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HomeMy WebLinkAboutGREEN FOREST BLK 3 LT 2Onsite File The well i_S - in the Utility Easement. an encroachement permit from ROW is required prior to lJp G Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211410 PID Number: 018-011-17 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Robert Bergeron ABSORPTION FIELD El Deep Trench 0 Wide Trench ❑ Bed ❑ Mound Ad SiteAd dress ddress Northern Raven Dr ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.6 GPD/SFJ 3.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.0 Ft. Gravel depth beneath pipe 2.5 Subdivision Block Lot Green Forest 3 2 Ft. Fill added above original grade Gravel length Township Range Section 2.5 Ft. 2 @ 64 Ft. Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Septic Absorption Holding Sewer Lift Station Total absorption area Number of trenches Ft. Dist. between trenches From Tank Field Tank Line 1000 Ft2 2 6.0'+ Ft. Well 100.0 100'+ 100'+ NA 25+ TANK K Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ 100'+ 100'+ NA Greer Tank 1250 Gal. Material Number of compartments Lot Line 10'+ 10'+ 10'+ NA NA HDPE 2 Foundation 10'+ 10'+ 10'+J NA LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to 3034 drainfield 3034 Deans Construction Drainfield 3034 Co/MT3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 230.6 ft Inspdection v, 6/7/2022 2nd 6/8/2022 Location and description 3" 6/8/2022 411 6/20/2022 See Site Plan, bottom of house trim ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF .. ...... .. even annoRe CE Septic System _ Approved Date 2 y�'• - 8149 y 1 �+/jj,•2024.02.29..7' Note: this approval does not include well permit requirements. (Rev 05/02/18) =0 O NM �m 0 m m N O m = N fD � o \ �\ 0 m �" c� 11 A (n v cn N O cn CIDm m Z� o � N 0 0 0 O Z N O m o m � =1N U) Zz �o o ;0 vo a:- r 2 2 m-n Z — � N� LA fl N V 0 \ O O \ \ N A OA \ CI mZ \ m a D \ SD I m Z \gymc� tD A O m rn m \ cn \ \ - �0 A x 7 mm \ \ z z 2 2 _ m m _ p z z n C 2 = N N N N 12 N O O O V p O O 3 ? O O O D N -• O W V m (A A 4 N- m m m z Z C) O m v r^ = 2 2 N N toN p v NO rn o y O O N Cn UN O 00 0 N Z D 0 C i Z H NOTES: PANNONE ENG SVC LLC (C.1. 1088) P.O. BOX 1807 PALER, AK 99645 OF REVISIONS DATE 12/13/2023 RECORD DRAWING PHONE (907) 745-8200 FAX (907) 745-8201 P•' SCALE GREEN FOREST B3 L2 ROBERT & GISELLE BERGERON 12570 NORTHERN RAVEN DRIVE '• •• ••• ... an" a CE 8149 20231213 DRAWN ACP P.I.D. NO 018-011-17 CHECKED JRL PERMIT NO. OSP211410 SECTIONS ANCHORAGE, AK SHEET 30F3 �cn 1 D -iN P VlD�7DnO cnc�p�=CO Oomorn;on-,a z� uo O-IF-zcn� m-�7�Z0rg0mcn z�OT��700� ti D -9 F- D m cA m F� Z• FTl �7 " E r r DOD c�DTCOm� �..0 r DOD c coD(_� �zocOmcXn O vmi < I �� C D-OPp> DN NO m �� Z� r�Tl-OPfJ-Di DNO nZ�Z Z-i - -i D m -I I?l pZ m0 m'O mr �f?7 D �m� z D 0No-Dp� U) 20 � ti E ir0� om� I ��� (l�PNpOClt� ,O DODO 00�NCTI -ice c z Z CJi x cfl m N 0• 0 0 n O N O. Ut (7 D mmpz Cf) rn fv O 41 0-1' O`er Co O� PO P Z D * rm- NU7 r70 m0-0 2 0� N r;1 (n-u� O-<D z r-m rn mrn O (n (n� mm m� O (n m p - -I m CD o N z D rn Z �- m p -0 oz O = Ln D� m = � c m C) N Z a m a m m U7 m x Ln a � K(-)K:(-) K:C-)K(-)rn 41 41 (A W N N�� Ul � N 0) rn Ul u ()1 rn -P cn -' p CO J P v Co N Ui A N D �I Ut N --I v LA 00 -P U Ut � cn ()I CY) j -P -P O Q') � CA CA LA N CO O N O N CO CO CO -I co \\ � w m 0��/\yam \ \lump _ \ w 0-00 'All I n n m _ _ r rmm�- to 9:Kcm>. arm \ v ;u OPm moo / K 0 O 'f1 Di7 \ 0- r �0D m>z 3 \ an�Z �mm I N� Z� I Imo'\� boo 1 mm >s I I \ Y xco c w / \ \ t o� aU min / Oo t-m -' oLn 00 I �m mm \ \ m E oy \ / I z C) N I i x Oo 3 � \ \ NORTHERN RAVEN DRIVE (,A w i NOTES: PANNONE ENG SVC LLC (C.1. 