HomeMy WebLinkAboutFREEMAN LT 5Freeman
Lot 5
#016-112-14
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
E
KI Is
Manulactmer GO E, . \ /�
DISTANCES
TO
FROM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
AOI°6a�33
WELL
1103,
1/0,4
Depen to pipe oonov m
Pnonetsl
_34ar- I Z
Permit No.
No. of Ne°rooms
LOT LINE
.3S'+
/O•
rte,
EFa Wi DESCRIebOe
Lot
S
BIOG
--1
Suoorvmpn
FOUNDATION
30 ±
451
33r
Townsn,p. Range. Semon
Yr � 1 1 O � E 1 C' O it
AS -BUILT DIAGRAM
ISnuw location of well, septic System. properly Ines, bunaauon,
TANKS
❑ SEPT �\ s;l ❑ HOLDING
Manulactmer GO E, . \ /�
Capacity in g.``auona
l W
Material .a 1\ t
No. of Companmenls
TYPE OF SYSTEM
❑ TRENCH BED ❑ W. DRAIN ❑ OTHER
Depen to pipe oonov m
total oeplh lrom original graou
original graoe L ,F FT
/ q,41
Fill owe0 aWve onq,nal graoe
D18ve1 OeplhF,II t,enealh pipe
.F:/1_'2L FT
FT
rF
a1—aL
Gravenengar
Gravel w,Du,
FT
001
Totat aba°rpuon area
Distance Wlween Ines
90,9 so FT
90,9
'
NumDCr OI Sites
sung
Roe malepal
asrti a 3osy
1
4-
/.50 SO FT
.2 h w: r Pk, C4 -
Inslaner G J Q n
❑ PRIVATE ❑ OTHER (Identifv)
Lid a.h Al ri IA,B.CI TOlal Depth Casal to
FT FT
mstane, \ Date Instailea
REMARKS:
46kd
2 6q
I � � •.� v v vv v
Municipal and State guidelines in elled on this
d/dattem/:
l
Health Department Approval:
1
9
1
lr mit
lnspectlons PerloZ D
C/q K
Date. C£. I()���.ry� sl
a
Ibis inspection was performed according to all
5 ;I
}y fin
a
MrAws
S�i1
ENGIN4ER'§,SEAL
1•r'aa: AA . r
rya<•µr^ ••ems
M U N I C I P A L I T Y O F A N C H O R A G L
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-4=i�t
V7Q/! a�
O N- S I T E S E W E R' P E R M I T
Permit Number: 900023 Upgrade SL_)fCmoZ.3
Date Issued: 10/29/90 Engineer Designed
Owner Mame: DENNIS O'DAY
Owner Address: 1633 BANNISTER DR.
ANCHORAGE, AK 99500
Day Phone:
Parcel Id: 016-112-14
Lot. Legal: Subdivision:0FREEMAN Late S Block:
Section: 20 Nownshipi 12N Range: 3W �
Not Size 29200 (sq.ft. or acres)
Max Bedrooms: This Permit: 4 Total Capacity: 4
SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
feet requires insulation over tank(s).
PROVIDE PERCOLATION TEST ON SILT LAYER. IF NOT PERCADLE THEIN
PROVIDE FILL TO GIVE 6' SEPARATION. NOTIFY DHHS PRIOR TO ANY
DESIGN ALTERATION AND PRIOR TO EACH INSPECTION. INSTALL PER
APPROVED DESIGN. THIS PERMIT IS ISSUED FOR THE EXISTING SINGLE
FAMILY DWELLING AND EXPIRES ON 12/31/90.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand JQat this permit is valid for a maximum of 4 bedrooms. 1
also understan that t,e capacity of the total system is 4 bedrooms and
any enlargemeyf�,y)�ll r- _ re an additional permit.
Signed:
(Owner) DENNIS 0'
- DATE:
------A1b-----
Issued Dy:DATE•
-- -- - -------------- ' ---
PERFORMED FOR
LEGAL OESCRIPT
municipalizy of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVl( i
825 "L" Street, Anchorage. Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
COMMENTS ^)C
a
SLOPE
WAS GROUND WATER
ENCOUNTEREOI
S
IFYES•ATWHAT 16" L
O
DEPTH? P
E
cc;n to Wdrf Ater I�„ 071C I O
RC's•• -(CNGINCERS *CAL)
ate` �!T ►� �
(FEET)
,.,f�7KS
1
nnnni
Cwt+S
a
LI
2
SPI
SQnct, 5/nv1l S+onrS
3-
4-
4
'ME '
SZO
SITE PLAN
u5=6
;5-'6
6-
sit+
6_6..
7-
10-
1011
11
•
121314161719
1
20
COMMENTS ^)C
a
SLOPE
WAS GROUND WATER
ENCOUNTEREOI
S
IFYES•ATWHAT 16" L
O
DEPTH? P
E
cc;n to Wdrf Ater I�„ 071C I O
RC's•• -(CNGINCERS *CAL)
ate` �!T ►� �
7 ":t
LI
a
'ME '
SZO
SITE PLAN
A
PERCOLATION RATE (miWcS/kKhI PERC HOLE DIAMETER
TEST RUN OCTINEEH FT AND FT
I I..__I Lam. ,�.-_ I � L" � � LL" I/I<
PERFORMCD C%-
ACCORDANCE OATH ALL STALE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:
72-000 (Pe . 4j8sl
WAS PERFORMEO IN
'U
VERIFY ALL DIMENSIONS PRIOR TO CUNbTXUl-Tlun
-Z"' FILL NATIVE //oe.Tr(POe.T MAIL . t' eG'MISED SySTc M : ED
oc/A A✓E
►r3__ F" STY LOFwocgi" 4 gD�MI /()SOILS
?:.>7,�`m�E 1 FAB2�c COui%�L'r-r J3ED ZdA.45 '-
9 N
h oT O °J.—q" PELF FivE 5�
v 6" 5£Lt E [ eax
�bii.I>n o •�' &cl iJ (J,' /fS' 6•1c.a; EXIT
6r�de. �t cl od, %nyl j 6e
EXIST. SYSTEM Adelecl vntr'e- Leo( fo
I o` InSvn/I 4' Se/X,Mf"
6 rO,"d (tjc..it/ r4 ! C -/D
Lehr 1 ee
W I F Enci. �Dlt
EXIST. TANK
LL In A"
, , .� TO BE AB1><I.IDONED---�— -- �� nf�.•' �..._ �.? �:
J
IUSTA L.I.IEW HOUSE /.cf,,s !A
LIa o q' p3gyt LINE , tom, CE :aC3 =%�'
j0 r-� - - ---- it
*PPOP.1000GAL
ScTAUK '
'/ No• SEE wow tUSTALL
70 I FouUDATIOU / I Nccc
y I G/o APPEOC
�i e 5 ti Z PWRXED� BED
610 *7100. TO WEc.LS sveeouoluG I
I
uOTF-
I IAWLIST LCrATIoN OF TANK
TO MAIUTAl1J 6EWITY FLOId
MAtUTAIU M•O.A.PEQD SEPAEATIOU
DISTA.Lk-- ES-
CENO
a kn?y Nj"%
dr Povered
pVB'x b w
30'
/ A y ce./ily IA on otwroTr s; c>7 of The
fo//or doscr/bed opMly-
[pT.5 F.[EEMAwr-Val-D.
