HomeMy WebLinkAboutSUNNY VALLEY LT 13 REMSunny V lley
Lot 13 REM
#050-354-14
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231345
Work Type: SepticTank Upgrade
Tax Code Number: 05035414000
Site Legal Address: SUNNY VALLEY LT 13 REM G:0057
Site Mailing Address: 9435 WEST LAKE DR, Eagle River
Owner: WHIDDON CALLY R
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
f-
L�epartit�cilr
10/11/2023
10/10/2024
56003
❑ Private Well ❑ 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
Received By: I s .S \. _ o C_r _G Date:
Issued By: L , Date: t c 1' 'Z023
4
MUMCIPAUTY OF ANCHORAGE
Development Services Department Phone 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-354-14
Property owner(s) CALLY WHIDDON Day phone 907-350-5095
Mailing address 9435 WEST LAKE DRIVE, EAGLE RIVER, AK 99577
Site address 9435 WEST LAKE DRIVE, EAGLE RIVER, AK 99577
Legal description (Sub'd., Block & Lot) SUNNY VALLEY; LOT 13 REM
Legal description (Township, Range & Section)
Lot Size
Sq. Ft.
Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑
Initial
❑
Single Family (SF) 0
ADU)
Septic Tank El
Upgrade
Upgrade
❑
(D) El
Holding Tank ❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR -
OR:DRAINFIELD
DRAIN FIELDTO WELL
(2- E D 1
e, 90'
[ Distance:
I certify that the above information is correctI-further certify that this—is—in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 2 2 �r Waiver Fees:
Date of Payment: J c � Z Date of Payment:
I
Receipt Number: (i 5 ZC Receipt Number:
Permit No. 05f Z `� % 5 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231345, Curtis Townsend, 10/11/23
'.j
(f n
Municipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 0 Fax (907) 343-7997
hftp://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
xARIAMC,"E/WAIVER REVIEW
Waiver#: WR910019
PID#: 050-354-14
Permit#: OSP231345
Legal Description: SUNNY VALLEY LT 13 REM
Engineer: Jeff Garness, PE
WR910019 was previously issued and is hereby amended: The new tank to be installed will meet
the required 100' separation to the private water well. The field to the water well approved
distance is 90'.
This waiver approval applies to the Existing septic field only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
❑The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
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Waiver is Granted: X Waiver is not Granted:
Date: to l, Z 2-o ZApproved by:
Name of Reviewer
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Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231345, Curtis Townsend, 10/11/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231345, Curtis Townsend, 10/11/23
LOT 14
LOT 12
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LOT 21B
(84-351)
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GRAVEL DRIVEWAY
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DESIGNED BY REBel
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SEE DETAIL
DETAIL
SCALE: 1" = 20'
Lot 13
Sunny Valley Subdivision
56,004 Sq. Ft. +/-
9435 West Lake Drive
3 Story Wood Frame House
With Attached 1 Car Garage
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G
E
PROFESSIONAL SEAL
Date:Frontier Surveys, LLC Project No:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
April 24th, 2023.
Legend:
Scale 1" = 50'
Gas Meter
Electric Meter/Outside Power
Deck
Septic
Telephone Pole Overhead Utility
Lot 13, Sunny Valley Subdivision
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
Melinda Pedersen
23-135 04/25/2023
P-631 SW058
Water Well Tel. Pedestal
Satellite DishG
E
S TW
Apr 25, 2023
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYORPierre M. Stragier
No. L.S. - 9812
DESIGNED BY REBel
SGS Ref.#
1235191001
Client Name
Gayness Engineering Group, Ltd (GEG)
Project Name/#
GEG, LTA,
Client Sample ID
9435 West Lake Drive
Matrix
Drinking Water
Printed Datefrime
Collected Date/Time
Received Date/Time
Technical Director
L13
J
09/29/2023 7:57
09/21/2023 9:20
09/21/2023 11:39
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results LOQ Units
Method Container ID Limits
Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00 ug/L
EP200.8 B (<10)
09/25/23 09/27/23 HGS
Waters Department
Total Nitrate/Nitrite-N
ND 0.200 mg/L
SM21 450ONO3-F C (<10)
09/27/23 EBH
Microbiology Laboratory
E. Coli Negative 1 100mL SM21 9223B A 09/21/23 M.A
Total Coliform Negative 1 I00mL SM21 9223B A 09/21/23 M.A
2of5
) ~ MUNICIPALITY OF ANCHORAGE k~.J'
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
l ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT
NAME P H-'-~ .~EW
LEGAL DESCRfPT]ON
J Well Absorption area r~ ~. ~,~
~ Manufacturer ~ ' Mate
~ ~ ]~ (~r~ ............. : Inside length Width Liquid depth
Liq. capacity in g&~ons .............
