HomeMy WebLinkAboutELMORE BLK 2 LT 3A
(Rev 05/02/18)
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP241261
PID Number: 018-171-53
Dwelling: Al Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Raymond W & Leslie G Hysom
ABSORPTION FIELD
❑ Deep Trench ❑■ Wide Trench El Bed ❑Mound
Site Address
4640 De Armoun Road
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
4
1.2 GPD/SF
JTotal
2.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.0 Ft.
Gravel depth beneath pipe
1.0 Ft.
Subdivision
Block Lot
Elmore
2 3A
Fill added above original grade
8-1 Ft.
Gravel length
2@44 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
n/a
Distance between lines
n/a Ft.
SEPARATION DISTANCES
To
Septic
Absorption
LiftStation
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
500 Ft2
2
7.1 Ft.
Well
NA
100'+
*95.5
NA
25'+
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
NA
100'
100'+
NA
Gal.
Material
Number of compartments
Lot Line
NA
10'+
10'+
NA
NA
Foundation
NA
10'+
10'+
NA
LIFT STATION
Manufacturer
Greer (Deep Bury)
Capacity
1000 single comp. Gal.
Remarks *See attached waiver request
Alarm location
Inside house by electrical panel
Electrical installed by
907 Electric
PIPE MATERIAL House to tank D3034 Tank to D1785
drainfield
Installer
Arctic Terra, LLC.
Drainfield D1785 CO/MTD3034
Inspector PES
BENCH MARK (Assumed elevation) 102.54 ft
Inspeection v, 10/24/24
11/05/24
Location and description
ction
3`d 11/06/24
2nd
41" 11/21/24
See Site Plan, Top Of Deck
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
®�00�®N
pF aL�sk`�
Conditional Approval:
Date
,ac:49 TH
..�. ...
Steven R. Pann•�ne
Septic Syste
G
CL I''l Q
S� p
+1i ,�` ...... `\
Approved 1/
DateI Z
��i��551�}C+��.�
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Note: this approva14
not include well permit requirements.
(Rev 05/02/18)
PROFILE
SCALE: NTS
1000GAL GREER
POLY TANK
PA
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Mun'dpaflty of Anchorage
lhyin Ung at '!.
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development ice Division
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV241065 COSA#:OSC241511 Permit#:OSP241261
PID#: 018-171-53
Legal Description: Elmore Blk 2 Lt 3A
Engineer: Pannone Engineering Services
Your request for a waiver of the required 100 feet horizontal separation from the lift station to the
private well has been approved. The approved separation distance is 95.0 feet. In addition, the
existing tank is approved to be 67 feet from the well.
This waiver approval applies to the existing lift station and tank only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another approval
from this department.
Waiver is Granted: X Waiver is not Granted:
Date: _ Z 5 Approved by: /����i%1_
Name of Revier
**** VARIAN C E/WAIVER REVIEW ****
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O. Box 1807 Palmer, AK 99645
Telephone: (907) 745 8200 FAX: (907) 745 8201
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Elmore Block 2 Lot 3A
Lift Station To Private Well Waiver Request
Ladies and Gentlemen:
We are writing to request a separation distance waiver between the existing well and newly installed lift
station. The lift station was inadvertently installed approximately (95.5’) from the well serving the subject lot.
The subject lot generally slopes from north to south, with slopes ranging from 5-20%. The existing well head
lies at a higher elevation than the present lift station; so, it is not likely that effluent would travel toward the
well head via land surface. No well log exists for this property, however the existing well located down
gradient on the adjacent property of (Elmore Block 2 Lot 1) depicts a soil composition consisting of (eighteen
feet (18.0’) of silty sandy gravel with large cobbles and boulders, sixteen feet (16.0’) of gravel cobble with
silty sand, forty feet (40.0’) of gravelly grey clay, eighteen feet (18.0’) of damp silty sand, sixteen feet (16.0’)
of damp gravelly sand, three feet (3.0’) of gravelly silt, eighteen feet (18.0’) of smally silty gravel, seven feet
(7.0’) of water-bearing gravel, and underlying brown gravelly silt. The static water level of this well was
measured at 78.8 feet below the top of the casing. Nitrate levels for this well with documented water sample
results show a level of 3.12 mg/L.
The existing well located on the subject property had a measured static water level of (79.8’) below the top
of the well casing in June of 2024 and has a documented nitrate reading of 2.8 mg/l. The ground water
flow/gradient is to the southwest from the well to the subject lift station. Absorbed wastewater will infiltrate
away from the well. PES was not notified by the contractor that staking of the existing well radius had not
been performed by a state of Alaska registered land surveyor during the installation of the lift station.
