HomeMy WebLinkAboutEAGLE CREST #1 TR A LT 63
/
DE~. OF ENVIRONMENTAL CONSERVATION /
ANCHO~G~ES~RN DISTRI~ OFICE /
555 CORDOVA S~E~
ANCHORAGE, ALASKA 99501
TONY KNOWI. ES, GOVERNOR
(907} 269-7505
July 19, 1995
RECEIVED
Gertrude Batten
P.O. Box 94
Eagle River, Alaska 99577
JUL 2 1 1995
Mu~ic.pahty el Ar~chorage
Dept. Health & Human Services
SUBJECT:
Lot 63, Tract A Eagle Crest Subdivision, Eagle River, Aia~s~.a~ Class C Public
Water System and Wastewater Disposal System, ADEC Project Numbers
9521-DW-037-083 and 9521-WW-037-204, Review
Dear Ms. Batten: :
I have reviewed your February 6, 1995 submittal regarding the upgrade of your single
family home into a Bed and Breakfast. Based on this review, I have the following
comments:
From the submitted information, it appears that the existing water system met all
regulations and guidelines when it was installed, Based on this information and the fact
that the demand on the existing water system will not be increased, it appears that the
water system will be able to meet the demand without modifications, Therefore, the
existing Class C Public Water System serving the two bedroom Bed and Breakfast and an
one bedroom single family residence located on the above-referenced property is approved
for the concerns of this Department, A final Operation Certificate, constituting this
approval, is enclosed,
The Department is assigning Public Water System Identification (PWSID) Numbers to all
public water systems in the state. As a result, the PWSlD number assigned to your public
water system is ,2.1~46~. Under existing State Drinking Water Regulations, Class C
Public Water Systems, with no know contamination problems, ars not required to conduct
monthly monitoring. However, is it is recommended that water samples be collected and
tested for nitrates (as nitrogen) and total coliform bacteria during February and August of.
each year.
From the submitted information, it appears that the existing wastewater disposal system
is being rested five months every year. We will not require an adequacy test to verify that
Gertrude Batten 2 July 19, 1995
the existing wastewater disposal system is functioning as designed. Thus, in accordance'
with the provisions of 18 AAC 72, Wastewatar Disposal Regulations and the Department's
guidelines, the wastewater disposal system serving the facility on Lot 63, Tract A Eagle
· Crest Subdivision is approved for operation based on the following requirements.
.. 1.. ,The,existing wastewater disposal system must be rested once a year f.o.r a total
Ii'.~ -! ',l 'of nb{ less than five months. No wastewater is to be discharged ~nto the
existing system during the five months period of mst.
,.. ;:. 2. The maximum capacity of the facility is limited to six people.
This letter constitutes final operation approval for the existing wastewater disposal system.
Effective November 10, 1994, the Department has been required to charge fees for all plan
reviews completed in the Drinking Water and Wastewater Disposal Programs. Based on
the fee regulations, the total amount due is $355.50. I have enclosed fee invoices (102505
and 203333) for your use. '
This approval does not imply the granting of any additional authod~.ations, nor obligate any
state, federal, or local regulato~j body to grant required authorizations.
Thank you for your coordination with this Department. If you have any questions, please
do not hesitate to contact me.
KKK/pt
Enclosures: As Stated
Sincerely,
Keven K Kleweno, P.E.
Environmental Engineer
Lynx Johnson, ADEN/SCROD/EH/D, w/o Enc.
Jim Cross, P.E., MA/DHOWS, w/o Enc.
