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HomeMy WebLinkAboutWALTER G PIPPEL ADDITION BLK 8 LT 1Wolter G 0 PI'D p p e I Addition Block 8 Lot 1 #050-124-16 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 " L" Street, Anchorage, Alaska 33502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Bill W I Ste' TO Address e"'SEPTIC ABSORPTION FROM TANK FIELD WELL t 7vII bas S+ Pndneis) Permit No. No. of Bedrooms WELL I 104, ,9¢ 7973 $8Gzz8 3 r Lot I � I TowrtsA,P. Section I T(4P! 2 Z `✓ TANKS SEPTIC ❑ HOLDING tlanurAA«:u�r� Capacity in gallons Matww No. of Compartments Sa-e�l 2 TYPE OF SYSTEM LOT LINE IAt 1 10 Is FOUNDATION 41' I f 50' AS -BUILT DIAGRAM (Show Iocaloon of cell. septic system, propery encs. loundabon. dnreway, v.iter bornes. etc.) $(TRENCH ❑ BED Depth TO pipebottom from ong"grade 4 FT ❑ W. DRAIN ❑ OTHER Total depth from orgmal grade II FT - ifa C I cauon lA.e. / Total Depth S FT Cased to FT ) FN added above original grade FT Gravel depth beneath pipe FT , Insta112t / Date Installed- Gavot "u, Z7 FT(. Gravel width FT I Total aLsaphon area `j7 SQ FT Distance between lines Nie "FT REMARKS: Lo Ext 4 �/ retie ¢.xiti"Iy� Gr��i s sial». !r`si-aNcd E S Numuer 0 noes Sa: teeing { I 125 SO FT Pope material P 3034— brstang COY'S 1 Date Installed WELLS ?I r ❑ P ATE El OTHER (ItdenOh/) - ifa C I cauon lA.e. / Total Depth S FT Cased to FT ) , Insta112t / Date Installed- l I REMARKS: Ext 4 �/ retie ¢.xiti"Iy� Gr��i s sial». !r`si-aNcd E S i �. �.:. IDO 0 G In $erre S I S "'+ 'S60 - scaleI to = 30'.' - ENGINEE"SEAL ;. Inspections Performed b 11 �OraS'T 1+v(,-I-1� .p OF ,#vw I�q�®i hh\ oo649,11 e+y g'Poo®eat t 4 t{� � ER2 .��I�IxNiY liladds lflEAeC6M WaS pedmmrC aceading Lrsll �,:usoeoeeeaao4a9ano1a itlN 04ami6psl and be gi idelines is e8ed on this dale: )O /is -Ila a I - 9 6} a N®. ➢�32•E.. d r .��'o° Jutt® 22 198E e"tt' Reaa lt Department ApprOyai I Dale. �OA482N. +' -- T 72-Q13 (3,PAJ CnMunicipality of Anchorage A*&)WJ Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Bill Wilson 17011 Easy Street Eagle River, Alaska 99577 Subject: Lot 1 Block 8 Walter G. Pippel Subdivision Permit #880228, PID #050-124-06 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system,_,the original as -built inspection report (three-part form) must be sent to this office for review and approval, and'for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. I£ there are any further questions, please call this office at 343-4744. Sincerely, �!. 70�Daniel J. R Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit ~ IV] iJNIClFHLITY OF ANCHORAGF Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 343 ` � ON3l|E SEWFR & %E PTIC TANK PERMIT ?ermit Number: 980��28 Upgrade Sa�e ��/x'�,!10/12/38 Engineer Pesigned Ow��er Mame: BILL WI!SON Day Phone: Uw//e, 0ddres: 11 iw�Y ST. 694-2973 EAGLE RIVER/ AK 99577 Parc�l {d: U50~124�06 Subdivision: WALTER G" PIPPEL Lot: 1 Block: 8 Section: 1 Township: 141\1 Range: 2N Lot Size 15000 or acres) M�x DeUrooms: This Permit: 3 Total Capacity: 3 SEI 11lC \ANK: Minimum total septic tank tank must have at least 2 compartments" feet reques insulation over tank(s)^ capacity: 1,0O0 gallons, Each septic Depth to top of septic tank(s) < 4"0 1NSTALL PFR �NGINEERG APPROVED DESIGN" 5O� 8ALLDN TANK TO BE lNSTALLFD 8ETWEEN EXISTING TANK AND ABSORPTION AREA. NOTIFY DI -IHS PRIDP TO EACH INSPI:':'.CTION" THIS PERMIT IS ISSUED FOR THE EXISTING 3 REDROOM SINGLE FAMILY RFSIDENCE ONLY AND FXPIRES 12/31/88" [ L��|<7IFY THAT: 1" I am �amiliar ��ith the requirements lor on-site sewers and wells as set �orth by the Municipa1ity of Anchorage (MOH> and the State of Alaska" 2. J. will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o1 this permit" 3, l will adhere t a]] MDA and State o� 8laska requirements for the setback disLances from any existing disposal systemo/|"��lic sewerage system on this or any adjacent or nearby lot" 1. T .':derstand that this permit is valid for a maximum ol 3 bedrooms" I also u/u|ersLend thaL ihe capacity of the total system is 3 bedrooms and any enlargement Will, require an addjtional permit. Gigned:DATE: __�.... ��... ..... --`~---'---`�--- ~--r--- (Owner) RIL/ W IssuedDATE: By� / PERFORMED FOR LEGAL DESCR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST )3'1 I 1 w f 15ov. LIS$ W-G.PIpvw-) (5Y52n 1 C. , 511 i•5 S)l4) , 9va„�e.11it, sa„ d SP- sw DATE PERF( Township, Range, Section: $ l FI 2W T14N SLOPE SITE PLAN ■■■f MENE MOM I MEN MENS MEMO NEON NONE NONN WAS GROUND WATER (.JO ENCOUNTERED? S IF YES, AT WHAT L N' A DEPTH? P E Depth to Water After Monitoring? NO Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (mmuteslinch) PERC HOLE DIAMETER FEST1 RUN BETWEEN FT AND FT COMMENTS I/25• Sg {-�/ bdr,,, PERFORMED BY:`tilrC I l CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:—Z'Srg 72-008 (Rev. 4185) N •000034(5�'E 135.00 0 0 135.00 / Cv o 0 _ b 99 CD ^�' NibACGeas - Bk I048eB D 285 T O W O D s a � O _— 99 7:0 - ro .�U, i1-Accesf_E.,r D. • WBa 9ai D.322 p N v) D Q o a -< •000034(5�'E 135.00 _ o 0 135.00 � O o _ b 99 CD ^�' NibACGeas - Bk I048eB D 285 T O W O V00 0345 E 135.00 a J O O _— 99 7:0 - ro .�U, i1-Accesf_E.,r D. • WBa 9ai D.322 N v) J O ' 0 O a o V00°0345"E 135.00 AZY 2( 25 2! 30 30 o� a h 1 r r _ o 0 135.00 ...bPPPJ��"'•VVV m Vi 0 + CD Q N o Fy s; a 3 I D co 7:0 D. o o n (p 135.00 135.00 0 N Q N o Fy s; 3 I D w o, D. 4" • 3 is !, i ' e I o I o (A \ P. ply o �J O �d eJY _ 0 o 0 p � / o 0 o - fN / 7 o o � o O p o U � Qj o o - u 0 = o 0 o O {J p 0m o 0 0 0 0 o U 0 0 0 u CD co w 0 1. 00 m 0 N Q N o Fy s; 3 I D D. r 0o r I o I o (A \ 0 ply o �J 0 p � / o / 7 � � o o U Qj o o - u w 0 1. 