HomeMy WebLinkAboutELMORE #1 BLK 5 LT 8Elmore #1 Block 5 Lot 8 #018-172mw22 trcev uoruL';rn) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231109 PID Number: 098-172-22 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name CARTRELL ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 4451 RIVERTON AVE ❑ other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Fl. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ELMORE #1 BLK 5 LT 8 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ 504 TANK 9 Septic ❑ S.T.E.P. E Holding ❑ Other Manufacturer GREER/ANCH TANK. Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 10,+ NA PLASTIC/DEEP BURIAL 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer MIKE N ANDERSON PE Drainfield Co/MT3034 Inspector MIKE N ANDERSON PE BENCH MARK (Assumed elevation) 100 ft Inspection1st 7/19123 Location and description dates:2nd TOP OF MH LID 3'" 4'" ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp ,.., A , •..T �'` Conditional Approval: Date r., , I JW moi.• r. ,� .�.'� ��'-�? • MICHAEL N. ANDLA5CN 'C— v' ', s '• � Septic System"' - Approved; _ j / Datefv�2 CE- 946 A l� v 2' •��`,� _ [Vote: this approval does not include well permit requiremen(S. trcev uoruL';rn) XXXXX X X X X X X X X X X X X X X X X X X X // / / / / /// MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231109 Effective Date: Work Type: SepticTank Upgrade Expiration Date: Tax Code Number: 01817222000 Site Legal Address: ELMORE #1 BLK 5 LT 8 G: Site Mailing Address: 4451 RIVERTON AVE, Anchorage Owner: GARTRELL MARK R & JOYCE L Lot Size in Sq Ft: Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: This permit is for the construction of: sl cnt Si ..+.. ;S Department 5/25/2023 5/24/2024 41498 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Prior to tank installation, locate the field to confirm that the 5' tank to field separation will be met. i �►�$Y: S5 "l A e rl +0 I'l/A e /1/, Date: Issued By: Date: �� Z� 3 n ����JMUPDAL. ffY OF nL\ HC �OG�AO= Development Services Department l Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 018-172-22 Property owner(s) GARTRELL Mailing address 4451 RIVERTON AVE Site address SAME Day phone Legal description (Sub'd., Block & Lot) ELMORE #1, BLK 5 LT 8 Legal description (Township, Range & Section) Lot Size 41,184 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade Q (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 10 Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 13b -n Waiver Fees: Date of Payment: Date of Payment: Receipt Number: OZ3 7 75 Receipt Number: Permit No. 0_!:� P2 3 11 C1 Waiver No. GADevelopment ServicesOuilding Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc MAY 20, 2023 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: ELMORE #1 BLK 5 LOT 8 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231109, Deb Wockenfuss, 05/25/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231109, Deb Wockenfuss, 05/25/23 \ n MUNICIPALITY OF ANCHORAGE f"` DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME u��t!':,s V�/l�wl.