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Home My WebLink AboutWILLIAMSON BLK 2 LT 1William on Block Lot I #015-073-24 MUNICIPALITY OF ANCHORAGE ~ 0 ft DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENWRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT PHONE NAME ~"~0'~ '~z_~ / ~/t[ ~-~ L~UPGRADE MAILING ADDRESS DESCRIPTION LEGAL LOCATION f O ,STANCETO: IWe'' ~:ZCL: Manu[acturer ~.~¢:- ~ jLq capacty naa onsJ~ /O~) ~,, IF HOMEMADE: DISTANCE TO: JWell NO, OF BEDROOMS JAbsorption area Dwellings. Material Inside length ~ JWidth Dwelling PERMIT NO~) ,:~ 0 3'-/,/ Liquid depth PERMIT NO. Manufacturer Liquid capacity in g~llons DISTANCE TO: -Length of eac ~ Ii No. o~ lines Top of tile to finish grade Width Material Foundation Nea est at e 'Total length of line Trench widtl~ Material beneath tile Depth Crib depth Building foundation Length Type of crib Crib diameter Well PERM NO. ' Distance between lin~s Total effective absorption area PERMIT NO. DISTANCE TO: Class Depth Driller PERMIT NO, DISTANCE TO: Building foundation Sewer llne Absorption area(s) Total effective absorption area Nearest lot llne Septic tank Distance to lot llne OTHER PIPE MATERIALS , v'c c l SOIL TEST RATING INSTALLER DATE LEGAL 72-013 (H~78) ~, & ~,~, ( l q ~, p c. '/~- '/ 6-/ Z:> e ,.'.~.~ ~,/ ~ J-C-~'v~'.'t~) - I~te Drilledl Static Water Level ~,1 feet Draw Down M/A feet '~ELL LOG .Type Material, Drilled: ~9 57 feet Gallons Per Minute Total Feet of C~sing 6~ ,' Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 F'ERMIT I",E). ,' i' F F I [ _.kl1`'~ F l)01`',1 DFIHL. L..OC:RT :[ 01`.,I 99TH LE(3FIL. L ::L D~":' !.,.IILLIFIH'.EdEIN ':;,."D LOT .:, I ~-E 25E L:/Z _,1.:.1...111F..E FE;ETI" "f"¢F'E OF _-,uIL HE,~,UI..F~ ]:U1`4 _,'r_,TEll tS: E:,RFII1`,IFIELE:, f,tFI:qlMUM 1`,ILII1EL. F. OF EE[..t~....J1`I .... : -",...Il... RFITINI3 ,::Si;! Fl, EL;-. ,:,.- THE REQI.J]:REEE:, :,I,.'-E. OF' TFIE z, L IL RBSOF.'.Fq"]:O1`'J ... r_ FEll '""' THE LEI".I(3TFI [:,IHENS;IL3N IL:.', THE LE1`.,IGTH (I1`'4 FEET) OF THE TRE:NCIq OR [:,RRI1`4FII:EL..D. THE DEPTH OF Fl TRENCH OR PIT :IS THE E:,:[E;TFtNCE BETI.4EE1`4 THEE ':!;URFRCE OF "f'FIE GROUND RND THE BOTTOH OF' THE E',,.,:C;FI',,,'RT :[ ON ,::I1'.~ FEET). THE GRR",,'EL DEPTI.4 :IS THE 1`dlI'.II1`"IUH DEPTH OF GP.R'v'EL BE'f'¢iEE1`',I TFiEII OIJTFFIL. L F:'IPE: RND THE BOTT01`"I OF THE E:XC:FIVRT:[OI",I ,:lIN FE:ET::,. PERH:[T HFFI_I...fti'JT HI I_, THE RE..:iFu[,L':,.[E ILZTT T') Z1`IFUF. I I FHI.::, E:,EF:'FrR"FMEI'.,IT B, URINEi THE I N 25 T Ft L. L. FI'F :[ 0 I'.4 Z 1' I.: F E. L. T I t J 1' ,I .., 0 F FI 1`.,I '~.' I-,I E L [ .... FI [;, ..T FI L-: E J",l T T 0 "F PI I S F' R O P E R T '¢ FII',I D T 1'"1E 1'g..IIIE, EF.;. C'iF:' REE;:£E:,ENCES THRT THE HELL HILl .... .E-.I..,E. b%.. DE .:.. IU :if: IF;:~ EEE idF F I.:..,. I-iL.. THIS I',r:[l'q:[l','ll. Jl',l E:, :[ STFI1`',ICE E:ETHE:EN FI HELL. FIND FIN"r' O1`,I-::5ITIE SE.tqFIEiE D]:SF'OSFIL S'.r'STEFI 100, FEET FOR I::ii F'Rt'v'RTE HELL. OR J..50 TO 200 FEET FROH FI PUBLIC HEL. L E:,EF'END):NG UPON THE T'.r'PE OF PUBL.:[C HELL. 1`"IZN'[MLIH £:,]::~TFI1`qCE FROH FI I::'I;.:Z',/F:KFE HELL TO R PR:P,,,'RTE SEI.,.IER L. I1`.,IE :IS 25 FEET FINE:, TO FI C01`4HLIN:[T'¢ 5;EEI.,.IER L.:[NE ZS 75 FEET. HEL. L. LOG'-L*.; RF.:E REQU:[RED R1`',ID 1`dU!S'f' E:E RETURNE[) TO THE [:,EPRFi'.T1`dE1`.,IT HITFIIN OF' THE HELL. COMF'LE:TION. OTHER REQU:EREHE1`.,IT~; HFI"r' FIF'F'L.'¢. E;F'EC:IFZCFIT3~ONE; FI1`',E:' CONS;TRIJF:T:[O1`',I E)ZFIGRFII"I:S FIRE i::IVFI]: LFIE:LE TO 11'',tE;IJI~:E PROPER 11`4E;'I"RI..LRT ]: ON. Ii: IZ:ERTIF'"¢ THRT _, SET d.: Z FIH F'FIHIL~FIF: H'ITH THE REI;¢JZREHENT:S FOR UH FL'IIRTH E:'¢ THE 1`,1'l...11`,Ji[ C ;Il PFIL.:[ T'¢ OF FI1`',ICHORRII3E. ..... I... E :-',. ;;ii:: I H:[LL Zhl...1 LL TI4E .:, ~_,~E. I I :IN FICC:ORDRNCE 14:['f'H THE ..... '~ '<' ]: I...I1`,IE,ER_Tt. IIE. -FHFtT THE u1`.