00 m ry $ 0 WNL C ,0c 44 ai �� D e c z D ^w X W w N n _ V, nC } o a p -P Lv L -40 b � LA 00 mr .b �� r N0 n � � v, r VX m ; T£ bm m ry $ 0 WNL C ,0c 44 ai �� D D 0 m _ 0 m Z r< Y D ^w X W A 0 �� mm m 1 m nC p -P Lv L -40 b � ANz mr .b �� r G � � v, r m ; T£ bm < D Z C D 61 -0 0 m z N d m o - W c J. c.o. X - Municipality of Anchorage • Development Services Department 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. 0,1b — 1.24 — 6 & 1. GENERAL INFORMATION Complete legal description zof Expiration D. : •. Location (site address or directions) 17011 EASY STREET + EAGLE RIVER, AK 99577 0 Individual On-site 0 Current Property owner(s) ARNOLD BLACKADAR Day phone 227-4127 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 17011 EASY STREET * EAGLE RIVER, AK 99577 Day phone BLAKE BUTLER w/ REMAX Day phone 110 WEST 38TH AVENUE " ANCHORAGEM AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 257-0161 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 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 engineers work. 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 and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life ofall wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _{L"07 Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following Phone 337-6179 Date 10 t 05- • WATER AND : PROGRAM •,. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other AI ZQV &' By: Original Certificate Date: jig IC2205 (R". 12101) Municipality of Anchorage Development Services Department Building Safety Division On -SAO water k wastewater Program 4700 South Bragaw St. P.O. Box 108650 Anchorage, AK 095194ZW www.d.anchorsgeAk.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WALTER G. PIPPEL SUBDMSION; LOT 1. BLOCK S. Parcel ID: CjE[) - 144-61D A. WELL DATA Well type PRIVATE If A, B, or C provide PWSIDN N/A Date completed 1966 Sanitary seal (Y/N) YES Total depth 46+ ft. Cased to 40+ ft. FROM WELL LOG Date of lest Static water level ft. Well production — 9 -p.m -WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 8.91 mgA. Well Log (Y/N) NO Wines property protected (Y/N) YES Casing height (above ground) 12+ In. AT INSPECTION 9/19/2005 43 ft. 4.7+ g.p.m. Other bacteria D colonies/100 ml. Arsenic: N/A mgA. Date of sample: 9/15/2005 Collected by: GEG. LtD. B. SEPTIC/HOLDING TANK DATA 196 Tank Type/Material STEEL Date installed 10/15/13988 500/ Tank size 1000 gal. Number of Comparlmants 2 Cleanouts (Y/N) YES Foundation deanout (YM) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 3/21/2005 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date instated 10/15/teas Soil rating (g.p.01tior t rrr 125 System type TRENCH Length 27 ft. Width 2.5 ft. Gravel below pipe 7 ft. Total depth 012-5 ft. Eff. absorption area 378 fe Monitoring tube YE_ Depression over field NO Date of adequacy test 9/19/2005 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth In absorption field before test DRY in. Water added920 gal. New depth 83 In. Elapsed Time: 280 min. Final fluid depth 66.5 in. Absorption rate k 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 6 type) NONE KNOWN If yes, give dap, D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size lo genons High water alarm level at Cycles tested Meets alarm 6 circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot •50'+/100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service fine 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhde/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 59+ Absorption field 50+ Water main N/A Water service line 101+ Surface we 100'+ Wells on adjacent lots ••85' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property We '45' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 001+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent Io5' F. COMMENTS INSTALLED PRIOR TO 1973. GEE ATTACHED WAM REQUEST 0. ENGINEER'S CERTIFICATION 1 cot* that I have determined through field inspecibns and*!' 1 F* review of Municipal records that the above systems are in ..... conformance with MOA HAA guideQnes in effect on this date. ... ..................... Engineer's Printed Name JEFFREY A. GARNESS ti 70M Date HAA Fees y,A) k , `� �A\ Date of Payment Receipt Number �� �� • m (Rev. 12M) Waiver Fee S WJJ- Date of Payment Receipt Number 1Fi3`I� 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 Nitrate Advisory Health Authority Approval # HA050542 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 8, Lot 1 of Walter G. Pippel Addition subdivision, a nitrate concentration of 8.91 milligrams per liter (mg/L) was reported for the property's water well sample. The Environmental Protection Agency (EPA) maximum contaminant level (MCL) is 10.0 mg/L. Although the subject water well sample is less than the MCL, it is suggested that periodic testing be performed to insure the wells continued suitability. More information on nitrates is available from the On -Site Water and Wastewater Program, at 343-7904. This advisory must be attached to all copies of the subject Health Authority Approval. 