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HomeMy WebLinkAboutORTH LT 3Orth
Lot 3
#015-342-06
Municipality of Anchorage
Community Development Department Page 1 of 2
On -Site Water and Wastewater Program
4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.MLini.org/onsite - (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSPI 81339 PID Number: 015-342-06 El New [Z] Upgrade
Name:
BRANDON & SANDRA ALLEN
ABSORPTION FIELD
El Deep Trench El Shallow Trench F-71 Bed El Mound
Address
5960 ORTH CIRCLE
E] Other
Phone
of Bedrooms
Soil Rating
depth from orioinal arade
lNumber
4
ITotal
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
FL
Subdivision Block Lot
ORTH 3
Fill added above original grade
Ft.
Gravel length
Ft�
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
on
Lift Station I Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Line
F t2
Ft.
Well
109.4
N/A
N/A N/A
100+
TANK El Septic E] S.T.E.P. 1771 Holding Ej Other
Manufacturer
Anchorage Tank
Capacity
125OGal.
Surface Water
100+
i N/A
N/A N/A
Material
STEEL
Number of compartments
2
Lot Line
42.2
1 N/A
N/A N/A
NA
Foundation
39A
N/A
N/A N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
50+
N/A
N/A N/A7,
Pump on level at
Pump off level at
High water alarm at
Remarks TANK REPLACEMENT ONLY
in.
in,1
in.
Pump make and model
Electrical Inspections performed by
Tankto
PIPE MATERIAL House to tank 3034 drainfield 3034
Installer
A+ Home Services
Drainfield CO/MT 3034
Inspector Pannone Engineering Services
BENCHMARK (Assumed elevation) 505 It
Inspection d
1" 10/05/18 10/09/18
Location and description
dates: 2
d
AT HOUSE POINT B
3 4 �1'
COMMUNITY DEVELOPMENT DEPART ENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
teven 001
C 8149
z
10
Approved LIX Date
Inspection Report-1-1-12.doc
|
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TRUE ORTH SCALE 50' EXIST,ING DRAIN FIELD
ZL
DCO
42 2
DV INSTALLED. 1250q SEPTIC TANK
CONNECT TO DCO (E)
REMOVED SEPIIC-TANK (E)
PER MOA CODE 58.0
TI 11.5 IL
II EXI.STIlk DRAIN FIELD
log/ A
SFD
IDRIVE�YAY DECK
./ / y|
� �o ' / /
CD
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- - � - / ~ ~' - ^ '/
/ / � ' ~~~ ^� -- -- -- ' cd
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/� / `` *uo
y �|� -
o ^__~
WELL ~490
485
NOTES:
PAMONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
—WATER LINE /
<
RECORD DRAWING
WELL RADIUS
0
d
---us---sv--' wcwscpnc
504 —
ABBREVIATIONS
PERMIT NO,
OSP181339
TH TEST HOLE
Sheet
(P) PROPOSED
1250
SEPTICy
(E) EXISTING
~
TANK
CO CLEAN OUT NO.
MT MONITOR TUB[ NO.
pno,'LE SCALE: NTS
TYp TYPICAL
NOTES:
PAMONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
ae a
V:10/19/201
Date
10/12/2018
RECORD DRAWING
Scale
ORTH L3
,BRANDON & SANDRA ALLEN
5960 ORTH CIRCLE
ANCHORAGE, AK 99516
015-342-06
PERMIT NO,
OSP181339
SITE PLAN
Sheet
1
Lot 4
a I
r
' a !
o° (
0)
46
it N
Q Q
SCALE: V= 50`
,Z �✓
q
Cplc3
v
/
Lot 220
'sr
r 0
Shed
o�
RECERTIFIED 10-08-184 fJ cry
a ! C
,,Septic vent (typ) ( E
o I N
IW
GO a I >
1=
I
1
i
Lot 3 I
I
I
I
I
I
I
I
AS -BUILT NO C RN f S SET THIS DATE ,. XXvk A I I
OF
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: LOT 3 /�P• • • •`s�
OR.TH SUBDIVISION 49 th •�'
� I
Anchorage Recording Precinct, Alaska, and that the • 00
improvements situated thereon are within the property lines .
and do not overlap or encroach on the property lying 4 .• •Iizabeth L. Wolatko .• oR I
adjacent thereto, that no improvements on the property lying • !
adjacent thereto encroach on the premises in question and �%. • 8036 - LS , • ��e �„
that there are no roadways, transmission lines or other o , , • . • •�,o
visible easements on said property except as indicatedoFessioNP+
hereon.fb
Dated at Anchorage, Alaska
this 14th day of JULY 2018. EASEMENTS OF RECORD, OTHER THAT+
FRED WALATKA & ASSOCIATES, L.L.C. FB 18-8, pg 31 THOSE SHOWN ON THE RECORDED 1
Engineers and Surveyors FB 18-4, pg 32 & 40 PLAT ARE NOT SHOWN HEREON
907-248-1666 BE UNLESS OTHERWISE NOTED.
I
M
O
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co
ti
rye
V
�0oU)
ter- 0)
12
It 0
0
0
PFA
0
�JN,�--PA���OR, MUNICIPALITY OF ANCHORAGE mcnt
/ ' On-Site Water&Wastewater Program ° Pr
arse
PO Box 196650 4700 Elmore Road f.
.r Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
. http://www.muni.org/onsite
, Dc partmen
t
NCHORP4
On-Site Wastewater Disposal System Permit
Permit Number: OSP181339 Effective Date: 9/26/2018
Work Type: SepticTank Upgrade Expiration Date: 9/26/2019
Tax Code Number: 01534206000
Site Legal Address: ORTH LT 3 G:2538
Site Mailing Address: 5960 ORTH CIR, Anchorage
Owner: ALLEN BRANDON B & SANDRA E Lot Size in Sq Ft: 50371
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
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 (18AAC72) and Drinking Water Regulations (18AAC80)
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
2
/277/
Q
kReceived By: ak I I Date: v
Issued By: /, PT Date: 06.4 -
£P( nPJS
mai
MUNICIPALITY OF ANCHORAGE
Community Development Department 4Lir 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. 015-342-06
Property owner(s) Brandon & Sandra Allen Day phone
Mailing address 5690 Orth Circle Anchorage, AK 99516
Site address 5960 Orth Circle
Legal description(Sub'd., Block & Lot) Orth Lot 3
Legal description (Township, Range & Section)
Lot Size 50,371 S q. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(E)all that apply)
Absorption Field ❑ Initial ❑ Single Family(SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑x
Duplex(D) ❑
Holding Tank ❑' Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APP ON I ES A VARIANCE/WAIVER REQUEST FOR:
Dis tante:
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: $ — Waiver Fees:
Date of Payment: ? a- Date of Payment:
Receipt Number: /��07 li3 2( Receipt Number:
Permit No. 05 P/ / 3�i Waiver No.
Permit App_;•: ,-..,:c:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE CONPUANCE
Pannone Engineering Services L Lc OSP/8/339,Deb lh(xkenfuss,09/26/:
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve(a)panengak.com
September 22, 2018
Subject: Orth Lot 3
Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 1,250g Septic Tank to replace an existing
1,250g Septic tank to be issued for this property. The existing tank has failed. It will be removed per code.
Currently the lot is developed. The proposed system will utilize a replacement 1,250g septic tank that will
be connected to the existing drain field. The existing tank is located outside the 100' well radius, the
proposed upgrade will be placed outside the 100' protective well radius. All other separation distances
will be observed.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5'+from any property line
10'+from building foundation
10'+ from any water line
100'+ from any surface water
100'+from any private wells
200'+ from any public wells
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 907.745.8200.