1088) P.O. BOX 1807 PALLIER, AK 99645 PHONE (907) 745-8200 FAX (907) 745-8201 ppAj ....4.. ....... "g;e,ro„ anrio�a CE 8149 $ REVISIONS DATE 2/3/2023 RECORD DRAWING SCALE 1" = 50' GREEN FOREST B3 L2 ROBERT & GISELLE BERGERON 12570 NORTHERN RAVEN DRIVE ANCHORAGE, AK DRAWN ACP P.I.D. NO 018-011-17 CHECKED JRL SITE PLAN PERMIT NO. OSP211410 SHEET 2OF3 G{ 9va7\ a«3 % \\\\\\ \\\} \ \}\ \ § NORTHERN RA /EN DR/VC � � MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program POBox 1sOO5U 47o0Elmore Road Anchorage, Alaska 8g519'0Vn0 Phone: '7904 Fax: (807)34o'r887 Permit Number: OSP211410 Work Type: Septic Upgrade Tax Code Number: 01881117000 Site Legal Address: GREEN FOREST BLK 3 LT 2 G:2833 Site Mailing Address: 1257ONORTHERN RAVEN DR, Anchorage Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 10/1/2021 10/112022 21813 R1Disposal Field R1 Septic Tank ElHolding Tank El Privy ElPrivate Well 171 Water Storage All construction shall bminaccordance 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 YVoab*vvahar Disposal 3. The wastewater code requires inepocUonodudngthe inubaUatinn.The engineer nhaUnoti the Development t Services Depa�nentper AMC 15.G5.Provide notification byceUinA(007)343-79O4(24/7'. 4� From October 15toAprU15. asubau�aoesoil absorpUonsystem under construction during �oezingweather shall be o. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Received By: Issued By: El MUNICIPALITY F ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-011-17 Property owner(s) Robert & Giselle Bergeron Mailing address 12570 Northern Raven Drive Site address same Day phone Legal description (Sub'd., Block & Lot) Green Forest B3 L2 Legal description (Township, Range & Section) Lot Size 21,913 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field X❑ Initial ❑ Single Family (SF) X❑ (w/wo AD U) Septic Tank FX-1 UpgradeX❑ (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: -05q 5 Waiver Fees: Date of Payment: a& )10V _ Date of Payment: Receipt Number: 0 -11 L Receipt Number: Permit No. 05102 111; ICS Waiver No. Permit App_.;- : ,'-:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211410, Deb Wockenfuss, 10/01/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211410, Deb Wockenfuss, 10/01/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211410, Deb Wockenfuss, 10/01/21 ;047 f AA V 41 i&A �I L71, Z 71 'FIAT '45C k4e, VAJ ell my rs v "? Pa's IVIntf sht-Mli, zt�t this Anhilt as ff ShOwn r fat tail aresup P n t A w i t a my, a mth t I io feo r t r t ter the P! at date % Aq- r cq , tp.,d TitlSea-Y 4400S. *- e r�h Nip, 4-r 1 tited NO bbundary or AM lines - UO furIve- or ta" res ponibilittis fvY txs ins f I XA " max FRECOFOIN-43- DISTRICT E' Ait A 9950 0- V* 21 -oo r ................ lot, low yo I Ps APIC mBUWI�, Tf- A k,  MUNICIPALITY OF: ANCHORAGE · ~,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L. Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N AM~.