 72, Wastewater Disposal Regulations and the Department's guidelines, the
wastewater disposal system serving the facility on Lot 4, Block 3, Thayermoore Heights
is approved for operation. This letter constitutes final operation approval for the existing
wastewater disposal system.
Thank you for your coordination with this Department. If you have any questions, please
do not hesitate to contact me.
�JSincerely,
Keven K Kleweno, P.E.
District Engineer
KKK/cf
Enclosure: As Stated
cc: .;_,, John Smith, MOA/DHHS, w/o Enc.
y
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
XNEW
D0/7'��+'m
❑ UPGRADE
MAILING ADDRESS
"1,
LEGAL DESCRIPTION h1
Lmt .8/ 3 h•� �r�o�-e
LOCATION
NO. OF BEDDROOMS
/f �s
DISTANCE TO:
Well Absorption area
< s
Dwelling
a
PERMIT NO.
O Y
f e,
�Z std
h Z
Manufacturer
Material
No. of co+lmpartments
N Fa-
'eB
V
Liq. capacity in gallons
Z
IF HOMEMADE:
Inside length
Width
Liquid depth
OGZ
TANCE DISTO:
Well
Dwelling
PERMIT NO.
Oz
F
Manufacturer
Material
Liquid capacity in gallons
OJ=
DISTANCE
Well
`��
Foundation
Nearest lot
t
P�� IT N57
&Wz44r2?
zk�
�LL
No. of lines
Length of each ting
Total length of lines
Trench width
Distance between lines
1- Z G
-
•
N inches
•---
F
Top of rile to finish grade
Material beneath rile +
Total effective absorption area
o
/O
JZ"ys �� !' inches
Cr"3!� tl7`
Length
Width
Depth
PERMIT NO.
w
C7
I H
Wd
Type of crib
Crib diameter
Crib depth
Total effective absorption area
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO:,.
J
DISTANCE TO:
Building foundation
Sewer line
Septic tank -
Absorpvonarea(s)
OTHER
-
PIPE MATERIALS
1J
SOIL TEST RATING
INSTALLER -
1
CA GL
REMARKS
w
O•e•H•4••• �®®
P
Z /
JES
•
a d
2 3• D
As
x •i �S�d i
APPROVED • LEGAL
-
2-,i 3 Inev. 3i78i
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET+ ANCHORAGE, AK 9950$' "f
264-4720 ANCHORAGE 594-2131 : EAGLE- RIVER
PER111T NO. 831.132
APPLICANT: 'DON THOMAS PHONE: 561-5500 ry
ADDRESS: 2818 E 20TH
ANCHORAGE, AK 99504
LEGAL DESCRIPTION.- SUBDIVISION:
LOT '.SIZE 0 SQ. FT. TOWNSHIP: - RANGE: -. SECTION: -
'mAXIMJM NUMBER OF BEDROOMS = 0 SOIL RATING = 0 0 0"(SQ. FT. ZBR)
LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING.YOUR SEPTIC x7
SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE.,
- - - - - - - - - - - - - - - - - - - - -
--
-- -- - -- - - - - -- -- - -- - -
i CERTIFY THAT:. - - -
1. I AM FAMILIAR WITH THE.REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SEt
FORTH BY THE MUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA.
`2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIyED
iA'COPY OF THE CODE SUMMARY AND DIAGRAM ATTACHMENTS WHICH IS PART OF THIS
PERMIT.
:I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE' ENLARGEMENT IF. THE.
,,RESIDENCE IS REMODELED TO INCLUDE MORE THAN, O'BEUROOMS. i,
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DURING
'THE INSTALLATION INSPEC'TION'S OF ANY WELLS ADJACENT TO_THIS:PRaPERTY'AND '
%THE NOMBER OF RESIDENCES THAT THE WELL WILL SERVE.
