HomeMy WebLinkAboutFISCHER BLK 1 LT 4A-2Fischer
Block 1
Lot 4A-2
#015-292-43
Municipality of Anchorage Page _L of 7
DEPARTMENT OF HEALTH AND HUMAN SERVICES -
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. _ SW 9 Z 03 XD PID Number: P152924 3
Name:
Address: MG , Wastewater System: §(New ❑ Upgrade
P.O. r Zyo7 ABSORPTION FIELD
Phone: No. Of Bedrooms:
O Deep Trench JKShallow Trench O Bed O Mound O Other
LEGAL DESCRIPTION Soil Rating Total Depth from original grade:
• GPD FI S #=r
Lot: Block: / Suubbdivision: Depth to pipe bottom from original great Gravel depth beneath pipe
r , S FI 3 fl
Township: Range: Section: Fill added above original grade. Grave[ length: Q
O Ft G8 Ft
WELL: ❑ New ❑ Upgrade Gravel asi NumDarofhnes: D"Utist.eenw„
tvlhrrL pt / FI
Clauibuhon (Private. A,B,C): C Tout Depth: Cased To: - TOW aDso tion area -
rp ea n Pipe material:
-. __.._------ _ Ft
rXJ
f oe/,: ,"A14ua
'i
oats Installed:
ID 9L
Yield: Pump Set at: Caung Height Aleve Ground.
GPM Ft. I Ft.
TANK
SEPARATION
DISTANCES
0
septic ❑Holding 0S.T.E.P.
To
From
Septic
Tank
Absorption
Fled
Lin
a41n,n
Holamg
b14(Prbats
Manufacturer Capacity In gallons:
G
Tent
$ewe, lin"
/ODD
Well
5 t
5y
Material: Sr L Number of Compartments:
7 Q
�Surface
wet
>150r
z
LIFT STATION
Lot
Line
+ ne
! !�Y/
I
i I
Sue in gallons:
Man rer.
Foundation
I q �F
V
q
!/
„I
1`t
"Pump on' levet at: ^Pu ' leve High water alarm ac
CDfeenn
Pump Mats
Electnullnspecnona perform,Dy:
BENCH MARK
and
Inspections performed by: 14• N D CR SO AJ Dates:1
Department of Health and Human Services approval
Reviewed and approved by: 44-41.� Z Date: 3
72-013 (1/91) MOA 25
Assumed
ENGINEER'S SEAL
a�\Oa1
3F A/ %It
And.mn
Permll No. SW 9L 0 330 Ppa Z
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
Lo
Legal Description: 4k- 4qpp '• PID No.:
i
n417 A ") 40A 25
6e%
117
ITA
0%, !r ..
sr p
49
,Michael E. An' dorwn
•, A381 - E
4 R�ict�avo�'�
PermltNo. sw9zv33o
Page 3 or 3
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
Description: 5U . PID No.:
D
YK ; �,, 10,
�\ 94 0Y k� TI�1K t
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.
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NOKIL: Il. lOr R a p" ;:�
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Vf�t r I IO � 9r.. Michael E. Anderwq W 0 -'-
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4F�pI0F:SL10as® c.'
n4h3 A "IJ 11OA 25
C
PEF
LEC
U
11
1:
1;
14
15
16
17
16
19
20
TEST RUN BETWEEN _(L FT AND ��LFT
COMMENTS S/u- Vm- 45 /n. TT—Le A n � i
FERFORMED BY: �• �•nF 5cxsc)A/ ( ,eJILA �%% �/ N
GERITFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE OATS —1,9119 I9 L
%2-c" (Rev. 41!3)
WALTER J. NICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
f
ANCHORAGE DISTRICT OFFICE /
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515 (907) 349-7755
January 6, 1992
Mr. Michael E. Anderson, P.E.
Anderson Engineering
P.O. Box 240773
Anchorage, AK 99524
Subject: Lots 4A-1 and 4A-2, Block Fischer Subdivision, Class 'C' Public Water
System, PWSID no. 217966; ADEC Project number 9321 -DW -041.
Dear Mr. Anderson:
The Department has reviewed the materials received in this office January 6, 1993, which
which addressed the items requested In the previous letter dated December 18, 1992,
from this office. The system appears to have been installed substantially in accordance
with State Drinking Water Regulations at the time. Results from the recent water samples
were satisfactory, therefore for the concerns of this Department, this system is in
compliance with State Drinking Water Regulations (18 AAC 80). Attached is a certificate
of Approval of On -Site Residential Water and Sewer Systems verifying this approval.
Although not required it Is suggested that this water system have samples analyzed for
total coliform bacteria and inorganics for nitrates (as nitrogen) annually. If water samples
are tested please reference the assigned PWSID #217966 so that results may be properly
credited. Thank you for your cooperation with this Department, If there are any further
questions please do not hesitate to call.
Sincerely,
M chael Lu, E .
Environmental Engineering Asst. II
Attachments
M L/pf
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS
PROPERTY DESCRIPTION
Lett 44-1 4,a 44-2 a►PcA 1
04che
�.MIIIK�U 1..w0 1p AppK�lwn Np:
9321- Du -O 1
This approval does not constitute a guarantee of any kind, explicit or Implied, as to the performance
of the water supply and wastewater disposal systems.
WATER SUPPLY
A recent water sample was tested and found to meet Department of Environmental Conservation drink.
Ing water standards for total coliform bacteria.
Ta* E D.W
01
on QA f Iy�1S
WASTEWATER DISPOSAL
The domestic wastewater system was:
❑ Inspected by the Departm\Engin
nmental
applicable requirements o
O Inspected by a Professionho cert
quirements of 18 AAC72;,
found to be In compliance with
the system Complies with applicable re.
❑ Installed by a Certified Installer who ce ' le that the system complies with applicable requirements
of 18 AAC 72; or
❑ tested by a Professional E neer who certifies t t the performance of the system is satisfactory
and that the system co lies with the minimum paration distances specified in 18 AAC 72.
This approval is va,"for a 0 single family O
with a total of bedrooms.
•aas-n.. a05, DISTRIBUTION WHITE—BANK•LENDING INSTITUTION: CANARY—APPLICANT PINK—DEPARTMENT
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
January 18, 1993
Municipality of Anchorage RECEIVED
Department of Heath & Human Services
825 "L" Street JAN 191993
Anchorage, AK 99502-0650 dept Hea alit of Human Services
Subject: Lot 4A-2, Block 1, Fischer Subdivision
Septic System As Built
Dear Onsite Services Engineer:
Attached is the as built of the septic system placed on Lot 4A-2, Block 1,
Fischer Subdivision under Permit No. SW 920330. The original design
required a two legged system with the distribution pipe buried two feet
below original ground because of the presence of a silt layer 7-1/2' below
the surface. During construction another test hole was dug at the location
shown on the drawing. This hole revealed the silt layer at 10' below the
surface. The percolation rate on the sandy soil at this location was also
substantially faster than the rate determined on the original two test holes.
In order to provide additional drop from the house to the septic tank and
then to the field, the distribution pipe elevation was lowered to 4-1/2'
below original ground. The bottom of the field was then 7-1/2' below
original ground with a 2-1/2' separation between the bottom of the system
and the underlying silt lense. Only one 68' distribution line was placed to
take advantage of the lower silt layer in this area. The length of the line
was not shortened even though the soils in this area percolated at a much
faster rate than the original test holes.
Attached also is the D.E.C. approval of the Class "C" water system in place on
the lot. Please advise if you have any questions or comments.
Sincerely, S
cal, -OL _
Michael E. Anderson, P.E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920330
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:PRESTON JAMES M
OWNER ADDRESS:P.O. BOX 240747
ANCHORAGE AK 99524
PARCEL ID:01529243
LEGAL DESCRIPTION: FISCHER BLK 1 LT
LOT SIZE: 31482 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
4A-2
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED:10/02/92
EXPIRATION DATE:10/02/93
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH
INSPECTION. PROPERTY WILL BE SERVED BY EXISTING CLASS C
WELL.