� X. PH/ONE ❑NEW Q'GPGRADE MAILING ADDRESS S 11- 6 ate- A 246207 LEGAL DESCRIPTION LOCATION NO. OF BEDROOM L) WellY C DISTANCE TO: J Absorption area r Dwelling 2 PERMIT NO. �� O QManufacturer w f, Materia No. of comp ments a Liq. capac'ty in gallons IF HOMEMADE: Inside length Width Liquid depth 6 Y Jd2 DISTANCE TO: Wel Dwelling PERMIT NO. S?t Manufacturer Mat ial quid kapacityin giiutaps- 0 W= DISTANCE TO: Well `� Foundation f 3 r Nearest lot line .f-1 0 PERMIT NO. 3 F u. W No. of line Ileinches Length of each line Total length o Ines Trench width �.. Distance betuueettli e� fCJ of Top of tile to finish grade 7 Material beneath ti e 4e Total effective a jon area W v Length Width Depth PERMIT NO. 461_ W d Typeof sib Cr b diameter ib d ih Tot eff ctive a orp ion ar ISTANC O: We Bwlding fou ion Nearest lbirline J J Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MAT RIALS - r/c/ k SOIL TEST RATING 71 1 'GJ _ INSTALLER y 7 f REMARKS APPROVED _ DATE LEGAL 72-013 (RevtO/78) 1 / r•1F�N I C I FiL I TY OF nrJCt jpF4FiGE �Y �..- DEPARTMENT HEALTH AND ENVIRONMENTAL' OTECTION e3 825 'L' STREET, ANCHORAGE, AK 99501 a • �� 264-4720 Oto—S I TE SE44ER F}EF<t-1 I T y� 3�1-I�� PERMIT NO. C 830402 > lKLty�0LcinJ APPLICANT LUTHER L IPPISCH SRA BOX 478A 99507 269-5744 LOCATION LEGAL L8 65 ELMORE #1 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EP•TH= O LEr-JGTH= 32 GRFikfEL E>EPTH= 4 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR bRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). RE:,DU I REl> SEPTIC TFirJK 4-,- I M!E= 1000 GFiLIL0h.15 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T440 C . 2 ] I NSFF ECT I 0Nn3 RRE REGtiU I REa BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS 11AY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERMIT E?{P I RES} D>ECEMF3ER 31s 1'x+03 I CERTIFY THAT 1: I AM FAMILIAR 14ITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE: 2: i WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED BY I vel (b 1, WW 7�7 P i rj IPPISCH p;7- �S / W Ci I'L V4. 0 L.L, Gm=�TER ANCHORAGE AREA BOROL�'�H ' HEALTH DEPARTMENT ' NO 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ME 333_ LOCATION La/_ L�l/'r C'f/°/' LEGAL DESCRIPTION I-OT,P/'ll�t'�y/yy+/i SEPTIC TANK: ZZ /p /NUMBER OF DISTANCE FROM WELLy MATERIAL -COMPARTMENTS LIQUID CAPACITY � %� l O GALLONS. INSIDE LENGTH 4i ' INSIDE WIDTH -DE TH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH ""�>e ', LENGTH "=, DEPTH LINING MATERIAL ���-y�� "/`-'T -/��� S . DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT LINE "�� ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SO. FT. TILE DRAIN FIELD: DISTANCE FROM NUMBER OF BETWEEN AREA SO. FT. LENGTH OF EACH NEAREST LOT TRENCH WIDTH LINES , TOTAL EFFECTIVE TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL; DISTANCE FROM /J///1'X. WATER TYPE � Zle-=2' DEPTH �l ,BUILDING FOUNDATION. //'� SAMPLE /�' NEAREST i NEAREST SEPTIC �� ' SEEPAGE I OTHER LOT LINE SEWER IINE TANK / , SYSTEM ��f , CESSPOOL , SOURCES— DISTANCES: I i 7//-�17� DIAGRAM OF SYSTEM I DATE (' e�. xS '–" M GAAB-HD-2 GREATEr"kNCHORAGE AREA TROUGH. Case NO.22-1:� IIEALTH DEPARTAIENT ' 327 Eagle St. Anchorage, Alaska 99501 279.2511 �l �D/is I7� SEWAGE DISPOSAL SYSTEM - APPLICATION Ik PERMIT 13 NAME OF APPLICANT <(Cu fft MAILING ADDRESS 1711-�k lk&f;PHONE /N�03S`Np7 RESIDENCE ADDRESS Wiz+{!. LOCATION OF INSTALLATION LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT , DRAIN FIELD I �, OTHER TO SERVE THE FOLLOWING FACILITY L .t 1tt4 61144�L"4! r— FINANCED THROUGH /TO BE IN8KALLED BY u PERCOLATION TEST RESULTS�`V �� ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS , PERMIT TO INSTALL ::jr AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE feoo TIYPE SEEPAGE AREA LA�TYPE I DIAGRAM OF SYSTEM DISTANCES: D �I HEALTH AUTHORITY OR ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ...................... LICENSED DESIGNER I certify that I am familiar with the requirements of Great above described system is in accordance with said code. C l 7 APPLICANTS SI DATE D er Anchorage Area Borough Ordinance No. 28-68 and that the GNATURE)��"C� GAAB-IID-2 $ GREATET'iNCHORAGE AREA r)ROUGH Case No.