.gyros erode on and IAo/ the
„rett12' p enfS situ ed thereon o rithh7 the
Props /loss and not o6w/oP or croach
on Me P Orly lywrp jocenf TbeMq Mf no
improreeren on Prl Ing adjacent re/o,
Dn/`L�
t/” v
PREPARED FOR,
DPW Br. lc7. DATE, SCALE+ Ad0'
CHOW BY, 6.e I W. R /VO. F.B. NO.
LOT 6
�r�t'E/4.aN SUBD.
SHEETNO. of
GRID
encroach a1 a prem/ses quest/bo and
/hers ori no ro ye, tion ssnv /hres or o,
VIS/b/0 easements sold Pr Orly erceof
erdlcofed 'woos.
Doted of Aachorage, osteo, IAi day, of
/98— .
LS NA
PREPARED BT
CORWIN Q ASSOCIATES
1000 E. DIMOND BLVD.
SUITE 205
ANCHORAGE, ALASKA 99515
(907) 522-1511
MUNICIPALITY OF ANCHORAGE
f 1
DEPARTMENT OF HEALTH & ENVIRONMENTAL
PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
_
825 L Street. Anchorage, Alaska 99501
Telephone 2644720
\ ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
�JOLJA2p &-be(z
PHONE
❑ NEW
PGRADE
MAILING ADDRESS
Z6Zo 51•> -4 -
LEGAL DESCRIPTION
Lor S SLrs�
LOCATION
NO. OF B DROOMS
Ar1�
Well
Absorption area
Dwelling
PERMIT NO.
DISTANCE T0:
O
S 2
Manufacturer
Material
No. of compartments
wF
Liq.gallons
72945)
IF HOMEMADE:
Inside length
Width
Liquid depth
f3 5e
DISTANCE T0:
Well
Dwelling
PERMIT NO.
J02
0 F
Manufacturer
Material
Liquid capacity in gallons
O
W =
DISTANCE TO:
Well ///
Foundat n C /
.J
Near Shne
PERMIT NO. S,
w D
No. lines
Length ch Ione
Total 1 hof lines
Trench wi th
Distance between lines
of 1
g of
�O
f2 W
\
Inches
Q G
Top finish
Material beneath the
Tot}�Ip�fe
of tile to r&�eA�
12
Z
�give absorption area
0
//1/ni/M JM
inches
(D L) S
Length
Width
Depth
PERMIT NO.
W
<I..
Type of crib
Crib diameter
Crib depth
Total effective absorption area
W L
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
3
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption &reals)
OTHER
r
2
PIPE MATERIALS
" -pv C, ,
SOIL TEST RATING
.SQ'FT lt>
INSTALLER
1<100 Q2
I
REMARKS
'^
J
Iwo
a
I
i
dbtiy: WEN L'XCILLLC•its Fy
�S}
� t . • wr, � r•• P
�
1 N •• •• `e4. T•N
YCb+i
aY.`O.V^ti.
APP DATE LEGAL
72-013 (Rev. 31781 ,41.774& 6W01 -0613T
. ,--- -_-----..._.rnttrs ;L C_1 r-^t-1L_.,1 1_Y_� _ LSF'_.-._HM4...".F _ VI_�;1=f t�L- • ..
\�` L CEP^RTMCIIT Or IICt1LTH AHD ENVIRONMCNTAL PROTECTION
025-t"`�CET, ANCHORRGC, RK. 990"" ya �)
2G4-4720 , d
PERMIT NO. ( 780355 )
APPLICANT HOWARD ELDER 2820 C STREET B4
LOCATION
LEGAL L5 FREEMnN S/D LOT SIZE 29334 SQUARE FEET
TYPE OF SOIL ABSORDTION SYSTEM IS: TRCNCii
Mil"IMUM NUMBER OF BEDROOMS = 4 SOIL RATING <50 FT/DR)- 125
T112 REQUIRED SIZE OF THC SOIL ADSORPTION SYSTEM IS:
r>=rlThI= a- LEt-i(3TH- 7*4 0r:ZnVEL E>EF?TH= ;2
THE LENGTH DIMENSION IS T11C LENGTH CIN FEET) Or THE TRENCH OR DRAINrIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN T11C SURF= Or T11C
GROUND nND THE BOTTOM OF THE EXCAVATION 111 FCE ). -t-
Ti �- ' b✓ . ^L ♦ r .v C
THE GRAVEL DEPTH IS TIIC MINIMUM DEPTH Or GRA'JEL BETWEEN T11C OUTFALL PIPE
AND THE BOTTOM OF THE EXCR'JRTION CIN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM T11I5 DEPA2TMC4T DURING THE
INSTRLLRTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPCRTY AND T11C
NUMBER Cr RESIDENCES THnT THC WELL WILL SERVE. '
--- 'rwcl <2> nmm mmlmu 11`CEa ---
Bt1Ci;rILLING Or ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEW1G3 DISFOSnL SYSTEM IS
100 FEET FOR A PRItiflTC WELL; OR
150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE Or PUBLIC WELL.