09-26-05;10:30 ; Lsil SGS Rcfx 1056098001 Client Name Garness Engineering Group, Ltd. Project NamcM Walter GPippelSDLIB9 ClicntSamplcM Walter 0PippcISID LIB8 Matrix Drinking Water PWSID 0 Samvlc Remarks: ;907 561 5301 # 2/ 4 All Dates/Times are Alaska Standard Time Printed Date/Time 09/22/2005 13:07 Collected DatefTime 09/152005 7:35 Received Datc/Timc 09/152005 14:20 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results FOL Units Method Conmin«ID Limits Data Date Init Nitrate -N 8.91 0.100 mg/L 'BPA 353.2 B (<-10) 09/15/05 AZS Microhiclogy Laboratory Total Coliform 0 coU100ml, SM209222B A (<-1) 09/15/05 TLF 10-03-05:11:35 ;907 561 5301 * 2/ 5 SCS Re(.b 1056130001 All Datesrrlmes are Alaska Standard Time Client Name Gamess Engineering Group, Ltd. Printed Datcrl'ime 09/30/2005 8:09 ProjectNamc/N Walter G Pippel CollectedDate/rime 09/152005 14:00 Client Sample iD Wolter G Pippel S/D: Lt I Bk 8 Received Date/time 09/162005 11:45 Matrix Drinking Watcr Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parnmcter Results POL Units Method Container 10 Limits Date Data Init 4r®tilz by SGP/MS Lead 5.16 0.200 Ug/L EP200.8 A (o-15) 09/27/05 09('9/05 SCL 10/01/2005 07:10 9073449821 JRS SEPTIC, PAGE 02 JRs Pumping PO Box 773415 Eagle River, AK 99577 (907)694-6454, Billing frtformMlon —, _ . I Amotd(Bortj Blackedar 17011 Easy Street Eagle River, AK 99577.7817 (907)698-5651 Job Slts Information Eters — —. . �... . -- 17011 Easy Street Eagle River, AK 90577 (907)688.5851 227-4127 Service Type Septic Service Under 2K Addldonal Location Comments: Service Agreement Number. 016149 Order Date: 21 -Mar-2005 Service Date: 22 -Mar -2005 12:00 am Technician: Tony Job Description: 15000 P.O. Number. Terms: Net 30 Salesrep: Kartia Job Type New Mao Book: Map Grid: a5 Cress StrQOW On corner of Easy St 6 Lazy St J Job Comments: Last 0 Sery 25104 - 15000 -- -" rCustomer will have gate unlocked - Please lock gate when you leave FIRST THING ^••••Backing up. Customer Bunks the L/F it frozen and not idraining-•.— Tax Percent 9 l� .....---... —.._.. ._..- - — . _. —.... Qty Price Each u 2 Man Tax Extension Actual 1 $120.00 No No 5120.00 On comer of Easy St 6 Lazy Lane - yard Is gated- Blue house w/while Trim 3bdnn septic • Tank located under Deux 10008 In Was w/ existing 6008, upgraded crib to trench Diagram: -- .-.-- •----�- .--. .. Gallons Planned: 1500 Gallons Actual: Hoax Length; 1 DoubleaTank: [3 • Tank Pump System: *C/O i Baffles Inlet. .; Barnes Outlet: ❑ • Crib f NonTaxabte Total Taxable Total Tax Total Grand Total Estimated Charges: $120.00 $0.00 $0.00 $120.00 Actual Charges: Customer agrees to the terms and conditions of this service agreement. THIS IS A BINDING AGREEMENT, Signature and Tide of Customer Representative Date Accepted by JRs Pumping Date Accepted For your added convenience we accept American Express, Dicover, Visa and Master Card payments over the phone. After 30 Days accounts will be turned over to collections. $25.00 For NSF Checks Returned. w a N N N O 0 0 FA P�<. OF q`�S��O 4 9 T—He ............................... 4 SHANE A. HOLT: y iA L£i•6914 : �yL N 89o58127"W 1 1 9.89 ' STREET SCALE TSURV (NO CORNERS SET THIS DATE) NOTES NO EASEMENT'S APPEAR ON THIS LOT ON THE RECORD /LAT. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETNEEN EXISTING STRUCTURES MD PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONNG ADDITIONAL STRUCTURES OR FENCELINES. I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEES INSPECTION OF THE FOLLOW NG DESCRIBED PROPERTY. LOT 1, BLOCK B. WALTER G. PIPPEL ADDN. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THEY IKE IMPROVEMENTS SITUATED THEREON ME WTNIN SHE PROPERTY LINES AS NOTED AND NO VISIBLE ENCROACHMENTS EXIST EXCEPT AS NOTED. EASEMENTS OF RECORD, OTHER THAN THOSE SHONN ON THE RECORDED PUT, ME NOT SHONN HEREON (UNLESS INDICATED) DATEDAT ANCHORAGE, ALASKA THIS 22ND_ N DAY Of SEPTEMBER 2005, NOTE ANY FENCELINES SHONN ME LOCATED APPROXIMATELY AND ME NOT TO BE USED TO DETERMINE PROPERTY LINES HOLT LAND SURVEYING 9900. h 12LL22 OR LOCATE STRUCTURES. TEL 3155513 ANY PAYING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS Municipality of Anchorage �• a I'0. lkm 196M) •.tnchon c. Alaska 9!4519-UVX) • Tcaphnnc (aX)7) 3tiC01 rax (917) a9�(X) : z • � �"� i 47(X) Ilmgaw Stma • Atwhomgc, A1askn!X45 )7 maV..mmnl.org Nayor Mark Begich Ilullding Safety Ditislon 10/14/2005 Gayness Engineering Group 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for Walter G. Pippel Addition Subdivision, Block 8, Lot 1 Waiver Request #WR050090 Parcel ID #050-124-06 HAA# IIA050542 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 85.0 feet. In addition, your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to private well and absorption field to property line separations only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. �Sincerely, —Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Coni n utiiy, Security, Prosperity Municipality of Anchorage Development Services Department • +� Building Safoy Division On -Site Water and WastewaterProgratn 4700 Bragaw Street P.O. Box 1%650 Anchorage, AK 99519.6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#: WR050090 PID#: 050-12406 HAM: HA050542 Permit#: Date Received: 10/14/2005 Legal Description: Walter G. Pippel Addition Subdivision. Block S. Lot 1 Engineer. Gerness Engineering Group Applicant: Arnold Blackadar Criteria: • t : I . ,: l : t,. :,: : s. : r •r •.r Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: �.9 ,02. 4 Total: I (D.1 sLu .......................................... ....................... ......ses@@@*@ Waiver is Granted: I Waiver Is not Granted. List Conditions or Reasons for above: Date: i� / By: �4.L. owl 4--EVame of Reviewer ............................................................................... Rec#: 75342 Amount: $1.150 Date Paid: 101141200 5 Walter G. Pippel Addition Subdivision, Block 8, Lot Parcel ID: 050-124-06 Waiver for 85 feet from absorption field on subject property to well on Lot 12 and 5 foot from absorption field to property line Issued October 14, 2005 General 1. Nitrates, total coliform and other bacteria were not detected for the water sample collected from the well on Lot 12. 