HomeMy WebLinkAboutDON JACK LT 1Ir {
Don Jack
Lot 1
#020-092-59
Municipality of Anchorage
• � Development Services Department
Building Safety Division = r:
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 Page 1 of 3
Onsite Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW020368 PID Number: 020-092-59
NOTe'KRISTINE & RICHARD MOORE
Wastewater System: O New ■ Upgrade
Address:
16415 BETTY STREET a ANCHORAGE, AK 99516
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 345-9036 3
00eep Trench ■Sholloei Trench OBed Oklound OOther
LEGAL DESCRIPTION
sail Rai".
3.0
Tota Depth Iran or4!rope:
3.0-4.5 MAX
GPM/Se. Ft.
n.
Block: Lot: SubdMsion:
apth b pix baht" Tram o^awa greae:
G,.l aplh 1 th ppe:
— 1 DON JACK
SEE DWG. Ft.
0.57 Ft.
Township: Range: section:
fa aeEed oboe arisina eraec
Gewl bath:
— — —
0.33-2.19 Ft.
30 rt.
WELL ❑ New ❑ Upgrade
Ga.a .4th:
5
Namba pl a ec
1
coax! Mbee avec
p1
FL
Cle.rlwotion (Pt.. Ae.C): Tela D.
Cosh To:
Taal abw t;on area:
Poe motenol:
Ft.!
Ft.
150 so. FI.
D 3034/ F-810
OIJwC Dale Dawe:
SWNater Lml:
ln.lal4r:
A+ HOME SERVICES
Dole inslalea:
11/14-20/2002
Ft
fyw:Party,
Set u:
Co" ebght oboe! GMM:
eftR.
R
SEPARATION
DISTANCES
Oseptic OHolding OS.T.E.P. ■Other
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
ablic/Pri ate
seer Lines
Yp1pfoctu :
ANCHORAGE TANK
Copxar in yawn.:
1500
rWell
too'+
too'+
—
25'+
Nplenal;Numbe,
FIBERGLASS
a Cpatmenle:100'+
2
too'+
too'+
too'+
—
—
LIFT STATION
5'+
10'+
5'+
—
_
site M flows:
Yanulactur.n
1500
ANCHORAGE TANK ORENCO SYSTEMS
Foundation
5'+
10'+
5'+—
IAIP an level et:
Pwnp on Nwl at:
Nigh pals awrm at:
TIMER 32"
TIMER 32"
46"/36"
Curtain Drain
NONE KNOWN
Pomp IIOM t Novel:
ENc4ca kn tion. xrrormee by:
ORENCO
M.O.A.
Remarks:
BENCH MARK
uxati ane a.eoripti :
"THIS IS AN ADVANTEX TREATMENT SYSTEM
TOP OF GARAGE SLAB
—EXISTING SEPTIC SYSTEM COMPLETELY ABANDONED
beun,ee EN 1.; 1 D
n.
ENGINEER'S SEAL
oQ� F
QokP� ... .....� ..S 0�
AKWWC, INC.
Inspections performed by: Dates: 1st i t/ta/2oo2
O�o�
0
D
2nd 11/14/2002
3rd 11/20/2002
QOO� ..J fr C3ness
oO
Development ervices Department Approval
E
p o
Reviewed and approved by: Date: 1111c3.—
o
��p°"Pr na,
pO ofess(on
(Ree. 12/01)
400000
PERMIT NUMBER: PARCEL ID NUMBER:
SW020368 AS -BUILT DRAWING 020-092-59
I / I
/ NEW DRAINFIELD
I� THi1<
Mir 1`
11
I T%7 1 1
I 11 ti
I it
E. 164 AVE.
1
--- - - - - - - - - - - - -
-
I
•r'.'.• NEW 1500 GALLON ADVANTEX '
TREATMENT SYSTEM
.K /
6.
EXISTING /
3 BEDROOM
SCO HOUSE
DON JACK S/D;
LOT 2;
VACANT-)
It_t•�=1•I
STI 32.27 15.16
MH1
38.95
25.07
MH2
43.22
30.85
MT1
59.15
F45.85
MT2
70.89
166.84
11
ALASKA WATER &. WASTE«'ATER SCALE: C.J.G.
CONSULTANTS, INC. 1" = 40
6901 DFRARR ROAD. SUITE 7R • ANCHORAGF. AK 99504 • FHONF (907)3374119 • FAX (907)338-3716
>REPARED FOR: PHONE NUMBER:
KRISTINE & RICHARD MOORE (907) 345-9036
DON JACK SUBDIVISION; LOT 1,
OF WORK:
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
3OF3
ffr GO"e s;
—7
... Al
PERMITNUMB' BUILT DRAWING PARCEL ID NUMBER:
SW0 AS—BUILT 020-092-59
TOP OF ADVANIM POD 70P OF MANHOLE -
98.39 (AVC.) (AVO.)
FINAL GRADE TOPOPOF MANHOLE
-99.31 (AVC.) —� 9a.a1 (AVC.)
TOP OF TANKI I I I rmll I - 93.49 ^
93.32 I1 TOP OF TANK
M—I
�a s milh,
NVERT - 92.67 ___x
•1 0
FILTER
TOP OF
- 92.74
UKUWNUWAlWl - 0/./4
RELATIVE ELEVATION OF BOTTOM
OF TESDK)LE - 85.24
1
FINAL GRADE -
95.37-95.93
/-ORIGINAL GRADE
/ - 93.74-95.24
�9JVERT OF PIPE
- 93.31 (AVG.);
SIZE: 135',
HOLE DMMETER:
035', SPACED:
EVERY 10'
BOTTOM OF TRENCH
- 90.74 (AVC.)
ALASKA WATL'R & WASTE WATRR SCALE: C.J.G. o
CONSULTANTS, INC. 1- = 40•
6901 OFRARR ROAD. SURF FS • ANCNORAC.F. AK 9050A • FMfNF 100))33741)9 • FAX M07)3563T66
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
KRISTINE do RICHARD MOORE (907) 345-9036 2 OF 3 QQ '•, j
'LEGAL DESCRIPTION:
DON JACK SUBDIVISION. LOT 1 Q0�4�
TYPE OF WORK:
PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
TO DRAIN
FIELD
ORENCO PUMP
VAULT
Eli
®1�
NOV-25-2002 06:198 FROM:A+ HOME SERUICES, IN $07 -BW -6770 _. T0:.J3.b;3246
AiRhtFAX 11/22/2002 5:36 PAOE 1/1 ltiahtFAX
- Inspection Report
Munlelpallty of Anchorage, Aullding Safety DIVislon
4700 South eragaw
INSPECTION: VOICE 843-8300 INSPECTION: FAX (007)240-7777 INFO: 543.8211
Name ED'S ELECTIC Parmlt 02-9129
Addy 16415 BETTY ST Phone 272.4593
Leel LT 1 Inspection Date 11/22/2002
AM
SutdtvTalon DON IACK
Comments or Diredlons
AM•'CALL fOR SITE MEET"SEFTIC LIFT STATION
Inspec"on Retro Electrl®I aeinspeetton N
NO NONCOMPLIANCE OBSERVED
❑ CORRECTIONS ESSENTIAL AS EXPLAINED BELOW
WILL RE-EXAMINE AT NEXT DO NOT CONCEAL UNTIL REINSPECTION
0 INSPECTION
COMMENTS: (tr Inspector use only)
L�/ i I�Ghs l.rr sell L /^/�r`✓112
Inepodor
6`v Date
NOV-22-Z-Ow FRI 06:17PM ID:P+ HOME SERVICES, INC. PAGE,:1
Permit Number: SW020368
MUNICIPALITY OF ANCHORAGE
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
Gf, 0C
Date Issued: Sep 23, 2002
Expiration Date: Sep 23, 2003
Parcel ID: 020-092-59
Legal Description: DON JACK LT 1
Design Engineer: 0041 AK Water & Wastewater Consultan- Site Address: 016415 BETTY ST
Owner Name: Kristine & Richard Moore Lot Size: 40513 SO. FT.