IF A_LIFT STATION IS INSTALLED, AN ELECTRICAL PERMIT AND INSPECTION MUST .j
6E OBTAINED. AS-BUILTS CANNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION'•
REPORT. THE ELECTRICAL WORK MUST BE DONE BY A LICBNSED ELECTRICIAN.-
,SIGNED:
LECTRICIAN.,SIGNED: 4
-----------------------------------
APPLICANT.: DON THOMAS
'ISSUED BY: DATE:, 12Zi4183
s;
1CY,
x+ -•i
to
,
i
OF ANCHORAGE Ib-21Departmen#U51aCIPALITY
thand Bnvironmenta rotection825Street, Anchorage, AK. 5501
264-4720
Permit # vJ 11� Y # # # HANDWRITTEN PERMIT # # #
ON-SITE SEWER PERMIT
Applicant:�on-1 Mailing Address/� � U
Location:
Legal Description:
Type of Soil Absorption System Is:
Trench: /,, Drainfield:'_,
Maximum Number of Bedrooms:
Phone Number:
_ _ _ _ S
tot Size:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) /,Sd
The Required Size of the Soil Absorption System Is:
DEPTH c (�P / LENGTH SD I �_ GRAVEL DEPTH Yom' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = j GALLONS # #
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.
* # * TWO(2) INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a -private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 * * *
I certify that:
(1)
I am 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 codes.
(3)
I understand
that the on-site
sewer system may r uire enlargement if
the residence
emodeled to
include more that 3 edrooms.
sign eL�
?=
Issued by:
pplicant
Date:
SWP_/024(1/81)
JAMES B. ROBERTS, PE, RLS
• ENGINEER SURVEY l SOILS LOG
• - 1207 EAST 74TH AVEN
ANCHORAGE, ALASKA 99502
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: 2Di1/7 DATE PERFORMED:
LEGAL DESCRIPTION: GOT Q '44 * , -, �Iz/
!-lu�U9
SLYPE SITE N
1
2
3
4
5 v
6 C7�
7
8 � o
9
v
o
•o.
•CSP.
12
o..
13
14
yz5 3f�/.3/L
i5DSr�B.2
WAS GROUND WATER �O
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? 1vZ14
Reading
Gross
Time
Net
Time
Depth to
Net
`pate
`o
Water
Drop
PSE
..F 4,Lq
s�
ISI&E
r �
Sw
20'� 0n>Tv�"s
PERCOLATION RATE (minutes/inch)
J TEST RUN BETWEEN FT AND FT
COMMENTS .PGG O/J'lis7G/?O Ti^G17G`i �7'�7�4JPGi9 %� r Z� 6PO�iGf
PERFORMED BY: t/A-Z' CERTIFI
72-008 (6/79)
1, .. a WELL LOG
Date Drilleds March 13,1984
Static Water Level9-1,r feet Gallons Per Minute 30
Draw Down_ as NA feet
Type Material Drilleds
Total Feet of O•asin&131
0 feet to in foot gnYd,n., / �rAvpl
1n foot to AS fact q.,d" rlov
175 foot to
to
Hefty Drilling
S.R.A. Box 1553 H
Anchorage,Alaska
99507
a
Lot 4
blk 3
Thavermore Heights
F�/,�, 0NT�O OF AN
'� aRO�GF
OCT 7 ., TecnovP
e
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
625 'L' STREET; ANCHORAGE, AK. 99501
264-4720
WELL_ F EF;;�M I T
PERMIT NO. s 800062 7
APPLICANT BEN KRLYKQWSKI f �j3 1001 BONIFACE PKWY #10F 99504 333-7487
LOCATION RUSSELL CIRCLE ii4
LEGAL LOT SIZE 25000 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
1.00 FEET FOR A PRIMATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIMATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET..
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.
F•EFRM I T E}4F' I FRES LSE EMF3EF2 :3:1:s X5 0
I°CERTIFY THAT
1: I AM 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.
SIGNED
APPLICANT BEN KRZYKOWSKI
ISSUED BY ------------------------------ DATE -y -a - A_a --- V4.0
'LJ A FARC kuru!