OTNCR RCQUIRCMCNT�. M1Y APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRt1M5 EIRE
AVAILADLC TO INsURC PROPER INSTALLATION.
I}I`MM I T C:XF" I f2E!M; r>M0EMCCI'� 31�
I CERTIFY THAT
1: I RM FAMILIAR WIT11 THE REQUIREMENTS FOR ON-SITE SEWERS
FORT11 BY T11C MUNICIPALITY OF ANCIIORRGE.
2: I WILL INSTALL THE SYSTEM IN RCCORDnNCE WITH THE CODES.
3: I U1lDER ;TAND THAT TIIC ON-SITC SCWCR ''rSTCM MRY REQUIRE
RESIDENCE IS REMODELED TO I114 -UDE MORE THAN 4 BEDROOMS.
SIGNED:
ICANT HOWARD
1.9'i 3
AND WELLS AS SET
CNLARGEMCNT IF THE
ISSUED BYJ�, _ Il_DRTE_.S- a o� '% V3. 2
GAAdMDI - GI 'TER ANCHORAGE AREA BOROr`I
DErARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
"� �U lee MAILING
NAME F c�./ k'#_A
ADDRESS �f X �7J �' Jl PHONE
LOCATION!2EEO'10111ty LEGAL DESCRIPTION i i S �k'rtW�✓�t.? X.,i)
SEPTIC TANK:
DISTANCE FROM
LIOUID
LIQUID CAPACITY Z,?5 0 GALLONS. INSIDE LENGTH INSIDE WIDTH-DEPTH-
SEEPAGE
IDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
SEEPAGE PIT:
OUTSIDE
WIDTH ,
DEPTH
LINING MATERIAL" . DISTANCE FRdNn1KELL ' BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SO. FT.
TILE DRAIN FIELD:
/ 1 TOTAL LENGTH
DISTANCE FROM WELL < < , FOUNDATIONS, NEAREST LOT LINE S , OF LINES.__/(<!�,
NUMBER OF LINES v DISTANCE BETWEEN LINES TRENCH WIDTH Oe-� IN. TOTAL EFFECTIVE
ABSORPTION AREA SO. FT. LENGTH OF EACH LINE /9' �•}
DEPTH: TOP OF TILE TO FINISH GRADE 2 DEPTH OF FILTER MATERIAL BENEATH TILE -IN. ABOVE TILE 7
�A/ELL; DISTANCE FROM I WATER
TYPE��fXc DEPTH .BUILDINGFOUNDATION. SAMPLE , NEAREST
_ NEAREST _ SEPTICSEEPAGE / _ OTHER
LOT LINE , SEWER LINE , TANK .5-eAo - a , SYSTEM 1_l_ek i -CESSPOOL . SOURCES_
DISTANCES:
DIAGRAM OF SYSTEM
DATE It 7
--------------------------
N
DATE It 7
--------------------------
REAM ANCUO'iA E AREA BOROUM
MI ALTIi DEPAETaENT
327 EAG:,E STREET
ASCHORAGE, ALA^Kr1 99501
CMIF d
PerPoracd Date Performed— q_'p_I .'lL
Leral D,=ripticn: Lot •s Block — Subdivlsion
—•--
;his Form Reports a: Soils Lor 7&7a-,
Depth
!"ecz Soil Characteristics Location Sketch
`
nct;sJAaw ..•c3c
'
I ii
��
r
Inlet
r
Trench
'-\-..ti,....•.c.,'..
i.ys
2.77
174
n -n. ^•A arc
E_
Ai
I
er colZ n
I
m;e
Vas Ground Eater Encountered.? °oo
?= Yes, At.What Depth _
I-II - A_ -I 1 i•_I
I I I1 i 1 1
Reading
I Date Gross Time
I ii
Net Drop
�
Inlet
L L
Trench
'-\-..ti,....•.c.,'..
i.ys
F= �:.�•-i
174
n -n. ^•A arc
Ai
I
I-II - A_ -I 1 i•_I
I I I1 i 1 1
Reading
I Date Gross Time
Net Time Depth To H2O
Net Drop
f
Inlet
De,to To Bottom 0: Pit Or
Trench
'-\-..ti,....•.c.,'..
i.ys
F= �:.�•-i
L� ':.a' .o2`N,
1
n -n. ^•A arc
er colZ n
Prctosed
Installation:—Seepage
Pit Drain
Field 1. —
�ept..'Cf
Inlet
De,to To Bottom 0: Pit Or
Trench
'-\-..ti,....•.c.,'..
i.ys
F= �:.�•-i
L� ':.a' .o2`N,
1
n -n. ^•A arc
Test Performed B);
Data Ccrti:ied Sy:- ,/ J.�: r ern (�• �r �.
Date: \ c'
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 016-112-14 Expiration Date:
1. GENERAL INFORMATION
Complete legal description FREEMAN LOT 5
Location (site address) 11400 READER ROAD *ANCHORAGE, AK
Current Property owner(s) DEBBIE PLESSINGER Day phone 830-9228
Mailing address 11400 READER ROAD *ANCHORAGE, AK
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
0
Received by: Date: 12. il z a I
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ `E (� Waiver Fee $
Date of PaymentB�% Date of Payment
Receipt Number 001126 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 GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
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 of all 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 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 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
337-6179
bedrooms, with the following stipulations:
ON-SITE
WATER AND
WASTEWATER
PROGRAM
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineerregistered 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 Checklisty Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
By: /
(Rev. 11/05)
Original Certificate Date: ^ 2 i `
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 LOT 5 Parcel ID: 016-112-14
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) NO/
Date completed 1971 Sanitary seal (YIN) YES Wires properly protected (YIN) I
Total depth *65+ ft. Cased to 40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test NO WELL LOG 10/24/12
Static water level ft. 51
Well production 9-P M. 9.23
WATER SAMPLE RESULTS:
Coliform U colonies/100 ml.
Arsenic: .V(0 ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal.
Foundation cleanout (YIN)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length ft.
Total depth ft. Eff.
Date of adequacy test
Fluid depth in absor ' field
Nitrate N Q mg./L.
Date of sample: 10/24/12
Number of Compartments
Depression over tank (YIN)
Pumper
.P.m.
Collected by: GEG. Ltd.
11�1:3�G7I.9�i3�7
Date installed
Cleanouts (YIN)
High water alarm
Soil rating (g.p.d./ftor ft'/bdr _ System type
Width ft. Gravel below pipe ft.
absorption a ft2 Monitoring tube_ Depression over field
Results (Pass/Fail) For bedrooms
before test _ in. Water added _gal. New depth _in.
Elapsed Ti —min. Final fluid depth _ in. Absorption rate >= g.p.d.
rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date
D. LIFT STATION
Date installed
Size do gallons
Manhole/Ac cess (YM
"Pump on" level at in.
"Pump off level
High water alarm level at in.
Datum
Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
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/deanout 100'+
Sewer /septic service line
25'+
Holding tank N/A
Animal containment areas
50'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING
TANK ON LOT TO:
Building foundation
Property line
Absorption field
Water main
Water service line
Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIEI D-ON"LOT TO:
Property line B ' oundation Water main
Water service line Surface water Driveway, parking/vehicle storage
rwflalfi�draln Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and *, 9TH_ �*
i
review of Municipal records that the above systems are in .. "... "' " '
conformance with MOA COSA guidelines in effect on this
Q. ..............
date. Q J e S.-
Engineers
:Engineer's Printed Name JEFFREY A. GARNESS Q� 9,OD—7953 a
Date 4nw'en ......
(Rev. 11/05)
PLAT NO. P-497
FREEMAN SUBDIVISION
LOT 5
29,334 S.F.
H J —CSV I L i
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
GASTALDI LAND
PROPERTY DEPICTED ABOVE AND THAT NO
SURVEYING,
SURVEYING, LLC
NGDI,
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
JEFF A. R.L S.
IT IS THE RESPONSIBILITY OF THE OWNER TO
2000 E. DOWLING RD., SUITE 8
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
ANCHORAGE, ALASKA 99507
COVENANTS OR RESTRICTIONS WHICH DO NOT
PHONE 248-5454
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
GRID
DATE
HEREON BE USED FOR CONSTRUCTION OR FOR
SW2633
12/17/2012
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
F.B. JOB NO.
12-07 FSLOT5 NOTE: NO CORNERS SET THIS DATE.
111=30'
OF AA4
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.DATE SCHEDULED
TIME
INSPECTOR
SUBDIVISION FREEa
BLOCKILOTITRACTLT
.
INDICATE NORTH
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'DATE
MUNICIPALITY OF ANCHORAGE
WASTEWATER
CONNECT PERMIT Do - 5446
WATER & WASTEWATER UTILITY DATE OF APPLICATION 09!2612000
3000 ARCTIC BLVD. SCHEDULED COMPLETION DATE 12/3112000
PHONE: (907)564-2782
BLOCKILOT/TRACT LT 5 X SINGLE FAMILY
SUBDIVISION FREEMAN MULTI -DWELLING No. APTS
COMMERCIAL
TAX CODE 1611214 GRID 2633 AS -BUILT -
STREET ADDRESS 11400 READER RD
OWNER PLESSINGER DEBORAH & PHONE
MAIL ADDRESS PO BOX 231833 ANCHORAGE, AK 995231833
CONTRACTOR GLACIER MASONRY & EXCAVATION
ASSESSMENTS
Repair Existing Service
Main Line Extension
X On Property Only
City Tap
;: Have Been Levied
Hydrant Only :,
50' or Langer
XII To Be Levied
Main Tap - To Property Line Only
Comments: C.I i 7 J
Main Tap ;& On: Property. Connect Row No.
Disconnect
R & R - Main Tap Onlyn
f
Owner �� . ! � Staff
CONNECT SIZE 4.".
-
ISSUED isuv
INSPECTION FEE $
104-00
PAID- j( CASH
PERMIT FEE. $
35.00
CHECK #f.
$
0.00
OTHER..
DEPOSIT' $
`' 0-00
INSPECTED BY
REIMBURSABLE TOTAL $
-.13900
ke v-, )- LL5
NUMBER.
'.
DATE /0 I gdC-V
REMARKSdXh,
PERMITTEE (Please Print) �.t �,.p,�PHONE
MAIL ADDRESS
SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
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MUNICIPALITY& H ANCHORAGE
• '� DEPARTMENT OFFHEALTH
&HUMAN SERVICES
Division of Environmental Services
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. a d 16 HAA # N A' 9 -70317
1. GENERAL INFORMATION
Complete legal description La 57/ faa t-ta'/ St/0
Location (site address or directions) !% ¢CO gz4zE• P'z<D
Property owner Mrz_� ( HP_S - LEE Day phone
Mailing address
5-61-4916
Lending agency G�T� lC`t i—�''G Day phone3
Mailingaddress
Agent 6212y—lam E:r� � V"LA i'� Day phone ate/ -CCGG
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
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 X
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.
1 ,
72-023 )Rw.1191) Front MOA 621
S.
6.
M
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 Iurtherverify 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
Address
Engineer's signature
DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Phone 337-6/79
Date `d
0„ LL'7
CE -7953
bedrooms, with the following stipulations:
i
l •�r� � ..c Date UQ—I/-9r%
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 orderto 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 engineers work.
77-025 (i4.. 1/91) SWk MOA Y!1
- s -
Alaska Water & Wastewater
8471 Brookridge Drive — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
August 9, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
AUG 111997
Municipality of Anchorage
Dept. Health & Human Services
Subject: Revised HAA for Private Well & Septic System. Lot 5, Freeman S/D.
To whom it may concern:
A 3 bedroom HAA was recently applied for, and issued by your department, for the subject
property. Since that time, the appraiser has made a determination that it is actually a 4 bedroom
house. The septic tank is 1250 gallons, and both the well and drainfield are adequate to meet the
demands of a 4 bedroom house (greater than 600 gallons per day). Therefore, we are requesting
that your department reissue the HAA for 4 bedrooms. Attached is a revised "blue sheet". If you
have any questions, please contact me at 337-6179, 244-9612, or on my digital pager at
1-800481-1162. Thank you for your assistance.
