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HomeMy WebLinkAboutT12N R3W SEC 33 LT 203TI 2N R3W ction 33 Lot 203 #018-322-03 MunicipalityofAnchor~?-?5 0~:79 I~age ~' of--~ · DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION " P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~'-~ c/C~l PID Number: N~: Wastewater System: ~ New ~Upgrade Addr,,,: ABSORPTION FIELD Phone: I N°' ~edrO°ms:- ~Deep Trench U Shallow Trench D Bed Q Mound D Other Soil Ratin : Total Depth from original grade: LEGAL DESCRIPTION ~. ~ Lot: Block: Subdiv~ion: Depth to pipe boEom f om o gna ,grade: Gravel depth beneath pipe ~¢~ ~.~ ' Ft. ~ ~ Ft W~; ~ New ~ Upgrade Iravel width:~ Ft. Number of lines:/ 0i~tance~een lines:~" Ft Classification (Private, A,B,C): Total Depth: Cased TO: ~otal absorption area: Pipe material: Ft Ft. ~ SQ. Ft. Driger: Date Drilled: StaticWater Level: ~nstafler; Date installed: Fb ~ ~ Yield: GPM PumpSetat: Ft. CasingHeightAboveGround:Ft. TANK SEPARATION DISTANCES ~s.pt~o a Ho,,ing ~ S:T.E.,. TO Septi~ Absorption Lift Holding 'ublio/Pr[vate Manufacturer: Capacity in gallons: From Tank Field Station Tank ~ewer Lines ~ Material: Number of Compa~ments: Su~ace /~ LIFT STATION Water / oO ~ / ¢O ~ Line I ~ I ~ ~ t Foundation /~ ~ / O ( Pump Make & Model Electrical Inspections pedormed Cudain Drain Remarks: BENCH MARK ENGINEE~;8 ~EAL Inspections performed by: ~,~~ ~ Dates: 1st 2nd Department of Health and Human Se~ices approval '~ Reviewed and approved by: Date:/-/~- 72~013 (Rev. 9/91) MOA 25 AS-BUILT VASTE~ATER ABSDRPTInN SYSTEM Lot 203~ ~W1/4, S33, T12N, R3W A-1=25,6' B-1=22.5' A-2=26.6' B-2=26,8' A-3=20,9' B-3=31.8' ~-4=19,7' I]-4=34,3' A-5=al,a' B-5=35,7' A-6=22,6" B-6=35,5' A-7=89,7' B-7=85,9' A-8=40,8' B-8=15,6' A-9=54,7' B-9=15,9' A-10=55,7' ])-10=16.3' A-11=61,7' B-ii=31,1' A-12=65,9' B-12=40.7' Designs Pert, Rate o? 3 mln/[nch 3 Bedroom House 375 SF o? Absorption Required Use Deep Trench 4' Deep, 50' Long To'~l Dep'~h Is 9' PREPARE]] FDR: Mr WllUam Bousque~ 15830 Old ~;ewerd Highway Anchorage, AK 99516 (907) 344-7073 STEVEN R, PANNDNE, P,E, P, D, BDX 142085 ANCHDRAGE, ALASKA 99514 274-0308, 272-8218 F~x DATE, 1-18-96 ! Ag-BUILT $CALE~ 1'=50' AS-BUILT DETAILS WASTEWATER ABSDRPTIDN SYSTEM Loi; 203, SW1/4, S33, T12N, R3W 96-01-15 08:19 IN Z PREPARED FDR" Mr WItil~ Bou~que'c 15~30 Did Sewe?'d Hlghwoy Anchor~e~ AK 99516 (907) 344-7073 STEVEN R. PANNDNE, P.E. P, D. BDX 142025 ANCHDRAGE, ALASKA 99514 274-0308, 272-B218 FAX DATE~ 1-12-96 [ ~UT TU SCALEI AS-BUILT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519 6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950401 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:ROWEN SIDNEY S & IDA B OWNER ADDRESS:iS230 OLD SEWARD HWY ANCHORAGE, AK. 99516 PARCEL ID:01832203 LEGAL DESCRIPTION: T12N R3W SEC 33 LT 203 LOT SIZE: 62900 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 12/06/95 EXPIRATION DATE:12/06/96 4~ 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 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: RECEIVED BY'~~ Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorago, AK 99514 (907) 272-8218 Municipality of Anchorage Department of Health and Human Services Environmental Services P.O. Box 196650 Anchorage, AK, 99519-6650 November 18, 1995 ATTN: Mr. Dan Roth RE: Lot 203, Section 33, Township 12N, Range 3W Request for Sewer Upgrade Dear Mr. Roth; On March 24, 1995 you issued a Conditional Health Authority Approval for the above referenced property. At the time of issuance our plan was to excavate the existing system, install new dean-outs and test the existing system for adequacy. The fill added above the existing system proved to be unstable sands and clays. We were unable to excavate to the existing system. We excavated a test-hole in the back yard in preparation for installing a new system. The results are attached. I would request that