~m:,l'fE SEZHER ._,~._'~LII HI:'1'./ REQUIRE E'1`.II.I:IF'3EHENT IF' THE kE.., 1DLN...E ):.:, REI'III)E:,ELED -1'0 ]: NC:IDJDE MORE THFIN ~: E:EE:,ROOHE;. _OIL RSSORPrfON q" t3F r~ I'IE'I.L COHPLEf[ON. FORTH 8V rile MIJHIC[PI~[I'V O¢ ~HCHORFtl3E. --~SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT O1-' HEALTH AND ENVIRONMENTAL PROTECTION 826 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16~ 17- 18 19 20 SLOPE GL- Gv, l WAS GROUND WATER IF YES, AT WHAT No ~, P E SITE PLAN " II1~1 Gross Net Depth to Net Reading Date Time Time Wate~ Drop · .,.'"'.; OF . ~..' ~ ,~' ",.~'~ ii.7:; ..... ti ,;'~,t, ;.. ·. . ,,r,'~,N~'.~'' PERCOLATION RATE DO 'ENTS ad 72-008 (6/79) CERTIFIED BY: Tom Fink, Mayor Ntuni¢,pality Anch rage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 20, 1993 Tobben Spurkland, P.E. 203 West 15th Avenue #206 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 1 Block 2 Williamson Subdivision Waiver Request ttWR930019, PID ~015-073-24, HA930203 Dear Mr. Spurkland: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are: the private well to leachfield on Lot 1 Block 2 Williamson of 96 feet;' 'the private well to the septic tank on Lot 1 Block 2 Williamson of 86 feet; the private well on Lot 1 Block 2 Williamson to the leachfield on Lot 2 Block 2 of Williamson of 99 feet; the private well on Lot 1 Block 2 to the leachfield on Lot 2 Block'4 Summit Estates of 92 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Concur: ff John Smith, P.E. Program Manager On-site Services ljm: MUNICIPALITY OF ANCHORAGE Departmen~ of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR930019 PID~ 015--073-24 HA~ HA930203 Permit ~ Date Received: April 22, 1993 Legal Description: Lot i Block 2 Williamson Subdivision Engineer: Tobben Spurkland, P. E. 203 West 15th Avenue #206, Anchorage, Alaska 99501 Applicant: Andy Gerhard Waiver Requested: well to leachfield on Lot 1 Block 2 - 96 feet; Well ~o septic tankon Lot 1 Block 2 86 feet; well to leaehfield on Lot 2 Block 2 of 99 fee-~; well to leachfield on Lot 2 Block 4 Summit Estates Criterza: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: Points: 3. Other: Waiver is Granted: /x List Conditions or Reasons Waiver is NOT Granted: for above: J~i ~ ~-,'~C~:~ Fee waived Rec ~: By: Amount: $ N iewer Date Paid: 6751 l'h I)IHOt~ Bi. VD, AItCIIORAGE, ALASK[~ 9%02.-590'4 (907) 248-5095 Pq::ir" :~ t 2 ;I . .L '.?gL!; .¢' lx /¢ L, nl¢£r~ I,..~£ 6YC/).wT-£~ PrT 7-/¢1.r ?/,~ ~' /'-/, ~. /¢. ~E C ¢,VSF4~ ~ c 7'~ ~ ~ ¢ T~.r' T-,CE /)-~'ou E /vB,,~'7-/ o ,~/~ C~ ~ ~ n~v P T IY ~ T I'~ X, z2 /]- L ,e ~r'£R OF ~14 lC If w l~ F~ r¢ F~-I~L E 7..2 ~OIL 5O~DT/OA/ 203 NEST 15TN, AVENUE SUITE 206 ANCNORAGE~ ~LASNA 99501 (907} 27%5~16 Robert F. & Eve].yn Banks 5420 East 99th. Ave. Ant:borage Alaska 995].6 Subject: Letter o.~: r'~o objection Dear' Si.r: During an s~.pt:i.c system approval inspec:'J'.:~orl for Mr. and Mrs. Gerhmrd at. 5~f;~0 East 9~tl'~. ~ve.. .ik was d:i. scow,~red that a section o4 their septic system wac leee than 't.h(~,~ recluired distance mway fr'om your well.. 'l"h~ dista~c:e between your Nell. 81qd their drain field appears to I::~(~z~ 96 f~.?et~ 4 .Foe'k less than 'the r~(:luired 100 f ei~t. The Gerhards :i,s applyinq ~:er a wa:Ever and your Iq[IN OBJE:CTION I-'~qu~est ed. Please sign this let'L'.er IF YOU DO NOT OBJECT to this waiw~r. I have included a plot plan .For' your '[:iles. We have NO OBJECTION · Robert F,, & Evelyn Bariks Tobber', Spurklan~ P. E:. ~ 203 ~ESl }SlH, AVENUE SUITE 206 ANCHOI~GE, ALASKA 99501 (907) 279-3916 Pau',~ S. & Brenda Upd'u.lrc:h 5310 East 99th. Ave. Anchorage Alaska 99'~16 May 12, 1993 Subject." Let'~er (:)~ ne objection Dear Sir: Dur i n g an seep t i i::: syst:~:,~m ap pr'ov,':,~], i n sl:)~c:t, i or] 'f or Mr. and Mr' s. (Der'hard at 532O Eas~: 9[]th. (~v~:e. it ~as dJ.