HomeMy WebLinkAboutATELIER BLK 1 LT 8 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
Permit Number: ,~1~/ 5)~,,0/~ PID Number:
Name~ ~~ Wastewater System: ~ New ~ Upgrade
Addre~ ~r~~ ~N~ ~95~ ABSORPTION FIELD
Phon~..~/~ ~ IN°'°fB'~°ms: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
Block: Subdiv~ion: Depth to pipe bo~om from odginal grade: Gravel depth beneath pipe
WELL: ~ew ~ Upgrade Gravel width: ~ Ft. / J ~ Ft.
Cla.ification~ ~, , A,B,C,: Total Depth: Cased To: Total absorption area:
.Driller: Date Drilled, Static WaterLevel:F,. Installer: ~~¢~
GPM Ft. Ft. .,
SEPARATION DISTANCES ~eptic ' U Holding a S.T.E.P.
From Tank Field S~tlon Tank Sewer Lin~ ~ ~ff~ ~
Welb' /~/ //2' ~/~ ~/~ /~' Material~r~ Number of Compa~ments:
Sudace
w,t~, PlO0~ ~ ~/~ LIFT STATION
Foundation ~?' ~ ~/~ "Pump on" level at: ~at: J High water alarm at:
Remarks: BENCH MARK
Location and Description:
~ /~ ~ ~t.
Inspections performed by: ~ ~ K ~ Dates: 1st O~/l~/g&
.,. . .
Depadment of Healt~and Human~e~ices approval ,,~. ~:~.,,,...~... ¥~o,~ ~x~--
Reviewed and approved by: Date: / 2 -2 7-~ ~'a~ ,~ .:~. ~,.
72-013 (Rev. 9/91) MOA 25
Permit No. SW960198 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: ATELIER LOT 8, BLK 1
PtD No.: 041-031-22
SCALE 1" = 60'
[] - TEST HOLE
· - MONITOR TUBE
o - SEWER CLEANOUT
+ - WELL
EASEMENT
LEACHFIELD
SWING TIES:
A - C = ;SS.3'
B - C - 29.9'
A - D = 69.0'
B - D = 56.5'
1250 GAL
SEPTIC TANK
TH1
DRIVEWAy
SCALE
CEA Esmf
507.07
ATELIER DRIVE
WELL
ELEVATIONS
(NOT TO SCALE)
TEkiP BM IS FLAGGED NAIL IN TREE
ASSUMED ELEV = 100.00
ORIGINAL
'l-
GROUND
I LEVEL AT:
+1' ^DDED FILL at,/ 98.01 ~_ /
N85.6
10/28/96
EN(~INEER'8 SEAL
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PAGE 1 OF 1
PERMIT NUMBER:SW960198
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:WALLEEN SHARON LYN
OWNER ADDRESS:1087 POTLATCH CIRCLE
ANCHORAGE, ALASKA 99503
DATE ISSUED: 7/16/96
EXPIRATION DATE: 7/16/97
PARCEL ID:04103122
LEGAL DESCRIPTION:
ATELIER ELK 1 LT
LOT SIZE: 65340 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL 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 WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 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:
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
July 2, 19961
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Atelier Lot 8, Block 1
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic system will have very limited impact on adjacent properties for
the following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all + 30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\1996\96-057A-NAR.DOC
SEPTIC
AREA
UNDEVELOPED
1250 GAL
SEPTIC TANK
i~TH 1
~ROP DRWEWA¥
PROP WELL
LOCATION
IOxl CEA Esmf
0
307.07
ATELIER DR
NO SURFACE WATER
NO KNOWN CURTAIN DRAINS
5
[] - TEST HOLE
· - MONITOR TUBE
o - SEWER CLEANOUT
+ - WELL
EASEMENT
SEPTIC
PROPOSED LEACHFIELD
~- EXISTING LEACHFIELD
WELL/SEPTIC SITE PLAN
LEGAL: ATELIER LOT 8~ BLOCK 1
OWNER: N/A
CONTRACTOR: HAGMEIER CONST. CO., INC.