// J) ) ~ONe MAILING ADDRESS Z LEGAL ~SCRIPTION ~ ~ . LOCATION.. ~ / ~ NO. OF B~D~OOM$ Well ~sorption area ~-- DISTANCE TO: I , /OO /O Dwelling Liq. capacity in gallons Inside~~ Width ~ ~ DIST~ Well Dwelling PERMITNO, ~= ~STANC~TO: m, IoO Foundation ~ Nearestlotline ~ ~ ~ Top of the to finish grade ' Material beneath tile ~otal effectiv~s6rDtion/l/~area Length Width Depth PERMIT NO. ~:~ Ty:cri~ ~ Crib diameter //~depth ~ ~[ / / Nearestlotline ~ ~ Z Buiidin~ foundation ~ Sewer tine Septic tank Absorption area(s) ~ DISTANCE TO: ~/~ OTHER -PIPE MATERIALS ~/~ I NSTAL~, IR EMAR "~ ~P~O~ED DATE LEGAL PERMIT NO. 8PPL I CANT LOCRT I ON LEGAL. LINC CONSTRUCTION INC S6(15 zHNrM ":IRF:LE CROW ST OFF HUFFMAN L2 B]~ GREENFOREST S/D I...OT SIZE 40C~3C4 SQIJFIRE FEET I'YF'E OF SOIL. AP]SORBTION SYSTEM IS: I'RENCH MAXIMUM NUMBER OF DEDROOMS = 3 SOIl.. RATING (Sg! FT,'"BR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF Fi TRENCH OR PIT IS THE DISTFtNCE BETWEEN THE SURFFICE'. OF'.' THE GROUND RN[) THE E,'OTTOM OF THE EXCAVATION (IN FEET). THERE I~; NO SET WIDTH FOR TRENCHES. THE GRFIYEL. t)EPTH IS THE MINIMUM DEPTH OF GRAVEl.. E:ETWEEN Tt4E OUTFRLL. PIPE RND THE 80TTOH OF' THE E,'.qCRVRTION (IN FEE'r>. F'ERM]:T ~PPLICRNT NAS THE EE_,FUNmlEILITN TO INFORM TFIIS [EFRRltlEN~f [)..RING THE tNSTFILLRTION INSPECTIOI'tS OF ANY WELLS FIDJACENT TO THI':'; PROF'ERTY AND THE NUMBER OF RESIE>ENCE$ THAT THE WELL WII_L SERVE. ........... ]-l,.~0 ,~: 2 ) I Ih..l:_-'5..F'ES C'f' I Cli',t S FIRE BFICKF'ILLING OF ANY SYS'FEM WITHOUT FINAl_ INSPECTION AND FIPPROVRL. BY THIS DEPARTMENT WILL BE SuBJrECT TO F'ROSECUTION. MINIMUM DISTFINCE BETWEEN R WELL FIND RNY ON-SITE SENRGE DISPOSAL SYSTEM IS t00 FEET FOR 8 PRIVATE WELL; OR 1SEt TO 20E~ FEET FROM Ft PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC I,,IELL.. WEL. L LOGS ARE REQUIRED FIND MUS;'r BE RETURNED TO THE DEPFtRTMENT 14ITHIN ]:E~ DRYS OF TNE HELL COMPLETION. OI'HER REQUIREMENTS MRY FIPPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS ARE AVAILABL. E TO INSURE PROPER INSTI:r~LLflTION. I CEF,'TIFY THRT t: I RM FAMILIAR HITN 'THE REQUIREMENTS FOR ON-SI"rE SEWERS RN[) WELLS RS SET FORTN BY THE MUNICIPP]LITY OF RNCHORAGE. 2: I N ILg~"f~4S"FRLL THE SYSTEM IN 8CCOR[:,FINCE H ITH I'HE CODES. , I F THE P ir- YES, AT WHAT 13 E DEPTH? 14 15 16 'T, ID 17 18 19 20 0 M 'N't E NT S 'ERFORMED BY:/" '2 008 (7/76) . Reading i D a *"a SOILS LOG 1 -1 Net Depth to i Net MUNICIPALITY OF ANCHORAGE Time N, DEPARTMENT OF HEALTH AND ENVIRONIMIENTAL PROTECTION PERCOLATiON Pouch 6.6150, Anchorage, Ala,;ka 99502 276-222f TEST SOILS LOG PERCOLATION TEST PERPORMED FOR: DATE PERFORl.lED: Q, 6 LEGAL DESCRIPTION: DEPTH-- - ----- - - ---- --- --_SLOPE__ ---- SITE -PLAN, ----- (FEET) L 0 c41 ev j 2 3 J, 0 7 10 11 WAS GROUND NATER S ENCOUNTERED? L 0 P ir- YES, AT WHAT 13 E DEPTH? 14 15 16 'T, ID 17 18 19 20 0 M 'N't E NT S 'ERFORMED BY:/" '2 008 (7/76) . Reading i D a *"a Gross 1 -1 Net Depth to i Net Time Time 'Water Drop 6 vG L/ ev j PERCOLATION RATE A (minutes/inch) TEST RUN BETWEEN f FT AND FT CERTIFIED BY: ( DATE: 0 Description of'Formation ..... [from Sand and gravel- , ....... ~..~'- ...."". ........... -,.:..,~:f.,(~,[,... - . ..:.:j~; ::.- .... , ...... ;-~..... :.... 25 71-- 71 I ~7 Driller SOMMERVILLE WELL DRILLING Star Rt. A, Box 1773 Anchorage, Alaska We advise you to attach this certificate to your deed. .............. ~.' .... : ...... · ~o" ;-' :~,~:~:y?:~-':"~ K: ,''". ..... = ~ ,- ...... , MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING i ' :~ilParCeIi. D.# ~/¢o~1/ I7 HAA# ,4~-~ GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) Location (address or directions) Property owne 7/-/ (] ._ Mailing Address (c) Lending Institution ,~'-/ Mailing Address (d) Real Estate Company and Agent Address ~¢¢(~ ~? Telephone ~¢5--~"% - ~ '~'~'~ (e) Telephone: (/home)_ ~, ~ Business ,~/~/e~phone '~"~/ .