HomeMy WebLinkAboutFREEMAN LT 13I
01 -112
-08
Mark Begich
Mayor
~ufid[~,9 S~fety bivision
On-Site Water & Wastewate~ Progr,~m
4700 ~ragaw Street
P.O. ~ox 196650
Anchoragz, ~ K
,~, 9951%6650
(907) 343-7904
Well Drilling Permit Number: SW
Parcel Identification Number:
Pump Installation Log
DateofIssue:7~/[!
()
Legal Description
/.3
Property Owner Name & Address: p~V'e OohrO ~Fo r~
I'1~¢o H.~,'0 ~, ~o~,
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: 7 0 feet
Pump Manufacturer's Name: f~e~[ j~4c~t?.f
Pump Model: ffJ ] ~_
Pump Size ~/?.. hp
PitlessAdapter BurialDepth: ~ feet
Pitless Adapter Manufacturer's Name: ~t'J
Pitless Adapter Installer:
Well Disinfected Upon Completion? ~Yes ~ No
Method of Disinfection:
Comments:
Pump Installer Name:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Waetewater Program, 4700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSP101281 PID Number: 016-112-08
Name:
n~,tid & Shirley Johnston Wastewater System: [] New [] Upgrade
Address:
I l ztCi(~ N~wkin~ Inns, Anr'hnrn~n~= AI~ 99S16 ABSORPTION FIELD
Phone: Number of Bedrooms: [] Deep Trench [] ShallowTrench [] Bed [] Mound [] Other:
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION 0.8 GPD/Ft2 5.0 Ft.
Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
1 3 FREEMAN 0.76 Ft, 4.24 Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
2.25-2.80 Ft. 75 Ft.
Well: r-] New [~ Upgrade Gravelwidth: Number of lines: I Diatance between lines:
5.0 Ft. 1, -- Ft.
Classification (Private, A, B, C): PRIVATE Total Depth: Cased to: Total absorption area: Pipe Material:
Existing Ft. Ft. 750-~-Ft~ D3034 & F810
Driller: Date Drilled: Static Water Level: Installer: Date Installed:
Ft. Mike N Anderson 1 2/11/201 0
Yield: I Pump Set at: I Casing Height Above Ground:
GPMI Ft.I Ft. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
' To Septic Absorption LiE Holding ~ublic/Private Manutacturer: (Japac~'y:
.rom
Tank Field Station Tank SewerLine Anchorage Tank 1 ZSOGs~.
We, 100'+ 100'+ NA NA 25'-.1- Material: Number of Compartments:
Steel
~ J
SurraoeW~ter 100'+ 100'+ NA NA ~ / LIFT STATION
Lot Line 5'+ 1 0' + NA NA/~ Size: Manufacturer:
Gal.
Foundation 5'+ 1 O'+ NA N A "Pump on" level at: "Pump off' level at: in High water alarm at:
in in
Curtain Drain N A * 50' + NA N A Pump Make & Model Electrical Inspections performed by:
~Rcrnarks:*None Known. Previously existing BENCH MARK
Location and Description:
tank/field decommissioned in place per code. Door sill
Assumed Elevation:
100 Ft.
Engineer's Stamp
Inspections performed by: ArcTerra Dates: 1st 1 2/1 1/1 0
2nd 1 2/1 1/1 0
Development Services Department Approval _~ ~? ~r:'.~ o.,.~ ~,~
Conditional Approval Date:
Reviewed and approved by: / ///~- ate:/A -2 ~ "'/O
AS-BUILT SYSTEM DETAILS/SITE PLAN Pe~-Mit~ osP~oms~
F'REEHAN LOT 13 PID~ 016-118-08
__ 291.04
~ NEW ~E~CH:
75'L~X 5'W X
0 ~LL
~ SCALE: 1' = 40'
~ B-C=75,8~
~ ~-F=116,4' ~ / ITANK I~ SEVER EDCK
o
"~ ~ ANCHBRA6E, AK 99515
~ ASBUILT: CEF DAm 12/27/10
/ AK. 99577
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System Permit
OSP101281
01611208000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: December 08, 2010 to December 08, 2011
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: FREEMAN
Site Legal Address: FREEMAN LT 13 G:2633
Owner/Address: JOHNSTON DAVID W & SHIRLEY R
320 MARINER DR ANCHORAGE AK 995153609
Site Mailing Address: 11400 HAWKINS LN, Anchorage
Lot Size in Sq Ft: 48167
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, Alaska 99507
www.muni.org/onsite
(907) 343;7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Property owner(s)
Mailing address
Site address
Legal description (Sub'd., Block & Lot)
· Day phone
Zip Code
Zip Code
Legal description (Township, Range & Section)
Lot Size z_/,,¢~/~ ? Sq. Ft.
