The URL can be used to link to this page

Home My WebLink AboutVALHALLA BLK 2 LT 10Valhalla Block 2 Lot 10 #015-212-22 Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us October 6, 1999 Ted Moore, PE Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 10 Block 2 Valhalla Subdivision Waiver Request #WR990075 Parcel 1D #015~212-22 HA990474 Dear Mr. Moore: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 94.0 feet. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. :- Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program WR~ WR990075 Date Received: Legal Description: Engineer: MUNICIPALITY OF ANCHORAGE Department of Health and-Human Services On-site Services Section Applicant-. Waiver Requested: Wa'iver Review Worksheet PID~ 015-212=22 HA# HA990474 Sept 21, 1999 Lot 10 Block 2 Valhalla Permit Ted Moore, PE, Flhttop Technical Services 14530 Echo Street~ Anchorage~ Alaska 99516 Ronald & Sheryl Stanek ~4~--4Z~ Private well to septicltank on lot of 94 feet Criteria: 2. 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: Points: 3. Other: Waiver is Granted: ~. List Conditions or Reasons Waiver is NOT Granted: for above: Date: Rec ~: 04293/9765 Amount: By: $ 625.00 Name of Reviewer Date Paid: Sept 21, 1999 I IAtlq. IIIEI~ ~tEST tzOR lot ]~ DArn 2.0 CIVIL & ENVIRONMENT/~L ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 September 19, 1999 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter we are requesting issuance ora waiver allowing the septic tank serving the 3-bedroom residence on Lot 10, Block 2, Valhalla S/D to be approved in its present location 94 feet from the private well on the same lot. A site plan, water sample test results, driller's logs of wells on nearby lots, septic installation as-built inspection reports and a completed HAA application are enclosed. According to the as-built inspection report the present 1000-gallon steel septic tank was installed in August of 1975 before the well was drilled. Despite its age, at the time of my inspection there was no noticeable depression over the tank indicating imminent collapse. The property owner arranged for Isaac's Pumping Service to jet out the waste line downstream of the tank to eliminate a partial blockage which I had noted in that section of pipe. The original soil absorption trench is 38 feet long and has an effective gravel depth of 10 feet. The system was upgraded in September of 1985 by the addition of a second soil absorption trench, 69 feet long with 6' feet of sewer gravel. The discharge line from the septic tank is fitted with a tee so that effluent flows into both trenches simultaneously. On September 3, 1999 1 conducted an adequacy test of the wastewater disposal system.. The 6" sump at the end of the original trench had fluid within 20 inches of the apparent invert of the horizontal distribution pipe. The monitor tube at the end of the newer trench extended 12 feet below ground level and was dry. The addition of 1285 gallons of water into the system never caused any measurable amount of fluid to build up in the monitor tube for the new trench. I based my conclusion that the system is still functioning adequately on the demonstrated large surge capacity of the new trench, which is in excess of twice the design daily flow for this residence. I was unable to locate a driller's log for the well on this lot, however driller's logs for