Owner Address: 16415 Betty St. Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99516 -
This permit is for the construction of.
CJ Disposal Field Q 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:
i,
'r-1 It 19��� Date:
`1! Date:%,
Municipality of Anchorage ,•
• Development Services Department
j' Building Safety Division
-- On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-092-59 Permit Number 020368
Mailing address BETTY ST. :N • :•
Mailing address (2)
Legal description (Lot, Block & Sub'd.) DON JACK S/D: LOT 1:
Legal description (Section, Township & Range) N/A
Lot Size ub,Sl F:2 Acre
THIS APPLICATION IS FOR:
Zip Code 99516
Number of Bedrooms 3
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade 0
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 do WASTEWATER CONSULTANTS, INC.
Permit
Date of Payment:
Waiver Fees
02 Date of Payment:
Receipt Number. C.: NQU I 'S:C• Receipt Number.
ALASKA WATER F& WASTEWATER
CONSULTANTS, INC. ._.. _. ___.._...... ........ ........
November 1, 2002
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
RE -DESIGN
(:6Vj0-Z_� 368
Ref: Proposed Welland Septic System for Lot I: Don .lacl. Subdn uwn.
ADVANTEXTM TREATMENT SYSTEM
To whom it may concern:
A permit was issued on this property on 9/23/02. Prior to construction the field technician
noted that the groundwater had risen to a point where there was less than two feet of
accepting soils. Another test hole was excavated west of test hole one on a small knoll.
Due to the high ground water and limited area we are proposing to use an Advantex
treatment unit and a five foot wide drainfield be installed. Comments regarding the
design are summarized as follows:
1. SOILS: See the attached log, which shows the soil classifications, groundwater
monitoring, and the percolation test results.
2. DRAINFIELD 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. A new test hole was dug and found that the percolation rate
was <1 minutes/inch. The Advantex system has received class III approval and %%e are
going to conservatively assume an application rate of 3.0 GPD.Tu.
3. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Proposed Application Rate: 3.0 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 150 fit
f. Total Depth: 4.5 feet (max. at any point)
g. M.O.A. Approved Sand Filter Depth: 2 feet
h. Effective Depth: 0.5 feet
i. Width: 5 feet
j. Minimum Length: 30 feet long
k. Effective absorption area: 150 Q
4. ORENCO PACKAGE SYSTEM: The STEP tank with the Advantex Treatment
System will be provided 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.
5. SURFACE WATER: There is no surface water within 100 feet of the proposed septic
system upgrade.
6. TOPOGRAPHY: The test hole is placed on a small knoll and the surrounding slopes
run approximately at 15% running northwest and southwest. There is a cut -bank west of
the test hole running on the edge of the road. An imaginary line from an elevation two
feet on top of the lateral to the tow of the slope is less than 25%. In short, there are no
slope concerns.
7. CLOSING: I am open to any suggestions from your department that %%otld be an
improvement to the proposed system. 1 am unaware of any negati%c impacts that this
installation wou impose on adjacent wells, or septic systems. If you e any
questions, pleapt�c ll havus at 337-6179.
.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, a topogrophy 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.
'+/ACANTD
PROPOSED SEPTIC SYSTEM UI
(SEE DESIGN PAGE 2 OF
--- r — �r— ----------------------------
------ I —
Op;
I
I ,
r
I 1 I
I I
,
I
I I I
I I
I I
E. 164 AVE.
-------------�
I I I
1 I I
� I I
� I I
' I I
I I
I I T—EXISTINI
I I 1 3 BEDRO
EXISTING SEPTIC (:7 i i HOUSE
I SYSTEM N I I
I I I
DON JACK S/D; I I
LOT 2: I I
I I I
I i
I I I
I I 1
I u
I
I
DON JACK S/D;
LOT 3;
I
I
I
I
I
11/1/2002
DRAWN BY:
ALASKA)NME'R & WASTEWATER SGA Z.T.G. ;'�
CONSULTANTS, INC.
001 (1FRe9R ROep. SUITE tR • eNCNOReOF. eK 9050E • PNONF I007711 -A09 • FAX (007)15Nd746
I" = 100'
EPARED FOR PHONE NUMBER: PACE NUMBER:
KRISTINE do RICHARD MOORE 345-9036 1 OF 4 1".7
;AL DESCRIPTION: �,�
DON JACK S/D; LOT 1;
'E OF WORK:
PROPOSED SEPTIC UPGRADE
DON JACK S/D;
TRACT A
C ACANTD
IL. arness.
1 PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 4.5 \ \
T
FEET DEEP MAXIMUM BY 5 FEET WIDE BY 30 FEET LONG. — —
ADD 2.0 FEET OF MOA APPROVED SAND. THEN ADD 0.5 \
I FEET OF CLEAN. WASHED SEWER DRAINROCK. THE
DISTRIBUTION LINE IS TO BE 1.25 INCH PVC WITH 1/4 E. 164 AVE.
INCH HOLES SPACED EVERY 10 INCHES ON CENTER (30
HOLES TOTAL). (SEE DETAIL DRAWING PACE 4 OF 4).
I
V TH/1 I i
PROPOSED 3 BEDROOM ADVANTFX /
TREATMENT SYSTEM WITH PUMP VAULT
\\\ • •. (SEE DETAIL, PACE 3 OF 4) /
THJ2
IO r.I
I
L"', - 3 BED OOM
HOUSE
EXISTING DRAINFlELD TO BE
COMPLETELY ABANDONED'
—EXISRNG SEPTIC TANK TO BE
COMPLETLY ABANDONED PER UPC
DON JACK S/D;
LOT 2;
WACA!�TD
NOTE: THE CONTRACTOR SHALL HAVE ALL 100 FOOT WELL
RADII SHOWN, AND THE NORTH AND WEST LOT LINES
FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO
CONSTRUCTION.
11/1/2002
='"'OF
DRAWN BY:
ALASKA MATER R WASTK«TATER
Z.T.G.
; �: 4
SCALE:
CONSULTANTS, INC..
° = 40�
""" "•"' ""' ""'
0001 MARA ROAD. SURF 29 • ANC.MAGF. AK 00504 ' F4MF (001175)-0170 • FAX (007)NIA-M0
PREPARED FOR: PHONE NUMBER:
PAGE NUMBER:
KRISTINE & RICHARD MOORE 345-9036
2 OF 4
Q p'•, y arne
oO °yi C 79 i)
LEGAL DESCRIPTION:
DON JACK S/D; LOT 1;
�odG
°D' 0
60100%
04400 0l
TYPE OF WORK:
PROPOSED SEPTIC SYSTEM UPGRADE
I
N(77E: dIu CRoss.
P.E. HAS THE
AD'JANTT7( uANVAL
AdvanTe)( Treatment System
AX20 - Mode 111 °
40041'od a M!