2. A well log is not available for the well located on Lot 12. The single-family dwelling located on Lot 12 is currently served by AW W U public water system. The well is currently inactive. 3. The existing absorption field on the subject property was installed In October 1988. The field is a totla of 12.5 feet below existing grade. The lots are generally flat in the area. If the septic system was to overflow, It appears that the effluent would not travel toward the well head. ADEC Criteria Points Water Table 4.1 Static water level on 9/19/2005 43 feet Total depth of absorption field -12.5 feet 30.5 feet x=0.5/10+4.0 x=4.05 Soil Sorption 4.5 Soil descriptions from well log for Lot 2 Sand & gravel 12 -16 feet Hardpan & boulders 16 - 28 feet Clay & gravel 28 - 57 feet (3.5/30.5 x 1.5) + (12/30.5 x 3.5) + (15/30.5 x 6.0) Permeability 2,8 Soil descriptions from well log for Lot 2 Sand & gravel 12 -16 feet Hardpan & boulders 16 - 28 feet Clay & gravel 28 - 57 feet (3.5/30.5 x 1.0) + (12/30.5 x 3.0) + (15/30.5 x 3.0) Water Table Gradient Y.9 Lot generally flat in the area. Assume 0% slope Horizontal Separation 2,4 85 feet between absorption field and well x=10/25+2.0 x=2.4 Total Points 16.7 As per ADEC waiver guidelines a point value of 16.7 is almost sure to be free of any form of contamination from household sewage. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS. October 13, 2005 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request and Health Authority Approval for Walter G. Pippel Subdivision; Lot 1 Block 8. The existing 3 bedroom house is served by a private well and septic system. We request you grant an 85 foot separation distance waiver from the septic tank and drainfield on the referenced property that was installed in 1988 to the inactive well on Lot 12, Block 8, Walter G. Pippel S/D that was drilled prior to 1984; The following items are justification for the waivers: • The lots are generally flat in the area. If the septic system was to overflow, it appears that the effluent would not travel toward the well head. • 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 of wastewater should the tank begin to leak. As can be seen on the attached well logs, there is approximately 30-60 feet of sand, silt and clay that serve to inhibit the migration of wastewater. Water samples were pulled from the inactive well on Lot 12, Block 8, indicated nitrate levels to be 0.1 mg/L and coliform bacteria results to be satisfactory. Attached are water sample results for nitrate from the surrounding area. Based upon the results it appears that the nitrate levels are elevated in the area and are not a direct result of the septic system encroachment. SURROUNDING NITRATE RESULTS: W.G. Pippel S/D; Lot 2, Block 8; 9.21 mg/L pulled 3/09/2001 W.G. Pippel S/D; Lot 5, Block 9; 7.62 mg/L pulled 5/13/1998 W.G. Pippel S/D; Lot 10, Block 10; 4.02 mg/L pulled 4/08/1996 W.G. Pippel S/D; Lot 1, Block 10; 3.4 mg/L pulled 9/21/1993 W.G. Pippel S/D; Lot 1, Block 8; 8.91 mg/L pulled 9/15/2005 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246 • Websitc: gamessenginecring.com If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengincering.com W.C. PIPPEL S/D; \ / / W.C. PIPPEL S/D; LOT 15, BLOCK 11 / LOT 2, BLOCK 11 W.G. PIPPEL S/D; W.C. PIPPEL S/D; / LOT 16, BLOCK 11 LOT 17, BLOCK 11 / / / W.C. PIPPEL S/D; W.C. PIPPEL 5/D: / LOT 3, BLOCK 11 LOT 1, BLOCK 11 --------_-- ,_—�� _—_HANSON --- \ / 1/ �\ 1 \ PE \I \\I 1 1 W.C.`P1ePEL S/D; ` LOT 78• BLOCK-b — 1 — — — / Z W.G. PIPPEL 5/D: / W.C. PIPPEL S/D; W.C. PIPPEL S/D: \ LOT 12, BLOCK 9 / LOT 9-11, BLOCK 9 LOT 8, BLOCK 5 I \ / SERVED BY PUBLIC W.C. PIPPEL S/D; \ / WATER AND SEWER LOT 714 BLOCKS i 'x-11 PPC\ \ — IV EAS -------J----------------------- -- - — — — — — — — — — — — — — — — — — — — — — — 1 W.C. PIPPEL S/D; W.C. PIPPEL S/D; W.G. PIPPEL S/D: W.C. PIPPEL S/D; W.C. PIPPEL S/D; N LOT 5, BLOCK 5 LOT 6, BLOCK 5 1 LOT 1, BLOCK 9 LOT 2, BLOCK 9 LOT 3, BLOCK 9 S E: 1 1' - 100' GARNESS ENGINEERING GROUP, Ltd. p C�' 4 +.� CONSULTANTS S. GENERAL CONTRACTORS Q•••••• ••••••••••D PREPARED FOR: PHONE NUMBER: PACE NUMBER: .. ••• ......••• ARNOLD BLACKADAR 227-4127 1 OF 2 .. V p ey A. Grness. LEGAL DESCRIPTION: DRAWN BY: Q4�,p CE-79 `F�p WALTER G. PIPPLE SUBDIVISION: LOT 1, BLOCK 8, C.J.G.vp TWE OF WORK: DATE: 40o4pO�QOio SITE PLAN FOR WAIVER REQUEST 9/30/2005 W.C. PIPPEL 5/D; W.G. PIPPEL S/0; LOT 8, BLOCK 7 LOT 7, BLOCK 7 EXISTING SEPTIC SYSTEM EXISTING 3 BEDROOM MOUSE W.C. PIPPEL 5/D; / W.G. PIPPEL S/D; LOT S, BLOCK 7 L0� 7 IN G. PIPP 1¢ S/D; W.C. PIPPEL S/D: W.C. PIPPEL S/D; W.G. PIPPEL S/0: LOT 11, BOCK 8 LOT 10, BLOCK 6 LOT 9, BLOCK 8 LOT 12, BLOCK 8 �SEARPTIC / EAA / W.C. PIPPEL S/0;4 W.C. PIPPEL 5/D; W.C. PIPPEL S/D; �/ LOT 2. BLOCK 8 ;OT 3, BLOCK 6 LOT 4. BLOCK 8 1 (Rev Of)0 51 51 EXISTING DECOMMISSIONED W.C. PIPPEL S/D; LOT 12. BLOCK 8. EXISTING 3 BEDROOM HOUSE \ 1 1 I I / / / / / / EXISTING 1000 CALLON SEPTIC TANK ,EXISTING \ 500 GALLON \ SEPTIC TANK \ EASY STREET GARNESS ENGINEERING GROUP, Ltd. pp� CONSULTANTS b GENERAL CONTRACTORS • • t L TIOOR IIO.D. fUllC 101 • M HOPAM M "501 • F1C,S (W1T11)-OIN • /M (YO»55 " • X0511[: w•.,sw•�.yMrYyw EPARED FOR: PHONE NUMBER: PAGE NUMBER: PR / Q ARNOLD BLACKADAR 227-4127 2 OF 2 Qp LEGAL DESCRIPTION: DRAWN BY: QO.cJ 4�d WALTER G. \ C.J.G. 1 TYPE OF WORK: 1 SITE PLAN FOR WAIVER REQUEST EXISTING 3 BEDROOM HOUSE \ 1 1 I I / / / / / / EXISTING 1000 CALLON SEPTIC TANK ,EXISTING \ 500 GALLON \ SEPTIC TANK \ EASY STREET GARNESS ENGINEERING GROUP, Ltd. pp� CONSULTANTS b GENERAL CONTRACTORS • • t L TIOOR IIO.D. fUllC 101 • M HOPAM M "501 • F1C,S (W1T11)-OIN • /M (YO»55 " • X0511[: w•.,sw•�.yMrYyw EPARED FOR: PHONE NUMBER: PAGE NUMBER: (ROv.01A5) CEG—/795 