�`f IIEALTN DEPARTd1ENT ' 327 Eagle St. Anchorage, Alaska 99501 279.2511 • SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT �7 97 NAME OF APPLICANT 1- LA � ) !- gpisel1 MAILING ADDRESS tha a6 L PHONE NO.- RESIDENCE ADDRESS s �^^t�� LOC TION OF INSTALLATIONS�,, x' LEGAL DESCRIPTION V R w 57 APPLICATION TO INSTALL: SEPTIC TANK 1/, SEEPAGE PIT DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY- FINANCED THROUGH 'Z_t1 TO BE INSTALLED BY PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION - t AlBELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS A 1 -� hbC PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF �1NIT TO BE SERVED h IL S ccs .SEPTIC TANK SIZE 112,00 TYPE SEEPAGE AREA TYPE DIAGRAM OF SYSTEM DISTANCES: CC'_'a v .. 4 o u b jI L 3CuuTN AUTHORITY L I I I I I I I I" I �• I I I I I I I I I I I I I OR j"SED DESIGNER ceftify that I am familiar with the requirements of Greater Anchorage Area Borough Ordina ce N 28-68 aad hat t e above described system i in accordance with said code. ei �U/ia' e-! K DATE APPLICANTS SIGNATURE <►/� „r CRF.P.TER ANCN^7A^E AREA R,- ffi:ALT:i D PA:.T:'E!JT ♦ 327 EA:,LE STREET CASE, ANCHOnP."F, A?,.1SKA 99501 Perfcraed For c _ Legal Ucscri tion ot�Sj' Date Performed This Fct•ri Reports a: Soils Lar, ✓ •rercolauon fes: Depth '•e^t Eoin Chir.. tcristics 9 Ic Lap9e F.ockc occuF Has Ground Nater Encountered?_ np 'joy 0 If }•es, At What Perth LOGlticn Swnt,l, Frcpo cd Insta:lat�ion.•"Seenare Pi: Depth Of IrOp 1 -jet 31 Crain Trend COMVIENT 3:Ce:o hottor Cf Fit Cr ':rerch Test Perforced By Data Certified Ey: Date:1_ MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section —� Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-172-22-000 Expiration Date: 9/18/2025 Legal description ELMORE #1 BLK 5 LT 8 Site address 4451 RIVERTON AVE Anchorage AK 99516 Current property owner(s) GARTRELL MARK R & JOYCE L X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 11/5/2024 his Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approvaljune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-172-22-000 Expiration Date: 9/18/2025 Legal description ELMORE #1 BLK 5 LT 8 Site address 4451 RIVERTON AVE Anchorage AK 99516 Current property owner(s) GARTRELL MARK R & JOYCE L X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 10/23/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE 'Rusl{ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-172-22 Complete legal description ELMORE #1 BLK 5 LT 8 Location (site address) 4451 RIVERTON AVE, ANCH AK Current property owner(s) GARTRELL 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel Plastic ❑ Concrete ❑ Fiberglass Age 1 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 5-5-6 330 Waiver Fee $ Date of Payment G� Z 5— L Date of Payment COSA # 0JC 2 l 1'357 Waiver # COSA Application_ June 2022 COSA Checklist Legal Description: ELMORE # 1 BLK 5 LT 8 Parcel ID: 018-172-22 If more than 7 