several nearby wells are enclosed. On September 3, 1999 the static water level stood at 42 feet below the top of the casing:' The bottom of the well is at 93.5 feet below the top of the casing. During the test, steady pumping of 1285 gallons of water from the well at the maximum pump output of 8.3 gpm caused the water level to be drawn do~n to 73 feet below the t6p of the casing, but no further. Based on the test data I concluded that the yield of the well is in excess of 8.3 gpm. This measured yield exceeds Municipal requirements for approval of any single family well, and also meets the FHA requirement~ C~ell~0/e[ D SEP 21 1999 MUNICIPALITY OJ: ANCHOP-A~E ENVIRONMENTAl- $~RVJCE$ DIVISION able to supply 720 gallons within a 4-hour period. Water samples collected from the well on September 3, 1999 were satisfactory, showing 0 coliform or other bacteria per 100 ml., and 1.07 ms/1 ofnitrate-N Of the six enclosed driller's logs from nearby wells four report well depths between 64 and 74 feet, and the other two report well depths of 136 and 170 feet. All report yields in excess of 5 gpm with predominantly silty material above the level of the aquifer. Using generalized information from these logs combined with specific information measured in the subject well, the following is a breakdown of how waiver analysis points could be assigned using DEC's 1985 "Separation Distance Waiver Guidelines for SCRO" Category Points Distance to water table (42' - 8' = 34') Soil Sorption (predominantly silt) Permeability (predominantly >50 rain/inch) Water table gradient (assume +5% from well to tank) Horizontal separation (94') Total 4.4 3.5 3 4.5 2.8 18.2 Based on this point assignment it appears that the requested waiver can be safely granted without concern as to potential contamination of the well should the tank start to leak. The fact that recent water samples confirm no contamination at the present time adds to the comfort level. When the present tank does rust out the replacement tank can be installed outside the 100-foot radius of the well. In conducting an adequacy test I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and the separation distances are measured to readily identifiable features. All system components eventually fail and satisfactory test results do not guarantee future performance of the system under different conditions, nor do they guarantee there are no hidden defects or encroachments. Please feel free to give me a call if you have any questions on this report. cc: Ron Stanek Sincerely, Ted Moore, P.E. WEL LOT 3 LOT 2 (VACANT) SEPTIC / SYSTEM; :-~ LOT 9 R 100' ~ 1000 ~...-; GALLON ] SEPTIC ' TANK 1975 , ,. , TRENCH ~ ~_ . , , / */ ; ', 1985 -- ,,' .,' /~c. TRENCH LOT 10' ",, /__ , BLK. 2 o -- ' " , ~ 5%- 10% R 100' ,, WELLJ SEPTrC SYSTEM LOT 11 ,,SEPTIC SYSTEM LOT ~ BLK3 ,,BLK 3 SE'RTIC LOT 10, BLK. 2, VALHALLA S/D WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 1999 NOTE: THIS IS NOTASURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. NAME L. ~/' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION _o ~ DISTANCE TO: ] Well ~ Z Manufacturer ~ ~ Lq. capacty nga ohs Insidelength Dwelling Material Width NC. OF BEDROOMS PERM IFHOMEMADE: Manufacturer DISTANCE TO: No. of lines ~.. Top of tile to finish grad~ / Width Type of crib Crib diameter DISTANCE TO: Well )~'~'1 K~'~ Depth DISTANCE TO: Building foundation