PR Q ARNOLD BLACKADAR 227-4127 2 OF 2 Qp LEGAL DESCRIPTION: DRAWN BY: QO.cJ 4�d WALTER G. PIPPLE SUBDIVISION; LOT 1, BLOCK 8, C.J.G. TYPE OF WORK: DATE: 1 9/30/2005 SITE PLAN FOR WAIVER REQUEST (ROv.01A5) CEG—/795 10-07-05 03:43PM FROM-CTLE ESI, SCS ENV SERVICES LSG$- SCS Ret# 1056434001 Client Name Aarow Pump & Well Service Project name/# 11831 Lazy Ln ER Client Sample ID 11831 Lazy Ln ER hlatrix Drinking Water PWSID 0 Sample Remarks: 9075615301 T-030 P.02/04 F-316 All Dates/Times are Alaska Standard Time Printed Date/time 10/062005 16:07 Collected Date/Time 09292005 13:00 Received Date/Time 09292005 13:45 Technical Director Stephen C. Ede Alluwabte Prop Analysis Parameter Results PQL Units Methal Container ID Limits Date Date Ing Nitrate -N 0.100 U 0.100 mg/L EPA 353.2 B (<-10) 0929/05 AZS Microbiology Laboratory Total Coliform 139 O , W/Coli No F coVIOOmL SM20 92228 (IF 04 10 /Vos- SQ,-tQsli Ori roil 0 A (-1) 0929/05 TLF 10-13-05;17:05 ; SGS/CTBE ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIOE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM roe ❑ PRIVATE WATER SYSTEM ❑ Send Results Send Invoice Fend Resuhs • Dal.: Ito 111GLI n..► eV yr SAMPLE TYPE ;907 661 5301 # 2/ 2 200 W. POTTER DRIVE ANCHORAGE. ALASKA 99518 Te1:907.552.2343, .. Fax 907-5615301 Lab flat No. 10568■0�8`- �tl� a Send Invoice ❑ Routine ❑ Treated Water P' Repeat Sample ❑ Untreated Water (rofor to tab no. 1 ❑ Spcelal Purpose Tnmspened to Lae By. 'Yv p{ Some as collector Other e.rn. ewv. TO BE COMPLETED BY LABORATORY Sample Reeeivingi Date:_ /o- /At.Sampbover30MMold: ❑ RUSH SAMPLE Time: 11 CI -21 Delivery Method: Reeelved B)r Comments: ........................ Anayala Bepan: lo�/z;�0•S� /9nd Analyst AnaVIcal Method: Membrane FIRer Reauhs liw be tsvellablo Phone #: taadwo Fax #: "A MMO•MUG (PW Taal Coftn: I Cat MEMBRANE FILTER RESULTS: Olmet Count A/AL Colonlesrltltxnt. ved4Cetlon: to ADCC: ANG FBK NN Sent to Cuent Phoned ❑ Faxed Dat nnw Spoke vAd¢ MMO-MUG (P/A)nwa.,• • L {ace i}�SaUsfactory t E ❑ Unsatisfactory Reported By: —� Datefrune: �+�/7 /05, ��1 :1d Fonn # FW- 0053 12M7103 1Wseslnas01%AW GroupOntaUPubAdDOCUMENrFORMSIapproved" Folm 121703ads Oct -14. 2005 1:09PM Garness Engineering Group, Ltd. No -0128 P• 4 .i•v�'`�,♦ '•_ Jprf'l': ✓ '_z� �` �tp�tifi�� �rilli �u • •• • • � : s 4.s.a.r•s.• A & L DRILLING COMPANY SOK N• EAGLE tlWIN. ALASKA $06" • TEtOMiITiE'EY,t!!I♦fE ^'�—._ 6Sy �, r..•;f Z!+'dtt• 4,j 3.11 SL �ivau.�+ ie w�l toff > J N'Q��� 'r �+,� •• 5S OWNER OF LAND C 1 iNKC -- --DEFINIF WELLC� < ESS << G ! �. ADDRSTATIC LEVEL OFWATER'FT. ..��.•�to'�-• LEGAL DESCRRTION, d f x S7.PGET Eeded CAIS. PER !Dt �� y � w -d �p�W DOWN FF. LaYEoB 1 T'T �" __ ' DATE • Started �s� PERMITNLwaERi KIND OFGWNC �.: Ar ark w._ /s? /l L!% C + 2l. .1 ._ t i teas YfAM a«wti. -rw,. FlotnQ_Ft.t+ Ft—Qy��li..tw rWG. From�Ft.tol{i�Ft From 16 to .� Ft HPr�(;o1sa�,g From �_1�FLto 4i .Pt_YE!(u.✓ l:(�r � •6�(�i,dL Froe�1_Ft. ts� Z�Ft f r 3 g^Ace+G FfO°'.SLFt.'to Ft N.AcF From Ft to Ft From Ft. to Pt From Ft to Pt from Ft. to - Ft M eft E IF lm— ly ,''s1 4�l.fv .�`"#`il rnn► �rM. T—' e� �.. From FL ro Ft. to a From Ft. to --Ft From Ft.4t - Ft rn i From Ft. ro Ft n Q _ ' From—Fl. Ftcm FL From ' FL � I , From Ft to Ft. "'t From 1 � ' Fran FL to Ft Frm- to cr �C A From Ft to --FL Flom Ft to Ft 'rem —Ft. tc FL From Ft to ----FL tom Ft to Ft. From Ft to Ft Wm —Fl- to Ftr Ftem Pito Ft. ! tom FL tl PL Frma Ft. tam Ft ', 1 ISCL.INFORMATION- MS'S . tU J DRILLERS NAME 4C r�� • MUNICIPALITY OFANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES M}� Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Ca, HAA # 1. GENERAL INFORMATION Complete legal description Lot 1; Stock 8; Watters G. Pippe2 Subdivision Location (site address or directions) 17011 Ew a StAeet Property owner Claudia Witton Day phone 694-2973 Mailing address 17011 Ea6N S.tAeet Eagte R.iveA Ataeha 99577 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water — Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ]2-025(A.v. 1/91) Front MOA 421 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water ordinances, and regulations in effect on the date of this inspection. supply and/or wastewater disposal system is in compliance with all Municipal and State codes, Name of Firm Address 77034 Eagle Rlver Loop Road No. 204Phone Engineer's signature Date OF M -i % % 't :R J. No. i na�� pROFESS1��aPw 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well forthis ro ert meets exist - State and Municipal Codes. There arod e nitrates present. It ing is continued suitability.Nitrate concentration is 8.3 m is rYt tea-pian—;-c-1[Ln g/1. EPA By: _,30 Date- The ate The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services l HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: f-2;LV- b Itgfr� 6". Parcel I.D. - A. WELL DATA Well type Py ­t vac If A, B, or C, attach ADEC letter. ADEC water system number fo Log present (Y&^'1IDate completed J 9- Driller, ✓ K Total depth UI1-Cased to 4 o s + Casing height 12" Sanitary seal O/N) Date of test Static water level Well flow Pump level FROM WELL LOG Wires properly protectedo'N) g.p.m. AT INSPECTION q-9-172 47 ' L. S; v� SEPARATION DISTANCES FROM WELL TO: tk Septic/holding tank on lot SD)p o ) ; On adjacent lots Absorption field on lot t ob } ; On adjacent lots _ t® c rz. LLJ 1+ Public sewer main dl4 Public sewer manhole/cleanout 'J Sewer service line -7-sr I Petroleum tank Z 14 t lkLV0Rsz5 A-OcGi A, -r WATER SAMPLE RESULTS: Coliform 10 jpO �' Nitrate $ 3 µyb Other bacteria Date of sample: 8 ' Z 6 _�J Z Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Soo 1M.PZtoR-n191i`d - oOG i- toc�o Dateinstalled