Number of Bedrooms
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of p~ope~ty o~'~or auihorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
cTe a Consulting, Inc.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
ANCHORAGE OFFICE (907) 868-3792
FAX (907) 868-3793
December 1, 2010
Deb Wockenfuss
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: SW040439 Permit Renewal - Freeman Subd. Lot 13
Dear Deb,
We have been requested by the current property owners to proceed with the septic system
upgrade as designed for the referenced permit. We have conducted a site visit on
November 23, 2010 of the subject property and have found that no changes have occurred
that would impact the previously permitted design. The testhole monitoring tubes were
both visable and the ground water depth was 10 foot below grade. This is consistant with
the original testhole water monitoring done in September, 2004.
The existing septic tank is in failure and time is of the essence to construct the new
system. The proposed garage was not built and the existing well is not enclosed within
the building.
There are no public or private wells within 200' of the proposed system location except as
noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 868-3792 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Kenneth M. Duffs, P..~
Attachments: Copy of Permit SW040439
Mayor Mark Begich
Municipality of Anchorage
September 13, 2005
Jennifer Featherston
6541 Bridget Circle
Anchorage, AK 99502
Subject;
On-Site Water and/or Wastewater Permit.
Permit Number: SW040439
Legal Description: Freeman Lot 13
Dear Ms. Featherston:
An On-Site Water/Wastewater Permit, number SW040439, issued by this office for a single-family
system, will expire on October 19, 2005. The permit is valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to
this office for review, approval and documentation. This as-built inspection report must be signed by
the licensed Professional Engineer who inspected the installation of the system. As-built inspection
reports are reqmred to be submmed ,~thtn 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. A new permit for a second year may
be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of
the original permit.
When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well
permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
Daniel J. Roth
Program Manager
On-Site Water and Wastewater Program
Enc: Copy &permit
Community, Security, Prosperity
MUNICIPALITY OF ANCHORA GE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Oct 19, 2004
Expiration Date: Oct 19, 2005
Permit Number: SW040439
Legal Description?.FREEMAN LT 13 '
Design Engineer: 0014 Anderson Engineering
Owner Name: JENNIFER FEATHERSTON
Owner Address: 11400 HAWKINS LANE
ANCHORAGE, AK 99516-1328
Parcel ID: 016-112-08
Site Address: 011400 HAWKINS LN
Lot Size: 48167 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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 dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued B~
Date:
Date:
Parcel I.D.
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
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Permit Number SW
Property owner(s) JennlferFeatherston
~M.ailing address (1) 6541 Bridget Clmle Anchorafle, AK 99502
~i~J address (2) 11400 Hawkins Lane
Legal description (Lot, Block & Sub'd.) Lot t3, Freeman Subdivision
Legal description (Section, Township & Range)
Lot Size 48,t67SF Acres/Sq. Ft.
Day phone 677.7005
Zip Code ~-/~
Number of Bedrooms.Four (4)
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only []
[] Water Storage []
[] Jac,,77! []
[] Water Softening Unit []
[]
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or autho~zed agent)
Permit Fees:
Date of Payment:
Receipt Number.
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
October 13, 2004
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Su~ect:
Lot 13, Freeman Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of the subject property intends to construct a four bedroom home on the
subject lot. We are therefore requesting a permit be issued for the upgrade of the
septic system to accommodate the new home. The attached Site Plan and backup
documentation identify the location and configuration of the existing and proposed
septic systems. Also identified on the plans are the locations of the existing well. No
conflicts exist between the proposed septic system and existing well and those on
adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The
drainage pattems will be maintained after construction. The existing septic tank will be
pumped, crushed, backfilled and abandoned in place. The existing absorption trench
will be abandoned in place.
The test hole placed for the original system indicated silty sand with varying amounts of
gravel in the area of the new absorption trench and alternate site. The percolation rate
for this matedal was 10 minutes per inch. We are proposing to place a new 1,250-
gallon septic tank and a 75' long by 5' wide by 4' effective depth absorption trench to
treat and dispose the effluent generated in the house. The elevation of the distribution
line in the absorption trench will be 1' below the surface and the total depth will be 5'.
Sufficient fill will be placed over the trench and septic tank to prevent frost penetration
and possible freezing.
The ground surface on the lot slopes at shallow grades from east to west and north to
south. The new trench will be constructed parallel with the slope as much as possible
in conformance with Municipal requirements. The new septic system will be
constructed a minimum of 100' from the existing well and any surface water in the area.
Eot 13, Freeman Subdivision
October 13, 2004
Page Two
If the system is constructed in accordance with our design the following statements
apply:
i. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
~ 15 ~ ~ 2 1
'
14
~ -~ ~ 3 4
Avenue
---, /
/
~ i 49th ~- ~
AREA MAP ~~.'-" ................. '-'"~
'~,;~.... ...... .. ~
3NV'I SNI>IA~VH
.Og'S9L ':1 .O0,OLO0 N',,
o0C~'~9 L ~A .00.0 LO0
Z
030~30BRSNR
LOT 13, FREEMAN SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom House 5' W~de Trench System
Peru. Rate: 10.0 Min./inch 1,250 Gallon SepticTank
Application Rate: .8 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD/,8 GPD/SF (Application Rate) = 750 SF Absorption Area
750 SF/5 SF * ,5 (Red. Factor) = 75 LF Trench Length
THEREFORE: Construct a 75' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 1' Below Odginal Ground Surface. Total Depth to be
5' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
See
4'0ee
3' Cover
Over Trench
Backfill ~ Geotextile -- Fabdc
----- Drainfield Rock
4" Perforated
PVC (Holes Down)
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. ~4~ .,¢ .~ ~ ~ ~.%
M~mmum 6 Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Walls in the Area.
Minimum 100' Separation From Surface Water or Streams.-
2
18.
PROJECT #:
PERFORMED FOR:
MUNICIPALITY OF J~ICHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
/,700 SOUTH BRAGAW ANCHORAGE, AK ggsIg
SOILS LOG - PERCOLATION TEST
Jennifer Feafher~fon DATE PERFORMED:
LEGAL DESCRIPTION: Lot 1]. Freeman Subdivision
TEST HOLE
Organic Fill
Roots, Etc.
SH
Small Amounts
of Gravel
SLOPE SITE PLAN
SM
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH?
DEPTH OF WATER
NO S
L
10/1~/~00~
READING DATE GROSS NET DEPTH OF NET
TiME TIME WATER DROP
Start 9/18 5:15 12.0'
I 5:L, 5 30 625" 3.'/5"
Recharge 5:~,6 12.0'
2 6:16 30 9.0' 30"
Recharge 6:17 11.75"
3 6:~'/ 90 8.75" 30"
PERC RATE: t0 MIN./INCH PERC. HOLE DIAMETER:
TEST RbNBETWEEN ~ FT. AND ~ FT.
COMMENTS:
Test Hole Pre Soaked Prior to Percolation Test.
TEST PERFO~ED BY: A._~.H l, NIICN^.-'.L ~. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 10/13/200t,
PROJECT #:
PERFORMED FOR:
LEGAL DESCRIPTION:
MUUICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUiLDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
/.,.700 SOUTH BRAGAW ANCHORAGE, AK gg$1g
SOILS LOG - PERCOLATION TEST
Jennifer FeQtherston DATE PERFORMED:
9/16/0t,
Lot 13. Freeman Subdivision
TEST HOLE #
~rganic Fill
Dots, Etc.
Silty Sand
SH
Small Amounts
of Gravel
2 SLOPE SITE PLAN
18.
COHMENTS:
SM
WAS OROLIqDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH9
DEPTH OF WATER
AFTER MONITORING:
DATE:
S
L
10'
10/13/200".
READING DATE GROSS NET DEPTH OF NET
TIME TIME WATER · DROP
Start 9118 5:25 11.63'
1 5:5S 30 8 5' 3.13'
Recharge 5:56 11.'/5'
2 6:26 30 875' 30'
Recharge 6:27 11,5'
3 6:57 )0 I[I ~," ) O'
PERC RATE: 1~ MIN./INCH PERC. HOLE DIAMETER:
TEST RUN BETWEEN ~ FT. AND ~ FT.
Test Hole Pre Soaked Prior to Percolation Test.
TEST PE~O~tED BY: AH I, Mrc. AEL E. ANDEPSON, CERTIFY THAT THIS TEST WAS PE~ORI'tED IN ACCORDANCE
WITH J~J-L STAT:- AND MUNICIPAL GUIDELINES ON THIS DATE: 10/13/200&
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 13, FREEMAN SUBDIVISION
GENERAL:
The scope of this project includes the pumping, crushing and backfilling of
the existing septic tank and the procurement and placement of a new 1,250-
gallon septic tank at the location shown on the Site Plan. Work also includes
the construction of a new 75' long X 5' wide X 4' effective depth absorption
trench at the location also shown on the Site Plan. The distribution line in the
trench will be placed at 1' below the existing ground surface. Total depth of
the trench will be 5' below the existing ground surface. A separation
distance of 100' from any well and 100' between the septic tank and
absorption trench and any surface water must also be maintained. A
minimum of 3' of fill is required over the absorption trenches and 4' over the
septic tank. In lieu of the required fill 2' of insulation and 2' of fill may be
placed.
Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified by the
Municipal Department of Health and Human Services for system installations.
Owners installing their own systems must receive pdor approval from
D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 13, Freeman
October 13, 2004
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below ground must be perforated.
Contractor shall verify the septic tank and drainfleld are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. Contractor shall verify this condition prior to placement of the
rock. All pockets of unacceptable materials must be removed and replaced.
·: I'ot 13, Freeman
October 13, 2004
Page 3 of 3
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct budal polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as-built of the completed system.
L
! '~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
· JPHONE I J-]NEW
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~* Monuf~turet ~~5~ ~ ~ ~atet~ No. ofcompartme~,,
Liq' 7~all°n' IF HOUE~DE= In,id, length Widt~ Liquid depth
Dwelling PERMIT NO.
m--~OZq Manu~ ~ ~~
Q Welt . Foundation ~ ~3 Nearest lot hne~ /
~ DISTANCE TO:
No. oflin~ Le t o eachlifl n ~ ? Trenchwidt~ Distance~ines
g ~, ¢ ~ Total length of l S
~ Top of tile to finish grade , , Materiaibe ,,, t'.
( ~ Type of crib Crib diameter Crib depth Total ef f~ti~ absorption area
m Wall Building f~ndation Nearer lot line
~ DISTANCE TO:
- I
m Building foundation Se~r line Septic tank Absorption area(sD
~ DISTANCE TO:
REMARKS
APPHOVED DAlE LEGAL
3178)
' '~ ~EPRRT~IENT ~ ~EALTH riND ENVIRONI'I~NT~L , .<OTECTION ~.~-~-~
~ ~ ~ ~25 ~L~ STREET, ANCHORAGE, AK. ~5~i IJ~ ~
PERMIT NO. ( 8Se35~ ) ~~~
~PPLIC~NT L~RRY O. PHILLIPS SR~ BOX ~7~5.R
LOC~TIO~I ~-/~ ' ~ > o~
LEGfiL LOT 13 FREE,lAN SUB LOT SIZE 999999 SOUflRE FEET
TYPE OF SOIL ABSORPTION SYSTE~I IS: DRAINFIELD
l'l~XIl,lUr,1 NU~IBER OF BEDROOr,1S = ~ SOIL RBTING <SQ FT/BR>=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTE~I IS:
85 ~&
DEPTH= IE~ LE~GTH= 54 GRAVEL DEPTH=
THE LENGTH DI~IENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEH THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCBVATION (IN FEET>.
THE TREe, CH L~IDTH IS --~. ~ElO FEET.
THE GRAVEL DEPTH IS THE ~'IINI~IUM DEPTH OF GRSVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOr~ OF THE EXCAVATION <IN FEET>.
REQU ~ RED ~EPT I C TAble( $ I ZE= :~E~O GALLON_C~
PERI'lIT APPLICA~IT HBS THE RESPONSIBILITY TO INFORM THIS DEPART~IENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUr~BER OF RESIDENCES THAT THE WELL WILL SERVE.
Tl~lO ( 2 > INSPECT I OD.IS ARE REQU I RED
BACKFILLING OF 8~lY SYSTE~I WITHOUT FINAL INSPECTIOr. I Ar.iD APPROVAL BY THIS
DEPARTI'IENT WILL BE SUBJECT TO PROSECUTION.
liININUI'I DISTANCE BETWEEN A WELL AND 8NY O~.l-SITE SEWBGE DISPOSRL SYSTEM IS
±00 FEET FOR A PRIVATE WELL OR i50 TO ~00 FEET FRO~I A PUBLIC WELL DEPENDINg]
UPON THE TYPE OF PUBLIC I~ELL.
I'IINI~IUM DISTANCE FROI~ A PRIVBTE WELL TO A PRIYATE SEWER LINE IS ~5 FEET AND
TO A COI'IMUNITY SEWER LINE IS ?5'FEET.
OTHER REQUIREMENTS M~Y APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERI'~IT E×PIRE~ DECEI~BER 2~ ~98~
I CERTIFY THBT
i: I AI'I FBlqILIAR WITH THE REQUIRE~IENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE ~IUr.IICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THat THE ON-SITE SEWER SYSTE~I ~18Y REOUIRE ENLARGE~IEHT If THE
RESIDENCE IS REMODELED TO INCLUDE ~IORE THBr.l ~ BEDRO0~IS.
V4. 0
PERMIT NO. ( 830080
I"lUhl I i:: I I"gL I TY OF' AhlCHr'~RAGE
DEPARTMENT ~. HEALTH AND ENVIRONNEMTAL '. .OTECTION
825 tL' STREET, ANCHORAGE, AK. 99501
264-4720
SEWER PERI'I I T
APPLICANT LARRY PHILLIPS
LOCATION
LEGAL 'L13 FREEMAN
SAR'BOX 1765 R ~44-6044
LOT SIZE 999~9 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT/BR>= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= :LQ iEt~GTH= ~6 GRRVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD,
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET>.
THE TREt~CH NIDTH IS 5. 000 FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM Of THE EXCAVATION (IN FEET>.
RE~.U I RED SEPT I C TRt~-~ $ I ZE= 10E~O GRLLON$
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
.INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
Ti*lO < 2 > I hlSPECT I ON--<:; ARE REQU I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPRRTNENT WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL,
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I t EXP I RES DECEMBER 2:L~ 19S~ '
CERTIFY THAT
I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE NUNICIPALITY Of ANCHORAGE. '
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
'-~FFE~ LARRY PHILLIE'S
POUCH 6-650
ANCHOFiAGE, ALASKA99502-0~i(0
(907) 264-4111
~Permit ~: 821102
· January 31, 1983
TO: Permit Applicant
Subject: Lot 13 Freeman Subdivision
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerel%
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
pERMIT NO. ( 823.102 >
APPLI CANT LRRRY -I ?~\~.~-
LOCRTION HRWKINS LANE
LEGAL . L l~ FREEMAN
MUN I C I~" ~ClL I T¥ OF t:thlCI-~--~RFiGE
DEP~RTMENT L HESLTH 8ND EN¥IRONMENTAL ~.,OTECTION
825 ~L~ STREET, 8NCHORAGE, ~K. ~9501
264-4720
SEIMER PERM I T
S.R.A. BOX 1765 R
LOT SIZE
~44-6044
20000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRRINFIELD
MRXIMUM NUMBER OF BEDROOMS
SOIL RflTING (SQ FT?BR)= 85
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
DEPTH= '1 0 LENGTH= 54 GRRVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THE TREt~CH WIDTH IS 3. 000 FEET.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCAVATION (IN FEET).
REQU I RED SEPT I C TRNK S I ZE= ~1.000 GRLLOI'-.IS
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTRLLATION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
TWO < 2) INSPECT IONS RRE REI;IU I RED
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION AND RPPROVRL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
i00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXP I RES DECEFIBER
I CERTIFY THRT
l: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDRNCE WITH THE CODES.
2: I UNDERSTRND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street. Anchorage, Alaska 99501 264~t720
SOILS LOG -- PERCOLATION TEST
jX SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
/-..o"/ 13 l~r ~ ~
3
4
5
7
8
10
SLOPE
11
12
13
14
15-
16-
17-
18-
19-
20
DATE PERFORMED:~
SITE PLAN
Col~bl~'s -~ WASGRO".OWATER CS ~ ,~
ENCOUNTERED?
~" (c=. v,,, ~o ~:
IF YES, AT WHAT E
DEPTH? /~ / ~
Gross ~ Net ~1~ Depth to Net
Reading Date Time~ ~ Time M Water I~* Drop
o o
~ I~//~ ~ ~ ~" ~"
~ /~ ~ ~ o" ~"
72-008 (6/79)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and 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
FOR A SINGLE FAMILY DVVELLING
Parcel I.D. 016-112-08
1. GENERAL INFORMATION
Complete legal description
FREEMAN, LOT 13
Expiration Date:
Location (site address) 11400 HAWKINS LANE, ANCHORAGE, AK 99516
Current Property owner(s) DAVID & SHIRLEY JOHNSTON
Mailing address
Lending agency
Mailing address
Day phone
320 MARINER DRIVE, ANCHORAGE, AK 99515
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE 0F WATER SUPPLy:
'` i'ndividua! Well, ~,:;.,:
Individual Water~.StOrage
Community'ClaSs Well
public water SYstem
4
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site [~
[] Individual Holding Tank r--]
[] Community On-site []
[] 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 Approval
are valid for 90 days from the date of issue for properties served by a pdvate 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 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 ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Pdnted Name KENNETH M. DUFFUS Date 12/27/2010
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not.be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctUate during the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these vadous and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
bedrooms.
DSD SIGNATURE
[,,-"/Approved for J"7L
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
By:
(Rev. 11105)
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: FREEMANr LOT 13
A. WELL DATA
Well type PRIVATE IfA, B, or C provide PWSID # __
Date completed 1966 Sanitary seal (Y/N) Y
Total depth 146 ft. Cased to
FROM WELL LOG
Date of test -
Static water level - lt.
Well production - g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100mL Nitrate 0.116 mg/L
Arsenic: 7.16 mg/I Date of sample: 12/03/2010
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 12/11/2010
Parcel ID: 016-112-08
Well Log (Y/N) N__
Wires properly protected (Y/N) Y
Casing height (above ground) 24 in.
AT INSPECTION
12/3/2010
37 f.
4.22 g.p.m.
Collected by: ArcTerra
Tank size 1250 gal.
Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanou~ (Y/N) _Y Depression over tank (Y/N) _N
High water alarm (Y/N) N Date of pumping NA-New Tank Pumper
C. ABSORPTION FIELD DATA
Date installed 12/11/2010 Soil rating (g.p.d./ff2 or ft2/bdrm) 0.8
Length 75 ft. Width _5 ft. Gravel below pipe 4.24 ft.
System type Trench
Total depth 7.25 ft. (From Existing Grade)
Eft. absorption area 750 ~ Monitoring tube Y
Date of adequacy test NA-New Field
Fluid depth in absorption field before test __
Elapsed Time: min. Final fluid depth __
Depression over field N
Results (Pass/Fail) Pass
in. Water added__ gal. New depth __
in. Absorption rate >-- ___g.p.d.
Any rejuvenation treatment (past 12 mo,) (Y/N & type) N__lf yes, give date--_~-
For 4 bedrooms
in.
D=
LIFT STATION
Date installed
"Pump on" level at __
Datum
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at __
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main
Sewer/septic service line 25'+
Animal containment areas $0'+
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 10o'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 1-00'+
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
100'+
Building foundation 5'+ Property line
Water main 10'+ Water service line 10'+
Wells on adjacent lots 1_00'+
Absorption field 5'+
Surface water 100'+
Water main 10'+
Driveway, parking/vehicle storage
Wells on adjacent lots 1-00'+
10'+
COSA Fee $250.00
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1-0'+ Building foundation 1-0'+
Water Service line 1-0'+ Surface water 1-00'+
Curtain drain $0'+ (None Known)
F, COMMENTS
*Per MOA HAA 1987 ~~~'~
- ' - d 'd u d '"
ENGINEER'S CERTIFICA I'~ION
· .
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 KENNETH M. DUFFUS '"!~..~~
Date 12/27/10 ' ~~~
~,~0
,',2.." ~g~ ~'
V
NOO'OI'OO"E 165.50
10' LtTILLiTY ESMT
Z
74;0
ADDITION
SO0'O1 'O0"W 165.50
HAWKINS LANE
SGS Reft# 1106415001
Client Name ArcTerra Engineering and Surveying Printed Date/Time 12/10/2010 13:41
Pro. iectName/# FreemanLot 13 CollectedDate/Time 12/03/2010 11:45
Client Sample ID Freeman Lot 13 Received Date/Time 12/03/2010 14:05
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals b~ ICP/MS
Arsenic
7.16 5.00 ug/L EP200.8 C (<10) 12/06/10 12/08/10 NRB
Waters Department
Total Nitrate/Nitrite-N
0.116 0.100 mg/L SM204500NO3-F B (<10) 12/08/10 AYC
Microbiolo~ Laborator~
E. Coli
Total Coliform
Negative 1 100mL SM20 9223B A 12/03/10 DLC
Negative 1 100mL SM20 9223B A 12/03/10 DLC
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a)
Legal Description (include lot. block, subdivision, section, township, range)
Location (address or directions) __
(b) Prope~Owner L~ ~[~mTeephone Home
(C) Lendinglnstitution ~f~l~ ~°¢~,Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the followino address: or: Check here ,~if hold for pick up.
List contact ~erson and day phone number below,
7
TYPE OF RESIDENCE
Single-Familyy
Number o! Bedrooma.
WATER SUPPLY
Individual Well~;~/' Community r-I Public I-I
Note: If community/'" well system, must have written confirmation from the State Department of Environmental Conservation
attesting to Ihe legality and status.
SEWAGE DISPOSAL
Onsite ~ Public I'1 Community [] Holding
Tank
Note: If community well system, must have written confirmction from the State Department of Environmental Conservation
attesting to the legality and status.
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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 ~::~e'~/,~<~,t I~ ~-~x'01,.~e ¢c/,~'~1 Telephone ~',~/--~'/'{9 7
E ' I
~'." · ',,:~.?_~.?;)"7'2
¥,'.gc, '- f/CE-4488 o.' ~'-.
DHHS APPROVAL t': <
Approved ~X~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
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.
Pe. ge 2 of 2
~[UNICIPALITY OF ANCHOr, AGE
[NVIRONM[NTAL SERVICES DlVlSlOI',~IUNIClPAMTY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
MAY ! z, 1987 CHECKLIST o FEBRUARY 1984
264-4744
RECEIVED
Legal Description:
WELL DATA · .
Well Log Present (Y/N)~,.)O Date Completed / 47 /-c=' ~¢=' Yi e I d .~,~,~_.~ ~/~' "Z)
Total Depth /z~'/c' ! Casedto ~'~.,1'{' Depthof Grouting
Static Water Level ~" ~-. / Pump Set At /..4'AJ ~q'xTO tO
Casing Height Above Ground _ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) /t.~ Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot / ~ ~ / ; On Adjoining Lots / C~¢:) /'-/-
To Nearest Edge of Absorption Field on Lot / ~-_~"" / ; On Adjoining Lots / C~) /
To Nearest Public Sewer Line /V/0'~''/~ To Nearest Public Sewer /
CleanouVManhole /~/o ~'~' To Nearest Sewer Service Une on Lot ~-.,'7'
Water
Sample
Comments
SEPTIC/HOLDING TANK DATA
Date Installed ~"//~/~-'~ Size
J O E)O¢'No. of Compartments
Standpipes {Y/N) t.~,~
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)/[,// , ./4//A'//,,~._ ; for
Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Air-tight Caps (Y/N) ~',j~O Foundation Cleanout (Y/N) ~"~
LastPumped '~/ ~'7/
~O Date '
- To Building Foundation (:3/O '
To Disposal Field ~ /
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
TO Property Line
TO Water Main/Service Line '~' ~) ·
Course
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date,, Installed
Width of Field
,~:luare Feet of Absorption Area
Length of Field --~'~
Depth of Field !~ ~ ~ '/! -! ~ ' :,i
Gravel Bed Thickness
~.~._.Z:z/' Standpipes Present (Y/N)
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well'
To Building Foundation ~174~ !
Lot ./ OC:) ·
TO Water Main/Service Line / DO t..~.
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots / 0
TO Cutbank (if present)
/,/o,/~'.
D. LIFT STATION
Date Installed
Size in Gallons
'Pump On" Level at
High Water Alarm Level
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
· Pumping Cycles durin'~ Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request °*
I certify that I haye c~ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection
Sig n ed.~_, j ..~_.~--...~,. ~~ .~-.,~..~,w_z~ Date "/----/ /7-- ~'~/~-~ "7 '
./. /.
Company MoA.o
Receipt No. .-~- ~ O? O 0 3 ::5 ·
Date of Payment ~' -// ~/'"~ 7 ~' ~'~-- ....... ~ ~
Amount: $ ~0 0 °R ~e ~Ttt~ E~?~s Seal
Page 2 of 2 ~.'~. % CE~4S8 .?/~ ~
I F 'I SUL
(o07) M1.SlO7
April 29, 1987
Larry Phillips
ll&O0 Hawkins Lane
Anchorage, AK
99516
RE: Lot 13 Freeman Subd
Adequacy Sewer System Test
Dear Mr. Phillips
At the request of your lender Mary of Intercontinental Mortgage and with your
approval I have performed the adequacy test on the on-site sewer system on the
above reference lot. The system consists of a 59' long drainage trench with a 1000
gallon septic tank. The well was also tested for delivery and measured for static
water level and minimum casing depth. There is no well log available but city
records show that it is 1~6' deep and is cased with 6" pipe to at least 52' ~ere
the static water level is currently. Well delivery was found to be adequate at a
sbeady 2.5 gpm for 2 hours for a total delivery of 300 gal lons, the required daily
loading for a 2 bedrocm home.
The sewer system was tested by adding water at the rate of 2.5gpm to the drainage
trench until the daily loading of 300 gallons was obtained monitoring the levels in
the trenches and septic tank at regular intervals. The septic tank was pumped
prior to testing and 1000 ~llons was removed. The results of the adequacy test
are tabulated below:
Date
&/27/87
Time Tank C.O.#1 C.O.#2 RATE(GPM) QUANTITY (gals)
0 10" 10" 5" 0 0
20 10" 12" 8" 2.5 50
60 10" 13" 8" 2.5 150
80 10" 12" 9" 2.5 200
100 10" 12" 9" 2.5 250
i20 iO" i2" 9" 2.5 300
&/28/87
0 iy' 7.5" 3.5" 0 0
15 13" 11" 5.5" 2.5 37.5
60 13" 12" 8" 2.5 150
90 13" 12" 8" 2.5 225
120 13" 12" 8" 2.5 300
4/29/87
O N/A 7.5 2" O O
Analysis of the test results indicate that the sewage disposal system is
functioning adequately for a 2 bedrocm ~ome. The well flow test and coliform lab
tests ir~icate that the well is also functioning adequately for a 2 bedroem borne.
A copy of this letter has been at%ached along with the necessary doc~ents and
application for hemlth ~uthority approval fr~m the ~unicipaliby of Anchorage.
If I can be of arg fu~her assistance in the future please call.
Sincerely,
Wayne Henderson P.E.
%~H:pes
5~3 B STREET · ~CHORAGE, ~S~ 99518 · TELEPHONE (90~ 562-2~3
ANALYSIS RE~RT BY ~LE
C1 lent PO# : VERBAL Req #:
C1 lent Smpl ID: ELL ~IATER
5/7/87, 1320 hfs by W. H.
SampleRec'd : HAY 7 87
Ordered ~ : W. HENDERSON
REPORTS ADDRESS # 1
PENINSULA E~ I NEERS
Work Drd~rNo. : 425
Client Account : PENINSP
~ate Report Printed:MAY 12 87 e 07:18
Released By
REPORTS ADD~ES5 #2
440 W BENSON STE 206
ANCHORAGE, AK. 99~03
Special LOT 13. FREEMANSUBDI¥ISION
Instruct:
ChemlabRef Ih 6158 Lab Smpl ID: I Matrix:Water
Al I owabl e
Parameter Tested Resul t/Units Method Limits
NITRATE-N O.l& mg/1 10 ~
Sample
Remarks:
I Tests Performed * See Special InstructionsAbove
ND=- None Detected ** See Sample Remarks Above
NA= Not Anal yzed LT=Less Than, GT--Greater Than
...-- APPLIC--NT FILLS OUT UPPER HAt'ONLY
Time Time Time '2 Time
Date Date Date ,' Date
( / ) APPROVED~DR~MS~ ~ ~ IR 'CONDmONSOFAPPROVAL
( ) OISAP~OVED ~ ~
Well lo Tank Septic T~k Size
SU.JECT L 1%
F
DATE
MESSAGE
REPLY
SIGNED
L~..,T~ jr~:Z~E~4~:~~ 4S 472 s~o P&I'TS I A.NO 3 WIT# C:AI~OC¢ ~TA~ -
DATE
DETACH AND FILE FOR FOLLOW-UP
September 1, 1982
Edward I. & Geraldine B. }Iolmberg
SP~% Box 1765 R
Anchorage, ~ 99507
Subject~ Lot 13 Freeman Sub.
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completedz
The top of the well casing sealed with a sanitary seal so
that it is water tight.
Ezposed electrical wires to the well head are in violation
of the Municipality of Anchorage codes and must be encased
in conduit.
,""ne water analysis report needs to be submitted to this
office from the Chum Lab, 5633 B Street, for our review.
The septic tank pumped with a receipt submitted to this
department. The total number of gallons pumped needs to be
on the receipt and verified by a registered engineer as to
the actual number of gallons pumped. This is to verify the
size of the septic tank.
Expose the septic tank manhole to verify its existence.
Locate and expose the standpipe to the seepage pit for our
inspection. This is to insure the minimum distance
requirements are met between the well and sewer system.
A four (4) inch cast iron cleanout needs to be installed to
the septic tank and/or leaching area.
An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system is
adequate according to ~;ational Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
,Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.