~ O ~ DIST~E TO: Well ~welfing// PERMIT NO;
.0~< ~ ~cturer ~ [ Material
-- ~ ~ ~uid capacity in gallons
~ Top of tile to finish grade ~Length . Width :~¢r DepthMateria' ~e~e~h tile d~r inches ~C~ ~ Total effective absorption area~.
Type Crib diameter / ¢Crib depth Total effectiveCptlo, area
~ Class Depth Driller Distance to lot llne PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank/(~ Absorption area(s)/~
OTHER
72-013 (Rev, 3/781
PERMIT NO.
RPPLICRN,f'
LOCRTION
LEGRL
HRMRNN CONST.
UNK IS ¢'
LO'F.2~-,SUNNY VRLLEY SUB
PO BOX 6±7 ERGLE RIVER
LOT SIZE
694-2776
43560 SQURRE FEET
TYPE OF SOIL RBSORPTION S~STEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS 4
SOIL RFITING (SD FT/BR)= 13~5
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
[:,E[-~'TH:= ::[ CZi ~_ E f",~ 13 T b~ = 45 GF-:R%¢E L B'EPT'H== -¢,
THE LENGTN DIMENSION IS TNE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF Fl TRENCH OR PIT IS THE DISTFlNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF ,f'HE EXCR',,,'RTION (IN FEET).
THERE I"-; NO SET WI[:,TN FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIblUM DEPTH OF GRRVEL BETWEEN THE OUTFFILL PIPE
RND THE BOTTOM OF THE E)'(CR',/RTION (IN FEET).
RE[:, '--=,EF'T T C: TFd~'~l[<
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING ,f'HE
INSTBLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY 8ND THE
NUMBER OF RESIDENCES THRT 'THE WELL WILL SERVE.
8RCKFILLING OF RNY SYSTEM WITHOUT FINFIL INSPECTION RND RPPRO'¢RL BY THIS
DEPFIR'f'MENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE E:ETWEEN R WELL FIND RNY ON-SITE SEWRGE DISPOSFIL SYSTEM IS
±00 FEET FOR B PRIVRTE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM Ft PRIVRTE WELL TO Fl PRI',,,'FiTE SEWER LINE IS 25 FEET FIND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MFlY FlPPLY. SPECIFICRTIONS t--~ND CONSTRUCTION DIFlGRFlMS FiRE
Fi'v'FiILP]BLE 'FEI IN_,URE F~_FEI~ IN'~TRLL- AN
F'E~'~'I I T' E,--,F I ~.Ez D E _-E~ ~E ER. ----'-': J_ ¢ .~ .....
I CERTIFY THRT
±: I AM FAMILIFiR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FlS SET
FORTH BY THE MUNICIPFlLITY OF 8NCHORFiQE.
2: I WILL. INSTFlLL THE SYSTEM IN RCCORDFlNCE WITH THE CODES.
3.: I UNDERSTFlND THFlT THE ON-SITE SEWER SYSTEM MFlY REQUIRE ENLFlRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THFlN 4 BEDROOMS.
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3=
5
6
7
8
9
~1o
12
13
14
15
16
17
18
19
20
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
ENCOUNTERED? pO
E
IF YES, AT WHAT
DEPTH?
/~' SOILS LOG
[] PERCOLATION
TEST
' , TE 'LAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
?