tbor,. I`ls$$—Tanksize 5r Compartments 1142 Cleanouts & ) High water alarm (YCNP Date of pumping Foundation cleanout ON) T— Depression (Y& w It Alarm tested (Y/N) '!IA - 20 -I I Pumper S &£ss�oo L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: + i loo' I 25 t 4 Well(s) on lot �o1On ad'acent lots ) no � � Foundation To property line 10 1 Absorptionfield S Water main/service line ZS Surface water/drainage 100 14- 72-026 4 72-026 (Rev.7/s1) Front - - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical "Pump on" level at Manufacturer Manhole/Access (Y/N) SEPARATlOk-DISTANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots --' "Pump off" level at Cycles tested Surface water _ Date installed Soil rating 1 25, �/il;l R-. System type TFLN br Length 211 Width 30 Gravel thickness % Totaldepth 11' Total absorption area Cleanouts present O/N) Depression over field (Y& Date of adequacy test 10- f 3-91 Results pa fail) 1085 for '%iRS.,�_ (3� _ bedrooms Peroxide treatment (past 12 months) (Ya �J'2/L If yes, give date /J//" SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot loa tk t FF��t 1a5- On adjacent lots l b o � Property line l e tze9o9-1r To building foundation To existing or abandoned system on lot On adjacent lots Cutbank '' 10< Water main/service line_ 1� Surface water Ino Driveway. r)arkinn/vahir.la ctnrana arca 1 +- rb ' `F Curtain drain E. ENGINEER'S CERTIFICATION' I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S e?, S ENGINEL^"RING 17034 Eaglo River Loop Road No. 204 Signature _ Engle -River, Aluka 99577 Engineer's Name Date HAA Fee $ ��`�y Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number _ if 2 No. 6215 :4Y CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 57637 Chemlab Ref.# 92.4550 Sample # 1 Matrix: WATER Client Sample ID L1 B8 WALTER G. PIPPEL PWSID : UA Collected AUG 28 92 @ 10:15 his. Received AUG 28 92 @ 14:30 his. Preserved with AS REQUIRED Analysis Completed AUG 31 92 Super vis r PHENC. ED_ E Releasedeleased By C_ Parameter NITRATE -N Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# Req# Ordered By :R. SHAFER Send Reports to: 1)3 & S ENGINEERING 2) _ Results Units Method Allowable Limits 8.3 mg/1 EPA 353.2 10 1 Tests Performed See Special Instructions Above UA -Unavailable ND. None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than 104? SE3S Member of the SGS Group (Societe Generale de Surveillance) POI :NONE RECEIVED MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES w} Division of Environmental Services - On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O S c' 1. GENERAL INFORMATION HAA #—l\C)9l ��1°1�) Complete legal description L_158 uoGi�'PPe,I is l)dr(iw�'� Location (site address or directions) 1701 1 G: � Property owner �' a W; )son Day phone Mailing address 1�0)t �'Sc�S+� le 2ve1-1 A -K, 99s7i'­1 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water — Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025 (Rm 1/91) Front MOA 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �rs+rv�k1���n� s Phone C99-�o9g Address 9Go( "B')aA J��Wevne��l I� �hora e %K,9951k Engineer's signature �"Date 6. DHHS SIGNATURE Approved for Ta�cis- 3 bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: By: Date /6- 11 ITIC v 11ITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72025 (Rev. 1/91) Back MOA 421 Municipality of Anchorage Department of Health & Human Services M HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LI 68 WCG- gip( t .tom Parcel I.D. OSb-IZR-66 A. WELL DATA Well type 'z'y�E If A, B, or C, attach ADEC letter. ADEC water system number N+) v i Log present (Y/N) N Date completed L) 0< Driller UN\e- Total depth VN'< Casedto 4d+ Casing height I -L - - J>,AOfTOry ALLY (SY GbNG PIPe Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION 10-13-91 IPALITY OF ANCHO GE Sz' ENVIRONMENTAL SERVICES DIVISION g.p.m. -7.o orgTp.�,5 1991 VNORECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot s� ; On adjacent lots C.5oo (iooa� Absorption field on lot On adjacent lots _ +100' + LOO' Public sewer main +z5'_Public sewer manhole/cleanout 4 - Public Public sewer service line i- 7-s' Petroleum tank -*ZS' WATER SAMPLE RESULTS: Coliform Nitrate Z Other bacteria, Date of sample: to -\3-9\ Collected by: C� S 4vdc� �� Gnso- s B. SEPTIC/HOLDING TANK DATA 45`� i1w (ohi 1000. 10-13- Date installed Or -Tank size l oDo� S Compartments z f riv r Cleanouts"(Y/N) ' y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) Date+ ofIpumping lo -7e0-91 Alarm tested (Y/N) N �) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot _ +'oo g tg On adjacent lots ICb / Foundation To property line Absorptionfield D Water main/service line Surface water/drainage t zoo t ZS1 + Z'S'' ]2-026(Rw. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at (-�= - "Pump off' level at High water alarm level . Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DIST FROM LIFT STATIONTO: Well On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed oC,+ 19ag Soil rating LZS s-� 6c l" System type +i e,,cl, Length Z Width 30 Gravel thickness -7' Total depth 11 Total absorption area 3�3 5(� Cleanouts present (Y/N) Y Depression over field (Y/N) Results (pass/fail) EL$ Peroxide treatment (past 12 months) (Y/N) _ Date of adequacy test for -t14KarC_ If yes, give date 13-91 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot +loo' On adjacent lots --t Property line 10 To building foundation + �50' To existing or abandoned system on lot tzS On adjacent lots +-'s Cutbank ^/ P1 —Water main/service line 4. Surface water NP1 Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION bedrooms I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect �aNvhinsp Signature AIA�� 'Q,/jK �1J'ryivVr Engineer's Name f 11 UJIL 56 ""°'"" •••••�•� Nn. tM� e Date 20, Z 5 1 1//+Tv.