RECEIVED BY
DATE: /0 7_ 9L
ISSUED BY: JOH14 177+ DATE: 10&119^
ANDERSON ENGINEERING
P.O. [lox 240773
Anchorage, AK 99524
Municipality of Anchorage
Department of Ilealth and Human Services
825 "L" Street
Anchorage, AK 99519
Attention: John Smith
DECEIVED
OCT 1 1952
a,1tity of Anchorage
-� Haallh L Human Service;
Reference: Lot 4A-2, Block I, Fischer Subdivision
Subject: Trench Section Redesign
Dear Mr. Smith:
I have redesigned the trench section for the septic system proposed for the
referenced lot to allow a minimum of 2' of accepting soil below the
drainfield rock. The system will now require a foot of fill over existing
ground to provide the minimum 3' of coverage over the field. In lieu of
the additional cover the installer may elect to place 2" of insulation above
the distribution piping. Both options are noted in the new design.
1 have also enclosed additional topographical information on the lot for
your use. Please advise if you need additional information.
Sincerely,
y41t,at
Michael E. Anderson. P.E.
H` SHEET NO
OF
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ER �PROrrcq\0�',�'
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September 3, 1992
Municipality of Anchorage
Dept. of Health & Human Services
Environmental Services Division
825 "L" Street, Room 502
Anchorage, Alaska 99501
Subject: Lot 4A-2, Block 1, Fischer Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The terrain on the subject lot slopes from Our Road gradually up to the
building site then drops off to the back lot line. None of the slopes are in
excess of 20% and usually much flatter. I have inspected the area
surrounding this lot and have arrived at the following conclusions:
1. The system, if constructed as designed, will have no adverse
impacts on the wells currently in use or to be placed in the future
on lots located in the area.
2. The system, if constructed as designed, will have no adverse
impact on existing septic systems in the area or those to be
constructed in the future.
3. The system, if constructed as designed, will have no adverse
impact on reserved space either surface or subsurface on any lots
located in the area.
4. The system, if constructed as designed, will have no adverse
impact on drainage patterns in the area.
Sincerely,/ as."''
vp'a
Michael E. Anderson, P.E.
JOB Lor NA -Zi 8 w U" 1. �rsu! en,,. Svc .
- SHEETNO. OF
} CALCULATEDSY Mc13 DATE 913&9-
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CALCULATED BY my* DATE 9/3 /9 L
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.r Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 •L• Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: SPI-JCIL /-QOM 05 DATE
LEGAL DESCRIP
NOR
d ?0.
2 •b ,•
3 0.4
6 .
4-
5-
6-
7-
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9
10
11
12
13
14
15
16
17
18
19
20
Lor '/i4 • z $Lout. 1
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Township, Range, Section:
WAS GROUND NATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
PC
Gtphle 1 pr
MWlwing? g? .t. ^l_E o„c 9/1/??
S
L
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E Anderson a•
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
tt 8 z7 9LJ--00
—
�c • y r.
TEST RUN BETWEEN
G:IS
/S
G s6•
/s •
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.
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7:OD
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:PERFORMED BY: �� • Ail =U 0.31 RTIfY THAT THIS TEST WAS PERFORMED IN
.ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE — g/s/ 9 T-
12-008
12-008 (Rev. 4,E5)
UPERCOLATION
RATE
(mintAeslnch) PERC HOLE DIAMETER
TEST RUN BETWEEN
3
FT AND ��L FT
COMMENTS 73t—HOLC
WAS PA.CsnAft-Cb
PUQR--
-M
:PERFORMED BY: �� • Ail =U 0.31 RTIfY THAT THIS TEST WAS PERFORMED IN
.ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE — g/s/ 9 T-
12-008
12-008 (Rev. 4,E5)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMEO FOR:_ 5? 1ti E(.f., p /-10;0E$ DATE PER
LEGAL DESCRIPTION: Lor 11A-7- BaowL 1 Township, Range, Section:
® PT- Ff $0410t SV(i DIVI S104 SLOPE
15
16
17
18
19
• r
■■■■.■■■■■
WHAT L
. r ■■■■■■■■■-
IF YES, A
DEPTH?
DtPth to WsI
y"Wring?
! VfcnwpF�n a:�c^y
•`s9a�P
... ...... ...... ...: •: A
•••• � o-0
Mfthael E. Andersen
...•._ 4381-E
Reading Data
Gross
Time
Net
Time
2
l Z7
tf: •/ PM
7"
3
0:0.
St to PM
/S
8 "
I',I'
4
S" -IS PM
/s
9'
e o
ado'
SP
5
iS
/0
I%40
.a
60A\Jt2L.y shVd
6-,
7
8-
9
9
s r\
;,'
10
12
t•'. �
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14aLC
13-
14
15
16
17
18
19
• r
■■■■.■■■■■
WHAT L
. r ■■■■■■■■■-
IF YES, A
DEPTH?
DtPth to WsI
y"Wring?
! VfcnwpF�n a:�c^y
•`s9a�P
... ...... ...... ...: •: A
•••• � o-0
Mfthael E. Andersen
...•._ 4381-E
Reading Data
Gross
Time
Net
Time
Depth to
Water
Not
Drop
l Z7
tf: •/ PM
7"
rtZ
St to PM
/S
8 "
I',I'
tb 3
S" -IS PM
/s
9'
/ "
tCy
0
iS
/0
I%40
20 { I v
II. JI PERCOLATION RATE �Z (minuteYnth) PERC HOLE DIAMETER G
[j TEST RUN BETWEEN "3 FTAND�FT
COMMENTS #0'- WAS P/LCS 644Let P/LI(1IL Tb 'TGG STI NG
PERFORMED BY: 14• AAIhtTLS TIFY HAT T S/JEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE
77-008 (R". 4,85)
ANDERSON ENGINEERING
P.O. [lox 240773
Anchorage, AK 99524
September 17, 1992
Municipality of Anchorage
Department of Ilealth & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reference: Lot 4A-2, Block 1, Fischer Subdivision
Subject: Septic System Design
Dear On Site Services Engineer:
RECEIVED
SEP 18 in?
Municipality of Anchorage
Dept. Health & Human Services
The owner of Lot 4A-2, Block 1, Fischer Subdivision has decided to use the
well on his property to serve two homes. The well will then be reclassified
as a Class "C" well and will require a 150' setback rather than the 100'
shown on the original permit application. I have enclosed a new site plan
and system design showing the 150' setback. Please review the permit
application based on the new information with the 150' setback. Thank
you for your cooperation with this change.
Sincerely, n
Michael E. Anderson, P.E.
JOB t4oT yA-Z, $�oe,��� FsCNE12. Sya.
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CHECKED BY DATE
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f ENVIRONMEN
i �, OL SERVICES, INC.
West 33rd Ave, Suite 6
CHORAGE. ALASKA 99503
J,,. (907) 361.5040
,OE "7 q,' Q444.0 A 'r-1fpc.P -,b
SHEET NO Of
CALCULATED BY %I. W/EA✓ DATE -14
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ANDERSON ENGINEERING
P.O. Box 240773
Anchorage, AK 99524
September 24, 1992
Municipality of Anchorage
Department of Flealth & lluman Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
SEP 2 8 1992
&Iunfcipality Cf Anchorago
Dept. Health G Human Services
Reference: Lot 4A-2, Block 1, Fischer Subdivision
Subject: D.E.C. Waiver for Septic System
Lot 4A -I, Block I, Fischer Subdivision
Dear On Site Services Engineer:
On September 6, 1985, the State of Alaska Department of Environmental
Conservation approved a waiver to allow separation from the Class C well
located on Lot 4A-2, Block I, Fischer Subdivision to the septic tank on Lot
4A-1, Block 1, Fischer Subdivision to be 125'. The septic system on this lot
falls outside the 150' setback established for the Class C well. The
Construction and Operation Certificate for the well and as built information
for the two lots is enclosed for your use. Hopefully this information will
aid in your evaluation of the septic system permit for Lot 4A-2, Block 1,
Fischer Subdivision. Please advise if you need additional information.
