HomeMy WebLinkAboutGREEN FOREST BLK 1 LT 1Onsite File
r7reen Fores?
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 4
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191206 PID Number: 018-011-02
Dwelling: ❑t Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
ABSORPTION FIELD I WEST/EAST
SLAVIK LUND
Deep Trench E] Wide Trench El Bed El Mound
Site Address
12400 SILVER SPRUCE DRIVE *ANCHORAGE, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-227-0762
4
0.5 GPD/SF
11/11 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
7.56/7.48 Ft.
Subdivision Block Lot
GREEN FOREST; BLOCK 1, LOT 1
Fill added above original grade
SEE DWG. Ft.
Gravel length
40/40 Ft.
Township Range Section
N/A
Gravel width
2.5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
1200+ Ft2
2
**10+ Ft.
Well
*50'+
*50'+
*50'+
N/A
N/A
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
INFILTRATOR
Capacity
1060 Gal.
Surface Water
*50'+
*50'+
*50'+
N/A
Material
Number of compartments
Lot Line
5'+
10'+
5'+
N/A
NA
HDPE
1
Foundation
10'+
10'+
N/A
LIFT STATION
Manufacturer
Capacity
110'+
1
1
Remarks *CAT II AWWTS **SEE ATTACHED LETTER
INFILTRATOR
540 Gal.
Alarm location
IN HOUSEt�rags•
Electrical installed by
K
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer
KURT WHITTERS
Drainfield D3034 CO/MTD3034
inspector DAVID GARNESS & TIM ECKLUND
BENCH MARK (Assumed elevation) 100.00 ft
Inspection1st 7/9/2019 7/10/2019
dates:
Location and description
2�a
3'd 7/10/19 4117/11/19
BOTTOM OF TRIM AT SE CORNER
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Sta p
Qo6op�0
Conditional Approval: Date
49 D
p........................... .D
.... ................. �
Septic S
Jr Garnes
Q '. Q
�Q4�
Approved (ti Date`
E-7 9 3
Note: this approval does not include well permit requirements.
#AEcc884O000000
(Kev u5/u2/18)
PERMIT NUMBER: PARCEL ID NUMBER:
OSP191206 RECORD DRAWING 018-011-02
z
- - - - - - - - - - - - - - �AOFFMAN
- - - - - - - - - - - - - - - - - --------
ROAD I \
I
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FCO 19.6 6.0 35.4 BOTTOM OF TRENCH AND TOP OF I
TANK INSPECTED BY MOA
ONSITE EMPLOYEE TIM ECKLUND�
I I
I
21.7 25.4 17.3
FURROW CREEK; BLOCK 1, LOT 1 AWWU
NEW IM -540 INFILTRATOR SEPTIC T\AXK
NEW SINGLE COMPARTMENT IM -1061
INFILTRATOR SEPTIC TANK -
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OR DRAINFIELD BASED UPON MOA RECORDS AND
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HOUSE v
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GARNESS ENGINEERING GROUP, Ltd
-- - ---�-- - ENGINEERING -- SALES? CONSULTING --- -
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337.0179 -FAX (907) 338-3246' WEBSITE:-gamessengineering.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
SLAVIK LUND 907-227-0762 2 OF 4
LEGAL DESCRIPTION: DRAWN BY:
GREEN FOREST; BLOCK 1, LOT 1 D.J.G.
TYPE OF WORK: DATE:
. SEPTIC SYSTEM RECORD DRAWINGS 7/19/2019
of AV ##
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#AECC884 /
MT1
15.9
31.8
25.5
MT2
49.7
54.1
14.3
MT3
18.5
41.1
37.5
MT4
49.0
61.6
27.9
C01
13.4
30.0
27.1
CO2
52.1
52.6
17.0
CO3 1
18.5
1 41.8
39.8
C04 1
50.1
1 61.8
27.1
FS 1
29.6
1 42.1
18.4
FD 1
21.4
1 26.7
17.2
MH1 1
34.5
1 13.6
34.4
MH2 1
31.3
1 17.2
25.3
MH3
23.8
21.7
18.3
MH4
22.9
25.0
17.7
STI
37.0
18.7
31.6
DC01
34.6
17.8
28.8
I CO2
33.3
17.6
27.8
TMT
C05
32.5
14.5
30.6
TANK INSPECTED BY MOA
ONSITE EMPLOYEE TIM ECKLUND�
I I
I
21.7 25.4 17.3
FURROW CREEK; BLOCK 1, LOT 1 AWWU
NEW IM -540 INFILTRATOR SEPTIC T\AXK
NEW SINGLE COMPARTMENT IM -1061
INFILTRATOR SEPTIC TANK -
z
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I
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OR DRAINFIELD BASED UPON MOA RECORDS AND
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BEDROOM °
HOUSE v
B CO 10'+ 0
CO MT
MT1
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S
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GREEN FOREST; BLOCK 1, =LOT
AWWU
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GARNESS ENGINEERING GROUP, Ltd
-- - ---�-- - ENGINEERING -- SALES? CONSULTING --- -
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337.0179 -FAX (907) 338-3246' WEBSITE:-gamessengineering.com
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
SLAVIK LUND 907-227-0762 2 OF 4
LEGAL DESCRIPTION: DRAWN BY:
GREEN FOREST; BLOCK 1, LOT 1 D.J.G.
