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HomeMy WebLinkAboutTERRACE HEIGHTS LT 15BHeights Lot 15B #017-074-59 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-5650 w',vw.cLa n choraqe.ak.us (907) 343-7904 Performed For: Soils Log - Percolation Test Legal Description: 1- 5- 6- 7- 8- 9- 10- 11- 13- 14- 1% 18- 19- 20- COMMENTS WAS GROUNDWATER ENCOUNTERED? $ IF YES, AT WHAT DEPTH? L Depth to Water After p Monitoring? '~ e Date: Date. Performed: (~ / / .~'/ )-,.[1'? j ~_~"~,) Township, Range, Section: Slope Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop o - " .- .~0 ~ ~,,~ ~,' 0'~ PERCOLATION RATE I ~ O '1~- (minutes~inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND J'~ FT BY $ & S F.~GINEERING, , r'~/'~¢ 2Z PERFORMED : .................. ~ .,_ ... ~ ~~ CERTIFY THAT THIS TEST/xWAS .... ~ '~ ' A~D ~ M~C[PAE ' ,/~: ,~Z~ ~~ GU DEL NES N EFFECT ON TH S DATE DATE' ~/l~/0 PERFORMED IN  Municipality of Anchorage ~) Department of Health and Human Services Building Safety Division On-Site Water and Wa~ewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519~650 Page 1 of 2 www. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW010 --'":~--- PID Number: 017-073-41 Name: Rnh R, .lanc_f .Inhn_~nrl Wastewater System: [] New [] Upgrade Address: 79413 IIp.n~_r De_Armrmd: 9~'11~ ABSORPTION FIELD ;~ [~Deepmmnch E]Shallowmrench E/Bed [3Mound ~Other:HoIding Tank LEGAL DESCRIPTION so, Redi~g: Total Depth from origina/grade: ~P~IFt~ Ft. I 13 Terrace Hts Ft, Et Ft. Fi. Well: [] New [] Upgrade a,.w~w~: Numberoflines: [ DisMnce between lines: Ciz*sifica'd on (Private, A, B, C): Teat ~r4h: Cased to: Tota~ absorption area: Pipe Material: Existinq ~. ~. ~ 3034 PVC ~,. Dan Beeks 6/22/2001 ~. TANK SEPARATION DISTANCES , [] septic [] Holding ~ S.T.E.P. ~ Other: T~To Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity: From ~ Tank Field Station Tank Sewer Une Greer 2000,~1. We, 106 76 Steel S.r~W.~, 100+ ~ / LIFT STATION Lot Line 28~ Size: M~nufacblrer: Curtain O~ain 100+ Pump Make & Model Electrical Jnspeclions pe~fo~rned by: Note: Lot number changed from the permit. BENCH MARK Discovered the property is on lot 13, not lot 12. SW Corner of house on Drive way 100.0 Ft. RECFiVED · Engineer's Stamp Inspections performed b?:Pannone En.q. Svc Dates: ¢6/22/2001 ' 2"~07/07/2001 ~ Department of Health Services approval Reviewed and approved by: f..~/¢~1~,¢' Date: /~-* J / ~'.~,'*o Ne. gL  PERMIT NO, SVOIO~8~ A S- ]3 U I L T P.z,~. Nh, o17-o73-41 WASTEWATER A:BSORPTIrlN SYSTEM  LOT 13 BLOCK 1 TERRACE HTS f / / ' ~' Ro~ / EXIST'G WELL~ EXIST'G WELL~ -- ~- -~ ~-- ---- ," .--~ ~- ~ ......... ~ ................. u... ~ i~ ~ I EXIST'G ~3 3R LOT UN])EVEL'~PE~ ~ ~! ---~ ~ HOUSE WELLS ER SEP~ICS~ ~ ~ ~ / O~ THT~ ~nT~ ~ ~ f' j / ~ N~'~ ~ i / / "x ~ x, / ' L, ,: /' NEW ~Oa~'h.-~ ................ "' ~ ::~DAN~N:~ "~ HU~:~G TANK, ~ ................. ~: RE'M'DVA:' TRENCH - IN FAILUREmC /# : .... 7 :ALLURE, ABAN~DN A~¢N~BN IN PLACE, ~///~%~ i IN PLACE, ; /"~ ~ -THi T~ a~,7 a~,o lO]ELecBk 693E~m~ ~ 49~ ~ A~41 2000g HDLDING TANK I HOLDING TANK ~.-..~.~.~ .......... a,.,., ~ ~ITH ALARM SYSTEM ............ onnon~V"-~ PREPARE]} FOR: PANNDNE ENG, SVC~LLC ~.. ; ~ Mp, Bob & d~ne~ Johnson P, D, 3DX 102954 Ancho~aoe, AK 99516 ANCHORAGE, ALASKA 99510 '~ ......... ~ ~7~-8~18 Phone ~ Fax eee~s~- )ATE, 5-24-ol ~ DESIGN I MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Dec 13, 2001 Expiration Date: Dec 13, 2002 Permit Number: SW010488 Legal Description: TERRACE HEIGHTS BLK 1 LT 13 Design Engineer: 0062 Pannone Engineering Services Owner Name: Bob & Janet Johnson Owner Address: 7940 Upper DeArmoun Anchorage, AK 99516- Parcel ID: 017~073-41 Site Address: 007940 HILLSIDE WAY Lot Size: 20700 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ~ Disposal Field [] Septic Tank [] Holding Tank ~ Privy Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must noti~ DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 'f5, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. / Date: / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-073-41 Permit Number SW- 0 10488 Property owner(s). Bob & Janet Johnson Mailing address (1) 7940 Upper DeArmound Mailing address (2) Anchorage, AK Legal description (Lot, Block & Sub'd.) Lot 13, Block 1 Terrace Hts Legal description (Section, Township & Range) Lot Size 20700 Acres/Sq. Ft. Day phone 486-1954 Zip Code 99516 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms 3 [] Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Pannone Engineering Services, LLC Consulting Engineer (907) 272-8218 December 4, 2001 P.O. Box 102954 Anchorage, Alaska, 99510 (907)272-8218 Fax Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Gentlemen: Lot 13, Block 1 Ten'ace Hts. Subdivision, Emergency Septic System Upgrade Permit Request My firm was contacted to design and install a replacement septic system for the referenced lot. The existing drainfield is in failure and backing tip into the house. I conducted a field invasfigafion to locate existing wells mid septic system as well as a record search before designing the proposed system. I discovered that there are two systems on this lot. The crib is assumed to have been installed in the late 60's, since there is no record of it on file with your Department. The trench system was installed sometimes in the last t5 years without MOA approval. We conducted a soils investigation in the most likely location for a replacement system. The soils were organic peat's, mlderlayed with blue fill gray clay with some gravel, with a percolation rate of greater than 60 minutes per inch (see the attached soils log and percolation tes0. I attempted to nm a percolation test, but the presoaking period showed no measurable movement of the water level over a twelve-hour period. Additionally, the ground water was monitored through the May 15t~ high water event and measured to be within five feet of the surface, leaving only one foot of unsaturated soils above the measured high water level. The area west of the ex/sting trench was deemed unsuitable for the installation of a soil absorption system due to repons of buried cars, rubbish, and unacceptable material. The area north of the field mid south of the well radius was not large enough to install an adequate system based on the histor/cal information of the soils in this area (typically percolates in the 45 to 60 minutes per inch range, requiring 1000 sf of absorption area.) I propose installing a 2000-gallon holding tank on the referenced lot due to high ground water m~d inadequate soils. The holding tank will have an alarm system. The lot is approximately 21,000 square feet in size. Lot 13 slopes to the south at a rate of approximately 3 to 5 percent. The proposed holding tank installation will be located in the central portion of the lot on a relatively flat area south of the existing house. There will be easy access to the tank for pumping tracks. The proposed locadon is greater than 75 feet away from any wells. The proposed system will be greater than 10 feet from the water service lines. The proposed tank will connect to the effluent side of the existing septic tank. The existing septic tank will be inspected and reused if fonnd competent. The proposed/nstallation will not affect the future development of the surrounding or existing lots. See the attached design. Pf~se contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation. Sincerely, %ven R. Pannone, P.E. Attachments:  PERMIT NO' SV010186 AS-BUILT F',~,D. NOl 017-073-41 LVAgTEWATER ABSDRPTIDN SYSTEM LOT ~3 ~LDCK 1 TERRACE HTS EXIST'G ~ELL~xEXIST'G ~ELL~ . ~: EXIST'fi [3 BR LDT UN]IEVE~OPED ,~ i'~ ~ ND ]NED 3¥/] EXIST'~ UNDOCUMENTED ":~:~ EXI~T'G CRZB~ IN TRENCH - IN FAILURE,- ~# ? ....... ~AILURE, ABANDON A~NDON ~N PLACE, ~ ZN PLACE .::. -.....? CO A ~ C1 ~9,4 19,7 T1 ~9,7 81,0 ] T~ 30,7 T3 31,1 ~:. ..... lO]Etec Esm~ ,~ ',,. Bk 693 PO 601 ~ ~e.7 GXlS-iTepm~ceH~s,DVG ~. ........ PER~ RATE~ GREATER THAN 60 MIN/IN~ ~--~.1..'" & "'~_ GROUND rATER V/IN ~' 49~ 2oOOg HOLDING TANK ~/~ . . PREPARED FDR~ Ponno.~. PANNDNE ENG, SVg,LLg 7g~O Upper DeAroDd ANCHORAGE, ALASKA 99510 .~ .... .e ~7~-~2~ Phone & FQx ~-- DATE, 5-24-01 ~ DESIGN ~CALE~ 1"=5D~ / Roi PANNONE ENGINEERING SERg/ICES, LLC P.O. BOX 102954 j . -- . .. . HENTE~ ~ EXIST'G CRIB TRENE O~ H1 W~ GRO~ WA~R 14 -- ENCO~D? No 16 -- DE~ ---- ~ HO~ MOP.G? D~ ~RO~ON ~ ~ {~/~) PE~ HO~ D~R 6 ~che~ ~ED BY: S~ R. P~on% P.E. I CE~ ~T ~S ~ W~ PE~ED ~ ACCO~CE PANNONE ENGINEERING SERVICES, LLC (90~ 27~-8218 i ~ EXIST G VELL~ EXIST fi VELL~ Ag~N~ON IN PLACE~ ~? WAS GRO~ WA~R 14 -- ENCO~? No ~H 17 ~ DE~ ~ WA~R ~R MOP,G? -5 ~D BY: ~n R. ~one~ P.E. I CERr~'~ ~T ~S ~ W~ ~ED ~ ACCO~CE O WELL CONSTRUCTION LOG "DriI~ling~'CO. ~3~ ½1 ~~ ~ ~_~_ %t ......................... No._ ~ 'Type of rig Date well completed Dri 1 1 e r. ~r~_~L~~' ~j~% ~ Well owner /rw~/~'~ ~ Nearest community Well locati%%-~'descriptionJZ~/t~7~'7-- Location sketc~V Depth of~,well_~7~ ft. Casing:depthR&,cft./dia.$ in. ~W~rw ~ 3'~,~; " Static wate~ level /~ft.(above,below land surface, Date~-J~-y~. Finish of well: (open-end,sc~een.~ DeScribe intervals and szze: ~,~ ~z~//~, ~, . Well yelld tested by(p~ping,bailing,ai~) gal/min, fop_~ hours with ~ ft. of drawdown from static level. DRILLER'S ~TERIAL LOG ELL CONSTRUCTION LOG Driilin~ Co. ~_~_~A/ G~P3~- USGS No. · "= - · '--37'; ............ ' ............. = Driller ~ .~_Az~-~t-V__ Type of rlg~~ate well completed Well owner ~~ /' ~NeaPest community Well locati%~g~~~n~~j~-~ Location sketc~6~- (a~ess)~~' ~~.~ ~c/ Depth of.,we~ft~ 'Casihg.depth~ft. ~i~ ~in. /~ Static water level ~/f ft. (above, below land surface· ~d~ ~ ~ ~ Date ~/~ __. Finish of well:(open-end,screen,open- hole,other). Describe intervals and ~ize: ~/~ Well yeild tested by(pumping,bailing,air) at gal/min, for_~//? hours with__~ i/~ ft. of drawdown fmom static level. DRILLER'S MATERIAL LOG remarks s T-25'- 17 3 /dot Oepth belo. Ilfld suffaee In lei! LOT- /Vtunicipality · Anchorage P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES December 5, 1986 Fred and Barbara Case 7940 Upper DeArmoun Anchorage, Alaska 99507 Subject: Water well in public right-of-wa?, Dear Mr. and Mrs. Case: It has come to our attention that the private well serving your house (Lot 13 Block 1 Terrace Heights Subdivision) is located in the public right-of-way. As the result of recent road drainage improvements, this well is subject to flooding and possible contamination from surface waters. This could result in the contamination of your water supply and of the aquifer that provides water to others in your area. Because of this risk, this department will require that this well be properly abandoned and sealed to prevent surface water intrusion. A new well must be drilled to provide water for your household. Please contact this Department at 264-4744 as soon as possible to discuss this matter and to obtain the required permit to drill the replacement well. Thank you for your cooperation. Sincerely, Robert W. Robinson On-Site Services Section Manager Municipality of Anchorage On-Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-074-59 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: TERRACE HEIGHTS S/D; LOT 15B (FORMERLY LOTS 13 & 14) 7940 UPPER DEARMOUN ROAD, ANCHORAGE, AK, 99516 ELNORA WANDS Day phone 109 W. ELLSWORTH AVE, DENVER, CO, 80223 Day phone 720-320-0746 TYPE OF DWELLING: [] Single Family (w/wo ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 3, NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] WaiverNadance request for: N/A COSA to be released to the engineer, unless otherwise requested by the engineer. Waiver Fee $ Date of Payment Receipt Number Waiver # $. 