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HomeMy WebLinkAboutVALHALLA BLK 3 LT 3Valhalla
Block 3
Lot 3
#015-212-16
- MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 LStreet -Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME 1 ,/—��-------�--- PIHONE /
NEW
UPGRADE
MAILING ADD 3ESS
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
Well (I> r
Absorption arel
f
Dwelling
PERMIT NO.
U Y
DISTANCE TO:
U
a Z
Manufacturer i
Material
No. of compartments
ILiq. capacity in gallons
IF HOME MAbB
n id ength
Width
Liquid depth
DISTANCE T0:
Well
Dwelling
PERMIT NO.
—:_
� Z h
Manufacture - . _ �
Material - -
__
ll- on
-Liquid capacity in ga
O
DISTANCE TO:
Well . ^� r r
"�
Foundation t
-f- U
Nearest lot Ijne
PERMIT NO.
w y
-
! k) `/n c'
J LL Z
No. of lines /I Length of each line
Total length of lines Trench width
Distance between lines
P Z w
- c-G_ /U / r)
- ,J O 3.G inches
tifl
o H
Top of rile to finish grade
Matarial beneath tier 477-Total
of ec]yve absorption area
c�y
aches
Length
Width
Depth
PERMIT NO.
w
Q H
Type of cr —
Crib diameter
Crib depth
Toflleffe n e absotion area \ --
w_
�
W
DISTANCE TO:
A101 _
- wilding foundation
Nearest lot line
Depth
Driller
Distance to lot line
PERMIT NO.
w
�
DISTANCE 70:
Building foundation
Sewer line
Septic tank
Absorptio ar a(s),
�
OTHER
PIPE MATERIALS
C
L ®
SOIL TEST RATING-
�c
INSTAL/LEER
REMARKSox
_
�r
v
)Ian-
HT
ea
i
�
I
APPROVED ., DATE LEGAL
72-013 1 v. 3/781
JNICIPALITY OF ANCHORAGE
Department c,_ Health and Environmental --otection _l2,
825 L Street, Anchorage, AK. 99501
264-4720
# # HANDWRITTEN PERMIT
WEbL-=A-nJ�-OR ON-SITE SEWER PERMIT
Applicant:Cr\I�-S�J� Mailing Address: �(�A
Location: Lc) k-� Phone Number: 7,D)' -_f S /`
Legal Description: L � �� ' / 3 A L 11ALLA SYb Lot Size: /C0 4
Type of Soil Absorption System Is:
Trench: K_- Drainfield: _ _Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) Q �D �
The Required Size of the Soil Absorption System Is:
DEPTH 3 tee LENGTH GRAVEL DEPTH P 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 _
Permit applicant has the responsibility to inform
installation inspections of any wells adjacent to
of residences that the well will serve.
this
this
GALLONS *
department during the
property and the number
* # * 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 1 * *
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 require enlar t if
th residency is remodeled to include more that 3 bedrooms.
Signed: wJ { jp Issued by:
pplicant
Date:
SWP / 0 2 4 (1 / 81)-
l'0 V 0 l �O
t,'
Municipality of Anchorage
Uj+:a►9 U
DATE: May 14, 1981
To: Al Carson, SRA Box 1581C, Anchorage, AK 99507
FROM: Division Manager, Environmental Health Division,
Department of Health and Environmental Protection
SUBJECT: Waiver Request and Sewer System Upgrade
Lot 3, BLK 3, VALHALLA S/D
After having looked at all the data submitted and
considering all options available, it is my decision
that the best current choice is:
InZstall the additional drain trench as
recommended by your engineer.
The data would tend to support this decision in that:
1. The soils are very tight and have for the past
eleven (11) years prevented any contamination
of the well.
2. This is the apparent final on-site upgrade available
to this property without drilling a new water
supply.
Ro,�'
Af .3trickland
RS/pas
ins4 �(VO pu � (�-
91
-(4/76)
C
Lij
6 P&d s3
�-
S aye ssa tr a a
v / •
� Vl i� L L. L l VJ_e_ L 1
Y�(gO t1
( 4J/�a b�
1�'� /
ins4 �(VO pu � (�-
91
-(4/76)
SOILS LOG
-° 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: At ` r�r So P•/ DATE PERFORMED:
��
LEGAL DESCRIPTION: �^`� � � `cat-* � � VL%�.� —��' SP„/'D
r'ri— I i SI nPF CITF PI AN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
/'&C'lr M
r9 f., C�L�.SiJll ttil
C� rt;w 2�i
„
GAA
COMMENTS L01& '1 ,N
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER / S
ENCOUNTERED? _ /U U L
O
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
3
er
1.41
.e.
2.
/:Z3
ID
1, z,YS`
/ 76-
l33
3
10
1,115-
.13Y3
Y -3
10
/'OS
.07
6-
/;5- 3
E�
v
Z<(')_s
to
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN �)✓ FT AND FT
,.t,.,.:.. / ",.'.SSC -tE /..t . F z .i
CERTIFIED BY:
DATE:
A
N
N
0
0
I EGEND
0 5/8 z 30`* REBAR RECOVERED THIS SURVEY
5/8 z 30' REBAR SET THIS SURVEY
w
ta
ita
co
OF
N0. 3245
Rnp,er L. Sn,,der
r
1 hereby certify that I have made a survey of the to+iowi,n.g
described property:
LOT 3, BLK. 3, VALHALLA SUBDIVISION
and that the imnrovements situated thereon are wit'7'n the
Dounoanes at ;ala "a -i and do not over iao k)r encroach on
the propertv lying adjacent thereto, :hat the improvements
on the property lying adjacent thereto do not encroach on
the premises in question and that there are no roadway3,
transmisslon Eines or other ,;sibl:e ea3ements on said
property, except as indicated hereon.
SURVEYOR'S CERTIFICATE
I, the undersigned registered surveyor, hereby certify
that a land survey has been completed by me or
under my direct supervision and that corners and mon-
uments have been located and established and that
the dimensions shown hereon are true and correct.
Date:` 1981
A. E. a S., INC.
274-6667 621 E. 484h AVENUE
ANCHORAGE, ALASKA 99503
LOT SURVEY
for
LOT 3 , BLOCK 3
VALHALLA SUBDIVISION
ANCHORAGE, ALASKA
WRVEYED BY: DATE:
R. L Snyder April 24, 1981
DRAW:d BY: SCALE: CHECKED BY:
P, Clark I" = 30. R.L.S.