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled '1973 Total depth 86 ft Cased to +40 ft ❑E Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 9/18/24 Static water level at beginning of test 59 ft. Comments 'FROM MOA FILE B. TANK DATA Measured operating fluid level in septic tank 58 Date of pumping 9/18/24 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/31/83 X ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑E Monitor tubes go to bottom of effective. If not, state depth into effective _ ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist—June 2022 Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes FE No ❑� Coliform bacteria is Negative Nitrate 2.89 mg/L ❑ Nitrate less than MRL (ND) Arsenic Collected by Date 9/18/24 _ ug/L H Arsenic less than MRL (ND) MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 10/26/24 Results ❑� Pass Fluid depth prior to test 16 in Water added 600 gal New fluid depth 24 in Elapsed time 1440 min Final fluid depth 16 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 16 in Effective depth remaining 32 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Do Yes if No _ ft Neighboring Tank > 100' Fiml Yes if No _ It Absorption Field on Lot > 100' E Yes if No _ ft Community Sewer Manhole/Cleanout > 100' ❑� Yes if No _ ft Private Sewer/Septic Line > 25' ❑� Yes if No _ It Holding Tank > 100' 9Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No _ ft Qo Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No _ ft Q Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No _ ft Surface Water > 100' 9 Yes if No _ ft Tank to Property Line > 5' Di Yes if No _ ft Field to Property Line > 10' R Yes if No _ ft Water Main > 10' ❑o Yes if No _ ft Water Service Line > 10'❑ Yes if No _ ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' E Yes if No ft ❑� Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. r Name of Firm /��� �'( e �. � d.�tf 4rJvl � �' � Phone 727-8864 Engineer's Printed Name G yr Q . Date 2 2 �'y� OF. •� 1 ,E F�. ... ....... '�. % !? MICHAEL N. ANDLRSCN ;,•`�= r� %'� �`"l,• CE 9469 VNK\�_,��4i__ COSA Checklist June 2022 XXXXX X X X X X X X X X X X X X X X X X X /// /// /// // / / / / /// 30 ' 30 ' 30 ' 30 ' WORK ORDER No:DATE:SCALE: DRAWN: HE CHECKED: ME/RL ZONING: 1"=40'July 14,2023 R6 GRID No:FB BOOK/PAGE: SW3036 166/6 SURVEY CERTIFICATION: FARPOINT has conducted a physical survey of the subject property, the improvements situated thereon are within the property lines as shown. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the Plat used for this survey. NOTE: Under no circumstances should any data hereon be used for construction or for the establishing of property lines. PREPARED FOR: Mark & Joyce Gartrell 4451 Riverton Ave, Anchorage Alaska ASBUILT SURVEY OF: Lot 8, Block 5, Elmore Add. 1 Subdivision, Anchorage, Alaska (Plat P-635A) Found Iron Pipe Cleanout Well Elec Meter Robert O. Lumpkin No. 10459 SERVI N G A L A SKA SI N C E 1 9 8 2 1.Bearings and distances are record per referenced plat unless otherwise noted. 2.Not all monumentation for this survey may be shown on this document. 3.Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. Found Brass Cap Cable Pedistal /POGO ZjojO (S G. �'/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St s P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. 