HomeMy WebLinkAboutT12N R3W SEC 27 LT 25AT12N, R3W,
Section 27
Lot 25A
#018-092-65
Municipality of Anchorage Page 1
DEPARTMENT OF HEALTH AND HUMAN SERyICES
ENVIRONMENTAL SERVICES DIVISION I
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 543-4744
On-Site Wastewater Disposal System and/or Well Ir~spection Report
I
Permit Number:. SW000418 PlO Number:, I 018--092--65
Name:GLENN ADAMS Wastewater System: J r-I New · Upgrade
133790 DAVIS ROAD ANCHORAGE, AK 99516 ABSORPTION FIELD
Ph°ne:(907~ / 3348-0445 3 E1 Deep Trench El Shallow Trench · Bed · Mound El 0that
LEGAL DESCRIPTION '~ "~: 0.7 ~1 ~ *0.92 - 33.12
25A (-)0.38 TO (-I-)1.82 n. 0.52
Townahip: 12N Range: 33W SecUon: 27 m ~ m ..~,,~ e',,~: J O.,,,e ~
1.9 - 4.1 rL 433.5
WELL: [] New [] 15 ~ 3 - 5
~t ~ 652.5 s~3. n. kSTM D 3034/ F-810/SCH 40
~. OWNER INSTALL J 10/10/00-10/13/00
SEPARATION DISTANCES Els, p,= El Holding ~,,,,,'~'S.T.E.P.
:rom Tank geld StaUon Tank Se~e*' ~ ' ~.~.~ I
Well 100'+ 100'+ 100'+ - 25'+
1aa'+ lOO'+ 1aa'+ - - LIFT STATION
Surface
Foundation 5'+ 10'+ 5'+ -- -
Dmln NONE KNOW
Remark=: e2.2' OF' U.O~. APPROVED SAND FILTER ADDED. BENCHMARK
TOP OF MANHOLE LID ON LIF'I' STATION.
I
I 1oo.oo
Inspections performed by: AWWC, INC. Dates: 1st lO/lO/2OOO ~'~cO.."~4~[/dll ~.
2nd lO/11/2ooo }.~/j~
Department of Health and Human Services. approval 'q~.l'..L:.~
P..~NU.B.~ AS BUILT DRAWING P~,O NU.B.:
SWO00418 ~ 018-092-65
/ \
/
/
/
DV 156.5 90.8 ~ ..... ~4 '...
C03 161.9 114,9
LOT
25;
AS-BUILT OF SEPTIC $YSIEM UPORADE '~%~
...... K.D.W,
GLEN ADAMS (907) 337-8380 3 OF 3 ~ ~:~ 'ness: ,
PROFILE AS-BUILT OF SEPTIC SYSTEM UPGRADE. '~A~
MUNICIPAUTY OF ANCHORAGE
Department of Health and Human Sen/ices
On-Site Sen/ices Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON.SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 04, 2000
Expiration Date: Oct 04, 2001
Permit Number: SW000418
Legal Description: T12N R3W SEC 27 LT 25A
Design Engineer:. 0041 AK Water & Wastewater Consulta
Owner Name: GLEN ADAMS
Owner Address: 13790 DAVIS
ANCHORAGE, AK 99516-
Parcel ID: 018-092-65
Site Address: 013790 DAVIS ST
Lot Size: 49487 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for Ihe construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either:. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date:
CONSULTANTS, INC.
September 12, 2000
Municipality of Ahchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Well and Septic Design for Lot 25, Section 27, TI2N, R3W
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The existing
drainfield is in a state of failure and needs to be replaced. A test hole was excavated on the
property. The proposed septic system will be designed around the 30 foot radius. We are
proposing that the existing 1000 gallon septic tank and the acreage systems lift station be
inspected for integrity and replaced if necessary, and a bed type drainfield be installed.
Comments regarding the proposed design are summarized as follows:
1. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and
the percolation test results. It is our opinion that due to the overall appearance of the soils, an
application rate of 0.7 gallons/day/ft2 should be used.
2. TRENCII DESIGN:
a. Percolation Rate: 1.0 minutes/inch
b. Allowable Application Rate: 0.7 gallor;s/day/ft2 (sand filter)
c. NumberofBedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 643 ft2
f. Total Depth: 3 feet (max.)
g. Effective Depth: 0.5 feet
h. Width: 15 feet
i. Sand Filter: 2.0 feet
j. Minimum Length: 43 feet long
k. Effective absorption area = 645 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 33%6179 * Fax: (907) 338-3246 * Website: akwwc.com
4. TOPOGRAPIIY: The average topography of this property is a 5 to 10 percent running from
approximately north to south; in short, there are no slope concerns.
I am unaxvare of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you
for your assistance.
Jeff :y~A4 amess, P.E., M.S.
Pre:
debt
NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 335-3246 * Website: akwwc.com
t LOT 17 LOT 16 LOT 15
SEC 27, T12N, RSW SEC 27, TI2N. RSW SEC 27, T12N,
NO CONC~NS I ~ NO CONCERNS
I t
I I
t I
SEC 27, T12N, RSW I
9/12/2000
GLENN ADAMS (907) 557-8~-80 1 OF
SITE P~N FOR PROPOSED SEPTIC SYSTEM UPGRADE
/
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/ \
\ , I I/ ,.'.".-:'"".".... \
/ I -.:.,.....
[XIS'T1NO .'. ' '.
- 3 .~.oo. ---1 ":.'""~. '.
HOUSr .......
( BVD DETAIL ~ [ -'-....... . /
~ [.;,,.'.;,.-;" ~ l[XIS11NO 1000 G~ON
S~I~C TANK TO BE I~SP£CT~D
~ . '. :",', ,' "' · ""; FOR STRUCI~JRAL INT~CRI1Y
\ R:..,..'.:,..~': /
~ i I'.:" ..: ./:=:.
~-. ..... ~ r~ :.,~
/ ~1 '~ ..'-,
~VA~ A BED ~T ~ 3 ~ ~ ..~ ~
OF MO~ ~PR~D ~D ~L~ / ' '.
~D ~ 0.5 ~ OF ~, / ..:: . OROUNDWA~R AT
W~H~ S~ D~NR~K. ~[ / .~.: ON 7/20/92
Di~IB~ON UNE ~ TO BE 1-1/4 / ,~. , H~W
INCH SCH. ~ ~ ~ 3/~6 ~CH / .. ~
3 ~ ON C~. / F'~ '~'
/
USED ~ A R~E~ ~
~Tg: ~,
9/12/2000
~,~.~..~.~.~,~.,~. 1" = 40'
GLEN ADAMS (907) 337-8380 2 OF 3 ~.
LOT 25; SECTION 27. T12N. RSW ~r'.
DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE
~ / ~ fi.ow c~f~g]ou sYs'~:
~ ~ 7 / V~S FOR REGU~ON
~Z ~ OF ~ TO ~E R~
ORiCI~ C~E~ ~ MONITORING TUBE~
MO~IORING TUBE R~L
~OM Ll~
~D ~L~R~ W~HED S~ER D~NROCK
~ ~E DI~I.~ON UNE IS TO BE
. 1.25 INCH D~ER SCH. 40 ~C
WATER & ASTE ATER
, GONSU~TANT$, lNG ....