Of 1TER ANCHORAGE AREA BOROI' 'H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 No ° 150
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING/
NAME L ADDRESSZ�Z/IF%L'.l' PHONE 21
LOCATION �'-i_=, .-!G� /T/_,.r/ LEGAL DESCRIPTION
SEPTIC TANK
_ NUMBER OF
DISTANCE FROM WELL•>� /lz-GG%/=�IA MATERIAL L_'/y�'C_'/'i°7/= COMPARTMENTS
'// S _'' <- / %'�) L _ LIQUID
LIQUID CAPACITY %-�' GALLONS. INSIDE LENGTH L INSIDE WIDTH `- _.- DEPTH ----
SEEPAGE SYSTEM: SEEPAGE PIT
NUMBER OF PITS_
LINING MATERIAL
NEAREST LOT LINE_
TILE DRAIN FIELD:
DISTANCE FROM WFII
NUMBER OFLINES_
ABSORPTION AREA
OUTSIDE DIAMETER L� OR WIDTH v LENGTHDEPTH ,
i
A-��,4 G � . DISTANCE FROM WELL �Z_ C'6' ='�i• � BUILDING FOUNDATION -
I
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) �- ' G' SQ. FT.
FOUNDATIO
CE BETWEEN LINES
SQ. FT. LENGTH OF
NEAREST LOT LI
TRENCH WIDTH
TOTAL LENGTH
10 i. 11c - -__
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEP"" OF FILTER MATEJAL'BENEATH TILE
IN. ABOVE TILE
WELL,/
11'
DISTANCE FROM ,_ WATER
TYPE ��% DEPTH
�
, BUILDING FOUNDATION. SAMPLE,
NEAREST
NEAREST
, SEPTIC
'__ SEEPAGE _-
__ OTHER
-
LOT LINE SEWER LINE—,
TANK
, SYSTEM , CESSPOOL
, SOURCES—
DISTANCES:
UTAUKyM OF 3131CM
DATE. ('J%-�1 APPROVED -`, .-c_HEAL�jHnuTHoalTv
i
1-
✓V ski < �
lt..✓
,Sv �l",
r
il+c
DATE. ('J%-�1 APPROVED -`, .-c_HEAL�jHnuTHoalTv
i
cnn$.nn-z GREATEE ANCHORAGE AREA . )ROUGH Case No.111_;5.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT N r ru _ �'- !I_r ) MAILING ADDRESS%7_-� ( Y PHONE NO.
�— S/J1L0// ''D el'r--r
RESIDENCE ADDRESS LviZ,7/& LOCATION OF INSTALLATION_ A/o%'rMdn/
LEGAL DESCRIPTION L A/ E3
APPLICATION TO INSTALL: SEPTIC TANK �� , SEEPAGE PIT DRAIN FIELDI , OTHER
TO SERVE THE FOLLOWING FACILITY
el -to
ua �.
FINANCED THROUGH<<'0`�TO BE INSTALLED BY'ce(� c' "'-c
PERCOLATION TEST RESULTS J- -,)L 5 B 13F)PMANTICIPATED DATE OF COMPLETION r� 4 h 1y0176£L
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS '7 k -L 17) / PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED-�
SEPTIC TANK SIZE _ 22) TYPE C-fLF_sEEPAGE AREA ����/ TYPE
DISTANCES:
(10
c
ith the re�u cements Of Greater Anchorage Area Borough Ordinance No. 28-68 and that th
accordance with said code,
yam= — APPLICANTS SIGNATURE"`
FEAD'QPKM7 CARL
OeyU
Leet:
�d�vrie„15w care
Oc
t&
Was Ground slater Encuuntere:d? e—/V. � ---
t
Drain Men o ...... ............0 ...-._..,_
Teat. Perforw d By:
bare ter_;;.:acct
F F.:a 1L U• L 7t _ t- �
7
..(Jr L+d
7Y -_.-s Fnrm�?e�.n t.. .,.
mac.,-
�''.� �._.u.>.
.Per,,,��_- .,-
OeyU
Leet:
�d�vrie„15w care
Oc
t&
Was Ground slater Encuuntere:d? e—/V. � ---
t
Drain Men o ...... ............0 ...-._..,_
Teat. Perforw d By:
tA 11� (Irv-
Time
APPLICP
'r FILLS OUT UPPER HALE IIVLY
P1oFerty Owner 141 l
,_ I I
- �' .1 by .� I� 11 _ I Phone
Mailing Addre,'s , 1 2
A 1 - —
I ( . _"�-�L Zip Code
Buyer
Date
J'
Address
Zip Code
Lending Institution
Phone
Address I _J
, (r_.�2 _lam
_ L _ ,- oj 0- Zip Code �
Realty Co. & Agent _
a_ �. I. 1- ,
,; i- k _. 'l, r- r I-� ._ .,
Phone
i; f
1
,.) 1-, E-
- C.
..
Address
_.
ci 1 :.1�� r Zip Code
Legal Description V�_,I It.
_ ` 1.�c1
�...._ 1, L-C�1- _= .i'.i I—
( ) DISAPPROVED
4v1-�i-�
Street Location
=�,. �._r. b=_.
.c� .,( =_
Type of Residence
Soils Rating
mingle Family
Well To Absorption Area
Fl Multiple Family
No. of Bedrooms
y
C Other
Septic Tank Size •-Z L7 _ __
Water Supply
(1
[yAndividual
Cl
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Fl Community 11`
For wells drilled prior to that date, give well depth (attach log if available).
!, Public Utility 1
Sewer Disposal
L7kIndivldual
Year Individual Installed: _ —
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
tA 11� (Irv-
Time
Time
Time
.,
Time
Date
Date
Date
Date I0
Inspector Inspector Inspector
Inspector
/\
Field Notes: t
�NVIkf7 Fli✓tSNIAL PRO'I E:.IIOi`1
8�CE�.�
( I APPROVED BEDROOMS 'CONDITIONS
OF APPROVAL.
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
BY:
Soils Rating
Dale Sewer Installed
Well To Absorption Area
Well Log Received
y
Well to Tank
Septic Tank Size •-Z L7 _ __
720291182) CA I
i2 a� dam.
October 25,193
Michael 8. Killer
Kathy G Miller
KRA Dox 1551 c
amG«< e, q g g,
SGw;c Valhalla:ayQame cot3 Block
Approval for the individual never and water facilities cannot
he granted until mefollowing w»n have been m7ywm
• The ,w the well casing should he maw so that it 6
water 99 .
• Exposed electrical wires to Jewell yon areb SoGSm
of the Municipality of < 6orago «u and must he encased
In conduit.
The septic,wA A ,wuareceipt submitted to this
department.
G req,«y toot weds to he mw«+u on the m intim
lam:W area. This wet will determine if the system is
equate «maim to National uGwams AlwGm of
private firs performing the testis enclosed. This meat
needs to :e suhmitted to this office for our mwm.
Please notify thin department for awm ectaaAa the
noted discrepancies have been corrected. IZG,a area7
further questions, plse call this office at 264-4720.
Sincerely,
Cory Willis, G:.
