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HomeMy WebLinkAboutFREEMAN LT 4Freeman Lot 4 #016-112-03 1 GRE1"cR ANCHORAGE AREA BOf"�IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 1AA(111CA RI)CR MAILING ADDRESS &x '174-9i0 gL7irh 9F507 PHONE o27a LEGAL DESCRIPTION 10T --/ FCZ_mAre SU . SEPTIC TANK: DISTANCE70 , NUMBER OF FROM WELL MANUFACTURERLO/Ak-" MATERIAL COMPARTMENTS INSIDE LENGTH —' INSIDE WIDTH LIQUID DEPTH : IQUID CAPACITY 1,350 GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER – OR WIDTI+al , LENGTHR3, DEPTH /A ¢., 95� LINING MATERIAL d /U.242 CRIB SIZE: DIAMETER'y DEPTH 9 DISTANCE FROM: WELL / r TOTAL EFFECTIVE BUILDING FOUNDATION S2L , NEAREST LOT LINE �� ABSORPTION AREA (WALL AREA) tSZ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE C' 37kilt1t' CONSTRUCTION �' r, 6(/u.GGd DEPTH BUILDING FOUNDATION CESSPOOL `— .736 1 DISTANCE FROM: NEAREST NEAREST I SEPTIC 1 SEEPAGE n / LOT LINE �0 SEWER LINE �O -f , TANK , SYSTEM 9`s OTHER SOURCES APPROVED !_� DISAPPROVED DISTANCES: '05 5/ioL0A) • lW ie INSTALLED BY: � PIPE MATERIAL:004t/he", _ LOT SLOPE: REMARKS:APlP t'AMIiO/i!/!t� Form No. EQ -031 REMARKS 4 DIAGRAM OF SYSTEM ft 95 4x- 'TranS:rG ?3' � Ql � kr sb ar DATE 3, .12124 APPROVED G.A.A.B. y GREATER ANCHORAGE AREA BOR UGH oTELEa• V4 � Q DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 •'C" STREET ANCHORAGE, ALASKA 99503 PHONE 274.4561 T f 's f J SEWAGE DISPOSAL SYSTEM — APPLICATIONN% ANDPERMIT r� NAME OF APPLICANT - /��CU.S.Cb �+/�+ f� MAILING ADDRESS �"'�// / // pNONEs 'z7 -E_ �W INSTALLATION LOCATION LEGAL DESCRIPTION"-// I/ 'Fo-«94'A/ Sx:;l& uU / INSTALLATION OF: SEPTIC TANK - �C , SEEPAGE PIT, DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE FINANCED THROUGH CJ / SOIL TEST RESULTS COMPLETION DATE ANTICIPATED B TAL TO BE INSTALLED BY - NOTE& THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BA --C FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY LL BE SUBJECT TO PROSECUTION. SEPTIC TANK S1ZE 1011 ��rr TYPE iI%/A 4&&� EPAGE MINIMUM DISTANCES, REQUIREMENTS 5/ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT / DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL - - /J / SEPTIC TANK -C SEEPAGE PIT ;za DRAIN FIELD S / TO NEAREST LOT LINE. WELL TO SEPTIC TANK 16-d SEEPAGE PIT /1" / DRAIN FIELD /&B' / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC A TANK � ,SEEPAGE PIT � , DRAIN FIELD SEPTIC TANK, /6` `SEEPAGE PIT A" DRAIN FIELD 161911 TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION B FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING I STALLATION. G.A.A.B. OR LICENSED DESIGNER SIZE 66r/e�X"z DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IISSS IN ACCOR NCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EO -016 n r'1 \ - / ;�' def 2 tits• .� / .•i -i. ! e: f �. ,� �n... ���... Qf J.•:a ^. f\�L//.: ,71%%v ;anaa.rrFVPl:' :: Ilj,.'p••gnf '$0 R 1t W/:1 a;:-r...Sn^ 0K IAO . .100 Certified h'k Well MUNIdPALITY OF AN4iOPAf3F;'•t ;t•' •: 7 120 DEPT. OFHEALTH& "'•- �'.'.= ••ter_, :. ForNeWo er:_. wril�.^...`iPTEQIOt�M T...' wTpp/ Location 1986 17 _ Date � ~ 2?5 Completed .. .Z �.._....._......»......_..___..».._.....__.._._.._ , 236 Depth Z' A e t bh [[ t( :' Y `, E D.:.r of well ... .._..._._......�.........._......-._.._.._ :R.L.�..1. • .•' •y •nnit •- Size of casing T ».. . Distance to waterR»......_......_._.._.._._.._�__.._. >t `• �• .. Distance to water whUe pumping at rate . of hour. -.4,21.1....... _.._._ gallons per Fre G Description of Formation from to Y.' ,71%%v ;anaa.rrFVPl:' :: Ilj,.'p••gnf '$0 R 1t W/:1 a;:-r...Sn^ 0K IAO ^ n ^�n1LG avPl:•% x?le�rw i^^ .100 117 alne ena itr ¢t'" nl �rT�^3^f - 117 120 ^l nt. "),i r4 ar- m,?P1 131 u -7r- v:'n4 120 170 171 :.v n.., 4 v.q ^lrnl r -A'? 