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PAYNE LT 1
+OIS- I (.D3 - (Do Municipality of Anchorage On-Site Water and Wastewater Program ° (907) 343-7904 Page / of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 06 ! 5 SD PID Number: 0 f c� — f (o 3 - t,_0 Dwelling: ❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New [&Upgrade Name: P AvalUn k'n.4, 1 ABSORPTION FIELD ❑ Deep Trench ❑Shallow Trench El Bed El Mound Address ❑ Other Phone Number of Bedrooms Soil Rafing Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivisio Block Lot TT✓ Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft SEPARATION DISTANCES ' To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftp Ft. Well TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other - Manufacturer I_ Ar'A 4K k, Capacity ( 2 i o Gal. Surface Water (uvfl- Material/I Cj�'Y Y l Number of compartments ?i Lot Line / p �.� /_7L NA Foundation / fJ `� LIFT STATION Manufacturer Capa city Curtain Drain UK kpw rt Gal. Remarks =Pumpevel at in. Pump off level at in. igh water alarm at in. Pump Inak�d rD1l1rD.eeee Electrical Inspections performed by Installer ff // ,n PIPE MATERIAL Housetotank 3t,-5L( LL Tankto drainfield 36) /Q.4 t-41 /u.4n I ev 4o vi IY/a Drainfeld -JVD CO/MT 343 Inspector r Iht N, AAI ,JAW lotr�, BENCHMARK (Assumed elevation) /((/ ft Inspection , dates:3p 2'/0 Z( /C- � Location and description 6L1c� C7a+asp Y-�00�/ S�ah. 3M COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Er np �. cl5_ j Conditional Approval: Date 49 4 �•� °N° ANDERSON e cCE 94 Approved lit% �J l\\® Date I o`®` inspeutiori Report -9- Permit No. OSP151350 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: On—Site Wastewater Disposal System and/or Well Inspection hM Legal Description: PAYNE LOT 1 Page 2 of 2 343-4744 Report PID No.: 015-163-60 MARK AI B 31 I i 30 \ col b TC01 N TCO2 28 I SEPTIC A\ NEW 1254 ALLON STEEL TANK �-\ — _ EXISTING TANK PNTED AND CRUSHED i G %� i BENCH GARAbE, SLAB CO3— /tC01 — — \\ C0ppp,' C2 \ \ 3 BEDROOM HOUSE \ \ 1 1 ..................,_,.....------L. - I - ® I I 1 1 ! ! I \ / \ / ASBUILT SCALE: 1"=50' coo rcm 702 49 TH. /�. V...........�.�. •♦� s tzw wuax SMa MP ............ ......... k $ • ........................... °•MICHAEL N. ANDERSON: + No. CEJ/ 9469 ♦♦♦�..........� SEPTIC SECTION On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151350 Tax Code Number: 01516360000 Work Type: SepticTank Upgrade Permit Effective Dates: October 19, 2015 to October 18, 2016 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: PAYNE Site Legal Address: PAYNE LT 1 G:2640 Owner/Address: KRAFT EDWIN C & RACHELLE-KRAFT AVALON R PO BOX 244991 ANCHORAGE AK 995244991 Site Mailing Address: 11201 SNOWLINE DR, Anchorage Lot Size in Sq Ft: 49409 Total Bedrooms: 3 This permit is forthe construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received B Issued By: By Date: lob t Date: ld �� MUNICIPALITY OF a Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D.r —40 f Property owner(s) AV A (u M t/4 , Day phone Mailing address 1/10/ �ih l lye t �p Site address Legal description (Sub'd., Block & Lot) R Legal description (Township, Range & Section) Lot Size —ft -I K0 a Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial ❑ Septic Tank Upgrade Holding.Tank ❑ Renewal ❑ Privy ❑ o Private Well ❑ f ,�^ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQI' TYPE OF DWELLING: Single Family (SF) [ (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ iTvsr�: ✓ v Zi .i I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. OT property owner or Permit/Rush Fees: 2 t 5- '/ 2 �{ Waiver Fees: Date of Payment::,- +S Date of Payment: Receipt Number: 4/2_73 Receipt Number: Permit No. OSP151M'U Waiver No. Permit App_: :_.,:c: soli! oma£ , m e•e.z ,ws 3� � { � � \ � 5 � } ƒ � � � \ � MUNICIPALITY OF ANCHORAGE /0 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEKA-q. _5 2AN� —I PHONE L —NEW UPGRADE MAILING ADDRESS LEGAL DESCRIPTION Lm LOCATION S NO. OF BEDROOMS My Q WN IF 2 Well DISTANCE TO: t � Q Absorption area ( Dwelling ' O t PERMIT NO. ,r g10 9 93 a ZQ W � Manufacturer w (�, Material CJIT BE E L. No. of comp gents r WO Cn Liq. capacity in gallons 10 IF HOMEMADE: Inside length Width Liquid depth 0 Y DISTANCE TO: Well Dwelling PERMIT NO. JAZ 2 z F Manufacturer Material Liquid capacity in gallons o W = DISTANCE TO: Well ' C) 0 Foundation 10t] Nearest lot line ' j C:11. PERMIT O Q3, J LL Z No. of lines Length of each lin Total lengthf li s Trench w ith Distance between lines H Z W ( Q inches �---+ HTop finish Material beneath tile Total effective absorption are of tile to grade © p inches Length Width Depth PERMIT NO. W F Type of crib Crib diameter Crib depth Total effective absorption area CL Wa W ti Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS C ST SOI L TEST RATI NG INSTALLER 4�T X REMARKS C'Q o IVI ' OF At1 040 ,may -P'• •;�1 *:.490 APPROVED DATE LEGAL La I 72-013 (Rev. 3/78) 1 �����I F" 1=1 L.. 1: -1- kr� C3 F= ������FA CB EE,. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, HK. 99501 � 264-4720 1-i FEE I.. I.. FE1 hi 1:1 f -) t 4 1_ U " r " L---. 1_4 FEE F;r*" 1:� PERMIT NO. ( 810934 ) APPLICANT KARL 8 LEE BRHNDT 3716 BISQUIER\ HNCH 33]-5]00 LOCATION SNOWLINE DRIVE LEGAL LOT 1 /D LOT SIZE 45000 SQUARE FEET A�``CA- TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SO FTIBR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��r-4 'C:�- -T- Fi= :J to C3 FZ F4 '%-.�'F L_ [E-_ ""'T�� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIEL[ THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ����1 F_'& 0 FEE F" 1- 1 1-7 1- f"I 1%4 k" 1- = E -E=-.: f. -Y (23 frEH C -A F::� L_ I_(:,-,I�� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY' WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 1- 1-1 K-) it: to :1 3C14-EE5 F* -'"F-'_' Y' I CD P4 0 FA F;?- E_E: ����1 F;?_ EEE E.� ___ � BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS HRE AVAILABLE TO INSURE PROPER INSTALLATION. ����X"T- -1.��� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPHLITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCETHAN ] BEDROOMS - SIGNED: �_______________ HF�'LI��NT KARL & LEE BRHNDT � ISSUED BY-------- DHTE4 m/ V4.0 16, SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � PERCOLATION TEST Pouch ' Pouch 6-650, Anchorage, Alaska 96502 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 14. L nil DATE PERFORMED: A444 - 441-6 _ LEGAL DESCRIPTION: DEPTH (FEET) 1 0%,4191ZT3aR b s•Ad 2 3- 4 .5 s s.A . 7- 9- 10 910 $. Vr 11 12- 14- 15 21415 j?#% 16- 17 18 19 20 COMMENTS SLOPE 5.4• V WAS GROUND WATER S ENCOUNTERED? #3 O L O P IF YES, AT WHAT E DEPTH? �< r'NTAvA% � n ti 00(i°°tl�y° w 0, :. e SITE PLAN It Reading Date Gross Time Net Time Depth to Water Net Drop f kn S1 AA147IM.. 1Vgr ,4J%PCOLATI0N RATE (minute:/inch) J TEST RUN IDETWEEN FT AND FT PERFORMED BY: 1. P- , S CERT'FIED BY: i�. / I Date: r .a SIEVE ANALYSIS DATA AND COMPUTATIONSHEET �� t Weight of Sample Sample and Test Number )0e Sheet Number Sieve Openings Sieve )Mesh Weight Retained in Grams Fervent Retained Cumulative Percent Finer Inches Milli- meters 2.00 1.5C 1.050 26.67 0.742 18.85 0.525 13.33 C.371 9.423 0.263 6.680 YY24 -7 9 2- 5 1% -750/6 0.185 4.699 C.131 3.327 0.093 2.362 "K 0.065 1.651 10 2 LI 0 o 36% 0.046 1.168 1 0.0328 0.833 0.0232 0.589 " 0.0164 0.417 y'i Q q -7 -7 Qla 0.0116 0.295 /415 0.0082 0.208 'w 0.0058 0.147 100 42-45 - vf 0.0041 0.104 '1-w 0.0029 G.C74 2C0 4)3 00 d� 0.0018 0.046 TOTAL SOILTEST INCORPORATED • 2205 LEE STREET • EVANSTON, ILLINOIS, U.S.A. DCL -5 Vame : � �Cj� nQ_ �?rc�cx9� . `�f Sample Date: Z8 SIEVE ANALYSIS DATA AND COMPUTATION SHEET � We ight of Sample -455 't d gm. and Toot Number Sheet Number (o = Sieve Openings Sieve Mesh Weight Retained in Grams Percent Retained Cumulative Percent Finer Inches Milli- meters 2.00 1.5C 1.050 26.67 C.742 18.85 0.525 13.33 0.371 9.423 0.263 6.680 /Z i Z, 10 —7 0.185 4.699 x 0.131 3.327 C.093 2.362 0.065 1.651 10 2-190-7 (e4 o/ o 0.046 1.168 ]r4' 0.0328 0.833 0.0232 0.589 ?� C.0164 0.417 940, -4i209 �jC'16 c/ O.0116 0.295 0 0.0082 0.208 fz 0.0058 0.147 100 (j C3 01O cr 0.0041 0.104 0.0029 0.074 2CO C'�g 99,10 0.0018 0.046 .3Q6 44saed* ,esh 9"*.e -q �J (� �i(� % Q TOTAL SOILTEST INCORPORATED • 2205 LEE STREET • EVANSTON, ILLINOIS, U.S.A. M'Awj)Am�r IDIMH,111JAD W�umm�; nox laot), A ANCIROHAC-Ell AILASKA 99502 344-7714 3 25 'Tcct- SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF _,_ �2") 00 DRILLED AT THE RATE OF PER FOOT. 0!Ldc"'l ect hi PROPERTY OWNER LOCATION OF WELL DRILLER WELL. LOG: 3 0;'o 20,; G�Lat COU2.6c bed)z-ock. Corvj..l.0nV'wt(?-- zo ck. `5' r)'cdAQcL- p.toduc/Uon "t -"L 2-80 8 0. -."?.8 4 1/2 a Ptodu.c 3houying. 4P. (,yjll.cj Cj Y, 1, Totu.L wa,te4, tJ,!eU1 ')ILO _pp! with 275 0/1 ").tal c — Thi I ,,houtd Wbth u.,3e to a 2880 ga•'6 b-1, a 24 qaL,3 peA 1'0(1,t X" 275 Ir/r0 in,ZeneAve- U'l pux'ql 'lhould he 15 to 90 of .110 0 .5 p l2vt .[-(jot X32 -5r feet: )7-150-00 00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ;'7172.00 THANK YOU VERY MUCH. BERNIE Cl.,A�F RAMPART DRiL ING WORKS `Q DATE— J�cu. 2ii.d, 196 �NA " SERVICE CHARGE OF I,/,% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS a .Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-163-60 Expiration Date: 1. GENERAL INFORMATION Complete legal description PAYNE S/D, LOT 1 Location (site address) 11201 SNOW LINE DR, ANCHORAGE, AK 99516 Current Property owner(s) AVALON KRAFT Day phone Mailing address .11201 SNOW LINE DR, ANCHORAGE, AK 99516 Real Estate Agent Day phone Received by: ZA& Date: COSA to be released to the engineer, unless otherwise requested by the engineer. ■ COSA Fee $` S?.G f 3/ = f// 6� Waiver Fee $ Gtr Date of Payment 6010-11' 9753 Date of Payment Receipt Number Receipt Number COSA# 0501515-fV Waiver# PQ Ss 2. TYPE OF DWELLING:< � s ❑ Single Family (w/Wo ADU) ❑ Duplex . ❑ Multiple Dwellings (Single Family and/or Duplex) _ _ �" �r os 10 3. 3. NUMBER OF BEDROOMS: - 3 9S y F Z �d 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 ❑ Waiver/Variance request for: Distance: Received by: ZA& Date: COSA to be released to the engineer, unless otherwise requested by the engineer. ■ COSA Fee $` S?.G f 3/ = f// 6� Waiver Fee $ Gtr Date of Payment 6010-11' 9753 Date of Payment Receipt Number Receipt Number COSA# 0501515-fV Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON. PE . Date 10/24/15 v. tea °` 3y mak 49` 6. DSD SIGNATURE d �� _ ' System #1 Approved for - bedrooms. 4 MICH?ea rr f tcce cr, y System #2 Approved for bedrooms. ����/., %zJ Disapproved. flkill, ®\Oti-Si�<'4� Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: i /gh§ The Municipality of Ancho a Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only uponthe 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 10-10-12.doo If more than 1 septic system is on the lot: COSA Checklist # Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: PAYNE S/D, LOT 1 Parcel ID: 015-163-60 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Well Log (YIN) Y Date completed 1111g/1981 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 3,*,V 32� i Cased to 51 ft. Casing height (above ground) .W IV" 574 907ya�wtvc(� L r f-eJ. FROM WELL LOG AT INSPECTION Date of test 111211981 10/1912015 Static water levelt.E� 9) ft. 44 ft. S -e G R 0 Well production 1.5 g.p.m. WATER SAMPLE RESULTS: it hot Ar -C'e'- 1-4 11y4r. Coliform a ,colonies/1,00 mL Nitrate _�' Lmg/L Arsenic: N IQ g/L Date of sample: 1 012112 01 5 Collected by: EW. Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Date installed 1012112015 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) . N Date of pumping' NEW Pumper NEW C. ABSORPTION FIELD DATA -1985 SYSTEM TESTED Date installed 121�I1981 Soil rating (g.p.d./fe or fe/bdrm) 85 System type DEEPTRENCH Length 2f�,_ft. Width 2.5 ft. Gravel below pipe 5.0 ft. Total depth 10 ft. Eff, absorption area 500+ fe Monitoring tube Y Depression over field N Date *of 'adequacy test 10116115 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 12 in. Water added 500+ gal. New depth 27 in. Elapsed Time: 24 HRS min. Final fluid depth 11 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YN & type) UNKNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons Manhole/Access (Y/N) "Pump off' level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 7! Sewer /septic service line Animal containment areas 1001+ in.High water alarm level at _ in. Meets alarm & circuit requirements? On adjacentlots 1001+ On adjacent lots + WAIVER ON FILE Public sewer manho a/cleanout -100'+ Holding tank t .q5"4- Manure/animal qS4- Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 54 Property line 5'+ Absorption field 5'+ Water main 1004 Water service line 10'+ Surface water 1001+ Wells on adjacent tots 100'+ ABSORPTION FIELD ON LOT TO: Propertyline 101+ Building foundation 10'+ Water main 104 Water Service line 101+ Surface water 1004 Driveway, parking/vehicle storage 10'+ Curtain drain 50'+INoneKnovml Wells on adjacent lots 1004 F. COMMENTS w p— t( cuudk' b.mWc.d- L,..% S 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. Engineer's Printed Name MIKE N. ANDERSON, PE Date 10127/2015 COSA canary sheet 2-6-15.doc OF Al%lkkl All- .. P A! MICHAEL N. ANDERSON C-969 Municipality of Anchorage Development Services Department Building Safety Division + $A ETY 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 # OSC151594 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Lot 1 of Payne subdivision. This inspection revealed a nitrate concentration of 12.0 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. RESIDENTIAL & COMMERCIAL WATER AND FRAC IMMMATES Jelin N eh.ft o fi630 ftdB Aw An h.re,.Alaska In regards to the property located at Payne Lot 1 in Anchorage Alaska. The Well located at this property was recorded per lab analysis results to have a high concentration of nitrates. Per request by the municipality in an effort to keep usable water production and prevent cross contamination the following was completed. 1. The well pump was removed and bentonite chips were added until the bottom of the well was reduced to 270 feet total depth to block off the documented water sources at the bottom of the well. 2. The pump was re installed and a flow test was conducted to determine new flow rate which resulted in 2.19 g.p.m 3. New nitrate samples were pulled and tested and a result of lower concentrations were found to be at 12.0 This well still yields enough flow from the 70' zone to allow a usable amount of water to feed the demands of the home although we do advise that heavy usage of the water for extended periods may result in the well storage being depleted for a short amount of time. The well system does have a pump-tec protection device in line that will shut the pump off in the event the well is depleted allowing the well to recover and will re initialize on its own to prevent damage to the pump. If there is any further information needed regarding the work performed at this IocationP please feel free to contact us. Thank you I John Netherton 907 Water Well Services 907-230-1868 o�sl6ac � Ufl VVf ca ? m w D A = Q w y ZpOmiZ02 myZm <myw�n amO��Z m.Am M— NmNxOHmDyy '�41ZNp0n ppN Z wM-222M OFy mop�vamRi m-iDOH�O ADD A �PT wpm ,waw co�pym ZZp m.7mm J.x ;�u cZaO awo,Zr ��SSa >0,Z c3a n�av mzZ �� Z Zni y TNA Zw I2 X m O 0, m� N y 0 00 m O NO m 9mZ�Zr, o$ Z F m y?m�O o O a Nn mgo� � m Zm� a :n 9zm< 8 Z m ZU Z O yy p� N� 4 a D C n nk 0 H O -I HTlnn y Z p W n T M H Z z C mnOom� A � Anmzi"'m m w <n no< m C 2A-�U� -<prpm < � y m cni m m zz m Z�+22 zi O -t = m2�0 nn rn N O O o ti H D O H H m C A T nH own �m Ln mxn vm I�' mAms aT N o zzn o , z8 n n�mrn o n �g "AmD wmSo n t~ittiti m x ,ppm O T �<s m� z b L ---------_- - SNOWLINE_ DRIVE N 00 Ai' RS" F 1aa eta mi WA MUNICIPALITY OF ANC,HORAG SERVICES DEPARTMENT OF En Aron ental Services ' Division ik of 6650 pn_Site Servicee Section 99519- P.O. p• Box 196650 Anchorag , 343-4744 HEALTH AUTHORITY CERTIFICATE SHEAL FAMILY DWELLING gppF10VAL FOR I A SINGLE HAA it Parcel I.D• # L INFORMATION 1. GENERA Complete legal description 1'i address or directions) Location (site hone 7 L Day P Property owner > L. W I ►_i Day phone address Mailin9 ss N h...). �, Lending agency Day phone Mailing address Agent Address will be held for pickup. Unless otherwise requested, HAA 2 NUMBER OF BEDROOMS: F WATER SUPPLY: 3. TYPE O Individual well —_ un Commity we"_�----attest - public water State ADEC tem, provide written confirmation fro NOTEIf community Well system . ing to the legality and status of system WASTEWATER DISPOSAL 4. TYPE OF Individual on-site Holding tank Community on-site public sewer �— from S provide written confirmation unity wastewater system, Y NOTE: if comm legality and status of system. attesting to the leg 72-025 (Rev. 1191) Front MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER 6. By: As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature as u ri�`�Ai't ,o i"�- CE_ A -el # —Qp Z DHHS SIGNATURE AApproved for bedrooms. Disapproved. Conditional approval for Phone 9'2'1 - 3'11 L _ Date `�L4�.•uC Gll ' bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that a = eri odi c Eesti nq he performed to insure the wells gAontinued suitability. Nitrate concentration is 7.51 mg/1. EPA Date h - r The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 821 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 ®r - Health Authority Approval Checklist T n �1 n Legal Description: %,U I1 }PAY N R S /.D Parcel I.D.: D G (, 3 -� b D A. WELL DATA rM Well type_ If A. B, or C, attach ADEC letter. ADEC water system number E G Log present (Y/N) ! Date completed All? � 6 1 E 11 Total depth 518 Cased to 5 1 Casing height (above ground) 12 - Sanitary seal (YIN) Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test Static water level Well production �Z.. g,p.m. Q g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate 7_5141 9 11 Other bacteria l o/Date of sample: t7 `Q S Collected by: T-1 =C51 B. SEPTICIHOLDING TANK DATA Date installed 17-!$ Tank size 1 o-cx> j0d Number of Compartments .2 Cleanouts (Y/N)_Y— Foundation cleanout (YIN) _ Depression (Y/N) _ High water alarm (Y/N) N�� Date of Pumping &/2 1/5'5 Pumper I -A aareS C. ABSORPTION FIELD DATA -� 1 & gl �� �� Date installed Soil rating (g.p.d./ftZ orft'/bdim) 7 System type Length „��i -Width .2.5 Gravel thickness below pipe Total depth 1 G7 Effective absorption area au) *D Monitoring Tube present(Y/N)_2�_ Depression over field (Y/N) N Date of adequacy test 10/., 7 I -5- Results (Pass/Fail) For -� bedrooms t l Il Fluid depth in absorption field before test (in.); b Immediately afterb'" gal water added (in.): 11 901JOS Fluid depth(ins.) NQuatebmk*pr:— Absorption rate =y g.p.d. Peroxide treatment (past 12 months) (YIN) a If yes, give date Z D. LIFT STATION N/ Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off' level at* Septic/holding tank on lot 105 t ; On adjacent lots O Absorption field on lot 1 O 1 On adjacent lots 91/6-21 , + Public sewer main Public sewer manhole/cleanout Y%A Sewer /septic service line 02.7 I Lift station rq1q SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: � r Building foundation q1D i Property line L 1 Absorption field 10 Water main/service line 1001 Surface water/drainage �� O Wells on adjacent lots ? 1cro SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation —110 1 Water main/service line I"i Surface water I -L I p Driveway, parking/vehicle storage area Curtain drain N p Wells on adjacent lots �(,�{) Property line l f F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review ofNtunicipal records that the above systems, are in conformance with MOA HAA guidelines in effect on this date. a Signature Engineer's Name Tilgering Seal here Date Ls`f�. ` °J✓ ---------------------------- ------------------------ -------- - ---------------- HAA Fee $ OD Waiver Fee $ Date of Payment j6 `J Receipt Number Rev. 8/95 OSS: haa.wk.doc Date of Payment Receipt Number T— 1 o—` 5 t'IELi i 1 :04 HOLT LA1.1D .,I_IR'•,'E`r` 9073455513 F'. C_7 I 1v u1� Ali M INFORMATION NERRON 1S FOR THE USE Of LENDING INSMUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS KNEEN EXISTING STRUCTUREi AW PLATTED LOT LINE ON EABENENT$ Nov To RE USED FOR POSITIjIAiING ADDITIONAL of ekmks OR FENCELINES a�QNC% • .�iCWCV i%Cf1! of RECORU, OTHER THAI- s HOSE 5,WM ON THE KCM00 PLAT, ARE NOT CIPAM N8 I 1" 40, A& BUILT SURVEY I hereby certify that Iihave perform,' i Mortpagse,a inspection of the folto4i-,;l described praperty:��� LOT i, PAYNE SUB. Anchorass Recording District, Alasx,, arx, f that the lWoyw*nts situated thefec�rr I are within the property tines art dt) rev; overtop or encroach on the property tying adJecent thereto, that no E improvowta on property tying Adlncej7 j thereto encroach ori the premi rtes In question end that there are no roadways, j transmission tinea, or other visime essaal«nts on said property except as indicated hereonlLMDated at Anchorrope, Ataakb this '-w,y of j H0164' AND ASSOCIATES LANI;l CT&E Environmental Services Inc. Laboratory Division iiiiwiiiiiiioiiiiiiiiiwwiiwwi►www®wwwwiwwiwwiiii CT&E Ref.# 95.4655-1 Laboratory Analysis Report Matrix WATER Client Sample ID L1 PAYNE Client Name TOBBEN SPURKLAND, P.E. WORK Order 18984 Ordered By Printed Date 10/23/95 @ 17:02 hrs. Project Name Collected Date 10/17/95 @ 16:45 hrs. Project# Received Date 10/18/95 @ 11:35 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By.��— Sample Remarks: SAMPLE COLLECTED BY: T.S. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------------------------------- Nitrate-N 7.51 mg/L EPA 353.2 10. 10/20/95 CMR * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U`= Undetected, Reported value is the practical quantification limit. LT = Less Than D,-= Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA ALCT&E Environmental Services Inc. CT&E Ref.# 95.4655-2 Matrix WATER Client Sample ID L1 PAYNE Client Name TOBBEN SPURKLAND, P.E. WORK Order 18984 Ordered By Printed Date 10/23/95 Q 17:02 hrs. Project Name Collected Date 10/17/95 Q 16:45 hrs. Project# Received Date 10/18/95 @ 11:35 hrs. PWSID UA Technical Director STEPHEN C. EDE Released Sample Remarks: SAMPLE COLLECTED BY: QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------------------------------- Total Coliform 0 #/100m1 SM16 909A 10/19/95 TAV * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Pavne Subdivision -, T12N R3W SEction 24 Location (address or directions) 11201 Snowline Drive, Anchorage (b) Applicant Name Karl/Lee Brandt Telephone: Home - 346-1602Business 274-•1665 Applicant Address ._ 11201 Snowline Drive, Anchorage 99516 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Qx Buyer ❑ ; Other ❑ (explain); (d) Lending Institution AK Federal Credit Union - Address 3400 LaTouche Anchorage, 99508 (e) Real Estate Company and Agent —� Address_ --- Telephone ---_ - ---_--- (f) Mail the HAA to the following address: Telephone—_276-8125 2. TYPE OF RESIDENCE Single -Family EY-xMulti-Family ❑ Other Number of Bedrooms Three 3 i 3. WATER SUPPLY Individual Well ax 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 ax Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 7, 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. Name of Firm Address Date Telephone This Department has received written confirmation from the engineer, Alaska Soil Testing & Engineering, regarding the conditions of December 10, 1985. The conditions have been corrected and inspected by the engineering firm and reviewed by this office. This property now meets with MOA regulations and is, therefore, approved. Engineer's Seal 6. DHEP APPROVAL Date __December 20,_1985 —_-- Approved for three�3?_. bedrooms by — Approved -- xxxxxxxxxx Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (1 1,84) Illi ALASKA SOIL TESTING AND ENGINEERING 6100 A Street, Anchorage, Alaska 99502 (907) 561-7453 December 19, 1985 Mr. Karl Brandt 11201 Snowline Drive Anchorage, AK 99516 4f4/& o /,poNM��Tlz PRA y 00-40't� o�C 1 �TF�'�M R ' 86 FCS j AFD Subject: Health Authority Approval Upgrade, Lot 1, Payne Subdivision Dear Mr. Brandt: We have reviewed the subject property and have found that the deficiencies noted on the Municipality of Anchorage's conditional Health Authority approval Cdated 1 have been corrected. The four upgraded items consist of: 11 Well seal. The well seal has been replaced with a sanitary seal of approved type; 21 Well casing height. The well casing height is now 13 inches above grade and is satisfactory; 31 Surface grade above the absorption trench. The surface grade has been improved to provide drainage away from the trench and is satisfactory; q1 Septic system caps. The caps on the septic system cleanouts are of an approved type and are satisfactory. All deficiencies which were noted on the conditional approval have been corrected. Please call again if I may provide additional service. Sincerely, ALASKA /S/DIL TESTING AND ENGINEERING Mark Holum, P.E.; ST135-260 Manager MUNICIPALITY OF ANCHORAGE. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEBI MENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH IJt_(� Q 2CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITYC I 264-4720 1'�'ovc rnber 2%, 1985 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) f_,ot 1, Payne Subdivision-; -,ec. 24, Tlc"P Location (address or directions) 11201 Srzowli_ne Drive, �'o chioi,, AK Ka.rl & Lee i_)T<ro-1 �t 346-1602 274-1665 (b) Applicant Name .___ Telephone: Home Business Applicant Address _11201 e> a.00�line Drive, z. ,raga: , AK 99516 (c) Applicant is (check one): Lending Institution El ; Owner/builder [n ; Buyer ❑ ; Other 0 (explain); (d) Lending Institution A_t ,sk,-An.:F'ederaliCredit iJnion Address (e) Real Estate Company and Agent Address -- — ---- - -- ----- - --- ----- ------ Telephone -- _-- --- ---- ------ — -- (f) Mail the HAA to the following address: ----------I1�1 for ickup f� - 2. TYPE OF RESIDENCE Single-FamilyM Multi-FamilyE] Other Number of Bedrooms iThree — Telephone_— `, Ov �D-% L4 " 0 3. WATER SUPPLY Individual Well El Community © Public Cl 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 0 Public Q Community ❑ Holding Tank C_i Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) a. (ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATIO As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and i for the number of bedrooms and type of structure indicated herein. I further verify that based on the information o from the Municipality of Anchorage files and from my investigation and inspection, the on --site water,supply wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in e the date of this inspection. Name of Firm /11 ? T ..>ai l_ Te,, t.Lri and Er�.�ineerin€telephone _ 56.t -?453 _.— --- Address 61,00 .A, `.)trey= t, Anck.ora� e, !IK J2 1dovviii ae r 27, Date------ --- ----- ---- 8T85-260 1'1 -ease note waJ ver' re 1,UeS3:t, 6. DHEP APPROVAL Approved for Apved __ yf�F 4�. r �l n_. (^,I�!f�i%�'�n. •tea oaa ao y',,ne �„p sv'C"ti'.ol+ ZV �� _bedrooms by —_— '�- ° `" Date _ Disa)<roved—__—_ — .__ Conditional Terms of Conditional Approval `_'ti' _-# - 0,c. `,a.,Q- ®1a.—/o W,:' L_96.91 C.hrar'.,JZr +0 ! e 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 to 72-OP5 (11/84) A. WELL DATA B Well Classification Private MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Sec. 24, T12 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION i1tC 0 21 M N Lot 1, Payne SuREC E 1 V E D , R3W. S.M. If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y; Date Completed 12-2-81 Yield 1'5gpm (Well log) Ref Total Depth 318 ft. Cased to 318 ftl Depth of Grouting N/A` Static Water Level __ 41 ft. Pump Set At 300 ft. Casing Height Above Ground 6" (Ref Comment ) Sanitary Seal on Casing (Y/N) N (Ref. Comment 3) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N`' Separation Distances from Well: To Septic/Holding Tank on Lot 104 ft. ; On Adjoining Lots 130 ft. To Nearest Edge of Absorption Field on Lot 106 ft. -;On Adjoining Lots 92 ft well -seepage pit cleanoi To Nearest Public Sewer Line 100+ ft. To Nearest Public Sewer (Ref. waiver request attached', Cleanout/Manhole 100+ ft. To Nearest Sewer Service Line on Lot 40+ Water Sample Collected by M. Holum, F.E. Date 11-21-85 Water Sample Test Results Satisfactory Comments 1)Well yield confirrned at 450 gal/day on 11-21-85 per four hour drawdown test. 2) Well casing to be extended 12" above grade. Funds to be escrowed for this purpose. 3)Well seal to be installted. Funds to be escrowed for the purpose. Refer to SEPTIC/HOLDING TANK DATA attached waiver request for well -seepage pit separation Date Installed 12-8-81 Size 1000 gal No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N" Date Last Pumped 11-22-85 Pumping/Maintenance Contract on File (Y/N) N/A' ; for Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 104 ft,. To Property Line 10 ft. To Water Main/Service Line _ Course 1 Comments Page 1 of 2 72-026(11/84) 104 ft. To Building Foundation 25 ft. To Disposal Field 5 ft. N/A To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 85 ft2/bdrm Type of System Design Date Installed, 12-8-81 Length of Field _ 26 Width of Field 30 inches Depth of Field Gravel Bed Thickness 10 ft 5 ft Trench Square Feet of Absorption Area 260 ft2 Standpipes Present (Y/N) Y Depression over Field (Y/N) Y (Ref. Comment 4) Date of Last Adequacy Test 11-22-85 Results of Last Adequacy Test Satisfactory (Exceeds 1000 gal/day) Separation Distance from Absorption Field: To Water -Supply Well 106 f t. To Building Foundation Lot N/A 85 ft. To Property Line ; On Adjoining Lots 10 ft. To Existing or Abandoned System on 90 ft. To Water Main/Service Line 85 f t • To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 100+ ft. 100+ ft. To Driveway, Parking Area, or Vehicle Storage Area 50 ft. Comments 4) Funds to be escrowed for filling depression over the absorption. trench. The owner has proposed additional landscaping winch will improve drainage, but this project must wait for thawed ground conditions. D. LIFT STATION Date Installed N/A�� Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Pump Off Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. j� 11-27-85 Signed �//i1 �p -�-� Date �4�tiag�' Company Ak Soil Testing & EngFAOA No. ST85-260 OF At nth Receipt No. 811L4 j qc-=s _ Date of Payment -lam! Amount: $ 4 r Page 2 of 2 72-028 (11/84) ++,te�e a a auo t 4Ca'••b••o•• •a.a� • �0 E 's S_ -e al • A^ www. ••..a •�• •• c MARK HOLUM • ,{ 4 `1 CE 5734 0` ° • �.Z f °0, n•w�v fi y°wocca'�`°ut`w fivl,� Il �.__ \\ P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 Anchorage TONY KNOWLES, �. MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES December 17, 1985 Mark Holum, P.R. Alaska Soil Testing and Engineering 6100 A Street Anchorage, Alaska 99502 Subject: Waiver Request WR 85-058, Lot 1, Payne Subdivision Dear Mr. Holum: This department has reviewed your request for a waiver of he minimum 100 foot horizontal separation requirement between the well on the subject lot and a seepage pit on the adjacent lot (Lot 2). A review of the as -built for this seepage pit (filed as Lot 31, Hideaway Lake Subdivision) shows that the cleanout of the seepage pit is located in the approximate center of the pit. The as -built dimensions indicate that the outside perimeter of the seepage pit is approximately ten feet closer to the well than the pit cleanout. Your waiver request for 97 feet between the well and seepage pit was therefore adjusted to 87 feet. The waiver evaluation was performed using State Department of Environmental Conservation guidelines. This waiver evaluation indicated that there was very little if any possibility that the well on Lot 1 could be contaminated from the seepage pit on Lot 2. You have noted in your request for a Conditional Health Authority Approval for Lot 1 that the well and septic system this property will require improvements to meet state and municipal standards. Based on these observations, a conditional waiver has been granted until June 15, 1986 pending the required extension of the well casing, installation of a well seal and septic system caps, and regrading of the trench area. If the aforementioned improvements have not been completed by the specified date this waiver is no longer valid. This waiver is valid for the existing septic system only. Sincerely, l' Stephen S. Morris Civil Engineer On-site Services SM4/dEH6 Ffr-r-. ALASKA SOIL TESTING AND ENGINEERING 6100 A Street, Anchorage, Alaska 99502 (907) 561-7453 November 27, 1985 MUNICIPALITY OF ANCHORAGc DEPT. OF HEALTH g, ENVIRONMENTAL PROTECTION uti; G 2 RECEIVED Municipality of Anchorage Department of Health and Environmental Protection Division of Environmental Health 825 L Street Anchorage, AK 99501 Subject: Application for Waiver of Separation Distance, Lot 1, Payne Subdivision Gentlemen: This letter, with the attached supporting documents, constitutes a request for a waiver of the minimum horizontal separation distance between an existing well on Lot 1, Payne Subdivison and a seepage pit on Lot 2, Payne Subdivision. The waiver request pertains to the seporatio -d-i-S-tgnce of 97 Feet between the well and the seepage pi r5leanout _—._....__..,_, In accordance with the ADEC memorandum of January 3, 1985, which pertains to separation distance guidelines, several documents are attached which may aid in your evaluation of the waiver request. A log of the well on Lot 1, a soil log, installation inspection reports, and a water quality report / are attached. The water level in the well was '11 feet below` grade on November 20, 1985. The ground surface near the—well is approximately 8 feet below the ground surface npar the seepage pit. 91 Please call if I may provide additional assistance in your consideration of the waiver request. Respectfully submitted, ALASKA SOIL TESTING AND ENGINEERING "� °:.,.x �,., •a;,,yar �, /� Mark Holum, P.E. Manager' - r1' r �c e �•rz.. m_ y,:._ �;.5 rf..a<'r., � ( � (LI 1 � °t.:..I ® M . rz/ivIBS r ALASKA SOIL TESTING AND ENGINEERING 6100 A Street, Anchorage, Alaska 99502 (907) 561-7453 November 27, 1985 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEC G 2 i RECEIVED Municipality of Anchorage Department of Health and Environmental Protection Division of Environmental Health 825 L Street Anchorage, AK 99501 Subject: Conditional Health Authority Approval Request, Lot 1, Payne Subdivision Gentlemen: As described on the following documents, the on-site sewer and water supply do not conform to current state and municipal standards. In order to facilitate the client's refinancing of the existing house, we request a conditional approval subject to obtaining a well -seepage pit separation waiver and upgrading the well height, well seal, absorption trench grading, and septic system caps. The client has proposed landscaping which would improve drainage near the well and the absorption area, but this project must wait for thawed ground conditions. The attached waiver request is under a separate cover letter. Please call if I may provide additional assistance. Sincerely, ALASKA SOIL TESTING AND ENGINEERING Mark Holum, P.E. Manager Ffr-r-. ALASKA SOIL TESTING AND ENGINEERING 6100 A Street, Anchorage, Alaska 99502 (907) 561-7453 Adequacy Test Location: Lot 1, Payne Subdivision Type: Septic tank and Trench Address: 11201 Snowline Dr. Client: Karl Brandt Date Time Quantity of Water Added to Trench 11-21-85 1:50 pm 11 -21 -BS 4:00 11-21-85 5:06 11 -21 -BS 6:35 11-21-85 8:12 11-21-85 8:30 11-22-85 11:50 am 11-22-85 12:06 pm 11-22-85 12:08 11-22-85 12:10 11-22-65 12:12 11 -22 -BS 12:16 11 -22 -BS 12:36 11-22-85 12:56 11-22-85 3:17 CGol] 0 72 156 261 'f 05 '155 0 100 200 300 'f 00 500 a, Depth Below Grade of Dater Level In Trench CInches] 72 71 70 69 69 69 71 65 1 / Lf 59 3 /'f 5'f 3/Lf SO 3/'f 'f 7 3/Lf S9 3/Lf 65 1 /`f 72 1 /'f MUNICIPALITY OF ANCHORAGDEP,; ENVIRpN * OF HEI,LTH & NTAL PROTECTION UfEG G 2 ,, RECEIVED Depth Below Grade of Water Level in Septic Tank CInches] 50 'f9 1/2 49 1 /'f 'f9 1/2 49 3/'f 'f 9 3/Lf 50 50 50 50 50 50 50 Conclusion: The absorption rate of the existing trench exceeds 1000 gallons per day and is adequate for the three bedroom single family dwelling. Comments: The septic system was in use prior to and during the test. Performed by: Mark Holum, P.E,, ST85-260 Lit d r�li m-��%-^G�O(�tl �i •' JYYp9� 0f 0•e. m:^9 MARK HOLUM ��, •Y, CE 5734 p{�[ � rr er•• � � V �rl/,` �SVr�on 6r Y'�'�• �� AGY/ fJf�l3t'EJ.71`.)i����3i► i ime Time `Lp Date Date Date Inspector Inspector Inspector Comments Conditional Approval �U F'(:33)APPrOved SedroOMS C0_ Ci � �-- n) Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available.' Sewagg. posal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner C{ Y / �l i' Phone Mailing Address' /,,2 Buyer Address _a Lending Institution Address! Phone l%' SCi ✓ %�c�+` G /i` ! , > C,� Realty Co. & AgentA� S ,. r Phone Address Legal Description Street Location Type p,1 -Residence ff Single Family ❑ Multiple Family ❑ Other No. of Bedrooms n) Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available.' Sewagg. posal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.