HomeMy WebLinkAboutDAV-DOR LT 4fav -Dor
Lot 4
#015-292-34
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP121338 PID Number: 015-292-34
Dwelling: N Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade
Name:
WENDY EVANS & MICHEAL POSS
ABSORPTION FIELD
X Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
5320 HENDRICKSON CIR., ANCHORAGE, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
1.2 GPD/SF
9.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original gradeGravel
4.3 Ft,
depth beneath pipe
6.1 Ft
Subdivision Block Lot
DAV-DOR 4
Fill added above original grade
0-1 Ft
Gravel length
45 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
Distancebetween lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
549 FP
1
NA Ft
well
>100'
>100'
NA
NA
>25'
TANK ■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1000 Gal.
Surface Water
>100'
>100'
NA
NA
Material
Number of compartments
Lot Line
>5'
>10'
NA
NA
STEEL
2
NA
Foundation
>5'
>10'
NA
NA
LIFT STATION
Manufacturer _
Capacity
Curtain Drain
>50'
>50'
NA
NA
Gal.
Remarks EXISTING DRAIN FIELD CONNECTED
Pump on level at
in. I
Pump off level at
in.
High water alarm at
I in.
VIA BULL RUN VALVE. EXISTING SEPTIC TANK
ABANDONED PER MOA REQ'S.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Installer
A+ HOME SERVICES
Dreinfield F810 CO/MT F810
Inspector LARS SPURKLAND & ANSON MOXNESS
BENCH MARK (Assumed elevation) 100 ft
Inspeection
1� 10/8/12 10/9/12
Location and description
ction 2w
s'" 10/9/12 4'"
BOTTOM SIDING NE CORNER HOUSE
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Dateo
A.Cq 11
�� lr
��.
y 4910 !0
.... .... ...
SPURKLAND.
11 00 j
Approved Date
inspection Kepon_a-T i[.co(e,�
Septic
Area
LOT 6
Septic
Area
LEVEL O®
LOT 5
OP -
INSTALLED 3 -BEDROOM SEPTIC SYSTEM
INSTALLED 1000 GAL SEPTIC
INSTALLED BULL RUN DIVfRT£R
TRENCH LENGTH 45 f££T
WIDTH 2 FEET
MAX EXCIVATION DEPTH 10 FEET
ROCK DEPTH 6.1 FEET
HENDRICKSEN CIR
p
LOT 3
Septic
Area
i
GARAGE
Well
N
LOT 2
Well
NOTE.• SLOPES EXCEEDING 25X WERE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED
ABSORPTION RUD LOCATION.
NOTE.' INS IS NOT A SURVEYED PLAT. WELL d SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
IMIIIIIIIIIIIIIIIII
25 0 25 50 75 100 125 150
SCALE,• 1' = 50 FT,
0
I' -C - Well
LOT 1
¢- Well
SPURKLAND
0
51JUNKLANU ENUINEEM1NG
203 V 15TH, AVENUE I I DAV -DOR LOT 4 I I SEPTIC SYSTEM ASBUILT
ANCH. AK. 99501 W£NDY £VANS DATE, DCT 11, 2012
(907) 279-3916 5320 HENDRICKSEN CIRCLE, 4NCHUR46E. AK 99507 SHEET, 2/3 GRIA 2537
I PERMIT # OSP121338 PID # 015-292-34 DAVDORL4,SC50PERMIT # PID # 015-292-34 ASB.BVA9
SWING TIES
A B
C
7.5 11.0
LEVELD
13.5 14.0
WSIRDRM
£
16.0 15.5
F
44.0 29.0
67.0 60.5
WellG
H
38.0 33.5
GARAGE
Well
N
LOT 2
Well
NOTE.• SLOPES EXCEEDING 25X WERE NOT OBSERVED
WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED
ABSORPTION RUD LOCATION.
NOTE.' INS IS NOT A SURVEYED PLAT. WELL d SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
IMIIIIIIIIIIIIIIIII
25 0 25 50 75 100 125 150
SCALE,• 1' = 50 FT,
0
I' -C - Well
LOT 1
¢- Well
SPURKLAND
0
51JUNKLANU ENUINEEM1NG
203 V 15TH, AVENUE I I DAV -DOR LOT 4 I I SEPTIC SYSTEM ASBUILT
ANCH. AK. 99501 W£NDY £VANS DATE, DCT 11, 2012
(907) 279-3916 5320 HENDRICKSEN CIRCLE, 4NCHUR46E. AK 99507 SHEET, 2/3 GRIA 2537
I PERMIT # OSP121338 PID # 015-292-34 DAVDORL4,SC50PERMIT # PID # 015-292-34 ASB.BVA9
Sil t
TH
E.G. £LEY.=97
£LEY.=BO'
Installed Bull
Connected to
Deep Trench:
2' Wide
45' Long
9,5' Deep
6,1' Sewer Rock
4' Cover Min.
NO SCALE
Installed Double Cleonouls
Pit
Installed New 1000 Gallon Tank
6.1 ft of Septic Rock
1250 Gal, Septic Tank
NO SCALE
BENCH MARK BOTTOM SIDING NE CORNER
ASSUMED ELEVATION 100'
I SPURKLAND ENGINEERINGI I DAV- DOR LOT 4 (I SEPTIC SYSTEM ASBUILT I
203 WI5th Ave DATE OCT Il, 2012
Anchorage Ak 99501 WENDY £VANS
279-3916 53RO H£NBRICKS£N CIRCLE, ANCHORAGE, AK 99,507 SHEET: 3/3 GRID, 0.537
PERMIT # DSPI21338
PARCEL ID # 015-292-34
DAVDORL4.D3-ASEBWG
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP121338
Tax Code Number: 01529234000
Work Type: Septic Upgrade
Permit Effective Dates: October 03, 2012 to October 03, 2013
Design Engineer: SPURKLAND
Subdivision: DAV-DOR
Site Legal Address: DAV-DOR LT 4 G:2537
Owner/Address: POSS MICHAEL P & WENDY E
5320 HENDRICKSON CIRCLE ANCHORAGE AK 995076831
Site Mailing Address: 5320 HENDRICKSON CIR, Anchorage Lot Size in Sq Ft: 22309
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By:
Date: L613l12-
Date: (613bp
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
I
Phone: 907-343-7904
Fax: 907-343-7997
1 ^ U s [-I • ) ON-SITE SEWER/WELL PERMIT APPLICATION
Parcell.D. 015-292-34
Property owner(s) Wendy Evans
Mailing address 5320 Hendrickson Cir., Anchorage, AK 99507
Day phone 306-3273
Site address Same
Legal description (Sub'd., Block & Lot) Dav-Dor Lot 4
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field Q Initial ❑
Single Family (SF)
❑
(w/wo ADU)
Septic Tank 0 Upgrade 0
Duplex (D)
El
Holding Tank ❑ Renewal ❑
Multiple Dwellings
❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST
FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable
Municipal
Codes.
jaNNyVY1V�__-
property owner or
Permit/Rush Fees: S Waiver Fees: _
Date of Payment: J2c� Date of Payment:
Receipt Number: Receipt Number:
Permit No. a> P 1 �gg7, 3 Waiver No.