Since, % `I
4
Steven R. Pannone, P.E.
Owner/Civil Engineer
Municipality of Anchorage
/
Ot r,itc Wates az❑!Watcvvatc,
I
W'
\ I 1 REVID FOR CODE CONPIJANCE
\ /N I I OSP181339,Deb thbckenfuss,09/2-V'
\ I
/ = //
- ' -,..:1 ''' � ' ' EXISTING DRAIN FIELD—
TRUE NORTH _�. SCALE : t'= 50' 4 --4,-
/,� I I ' \
' I
cf.)
_ M �D� I
,: / ' �W ' / 42.2' IN T• 1 I. PTI TAN P
Q <vF / /
�� REMOVE SEPTIC TAE) CONNECT TO DCO (E)
J PER MOA CODE _.��
58.0/� /
/ 1.5 I /
M / ' t, i +EXISTING DRAIN Fl ,D /
W
r
'''''''N/
\ I ,, ( WELL (E�
M M�� / � SPD / \ dim � v/ / ''
,, 10 —L /—/ '
JJ� / /
W DRII/�wAY I I I '/
/ ! I/ I
i
/ ---- I / / r r '- I /
i
O / 3 505 / / / I / i \
-.t: 0 3"// ---. .- .1' w
ki
- \ 500 // - - I -i
1. / 495 / /(�
°/ '
�/ 490 / ' I Z
w ...11/:
�-' �v' I •
/ � � 1: 485 I I
. \1\ -1 --:
� ' � ` /
/ / I
+
/ � I
/ \ / Z � /
– I
PI/ �` / -Y� (ABBREVIATIONS
/ '" Q \ TH TEST HOLE
/ — \ I ����" I(P) PROPOSED
r — I by _w —w\ WATER LINE / I(E) EXISTING
2ELL RADIUS CO CLEAN OUT NO.
4 —SS —SS — v SEPTIC TMP NPC L TUBE NO.
NOTES: PANNONE ENG SVC, LLC . Dote
P.O. BOX 102954 ANCHORAGE, AK 99510 G.9t•• _ 9/22/2018
-�-C2 cei1.-2S-020C-770A) PHONE (907) 272-8218 FAX (907) 272-8211 et'•• Scale
� . 1" = 50'
I F3Ci cZ Z -_-� .�.• • i *
••• P.I.D. NO
ORTH L3 t� •• - a -342-06
DRAWN ACP BRANDON & SANDRA ALLEN ••4}'even A. I annoae PERMIT NO.
5960 ORTH CIRCLE v,..• CE 8149
SITE PLAN ANCHORAGE, AK 99516 S '•41` Sheet
ES '
1 OF 1
\
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181339, Deb Wockenfuss, 09/26/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181339, Deb Wockenfuss, 09/26/18
Watkins Engineering, Inc.
P.O Box 110443, Anchorage, AK 99511
(907)349-1851 cwellis@gci.net
Janua~ 8,2004
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
RE:
Orth Subdivision, Lot.3
Septic System Repair
To Whom It May Concern:
The septic tank at Orth S/D Lot 3 was recently raised to accommodate use of an old
'drainfield, since the existing drainfield is surcharged. A permit was not required, as per
Mr. Dan Roth, because the work is a repair. A new as-built is attached, showing the
new elevation of the tank.
The original trench was installed in 1975 and consists of a 39 ft long, 3 ft wide trench
with 6 ft effective depth. The septic system was upgraded in 1996, and a new tank and
drainfield were installed. The tank was set too deep to achieve gravity flow to the 1975
drainfield.
The 1996 trench is now surcharged, so the tank was raised and the 1975 trench was
connected. The tank was inspected and found to be in good condition. A divertei' valve
was installed to alternate between the drainfields. The work was performed I~y A Plus
Home Services.
If you have any questions or need further information, please call me at 349-1851 or
360-3389 (cell).
Yours truly,
Cindy V~'Ellis, P.E.
President
i n CHANGE TO 1 c~E~ IT3
CO
DI~O DIVERTER VALVE INSTALLED
RAISED AND 1 c~75 TRENCH CONNEr
MONITORING TUBE DRIVEN Tl'
A
IT1 6.25 Fr' BELOW INVERT
OF LATERAL.
WELL
100 ft well radius
'Lot 3, 0rth Subdivision
Sandy Allen
Septic System Repair
November 13, 2003
Scale: 1" = 30 ft
Watkins Engineering, lnc_
Cindy W. Ellis, P.E.
(907) 349-1851
P.O. Box 110443; Anchorage, AK 99511
MARK
Fcn
A B
2B.g 17.:3
44.1 51 .g
5~.. I 57.B
DP.O 1 5:3.9 59.:3
DP. D2 55.2 60.:3
DV 56.~. 6n.B
37.cj 3B.3
MT3
7n.~. 33.2[
42.~. 33.7
54.7 70.3
04.5
00.5
102.5
9c:J.2
TED ·
11
11
Name:
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
Permit Number: ~ q 600"/I PID Number: o/5'-~,'4 ~ - o c.
Address:
-
No. of Bedrooms:
Phone: ~H~ -- ~ ~'-/--~ ~/-
LEGAL DESCRIPTI'ON
Lot: Block: Subdivision:
Township:~. Range: -. Section: ~
WELL: ~Xls. r/~[]~New [] Upgrade
Classification (Privat,~.A,B,C): I Total Depth: J C.C.C.C.C.C.C.C.C.~.~(P'T"~-: "¢
~riller: /~Ddlled: I Slalic Water Level:
~i~'~: ~ I Pu~p set ~t: I casin9 Height Above Gte.nd:
~ ~"~ / Ft. I F~.
SEPARATION DISTANCES
TO Septic
Absorplion Lift Holding Public/Private
From Tank Field Station Tank Sewer Lines
Well' 1 o o~ +
Surface
Water )°~/'+
Lot ~
Line /-¢:g +__
Foundation ~)oI
CurtainDrain
Remarks: P~v~,¢r6A
Wastewater System: [] New ~ Upgrade
ABSORPTION FIELD
Deep Trench [] Shallow Trench [] Bed [] Mound [] Other
Soil Rating:
O · ~ GPD/Sq, Ft.
Depth to pipe botlom from original grade:
~ Ft.
Fill added above original grade:
-. ! lO O Ft.
Gravel width:
Ft.
Total absorption area:
"7'~O SQ. Ft.
Installer:
TANK
Total Depth from original grade:
Gravel depth beneath pipe
"'7 Ft
Gravel length:
5'4
Ft..~
Number of lines: Distance between lines:
I I ~" Ft~
Pipe material:
Date installed:
6iLSeptic [] Holding [] S,T,E,P.
Manufacturer: Capacity in gallons:
~ ~CI4oC. AG~ 'T'Ar4 t~- i"Z.6 o
Material: ~'~r'~ E.L. Number of C~,~partments:
LIFT STATION ~....---~'~ __
Size in gallons: Manufacturer: ~
"Pump on" level at: ..~PJJm~ fffffffff~level at: High
M'E~T'~'' Electrical Inspections performed by:
BENCH MARK
water alarm at:
Location and Description:
'1~6, t4 - 0o0~
Assumed Elevation:
I0o. o
EN( AL
_ .S&SF, NGINEERING , .., ,,, (~/z:~/'/~.
Inspections performed Dy. 17034 JEagie River Loop ,,aa .... =. ~es: 1st
Eagle River~ Alaska 99577 2nd ~;/z~/'~c
zrA -//~-/_____._~c__=_
Department of Healt~ and I'¢/u~pi Services approval
ROBERT C. COWAN
CE - 8801
. . ' l.."
PermH No.
