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HomeMy WebLinkAboutSUNSET HILLS WEST BLK 1 LT 13Sunset Hills West Block ! Lot 13 #018 230-13 R UUINAu LIL11 Municipality of Anchorage JAN I ' On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211374 PID Number: 018-203-13 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JEFFREY &SUSAN CHILDS ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 14201 HANCOCK DRIVE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SUNSET HILLS WEST 1 13 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well*86'+ -- 2cc++ TANK-- ® Septic [:]S.T.E.P. El Holding El Other Manufacturer GREER Capacity 1000 Gal. Surface water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 1 Q'+ __ LIFT STATION Manufacturer Capacity -Gal. Remarks Tank insulated. *SEE ATTACHED LETTER Alarm location Electrical installed by Installer DENALI EXCAVATION PIPE MATERIAL House to tank 3034Tank to d a afield 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ection 1s' 10/5/2021 10/5/21 Location and description 2�d 3" 11/22/21 4'" ITOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Z 4 OF l� Conditional Approval: Date .: *: 49TH ....�:*�� • • .:. '. Curtis Huffman �# Septic A provedstem PP Date 1 (k S z ��c'. CE 128991 i�� r ��1stFR•. 11/22/20;1- IA PROFESSO .� Note: this ap oval does not include well permit requirements. (Kev u5/u1/1 a) PID: 018-203-13 PERMIT: OSP211374 �o• LOT 14 O ry� Aj s �.0. FtiC 0 0 1�. PAVED ?gip. D/W DFC H CO t CO E G 0 57 ^p 94/;S,stic \aL LOT 12 A—C=58.4' B—C=49.8' A—D=61.2' B—D=50.7' A—E=63.8' B—E=51.3' A—F=72.7' B—F=61.1' A—G=65.4' B—G=51.7' A—H=65.3' B—H=50.0' v \TrF '°o s LOT 13 \�T BLK 1 SUNSET HILLS WEST BLOCK 1, LOT 13 PREPARED FOR: JEFF & SUSAN CHILDS 14201 HANCOCK DRIVE ANCHORAGE, AK 99515 FIRST WATER CONSULTING SEPTIC SECTION SCALE, NTS 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmail.com �urrurc i �trcvi�ta OF A4' c g T11* - >k DATE: 11/22/2021 rtis Huffman SURVEY: JLSi DRAWN: FWCS `! 1E1/22/211�Ao SCALE: 1 , = 30, PAGE: 1 OF 1ssi0��' 110 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SUNSET HILLS WEST LOT 13 BLOCK 1 PLAT P-600 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enehroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E-MAIL• OCT 25, 2021 1"=30' schuller*9k.net 21-133-2 MAWN BY CNECM BY GRID NUMBER: BOOK/PTM JLS SW3033 210355 \ NOTE: 1. NO OUTBUILDINGS LOCATED THIS SURVEY = OO FT\D 5/8 REBAR ASW * 49TH 0 ' HN L. SCHULLER: s LS -10408 0 AW n %� fessiono� \- A LAND \1 1831 Talkeetne. Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax �(' t_7 Municipality of Anchorage ung+:rcment 1. P.O. Box 196650 s 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221002 COSA#: Permit#:OSP211374 PID#: 018-203-13 Legal Description: SUNSET HILLS WEST BLK 1 LT 13 Engineer: Pannone Engineering Services Your request for amending the existing waiver of the required 100 feet horizontal separation from the septic tank on Blk 1 Lt 13 to the neighboring private wells have been approved. The approved separation distance are: 91 feet from the well on Blk 4 Lt 6 • 86 feet from the well on Blk 1 Lt 14 • 93 feet from the well on Blk 1 Lt 13 In addition, the tank is approved to be 3 feet from the northern field. This waiver approval applies to the existing septic 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. Per the 1998 waiver for the well on Blk 4 Lt 6 is approved to be 70 feet from the field on Lt 13. Waiver is Granted: X Waiver is not Granted: Date: Jg &Z Approved by: (�t/ Name of Revi er ..................................................... 0 H 7 ■ .................. ■ 1 **** VARIANCE/WAIVER REVIEW **** 0 F451 Wder 4_ CONSULTING 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com January 14, 2022 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: OSP211374 - SUNSET HILLS WEST BLOCK 1, LOT 13 Per the permitted design, the existing tank was removed and the new improved HDPE tank installed in the same location and best fit to existing conditions (field, driveway, wells,...). Based on these restraining conditions along with the dimensions of the HDPE tank, post construction measurements were made and we respectfully request adjustment of the existing waiver WR980015 as follows: 91' from the well on L6, B4, 86' from the well on B 1, L 14 and 93' to the subject L13, 81 and 3' to the northern most field. The integrity of the field was not compromised. Additional cleanouts were installed for the two fields as shown on the inspection report drawing. Continuance of this waiver is warranted per the original justifications and the improved tank material. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, i Curtis Huffman, P.E. . ....:�` Curtis Huffman CE 128991 f uIIIFG FlVICrS C � � 1iE 01 hRS1EYlAIFA '-1 P9 i PtaNNIN6 MUNICIPALITY GF ANCHORAGE On -Site Wator & 1lwaslewater Program PC &DX 198650 4700 E=imare Rrad AncWr$gs, Ars" S1$-9550 +tie' (947} 345.7904 FOX: (907 343-7997 hNp.1MvAw.muni.c4Vcmibe On -Site Wastewater Disposal System Permit Permit Number. O P211374 Work Type. SepticTank Upgrade Tax Code Number= 01820313000 Site Legal Addrew SUNSET FilLLS VDT 8LN 1 LT 13 C—:3033 Site mailing ,fid d ress: 14201 HAN COCK DR. Anchorage Owner: CH I 1_08 JEFFREY H & BU SAN A Design Engineer` FIRST WA7ER CONSULTING Th is perm it i s for th 9 con structl on of - Effective Date: Expiration Date No � - n d De -113 r tmf. n I Lot Size, in Sq Ft,. Total Bedrooms,. 