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN BETWEEN FT AND -- FT
PERFORMED BY:
.$ & S ,~nqinee~g
72-008 (6/79)
by
DOC Co. c1ba
SULLIVAN WATER WELLS
P. 0. BOX 272, CHUG IAK, ALASKA 99567 9 TELEPHONE 688-2759
OWNER OF LAND DEPTH OF WELL
ADDRESS STATIC LEVEL OF WATER FT.
LEGAL
DATE - Started Ended
PERMIT NUMBER
DRAW DOWN FT.
GALS. PER HR —9
KIND OF CASING
KIND OF FORMATION:
Ftorn-0---Ft.
Frorn------Ft.
to-- -Ft.
From— Ft. to 2,2— Ft.
From
to ----Ft.
From Ft. to-- Ft.
From
—Ft. to ' —Ft.
F rom Ft. to Ft.
.
From
Ft. to.---Ft—
From-
From
--Ft. to---Ft---,-
From Ft. to Ft.
Ft. to, —. Ft.
From
From-
Ft. to Ft.
From
Ft. to., -----Ft.
Froin —Ft.
Froin
—Ft. top —Ft. _,__
From. --Ft.
From.
Ft. to ---Ft.
From -----Ft. to----Ft.—
Froln
—Ft. to _.Ft.
From ------Ft. to ------Ft--
From
_Ft. to---Ft.,,-
From ---Ft. to---
From
--Ft. to—. --Ft.
From Ft. to_.--. Ft.
Frorn
--Ft. to-----Ft.—
From --Ft. to—FC---_._
Frorn..—Ft.
to—Ft.
From — Ft. to---- Ft.
From ---Ft,
to___Ft.
From --—Ft. to-_-..--. Ft. ---
From—
Ft to
---Ft
MUNICIPALITY Or7An—CH%A-0r-----
MISCL. INF001ATION:
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
A U IP r'71981
RECEIVED
DRILLER'S NAME-_-_-_-___
PERMIT NO.
DEF'RRTMENT C~-~/ HERLTH RN[:, EN',/I RONMEIqTRL ~..~.OTECT I ON
825 "L'" STREET., RNCHORRGE., BK. 99SFl:t
264-4720
l-..,~ ELL F"ERI'"I :E T
,:: 810172 ::'
APPLtCRNT
LOCATION
LEGAL
CHRMBERS CONST.
MILE 4 ERGLE RIVER RORD
LOT iS SUNNY VRLLEY SUB
SRA BOX 447-R
LOT SIZE
688-9224.
56000 SQURRE FEET
MINIMUM DISTRNCE BETWEEN R WELL AND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 50 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS WRY APPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
I CERTIFY THRT
l: I AM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS AS SET
FORTH BY THE MUNICIPRL. ITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
S I GNED: ...........................................
RF'PLIC:A~' CHRMBERS CONST.
V4. 0
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 ~'L~ Street, Room 502
· P.O.Box.196650 Anchorage, AK;9951.9-6650
- ,' ~ :'-: ,.;. " : :; www.ci.anchorage.ak.'ds --' '
,-7 ;.(907).343:4744:' .';~:,' - ':: ....
~-; ,-, -.. CERTIFICATE OF HEALTH
FOR A SINGLE FAMILY DWELLING
-~;~,,' ~ ~, e~ % Expiration Date.
~u[~ht. P?0p~r dwner(s)
Arnola Fritz ....... ' ..... ,Dayphone "696-7367
Mailing address 9435 ~est Bake Dr~ve~ ~agIe R~uer~ AK 99577]
Lending agency Day phone
Mailing address
Real !~s!.ate. Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2:' NUMBEROF BEDROOMS." - -- 3 ............
3. TYPE'OF"WATER SUPPLY: '" TypE'oF'~/ASTEW/~TER DISPOSAL:
- -' Individual Well ....... [] .... In'digidual on:~ite
Individual Water Storage- -- [] ndividual Holding Tank
Community Class Well [] _ Community On-site .