TO PROPOSED DRUNFIELD
D'
30 INCH
INSULATED
1
!' ABS PUMP–OUT I i
CTI I I
B' ABS COUPLING i
(x>,ImT(Tvv.x>�
i
sEwFx
�eROpC �
INLETORENCO
7 -- --- — --
BIOIUBE
OPTIONA — —I - --- — _ — SCREENED
VAULT
SUDE SECTIONOf IT' PIPE
li
OVER THIS CONNECTION
TO PROVIDE 3 BEDROOM ;' p}�DaT
sNEER PRD0�0NTENDiD F18ERGLASS TANK PUMP
BRIDGE EXCAVATION
DATE: oop6oppp�4
11/1/2002 0
.. ��.jjY-' Vii'• DRAWN BY: d C� O �S14p
ALASKA WATER & WASTEWATER SLE: Z.T.G. 4 �op�
GG
CONSULTANTS• INC.-N.T.S. """ "' " " "' """"'�
SOOT DFGAGOAD. SURM
F 78 • ANCH A(IF. AR GVSM. • MMJF (OD7)!!7- 179 • FGR (OOT!lR-1766
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
KRISTINE & RICHARD MOORE (907) 345-2491 3 OF 4 Oma'•, a A. Ca SS.-
LEGAL
s-LEGAL DESCRIPTION: Q ° 7 3 ReQ
DON JACK S/D; LOT 1; O�d o ......essloo�Xv��o
TYPE OF WORK: ro �4
DETAIL DRAWING OF ADVANTEX TREATMENT UNIT O�Oppoo��
30 FEET LONG
AIT
I
---------------------------------
0!
I
i0 I
'—LMT-------------- ----------- ------
—)
THE DISTRIBUTION LINE IS TO BE 123 INCH
PVC WITH 1/4 INCH HOLES SPACED EVERY 10
INCHES ON CENTER (30 HOLES TOTAL) -
FINAL GRADE
FABRIC
V ILNIVC •, �
2 FEET OF SAN
FILTER
11
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
6061 6cRA" Y060 SIIITF >N • 6NCm AC.F C6 00%ft • PHMF fWA331.6170 • FAX f00))338 -3T<6
4.5 FEET DEEP
MAX )mum
1
Z.T.G.
N.T.S.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
KRISTINE do RICHARD MOORE 345-9036 1 4 OF 4
DON JACK SUBDIVISION; LOT 1
OF WORK:
PROFILE OF TRENCH
u ADVANTEK
SYSTEM
w
..
........ .. ............
re am ss:�
'•. —79 .•' FFG
Performed For. %- It IS rl
Legal Description: L O T /
Depth
(Feet)
i LZ2 OA&A. rc 3
COMMENTS
(907) 343-7964 L
Soils Log Percolation Test' Ali z�:0
l,..
,f^100A 6 i': DatePerfomed
'Township Range Section.. .
::Slope .Site PUn a .. ..
®NINE,
.,�� 0F..,�C'i
'Gross Time
Municipality of Anchorage
C2 GINEER'
Net Drop .
Development Se— ces Department .
c�i3 va—
9:
•';:BtnlEmgSafetyDrvisiarl
on -Site Waters d Wastewater Program :4"'�'"�
••
Er
..'• 4700 South 8' ' i * L ' .
t' .
o6Andlorage AK6951a-E650
P.O. Box 1650
wwv,.d arichorzne ak os
_
RDEERT G COWAN,
p11PIN -CE;8801
„
f mer -
(907) 343-7964 L
Soils Log Percolation Test' Ali z�:0
l,..
,f^100A 6 i': DatePerfomed
'Township Range Section.. .
::Slope .Site PUn a .. ..
®NINE,
Dale"
'Gross Time
Net Time
®®®®MOMM.
Net Drop .
PR4'sch
c�i3 va—
®®®®i
o 6 " I
10
®®®®
3 "4
611 "
NONE
6114,0
No
0
NOONi
NOON
6 '�, •
k o
■NEE
I cl aiy.
S11
ML pc•vr4. -
S,cr -
VrtVnci.7 t13C.&IWASGROUNDWATER
cl. If X., ENCOINTEREDT YES
. � s
IFYES.ATVMTDEPTH7 G L
Depth to Water AfterJ P
Monitoring? � S /3' 'E
SV y
ReaEny
Dale"
'Gross Time
Net Time
Depth to Water
Net Drop .
PR4'sch
c�i3 va—
iZ4o,.,i
o 6 " I
10
914,
3 "4
611 "
PC
6114,0
3 vy-
,.
6 '�, •
k o
I cl aiy.
S11
S'O
cl -1/gr •
3 ray ,.
PERCOLAMCNRAT= J-4 (M- VIMV.c1) FERC Y.CLE D=IETER (,a ••
TEST RUN BETWEEN �;L_FT AND 3 FT
PERFORf.1ED BY: S NGINEERING I ft_CERTIFY THAT THIS TES WADS
R
PERF0R%IE01NMf" 34fdoh-,%k Aicw. PU..�IPALGUIDELINES INEFFECTON'THIS DATE. DATE: at 10%
Eagle River, Alaska 99577
ALASKA
WAT
CONSULTANTS.
• WL 9
L'R & NNASTENVA71'ER
INC._..
• W -el 9 • AX.(907)=-3246 • ee c.4
000
0
S'�Q00
6901DERMR ACAD.SUItE"HORAGF-
SOIL LOG
— PERCOLATION TEST
.. . ...... .. D
LEGAL DESCRIPTION:
DON JACK S/D;
LOT 1
�Q a of a .n s:' e
��06�
PERFORMED FOR:
RICHARD KRISTINE MOORE DATE: 10/z1/zoo2
' .• ' q�dQ�
DEP ___
6'
;
��^edP�ofessio�° •��
(feet
ORGANICS
TEST HOLE
—
4
—
4
0'
6•
SOIL CLASSIFICATIONS 1-- ----------t
r
2
—
I /
GW
E. 164 AVE.
—
GP ML I rJ------ -- .J ' ------------------------
3
4
GM CL
6•
4
GC OLMH
5
SM/GMSP
'• Le• 7
CH
• • i
SM : OH F-11
SC i k --J
DON JACK S/D;
6
'
--� LOT 1:
7
DEPTH TO DATE I
GROUNDWATER ;
I
qA`AN-�
8
B'0/21/200 j
7.5' 0/25/200 i I
9DON
OT T
7.7' 0/30/200 ,
L SITE PLANS
8' 0/31/200 i
1'=100'
10 0.0.11.
DATE READING CLOCK NET TIME
WATER LEVEL NET DROP
11
TIME (MINUTES)
READING (INCHES)
0/25/2002
12
13
14
15
16
17
18
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 3.0 FT. AND 3.5
FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: [--]YES N NO
SOILS LOGGED
BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY:
MATT FISHER
COMMENTS:
AKWWC. INC. 1•
JEFFREY A. GARNESS. CERTIFY THAT THIS W
ERFORMED IN ACCORDANCE
PERFORMED BY
WITH ALL STATE
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
1
—
—
6•
—
2
—
4
0'
6'
3
—
—
6'
—
4
—
4
0'
6•
5
—
—
6'
—
6
—
4
0'
6•
ALASKA WATER & WASTEWATER
CONSULTANTS, INC.
September 13, 2002
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 Well and Septic System for Lot 1; Don Jack Subdivision;
ADVANTEX'n' TREATMENT SYSTEM
To whom it may concern:
1. GENERAL: The existing 3 bedroom home is served by a private well and septic
system. The septic system is completely surcharged and must be upgraded. One test hole
was excavated on the property by S&S Engineering. We are proposing to design the
septic system around the 30 foot radius of this test hole. Due to high ground water and
limited amount of receiving soils, 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. S&S Engineering performed a percolation test in the test hole
at the depth of 2.0 to 3.0 feet and found the rate to be 3.3 minute/inch. The Advantex
system has received class III approval and we are going to conservatively assume an
application rate of 3.0 GPD/FT2.
4. TRENCH DESIGN:
a. Percolation Rate: 3.3 minutes/inch
b. Proposed Application Rate: 3.0 gallons/day/ftz
c. Number of Bedrooms: 3
d. Design Flow: 450+ gallons per day
e. Minimum Absorption Area: 150 ft2
f. Total Depth: 2.5 feet (max. at any point)
g. M.O.A. Approved Sand Filter Depth: 2 feet
h. Effective Depth: 0.5 feet
i. Width: 5 feet
j. Minimum Length: 30 feet long
k. Effective absorption area: 150 fl2
5.ORENCO PACKAGE SYSTEM: The STEP tank with the Advantex Treatment
System will be provided 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. TOPOGRAPIiY: The area around the proposed drainfield is relatively flat, 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, pleas4all us at 337-6179.