No. of compartments Liquid depth PERMIT NO. ]lions Nearest Jot line j/ / PERMIT NO. ~;~,~;~? ~' Total [engt , Ij~es Trench widt, l~o inches Material beneath tile ~' f/ ~ inches Depth Distance be tween Il n es~,~/~ Total PERMIT NO. Building foundation Total effective absorption area Nearest lot line Driller Distance to lot llne PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS "/""~'-'"~'" ~ L! APPROVED (7 c'~iI (' DATE LEGAL 72-013 (Rev. 3/78) if PERMIT' lq[): DAI"E ISSUED: DEPARTMENT OF HEAL_TN AND ENVIRONME".NTAL F.:KO]I']ET]O' " ', 825 I_. STREET, ANCHGRAGE, AK c~,9d.=¢t 850575 ()9 / 10/85 APF'L I CANT: ADDREGS: CON'TACT PHONE: ACHESON lENT. 11751 PADDOCK L..ANE ANCHORAGE, Al< 995 15' :]";45 - :-27:1. 5 LEGAL DESCRIP: SUBDIVISION: VALHALLA LOT: 10 SECTIGN: 22. 'f'OWNSHIP: I2N RANGE: 3W LOT SIZE: 20000 (SQ.F'F. OR ACRES) MAX BEDROOMS: 3 BLOCK L. isted belew are 'the ept. i[mns available tm you in designing your septic system. Choose th'e option that best fits yom' site. "IF II:R: E: }b,~ ~LE~ ~--~ DEPTN 'FO PIPE BGTTOM (F'I".") 8.0 GRAVEL DEPI"H (F:T. ) ~;. 0 'TGTAL DEP"FH (F'T'.') 1 l. 0 GRAVEL. WIDTN (F'T.) 2,5 GRAVEL LENGTH (F'F.) 63.0 GRAVEL VOLUME (CU TANK SIZE (GALS) 1,000.0 ~..~ SOIL RATING (SQ.FT. /BR) *~ TANK MUST HAVE AT L. EAST "rw0 COIdF'ARTMENTS I certify that: ~.. I am f'a.miIiar with the r'equJ, pemen~:s fcm on-site sewer, s aod well's as set forth by the Municipality oF Anchorage (MOA) and the State oF Alaska. 2. I will install tile system in accordance with ali MOA codes and regulations, and in compliance with the design criteria of this permit. 3..I will adhere to all MGA and State o¢ Alaska requirements rep the set back distances,from any existing well, wastewate¢ disposal sys~.em or public sewerage system on this mr any adjacent et' nearby lot. 4. I understand that this permit is valid far a maximum of 3 bedrooms and any enlargement will require an additional perm:Lt. LIF]' STA:TIGN IS INSTALLED IN AN AREA COVERED BY NGA BUILDING CODES, (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE SBTAINED; (2) AS-BUILTS AND (:5) THE 'IF: A 'THEN WII-.L. NGT BE Af I I~[.]VE.D WI'f'HOU'I" AN ELECTRICAL IN,~FE[,I IGN REPORT; ELECTRICAL WORK NUS'F BE".' :(}ONE BY A L1CENoED ELE. C1RiC.[AN. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~_/O, ~,~ dot (L,& (/~' Township, Range, Section: ( ! ' SLOPE SITE PLAN 1 2 4 5 7- ¢/o~ ~'~ WAS GROUND WATER 11 IF YES. AT WHAT 12 ~//--T~ ~l~J ~ ~ DEPTH? Del]ih to Water After 13 ~ ~ I Ionitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop 14 16 17 18 19 20- PERCOLATION RATE __ (minutes/inch) PER~.HO~LE DIAMETER __ ti f t J I ~T~ESfT RUN BETWEEN ~'/''-~ FTAND~FT ' ' · - 2 ~ ~/ x ~ ' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~"- ~ ~-- 72-008 {Rev. 4/65) oGREA! .yANCHORAGE AREA BORr .',i Anchorage, Alaska ggE03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM INSIDE LENGTH MANUFACTURER /~'~'~ MATERIAL ~ NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CA PAC I TY/'~J"~G A L LO N S. TILE DRAIN FIELD: ~b.,~,~./,~,,,) ~_~,'-- / DISTANCE FROM WELL '~g'J~ FOUNDATION '~"~/~ / I NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~ ! DEPTH OF FILTER MATERIAL BENEATH TILE/ ¢ ! TOTAL LENGTH / NEAREST LOT LINE /~" OF LINES TRENCH WIDTH *'~/IN. TOTAL EFFECTIVE IN. WELL: TYPE p~'~t) p ' CONST RUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE , TANK