~o.# ~-OS:AI O~T~-: :/a/~a I SC~L~- ~" = ~0'
EAGLE RIVER ENGINEERING SERVICES
A P.O. Box 773294
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
Township, Range, Section:
1
2
3
4
5
6
7
8
9
lO
11
12
13
14
15
16
17
18
19
20
COMMENTS
SLOPE SITE PLAN
/ I
'/
WAS GROUND WATER /V,~
ENCOUNTERED?
S
L
IF YES, AT WHAT -- O
DEPTH? p
E
0epth t0 Water Alter
Monitoring7 ~ Date: 7-8 '~
Reading Date Gross Net Depth to Net
. ~--.Z~/~ J~__ Time Time Water Drop
/ ,~/p,/~, ~; ~ ~ ~ ? 5/Ju',
PERCOLATION RATE ~o.___~._O (mmuteshnch) PERC HOLE DIAMETER
TES~ RUN ~ETWEEN 5':, 5' ~T AND ~" 5 ~T
.ERFORMED 8~: Wt~ , ~P.~S~.-~..-- C,RT,F~ THAT TH,S TEST. WAS ,ERFORMED ,N
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: "~ ~'~
72-008 (Rev. 4/85)
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 96-057
Calculated By: LB
Date: 7/2/96
Legal: ATELIER LOT 8 BLK 1
Single Family 4 Bedroom Dwelling
TEST HOLE
Deep Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 600 gallons
Percolation rate = 2 minutes per inch
Wastewater application rate = 1.2 gallons per day per square foot
Required absorption area = 500 square feet
Trench width (W) = 3 feet
Gravel depth (D) = 9.5 feet
Required length = Required absorption area / 2 / D
Required length = 500 / 2
Required length = 30 feet
Total Excavation Depth = 12.5 feet
/ 9.5
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL:
Atelier Lot 8, Block 1
07/02/96
GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
9. Any remaining open test hole excavations shall be filled.
SEPTIC TANK
1. Septic tank shall be a 1,250 gallon MOA approved tank.
TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth
of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 12.5' at any point.
4. The effluent line within the trench shall be laid level within 0.03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface
water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing
private well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 12.5' GRAVEL DEPTH = 9.5' under pipe, 2" over pipe
TRENCH LENGTH = 30' TRENCH WIDTH = 3'
SOIL RATING = 1.2 GPD/ft2 BEDROOM CAPACITY = 4
SEPTIC TANK = 1,250 gallons minimum
Twenty-four (24) hours notice required for all inspections.
\1996\96-057a-spc.doc
~er{orrned For Tom Taylor
Lena] qescrintion' Lot 8 Block ....
This Form Renorts 5oi t s Loo Yes
2204 Cleveland Anchorage, Al. aska 99503'
Ba~e performed 7-30-77
Percolation Test ...............
nenth
r=et , Soil Characteristics
Sandy Gravel
10--
Hard Drilling
16
!8--
Was Ground Water Encountered? No
IF Yes, At what Denth~
I
- i I
JReadinQ .qate Gross Time Net Time Depth to H20
?ercolation Rate .... ~, ·
Proposed Inst~-~,'-l'~'{-i°n' Seena~e Pit urain F~eld
Beoth of Inlet Deo~h"To '~'0tTom Of Pit O'P'--~
.- ' .~ ~'.,q(,3
- C;,T-r ~'d 7-30-77
Tom Taylo~ ''~ S bdivi~it, n
-,,~,cri r,t~ ~n Lot B E,'i o c 1~ u ~st
· . ._ Fercolat~on '- --
r'orts soils Loa Yes ...........................
ret, th
r r (., t . .