TYPE OF WORK: DATE:
. SEPTIC SYSTEM RECORD DRAWINGS 7/19/2019
of AV ##
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1 �^ •; Je re A.GGarness 4 =
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#AECC884 /
PERMIT NUMBER: PARCEL ID NUMBER:
,OSP191206 RECORD DRAWING 018-011-02
WEST EAST
TH MT CO FINAL GRADE = 98.62-99.37 MT CO FINAL GRADE = 98.75-99.34 TH
ORIGINAL GRADE @ ORIGINAL GRADE @
HIGHEST POINT = 98.22 HIGHEST POINT = 98.54
FILTER FABRIC FILTER FABRIC
e 'o
°o
o INVERT OF PIPE = 94.78 INVERT OF PIPE = 95.02
°o
°o
°o
' 7.56 FEET 7.48 FEET $
°0 0
s a
BOTTOM OF BOTTOM OF
TRENCH = 87.22 TRENCH = 87.54 '
� 0
10+ °
RELATIVE ELEVATION @ *SEE ATTACHED LETTER RELATIVE ELEVATION @
BOTTOM OF T.H. = 83.22 BOTTOM OF T.H. = 83.54
lkeVAo�
.•'-�E OF
44
1� IIV
!
GARNESS ENGINEERING GROUP, Ltd .... 9
::.....4...... ...................
CIVIL & ENVIRONMENTAL ENGINEERS _-- – —� 10 �� �
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 33&3246' WEBSITE: w. .gamessengineering.com � •• � ••••••• \ •,•.•, • •• .......... �
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: /� J Frei �A�Ga` nye S •� =
SLAVIK LUND 907-227-0762 3 OF 4 �#G�J,
PROJECT/LEGAL DESCRIPTION: DRAWN BY: •�♦��•. �� / `�����
GREEN FOREST; BLOCK 1, LOT 1 D.J.G. 1� FQ�•'• • ....•• • '• *�, •�
TYPE OF WORK: DATE: LICENSE FESS0't
SEPTIC SYSTEM RECORD DRAWINGS 7/19/2019 #AECC884 1 ��°���
PERMIT NUMBER:
OSP191206
PARCEL ID NUMBER:
RECORD DRAWING 018-011-02
NAL GRADE = 96.89-96.98
STI
TOP OF TANK
AT INLET = 92.98
INVERT OF BUNG
AT INLET = 92.50
1060 SINGLE -COMPARTMENT INFILTRATOR
SEPTIC TANK
FINAL GRADE = 96.80
TOP OF TANK AT INLET = 92.86-92.85
INVERT OF INLET BUNG = 92.16
IM -540 GALLON SINGLE COMPARTMENT INFILTRATOR TANK
2" HIGH DENSITY INSULATION
(PER CONTRACTOR)
— TOP OF TANK
AT OUTLET = 92.99
INVERT OF BUNG
AT OUTLET = 92.28
2" HIGH DENSITY INSULATION (PER CONTRACTOR)
GARNESS_ ENGINEERING
GROUP, Ltd
ENGINEERING
RA976SALESCONSULT ING
NDOR ROAD, SUITE 101*ANCH 03 engneenn9.wm
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
SLAVIK LUND
907-227-0762
4 OF 4
LEGAL DESCRIPTION:
DRAWN BY:
GREEN FOREST; BLOCK1 , LOT 1
D.J.G.
TYPE OF WORK:
DATE:
SEPTIC TANK PROFILE
7/17/2019
, • •,. /
e re . Garn s �:
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LICENSE '1� "ROFESS��+•♦
#AECC884 ri\\\\\ /
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) a43-7904 Fax: (907) 343-7997
hUp:/Aw^v.muni.or9/onsite
Permit Number: OSP191206
Work Type: Septic Upgrade
Tax Code Number: 01 801 1 02000
Site Legal Address: GREEN FOREST BLL 1 LT 1 G:2833
Site Mailing Address: 12400 SILVER SPRUCE DR, Anchorage
Owner: ROHDE TROY A
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
0 Disposal Field 10 Septic Tank 0 Holding Tank 11 Privy
Effective Date
mnlq� i
Total Bedrooms:
, I' �_n r ,
No
Department
6/1912019
6/1812020
16604
f-1 Private Well n Water Storage
13
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (1 8AAC72) and Drinking Water Regulations (1 8AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The area where the drainfields are being proposed is currently a driveway/parking area.