-o f \ MUNICIPALITY OF ANCHORAGE
.... DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENGINEERING DIVISION
ENVIRONMENTAL
825 L Street. Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGA~ DESCRIPTION
~ ~ Manuf. turer~e_ / .~ / No. of compartments ~ :,
DISTANCE TO:
z--~o z ~ Manulacturer /~ / / ~ Material Liquid capacity in. lions,
~ DISTANCE TO:
~ DISTANCE TO:
PiPE MATERIALS ~7 ~eb -
SOILTESTRATING 2~ ~ ~
REMARKS - /
APPSOVE DATE LEGAL
72-013 IRe~ 1/78)
PERMIT
APPLICANT TOM BATTEN PO BOX 94 ~577
LEGRL (.~L-~T-j~..~'~R~ICT-AiEAGLE-CREST 'S/~ LOT SIZE
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
16~00 SQURRE FEET
MRXIMUM NUMBER OF BEDROOMS
SOIL RATING <SQ FT/BR)= 244
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= '12 LEr~IGTH= 4'1 I~RRVEL 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
GROU~ID RND THE BOTTOM OF THE EXCAVATION <IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES,
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REQU I RED SEPT I C TRblK S I ;;'E= '1000 m~RLLOr~S
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,
Thio < 2 ::, I r4SPECT I Ot4S RRE REi~U I RED
BRCKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM ,IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPO~I THE TYPE OF PUBLIC IdELL, ~
MINIMUM DISTANCE FROM A PRIVRTE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET,
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTIO~I DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION,
PERM I T EXP I RES DECEMBER ~'1~ '1980
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS.FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF RNCHORRGE.
2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~: I UNDERSTAND THRT THE ON-~ITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THR[I ~ BEDROOMS.
SIGNED'
RPPLICRNT TOM BRTTEN
', ~UED BY .............................. DATE_J~.--.~..-.~-___
V4. 0
DEPARTMENT OF HEALTH AND'ENVIF:O~ME~!TRL P[OTECTION
. ,-, .r . 825 'I~-~TF:EET~ At.~CHORRGE, R~:.. ~3~
PERMIT
LOCATION.
MAXIMUM ~IUMBER OF BEDROOMS
SOURRE FEET
.SOIL RATING (SO FT/BR)=
THE REQUIRED SIZE OF THE SOIL ~B$ORPTION SYSTEM IS:
PERMIT APPLICANT HA~ THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DU~IItG THE
INSTALLATION INSPECTION~ OF ANY WELL~ ADJACENT TO THI~ PROPERTY AND THE
NUMBER OF RESIDENCE~ THAT THE WELL ~IILL SERVE.
------ TLdO ( 2 ) I tqSPECT I Or4S ARE RE['~U I RED
BACKFILLING OF AN'¢ SYSTEM ~IITHOUT FINAL I)~SPECTION AND APPROVAL BY THI-~
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND A~IY ON-SITE SEWAGE DISPOSAL SYSTEM IS
iCC FEET FOR A PRIVATE ~tELL OR 150 TO 200 FEET FROM A PUBLIC ;,IELL DEPENDING
UPOt.~ THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM R PRIVATE ~ZELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUtlITY SEWER LIt,E IS 75 FEET.
- ~IELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 3~ DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. _~PECIFICRTIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERrlI T EXP ! RES DECEMBER -?-:l... ::L-C'-.SO
I
l:
FORTH BY THE MUNICIPALITY OF Rt. ICHORAGE.
2: I }IILL INSTALL' THE SYSTEM It~ ACCORDANCE I~ITH THE CODES.
I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT
RESIDENCE IS ~EMODELED TO INCLUDE MORE THAN ~ BEDROOM1
CERTIFY THAT
I RM FAt4ILIRR WITH THE REQUIREMENTS FOR O~I-SITE SEWERS AND ~IELLS RS SET
IF THE
V4. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street0 Anchocmge0 Alatkl 99501 264~4720
SOILS LOG - PERCOLATION TEST
$o~Ls LOG /
,/
PERCOLATrON
TEST o:
PERFORMED FOR:~ DATE PERFORMED::~~')
-- ' SITE
16.
17-
18-
19-
20-
COMMENTS
/~/~
A. Shafmr
Ho. 1457-E
1
2
"'-- 3
~ 4
5
7
10
WAS GROUND WATER ~/~ SL
ENCOUNTERED? pO
E
IF~YES, AT WHAT /
!PTH?
Gross Net ~.~I~C~ Depth to Net
Reading Date Time Time ~'1' , Water Drop
/ /ZO~.-r $.'5~ -z~ ' --
Z ,,4,'zo ~o ~ ~.~ ,,
7
PERCOLATION RATE ~
TEST RUN BETWEEN FT AND
II
72-008
CERTIFIED
DAT~_£~ r.~
Russell Oyster
694-2774
Civil Engineering
SOUS E~ Foundations
,/"~
'.0.8' E Elv~INEERING ~ DEVELuI~MENT CO.