SW960071 Page 2 of 2
Municipality of Anchorage
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
Legal Description: LOT .5, ORTH SUBDIVISION PIDNo.: 015-.542-06
WELL
NEW Z50
C TANK
10' UTIL. :SMT. NEW
SCALE 1" = 40'
ST1 ST2 FINAL
C(
C(
MT 1
.~Ol &
= 92.6'
72-013 A (Rev. 9/91) MOA 25
= 852
= 85.4'
NO
79.¢
,1.4'
JND WATER
B.O.H.
ROBERT C, COWAN
CE -8801
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
\
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW960071 DATE ISSUED: 5/09/96
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 5/09/97
OWNER NAME:EGAN GARY M & MARY
OWNER ADDRESS:5960 ORTH
ANCHORAGE, AK. 99516
PARCEh ID:01534206
LEGAL DESCRIPTION:
ORTH LT 3
LOrE SIZE: 50371 (SQ. FT.)
NUMBER OF BEDROOMS: 4 TI{IS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 WASTEWATEN DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343 4744 ( 2~ HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
ISSUED BY
DATE:
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
HEALTH AUTHORII~
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUDIES
AND REPOR'fS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
WAS'r EWATE R
DtSPOSAL SYSTEM
DESIGN
April 30, 1996
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 995:[9
REFERENCE: Lot 3, Orth Subdivision
Reques% you issue a permit to upgrade the septic system
serving the existing four bedroom house on the referenced
property. Also, request you issue a Conditional Health
Authority Approval, system to be upgraded by June ].6, 1996,
due to frost in ground and road load restrictions.
A test hole was excavated and percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
At the time of excavation water no was encountered. The
monitoring tube has been checked and found to be dry.
Attached is the proposed upgrade design.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
The proposed 1250 gallon septic tank is to be placed
outside the well protective radius. Attached is a site
plan which depicts the location of the proposed tank.
If you require additional information, please contact us.
Robert C. Cowan, P.E.
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
50'__! SITE PLAN I DESIGN
~ ~s~,,, 0 o~_~o
%~,='mm Z
.~Z
Z~Z-
P
\
--t~O
F~m-0
Zo
ZIZFq
100' WELL RADIUS
SCALE
o
% o
0
NP ac,-
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
COMMENTS
V ,'~,t '1'
mL
fi.
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT 0
DEPTH? p
E
SLOPE SITE PLAN
Water
/
Alter
/
"'L" ~/1 /¢/(~
Monitoring? ,u'/, 7 Dale:
I
Reading Date Gross Net Depth to Net
Time Tirne Water Drop
,//~v/q¢ / ',~,t _ L. '/~ ,, ...
I 'q(, '~ m~ 7" Y~'"
I '~Y '7'7~."
i'$'0 ~,,
i ~4'~ ~- %."
PERCOLATION RATE ~'/ -- tmmutesqnchl PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND c~ FT
' /.j?
17034 Eagle River Loop road No. 204
ACCORDANCE WlTBa~ ~iIE,/jI~i~SI~dJ~I~I~L GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 I_ Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LE(~AL DESCRIPTION
LOCATION
IWell ~ IAbsorption area Dwelling
DISTANCE TO: ~,/~_.. :L- I
DISTANCE T.gl.~-~ Dwelling
DISTANCE ~0 I Well Foundation
ND. of lines~ I Length of each li~ Total length ofline~7~ ] Trench
Top of tile to finish grade
Length
Material beneath tile
Width
Depth
PHONE . [ E~NEW
NO, OFBEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
J.,i~ui'E~apacity in gallons
PERMIT NO,
Distance between
~otal effective absomtion area~
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line [PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank I AUsorptio~aree{s)
OTHER
PIPE MATERIALS
SO,L
INSTALLER/'} .'~
REMARKS
APPROVED
LEGAL
DATE
F:I P F:' L :[ C F:I r.] T
L 0 L- I'::I T' ~ 0 r.,I
L,.EEiFiI_.
G FIF.:"r' EI3FIN
LOT :3: CIRTH SUBDT.',/I'~ION
E:,EF:'FIRTi',IEr.~T OF HE'FILTPI FINE:, EN'v'IRONP1ENTRL F'POTE-~C:T]:ON
825 ." L 5 T R E E'I"., R N C H O F.: FI O E., FI K. 99 L
F'O E:O::':: ;209::J. 99510
TYPE OF 2'i0]:L FIE:SnFE:PTION '=-;'T':E;TEr,1 IE;. ]F~E:N_.I.~'
I_ E 'r :5 ]: 2:E
;;:.'3.000 '.":;QURF..'E FEET
I'"IF:IX,[MUM N.t'"tFEF~ OF' EEE:,F:'OOM':=; :-" 3:
~gOIL B.H f IN ~ F 1 ,. E,I~.. -.- '150
: ":- '"' '' Z
'T'HE RE:L--.!IJ]:F.:ED SIZE OF THE: Si:ilL I IE,_,UF..FTIUN $'¢E;TEM :
THE LENGTH DIHEN'.E, ION IS THE LENGTH '::IN FEET::' OF 'n4E TRENCH OR F-."RRINFIEL[).
THE DEPTH OF FI TRENCH OR PIT IE; 1'HE PI'=STRr4cE BET!.4E:EN THEE :BURFFICE OF THE
GF.:OUI'.4D I=IND THE; 8OTTCd',I OF THE EXCR',,,'FIT:(ON (IN FEET).
'THERE .'[:-3 NO E~,ET 14]:DI"H FOR TRENCHEE;.
THE GRR',,¢E% E:,EF'TH ~.S THE H.~N'm'i"ILIH DEF'TH OF GF.:RVEL E,'ETHEEN THEE OUTFF:IL.L PIF'E
FIND THE BoT'r'or,'l OF' THE EXCR'v'RTTON (~.4 FEET).
F::'E.."I:;;~I','! ]; I" .JFFLIL. HNT FIRE; THE F.I::,FLNzIE, TL.[ F~ 'l"lr3 INFORM THIE; DE:F'RRTMENT E:'IJF.:IN6 THE
J~N:':';TFIL. LFITZON --TNL='PECTTON'=q OF RN¥ klE'LLS FID..'rRE:ENT TO TI...I]:E; F'P3PF._'F.~T'¢ FIND ~r'HE
NLrlBEI, r/F." .F.'.E'_:;.EE:,ENL':EE; THFIT TFIE klEL. L NILL SERVE.
MINti',ILIM DI.S'TFINCE E:E"F!4EE:N R klELL FINO FtN'.r' ON-.LSlITE E;EHRGE [:,IE;F'O':"~iFIL S'¢SI"EI"I IS;
::LO0 F'EET FOF..: FI F'F.'.I'v'RTE HELL OF.'. :l.50 TO 200 FEET FROM R F'LIE:/.:[C 14ELL E."EPENDINEi
uPor.,I "FHE TYPE OF F'UDLIC HELl_.
t'"tl'I",IZhlUH DIL=;T'FtNCE F'FRm:fl'4 FI F'R]:'v'R'r'E NELL. TO FI PF.:I'v'FiTE :SEI.4ER LZNE ]:2; 25 FEET RI'.,ID
TO R COMMUNZT? ZE[,.IER LINE I9 ;'5 FEET.
OTHER REC..:!UIF.'.EHENT:i~; I','lR't' RF'F'L'¢. E;F'ECIFICRTION':":; RND C:ONSTF.:UCTION DIRGRRI"IS RF.tE
FI',,¢R Z LRBI.~E..' 1"O Z.r.~E;UF..'E PF.:OF.'ER ]: NSTRLLFIT I ON.