019"1112'22,, HAA it 80 0 S_01 � Expiration Date: _7 12% 05, 1. GENERAL INFORMATION � Complete legal description zo/B. e SH /d *7/en %f/ Lo=tion (site address or directions) yysi X41e f've., 4,ne her.,, y e, 4k Current Property owner(s)Sjrve'4 Day phone J d'/- ins' Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 0 -tel. .09&.W_ 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:, TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approvabare valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address 99e' a Engineer's Printed Name On" /was Y'. Ale -,2 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Phone 007% 7yl - l073 Date Ir�00' bedrooms, with the following stipulations: Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:4L 1 or (R.v 0IM2) Municipality of Anchorage •°, Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak. us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /otg' /3/ock/i, 171wffe Sze 6di."si©n!`/ Parcel ID: A. WELL DATA Well type Rdv. If A, B, or C provide PWSID # Date completed x/973 Sanitary seal (YIN) -y— Total depth*eft. Cased to MC' t ft. FROM WELL LOG Date of test Static water level ft. Well producti g.p.m. R SAMPLE RESULTS: Coliform B colonies/100 mi. Nitrate 0 • / mg./1. Arsenic: mg.A. Date of sample: B. SEPTICIHOLDING TANK DATA Tank Type/Material _s,a f.'G z4 ;�'e e / Tank size /foo gal. Number of Compartments Well Log (Y/N) Al Wires properly protected (YIN)_ Casing height (above ground) /3 in. AT INSPECTION -t;' ft. f/ ✓� 9 - p.m - Other bacteria b colonies/100 ml. Collected by:F tea — Date installed n!2 3 Cleanouts (Y/N) Foundation cleanout (YIN) _)4— Depression over tank (YIN) V High water alarm (Y/N) 4d' Date of pumping . - Pumper Wo /o- X o o ft j - C. ABSORPTION FIELD DATA Date installed 6/&3 Length q7 ft. Soil rating (g.p.d./fe or /bdrm L✓r Width 9 Systemtype 7-rtnch ft. Gravel below pipe ft. Total depth Y_S ft. Eft: absorption area 376 fe Monitoring tube _L_ Depression over field t/ Date of adequacy test -01105- Results (Pass/Fail) TSA SS For _9 bedrooms Fluid depth in absorption field before test S Vr in. Water added "%gal. New depth /Z I in. Elapsed Time: 86 min. Final fluid depth// in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) // If yes, give date = D. LIFT STATION Date installed 'Pump on" level at Size in gallons in. 'Pump otr Cycles tested E. SEPARATION DISTANCES Manhole/Access (YM) level at in. Meets alarm 6 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot * rS On adjacent lots Xe'.4 f Absorption field on lot le 5' Public sewer main 4, -If Sewer /septic service line On adjacent lots I Oe7l Public sewer manhole/cleanout it -14 Holding tank "Y/,V SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /S'.` Property line _y,471 ' Absorption field 6 Water main 4111-V Water service line 1 f� ' Surface water / ed >< ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '7o ' Building foundation z -57r ' Water main W/� Water Service line ✓^Sy Surface water id 3 f ' Driveway, parkingtvehide storage /4 Nana Known Curtain drain -tv erlsy Wells on adjacent lots loci+` I . wr-..+...lorwtc!oce?tx,e, fi.d.+c I/u /JAA B 1.e " 14 Q7 � F. COMMENTS oo77 c it r fyie 1. lxxe..'Z.&— &&rte s/6/ ,3 -Vd„ a �P f„ ` .f y �^' .(l•.tirr s• -+r t�Y n'�t-.