SYSTEM CESSPOOl OTI4ER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: INSTALLED SEWER LINE DEPTH<~ PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE ~PPROVED G.A.A.B. Form LQ-032 GREATER ANCHORAGE AREA ~OROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO 3330 "C" STREET ANCHORAGE, ALASKA 99~03 -- ~ . TO BE iNSTALLED BY /O /~ ~ ~ ~ NOTE. THIS ~RMIT I$ NOT VALID WITHOUT SOIL ~ST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BAC:KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITy WILL BE SUBJECT TO PROSECUTION. ~ ITWALL ~L/ j SEPTIC TANK ~ ~ DR~ TO NEAREST LOT LINE, WATER MAIN TO SEPTic TANK /~ '~ SE~T'c TANK. Z~ ~ ?S~EPA~E ~:T Z''~ ~" I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED :SYSTEM IS IN ACCORDANCE WITH SAJI~ CODE. FORM N~016 ' SIGNATURE -, ~ - .. The soil conditions Were very erratic in this area. M1, Ch and Sp occured in erratic layers and lenses. By measuring the layers taking an average I estimated the overall fraction percentages asl followes- M1 40~, Ch 20% and Sp ~o%. The water content was very high due to melting snow in the imediate vicinity. Parcel I.D. C:2'.5''° ~ ! ~ - 1, GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency /tn Municipality of Anchorage Development Services Department Building Safety Division ~i~,~-~ On-Site Water and Wastewater Program ,, 4700 South Bragaw St. .~'~'/ .~' P.O. Box 196650 Anchorage, AK 99519-6650 ~,~'////-~...~'.,~',~X~.; www.ci.anchorage.ak.us /7/~.. (907) 343-7904 ""~ ~'~' CERTIFICATE OF HEALTH AUTHORITY APPROVA. L FOR A SINGLE FAMILY DWELLING HAA# Expiration Date: ~ - '7- O .-~ Day phone Day phone Mailing address RealEstateAgent ~.1~ ~,,~l~n,~ Dali R~,~/~.! Dayphone UailingAddress 3"5'~- I-~, /~o.,'t'~trn J.,,¢)~ ~},,~..(¢..,,.1~ d Unless otherwise requested, HAA wi# be held by DSD for pickup' r~ ¢ ~ 2. NUMBER OF BEDROOMS: '~' '~'~"~ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well [] [] [] [] 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 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) 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 prope~es served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 omissicns in the professional engineer's work. Municipality of Anchorage Development Services Department B~i_~rag Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 ~ge, AK 99519-6650 www.ci.ancflorage.ak.us (907) 343-7~04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Desoriptten: A. WELL DATA Well type *J%, ~ Date completed Total depth _.~.~ft. Date of test Static water level Well production If A, B, or C provide PWSlD # -- Well Log (Y/N) ~"/~'~5" . Sanitary seal (Y/N) }" Wires.pro.petty protected (Y/N) Cased te*~' ¥O fl. Casing height (above ground) I'y in. FROM WELL LOG AT INSPECTION ¥/ f~. 7, ~ *f' g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Date of sample: ¥ ,/2,9/C~ Z. B, SEPTIC/HOLDING TANK DATA TankTypeJMaterial ,~ .~h'c / Tanksize ~o00 gal, Foundation cleanout (Y/N) Nitrate o,7&'9 mg./I. Other bacteria ~ coloniesJl00 mi. c~ectea~y: f=t~.~ 7'ec6 ..C,.,c, · ., Date ,installed 8 / &' / 7,5-- Number of ~ortments I Cleanouts (Y/N) Depresalon over tank {Y/N) ~/ High water alarm (Y/N) ~'. Date of pumping ~'~/y/~,o'o~. Pumper C. ABSOR~ION FIE~ DATA Dam ins~lt~ ~ Soil mfiog (g.p.d.