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
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hh\ oo649,11 e+y
g'Poo®eat
t
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.��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.
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-- 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
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
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LIS$ W-G.PIpvw-)
(5Y52n 1 C. , 511 i•5
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DATE PERF(
Township, Range, Section: $ l FI 2W T14N
SLOPE SITE PLAN
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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)
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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.
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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
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LaYEoB 1
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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