you issue a permit to construct a new waste water disposal system per the attached engineering plans. The new system would be located on top of the bluff adjacent to the southwest corner of the existing structure. It will be located over 100 feet from the water well serving the property and from adjacent wells. A steep bluff surrounds the existing house on the south and east sides. The new system will be located greater than fifty feet away as required by the Municipal Regulations. The surrounding terrain promotes positive drainage away from the proposed system. Rabbit Creek is located greater than 200 feet fi'om the proposed system. There are no other surface water in the vicinity. The existing septic tank will be inspected and, if found competent, reused to serve the new system. If the tank is found to be deteriorated from use and time, it will be replaced with a new 1000 gallon septic tank. The existing system will be abandoned in place, and all lines feeding the system will be plugged. If you have any further questions, please give me a call Sincerely; StevenR. Pannone, P.E. C:\W'ork\15230OSH.LT2 DESIGN WASTEWAT£R ABS[]RpTIrlN SYSTEN Lo~; 803, SW1/4, S33, T12N, R3W 85 LF / luFF Design, Pert. Rate oF 3 ~ln/lnch 3 Bedroom House ./~Fi~u~ 375 SF o? Absorptlo~equlre, d Use ~eep TrenEh 4'~Deep, 50 Lon9 To~L Depth Is ~1~ PREPARE)] FDR~ Hr WILII=M ~ousque~ 15830 Dl~ Sewerd Hlghwo. y Anchor~lge, AK 99516 (907) 344-7073 STEVEN R. PANNDNE, P.E. P. D. BDX 148025 ANCHDRAGE, ALASKA 99514 274-0308, 878-8818 Fax DATE' 11-9-95 ~ ~ESIGN ~ALE~I'=50' DESIGN DETAILS WASTEWATER ABSFIRPTIBN SYSTEM Lot 803, SW1/4, S33, T18N, R3W Z Ld PREPARED FDR~ Mr William Bousque~ 15230 Did Sewerd Highway Anchor~ge~ AK 99516 (907) 344-7073 STEVEN R, PANNDNE, P,E, P, D, DDX 142025 ANCHDRAGE, ALASKA 99514 274-0308, 272-8218 FAX DATEI 11-9-95 NDT TD SCALE DESIGN i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~'~./) LEGAL DESCRIPTION: ~Zo~/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS DATE PERFOF Township, Range, Section: T/.~ J'~l I~ ~ SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? p E Depth (o Water After Gross Net Depth to Net Reading Date Time Time Water Drop II- 1 1~-.~5 -~ ~ ',/~ I'~ ~-~ z_ =~ '/~ ~/~ PERCOLATION RATE -~ (minutes/inch) PERC HOLE DIAMETER TEST RUN ~ETWEEN ~E FT^ND :~£ FT PERFORMED BY: ~ .~ ~/~9,,~,~.~ ~, I~ ~ ~ CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /~'--//~;' -- ~ 72-008 (Rev. 4/85) Anct orage P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-~k1~ 4 7 4 4 TONY KNOWLES. MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 9, 1987 Ralph Peterson 4929 West 80th Avenue Anchorage, Alaska 99502 Subject: T12N R3W Section 33 Lot 203 On-site Sewer & Well Permit ~860253 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are. issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Sinc~ely§ R.W. Robinson Program Manager On-site Services RWR/ljw eric: copy of permit ~)EPARTMEN]' bF HEAL. TH AND ,_N,2 J.l~l.)NI _N 1 AL.. PRE]TECT'I ON 'V' ~ " 'F -. ~ "~ ]'" :'~r 995~: 1 86 ] ~75 ]! E:lxlb.[ I,~EI._.I ~L.I. DES I GN 07/3 l 186 AI::)PL .[ .r.]~::fiqT '_-' RALPH I::"IETERSON a[)l)t';,'EL:i~ili .q-9;:i~9 IAI. 80r'H AVE. ANCI'IOI::;:A~GIE, Al< 9?502 CON'f-A[H F'HONI~:; ~ 2-q. 3-~ 12'.08 LEGAl_ DE?.E. RIP~ SLJBDIVISII]N: I'qJ.:f I_OT~ BI_M 2":}'; ..ECl I014,, ...,..:, I[.)WNoHiI-. .I.~:1,1 RANGE;: LOT S'.'2E: 80000 (SQ.,F:'T. OR ...~I..,RE,.,) I L ILl... NA i c:ei*t.:i, iy that: :1.,, I am familiai' wi'Lb 'l:.ba' I-equinement. s top ,on-.site sewer's arid wells as set. ~ol-'tb I:)y U]e Mun:i.c:ipalit. y of Anchol'age (MOA) and IL[]e State of A!aska. 1:~, i ~):i. II inst. aI1 .the myst. em in ac;cc~nclance with all MOA c:odes and Pegulat. ions, and in compliance wi'Lb the des~igi'] c~-i.t, er'ia of tbis per'mit,, :;i;~ I w:i. ll adber'e 'Lo all MOA arid Bt. ate of Alaska peciuii"emerit, s fop tbe set. back d:i.;~itanci?s ir. om any existing k~e].l:, ~ast. et4ata'l* disposal, system op public .