Box 90. Davis St., Eagle River, Alaska 99577
6..~4-2774 or 333-5240
SOIL LOG
£ad Ellis
333-5240
Surveying
Lanai Development
Performed for: Name: ~x~"~-. ~L-c~
Mailing Address:~ %a~,~
Legal Description:'-'~'~-c'~-~ ~, ~ ~,~
Depth (feet)
Tel. No. .~
Sot1 Characteristics
0
1
2
3
4
5
6
7
11
12
Ground Water Encountered: Yes No v'~ If yes, what depth
Proposed Installation: Seepage Pit v/ Drain Field
Commen~s: ~ m,'T~"~C.~ ~. ~' ,,.) Tr'~.~
CHUGIAK, ALASKA
688-3199
~'~RILLING CO. ~
WE SERVE ALI. ALASKA
OFFICE ~OX 42 - CHUGIAK, ALASKA
OWNER OF LAND ? -
ADDRESS ...............................................................................................
DATE - STARTED ........................... , ....................................................
DATE - ENDED ............. ~..~.T..?.~..~..'.: ..........................................................
KODIAK, ALASKA
MUNICIp,~J,~.-~ORAGI~
DEPT. OF H?,LT;I &
ENVIRONMENTAL; ~ OT~CTION
1981
DEPTH OF WELL ....?.I.~....~., ................................................................
STATIC LEVEL OF WATER FT. 2.?....2C.t... ~-..~_.~"~;.· ............................
u~w DOWN FT..=...Z~...~:. .............. J ......................................................
GALS. PER HR ........ J.~;~...~c.~..: .............................................................
KiND OF (~ASmNC ......... ~.~.~-~.~"~.~J~!i~!.'~.ii~i......~J.......J....'..~..'.'.......~.....'...
KIND OF FORMATION:
FROM ............~ ....... FT. TO q
FROM ............3. ....... FT. TO .......,lj.~ ......... FT. g;2~..J....~..,.?..?. ~.:~ ~..1
FROM ...................... FT. TO
FROM ......... ~JL ....... FT. TO
FROM ............. ; ....... FT. TO
FROM ....... ., ............. FT. TO
FROM ....................... FT. TO ....................... FT ..................................
FROM ....................... FT. TO ........................ FT .................................
....... .r.,.k ......... FT. ::.~.~...:,.._.c,..~.~?.~!,.~FROM ....................... FT. TO .......... ,, ............ FT .................................
oc;c S~v.d ,~ G]t~vel ;~ Cln"
.... .y..:..~ ......... FT...iL.: ........................... FROM ....................... FT. TO ....................... FT .................................
.... 2.'.'?. ......... FT. 52.?.'.J....~%...C.'!.'?..'.".5.1 ' FROM ....................... FT. TO ........................ irT ................................
.... 2.!.2 ......... ~. ?.,.r..~..v.g~..:i=...i:{~.~.? r FROM ....................... FT. TO ........................ FT .................................
FROM ..................... FT. TO
FROM ...................... FT. TO
FROM ...................... FT. TO
FROM ...................... FT. TO ........................ FT .................................
FROM ..................... FT. TO ........................ FT .................................
FROM ....................... FT. TO ...... ' .......... :~.....rr .................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ....................... FT. TO ........................ FT .................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ....................... FT. TO ....................... FT ..................................
FROM ...................... FT. TO ...................... FT ....................................
FROM ....................... FT. TO ........................ FT .................................
MISCL. INFORMATION:
PERMIT NO.
DEPARTMENT.~'~HEALTHANDENVIRONMENTALr'~OTECTION
,' 825 '~ STREET, ANCHORAGE,
264-4720
~dELL PERMIT
( 800¢4S )
APPL I CANT
LOCATION
LEGAL
BERLY R. BATTEN PO BOX 9~ 99577
EAGLE RIVER .... ~
t~3~'.~a.~__i'i~T'A EAOLE CREST~,,'D ~ LOT SIZE
694-2523
17550 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS ~5 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BV THE MUNICIPALITY OF ANCHORAGE.
~: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
SIGNED'
APPLICANT BERLY R. BATTEN
ISSUED BY,
V4. 0
'P 'RmI : NO. <
LOCAT I ON
LEGAL
TYPE OF SOIL ABSORPTION
DEPARTMENT ~J;L~ HEALTH AND'ENVIRONMENTAL ~-~OTECTION
825 ~' STF'.EET, ANCHORAGE, AK. 9~ .l
264-4~2~
THE REQUIRED SIZE OF THE ~OIL ~BSORPTION ~VSTEM
DEPTH= LE~IGTH: GR~%"EL DEPTH=
SQUARE FEET
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUt. ID AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION <IN FEET).
RE~.U i RED --~EPT
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 Cc';, II'.I'qPECTIOI'4_~· lIRE REC~LIIRED
mmm · m
BACKFILLING OF ANY SYSTEM HITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMEHT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL or 150 TO 200 FEET FROM A PUBLIC HELL DEPEHDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DI~TRHCE FROM R PRIVATE HELL TO R PRIVATE ~EWER LINE I~ 25 PEET AND
TO R COMMUNITY ~EWER LINE I~ ~5 FEET.
WELL LOGS ARE REQUIRED AND MU~T BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENT~ MAY APPLY. SPECIFICATIONS AND CONSTRUCT[ON DIRGRRH5 ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERt'l! T E×P ! RE--'---. DECEMBER ..3::1... '1_'~.80
I CERTIFY THAT
l: I RM FAt4ILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS -~ET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL' THE SYSTEM Itl ACCORDANCE NITH THE CODE~.
I UNDERSTAND THAT THE ON-~ITE DEWER $Y~TEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE I~ REMODELED TOI,~RE THAN ~ ~EDROOM~.
__ ...........
ISSUED BY__ DATE__ ~/~ -~-~ V4. e
•
•t c_ Municipality of Anchorage y v� ,� ►—, :ate,
On-Site Water and Wastewater Program '; . ; ll 1
(907) 343-7904 E` AUG, - s r F Err .�
Certificate of On-Site Systems Approval
fir/ 4 �,\
! .
050-304-28 c, s � �� 9
Parcel I.D. Expiration Date: 12r 5 � f
1. GENERAL INFORMATION
Complete legal description Eagle Crest #1 Tract A Lot 63
Location (site address) 19514 First St.
Current Property owner(s) Thomas Batten Day phone
Mailing address PO Box 770094 Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well El Individual E
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
- r }
Received b : ;.�i A../04.i ' A �' ° ' Date: q/LC i 7
- F 1
COSA to be released to the engineer,unless otherwise requestedthe engineer.
COSA Fee $ 524, " Waiver Fee $
Date of Payment ''/12 )13- Date of Payment
Receipt Number 09-3-.71-
9 -.71 /6 Receipt Number
COSA# 650'4 1 (,c/ Waiver#
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 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.
In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 soil
condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 8/17/2017
OF AL.Ai5kk
6. DSD SIGNATURE
System #1 Approved for bedrooms •Steven R. •annone
System #2 Approved for bedrooms ��oq,-• CE-8149 i�
y Awe
Disapproved � •FPOrESS ��C
Conditional approval for bedrooms, with the following stipulations:
s
,c �J
C. u.,_ 2
i
Original Certificate Date: 7 S ^C 7
The Municipality of Anchorage Development 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. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_f
If more than 1 septic system is on the lot:
COSA Checklist# I of
Structure served by this system '
Certificate of On-Site Systems Approval Checklist
Legal Description: Eagle Crest #1 Tract A Lot 63 Parcel ID: 050-304-28
A. WELL DATA
Well type Private If A, B. or C provide PWSID# Well Log (YIN) Y
Date completed 12/5/1980 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 31 3 ft Cased to 313 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 12/5/1980 8/9/2017
Static water level 20 ft 283 ft.
Well production 7 g p m 4'3 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2.14 ,ng/L
Arsenic ND ug/L Date of sample 8/8&11/17 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 11/6/1980
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping
6/16/17 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed
11/6/1980 Soil rating (g.p.d./ft2 or ft2/bdrm) 244 sf/bdrm System type Trench
Length 41 ft. Width 2.5 ft. Gravel below pipe 7 ft.
Total depth
10-11 ft. Eff. absorption area 574 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/9/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test Dry* in. Water added 455 gal. New depth 18 in.
Elapsed Time: 1 80 min. Final fluid depth Dry in Absorption rate >= 450+ g p d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
*Sump/MT only extends 30" below pipe invert.
G. ENGINEER'S CERTIFICATION ,.Zel OF ,4[\`�1
kk
/ certify that ! have determined through field inspections and ���'�. ...1,—.:•1"7‘,0
review of Municipal records that the above systems are in *; • • ilk • * ,
conformance with MOA COSA guidelines in effect on this date. 4 `? •��� �•
Steven Pannone `tm. . << •• •••• /
Engineer's Printed Name i •S e . .nnone
Date 8/17/2017 OTIN...1:-. CE-8149 %
5.
aiolssi4 o '
,t\it.�""b-�
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Vbb E;.-0 1-3 Y S .12_..-f-jok,t/..,e4)/ve?-,l'.6- • - . . .
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I hereby certify that I have surveyed the folloyiro
. • , . __ / .., ri--age-c.Y..A
described property: 1-, 1 7' Ca'.-5.,
• ' :* r-4c.. .- ' ' ,---e.- ' - $14.,. -el 4-LLA-414-
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,., . • • 7%,':•-• I
• ,Ltv.A.• -7) 7-74- AI i R i 1-1-1 5
--•:"' , :'"•-•:.t Anchorage Recording Precinct, Alaska, and that- the.
.•. ...):- .?j ...., ,•1 improvements situated•thereon are within the property.. -.
' "I N 111. li nes and do'not 'overlap or encroach on the property:
' .2' ••• 1--. '. .-.•'."/
lying adjacent thereto, that no improvements on prop-. *.-.
r • . , city lying adjacent thereto encroach on the premises in ..
vf .4 •••••14:1-1 4; • % * p question and that there are no roadways, transmission
••• . %, 11. e
.:,•..1.........••...........•.•,-.3••.•/ hoes or other visible easements on said properly except.
— ' -.I --'- ' -•
' - A 1.1 ,1 . . ---144-, 1].•.-e_.0„f.:,-. as indientri hereon. ' .. ,
.• ''
- Dated at 1.4"*.ngle Rit-er. Alaska ._
.. this_ i r•-=C
of 19-Pc"
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' . ROBERT C. JOHNSONc...?_.,1:•-.6- - . -
' SCALE: Regislered Land Surveyor No. 880-LS..
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: 1" -_-_ 2 ,. / Box 456, Er.gle River, Alaska
Phone 694-2543 • ,
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,,~ -~. --' SATE RECE,VED
'~'_ ' INSPEC't~r0~I APPOINTMENTS~' ~/._~,~--~' ~t~ ' ~
MUNICI~AMTY OF ANCHORAGE ~UNIC~A~OF, AN~O~
ENVIRONMENTAL SANITATION DIVISION JAil 1 2 1981
Tele~e
wX. .D
DIRECTIONS: Complete all parts on page 1. Incomplete ~u~ will ~ot ~ pr~. Please allow ten (10) days for pr~essing.
PROPERTY RESI~NT Ill di[lere4[ fr~ ~o~) ' ' ~ PRONE
2. BUYER . , PHONE
MAILING ADDRESS
~MAILINGLENOING INST~TUTIONADDRESS ~~ ~ ~~ I PHONE
4. REALTO~/AGEN~ ~ PHONE
I
MAILING ADDRESS
6. TYPE OF RE$1D~:NCE .... j NUMBER OI=~I~EDROOMS
~SING LE FAMILY [] One I-'1 Four [] Other~
D /Two [] Five
I'--I MULTIPLE FAMILY I~ Three [] Six
7. WATER
[~ IND(VIDUAL°
r'~ COMMUNITY
[] PUB,LIC UTI LITY
8. SEWA G/E D/~ielJ~A L SYETE M
INDIVIDUAL/ON-SITE
PUBLIC UTILITY
· ATTACH WELL LOG. A well log is required for all wells drilled '
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
YO YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
-.. THIS SIDE FOR OFFICIAL USE ONI~Y
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
I'-IINDIVIDUAL/ON *SITE DATE INSTALLED
[]PUBLIC UTILITY \ q ~'~
Connection Verified INSTALLER
[]Septic Tank or r-IHoldingTank
Size: ~ (~(-(~)(~ If Tank is homemade BOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL . -
5. COMMENTS
~ CONDITIONAL APPROVAL {letter must accompany certificate}
[] DISAPPROVED
72-010 (Rev. 6/79)