M�IIN I C I P FiL I T4' OF 1=1 MCS HaMIZ4 iE
DEPARTMENTS(QHEALTH AND ENVIRONMENTAL OTECTION
825 L STREET, ANCHORAGE, AK. 9 1 01'e-0 c, ate-c�
264-4720e
WELL- - - F}ERM T'T
PERMIT NO. C ) _-a �3 3 2y(J'/
6n�rrf�t' /OF
APPLICANT-�'�- K�
LOCATION -�� 4400"
0 6 3
LEGAL L� 1 h fj.y r r 7) Jc "
LOT SIZES S-6 Ob SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: _
MAXIMUM NUMBER OF BEDROOMS = - SOIL RATING (SQ FT/BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
OEF=`H= LEMC3TH- 13RAVEL f7EPTH�
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
RE:Gl J I FZEC} SEPTI C TIRFVK 1510a- r3F4LL0M4Z
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.
--- TWa C 2 > F1FZM REQU I ME:E} -
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL; OR
150 TO 200 FEET FROM A 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.
PEF:ZM I T E}{P I RES L?ECEMaaFZ 3 3..
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
3Sr?'9
AND WELLS AS SET
ENLARGEMENT IF THE
Municipality of Anchorage
n -Site Water and Wastewater Program
r (907) 343-7904
t
Certificate of On -Site Systems Approval
Parcel I.D. 015-081-11
1. GENERAL INFORMATION
Expiration Date: I - 1,�! '7
Complete legal description THAYERMORE HEIGHTS BLK 3 LT 4
Location (site address) 7220 RUSSELL CIRCLE ANCHORAGE AK 99502
Current Property owner(s) MALCOLM BULL Day phone
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING: x
USIVj
® Single Family (w/wo ADU) l J
❑ Duplex JUN Y
F] Multiple Dwellings (Single Family and/or Duplex) 7 2014
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: NONE Distance: --
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $Q_ct/Sh Waiver Fee $
Date of Payment �, �!`1 I �- Date of Payment
Receipt Number OReceipt Number
COSA# nSclq X24•`{ Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
_jZ System #1 Approved for _1i bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 279-3916
Date 6/13/14
4SPURKLA!,
OFAt
ef
i G
Z_��
"i D •w j
p �r"..
��
Conditional approval for bedrooms, with the following
By: Original. Certificate Date:
The AA icipap Q Anc ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue ahem f ., c
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: THAYERMORE HEIGHTS BLK 3 LT 4
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWS ID #_
Date completed 1984 Sanitary seal (Y/N) Y
Total depth 131 ft. Cased to 131 ft.
FROM WELL LOG
Date of test 3/13/1984
Static water level 90
Well production 30
WATER SAMPLE RESULTS:
fid
Coliform NEG colonies/100 mL Nitrate 4.82 mg/L
Arsenic ND ug/L Date of sample: 6/2/14
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date of pumping NEW
C. ABSORPTION FIELD DATA
Depression over tank (Y/N) N
Pumper
Parcel ID: 015-081-11
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
5/28/14
88 ft.
132
g. p. m.
Collected by: ANSON MOXNESS
Date installed 6/12/14
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date installed 10/84 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type TRENCH
Length 53 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 18 ft. Eff. absorption area 636 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5/2/14 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600 9 p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
in. "Pump off' level at _
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tank/lift station on lot 100'+
Absorption field on lot 1004
Public sewer main NA
Sewer /septic service line 25'+
Animal containment areas 50'+
Manhole/Access(Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots100+
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 51+
Water main NA Water service line 10'+
Wells on adjacent lots100 +
ABSORPTION FIELD ON LOT TO:
Property line 0* Building foundation 10+
Water Service line 10'+
Curtain drain 50'+ (N.O.)
F. COMMENTS
*WAIVER ON FILE
G. ENGINEER'S CERTIFICATION
Surface water 100'+(N.O.)
Wells on adjacent lots100 +
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKLAND
Date 6/12114
COSA brown sheet -1 0-10-1 2.doc
Absorption field 51+
Surface water 100'+
Water main NA
Driveway, parking/vehide storage10+
no
.. 11
/ ..... „ /
AR SPURKLAND.
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MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # !` I �,-( 1— 1 \
1. GENERAL INFORMATION
HAA # Q', Cl :) ",7 �4
Complete legal description C o ` `4 alar k 3 TAcAv ei rrGrL ff fy
Location (site address or directions) 7,2 20 h'urrell Ccrr!
