HomeMy WebLinkAboutJEFFERS LT 2Jeffers
Lot 2
#020-101-17
Municipality of Anchorage
Development Services Department �'�=-'
• ,.� ._--
Building Safety Division =_--
% On -Site Water & Wastewater Program, 4700 South Bragaw St. e A ; r,
- P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW030368 PID Number. 020-101-17
Name: ROGER & KATE JARVIS
Wastewater System: ❑ New ■ Upgrade
Address:ABSORPTION
FIELD
17101 GOLDEN VIEW DRIVE *ANCHORAGE AK, 99516
Phone: No. of Bedrooms:
(907) 345-7166 4
O Deep Trench ■ Shollow Trench O Bed O Mound E3 Other
LEGAL DESCRIPTION
Sol Rating:
3.0 CPD/Sq. In.
Total Depth from original grade:
SEE DWG. FL
Block: lot: Subdivision:
Depth to pipe bottom from original grade:
Crawl depth beneath pipe:
N/A 2 JEFFERS
SEE DWG FL
0.5 FL
Township: Range: Section: —
— —
Flt added above original gmde:
Grovel Mn9th:
40
SEE DWG rL
FL
Growl width:
Number of Anes:
Distance between Knee:
WELL: ❑ New ❑ Upgrade
5.0 FL
1
— FL
classification Private, tiB,C : Total De
Coved To:
Total absorption area:
200
Pipe material:
D 3034/ F-810—
n
R
1 so. FL
Driller. EX�S Dote Draped:
Static water Level:
Waller.
INC.
Data 9%23-10/1/2003
Yield:
Pump Set A<
coming Height Move Ground:
TANK
CPM
R
FL
SEPARATION
DISTANCES
aseptic 0Holding 0S.T.E.P. ■*Other
To
Septic
Absorption
Uft
Holding
Publa/PrIwG
Manufacturer.
ANCHORAGE TANK
Capacity in gallons:
1500
rrom
Tank
Raid
Station
Tank
sewer un«
Well
too'+
too'+
too'+
—
25'+
Mate":
FIBERGLASS
Number of comportments:
2
surface water
too'+
100'+
too'+
—
—
LIFT STATION
Lot orae
5'+
10'+
5'+
—
—
Size N gallons.
1500
Manufacturer.
ANCHORAGE TANK No SYSTEMS
mp on level oC
Pump offlevel at,
g? water obrm 'L
Foundation
Foundation
5'+
10'+
5'+
—
—
TIMER
I TIMER
44"
Pump Maks * Modsi:
0ectrical YupeeDons performed by:
Curtain Drain
NONE
KNOWN
#20 OSI 05 HHF
M.O.A.
BENCH MARK
Remarks: THE EXISTING SEPTIC TANK AND DRAINFIELD
location and D**cription:
WERE COMPLETELY ABANDONED PER UPC
TOP OF MANHOLE
Assumed °.,°Dan`
103.88
*THIS IS AN ADVANTEX TREATMENT SYSTEM
FL
ENGINEER'S SEAL
_oOQOO C
..•:
V O
p�fi�' y�OO
4
Dates: 1st 9/23/2003
Inspections performed by: AKWWC, INC. 2nd 9/24/2003
0 * �
3rd 9/25/2003
D
4th 9/26/2003
O i fff Gar ss.: O
Development Services Depart ent Approval
° c 7 ,e
QOpOa
Reviewed and approved by: W• Date:
rofessiana`�cc
(Rev. 12/01)
�OOOOo���
PARCEL ID NUMBER:
SWO30368 AS -BUILT DRAWING 020-101-17
A B
ST1 52.68 90.96
MH 53.61 85.55
DBL3 56.20 89.38
DBL4 57.10 90.16
C01 70.81 99.96
MT1 68.16 1 97.79 '
CO2 168.05 1114.94
MT 2 66.36 1113.03 r.
INSULATED UNDER DRIVEWAY WITH
4 INCHES BLUE BOARD INSULATION ell
\ JY..
.c•-..••�j� DSL2
APPROXIMATE LOCATION� -� ; :4 •,;.: ;
DBLI
OF TOE OF SLOPE—\/�! � , \ '�' � i •..'
DBL4 �MT2
II
NEW DRAINFIELD
+THp2
NEW 1500 GALLON
ADVANTEX TREATMENT TANK— _ _ J
FOR AGRICULTURAL
•'` ' USE ONLY
.'�T. � �: �,• . •.' I.L.
' 10/24/2003
F J
DRAWN BY:
ALASKA AVATKR & «TASTENVATKR A.J.G.
CONSULTANTS, INC.SCALE:
5701 F. TUDOP ROAD. SU1TF 101 • ANfMOQAGF. AK 99507 P.�ONF (007)557-6179 •FAX (907)338-321.6
1" = 40'
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
ROGER & KATE JARVIS (907) 345-7166 2 OF 3
LEGAL DESCRIPTION:
JEFFERS SUBDIVISION; LOTS 2, BLOCK 1,
TYPE OF WORK:
AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
Z
PERMIT
SWONUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SW030268 020-101-17
TOP OF MANHOLE
103.88 (AVC.)
FINAL GRADE -
103.68 (AVC.)
TOP OF TANK
- 100.72 -
INVERT OF PIPE
- 99.83 -
1500
FILTER
)P OF TANK
- 100.73
FINAL GRADE -
100.06-100.78
RICINAL GRADE -
' ^• 2+ FEET OF ,
`INVERT OF DISTRIBUTION
TOP OF SAND („M.OA APPROVED.s;Y
"` UNE - 97.06
- 96.55 (AVC.) , r,`D F1L1ER ?rte
�� • �`' ��'`�
far`
RELATIVE ELEVATION OF
GROUNDWATER -
`-BOTTOM OF TRENCH
- 93.46-94.55
)TTOM OF TRENCH
- 91.91-93.99
RELATIVE ELEVATION OF BOTTOM
OF TEST HOLE - 83.55 -
0/24/2003
DRAWN BY: �� O
ALASKA «'ATi:R & WASTLNNWE R SCALE'
A.J.G. opt • ' 50000
"'"•"- �'^.-•^-'----- CONSULTANTS, INC.----"m-----�-� 0 ** p
3701 E. TUDOR ROAD. SUITE 101 • ANCHCRAGE. AR 99507 • PHONE (907)337.6179 • FAX (907)336-3246 N.T.S. O "" ' .."' • • • •' • . . • • • • • •'O
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
ROGER &KATE JARVIS (907) 345-7166 1 3 OF 3e A. r ss �PA
LEGAL. DESCRIPTION:
OO�p� 7953 e`p
JEFFERS SUBDIVISION; LOT 29 BLOCK 19
TYPE OF WORK: V �c pro(essio�°oma
PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ��O00000a
RightFax 9/29/2003 6:45 PAGE 1/1 RightFax
inspection Report
Municipality of Anchorage, Building Safety Division
4700 South Bragew
INSPECTION! VOICE 343-8300 INSPECTION! FAX (907)248-7777 INFO: 343-7962
Name Dave Permit 03-9216
Address 17101 GOLDEN VIEW DR Phone 727-0972
Lega622-6777
Subdivision JEFFERS
Subdivision
LT 2 Inspection Date 9/30/2003 PM
S
Comments or Directions
Inspection Final Electrical L,,;
Reinspection N
NO NONCOMPLIANCE OBSERVED
❑ CORRECTIONS ESSENTIALAS EXPLAINED BELOW
❑ WILL RE-EXAMINE AT NEXT ❑
INSPECTION DO NOT CONCEAL UNTIL REINSPECTION
COMMENTS: (for Inspector use only)
L-0
Inspector �✓' <„ V !' �� �/ f
��, Data:
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW030368
Legal Description: JEFFERS LT 2
Design Engineer: 0041 AK Water & Wastewater Consultan+
Owner Name: Roger & Kate Jarvis
Owner Address: 17101 GOLDEN VIEW DRIVE
ANCHORAGE. AK 99516-5407
a; 3C
IU aw
Date Issued: Sep 09, 2003
Expiration Date: Sep 08, 2004
Parcel ID: 020-101-17
Site Address: 017101 GOLDEN VIEW DR
Lot Size: 99778 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By.
Date:
Date: -4/f 10.3
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.ek.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D._ 020-101-17 Permit Number 5t'40"O3o368
Property owner(s) ROGER & KATE JARVIS Day phone 345-7166
Mailing address (1) __ 17101 GOLDEN DRIVE • ANCHORACE. AK
Mailing address (2)
Zip Code 99516
Legal description (Lot, Block & Sub'd.) _ LOT 2. BLOCK 1 • JEFFERS SUBDIVISION
Legal description (Section, Township & Range) N/A
Lot Size Acre /SgrFt. Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade i
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
-(Signeture-of {xoperty-owner-or-euthorized-agent) -
Permit Fees: �'Ao0 • Waiver Fees:
Date of Payment: g Z103 Date of Payment:
Receipt Number:1 Receipt Number:,
ALASKA WATER F- WASTEWATER
CONSULTANTS, INC.
August 29, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
Ref: Proposed Septic Upgrade for Lot 2, Block 1; Jeffers Subdivision
ADVANTEk "I TREATMENT SYSTEM
To whom it may concern:
1. GENERAL: The existing 4 bedroom home is served by a private well and a private septic
system. There is 41so a agricultural well located in the southeast comer of the property. Two test
holes were excavated on the property for the purpose of upgrading the septic system. We are
proposing to design the septic system around the 30 foot radius of test hole #2. Due to the limited
area available, the high groundwater and the steep slopes, we are proposing to use an Advantex
treatment system and a 5 -wide trench type drainfield.
2. SOILS: See the attached log, which shows the soil classifications, groundwater monitoring,
and the percolation test results.
3. DRAINFIELD APPLICATION RATE: The intent is to install an Advantex Treatment
System that will allow the use of a small drainfield in the area around the 30 foot radius of the
test hole #2. Given that the Advantex system has received class III approval, the allowable
application rate is 6.0 GPD/FTZ. We are going to conservatively assume an application rate of
3.0 GPD/FT'.
4. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Proposed Application Rate: 3.0 gallons/day/f12
c. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 200 ft2
f. Total Depth: 2.5 feet (max.)
g. M.O.A. Approved Sand Filter: 2.0+ feet
6901 Debarr Road, Suite 2B — Anchorage, AK 99504 -- Ph: (907)337-6179 — Fax: (907)338-3246
h. Effective Depth: 0.5 feet
i. Width: 5 feet
j. Minimum Length: 40 feet long
k. Effective absorption area: 200 82
5.ORENCO PACKAGE SYSTEM: The STEP tank with the Advantex Treatment System will
be manufactured by Anchorage Tank & Welding to meet the latest design criteria established by
Orenco Systems, Inc. The point of contact at Anchorage Tank is Lowell McNutt. As with their
standard STEP tank, it is equipped with a high water alarm per M.O.A requirements.
