HomeMy WebLinkAboutDAV-DOR LT 6DAV- bOR
Lot 6
015-292
-32
; (. r ..
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE I I-~NEW
~IAILING ADDRESS
~ DISTANCE TO: [Well [ Absorption area O~lling PERMIT NO. .
Liq, capacity in gallons IF HOME.DE: Inside length Width Liquid depth
~O ~ Well Dwelling PERMIT NO.
DISTANCE
TO:
O Z ~ Manufacturer Material Liquid capacity in gallons
No. of lin. Length of e~h line~. ~ Total length of
-- O0 inches
Length W~dth ~pth PERMIT
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(s)
OTHER
PiPE MATERIALS
SOIL TEST RATING
REMARKS
//
APPHOVED DATE LEGAL
72-013 (Rev. 3~78)
Permit
Applicant:
,--% MUNICIPALITY. OF ANCHORAGF"%
Departmen ~f Health ana Environment& 'Protection
825 L Street, Anchorage, AK. 99501
264-4720
"* * HANDWRITTEN PERMIT * * *
~3C~/"QELL~ AND/OR ON-SITE SEWER PERMIT
~c't/ Mailing Address:
Location:
Legal Description: L ~&~ ~97~
Type of Soil Absorption System Is:
Trench: ~/ Drainfield:
Maximum Number of Bedrooms:
Phone Number:
~ Lot Size:
Seepage Bed: __ Holding Tank:
Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
DEPTH F LENGTH ~ GRAVEL DEPTH V WIDTH
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 width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* # REQUIRED SEPTIC(HOL-DrNGJ--TANK SIZE = /d)-DO GALLONS * *
~ermit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent-to this property and the number
Df residences that the well will serve.
* ~ ~ TWO(2) INSPECTIONS ARE REQUIRED ~ ~ #
Backfilling of any system without final inspection.and approval by this departmeni
~ill be subject to prosecution.
~inimum distance between a well and any on-site sewage disposal system is 100 fee~
for a private well or 150 to 200 feet from a public well depending upon the type
Df public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
~nd must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * # PERMIT EXPIRES DECEMBER 31, 1 9 8 3
I certify that:
(1) 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 codes.
(3) I understand that the on-site sewer system may require enlargement if
the~resideDce is remodeled to include more that 3 b~rooms.
t Date:
/
SWP/024(1/81)
GRE ",ER ANCHORAGE AREA BOP UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~)¢'-~-'~'~%~"/ ('~,~/.qT- MAILING ADDRESS /,t~/ ~, ~E~ PHONE
LOCATION //~ ~.~ ~~t~ ~zF ~{'~*'~'rLLEGAL DESCRIPTION /~ ~> ~ - ~O~
SEPTIC TANK:
DISTANCE
FROM WELL )~'1 ~ ~- MANUFACTURER
INSIDE LENGTH ~ INSIDE WIDTH
NUMBER OF
COMPARTMENTS
LIQUID DEPTH I IQUID CAPACITY. /GOO .GALLONS.
SEEPAGE PIT:
NUMBER OF PITS I DIAMETER
LINING MATERIAL l('fj~''' CRIB SIZE=
BUILDING FOUNDATION°'~O
OR WIDTH ~ LENGTH I~ DEPTH
/
DIAMETER*[~3"DEPTH ~'~ DISTANCE FROM:
t TOTAL EFFECTIVE
NEAREST LOT LINE '~ ABSORPTION AREA (WALL AREA)
WELL '~r~/?-~/r;~'/CO/-/-'.
SQ. FT.
ADDITIONAL ABSORPTION
WELL: ~^3c~c~4-/3 '70 I'ntz'~ ¢~,q/~
TYPE I A//~ t/ CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL. OTHER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER LINE
REMARKS
~'/._/~,L/~'~
DEPTH DISTANCE FROM:
SEPT mc SEEPAGE
TANK SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE: '"'- .