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 Qn- Site Systems Approval Guidelines for this application, shows that the on-site water supply and/er 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 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting thl~ evaluation, GEe, LtD. atlempled to provide a thorough, conscientious engineering analysis of the system in accordance with AOEC and MOA DSD Guidegnes & Regulations The repeRed results described the performance of fha system under the conditions encountered at the time of the test, and separation distances measured lo readily identifiable fealures, The operational life of all wells and 6. DSD SIGNATURE System #1 Approved for System #2 Approved for bedrooms. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: The M'~inicip~lty ~or Ar~orage DeveloP'ernt Serv,ces DIv,slbn(DSD ....... ( , ',ssues Cettificates of On Stte S ' -' y sterns A pp royal ( CaSA ) based on, y upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska, The Municipality of Anchorage is not responsible for ¢~rors or omiss'ons in the professional engineer's work. 7, ATTCHMENTS: CaSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other 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: TERRACE HEIGHTS S/D; LOT 15B Parcel ID: 017-074-59 A. WELL DATA Well type PRIVATE Date completed 3/26/1987 Total depth 275 ft, IfA, B, or C provide PWSID# __ Sanitary seal (Y/N) YES Cased to 2OO ft. N/A Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 3/26/1987 12/22/2014 Static water level 197 ft. 195 ft. Well production 5.5+ g.p.m. 6.36+ g.p.m. WATER SAMPLE RESULTS: Coliform (.~ colonies/100 mi. Arsenic: j~ ~ ug./L. NitrateL¢, 3 Smg./L. Date of sample: 12/22/2014 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material HOLDING/STEEL Date installed 6/22/2001 Tank size 2000 gal. Number of Compar[ments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES SEE ATTACHED Date of pum, ping RECORDS Pumper. A+ HOME SERVICES C. ABSORPTION FIELD DATA . w ~ ¢~. ~,~ c~,~¢c~' ~ , 2 2 Date installed Soil rabng (g.p.d./~ or ff ~bdrm) ~ System type Length _fl. Width fl. Gravelbe~ ~. Total depth ~. Eft. absorption area ~ Monitoring tube ~D~ression over field Date of adequacy test Res~~ For bedrooms Fluid depth in absor~~~%~ Wa~r ~ ~ gal. New depth in. Elapsed Time: ~~na~ depth in. Absorption rate >=__ ~ g.p.d. ~treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at__.in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas_ Size in gallons Manhole/Access (Y/N) "Pump off" level at ' ' wa er alarm level at Cyc es tested. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank 75'+ Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS *SEE ATTACHED LETTER REGARDING SEPARATION DISTANCES. Absorption field Surface water N/A Building foundation Water main Surface water _ ' way, parking/vehicle storage Wells on adjacent lots. 100'+ G. ENGINEER'S CERTIFICATION I cerfffy that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 10/12/12) AS-BUILT SURVEY ~" = 20' ~[ HEREBY CERTIFY THAT I HAVE PERFORHED A SURVEY OF THE FOLLOI~ENG DESCRIBED PROPERTY LOT 25 E, TERRACE HE~6HTS EU~. ( PLAT 2002-~.7l) GARNESS ENGINEERING GROUP, Ltd ~ ~: ~-~;~ ~ ~:~-~ ~--!