HomeMy WebLinkAboutNORTH SLOPE BLK 2 LT 4North Slope
Block 2
Lot 4
#050-511-24
Municipality of Anchorage
Community Development Department Page 1 of 3
Onsite Water 8 Wastewater Program
4700 Elmore St. a P.O. Box 196650 Anchorage, AK 99519-6650 • http:/ANww.muni.org/onsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP121272 PID Number: 050-511-24 ❑ New ®Upgrade
Name: SCOTT & BARBARA AMY
ABSORPTION FIELD
❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound
❑ Other
Address:
30711 PRUDHOE BAY AVENUE *EAGLE RIVER, AK
Phone: No. of Bedrooms:
(907) 301 —6118 3
Sal Rating:
0.45 GpD/sq. Ft.
Total Depth from original grade:
*5 MAX Pt.
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
Gravel depth beneath pipe:
2.50 MAX Pt.
2.50/2.50 pt,
Subdivision: Block: Lot:
NORTH SLOPE 2 4
FlII added above original grade:
SEE DWG. n.
Grovel length:
2 @ 65' = 130 pt.
owns Ip: _ anger — ec ion: —
Grovel width:
Beds Number of lines
Distance between lines:
5 rt.
—
—
R.
SEPARATION
DISTANCES
Total absorption area:
1 01 5 So. R.
umber of trenches:
2
Dist. between trencher:
10+ Ft.
TO
From
Septic Absorption Lift Holding Public/Private
Tank Field Station Tank Sewer Lines
well
100'+
100'+
—
—
25'+
TANK ® Septic ❑ S.T.E. P. 01 -folding ❑Other
Surface water
100'+
100'+
—
—
Manufacturer:
ANCHORAGE TANK
Capacity:
1000 Gal.
Lot Line
5'+
10'+
—
—
N/A
Material'
STEEL
Number of wmpartmentr
2
Foundation
5'+
10'+
—
—
LIFT STATION
Curtain Drain
NONE KNOWN
MenW chnen capacity:
Gal.
Remarks: PER CONTRACTOR OLD SEPTIC TANK WAS
'Pump on" level at: •Pump off level at: Ni r owm aL
DECOMMISSIONED PER UPC.
pumv Mala a Mod
trical Inspections performed by.
*5' MAX DEPTH APPROVED BY MOA DURING INSPECTION,
BECAUSE G.W. IN TH#1 WAS 0 10' B.G. ON 9/4/12.
PIPE MATERIAL
House to tank D3034 Tank to 03034
drainfield
Installer
NORTHERN EXCAVATION
Drainfield D3034 CO MT D3034
CO/MT
GEG, Ltd.
BENCHMARK (Assumed elevation)
91.50 pt.
Inspection
Dates: 1st 9/4/1 2nd 9/4/12
Location and Description:
3rd 9/4/12 4th 9/5/12
BOTTOM OF TANK (ST2)
Community Development Department Approval
�aM�
oo�o
o O.F.
Conditional approval: Date:
`� S00
....... ... ......... ..... .....�
QO f r A. Gar ess:•
Approved: Date: 1 -/
9• C 95 emp
.t3 a\�o
pyo Pro
rofessio� 00
�DD000�a
PERMIT NUMBER:
OSP 121272
G mw -
ST1
�7�
ST2
%
88.11
N 5
72.45
DBL1
90.24
74.60
DBL2
91.36
75.69
BR
92.00
76.39
FS
1
129.73
110.19
C01
96.41
80.31
MT1
97.67
81.721
CO2
160.94
139.68
MT2
159.39
138,39
'� �
CO3
107.51
95.18
107.29
94.89
E164.56
16594
146.74
145.28
mm
ARCEL 1511
NMBER:
AS -BUILT DRAWING P 050 -511— U 24
100' WELL RADIUS
EXISTING
DRAINFIELD
POTENTIAL
FUTURE SITE
FOR
PROSPOSED
SHOP
..........
EXISTING 3
BEDROOM
HOUSE
DELI
CO373
TH#I
<�T,3
H
#1
MT21
T T
4
F4
4
e. +TH
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
3701 L NOOK N060, WM 101_• .UICHORAOEi M 99509 • NONE (90))=-6179 * FM (907)3 -320 * WE M.
PREPARED FOR: IPHONE NUMBER: PAGE NUMBER-
'
SCOTT & BABARA AMY 301-6118 2 OF 3
LEGAL DESCRIPTION: DRAWN BY.
NORTH SLOPE; BLOCK 2, LOT 4 PNB
TYPE OF WORK: DATE:
AS—BUILT DRAWING 9/12/12
NEW 1000 GALLON
,SEPTIC TANK
DRAINFIELDS
PERMIT NUMBER: AS -BUILT DRAWING t ING PARCEL ID NUMBER:
OSP121272 050-511-24
-
TOP OF TANK
AT INLET = 96.37
INSULATION
r FINAL GRADE = 99.46-100.37
- TOP OF TANK
AT OUTLET = 96.46
I NEW 1000 GALLON
INVERT OF BUNG SEPTIC TANK INVERT OF BUNG
AT INLET = 95.77 AT OUTLET = 95.68
MINIM
FILTER FABRV
IMIATION
FINAL GRADE -
98.21+
r ORIG M
0 HN
RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 82.50 (GROUNDWATER 0 87.50)
ELEVATION OF BOTTOM OF TESTHOLE = 80.25 (GROUNDWATER AT 83.25)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
13701 E NOOK ROTO, 900E 101 • NION E. N( NW7 • ffl N (907)337-9179 r FM (907)33 U— • M M.. W'+�,9am9w9n9MxOgmm
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
SCOTT & BABARA AMY 301-6118 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
NORTH SLOPE; BLOCK 2, LOT 4 PNB
TYPE OF WORK: DATE:
PROFILE AS -BUILT DRAWING 9/12/12
On -Site Wastewater Disposal System Permit
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
Permit Number: OSP121272
Tax Code Number: 05051124000
Work Type: Septic Upgrade
Permit Effective Dates: August 29, 2012 to August 29, 2013
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: NORTH SLOPE
Site Legal Address: NORTH SLOPE BLK 2 LT 4 G:0703
Owner/Address: AMY J BARBARA REVOCABLE TRUST
AMY SCOTT A & BARBARA J / COTRUSTEES 30711 PRUDHOE BAY AVENUE EAGLE RIVER AK 995771
Site Mailing Address: 30711 PRUDHOE BAY AVE, Eagle River Lot Size in Sq Ft: 111644
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank 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.