~ Len~h ~, fl. ~ 3 ~ fl. To~I depth ~ fl. Eft. abso~fi~ ~ ~m Monitor~ tu~ Date ~ ad~ua~ ~t ~/~/O ~ R~ul~ (P~Fall) Fluiddep~fi~fl~dbef~t"t ~ ~. Wa~add, l~gal. Ela~ Time: -- ~n. Fin~ fl~ ~p~ ~ in. ~y rejuvenation ~a~t ~ast 12 ~.) ~ & ~pe) Gravel below pipe t~' ff. Depression over field For ~ bedrooms New depth ~:~ in. Absorption rate >= ~f,.~'{;~ g.p.d. ~-,~,,~.~,~ If yes, give date --" '1 I I~ ~ * ,~9" Od" W 200. od 200 N8'9" t~9' oo" W 30,0 . ~ EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON. "ASBUILT" No corners sot THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT UNES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCEUNES. I hereby certfly that I have su~eyed the following described property, Lot /~) , Block ~ I/,~.iL/~I..L,,~ 5/J~D. Anchorage record*ng a,strict Alaskl, and that the *mprovemente situated thereon are within the prope~/fines and do not OVedap or encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission hnes or diner 'visible easements on laid proper~ except as JncJcsted hereon. A.~chorage. Alaska Book Pg r/,~ £ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ' Division of Environmental Services · , ~ On-Site Services Sectior P.O. Box 196650 'Anchorage, Alaska 99519-6650 - . ,343-4744 CERTIFICATE OF HEALTH AUTHORITY '" A~PROVAL' FOR A SINGLE FAMILY DWELLING Parcel I.D.# -O/,5-'-~/~-~' '"': REA# GENERALINFOR~ATION ,.~ ~,, , . , ~ ~ ,, . ..,,.. , · . ,.. ~.~, :' .. .:. _** ?,. >. .. ~}?~,: - ,-. -. Compiete'~le. gal 'descrJpfi~'n ::' .' :/--~ F :7 ~'z' i~'/~,Z/~' ~, ~'~/~//~ Location (site address or:directions)~' · .' ~ ~ ' '/~ ' ,':}_~:~.,,.~.._. ;,;.', .;. ' , ' V .v. · ' ' M~'ilingaddreSs 300 ~'-~"' ;t.) ~,f~ ~ ~r~ ~,~e~3 Agent N~. F~ ~ 0 ' ' ' _.Dayphone ' Address Unless otherwise requested, HAA will be held, for pickup. 2. NUMBER OF BEDROOMS: ~ 3. NOTE: Individual well Community,,wetl Public water ' ~f communitywell system, provide written confirmation from State ADEC attest- -, ~'~ -, lng to the legality and status of system. TYPE dF 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, STATEMENT OF INSPECTION BY ENGINEER AS ,certified b~ n~::~e:ai affiXed hereto add as of the Validation daieShoWn beloW, verify that my · 'in~JeS'~igafi0~ ~f tl~i~' ~eaith AUthOrity Al~Pr0Val appliCation shoWs that ~he:'onLsite water SuPply and/~l?waSteWater disPosal SyStem is safe,:funCtionai and adeqUate'for the number of bedr(~oms and tyPe Of structure indicated herein. I further verify that based °n the information obtained from : :.~ the M~i~c~P~iil ' ~e~iles and from my i~stigation a~d inspection, the 0n~Site Water sUPp ~ ~d~r ~[ s~ste~ isi~ .~p!ianse ~ith:a i MUnicipal a~8 State cOdes, ', Addlbonal Comme ts .. ' r -- The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer ragistered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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. . RECEIVFD Municipality of Anchorage 8EP 2 1 1999 DEPARTMENT OF HEALTH & HUMAN SERVIq~iClPALiTY o~ ^N Environmental Services Division ENVIRONMENTAL SERVICES 825 L Street, Room 502 · Anchorage. Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: J-~ ~L tN /~/oc ~ ~ ~,"~/J~4,//¢~ E/J_) Parcel I.D.:. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~ Date completed Total depth ~ $ ' Cased to ~. '/'4~ ' Casing height (above ground) / ~'" Sanitary seal (Y/N) 7' Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test ~ / 3 / ?,~ Static water level Well production g.p.m. __ ,~. --? 