91812021 91812022 15004 11 Disposal Field 0 Septic Tank Ell MAding Tank ❑ Primo ❑ Private Well ❑ dater Storage All construction shall be in accordance with 1. The attached approved design - All requirements spe&ied in Anchorage Municipal code Chapters 15-85 and 15.65 i rnd the Stake of Alaska Wastewater Di oposat Reauletioris f i 6AA M and Di i Dkina Water Regulations (18AAC80) 3. The wastewater code requlres InspecIlionS during the inslaIV�on, The engineer shall notify the Developmerkt Serwices Department per AMC 15.65. Pfovido notlSoation by caliing {$07) 343-7M4 (2417)- 4. From C�P_tober 15 tiD April 15, a subsurface sail absorption systorn under construotlorl during freezing weaih er Shall be either a. Opened and Closed ori the same day. or d- Cavomd, sealed, and he@Wd to prevent rreezing fp�� Speeia I F r ovisiorls: ' 1. I_omte the the sauthwaslern Field end the beginning of the northernmost field to conflrrn that the 5' separation between the tank and bald voIl be met. 2- The approved separations for the axistirig tank to surrounding W01115 by WR980015 will apply to the new lank, f Received By: Issued By. gJ101 Dntc. Date: VZ 3 MUNICPALITY OF G Development Services Department On -Site Water & Wastewater Section - Parcel I.D. 018-203-13 ON-SITE SEPTICM/ELL PERMIT APPLICATION Property owner(s) JEFFREY & SUSAN CHILDS Day phone _ Mailing address 14201 HANCOCK DRIVE, ANCHORAGE, AK 99515 Site address 14201 HANCOCK DRIVE, ANCHORAGE, AK 99515 Legal description (Sub'd., Block & Lot) SUNSET HILLS WEST 131, L13 Legal description (Township, Range & Section) Lot Size 15,000 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Q (D) El Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 S Waiver Fees: Date of Payment: 2 1 1 x2021 Date of Payment: Receipt Number: 31105 W Receipt Number: Permit No. OS PZ 1137 L( Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 30, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SUNSET HILLS WEST BLOCK 1, LOT 13 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. We respectfully request the continuation of the existing waiver (WR980015) with possible slight modifications given the dimensional differences of the existing steel tank and proposed HDPE tank while maintaining 5’+ to the field. Continuation of this waiver to the proposed tank (85’ from the well on L6, B4, 93 ’ from the well on B1, L14 and 98’+ to the subject L13, B1) is warranted per the original justifications and the improved tank material. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211374, Deb Wockenfuss, 09/08/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211374, Deb Wockenfuss, 09/08/21 1\ ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SUNSET HILLS 'BEST LOT 13 BLOCK l PLAT P-600 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAIL AUG 30, 2021 1 "=30' schuller®ak.net 21-1,33 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE JLS SW3033 210308 \ NOTE: 1. NO OUTBUII,DINGS LOCATED THIS SURVEY \X�) OO = FND 5/8 REBAR Am' �, . , ..F... ,A.��L LAND .� 49TH ••:`� o� '� / % r . ...... ...................:. ..� ••.J HN L. SCHULLER.• o 's LS -10408 �,, • . , . ,� • • �� 1831 Talkeetna Street r,�.. .. •`''� 6 Anchorage, Alaska 99508 o fe o\ �. ,... (907) 227-1455 office ,�, s s io��,,e`•�r. (907) 274--4992 f ax t`� HA~w. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE . 1~Ew NAME MAILING ADDRESS )EGALDESCR'PT'ON LOT t NO. OF BEDROOMS Dweging PERMIT O Inside length WMth __fT~ ~ ~ i~ / LOCATION ~ H ,,co c DISTANCE TO: ! IOO Manufacturer DISTANCE TO: IF ROMEMADE: Well Liquid depth PERMIT NO. Well DISTANCE TO: l DO NO. of line~,~ Le~ ¢ ~(.¢th of each~ ile to,,finish grade Length Type of crib Crib diameter Well DISTANCE TO: Ctass DISTANCE TO: Depth ' Building foundation OTHER -PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS Matmial t Jine o f.~li nes Tr0nch width Material beneath tile ____ Building foundation Driller Sewer line e absor PERMIT NO. Distance to tot line IP[:RMIT~ERMIT NO. tic tanl~ ~lAbsorotion ~rea (s) APPROVED 72-013 (Rev. 3/~'8) DATE II.~,v.~ l LEGAL tFFL :[ L. OCFITZ 3N HFINCOCk; E:,R LEGRL L:L:: E.,::L ':5LINE;ET I'IILL_ .tiE_-',1 T"r'F'E OF =,C):L FIB...F4. I-ll..N ..,'L, TEfl l.:,. I','lFi,'...',lhllJ{',l N.II'IE,EF. OF E',EEE...LH ..... .s T F.:E i'.,IC:H _dJ.EL F:h'fTi",!a ,::L:;C..! F]',.."E:f,::.~= 'THE REI21.JZF::EE:, :,.[~.E. OF 1'HE LE;CilL. -":-;':' " ¢"' '- ..... ' HE_UL.F ~'ZLfi'I :,r:,l'E:i'l THE L.ENf3TH E:,:[HENL':.;:ION I.E'; THE LEN(aTH (:l['.,I FEET> OF THE: TRENC:H OR ['.,fRFIINF'ZELE:,. THE I)Ef:'TH OF R TRENCH OF? PIT l~; THE D:[2;TFINCE E:ETt.4EEN 'rile St. IRFRCE OF' THE GI~tOIjI'4[:, F:INE:, THE DOTTOH OF THE E;?.,'CFI',,,'FITION 4 I1',1 FEET::,. THERE ]::5 NO SET I.,.I]:DTH FOf~: TRENCHES. THE CiF:'.FI',/EL E:,EF'TH :l:S THE H:[i'.,I):HUH BEPTH OF:' GF..'R',,¢EL BETHEEN TFIE OUTFFILL. F'IPE: FIND TI..IE BOTTOH OF' THE E',qCFI',,,'F:rT' ): ON (:IN FEET::,. F'ERHZT tlF. FLI...