HomeMy WebLinkAboutCALKINS LT 15
MunicipalitY of Anchorage Page . ~ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~t.t3 ct30~Z. PID Number: O~'O?..tt%% ,
Name:
~ r~0~-~'- ~, ~.~,; ~O~tS Wastewater System: ~ New ~Upgrade
~'~: ~0~ ~ ~e ~., E~ ~o~, ~. ABSORPTION FIELD
J No. of B~rooms:
P~one: ~'~[~ , ~ Deep Trench ~ Shallow Trench DBed QMound ~Other
LEGAL DESCRIPTION so, Ratmg: Total DeDth from ong,nal grade:
Towns~,o:mRange: I Section: Fill added above original grade: Gravel length:
WELL: ~ New ~ Upgrade Gravel width: Number of lines: Ciltance =etw~n lines:
Class~f,cahon (Private. ABC): Total OeDth: Casea TO: Total absorption area. PiDe material:
SEPARATION DISTANCES ~Septic ~ Holding 0 S.T.E.P.
I t Material: Number of Compartments:
Su,ace LIFT STATI O N
Water ~ ~ ~ ~
LineL°t ~l ~1 -- -- -- Size in gallons: J Manufacturer
, "Pump on"level at: I"Pump orr'level at: I Hign wate~ alarm at:
Foundation ~O ~ ~ -- --
CuRain Pump Make & M~el ~ Etectrical Inspections pe~orme~ by:
Drain ....
Remarks: BENCH MARK
Location and Description:
I Assumed ~ ,O~
Elevation:
Department of Health and Human Se~ices approval tj~t..,. ..,..[~
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89'42'52"
125;.19 i
LOT 15
20,66t
'51'89'42'52'
~ LOt 15
JO
SCALg: t' = 40'
~ i ALL 8~ARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
I ~~~ ...~1 .... / 9~-o7.o~ ~.M.
CORPORA TION ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE)
PAGE 1 OF 1
8~ 2. 7- q3 /~: ~ e.
PERMIT
PERMIT NUMBER:SW930322
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:HOLLIS HAROLD L & SANDI E
OWNER ADDRESS:10440 HIGH BLUFF DR
EAGLE RIVER, ALASKA 99577
PARCEL ID:05021111
LEGAL DESCRIPTION: CALKINS LT 15
DATE ISSUED: 8/24/93
EXPIRATION DATE: 8/24/94
LOT SIZE: 20661 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE CONDITION OF THE EXISTING SEPTIC TANK TO SERVE THE
PROPOSED ABSORPTION FIELD MUST BE VERIFIED ON THE INTERIOR
?FFMAN
Gl ~ £ E RS
August13,1993
Municipality' of Anchorage
Department o.f Health & Human Services
On-Site Semccs
825 L Street
Anchorage, Alaska 99501
Attention: Dan Roll]
Proj~land
Reference:
LOT 15, CALKINS SUBDIVISION
SEPTIC SYSTEM UPGRADE APPLICATION
Dear Mr. Roth:
Enclosed is permit application for a septic system upgrade to the subject property. The proposed
upgrade includes installation of a new 65 ft. deep trench with 6 ft. effective depth. The new trench
is located such that the required minimum horizontal separation distances from the subject property
and all adjacent property water supply wells and wastewater systems are maintained in accorda..n, ce
with 18;AAC-72. Reserved space is available on the property for future use if needed. Surface
dnfinage will remain unchanged.
No adverse impacts to adjacent properties are foreseen with the installation of this upgrade. If you
have any questions or need additional information, please call me at 276-6664.
Sincerely,
COFFMAN ENGINEERS, INC.
Will Veelman, P.E.
Principal
enclosures
Coflman [ns~rem, lnco*'peratH
$50 W. ~,~nlh ~,mu~ S~ite 200
AndmraEe, AI,nl~ W$OI
LOT
~'. lO0 WELL \
~'.. ~OTr.~ON t,~n/~
\
· " I '".. LOT ~4 \
% \
/t'/,il
I
o ~.r. ii
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N~ C/O
'5'1~89'42'52" E
LOT ~6
SITE
SCALE: I" = 40'
NOTE: .SHr i o~' ,~
ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
lOT: % 5 BLOCK:
~'~'D~WSi~:- -
APPD:
CA LKI#3 SUBDI V~SIOh~
PLAN
/ "~-~ CORt~ORAT/OAr
4900 PALM£~-WA~LA HWY., SU~ 3 WA~L~A, AK 99~4
(g07) 376-8800 FAX (907) 376-9629
DA~.:
dO~ NUU8[~:
9,3-07.08
OHEC~ED:
DRAWN:
NOTED epf
PERFORMED FOR:
LEGAL DESCRIPTION:
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4
5
6
7
8
9
10
11
12
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14-
15-
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19-
20-
Municipality 0! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
COMUENTS 'U,F' ~1 p=,~
Township, Range. Section: '7"/Y ~
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
F S
IF YES. AT WHAT ~/A gL
DEPTH? . p
E
Depth to Water Atler
Monitoring? ' /~' + nab
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ 7. Zg-~ 8:3~
SY~ 7- zg.~ ~ .' 3 t ~ o ~ 7z
~ ~.z¢-e~ ~:~/ /
PERCOLATION RATE ~ 0 Im,nutes/,nch) PERC HOLE DIAMETER __
TEST RUN BETWEEN "~ FTAND ' ~// ' ' FT
PERFORMED BY: Ze ~:~/''~ r~. ~/,~_~ A t'a ~'//° I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE ANO MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. OATE;
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
'SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
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8
9
12
14
17-
'~,,'~J. Township. nange. Section: '~"J¥,l~, ~ II/J, ~. ~. ~ /3'1.
SLOPE SITE PLAN
WAS GROUND WATER /V~/O.
ENCOUNTERED?
S
IF YES. AT WHAT ~4 ~
DEPTH? p
E
Oeplh to Warm' Alter
Id~flileriflg? ,/6 ~' Oal~ ~-?-9~
Reading Date Gross Net Death to I Net
Time Time Water Drol3 .
PERCOLATION RATE t/' 3 [m,nuteshncn) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ° 4/ FT
PERFORMED BY: ;~o~-~'.,l~. ~.~'~ 4/ I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.;
72-008 (Rev. 4/85)
-., .: /"%, MUNICIPALITY OF ANCHORAGE
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 IPRONE I[]NEW
LEGAL DESCRIPTION
LOCATION ~ NO. OF BEDROOMS
~ Well ~ Absorptmn area Dwelling PERMIT NO.
DISTANCE
TO:
I
~ Manufacturer ~ / *W/~ * Material No. of compartments
Liq. capacity in gallons IF HOME,DE: Inside length Width Liquid depth
~O~ DISTANCE TO: Well ~/~ . Dwelling PERMIT NO.
O z ~ Manufacturer~ Material Liquid capacity in gallons
a Well Foundation ~ /, Nearest tot line
~ No. oflines ~ Length of each line.~, . Totallength~f~ne, Trenchwi~ inches Distancebet~enlines~J
/ Material beneath tile ~. inches Total effective absorptip~area
PERMIT
Length Width / Depth
~ ~ Type of crib Crib diam~t Crib depth Total effecti~ absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
Drpt~ ~ Driller Distance to lot line PERMIT NO.
~ Building foundation Se~r line Septic tank Absorption area(s)
DISTANCE
TO:
OTHER
PiPE MATERIALS
'SOl L TES ATING ~ ~
REMARKS
13 (Rev. 3~78)
/
MUNICIPALITY OF ANCHORAGE ' D
Department~ Health and Environmenta,~rotection ~//_~
~" 825 ' ' Street, Anchorage, AK. ' 3501 ' ~v;~-l '. ~-
264-4720 //~ ~/~~~
* * * HANDWRITTEN PERMIT * * * ~~~'~''
Pe~it ~ ,
. ~OR ON-SITE S~WER PERMIT ~
.
./,
Location, ./~,,~ ~ Phone Nu~er: ~ ¢¢ Z¢ ~
Legal Descrip,ion, ~/~ C~/~ ~ Lot Size: --
Type of Soi~sorption System Is: /
Trench: .~.. Drainfield: Seepage Bed: Hold~g Tank:
Max~ N~er of Bedrooms:~ ~ Soil Rating(sq.ft/br) ~ ~'
The Required Size of the Soil ~sorption System Is:
~IDTH
The length d~ension 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 m~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet). , f /~ ~
· * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS
Pe~it applicant has the responsibiiity to info~ t~is department during the
instailation inspections of any weiis adjacent to this property and the n~er
of residences that the weli wiii serve. '
~ ~ * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfill~g of any system without final inspection .and approval by this departmen~
will be subject to prosecution.
Minimum 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
of 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
and 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.~stall the/system an accordance with codes.
(3) I un, rs/card that/~ on-s~te sewer system may require enlargement if
th~/re~¢e~odeled to include more tha~ 3 bedroom~.~
Signe~, ~~~/~'/ Issued by.- ~~
Date-
S~-P/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
I-I SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4-
5-
6
7
8
9
0 E..G~rz lc_,
SLOPE
DATE PERPORMED: 7- 7 -- frs
SITE PLAN
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1!
12
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17-
18-
19-
20-
COMMENTS
PERFORMED BY:[~'~[-~ ~[WF.R, _A~.~,_~.~'~T~ ~
72-008 (6/79)
WAS GROUND WATER ~!
ENCOUNTERED? f~ O
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE Z-7 (minutes/inch)
TEST RUN BETWEEN "~ '~ FT AND ~) ,FT
CERTiF, ~~~.~'~
DATE',~~
.~..,.. GREJ,,,ER ANCHOR GE AREA BO GH
!' Department Environmental Quality
of
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ff/,P"'O '/T,
, PHONE
LOCAT,ON
SEPTIC TANK:
/
D,STANCE
FROM WELL MANUFACTURER ~'~' ~E T' MATERIAL
NUMBER Of I
COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 4~30g~, GALLONS,
TILE DRAIN FIELD: [~4,zTrF ~s~-,'r)
DISTANCE FROM WELL./¢¢ ~ ~/ TOTAL LENGTH ~2 '
FOUNDATION NEAREST LOT LINE, ~ ~ OF LINES
NUMBER OF LINES / DISTANCE BETWEEN LINES ~/~ TRENCH WIDTH ~/~N. TOTAL EFFECTIVE
ABSORPT ION AREA ¢ ¢ ¢ ~ j ~
s~. FT. L~TH OF ~ACH U~ / ~ ~ ~
DEPTH: TOP OFTILE TO FINISH G~ADE ~ ~ DEPTH OF FILTE~ ~m
MATERIAL BENEATH TILE IN. ABOVE TILE· ~ /~ IN.
WELL: ~
TYPE--~ ~'~L~~//~//~ , .CONSTRUCTION ~ ~**~/~I~//l~ ~ DEPTH ~/~/~ DISTANCE FROM:
BUILDING j.~ NEAREST NEAREST SEPTIC _ _7 SEEPAGE
FOUNDATION . LOT LINE I 7 /, SEWER LINE /~/'/~' , TANK,.7¢', SYSTEM
CESSPOOL /~.~/,~1 ., OTHER SOURCES ,~
APPROVED DISAPPROVED REMARKS ~') ~--'// '~/2/~'() ,~')'~f /t"" ~---.
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
;Iz DATE APPROVED
17'
/
G.A.A.B.
Form EQ-O32
'"/r,', LOG OF DRi!i/":,NG by A 6' L DRILLI,'"'3 COMPANY
· £.~.....r...c...~ .0 ?.'..C.~ .~..o.~r~.~ %~T "-~?' 3"
OVmER OF LA~D .7. .'] ,,Or ~ oF WELL ,',
ADDRESS ...................................................................................................
WELL SITE.40. T....L$.:. ........ C..~.~.Z,..m.:'.~.:.i ...... .~...a...0., ...........
D A TE--~T AR TED ..... I./..~..:!/..7..~ ...........................................................
...... ...........................................................
STATIC LEVEL OF WATER FT. ."; o ~ #
DRAW DOWN ~-,'.
OALS. ,'ER ~R ....... .6.'.L~. ..................................................
KiN~ o~' CA-~IN~ .... .':L..:?....°...O. .....................................
KIND OF FORMATION:
FROM ...... .~.~.~. ............ FT. TO....'...:~,. ............... FT. ~i.",-?:.'.',. ;¢../..~..?..~:.!'9.,'.'' '''~t FRO M.....'.?..'~..C ...... FT.
FROM ~"~ FT....,., 3'." ,-.. r,,,~:.,,~.~ ,,,../~,~:~:,:',. - ~ "
................................................................ :.~ ............ FROM.......'~..?...~. .......... l~r.
,,"- To...:.: .C.. ............. rr.!~:f~../Z-.,:~Z S .............................. , ,.
FROM ...... :..~ ............. FT.
FRO.~ ...... L.%--... ......... FT.
TO...-:.....: ............... ~-~ ..-.:.....~..'.... !?. ......... 7_ £ROM......?'....~. ............ FT.
FROM.....55:,'. ........... FT. TO....L~ ............. rr..C.(t,.f..L'..~.L57''; ~' rROM.,?.,~ ........... FT.
., ,:,
rROM..J..~: ............. FT. TO...:....'.~.. ............ FT....~..¢.:.....~.../.<:.~::.?- ' rROM...~.....O. ............ ~-r.
rROM...Z'.?.'.~ .......... FT. '
TO..L.~'.{LJ. ............. FT.. J.L~.. ~:..~:~: :.'.: .~:.
FRoM...../.~.:..O.. ......... rT. TO..&,257.. ......... rr....(2.~.r....C.,..,.~'£.' -'FROM ........................ FT.
TO...3..~:. ......... ~",-..~:dS.~...=. f~.".'.
TO ..!.~. ............ FT..4.~.Z...C4..&.(~.~.
............ ~ ~'~'/~'~w'"'::'-
TO ...................... FT. ........................ i..
TO ........................ FT. ..............................
MIS~L. IN'FORMATION:
,,cF..,~ ,~ ,Z,,Z~ o,~ ~."z.
DRILLER'S NAME ~-'~- ~' o",--~ ................
GRE~/~E,R ANCHOR:'.GE /',REA BO?'UC.-i
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330.,"~" STR ~-...~T ANCHORAGE, ALASKA 99503
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
PERMIT NO.
,NSTALLAT,O. 'DCAT,ON >, ·
'E:GALOESG"'PT'ON L,_
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ,°RA N F ELD · OTHER
SOIL TEST RESULTS NO~l THIS PERMIT IS NOT VALID WITHOUT SOIL
COMPLETION DATE ANTICIPATED
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.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK ~,~
FOUNDATION TO SEEPAGE PiT . ~ DRAIN ~
SEPTIC TANK TO SEEPAGE PIT WALL ....
SEPTIC TANK ,~ / . SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /"~
SEEPAGE PIT /~:~
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK . SEEPAGE PIT
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBE~ SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO BOROUGH REGULATIONS REGARDING I
CERTIFY THAT I AM FAMILIAR WITH THE: REQUIREMENTS OF CREATER ANCHORAGE AREA BOROUGH ORDINANCE: NO. 28.68 AND THAT THE: ASOVE
O ~- E GEOT~CHNICAL ~- DEVEL(.,,,-'MENT CO.
Ru~sel! Oyster
694-2774
Soils Et Foundations
Perfomed for:
Legal Descrtptton:...,~?-
Box 90. Davis St.. Eagle River. Alaska 99577
694-2,,74 or
DeE)h (feet)
Sotl Characteristics
o
1
Earl El~is
688.2280
Land Development
w
6
7~
8
Ground Water Encountered: Yes,
Proposed Installation: Seepage Pit
Co~ents:,
· No. ~f yes, what depth
Dratn Fte~d
Performed by:
MUNICIPALITY OF ANCHORAGE
Development Services Department . , Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 050-211-11 Expiration Date: 7 0-(1
1. GENERAL INFORMATION
Complete legal description CALKINS LT 15
Location (site address) 10440 High Bluff Dr
Current property owner(s) MCCAFFERTY Day phone 242-4330
Mailing address
Real estate agent Suzanne Cool Day phone 242-4330
2. TYPE OF DWELLING: �4q
Ix i Single Family (w/wo ADU) „,,-)\41-.^1u o�
❑ Duplex
Multiple Dwellings (Single Family and/or Duplex) a. Ari- 08 2.u19
3. NUMBER OF BEDROOMS: 3c> (5�w
01 r3 1,
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DIS' •- •L:
Private Well U Private Septic Ix I
Water Storage ❑ Holding Tank
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer Li
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 550 / Waiver Fee $
Date of Payment `i t$l Date of Payment
Receipt Number 0(0L((o71) Receipt Number
COSA# J5C14 /IOO 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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 4/8/19
Lapis'..OF t;'c''a
•' -y►°°°v keys
'* �b � • V
1
6. DSD SIGNATURE '•
fp
System #1 Approved for bedrooms ;ZOO
System #2 Approved for bedrooms s , �
'I wy L, ..o
Disapproved ` . ;
Amor
Conditional approval for bedrooms, with the following stipulations
s �5\�CE tyC
} WP cct PEER
Nl PSr\M
PReNGR
44 SFR
By: Original Certificate Date: 11-10—( 9
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA ChecR st blue sheet
COSA Checklist
Legal Description: CALKINS Lot 15 Parcel ID: 050-211-11
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
0 Well log is filed with Onsite (or attached) Well production at time of test 6+gpm
Date drilled 1/28/76 Water storage tank volume 0 gallons
Total depth 347 ft Well disinfected for coliform test? ❑ Yes 0 No
Cased to 40+ft Coliform bacteria is Negative
0 Sanitary seal is functioning correctly Nitrate mg/L ❑■ Nitrate less than MRL (ND)
0 Wires are properly protected Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Casing height(above ground) 36 in. Collected by NRimEng
Date of flow test for COSA 3/12/19 Date of Sample 3/12/19
Static water level at beginning of test 308 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 2/76 years ❑ Required maintenance completed
Tank type/material Fiberglassq`f Age of lift station years
Measured operating fluid level in septic tanks Lift/ Lift station material
0 Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 3/19/19
D. ABSORPTION FIELD DATA 8/30/93
Which system tested (date installed) 8/30/93 Adequacy test date 3/12/19
0 ALL standpipes present per record drawing Results Pass For 3 bedrooms
Total measured depth from grade 10 ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 3.5 ft(min) Water added 450 gal
❑ N/A—pressurized field New depth 2 in
❑■ Monitor tubes go to bottom of effective. If not, state Elapsed time 30 min
depth into effective
0 Code-required soil cover over field Final fluid depth 0 in
Absorption rate 450 gpd
❑ System presoaked unk
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' 73 Community Sewer Manhole/Cleanout > 100'
El Yes if No ft n Yes if No ft
Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft
Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft
-❑✓ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes if No ft 0✓ Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ❑✓ Yes if No ft
Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' ✓0 Yes if No ft
Water Main > 10' ✓0 Yes if No ft Community Wells > 200' ✓0 Yes if No ft
Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ✓0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' ✓0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' 0✓ Yes if No ft
Water Service Line > 10' 1.1 Yes if No ft Community Wells > 200' 0✓ Yes if No ft
Surface Water > 100' ✓0 Yes if No ft
F. ENGINEER'S COMMENTS
Waiver For Tank To Well.
®ems w,
G. ENGINEER'S CERTIFICATION ,®:.,c,-,u,..." -..°..iS ,A
I certify that I have determined through field inspections and review :co:""". a , e. �yC
of Municipal records that the above systems are in conformance with e4.- ,. ;,., °' `'
MOA COSA guidelines in effect on this date. ,— ' OA_, e�
Ir L ,ca
COSA Checklist yellow sheet
et
f •
/ LOT 14
LOT s
Ij. 100' WELL.
J PROIEC1ION RADIUS
S 89'42'52" F
•
125.19 •
30
Q
I I
i
I NEU. 0 W
_
•
o �,
\‘t .0
LOT 15 ; ma• q
20,667 S.F.
c.A20 00 OW". 7l0 0
c/b lo
11
V� 2—STORY 0
O h \ WOOD FRAMoE S ;$'
HOUSE h [
i r-
26
• MOOD DECK
0 ''•• —
LOT 7 r,/o Q�
�
. .,
e ��
/ OCL rl
:3'. Q� We iN
O
• RECOVERED 4
.---...I.,c....52iNCE
POLE 125.19 RERe4W (TYPJ
30
S 89'42'52" F e •
LOT 8 LOT 16
NOTE:
ALL BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED OTHERWISE.
EXCLUSION NOTE:
IT IS THE RESPCNSIBUUTY OF THE OWNER TO DETERMINE THE DISTANCE OF ANY EASEMENTS,
COVENANTS, OR RESTRICTIONS WWCH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR •
ESTABUSHINO BOUNDARY OR FENCE LINES. •
AS—BUILT CERTIFICATE:
I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY:
• .LOT r6. jA 16 CALKINS 3(IDDI17SI0I1
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. .
,siopui‘ LOT: BUM •
4\
IX
X180"` C4L.XINS WO 0111101-11411A MIMI�1 .�N .
(14-
gth St19,1�1 7SMN ('7)7'-+eo° rax OT)IN-IS
SECIM4
7 tv+<taFfp 14 N 'E 1 W Dam +� ra Krum
SEWARD 7/��T 3 _93-07.06 9306.34
Erta P. PUgtutod " N. 72-218 » MIN amps
Nmrzt8-s SEC ANCHORAGE r oltta DISTRICT 1"=3O' �FRDI�1
yap
Vs3l0140, ►uw GRID NW 55 AS -BUILT
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
BEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O, Box 196650 Anchorage, Alaska 995'19~6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1.. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
'~J,..~__
Day phone
Agent \J~ r~,t ,.3~ ~..~ t=~ ~..~ .- ~v;~'x, .
Address I ~,~ d"~-~,-'r~T__~'~_L,\ ~,"~. ~, ,--£
Unless otherwise reqUested, HAA will be held for pickup.'
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
NOTE:
Day phone
Individual well '
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-.
ing to the legality and status of system,
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
"Community on-site ·
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 {Rev. 1/91) F~'ont MOAII21
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 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
I
Engineer's signature
Date
DHHS SIGNATURE
Z . Approved for
bedrooms.
Disapproved.
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 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 p.rofessional engineer's work. :
72-02~[Rev. l/~1) Back MOAiI21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I--~,T ~ (:z~.u4.t,,.-..~ %[~ Parcel I.D.
· A. Well Data '
Well typo '-~.-t,a,.~-r~ If A, B, or C, attach ADEC letter. ADEC water system number,
Log present (Y/N) ~(~-% Date completed ~ ~ ~ ~[ '3 lo Driller 1~.
Total depth ~-i ,Cased to, "~ t Casing height
Sanitary seal (Y/N) "{ ~-% Wires properly protected (WN)
FROM WELL LOG
Date of test
I
Static wat'er level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 'q ~,
Absorption field on lot t [ ~)
Public sewer main
Sewer Service line
g.p.m.
AT INSPECTION
~.0
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
.Petroleum lank
I, AuNtCIPALITY OF ANCHORAGE
C~.~/i,RONMENTAL SERviCES DIVISION
AUG ~ 0 1993
g.p.m.
RECEIVED
WATER SAMPLE RESULTS: '
Coliform °/~c~c~ v~_c. Nitrate (D.~ ~-',-~, It'_ Other bacteria
Date of sample: -~J~?-.l'~'~ * ~1~/'~ Collected by:
SEPTIC/HOLDING TANK DATA ~ ~___'ff,.~ ~,T', ,~-b/..k )
Date installed -7_/'3 I~ Tank size tr.._~:z~ ~', ,~.t_.
Cleanouts (Y/N) '{~ Foundation cleanout (Y/N)
High water alarm (Y/N) ~'
Date of pumping ~..7~! ~-~, I~ '~ Pumper
Compartments 'z.
Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot "-J '~ On adjacent lots t ~) .+
To property line Zr-'~' Absorption field
Surface water/drainage
Foundation
Water main/service line
~.o2s (~)' Fmc, CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) , ~ ,"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
Date installed ~:,! ~ !~ ~.
Length LoLo' W~dth
Total absoq3tion area '-~ Z %q
Date 6t adequacy te~t ~
On adjacent Io{s
.Manufacturer
, Manhole/Access (Y/N)
'Pump off' Level at
,Cycles tested
Soil rating (GPD/FF)
Gravel thickness
Cleanout present (Y/N)
Results (pass/fa,l)
Water level in absorption lield before test "
Peroxide treatment (past 12 months) (Y/N) ~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Surface ~vater
,System type .-~.._~o,J,
.Total depth \ 0
Depression over field (Y/N) ILo
,for ~ Bedrooms
After test
I1 yes, give date ~
Well on lot \ ~ E:, ,On adjacent lots tOO 4- Properly line
To building foundation '~-% To existing or abandoned system on lot
On adjacent lots ~ Cutbank Water maiWsewice line
Sudace water ~ Driveway, perking/vehicle storage area
Curtain drain -'"-
E. ENGINEER'S CERTIFICATION
I ce~fy that I have checked, verified, or conformed to all MOA ~nd H~A gUidelines in ef_f~e of this inspection.
.. '- , .,-~.,~ OF A~
~A~'~.." - '
S ig,ature 1~(~ '
HM Fee $
Date of Payment
Receip~ Number
Waiver Fee $ :
Date of Payment
Receipt Number
?2-026 (&'93)* 8ack
ENVIROLAB
*Environmental Assessment Laboratories of AK,Inc.
P.O.Box 872988, Wasilla, AK 99687-2988
Ph.(907)373-4143 FAX 376-8016
REPORT ON DRINKING WATER ANALYSIS
SATISFACTORY
93-07.08
Acumetrix
4900 Palmer/Wasiila Hiway #3
Wasilla, AK 99654
Sample collected: 7/12/93 1315 RH
Sample received: 7/12/93 1710
Sample type:Routine
Water Treatment: None
,.
TEST NAME: Presence/Absence o£ Total Col iforms
Results:O/lOG mls0 number of positives w/lO0 mls inoculated.
Normals: 0 positives per 100 mls.
Reported: 7/~4/93 1610.
'Report sent to AKDEC: N/A
Comments:~L15 Calkins Sub.
Thank you,
Richard Hope, Envirolab
COMMERCIAL TESTING & ENGINEERING CO.
ENVIRONMENTAL LABORATORY ~RVICES
Chemlab Re~.'~ :~.39', 1-t
Cli.-nt ~<~mple ID .'L~5 CA.r.~IOUN
Clien~ Name =ACU~iX COPJ=O~ATION WORK Order :69264
.gr~,e£ed By :ROB Regort Completed :Q8/i0/93
Project Name : Collected :08/05/93 @ 12:30
Project~ : Received :0B/05/93 @ 15=00 hfs
PWSiD :UA Technica~ Direc~or:ST~-..~:,-~N C. ~E
ROUTINE S~P~ COLLECT, KO ~',': EOa~'F~',~ g. li/JSHRAL/.,.
Allowabl~ -mt. Anal
~r.am~er Results ~ai Unit~ ~e=hod Limtts Date
Ni~rate-N 0.10 U mg/L ~A 353.2/300.0 10
S~,e .~p~cial Instructions A~,~ve UA - Unavall~Dae
See ~m~le R~m~r~ A~ve NA = Not ~al'~
Uc~ete~ed, Re~ed valtte 1~ the pra~!c~ ~nttflcatlon ,,m,t LT = ~ess Than
Zec=nd~ry dilution. GT - Gre~t~r ~.ban
' WELL FLOW TEST.
CORPOR/~T]'ON ~ .' .. .~ Da ~ e · ..
I .
· .- ~ ~~~.
Inspector
Pro~ ec
Sto~ic W~ter Level.' ~ [~t.) .'.
Woter Volume Cum Heter
' ~eading
Time Level (~al.') Volume (~pm) Comments
. ~ z..~~ ~zS~ /~0 ~/, z~
1'4o ~ 7o D~
'/.'V% /RD.., 5¢0 ~/ ,~
.~.v~ " .. 7Z~ ~,
~,.'~5 I~ o~ ~/, / 2~
~;~- .~8~ /~0 '1, ~0 ~_~
RECOVERY COHHENTS
kVERAGE FLOW RATE: ~,0 (gp~)
REVIEWED BY:
Under,round conair ions are subject Io cNan~e over ire course of time'
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
L.o-r tS"
Well type '~:Y~.t,3~,-r~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) '{ ~-~ Date completed ~ [ z~ [~ b Driller ~ ,~ t.. '~ c~t.~.,~[.-,
Total depth ~r~ Cased to. A~ 4. Casing height
Sanitary seal (Y/N) '~ ~ Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test ~ [ ~.~, ['1 I,, ~ I ~ ~. I~i'~
Static water level ~>~,
Well flow ~,.o g.p.m. ~.0 g.p.m.
Pump level1 ?, ~>
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
: On adjacent lots
; On adjacent lots ~00. '+-
Public sewer manhole/cleanout.
.Petroleum tank -
WATER SAMPLE RESULTS:
Coliform c>
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N) . .
High water alarm (Y/N)
Date of pumping
Nitrate o,to w.~ /~
~' J~' I~ 3, Collected by:
Tank size ~ Oc~o .~
Fou~a~on cleanout ~IN)
Other bacteria.
Compartments
.Depression (Y/N)
Alarm tested (Y/N),
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot . -30 On adjacent lots t, cO .+
To property line ,'~.%' Absorption field
Foundation
Water main/service line
Surface water/drainage
72-o2s (3,m~3 ·
CCNTINUED CN BAC',< .=AGE
C. LIFT STATION
Date installed
Size in gallons,
Vent (Y/N)
High water alarm level
Date installed
Length (eL~
Total absorption area
Date of adequacy test
'Pump on' level at
Manufacturer
Manhole/Access (Y/N)
'Pump off' Level at
Cycles tested
Surface water
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lois
D. ABSORPTION FIELD DATA
Width
"1'~ Z-
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ t
To building foundation
On adjacent lots,
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
Soil rating (GPD/Ft2) O. ~ System type 't"~L~,..~..~,
· ': Gravel thickness q, Total depth
,Cleanout present (Y/N) "{ ~5 Depression over field (Y/N)
Results (pass/fa~) -- for '& Bedrooms
-- After test
If yes, give date
On adjacent lots
,Property line
.To existing or abandoned system on lot
Cutbank. -- ,Water main/service line
Driveway, parking/vehicle storage area
I cerO?y :hat I have checked, ved§ed, or conformed to alIMOA and HAA guidelines in effect on~Z~C~.of ~hi$ inspec~n.
SignOre
Engin~fs Name ~,~ ~J~~
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
ReceiFt Number
fflunlC,pa ,ty oi Anckorage
Department of Health and Human Services
825 "L" Street
Tom Fink,
Mayor P.O. BOX 196650 Anchorage. Alaska 99519-6650
343-4744
September 24m 1993
Will Veelman, P.E.
Coffman Engineers, Inc.
550 West 7th Avenue
Suite 700
Anchorage, Alaska 99501
Subject:
Waiver Request for Lot 15 Calkins Subdivision
Waiver Request %WR930052, PID #050-211-11,SW930322
HA930533
Dear Mr. Veelman:
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 a private well to the
septic tank of 70 feet.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Concur: ~
~~, P.E.
~rogram Manager
On-site Services
ljm:#6
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# [1A~ 1/V%~ PID# 050-211-11 HA#
Date Received: August 13, 19.93.
Legal Description: Lot 15 Calkins Subdivision
Engineer:
Applicant:
Permit #
Will Veelman,.. P.E., Coffman Engineers, Inc.
550 West 7th Avenue. Suite 700, Anchorage, Alaska
Harold L. Hollis
99501
Waiver Requested:
Well to septic tank - ]~ feet
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
Special Conditions:
me
3. Other:
Waiver is Granted: ~/ Waiver is NOT Granted:
List Conditions or Reasons for above: _f~f ,~5r/~6f~
~44~v~ewe r
Rec #: 25033/9540
Amount: $ 410.00
Date Paid: 8-13-93
ELL Pl~ r19 -
I I
25-~ *- .: I =
. . >'~
.X'=,$ ~'g
6 4~a rar~ L
2./
September 24, 1993
Municipality of Anchorage
Department of tlealth & Human Services
On-Site Services
825 L Street
Anchorage, Alaska 99501
C FFMAN
INFERS
Han~ment
Attention:
Reference:
Mr. Dan Roth, Civil Engineer
LOT 15, CALKINS SUBDIVISION
Dear Mr. Roth:
This letter is in regards to the abandoned well on the subject property that lies 9' cast of the existing
private well. In accordance with your request and direction, the abandoned well has been filled
with concrete, the 6" diameter steel casing cut off 18" below ground surface, and backfilled to
original grade.
If you have any questions or need additional information, please call me at 276-6664.
Sincerely,
COFFMAN ENGINEERS, INC.
Will Yeelman, P.E.
Principal
Coffm~n E~i~
SSO W. ~h ~en~ ~ae 7~
September 9, 1993
Mtmicipality of Anchorage
Department of Health & Huma,n Services
On-Site Services
825 L Street
Anchorage, Alaska 99501
,C)FFMAN
GIN E ERS
S~ruclural
fro;m
LOT 15, CALKINS SUBDIVISION
S ~EPARATION WAIVER REQUEST
Gentlemen:
Please consider this request for a waiver to the horizontal separation of the well and nearest comer
of the septic tank located on the subject property to 70 feet. The existing well and septic tank
located on this property was installed under Greater Anchorage Area Borough permit dated
September, 1975. The well was drilled in January, 1976 and the septic system was installed in
February, 1976. The installation of the septic system was inspected by a representative of the
Greater Anchorage Area Borough. The horizontal distance was established and accepted by the
Borough at that time.
The well log indicates a static water level of 305 feet with bottom of the well at 347 feet. The static
water level was measured at 300 feet during an inspection conducted on July 12, 1993. A coliform
bacteria analysis of the water taken at this time was satisfactory.
The general slope of the surface is from the well to the septic tank. Thc source of water in this
well is protected from surface contamination by many layers of dense silty sand and clay. This
system has been in use for over 17 years without any indication of contamination. Therefore, we
contend that them is adequate evidence to show that the horizontal separation required by 18-AAC-
72.021 is not necessary to prevent contamination of this well.
Enclosed is a site plan, well logs, and letters of nonobjection from adjacent property owners. If
you have any questions or need additional information, please call me at 276-6664.
Sincerely,
COFFMAN ENGINEERS, 1NC.
Will Veelman, P.E.
Principal
enclosures
W. ~th ~ffl~ ~ite 1~
~h~e, ~ ~l
Municipality of Anchorage
Department of Health & Human Services
Environmental Services Division
825 L Street, Suite 502
Anchorage, Alaska 99501
Reference:
LOT 15, CALKINS SUBDIVISION
SEPARATION WAIVER REQUEST
Genflemen:
I am aware that a waiver to the horizontal separation of the well and the septic tank located on Lot
15, Calkins subdivision is being requested. I understand the request is to allow an existing
installation to remain with a horizontal separation of 73 feet between the well and the septic tank. I
also understand this system was installed in 1976 and has been in use since then with no
contamination of the well.
I have no objection to the waiver request.
Signed,
LOT fa,, CALKINS SUBDIVISION
Address:
Phone:
Municipality of Anchorage
Department of Health & Human Services
Environmental Services Division
825 L Street, Suite 502
Anchorage, Alaska 99501
Reference:
LOT 15, CALKINS SUBDIVISION
SEPARATION WAIVER REQUEST
Gentlemen:
I am aware that a waiver to the horizontal separation of the well and the septic tank located on Lot
15, Calkins subdivision is being requested. I understand the request is to allow an existing
installation to remain with a horizontal separation of 73 feet between the well and the septic tank. 1
also understand this system was installed in 1976 and has been in use since then with no
contamination of the well.
I have no objection to the waiver request.
Signed,
LOT ~..., CALKINS SUBDIVISION
Phone:
Date: S/~,/~..~
/ r
Municipality of Anchorage
Department of Health & Human Services
Environmental Services Division
825 L Street, Suite 502
Anchorage, Alaska 99501
Reference:
LOT 15, CALKINS SUBDIVISION
SEPARATION WAIVER REQUEST
Gentlemen:
I am aware that a waiver to the horizontal separation of the well and the septic tank located on Lot
15, Calkins subdivision is being requested. I understand the request is to allow an existing
installation to remain with a horizontal separation of 73 feet between the well and the septic tank. I
also understand this system was installed in 1976 and has been in use since then with no
contamination of the well.
I have no objection to the waiver request.
Signed,
Phone:
Municipality of Anchorage
Department of Health & Human Services
Envkonmental Services Division
825 L Street, Suite 502
Anchorage, Alaska 99501
Reference:
LOT 15, CALKINS SUBDIVISION
SEPARATION WAIVER REQUEST
Gentlemen:
I am aware that a waiver to the horizontal separation of the well and the septic tank located on Lot
15, Calkins subdivision is being requested. I understand the request is to allow an existing
installation to remain with a horizontal separation of 73 feet between the well and the septic tank. I
also understand this system was installed in 1976 and has been in use since then with no
contamination of the well.
I have no objection to the waiver request.
Signed,
LOT It/t, CALKINS SUBDIVISION
Date:.
Address:
Phone:
Municipality of Anchorage
Department of Health & Human Services
Environmental Services Division
825 L Street, Suite 502
Anchorage, Alaska 99501
Reference:
LOT 15, CALKINS SUBDIVISION
SEPARATION WAIVER REQUEST
Gentlemen:
I am aware that a waiver to the horizontal separation of the well and the septic rank located on Lot
15, Calkins subdivision is being requested. I understand the request is to allow an existing
installation to remain with a horizontal separation of 73 feet between the well and the septic tank. I
also understand this system was installed in 1976 and has been in use since then with no
contamination of the well.
I have no objection to the waiver request.
Signed,
LOT [ ~o, CALKINS SUBDIVISION
Address:
Phone:
ENVIROLAB
"'Environmental Assessment Laboratori'es of AK0'Inc.
P.O.Box 872988, Wasilla, AK 99687-2988
Ph.(907)373-4143 FAX 376-8016
REPORT ON DRINKING WATER ANALYSIS
SATISFACTORY
93-07.08
Acumetrix
4900 Palmer/Wasilla Hiway #3
Wasilla, AK 99654
Sample collected: 7/12/93 1315
Sample received: 7/12/93 1710
Sample type:Routine
Water Treatment: None
RM
TEST NAME: Presence/Absence of Total Coliforms
Results:O/lO0 mls, number of positives w/lO0 mls inoculated.
Normals: 0 positives per 100 mis.
Reported: 7/14/93 1610.
Report sent to AKDEC: N/A
Comments: L15 Calkins Sub.
Thank you,
Richard Hope, Envirolab
Zt _
,~o..~,: ~-I~- ~I~VI~I.Ir~I~NIN/ LlqB SERVICES -~ 90737G9629 N0.232
.~,l=~ --. ~·
COMMEI:IClALTI:. TING & I NGINI £1:::IING
ENVIRONMENTAL LABORATORY SERVICES "~
Chemlab Eef.~ :93.3911-i
Client Sample ID :Li5 CALHO~
Matri× =WATER
$63-~ B STREET
ANCHORAGE. AK 99S I$
TEL: ~'907) 562-2343
Client Name :ACg~!~l× COP~ORATION WORK Order :69264
.Drdered By :ROB Report Completed :Q8/10/93
Project t~e : Collected :08/05/93 @ ~2:30 hfs
ProJect~ : Received :08/05/93 @ 15:00 hrs
PW~[D =UA Technical Director:STEPHEN C. F_DE
Released By : /" .'
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: ROBERT D. MUSHPJ%LL.
QC Allowable Ext. Anal
Parameter Results Oual Units Method Limits D~te' [late Init
Nitrate-N 0.10 U mg/L E?A ~55.2/300.0 i0 08/09
* See Special Instructions Ab3ve UA ~ Unavailable
~* See Sample R~m~rks Above NA = Not Analyzt~d
U - Undetected, Reported value is the practical ~uantificatlon limit. LT = Less Than
D = Secondary dilution. GT = Gre~ter Than
~'~,- '" ~, APPLIC'-'NT FILLS OUT PER HAt'"'~ONLY
Mailing Address
' ~ ~( '"'- ,'-' Zip Code .~.;_% · .... -"~.
Realty Co. & Agent · ' \ · Phone
Address -. . Zip Code ~
Type of Resl~nce
~ Multiple Family .~ . No. of B~roo~
~ Other
Water Supply ,
~divid~l A~ACH ~LL LOG. A wd[ log Is requlr~ for all wells drl~ed since June 1975.
~ ~mmunlty .. For wells ~illed prior I~ ihat d=te, give well depth (attach log If available),
~ Public Utility
Sewer Disposal
~divld~l Year IndivMual Installed: [ ~ ~ ~
~ Public ~llity When ~nnected to Public Ut~lty:
~ Holding Tank
, NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time
Date
Insp,ector
Time
Date
Inspector
Field Notes: t
I DISAP~OVED
) CONDIT~NAL APPROVAL'
Time
Date
Inspector
Time
Inspector
JUN 2 7 1983
*CONDITIONS OF APPROVAL
Soils Rating
Well To Absorptl.on Area . . Well Log Received ~
Well to Tank Septic Tank Size / ~3 ~-~ ~)
EXCAVATION
ROBERT A. SHAFER
· WORK
July 10, 1983
CIVIL ENGINEER
694-2979
Joe Kunes
Box 177 Highland Drive
Eagle River, Alaska 99577 "~
Dear Mr. Kunes, <'
'Reference: Lot 15; Calkins Subdivision
A sewer system adequacy test was performed on the system located
on the referenced property as you requested. The septicAtank
was pumped with very little material being removed as a result
of the solids and sludge which existed in the tank. sanitary
Pumpers were requested to add'chemicals to the system to
break the solids down and then repump the tank. O~ the second
pumping, approximately 1000 gallons was removed. :
A continuous fl~w of water was added to the absorption system
for a period of 24 hours. During this time, water backed up
ihto the septic tank and was observed flowing out of the sump
at the end of the drainfield.
As a result of the above test it is determined that the septic
tank is adequate for the three bedroom residence located on
the property. .However, the absorption system seems to have '
completely failed. It will be necessary to have the system
upgraded. At your request a soil test has been performed and
a pe=,,,it has been obtained for the upgrading work and this work
should be accomplished in the very near future.
If we may be .of further service, please to do not hesitate to
contact us.
cc: MuniciPality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAG~.E RIVER, ALASKA
MUNICIPALITY OF ANCHORAGE r'~q'/!~ON;*I~NTAL i..~ ;~CTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
. ENVIRONMENTAL ENGINEERING DIVISION
REQUEST FOR APPROVAl. OF INDIVIDUAl. WATER AND SEWER FACli.ITIE$
DIRECTIONS: Complete all parts on page 1. Ineomplet~ requmt~ will not be p,oeea~ld. Please allow ten (10) days for processing.
I PHONE
MAILING ADDRESS
PROPERTY RESIDENT (1! d~'ferent from above) ~ PHONE
2. BUYER PHONE
MAILING ADDRESS
· I PHONE
MAILING ADDRESS
-- PHONE
MAILING ADDRESS ~
#<
LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
N~MSER 0~ 9E~ROOMS
[] One [] Four
[] Two [] Five
.J~' Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
SEWAGE DISPOSAL SYSTEM
.'I-~l INDIVIDUAL/ON-SITE**
r-I PUBLIC UTI LITY
.~/
*.*If individual/on-site, give installation date -'"J-~ /~
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
724310{3/78)
., THIS SIDE FOR OFFICIAL USE ONLY .
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE I DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[--I SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
' PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified* LOG RECEIVED .:' ~_
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
I--IINDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ~*~ -- I "~--'~ ~
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: ~ If Tank is homemade SOILS RATING
give dimensions: c~
TYPE OF TANK I MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
,. D,STANOES W,L'TO:Se""c'H°'"'n" Tan' IAbr~' Area ?S' I~"w""''"" IN"r"''°r L'ne
Absorption Area to near~t Lot Line
5. COMMENTS
~ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate}
[] DISAPPROVED
DATE BY (Title _~C
LEGAL DESCRIPTION
.k
72-010 (Rev. 3/78)
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GE()[IGE M. SULLIVAN,
X1A¥OF!
May 23, 1979
Morgan Simpson
% Robert H. Padgett
1709 Bragaw - Suite A
Anchorage, Alaska 99504
Subject: Lot 15 Calkins Subdivision
Approval for your individual sewer and water facilit'ies
will not be granted until the following items have been
completed:
The water analysis report be delivered to this office
from Chem Lab, 5633 B Street, for our review.
(~/ The septic tank is pumped with a receipt submitted to.
this office for our review.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,'
Robert C. Pratt, R.S.
Associate Specialist
aCP/ljw
cc: National Bank of Alaska
Mortgage Loan Department
Pouch 7-025 99510
0j GREATER ANCHORAGE AREA BOROUGH
Department Environmental Quality
of
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received August 11, 1976
Time of Inspection ~
Date of Inspection ~o/~i-Ob._
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
l. Approval requested by: Lomas and Nettleton Company '
Mailing Address: 4449 Business Park Blvd.
2. Property Owner: Vernon Risch
e
4.
5.
6.
Phone: 274-7661
e
Phone: 344-0640
Mailing Address: 7245 Blackberry
Legal Description:
Lot 15 Calkins Subdivision
Location:
Type of facility to be inspected . .Single Family No. of bedrooms
Well Data: Individual ~~~
A. Type ~ B. Depth
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank: 1.
D. Bacterial Analysis
On-site system
B. Installer
Size ?00 2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
'Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
C. AbsorPtion area to nearest lot line
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
tdUNICIPALIi~, OF' ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
AUG I ! lg76
RECEIVED
1. Type of Inspection: CMRO
2. Property Owner: Vernon Risch
VA., FHA
CONV_ x
Mailing Address:. 7245 Blackberz~z, Anchoraqe Day Phone:
3. Name of Buyer: Morgan W. Simpson
· Mailing Address: 5836 S. Tahiti Loop, DayPhone:
Anchorage, Ak.
4. Name of Lending ~nstitution: The Lomas & Nettleton Co.
Mailing Address: 4449 Business Park Blvd. Phone:.
AnchoTage, ~,k. 99503
5. Name of Realtor or Agent: NON~
Mailing Address: Phone:.
6. Legal Description: Lot 15~ Calkins Sub
Location:. Eaqle River, Alaskar
Highland Drive
344-0640
277=7517
274-7661
Type of Facility to be Inspected:.sinqle family resi.
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served one
No. Bdrms. 2
Individual x
If Individual, depth of well.
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation unknown
Contact builder, Vernon Risch for
Individual (on-site) x
information
72-003(3/76)
,Page 2 of two pages - Rec~'~t for Approval of Individual ¢~"~ & Water Facilities
Legal. Description Lot 15 Calkins Subdivision
Comments
Approved Disapprovedo~ Date
Approval .~Valid for one
Greater Anchorage Area Borough, Dep~l~ei~%~P~r)F~nl~en~ Q~l~'~y
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities'and these facilities
are operating satisfactorily.
SIGNED
EQ-034 (1/74)
Date
4.1
'Vermmm RAm:~
72&$ ~lack. bex'~
An~mogage ~ Alaska
99502
Lot: 15 CAll,ns Subd~vls~
D~r~. Risch~ '
· he sub:Jeo~ property ~ an abandone~ yell (~8e~) ~l~b
need~ to ~ oa~ of£ ~o provent possible ~taMlmA&lon
~ wa~ a~uAfe~o A sanAt&r~ seal or & welded plate
t2m u~ual me~ho~, u~ed.
~h_~en ~Lnwo~k Aa ~cM~XoI~, ~lease ~ontac~ tJ~is office
~ve ~bowell Ano~eo~e~.lno~de~to ftnalise ~Jae
approval ~equest. e~by ~he XendAng Ans~Ltutio~ on
at'276-2221, ex~ensAon 286Z
Lem,H, Buchholz,
Authorized D eale. r
Phone 907-344-9422
The Vern Risch Co.
2300Ea~ 88th Ave.
Anchorage, Alaska99507
344-9422
RADIANT ELECTRIC HEATERS
Franchised 'D~tributor
September 30, 1976
Mr. Bern/e Claus
,-Rampart Drilling Works
SRA Box 1369
Anchorage, Ak. 99502
Dear Bernie,
I an enclosing a letter from the Environmental Protection Dept. ad-
vising us that the extra well casing on Lot 15, Calkins Subdivision
must be sea]ed. I know this might add insult to injury based on the
time and expense you had there and ending with the collapsed casing,
but it should have been sealed before leaving.
Pleas~ontact me if there is any problem'to you doing, thise
/
Vern .~ts ch
cc~ Dept. of Health and Environmental Protection
The Finest in Homes and Heating
Municipality
of
Anchorage
POUCH 6 650
ANCHORAGE. ALASKA 99502
{907) 278-4531
GEORGE M SULLIVAN.
MA Y OR
[~EPAHTMENTOF HEALTH AND ENVIRONMENTAl. PROTECTION
Environmental S~lmtation Division · ~1~,~
(2'510 East Tudor Road}
September 15, 1976
4.i
Vernon Risch
7245 Blackberry
Anchorage, Alaska
99502
Subject: Lot 15 Calkins Subdivision
Dear Mr. Risch:
The subject property has an abandohed well (cased) which
needs to be capped off to prevent possible contamination of
the water aquifer. A sanitary seal or a welded plate is
the usual method used.
When this work is completed, please contact this office to
have the well inspected inorder to finalize the health
approval requested by the lending institution on the
property.
If there are any questions, please contact this office
at 276-2221, extension 286.
Sincerely,
Buchholz,
Sanitarian ~
LNB/ljh