1:-+..9 17n 17 17 2?5 4 r. r 'vPl ': .:ate^ rp-- 23 236 SE 41VE4 $WINO' 22 — 1415022-6 above true and correct. r Driller FOSS DRILLING 1396 NGRA PH. 279.2649 ANcHonAG$ ALASKA 99501 you to attach this certificate to your deed. cc-. DWS Cc: -Mwni of 'Ancko.,9e 2/66 •> ('. Y.' '.i - .lT '� t\.:'''. V �. iV i•N \",'L � 1r W"l'i• + J ,t RLJEIVED GREAII.R ANCHORAGE AREA BOROUGH JUN 1 :1974 Am DEPARTMENT OF ENVIRONMFFITAL QUALITY Case N 3330 "C" Street w0,1.IPCHORAJ IMI&QUl0iii" ANCHORAGE, ALASKA 99503 of Performed For Howard Elder Dated Legal Description: Lot 4 Block Subdivision This Form Reports Soils Log_ XX - Soil Test Must Be Logged To 4' Below Proposed Depth Feet Soil Characteristics 1-- 2- 3- 4- 5- 6- 7— 13- 14— Light brown sandy silt SM Grey coarse sand SP Sandy silt and medium gravel GM Coarse gravel and sand Sw Was Ground Water Encountered? No If Yes, At What Depth? Performed June 11, 1974 Freeman Percolation Test Seepage System - -Reading Date Gross Time Net Time Depth to H2O Net Drop I Percolation Rate Minute Proposed Installation: Seepage Pit x2L Drain Field Depth of Inlet Depth to ottom of Pit or Trend COMMENTS: Based on Borough regulations, we recommend 187 sq. ft. per bedroom. Test Performed BY JohnJameson Date Certified BY: Date: iv F-13 F.UG 9 1974 ANS GREATER ANCHORAGE AREA BOROUGH 0RAU AREA$ORGN DEPARTMENT OF ENVIRONMENTAL QUAI.ITI{4ttA'"o" S0 §PIAL 3330 "C" Street pan. ANCHORAGE, ALASKA 99503 Revised Performed For Howard Elder Dated Performed Aug. 7, 1974 Legal Description: Lot 4 Block Subdivision Freeman This Form Reports Soils Log xx Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 1- 2- 3- 4- 5- 6- 7- 13- 14— Light brown sandy silt Date SM Net Time Depth to H2O Net Drop Grey coarse sand /`>� SP Sandy silt and medium gravel GM Coarse gravel and sand /25 SW Coarse rocky fine sand �5� SP EM I Was Ground Water Encountered? No If Yes, At What Depth? i Reading Date �-Grvss� Net Time Depth to H2O Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit xx Drain Field Depth of Inlet Depth to Bottom of Pit or Trenc�4� COMMENTS: Extension of previous excavation for death. Originally reported June 11, 1974. Water table in this area is about 40' to 50' below the knoll surface. Test Performed BY W. Attwood Date Certified BY: Date: GREATLR ANCHORAGL AREA BOROUGH DEPARTMENT OF ENVIRONMF11TAL QUALITY Case N 3330 "C" Street ANCHORAGE, ALASKA 99503 Second Revision Performed For Howard Elder Dated Performed Sept. 11, 1974 Legal Description: of 4 Block Subdivision Freeman This Form Reports Soils Log_ xx —__Percolation Test - Soil Test 14ust Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 2 -- 4 — 6 — 8 10- 12- 14— I 0- 12- 14- Light brown sandy silt SM Grey coarse sand SP Sandy silt & medium gravel CM — Coarse gravel and sand SW Coarse rocky fine sand SP Was Ground Water Encountered? No If Yes, At What Depth? =C:�::CM NOMMEMMM Reading Date Gross Time Net Time Depth to 1120 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to ottom of Pit or Trenc 1i 6' COMMENTS: Extension of previous excavation for depth. Originally reported June 11, 1974. Water table is 80' below knoll surface and 50' plus below surrounding surface (well loesl.__ Test Performed BY W. Attwood Date Certified BY: ALASKA MINERAL & MATERIALS LAB Date: Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 016-112-03 Expiration Date: 7 1. GENERAL INFORMATION Complete legal description FREEMAN S/D; LOT 4 Location (site address) 11300 READER ROAD, ANCHORAGE, AK, 99516 Current Property owner(s) KENNETH DAZEY Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 11731 HILL TOP DRIVE, ANCHORAGE, AK, 99515 KEVIN ELFRINK W/ GLOBE REAL ESTATE Day phone 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request for. n/ c 11 345-1153 727-2150 Received by: i Date: 1 L=' COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5210— Date 21O—Date of Payment L4 L ITl iq Receipt Number (lLIIG� COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: TYPE OF WASTEWATER DISPOSAL: IN Individual On-site ❑ ❑ Individual Holding tank ❑ ❑ Community On-site III ❑ Public Sewer 0 Received by: i Date: 1 L=' COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5210— Date 21O—Date of Payment L4 L ITl iq Receipt Number (lLIIG� COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 watersupply 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 INS.TL-E, Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineers 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 of all wells and septic systems depend on the local sails 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 ofhowlong the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sale benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for __4_ bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following 337-6179 OF , CE -79 3 If�j�/elf F d Pro f as slolioll; 2P�\AY tOFt t V6 `6ri/� ON-SITE WATER AND WASTEWATER n1 Original Certificate Date: r l T The cipalr y MbnlDr Ancho4ge Develop, emt 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. ATTCHMENTS: COSA Checklist t/ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other In- 11/W If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: FREEMAN S/D; LOT 4 Parcel ID: 016-112-03 A. WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/6/1974 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 236 ft. Cased to *40+ ft. Casing height (above ground) 12+ in. Date of test Static water level FROM WELL LOG 9/6/1974 75 Well production 8 WATER SAMPLE RESULTS: Coliform loer colonies/100m]. Arsenic: 5' G(V ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material AT INSPECTION 3/13/2014 75 ft. 5.8+ g.p.m. Nitrate r7. 36 mg./L. Date of sample: 3/13/2014 Tank size gal. Number of Compartments Foundation cleanout (Y/N) Depression over tank (Y/N) Date of pumping C. ABSORPTION FIELD DATA Collected by: GEG, Ltd. PUBLIC SEWER Date installed Cleanouts (Y/N) High water alarm Date installed Soil rating (g.p.d./ft2or ft2/bdr Length ft. Width ft. Total depth ft. Eff. absorption ea ft2 Monitoring tube Date of adequacy test Results (Pass/Fail) Fluid depth in absor n field before test in. Water added Elapsed T' _ min. Final fluid depth in. yrejuvenation treatment (past 12 mo.) (Y/N & type) System type Gravel below pipe In Depression over field For bedrooms gal. New depth _in. Absorption rate >= If yes, give D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off' E. SEPARATION DISTANCES level at Cycles tested Meets alarm & circuit requirements? QEQ yooj CoSst Ra S �S F�6„ Ems•+� SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 2��F Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Wells on adjacent lots Property line Absorption field Water service line Surface SEPARATION DISTANCE FROM ABSORPTION Property line , Water service n drain F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water Wells on adjacent lots I certify that t 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 �j16/Af (Rev. 11105) TO: Water main Driveway, parking/vehicle storage Lot 2 Lot 3 O 0 0 N W O O O 0 O O Lot 1 9 II_ MONA AVENUE �P 49th00 A���9I,I 00 ... .L....... s-00 0 %Fred Walatka. ff i titill, 3255 - S e SCALE: 1"= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FH, pg 47-49 0 8395L 30 LU W W o �to 0 N �I W W C7 O Q O W O � 0 O O Z I 30 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Morkgagee's inspection of the following described property: LOT 4. FREEMAN SUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the properly lines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on the properly, lying adjacent thereto encroach on the premises In question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 11th day of April 12014. FRED WALATKA & ASSOCIATES Engineers and Surveyors BE 1 (907-248-1666) 0 Municipality of Anchorage Pipe Types AB Acrylonitrile -Butadiene -Styrene AC Asbestos Concrete CC Concrete Cylinder Cl Cast Iron CM Corrugated Metal CN Concrete CU Copper DI Ductile Iron GI Galvanized Iron MLC Mortar Lined Concrete PE Polyethylene PLNT In Plant Flow Channels PV Polyvinylchloride RC Reinforced Concrete RE Relined RP Techite ST Steel TN Tunnel UNK Unknown VC Vitrified Clay WS Wood Stave WSP Welded Steel NP No Print " Private System N A 150 300 600 Feet Map Created: 05/11/2009 Grid Number SW2633 i i S2534 H Wastewater Coll i 3 e; i Y Wastewater Coll 3 e; Wastewater Coll DATE SCHEDULED 7.J2G.to � TIME Cp'; p0 .... INSPECTOR { SUBDIVISION FREEMAN BLOCK/LOT/TRACTLT 4 INDICATE NORTH d E f a� a SIZE MAIN: TYPE MAIN: DEPT AT MAIN: AT PROP. LINE: -7 f CONNECT LOCATION: COMMENTS: d- INSPECTED BY: ,� _ DATE: 7-Z MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: {907}564-2762 JC_- t WASTEWATER CONNECT PERMIT 05 - 3604 1 Y DATE OF APPLICATION 06/24/2005 SCHEDULED COMPLETION DATE 12131/2005 BLOCK/LOT/TRACT LT 4 X; SINGLE FAMILY SUBDIVISION FREEMAN MULTI -DWELLING No.APT5_ COMMERCIAL TAX CODE 1611203 GRID SW2633 AS -BUILT STREET ADDRESS 11300 READER RD OWNER DAHL ,JON G &THERESA E PHONE MAIL ADDRESS 152 BOYER RD GRANTS PASS, OR 975269705 CONTRACTOR 'UNKNOWN ASSESSMENTS Repair Existing Service X _ Main Line Extension X On Property Only ,., . City Tap Have Been Levied Hydrant Only _- 50' or Longer- To Be Levied Main Tap - To Prop" Line Only Comments: Main Tap & On Property Connect Row No. Disconnect R & R- Main Tap Only Owner - Staff ,.,.%7%' CONNECT SIZE 4" ISSUED. vrwecm .INSPECTION FEE $ 64.00 X, PAID CASH PERMIT FEE $ 38.00 CHECK # $ 0.00 X7 OTHER VISA DEPOSIT $ - 0.00 INSPECTED BY REIMBURSABLE TOTAL $ 102.00;Ug,g DATE 7 FP'd NUMBER REMARKS PERMITTEE (Please Print) PHONE MAIL ADDRESS . t . "?--,. SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Original 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. n1 A-11 a-ni HAA # n5Q.V-10 Expiration Date: 11 1411.4ppt e 1. GENERAL INFORMATION Complete legal description _Lot 4: Freeman Subdivision Location (site address ordirections) 11300 Reader Rd. An hora£P', AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address John Dahl Day phone Day phone Ray Dahl Day phone 244-7611 12836 Lindsey Cir. Anchorage AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 7[X] Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer a 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 between 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 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 sample results. (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 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 Health Authority 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 S 6 S Eneineerine — Phone 694-2979 Address 17034 N Eaple River LooD Ste. 204 Eaple River, AK 99577 Engineer's Printed Name R084!41 C . Cot -.4-1 Date / O l 3 /o S� 5. DSD SIGNATURE Approved for ___4_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev OUA2) Municipality of Anchorage ••.,_ ' Development Services Department Building Safety Division - 011 - On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST' Legal Description: -eT q Faiw—m04U S/b Parcel ID: 016 A. WELL DATA Well type t�iLlVmt. Date completed �/'j4 Total depth o23G, ft. If A, B, or C provide PWSID # Sanitary seal 6N) LL` -S Cased to 0M' ft. Well Log&) Wires properly protected �f! ) Ire, Casing height (above ground) let in. FROM WELL LOG AT INSPECTION Date of test _� `6 �'� ri Static water level eiri Well production. g.p.m. S�`� g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate 0, 139 mg./I. Other bacteria C> colonies/100 ml. Arsenic: — mg./I. Date of sample: /05 Collected by: s4"C 1EA.)4(k19CttAK76 B. SEPTIC/HOLDING TANK DATA PL, BL le— gELt3la� Tank Type/Material Tank size -3 