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HomeMy WebLinkAboutSHENANDOAH HILLS LT 9h nondooh H ills Lot 9 015-212 -46 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191180 PID Number: 015-212-46 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name Corrine Finnie ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑■ Bed ❑ Mound Site Address 12130 Shenandoah Road *Anchorage, AK ❑ Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 907-350-2490 4 *5 (Horizontal) GPD/SF SEE ATTACHED DWraFt. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE ATTACHED DWG. Ft. Gravel depth beneath pipe 0.55 Ft. Subdivision Block Lot Shenandoah Hills; Lot 9 Fill added above original grade SEE ATTACHED DWG Ft. Gravel length 40 Ft. Township Range Section - Gravel width 20 Ft. Beds: Number of Lines 4 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 120 Ftz - - Ft. Well *501+ *501+ *50'+ - _ TANK ❑ Septic 0 S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1500 Gal. Surface Water *50'+ *50'+ *50'+ - Material Number of compartments Lot Line 5'+ 10'+ 10'+ - NA Epoxy Coated Steel Septic Tank 2 Foundation 10'+ 10'+ 10'+ _ LIFT STATION Manufacturer Capacity Remarks Old tank decommissioned per upc per Anchorage Tank 109 Gal. contractor Alarm location Inside Home Electrical installed by ml0A PIPE MATERIAL House to tank D3034Tank to D2665 drainfield Installer A+ HOME SERVICES Drainfield D2665 CO/MTD3034 Inspector DAVID GARNESS AND TIM ECKLUND BENCH MARK (Assumed elevation) 99.47 ft Inspection15` 7/16/19 7/19/19 Location and description 1 OF MW 3`° 7/18/19 4117/22/19 ITOP ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date Engineer's Stamp o 950 .....••. �O��D �........................� Septic System Approved QDate 1311 1 Q ff A. Gar ess. 00 ' . CE DOS Note: this approval does not include well permit requirements. of #AECC884 (Kev 05/02/18) GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING -­—__—____._- July ----_ July 30, 2019 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Section 4700 Elmore Road Anchorage, Alaska 99507 Attn: Tim Ecklund Ref: Shenandoah Hills, Lot 9 — Separation from new drainfield to "surface water" Mr. Ecklund: When the permit (OSP191180) was issued for the subject property we had addressed surface water in the road ditch on the east side of Elmore Road. This surface water was noted on 4/24/2019, during Spring break-up. This surface water was addressed in the design package used to obtain a permit and it was stated that the new drainfield would be at least 50 feet from surface water. During the installation of the drainfield in July 2019, the subject road ditch was dry. According to the MOA wetlands/stream mapping (copy attached), there are no surface waters present in the subject road ditch in the vicinity of this property. The separation distance from the closest monitoring tube in the new drainfield, to the road ditch is approximately 50 feet. Given that there is no mapped stream in this area and the fact that the road ditch was dry in July 2019, we are assuming that there is no separation distance concern between the drainfield and surface water. Please call or email if -you have any questions. I.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com ARCEL PERMIT OSP191180 RECORD DRAWING P015-2 2-46NUMBER: 015-212-46 N 50 f�f w m m m m _ 0 z m m D m m m m z 1 GREEN HOUSE NEW DRAINFIELD - - - - NEW EPDXY COATED 1500 I I GALLON STEEL SEPTIC TAN I MT3 GEG T.H.91 MT2 I IISES nnua J I I I TMT1GItiZ-��� T1 B FCO EXISTING 4 BEDROOM HOUSE -APPROXIMATE LOCATION OF / PUMP VAULT (ASSUMED FtOR FOUNDATION DRAIN) ASSUMED LOCA/ORDS / SUBSURFACE DRD / UPON MOA RE :g '. ` c • • DRIVEWAY a 0 Z I Q O Q O 0 / I100' WELL RADIUS � / I BOTTOM OF BED AND TOP OF W / TANK INSPECTED BY MOA GEG T.H.#2 ONSITE EMPLOYEE TIM ECKLUND / 'CONTRACTOR DID NOT TAKE MEASURES TO BALLIST/ANCHOR THE PUMP VAULT AND STEP TANK TO COMBAT BUOYANCY FORCES; A TANK I I MONITORING TUBE WAS INSTALLED TO MONITOR GROUNDWATER PUMPING AS REQUIRED FOR PLASTIC SEPTIC TANKS' NO SURFACE WATER IN ROAD kAI \ \ DITCH ON 7/15/2019. SEE I ATTACHED LETTER DATED N 1 I \ 7/30/19. ALE: / 1"=40' GARNESS ENGINEERING GROUP, Ltd ENGINEERING - SALES --CONSULTING - - -- - 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 336-3246' WEBSITE: w gamessengineemg.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CORRINE FINNIE 907-350-2490 2 OF 4 LEGAL DESCRIPTION: DRAWN BY: SHENANDOAH HILLS; LOT 9 D.J.G. TYPE OF WORK: DATE: �,_ SEPTIC RECORD DRAWING 7/30/2019 OF � ....... 9 ....... ......... � .� :; J Garn s � i # X • CE -79 =o #�e� �Fo �•.. , 3r : �s p�OF LICENSE 10,1` #AECC884 PERMIT NUMBER: RECORD DRAWING PARCEL ID NUMBER: OSP 191180015-212-46 FINAL GRADE ELEVATION = 99.3-99.2 f ELEVATION AT TOP OF MANHOLE = 99.46 ELEVATION AT TOP OF MANHOLE = 99.45 ELEVATION AT TOP -I Ill �I I II OF TANK = T TO OF TANK = 94.52 Ll II ELEVATION AT TOP ELEVATION OF INVERT = 93.95 ANCHORAGE TANK 1,500 GALLON S.T.E.P. TANK (RATED FOR 10 FOOT BURIAL AND EPDXY COATED) PASSIVE AIR VENT (TYP) ELEVATION AT TOP OF POD = 99.2-99.3 ANCHORAGE TANK & WELDING DISCHARGE PUMP BASIN WITH ORENCO COMPONENTS - TO DRAINFIELD AX -20 POD WAS NOT PLACED DIRECTLY OVER TANK DUE TO THE PRESENCE OF SEASON GROUNDWATER ELEVATION AT INVERT OF INLET = 96.11 n ANCHORAGE TANK 1500 GALLON S.T.E.P. TANK (EPDXY COATED) ELEVATION AT BOTTOM OF PUMP VAULT = 91.42 - GARNESS ENGINEERING GROUP, Ltd ENGINEERING -,SALES CONSULTING!---_- -- 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 -PHONE (907) 337.6179 -FAX (907)338-3246 ' WEBSITE: vnrx.gamessengineering.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CORRINE FINNIE 907-350-2490 3 OF 4 LEGAL DESCRIPTION: DRAWN BY: SHENANDOAH HILLS; LOT 9 D.J.G. TYPE OF WORK: DATE: � SEPTIC TANK PROFILE 1 7/30/2019 .♦♦e��®eee� ♦♦�� OF v,01 s ; ;..J...,�...., 0 . effI r�y A. mess 411 i �. V C -7953 = o 1 �r 411, LICENSE'��11�;`S`S� •®® #AECC884 / r- 0 m > m r- ;u om0l m 0 CQ Co mX z _0 > 0 < m z Z z m 0 > > V) z > LA F kA m C: M 1> r) 0 0 (D rD 0 < _0 (D M 1�j (D (-n 0) r- 00 41 a) Cl) �j ID I(D ('D - 00 (-n cu m C2 ID ti > Z cn 00ET z > -3 j X" z 0 > Un =O OC], PIvin C> Ln nm'vODA^'2: D n;a ;o m 0 > > >C 0 < r) m m z z > > z > r) Z Co 0 z Co :5 > 02! - Z ' 0 , o z :Ej to > -,I V) o Ul z n Ln �o - Cz z m mZT 0 in OO G1Z A v > Z > -4- - 0,0 -TI + 0, - z - fn n 0 2 � 0 ;a �7 m z A :,j z <0 � - 0 > m, Z 00 0 .0, Zo C) ;U g I , 0 z m om 0> > W Z7 Ul c --I m 0 N >, 2 --A 2 - ;mo 7 r) > �z -, �0- rl� 6-cr) n 0 vmi=m o m< 0= --j x :5 ,< K;o W CY) o SN m< -0 � so 0 0 z z Z> 0 n _.I m 0 r- 0 ELMORE ROAD ANN= NEW— w w Ln Ln NOOO 03'30"W 292.25' X x x x x x -x --x --x Z Ln o 0 O m Z mtQ 00 00 m m Ln L/I r- m C -V x U) --j D-DiZ c -m 60 m x > m r - Lf) r- 0 r=1 M ;o M Ln z :F- > ;a 00 V) m M,- z 00 < G) o -i Z C) 0- mm m ;v r) co > > 0 m Ln C Z > 0 z m z m 0 m 0 K 0 r) V) m ul 00 z mr) -n -V > 0 F i;� -n o 0 K 1 Cri Ln z 0 24.2' DU -n OD m 0 M o z C 0 O U) ni-n m r- 50' 0 r- > < N) 4��/sLA 7y/v U) > 0000 XNor- , Z o --j us" -11E� m --A 110.4' 46.3' r) o X X . . . . . . . . . . . oQ6a�� : �ST��4 PO Ul dam M F- r<n Qo v (D NOT 02'00"E 193.50' > . 1 R=180.00' L:=44.04 Q�44GP�e z 4= w C) w C? — — .--- — m SHENADDOAH ROAA, MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://w,vw.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191180 Work Type: Septic Upgrade Tax Code Number: 01521246000 Site Legal Address: SHENANDOAH HILLS LT 9 G:2736 Site Mailing Address: 12130 SHENANDOAH RD, Anchorage Owner: POTPOURRI TRUST Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: RI Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: t t cod 17 . tso it 71z 77- 7h moo, Department 6/3/2019 6/2/2020 57192 ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: On the record drawing, show the location of the waterline that serves the shed. If it does not meet the required separations, the line is to be removed. Received Issued By: Date: /r Date: 4 EPft7 MUNICIPALITY OF ANCHORAGE Community Development Department \ - Phone: 907-343-7904 Development Services \ Fax: 907- 343-7997 On-Site Water& Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-212-46 Property owner(s) CORRINE FINNIE Day phone 907-350-2490 Mailing address 12130 SHENANDOAH ROAD*ANCHORAGE,AK 99516 Site address 12130 SHENANDOAH ROAD"ANCHORAGE,AK 99516 Legal description (Sub'd, Block& Lot) SHENANDOAH HILLS: LOT 9 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family(SF) Absorption Field ® (w/wo ADU) Septic Tank ® Upgrade Duplex(D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: N/A Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 546 Waiver Fees: Date of Payment: /(5-1/91 1 Date of Payment: Receipt Number: Q 056-46 Receipt Number: Permit No. QJP`/of/90 Waiver No. (Rev.01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Page 2 of 2 above existing grade. We are proposing to utilize the 1 feet of sand between 1-2 feet below grade as a path for horizontal conveyance. This means the "effective area" would be the perimeter of the bed times 1 foot of receiving soils (40 + 40 + 20 + 20 = 120 feet). In addition, we are proposing to utilize CAT III application rate due to the fact that the CAT II effluent will pass through at least 2.5 feet of MOA filter sand before it reaches the "zone" of horizontal conveyance. It is reasonable to believe that the CAT 11 BOD/TSS levels will be reduced to CAT III levels (non-biomat forming) by the time it passes through 2' of MOA sand. 6. DISCCUSION REGARDING LIMITED DESIGN OPTIONS: Due to challenging soil/groundwater conditions, the proposed system is one of the few wastewater treatment/disposal options for this property. The only other viable options appear to be a "holding tank" (which is the current practice), or a surface discharge system. If the proposed drainfield were to fail to perform adequately due to rising groundwater or other unforeseen circumstances, it may be necessary to resort back to using a holding tank or consider tertiary treatment and surface discharge. The ability to implement surface discharge is uncertain at this time. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. ce Jefffe�!,EGarnes's, P.E., M.S. Pre;Aelnt `---/ 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191180, Deb Wockenfuss, 06/03/19 -' _ MUNICIPALITY OF ANCHORAGE D~ITMENT OF HEALTH AND HUMAN SER~, ~S E~iRONME~AL PROTE~ION -'~ Environmental Health Division ~' ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ~;~ N 1 9 1987 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INspEcTION REPORT Name DISTA J V ~/' ~' ~ ~ +~ ~ ~ ~ ?n SEPTIC ABSORPTION Ae.,es~FROM~" TANK FIELD WELL Phone(s, IPerm.t.o. J.oj~om~ WELL LOt J Subdlws~on Township, Range, ~bon AS-BUILT DIAGRAM IShow Iocabon ct well, sepbc system, prope~y hnes, loundahon, ~ ~ ( ~ ~ ~ / ~ ~ ~ driveway, waler bodies, etc.) TANKS ~ SEPTIC ~OLDING Manufacturer Capacity in gallons Material No. of Compa~ments TYPE OF SYSTEM TRENCH g ~E= a W..RA~N gOTHER /%' J Depth to p,pe bottom from Total depth from original grade original grade FT FT hll added above original grade Gravel oepth beneath p~pe FT FT Gravel length Gravel w~dth FT FT Total absorption area D~stance ~tween hnes SO FT FT o Number ol hnes ~ Sotl rahng P~pe mater~al I SQ FT Installer Date Installed WELLS ~ PRIVATE ~ OTHER {Identify1 Class~hcabon (A,B.C) ]oral Depth ~ Cased to Inslalle~ Date InstalleO: REMARKS: ':'~ ~, ENGINEER'S SEAL I _ ~ ' cedily that Ibis inspe~ion was pedormed according t0 all u~elines in effect on this date: ~ ~ j -- ~ ' . Health Depadment Approval: ~ _ _ Date: 72-013 (3/85) PERMIT NO: DATE ISSUED: APF'L I CANT: ADDRESS: CON'FACT PHONE: ['-'lltJ I'.! :[ C I~AL I TY OF ANC~RAGE DEPARTMENT i HEALTN AND ENV I RONMENTAL~ ROTECT I ON 825 L STREET, ANCHORAGE., AK 99501 264-4720 OI',1-S I TE SEWEF~ F'ERM I T 86¢)282 HOLDING TANI< 08/1.5./86 H.P. CHRISTENSEN P.O. BOX 1'1'1443 ANCHORAGE, AK 99511 345-5066 LEGAL DESCRIP: LOT SIZE: SUBDIVISION: SHENANDOAH HILLS SECTION: 22 TOWNSHIP: 12N 1.3A (SQ. FT. OR ACRES) LOT:. 9 RANGE: 3W BLOCK: N/A I certify thai.: . 1. I am ~amiliar with the requirements £or on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State or Alask. a. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria or this permit. 3. I will adhere to all MOA and State o~ Alaska requirements £or the set back distances ~rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS. INSTALLED IN AN AREA COVERED BY MOA BUILDING .CGDES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; .(2) AS-BUILTS WILL NOT BE AF'F'ROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED.ELECTRICIAN. S I GNED DATE APF'L I CANT: H,, P. CI-IR I S:I"ENSEN / ISSUED BY, , ' DATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~"'~1LS LOG · [~ERCOLATION TEST "ERFORMED FOR:C' I~~[~. tAohle~ LEOAL DESCR,PT, O.: St'~. ~ 1 2 3 4 5 6 7 8 9 SLOPE ~ )I_ I ¢U WAS GROUNDWATER l~IO S L 11 ENCOUNTERED? _ O P 12 E IF YES, AT WHAT DEPTH? 13 - Gross Net Depth to Net Reading Date Time Time Water Drop 1:3c~ 14 15 16 17 18 19. 2O PERCOLATION RATE ' (minutes/inch) c/ , ti,<-- . TEST RUN BE]WEEN , {. FT~A.~Nq p ! FT - 72-008 [6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~720 SOILS LOG -- PERCOLATION TEST [~'~OI LS LOG [] PERCOLATION TEST I GA, 1 2 3 4 5 6 7 8 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 19 20 COMMENTS WAS GROUND WATER HO [ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch} FT AND . FT DATE: 72-008 {6/79) .... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~SOI LS LOG r'l PERCOLATION TEST · EOAL DESCR,PT,ON; 3 N~ 4OO-V~ I~; It:~ 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop COMMENTS 72-008 (6/79) PERCOLATION RATE ' · (minutes/inch) TEST RUN BETWEEN FT AND ~ FT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~1720 SOILS LOG - PERCOLATION TEST SOl LS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESC.,PT, O.: '-~k~ a ~ct~.k FEET) 3 5 6 8 10- WAS 1 1 - ENC( 12 IF YI DEP~ 'H? 13 R 15 PER SLOPE SITE PLAN )UND WATER ITERED? 14 :, AT WHAT r~../"-,:~ / uo~Il S CERTIFIED BY:~ CO LATION RATE TEST RUN BETWEEN FT AND FT DATE: {minutes/inch) COMMENTS PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net .. Reading Date Time Time Water Drop ' ;. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 20 COMMENTS PERFORMED BY: 72-008 (6/79) DATE PERFORMED: ~,~'- I-6~q q "-/-/4 ~ SITE PLAN SLOPE WAS GROUND WATER S ENCOUNTERED? '~--;~l 0L P IF YES. AT WHAT ~'~/('"'~'i~,) ~ E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch) FT A.~ - FI L MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE DATE PERFORMED: SITE PLAN 10 11 12 13 14 15 16 17 18 20 WAS GROUND WATER S ENCOUNTERED? ~.~ ..0.,~ ~ P IF YES. AT WHAT ,.~.,...~__~ ,/,~ E DEPTH? Gross Net Depth to Net Reading Date Time Time ' Water Drop PERCOLATION RATE (minutes/inch) COMMENTS 72-008 (6/79) TEST RUN BETWEEN riot0 CERTIFIED BY: FT AND FT HOME SERVICES 15900 Francesca Drive Anchorage, Alaska 99516 907-345q890 ..Hal & Claudia Christcnsen P. O." Bo:: 111443 "':' ~' ' ' ' Anchorage, Alaska 99511 Date 12130 Shenandoah Lot 9 Blk. Shenandoah Hills I, ~l~,,a~o/~l rh~i~o.~o, agree to have A+ HOME SERVICES pump my holding tank(s) on an as needed basis or on a date specified by me for a period of one year. Total volume of tank(s) z aaa~¢1]nn~ Pri=e per pumping, S50 Der 2, 000 ~all0n 10xd. Hal/Claudia Christensen J~mes R. Wingerd '/ .. A+ HoME SERVICES * Price reflects pumping during normal business hours. A+ HOME SERVICES reserves the right to increase their rates in accordance ~ith any rate increase incurred from the Municipality or any other agency. DEPI. ENVI~ONM"~',II ,% P~OTECTION FEB 2 9B7 RECEIVED ' : "!i. · · I~ISPECT ..... "lNG SAFETY OlVlSIO N ' I r' ' TY oF ANCHORAGE' ~U~'~ ,. ' MUNICIPAL! 350o EAST TUDOR ROAD~i)i~iNiSTRATiON (9O7) -/86-8301 ~,,:PLBG:UNDGR'~ ~ ~ ELEC, TEMP' ~ ~ ;'~.~:'PLBG. ROUGH ~ ~ ELEC. SERVICE ~ O::':' GAS TEMP. ~ ~ ELEC. ROUGH ~ ~".G~S ~ FOOTING .~ FOUNDATION ---'-- BOND BEAM --------- FRAMING '------"'--' iNSULATION -----'""-- SHEETROC, K -----'"'-' NAL ~ NO~COMPLIANCE OBSERVED ELEC. FINAL ~ E ~ ~EC.AN,CAL------ ~~O PLBG. FINAL ~ O FIRE FINAL ~ ~ OTHER ZONING ~ . · ~ ~ORRECTIONS ESSENTIAL AS '- '~ .: EXPLAINED BELOW .,, . , ,?.:: .. ~ .... I";:: .... EcT,oNs ARE UADE. p~.EASE C~. ,NSPECT,ON _.._____--- WHEN GUt'ir~= ....... DO HOT REMOVE THIS NOTICE 84-002 {Rev 101861 1 6 ? 8 9 10 11 12 13 14 15 16 ! 17 ALASKA 8 LIII OFIm( rlTAL COrlTI OL Il'lC. I~cji~eeri~q $ i~ui~o~m¢~tal StudJes John W. Colver, Esq. 427 E. Street, Suite 500 Anchorage, Alaska 99501 July 9, 1985 M'JI' "C?'~tltY OF ANCHORAC~E DE;"[. OF I'tEALTH & ENVI~C ' ", ":"qTAI. PROTECTIOJ~ AUG . 8 ig88 [' £CEIVED Dear Mr. Colver: I have reviewed the three legal documents that you left. me last week. The first being the Affidavit of Charles E. Jackson, the second'being the Opposition to Motion for Summary Judgment, and third being the Errata Sheet. Here are my observations: 1. The curtain drain was installed in the summer of 1974. It encompasses the foundation and the sewer system. It has removed the water from the basement area and since it is upstream of the seepage trench, external water is cut off from the field. If water were the only problem then the system would now properly function. However, the system is still not functioning. This indicates that the soils in which the system is installed is tighter than that indicated on the soils test and on the inspection report. 2. On June 27, 1984 when making an inspection of the construction of the curtain drain, I had the excavator dig a test hole between the system [9~ the location.~f the curtain drain. 3. During an inspection of the b~ilding, I noted that water was pouring under the footer in the vicinity of the stairs· The stairs are located adjacent to the garage which WOuld be the northeast corner of the living quarters. The pipe from the well is located in the southeast corner of the building. Where that pipe came out of the ground no flowing water was evident. ', · [,,As -of. th~s date ~nonb'.of 'the" four~ soils tests" generally a gray silt. Past experience ~"~h'6~'~-~h'~'S*~' soils to be ,~[ly impermeable. Unless a suitable site can be located, kank ~s ,the-:,only,.recourse left;:for"a 'sewer:'svstemf Genera1%'~'this depreciates the value of the house. ~e sozls logs are enclosed. If I can be of any further help please let me know. Sincerely, ~ero ~id Jr'., ~D, Preslde~ PE 1200 J. JUesl 33r(J Aucnue. Suite B* AncJ~orag¢. Alaska 99503,,(907) 561-5040 CONTROL SERVICF,.S. INC. 1200 West 33rd AvenL~' 'Suite B ANCHORAGE. ALASK,. ~/9503 Phone 276-1361 SHEET NO. CALCULATED BY CHECKED BY SCALE ,/b ~' J OF DATE DATE Z 6//z //. ~EFmmY~.~\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I .............. ENVIRONMENTAL ENGINEERING DIVISION ~ / ~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 i~ SE_WA, GE DISPOSAL SY TEM AND/OR WELL INSPECTION REPORT r MAILiNGAD~RES~ '~"~ ~.M ~ ---- D,STANCE TO; t Manufacturer ) Materia~ IF HOMEMADE: length depth DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer No. of lines I~nqth ~s -- ~ inches ~ eathtile ~ inches ~~s~pti~area  ~HMIT NO. ~ effective absorption area Type of crib Crib diameter Crib depth DISTANCE TO: Well Building foundation y in gallons 3th Driller Building foundation Sewer line DISTANCE TO: OTHER SOIL TEST RATING R EM~'KS ' --' Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area (s) DATE LEGAL 72-013(Im'rb"~. 3/78) -- PERMIT NCo APPLICANT CHARLES E. JACKSON LOCATION SHENANDOAH PLACE LEGAL : ............................. MUN ! C IhAL I TV OF Af4CF~ '.,i., RAGE /;~ .... · DEPARTMENT,.L,~' HEALTH AND ENVIRONMENTAL · 825 L STREET'"ANOHORAGE, AK. ''50i 264-4728 · NELL Rf4D 0~4--S ITE SEWER PERM BOX 10-&06 ~. 51~0 ~44-04~1 LOT SIZE 4~ SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING THE REQUIRED size OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= :[~_ LENGTH= GRA~/EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> Of THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. THERE IS NO SET I,~IDTH FOR TRENCHES. THEiGRAVEL DEPTH IS THE MINIMUM'DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND!THE BOTTOM OF THE EXCAVATION (IN fEET>.' REQUIRED SEPTIC TANK SIZE= ' ~_800 GALLONS PERMITjAPPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMEN~'bURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER iOF RESIDENCES THAT THE WELL WILL SERVE. TPIO ( 2 ~ INSPECT IONS ARE REQU I RED BACKFILLING Of ANY SYSTEM WITHOUT FINRL"INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT. TO PROSECUTION. ',. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS " i00 FEET FOR A PRIVATE WELL Or i50"tO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC'iWELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE IqELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND' CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES DECEMBER ;1, 1988 i I CERTIFY THAT · l: I AM~ FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2' I WILL INSTALL' THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTA~ THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE ~PPLICRNT ~S E. ,.// .Tes~ Hole #1, lA Table A WO #A19110~ Date: 10/22/79 Logged by: J. Finley Depth in Feet From To 0.0 2.0 2.0 16.0 Soil Description Dark brown Peat and Organic Silt, wet, soft, Pt F-4, grayish brown Sandy Silt with gravel and occasional cobbles, moist, dense, non-plastic, saturated at 15' ML Bottom of Test Hole: Frost Line: Free Water Level: 16.0 Feet None Observed 15.0 Feet While Drillinq Minimum Percolation Rate = 20 minutes/inch with water level at 40" Sample Depth Unified Number (feet) Classification 1 5 ML 2 10 MI, 3 16 MI, Remarks: 1. ® Samples obtained from cuttings brought to surface by solid flight auger. General Information, see Sheet 1. Frost and Textural Classification, see Sheet 2. Unified Classification, see Sheet 3. V/ATEN ;';ELL LOC- FOSS DRILLING ASSOCIATED 909 CHUGACH DR. #3? ANCHORAGE, ALASKA 99503 WELL OWNER ChArles Jackson USE OF WELL Domestic WELL LOCATION Lot ~. Shenandoah Hills Subdivision SIZE OF CASING 6" STATIC WATER LEVEL REMARKS DEPTH OF HOLE 65 FT. 4-5 FT. G. P.' M.. 7 CASED TO 65 FT. WITH 58 FT. OF DRAWDOWN. DATE COMPLETED 4/15/80 PUMP TO BE SET AT 64' Oto5 Organic: brown color and soft _~to 35 Alluvium: brown color, medium hardness; with water 35 to 45 Alluvium: grey color, medium hardness 4~ to 55, Sand and Silt: grey and soft; with water ~5to60 Alluvium: grey color, soft: %:,ith water 60 to 65 Sand and Gravel: grey; with water tO ___to__ to to to to to to to to to to to ' •Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 S a E T Y Parcel I . D.015-212-46 Certificate of On -Site Systems Approval Expiration Date: -3 t 17 1. GENERAL INFORMATION: Complete legal description Shenandoah Hills: Lot 9 Location (site address) 12130 Shenandoah Road *Anchorage, AK 99516 Current Property owner(s) Corrine Finnie Day phone 907-350-2490 Mailing address Real Estate Agent Kevin Elfrink Day phone 907-727-2150 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ t1 t/ Date of Payment 7- 3) Receipt Number V 13 5 17 COSA# QS L I t��� Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 31 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms �Qp�ITYIp���/�/ System #2 Approved for bedrooms ',/��i� Disapproved 0 -SST y0 ^l Conditional approval for bedrooms, with the following stip tda ' ns- 87g FRA Q pR ��''� TER z, �C.b Original Certificate Date: '�S l l 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other r Legal Description: SHENANDOAH HILLS; LOT 9 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/15/80 Total depth 65 ft Cased to 65 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/22/19 Parcel ID: 015-212-46 Structure served by this system Well production at time of test **9.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 2.7 mg/L ❑ Nitrate less than MRL (ND) . -- Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 4/22/19 Static water level at beginning of test *UNK ft Comments *ARTESIAN WELL - HAS PLUG **PUMPED 1566 GALLONS IN 150 MINUTES B. TANK DATA Age of tank(s) NEW years Tank type/material sEP...... E Measured operating fluid level in septic tank - ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA ADVANTEX SYSTEM Which system tested:(date installed) NEW ❑ ALL standpipes present per record drawing Total measured depth from grade * ft (max) Measured depth to pipe invert from grade * ft (min) ❑ N/A — pressurized field F0 Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: 'SEE ATTACHED INSPECTION REPORT COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material PVC Comments: N/A Adequacy test date - Results ❑ Pass For 4 bedrooms Fluid depth prior to test - in Water added - gal New depth - in Elapsed time - min Final fluid depth - in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date - E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100''Community Sewer Manhole/Cleanout > 100' F1 Yes if No *50 + ft M Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' EZI Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50'✓❑ Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) t7'*50 Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' El Yes if No + ft w Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑ Yes if No *50 + ft Water Main > 10' 7/1 Yes if No ft Community Wells > 200' ✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' MV Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft I{, Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft I� Surface Water > 100' ❑ Yes if No *50'+ ft F. ENGINEER'S COMMENTS *CAT III ADVANCED WASTEWATER TREATMENT G. ENGINEER'S CERTIFICATION 0000bo�� 1 certify that / 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. .. . . COSA Checklist yellow sheet V, —1'V . QO .J ff e A. arne S: QO9. '• E-79 •3 � rofes o� o #AECC884 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM. MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this, ' -' Day of �j _ of 20_./2 , by and between JA W{ sy / " , herein the "OWNER.," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 1` A,,j,5x/1Ac located at (legal description) < �� �. 141AS Ll 2. Maintenance. Repairs and Alterations. ( ner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all ( repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This I includes an annual maintenance fee (typically $400 to S600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 o£3 r Owner acknowledges that the Municipality may request records of maintenance and (repairs from the manufacturer's representative or maintenance provider. 1 / Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be in accordance with AMC 14.60.030. �Wssessed wner agrees to grant the Municipality reasonable access to test and inspect the WWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new certificate of On -Site Systems Approval. wner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing uidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of AIaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: B! ? " (signature) Date: (print name) STATE OF ALASKA ) } ss. T1-11RD JUDICIAL DISTRICT ) The foregoi inshliment was acknowledged before me this 51 day of 20 �I, b Public PERRIER AR Alaska My Commission expires: ob . i gZ0ZF7f mmission Expires Feb. f8, 2020 MUNICIPALITY: By: t (signature) (print name) Date: V-7 � i ,; Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section - ' ' P.O. BOx 196650 Anchorage,'Ala'ska 99519-6650 -- 343-4744 , - CERTIFICATE OF HEAL'i'H AUTHORITY ..' ,i " APPROVAL FOR A SINGLE FAMILY DWELLING Par~ell.g.~ .'015~212-46 ~ .-:.-::.~"' ','. ;., ,.:.,. :..,HA~t.::~ 97.';0124.. ....... 1. -' GENERAL INFORMATION ' ' ~:::' ' '~ ............ ' ........ Complete legal description Location (site address or directions) .,f,~.' ,,' -: ... :-,;, 12130'Shenandoah Road Anchoraqe, AK 99516 345-0046 ~ P. roi~erty owner"' Terri Bram!ett Day phone ;. -.~. , . :~ . ~'~ .... Mailing ~dd~:e~$. '12130 Shenandoah Road Anchorage, AK 99516 ;:.,~,'ii Lending ag?cy ..... ,'.,' Day phone ',. 'Mailing a'ddress "~e. nt Tim Wor~hon - Crawford/Century 21 Day phone Address 337-7258 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4- 3.- - TYPE OF WATER SUPPLY: ........ Individual well y, xx · . Community well ....... Public.water ..... ' . .... .: ,.'.: .,.::.,, i"" ' ~.. · NOTE: · If community well system, Provide written Confirmation from State ADEC attest-'~ ' . : . .:.~ ,: .., ". ing to the legality and ~tatus of System .... : :. ~ .: '. :' DispOs 4. ~ ,TYPE OF.wAsTEWATER AL: , , · '~- . .;.', .%... .--.. · ;-,-: .: ...... . .... , -. .: In'div uhl on-site '.., ..... - ..~::. ..: '" : Hodngtank: .,.~ xxx ".' ' '"" · :. ':"' ":' :': ;": i" :"' :'!'-' :! ' · . Community on-site .' -.- .... .~- : : "· ...... - . · , ... ,.' ~ . ·, . .... ~ . ~ · , ...; :'. ,', , -. : Public ........' " .... ' ' ~'" : ' . sewer; .. : :. ;... . .. ,... . .. .... : "NOTE:' :If commUnity te sYS!em,'Pro ide writ ion from s e ADEc ' '.:'.. Wastewa r v ten confirmat tat .: ...... .. , , ! ; ;~;'''~: . ;; ~ , ' · , ; ..,. · ~ .. g litya Ystern 'tO the lea nd StatuS of s ~:i': .! ::. ! :F,:~ ~..:.t' ,~-, :,~ :.. ' ' 'attesting .' 72-025(Rev. 1/91) Front MOAII21 '-.' . .i' '. : 5. STATEMENTi, OF INSPECTION BY'ENGINEER.' , "*;~';*~ ; . ~ :.~ .i'.;.:;}~.ix." - As certified by my seal affixed hereto and as of the validation date shown below, I verify that my * investigation Of this Health Author;ity Appr0va!applicat!on shows that the on-site water supply and/or Wastewater disposal system is safel functional ai~id.'adequa~'i°!ithe number of bedrOoms and type of structure indicated herein. I further verify that based on the information obtained from ..... the Municipality of. Ancho_rage files and from my .invesfig~ionand'inspection, the on-site water ' ':' ;' .supply'and~0i'~a~e~v~'e~;:~i~)~s~i~t~'i~: - · . $ &SENGINEERING ' ' .... ~ ' '--W - ·Name of Firm 6, . DHHS SIGNATURE {~ . Approved for ~'~t?,-/L~i bedrooms. Disapproved. Conditional approval for bedrooms, wi{h the:following stipulations: ; ~ .Additional Comments .., ,. . .. '_,.,.,:.*.;%... .... . .... ,.,?~.-. *. . .; ..L~' , '.~';~ .;..: .,' .; .... -~. ,..~..~..~ ;. . .:'C ' · The Municipality of ~n.ch0rage Department Of .Health and Human ~r~i~e~'"iDHHs) iSSues· H~alth Authority' . ·Approval Certificates ibased only upon the representations given in paragraph 5 a,bove by an independent ' pr0fe~ion~l ~n~in~e~ r~ist~'re~! in {h~ sta~e ~)}',kiA~k-A:'~-·~'e DHHs d(~es this as ~,:c(~u ~e~y;t(~ Purchasers of homes ' ~' and..t.~,ei .r le:nding i,n~i~uti0.n,~ in 9[ er to, satis, fy?ert, ai,,n~ f.ed. ~! ~nd ~tate req uireme.n,,.ts: E.m. ployees of DHH,S do not. - -.conduct inspections or.analyze data before a certificate is issued..The Municipality of Anchorage is not '/~s':ls0n~sii~ie·'f61; ~;~;~)'r~ Or ~mjSSi0~s in'the p~;~3f~i~i'eh'gi~r~ W;or{<. ~" · ' ' * "*mr';'' ' ...... I~.,~lCIPALIPI OF ANCHOi~GE : : -. ~ "~ ~NVIRON~ENTAL ~ERVICES I : ' ' DIVISION i, Municipality of Anchorage PR 09 1997 i DEPARTMENT OF HEALTH & HUMAN SERVIGES. ~"~ ' '! : ': 'i E~ir°nmentarserVices Division :JJ~ ~'~:~ ! t/r' ~, ~ 825 L Street Roo .... :.' ' ' ' ~'' ?%""'' ::' i , ,". ' m.: 5q2~ Anchorage,., Alaska,,. 99501° (.,907)_; 343.417~4E .... U ii : ':' Health AU'h°rity'ApptOval Checklist ~J'J'Jl ' . : ','~ ~ : '; ' · i ''J! I ' ' Legal .... . o~ . ' ' .a.~=, ,.~,: ,i ~ - --'..- - - . A. WELL DATA Well t:CPe ' _ 'Log pr,esent (~N)~; YE .~ .: Total de.' pth Sanita .ry seal ¥ Date of test Static water level Well production WATER SAMPLE RESULTS: ',Nitrate Coliform :O 0 .... ~' /,4 / .'~/~ , : - .. uate o~ sample' ~: --' ~ - · ~. ~. .: ~nlln~.t~_d h~. ..~..., ~ I ~' ~ ' ;~ · _. ' : : ,, - : ....... ..~- ,.. . ,; '~ ' ~ ' fl' . ' ' - ' ' ' ;- ' ,. Ea leR~ver ~laska 9957 '" IH ~ ..... , .... g , 7, . I' B. SEPTIC HOLDING~ANK DATA , ~;' Date~nst~lled~,~I'1 ~ ~:'' .Tanksize' .~¢¢o ~NumberofCompa~ments ', ' ' ~% ' . ~' Foundatmncleanout ~), .Y[~ ;,.'.,,Dent' 'f ~: ( . · · ,, ..ess~o!~/~'~wo.. ,,,~.,..~ ~.,,,~,¢,~ - ;. Dateo[Pumplng:~-31~;~7 :. Pumper'S' .t ~ ~ ~]¢,~v, ce~ . ; ..... ~ ~ 'r ~"~' "'' ', .',' " ' ' : '' : ' ~ ~J~ ~C. ABSORPTION,FIELD DATA :"',. :; bridle , i: ~. Dale~nstalled~~ .... ~ Soil~atn~'t-'-~/~or'fl~d~ ~ " * / ~'~' ' m). . . se n~pe · ,~, Date°fadeq~'a'[V;t~si'' ;.~ ~ ' ~1:, ' ' ~ j~ ~,; bedrOOms Fluid depth in abso!l~tior~ field Fluid de tre~ 1'2 months), (y/N) 72'0~ (Rev. *;' ' 3~96) yafter~.: :g rate = Yes'~, give date at~r added :(in.): ' - g.p,d, LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level~ E. SEPARATION DISTANCES Size in gallons_~  off" level at* "Pump *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank on lot l § o -~- Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout ! I o 0 -/' Lift station SEPARATION DISTANCES FROM SEPTICS, LDIN~T'ANK ON LOTTO: Absorption field Wells on adjacent lots /"/4 ! Foundation ) 5- -'J- Property line I Water main/service line 3 o/-/- Surface water/drainage /o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I 1oo q' ! I0O -!- Property line Surface water . Building foundation _._-.-Water,lain/service line / Driveway. parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION ,cedi ,hat lhave determined thru field inspections and review of Municipal record_~3e~.~.o...~.~l~n~ s are fY ...... ~"/,, ~...."- .. in conformance with MOA HA~A guidelines in effect on this date. j c~-..-- /~ '"....~-~. Si nature Engineer s Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 1. GENERAL INFORMATION Complete legal description MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DivisiOn of Environmental services ~ ~' on-site ser~,iCes section'~ ~ P.O. Box 196650 Anchorag~. A~laska' '99519-6650 " ' ;343'-4744 CERTIFICATE *OF HEALTH AUTHORITY ~APPROVAL FOR A SINGLE FAMILY DWELLING i :':. !' ;I ~,' HAA # ~q Lot 9, Shenandoah tlills Subdivision Loca'{i~n..(sJte add~'eSs 6r directions) 12130 shenandoah Road, Anchorage, Alaska Property owner Mailin~l addres§ Lending agency Mailing address Agent Address 'Virginia.Mann-Marston Day phone 2816 Sterns Road.. Brandon: FI~ 33594 Commonwealth Mortgage Co. Day phone 753-3586 Unknown Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NO:rE: Individual well x Community well ~-. Public water if Cor~munity 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 NOTE: Public sewer . If community wastew~ter system, prov~ide written confirmation frorn"state ADEC attesting to the legality and status of system. 72-025 (Rev. 119t) Front MOA #21 · , ,,~ ;, · , ..:,~ ~ .... SlUOWwoo I~upIIIPPV -..:suollelnd]ls ' 13UIMOlIOI' eH1 :qI!M--'SLUOOJpeq ...... "JOJ~ I~)~oJdde~ 18UOlllpuoo ,-, -., 'swooJpoq ,.: ; ,,'.: eleCl ' '9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVALCHECKLIST *LegaI DeSc~;ipti0'n: LOt 9,' Shenandoah Hills Subd ' A. WELL DATA Well type Residential If A, B, or C, attach ADEC letter~ Log present (Y/N), 65' Total depth sanitary seal (y/N) Parcel'l.D. Plat #77-187 ' Yes ' ADEC water system number : ~,. .N/A Date completed 4/15/80 .Driller Fos'~' Drillin Assoc. Cas!rig height Wires properly protected (Y/N) '/es Date of test Static water level ,FROM WELL LOG AT INSPECTION .... 4/15/80 - '23 May 91 ":. ' ~": ·Artesian ' 4.5' Well flow 7 '; g;p.m. 7,48 64' · ,- '64', Pump level SEPARATION DISTANCES FROM wELL TO: SeptiC/holding tank on let 130' Absorption field on lot N/^ Public sewer main N/A z_U o~ ~. Public sewer service line ' ~N/A. ;On adjacent lots 260' South/ i On adjacent lots · N/A 'Public sewer manhoie/cleanout N/A 300' North Petroleum tank N/A WATER sAMPLE RESULTS: Coli~orm Nitrate Date of sample: Collected by: Other bacteria SEPTIC/HOLDING TANK DATA Date installed 8/.1/86 .- ..,... ,Tank size /4'000gJl' CleanoutsJv'~''{,.,,,,, "' ..... . · ,,=. s -.-£L.-Foundation cleanout (Y/N) '/es High watbr a{arm (Y/N) !; ~ Y~s" '~"~' ' Alarm tested (Y/N) Date of',p.u.m.p, ing ..,; 51719 .:, ,.. · SEPAR~,;i"I'~i~I DIST~NC'~S FROM SEPTIC/HOLDING TANK TO: Well(s) on lot. '130'" ~.; ~" ~; Onadjacentlots260's/~00'N To property line "80 ~..' ~ ' ^bsorption field Surface water/drainage 146 ' Compartmen,ts Depression (Y/N) Yes ,'i; No Foundation 25' 'Watermain/serviCe line' N/A *. coNTINUED ON BACK PAGE 72-0.26 (Rev. 3/91) Front MOA 21 ' LIFT STATION Date installed , ,~." ~NOT APPLICABLE Manufacturer Manhole/Access (Y/N) Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes(Y/N)' ,' "Pump off" level at. Cycles tested .... " :i . ~.: ' SEPARATI0'I~I"DjST/~NCE FROM LIFT STATION TO: , ~ . I;~::'., '~ ' '' ' '',' "' '" .... ~: .,' '. i' Well on lot On adjacent lots Surface water · ',; i'.'; i !'..:!J:~i ....... · i .... System type Gravel thickness ........... Total depth Cleanouts present (Y/N) Date of adequacy test D. ABSORPTION FIELD DATA NOT APPLICABLE ~'Date installe~l (. ' .... ' ;Soil rating ~Total absorpiiOh area [Depression ~v~. field (Y/N) ~1~ (~ ~il) l~r If yes, give date Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: NOT APPLICABLE, ............ ~: '~ ~!i::,,'I-;~ ; ,' - .......... ....... Well on lot On adjacent lots Property line To building foundation To existing or abandoned system on lot On adjacent lots Cutbank Water main/service line Surface water Driveway, parking/vehicle storage area Curtain drain ......................... ;'. "~ i') ..,.,{:' :!, .: '~ ............... E. ENGINEER'S CERTIFICATION bedrooms .................. '.I. .' ....... : ',' : !~., '.- ~:~, Signature .~~/, Engineer's Name L.D. Randolph~ PoE. Date I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect~o~.o~t~.e~d~a~_oo.[ e. of this. inspection. "--~ OFAX~V'~:~ ';' '" .. ...................... ~ ', _. .:.. :.: .~.:: . ' ~.' ..~ -.....':. ~., ,, a,e o . men, "' Recei.~.umbe~. ~ ~ a-3-,? (~ ?~) Receipt Num~e~ - 72-026 (Rev. 3/91) Back MOA 21 LDR consulting services (907) ~488-3453 p. o. box 73576 fairbanks, alaska 99707 To: Municipality of Anchorage Dept. of Health & Human Services Anchorage, Alaska OctOber 5, 1991 Ref: Lot 9, Shenandoah Hills Subdivision Plat #77-187 RECEIVED Sub: Holding Tank Inspection OOT 8 1991 Att: R. Robinson ; .,.~., .,~f ^nchorage Health & Human Services Gentlemen: On October 5, 1991, the property noted above was visited and an inspection of the sewage holding tank high water alarm system was conducted by the undersigned. Witnessing the inspection were James Bratcher and David Marston. The system controller, light and klaxon are located in the garage of the house. Both the light and klaxon operated when the system was function checked in the "test" mode. The klaxon horn is very loud and can be heard throughout the household. The new occupant verified that the system operates properly, citing an instance When she heard the horn while showering. She further indicated that the alarm had operated on more than one occasion when the tank was nearly full. I am confident that the alarm system is installed and operating correctly, with no reason to believe otherwise, based upon personal inspection and discussion with the homeowner. NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 (907) 277-8378 · FAX 274-9645 David H. Marston 4720 Ham Lane Anchorage AK 99517 Attn: - Report Date: Date Arrived: Date Sampled: Time Sampled: Collected By: 08/29/91 08/27/91 08/26/91 1025 DHM Our Lab ~: Location/Project: Your~sample !ID: SamPle i~atrix, Comments: Al13412 12130 Shenandoah Water Flag Definitions U = Below Detection Limit DL Stated in ResUlt~ B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Method Parameter Date Units Result Flag Analyzed EPA 300.0 Nitrate-N mg/1 0.4 08/27/91 Reported By:'William E. Buchan Anchorage Operations Manager r CITY, STATE AND ZIP CODE DATE OF PLANIS We hereby submit specifications and estimates for: rnpn al · ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 (907) 563-3300 PHONE JOB NAME JOB LOCATION Page No. of Pages IJOB PHONE t~I~ ~rllllllfl~ hereby to furnish material and labor -- complete in accordance with above specifications, for the sum Payment to be made as follows: dollars ($ ). All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifica- tions involving extra costs will be executed only Upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen°s Compensation Insurance. Authori~ed~ %. ~'7~' I. ~ ~ S gnature N~. This proposal may be withdrawn by us if not accepted within days. ArtepIa.re o[ ropnsa! --The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: ' Signature Signature ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 (907) 563-3300 of Pages PROPOSAL SUBMITTED TO STREET PHONE JOB NAME CITY. STATE AND ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS ~ JOB PHONE We hereby submit specifications and estimates for: ......... .................................. We propose hereby to furnish material and labor --complete Payment to be made as follows: in accordance with above specifications, for the sum of: dollars ($ ). Allmaterialis guaranteed to be as specified. AII work to be completed in a workmanlike [ f.%~~.~3 manner according to standard practices. Any alteration or deviation from above specifica- Authorized ! tions involving extra costs will be executed only upon written orders, and will become an Signature ~_]C~'IC%.(1% ~ ~-,,.~,~_t' t ~ extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Arreplanre o~ ~roposal--The above prices, specifications and conditions are satisfactory and are hereby accepted· You are authorized to do the work as Specified. Payment will be made as outlined above. Date of Acceptance: Signature Signature n c pal ty AnchOr ¢ MEMORANDUM DATE: January 18, 1983 TO: Risk Management - Attention: Jill FROM: Environmental Health Division SUBJECT: Claudia Mobley Property - Lot 9 Shenandoah Hills Subdivision In reference to "Description and Manner of Occurence" I have noted 1 - 5 items and comments on each one. (1) This department does not have the responsibility of inspecting any .plumbing inside a dwelling. (2) This would have been inspected at time of installation and also a second time at the request of the lending agency. I feel it would be very unlikely that this would have been overlooked twice. Had the vent caps been installed, it would still not have alleviated the problem. (3) The sewage from the septic tank is probably backing up do to a high or fluctuating ground water table, which is an act of nature and this department has no control. The soils test submitted to us indicates no ground water to fifteen(15) feet. Th~ inspection report shows that the bottom of the seepage trench is eleven(il) feet which is four(4) feet above the water table and this four(4) foot separation between water table and trench depth is approved by ordinance from this department. (4) The 208 Hillside Wastewater Plan was not approved until May 18, 1982. The sewer system was installed prior to that date. (5) Enclosed'. you will find a copy of the inspection forms and approvals from this department, dated April 4, 1980 and July 7, 1980. I feel the Municipality of Anchorage is not responsible for this · claim. If there are any further questions, please call this office at 264-4720. Robert C. Pratt, R.S. Acting Program Supervisor RCP/ljw cc: to file enclosurers 91-010 (5/78) .an unsuitabl~'Site for a conventional on- site septic tank, a m~und-type system will be required at a cost of $20,000. The settling damage that has already occurred due to improper hook-ups of the plumbing and septic system, r~sulting in several feet of standing water in the crawl-space for a period of months, is estimated to amount'~ to $10,000. total $30,000 vii and VIII Description and Manner of occurrence The house was purchased new in July of 1980.. During the winter of 1981, we noticed an odor.~innthe-lst..flooDf the house:.and found the crawl-space to be wet, with some areas of standing water. We thought that the water was due to the extremely wet winter and that the odor was from stagnation. The house had very little use during the summer and fall as we were gone much of that time. The problem of water in the crawl-space% worsened and in,he fall of 1981 there was four feet of foul-smelling~ Wa-t~"ben'~ath'the house'.'Uw%~e had a sump pump installed. }~oticing that the pump ran almost continuously, we had the plumber check it. He found that the main pipe which drains sewage from the house into the septic system had not been capped off, and that although most of the solid waste was going into the septic tank, t~e waste water was being disposed of in the crawl-space. He capped off the pipe~At the same time we found that the sewage overElow pipe next to the house on the North side had ~been capped, so that spillage from it was also seeping into the crawl-space ~,~ow that these problems have been corrected, the water from the septic tank backs up into the garage. We have to ve the system pumped every few days. ' According to the Hillside :';astewater Management Plan of 1982, .the entire area of Shenandoah Hills is unsuitable for on-site sewer systems, yet it is not included in plans for public sewer installation. ?Ye hold the Municipality responsible for allowing building to be done in an area kno%a~ to have unsuitabl'e drainage and no access to public sewers~In addition, I have h~d Municipal Ombudsma~'s Investigator Kathy Foltz check into the final inspec..t, i0n of?the house. After a thorough check, she was unable to find one, leading me to'believe there was never one done. We request reimbursement for damages and i~medi~'te at%ention to correction of the problem, i.e., a mound-type system. " "~ .. : AGAINST: &IUNICIPAL USE ONLY Name Claud ia,~Hobley Home AclU;tess I Mailing Address 12160 .qhen&~d0ah Pl. PO BOx. 10-1443 nnctDra~,e 99511 Il. DATE, TIME, PLACE OF INJURY OR DAMAGE Date (Mo.,. Day, Year).~.'/A I Time~]~;AOrpm) I Place/LOcatiOn III.PROPERTY INVOLVED Description Lot 9 Shenandoah }{ills Subdivision I[ Vehicle (Year, Make, Model and License No.) ju~y or damage. ~ I, the undersigned, do hereby submit U~er . person or property. I do hereby ~ntend to hold PERSON OR PERSONS MAKING CLAIM IV. MUNICIPAL DEPARTMENT INVOLVED (II known) Department I Municipal Employee Ilealth Department, Zoning and Platting N/A I V. INJURED PERSON/PERSONS (Use attachment if additional space is necessary) 1) Name [';/A Age 2) Name Age Address Telephone Address Telephone Occupation Employed By Occupation Employed By Person's location when injured Person's location when injured Person's activity when injured Person's activity when injured How did injury occur? How did injury occur? VI. AMOUNT CLAIMED. (Please a~tacban ~stimate or itemization of the dama es claimed) 30,000 s VII. DESCRIPTION (Nature and extent of injury or damages. Please describe in detail.) see attached sheet , 2.. N[u cipality , :, DATE: I ' TO: FROM: Jill, Risk ~nagement o¥ SUBJECT: Request for additional information regarding: Employee or Incident Accident Date at_tacb~d cl ~im Our File No.. pendin,~ Vehicle No. Adverse Operator Location Claudia Mobley Lot 9, Shenandoah Hills Please furnish the following information to Risk Management so that we can give further consideration to this claim. PER ATTACHED WE NEED THE ITEMS MARKED BELOW. [] Workmen's Compensation Claim Form 07-6101 (Formerly ADL 07-210) [] Supervisor's Report I--I Request to Doctor [] Return to work notice [] Medical Authorization [] [] [] Exactly how many working days has this employee lost from work Auto Accident Report (completed by employee) Itemized repair cost Itemized repair estimate (vehicle damage) Complete copy of your file and/or all back material (All supporting documents) Other: PLEASE SF. ND ANY INFOI~i~TION ON THIS? If the information requested above has not been sent, please do so immediately. If you are unable to give information pertaining to this incident, please advise Risk Management at 264-4201. Please attach this request to your return correspondence. Thank you, Jill ' Risk Management Division Property & Facility Department g5-013 (10/82) 4040 '°B" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 October 25, 1979 W.O. #A19110 Grid #2736 Perry Eaton P.O, Box 10-1592 Anchorage, Alaska 99510 Subject-. Subsurface Investigation for Suitability of On-Site Sewer, Lot 9, Shenandoah Hills Dear Mr. Eaton: We hereby transmit the results of the.above.referenced investi- gation performed by Alaska Testlab on October 22 and 23, 1979. The scope of this project is the.investigation for suitability of an on-site sewergge system. Included in this transmittal are: Si'~e Plan' Test tIole Log Explanatory Information Figure' i' Table A' Sheets 1-3 The exploration was conducted using a continuous flight solid stem auger drill rig owned'and, operated, by Denali Drilling, Inc. The drilling was supervised, the.test hole' logged and percolation test performed by Mr. J..Finley, Alaska Testlab geotechnical engineer. Soils encountered consisted of approximately two feet of organics overlying sandy silt 'with gravel and occasional cobbles to 16 feet, the maximum boring depth. Ground water was encountered at 15 feet while drilling. Therefore, a second test boring was drilled near the first boring to perform the percola- tion test. This boring was drilled to a depth of 11 feet. ~'~en drilling was completed a 3/4 inch slOtted PVC pipe was inserted into the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to saturate. On returning the ne>;t day, the hole-was ~refilled with water, and the drop in water, level carefully monitored over the nexti60 minutes. This procedure is not a standardized percolation test, however, we understand the Mun~cipal~t~ of Anchorage, Department of Public Health and Environmental Pretection, ~refers tests performed in this manner to evaluate a site for proposed on=site sewage system. .Perry Eaton October 25, 1979 · Page Two Using the above test, the observed minimum percolation rate was 20 minutes per inch. We recommend the system be designed for.an absorption area of 210 square feet per bedroom. This recommendation is based on criteria in the "Manual of Septic Tank Practice", U.S. Department of Health, Education and Welfare, Public Health Service. We recommend that the seepage trenches be inspected priOr to · installing the system as the above recommendations are based on a six inch diameter test hole. The seepage trench will provide a much clearer picture of subsurface conditions than a test hole. If conditions are different than encountered in the test hole, it may be necessary to modify the design. We hope this report meets your present needs. If we can be of further service, please fe~l free to contact us. Very sincerely, ALASKA TESTLAB James R. Finley, Jr., P.E. Geotechnical Engineer Approved by: Melvin R. Nichols, P.E. Laboratory Manager JRF/ms Attachments .,~ "-, "~..'MUNICIPALITYOFANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION - DIVISION OF ENVIRONMENTAL HEALTH -' '~" '::"= '-":"" ...............":(~'ERTIFICATE '0'F INsPECTiON 'FOR HE~i':T~I' AUTHORi~'Y APPROVAL. : OF ON-SITE SEWER AND WATER FACILITY 264-4720 ' Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) " 1~13o .~U~qAN[~AFI ROAD (b) ·Applicant Name COtVIlV[O~~ MOR'I~AG]~l'elephone: Home N/A Business Applicant Address 3L601 C $~'R'~m~7; SUITE 222 ANCHORAC-F.; AK 99503 '--.:.- (c) i"Applicant is (check one): Ler~ding Institution ]~J~; Owner/builder []; Buyer []; Other [] (explain); 562-6477 ".' (d) 'Lending Institution APPT,TO,,AN'P Telephone ,- Address 'ARi3~/'R, . . . ;" , i ;"i: :(ei: '~'ai'Estate Company and Agent HOWARD RRT/1P, Aq~TON nRC)!m ..... ~ .....L:; '. :,.'" '. '.. ...... · ,. i~WATER~ 'stem, must have written conf rmatlon from the State Id status. 2; ~; ~,c,, ,;,?,/: ,.- .:.., .,,~. ;; "4 J t;::~ ': '.:-;:;' ~;,:-:.~.~' .-~:.;....:m :.,?. -:T, .... · -..v-. - t ~.: '..:~.L~':..- · attesting .t~ the legalityand status. Page 1 of 2 72-025 (11/84) '" ' .' '.: 4. -::SEWAGE DISPOSA,Lt ::,.' ='..-.:. -:--':..-. :':-.: i -: .i.. -.,: :- .' -- ;: :T: ':'. i - :',-:.).: '. =.,y ":".. :: :':'".. ::;:'. :'!", ::-;'*.: .4 -': r: ~.~' ' 'F; ,.:":=~": ".' ...... ,:': ........ :.. '?~.'-'":.":;~;t::';-;::'.-.:~'~'.:. U::'~':'.'.: :: ,'."':'.. ~ '. '" =" ' ' : - ' ": ".. ' :: ...... ...:".. ,"'~:.': /": ' : -. ': ,: ' :!,._ .: . ..... .~ ..... -. , . · . :-,,~ ....... , '-'. '. -; :',.,-~ ', ."-' ' ..... : ~,'""7"~:~':";.'.";.it - :=~ '" ": I~10'i~-:~ii';;i~ n~;n'ii~-;;ll s~,stem, must have written confirmation` from the State Department of Environmenta~ Conservation '.' Address P.O' P[~'x' 77329/4 Date ,//,~/,~"~ ENGINEERING FIRM PROVIDIN(. SPECTIONS, TESTS,.FILE SEARCH, DA'~ :~ND INFORMATION As certified by my seal affix(~d he'retoand as of the validation'date shoWh 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 herei.n. I further verify that based on the information obtained from the Municipality of Anchorage files and from.my investigat on and inspection, the on-site water supply and/or wastewater disposal system is in complianc~r With all Municipal and state Codes, ~6'rdih'ances, and regulations in effect on the date of this inspection. Name of Firm ~_AG[,]~ R~ ]D'~'P,~G' F;RRV-[C-'ES Telephone : ::',:' ,.:Terms. Of Conditional'APpr6~l :'- ':' ' '-:'~ "" '. ...... :;- ':-'."-',.': ,":' : ' - ' .:'-.:: ',~, '..'"The ~i~n¢iPality of ~nchorage D~pa~tment of' Health and Environmental. Pr~tefitiOn (DHEP) issues Health A~thorii~ '" '. : '..- ~ Approval certificates based solely upon the representations §iven in paragraph 5 above by an indel~e'ndent'p~0fe~sional '.i' :}'~·.';7: · engineer registered in the State of Alaska. The DHEP does this as a courtesy to pub:chad/erS of homes and their lending ' institutions in order to satisfy.certain federal and state requirements. Eml~l°yees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality' of Anch°i'age is~not responsible for errors or omissions in· the professional engineer's work. ..~ Page 2 of 2 72-025 (11/84) ~ MuNICIpALITY OF ANCHORAGE ~ ~ *' PROTECTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL DIVISION OF ENviRONMENTAL HEALTH" CERTIFICATE .... OF INSPECTION FOR HEALTH AUTHORITY APpROVA OF ON'SITE SEWER AND WATER FAClLI~ 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) .-:~,-'-'-~- ; ~./~-[ [-T'i'T,T~q SEC. 22, T12N~ Location (address or directions) 12130 SEEN~AH ROAD (b) (c) Applicant NameCOM240NWEALTH MOR'I~AGE Telephone: Home N/A Business 562-6477 Applicant Address 3601 "C" ~, SUITE 222 ANCHORAGE, AK 99503 ApPlic.ant is (check one): Lending Institution ~; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution APPI~,ICANT Telephone Address AROVE (e) Real Estate Company and Agent HOWARD RELOCATION GROUP Address 190 SOT~-~ OPAUC~g LMNGSTON, NJ 07039' Telephone (f) Mail the HAA to the following address: MS. GAYLE DOMZALSKI 2. *' TYPE OF RESIDENCE _..Single-Family ~ Multi-Family [] - .Number Of Bedrooms 3 Other WATER SUPPLY .... Individual Well [] 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 [] Public [] Community [] Holding Tank J~] ' Note: if community well system,,must have written confirmation from the State De partment of Environmental Conservation attesting to the legality and status. .72-025 (11/84) Page 1 of'2 5. ENGINEERING FIRM PROVIDING .$PECTIONS, TESTS, FILE SEARCH, DA'i'. ND INFORMATION As certified by'my se.al affixed he~e~0 and asof the validation date shoWn below,:l vei'ify that my investigation of this Health .... Authority Approval shows that the on-site water supp y and/or wastewater disposal system is safe, functional and adequate '" .... ?~f°r t-h~nUm, ber of bed,rooms and type of strucidr(~ indicated herein. I further verify that based'~'6 i~'fo'rmati~'n~obi~ from the Municipality of Anchorage files and from my in, vestigation and inspection, the on-site water supply and/or ·wastewater disposal system is in complianCe with all Munic. ipal and State Codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .'EAGLE R1-VER-ENGINEMRING SERV-ZCES Telephone 69~-5195 'Address P.O. BOX 77q2q4 EAG3_,~, RIVER, AK 99577 .......... , .................... CAUTION ..... ~ ............~..., ............... k~, ~;~{.~!Approval Ceaificates based solely upon the representatiofis given in paragraph 5 ab0V~' ':'.:" ':..~.;::?~::ehgin~e~'rdgistered in the State of AlaSka. The DHEP does this as a cou~esy t° ~u'rcha'~erS ~f hCmes"~dd their lending" '"' :';::' ~' ': "'~?..~:institutio~ in Order to satisfy ce~ain .f~deral and state requirementS. Employees of DHE~.~6'fi&t ~d~ct inspections or '.' _:.. ~'fi~l~z0 dat~ before a ce~ificate is issued. The Muni~}pality.o~ ~nChora~e i~ not responsible for e~ror~'°r omissions in tho ~'~a~e2o12 · · ... : ... . .;'Lr.v.- ...... :-.~...,.-. ........ ~.~...r.. ' . ~"' · : ·. . . : .(.'-' WELL DATA Legal Description: MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY.1984 264-4720 Well Classification Ii A, B, C, D.E.C. Approved (Y/N) Date Completed ~_/',,.~-//~ o Yield Cased to ~'~- / Depth of Grouting ~,---,~-- Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /-/go' ; On Adjoining Lots Well Log Present (Y/N) Total Depth ~"5" / Casing Height Above Ground ElectriC:al Wiring in Conduit (WN) Y Separation Distances from Weil: To Septic/Holding Tank on Lot To Nearest Eclge of Absorption Field on Lot To Nearest Public Sewer Linel ,,?/~ CleanouVManhole Water Sample Collected by Water Sam pie Test Results Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot · . ~',,v.r~.~c~,-,~,.r ; Date :/ B. sr=IaA~=7HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~'/' Se paration Distances from Septic/Holding Tank: To Water-Su pply Well '/'~ To Property Line ~-z-'/ To Water Main/Service Line ~/'~ Course Size ,/_-~o ,5</o No. of Compartments / Air-tight Caps (Y/N) Y ii . Foundation Cleanout (Y/N) Date Last P~gmped --'~.,'/~ ~ ~"_¢',¢-r¢.r ":,'for ~'~'~/-/,~""'",'" Temporary Hol~?g, Tank Permit (Y/N) To Building Foun'dation To Disposal Fiel(~': ' TO'Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N). : Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line :i I To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or v~ihilcle-' Storage Area Type of System Design Length of Field ,Depth of Field Gravel Bed Thickness Standpipes Present (WN) : Date of Last Adequacy Test To Property Line T° Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if pre~;ent) Comments D. LIFT STATION Date Installed 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 Vent (Y/N) Pumping Cycle~ during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Si~ned ~'~"'~~~ ~' ,/-///! ~ ,' ' Male ..,/ Company ,Z~',,,~,~__~, _C. ,i I MOANo. "~'?' Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (I 1/84) -~' '~." DATE RECEIVED INSPECTION APPOINTMENTS ',~-d.. ~.--'"~-~ (? .~: DATE DATE DATE NSPECTOR : ~. INSPECTOR .. INSPECT " MUNICIPALITY OF ANCHORAGE ~ uilulCIPAL OF ANCHORAGE ' ~ I~' _1~  ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT '~;;~ ~" I & ..... T. OF I..:ALT~ 825 L Street - Anchorage, Alaska 99501 E~IRONMENTAL F;,OTE~IO~ ENVIRONMENTAL SANITATION DIVISIONjUJq 2 1980 ' Telephone 264~720 ' :' ' ' DIRECTIONS: ~omplete all parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ~eq (10) days for processing., MAI ~ADDR ESS PROP~TY RE'DENT (If different ~m above) , ' PHONE ~ ; PHONE 2. BUYER ~ : MAILING ADDRESS ~ 3. LENDING INSTITUTION ' ~ PHONE MAILING ADDRESS' 4. REALTOR/AGENT ,: : ~ PHONE I MAILING ADDRESS .' 6. TYPE OF RESIDENCE [~SING LE FAMILY I-'1 MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] ~ [] Five ~ Three [] Six [] Other 7. WATER SUP~.L-~ I~"INDIVIDUAL' [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) 8. SEWAGE D.~38AL SYSTEM ' ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY '" /~;~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ........ THIS SIDE FOR OFFICIAL USE ONLY, , . l.~ . i~ 1. TYPE 'OF RESIDENCE ' [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE i~ [] FIVE [] TWO [] FOUR I ~-1 SIX [] OTHER 2. WATER SUPPLY []. INDIVIDUAL []~ COMMUNITY [] PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE DRILLED 3. SEWAGE DISPOSAL SYSTEM , E ::" []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size:- /~ o' OD ' If.Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA ....... 4, DISTANCES WELL'TO: DEPTH OF WELL LOG RECEIVED PERMIT NUMBER DATE INSTALLED .. MANUFACTURER MATERIAL ...... Absorption Area to nearest Lot Line 5. COMMENTS .... ........ [] CONDITIONAL APPROVAL (letter.must accompany certificate) .... []-' DISAPP-ROVED 72-010 (Rev. 6/79)