FP ac q — 4 Sh
Permit App_9-1-12.doc ICA al -'1 a
lb* oowSG�
SpuvE and EngoMemopng
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
Dav-Dor Lot 4
Municipality of Anchorage September 28, 2012
Development Services Department Revised Oct.2, 2012
On Site Water and Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Septic System Installation Permit
Dav-Dor Lot 4
Ladies and Gentlemen:
I am writing to request a septic system installation permit for the above referenced property. The
existing system did not meet COSA requirements. The proposed system will serve a 3 -bedroom
single-family residence. Soil logs, design calculations, a site plan, design drawings and
construction specifications are enclosed for your review.
Design Calcs: No groundwater observed up to a depth of 16.5 feet below ground surface.
Soil rating. From testhole 9/21/12
<1 min/in =1.0 gal per sq.ft/day
No. of Bedrooms 3
Required Area per Bedroom: 15011.0 = 150 sq.ft.
Total area required: 150 x 3 = 450 sqft
Use deep trench with 6 feet effective depth
Minimum trench length: 450 sq.ft./12 ft = 37.5 feet
System: We are proposing 1000 gallon septic tank with a deep trench absorption field. The
absorption field will be 45 feet long and 2 feet wide and contain 6 feet (540 sq.ft. effective) of
sewer rock.
Soils: A test hole was excavated on September 21St, 2012. Seethe attached soil logs. A
percolation rate of <1 min/inch was observed. A filter sand layer is not required because the
insim material is a sand and should provide excellent filtration of the septic tank effluent. Ground
water was not observed. Ground water monitoring will continue through construction of the
septic system.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
SpuMaimd En oimesfing
Environmental Consulting and Design
Surface Water: There are no surface waters within one hundred feet of the proposed septic
system upgrade.
Topography: The ground level is generally level around the entire property.
Waivers: None
The installation of this septic system will not prevent wells and septic systems from being
installed on 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.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
S44��
Lars Spurkland, P.E.
Civil Engineer
203 West 1501 Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
Septic_) LOT lD
Area
�3 LOT LC -�- Wel
Lor 18
�� Well
Lor x � Well
I _�- Well
i \ RSI O
Septic)EE��
Area
°AV $eptic!)
1^ HHrea I Septic
LOT 7 !y Area
EE�� i
Septic) Lor s
�15G LOT 28 CjA" LOT HfNDRICKSEN ClR_
Of` LOT 5
(�1, V \
V
Septic LOT d
EE�� I
Area ; " (,Arealc�
Septic)
Area
--- -- I Well':a:
LOT 2A
-� Wel.
Well _ _ —
Lor s cor r h Well
Septic)- -- Well Y
Area
NOTE.• THIS IS NOT A SURVEYED PUT. WELL d SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCAAONS SHOWN ARE
APAWMANTE.
50 0 50 100 150 200 250 300
SCALE I' = 100 FT.
—LOT 18
LOT 17
Well
I� I
(� Well
LOT
0
I cors
Well \
Well LOTOT
SPURKLAND ENGINEERING I I DAV-DOR LOT 4 I (SEPTIC SYSTEM DESIGN
2033C V 15TH. AVENUE VENDY EVANS BATE, SEPT 20, 2012
9D7 2 9 99501
16 5320 HENBRIEKSEN ENCLE, ANCHLIRA5E, AK 995507 SHEET=..- 113 &RIB, 2537
PERMIT # OSPI11OXX PIB # 015-292-34 BAVBORL4.SC100.BVG
Area _ HENDRICKSEN CIR
LOT 6
Septic O
(— Area I
�3 OR
LOT 5 `LES i O LOT 3
OPV LEVEL Septic!
INSTALL 3 -BEDROOM SEPTIC SYSTEM Area
1000 GALLON SEPTIC TANK LOT 4
INSTALL BULL RUN DIV£RT£R /
TRENCH LENGTH 45 FEET
WIDTH 2 FEET TH INSTALL FOUNDATION CLEANOUT
AMX EXCIVA77ON DEPTH 10 FEET
ROCK DEPTH 6 FEET
COVER 4 FEET
3-BORM
ABANDON EXISTINGSEPTIC sm
MEM PER UPC REQUIREMEN C`R
LEVEL Z\
III ¢ Well
I
h GARAGE Well
L — Well —
T� T 10UTR ESMT
J
LOT 1 LOT l
�1- Well
-¢- Well
NOTE.• SLOPES EXCEEDING 25X WERE NOT OBSERVED O
............
*7710*771050 fE£T DOWN GRADIENT...
Of THE PROPOSED ��� ••
ABSORPTION RELD LOCATION. = •• •' ���
NOTE.* THIS IS NOT A SURVEYED PLAT. WELL d SLPOC'• 49t•••e •�
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER �"' ••••
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE �„ ,............... ,
APPROXIMATE. LAR SPURKLN
•1 f'•.• NO. CE -11500 �c_'AV
AF
25 0 25 50 75 100 125 150 ••i••'•10 Z Ste••
SCALE 1' = 50 FT
SP RKLAND ENGINEERING DAV —DDR LOT 4 SEPTIC SYSTEM DfS/GI
203 W 15TH. AVENUE
AK 99501 WfNDY £VANS DgTF SEPT po, �p�p
C90 279-3916 5320 HENDRICKSEN CIRCLE, ANCHORAGE, AK 99507 SH£ETr 2/3 GRID 255
PERMIT #OSPI21OXX PID # 015-292-34 DAVBBRL4,SC50.DVG
Slit Barrier
Install Foundation Cleanout
1000 Gal. Septic Tank
Install Double Clean Outs
Connect to Existing Droinfield
Deep Trench;
3' Wide
45' Long
10' Deep
6' Sewer rock
4' Cover
NO SCALE
0
U
Install Bull Run Diverter Valve
6 ft of Septic Rock
1000 Gal. Septic Tank
Na SCALE
SPURKLAND ENGINEERINGSEPTIC SYSTEM DESIGN
203 W15th Ave DAV—DOR LOT 4
Anchorage Ak 99501 WENDY EVANS DATE, SEPT 21, 2012
,,....,.1 5310 H£NORICKSON CIR.. ANCHORAGE, AK 99507 SHEET, 3/3 GRID- 2537
PERMIT # DSPXXXX PARCEL ID # 015-292-34 DAVR0R;4D3)DWG
1
1
1
1
1
1
Municipality of Anchorage n X'3� )�
Development Services Department r <<G. �,..