Property ownerL're✓in SnyoCer Dayphone Yo 276-2776
Mailing address Yo ERA P Rear _=r/-
Lending
shLending agency r^y f7/}C Day phone S6 2-Z161
Mailing address y6O rte. T< ac r Ra. An cbor«mit �4h p9So 3
Agent Bae4cz'a Bowden - ERA Rsrl ESI�16 Day phone 276'2_77
Address 270 2 6:am 6 -ell Sf.. ,¢^chone^ rq-k 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
y
✓
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site ✓
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Ront MllAml
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 Phone 345- - 13SS
Address /HS3o Echo S�. /4nchazrge
Engineer's signature f ni� Date Z6 /2 6/9 2
$� 0r A4.ht 4
. Tr'cOut
6. DHHS SIGNATURE
\' Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
M
ZILTT[',
bedrooms, with the following stipulations:
Date _//�4L
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev 1/91) Rack MOA qi
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lor 4 RLK 3 . TdAYeeMoo2e Parcel I.D.
A. WELL DATA
Well type FRwRTc If A, B, or C, attach ADEC letter. ADEC water system number N. A .
Log present (Y/N)Date completed 3113/8Y Driller NEF?Y DRIL(rNG
Total depth 13:1 Cased to 13 I / Casing height 2'f ,e
Sanitary seal (Y/N) Y Wires properly protected (Y/N) y
FROM WELL LOG AT INSPECTION
Date of test 3 ) 1312 Li
Static water level 90 9 I ✓
Well flow 3o g,p,m. N. ! -r
g.p.m.
Pump level > 91,
SEPARATION DISTANCES FROM WELL TO
Septic/holding tank on lot 1 15 , ; On adjacent lots > !00
Absorption field on lot I lS r ; On adjacent lots > /00,
Public sewer main N.A. Public sewer manhole/cleanout N.A.
Sewer service line 105 Petroleum tank NDNE o 3s ERvE b
WATER SAMPLE RESULTS:
Coliform O co ( levo." { Nitrate 2• /m a It Other bacteria O co/ lroo M
Date of sample: !o /9 /-12 Collected by: FLATTOP TEc if 5✓cs
B. SEPTIC/HOLDING TANK DATA
Date installed 10123 Z_� Tanksize 125° GAL Compartments 2 /
Cleanouts (Y/N) Y Foundation cleanout (Y/N)
High water alarm (Y/N)
Date of pumping to / 2y / 92 i
Alarm tested (Y/N)
Depression (Y/N) AI
N.A,
Pumper =sera'_
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
r ,
Well(s) on lot1 On adjacent lots > /oo Foundation I Z
To property line 6 • Absorption field 3 Water main/service line > eo'
Surface water/drainage
72-026 (Rev. 7191) 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/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water _
Date installed 10/ 53 Soil rating ISo 13 / BDRM System type TRENcy
Length 53 Width 34 Gravel thickness Total depth i(o1 PER AS -BUILT
Total absorption area io36 to Cleanouts present (Y/N)
Depression over field (Y/N)
Results (pass/fail)
Date of adequacy test 101419-4 i
for
Peroxide treatment (past 12 months) (Y/N) NoNE KNowN If yes, give date N•A
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO: otecl sa pJ.�
Well on lot IIS On adjacent lots > /1OProperty line O
– To building foundation 2S To existing or abandoned system on lot NA
On adjacent lots > 3o Cutbank N•A � Water main/service line :>
Surface water
Curtain drain f{DNE oaSERVEiD
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature f 9R4- -c s *%� d AFH �� e •:.'
D.....................i..
