HomeMy WebLinkAboutWILLIAMSON #2 BLK 3 LT 9 Municipality of Anchorage Page _
DEPARTMENT OF HFALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~>~J ~'~O H~ PID Number: o1~ - o"/~
Name:
.3~4 vJu-~o-~ ~/~ ~ ~m-~ ~.~.~,~ Wastewater System: D New
Address
~ ~ ~ II ~ D 8hallo~Trench ~ BeO ~ Mound ~ Other
LEGAL DESCRIPTION so,~t~: J' ~ ~/sq.~. w.~ -
Lot: Bloc~: Subdiv~ion: Depth to pipe bottom from original grade: Grave] depth beneath pipe
Township: ~--I~ Range: ~I~ Section: ~ Fill added~ abovel ~ O,~°riginal grade: Ft. Gravel length: ~1 Ft.
Gravel width: Number of lines: ~ Dist¢nce betwee~ lines:
WELL: l~.T/~New D Upgrade ~ ~.~ Ft. II ' Ft.
Classification (Private, A,B,C): Total Depth~ ~d To: ITotal absorption area: Pipe material:
Date inst lied:
Driller: / ~e Drilled: StagcWater LeVehFt. [nstaller:~ ~T' JZ ~ I~ -
Yield: ~ Pump Set at: Ft. Ft. TANK
SEPARATION DIS'rANCES ~ ~ Holding ~ S.T.E.P.
To Septic Absorption LiR Holding ~ubllc/Priva[e Manufacturer: Capacityin gallons:
From Tank Field Station Tank Sewer Lines ~F~ 0~ ~
Material: Number of Compadments:
Sudace
Water ]OOt+ ~oo~+ .... LIFT STATION
Lot Size ,~nu,acturor:
Cu~ainDrain ~ ~oN,~ K~ "- ~ ~u~~Irica~l.speotionsp.rformed by:
Lo~ation and Description:
I AssumedElevation: Io&.l~. F~,
Inspections performed by: ~.~,~.~ ~ J~c. Dates:lst_
Department of Health and Human Se~ices approval ~ , ,~.. .... ..
72-013 (Rev. 9/91) MOA 25
"["~'VswBao,~,~"~": AS - BUIILT DRAWING
NEW DRAINFIE[ D-
z~l.. ~t ,~
/
PROFESSIONAI.LY I OCA1ED PRIOR ~ ' : '~ Mr - - 60 9
I0 CONS}RUCDON. 10' SEPARATION ~ / ' ,' , / [ ~ - ""-
BERVEEN THE WA~ER I IHE LOCATE ' ~ / * * / C02 75.7
5 O '
'/--' ~ % ~ '/ ..... NUW 1000 GALLON
~S~ WATER AND WASTEWA~R CONS~T~S, ~C.
6901 DE~RR ROAD, SUITE aB. ANCHO~OE, ~, 90504
~. ,,~ "~.,. ~:,~
PHONE: (907) 337-6179/FAX: (907) 33B-3248
WILLIAMSON SUBDIVISION ~2, LOT 9, BLOCK 3
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
JACK WHITE REAL ESTATE 762-511~
A.C.O. 1 = 30' 2 OF 2
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box '196650, Anchorage, AK 995'19-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PE-'RMI'T
Upgrade
Date Issued: Nov 25, 1998
Expiration Date: Nov 25, 1999
Permit Number: SW980456
Legal Description: WILLIAMSON #2 BLK 3 LT 9
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: JEAN WILCOX
Owner Address: PO BOX 261
KING SALMON , AK 99613-0261
Parcel ID: 015-074-09
Site Address: 005041 98TH AVE E
Lot Size: 11801 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
Private Well [~ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Issued By:/~~'-~'J~
Date:
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B. Anchorage, Alt * 99504
(907) 33%6179 ~ Fax (907) 338-3246 ........... ~.~, ~
Consnitmg Eugineet s
1 9
November 17, 1998
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: Septic Upgrade Design for Lot 9, Block 3, Williamson Subdivision #2
To whom it may concern:
The existing 3 bedroom honse is served by a private septic system and a private well. The existing
septic system, which consists of a septic tank and a deep trench, will not pass an adequacy test.
The septic system must be upgraded prior to the sale of the house. Comments regarding the
proposed upgrade design are summarized as follows:
1. SOILS: Attached are the soils logs which shows the soil profile, and the percolation test
result. The soils below the organics in the test hole are a SM material to a depth of I6 feet
(bottom of test hole). No groundwater was encountered during the excavation of the test holes.