Prior to inspection report approval, the engineer shall confirm that the area has been modified so that it no longer
Prior
as a driveway/parking area.
Z-11-7
Received By: Date:
Issued By: Date:
Municipality of Anchorage_
P.O. Box 196650 a 4700 Elmore Road
Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
,mcnr S•
l)1; �1:11'CIII L'Ilt
x x x x VARIANCE/WAIVER REVIEW X X X*
Waiver#: OSV191043 COSA#: Permit#:OSP191206
PID#: 018-011-02
Legal Description: Green Forest Block 1 Lot 1
Engineer: Garness Engineering Group
Applicant: Slavik Lund
Your request for a waiver of the required 18.0 feet horizontal separation from the
absorption field to the existing seepage pit has been approved. The approved separation distance
is 10.0 feet. See engineer's waiver request for justifications.
This waiver approval applies to the proposed absorption field only. ' Any fixture upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
................................................................ ■ ■ ........... ■ ,
Waiver is Granted: X Waiver is not Granted:
Date: 9 / Approved by:
Name of Reviewer
............................................... ■ ............................. ■ 1
**** VARIAN C E/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
On -Site Sewer/Well Permit Application .
For A Single Family Dwelling
Parcel I.D. 018-011-02
Property owner(s) SLAVIK LUND
Mailing address 12400 SILVER SPRUCE DRIVE *ANCHORAGE, AK 99516
Site address 12400 SILVER SPRUCE DRIVE *ANCHORAGE, AK 99516
Legal description (Sub'd, Block & Lot) GREEN FOREST; BLOCK 1, LOT 1
Legal description (Township, Section & Range)
Lot Size
APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Sq. Ft. Number of Bedrooms
APPLICATION IS AN:
Initial ❑
Upgrade
Renewal ❑
Day phone 907-227-0762
4
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
TYPE OF DEWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
WA by-"" +D fie_ .g&g& .&g&nl I Distance: � 12
I certify that the above information is correct. l further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5_46- Waiver Fees: a a
Date of Payment: �Z20 %q Date of Payment: j /19
Receipt Number: Q3 ��? Receipt Number:
Permit No. - 1 06 Waiver No. 05091 D `4 3
(Rev. 01/11)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191206, Rebecca Carroll, 06/19/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191206, Rebecca Carroll, 06/19/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191206, Rebecca Carroll, 06/19/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191206, Rebecca Carroll, 06/19/19
Carroll, Rebecca M.
From: Jeff Garness <Jeff@garnessengineering.com>
Sent: Tuesday, June 11, 2019 10:06 AM
To: Carroll, Rebecca M.
Cc: David Garness
Subject: FW: 12400 Silver Spruce Dr - Sewer
Attachments: Capture.JPG; 12400 Silver Spruce Dr - Sewer Main RD.tiff
Follow Up Flag: Follow up
Flag Status: Flagged
Hello Becca. See the following input from AWWU regarding service to the subject property.....................................jeff
From: Curtis, Nick J. <Nick.Curtis@awwu.biz>
Sent: Tuesday, June 11, 2019 9:54 AM
To: Jeff Garness <Jeff@garnessengineering.com>
Subject: 12400 Silver Spruce Dr - Sewer
Hi Jeff,
I have attached a copy of the main line record drawing as well as a clip of our mapping system showing the general
location of our mains. I have spoken with our engineering department to determine if this property is served by our city
sewer system. They have determined that even though this property is fronted by a sewer main across Huffman, they
will need a main line extension on Silver Spruce Dr if they would like service. Without the main line extension, this
property is not considered served. If you have any questions, please let me know.
Thank you,
Nick Curtis
Engineering Tech 11
Anchorage Water & Wastewater Utility
Direct: 907-564-2708
Nick. Curtis(cDawwu. biz
Excellence Through Innovation www.awwu.biz
1
Municipality of Anchorage Page I of '~,
DEPARTMENT OF HEALTH 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
Name:
¢4 s, L ~ /~~ Wastewater System: D New ~Upgrade
Address:
/~ ~ ~~ ~~ ABSORPTION FIELD
Phone: Nc. of ~drooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so, Rating: Total De~iginalgrade:
GPD/Sq. Ft.
Block: Subdiv~ion: Depth to pipe bottom from original grade: ~vel depth beneath pipe
Township: Range: Section: Fill added above original g~ Gravel length:
Ft. Ft.
WELL: ~ New ~ U~ Graveiwid~ Number of [ines: Distance between lines:
.~ Ft. Ft.
Classification (Private, A,B,C): ~pth: Cased To: ~orption area: , Pipe material:
~, ~ )~ Ft. Ft.