Sincerely,
7VI. 4E ( ,d
Michael E. Anderson. P.E.
or
7 STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
PUBLIC WATER SYSTEMS
A. APPROVAL TO CONSTRUCT / LJ ,J ( -/X2_
A n L
Plans for the construction or modification of Lis / /I / XY / /7 2 • /l1c
Ftbiar 1v44wee . CkLi public water system located
Alaska, submitted in accordance with 18 AAC 80.100
approved. 1;
been reviewed and are
❑�cond�i%tionally approved (see attached
conditions).
BY TITLE DATE
If construction has not startee :..x two years of the approval date, this certificate Is void and new plans and
specifications must be submittea lu. r^•:r.w and approval before construction.
S. APPROVED CHANGE ORDERS
Change
(contract aa. W/. o� CI � « Apfl" mf *( ! Approved by Date
IV. vsl" 7/7,. t.<-11 Jc. tai//'c 4,1- Ar X-,,7 reni'o✓r
U
C. APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by thA Department before any water
Is made available to the public.
The construction of the `.;2 iqamI public
water system was completed on (date). The system is hereby
granted Interim approval to operate for 90 days following the completion date.
BY TITLE DATE
As -built plans submitted during the Interim approval period, or an inspection by the Department, has confirmed
the system was constructed according to the approved plans. The system is hereby granted final approval to
operate.
BY TITLE �- DATE '
18407 (FW. III"
DISTRIBUTION: 1. WHITE • ENGINEER (Complete Sa Ion C)
_. YELLOW • WATER SYSTEM FILE (complete Sactlon C)
S PINI( - ENGINEERIMUNI-BOROUGH (Ca pNta Sa Ilon C)
a. GOLDENROD • MUNI-0OROUGH (O mpMte Sa Oon A)
ALASKA ENVIRONMENTAL
CONTROL SERVIC°5, INC.
1200 West 33rd Ave, Suite B
ANCHORAGE, ALASKA 99503
• (907) 861.5040
. - ... ACor'iN� totAlroA/
Joe LDS Ht% Gcac c / Li�Gr/t F "P
SHEET NO OF
CALCULATED BY DATE
DATE 7/�•"
CHECKED BY DATE
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Data It RI C E r V E
,`MAY 19 1986
D(cTDI,•T n
�FF1rc
STATE OF ALASKA
D EPARTMENT 0 F E NVI R ONMENTA L CONSE RVATION
APPLICATION FOR ONSITE WATER AND SEWER
SYSTEM APPROVAL
I. GENERAL INFORMATION
Type of Water Supply System
Treatment of Water (Check all that Apply)
Legal Description of the Location
❑ Private
JFrNone
,0 �A/ SLOCK /
�iSe�ER S�BaI✓Isi�
T7
Public (Serves more than one
Tr-.✓ RsaJ sEc /S
❑Mineral Removal
13 Holding Tank
Applicant Na/me
❑Other:
AP liunt 16 (Check one)
Bank ❑certified Installer No.
/UGTL
CLAs5 t G �r
Owner/Builder
Address (Street or P. O. Bos)
Wan Data
Is the Height of the W.II Casing more than 12" above the Ground?
Type of Residence Toul No. of Bedrooms
62S Al S� !;✓r
SuiTr E
1a Slnpl•FamilY ❑ MuItI•Family
City, Sate and Zip Code
10daoz.%d-i9x!
`J1S0/
Telephone
r{/J 3��-3»� 'JK 5'l.1-3/YQ
Send Approval to:
Depth of Well (Foot)
Static Water Level (Food
❑ Applicant ❑ Others (Give Name & Address)
r V CVCTGa1
Source of Water and Containment (Check all that Apply)
Type of Water Supply System
Treatment of Water (Check all that Apply)
XWell (Drilled or Driven) ❑ Surface (Identify)
❑ Private
JFrNone
❑Chlorination
❑ Roof Catchment —[]Filtration
❑ other (Identify)
T7
Public (Serves more than one
❑Mineral Removal
13 Holding Tank
family)r
❑Other:
CLAs5 t G �r
Wan Data
Is the Height of the W.II Casing more than 12" above the Ground?
1K Yoo ❑ No
H a sanitary tool installed on the wall using?
tEL Yes ❑ No
Is drainage directed away from or around the casing within a radius of 10 feet of the well casing'
❑ No
Yes
Date Drilled
Depth of Well (Foot)
Static Water Level (Food
Yield (If Avedable)
Pump Rata (If Availeblel
<
&-//-JS's
ZS'Or
Z4 C,
/O
Gal/Mm
B,44 -n/. -JJ Gal/Min
Separation Distances from the Well Casing to each of the Following Sources of Con lamination:
Septic/ffoldmg T on
Sewer Lines on Lot'
Absorption Area on Lot
/�3
//3
/SZ"
Closest Sept Dnp ank on Adjacent Lot
r
Closest Sewer Lines on Adjacent Lot
Closest Edge of an Absorptiom Ars, on Adjacent Lot
r
/SO 7 -
If tonic materials are stored on the property, including fuel tanks, paints, lubricants and other petroleum
It
On Lot
On Adjacent Lot
based materials. pesticides, fungicides or herbicides, indicate distance from contaminants to well casing:
_ /O .lE
Water Sample Taken by: Name
Sampler Is.
%}jKf% <&,&,er I.JC.
❑ Buyer 15� Engineer
11 BankerGovernment Official
Address
/L(?1 la/�)5e. J%SOi
Weis, Sam �7Vc
Attach \ :s tory • Oate: �❑ Unsatisfactory • Date:
/ra/rMJ 10 4-C/r0 ^,N>a /W Lc/ +n . 5.L, •!7 1n • —.vr cr .-• I
correct:
......... "...0
G REID, JR. . /
G
eCertified Installer, Professional Engineer, Departmenr of Environmental Conservation or the OwnerlOuilder
Date Received
f
' ^
Source Of Water and Containment (Check all that Apply)
STATE OF ALASKA' Esq
Trearment of Water (Check all that Apply)
DEPARTMENT OF ENVIRONMENTAL CONSERVATI07gPrQr
Imo.. of h4tl uoz
❑ Private
0sto"
❑Chlorination
f
APPLICATION FOR ONSITE WATER AND SEWEf9 1
Ir7vd�I��
(Servat
SYSTEM APPROVAL p
❑Mineral Removal
�C f
I. GENERAL INFORMATION
Legal Description of the Location
❑ Holding Tank
F/�Cya'� �scraD�vrslc[L[
&cc r I� Lor y/la
Wall Data
Applicant Name
1 1�� 7y
It the Haight of the Well Casing more then 12•' above the Ground?
Ap l aant I" (Check one)
❑Certified Installer No.
K! [ G
IV Yes ❑ No
caner/Build..
Address (Street or P. O. Bo(k xl lIA,
o / �.�/v
/S
No
Type of Residence
L�'Sinola Family ❑ Mufti -Family
Toth No. of Bedrooms
3 Da m
City. State and Zip Code
GF 4:9S/�
Yield (If Available)
Twphone
Send Approval to:� �
[I Applicant U%Dther: (Give Name & Add•est)
/
!'2 60 611,1-
/
[/G
11. WATER SUPPLY SYSTEM &MC
Signature
Source Of Water and Containment (Check all that Apply)
Ype of Wau• Supply System
Trearment of Water (Check all that Apply)
014-111 (Drilled at Driven) ❑ Surface tldentifV)
❑ Private
0sto"
❑Chlorination
❑ Roof Catchment
Ir7vd�I��
(Servat
[]Filtration
❑Mineral Removal
❑ Other (identify))
1[t'ubliC more than one
❑ Holding Tank
family)
❑Other:
Wall Data
It the Haight of the Well Casing more then 12•' above the Ground?
a Yes ❑ No
Is a sanitary seal Installed on the wall using?