Building Safety Division �Q•• i�
yam{ On -Site. Water and Wastewater Program ,•
4700 Elmore Road 49
P.O. Box 196650 Anchorage, AK 99507 /t
www.ci.anchorace.ak.us
(907) 343-7904 / 59- E. PURK
115
j
Soils Log - Percolation Test I� z �
Performed For: WENDY EVANS1312
Date Performed:
Legal Description: DAV-DOR LOT 4
Depth
Gross Time
ENCOUNTERED?
(Feet)
Net Drop
9/21/12
ORGANICS
IF YES, AT WHAT DEPTH?
-
L
2_
9/21/12
5omk Sgao
3-
n1f{
s4r�y
Date:
i0 i
GruJcl
4-
6.000"
6.000"
0.000"
4-4 4+
10:45 AM
5-
6.000"
6.000"
6-
44 +v
10:50 AM
5M 25S
-1.1-+4
6.000"
&oM
Township, Range, Section:
WAS GROUND WATER
Date
Gross Time
ENCOUNTERED?
NO
Net Drop
9/21/12
5
IF YES, AT WHAT DEPTH?
-
L
Depth to Water After
9/21/12
o
P
Monitoring?
n1f{
E
Date:
i0 i
a
4M 15S
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
9/21/12
10:32 AM
0 MIN
6.000"
0.000"
9/21/12
10:36 AM
3M 40S
6.000"
6.000"
0.000"
9/21/12
10:40 AM
4M 15S
6.000"
6.000"
0.000"
9/21/12
10:45 AM
5M OS
6.000"
6.000"
0.000"
9/21/12
10:50 AM
5M 25S
6.000"
6.000"
0.000"
9/21/12
10:55 AM
5M 30S
6.000"
PERCOLATION RATE C 1 (minWWnch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 4.0 FT AND 5 FT
COMMENTS PRE-SOAKED.
PERFORMED BY: ANSON MOXNESS I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL19MB14INES IN EFFECT ON THIS DATE. DATE: 9/24/12
GRE" ER ANCHORAGE AREA BOP`UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME hf)? N (" ~I N/VS7_- MAILING ADDRESS "SO/ C-, PHONE .894
LOCATION )1e--AlAAl e'�, c01, LEGAL DESCRIPTION le' -4 ltd -')e s34/5
SEPTIC TANK:
DISTANCE �2G, J -CC ,, // NUMBER OF
FROM WELL r MANUFACTURER Chl-:��-TL MATERIAL"L/4 �%C96 COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH J 1 (QUID CAPACITY SCC O GALLONS.
SEEPAGE PIT:
i
NUMBER OF PITS DIAMETER — OR WIDTH�`� LENGTHY -L, DEPTH
LINING MATERIAL( h2l T t?RIB-SIZE: DIAMETER �L_DEPTH �`-' DISTANCE FROM: WELL rl '
TOTAL EFFECTIVE
BUILDING FOUNDATION30 NEAREST LOT LINELL_. ABSORPTION AREA (WALL AREA) O SQ. FT.
ADDITIONAL ABSORPTION
WELL: pc)rp,,cl -ib Ivo 611tl_,i Pc4u,/,ff„FJ"TS
TYPE I'-tr TO'h10 CONSTRUCTION
DEPTH
DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM.
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS 0)
DISTANCES. 04 S lzcLJw DIAGRAM OF SYSTEM
167 1
INSTALLED BY: t� r
PIPE MATERIAL: w ro-d ()An I I
1 -cu lush m
LOT SLOPE:
REMARKS:S1a,,O `tr1- flietlr-.-
�QaU Cc.A hl,iy
lawn- \
r,
LOT 5
DATE Oel.93 Ji71/ APPROVED
Form No. EQ -031
G.A.A.B.
S°
� r
GREATER ANCHORAGE AREA BOROUGH
J'•�4• DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
d G�AQ q 3330 "C" STREET ANCHORAGE, ALASKA 99803
TELEPHONE 274-1881
/L/,eLC)
.. - _ .. .
SEWAGE DISPOSAL` SYSTEM APPLICATION AND PERMIT_
NAME OF APPLICANT PHONEPeaF �s�✓ `CD.,ST: _ MAILING ADDRESS 0� �• Jr�KO PHOb�
INSTALLATION LOCATION
LEGAL DESCRIPTION
Lor 77/ny_ 702 5/0
INSTALLATION OF: SEPTIC TANK ✓ SEEPAGE PIT DRAIN FIELD � OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS y,�C30C�t] TNO TH/IS PQERM
TE ANTICIPATED
IT IS NOT VAL WITHOUT SOIL TEST
COMPLETION DA i'
FINAL INSPECTION: 24 HOUR NOTICEREQUIRED. BACKFILLING OF ANY -SYSTEM WITHOUT FINAL'INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. - - - -- -
SEPTIC TANK SIZE TYPE 6 PAGE .AREA 6IZ TYPE
._ ... .. _,.. .. .. .. __ __.. _
MINIMUM DISTANCES. REOUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK - -
'FOUNDATION TO SEEPAGE PIT DRAIN FIELD /� _
SEPTIC TANK TO SEEPAGE PIT ♦WALL -
r .. .. _
SEPTIC TANK d / / ._ SEEPAGE PIT �'� .DRAIN FIELD
TO NEAREST LOT LINE. 1 ...._ ... .. _ .. _ .. _
WELL TO SEPTIC TANK / 'SEEPAGE PIT
DRAIN FIELD ��� / ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, �D SEEPAGE PIT DRAIN FIELD Q Q
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATIONS FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL - -• - _. _. ._... _. .. _
i
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE 7-,,l-7,/ APPLICANT'S SIGNATURE
FORM NO. EO -016 - - - - -
�� .. 8'0I'L8 LOd: -- ►-
W CLIENT Pederson BY Korynta �+
6-28=14
P OJEC.T 'Dav Do.r. Subdivision' s " DATE r
1 _ EV TOP OF HOLE , } , ` W.O+ D10.� a
22
" Dam i3 own Silt ''Sand gavel SSI GIKJ "
t ,
;. --- 5
5.