•cam y+r,.. esus! !s' aUclw t.. -...G G. ENGINEER'S CERTIFICATION ,�... . �? I certify that I have determined through field inspections and fit 9TH it review of Municipal records that the above systems are in �' • ' conformance with MOA HAA guidelines in effect on this date. r y14,T ?. Al , Z. �IIEr. Engineer's Printed Name /lou en �CG� ; ,( �3,0j ��u CE i Date '"�' HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number LO .� C) L 101 ��►t * O NRW0 (13 68,'86ti 3,.00 LO.00S) ����c; �1LL- �� u7 � i O 13 88'86ti 3.,5E.LO.00S S113W I w G�y;P' �'••.� o O 0 x Z i v a �♦' ctrl O �f ..� W O Z Z goo En w /Q• ` oC Z Z w 0 1-I W LE) d o • i Q m H ',�� •�••: :••• A H U)U w o z LU '�S'�c ; } z ¢ cn cc LU LLJ Q Q cn Cu Cu H J\ H H Q H ¢\ \ 0 W U 0p Z m -4 -4 I 3 \ ¢ 117 p � I p U U O p 1170 L[7 CrCrH H W [+7 I 0 0 0 � Y Q w z z z o w� Y H U U tDZ I nir-- Ob o= o U� a z z z coU7 U' _j 1 o I 1� 00, o 0 o w Q w Q o w a o J O \ � LI,J u. 1L w ¢ 3 (1] 1- Z LL m H ¢ J � I Z 0 I I—j 0 W I N330 �' 0 v Q ® ® Xi U _J co > z �' cy)LL w Ch L t_ !i W c Y W D O In Q 0 o O od w i t\ m J a Q C) ,,� , � w o ^ o z I ¢ rn ¢ cu H I cn o a 071 i�' o > O cn w x NII i 0.01 �,, Z� N ¢ w Q cr O U ED z O I C / 3 Z Q J Q cl' 3 J I J oY a'Y / j� Ha Q ow JZ w a l O N w / Q w l 3S o w az w~Zw�cn w z °° o > I o >• f- z w n. U Z °° rn LO w 0'4 ��� :n x" 1.L VlHfn>Qo CX) rn 0 9 N `� ' m ¢ �~-+ ¢ LD 0 Cr En En H ! to Ln m � I O ` LLO > ¢~W UWW J a � I ` + zQ cn ~ > -w¢x v Ln i v O I N o N �`- v QO LU OZ V ¢¢Zp o [17 r-+0 I _ '- cn 0'8Z ~ u 1- w o H a f=n 3} 3 J C- -l� dM3AR10 13AV210 w H " x U o Q x o Q a so _ QH¢ w o� H azp¢N� c, u, _ Q ----------- 3�H=WJ ~ QJHEn ZHF=F- ¢ n ra ' OxU70 fn EL LL HUF--=wow wUr n L. cn U7 W C7 fn H II w �c ¢ x z ¢ L 2T r<o l� 0'OF zHOZ O a Q cnoH x zo Uz o -i Cl) X oo¢ ~ U) �¢�wo U 0 C) .-I I Ivl w L) w 3 v1 [n >- a >- w m¢ °C CD CU 3 LO WQQ N >•a cc �ONmHQQ I I Hu7w ¢ >w 0 ¢oQ o�cL)nEn MMLD W ¢Z >-WWJQQwH \ W U7 ¢aa0 ¢ }wlL} MW O o o� � O o n - - - --_ o x U En wc.4ow .Qo v 13 25'866 M..00,LO.00N woz O =w Cl m-jw¢o�¢ N, w °D 6 10� O cc z �p iz <U)U)X= 0O o z o w o Z ..; N m U7 H Q U) Q> w 0 � ac = Q U O U O (n DZunicipality of Anchorage !j P.O. Dix P.MiGM • Anchornge,.Vnslui!k6i19-66N) - Tckphunc MM343-K301 - Fax HMM 343-R_IMI 471M1 nragaw SIreel • Anchonigc, Alaska !.15117 %im.numLorg Mayor Jlark Begich I3ui1<linl; Safety Dhision April 21, 2005 Doug T. Kenley, P.E. Kenley Engineering 9960 E. Puffin Dr Palmer, Alaska 99645 Subject: Waiver Request for Elmore #1 Block 5 Lot 8 Waiver Request #WR 050021 Parcel ID # 018-172-22 IIAA050154 Dear Doug T. Kenley, P.E.: 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 85.0 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 343-7904. Sincerely, Goodall evil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department • +• Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchomgc.ak.us (907)343-7904 Waiver Review Worksheet WR#:050021 PID#:018-172-22 HAIPermit# has050154 Date Received: April 21, 2005 Legal Description: Elmore #1 Block 5 Lot 8 Engineer. Doug T. Kenley, P.E. Kenley Engineering 9960 E. Puffin Dr Palmer, Alaska 99645 Applicant: Roger Ippisch Waiver Requested: 85' Horizontal separation from on -lot well to on -lot septic tank Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: 5-4 Z• L Y•S Total: / 7' 7 - Waiver is Granted: Waiver Is not Granted: List Conditions or Reasons for above: Date: By. am of eftevver L (— �'T 7 Name of Reviewer Rec#: Amount: $ Date Paid: 41211205 State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3, 1985) Waiver Request for: Elmore #1 