We used the ADEC Separation Distances Waiver Guidelines Memorandum, dated January 3, 1985--to
evaluate the acceptability of the waiver. Our evaluations are tabulated below:
Absorption Field to Well:
Distance from sewer system bottom to groundwater 5.69
Soil sorption below sewage system 2.53
Soil permeability below the system 0.79
Water table gradient 2.90
Horizontal separation 2.88
Total Points 14.79
Page 2 of 2
Mailing: P.O. Box 1807 Palmer, AK 99645
Telephone: (907) 745 8200 FAX: (907) 745 8201
The sum of the above values indicates the following condition: “No bacteriological pollution possible but
chemical pollution possible but unlikely from household chemicals.’’ Based on the area’s topography, soil
composition, and the measured ground water elevation; it is the opinion of this office that granting this
waiver does not pose a risk to public health or the environment.
Effluent leaving the existing septic tank and traveling toward the newly installed lift station has received
primary treatment and is permitted to discharge. If the reduced separation from the existing tank to the well
was deemed to not pose a risk to public health or the environment; then common sense would support a
conclusion that the requested reduced separation to the lift station would not pose a risk to public health or
the environment.
If you have any questions or concerns, please contact me at (907) 745-8200.
Sincerely,
Steven R. Pannone, P.E., F. ASCE
Owner/Civil Engineer
March 22, 2024
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: OSP241261
Work Type: Septic Upgrade
Tax Code Number: 01817153000
Site Legal Address: ELMORE BLK 2 LT 3A G:3036
Site Mailing Address: 4640 DE ARMOUN RD, Anchorage
Owner: HYSOM RAYMOND W & LESLIE G
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
1,
[ parlment
9/20/2024
9/20/2025
80858
Q 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
JZEee#ved-By: 10
f `J
Issued By:
Date:
Date:
4
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 018-171-53
Property owner(s) Raymond W & Leslie G Hysom
Mailing address
Site address 4640 De Armoun Road
Legal description (Sub'd., Block & Lot) Elmore Block 2 Lot 3A
Legal description (Township, Range & Section)
Lot Size - 80,858 _Sq, Ft. Number of Bedrooms
Day phone
In
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
[_X�
Initial D
Single Family (SF)
FRI
(w/wo ADU)
Septic Tank
Upgrade nX
Duplex
❑
(D)
Holding Tank
❑
Renewal
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
NEWS"
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: 2-'r Z_
Receipt Number:
Permit No. D 'S
Permit App_-'- '- ;
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O.Box 1807, Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, Alaska
Subject: Elmore Block 2 Lot 3A
Septic System Upgrade Permit Request
This is a design narrative for a permit to install a septic system upgrade on the subject property. The proposed upgrade will
serve an existing four-bedroom (4) house. This lot and surrounding lots are served by private wells. The existing 1250-gallon
septic tank is to be exposed and verified to be in sound operating condition. If the existing septic tank is found to be suit able,
the proposed upgrade will consist of the installation of a diverter valve to the existing field and lift station to the proposed soil
absorption system. If the existing septic tank is found to be compromised, the proposed upgrade will consist of a new 1500-
gallon STEP tank and proposed soil absorption system.
1. Soils:
A test hole was performed on this lot by Pannone Engineering Services, LLC on 08/05/2024. Groundwater was not observed
during the excavation of the test hole, and bedrock was not encountered. Groundwater was observed in the test hole monitor
tube after 7-days at a depth of 7.5’ BGS on 08/14/2024. Ground water was later observed within the test hole monitor tube at a
depth of 11.2’ BGS on 09/12/2024, and 9.5’ BGS on 09/20/2024. PES feels the 08/14/2024 ground water depth to depict the
seasonal high, due to record rainfall in August. The September readings are significantly lower. Based on the results of the
percolation test and overall soils appearance an application rate of 1.2 gpd/SF was used for the design of a conventional
wastewater treatment system in the area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water:
There is no surface water within 100 feet of the proposed septic system.
4. Topography:
See attached site plan for area topography.
5. Drawing Markings: The Drawings are marked “For MOA Review Only”. When written notification that the review is
complete and no further comments are received from MoA On-Site Department, the note will be removed and “For
Construction” drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, please contact me at (907) 745-8200.
Sincerely,
SRP
Steven R. Pannone, P.E. F. ASCE
Owner/Civil Engineer
20 September 2024
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241261, Deb Wockenfuss, 09/20/24
PA
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Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241261, Deb Wockenfuss, 09/20/24
PA
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N
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2.2. SCOPE OF WORK:INSTALL SYSTEM IN ACCORDANCE WITH THE ATTACHED DESIGN AND SPECIFICATIONS.