' 6
tamp $roWn �'an�Y.
6 //
I I
10 1
14 $e¢ Note_Rqr 1esL }lnle lid ;; - _� 1
�-
15 }
16 w - - ..r
.17. ;. ®�►vm�ea N 181
• L
19
20 2
P1 1 23-B , . 2
ce
22 F�`S� • �°" -� 2
23 :.. _ ®em 2
24 " ry
0.'Bok4
-122
. "Tt
!Well Owner
.0
A. .
WnS SeCU;n *'i*f known, i5tince main'
LocaU01111 .(addRsi'6f:;"To hi Ran wn, .
Dave Dor.
zL
iw
epth of Hole- -6 7 1'.' 11...1 liv.
Size of casin AW i
7.5 d ��feet
(check.. ... _ , �L, niL ct e 1 .!' e. . •:IV� /7f/�'�j.'/�t Lr t� � �'�
t r,
Static water leve L hei ;'u'rface--,:F� in: Igh of well
erfo-
.Screen*
Describe screen or perfor.
ell pumping test ,at ons:; r m u e ours
of drawdown .from 'static ve
TQK
"S. -
ate of comp
Pepth in feet from
"Z4
. size of material, color and hardness 'Prinations penetrated, ground surface
L 0 3
A.
TO
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3 31
TO 6PAUTYOf
jAL pgbl
li L
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.484 :.60
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TO
VA
"Zoe
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—TO—
r�-tr,ef nr
. .-7Certificate Nds.'814 & 973.
Nil 14,
_To
—TO—
D G G S
./V uni¢ipaH y
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Anchorage
POU,-,H 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLE$
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit %: 84016l
January 31, 1985
TO: Permit Applicant
SUBJECT: TI2N RJW Section 15 Lot 18
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Depar=ment for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for doc=mentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Keith E.
Environmental Engineering Program
KEB/lJw
enc: Copy of Permit
SWP/057
Id~l~ ~ I PALITY I3F A~413HC~RAGE
DEPARTMENT OF HEALTH AND ENYIRONI.IENTRL PROTECTION
825 L STREET~ ANCHORAGE, 8K ~9501
2~4-4720
0~4--$ I TE _'5. E I,IER .~-: I,~ELL PERI'~ I T
PERMIT NO:
[)ATE ISSUED:
8PPLICArIT:
ADDRESS:
COHTRCT PHONE~
LEGAL DESCRIP~
LOT SI~E!
MAX BEDROOMS:
840i6&
04710/84
~8HRENCE ERIE
5~20 HENDRICKSON CIRCLE
ANCHORAGE, RK
246-1~29
SUBDIVISION: N~
SECTION: 15 TOHNSHIP:
?5240 (SQ. FT. OR RCRES)
LOT:
RAHGE:
BLOCK':
.LISTED BELOH ARE THE OPTIONS R'¢AILRBLE TO YOU IN DESIGNING YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE.
TREf4CH
DEPTH TO PIPE BOTTOM (FT.) ll.O
GRAVEL DEPTH (FT.) 5.0
TOTRL DEPTH (FT.) ~6.0
GRAVEL HI,TH (FT.) 2.5
GRAVEL LENGTH (FT.) 26.0.
GRAVEL VOLUME (CU. YDS.) .1~.2
TRHK SIZE (GALS) $,000.0
SOIL RATING (SO. FT./AR) 85
,~* TRNK I'IUST HRVE AT LEflST THO COMPRRTMENTS
I CERTIFY THRT
I. I RM FAMILIAR HITH THE REQUIREMENTS FOR ON-SITE SEHERS'RND HELLS RS SET
FORTH B'T' THE MUHICIPRLITY OF RNCHORRGE (MOR) AND THE. STATE OF RLRSKR.
'. 2. I WILL INSTRLL THE SYSTEM IN RCCORDRNCE HITH ALL MOR CODES.AND REGULATIONS,
RND IN COI'IPLIRtlCE HITH THE DESIGN CRITERIA OF THIS PERMIT.
~. ~ HILL RDHERE TO RLL MOA AND STATE OF 8LRSKR REQUIREMENTS FOR THE SET BACK
DISTRNCES FROM ANY EXISTING WELL, HRSTEWRTER DISPOSAL SYSTEM OR PUBLIC
SEHERRGE' SYSTEM ON THIS OR AMY RDJRCEMT OR NERRBY LOT.
4. I UNDERSTRND THRT THIS F'ERMIT IS VALID FOR R MRXIMUM OF ~ BEDROOMS AND
ANY ENLARGEMENT WILL RE~]UIRE.RH ADDITIONAL PERMIT.
IF R LIFT STRTION IS INSTRLLED IM RH RRER COVERED BY MOA BUILDING CODES,
THEN (1) RN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) RS-BUILTS
WILL NOT BE RF'PROVE[.' HITHOUT RN ELECTRICAL INSPECTION REPORT; AND .(~) THE
ELECTRICAL HOR~'ILI~ BE DO~Y R LICENSED ELECTRICIRN. .
- / .................
RPF'L I CR~4~gE ERIE , '
................
MUMCIPALITY OF ANCHORAGE
Develo ment Services Department �_� Phone: 907-343-7904
p p
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-292-34
1. GENERAL INFORMATION
Complete legal description Dav-Dor L4
Location (site address) 5320 Hendrickson Cir
Current property owner(s) Joseph ,JUnker
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Expiration Date: —1 Z
-?l
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
E
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ $840
Date of Payment 3 —1 Z_ 11
Receipt Numbery 3 F.CTG
COSA # OSC211106
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not
guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot
provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole
benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.Date 205
A
co
,;V* 49 TH 9�
6. DSD SIGNATURE f • • • :..
System #1 Approved for bedrooms Steven Ponnone
System #2 Approved for bedrooms ��$��c 0149 f\
Disapproved��w 0 ESS ,
Conditional approval for 3 bedrooms, with the following stipulations:
e
`o
%<
�m
J
JC
ZI
ALT YY o
WAT
AST=V''AT
rn_.
