HomeMy WebLinkAboutELMORE #1 BLK 3 LT 1Elmore #1 Block 3 Lot 1 #018-171-27 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241401 PID Number: 018-171-27 Dwelling: ❑■ Single Family (SF) ❑■ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name PATRICK SIMPSON ABSORPTION FIELD ❑ Deep Trench ■❑ Wide Trench ❑ Bed ❑ Mound Site Address 4100 Shoshone Ave, Anchorage ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 907.444.5860 13+1 1.2 GPD/SF JTotal 7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.0 (avg) Ft. Gravel depth beneath pipe 3 Ft. Subdivision Block Lot Elmore #1, Block 3, Lot 1 Fill added above original grade .3 (avg) Ft. Gravel length 58 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines 1 Distance between lines NA Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 600 Ft2 1 NA Ft. Well 109.3 120.3 NA NA >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer/ATW deep burial Capacity 1250 Gal. Surface Water >100 >100 NA NA Material Number of compartments Lot Line 35' NOTE 1 NA NA NA HDPE 2 Foundation 67' 71' NA NA LIFT STATION Manufacturer Capacity Remarks See waiver for existing septic field Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank ASTM BTank to drainfield pVC 3% CIC General Drainfield pvc3034 CO/MTpvc 311i Inspector BENCH MARK (Assumed elevation) 100' ft Inspection2/12/25 1m 2/11/25 Location and description 2nd es: 3'd 2/13/26 4112/19/25 NW corn of home(A) lip of FCO ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp g4pOO�4pq�� Conditional Approval: Date � ., D PSP, ...I7F v� 49TH .•�Op p............................... p Q ........................... �, ;. Charies A. Leet.. a Septic Syste _•.� `� d dada Approved Dat 5 oo��da ote: this approval does not include well permit requirements. 2/26/2025 (Rev 05/02[16) PERMIT NUMBER: OSP241401 I RECORD DRAWINGS I PID NUMBER: 018-171-27 SHOSHONI AVE\ i is �I/zI l W 0 (B'; DCO f LOT 1 ti BLOCK 3 �� FC. J I SV MH1 � I 1 Cot 1 MT2 MT1 � SCS' % CO2 ��8 I /&11 335 1 10' GENERAL vnLrrl' Eswr. OT IS BLOCK 3 SYSTEM CRITERIA: NUMBER OF BEDROOMS: 4 GALLONS PER DAY: 600 PERCOLATION RATE (MIN/IN): < 1 APPLICATION RATE (GPD/SFT): 1.2 MINIMUM DRAINFIELD AREA (SO. FT.): 500 L � L DRAINFIELD CRITERIA: FEET TOTAL DEPTH (FT.): 7 FIELD LENGTH (FT) 58 FIELD WIDTH (FT) 5 EFFECTIVE DEPTH: 3 REDUCTION FACTOR: .58 DRAINFIELD AREA: 600 NOTES: 1. CONTRACTOR SHALL VERIFY GROUND WATER AND SEPTIC TANK OUTLET ELEVATION PRIOR TO SEPTIC FIELD INSTALLATION. MINIMUM SEPARATION DISTANCES THE PROPOSED SEPTIC IS GREATER THAN: VERTICAL; 6' SEPARATION TO IMPERMEABLE STRATA 4" SEPARATION TO SEASONAL HIGH WATER HORIZONTAL MINIMUM 100' SEPARATION FROM PRIVATE WELLS MINIMUM 100' SEPARATION FROM SURFACE WATER OR STREAMS MINIMUM 10' SEPARATION WATER SERVICE LINE MINIMUM 10' SEPARATION TANK AND FIELD FROM FOUNDATION OF 49TH end G eol! . o! ............i oe� Charles A. Leet e>� CE 10480 I KEYNOTES: �1 NEW ABSORPTION FIELD AND INFLUENCE AREA f �2 EXISTING ABSORPTION FIELD AND INFLUENCE AREA REMAINS IN SERVICE VIA BULL RUN VALVE SWING TIES DESCRIPTION BLDG GRN A BLDG CRN S FCO FOUNDATION CLEAN OUT 2 24.5 SV1 SEPTIC TANK SV 58.1 76.9 M112 SEPTIC TANK MH 2 71.7 80.1 DCODDOUBLE co OPPOSING CLEANOUT 74.8 82.5 B�RV BULL RUN VALVE 76.3 83.5 SCO SANER SERVICE CO 58.3 33.6 ABSORPTION FIELD MT1 NORTH MONITORING TUBE 71.7 74.1 C01 NORTH CLEAN OUT 75 77.6 MT2 SOUTH MONITORING TUBE 76.8 60.8 CO2 SOUTH CLEAN OUT 76-0 58.4 ALL MEASUREMENT ARE WITHIN t0.3 FT. ALASKA RIM ENGINEERING 1920 N. Kentucky Derby Drive Palmer, Alaska 99645 PH: (907)775-2347 EMAIL:alaskarimengineering.11c®gmail.com I PAGE: 1 OF 21 W0: Consulting Civil Engineers: Planners I SCALE: 1 " = 50' 1 REV: ELMORE #1, BLOCK 3, LOT 4200 SHOSHONE PLAN RECORD DRAWING 2024070 1/23/25 1 &JANUARY 1, 2025 PERMIT NUMBER: OSP241401 I RECORD DRAWINGS I PID NUMBER: 018-171-27 1" I; y —U 5. U? i Cl n r� rf � v t M BRV i I rl l I 1 � •� INSTALLED 15LF 4" SDR35/3034 INSTALLED SELF X 5'W X 3'ED INSTALLED CO AND MT AT THE END OF MEW ` CO1 f� M T1 I 20' r .— FCU LID 100' 99'8' FCO FG 99. LEGEND; FOUNDATION CLEAN OUT FCO SEPTIC VENT SV DOUBLE CLEANOUT DCO MONITORING TUBEMT CLEAN OUT (0 CO TEST HOLE/PIT 0 TH PERCOLATION TEST HOLE PT SEWER MANHOLE l J 1 °nF ZZ2 ° aC T Charles A. Leet CE 10480 �Qi1 � pR�FES�tdN?��� 7 r � INSTAIIED BULL RUN VALVE AFTER _ DOUB E CLEAN OUT. PROVIDE OWNE WITH KEY FOR VALVE DCO` I _ FC MH1�� � SV i M T2\ 1S C C- �Cc o� Cl LOT 1 BLOCK 3 FCC SV2 DBL COO FG g9 g' MT/C0 1 MT/CO 2 FG 99.5 FG 99.4' x -x OG 99. 99.4' INV OUTINV 92.$' NV 95.5' INV 95. �i 1 TEST HOLE DEPTH 15.0'BGS GW 13.0'BGS k9 92.5' 92.4' 84.5' BOTTOM OF TEST HOLE BGS — BELOW GROUND SURFACE ALASKA RIM ENGINEERING 1920 N. Kentucky Derby Drive Palmer, Alaska 99645 PH: (907)775-2347 EMAIL: alaskarimengineering.11c®gmail.com PACE: 2 of 2 WO: 2024070 Consulting Civil Engineers : Planners I SCALE: 1 " = 20' REV: 1/23/25 ELMORE #1, BLOCK 3, LOT 1 4200 SHOSHONE PRnFII F RFC npn npAwilmr ©JANUARY 1. 