Special Provisions: The permit includes waiver OSP121273, allowing the drainfield to be a
minimum of 25 feet from a 25% or greater slope.
Received
Issued By
Muni
ality of Ancho
P.O. Box 196650 • 4700 Elmore Road
AnchoragFax (907)343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
pent
i
o P� ps � rn
Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP121273 COSA#: _ Permit#: OSP121272
PID#: 050-511-24
Legal Description: North Slope, Block 2, Lot 4
Engineer: Garness Engineering Group
Applicant: Scott & Barbara Amy
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to a 25% or greater slope has been approved. The approved separation distance is 25.0 feet.
This waiver approval applies to the proposed absorption field 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.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
................................................................ a..............
Waiver is Granted: x Waiver is not Granted:
Date: n Approved by:
Name of Reviewer
.............................................................................
Rec#: 06484G Amount: $200.00 Date Paid: 8/27/2012
**** VARIANCE/WAIVER REVIEW ****
�\�sW,
MUNICIPALITY OF ANCHORAGE' RUSH!
Community Development Department • Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
On -Site SewerNVell Permit Application
For A Single Family Dwelling
Parcel 1.D. &50 — -51 D- 'A
Property owner(s) SCOTT & BARBARA AMY Day phone 301-6118
Mailing address 30711 PRUDHOE BAY AVE *EAGLE RIVER, AK 99577
Site address 30711 PRUDHOE BAY AVE *EAGLE RIVER, AK 99577
Legal description (Sub'd, Block & Lot) NORTH SLOPE; BLOCK 2, LOT 4
Legal description (Township, Section & Range)
Lot Size
Sq. Ft. Number of Bedrooms 3
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
❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
EXCESSIVE SLOPE WAIVER
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.
GARNESS ENGINEERING GROUP. Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No. CDS�0c��1a
Date of Payment:
Receipt Number:
Waiver No. OSP 10 1 a -13
(Rev. 01/11)
August 16, 2012
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic Upgrade for North Slope; Block 2, Lot 4
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The existing drainfield is in a
state of failure and needs to be upgraded. We are proposing to install a new 1000 gallon septic tank and a
dual 5 -wide trench type drainfield. One test hole was excavated on the property. The drainfield will be
designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as
follows:
1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY & SLOPE WAIVER: As can be seen on the attached design drawing the
topography around the drainfields are relatively flat. However, there is a cutbank within 50 feet of the
proposed drainfields. We are requesting a 25' waiver be granted from the drainfields to the cutbank. As
can be seen on the attached drawing, at a 25% slope (starting 2.5 feet above the drainfield) the potential
point of daylighting is greater than 50' horizontally from the nearest drainfield.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
q
ly, ar .E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic system. (Contact G.E.G. Ltd for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengincering.com
NORTH SLOPE #1; BLOCK 3, LOT
/7w`/'^
\
\
\
\
1m/WELL RADIUS
\
/
/
/
/
/
/
CSEPTIC
AR 1D
NORTH SLOPE; BLOCK 2, LOT 3
DH
[ CS-EPTIC 1 00' WELL RADIUS
NORTH SLOPE #1; amo 3�1.,GT 8
/ ,00' `�
WECL RAG'
/
/
/
/
NORTH SLOPE; BLOCK 2, LOT 5
NORTH SLOPE; BLOCK 1, LOT 2
GARNESS ENGINEERING GROUP, Ltd -
PREPARED FOR: PHONE NUMBER: PACE NUMBER: .. ......
NORTH SLOPE; BLOCK 2, LOT 4 P B
SITE PLAN
TYPE OF WORK: I DATE: 2112
NUMBER OF BEDROOMS: 3
GALLONS PER DAY (GPD): 450
PERCOLATION RATE/S: 60 MIN/INCH
PROPOSED APPLICATION RATE: 0.45
MINIMUM DRAINFIELD SO.FT.: 1000
NOTE: THE CONTRACTOR
SHALL HAVE ALL WELL RADII
FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO
CONSTRUCTION.
\ \1
100' WELL RADIUS \ \
MAXIMUM DEPTH: 4 FEET
WIDTH: 5 FEET 3. \
LENGTH: 2 ® 65 FEET = 130 FEE( ;•> ?. .
REDUCTION FACTOR: 0.64 I
EFFECTIVE: 2.5 FEET
ACTUAL SO.FT.: 1015
EXISTING 3
GEG, Ltd. HAS A 7 PAGE SPECIFICATION BEDROOM
LETTER THAT PERTAINS TO THIS DESIGN. HOUSE
TO OBTAIN A COPY OF THE LETTER
CONTACT GEG. BY PROCEEDING FORWARD /
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER, CONTRACTOR AND /
PROPERTY OWNER AGREE THAT THEY /
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
CONDITIONS OUTLINED. \ \ INSTALL FCO
P• \ IF ONE IS NOT
PRESENT /
i
NOTE: INSTALL 2"
OF INSULATION - OVER DRAINFIELD PROPOSED
POTENTIAL 1000 GALLON
FUTURE SITE SEPTIC TANK
FOR N
PROSPOSED
SHOP
XISTING 1000 SCALE:
GALLON SEPTIC
• •4: TANK TO BE 1" = 40'
DEOMMISSIONED� STI
\ PER UPC. �% T2
/ DBL1&2
\\ \\ \\ r
TH#
C
\ \ \ T3 \ A
\ \ COsEXIST
\ \
\ , \
DRAINFIELD
ELDTH2\\
\ \ \\ \ MT2 C 2
04
PER THE PROPERTY OWNER EXISTING f \ 4
DRAINFIELD HAS NEVER EXPERIENCED •,!''`• ` \
ANY FREEZING. IT IS ASSUMED THAT A ?`'•�`' /20\ PROPOSED DR NFIELDS
THERE IS INSULATION UNDER THE `
DRIVEWAY.