sandy
lO -
l~ard
16
Vas firoun4 N~'ater
l~ Yes, t,t what
Soil F. ha r.~ c.t-e r i s t ~ c s
Gravel
Drilling
Enrot~ntered? No
Der, th~
Date
- ~ .................. : .......... '.'fi nute
?er,:olatinn P. ate ..... Seenaoe P~t
F,r, rcsed Installation: ~.anth 'To
Grnss TiT, e Net
t
1
r.;; n th tO
n Field
(if Pi t Or
r,r,~,th of Inlet .
crv!,~Lt, iS. 100 s q~..t.a!i
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: �Zt5 Zc
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and 000c00
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or • • • "'
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions. O i
groundwater levels (that may fluctuate during the year), quality of construction (materials and � A TH
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and P """' •"• •.• •"•.' .•.•""•
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of , - • • • • • • •
the well or septic system. GEG makes no representation whether an alternative well or septic system fA. Gorne-s:
can be installed on the property in the event either of the current systems fail to perform adequately in OQI� 9. , E3�'
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or�o�o
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �� roresslo0 � oQ
whatsoever.
04000���
6. DSD SIGNATURE �.`
V' System #1 Approved for � bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with
tOF(�i� #AECC884
ON-SITE
g WATER AND m
WASTEVVATER )
J Ilovyr��`�,ons
J `0n <l�
S9
))))})111
By: / Original Certificate Date: �J Z
The Municipality of Anchorage evelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist �� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
CA
1. GENERAL INFORMATION:
Complete legal description ATELIER; BLOCK 1, LOT 8
Location (site address) 9330 Basher Drive *Anchorage 99507
Current Property owner(s) Tracy Davis Day phone 907-242-1442
Mailing address
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:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class_Well
❑
Community
❑
Public Water System
❑
Public Sewer,
❑
WaiverNariance request for:
Distance:
Received by;
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ U10 Waiver Fee $
Date of Payment a 7 Date of Payment
Receipt Number Q r3 59 G Receipt Number
COSA # 0-'5D'G2.01 LI65 Waiver #
0101
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date'. J . 0t 2a
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features, Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
i«((((((((#AECC884
6. DSD SIGNATURE OF,q,�/��
L-'� System #1 Approved for bedrooms
System #2 Approved for bedrooms _ ON-SITE '
Disapproved
WATER AND m
WASTEWATER z
Conditional approval for bedrooms, with
Ilons,
1
01
TH
,J f\A. Go -
rne-s.
I��'s.�•
E--74&3—
^G
Pro(.55110 &
By: ,�� ����� Original Certificate Date:_ A�Z-Z
The Municipality of Anchorage development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist_ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
IA,
CASA Checklist
Legal Description: ATELIER; BLOCK 1, LOT 8
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 2/6/97
Total depth 192 ft
Cased to 180 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 8/6/20
Static water level at beginning of test 44.4 ft
Comments
B. TANK DATA
Age of tank(s) 24 years
Tank type/material SEPTIC/STEE
Measured operating fluid level in septic tank
50"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 7/23/20
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 8i29i96
0 ALL standpipes present per record drawing
Total measured depth from grade 16.1 ft (max)
Measured depth to pipe invert from grade 6.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective BOTH 9.25'
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 041-031-22
Structure served by this system
Well production at time of test 3.8+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes Q No
N Coliform bacteria is Negative
Nitrate 7.53' mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by GEG, LTD.
Date of Sample 8/6/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Adequacy test date 8/6/20
Results QPass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 737 gal
New depth 6 in
Elapsed time 130 min
Final fluid depth 0 in
Absorption rate 600+ god
Any rejuvenation treatment (past 12 months) NONE
If yes, enter date N/A
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Q✓
Yes
Community Sewer Manhole/Cleanout > 100'
rv7 Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' F� Yes
if No
ft
Private Sewer/Septic Line > 25' F71 Yes
if No ft
Absorption Field on Lot > 100' F/� Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Q✓ Yes if No ft
Water Main > 10'
Animal Containment > 50' R] Yes
if No ft
❑✓ Yes
if No
ft
Yes if No ft
Water Service Line > 10'
F/
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' M Yes
if No
ft
n Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q✓
Yes
if No
* ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
M
Yes
if No
ft
Wells on Adjacent Lots:
if No
Absorption Field > 5'
Q✓
Yes
if No
ft
Private Wells > 100'
Q✓ Yes if No ft
Water Main > 10'
✓Q
Yes
if No
ft
Community Wells > 200'✓Q
Yes if No ft
Water Service Line > 10'
F/
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q✓
Yes
if No
ft If absorption field is under driveway comment below
Property Line > 10'
Q✓
Yes
if No
ft Wells on Adjacent Lots:
Water Main > 10'
✓Q
Yes
if No
ft Private Wells > 100' Yes if No ft
Water Service Line > 10'
F/�
Yes
if No
ft Community Wells > 200' Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
*6.5' FROM ST1 TO SHED
ON CMU BLOCKS
G. ENGINEER'S CERTIFICATION v OF ��04
1 certify that l have determined through field inspections and review �O�Q� s/�
of Municipal records that the above systems are in conformance with T y Q
MOA COSA guidelines in effect on this date. ......
............. ......�
J %y . ess., Q
OQO 9, CE -795
COSA Checklist yellow sheet QO�a pr of e s s'xoo
#AECC884
MINS/A Aj
49 1H
-
u
s SHANE A. HOLT
pe LS -6914
ppap '-....... oa
0��°Jessional Lo
N 89 57' 06" E 307.07
DRI HE
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OFRECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON (UNLESS INDICATED)
NOTE, FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
AS-BU/LT SURVEY f"=40'
NO CORNERS SET THIS DATE
8
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 8, BLOCK I,, ATELIER SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 5TH DAY OF
AUGUST , 2020
HOLTLAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
14745, FB 207--39 3455513
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. #
o4[-o31-22
CERTIFICATE OF HEALTH AUTHORITY.
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Atelier Lot 8, Block 1
Location (site address or directions)
9201 Atelier Drive, Anchorage
Property owner John & Judy Hagmeier
Mailing address 2204 Cleveland, Anchorage, Ak
Lending agency N/A
Mailing address
Day phone
99517
Day phone
248-6789
Agent
Ad dress
N/A
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well ×x
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA#21 '
5. STATEMENT OF INSPECTION BY ENGINEER
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 disposa,! 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 ~.ag]_e" R:Lver ~.ng:Lneer.Lng Se~-v'ices Phone 694-5195
Date
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms,
with the following stipulations:
Additional Comments
':: The M~ici,p,ality of A~Schorage Department of Health and Human Services (DHHS) issues Health Authority
,Approval Certificate:s.,based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does th s as a courtesy to purchasers of homes
and their lend ng institutions in o'rder 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 engineers work.
72-025 (Rev, 1/91) 'Back MOA t121
Legal Description:
A. WELL DATA
Well type /P~?I [/t~ If A, B, or C. attach ADEC letter. ADEC water system number
Municipality of Anchorage ~
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNICIPAUTY O1= A,NCHOP. AOE
825"L" Street, Room 502 · Anchorage, Alaska 9950~(~A~h~.7~¥~E$ DIVISION 1
FEEl 2 8 1997
Health Authority Approval Checklist
tt ECE[ ED
Date completed 0 ]/P.~//~ 7
Cased to /~ / Casing height (above ground~ ~ /
Wires properly protected (Y/N) ,V
Log present (Y/N) ~/~5
!
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production .
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: t~ ~//~
FROM WELL LOG
,
!o
g.p.m.
g.p.m.
Nitrate /, ~,L/ /~{~ /~_ Other bacteria
Collected by: ~"~ ~.--~
B. SEPTIC~G TANK DATA
Date installed /)~/~{.~ Tank size
Foundation cleanout(Y/N)
Date of Pumping /~/~?/~/
C. ABSORPTION FIELD DATA
Date installed tO
Length ,,.~ (~ / Width
/, ~6/) Number of Compartments i~- Cleanouts (Y/N) ,)/3-5
Depression (Y/N) /x/tS' High water alarm (Y/N) -
Pumper ~
Soil rating (g.p.d./ft:~) /' ~' System type
~.~ ! Gravel thickness below pipe ~, ~ Total depth
Effective absorption area ~'70 ~ Monitoring Tube present(Y/N) J/£5 Depression over field (Y/N) /%//)
Date of adequacy test
Results (Pass/Fail) ~..~ For ~
bedrooms
Fluid depth in absorption field before test (in.); ~'
Fluid depth ~'~ (ins.) Minutes later:
Immediately after. '--- gal. water added (in.):
Absorption rate = ~ g.p.d.
Peroxide treatment (past 12 months) (Y/N) '"'- If yes, give date '""-
LIFT STATION
Date U~stalled~
Size in gallons
Manhole/Access,(Y/N) , , " '
High water ~l~.~v~ a~* 'i }i ~ *Datum
"Pump off" level at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/l~flding tank on lot /t3 ¢ J . On adjacent lots
Absorption field o~lot J~ q J . ; On adjacent lots
Public sewer main ,A///q Public sewer manhole/cleanout A/L4
Seave'r/septic servi~e line / ~ / Lift station
SEPARATION DISTANCES FROM SEPTIC/H~g;gXII~ TANK ON LOT TO:
Building foundation ~ t Property line ~ q t
. Absorption field
-
Water mrna/service line ~0 Surface water/drainage P //-)O / Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Water,mairdsemice line 5~O '
Driveway, parking/vehicle storage area
Fe
Engineer's Name; ~1~ ~/~ Lt 7'~.4~ /~. ~-"" '
Date ~ ~:~g'a,/fv~
HAA Fee $ .~Y'~ ~ ~ Waiver Fee $
Date of Payment ,:~/2~'/~ ~7
Receipt Numbera:r94~/~>-- ;~
Rev. 8/95 OSS: haa.wk.doc
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspe~ctions and review of Municipal
tn conformance w~th MOA HAA guidelines in effect on this date.
Signature ~~~~'~
Curtain drain /4f>/gfi ~/'47' Wells on adjacent lots
Property line
Date of Payment
Receipt Number
e2/24/cJ'?
Cliutt Nmue
A'u~e~
17: ID~
CT~E ESI
II . . _
Atdic.t Z,m 8 Blo~ 1
1.d,4
O. ~00 ~/L
,t~li 1~1.
GH15 4~QO-NC~,P
FROH
: .TOHN I-I¢:IGNEIRE CO. PHQNE NO. : 248E~434 Feb. 19 J.997 ~9:$$¢~1 p1
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING & WATER MGMT
LOCATION OF WELL WATER WELL RECORD
D~ M~U~ FROM~sing'top ~.9rou~ sub,ace ~LL DEPTH: DATE OF COOL,ON
: '-- DeCth of hole: / ~ ft
BO~ DAT~ ' Depth Depth of ~sing: / ~O --f~
Material T~e and Colo¢ ,. Fro~ To
--- ' , ~' ,ff below
:~ USE OF W~: '~o~e~c
GRO~ TY~' Volu~:
PUMP ~AKE D~H: ft Hor~pow~:
~. ~ DIS~FE~ ~ COMPL~ON? ~ YES ~ ~O.'
~-"~-~r~* /'~¢~-,~ ..~.--,~-- ~,,,~ PLEASE 'MAIL WHITE COPY OF LOG TO:
Signature of Authonze~f Resii~enta'ti,~o 'D t DNR/DIVISION OF M_ININ_G & _WATER MGMT
....... a e 3601 C ~t, Suffe 800
ANCHORAGE AK 9gs03-5935.
I~tone ~07t:~89-8639, Fa~x (9071562-1384,
Atelie
Block
Lot 8
#041-031-22
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 041-031-22
1. GENERAL INFORMATION
£xpiration Date:
Complete legal description ATELIER SUBDIVISION; LOT 8~ BLOCK 1
Location (site address or directions) 9330 BASHER DRIVE * ANCHORAGE, AK 99503-1278
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SHARON WALLEEN Day phone.337-9147
9330 BASHER DRIVE * ANCHORAGE~ AK 99507
Day phone '
KEN McKF_AN w/ REF~X PROPER'TIES Day phone
2600 CORDOVA STREET * ANCHORAGE, AK 99503
276-2761
Unlesaothe~isemquested, HAAw~beheldbyDSD~rpick~.
2. NUMBER OFBEDROOMS: 4
3. 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 Department (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 pdvate or Class C well and may
be reissued with new water samples. (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.
~ Noto: Alaska Water and Wastewater Consultants, Inc. shall be paid $ Ii /-I ~ at, or pdor I
to closing for the engineering services provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As cerb'fied by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Health Authorfty Approval Guidelines for thia 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 vedfy 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 alt applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, surrE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFI-NEY A. (;ARNESS, P.E.
Phone 337-6179
Date
Englneer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough.
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the perfon'nance 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 soils condition, groundwater levels that may
fluctuate dudng 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 futura pedormanca of the system, horde they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of hew long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. 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 authotfzed, nor will it confer any legal ~fght whatsoever.
5. DSD SIGNATURE
~ Approved for J'~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the fllowing stipulations:
-'-.7og%
~. WATERAND :m
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
~ :. WASlbWAIl:.K
~=. ;.. PROGRAM
....
(Rev. ~2~)
Original Certificate Date: ~-"-- ,~ 4'] - 0 ~
Municipality of Anchorage
Development Services Department
Building Safety Dlvlsldn
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(oo7) :~3*'~M
Legal Description:
A. WELL DATA
Wall type ~ATE
Date completed
Total depth
HEALTH AUTHORITY APPROVAL CHECKLIST
ATELIER S/D; LOT 8, BLOCK 1 Parcel ID: 0¢I-031-22
2/1997
192 ft.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform f') colonies/100 nd.
Amenic: ~/A mgJL.
e. SEPTIC/HOLDING TANK DATA
Tank Type/Material
If A, B. or C provide PWSlD~ N/A
Sanlte~y seal (Y/N) YES
Casedto 180 It.
FROM WELL LOG
2/1997
45 lt.
10 g.p.m.
Weld Log (Y/N)
Wlrea prope~y protected (Y/N)
Casing height (above ground)
AT INSPECTION
5/21/2002
47
a.1 g.p.m.
YES
24+ in.
Nitrate ..~mg./L. Olher bacteria ~.._colonles/100 mi.
Date of sample: 5/21/2002 Collected by: AKWWC, INC.
Date installed 8/1996
Tanksize 1250 gal. Number of Compertments 2
Foundation cleanout (Y/N) YES Depression over lank (Y/N) NO
Date of pumping 5/21/2002 Pumper
C. ABSORPTION FIELD DATA
Date installed a/1;;e SoU rating ~,r fl~odrm) 1.2
Length 30 ft. Width 3 .ft.
Cleanouts (Y/N)
High water alarm (Y/N)
CHUGACH PUMPING
System type. TRENCH
Gravel below pipe 9.5
Totaldapth 16.o ft. Eff. absorptionaraa 570 ft= Monitodngtuba YES
Date of adequacy test 5/21/2002 Results (Pass/Fall) PASS
Fluid depth in absorption field bafom test 29 in. Water added 7.t0 gal.
Elapsed Time: 15 min. Final fluid depth *35 in. Absorption rate >=
Any rajovenation treatment (.mast 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
*LAST 580 GALLONS ADDED ONLY CAUSED A RISE: OF 2'
Depression over field NO
For 4. bedrooms
New depth 37 in.
600+ g.p.d.
D. LIFT STATION
Date inst~lled SIz~ in gallons
'Pump on" level at in. 'Pump ol~ . High water alarm level at in.
~ Cydes tested. Meets alarm & cimuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot100'+
Absorption field on lot 100'+
Public sewer main N,/A
Sewer/septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N,/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N//A Water sew/ce line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water sew/ce line 10'+ Sudace water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
Absorption field 5'+
Surface water 100'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
mvtew of Municipal records that the above systems ere in
conformance with MOA HAA guidelines in effect on this date.
Water main N/A
Driveway, parking/vehicle storage !0'+
Engineers Printe~J Nan~e .
Date __/~2-'
JEFFI~EY A. C.-ARNES'~
Date of Payment
Receipt Number
(Rev. 12A)1)
Waiver Fee $
Date of Payment
Receipt Number
18:41 2781149
1"--30'
LOT 8
ATELIER SUBDIVISION
LOT 8, BLOCK 1
AS-BUILT '"' ....... ' "" '
~Yo23-02 02:22~ FROR-CT&E ENVIRO~NTAL SRV
~tr~ CT&E EnvironmentalServlceslnc.
907561530l
T-952 P.02/03 F°485
CT&E Ilef,~
Client Name
Project Namo,W
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remarks:
1022860001
AK Water & Wastewatcr Consultants Inc.
Altelier
Atelier Lot $ Block 1
Drinking Water
0
All Dates/Times are Alaska Standard Time
Printed Date/Time 05/23/2002 11:18
Collected Date/Time 05/21/2002 12:45
Received Date/Time 05/21/2002 13:20
Results PQL Uniu Method
Allowable Prep Analysis
Limits Date Date Init
NitTnte-N
1.50
0.200 mgq. EPA 300.0 (<10) 05/21/02
~/crobiolog~
Total Coliform
col/lO0~. SMIg 9222B
05/21/02 KAP
CT&E Environmental Services Inc.
Laboratory Division
200 W. Potter Drive
Anchorage, AK 99518-1605
)rinking Water Analysis Report for Total Coliform Bacteria Te~: 10o?) 562-23~3
, . IDE BEFORE COLLECTING SAMPLE Fox: (907) 561-5301
,v.,~o llvsrRuc~~" ~.v_u_.~-~''~'' ...... ~TOV,¥ ·
~F.K SUPPLIER Annlysie shown fifth Water SAMPLE to be:
= pUBLlCWA Z"SYS '"" 'UI I I I I [] ' '
WATER SYSTEM
Send Invoicit
SAMPLE DATE:
SAMPLE TYPE:
Month
t3 Repent Sample (for routlnesample
with lab ref. no. . )
[] Special Purpose
Day Year
O Treated Water
[3 Untreated Water
Time Collected
Satisfactory
Unsatisfactory
Sample over 30 bouts old, result~ may
be unreliable '
Sample to~ long in transit; sampl.e nh. ould
not be over~ {~houts old at exammatio,n
to indicate tellable r~ults. Please seuo
new sample via special deli,v~y mail.
Date Rectlvcd -
Time Received ~ ~ '~
Annlysls Began ~ U~L~ 0
Annlytleal Melhod: l~t_Membranc Filt~
"~ MMO-MUG
Number of colnniedl00 mi.
Lab Ref. No. ResUlt* Analyst
SAMPLE LOCATION .~ ' Collected ~By
BACTERIOLOGICAL WATER ANALYSIS RECORD
E. Call
Comments:
II.
SenttoA.D.E.C. Aech rbks Jun ~
Fazed
D~ts: Timo:
Client ootlfled of unsatisfactory resulis:
[] []
Phoned Spoke with Fa~td
Date: . Time:
Colonltdl00 mi
, COLIFIR~ ....
Cofiform/100 mi
M.Mo-MUG Rtsult: Total C~liform
Membrnne Filter:. Direct Count
Verification: LTB BGB
Fecal Coliform Confirmation
Final Membrane Filter Results
Reported By ~ Dale _
§8~-~ [O/EO'd Z96-1 IOE~l$~106 MS 3YIN~NO~IAN] t{13-~0~t IIdZZ:ZO ZO-(Z-IY~