-N'f ~1~1~. THE F..E._,f .N....IE, ILII~ 'l'O Ifli ..B. II FIII_, [::,EF'RRTHENT D...RJ:N::i TIqE ~N.::~HLLR [ ~ JN ~1-~ L_. F~LN_: OF' FIN'?' rIEL, L,::, RE)J'FIE:ENT TEl "I'H:[5 ~ L .PE~I · FINE) THE N.,HDEF' OF F,.E_EEE, H_E._. THRT THE HELL F,I~LL 1:3FIC:I':::F'ZLL:[NG FIF' F"I~'TIiT' --J "~'' ; .... ' "1' ........ ' -- :'~:'fLII H]:THOIJT F:[Nf:IL :[N.:.'FE--.T]:uI''! HI'IE' E:~EF'FII::THFNT .ktlLL ErE . 'UE'..TE--.T TO~::F' ......... J:'EI..U] J.I.IN. .... B'¢ T I I I .-., HFF~- FL. H!N:[HUH [:,:[STRNE:E E~ETI.qEEN I:1 14EI_L FIN[::, FINY ON-L-qlTE '.-.:E.klRGE DISPOSFIL E;'¥'STI-::PI IS; ::L(!'iO FEET FOF?. R PR:['v'RTE 14ELL OR ;:[.~;l::~ 'fEi ;:_'EIE~i FEET FF::OFI R F'UBLIC 1.4EL. I... B, EPE:NDIi'.,h:]i UPON THE T'T'F'E OF F'LIBL):C 1.4ELL. f'I]:NZHUH E.',IE;TRNCE FF?.L-II"I I::I PRI',,,'R]"E I.,.IELL TO R F'RI',,,'RTE '2;EI4ER I. li'.,{E IS 25 FEET FIN[> TO Fl COi"IHUNIT'¢ ~;EkIEF:: LINE I:5 7'5 FEET. .klELL LOG'.E; RF<E I~':EtTgJIRED FIND HUF, T BE RETLIRNE:[:, TO OF THE HELL. COI"IF'L.ET]:ON. OTHER RE(:!t_I:[F.:EhlENT:.E; HFI'¢ RPPI...'¢. 2;F'EC:IF':[CRT):ONS RI,ID E:ON2';TF~:UCTION I)I. RGRR{"IS F'II"4:E R',/FIILRE:LE TO I}'.,ISLIF~'.E Pf~:OPEF.'. IN':;TRLLFITIL'd'.,!. :1: CEI::TIF'¢ THRT !: ]: FIh'l F'Ri"IILIFff;:: HITH "FHE F::EQU]:REHEN'I"2; FOR ON-::ITE E;E"HERE; RND, IqEL.L.E; FIS '.:.:E:T FORTH B'¢ THE i"IUN:£CZPFILZT'¢ OF' FINCHOF:R6E. 2: ]: HILL INE;TRI._L THE E;'¢$TEH :IN RCC':OF'.DRNC:E HI]"FI THE 3:: I UNDERSTRN[:, 'rHW[' THE ON-..'_.5]:TE !:;E!.qER S'.r%TEH HR'¥' RE6!UIRE ENLRRGEHENT IF THE ~ROUt,~ RND THE E:OllOl~ Of lit RF'D'L3C":B[.II' HFLG 1HE kl~.4 Ult~:,l[-iL:ll'q '1[) :)NFODH 114~[.c, I~Et:'FIF~']VLE:NT DLIR~iNG THE [~LLB'!ION ]Ng~'IE[:I]OI,I~, OF RI-I~~ Id. ELL~. R[:,31~E:E.14'J IO li4:Ig. PF:Og'Elr~3N' '.qND 1fie ]tie 'IS?[ OF F'UDLJC Ht~LL i~[ HELL ~ R[~LI]~E~ENT~. H~'¢ ?'F~Lg, ~EC~]eRI]ON~. ~ND C;~.]~UUi~OH [)][~URH~, fiRE ~ B~' 'I~ HLIN]C:~P~JT~~ OF RNC:HDRF~GE', ELEVATION: V~O. NO. LOGGED BY DEPTH KEY PP: UNCONFINED COMPRESSIVE STRENGTH (PENETROMETER)(TSF) TV: SHEAR STRENSTB (TORVANE) (TSF) MA-- MECHANICAL ANALYSIS LL= LIQUID LIMIT (%) PI --= PLASI'IC INDEX []- GRAB SAMPLE (~- SPT SAMPLE II - 2.5" I.D. SPOON' SAMPLE 340~ WEIGHT, 30" FALL [] - SHELBY TUBE - PUSHED ~ -GROUND WATER TABLE -~ WH,L~ DR,'L,NG TEST PIT LOG June 10, 1981 Mark Holum 3531 East 42, ~111 Anchorage, Alaska 99504 Subject: Percolation Test Results, Lot 13, Block 1, Sunset Hills West, Anchorage, Alaska Dear Mark: A percolation test was performed on May 31, 1981 on the above referenced lot. The soils conditions were determined by digging a 14 foot deep test pit at the location shown on Figure 1. The soils consisted primarily of silts except for a 1.5 foot thick sand layer at a depth of 6 to 7.5 feet. Three percolation tests were conducted in the test pit. The tests were conducted in accordance with procedures outlined in the "Manual of Septic Tank Practice", U.S. Department of Health, Education and Welfare, Public Health Service. Measured percolation rates are shown on the attached test pit log. I recommend that the seepage trench be extended to intercept the permeable sand layer at six feet depth. Assuming soil conditions throughout the drain field area are similar to those encountered by the test pit, the following design absorption areas are recommended. Maximum Trench Depth (feet) Design Absorption Area (ft2/bedroom) 4 225 6 250 7.5 225 10 250 If you have any questions, please contact me. JRF/mg Attachment Sincerely yours, dames R. Finley, Geotechnical Enqineer Paul Gardner 8620 Jade Street ,~lehora~g~, Alaska 99~302 Subj ec.t, Permit A permit issued by this de. partmonfi for well and/or on-$£ta ~owar installation on Lot 13 Blook 1 ~tunsot Hills W~sL gtlb~ivision has expir~d ~in~e the isslle d.ato oxo~l~tis one(i) In the~ event you still plan to install thc well and/o~: soil Lest may be u~md to ol)'[;ain a (nlrrent If the well has been drillod, a well lo9~ should be sent to this (teparLP. lcnL %0 ¢locum~nL the installation If.: you haw~ any questions regarding the above matter, please contact this office iI~-.qedfately at 264-4720. Sincerely, Los N. Buc, hholz~ Bonier Environ~lt~n~al GRE, ER ANCHORAGE AREA BO,. UGH DEPARTMENT O1~' ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPIJCATION AND PERMIT PIT _, DRAIN COMPLETION DATE ANTICIPATED LD WITHOUT ~OlL TES~I' CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WiTH AIRTIgHT REMOVABLE CAps. EM WITHOUT FINAL INSPECTION I~Y THE OSECUTION. EQ-O16(3-75) ~ [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPAR'FMENT OF HEALTH AND ENVIRONMENTAl PROTECTION Pouch 6-550, Anchorage, Alaska 99502 ~76-222~ SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: ~LtJ,~\ LEGAL DESCRIPTION: ~b ~- /~'~ 1 2 3 4 5 6 7. 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTFI? Reading Gross Time Net Depth to Water Net Drop ' 50" It PERCOLATION RATE ~ C) (minutes/inch) TEST RUN BET1A/EEN ,~'5" ~ AND ~-- FT CERTIFIEDB Rick Mystrom. Mayor Department o'f Health and Human Services 825 "L" Street P.O. Box 196650 Ar~chorage, Alaska 99519-6650 343-4744 May 13, 1998 Tobben Spurkland, P.E. 203 West 15~" Avenue, Suite 103 Anchorage, Alaska 99501 Re: Waiver WR86-051 Amendment Request For Lot 13 Block 1 Sunset Hills West Subdivision, New Waiver Number WR980015, P.I.N. 018-203-13 Dear Mr. Spurkland: Your request to amend the subject waiver granted in April 29, 1986 has been approved. The approved Separations are as follows: (All Lots Are Sunset Hills West Subdivision) 1. The well on Lot 6 Block 4 to the septic tank and absorption field on Lot 13 Block 1 from 94 feet and 80 feet to 85 feet and 70 feet respectively. 