~c(:)ver(.:~(:~ '~hat a see'S:ion o~ '~h~ir' septic system was :L~ss ti]an the I'"t~)qL,l~red dJ,~i'[:al]c:~* away · Field appears to be 98 ~eet~ 2 'feet loss than the i'"eqL~ir'~)d 100 ~e~. 'l"he Gerhar'cJs is applying ~:or a waiver and your requested. F'lease sign this let:ret IF YOLI DO NOT OBJECT I have included a plot plan .~or your NI]lq OBJECTION this waiver. N SCALE, 1' = 50 FT, I I I I 'DBBEN ~PURKLAND P,E, W 1DTH, AVENUE ANCN, AK, 99501 LOI' I J?LOCK 2 ~/II, LIAN$ON SEC l~ ~$eO E 9B~t AV~ S~PTIC SYSTEM LA'YDUT DATE, M~Y I£ I993 SHY'El', lyf GRID~ ,2437 WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 June 20,1994 (907) 349-7755 RECEIVED JUN 21 1994 klunicipal[ly of Ancho. a.,g.,e Dept. Health & Human Kary R. Erickson 5320 E. 98th Ave. Anchorage, Alaska 99516 Subject: Lot 1, Block 2, Williamson Subdivision, Anchorage, Alaska, Public Water and Wastewater Disposal Systems, ADEC Project Numbers 9421-DW-165-163 and 9421-WW-165-125, Review Dear Ms. Erickson: I have reviewed your June 14, and 15, 1994 submittals regarding the upgrade of your single family home into a Bed and Breakfast. Based on this review, I have the following comments. From the submitted information, it appears that the existing water system met all regulations and guidelines when it was installed. Based on this information and the fact that the demand on the existing water system will not be increased, it appears that the water system will be able to meet the demand without modifications. Therefore, the existing Class C Public Water System serving a three bedroom Bed and Breakfast located on the above-referenced property is approved for the concerns of this Department. A final Operation Certificate, constituting this approval, is enclosed. Normally, public water systems serving Bed and Breakfasts are not assigned Public Water System Identification (PWSlD) Numbers and are not required to monitor water being provided to the public (your clients). However, due to the elevated level of nitrates (4.16 mg/I) and the existing separation distances, monitoring will be required as a stipulation for operation of the existing public water system. The PWSID Number assigned to your Class C Public Water System is 218441. Please sample for nitrate (as nitrogen) and total coliform bacteria once in either January or February and then again in either May or June each year. It appears that the existing wastewater disposal system was also installed in accordance with state and local regulations and guidelines at the time of installation. Aisc, the existing wastewater disposal system was able to accept the necessary amount of water to pass N 25 ~ 25 Well Lgr ] yI LOt 5 50 75 100 SCALE: I' = 50 FT, 125 150 TDB~EN SPURKLAND P,E, 203 W 15TH, AVENUE ANCH, AK, 99501 LOT 1 ]?L~ICK 2 ~/ILLIANSDN SEC 15 l'l£N 5320 E 98TH AV£ SEPTIC SYSTEM LAYBUT DATE, ~hY 1~ 19~3 SHEET, 1/1 GRID, 2437 Municipality of Anchorage Development S~rvices Department Building Safety Division On-Site W~.ter and Wastewater Program 470g South Bragaw St. P.O. Box 196650 Ancnora.=e, AK 99519-6650 w~,w. ci.snchomge.ak, us (g07) 343.7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELUNG ParcelI.D. o t ~- - o ~ 3 - ~ y HAA# Expiration Date: GENERAl. INFORMATION Complete legal description Location (site address or directions) Current Propertyowner(s) ~-~_¢.