One soil percolation test was performed at a depth of 6 feet (see attached soil logs). It is om'
opinion that the insitu soils the trench isto be placed in will act as a sand filter.
2. TRENCH DESIGN:
a. Percolation Rate: 1 minute/inch
b. Allowable Application Rate:_ 1.2 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
Al.ca:
ft2
e. Minimum Absorption 375
f. Total Depth: 8.5 feet (max.)
g. Effective Depth: 7 feet ofdrainrock
h. Width: 2.5 feet
i. Minimum Length: 40 feet
j. Effective absorption area = 600 ft2
k. Entire system is to be insulated.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The area where the proposed trench is to go is virtually flat. There are no
concerns regarding the slope of the terrain.
I am unawm'e of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179. Thank you for your
assistance.
Sincerel1
James P. Williams, P.E.
Civil Engineer
~ AREA
WElt R_Aplt Jj~
/
SUBOIVISION ^IRE SERVE[~ BY,A OOMMHNI1Y
LOT 12, BLGCK 5
WILLIAMSON S/D
OI LtLOCK 3
WILLIAMSON S/D
LOT 10 BL()CK 3
- PNOPOSED SEP'flC
(SEE DESIGN,
2 01- 2)
L () J"~ ]LOCK
/,~1[[ IAUSON S/O
/
_or / Dt. OCN
W LllAMSON B/D
WILt.lAMSON
LO[ 33, BLOCK 2 '%, -
ALASIL& WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAO, SUITE 29. ANCHORAGE, AK, 99504-
PHONE: (907) 337-§I79/FAK: (907) 339-~249
LFGAL DFSCRIPT[ON:
WILLIAMSON SUBDIVISION #2, LOT 9, BLOCK 3
IYPE OF WORK:
SITE PLAN
F~RFPARED FOR: PHONF NiJMRER:
JACK WHITE REAL ESTATE 762-3116
DA'rE: DRAWN BY: SCAI E:
11/17/98 A.C.G. 1 = 100' 1 OF 2
P. WILIJ AM S,:
", NO. 9608 ,"
NOTES:
1) lite GONFRACIOR SIfAIL IIAVE THE NORFH
t. OT t. INE FLAGGED DY A REGISTERED LAND
SURVFYOR PRIOR 'l'O CONSTRUCTION,
2) THE 60NTb~ACFOR SHALl_ HAVE IHE WAFER
I.INE PROFESSK)NAUY t_OCATED AND 'FILE I0'
SETI3ACK ELAGOED PRIOR FO PRE ¢:ONSTRUCTION
SllE VlSlI WiTH THE ENGINEER,
/
OF" W/(FER EINE (SEE NOTES)
/
BOX
!
Y
B..~' DF.EP (MAX,)
laVl/ 7' OF CLI'~,N,
APPROXIMATE LOCAIlON
PER MO.A. FILES.
(SEE NOTES)
FCO lDO0 CALL ON
LOI B, BLOCK ,]
Wll I lAMSON S/D
ALASKA WATER AND WAKI~W. ATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUFfE 28. ANCHORAGE, AK, 99504
I~HONE: (gO7) ~37-617g/FAX: (907) 558-3246
LEGAL DESCRIPTION:
WlLLIAMSON SUBDIVISION, LOT 5, BLOCK B
SITE PLAN
WILLIAMS.."
JACK WHITE REAL ESTATE 762-~116 ', NO. 9608 .'"
11/17/98 A.C,G. 1 = 20' 2 OF 2
ALASKA WATER & WASTEWATER CONSULTANTS~ INC.
[SOIL LOG - PERCOLATION TEST} .o...'--t. 9_T_I:Fj~,///..'F
LEGAL DESCRIPTION: WlLLIAMSON SUBDIVISION, LOT 9, BLOCK .3~ w,~,,[/7 '¢" '"/~ .......................
PERFORMED FOR: JACK WHITE REAL ESTATE
w-, ~^uc ----,,JAMES P. WI_LIAMS:
DATE PERFORMED: 11/7/98 ~ · '
-- ~ m " NO. 9608 ,'
ORe ......... '
(f,~O':: : TEST HOLE ~1.