I CERTIF'Y THRT
:1.: :[ I=ff'l F=F%IZLIFIR 1.4~TH THE REQUIF.'.Ei"IENT'=; FOR. or.4-'...!;ZTE E;E.t4EF.% Rr,tD klELLS l:r~S;, SET
F:'OF;:TFI E:'T' 'THE HUN:[CIF'FIL. IT¥ OF RNE:HORFIGE.
2: ]; HILL. IN£'iTRLL. THE L=,YE;TEr,'I :IN RCE:OF.:E:,Rr.&-:E klITH THE CODES;.
3:: I UhtDER[-:.,T'FINE:, THRT THE ON..~.E;ZTE ':E;EHEF...' ':?,'T'STEM I"1R'¢ REQUZF.:E ENLFIF...'GEHEI'.,IT :IF THE
F.'.E.'.:51' E:,ENE:Ei :[ L=; F.:EHODELE[> T'O I NCLIJE:,E i"IORE THRN 3. E:EE:,F.'.OOMS.
E; ]: GNED: ...........................................................................
FIF:'F'L. I cRr-,IT GFtF.'.'T' EI3F;N
[:,EF'RRTHENT ~F' HERLI'I-! Fir-;[:, F.]t-~'¢IF:E~HP1F. HTF~ ::'R.FT£':'FI']ff'~ ~
~... 264-4 7'20
'~"' I .~~~- C~ ~'-4 -- :~!: 11 'T- E£ :?~; EE !..1 E ~':~: F~ E: f~ I"1 ~ -[
HFt;;.::Ir'ILIP1 f. ILU'IDER OF E:EDR:L-,]HL~; = ~_'~
'.'5OI1_ R;':IT!H] (%1;~ F'T,?E:f;:::,= / ~- (.)
E:' E F:' T' F! .... ¢
THE LENGTH £:'I HENSI F'_lf,~ I S THE LENG.TH < II',l FEE'T) OF' 'tHE TREI.~C:H OP [',RFtI NF: IELD.
THE C, EPTH OF R TRENCH OR PIT IS THE D~"STIat-IC'E E'.E:THEEN THE SURFRE:E OF THE
G~:I]UI.ICI Rt4C, THE BOTTOf'I OF THE E>::C:flVRTION (IN FEET).
TtiERE IS NO SET HIDI'H FOR TFtENCtiES
'rile GF:R',z'EL DEF'TH IS THE H INIHLIP1 [>EPTH OF OR~VEL BE'T'i,IEEH THE I]UTFRLI_ PIPE
~HD THE E:OTTOH OF THE EXCFFv'AT~OH (IN FEEl').
PE:RPIIT F/PF'LICRNT HAS THE RESPO~tSIE:ILIT'¢ TO INFOF<H FI.tIS DEF'Fff?TP1EHT DLIrtIr4Ci THE
IU::qTFtLLI:/TIOfi 1NSF'E':TIOH% F_iF RNY NEiLLS RC, JI~CEHT TO 'THI% PI~;EPERTY RHD ~T'HE
NUP1E:ER OF RESIDEH_.E_-, THRT THE HELL HILL _~EF:k'E
EFflZ:KFILLING I.'IF FIHY
[:,EF'FiRI'PIEHT l,lI LL BE SLIE:..IECT ]'O F'RO'-]EIZ:LITI ON.
HINIMUH DIS'¥RHCE E:ETHEEH
j.¢IE~ FEET FOF.' R F'R'.IVFtTE l,lEl...l._. OR ±5~!~ TO 2E~O FEET FROP1 Ft PUE',LIC I.IF.'LI_ [:,EF'EH[:,IrlG
UPON THE TYF'E
r.lI H I I'ILIH [:, I S TFIf. II]E
TO R COt'IHI_IHIT'Y SEldER LINE IF 75 FEET.
HELL LOGS APE REQUIRED RHD HUST BE PS:-TURt-IE[:, TO TIYE £:,EF'¢~R'FHEHT HITHIH 3:0 DFIYS
OF THE I,.IEI_I_ C:OHF'LET !
OTHEF: /-:EQI.I I F:EP1ENTS
R',,,'RILRBI_E TO ir. lSl_lf;% F'ROF'ER Ir. ISTRt_LF~TIOH.
l' C_:E~;:]- ! F'T' 1-1iFIT
!: I Ri',I FF~;'IILIF1F: I,.IZTH 'FHE REC!UIF;::EHEi'.i'fL:, FI]F.: OH.-SII'E ':-],EHER!~: FINE:, HEt..I..S Fr.5 5ET
Fi]F:TH E:"¢ TH[~: 1,11]N I C I F'Fi[. ! TY OF'
2: I NIL_L IHSTF~LL TIlE S'¢S-FEH If..I Ftl]:I]O~:C:,Ftht.C..E I,IITFI THE CO[:,E$.
3:: I urlC, EF:'.:_;TRN[:, THFFF THE: ON--SITE SEI.IER '.:;'¢STEI'I HFtY REQI]II;:E EHLARGEHEtI'f'
F:E'_:iI[:,ENE:E I':7, REMODELED Tm_-] I IIC:LLIDE HORE THRH 3 E:EDRL]OPI'S
F ' ff- v
THE
,/~% GREI
R ANCltORAGE AREA BOR'
Department of Environmental Quality
3330 C Street
Anchorage, Alaska ggs03
3H
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING A D D R E S S ~?(~/,/~flj' 'F~_(,.)E~*/ /~//'F~/~ PHONE
LEGAL DESCRIPTION__//.)/?'
SEPTIC TANK:
DISTANCE
FROM WE L L/~/~//
INSIDE LENGTH
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPAClTY_/~/~) GALLONS.
TILE DRAIN FIELD:
~ ~'~/,~, / ., TOTAL LENG-FH
DISTANCE FROM WELL FOUNDATION__ /~',-/-._N[AREST LOT LINEJ~'~¢i~'- OF LINES ~"'"~ j
NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH~IN. TOTAL EFFECTIVE
ABSORPTION AREA /4~ E SQ. FT. LENGTH OF EACH LINE 6'2'~"~,
DEPTH: TOP OF TILE TO FINISH GRADE /'~ ] DEPTH OF FILTER ! ~/
MATERIAl_ BENEATH TILE ~'~ ~1. ABOVE TILE . IN.
WELL:
TYPE__ J~ J~ _____CONSTRUCTION
BUILDING NEAREST
FOUNDATION ___, LOF LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVE[) ....
__ DEPTH
NEAREST SEPTIC SEEPAGE
SEWER LINE , TANK ___ SYSTEM
REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY:'
SEWER LINE DEPTH:
PIPE MATERIAL: '~,'¢/~/
j,,,,~. ~/]
'/D/Cz'x-' ~;~./¢,¢ ~,~/~,,,-~. .
LOT SLOPE:
REMARKS:
Form EQ-032
DIAGRAM OF SYSTEM
GR[., ER ANCHORAGE AREA ~0, UGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 $mclI STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4§61
SEWAGE DISPOSAL SYSTEM -- APPLICATION ANID PERMIT
,NSTALLAT,ON LOCAT,ON
LEGAL DESOR,PT,ON 7' 3
iNSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
TO BE INSTALLED
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TES~r
FINAL INSPECTION: 24 HOUr NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE
DEPARTMENT OF ENVIRONMI.'NTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
FOUNDATION TO SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALl
DRAIN FIELD ~ '~J¢% .~
WATER MAIN TO SEPT T ¢
i DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
.. SEEPAGE PIT
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S Feet INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST rRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL Z~
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
DI OF
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIB. j~ SYSTEM IS IN ACCORDANCE WITH SAID CODE. -~
DATE . ~ ~4~- APPLICANT'S SIGNATURE ~. )~ ~.~_._~..,~.~
CONSULTANTS, INC. JUNEAU
August 7, 1975
R & M No. 562086
Gary Egan
P. O. Box 2091
Anchorage, Alaska
99510
RE: Test Hole and Soil Log Report for Sanitary System
Lot 30rth Subdivision
Dear Mr. Egan:
We are submitting herewith the test boring results and our comments regard-
lng soil conditions encountered at the subject site. This investigation
was performed in accordance with your request of August 6, 1975, and those
procedures outlined in a letter dated July 15~ 1975, by Mr~ Rolf Strickland
of the Greater Anchorage Area Borough Department of Environmental Quality.