[1::' A I..!F'I STAT!OIg IS INSTAL. I_EI) !N AN AREA COVIERED BY MOA BLIIL.D.[NG ~]ODIES, tHiEI',t (~) AN E:L.ECTRICAI. PERMIT AND INSF'EC]-ION HUST BE OBTAINED; (2) AS-DUII-TS Ni:L.i. NOI BIE AF't::'ROVED MI"I'HOUT AN EL,.ECTR!CAL., INSF'ECTIOI'4 REPORT; AND (3) THE ,:;:.L,I:::,t,,!~..!~,AL W(..~r... Ilb.:~ ,:,1:: 9t.,~t~L ¢::,~' A L.J,M_N.,..~ED L[...L...fF ....... I. AI.t. ............. ......... ........................................................................................... ~:g::'Pt,... I C~I'i I ~ !-bd.,.F'l I PE'i ERSOi".! '' ' T ENE,.JY PRODUCT DESIGN ~] CONSTRUCTION I~} RESOURCE DEVELOPMENT SOILS LOG - PERCOLATION TEST PERFORM'ED FOR: ,/~ L P// ~)E T ~",'~-~ o/%/ DAtE"EREORMED'- %///./a~ LEGAL DESCRIPTION: 1 4- 5- 6 7- 8 9 7:,/-/, ~ / SLOPE 10 11 12 13 14 15 16 17 18 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT · T r ..GY ARNA. D PLAN ~ MACHINE --' pRODUCT e~ ~ MATERIAL · ~: i~l RESOURCE DEVELOPMENT ~. I--I DESIGN ~] CONSTRUCTION SOILS LOG -- PERCOLATION TEST PERFORMED FOR: /~::~/4~ L LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 g. 10- 11 13- 15- 16- 17- 18- 19- p~-TE--,e~ o lv DATEPERFORMEO: /vO Y SLOPE ' SITE~PLAN Emi R, ~,arnatd WAS GROUND WATER ~ ENCOUNTERED? F~ O P E IF YES, AT WHAT ~ OEPT.~ // Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minute/inch) TEST RUN BETWEEN , FT AND FT COMMENTS ~/'~) ~/-~"~ / ~-J ~ ]',/~' July. 29, 1986 Municipality of Anchorage Department of Health and Human Services Environmental Services Division Off Site Services Program Box 196650 Anchorage, Alaska 99519-6650 Attention: John Kennedy Subject: B.L.M. Lots 203, and 203A, S.W. 1/4 Sec. 33, T 12 N., R 3 W., S.M.; Granting of alternate absorption drain field for septic tank. Dear Mr. Kennedy: I, the undersigned, Ralph Peterson of 4929 West 80th Avenue in Anchorage, Alaska, am the owner of record of both of the above subject lots located in the area of Anchorage known as Rabbit Creek and do hereby agree to the following easement on Lot 203A located in the S.W. 1/4 of Sec. 33, T 12 N. R 3 W., S.M. as follows: 1. This easement is an alternative easement to be utilized only when and if reasonably necessary for additional absorption field drainage of that certain septic tank system On said lot 203 as indicated by the design and application of Ralph Peterson dated June 19, 1986 (prepared by Barnard Engineering of Anchorage, Alaska). ~ copy of said design is attached hereto as Exhibit A. 2. This easement shall be located in accordance with said engineering firm's drawing (Exhibit A) as a natural and logical extension of the drainage field currently found on such drawing on said lot 203, the exact location and length of which to be determined as needed at the time. 3. This easement shall continue until such time as the Municipality of Anchorage has installed a public sewer system servicing said lot 203 and until said lot has been hooked up to said sewer system, at which time this easement shall automatically, without more, cease to be effective. ~ DATED THIS ~ of July, 1986 R~lp{5 Pe~e~son, Owner ~ ~-~~/~ 4929 West 80th Avenue ~~~ Anchorage, Alaska 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) /c..q~ ~ otb ~,~--~o_~-~ ,,~/6t~A'~: Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. -5 NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1t91) 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 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~-~A,,u,~ow¢ Address Engineer's Phone ~'~_-¢~7~/? Date i .-¢z - ? ¢, DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date/-//,¢' ~"~/ The Munlcipality of An'chorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lerCding institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage 96-07-15 08:18 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825%" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well type'~J~ r~ tv Lo~ present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well produ~tig[t Health Authority Approval Checklist ...q;5~ Tt"z~a ~.