IV Yes ❑ No
Is drainage directed away from or around tlu casing within a radius of 10 feet of the well Cadng? ID/ Yes ❑
No
Data Drilled
Depth of Well (Fast)
Static Water Level (Feet)
Yield (If Available)
Pump Rate/(If Available)
/t(,,' -F�
e-� r
/
/{,,.'
Gal/Min
�1.� Gal/Min
Separation Distances from the Well Cuing to each of the Following Sources of Contamination:
Septic/Holding Tank on of r
Sower Lines on Lot
Absorption Area an Lot
�••/�
Clous Septi inp /HoltlTMk/ On Adjacent Lot
CI nt S wo Lines on Adjacent Lot
Clo st E sof an bso•ptiomAraa on Adjacent Lot
If toxic materiels aro stored on the property, including fuel tank$, paints, lubricants and other petroleum
On Lot
On Adjace Lot
based materials, pesticides, fungicides or herbicides, indicate distance from contaminants to well Cuing:
/� �j
�f-
1 �f
n
Water Sam le Taken by: Name
Sampur lc
t
k H/ D�
❑Buyer nglnee•
❑ Banker ❑ Government Official
Adtlroff
I• ere. ' -s N�f C�;;
Y G'l'27C
Ware• Sample Results: c
�otisfaclory. ❑
Attach Copy Date: - CS Unsatisfactory • Date:
1 certify that the above information is correct:
Signature
TVpod/Panted Nome
TItlO
Dau
NOTE: M✓sr be signed by eC#rrified Installer, Professional Engineer. Department o+ Enr:ronmentel Cdnrarvarion or the OwnerBuilder
❑ Septic Tank/Absorption
C
Holding Tank • Capacity of T alk I Where Wane is Disposed / (Frequency of rumpmg
❑ SOKIIY:
F13Septic Tank Outfall \ I ❑ Other (SpecifYF
Discharged To: (Outhouse, Inelno tor, ate.)
u
Name .---- _ • _-_
Ot Innaltar
Data installed
❑ Certified Installer ❑ Other:
Type/Ma-ut ufar
❑ Owner/Bulldo
Registered Professional
No.
Soil Type or llting
Septic Tank Site (Gallons) Number of Com •tments
Soil TVpa r Rating
Type Soil Absorption System
Di Msions/S(te Soil Absorptio SYstam
/Quntity Backfill Material used for Soil
Tyoe a
Date Septic Tank Pumped (Attach Copy of Race
❑ Pus 13 Fail
Absorption System
Percolation Test Results
Pere o tion Test by: (Name
Minimum Ground Cover oyer Absorp•
Minimum Ground Cov • over Septic
Cleanout P. wCaps Installed on
leanout Pipes/Caps installed on
bsurptian SYstam
tion area
Tank
Sopt.e Tsnk
❑ Yes ❑ No
❑ Yes ❑ No
Feet
est
Feat sat
Feet
f
Water Supply Source on Lot
N Nest wet. uDpl Source On AdlKent
Nearest BotlY of Water
Water Table/Bedrock Lot Lina
Separation
Lot
Distance to:
Feet
Feat
Feet
Feet Its
Comments/ Recommendations
I certify that the above Information is correct:
Signature
TVDe /Printed Name
J Title, Reg. /Cot. No., $net. No.
Data
NOTE: Must be signed by a certified Ins/ler, professional engineer or Cstaff.
Name of Installer
Date Installed
❑ Owner/Builder []Certified Installer ❑ Otho:
TVDe/Ma lecturer -
No.
Registered Professional
Septic Tank Sita (Gallons) Number of Compartments
Soil Type or llting
Type Soil Absorption System
Dimensions/Size Soil Absorption System
Type/Quantity Back till Material used for Sail
Absorption System
Adequacy Test Results:dequ
KYTest Performed BV:IAltach Copy of Rapp 1
Date Septic Tank Pumped (Attach Copy of Race
❑ Pus 13 Fail
Minimum Ground Corer over blest•
tion Area
Feat
Minimum Ground Cover over Septic
Tank
Ful
Cleanout Pipe./C"". Instal don
Sep tit Tank
Yes No
Cleanout PipWCapf Installed on
Absorption System
Yu rl No
Separation
Wer SupplySourceon Lot
::at
Nearest Water Supply Source an Adjacent Nearest Body f Water
Lot
Water Table Bedrock
Lot Line
Distance to:
Feat sat
Feet
f
Comments/Recom ndations
I certify that information is correct:
Sionsture
Typed/Printed Name " 1APsJ!L/Grt. NO., Inst. No.
Date
O G
ea:-7ivQ�_1•� h
NOTE:
a . .�
y C, R=id, 1r..- � �J
SEAL
No. 225's 'E �.- I �r'a
.y �•�
Registered Professional
00........
hi r_!%„'
Engineer
=u'
k
ALASKA ENVIRONMENTAL SHEET NO. OF 7
CONTROL SERVICE'' 'NC. CALCULATED BY �� 1�LDATE 6s
1200 West 33rd Avenue, ouite B
ANCHORAGE, ALASKA 99503 CHECKED BY DATE
(907)561.5040
C,4Li&4AT/ONS FO,C wizz SYS7& / SUf�°G/ED 8Y 'CLI►JS �L" tvSLC�'
3YSTb�/. 6a9 �b ) (ZO Pn r$;3 Z�aY� 3ZO 9a��i�3
rt
�3Su.�?�..�IU,c4eGE'_T•4N.e //95--40_% AY•a/[ABLE._3Ta.PsiCrE.._.cAPr4t/ry.._-
_._. _ /zo .�._o.,40,K
---- -
_ -
'
X . = 300
I �
i
IIOpIR1 At{ ni.14 w[. �„� K� 1411
F. _iso .dors, .coe;
MUNICIPALITY OF ANCHORAGE
• �1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L St,W. Anchorage, Alaska 99501 2644720
SOILS LOG - PERCOLATION TEST
PERFORMED
LEGAL
1 ,Ft 'eA-- MOE-A- 8rcxw✓%
I S',, 17,
SLOPE
SOILS LOG
❑ PERCOLATION
TEST
3 09 7
DATE PERFORMED: -7' ��BS
SITE
WAS GROUND WATER S
ENCOUNTERED? L
O
P
IF YES, AT WHAT E
DEPTH?
®®mmm
..e
•
,, I?
%C4VGttY ' A✓Jb
3
4
111'
/tom /te)
5-
6
6-
7-
79
9-
10
10-
11
11
t f
2
12-
13
13-
14
14
bre,
15
-w
6
16-
17-
171s
18-
19-
moC g r -y
20
I S',, 17,
SLOPE
SOILS LOG
❑ PERCOLATION
TEST
3 09 7
DATE PERFORMED: -7' ��BS
SITE
WAS GROUND WATER S
ENCOUNTERED? L
O
P
IF YES, AT WHAT E
DEPTH?
®®mmm
---_m_'
mm�r►.ims
mm
mmmm��
m—_m_�
.
PERCOLATION RATE 1? (minutes/Inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: ROS Iy t'JS'�I aX �7 CERTIFIED
72.008 (6/79)
ti
Z
(907) 243.2282
KENJOHNSON
rKEWS COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
30 YEARS ALASKA DRILLING
RANDY FOLTZ
10251 OUR ROAD
Anchorage, Alaska
Rei Lot 4A Blk 1 Fisher Subd.
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
JUNE. 19, 1985
( 346-3776 ) ( Wk. 277-6685 )
WATER WELL LOG
Pump breaking suction..Pull pump.. 3'ft 7 in. water in well.
.Dig up pitless & patch casing & back £ill..Move rig on hole.