A single test hole was put down within the Lot 3 area for the purpose of
defining general subsurface soil conditions for the proposed sanitary sys-
tem. Excavation was accomplished and the test hole was extended to a total
depth of 14.0 feet below ground surface. The final log prepared for the
test hole has been included in Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given 'this opportunity to be of service to you. Should
you have any questions with regard to the above, please do not hesitate to
contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James W. Rooney ~ /
Vice President
~'[R/ja
xc: GAAB
T.H. -1
8-7-75
ORGANICS
SILTY SAND
TPeACE OF GRAVEL
SA~FD
TP~XCE OF SILT
Fine Grain (SP)
NO WATER TABLE
0.0~
0.5'
4.0I
14.0'
Log represents
Lot 30rth Subdivision
Consulfants Inc.
ANCHORAGE FAIRBANKS
ALASKA CUNE~U
GARY EGAN PROPERTY
Log of Test Hole
Anchorage, Alaska
rv1-w DRILl.lNG, Inc.
P.O, Box4-1224 · 1310C International Airport Road
(907) 274-461 ]
ANCHORAGE, ALASKA 99509
Well Owner
DRILLING LOG
Use of Well
Location (address of: Township, Range, Section, if known; or distance main road
Size of casing. ~ .Depth of Hole ' ? feet Cased to : '- feet
Static water level ?'r: ft. (aboVE) (below) land surface. Finish of well (check one) open end (
Screen ( ); Perforated ( ).
Describe screen or perforation ~ ·
Well pumping test at_:!~' gallons per (-hbu'r) (minute) for.
of drawdown from static level.
.hours with
Date of completion
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
);
ft.
TO_
.TO
.TO.
____TO
_TO.
_TO
_TO
____TO
TO
TO
TO
TO
TO ;'-
TO. r
2 -- STATE
•
•
VC Q`
• Municipality of Anchorage
On-Site Water and Wastewater Program midi
(907) 343-7904 SAF (TV
Certificate of On-Site Systems Approval r ?
Parcel I.D. 015-342-06 Expiration Date: ( 1 -
1. GENERAL INFORMATION
Complete legal description ORTH LOT 3
Location (site address) 5960 ORTH CIRCLE
Current Property owner(s) Sandra Allen Day phone
Mailing address 5960 ORTH CIRCLE ANCHORAGE, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
• Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
c i
Received by: \ .1),101/4. Date: sii
COSA to be released to the engineer,unless otherwise requeste. by the-ngineer. v`
COSA Fee $ ( Waiver Fee $
Date of Payment to 'VI ��D Date of Payment
Receipt Number Olo12-2-61_ Receipt Number
COSA# 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 6/14/2018
"OF A t
k%
6. DSD SIGNATURE oi011 • •••''---
System#1 Approved for ...S bedrooms / Steven R. 'annorie
! s CE-8149 •
System#2 Approved for bedrooms �� 9s . . �r
Disapproved kl�DfNOFE5S4P
Conditional approval for bedrooms, with the following stipulations:
;* [ c�S S c 4-etv4Ci S Z.Z 4 Pa.v S 01->
AWAGLfe -3916e ,t)Gc{,i/'c L.b
ith thePROGRAM
o
WATAND rr
•
WASTEWAT
c`
G�
By: r Original Certificate Date: ZS l J —I
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 X Nitrate Advisory. ,
Septic System Advisory Arsenic Advisory.
Well Flow Advisory Other .
COSA blue sheet t" '- c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: ORTH LOT 3 Parcel ID:015-342-06
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 11/12/75 Sanitary seal (Y/N) Y Wires properly protected (Y/N) y
Total depth 90 ft. Cased to 90 ft. Casing height(above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 11/17/75 5/29/2018
Static water level 70 ft. 70.8 ft.
Well production 10 g.p.m. 4.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 4'50 mg/L
Arsenic ND ug/L Date of sample: 5/29/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 6/25/96
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping 10/12/2017 Pumper NORTHLAND PUMPING
C. ABSORPTION FIELD DATA
Date installed 6/25/96 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type TRENCH
Length 54 Width 3 ft. Gravel below pipe 7.0 ft.
Total depth I ft. Eff. absorption area 750 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 5/29/2018Results(Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 37.5/38 in. Water added 450 gal. New depth 58/58 in.
Elapsed Time: 300 • min. Final fluid depth 37.5/38 in. Absorption rate >= 450 g p d
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas N/A
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 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
SURVEY ON FILE
. its 44' o. CDVvu
G. ENGINEER'S CERTIFICATION ,�f. yv ,AA lk#
I certify that I have determined through field inspections and /0�p�v ' s,�
review of Municipal records that the above systems are in Ø* • 4 • • I\ *7
conformance with MOA COSA guidelines in effect on this date. d•••• fa, .A • ••••
Engineer's Printed Name Steven Pannone i•••Haven tt. onnone• j
Date
6/14/2018 h��lg�•• CE-8149 a ��
r
41kk���S��``..
COSA canary sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT j • ! i 907-343-7904
On-Site Water and Wastewater Section , ` / Fax: 343-7997
www.muni.org/onsite _--�
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC181274
Subdivision: ORTH, Lot: 3
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 22 years old. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
4,, r'°'C .:i:-tea ..J.1 .:.
$ H., AVI
� N.
tZr
P^ '
f 31p � `
Hr �
4A, .'iiyI
AIS
{'
j 'RYI
Mailing Address: P. O. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org
8475C
Lot 40 �0� " //��
°
°
04 359
0 0) e M
•
°?h ° c
II i/fSeptic vent(typ) E
zi.) ---1 p?; Ce
•
Uv(9 w
SCALE: 1"= 50' / Q— ,��, m� 4 o o
OOH' a °°� ° '40..'�� � - - -
h<0•h0; CO
uoa�..,.°.p ' , a15j+ Mzyz—l'ssZ'
�
/ �/<44,/Oj 1 N 7
, \ •
/ Lot 3 °
7.`")(5` Shed O 0
0
70
/ 7
z
/ / Lot2 kDO
1 —Le —
ci
'On
AS-BUILT NO CORNERS SET THIS DATE .+N`It,‘` 1
I hereby certify that I have performed a Mortgagee's inspection A PX. . •OF •/6i 11 J
of the following described property: LOT 3, ...4,•
o
ORTH SUBDIVISION �• 49th is • •9 �/
%
Anchorage Recording Precinct,Alaska,and that the • •� .
••
improvements situated thereon are within the property lines .. . ,``� /,•�{
and do not overlap or encroach on the property lying r lizabeth L. Walatka: ' AO
adjacent thereto,that no improvements on the property lying / % • •
adjacent thereto encroach on the premises in question and ,`s,z,••• 8036 — LS ••ye- �,
that there are no roadways,transmission lines or other f •
o • , , , . • •�o
visible easements on said property except as indicated 4 �or'ssioov
hereon. ' ]%%"�%�
Dated at Anchorage,Alaska •-7.-Zi ,,b
this 14th day of JULY ,2018. EASEMENTS OF RECORD,OTHER THAN
FRED WALATKA&ASSOCIATES,L.L.C. THOSE SHOWN ON THE RECORDED
Engineers and Surveyors FB 18-4, pg 32&40 PLAT ARE NOT SHOWN HEREON
907-248-1666 BE UNLESS OTHERWISE NOTED.