1 -- :::::: :
,,~% ' ~. GW ::::::::: ORG / WILIIAMSONS/D ¢~4l~R'
, ,, ~: GM GL i ~ 'FfilTE PLAN~
4--~ ,l~ ~ IGC OL
~' ~6~ ~ WI~HAMSON S/O
5--, '~hf~ :~ SP CH
~' ~[~ SM ~ SH OH
~. ,~ ~; SO~, SIL~
,, ,~,~ DEPTH TO
~ t" ~ 3ROUNDWATER DATE --
t. ; ~,~ DRY 11/7/98
/ x
i ~?~ CLOCK NET TIME WATER LEVEL NET DROP
11 -- ~, ; ~ ~ DATE READING
~ ~ ~ TIME (HINUTES) READING (INCHES)
~ *~, ~ 11/9/9[ NO PRESOAK REQ[ RED
13--~; ~ 1 12:47 --- 10"
~,~ ~,,~ 2 12:55 B DRY 10"
14~ ~ ~{,~? 3 12:55 10"
~l~ 4 1:05 10 DRY 10"
~,~ ~, 5 1:05 -~ 10"
16--~ B.O,H, 6 1:15 10 DRY 10"
17~
1B~
THIS WAS PERFORMED IN ACCORDANCE WITH ALL ISlA~E AND MU~ ClPAL GDIDELINES IN EFFECT ON THIS
DATE. DATE: ~ ~ ~% ',J
DEPTH TO
GROUNDWATER DATE
DRY 11/7/9B
MIJNICIPALITY OF ANCHORAGE
DEPARTMENT OF IIEALTH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Str0e[- Anchorage, Alaska 99,501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WE.I.L INSPECTION REPORT
[] UPGRADE
MAI LING A~_.~ ESS,~,
~ Manufacturer
~-- Lq. ca a it~ g~ ons nsdelength
~ ~ ~ DISTANCE TO' Well Dwelhng
Length q ach lin
Top of tile to finish grade
Length Width ¢ Depth
Type of crib
Crib diameter
Well
DISTANCE TO:
Class Depth
Building foundation
DISTANCE TO:
Foundation
Total
IDwelling .~__. tw
j~-d-t h
Nearest lot li,~t,~¢" ~.¢
NO. OF BEDROOMS
NZ. o__,
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.~//d
Distance bet eer lines
eta e t'vpa~rpt'o ~rea
PERMIT NO.
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
OTHER
PIPE MATERIALS
"5o 'sq '
SOIL TEST RATING ¢
REMARKS
72-013 (Rev. 3/78)
F:'ElqJ'"I I T
I::IF:'[:'L. l C:F:Ii'.,['r '.'..~;UN i::OI'.,.I'_:.71"F.:UC'I" Z Ell'.,]
L OCF:IT Z
LF-GFIL LS, Bi: I.,]ILL. IFfl"IS;OIq ':5,.."D
T'T'F'E OF SO I L F:IEFE;OF~:F'T I ON E;"r'E; FEM
MFI'?:',IML.IM NLIMBER OF BEE:,I'~'.OOHS =,
THE
FI['-::FIL. TH FIN[:, [:1,1, II~._fli'l[.ht'iHL 3-F[O'":T!FN
..... 1 fi..LE. I., FtI",IC:HOF?FIGIE., I::11-:::.
· c :,q.- .]',
,'::':, I1"-,I~ .-- -"E~; :E T' EEl
_4, 4 [, J,.., 4.'F4E
LOT -SIZE
--;-' , ....
'SOIL PFI'I"If.,C~ "9 :' F"I",'Ef;'"
REQL.IIP. ED '.~IZE: OF -[TiE: _,tlL. ~E,:,.k.[ FION =,r_,IL,M I=.
/'--/
THE LENGTH DIMENS I Clhl I'-=, THE LENGTH ,:: I r.,I FEE:T ::, OF TFIE I'F .... E hl_.H' OR [::,F~FII NF'I E:LD.
THE DEPTH OF' FI TRENCH OF: F'II' IS l'TiE [:,iSTFINCE E:ETNEEN THE :~;I..J[~'.FFICE OF' THE
EiF[:OL.INE) FIND "['H[E E~O"f'TCff"I OF 'FHE EXOFI'v'WrzoN ,::]N F'EET>.
TFIEF4tE: Z~; NO SET NZI>TH FOD. TR~ENCHE::E;.