Acting sower and water
Program Manager
ev Z ZZ m
:«zue
S t r' T I L,
, DEQUACY REPORT I
I ngi,wer. Pia!, :: ck ms ins r
16 10 Lim •._ E -r_ _
4:�l
,ATE OF TE£T
7EG4.I __.. L>�G.IFTIC.L_-_____ r I__ � -: !i:.> %-,/ c .;UK li
SR 11N
I
1 I I
i...._ N , F -. _A S P Al ASCA
PER'34 KA D FOE: RF : V Ez EY:
I
TYFE OF .STFN - Z. _. 1 C 7A4LC-;5
!c Lr S <`1 _ FIT
IV' LFACK F;E�
�
u o qc.�s ao
It
"*
49TH— � ¢
SEFT IC TA NK ASS F..FaM 1 Y 5. —. No 00. ..... •aY' ..... •�
�AFGISYE�F�•��``�AV
�O�S/ONA\, e�Q'
i
NOTES 6 OBSERVATIONS' __ /'e!'°-_ �� z-%�6✓. aJ.j _ /"_� "Jt-!O� 7p ,J,;/ �2cy:
c
TE5T PERFC =.LEL BY: / �`'/P / A:-PJ'2i FRL; f EY.
2 "f /
AF 7 F,0 F D BY
STANLEY BRUST & ASSOCIATES
Engineer - Planners - Sjjriejors
Legal Description
No of Bedrooms
Adequacy Test Log
Project N o
Date Time
Level
Readin s
Remarks
septic tank
A
Jae be_ (14 0 '):00P"11.
5, LE AL ESCRIPTION n j(yl
/i/
1
DATE RECEIVED
-
INSPECTION APPOINTMENTS
TIME
TIME
TIME
❑ One ❑ Four ❑ Other
[ SINGLE FAMILY
❑ Two ❑ Five
DATE
Three ❑ Six
DATE
DATE
M INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
k - -
INSPECTOR
depth (attach log if available.)
INSPECTOR
INSPECT
�h INDIVIDUAL/ON-SITE**YEAR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC7'I
dEPT. OF HEALTH &
Ef`1VIRONMENTAL
•
825 L Street - Anchorage, Alaska 99501
PROTECTION
ENVIRONMENTAL SANITATION DIVISION MAR 31 1981
Telephone 264-4720
REQUEST
FOR APPROVAL OF INDIVIDUAL
((.. //`` [[,,�IFAdiIL��//
1I3Q
WATER AND
SE�R
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
PHONE
-5577
MAILING AD/S
(-7
1 (SD�R
9
s (f. 9
PROPERTY RESIDENT
(If different from above)
PHONE
2. BUYER
PHONE
01
J
MAILING ADDRESS
CJt��
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. E}.EALT /AG
N
PHONE '!
)
MAI NGDDRESS
C�M
5, LE AL ESCRIPTION n j(yl
/i/
1
-
STREE O TI N �
i
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
[ SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
Three ❑ Six
7. WATER SUPPLY
M INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
"_
�h INDIVIDUAL/ON-SITE**YEAR
12 ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev, 6/79) L,j-dl' iYA)'/Cl-tt''
Tier
'-
70
R
O
M
SUBJECT
MF-ssAGE a C. -
SIGNED
_ --\ <. ,�1V �� p �q,,�n p• „Atm �j
F%EPLY
D WID 3 WILH CARBON
S urv�,....
.. ?ARL 3 LL B ROUP.NID WRH Rmy-
RmIFORM 45 472
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✓"(a v o�jrl e eOYt su /x, a bh -7�1�4 11Si a/,- �/LS
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4A� yy�o�
ALASKA RUIROWWAL COnTROL SRRUICCS, IX
Cngineerinq f 6nuironmental Studies
May 12, 1981
Mr, Les Bucholz
DHEP
825 L. Street
Anchorage, Ak. 99501
Dear Les:
MUNICIPALITY OF ANCHORAGE
DEPT, OF P. -..:%+Li. 3
ENVIRCivU(,JT-'-- -CTION
IVii±�i A 1 iCiG
RECHV ED
Enclosed is the adequacy test and a soils test for lot 3,
block 3, Valhalla Subdivision. The adequacy test shows the
system capable of absorbing 360 gal/day. My advice is to
install enough trench for one mo�ree earoom. our soils test
indicates the soils at 264 sqft per bedroom. There is room
between the existing pit and the lot line for a trench of 20
feet and still maintain the existing distance from all wells.
The trench would be installed between 5 ft and 13 ft and be 20
feet in length. We would need a waiver of the lot line
distance in order to install the system.
Mr. Carson has asked me to handle this problem for him and to
work out details with you in order to get the problems
resolved. Please call me on this problem.
Thank you.
Sincerely,
eroy Reid :, PhD, PE
Presi nt
1220 West 25th Auenue a Anchoraqe, Alaska 99503 a 907) 276-1361
ALASKA CnUIR011ITI TAL C011TROL SMICCS, Inc.
6ngineerinq & enuironmental Studies
MAY 1, 1981
AL CARSON
SRA BOX 1581 C
ANCHORAGE, ALASKA 99507
SELLER AL CARSON
SUBDIVISION — VAL HALLA BLOCK -3 LOT -3
THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 456
SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 360 GALLONS OF WATER
PER DAY.
BASED UPON THE `PEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A
HOME OF 3 BEDROOMS,
THE SEPTIC TANK WAS PUMPED ON 5-1-81
oY C. Roid, Jr,
No aasr.e
1220 West 251h Auenue • Anchorage, Alaska 99503 0 (907) 276-1361
r =y .� r�
,�.
a
�� 5
� •� % �� ���i� ��
,�
�� �`
o!rt n
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o. Cl.. t . �
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.: � ,;
._,._ '�n 4�_,i
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r-`
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.,
_ �C r'
April (, 198= J-
3 a /Jo inin Car t
ShIr ROUic 1 BON 5310
Anchorage, Alaska 09507
S,ib t:
lol 3 Clock
ock 3 Valhalla Subdiv i.sion
(l
Approval
for he
idM dual :,c ,aer and water
fa::i' i ti -s
uannol hp
granted ted
ll,l'Al she following items
En
have been
(ti,
coiP.j:j c ted
:
,
(:t) he
water a -i
a 1 ?sis report needs to be delivered
to
this
office
from om t h Chea Lab, 5633 it
Si rwc.;, for
our
review.
(l_) Thu soot is t ink punjod with a rc-ceipL Submitted to
this oft,
(3) Expose the cleanout to the seepage pit for our inspection.
This; is to asurc the minimum distance requirements are
mei: between the well and sewer system.
(4) if the seepage pit is 100 feet from the well, you oi_l.l
need to have an adequacy Lest performed. This test
will det-e:rmi.ne if the system is adequate according to
National S?_andards. n l.i5ving of private firms perform.inq
the Lc is enclosed, This -report needs Co be submitted
to thiq nQ ice for nor review.
(5) If the seepage pit is lnsq vilan the 100 feet from the
well, the sappaqc arca will need to be relocated.
EF there are any furthar questions, please, call this offi-ce-,
ai.- W-4720,
S neerr.l-y,
Roheort C. PraU, R,S.
Associate Speci l -:is!