6. SURFACE WATER: There is no surface water within 100 feet of the proposed septic
system upgrade.
7. TOPOGRAPHY: The drainfield is to be installed on the toe of a slope greater than 25
percent. The area downhill from the drainfield is a 10+/- percent slope running approximately
east to west. In short, there are no slope concerns.
8. CLOSING: I am open to any suggestions from your department that would be an
improvement to the proposed system. I am unaware of any negative impacts that this installation
would impose on adjacent wells, or septic systems. If you have any questions, please call us at
'2'2'7 <»n
.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, an Advantex detail, a trench detail,
two soil logs, and a 7 page construction specification letter which are all part of the design
package for this septic system.
6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246
ROEHL SUBDIVISION
LOT 15
ROEHL SUBDIVISION I
LOT 14 tl
I
1
ROEHL SUBDIVISION
LOT 13
NO CONCERN
FIELD VERIFY/ 1
/
I
1
1 100' WELL RADIUS
ROEHL SUSDMSION
LOT 12
1
I
_ EAST 172 AVENUE ___'
L]
%SUBDIVISION:
PENNINGTON PARK
LOT 9. BLOCI 2
100' WELL RADIUS
W
I
QI
/
/
O
C01
T11N, R3W, SEC. 2
N2, SW4, SW4, SW4
/ \\ `—SEPTIC ARS
I
100' WELL RADIUS j
I � I
1 /
r --
I
I
I
I
I
I
I
I
I
-
/
/ EXISTING
/ WELL
1
toe' WE11 RADIUS _
I
1
\ EXISTING
\ SEPTIC
\ \\ SYSTEM
THI I
\ :k !.� \ bid•
TH112+ �; 11
I
EXISTING\\
4 BEDROOM
I
HOUSE—V
I
I KENO HILLS SUBDMSION
I LOT
I NO CONCERN
I
FIELD VERIFY •
DATE:
8/29/2003
DRAWN BY:
ALASKA WATER & `NASTENVATER
CONSULTANTS, INC.
5701 F Tl DOR ROAD. SIIITF 101 • ANCHORAGF, AK 09507 • PHONr (007)1374Sl70 • FAX (0071518-57[
PREPARED FOR PHONE NUMBER:
ROGER do KATE JARVIS 345-7166
LEGAL DESCRIPTION:
JEFFERS SUBDIVISION; LOT 2, BLOCK i
TYPE OF WORK:
SITE PLAN FOR SEPTIC SYSTEM UPGRADE (ADVANTEX
J.L.M.
1" = 100'
JEFFERS SUBDMSION
LOT 1, BLOCK i
\
\ CP
1
I
I
1
♦
EXISTING \
WELL
I
KENO HILLS SUBDIVISION
LOT 2, BLOCK 1
NO CONCERN
FIELD FY
1 OF 4 1 ;;`' jbffW[A'.Vrjess-
E 7955
A74p ,pyo f eesior`O ��'
I 10p' WELL "D1U5
I EXISTING WELL
1 NOTE: THE CONTRACTOR SHALL
HAVE THE 100 FEET WELL RADII
PROPOSED 1500 GALLON AND THE SOUTH LOT UNE FLAGGED
FIBERGLASS ADVANTEX BY A REGISTERED LAND SURVEYOR
TREATMENT SYSTEM PRIOR TO CONSTRUCTION.
(SEE DETAIL DRAWING
PTI
PAGE 3 OF 4) \\ ////----EXISTING SEC SYSTEM TO
INSTALL DOUBLE
BE COMPLETELY ABANDONED
/'
\ INSTALL FOUNDATION
CLEANOUT.
i
TH#1
APPROXIMATE LOCATION I • :"
OF TOE OF SLOPE \\ ,: •, �` _ -- — /
?OPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 2.5 FEET DEEP
MAXIMUM BY 5 FEET WIDE BY 40 FEET LONG. ADD 2+ FEET OF
M.O.A. APPROVED SAND FILTER AND THAN 0.5 FEET OF CLEAN,
WASHCD SEWER DRAINROCK(SEE DETAIL DRAWING, PACE 4 OF 4).
DATE:
� � T ' J.L.M. v'` \v I J�u�I
ALASKA. WATER & WAS TENVATE oma,:
CONSULTANTS, INC. Ste: O ++ : •: a
3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-6179 • FAX (907)338-371.6 1"
— 30• O • • •
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
ROGER do KATE JARVIS (907) 345-7166 2 OF 4 _ am gs: "
LEGAL DESCRIPTION: 79 3 e�G
JEFFERS SUBDIVISION; LOT 2, BLOCK 1
TYPE OF WORK: �v4^�dp�0 e33100����
DESIGN OF SEPTIC SYSTEM UPGRADE (ADVANTEX SYSTEM) ��OO�000�a
,�. .. `
�..
O
pGJ,'P$G
..i•
TH/2� I
1
1
\� I
•' ' �'
: !'4' EXISTING WELL
?OPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 2.5 FEET DEEP
MAXIMUM BY 5 FEET WIDE BY 40 FEET LONG. ADD 2+ FEET OF
M.O.A. APPROVED SAND FILTER AND THAN 0.5 FEET OF CLEAN,
WASHCD SEWER DRAINROCK(SEE DETAIL DRAWING, PACE 4 OF 4).
DATE:
� � T ' J.L.M. v'` \v I J�u�I
ALASKA. WATER & WAS TENVATE oma,:
CONSULTANTS, INC. Ste: O ++ : •: a
3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-6179 • FAX (907)338-371.6 1"
— 30• O • • •
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
ROGER do KATE JARVIS (907) 345-7166 2 OF 4 _ am gs: "
LEGAL DESCRIPTION: 79 3 e�G
JEFFERS SUBDIVISION; LOT 2, BLOCK 1
TYPE OF WORK: �v4^�dp�0 e33100����
DESIGN OF SEPTIC SYSTEM UPGRADE (ADVANTEX SYSTEM) ��OO�000�a
AdvanTez Treatment System
d"��,,,, o?
PETE:�JISMTHEOSS,
THE
INSALLED OVER THDEISEPTICOTANK do 4•
AX20 -Mode 1 a
'N.'
ADVANTEX MANUAL
EYOND ON ALL SIDES EXCEPT UNDER
HII
THEFO AD
40x94Pod
EAST 0 ESCAPE OM TANK&WOW
RISE TO THE FILTER ABOVE IT.
INLET _
6' JIM CAP
FINAL CRADE—� (TYP.2)
6' PVC PUMP—our
(TTP -2)
6' PVC COUPLING
CLUED TO TANK
(TYP.2)
INLET _
OPTIONAL
SLIDE SECTION
OF 6' PIPE
OVER THIS CONNECTION
TO PROVIDE
SHEER PROTECTION—
EXTEND TO
BRIDGE EXCAVATION-
AX20
,,.,,,....,_..,._...� DATE:
8/29/2003
DRAWN BY:
ALASKA WATER & WASTEWATERS�LLE J.L.M.
CONSULTANTS, INC. N.T.S.
3701 F. TIMOR ROAD, SUITF 101 • ANCHORAGF. AK 99507 • PHONF (907)331.6179 • FAX (907)338.3246
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
ROGER & KATE JARVIS (907) 345-7166 3 OF 4
LEGAL DESCRIPTION:
JEFFERS SUBDIVISION; LOT 2, BLOCK 1
TYPE OF WORK:
PROFILE DRAWING OF ADVANTEX TREATMENT SYSTEM
30 INCH
INSULATED
SCREENED
VAULT
EFFLUENT
PUMP
CALLON
Je f e 4A."m s
�04 —7953 cP`v
dpro fession000
���0000�o
--------------------------------------------i
I
Ni i MTO C01
t In iC0 OMT I
----------------------------------------------
----40
--------------------------------------------- 40 FEET LONG
2' OF M.O.A• APPROVED SAND FILTER
WIDE—1
GRADE
�•y. ...UATE:8/29/2003
6iiiih oo�0Qp
F
O
DRAWN BY: G� •... .` S�0
ALASKA. WATER & WASTE `VATER J.L.M. � • ' �Op
CONSULTANTS, INC."scALE: �'DO
3701 F. TUDOR ROAD, SUITE 101 • ANCHORAGF. AK 99507 • PHONE (907)337-0179 • FAX (907)338-3766 N.T.S. • • • • • • • • • .......
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q Q
ROGER & KATE JARVIS (907) 345-7166 4 OF 4e r Carne
LECAL DESCRIPTION: OQO o — 3 eQO
JEFFERS SUBDIVISION; LOT 2, BLOCK 1 e.O olesaloo
.�v
TYPE OF WORK: e
DETAIL DRAWING OF PROPOSED DRAINFIELD d���
00000
•
/
I
� I
a- i
:. .
�
��' �///WA �Illlll/■I
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION: JEFFERS SUBDIVISION; LOT 2, BLOCK 1
PERFORMED FOR: ROGER & KATE JARMS DATE: 8/13/2003
DEP
(fee
ORGANICS ITEST HOLE #fl
1
2
3
4
5
6—
SM
7
B
9
10
GP/GM
12
B.O.H.
13-
14-
15-
16-
17-
18-1
31415161718
DEPTH TO DATE
GROUNDWATER
10' 8/13/2003
3' 8/28/2003
�ffil
I
/.,
AGa ess:
a
SITE PLAN
EXISTING
WELL
\
\t
1'=100'
/
1131191
VZZZA
KOM,
"HE •
1'11'1111
R OR
I loo' wm
1
!�li��ls�
7AiI�I •
SEPTIC
4 BEDROOM
�\
DEPTH TO DATE
GROUNDWATER
10' 8/13/2003
3' 8/28/2003
�ffil
I
/.,
AGa ess:
a
SITE PLAN
EXISTING
WELL
\
\t
1'=100'
/
1
RM O
Fo
QE 3
Q��GO EaG�
N zo \N
I loo' wm
1
EXISTING
; EXISTING 1
SEPTIC
4 BEDROOM
�\
/
SYSTEM
HOUSE
/
i
�x:,e • f
TH#2+
/ `-''i:,
EXISTING
r:
WELL
:S-:�� ;i •w �Y VT: :�j..i. Hi'.i f �:.. YH�1.V]{Y:Ti�.