2. The well on Lot 14 Block 1 to the septic tank on Lot 13 Block 1 from 97 feet (waiver WR85-028) to 93 feet. 3. The well on Lot 13 l:31ock 1 to the septic tank on said lot of 98.9 feet to not require a waiver. This approval applies to this existing wastewater disposal system to wells separation only.% Any upgrade to this wastewater system will require all separations be met or another approvalfrom this office. Sincer~.~._ -4 Daniel J. Roth Civil Engineer On-Site Services WR~ Date Legal Engineer: MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR980015 PID~ 018-203-.13 HA~ Permit Received: April 24, 1998 Description: Lot 13 Block 1 Sunset Hill West Subdivision Tobben Spurkland, P.E., 203 WEst 15th AVenue, Suite 103 ANchorage, Alaska 99501 Applicant: Mark Holum Waiver Requested: septic tank on Lot Waiver requesc from a private well on Lot 14 13 Block 1 of 93 feet; well on Lot 6 estimated Block 1 to the to be 70 feet ~_the drainfield on Lot 13 Block I and 85 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: from the septic tank on Lot 13 Block 1. Points: 2. Special Conditions: 3. Other: Waiver is ~ ~ List Conditions or Reasons Waiver :ts NOT Granted: for above: ~ /~/~ Name of Reviewer NOTE: no fees were paid are they requied??? Rec ~: ~~ ~ount: S Date Paid: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 RF.C IV[D · alit ot Anchorage Munic~p Y 8 Dept, Health & Human Service Municipality of Anchorage Department of Health rind Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Waiver Lot 13, Bk 1 Sunset Hills West April 21, 1998 Gentlemen; A Health Approval for this property was issued in 1986 together with a waiver to the well on lot 6, Block 4 of Sunset Hills West.. A recent resurvey of the property revealed that the information in the 1986 application was incomplete. We are therefor resubmitting the application and request that the waiver be amended to include the well on lot 14, Block 1 as well. The submittal in 1986 indicated that the separation distance between this well and the septic tank on lot 13 was less than 100 feet, but a specific request for a waiver was not made, and the waiver did not include this well. Based on the resurvey the well on lot 14 is 93 feet fi'om the septic tm~k on lot 13, and 100 feet from the drainfield. The well on lot 6 is estimated to be 70 feet from the drainfield, estimated because there is no cleanout to define the end of the field, and 85 feet fi'om the septic tank. The corresponding distances as stated in the 1986 waiver are 80 and 94 respectively. The resurvey also revealed that one of the treuches was less thm~ 10 feet away fi'om the property line. A property line waiver is also requested, to 2 feet. Yours T. Sp~ LOT 6 "~-- / LLTT 7 · 49th SPURI<L~N]) N 15 0 15 30 45 SCALE: 60 7,5 90 TOBBEN SPUN(LAND P,E. 205 W 151'N. AVENUE ANCH. AK. 99501 .(907) 279'-5916 SUNSET IIILLS I~EST LOT 15, BLOCK l 1420! HANCOCK SITEPLAN DATE: APRIL J, 1998 SHEET: 1/1 GRID: 5055 PEBMII' # PIB fl SH~/OiI3£,DI¥5 MUNICIPALITY OF ANCHORAGE MEMORANDUM Department of Health and Human Services DATE: TO: FROM: SUBJECT: May 12, 1998 File of Lot 13 Block 1 Sunset Hills West Subd. Daniel Roth, Civil Engineer, On-Site Servic~'~ Waiver Amendment For WR86-051, New W'aT'ver Number WR980015, P.I.N. 018-203-13 This memo is to document the reasons for the amendment of the subject waiver granted by Steve Morris on April 29, 1986. On April 24, 1998 Tobben Spurkland, P.E. requested this office to amend the following existing waiver approvals that he obtained on April 29, 1986 for a septic system that he constructed on September 30, 1981: (All Waivers Are In Sunset Hills West Subd.) 1. The well on Lot 6 Block 4 to the septic tank and absorption field on Lot 13 Block 1 from 94 feet and 80 feet to 85 feet and 70 feet respectively. 2. The well on Lot 14 Block 1 to the septic tank on Lot 13 Block 1 from 97 feet (obtained by another engineer Sept. 25, 1985) to 93 feet. 3. The well on Lot 13 Block 1 to the septic tank on said lot of 98.9 feet to not require a waiver. After discussion with the program manager Jim Cross, P.E., he authorized me to utilize Steve Morris's points calculated in 1986 and recalculate the separation distance points to justify the amendment to the Lot 6 Block 4 waiver. The Lot 14 Block 1 waiver same. He also authorized me to not require a waiver from the Lot 13 Block 1 well to septic tank separation of 98.9 feet since when measuring from the septic tank stand pipe to the well, the distance measures 101.3 feet. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTtt AND HUM~/q SERVICES WAIVER REVIEW WORKSHEET DATE RECEIVED:__~p.~i~ 21_i 1986 ENGINEER; ~Tobbe._n_.~Ru~rkla~nd~ P~E, 203 West 15:h Avenue .