I
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, A~aska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
015-54-2-06 HAA #
1. GENERAL INFORMATION
Complete legal description 0RTH SUBDIVISION: LOT 3
Location (site address or directions) 5960 ORTH CIRCLE. ANCHORAGE. AK 99516
Property ownerPHILLIP AND PHLETA CALANDRA c/o BONNIE MEHNERDay phone (907) 56.3-5500
Mailing address JACK WHITE, 5201 "C' STREET. ANCHORAGE, AK 99505, ATI'N: BONNIE MEHNER
Lending agency Day Phone
Mailing address
Agent BONNIE MEHNER w./ JACK WHITE Day phone (907) 563-5500
Address .~201 "c" STREET. ANCHORAGE. AK 99503
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE: If community weft system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding Tank
Community on-site
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
lng to the legality and status of system.
72-025 (Rev. 1191 ) Front MOA &e21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1200. O0 at,
or prior to, closing for the engineering services provided.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I further verify that based on the information obtained from the Municipality of
Anchorage files and from my investigation and insp. e~ction, the on-site water supply and/or wastewater
disposal system is in campliance with all Municip, ac~,~t~d State codas, ordinances, and regulations in effect
on the date of this inspection.~ 7 //~/ t
Name of Firm ALASKAW'ATER~.~ /~ST'EWATER CONSULTANTS, INC. Phone (907) 337-6179
Address 6901 DEBARR(ROAD, ~' !,~B,/~'/~NOHJDRAGE, ALASKA 99504 ,
In . , ~ ~ ~ .. i /
conducting th,a evaluation, AWWC, /nc//at~n ted to prov~cle a thorough, conscientious engineering analysis of the
system in accordance with ADEC and M~A ~)H ~ Guidelines & Regulations. The reported results described the
performance of the system under the condition~ ,ncountered at the time of the test, and separation distances
measured to readily identifiable features. The e ~erational life of afl wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system. These conditions are outside the control of ,=~
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
~ Approved for ,~ bedrooms
Disapproved
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: (¢.~-~,~¢'.---,,--~ Cd/, ~o-,._~ Date ~- ~.2. o - c:) o
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of
DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21 Computer Version
ECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES JUN 1 6 ~0~nn'~'
Environmental Services Division /viUNICIP^LIT¥
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4)'I4~',IMENTAL sEI~vIC~J~
Legal Description:
A. WELL DATA
Well Type PRIVATE
Log present (Y/N)
Total depth 90'
Sanitary seal (Y/N)
Health Authority Approval CheckliSt
ORTH SUBDIVISION; LOT 5 Parcel I.D.:
Ifa, B, or C, attach ADEC letter. ADEC water system number
YES Date completed 11/12/75
Date of test
Static water level 70'
Well production 10
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 6/8/2000
B, SEPTIC/HOLDING TANK DATA
Date installed 6/25/96 Tank size
Foundation cleanout (Y/N)
Date of Pumping 5/5/2000
C, ABSORPTION FIELD DATA
Date installed 6/25/96
Length 54' Width
Effective absorption area 750
Cased to 90'
YES
FROM WELL LOG
11/17/75
015-342-06
N/A
Casing height (above ground) 24"
Wires properly protected (Y/N) YES
AT INSPECTION
5/5/2000
72'
g.p.m. 5.6 g.p.m.
Nitrate 2.79 mg/L Other bacteria
Collected by: A.W.W.C., INC.
125O
YES Depression (Y/N) NO
Pumper McDONALD'S PUMPING
[MT1/MT2]
Soil rating (g,p,d./ft2 or ft2/bdrm)
Number of Compartments
5/19/2000 Results (Pass/Fail) PASS For
Date of adequacy test
Fluid depth in absorption field before test (in.);
Fluid depth 75.75"/79" (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/9S) ComputerVersion
2 Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
J*20 GALLONS/INCHI
0.8.System type TRENCH
3' Gravel thickness below pipe 7 Total depth 15'
Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
3 Bedrooms
39"/42" Immediately after 899 gal. water added (in.):'83.25"/87''
285 Absorption rate = 450+
NONE KNOWN If yes, give date
D. LIFT STATION ~
Date installed_ Size
Manhole/Access (Y/N)~* "Pump o~" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot.
Absorption field on lot
Public sewer main
Sewer/septic service line
100% On adjacent lots 10o'+
100% On adjacent lots 100'+
N/A Public sewer manhole/cleanout N/A
25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10'+ Surface water/drainage 100%
Absorption field
Wells on adjacent lots
5'+
100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line_
lO'+
Building foundation 10'+ Water main/service line
Surface water
100'+
Curtain drain
NONE KNOWN
F. ENGINEER'S CE~.,~I
I certify that I ~)~ve d~
of Municipal ~ecordsli
with MOA H~A guid~
Signature I,._.~ ~' ,~
Engineer's Name// J
Date
~e/a~ove
dFFFRr~ ^. G^RNFSS
inspections and review
terns are in conformance
s date.
10'+
Driveway, parking/vehicle storage area 10%
Wells on adjacent Iots~
.....
HAA Fee $ ,~ ~ ' '~
Date of Payment /~//~//~'7.~
Receipt Number (~ (~ Z.G ('
72-026 (Rev. 3/96)* Computer Version
Waiver Fee $
Date of Payment
Receipt Number
ALASKA WATER & WASTEWATER
May8,2000
Phillip and Phleta. Calandra
5960 Orth Circle
Anchorage, Alaska 99516
Ref: Well and Septic System at 5960 Orth Circle. Orth S/D, Lot 3
Dear Mr. & Mrs: Calandra:
Per your request we inspected/tested the well & septic system which serve the subject property.
Our findings are summarized as follows:
WELL: On the day of our inspection (5/5/00) the static water level was 72 feet below the top of
the casing (BTC). Water was pumped fi:om the well at an average rate of 5.63 gallons per minute
for 120 minutes. During the initial minutes of pumping, the water level dropped 4 feet in the
casing and rema'med at that level throughout the rest of the test. Based npon this data it was
determined that the well production exceeds the MOA requirements for a 4 bedroom house (600
gallons per day).
SEPTIC SYSTEM: Per MOA records, the existing septic systems consists of a 1250 gallon steel
septic tank, and a trench type dra'mfield that were both installed in June of 1996. On the day of
our inspection (5/5/00), the liquid level in the dra'mfield was 13 inches below the invert of the
drainpipe, indicating that it was approximately 85% full. The test was started at 2:00 PM on
5/5/00. Over a period of 68 minutes, 392 gallons was introduced, which brought the liquid level
to the top of the drainpipe lateral. Over the next 715 hours (until 10:30 PM on 5/5/00) an
additional 223 gallons were introduced (615 gallons total). At the end of the filling period the
water level in the draintield was about 1.5 inches above the top of the drainpipe lateral (slightly
surcharged), indicating a total rise of 18.5 inches. The level was checked 8.25 hours later (6:45
AM on 5/6/00, Saturday) and it had only dropped 5.5 inches (at the drainpipe lateral). Based
upon this data it was determined that the drainfield does not meet the absorption requirements
established by the Municipality of Anchorage for a 4 (four) bedroom house.
