HomeMy WebLinkAboutFREEMAN LT 4Freeman
Lot 4
#016-112-03
1
GRE1"cR ANCHORAGE AREA BOf"�IGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME 1AA(111CA RI)CR MAILING ADDRESS &x '174-9i0 gL7irh 9F507 PHONE o27a
LEGAL DESCRIPTION 10T --/ FCZ_mAre SU .
SEPTIC TANK:
DISTANCE70 ,
NUMBER OF
FROM WELL MANUFACTURERLO/Ak-" MATERIAL COMPARTMENTS
INSIDE LENGTH —' INSIDE WIDTH LIQUID DEPTH : IQUID CAPACITY 1,350 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER – OR WIDTI+al , LENGTHR3, DEPTH /A
¢., 95�
LINING MATERIAL d /U.242 CRIB SIZE: DIAMETER'y DEPTH 9 DISTANCE FROM: WELL
/ r TOTAL EFFECTIVE
BUILDING FOUNDATION S2L , NEAREST LOT LINE �� ABSORPTION AREA (WALL AREA) tSZ SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE C' 37kilt1t' CONSTRUCTION �' r, 6(/u.GGd DEPTH
BUILDING
FOUNDATION
CESSPOOL `—
.736 1
DISTANCE FROM:
NEAREST NEAREST I SEPTIC 1 SEEPAGE n /
LOT LINE �0 SEWER LINE �O -f , TANK , SYSTEM 9`s
OTHER SOURCES
APPROVED !_� DISAPPROVED
DISTANCES: '05 5/ioL0A)
• lW
ie
INSTALLED BY: �
PIPE MATERIAL:004t/he", _
LOT SLOPE:
REMARKS:APlP t'AMIiO/i!/!t�
Form No. EQ -031
REMARKS 4
DIAGRAM OF SYSTEM
ft
95 4x-
'TranS:rG ?3' � Ql
� kr sb ar
DATE 3, .12124 APPROVED
G.A.A.B.
y
GREATER ANCHORAGE AREA BOR UGH
oTELEa• V4
� Q DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3330 •'C" STREET ANCHORAGE, ALASKA 99503
PHONE 274.4561
T
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J
SEWAGE DISPOSAL SYSTEM — APPLICATIONN% ANDPERMIT
r�
NAME OF APPLICANT - /��CU.S.Cb �+/�+ f� MAILING ADDRESS �"'�// / // pNONEs 'z7 -E_ �W
INSTALLATION LOCATION
LEGAL DESCRIPTION"-// I/ 'Fo-«94'A/ Sx:;l& uU /
INSTALLATION OF: SEPTIC TANK - �C , SEEPAGE PIT, DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE
FINANCED THROUGH
CJ /
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
B
TAL
TO BE INSTALLED BY -
NOTE& THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BA --C FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY LL BE SUBJECT TO PROSECUTION.
SEPTIC TANK S1ZE 1011
��rr TYPE iI%/A 4&&� EPAGE
MINIMUM DISTANCES, REQUIREMENTS
5/
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT / DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL - - /J /
SEPTIC TANK -C SEEPAGE PIT ;za DRAIN FIELD S /
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK 16-d SEEPAGE PIT /1" /
DRAIN FIELD /&B' / ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC A
TANK � ,SEEPAGE PIT � ,
DRAIN FIELD
SEPTIC TANK, /6` `SEEPAGE PIT A" DRAIN FIELD 161911
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION B FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING I STALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
SIZE
66r/e�X"z
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IISSS IN ACCOR NCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE
FORM NO. EO -016
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.100
Certified
h'k
Well MUNIdPALITY OF AN4iOPAf3F;'•t ;t•' •:
7
120
DEPT. OFHEALTH& "'•- �'.'.=
••ter_, :.
ForNeWo er:_. wril�.^...`iPTEQIOt�M
T...'
wTpp/
Location 1986
17
_
Date
� ~
2?5
Completed .. .Z
�.._....._......»......_..___..».._.....__.._._.._
,
236
Depth Z' A e t
bh [[ t( :'
Y `, E D.:.r
of well ... .._..._._......�.........._......-._.._.._
:R.L.�..1.
• .•' •y •nnit
•-
Size of casing T
»..
.