~~ SO. Ft. ! Dat~%;d
Driller: ' - Date Drilled: Static Water Level: Installer:
~ [ Pump Set at: Casing Height Above Ground:
~.~ ,~. ,t. TANK
SEPARATION DISTANCES ~ s~ptic ~o~i~ ~ S.T.E.~.
TO Septic Absorption Lift Holding Public/Private] Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~~
Material: Number of Compa~ments:
Water /~
LineL°t / ~ /~ Size in gallons: ~H
Foundation /~ ~ ~ "Pump on" level at: .... igh water alarm at:
Cu~ainDrain ~ % /¢0 ~~ ~Electrical Inspections pedormed by:
Remarks: ~tV~ ~CV~ ~S~d~ BENCH MARK
Location and Description:
Assume~ Bevation:
Department of Health and Human Services approval
Reviewed and approved by: ~ Date: ~ ~' ~ '"~. ~'~OrESS~O~'~'' ·
72-013 (Rev. 9/91) MOA 25 ' ,
PERMIT NO: SW990208 P.I.D. NO: 018-011-02
AS-SUILT
WASTEWATER ABSORPTIBN SYSTEM
LOT1, BLOCK 1 GREEN FOREST S/I)
EX]ST'G
SEPTIC
TO BE REUS
NEW 3000g
HOLDING TANK
ALARM SYSTE~
EXIST'G CRID
Tn 'RE
SWING TIES
CO A B
DV 10.0 6,B
CI 9.3 7.5
ET B.5
ED 5.7 17,8
EC 19.9 34.7
CP 12.4 6.8
C3 14.6 10.8
C4 17,5 17.3
C5 EO,3 21,5
C:\kVork\2-1SPRNG,DWG
HUFFMAN
94,83
96,36
J
TH 1
]9'O0"E
DESIGNI
PERC RATE: 75 MIN/IN
NOT SUITABLE FOR SOIL
ABSORPTION SYSTEM,
HOLDING TANK - 30009.
87' BURIAL DEPTH TD TOP.
96,36
31_
98.2
NH~D ~OGOO?ANK I4'7
TANK SECTIBN
PREPAREI) FOR:
Ms. Lynn Kenney-Owner
Mr. Gtenn Hugh~on-Agen~
C/o Dalt Reat~y
555 W. Northern Lights
Anchorage, AK 99507
(907) 844-5559
PANNONE ENG, SVC
P. D, BOX 102954
ANCHORAGE, ALASKA 99510
278-88t8 Phone & F(lx
DATE: 7-28-99 AS-BUILT
SCALD 1'=50'
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Serv/ces Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(9O7) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 20, 1999
Expiration Date: Jul 19, 2000
Permit Number: SW990208
Legal Description: GREEN FOREST BLK 1 LT 1
Design Engineer: 0062 Pannone Engineering Services
Owner Name: Lynn Kenny
Owner Address: 12400 SILVER SPRUCE DRIVE
ANCHORAGE , AK 99516-2601
Parcel ID: 018-011-02
Site Address: 012400 SILVER SPRUCE DR
Lot Size: 18000 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] 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.
Date:
Steven R. Pannone, P.E.
Consulting Engineer
(907) 272-8218
P.O. Box 142025
Al~chorage, Alaska, 995 I4
(907)272-8218 Fax
July 11, 1999
Municipalily of Anchorage
Dept. of Health & Human Services
On-Site SmMces Section
P. O. Box 196650
Anchorage, Alaska 99519
Sllbject:
Lot I, Block 1 Green Forest Subdivision,
Septic System Upgrade Permit Request
Ladies and Geutlemeu:
My finn was contacted to design and install a replacement septic system for tile referenced lot. The existing draiufield
is in failure. 1 conducted a field investigation to locate existing wells and septic system as well as a record search
before designing the proposed system. We conducted a soils investigation in the most likely location for a replacement
system. The soils were tight silts, with a percolation rate of greater than 60 minutes per inch (see the attached soils log
and percolationtest). I propose installing a 3000-gallon holding tank on the referenced lot. The holding tank will have
an almm system, as well as a concrete balast mat to prevent the tank ii'om floating.
The lot is approximately 18,000 sqaare feet in size. Lot 1 slopes to the west at a rate of approximately 3 to 5 percent.
The proposed holding tank installation will be located in the eastern portion of the lot on a relatively flat area south of
the existing house. There will be easy access to the tank for pumping tracks. Tile proposed location is greater than 75
feet away fi'om any wells. The proposed system will be greater than I0 feet from tile water service lines. The proposed
installation will not affect the fi~ture development of the sun'ounding or existing lots. See the attached design.
Please contact me at 272-8218 or 22%3522 if yon have any questions about the proposed installation.