'f- g.p.m. WATER SAMPLE RESULTS: Coliform 0 ¢,:,1 //~,o v,~y Nitrate /. g, 7 ~? /~' Other bacteria No,,~ Date of sample: ~/~ / 2~ Collected by: /--/~/-,~--v~ 7-'~.~-4. 5"c,~-. B. SEPTIC/HOLDING TANK DATA Date installed ~/~'/ 7.~- Tank size ~ Number of Compartments / Cleanouts (Y/N) '7' Foundation cleanout (Y/N) Y' Depression (Y/N) /V High water alarm (Y/N) A/, ~ Date of Pumping ~/)/9~ Pumper C. ABSORPTION FIELD DATA Date installed ,~/~'/'7~'- Length ? ~' ' Width 3' ' Gravel thickness below pipe Effective absorption area 7dd,' r~, Monitoring Tube present (Y/N) Soil rating (g.p.d./ft~ or fF/bdrm) 'z,/~, .~ . System type -3-~v,~4 Total depth ! z.~'- ' Depression over field (Y/N) ?,~'~"-~ For -~ bedrooms 0 Immediately after ~'~,~-,r[lal. water added (in.): J Absorption rate = '~ ~/3-0 g.p.d. Date of adequacy test ~)/~ / 99 Results (Pass/Fail) Fluid depth in,,,absorption field before test (in.); Fluid depth O (ins) Minutes ater: Peroxide treatment (past 12 months) (Y/N) /Vo,~g /-c,~.., If yes. give date /',/. ,4. 72-026 (Rev. 3/96)* £w~e Septic/holding tank on lot Absorption field on tot Public .sewer main Sewer/septic service line D. LIFT STATION ~* -~. Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ~ I~.~/ Size in gallons "Pump on" level at* "Pump oH' level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ Property line ~ ~" Absorption field Water main/service line ~>/~' Surface water/drainage '> /~:~ ' SEPARATION DISTANCE FROMABSORPTION FIELD ON LOTTO: Building foundation ~ ~/,~ ' Driveway, parking/vehicle storage area Propertyline ~ I?' Surface water ~- /~'~' Curtain drain F. ENGINEER'S CERTIFICATION I certify that I have determined ~ in conformance with MOA HAA guidelines in effect on this date. Signature ~ ~. ~ Engineer's Name -7-~'~-~" F. ,~'~c,,-~ Date -~'~'? /~'~/~' ~ ,,900 Water main/service line Wells on adjacent lots HM Fee $ ~ -- Date of payment Receipt Number Z:~,~-2-- ~/..~ 72-026 (Rev. 3/96)* Waiver Fee $ ~"~-_4" Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1o C~neral Information Application Date ['~, /]/~' / , ~____ (a) legal Description (include lot~ block, subdivision, section, township, range) Location (add~ess or directions) (b) Applicants Name Applicants Add,ess /~A~. (c) Applicant js (che~ o~) ~nding Institution (d) ~ndi~' Institution . ; ~ Ad,ess /.~ ~ (.ii (e) ~al Estate ~ & Agent Owner/builder Address Telephone 2. Type. of l~sidence Single-Family Number of Bedrooms 3. Wate~ Supply Multi-Family O~er (dearie) Individual Well ~'~ Conmunit~ ~ Public ~-~ Note: If cc~unity ~11 system, must have w~itten confirmation frc~ the State Department of Environmmntal Conservation attestin~ to the legality and status° Is the ~11 adequate for the numtx!r of bedrocms specified in this HAA (Y/N) 4. Sewage Disposal Onsite ~ Public ~ Corm~nity ~ Holding Tank ~-~ Is the wastewater disposal system adequate for the number of bedrooms (Y/N) [Page 1 of 2] 2-15-84 5. ~.n. gineering Firm Providing Inspections, Tests, Data and Information I certify that I have ckecked, verified, or conformed to all MOA effect on the date of this inspection. Signed · (ENGINEER SEAL) Telephone ;50t ~-__f~ '7/f 6. DHEP Approval Approved for ~ kedr oc~ns pprove msap oved [--] Te~ of Conditional Apu~oval Conditional ['i Date The Municipality of Anchorage Department of Health and Environmental P~otection doss not ~uarantee the continued satisfactory perfonmance of the water supply