~-o ParcelI.D.: WATER SAMPLE RESULTS: Coliform O IfA, B, or C, attach ADEC letter. ADEC water syste]n number Date completed Cased to -.7- c? I Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION FROM WELL LOG / ~ g.p.m. ':3-. ~ g.p.m. Nitrate ~>, q~...~ Other bacteria ~ Collected by: { a~oO Number of Compartments ~- Cleanouts (Y/N)__ Depression CZ/N) b-~ High water alarm (Y/N) ~ Date of sample: ~--~,~[ '~ q~ B. SEPTIC/HOLDING TANK DATA Date installed lc[, ~ {o Tank size Foundation cleanout (Y/N) ~ Date of Pumping ~ t'z-~t~-e,.CPumper C. ABSORPTION FIELD DATA Date installed 1'2--2~ Length ~ 0 ' Width Effective absorption area Date of adequacy test :,t; Soil rating ~or fl'zfodrm) l, 2... 2 / Gravel thickness below pipe System type ~ ' ~., Total depth l$.-t Monitoring Tube present(Y/N) '"C Depression over field CZ/N) Results (Pass/Fail) c-~0x.-.%25 For ~ bedrooms Fluid depth in absorption field before test (in0; Flnid depth (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/Iq) hnmediately after gal. water added (in.):"'~Ct V Absorption rate = g.p,d. If yes. give date Llliq' STATION Date ins~tallcd-~--'~ Size in gallons Manhole/Access fY/N)~1 at* at* High water alarm level *Datum ~ Cycles tested ~ "Pump of£' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic sea,'ice line : On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building £oundation / 0 ~ Property line ~ ~ AbsOrption field / d) t Water main/se~wice liae _ / OC>q'' .Surface water/drainage { ~O'4'' Wells on adjacent lots ! ~ t:,"t'- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundatioa / Surface water / O o -4'- Curtain drain F. ENGINEER'S CERTIFICATION Water main/service line / o O Driveway, parking/vchiclc storage area Wells Oll adjacent lots / ~ * ~'-- Property line I cert~[_P that i have determined thrufield inspections and review of Municipal records in coaJbrmance with MOA IIAA guide[iaes in effect on this date, Engineer's Name Date CE-8149 HAA Fee $ Date of Payment Receipt Nmnber Waiver Fee $ Date of Payment Receipt Number Rev. 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) l~' Property owner ,- ~D,,IL-L Day phone Lending age.n .cy_ Day phone Mailing address. Agent Address Day phone U~les_s,oth?rvWse requested, HAA will be held f(~r pickup. ' NUMBER OF BEDROOMS: ,-~ TYPE OF WATER SUPPLY: _ Individual wel "(' Community well Public water NOTE: lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: NOTE: if community well system, provide written confirmation from State ADEC attest- Individual on-site Holding tank Community on-site . .,.~, Public sewer ,,, ,7:? ? .... " .,. If community wastewater system, provide written confirmation from State ADEC attesting to the legalit7 and status of system, 72-025(Rev, I/91) Front MOAI~21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and al 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 Address Engineer's signature DHHS SIGNATURE Approved for · ~ Disapproved. ~)edrooms. Phone c~ ¢ ..q-/~ Conditional approval fc~r ' '~ ~ ~ b~lrooms, With the following stipulations: ~'REN¢/-/ ~1~ CL~/~A/F)~T¢ O~ ~OLlYP ~ ~ LI~/E FRO/~ gEPTI~- ~-/~ }-43 Additional Comments /1ONE}~ hv E[4R~ $/~z · PEP RTM V 61vE5 F LL Date ,~ - 2, ,¢ - ~'2"- '-'.- k?he Md-hJbi~¢lity of .A'r~c~orage Department of Health and Human Services (DHHS) issues Health Authority x.~pproval C~rbf cates.,[ased only upon the representabons gwen ~n paragraph 5 above by an independent professional en~ neet r,eg~stered ~n the State of Alaska. The DH HS does th~s as a courtesy to purchasers of homes and tb~/r,~e{tding i'nstit'utions in order to satmfy certain federal and state requirements. Employees of DHHS do not conduct' [nSp~Sti~ns or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~5(Re~.1/91) Back MeAnt21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: [%o$ / 5 ..