11.2 FEET
11.2 FEET
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241261, Deb Wockenfuss, 09/20/24
PA
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COMMENTS: Test hole excavated by A+ Home Services, Inc.
PERFORMED BY: PANNONE ENGINEERING SERVICES, LLC. I CERTIFY THAT THIS TEST
WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES
IN EFFECT ON THE DATE OF THIS TEST.
·1.13 (min/inch)
·6"
·2 FT AND 3 FT
·
SOILS LOG & PERCOLATION
TEST
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241261, Deb Wockenfuss, 09/20/24
N
0
0
°
0
7
'
0
0
"
W
3
8
7
.
4
2
'
N 89° 46' 30" E 208.71'
S
0
0
°
0
7
'
0
0
"
E
3
8
7
.
4
2
'
S 89° 46' 30" W 208.71'
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Department of Environmental Quality
333QCStreet
Anchorage, Alaska 98S03
INSPECTION REPORT
ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
MAILING ADDRESS C2
PHONE
LOCATION
LEGAL DESCRIPT
SEPTIC TANK:
DISTANCE /
NUMBER OF
FROM WELL
MANUFACTURER MATERIAL
2_
COKxpARTmENTS__-____
|mG}DE LENGTH—/O___'
/
INSIDE vv|oTH______-L/QU/o
DEPTH_____.L|WU|D CAPACITY ALL0mS.
SEEPAGE PIT: /
_�*�
NUMBER |T3 _-Z___ � DIAMETER ____Onvv|DTH_�-. LEmGT* --
/ DEPTH
LINING MATERIAL / Cn|BS|ZE. o|*mEr�n___-ocpT*�,o|3TANCEFROM. WELL
TOTAL EFFECTIVE
BUILDING FOumo*T|Om___-. NEAREST LOT LINE _____ *eSORpT|0m AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
�
TYPE ^= �ON5TRUcT0m
BUILDING NEAREST NEAREST
rOumopJ|0m_____'. uJTUmE____-__. SEWER LINE
CESSPOOL ________. OTHER SOURCES
APPROvEO________DISAPPROVED _________REmaRnS
/w5TAU-EoeY. `
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
' T*mK_____. SYSTEM .
O|AGRANyOFSYSTEK8
DATE APPROVED _L
F'E~I T NO.
['1 El r-~ 'Ir ~-: [,~"~ FI L I T ITl I__--I F t---I r'J L--: I-,~.a F-.' Fl ~_~ E
[:,EF'FtP. Tr,IENT ~_,F HERLTH RN[> EriVIF;C~NHEh~TRL r'F'.OTECTION
25.t6 E. TUDOR RI:,., RiqCHORRL3E, RE. 9~507
iDl'-4--S I TE SEL,IEF: P'EF-:r4 I T
767(12 )
RF'F'L I CRNT
LOCRT I ON
LEGRL
DERRr. IOL N F:ORD
L-~A E:2 ELHORE SUB
F'. 0. E:O;:.: 2302 RNCH
LOT SIZE
.uc.~c. SI;!LIRRE 'FEET
c;,,,-T:~.t IS: TRENCH
TYPE OF SOIL RBSOP. E:TICIH _~ ....
i'.IR>~Ir. IUH I'IUF1E:ER OF BEE:,ROOHS = 4
SOIL RRTING (SC! FT/E:R): -135
THE F:EQI_IIF:ED SIZE OF THE SOIL RE,_,ORFTIOi"i S'¢$TEH IS:
E:,E P T t-I-- :..1_2 L E I'-.i t_3 T H = 46 6 F-: R '..-' E L C, EF'TH= (;
THE LENGTH DIr. IEfISION 15 THE LENGTH <Iii FEET) OF THE TREtlCH OR DRRINFIELD.
THE DEPTFI OF 8 TF;:EIqCH OR PIT IS THE DISTRNCE BET!4EEN THE SURFRCE OF THE
GE:OOi"lE:, Ri"ID THE BOTTOH OF THE EXCFIVFITION <IN FEET).
THERE IS N0 SET I,IIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE HIIqlHUrl DEPTH OF GRRVEL BETHEEIq THE OUTFRLL PIF'E
FIND THE BOTTOft OF THE EXCRVRTIOIq (.IN FEET).