Sincerely,
Attaclunents:
C:\WORK\I- [ (}RI~]£NI:ORI,:ST 00 I.t)()C
PERMIT NO, SW P.I.D. NO: 018-011-02
DESIGN
WASTEWATER ABSBRPTION SYSTEM
LOT1, BLOCK 1 GREEN FOREST S/D
HUFFNAN
EXIS1G
EXIS 10009
SEPTIC
TO BE A
IN PL
EXIST'G CRI3
ABANDBN IN PL
C:\V/ork\2-1SPRNG.DWG
94,83
EXlST'G
WELL'~'-o
~~ F3 - 5
0% TH 1
39'O0"E
PREPARED FBR:
Mr, Glenn Hugh~on
C/o D~ Rea[¢y
555 ~. Northern Lights
Anchorage, AK 99507
(907) 244-5559
WELL'~-o
~ Ld
PROPOS/ED o
ING TANK
ALARM SYSTEM,°
?
DESIGN:
.... ~6,3~
PERC RATE, 75 MIN/IN
NOT SUITABLE FOR SOIL
ABSORPTION SYSTEM.
HOLDING TANK - 30000.
87" BURIAL DEPTH TO TOP.
PANNONE ENG. SVC
P. 0. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 Phone & Fax
BATE, 7-13-99 [ DESIGN
SCALE: 1':50'
I
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
/ -/ ¢ 12LaT~/L,/ F'o/z~._??- Township, Range, Section:
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
1
2
3
4
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? '~
P
E
Oeplh Io Water After .
Monitoring? T~ VL'T' Date:
SITE PLAN
Reading Date Gross Net Depth tm'c~ Net
Time Time Water Drop
PERCOLATION RATE ~ ¢~ tm,nutes/,nch) PERC HOLE DIAMETER
TEST RUN BETWEEN dO FT AND "~ F7
, '~ CERTIFY TH~NT T/HIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 'f~///~/4'~¢
72-008 (Rev. 4/85)
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D.018-011-02 Expiration Date: 10-26`1
1. GENERAL INFORMATION:
Complete legal description Green Forest; Block 1, Lot 1
Location (site address) 12400 Silver Spruce Drive *Anchorage, AK
Current Property owner(s) Slavik Lund Day phone 907-227-0762
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless
otherwise requested by the engineer.
COSA Fee $
i ��
YNaiver Fee $
Date of Payment ��o'���1 q Zq�
Date of Payment
Receipt Number ®a(QZ5_6
#
Receipt Number
COSA # QJC Lql 39
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: ' ( C) F
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and 00000 00
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ` 7
encroachments may exist that were not identified during the evaluation. The operational life of all wells S
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, of
groundwater levels (that may fluctuate during the year), quality of construction (materials and0� L T
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and • • • • . • • • • • • • • • • • • • • • • • . • • •
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ,
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of `
the well or septic system. GEG makes no representation whether an alternative well or septic system.
� rr�'ess;• ...
can be installed on the property in the event either of the current systems fail to perform adequately in �00 9 I . yC —791 3 �� G
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �Qea pyo f e ssio^°oma
whatsoever.
�fHCl.l.25t54
6. DSD SIGNATURE
K System #1 Approved for -t(— bedrooms
By:
System #2 Approved for bedrooms
Isapprove
Conditional approval for bedrooms,
(OF�t 6�
with t llowi VV A- ffatioi v
WATER AND
Q
PR(_)( -,P AiVi 6
JJJJ�O.O C`�
"NTSFR�►�,L
Original Certificate Date: 7 2L 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 Nitrate Advisory r
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: GREEN FOREST; BLOCK 1, LOT 1
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled UNK
Total depth 98.7+ ft
Cased to UNK ft
FOR Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 41512019
Static water level at beginning of test 41.8 ft.