~/~/' Mailing address 5'3 Lending agency Day phone Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ~' Day phone ,.q'~"~ '- TYPE OF WATER SUPPLY: ' Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Departmer~t (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 Health Authority 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. NameofFirm /~/',~/','~,r. ~"~,~'~c~{ ~-,-,?-~- Phone Address /"/5'~'~ ~'~.Ao ~/-... ,4~.-A~,,- ~,~.,.~ /'~-/.c. 4)~/5-,,~' Engineer's Printed Name "~"~,oc=('of¢ ~ ~-/'c,~,-c. Date DSD SIGNATURE J~ Approved for .~ Disapproved. Conditional approval for bedrooms. ~ ~ bedrooms, with the following Additional Comments By: (Rev Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 'B. M,nicipality of Anchorage __o Development Services Department Building Safety Division '~ ' On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anc~mage, AK 99519-6650 www.ci.anchomge.ak.us (90?) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WELL DATA walt type ' Date completed .7/ 2d/~,~ Sanite~ seal ~IN) Total depth ~y fl. Cased t~ If A, B, ~' C provide PWSID # FROM WELL LOG Date of test -//~; / 82. Static water level ~f I fl. Well production I Z. g.p.m. WATER SAMPLE RESULTS: Parcel ID: ¢:P tS"-cP'~3' - Z~' Coliform 0 colonies/100 mi. Date of sampte: SEPTIC/HOLDING TANK DATA Tank Type/Material .~ep~',c Tank size ~00'~, gal. Number of C~.pa~b.ents "~ Foundation cJeanout (Y/N)... Y Depression over tank (Y/N) Date of pumping ~/'Il/?.xPO Z Pump~ Well Log (Y/N) wires propen'y protected (Y/N) Casing height (above ground) AT INSPECTION v~ fl. In. Nitrate ~.~*~' mgJt. Other bacteria ~:~ coloniee/100 mi. C=Sec~d by: F/,~/./~/, -'r',~ 4 ABSORPTION FIELD DATA Date installed ./~.Z.~=J~-? Length 5'O fl. Total depth 7 - 4'.~'ff. Data of adequacy test Date installed C~eanoute (Y/N) High water alarm Soil rating (g.p.d./fl= or ~fodrm) &~'~- ~.~.- System type $~-~ Width $ fl. Gravel below pipe Eft. absorption ama 3?0 ~ Monitoring tube ~, / ~ v / ~o Z Results (Pass/Fall) Fo.rj Fluid depth in absorption field before test ~ in. Water added?P-~' gal. Elapsed Time: ~'~ min. Final fluid depth ~...~in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) /~,/~,,*, Depression over field N' For .3' bedrooms New depth2~ ~Jn. flf~'O g.p.d. ff yes, give date /~, ,~ D. UFTSTATION J¥'. A. Date instaJled Size in gallons Manhole/Access (Y/N) "Pump on" level at __ in. "Pump off' level at __ in. High water alarm level at Datum Cycles tested Meets alan~ & circuit requirements? E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absoq~fion field on lot Public sewer main sewer/septic service line ~g"' ~ ¢,0. ' On adjacent lots ~" '~ On adjacent lots ~./J.. Public sewer manhole/cleanout '~. 'Z.~" Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I ~-' Property line 1 3 Water main lu, ,4. Water service line Absorption field ~ ~ ' Surtace water '~ ~c,o' Wells on adjacent lots ~ too ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain Building foundation ~- :3~ ' Water main Surface water '~, t 00, Driveway, palting/v~tiole storage Wells on adjacent lots 9 2- ' ~ 9 7' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are/n conformance with MOA HAA guidelines in effect on this date. Engineer's Pdntecl Name '7-/t~c~fo ~,,~ ~../"too~ HAA Fee S 3 '7.