2025 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: OSP241401 Work Type: Septic Upgrade Tax Code Number: 01817127000 Site Legal Address: ELMORE #1 BLK 3 LT 1 G:3036 Site Mailing Address: 4200 SHOSHONI AVE, Anchorage Owner: SIMPSON PATRICK Design Engineer: ALASKA RIM ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: 1/30/2025 1/30/2026 37299 Q Disposal Field D 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 Received Bps 5 5,u, A to 14 A Pi t'­� Date: Issued By: /t/ Date: -5 4 Municipality ii \ 1 nc•_ i I rpai tmrnt ' P.O. Box 196650 a 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.or_q/Onsite Development i Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV241006 COSA#: Permit#:OSP241401 PID#: 018-171-27 Legal Description: ELMORE #1 BLK 3 LT 1 Engineer: Alaska Rim Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field 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: 2�1 5� Approved by:—L&_w/1L -- Name of Review;, **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 018-171270 ANCHORAGE ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) Patrick Simpson Mailing address PO Box 241367, Anchorage, 99254 Site address 4200 Shoshoni Ave Legal description ELMORE #1 BLK Number of Bedrooms 4 3 LT 1 Engineering Firm Alaska Rim Engineering Building Permit Number Phone- 907-343-7904 Day phone 907.444.5860 Not Applicable 0 APPLICATION IS FOR: APPLICATION IS AN: (E all that apply) Absorption Field Q Initial ❑ Septic Tank El Upgrade F J Holding Tank 0 Renewal El Privy D Well El THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees: Sq S Waiver Fees: 0�V261no-6 Date of Payment:l%j Date of Payment: 5 1 /Z 5 - Permit No. 2 L-11 L4 01 Waiver No. 2- Revised 1/29/2025 ARE, LLC dba ALASKA RIM ENGINEERING CONSULTING CIVIL ENGINEERS & PLANNERS 1920 Kentucky Derby Dr. Palmer Alaska 99645 Telephone: 907.775.2347 Email: alaskarimengineering.llc@gmail.com Professional Consulting --- Practical Solutions ARE LLC, project # 2024070 December 24, 2024 Municipality of Anchorage, D.S.D., On-Site Water and Wastewater Department 4700 Elmore Road, Anchorage, AK, 99519 Re: Elmore #1, Block 3, Lot 1 4200 Shoshone Parcel ID 018-171-27 Subject: Septic System Replacement/Upgrade Design Narrative and Permit Application Dear Plan Reviewer, The owners of the above 3-bedroom with a one bedroom ADU over the garage plans to sell their home in the spring 2025. A COSA was started in November 2024, during the inspection of the septic field was found to be in a failed condition. Therefore, the attached following summarizes the proposed plan to replace the septic field. SOILS One test hole was excavated on December 4, 2024. The test hole is located on the drawing with a 30- foot radius centered on the test hole. See the attached percolation test and soil log for the groundwater monitor results. A second test hole was dug on January 14, 2025 to obtain a soil sample of the receiving soils for laboratory testing, see attached gradation test results from Hansen, PE, dated January 21, 2025. TOPOGRAPHY The lot slope from the northeast to the southwest is basically uniform. There are no topographical issues on the subject parcel. See the attached site plan for the topography. SEPTIC TANK REQUIREMENTS The existing septic tank is located on the attached drawings. The tank was installed in 2007 we plan to inspect the tank during construction of the field. The tank was inspected on January 14, 2025, and found to be in need of replacement. We propose a 1,250 gallon HDPE tank meeting MOA Wastewater Code Chapter 15.65. The existing tank will be decommissioned per UPC and the new tank installed in the location of the old tank thus preserving the existing septic system grades. DRAIN FIELD DESIGN See the attached drawings for the drainfield design Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241401, Deb Wockenfuss, 01/30/25 Elmore #1, Block 3, Lot 1 Page 2 of 2 December 24, 2024 Professional Consulting --- Practical Solutions ARE LLC, project # 2024051 REPLACEMENT SYSTEM This is a replacement system. SURFACE WATERS There is no surface water within 100-feet of the proposed system. Drainage arrows on the site plan indicate the slope and direction of stormwater runoff. (See attached site plan) WELLS & DRINKING WATER There are no water wells within 100-feet of the proposed system. The property is served by a private well. SURROUNDING PROPERTIES We do not anticipate any adverse effects on the neighboring septic systems, reserve areas or drainage patterns by the installation of the proposed wells and septic system. PROPERTY LINE WAIVER REQUEST During the review it was pointed out that the existing absorption field is within ten feet of the property line. Therefore, we respectfully request a lot line waiver of be granted of 5-feet. This absorption field has been in this location for over 18 years and possibly longer. The edge of the field is 