Sound hole.. Tools dragging badly 35 ft. off bottom ( 235' )
Tools run free on bottom ( 263' +- ) commence drilling..
Casing drives hard at intervals.
26g ft to 274-6 ft Course gravel & light Brown silt
274-6 ft to 275 ft Weep in 5 ft H2O.. Bail dry
275 ft to2?7-6 £t Formation same..Casing very tight
277-6 ft to 279-6 ft Weep in 14 £t H20..Bail down to 2 ft.
279-6 ft to 280 ft Clean water bearing fine grav & med. sand
20 ft head
Test bailed 10 GPM
2 ft. Drawdown
Good recovery ..Bottom stable
Total casing 281 ft 0 in.
Dig hole and install pitless..Set pump..
TEST
TIME
1100
1200
1230
1300
1400
1500
1505
PUMP DATA Static water level 260 ( TOC ) -
GPM
DRAWDOWN
10
231
10
260-10"
10
260-9 in.
SO
260-9 in.
10
260-9 in.
10 -
260-9 in.
Shutdown
REMARKS
Dirty brown..Pump at 276 ft
Clear
clear
-Clean & clear
.Clean & clear ( sparkles )
Returned to Static immediat&17
Y
ro*�' S—� 7
KEN'S COMPQN?
WATER WELL DRILLING /ue"3 W:-) IA
PUMP SALES & SERVICE
(907) 243-AsYJ 3103 LINOtN DRIVE
KEN JUHN$vA-%vCHORAGE, ALASKA 99502
September 24, 1977
Randy Folti
Our Road
WELL LOG
0' to 15' Silty Sand
15' to 21' Gravel with silt
21 -to 22' cobbles
22' to 40' gravel with gray silt
40' to 85' brown silt and gravel ( drills open 5' to 10'
85' to 110 "'glacial till(gravel with gray silt binder)
110' to 120' gravel with brown silt
120 ' to 189' hard pan ( drills openbut slow, course gravel
with gray silt
189' to 200' cobbles with compact gravel
200' to 215' course gravel and brown silt
215' to 230' Brown sand ( wet) no open drives hard
r� 230' to 252' gravel and brown silt
252' to 253'-6" Large boulder (pulled casing back and
Blasted... Rotated casing 180 degrees
253'-6" to 165' gravel and brown silt
265' clean sand and gravel ( water bearing)
12' head
water bailed 2 hrs. at five GPDI
Set test pump and test pumped two hrse
at six GPDI
Bottom stable drawdown nil ... very clean
Total casing 267'-0"
(907) 243.2282
KEN JOHNSON
f ! r'
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
,I II 30 YEARS ALASKA DRILLING
N-e1C (1. 01"I ca /o l W PI'I /od
SUNDANCE DESIGNS
PAUL LETHENSTROM
P.O. BOX 110367
ANCHORAGEe ALASKA 99511 ( 346-3799 )
C a� ?
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
SEPTEMBER 3. 1984
REs LOT 114 Sect. 15 T12N R3W SM (Pacer & 101st off Hanley)
WATER WELL LOG
0 ft to 8 ft
Brown sandy silt with some medium gravel
8 ft to 59 ft
Brown silt with trace of fine grav
56 ft to 64 ft
Brn silt & fine grav '
64 ft to 68 ft
Course grav & bron silt ( tight )
68 ft to 69 ft
Same..weep in 20' bail dry ( poor )
69 ft to 81 ft
Course grav & brn silt ( dry )
81 ft to 95 ft
Brn silty sand ..some grav
95 ft to 161 ft
Course grav with grey silt & some cobbles
161 ft to 203 ft
Same with Brown silt
203 ft to 232 ft
Brown silty sand & grav
232 ft to 234.5 ft
Ned. grav & brn silt weeps 6 ft H2O
234.5 to 244.5 ft
Course grav & brn silt ( tight ) DRY...
244.5 ft to 250 ft
Course gravel & brown silt with small H2O
Seame.915 ft head bails dry at 3 GPM
250 ft
'Clean
water bearing med. Gravel & sand
21 ft head
-Test bailed at 7.5 GPM for 1 hr.
6 ft drawdown ( 2 min. recovery ) Clearing..
Total casing 250.00 ft.
Bottom stable..
Set perminaftL pump 1 ft. off bottom..
gAAD69c
I'ALNJCIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
EWIROWENTAL PROTECTION
FEEL
RECEIVED
. ia..• or''.
i CHEMICAL & GE0"*�OGICAL LABORATORIES i 1 ALASKA, INC.
TELEPHONE (907) 562.2345 ANCHORAGE INDUSTRIAL CENTER S V ,
i-`
5633 B Street 7 c 7
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM: (') See h on back
LD."O.
Water syn.m Nemo rhw No.
Meiling Addre
d
s..
SAMPLE DATE: O% 1 a� 3
1 r -
Mo. pry Year
Mo Ccd/
SAMP
_L tm TYPE:
tine
O Check Sample (for routine sample O Treated Water
with tab rof. tto-
0 Specbd Purpose 0 Untreated Water
SAMPLE Tirne NO. LOCATION ColleevIed Coley ed
fir 63
-4
' READ INSTRUCTIONS
BEFORE
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
Satisfactory
❑ Unsatisfactory
❑ Sample too long in transit; sample should
not be over 30 hours old at examination to
Indicate reliable results. Please send new
sample via special delivery mall.
Date Received
Time Received
Analytical Method:
❑ Fermentation Tube
Membrane Filter
PV
Lab
Reef.. No.
Result' Analyst
�J m
I —i m
.bar M 0r+r/100 •r r No. M P., prgry.
9&122004 BACTERIOLOGICAL WATER ANALYSIS RECORD
Fn. INS
Membrane Filter. Direct Count Coliformrtooml
Verlflealk
Final Men
Reported
COLLECTING SAMPLE
TNTC= Too Numerous To Count .
ALASKA ENVIRONMENTAL SHEET HD ► 0._7
CONTROL SERVICES—(NC. CALCULATED DATE
DATE
1200 West 33rd AvenuE Ate 0 —
ANCHORAGE, ALASKA 99503 CHECKED BY DATE
(907) 561.5040
SCALE 1 SO
_MUNICIPALITY OF ANCHORAGE .. .. .. ... .
" -"DEPT.'O"EAILTH& '>
s
! ENVIROWENTAL PROTECT O
N,
RECEIVED
,
e ,
;.o.kkh
Tlf -1
I
_j
'lA
got-yhi �,— ---� `- • - - -:....r m���
t,
tiT
I—�--__—••_—• , __ �� ��,:.-rte—=— - !--'------... _._ .. _ _.__ _—�—' _
17.
t
i I ,
BILL SHEFFIELD, GOVERNOR
DEPT.OF.EN%'IltON."ENTAI,CONSEII'tATION j
ANCHORAGE/WESTERN DISTRICT OFFICE
437 ".E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501 274-2533
August 9, 1985
Alaska Environmental Control
Services, Inc.
1200 W. 33rd Avenue, Suite B
Anchorage, Alaska 99501
SUBJECT: Lots 01 and 02, Block 1, Fischer Subdivision,
Anchorage, Alaska (8621 -WA -038)
Dear Sir:
We have reviewed the subject waiver request and cannot approve it at
this time. However, a second request for approval may be submitted
to us with either one of the three following modifications:
1. The existing Seepage Pit and Trench be abandoned and a new
absorption field be built outside the 150 ft. Class "C" well
barrier. Note, a waiver will still be required for the
septic tank.
2. When the new house on Lot 02 is built, the existing septic
system on Lot 01 must be abandoned and a new combined septic
system for both houses be installed outside the Class "C"
well barrier.
3. A new well be drilled, giving each house their own private
well which therefore would not require any changes for the
existing septic system on Lot 4A1.
If you have any questions, please contact me at 274-2533.