and/or the wastewate~ disposal system° This approval indicates that, as of th~ validation date shown above, based on the data and info~mation furnished by an engineer registered in the State of Alaska, the water supply and v~stewater disposal system is safe and fun.c- tional fo~ the number of bedrcc~s and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/dS/s [Pag~ 2 of 2] 2-15-84 A® MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ~;W~ Well Log P~esent (Y/N) ~ Date Ccapleted Total Depth_ ~ Cased to ? Pump Set At Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) ~/~ Separation Distances f~om Well: To S~ptic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleancut/Nanhole ~///--~ Water Sample Colleete~ By Water Sample Test Results C~nts MUNICIPALITY OF ANCHORAGE DEPT. OF HEAI,TII & ENVIRONMkNTAL PROT,~CflON ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed ~''~(;~ Size /~9<~ ,G'///- No. of Cc~pa~tments / Standpipes (Y/N)?F~_~ Air-tight Caps (Y/N)~(z]~ Foundation Cleanout (Y/N(~'%~/ Depression over Tank (Y/N)~/O Date Last Pumped ~/~ Pumping/Maintenance Contract on File (Y/N)~///~ ; for Holding Tank High-Water Alarm (Y/N)/~'/,~ Temporary Holding Tank Permit (Y/N)z~//~ Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well /~r')' TO P~operty Line ,~(~' TO Water Main/Service Line To Building Foundation Z~'~ To Disposal Field_ /~ ~ To Stream, Pond, Lake, c~ Major D~ainage Con~ents [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~/~) ~D~;~ Type of System Design Length of Field <~{ t Depth of Field /~ ~ Gravel Bed Thickness /(~' Square Feet of Absorption A~ea 7~(~ Standpipes P~esent (Y/N) Depression ove~ Field (Y/N) ~'0 Date of ~st A~a~ Results of ~st A~a~ ~st ~p~ation Distan~ ~ ~sorption Field: To ~te~-Supply ~11 /~ ~ ~ To ~o~ty Li~ To BuildinG Foun~tion ~ / To Existing o~ ~ndo~d System To Wate~ Main/~vi~ Line ~d'+ To ~t~(if ~e~nt) To St~e~ond~ke/~ ~jo~ ~aina~ ~ ~/~ To ~iveway, P~ki~ ~ea, ~ Vehicle St~a~ ~ea ~O~ ~ Corm~nts Date Installed Size in Gallons "Pump O~" Level at High Wate~ Alarm Level at Tested for Electrical Codes.(Y/N) Con~nts Din~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA ** Check P~rmitted Bed~oc~ Rating AGainst HAA ~guest I certify that I have checked, verified, o~ confo~r~d to all MOA HAA Gu~.in effect on the date of this inspgcticn~, ~. ~ · ~,~ Signed Date ~./f3/~4 y~ .~ ~f~ C~any KB1/d5/s v~ ~ .. - CE- 4369 [Pa~ 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE DEPAR~T~EL.~.~F HEALTH AND ENV[RONMEN~L~...~?ROTECTION 825 L Street, Anchorage, Alaska 99501 279--25ii, ext. 224 or 225 Time Date Received: August 12, #3: Time 1977 Date Date Insp Insp ~'FOR APPROVAL OF titution Request: Ma~]in.g Address:Post___ _ Office Box 720 99510 Prop~r Ly.?Q~ner: James/Connie Bensler Star Route A Box 1566B 99507 INDIVIDUAL SEWER AND WATER FACILITIES First National Bank of Anchorage % Marie Iiams , ~ 276-6300 Pnon..: Phone: 344-0146' ~'.' Lega~ Description: Lot 10 Block 2 Valhalla Subdivision_ ._ 4.:' Single Fa'mily Residence: (x) Number of Bedrooms: Multiple. Family Residence: ( ) Number of Bedrooms: Weli~System. Individual well Permit ~ ~_~/~._.. ._ Depth of Constructional. _ Sewage Disposal System: On-site Per~it.'