5.4-feet from the property line. The property line is also the Right-of-Way line for Elmore Road which has an 80- foot ROW. It is doubtful the road will be widen in to the Gas line easement furthermore Elmor Road terminate prior to Rabbit Creek to the south. Granting this waiver has not and will not have an adverse effect on public health, welfare and safety be at risk. If you have any question, please call me at 907.775.2347. Sincerely, January 29, 2025 Charles A. Leet, P.E. Principal Engineer Attachments: • Permit application • Overall Project Area • Proposed site plan • Trench detail • Soil(s) log w/ percolation test data • Asbuilt • Enstar Letter of Non-objection Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241401, Deb Wockenfuss, 01/30/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241401, Deb Wockenfuss, 01/30/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241401, Deb Wockenfuss, 01/30/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241401, Deb Wockenfuss, 01/30/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241401, Deb Wockenfuss, 01/30/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241401, Deb Wockenfuss, 01/30/25 ENSTAR Natural Gas Company, LLC Engineering Department, Right of Way Section 401 E. International Airport Road P. O. Box 190288 Anchorage, Alaska 99519-0288 (907) 277-5551 FAX (907) 334-7798 January 27, 2025 Patrick Simpson 4200 Shoshoni Avenue Anchorage, AK 99516 Subject: Letter of Non-Objection Blk 3 Lot 1, Elmore Subdivision Addition No. 1 To whom it may concern: ENSTAR Natural Gas Company, LLC (ENSTAR) has no objection to the existing and proposed septic absorption field encroachment located within a thirty foot (30FT) wide natural gas easement located within Block 3 Lot 1, ELMORE SUBDIVISION ADDITION NO. 1, according to the official plat thereof, filed under Plat No. P-635A, in the records of the Anchorage Recording District, Third Judicial District, State of Alaska. Acceptance and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: •Landowner/Contractor working near ENSTAR gas facilities shall contact the Alaska Digline, Inc., (907) 278-3121 or 811 for line locating two (2) business days prior to any related excavation. This service is free of charge. •ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. •Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. •Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the land owner. •All applicable safety code regulations will be observed and maintained. •A minimum of 36 inches of separation must be maintained from the existing natural gas transmission pipeline and a minimum of 12 inches of separation must be maintained from the existing natural gas main pipeline. •Pipeline standby must be coordinated with ENSTAR prior to any excavation at (907) 334-7940. •This letter of non-objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. If you have any questions, please feel free to contact me at 334 -7944 or by email at james.christopher@enstarnaturalgas.com. James Christopher Right of Way & Compliance Agent ENSTAR Natural Gas Company, LLC 30' LOT 10 BLOCK 1 SHO SHO NI A Vim' V o (N 89°46'30" E 208.71') I I \ I I \ I I \ \ I I \ \ SHED I \ 50' I \ I I I FO z I 100' WELL" I RADIUS 0 c CD co 0 I I I \ LOT 10 BLOCK 1 SHO SHO NI A Vim' V o (N 89°46'30" E 208.71') I I \ I I \ I I \ \ I I \ \ SHED I \ 50' I \ I I I FO z I 100' WELL" I RADIUS 0 c LOT 1 BLOCK 3 72.9' .. I 0 I � I 0 0 I 52.5' 25.3' oo 7171 26.2' \NEU N H � I\ i 66.5' I \ 25.3' 10' GENERAL UTILITY ESMT. - — — _ (N 89°46'30" E 208.71') LOT 18 BLOCK 3 LOT 9 BLOCK 1 LOT 2 BLOCK 3 LOT 1'7 BLOCK 3 ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. LEGEND () RECORD DATA PER PLAT #P -635A GRAVEL DRIVEWAY/ROAD _B 4" ABS/PVC PIPE 6" ABS/PVC PIPE ® WELL DECK CONCRETE � ' OF A�` 0' 30' 60' Q� ' ;9s'`rli� SCALE: V= 30 FEET ; *. ••49TH , , , ••* (11"x17) � .��!�:"..�l•.: ������ ••Ryan G. Johnson; WINTER SURVEYNOTE: +/- 6INCHES OF �� •, No. 192159 SNOW ON-SITE AT TIME OF SURVEY. ONLY ' ' • 11/28/20 4' ��i VISIBLE IMPROVEMENTS SHOWN HEREON. * illy sSIONK -�� AS -BUILT OF: CD co 0 m I m T cn I � I J � � LOT 1 BLOCK 3 72.9' .. I 0 I � I 0 0 I 52.5' 25.3' oo 7171 26.2' \NEU N H � I\ i 66.5' I \ 25.3' 10' GENERAL UTILITY ESMT. - — — _ (N 89°46'30" E 208.71') LOT 18 BLOCK 3 LOT 9 BLOCK 1 LOT 2 BLOCK 3 LOT 1'7 BLOCK 3 ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. LEGEND () RECORD DATA PER PLAT #P -635A GRAVEL DRIVEWAY/ROAD _B 4" ABS/PVC PIPE 6" ABS/PVC PIPE ® WELL DECK CONCRETE � ' OF A�` 0' 30' 60' Q� ' ;9s'`rli� SCALE: V= 30 FEET ; *. ••49TH , , , ••* (11"x17) � .��!�:"..