It may be possible that the septic system has been hydraulically overloaded due to plumbing leaks
inside the residence. If so, it may be possible to repair the leaks, allow the system to recover for
several days, and run another test. In short, please check for plumbing leaks before we proceed
with any of the proposed alternatives.
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc, com
The options available at this time are to either attempt to rejuvenate the system or perform an
upgrade. The cost to rejuvenate a system will vary from $1500.00 to $2500.00, depending upon
whether it is chemically treated or Terralifted. The adequacy test could not be performed until 30
days after testing, which would be $500.00 (which includes pumping of the tank). As you can
see, the total cost to rejuvenate and test will be from $2000.00 to $3000.00, with no guarantee of
success.
Another option would be to attempt to find the old septic system, which should be completely
rejuvenated at this time, and run aaa adeqnacy test on it. If it passes (which is highly probable)
then it would be necessary to either install a lift station or raise the septic tank so that flow could
be diverted to it. Please contact us directly for more specific information regarding this option
(which is probably the best course of action).
If you opt to install a new septic system, the engineering costs associated with the upgrade are
summarized as follows:
Charges to date for records research, inspection of septic system, well test, and pumping of
the septic tank: $700.00~
Excavator to dig one test holes: Typically $350.00 for the first hole and $125.00 for each
hole thereafter. Only one test hole is anticipated.
Percolation test: $400.00 for one perc test, & $200.00 for each additional pert test (only one
percolation test is anticipated) ~
Engineering services to design the septic system: $500.00. This is based on a conventional
gravity flow septic system with no waivers to surface waters, or nearby wells.
M.O.A. sewer upgrade permit: $320.00. Payable to the M.O.A?
Engineering services to inspect the installation of the septic system and prepare asbuilt
drawings. Assuming a conventional gravity flow septic system with a single trench or bed
without a sand filter: $450]00
If an innovative septic system is required, such as an Intermittent Sand Filter (ISF), a
BioCyele, or a Recireulating Upflow Filter (RUF), the design and inspection costs will be
$950.00 higher. An im~ovative septic system is not anticipated.
The items marked with an asterisk must be paid prior to submitting the design package to
the Municipality of Anchorage.
The cost for the excavator to perform the installation is unknown at this time. ARer the soils
testing and design is completed you should obtain bids/~om several reputable contractors. We
can provide you a list of recommended contractors. After the upgrade is performed, we will
need to do the following:
Apply for a Municipal Health Authority Approval (HAA). The Municipality charges $300.00
to process the HAA.
Water sampling and analysis: $100.00
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc, com
If you have any questions, please contact us at 337-6179. We look forward to assisting you with
your engineering needs and will do our best to provide a cost effective solution.
Jeffi:ey A~ .S.
Presidenl
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
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
1. GENERAL INFORMATION
Complete legal description
Lot 3; O:?th Subdivision
Location (site address or directions)
5960 Orth Circle
Property owner Gar'.[ & Jill ~cjan Day phone
Mailing address P.o. Box 2091 Anchorage, AK 99510
Lending agency G?%~C Mortgage Mina C~ell Day phone
Mailing address__ 460 ~.TEst Tudor Road Anchoraae, AK
562-21 ,°,l
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
JUL 12 1996
RECEIVED
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 (Roy. 1/91) Front MOA ~121
-5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system issafe, 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
Engineer's signature
S & S ENGINEERING
17034 Eagle River Loop Road No, 204
Eaale Rive~.~Al~s~a 9957~'
Phone
Date
PLEASD RELEASE THE CONDITIONAL HEALTH AUTHORITY APPROVAL. A_~. ~_~.~.'~"~,
PER M.O.A PERMIT ~SW 960071 HAS BEEN COMPLETED. ::/¢~'~'" ~'"~',~.?~O1~~
6. DHHS SIGNATURE 'i~ ~0~C::~,3~.',t-'-~
,or edroo s.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA
Legal Description: LOT
MUNiC PALITy OF A ~
I.:NVIRO /'/CH
Municipality of Anchorage ~EmALSERViCE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division EUL 72 7996
825 L Street, Room 502 · AnchOrage, Alaska 99501 · (907) 3A3-4744
Health Authority Approval Checklist ~ cE/VED
OA'~H ~/~ ParcelI.D.: OI ~-- }y~-o ~
A. WELL DATA
Well type DA
Log present
Total depth
Sanitary seal
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Il / I '/ [ 7 ~-
Cased to q 0 Casing height (above ground)
Wires properly protected G/N) "/¢ J'
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FROM WELL LOG AT INSPECTION
/
'70
/ o g.p.m. ,(~.'7 4
g.p.m.
Coliform (2 Nitrate
Date of sample: ~/~ Y'/~ (,
ri.~'~.._~T~HOLDING TANK DATA
Date installed (o /~,J;'/~C Tanksize
Collected by:
Number of Com ~artments
Other bacteria
$ & S ENGINEERING
J7034 Eagle River Loop Road No, 204
Eagle River, Alaska 99577
2_ Cleanouts
Foundation cleanout (~f/N)
Date of Pun~ping ~'A
C. ABSORPTION FIELD DATA
Date inStalled G/~ 5'/~ (,
/
Length ~ E Width
Effective absorption area
Ye- ~ Depression (Y/f~ ,,'¢ 0 High water alarm (Y/~i). /,-, o
r~ ~ ~,~, Pumper ~
Soil rating ~or fF/bdrm) ¢' ~
Gravel thickness below p~pe '7
Monitoring Tube present ~N).''/'~ -~ Depression over field (Y/,.~ ~ ~
System type ':~4
Total depth
Date of adequacy test t,,,/// - ,,v E ~ Results (Pass/Fail) For ..~------'5~drooms
Fluid depth in absorption field before test (in.);
Immed_~ gal. water added (in.):
~/ Absorption rate =
Fluid depth (ins) Minutes later:.._--, g.p.d.
(Y/N) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/AcCess
High water alarm level at*
Cycles tes~
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level a_~.~..E...--~~
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
~olding tank on lot ! 0
ABsorption fielO on lot ! o
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
/ oo
Sewer/septic service line ~ $' / ''¢- Lift station
SEPARATION DISTANCES FROM~--1E ,P~HOLDING TANK ON LOT TO:
Foundation a't o Property line 6' ,~" ~ Absorption field
Water main/service line ~ -~- -W Surface water/drainage ,/oo + Wells on adjacent lots
' Property line
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
;~ ~' Building foundation $~5- -~ Water main/service line
I o O -/- Driveway, parking/vehicle storage area
,v0,,, ~ ~,,., o ,., ,¢ Wells on adjacent lots / o o -,'/
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
in conformance withM~A..HAA.q~idelines.in effect on this date.
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # Ol ~"- 3'~'D -- C,L- HAA#
1, GENERAL INFORMATION
Complete legal description Lot 3; 0rth Subdivision
Location (site address or directions)
Property/'owner
Mailing address
5960 Orth Circle
Anchorage, AK
Gary & Jill Egan
P.0. Box 2091 Anchorage, AK
__Day phone 346~2332
99510
Lending agency
Mailing address
Day phone
Agent
Address
Marilyn Moor~/ R~ma~ Properties
Anchoraqe~
2600 Cordova St. Suite 100
Unless otherwise requested, HAA will be held for pickup,
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
Day phone 276-2761
AK 99503
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:
X×X
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Address Eagle R, iv..6r, Ala.~i~a ~5~7
Engineer's signature /'~ ',~/f~/~c~.
Phone
Date
REQUEST A CONDITIONAL HEALTH AUTHORITY APPROVAL DUE TO
FROST IN THE GROUND. SYSTEM TO BE UPGRADED NO LATER
THAN 16, JUNE 1996
6, DHHS SIGNATURE
Approved for I--¢..'{.~.F~?/bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Escrow monies to ~erform all work necessary to upgrade the
septic system per On-site Wastewater Permit #SW960071.