Sincerely,
%W//1 v"
Michael P. Lewis
Environmental Engineer
MPL/msm
n
C T 5
C
Mr. Michael P. Lewis
Environmental Engineer
Dept. of Environmental Conservation
437 "E"..Street, Suite 303
Anchorage, Alaska 99501
Re: Lots 4A1 and 4A2, Block 1 Fischer Subdivision,
Anchorage, Alaska (8621-Wa-038)
Dear Mr. Lewis:
We have', completed item number 1 of your letter dated August 9, 1985.
Enclosed. are the inspection reports completed by Alaska Environmental
Control Services, Inc. and a .permit. issued by the Municipality of ,
Anchorage for a sewage system upgrade.
Per your letter we are requesting approval for a Class "C" Water System on
the subject lot and a waiver for setback to 123 feet from a septic tank.
The entire' leach field has been removed from the 150 setback. All other
information is as stated in our request dated August 1, 1985.
If you have any questions please call.
Sincerely,
Randy F tz
AN ALASKAN CORPORATION ,
625 WEST FIFTH AVENUE SUITE E ANCHORAGE, ALASKA 99501.
T E L E P 11 O N E 907-277.6685
• 17
yr♦ Y `` P,F�
'` Munrcipahty of�Ancho`a
rge E '
I t �` •
�D_ eve'lopment•Senrices Department `_ u
+,C r iA �.. Building`Safety Division'., . :� n♦ '.ii
On -Site Water and Wastewater Program ` ` • • ,
4700 South BragawStteet; ` • i ~
P O Box 196650 'Anchorage; AK 99519.8850 ' s
`r; www Aanchorage.ak_.us`
(907)_343
A OF HEALTHAUTHO �A k20VAL
D $INGLEFAMILY,iDWELLLN s
4
s urwwr SUPPC ; ` TYpErOFayyASATER DISPOSAL '"
.WC Mdue e c i "�' r ." ,4r • I f E E r :. tit
(ndMduar o site "
Individual.
a tilt �> f , ndtviduaf Holding tank r
;;1♦ Commundy,;Gass`CjWeIIP. '�,® �%;` Commun >: .� t 1 ,t
t, � Pubhc jW" afar System,` � ,i, , Y 0 , � ' • , • PubhcjSewer•� ` ; � 0 y ,` ;
i r
,
The Mun'iapalrty of AnchoragetDevfilopmeM Semces De rtrnent T ' . ''r''
pa (DSD) Issues CefLficates of Heatth Authority+
Approval (HAA) based
on upon tfierepreseritations gN n in'paiagraph'S .bylan independent professtonel civil d
enginee,"Wered In the State of Alaska , Certficates o(Health Authority Appnpval are required for the tn3nsfer of
,4. .
`title,(except tieMieen spouses) on properties served by�a single family on-site:wastewater disposal and/or water
supply system E 6§10111 lso issues HAAs. upon request to home ownersr Cerhficates of Heattti AuthorityrApprovai are .>
valid�for 90 days.from the date of issue, or properties served by a private or Class C well and maybe reissued With 1
new water sample results Less than 30 days old Certificates are valid for one yearrfor properties served by Class`A
or B wells or a public , .ersystemI. l7ie Municipality of Anchorage rs not responsible for errors or omissions in the
�professionat engineer's aloft(?,•,°t°�ry,'r t, • y?. { r ''1 � 4 1 -°-> l +( ;p•
'.� • 1 !� r. ` it 1 �
':�1 1 � i'� , •
t 1 r
"CER
'` Munrcipahty of�Ancho`a
rge E '
I t �` •
�D_ eve'lopment•Senrices Department `_ u
+,C r iA �.. Building`Safety Division'., . :� n♦ '.ii
On -Site Water and Wastewater Program ` ` • • ,
4700 South BragawStteet; ` • i ~
P O Box 196650 'Anchorage; AK 99519.8850 ' s
`r; www Aanchorage.ak_.us`
(907)_343
A OF HEALTHAUTHO �A k20VAL
D $INGLEFAMILY,iDWELLLN s
4
s urwwr SUPPC ; ` TYpErOFayyASATER DISPOSAL '"
.WC Mdue e c i "�' r ." ,4r • I f E E r :. tit
(ndMduar o site "
Individual.
a tilt �> f , ndtviduaf Holding tank r
;;1♦ Commundy,;Gass`CjWeIIP. '�,® �%;` Commun >: .� t 1 ,t
t, � Pubhc jW" afar System,` � ,i, , Y 0 , � ' • , • PubhcjSewer•� ` ; � 0 y ,` ;
i r
,
The Mun'iapalrty of AnchoragetDevfilopmeM Semces De rtrnent T ' . ''r''
pa (DSD) Issues CefLficates of Heatth Authority+
Approval (HAA) based
on upon tfierepreseritations gN n in'paiagraph'S .bylan independent professtonel civil d
enginee,"Wered In the State of Alaska , Certficates o(Health Authority Appnpval are required for the tn3nsfer of
,4. .
`title,(except tieMieen spouses) on properties served by�a single family on-site:wastewater disposal and/or water
supply system E 6§10111 lso issues HAAs. upon request to home ownersr Cerhficates of Heattti AuthorityrApprovai are .>
valid�for 90 days.from the date of issue, or properties served by a private or Class C well and maybe reissued With 1
new water sample results Less than 30 days old Certificates are valid for one yearrfor properties served by Class`A
or B wells or a public , .ersystemI. l7ie Municipality of Anchorage rs not responsible for errors or omissions in the
�professionat engineer's aloft(?,•,°t°�ry,'r t, • y?. { r ''1 � 4 1 -°-> l +( ;p•
'.� • 1 !� r. ` it 1 �
zl� 5.tJSTATEMENTOF INSPECTION BY ENGINEER
As led by-m� seats he o'A i's" of the validation date shown below I
verify that
,'- ,-
' my Inves
tig. Fon
n procedures outlinedIn the HAuthoryAppmv HiathAuthdity'Approva
ionshowsjhate iiia- e erjpply.a6d/ol,wasi emis.safejuncuna and
i",;
adequate for the number of bedrooms a structure A' eriveft that based on their
infonnabon type of .. re.,indicated
M h
from,the' unicipal ... of,Anchorage files i -I igation and nspection,-t
... - -i,v- -- I . -&'.. '. M 4— 1 -
on ensupply-i-a-rid, ii -'r I p cable unicipa �an
for;wast hiiteir*�J&si�p6iij.! ystern-is iwcompliancewith:a I!ap i d-
es, i,
effect at me umeof'installation'
i
Name of Finn Pannone,Erd SWc
218e;
Og
W ✓
,( nuulYV1 M1 W111411=114 r+ ivi IMA QYQAFA�CU I� 041
ip
PROGRAM
/j 1%zNT bta" I i)
A Ch mentS..
.. . ...
I.M C
hediist); Xt, "I' Maintenance'Agreements si
ti; .-4 .
�V - ',Septic y -;Stippliitmdfital Erignaers Report •
• spry
Well F1
By-
.0
Original Certificate t07
6ili "A' .:,7
Reiss
!Expiration C Lie Date.
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 190850 Anchorage, AK 995198850
www.cl.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 4A-2. Bk 1. Fischer S/D Parcel I.D.: 015-292.43
A. WELL DATA
Well type _q If A. B, or C provide PWSID # 217966 Well Log Y
Date completed 6/19/1985 Sanitary seal X. Wires property protected Y
Total depth 280 ft Cased to ft Casing height (above ground) 24" in.