-.AM
Original Certificate Date:_
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
� 10
Legal Description: Dav-Dor L4 Parcel ID: 015-292-34
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
F01 Well log is filed with Onsite (or attached)
Date drilled 7/26/1966
Total depth 75 ft
Cased to 71 ft
0 Sanitary seal is functioning correctly
FER Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 2/16/21
Static water level at beginning of test 23.1 ft.
Comments
B. TANK DATA
Age of tank(s) 9 years
Tank type/material S`°'U'tW
Measured operating fluid level in septic tank
FMI Standpipes/foundation cleanout per record drawing
Date of pumping /a
D. ABSORPTION FIELD DATA Seepage Pit
Which system tested (date installed) 1974
0 ALL standpipes present per record drawing
Total measured depth from grade 3.8 ft (max)
Measured depth to pipe invert from grade 9.8 ft (min)
❑ N/A — pressurized field
F Monitor tubes go to bottom of effective. If not, state
depth into effective
01 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 3.57 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes [ No
M -Coliform bacteria is Negative
Nitrate 062 mg/L ❑ Nitrate less than MRL (ND)
Arsenic u /L Arsenic less than MRL (ND)
Collected by _& Allo Cr ;/itPCC, j_ncl
Date of Sample 2/
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 2/16/21
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 18 in
Water added 450 gal
New depth 28 in
Elapsed time 1440 min
Final fluid depth 18 in
Absorption rate '450 gpd
Any rejuvenation treatment (past 12 months)
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'
El
Yes
Community Sewer Manhole/Cleanout > 100'
0 Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' 7 Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' F/1 Yes
if No ft
Neighboring Absorption Fields > 100'
ft
Private Wells > 100'
Animal Containment > 50' [7� Yes
if No ft
M Yes
if No
ft
if No
ft
Community Wells > 200'
Fv� Yes if No
ft
Manure/Animal Excreta Storage > 100'
F/�
Community Sewer Main > 75' ❑✓ Yes
if No
ft
F,,� Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
El
Yes
if No
ft
Surface Water > 100'
Yes if No
ft
Property Line > 5'✓Q
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
® Yes if No
ft
Water Main > 10'
✓v
Yes
if No
ft
Community Wells > 200'
Fv� Yes if No
ft
Water Service Line > 10'
F/�
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'
E✓
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
[1
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓M
Yes
if No
ft
Private Wells > 100'
Yes if No
ft
Water Service Line > 10'
M
Yes
if No
ft
Community Wells > 200'
Yes if No
ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
5,C -P
G. ENGINEER'S CERTIFICATION
l certify that 1 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
QF Ilk
q�,Q� ppb
• j! C
Stc72 R Pannor.,e
'�0 n t UEE Si
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
March 10, 2021
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Bot 196650
Anchorage; Alaska 99519
Subject: Dav-Dor I_4
Conditional COSA Request
Ladies and Gentlemen:
I am writing to request a conditional COSA be issued for this property to accommodate its sale in the near future. At
the time of the adequacy testing, the owner had been out of town during the cold snap in Anchorage. There was
minor frost buildup at the exit of the tank to the field. The lines were jetted and we re -inspected the line a week later
Finding no sign of additional frost build-up. The system is back in use and no additional frost issues are anticipated.
Per the COSA checklist, the tank and field are a little short on fill, but with the current temperature and snow/ice
conditions. we are requesting a conditional COSA to allow fill and/or insulation to be added in the near future when
(Dround conditions are more suited for such work. The owner was questioned about firost/freezing issues in the past
and has indicated that none have ever occurred before. The repair costs will be less than $2000.00.
If you have any questions or concerns, please contact me at (907) 745-8200.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 1807, Palmier, AK 99645
Telephone: 19107} 71.5-820 FAX: (x'07) 745-8201
SERVING ALL OF ALASKA
BILL TO
Josephjunker
5320 Hendrickson Circle
Anchorage, AK 99507 USA
Alaska Sewer & Drain LLC
P.O. Box 221914
Anchorage, Alaska 99522
(907) 248-9557
www.aksewer.com
INVOICE
103686
JOB ADDRESS Completed Date:
Joseph junker Technician: Scott Wiles
5320 Hendrickson Circle
Anchorage, AK 99507 USA
Technician: Thomas Longlet
D ES -C i\1P ! IONI OF 'Jif ORK
Inspected outside CO and possibly ice build up. First metal cap from stairs look to be okay but the last metal cap from
the stairs is holding high. Recommend having tank pumped as it is holding high. Test leach field after pumping to see
if water come back to tank. Also test from the house to tank.
3/2. Pumped tank out blew air to stir solids. Used hydro jetter to melt ice clog found at tank entry. Cleared ice clog
down line into leach field. Leach field was taking 12 gpm with jetter. Checked tank entry from house. Used pump
truck to mitigate excess water from spilling out stand pipes. Tank is clear and flowing.
TASK DESCRIPT'ON QT" PRICE T0TAL
Service
Service Call:
1.25 $155.00
$193.75
Call
Service Call
Pump
Pump Truck Septic Anchorage (Per Gallon):
1250.00 $0.24
$300.00
Truck
Pump Truck Septic Anchorage (Per Gallon)
Septic
Anchorage
(Per
Gallon)
Large
Large Hydro -Jet - 2 hour minimum:
1.00 $650.00
$650.00
Hydro -Jet
Large Hydro -Jet - 2 hour minimum
- 2 hour
minimum
Pump
Pump Truck - 2 hour minimum:
1.00 $600.00
$600.00
Truck - 2
Pump Truck - 2 hour minimum
hour
minimum
'AfD ON -! t,P iisEfv10 /,.i,1CFtrNT,
3/2/2021 Visa $1,743.75
SUB -TOTAL $1,743.75
TAX $0.00
TOTAL DUE $1,743.75
PAYMENT $1,743.75
BALANCE DUE 10.00
Thank you for choosing Alaska Sewer & Drain LLC
CUSTOMER ,"Wl-i-OI;sZATI }: t
By signing here I agree to pay all the charges presented on this invoice, whether by credit/debit card, cash or check.
Sign here
Date
CUSTOMER A l i\40.AlLEDGEMENT
I find and agree that all work performed by Alaska Sewer & Drain LLC has been completed in a satisfactory and
workmanlike manner. I have been given the opportunity to address concerns and/or discrepancies in the work
provided, and I either have no such concerns or have found no discrepancies or they have been addressed to my
satisfaction. 1 ALSO UNDERSTAND THERE IS NO WARRANTY. My signature here signifies my full and final acceptance of
all work performed by the contractor. Not responsible for lost or broken canle in the line
Sign here
Date
I authorize Alaska Sewer & Drain LLC to charge the agreed amount to my credit card provided herein. I agree that I
will pay for this purchase in accordance with the issuing bank cardholder agreement.