\
DATE READING CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL NET DROP
READING (INCHES)
RM O
Fo
QE 3
Q��GO EaG�
N zo \N
19 PERCOLATION RATE - (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.0 FT. AND 4.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ONO
SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY:
COMMENTS:
PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAF P FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Sim
� 0
aeem®fefn asaeeneneei !�'``!•' ,.S1Q�
ALASKA WATER � WASTEWATER . '00'
CONSULTANTS. INC. 34 L Tu �0
' - o
SOIL LOG - PERCOLATION TEST 0
LEGAL DESCRIPTION: JEFFERS SUBDIVISION; LOT 2. BLOCK 1ffr y G ness.
PERFORMED FOR: ROGER & KATE JARVISpgTE; 8/13/2003 QO ` E 79 4`p
DEP �Q ....••
(feet) _
1 ORGANICS TEST HOLE 2
—
2 SOIL CLASSIFICATIONS SITE PLAN EXISTING �
'd.`o"• GWORG 10=100'
WELL
3 ,�+ GP ML j
GM CL I ]Q9' WELL RADIUS I
I
4GC OL EXISTING I EXISTING I
MIX OF ° o oSEPTIC 4 BEDROOM
SM/GM/ML ° ° ° ° SW MH SYSTEM HO
5 •'• SP CH
SM OH
SC THd
7 DEPTH TO
GROUNDWATER DATE TH12+ / •t:��
<'=.?: _ EXISTING
8 13' 8/13/2003 1;;, WELL
GM/MLI
5'+ B/28/2003 ;..ry. •,:,
9 nrrcr>sy
10
11
12 SM moo MIN
13
14 B.O.H.
15-
16-
17-
18-
19
516171819 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 3.0 FT. AND 3.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED:
❑ YES NO
SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: SUSAN OSWALT
COMMENTS:
PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PER RMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Z
K4UNICIPALITY OF ANO'IOP, AGE
DEPT. OF HEALTH &
ENVIRONMENTAL I)ROTECTIOhI
:JAN ! 4 SG~
RECEIVED
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological 8 Geol~hy$ical Surveys
...... E] r'l
su,foc. ..~'70 ft. ~: - ;" - '"
-~: :.:.'~ li0
~ BOck filling Gravel pock
' '' .... ~'~' I0. STATIC WATER LEY~ ': ~ "' '
· - tr. ;'/.'~
'--~ ' ~ Above o, ~eelow Iafl4 lurtoce Dote
.... , ............. :~"'. ~..;G ~ ': ...........
/
u
Ti.
J 11r.41A 7Wlbbix .. L11 91.41 IL -/441's.{{e11•I• NL T•YN.It N0 fue C0Yx1UN
Anch EFFERS:; 2 —1f-84 •O r0
t
' • . AN1.4.:
IIi S
WATER WELL RECORD
1
STATE OF ALASKA
!II •.1
DEPARTMENT OF NAfUNAL RESOUNES
Division of 13401091C01 E 641004710at Surr1T•
1' 1
•
• • __ ._ _.._
Orllllq Peelle N.. 870041
OIL N.. _
Ti.
J 11r.41A 7Wlbbix .. L11 91.41 IL -/441's.{{e11•I• NL T•YN.It N0 fue C0Yx1UN
Anch EFFERS:; 2 —1f-84 •O r0
i l.. DI7TANC9 ANO DIRECTION FROM No•01NT[n7ECTIOM{ 9 OWNER Of WELL: RAY JEFFERS
' • . AN1.4.:
.. r
btrxl ANrm W Ant if Well Lewis. '
L.1 A.I.•
A, WELL DPTM: (11-.11 S. OAT[ Of COMPLETION
E. Will LOS .. A..f.N ' -
�— IwQ— R7
Y 11..111 T1N The 9.111.
❑COLLA 11.1 )MRel.41 00',... 00.1
1•
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,'
hat.O7[:
grny
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streaks rl
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❑ tell owl ❑ OIAe:
F r
CA{Nlq, 0 TAr.N.4 Sell.4
1...-6 1.. M73It.0.P0 rstotf—IL../11.
f.-11. O.FIA {tlt.t11-11.
see 8 e
ry• m' .110' ''
9. FIN17N Of WELL+
Tn.: n_,nPn holes DI•..Ier
f1.1/Y.1N Sta.: L.•11•:
{.t NINx It..N 11.
NNIMMq 91...I P.11
y I.
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1
P. {rATle rn[R uvev
❑ •1.Y. a 1$9.11. 14N -..f.1. Ow.
C1.11wM1 0.1'
`
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ft. .Ite s,.. PMPI.1��7•P •,
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•
r'
L.rgtL 11 Duo PiN —IL 1.N.IIf 1 0...
❑ {NL.. ❑ Jet O C..RIfll11 O 011ie '
1; 11RtNARR{ LINED WITH 4$" I.D. 1
PVC WELL PIPEN/!'
.4. WATER SELL CONTRACTON'{ CERTIFICATION: 11, Wele Lwfe.tw. 0 F ❑ c 1
T1N1 .UI i.. lrllbl ..1e el11•dWp4. ..1 x1.'*"f11. Ire 1.11. NU 11 .1 L... bp.. -f Ldbr(
AK NQSL-j1ML.L11U4Lc DU T TNG 6 ENT --roX.� N..e.r
P.Il.le.l 9..1..4. N1.. ,deed
Alm...' 12211 Avion s Anch A e K 99516
•
717•.1• D.t.: 1
AY 11e I..4 '6 ..t.rlN I
... ._.. •• w n,...•...r.r. ..le`11.I. DOO7. PINX Nines. EAMANT`C..I.Mr
DALLY DRILLING LOG
SYREN BROS. DRILLING, INC.
2'/01 F~8le Street
Anchotase, A!.~- 99503
274-6437
ow~zz o~ L,,ao._.R.~g._.J_e...f..f._e.rs
AOOR~S.....1.,~..1..c~ Ma._r_.t.:L_n_._.S~.__._Anch.....~k_:_..9..9_.5. 0~
WZLL=,Srt£...S..o_u...t_h.e..a__s..t..~.c_o.r._.n.e_r. of lot
DATZ--ST~._.~_.~/.~_0.. .........................................
DA;~--~,~D ....... y./_.5/.~..0. .............................................................
FRO~.......~ .............. ~. TO.__.~t ....... _rt..o.~.~r~_u.r,~.~...n_ ......
n~oM..._..~ ............ ~. To__.l..6.. .......... ~.~..'..~,...~r.a~.~ ~-
8 water, clay,.
FROM ........
0 clay
FROM ........ .L~ ........ .rt. To.......'~ ............ .rt.sand...&..gra.V..el
_ soft bedrock
FRO~ ......... :~Ct .......... rt. TO.......'~.~ ........ ..rt,...Lc~.e.~.J. ..............
F~.~. '~R =-,, -~, (" 2~26-~ ,~uncased bedrock
,,,, .......... _., ................... ,._ ..............................................
\'
FROM ........................ .ri', TO ........ h.,~..r~ ...................................
FROM ....................... .Fl', TO ................. ~ ....................................
FROM. ........................ .FT, TO ...................... .r~ ....................................
FROM ......................... .FT. TO ......................... rt ......................................
FROM ........................ .FT, TO ...................... .ri' .......................................
FROM ...................... .Ff, TO ....................... FA' ....................................
MI$CL INFORMATION:
Dg,~rU O~We~z 226 feet
STATIC LEVEL OF WATER rt,._.2..0.._f..e_..e.T_._f..r_o...m_...g.r_.o..u_.n..d._.level
~z~w oow~ rt ....................................................
e~ts. t~ u~__.L..~...m.....(.g,.a.,!Lo...n._p..e_.K...m_i..,n...u_t.,.e_) ...............
KIND or CA$1NG.....6....~..Y~..~.f...(~...~...d..,_....B../....A.....~.~......s...t...~....~...1. ...................
FROM- ........................ rt, TO ...................... ~ ...................................
FROM ...................... .FT. TO ....................... ri' .....................................
FROM ......................... .FT. TO ...................... .ri' ...................................
FROM .......................... rt. TO ......................... ~ .......................................
FROM ....................... A;~. TO ........................ rt ....................................
FROI~ ......................... rt. TO ........................ rt ......................................
FROM- ...................... .FT. TO ......................... rt ........... .: ..........................
FROM .......................... FT. TO .......................... rt ......................................
FROM ..........................
FROM ..........................
~ ~- z~
~:.
FROM- .........................
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FROM .........................
z
L
'1; 5~
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VOL,
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7.7
uni¢ipalitYo¥
Anchorage
.O. BOX 196650 ....
ANCHORAGE, ALASKA 99519-6~5~37'~,
(907) 343-4200
7~~ Tom Fink
MAYOR
January 8, 1988
Raymond D. Jeffers
17101 Goldenview Drive
Anchorage, Alaska 99516
Subject: ' L0t 2 Jeffer~ Subdivision
Permit %870041, On-site Well Permit
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1987.
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.
Effective January 1, 1988, a new fee schedule is in effect.
When re-applying for a new permit, the new fees are; $90.00 for
an on-site sewer permit; $50.00 for a well permit; $140.00 for
a combined sewer and well permit.
If there are any further questions, please call this office at
343-4744.
Robert W. Robinson
Program Manager
On-site Services
RWR/ljw
eric: Copy of Permit
HUN I C I F'AL I TY OI= ANCH~]i~AGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE~ AK 99501
264-4720
OI'-~--S I TE IilELL t~EIRM I T
PERMIT NO:
DATE ISSUED:
870041
04/02/87
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
RAYMOND D. JEFFERS
17101GOLDEMVIEW DRIVE
ANCHORAGE~ ~1< 99516
545-2452
SECTION: ')
~ ]OWNSHIP: 11N RANGE: 5W
2.4A (SQ.FT. OR ACRES)
I certify
1. I am
that:
~amiliar with the ~equipements ~or on-site sewers and wells as set
~opth by the Municipality o~ Anchorage (MOA) and the State oF Alaska.
I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria o~ this permit.
I will adhere to all MOA and State o~ Alaska requirements ~op the set back
distances ~rom any existing well, wastewater disposal system or public
sewerage system on .this or any adjacent or nearby lot.