~ .- T/Z.~I; IL. $ '.4 Parcel I.D. A. Well Data Well type(-~) P- ~ U/~-F-C~. Log present (Y/N) '~'.~' Total depth Sanita~ seal (Y/N) if A, B, or C, attach ADEC letter. ADEC water system number Date completed ~o(t31 ~ Driller T~ ~ ~_~t,,~. Cased to ~- ? ' Casing height ~Z? · W res properly protected (Y/N) ~ AT INSPECTION ~- FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot / / Public sewer main Sewer service line ; On adjacent lots ,~ / oc) ~ ; On adjacent lots ~ ./~ Public sewer manhole/cleanout ,,,.-'/~4 Petroleum tank /~'//~ ~.> WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: Collected by: Other bacteria © SEPTIC/HOLDING TANK DATA Date installed / Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size / Omc) Foundation cleanout (Y/N) Compartments Depression (Y/N) Alarm tested (Y/N) -'- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ,/"2-o ~ On adjacent lots To property line (~ c~ ' Absorption field Sudace water/drainage / ~ Foundation / C) Water main/service line ~b '..._m 72-026 (3/93)- Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~/~ Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed / ~ E~ Soil rating (GPD/FF) / Length ~.5'- Width .5' Gravel thickness Total absorption area ,"~:~-5- Cleanout present (Y/N) System type L~-~R,~- 'vP_a,dc¢ Total depth / ~c' % Depression over field (Y/N) L/O Date of adequacy test~¢~ A-T-CA c~-.z~ Results (pass/fail) Water level in absorption field before test ~ ~¢ ~rv~¢,.c H ~-¢ Peroxide treatment (past 12 months) (Y/N) /'%/ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water Curtain drain for c ~'-¢¢-JCAfter test If yes, give date On adjacent lots ~ / oc~ Property line To existing or abandoned system on lot Cutbank Water main/service line Bedrooms 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 of this inspection. Signature.~~~ EngineetsName Date HAA Fee $ ~:,=-.~'/~ · ~ Receipt Number '-~' ~' (/c::~'~;?~'? J 72-026 f3/93)° Back Waiver Fee $. Date of Payment Receipt Number CE-8149 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD, # ~:~/~" ~'~' -<¢)'~ 1. GENERAL INFORMATION Complete legal descri ption Location (s. it.,e, address or directions) F/~sr .,.~,c..s¢ ~.,,~ ~/~f, ~/¢~/~-/¢ Pro perty own~./~-,'~'~ ~/z~=,s~,,,~,4s< ~- ,~'~-~-~-'~_.~,,~/ ' Mailing-address' ~ ~', ~"¢"~¢ /~,/o Lending agency Mailing address" Day phone Day phone Agent Day phone Address 3. TYPE OF WATER SUPPLY: Individual wel Community well Public water Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: .~ NOTE: lng to the legality and status of system. _. If community well system, provide written confirmation from State A'DEC attest- - 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 IRev. 1/91) Front MOA #21 sluewwoo leuo!)!pp¥ :sUO!lelnd!is BU!MOlIOJ sql q)IM 'stuooJpsq Jo~ leAOJdde leUO!~!puoO 'DSAoJddesIO 'suJooJpsq JOj ~s^o~ddv /N( 21:In.LYNgI$ SHHa '9 'uo!loedsu! s!ql jo e~ep eq~ uo lostje u! suo!lelnBeJ pus 'seoueuipJo 'sepo9 els19 pus led!o!unlAl lib ql!~A eoUe!ld~uoo u! s! uusls/~s lesods!p Je)e~Aelse~ Jo/pus XidUns- ce~eA~ el!s-uo sql 'uogoedsu! pus uo!leS!)se^u! Au~ ~uo~j pus selU eBe~oqsu¥ jo Xl!led!o!un~;eql uuo~¢ peu!e)qo uo!le~u~oju! eq~ uo paseq 1eql~Jps^~eqMnj I 'u!eJeq ps~eo!pu! e~n~on~ls jo ed~l pus · s~uoo~peq to ~equunu eLl~ ~oj e~enbepe pus leuo!leunj 'eJes s! ~e~s~s lesods!p ~e~e~e~,set~ ~o/pue ~lddns celeA~ elfs-uo sql leLl~ st~oqs uo!leo!ldde le^o~ddv XlMoqlnv q~leeH s!q~ to uo!leB!~se^u! /~Lu 1sql ~JMSA ] 'A~oleq uA~oqs elep uo!lep!le^ sql to se pus o~e~eq pex!JJe lest ~uu ~q psu!l~eo s¥ ,, EI=~=INION=1 AB NOI.LO=IdSNI 40 .LN~IN3.LVJ. S "g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA ~LITY OF ANCHORAGE F~NTAL SERVICES DIVISION R_EEEIVED Well type ,,~,~/z.