SEPT I C TRI'41---:_--q I ZE= J-2$1Z.~ GFILLC~I'-.IS
T I-.-i~_-~ .-'. 2 ~. I; I'-.ISF'EOT I '---]r-4S I----IRE r'~:EalJ I F-.'E D,
E;RCKFILLIHG OF Ri'PT' _~'-~TEH I,IITHOUT FIHRL IHSF'ECTION RND RPF'RO'v'RL E:Y THIS
DEPRRTHENT !'fILL E:E SUB.TEOT TO PROSECUTION.
rllrllr,lLl~,l DISTRNCE BETHEEN FI HELL RND RNY ON-SITE SEHRGE [:,ISF'OSRL SYSTEF! IS
.tOO FEET FOR R PRIYRTE HELL OR 2ElO FEET FOR Fi PUBLIC [,,fELL.
SPECIFICRTION:~ RI'ID COi'ISTF,'UCTIOtl DIRGF,'FIHS aRE Ft'v'RILFIBLE TO II'.iSURE PROPER
I N:~TFILLRT I
F'ERI-1 I T %."RL I I~:, . FETE: I]l'-,IE 'T'EIZlF.: FF-iOM I SSI_IE
I CERTIFY THaT -' . ~
±: I AH FRf'IlLIRR I.IITFI THE REC!LIIREHENTS FOR ON-SITE :.ENER_.¢ .c AND HELLS A:,¢ SET
"' II
FORTH E,T THE H_NICIFRLIT~' OF RNCHORRGE.
2: I 14ILL INSTRLL THE SYSTEH IN ACCORDRHcE HITH THE CODES.
~:: I LIN[.EF. zTFIND THRT THE OH-SITE SEHER S'T'STEH !'IRY F:iEQLIIRE ENLRRGEF1ENT IF THE
RESIDENCE IS F:EHO[>ELED TO' INCLUDE !'lORE THRi'I 4 BEC4ROOF1S.
- '- · __ "- ............ ....
RPF'LIL. RrIT GEOF.'~£ H r,`fu coy - ' .... .
,,
DEARMOUN ROAD
House
T.H. 1
LdExisting septic Tank
8-27-76 T.H.
GRAVELLY SAND
GRAVEL w/some SAND (GP)
Occasional Cobbles
and Boulders
Very Loose
GRAVELLY SAND w/Trace
SILT (SP)
I~o~ Tar
SANDY GRAVEL (GP)
Occasional Cobbles and
Boulder
Loose
tl.5'
SAND w/SOME GPAV~L
and Trace Silt (SP)
Loose
SANDY GRAVEL (GW)
L5'
SAND w/SOME GRAVEL AND
Trace Silt (SP)
No Water Table
This log represents subsurface soil
conditions within Elmore Subdivisio~
Block 2, Lot 3A, Section 34, T12N,
R3W, gnchorage, Alaska
CKD:
DATE:
SCALE:
R&M CONSULTANTS, INC,
George McCoy
Anchorage, Alaska
I[F.B
GRID:
iLOWG..O. A-O .
MUNICIPALITY OF ANCHORAGE
Aftwwf
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC241511
Parcel ID 018 -171-53 Expiration Date:
Legal description ELMORE BLK 2 LT 3A
Site address 4640 DE ARMOUN RD
Current property owner(s) HYSOM RAYMOND W& LESLIE G
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By: LZOriginal Certificate Date: 1/6/2025
This Certifica� f°On-Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) i a a in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
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 Application
1. GENERAL INFORMATION
Parcel I.D. 018-171-53
Complete legal description
Location (site address)
Elmore Block 2 Lot 3A
4640 De Armoun Road
Current property owner(s) Raymond W & Leslie G Hysom Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: F0 Private Well r_J Private Well serving 2 dwelling units
El Private Well serving 3+ dwelling units r_1 Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: FN Private Septic 0 Private Septic serving 2 dwelling units
M Holding Tank. M Community Septic or Public Sewer
5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete 0 Fiberglass
Age 48 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: E] AWWTS F Bed F Deep Trench FE Wide Trench F Seepage Pit
Waiver request for: L IL I FT- Distance:
Expedited review requested: R
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 $ Waiver Fee $ it 180
Date of Payment 1 Z Llozz=v Date of Payment /zz/0.Lz_Q1
COSA # d C 2 y/ 571 Waiver # 05-V 2
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 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 Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B.TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D.ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
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
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
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’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system
under the conditions encountered at the time of the test, and separation distances measured to readily identifiable
features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that
may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside
the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we
cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this
report is for the sole benefit of the owner listed above.