RCP11. j %;
•
• 1)67 8'9 •� B�,
• Municipality of Anchorage v
On-Site Water and Wastewater Program
(907) 343-7904 Q ti 1�
S E P 1 i. r
Certificate of On-Site Systems Approval
Parcel I.D. 015-212-16 Expiration Date: more
TF:
1. GENERAL INFORMATION
Complete legal description Valhalla Block 3 Lot 3
Location (site address) 12303 Shiloh Road
Current Property owner(s) Philippe & Natalie Janicka Day phone 907-250-0320
Mailing address 12303 Shiloh Road, Anchorage AK, 99516
Real Estate Agent Tami Taylor/REMAX Dynamic Day phone 907-244-3504
2. TYPE OF DWELLING:
1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
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 ❑
WaiverNariance request for: Distance:
Received by: (j.,Q/i (3-4 / C. Date: # l
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52L Waiver Fee $
Date of Payment q 11.211 g Date of Payment
Receipt Number 063 //-0 Receipt Number
COSA# 06C I /`1%o 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 Forge Engineering Phone (907) 522-7773
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 9/11/18
,t OFA/,•gdl
file: 49TH 4c..-.177,•* /
11,
6. DSD SIGNATURE #1 . > �
System #1 Approved for , _) bedrooms •� Be
Y pp �� Benjarri�Schiller
2
System#2 Approved for bedrooms r$a� s��slF9.,C• 9/11/18 •. ��
Disapproved ll�FDpROFESSIO
‘�\®a®� a
Conditional approval for bedrooms, with the following stipulations:
= ON-SITE j
WATI=R AND
WASTEWATER z
PROGRAM o:
o�-F�'r ��a-
SERV�G
•
By: — In/v\1 = Original Certificate Date: 99- 1 --(-1 .
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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f • c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Valhalla Block 3 Lot 3 Parcel ID: 015-212-16
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed C. 1 970 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth *55+ft. Cased to *40+ft. Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test No well log 6/01/18
Static water level ft. 54 ft.
Well production g.p.m. 5 6 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 1 .33 mg/L
Arsenic ND ug/L Date of sample: 8/31/18 Collected by: Forge Engineering
*Information taken from previous COSA paperwork
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Concrete Date installed 1970
Tank size 750 gal. Number of Compartments 1 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) N Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping 6/14/18 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
9/29/1970 UNKNOWN/ LOG CRIB/
Date installed 6/02/81 Soil rating (g.p.d./ft2 or ft2/bdrm) 264 sf/bdrm System type TRENCH
Length 1 8 20 ft Width 20 3 ft. Gravel below pipe 6 / 8 ft.
456+
Total depth 13.5 ft. Eff. absorption area 320 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/01/18 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 16 in. Water added 616 gal. New depth 48.5 in.
Elapsed Time: 1440 min. Final fluid depth 22 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None If yes, give date
FIELD CONSISTS OF OLDER CRIB THAT WITH A TRENCH ADDED LATER
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 62' On adjacent lots >100'
Absorption field on lot 65/75' On adjacent lots >100'
Public sewer main '75' Public sewer manhole/cleanout >100'
Sewer/septic service line '25' Holding tank '75'
Animal containment areas 'S0' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
1 01Building foundation ' Property line 'S Absorption field 'S
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
0'Property line Building foundation >10Water main '10
Water Service line >10Surface water '100 Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots 90'/95'
F. COMMENTS
Waiver R030025 on file for separation distances
G. ENGINEER'S CERTIFICATION _-��tix-VN\v
�,�of q�gili
I certify that I have determined through field inspections and ��Q. .• • .0+ a
review of Municipal records that the above systems are in6•60.. `I�• .-9 ��
conformance with MOA COSA guidelines in effect on this date. % *: 49 I! I\ • 19
9
Engineer's Printed Name Benjamin Schiller, PE d `i `":
Date 9/11 /18 i/J • • •. •Benja•'ry chiller . • j
r+ �'c6' CE 12592 •t`v��
�l�%f}F�.••9/11/18• •.' �!
kkti PROFESSION.`'
A\\\vim~-'-
COSA brown sheet 10-10-12.doc
ui I hereby certify that i have made a survey of the following
described property:
LOT 3, BLK. 3, VALHALLA SUBDIVISION
tiii'--
l
� f and that the improvements situated thereon are with ^ the
{ f
LOT 4 t LOT 9 > councar:es et said . :.,i and ao not oVe:icp vi ncroach on
_ the property Tying adjacent thereto, :hat the improvements
S 89' 59' 00" E !60.001 I , J on the property lying adjacent thereto do not encroach on
f LOT LO the premises in question and that there are no roadways,
o 0 transmission lines or other "";sb'e eas,ements on said
O property,except as indicated hereon.
0
4 - 1
49.77 f
SURVEYOR'S CERTIFICATE
1 24.25 15.6'
sc EWEt_L I, the undersigned registered surveyor, hereby certify
�, } /� t i that a land survey has been completed by me or
o o w I ( under my direct supervision and that corners and mon-
us w
'0.t 3 o ` umerts have been located and established and that
o N/ o t the dimensions shown hereon are true and correct.
T p -— -�
50.92` 11 �� ')
- ( .f' 7Z l
o { i c o Date: r 1981
i
Cr) 7A Glx CHAIN LK.
kY FENCE
`o - ---- - .— N 89:25:.'l-9/
9059 00" W 160.00` LOTS tt
- TIC rs,
LOT 2 , Ip Id I
—
A. E. S., INC.
„...,.„,..- ..",,,z,,,, 274-6667 621 E. 48th AVENUE
/��A OF 4/4 `a� A ANCHORAGE, ALASKA 99503
i� C_ se°• 00°° .1 Ji1`� V
o
Pc') :` rhe ,9 � I LOT SURVEY
r for
i$3f •Cur°° f°at
%`� - - LOT 3 BLOCK 3 -
������ 4'c 7
VA NO. 3245•S
V-7- • Rn.4,• LSr,der :-O.:::'. VALHALLA SUBDIVISION
EY
O 5/ x 30" REBAR RECOVERED THIS SURVEY '` :., ' '°��'��
e :. � -• -• . ANCHORAGE, ALASKA
,4:-.,,F,-.6-•:-.--:.;-:... _:t : S�.-- SURVEYED By: DATE:
-
• 5` x 30p REBAR SET THIS SURVEY "`- R. L Snyder April 24, 1981
B 1 DRAWN BY: SCALE: CHECKED BY:
P.Clark I" = 30' R.L.S.
r
Municipality of Anchorage
Development Services Department `' a ►';
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-212-16 HAA#_ NA
0
1. GENERAL INFORMATION
Expiration Date:
Complete legal description VALHALLA SUBDIVISION: LOT 3, BLOCK 3
Location (site address or directions) __ 12303 SHILOH ROAD ' ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
RODNEY 0. EVANS
Day phone 345-2448
12303 SHILOH ROAD • ANCHORAGE. AK 99516
RANNA FEKRAT w/ PRUDENTIAL JACK WHITE
Day phone
Day phone
3201 "C" STREET « ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
762-5815
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
V.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid S at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, i verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
S and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179
Address 6901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 3 3 103
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
coo�4p 04
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported described the the
'` '
results performance of
system under the conditions encountered at the time of the test, and separation
. •
Qap
S1�0o0
distances measured to readily identifiable features. The operational life of all wells and
© "�
septic systems depend on the local soils condition, groundwaterlevels that may
*.:. . .. ............:.*
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
.