~ ~:¢~- Mail the HAA to the following address: (or check hereXif hold for pick up.) List contact person and day phone number below: .:-::'- i.:ii 2. TYPE OF RESIDENCE Single-Family~;~( Number of bedrooms 4 3. 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. 4/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 legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Name of Firm C('~ ~_~)/,.f..) Address 1 (~(~ Date ¢//'~ 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona .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. Engineer's Seal Approved for ~/'--' 'bedrooms b Approved ~ Disapproved Conditional Terms ofCo'nditional/v Approval 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 asa courtesy to purchasers of homes and theirlending .i;~ institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections orana yzedatabeforeacert f cate s ssued TheMun c pa ty of Anchorage snot responsible for errors oromission~'::, in the professional engineers work. . ,. 5.,.~,:~:¢:/~,,,~:,,,.~.. 72-025 (Rev. 7/88) Back Page 2 of 2 ;: ;;<~; : ¢.L:,: :,:, :~;~:~5:~''~'''~ ~ ' MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: .~-7 A. WELL DATA Well Classification _~/:)j~(.~ .,-/Lc_ ,_% IfA, B, C, D.E.C. Approv,~d (Y/N) Well Log Present (Y/N/) /_ ~ Completed. /////;%' //7,¢ Yield Total Depth /O,~ Cased t0(~D~pth of Grouting f/t~ Static Water Level ~' %'-' ~ '/' ~ ' Pump Set At Casing Height Above Ground ~ ~ Electrical Wiring in Conduit (Y/N) _y' SEPARATION DISTANCES FROM WELL: Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot. /f~' '~~,~.); On Adjoinirlg Lots To Nearest Edge of Absorption Field on Lot _ ; On A~joining Lots TO Nearest Public Sewer L~ne _ k~//~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~O' ~ Water Sample Collected by ~)~ ;'~'~ ~ ~ / -- ;Date__ /,~/ Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed ~Z~//YP,.Size Standpipes (Y/N) J Air-tight Caps (Y/N) Depression over Tank (Y/N) _ ~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~:~l//~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: .No. of Compartments ~ Foundation Cleanout (Y/N) ~"' [)ate Last Pumped ~/~ ?/oF ~ ;for NT/~t To Building Foundation To Disposal Field To Water-Supply Well /(') '¢ ' ''/ To Property Line /0 ~ To Water Main/Service Line .~(.) , 4- To Stream, Pond, Lake or Major Drainage Course Comments ~tCx'.4¥0(,,~5 ~-r, ff f¢ ~,o~, L 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /©//!/'-7S v' Width of Field ~ ~" ..C~-~./-/~F~c/r-,~, Type of System Design '"~r c / Length of Field ~ .~ ~"~~ /~' / /~ Depth of Field -~ ¢/~.~ --,~ ~' Gravel Bed Thickness ~' ~ ~ ...... Square Feet of Absortion Area //~ g~ ~ Statndpipes Present (Y/N) Depression over Field (Y/N) X( D~}e of Last Adequacy Test ~[~ Results of Last Adequacy Test .~'¢/.~ ~~ -- ~5~ ~c~¢~/~ ~- ~c/~' ¢~ ~/6/¢c~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~ ' ~ To Property Line /O t To Building Foundation ~ ~ To Existing or Abandoned System on Lot ~ ; On Adjoining Lots ~O~ + To Water Main/Service Line '¢~-O ' 4- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments(~).~: /4-'/~ O-~- C2~l)u, ).-J-. To Cutback (if present) D. UFT STAT O. Date Installed Size in Gallons "Pump On" Level at THiegs~e~V:~r Alarm Level % Meets MOA Electrical Codes ,(~) Comments \ Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check PermUted BedrooJRating Against HAA Request** I certify that/t e'ohe rified, or conformed to all MOA and HAA g.u.[¢elin6 inspection.