T'H[E GRFIVEL DEF'TH IE; 'FFIE MINIMUM DEF'TH OF' GRFIVEEL E~E:THEEN THEE OI.I'T'FI::ILL F'IPE
FIND THE BO'FTOM OF THE EXCFI',,,'FI-r ]z oN < IN F'EE-r).
''' ..... ., ...... ' ......' ........ I'F..[=. [:,EF:'F:IE;:]'i'tEI'..FI' [:,I_IF;:Ii'-.IG THEE
F:'E;~?JYIIT -F.F L [ ..I. J'IT HF:!L~ THE [4E=:_.Ft hi=, [E,f. LI ]., TO i'NFO[;;:H "~' '-
JILl L.L ].[_N :'
.II'l_[ E....1 ]._[',L=,OF FI[",P'r' JLLL.[ .... F:I[:,.]'F]C[{~"~T l"O I"I"II:E; F[._I E[ [~ FIN[:, THE
flI_II'IEEF. OF I::~'.EE;IC, ENCES THFIT THE HELl_ t.,.IILL_,E.R: ..... , E..=
DRC:I<F I L..L I i",IG F F' F:IN'-r' S"r'L:;.;-FEM H I THOUT F' I i",IRL.. I Iq= F E ... I I. i"4 FIND
[:'EF'Fff;?.THE[",IT HILL E,[- =:,LIB3E_.] TO FI:,.U=,E._.LIrlCiN.
Ffl.~..vi.L Er tllI::,
M I i',l I HLIM D I SI"FINE:E E~EI'b. IEEN F:i HEL. L FIND RN'.r' ON...S I TE '.SEIq:~GE [:, I E;F'O'Z.;F]I_ E;"r'STEM I
/I. EIEI F:'FEET FrCIF;i: Ft PF~:I',,,'FITE I.,.IE:L.L OF?. :]..~iEi 'to 2~lI;~ FE:E:-F Ff;:'.Ofq F:l f:'UBLIC HELL. [:,EF'E~:NDII'.,ICi
I..IPOIq THE 'I"¢PE OF:' PUBL. IC HE:L.L
MINIi"IUM DISTI=INCE: F'F~:CIM f:l F:'I'~'.IVFI]'E HELL 'f'O Ft F'F~:I',,,'FFFE SEHE:R LINE I::; 2f5 F'E:E:T F:II'.,I[:,
]"Ill FI (::Of'11'qLINIT'¢ :~;E:I-,J[ER LINE: I'.::1 7~jl F:'EE:]".
HEL..L.. LOGS FIF::E: REQIJlF.:E:[:, [:IN[;' MUST [3E F4:ETURNE[:, TTJ THE DEPFIF.:.'TMENT I,.IITI'U:N S('] [':,F:I"r'S
OF:' THE HEL. L COMf:'L. ETIOi",L
O'I'F~EF?. RE(;!LII[~:EMEF.IT'~; I"11:1"," FIF'PL'¢. E';F'E:C:IFIC:FITIE~N:E; FIND C:ONSTR'UC:TIL-)N DIFIGRFIMS
F:P,,"FIIL. FIDLE TO It",IE;LIf;d:Z F:'[~%~PEF: IN~';TFtLL.f:ITION.
...E.[;. I ] F ~ THFIT
:1..: I FIH F'FIMIL.]:FIP. HITH THE F~tE[.:!LJIREMENT% F'3F;' _N _,IIE ....,E.I-.IEF .... Mill ItEl..[ ..... FI2; SET
F OF4t'T'H E, r' 'THE HL N 1 :.' Z F'FIL I T'Y OF FINCH Z F?FICiE
2' ........ I HILL..[I,L I?LL THE ~...,[L.II IN Id ........ R[:.Hi'I...E. HITH THE CO[:,ES.
:ii:: I Lli",I[:,EF:!~;TFIi",ID THFIT THE Cd",I-S I'FE '.'SEHEF4'. S:';"r'STEH r'IFI'T' RE:QLI I F'tE EHL FIR 3EZME'FIT Z F THE
I:..L. I£.E.i'I~.E. i=, F:EMO[:'ELEI ?'T'O i i",tL-:LLI[:,E f'IEtRE; THFIN-..':' [..,E. DF, LJUI'I-' ' ' ' ....
I E':.::;LIF:[':, [fiT'. .............