OO G
results do not guarantee future performance of the system, nor do they guarantee that
J f r y A. ess ,
o Q
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
future how long the
E-7953
�� PSP
any warranty or estimate of the system will continue to meet
A�cPoO
�o
operational requirements of the ADEC or MOA DSD. The content of this report Is for
c�
0�0°��000a�Q
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
,
5. DSD SIGNATURE
Approved for _ 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
Y �
WATER AND • ��m"
h ICV
PROGRAM
Attachments:07
HAA Checklist x Manitenance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: Original Certificate Date: I k/03
(Rev. 1901)
_........._.._.....,_....�_.._.._... .._.._.....,.._..,._.........._..___.._........_..._._.. •...__... _......... _............. .. _...... ...... -
Municipality of Anchorage
• Development. Services Department
Building Safety Dtvislon
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anchorageak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: VALHALLA SUBDIVISION; LOT 3. BLOCK 3, Parcel ID: 105-212-16
A. WELL DATA
Welltype PRIVATE If A. B, or C provide PWSID# N/A
Date completed _. 1970� Sanitary seal (YM) YES
Total depth 55+ R Cased to 40+ ft
FROM WELL LOG
Date of test G
O
Static water level ���.� ft.
Wen production
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate 0.898 mg./L.
Well Log (YIN) NO
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
02/26/03
54 ft.
5.75 G.P.M.
Other bacteria O colonies/100 ml.
Arsenic: N/A m9JL. Date of sample: 2/26/2003 Collected by: AKWWC. INC.
•FCO INSIDE FOUNDATION. SHOWER DRAIN SNAKED BY MCDONALDS
B. SEPTICIHOLDING TANK DATA PUMPING. PROVIDING THAT THIS WILL ACT AS A FOUNDATION CLEANOUT.
Tank Type/Material CONCRETE Date installed 9/29/70
Tank size***750 gal. Number of Compartments
Foundation cleanout (Y/IV) "ESS Depression over tank (YM) NO
Cleanouts (YIN) YES
High water alarm (YIN) N -(A
Date of pumping 2/2642003 Pumper CHUGACH PUMPING
C. ABSORPTION FIELD DATA 10BELOW Exisn93M
9 9 UNKLOG CRIB—SEEPAGE PIT
Date installed oV/3as1970 Soil rating (g,p.dJft�r( 5�d 26 System type /DEEP TRENCH
Length 18/20 Width .. /20/3 ��ft. Gravel below pipe 6/8 ft.
Total depth *14.92 ft. Eff. absorption area 4326 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 2/26/2003 Results (Pass/Fall) **PASS For 3 bedrooms
Fluid depth in absorption field before test10 in. Water added 1225 gal. New depth 29.5 in.
Elapsed Time: 15 min. Final fluid depth 24.5 in. Absorption rate >= 450+ g.p,d,
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date —
**TESTED TRENCH ONLY.
***APPROVED AS A 3 BEDROOM SYSTEM ON 6/2/1981
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in.
E. SEPARATION DISTANCES
High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *62'
Absorption field on lot *65' & 75'
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *0' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 0'
Curtain drain NONE KNOWN Wells on adjacent lots *90' & 95'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
JA
v
I certify that I have determined through field inspections and y
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date. ........
Q f A.
Engineer's Prin ame JEFFREY A. GARNESS �o�, •, —7953
fe p4
Date 1
�Qa��c f esaic��
HAA Fee $ 375.
Date of Payment
Receipt Number
(Rev. 12101)
Waiver Fee $ 1000 /
Date of Payment 3'liii' 10
Receipt Number a� JrL�
W U-bocd-�s
3- 3-03; 3:27PM;
LMCUE Environmental Services Inc.
CT&E Refit
1031064001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/#
Valhalla L3 D3
Client Sample ID
Valhalla L3 D3
Matrix
Drinking Water
Sample Remarks:
;907 5815301 # A- 2
All Dates/Times are Alaska Standard Time
Printed Date/time 03/03/2003 14:20
Collected Date/rime 02/26/2003 17:20
Received Date/time 02/27/2003 16:15
Technical Director St phen C. Ed
Released By
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Waters Department
Nitrate -N 0.898 0200 mg/L EPA300.0 (<-10) 02/27/03 JS
Microbiology Laboratory
Total Coliform 0
eol/100mL SM18 9222B (<-1) 02/27/03 SKW
3— 3-03; 3:27PM;
;907 5615301 a A- 3
CT&E .Environmental Services tnc:
Laboratory Division ra.�e,sr�r©.testy-®�m�,a���,�o,�,r �z riot, � &7ZrA? vcW
• �esrtit,'YtA►�?...Lt'L~c%J�Y�9.��ea�1
200 W. Potter Drive
Drinking'VVater Analysis Report for Total Coliform Bacteria Anchorage, AK 99 51 8-1 605
READ INSTRUCTIONS ONREYERSE SIDE BEFORE COLLECTING SAMPLE Tei: (907) 562-2343
Fax: 907)561-5301
�( MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY
I�li� UBLIC WATER SYSTENT LD. h
fy PRIVATE WATER SYSTEM
SendResults, D Send Invoice
T/J'�i�1/III� fy�y rw.c M"M
AMP�G�17�r 33g'3a4 ti
ono r ^ u u
901 tte/4ar-I 5,42ea6
ny zip
0 Send Results •A Send lnroke
V• y N., w w.a
1
cily Y4 zip cQ&
SAMPLE DATE: 7 (5
Month
SAMPLE TYPE:
mARoutine
D Repeat Sample (for routine sample
with lab ref. no. )
• Special Purpose
SAMPLE LOCATION
vQ) wig 1,3 63 r -
Comments:
Fo'U 03
Day Year
OTreated Water
VUntreated Water
Time
Collected
Collected
By
_ mr
Ylcrrc Prot
Analysis shows this Water SAMPLE to be:
+~% Satisfactory
o Unsatisfactory
O Sample over 30 hours old, results may
be unreliable
O Sample too long in transit; sample should
not be over3;Vhours old at examination
to indicate reliable results. Please send
new sample via special delivery
mail.
Date Received ^"'27 y
Time Received �I
Analysis Began G! S
Analytical Rlethod;N • Membrane Filter
13 MMO-MUG
10 ml.
1031064 e -/A- Result*
IN�IIIII�I�N�lll�il� �II�II � •.
Sent to A.D.F C. Anch Fbks Jun
i
Analyst
A `<�
Faxed
Date: Time:
Client notified of unsatisfactory results:.
❑ ❑
Phoned Spoke with Faxed
Date: Time:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MNiO-MUG Result: Total Coliform rr� E Coli
bfembraneFilter- Direct Codtlt r Colonies/100 ml
Verification: LTB
Fecal Coliform Confirmation .