SIGNED
APPL I CANT:
ISSUED BY
SCALE
f~ -~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
~ 825 L Street - Anchorage. Alaska 99501 Telephone264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME /.~ ~ ¢~ PHON~ ~ ~/ ~ NEW
LEGAL ~ESCRIPTION
LOCATION
NO. OF BEDROOMS
No. of co~rtments
Liq. ~a~ in g~lJons IF HOME.DE: Inside length W~dth Liquid depth
~ ~ DISTANCE TO: Wetl Dwelling PERMIT NO.
PE IT NO.
NO. of lin~l Length of each r e Total len th of lines
Length~_~] I W,dth ~ Depth ~ PERMIT NO.
OTHER
PERMIT NO.
MUNIi::,PALITY OF ANt.,.-IORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4?20
WELL AND ON--S I TE SEWER PERM I T
( 8000i¢ )
APPLICANT
LOCATION
LEGAL
RRY JEFFERS
RRBBITCREEK
LT. 2 BLK. 1 JEFFERS
1507 MARTEN
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
LOT SIZE
~?7902
107000 SQUARE FEET
MRXIMUM NUMBER OF BEDROOMS = 3 SOIL RRTING (SQ FT/BR)= 260
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 12 LENGTH= $9 GRAVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE Of THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCRVRTION (IN FEET).
REQUIRED SEPTIC TRNK SIZE= :1-OOO GALLONS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS RDJRCENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
------ TWO (;2) INSPECT IONS ARE REQU I RED
BACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS
180 FEET FOR R PRIVATE WELL OR 158 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM ! T EXP ! RES DECEMBER
I CERTIFY THRT
i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
SIGNED:,
ISSUED
V4. 0
March 7, 1979 R&M No. 952138
Ray Jeffers
1507 Marten Street
Anchorage, Alaska 99504
Re: Resubmittal of Test }Iole and Soil Log Report for Sanitary Sewer
System, Lots I and 2, Block 1, Jeffers Subdivision
Dear Mr. Jeffers:
Per your request of }~rch 5, 1979, submitted herewith are the test boring
results and our comments regarding soil conditions encountered at the
subject site. The purpose of this letter is to relate past soils infor-
mation in this area to the newly established properly lines and lot loca-
tions. This investigation was performed in accordance with your request
and outlined in a letter dated December 19, 1974, by Mr. Rolf Strickland
of the Greater Anchorage Area Borough Department of Environmental Quality.
Two te~t holes were placed in Lot i and one test hole within Lot 2 for -
the purpose of defining general subsurface soil conditions for the pro-
~osed sanitary sewer system. Excavation was accomplished with an auger type
drilling rig and the test holes were extended to a total depth of'19.0 feet
to 20.0 feet below the ground surface. The boring logs for the test holes .
are presented in Drawings A-01, A-02 and A-03.
A groundwater table was not encountered in the test holes.
We appreciate being given this opportunity to be of service to you.
Should you have any additional questions concerning this ~nformation, please
contact us at your earliest convenience.
Very truly yours,
R&M CONSULTANTS, INC.
Michael C. }{artley ~ .
Staff Engineer
~.~1-1,/kah
T.H.-1
7-16-75
ORGANICS
ORGANIC SILT, TRACE SAND
'SILTY SANDS, SOME GRAVEL
OCCASIONAL COBBLE
(S~)
0.0~
1.0'
2.5~
19.0' T.D.
Log represents
Lot 1 Block 1~
Jeffers subdivision
Engineering 8~ Geological Consultants Inc.
*.C.O.AG[ ,A.a.A,XS ALASKA ~u.[Au
J~ffers Property
Log of test hole
Anchorage, Alaska
7-26-75 scauc 1"=3' IDWN sv WED J C-KO sv ~ED I"-oa. No.562052 Iow~ NO. A-01
7-2-75 0.0~
ORGANICS
0.5'
SILTY SA~ID (SM)
· 1.5'
SA}IDY SILT w/SOME GRAVEL
' 3.5'
SILTY SAND w/SOME GRAVEL (SM)
11.0'
SILTY GPJ%VELLY SAND w/OCCASIONAL COBBLES (SM)
SILTY SAND w/SOME GRAVEL AND OCCASIONAL COBBLES (SM)
20.0' TD
Lot .2, Block 1
Jeffers Subdivision
Consultants In=
ALASKA
Jeffers Property
Log of Test }Sole
Anchorage, Alaska
7-3-75 IscAcg 1"=3" Iow, sY VRZ ICH~OBY B~D I~o~.No 562052 Iow~ NO. A-02
T.H.-2
7-16-75
ORGANICS
0.0I
' 1.0'
ORGANIC SILT, $0~, SAND
' 2.5'
SILTY S;~DS I{ITH SOME GRAIL
(~CA$ I ON~J~ COBBLE
(SM)
NO WA~ER TABLE
19.0 T.D.
Log represents
I~t 2 Block 1
Jeffers Sut~ivision
Engineering 8~ Geologlcal Consultants Inc.
A.C.O.AG~ ~A,..~.KS ALASKA
OWN DY ~D
Jeffers Property
Log of Test Role
Anchorage, Alaska
WED p.O~. ~0. 562052 ow~ -O.A-03
PSN
Municipality of Anchorage" ..
Development Services Department'
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
1
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ' IWL — 101- 117 COSA# DWS S
1. GENERAL INFORMATION Expiration DatE
Complete legal description JEFFERS: LOT 2
Location (site address)
Current Propery owner(s)
.Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
17101 GOLDENVIEW DRNE *ANCHORAGE, AK 99516
JOHN PURKEY Day phone
17101 GOLDENVIEW DRIVE 'ANCHORAGE. AK 99516
Day phone
350-4391
MIKE MULNEAUX W/ROY BRILEY Day phone 297-2912
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a 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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal afgxed 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 watersupply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type o1 structure indicated herein. 1 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. Phone 337-6179
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, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines b 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 file of all wells and
septic systems depend on the tical 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.
5. DSD SIGNATURE
Approved for _4_1 bedrooms.
Disapproved.
Date Is' /1 00 6
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist C/
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
UN
•. ON-SITE
WATER AND
WASTEWATER ;
PROGRAM
By: ` J- Original Certificate Date: $
lRwr 11M1
I
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: JEFFERS; LOT 2 Parcel ID: D a O - / 0I - / 7
A. WELL DATA
•PRNATE RESIDENTIAL YES
Well type ""PRNATE AGRICULTURAL If A. B. or C provide PWSID# N/A Well Log (Y/N) YES
•10d 7/1987 YES YES
Date completed •• 5980 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
•270 •23 12+
Total depth •"226 ft. Cased to '•38 ft. Casing height (above ground) 12+ in.
"RESIDENTIAL WE '
TESTED ONLYLL FROM WELL LOG AT INSPECTION
Date of test 10/27/1987 8/6/08
Static water level 3 ft. 5 ft.
Well production 3.5 g.p.m. 3.27 g.p.m.
WATER SAMPLE RESULTS:
Coliform_ colonies/100 ml. Nitrate L-(&Qmg./L. Other bacteria colonies/100 ml.
Arsenic: ) v V ug./L. Date of sample: a _9W g Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA THIS IS AN ADVANTEX SYSTEM
"DOUBLE C/O PRIOR TO! TANK.
Tank Type/Material SEPTIC/FIBERGLASS Date installed 9/23-10/1/03
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N)••YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping AS REO'D Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA BELOW EXISTING GRADED MT S
Date installed 9/23-110/1/03 Soil rating (g.p.d./ft'o t /bd 3_0 System type TRENCH
Length 40 ft. Width 5 ft. Gravel below pipe 0.5 ft.
Total depttt3.41-3.91ft. Eff. absorption area 200 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/6/08 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test DRY in. Water added 600 gal. New depth DRY in.
Elapsed Time: 0 'min. Final fluid depth DRY in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
D. LIFT STATION *SEE MAINTENANCE REPORT BY A+ HOME SERVICES
Date installed 9/23-10/l/03 Size In gallons 1500 Manhole/Access (YIN) YES
"Pump on" level at TIMER in. "Pump off level atTIMER in. High water alarm level at 44 in.
Datum BOTTOM OF TANK Cycles tested ' Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
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 line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 100+ 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
G. ENGINEER'S CERTIFICATION o�� `!:...
1 certify that I have determined through field Inspections and
review of Municipal records that the above systems are In 1.
conformance with MOA COSA guidelines in effect on this.... ......
date. QQ •.Je am ss.:
Engineer's Printed Name JEFFREY A. CARNESS�, —79 e i
Q
Date p� �IlO 00 10.
•. c4/L� Q$cQopG
0
40Oqpro/aasio'000
COSA Fee% 4'�J 7"
Date of Payment V'D&
Receipt Number A,;l 10-43
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
SGS ReEB
Client Name
Project Name/N
Client Sample ID
Matrix
PN SID
Sample Remarks:
1083771001
Gayness Engineering Group, Ltd.
Jcffcrs S/D Lt2
Jeffers Lt2
Drinking Nater
0
All Dates/TImes are Alaska Standard Time
Printed Date/Time
08/142008 8:26
Collected Date/Time
07292008 9:17
Received Date/Time
07292008 10:26
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Init
Metals by ICP/MS
I lardness as CaCO3 ND 5.00
Waters Department
Total Nitratc/Nitritc-N 1.60 0.100
Private Individual Analvais
Aluminum
Antimony
Arsenic
Barium
Cadmium
Calcium
Chromium
Copper
Iron
Lead
Magnesium
Manganese
Chloride
Fluoride
Selenium
Sodium
Silver
Thallium
Sulfate
Zinc
mg/L SN1202340B D
mg/L SM20 4500NO3-F B
07/30/08 08/01/08 NRD
08/04/08 JDZ
ND
20.0
ug/L
EP200.8
D
07/30/08 08/01/08
NRB
ND
1.00
ug/L
EP200.8
D
(<6)
07/30/08 08/01/08
NRB
ND
5.00
ug/L
EP200.8
D
00)
07/30/08 08/01/08
NRB
ND
3.00
ug/L
EP200.8
D
(0000)
07/30/08 08/01/08
NRB
ND
0.500
ug/L
EP200.8
D
(<5)
07/30/08 08/01/08
NRB
ND
500
ug/L
EP200.8
D
07/30/08 08/01/08
NRB
ND
2.00
ug/L
EP200.8
1)
(<I00)
07/30/08 08/01/08
NRB
21.3
1.00
ug/L
EP200.8
D
(<1300)
07/30/08 08/01/08
NRB
ND
250
ug/L
EP200.8
D
(<300)
07/30/08 08/01/08
NRII
0.547
0.200
ug/L
EP200.8
D
05)
07/30/08 08/01/08
NRB
ND
50.0
ug/L
EP200.8
D
07/30/08 08/01/08
NRB
ND
1.00
ug/L
EP200.8
D
(<50)
07/30/08 08/01/08
NRB
10.6
0.100
mg/L
EPA 300.0
C
(250)
08/04/08 08/05/08
LCP
ND
0.100
mg/L
EPA 300.0
C
(Q)
08/04/08 08/05/08
LCP
ND
5.00
ug/L
EP200.8
D
(<50)
07/30/08 08/01/08
NRB
2030
500
ug/L
EP200.8
D
(<250000)
07/30/08 08/01/08
NRB
ND
1.00
ug/L
EP200.8
D
(<100)
07/30/08 08/01/08
NRB
ND
1.00
ug/L
EP200.8
D
(Q)
07/30/08 08/01/08
NRB
25.5
0.100
mgR.