-'~/~'~' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) .'4'/X' Date completed/,~,,/~,~/,~'~ Driller Total depth 7~ ~ Cased to ~ ~ / Casing height Sanitary seal (Y/N) ~ , Wires properly protected (Y/N) FROM WELL LOG~ AT INSPECTION Date 0f test ' /~/~ ¢ Static water level 5~2 ~' / ' Well flow ' /~ g.p.m. ~,~ Pump level 5~ SEPARATION DISTANCES FROM WELL TO: o~/~Y ~ Septic/holding tank on lot / ~ ~ /~ ; On adjacent lots ~ Absorption field on lot //~ ~ ; On adjacent lots ~ Public sewer main ~ Public sewer manhole/cleanout Public sewer service line ~ Petroleum tank ' WATER SAMPLE RESULTS: B, SEPTIC/HCLD;;,;C TANK DATA Date installed /P'~'~ Tank size Cleanout~ (Y/R) /v/ ' '" -').. Foundation cleanout (Y/N) High water alarm (Y/N) :~ ~!(::~/¢/./~ Alarm tested (Y/N) Date of PumPing .5".~z~. ~,, SEPARATION DISTANCES FROM SEPTIC/J JCLD=NC TANK TO: Well(s) on lot / ~. 4:~" On adjacent lots To property line "~ ~'~-~ Absorption field Surface water/drainage / d-'3- Other bacteria Compartments Depression (Y/N) Foundation /'¢~ Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C, LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed / ¢,¢¢'¢ Length 7~'. Width 45~ Total absorption area Dep[essi~)n over field (Y/N) Results (pass/fail) P,,4 .¢',~' '~ Peroxide treatment (past i2 months) (Y/N) Soil rating Gravel thickness /2, ,/ Cleanouts present (Y/N) Date of adequacy test for ~" · System type Total depth If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ./2_4::~' On adjacent lots ,~ /'~:~ / Propertyline ~-,c~ / To building foundation ,.,.,.,.,.,.,.,.,..~(~;'/--~ To existing or abandoned system on lot On adjacent lots ,~ /,~'¢ Cutbank /¢/-.'~/A'¢' Watermain/serviceline Surface water ./,¢~¢I~ ' Driveway, parking/vehicle storage area ...C'~ Curtain drain '/C/./'~ ~ 2'/~'~- ?'-,~ '/Z'~/~/4 ~.,,4 ~ ~~ E. ENGINEER'S CERTIFICATION ~/~/ c~ ~ ' I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineers Name HAA Fee $ ,/'~ Date of Payment Receipt Number 72-028 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ~teven R. ~annone, ~.~. Consulting Engineer P.O. Box 142025 Anchorage, AK 99514 (907) 274-0308 Municipality of Anchorage Department of Health and Human Services Environmen~tal Services P.O. Box 196650 Anchorage, AK, 99519-6650 March 20, 1995 ATTN: Mr. Dan Roth RE: Lot 203, Section 33, Township 12N, Range 3W Request for Conditional Health Authority Approval Dear Mr. Roth; I am writing to request a Conditional Health Authority Approval be issued to Lot 203, Section 33, Township 12 North, Range 3 West. At this time I am unable to conduct a full adequacy test of the on-site soil absorption system due to the lack of clean-outs on the system. The following are the justifications for issuing the conditional approval. A permit was issued to construct an on-site sewer and well for Lot 203 in July of 1986. According to the soils logs in your files, the soils in the area of the new system consist of gravels and sandy gravels. Water was encountered ten to eleven feet below ground level. The on-site sewer system was installed in September of 1986 in accordance with the approved plans and permit. Between September of 1986 and September of 1991, deep fills have been added over the system, covering the clean-outs and monitor tubes to the system. Two 4 inch diameter pipes also were added in the approximate location of the system. However, my investigation show that these pipes cannot possibly be attached to the system. One they are in the wrong location than those shown on the approved as-builts. And two, when water is added into these pipe, they fill-up and over flow. After the source of water is removed, the water level in the pipes slowly drops. In September of 1991, a Health Authority Approval was issued by The Department. This Approval indicates that the system was working fine in 1991. Since this time the current owner has lived on the property alone. Mr. Dan