/ V' 'T.D
¥:, D: /0
PERFORMED FOR:
LEGAL DESCRIPTIO'N:_
1
2
3
5
6
7
9
10
11
12
13
15-
16-
17
19
20
COMMENTS
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO'FECTION
82s L. Street, Anchorage, Alaska 99S01 264-4720
SOILS LO(3 - PERCOLATION TEST
PERCOLATION
TEST
SLOPE
ENCOUNTERED?
IF YES, AT WHAT
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE c~._ (minutes/inch)
TEST RUN BETWEEN '~ ~*~- FT AND '~ FT
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGA' DESCR,PT,ON:_. ?
1
2
3
5
6
7
8
9
10
11
17-
18-
l~-
(~r~ O, T~lbot
COMMENTS
PERFORMED BY:
[] SOILS LOG
72-008 (6/79)
PERCOLATION
TEST
SLOPE
DATE PERFORMED:_//?~/
SitE F,AN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
Reading Date Gross Net Depth to Net
Time Time Water Drop
RCOLATION RATE '~ ' (minutes/inch)
BETWEEN '~/ //~'- FT AND ~ FT
CERTIFIED BY:
•
Municipality of Anchorage
On-Site Water and Wastewater Program a' : -
(907) 343-7904 5 a E T Y
Certificate of On-Site Systems Approval
Parcel I.D. 015-074-09 Expiration Date: 1 - 17
1. GENERAL INFORMATION:
Complete legal description Williamson #2; Block 3, Lot 9
Location (site address) 5041 E.98th Avenue. .
Current Property owner(s) Robert Tierney Day phone (970)485-9774
Mailing address 3637 E.67th Ave.
Real Estate Agent Christina Ball Day phone 317-8961
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
0 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank LI
Community Class Well ❑ Community LI
Public Water System ® Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: 5/io /17-
COSA
l7-
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment 5/q/i7 Date of Payment
Receipt Number (f act Receipt Number
COSA# Oj'/' I/'(o Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 5/C7-9-
In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system OF A
�4QQao�4t,v .N
in accordance with the guidelines and regulations established by the Municipality of Anchorage and o -•,• ... Q
industry practices. The reported results describe the condition of the system/s on the date/s of the ,,:;f0 '1r ' / •S��Qn
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or `tom" V
• t
encroachments may exist that were not identified during the evaluation. The operational life of all wells / * ` 1 U 7,4 vO
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, / Q
groundwater levels (that may fluctuate during the year), quality of construction (materials and VA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary, and a... Q
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the �/n1 ••J: - ess,
•
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of V '. , E—,795,3 a OO
the well or septic system. GEG makes no representation whether an alternative well or septic systemQn
can be installed on the property in the event either of the current systems fail to perform adequately in u��er ••• J vlcv
the future. The content of this report is for the sole benefit of the person/party that retained GEG to Professlo('°QQ
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms \� ����f 01= G'ye(
•p
Disapproved ON-SITE •
G, •
Conditional approval for bedrooms, with the followi� st AND rT'
m
Ak
WATER
PROGRAM
17 By: \ ►•� Original Certificate Date: _l
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist )7
Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Williamson #2; Block 3, Lot 9 Parcel ID: 015-074-09
A. WELL DATA
Well type Community If® B, or C provide PWSID# 210639 Well Log (YIN)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N
Total depth ft. Cased to ft. Casing height (abo - 'round) in.
FROM WELL LOG AT I ' CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESU :
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
-nic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 12/18-19/1998
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Yes
Foundation cleanout (Y/N) Yes Depression over tank (YIN) No High water alarm (Y/N) N/A
Date of pumping 6/29/2016 Pumper A+ Home Services
C. ABSORPTION FIELD DATA ['Below Existing Grade
Date installed 3/20/2013 Soil rating .p.d./f r ft'ibdrm) 1.2 System type Trench
Length 42 ft. Width 2.5 ft. Gravel below pipe 4.5 ft.
Total depth *11.2+ ft. Eff. absorption area 378 ft? Monitoring tube Yes Depression over field No
Date of adequacy test **4/27/2017 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test**43 in. Water added**731 gal. New depth**55 in.
Elapsed Time: 1,265 min. Final fluid depth **43 in. Absorption rate 7= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date —
Information on 1998 trench is in MOA records.
**Tested South (2013) trench, which was in use. North (1998) trench was dry upon arrival on
4/27/2017, viability of 1998 trench was not evaluated. MT's in both trenches appeared to extend to
correct depth.