Monies to remain in escrow until final approval is granted
from this Department.
Additional Comments All work must be completed on or before
June 15 1996.
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certifio~tes based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72~)25 (Rev. 1t91) Back MOA ~21
Legal Description: L 0 7--
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SEP, VICI~ E C ElY E D
Environmental Services Division
825"L." Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
MAY 2 1996
Health Authority Approval Checklist
0 gq Tt¢ 5'[/,9 Parcel I.D.:
Municipality eT Arlcnorage
Dept, Health & Human Services
0/5-
A. WELL DATA
Well type {9/q ! ¥,4, 7',f_ If A. B, or C, attach ADEC letter. ADEC water system number
Log present ~N) '7/2 5 Date completed ///) '7
! /
Total depth ~ 0 Cased to c3 O Casing height (above ground)
Sanitary seal
Wires properly protected (~/N) ¥ g 3'
FROM WELL LOG Al' INSPECTION
Date of test
Static water level "70 / '~ ~ /
Well production / 0 g.p.m.
WATER S~LE ~SULTS:
g:p.m.
Coliform © Nitrate ~), ;)_ O] Other bacteria 0
Date of sample: 14 / t ~' / g'~ Collected by: S & S ENGINEERING
' ~4 Ea[l~ver Loop Road No. 2U4
;~agle River, Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Date installed ~'{/a I/.75-. Tattk size / O 00
~omid~rt i,o n ~ban;~t 'ON)
t ~tb oUffiJ!nptng . Puml)er
¢. ':'~BgOR~ION' FmLD DATA
L~ii~th ~ ~ ' L'~ Width
Number of Compartments / Cleanouts ~'N) P~J
Depression (Y/~ /-' o
High water alarm (Y~ ,w O
Soil rating (g.p.d./fl- or t~dr.d~
3
/ ,5-0 System type T
Gravel thickness below pq}e ~ Total depth
Monitoring Tube present(~qN) Y'/J Depression Over field (Y~
Effeciivei~bsorptim~ area
Date of adequacy test "/
Fluid del)th in absorption field before test (in.): __
Fluid depth (ins.) Minutes laler:
Peroxide treatment (p~LLC-amlffI~s) (Y/N)
Results (Pass/Fail). FA~, For ~ bedrooms
3/'r?',~,44 7-4.0 -- ,,~ o ')-rg ~ 'T-
hnmediately after gal. water adde~_(~!L): ~
~iou rate = g.p.d.
If yes, give date
D. LIFT STATION
Date installed Size ~
Manhole/Access (Y/N) "Pm~* '~Pump ofF' level at*
High water alarm level at* ~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tamk on lot 7 o ,'J r~. ,R 4_ ?t.&o¢/9 ; Ou adjacent lots
Abso~tion field ou lot r~ 3 ~ R~n~O : On adjacent lots
Public sewer main N / & Public sewer manhole/cleauout
Sewer/septic se~,ice line ~0 ) + Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 7- 0 /3 .q.. ,'~ q.-~/--~- c-~20
Building foundation Properly. line Absorption fiel~~-"
Water main/service line Surface water/drainage ~---"'~ells on adjacent lots
SEPARATION DISTANCE FROM ABSOR~ON LOT TO:
Building foundation ~ Water maiWservice line
Surface water ~ Driveway, parking/vehicle storage area
Cu~~ Wells on adjacent lots Property. line
F. ENGINEER'S CERTIFICATION
m conJbrmance wit0 3/ff~Aj-[/~ guidelRws m effect on this date.
Signature ~~ ~~
.....................................................................................
...............................
HAAFee $ ~ ~ Waiver FeeS
Date of Payment ~/~y~ Date of Paymeut
Rev. 8/95 OSS: haa.wk.doc
CT&E Environmental Services Inc.
Laboratory Division r.a~i~er,~'~m~ea~r,~',~-,~m~.~',~r~r
Laboratory Analysis Report
CT&E Ref./~
Client Sample 1I)
Matrix
0
961316.10617
LOT 3 OF, TH S/DE I316-01
Drip,dug Water
Collected Date 04/15/96
Technical Director
Sample Remarks:
2.29
Oua[
Units Method AlLowabLe Prep AnaLysis Inir
Limits Date Date
m~/L EPA ~00,0 0~/t5/96
u - Undetected
LT - Less than
OT - 6rearer than
D - Secondary DiLution
d · BeLow the calibration r0
200 W Potter Drive, Ancl~orago, AK 99518-1605 -- Tek (907) 562-2343 Fax: (907) 561-5301
3180 Peger Road, Fairbonks, AK 99709di471 -- Tel: (907) 474.8656 Fax: (907) 474-9685
ENVIRONMEr'~TAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS. MARYLAN0, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEgT VIRGINIA
APPLIC tIT FILLS OUT UPPER HA[ ONLY
Address Zip Code
Phone
Address
Zip
Code
Realty Co. & Agent
Address . Zip Code
Street Locati~
Type of Residence
~Single Family
/~ Multiple Family No. of Bedrooms
~ Other
Phone
~. ,///
Phone
wa_te~/Supply
L~ Individual ATTACH WELL LOG, A well log is required fo~ all wells drilled since June 1975,
d~ Community For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utilily
Sewer Disposal
~/Individual
'~1 Public Utility
L~ Holding Tank
Year Individual Installed:
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
[)ate
Inspector
Time
Date
Inep t°r/1
Time
Date
Inspect%
Date ~/ / ! / · r
Inspeclor /'~
/
-!
Field Notes: /. '/.. '~
/¥~ ¢
(¢) APPROVED BEDROOMS
( ) DISAPPROVED
/ /CONDmONA~.A.PROVAU
'CONDITIONS OF APPROVAL
Soils Ratin~g
Date Sewer Installed
Well To Absorption Area ,~/' ~,.~
Well to Tank /"¢ ~)
Well Log Received
Septic Tank Size
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received _ Jnn~ 1 nj 197_6___
Time of Inspection ./F~,'~) ~?, _
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
/'
FOR
1. Approval requested by:
Conv.
Alaska Mutual Savin%'s Bank
Mailing Address: Post Office Box 1120, 99510
Phone: 274-3561 x 233
2. Property Owner: Gary M & Mary L. Egan
Phone: 277-2575 (Mary)
Mailing Address: Post Office Box 2091
3. Legal Description: L/~/. ~.
Orth Subdivision
4. Location:
5. Type of facility to be inspected Single Family No. of bedrooms 3
6. Well Data: ~Individual
A. Type ~2~-~x B.
Depth
C. Construction~'~/~~(~c~~ D. Bacterial Analysis ~2 ~
7. Sewage Disposal System: On-site subdivision~d~ ~,~-~,~/~~
A. Installed B. Installer
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: t. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank , Absorption area , Sewer Lines
Nearest lot line , Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages -Re~ st for Approval of Individual ~ ar & Water Facilities
Legal,Description Lot
Orth Subdivison
Comments
App~a¥aq Yalid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE l]i,.,"v'ulot,~.'..u :x::.~ ~..;, .,1: x;¢.J
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ,. ii ii '!?i]
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner'._
Mailing Address: ~-'~' ~~/'
3. Name of Buyer: %~~
FHA _CONV //
Day P~'one :_
Mailing Address: Day Phone:_
4.Name of Lending Institution:
5. Name of Realtor or Agent:
Mailing Address: ,,, ~ ., Phone:_
- C2.b¢ d4-/ - ,
6.Legal Description:
Location'
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
,Individual
Individual (on-site)
72-003(3/76)