M.S.
NOTE: Attached is a site plan drawing, a design drawing, a topogrophy 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.
` VACANi�
,.-r-- ------------------------------------------------
.'� I \`
---------------------------
---------------
1 I 1
1
1 I i1 TMi�
I '
I 1
DR.
E. 164 AVE \1
--------------L
1
1
1
1
/
/
/
\ DON JACK S/D:
— LOT 1;
DON JACK S/D;
LOT 2:
rACANTD
i DON JACK S/D;
LOT 3:
I
I NO
I ENCROACHMENT
I CONCERNS
I
I I
i I DON JACK S/D;
I I TRACT A;
1
I 1
I I
I I
I I
I I
I I
I 1
I 1 rVACANT�
I I
I
1 I
I I
ALASKA WATER & WASTI✓WATI;R B.S.G. 4 v(
CONSULTANTS, INC. = 1001
901 DFRARR ROAD. SUITE 2R • ANCHORAGE. AK 90506 • MONF (001)331-0170 • FAX (00T)33M-3760 ,
EPARED FOR PHONE NUMBER: PACE NUMBER: I
KRISTINE do RICHARD MOORE 345-9036 1 OF 4 4%p ff y A ame
;AL DESCRIPTION: y�111 ai E 795 J
DON JACK S/D; LOT 1; �i.°/sem''•.,•, ,,,.•' �q`��
IE OF WORK: ��l`Cv^Pro /e eslo,'
100 SCALE SITE PLAN ^.aI.
INSTALL DOUBLE t ' \
CLEANOUTS , • .t
If
q ay -0a
------ I 3 NBEDROOM
OUSE
------ t 0�
� Rom
`•—LXIbT]NU UNNNrILLU IU NL INSTALL A FOUNDATION
COMPLETELY ABANDONED. CLEANOUT IF ONE IS NOT
PRESENT.
$TING SEPTIC TANK TO BE
PUMPED CRUSHED &
ABANDONED.
DON JACK S/D; `•'dACAN
LOT 2;
DO Nar (,ISL f:&L C0A(S;�n.�c;1o✓.
ETHENTRACTOR SHALL HAVEALL 100 FOOT WELL
N, AND THE NORTH AND WEST LOT LINES
A REGISTERED LAND SURVEYOR PRIOR TO
CONSTRUCTION.
ALASKA `VATER & NVASTENVATCR
PnKMIIITAMTQ Il.ln
13/02
B.S.G.
1" = 40'
PREPARED FOR: PHONE NUMBER: i•M:L NUMUM
KRISTINE do RICHARD MOORE 345-9036 1 2 OF 4
DON JACK S/D; LOT 1
OF WORK:
40' SCALE SITE PLAN
�. Came
7953
.� �d
- T
-
ROPOSED DR/JNFIELD. EXCAVATE A
TRENCH THAT IS 2.5 FEET DEEP
I
/
MAXIMUM BY 5 FEET WIDE BY 30
E. 164 AVE.
FEET LONG. ADD 2.0 FEET OF MOA
APPROVED SAND, THEN ADD 0.5 FEET
OF CLEAN. WASHED SEWER
\
., DRAINROCK. THE TRENCH IS TO BE
• INSTALLED PARALLEL TO ALL SLOPE
\
_ —
r
—
CONTOURS (SEE DETAIL DRAWING. — — — — — —
••�,
— — — — — —
I
I
PAGE 4 OF 4).
I
DRIVEWAY FO p,
Wf�
f
DON JACK /D;
r
RgOj
LOT
LOT 1;
TH/1
4'+/
`\+
PROPOSED 3 BEDROOM ADVANTEX
If
I/
\
• '• •
TREATMENT SYSTEM WITH PUMP VAULT
/
,
(PUMP VAULT MAY NOT BE REQUIRED)
(SEE DETAIL. PAGE 3 OF 4)
INSTALL DOUBLE t ' \
CLEANOUTS , • .t
If
q ay -0a
------ I 3 NBEDROOM
OUSE
------ t 0�
� Rom
`•—LXIbT]NU UNNNrILLU IU NL INSTALL A FOUNDATION
COMPLETELY ABANDONED. CLEANOUT IF ONE IS NOT
PRESENT.
$TING SEPTIC TANK TO BE
PUMPED CRUSHED &
ABANDONED.
DON JACK S/D; `•'dACAN
LOT 2;
DO Nar (,ISL f:&L C0A(S;�n.�c;1o✓.
ETHENTRACTOR SHALL HAVEALL 100 FOOT WELL
N, AND THE NORTH AND WEST LOT LINES
A REGISTERED LAND SURVEYOR PRIOR TO
CONSTRUCTION.
ALASKA `VATER & NVASTENVATCR
PnKMIIITAMTQ Il.ln
13/02
B.S.G.
1" = 40'
PREPARED FOR: PHONE NUMBER: i•M:L NUMUM
KRISTINE do RICHARD MOORE 345-9036 1 2 OF 4
DON JACK S/D; LOT 1
OF WORK:
40' SCALE SITE PLAN
�. Came
7953
.� �d
1
pou6�
--�-- - - - - -•--- .-- -
/ ROPOSED DRAINFIELD. EXCAVATE A \
TRENCH THAT IS 2.5 FEET DEEP
/ MAXIMUM BY 5 FEET WIDE BY 30
FEET LONG. ADD 2.0 FEET OF MOA E. 164 AVE.
APPROVED SAND, THEN ADD 0.5 FEET \
OF CLEAN, WASHED SEWER
DRAINROCK. THE TRENCH IS TO BE 1
A + INSTALLED PARALIFI TO ALL SLOPE
CONTOURS (SEE DETAIL DRAWING, — — — — — — — — — — — —
•• PACE 4 OF 4). I
i DRNEWAY FOp,
•' • W� DON JACK /D;
%r RqLOT 1;
H)1 y,.,A• US
PROPOSED 3 BEDROOM ADVANTEX '
•'••• TREATMENT SYSTEM WITH PUMP VAULT /
(PUMP VAULT MAY NOT BE REQUIRED)
L� (SEE DETAIL. PACE 3 OF 4)
\ 3 BEDROOM
HOUSE /
O
-INSTALL A FOUNDATION
CLEANOUT IF ONE IS NOT
PRESENT.
TING SEPTIC TANK TO BE
PUMPED CRUSHED B
ABANDONED.
DON JACK S/D;
LOT 2;
(-VACAND
NOTE: THE CONTRACTOR SHALL HAVE ALL 100 FOOT WELL
RADII SHOWN, AND THE NORTH AND WEST LOT LINES
FLACCED BY A REGISTERED LAND SURVEYOR PRIOR TO
CONSTRUCTION.
PmPq
=s�� __ _.__ '_
_ _ B.S.G. '
ALASKA RATER & WASTEWATER o �: 4
CONSULTANTS, INC 1" = 40' •.• ••• •• • • •••'
6901 °FRA" ROAD. SURF 7R ' ANCNORAGF. AK 9950E • PNONF (90))331-0179 • FAX (901)338-3746 a
REPARED FOR: PHONE NUMBER: PACE NUMBER:
KRISTINE d( RICHARD MOORE 345-9036 2 OF 4 O A', of r A. ess
.CAL DESCMPTK)N: Q -E-7953
DON CK S/D; LOT 1;
rP OF WORKprofessioll
40' SCALE SITE PLAN ��OO0000�
NOTE: JIM CROSS,
P.E. HAS THE
�� ►w+uAL
llI.
ll�M •
AdvanTex" Treatment System
AX20 -Mode 1a
40x94Pod
6ROul•I
1La167(
IF
NOTE: THE BOARD INSULATION TO BE
INSTALLED OVER THE SEPTIC TANK k 4'
BEYOND ON ALL SIDES INCEPT UNDER
THE ADVANTEX FILTER. THIS WILL ALLOW
FOR HEAT TO ESCAPE FROM TANK k
RISE TO THE FILTER ABOVE IT.
M CAP ANX
FINAL GRADE— !' 2nYP.2)_\ �AX20 P00
6' ABS PUMP—OUT
(TYP2)
e' ABS COUPLING
CLUED TO TANK
DRNNFIELD
1L7i"III
,■ '���'
.ySA:1:': •w •�n ��
INLET
.-
:•
wa
-aa a
OPTIONALSLIDE
V ink ��IIII1
SECTION
PIPE
' CONNECTION 12II
TO PROVIDE'
a a
ar..a
FIBERGLASS TANK
a . 7MO
DRIOCE EXCAVATION
9/13/02
..-.r—•� _Y.� " _ DRAWN B S.G. �,..•••• ��0�
ALASKA WATER & WASTEWATER 5
CONSULTANTS, INC. N.T.S.
6001 DFRAOR ROAD, S1➢TF 76 • ANCHORAGE. A6 OOSOG • PW WF (00713374170 • F6[ (007)336.3746
REPARED FOR: PHONE NUMBER: PACE NUMBER:
KRISTINE & RICHARD MOORE (907) 345-2491 3 OF 4 p of e A Co ss-'
EGAL DESCRIPTION: Q •yam - 53 •`�
DON JACK S/D; LOT 1;
Apd
YPE OF KDRAWING OF ADVANTEX TREATMENT UNIT 4��kkG; -q
DETAIL §
UR STATIO IS INSTALLED THE DISTRIBUTION
UNE IS BE 1 >]' PVC PIPE WITH >)' HOLES E1u.�Q V4ML-T
SPACED EVERY 24 INCHES ON CENTER (16
HOLES TOTAL) IF GRAVITY FLOW IS ACHIEVED
INSTALL CLEAN -OUTS AT EACH END---
F----------- - ----------------- --
I
� , I
� 0... 1
I
wr
30 FEEf LONG
ADD 0.5' OF
DRVNROCK
2.5'1 2' OF M.OA
APPROVED SIN
FILTER
FINAL GRADE
FABRIC
-5' WADE ----d
.M:q
3/02
mss.----_ B.S.G.
ALASKA WATER & WASTEWATER SCALE.: -
CONSULTANTS, INC. N.T.S.
6001 DFRARR ROAD. SUITF 7R • ANONORAGF. AK OOSOA • fl F (007)137-0179 • FAR (00])536.3746
PREPARED FOR: PHONE NUMBER: PACE NUMBER
KRISTINE do RICHARD MOORE 345-9036 4 OF 4
LEGAL DESCRIPTION:
DON JACK S/D; LOT 1;
TYPE OF WORK:
PROFILE OF TRENCH
UNE
MINIMUM
X lwk&�ess.-
—mac 0 r.
Municlpality'ofA6chorage h GINEER' ^ �c
Development Services Department *ABuildingSafeyDivision' . 49 , ....«...:....«/
• y�. -
On -Site Water WWastewater Program ���,,...
Wit
4700 South Bragaw SL .
P.O. Box 196650Mdxrage,AK99519-6650 ,p ROBERT C. COWAN. IO
www d.anchorace ak us rc� CE - 8801 2
(907) 343 -Mi
Soils Log = Percolation Test ii><�,r�.,`'���
Performed For. % R 15 ra,,,,E d. Rr C1�.1 RJ '. .`'N'100R� Date Performed:' /13 0 D-
-
Legal Description: L O T / Dori ...T Q enc SIO '.Township, Range, Section:
Depth
1
La.
2�
OA4A,,,ac S
2-
Depth to Water
Net Drop
PQf-5'01)
?/j$/02
O
3-
3-
G
4-
4-5
O 6„
10
5
9
3 liy
It
(,'i "
oZo
7-
91iy"
COMMENTS
ML Ctwirt
Sra—T
V/I yq�e.y
WAS „ GROl1t10 WATER
Q.C, J/ /'"� ENCOUNTER.' -.D7
� 5
IF YES. AT WHAT DEPTH? G L
O
Depth to Water After t p
Monitoring? S /} E
Si�O/e i Data O
PERFORMED BY:
PERFORMED IN/
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
PQf-5'01)
?/j$/02
O
1
G
(L4cr.,.
O 6„
10
/o M,,j
9 s/,, N
3 liy
It
(,'i "
oZo
91iy"
3'iy"
,r 1
4
3
}
,.
6 '�,'
k o
E
9 aiy.
3 /i
60
9'/x"
3 "
PERCOLATIONRATE S. S (rmutenlmh) PERCHOLE DIAMETER GI.
TESTRUNBETWEEN ';;L FT AND FT
1 �M G C-�%Tc� CERTIFY THAT THIS TES WA
IPALGUIDELINESINEFFECT ONTHIS DATE. DATE: 2,107..
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING
0*�o
DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION
REPORT
NAME
PHONE
I&NEW
3r--._161441
OUPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATrI0`�y
L1c
NO. OF BEDROOMS
1 `ATJK .rt -yam) .t.-.� - li+�-f''
_-I-'
DISTANCETO:
Well
NpT
Absorption area
'
Dwelling
PERMIT NO
DY
ti/
IC
Al or/.v
;:Z
Manufacturer K
Mall�rjlL.E
No. of compartments
Wf
Llq, capacity in gallons
IF HOMEMADE:
Inside length
r-�
Width
Liquid depth
,
602
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_ 4
Manufacturer
Material
Liquid capacity in gallons
W =
DISTANCE TO:
Well
Fo ndation
Nearest lot line
PERMIT NO.
,Z2
No. of lines
Length of each line
oral length of lines
Trench width
Distance between lines
H
inches
It,h
Top of the to finish grade
h terial beneath tile
Total effective absorption area
inches
Length i
Width r
De th ! asJ w
o
IU PI GG
IJJ�N y
PER'90--41
SSS 41332_
i 4
Type of crib
Crib diameter
Crib depth
Total effective absorption area
u,
& / 2.
6�W11r
y
DISTANCE TO:
Well
;V07-.1AJ
Building foundation
Ne'—/ti/
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
/V
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption areas)
OTHER
if
T
PIPE MATERIALS
CAST G 30 8
SOIL TEST RATIN
�i
�LCJ
INSTAL ER
REMARKS
��
tr
.. P SOF •...
VU
T
t
t •i.b.A
r^s A. SheSer
H
G
L
o.
It -' , •r,
'•.. ...• E`�s
4 P rc
Y
APPROVED SRD 13GX D E }EGAL
G.,%LE nIVGR. ALASKA 'fi=Z f//
PH. C04-2079 UUU
Q
lY
72-0131Rev. 3/78) 1 / 1/ ---
MLJN I C I F-�L I TY OF ANCHO�AGE
DEPARTMENT 0, iEALTH AND ENVIRONMENTAL F �TECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720, ` A
ON—SITE SEWER u WELL PERM I T a
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
850332
06/19/85
B&H CONST. INC.
4811 BISHOP
ANCHORAGE, AK 99508
338-1674
SUBDIVISION; DON JACK
SECTION: 3 ' TOWNSHIP: 11N
42000 (SQ.FT. OR ACRES)
3
LOT: 1 BLOCK: NA
RANGE: 3W
Listed below are the options available to
you in designing
your septic
system. Choose the option
that best fits
your site.
- - - - - - - - - - - - - -
- - - - - - -
- - - - - - ---
- - - - - - - - c - -
TF2ENC=" ,
SE13
W _ 13 F2 A.2 N
DEPTH TO PIPE BOTTOM (FT.)
4.0 Ka
4.0
4.0
GRAVEL DEPTH (FT.)
6.5
0.5
3.5
TOTAL DEPTH (FT.)
10.5
4.5
7.5
GRAVEL WIDTH (FT.)
2.5
17.0
5.0
GRAVEL LENGTH (FT.)
28.0
32.0
39.0
GRAVEL VOLUME (CU.YDS.)
18.2
20.2
28.9
TANK SIZE (GALS)
1,000.0 >f*
1,000.0 **.
1,000.0 �*
SOIL RATING (SQ.FT./BR)
120
120
120
* TANK MUST HAVE AT LEAST TWO COMPARTMENTS
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I certify that:
1. j am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the`set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT;.AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED, ----�----------- DATE:
APPLICANT: B&H C �T. INC. 1
ISSUED BY -- DATE:
r,
fti7 SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: QUEST ENTERPRISES, INC. DATE PERFORMED: July 12, 1983
Recertified: June IZ,
LEGAL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
)N: Lot 1, Don Jack Subdivision
SLOPE
Organic Mat (PT)
Clean well -graded
sandy gravel (GW)
Sandy gravel with
cobbles. Occasional
silt layers (Minor)
(GP)
Bottom
of test
pit
SITE PLAN
• ■■.■■■■■■■
Reading
Date
Gross
\�
Net
Time
Depth to
Water
Net
Drop
*
jr* =°4
--
• I
f;: e.....
:
9 i ••
0� �+� ;•
n eu
4301 _E
n' . 4,
NN.•
PROFESSIONP
a
20 -{
IL JI PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS Recommend seepage trench designed for 120 square feet per bedroom.
PERFORMED BY: H.J. Moenina CERTIFIED BYWIC/L 1&, 1.G
72-008 (6/79)
t^ WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological 9 Geophysical Surveys
Drilling -Permit No.
LOCATION Of WELL (Please complete either Id, to Of la.) A.D.L. No.
lLa)lBorough Subdivision Let Block lbt/a airs. Section No. Township N❑ Range E Meridian
Vn �—of_ef_of— s❑ w0
Ic DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS S. OWNER OF WELL:
�J��
Address:
Street Addr... and Area o/ W11 Location
FeeSf 9e1o+
2. WELL L0MaterialMaterialarface
a. WELL DEPTH: (final)
S. GATE Of COMPLETION
a,_ FI.
�L_!1 Q
� =]"J
Ma eI Type Top Bottom
8
6. ❑ Cablo tool t(j Rotary C]Driven❑ Dag
Auger ❑J•ffea ❑ Bored ❑ Otheur
i /7
T.USE: tk Domestic ❑ Public Supply ❑ Industry
❑ Irrigation ❑ Raeharge O Commerical
❑ Test Well ❑ Other:
t.i�
a 1Q0
S. CASING: C] Threaded W Welded
-.q* In. lo.%�ft. Depth Weight—lbs./ft.
dia.. in. to_ ft. Depth Stickup ft.
01,45 /Qb 11nof,..
.�e,_, .,A
A 4r, S
9. FINISH OF WELL:
L.3 J
,� Q
Typo: ._.�'rY ! DIomN•r, /J
Vq nm7at jS-0
Slot/Mesh SI»; Length:
$•1 bet.*" It. and ft.
Backfilling Gravel peck
10. STATIC WATER LEVEL: ft.
0 HEALTH❑
Above or Below land surface Dote
/IRONME T
777dd
Equipment used:
{� n
11 . PUMPING LEVEL beta• lone surface and YIELD
�. 11. alter hrs. pumpina1/�6.P.m.
n offer hrs. pumping —g.p.m.
12.61ROUTING Well Graul•d: 0 Yee No
Material: o Neat cement ❑ Other:
Ii. PUMP: (If available) HP
Length of Drop Pipe ft, capacity a.p.m.
❑ Seem. ❑ Jet ❑ Centrificdl ❑ Other
I 1/.REMARKS:
i-
1-6. WATER WELL CONTRACTORS CERTIFICATION:
la. wafer Temperature ❑ f ❑ D
_•
well . �e dg,r.,11 a u�na.,,,--,m,r l.ulIrlsatc ton nd inia r orkls nue to the gest of my knowledge and belief;
%1
�This
(�t.�-g.%aL.�l1`3.J..f�d�� 3
RegbterW Business Nam Contract Lip n Numb•+
Cdg,. 1s �a� i F�,
Sianed:�f�,p.F� Date• 9 9PS
Authorised Floplosentolive 100,
Form 02-WWR (II/61) Copy Distribution: WHITE -State OGG$, PINK-Wilbr, CANARY-Castemor
JIV�Ukn°Au0 -� y or 0'�'Cllo eta
Development Services Department t Phone: 907-343-7904
On -Site Water & Wastewater Section '--- Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-092-59
1. GENERAL INFORMATION
Expiration Date: N d v 30 , 0 21
Complete legal description Don Jack Sub, Lot 1
Location (site address) 5220 E 164th Ave, Anchorage, AK 99516
Current property owner(s) Jose & Sandra Vasquez Day phone (907)223-1974
Mailing address
Real estate agent
2216 Loussac Dr, Anchorage, AK 99517
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
❑Q
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
C,
COSA Fees J 5 0 Waiver Fee $
Date of Payment S/ y /z l
Receipt Number L i2G SIJ
COSA # 0 S C 115 0'7
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 8/11/21
TH
6. DSD SIGNATURE
System #1 Approved for bedrooms Benjarri Schiller
System #2 Approved for bedrooms ����slF�. 8/112292 .���'�
Disapproved ��k� PROFESSO
Conditional approval for bedrooms, with the following stipulations:
OF
4� ON-SITE
WATER ANC
t
WATAS:
By: �_iOriginal Certificate Dater D ,ZOO 1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test?Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA ______________________
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
Don Jack Sub, L1 020-092-59
■2.5
7/5/85
260
25
■
■
23 Forge Engineering
8/3/21
5.6
8/4/21
18 ■
Fiberglass/Advantex
N/A
18
Fiberglass
■
Shallow Trench
11/14/2002 8/3/21
■3
3.6 0
499
■0
■
■
1440
3.6 0
>450
✔
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to:(Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’Yes if No ft
Holding Tank > 100’Yes if No ft
Animal Containment > 50’Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
From Septic/Holding Tank on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Property Line > 5’Yes if No ft
Absorption Field > 5’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to:(Please enter distances if less than required)
Building Foundation > 10’Yes if No ft
Property Line > 10’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
F. ENGINEER’S COMMENTS
G. ENGINEER’S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
8/9/2021
✔✔
✔
✔
✔
✔
✔
✔
✔✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
05/31/2021 14:12 8686770 APLUS
395 576
NMI ■■M■M■MMM■ MOSSES ■ ■
0. O'i■ ■ ONO ■N■ on ■ ■
■ IN NOON ■ ■ ■N■ ■ ONE
[A�Ivarffea I Field Maintenance Report
Annual InspE ction
PAGE 08
soon
AnchorageTank
907-272-3543
Prop.ny nwnorl .A king M
p (6-91 DO (2.6)
?r S 3
OP^Hier
Riser/Lid .......... .........
Jose & Sandra Vas uez
2nd Compartment
Larry Betts
Previous
St. AddMS
Float Cords ........ .........�
Canna Pbonc
5220 East 164th At �, Anchorage AK 99516
Floats-----
loats.............Pump
(907) 223-1974
Ax 9xn to r
CwrHy to u
PM*
RTU tnlL x
prate of Lae! InapWion
AX -100337
SW020368
200793
RTU101284
10/27!2020
Retrieve o&M Info
Daily flow
Recite ratio _
Timor settings!
Perform Field Sampl ng/Observations
NTU (15 x NTUs)
,,
p (6-91 DO (2.6)
?r S 3
Clean
Riser/Lid .......... .........
Oder of Sample
Typical ❑ Must Earthy ❑ Moldy
Non -typical ❑ Sulfir ❑ Cabbage ❑ Decay
Oily film in PVU yJ E Yes No
Foam In tank E ]Yes /ONO
Check Control Pane
Recite Amps Discharge Amps
Audible and visual ala ns K
Dial tone (telemetry at y) Ycs ❑ No
inspect/Clean PumF System
Comments
Signature T
Measure Sludge/Scum
Sludge
Scum
tat Compartment
Inspect
Clean
Riser/Lid .......... .........
Previous
2nd Compartment
Splice Box ......... .........
Previous
Current
Float Cords ........ .........�
Floats-----
loats.............Pump
Pump............. ... ...
�YJ
Biduben° Fitter. .........�
Biauna Pumpmp vault . ......
Recirculating Splhter alve....
.,.�
Comments
Signature T
Measure Sludge/Scum
Sludge
Scum
tat Compartment
Previous
current
Previous
2nd Compartment
aOv�,nt
Previous
Current
Pmv;eus
Inspect/Clean AdvanTex Filter
Inspect Clean
Odor yJ Normal ❑ Pungent Laterals/011flees �I
Biomat; ,ter Normal ❑ Excesaive Pod Bottom
adZ
dgingiftnding; Nono/Minor ❑ Excessive I Intake Vent
Inspect/Clean Discharge Pump System
Inspect Inspect Clean
Riser/Lid Floats �z
Splice Box Pump
Float cords f%
Inspect/Service Other System Components
Inspect ClZn I ped an
Disinfection Equipment N Dispersal Latorals/OrMcesA.
Observations
Additional Services Rendered
❑ Cleaned textile sheets? ❑ Replaced W items?
❑ Replaced/Used other Items?
Parts Used: W = Warranty, B = Billable (/ appropriate selection)
W B Item Number Description
Final/Safety Inspection rrrr����rrrf
RSV reinstalled �Lida bolted on
rrryyy���
/❑ Manifold reconnected; flush valves closed Control panel reactivated
Sum /Recommendations
7System performing; no further action needed
❑ Call for scrvioc
Fax Completed form to 1-866-384-7404
❑ Tank needs pumping
❑ Other?
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR A REEMENT, herein the "AGREEMENT' made and
e tered into as of this % ZDay of S z of 20_41by and between
/,</�✓Ji�/r�� _ , erein the "OWNER;' and the Municipality of
Anchorage. herein the "MUNICIPALITY". in accordance with Anchorage Municipal Code
(AMC) 15.65365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treats pt System (AWWTS),
described asell
located at (legal description)
S2ao E i 01 Ave -
2. Maintenance, Repairs and Alterations.
e 7-1?- q�51 �
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipments approval for operation in the Municipality.
V 6 It shall be the responsibility of the Owner during the tern of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically S400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
l Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018)
Pagel of 3
U7 6 Owner acknowledges that the Municipality ma} request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
Aw'WTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
_ Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owners AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title. and shall continue
while the AWWTS is operational or until title is transferred.
4. \onwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof. or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any eivil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05!1812018) Page 2 of 3
ONVNER:
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STATE OF A,177t�,_-- I
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THIRD .11,J)ICIAL DISTRICT
I -lie 1,61 wing
instrunnentwas acknovledoed b for- me this IL dav of
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A. M P, yi f
_--- _ __- OFFICIAL STAMP
T,1R,Y PITBI IC I_0 2\i.XS1�A *MARIE ISLANDE FE
GON
NOTARY PUBLIC -OREGON
till tmIIIIIissi0"I exPIr R1 -11W COMMISSION NO. 986220
MY COMMISSION EXPIRES APRIL 14, 2023
D
MUNICIPALITY:
Bv: 00"IJ-(siumature) Date:
LAY two l� (primmme) Title:
(rev. 05/1 W201 8)
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Municipality of Anchorage C540
• 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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-092-59 HAA# Np U 3 tOC 3
1. GENERAL INFORMATION Expiration Date: _/s'/r Z
Complete legal description DON JACK S/D; LOT 1
Location (site address or directions) 16415 BETTY STREET • ANCHORAGE. AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KRISTINE & RICHARD MOORE Day phone (907) 345-9036
16415 BETTY STREET • ANCHORAGE. AK 99516
JILL HOELTING
Day phone
Day phone (907) 727-2454
DYNAMIC PROPERTIES • 3111 C STREET • ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
0
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 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 Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 26 ' ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
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 8 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
L"..' Approved for _�_ bedrooms.
337-6179
Date IZ 2¢10d-
_ / Disapproved.
Conditional approval for bedrooms, with the fllowing stipulations:
At the time of title transfer, the new property owner shall sign the attached maintenance
agreement is shall e returned o tfus ollice before an unconditional appro.val is issued..
Attachments: /
HAA Checklisty
Manitenance Agreements
VV . n,
Septic System Advisory Supplemental Engineer's Reort= �r
Well Flow Advisory Other
Jf ..
By: Original Certificate Date: f
(Rw. 11101)
U V
Municipality of Anchorage
• Development Services Department u `:
Building Safety Division '
OnSke water & Wastewater Program • ",
4700 South Bragaw SL
P.O. Bon 196650 Anchorage, AK 69519$650
www.cI.snchorageAk.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: DON JACK S/D: LOT 1 Parcel ID: 020-092-59
A. WELL DATA
Wen type PRIVATE If A, B, or C provide PWSID# N/A
Date Completed 7/5/85 Sanitary seal (YM) YES
Total depth 260 ft.
Data of test
Static water level
Cased to 25 ft.
FROM WELL LOG
7/5/85
Well Log (YM) YES
Wires property protected (YM) YES
Casing height (above ground) 12+ in.
AT INSPECTION
8/6/02
23 ft.
Well production 3 g.p.m. _
WATER SAMPLE RESULTS:
Collform __4�_ colonies/100 ml. Nitrate 0..;t mgJL.
Arsenic: N/A mgJL. Date of sample: 17_/Iq o
B. SEPTIC/t•IOLDING TANK DATA
Tank Type/Material FIBERGLASS
Tank size 1500 gal. Number of Compartments 2
g.p.m.
Other bacteria 9 colonies/100 ml.
Collected by: AKWWC. INC.
Data installed 11/14/02
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (YM) YES
Date of pumping NEW Pumper NEW
C. ABSORPTION FIELD DATA
Date installed 11/14/02 Son rating .p.d r ft°lbdrm) 3_0 System type ADVANTEX
Length 30 ft. Wkith 5 ft. Gravel below pipe 0.57 ft.
Total depth 2.8-3.2 ft. Eff. absorption area 150 ft' Monitoring tube YES Depres;ipn over field NO
Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test _ in. Water added — gal. Newdooff _in.
Elapsed Time: —min. Final fluid Absorption rate >= g.p.d.
(past 12 mo.) (YM & type) NONE KNOWN If yes, give date -
0. LIFT STATION & PUMP VAULT
Date installed 11/14/02
TIMER/32-
"Pump ono level at _in.
Datum BOTTOM OF TANK
E. SEPARATION DISTANCES
Stze in gallons 1500/43.5. Manhole/Access (Y/N) YES
TIMER/3
"Pump oft" level at _In. High water alar level at 46/36 in.
Cycles tested NEW Meets alar & circuit requirements? YES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenkllift 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/deanout N/A
Holding tank N/A
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 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, perldng/vehide storage 10'+
Curtain drain NONE KNOWN Wells an adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ��F. `','•••
I certify that I have determined through field inspections and `J ^ f 'a
review of Municipal records that the above systems are In
conformance with MOA HAA guidelines In effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
DateA.
4 /[�7 V 4QJ�?�ofeesw�
HAA Fee $ SIZE ► Waiver Fee $
Date of Payment 12---2-4 -02. Date of Payment
Receipt Number 29 530 Receipt Number
(Ray. 12101)
01-09-03 11:16as From-Hocestate Yortsaee
9377625899
app _ Municipality of Anchorage
Development Services Department
nu0dimg 6•1cty D7rlsl0a
On -Situ Wetcr=W WaclewQerptopam
4700 Dngaw Soca
P.O. Box 196630 Anchmratc, AK 99519-6650
WwWAwchompoa Us
(907) 343.7904
T-251 P.002/003 F-963
•
e a
020-492
PROPERTY OWNER AGREEMENT FOR THE MAIA"MNANC)E or
WASTEWATER DISPOSAL SYSTEM
AN ON-SITE
This agreement, dated is made between the Municipality
Development Services 4par�t=(IS9�1))Lndthe property owner(s) of:
of Anchorage
4' 99S//_
This agreement is made for the purpose of maintaining an on-site wastewater disposal system on
the subject property.
The property owners agree to the following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation
statement from a registered professional engineer. This inspection and operation statement shall
verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any
deficiencies have been repaired and that the system is functioning as designed.
(Signature) �� (Slgnatttre)
Jose L. I/AC-Wee . Avg UGS P
(Printed Name) (Printed Name)��
NP.
th'
��t
TIS Pore oIn
305E g lInstr"mo°t was acknowledged be ore the by
piARy"_
aQA• VA 9 day of
PU61-�G
u 20•
.` ��• '''g' ":
seal.
ittessmYlaturc)
�''•.,, '. ,,•''
No ry Publ
C OA(V,:C6
(N ary's prwicd name)
y Commission Expires �o-� aGY1S
- 59
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(MME111EMOM
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Timm A. SI IArrI1, Pr.
CML ENGWEETIS
(907) 694-2979
WELL rLoW TEST bAtA rAx(907)694.I211
CLIENT: G-I),c,InW.E A A, 1 ,h cc ,It DATE: 8�C✓Uz
LEGAL I)ESCMPTION: L.p , / Do ,4 Z3 A c
WELL bEPTIl: a bo CASINO mptll: S 8.0,
bATL bnILLING COMPLEtrb: %1PI ks- bnlLLtn:y"R S
MISC. bATA: CASINO IIEIGIit: • ,i 1 4 SANItnnY SEAL: yG s
WIRES IN CONDUIT: YXf GRAbING O.K.: Y1F t
BACTERIA AND NIThA1E SAMPLES COLLrCTED (date):
TEST BATA:
clock
TIME
METER
hEAbING
(GAL)
PUMPING
hAfE
(GPM)
DEPTII TO
WATER
(rT)
REMARKS
-Yo
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—
a3 swI
o f
3-,L
u o q
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do c1 is 76
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/331 q
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12-23-02; 3:13PM;
CT6E Environmental Services Inc.
CME RcLs
1028531001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/#
Don Jack Ll
Client Sample ID
Don Jack Ll
Alatria
Drinking Water
PWSID 0
Sample Remarks:
;907 5513301 0 2/ 3
All DatesMmes are Alaska Standard Time
Printed DateMme 12/23/2002 10:22
Collected Date/Time 12/19/2002 11:55
Received Date/Time 12/19/2002 14:10
Tecbnial Director Zti�
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Released By
Allowable Prep Analysis
Pammeta Resaln PQL Units Medad Limits Date Date Init
Waters Department
Nitrate -N
Microbiology Laboratory
Total Coliform
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0.200U 0.200 mgjL. EPA 300.0 (<-10) 12/19/02 PLW
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MUNICIPALITY OF ANCHORAGE n
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
2644720
Application Date
1. GENERAL INFORMATION
(a) Legal De3cription (inc
Location (address or <
(b) Applicant Name 4
Applicant Address _
Home3?,f Business
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builderg; Buyer ❑ ;Other ❑ (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) -=the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family 9 Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well r Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite yp Public ❑ Community ❑ Holding Tank ❑
Note: It 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(1+,N)
a^ t'\
5. ENGINEERING FIRM PROVIDING ...SPECTIONS, TESTS, FILE SEARCH, DAT. .ND 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 a £ c=imc iTWA
Name of Firm _ SFR l°"x „ P-919. Telephone
Address
Date
6. DHEP APPROVA
Approved for Zbe
Approved
Terms of Conditional Approval
t
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(11154)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF AND40PAGE
CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH &
264-4720 ENVIRONMENTAL FROTEMON
Legal Description: _L•l'r ( NOV 14 Qb
A. WELL DATA RECEIVED
a
Well Classification s•F • If A, B, C. D.EC. Approved (Y/N) Q
Well Log Present CPN) Date Completed %- 5 - BOA Yield -- 3 G►PM
Total Depth Zlb� Cased to ZS Depth of Grouting '' 16
Static Water Level Pump Set At /J.,{
Casing Height Above Ground Z `t Sanitary Seal on Casing (ON)
Electrical Wiring in Conduit &N)
Separation Distances from Well:
To Septic/Heldmg Tank on Lot _
Depression Around Wellhead (Yo
On Adjoining Lots '/C�o '14 -
To Nearest Edge of Absorption Field on 1pt On Adjoining Lots /oo f
To Nearest Public Sewer Line P p To Nearest Public Sewer
Cleanout/Manhole ,375 To Nearest Sewer Service Line on Lot ZS �f
Water Sample Collected by Sfs . "1 ;Date //—/0- 95,
Water Sample Test Results
Comments # 4'46-06-c>
B. SEPTIC/UOLGINQ•TANK DATA
Date Installed �" Z -BS Size —/ 0000 No. of Compartments —7 -
Standpipes &N) Air -tight Cap§T)yN) Foundation Cleanout (!ON)
Depression over Tank (Y4V Date fast Pumped Ne -t'-_7
Pumping/Maintenance Contract on File (YIN) n ; for
N
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) �
Separation Distances from Septic/Holding Tank:
To Water -Supply Well / y O To Building Foundation —LC
To Property Line 0 To Disposal Field D JI
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-026(11/84)
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata / Ze / Type of System Design
Date Installed gs, Length of Field
Width of Field 17 Depth of Field y' S
Gravel Bed Thickness
Square Feet of Absorption Area (off Z 46. Standpipes Present O/N)
Depression over Field (Y/6? Date of Last Adequacy Test
Results of Last Adequacy Test -,5 ,a
Separation Distance from Absorption Field:
To Water -Supply Well To Property Line
To Building Foundation
Lot a
To Water Main/Service Line
.*It -
To Stream/Pond/Lake/or Major Drainage Course
To Existing or Abandoned System on
On Adjoining Lots /4-
To Cutbank (it present) N A
N �t
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
KA. Whole/Access (Y/N)
"Pump On" Level at
"Pump Off" Level at
High Water Alarm Level at
Vent (Y/N)
Tested for
Pumping Cycles
during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
" Check Permitted Bedroom Rating
Against HAA Request "
I certify that I have checked. verifiorconformed to all MOA and HAA guidelines
in effect on the date of this inspection.
,,, & C EVGWEERIa
Signed �g 1N�951f
Date
Company1t VE`..: LE
MOA No.
/�qs?yS��9 22
�
Receipt No.�1�9�e
Date of Payment l 1-1 L 1 _ $
S
,pc ••••.S�f ���
Amount:$ to C',
i
% Ze A�
Jp wt»r �.sh.7.,•.:4"
No.
Page 2 of 2
J+l,•. 7157.E ` r
it DOFFSSi.� �s+�
77026 111,841
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