•• wn. �, t�� HAA Fee $ / �� d Date of Payment Receipt Number 72-026 (Rev. 3191) Back MOA 21 �,3/��,% g'e78 Waiver Fee: $ _ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 4563125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 2778378 • FAX 274-9645 Constructing Engineers Report Date: 10/21/91 9601 Buddy Werner Drive Anchorage AK 99516 Date Arrived: 10/14/91 Attn: Chuck Landers Our Lab #: A114738 Location/Project: - your Sample ID: L1B8 WG Pippel Sample Matrix: Water Comments: Method Parameter --------------------- EPA 353.3 Nitrate -N N1" F, Reported By: William E. Bu Anchorage Operations Manager Date Sampled: 10/14/91 Time Sampled: 1430 Collected By: CAL Definitions MDL = Method Detection Limit B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Units Result-��lag MDL Analyzed mg/1 0.1 10/18/91 - � - INSPECTION APPOINTMENTS\'�-- DATE RECEIVED TIME TIME - Eos sT 6. TYPE OF RESIDENCE :UAA DATE DAT E INSPECTOR INSPECT0 INSPECT MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF H-=ALTH & Alaska 99501 PROTECTION 825 L Street - Anchorage, ENVIRONMENTAL • ENVIRONMENTAL SANITATION DIVISION Pj ON] 13 1980 - Telephone 264-4720 -❑L1' [c �1/ Ce Inl REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVIRIEGGILNfIIED DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. JC�OPE TY OWNER �a � '� � K- k4 o rt YEAR ON-SITE SYSTEM WAS INSTALLED. PHONE Com -� . Fv= NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING DRESS ro, ��,� -� iL�5 -7-7 PROPERTY RESIDENT(If different from above) r o Y' `!V �'. Y' 'G i'c= S l E C-.RZ'� l,Nr L C.- i�:; E=t�.s P+'" l �+ � r"l 1 /ONE (,,9q 3q -2-S 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION LmT Yv STREET LOCATION Eos sT 6. TYPE OF RESIDENCE p�NUMBER OF,BEDROOMS ❑ One El Four Other SINGLE FAMILY Two ❑ Five ❑ MULTIPLE FAMILY -Three ❑ Six 7. WATER SUPPLY I ' ATTACH. WELL LOG. A well log is required for all wells drilled 0INDIVIDUAL* COMMUNITY since June 1975. For wells drilled prior to that date, give well "ib ❑ PUBLIC UTILITY depth (attach log if available.) 13ut�T, 8. SEWAGE DISPOSAL SYSTEM /7/0.- fir- 1,11 INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY ''?ECI�v`Z 0—ir KK -'= -2�k)i<-T' (,) NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) a" bLF J (\A��1� [_L ' AA !®J ' THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLEFAMILY NUMBER OF BEDROOMS ❑ ONE ❑I THREE ❑ FIVE ❑ OTHER ❑ TWO ❑I FOUR ❑ six 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANKf SA MANUFACTURER TOTAL ABS RPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 6. COMMENTS11 yy/� Ek-l" APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ' ]&L T ISAPPROVED DATE ,5' BY 72-010 (Rev. 6/79) s 825 "L S(RFEl ANCHORAGIL, ALASKA 99501 (907) 264-4111 GEORGE M.SULLIVAN, MAiOR DEPARTMENT OF HEALTH AN/D ENV IRONMEN I AL PROTECTION April 24, 1931 C. Jeffery/Donna. M. Abbott Post office Box 1321. Eagle River-, Alaska 99577 Subject: Lot ]_ Block 8 W. G. Pipple Subdivision Approval for the _i.ndividual sewer and water facilities cannot be granted until the following items have been completed: d (1) The water analysis report needs to be delivered to �c� this office from the Chem Lab, 5633 B Street, for v our review. OX -(2) The septic tank pumped with a receipt submitted to this office. ()CC3) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw 4 Jeff Abbott P.O. Box 1321 Eagle River, Alaska 99577 Dear Mr, Abbott, DAVID A. SLENKAMP MECHANICAL ENGINEER 694-9055 May 12, 1951 Reference: Lot l; Block 5; 'Walter G. Pipple Subdivision ROBERT A.SHAFER CIVIL ENGINEER 694-2979 A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage pit was charged with 1000 gallons of water and after a period of 24 hours approximately 650 gallons had percolated out of the crib. It can be concluded from the above test that the on—site waste ,,rater disposal system is currently functioning adequately for the three bedroom residence located on this property. The system cannot be guaranteed, however, against subsequent failures. If we may be of further assistance, please do not hesitate to call. Sincerely, cc: First National Bank of Anchorage cr_/ r—LAvOiA 3v-�vs ATTENTION:- Donna Nail A N Q /-j Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA MUNICIPALITY OF ANCHORAGE !� 'iEPARTME.N�JF HEALTH AND ENVIRONMENTrPROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, exL. 224 or 225 Date Received: May 26, 1977 #1: Time 2: m. #2: Time a� � #3: Time Date 6-9Thurs. (7�7 Date (D( �rn�.� Date (D-/�J: j� CLpS Insp Pr Insp /1 x Insp _ ILZuut� REQUEST FOR APPROVAL OF INDIVIDUAL SEWERAND WATE FACILITIES l n e 1. Lending Institution Request: Lomas and Nettleton Mailing Address: 4449 Business Park Boulevard 2. Property Owner: Mailing Address: Thomas W. Keene Phone: 274-7661 Phone: 694-2633 3. Legal Description: Lot 1 Block 8 Walter Pipple Subdivision 4: Single Family Residence: (z) Multiple Family Residence: ( ) 5 Number of Bedrooms: Number of Bedrooms: 2 Well System: Individual Well (X) Community/Public System ( ) Permit # Depth of Well Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: on-site System (�9 Public Utility ( ) Permit # Installed Installer Septic Tank Size Manufacturer. Absorption Area Soils Rate Material _ 7. Distances: Well to Septic Tank to Absorption Area _ to Sewer. Line Nearest Lot line _ Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE • �.[ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA C 0 N V__PLLT'C_, 2. Property Owner: ' 41&n_� krze' • Mailing Address:—(14J � Day Phone: ` 3. Name . I U u r 9 Mailing Address: 4 A 5--e Day Ph6n i 4. Name of Lending Institution: ? Mailing AddressA14!j9 hone: 5. Name of Rea Mailing 6. Legal Descrir Location: 7. Type of Facility to be Inspected: ' e– ,`I No. Bdrms. 8. Water Supply p� Type of Supply: Public Utility—Individual�X� If Individual, number of dwellings presently served ' I If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site)T 1 If Individual, date of installation Un,�llt`r > 72-003(3/76) L ?wo Department of health and Environmental Protection Request for. Approval of Individual Sewer. and Water facilities Legal Description: Lot 1 -Block 8 Walter Pipple Comments : L moo- i� X�Y x i' e,n`° ur `--c--r, Affa.davit Attached: ( ) Letter Attached: ( ) Approved: Date: C/ Disapproved: �� Date: -- Department Worksheet: REPORT OF INSPECTION -INDIVIDUAL SEWAGE -DISPOSAL SYSTEM PRIMARY TREATMENT consists of ❑ Septic tank. ❑ Cesspool. Septic Tank: Distance from well, feet. Material, Number of compartments Total liquid capacity, gallons. Capacity inlet compartment,_ Inside length,_ _feet. Inside width, feet. Liquid depth, feet. Cesspool: Distance from: Well, feet; foundation, _feet; nearest lot line at ❑ front, ❑ side, ❑ rear,_ Inside diameter, feet. Depth, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of ❑ Tile disposal field. ❑ Seepage pits. Other. Tile Disposal Field: feet. Distance from: Well, feet; foundation, feet; nearest lot line at ❑ from, ❑ side, ❑ rear, feet. Total length of tile lines,— feet. Number of lines, . Distance between lines, feet. Trench width, _inches. Total effective absorption area in bottom of trenches, square feet. Length of each line,_ feet. Depth, top of tile to finish grade, inches. Type of filter material: ❑ Gravel. ❑ Broken stone. Other_ Depth of filter material beneath tile, _inches. Depth of filter material over tile, inches. Seepage Pits: Number of pits__. Distance from: Well, Outside diameter, feet. Depth, feet. Lining material feet; building foundation,_ feet; nearest lot line at ❑ front, ❑ side, ❑ rear Inspection made by: ❑ State. ❑ County. ❑ Local Health Authority. Inspected by Date of inspection 19 (oll,lo REPORT OF INSPECTION -INDIVIDUAL WATER -SUPPLY SYSTEM feet. Distance to nearest public water main,_.—feet. Size of main, inches. Individual wells ❑ arc• ❑ are not customary in neighbgrhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood ❑ are ❑ are not being developed with both individual water -supply and sewage -disposal systems. Lot sae: feet wide,__ —feet deep. Dwelling set back from front property line, feet. Individual water supply from: ❑ Drilled well. ❑ Driven well. ❑ Dug well. ❑ Bored well. Distance of well from: Building foundation, __feet; nearest lot line at ❑ front, ❑ side, ❑ rear, feet, cast iron sewer, feet; tile sewer, feet; septic tank, feet-, disposal field, feet; seepage pit, feet, cesspool, feet; other sources of possible pollution, feet. Well construction: Diameter, inches. Total depth, feet. Type of casing, Depth of casing, feet. Approximate depth to pumping level of water in well, Feet. Approximate yield, gallons per minute. Sealed watertight to depth of feet. Exterior space around casing sealed with: ❑ Cement grout. ❑ Puddled clay. ❑ Ordinary backfill. Well cover: ❑ Concrete. ❑ Wood. ❑ Metal. Openings in well cover watertight: ❑ Yes. ❑ No. Pump: ❑ Shallow well. ❑ Deep well. Length of drop pipe, feet. Pump capacity, gallons per minute. Located in: ❑ Basement. ❑ Pumproom off basement. ❑ Pumphouse above ground. ❑ Pump pit. Pumproom properly drained: ❑ Yes. ❑ No. Pump mounting watertight: ❑ Yes. ❑ No. Type of storage: ❑ Pressure. ❑ Gravity. Capacity,_gallons. Has bacteriological examination of water been made? ❑ Yes. ❑ No. If answer is "yes," give date Quality of water ❑ is ❑ is not satisfactory for human consumption. Installation ❑ does ❑ does not comply with approved exhibits, if any. Inspection made by: ❑ State. ❑ County. ❑ Local Health Authority. Inspected by Date of inspection 19 19_ GPO 889088 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEYVED: `/- i0 7✓ INSPECT: //- i 7i TIME: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES FOR 1. APPROVAL REQUESTED BY: ADDRESS:J/G PHONE: 2. PROPERTY OWNER: %�D71� f ��Gid��U �ff/1 .PHONE:. G 3. LEGAL DESCRIPTION:��Z A/ 4. TYPE FACILITY TO BE INSPECTED: STREET: NUMBER OF BEDROOMS: 5. WELL DATA: A. TYPE 01. B. DEPTH C. SIZE lo ('. G D. CONSTRUCTION YjywG PC� E. BACTERIAL ANALYSIS 6. SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE 2. AGE v f,2:f'n, 3. MANUFACTURER 4. INSTALLER ��- 6--7 hA 7 F.? APPROVAL REQUEST FOR SEWER & WATER FACILITIES PAGE TWO B. SEEPAGE PIT 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT 8 �t C. WELL TO SEWER LINE D. WELL TO PROPERTY LINE E.. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK G. FOUNDATION TO SEEPAGE PIT H. SEEPAGE PIT TO PROPERTY LINE COMMENTS: APPROVED: DISAPPROVED: DATE: DATE: APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY November 24, 1971 First mational Bank of Anchorage P.O. Box 720 Anchorage, Alaska 99510 SubjRct: Lot 1, Flock 8, POPIC Subdivision. Bear Sirs: Ars inspection on novotypemofr13, sowerl971 systemv€hatdthat the well the subject lot was buried. The type has is unknown. before our 4pproval of the w011 can bo givon, th* well cas- Ing needs to be brought above ground levOl. Since this wepcanf4rneith€arent oesap#sroVo nornot %riotq }at tile seer disapprove theystem sewereOnsistfi of, system. If ,you have any questions regarding the above, please do not hesitate to contact this office. Sincerely, Lynn S. Goad Environmental Specialist st cc: federal housing Authority Zmuda Realty