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HomeMy WebLinkAboutT13N R3W SEC 22 LT 13Municipality of Anchorage SEP -002018 -- Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171145 PID Number: 006-314-01 ❑ New ❑✓ Upgrade Name: CHARLES & LINDA BOWERS ABSORPTION FIELD ❑ Deep Trench El Shallow Trench E:1 Bed E] Mound Address 5101 E 22ND AVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 0?— /01 Pws GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravelde eneath pipe Ft. Subdivision Block Lot 13 Fill added above original grade 0 Ft. Gravel length Ft. Township Range Section 13N 3W 22 Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total ab ption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line FC Ft. Well 92.9 N/A N/A N/A 39.7 TANK ❑p Septic [:1S.T.E.P. El Holding ❑ Other Manufacturer Anchorage Tank Capacity 1000 Gal. Surface Water 100+ N/A N/A N/A Material Steel Number of compartments 2 Lot Line 73.9 N/A N/A N/A NA Foundation 55.1 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A N/A N/A Gal. RemarksTANK REPLACE ONLY � Pump on level at Pump off leve in. High water alarm at in. Pump make model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield A+ Home Services Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 240ft Inspection st 1 6/29/17 5/15/18 Location and description dates: 2°d NW BOTTOM HOUSE TRIM 3rd 4,h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp �2 k1� Ak Conditional Approval: Date • 'Q��� ��Q'�rG. co. •'9 *: 49 TH •.* �� •te'veri •f : Nva none' PES, ib coa4cl 4-o S-TP3 i li hnJ js Wnoc 0_�e / �. •E 8149 odFi?OFESS Approve (' Q, �Q Lp �J( Date 11105 ao Is k A Inspection Report_1-1-12.doc EXISTING DRAIN FIELD INSTALLED NEW 100 Co SEPTIC TANK WITH DCO BEFORE AND AFTER DCO T2 ABANDONED EXISTING 800_g - SEPTIC TANK PER MOA CODE T1 GARAGE DCO .0 10 0 0 A B DCO 21.7 22.9 T1 58.0 57.2 T2 64.9 64.6 DCO2 67.4 67.2 0 0 wo �z z z Jo M, < < m< �z D OG./FG. 240 4.0 I — � L 1000 g SEPTIC 23=5 2 5.4 TANK PROFILE SCALE: I"= 10' NOTES: PAMONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211Scale *n*o* A, ;' CE 81 Date 05/23/18 RECORD DRAWING Rav 1 4 6aoz- 1" = 50' T13N R3W SEC 22 L13 CHARLES & LINDA BOWERS 5101 E 22ND AVE ANCHORAGE, ALASKA 99508 P.I.D. NO 006-314-01 DRAWN ACP PERMIT NO. OSP171145 SITE PLAN Sheet 2 OF 2 os,0,0,A„,e0, MUNICIPALITY OF ANCHORAGE ,p,,„r On-Site Water&Wastewater Program ' ;-`> PO Box 196650 4700 Elmore Road Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 httpllwww.muni.orglonsite ; l)_l>artitivnt 4hCMp0.of On-Site Wastewater Disposal System Permit Permit Number: OSP171145 Effective Date: 6/23/2017 Work Type: SepticTank Upgrade Expiration Date: 6/23/2018 Tax Code Number: 00631401000 Site Legal Address: T13N R3W SEC 22 LT 13 G:1537 Site Mailing Address: 5101 E 22ND AVE, Anchorage Owner: BOWERS CHARLES C & LINDA K Lot Size in Sq Ft: 88601 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 2 This permit is for the construction of: ❑ Disposal Field I1 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Tank to be located as far from well as possible and protected from corrosion (both inside and out)with coating required by STI-P3 (similar to Advantex tanks). CReceived By: J I'II I Date: 4002/1 Issued By: '211-te(3R u6' Date: 6/23/.-O i 7 Municipality of Anchorage n�en� n,a oiWU; 1 eparlmenl P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:llwww.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: COSA#: Permit#: OSP171145 PID#. 006-314-01 Legal Description: T13N R3W Sec 22 Lot 13 Engineer: Pannone Engineering Services Applicant: Charles & Linda Bowers Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 85.0 feet. Tank to be protected from corrosion inside and out with coating required by STI-P3 (similar to Advantex tanks). This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. n Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. [A Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date. C,/2,3l 2 017 Approved by: ;t-e,t_o_ \,_Q-,-L, _ Name of Reviewer **** VARIANCEIWAIVER REVIEW **** QMQ1P-CJ\ C MUN ' IP A LI 0 A CHORAGE e. Community Development Department /r Phone. 417-' • Development Services Division F. - latilifir9• �o On-Site Water& Wastewater Program N ON-SITE SEWER/WELL PERMIT APPLICATION a JUN 1. 