Sincerely,
JefYrJYA. Garness, P.E., M.S.
Principal
c.c. Cook Inlet Realty, Valerie
• - MUNICIPALITY OF ANCHORAGE
• ,- DEPARTMENT OF HEALTH & HUMAN SERVICES-IPALITY CP ANCHORAGE
Division of Environmental Services 'MENTAL SERVICES DIVISICN
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650 JUL 2 8 1997
343-4744 RECEIVED CERTIFICATE OF HEALTH AUTHORITY RECEIV`/
E D
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 016 —112 -//-/ v HAA #
1. GENERAL INFORMATION L_
Complete legal description LT 5 r RtCMAN S/0
Location (site address or directions) %Iwo R AUcR I�a�
Property owner /I�f /�/A'S• LEE
Day phone 561-420
Mailing address
Lending agency
Day phone
Mailing address
Agent Com- ZyLz� haz!,.
Day phone 226 -0000
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 `
3. TYPE OF WATER SUPPLY:�,.ri✓TS
Individual well
�Yl- QIGIG-a P
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-M(Aft.1/91) From MOA621
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 furtherverify 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
Address
Engineer's signature
F-.>j6,r&1- .sik-oit. Qr-- P4 -o #tam'
e Gwsta�r. travc lLr-E
Cook- Wt.Oc,— VhCCW6eFFa
6. DHHS SIGNATURE
y Approved for 3
Disapproved.
Conditional approval for
Additional Comments
By:
bedrooms.
Phone 237'117
Date '7
bedrooms, with the following stipulations:
Date o8 -04-9i
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 orderto 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.
rJ-= (N«• M BKt MOA m
6R01,"WAL
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNICIPALITY OFENVISERV
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
} Health Authority Approval Checklist JUL2 8 1997
Legal Description: bir _hnexlAn1 S/P Parcel I.D.: OM —1 F0%((��!W V E D
A. WELL DAT
Well type l UA7t -,If A. B, or C, attach ADEC letter. ADEC water system number MA
Log present (Y40—NQ Date completed 5 f 7�
r
Total depth %�7 Cased to yo 4 Casing height (above ground) I9
Sanitary seal */N) YDS Wires properly protected (Y/N) *,jF1S'
Data of test
Static water level
Well production
FROM WELL LOG
uNFk/dhCM14
It
I ,
AT INSPECTION
rJ� 1
g.p.m. Aa.N, g.p.m.
w p� MU. D90#3 o« N
WATER SAMPLE RESU TS:
Coliform Nitrate • 1 ^� ND Other bacteria
Date of sample: �II� Collected by: �� w
B. SEPTICIHOLDING TANK DATA Co .+ cVZ -'L--
Date installed 101!5 1 Tank size PPO Number of Compartments �_ Cleanouts (9N)�
c
Foundation cleanout (Y,O�� �'flog 92 4 A Depression (YZA High water alarm
-
Date of Pumping � Pumper Af N,.Sr
C. ABSORPTION FIELD DATA
Date installed IS 90 Soil rating (g.p.d /ttz o tl'/bd System type
Length y5_ Width a10' Gravel thickness below pipe 6" Total depth 56"
Effective absorption area '?ODSF Monitoring Tube present (9N) -Y- Depression over fisiq (Yo _X
Date of adequacy test ��111i� Results (Pass/Fail) P For 3,`�', bedrooms
Fluid depth in absorption field before test (in.); 3�1 Immediately atter3l gal. water added (in.): yAXa
Fluid depth ' (ins) Minutes later. Absorption rate = 4570,4 g.p.d.
Peroxide treatment (past 12 months) (Y/9 OF Knn•w If yes, give date N%
72.020 (Rev. 3(90)-
LIFT STATION/IA-
Date installed ////
Manhole/Access(Y/N)
High water alarm level
E. SEPARATION DISTANCES
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Size in gallons
ar
"Pump off" level at*
IPRwn i
Septietholding tank on lot gD t 1943 On adjacent lots /0011
Absorption Held on lot 166 14 On adjacent lots 100,4
Public sewer main him Public sewer manhole/cleanout 44
e
Sewer /septic service line 2 % Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation /0 '/ Property line to'/ Absorption Held x 9 EirW471V
Water main/service line /0� Surface water/drainage /06� Wells on adjacent lots /00 �L
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line /0 ' Building foundation /0 + Water main/service line /r7
Surface water /Od Driveway. parking/vehicle storage area
Curtain drain AAAf Wells on adjacent lots l�
F. ENGINEER'S CERTIFICATION see, Qom_,(
OF A[ !A1.
I certay that I
in contomran
Signature _
Engineer's Ni
Date
HAA Fee $
Date of Payment 8
Receipt Number
72-026 (Rev. 3/96)•
inspections and review of Municipal
rs in effect on flus date.
G
Waiver Fee $
Date of Payment
Receipt Number
.PP 0Ft<�;C'';
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Alaska Water & Wastewater
8471 Brookridge Drive — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
MUNICIPALITY Of ANCHOXAGL
July 25, 1997 ENVIRONMENTAL SERVICES DIVISIC
JUL 2 8 1997
Municipality of Anchorage RECEIVED
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: HAA for Private Well & Septic System. Lot 5, Freeman S/D.
To whom it may concern:
The subject lot has a 3 bedroom house on it which is served by a private well and septic system.
The results of the field investigation and adequacy tests are summarized as follows:
A. WELL: The static water level on 7/22/97 was 57' BTC. Water was pumped from the well at
a rate of 4.32 gpm for a total of 181 minutes (781 gallons). Within the first 10 minutes of
pumping the water level dropped 10', down to 67' BTC, and remained there throughout the rest
of the test, indicating the well will continuously produce at least 4.3 gallons per minute. Based
upon this data it was determined that the capacity of the well exceeds the Municipal requirements
for a 3 bedroom house (.31 gallons per minute). This well meets FHA financing criteria, in that it
produces greater than 3 gallons per minute.