~' ~ Waiver Fee $ Date of Payment Receipt Number (Rev. 12/00) Date of Payment Receipt Number 2 EAST 98TH (EAST 90i:h AVENUE DRIVE) R=240.00' N 89'56'00" E 69.54' L=17.67' ~u.,s ~ · ' 23.6' 13.2' 0 -~ EXISTING · ~ o~ HOUSE ....t, o 46.3' LOT 1 10.2 ~" 0 5 2 , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTN & HUMAN sEFIVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description __ CERTIFICATE OF HEALTH AUTHORITY· APPROVAL. FOR A SINGLE FAMILY DWELLING O'~ -- ,~- ~'/ HAA# Location (site address or directions) Property owner Mailing address' Lending agency 'T-~-dz,4,¢,~ /~_ Mailing address Agent" Address Day phone ~ ~6,--,~&~+ 7 Day phone Day phone ',-: .... .,Unless.'otherwise requested HAA will be he/( r pickup. '.: . ,...- .-., : 2, ' NUMBER OF BEDROOMS: .. ' ' ..... 3. TYPE OF WATER SUPPLY: : :'.'." ;, ;;ii;; . .:7 Pdblic'Wat'e~ NOTE: I? commun(ty well system, orovide written confirmation from State AD~C attest- .lng to the legality and status of system, 4, TYPE OF WASTEWATER DISPOSAL: ./ Indi~;'i~uaJ 0n-site Holding Comm, u,.,n: ity on-site ,_, · .' '? :~, .. Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. r i i i o 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 iVlunicipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address ~O~ Engineer's signature Date DHHS SIGNATURE ~' Approved for "~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments -r ,4unicipality of An rage spartment of Health and Human ,~ces (D :ssues Health Authority A? oval Certificates t d or upon the representations given in paragrap .ave by an independent professional engineer r~ ;tered m the State of Alaska. The DHHS does this as a c y to purchasers of homes and their lending institu ,ons in order to satisfy certain federal and state requireme, :mployees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Mumc~pality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmentai Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well type ~ Log present (Y/N) Total depth _ Health Authority Approval Checklist If A, B, or C, attach ~EC letter. ~EC water system number Date completed Cased to & c/ Casing height (above grouod) ~/ Wires properly protected ff~) ~OM WELL LOG AT INSPECTION Saaitary seal (Y/N) Date of test Static water level Well production g.p.m, , _C> g.p.m. WATEF, SAMPLE RESULTS: Colifol'm Date of sample: ~/1~ Iq Nitrate ~. (~,.~ Other bacteria __ Collected by: L. B. SEPTIC/HOLDING TANK DATA Date installed to/.xH [ ~ ~ Tank size Foundation cleanout (Y/N) 7 Date of Pumping ~/~7,/57 ~ } O~ Number of Compartments fi--- Cleanouts (Y/N) Depression (Y/N) _ N/ High water alarm (Y/N) N/2, Pumper A -¢ Y C. ABSORPTION FIELD DATA Date installed Length ,.~1~) Width Effective absorption area Date of adequacy test Gravel tlfickness below pipe Monitorit~,g Tube present(Y/N) "/ Results (Pass/Fail) '-~ Soil rating (g.p.d./ft2 or fl2/bdnn) ]'~'~ System type ' -~0 Total depth ~,, Depression over field (Y/N) For ..~ bedrooms Fluid depth io absorption field before test (in.); / 7 hnmediately ~ffter 7egOgal. water added (in.): 02 '~ Fluiddepth c~L/ Minutes later: //9~r25 (in.) Absorption rate = //&O g.p.d. Peroxide treatn~ent (past 12 months) (Y/N) f'7/ If yes, give date D. LIFT STATION INA Date installed Size iu gallons Manhole/Access (Y/N) "Pump oil" level at* "Pump off' level at* High water alarm level at* *Datuul Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdiug taok on lot Absorption field on lot Public sewer main Sewer/septic sen, ice line ; Oil adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift statiou SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundatiou / v~- Property lioe / ~ Absorption field ~ Water main/service line ~.g~3 Surface water/drainage ~l/eP Wells on adjacent lots I Or~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building fouudation Surface water Curtain dram F. ENGINEER'S CERTIFICATION Water maiidservice lille ~ ,~ ~ Driveway, parking/vehicle storage area ~> ~ CD Wells ou adjacent lots c~,,q-qPdj q '7 ~6 1 certify t/tat I have determined thrufield iaspections and review of Municipal rec'or~& that }he dbove aystems are ill cotlformance with g,lOA IfzlA guidelines itl effect on this date. Da,e [ HAA Fee $ ~dgO ' ~ Date of Payment Receipt Waiver Fee $ Date of Payment Receipt Number Re,,,. 