/~5- ~3' .$~,~,~
Form NO. EQ-031
DIAGRAM OF SYSTEM
G.A,A.B.
Well Owhe'r
" M W DRILLING,'Inc ' ' '
P. ~. Box 4-1224 · 1310C International Airport Road
(907) 274-461! .
ANCHORAGr'0 ALASKA 99509
DRILLING lOG
· ' '' "' · '' ~'' , ';.'.(.'".i,.' ' ' '" "~ ' L.' .:.. · .v ·
P~der.~on Constructlo~ ' Use of Well Dom
Location '(address of: T. owns.hip, P, ang~, Section, if .known; or distance'main.road'
LO, BI~ Dave r~r ~ubdiv
Depth of Hole
open end ( ~ );
Size of casing 6
Static water level ] a ~t. ~[~9'~)
Screen ( ); Perforated (
Describe screen or perforation ' Hone
Well pumping test at r~ gallons per (hour)
of drawdown from static level
Date of .completion 1 n :.:a- ??
feet Cased to 4 0 feet
(below) land surface. Finish of well (check one)
,1 hours with
(minute) for ] 007- ~c
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
___!6__TO ~ o
TO
TO
TO ~--
TO
TO
TO
&
TO
.TO
qi 1 tv Gr.,x- ,'-1
Certified Cra:tractor
C~tiIicate l~o's, lin ix
2 -- STATIi:
GReATer ANCHORAGE AREA BOrOUGh
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
3'0"C"STREET ANCHORAGE.^'ASKA
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME OF" APPLICANT /~)~'~-'/~"/~'~)A'/ ~'~'' MAILING ADDRESS
INSTAL~TION LOCATION ~ ~ ~ /~
LEGAL DESCRIPTION ~ ~ ~ ~ ~- ~ ~/~
DRAIN FIELD / OTHER
PHONE
TYPE AND SIZE OF FACILITY TO BE SERVED
SO'L TEST RESULTS
COMPLETION DATE ANTICIPATED
TO BE INSTALLED BY
NOTEs
HOUT ~OIL
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK / ~'*'~g) .~-TYP E
EEPAGE AREA
TYPE
MINIMUM DISTANCES, REQUIREMENT~
FOUNDATION TO SEPTIC TANK "~ /
FOUNDATION TO SEEPAGE PIT ~"'~ /
/
WELL TO SEPTIC TANK /4~'~
DRAIN FIELD ~/~'~ ·
DRAIN
/
SEEPAGE PiT ---
ALSO CONSIDER AREA WELLS*
SEPTIC TANK. /~'"~ / SEEPAGE PiT
SEEPAGE PIT
/p.~ /
DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEE'F INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
DIAGRAM OF SYSTEM
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 E!more Road
P.O. Box 196650
Anchorage, AK 99519-6650
w¥¢w.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-292-52
1. GENERAL INFORMATION
Expiration Date: ,/~)- ~ -2r~- / i
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing...address
DAV-DOR S/D;
5501 HENDRICKSON
DAN ROTH
5501HENDRICKSON
LOT 6
CIRCLE * ANCHORAGE~ AK * 99507
Day phone
CIRCLE *
947-2166
ANCHORAGE, AK * 99507
Day phone
Day phone
Unless ,otherwi"Se requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
IndMdual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class__Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewate[ disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are 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 samples. (Certificates may be reissued for a period of 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.
4. STATEMENT OF INSPECT!ON BY ENGINEER
As certified by my sea/affixed hereto and as of the validation date shown be/ow, I verify that my
investigation, based on procedures outlined in the Certificate of Qn-Site Systems Approval Guideiines 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 furt,Ser vefi~ t,~at based on t,Se
information obtained from the Municipafity of Anchorage files and from my investigetion 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. Phone 557-6179
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
o
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described 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 daft wells and
septic systems depend on the local soils condition, 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 the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owne~ listed above. Any refiance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
.__~' Approved for
Disapproved.
bedrooms.
Conditional approval for
C~ ~eukdst
COSA
Septic System Advisow
Well Flow Advisory
(Rev, 1
Amenic Advisow
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~"~- ~.~, ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF 0N-SITE SYSTEMS APPROVAL
CHECKLIST
Legal Description:
DAV-DOR S/D; LOT 6
parcel ID: 015-292-32
WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 5/10/1975 Sanitary seal (Y/N) YES
Total depth 40 .ft. Cased to 40 ft.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
YES
YES
12+ in.
Date of test
FROM WELL LOG
5/10/1975
AT INSPECTION
6/28/2011
Static water level 19 ft.
24 ff.
Well production 9 g.p.m.
7.9+ g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 mi.
Arsenic: I~,~ ug./L.
Nitrate 5' ~mg./L.
Date of sample: 7/1'3/2011
Collected by: GEG, Ltd.
Bo
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tanksize 1000 gal. Number of Compartments 1
Foundation cleanout (Y/N) YES
Date of pumping
ABSORPTION FIELD DATA
5/10/1974
Date installed 9/6/1983
Length 1 6/50 ft.
*8.6/
Date installed 10/22/1974
Cleanouts (Y/N) YES
Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Pumper ~/'~~ ~J~'~/OC~ }~~J'q~-~'
·
I'BELOW EXISTING GRADEI 11974 CRIB/1983 TRENCHI
105/
Soil rating (g.p.d./ft2or~
105
Width 13/5 ff.
345/
System type CRIB/TRENCH
Gravel below pipe 6/1.5 ft.
Total depth *7,4 ft. Eft. absorption area 520 ft2 Monitoring tube YES
Date of adequacy test *'6/28/2011 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 2 in. Water added 630 gal.
Elapsed Time: 120 min. Final fluid depth 16 in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
**TESTED CRIB ONLY. TRENCH WAS DRY AT TIME OF INSPECTION.
Depression over field NO
For 3 bedrooms
New depth 25 in.
450+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at,__
Size in gallons Manhole/Access (Y/_..~ ~
in. "Pump off" leVe~aJ---~ High water alarm level at
in.
Bantam J
E. SEPARATION DISTANCES
Cycles tested,
Meets alarm & circuit requirements~
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas, 50'+
100'+
On adjacent lots *95'
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main N/A Water service line. 10'+
Wells on adjacent lots 100'+
Absorption field 5'+
Surface water. 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
Building foundation
Surface water 100'+
Wells on adjacent lots. 100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
F. COMMENTS *PER EXISTING WAIVER
G. ENGINEER'S CERTIFICATION
! 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 JEFFREY A. GARNESS
Date 7 / Z I / I '
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number,
LOT t B
LOT 2C
0
0
N 89'58'00" W
zuouu ~ 10'
LOT t C
UTILITY EASEMENT
The location of .the ~'~
shows on this record drawing
(as-built) complies wi. th. Title 21, AMC,
By:~
. . Dat~~
LOT 7
LOT 6
33.3'
'
.N89'55 O0 E ' 100.36
LOT 5
I
CERTIFICATE of SURVEY
I hereby certify that the following described properly has been surveyed by me or under my supervision,
and thal Improvements sllualed thereon do not encroach on adJacenl properly, Ihal ImproYements
on adjacent property do not encroach on the surveyed premises, and that lhere are no power lines,
lransmlsslon lines or other visible easements or rights-of-way except as shown hereon. It Is lhe
responsibility of the owner to determine the existence of any easements, rights-of-way, convenants,
or restrictions which do not appear on Ihe subdivision plat.
PERMIT' NUMBEF4
~.~~.~plot lan Approved plans and spec ....... .... ~._ 5 ~,~
USE ZON~ '~ ig /~ ~
APPROVED
cati
or
W~/..L
I b~ done as shown onj~.is/.MNO Et[y
~nd sp~ifi-
not be changed, modified
first obtaini~ a valid
/I TI-/,J. CI./~-
I~ B.LM. Brass Cap Monument Fnd.
iCJ Al. Cap Moumenl, Sel _, Fnd._
~ B~e$$ Cap Monument, Sel__, Fnd_
~ Iron Pipe, ,Set _, Fnd._
· 518"x 30" Rebar. Sel__, Fnd.x
El Survey Hub & Tack, Set __, Fnd. ~
?jP£5
LOT BLOCK '--
SUBDIVISION i~,z~.,,,/-
· ~~--~=~I~,~*RECORDING PRECINCT, AI.~SKA
ASBUILT
FOR
_.J..--'7..~..'-'~ ~"~x, b~P.
UN.WIN : SC'HEBEN ° KORYNTA ° HUETTL
ARCItlTECTURE ENGINEERING LAND SURVEYING PLANNING
SGS Reft# 1113138001
Client Name Garness Engineering Group, Ltd Printed Date/Time 07/19/201 l 12:28
Project Name/# Day - Dor Lot 6 Collected Date/Time 07/13/2011 9:30
Client Sample ID Dav- Dot Lot 6 Received Date/Time 07/13/2011 15:25
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/13/11 07/14/11 NRB
Waters Department
TotalNitrate/Nitrite-N 3.84 0.100 mg/L SM20 4500NO3-F B (<10) 07/18/11 AYC
Microbiology Laboratory
E. Coli Nezative 1 100mL SM20 9223B A 07/13/11 DLC
Total Coliform Negative 1 100mL SM20 9223B A 07/13/11 DLC
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Envir6nmental Services
On-Site Services Section
P,O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. # ~'~//.~'-'
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
]
Lot 6; Pavdo~ Su~u~Zo~
Location (site address or directions) 5301 N~td~u~ck6on C~c~
Property owner
Mailing address
Lending agency
Mailing address
/,Fnn HaPloid Day phone
5745 T~tr,*,ce P~cZv~ Anchor~;;,, AK 99502
248-3061
265-4189
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Y, XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADE~ attest-
. .. ing to the legality and status of s~/stem.
4. TYPE OFWASTEWATER DISPOSAL: ..
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of AnchOrage files and from my inves.ti..,qation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance' with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection~
Name of Firm
Address
Engineer's signature
17034 EagTe ~ver~oop Ro~o. "/04
DHHS SIGNATURE
.~ Approved for
__ Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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 DH HS 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription:~ ~/~/~ ~//'~
!
Pamel I.D.
A. Well Data
Well type/~/C~-~ If A, B, or C, attach ADEC letter. ADEC water system number ~
Log present, N) ~' Date completed //~/t~/~ ~- Driller /Y~ '"" ~ ·
Total depth[~ /~(~ Cased to ~7z O ' Casing height /Z i, .~_
Sanitary sea~) .Wires properly protected).
FROM WELL LOG
Date of test- ~///~ ~-- r-/~'
Static water level ~'~;~ *'
Well flow ~ .g.p.m.
Pump level1 ~'{ ~
AT INSPECTION .
/
/~UNICIPALITY OF ANQ~OP,~G~-
ENVI~OH~{ENTAL SERVICES DIVISION
I~0V 2 g 19~3
.p.P ECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/~=-~::~ tank on lot /'~'~
Absorption field on lot /~) ~'
Public sewer main ~ //'~r'
Sewer service line ~,.~'
; On adjacent lots
; On adjacent lots
Public sewer manholelcleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform t~ Nitrate
Date of sample: /~/..~"
B. SEPTIC/I'II~t~3~ TANK DATA
Cleanou~N) y
High water alarm (Y/N)
/
~. ~Z /~/.~/~ Other bacteria
/
Collected by: ~ ~' ,~' ~'"~ ~'/~'~','"/
Tank size /~:? ~) .Compartments.'
Foundation cleanout~N, ~ Depression (y~
Date of pumping
Alarm tested (Y/N)
~u_mper, ~, !~"
SEPARATION DISTANCES FROM SEPTIC/~;~g~I~ TANK TO:
Well(s) on lot ,,./~:~ ~ On adjacent lots
To property line ~0 ?t- Absorption field
Sudace water/drainage /~ Y.1z-
Foundation ~" ~"
Water main/so,ice line ~
..,~'/~'./-L~ A//~: ,~- ,5'~,'/~.~-~.f ~=/~ '7'- ,.~.ONTINuED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level __
(Y/N)
Manufacturer
Manhole/Acce~
.'Pump off" Level at
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot ..-//On adjacent lots
/-'" .Sudace water
D. ABSORPTION FIELD DATA
Date installed [~C/~I,~ ~[.~" oil rating (GPD/FF) ~ System~e~ ~
Leng~ ~ ~d~ ~ / /
Total dep~ ~, ~
Total ab~fion area ~ ~ ~ [~l~leano~ present~) .Depre~ion ~er field ~
Date of adequa~ test ///~/~ Resul~(p~ail) ~ ~ for ~ ~dr~
Water l~vel in abso~fion field ~fore test ~0 I. Affertest ~ ~ Ir
Peroxide treatment (past 12 mon~s) ff~ ~ If yes, g~e date ~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot /~ -/' Onadjacentlots ~/~ ~ .Propertyline /~)/ ,./-
To building foundation ~. ~.. v .To existing or abandoned system on lot ~ ~.~ ~",,~5'/,~
On adjacent lots ..~c.3 v~-- Cutbank ,~:~ ~l.J ~ Water main/service line /~C:~ /
Surface water /O~::~ !//" Driveway, parking/vehicle storage area ~(-,~"' /-/--
Curtain drain '~/,,'O/~I~E ~/,~ o ~
E. ENGINEER'S CERTIFICATION -- -- --
I cerb'[y that I h~ave checked, vefifi~or conron:ned to all MOA and HAA guidelines in effect on the.. date of this inspection.
-- , / / ,
· ....
HAAFee$ ~-'~ ~
Waiver Fee $
Date of Payment //- ,~ ~'-,9--.% Date of Payment [/-,-?-F--.9 '~,
ReceiptNumbercOS'-z/<~--A' ' ~.~.~/2), Receipt Number ,:~ ~'-,Fr/~-~
72.026 (3~33)' Back .,
Pederson .. '. , 'BY Korynta m )~i '
k., .
' I
.12;
15
· ...:.... :.: .. ': . ,..
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY SERVICES
Chemlab Ref.t :93.5992-1
Client Sample ID =L6 DAVDOR S/D
[~atrlx :WATER
R~ORT of ANALYSIS
5633 S STREET
ANCHORAGE, AK 99518
TEL: (907) 562-2343
FAX: (907) 56{-5301
Client Name :S & S ENGINL~.~ING WORK Order :72952
Ordered By :R. SHA~_~ Report Completed :11/10/93
Project Name , 'Collected =11/05/93 @ hrs.
ProJectt : Received :11/05/93 @ 16:00 hrs.
Technical Dlrector:$'£u~HEN/C. EDE
PWSID :UA Released By , ~. ~~
Sample Red, arks: ROUTINE SA~ COr~Cz-~ BY, S.S.
OC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
Nitrate-N 2.4 mg/L EPA 353.2/300.0 10 11/09 Ct~R
* See Special Instructions Above UA = Unavailable
** See Sample Remarks Above NA= Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT - Less Than
D = Secondary dilution. GT= Greater Than
~.~WiSI~S Membe, of lhe SGS Oroup (Soci6t,~ G~n6rale de SurveiIlance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO. UTAH, ILLINOIS. OHIO. MARYLAND. WEST VIRGINIA. NEW JERSEY. SOUTH CAROLINA
uni pality of AnchOrage
Tom Fink. 825 "L" Street
Mayor P,O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
November 29, 1993
Robert A. Shafer, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 6 Dav-Dor Subd. PIN 015-292-32
Waiver Request %WR930076
Dear Mr. Shafer:
Your request for waiver(s) of the required 100 foot horizontal
separation of a septic system to a private well has been approved.