GARNESS ENGINEERING GROUP, Ltd.
GENERAL CONTRACTORS= .----. — __._.
X3701 E. WWR R . SURE 101 • MCHO E, Mf 995 - PHONE (907)337-6178 • FAY (907)33B-3246 WEBSITE: rw,rAameasen9lneeHn9.cmn
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
SCOTT & BABARA AMY 301-6118 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
NORTH SLOPE; BLOCK 2, LOT 4 PNB
TYPF OF WORK- DATE:
DESIGN UPGRADE
8/15/12
CE -
r
P"
`ll
5 FEET 20 FEET
FLAT
35%
FEET
SCALE: 1 " = 10'
SECTION A -A
5 FEET
FLAT
OF..
GARNESS ENGINEERING GROUP, THS*
CONSULTANTS & GENERAL CONTRACTORS- ....... .....
r..
701 E. iUODR ROOD. SUITE 101 - MICHORAGE, OK 99507 PHONE (907)3}7-61]9 - FM (907)338-3918 MEBSUE: Pomeam9lnee 9.com j' ��J
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: r
SCOTT & BARBARA AMY 301--6118 3 OF 3 f e A. arness:'
LEGAL DESCRIPTION: DRAWN BY: VA s E-795. ,•'.�
NORTH SLOPE; BLOCK 2, LOT 4 PNB�g��• (o°o
TYPE OF WORK: DATE: V�4d p�o}essioo
CROSS SECTION DRAWING — WAIVER REQUEST 8/27/12 �DOOo��o
OF
GAR
NESS
ENGINEERING GROUP, Lt
CONSULTANTS& GENERAL CONTRACTORS T
3701 E. MOOR
ROAD. SUn
101 - ANCHOWE. M. 99507 - PHONE: (907)337-6179 - FM: (907)338-32" * WEMM gams.u�in�dng.� .......... ...........
ISOIL LOG - PERCOLATION TE . ... ... .. ...
LEGAL
DESCRIPTION:
..
NORTH SLOPE; BLOCK 2, LOT 4 t - y . rness...
PERFORMED
FOR:
SCOTT & BARBARA AMY — DATE: 8 8 12 C --77153
.1a) 0.
DEPTH
(feet)
ORGANICS oap ro es �00
ITEST HOLE #11
I
SOIL CLASSIFICATIONS
G W ORG
3
GP ML
G M CL A
4 —
GC OIL
Isc
SW LLLU, MH
5 —
SIP CH
SM OH
6 —
SEE ATTACHED SITE PLAN
GM TO ML
7 —
DEPTH TO DATE
GROUNDWATER
8—
DRY 8/8/12
10' 8/14/12
9—
10' 8/16/12 SCALE:
10—
1" = 100,
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
11 —
TIME (MINUTES) READING (INCHES)
12—
8/14/12 1 — 6.00" —
2 — 30 5.50" 0.50"
13—
3 — — 6.00" —
4 — 30 1 5.50" 0.50"
14—
5 — — 6.00" —
6 — 30 5.50" 0.50"-
15—
B.O.H.
16-
17-
18-
19—
PERCOLATION RATE 60 (MIN./INCH) PERO. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.5 FT.AND 5.5 FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: CR YES E] NO
SOILS
LOGGED
BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY:— JODY MAUS
COMMENTS:
PERCOLATION
RESULTS ARE WITHIN 1/16TH OF AN INCH
PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WASIPEFFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ?I
TIME
(MINUTES)
14'
8/27/12
4
1
-
-
6.00"
-
2
-
GARNESS
5.25"
ENGINEERING GROUP, Ltd
°SP
,_
..._.:::•� —CONSULTANTS& GENERAL CONTRACTORS. .:_,,,:.-.�., ,„ ..,,,<...
e 4
0�
37°1 E. MOR
ROPD, SUITE 16f � ANCH°RAGE, W. 995W � PHONE: (90])33]-8199 � FAX: (907)]38-3246 WEBSITE. g°meeeengneefing.c°
p C...., . .......
P , D
4
-
SOIL LOG - PERCOLATION
5.25"
0.75"
5
-
LEGAL
DESCRIPTION:
NORTH SLOPE; BLOCK 2, LOT 4
p jJJ r4f y mess:
ICYE1-7795y�
PERFORMED
FOR:
SCOTT & BARBARA AMY DATE: 8/20/12
9�+ 1,•' c10
DEPTH
= -" ORGANICS
o4ap✓/-�A{°��oo
(feet)
TEST HOLE #2
o4 fessio90
1
SOIL CLASSIFICATIONS
GW ORG
GM Cl-
4
GC OL s
pO°
o a0006 SW MH
5
• : SP CH
.00
SM ' ' OH
6
Sc SEE ATTACHED SITE PLAN
GM TO
ML
7
DEPTH TO DATE
GROUNDWATER
8
DRY 8/20/12
9
SCALE:
10
1„ = loo,
DATE READING CLOCK NET TIME
WATER LEVEL NET DROP
11
12
13
B.O.H.
