HomeMy WebLinkAboutSUMMIT ESTATES BLK 4 LT 1
GP" ~.TER ANCHORAGE AREA BORG~' ~,H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 2~'9-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
DISTANCE FROM WELl
LIQUID CAPACITY
/ NUMBED OF /
MATERIAL ~"~'7~'~''~ ~ COMPARTMENTS
GALLONS. INSIDE LENGTH INSIDE WIDTH '~--: LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MAIERIAI
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER 4~ // OR WIDTH . LENGTH , DEPTH . ~:~ '/
~)A.)C_/'~-~.~ 7'~ . DISTANCE FROM WELl /~O / BUILDING FOUNDATION ~"'-'~'~,/
'J ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES.
ABSORPTION AREA
· FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
, NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
, OF LINES.
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL: TYPE _~-t//i~-'O , DEPTH /(-gO'
NEAREST SEPTIC
LOT LINE . SEWER LINE . TANK
DISTANCE FROM
· BUILDING FOUNDATION
~Z) S~' SEEPAGE=
SYSTEM_
/~- /WATER
~ SAMPLE
/oo" '
· CESSPOOL
, NEAREST
OTHER
, SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
HEALIH AUIMORIIY
GREATEL/ANCHORAGE AREA ~,.DROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No,
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ,~ ~/L'/'~';~ ~') .~,.L/~... MAILING ADDRESS
RESIDENCE ADDRESS D.~ ~ ~'~'~ (:~ ~ LOCATION 0F INSTALLATION ~/~
LEGAL DESCRIPTION ~'~-.7 /
APPLICATION TO INSTALL: SEPTIC TANK ~ .,SEEPAGE PiT ]~ , DRAIN ~IELD ., OTHER
FINANCED THROUGH ,~I/~ ~'A ' TO BE NSTALLED BY ,
PERCOLATION TEST RESULTS ~ ~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
PHONE NO,:2'/~-:~/~/
THIS IS TO SERVE AS ~)'/.4.~, /~..~ , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
_. SEPTIC TANK SIZE ~ .TYPE ~SEEPAGE AREA 0 ~ ~2~" .TYPE
DISTANCES:
Authority
/..o5 S
./OEO ~ .~C. DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code. ,
.--itic_"� Municipality of Anchorage '( �
On-Site Water and Wastewater Program -( t'U 1112.,u 17. ' -1
(907) 343-7904 � ) 9, . .,Fj "�
Certificate of On-Site Systems Approval ��`�°-' 0 .i�
Parcel I.D. 015-071-01 Expiration Date: 2— .(t—i f
1. GENERAL INFORMATION
Complete legal description Summit Estates Block 4 Lot 1
Location (site address) 5400E 98th Avenue.
Current Property owner(s) Renee R. Mackey Day phone
Mailing address 5400 E 98th Avenue. Anchorage, AK. 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex qP\
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received b : i- • %. 0 • Date: 41/29//
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ (I6 Waiver Fee $
Date of Payment /i/ZQ I/ Date of Payment
Receipt Number O(.0219-41641C� Receipt Number
COSA# 1056/7/5 1-19 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 11/22/2017
...�oAN
F 104,14N�t
0*. 4911 !
6. DSD SIGNATURE �% •• �O o
tr System#1 Approved for 3 bedrooms /� .S{even R. Pannone
I,• - CE-8149 ,,�;
System#2 Approved for bedrooms It�9 ' ."4-
�k '`PNOFES$10 �s
Disapproved \��t"1�+
Conditional approval for bedrooms, with the following stipulations:
)r—} �tS f L \ a do 3 q EGLl�'� c-e
_ S
vie-�'o� e e be
S o,.0 7 eovv- s ace
=s0 ON-SITE -ib
'g'
=` AND
WATER "m
WASTEWATER z--:
; oma
PROGRAM moo_
By: Li
IAA- ~ - Original Certificat iER\J - —(7
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 blue sheet_f c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Summit Estates Block 4 Lot 1 Parcel ID:015-071-01
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed UNK Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth UNK ft Cased to UNK ft Casing height(above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test UNK 7/19/2016
Static water level UNK ft 46 ft.
Well production UNK g p m 4.6
9.P.m
WATER SAMPLE RESULTS:
Coliform ` 0 --colonies/100 mL Nitrate 4.10 mg/L
Arsenic ND ug/L Date of sample: 1 1/7/17 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/21/1969
Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) N Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping 1/30/2017 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 5/21/1969 Soil rating (g.p.d./ft2 or ft2/bdrm) Unknown System type Seepage Pit
Length 4 ft. Width 4 ft. Gravel below pipe 6 ft.
Total depth 9.6 ft. Eff. absorption area 288 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/19/2016 Results Pass/Fail
( ) Pass For 3 bedrooms
Fluid depth in absorption field before test 36 in. Water added 457 gal. New depth 43 in.
Elapsed Time: 130 min. Final fluid depth 36 in. Absorption rate >= 450+ d.
9.P.
No
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
* +
Septic tank/lift station on lot 62 On adjacent lots
93* On ad acent lots 100+
Absorption field on lot 1
75
Public sewer main
75+ Public sewer manhole/cleanout 100+
25+ Holding tank 100+
Sewer/septic service line
Manure/animal excrete stora a areas 100+
Animal containment areas 50+ g
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIE D ON LOT TO: .
Property line + <s�tic�n IB Building foundation 10+ Water main 10+
10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage
Curtain drain 50+ Wells on adjacent lots 10
0+
F. COMMENTS
"Required separation distances in 1969 for"well to absorption field" and "well to septic tank"were 50'+
Survey on file. (,4J ± OS ti 17106Z_
G. ENGINEER'S CERTIFICATION 4� . AL,Q��i�
I certify that I have determined through field inspections and /Ar'4) . �4 ,91�
review of Municipal records that the above systems are in 0*:49 7H /\ '.*00
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven Pannone "' S
11/22/2017 at.. CE-81 9 40,
Date `f' ��
�kk �o�sss7ctt .t""
COSA canary sheet_2-6-15.doc
• ,T
• _� Municipality of Anchorage E t
On-Site Water and Wastewater Program JUS M
(907) 343-7904
Certificate of On-Site Systems Approval �� oc712'
015-071-01p CU 1f 017
Parcel I.D. Exration Date:
1. GENERAL INFORMATION
Complete legal description Summit Estates. Block 4, Lot 1 .
Location (site address) 5400E 98th Avenue.
Current Property owner(s) Renee R. Mackey Day phone
Mailing address 5400 E 98th Avenue. Anchorage, AK. 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: C SC`-0-:k o Y\ �� }0 l0 t 1.1 ‘f) Distance: I C k-f
Received b : ia: .i_I �����1 0 ' Date: s`1D/j
NoOPI• w
COSA to be released to the engineer,unless otherwise req = ted by the engineer.
COSA Fee $ 5 2.6 Waiver Fee $ a 1 5
Date of Payment l0 lJ� I Date of Payment cql 0/02011
Receipt Number CV-}OSS 16\ Receipt Number (5 `i`l G
COSA# 03 Q. f 27 D Waiver# ()S'-2_.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are),safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at
the time of installation.
In conducting an adequacy test.I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 6/29/2017
Alik..abj. OF 444.r,006
6. DSD SIGNATURE
-J System #1 Approved for 3 bedrooms SieveriR.•�annore• ' l
fi CE-8149 . ���
System #2 Approved for bedrooms s
Disapproved
Conditional approval for bedrooms, with the following stipulations:
(� C - v, Jaw OLci, a-v �.
\cls ,,t_
1 0
S-Ie 1 Ih' w 2U Ly_cc. -`-;
By: ,`t CC ckCcuuutg Original Certificate Date: cS/JO/ O
7
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 X
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Summit Estates. Block 4, Lot 1 . Parcel ID: 015-071-01
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed UNK Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth UNK ft Cased to UNK ft Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test UNK 7/19/2016
Static water level UNK ft 46 ft.
Well production UNK gpm 4.6 g p m
WATER SAMPLE RESULTS:
Coliform NEC' colonies/100 mL Nitrate 5.61 mg/L
Arsenic ND ug/L Date of sample: 5/31/2017 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/21/1969
Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) N Depression over tank (YIN) N High water alarm (Y/N) N/A
Date of pumping 1/30/2017 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 5/21/1969 Soil rating (g.p.d./ft2 or ft2/bdrm) Unknown System type Seepage Pit
Length 4 ft. Width 4 ft. Gravel below pipe 6 ft.
Total depth 9.6 ft. Eff. absorption area 288 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/19/2016Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 36 in. Water added 457 gal. New depth 43 in.
Elapsed Time: 130 min. Final fluid depth 36 in. Absorption rate >= 450+ g.p.d.
No
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 62* On adjacent lots 100+
Absorption field on lot 93* On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD(( ON LOT TO:
Property line )' + Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
*Required separation distances in 1969 for "well to absorption field" and "well to septic tank" were 50'+
Ail FCCD i nSct Ac tse
G. ENGINEER'S CERTIFICATION _�����``��
Ii P�� A��S',��
certify that I have determined through field inspections and ,,sw'�.• _) . •.76
TA
review of Municipal records that the above systems are in *: / •
conformance with MOA COSA guidelines in effect on this date. '� •-
Steven Pannone _ t--ki.N
Engineer's Printed Name —91,..:t}even W. Pannone:'
-�
6/29/2017 1 . CE-8149 .. iDate � 4k
s.
COSA canary sheet_2-6-15.doc
Municipality of Anchorage
• f Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC 171270
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 4, Lot 1 of
Summit Estates subdivision. This inspection revealed a nitrate concentration
of 5.61 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
•
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage. Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ** **
Waiver#: OSV171082 COSA#: OSC 171270 Permit#:
PID#: 015-071-01
Legal Description: Summit Estates Block 4 Lot 1
Engineer: Pannone Engineering Services
Applicant: Renee R. Mackey
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is less than 10.0 feet.
This is an existing seepage pit; exact distance to property line is unknown.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
n Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver is not Granted-
Date: Sill 1;2o
11 Approved by: � tiif L'.C4� &LA 0'�Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
cf. uttniAN
tee WATER WELLS
Drilling• Piling• Pumps Date: 8-7-17
P.O. Box 670269 Chugiak,AK 99567
P: (907) 688-2759 F: (907) 688-2259
Pannone Engineering
5400 E. 98th Ave.
Anchorage, AK 99507
Well Camera Report
No breaks or perforations found.
At first welded joint, it appears that some water may have been leaking at some point based on water
stain, but zero leaking was detected at time of inspection.
EAST 98TH AVEI JUE
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G 0 NC CORNERS SET THIS DATE
o aL P OD I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
* . �11� oo OF THE FOLLOWING DESCRIBED PROPERTY
QC 49TH0
�/� LOT 1, BLOCK 4, SUMMIT ESTATES ( PLAT P-628)
S �/ �^" THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
V -O CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS.AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
03t °Q THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
O r SHANE A.HOLT m NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES.IMPROVEMENTS,OR FENCELINES
Q a EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT.ARE NOT SHOWN
EXIST OTHER THAN NOTED.
v4°. LS-6914 O HEREON(UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS _28TH_ DAY OF
!10'o odd NOTE: FENCELINE5 THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE ]UNE , 2017-
�O/es si°naH`bo PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
�D�OOoo� ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE HOLT LAND SURVEYING
9309 DROVER DRIVE
ANCHORAGE AK 99507
4095, FB 183-38 3455513
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. # (~'~ \ _~_ - ("~-~ \ -C/\ HAA# 4~(~
GENERAL INFORMATION
Complete legal description
Location
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~¢ ,3
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.
72-025 (Rev, 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
Address 8ol ~O~ ,~h
EngineeCs signature
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 mid/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm A~'~r,'c-~'l,~¢~ 0_¢,~,~ G¢o0,¢ -7~c, Phone
DHHS SIGNATURE
7~ Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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 engineeYs work.
72~25 (Roy. 1/91) Back MOA ~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Parcel I.D:
A. WELL DATA
Well type P/'"u'~[/-~
Log present (Y/N) ,'~r)
Total depth I co
Sanitary seal (~¢~'N) ~'~, 5
If A, B, or C, attach ADEO letter. ADEC water system number
Date completed C),~ ¼,~..~.~ Driller
Cased to L~,~ ~,,~ 6,~,~~ Casing height
Wires properly protected (~'/N) ~'
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ Z ' ''~
Absorption field on lot
Public sewer main I
Sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
g.p.m.
AT INSPECTION MUNICIPALITY OF ANCHORAGE
! Z /' Z_~ /~NViRONMENTAL SERVICES DIVISION
JAN 0 1992
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
io.G-~l SEE ATTAC~3
F,E~Utk~0 50' 5~p&~/~0t~ I~J t~69
Nitrate 5~r~ ~. ~ , /[ '"~/~ Other bacteria
Collected by: 14¢~ ~o~;w~
I .EIVED
B. SEPTIC/HOLDING TANK DATA
Date installed 5Jz.!
Cleanouts ~,)N)
High water alarm (Y~__~
Date of pumping
Tank size 10oo ~¢~1 Compartments
Foundation cleanout (Y,~ ~[0 Depression (Y~I~
Alarm tested (~'/N)
Pumper ~,~{'~ -
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~Z. ' "~:¢' On adjacent lots /0o'~
To property line ' ;~ (3 * Absorption field '~ Z '
Surface water/drainage ioo ~-
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
. "Pump on" level at
Manufacturer _
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length ~
Total absorption area 2. ~5~, ~(~j. ~-~-.
Depression over field (Y/Q) /U~
Results (pass/fail) /5~s~
Peroxide treatment (past 12 months) (Y~ ,CJi,
Soil rating ~ System type _:5
Gravel thickness. --- Total depth
Cleanouts present (~N) ¥ ¢~
Date of adequacy test l¢/~o('
for ,~._~
If yes, give date. '-
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot ~/3
To building foundation
On adjacent lots Z
Surface water too ~-
On adjacent lots /OO ¢ Propertyline
To existing or abandoned system on lot
Cutbank (crc'f` Water main/service line
Curtain drain __L '-----------------(~ r
Driveway, parking/vehicle storage area
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.
Signature
Nam
HAA Fee $ / '~)
Date of Payment
Receipt Number
72-028 (Rev. 3/9~1 Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
: · :;: :':. : : :
:'~ ~a ~ CLEANING SERVICE
RO. BOX 112688 PHONE 345-2513 ANCHORAGE, ALAS~ 995fl-2688
JobAddress
ROTC-ROOTER SERVICE CALL HRS.
STEAM THAWING HRS.
TRIPCHARGE HRS.
OVERTIME CHARGE HRS.
ADDITIONAL ~BOR CHARGE HRS.
L.,,~MPINGSERVICE,,~/?,-~/'p (GAL.) HRS.
HYDRO-JET SERVICE H RS.
MATERIALS
PLEASE PAY FROM THIS INVOICE
TOTAL FOOTAGE CLEAN ED OR THAWED
/
?
TOTAL
BLADES USED
LINECLEANED
[] JOB NOT GUARANTEE,~R FOLLOWING REASON
Torn Fink,
Mayor
unicipality Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
January 17, 1992
Carey Meyer, P. E.
Arctic Slope Consulting Group,
301 Danner Avenue, Suite 200
Anchorage, Alaska 99518-3035
Subject:
Lot 1 Block 4 Summit Estates
Health Authority Approval
Subdivision
Dear Mr. Meyer:
During this office,s review process of the subject Health Authority
Approval request, it was noted that the horizontal separation
distance between the well and absorption field was 93 feet, and
a question was raised regarding the necessity of a waiver. As
pointed out in your letter dated January 14, 1992 and subsequently
confirmed in our files, the subject on-site wastewater disposal
system was installed under a permit dated May 21, 1969. The
applicable setback distances were those in effect at the time the
permit was issued, which were 50 feet well to septic tank and
50 feet well to absorption field. It is therefore not required
that a waiver of setback distance requirements be obtained.
If there are any further questions, please call our office at
343-4744.
Sinc~y, ~
/Robert W. Robinson
Civil Engineer
On-site Services
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers e Architects o Scientists o Surveyors
January 14, 1992
RECEIVED
JAN 1 6 1992
Municipality of Anchorage
Dept, Health & Human -Services
Mr. Robbie Robinson
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
Re:
Well to Seepage Area
Lot 1, Block 4, Summit Estates
Dear Mr. Robinson:
The well on the above referenced lot was found to be 93 feet from the seepage pit. The permit
for the sewage disposal system was completed 5/21/69. At the date of the permit the required
separation distance was 50 feet. Based upon data from the field test 12/20/91, the system is in
acceptance for a four bedroom home.
Very truly yours,
CM:MLT: 11'10-0026
301 Danner Avenue, Suite 200 Anchorage, AK 99518-3035 (907) 349-5148 FAX (907) 349-4213
A subsidiary o/Arctic Slope Regional Corporation
. r~ L)~,~R EC EiV ED
INSPECTION APPOINTMENTS
TiME
INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE ENVJRONMENTAL PROTECTION
DEPARTMENT OF HEALTH & ENV,RONMENTAL PROTECT,ON
~ 825 LStreet. Arlchorage, Alaska 99501 AUG 1_ 2 /981 ,
~ ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
~ B P"ONE
STREET LOCATION'
[] One [] Four [~] Other~
.~"' SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [~ Three [] Six
7. WATER SUPPLY
~ INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June !975. For wells drilled prior to that date, give well
[] PUBLIC UTILITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM CF
~'~' INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED.
PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
1, TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3, SEWAGE DISPOSAL SYSTEM
[~]INDIVr DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or []Holding Tank
Size: If Tank is homemade
givo dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOGRECEJVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING .
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
Septic/Holding Tank
Absorption Area Sewer Line
Nearest Lot Line
5. COMMENTS
DATE
[~;]/~APPROVED FOR _~ BEDROOMS
[] CONDITIONAL APPROVAL (letter m ompany certificate)
~/ DISAPPROVED u ~.a~
72-O10 (Rev, 6/79)
ALASKA eFIUIROFImeFITAL cOrlTROL SeRUICeS,
~nqineerin§ ~- [~nuivonmcntal Studies
InC.
8/11/81
MUNICIPALITY OF ANCHORAQE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
AUG 1
RECEIVED
DON DAHL
SRA BOX 78
~LNCHORAGE AK 99507
SET.T,ER - DON DAHL
SUBDIVIS ION-SUNMIT ESTATES
ADEQUACY TEST FOR SEWER SYST~4
THE T~PE OF ABSORPTION SYST~4 IS A PIT WITH AN AREA OF 288 S~T.
THE SYSTSM IS CAPABLE OF ACk.lING 450 GALLONS OF WA'l'ea{ PER DAY.
BASED UPON ~dE TEST DATA THE SYST~4 IS ACCRUABLE FOR A
3 BEDRCOM HOME.
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
1220 [IJest 25th ~uenue '* ~chorage, J~Jasb 99503 · (907) 276-1361