Final Membrane Filter Resul s
Reported By
ECB __ COLIFIRM_
Collform/100 ml
Time &3 O -L.-_ hrs
TNTC- Too Numaour To Count
Oa-Other&ctcrio
8(#400 C) S -_ Member of the SGS Group (Socibtb G6n6rile de Surveillance)
ENVIRONMENTAL FACILITIES IN ALASKA, CA ORMA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
3-14-03; 8:09AM;
SCS Ret.#
1031307001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/#
Valhalla Neigh Well (North)
Client Sample ID
Valhalla Neigh Well (North)
Matrix
Drinking Water
;907 5615301
Ln -c 1\ 1 GLbcv-
u 2/ 3
All Dates/Times are Alaska Standard Time
Printed Date/Time 03/13/2003 13:13
Collected Date/time 03/11/2003 15:35
Received Date/time 03/11/2003 16:07
Technical Director r, /Step;C. .de _
Released
/ dpuij
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Inil
Waters Department
Nitrate -N 0.841 0.200 mg/L EPA 300.0 (<°10)
Microbiology Laboratory
Total Coliform 0 coU100mL SM18 9222B (<=1)
03/11/03 JS
03/11/03 KAP
3-14-03; 8:09AM;
;907 5615301 n 3/ 3
ME Environmental Services Inc.
Laboratory Division tiveo�Pso®t,.r®eo®oomosoo�ooioosve�.mage®.e►®®v�oo®row.
200 W. Potter Drive
rinking Water Analysis Report for Total Coliform Bacteria Anchorage, AK 99618.1605
Tel: (907) 562-2343
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907) 561-5301
MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY .
Analysis shows this Water SAMPLE to be:
O/ PUBLIC WATER SYSTEM I.D. # Satisfactory
t7 PRIVATE WATER SYSTEM O Unsatisfactory
Send Results O Send Invoice
Cl Send Results O Send Invoice
a. =Addax
uw .0 coft
dy
SAMPLE DATE: FO -T-3-1
Month
S, MPLE TYPE:
V Routine
O Repeat Sample (for routine sample
with lab ref. no: ) .
o Special Purpose
SAMPLE LOCATION
Comments:
11 ,
F - O3
pay Year
o Treated Water
t(. Untreated Water
Time
Collected
Collected
By
•
Pkaa Print
O Sample over 30 hours old, results may
be unreliable
O Sample too long in transit; sample should
not be over3tOttours old mit examination .
to indicate reliable results. Please send
new sample via special delivery mail.
Date'Recclved t•�I
Time Received
Analysis Began �1Z�
Analytical Method:. -Membrane Filter
O: MMO-MUG
1031307•j>� R`5ttlt•
1 Sentlo A.D.E.C. Ar
Date: Time:
M
I Fbks
Analyst
Jun ❑
Fared
Client notified of unsatisfactory results:.
❑ ❑
phoned Spoke with Fazed
Date: • Time:
BACTERIOLQGICAL WATER ANALYSIS RECORD '
MMO-MUG Result: Total Coliform E. Coli
blembrane Filter: Direct Count Colonies/100 ml
BGB
COLIFIRM ' 7NTC- Aa Nmnemua To Cnwt
Verification: LTB
OB Other BeNerld
Fecal Coliform Confirmation
Final Mcmbrane Filter Results Col9rnvi00 ml
Reported ByDate 03 Time � hrs
S
r®�.7{�.GS
7 Member of the SGS Group lSoeiAtAGAnAraledeSurveillance)
v
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WR#: R030025 PID#:015-212-16
Date Received:l,3 24103
HAM HA030123 Permit#:
Legal Description: Valhalla Subdivision Block 3 Lot 3
Engineer: Jeffrey A. Garness. PE
Alaska Water & Wastewater Consultants Inc.
Applicant: Rodney O. Evans
Waiver
Criteria:
Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Waiver is Granted: X Waiver is not Granted.
List Conditions or Reasons for above:.5 FE ATTA o4 EAo
Date: 9 hLo 3 By: t991V
Name of Reviewer
Rec#: 32856 Amount: $1,000.00 Date Paid: 3/24/03
George P. Il'ucrch,
Magor
April 9, 2003
Anchorage
Municipality of Anchorage
All -America City
Bttildinct Safety Ditision '
2002
343-7904
Jeffrey A. Garness, PE
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B
Anchorage, Alaska 99504
Re: Waiver Request For Valhalla Subdivision Block 3 Lot 3
Waiver Request Number WR030025
Parcel Identification Number 015-212-16
Health Authority Approval Certificate Number HA030123
Dear Mr. Gamess:
Your request for waiver of the required 100 feet separation between a water well
on the subject property and the following wastewater disposal systems has been
approved. The approved separations are as follows:
• Subject well to the on -lot absorption field of 65 feet
• Subject well to the Valhalla Block 2 Lot 11 absorption field of 90 feet
• Subject well to the Valhalla Block 2 Lot 10 absorption field of 95 feet
This waiver approval applies to the existing wastewater disposal systems only.
Any upgrade to the on-site wastewater disposal system will require all
separations be met or another waiver approval from this department.
If you have questions please call me at 343-7907.
S' cerely,
Daniel J. oth
Civil Engineer
On -Site Water & Wastewater Program
P.O. Box 100650 • Ancliornac, Alaska 99519-6650 • Tcicplione: (907) 343.8301 • P:Le: (907) 343-8200
4700 South Bra(lase Strcct • Anclioragc, rllaslut 99507
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MUNICIPALITY OF ANCHORAGE
\\
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAMEHO�NF. .� NEW
CZ( CGt.t,�-6z�/ --- - - -- - .�3`� 5- y�a7 JX� UPGRADE
_.._._
MAILING ADD ESS A
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
/ ,
WellAbsorption
area f
Dwelling
PERMIT NO.
D x
DISTANCE T0:
U
ZQ
Manufacturer �
Material
No. of compartments
a
wF
Liq, capacity in gallons IF HOMEMADE: ttl ength
Width
Liquid depth
Y
DISTANCE T0: Well Dwelling _
PERMIT NO. - -
S FQ-
Manulactu�� _�= ^•...,^ Material " "Liquid
cam pacitgellons
O
W=
DISTANCE TO:
Well p C r
Foundation/
L9
Nearest lot tine
PERMIT N0.
LL Z
No, of lines
Length of each line
Total length of lines Trench width
Distance between lines
H z w
�U / /,_
J. L ..._...._ 3; inches
ti A
_)
Top of tile to finish grade .q�� r
H
Material beneath 'a�y
Total el ecJy, a absorption area
O
N
as
Length
Length
Width
Depth
PERMIT NO.
w•
aa
Type of c .