5 2017 Parcel I.D. 006-314-01 Charles & Linda Bowers �� 6 8 L Property owner(s) Day phone Mailing address 5101 E. 22nd Avenue Anchorage, AK 99508 Site address 5101 E. 22nd Avenue Legal description (Sub'd., Block & Lot) Lot 13 Legal description (Township, Range & Section) T13N R3W Section 22 Lot Size 88,601 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 216-- Waiver Fees: Date of Payment: (, 11 ke<c1 Date of Payment: Receipt Number: (Q1 a-O 6\ Receipt Number: Permit No. OcDe11 I N S— Waiver No. Permit App_.-: ..:c Pannone Engineering Services Lic Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com June 15, 2017 Subject: T13N R3W Sec 22 Lot 13 EMERGENCY: Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,000g Septic Tank to replace an existing 800g tank to be issued for this property. The existing tank has collapsed and is backing up. The new tank will be placed in the same spot as the existing. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,000g Septic tank that will be connected to the existing crib. The existing tank is located approximately 55' from the well and was installed in accordance with the code in effect at that time (1959). All other required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property line or building foundation 10'+ from any water line 100'+ from any surface water 100'+ from any surrounding private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, . kAkt, 4 0 • • • • • Steven R Pannone y $ qQl Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage. AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 MUNIUPAUTY OF ANCHORAGE Development Services Department �`°r Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 00631401000 1. GENERAL INFORMATION Rao Complete legal description T1 3N -VV S22 L13 Location (site address) 5101 E 22ND AVE Expiration Date Current property owner(s) Charles Bowers Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5U Date of Payment '�'-1 13 Receipt Number 07 51 5_G Waiver Fee $ Date of Payment Receipt Number COSA # 05C- 2 11050 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for 2 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date OF A�qs���� TH T.Ste,er R.•Pannone I CE 81 do D'40r�SS��';� Conditional approval for bedrooms, with the following stipulations: By: r Original Certificate Date: 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 Checklist blue sheet PT A T1 D COSA Checklist? -I--.. Legal Description: T13N R W S22 L13 Parcel ID: 00631401000 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled "1959 Total depth unknown ft Cased to unknown ft OR Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 1/26/21 Static water level at beginning of test NA ft. Comments M -W Drilling performed well flow. B. TANK DATA Age of tank (S) 612017 years Tank type/material Measured operating fluid level in septic tank 48in 0_1 Standpipes/foundation cleanout per record drawing Date of pumping 7/18/20 D. ABSORPTION FIELD DATA Crib Which system tested (date installed) -1959 N ALL standpipes present per record drawing Total measured depth from grade 11.7 ft (max) Measured depth to pipe invert from grade 5.7 ft (min) ❑ N/A - pressurized field 01 Monitor tubes go to bottom of effective. If not, state depth into effective W Code -required soil cover over field X System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 10 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes ❑✓ No 0 Coliform bacteria is Negative Nitrate .(,;'.5 `; mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L F Arsenic less than MRL (ND) Collected by � 0.2 Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 1/29121 Results Q Pass For 2 bedrooms Fluid depth prior to test 15 in Water added 350 gal New depth 54 in Elapsed time 1440 min Final fluid depth 16 in Absorption rate >300 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 92.9 Community Sewer Manhole/Cleanout > 100' F-1Yesif No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q✓ Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 2 Yes if No ft Neighboring Absorption Fields > 100' F/� Yes Animal Containment > 50' EJ Yes if No ft [D Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' E] Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100' 0 Yes if No Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No Water Service Line > 10' F/� Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓l Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS _ G. ENGINEER'S CERTIFICATION l 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. 2 I dZ COSA Checklist yellow sheet OF A�q :49TH �1 Steven R. Pcinnore J ft ft ft ft SGS Rel:# 121081 1001 Client \Ante 907 Water Well Services I'roject Name/# 5101 E: 22nd Ave Client Sample 11) 5101 E 22nd Ave kiatri. Drinking Water Sample Remarks: Printed Date/Time 03/10/2021 10:46 Collected Date/Time 02/23/2021 13:18 Received Date/Time 02/23/2021 14:01 Technical Director Stephen C. Isde Allowable Prep Analysis Parameter Results I.OQ Units Method Container Ill Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliiorm ND 5.00 6.54 0.200 Negative i Negative I u -/L L'P200.8 13 (<10) 02/2421 03/04/21 DSD mg/L SM21450ONO3-I' C (<10) 100m1. SN1219223B A 100mL S1M219223B A 03/02/21 DMM 02/23/21 A.A 02/23/21 A.A Page 2 of 5 Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211050 Subdivision: T13N R3W Sec 22 lot 13 A water sample revealed a nitrate concentration of 6.54 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Marling Address P O Box 196650`* Anchorage, Alaska 99519 6650 *www mute org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org Water907 Water"We Keep Alaska's • ;" 30-1868 Concerning the property located at 5101 East 22" d avenue in Anchorage Alaska 99508. A well camera inspection was conducted on 2/23/2021 at approx. 1:00 p.m The results are as follows below: Casing Stickup 18.5" Pitless depth 0+ (well is indoors) Total depth 77'+ S.W.L 71' Sanitary seal is intact No cracks, breaks, or perforations. No other signs of visible contamination of failure of construction found. If there any further questions regarding the well on this property please feel free to contact us. John Netherton • O M r I O ca 0 ro Ln O O -_j i c" Q D E 9976Z M..OE.60o00N 0'££ o g "LS 2 m o i cll E:6 c C7 LL- o�7, v O N C E �y I > 3? o O I I cll c >, O a ai O _'- O N Z 72U v D- o m cu r-i I I LO Cf)mZoa`� 3 t-I \ v O 1 N i a_ aTi i0+ f N =U I w w I �0c s 0Z' i; F- I a� a> L z o v) cII O 6 LL > co n @ m ❑ Q 1 M N CI- Co N U `�° j I Hd°'aa 0 !- a �I �n� u Lll v. 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V / J til ') \ U N U1 I '--i' y 2 4J w 99'16Z 3..OD.ZO o00S n Cl) ° ° //'"' s OLL O o / O I may,., 4; N o£ o /// � .\`� Qom' -- o \ / v v z 0a a/rr ' �y' St`�� — �--�-- Z31 x N - - - - - 1���J1S N�I� b`�J ----- Q,; F ,N v Q Q ti's,;,..: �'� "� I N `Uij o ,- ci 6 v Mulficipality'of Anchorage Development Services Department Building Safely Division On-Site Water and Wastewaler Program 4700 South Bra(jaw St. 1 P.O. Box t96650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 34:J-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL' FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complele legaldescription Lot Location (site address or directions) Joe]. 2209 Current Properly owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Expiration Date: 0. o 17 13; Section 22; T13N; R3W Schwantes Dayphone Eureka St. Anchorage, AK 99503 230-9537 Day phone Day phone NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site X~] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon Ihe representations given In paragraph 5 by an Independent professional civil engineer registered In the State o[ Alaska. Certificates of HealU] Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal ahd/or water supply system. DSD also issues HAAs upon request Io homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less ti]an 30 days old. (Certificales may be reissued for a period of up Io one year with valid water samples.) Cerlific~les are valid {'or one year for properties served by Class A or B wells or a public water system. The Munlctpafi[y of Anchorage Is not r~sponsiblo for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY E~JGiNEER and reg. ulat!ons In effect at Ihe time of Installalion. " Name of Firm S & S Engineerin~ Address 17034 N. F. agle River Loop Ste. Engineer's Printed Name Robert C. Cowan As certified by my seal affixed hereto and as o{~ Ihe valida[ion da{e shown below, I verify Ihat my Invesligalion, based on procedures outlined in the Health Authorlly Approval GLlldelines for Ihis application, shows Ihat the on-site water supply and/or wastewater disposal syslerrt is(are) sate, functional and adequate for Ihe number of bedrooms and type of structure Indicated herein. I further verify Ihat based on Ihe Information obtained from Ihe Municipality.of Anchorage files and from my Investigation and Inspection, Ihe on-site water supply and/or wastewater ,disposal system is(are) In compliance With all applicable Municipal and State codes, ordinances, Be DSD SIGNATURE ; , ~ Approved [or ~ bedrooms. Disapproved. ' 204 Eagle Phone 694-2979 River, AK 99577 Date ,F'//0/0 ~ ~ t%~ ............ ,. "'/,, , / ~ z , '~ ~ ' ~,~.~/,....~: .... '1~ ~.~' --~. ~.~.. .... ~.~ [~ ~j .; .............. f,,~ · .. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic Sys|em Advisory Well Flow Advisory Maintenance Agreements SUpplemental Engineer's Report Olher Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program ~ 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-79O4 Legal Description: A. WELL DATA we, type Date completed w.. I Total depth t,,J~( ff. HEALTH AUTHORITY APPROVAL CHECKLIST L , 9.,; 5,'< ,-)~ ~_ Tl ~t.'.) ,~ Parce,,D: o o; - 3,'~-o / If A, B, or C provide PWSID # -- Well Log (Y~ ~ Sanitary seal ~/N) "/'~.,r Wires properly protected (¥..~i~1) Cased to. [/l~ ft. Casing height (above ground) in. FROM WELL LOG Date of test Static water level ~ ft. Well production WATER SAMPLE RESULTS: Coliform O colonies/100 mi. g.p.m. SEPTIC/HOLDING TANK DATA TankType/Material $~.,o-r~ / Tanksize ~'~O '~gal.' Number of Compartments Foundation cleanout (~N) ~Y?~L Depression over tank (Y~) Date of pumping. ~r//~/~ ~ AT INSPECTION ~-/~/o.~ g.p.m. Nitrate ~.~, mg./I. Otheroacmna ,-~ colonies/100 mi. '~,~ $ & $ ENGINEERING Date of sample: ~'/~'/05 Collected b~lTn~a ~,_Me Ri~er Leep Read No. 204 Eagle River, Alaska ~577 Pumper. Date installed Cleanouts (~/N) High water alarm ABSORPTION FIELD DATA Date installed ~ I ~ ~/ Soil rating ~r ftt/bdrm) J- Length u [ k fl. Width u / ~ fl. Total depth ) ' ft. Eft. absorption area u ~K .fit Monitoring tube Date of adequacy test J~' ' ~'-0 ~ Results (Pass/Fail) Fluid depth in absorption field before test ~" "in. Water addedS'7~gal. Elapsed Time: ..~ min. Final fluid depth .'~'3in. Any rejuvenation treatment (past 12 mo.) (YIN & type) O.J~/'/W,v System type Gravel below pipe ,-n.. ~; ft. Depression over field /~ 0 For ..~ bedrooms New depth o~ ~ in. Absorption rate >= /"/~) ~' g.p.d. If yes, give date ION Date installe~'d"----~._ "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. High water alarm level at Cycles tested ~cuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots / O o /-~ On adjacent ?~s, Public sewer manhole/cleanout Holding tank ,V ,,/,'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5" ~ Property line 5"/-/'-- Water main /O -/- Water service line Wells on adiacent lots ! 0 0 --~ Absorption field Surface water /oo 5/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line J Water Service line I 0 .4- Curtain drain Building foundation Surface water / o Wells on adjacent lots Water main Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name /~0~4~,¢7- C'. ~'o~#~' . Date 5"'/! ~ /o 3 HAAFee $ 3"7,)"'. ¢~' '~ /3'-O Date of Payment J"/'~'7/~ .7 Receipt Number C9 ~ Go,~ ! ~ ~3' Waiver Fee $ Date of Payment Receipt Number (Rev. 12/01) Performed Fort ~'O ~/.. Municipality of Anchorage Development Services Department Building Safety Division On-Site Wat6~' and'Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 vc~',v.ci.anchoraqe .ak .us (907) 343-7904 'dru,~ V y Soils Log - Percolation Test L.=31D._.np,.cn. ~-.0 '7" I ~ SloCe q WAS OROUND WATER 9- ~ "{ I, [.. (~ ~/)~ O ENCOUNTERED? 10- ~o / F,~ IFYES, AT W~T DEPTH? 1 1- ~0 Depth toWater A~er ~Icnitoring? 13- Reading Date Gross Time Net Time Depth to Water Net Drop put ~- 14- 15- 16- 17 13 . cn . H . 18- 19- 20- PERCOLATION RATE '~ I (mnutes.'inch) PERC HOLE DIAMETER TEST RUH B~TWEEN ~ FT AND ~ FT PERFORMED By: $ & $ I~IGINEER'NG I '~ZZ~ CERTIFY THAT THIS TES'[ WAS PERFORMED IN A'~J~'DF~ I~,iFJeclF,J~L~3~OlI~I~,~,~.~4OlPAL GUIDELINES IN E~FECT ON THIS DATE. DATE: Eagle R~¥er, Alaska ~577 tIJ GLACIER STREET w ca w w N 00002'00"W 297.66' (R) 33 E ((o `^ o � 126.8' • , 3e.z' `\\, 0 EXIST. HSE. �[ • ✓� m EAVES 3.8' FO O w O o 38.' i s� D vsAf g a U)ca �o N a, N cn ap ati 93.5' ((0 ro o o, C� m A o x < m wo Z — �A 1--r7 33 BASIS 297.66 (ft) N 00°02'00"W 297.70' (M) 30 f i b z O_ O M3 N j' C. O. O ..{ �I N W 4 m O ~ m ,0,. W a 2- m f+1 \ 03 Z 0. iyD O < fD N 3f3D '�� `�. M o f �A P!S • n Gi O �.n J .E � ]'. J Ol O n ,�` PSP • ♦ i •wI/�/19 OT EO W II �. c co 0.0 N o .NrN toil 0 /o�:•r CL Mo r + m o.a v, o y y mnCL 7 onp by�m°v(n o o 30 z � r AV z AP v :tl 0O O � '• @ C O- O (Oi, ((D 0 j a 6 1 m y' � �. w Ep Cn I O D O y 0