The approved separation distance(s) are 95 feet from the well on
the subject lot to the septic tank on adjoining Lot 7 Day-Der
Subdivision.
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, ~
! Robert W. Robinson
Civil Engineer
On-site Services
Concur: /
On-site Services
ljm:~6
MUNICIPALITY OF ANCHORAge-
Department of Health and Human Services
On-site ServiCeS Section
Waiver Review Worksheet
PID9 015-292-32
WR9 WR930076
Date Received: 11/29/93
Legal Description: Lot 6 Dav-Dor Subd.
Engineer: S & S Enqineerinq
17034 Eaqle River Loop Road,
Applicant: Lynn Halford
HA9 HA930729 Permit
Suite 204
Waiver Requested: Well On Lot 6 Dav-Dor Subd.
Day-Der Subd. of 95
to Septic Tank On Lot 7
Criteria: 1.
Geology: , Points:
A. water Table~/~/~'~ ~O
$. Soil Sorption ~,~
C. Permeability ~, %
D. Water Table Gradient ~ F2~i /~
E. Horizontal Separatio~
TOTAL:
2. Special Conditions:
3. Other:
Waiver is
Granted:
List Conditions or Reasons
Waiver is NOT Granted:
for above:
Rec ~: 25463
Amount: $ 625.~0 Date Paid:
ROBERT SHAFER. P.E~
ROGER SHAFER. P.E.
November26, 1993
CIVIL ENGINEERS
(907) 6~4-2979
FAX 694-1211
SITE PLANS
Municipality of Anchorage
DEPARTMENT OF HEAL TH AND HUMAN SERVICES
825 L Street
PO Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 6, Dav Dor Subdivision
5301 Hendrickson Circle
Request you grant a waiver for the horizontal separation distance between
the well serving the referenced property and septic tank on the adjacent Lot
7 at a distance of 95 feet.
A waiver of the separation distance down to 95 feet should be granted for the
following reasons:
o
A slope of roughly 5% provides good positive drainage away from
the well.
A stretch of heavy vegetation and rough ground will deter effluent
from reaching the well in the event of surfacing on Lot 7.
Nitrate levels in the well meet Municipal requirements at 2.4 mg/l
and no coliform or other bacteria are present. Nitrate levels are
typically higher in shallow unconfined aquifers like the one serving
the referenced property verses deeper confined aquifers.
The well log indicates the well serving the referenced property is
cased to its full depth of 40 ft.
17034 NORTH EAGLE RIVER LOOP" SUITE 204 "EAGLE RIVER. ALASKA 99577
Page Two
Dav Dor Subdivision, Addition #2; Block 9; Lot 2
July 6, 1993
The well log indicates the static water level was 19 feet
when the well was drilled. The current static water level is
at 24 feet below ground level. Surface water or septic
effluent must filter through roughly 25 ft of silty gravel
material and then penetrate 10 feet of clay in order to reach
the water bearing gravel at 40 feet· Contaminants will be
removed before reaching the aquifer.
Records on file for Lot 7 show the septic system receiving
soils to be rated at 105 sq. ft. per bedroom. This type of soil
is generally very effective in filtering harmful effluent
contaminants from water as it passes through the soil.
The septic tank is a confined vessel which would not
normally allow effluent to reach the soils except through the
absorption area which is located over 100 feet from the well.
If you have any questions or require additional information for your review please
contact us.
· SHAFER, P.E.
RA S/LSU//su
LEG^L LOT 6, DAVDOR SUBDIVISION
D~WN L. S. ULSHERIc~D-R.A.S.ID~TEll/~6/9~
-I
~o' ~ ES~ J" ~ ~ ~ STRUCTURES, EASEMENTS, OR ENCROACHMENTS
mm ~ ~ ~ j SHOWN ON THIS SITE P~N ARE AS SHOWN ON
~ ~ ~ ~ / AN AS-BUILT SURVEY DRAWN BY:
I q q ~ / U.S.K.H.