Roth March 20, 1995 Page 2 The owner is aware of the situation. He has agreed to install the required clean-outs and monitor tubes when snow conditions allow, approximately mid April. A full adequacy test of the soil absorption system will be conducted after new clean-outs are installed. In my opinion, the on-site soil absorption system stands a good chance of passing an adequacy test for the following reasons; - It is a relatively new system, being installed in September of 1986 - It is installed in clean gravels, conducive to effective absorption of effluent and not as subject to clogging as tighter soils are. - It has received very little use over its life. There has only been one person living in the house since 1986. A test of the onsite water supply system indicates its producing 7.8 gallons per minute and meets all separation requirements required by the code. A quality test indicates there are no bacteria (Coliform or other) and 0.43 mg/1 Nitrate in the water. Therefore, a Conditional Approval should be issued. A final Health Authority Approval will be sought toward the end of April or beginning of May. If you have any further questions, please give me a call. Sincerely, Steven R.Pannone, P.E. .I.. CERTIFICATE OF SURVEY I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AS RECORDED IN THE ANCHORAGE RECORDING PRECINCT~, ALASKA, AND THAT THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT, AND THAT THERE ARE NO ROADWAYS, TRANSMISSION LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON. DATED AT ANCHORAGE, ALASKAi THIS /~"~-~l)A'~---(~' ~"L~--- ~'~-.'-~.~.i i9--~- ~.~i ~ SURVEY /'/~..~z z~?ITLE _~/~ SCALEJ 900K NO , DRAWN BY, /~'~CHECKEDBY,~'~---.. ~OB NO. .GRID NO., BARNA"O ENGINEERING CONSULTING ENGINEERS SURVEYORS 2o5 W. 15TH AVE. PHONE ~ ~ ~ ~u~. ~~ ~~N . 4~ ~, 2~ · :~.. . ~ ' ~ . / / ~"~,G,~ /.,.~ . / ~ ~ , o ~ ~ ~ v ..... ~.~.'--i ~-~ Off/ / ~ I I . ~ , ~-~=~ ~ : ~' / : / ~ ~ / . / ,~,-',~: / ,~ / ~ ~ ,/ / / _.-~.,,~_ , lex I k k~;~;~,~~ ANCHORAGE, ALASKA 99501 CKD. B~; ;~ AN~o;~ ~. 0F DT1002380 I x./RP Municipality of Anchorage Development Services Department Building Safety D[viston On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho rage.a k.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-322-03 1. Expiration Date: GENERAL INFORMATION Complete legal description Lot 203, Sec. 33, Tt2N~ R3W~ Seward Meridian Location(site'address or directions) 15230 Old Seward Hwy, Anchorage, AK 99516 Current Property owner(s) Sidney S. Rowen Day phone 345-0023 Mailing address 901 S. W. 128t~ Ter~ Cambridge Apt214~ Pembrook Pines, FL 33027. Lending agency Day phone Mailing address Real Estate Agent Mailing Address Jeri Ann Strand Day phone 350-4378 2531 Laird Circle~ Anchora.qe, AK 99516 Unless otherwise requested, HAA wfll be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 3YPE 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 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. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval ara 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 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. 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 Health Authority Approval application shows that the on-site water supply andlor 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Phone 272-8218 Address -P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date "9-z— Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious O F A' 44 engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. TheAw ......... i4� �'O't reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all AV wells and septic systems depend on the local soil condition, ground water levels that may fluctuate AV 1P during the year, and the water usage of the family being served by the system. These conditions are .......... ...................... outside the control of the