Comments
B. TANK DATA
Age of tank(S) NEW years
Tank type/material HDPE
Measured operating fluid level in septic tank NEW
❑ Standpipes/foundation cleanout per record drawing
Date of pumping N/A
D. ABSORPTION FIELD DATA NEW
Which system tested (date installed) 7i2019
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade * ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective -
Parcel ID: 018-011-02
Structure served by this system
Well production at time of test 4.8+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes BE No
FOR Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic 22.7 ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG
Date of Sample 4/16/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station NEW years
Lift station material NEW
Comments: N/A
Adequacy test date N/A
Results ❑ Pass For 4 bedrooms
Fluid depth prior to test - in
Water added gal
New depth in
Elapsed time - min
❑ Code -required soil cover over field Final fluid depth - in
❑ System presoaked Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: 'SEE RECORD DRAWINGS
COSA Checklist yellow sheet
0
e
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
✓v Yes
*50+
Community Sewer Manhole/Cleanout > 100'
**
45
❑ Yes
if No
ft
❑ Yes
if No
ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25'E] Yes
if No
ft
Absorption Field on Lot > 100' ❑ Yes
if No
*50+ ft
Holding Tank > 100' ❑✓ Yes
if No
ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
❑
Animal Containment > 50' ❑✓ Yes
if No
ft
M Yes
if No
ft
**45
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' [:]Yes
if No
ft
❑✓ Yes
if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ✓0 Yes if No ft Surface Water > 100' ❑ Yes if No *50+ ft
Property Line > 5'
✓v Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
✓❑ Yes
if No
ft
Private Wells > 100' ❑ Yes if No *50+ ft
Water Main > 10'✓❑
Yes
if No
ft
Community Wells > 200'✓0 Yes if No ft
Water Service Line > 10'
❑✓ Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓❑
Yes
if No
ft
Private Wells > 100' ❑ Yes if No *50+ ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
❑
Yes
if No
*50+ ft
F. ENGINEER'S COMMENTS
*ADVANCED WASTEWATER TREATMENT SYSTEM
**SEE ATTACHED RECORD DRAWING FROM AWWU WHICH SHOWS ALL JOINTS
WERE "HEAT SHRINK (SEAL ALL JOINTS)"
G. ENGINEER'S CERTIFICATION
_
1 certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with p C'D 4T
MOA COSA guidelines in effect on this date. 0, :., i ..... ...
.f r Garn ss,:
00 9 CE—` (3 c�G
4p r �1 �� G•'t�3 ��AO
COSA Checklist yellow sheetrooms
#AECC884 ofess*
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Arsenic Advisory
Certificate of On -Site Systems Approval #OSC191334
Subdivision:Green Forest,Block, 1 Lot 1
A water sample revealed an arsenic concentration of 22.7 micrograms per liter
(ug/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. information on arsenic is available from the On -Site Water and
Wastewater Program website (www.muni.org/onsite) or at 343-7904. _
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Municipality of Anchorage
P.O. Box 196650 a 4700 Elmore Road
Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Department
On -Site Water and Wastewater Section
.�»cnr S•
l
Department
III
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV191043 COSA#: Permit#:OSP191206
PID#: 018-011-02
Legal Description: Green Forest Block 1 Lot 1
Engineer: Garness Engineering Group
Applicant: Slavik Lund
Your request for a waiver of the required 18.0 feet horizontal separation from the
absorption field to the existing seepage pit has been approved. The approved separation distance
is 10.0 feet. See engineer' waiver request for justificatio s.
Vl acv,¢ r - f o f ce e6-� � � bel,- t v� � Ajarwme d 4-& Ise i d
This waiver approval applies to the proposed absorption field only.' Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
............................................... ■ ............................. ■ I
Waiver is Granted: X Waiver is not Granted:
Date: (p 9 9 Approved by:
Name of Reviewer
................ a .............................. ■ ............................. ■ t
**** VARIAN C E/WAIVER REVIEW ****
RECORD DRAWING
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llnnlqu ANO F1 Uf; SMITH t—�•—+ -• a —a——a—,.+— BEFORE YOU DIG
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CLOSED INVERTS PER SSATH 12�T.o _ - -r -ROW-- CALL FOR FREE
BSE PLAN DETAIL SHEET S5 NI T _ 1 c '1, UNDERGROUND
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....:....'//.....:....:.NOTE...:....:........
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RUCTION
OLD SEWARD HWY TO
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LAKE 0715 PRWY
1D6.55 LF: 8* DIP CL50.0 0:40X: : 41.84. LF 81 DIP CL50'O U.40X�:'
,_,���
SEWER PLAN AND PROFILE
ROFI
100.00 101.00 1(12.00
190
STA 100.00.00 TO STA 101.98.39
GARNESS ENGINEERING GROUP, Ltd
--==
ENGINEERING > SALES-, CONSULTING r----=
July 1911, 2019
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Waiver request for Green Forest; Block 1, Lot 1
To whom it may concern:
QuardicS,
Advanced T c.3bncvlt System
D - -
The new septic system was installed on 7/9-11/2019. During the installation, the new dual
trench type drainfields were installed 104 apart. Per MOA onsite code, the drainfield should be
installed a minimum of 10'+ or twice the effective depth. We are requesting that your
department issue a variance and allow the drainfield to remain in place and add the new
"waiver" to the existing waiver from new drainfield to the existing seepage pit (OSV191043).
Justification for granting this wavier is as follows:
• The new drainfields receive CAT II effluent
• Per the T.H. and percolation test in MOA records, the soils percolated at 69
minutes/inch. Our design proposed an application rating of 0.5 gpd/ft2. This is
conservative as the absorption rate is on the "lower/faster" end of the spectrum which
applies for soils up to 90 min/inch.
• There is a reserve site and flow diverter for the drainfield
• The old seepage pit is surcharged and during the excavation of the septic tanks, no
effluent was noted weeping into the excavated area, which was less than 10' from the
surcharged seepage pit.
In short, it is reasonable to believe that there will be minimal hydraulic connectivity between the
two new trenches.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance. A
Sincerely,
a�
3701 East Tudor Road, Suite 101 "Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this I � Day of 64 M of 20] 41, by and between
Q&OCK' ck i erk-- Vli 1I MNerein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
located at (legal description) ;
LT I
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Ihroughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
l includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
vo Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
n_W Owner agrees that any sale or transfer of title of the property will not occur without a new
CCertificate of On -Site Systems Approval.
�113 Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
' Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the -Agreement -or -any -part hereof, or the right of the Municipality-- --
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER: By:&_k_W4 (signature) Date:
lDebi� i I r'cKh
A�a b!u"N (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing i strument waA acknowledged before me this ]L day of
20/(, by
&OZ],
MKS
NOTARY PUBLI FOR ALAS
My Commission expires: Brophy
l ne t4, 2023
MUNICIPALITY:
By: (signature)
(print name)
Date: [zl� j
Title:
(rev. 05/18/2018) Page 3 of 3
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519~6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING.
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner ·
Mailing addres~
Day phone
Lending agency
Mailin. g address
Day phone
Agent ~B. ~ L-~ ¢uqP-z--o~v Day phone '~4'~-~._~;~-9.
Address '-S'.--%S- ~¢~% ,u, oa--ct~.~,¢t4/C--cj '-8, c,4b: A~oI~- 'A ~ ~¢,..¢~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA~21
5. STATEMENT OF ~ INSPECTION BY'ENGINEER= i~ : ' : ·
-:~ ' As certified by mYi~al~ affixed h~ret~ and ~s of the Validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that th'e on-site water supply
and/or wastew,~ter 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 investigatio~ and inspection, the on-site water
supply and~°r wastewater dispOSal' system is in .compliance with all Municipal and State codes,
ordinances, and regu. lations in effect On the date of this insPection.
Phone
DHHS SIGNATURE
"/ ApProved forbedrooms.
Disapproved.
Conditional approval for
Date ?'E'o -7-~- E
·
bedrooms with the following stipulations:
Additional Comments
By: Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in'paragrap'h~5-above by an_independent
· professional engineer registered in the State of Alaska. The DHHS does this as a couAesyto purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not
conduct inspections or,ana!yze.da,ta .bef,.o..re.a !;erfifica,te is issued~.,The Municipality of ,Aqchorage. is not
responsible fo~: errors 0~; OmiSSions in'the pro!. ,e~?!~na!.?gine~r'~. ~o~k..: i:-.,.,"~:. ~ '.. ' , ' ~'
~-~,.~ ~ ~oX~' ..... : - . _...-. . .
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
SEPARATION DISTANCES
Size in gallons
uat*eC6T~~'-~ off" level at*
"Pump
m
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
On adjacent lots
On adjacent lots
Public sewer main
Sewer/septic service line
/c~¢--t-
Public sewer manhole/cleanout ,' c,¢ '~
Lift station / c~'~-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation P,- /¢,~ Property line /~-' Absorption field /c~
Water main/se~ice line ~' Sudace water/drainage '~ ~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation / C~ ~ Water main/service line
DriveWay, parking/vehicle storage area ~--(:~
Wells on adjacent lots
ENGINEER'S CERTIFICATION .,.. ....
..
/certify that/have determined thru field inspections and review of Municipal recor~C~l~ 'C ::,~'e~'~*~ --
in conformance with MOA HAA guidelines in effect on this date. ~~.~7;:,,,~,,~. · ;.
Signature- ~
Engineei's Name ..~'7'-c.-.-~ ~,,j,x. jc,~r'~
Date '7¢/"~ ~/¢/~'~'
HAA Fee $ ~,f'~('l. ¢')U Waiver Fee $
Date of Payment ~'/- ,.C~. OL~ Date of Payment
Receipt Number ~:~'~'~\ 4' '~O ..~ ~' ~) ' '' r ~ ~ R~%iptNumber
72-026 (Rev. 3/96)*
Municipality of Anchorage R E C E !~--~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUL 2. 6
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 34~i~r~4,,4-alily-.v,,
Dept. Health of 4,,rn~,Anch~r_ag.e
Health Authority Approval Checklist & I_....,~,, ~erv~ces
Legal Description:
Parcel I.D.: O/,¢~'- ~/1~0'"~
A, WELL DATA
Well type
Log present (Y/N) ~ ~ Date completed
Total depth ~ ~,,,u' ouur'~' Cased to
Sanitary seal (Y/N)
IfA, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
~/~ { ~ ~
g.p.m. /-4. ~ g.p.m.
WATER SAMPLE RESULTS:
Coliform ~-' ~ ~
Nitrate ~)' ''~-' (-~ Other bacteria
Date of sample: '7-/"21 / ~ ~' Collected by: ~ ,[2 '~:~wa)o,] t~'
B. SEPTIC/HOLDING.TANK DATA~ ~m~ ~¢7 ~ ~,F,~. A~uAc o~ ~ ~w~.
~te install~ TM/~ / ~ Tank size 1~o Number of Compadments ( Cleanouts
Foundation cleanout (Y/N) ~ Depression (Y/N) ~ High water alarm (Y/N)
Date of Pumping ~[~L[q~ Pumper ~%
~t&T,~% ~~tt~ ~~t~ ~,~h.
C. ABSORPTION FIELD DATA ~ ~ ~ ~t~ ~ ~ ~ ~~, ~H~ ~>
Date installed ~/~ / ~ Soil rating (g.p.d./~2 or ft2/bdrm) ~ ~ System type
Length /~ r Width / b ~
Effective absorption area :~'c¢__ ~
Date of adequacy test ,5-/ /&'--/ q, ?
Fluid depth in absorption field before test (in.); ct ~
Gravel thickness below pipe
Total depth /-5"- /
Mon tot ng Tube present (Y/N). t Depression over field (Y/N)
Results (Pass/Fail) ~'r,k ~(- For ~ bedrooms
Immediately after ~ gal. water added (in.):
Fluid depth (ins) Minutes later:.
Absorption rate
g.p.d.
Peroxide treatment (past 12 months) (Y/N) .~
If yes, give date
72-026 (Rev. 3/96)*
~615301
T-223 P.O~/03 F-g~4
CT&E
Client Name
P~oJ~ Nal~e/~
Client Smnpl~
Or~er~ By
To,ut KoLif~rm
O.SO0 u 0,§00
Client PO~
PHaI~d Date/Time 07127/9~ 12:36
Co]le¢l~ Dnte/Tt~ 07/21/09 18:00
]Received Date/Tl~e 0~/')2199 10:30
Teehlll~ll Director: Stephen C,
EPA 300,0
O?72Z/~
10 ma~ 07t~2/~ 07/22/~
GAAB-HD I
GC~ ~,TER ANCHORAGE AREA BORC .... H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
LEGAL DESCRIPTION~. ~z~?~:°-//.._~-.~(~'.:. d~Zf~4././~4r~/:
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
/
MATERIAL " .- . NUMBER OF
'~--~'~f'~ ~--~ COMPARTMENTS
GALLONS. INSIDE LENGTH ;~ ~/~INSIDE WIDTH ~
LIQUID
DEPTH ....
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER ~ OR WIDTH //
LINING MATERIAL__c'~I~-c~./2 (Z~'d~J~'~- ~-~/~'?~J' DISTANCE FROM WELL
/
NEAREST LOT tINE
totAL EFFECTIVE ABSORPTION AREA (WALL AREAl
LENGTH ,/.dx> .*'
, , DEPTH
BUILDING FOUNDATION
?u/'~) ~'~"-' SQ. Ft.
TILE DRAIN FIELD:
DISTANCE FROM WELL ~_.~.~.~'~-"~"4~FOU~ATION_ , NEAREST LOT LINE
NUMBER OF LINES..../"' DISTANCE BE:EEN LI~
ABSORPTIO~A SQ. FT.
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO 'FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE.~._'/~J/~/~"~~°, DEPTH ~".~ x
NEAREST .~ SEPTIC
LOT LINE ~' / ~ , SEWER LINE ,TANK
DISTANCE FROM / WATER
, BUILDING FOUNDATION..~- ~ ?L~ SAMPLE ./~/'~'~ , NEAREST
, SYSTEM , CESSPOOL '-~ , SOURCES ....
DIAGRAM OF SYSTEM
~. 6 2~' ~<-/x~'~-'
DISTANCES:
GAAB-HD-2
GREATE
327 Eagle St.
ANCHORAGE AREA
HEALTtI DEPARTMENT
Anchorage, Alaska 99501
)ROUGH
279-2511
Case No. _.~ ~'
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPI_ICATIONTO INSTALL: SEPTIC TANK ~' ,SEEPAGE PIT ~ ,DRAIN FIELD
TO SERVE THE FOLLOWING FACILITY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
MAILING ADDRESS ?~'0,2. ~z,e,,-,,..~,..~. PHONE NO.?
LOCAT,ON OF INSTALLAT,ON
,OTHER_
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /'/~c/~ /~:~,-.c~r' , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE "Tff-d~ TYPE ..~/e~._~ _SEEPAGE AREA
DISTANCES:
I certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above ~gsc~ibed system is in accordance with said code. ~o~-t~.g~c~
,, ,~ ' . ,~ '~ ~'. ,; ,
DATE. ~ APPLICANTS SIGNATURE