FROM WELL LOG AT INSPECTION
Dale of test 6/19/1985 6/16/2001
Static water level 260 ft 252 ft
Well production 10 g.p.m 5
g.p.m
WATER SAMPLE RESULTS:
Colifonn__L�colonies/100 ml Nitrate ' $ mgll Other bacteria colonies/100 ml
Date of sample: Z 0 Collected by: � akLKA x/1/1 CMD
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Date installed 10/29/1992 Tank size1_ 000 gal Number of Compartments 2
Cleanouls Y Foundation cleanout Y Depression over tank N2 High water alarm No
Date of pumping IVIS/2000 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date Installed 10/29/1" Soil rating (g.p.d tft2 or f?/bdnn) Sayd/ System type Shallow Trench
Length j`8 ft Width F It Gravel below pipe 30 ft
Total depth g: ft Effective absorption area6W fe Monitoring tube Y Depression over field N
Date of adequacy test W1612001 Results (Pass/Fail) Pass For _I bedrooms
Fluid depth in absorption field before test ja in Water added450 gal. New depthg In.
Elapsed Time: 200 min Final fluid depth jay in Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 rho.) (Y/N 8, type) pilo If yes, give date
(Rev. I IM)
D. LIFT STATION
Date Installed Size in gallons
'Pump on' level at _ in'Pump off" level at
Datum Cycles tested _
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access
In High water alar level at _ in
Meets alarm & circuit requirements?
Septic tank/lift station on lot 163' On adjacent lots 121.7"
Absorption field on lot 162' Is. end) On adjacent lots 162
Public sewer main N/A Public sewer manhole/deanout N/A
Sewer /septic service line 120' Holding tank 76+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10' Property line 10+ Absorption field 6'
Water main 25+ Water service line 26+ Surface water _100+ `
Drainage 100+ Wells on adjacent lots 00+
SEPARATION DISTANCE FROM ABSORPTION FIELD 'ON LOT TO: -
Property line 10+ Building foundation 16' Water main 100
Water Service line 25+ Surfacewater 100+ Driveway, parkinglvehide storage 1_
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA gwdahnes in effect on this date.
Engineer's Printed Name Steven R. Pannone. P.E.
Date 6-19-01
c�
HAA Fee $ 00 Waiver Fee $ _
Date of Payment !i Z Date of Payment
Receipt Number �/J Receipt Number
(Rev. 71188)
l i
3 491" M
Steven R. Ponncne�
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH 8 HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIF1 ATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # O t.5— z 4 2 — 142 HAA # tfA T
1. GENERAL INFORMATION
Complete legal descript;on Lo -r- a A—z ,—�?' LccfL I 5%
Location (site address or directions) io -Z r I r^ o -a 12 m
Property owner _-Z - ,, #_�t c't2cs Tn^4 Day phone Z2 "Of?
Mailingaddress cU2. Q2b .Alvclt• AV_ 0OU-16
Lending agency
Mailing address
Agent
Address
Unless otherwise requested. HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
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 x
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status o/ systm.
72-025(A*%1/91) Fro l MOAN21
S. 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 furtherverify 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 2Q�IgAtw ^/& , rP cz . Phone 2�z-8zif�,
Address P•o 2Kc9y- le42c-zS' A,ucl c,-nP4 AV_04Ps-izr
Engineer's signature -,_-m ^%1, Date 41r 197
6. DHHS SIGNATURE
Approved for T1�G bedrooms.
JM
Disapproved.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
4
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 registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending 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.
ams In«. wig 6. POA m
Municipality of Anchorage
(b DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division p
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-49 C E
Health Authority Approval Checklist APR 151997
Municipof Anchors
Legal Description: L4A-2.%I 'FsscNm2 �trn Parcell.D.: oIc--0l�t9tRMmuRd ge
rvices
A. WELL DATA
Well type C If A, B, or C, attach ADEC letter. ADEC water system number 21 ';L 4 4 6
Log present (Y/N)
Date completed 6 // 9 %BS
Total depth Z°FS O Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Date of test (o %I 4 / %S'
Static water level -06 G
Well production g.p.m.
WATER SAMPLE RESULTS:
Casing height (above ground) -' y 4
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
Coliform
O
Nitrate ci • O
Other bacteria b
Date of sample:
3 NO / 4 7
Collected by:
S • Q 17�PA.v.vo-✓ Ls
B. SEPTIWHOLDING TANK DATA
Date installed tol a4 r'4 i Tank size Number of Compartments Z— Cieanouts (YM) Y
Foundation cleanout (YM) `r Depression (YM) N High water alarm (YM)
Date of Pumping 2/z rile f Pumper At -
C. ABSORPTION FIELD DATA
Date installed Ir lz s/r- 2- Soil rating (g.p.dJff: or ft2/bdrm) 0.2S System type 64AUow "bwcbtl
Length 9 ` Wldth S ` Gravel thickness below pipe 3 Total depth r
Effective absorption area .5754 Monitoring Tube present (YM) f Depression over field (YM) A-)
Date of adequacy test 3 1'2 4 t4 7 Results (Pasa7Fail) SPA s S For _3 bedrooms
Fluid depth In absorption field before test (in.); fl-' Immediately afteruSO gal• water added (in.): 'D 2Y
Fluid depth •Ae`r (ins) Minutes later: I Absorption rete = G. r us o a.p.d.
Perwdds treatment (past 12 months) (YM) ✓y If yes, give date
72-0211 (Rev. 3/913)•
D. LIFT STATION
Date installed ` T
Manhole/Access (Y/N).
High water alarm I
E. SEPARATION DISTANCES
on" level at*
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /
"Pump off" level at*
IZI- 4-&.Ar3-r. wAwK'L-
On adjacent lots NEW srA-P Acaro 2-c'
Absorption field on lot /S2, 5 • e N a On adjacent lots / so '+ i SZ ,< a)
Public sewer main n, /A Public sewer manhole/deanout `1 W
Sewer /septic service line
I
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation / o ` Property line ,0+ Absorption field S r
Water maintservice line R S Surface water/drainage /&w -t- Wells on adjacent lots /fit
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /oBuilding foundation /S Water main/servioe line 2 Sr
Surface water oo Driveway, parldng/vehicle storage area -3S'
Curtain drain / c7o T Wells on adjacent lots ( oo t
F. ENGINEER'S CERTIFICATION
I certify that I have determined Mru field inspections and review of Municipal records that Ma 9bave systems are
in conformance wiM MOA HAA guidelines in effect on this date.
Signature
[ett P W .bt kt
R.
Engineer's Name �"rlo.lrZ.n� 2•Pdnfr✓oNtl�Vae� �". . , , , '�
Date q111�4�
HAA Fee $ 7300 Waiver Fee $
Date of Payment 4(- 1 — 4 Date of Payment
Receipt Number 0 2 8 v 4 ((v 33 �� Receipt Number
72-026 (Rev. 3/96)"
acus Ka TONY KNOWLES, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGENVESTERN PUBLIC SERVICE AREA OFFICE
555 CORDOVA STREET
ANCHORAGE, ALASKA 99501 (907) 269-7505
April 24,1997
Mr. Steven R. Pannone
P.O. Box 142025
Anchorage, AK 99514
SUBJECT: Lot 4A-2, Block 1 Fischer Subdivision -10201; Class "C" Public Water
System ID no. 216287, AWPSA Project No. 9736-0201-WJ-015.
Dear Mr. Pannone:
This letter is in response to the information received in this office April 17, 1997, requesting
a letter of compliance for the above Class "C" Public Water System serving a single family
residential dwelling. The Department has completed its review of the submitted
information, which included site plan for the well located on Lot 4A-1 Block 1 Fischer
Subdivision, and recent water sample analyses for total coliform bacteria and inorganics for
nitrate. A review of the recently submitted information indicates the actual separation
distance between the class 'C' well and on-site wastewater disposal system located on Lot
4A-1 is closer than previously approved by this Department. Assuming that there have
been no modifications to the properties since the original approval was granted, it appears
that the lesser separation distance which was recently measured does not void the
previously approved waiver for this well.
