HomeMy WebLinkAboutGRANITE VIEW BLK 6 LT 7 Municipality of Anchorage Page / of _2.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name: ~Vl'~ ~l'n~]] Wastewater System: D New ~ Upgrade
Address: ~O~ I ~, Ct~/e; ~5o7 ABSORPTION FIELD
Phone: ~ff?-/355 No ofBedrooms:~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound OOther
Tolal Depth from original grade:
LEGAL DESCRIPTION SoilRating: O, ~ GPD/Sq. Ft 13 ~'
~ Subdivision: Depth lo pipe bottom Irom original grade: Gravel depth beneath pipe
J Township: I ZN Range: ~ W ]ST;'lion: ~ ~ Fill added above originai grade: Gravel length:
Number of lines: Distance belween lines:
WELL: D New Q Upgrade Gravel width: ~--~ Ft. ] -- Ft.
Classification (Private, A.B.C): Total Depth: Cased To: Total absorption area: Pipe materiah
Driller ? ~ ~ ~ Ft
Pump Sel al: Casing Height Above Ground:
8~PARATION DISTANCE8 ~s~,ic ~ Holding ~ S.T.E.P.
From }ank Field Station Tank S ..... Lines
w~,, ~g' /0~' N~ ~ +~o~ '~'~ri~': 3~/ Number°fC°mpartmenls:Z
Surface
w~t~,- N~ ~ No~ ~c ~ LIFT STATION
Lot ~ t ~m~ufacturer:
Line $ /O ~ ~ +~ Size in gallons:
Foundatio~ / ?¢ /O ~ ~ ~ +/~ ( "PumLon" level al: ~ "Pump off'__ level at: High ~water alarm at:
Curtain Electrical
Dram ~ ~ NI~ N~ ~ Pump Mak:&Model Inspections~:rformed by:
72-013 (Rev 9/91) MOA 25
Permit No. Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERWOE$
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: ~-F, ~ ~ ~--____.~'--¢0~,'-A V]'¢.~ -~/]..~ PID NO,:
102-'
_ /
72-013 A (2191) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHOPJtGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE)
PAGE 1 OF 2
PERMIT
PERMIT NUMBER:SW940127
DESIGN ENGINEER:POLARCONSULT
OWNER NAME:LINNELL SWEEZEY CHRISTIE ANN &
OWNER ADDRESS:3031 NORTH CIRCLE WAY
ANCHORAGE, AK 99507
DATE ISSUED: 5/16/94
EXPIRATION DATE: 5/16/95
PARCEL ID:01430105
LEGAL DESCRIPTION: GRANITE VIEW BLK 6 LT 7
LOT SIZE: 12900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 (18AACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
WAIVER WR940024 ISSUED 5/16/94 FOR THE FOLLOWING WAIVERS;
85 FT. WELL ON LOT 7 BK 6 TO NEW TANK ON LOT 7
90 FT WELL ON LOT 7 BK 6 TO NEW TRENCH ON LOT 7
75 FT. WELL ON LOT 8 BK 6 TO NEW TANK ON LOT 7
PAGE 2 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
80 FT. WELL ON LOT 8 BK 6 TO NEW TRENCH ON LOT 7
72 FT. WELL ON LOT 2 BK 7 TO NEW TRENCH ON LOT 7
5 FT. LOT LINE WAIVER LOT 7~.~ TO NEW TANK ON LOT 7
RECEIVED BY: ~',~.~ .y~,/,. ~'~/
May 17, 1994
Earle V. Ausman, P.E.
Polarconsult Alaska, Inc.
1503 West 33 Avenue
Suite 310
Anchorage, Alaska 99503
Subject: Waiver Request for Lot 7 Block 6 Granite View Subdivision
Waiver Request #WR940024, PID #014-301-05, SW940127
Dear Mr. Ausman:
Your request for waiver(s) of the required 100 foot horizontal
separation of a septic system to a private well has been approved.
The approved separation distance(s) are well on Lot 7 Block 6 to
the septic tank on Lot 7 of 85 feet; well on Lot 7 Block 6 to
new trench on Lot 7 of 90 feet; well on Lot 8 Block 6 to new tank
on Lot 7 of 75 feet; well on Lot 8 Block 6 to new trench on Lot 7
of 80 feet; well on Lot 2 Block 7 to new trench on Lot 7 of 72
feet and lot line waiver of 5 feet to new on Lot 7.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincere_ly,
1�Obert W. Robinson
Civil Engineer
On-site Services
RWR. ljm
MUNICIPALITY OF ANCHORAGm
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR940024 PID# 014-301-05 HA#
Date Received: May 4, 1994
Legal Description: Lot 7 Block 6 Granite View Subdivision
Engineer: Earl Ausman, P.E., Polarconsult Alaska, Inc.
Permit #
1503 West 33rd Avenue, Suite 3].0 Anchorage, Alaska 99503
Applicant: Kevin Linnell
Waiver Requested: Private well on Lot 8 Block 5 to septic tank on
Lot 7 Block 6 of 65 feet; Private well to Lots2 and 3 Block 7 of 80
feet. ~/~
Criteria: 1. Geology: Points:
2 o
A. Water Table
B. Soil Sorption
Co Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special ConditJ. ons:
3. Other:
Waiver is Granted: Waiver is NOT Granted:
List Conditions or Reasons for above: _
..... / . ~ ~ . ..,-- , . / ' /- ~-.
/ N~e of Reviewer
Rec #: 25877 ~4079
Amount: $920.00
Date Paid: May 4, 1994
tI t~
polarconsul't alaska, inc.
ENGINEERS" SURVEYORS · ENERGY CONSULTANTS
May 13, 1994
DHHS, Environmental Services, On-site Services
P.O. Box 196650
Anchorage, Alaska 99519
Attn: Permit Review Officer
Re: Waiver Application for On-site Sewer System
Upgrade at Lot 7, Block 6, Granite View S/D.
Dear Sir or Madam:
We are applying, on behalf of Mr. Kevin Linnell, for a "well to tank" and "well to
field" waiver for a system replacement/upgrade at the above property. We are
requesting permission to waive the separation distance requirement from the absorption
field and septic tank to the domestic water wells located on Lot 8 (Block 6), Lots 2 & 3
(Block 7), and the subject property's well.
As shown on the attached site plan, we are requesting the following exemptions for the
system upgrade ("new septic" and "new trench" refer to planned system upgrade, i.e.
septic tank and leach field, respectively, on Lot 7):
· 85 feet
· 90 feet
· 75 feet
· 80 feet
separation distance from Lot 7, Block 6 well to new septic.
separation distance from Lot 7, Block 6 well to new trench.
separation distance from Lot 8, Block 6 welt to new septic.
separation distance from Lot 8, Block 6 well to new trench.
72 feet separation distance from Lot 2, Block 7 well to new trench.
5 feet separation distance from new septic to LotT/8 lot line.
Please note that there already exist at least two wells which are within 100 feet of the
current system. The static water level in the subject property's well is approximately
46 feet below surface. Also, as other mitigating circumstances, the house Gn Lot 7
separates its well and septic system, and North Circle Way divides any and all wells in
Block 7 from the subject property's well, namely the well on Lot 2, Block 7. The
septic tank will utilize Colder water-tight couplings and will be protected from
corrosion (sacrificial anode).
1503 WEST 33RD AVENUE · SUITE 310 · ANCHORAGE, ALASKA 99503
PFIONE (907) 258-2420 · TELEFAX (907) 258-2419
polarconsult
The only suitable location for an upgrade system, while maintaining the greatest
possible separation distances, is shown on the site plan. In addition, based on the
assumed location of sewer rock surrounding the existing crib, the proposed system may
encroach on the 15 foot leachfield separation requirement.
We would like your concurrence regarding these waivers as soon as possible. Please
find enclosed a check for $920. If you have any questions, please give me a call.
Sincerely,
Matthew Korshin
POLARCONSULT
polarconsult alaska, inc.
ENGINEERS" SURVEYORS · ENERGY CONSULTANTS
May 2, 1994
DHHS, Environmental Services, On-site Services
P.O. Box 196650
Anchorage, Alaska 99519
Attn:
Re:
Permit Review Officer
Design and Construction Approval for On-site
Sewer System Upgrade at Lot 7, Block 6, Granite
View S/D.
Dear Sir or Madam:
Please accept the following design for review and permitting. The proposed system
upgrade does not affect the current use of the adjacent properties and will have
minimum future impact.
The present septic tank cannot be reused due to corrosion, so it will be pumped,
crushed, buried on site, and replaced with a new one.
Sincerely,
Matthew Korshin
POLARCONSULT
Attachments:
On-site Sewer/Well Permit Application
Site Plan, Sheet 1 of 4
System Design Calculations, Section, Sheet 2 of 4
Percolation Test, Sheet 3 of 4
Waiver Application, Sheet 4 of 4
$320 Check for Permit Fee
$920 Check for Waiver Fee
1503 WEST 33RD AVENUE" SUITE 310 · ANCHORAGE, ALASKA 99503
PHONE (907) 258-2420 · TELEFAX (907) 258-2419
polarconsult alaska, inc.
:[503 West 33rd Avenue · Suite 3:[0
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258-2419
SHEET NO.
CALCULATEDBY
CHECKED BY_
DATE
polarconsult alaska, inc.
1503 West 33rd Avenue · Suite 3:[0
ANCHORAGE., ALASKA 99503
(907) 258-2420 Fax (907) 258-2419
SHEET NO~
C^LCU~TED~V
CHECKED BY
SCALE / "~ ~'"'~/
DATE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:.
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
5/'1
"Co"
COMMENTS
DATE PERFORMED:
Township, Range, Section: "~"/'2-/'J,
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT ~ O
DEPTH? p
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
~0,~ Y/~ 7-' o - -- -
~ q/z:~, ~,'~. - ~" -
2- 'dz7 :7 ~,',*. 2- ~,.'.. ~ y~,, ~.
~ 'dz7 z~ ~,~. ~ ~,~. 3 ,~" ~Z~',
~ ~/:~ ~ ~,.. ~ ~;., ~ ~" ~//~"
PERCOLATION RATE ..-~'~"/7/_ (mmutesnnch) PERC HOLE DIAMETER __
TEST RUN BETWEEN 7 FT AND ~) FT
' ~'~ CERTIFY THAT THIS TEST WAS PERFORMED IN
*CCO~ANCS w~m AL. ST*TE*ND MUNiCh,*. eU~DE,NES ~N EFFECT ON T,~S DATE. D*TE: _
72-O08 (Rev. 4/85)
polarconsult alaska, inc.
1503 West 33rd Avenue * Suite 310
ANCHORAGE, ALASKA 99503
(907) 258-2420 Fax (907) 258-24:[9
~o~__ /-7,
SHEET NO__ OF
CALCULATED BY DATE
CHECKED BY
GR' 'ER ANCHORAGE AREA B~r'OC ~
DL:,ARTMENT OF ENVIRONMENTAL .,. LI',. ,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 2'79-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOcAtION ~-/O, ¢ A
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY~/~'
,/(/'r.;' (.,C)e/! MATERIAL
MAILING ,~ £t .Cc~ _~/.
ADDRESS. .
LEGAL DESCRIPTION
GALLONS.
NUMBER OF
COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID
DEPTEI ____
SEEPAGE SYSTEM: SEEPAGE PIT=
NUMBER OF PITS ' OUTSIDE DIAMETER OR WIDTH '"
LININGMATERIAt ~'--~' ~:--r/j? r"~'x2~'~.., DISTANCE FROM WELL '~O (C)~//
NEAREST LOT LINE /(D
TOTAl EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH ~- / ' . DEPTH
, BUILDING FOUNDATION /'/1
~/o(/'~) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL__ , FOUNDATION , NEAREST_..~g.J~bINE'~'~-~-~'~
NUMBER OF LINES__._ DISTANCE 8EfW.~-"Ldt'q'E%''/~ TRENCH WIDTH
ABSORPTION AREA _..~'""-"~' SQ. FT. LENGTH OF EACH LINE
BEFTR"~: 10~ OF 11LE TO FINISH GRADE DEPTH OF FIllER MATERIAl BENEATH TILE.
......... T~ iA i- LENGTH , OF LINES
IN. TOTAL EFFECTIVE
IN, ABOVE TILE __
WELL:
LOT LINE
¢; ' ' ' DISTANCE FROM WATER
TYPE : ' , DEPTH , BUILDING FOUNDATION .... SA..j~P~..E
NEAREST ~__._.-.-~--.-~lZT'l~-'~----'-------~ S E E P A GE
~qE__ , TANK ,SYSTEM_
, CESSPOOL
~- NEAREST
OTHER
, SOURCES.
DISTANCES:
¢',,1,,~- ¢ ,.J
/(: ;:':. :
DIAGRAM OF SYSTEM
DATE
DEPARTMENT OF ENVIRONMENTAL QUALITY
ANCHORAGE. ALASKA 995Og
DI[PO~AL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
2229
PHONE
TYPE AND SIZE OF FACILITY TO BE SE VED ~ ~/~'.~~ Z~-~ff/t'/}~
FINANCED THROUGH TO BE INSTALLED BY
~--/~~- NOTE: THIS PERMIT IS NOT VALID WITHOUT ~OIL TEST
SOIL
TEST
RESULTS
COMPLETION DATE ANTICIPATED
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION,
SEPTIC TANK SIZE /~'~'~ )~/~ 4 TYPe
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL /
/
SEPTIC TANK ,.
TO NEAREST LOT LINE.
/O~
DRAIN FIELD
SEEPAGE PiT. ., DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
!
SEEPAGE PIt
/00 r
., DRAIN FIELD
DIAGRAM Ol" SYSTEM
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO.UNDIS~T_~EJ3-,,~.OIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
PITTED WITH AIRTIGHT REMOVAEILE CAPS.
GRAVEL BACKFILL
CONFORM tO BOROUGH REGULATIONS REGARDING INSTALLATION.
CERTIFY THAT I AM FAMILIAR WITH THE rEQUIREMENTS OF GREATER ANCHOr,~(;E ArEA BOROUgh ORDINANCE NO. 2S-6S AND THAT THE AI]OVE
DESCRIbeD SYST~ IS IN ACCORDANCE WITH SAID CODE.
DAT~ ~ APPLICANTIS SIGNATUR ~ ~. '
/ W [/- ,. /
Performed For
Lecal Description:
This Form Reuorts Soils Lea
,, EATEP ANCHORAGE AiqEA
DEPARTMENT OF ENt,~[ROI,IF!~NixL
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
Percolation TesL
qeoth
Feet
6
7
Soil Characteristics
Was Ground Water Encountered?
I~ Yes, At what Denth?
Readinq Date Gross Time
!---d
Net Time Denth to H20 Net
ercolation Ra~e !'ii mu~e
Proposed Installation: See~acle Pit___ ~. .... Drain Fie'Id
,r)eeth of Inlet ,.F)em~h 'Fo Bottom Of Pit Or ]rench
•
r_� Municipality of Anchorage ti� =oft
,�'�Ai
On-Site Water and Wastewater Program
(907) 343-7904 a MAY 19 20 - s114Y
V
Certificate of On-Site Systems Approve
A`"
Parcel I.D. 014-301-05 Expiration Date: ? a r 't
1. GENERAL INFORMATION
Complete legal description Granite View Block 6 Lot 7
Location (site address) 3031 North Circle
Current Property owner(s) Mark Finstrom Day phone
Mailing address 3031 North Circle Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
E1 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: Distance:
Received by. r 'r i Date:
ODA ?-
COSA to be released to the engineer, unless otherwise requested the engineer.
COSA Fee $ j� — Waiver Fee $
Date of Payment Gj}ZZ!ll Date of Payment
Receipt Number 0Lti /7�1 Receipt Number
COSA# O�n h l `"l a 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 inform•On.eibtqied from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater diol.s tem 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 separationccijstances: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 5/19/2017
.� OF AL,q�'���
6. DSD SIGNATUREer .•" ' i�j �6
•
System #1 Approved for S�ev bedrooms �� E •.8l o none: • ,�
•
System #2 Approved for bedrooms �96)x'•,
Disapproved 'kl'. OFESSIOt
Conditional approval for bedrooms, with the following stipulations:
•
3 ON-SITE r•G�,
MATER AND
WASIFAWNER c
0ROGRAN'
By: Original Certificate Date:
•
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 r - ,.
If more than 'I 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 Granite View Block 6 Lot 7 Parcel ID: 014-301-05
A. WELL DATA
Well type Private If A. B, or C provide PWSID# Well Log (YIN) N
Date completed Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 104* ft. Cased to 40+ ft Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test N/A 5/11/2017
Static water level N/A ft. 49 ft.
Well production N/A g.p.m. 5.0 g.p m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic 7.86 ug/L Date of sample 5/11/2017 Collected by. PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/23/1994
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N)
Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping Cj 1 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 5/23/1994 Soil rating (g.p.d./ft' or ft2/bdrm) 0.6 GPD/SF System type Deep Trench
Length 50 ft Width 3 to 4 _ ft. Gravel below pipe 7'5 ft
Total depth 13 ft. Eff. absorption area 750 ft` Monitoring tube _Y Depression over field N
Date of adequacy test 5/11/2017 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 455 gal. New depth 2 in
Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d
N
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 85+** On adjacent lots 100+
Absorption field on lot 90+** 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+ yWater service line 10+ Surface water 100+
.r-';� 5-i
Wells on adjacent lots a�'•�
ABSORPTION FIEL LOT TO:7- ----0-____,
Property line tglir i Building foundation 1 a+ Water main 10+
Water Service line 10+ Surface water 100+ Drivewa ehicle storage 10+
Curtain drain 50+ Wells on adjacent lots ilie6fOq - -7 r!
F. COMMENTS
*Well depth per engineer's installation report 5/23/1994, probed to 75' on 8/31/2009
** aived on permit #SW940127, WR #940024. Survey on File
W at r24-- n
G. ENGINEER'S CERTIFICATION ,��� OF Ai ��k
I certify that 1 have determined through field inspections and / ,�
review of Municipal records that the above systems are in * , • 6� ;; IVO
conformance with MOA COSA guidelines in effect on this date. I-• ••i •� �� ••• 0
Engineer's Printed Name Steven Pannone 01 .M.•••1?../5.••. rno pi
CE-6149 .
5/19/2017 f+�'¢s , �/
oe
Date
COSA canary sheet_2-6-15.doc
w.
. .
OMNI
•
i ,....... 0,6't
i'15/' . . ' Ititfel .
1
Oh
• ,��NN .� l
' . '`` .If,V• o\\• 9. i
.1.' .4 ,'rel ti-%0:'• ; 4
r ♦
lig
•
,9.`r lyf�i,`r�a4.•-- d5i'o/9.
ASBUILT •
------ . ' SWARD & ASSOCIATES LAND SUftVBYIIIG 6 4-0829
HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE!
FOLLOWING DESCRIBED PROPERTY! �_- � .�••OF
�,o.✓rrr ~..(0/s�Bd toT7.6�.r: DATE! •.� OF A�
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS + •..• ..� y
INDICATED. IT I5 THE RESPONSIBILITY- OF.THE .r+'���y ;• �'-
OWNER TO DETERMINE THE EXISTENCE OF ---� * TH .5��
EASEMENTS, COVENANTS, OR RESTRICTIONS Y GRID!
•.P •
... '.••,6
WHICH DO NOT APPEAR ON THE RECORDED SUBDI. •-/
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD F8' • f .. ou. M'rk 3.....Q : r
ANY DATA HEREON BE USED FOR CONSTRUCTION 7,`rs' .if r•,• ..... • :,err
OF FENCE LINES, OR FOR ESTABLISHING BOUND- !6-to f4'.'•.......• ,•'' �'
ARY LINES. DRAWN= '�it - 1L �'
O.4rf akaymov�.
Parcel I.D. #
GENERAL INFORMATION
Complete legal description
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
~'~/ - (~')/-~ NAA #
J
Location (site address or directions) ~0 ~ I Ctrq% 7
Property owner
Mailing address
Day phone
o
Lending agency
Mailing address ¢"/'g- ¢ .¢/¢~//¢~ z'4?'~-
Agent /z~/~,¢d_ ~/~r~
Address //~/ ~" 7~~'l~ //~d. £~+~ ~nr~,
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATFR SUPPLY:
Individual well
Community well
Public water
NOTE:
Day phone
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
Holdin9 tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
72~)25 (Rev. 1/91) Fron[ MOA 1~21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ~°/°~rc<m~/TL Phone
Address /5/(2 ~ k~,/f .~3 '~J /Z~v¢-. ~/~¢~ ~¢~O5
Engineer's signature ~~~ Date
DHHS SIGNATURE
Approved for J
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
The ~uni¢ipaliW of Anchorage Depa~ment of Health and Human Services (DHH$) issues Health Authodb/
Approval Oe~fifica~es based only upon the ~epresen~afions given in paragraph 6 above by an independent
professional engineer registered in ~he $~ale of Alaska, The DHH$ does this as a ecu n~esy ~o purchasers of homes
and their lending institutions in order ~osafis~ certain federal and s~a~e ~equirements. ~mployees of DHH$ do no~
¢ondue~ inspections o~ analyze data before a cerUficate is issued. The ~unicipalib/ of Anchorage is not
responsible for errors o~ omissions in lhe pro~essional engineers work.
72~125 (Rev. 1/91) Back MOA Ir21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Parcel I.D.
A, Well Data
Well type 1~r*iV~Jr¢,
Log present (Y/N) /~/
/
Total depth /
Sanitary seal (Y/N)
If A, B. or C, attach ADEC letter. ADEC water system number --
Date completed ~h ~,~,~ Driller
Cased to ~n ~:~o~,¢r~ Casing height /z///
Wires properly protected (Y/N) Y
FROM WELL LOG AT INSPECTION
Date of test ~) ~' ~-~q ~ 'z//2--~/?/'/
It
Static water level z/~z. ~ * ['Fl(~/,t C~'//V ~-}
Well flow ~' g.p.m. 6, ~Z.
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot-
Absorption field on lot
Public sewer main 'f'/00
t'- .,~O/
Sewer service line
; On adjacent lots
; On adjacent tots
Public sewer manhole/cleanout +/0(~
Petroleum tank
WATER SAMPLE RESULTS:
Coliform O, I m~/~-
Date of sample: ~//2 ~/¢]zf'
Nitrate
Other bacteria
Collected by:
B, SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N) Y
High water alarm (Y/N)
Date of pumping
Tank size /0~ ¢-,,/ Compartments ~
Foundation cleanout (Y/N) ~ Depression (Y/N)
Alarm tested (Y/N) --
//~/e~ "7~o,,~k Pumper ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots '~" Foundation / ¢'
Absorption field ~ ~ Water main/service line
72-026(3¢93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) -
High water alarm level -
Meets MOA electrical codes (Y/N) -
"Pump on" level at
Manufacturer -
Manhole/Access (Y/N) --
"Pump off" Level at
Cycles tested -
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot ~ On adjacent lots
Surface water --
D, ABSORPTION FIELD DATA
Date installed 5/2-
Length _~O / Width
Total absorption area
Date of adequacy test /Vo'r
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft2) O,
z_// Gravel thickness
Cleanout present (Y/N) ~"
Results (pass/fail) --
System type ~)'~-.¢ '7-'r~,~/~
~ ~ / Totaldepth J ~ /
Depression over field (Y/N)
for -
After test -
If yes, give date ~
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /05 '
To building foundation
On adjacent lots +'
Surface water +
/9/
/ ! /
On adjacent lots -~/,~ ~ ,~/DC Properly line
To existing or abandoned system on lot
Cutbank -- Water main/service line
Driveway, parking/vehicle storage area- /{~
"/-/00 '
Cudain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to ali MOA and HAA guidelines in effect on
Signature ~~
Engineer's Name ~'-~¢'/6_ ./~.¢,~,~
Date 5,/'~ ~Y//'~ ~'
HAA Fee $
Date of Payment
Receipt Number ~-~)',~~ c~ ~"~
Waiver Fee $
Date of Payment
Receipt Number
CT&E Ref.#
Climtt Smnple iD
Matrix
Commercial Testing & Engineering Co.
Environmental Laboratory Services
LABORATORY ANALYSIS REPORT
94.1936-1
L7 B6 GRANITE VIEW
WATER
Client Name POLAR CONSULT WORK Order
Ordered B y MA I'IHEW KORSI-IEN! Printed Date
Project Name Co 1 lected ~tt e
Project# Received Date
PWSiD UA
77920
05/03/94 ~09:10
04/29/94 ~13:24 l~s.
04/29/94 ~I4:30 hrs.
Techn i cai Direct o r STEPItEN C. EDE
Released By: ~ ~', ~_______~'~
Sample Rexnarks: ROUTI/qE SAMPLE COLLECTED BY: M.K.
QC
Parameter Results Qual
Units
Allowable Ext. Anal
Method Limits Date Date htit
Nitrate-N
0.10 U ing/L EPA 353.2/300,0 10
05/02/94 MCE
* See Special Instructions Above
** See Smnple Remarks Above
U = Undetected, Rep orted value is the practical quantification limit.
D = Secondary dilution.
UA = Unavailable
NA = Not Analyzed
LT = Less Than
Gl'= O'eater qhan
5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO. FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY. OHIO, UTAH, WEST VIRGINIA
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
"C" Street, Anchorage, Alaska 99503 274-4561
Time of Inspection
.
~ /~- .-
. / ~ ~ <- REQUEST FOR APPROVAL OF
/, _- INDIVIDUAL SEWER
pp v 1 requested by:
Mailing Address: ~ ~?'/
2. Property Owner: ~
Mailing Address:._~:
3. Legal Description:
4. Location:
Phone:
Phone:
5. Type of facility to be inspected ~,,'~ ' :: No of bedrooms
6. Well Data: / '''~
/
A. Type -~ ~/, B. Depth
C. Construction
D. Bacterial Analysis
Sewage Disposal System:
I-
A. Installed .'.,~ ,4 ~ B. Installer
C. Septic Tank: 1. Size ~/g~.C~C~ 2. Man,facturer
Absor 10 Cea ~</.~/)/~ ~
D. Seepage Pit: 1. pt' n A ea ~ Z. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
-.9-/ , Absorption area
C. Absorption area to nearest lot line ~_Z/~/
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
3330 "C"
!I:(/IIESf FOf~ At'I~R()VAt OF
It'IDI¥II)U~L SEWER & U/k'f[l/ FACILIilES
3 o
Type of Inspection: CNP, O VI\ Ilia CONV
Pruperty OWIlOl. _ ......................................................... ':'. !
Ha~,)e of Buyer: .
I~ai '1 illg /~odt~esb: [)rZ.
rial] lng ~ddress:
Hail'lng Address: ~.~_ .......
?
8.
Type of :acility to be insl.,ecte, d: ..,,~_~_..Y_ ............ (?2_._~!.~.j?s.__.~_~ __
Water Su ~t)ly ,,
Type of' Supply: Public t/I. ility ....... [ndividual
If Individt~al, number of dv~ellin!js p;"esenLly served
If Individual, depIzh of v'el] ~
9 Sewage Disposal' Sys
·
'l'yi)e o Systel,~: Public tJi. il ity ludividud'l
(on-site)
Page 2 of two pages - Req
Legal Description
st for Approval of Individual S
~r & Water Facilities
Comments
Approved .~C.?}.~,~' '~' ~:"~ ~.,,~1~.~.~! Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)