Block 5 Lot 8 Parcel I D#: 018-172-22 Waiver Request Number: 050021 Waiver Requested: 851 Horizontal separation from on -lot well to on -tot septic tank IIAA050154 Septic Tank Data The well and septic system was installed on October of 1970. Then in May of 1983 the septic system was upgraded and the septic tank was replaced with a 1500 gallon septic tank. The 85 foot septic tank to well encroachment has been in existence since 1983. Well Data The well was installed in October of 1970. The well and septic tank configuration has been in existence for over 20 years. Water sample results show 0 Coliform, 0.1 Nitrates, and 0 Other Bacteria. State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3, 1985) Waiver Request for. Elmore #1 Block 5 Lot 8 Parcel ID#: 018-172-22 !L Waiver Request Number. 050021 Waiver Requested: 85' Horizontal separation from on -lot well to on -lot septic tank IIAA050154 Water Table Depth of well: 88 Depth of septic system: 9 79 Distance from the bottom Point Clean Gravel of the system to the highest Value 1 water table In feet 1.5 Sand w/ Small Amt of Clay 0 0 8 1 17 2 24 3 30 4 40 5 85 6 100 7 290 8 1000 9 10 Straight line Interpolation is permitted between any two values Soil Sorbtion Soil Type Point Value Clean Gravel 0 Fractured Rock 1 Course Clean Sand 1.5 Sand w/ Small Amt of Clay 2.5 Silt 3.5 Clay and Sand Equal 4.5 Clay 6 Points 5.87 Points „M 2.59 f 79 1 1 + [ 79 14.5 + [ 79 1 + [ 79 + l 79, + [ 79, + [ 79) + [ 79, 0.2 + 2.1 + 0.4 + 0 0 + 0 + 0 + 0 'Use the predominant soil type but values can be averaged for a mixture Permeability Soil Type I Point Value Clay(will channel) 0 Silt and Sandy Clay 2 Clayey Sand 3 Fine Sand 1.5 Sandy Gravel 1 Fractured Rock 0.9 Course Sand (30 grit) 0.4 Clean Gravel 0 Points „n 1.86 ( 79 1 .9 +1 36 79, 3 +r 79 1.9 + r 9 1 1 79 +( 9 1 1 +r 9 1 1 +r 9 1 1 + r 9 1 1 0.15 + 1.37 + 0.34 + 0.00 0.00 + 0.00 + 0.00 + 0.00 'Use the predominant soil type but values can be averaged for a mixture Gradient Points 4.5 4.50 % Slope -30% 0.3 Separation -20% 0.7 slopes toward well -10% 1.2 25 -5% 2 1 0% 2.93- flat 5% 4.5 5 10% 6 slopes away from well 60% 7 'If the gradient Is unknown, assume the worst case Horizontal Points „a 85 2.4 Horizontal Point Separation Value In Feet 0 0 25 0.7 50 1 75 2 100 3 150 5 200 6 300 7 *Linear Interpolation between two point value is acceptable. Horizontally means straight line distance to the well not the contaminate travel distance to water table which may be greater. Conclusion: Grant Waiver Total Points: 117.218, Douglas T. Kenley, PE 9960 E. Puffin Dr., Palmer, AlasAa 99615 (907) 716-/076 April 19, 2005 Mr. Joe Goodall Municipality of Anchorage Health & Human Resources On-site Services Re: Well to septic tank waiver Lot 8, Block 5, Elmore # I Subdivision 4451 Riverton Avenue Anchorage, Alaska 99516 Owner: Roger Ippisch and Steve Ippisch Dear Mr. Goodall: On behalf of my clients, Roger Ippisch and Steve Ippisch, I am submitting information necessary for your determination of a waiver of separation distance, well to septic tank, to 85 feet for the above -referenced lot. The well and septic system appear to have been installed in October of 1970. The Inspection Report On -Site Sewage Disposal System, dated October 15, 1970, stated that the septic tank was 89' from the well. In May of 1983, the septic system was upgraded with a 47' long by 3' wide trench