Name of Firm
Phone
Engineer’s Printed Name
Date
INIUNICIPAUTY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMEN r
907-343-7904
On -Site Water and Wastewater Suction � J' ax: 343-7997
wi,immuni.org%onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC241511
Subdivision: Elmore Block:2, Lot: 3A
The septic tank for this property is 48 years old. Some previously installed fiberglass
tanks have been replaced because they leak. Leaking septic tanks are a hazard to
public health. Typical replacement costs are $15,000 or more, not including
engineering, surveying, MOA permitting fees or site restoration.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
N
0
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8
7
.
4
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'
N 89° 46' 30" E 208.71'
S
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°
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7
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E
3
8
7
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4
2
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S 89° 46' 30" W 208.71'
Authentisign ID: 444A77FA-E3C6-EF11-88CF-002248299057
MUNICIPALITY OF ANCHORAGE
Development Services Department
Right of Way Section
4 5 y Y
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n,enr
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rpartmenr
THIS AGREEMENT made this 27th day of December 2024, by and between Raymond W &
Leslie G Hysom and their heirs, administrators, and assigns, hereinafter called "PERMITTEE", and
the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and
the laws of the State of Alaska, hereinafter called the "PERMITTER".
WITNESSETH:
WHEREAS, PERMITTEE is the owner of the following described real property:
ELMORE, BLOCK 2, LOT 3A, according to the official records thereof, on file in the
office of the District Recorder, Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTER owns and/or maintains the real property more particularly
described as follows:
The TWENTY FOOT UTILITY EASEMENT, intersecting PERMITTEES property
as shown on Plat No. 75-108, on file in the office of the District Recorder, Anchorage
Recording District, Alaska, and;
WHEREAS, PERMITTEE has placed a leach field upon the referenced real property which
encroaches 8.0 feet x 14.0 feet upon the PERMITTER'S 20' utility easement.
NOW, THEREFORE, it is mutually agreed between the parties hereto that:
The PERMITTER, acting through the Director of Development Services
Department, hereby grants to the PERMITTEE the privilege of allowing the
leach field to encroach 8 x 14 feet upon the PERMITTER'S 20' utility easement,
as shown on "Attachment A," included herewith.
The PERMITTEE agrees forever to indemnify, defend, save and hold harmless,
the Municipality, its officers and employees, from any and all lawsuits, claims or
actions brought to any person for or on account of damage to property or injury,
disease, illness or death of persons, including all costs and expenses incident
thereto, arising wholly or in part from or in connection with the existence of.
alterations, maintenance, repair, renewal, reconstruction, operation, use or
removal of the encroaching leach field, as placed upon the PERMITTER'S 20'
utility easement. y
The PERMITTEE shall not assign or transfer any of the rights granted herein to
another individual or company without first notifying and securing the approval
of the Director of Development Services Department.
Authentisign ID: 444A77FA-E3C6-EF11-88CF-002248299057
4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S
real property whatsoever, except only the encroachment rights described herein.
5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days
written notice to the PERMITTEE. The PERMITTEE agrees upon such notice
of revocation, to move said encroachment(s) from the Natrona Avenue Right of
Way in which it is placed. Should the PERMITTEE refuse or fail to comply with
said written notice, the PERMITTER may, without further notice to the
PERMITTEE, remove or cause to be removed the encroachment(s), and the
PERMITTEE hereby agrees to reimburse the PERMITTER for all costs
incidental to the removal thereof.
In addition to the mutual promises heretofore made, the PERMITTEE has paid the
PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the
annual fee of $315.00.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day
and year first hereinabove written.
GRANTEE:
, k" ,Ohd HvSoh, F�P/ &, 2 j'b Y! 12/30124
Raymond W`_& Leslie G Hyson
Owners
GRANTOR: MUNICIPALITY OF ANCHORAGE
John W Snelson
Right of Way Supervisor
'r.2-3a- Lacy
DE ARMOUN ROAD
N 89° 46' 30" E 208.71'
00 - ASPHALT
DRIVEWAY 4
GRAVEL
PAD
4 SEPTIC CLEAN OUT PIPE
4 c TIES TO RECOVERED
MONUMENTS
16.0' X 10.0'
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C.O. 4
193.0
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576 DECK SHEDS
C.O. 6
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C.O. 7
DECK GREENHOUSE 12\ DECK 0C.0.I
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C.O. 2
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C.O 5
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C.O. 6
246.3
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C.O. 7
210.8
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212.4
220.3
C.O. 9
212.6
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LIFT STA 211.1
226.5
C.O. IC
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235.3
C.O. 11
208.9
249.4
C.O. 12
239.4
274.1
C.O. 13
243.7
259.7
12/23/ 4: RLS to verify high
water ark and set back
b re shed to be moved.Shed
to be removed and 10*16 shed
relocated oustide the
setback and to a legal
location on or before 1/3/25.
S 89" 46'30" W 208.71' G �F•• 44
SHOSHONI AVE•.;�
S E O•SCERTIFICATE % *+9T .� H * * i
JON C. GUFFEY •• �'
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE ®� • 15.14463 �
PROPERTY DESCRIBED ON THIS PLAT. I DECLARE O sf4 �7��3-�Zoz�f • y
THAT IMPROVEMENTS AND VISIBLE ENCROACH -f0 AV
MENTS HAVE BEEN ESTABLISHED TO THE BEST ' mor . ••.••• fav .�
ESS IDFtAI '®d'
OF MY PROFESSISONAL KNOWLEDGE AND BELIEF.®®®®r►®
SuRvey ALAsCA, `LC LOT 3A,
7 A DDUIL 1 LEG
6� BLOCK Q @ SEPTIC CLEANOUT PIPE
6402 Air Guard Rd. l Il! ® WELL
Anchorage, Alaska 99502 ELMORE SUBDIVISION 0 FOUND 5/8' REBAR
(907) 317-3140 COA#: 220035 ANCHORAGE RECORDING DISTRICT ® FOUND PRIMARY MONUMENT
DRAWN JCG CHECKED JCG SCALE; 1'- 40' GRID SW3036
FILE, S062124 I F.B. 2023-01 PLAT NO 75-108 DATE: 11/14/2024
(~ MUNICIPALITY OF ANCHORAGE "*: !"'
· DEPARTMENT OF HEALTH & HUMAN SERVICES.
' .' -' , ' " :DivislonofEnvironmentaISe~lces · ~ .,: ,,~ ~..
,, .. :..'.,- .', . ........ On-SiteServcesSection , .
· , ;.- ~,.:~;~ . ~: P.O..B.ox 196650 . Anchorage,'Alaska ,. 99519-6650 , i .: '
;,. ..... .... , . : , 343-4744
:'-' : ' CERTIFICATE OF HEALTH AUTHORITY
~' '~ '?,' APPROVAL FOR A SINGLE FAMILY DWELLING ~.'
1. GENERAL INFORMATION
C0mpletelegal des(~Hptlon t&oT "~ :'~Loc~-. ~-- ' F-_Lf-4 o P-..'=--
Location (site address or directions) /~I.(~ H O ~.~ ~ ~'v~ o Ot~t '~.c~.
Property owner ~-~<3 xl
Mailing' addres~ .... L[- h. q O
Lending agency
Mailing address
Dayphone ~L~5- c~l'~
Day phone
NOTE: If community well system, provide written confirmation from State AD~C attest-
lng to the legality, and status of system, " ......- ,,', ' '
4. "'TYPE OF WAS*TEWATER DISPOSAL: ......... "-
Community on-site ..............
· ;i. NOTE: 5". If community wastewater s,wtem, provide written confirmation from State ADEC
Unless otherwise requested, HAA will be held for pickup. '..'.,
~L/' ~ ":~!" -"' ....
2.
NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: . *. *
'.:. - .~:..._: ~lndi¥idualWell ......
5. ENGINEER "~ ~"' . . ~': "~:~
As ce~h~ b~ my ~1 affix~ berne and as o(t~e ~lidat[on date shown ~ ow, I ve~ t~at mv
Inv~flgatmn of thls H~lth A~hon~ Approval apphmbon sho~ that the on-s~to water supply
an~or ~temter dts~l s~em Is ~fe, ~q~onal and ad~ua~e for the numar of ~r~ms
and ~ of stm~ure Indi~t~ heroin. I ~her veH~ that ~ on ~e Info~ation ob~in~ from
the Munici~li~ of Anchorage fil~ and f~o~ my lq~igation and Ins~ion, the on~ite water
,upply ancot wa~towat~r di~l ~em I, in eompli~n~ ~h all ~unlcipal and 8~to
ordina~,... _ _ . ___ ..~d r~ulatio~ In eff~ on the date of this ins~ion. ,
........ . . . .. ~ , ~ .- . .
. . .. ........... .~ ~.~~ ..,,. .
' ;.~nd~tlonal appro~l for ' .~r~ms, wi~ the'following ~ipulations:'~
Municipality of Anchorage
Department Of He:~lth and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: L~T,.~A-'~k"I E'I~,,,.~-. ParcelI.D.
A. Well Data
Well type "~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date oflest
· Staticwaterlevel
Wellflow
Pump level1
Cased to
FROM WELL LOG
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed I ~t ~,,, ~ .7.. Driller
~ c~ C) Casing height
Wires pmpedy protected (Y/N)
AT INSPECTION
g.p.m. ,-~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot~ "-/./-7/
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
I~ublic sewer manhole/cleanout
Petroleum lank
WATER SAMPLE RESULTS:
Colitorm ¢ Nitrate
Date of sample:
;,~, 0 ~:~ Other bacteria '/ {/','Z~'~-''//~'¥)
Collected by: "~-"~..~
B. SEPTIC/HOLDING TANK DATA
Date installed Ic~"7~, ,~.~'~ r~ Tank size ~ ~L~C) Compartments
Cleanouts (Y/N} y Foundation cleanout (Y/N) 1'~ Depression (Y/N)
High water alarm (y/N) tT',/'/~. Alarm tested (Y/N)
Date of pumping (~/.~:-~-/q-~ ' Pumper J ~ *,~ c~/..~. ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot '7'
To property line ~ /~
Surface water/drainage
On adjacent lots '~ I ~ Foundation ~-"7
Absorption field {-,f Water main/service line
CONTINUED ON BACK PAGE
C. UFT STATION I')///~_
Date Installed
Size In gallons
Vent (y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
'Pump on" level at
Manufacturer,
Manhole/Access (Y/N)
'Pump off' Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on let On adjacent lots
.Suflace wat(~r
D. ABSORPTION FIELD DATA
Dateimtalled, E/7/7~ Soil rating (GPD/Ft2) J~r~ Systemty?e,
Length ~'..';7. W'~th ~ Gravel thickness ~, Total depth
Total absorption area /~ ~ ~/ Cleanout present (Y/N) ~/ DepreSSion over field (Y/N)
Date of .adequ~'y test t~/~/~/~/ ' Results (pess/fail) '~ for
Water leval In also.ion field ~fore test L4 ~,- ~ Nter test ,~' ~
i=er°xlde treatment (past 12 months) (Y/N) P'~ I! yes. give date
On adjacent lots
· Surface water
Curtain drain
F- ENGINEER'S CERTIFICATION
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~'-'~'-: ~q On adjacent lots I ,.~ 0 '/' Property line
To building foundation '7 7 To existing or abandoned system on lot
~ ~ Cutbank I'~ e vt -~ Water main/service line
q.~..Z .~.~j~; j. ~.~..~ Driveway, parking/vehicle storage area
I cer~fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~.t on l~e ~tate of this ins~ec~on.
Waiver Fee $
Date of Payment
Receip~ Number
HAA Fee $ ~
Date of Payment
Rece~ Number
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
September 26. 1994
Tobben Spurkland, P.E.
6751 W. Dimond BIvd
Anchorage, Alaska 99502-3904
Subject:
Waiver Request for: Lot 3A, Block 2, Elmore Subdivision
Waiver Approval: # WR940052
Dear Mr. Spurkland,
Your application for waiver(s) from the required separation distances is
approved as follows:
Well to Tank
Well to leachfield
Leachfield to sudace water
74 feet
98 feet
92 feet
This waiver approval applies to lhe existing septic system only. Any future
upgrades or Health Authority Approvals will require all separation distances be
met or another approval be obtained from this department.
Program Manager
On-site Services.
Ijm: #6
MUNICIPALITY OF ANCHORAG~
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR940052 PID# 018-171-53 HA# HA94041! Permit #
Date Received: 09-26-94
Legal Description: .Lot 3A
Engineer: Tobben Spurkland.
Applicant:
6751 West Dimond Blvd..
Reqqy McCoy
Waiver Requested:
Criteria: 1.
Well to tank -- 74ft,
W~ll to leachfleld ---98
Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Points
2. Special Conditions:
3. Other:
Waiver is Granted: / Waiver is NOT Granted:
List Conditions or Reasons for above:
Date:
00204
00320
Rec #: Amount:
N~e of Reviewer '~
$625.00 09-07-94
$295.00 Date Paid: 09-23-94
T.SPURKLAND P.E.
6751 W. DIMOND BLVD.
ANCHORAGE, ALASKA 99502-3904
(907) 248-5095
Municipality of Anchorage
Division of Environmental Health
Department of Health and Social Services
820 L Street
Anchorage, Alaska 99501
September 20, 1994
Subject:
Gentlemen;
REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR
PRIVATE WELLS TO SEPTIC TANK,
PRIVATE WELL TO DRAINFIELD
SURFACE WATER TO DRAINFIELD
LOT 3A BLOCK 2 ELMORE S/D
We are submitting a request for waivers from the separation distances stated in Title 18, Alaska Administrative Code,
Chapter 80.020.