//? '~/~,'~-~// "~"' '" : ' Signed //~'~ Company in effect on the date of this Engineer's Seal MOA No. ~---~-",/:~ ~-¢~,/¢¢ Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Tom Fink, Mayor 343-4744 March 6, 1989 Bruce Corwin, P.E. Corwin & Associates, Inc. 1000 East Dimond Boulevard, Suite 205 Anchorage, Alaska 99515 Subject: Waiver Request for Lot 2 Block 3 Green Forest S/D Waiver Request ~WR890007 Dear Mr. Corwin: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 91 feet from sewer system (trench) on Lot 2 Block 3 to the well on Lot 3 Block 3. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Robert W. RobJ. nson Civil Engineer On-site Services RWR/ljwI~6 associates,inc. Consulting Engineers 1000 E. Dimond Blvd. * Suite 205 · Anchorage, Alaska 99515 · (907) 522-1311 February 27, 1989 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 SUBJECT: REQUEST FOR WAIVER OF SEWER SYSTEM FROM WELL SEPARATION DISTANCE - LOT 2, BLOCK 3, GREEN FOREST SUBDIVISION Ladies and Gentlemen: When performing a Health Authority Approval (HAA) on the above referenced property, it was brought to our attention that the original sewer system on the subject lot was installed too close to the well on Lot 3, Block 3, Green Forest Subdivision. The original sewer system was inspected and approved by the Municipality of Anchorage in October 1978. Nothing has been altered or changed on this lot since ].978 and your department approved a HAA on the subject lot in 1986 without notation of the separation problem. We now understand that your department requires our client, the U.S. Housing and Urban Development, to apply for a waiver because of the installation problem in 1978. We are hereby complying with your request. We request a waiver of the sewer system (trench) on Lot 2, Block 3 to well on Lot 3, Block 3 oeparatlon distance from the required 100 feet to 91 feet. Our basis for granting the waiver is as follows: The original system has been installed since 1978 and the Municipality of Anchorage was responsible for the original waiver in the field which allowed a lower installed separation distance. Nothing has been done by the present owner to alter or change the system since it was originally installed. A Municipal decision was made to allow the lesser distance in 1978. The well on Lot 3, Block 3 is 102 feet deep, the well on Lot 2, Block 3 is 103 feet deep and the well on Lot 1, Block 3 is 100 feet deep. W~nile we have not been able to locate a well log for Lot 3, Block 3, we do have a well log for Lot 2, Block 3 which should be DHHS February 27, 1989 Page Two similar in every respect to the other lots since the soil conditions in the area and the well depths would justify such a similarity. Also the water table depths would not be drastically different in such close proximity of the area or the well depths would be different as well. 3. The well log for Lot 2, Block 3 indicates sand, gravel and clay to 25 feet, then there is a layer of hardpan from 25 to 62 feet, then clay from 62 to 7]. feet, and sand and gravel extend from there to the final depth of the well. Based on local geology and well depths, we believe that the well log for Lot 3, Block 3 will be similar to that described above. 