II ~ ~. ~ / IT IS THE RESPONSIBILTIY OF THE CONTRACTOR
,, ~ ~o~-/ co,s~,uc~,o,.
"~.mX X~~ '
i '- ~1 / ~A~'c~so"
ROBERT SHAFER, P.E.
ROGER SHAFER. P.E.
W~T.T. ~ TEST DATA
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
c~.z~"~ ~ L ¥,d/J
LOCATION OF WELL (Legal Degcrt~tlon)
~ST ~TAs
CLOCK DEPTH TO DRAWDOWN PUMPING
T~ WATER BATE
MISC. DATA t CASING HEIQHTI ~_ 4- , SANITARY SEAL? s ~-~,
WIRES ZN CONDUIT?s ~ GRADING O.K.?s ~
BACTERIA & NITRATE SAMPLES CO?.~.~CTEDs It~l?W
FLO~ BATE NOT (~NTEED--BOBSEQUENT VARL~TIONS CAN OCCURI
O~ SrTE
17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577
CERTIFICATE of SURVEY
I hereby certify that Ihe following described property has been surveyed by me or under my supervlslon,
and that Improvements sltualed thereon do not encroach on adjacent property, Ihat Improvements
on adjacent property do not encroach on tho surveyed pramlses, and that there are no power lines,
transmission lines or other visible easements or rights-of-way except as shown hereon. It Is the
responslblllty el the owner to determine tho existence of any easements, rights.of-way, convenants,
or restrictions which do not appear on th? ~subdlvlslon plat.
. '_ o
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Dar e ~-~/~- -~ /~', ~,
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name ~-~? hI~lJ-~:~-j'~ Telephone,~.Home ~-~--"~'-'~'Z'B(%siness
Applicant Address
(c) Applicant is (check one): Lending Institution
z.c - , 170
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Fa mity~,~ M ulti-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well~. Community rl Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. ,.,,\~ ~' t ( ~', ?.
4. SEWAGE DISPOSAL ~; '. ;~ t,~,,.
Onsite/~ Public[] Community[] Holding Tankl'l : ~ I
Note: Il community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
P? 1 of 2
iENGINEERING 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 t~3 ~-~ ,I"L-'-~¢',,-'?~ ~ '~l".~.{~"--'¢J-~'"~.e.ephone ~-'~' --"7~'O ~
Address ~:3 ~----' - ~"
Date ~ ~
Approved for (~/~Jt _ bedrooms bye..
Approved ' ~ Disappro~/e'd
Terms of Conditional Approval
Conditional.
· '~" ~'~,ll~l
, ~'"~ ' CAUTION
The Muncipality of Anchorage Department'of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations' ~iven in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHE,P,does this as a courtesy to purchasers of homes and their lending
institutions In order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
;~AG~HECKLIST - FEBRUARY 1984
ANC.~O ' 264-4720
j,,,,,jb~',Ct ?ALtTY OF ..... &
D~FT. OF
ENNt?.O,%V,~.N1 AL I: ~-O"~ [ CT '0 N Legal Description: L~:~r- ~
WELL DATA
Well Log Present (Y/N) [~-,~' Date Completed ~'s'~"~-~'°"~"'-~'"~ Yield
Total Depth ~ Card to ~ Depth of Groutin,
Static Water Level ~ ~ Pump ~t~
Casing Height Above Ground ~// Sanita~ ~al on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/~
Separation Distances from Well:
To Septic/Holding Tank on Lot { ~:~" "J-"
To Nearest Edge of Absorption Field on Lot { ~-'~' ·
To Nearest Public Sewer Line
Cleanout/Manhole ~/1~
Water Sample Collected by
Water Sample Test Results ~
; On Adjoining Lots
; On Adjoining Lots [ ~ ~ 't-
To Nearest Public Sewer
·
To Nearest Sewer Service Line on Lot ~OO
Comments