During a IIAA inspection of this property we measured the following separation distances were found:
Well to Septic tank standpipe 74 feet
Well to leachfield standpipe 98 feet
Leachfield stand pipe to creek 92 feet
This septic system was installed in 1976 as a replacement to a system that was installed in the late 60's. It was inspected
by a Municipal Inspetnor who waived the distance to the creek, reported 100 feet between the well and the drainfield,
and approved of the installation of the new tank at the same location as the existing one. The original tank was installed
74 feet from the well.
No well log exist for this property, however logs from two adjacent properties show clay and rocks to 100 feet or more.
Static water level is 60 to 80 feet.
A ten foot bank separates the well and the septic system. Overland flow to the well is not possible.
The septic tank was exposed on September 9, 1994. Mechanical couplings had been used and were still in place. No
leaks or sU'uctural strains were observed.
A water quality sampling of the well water on 8/09/94 indicated 2.06 mg/I nitrates and 1 colony of bacteria,(OB). A
resample on 8/15/94, showed no bacteria.
The granting of these waivers are justified as follows:
I. The installation of this septic system was inspected and approved my a Municipal Health Inspector. Thc notes on
the inspection report clearly show that the inspector considered the possibility of contamination of the creek or the well
by encroaching on the required separation distances trivial. The septic system could have been installed with the proper
separation distances if there had been the slightast ooncem about contamination. If it can be shown that the Municipal
inspector was in error and that contamination is a real possibility, then the septic system should be replaced at no cost
to the present or future owners.
2. The required separation distance of 100 feet are arbitrary and cannot be supported through technical or
scientific arguments. Common sense will suppor~ the idea that a minimum separation distance is both prudent and
desirable. Common sense will also support the view that if 100 feet is safe, so is 99, and 98. A separation distance of
100 feet will probably prevent septic system effluent contamination in 99.999% of all cases.
There have been recorded instances where a well have been contaminated by septic system effluent. In all cases this
have happened where the ground consist of fractured bedrock or hardpan that will channel effluent into streams.
Contamination may also occur if the sabsurface soil consist of clean gravel or rock deposit with no sand or f'mes. When
the subsurface soil consist ora mixture of gravel, sand and fine materials, the septic system effluent is effectively filtered
and rendered harmless in a very short distance. Both the ADEC and the Munlcipal Health Depar~nent recognizes the
filtering ability of sandy material by actively supporting and promoting the installation of a 2-foot sand filter as a
superior alternative to the standard soil absorption systems. So confident are the two agencies of the filtering
capabilities of the sand filter that they have reduced the required separation distance to groundwater and bedrock by
50% and 33% when the sand filter is used.
The static water level for the well on this lot was measured at 90 feet. If this well are like most ofthe wells in the
Anchorage area, the well casing extend for at least another 20 feet below the static water level. The ground surface at
the well site is approximately 10 feet hlgher than the septic system elevation. Assuming that the effiuent from the septic
system can travel through the soil and reach the open end of the well casing a travel distance of more than 140 feet
would be required for fluid from the trench and 124 feet for any fluid that would escape from the tank. These distances
are 70 and 62 times greater than the 2 feet of filter sand in the recommended sand filter. The liquid depth in the trench
was found to be 46 inches, a strong indication that the in situ soil contains enough sand and fines to act as an effective
filter and barrier to effluent migration. The conclusion must therefore be that contamination ofthe well is not possible
because or,he location of the septic system. Since the elevation of the well head is 10 feet higher than the septic system
overland flow and the resulting contamination is not possible.
3. The direct line between the Irench and the creek is 92 feet. Again this is 46 times the filter thickness, and no
contamination is possible through soil migration of sewage effluent.
4. Overland flow of effluent. There are no defined drainage patterns between the Irench and the creek.
Concenmted overland flow of surface water is not evident. The area between the trench and the creek is surfaced by
maintained lawn and natural vegetation. Any possible effluent would soak into the ground within a very short distance
of the surfacing point.
In conclusion: There are no valid arguments why these waivers should not be granted.
Yours
2
ToP
J
I
I
-I
t
I
50 ?5 1~ 1~5 15'~
SCALE: I' = 50 FT.
TOBBEN SPURKLAND P.E.
203 W 15TH. AVENUE
ANCH. AK. 99501
LOT SA BZOClt' 2 ELJIORE $/D
4640 fl£ARMOUN DRIV£
PEGGY McCOY
SEPTIC SYSTEM LAYOUT
DATE: SEPI'. 6, 1994
SHEET: I/I GRID: 3036
co~ . ~/1, $ coC_lc z,