EPA 300.0
C
(<250)
08/04/08 08/05/08
LCP
5.10
5.00
ug/L
EP200.8
D
(<5000)
07/30/08 08/01/08
NRB
SGS RcEN
1083771001
Client Name
Garncss Engineering Group, Ltd.
Project Name/p
Jcffcrs S/D Lt2
Client Sample ID
Jeffers Ll2
Matrix
Drinking Water
PN'SID
0
All Dates/Times are Alaska Standard Time
Printed Date/Time
08/14/2008 8:26
Collected Date/Time
07/292008 9:17
Received Date/Time
07292008 10:26
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date [nit
Private Individual Analvaia
Total Dissolved Solids
288
Nickel
ND
I ICO3 Alkalinity
141
CO3 Alkalinity
ND
OI I Alkalinity
ND
Conductivity
481
pit
6.57
Alkalinity
141
Colony Count
0
Total Coliform
0
Fecal Coliform
0
10.0
mg/L
Sh120
2540C
E
(<500)
2.00
ug/L
EP200.8
D
(<100)
10.0
mg/L
S\120
23200
E
0729/08
10.0
mg/L
Sh120
2320B
E
10.0
mg/L
SM20
23200
E
1.00
umhos/cm
SM20
25100
E
0.100
pll units
SN120
4500.11 D
E
(6.5-8.5)
10.0
mg/L
S%120
23200
E
coV100mL
SN12092220
A
coVl00mL
S%120
9222B
A
(<I)
coVl00mL
SM20
9222B
A
07/30/08
SYll
07/30/08 08/01/08
NRB
07/31/08
SYII
07/31/08
SYII
07/31/08
SYII
0729/08
SYII
0729/08
SYII
07/31/08
SYII
0729/08
DLC
0729/08
DLC
0729/08
DLC
_ _________________________________________________I
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Meld Mairtlteskanoe Report
Inspection
07/31/2008 16:08 4489 P.001/001
70:19663847434 P:1/6
102 833
on a us on EVEN* bips 68
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AnchorageTank & Welding, Inc.
907-272-3543
.awd o
John Purkey
pn IS -91
u......,
[_6-7
PreWos
the canparkmrn
17101 Goldenview
Drive, Anchorage, AK 99516
(907) 6444146
axe.Os
purnp ❑
e.er.D•
P.e.a1V
WL•
aWFW
AX -102337
020-101-17
201966
RTU102140
1083/2003
Retrieve O&M Into
Daily non
Tlmar semnpe
Recirc Off Cycle Time-19.5hnin
Recirc On Cycle Time - 0.51min
Perform Field Sampling/Observations
NT p 5 t Muy
pn IS -91
D012A
[_6-7
PreWos
the canparkmrn
Odor of Srnple.
W0041 XMsty ❑Erthy ❑Moldy
No typiesl ❑SuyWe nC-bb.pe ❑Decay
olylllmin FVU Urs ONO
Fusin In tank ❑ yin ❑ No
Check Control Panel
%s I DWW9e AMP-
A.dbl. W.isuel alarms :,OK
oiJ tone Qelernetry eriy) ,met ONO
Inapect/Ciaan Pump System
Inspect clan
Ica rNd ...................... �M
Solloe Box.....................C^
FlW Cads ................—A
r�
rk.oW........................ 7r g
Pump .......................... a
Dkriub.-Flker................. d .Q_1
BkA.be Pvnp Vail ............ M- 1TJ
ReciradmHp Sputter lbhre........ 3L
Oanm»nts A -'s iC� tom% IcRc�
Measure Sludge/Scum
Shrdoe
re Grnr.-rtnwm
c � ,
Pr. .
can r
PreWos
the canparkmrn
eurrp/nt
Pwvbus
el�fn
O�
Preview
Inspect/Clean AdvanTex Filter
Ineu.ce Coven
Odor. SNpmad ❑ Pungent Lat rswonries fEL
tfius'�m
t Nowt n Exo.esh�
e Pod sonom n s
B4dglnWVondmq:45mnelMtsr ❑swke
.o..s intaVent F= ,
Inspect/clean Discharge Pump System
Inspeet/Servk:e Other System Components
Ispse clean kw"et clean
Dtsinlseion Egripment ❑ ❑ Diapsrsw laterailmritis. U U
Obesry dans
Additional Services Rendered
❑cksrwdtwliashrLT
krrcpee
frappe
clean
AisarlLkl
❑
Floats raj
❑
Spies Boa
❑
purnp ❑
❑
Fkrat cords
❑
ne lunh..-etwn n%no.ny
UT-nt n.-o-pw plr.a
Inspeet/Servk:e Other System Components
Ispse clean kw"et clean
Dtsinlseion Egripment ❑ ❑ Diapsrsw laterailmritis. U U
Obesry dans
Additional Services Rendered
❑cksrwdtwliashrLT
0116040ed UVR.m.T
❑ Replaeodwsod opwr ltrrrt
Final/Safety Inspection
❑ n5V relnelesed
❑ D.k1s balled m
❑ MUN.W r Iwd.d push Vats cbsed
❑ Callmf Pasl Im V dad
Summa ry/Rocom mandation
❑ Tr-atrnent system is perlonfing
❑casforarvroe
ne lunh..-etwn n%no.ny
UT-nt n.-o-pw plr.a
❑Otneri
%/ Ait Pr
51.3natun_ �Y"' L-%� Date
Fax completed form to 1-866-384-7404
AUG -19-2008 TUE 11:33 AM REAL ESTATE BROKERS OF A FAX NO. 9072972909 P. 01
Aug. 19. 2008T11:12AY2 AM REAL ESTATE BROKERS OF A FAX N0. 9072972909 No. 1338 P. 71..:o2 I
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCR AND
REPAIR AGREUMLrNT
MEMORANDUM Or, UNDERSTANDING
BICTAND I lYU l= OTi ANCI{ORAOE
1.IIdY1' F. Y L_. C� vc.-i ck-mejln
THIS MEMORANDUM OF UNDi R.STANDINO made and f¢ntcred into Ps of this
ry W1111Wr V.vx,.lt'
day of oP2000, by and botwocn� s I= • Cvtar�rier�C.'I��It:�1f1
herein the "OWNM," rind the Municipality of AnchornQo, herein the
'"MICIPAUT V." In oonsideratlon of Ura mutual covenants contained horetn, 9110
parties to this Memorandum ofUndcrstandlnG agreo ss follows
1.' ADVANCED WASTIEWATLATREATMENTSYSCEMS. Mlmiolpnlity ,
grants permission to Owner to utilize and operate an Advanced Wastewater
TreatmontSyss`tem (AWWTS), described as located
at:1�Q( l7' O�(r�t(1 U if DY . , Anchorage. Alaska,
2, Dollnitlous.
WTS that ,
Includes the Installation or removal of any Potts, Component" err Pleas"
not Inoluded In [110 original construction parmit mud design. Priorto
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal Sydtenl Construction Permtt from the Mu riolpallly
pursuant to Anehornaa Munioipal Code (hereinafter. "AMC'') 15-65-
B. Cel'tliteate of 01.•Sito Systems Approval. An approval by dre
Municipality of existing water and wastewater disposal mystellra glv4n at
the time ofpraperty ante and title han"for In accordance with AMC 15.65.
AUG -19-2008 TUE 11:33 AM REAL ESTATE BROKERS OF A FAX NO. 9072972909 P. 02
Aug_ 19. 2008711:12AM, AH. REAL ESTATE BROKERS OFA FAX NO. 9072972909 No, 1338 P. 31, 103 I
i
Those approvals certify that the systems are adequate for the homes that
i
they support and most the codes that were in place at the time of system
construction,
C. Dernago. Any man-made or natural olanngo Ill a system that would Inhibit
the system from parfbrmtng as designed.
D, Mahttonmrco and ltopnlr. The scheduled slid as needed replacement of-
existing
fexisting parts, components and pieces clan AW WTS that were inoluded in
ilia original design which would allow the AW WTS to continue to
perform as designed,
U. pot•tttit (Constr•tteNon) An on -Site Wastewater Disposal System
Constructlon Potmit as dafined by AMC 15.65.
jr. pot•mit (Opernting) An Advanced Wastewater Trantment System
Operating Permit. An annual permit, Issued by the Municipality, that
allows the Owner to operate an AW=S. Upon meeting all the
requirements of this agreemen; the conditlona of operating Permit, the
requirematts of Ura On-site Wastowater System Consh'uetioA Pcnnit and
_011 relevant Provisions of AMC 15.65
3, ,V; Owner$hall pay to Municipality an annual fee of
payable on or before 1110 issunnoe of the operating permit and annually
thereafter. Tile annual fee is due on or before the anrtiveireary date of the approvpl by the
Mttulolpality of lusrntled system,
4, Term. The term of this Memorandum of Understanding sliall be for the life of the
AWWTS.
AUG -19-2008 TUE 11:33 AM REAL ESTATE BROKERS OF A FAX NO. 9072972909 P. 03
Aus. 19. 2008711: 12AY2 AM REAL ESTATE BROKERS OF A FAX NO. 9072972909 No. 1338 F. ar. 104
The Term boglos on the data of approval by the Municipality ofthe hutniled system and
shall continue whilo the AWWTS system 13 in use or operational or until the property is
sold or title is Iransferred by aweer and a now eertifieats of On -Site approval to issued to
the new owner or trattstbree of the property.
S. Altoraflarm Tnetnllnttnn apd Removal of AddijjonalU991 nneAt Owner agrees
not to make any sharntlons, removal of parts or additions to the AWW without a
Construction Permit from the Municipality.