14
15
16
17
18
19
PERCOLATION RATE 40 (MIN./INCH) PERO. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.5 FT. AND 5.5
FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO
SOILS
LOGGED BY:
ROB CAMPBELL PERCOLATION TEST PERFORMED BY:
ROB CAMPBELL
COMMENTS:
PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH
PERFORMED BY GEG,
Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ER ORMED IN ACCORDANCE
WITH ALL STATE AND
MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: rB 19 IZ
TIME
(MINUTES)
14'
8/27/12
8/14/12
1
-
-
TIME
(MINUTES)
READING
(INCHES)
8/14/12
1
-
-
6.00"
-
2
-
30
5.25"
0.75°
3
-
-
6.00"
-
4
-
30
5.25"
0.75"
5
-
-
6.00"
-
6
-
30
5.25"
0.75"
CD
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LL
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PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL SYSTEM PERMIT
PERMIT NUMBER:SW920001 DATE ISSUED: 1/10/92
DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 1/10/93
OWNER NAME:VORST RONALD C & CAROL M
OWNER ADDRESS:19441 OSTOVIA CIRCLE
EAGLE RIVER, AK 99577
PARCEL ID:05051124
LEGAL DESCRIPTION: NORTH SLOPE #1 BLK 2 LT 4
SEC 32, T14N, R1E, SM
LOT SIZE: 111649 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE: 1--,2 /'- hQ-
DATE:")
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
A „• 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
NAME
PHONE
EW
Li_
- t,3 A,
❑UPGRADE
MAILINGADDRESS
tvC
T72 - i2 A.��c �1
ei
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
nn ^^
Well
Absorption aref
Dwelling
PERMIT NO.
V Y
DISTANCE TO:
om. z
n
Manufacturer
Material
No. of compartments
W F
t
Liq tin gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
s'
DISTANCE TO:
Well
elling
PERMIT NO.
JZZ
_ — F
Manufacturer
Material
Liquid capacity in gallons
D
DISTANCE TO:
Well
Fo ndation
Nearest lot line
PERMIT NO.
w=
J LL Z
No. of lines
Length of each
lineT
al length of lines
Trench width
Distance between lines
Z W
FQ�inches
a, f.
Top of rile to finish grade
pflaterial beneath rile
Total effective absorption area
O
inches
Length i
Width
i
Depth t
12 S.(L, Diol Ift:,
PERMIT NO.
6 1 L
W
Type of, crib
Crib dj2ggi
Crib depth
Total effective absorption area
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
—
�f
DISTANCE TO:
Building foundation
Sevkkr line
Septic tank
Absorption area(s)
OTHER
•.
i
PIPE MATERIALS
SOI L TEST RATI NG
1109
INSTALLERTl
•
•®,
•W
/
£, Irl
t„
pari
1-7
•
•E•�
REMARKS ,tP .•• �•
•fE
•
r
Ulf.
i
� � � E:dt3lFYEERIYC�
APPROV -
:,, RIVER. ALASKA 30577
DAT LEGAL
PH. 604.2973
S
g
-,
72-013 (Rev. 3/78)
MUNICIPALITY OF ANCHORAG
Departmesof Health and Environment Protection
Pouch 6-650, Anchorage, AK 99502
264-4720
On-site Sewer/Water Permit
HANDWRITTEN
Permit No:
i
Date Issued:
Applicant:
/1'7.
Address: .-3C?C /0.c.f4-L. i?. t+ -L. �J-/2_. tf ✓.j L i
Legal Description: S/D: 46-_IZ7" t. ,ne_' �� Lot/ Block: -�
Section: �-- Township: Range:
Lot Size: ' ,5 / or Acres)
Lot Location:
Max. Bedrooms: '7
Listed
system.
below are the options available to you in designing your septic
Choose the option that best fits your site.
TRENCH
Depth to pipe bottom(ft.)
Gravel depth (ft.)
Total depth (ft.)
Gravel width (ft.)
Gravel length (ft.)
Tank size (gal.)
Soil rating (sq. ft./br.)
----------------------------
BED W. DRAIN
/, C
5
Gravel length 75 feet requires multiple runs (not exceeding 75 feet each)
Tank must have at least two compartments
--------------------------------------------------------------------------------
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage(MOA) and the State of Alaska,
2. I will install the system in accordance with all MOA codes and
regulations, and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of. Alaska requirements for the set
back distances from any existing well, wastewater disposal system or
public sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for the maximum number of bedroom
stated above, and any enlargement or modification will require an
additional permit.
IP A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN
(1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL
NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL W R,K///J/M;�UST BE DONE BY A LICENSED ELECTRICIAN. // _ _
SIGNED: �/(�{;KX--�^-��_ DATE: 1� L '� �3
Applicant
ISSUED BY: t- 4411A -{„t DATE: /-/:i -T's,
SWP/024 rev,1/85
~
PERMIT NO:
DATE ISSUED:
��
��
��
M tJ " I C-- I F"dmk L- I -T - "V� C3 F= ic�b fq I-- " C11 FR gc� C9�E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION/
825 L STREET, ANCHORAGE, AK 99501
264-4720 ~
" P4_!E; I -V U- E3 E--- W ER F�Z W FE L- L-- F� E-= FC M I -F
850412 HAND WRITTEN
07/15/85
APPLICANT:
WILLIAM E & GINA M BAKER
.
ADDRESS:
2360 COMMERCIAL DRIVE BOX 312
ANCHORAGE, AK 99501
CONTACT PHONE:
688-2521
LEGAL DESCRIP:
SUBDIVISION: NORTH SLOPE #1
BLOCK:
SECTION: 32 TOWNSHIP: 14N
RANGE: 1E
/
LOT SIZE:
2,5A (SQ^FT° OR ACRES)
I certify that:
1" I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA)� and the State of Alaska"
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit"
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or, nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL, PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WnR ST DONE BY A LICENSED ELECTRICIAN"
r
.� | J
SIGNED
��_/!^____~`__ ��\ DATE:
APPLICANT. WILLIAM E & GINA M BAKER
ISSUED BY
DATE:
`��/
�~�`� ��
AE��7-
/2,C7 /'S
/-���*� 7�
/��,�
�_''/
�7^���
v
m
PERFORMED FOR
LEGAL DESCRIPTION:
'e, -Yrr
P SOILS
VNICIPALITY OF ANCHORAGE • , V V b \ /
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECT,�Ilu PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
C
C,< 1r
M
7
8 ' f
w
10 1'T ., }
i .