Recommend switching flow to 1998 trench.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" level at _in. High water alarm level at in.
Datum Cycles tested Meets alarm & circui .uirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: Community
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/se. ervice line Holding tank
• imal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line_ 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+ Public, 100'+ Priva':e
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *2' Building foundation_ 10'+ Water main 10'+
Water service line **10'+ Surface water 100'+ Driveway, parking/vehicle storage 2'
Curtain drain None Known Wells on adjacent lots 200'+ Public, 100'+ Private
F. COMMENTS
*WR#980102 (1998 trench) **Per contractor locate during 1998 drainfield installation-
4oQoap�
G. ENGINEER'S CERTIFICATION OF A', 4 od
c
1 certify that f have determined through field inspections and d = 4 1- I •" �,��4
review of Municipal records that the above systems are in vn
conformance with MOA COSA guidelines in effect on this I 0
date. ff
• • ss,'
Engineer's Printed Name JEFFREY A. GARNESS �0� '! l E— 95 opt
pO
Date /57i 40 Q� a'• .� r4�c
profession o
#AECC844
Rev. 11;05)
MUNICIPALITY OF ANCHORAGE
DEPARTMEN'I' OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 01 5-074-09
1. GENERAL INFORMATION
Complete legal description
Lot 9; Block
3; Williamson Subdivision #2
Location (site address or directions)
5041 E. 98th Avenue
Anchorage, AK
PropCr'ty owner
Mailing address
Lending agency
Mailin. g address
Agent
Address
Jean Wilcox Day phone
C/O Jack White Real Estate 3201 "C" St. Anchoraqe,
[)ay phone
Patty Seymour/ Jack White
[Pay [)hone _762-3152
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3
NOTE:
Individual well
Community well x×
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4, TYPE OF WASTEWATER DISPOSAL:
NOTE:
xx
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
AK
99503
72-025 (Rev, 1191) Front MOA#21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address ~o00
EngineeCs signature
ALASKA WATER & WASTEWATER CONSULTANTS, INC
IS TO BE PAID $585.00 BAL. DUE FOR ENGINEERING
SERVICES PERFORMED.
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with th-e following stipulations:
Additional Comments
.~8.,.~: ...... Date
~1~ Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health
Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
,~n,l~r~fessio n al engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
~heir lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
RECEIVED
DEC 2.9 1998
Municipality of Anchorage E
DEPARTMENT OF HEALTH & HUMAN SE~~Y o~ ^NCHO~G
Environmental Services [)ivisio~vm°~'~YA~ SEP, VICE$ DIVISION
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: {.~ ~-~,~;~r~
_~uC.r~V~o~J Z ~ Parcel I.D,:
A. WELl. DATA ~o~udJ~
Well type ~b~
Log present(Y/N)
Date completed
Total depth
Sanitary seal (Y/N)
Casedto
Casing height (above ground)_ -
Wires properly protected (Y/N)
Date of test
Static water level
Welt production
FROM WELl. LOG
g.p.m
AT INSPECTION
g.p,m
WATER SAMPLE RFSULTS:
Coliform
Date of sample:
Nitrate Other bacteria '-----'
Collected by:
B, SEPTIC~I~ TANK DATA
Date installed ~,/6 ~ 1'~/~8 Tank size
Foundation cleanout (~TN) "('e 5
Date of Pumping _ ~ e. vJ Pumoer
Iooo _ Number of Oompartments '~ Cleanouts(~N). ~[~--~
Depression (Y/{~ /~ High water alarm (Y/~.
C. ABSORPTION FIELD DATA
Date installed J'Z/I '~
Length_ ~ Width ~-- ,-~
Effective absorption area
Date of adequacy test
.Soil rating ~~). I, '2. System type_ '~,~Nc,~ .
Gravel thickness below pipe _ -~. Z~' .Total depth _ -I.--~ "~'
Monitoring Tube present L'~/N) '~ ~- Depression over field (Y~ ___/'Jo
_ Results (Pass/Fail) '--'-- For '~ .bedrooms
Immediately after_ gal. water added (in.): _
Absorption rate =_ _g.p,d.