8/95 OSS: haa.wk.doc 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 Complete legal description Location (site address or directions) Property owner Mailing address Dayphone ~(~" /'lOc//'--/~ Lending agency H?P Mailing address Agent Add ress ]~ Unless HAA will be held for pickup. otherwise requested, 2. NUMBER OF B[-'DROOMS: , Day phone Day phone .¢G~- ~ qb~ TYPE OF WATER SUPPl..Y: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written conf'rmat'on from State ADEC attesting to the legality and status of system. 72-025 (Rev, l/91) rtonl MOA~21 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 [o~lv,6~ ~]) ~ f ~,'.~. La.4.,t.~ ~ ~ Phone Address ,-f)-tO ~ ~ ~ ~ Engineer's signat;re %~_~. Date ¢ DHHS SIGNATURE Approved for Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Sorx, icos (DHHS) issues Flealth Aathority Approval Certificates based only upon the representations givon in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional ongineer's work. Municipality of Anchorage Department of Health & Human Services HFAL'rH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WFLL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) IfA, B, orC, attach ADEC letter. ADEC water system number Date completed-7/'2///~--~ Driller Cased to (¢ '~' Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level ~ I Li/ 2... Well flow I Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots _ Sewer service line '~ 5'~ ; On adjacent lots ~ I¢-c> Public sewer manhole/cleanout Nc//A Petroleum tank ~4. I 0 WATER SAMPLE RESULTS: Coliform .¢ Date of sample: ~l~-~ ff ~:> Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed __ ~ d/¢'~ ]~ '~ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping ___ Tank size I e.¢_~..~ Compartments Foundation cleanout (Y/N) f.-~' Depression (Y/N) I'ff//.~, Alarm tested (Y/N) ~"'~/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 4~ On adjacent lots ~. /O~_ Foundation To property line ~ ,~ _Absorption field Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at On adjacent lots High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot Soil rating D. ABSORPTION FIELD DATA Date installed [ (_o/.,~.,~/ l~ ~ Length ~5--(~ Width ~ Total absorption area -~c~ ~ Depression over field (Y/N) ~'~ Results (pass/fail) ~'~ Peroxide treatment (past 12 months) (Y/N) Gravel thickness_ Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water 137 System type ~' "¢¢/'~ ..~ O Total depth Cleanouts present (Y/N) Y Date of adequacy test L~ l~ Ic~.~ for ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots <~2~ 9-? Property line To existing or abandoned system on lot Cutbank t'--///.~, Water main/service line Driveway, parking/vehicle storage area Well on lot ~ ,~ To building foundation On adjacent lots Surface water Curtain drain ~ I bedrooms E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ef~.¢t on the dat. e of this inspection. Date HAA Fee $ /' ~ '~'~- Date of Payment 72 026 (RoY 3/91) B~ck MOA 21 Waiver Fee: $ Date of Payment Receipt Number EAST 98TH AVENUE (EAST 90th DRIVE) R=,24-0.00' N 89'56'00" E ~9,54' ~ LOT I ~ 2 MUNICIPALITY OF ANCHORAGE DIVISION OF 5?4VIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEAL%]~ AUTHORITY APPROVAL CEW£IFI(iATE 1. Ger. e~al Information Application Date .- .... Legal Description (include lot:, block, subdivision, section, township, range) Location (add~;ss or directions) (a) (b) (c) (d) Applicants Nane JJ-Y)/_~__ ~z~_ '__~_ ~ ~C~ TM ' /~ . /<~ ~ ~..7~c-(7 .