SLOPE
DATE PERFORMED: ~T_
SITE PLAN
WAS GROUND WATER
11 ENCOUNTERED? it f�D
12 IF YES, AT WHAT�(� 1
DEPTH?
13
14
15
16
17
18
19
20
r
COMMENTS '-
H 7 6 t-
PERFORMED BY
,'2-D08 !6+79)
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
A
w
PERCOLATION RATE C-++ LC^K+?'i''an 4• (minutes/loch l
�: •, i � 8 D 13aRM
TEST RUN BETWEEN FT AND �G''> 4 FT
CERTI FIED BV: - fi DATE:__
r
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Parcel I.D. 050-511-24
Certificate of On -Site Systems Approval /1 /
Expiration Date:l
1. GENERAL INFORMATION
Complete legal description North Slope; Block 2, Lot 4
Location (site address) 30711 Prudhoe Bay Avenue, Eagle River
Current Property owner(s) Forclosure (Veterans Admin) Day phone
Mailing address
Real Estate Agent
Barbara Bowden
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3.NUMBER OF BEDROOMS: 3
iXI
4.TYPE OF WATER SUPPLY:
❑
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
WaiverNariance request for: N/A
Received by: I
Day phone (907) 727-2272
TYPE OF WASTEWATER DISPOSAL:
Individual
iXI
Holding Tank
❑
Community
❑
Public Sewer
❑
COSA to be released tb the engineer, unleds otherwise requested by the engineer.
COSA Fee $ 5&4 't- 3 J� N1' �O
Date of Payment g] I MI J'—
Receipt Number O6901, I
COSA # D 5G e� /C),5�
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
N/A
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.
Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179
Address 3701E Tudor Rd Suite 101 Anchorage AK 99507-3246
Engineer's Printed Name Jeff ey A. Garness Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance
with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported
results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to
modify identifiable features. Hidden defects or encroachments may exist that were not identified during the
evaluation. The operational life of aft wells and septic systems depend on a variety of variables including, but not
limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials
and workmanship), and the water usage of the family utilizing the systemis. These conditions can vary, and are
outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore,
GEG makes no warranty (express or implied) regaMing the future performance of the Weil or septic system. GEG
makes no representation whether an aftemative well or septic system can be installed on the property in the event
either of the current systems fail. The content ofthis report is for the sole benefit of the person/party who retained
GEG. Reliance upon the information provided in this report by any otherperson or party, including but not limited to
subsequent property purchasers, is not authorized. In short, GEG disavows anylegal duty to anyone other than the
person/pally who paid for his report.
6. DSD SIG ATURE
System #1 Approved for E bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the
Original Certificate
(VThen of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
u n 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 —� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.doc
\,iititlllfit;;
_ ON-SITE
�vl.
WATER AND
m=
WASTEWATER
Z^
PROGRAM
Original Certificate
(VThen of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
u n 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 —� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 9-1-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system_ _
Certificate of On -Site Systems Approval Checklist
Legal Description: North Slope; Block 2, Lot 4 Parcel ID:050-511-24
A. WELL DATA
Well type Private If A, B, or C provide PWSID # N/A Well Log (Y/N) YES
Date completed 1/23/1992 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 130 ft. Cased to 130 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 1/23/92
Static water level 65 ft.
Well production 5 9.p -m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 0.116 mg/L
Arsenic ND ug/L Date of sample: 1/30/2015
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO
Date of pumping 2/10/2015 Pumper JRs Pumping
C. ABSORPTION FIELD DATA
1/30/2015
ft.
2.5+ g.p.m.
Collected by: GEG, Ltd.
Date installed 9/4-5/12
Cleanouts (YIN) YES
High water alarm (YIN) NO
Date installed 9/4-5/12 Soil rating (g.p.d./ft2 o ft2/bdrm) 0.45 System type Dual Trenches
Length 2 0 65 = 130 ft. Width 5 ft. Gravel below pipe 2.50/2.50 ft.
7
5
Total de th.1+/5.75 YES Depression over
p R. Eff. absorption area 1015 ft2 Monitoring tube field NO
Date of adequacy test 1/30-31/15 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY in. Water added 2660** gal. New depth4.75/13in.
Elapsed Time: 806 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None known If yes, give date N/A
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pum
D Cycles tested _
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 100'+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 10'+
Water main 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+/'7'
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 100'+
Manure/animal excrete storage areas 100'+
Absorption field 5'+
Water service line 25'+ Surface water 100'+
Building foundation 10'+ Water main 100'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
"PER EXISTING WAIVER (FOR OLD BED)
t'-% r- Ins OLD 6-d tWf�r C)aA, 6AI 2/i8hgy
G. ENGINEER'S CERTIFICATION
I certify that f have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Jeffrey A. Gamess
Date Zll q /I r
COSA brown sheet 10-10-12.doo
in.
Municipality of Anchorage o
On -Site Water & Wastewater Program mac'
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL t�U�' /
It J
Parcel I.D. 050-511-24
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
Expiration Date: 6 "'S, - I _7y_
NORTH SLOPE; BLOCK 2 LOT 4
30711 PRUDHOE BAY AVENUE *EAGLE RIVER. AK 99577
SCOTT & BARBARA AMY Day phone 301-6118
30711 PRUDHOE BAY AVENUE *EAGLE RIVER, AK 99577
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
Individual Water Storage ❑
Individual Holding tank
❑
Community Class Well ❑
Community On-site
❑
Public Water System ❑
Public Sewer
❑
G
Received by: =/��
Date:
COSA to be released to the enginee unless otherwise requested by the engineer.