~ CIVIL & ENVIRONMENTAL ENGINEERS December 29, 2014 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road, Anchorage, Ak 99519-6650 REFERENCE: Terrace Heights S/D; Lot 15B. Separation Distances. To whom it may concern, In December of 2001, Lots 13, 14 & 15 of Terrace Heights S/D; Block 1 were re-subdivided into Lots 15A & 15B. Records for Terrace Heights S/D; Block 1, Lot 13, contain the original information for the well and septic system in place on the property. GEG, Ltd. recently inspected the subject property to obtain a C.O.S.A. The wintertime conditions, construction of surrounding septic systems (missing pipes and lack of pipes), and limited MOA records presented some challenges to confirming separation distances. The issues are summarized as follows: Windchimes S/D; Lot 3 (Northwest of subject lot); No drainfield cleanouts or monitoring tubes could be located. None are shown on the MOA inspection report. Matin S/D; Lot 4 (Northeast of subject lot); While tank pipes are present, no drainfield standpipes could be located during this inspection. GEG made contact with the homeowner within the last 2 years during a separate inspection, who conveyed to us the general location of the drainfield and that no standpipe was installed in the drainfield. Terrace Heights S/D; Block 1, Lot 12; (East of subject lot); No plan view type drawing was submitted for either the permit or the inspection report of the septic system. During our inspection, no standpipes for the tank or the drainfield could be located. Based upon site specific conditions, it appears that the subject well is likely 100 feet or more to the septic systems on the aforementioned lots, but GEG cannot certify this separation under the current circumstances. The exact distance from the subject well to surrounding septic systems is therefore unknown. A water quality sample taken on 12/22/2014 indicates that water quality is satisfactory and not likely being compromised significantly by a neighboring septic system. (see attached) 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineedng.corn Page 2 of 2 Well to Animal Containment Area; The well is within the fenced front yard area which could be used to contain small animals ifa homeowner chose to do so. If you have any questions, please contact us at 337-6179. 'nceI Pre~ P.E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 v¢,vw.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-073-41 1. GENERAL INFORMATION Expiration Date: ~/! 3/CZ Complete legal description -Lot 13, Block 1 Terrace Hts S/D Location (site address or directions) 7940 Upper DeArmond, 99516 Current Properly owner(s) Mailing address Lending agency Mailing address Bob & Janet Johnson 7640 Upper DeArmond, 99516 Day phone 486-1954 Day phone Real Estate Agent Henry Graper Day phone 272-0571 Mailing Address Totem Realty Un/ess otherwise requested, HAA wi/I be held by DHHS fc~ Pickup. HAA picked up by: NUMBER OF BEDROOMS: _3_ 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System We!! TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank [] Community On-site [] P~,bllc, ' S,.v*..~,~ ,~. The Municipality of Anchorage Department of Health and Human Services (DBHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations oiven in paragraph 5 by an indeoendent professional civil engineer registered in the State of Alaska. Certificates of Heaith Authority Approval are ~tequired for the transfer of title (except between spouses) on properties sen'ed by a single family on-site wastewater disposal and/or water supply system. DBHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from ~he date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at me time of installation. Name of Firm Pannone Enq. Svc. Phone 272-8218 Address P.O. Box 102954~ Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 11/1212001 Engineers Comments: In conductJsg ,'tn adequacy tesL I attempt to pro~dde a thorough, conscientious enghanering analysis of the systern ha accordance wi~h MOA DImS Guidelines & Regulations The reported results describe the perfom~ance of the ~stem trader the con ' 'o s encolmfere.4 af th2 *'~ c .t. '~'? test. and separation d~stanccs measured to readily ~dent~fiable features The oeerafional life of ull ,~,.m ..a scplm s3 stems depend on the local sod con&hen, ~ound water levels that ma., flu.