Fluid depth in absorption field before test (in,);
Fluid depth ~ (Insl Minutes aterl
Peroxide treatment (past 12 months) (Y/N) -~
If yes, give date
72-026 (Rev. 3/96)*
D, LIFT STATION
Date installed ~ Size in gallons
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: ~-~ ¢~ Iv~ vN ~1'-y b,.) A~r-~ ~4.. ,,~' ~_~ ,r~.X
On adjacent lots ..,.---.-----~
Septic/holdin , lot
Absorption field on lot
Public sewer main ~-~'~'~ ~e/cleanout
Sewer/~ine Lift station
SEPARATION DISTANCES FROM SEPTIC/kl~ TANK ON LOT TO:
Foundation ~' Property line ~E,1+- Absorption field
Water main/service line 101-{- Surface water/drainage /ooLF Wells on adjacent lots
Property line
Surface water ~ co~ -'l-
Curtain drain
F, ENGINEER'S CERTIFICATION
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
~ 'Z. t,,~ Building foundation ~Lp
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots loo~-Y
I certify that I have det~r~nine~Y~Z 'd inspections and review
Signature
Engineer's Nam~
a,e
are
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Rick Mystrom.
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http:;/www.ci.aoci~orage.ak.us
January8,1999
Jeffrey A. Garness, MS, PE
Alaska Water & Wastewater Consultants, Inc.
6901 Debar]' Road, Suite 2B
Anchorage, AK 99504
Subject:
Waiver Request for Williamson #2 Subdivision, Lot 9, Block 3
Waiver Request #WR980102
Parcel 15) #015-074-09
Health Authority #HA980519, As-Built for Permit #SW980456
Dear Mr. Oarness:
Your request roi' a waiver of the required 10 feet horizontal separation from the
on-site wastewater disposal system to property line has been approved. The approved
separation distance is 2.0 feet.
This waiver approval applies to the existing on-site wastewater disposal system to
property line separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval fi'om this
department.
If there are any further concerns or questions regarding this waiver, please call om' office
at 343-4744.
Sincerely,
Donna C. Mears, MUP, EIT
Civil Engineer
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
wR~ WR980102 PID9 015-074-09
Date Received: December 29, 1998
HA~ HA980519 Permit = SW980456
Legal Description: Lot 9 Block 3 Williamson
Engineer:
Jeff Garness, P.E., Alaska Water & Wastewater Consultants. Inc.
6901 De Barr Road Suite 2B, Anchorage~ Alaska 99504
Jean Wilcox
Applicant:
WaSver Requested:
north property line.
Lot line waiver of 2 feet from the absorption field to the _
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizon%al Separation
TOTAL:
2. Special Conditions:
Po.tnts.
3. Other:
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above:
By: ~z4~__
Na~. of Reviewer
Rec ~: 04406(9650) Amo~[nt: S 115.00 Date Paid: 12-29-98
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504
Phone (907) 337-~6179 ~ Fax (907) 338-3246
December 28, 1998
Municipality of Anchorage
Department of Health & Human Services
P.O. Box 196650
Anchorage, AK 99519-6650
REFERENCE: Lot 9; Block 3; Williamson Subdivision #2
Property line waiver request
Request you issue a two (2) foot property line waiver from the new absorption field on the
referenced property to the north property line. We do not anticipate any adverse effects to
the neighboring properties with the issuance of this waiver.
If you require additiona,~ Ormation, please contact us at 337-6179.
JAG/gk
DEPT. OF ENVIRONMENTAL CONSERVATION
/
ANCHORAGE/WESTERN DISTRICT OFFICE
360]. C STREET, SUITE 316
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE: January 19, 1989
PWSID: 210639
To Whom It May Concern:
According to the records on file in this office, the __
WILLIAMSON SUBDIVISION Water System is in compliance with the
State of Alaska Drinking Water Regulations.
Please note that departmental records indicate ..~at the public
water system was installed prior to the 1978 implementation of
the Alaska Drinking Water Plan Review regulations. No as-built
plans have been reviewed or approved by the department, nor are
any necessary. Since the system has submitted acceptable water
samples on a regular basis and received a satisfactory sanitary
survey evaluation by the department, the system is acceptable
under the standards in effect at the time of the installation.
An official "Certificate To Operate" may be issued upon receiving
a complete set of as-built plans. Any expansion of the water
sysetm after 1978 will require plan review and the issuance of a
"Certificate to Operate" permit.