Date installed gal. Number of Compartments _ Cleanouts (Y/N) Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft. Total depth _ ft. Eff. Date of adequacy test Pumper Soil rating (g.p.d./ft2 or Width System type ft. Gravel below pipe ft. fe Monitoring tube _ Depression over field Results (Pass/Fail) For _ bedrooms Fluid depth in absorp ' ield before test _ in. Water added_ gal. New depth_ in. Elapsed Tim min. Final fluid depth _ in. Absorption rate >= g.p.d, treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on" level at _ in. "Pump off" l� Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N K Absorption field on lot P 14 Public sewer main i High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots N t On adjacent lots I DD � i - I Public sewer manhole/cleanout Sewer /septic service line ,7-{ I t- Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Pu6t-1C- Building foundation Property line Water main Wells on adjacent lots SEPARATION DISTANCE FROM Property line Water service line Surface water FIELD ON LOT TO: PL)V -tc- foundation Water main Water Service line/ Surface water Wells on adjacent lots F. G. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage I certify that I have determined through field inspections and review of Municipal records that the above systems are in/?, conformance with MOA HAAnguidelines in effect on this date. " . ; sosErtT c aow,w f 1�Cgt%.�i Cw'i✓ �s.�` cE-tif301 wf Engineer's Printed Name ��, Date HAA Fee $ 3 0 • JJ Waiver Fee $ Dale of Payment 10 % -tlo S"- Date of Payment Receipt Number O 7 f b' 13 Receipt Number (Rev. 12101) V ►>\ ------------- k'I,V 1: 'A G a a.l.r o N QI :.�.a• .....: N p ecALC 1 �r~� •'��. FR ANL ti /- 6I4-4-t�t/ /lolisE x w(• (got F ,S O �01 i VOi H /j s�vl, qi 4-11 .� 200. so '•Ar� •1 /JPT• 7 W ,01 w°,i.fhN MORIA AVE•. ~ I EASEMENTS OF PEC0R0, OTHER THAN t THOSE .',HO YN ON THE RECORDED t A/ 4-w,1 4 I LAT, ARE NOT SHOWN HEREON, Ha C•re«/ L•1 TTn Ou• {AW Na, Pap Na. lA! ,c _��� 1 he's e.nih tw•t 1 Iwt urt.ya IM IINb.•crl� 0•IaIDW OroOarM1, 1a1IlocY `� .: C OF A, (,tl, fPCh1AN 3uAD• v Ahi n4- h, OO.,, �!!i•I/,� AYMr, lnd Meet \a.•�'•••• � ! In..roro..r•..\II a,1u11•A tr«won «1 wAlwn IN M00«I• 1j." .M M Pel w«4► o. y'l4' • l'4� ' •MILAN M IM MOw•ry I►In. aCl•o.nl IMr/10, IMt M lnPMwwrIH ♦• WDw �y'�� Il•M w71•t•^I In wale Intr4-•rJ\ an 111• p•mwl In y,wlam And In•1 11.•,1 We" ro; J.,4- y � *�g •., � � I% Vln«NNwn on" p Stow •i\IOb ""rrf•no py 1414- • •«,n •..•r. r•...w n, 1 Pr•v...T I•I/pl M l..11w.l,d Pw•on. �,,Adltxrd7r\f•V /r •t \N •„t. M•.. N. .M' # le ' ' I J, ti v. H 1)04-4 ; { AMMI••a, Alwv: __ S SEP/: 1496 � �,, •. ��r S& HFALTHAITHOWTV APPROVALS SEWERAWATER MAIN C(TEtbgNS SEWER 6 WATER INSPECTION ENDWERWGSTLIDIES AIDREPORTS WEN.NSPECDON A FLOW TEST SITE PUNS r rn PERCOLATION TEST STRNCTLRA1d MECHANICAL INSPECTIONS ONSITE WASTEWATER OtSPOSALSYSTEM DESIGN October 14, 2005 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 4; Freeman Subdivision 11300 Reader Rd. Anchorage ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907)6942979 FAX (907) 6941211 This letter is to certify that the septic system has been decommissioned according to M.O.A. regulations. The house has been connected to public sewer. The tank has been pumped crushed and abandoned and the septic stacks removed. The attached as - built survey was done prior to decommissioning and is for purposes of well head location only. If you req . e a itional information, please contact us. A. Shafer, P.E. 17034 NORTH EAGLE RNER LOOP A SURE 204 • EAGLE RMR, ALASKA 99577 Municipality of Anchorage -• Development Services Department r$`' Building Safety Division =/a On -Site Water and Wastewater Program S A .. T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET To: Bob Cowan Legal description: Freeman lot 4 The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. ® Incomplete; missing Old septic system (including Pipes above groundl must be permanently abandoned. ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: Jeff Date: 10/6/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OF ANCHORAGE ARL 44�iz DEPARTMENT OF HEALTH & HUMAN SERVICES AIML Division of Environmental Services IBM On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 11l L -x- I m • t 1,; 1. GENERAL INFORMATION Complete legal description Lo E yy Fret man S113 Location (site address or directions) 1 f 3 00 Reade/ Rat , " Property owner W111154m r. Dewev Day phone 3'rN-02 to Mailing address I13oo Recco(Gr Rd� An'chvrag, Ate 9,75-1 -13Y8 Lending agency ` Day phone Mailing address Agent H1kP htestick . RG.htc+)r Pf0rtrl;e/ Dayphone 17tr-Z7d1 Address 2600 rarceO m Sf.. A� Arc 9450 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 72-02SJR..1/91) Ffml MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health Authority Approval application shows that the on-site water supply, and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms ' and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes. ordinances, and regulations in effect on the date of this inspection. Se/4ra.rrOR dr<A.Ace Wafv</ titewl-e. Nameof Firm l=W&,a Tec-4,1,cef Srvrre' Phone 3ys'-I-TS' ' Address 1HS20 EcSo Sf.. AAc-4ot-ale his YZrld' Engineer's signature �?r 91ue 'c Date AV 6 1996 6. DHHS SIGNATURE r/ Approved for �tL ly� bedrooms. Disapproved. Conditional approval for Additional Comments MLODoxa r. rwnxE bedrooms, with the following stipulations: 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. 7t ori (1tev. wq 6. h MOA g1 Municipality of Anchorage AUG 07199G DEPARTMENT OF HEALTH ���HUMAN SERVICE cC I IED 40 825*V StreetEnvironmental Servicc es Division G G G , Room 502 • Anchorage, Alaska 99501 • (907) 3434744 Health Authority Approval Checklist Legal Description: L. it9,, Free tn.en SID Parcel A. WELL DATA M Well type Prover fc ICA, B, or C, attach ADEC tetter. ADEC water system munim N. A. Log pmt (Y/M Y Date completed 9 / 6 / 7Y Total depth 274f ' Cased to 236' Casing height (above ground) 1,109 Sanitary seal (Y/N) Y Wires Property protected &) Se v.;yt her e FROM WELL LAG AT INSPECTION Date of tat 9/6/7,1 7/30/9x; Static water level 7t r 970 Well production 7 g.p.m. 7.B t 9 - p.m - WATER SAMPLE RESULTS: Coliform Q [ol /toOn1l Nitrate </�C Other -bacteria Kos It�oiir.I Dateofsample: 7/30/9jC Collected by: F[attU Tech Swe B. SEP'nC/TTOLDING TANK DATA Date installed 9/23 / 7r Tank size 1 SO Number of Compartments ! Cleaoouts (Y"_ Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N. A. Date of Pumping B 11 l9 6 Pumper r-rt2o Gf C. ABSORPTION FIELD DATA Date installed 91? -317Y Soil rating (gp.dJfe or felbdrm) 1 8 7 0' System type Cpox. Row to r/A Pet sairm Length 23' Widtb 23' Gravel thickness below pipe9' Total depth it, Effective absorption area OU Ce Monitoring Tube prescnt(Yltp Y Depression over fieid (Y/N) N Date of adequacy test "71300d Results (Pass/Fail)Pow_ For N bedrooms Fluid depth in absorption Reid before tat (in.); 6Y Immediately aiterM gal. water added (in.): 80 yt Fluid depth 7) !I (ins•) Mmuto iatcr:_ M Absorption rate - > 6 0O0 p d Peroxide treatmem (past l2 months) (Y/N) None {mane If yc% give dateN. of, D. LIFT STATION N. A Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* Higb.water alarm lend at* $Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump air level at' Septidbolding tank on lot 7 c.o- ; On adjacent lots > '00' 70' pef- uv/. rtPv�# Absorption field on lot ; On adjacent lots n, 1 o0' ( Ys' Per ,�Pnpe• F Public sewer main N. A Public sewer manholdcleanom N. A, Sewer /septic service line 2S' Lift station N. 4. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation A' Property line 7,01 Absorption fold rs' Water main/service line > to' Surfaoe wateddminage �, Iso' Wells on adjacent lots > 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 3S' Property Line ,gr Water main/service line > to Surface water _�* foo' Driveway, paddng/veWcle storage arca Ad. vc� eo 1 Curtain drain Nowe cern Wells on adjacent lots %-o foo F. ENGINEER'S CERTIFICATION I certify that I have determined dhru field hWeetions and review ofMunidpai re In Conformances with MOA HAA guidelines In effect on this date. See aLt4wc i d" Sig==Jt- ♦ er ; .. _ Engineer's Name -Aeoo� :_ Mao, -e •. s.s •. ::. i.. •.::i� Daae Acro d;0 Igo "�y;�; '� .......•, r r'y: HAA Fee S X00 Dale offtmumt it 11 f 1 L l Rempt Number Rev. V95 OSS: haawk.doc waiver Fee S Ne Fee Date of Payment Receipt Number Mont 6ipahty of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrom, 8 Mayor P.O. Box 196650 Anchorage, Alaska 99519.6650 August 27, 1996 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 4 Freeman Subdivision Waiver Request # WR960040, PID #016-112-03, HA960342 Dear Mr. Moore: Your request for waivers of the 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distances are the private well to the on-site septic tank of 70 feet and the private well to the on-site seepage pit of 95 feet. This waiver approval applies to the existing septic system to well separations only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any further questions or concerns regarding these waivers, please call our office at 3434744. Si erely,/ Vv amen P. Williams Civil Engineer On-site Services JPWAjm:Dewey j •;JNUNICIPALITY OF ANCHORAGE`-'' Department of Health and Human Services On-site Services Section Waiver Review worksheet WR#( l,,Og1,.ML1PID# 016-112-03 HA# Permit # Date Received: August 7, 1996 Legal Description: Lot 4 Freeman Engineer: Ted Moore, P.E., Flattop Technical Services 14530 Echo street, Anchorage, Alaska 99516 Applicant: William F. Dewey ****** Waiver Requested: Private well to septic tank of 70 feet; private well and seepage pit of 95 feet. Criteria: 1. Geology: Points: A. Water Table <,W B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: I71 2. Special Conditions: 3. Other: ****** Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: �ti� �✓UG/r1,��'iLS �t=T<z=:2 QED l�''�G6�96 Date: tom- n+evapls Rec #: Amount: $ By: Date Paid: n W�2 � 0 SAIL SOZPTIOPJ: ko eO/2RA�', P. v, Sf Q— 4$ I CLAY ( &Pr,'O 4 (*1, zL 1kl��: �s x laa 3 Mc- ,.2,SG7S qi, P7S' 6r TW- ?As y,S f 3,0 4 s M ` Iii' � � - �► ,t_ ,•1.. _ � 1 ,� t „� 7� tip'• L, s M ,t_ ,•1.. .��1Srr1.,I s FLATTOP'T AiCHNICAL SE�RY}ICES:._ CIVIL & ENVUtONMENTAL ENGLNEERLNG • E.ti ERGY CONSERVATION & ANALYSLS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 A&1CHORAGE, ALASKA 99516 August 6, 1996 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter we are requesting issuance of a formal waiver approving the 95 foot separation between the well and seepage pit and 70 foot separation between the well and septic tank on Lot 4 of Freeman S/D, located at 11300 Reader Road These separation distances were clearly noted and approved on the 1974 inspection report for the sewage disposal system. Because of this prior approval, I understand that the property owner will not have to bear the additional expense of the Municipal waiver fee. To assist you in your review we are enclosing a site plan and water sample test reports as well as copies of the well driller's log and inspection report from your files. According to the driller's log the well was completed in September of 1974 and has a total depth of 236 feet, a static water level of 75 feet, and a yield of 7 gpm. On July 30, 1996 we conducted a yield test of the well. At that time the static water level stood at 87 feet below the top of the casing. Steady pumping of 782 gallons of water from the well at the maximum pump output of 4.8 gpm caused the water level