Sign here Date 3/2/2021
FiENDRICKSON CIRCLE
=50.00 L-60.10�'
c
�a
47Q
14
LOT 4
` ire fence
Shed \�
s t
2� o
Wood fence �, Chain link fencE
N
o
hain link fence Z� p 9.4—
Well
20' Utility Easement N
cC)
0
0
to
0
0
O
O
Lot 3
8375S
gfm
SCALE: V= 40'
N$9055'20"E 16$_07 �.,
.- .—
Lot '1
Lot 2
AS -BUILT NO CORNERS SET THIS DATE
® O�
,4�
y certify that 1 have performed a Mortgagee's inspection
llowing described property: LOT Q
� e
DOR SUBDIVISION
49tai •�age
F,lot
Recording Precinct, Ataska, and that the
ments situated thereon
are within the property lines
noverlap or encroach on the
•••..•.•
Fred WaIatka.• �t
ro p petty lying
t thereto, that no improvements on the property lying
thereto encroach on the premises in
'`�,� • • 3255 — S • ° ��`
•
�`O
question and
that there are no roadways, transmission lines or other
visible easements on
yJ
• • •�a ,�,
%pl�SStoKkx- Axzl
said property except as indicated
hereon.
Dated
4
EASEMENTS OF RECORD, OTHER THAN FXV%
at Anchorage, Alaska
this 18th day of October 2012
THOSE SHOWN ON THE RECORDED
PIAT ARE N07 SHOWN HEREON.
FRED WALATKA &ASSOCIATES
Fb 12-7, pg 33-35 BE
(907-248-1666) Engineers and Surveyors
• Municipality of Anchorage iP
On-Site Water and Wastewater Program
i�
(907) 343-7904 s, f E*,
s
Certificate of On-Site Systems Approval ir
Parcel Expiration Date:- frr
1. GENERAL INFORMATION
Complete legal description DAV -DOR LOT 4
Location (site address) 5320 HENDRICKSON CIR., ANCHORAGE, AK 99507
Current Property owner(s) WENDY EVANS Day phone
Mailing address
Real Estate Agent MARCI BOUCHARD Day phone 230-7123
2. TYPE OF DWELLING:
n Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: NONE Distance: ---
/ \ y t 1
Received by: 1 � �(� .T r� Date: i° I°k I -L-
COSA to be release °to the engin er, unless otherwise requested by the engineer.
COSA Fee $ o?5b — Ex15'ii'Y+i nn /9 YLv-5)1 Waiver Fee $ _
Date of Payment jol l'i J) ar Date of Payment
Receipt Number ���br Receipt Number
COSA # 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 SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Phone 279-3916
Engineer's Printed Name LARS SPURKLAND Date 10/16/12
�O
OF
6. DSD SIGNATURE 00 4
V System #1 Approved for-3—bedrooms a
J spugKLAND.'
System #2 Approved for bedrooms a 0 �d
Disapproved
PP lFCPIOE S���_
Conditional approval for bedrooms, with the following stipulatl����`
By: Original Certificate Date: J.0 "
The niciDevelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSH) 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue had r i c
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: DAV-DOR LOT 4
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID #-
Date completed 7/29/86 Sanitary seal (Y/N) Y
Total depth 75 ft. Cased to 71 ft.
FROM WELL LOG
Date of test 7129186
Static water level 30
Well production 7
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL
ft.
Nitrate 2'83 mg/L
Arsenic ND ug1L Date of sample: 9110112
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date of pumping NEW
C. ABSORPTION FIELD DATA
Depression over tank (Y/N) N
Pumper NA
Parcel ID: 020-052-81
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) >12 in.
AT INSPECTION
9/10112
8 ft.
>2.2
g.p.m.
Collected by: ANSON MOXNESS
Date installed 10/8112
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date installed 10/9112 Soil rating (g.p.d./f:2 or ffz/bdrm) 1.2 System type TRENCH
Length 45 ft. Width 2'5 ft. Gravel below pipe 6'1 ft.
Total depth 9.5 ft. Eff. absorption area 549 fl? Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth _ in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
in. "Pump oft' level at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tankilift station on lot >100,
Absorption field on "lot >100'
Public sewer main NA
Sewer /septic service line >25
Animal containment areas >50'
Manhole/Access(Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100,
On adjacent lots >100,
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas >100,
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5
Water main NA Water service line >10,
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10 Building foundation >10,
Water Service line >10' Surface water >100' (N.O.)
>50' (N.O.) >100,
Curtain drain Wells on adjacent lots _
F. COMMENTS
G. ENGINEER'S CERTIFICATION
t certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKAND
Date 10/16/12
COSA brown sheet 10-10-12.doc
Absorption field >5
Surface water >100' (N.O.)
Water main NA
Driveway, parking/vehicle storage >10,
in.
�..r^�,
r .4UNICIPALITY OF ANCHORAGE
DIVISION OF ENVIROM ENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date Y / 211b9
(a) Legal Description (include lot, block, subdivision, section, township, range)
/_ni_ H Dnu —pn/' SttL 4,u z,,bn
Location (address or directions)
.5320 Hene%l rt t kcan C, ri to
1.. 3N10-13zc. a (o_G5co5
(b) Applicants Name 1-uwance4.Jane Erie. Telephone — Home Business 7
Applicants Address 53?0 HerldriGksOn C1rf.ke_ Avinhorrt ,e. 5151 t
(c) Applicant is (check one) Lending Institution ; Ower/builder ;
Buyer Q ; Other E=1 (explain);
(d) Lending Institution T71rs4 Ak'nJ Mbr: GCt y Telephone 5&:k -;1013
Add Tgss RuSineSs Dark: Blvd Awkorezce. 801503
(e) Real Estate Co. b Agent — nc>DIe —
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Kesiaence
Single—Family Multi—Family
Number of Bedrooms 3
3. Water Supply
Individual Well to Community M
Other (describe)
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 1,,
Onsite [EKI Public Community Holding Tank
Note: If community well system; must Vave written confirmation from the State
Department of Environmental Conservatiohtattesting to the legality and status.
[Page 1 of 2]
S. 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 andAr-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 ander-wastawatar_diaposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect an the date of this inspection.