____Anchorage, Alaska 99501 AP?LICANT: Mark Holum WAIVER ~EQUESTED:___ LEGAL:_Lot ,1,3 Block_~l Sunset Hills West S/D CRITERIA: 1) Geology: A. Water Table B. Soil Sorption C, Permeabili~y D, Water Table Gradient E. Horizontal Separa~ion Poin~: WAIVER IS:_ ~" granted, with conditions liseed below: -- not granted for reasons listed below: MUNIClPAL ITY OF A NCHORA GE ON-SITE WASTEWA TER DISPOSAL SYSTEM FIELD AUDIT Date ~ ~ ~._~ Legal Description Document Type Site Address Engineer/Firm ~ q 7.0 \ Excavator Inspection Findings Follow-up Notes Initials /463-5-92 fi/ unicipalitYo Anchorage P,O, BG^ 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES May 1, 1986 Tobben Spurkland, P.E. 203 West 15th Avenue, C Suite 203 Anchorage, Alaska 99501 Subject: Lot 13 Block [ Sunset Hills West Subdivision Waiver Request, WR86-051 Dear Mr. Spurkland: Your request for waivers of tile required 100 foot separation between the well on Lot 6 Block 4 Sunset Hills West Subdivision and the septic system on the subject lot has been granted. The required distances has been waived to 94' and 80' for the septic tank and leachfield, respectively. This waiver is valid for the existing septic system only. Any upgrades or enlargements of tile system must meet current separation distance guidelines. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw CONSULTING ENGINEFR ~ ~ ~ ANCHORAGE ALASKA 99501 TELEPHONE: (907) 2'79-3916 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTB AND HUMAN SERVICES P.O. BOX 6-6650 ANCHORAGE, ALASKA 99501 APRIL 21, 1986 SUBJECT: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL. Gentlemen; We are submitting a request distances stated in Title 18, 80.020 for waivers from the separation Alaska Administrative Code Chapter This submittal follows the format outlined in a Memorandum dated January 3, 1985 on the subject of "Separation Distance Waiver Guidelines for SCRO", prepared by Mr. Bruce Erickson, District Office Coordinator. State of Alaska, Department of Environmental Conservation. This Memorandum outlines a procedure to be used in the evaluation of waiver requests by assigning number values to geological features addressed in the waiver request. In this request I have followed this procedure and assigned values no the pertinent features as follows: 1. Vertical Distance Between Sewage System and Ground Water. From well log for lot 13 and also for lot 6, Block 4. From both well logs 100 feet to damp materials. Point value assigned 7.0 2. Soil Absorption. Well logs show clay and grave for lo~ 13, sandy silt 6. Point value assigned 4.0 for lot 3. Permability: The material described in the well logs has a percolation rate larger than 50 min/inch. Point value assigned 3.0 4. Water Table Gradient. This is a confined aquifer with 10 feet of pressure head. At maximum drawdown the gradient of the waner table will be 0%. At less than maximum drawdown the gradient will be positive. Point value assigned 3.0 Tobben Spurkland P.E, Waiver Request Lot 13, Block 3, April 21, 1986 page 2 Sunset Hills West 5. Horizontal Separation From well to septic tank 94 ft. From well to leach field 80 ft. Point values assigned For seDtic tank For drain field 3.0 2.0 TOTAL POINTS For septic tank For drain field Both of these totals show that contaminate the ground water. Cast iron was used has water tight operation I requesL this sysLem zs almost in the construction of the system° couplings. Water sample taken 20.0 19.0 sure not LO Septic tank during the of the system have not shown any contamination. that a waiver be issued for this properly. Yours LEIT WELL RIO0.O0 WELL RlO0,O0 HOUSE LOT 13 ILBCK 3 SEPTIC TANK #1 SUMP #~ ' 4 9 i!J -~ lNG 25, 1971 .'.,.,,o LB}' 5 LOT 6 BLOCK 4 LOT 7 VACANT SEPTICSYSTEH LOT 13, BLOCK 1 SUNSETHILLS WEST 1,~ 0 30 60 90 I'B]]]3EN SPURKLAND P,E, 2.03 WEST 15TH, AVENUE'. ANCHIDRAGE, ALASI<A, 99501 APRIL 18, t986 Municipality of Anchorage !� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-203-13 1. GENERAL INFORMATION HAA #_ M e;'7067& Expiration Date: Complete legal description Lot 1 3- R l no k 1 i C iin c a t_ H; 1 1 s raa a t Location (site address or directions) 14201 Hancock Dr. Anchorage, AK Current Property owner(s) Greg Branch Day phone 563-6538 Mailing address Lending agency Mailing address Real Estate Agent 1042 East 6th Ave. Anchorage, AK 99501 Alaska Pacific Title Co. Dayphone_ 7705561 Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. � .%�Z � �. i �y �L/O 3 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certiridates are valid tot one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: Ek Individual On-site a ❑ Individual Holding lank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certiridates are valid tot one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage riles and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance ^ith all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan 5. DSD SI NATURE Approved for —� Disapproved. Conditional approval for Date 3/ -7 A .3 �ti� ..................i% R CF_Ai6INEEBLS % STAMP i%i� v • ' - `� ROBERT C. COWAN iv Pi.°\ CE - 8801 bedrooms. �tl i, .%, lyZ�►� y i�`t bedrooms, with the following stipulations: I(((((rrrr Additional Comments ``\ ON-CITF F - . WATER AND • m `- IAIAOTr(nrcr7 PROGRAM Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: .