Since this drinking water system has been previously approved by the Department, and
because it serves less than 13 bedrooms or 25 residents, this water system is viewed as a
Class "C" Public Water System. Verification that the water supply has been recently tested
will be required to maintain compliance with State Drinking Water Regulations. The
submitted water analyses were satisfactory for both total coliform bacteria and nitrate,
satisfying this concern. Therefore, for the concerns of this Department, this system is in
compliance with State of Alaska Drinking Water Regulations (18 AAC 80). Please note that
this system has shown an increase in the level of nitrate since water sample results were
last received in this office. Attached is an "Approval of Onsite Residential Water and
Sewer Systems" certificate verifying this system's status as an approved water system that
is in compliance with 18 AAC 80.
Thank you for your cooperation with this Department, if there are any questions regarding
the above, please do not hesitate to call.
Sincerely,
N44.1
Environmental Engineer
Attachments
G:WooVnlhYwcbc ,�q,
`.� printed on recycled paper b y C.D.
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS
PROPERTY DESCRIPTION
1�t -14-2, a%et
fIJSLP x..217466
CA J.Cate b.VM to, AppbC.b011 NO:
5734-020 - (JJ -02'/
This approval does not constitute a guarantee of any kind, explicit or Implied, as to the performance
of the water supply and wastewater disposal systems.
WATER SUPPLY
A recent water sample was tested and found to meet Department of Environmental Conservation drink -
Ing water standards for total coliform bacterla.and %;fo&to_
N.� rm°Eate
!:1 - o 1
WASTEWATER DISPOSAL
The domestic wastewater system was:
❑ Inspected by the Departm nt of Environmental Conservation ound to be in compliance with
applicable requirements of 8 AAC 72;
❑ Inspected by a Professional E sneer who certif that the system complies with applicable re-
quirements of 18 AAC 72;
❑ Installed by a Certified Installer who ies that the system complies with applicable requirements
of 18 AAC 72; or
❑ tested by a Professional En eer who I
and that the system co les with the
This approval is valor a ❑ single family ❑
that the performance of the system is satisfactory
m separation distances specified in 18 AAC 72.
unit with a total of bedrooms.
184404 (Ra. des) DISTRIBUTION: WHITE—BANKILENDING INSTITUTION; CANARY—APPLICANT. PINK—DEPARTMENT
MUNICIPALITY OF ANCHORAGE
ON-SITE WATERIWASTEWATER DISPOSAL SYSTEM
FIELD AUDIT
Date 4djol % Document Type
Legal Description
Site Address /0,201 OC R. /lci
Engineer/Firm 57EI/z j v"Lli Excavator
<X/U 1&4EtC%
4�q
Inspection Findings /MIL . /181 575C'C,trr e l�ui L
LoT yA 9LxI Frcht�2S/O
C/V l-%7 101 QUC( Fi-fCAM'/O 4 L ISO r 7e /kr4;2274ye/
Fin rN La 114LI, sites F'.� -s'/O,
initials
Follow-up Notes dlM axc
U✓/LL �izdu8� �r ff/�9 L�7rVN S1&v1" x_1067
Time
/463-5-92
r
MUNICIPALITY OF ANCHORAGE
O DEPARTMENT OF HEALTH & HUMAN SERVICES AULD
Division of Environmental Services low
On -Site Services Section EFTIS
P.O. Boz 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D. #
1. GENERAL INFORMATION
HAA# �\Pk'\1Q10Q
Complete legal description Lor VA— Z , 7ZLOC.K I SfA
Location (site address or directions) 10 Zo 1 C>02 2 D
Property owner --XA- eA 2s 'ter T Es-Tm F4 Day phone Z7-7- oo 12
Mailing address 15"20l' otyw tZ�j , p,v cN AK °.5 9s-1 b
Lending agency
Mailing address
Agent
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
RECEIVED
APR 61 1997
Municipality of Anchorage
Oept. Health & Human Services
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
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.
7V= (FW. 1191) Font WA 621
& 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.
Nam a ofFirmN RZPAVNONE,P•ca. Phone 2-72-23ZIR
Address o.�ox i4zr�zs i A.ortcAK �" of
Engineer's signature__ Date 3 /Z 414 �t
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:
HITir
Date
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 registered in the State of Alaska The DHHS does this as a courtesy to purchasers of homes
and their lending 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 engineers work.
MM ow.M e.ak MOA 01
& DHHS SIGNATURE+'`•`�3z4"'
`:;_J;:
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By:
HITir
Date
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 registered in the State of Alaska The DHHS does this as a courtesy to purchasers of homes
and their lending 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 engineers work.
MM ow.M e.ak MOA 01
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICIM C E V E D
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907), -47497
Health Authority Approval Checkilej Municipality of Anchorage
ept. Health & Human Services
Legal Description: L 4A -z,13 t 1=%cgbw- 5/D Parcel I.D.: Olb - Z 4 Z - of 3
A. WELL DATA
Well type _C If A, B, or C, attach ADEC letter. ADEC water system number 217 T6 6
Log present (YM) I Date completed 61 19/847-
Y
Total depth 2 `13 O Cased to Casing height (above ground) Z�
Sanitary seal (YM)
Date of test
Static water level
Well production
K 05
FROM WELL LOG
&/t q IA
WATER SAMPLE RESULTS:
Collform O
260
f
,,to O.P.M.
Wires properly protected (YM) Y,
AT INSPECTION
31 ZY 14 7fi
-5
g.p.m.
Nitrate 4if D Other bacteria 2
Date of sample: 9 T Collected by: S R Aa j J o nl
B. SEPTIGHOLDINGTANK DATA
Date installed Z Tank size Imo Number of Compartments —_ Cleanouts (YM) Y
Foundation cleanout (YM) ti' Depression (YM) to High water alarm (Y/N) N
Data of Pumping 7 /2 9/4 Pumper A't 16,w a SV C
C. ABSORPTION FIELD DATA
Date installed tot29 t q L Soil rating (ap d /ff' or tt'/bdrm) o.16 SysWm type S NAUcw -m c8
Length 68 f Width SGravel thickness below pipe 3 f Total depth B f
Effective absorption area SBL f Monitoring Tube present (Y/N) Y Depression over field (Y/N)
Date of adequacy test 312 fl f3 Results (Pass/Fail) IZZPA cs For 3 bedrooms
Fluid depth in absorption field before test (in.);-bQ' Immediately attar`yam gal. water added (in.): -Oat'
Fluid depth-AtZ�r (ins) Minutes later: 151 Absorption rate = Cr '4" a.p.d.
Percodde treatment (past 12 months) (Y/N) At) If yes, give date
72-026 (Rev. 31913)•
D. UFT STATION
Date installed
Manhole/Access (V/N)
High water alarm level at -
E. SEPARATION DISTANCES
`Pump on"
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons
"Pump off" level at'
RECEIVED
APR G 11997
Municipality of Anchorage
Dept. Health & Human Services
Septic/holding tank on lot
/S3 r
On adjacent lots
/,50
r{
Absorption field on lot _
/.SLm l5
•ectal On adjacent lots _
/ Z"O
-F
Public sewer main IV�
Public sewer manhole/cleanout `-, iA
Sewer /septic service line 1 Z o I Lift station So
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 1 O r Property line /G -I- Absorption field S r
Water mairdservice line -ZS4 Surface water/drainage 100 -'-Wells on adjacent lots / oo 't
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / Building foundation 1.5- / Water main/service line 71,5
+
Surface water / �� Driveway, parkinghrehicle storage area 3S r
Curtain drain /c, p t Wells on adjacent lots ! cao •t
F. ENGINEER'S CERTIFICATION
I ceRRily that I have determined thru field inspections and review of Munidpal rewrds th$�time.above systems are
in conformance with MOA HAA guidelines in effect on this date.
Signa
Engineer's Name _�-r e�¢N 2Qew �k v� • d
Data 3 12 4`9 2z
HAA Fee $ ix • CY-? Waiver Fee $
Date of Payment
Receipt Numbered
72-028 (Rev. 3/913)'
'. , �• � £;uv� F. f!nnno! ' f .. is
is -8145 •/v ..
� ;•., rb3z q , •0;,
Date of Payment
Receipt Number