evaluator of this system. All systems eventually fail and satisfactory test 0 results do not guarantee future performance of the system, nor do they guarantee that there are no .. .. ............... ti7v �.. W hidden defects or encroachments. PES can therefore not provide any warranty for future perform �k- — ance Steven R. Pannone; :1 nor give any estimate of how long the system will continue to meet the operational requirements of the CE 8149 a ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any. 4�)� -W ��X N. 00 AV reliance upon or use of this report by any other person or party is not authorized nor will it confer any•........••'°`40 legal right whatsoever. 6. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 111141, W",' " I."( " OF A Additional Comments —Z WATER AND PPOCRAM Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report U23W�i XM By: Original Certificate Date: Expiration Date: (Rev. 11/99) Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7e04 ' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type P Date completed 10113/i986 Total depth 79 fl Lot LN)~, Sec. 33. T12N, R3W, Seward Meridian Parcel I.D.:~ If A, B. or C provide PWSID # Sanitary seal Y Cased to 79 fl FROM WELL LOG Dale of test 1011311986 Static water level 52 Well production 1~ WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: ~~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material $~1 Date installed ~/1/1986 Tank size Cleanouts Y Foundation cleanout _Y ft g.p.m Well Log Y Wires properly protected Y_ Casing height (above gmuod) :~2 in. AT INSPECTION 3.0+ g.p.m Nitrate .~13 mg/l Other bacteria 0 colonies/100 mi Collected by: Laura Panrt(~ne 1000 gal Number of Compartments 2_ Depression over tank N High water alarm N_._ Date of pumping ~ Pumper Nqrlhlar~d Pum~)ina c. ABSORPTION FIELD DATA Date installed 12/2911995 Soil rating (g.p.d./ff= or ft2/bdrm) 1.2 System type Deeo Trench Length 60 fl W'idth ~ ff Gravel below pipe 4 To*al depth 9,5 ff Effective absorption area 400.~ I~)nitoring tube Y , Depression over field Date of adequacy test 4/2912002 Results (Pass/Fail) P For :3 bedrboms Fluid depth in absorption field before test dW in Water addod450 gal. New depthd_~ in. Elapsed Time: _~ rain Final fluid depth al_IX in Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date (Rev. D. LIFT STATION Date installed Size in gams "Pump on" level at in"Pump T level at Datum Manhole/Access in High water alarm level at in Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 123 On adjacent lots 100+ Absorption field on lot 130 On adjacent lots 100+ Public sewer main 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' Property line 88' Absorption field 25' Water main 25'+ Water service line 25'+ Surface water 155' Drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 12' Building foundation 16' Water main 100'+ Water Service line 25'+ Surface water 100'+ Curtain drain N/A Wells on adjacent lots 100'+ F. COMMENTS Driveway, parking/vehicle storage 50'+ G. ENGINEER'S CERTIFICATION 4 G�• ",...`�;s♦j 1 certify that 1 have determined through field inspections and AV S 4 ° T" ■3..........' ...® review of Municipal records that the above systems are in 0 ..... .'' conformance with MOA HAA guidelines in effect on this date_ ......••........... •..•.............K�. 0 :Steven R. Pannone: dui Engineer's Printed Name Steven R. Pannone. P.E. ♦♦r Nc. CE14 ° AV Oe Date .�'— f o° Z ♦� ................4W G HAA Fee $ Waiver Fee $ _ Date of Payment 5 G —2- Date of Payment Receipt Number J C� �� Receipt Number (Rev. 11/99) .5, · .... , 203 ~ ,' UND~ NO ~  ~ SURLY ~E ~B~ PLOT P~NS & LOT ~R~ Prepared ~*~ ~x ............. ~e. Professional Land Surve~rs --------- ----'-- ~ ~ 60' ~.- -,------, ~J~L~:' ~Y 3. 2002 ~M,T ML3 ~ ~ 3t 2002 3134 22050 __~.~ v.4iq...% ................. b~ B~ LO.T 203, SW ~, SEC 33, T12N,R3W ......--~a°~i,~nd SEWARD MERIDIAN