Crib diameter
Crib depth
To�ll.effectivo ebso tion area - "
w_
�
_
W
rn
r
DISTANCE TO:
__
c I
riding foundation
_
Nearest lot line
J
C
Depth
Driller
Distance to lot line
PERMIT NO.
w
3
DISTANCE TO:
Building foundation
Sower line
Septic tank
Absorpto ` als1r-7—
IK
OTHER
C
PIPE MATERIALS
• _
__.
� IZZ
`
LL TE
SOIST RATING
r
(k
Ile
a
INSTALLER
REMARKS /' n
rt
I
A
-1-6 -CLQ
u�-C.G(,<-�
/
I b.
t
I
APPROVED s DATE LEGAL
a^R- 6l a rP
72.013 IWev. 3/781 / /
SOILS LOG
y MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 00501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: At \irnN-St.'1 (4 DATEPERFORMED: 5+ - l — st
LEGAL DESCRIPTION: E^ �� oyV� Vcx ` tln�j� S`Z)
I';t1 / SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
M. Nor.(
Ml'& M
G
0 f-,C.0Z l o u a.( & t. ,
C, �tw fr`
WAS GROUND WATER I / S
ENCOUNTERED? /�!O _ L--
0
• P
G /V% IF YES, AT WHAT E
DEPTH?
Reading
Dato
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Z
/:Z3
10
lrZyS`
�/ 6�
3
/:33
10
1rls
40115-
0113Y3
Y3
10
/•O$
.07
.i'
1a13
i to
1 J.03
to -.i
I to
65'
1 0F5
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND _� FT
..w, r,.. �., 3ti , ?-', 6'G w. F, Z .fie/
PERFORMED BY: CERTIFIED BY:4/ n ' DATE:
72.008 (6/79)
IN
u
ALASKA WATER :& WASTEWATER
CONSULTANTS, INC.
March 18, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Waiver Request and Health Authority Approval for Lot 3, Block 3; Valhalla Subdivision
WELL WAIVER REQUESTS: The existing 3 bedroom house is served by a private well and
septic system. The well is believed to have been drilled in 1970. The septic system consists of
750 gallon concrete septic tank (installed in 1970), a log crib/seepage pit (installed in 1970), and
a deep trench type drainfield (installed in 1981). The system was approved for 3 bedrooms on
6/2/1981 with an 85 feet separation distance from the septic tank and trench to the well. We
recently performed a well flow test and a septic adequacy test on the property and found several
separation distance encroachments. Attached is a site plan and detail drawings that show the
separation distance encroachments. We request that the following separation distance waivers be
granted for the septic system:
1.) A 62 feet waiver from the well on the referenced property to the 1970 concrete septic
tank. Since both the well and the septic system were installed prior to October 1973,
this separations distance should be grand fathered.
2.) A 65 feet waiver from the well on the referenced property to the 1970 log
crib/seepage pit.
3.) A 75 feet waiver from the well on the referenced property to the 1981 deep trench
type drainfield.
4.) A 90 feet waiver from the well located on Lot 11, Block 2; Valhalla S/D to the 1970
log crib/seepage pit and to the 1981 deep trench type drainfield.
5.) A 95 feet waiver from the well located on Lot 10, Block 2; Valhalla S/D to the 1970
log crib/seepage pit.
The following items are justification for the waivers:
• Topography: For the well located on the reference property, as can be seen on the attached
topography site plan, the ground elevation for the well is higher than the ground elevation
over the septic system. The house is also located between the septic system and the well. If
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
the septic system were to overflow, it would be impossible for the effluent to travel towards
the well. For the wells located on Lot 10 & 11, as can be seen on the topography site plan, the
ground elevation for the wells is slightly lower than the ground elevation over the septic
system. Shiloh Road is between the wells and septic system and the road is well developed
with a ditch line on each side of the road. If the septic system was to overflow, it appears that
the effluent would not travel toward the well head because of these ditch lines.
• The location of the septic system is in a very visible area so that if any effluent was to
surface, it would be noticed and the problem corrected.
The other path of contamination is subsurface migration wastewater. On the date of are test the
static water level was at 54 feet below the top of the casing. As can be seen on the attached well
logs, there are several feet of silty, clay soil above the aquifer that have served to inhibit the
migration of untreated wastewater into the aquifer. Recent water samples from all three well
have been taken and the results indicated nitrate levels and coliform bacteria results to be
satisfactory (see attached). These separation distance encroachments have existed for over 20
years and, as can be seen from the attached water samples, the aquifer has not been adversely
affected. Also, it should be noted that during are research we found several well waivers that
have been granted in the neighborhood and it is our opinion that our request is consistent with
these past waivers. Based upon the aforementioned facts, it appears that there is minimal risk
associated with the granting of these separation distance waivers.
LOT LINE WAIVER REQUEST: We request that a 0 feet lot line waiver be granted from the
south lot line to the deep trench type drainfield. We are unaware of any adverse effects on the
neighboring property with the granting of this waiver.
We also request that your department issue a Health Authority Approval.
If you have arty questions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
,
SHENANDOAH HILLS
S/D; LOT 2
I I
I I
I I VALHALLA S/D;
I I LOT 7, BLOCK 2
I I
I I
I I
I I
I I VALHALLA S/D;
I I LOT B. BLOCK 2
I I
i
I 1 VALHALLA S/D;
I I LOT 9. BLOCK 2
I I 4
I I 477 p -00, WFI I RADIUS.-
I I LOT 1� CK 2
1 I L -1-Q4' v/ELL-liAQltli.
1 I /, 0 � / �`�--
I 1
I
I I
I I
SHENANDOAH HILLS I I
S/D; LOT 3 I I
I I
I I
-----------J 1
VALHALLA S/D;
LOT 13, BLOCK 3
I I
VALHALLA S/D; I I VALHALLA S/D;
LOT 6. BLOCK 3 I I LOT 7, BLOCK 3
1 I
I I
I I
VALHALLA S/D; I I VALHALLA S/D;
LOT S, BLOCK 3 I I LOT 8, BLOCK 3
I I
\ $'r3/ j
j \ VALHALLA S/D'
\\
�0�
1 LOT 9, BLOCK 3
/4� VALHALLA S/D; j
`II EXISTING
LOT 4. BLOCK 3 I
3
I \
\f^
ytiopON
A%PP x. l iI'
BEDROOM
\ I
VALHALLA S/D;
LOT 10, BLOCK 3
1 /
tADIUS
10
VALHALLA S/D; I I VALHALLA S/D;
LOT 2. BLOCK 3 I I LOT 11. BLOCK 3
I I CVJ'� VALHALLA S/D;
I I LOT 11, BLOCK 2
I I 1 I I
VALHALLA S/D; ( VALHALLA S/D; I I VALHALLA S/D;
I I LOT 12, BLOCK 2 LOT 1. BLOCK 3 I I LOT 12. BLOCK 3
I I I I I
I 1 I I I
HUFFMAN ROAD
,�.�.... DATE:
3/12/2003
DRAWN BY: '
ALASKA WATER & WASTEWATER J.L.M. Q
CONSULTANTS, INC. RGA !;
6901 DFRARR ROAD. SUITE 28 • ANCHORAGF. AK 00504. • PHONF (901)337-6170 • FAX (007)338-3766 1 — loo,
ti
A
PREPARED FOR PHONE NUMBER: PAGE NUMBER:
RODNEY EVANS 762-1568/345-24481 1 OF 2 y, e
LEGAL DESCRIPTION:
LOT 3, BLOCK 3; VALHALLA SUBDIVISION
,
TYPE OF WORK:
SITE PLAN FOR WAIVER REQUEST
,
,
,
I
,
I
,
I
,
I
,
I
,
,
I
NQ0.