B. NO WELL LOG ON FILE AT M.O.A: There is no well log on file for this lot. The first
septic system was installed on this property in October of 1971. It is reasonable to assume that
the well was drilled at approximately the same time. Wells in this area are not in bedrock,
therefore, they must be cased throughout their entire depth. During the adequacy test, the water
level was drawn down to 67' BTC. In short, the well is at least 67' deep.
C. SEPTIC TANK SIZE AND CONSTRUCTION: According to the 1990 HAA (Corwin
and Associates), the septic tank has 2 compartments, a capacity of 1250 gallons, and was installed
in 1978. The upgrade inspection report, dated 2/15/90 (Corwin and Associates), states that the
septic tank has a capacity of 1500 gallons. The same inspection report states that the tank's
structural integrity was inspected, but did not indicate whether it was concrete or steel. Based
upon my review of the DHHS records, it appears that the only documented septic tank was
installed on 10/15/71. According to the inspection report, it is a 1250 gallon, concrete tank
(Espinoza). The 1978 inspection report does not indicate that a septic tank was installed at that
time. The February 1978 HAA indicates that the tank is a 1250 gallon concrete tank. When the
tank was pumped on 7/22/97 approximately 1100 gallons was removed (8.5 inches still on
bottom). In short, based upon the information I could find, it appears that the tank was installed
in 1971, is 1250 gallons, and is made of concrete. Given this, the required separation distance
from the septic tank to private wells is only 50 feet.
D. NO FOUNDATION CLEAN-OUT FOUND: According to the 1990 inspection report,
there was a foundation clean-out present; however, the as -built survey done by the same firm did
not show the foundation clean-out. On the day of our inspection no foundation clean-out could
be seen. It is possible that it is buried below grade. In the future, if an obstruction occurs
between the foundation and the septic tank, it will be necessary for the new homeowner to expose
this clean-out (if it exists), or install a new one.
E. SEPARATION DISTANCE FROM BOTTOM OF DRAINFIELD TO
GROUNDWATER: The monitoring tube for the test hole (1/19/90) is still present on the lot.
We shot the elevation at the bottom of the bed (through the bed MT) and shot the water level in
the test hole monitoring tube. Based upon the elevation shots, the bed is 4.07 feet above
groundwater. It is unknown what the groundwater conditions are like during the spring, and
whether the drainfield is greater than 4 feet from groundwater under such conditions.
F. LOCATION OF BED RELATIVE TO THE UTILITY EASEMENT: Given the location
of the drainfield clean -outs on the as -built survey (Corwin and Associates, 1990), and the known
dimensions of the bed, it appears that the northwest corner of the drainrock may encroach slightly
into the utility easement. The only way to verify this would be to expose the drainfield.
According to the inspection report (Corwin and Associates) the drainfield is 10 feet from the
property line.
G. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 20 foot wide bed, that is 45
feet long, and has an effective depth of .5 feet. Prior to starting the adequacy test, the M.T. had
3.5 inches of liquid in it. Water was introduced into the bed at a rate of 4.32 gpm for
approximately 181 minutes (781 gallons). The water level rose 1 inch, to a total depth of 4.5
inches. After recovering for 10 minutes, the level had dropped down to 4 inches. Throughout the
test, the bed clean -outs remained dry. The septic system could have been filled to a greater level
(up to 6 inches in the MT), and a higher absorption rate achieved. Based upon this data, it was
determined that the absorption rate of the drainfield exceeds 450 gallons per day, as required for
a 3 bedroom house.
NOTE. The adequacy of a septic system is influenced by numerous factors, including, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), .
type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects),
Id the amount of water being introduced on a contimlal basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected No warrantee is made regarding the future performance of this well or septic system
If you have any questions, please contact me at 337-6179, or on my digital pager at
1-800481-1162. Thank you for your assistance.
c.c. Cook Inlet Realty, Valerie
MUNICIPALITY OF ANCHORAGE
O Department of Health 8 Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel l.D. # LAI— - 1 12 - I �J HAA # IL nq%'� i4A
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
I Id P gun=P I.IC.t-i AK c%C/S/c:
(b) Property owner n=t.LliC %,'»V Telephone: (home) Business
Mailing Address 14•73 QjloIT = eA Lir H AI�
(c) Lending Institution Telephone J1�L
Mailing Address U kA
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check hereA. if hold for pick up.)
List contact person and day phone number below:
,-7;7 7 — / z ) I
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms 4
3. WATER SUPPLY
Individual Well Community O Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public 0 Community 0 Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72 -MS (Ftev. ?/NJ Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein, l 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" '' r' ?c' ki !i 4sca- Telephone _7
Addre
Date
i
C.'
Y
-----^�� Engineer's Seal
6. DHHS APPROVAL�� Date b
Approved for /T bedrooms by _ /s _ J O
Approved Disapproved Conditional
Terms of Conditional Approval
..tir ..._
CAUTION.
The Municipality of Anchorage Department of Healthand Human Services (DHHS) issues Health Authority Approval
cerificated 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.