SEPTIC/HOLDING TANK DATA
Date Installed __ Size
Standpipes (Y/N) ~'~"'~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) I,O C~
Pumping/Maintenance Contract on FiFe (Y/N)
Holding Tank High-Water Alarm (Y/N)
separation Distances from Septic/Holding Tank:
To Water-Supply Well ~ ~::~C~ I ~
TO Property Line J ~--
To Water
Course ~
No. of Compartments . ..~
Foundation Cleanout (Y/N)
Date Last Pumped
:fo
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~" /
To Disposal Field I 0/- ('-'
To SIream, Pond, Lake· or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption .Strata
Date Installed c~/~/~:~
Width of Field ~¢:> C:~ '/
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field '7 ~
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last'Adequacy Test
Separation Distance from Absorption Field:
To Water-Suppl~, Well I ~,,"~,> ~' To Property Line '~,~,, [
To
Building Foundation To Ex[sting or Abandoned System on
Lot ; On Adjoining Lots ~2~t ~
TO Water Main/~ ~---5 /-~"'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutbank (if present)
LIFT STATION
"Pump On" Level at / /"Pump Off" Level at ~
High Water Alarm Level at ~,~ / Vent !~
Tested for // / Pu~J;~,~ Cycles during Adequacy Test. Meets MOA
Elect rical Codes (Y/N)~ / / . ·
*" Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, ~nformed to all MOA and
Signed ~w~, A~Date
Company ~..~"~'~l'~-~"~a.-~41L ~l'~.a[ No. ~,
Dateof Payment~(~ ~ I ~ ~
Amount: $ ~0~t~
HAA guidelines in effect on the date of this inspection.
Page 2 of 2
Engineer's Seal
"' -" APPLIC--NT FILLS OUT UPPER HAI"~ONLY
Phone
a Pubfic Utility
Sewer Disposal ~/
~ Holding Tank
NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
~ ) DISAPffiOVED
(~) CONDIT~NAL APPROVAL
Soils Rating Date ~wer Install~ Well TO ~sorptlon Area /~ ~ I ~ Well Log Recelv~
August 18, 1983
Commonwealth Area
Marilyn Riggle
4794 Business Park Blvd.
Anchorage, AK 99503
Subject~ Lot 6, Day-Dot Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
" The septic tank pumped with a receipt submitted to this
department.
" An adequacy test needs to be performed on the existing
leaching area. This test will determinc if the system is
adequate according to National Standards. A listing of
private firms performing 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,
RP33/ej/E2
Enclosuru
Robert C. Pratt
Associate Environmental Specialis~
AI ASKA
I IiiJIRORm I TAL COFITROL SE RulCeS, Ii'lC.
~ncjin~rinq ~ ~nuironm~nl~l $1u~i¢$
KEN MARSH
GENERAL DELIVERY
TRAPPERS CREEK
AK 99688
AUGUST 18 1983
MUNICIPAUTY OF AN
f.N¥1RON~,A'--NTAL p~OT f. CTION
AUG 1 g
RECEIVED
SELLER - KEN MARSH BUYER - ROBERT flALLFORD
SUBDIVISION - DAV ]~3R BLOCK - 0 LOT - 6
ADEQUACY TEST FOR SE~IER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A PIT/CRIB WITH AN AREA OF 348 SQFT,
THE SYSTEM IS CAPABLE OF ACCEPTING 1 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 7 GALLONS,
THE SYSTEM IS UNACCEPTABLE BECAUSE THE SURGE CAPACITY IS LESS THAN
75 GALLONS.
THE SYSTEM IS NOT CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUEE OF
THIS 3 El)ROOM HOUSE.
,,,.. ~.'% ........
· j~t..- ~o. ~-f .. ',~
' ~ i~'l., .....
1000 IS ADEQUATE FOR
1200 Igest 33rci Aucnue, Suite B · Anchora~lt, AlosLa s95o3 · (9o7} 276-1361