Engineer's Name Thec,cPo2 F. Kaa��j �,y
Date �Gi�G/ 26� 09 2 :7HEODORE F, MOORE;
CE -35E9 % �• f, d
Ti N ••.a..•••
e4," 4V
HAA Fee $ 17b ' 0O
Date of Payment /d —Z k —4? L
Receipt Number ?=A/,?4 � Sf`�✓
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
• 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 nn
264-4720
Application Date 31-71 / S
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Vcclz 3 /r S /D
Location (address or directions)
7Z7 -O R.are tI C r[IG 4nc4or-cty
V
(b) Applicant Name r=ed,414dka Fidero/ C -U -Telephone: Home Business 276'-101/
Applicant Address Pouch 7-SoS Anr4c/-ago /+k9gslo
J �
(c) Applicant is (check one): Lending Institution ®; Owner/builder 19; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Cen {raj f' Ma, - 'i t e Telephone e' 9'
/- 930
Address hrl1OO 04d S'CUJQrC( *y4wuy _ S�+<,<< 103 Anc.ho.¢yc ¢9so3
v -
(e) Real Estate Company and Agent� aam is Rea 11-y - Grncla- /iu !/
Address �f w• Ata ftiun G < kfy 4nckor' �!z 99s-r�3
Telephone 2 79
(f) Mail the HAA to the following address:
(N� rd :rT 'o' e
2. TYPE OF RESIDENCE
Single -Family S Multi -Family ❑ Other
Number of Bedrooms I/
3. WATER SUPPLY
Individual Well R1 Community ❑ Public ❑
Note: If communitywell system, must have written confirmation from the State Departmentof Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite 9 Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11;84)
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MUNICMPN'1ALOER VICES
•
ORI
ENVIROhM-
MUNICIPALITY OF ANCHORAGE (MOA)
�� 198
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
RECEIVED
264-4720
Lo f '/
Legal Description: Stock 3
TAVeriooere lfetghff S/�
A. WELL DATA
Well Classification Prrva1-e If A, B, C, D.E.C. Approved (Y/N) M:A.
Well Log Present (Y/N) i Date Completed 3113 IS Yield __30 0aer
Total Depth 131 Cased to 131 Depth of Grouting X. A•
Static Water Level 4Y' Pump Set At G(n /r
Casing Height Above Ground 2 `to Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Depression Around Wellhead (Y/N)
On Adjoining Lots
To Nearest Edge of Absorption Field on Lot Its" ; On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Manhole
— To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
oI
Water Sample Collected by TI t Date 3 /aY / A 7
Water Sample Test Results i4 o#- o%Ae/r bcrc�tric( `�
Comments S4ac(y IF H•6 aP" nmxes no snecuaraL/�
J �/
�ra t✓ olo wn a f wa Ft !c �t / i4 u e U
B. SEPTIC/HOLDING TANK DATA
Date Installed 10/63 Size IIS -0 cyal No. of Compartments 2
V
Standpipes (Y/N) Y Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) N Date Last Pumped 3 /So / 6 7
Pumping/Maintenance Contract on File (Y/N)
for
Holding Tank High -Water Alarm (Y/N) N• A. Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well tis' To Building Foundation le r
Al.
To Property Line •G' To Disposal Field
3'
To Water Main/Service Line N• 14, To Stream, Pond, Lake, or Major Drainage
Course __ > too,
Comments Rvaleta anex sfrarah/c9.aC c.a. 46 allow accc-cs 6
Pfrdf cOA.I'q r-AmenF 3/L7(67
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata f SO a' Type of System Design -neem c S
Date Installed fa 163 Length of Field r:y
Width of Field 3 y" Depth of Field 16 ` 1ee� of - y , r F
Gravel Bed Thickness r
Square Feet of Absorption Area 6 -76 Standpipes Present(Y/N) Y
Depression over Field (Y/N) /V Date of Last Adequacy Test 3127 /87 - 3 / 7o/ a 7 c�
Results of Last Adequacy Test A!ft rruafe gar. y 4 ea(�c _r
Separation Distance from Absorption Field:
To Water -Supply Well tt S ` To Property Line O
To Building Foundation 2S ` To Existing or Abandoned System on
Lot N. A. On Adjoining Lots ,� 30'
To Water Main/Service Line N.A- To Cutbank (if present) Al. A.
To Stream/Pond/Lake/or Major Drainage Course > too,
To Driveway, Parking Area, or Vehicle Storage Area 160
Comments _-Bepai;�ec( benf� b roh e «nd Lv ed Mon fei- A+ 14er «i
wasA f- WerA en 6G a A-c'o � french 1-ten'Aoe li�t6e a/ las/ end e04
foe )4-ene/1 it 04 -t*e 5o"fA Pe re -Ay 1i'ee.