Name of
Firm
Fla*
Technical Selrilictvr
Telephone 3` -13SS
Address
4�47r
kt p'
Box 73&61-N Anchorew
Alarlra 9-7.A;
Date A ri l 21', /98S v s � Q�• ii(q °�
(ENGINEER SEAL) ��••49T" •9*iii
6. DHEP Approval1� ,
Approved for [ •� bedrooms
Approved (i Disapprov,
Terms of Conditional Approval
CAUTION
r•..r•.«.•.•..•.A.
DORE F. MOORE . a/.
CE -3589 Qlt- f
• K
•••••••.•� cow :3
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DEEP 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.
RR4/ej/D18
[Page 2 of 2]
(DHEP SEAL)
7-19-84
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
' MUNICIPALITY OF ANCHORAGE (MOA)
HFALTH ALMMRITY APPROVAL (HAAT APR 2 3 M5
CHECKLIST -FEBRUARY 1984 J�/'�'sL1d C D
A. WELL DATA Legal Description: L'C��( V� L
t Y Dav -4>o,- Sw1
Well Classification Pr;vetk If A, B, or C, D.E.C. Approved(Y/N) —
Well Log Present (Y/N) N. ---Qate Ccapleted Unik Yield I +;z=
Total Depth 6O' * sed to Un kDepth of Grouting
Static Water Level 2'/ At 59' +
Casing Height Above Ground 26", Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) nl
Separation Distances from Well:
To Septic/Holding Tank an Lot 130' ; On Adjoining Lots 160'+
To Nearest Edge of Absorption Field an Lot 160' ; On Adjoining Lots loo'+
To Nearest Public Sewer Lire N.A. To Nearest Public Sewer
Cleanaut/Manhole 1Y -A. To Nearest Sewer Service Line on Lot N:/{.
Water Sample Collected By TF N ; Date H / 17
Water Sample Test Results-Vafu46cle� - No Cohlorn•,
Camments
B. SEPTIC/HOLDING MM DATA No f fes tvzA
Date Installed (&/Z3/ -?If Size 1000 No. of Cc partments 1
Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N)
Depressicn over Ta � (Y �1) Date Last Pumped Sege- 4 Rcltec% R, • � yo -per
Puaping/Maintenance Contract on File (Y/N) for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank: _
To Water -Supply M11 13O' To Building Foundatic��)
To Property Line To Disposal Field 30.
To Water Main/Service Line To Stream, Pond, Lake, cr Major Drainage
Course > i0o'
Comments
Receipt #
Date Paid: y•�3-g5�
Amount: yam/
(Page 1 of 21
2-15-84
C. - ABSORPTION FIELD DATA (vf TesFra�
Soils Rating in Abscrpticn Strata 106 O'led— Type of System Design a P.f
Date Installed ru/t3/7y Length of Field 16'
Width of Field 1q, Depth of Field 9'
Gravel Bed Thickness
Square Fleet of Absorption Area 60 v' Standpipes Present (Y/N) Y
Depression over Field Gate of Last Adequacy Test to / 27 /6 3
Results of Last Adequacy Test �S; k&fac4r4 .
Separation Distance frac Abscrption Field:
To Water -Supply 4bll 160 To Property Line Iy'
To Building Foundati� To Existing or Abandoned System cn
L@I On Adjoining Lots 3y'
To Water Main/Service Line To Cutbank(if present)
To Stremw?cnd/Lake/cr Major Drainage Course > b2S
To Driveway, Parking Area, or Vehicle Storage Area to,
Comments
D. LIFT STATION 14,14.
Date Installed
Size in Gallons
Dimensions
Manhole/Access (Y/N)
"Rump On" Level at *Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes(Y/N)
Ccaments
**
Pumping Cycles during Adequacy Test. Meets M]A
Check Permitted Bedrona Rating Against HAA Request **
I certify that I have checked, verifiedo cr conformed to all MDA HAA Guidelines in effect
on the date of this inspection. -
Signed `� 7iZo.�c Date y/ 2 /es' �� OF At `\\
Carpany F(af�o� Terrbn l MDANo. aS'-a572 i�Q, ••• ••'4s��a
�: .
..................
MU/d5/9..........
• THEODORE/
,. •, • . F. MOORE�
3589 •
(Page 2 of 21
-a r APPLIC' NT FILLS
OUT UPPER HAL"�ONLY
Property (Avner dim d Cindi Walton
Time
ne
NHN Hendrickson Circle
Date
344- 8
Ti
Mailing Addressnny
ZiAnchorage, Akp Code
Buyer Larry Erie
Inspector
Box 139
Inspector
Address Chu iak
Zip Code
Lending institution Alaska Pacific Mortgage
Co.
Phone
Attention: Terri Dubel
Address 101 W. Benson Bl
Zip Coda
-
RealtyCo.aAgent Associated Brokers, Inc.
Phone
Louis D. Campbell
MUNICIPALITY OF ANCHORAGE
;
Address 640 W. 36th Ave.,Zip
Code qqc;nl
Rel -1113
Legal Description Lot 4 Dav Dor
ENVIRONh1=NTAL PROTECTION
Hendrickson,Circle
Street Location
Type of Residence
RECEIVED.
jl{ Single Family
( ) DISAPPROVED
❑ Multiple Family No. of Bedrooms
❑ Other
Water Supply
,�1
�^-^^^, t`.S
iTJ Individual
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
❑ Community \ c�
For wells drilled prior to that date, give well depth (attach log If available).
O Public Utility '3
r
Sewer Disposal
- 7
•�
Ql Individual
Year Individual Installed: ' �/
❑ Public UIIlity
When Connected to Public Utility: a
O Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
4IAJL 11 -P,Po �?
/'t_ 7'-
Time
y
Time
Time
Time
Time
Date
Date
Date
Date r/— / L _ 3
Inspector
Inspector
Inspector
Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
rEPT. OF N`/.LTII f.
ENVIRONh1=NTAL PROTECTION
14 o
�4z� l �✓ �
RECEIVED.
( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL AP ROVAL-
-
DATE —d— 1
BY: conj
,�1
�^-^^^, t`.S
Soils RatingDate
Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size OO D
10
f (D -2 3 — 74{
Well to Tank
72 n r
ALASKA DEVELOPMENT CONSULTANTS, INC.