6. Meintennnee and ROnnIrA.
A. Throughout the terns of this Memorandum of [luderstanding, Ilia Owner shall
maintain AWWTS In good repnir. In addition, It aball be the responsibility of the
Owner during the term of Ibis Memorandum of Vaderstanding. and atty extensions or
renewals thereof at tho owner's sole v9pense, to pny for any and all: (1) repalr(s), (2)
maintenance, (3) arllustment(s). (a) replacement coats, and (5) Inspection costs.
Further, Owner agrees to comply will All applicable ordiunnee, laws, regulations,
ndes and orders fortho AWWTS.
U. Owner Agreen to provide the Mwtieipaltty awritten schadnia of routine
maintenance and ropaira which have bean performed on the system pursuant to the
terms AM conditions contained In the Ownees AWWTS Operating Permit This
sohodutc shall be rubmltted to the Muniolpaltty annually upon the'enewat of Ute
permit. The schedule of maiutauuee and repair contained in the Owner's AWWTS
Operating Permit is:
C. Owner uolcnowledgoa that the fine schedule for falling to maintain and repair an
AWWTS are codified III AMC 14.60.
AUG -19-2008 TUE 11:33 AM REAL ESTATE BROKERS OF A FAX NO. 9072972909 P. 04
Aug. 19. 2008TI 1: 13AMe All REAL ESTATE BROKERS OF A FAX NO. 8072972909 No. 1338 •P. 5�: SOS-
D. Owner agrees that only maintenance, repair personnel eertiSed by the
Munioipnlilywill inspect and make ally nocessaty maintenance, repairs or permitted
alterations to the system.
M Owner agrees to grant the Munleipolity reasonable access to test and inspect the
AW VrS upon 24 hours written nptloe.
F. Owner agrees that any sale or transfer of title ofthe property will not occur
without a new Certificate of Ott -Silo Systems Approval.
O. Owner agrees that the relevant provielons of the atandnrd specification guidebook
fur AWWTS is the govarntna profesatonal gttldeltnes for the oomtruetion,
mointonance and repair oftlre Owner's AWWTS.
7, Nonwaiver•. The failure of eiLLwr party at any time to enforce a provislon of this
Memorandum ofUaderstandine shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of UnderstundlnE or any part
hereof, or the right of such party themaftcrto onforco each and every provision
horoof.
l;, Arncndntent.
A: Tl" Mamorandtun of Understanding shon only be Ametrdad, tnodifled or changed
by a writing, executed by authorized represeutntives of the patties, with the some
formality of this Memorandum of"Undcrstandina was executed said Buell writing shall
be attached to this Memorandum of Understanding as on amendment.
B. For the purposes of any amendment tnodifioatioll Be ahange to the tutus and
conditions of tills contract, the only authorized reptosentativea of the parries pre.
AUG -19-2008 TUE 11:33 AM REAL ESTATE BROKERS OF A FAX NO. 9072972909 P. 05
Aug. 19. 2008711:13AV2 AM REAL ESTATE BROKERS OF A ' 'FAX NO. 8072972909 No. 1338 • P. 6t, P8
Owner. SP1 =L o Qt? fYJ�CLLIJG 1 ►KLA/� -t-
Anchorage: Purchn4ing Officer
C. Any attempt to aracnd, modify, or change this contract by either an
unauthorized toprosentativo orunauthorlzcd moans shall be void.
9. jurisdictlept VIvoiceofLaw . Anyt:ivUsetlonatisinGfi•omlIilsMctnorandamof
Underattnnding ahall ho brought in the Superior Court for the Third Judlelnl Dlstt'lot of the
State of Alaska at Anoltorago. The lawr of the Gram of Alaski shalt govern the rights and
obligations of the parties under this Memorandum olUnderstanding.
10, ^u_nvprobilitv,. Any provisioue of tbia Memorandum of Understandlmg doorood
Invalid by p court of compotontJurlsdiolion shall not invalidate the remaining provisions
of the Memorandum of Undeatutding.
QWNEnr ^ /�
Dy
STAT13 OF ALASKA
7711RD JUDICIAL DISTRICT
Tho foregoing Itsuvmentas a owt
20-1&,, by aeNe, �ra nCK,
R ItLC •ORA.A
My Commission exPlron: �(
C A �yri�
By: ,� •
Tltlo;
)as,
Ak
ed before mo this 1 day of ash
NOTA
Municipality of Anchorage
• ''` Development Services Department ��' ;'
a
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING/� ^ , r
Parcel I.D. 020-101-17 HAA# l S� `T
1. GENERAL INFORMATION
Expiration Date: a — /a. — d
Complete legal description LOT 2: JEFFERS SUBDMSION
Location (site address or directions) 17101 GOLDEN VIEW DRIVE * ANCHORAGE. AK
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
ROGER AND KATE JARMS Day phone 345-7166
17101 GOLDEN VIEW DRIVE * ANCHORAGE. AK 99516
Day phone
NIEL THOMAS w/ COLDWELL BANKER Day phone 265-9106
2525 C STREET * ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. .TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
4
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates 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. 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 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.
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
❑
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 the representations given in paragraph 4 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 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.
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 riles 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 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
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.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
337-6179
Date Z03
bedrooms, with the fllowing stipulations:
WAST\GRAM-
EWA TER
PR
Attachments: ��'• •'•��\
HAA Checklist Manitenance Agreements 'J�J///j� irrSEN �NN
Septic System Advisory
Well Flow Advisory
Supplemental Engineer's Reort
Other
By: Original Certificate Date:
(Rev. 12101)
, .......... - .. ..I -. . - - . . - " ., - , - . . . . . . . . . . ... ... . ... . . . . .. . . . . ....... . ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - , .. . - , . . . . . . . . . . r , I . . , . , . " I .. - . I . . I r I I . , . . I . I I r I I . . . .1 . r 1.
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
1 a
�HEALTH, AUTHORITY: APPROVAL CHECkLisTl
Legal Description: LOT 2; JEFFERS_!SUBDIVISION Parcel ID: :020-101-17
*AGRICULTURAL WELL
A. WELL DATA **CASED TO BEDROCK
***TESTED RESIDENTIAL WELL ONLY
PRIVATE If A, 13, or C pr NIA YES
Well type provide PWSID# Well Log (Y/N)
1.1 ole2�7� 1�9 187
�O
Date completed ; *9/5/ ;8 Sanitary seal (Y/N) YES !Wires properly protected (YIN) YES
**38 12+
226
Total.depth *270 *12+
Cased to *250 Casing height (above ground) in.
;FROM WELL LOG AT INSPECTION,
10
10 26/11987
t ***7/24/2003
Date of tes /1980
20
14
Static water level 1 *3, ft.
Well production i*3.5 9.p.m. 2.5 .9 -P.M.
WATER SAMPLE RESULTS:
�
Coliform colonies/100 ml. Nitrate 0.737 nri Other bacteria 0 colonies/1100 ml.
Arsenic:N A mg./L. Date of sample:7/24/2003, Collected by: AKWWC, INC.
B. SEPTIC/HOLDING TANK DATA' THIS IS AN A DVANT 'TREATMENT SYSTEM
:
Tank Typelmaterial i FIBERGLASS Date installed 9/23-10/1/2003
j�
Tank size -1 500 (gal. Number of Compartment- 12 Cleanouts (Y1N) YES
jr, Depression over tank (YIN) NO arm (Y/N) YES
Foundation cleanout (YIN) YES High water al
Date of pumping NEW Pumper
—
THIS IS AN ADVANTEX TREATMENT SYSTEM
C. ABSORPTION FIELD DATA j
ISI;*BELOW FINAL GRADE.
Date installed 9/23-10/1/03SOij rating p.d./ r ft1bdr1m) .0 Sylstern type i 5—WIDE
Length 40, 5 Width Gravelbelow pipe 0.50 ft.
Total depth *3.5-412 ft: Eff. absorption area 200 ft', Monitoring tube YES Depression over field NO
equal Results Fail) 4
juicy test Pass/
Date of ad For bedrooms
Fluid depth in absorption field before test = in. Water addedgal. ! New depth � in.
Elapsed Time: min Final fluid depth In. Absorption rate >= g.p.d.
Any rejuvenation tre'atrrent(past 12 mo.) l & ll If yes, give date
D. LIFT STATION
Date installed 9/23-10/1/03 Size in gallons 1500 Manhole/Access (YIN) YES
"Pump on" level at MMER in. "Pump off' level at MMER in. High water alarm level at 44 in.
Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
100'+
Absorption field on lot
100'+
Public sewer main
N/A
Sewer /septic service line
25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
A
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 1000+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ 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
G. ENGINEER'S CERTIFICATION
I certify that l 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 Na e JEFFREY A. GARNESS
Date 03
HAA Fee $ 3-75. c'O
Date of Paymenjl:g—aA
Receipt Number
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
-----------------------------------
--------_ -- --- J ----_---------
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'. - , :...,:..-'..~ '.,,.:;'.,.T,~,.Z;..:",..~J.:- ::..*.. Division of Environmental Service~ :::,: :_.j:;~l~ :&hi;b;, ':.:,,.:.L, . ,..
.. .: .. ,.,.-.:.-:,-,:':-~,,T..:~-:,,:.=.~--~;, .... ~.._, ,,....,:~On-SiteSewlcesSectlon ,_'~,_:--..:T,:'-:7'~..~ :.,;::,,,..-.-~,.v~_ . ~-"::
...... ~ - . , ..... P.O. Box 196650 .Anchorage,'Alaska .99519-6650 -. -..
-.. . CERTIFICATE OF HEALTH AUTHORITY ,' ': .'-:". ' : .'
- ~ -' ......... APPROVAL FOR A SINGLE FAMILY DWELLING . ',' ". , . . '.
"' .......... .7- . - .-.-'~
- 1.: GENERAL INFORMATION ....... ~' ........ --':
,- ..... .Complete legal description C ~ :~. ~:]~*~"I~-~/'"~S ~ '.~. ' ....... :-.
: J.,.- '~5 L.°..c~..ti_°r~ ( 'te dd ' )
.'.. ,., , s~ a re,ss or d~recflons ....
: "_r"*.--.~,~,~ - ,. _ yphone_ ~.
..... :;W~ endln~agen .;'*': ................. : Day phone
' -- -~,::~: 3. ~: ~PE OF WA~R SUPPLY: '":" :*- ' ............ ' -". -- ............ · - ......... :' - ;::' :' :~:"' ~'; ~:'-:'.-','-"": ....