<D Original Certificate Date: 3` % — (7 (Rev. )2100) Municipality of Anchorage00, • �' Development Services Department = } Y f • Building Safety Division On -Site Water & Wastewater Program ' " "` 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriptlon:L0 7 13 8"41"— 1 -Va^d4- H«s WEST Parcel ID: O 1 T —010 3 —13 A. WELL DATA Well type PR' v4rC- If A, B, or C provide PWSID * = Date completed LI—M-1 Y -Z Sanitary seal &N) Y49J Total depth -LO —Ift. Cased to A0 f R FROM WELL LOG Date of test )//Y-/ $ Z Static water level V / K ft. Well Log ON) YE .s Wires property protected ®/N) :'E S Casing height (above ground) ;"i+ in. AT INSPECTION -7/q/0 1 '77 ft Well productionO.P.M..p.m. q. S 9— p.m-WATER SAMPLE RESULTS: # w• r 14 174 4 -e Y P� "+/' C Coliform ! colonies/100 ml. Nitrate 1,0 mg.A. Other bacteria 0 colonies/100 ml. Ars Date of sample: &ATJ03 Collected by:S & S ENGINEERING 17034 Nle Itfier Loop Road No. 404 B. SEPTICIHOLDING TANK DATA Eagl• RW r, Alaska 99577 Tank Type/Material SE AT i c. 1 STC- L Date installed 11/30/s/ Tank size )000 gal. Number of Compartments Cleanouts ON) y c J Y ter ( A 4Depre Foundation deanout�YN)ssion over tank (YA@ NN 0 High water alarm (YA1 w a Date of pumping 3/`/ /0 3 Pumper t rt R v. c t j C. ABSORPTION FIELD DATA Date installed I/�3o%8 / Soil rating (g.p.d./ft� or /bdrm0 System type TEEN c- #q Length ! 3 f �0i 0 ° It. Width 3 ��Z ft Gravel below pipe Total depthj—AO fL Eff. absorption area 10 90f Monitoring tube Y&s Depression over field NO Date of adequacy test �� 9/01 ResubDp if ail) For 3 bedrooms Fluid depth in absorption field before test in. Water added-YT—A gal. New depth Y' in. Elapsed Time: // 6 min. Final fluid depth Y in. Absorption rate >= AIS-0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NC^"% kmaw•✓ If yes, give date_ ` 3 5-.1 C,*L.,t aSaR'8f-O i N �7 Ir M�^ow rt.J 14/0 L4, 7H1 1 LCvCL , M7 /S Lt1E 9.0G44 0A1 2/dt/u.7 47- 0 47— p " ooc WA'r4,t_ D. LIFT STATION Date installed Size in gallons "Pump on" level at —in. "Pump ofr level Datum ycles tested E. SEPARATION DISTANCES Manhole/Access (Y/N) water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 9 8.49 (r" ey & 0 o 15- ) On adjacent lots Absorption field on lot /00 '-+ On adjacent lots /00 'f Public sewer main 1.4 Public sewer manhole/cleanout _ Sewer /septic service line as- r+ Holding tank N N 1.¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S�d r+ Property line / Absorption field 10 Water main N A Water sgrvice line 10'4- Surface water /00 4- 713 er/Yd"t/) WR9R 0©1S Wells on adjacent lots 1'6 r 6 Rl, K -0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: '� W R 9f"'s 14 Property line l Building foundation r3 7 Water main N Water Service line /0 ♦ Surface water ) a0 �+ Driveway, parkinglvehide storage J 0 Jrrl- k v4w,4 Wells on adjacent lots 70 tea'- c ALK k) W Curtain drainN j F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and ; :...:.. , . :....... �r review of Municipal records that the above systems are in 4. conformance with MOA HAAuidelines in effect on this date. 9 UAM01 f �' Engineer's Printed Name R 0,64A7- C Co N�,✓ � ��.`�•.., Date _S/7/03 3 Ittii`�� .+o HAA Fee $ 37j- • Waiver Fee $ Date of Payment 3/_7 103 Date of Payment Receipt Number ° 3 Baa Receipt Number (Rev. 12/01) 5. IUI-' 12:01 PAX Jul 216 0879 seALE / '3o' KARLUK DESIGN \ •l kecevfified x -27--o3(1, k1 0 aal- ..... . ... .. •.+ NO. 223" 1. i _ASEMENTS OF RECORD, OTHER THAN (HOSE SHOWN ON THE RECORDED n 0M ' )LAT ARE NOT SHOWN HEREON. PS -60 f krr r4 be lrt i ko9 jilt •1` - 3A - AS•13UILT NO CORNERS SET THIS DATE UUox t6ZZ6G I hereby certify that I have performed a Morlgagee'a Inspection of the following described property: 4 e T 18� BLo_ Gk !� suusEr 141tl5 WyZsr saes_ Anchorage Recording Pretihct, Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or :encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises In question and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated at Anchorage, Alaska this —day of JULY -2001 FRED WALATKA 6 ASSOCIATES (907) 248-1666 Engineers and Surveyors n Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.a k.us (907) 343-7904 CERTifiCATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING' Parcel I.D. OI ~' -~-o 3- 13 ~1'.-~ GENERAl.; IN E~R. MATION ."-J:.' Complete legal'deScription :LOT 13 BLOCK 1 SUNSET EILLS ..... Loc~fion (~teaddressord~rections) 14201 ItAiNCOCI~ DR At, ICI'tOIl^GE ..'Current Property.. owner(s) ':". Mailing address Lending agency Expiration Date: /C:) - ,/~'- tO ! ,JESSE RAY Dayphone 348-7725 14201 HANCOCK DR' ANCHORAdE AK '9951 Day phone Day phone Mailing address · Real .Estate Agent -' Mailing Address · Unless otherwis,e 'requested, HAA wi#be heldbyDSD forpicku~. 2. NUMBEROF BEDROOMS: 3 3.' ,TYPE OF WATER SUPPLY: Individual Water Storage Community Class .~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site ~ Individual Holding tank [] ~[~ Community On-site [] Public Sewer [] The Municipality of Anchorage Deve!opment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single fam~y on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may b~ reissued for a peri6d of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER As certi~ed byfny seal affixed hereto and as of the validation date shown below, I verify that my investigafion, based on'procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-sita water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm S&S £NGINEEItINC_. Phone 69/~-2979 Address 1703/~ N. F.a,~le R-iver Lp suite 20/~ ]~oI1. AK~'99577 Engineer's Printed Name Robert C. Co,,ran P.E. 5. DSD SIGNATURE Approved for ..