GLEN ADAMS (907) 557-8580
PROFILE P~N ~OR SEPTIC SYSTEM UPGRADE. '~A~
6901 O[BARR ROAD, SUITE 29 · ANCHORN;E. AK. 99504
I SOIL LOG - PERCO~TION TEST I
LEGAL DESCRIPTION: T12N, R3W. SEC 27, LOT 25
PERFORMED FOR: G~NN ~AMS ¥~. [.%. ,~y: ........... ?..-.~
DATE PERFORMED: 9/7/2000
feet)
ML I IF ATI N //
. ~ /
....... ~ I
SP CH ~ I ~.g; /
DEPTH TO DATE
OW 3ROUNDWATER
6.0' 9/8/2000
s.7~' g/~/2ooo
10
11 DATE RE.lNG CLOCK NET TIME WATER LEVEL NET DROP
TI~E (~IN~ES) READING (INCHES)
2 5:40 10 O" 10"
4 5:50 10 O" 10"
14 5 5:50 - 10" -
6 6:00 10 O" 10"
15 7 6:00 - 10" -
16 8 6:10 10 O" 10"
9 6:10 - 10' -
17 10 6:20 10 O" 10"
18 12 6:50 10 O" 10"
19 PERCO~TION ~TE 1.0 (MIN./INCH) PERC. HOLE DIA.. 6" (INCHES)
2
TEST R~ BETWEEN, 2.2~ FT.~ID 2.75 FT.
COMMENTS: /x ~//
PERFORMED BY A~ WATER · W~ATER I. _ , CERTI~ T~T
THIS .W~ PERFpRMEg IN AOCORO~CE Wire A~ ' ~ ~IPAL GUIDELINES IN EFFECT ON THIS
DEPTH TO DATE
3ROUNDWATER
8.0' 9/7/2000
6.0' 9/8/2000
6.75' 9/15/2000
Friday, September 29, 2000
Municipality of Anchorage
Depam'nent of Heahh and Human &~v,'ices
Division of 'EnvironmenO Sen'ices
On-Site Sen'ices Section
P.O. Box 196650
Anchora~. Alaska 99519-6650
Ret: $cpnc upgrade tot Lot 25. Section 27, TI2N. R3¥C
To whom it may concern
RECEIVED
OCT 04 20C0
Municipality el Anchor~
Dept. Health & Human E. evv~
I. Glen Adams- homcmvner of above mentioned properr),, pyro to install the upgrades to our
septic system designed for us by Alaska Water and Waste~ater Consultants. Inc.
hi3' experience is as t'ollmvs:
-I leaD, equipment' operator and mechanic in fl~e Operating Eng/neers since 1975 (dozers,
grater,s, loaders, backhoes, tm&s, etc.)
-Designed and installed sepdc system to code for home in Talkeema.
-Assisted Mincher En~,'~fises' i~~''--: .....
IXar'ks Highway. ---j- urea.un on rms~ t>ea system for Big Su Lodge mi 105
-I have done all plumbing in the construction ofm'o o£our homes.
I am confident that with the plan and advice of Alaska Water and Wastexvater Consultants. I
will be able m construct this nexv drainfield to the saE~thcfion of thc M.O.~L
Sincerely.
Gk-n Ad.nns
13,'790 Davis St.
Anchorage. Ak. 99516
Municipality of Anchorage Page I o!
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On=Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'¢d ~"~..C~";~ PID Number:
Nmne~~O~ N[ I~ Wastewater System: ~ New ~Upgrade
Address:
~%~o p~ ~mj~~q~¢ ABSORPTION FIELD
I No of Bedrooms
Phone ~¢~ . ~ UaeepTronch ~ Shallow Trench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION soi,~,i,~ ,g o,~sq
Lot ~ Block Subdivision Depth to pipe bottom Imm original grade Gravel depth beneath pipe
Township I Ran~ ~ I Se6~ Fill added above orJgh~l grade: Gravel length
WELL: Q New ~ Upgrade Gravolwidth: Z~ Fl ~I ~ Ft
GPM Pump Set at Ft~~ Ft TANK
SEPARATION DISTANCES ~Septic U Holding 'S.T.EP
W~tor ~o~ .... LIFT STATION
kot
Foundation ~3 q L qO 'Pumpon"levela,:¢~,~
Gu Drain rtai, ~ ' ' ~o,0,urq I Electrical, ~O* .- ~6 nspections ~ performed~:
Remarks: BENCH MARK
Inspoctions performed by: ~ ~,' Dates: ~st ~
2nd lO/~[~ :. ~,_x . ... .
,/,¢
Department of Health an Humg~rwces approval
Revlewedand a,provod~ 7~4 ~-- Dar
b
72 013 (Rev 9/91 ) MOA 25
Permit No. ~> L~' ~'Z-O 'Z..~'~ Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · TeLephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
L( ~al Description:
PID No.:
ROAD EASE!
EAL
72 013 A (Rev 9/91} MOA 25
Permit No. ~/
Page ~ of '~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: '~l"t ~OI t?--'~ vJJ %~E_ '~-j/~'F 7. _%-
~ ~PID N~'
o~ e~ ~ I IBUSE
o I ~'-r~q
BREAK LINE
10
20
30
4O
50
6O
70
BREAK LINE
72 013 A (Re¥ 9/91) MOA 25
INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
INSPECTIONS (907) 563~3464 ~ II'FORMATION (907) 786-8211
LOT ~BLOOK / S UBDIV. ~~ /DATE~
FOOTING [] ELEC. TEMP. [] PLBG. UNDGR. []
FOUNDATION [] ELEC. SERVICE __ [] PLBG. ROUGH __ []
BOND BEAM [] ELEC. ROUGH __.~--~ GAS TEMP. []
FRAMING [] ELEC. FINAL. [] GAS []
INSULATION [] OTHER [] MECHANICAL __ []
SHEETROCK __ [] MECH. FINAL []
STRUCT. FINAL __ [] FIRE FINAL [] PLBG. FINAL __ []
OTHER [] ZONING [] OTHER []
O NONCOMPLIANCE OBSERVED [] CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
[] WILL REEXAMINE AT NEXT INSPECTION [] DO NOT CONCEAL UNTIL REJ,NSPEC.~TBD.
COMMENTS ....
/~ iNSPECTOR DATE
~HENCORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION
DO NOT REMOVE THIS NOTICE
84-002 (Rev. 11/87)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW920257
DESIGN ENGINEER:MOUNTAIN ENGINEERING
OWNER NAME:NIESEN LENORA H
OWNER ADDRESS:13790 DAVIS ST
ANCHORAGE, ALASKA 99516
(UPGRADE) PERMIT ~3~
DATE ISSUED: 9/01/92
EXPIRATION DATE: 9/01/93
PARCEL ID:01809220
LEGAL DESCRIPTION: T12N R3W SEC 27 LT 25
LOT SIZE: 54450 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST 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 (18AACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS OFFICE MUST APPROVE ANY DOSING SIPHON TO BE USED ON THE
PROPOSED SYST~EM~ ~f_p~ TO ITS' INSTALLATION.
RECEIVED BY:._ ~/~ "~
DATE:
DATE:
MOUNTAIN ENGINEERING
3868 Shannon Circle
Anchorage, Alaska 99508
(907) 562~1500
August 20, 1992
Municipality of Anchorage
On-Site Services
P.O. Box 19-16506
Anchorage, AK 99519
Dear Sirs:
Re: T12 N, R 3 W, Section 27, Lot 25
Owner- Mr. Greg Niesen
RECEIVED
AUG :J 1 199
Municipality of Anchorage
Dept. Health & Human Services
The purpose of this letter is to provide the required design
narrative in support of our application for a permit to upgrade
the septic system on the above referenced lot. Attached for your
reference are the soils log, percolation test results, a land
surveyor's site plan, and d~sign drawings.