"' ' '" ' . ~ ~uum'n:'v'~''-'well ~.v
:'~:'L::~NOTE~lfcommu~i~-~lls~tem, ~oide ' ' ' .........................
- -..- ............... ~--Ho dine ~nk, ........ '-',
.?-.., ............ ,, ~ Public,wet ~,. ,,.~.--~ ....... ~, ......... c- --~-'" w'-, ...... :~
. ".: ":z::: NOTE::.lf~mmum~ter~em, provide w~en confi~ation from S~te ADEC
- a~t~ng to the legall~ and sMtus of ~tem.': "" '* ........... -. -"~ -,
5. STATEMENT'OF INS~,ECTION BY ENGINEER ................ . .... : :'"'
........ . .:.. As .cerflfledDym. y seal affixed hereto and as of the vafldafion date shown below, lverifv~atm¥-- ~ -- ..:
' ~.nd~or wastewater dJ~-P~ ~st~r~ i~ ~afe-"f~h*cttonaf ~d*'ad~quate for the number of ~r~ms
. ., .' _ . -:'~ and type of structure Indi~,~ted herein21 ~ther ~ertf~'that b~sed on the information obtained from - --
the Municiptflity of Anchomgefll~ ~nd fi'om my In'~-tigaflon ~nd In~on, the or~it~ water
- 'supply ~nd/or w~tor di~l:~ml ~m I~ in eompilafi~ ~ all Muni¢il~d ~nd
.... 'ordinance, ~nd r~ulatio~ In ~iff~--t on th~ dat~ of thi~ in~l~'tion..
. ._.. '.... Engmeees s,gnatum . Date
':," - ~. L' ..,:'- -'.-.,,-,-. ~ .......... _-'. ..... - .... ~ ........~ ....... -.' --. ...........
.~' ;ii Xa~Jitional Comments ' ~ ~o :~'~ ' : ..... ' '
................::~..;:.:;/__._._ ~ ......... ~ ~: :~.. :~--_/,__.-- ......... ..-~,.
;. ................ ._ :. :.._:_..::.__. :.
'. ~- ,::,--' ..... -:.~:~ - ',~'~ -"',,~* ';~ .:: ' _--r;~ :~.: ,'.-'*"?-~"~.'~::~'~.~2:
..... ..~.,,. :: ,Approval .Certlflcate~ based only upon..the .representations gtven.ln paragraph 5 above by' an Independent
:~ :.:.'.~ ,'~ :.:'."-?, .m~d., ~I~...r ~e_n,d. lng ~ons.ln.~ ~ ~ce. ~rtaJn fe?_ml_ ..~_d ~mm, require? Employees of DHHS do not ,..' responsible for errom or omlssl.ons In. the p~Jonal engineer's work. · .' ' '. , · . ::
Hea th and I-:lUma'n Se'~,ices
,' ~ , .Depa~m,e,n?f''. . .;~'"" '
~*" "':' ~;" ~ ' ;HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type (.)~-'7-r-~ if A, B, orC, attach ADEC letter. ADEC water system number
Log present (y/N) 'y Date completed ~/~'~f_~"~ Driller ~F/~
Total depth ~ ~ C /
Cased to ~ ~ Casing height
Sanita~/seal (Y/N) ~/ Wires propedy protected (Y/N)
Date of test
Static water level
We, ,ow ~,:~ ~' .~.>
g.p.m.
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot / /r ~ /
Public sewer main ./~
Sewer service line
AT INSPECTION
: On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum ~nk
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: +//'~ f~' -~
Collected by: J -
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ' ~<:'*/~' ~;;'~:~ Tank size / ~ ,~(~ Compartments ~
Cleanouts (Y/N) ' ':,~'*' //' **",' Foundation cleanout (Y/N) ~ Depression (Y/N)
High water-alarm (y/N) ~ , ,," Alarm tested (Y/N)
Date of I~umpi,g + /./ c7' ,~ Pumper
SEPARATI(~N DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~)~-)~' ,.~ On adjacent lots ~/~)(~ /
To prope~ line ~ ~ Abso~tion field ~-~ /
Sudace water/drainage ~ / ~ ~ C
Foundation g/'~'7
Water main/service line
~.e2e (~3y F,~t CONTINUED ON BACK PAGE
C. UFT STATION
Date installed '--... Manufacturer
Size in gallons '"'"'""'~ ~).~--
High water ala..~.~. Cycles tested
Meets MOA electrical cedes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot /~//~ On adjacent lots
/
D. ABSORPTION FIELD DATA
Date installed ~-~'~' / ~ ~-~
Length ~ C~/' Width
Total absorption area -- z r~ Cleanout present (Y/N)
Date of adequa~ test ~//,~/~¢ Results(pass/f~i,)
Water level In ab.~rpfion field before test .' ~ · ~'
Peroxide treatment (past 12 months) (Y/N) /~'
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Sudace water
Soil rating (GPD/FF)
,~2 '~'~ Grovel thickness
for
After test
If yes, give date
Total depth
Depression over field (Y/N).
Bedrooms
Well on lot / / ~ / On ~djacent lots .~/'(~)0 / .Propertyline '~/-~:) "~
To building foundation "~ / To existing or abandoned system on lot
Onadjacentlots ~'/~;~ ' Cutbank M~//~i~. Water maln/service line ,..~(.r,~ /
Surface water I ~ [ Driveway, parking/vehicle storage area ./s~)/,'
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspecb'on.
'
Date //--/,/// '//
' ', ' ' , - / - -
HAA Fees 3PD, ~ Waiver Fee S
Date of Payment Z//Z-?/c~ ~ Date of Payment
Receipt Number ,5~"/-/7 (~'~) Receipt Number
72-026 (3/93)' Back
MUNICIPALI'rY 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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Completelegaldescription /--~-~- J~/' ~J~-~'~'/'~'/~"~ ..~6/'~"~.
Location (site address or directions)
Property owner /~/~'-
Mailing address ~
Lending agency Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
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:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
Se
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
sup'ply 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~./~',',~//~,~ ~/":~:~-/~'[/~'c~_~r Phone ~'--/,~ 7~
Address ~ [~ ~ ~ ~ ~ ~/~ ~'
Enginee~ssignatur~~~~~ Date ~ ~ ~ )~
DHHS SIGNATURE
"~"' Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
June 28, 1993
Accounting & Budget, DHHS
On-site Services, DHHS
Request for Refund - Account %2570-9426
After initial review and further testing by the engineer it
was found that this permit application did not need to be
processed or a permit issued. Please make arrangements for
a refund to the applicant.
Thank you.
Ray Jeffers
PO Box 110844
Anchorage, Alaska
99511-0844
Receipt %24817/8547
Account %2570-9426
AMOUNT: $200.00
Lot 2 Jeffers Subdigision
Permit Upgrade Application
Lau~omery
On-site Services
cc: File
Property Owner Name
Mailing Address
Legal Description
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Sendces
On-Site Sewer/Well Permit Application
SINGLE FAMILY DWELLING
Day Ph~ ~')
Zip Code~
'-'"" RF.C Fi'YE-D-
Lot Size ~ ~J ~' '~ ~ *c,~ Inspections will be conducted by:
Number of Bedrooms: ~ Approved Engineering Firm ~UN 2 1 1995
~ ~ ~ ~ ~o ~ ~5. Municipali~ (permit fee Inclu~iclpali~ of Anchorage
Does your house contain any of the following: Hot Tub. Swimming Pool. Therapy Pool. Jacu~t' Health & Human Se~ices
or Water Softener Unit? ~ If yes, which one? ~ ~ ~
This application is fo~ Sewer Only Sewer and Well ~ Sewer Upgrade ~ Well Only
I ce~i~ that Ihe above information is corre~. I fuRher ce~i~ that this application Is being~ade for a S{ngle~wellin~
and In accordance with applicable Municipal codes. ~ ~ ~ [~ ~ k~ I ~ ~ ~. _~
Fees' ~ 'Receipt. ~[~ ~,,. 0~~ ~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Envi~:onmental Services Division
Telephone: 343-4744
ON-SITE SERVICES FEE DOCUMENTATION
Date Pald: [.o -~).~-dt ,z~ Permit Number:.
N,~me~f Payer: (Name on Check) ~--~
I
Ma~ng Add's: (Off~f check)
Legal Description(s): ~ ~ ~~ %~
OS- 24817
Type of Payment: (Indicate Amount Paid)
Health Authority:
Sewer & Well Permit:
Well Permit:
Sewer Permit:
Copy Request:
72-034 (Rev. 10/87)
Excavator Permit:
Engineer Permit:
Pumper Permit:
Well Driller Permit:
Tank Manufacturer:
(Waste Treatment)
DISTRIBUTION:
, WAIVERS:
Lot Line:
Well to Tank:
Well to Field
Field to Surface Water
Tank to Surface Water
WHITE--MASTER FILE
CANARY--PROGRAM FILE
MUNICIPALITY OF iANCHORAGE
MEMORANDUM
DATE:
June 28, 1993
TO: File
FROM:
Robert W. Robinson, Civil Engineer, On-site Services
Department of Health and Human Services
SUBJECT:
Lot 2 Jeffers Subdivision - Permit Application
A soil/percolation test conducted on June 25, 1993 showed an4~
SM accepting soil having a perc rate 0f 20 minutes/inch. The
absorption system installed on September 1, 1980 for a three (3)
bedroom single family residence was designed on the basis of the
accepting soil being visually rate at 260 square foot per bedroom.
This system was installed to a total depth of 12 feet with 8
feet of gravel below the perforated pipe. The perc test on
June 25, 1993 of 20 minutes/inch is equivilant to 213 square foot
per bedroom. With 8 feet of gravel below the perforated pipe,
the absorption area for 59' Of trench is 944 square foot. The
absorption area required for four (4) bedrooms is 852 square foot
therefore this system can be approved for a four (4) bedroom single
family residence.
RWR~ljm
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: /-- ''~ g"~--~--~'~,~ .~/~Township, Range. Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT ~'
DEPTH? pO
E
Oep~h to W~er Nter
Idoni~ing? Oate:
I III
I III I I~¢.,~I I I I
COMMENTS l~r"~/
PERFORMED BY: , ) * I ERTIFY THAT THIS TEST WAS PERFORMED IN
72~ (R~. 4/~)
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
Dross Net De~th to Net
Reading Date Time Time Water Drop
~ I~ ~//~ ~.
PERFORMED FOR:,
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFOR~'~~.
Township, Range, Section:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT -
DEPTH? pO
E
Depth lo Water A~er
Idonit~lflg? I)ite:
SLOPE SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
h) PERG HOLE DIAME'TER
PERCOLATION RATE (minutes/mc
TEST RUN BETWEEN __ FT AND FT
COMME.TS, "
PERFORMED BY; I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
RECEIVED
Municipality of Anchorc=~
D~pt. Hcelth & Human Se~'[ce~
'UEAC. I4 FI F-.LD ADOITIOA/
.LO-l' ~_,J-PFF~R$ 30~P,
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. # I~ ~ ~ - ~ ~t- ~ "~ HAA # _ ~ {'~c~
1. GENERAL INFORMATION
Complete legal description /-- '~'
Location (site address or directions) /7/~/ C"'~/~/~-/~ U;'~'~'~-2 ~/'~'~, ~/'~0~ .(~"~,/'~
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone ~"'~' -- '~-~--'-~
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well X,
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site ~,
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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.
Name of Firm ,.J~-,~/"}l~-~ '-~ ,;~--7-'~/,~c~/"~- ~t/~5-~'.'C Phone 7~'~'~/
Engineees signatur~ ~/~ ~ _ <~r~~' Date
· , .~' ~i~ ~t~ ~ OF
~3r ~Y ~¢~. ~r.d~5 t~ f /I . ,~ ~.., ~
~ ~ ~,t~,c~9~/ ~... ( ~ ..... ....... ~..~t~
-"~ ' I ~ - I~ '' ~ .' . ~. '
~ ROr=S$.C,.~'
DHHS SIGNATURE %~.
. bedrooms.
Approved for
Disapproved.
~-'-z~,.. Conditional approval for
- { ., ~ / 2 / / ,
Additional Comments
bedrooms, with the following stipulations:
By: - Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Mu'nicipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L~.~,' 6[ ,,-~~-~ .~U~. Parcel I.D. ,~-~-~'~//-/~Z
A. WELL DATA
Well type p/'~3 7~ If A. B. or C. attach ADEC letter. ADEC water system number
Log present (Y/N)
/
Total depth
Sanitary seal (Y/N) Y
Date completed ~'/[ '~',/~'~ '~ D rille r ~ I~,Oc--~
///
_' . .
gasedto .~' ~ ?_J~ Casingneigh! [~- '
Wires properly protected (Y/N) Y
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
g.p.m.
AT INSPECTION
/, EI.~/i~ONMENTAL SERVICES DIVISION
g.p.m.
RECEIVED
SEPARATION DISTANCES FROM WELL T/O:
Septic/holding tank on lot
Absorption field on lot J [
Public sewer main
Sewer service line
; On adjacent lots '-~ /(~'~
; On adjacent lots ~ /{~, /
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~) Nitrate
Date of sample: /
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ~'-- [ -- ~"(~ Tank size
Cleanouts (Y/N) y Foundation cleanout (Y/N)
High water alarm (Y/N)
Compartments
Depression (Y/N)
Alarm tested (Y/N)
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /t'~ .~- ~ (~ ' On adjacent lots ~/(~ ('
'
TO propertyline &(? [ Absorption field ~ '-~
Surface water/drainage ~r~'t ~'~ ~) ~9 ~
72-026 (Rev. 7/91) Front
Foundation
Water main/service line
CONTINUED ON BACKPAGE
C. LIFT STATION
Date installed
Size In gallons
Vent (Y/N)
High water alarm level
Meets MOA electrica.~YJ~
Manufacturer
at f_ ~ Pump off" level at.
~ Cycles tested
Surface water.
D. ABSORPTION FIELD DATA
~. Date installed ~ ~" / ~ ~-'~(~ (~ c> / '
Length ~ C~ '/ ,"/' Soil rating ~-- ~::~(~)z~'~///'~/~' System//type
· ' Width '~ ~ Gravelthickness ~ ~ (:~ Totaldepth //~---- ·
Totai absorption area '~>,'~, ~- ~ r /D~/4) ~tY/:~,,~c/.
Cleanouts present (Y/N)
Depressio. n over field (Y/N) l/~ Date of adequacy test. / ~--/~'"- ~.---
Re'suI~s (l~a~s/fail) F~ ~ ,~ for "~ bedrooms
Peroxide treatment (past 12 months) (Y/N) H If yes, give date
SEPARATION DlSTANCE FROM ABSORPTION FIELD TO:
Wellonlot / I ~ [- Onadjacentlots ;::=="/~(~:~:) / Propertyline '~--~
To building foundation ~ / To existing or abandoned system on lot ,"~~
Onadjacentlots ~ / (~(~/ Cutbank ~/~/~ ~ Watermain/serviceline, .,~'.'.'P
Surface water /~ 0 ~ ~ Driveway, parking/vehicle storage area /'~*~ '/
Curtain drain ~l 0~,,7 ~
E. ENGINEER'S CERTIFICATION
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 $ j
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) B~Ck MOA 21
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
GENERAL INFORMATION
.(a) Le~lal Description (inqlude lot. bio, ck, subdivision, section, t(~wnship, range)
Location (address or directigns) '
~b) Applicant Name~/~Je~Tel~phone: Home ~ Business ~
Applicant Address 1~/~1 ~0/~ V( CF~ ~
(C) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other~ (explain);
(d) Lendina Institution ~ ¢~;~ ~ /~'=~ Telephone ~ ~ ~- --/¢
(e) Real ~tate Company and Agent ~/~
Address
~TelePhone
(t)
Mail. the HAA. to,the following address:
qr. )
TYPE OF RESIDENCE
Single-Family J~.. Multi-FamilyFI
· Number of Bedrooms "~
Other
WATER SUPPLY
Individual. W~II j~, Community [] Public [] .,' · ,
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to !he legality and status.
4. SEWAGE DISPOSAL ,"',
- onsite~i Public[] Community[] Holding Tank[]
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
' attesting to th(~ legality .and status.
Pagelof2 ." 'i"~ ."
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
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
MUNICIPALITY OF ANCHORAGE (MOA) *
HEALTH AUTHORITY APPROVAL (HAA)
~ CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ^NOiOl~(3~
DEPT. OF HE.e~LTH &
ENVIRONMENTAL. PROTECTZON
FEB 0 z 1986
_RECEIVED
Legal Description: L.~-. (~/~~
WELL DATA
Weft Classification
Well Log Present (Y/N)
Total Depth ~"~'"~;;~ Ca~dto
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
If A, B, C. I~E.C.,.A£proved (Y/N)
O Yield
Depth of Grouting
Pump Set At ~ ~
Sanita~ Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
/ O O ! C'/") ; On Adjoining Lots /~m") ! ~'-/--)
TO Nearest Edge of Absorption Field ~)~l~/Ot /~),~/' ; On Adjoining Lots /~ [~/-) '
TO Nearest Public Sewer Line /~////Zf To Nearest Public Sewer
Cleanout/Manhole ./'~//~r To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ? ~-...-~ "~d::~/"~'" ; Date ~
Water Sample Test Results ~
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed .~.'/ )~:;~) Size /,~-.~") No. of Compartments
Standpipes (Y/N) Y Air-tight Caps (Y/N) .~
Depression over Tank (Y/N) ~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~/~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well FI~>~
To Property Line
To Water Main/service Line
Comments ·
Foundation Cl.eanout (Y/N) Y
Date Last Pumped'JellY
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation Y_~ ~'
To Disposal Field ~- _~ ~'
To Stream, Pond, Lake, or Major Drainage
· Page 1 of 2
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed -,'~1~ f~'~' ]
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /~
To Building Foundation
Lot jl~/~,./~] ~
TO Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness ~:~"
Standpipes Present (Y/N)
., Date of Lasl Adequacy Test
To Property Line ~ b
To Existing o.r Abandoned System on
;On Adjoining Lots /~)
TO Cutbsnk (if present) /~/~)1.
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
Vent (WN)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that ~ave checked, ve~ifi{d, or conformed to all MOA and HA~,~idelines in effect on the date of this inspection.
Company//JE;""~ ~'~.J~'~'MOA NO. -
Receipt No. ~."7 ~(,,, ~. ~_
Date of Payment .~'-5'L'~'
Amount: $ ~.~ ..~o~
Page 2 of 2
.j DA ~ ~ RECEIVED
.,*" INSPECTION APPOINTMENTS
INSPECTOR ~
MUNICIPALITY OF ANCHORAGE ~P[ OF HEALTH &
ENVIRONMENTAL S~ITATION DIVISION JUL 2 8 19B1
BEQUEST FO~ ~PBOVAL OF INDIVIDUAL WATER ~D SEWE~ FA01LITI~
2. BUYER ~ / PHONE
3. LE~DING INSTITm~N
VEOP4E5 j PHONE
MAI LING ADDRE~
~ REALTOR/AGENT J PHONE
I
6. TYPE OF RESIDENCE
~]~J[ SINGLE FAMILY
I-1 MULTIPLE FAMILY
7. WATER SUFffLY
INDIVIDUAL*
r-t COMMUNITY
[] PUBLIC UTILITY
~ SEWAGE DISPOSAL SY~'rEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
NUMSER OF BEDROOMS
I--'1 One [] Four
~ Two [] Five
[] Three [] Six
[] Other
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date. give well
depth (attach log if available.)
/~'~ YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF ~ESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [~THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[~INDIVIDUAL DEPTH OF WELL
[] COMMUNITY )ATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
NoiAGE DISPOSAL SYSTEM PERMIT NUMBER
VIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified. INSTALLER
•Septic T~lnk or [] Holding Tank
Size: I'~'~{~ IfTankishomemede SOILS RATING
9[Ye dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
S. COMMENTS
~ APPROVED FOR ~ BEDROOMS,
f--I CONOITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
unicipality f
nchor ¢
fll n,
825 "L'° ST R E ET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEOIIGE M. SULLIVAN,
MAYOR
July 31,
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Ray/Rachael Jeffers
1519 Marten Street
Anchorage, Alaska 99504
Subject: Lot 2 Block 1 Jeffers Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1)
The water analysis report needs to be submitted to
this office from the Chem Lab, 5633 B Street, for
our review.
(2)
The depression around the well casing n6eds to be
filled in with impervious type soil so that it slopes
away from the well casing.
(3)
Exposed electrical wires to the well head are in
violation of the Municipality of Anchorage codes and
must be encased in conduit and buried.
Please notify this department for a reinspection when the
noted descrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
James $. Roberts
Associate Environmental Specialist
JSR/ljw
cc: Peoples Bank and Trust
Pouch 7-007 99510