(/ M
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,
,
I
,
I
,
(
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.......
A G ness:•
--7953
N
1-01
QI �\ /
O I \ \ / I / LOT 4, BLOCK 3;
VALHALLA S/D
O�
_ I I
-EXISTING
WELL
100 FE WELL RADIUS/
EXISTING
3 H OUSE
o
3e
40c
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/—EXISTING b
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/ WELL I 10 � N /\` ,% `��
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ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
6001 OFRARR ROAD. SIIITF 28 • ANCHORACF. AK 99506 • PHONF (907)337.6170 • FAX (907)338-324
PREPARED FOR: PHONE NUMBER:
RODNEY EVANS 762-1568/345-2448
LEGAL DESCRIPTION:
LOT 3, BLOCK 3; VALHALLA SUBDIVISION
TYPE OF WORK:
DETAIL DRAWING OF WAIVERS REQUESTED
LOT 2, BLOCK 3;
VALHALLA S/D
KISTING
WELL
3/12/2003 ,o(-cs�- �F Q
AWN BY:
J.L.M.
ALE. 4 I
„E NUMBER:
2 OF 2 O eff y G rn ss.:
C 795 �v
nnlOc•' .,.•''�cA�G
u4 �Pr essio�°oma
�k'16 o4
Tnuun lm
nox 1*01099 S irmi Mourn. A A'UlIl0ltAGl','V a1T.Al+{Ii„� :)iDxo`a
:1411431071d 14
SIX INCH WATER WELL. DRILLED AND CASED OUT TO THE DEPTH OF 170 7W-9_
ti
DRILLED AT THE RATE OF 818.50
PER FOOT.
PROPERTY OWNER _ Jlt• Dom Dahl. 344-5120
LOCATION OF WELL SITE L,_._1SL___�__?•�
DRILLER �P&VLte C.lau-3 04 �
WELL LOG:
0----34' �Aava and 4tu cbzt .G.l,:cdat.
34---95' St,Lty.jaI±L_Aavr.L wet wLth 3 . --- --. ---
95--734' Wet etc#. 15% nand* xa teA-tat. Ito gaau"
134-169' HaAdpan.
769-170' food atoan 1JatAA 4eaAAn.g gRavel, wtth a ptoductt4n. of. 10 4PGf w4Ah 30 .deet
o/. wat#A .stand Lt eaatng. 1/2 Ilotiee Swb pump 4hoOd 4e-lrwtadled ttve IxAt a".
botttone. ,
4 ./.oat exttnatoa..addeA to the 170 jeett: ChaAge: $28.00
no U=44e pt VeU Sea.L.
m1
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THIS SUM or. $3173.00
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
DAT__15th.,_ 1979 _ %—..)E.�"�
•
1`",'~,.�,..! Y•R'�'V.:�AA�+.;��`J�C?rt" ��' d� V.'�:�.' y?+ea-�r!s',St;a<,
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,....• ' �?:+i!YJ.�!d.t1S11D_r•_�6''F•,t :.}i•_' •/n.i•71+i�..�•Uk_T..L�'•h 1H.•b'. •. ''
Al
Certified Well
%�• fja
For .. j.errs Goode .... ....... ... ... .......... .
Location... .'rildemess.tAm . .
Date completed....I.pril .25, ISO
Description,ot
Depth of Dell.. .....118.F.e:t~.
to
sal laN ci r 4t_��r.=a vr�
Size of casing . .......6..Inct:. ........
_
—KardraTncrn .:;�::� =;� •=.�
, ...............
�—:....—
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::'•
Distance to water.
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Distance to water while pcmpisig11A.F.ca;, rt rate
t
....
;...
,i,%:
.%
....... ga1lom4*rh?ur:IW
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Description,ot
from
to
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Q Q 1►�1 MILLING
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11MIn park 074aAey Road
.
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1: iejitfy the above true. and 9=ect.
::'•
.,�!Driller
'LL
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Q Q 1►�1 MILLING
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�`� •i,f,'
11MIn park 074aAey Road
.
1.
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$petard. Alaska t '
P.*. W4 W9 adtWo you to tatinch this eortlfientr to your decd ;r
•+♦•mow.. '� •:i, •Ii ;'_�''_: •� ;;,•..�•'��,r�.-w •.r •�i I•J•,, . • ..
•.wf�et'.1+'��{•y' .:r •i.tiY�y1, ,., •L.li �% •^. ,,1 t11 + y
• � 'pti'�ri �, �afy.di`S.. t1j k��i%N �`J" ��/ b'," � .. t
iIf
For ... ............
,1-. ............ ...........
Location .....•<.Y'�..,� ........1.1�t;�`f� ...�..rl,l'r.C.ri� .....L �r<..c
Date completed ...... �l,.G.f�.../.%/.%7%................ ...............................
Depth of well......../1. ...... ..........
Size of Easing.......1..!!��.
Distance to water......Sx2...1w,
................ ...............................
Distance to water while pumping.•::::•: r.A....1ae..................at rate
of........rlv...40. ......... ...............gallons por hour.
Formation
I from I to
mo
bVe,
' .4
Diller
DELTA DRtLL110tOMpANY
ORA 004 $04 s
ANCMOnAf C. ALASKA S*SOP •' '
P WeIN?1L
For ..........
Locatlon..4:��.-...
Date completed ........... x,
Depth of well, . . .........
Size of casing .....
1)[stance• to water ......... .. .....
Distance to water while ptunpinga
of....... ........... ................ 9 on Pe
ee�ll
. I
.....................
.............................. ........
.................................
.............................................
................... at rate
ormatioa :'
from
to
2!
7 ee/
lit
't A.
4.4
DELTA DRILLINCCOMPAN
ANGHO A
I A
V
4
19
Well Log
�i
r or ........y �•/.... q....rf .......� .u.� uH..J.. r ig.... •................ ................
Location." • %.....,{...... ' ''� l tf!-f)r!i ........'n:j�%i:.t.....
Date completed ... /.lt,...'......:.:!:.��%�r................................................
Dep ` '
th of,well......�,1......,/:..:1..'.............................................................
Size of casing..........°'( �, ..... .
Distance to water...a.;;t�./............. ................... I. ..... ....... ....... . .
Distance to water while pumping... " ........................at rate
of...A:, Yx;?4 ...........................gallons per hour.
Formation
from
Ito
Jai '•.'. !
-
Driller
DELTA DRILLING COMPANY
95A OOY 094 •
A:JCMOftAQ4. ALASKA 19501