�l•.: ������ ••Ryan G. Johnson; WINTER SURVEYNOTE: +/- 6INCHES OF �� •, No. 192159 SNOW ON-SITE AT TIME OF SURVEY. ONLY ' ' • 11/28/20 4' ��i VISIBLE IMPROVEMENTS SHOWN HEREON. * illy sSIONK -�� AS -BUILT OF: CIVIL & ENVIRONMENTAL ENGINEERING - ENERGY CONSERVATION d ANALYSIS TED MOORE. P.E. 14530 ECHO CANYON ROAD PHJFAX: (907)345.1355 ANCHORAGE, AK 99516 E -Mail: tgmoore@gci.net March 14, 2007 Bill Rieth, P.E., Environmental Engineer ADEC Wastewater Discharge Program 555 Cordova Street Anchorage, AK 99501 Re: Lot I, Block 3, Elmore S/D. - Domestic Wastewater Modification Plan Review and Separation Distance Waiver Dear Mr. Rieth: By means of this letter I am requesting DEC's Plan Review for a modification of an existing M.O.A. approved wastewater disposal system that causes it to fall under DEC's jurisdiction. Approval will necessitate issuance of a separation distance waiver allowing the existing private well to be reclassified as a Class "C" well located as close as 105 feet from the existing wastewater disposal facilities. Because the existing wastewater disposal system was adequately sized for a 4 -bedroom residence, and because the system appears to be functioning adequately at this time, the configuration of the existing septic tank and soil absorption system will remain unchanged. To support this modified plan approval and waiver request, I am enclosing a site plan as well as the required checklists, nitrate test results, well drillei s log, original soils log and MOA (GARB) approved inspection report for the existing sewage disposal system. The existing wastewater disposal system was installed in July of 1977 and consists of a 1250 - gallon septic tank that discharges effluent into a 46 -foot long soil absorption trench containing 6 feet of sewer gravel, which corresponds to a total effective absorption area of 552 square feet. According to th= 1977 soils log for this lot the receiving soils are sandy gravel rated at 100 square feet per bedroom with no water table encountered to a depth of 15 feet. During a visual inspection conducted on 2/21/07 the system appeared to still be functioning adequately with no depression over either the tank or drainfield. The fluid depth in the tank was 50" which is considered normal, and the fluid level in the drainfield was approximately 2 feet lower than the invert of the tank outlet. According to the driller's log the existing private well was drilled in 1977 at the time the house was constructed. The well log is a little difficult to read, but it appears that the well has a total depth of 118 feet, a static water level of 18 feet and a yield of 6 gpm. A water sample collected on February 22. 2007 contained 1.49 mg/I of nitrate -N (see enclosed lab report). The fact that these test results indicate the absence of any significant contamination after 30 years of use of the well indicates that the aquifer i draws from is adequately protected by the overlying geologic strata. Because the proposed garage project includes an ADU located in a detached structure, the classification of both the water supply and the wastewater disposal system will be converted from single-family under the regulatory jurisdiction of the Municipality of Anchorage to multi -family under the regulatory jurisdiction of DEC. The existing well will still serve only 4 -bedrooms, which is less than many private wells that are approvable as close as 100 -feet from septic systems. However, DEC's minimum separation distance criterion for multi -family wells is 150 feet from septic systems. This leads to the necessity for issuance of a separation distance waiver allowing the newly -converted Class "C" well to be as close as 105 feet from the closest septic system components. As indicated on the site plan no other septic systems are situated within 150 feet of the well. The new waste line from the proposed garage with its ADU will be 4" diameter ASTM D-3034 with a minimum slope of 2%. For frost protection the waste line will be insulated with 2" of rigid, burial type insulation plus have a minimum of 2' of soil cover. The portion of the line that passes undo: the existing gravel drive will have 4" of insulation. The new waste line will be wyed into the existing waste line upstream of the existing septic tank Based on the above facts which show that the existing private well has no indication of contamination after many years of operation and that the proposed reclassification of the well is essentially comparable to other typical private wells we feel that the requested waiver can be safely granted without concern as to the potential for contamination of this well by effluent originating in the proposed upgraded wastewater disposal system. Please give me a call at 345-1355 if you have any questions on this submittal. cc: MOA DSD On -Site Services Patrick Simpson, owner Sebastian Eckmann, Nordic Constructors Sincerely, Ted Moore, P.E. c u P, ark : "+. • • . tt �♦ ...• Y Y\.a Vw.y T%IECY•v,,rE % d�J2E ; if C''-3559 V,r +.