D. LIFT STATION N,A,
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 certifythat II havechecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed '%' Date 3131197
Company F4xAfi% Tech S'ver MOA No. 66 o6Z
Receipt No. o? ` O O /--0 O
'/ r �® g�9
Date of Payment z �— d 7 .�� OF At�n�
3'1'/ o�C
Amount: $ X Z ��}._ a e ® Engineer's Seal
Page 2 of 2 �y ..T F•r;o
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Municipatty
of
Anchorage
April 3, 1987
PAX 196650
ANCHORAGE, ALASKA 99519-6650
(907)264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Lot 4 Blk. 3 Thayermore Hts. Subdivision
Waiver Request WR87-025
Dear Mr. Moore,
Your request for extending the existing property line
waiver, for the subject property, has been granted. The
separation distance has been waived to zero feet in this
case. This waiver is based on the information provided our
office and is valid for the existing four bedroom single
family dwelling only. Any upgrades or enlargements of the
existing system will invalidate this waiver.
Sincerely,
Z
Daniel N. Bolles
Engineering Tech. III
On-site Services
cc: Gus Andress, P.E.
Manager, On-site Services/ Water Quality
•
CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 April 1, 1987 ANCHORAGE, ALASKA 99516
M.O.A. Dept. of Health and Human Services
P.O. Box 6-650
Anchorage, AK 99502
RE: Waiver to property line - L4, B3, Thayermoore S/D
Dear Sirs:
On January 17, 1985 your department issued a waiver allowing
the wastewater disposal trench serving the subject property to be
within 2 feet of the property line, based on a survey of the
position of the monitor tube. At the time of my adequacy test of
this system, on March 28, I found the monitor tube to be non-
functional due it's having been bent over, and partially filled
with soil. I had the tube entirely dug up and replaced, and a
new survey done to verify it's new location. This survey showed
the tube to be right on the property line. Since this represents
the apparent extreme extent of the trench, and the property
owners to the south have indicated their non -objection to the
granting of a waiver, I request that you extend your waiver to
allow a zero foot offset from the property line in this case.
Please call me if you have any questions.
cc: Linda Ball, Dynamic Realty
Dana Burger, FedAlaska
Sincerely,
Ted Moore, P.E.
per�,,®® • O �9
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Anchorage
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(907) 264-4111
T ONY KNO b'/LES.
F/A YOH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
September 5; 1984 �,,.✓� ��
Mr. Don Thomas ?
2818 East 20th Avenue
Anchorage, Alaska 99508
Subject: Lot 4 Block 3 Thayer mv=osg Heights Subdivision
We have received your engineer's as -built drawing of your
sewer installation. The engineer originally had requested
a lot line waiver. The as -built, however, shows that the,
trench actually crosses the lot line on the south. This
Department will not write waivers across lot lines. We
are also informed that the system was actually installed
in October 1983 without benefit of required inspections.
You are now required, within seven(7) days, to obtain a
new permit to move the trench. The existing trench will
have to be properly abandoned -As part of the permit you
must conform to the requirement of two(2) inspections on
the new trench.
If you have any questions, please call this office at
264-4720.
Sincerely,
Susan Oswalt
Engineering Tech III
SO/ljw
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION MR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
F-. I (r • { �L,c-" Via,;- � N r�-F,-t'.�L•[=. d L q--,t�. P� �� `) `=�';=s
14v
(b) Applicants Name ( `I �''r l �' Telephone
Applicants Address_[
(c) Applicant is (check one) Lending Institution Owner/builder
Buyer F�::j ; other (::� (explain);
(d) Lending Institution Telephone
Address
(e) Peal Estate Co. & Agent 1\"� 'f�__--
Address
Telephone
2. Type of Residence
Single -Family Ezi Multi -Family Other (describe
Number of Bedrooms
3. Water Supply
Individual well r]7f Community Public
Note: If community yell system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the Xll adequate for the number of bedrooms specified in this HAA (Y/N) 'err
4. Sewage Disposal
Onsite Public Community Holding Tank
Is the wastewater disposal system adequate for the number of bedrooms (YIN) ("-
[Page 1 of 21
2-15-84
5..Engineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, or
effect on the date of this -inspection.
�/
Signed % `%/ fes- �_� 2
l
Name of Firm ✓?1': ,=.. s `i>fi= }"y lal„Telephone
conformed to all NIDA HAA Guidelines in
Date
—;.- .'../r'<
Address
Signed by
Via® ®� �
Date j ! r.”
e
. n
*....
® ..
.� r-�✓ /4 /....
(ENGINEER SEAL)
. •• ••Lir•• v'
Q JAMM 8 RODERl9
CE -1516
6. DHEP Approval
Approved for bedrooms By
Date
Approved Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Environmental Protection does
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedroom and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address-
KB2/d5/s
(Page 2 of 21
2-15-84
f
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
JUL 17'0?
Legal Description: Lcfi L/ `.� / </< .'z
Well Classification -iy2 If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (Y/N) Date Campleted ? - W sy Yield
Total Depth iii Cased to I3t Depth of Grouting
Static Water Level %'G Pump Set At
Casing Height Above Ground Sanitary Seal or. Casing (Y/N)
Electrical Wiring in Conduit (Y/N) y c.s Depression Around Wellhead (Y/N) /;n
Separation Distances frau Well:
To Septic/Holding Tank on Lot /1S / On Adjoining Lots Gc r
To Nearest Edge of .Absorption Field on On Adjoining Lots
To Nearest Public Sewer Lire Iy 9 To Nearest Public Sewer
Cleancut/Manhole /✓ F To Nearest Sewer Service Line on Lot !,,x
v -
Water Sample Collected By _; Date 1
Water Sample Test Results mu s/ T—,
Cam -ants
B. SEPTIC/HOLDING TANK DATA
Date Installed ',O �� i Size lZf�TGk'�L- No. of Canpartments 2
Standpipes (Y/N) Air -tight Caps (Y/N) `SLS Foundation Cleanout (Y/N) -ice
Depression over Tank (Y/N)y_rDate Last Pumped
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (YIN) \; Temporary Holding Tank Permit (Y/N) G
Separation Distances fran Septic/Holding Tank:
To Water -Supply 1%bllTo Building Foundation
i
nE s
To Property Line lj,tn t <;.. To Disposal Field
To Water Main/Service Line Lala To Stream, Pond, Lake, or Major Drainage
Course 1s.
Commnts
[Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata I -: '] Type of System Design
Date Installed Length of Field logr•j`
Width of Field _ j '' Depth of Field _ 1061
Gravel Bed Thickness Cf
Square Feet of Absorption Area Standpipes Present (Y/N)
Depression over Field (Y/N) Date of Last Adequacy Test
Results of Last Adequacy Test IU4q
Separation Distance frcm Absorption. Field:
To Water -Supply Wall 1L:7;re To Property Line 7
To Building Foundation 0�- 2 -') To Existing or Abandoned System rn
Lot 1LG�iL On Adjoining Lots 15c'+ y
To Water Main/Service Line To Cutbank(if present) i//
To Stream/Pond/Lake/cr Major, Drainage Carse ivc;
To Driveway, Parking Area, or Vehicle Storage Area 7L
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Camments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MDA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or, conformed to all MOA HAA Gu
on the date of this ins ior%
r
Signe jM41-
i
Company I ' t CE I?LSMOA No.
KB1/d5/s
[Page 2 of 21
in effect
.�............ :..... :
JAM!® 8 NOBEWS
CE -1516
<i
IATN ®
2-1584
October 9, 1984
Municipality of Anchorage
Division of Environmental Health
Fourth Floor West
825 "L" Street
Anchorage, Alaska 99501
Gentlemen:
We hereby certify that we are the owners of Lot Four
(4), Nettleton Subdivision; that we understand that the
absorption trench installed on Lot Four (4), Block Three (3)
of THAYERMORE HEIGHTS SUBDIVISION extends across the common
line between these respective lots onto our property 0.6
feet as shown on the attached on-site Sewage Disposal System
and/or Well Inspection Report prepared by James B. Roberts,
P.E., Registered Civil Engineer; and that we voluntarily and
of our own free will grant an encroachment easement for this
installation to remain.
JANI D. SIEFKER