..... PU'[~Iic Water 'S~siem ...... Public Sewer
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health AuthorityApproval (HAA) based only upon the representati0~s.given m paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date (~f issue for properties served by
a private or Class C well and may be reissued with new water sample resblts less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 01/00)*
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto· and as 6f the validation date shown below, I verify that my investigation
.based on procedures outlined in the Health AbtJ'lority Approval Guidelines for the Health Authority Approval
application show that the on-site water supply;and/or wastewater d sposa system s 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 o~ Anchgrage files and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in.compliance with all applicable Municipal and State
codes, ordinances, and reaulations in effect at the time of installation
$ & $ ENGINEERING '
17034 Eagle River Leep Road No. 204
Nameof Firm ,EageRver,'Aaska~5??~ ~, , ~ :,.i phone= '1'__
Engineer's Printed Name ~.obez:tc Cowan
U?". Approved for ~ bedrooms ..... .
Disapproved.
· bedrooms, w~th the following stipulations.
Additional Comments
Attachments: ': :'
HAA ChecMist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:__
75-025 (Rev. 0~/00)*
Original Certificate Date:
Reissue Date:
Municipality of Anchorage AUG 0 ? 2000
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: ~..~T'/..~/' ,¢~/.//v'~.../y ]/"/-~'Z-/_..~Cz/ S/,O Parcel I.D.:
A. WELL DATA
Well type
Log present Y~N)
Total depth
Sanitary seal~'N)
Date of test
Static water level
Well production
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform
Date of sample: ;~-/~ /~
/ /
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed 4/,~/~/
/
Cased to '~¢) ? Casing height (above ground) /
Wires properly protected (Y/N)
[
AT INSPECTION
g.p.m. ~ g g.p.m.
Nitrate ~. ~ Other bacteria
Collected by: ~.~.%~G~N~
Eatjle ~]ver~ Alaska 99577
B. SEPTIC/HOLDING TANK DATA
Date installed -~/~/ Tank size//~) Number of Compartments ~- C leanoutCN)
Foundation cl~a.,nou~l) (-~.(~ Depression (Y/~ A./(~) High water alarm (Y/N)
C, ABsoRPTiON FIELD DATA '~ '.
Lengt'h '.,4& Width' '~"'~ ~' Gravel thickness below pipe ~ Total depth //~
Effective'absorption area ~-~-Z ¢ Monitoring Tube present, N)¢"~ Depression over field (~_~_ ,?~O
' ~/,~¢/~J Results (Pass/Fail) p,,~'% ~ For '~-'-~ bedrooms
Date of adequacy test
Fluid depth in absorption field before test (in.); Immediately after,,C~gal, water added (in.): ~'~-.~//
Fluid depth z¢. ~//,~' (ins)Minutes later: ~) Absorption rate= ¢ ~'-'~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) /'¢/'¢,4/~---.,~V'/'//J/V' If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed ~J/,,.4
~i;~h;l~/6Ar c~;;~ (i ~/v~)l at* _~~¢~rC, oDni'tulemvel at*
Cycles tested
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
'(
Septic/holding tank on lot ~ ~ I~ F~:¢'/ I
Absorption field on lot ¢J&"' ¢(' I,~ ~-l'l.'do I ¢l '~
Public sewer main ~,-f/~
Sewer/septic service line ~,~...~ /..~
On adjacent lots _
On adjacent lots
Public sewer manhole/cleanout
Lift station ___
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ /
· w- Property line /'~ /¢- Absorption field
/ /
Water main/service line __ / ¢'7) ./ Wells on adjacent lots
/ 0 -/- Surface water/drainage
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / 0 / /~-
"/- Building foundation //-~ /
'-' Water main/service line / O
Surface water__/(_~ /¢'~ Driveway, parking/vehicle storage area /f/') ~
Curtain drain ./V/~/v'E- ,~/~'~A/A/ Wells on adjacent lots //.'~ /''¢--
F. ENGINEER'S CERTIFICATION
I certify ,hat lhave determined thru field inspections and review of Municipal recor~l~.~.~,~.".~'~"',~¢ms~-""~'---''-- are
in conformance with MO~ HAA ~uidelines in effect on this date. ~., ~ "., ~ ~
Engineer's Name '~*~% C. C0 ~ "~;17/J
HAA Fee $ 3 ('",) O '
Date of Payment
Receipt Number
72-02~ (Rev, 3/g~)
Waiver Fee $
Date of Payment
Receipt Number
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
GENERAL INFORMATION
Lot 13;
Complete legal description
Sunny Va~¢y Subdivision;
Location (site address or directions)
West Lake Drive
Property owner Hudspeth Day phone 248-6793
Mailingaddress ~'TOn Nn~-I~n~/a£ ¢.nu~-~ A~n~g~; Ab. 99517
Lending agency Day ph
Mailing add ress
Agent Glen Hu.qhton Red Carpet/Anchor Realty Day phone
Address 750 Ea~,¢ Fx'~w¢~.r/ .~uJ~. ¢¢101 Ane. h~-J~aa¢.. Ak. 99503' ..
Unless otherwise requested, HAA will be held for pickup. ; ~..¢ ,~
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
ndividual well
Community wel
277-6655
Pub lic water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
mg to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
×X
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA#21
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Legal Description:
A. WELL DATA
Well type
Log present (~VN)
Total depth \~'~
Sanitary seal ~N)
Date of test
Static water level
Well flow
Pump level
MUnicipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I.D.
If A, B, or C, attach ADEC letter.
Cased to
ADEC water system number
Date completed
FROM WELL LOG
Casing height
Wires properly protected ~)/N)
AT INSPECTION
~. ~. ~::~ ~% ~
,,/
sEPARATION DISTANCES FROM WELL TO:
Septic/h-"Olfl~0~ tank on lot
Absorption field on lot
Public sewer main
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE
Coliform ~ ,~ t ~=.~...~2_ Nitrate
Date of sample: ~"~ \-~
Other bacteria
Collected by: "'"--~ Jr~ ~ ~::~---~';ii~ ..
B. SEPTIC/HOLDING TANK DATA
Date installed "7- \"~-- ~ [ Tank size ~. '~-~'-t:::> Compartments ~
Cleanouts~N) V Fo d cleanout~C[~N) "~/ Depression (Y~ J
High water alarm (Y/N) ~.~ ~n Alarm tested (Y/N) "-----'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ On adjacent lots . \ ~ j'''~ Foundation
To property line \ c~t-''~ Absorption field \"7 Water main/service line
Surface water/drainage
(Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
Date installed Manufacturer
Size in I1~ ,, Manhole/Access (Y/N)
Vent (Y/N) ~ Pump on" level at ' "Pump off" level at
High water alarm level -"'"'~ ~ Cycles tested __
Meets MOA 'electrical codes (Y/N) __~
.. %;.T,oOe: 7oCt;
D. ABSORPTION FIELD DATA
Date installed ~ ~/~ ~ ~
Length g:¢¢~ ~ Width
Total absorption area
Depression over field (Y/"Z~
Resu It s~Yfa{+)-.
Peroxide treatment (past 12 months) (Y/N)
Soil rating / :;2~ ~."-'~_//~ ~
, System type [
. Gravel thickness ~ (
Total depth
Cleanouts present~'N)
Date of adequacy test
for
~ if yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTfON FIELD TO:
Well on lot ~t, ~
To building foundation
On adjacent lots ~
Surface water
Curtain drain
.On adjacent lots I ~::~t .~ Property line_
~ To existing or abandoned system on lot
Cutbank ~'~'f'~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date
Signature ~ ........
Engineer,sFK]~jJ~{iver, Alaska 9~577
HAA Fee $ J q ~)' (~(-~
Date of Payment
Receipt Number
72-028 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Tom Fink,
Mayor
Municipality Anchorage
Department of Health and Human Services
$25 "L" Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
May 13, 1991
Robert A. Shafer, P. E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject:
Waiver Request for Lot
Waiver Request
13 Sunny Valley Subdivision
#WR910019, PID ¢050-354-14, HA910154
Dear Mr. Sharer:
Your request for waiver of the required 100 foot horizontal
separation of a septic system to a private well has been approved.
The approved separation distances are: the well to the septic
tank is 94 feet and the well to the leachfield is 95 feet.
This waiver approval
well separation only.
require all separation distances
from this department.
applies to the existing septic system to
Any future upgrade to either will
be met or another approval
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Concur: /
/~ohn Smith, .