The existing crib on the lot has failed, and is overflowing
sewage on the surface. We performed a soils log and percolation
test at the location indicated on the design drawing. The
resultant percolation rate was 2 min/inch. Groundwater rose to
3.5 FT from 'the existing grade during the groundwater monitoring
period. Design was therefore limited to a mound, and the
application rate was .8 GPD/SF. The house has 3 bedrooms, and
the required absorption area is 3 X 150 / .8 563 SF. We have
elected to use a bed size of 20 FT X 30 FT. There will be a
leveling-course of sand, which will raise the bottom of the bed
to 1FT above the existing grade.
The topography of the lot in the vicinity of the proposed bed
slopes towards the south at 3% to 5%. The only water well within
200 FT of the proposed system ls on this lot, and is outside of
the 100 FT radius.
Please contact me at 562-1500 if you will need any additional
information.
~G
Mark Pearson, P.E.
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~[-I'~,-~ I
(,,.
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
1
2
3-
4
5
Township, Range, Section: 1-1"/~./'J/
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT
DEPTH? ~- p
E
Depth to Waler Alt, r..~. ~.~_t
Moflilorino~ ~ Oale:
SITE PLAN
Gross Net Depth to Net
Reading Date
Time Time Water Drop
!
PERCOLATION RATE ~'~ (minutes/inch} PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND ~ FT
PERFORMED BY: I~J~L/C"J~'~ '~"¢~ I ~N'~'""~-'J¢- p~.,~,c~L.~,~.-~ CERTIFY THAT THIS TEST WAS PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
her
h"L-
h"L
t,'2.
l,O
ho
~.,o
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-6S0, Anchorage, Alaska 99602 ')76-2221
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
8
9
10
11
12
13
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
0t: ~OLV?EPT~?
DATE PERFORMED:
SLOPE SITE PLAN
14
15
16-
17-
18-
19-
20
COMMENTS
1
PERFORMED BY:
Gross Net Depth to Net
Reading Date Time Time Water Drop
,,~ ~: AL ~
,.7,,~'.~ ,.,~/~.."f '.:,
PERCOLATION
TEST RU BETWEEh
(minutes/inch)
DATE:
72.008 (7/76)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6,650, Anchorage, Alaska 99502 276-222'~
SOILS LOG - PERCOLATION TEST
"~ SOILS LOG
[] PERCOLATION
TEST
DATE PERFORMED:
SLOPE SITE PLAN
10-
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER /~, ~.~ S i
ENCOUNTERED? L
O
E
IF YES, AT WHAT , , ,
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
T ST RUN 13ETW~EN FT AND FT
PE"FO"MED BY: /' &6~'~6~¢L( - CERTiFiED BY: DATE:
72 008 (7~76)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
.: 47'00. B ,r, aga~,S,t,r~t
p.o. Box"';~ 96~)
Anchorage, AK 99519-6650
www.muni.org/onsite ~ .._~'~
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEIV1S APPROVAL"
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 018-092-65
1. GENERAL INFORMATION
COSA#
Expiration Date: /- ,~. "~ / /
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
T12N, R3W, SECTION 27; LOT 25A
4455 E 158TH AVE * ANCHORAGE, AK * 99516
ALISA GILBERT
4455 E 138TH AVE *
Day phone
ANCHORAGE~ AK * 99516
Day phone
351-4641
MIKE MULNEAUX W/ REAL ESTATE BROKERS OF AK Day phone 297-2912
3300 C STREET~ #200 * ANCHORAGE~ AK * 9950,3
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
.I
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 samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As ce~ified by my seal affixed hereto and as of the validation date shown below, I '~ri,~? t,Sat my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or.wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained'from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 557-6179
Address 570'1 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
o
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system°
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do 'not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
A,ta,.hments: COSA Checklist
Septic System Advisory
Well Flow Advisory
1/05)
Arsenic Advisory.
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building .Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
Legal Description:
T12N, .R3W, SECTION 27; LOT 25A
Parcel ID: O
WELL DATA
Well type PRIVATE
Date completed ~1961
Total depth '152+ ft.
*PER GEG INSPECTION. **PER AAROW PUMP AND WELL INSPECTION. SEE ATTACHED.
If A, B, or C provide PWSID# N/A Well Log (Y/N) NO
Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Cased to **45'+'ft. Casing height (above ground) 12+
in.
Date of test
Static water level
Well production
FROM WELL LOG AT INSPECTION
NO WELL LOG I 10/15/2010
Jif. 129 ft.
J g.p.m. 5.73 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/lO0 mi.
Arsenic: ND ug./L.
Nitrate O. 157 mg./L. Other bacteria __
Date of sample:l 0/13/2010 Collected by:
0 colonies/lO0 mi.
GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
SEPTIC/STEEL
Date installed
1000 gal.
Tank size__
Foundation clean°ut (Y/N) YES
Date of pumping 5/1,3/1 0
ABSORPTION ,FIEL:D DATA
9/3.0-10/2/92
Date inst~alled 10/10,13/00
,31
Length 4,3.5 ff.
10/2/1992
Number of Compartments 2 Cleanouts (Y/N) YES
Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Pumper SANITARY PUMPERS ,~ ~¢ ~ ~f,~-o.r..~<,d
1*BELOW EXISTING GRADEI
0.8 BED
Soil rating (g.p.d./ft2o~ 0.7 System type BED
0.5
Width 15 ft. Gravel below pipe 0.52
. *4 682
Total depth '2.9-3.5ft. Eft; absorption area 652.5 ft2 Monitoring tube YES
Date of adequacy test *'10/15/2010
Depression over field NO
Results(paSs/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in.
Elapsed Time: - min. Final fluid depth 0
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
**2000
Water added 480 gal. New depth 0 in.
in. Absorption rate >= 450+ g.p.d.
NONE KNOWN If yes, give date -
DRAINFIELD WAS PRESOAKED & TESTED. DRAINFIELD WAS PRE-SOAKED WITH 1560 GALLONS PRIOR
TO TEST. PRE-SOAK APPROVED BY JEFF POET 10/15/10.
NOTE: 1992 BED CONNECTED AS RESERVE SITE. CURRENTLY NOT IN USE AND DRY.
D~ LIFT STATION
Date installed 10/2/1992
"Pump on" level at 89.3'
*SOUTH BASEMENT
Datum DOOR THRESHOLD
*ELEVATION = 100.00
Size in gallons 150
"Pump off" level at 88.3'
Cycles tested 3
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
YES
Septic tank/lift station .on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
100'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
91.7 in.
YES
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line. 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
N/A
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
COMMENTS
*PER PREVIOUS H.A.A.
