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HomeMy WebLinkAboutUS SURVEY 3200 LT 10B1Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191407 PID Number: 090-041-49 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name DEREK HELMERICKS ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bedound Site Address 170 HUOT CIRCLE *INDIAN, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-460-2509 3 GPD/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot US SURVEY 3200; LOT 10131 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Tol Septic Absorption LIR Station Holding Sewer Tota( orption area Number of trenches Dist. between trenches From Tank Field Tank j Line Ft2 Ft. Well 1001+ TANK © Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1000 Gal. Surface Water *40'+ Material Number of compartments i Lot Line 5'+ I NA HDPE 12 Foundation 101+1 I LIFT STATION Manufacturer Capacity i Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR "WR#910032 - SEE ATTACHED LETTER Alarm location Electrical installed by PIPE MATERIAL House to tank EXISTnn6� drainfield Tank to ' D3034 'S� Installer WILCO EXCAVATION Drainfield D30341EXISTING Co/MTD3034 Inspector DAVID GARNESS, PE AND TIM ECKLUND BENCH MARK (Assumed elevation) 100.00 ft Inspection 15' 4/8/2020 - Location and description 2 d TOP OF MH YJ _ 4"'-�— ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer' Stamp _0060 Opp Conditional Approval: Date �T �O �.... i ./ .................. .. ._1: t . . ........... ........� . Septic System 1�r� f� �+� ress.c �(� qs nn . } Approved J�-VC L;( 9�. l Sity ` Date I (? CE 95 QOQO �� f4. 6 �4 Note: this approval does not include well permit requirements. �Ofess'oc=a #AECC88X0000 (Rev u5/uZ/l t9) PERMIT NUMBER: PARCEL ID NUMBER: OSP191407 RECORD DRAWING 090-041-49 STANDING WATER TO THE EAST AS NOTED ON THE \ DESIGN WAS NOT PRESENT DURING THE \ ENGINEER INSPECTION ON 4/8/2020; IN ADDITION, NO WATER WAS NOTED RUNNING THROUGH THE CREEK EASEMENT/INTO THE CULVERT THERE WERE ADDITIONAL SURFACE WATERS TO THE WEST; DUE TO THIS FACT, THERE WAS AN AMENDMENT TO THE EXISTING WAIVER. THIS WAS DISCUSSED WITH THE MOA ONSITE DEPARTMENT AND APPROVED PRIOR TO INSTALLATION - SEE ATTACHED LETTER. IT SHOULD BE NOTED THAT THE SURFACE WATERS TO THE WEST OF THE TANK WERE NOT PRESENT DURING A GEG SITE VISIT ON 671/2021 USS 3200; LOT 10C /a NEW 1000 GALLON HDPE GREER TANK RATED FOR 10' BURIAL - v I EXISTING 3 / I BEDROOM / I HOUSE A DRIVEWAY '•'• 4. kl- • 19 33\ EXISTING STING DRAINFIELD \ •`' DBL MH DBL 2 O ST1 / TMT ° BL3 BL / F • CO1T1 / MM Z iI- USS 3200; LOT 10A HUT _ E '--__-•�..___`_ 1MP�� 100 ��� � C PPP eLU74' -. „� •._, _�, ..._ �/• ENGINEERING-, SALES - CONSULTING 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907) 3375179 • FAX (907) 336-3246 • WEBSITE —gam—ngheemg.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DEREK HELMERICKS 907-460-2509 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: US SURVEY 3200; LOT 10 B1 D.J.G. TYPE OF WORK: I DATE: � SEPTIC TANK RECORD DRAWINGS 6/25/2021 T'] ;. .. .. Ga ss kv -797 'y 72 Z4, i1�', �FE5S\�•�••� LICENSE #AECC884 MB PERMIT iVt 140 RECORD D RAW I N G PARCEL ID NUMBER: O'S 7) 090-041-49 TOP OF MANHOLE = 100.00 FINAL GRADE = 98.09-99.14 MH ST2 2" INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 95.25 TOP OF TANK AT OUTLET = 95.24 NEW 1000 INVERT OF BUNG AT INLET = 94.63 GALLON H. D. P. E. INVERT OF BUNG AT OUTLET = 94.54 SEPTIC TANK NO GROUNDWATER WAS ENCOUNTERED DURING SEPTIC TANK EXCAVATION PER CONTRACTOR. OF• J ENGINEERING, SALES CONSULTING i 3701 E. TUDOR ROAD, SUITE 101 "ANCHORAGE, AK 99507 • PHONE (907) 337-6179' FAX (907)335-3246 - WEBSITE. —g.——g— nngcom ...... .. ............. ; PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DEREK HELMERICKS 907-460-2509 3 OF 3 ��: . e re.............. . . Garn , s "� wAV LEGAL DESCRIPTION: �♦ �� C -7 53 •; �_� DRAWN BY: �♦ F,�,"'•.�; / �Zl%.•'' US SURVEY 3200; LOT 1081 D.J.G. TYPE OF WORK: DATE: LICENSE �a pROFESS������• SEPTIC TANK PROFILE 4!2712020 #AEcc884 ���YA%Iklk GARNESS ENGINEERING GROUP, Ltd roCe l ENGINEERING SALES = CONSULTING>.7.., April 27'", 2020 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: US Survey 3200; Lot 1061 -Waiver Amendment WR#910032 To whom it may concern: During the engineer's inspection at the subject lot on 4/8/2020, it was noted that there were additional surface waters to the west. This is in addition to the "duck pond" that was previously noted on the design. These surface waters were approximately 42 feet from the proposed tank. During the installation of the septic tank, this waiver amendment was verbally approved by MOA onsite employee Rebecca Carrol. Justification for granting this wavier amendment are as follows: • The grade from the surface waters and the new tank are such that if effluent were to overflow, they would not travel towards the surface waters to the west (see attached photo). • The driveway is located between the new tank and surface watersJ effluent were to overflow, it would be evident to the owner/resident and corrective action taken. • The old tank is close to the surface waters and is steel. The new tank is an improvement in separation and material (HDPE). • The surface waters to the west are believed to be intermittent. • The old tank had likely encroached upon these surface waters for the life of the tank. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. '.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 W a 0 Q 7— 0 I- (j a V LU O a F W Z .0 M o Y �. O V0)V,aj O�WQ r- LLJ Li JV' ZOO v)H00 F < O O_Jzz -jLaQ W W U r 0J V w _o w M ui ~ 3 N 0.. W W of ° } a o V CO L,)> &5 J IM U C m w> > O <UJ FW... d3 Z O' G J 4 U) U 5 — a p z u w u`)i m J W Q w x V O m z V z o w Lu -ja®<� <�®® I 9 -ZCIA E4 . .,Go a M uj r , * y , v , , 7 , a tp 9e � � 4 Z4to 00 C*4 Co CL c Ul) C14 64 c to x mLO26-ozos3tt c tool 0 G a Co c c to x c tool 0 0 0- 0 0 0 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191407 Work Type: SepticTank Upgrade Tax Code Number: 09004149000 Site Legal Address: US SURVEY 3200 LT 10131 GA455 Site Mailing Address: 170 HUOT CIR, Indian Owner: HELMERICKS DEREK J & CYNTHIA L Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: y/7/zo u7 n n Depa1,till ent 9/11/2019 9/10/2020 49545 ❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing — Special Provisions: Wavier #WR910032 is re -issued to apply to this tank replacement. As stated in the original waiver, if at any time the wastewater disposal system contributes to the degradation of the water quality of the applicable surface water features, this waiver will be considered void. - S1rw t t1 1,v. 9 an b su,1� e�- . y'q /zo zA Received B� Issued By: Date: Date: �11CI1C Municipality of Anchorage Department 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 * x * * Waiver#: WR910032 COSA#: Permit#:OSP191407 PID#: 090-041-49 Legal Description: US Survey 3200 Lot 10131 Engineer: Garness Enqineerinq Group Applicant: Derek & Cynthia Helmericks Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the surface water has been approved. The approved separation distance is 40.0 feet. This waiver amends the tank to surface water waiver originally granted in 1991. The tank is located down - gradient from the surface water and the replacement tank is plastic, so should not be subject to leaking. As noted in the original waiver, if at any time the wastewater disposal system contributes to the degradation of the water quality of the applicable surface water feature, the waiver will be considered void. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ..............................................................................t Waiver is Granted: X Waiver is not Granted: Date: J�?Ix2o Approved by: J CQ_'�Ux_ ame of Reviewer .....................................................................11........t **** VARIAN C E/WAIVE R REVIEW **** MUNICIPALITY OF ANCHORAGE78 �-u �►. Community Development Department Phone: 90,-,43- 904 2019 Development Services Fax: 90 3-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan a 8 L 9 5„ ,yOn-Site Sewer/Well Permit Application 0 9 6-6Ltt For A Single Family Dwelling Parcel I.D. 0 01 Property owner(s) DEREK HELMERICKS Day phone 907-460-2509 Mailing address 170 HUOT CIRCLE 'INDIAN, AK 99540 Site address 170 HUOT CIRCLE *INDIAN. AK 99540 Legal description (Sub'd, Block& Lot ) USS 3200; LOT 1081 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ ® (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal 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) Permit/Rush Fees: 61.aS Waiver Fees: Date of Payment: c1110119 Date of Payment: Receipt Number: cc n 0531x11 C9 Receipt Number: Permit No. Q5p/q I qU T Waiver No. (Rev.01/111 If 42' As_ Quanics GARNESS ENGINEERING GROUP, Ltd -,,.,r,„int ENGINEERING SALES CONSULTING p September 3, 2019 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for USS 3200; Lot 10B1 To whom it may concern: The existing 3-bedroom house is served by a private well and septic system. The septic tank is 36 years old and needs to be upgraded. We are proposing to decommission the existing 1,000- gallon steel tank per UPC and install a new 1,000-gallon Greer HDPE septic tank in the same vicinity. There have been surface waters noted in the past to the southwest of the property, and on the east portion of the lot (by land surveyor Fred Walatka, PLS); however, during our site visit on 8/29/19, the only surface waters noted in the area was at the discharge point of the culvert on the southeast corner of the lot. Although, the surface waters previously noted are not evident at this time, we are still requesting your department honor the existing waivers (granted July 22, 1991) in place from the old septic tank for the new replacement septic tank. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, Jeffre; A . arnes ,-P.E., M.S. Presi•- 3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com P1 USS 3200: LOT 9 111111 1.J LL RADIUS I SEPTIC AREA 200' . - - .111 14161,100' vs.x__ No it. 10 ....• 10.441•DIUS �• 1 asippi 1110 Ill USS 3200; IF LL RADIUS LOT 10C »;J , y.•,,.: , ,1r `.M'I���.yY. IG�se- ilir USS 3200: 4 LOT 10D �, - 3200: NOUT CIRCLE _'', LOT .. �- SEPTIC AREA USS 3200; LOT 13A USS 3200; ,:::: 1 LOT 13B0 100' T •.•• VACANT VACANT 1"=10' USS 3200; LOT 13C A 41'44 1.' \'� • f♦f. -I\ c `'i• • •. GARNESS ENGINEERING GROUP, Ltd *` I.� -* ENGINEERING SALES CONSULTING ' . ' or 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE.AK 99507•PHO,J•lE(907)337-6179•FAX(907)338-3246'WEBSITE:www garnessengineering corn .... • • 0 PREPARED FOR: PHONE NUMBER. PAGE NUMBER: ♦ y^ A. t' -•S =•�a DEREK HELMERICKS 907-460-2509 1 OF 2 •j0 i v 79 3 ••_� PROJECT/LEGAL DESCRIPTION DRAWN BY: ♦,.�4,,,••••91L7•�I )' c$. USS 3200; LOT 1081 PNB fff PROF`..... •P\•4 TYPE OF WORK DATE• LICENSE ff II t FESS\ - SEPTIC TANK DESIGN UPGRADE 9/3/19 #AECC884 • C, t / ' __- 1 \ / _ _ � NOTE:CONTRACTOR MUST HAVE GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER THE WEST LOT LINE,ALL WELL RADII TANK DESIGN ONLY THAT PERTAINS TO THIS DESIGN.BY PROCEEDING FORWARD WITH THIS INSTALLATION,THE THAT ENCROACHES SURFACE SUBJECT I / ENGINEER,WELL DRILLER,CONTRACTOR AND \ \ �\ LOT,AND ALL WATERS / / PROPERTY OWNER AGREE THAT THEY HAVE \\ \ INCLUDINGROCULVERT)FLAGGED BYR A PROFESSIONAL LAND SURVEYOR READ THESE SPECIFICATIONS AND AGREE TO \ PRIOR TO ENGINEERS LAYOUT ACCEPT THE TERMS AND CONDITIONS OUTLINED. AND/OR CONSTRUCTION. / L—y, NOTE:GEG EMPLOYEE,PIERCE \\ \ / / BLEWETT,MADE A SITE VISIT ON \ / 8/29/19 AND THE ONLY SURFACE \ Creek uv9cJDtr Esmt. _ / WATERS ENCOUNTERED WERE AT \ /i \ // / THE SOUTHEAST CORNER OF HHE \ / / PROPERTY. \ \ / / I / I / I1 I /I I I °1I - 100'WE -• DUS I / I I 1 EXISTING 3 / ' BEDROOM / \ E USS 3200;LOT 10C 1 HOUSE / IIIIIIIIIII I I / PER LOU BUTERA,P.E.,THERE IS \ �v---" I DRAINAGE FROM A DUCK POND TO •. •. iii{n : • I I 100'WELL RAIDUS THE WEST THAT WE DID NOT \ A• '., , • •.' .• I 1 ' OBSERVE DURING OUR SITE VISIT •' < •r . ' '� I 1 / ' 1 / ON 8/29/19.WE ARE STILL }JR1VdVPY'•, REQUESTING THE EXISTING 52' ::'' - :',•*•s \ / I WAIVER STAY IN PLACE FOR THE •+ -- ` ."48 .--.0..:.,:,.t,.••i•: '• 1 1 / PROPOSED SEPTIC TANK. • . . • ,r•:•• i :'.STANDING WATE:, R WA TKA 1 1 i' .,'::,:•.•.- SURVEYI•= •N 10/18/16(N / •• ` ' • • •• SURFA ' ATER OBSERVED HERE V ••-••" •G GEG SITE VISIT ON 8/2919) 116 -..... PROPOSED 1,O�U 6ALLQN _ �/ ei GREEKHDPESEPTIC TANK— /STOUBLECO'S&FD UMP /EXISTING 1,000 GALLON TANK •BE DECOMMISSIONED PER UP 4�' UM• / \N NOTE:IT IS UNKNOWN WHAT ALL �" EXISTIN N PIPESTIARE AROUND THE / — —b�, •S� CULVET EXISTING TANK.CONTRACTORa, SHALL REMOVE THE EXISTING INSTALL CO&MT PIPES AND INSTALL DOUBLE / —k __ PRE-TANK CO'S,DOUBLE POST / / / r TANK CO'S,A FD,AND A CO AND / N % MT ON THE WEST END OF EACH / / \ USS 3200;LOT 10A TRENCH. // / di \\ / \ 1/607-CIRCI \ S ALE: 1111- IIIIIIIIIWBIEIIIIIISIIIIIIIgs......__ -_, . ,..._ .0.'7 ilk*. t GARNESS ENGINEERING GROUP, Ltd f I •. ao % • ENGINEERING•SALES*CONSULTING -- - • •• 3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AK 99507•PHONE(907)337-6179•FAX(907)338-3246'V�EBSITE:www.gamessengineenng.can ••• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 1/Cn%• •j Ittliii. rtg- DEREK HELMERICKS 907-460-2509 2 OF 2 #•7 C -7 .�• w./ PROJECT/LEGAL DESCRIPTION: DRAWN BY: I '. •4 USS 3200; LOT 10B1 PNB *v� ♦ •' •• t P�-�.� TYPE OF WORK: DATE: LICENSE 4444s"`� ,t44 SEPTIC TANK DESIGN UPGRADE 9/3/19 #AECC884 ' 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 V1AILI NG ADDRESS ~ox lOOO ~ LEGAL DE~CEI~TION LOCATION UPGRADE NO, OFBEDROOMS I o~ I O,STANCETO: IWe" Manufacturer DISTANCE TO; Well Manufacturer / ~o. ol bn~s I ken~th of ~a~h line ~~ ~ Type of crib DISTANCE TO: Well Class Depth Building foundation IAbsorption~area Inside length Dwelling Dwelling Material Width F°undati°~o ! Total ~l~h.of lines Mat eria~,en(~at ~ti le Depth Nearest lot lin~. inches inches PERMIT NO, Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. ~%oo~ Distance between lines Total effective bsorption area PERMIT NO. Crib depth Total effective absorption area : Building foundation Nearest lot line Driller Distance to lot line PERMIT NO, Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS 1%OCAT t'~O 0t-O 'T 12_~ McJ/f LEGAL 72-013 (Rev. 3/781 U.S.G.S. Local I(o. Drilling Permit NO, A.O.L, No. Feet TOD 126 9 l& STATE DEPARTMENT OP RATUP, At John Huot 4- WELL DEPTM: (completed} Surface Elevation D~t cot 128 ~t. 6. usE: ~]Do~sti¢ [~ ;rrlgat ion ~ Recharge CASING: [] T~readed ~Welded ~ i.. to 1.ZS_f:. a~pth ~l*~g~t __5; FINISH OF WELL: 12. GROUTING: Well Grouted: [] Yes J~NO Materia): []Neat Cement E] Other: 13. PUMP: (If available) HP Length o~ Drop Pipe -- f~, ca.city Type: ~ Sub~rslble ~ Reciprocaclng ~ Jet ~Oth~r: X~, V~, aEM^RKS: Bailed for 1 hour ~ 336 drawdown to 97'. _n~.e=. nr~ll4.o AAO512 .... ~e~-is~ereo ~usin~ss Name Con:ract Ligense Number 8537 ~lar. tza12. Anchoraqe. Alaska 99507 PERt,!I T NO. APPLICBNT LOCBTION LEGAL JOHN HOUT U S S 3200 L PO. BX 10-006 ANCH LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING <SQ FT?BR)= t65 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:.EF"TH= tl L E~-~3TH= 62 G FtA%~EL [:.EPTH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND BND THE BOTTOM OF THE EXCBV8TION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFflLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F:E,ZgJ I ~:E[:, SEF"T 1- C: TFib~F: S 1] ZE= tE30~-3 ~.3RLLC~b~S 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. Tb~C] (2:) I ~SPEE:TI C~'----] AF:E F~E~2:JI F: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 ±00 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM ~ 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 THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAIL. BALE TO INSURE PROPER INSTALLATION. PER~4 I T E :---:-"F" i F-:ES [)EC:Et-IE:EF-: --?-1.. i CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH 8Y THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. I'-IL"F,t 'ir ,'--: T, RL Z T"-r" "3F RI'-,ICH~JF-'RGE '(> .... DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /(JL,*,, ( , 825 'L' STREET, RNCHvRRlJE, RK. ~950i 264-4720 14ibb R~-I[:, L']i'4--S I TE SEI-4ER F'iRr4 ][ T PERMIT NO. ( 820990 ) RPPLICANT LOCATION LEGAL JOHN J HUOT USS ~200 LiOB BOX 10006 SO STN LOT SIZE 9S9999 SQURRE FEET TYPE OF SOIL RBSORF'TION SYSTEM IS: TRENCH M~<IMUM NUMBER OF BEDROOMS SOIL RRTING (SQ FT?BR)= ±65 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: [:"EPTH= ~L-1 LEi'-JGTH= e%2 G F-:FP/E L C"EPTH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET), THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCAVATION (IN FEET). KEPT I C: TR~4K: S Z ZE= 'l,-],OEl ,3RLLC,~4S PERMIT RPPLICRNT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTALLATION INSPECTIONS OF RNY WELLS RDJRCENl TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T'~C~ (2) I ~4~;F'E,DTI C~r~S R~:E REE4UZRE[:, BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL RND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET RND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T E~-,'P I I-~:ES [;.EC:EI-4E:ER ~±, ± 5--~8 c.S~' I CERTIFY THRT ±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3: I UNDERSTRND THRT THE ON--SITE SEWER SYSTEM MRS' REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN -~ BEDROOMS. SIGNEC"- %,:'.-::: ' , ~"-' '~-'L ~ RPPLICRNT JOHN J HUOT ~h I fl ~,5 n~'~ I__ d ..... ¢ .............. ~ .... ........... 825 "[ "STREET ANCHORAGE, ALASKA 99501 (~fT) ?64 4111 December 31, 1979 John Huot Post Office Box 10-006 Anchorage, Alaska 99511 Permit ~ 790009 Subject: Lot 10B U.S.S. ~3200 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 an engineer has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this ozzlce at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Speci~s~-- LNB/ljw enc: Copy of Permit PERMIT NO, ~>EPARTMENT, Or HEALTH AND ENVIRONMENTAL F.',-,,]TECTION 825 "L.~ STREET, RNCHORRGE, AK. ~501 264-4720 APPLICANT LOCATION LEGAL JOHN HUOT HUOT CIRCLE OFF INDIAN RD LOT 1OB US SURVEY 2200 BOX 10006 L. OT SIZE 6}58~8~ 54450 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MA',,~:Ir,ILIM NUMBER OF BEDROOMS = 3 SOIL RATING (:.~Q FT/BR)= 165 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: r;.EF°TH= -1-:1_ L E ~-~ C~ T'H = E;2 (-.~ F.." Fl ',.,~ E L [:. E F' T F.~ = 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET.".' OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFFICE OF TFIE GROI.IND AND THE BOTTOM OF THE E)<CAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRL. L PIPE FIN[:, THE 80TTOM OF THE E~<CR'VATIOW (IN FEET). ~:;~:E _F-~. !_! I F~:E[:, SEF'T I aL'-:. TRI'4K $ I ZE= :..1..0~.Z~ E'~ PERMIT APPLICANT HAS THE REsPoNsIBILITM TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS RDJAC:ENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELl. WILL. SERVE. TI-.~C~ ,:.] 2 ) I ~'-,~$F'EI]:T I Cl['-.~ L--;. RF~E F]{EZC~L! ii.. RE[:, BACKFILLING OF RN9 SYSTEM WITHOUT FINAL INSPECTION FIND APPRO'¢RL BV THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL. AND ANY ON-SITE SEWRGE DISPOSAL. S'¢STEM IS t00 FEET FOR R PRIVATE WELl_; OR :150 TO 200 PEET FROM FI PUBLIC WELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL. WELL LOGS FIRE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN .T,::O DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICFITIONS AND CONSTRUCTION DIFIGRAMS ARE FI',,,'AtLABLE TO INSI.IRE PROPER INSTALLATION. I CERTIFY THAT :L: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH B"r' THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDBNC:E WITH THE CODES. ~:: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ]: BEDROOMS. ~~T JOHN HUOT ~./~ D,-, ,:t&TM~.NT L-IF HEFILTFI FIND ENVIRONMENTFIL.----.PROTECTION '"'~¢" PERMIT NO.' FtF'PL I CRNI' ,.T OHM HUOT LOCATION HUOT CIRCLE OFF INDIAN RD TVPE OF SOIL FtBSORBTION SYSTEM IS: TRENCH MBXIMUH NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR): 165 Tlt[S REQUIRED SIZE OF THE SOIL FIBSORPTION SYSTEM [;, E P-f :.-~ = :_lk '.dt_ L E~'-,IGTI.-I= 62 G F~ I:l"-,-" E L ET.~E P T I-~ = THE LENGTH DIMENSION IS TIIE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF Till; GROUND FIND THE BOTTOM Oft:. THE E;,*;CRVRTIOI',I 4IN FEET). TtIERE I5 NO SET WIDTH FOR TRENCIIES. THE GRfl'-,,'EL DEPT;.'I IS TIlE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND l'HE BOTTOM OF THE EMCFIVRTION (IN FEET). PERMIT APPLICBNT HI=IS THE RESPONSIBILITY TO INFORM TI.lIS DEPARTMENT DURING THE INSTFIL.LFITION If,ISPECTIONS OF ANY WELLS FIDJRCENT TO TI.lIS PROPERTY FIND TIlE hlUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF FINY SYSTEM WITHOUT FINFIL INSPECTION FIND APPR. OVRL BY THIS DF-F'FIRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTFINCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS .-'LOf,3 FEET FOR R PRIVATE I4ELL.~ OR :I.,58 TO 208 FEET FROM A PUBLIC WELL DEPENDING UPON TI4E TYPE OF PUBLIC WELL !.,.IELL LOGS FIRE REQUIRED AND MUST BE RETURNED TO TIIE DEPARTMENT WITHIN ;8 DRYS OF' TILE; WELL COMPLETION. OTHER REBUIREMENTS MAY APPLY. SPECIFICATIONS FiND CONSTRUCTION r:~If:'IGRRD1S ARE AVAILABLE TO INL~URE PROPER INSTALLATION. I CERTIFY THFIT 2.: IRM FAMILIAR WITH THE REQUIREMENT5 FOR ON'"~51TE SEWERS AND WELLS FIG SET FORTH DV THE MUNICIPALITY OF RNCI.IORRGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITII TIIE CODES. 3: I UNDERSTAND TI-IRT TIlE ON-SITE SEWER SVSTEM MAY REQUIRE ENLARGEMENT IF TME RESIDENCE I5 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. / I~F'PI_II:::~'T JOHN HUOT I ~,S LIE D I-ITE_? 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: 907-279-2581 Municipality of Anchorage On -Site Water and Wastewater Program , (907) 343-7904 5 `! < < Certificate of On -Site Systems Approval Parcel I.D. 090-041-49 Expiration Date:©* CSG 1. GENERAL INFORMATION: Complete legal description US SURVEY 3200: L10B1 Location (site address) 170 Huot Circle *Girdwood Current Property owner(s) Derek Helmericks Day phone 907-460-2509 Mailing address Real Estate Agent 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family acrd/or Duplex) . Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY:" TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑X Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment 7f2�2� Receipt Number Sh�f7 (�- COSA # 05C2-.11-371 Waiver Fee $ Date of Payment Receipt Number Waiver # TO 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. 1 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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A Garness Date: i In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation, Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE ./ System #1 Approved for Ja bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the follovstipy���fs�' w .I QST ;" aM _ By: C q, ea_� X Original Certificate Date: 1 ;D I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist ' ' US L10B1 Le0�lDe�c�ptk»n: If more than I septic system on lot: COSA Checklist # 1 of 1 O Parcel |�}:9O'O41-4S Structure served by this system 1 A. WELL DATA [WWell log iefiled with Onsite (or attached) Well production ottime oftest 2-8+ gpm Date drilled '10111m3 Water storage tank volume N/A gallons Total depth 128 ft Well disinfected for coliform test? F-1 Yes �� No Cased to 128 ft AlColiform bacteria isNegative # Sanitary seal iofunctioning correctly Nitrate 111 mg/L E]Nitrate less than MRL (ND) ��Wires are properly protected ArseniouQ/L ��Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG'LTD. Date of flow test for C{}SA 8/9/19 Date of Sample 6U/21 1 Static vvaterlevel etbeginning oftest 26.1 ft. Comments 'PER LOUISA. BUTERA ON 1991 COSA. WELL LOG HAS ILLEGIBLE DATE& GPM, ASSUMED THAT ENGINEER HAD LEGIBLE COPY OF WELL LOGIN 1991. B.TANK DATA Age ofbank(s) _^yeern Tankh/pe/materia| '_~~~, Measured operating fluid level in septic tank 50" ��Stand pipeo/fzundationcleanout per record drawing Date of pumping C.LIFT STATION M Required maintenance com Age of lift station a rs Lift station materl ri Commen -. � D. ABSORPTION FIELD DATA DATAFOR1983TRENCH X- Which system tested (date installed,8/4/83 Adequaoy��tdat� 8/9/19� F*ALL standpipes present per record drawing Results [ZPeso For 3 bedrooms -� Total measured depth from grade 7.66 ft (max) Fluid depth prior totest O in ^ P> Measured depth topipe invert from Qnade_4.2�5�_ft (min) Water added _4_8_8 _gal L[:1 N/A —pressurized field New depth 4 in E] Monitor tubes go to bottom of effective. If not, state Elapsed time 85 min ~ depth into effective ^""»°' ---- ---- O ~~ Code -required Fine| fluid depth ----- in ��System presoaked Absorption rate 000+ gpd ---- �� (Required ifvacant for greater than 3Odays prior to Any rejuvenation treatment (past 12months) N/A date oftest) ntroduo*d N/A "aUn.o |fyes, enter date N/A COSA Checklist yellow sheet E. SEPARATION DISTANCES � N From Private Well nnLot to: (Please enter distances if less than required cxifcommunity well) ifNoft �D Septic Tank/Lift Station unLot >1O0' Wells ooAdjacent Lots: Absorption Field >5' Community Sewer Man ho|e/Clean out>10O' ~�^ f7Yee ifNoft Private Wells >100' MV Yes if No. ��Yes if No Yes Neighboring Tank >1OO' RlYas if No ft Private Sewer/Septic Line >25'[7lYes if No d) Absorption Field on Lot> 1OO' P�Yes —_ �^ if � Holding 100' �1Yes _ if No � _ � rJ Ne|ghhoring Absorption Fields > 100' Animal Containment > 50' [ZI Yes if No FV-1YesifNoft Manure/Animal Excreta Storage >1OU' i --Community Sewer Main >75' 21/es ifNoft F71 Yes if No From Septic/Holding Tank unLot to: (Please enter distances if less than required) Building Foundations > 10' IZI Yes if No ft Surface Water > 100' ft Property Line >5' ��Yea ifNoft ifNoft Wells onAdjacent Lots: Wells ooAdjacent Lots: Absorption Field >5' ED Yes ifNoft Water Service Line >1U' Private Wells >100' MV Yes if No. Water Main >1O' 17/1 Yes ifNoft r-1Yes Community Wells >2OD' E] Yes if No. Water Service Line >10' M/ Yes ifNoft |fseptic tank isunder driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' M Yes if No ft If absorption field is under driveway cornment below Property Line >10' Yes ifNoft Wells onAdjacent Lots: Water Main >1O' Yes ifNoft Private Wells >1OO' &4Yes if No Water Service Line >1U' P�Yes ifNoft Community Wells >2O0' Yes if No Surface VVatar>1OO' r-1Yes if No *20+ ft F.ENGINEER'S COMMENTS *NR#10072 "ONLY ABLE TO PHYSICALLY FIND AND MEASURE TOOKJESEpT|C PIPE (7NUSS 3200'LOT 1OC /certify that / have determined through field inspections and review ofMunicipal records that the above systems are /nconformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 01 A ft ft ft ft 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 HAA # 1. GENERAL INFORMATION Complete legal description Lot 10-B-1 USS~ 3200 Location (site address or directions) ~ Huot CD:cie, Tndlan Property owner J~hn ~ Be_tt_v Ruot Day phone 653-7379 Mailing address :P.O. Bo× 11006, Anchorage, AK 99511 Lending agency Mailing address Agent Seattle Mortgage 56~ E. A4fh Av~.: Anchorage: AK Kay Marie/Fortune Properties Address 3000 A Street, Anchoraqe, AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: individual well Community well Public water NOTE: Day phone 562-5626 99503 .'" Day phone 562-7653 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: x If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 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. With approval of surface water drainage distance to septic by M.O.A.. Name of Firm Eaql~ R~ver Engineerinq $~rvices Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature o //~SIGNATURE Approved for Z Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Date 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Em ployees of DH HS 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~)25(Rev. 1/91) Back MOA~2! Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ParcelI.D. A. WELL DATA Well type /~'~-~"~' f-~ Log present (Y/N) Total depth /.~2' / Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number ~V' ' ~ Date completed /~//'/"¢~; ~ Drifter Casedto /-~; Casing height '/~' ~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level /~' Well flow Pump level ~"' '~"" ; On adjacent lots ; On adjacent lots SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /'~-~ Absorption field on lot /'~' Public sewer main Public sewer service line Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform p Dateofsample: ¢'?"~'~/¢/ Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed /¢ Cleanouts (Y/N) High water alarm (Y~)' Date of pumping Tank size ?¢¢~ ~¢---~- Compartments ! Foundation cleanout (Y/N) ? Depression (Y/N) Alarm tested (~¢~ SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot To propertyline Surface water/drainage On adjacent lots //~ ¢ Foundation ~-/ AbsorPtion field Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots' Surface water D. ABSORPTION FIELD DATA Date installed J,~' ~"'¢ Length E, ¢~ ' Width Total absorption area /./~b' Depression over field (Y/N) Results (pass/fail) /.~ .r ~' Soil rating /¢~- System type Gravel thickness z/, Total depth Cleanouts present (Y/N) Date of adequacy test for Peroxide treatment (past 12 months) (Y~N.~) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /¢ ~ On adjacent lots /~/¢¢~ / To building foundation On adjacent lots Surface water ~- Curtain drain If yes, give date Property line · ~?'¢ ~ To existing or abandoned system on Cutbank ,¢/4 , Water main/service line Driveway, parking/vehicle storage area bedrooms E, ENGINEER'S CERTIFICATION Engineer's Name Date certify that I have checked, verified, or conformed to all MOA and HAA,guidelines in effect on the date,of this inspection. HAA Fee $ /90 .~ Date of Payment ~ '///-/"-¢ / Receipt Number ~ ~- ~:¢/~ F qf~ f'0 ~ Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 07' Lof Tom Fink, Mayor Municipality oW Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 22, 1991 Lou Butera, P. E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for USS ~3200 Lot 10B-1 Waiver Request ~WR910032, PID ~090-0~1-49~ HA910224 Dear Mr. Butera: Your request for a waiver of the required 100 foot horizontal separation of a septic system to %he surface water has been approved. The approved separation distances are: 1) septic tank to SW drainage 52 feet; 2) upper leachfield to upstream culvert end - 81 feet; 3) upper leachfield pipe to downstream culvert end - 75 feet; 4) original leachfield pipe to downstream culvert 70 feet. If at any time the culvert fails to capture all surface water flow or if at any time the subject wastewater dispsoal system contributes to the degradation of the water quality of the adjacent surface water, this waiver will be considered void. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Robert W. Robinson Civil Engineer On-site Services Con~ur: / Jphn Sm~h, P.E. ljm:~5 Louis Butera, P. IL Registered Civil Engineer July 16, 1991 Robbie Robertson Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 RECEIVED JUL 1 7 1991 bmn~oq)~ ~y o~ Aritho,ag Dept. [-laalth & Human Services Re: Lot lOB, USS 3200 Dear Mr. Robertson, At the request of our clients, John & Betty Huot, we are requesting a waiver of separation distances on the above referenced property. As per our telephone conversation June 24, 1991, the main concern was the creek to leachfield separation. The owners have installed a culvert to contain the drainage on the East of the property along a 140' course as per the attached site plan. The following are the requested waiver distances: A. Septic tank to SW drainage = 52' B. Upper leachfield pipe to upstream culvert end = 81' C. Upper leachfleld pipe to downstream culvert end -- 75' D. Lower (original) leachfield pipe to downstream culvert end = 70' The drainage along the Southwest of the property requiring a waiver of tank to surface water distance is the overflow from a neighbor's lot which is directed under the road to the South. The concrete septic tank is located upstream from the stream bed, but is offset to the East. The stream affecting the septic leachfield was culverted along its natural course to where the nearest portion of the stream to the septic leachfield end is 70'. At this point the surface water enters the road drainage ditch and can not be contained on the property. Stream flow is estimated at 10-20 GPM. Soil in the area is an SM type with the septic system passing adequacy for three bedrooms. The septic system is installed on a bench with a 15-30% slope to the South. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 6944195 · Fax (907) 6944297 ~ JUL 1 7 19~1 DRAINAGE FRUM I ~ ,/ / ~x~RAINAGE FRBM · - MONITOR TUBE o - SEWER CLEANOUT ~ - WELL ~",~',',',~',',~- EXISTING L~CHFIELD NO KNOWN CURTAIN DRAINS EASEMENT SEPTIC SITE PLAN '"": OWNER: HUOT ~ ~"' "~ ' ~ CONTRACTOR: ,, JOB ff 91-06d DATE: 06/25/911 SCALE 1 = 60' EAGLE RIVER, AK. 99577 '~.~', APPLIC " IT FILLS OUT UPPER HAL "ONLY ,~?roper~y ~'r,.~r~ ~_ ~' ' ,, ':. ~ / ,'." .~ I/ ' '~- ~.~, f' ?- Phone ~ , . ~ ' ' ~;;:' ~ /; ~-, Zip Code Buyer ' Address Zip Code Lending Institution -'%Zz~ ,,~' //,~ ~L~, ~;/,, ,,..~ ,~' .. ~, ~, ,/~/ ~, .~.~ Phone Realty Co. & Agent ~ ~-- Phone Address Zip Code Street Locati~ /-/~ ~ ~ ~ ~.~¥- /~ Type of Resi~nce ~Single Family ~ Multiple Family NO. of Bedroo~ ~ Other Water Supply ~ndividual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that d~te, give weft depth (attach log if available), ~ Public Utility Sewffr Disposal ~lndividual Year Individual Installed: / ~ Public Utility When Connected to Public utigty: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Date ~j_l ~'~~ Date Date Date ~2 - ~ Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ~NO'IOP. AOI~ ~NVIRO~M~NTA~ PROT~CRON ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ~ CONDI~L APPROVAL* ~ ~ ' Soil~ Ratin Date ~wer Installed Well TO Absorption Area Well Log Rece' ~ / ~ ~ ?--~-- ~ WelltoTank Septic T~k Size