inside the casing to be drawn down to 136 feet, but no further. Based on the test data we determined that the total yield of the well is in excess of 4.8 gpm, which is more than adequate for a single family residence, and also meets the FHA lending criteria that a well be able to supply 720 gallons of water within a 4 hour period Water samples collected on July 30, 1996 were satisfactory, showing 0 coliform or other bacteria and non-detectable nitrates. According to the Municipal as -built inspection report the wastewater disposal system was installed on September 23, 1974 and consists of a 1350 gallon concrete septic tank which discharges into a 23' x 23' seepage pit with an effective gravel depth of 9 feet. The separation distances shown on the inspection report (which are noted as approved) are 70 feet between the well and septic tank and 95 feet between the well and seepage pit. The measured distance on an as -built property survey between the well and the septic tank standpipe is 75 feet and between the well and the seepage pit standpipe is 98 feet. Presumably the differences are attributable to the underground projection of the wastewater system components. On July 30, 1996 we conducted an adequacy test of the wastewater disposal system. The initial fluid depth in the seepage pit was 64 inches and after the addition of 782 gallons of water over a three hour period the maximum fluid depth achieved was 80.5 inches. The fluid depth receded to 79.5 inches within 20 minutes after the flow of water was stopped. Since this rate corresponds to an absorption rate of greater than 600 gallons per day, we concluded that the system continues to be able to absorb at an adequate rate for a 4 bedroom residence. The lot encompasses a broad hilltop with the house and well near the top and the septic system standpipes at a slightly lower elevation. Thus, any surface flow from a failing septic system would tend to flow directly away from the well. Furthermore, the well log indicates a high silt and clay content in the several strata above the aquifer which is first encountered at 178 feet. The actual intake is at 236 feet. The fact that the static water level inside the casing comes up to 87 feet indicates that the overlying strata confine the aquifer, and thus serve as an effective barrier preventing contamination of the aquifer from pollutants originating in the vicinity. The following is a breakdown of how waiver analysis points could be assigned using D.E.C.'s 1985 "Separation Distance Waiver Guidelines for SCRO" Category Points Tank Seepage Pit Distance to water table (top of aquifer) (178' -1' -11') 7.33 7.33 Soil sorption (predominantly clay and sand) 4.5 4.5 Permeability (predominantly clayey sand) 3 3 Water table gradient (assume 5%) 4.5 4.5 Horizontal separation (70'. 95') 1.8 2.8 Total 21.1 22.1 Based on this assignment of points it appears that there is no danger of contamination of the well attributable to the proximity of the septic system components. The fact that the systems are 22 years old and still there are non-detectable nitrates only strengthens that conclusion. Please feel free to give me a call if you have any questions. cc: William Dewey Sincerely, 5�_%ile� Ted Moore, P.E. �.trlea�na.b.>, THEOOQ^.E F. ;A03Rg j 1 CE -35E9 c Ap�� ,4�'Zi�vw7y.�. BLDG ° ° ; HSE WELL w SEPTIC SYSTEM , �Iw ccIL ; DRIVE -y SEEPAGE PIT - (CONFIGURATION PLOTTED PER INSPECTION REPORT) ' 1350 GALLON CONCRETE \ 9F i SEPTIC TANK I \sr09 ,• HSE SEPTIC SYSTEM IN THIS AREA 11100, WELL w 0 ¢ MONA AVENUE �y•�� �NH4w� �.,w �v.. /7 ✓� a . Rely •w '.w T!f G LOT 4, FREEMAN SID �'••"""•••••••:..W WELL AND SEPTIC SYSTEM SITE PLAN yAr FLATTOP TECHNICAL SERVICES 1 INCH .50FEET ��•+Y 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 AUGUST, 1996 •MM\S Y-iY` NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE.