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HomeMy WebLinkAboutBURLILE LT 76ABurlil Lot 76A #018-251-26 Municipality of Anchorage Page J of 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 Permit Number: '~[/¢¢/'~' (~'~7] PID Number: ~/o~'-¢3-~I- ~L(¢ Name: Address: Phone: INo. of Bedrqoms: LEGAL DESCRIPTION Lot: '7~ Block: Sue(,ivksion: Range: I Section: Township: W£LL: [] New Classification (Private, A,B,C): Driller: Yield: [] Upgrade Total Depth: I Cased To: Date Dr ed: Ft. Static Water LevFetllFt. I Pump Set at: I Casing Height Above Ground: GPM Ft.I Ft. SEPARATION DISTANCES we,- if b I ___ _ 72-5 Surface Water O ~,.'~ ~ Line "~ O ~(.~ I , Foundation .22 ~ Curtain Drain 0 /NJ ~ Remarks: Wastewater System: [] New [~Upgrade ABSORPTION FIELD [] Deep Trench ~'Shallow Trench [] Bed [] Mound [] Other Soil Rating: ¢.W G PD/F~:=Et. Depth to pipe bottom from original grade: ~ Ft. Fill added above original grade: / '/'~ ~ Ft. Gravel width: Total Depth from original grande: Gravel depth beneath pipe ~), ~ Ft. Gravel length: 50 Ft. Number of lines: Distance between lines: ~- '~ ' Fr. Pipe material: Date installed: / ¢.~/~ ~¢, Ft. Total absorption area: ~_~0 so. Ft. Installer: TANK [] Septic [] Holding [] S.T.E.P. Manufacturer: Materially'; b,~r" ~ LIFT STATION Capacity in gallons: Number of Commitments: Size in gallons: I Manufacturer: "Pump on" lev~i at: "Pump off" level at: I High water alarm at: Pump Make & Model Electrical Inspecti~or~s, coerformed by: B£NCH ~ARK Assumed Elevation: ENGINEER'S SEAL Location and E), scription: Inspections performed by: 2nd.' Department of He~qd Hum~ervices Reviewed and approved by: ~~~Date: 72 0t3 fRev 9;911 MOA 25 F;, RECEIVED JUN 1 ~; t997 OL PANEL / I N 5 fT WIDE , ~s/ }}oc~c., ~ooo ./ 1 ! ®~ ~o er LoNG L ~ ~ED CLEANOUTS BC 60 AD 58 ~D 65 AMT 120 Bi, iT ~20 Municipality of Anchorage Dept. Health & Human Services AC 55 FT DOUBLE CLEANOUTS BIOCYCLE I~iONITOR N £$ BENCH WARK: GARAGE FLOOR ASSUWED ELEVATION I00.00 FT, TOBBEN SPURKLAND P.E. Il 205 W 15TH. AVENUE II ANCH. AK. 99501 (907} Z79-~916 LOT 76A BURLILE 14405 WILDIEN DRIVE MRS. LOUANN BENSON J I SEPTIC SYSTEM AS BUILT DATE: DEC. 17, 1996 SHEET: 2/3 GRID: SW960571 PID / 018-251-26 BURO76A2. DWG ~ 4-INCH INSULA T/ON 1-I/4 PVC WITH 1/8" HOLES A 5 X 50 DRA/NFIELD 96.5_~ SAND BACKFILL B/OCYCLE 6000 LEGE D: 2. AERA T/ON TANK 20J ~5~h Ave DA~E: DEC, ~C ~996 27~-J~ LOUANW BEMSON SHEE~: S~9~0J7~ P/D ~ 0 ~8-25 ~-2~ BUNO76AJ. Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ,/'/'F 7~A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? Township, Range, Section: SLOPE S L IF "rES, AT WHAT O DEPTH? p E Depth~a Water After Monitming? Dale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop q; ~ ~ - '7'/~ .~,~ ~ ~7~ / ~ PEF%OLATION RATE "~ '~ (minutes,tach) PERC HOLE DIAMETER COMMENTS PERFORMED BY: ~t. ~ , ~ ~' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUICE. LINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85} CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Jim Williams Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: As Built Pink Sheet Lot 76A Burlile Gentlemen; As requested we are submitting additional percolation results. show the location of this testhole. Yours T. Spurkland P.E. June 13, 1997 RECEIVED JUN 1 6 1997 Municipality of Anchorage Dept. Health & Human Services A site plan has been included to MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ~ 1 '\ ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960371 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:CURTIS LOUANN E OWNER ADDRESS:14405 WILDIEN DR ANCHORAGE, AK. 99516 DATE ISSUED:12/03/96 EXPIRATION DATE:12/03/97 PARCEL ID:01825126 LEGAL DESCRIPTION: BURLILE LT 76A LOT SIZE: 43870 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION 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 (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT 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: 1.) RECOVER OR INSTALL FOUNDATION CLEANOUT AS REQUIRED. 2.) PROPERLY DECOMMISSION EXISTING SEPTIC SYSTEM 3.) CONSTRUCT DRAINFIELD NO CLOSER THAN 5 FT. FROM TESTHOLE. RECEIVED BY:~ ~ ~~}~Y~ DATE: ISSUED BY: f /~[~!t / v' ~ DATE: 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 76A BURLILE S/l) LOUANN BENSON 14405 WILDLIEN DRIVE Municipality of Anchorage 820 I Street Anchorage, Alaska 99501 October 7, 1996 We are submitting an application for septic system upgrade for this lot. The system was tested and failed in 1995. The submittal consist of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system are subject to this per,nit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Ground Water ~ 4 feet in testhole # 1 Slow percolation and possible groundwater at 9 feet in testhole #2 Use BioCycle with Standard Trench Install bottom of trench at 3.5 ft. Soil Rating. <5 min/in = 2.4 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/2.4 = 62.5 sq.ft.. Total area required: 4 x 62.5 = 250 sq. ft Gr at testhole 95.5 Gr at exist. Septic tank 97.7 Bottom Siding 100.00 5+- ft cover over existing tank SYSTEM CONFIGURATION BioCycle 6000 5-WIDE STANDARD TRENCH TOTAL LENGTH 50 FT TOTAL WIDTH 5 FT TOTAL DEPTH 3.5 FT ROCK DEPTH 0.5 FT COVER 3 FT The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. LE?E£ L~T 54 L~T 77 LZT 843 V~CANT · LET 85 ~00 L~T 75 300 / TOBBEN SPURKLAND P.E. II II 203 W ISTH. AVENUE ANOH. AK. 99501 (907~ 279-3916 14405 WILDIEN DRIVE ~PS. LOUANIV BENSON I I SEPTIC SYSTEM DESIGN DATE: OC1-. 07, 1996 SHEET: 1/$ GRID: 3054 7 --x-- _,<_ _ x~ ~ ® #z /p> PROPOSED DRiAII r/ELD -I PR BIOOrCL£ ~000 50 FT LONO I x q r / BENCH ~kRK~ //// ~ 5.5 FT DEEP * *. *, * * *, ~ ~ Il ABANDON , .....~..:.?::?:::::::J:/ '' :::::::::::::::::::::::: :....:.'.'....: , / L ~,~ I""~ ........... ~ ............ ~"~ / I I ~A*- ~ ' ' "~- ,~ I  / BENCH ~ARK: BOTTOW SIDING TOBBEN SPURKUAND P.E. LOT 76A BURLILE 205 W 15TH. AVENUE 1~405 WILDIEN DRIVE DATE: OCT. 07, 1996 ARCH. AK. 99501 M~S. LOUANM BENSON SHEET: (9o7/ 279-~916 © ©co ~ AI£CO~P,~ I.~ AIR LIN~ 4-/NCH INSULA T/ON 5 X 50 DNAINFIELD SLOPE TO DRAIN B/OCYCLE 6000 LEGEND: I. PR/MANY TREATMENT, SEPTIC TANK 2. AERATION TANK 5. CLAN/FICA TION TANK 4. DISCHAROE TANK 5. SOIL ABSORPTION ?OBBEN SPURKLAND P.E. II 205 W15th Ave II Anchorocle Ak 99501 279-5976 BURLILE $/D LOT 76A Y/ASTEWATER SYSTEM SCHEMATIC LOUANN BENSON SEPTIC SYSTEM DES/ON DATE: OCT. 07, 1996 SHEET: 54/5 GRID: 5054 Municipality of Anchorage DEPARTMENT OF HEAL'TH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lo'T 7~ A ~OiZLIL. F--. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Township, Range, S~,ction: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? \/ ,~ s IF YES. AT WHAT ~ ~) DEPTH? ~ p Oeplh to Water Alter hlonitorlng? Oate: ¢{eading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND FT PERFORMED BY: ~ % I ~ :~ . ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: Municipality of Anchorage DEPARTMENT OF HEAL'TH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS DATE PERFORMED:. Township, Range, Section: OF-- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 .. S IF YES, AT WHAT ~__~/~ ~].~ DEPTH? ~ ~ ? ! OL P t-~ Ej,,,~'~lh lo Water Alt , /~/'7/q (~ hloniler~ng7 ~-~ q'~ Oate: ' qeading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~-~ [m,njtes/,nch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FTA?~3 ~.~7Z,. FT PERFORMED BY: . CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS 72-008 (Rev. 4/851 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEAL'TH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) Township, Range, Section: SLOPE W,;3GROUNDWATER ENCOUNTERED;' S L IF YES, AT WHAT 0 DEPTH;: p E Depth 1o Water After Monitoring? Date: SITE PLAN qeading Date Gross Net Depth to Net Time Time Water Drop ,,, Io" ~ ; :5~ Jr"-/ ~/r PERCOLATION RATE l~'~' tm,nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~:~ FT-'FT PERFORMED ~Y: I ~ ' ~ ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, 72-008 (Rev, 4/85) DATE: l o/z/r.,lc, GRE,' 'ER ANCHORAGE AREA BOt UGH  Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAI LING ADD RESS ~i~'/~ ~ ,/~('X -//('.2 (~L /f/~c('/, PHONE LEGAL DESCRIPTION SEPTIC TANK: t ~ _ ~ NUMBER OF DISTANCE ///,,~ ~..~t~,,1 ~,/'~ MATERIAL COMPARTMENTS FROM WELL ANUFACTURER INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~' :'~ ('';' GALLONS. SEEPAGE PIT: / NUMBER OF PITS / DIAMETER __OR WIDTH //~/c LENGTH,~/' DEPTH LINING MATERIAL ,'l(~;/~'g /~ /~ B SIZE: DIAMETER DEPTH__ DISTANCE FROM: WELL /£'( ~"(: ~- · ~ TOTAL EFFECTIVE BUILDING FOUNDATION .~/~ . NEAREST LOT LINE'-~('3-/~' ·~- ABSORPTION AREA (WALL AREA) ,..~'> (/ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE /~ ~-~' ~/ BUILDING FOUNDATION __ CESSPOOL APPROVED //~ CONSTRUCTION DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC/,,,(-/,, SEEPAGE , LOT LINE SEWER LINE TANK /t /~:-~,: SYSTEM /'"(."( /-"<' '~ OTHER SOURCES DISAPPROVED REMARKS DISTANCES: PIPE MATERIAL: ('h:) LOT SLOPE: ~/o . ~" REMARKS: DIAGRAM OF SYSTEM DATE APPROVED G.A.A.B. / GREATER ANCHORAGE AREA BOROUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-~, 561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME CE APPLICANT LegAL DESCriPTiON Z&;) INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE Pit ~ DRAIN FIELD TO BE INSTALLED BY _ X SO,L TEST RES~LmS _ /~E COfCPLETION DATE ANTICIPATED OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TLS1 MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNL;ATION TO SEEPAGE Pit_ SEPT!(; '~ANK TO SEEPAGE Pit WALL ~WELL ~O SEPTIC TANK DRA~N FIELD FINAL. ~'NSPECTION: Z4 HOUR NOTICE REQUIRE[;). BACKFILL, lNG OF ANY SYSTEM WITMOUT FINAL ~NSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WiLL BE SUBJECT TO PROSECUTION. . TYPE DIAGRAM OF SYSTEM WATER MAIN TO SEPTIC TANK DRAIN F;ELD ~EPTIC TANK. //~/__2 / SEEPAGE PIT -- DRAIN FIELD ~c,/ DRAIN FIELD . / SEEPAGE PI'T //~'~ ALSO CONSIDER AREA WELLS. · SEEPAGE PIT ,DRAIN FIELD . TO R!¥ER. LAKE. STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of EXCAVATION 5 FEET into UNDISTURBED SOIL. 4 inCH ~iA~ETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED W;Tti AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORm4 TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT ~ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. FORM NO. LQ'016 GPr~TER ANCHORAGE AREA BORO"~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME-~'-)~ ~H.:~ '~ LOCATION Z : tt q'e"j' SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY / ADDRESS MATERIAL GALLONS. LEGAL DESCRIPTION INSIDE LENGTH PHONE NUMBER OF COMPARTMENTS INSIDE WIDTH DEPTH__ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PiTS LINING MATERIAL NEAREST LOT LINE OUTSIDE DIAMETER OR WIDTH / ~' / LL--/~( DISTANCE FROM WELL / '(~' ~ ) ,.. qL4'' "~ ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH /V DEPTH (~ BUILDING FOUNDATION g~" '~f '~--? L''-T SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELt NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION NEAREST LOT LINE DISTANCE BETWEEN LINES TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE WELL: TYPE ~-) ~'! / E (- ~7 'l~), DEPTH d/~:'/''L (- 't / NEAREST //~' I SEPTIC LOT LINE SEWER LINE , TANK DISTANCES: ~.E~F'- DIAGRAM OF SYSTEM DISTANCE FROM /u/~/~i~ / WATER , BUILDING FOUNDATION. SAMPLE 4, :'("" , NEAREST OTHER '- ' , SOURCES__ APPROVED HEALTH AU]HORITY GAAB-HD-2 GREATEL ANCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 . ROUGH 279-2511 Case No. ~ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT _ MAILING ADDRESS 5~,/~', /~ NAME OF APPLICANT ~ ~AY~ RESIDENCE ADDRESS /~/~:~?--//~///f ~YbI~TION OFINSTALLATION' ~r ~ LEGAL DESCRIPTION '~ ~ ?- ~'~:12~_/ ~~ APPLICATION TO INSTALL: SEPTIC TANK / , SEEPAGE PIT, ~ ,DRAIN FIELD TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~ ~--~c, ~- ff~TRqL~-C~rl3~ TEST RESULTS / ,OTHER TO BE 'NSTALLED BY ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE /~_5--~]) TYPE ~ T~z SEEPAGE AREA DISTANCES: %oc,.j~ I .TYPE DIAGRAM OF SYSTEM I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described lysteT is in accordance with said code. ~' ,~ :? DATE APPLICANTS SIGNAT GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 CASE # Performed For )'~\r '~,r%~-' Date Performed ' '"' " "~ k ' :' ' '-- " Legal Description: Lot~Bloc _~ ~S~dzv~slon, ~. ~ .~ , ~ This Form Repomts a: Soils Log, /- -PePcolation Test Depth Feet Was G~ound Water Encountered? If Yes,~'~ ~'~'~r Depth Location Sketch Readi~:~ I Daze Gross Time Net Time Depth To H20 Net Droop , ,~ ~-----___..~.__, ,,,, ~ Frcp-,sed Installation: ~eepage Pit ,/ .... Dmain Field Depth Of Inlet ~.~E~¢,:'J ~ ~ Depth To Bottom 0~ '~i% O~ TPenc~'" CO~M~N ~.~ ,~p ~, ~,.~ ..rAJ ....-~..~ ~.~. Z,~~_ ~.~Z i~..,~.:~Yz ~X~. / , " - ~ ' '-~ '- .............. ' 7 ' ~ ~; Tes¢ Performed Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage,ak,us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O/~;~-,~Q--51- ~'-'~ 1. GENERAL INFORMATION Complete legal description NAA# Expiration Date: "~ "~ /"/ "O ,.,'.'.'.'.'.'.'.'.~_ Location (site address or directions) I t~ L~ O ~ Current Property owner(s) Mailing address Lending agency Day phone Day phone Mailing address Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except betv/een spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval ara valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with .new water sample results. (Certificates may be reissued for a period cf up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Development Services Department Building Safety Division On-SEe Wafer & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage, ak. us (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,/.O ~' ~ A *~O10..~..tL~---= Parcel ID:~(,~ A. WELL DATA Dam completed Iq'*J~ ~ Total depth ~lt. IfA, B, or C provide PWSID # ~ SanEe~y seal (Y/N) ~ C_,k~) ft, fL FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: -- Amenic: mg./I. Date of sample: e. SEPTIC/HOLDING TANK DATA Tank Type/Material '~ tO~-'%/~. L~_- Tank size ~gal. Number of Compartments Foundation claanout (Y/N) ~ Depm_-_$ion over tank (Y/N) Date of pumping ~ Pumper A C. ABSORPTION FIELD DATA Date installed IZ//~/~ Soil rating (g.p.d./ft~ o~) '~ Well Log (Y/N) ~ Wires properly protected (Y/N) ~ Ca,~ing height (above ground) [ J ~ in. ATINSPEC~ON g.p.m. Otiler bacteria . Collected by: ~ colonies/100 mi. Cleanouts (Y/N) H ~ ~ e ~ ~. High water alarm (Y/N) ~'/ System type Length F~ fL Wkilh ~ fL Gravel below pipe t~e ~ fL Total depth y ff. Eft. abeoq:~lon ama ,~/,3e Monitoring tupe ~ Depression over field Fluid depth in absorl3fion field before test i~) in. VVater added b~,~Tgal. New depfll ~ in. la =edT m.: O Fi. ,,uade r.) i.. som,on=te >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~ If yes, give date Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wast~ater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorag¢.ak.us (907) 343-7904 PROPERTY OWNER AGREEMENT FOR TttE MAhNTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated ,O'/../~ ::=- , is made between the Municipality of Anchorage Development Services Department (DSD) and the property owner(s) of: LoT "/~A This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to the following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) (Printed N"'ame) (Signature) (Printed Name) The Foregoing Instrument was acknowledged before me by ,4f,( 1 ,20 o._~ ~ary Public (Si)~re) (Notary s printed n~e) My Co~ission Expires EAST 1 44TH AVENUE N 89 57' 24' W 276.79 ,~ ~0." 49 TH~ '~e ~ ~.~.~ ........ ~ ........ :...~...~ v~':" ~.'" S~E A HOLT / ~ ~.~ "... ...-/~ %~,0, .... ,~ 2 ¥ N 89 57' 42' £ 296.80 FAN A MUNICIPALITY OF ANCHORAGE MuN,ct,'^,-,- o clio, .... , DFPAR'EMENT OF HEALTH & 'U~AN SERVICES E~I.ONMENTAL SERVI~y~N OF ENVIRONMENTAL SERVICES CERTIFI~E OF INSPECTION FOR HEALTH AUTHORI~ APPROVAL 111~[ ~ ]~OF ON-SITE SEWER AND WATER FACILITY 264-4744 RECEIVED ApplicmJon Dine 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL/ (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Lo'; "[ ~ ~ % o (~.. L ~ t.. ~ SEC_ ~ ~ '7- t 2 N ~ P__ ~ ~/ Telephone: Home J.,/~e_z~'("- Business Telephone Location (address or directions) Property Owner Mailing Address J~ ~Z' '~t./ Lending Institution ~---I Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here'S, if hold for pick up. List contact person and day phone number~ ~bel°w' TYPE OF RESIDENCE Single-Family/[~ Number of Bedrooms 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. SEWAGE DISPOSAL Onsitex Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72~025 (Rev 8'86/ From ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection._/"] ' Name of Firm ~-~ Telephone Address Date Engineer's Seat Approved for ¢ bedrooms by ate ~"-- ,~ F-- ~ ~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 ,'Rev 8,'86) Back MUNICIPALITY OF ANCHOP~INICIPALITY OF ANCHORAGE (MOA) WELL DATA DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST- FEBRUARY 1984 264-4744 JUN 1. 3 1988 Legal Description: RECEIVED Well Classification ~ ~_.__c..c.~ Well Log Present (Y/N) Total Depth ~' ~ Cased to Static Water Level ~;~ Casing Height Above Ground I C~ ~ I Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/l-~e4,~g Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments 4¢ +¢ If A, B, C, DEC. Approved (Y/N) Date Completed · ' Yield Depth of Grouting N ON ~--- Pump Set At _~ ~ ~' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) · On Adjoining Lots I1.~~ · On Adjoining Lots To Nearest Public Sewer /'¢///-~ To Nearest Sewer Service Line on Lot ~ ! C) ~ -~ · Date ~-///~//~ ~ B. SEPTIC/~ TANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Date Installed ~ i0/ Standpipes (Y/ND 0 ~1 ~ Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size / ~. ~,~O No. of Compartments Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) Date Last Pumped "~'///~/¢~ Temporary Holding Tank Permit (Y/N) To Building Foundation ~ ~ X To Disposal Field ~Z ;~ 14 To Stream, Pond, Lake, or Major Drainage Comments 44 ~'¢'~v~ .4 J-~:27 ;~ Page I of 2 72-026 fRPv 8'86t Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ ~-~ Date Installed ~ I ~j'7 ~ I lC) Width of Field I~::~ --- 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 No To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design (-~ ~ / ~ Length of Field ~ / Depth of Field ~ ~ Gravel Bed Thickness ~ Standpipes Present (Y/N) ~) /%/~ Date of Last Adequacy Test ~'//~ /8~ To Property Line To Existing or Abandoned System on · On Adjoining Lots ~ "'~ To Cutbank (if present) t,4 o t,,/ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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. Signed ~ ~ Date MOA No. Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 IRev 8"86~ Back Engineer's Seal Tom Fink, Mayor ¢[unicip&lity of Anchora¢¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 12, 1988 Tobben Spurkland, P.E. 203 West 15 Avenue "C" Suite 203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 76A Burlile Subdivision Waiver Request #WR88-027, H88-0223 Dear Mr. Spurkland: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 88 feet. 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. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljw~6 CONSULTING ENGINEER _'03W 15thAVE "C' SUI?F 203 ANCHORAGE, ALASKA 9950~ TELEPHONE: (907) 279 3916 Municipality of Anchorage Division of Environmental Health i~uNIClPAUI'Y OF ,a,NCHO~''a'G~ DEPI- OF HEAL1-H & r~¥iRONM£N'[AL pRoTEC'I'tOI~ RE. CE /ED Department of Health and Social Services 820 L Street Anchorage, Alaska 99501 Subject: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL TO SEPTIC TANK Gentlemen; We are submitting a request for waivers distances stated in Title 18, Alaska Chapter 80.020. from the separation Administrative Code, On an health authority inspection on May 16, 1988 discovered that the distance between the well and the tank was 88 feet. is was septic Following the standard procedure of point computation the point for this situation is: Ground Water ( 140 ) .......... 7.5 Soil Sorption .... Silt, Clay, Gravel.4.5 Permeability ........................ 3.0 Gradient Artesian 3.0 Separation 88' ............... 2.0 Total ............................. 20.00 This indicate that this septic system is contamination potential. almost free from T.Sp~kland P.E. x CONSULTING ENGINEER .'03VV 15thAVE 'C' SIJI[E 203 ANCHORAGE, ALASKA ,995 TELEPHONEz (90712'2'93916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: Lot 76A, Burlile 14405 Wildien Wood Residential, Single Family No INSTALLATION REQUIREMENTS MET: No, Well too close to septic tank. Required separation distance is 100 feet. Actual distance between well and tank standpipe is 88 feet. PUMP YIELD FROM TEST: 8 gallons per minute DATE OF INSPECTION: May 16, 1988 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 86 feet below top of casing. At a pumping rate of 8 gallons per minute the water level dropped to 96 feet after 15 minutes of pumping. Pump cycled and water level fluctuated between 92 and 96 feet. A total of 650 gallons were pumped in a time period of 90 minutes. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrates on May 18, 1988 E.Coli 0. Total Nitrates 1.2 mg/1. Max. allowable Total Nitrates 10mg/1. TEST RESULTS: This well meets the Municipality of Anchorage. requirements of the THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR THAN FOUR HOURS MORE The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. ' CO.NSULTING ENGINEER zO3W 15thAVE 'C"SUITE 203 ANCHORAGE, ALASKA a ~')' TELEPHONE: (907) 279 39~,':i SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WELL: Lot 76A Burlile 14405 Wildien Drive Wood Single Family, Four Bedrooms On Site, Single Family SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: Espinoza Concrete. 1250 gal. One Compartment ABSORPTION SYSTEM: Concrete Crib ABSORPTION AREA: 819 sq. ft. SOIL RATING: 125 INSTALLATION DATE: June 1973 DATE OF LAST PUMPING: May 19, 1988 Marx DATE OF TEST: May 16, 1988. TEST PROCEDURE: System was inspected and measured. Tank was found with six feet of cover and 38 inches of liquid. Crib was 13 feet deep and with a liquid level of 31 inches. 650 gallons of clean water were added to the crib while the water levels in the crib and the tank were monitored. Tank level did not change. Water level in the crib rose 44 inches at a decreasing rate of rise.. The infiltration rate was monitored for 20 minutes. During this time the water level dropped 10 inches, indicating a rapid infiltration into the soil. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. · DATE RECEIVED - INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SAN ITATION DI VISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER :~ ~ I PHONE . /~- MAI LIlaC A D D F~'E'SS PROPERTY RESIDENT (If different from above) ~ PHONE 2, BUYE~ PHONE MAI ~1~ ~'DDR ESS 3. LEN~INGINSTIT~TION / ' / ~ PHONE .' :- _. . MAILING ADDRESS 4. ~E~LTOR/AGENT ~ ~ PHONE' 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ',~- Four [] Two - I--I Five [] Three [] Six [] Other 7. WATER SUPPLY 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 DISPOSAL 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 NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE I~ SINGLE FAMILY [] MULTIPLE FAMILY [] ONE [] THREE [] FIVE [] TWO I~ FOUR [] SiX [] OTHER 2. WATER SUPPLY ~ INDIVIDUAL ¢t°~ [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~d~ DIVI DUAL/ON-SITE F-] PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Line 5. COMMENTS DATE ~ APPROVED FOR 4' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) =-9'O0"E 299.7t HV~ 29974 J, ,~9o59'5£, W '~29 67 DO RO____W Esmi __ N$9o57'42"W- - 599.79 WR~,A- ' EAST 144th Avenue ,? , 33 296.79 . ~' ,L v I 296 O0 S Bgo 57'30"E 29681 WRA August 13, 1982 Ricky V. and Pamela J. SEA Do× 4026 Anchorage, Subject: L 76A P, urlile Sub. Approval for the individual sewer and water facilities cannot be qranted until the following items have been completed~- The top of the well casinq sealed with a sanitary sea]. so that it is water tight. The water analysis report needs to be submitted to this office from the Chem Lab, 5633 ~ Street, for our review. The septic tank pumped with a receipt submitted to this department. An adequacy test needs to be performed on the existing leachin? arem. This test will determine if the system is adequate according to National Standards. A listing of private firms performinq the test is enclosed. This report needs to be submitted to this office for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Enclosure Cory l'3illis, R.S. ALASKA E:F1UIROFImErlTAL COFITROL SEBU Ce$, IFIC. ~n§in¢¢rin§ 6 ~nuironmcnIol Stuclics 8/12/82 BARBARA GARDENER 507 W NORTHERN LIGHTS ANCHORAGE AK 99503 SELLER - DODD SUBDIVISION-BURLILE BUYER-HODGE BLOCK- LOT-76A ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 819 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 600 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 8/12/82 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 4 BEDROOM HOUSE. · ,..,.2~~'' .... ,,,o,7'.~' 1250 IS ADEQUATE FOR 1220 LUest 251h Aucnu¢ * Anchor~§¢, Ahsko 99503 * (907) 276-1361