72-075(acv. TIN) Back Page 2 of 2
!/ MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
MUNICI'ALIW OF AN-H34f4744
ENVIRONMENTAL SERVICES DIVISION
Legal Description: 1yT
FEB 1930 FP-,Er=MAAI
A. WELL DATA
Well Classification P r I II zA TR E C E I V E D If A. B. C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) N_Date Completed (1 Al LLUJM Yield!2lrh-
�
Total Depth 't Cased to 4S r Depth of Grouting Lh1 keltx- ti I
Static Water Level 63 I Pump Set At MJ )Qit-h</Q
Casing Height Above Ground N Sanitary Seal on Casing (Y/N) r
Electrical Wiring in Conduit (Y/N) %� Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 1031 ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ;On Adjoining Lots
To Nearest Public Sewer Line M JATo Nearest Public Sewer Cleanout/Manhole—
To Nearest Sewer Service Line on Lot 7 50 ` j
Water Sample Collected by sc-v ;Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed �6,1�z?Size �Z 2_ No. of Compartments Z
/
Standpipes (Y/N) rt, Air -tight Caps (Y/N) X Foundation Cleanout (Y/N)
Depression over Tank (Y/N) N Date Last Pumped aZ9v SSAxlcl' p "O,
Pumping/Maintenance Contact on File (Y/NPA
Holding Tank High -Water Alarm (Y/N) KI Temporary Holding Tank Permit (Y/N) _
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 103' To Building Foundation
To Property Line 35" + To Disposal Field S
To Water Main/Service Line 114M
To Stream, Pond, Lake or Major DrainageCourse -Ll iA
Comments �Pe/- N1ia1; ee,-C"/ S
72-M (Rm. 7M) Front Page 1 of 2
C. ABSORPTION FIELD DATA p
Soils Rating in Absorptio Strata mvs Type of System Design I�FD
Date Installed � Length of Field 4 6
Width of Field �y` Depth of Field �8
Gravel Bed Thickness ` /
Square Feet of Absortion Area 9��.Y a Statndpipes Present (Y/N) Y c
Depression over Field (Y/N) Date of Last Adequacy Test
n
Results of Last Adequacy Test A! o f � V44E! ,
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well lin To Property Line
To Building Foundation 45-1 To Existing or Abandoned System on
Lot /S ` ; On Adjoining Lots 3U
To Water Main/Service Line >,10 ` To Cutback (if present) !L1
To Stream, Pond, Lake, or Major Drainage Course (I �A
To Driveway, Parking Area, or Vehicle Storage Area 30 ` t
Comments
D. LIFT STATINLevel
Date Install
Size in Gall
"Pump On"
High Water
Tested for
Meets MOA Electrical Codes ('
Comments
"Check Permitte edroom
I certify that I h cke
Inspection.
Signed
Company
Date
MOA No.
Dimensions
Manhole/Access (Y/N) .
—"Pump Off' Level at
Vent(Y/N) _
Against HAA Request"
or conformed to all MOA and HAA
Receipt No. 9q / 230
Date of Payment `z -9- 90
Receipt No.
Waiver Fee: $
Amount: $ % 7n • C2 Date of Payment
72-M )RW.7/88) Beck Page 2 of 2
Pumping Cycles during Adequacy Test.
i
on the date of this
:JEnglneer's Seal
Lce7Wc„ r 4r
CU293
PROJECT: S rf6M.4I/ OAT" OF TEST:a (� p
•LOCAT1O:1 OF WELL (Legal Description): _
WELL DEPTH: 120'' FT. CASING: FT SCREEa:
DATE DRILLING CONPLETEO: DRILLER:
• STATIC DATER LEVEL (Top of Casing): ' 63' FT
apsen. ine Jincel
Clock Pumping'Starfed/Depth to Oraxdown/ Punping Renarks
Tine Stopped. liin. I Yater. ft. Recovery Rate. r,Pt1
/j 0 163' sul 0 0 .Start
.1 6
I b
/'
1
:zo
I 66'
I
O
I
-TSI
7'
20
I 67'
4'
I25
/7
O
G; .
G
= 50
35
4'
i %'
7'
4'
o
:!7
o
�77O
o
o
hour 1
4
/1.0 1
RECOVERY
0
YI
+Y • 4
uwuronu
L
CHEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC
5833 li STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343
FEDERAL TAX ID M 92-0040440
ANALISIS REPORT BI SAMPLE for Work Order f 19734
Date Rarort Printed: EEE 12 90 0 12:29
Client Osmole IO:LS FREEM
PxSID :CA
Collected FLB 6 9D 1 16:45 hts.
Recaved Fib 7 90 4 15:30 Kra.
Preserved with :AS REQUIRED
Client Name CCRWIN S ASSOC
Client Aect COP.WINP
P.O.1 NCA! RECEIVED
Req I.
Ordered By : 33UCE CORWIN
Lr<Iys13 Comleted :EER 9 90 Seed Reports to:
Laboratory Supervitor :STEPHEN C. EDC 1)CCRWi1I 6 1223C
Releared By �rf_1 ,IG �j 2)
...............�.......................................................................................................................
Special LS FREEMAN
InstI'1ct:
Chetiab Ref B: 900037 Lab Smpl ID: 1 Xatr1:: WATER
Falameter Tested Result Units
------------------------------------'...-------------- _ _._ _ .
NITRATE•N ND(0.10) m9/1
Sample
Re,u.ks:
Method
EPA 353.2
.............................................................................................
1
Teats Perfoired
Sao
Special Im ttuotlons Above UA-Unavallebie
RD.
None Detested
Sae
Saaple Ramada Above
!IA-
Nat Analyzed
LI -Lees
!hen. GT-Giester Than
Allowable
Limits
'-------------
10
YYIrA; L_ 'C-,-. - an'", -K O,T
Time
APPLIr``NT FILLS OUT UPPER HAP" ONLY
Property Owner e n n t 5 + G n e'�� 0' AY
Phone
MaMngskddress
to Zip Code
1342-!2107
Byer pA.l';d
Reed �yy- �a33 ►�,,,,e
Address
o ZIP Code
Lending Institution
Flrs,-t Nalioyta[ An o RY1cSlD Y4 �'rr: .Ltuotnn
Phone
��ryan
Inspector
Address
~ Vic zip Code
Realty Co. d Agent
Field Notes:
Phone
NICIPALITY OF ANCHORAGE
None.
^
Address
Zip Code
Legal Description
(
�d �/'' �'f eL mQ S L P
AUG 3 1y
Street Location ceprAerE
Type of Residence
I Single Family
[[]] Multiple Family
No. of Bedrooms_
*CONDITIONS OF APPROVAL
❑ Other
'
Water Supply
L
BY:
MIndividual
a.9. qcli
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
If
Community
For wells drilled prior to that date. give well depth (attach log
avallable).
❑ Public Utility
`
y iiirWell
to Tank
Sewer Disposal
t Ci -74
IA Individual
Year Individual Installed:
[[]] Public Ulllity
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED.
YYIrA; L_ 'C-,-. - an'", -K O,T
Time
Time
Tim
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
NICIPALITY OF ANCHORAGE
LL
^
HEALTHDEPT. OF
t N
ENVONM TAL PROTECTION
l td 3 X15
AUG 3 1y
RECEIVED
( ) APPROVED BEDROOMS
*CONDITIONS OF APPROVAL
( Lf) DISAPPROVED
( ) CONDITIONAL
ppAPPROVAL-
DATE-
V l
BY:
Solis Rating
Sewer II stalled
D�
Well To Absorption Area '{
Well Log Received
`
y iiirWell
to Tank
Septic Tank Size 1,2.SO
�\ MUNICIPALITY OF ANCHORAGf.
DEPARTME OF HEALTH AND ENVIRONMEN PROTECTION
��� 825 -L Street, AnchoraaP. Alasxa 99501
vxr264-4720
#1: Time 3:15 p.m. #2: Time
Date 2-28-78 Tuesday Date
Date Received: February 24, 1978
#3: Time
Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: First National Bank of Anchorage
Mailing Address: Post Office Box 4-2090 99509 Phone:
2. Property Owner: Howard J. Elder Phone:
Mailing Address: 8 Jess Holliday Company 276-8188
3. Legal Description:
Lot 5 Freeman Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Four
Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System ( )
Permit #
Construction
Depth of Well
Well Log on File ( )
Bacterial Analysis
6. Sewage Disposal System: On-site System (x)
Permit #
Installed 1971
Public Utility ( )
Installer
Septic Tank Size 1,250 gallons Manufacturer Espinoza - Concrete
Absorption Area 267 sq.' Soils Rate
7. Distances: Well to Septic Tank
to Sewer Line
to Nearest Lot Line
Nearest Lot line
Material Drainfield
to Absorption Area 100' req.
Absorption Area
Page Two i
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Freeman Subdivision
Comments:
Affadavit Attached: / p ) Letter Attached: ( )
t
Date: I"--1)' 2
Disapproved: Date:
Department Worksheet: E _ .
i tro-arw¢er•odo• 11Y1M 1YN011YN831N1 tl01 ION 1167•+d
1 (#P" +•Y+" ••S)—0301AOU 30Mtl3AO3 33MUNI ON 008E YYad td
_..__......._._...._........ (P•+IMu w/ opp•) MAIM �7Y103dS
................
'...................................... 11YA iiff]YllllV !11 Y]A�1an
ISM -------.1.9.rwrppr of u+All+p 1.141M...42
IIM fl]IAY7f
ISE" I+wgl+p 9"44 YY+ IWIP.;+Y. ge.Wf'f 1d1303Y
ISS AIpO utf+�pp+ 01 AleAII,p YIIM
IS7 P++rll- _ Jo+_- 1 u•YS_ Y NY013Y
f37! 1YM011100r Y01 f3]I�YIf 1VN01140
300] dll ONY UYL-Plea 00
Q)
'ON ONY 13381S - C )
snld) Occ— IIVW 031311833 80A 1313038
I
r MUNICIPALITY 01 ANCHORAG L
Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
\+ 264-4720
quest for Approval of Individual Sewer and Water Facilities
1. Property Owner: :�7./pulAiC,[ C/ C�, /alter' y i
,,49;ANC / 1.641C
Mailing Address: Phone:,,2,76-y/8
2. Name of Buyer: -N�u, n,;,,
Mailing Address: ,� Phone:
3. Lending Institution: `Qf A / �/ 1.lAvl j7Z-C l7t IV
Mailing Address: Phone:
4. Realtor/Agent: /
Mailing Addre
pp oZ0a_0 e St ^�C/ `f Phone:
5. Legal Description: ✓t't MAA( J a 4
.. 11 p c1vtE,� o'A'c
Street Location: 0.1? 'MoWA JAur-- 4 e tlE�C 1oAd
q
6. Single Family Residence: (V� Number of Bedrooms: ' "`-
Multiple Family Residence: ( ) Number of Bedrooms:
7. Water Supply:_ *Individual Well (`) Public/Community System ( )
If Individual Well, well depth
If Community System, name of system
8. Sewage Disposal System: *ion-site System (� Public System
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
**If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
August 16, 1903
Dennis & Ginette O'Day
P.O. Box 11-1435
Anchorage, AK 99511
Subject: Lot 5 Freeman Subd.
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
° Exposed electrical wires to the well head are in violation
of the Municipality of Anchorage codes and must be encased
in conduit.
° The standpipes to the septic tank and the leach field were
full of effluent to above ground level. There was evidence
of previous overflowing in one of the standpipes. The
current tenants said that the tank had been pumped fre-
quently this year with the last pumping having occurred
about two months ago. The septic system appears to have
failed and will need to be upgraded.
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 2G4-4720.
Sincerely,
Robert C. Pratt
Associate Environmental
RP33/p/E
Specialist
.w. r • i !
1'Viunidpality
of
Anchorage
f,
rdw
POUCH 6650
ANCHORAGE, ALASKA 99502
(907) 264.411,
QEORGE 1A SULLIVAN, "
MAYOR
'H•'. N�::. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
•1.•': I
1825 ..L" Svwt)
February 28, 1978
:Howard Elder
gl� 8 Jess Holiday
a 2820' C.•Street, Suite 4
• -:anchorage,-Alaska 99503
Subject: Lot 5 Freeman Subdivision
The request for sewer and water approval on the subject
property can not be approved at this time, for the
following reasons:
(I) The sewer system is overflowing and obviously has
failed.
(2) The sanitary seal on the well casing is not airtight.
Before this department may approve the request, an upgrade
will be needed.on the subject property. The upgrade of the
sewer system would include seventy(70) lineal feet of
• drainpipe with a five(5) foot wide trench and two(2) foot
of•gravel below the perforated pipe.' The gravel backfill
should be placed between two(2) to four(4) foot.
A permit must be obtained from this office prior to any
construction. Monies may be escrowed, so that the upgrade
can be completed during the normal 1978 construction season.
Temporary approval would be granted if monies are escrowed.
If there are any further questions, please contact this
office at 264-4720.
Sincerely
?. C..
Robert C. Pratt, R.S.
Sanitarian
RCP/ljh
cc: First National Bank of Anchorage
Post Office Box 4-2090 99509
7o Y A
I