~, Applicants Ad~res~ ~r. Applicant is (ched< o~g) ~nding I[gstit~tion ~; ~er~uil~r ~'; Le.nding Institution ~ lephone Adduess (e) Real Estate CO. & Agent Add~ess Telephone 2. T_~f~e of Residence Single-Family [~----i NuzRber of t~edrocam OtJ~er (describe) 3. _Wa.__te~ Su_.,~p_~:.,f_ Ind~.vz~ual ~11 Ccm~]nityE~ Note: If cc~unity well system, must ha~ w~itten confirmation f~cm the State Depa~tn~nt of fhvironm~ntal Conservation attestinG to the legality and status. Is the ~11 adequate fo~ the number' of bedrocrms specified in this H~% ~y~) .... onsite L--~ ~ablic [~ con, unity E-~ Hold:lng Tank Is the wastewater disposal system adequate fc~. t3~e nim~er of ~dro~s ~N) [Page 1 of 2] 2-15-84 ~ 5. J~n~ineez~in~ P~o_vi___dl~ng_In~ctions~ 'lbsts, [k~ta and Information I c~.tify that I have checked, verified, ~r confo]n~d to all, MOA HAA Guidelines in effect on th~ date of this inspection. 6. [)HEP A_J2proval Approved for ~ Approved ~X Terrr¢~ Of Conditional Approval The Municipality of Ancho~'age Deparhn~nt of Health and Enviro~rmntal Pcotection ¢lces not guarantee the continued satisfactory ~erformanoe of the wate~ supply and/o~ the wastewate~ disposal system. This approval indicates that, as of th~ validaticn date shown above, based on the data and information fu/rnished tTf em e~ir~.~er registel-ed in the State of Alaska, the wate~ supply a~d wastewater disposal system is safe and func- tional for the nur~ of hedroc~ and type of structu~_.e indicated. ( IYclEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 ao WELL DATA Well Classlflcatl. on _ Well ]Log P~esent ~ Total Dep~____~ff Cased to Static Water Level Casing Height Above Ground_ Electeical Wi~ing in Conduit MUNICIPALITY OF C~CKLI~ - F~RU~Y 1984 Sanitary Seal on Casing (Y_/N)~Ls Depression A~ound Wellhead (y/N)13~ 9% ; On Adjoining Lots % / ~ ; On Adjoining Lots To Nearest Edge of ~l)sorption Field on Lot To Nearest Public Sewe~ Line ~J]zl To Nearest Public g~wer Cleanout/Manhole ILJ~A.- To Nearest Sewer Service Line on Lot Water Sample Collected By ?~'~_3~y~ ~ ; Date '2~}./~cJ Water Sample Test Results ?-~t,~-~,,~=-~a.~'-( . -- SE~IC/HOLDING T~ ~TA Date Installed /°~¢/~3 Size __ff_~)C9 ___ No. Of Ccmpa~tments __~ Standpi~s (Y~) ~t; 5 Aid-tight Caps !~~ Foundation Clean~t ~~ ~ession o~ TaI~ ~N) ~te ~st P~d ~//e P~ing/Maintenan~ ~nt~act ~ File (~/N))J~ _; fo~ tU~A' Holding Ta~ High-Wate~ Ala~ ~Y~) ~u]~ ~a~y Holdi~ Tank Per~t (Y~) /v/~ Sep~ation Distan~s ~ ~ptic~iolding Tank: / To Water-Supply ~11 _~--.~ ~ To ~ildin9 F~ndatio~,~ / To P~operty Line To Water Main/Service Line . course To Disposal Field ___ To Stream, Pond, Lake, C~? Major Drainage, [Page 1 of 2] 2-15-84 [~ ~o ~: eD~6] s/~p/~ ~oej~e u7 sau!ieg!nD ~H ¥0~ I'[~ oq pe~u~o~uo3 ao ~pe!~j.ze~ 'pe~aeqo eAeq I qeqq Z~!qgeo I ¥C~ s:l eerA (N/Z) qUaA q~ IeAeq ,,~O dam&, suo!sueaTd NOIL¥%S J~Iq 'G / ~\ euTq Aq~ado,:kI o& .~... /~--% ITeM ~Iddns-ze~eM oi :pIeI~ uoT~dzosqv~uo=~ eoueqs!G uoIqeaedes 4~],,,v qsei ;,aenbep¥ ~seq ~o sqInse~ Q~ weatf uoIldzosqv ~o qeed eaenbs 'D e UIROrlITII FITAL CORTROL $ hulC85, IRC. Hatch 6, 198/* Mr. Robert Robinson Depar~ ~: of Health and Envlronmental Protection 825 L Street Anchorage. Alaska 99501 Mr. Robinson: During a Health Authority Site inspection conducted on February 28, 1984. it discovered :hat the septic system o£ l. ot 1, Block 2, Williamsou Subdivision was placed in a compromised position relative to its Yell. The septic system van installed on October 26, 1983, and had Ob:aimed waivers ft'~ your concerning setback distances of the dralnfield [rom tis ~{ veil mud two neighboring veils, as noted in permit {830516. 'The septic ta~k itself was nor addressed i ' '~/ ~pear :ha:., ~n order :o comply with Nunioi.~.~tth..e ~:~vev., however. It would ~.o con~:ra:n:s of the ~aivers the s-=-t- ~-t.~ .... Y.~ Anchorage regulations a . onete Petaonal ~ell. ~ ~el ~z:~n 86 tn 88 ~eet o[ the In view o[ the constraints concerning separation fr~ neighboring vellm and bearing in mind :hat the aep:~,c tank is an enclosed ~ater_tlght coutainer~ with calder couplln8s on both :he inlet and outlet~ it would not appear that this placement poses any health hazard to the h~eowner. I: ~ould seom that the gram:lng o~ an additional waiver con:erning the epttc tank would provide the most st-aight-~orvard aolutlon to this problem. ~ ~ would appreciate your assistance in resolving this matter and will look toward :o your reply. If you should require any additional lnformaCton~ I would be pleased to assist you. HRE/caj Sincerely, tlarald R. ghlers Envlro,~mentai gngineer ALASKA B, LIIROFIITleFITAL COFITROL Sel ulCe$, IFIC. ~nqineerinq 6 ~nuironrnenlal Studies March 6, 1984 Mr. Robert Robinson Department of Health and Environmental PCotection 825 L Street Anchorage, Alaska 99501 Mr. Robinson: During a Health Authority site inspection conducted on February 28, 1984, ii: was discovered that the septic system of Lot 1, Block 2, Williamson Subdivision was placed in a compromised position relative to its well. The septic system was installed on October 24, 1983, and had obtained waivers from your office concerning setback distances of the drainfield from its own well and two neighboring wells, as noted in permit #830514. The septic tank itself was not addressed in the waivers, however. It would appear that~ in order to comply with Municipality of Anchorage regulations and the constraints of the waivers, the septic tank would have to be placed in such a compromised position. As such, the septic tank lies within 86 to 88 feet of the homeowners personal well. In view of the constraints concerning separation from neighboring wells and bearing in mind that the septi~ tank is an enclosed water-tight container, with calder couplings on both the inlet and outlet, it would not appear that this placement poses any health hazard to the homeowner. It would seem that the granting of an additional waiver coneern'ing the septic tank would provide the most straight-forward solution to this problem. I would appreciate your assistance in resolving this matter and will look forward to your reply. If you should require any additional information, I would be pleased to assist you. Sincerely, Harald R. Ehlers Environmental Engineer HRE/caj 1200 LUcsl 33rtl Au¢~ug. $ui1¢ ~ · Anchoreq¢. Alosko 99503 ,[907) 561-50z10 ALASKA ENVIRONk ,~ITAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 CHECKED BY. DATE. . :.: ,8~ ! i ii -INGER--S~'REE T- APPLIC NT FILLS OUT IJPPER HAt ONLY. Property O~vner ~(.~_ [~ ;~j/,.jh -] ~)/(/11::~,~ Phone Lending Institution /~:~¢~./['~L. f%~/¢)A//( :'): /~E./~':,'/; /"~ I /11/~/ /'~/11~; ~_W¢¢~2:,~¢~ Phone /* / Type of Resigned ~Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply ~(dndivldual ATTACH WELL LOG. A w~l Icg is required for all wells drilled sln~e Jun~ 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg If available). ~ Public Utility Sewer Disposal ~ndivldual . Year Individual Installed: ~ Public Utility '~ When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING OAN BE INITIATED. Time Time Tired Time Date Date Date Date '~ - Insp~tor Insp~tor Insp~tor InsB~tor Field Notes~ ~ ~)APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well 1o Tank Septic T~k Size