-h,~,- .t,,.4.~ ,~ ..... and the water usage of the fam/ly being served by the s~tem. These conditions are outs/de fl~. ,-,.m,-~4 ,.¢ the e~ aluator of this g's~m. All systems eventually fad and satisfactory test results do not m~ara.t~ , ~"'~'~"'PI~'"~i'~ future performance of the syste~r~ nor do they gu~antee that there are n'o hidden defects or ~n~r~)'~'l~nent ~'~ PES can therefore not provide any ;var~tv for future perfermal~ce nor aive any estimate o£ haw lan ~, *h~-'~,'~';J '~ '"',? sb~tem ,,~1[ continue to meet the operational reqmrements of the ADEC or MOA DHHS. The content of ~h? repot1 is for the sole benefit ortho o,,mer listed above. Any reliance upon or use o£this report by anv otucr person or party is not authorized nor will it confer mw le¢al right wtmtsnever ¢ ' ~ ,~ ~-- . 6, DHHS SIGNATURE Approved for _ 3 bedrooms. Disapproved. Conditional approval for _ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Expiration Date: '~/' '/C ~ Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:ffZ// Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak,us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriplion: Lot 13, Block 1 Terrace Hts A, WELL DATA Well type Provate Date completed 3/26/1987 Total depth. 275 ft FROM WELL LOG Date of test 3/26/1987 Static water level 197 Well production 5.5 WATER SAMPLE RESULTS: IfA, B, or C provide PWSID # Sanitary seal Y Cased to 40+ ft ft g.p.m Coliform -~:~ colonies/100 mi Date of sample: 11110/2001 B, SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installec 6/22/2001 Tank size Cleanouts _Y Foundation cleanout _Y Date of pumping 11/5/2001 C. ABSORPTION FIELD DATA Parcel I.D.: 017-073-41 Date installed Length ft Total depth __ ft Date of adequacy test __ Well Log _Y Wires properly protected Y Casing height (above ground) 18 AT INSPECTION 11/10/2001 197 ft 5.0 g.p.m Nitrate ~,c~/ mg/I Other bacteria ~ coloniesll00 mi Collected by: S.R, Pannone 2000 gal Number of Compartments _1 Depression over tank _N High water alarm Y__ Monitoring tube __ Pumper A+ HOME SVC Soil rating (g.p.d/ft2 or ft2/bdrm) N/A Width ft Effective absorption area ft2 Results (Pass/Fail) .__ Fluid depth in absorption field before test in Elapsed Time: __ rain Final fluid depth ___ Any rejuvenation treatment (past 12 mo.) (Y/N & type) (Rev, 11/99) Water added in System type Gravel below pipe ft Depression over field For bedrooms __ gal. New depth Absorption rate >=__ If yes, give date in. g.p.d. D. LIFT STATION Date installed "Pump on" level at __ Datum Size in gallons in"Pump off" level at Cycles tested in Manhole/Access High water alarm level at .-- in Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manho[e/cleanout Holding tank 106 E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot NIA Public sewer main NIA Sewer/septic service line 75 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line 2.._.~8 Water service line 75+ Wells on adjacent lots 100+ Building foundation 19.7 Water main NIA Drainage 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water. Wells on adjacent lots Property line NIA Water Service line Curtain drain NIA Absorption field NIA Surface water 100+ Water main Driveway, parking/vehicle storage F, COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that t have determined through field inspections ~nd review of Municipal records that the above systems are in conformance with MOA HAA guidetinee in effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. Date 11-t 2-01 HAA Fee $ -, DateofPayment I I / l ~ / © I Receipt Number (Rev. 'i t/99) Waiver Fee $ Date of Payment Receipt Number