Since/~ly,
~V~ E. Craig ~
Environmental Field officer
Drinking Water Program
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
·
Mailing Address
(c) Lending Institution ~'~
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone: (home)I ~ ~/~ ~¢~¢~US ness
(e) Mail the HAA to the following address: (or check here,,~if hold for pick up.)
List contact person and day phone number below:
!
TYPE OF RESIDENCl:-
Single-Family(.~ Number of bedrooms ~
WATER SUPPLY
Individual Well [] Community/~ Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site"~ Public [] Community [] Holding Tank []
Note:['If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/aS) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is
Health Authority Approval 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 struct_ure 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.
NameofFirm } o~b.,z~,l d ~-~,C,~,o~,~, !2--- Telephone
Address ~iP ~'~ ~
Date
· Engineer s Seal
6. DHHS APPROVAL
Approved for ~
Approved ../~
bedrooms by
Disapproved
Terms of Conditional Approval
Conditional
Date z-~'-~-¢4'~,~' -~d;),/ /¢,'¢~. .
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 DH HS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev 7/88) Back Page 2 of 2
MUNICIPALI'rY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
A. WELL DATA
Well Classification _~
Well Log Present (Y/N)
Total Depth Cased to
_ Date Completed
Depth of Grouting
If
A, B, C, D.E.C. Approved (Y/N) ~
Yield
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Floldieg Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest; Public Sewer Cleanout/Manhole
; Date
B. SEPTIC/HOLDIN(~ TANK DATA
Date Installed _~/~';~ /___Size /~-~d.~
Standpipes (Y/N) O~,v'~---- __Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
No. of Compartments ~/" ~ o
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Y
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line '2 ,,~,.~
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
'Fo Disposal Field _
Temporary Holding Tank Permit (Y/N)
lC>
72-026 (Rev 7/88) F(ont Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed _ 7,/~/
Width of Field ~ !
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field /,'2
~Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot k,¢/~,
To Water Main/Service Line
To Property Line ,~O ~
To Existing or Abandoned System on
; On Adjoining Lots ,.2S~) 'f
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~' /=','¢-o/-¢ ~, U N / (-~.~,.-
/"/O
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection. ~ ~~_~
MOA No.
Receipt No. ~-~f~¢
Date of Payment
Amount: $
effect on the date of this
Receipt No.
Waiver Fee: $
Date of Payment
Engineer's Seal
7~-o~ i.~v 7/,~).~ Page 2 of 2
INSPECTION APPOINTMENTS
TIME
~--~TE
NSPECTOR
'rIME
DATE
INSPECTOR
DATE
INSPECTOR
x.~) ENVIRONMENTAL SANITATION DIVISION ~
AUG
0
1981
Telephone 264-4720 - · _
, R [: C I::1 VFD
REQ!JEST FOR APPROVAL OF INDIVIDUAL WATI:R AND 8EWER FACILITIES
MUNICIPALITY ~DF ANCI-JORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALT/I &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~'~NMENTAL CROTECTION ~
825 L Street - Anchorege, Alaska 9S501
)1 R ECTIONS: Complete all Darts on page 1. Incomplete requests will not be processed. Please allow ten (1 O) days for processing.
,ROP."RT¥ OWNE~ ,,'3
~HONE
~AILI NO A~DRESS
· PHOi~IE '
MAILING ADDRESS
~. LEGAL DESCRIPTION
STREET LOCATION
'~, TYPE OF RESIDENCE
SINGLE FAMILY
VlUL.TIPLE FAMILY
~, WATER SUPPLY
NUMBER OF BEDROOMS
~1 One [] Four [~ Other
[] Two E~ Five
~] Three E3 Six
[] NDIVIDLJAL°
COMMUNITY
PUBLIC UTILITY
L SEWAGE DISPOSAL SYSTEM
I~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI EITY
ATTACH WELL LOG. A well log is requ'red for all wells drilled
since June '1975. For wells drilled ~rior to that date, give well
depth (attach Io§ if available.)
-t 'YEAR ON-SITE SYSTEM WAS INSTALLED.
/
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] I N DI VI DUAL/ON -SITE DATE INSTALLED
E::] PUBLIC UTILITY
Connection Verified INSTALLER
L~Septic Tank or []HoldingTank
Size: If Tank is homemade SOILS RATING
give dimensions;
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AR EA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
B. COMMENTS
E~APPROVED FOR __.~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ~
DATE B Y~7_
72-010 (Rev. 6/79)