'Program Manager
On-site Services
ljm:#6
~rZ_Y
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~ 4.2.?
,2. 7~
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ROBERTSHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
April 30,
1991
Muni~pallty of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 13; Sunny Valley Subdivision;
Request you issue the at, chad Health Autho~y Approval and grant
separation distance waiver for the distanc~ b~een the private w~ll
and septic tank and leachfield located on the referenced property at
approxlmately 94 ft. and 95 ft. r~spectivaly.
The wall was installed in May, 1981, under permit #810112. The septic
system was installed in July, 1981 under permit #810382. The
installation was inspected by the Municipal Health Depart~entwith the
separation distances apparently inaccurately reported as 100 ft. at
that time. In August of 1981 the property was purchased by the current
owners, Dave and Tisha Hud~peth, with the use of a Heath Authority
Approval issued at that time.
Although we are unaware of a regulation identifying a required
separ~tion distance between a well and the effluent pipe from the
septic tank to the leachfiald, we have been informed by Kevin Kleweno
with the State Department of Environmental Conservation (D.E.C.} and
Dan Roth of the Municipal Health and H~man Services, the policy is to
require a 100 ft. separation. Therefore, we have included the distance
between the well and the effluent ~ne as part of this waiver request.
For the following reasons we feel the separation d~tanc~ pr~cribed
by 18AAC72.015 are not required in this case:
The wall log for this prop~y and several neighboring
properties show thiak layers of clayey soil~ §~tween the ground
surface and the aquifer which serves the w~ll. These clay
layers would d~tour the migration of septic effluent into the
aquifer.
Water samples w~re taken and tested for co,CLfo,'u~ ba~t~a and
nitrates. The results w~re satisfactory. In feel, there were
no nitrates d~euted. Since nitrates travel through the soil
virtually und~turbed, and septic effluent is very high in
nitrates, it appears the septic system is st~ not influen~ng
the w~ll after 10 y~ars of use.
ON SITE
WASTE WATER
DISPOSAL SYSTEM
OESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Page Two
Lot 13; Sunny Valley Subdivision;
April 30, 1991
3. The ground Slopes perpendicular to a line drawn b~een the wU and
septic. Therfore, if soils stratus were to flow the con, tours of the
land as is typical, effluent wo~d travel to the south and not toward
the well.
4. The lot~ in this area are large. Therefore, the w~ll and septic
densities are low, thereby decreasing the possibility of w~ll
contamination for the area.
If you have any questions,
us.
//~B~RT A. SHAFER, P.E.
JJ/gm
ATTACHMENTS.
or if we may be of further service, please co~o_~t
RECERTIFICATION 4/29/91
ASBUIL:i'-NO CORNERS' SET THIS DATE.
J HERE~ CE~IFY THAT I HAVE SURVEYED THE ~
F~LOWlNe DESCRIBED PROPERTY: 1"=30' --~m.
~D ~AT NO EN~HMENTg EXIST ~CE~ Ag 3-13-91
INDICA~. IT IS THE RES~SIBILI~ OF THE ~/~/ql TH
~ ~ D~INE THE EXlSTEN~ OF ANY ~ID~ ~~
~TS, ~V~ANTS, OR RESTEICTI~S SW 58
~ ~T~ 8~ ~ ~$~ F~ ~$~10~ 19-26 ~ ~.. ....... .~' ~ *
ARY LINES.
'~ INsPEcTION APPOINTMENT~
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~VIRONMENTAL PROTECTION
825 L Street Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION Di'VISION ,AU~ ~ ~8~
Telephone 264-4,20
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAClLI
1. PROPERTY OWNER , ¢~'B~&~
MAILING ADDRESS
PROPERTY RESID[NT (If different from above) ~ PHONE
PRONE
2, BUYER
3. LENDIN61N~TITUTION I PHONE
~AILING ADDRESS
LEGAL DESCRIPTION
TREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* 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 ~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENqE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] iNDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED ? ~
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER
[~]Septic Tank or [] Holding Tank
Size: [~i~'~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIALf --
4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
I~""~APPROV ED FOR '~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED //~
72-010 (Rev. 6/79)