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Absorption field *5'+
Surface water. 100'+
10'+
Water main N/A
Driveway, parking/vehicle storage
100'+
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 COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
COSA Fee $ ~ ~ O
Date of Payment (o/7.:z/zolo
Receipt Number O~'~/Z-~ 7_
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS Ref.# 1105531001
Client Name Garness Engineering Group~ Ltd Printed Date/Time 10/20/2010 10:07
Project Name/# T12N R3W Sec27 Lot25 Collected Date/Time 10/13/2010 12:00
Client Sample ID T12N R3W Sec27 Lot25 Received Date/Time 10/13/2010 12:40
Matrix Drinking Water Technical Director Stephen C. Ede
Saml~le Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Hardness as CaCO3 101 5.00 mg/L SM20 2340B C
10/15/10 10/18/10 KDC
Waters Department
TotalNitrate/Nitrite-N 0.157 0.100 mg/L SM20 4500NO3-F B 10/13/10 AYC
Microbiology Laboratory
E. Coli
Total Coliform
Negative I 100mL SM20 9223B A 10/13/10 DLC
Negative 1 100mL SM20 9223B A 10/13/10 DLC
Private Individual Analysis
Alkalinity 104 10.0 mg/L SM20 2320B D 10/14/10 LP
Aluminum ND 20.0 ug/L EP200.8 C 10/15/10 10/18/10 KDC
Antimony ND 1.00 ug/L EP200.8 C (<6) 10/15/10 10/18/10 KDC
Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/15/10 10/18/10 KDC
Barium 5.80 3.00 ug/L EP200.8 C (<2000) 10/15/10 10/18/10 KDC
Cadmium ND 0.500 ug/L EP200.8 C (<5) 10/15/10 10/18/10 KDC
Calcium 26300 500 ug/L EP200.8 C 10/15/10 10/18/10 KDC
Chloride 4.39 0.100 rog/L, EPA300.0 D (<250) 10/14/10 10/16/10 SDP
Chromium ND 2.00 ug/L EP200.8 C (<100) 10/15/10 10/18/10 KDC
CO3 Alkalinity ND I0.0 mg/L SM20 2320B D 10/14/10 LP
Conductivity 224 1.00 umhos/cm SM20 2510B D 10/14/10 LP
Copper 13~6 1.00 ug/L EP200.8 C (<1300) 10/15/10 10/18/10 KDC
Fluoride 0.134 0.100 mg/L EPA300.0 D (<2) 10/14/10 10/16/10 SDP
HCO3 Alkalinity 104 10.0 mg/L SM20 2320B D 10/I 4/10 LP
Iron 743 * 250 ug/L EP200.8 C (<300) 10/15/10 10/18/10 KDC
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
4455 E. 138th
Well inspected by camera down to 45'. No perforations noted.
Brian R. Wille
Aarow Pump & Well Service
Pierce Blewett
From: Sonja Blewett
Sent: Friday, October :22, :2010 2:10 PM
To: Pierce Blewett
Subject: FW: 138th Septic
From: Mike Mulneaux [mailto:rebrokersak@gmail.com]
Sent: Friday, October 22, 2010 1:57 PM
To: roybriley@gmail.com
Cc: Sonja Blewett
Subject: 138th Septic
I talked w/Alisa. She said the guy that came out originally did not understand the system. So they pumped it and said he would
come back to check it in 3 weeks. When he came back out 3 weeks later, he said everything was fine and recanted what he had
originally said. Alisa is going to get the second invoice from Denali Sewer and Drain and also see if they will write a quick letter
stating 'that the error was on Denali Sewer and Drain's end.
Thank you,
Mike Mulneaux
Real Estate Brokers of Alaska
Contract Manager
Licensee
3300 C St. Anchorage, Ak 99503
(907) 297-2912 Office
(907) 297-2910 Fax
rebrokersak@g mail.com
~i~ }'lease consider the environment before printing this e-mail
CONFIDENTIALITY NOTICE ~ This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential. If
you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that
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saving them in any manner. Thank you.
10/22/2010
1~10/20/2010
05:54
Bill To
Eliza Gilbert
4455 E. 13gthAve
Anchorage, AK 99516
9073339776
Denali Sewer & Drain
Dermli Sewer & Dra/n Service
POBox 141811
Anchorage, AK 99514-1811
Bus.(907) 333-5794
Fax (907) 333-9776
0001/0002
Invoice
I
Date Invoice #
5/13/2010 00538
Item
Vac Truck
P.O. No.
1 pump septic
Credit Card
Description
Rep
Project
Service Date
***Ground water flowing into 2nd tank...Pumped
1000+ gaIlons...return I week to m-pump and
evaluate
**Pd CC#2486
/
Qty
Rate
1 155.00
5/13/2010
Amount
155.00
Total
$155.00
Please note our mailing address has
changed. Please update your records.
Payments/Credits $-155.oo
Balance Due ,o.0o
iU/>'2/ZU.LU 10:57 VA3~
Bill To
Eliza Gilbext
4455 E. 138th Ave
Anchorage, AK 99516
~U7~776
De~all ~ewer & Drain
Deaali Sewer & Drain Service
PO Box 141811
Anchorage, AK 99514-1811
Bus.(907) 333-5794
Fax (907) 333-9776
denalisewerdrain~~
www. denalise~k~m
~ 0OOl/OOOl
Invoice
Date Invoice #
5/24/2010 01108
P.O. No. Terms Rep Project Service Date
Credit Card Joe 5/21/2010
Item Description Oty Rate Amount
Vac Truck 1 pump septic 1 .155.00 155.00
***Found no problems with tauk this trip...tank in
good shape
***Pd CCg3007
Total $155.o0
Payments/Credits $-155.00
[ Please note our ma{llng address has1 Balance Due $o.oo
changed. Please update your records.
10,."/i, :?.01t,} 15; 23 .q075615625 L~NTECH, ]:NC, PAGE 02102
LOT t7
LOT lB
LOT 15
LOT 24.
5B'9~
89'53'21" W 165,04'
10' T ~ E EASEMENTI
Stable
56.4
Well
Exletlng
:o
LOT 26
LOT 2.5A
Shed
50" Piaetic
22' Dia.
Pipe & ®
Lid
L~lr~ O~¢rip tT~:
EAST
N 89'51'54" E
165.05'
158TH AVENUE
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT
PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH.
AS-BUILT
BLM Lot 25A, Section 27,
T12N, R3W, Sewmrd Meridion,
~ 2938
nee 2000~L-584
AK
~RVE? CERTI.FICATION: LANT~CH baa condueimd ~ phy~t=al ~,,rve¥ of the
. ~ ~Y ~a. ~nt~, rea~¢[l~ or rlght-of-wuy
~S ~ am net appear on ~e ~ed aub~ion plaL Under
~ ~nc~_~ul~ ~y data h~n be
Oat= October 21, 2010 ~n B~ PL
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
w,~vw.ct.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Pamel I.D.
018-O92-65 HAA~
t. GENERAL INFORMATION
Expiration Date: ~'-/-~- ¢3 !
Complete legal description T12N,
~ [.ocatlon (site address or directions)
· Currant Property owner(s)
*'* ,', Mailing a~dres~" ~':
' Lendingagency - ,
-..~. ' Mailing address*
Real Estate Agent
,. :' Mailing'address'
RSW, SECTION 27; LOT 25A
15790 DAVIS ROAD ANCHORACE~ AK. ~9516"
. :GLENN ADAMS -. Day phone. (907) .348-0445
'15790 DAVIS ROAD ANCHOEACE~ AK..'99505 ......
· ' ' "* "' *" ' '~'* Day phone *
AINSL[E PHILLIPS w/PRUDENTIAL JACK WHIYE Day I~hone
4241 "B' STREET ANCI4ORACE AK ·99505
Unless otherwise requested, HAA will be held by DSD for pickup.