�. , LOT 9, BLOCK 1 LOT 10, BLOCK 1 ELMORE S/D #1 i ELMORE SID 191 ' SEPTIC—�/ l � I WELL—\ SYSTEM �; WELL ------ i , N r �SNOSHONIAVENUF-' L----- - ----------- -- -- - -- �� - - --� - 0 +\ I . � w EXISTING ; -- 00 ; 1 PVT. WELL CONVERTED' i w ------- :EXISTING TO CLASS "C" 1250•GALLON SEPTIC TANK v R 100 WELL t .GRAVEL ' I DRIVE I EXISTING SOILABS. nN TRENCH eppY SE :PROP. ; DRNE DECK I ' % I ? P, PROPOSED NEW +8DR- _ SI 7 I %4" DIA. ASTM D-3034 -------- ADR LOT 2, BLOCK 3 c WASTE LINE 0 2% I R 1 -;ELMORE #1 LOT 1,BLOCK 3 --- 1L'ES01UnRYAEMENT ELMORE SID #1 —_ -_----1------------------� __-.-r—_-- -------------------------- I I I j LOT 18, BLOCK 3 LOT 17, BLOCK 3 I SEPTIC ELMORE S/D #1 ELMORE SID #1 I AREA I LOT 1, BLOCK 3, ELMORE S/D #1 �ti• .. ��, SEPARATION DIST. WAIVER 3 PLAN APPROVAL *G; 49..I.... r...: *.0, SITE PLAN .........49....... FLATTOP TECILNICAL SERVICES ; 1INCH =50 FEET :�. THEODORE F. YORE,.// 14530 ECHO CANYON ROAD DRAWN BY ';FAI ", CE -3589 : �cAr ANCHORAGE, ALASKA 99516 MARCH. 2037 AV IAS ores ""' �\ �� NOTE: THIS IS NOT A SURVEYED PLAT. I ,1\;� ���� ALL LOCATIONS SHOWN ARE APPROXIMATE. GRE„ I L.R ANCHORAGE AREA BOK.,, _ jH G�� Department of Environmental Quality �'}'t 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ..y) I rnC �kh^�N1G✓;JiWA-- MAILING ADDRESS -6R4 �M �fj I rG `x' PHONE 34- 1 C' � LOCATION SkIOAXP^; ham_ LEGAL DESCRIPTION L_ 1 11 SLJO SEPTIC TANK: GQ -0 - DISTANCE I NUMBER OF FROM WELL ( w MANUFACTURER a_V4.kr MATERIAL 5COMPARTMENTS Z INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY-I:)-5-QGALLONS. - - ' - 46E- DRAIN FIELD: �' IIt TOTAL LENGTH ,�ry�,Jr DISTANCE FROM WELL L. FOUNDATION '20 NEAREST LOT LINE I ( ~ OF LINES NUMBER OF LINES I c DISTANCE BETWEEN LINES !V/ TRENCH W,IrD,TH.(2 IN. TOTAL EFFECTIVE ABSORPTION AREA �]�� SQ. FT. LENGTH OF EACH LINE I DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE T MATERIAL BENEATH TILE _*_1_1 -IN. ABOVE TILE LO- IN. WELL: 1_ `` ,,,� TYPE 1�%25N w0. CONSTRUCTION �A LOPNCC. DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION_, LOT LINE , SEWER LINE , TANK , SYSTEM , CESSPOOL . OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: soils 100 INSTALLED BY:54 ~ f SEWER LINE DEPTH: PIPE MATERIAL:-� k LOT SLOPE: k-V-VA.t . C REMARKS: y��15 1 Form EQ -032 DIAGRAM OF SYSTEM DATE�19/77 APPROVED G.A.A.B. ENKINS WELL DRILLING Aq P.O. BOX 3.142 ECB AV ANCHORAGE, AK 99501 PHONE 34r-3;92 A /4 G �• DRILLERS WELL LOG i ; CUSTOMER 1I /li- re. / . ,. ,.•rri :Z r... .//, - e`,'1 ?., LOCATION .l.7 SIZE •r DEPTH CASING DEPTH !!l GROUTING DEPTH YIELD STATIC WATER LEVEL '/%� HOW TESTED-- PUMP INSTALLED rr, i' TYPE -,/'J 4 - /:.FORMATIONS FORMATION . S ENCOUNTERED AND APPROPRIATE DEPTHS TO %! ... '. , . , ! •,�/'.,.r: • �iy c-.. 1. -,� , _ r t ,:. To !/ TO/Ji i TO TO . TO TO TO TO f r'1 LJ rJ I C r -i L_ I T Y - O F= F1 rpt C' 'F2 Fi r3 EZL,Q.�.'7 DEPARTMENT Jr HEALTH AND ENVIRONMENTAL-Y,OTECT 825 'L' STREET. ANCHORAGE, AY.. 99501 279-2511 WELL AND OrJ—SITE SEL IEA F' 1-1 P7 I T 7-/ 77 PERMIT NO. C 77095 APPLICANT JIM SUMGARDNER_ SRA BOX 474E 344-193' LOCATION SHOSHONI DP. LEGAL L1 83 ELMORE SUBD LOT SIZE 43500 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSO FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EF�'TH= 1-1 L_ErJGTH= 34 GRf7i',r'EL_ E>EF3TH= vS THE LENGTH DIMENSION THE DEPTH OF A TRENCH GROUND AND THE BOTTOM THERE IS NO SET WIDTH THE GRAVEL DEPTH IS TI AND THE BOTTOM OF THE IS THE LENGTH CIN FEET) OF THE TRENCH OP. DRAINFIELD OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE OF THE EXCAVATION CIFJ FEET). FOR TRENCHES. HE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE EXCAVATION CIFJ FEET). REQU I REF7 SEF''T I C TAPJK S I LE= 1250 GALLOr4"_; a LA CA C 2 ] I rJSFF'ECT I CAtJS ARE F2EiGLJ I F2EF7 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 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER, INSTALLATION. F='ERM I T NAAL I © FOR CALVE YE=F4K F= ROrl I SSJJE I CERTIFY THAT 1: I AM FAMILIAR, WITH 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: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED ISSUED • r/L� APP CRFJT JIM ' MwARDNER BY --- A---=`�---------- DATE--�1-�--- • ^.., - ^� Gi SOILS LOG MUNICIPALITY OF ANCHORAGE ^� • ❑ PERCOLATION 'I! ♦ .... r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 7E57 't. ' Pouch 6650, Anchorage, Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: xl/n i?�IMG(.rdfl-r•• DATE PERFORMED: I -%U rrI7 /% LEGAL DESCRIPTION: nT' /I�L ECIC3 1= LHOC3 1 SLOPE SITE PLAN :IEEE 12CGidLl Q/ �Q i/ (!/7if• 1 b. '. j GrG:✓P/3 2 d o /90 /s7 Ao iwef 3- 4 - ?v 4Oo o, 5 ti.,o 6- 7 7 OO. G V 8 obi 9 • O, 10- 11 0 11 b oma' Q 12 OO•� b .Op• 13 14- 15 4 15 16 17 18 19 20 :520d? !rave/ (Gw) l012da1re3 o%undenr Cu66/ez /lo/ae- fo c%ghfi/y mo. s7` lrayc/3 and eal yr.1 uKI/- /-aanJed fo ov6-rr�unded dUnEaln3 Q ;rinCe^ rc MG!G r4cr & e, Eu re. 4o roff off' ha'e WAS GROUND WATER S ENCOUNTERED? 16. 0 P IF YES, AT WHAT E DEPTH? ■w MEM-MVIEM Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) ff P TEST RUNBETWEEN FT AND FT COMMENTS /BYO !-/ 1i ^JnfiD.o✓�PTf/ie 7�iOCC 6:1 /.I? ruo /'NrnmmBnr/ u�/ina it vo Gtr �.