`'f o o 0)
COSA Fee $ ,
Waiver Fee $
Date of Payment 2 /it/ /1,;2
Date of Payment
Receipt Number 33375 6
Receipt Number
COSA# dig -,`� �
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.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LfD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
Phone
337-6179
Date 1 r3 L_
bedrooms, with the following stipulations:
"OF
A. G ness;
C 3
OF
ON-SITE
WATER AND
WASTEWATER
PROGRAM
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other
By (ti/ Original Certificate Date:
(Rev. 11105)
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: NORTH SLOPE; BLOCK 2, LOT 4
A. WELL DATA
Parcel ID: 050-511-24
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 1/23/92 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 130 ft. Cased to 130 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 1/23/92 7/26/12
Static water level 65 ft. 49 ft.
Well production 5 g.p.m. 2.76 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate ND mg./L.
Collected by: GEG. Ltd.
Arsenic: mug./L. Dateofsample: 7/26/12
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Date installed 9/4-5/12
Tank size 1000 gal. Number of Compartments E
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO
High water alarm (Y/N) N/A
Date of pumping NEW Pumper —
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
UPPER/LOWER
Date installed 9/4-5/12 Soil rating (g.p.d./ft`or '/bdrm 0.45
System type DUAL TRENCHES
Length 2 ® 65 = 130ft. Width 5 ft.
Gravel below pipe 2.50/2.50 ft,
Total depth*5.71 +/5.75+ft. Eff. absorption area 1015 ft2 Monitoring
tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test = in. Water added
=gal. New depth =in.
Elapsed Time: min. Final fluid depth = in.
Absorption rate >= 450+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE
If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump ofF' level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots
Public sewer main
Sewer /septic service line
Public sewer manhole/cleanout
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service
Wells on adjacent lots 100'+
10'+ Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+/*7' Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*PER EXISTING
G. ENGINEER'S CERTIFICATION
Nm
1 ceriify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date q12 11.2
(Rev. 11105)
\ Lot 9 /
N69 3
38„ W l
14RU j
Lot 5
iH 9p
Y/ ie Thomas H. Dree r,
LS -7626 '
m J
10
n�=163.98'
N/5°23, Q,w
\ 86 45' o
P udho— e \ '-
oy q Von \
Ordered by:
Scott Amy
Legend:
Well
®
Set Rebar with
Cap O
h
Asbuilt
AL Monument
0
Lot
3 f 113.6'
F" O
v � Shed
739.7• `.
Monument
0
Existing House
/
Septic
GM)
Pavement
Survey Certification: I hereby certify that a Mortgagee's
Overhang
�i
Inspection was performed on the described property.
Notes: It is the owner's responsibility to determine the
Wood Deck
existence of any easements, covenants, or restriction
which are not on the recorded subdivision plat. This
Gravel
7 Septic
Stand Pipes
C u
CDc -
(S-2 Septic Stand
Pipes
S�
n
SE702
co
• • Job 2012-60 Field Book: 114 Plat 69-131
Date: 9/11/2012
�o
0
,N
s
Lot 4
0_
Lot 5
iH 9p
Y/ ie Thomas H. Dree r,
LS -7626 '
m J
10
n�=163.98'
N/5°23, Q,w
\ 86 45' o
P udho— e \ '-
oy q Von \
Ordered by:
Scott Amy
Legend:
Set Rebar with
Cap O
Legal Description:
Asbuilt
AL Monument
0
Found Rebar
_
loc 2'
Lot A' Block
Monument
0
/
Septic
o
Pavement
Survey Certification: I hereby certify that a Mortgagee's
Overhang
_
Inspection was performed on the described property.
Notes: It is the owner's responsibility to determine the
Wood Deck
existence of any easements, covenants, or restriction
Lot 5
iH 9p
Y/ ie Thomas H. Dree r,
LS -7626 '
m J
10
n�=163.98'
N/5°23, Q,w
\ 86 45' o
P udho— e \ '-
oy q Von \
Ordered by:
Scott Amy
Legend:
Set Rebar with
Cap O
Legal Description:
Asbuilt
AL Monument
0
Found Rebar
_
loc 2'
Lot A' Block
Monument
0
North Slope Subdivision
Septic
o
Pavement
Survey Certification: I hereby certify that a Mortgagee's
Overhang
_
Inspection was performed on the described property.
Notes: It is the owner's responsibility to determine the
Wood Deck
existence of any easements, covenants, or restriction
which are not on the recorded subdivision plat. This
Gravel
asbuilt shall not be used for construction or for
establishing property lines.
�t• r
Checked by: THD Drawn by: CB Scale 1° = 80'
Grid
SE702
,� �
• • Job 2012-60 Field Book: 114 Plat 69-131
Date: 9/11/2012
Municipality of Anchorage
• Development Services Department 011
Building Safety Division
On -Site Water and Wastewater Program
$ fETY
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci,anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-511-24 HAA# /16-030c;20
Expiration Date: 9 - q - 03
1. GENERAL INFORMATION
Complete legal description Lot 4; Block 2; North Slope
Location (site address or directions) 30711 Prudhoe Bay Ave
Current Property owner(s) Ron Vorst Day phone 694-7202
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
30711 Prudhoe Bay Ave. Eagle River AK 99577
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD (or pickup. G,;7+ (-443
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Individual On-site
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
�a
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certifid'ates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm S & S EngineeringPhone 694-2979
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan Date S- 1yA 3
Additional Comments
9N SITE
WATER AND ; On
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 12M)
X Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
5. DSD SIGNATURE's
ROBERT C.-QOf4%xx
/
CE -3304
pAR�c''w..
V Approved for 3
bedrooms. °-
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
9N SITE
WATER AND ; On
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 12M)
X Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: �T�i v„ , *,1,- d /Ux)S/oPL
A. WELL DATA
Well type PRtV�C If A, B, or C provide PWS ID # Nm
Date completed"3 `% Sanitary sea (Y ) /O5
Total depth 13y ft. Cased to / 2,0 ft.
FROM WELL LOG
Date of test _00*
Static water level 65 ft.
Well production 9—
p.m-WATER SAMPLE RESULTS:
Coliform O colonies/100 ml. Nitrate 0. 1 mg./I.
Arses c_—=�mg.11. Date of sample: qlld03
B. SEPTICIHOLDING TANK DAT
Tank Type/Material SP f L 5'7�✓/
Tank size 1450 gal. Number of Compartments a
Parcel ID: 0
Well Logy/N)
TSS
Wires properly protectedCY/N) yPS
Casing height (above ground) "-f8' ' in.
AT INSPECTION
—c3 9-6) t3
<�-U
3.c,
Other bacteria
ft.
0 colonies/100 ml.
Collected by: i & S ENGINEERING d No. 2Q4
Eagle River, Alaska 99577
Date installed 69 / 6�-
Cleanouts(o)/N)
Foundation cleanout ()YN) a5 Depression over tank (Y(e L0 High water alarm (Yt�l V L
Date of pumping S 3 Pumper 9j6
C. ABSORPTION FIELD DATA
Date installed 0 21 q5' Soil rating (g.p.d./ft2 o ft2/bdrm10 System type
I?o'q
Length ft. Width I a ft. Gravel below pipe
i
Total depth 5 ft. Eff. absorption area 110%f ftz Monitoring tube Depression Depression over field NO
Date of adequacy test Result (Pas Fail) Q455 For -7 bedrooms
„ 'DRY " in.
Fluid depth in absorption field before test � in. Water added�S6 gal. New depth S in.
COx // c��
Elapsed Time: CO min. Final fluid depth Rni Absorption rate >_ T )y 'r g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y6_i1 type) Na-ve 4 , i If yes, give date
.-)C- ?IT- F-itrbh.r7 F""'n ARIVC.-+y (Oxy) 4PP4445 ro "v 7- ,tx ia.-D Ta
Or' 5 li- « f.2 Ae � v , 0 rq". h r Ait-n r N- Vic >
D. LIF TION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
Cycles
off' level at _ in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /UU f
Absorption field on lot /0Z' f
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots /--�- ti -
On adjacent lots /0
Public sewer main 144 Public sewer manhole/cleanout W14
Sewer /septic service line 05-I- Holding tank �v/•4
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5-� Property line AV s -t Absorption field Sf
Water main /U 'k Water service line /4 f
Wells on adjacent lots /w"t
Surface water /u u t
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
�WAruL1 IQ�Q�J37£0�
Property line 7 . Building foundation f 0 Water main i0 t
Water Service line l 0 f Surface water yW ?- Driveway, parking/vehicle storage /o Y -
Curtain drain ,114 Wells on adjacent lots /00+-
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 HAAA� guidelines in effect on this date. ROBERT G COWAN
Engineer's Printed Name /� 88'� �T c- t�d�/ i �� ��°.1+ CE -8801
Date - - $— �/��03 kit-
HAA
2.
HAA Fee $ 3 7 S • Waiver Fee $ ��-
Date of Payment 5' / rrl0 3
Date of Payment
s -Ira -/o3
Receipt Number O 35-Y fli Receipt Number 0 -3 SH fr fr"
(Rev. 12/01)
in.
14/03 1 AS BUILT 58-34
DATE FLD. BK.
4t OF A44-%14
49m W "
:*�
m D. Fleming �* o'
LS -5773
o �
f,e,�D7Bsal9notL���
NOTES. Easements not appearing on record subdivlslon
plat are not shown unless description of easement is
provided by client. It is the responsibility of the owner
or builder, prior to construction, to verify proposed
building grade relative to finish grade and utilities
connections, and to determine the existence of any
easements, covenants, or restrictions which do not
appear on the recorded subdivision plat.
Elevations based on assumed datum unless otherwise
indicated, and bearings and distances are record data.
S81S Engineering
SBS 17034 EAGLE RIVER LOOP ROAD
Engine��in9 EAGLE RIVER, ALASKA 99377
(907)894-2979
LEGAL DESCRIPTION
LOT 4, BLOCK 2,
NORTH SLOPE SUBDIVISION
PLAT NO. SCALE GRID
69-131 1"=40' SE 703
George P. 417uerch,
Mayor
6/4/2003
Anchorage
Municipality of Anchorage All -America
Building Safety Division I I I 111 F
2002
Robert C. Cowan
S & S Engineering
17034 N. Eagle River Loop Ste. 204
Eagle River, AK 99577
Subject: Waiver Request for North Slope Lot 4 Block 2
Waiver Request #WR030042
Parcel ID #050-511-24
HA030203
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
7 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
-A
Jeffrey W. Poet
Engineering Technician
On -Site Water & Wastewater Program
P.O. Box 196650 • Anchorage, lklaska 99519-6650 • Telephone: (907) 343-8301 • Fax: (907) 343-8200
4700 South Bragaw Street • Anchorage, Alaska 99507
liltl)://ix�nv.ci.a.lichorage.alc.us
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.ci.anchorage.ak.us
(907)343-7904
Waiver Review Worksheet
WR#: 030042 PID#:050-511-24 HA#:030203 Permit#:
Date Received: 614103
Legal Description: North Slope Lot 4 Block 2
Engineer: S & S Engineering
17034 N. Eagle River Loop Ste. 204
Applicant: Ron Vorst
Waiver Requested: Between the leachfield and the west property line 0- 7 feet
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
...............................................................................
Waiver is Granted: Ll___� Waiver is not Granted.
List Conditions or Reasons for above:
Date: (o - - D By:
:146mviewer
.............................................................................
Rec#: 35489 Amount: $150.00 Date Paid: 6/4/2003
S&S
May 14, 2003
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX (907) 694-1211
HEALlHAJTHORIry
APPROVALS
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
SEWER
gWATER
Anchora e, AK 99519-6650
T
EXTENSIONS ENSIONS
REFERENCE: Lot 4; Block 2; North Slope Subdivision
SEWER& WATER
INSPECTION
Request you grant a waiver on the referenced property for the horizontal separation
distance between the leachfield and the west property line at 7 feet.
ENGINEERING
ENGINEERING STUDIES
We do not anticipate an adverse effect on the adjacent property.
I y I I1 p Y'
EPORTS
If you require additional information, please contact us.
WELL INSPECTION
&FLOWTEST
Sincerely,
y
SITEPLANSWtZ
P.E.
,
RCC/ts
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577
v 09 -�
O MUNICIPALITY ANCHORAGE
• DEPARTMENT OF HEALTH R HUMAN SERVICES
Division of Environmental Services
On -Site Services Section ME
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 050-511-24
1. GENERAL INFORMATION
Complete legal description
North Slooe .. Lot 4 Block
Location (site address or directions)
HAA # W t Q `i-0 S; 2 -
NHN Prudhoe Bay Road Eagle River
Property owner Ron & Carol V or Day phone 6g4-7�,_?
Mailing address P.O. Box 771154, Eagle River, Ak 99577
Lending agency FNBA / Susan Garrett Day phone 694-2103
Mailing address. p.o. Box 77094A RaglP River Ax ggF77
Agent "I/A Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well x
Community well
Public water
NOTE: If community well system, provide written confirmation from State AIJEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. "1) Front MOA V1 ._
5. STATEMENT OF INSPECTION BY ENGINEER
I
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my'
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Eagle River Engineering Services phone 694-5195
Address P O Box 773294 Eagle River AK 99577
Engineer's signature �>Rn Date
6. DHHS SIGNATURE
Approved for 4_1 bedrooms.
Disapproved.
Conditional approval for
1
Additional Comments
By.
r; A. But
C.-6716
bedrooms, with the following stipulations:
Date
The V nicipality 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 purchasersof homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72.M(Bw.1/91( Beck MOAM21
.. Municipality of Anchorage
Department of Health and Human Services it
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: lk-fH SLo?6 {/ "7-Z/ AIZZ Parcel I.D. 050- Si/ - ;?-q
A. Well Data
Well type n,P11/P1L-- If A, B, or C, attach ADEC letter. ADEC water system number M
Log present (Y/N) YGS Date completed 0117,y 9 Driller S/9Y GV/LL11gP4S
Total depth J301 Cased to /3n / Casing height 4y -
Sanitary
y
Sanitary seal (Y/N) y6s Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump levelt
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
e
/0�/�f�9�
o z_
If'17111
m v
a• S
m. g.p.m.
N o
m
a
Septic%rng tank on lot /36/ ; On adjacent lots
Absorption field on lot t
On adjacent lots
Z
60 m
rn
P N S
p C
f/dO o m
Public sewer main Public sewer manhole/cleanout
Sewer service line 5'0' Petroleum tank tiv 71,A6,�
WATER SAMPLE RESULTS:
Coliform "Ie�
0• l M&IL Other bacteria
Date of sample: /0//W qz/ Collected by: 1N(7/NCF,/Q
B. SEPTIC/UTANK DATA
Date installed 07/5 Tank size /Z.50 Compartments
Cleanouts (Y/N) y1S Foundation cleanout (Y/N) X55 Depression (Y/N) M2
High water alarm (Y/N) /(Zfq Alarm tested (Y/N) A19
Date of pumping N%/9 /t/LI/CE PligeEQ /N SLIC-E. Pumper /✓/y
SEPARATION DISTANCES FROM SEPTICLUDIL&NIG TANK TO:
Well(s) on lot -/-/50, On adjacent lots f/DO Foundation _/_75
1 �
To property line f/0 Absorption field 7Z 5 Water mart/service line /a s'
Surface water/drainage 71oa 1
72-026 (3193)` Front CONTINUED ON BACK PAGE
C. LIFT STATION Nlw
Date installed
Size in gallons -
Vent (Y/N)
allonsVent(Y/N)
High water alarm level
Meets MOA electrical codes
"Pump on" level at
SEPARATION DI SCE FROM LIFT STATION TO:
Well
D. ABSORPTION FIELD DATA
adjacent lots
Manufacturer
(Y/N)
"Pump off" Level at
tested
water
Date installed D���S Soil rating (GPD/Ft2) /� 3 �3 System type ?Ieb
Length 9Z )Width Gravel thickness i9 (2�Totaldepth /•s'��ee )
Total absorption area /l04 $ Cleanout present (Y/N) a 5 Depression over field (Y/N) Alb
Date of adequacy test /0.11g119g/ Results (pass/fail) f �S 5 for 1f Bedrooms
Water level in absorption field before test V After test /.s -
Peroxide treatment (past 12 months) (Y/N) If yes, give date AM
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 7,/50/ On adjacent lots _7` /M I Property line :?� SO /
r
To building foundation To existing or abandoned system on lot
On adjacent lots 'f" 3o I Cutbank 49 Water wain/service line
Surface water A/l9 Driveway, parking/vehicle storage area
Curtain drain
E. ENGINEER'S CERTIFICATION
/837
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection
HAA Fee $ SOD , Lo
Date of Payment
Receipt Number Z// % 67 4y
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
"
Signature
Engineer's Name 1,00/5 &22LO4i
Date
HAA Fee $ SOD , Lo
Date of Payment
Receipt Number Z// % 67 4y
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number