Engineers 2 Surveyors Planners
5313 Arctic Blvd., Suite 201-P.O. Box 4-3187
Anchorage Ak. 99502 S Anchorage, Ak. 99509
Office:(907)561.1044 `A�\
October 27, 1983 ADC NO 83131
MUNICIPALITY OF ANCHORAGE
Mr. Jim K. Walton CEPT- Of "c"T" r.
c/o Associated Brokers ENVIRON; -NTA' PKOiECTION
640 W. 36th Avenue iSOv $ tA;
Anchorage, Alaska 99503
RE: Septic System Adequacy Test for RECEIVED,
Lot 4, Dav-Dor Subdivision
Dear Mr. Walton:
At your request, our office conducted a percolation adequacy test
on your existing septic system at the above -referenced location
during the period October 25 through 27, 1983. The
Municipality's Department of Health and Environmental Protection
verified that your septic system consists of 1000 -gallon steel
septic tank and a'6 -foot deep seepage pit.'
The septic tank was reported to have rot been pumped prior to the
percolation test. Since the 3 -bedroom house had been occupied up
to the time of the test, a rormal degree of saturation with the
leach field is assumed.'
In accordance with Archorage Municipal Code, Chapter 15.65, Waste
Water Disposal Regulations, any on-site sewage disposal system
"shall have adequate capacity to properly dispose of the maximum
daily sewage flow". The maximum daily flow is computed at 75
gallons per capita -day (gcpd). Since the population of
dwellings shall be estimated at two persons per sleeping room"
the maximum daily sewage flow for your 3 -bedroom house is 450
gallons per day (gpd).
To test the soil absorption capacity as well as the surge
capability of your system, 110 percent of the maximum daily flow
or 600 gallons of fresh water was added in 50 -gallon increments
to the septic tank. The water was obtained from your and your
neighbor's on-site private wells at a flow rate of about 3
gallons -per- mirute (gpm). The liquid levels were moritored
,closely to detect any backup in the septic system.
The attached Table of Test Data represerts the depths of liquid
in the septic tank and seepage pit and the quantities of water
added. The septic tank was determined to be 8.3 feet deep
(bottom of tank to ground surface) with an initial liquid depth
- n n
Mr. Jim K. Walton
October 27, 1983
Page -2-
of 4.2 feet in the tank. The seepage pit was measured to be 8.5
feet deep with an initial liquid depth of 2.6 feet. Ground
elevation at the septic tank standpipe is approximately 1.6 feet
above that at the seepage pit standpipe.
The attached Summary of Test Results indicates that the liquid
level in the seepage pit at the begirning of testing on Day 2
fell to 0.13 feet below its initial static level or Day 1 during
a recovery period of 24 hours. On Day 3, the level had fallen to
0.02 feet above its static level on Day 2 durirg a recovery
period of 24 hours.
The level it the seepage pit at its highest level during the test
(3.4 feet liquid depth) was approximately 2.7 feet below the
liquid level in the septic tank.
Based on two days of testing, a
your existing septic system
,indicated. Since, on-site sewage
`dwelling should be capable of
effluert per day, your syste
adequately at this time.
r average percolation rate for
of approximately 500 gpd is
disposal system for a 3 -bedroom
disposing of 450 gallons of
m appears to be functioning
Many factors affect the operation of a soil absorption type of
sewage disposal system. Soil type, grourdwater depth, age and
history of mairterance of the system, and types of waste are a
few. This test has been performed in an attempt to determine
actual soil absorption capabilities of your septic system under
normal usage by considering the degree of saturation of the leach
field and surge loads that might be imposed or. the system, This
test car only evaluate apparent performance at a given point in
time, and cannot determine either the condition of the leach
field, seepage pit or other components of the septic system, or
the depth of the water table.
We appreciate the opporturity giver to perform this adequacy
test. If you have ary question regardirg this test, please
contact this office.
Very truly yours,
ALASKA DEVELOPMENT CONSULTANTS, INC.
Stephen. D. Shrader, P.E.
Project Marager
til.ciSK11 D1sVE1.//P�IFNT C0NSIILTA?�TS.71NC.
r
n
Adequacy Test for Existing Septic System
Owner: Jim Walton Project No. 83131
Address:c/o Lou Campbell, Associated Brokers, 640 W. 36th Avenue,_ Anchorage
Legal Description: Lot 4 Dav-Dor Subdivision
Components of Septic System: Septic Tank & Seepage Pit
Number of Bedrooms: 3 Occupied prior to test:. Tea X No
How long vacant: N/A Last pumped: Approx. A mnnfha
Test performed by: Doug Popham Water meter/S.N.
Initial Static Levels: Septic Tank 4.2' ; Seepage Pit 2.6'
TEST DATA
Time
-,Liquid�Deoth ft*
Water
Added, gal
Meter
Readinei gal
Remarks
Sept1c Tank
Seepage Pit.
9:14
4.50
3.92
0
40050,
Start Test -
10/25/83
9:28
4.38
3.81
50
40100
9:40
4.38
3.56
50
40150
9:55
4.38
3.34
50
40200
10:11
4.38
3.18
50
40250
10:26
4.41
3.12
50
40300
10:55
4.41
3.18
50
40350
to-noighborrc
11:11
4.39
3.20
50
40400
11:30
4.38
3.12
50
40450
11:46
4.38
3.11
50
40500
12:03
4.38
3.10
50
40550
Stop Test
500 Gal.
*NOTE: Above d
pths are measuzements
Top of
Liquid Level.
Caner:' Jim Walton
n
Legal Description: Lot 4, Dav-Dor Subdivision
TEST DATA (Cont'd)
Project No.83131
Time
Liqui
Det *
Water
Added, gal
Meter
Reading, gal
Remarks
Septic Tank
Seepage Pit
8:40
4.47
4.05
0
40550
Start Test
10/26/83
9:02
4.38
3.87
50
40600
9:12
4.38
3.64
50
40650
9:22
4.38
3.51
50
40700
9:40
4.38
3.31
50
40750
9:58
4.40
3.23
50
40800
10:20
4.39
3.20
50
40850
SS
toan�ighboiro
10:38
4.39
3.15
50
40900-
11:01
4.38
3.15
50
40950
11:20
4.39
3.13
50
41000
11.37
4.39
3.10
50
41050
Stop Test
"Ga LT
9:00
4.48
4.03
Check final
levels
27 83
SUMMARY OF TEST RESULTS
Day 1 Day 2 Day 3
Water added to Septic Tank 500 gal 500 gal -0-
Rise in Seepage Pit 0.8' 0.95'
Rise in Septic Tank 0.1' 0.1'
Recovery Time between Test 24 hrs 24 hrs
Drop in Pit during
Recovery 0.95' 0.93'
Average Absorption Rate 500+ S00
(gal/day)