� /00 f=or �;/,3�en77 iiPdirn . PERFORMEDBY: 140'I/Uf-!/ T. /rNC/ CERTIFIEDBY: DATE: Kirch /2,9� AoSx. Luc, 72008 (7/78) /" „� /^� ` �.�� -� �_ ��. - ' �. `�' � o � �a �.� �- �. �� 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 OSC251062 Parcel ID 018 -171-27 Legal description ELMORE #1 BLK 3 LT 1 Expiration Date: 11/25/2025 Site address 4200 SHOSHONI AVE Current property owner(s) SIMPSON PATRICK X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: 0 Original Certificate Date: 3/4/2025 This certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject sstems) is/are 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 Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services DepartmentPhone: 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. 018-171-27 Complete legal description Elmore #1, Block 3, Lot 1 Location (site address) 4200 Shoshone Current property owner(s) Patrick Simpson 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑ 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: ❑ Private Septic ❑■ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass Age new - 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 $ '�56 Waiver Fee $ Date of Payment Z / Z �=� �' S Date of Payment COSA # 0 !E�G 2.S 106 Z Waiver # COSA Application—June 2022 COSA Checklist Legal Description: Elmore #1, Block 3, Lot 1 Parcel ID: 018-171-27 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 5/77 Total depth 128 ft Cased to 128 ft 01 Sanitary seal is functioning correctly OR Wires are properly protected Casing height (above ground) 23 in. Date of flow test for COSA 11/26/2024 Static water level at beginning of test 89.4 ft. Comments B. TANK DATA Measured operating fluid level in septic tank new Date of pumping na ❑ Required maintenance completed, if AWWTS Comments: New Tank installed 2/25 D. ABSORPTION FIELD DATA Which system tested (date installed) new 0 ALL standpipes present per record drawing Total measured depth from grade 7 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. FO -1 Monitor tubes go to bottom of effective. If not, state depth into effective na ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced na gallons na date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: New Absorption Field installed 2/25 COSA Checklist June 2022 Well production at time of test 9.9 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes Q No ❑■ Coliform bacteria is Negative Nitrate 2.28 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L R Arsenic less than MRL (ND) Collected by Brandon's On -Site Services, LLC Date 11/25/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station na years Lift station material na Comments: Adequacy test date na Results ❑ Pass Fluid depth prior to test Water added na gal na in New fluid depth na in Elapsed time na min Final fluid depth na it Absorption rate na and FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 36 Effective depth used 0 in Effective depth remaining 36 in 2 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' Fm-] Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' a] Yes if No ft Holding Tank > 100' QYes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft ❑■ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' no 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' Fm-] Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' ❑i Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No 5 ft Private Wells > 100' 5_1 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' no Yes if No ft Water Service Line > 10' [KI Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS See Field to Property line waiver in file 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. Name of Finn Alaska Rim Engineering Phone 907.775.2347 Engineer's Printed Name Charles A. Leet, p.e. Date 2/26/2025 .t • • � jy '*r 49TH :r s f a aaaaaaa//a��araaaaaaaaaaaaaaaaaaaar e4ai Ca, 4, Zee •alaff ffffflf •ffflaf•aF•ffla•ff f • )to. Charles A. �L+eet CE y a"""`f•a••`•"aaa C9 COSA Checklist—June 2022 4 .6 '1 . 9 ' 8 .8 ' 8 . 2 '1 1 .2 ' 1 0 . 1 ' 1 6 .0 ' 2 6 . 6 ' 4 0 .6 ' 2 6 . 6 ' 26.2' 42 . 0 ' 26.2' 42 . 0 ' GA R A G E W / 2 N D ST O R Y A P A R T M E N T 8' x 4 0 ' C O N E X 8' x 4 0 ' C O N E X R E S I D E N C E2 S T O RY SHED 2 .0 ' C A N T I L E V E R 2 .0 ' C A N T. TEST HOLE LEGEND GRAVEL DRIVEWAY/ROAD DECK CONCRETE RECORD DATA PER PLAT #P-635A 4" ABS/PVC SEPTIC PIPE WELL SEPTIC TANK LID 6" ABS/PVC PIPE TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 24.229 SCALE: 1" = 30 FEET DATE: 2/24/2025 SHEET: 1 of 1 MOA GRID: SW3036 SCALE: 1" = 30 FEET(11"x17") 30'0' 60' AS-BUILT OF: ADDRESS: 4200 SHOSHONI AVE, ANCHORAGE, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 1, BLOCK 3ELMORE SUBDIVISIONADDN. NO. 1, PLAT #P-635A WINTER SURVEY NOTE: VARIABLE DEPTHS OF SNOW ON-SITE AT TIME OF SURVEY. ONLY VISIBLE IMPROVEMENTS SHOWN HEREON. r W MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Vow melw& 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) � OT L, i31�3�_� L�P�.E��E_�J 1 .�•�,-��1U-r-SM Location (address or directions) qA&0 1 s oNI (b) Applicant Name ErzS+LJEJB4Kk_ Telephone: Home Business Applicant Address io 1-1fC — 'pis =_VlNekt (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder (, Buyer ❑ ; Other ❑ (explain); (d) Lending Institution f.Q1K►W ,nK Telephone 54a=�ry77 Address (e) Real Estate Company and Agent Address Telephone (1) Mail the HAA to the following address: 4 Q"L> 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms _ 3. WATER SUPPLY t, Individual Well Community 13Public ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE //DISPOSAL Onsite ►7� Public [3Community 13 Holding Tank ❑ Note f community well system, must have written confirmation from the Slate Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,54) W 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 3 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Healtfi Authority Approval 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 allMunicipaland State codes, ordinances. and regulations in effect on the date of this Inspection.C37 ws' !.K — Name of Firm U e � Telephone 971-3 V,6 Addre Date �N%% , r OWL • •.) t �,,. �.,, .. • d O.S.E 2225-E d: 2S. 1971 DHEP APPROVAL 0) Approved for bedrooms by ate Approved Disapproved Conditional Terms of Conditional Approval CAUTION Seal J�g The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given In paragraph 5 above by an independent professional engineer registered In the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions In order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-M (11/84) n ii^"! iPAUTYT. OF OF ANt3K*99 DEPHEALTH 6 ZrlftONMENTAL PROTE 1014 MAY 191986 RECEIVED A. WELL DATA r1 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (MAA) CHECKLIST - FEBRUARY 1884 264-4720 Legal Description: - LOT 1. $K *S F -1 -moms SEL Sq : 10.NE x z %y/ Well Classification S If A, B, C, D.E.C. Approved (Y/N) ' WA Well Log Present (Y/N) Date Completed Hpt 141 77 Yield OR 6 P Total Depth > It N Cased to /28! Depth of Grouting NONE Static Water Level /47 Pump Set At > /2& r Casing Height Above Ground .2y Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) —i Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/kJaldiag.Tank on Lot E c 9 ; On Adjoining Lots 7 ISO To Nearest Edge of Absorption Field on Lot On Adjoining Lots > /oO To Nearest Public Sewer Line 6fCiNg To Nearest Public Sewer Cleanout/Manhole HONE To Nearest Sewer Service Line on Lot )U D Water Sample Collected by 7 S• _ ; Date is A* /n Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date InstalledHM IT Size 1Z60_— No. of Compartments�_W_ Standpipes (Y/N) —0-"— Air -tight Caps (Y/N) Foundation Cleanout (Y/N),_)!� Depression over Tank (Y/N) iq Date Last Pumped Pumping/Maintenance Contract on File (Y/N) WA ; for ./A Holding Tank High -Water Alarm (Y/N) _A Temporary Holding Tank Permit (Y/N) WA Separation Distances from Septic/Holding Tank To Water -Supply Well 104? To Building Foundation 68 To Property Line >10 To Disposal Field IV To Water Main/Service Line 1 so To Stream, Pond, Lake, or Major Drainage Course /s0 Comments Page 1 of 2 72.02601,64) C. " ABSORPTION FIELD DATA Soils Rating in Absorption Strata O.O Type of System Design T 12E 94L" Date Installed F• Ad #77 Length of Field D5 Width of Field 34 -% Depth of Field I co Gravel Bed Thickness Square Feet of Absorption Area .952. Standpipes Present (Y/N) -rw/O Depression over Field (Y/N) IN Date of Last Adequacy Test S Results of Last Adequacy Test 'nss Fir Fo V r a-Ldw-ve ►uJ Separation Distance from Absorption Field: To Water -Supply Well A7 To Property Line To Building Foundation Bro To Existing or Abandoned System on Lot NO KE ; On Adjoining Lots 12 /en To Water Main/Service Line ! /a To Cutbank (if present) No N To Stream/Pond/Lake/or Major Drainage Course % /0-0 To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION No NE Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertify th av checked verified e) conformed OA and HAA guidelines in effect on the date of this inspection. Signed o/C/ Date � 0 �Q�6 Company MOA No. Receipt No. 9 S UC� Date of Payment �Z-' Amount:$ coS,np Page 2 of 2 72-026 (11,84) �E C)F �tl �t1 r ••• .s N 2225 UNL 25, 1971 : ;` i Engineer's Seal Time APPLK NT FILLS OUT UPPER HAL�IONLY Time Property Owner GE',PiiL I] µJ, 1r/UFx' Date Phone � Mailing Address SrQ/� ,(. ilNG rid E'i1GC ,1 At ZIp Code SO Buyer ,vlT �E FrN>).�KE Inspector Address Inspector Zip Code Inspector Lending Institution ANCHORAGE DFPT C' I c' lT l A Phone Address ENVIRJ,1L.ct..A._ :..O.R.TION Zip Code Realty Co. d Agent fibfI rC let cl 7Ak/.'�%I E�76-� Phone Address l o l t • %6T~ S /. L✓ Zip Code 94 S-4).2 Legal Description EL /+10 4'4� <67- / i /. UC'e 9 Street Location y,2 0 17 SOOT P o �) Type of Residence 16 Single Family Soils Rating Date Sewer Installed ❑ Multiple Family No. of Bedroom+ Septic Tank Size ❑ Other Well to Tank Water Supply In Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community For wells trilled prior to that date, give well depth (attach log If available). ❑ Public Utility Sewer Disposal ,6 Individual Year Individual Installed: /moi ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RECUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time P �1 Date Date Date Date QS Inspector Inspector Inspector Inspector Field Notes: ANCHORAGE DFPT C' I c' lT l A ENVIRJ,1L.ct..A._ :..O.R.TION J.'. N 2 4 9933 RECEIVED Q� APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL - DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank rzo» nM4 � DAfE RECEIVED ' INSPECTION APPOINTMENTS Su TIME TIME TIME DATE DATE DATE ❑ Two ❑ Five .c. INSPECTOR INSPECTOR INSPECTOR Of n MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • 1 ENVIRONMENTAL SANITATION DIVISION NOV 12 1981 Telephone 2644720 RRECC FE IIV REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERFi4�ILfTfES E D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPE =R Su PHONE//?V D 417 'W ❑ PUBLICUTILITY MAILING ADDRESS SR4 3oLLL PROPERTY RESIDENT (If different from above) PHONE 2. BUYER AM Gu a.LcP Se A o r r PHONE a 711-'/! 3 MAILING ADDRESS 23ZU rn ceY 3. LENDING INSTITUTION PHONE MAILING ADDRESS L -Pq r- 4. REALTOR/AGENT TOGAVne_ PHONE MAILING ADDRESS kiezza 5. LEGAL DESCRIPTION Lv/ / 61cc% 3 SI,nor Su STREET LOCATION S. TYPE OF RESIDENCE NUMBER U BEDROOMS 10 SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ® Three ❑ Six 7. WATER SUPPLY IN INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) & SEWAGE DISPOSAL SYSTEM 129 INDIVIDUAL/ON-SITE" -1927 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010 (Rev. 6/79)Pj _ 1 72010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL GATE GRILLED LOG RECEIVED 1 �tii 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED �7 INSTALLER .f ❑Septic Tank or ❑ Holding Tank Size: '-�LS'o If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: SePtit/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS hA ❑ APPROVED FOR BEDROOMS ❑ -CONDITIONAL APPROVAL (letter must accompany certificate) E§--DISAPPROVED DATE _7� V_-4 L BY e(zaf I 72010 (Rev. 6/79) � n Ihunicipality ®f .Anchora�c r'1 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 2G4-4111 i (A 01".1 M. „UI I IVAN. inAY01t DI VAIMILP.r OF ALAI!H AND LP.V1RXA1FNTAI_ PROTECTION Plovember 23, 1981 Robert E./Susan M. Dahl Star Route A Box 304L Anchorage, Alaska 99507 Subject: Lot 1 Block 3 Elmore Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: �1) The water anlaysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this office. (3) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 4-2090 99509 Joan Ramirez 8 Polar Realty 1101 East 76th Avenue 99502 MUNICIPALITY \I DEPARTI"'� OF HEALTH - 82bL Street, inNc j #1: Time 11:30 a.m. Date 1- Insp Buchholz 472 ANCHORAGE VIRONME, . PROTECTION aae. PL.as. i 99501 ive/: January 3, 1978 #3: Time. Date Insp REQUEST FOR AXZ30VKL OF INDIVIDUAL SEWER AND WATER FACILITIES La.; ._j INnL rlcalm y _ 1. Lending Institution Request: First National Bank of Anchorage V� Mailing Address: Post Office Box 4-2090 99509 Phone: 2. Property Owner: James Bumgardner Phone: 344-1933 Mailing Address: Box 474-E Star Route A 3. Legal Description: Lot 1 Block 3 Elmore Subdivision 4: Single Family Residence: (x) Number of Bedrooms: Two Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (x) Community/Public System ( ) Permit # %� Depth of Well Well Log on File ( ) Construction Bacterial Analysis , 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # / Installedy977 Installer Septic Tank Size 125-0 Manufacturer Absorption Area S.`M_ Soils Rate 160 Material 7. Distances: Well to Septic Tank /00 to Absorption Area /0:A 7 to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line r7iUNICIPALITY OF ANCHORAGE,_ Department of Health and Environmental Prote�ctiioii,�, 825 L Street, Anchorage, Alaska 99501 264-4720 •, = _ equest for Approval of Individual Sewer and Water Faeiitiey S0 Al G N .rI TR u Ct. , i✓.=[i. ' 1. Property Owner: �A Asoj to •i v dyl ey ' 2. 3. 4. Mailing Address: Name of Buyer: /� • phone: 3' — t 33 /rE'S• A ,t✓i Mailing Address: N� Phone: Lending Institution: Mailing Address: e340 Phone: Realtor/Agent: Mailing Address 5. Legal Description: Street Location: 5 ho S A ef► / Re 6. Single Family Residence: Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (•-Ir Public/Community System ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: "On-site System (r?'Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77� 164J4 - -Z�; 0004� 1:..0044.�V LaLA44 —,.v 9 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 1 Block 3 Elmore Subdivision Comments: Affadavit Attached: '( ) Letter Attached: ( ) Approved: Date: 'I'4/ V i / 0 Disapproved: Date: Department Worksheet: