HomeMy WebLinkAboutT15N R1W SEC 18 LT 195TI5N RIW Section 18 Lot 195 #0§1-232-22 NAME MAILING LEGAL DESCRIPTION LOCATION ~ DISTANCE TO: ~ ~V-r /~ D ~ Manufacturer m ~ ~n gallons IF HOMEMADE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE B ~:~' Z C~c~'~ [] UPGRADE Manufacturer Material Nearest lot li~e, Tren(h'~wdth'¢~ .,:~r~ inches Foundation Total le~/~h&f ~nes Material beneath tile Depth NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines .~/~ Total effective absor ion PERMIT NO, C~ass DISTANCE TO: BuiJding foundation OTHER PIPE MATERIALS SOIL TEST RATING //~> INSTALLER REMARKS Crib depth Total effective absorption area Building foundation Nearest lot line Distance to lot Hne Sewer line Septic tank APPROVED 72 013 (Rev. 3/78) lhdl IL]I II'dt ][ I....,...IL II ,4, L. % T '"',"~ C) IF::;" . II .11J......,. 11 Il L] II ,... I.... I ....... DEF"'AF/]"Mli!H',i'T' OF:' HEAL. TH AND ENVII::/OI'~UqlENTAL I.... S]'RE:E:T', ANCI 2 6 zl .,'.. 4 '7 2" .... : II,,dlIEE]L..,..II ........ F:"EEII:::;;i:tr'dl ][,'"1t .... RANE)E: :i,W syst em C1"1 c)(:;)se 't,. h e C)p'L :i. (::m t h at b es~'t:, f' :1. 'L s you r' ....i.t.. c. .... ir" ii::::;;.,: lEE: IP.,.II i1]]::]:: E....II ]E!l: E!!E lED II,,,,dl ,,,, JEll, ,~::::;;:: ,l?.:all ;]ii]: Ii'dj DE]:::'TH 'T'C] F::'II:::'E~; BC)T'T'CIM (1:::'"1",,) 4,,0 4..Ci 4,,0 GRAVE].,. DI!EI::)'T'H (F'T,,) 6., () 0,. 5 3., 5 'T'O'T'AI.,,. DE]:::"T'H (I:::"T'.,) :!.0.0 4,, 5 '7,, 5 GRAVlE]_ I/,IID'I"H (1:::'"1" ,, ) 2.5 ;I. 6 ,. 0 5,, () GRAVI:EL. I....IE]xI[~:'Ff'H (I:::"T' ,, ) 28 ,, 0 3 1 ,, 0 36 ,, () GRAME:L, MC)I...UME (CU,, YDS,, ) 16,, 9 :1.8,, 4 26,, 7 TANK S ;1: ZE (GAL,,S) :L', ()()C~. 0 '~"~' :I. ~, 000., 0 '~"~' ~. ~ 000 ,. 0 '~"~' S[] ;1: L.. R A'I" I IqG ( S~]~ ,, I:::'T ,, / B R ) :t. :1. 0 :!, 1 () :[ :i. () '~"~' TAr,,IK MUS'F HAVE A'T' I...IE;AS'T' ]"WO CEIMF::'AF:Uf'i','tE],,I'T'S :[ ,, I .:?~. ff~ {' ,i,]. fl'l ;{, ]. ;i. a r' ,,-~ :i. t h '!L h 6:9 P E) CI L,t :i. r' (..')t Eft E;.!}1"1 'L !~i~ f' c) l .... ,::' ' :* . {'cm't:.h by 't:,h~:e Idt. u"~ic::id::~al:i, ty,c>{' Ar'1c;hE]r'E~(:}E:> (MOA) ,',Er'ici 'Lh~,::, ,,':,'~,"~' ,,:::~' ,;:'", ,, I [4 ;i. 11 i ri ~i~t a ;L ]. '[' h =, f~i;y s t e fl) i I'] ,3'~ C; C: C) P CI <'::~1'] C; ~:.)~ [/,i ;i. '[, h ~:~ ]. ]. .," ..., .... ,, ];. ~:i. ]. ]. 't,.,tll,..,l' ~..,", 'Lc:) 8].' ]. 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F:L I:i::I":'T'R ]: C I AN ,, AI:::'F:'I.,,ICAI'q'T': AMEi]::~IC~'AI',I IE~'C;AVA'T'I[]Ix~/~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~L SOILS LOG [] PERCOLATION TEST PERFORMED FOR: ~Jk,/~'C~_~ ('J~.~ ~"~,.~-,~/~z~--~r' tt'-~..~ DATE PERFORMED: Z~'~r~ '~ LEGAL DESCRIPTION: ~q- [~ ' ~' ~ ~ '~%~ ~ ~L~'~'XN' } SLOPE ~ SITE 5 6 7 8 9 10 11 12 13- 14 15- 16- 17- 18- 19- 20- COMMENTS ENCOUNTERED? O O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ,/,~ (minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTIFIE DATE: 0 0 0 0 0 0 0 0 0 0 0 0 0 0 '11 0 :0 -- m 0 ~ m N ~ ~ 0 ~ m ~ m 0 z 0 ~ m I 0 X P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 _ (907) 264-4.111 DEPARTMENT OF HEALTH & HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850022 T15N R1W Section 18 SW¼ Lot 195 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 19'85. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oewalt Program Manager On-site Services SEO/lJw enc: Copy of Permit DEi:F:'~;~FN"I"IL::hFT OF:' I'"IEY-hL. TF'I AND Erqv'.I:F~ONHE~NTF~L. F::'F~:CYT'[!~.CTION I II II ...Il ""Ir"' IEEi '.E~ IE!!!ii II,..,,Jl IIiE.~!ii I[:::~;::,,..~... 16.dl IE:.'i Il._.. Il ....... [1 L. II ,. Ii 1[ ][ 'T' L..C)T :: !51/,J 1/z . L..II:::'T [!]'T~-VI"ION I,~!~ " ~ ........ J. N,:~ 1 r'41...,l,...l::.D I N rr~lxl ~FREi:rq COVEf]::RE!:D )~3Y 190tq ~)l.J I L.D :1: IxlE)L, LJD ..... .......... (1) ~lxl ~: ....................... ~, .... ,=.I....E.[..,ll,.i(..,~L. I'l::l,.liII f-~ll'.lX) INSF'E!:C,I"I[:'Jr',I MLJ~BT ;E~IE!: [::]):iYl"f.~INEi:C,~ (;~!!) NC)"f'.]~.~Ei: ~qH'"lxO,l:.D NITHC:ILJ'T' 1'4N L. LL,.L, tI~IL, rr~I... .I. I1,:1 I:.C,I.LDN I,I.,~1 (.JillI, K~IIxI:(:) C:i!;) 'T'F'IIii~ MUNICIPALITY' OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ,~ SOILS LOG [] PERCOLATION TEST LEGALDESCR'PT'ON: Z~Z ~ ~07-- /?~r ~<;/~SLOPE 1 2 3 4- 6- 7- 8 ~W DATE PEREOR*ED: 10 11 12 13 14 15 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: 72-008 (6/79) ENCOUNTERED? O P E IF YES, AT WHAT ~0 '~"0~/~ ~ ~- /'?O~'~'DEPTH? PERCOLATION RATE (minutes/inch) Gross Net Depth to Net Reading Date Time Time Water Drop TEST RUN BETWEEN FT AN , -- FT 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.anchorag e.ak.us (907) 343-7904 CERTIFICATE OF HEALTH .A, UTHORITY .A, PPROVAL FOR .b, SINGLE FAHILY DWELLING Parcel I.D. 051-252-22 1. GENERAL INFORMATION Expiration Date: ,.5"'-- / ~- Completelegaldescription T15Nr R1W~ SECTION 18r LOT 195 Location (site address or directions) 18140 BIRCHWOOD LOOP ROAD * CHUGIAKr AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WILLIAM &: LAUREL BECKER Dayphone 688-4693 18140 BIRCHWOOD LOOP ROAD * CHUGIAK~ AK 99567 Day phone ROGER MORRIS w/ PRUDENTIAL MORRIS Dayphone 689-1812 16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site ~[~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Cedificates 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER o As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. (~ARNESS, P.E. Date 357-6179 Engineer's Comments: In conducting this evaluation, AKWWC, Inc. 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. AKWWC, Inc. 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. DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ', \~'~ OF A,5,Fr, r~.,._ ' ,~,~? .. . -... ~. WATER AND . _ bedrooms. Attachments: HA,& Checklist Septic System Advisory Well Flow Advisory '~ ;. ~ ~..~-. .. ~,.~... ......· ~s~L.,~ - Manitenance Agreements .~.x~,- ,,,--~ I o- ,',,~,, - Supplemental Engineer's Reort Other (Rev. 12/01) Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 995196650 www.ci.anchorage~lcus (907) 3~3-7004 HEALTH ~,UTHORITY ~,PPROVAL CHECKLIST Legal Description: A. WELL DATA T15Nr RlWt SECTION 18t ~.OT 195t . , Parcel ID: ,051-232-22 Well b'Pe PRNATE If A, B, or C provide PWSID~ Date completed , 8/14/85 , Sanitary seal (Y/N) YES Totaldepth .245 ft. Casedto ,121 ft. Date of test Static water level Well produ~on WATER SAMPLE RESULTS: Coliform '. ~. colonle,/lO0 mi. ~ni~ ~ ~' rog.&. SEPTIC/HOLDING TANK DATA FROM WELL LOG ,8/14/85 3 g.p.m. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ,9/11/2002 48 It. 0.58+ g.p.m, Nitrate Q~mgJL. Other bacterta Date of sample: ~ Collected by: YES 12+ in. ~ colonies/lO0 mi. ,, AKWWC~ INC. Tank Type/Material STEEL Tank size, 1000, gal. Number of Compartments 2~, Foundation cleanout (Y/N) YES Oeprassion over tank (Y/N) NO Date of pumping, 9/10/2002 Pumper ABSORPTION FIELD DATA ~ Date installed ,, 4/24/85 Soil rating (g,p.d./ft~or(~ 110 Length 28 ft. Width 2.5 ft. Total depth .o.s8 ft. Eft. absorption area 336 fl' Monitoring tube YES Date of adequacy test _ 9/11/2002 Results (Pass/Fall) PASS Fluid depth in absorption field before test**DRYin. Water added 883 gal. Elapsed Time: 851 min, Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **MONITORING TUBE ONLY EXTENDS 4.7' INTO EFFECTNE Oate Installed ...... 4/24/85 Cleanouts (y/N) YES High water alarm (Y/N) N/A JR'S PUMPING System type TRENCH Gravel below pipe , ,, 6 ft. Depression over field, NO For, ,3 bedrooms New depth 28 in. 450+ g.p.d. D. LIFT STATION Date installed Size in gallons ~ "Pump on" level at in. "Pump off" in. 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, Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Fo Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN COMMENTS *WR980028 Building foundation 10'+, Surface water, *75' Wells on adjacent lots 100'+ Absorption field 5'+ Surface water. 100'+ Water main N/A Driveway, parking/vehicle storage 25'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and mvfew of Municipal records that the above systems ere in conformance with MOA I-IAA guidelines in effect on this date. Engineer's Printpd I~me Date ~./IO/C~ JEFFREY A. GARNESS HAA Fee $ 375 Date of Payment Receipt Number, (~. ~) ~'¢ ~ Waiver Fee $ Date of Payment Receipt Number o/ / / / / / NOISINQgflS H.LIIq$ 'H tic / / / / / / / / / / / DATE FLD. BK. ISOB ' ~ / / /. / / 190A 190B THIOAIJt. T SUBD~SION N 8~"T,,9°41'W 12~.83 (F~,~,,) ,/ / / / / / / / NOT~ D~'V'~IAYSo POV~rR ON THE SOU11.EAST S~ OF BiROgI'OO~ LOOP ~). ~ NOT SHOW~. k"~N THOUGH I. OCAT~D ON LOT EASEMENTS ~t'KTIN AR[ BASED ~ MUN'CIPAL C,4~O IdAP. FUR*fi"~ER R£S[AKCH iS NE~:D~D TO ~ LOCA1TD 9/18/02. WAS NOT NOTICED "ON 11~ O~G~NN,. AS BUILT OF I I'1 9)'18/0~ SHO~ SECOND ~ ~,-43 DATE FLD. BK.] S8,S Engineering LEG~. DESCI~PT~OM LOT 19~ SEC. 18, TIS#, PLAT NO. I SCALE I ' GRID B1,.M I' -30' NV/ IO~4 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastcwatcr Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 030065 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 195 ofT15N, RlW, Section 18 subdivision, the well's productivity was determined to be 0.58 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3obedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concemed are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~-~-'~ ~ \ - ...... ! 2%_~r. - ~,~ NAA # 1. GENERAL INFORMATION L,L~0_ .~'b ~(-~,~,~ Completelegaldescription BLM Lot 195; ~a,e,~---~,~ Sec 18; T15N; R1W Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Jim Lewis 18140 S. Birchwood Loop Rd. Chuqiak, AK P.O. Box 772423 Day phone Eaq].e River, AK 688-5432 99577 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 3 Individual well xxx Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Re',' 1/91) Front MOA #21 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 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. Phone_ Name of Firm Alaska Water & Wast~wa~r 7320 East chester Address ,'vc~°~' '//,e,//A!~7{"1?f Engineer'ssignature ( A/'~///~ ~ (~ .... Date ALASKA WATER & WASTEWATER SVCS. SHALL BE PAID ~i~i~ ~ FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE /V~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ' / Date The Mun(cipality 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeYs work. 72-025 (Rev. 1/91 } Back MOA ~21 Legal Description: Municipality of Anchorage IV E DEPARTMENT OF HEALTH & HUMAN SERVICES JUN 2 5 1998 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Checklist MUNiCIPALiTY OF ANCHORAGE J.~'t' l~ ~-.~. I~,! 'J'l_~/,J~. I~lCk) Parcel I.D.: FNVIRC~NMENTALSERVI~E,~rJlVm~©N A. WELL DATA Well type Log present (~/N) Total depth Sanitary seal (~'N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to I?-I~ Casing height (above ground) ~W"'f" Wires properly protected (~)'N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION /-/'o ' ~ g.p.m. 0/'70 g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed z.J/~.~f/8~- Tank size Foundation cleanout (~N) Date of Pumping Nitrate / O. Ioo m3/t_ Other bacteria Collected by: Alaska Wa_~.er & W.a.?te~w.at? 7320 l~ast ~nester n[~. ~..~[~:,c Anchorage, Alaska 99504 ,/OOO Number of Compartm.ents ~--- Cleanouts (~/N). Depression (Y/~J ~o High water alarm (Y/~) Pumper C. ABSORPTION FIELD DATA Date Installed I.J./.,~ ~/,~ Length ~.~ I Width Effective absorption area Date of adequacy test Soil rating (f~j. ..... .or~ Gravel thickness below pipe Monitoring Tube present(~N) Results J~l/Elf~) l Jo System type -/7_ Total depth Io Depression over field (Y~ For ---~ bedrooms Fluid depth in absorption field before test (in.); ~ . (,, Immediately after //~'~gal. water added (in.): ~'7. ('' Fluid dept~l. ~' (ins) Minutes later: ~ Absorption rate = G~ .g.p.d. Peroxide treatment (past 12 months) (Y~ ~ ~,~ If yes, give date 72-026 (Rev. 3/96)*~A ~ LE~ ~55u~EO ~o ~E ~T ~oP ~ ~E~OED D. LIFT STATION Date instaJ!~d Size in gallons Manhole/Access (Y/N) ~ ~.~ump on" level at* ___..___"~ High water alarm level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot II?--~ Absorption field on lot "~.o Public sewer mare Sewer/septic service line ~J ~'f' On adjacent lots On adjacent lots Public sewer manhole/clea~0ut Lift station /'J/~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation -7 ~ ~ Property line I O I-f' Absorption field Water main/service line t o'+ Surface water/drainage iccI ~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I o ~ '1' Building foundation I ~ '~ Water main/service line Surface water Curtain drain , ENGINEER S CERTIFICATION ,nconforman~ Signature { Engineer's Na~e Driveway, parking/vehicle storage area Wells on adjacent lots I® inspections and review of Municipal records a 7es in effect on this date. L~TT~E. Date of Payment Receipt Number ~' ~,~:~ ~ 72-026 (Rev, 3/96)* Rid( Mystrom, Mayor ,~'~.~..~ ii.-t,..',~.'. ...... ',, ~ ~.~ i,:~,~'~, ~ ' ,, ¢.I. ;. '..' Department of Health and Human Services ~25 "L" Street P.O. Box196650 Anchorage, Alaska99519-6650 hHp:,/www ci ~nchom~e ak.us July 14, 1998 Jeff Garness, P.E. Alaska Water & Wastewater 7320 East Chester Heights Circle Al~chorage, Alaska 99504 Subject: Waiver Request for T15N RlW Section 18 Lot 195 Waiver Request #WR980028, PID #051-232-22, HA980163 Dear Mr. Garness: Your request for a waiver of the required 100 foot horizontal separation of an on-site wastewater disposal system to the surface water has been approve. The approved separation distance is 75 feet from the drainfield to the surface water. This waiver approval applies to the existing on-site wastewater disposal system to surface water 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. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. If there are any further questions or concerns regarding this waiver, please call our office at 343- 4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Services Program WR~ WR980028 PID= Date Received: June 25, 1998 Legal Description: T15N R1W Section 18 Lot 195 Engineer: Jeff Garness, P.E., Alaska Water & Wastewater 7320 East Chester Heights Circle~ Anchorage, Alaska Applicant: James Lewis MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet 051-232-22 HA~ _~ Permit 99504 Waiver Requested: water of 75 feet. On-site wastewater disposal sTstem {drainfield) to surface Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver zs Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: ~ ~/SuC~ ~M~/~F$ Name of Reviewer Rec ~: #03927/2237 Amount: S 920.00 Date Paid: June 25~ 1998 I Alaska Water & Wastewater 7320 East Chester Heights Circle - Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Cons~n~ ~) Municipality of Anchorage ........ MUNICIPALITY OF ANCHORAGE Depa~ment of Health & Human. _ ~e~icermVlRONMmrA[ SERVICES DIVISION Division of Environmentm Semices On-Site Semites Section P.O. Box 196650 Ref: Waiver Request and Health Authority Approval for Lot 195, Section 18, T15N, R1W To whom it may concern: The existing 3 bedroom house is served by a private septic system and well. On June 5, 1998, we went to the referenced property to perform a well flow test and a septic adequacy test. On our site visit, the existing sump was found to be filled with rocks up to approximately 6 inches from the bottom of the invert. On June 8, 1998, a 2 inch steel monitoring tube with perforations in it was drove in to the leachfield by Rasmusson Excavating. On June 9, 1998, the well flow test and the septic adequacy test was performed. The well was found to produce 0~70 gallons per minute and the septic will adequately absorbed 450 gallons a day. Also, during our site visit, we determined that the existing creek to the north of the septic system is approximately 75 feet to 80 feet away (see attached drawing). We request you issue a Health Authority Approval and grant a 75 feet separation distance waiver from the septic drainfield to a surface water. The following items are justification for the waiver: l. If the existing septic system becomes surcharged, the effluent would most likely back into the house. 2. If any effluent was to surface, it would have to travel through heavily vegetated areas, and cross a gravel road fight of way. In short, there is no direct path from the septic system to the creek. I am unaware of any adverse impacts this waiver would have on adjacent wells, septic systems or surface water. If you ha~ ,e any questions, please contact me at 337-6179, or 244,9612. Thank you for your assisted/ Princ~al[/ I ,J,, LOT 190A, SEC. LOT 190B. SEC. [j~ LOT 1~9. SEC 18. T15N, RlW 18. T15N, RlW / LOT 2, C~UDE xx ~, // / / / / H SMITH S/D ~ 'x ~ / ./ / / LOT 194B, MINK LOT 195, SEC. 18, T15N, R1W · .EP~E~jiM LEwIsF°m PHONE .U.aEm Oh~' '. A.c.m ~ = ~oo' ~ or 2 \ / \ ',. / \ M NK DR VI- '--' ',, LOT 1, CLAUDE H. SMITH S/D ~ C02 ,~,~ MT ' ~ ~0~ ~ 0 X~F ,/ ~ ~ x ,' ~ELL (NOT IN USE), I ~ iI I ' (~100 WELL RADIUS~, , ~ ~ EXIST. ,,WELL ~ S~ N ~~lllllll A~S~ WA~R & WAS~WA~R ~..