Distance to waterR»......_......_._.._.._._.._�__.._.
>t
`• �• ..
Distance to water whUe pumping at rate
.
of hour.
-.4,21.1....... _.._._ gallons per
Fre
G
Description of Formation
from
to
Y.'
,71%%v ;anaa.rrFVPl:' :: Ilj,.'p••gnf
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.100
117
alne ena itr ¢t'" nl �rT�^3^f
- 117
120
^l nt. "),i r4 ar- m,?P1 131 u -7r- v:'n4
120
170
171 :.v n.., 4 v.q ^lrnl r -A'? 1:-+..9
17n
17
17
2?5
4 r. r 'vPl ': .:ate^ rp--
23
236
SE 41VE4 $WINO'
22 — 1415022-6
above true and correct.
r
Driller
FOSS DRILLING
1396 NGRA PH. 279.2649
ANcHonAG$ ALASKA 99501
you to attach this certificate to your deed.
cc-. DWS
Cc: -Mwni
of 'Ancko.,9e
2/66 •>
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V �. iV i•N \",'L � 1r W"l'i• +
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RLJEIVED GREAII.R ANCHORAGE AREA BOROUGH
JUN 1 :1974 Am DEPARTMENT OF ENVIRONMFFITAL QUALITY Case N
3330 "C" Street
w0,1.IPCHORAJ IMI&QUl0iii" ANCHORAGE, ALASKA 99503
of
Performed For Howard Elder Dated
Legal Description: Lot 4 Block Subdivision
This Form Reports Soils Log_ XX
- Soil Test Must Be Logged To 4' Below Proposed
Depth
Feet Soil Characteristics
1--
2-
3-
4-
5-
6-
7—
13-
14—
Light brown sandy silt SM
Grey coarse sand SP
Sandy silt and medium gravel GM
Coarse gravel and sand Sw
Was Ground Water Encountered? No
If Yes, At What Depth?
Performed June 11, 1974
Freeman
Percolation Test
Seepage System -
-Reading Date Gross Time Net Time Depth to H2O Net Drop
I
Percolation Rate Minute
Proposed Installation: Seepage Pit x2L Drain Field
Depth of Inlet Depth to ottom of Pit or Trend
COMMENTS: Based on Borough regulations, we recommend 187 sq. ft. per bedroom.
Test Performed BY JohnJameson Date Certified BY:
Date:
iv F-13
F.UG 9 1974 ANS
GREATER ANCHORAGE AREA BOROUGH 0RAU AREA$ORGN
DEPARTMENT OF ENVIRONMENTAL QUAI.ITI{4ttA'"o" S0 §PIAL
3330 "C" Street pan.
ANCHORAGE, ALASKA 99503
Revised
Performed For Howard Elder Dated Performed Aug. 7, 1974
Legal Description: Lot 4 Block Subdivision Freeman
This Form Reports Soils Log xx Percolation Test
- Soil Test Must Be Logged To 4' Below Proposed Seepage System -
Depth
Feet Soil Characteristics
1-
2-
3-
4-
5-
6-
7-
13-
14—
Light brown sandy silt
Date
SM
Net Time
Depth to H2O Net Drop
Grey coarse sand
/`>�
SP
Sandy silt and medium gravel
GM
Coarse gravel and sand
/25
SW
Coarse rocky fine sand
�5�
SP
EM
I
Was Ground Water Encountered? No
If Yes, At What Depth?
i
Reading
Date
�-Grvss�
Net Time
Depth to H2O Net Drop
Percolation Rate Minute
Proposed Installation: Seepage Pit xx Drain Field
Depth of Inlet Depth to Bottom of Pit or Trenc�4�
COMMENTS: Extension of previous excavation for death. Originally reported June 11, 1974.
Water table in this area is about 40' to 50' below the knoll surface.
Test Performed BY W. Attwood Date Certified BY:
Date:
GREATLR ANCHORAGL AREA BOROUGH
DEPARTMENT OF ENVIRONMF11TAL QUALITY Case N
3330 "C" Street
ANCHORAGE, ALASKA 99503
Second Revision
Performed For Howard Elder Dated Performed Sept. 11, 1974
Legal Description: of 4 Block Subdivision Freeman
This Form Reports Soils Log_ xx —__Percolation Test
- Soil Test 14ust Be Logged To 4' Below Proposed Seepage System -
Depth
Feet Soil Characteristics
2 --
4 —
6 —
8 10-
12-
14—
I
0-
12-
14-
Light brown sandy silt SM
Grey coarse sand SP
Sandy silt & medium gravel CM
—
Coarse gravel and sand SW
Coarse rocky fine sand SP
Was Ground Water Encountered? No
If Yes, At What Depth?
=C:�::CM
NOMMEMMM
Reading Date Gross Time Net Time Depth to 1120 Net Drop
Percolation Rate Minute
Proposed Installation: Seepage Pit Drain Field
Depth of Inlet Depth to ottom of Pit or Trenc 1i 6'
COMMENTS: Extension of previous excavation for depth. Originally reported June 11, 1974.
Water table is 80' below knoll surface and 50' plus below surrounding surface (well loesl.__
Test Performed BY W. Attwood Date Certified BY:
ALASKA MINERAL & MATERIALS LAB Date:
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 016-112-03 Expiration Date: 7
1. GENERAL INFORMATION
Complete legal description FREEMAN S/D; LOT 4
Location (site address) 11300 READER ROAD, ANCHORAGE, AK, 99516
Current Property owner(s) KENNETH DAZEY Day phone
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
11731 HILL TOP DRIVE, ANCHORAGE, AK, 99515
KEVIN ELFRINK W/ GLOBE REAL ESTATE Day phone
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
WaiverNariance request for. n/ c
11
345-1153
727-2150
Received by: i Date: 1 L='
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5210—
Date
21O—Date of Payment L4 L ITl iq
Receipt Number (lLIIG�
COSA #
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
TYPE OF WASTEWATER DISPOSAL:
IN
Individual On-site
❑
❑
Individual Holding tank
❑
❑
Community On-site
III
❑
Public Sewer
0
Received by: i Date: 1 L='
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5210—
Date
21O—Date of Payment L4 L ITl iq
Receipt Number (lLIIG�
COSA #
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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, 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 watersupply 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.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
INS.TL-E,
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineers 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 sails 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 ofhowlong the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sale 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. DSD SIGNATURE
System #1 Approved for __4_ bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following
337-6179
OF ,
CE -79 3
If�j�/elf F
d Pro f as slolioll;
2P�\AY tOFt t V6 `6ri/�
ON-SITE
WATER AND
WASTEWATER n1
Original Certificate Date: r l T
The cipalr y
MbnlDr Ancho4ge Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist t/ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
In- 11/W
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description:
FREEMAN S/D; LOT 4
Parcel ID: 016-112-03
A. WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS.
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 9/6/1974 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 236 ft. Cased to *40+ ft. Casing height (above ground) 12+ in.
Date of test
Static water level
FROM WELL LOG
9/6/1974
75
Well production 8
WATER SAMPLE RESULTS:
Coliform loer colonies/100m].
Arsenic: 5' G(V ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
AT INSPECTION
3/13/2014
75 ft.
5.8+ g.p.m.
Nitrate r7. 36 mg./L.
Date of sample: 3/13/2014
Tank size gal. Number of Compartments
Foundation cleanout (Y/N) Depression over tank (Y/N)
Date of pumping
C. ABSORPTION FIELD DATA
Collected by: GEG, Ltd.
PUBLIC SEWER
Date installed
Cleanouts (Y/N)
High water alarm
Date installed Soil rating (g.p.d./ft2or ft2/bdr
Length ft. Width ft.
Total depth ft. Eff. absorption ea ft2 Monitoring tube
Date of adequacy test Results (Pass/Fail)
Fluid depth in absor n field before test in. Water added
Elapsed T' _ min. Final fluid depth in.
yrejuvenation treatment (past 12 mo.) (Y/N & type)
System type
Gravel below pipe
In
Depression over field
For bedrooms
gal. New depth _in.
Absorption rate >=
If yes, give
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off'
E. SEPARATION DISTANCES
level at
Cycles tested Meets alarm & circuit requirements?
QEQ yooj CoSst Ra S �S F�6„ Ems•+�
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 2��F Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation
Water main
Wells on adjacent lots
Property line Absorption field
Water service line Surface
SEPARATION DISTANCE FROM ABSORPTION
Property line ,
Water service
n drain
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water
Wells on adjacent lots
I certify that t 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 �j16/Af
(Rev. 11105)
TO:
Water main
Driveway, parking/vehicle storage
Lot 2
Lot 3
O
0
0
N
W
O
O
O
0
O
O
Lot 1
9
II_ MONA AVENUE
�P 49th00
A���9I,I
00 ... .L....... s-00
0 %Fred Walatka. ff i
titill, 3255 - S
e
SCALE: 1"= 40'
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FH, pg 47-49
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AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Morkgagee's inspection
of the following described property: LOT 4.
FREEMAN SUBDIVISION
Anchorage Recording District, Alaska, and that the
improvements situated thereon are within the properly lines
and do not overlap or encroach on the property tying
adjacent thereto, that no improvements on the properly, 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 11th day of April 12014.
FRED WALATKA & ASSOCIATES
Engineers and Surveyors
BE 1 (907-248-1666)
0
Municipality of Anchorage
Pipe Types
AB
Acrylonitrile -Butadiene -Styrene
AC
Asbestos Concrete
CC
Concrete Cylinder
Cl
Cast Iron
CM
Corrugated Metal
CN
Concrete
CU
Copper
DI
Ductile Iron
GI
Galvanized Iron
MLC
Mortar Lined Concrete
PE
Polyethylene
PLNT
In Plant Flow Channels
PV
Polyvinylchloride
RC
Reinforced Concrete
RE
Relined
RP
Techite
ST
Steel
TN
Tunnel
UNK
Unknown
VC
Vitrified Clay
WS
Wood Stave
WSP
Welded Steel
NP
No Print
"
Private System
N
A
150 300 600
Feet
Map Created: 05/11/2009
Grid Number
SW2633
i
i
S2534
H
Wastewater Coll
i
3
e;
i
Y
Wastewater Coll
3
e;
Wastewater Coll
DATE SCHEDULED 7.J2G.to � TIME Cp'; p0 .... INSPECTOR {
SUBDIVISION FREEMAN BLOCK/LOT/TRACTLT 4
INDICATE NORTH
d E
f
a�
a
SIZE MAIN:
TYPE MAIN:
DEPT AT MAIN:
AT PROP. LINE: -7 f
CONNECT LOCATION:
COMMENTS:
d-
INSPECTED BY: ,� _
DATE:
7-Z
MUNICIPALITY OF ANCHORAGE
WATER & WASTEWATER UTILITY
3000 ARCTIC BLVD.
PHONE: {907}564-2762
JC_-
t
WASTEWATER
CONNECT PERMIT 05 - 3604
1 Y
DATE OF APPLICATION 06/24/2005
SCHEDULED COMPLETION DATE 12131/2005
BLOCK/LOT/TRACT LT 4 X; SINGLE FAMILY
SUBDIVISION FREEMAN MULTI -DWELLING No.APT5_
COMMERCIAL
TAX CODE 1611203 GRID SW2633 AS -BUILT
STREET ADDRESS 11300 READER RD
OWNER DAHL ,JON G &THERESA E PHONE
MAIL ADDRESS 152 BOYER RD GRANTS PASS, OR 975269705
CONTRACTOR 'UNKNOWN
ASSESSMENTS
Repair Existing Service
X _ Main Line Extension
X On Property Only ,.,
. City Tap
Have Been Levied
Hydrant Only _-
50' or Longer-
To Be Levied
Main Tap - To Prop" Line Only
Comments:
Main Tap & On Property Connect Row No.
Disconnect
R & R- Main Tap Only
Owner - Staff ,.,.%7%'
CONNECT SIZE 4"
ISSUED. vrwecm
.INSPECTION FEE
$ 64.00
X, PAID CASH
PERMIT FEE
$ 38.00
CHECK #
$ 0.00
X7 OTHER VISA
DEPOSIT
$ - 0.00
INSPECTED BY
REIMBURSABLE TOTAL
$ 102.00;Ug,g
DATE 7 FP'd
NUMBER
REMARKS
PERMITTEE (Please Print) PHONE
MAIL ADDRESS . t . "?--,.
SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
AWWU INSPECTOR Original
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. n1 A-11 a-ni HAA # n5Q.V-10
Expiration Date: 11 1411.4ppt e
1. GENERAL INFORMATION
Complete legal description _Lot 4: Freeman Subdivision
Location (site address ordirections) 11300 Reader Rd. An hora£P', AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
John Dahl
Day phone
Day phone
Ray Dahl Day phone 244-7611
12836 Lindsey Cir. Anchorage AK 99516
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well 7[X]
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ❑
Individual Holding tank ❑
Community On-site ❑
Public Sewer a
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority 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. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm S 6 S Eneineerine — Phone 694-2979
Address 17034 N Eaple River LooD Ste. 204 Eaple River, AK 99577
Engineer's Printed Name R084!41 C . Cot -.4-1 Date / O l 3 /o S�
5. DSD SIGNATURE
Approved for ___4_ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
(Rev OUA2)
Municipality of Anchorage ••.,_
' Development Services Department
Building Safety Division - 011 -
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST'
Legal Description: -eT q Faiw—m04U S/b Parcel ID: 016
A. WELL DATA
Well type t�iLlVmt.
Date completed �/'j4
Total depth o23G, ft.
If A, B, or C provide PWSID #
Sanitary seal 6N) LL` -S
Cased to 0M' ft.
Well Log&)
Wires properly protected �f! ) Ire,
Casing height (above ground) let in.
FROM WELL LOG AT INSPECTION
Date of test _� `6 �'� ri
Static water level eiri
Well production. g.p.m. S�`� g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate 0, 139 mg./I. Other bacteria C> colonies/100 ml.
Arsenic: — mg./I. Date of sample: /05 Collected by: s4"C 1EA.)4(k19CttAK76
B. SEPTIC/HOLDING TANK DATA PL, BL le— gELt3la�
Tank Type/Material
Tank size -3
Date installed
gal. Number of Compartments _ Cleanouts (Y/N)
Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length ft.
Total depth _ ft. Eff.
Date of adequacy test
Pumper
Soil rating (g.p.d./ft2 or
Width
System type
ft. Gravel below pipe ft.
fe Monitoring tube _ Depression over field
Results (Pass/Fail) For _ bedrooms
Fluid depth in absorp ' ield before test _ in. Water added_ gal. New depth_ in.
Elapsed Tim min. Final fluid depth _ in. Absorption rate >= g.p.d,
treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on" level at _ in. "Pump off" l�
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N K
Absorption field on lot P 14
Public sewer main i
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
N
t
On adjacent lots I DD � i -
I
Public sewer manhole/cleanout
Sewer /septic service line ,7-{ I t- Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Pu6t-1C-
Building foundation Property line
Water main
Wells on adjacent lots
SEPARATION DISTANCE FROM
Property line
Water service line
Surface water
FIELD ON LOT TO: PL)V -tc-
foundation Water main
Water Service line/ Surface water
Wells on adjacent lots
F.
G. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in/?,
conformance with MOA HAAnguidelines in effect on this date. " . ; sosErtT c aow,w f
1�Cgt%.�i Cw'i✓ �s.�` cE-tif301 wf
Engineer's Printed Name ��,
Date
HAA Fee $ 3 0 • JJ Waiver Fee $
Dale of Payment 10 % -tlo S"- Date of Payment
Receipt Number O 7 f b' 13 Receipt Number
(Rev. 12101) V ►>\
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S&
HFALTHAITHOWTV
APPROVALS
SEWERAWATER
MAIN C(TEtbgNS
SEWER 6 WATER
INSPECTION
ENDWERWGSTLIDIES
AIDREPORTS
WEN.NSPECDON
A FLOW TEST
SITE PUNS
r rn
PERCOLATION
TEST
STRNCTLRA1d
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
OtSPOSALSYSTEM
DESIGN
October 14, 2005
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519-6650
REFERENCE: Lot 4; Freeman Subdivision
11300 Reader Rd. Anchorage
ROBERTC. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CML ENGINEERS
(907)6942979
FAX (907) 6941211
This letter is to certify that the septic system has been decommissioned according to
M.O.A. regulations. The house has been connected to public sewer. The tank has
been pumped crushed and abandoned and the septic stacks removed. The attached as -
built survey was done prior to decommissioning and is for purposes of well head
location only.
If you req . e a itional information, please contact us.
A. Shafer, P.E.
17034 NORTH EAGLE RNER LOOP A SURE 204 • EAGLE RMR, ALASKA 99577
Municipality of Anchorage
-• Development Services Department r$`'
Building Safety Division =/a
On -Site Water and Wastewater Program S A .. T
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: Bob Cowan
Legal description: Freeman lot 4
The attached paperwork has been reviewed and Is being returned for the following reasons:
❑ Original signature or stamp missing on _
❑ Calculation error in design.
❑ Additional soils information needed.
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate.
® Incomplete; missing Old septic system (including Pipes above groundl must be permanently abandoned.
❑ Incomplete; missing
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
❑ Other.
Name of reviewer: Jeff
Date: 10/6/2005
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE ARL
44�iz DEPARTMENT OF HEALTH & HUMAN SERVICES AIML
Division of Environmental Services IBM
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. # 11l L -x- I m • t 1,;
1. GENERAL INFORMATION
Complete legal description Lo E yy Fret man S113
Location (site address or directions) 1 f 3 00 Reade/ Rat , "
Property owner W111154m r. Dewev Day phone 3'rN-02 to
Mailing address I13oo Recco(Gr Rd� An'chvrag, Ate 9,75-1 -13Y8
Lending agency ` Day phone
Mailing address
Agent H1kP htestick . RG.htc+)r Pf0rtrl;e/ Dayphone 17tr-Z7d1
Address 2600 rarceO m Sf.. A� Arc 9450
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. 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.
4. 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.
72-02SJR..1/91) Ffml MOAN21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l 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. Se/4ra.rrOR dr<A.Ace
Wafv</ titewl-e.
Nameof Firm l=W&,a Tec-4,1,cef Srvrre' Phone 3ys'-I-TS' '
Address 1HS20 EcSo Sf.. AAc-4ot-ale his YZrld'
Engineer's signature �?r 91ue 'c Date AV 6 1996
6. DHHS SIGNATURE r/
Approved for �tL ly� bedrooms.
Disapproved.
Conditional approval for
Additional Comments
MLODoxa r. rwnxE
bedrooms, with the following stipulations:
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.
7t ori (1tev. wq 6. h MOA g1
Municipality of Anchorage AUG 07199G
DEPARTMENT OF HEALTH ���HUMAN SERVICE cC I IED
40
825*V StreetEnvironmental Servicc es Division G G G
, Room 502 • Anchorage, Alaska 99501 • (907) 3434744
Health Authority Approval Checklist
Legal Description: L. it9,, Free tn.en SID Parcel
A. WELL DATA
M
Well type Prover fc ICA, B, or C, attach ADEC tetter. ADEC water system munim N. A.
Log pmt (Y/M Y Date completed 9 / 6 / 7Y
Total depth 274f ' Cased to 236' Casing height (above ground) 1,109
Sanitary seal (Y/N) Y Wires Property protected &) Se v.;yt her e
FROM WELL LAG AT INSPECTION
Date of tat 9/6/7,1 7/30/9x;
Static water level 7t r 970
Well production 7 g.p.m. 7.B t 9 -
p.m -
WATER SAMPLE RESULTS:
Coliform Q [ol
/toOn1l
Nitrate </�C Other
-bacteria Kos It�oiir.I
Dateofsample:
7/30/9jC
Collected by: F[attU
Tech Swe
B. SEP'nC/TTOLDING TANK DATA
Date installed 9/23 / 7r Tank size 1 SO Number of Compartments ! Cleaoouts (Y"_
Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N. A.
Date of Pumping B 11 l9 6 Pumper r-rt2o Gf
C. ABSORPTION FIELD DATA
Date installed 91? -317Y Soil rating (gp.dJfe or felbdrm) 1 8 7 0' System type Cpox. Row to r/A Pet
sairm
Length 23' Widtb 23' Gravel thickness below pipe9' Total depth it,
Effective absorption area OU Ce Monitoring Tube prescnt(Yltp Y Depression over fieid (Y/N) N
Date of adequacy test "71300d Results (Pass/Fail)Pow_ For N bedrooms
Fluid depth in absorption Reid before tat (in.); 6Y Immediately aiterM gal. water added (in.): 80 yt
Fluid depth 7) !I (ins•) Mmuto iatcr:_ M Absorption rate - > 6 0O0 p d
Peroxide treatmem (past l2 months) (Y/N) None {mane If yc% give dateN. of,
D. LIFT STATION N. A
Date installed Size in gallons
Manhole/Access (Y/N) "Pump on" level at*
Higb.water alarm lend at* $Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump air level at'
Septidbolding tank on lot 7 c.o- ; On adjacent lots > '00'
70' pef- uv/. rtPv�#
Absorption field on lot ; On adjacent lots n, 1 o0'
( Ys' Per ,�Pnpe• F
Public sewer main N. A Public sewer manholdcleanom N. A,
Sewer /septic service line 2S' Lift station N. 4.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation A' Property line 7,01 Absorption fold rs'
Water main/service line > to' Surfaoe wateddminage �, Iso' Wells on adjacent lots > 100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 3S' Property Line ,gr Water main/service line > to
Surface water _�* foo' Driveway, paddng/veWcle storage arca Ad. vc� eo 1
Curtain drain Nowe cern Wells on adjacent lots %-o foo
F. ENGINEER'S CERTIFICATION
I certify that I have determined dhru field hWeetions and review ofMunidpai re
In Conformances with MOA HAA guidelines In effect on this date. See aLt4wc i d"
Sig==Jt- ♦ er ; .. _
Engineer's Name -Aeoo� :_ Mao, -e •. s.s •. ::. i.. •.::i�
Daae Acro d;0 Igo "�y;�; '� .......•, r r'y:
HAA Fee S X00
Dale offtmumt it 11 f 1 L l
Rempt Number
Rev. V95 OSS: haawk.doc
waiver Fee S Ne Fee
Date of Payment
Receipt Number
Mont 6ipahty of Anchorage
Department of Health and Human Services
825 "L" Street
Rick Mystrom, 8
Mayor P.O. Box 196650 Anchorage, Alaska 99519.6650
August 27, 1996
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 4 Freeman Subdivision
Waiver Request # WR960040, PID #016-112-03, HA960342
Dear Mr. Moore:
Your request for waivers of the 100 foot horizontal separation of an on-site wastewater
disposal system to a private well has been approved. The approved separation distances
are the private well to the on-site septic tank of 70 feet and the private well to the on-site
seepage pit of 95 feet.
This waiver approval applies to the existing septic system to well separations only. Any
future upgrade to either will require all separation distances be met or another approval
from this department.
If there are any further questions or concerns regarding these waivers, please call our
office at 3434744.
Si erely,/
Vv
amen P. Williams
Civil Engineer
On-site Services
JPWAjm:Dewey
j •;JNUNICIPALITY OF ANCHORAGE`-''
Department of Health and Human Services
On-site Services Section
Waiver Review worksheet
WR#( l,,Og1,.ML1PID# 016-112-03 HA# Permit #
Date Received: August 7, 1996
Legal Description: Lot 4 Freeman
Engineer: Ted Moore, P.E., Flattop Technical Services
14530 Echo street, Anchorage, Alaska 99516
Applicant: William F. Dewey
******
Waiver Requested: Private well to septic tank of 70 feet; private well and
seepage pit of 95 feet.
Criteria: 1. Geology:
Points:
A. Water Table
<,W
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
I71
2. Special Conditions:
3. Other:
******
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above:
�ti� �✓UG/r1,��'iLS �t=T<z=:2 QED l�''�G6�96
Date:
tom- n+evapls
Rec #: Amount: $
By:
Date Paid:
n
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FLATTOP'T
AiCHNICAL SE�RY}ICES:._
CIVIL & ENVUtONMENTAL ENGLNEERLNG • E.ti ERGY CONSERVATION & ANALYSLS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 A&1CHORAGE, ALASKA 99516
August 6, 1996
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
By means of this letter we are requesting issuance of a formal waiver approving the 95 foot
separation between the well and seepage pit and 70 foot separation between the well and septic tank
on Lot 4 of Freeman S/D, located at 11300 Reader Road These separation distances were clearly
noted and approved on the 1974 inspection report for the sewage disposal system. Because of this
prior approval, I understand that the property owner will not have to bear the additional expense of
the Municipal waiver fee. To assist you in your review we are enclosing a site plan and water
sample test reports as well as copies of the well driller's log and inspection report from your files.
According to the driller's log the well was completed in September of 1974 and has a total
depth of 236 feet, a static water level of 75 feet, and a yield of 7 gpm. On July 30, 1996 we
conducted a yield test of the well. At that time the static water level stood at 87 feet below the top
of the casing. Steady pumping of 782 gallons of water from the well at the maximum pump output
of 4.8 gpm caused the water level inside the casing to be drawn down to 136 feet, but no further.
Based on the test data we determined that the total yield of the well is in excess of 4.8 gpm, which
is more than adequate for a single family residence, and also meets the FHA lending criteria that a
well be able to supply 720 gallons of water within a 4 hour period Water samples collected on
July 30, 1996 were satisfactory, showing 0 coliform or other bacteria and non-detectable nitrates.
According to the Municipal as -built inspection report the wastewater disposal system was
installed on September 23, 1974 and consists of a 1350 gallon concrete septic tank which
discharges into a 23' x 23' seepage pit with an effective gravel depth of 9 feet. The separation
distances shown on the inspection report (which are noted as approved) are 70 feet between the
well and septic tank and 95 feet between the well and seepage pit. The measured distance on an
as -built property survey between the well and the septic tank standpipe is 75 feet and between the
well and the seepage pit standpipe is 98 feet. Presumably the differences are attributable to the
underground projection of the wastewater system components.
On July 30, 1996 we conducted an adequacy test of the wastewater disposal system. The
initial fluid depth in the seepage pit was 64 inches and after the addition of 782 gallons of water
over a three hour period the maximum fluid depth achieved was 80.5 inches. The fluid depth
receded to 79.5 inches within 20 minutes after the flow of water was stopped. Since this rate
corresponds to an absorption rate of greater than 600 gallons per day, we concluded that the
system continues to be able to absorb at an adequate rate for a 4 bedroom residence.
The lot encompasses a broad hilltop with the house and well near the top and the septic
system standpipes at a slightly lower elevation. Thus, any surface flow from a failing septic
system would tend to flow directly away from the well. Furthermore, the well log indicates a high
silt and clay content in the several strata above the aquifer which is first encountered at 178 feet.
The actual intake is at 236 feet. The fact that the static water level inside the casing comes up to
87 feet indicates that the overlying strata confine the aquifer, and thus serve as an effective barrier
preventing contamination of the aquifer from pollutants originating in the vicinity.
The following is a breakdown of how waiver analysis points could be assigned using
D.E.C.'s 1985 "Separation Distance Waiver Guidelines for SCRO"
Category
Points
Tank Seepage Pit
Distance to water table (top of aquifer) (178' -1' -11') 7.33 7.33
Soil sorption (predominantly clay and sand) 4.5 4.5
Permeability (predominantly clayey sand) 3 3
Water table gradient (assume 5%) 4.5 4.5
Horizontal separation (70'. 95') 1.8 2.8
Total 21.1 22.1
Based on this assignment of points it appears that there is no danger of contamination of the
well attributable to the proximity of the septic system components. The fact that the systems are
22 years old and still there are non-detectable nitrates only strengthens that conclusion.
Please feel free to give me a call if you have any questions.
cc: William Dewey
Sincerely,
5�_%ile�
Ted Moore, P.E.
�.trlea�na.b.>,
THEOOQ^.E F. ;A03Rg j 1
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BLDG ° ° ; HSE WELL w
SEPTIC
SYSTEM
, �Iw
ccIL
;
DRIVE -y
SEEPAGE PIT -
(CONFIGURATION PLOTTED
PER INSPECTION REPORT)
' 1350 GALLON CONCRETE \ 9F
i SEPTIC TANK I \sr09
,•
HSE
SEPTIC
SYSTEM
IN THIS
AREA 11100,
WELL
w
0
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MONA AVENUE
�y•�� �NH4w� �.,w �v..
/7 ✓� a . Rely •w '.w
T!f G LOT 4, FREEMAN SID
�'••"""•••••••:..W WELL AND SEPTIC SYSTEM
SITE PLAN
yAr FLATTOP TECHNICAL SERVICES 1 INCH .50FEET
��•+Y
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 AUGUST, 1996
•MM\S Y-iY`
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.