% Installed ize Sep%ic Absorption Area (c) Community/Public System ( ) Well Well Log on FJ.i~ ( ) Bacterial Analyszs 7.,~, Distances: Well_ to Septic tO ~ewer Line to Nearest Lot Line Publm~ utility ( ) System ( Qc '~ 1~Q- Installer ' Manufacturer _~A~r~ Soils Rate ~O _ Material T an k to Absorption Area ~/~ 'Jj Nearest Lot line Absorption Area ~artment of for Approval Health and Environmen~Lal Protection of Individual Sewer and Water Facili~.zes Description: Lot 10~Block 2 Valhalla Subdivision f&davi~ At~ached: ~isapprovod: ( ) Letter Attached: ( Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AU8 2 1§77 RECEIVED I. Type of Inspection: CMRO. VA 2. Property Owner: James & Connie Bensler FHA CONV. X Mailing Address: S~ ~ox 1566 B 99507 Name of Buyer: ~onald & She~y1 Stanek Mailing Address: 101 Agate Cr. 99504 Day Phone: 344-0146 Day Phone: 277-2481 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Location: First National Bank of Anchorage P. O. Box 720 Phone: -~ nora Phone: Lot 10, Block 2, Valhalla S/D NHNShilohRoad Anchorage, Alaska 99507 7. Type of Facility to be Inspected: Sinqle Familv Residence 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. 4 Individual Individual (on-site), Marie Iiams 8/11/77 72 003(3/76) June 21, 1972 VA Administration Loan ~uaranty Of¢ice 429 "D" Street Suite 214 Anchorage, Alaska Subject: Lot 10, Rampart #1, and Yalahalla Subdivision Dear Sir: ~t is presently economically unfeasible sewage and/or water system in the above present time. to establish a public subdivision at the Permits and specifications for on-sitn sewage disposal have been issued by this Department for the above lots. These permits are valid pending acceptable soil test results on said lots. If you h~ve any questions regarding the above information, please do not hesitate to contact the undersigned. Sincerely, Tim Rumfelt Sanitarian bb cc: Dennis Hartke Approval requested by: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "c" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of InspectionS. Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Mailing Address: ~\[~') ~r~c~~ ~'~b~ ~XOC~ Phone: ~qq- flL~Sq Property Owner: ~o~r~ ~os~ Phone: ~l ~ ~t~ ~ ~ '. ~. Mailing Address: ~ ~,~b ~ 5. Type of facility to be inspected ~L~ QO~O~, NO. of bedro~ 6. Well Data: ~ ~~ A. Type [t~,A~,r,~ B. Depth ~ C. Construction ~~ Sewage Disposal System: A. Installed ~ -~ B. C. Septic Tank: I. Size D. Bacterial Analysis Installer ~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~.a~ge 2 of tw.6~ pages - Req~for Approval of Individual ~:}& Water Facilities Legal Description <~¥ \0 ~/(~c~. ~. ~ ~0~ ~/[-~ ~ ~'~ ;'. Appro,'ged /A~ Disapprovee Date ' V ~m- ~ .... '~ ' ~ - . Approve,Valid for one year from date signed Greater Anchorage~r'6~ "Borough, Department of .Environmental Quality DIAGRAMI OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) · GREATER ANCHORAGE ARE/'~ BOROUGH Department of Environmental Quality 2320 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: Mailing Address': 3. Name of Buyer: Mailing Address: VA FHA CONV ~x Day Phone 4. Name of Lending Institution: ~i 1 i n g Address: 5. Name of Realtor or Agent: Phone Hailing Address: ' Phone 6. Legal Description:' .~/~ ~q~ //~//~>//~ ~/~ 7. Type of Facility to be inspected: ~ No. Bdrms. 8. Water Supply Type of Supply: If Individual, Pub'lic Utility IndiVidual ~ number of dwellings presently served / If Individual, depth of well Sewage Disposal'System · Type,of S~stem: · Public Utility If Individual, date of installation Individual (on-site)