~ bedrooms. ~. _ Disapproved.. Conditional approval for bedrOoms, with the following stipulations! Datc/,~.~?. u 1¥ 2001 Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other, Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.encflorage.ak.us (907) 34.~7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT" Well LogaN). ¥~J Wires properly protected ~¥N) 'Ya ..r Cas~g height (above ground) 3 ¥ ~ AT INSPECTION / A. WELL DATA Well type j).e,v~ ~' ~ Date completed I/S'/~' ~- Total depth /el ft. IfA, B, otC provide PWSID # Sanltmy seal ~q%l) 7a J' Casedto bO,/' It. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m. '7'7 g.p.m. Coliform O colonies/100 mi. Nitrate , O. $" mg./I. Date d sample: , '7/<~/~1 Coilectedby: B. SEPTIC/HOLDING TANK DATA Tank, Type/Material ,51~. ,~7, c / 5"7~ ~,. t_ Tank size ] O o O gal. '* Number of Compartments ' F~Undafion cieanout~)* Ye I Depression over rank : Date of pumping '7 /la.]gl Pumper :. C: ABSORPTION FIELD DATA Other bacteria o colonies/100 mi. $ & S ENGINEERING 17034 ugm ~tiver La~p Ry.,,: ::C,. *.".-~* Eagle River, Alaska Date installed Cleanouts ~.)N). High water alarm (y(~ Date installed 11/30/t'| Soil rating (g.p.d./ft~ 0~-'~"~ ~ ~ 0 System type "7' ~'l a,., c./4 Length I ~,X- 'r,~;4~.fl. W;dth ~t ~/'.~ .ff. Gravelbalowpipe. 1/~ ft. Toteldepth7-~0 fl. Eff. absorpfionarea,/O$O ft2 Monitoring tube , ~dl ,j Depression over field Dateofadequacytest"7/q/O ~ Results'~'~ail) Iod-£J For '~ bedrooms Fluid depth in absorption field before test O in. Water added ½S'~. gal. New depth ~ q'4. in. Elapsed Time: ~b min. Finalfluiddepth, 4f in. Abeorpfionrate >= /../~O g.p.d. Any rejuvenation treatment (past12 mo.) (y/N & type) /dO/.,4.. ~:.,o~,.., Ifyes, givedate D. UFT STATION Size in gallons . ~ Date installed 'Pump ~,~'-'''-l-~''''~. · H~h water ~arm level at 'Pump on" level at ~ _ ~ Datum ~ Cycles tested _ _ Meets alaml & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift statlen on lot fl ~o~/ (~k°l~eol£) Onadjacentlots 10o Jn. ,~. ldo Absorption field on lot I oO On adjacent lots Public sewer main. ,A//A Public sewer manhole/cleanout ~. 3' ~-~ Holding tank pJ/,4 Sewer/septic service line _ sEpARATioN DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. ~ O '4- _ property line_/o ' 4- Absorption field /0 Surface water Watermain /d/~ Water service line _ 10 '+ . leo ~ Wallsonadjacentlots~' (~.r & 4,.,~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property lin~ .~-L~, ( t,,R~. ~'Buflding foundation D '1 Water main Water Service line I 0 ' 4. Sudace water_ 10 ~ + Driveway, parking/vehicle storage Curtain drain /doa,~. ~,e~,~v Wells on adjacent lots ~ O ( ~'~;' (' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name t00~e,4.7' ~'- Cdk/~t'~ Date ~ -- HAA Fee S Data of Payment Receipt Number (R~. 1 ~) Waiver Fee $ Date of Payment Receipt Number 8801 MUNICIPALITY OF ANCFIORAGE DEPARTMFNT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 0 NAA# 1. GENERAL INFORMATION Completelegaldescription ~OT 17, /~/~-I~ .~u~,1.,¢-~-~- I-~¢'/,/~ ~,¢/4¢-/- _ Location (site address or directions) Property owner L~.~t.~ Day phone Mailingaddress 0~.0 5' ~.~. b;~.~t~.~.t~¢,(] ~:L i~,L(' Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If.community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) F¢onl MOA ~21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply ahd/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ ~ Phone Address r~/2 ~ " ~ .~ Engineei~ signature ~ ~.t.-~ Date DHHS~SIGNATURE Approved for --~---,~ E~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. of Anchorage ~ ~ C Municipality DEPARTMENT OF HEALTH & HUMAN SERVICES MAR 26 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · ~N¥IRONM~NTAL SERVICES Health Authority Approval Checldist Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (WN) .~L]I',I$'t~T gL I,LS_ Parcel I.D.: O/~'--.,~..,0'~-- I"~ If A, B, or c, attach ADEC letter, AI::)EC water system number Casing height (above ground) Wires eroperly protected (Y/N) Date completed Cased to !(PI Date of test Static water level Well prodgction FROM WELL LOG AT INSPECTION ./- I lo 7 g.p.m WATER SAMPLE RESULTS: Coliform ~ t~ Date of sample:_ ('&/'~ / q ~ ! % B. SEPTIC/HOLDI.NG TANK DATA Date installed 'PI~,OI ~ [ Tank size · Foundation cleanout (Y/N) _ Date of Pumping C. ABSORPTION FIELD DATA Date installed Length I ~,~ Width Effective absorption area J_O ~0 Date of adequacy test ~. Nitrate ~'t I-~ Other bacteria 3,//~,/¢,q Collected by: '"~"'.~ ~ / ¢Y-.~.) Number of Compartments ~. Cleanouts (Y/N) Depression (Y/N) 'J~ High water alarm (Y/N) 'h'~ Fluid depth in absorption field before test (in.); # Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Y Soil rating (g.p.d./ft2 or fF/bdrm) ¢~O System type ' ¢~ Gravel thickness below pipe /7/ ~ Total depth 7~/O / Monitoring Tube present (Y/N) "/ Depression over field (Y/N) Results (Pass/Fail)_ ? For '~ .bedrooms "t "~¢ Immediately after ~¢2-/.2gal. water addeo (in.): Absorption rate = ~ Z//O~(~) g.p.d. If yes, give date 72-926 (Rev. 3/96)* D, LIFT STATION Date installed 1-1/A . Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I ~ '- Absorption field on lot J 0'0 .I- Public sewer main h'C/A Sewer/septic service line ~ ¢)--,~ ~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HGLD:.%'C TAF,H~ ON LOT TO: ' / Absorption field Foundation ~/¢ Property line JO ' ~ Water main/service line ?~.~ ~ Surface water/drainage f'~ I ¢_.2 Wells on adjacent lots I0 I SEPA',RATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: I ~ 0 Building foundation ~ 7 Water main/service line Property line Surface water Curtain drain F. BNGINEER'S CERTIFICATION ¢ ~';~' r,, ,~/8~ I certify that I have determined thru field inspections and review of Municipal rec, o~;ifiat tl~ bbO~ $~te,(ns are in conformance with MOA HAA guidelines in effect on this date. ~ ' '¢: .! ;: "; ",' ' Driveway, parking/vehicle storage area 10 ~ Wells on adjacent lots ~) '7~ ./b~.~. Engineer s Name Date HAA Fee $ ~ <¢ d2 . ../2 Date of Payment ~_3S --' Receipt Number O /-~FZ/~./ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE DEPARTMFN r OF HEALTH AND ENVIRONMENTAL PR~. i ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 ~~,~L Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~ ~O~ ~ Telephone: Home ~-7/~O Business Applicant Address . J ~ ~O I ~~ Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution C~ ,b~_~_~.-,( ¢¢ .~-_~.1~ Address __Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms __ Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If corn m unity well system, must have written confirmation from the State Department o! Environ mental Conservation attesting to the legality and status, SEWAGE DISPOSAL Onsite/[~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 ol 2 72.025(11/84) ENGINEERING FIRM PROVIDII* NSPECTIONS, TESTS, FILE SEARCH, Dl AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, [ verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, fonctional 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 suppJy and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect o~ the date of this inspection. Address ~ ~ ~ l~ Engineer's Seal DHEP APPROVAL Ap pr:ov4~,4er-- '/~j~ '~'~ ~- Approved bedrooms by /~/~¢"~'"" "~)' '~//"~"~'~"' Disapproved Conditional Terms of Conditional Approval CAUTION The MuncipalJty 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 72~025 (11/84) MUNICIPALITY OF ANCHORAGE DEPT, OF ItEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) 2 '11986 HEALTH AUTHORITY APPROVAL [HAA) CHECKLIST - FEBRUARY 1984 264-4720 L~I DescriDnon: J.~O~" t"~ ~_~. J~ RECEIVED WELL DATA Well Classification "~ ~.,~. Il A, B. C, D,E.C. Approvea (Y/N) Well Log Present (Y/N) _ 7 Date Completed ~'/~ ~'~ Yield Total Depth _ J~:~ J Cased Static Water Level ~'~ ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot _ J % (~ To Nearest Public Sewer Line ~ ~_'~[ ~ Cleanout/Manbols Water Sample Collected by Water Sample Test Results Comments Depth of Grouting N O Pump Set At Sanitary Seal on Casing (Y/N) Deeression Around Wellhead On Adjoining LOtS On Adjoining Lots To Nearest Public Sewel To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed NO ~ ~ t Standpipes (Y/N) _T'~'~ Depression over Tank (Y/N) ~ Pumping/Maintenance Contract on File [Y/NJ Holding Tank High-Water Alarm (Y/N) ~'A Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~ To Property Line .~ I~ To Water Main/Service Line Size J (~"~'~"~ No. of Compartments T'~'~ ~'~ Air-tight Caps (Y/N) _~'" Foundation Cleanout (Y/N) Date Lest Pumped /Z,~3 ;for Temporary Holding Tank Permit (Y/N) . To Building Foundation To DJsposa Field Course To Stream, Pond LaKe. or Major Drainage Comments Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ ~ ~ To Building Foundation ~,,'"7 Lot To W~ter Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field Depth of Field ~, Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ! O To Existing or Abandoned System on ; On Adjoining Lots ~:~ ~ 1~ To Cutbank (if present) 1~10 N ~ To Driveway, Parking Area, or Vehicle Storage Area Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verifie~, or conformed to al! I'j,40~, and HAA guidelines in effect on the date of this inspection. Signed ~~ Date/1///~/~///~ Company MOA No. Receipt No. "~'~ Date of Payment /,~ Amount: $ ~¢ ~-'o ~ Page 2 of 2 72-026 (11/84) Engineer's Seal Inspector Time Date Condltlona Approval e Date Soils Rating Permit No, We To Abeorat[on Area Well to Tank Septic Tank Size / ~,dO CD Holding Tank Size Well Log Received APPLICANT FILI.S OUT LOWER HALF ONLY Property Owner Mailing Address IPhone 77- Buyer ," /-,. /: >f~ /~.,,~., Address ~' G s' J /'- ~-/.? /-//// Lending Institution Address Realty Co. & Agent Address Phone Phone Legal Description z. ~. ¢' / .~ ¢'¢;~- / J ~..¢ r..:' / //- ¢//J- /.-c-'¢--// Street Location / /¢ .2 ¢.~ ~- /" '" - ~ <_ ~ ~r /?,'. ~' ~ Type of Residence ~ Single Family ~ [~ Multiple Family ~o, of Bedrooms (~ Other Wator Supply ~'~ Individual [~ Community Sewage Dl.,~posal /~ Individual © Public Utility [~ Holding_Tank ATTACH WELL LOG, A well og is required for al wells erilled since June 1975, For wells drilled prior to that date. give well denth (attach log ~¢ available Year Individual Installed: When Connected to Public Utility NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.