4. With at least 37 feet of hardpan, it is doubtful that any contamination could occur. Further, static water level in the wells is 70 to 85 feet and the nitrate level in Lot 2, Block 3 was not detectible (less than 0.10 mg/1). We believe this demonstrates no real problems in the acquifer for the area. Se Drainage from the sewer system on Lot: 2, Block 3 is directed away from the well on Lot 3, Block 3 due to a depressed area between the two locations which would move the flow in an opposite direction. In summary, we believe the original decision to allow the lesser separation distance was valid and see no way that the sewer system on Lot 2, Block 3 could contaminate the well on Lot 3, Block 3 based on the factors listed above. We recommend that the waiver to the lesser separation distance be granted. Ver~ truly y/6urs, CO~7~i~N & A~ATES, II :,.. , I :' bruce ~. /Corwin, P.E. ~ PresidenB INC. enclosures CORWIN & ASSOCIATES, INC, 1000 E. Dimond Blvd. Suite 205 ANCHORAGE, ALASKA 99518 (907) 522-1311 SHEET NO CALCULATED BY CHECKED BY SCA,E_A/T ~ DATE TAN ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl. TH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date .~~ GENERAL INFORMATION (a) (b) (c) Legal Description (in_q. lude lot, block,.~bdivision, sectio/g~k townsh~, range) L ° c a t i,~o~('(~-.~s~r e c t i ~~~ Applicant Name ~;~.,~'/~ ~_~ Te;eohone' Home/~-~/",~'-,,~3,,'~X..Busine~s Applicant is (check one): Lending Institution []; Owner/builder,~J"~ Buyer []; Other [] (explain); ,,._ _ (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF.ES ENC "Si n glo- Fa m ily',J~ M u Iti~.Fam ily. [-I Other -: Number of B.edrooms ~-' 3, WATER SUPPLY ' ..:, , . Individual W II Community [] Public [] .... Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWA,~E DISPOSAL Onsite~/ Public [] Community [] Holding Tank [] Note: If comm'unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025(11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA]A AND INFORMATION 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 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all h.,micipal and State codes, ordinances, and regulations in effect on the date of this ins ~ctl~/ ,.%. ~- -'"~"'(.~. ~. DHEP APPROVAL Approved for Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHEP 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. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (Mf.~,l HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: /-' ¢O, ~. ~z/?~"~ ~ ~..~. i2/vc ~. · ~., r ~ ' ( Well Log PresentlY, IN) __ __ Date Comp)eted ([- /~ 7~¢' Yield Total Depth [~ Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing/(,Y//N) Depression ArounO Wellhead Static Water Level ~¢' ' Casing Height Above Ground Electrical Wiring in ConduiCY~N) Separation Distances from Well: / TO Septic/Holding Tank on Lot It'¢2~. /12 S,/~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~ ( ~ ; On Adjoining Lots To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ,-~ _%""' '¢ Water Sample Collected by ~ ~o'~--' ;Date _--~.' /~-'~ Water Sample Test Results '~'¢~'S%~¢"/~1,- ~' B. SEPTIC/HOLDING TANK DATA Date Installed J¢-rl- StandpipesCN).,'f'3 Air-t!ght CaPs~.4(I} Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N} Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well ./fP .~ To Prope~y Line To Water Main/Se~i~ Line Size '~'""'~'(~ No. of Compartments ~ "' Foundation Cleano~N} / Date Last Pumpe("J c~ Temporary Holding Tank Permit (Y/N) To Building Foundation. To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed [(~-{'~_..- 7~~'' Width of Field '~ f Square Feet of Absorption Area ///~'~ Depression over Field (Ye Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /¢2¢ (' To Building Foundation Lot Type of System Design Length of Field 7 ~;~ Depth of Field Gravel Bed Thickness _ Standpipes Present'N) Date of Last ,~dequacy Test -(~ '('~¢./.4. ct $:~i~r/'7//- )T° Pr°perry Line /~ To ExJstJn~ or Abandoned System on ; On AdjoinJng Lots To Water Main/Se~ice Line ~ ~ ~ To Cutbank (if present) / To Stream/Pond/Lake/or Major Drainage Course ~ To Driveway, Parking Area, or Vehicle Storage Area ~'~- f~ ~ 'Comments ¢ ~ ~4 ~;~- ~o ~¢~ ,~ ¢~,~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions/./../'''''~ Men,hol~s (Y/N) ___ ~.,,pd~mp Off. LeVel a't -----~ . ** Check Permitted Bedroom Rating Against HAA Request ** ~ certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed . ~/~""-- ~"~ Date ~ Company ~' ~'"~r~-¢ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11,84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAl. HEALTH CERTIFICATE (DF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name /¢'¢~ ¢-"I¢'~ ~-Z c,~ c~-,.~ Telephone: Home ~ ~'5-'- 7~'~/ Business ,.....~," ~""~'-'z' ~ ~'~"f/" 'Applicant Address ['¢""~ ~-D-- ~V ,¢"/u*~-, ¢- ~e,.,-,~ /~[Z (., ~o~, /¢~,:-~t '¢ ~'~,~..~ (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending institution' " ' .-.-: ~ :!" Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY individual Wel~Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsit.e/.~ 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. Page 1 of 2 72-025 (11,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS~ TESTS, FiLE SEARCH, DATA AND INFORMATION ~ As certified by my seaJ affixed hereto and as of the validation date shown below, I verify that my investigation of this 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 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 /~:::-(~ -~'"'¢'"'~ Telephone Approved for ~'~bedrooms b~ ate Approved 1[~' Disappr ed Conditi n 5,,t,I T. rm, -/ ' / / - CAUTION The Muncipality of Anchoraqe Department of H~RJth :qnd F:m6r,~,r~,~.~l~D.~,~c~ ,'~ ,r-r~ ........... MUNICIPALITY OF ANCHORAGE (MOA) MUNIC~E~t.YI'~IFA4J¢'I~O~(~'~ APPROVAL (HAA) 1~lCL FNO[E~720 WELL DATA RECEIVED Well Classification: ~r,~.~ If A~ B, C, D.E.C. Approved (Y/N) Well Log Present'N)r Date Completed (~- /~Z 7~ Yield ~'~¢_ ~_ Total Depth ~__~'~ Cased to (~ Depth of Grouting ~f~t~ ~ ..... Static Water Level ~¢ ' Pump Set At _ Casing Height Above Ground Electrical Wiring in Condui¢'_Y)N) Separation Distances from Well: f Sanitary Seal on Casin~/~N) Depression Around Wellhead (Y/~N~ i To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cfeanout/Manhole To Nearest Sewer Service Line on Water Sample Collected by ~ ~o~ ; Date ~,~ /~_ Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed_ to-ri- ?fi*_ Size StandpipesCN)~ Air-tight Caps(~) Depression over Tank (Y(.~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: t ' To Water-Supply We,57 To Property Line ____ [(~_ ("~ No. of Compartments _ Foundation Cleanou~/~N) Date Last Pumped ~Y~ - Temporary Holding Tank Permit (Y/N) To Water Main/Service Line Course _ Comments I , To Building Foundation _~Y? / 9~__-~¢/~ To Disposal Field /~::2 '" To Stream; Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed . (6P'%/('- '~-~ Width of Field ~ Square Feet of Absorption Area /'//~J~ Depression over Field (Y~(_~ , Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation __ Lot To Water Main/Service Line _ Type of System Design Length of Field '7'~ Depth of Field __ ,/'~.~/ Gravel Bed Thickness _ Standpipes Present~//N) Date of Last A/dequacy Test -(~ ,~_c~./~, ~ .sz~ 4¢/~//.. )T° Pr ° P e r t YLine To Existin/g or Abandoned System on ; On Adjoining Lots ~ 4~' ¢'//d2 ¢/ TO Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions j'~"- Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I.have checke.¢, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~--~' ~ Date. Company ~ ¢1 '~'~' ~: MOA NO' Receipt No. r~q~. Date of Payment ~.~-. - / ~>1 Amount: $ r,4D ~ Page 2 of 2 72-026 (1 U84) ALASKA ENVIRONI~'-NTAL CONTROL SERVIC£_, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 SHEET NO CALCULATED BY CHECKED 8y SCALE__ DATE DATE .-: ,/ Time Date inspector Time Date Inspector ,10 Date Inspector Comments Conditional Approval Date Sewer Installed lO Soils Rating Permit No. Well To Absorption Area Well to Tank Septic ]'ank Size Holding Tank Size Well Log Received APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~(:~ ~ Mailing Address %~,~,~ ¢~. Buyer ~- "~'"' ~ /'7 Address ~ Lending Institution Address Realty Co. & Agent Address Legal Description Street Location Type~f/Ct~sldence ~ Single Family Phone Phone Phone Multiple Family Other Wa~e. pSO'pply Individual No. of Bedrooms ATTACH WELL LOG. A well Icg is required for all wells drilled since June Community Public Utility ~ev~)¢' disposal Individual Public Utility Holding Tank 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) Year Individual Installed:"-¢~/"¢~ When Connected to Public Utiltty: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ,~-~,~ ~ ~? ~'~ ~ PALITY OF ANCHORAGE ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION .MUNICIPALITy OF ANCHORAOE 825 L Street - Anchorage, Alaska 99501 DEPT, ' '1.', ENVI~o~ "~' 'ON ENVIRONMENTAL ENGINEERING DIVISION ' " 'relephone 264-4720 ~.~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER~AClLITIES DIRECTIONS: Complete all parts on page 1, Incomplete reques~ will not be processed, Please allow ten (10) days for processing, ~ PROP~RTYOWNER ~ PHONE ~AILING ADDR ~SS ~OPERTY RESIDENT (If different fFam above) PHONE ~ BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTIONf~ ~ C ' ~ ~ PHONE ~AILING ADDRESS ~ REALTOR/AGENT F;HONE ~AILING ADDRESS ' - _. ....... ? T ' LI~GAL DESCRIPTION REET LOCATION ' -- TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY 7, WATER SUPPLY ~[~ INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One E:~ Four E~ Other [] Two [] Five ~ Three E; Six ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM [~ INDIVI DUAL/ON-SITE~* [] PUBLIC UTILITY / **If individual/on.site, give installation date If system is over'[wo (2) years old ar adequacy test ~s required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH FIEQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAl_ USE ONLY DATE RECEIVED INSPECT[ON APPOINTMENTS '~'IME TIME TIME -DATE DATE DATE -~NSPECTOR INSPECTOR INSPECTOR ~)IRECTIONS: [] 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY I--1 ONE [] THREE [] FIVE [~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED r=3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY 1(~) '~'~ Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: /~'.~-~"~--) If Tank is homemade SOILS RATING give dimensions: ~-~ ~ O ~TYPE OF TANK MANUFACTURER -TOTAL ABSORPTION AREA MATERIAL -4. DISTANCESwELL TO: 8aptic/Holding Tank Absorption Area 8ewer Line Nearest Lot Line Absorption Area to nearest Lot Line ~ APPFIOVED FOR ~1~ BEDROOMS [] CONDITIONAL APPROVAL {letter must ny certificate) LEGAL DESCRIPTION 72-010 (Rev, 3/78)