with 4' effective depth of gravel, which meets the requirement for a three bedroom house; however, the owner requested that a 1500 gallon tank be utilized. The tank was installed 85' from the well, which was approved on both the On-site Sewer Permit dated May 18, 1983 and the On -Site Sewage Disposal System and/or Well Inspection Report dated May 31, 1983, signed by a Mr. Lindquist. During the adequacy inspection, the distance was confirmed to be 85'. No well log is available. The sons of the deceased owner, Roger and Steve Ippisch, recall seeing the depth of the well written on the wall of a shed as approximately 88' deep, which is close to the reference of 86' listed on the October 15, 1970 Inspection Report On -Site Sewage Disposal System mentioned above. During testing of the septic system and well, it was determined that the static water level was 57.5 feet. The slope from the well to the tank is approximately I to 2%,. the well being at the higher elevation. Nitrate and ecoli readings are 0.1 and satisfactory respectively from tests taken on March 23, 2005. Nitrates, water tables, well depths, and static water levels are shown on the attached site plan of adjacent properties (where available), as well as the approximate locations of wells and residences. . The slope of the subject property and adjacent properties, for the most part, is from northeast to southwest, with the exception of Lot 4, Block 5, which has a cutbank exceeding 25%, sloping from the southeast to the northwest. The difference in elevation from the highest point on the lot to the lowest is approximately 5 feet. Mr. Dan Roth Page -2- May 25, 2000 If there are any questions, or if additional information is required, please feel free to contact me at 746-1073 or 243-5372. Sincerely' Douglas T.Kenle4PE.,76. Encl.: HAA certificate application Adjacent properties site plan Available well, soil logs, and nitrate readings Page 2 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 35M Tudor Road, Anchorage. Alaska 99507 279-8p686 Date Received d -G- 73 Time of Inspection G+r Q Date of Inspection 1-7-73 Y ✓ REQUEST FOR APokOVAL OF y INDIVIDUAL SEWER b WATER FACILITIES �� �'7"°f �� FOR �y 1. Approval Requested By: Aldress. Phone: 2. Proaerty Nner: p �.X�pn��Kry / Phone: 33'1- 3. Legal Description % ns of i p G�.��+j- s� 4. Locet-on: K w��"^/ 5. Type of Facility to be Inspected:_ 4-A4 P Numher of Bedrooms: 3 6. Well Data: A. Type off+ B. Depth J74 C. ConRtruction GriWi2,1 D. Bacterial Analysis 'T— 7� 7. Sewage Disoesal Systems A24-046 �^^�- /O-1r''7O A. Installed /p//r�9® R. In8taller omff:k,/t7t/,t/Jyl�.Ea'�+�.rk •/C. Septic Tank: 1. Size /Pre 2. Manufacturer / / VI). Seepage Pits 1. SizV,,4%1iYY1 2. Material TSL E. Disposal Field: Total Length of Lines 9. Distances: A. Wel 1 Too Septic Tank, Absorption Area //!s /. Sewer Lines �p fit' Nearest Lot Line 2'D / Other Contamination C 0. Foundation to Septic Tank-," ye, ,► Absorption Area 1D f' C. Absorption Area to Nearest Lot Line .�D Request for Approval ot.l�+lidw l newer b nater raeilitz" Page Two Apnrovea�Z- ••od.�sapproved Date Q Approval Valid for One Year From Date Signed Grsater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM. I certify that the information contained in this request for approval to be a true and accurate representation of the suhiert sewer and water facilities located at: Signed Date I m y I,