·
[]
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual ~n-site - ·
Individual Holding tank El
Community On-site
Public Sewer []
2. - NUMBER OF BEDROOMS:
3. TYPE OF WATER sUPPLY:
". IndividuAl Well ......
Individual Water Storage
· Community Class Well
Public Water System
3
(907) 562-6464
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. Certficates of Health Authority Approval are required for the transfer
of title (except between spouses) for propertes served by a single family on-site wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certficates of Health Authority
Approval are valid for 90 days from the date of issue for propertes served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certtificates may be reissued for a period of
up to one year with valid water samples.) Certficates ara 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.
Note: Alaska Water and Wastswater Consultants, In~ shall be paid $250.00 al or pdor I
to closing for the engineeflng services provided.
I
4. STATEMENT OF INSPECTION BY ENGINEER
As certifled by my seal affixed hereto andas of the validatfon date shown below, I vetffy that my
Inves6gatton, based on procedures outlined In the Health Authorily Approval Guidelines for this application,
shows that the on-site water supply and/or wastswater disposal system Is(are) safe, funcflonal and adequate
for the number of bedrooms and type of sbt~ture Indicated beraln. I furthor t~rify that besed on the
· Infermaffon obtained from the Munlclpali~y of Anchorage fries and from my Investigation and Inspecffon, the
on-site water supply and/or wastewater disposal system Is(are) In compl~lce with all applicable Municipal
and State codes, ordinances, and regulaUons In effect at the grne of Installation.
NameofFlrm . ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 357-6179
Address '~ 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. C.,ARNESS, P.E.
Engineer's 'Comments:
DSD Guldellnes & Re~Jlaffc~r~. The mported msu~ __ __~. lhe perfon~ance of the
5. DSD SIGNATURE
.f
,~';.- .....,.".9',4~ ..
Approved for.CJ' bedrooms. · . . . .~.' ·
E~ · ON-SiTE ,
Disapproved. ~-' WATERAND
Co' · :' ' [ :. WASTEWATER:
nd~tional approval for bedrooms, with ~e fllowtng stipulaflor~s: ., .D~nc.r~AM :
.. .. ....... ..~ '.. . ..'
.....
.
Attachments:
HAA Checldist L,~ Manltenance Agreements'
· Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other.
..~(~//' ~ Orlginal corUficat, Date:
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewster Pmgram
4700 8oulh Bragaw St.
P.O. Box 196850 AItc~, AX gg51g-6850
Legal Description:
A. WEM. DATA
Well ~ p~VATe
Date completed
Totaldeplh .182 It.
HEALTH AUTHORITY APPROVAL CHECKLIST
T12N, RSW, SECTION 27; LOT 25A ParcoIID:
I,pE~ PREVIOUS HAAI
IfA, B, ore provMe PWSlD~ N/A Well Log (Y/N)
* 1961 ~anJtely seal (Y/N) YES Wires propedy I~ (Y/N).
Cased to *40 It. Casing belght (above ground)
FROM WELL LOG AT INSPECTION
,/- e/3~/2ooo
g.p.m. 4.43 g.p.m.
Date oftest
Static water level
Well produ~lm
WATER SAMPLE RESULTS:
018-092-65
,teof,,mpl,:
SEPTICAHOLDING TANK DATA
Tank Type~lWterlal SEPTIC/STEEL
Tmtk~tm 1000 gal. Number of Compmtmente 2
FoundaUondeanout~i_/~YES Depresalonovertenk(Y/N) NO
Date of pumping 1 g/30/2000 Pumper
ABSORPTION FIELD DATA ~
NO
40' I1~,
Date of adequacy test NEW Rl~tJlte (Pass/Fsi) ~
Fluid depl~ In absorp~ flald be~~__~_ ~ New deP~ __In:
Cmtion treatment (past 12 mo.) (Y/N & type) If y~s, glv~ date
LengUl 43.5 .It. Width 15
Toteldepth *2.e'+/-fl. Eff. absorplJonafla6S2.Slt" Molll~tube YES Depressh311overfleld NO
Date Instelled ~o/m/m-~o/~3/m Soil mUng ~ ~/bdnn) 0.7
System t~3e BED
Gmval below pipe 0.52
Date Installed 10/2/92
Cmanoute (Y/N). YES
High Water alarm (Y/N) N/A
ROTO ROOTER
Other becteda ~ calonles/lO0 mi.
AWWC~ INC.
D. UFT 6TATION
Date Installed 10/2/92
· Pump on' level at 89.3' in.
Size in gallons 150
'Pump off' level et88.3'in.
Datum SOUTH BASEMENT Cyclasteeted 3
E. SEPARATIOH DISTANCES
SEPARATION DISTANCEs FROM W;; I ON LOT TO:
Septic tank/lift stefion on lot, 100'+
Absoq31]on field on lot 100'+
Publio sewer main N/A
Sewer/eepUc een'lce line 25'+
Manhole/Access (Y/N) YES
High water alarm level et 91.7' in.
Meets alarm & circuit requirements? YES '
On adjacent lots. 100'+
On adjacent lots, 10o'-+
Public sewer rnanhole/cleenout
Holding tank 100'+
N/A
SEPARATION DISTANCES FROM $E~'I lC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water eendce line 10'+
Wella on adjacent Ints 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO.'
Property fine 10'+ Building foundation 10'+
Water eervlce line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
F. COMMENTS
I*pE PREMOUS HAAJ
At~orpfion field *§%
Surface water: 10o'+
Water main N/A
Driveway. perldng/vehlcle storage __
50'+
G. ENGINEER'S CERTIFICATION
I ce~Jfy that I have determined through field inspections end
review of Municipal records ~hat the above systems are In
cord~mmnce ~ MOA HAA guldeflnes in effect on this date.
F.n~lmfl INlntad ~ame
Date ~
JEFFRE~ A. GARNESS
Date of Payment
Receipt Number
300.00
11/27/00
Waiver Fee $
Date of Payment
Reeelpt Number
Parcel I.D. #
MUNICIpALITy OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DMsion of F_nvimnmental Services
On-Site Services Section
P.O. Box 196650 Anchorage. AJaska 99519-6650
(9o7) 343.4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
018-095-65
1. GENERALINFORMA~ON
Completelegaldescdpfion T12N-R3W. SEC~ON 27t LOT 25A
Location (site address or direcfions) 13790 DAVIS ROAD ANCHORAGE_ At( 99516
Property owner GLENN ADAMS
Mailing address 13790 DAVIS ROAD
Lending agency
Mailing address
ANCHORAGE. AK
Dayphone
99516
Day phone
~07) 348-0445
Agent
Address 4Z41 "B" STRE~-"r ANCHORAGE AK 99503
Unless otherwise requested, HAA will be held for pickup~
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
NOTE:
PHILLIPS w/ PRUD[NT1AL JACK WHITE Day phone
(g07~ 562-6464
If Community well system, provide wrftten COnfirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding Tank
Community on-site
Public sewer
NOTE: /f community wastewater system, provide written COnfirmation from State ADEC
lng to the legality and status of system.
T2-025 (Rev. 1~91) Front MOA #21 Computer Vemion
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 vedfy that be§ed on the Information obtained from the Municipality of
Anchorage files and from my investigation and)r~spection, the on-site water supply and/or wastewater
disposal system Is in compliance with all Mun[~al and State codes, Ordinances, and regulations in effect
on the date of this Inspection. ,1_/ I
NameofFirm ALAS~I 'A/b~T~WIkTERCONSULTANTS, INC. Phone (g07)337-6179
I IIII i itl t
Address 690J DEBARR ROAD[ ~ 'E~2B.-A~CHORAGE. ALASKA 99504
Engineer's Signature ~ /~{', ~,/~ F Date
Inconduc§ngthtsevaluation, AWWC, lnf~ttq etedtoprovideathorough, conscien#ousengmeenng~/na(ystsofthe
system in accordance with ADEC and I{~O~4 Df IS Guidelines & Regulations. The reported results described the
performance of the system under the conditions encounter~l at the time of the test and separation distances
measured to reedi(y identifiable features. The operational life of all wells and septic systems depend
on the local sells condition, ground water levels that may fluctuate durfng the year, and the water
usage of the fami~/ being served by ~he system. These conditions are outside ~he conlrel of
the evaluater of the system. Satisfactory test results do not guarantee future pedormance
of the system, nor do ~hey guarantee ~hat there ara no hidden defects er encroachments.
AWWC, Inc. can therefore not provide any warranty for futura estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party Is not authorized,
nor will it confer any legal right whatsoever.
6. DHHS SIGNATURE
~ Approved for ~
Disapproved
~ Conditional approval for
bedrooms
bedrooms, with the following stipul,ations!
Additional Comments
Date / :~ ' /-'//-0 0
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an Independent
professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasem of
homes and their lending institutions tn order to satisfy certain federal and state requirements. Employees of
DHHS do not conduct inspections or analyze data before a certificate is Issued. The Munidpality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Ba~ MOA #21 Computer Vemion
Legal De_~_. paon:
A. WELL DATA
Well Type PRIVATE;
Log present fi/N)
Total depth
Santia~/seal (Y/N)
Date of test
Stallo water level
Well product]on
Municipality of Anchorage R E O
DEPARTMENT OF HEALTH & HUMAN SERVICES
· Environmentel Services Dlvleinn NOV
825 'L Street, Rm 502 Anchorage, Alaska ggs01 (907) 343.474~'
i/~JNIClPALITY OF ANCHORAGE
Health Authority Approval ChecRiistE]W~AL SE~CES DMaC~
T12N, RSWf SECTION 27; LOT 25A Parcoll.O.: 018-092-65
I'PE" PRE OUS HAAI
If A, B, or C, attach ADEC letter. ADEC water m/stem number N/A
NO Date completed
* 10g' Cased t~ *40%
'1961
Casing height (above ground)
YES
Wires prope~y protected (Y/N)
YES
FROM WELL LOG
ATINSPEC~ON
8/31/2000
g.p.m.
WATER SAMPLE RESULTS:
Coaform 0 Nm'ate
Date of sample: 10/30/2000
B. SEPTIC/HOLDING TANK DATA
Date installed 10/2/92 Tank eize 1000
Foundation cteanout (y/N)
Date of Pumping 11/20/00
C. ABSORPTION FIELD DATA
Date Installed ~o/~o/oo-~o/~3/oo
Length 4.3.5' Width
o.ee m,~/L
Collected by:,
Other bacteria.
A.W.W.C.~ INC.
YES Depression (Y/N)
Pu/nper ROTO ROOTER
Soil rating (~)or fl2/bdrm).
1,3'
Number of Compartments 2 Cleanoute (y/N) YI~$
NO High water alarm (Y/N) N/A
~*BELOW FINAL O"~EI
0.7 System type
Gravel thlcknass below plbe 0.52' Total depth
~ED
'2.8'+/-
Date of adequacy test NI[[:W Results (Pass/Fall) ~ ~
Ruld depth in absorption field before test ~n.)', ~.~___~/~ gal. water added (In.):
Fluid dep~ ~ AbeOl~tioll rote =_
P nt (past 12 months) (Y/N) ff yes, give date
Effecliveebsof13flonama 652.5 SQ.FT. MonlterlngTubeprasent(Y/N) YES Depmsslonov~rfleld(Y/N) NO
D. LIFT STATION
Date installed 10/2/92
Manhole/~ess (Y/N) YES
High water alarm level ate 91.7'
Size in gallons 150
"Pump on" level at* 89.3' "Pump off' level ate.
*Datum SOUTH BASEMENT
DOOR THRESHOLD
= 100.00
88.3'
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption tleld on lot
Publlo sewer main
Sewarlsepflc service line
100'+ On adjacent lots 100'+
100'+ .On adjacent lots 100'+
N/A Public sewer manhole/cteanout N/A
25'+ _ Lift 8tetion 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: l'PER PREVIOUS HAAI
Abeo~ption field.
Wells on adlacent lots.
Foundation 5'+ Property line 5'+
Water main/service line 10'+ Surface wate#dralnega 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property Ilns 10'+ Building foundation 10'+
Surface water 100'+
'5'+
100'+
Water main/service line, 10'+
On'veway, parklng/vehlcte storage ama 10'+
I
I cerUfy that I hi'ye ~l~nl/~cl thr~ ~eld inspections end m~ew
of Munl~ ~ ~ ~ ~ms em ~ ~a~
Sig~m~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. #
HAA tt
1. GENERAL INFORMATION
Complete legal description
Lot 25; Sec 27; TI2N; R3W
Location (site address or directions)
13790 Davis Road
Anchorage, AK
Property owner
Mailing address
Lending agency
Mailing addre§s
Agent Bo n~ie. Gorre£~./
Bonnie. Harris & Zoe OakZett
13790 Davis Street Anchorage,
Day phone
AK 99516
269-5243 Bonnie (w)
Day phone
Remax Property',es
Day phone 257-0124
Address 2600 Cordova Stre.et Anchora,ge, AK
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3 ~.,
TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE:
99503
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:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72 025 (Rev, 1/9t) F~onl MOAI~2~
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 and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm. S & $ ENGINEERING Phone ~_-'i '¢ ~
17034 Eagle River Loop Road No. 204
Engineer's signature .~ff/ C . Date
DHHS SIGNATURE
j~k. Approved for -75
Disapproved.
Conditional approval for
bedrooms.
robert c. cow^N /~ ~
ce. sol ,,..'.?,¢
bedrooms, with the following stipulations:
Additional Comments
By: __
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) eack MOA
MUNIQPALi
t~NVIRONM~NTAL
Muniaipnli~y of Anahornge
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Se~ices Division
825"L" Street, Room 502e Anchorage, Alaska 99501e (907)343-4744
Health Authority Approval Checklist
LegalDescriptioo: Z07- PC- £*C. &-t 'Tt),,v /~ ParcelI.D,: ti.')/ ~; -0¢1~-- .~ o
A. WELL DATA
Well type
Log present (Y'~ W O Date completed
Total depfl~ I
Sanita[y seal ~,q~) ¥
~OM ~LL LOG
Date of test O
Static water level
Well production
IfA, B, or C, attach ADEC letter. ADEC water system number
1~6/
Casing heigbt (above ground)
Wires properly protected
AT INSPECTION
u/< g.p.m. '3,6..$k_ g.p.m.
WATER SAMPLE RESULTS:
Coliform O
Date of sample: 3 t~ ~_ x / '5 6
B -~E--~-q,'HOLDING TANK DATA
Date installed /o / :t / Old. Tank size
Fmmdation cleanout (ig/N) ¥/~ ~'
Date of Pumping
Nitrate O, q 7-7 Other bacteria
Collected by:
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99877
! co o Nnmber of Compartments 5l Cleanouts (l~Aq) yt 3
Depressioe (Y/~ ~, o High water alarm (Y/~ r~ 0
q ~/O/q;- Pumper / S 4//c ~' "q
C. ABSORPTION FIELD DATA
Date installed Io/~,/~, Soilrafing~g.'~d]/fl~orfl%drm) 0. ~ Systemtype
Length ~ I Width 3 ~ Gravel thickness below pipe ,:O. g' Total depth
Effective absorption area to ~' ,1, Monitoring Tube present~C)'N) V~-J Depression over field (Y/l~r}
Dateofadequacytestt~/~ - s,~-r r,,~z,;.o ~ c,~s; 7-~s~- '7 /~/
Results (Pass/Fail) P,~ s $ For ~____~-bech'o-0ms
Fluid depth in absorption field be~~tely after gal. water added (in.):
~l~uid.~de~~Minutes later: Absorption rate = .g.p.d.
Peroxide treatment (past 12 months) (YBq) w0,-~4 w,~o~,o If yes, give date
D. Lllq' STATION
Date installed ]0 /x /ffZ Size in gallons ) 5-0
Manhole/Access ((~/N) ¥~ J "Pnmp on" level at*
High water alarm level at*
Cyclestested ~ T '~ ~ f ~ ~ -~ / ~'t / ~ "/
E. SEPARATION DISTANCES
"P~Tump-off'24evel at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
~p~c~bolding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM~§~'I~HOLDING TANK ONLOT TO:
Building foundation ~ 0 f 4- '
Proper~ line g oe- Absorption field
Water main/service line "1 S- ~- Surface water/drainage /o o ~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain I,~o,,~
Property Line ~ -~- Water main/service line
Driveway, parking/vehicle storage area / 0
Wells on adjacent lots t O0 ~
/-ac
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records
in conformance w~. 2~ideline~in effect on this date.
Date 3 /~/ /~ ~
Date of Payment
Receipt Number ~7 (~//r/)
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
SEWER & WATER
MAIN E~TENSIONS
SEWER & WAT ER
INSPECTION
ENGINEERING S f UDIES
AND REPORTS
Sire pLANS
SOIL TEST
PERCOLATfON
TEST
STRUC[URAL&
MECHAN[CAt
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
Ap~ 17,
1996
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Haman Servic¢~
Attn: Jim Williams
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot 25; Sec. 27; TI2N; R3W
13790 Davis Road
RECEIVED
APR 8 1996
Mur/icipality of Anchoraqe
Dept. Health & Human Serwces
We have, investigated your observation during your site visit of 4/8/96
of a second 4" diameter line ent~J~ng the lift station for the
referenced property.
We have probed the interior of this line and found it to be capped
about 3 to 4 inch~ from it's outZet. There are no floor drains in
the garage or house nor are the~e any underground drainage systems
known to exist.
we coy~u~ted with the Engineer that performed inspections during the
insta~at~on of th~6 syste~ and hc did not know of anything that might
be connected to this lift station othe~ than the septic tank.
If you require additional information please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/gk
17034 NORTH EAGLE RIVER LOOP o SUITE 204 · EAGLE RIVER. ALASKA 99577
MUNICIPALITY OF ANCHORAGE
DEPARTMENT 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
1. GENERAL INFORMATION
Complete legal description
Lot 25, T12N, R3W, Section 27
Location (site address or directions) 13790 Davis St, Anchorage, Ak 99516
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
~r=~g-~ Lenora Niesen Day phone
13790 Davis St., Anchorage, Ak 99516
Day phone
344-2205
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
..3
Individual well x
Community well
Public water
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:
x
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72q)25 (Rev. 1/91) Fronl 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 invest~ation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm Mountain Engineering
Address 3868 Shannon Circle, Anchorage,
Engineer's signature
Phone 562-1500
Ak 99508
DHHS SIGNATURE
/V% Approved for
Disapproved.
Conditional approval for
bedrooms,
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 25, T12N, R3W, S27 Parcel I.D.
A. Well Data
Well type Private
Log present (Y/N)
Total depth /~'~
If A, B, or C. attach ADEC letter. ADEC water system number
Date completed /~ o~ (,¢ ( Driller ~,~LEA,v¢-¢~ ~.,x
CasedtoJc,~E-,t*,~,._,~-~. ,'¢(~/'/- Casing height 3'
Wires properly protected (Y/N) ¥
126'
; On adjacent lots 200 ' +
; On adjacent lots 200
Public sewer manhole/cleanout n/a
Y
FROM WELL LOG
Date of test
Static water level
Well flow g.p.m.
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 107 '
Absorption field on lot 117 '
Public sewer main n/a
Sewer service line n/a
Sanitary seal (Y/N)
AT INSPECTION
7/31/94
Petroleum tank n/a
WATER SAMPLE RESULTS:
Coliform None
Date of sample: 7/31/94
Nitrate
0.91 mq/1 Other bacteria None
Collected by: Brent Eaton
B. SEPTIC/HOLDING TANK DATA
Date installed I
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date of pumping
Tank size 1000 9al Compartments 2
Foundation cleanout (Y/N) ¥ Depression (Y/N)
Alarm tested (Y/N) n/a
Pumper ~_~e~c¢
N
SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK TO:
Well(s) on lot 107 '
To property line . 55 '
On adjacent lots 200 ' +
Absorption field 5 '
Foundation 83 I
Water main/service line n/a
Surface wateddrainage
72-026 (3/93)* Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed 10 / 92
Manufacturer Acreaqe Systems
Size in gallons 150
Vent (Y/N) Y "Pump on" level at
High water alarm level 91.7 '
Manhole/Access (Y/N) Y
89.3 ' "Pump off" Level at
Cycles tested ~
88.3'
Meets MOA electrical codes (Y/N) Yr HCA Joe Jameson
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot 1 10 ' On adjacent lots 200 ' + Surface water n/a
D. ABSORPTION FIELD DATA
Date installed 10/92 Soil rating (GPD/FF) 0.8
Length 31 ' Width 22 ' Gravel thickness
Total absorption area 682 s£ Cleanout present (Y/N) Y
Date of adequacy test 7/31/94 Results (pass/fail) Pa s s
Water level in absorption field before test 4.3 ' f rom top
Peroxide treatment (past 12 months) (Y/N) N
.System type Hound
0.5 ' Total depth 4 '
Depression over field (Y/N) N
for 3 Bedrooms
of pip{Aflertest 4.3' from top of pipe
If yes, give date n/a
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 117 '
To building foundation 92 '
On adjacent lots 200'+
Surface water n/a
Curtain drain n/a
On adjacentlots 200 ' + Propertyline 45 '
To existing or abandoned system on lot 60 '
Cutbank n/a Water main/service line n/a
Driveway, parking/vehicle storage area 10 '
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to afl MOA and HAA guidel/nes in eff~¢~ QoJ.he date of this inspection.
Signature ~~~" -
Engineer's Name Mark Pearson
Date ~?(q I'~ ~
HAA Fee $ 'P-~.¢~'~.
Date of Payment
ReceiptNum er '¢
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
DATE RECEIVED
INSPECTION APPOINTMENTS ~ .~,.~ .
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPEOT~R
MUNICIPALITY OF ANCHORAGE
) DEPARTMENT OF HEALTH & ENV, RONM ENTA L PROTE~I~F~F, :,t~H~AG~
825 L Street - Anchorage, Alaska 99S01 ENVIRONMEN], ~ ;, :)i 2CTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 MAR ~
DI R~CTiONS: Complete all parts on pa~ 1, Incemplete requests will not be pre~assed, Please allow ten (10) days for precessin~.
PHON~
MAILING ADDRESS
pROPERTY RESIDENT (If different from above) Z';-~.z ~1~'~-.,d..;z.~//' ¢""~'-~"'" --''5 PHONE
PHONE
MAILING ADDRESS
- .....
M~(L~N6 ABChESS ~
E. LEGA DESCB,ET,ON
STREET LOCATION ~
6, TYPE O~ RESlBE~SE NUMBER O~BEDROOMS
~ One ~ Four
~' SINGLE FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
[] Other
7. WATER SUPPLY
J~3 INDIVI DUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach Icg if available.)
8, SEWAGE DISPOSAL SYSTEM
I~] INDIVIDUAL/ON-SITE** )~'~-"' YEAR ON-SITE SYSTEM WAS INSTALLED,
, [] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY ~ TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[] APPROVED FOR ~ BEDROOMS
I~ONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev, 6/79)
M~rotl 20~ 19~0
Grayc~ Oakley
% ~)(-)nali Roali;y
2458 Sprucewoo~{
~uchorage, Alask~i
,~qubje~i'12N R3W ~otJ.on 27 ~r~ 25 ~,~nlra Hosoly
Approval f6f 7our J.n~livicl. ua]. s~,/or anf{ w~t~r fi~cilitios
can not be grante~[ un%il the followinf~ itc~m[~ have b~n
completed:
(i)
(2)
?he wator ana.Lys~3 report be doliver,).d to this office
.ro,,~ Che'4~ L~%b, 5633 B S'~].~o~t, for ou~..review.
'2he se. ptic tanl~ pu~uped with a re¢3eipt sub~ittod
Chis office.
(3)
~,.~.~3.~. tank m~u%hole to verify its ox~s'tanCeo
will n(~e~] to be re-.-inspe, cte~ by t~his offic;e.
(4)
Locate and ~}~pose the stan]])ipe to ghe ~e. epaqe pit for
our inspects.on, his J.s to insur~ the minl]~u~n distance)
r~q~/rren~s~ts are ]a~t between your well and sewer syst~n%.
In the ove. nt th~% ~wer system is locatad within
protectiv(~ r~di~ls require~%t~nt of the well~ i%
to be relooated. Prior %o reloea~ion a soils
llee(~ to b~ obtaJ.nect anal a p~rmlit, iss~ied by this
departutent.
Gray~e Oakley
i.~e',rch 20,. 19~]0
(6) /.f Bho~re is not a tank~ on~ ~;ill need to be
inmtallad.
(7)
An ad(~q~acy test be performed on the existing lea~l~ing
aroa, 'f'his ~est will determine tf the sysqe~ is
adequate accord, ing to National Standards. A listing of
private firms perfor~%ing %he test J.s enclosed. '~3his
report need. s to be submitted to this deparg~%ent ~or our
review ~
)]f l~h~r~ are any furt~her questions~ please3 co'ntaot this
office~ at 264~-4'720o
Robort; C. l?ratt, ll.S.
Associai;e
Coast >~ortga~ie Company
4797 BusJ. nes£,~ Park Boulovar.~l 99507~
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quelfty
3500 Tudor Road, Anohorage, Alaska 99507 279-8686
Time Inepeotton ()
Date of Inspect~on~~
REQUEST FOR APPROVAL OF
INDIVIDUAl. SEiNER a WATER FACILITIES /~../~ ~-~
5. Type of
Number of Bedrooms:
C. Oonstru:tion , .D. Bacterial Analysts' .,,
A. Installed B. Installer ...... ,,
C. Septic Tank: 1, Size 2. Manufacturer
D. Seepage Pit: 1. Size 2. Material ...... · : ....... ,
E. Disposal Field: Total Length of Lines
8. Distances:
A. Well To:
Septic Tank
, Nearest Lot Line
, Absorption Area~, Sewer Line8
, Other Contamination ....... ·
B. Foundation to Septic Tank
"~ Absorption Area ..... ·
C. Absorption Area to Nearest Lot Line ....
~!~quest for Approval of ~nazvidual Sewer & Water Paeilit~s
Page Two
9. Comments:
Approved Disapproved Date
Approval Valid for One Year Prom Date Signed
Greater Anchorage Area Borough, Department of ~nvironmenta] Quality
D~AGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate representation of the subiect sewer and water facilities located et:
Signed
Date
Nr. Richard Il. Jenson
PO ~ox 1U20o Klatt Road Station
Anchorage, Alaska 99502
Subject: Sewer and water lnspoction
I)(~ar hr. Jensen:
Un October 31, 1972, our office made a routine sewer and water ~nspec-
tton of your proper&y, Lot dS, Sectlm1 ~7, TI2N, R31~, and noted an
proper sewage disposal sysl~em and well house at. that 1qcat;JoJl.
The sewage sy,,',ter~l consists of two (2) adjotbtng cesspools .pproxir, Jati:ly
thirty (30) fe~:t from ~be building foundation on tt~e Soutmtest side of
the lot. Sin(;e cesspools are no longer i~ccep~able in the Borougil~ .yo~
must upgrade ~i~e sys gem by instal 1 lng im approved sepgic tan~ and seep-
age pit or dratnfield, Before you s[art 'Jnsl;allaLiun, iL is Jlecessary
to obtain a soils gest from a~l approved firm and also obtain an instal-
lagJon pemdt from gms office. A~ ghat gime, you ~'iJll 6e lnfor~,~ed as
to mini;,~um distance require,~mts from the well to septic Lank, etc. This
is t~,)por6aJ)~ because at present~ your cesspo&ls are too, eJo~e to the
well casing on your proper~y. ':',,
l'he well must also be upgraded ~o confon~l to Bor6u.gil health sgamlards.
YOU lJlUS~ ~!X~(}lld ~Jle ~-le'J] casing above &ne ground and eliminate ",
~1~ WOOd*-
un well tmuse which pres~nLly stands,
As per our telepimone conversaLton on Octobar 31, 1972, tim Borougt) will
allow .you ten (10) months, or until August 1, 1~73. to complete
grade on your sewer and water facilities.
Any questiens may be directed to tills office,
Sincerely,
Oeboratl Anne Bart
Envt ronme,tal Control Officer
mid
Ma~ ~e,~ich
Maycr
Well Drill~g permit Number:
parcel Idendfk~don Number:~
bfvfJapm¢,"d' ~¢rviae-~ OeP
Pump Installation Log
Date or,sue:
ler~ Owuer Nome
pump l~ke .Depth BetowTop of Well C~sing: ~ 7~ feet
pifless Ad.'tpt!r ButYl Depd~: ~ fee~
~ttesS Adaptar InClen ~/~
D~infec:ed Upou Comple~on?~%/~ ~ ~o
~hod of D~infec~On:
A~anliou: The pu~.p i,us',.slle:/hail provide a pump i.us'..=ll?s~.o: log to th~ DSD wi~.i~ 30 days of pu.u:p