-': .... LOT 195, SEC. 18, T15N, R1W ~ . ~P~ OF WORm DETAIL OF WAIVER REQUEST JIM LEWIS (907)688-5452 ]A~[:6/22/98 ID~wN ~: r~E: IPAGE: A.C.G. 1 = 40' 2 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _~.¢..A ~:~.~,~t<g Telephone: Home ~ ~ Business -'Z...~ Applicant Address ~:;:~::;,X ~"]-~"?.....'~ ~'~j;~x.C.~t_..~.. ~-~t~t /~--t~..-, (c) Applicant is (check one): Lending Institution []; Owner/builder J~'; Buyer E]; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) M~ffthe HAA to the following address: $ & S Eaglneering _ ~Eegle River, AJaska 99~77' TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms __ ~ Other WATER SUPPLY Individual WellC~r Community [] Public [] Note: If corem unity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~ Public [] Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of~Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone ~ & $ Ertg~ leer|llg Address .~r~R ~e~x ^pproved for bedroomsby2 Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (1 t/84) MUNICIPALITY OF ANCHORAGE (MO~/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4726 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION If A, B, C, D.E.C. Approved (Y/N) Date Completed 0¢" / ~'~ ~- Yield Depth of Grouting ~ '" Pump Set At Sanitary Seal on Casing Depression Around Wellhead ; On Adjoining Lots i~;:)~ t ,~ ; On Adjoining Lots WELL DATA Well Classification Well Log Present Total Depth ~-'~--¢ Cased to IZ..J Static Water Level Casing Height Above Ground Electrica Wiring in Conduit,¢¢'~ Separation Distances from Well: To SeotJc/Holding Tank on Lot To Nearest Edge of Absorption Field on ,Lot To Nearest Public Sewer Line ~'J ~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sam pie Test Results Comments ~/'~ l I¢~ B SEPTIC/HOLDING TANK DATA ZT/" ~' ~"~ '~' Size /4) o ~3 No. of Compartments Foundation Cleanout Date Last Pumped ,'~ ; for Temporary Holding Tank Permit (Y/N) Date nstalled Stanc pipes ~,~,t~ Air-tight Caps Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank ~lgh-Water Alarm (Y/N) ~ Separation Distances from Septic/Holding Tank: To Water-Supply Wel /~ o ! ~- To Property une To Water .~.~._~!WService Line Course To Building FOundation ~--.I f- To Disposal Field //¢;>] To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Z~ Lot To Water .M'~frr/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~ Depth of Field Gravel Bed Thickness Standpipes Present~,N) Date of Last Adequacy Test To Property Line ; On Adjoining Lots To Cutbank (if present) To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) / /"Pump Off" Level at A/ Pu:~tn ~/~ p' g ' g Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO,~, and HAA guidelines in effect on the date of this inspection. Signed $&S Enal,~,m-!~ Date C°mpan~ie ~iver, ~laska ~5~ Mo~ mo. Receipt No. ~ ~ Date of Payment ~- ~ - ~ Amount: $ ~ Page 2 of 2 72-026 (11/84)