HomeMy WebLinkAboutALLEN LT 4
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ALLEN SUED/U/S/ON
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ENGINEERING, INC.
2525 Gambell Street, Suite 200, Anchorage, Alaska 99503
Tele: (907) 563-3835 Fax: (907) 563-3817
AS BUILT OF:
Lot 4, Allen Subdivision, Plat 77-250
Anchorage, Alaska
WORK ORDER NUMBER: PD -
SCALE: E-MAIL:
ber 1 2020 1"=30' wessels@eeiteam.com
9729 CHECKEDBV GRIDNUMBER BOOK PAGE
SMW SW2634 589/54-55 - 501160
00
N
X
128.9'
ROOF
OVERHANG
" i DOUBLE
•.. CLEANOUT
11150 CANGE ST
/Old 39•S
-----
jos------
DECK
300.00'(R) '
SURVEY CERTIFICATION:
EEI has conducted a physical survey
of this property as shown on this
drawing and that the improvements
situated thereon are within the
property lines and no encroachments
exist other than noted.
EXCLUSION NOTES:
It is the owners responsibility to
determine the existence of any
easements, covenants, or restrictions
which do not appear on the recorded
subdivision plat. NOTE: Under no
circumstances should any data hereon
be used for the construction or for the
establishing of property lines.
DOUBLE
20" MANWAY[ CLEANOUT
.. °
o
N - �
DOUBLE DOUBLE
CLEANOUT CLEANOUT CLEANOUT
L0r 4
ALLEN SUED/v/S/ON
/
(1-1141- N0 11-0250)
/' 40, 533t SF
/
/
EAST 112TH AVENUE
NOTE:
1) Bearings and distances are as per Plat No. 77-0250.
2) Building dimensions are measured to siding if no
foundation is exposed.
OF, Al
)cTM. Wessel : e
No. 107877
0,/07.r
OFtccinnin\.
0
0 30 60
SCALE: 1" = 30'
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in \ MUNICIPALITY OF ANCHORAGE
... 111Ell
(
On-Site Water&Wastewater Program 'S`,
/ * : PO Box 196650 4700 Elmore Road �
41:1m Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r
•http:/Iwww.muni.org/onsite
epartment
4h<NORAOE
On-Site Wastewater Disposal System Permit
Permit Number: OSP191401 Effective Date: 9/11/2019
Work Type: SepticTank Upgrade Expiration Date: 9/10/2020
Tax Code Number: 01527157000
Site Legal Address: ALLEN LT 4 G:2634
Site Mailing Address: 11150 CANGE ST, Anchorage
Owner: MARKEL SAMUEL A& CAROLYN R Lot Size in Sq Ft: 40533
Design Engineer: Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field E1 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
co-15`i q/6/,9 Tank be//4ce1 �� f�c .se ,soca-Ec�rl
ae ( ^.y
7 ii /7
Received By: Date:
Issued By: - G�0 Date: R /I /'
MUNICIPALITY OF ANCHORAGE
� ffak
Development Services Department t Phone: 907-343-7904
On-Site Water & Wastewater Section - Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-271-57-000
Property owner(s) Samuel and Carolyn Markel Day phone 9073176028
Mailing address 11150 Cange Street, Anchorage, AK 99516
Site address 11150 Cange Street, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Allen Subdivision, Lot 4
Legal description (Township, Range & Section) Allen Subdivision, Lot 4
Lot Size 40,533 Sq. Ft. Number of Bedrooms 03
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field H Initial ❑ Single Family (SF) L J'
(w/wo ADU)
Septic Tank ? Upgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage fl
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 00 5 - Waiver Fees:
Date of Payment: 9-1,0 -P1 c?S5) Date of Payment:
Receipt Number: 29.3iO Receipt Number:
Permit No. OSP)gJ vo I Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
MMI M wwMAIM
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ENGINEERING, INC.
September 06, 2019
Ms. Rebecca Carroll
Onsite Water and Wastewater
Municipality of Anchorage
4700 Elmore Road
Anchorage, AK 99507
Subject: Septic Tank Replacement Application Narrative
Markel House Septic Tank Replacement
11150 Cange Street, Anchorage, Alaska 99516
Dear Ms. Carroll:
Enterprise Engineering, Inc. (EEI) is submitting this Septic Tank Replacement Application
Package on behalf of Samuel Markel. The Markel house is located on Lot 4, Allen Subdivision.
The site is in the Municipality of Anchorage (MOA) Grid SW2634. We are requesting approval
to replace the existing septic tank with a new septic tank and associated cleanouts.
The existing septic system is a typical deep trench system with a 1,000-gallon steel septic tank.
The system was designed for a 3 bedroom house. Per the On-site Disposal System Inspection
Report dated 7/14/1980, the "top of tile to finish grade" dimension is 4 feet and the "material
beneath tile"dimension is 8 feet. The total length of the drain field is 27 feet. The existing septic
tank is approximately 110 feet from the onsite private well.
The project will include abandoning in place the existing septic tank and providing a new 1,250-
gallon, MOA approved septic tank. The proposed tank will be located 1 foot south of the
abandoned tank and new 4 inch sewer pipe will tie the tank into the existing system. A double
cleanout will be provided upstream of the tank within 10 feet of the tank inlet, as well as
downstream of the tank within 10 feet of the tank outlet. The proposed 1,250-gallon tank will be
approximately 109.7 feet from the existing private well.
Anchoring or ballasting the proposed tank will not be necessary due to the existing system being
a deep trench design. The water table is below the bottom of the trench which is 8 feet below the
tank outlet. Therefore, there will be no buoyancy forces on the tank caused by the water table.
There are no adverse impacts to adjacent properties anticipated by this septic tank replacement
project as the proposed septic tank is approximately 53.5 feet from the closest property line and
more than 100 feet from any known wells.
Anchorage, AK 99503 • 2525 Gambell Street, Suite 200 • 907.563.3835
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ENGINEERING, INC.
If you have any questions or need additional information, please feel free to contact me at 907-
563-3835 or markelk@eeiteam.com.
Sincerely,
Enterprise Engineering, Inc.
Prepared by: Approved By:
/1.4d(f344
Kyle Markel, EIT Nick Homerding, P.E., PMP
Civil Engineer Principal/Project Manager
Attachments:
• Public Inquiry Parcel Details
• On-site Disposal System Inspection Report
Anchorage, AK 99503 • 2525 Gambell Street, Suite 200 • 907.563.3835
LOt) I `
A//IN SUASION
-- — - - - - - - - - - -- - - - - - - ---- -�- GENERAL NOTES
1. CONSTRUCTION MUST BE IN CONFORMANCE WITH THE MUNICIPALITY OF ANCHORAGE
10,1 STANDARD SPECIFICATIONS.
AllEN SU&,1WSON I 2. VERIFY UTILITY LOCATIONS BY OBTAINING LOCATES PRIOR TO CONSTRUCTION.
(PM/NO 77-0/50) I 3. FOLLOW MOA REGULATIONS FOR NOISE, HOURS OF OPERATION, AND DUST CONTROL.
/0,5JJf SJ 4. RESTORE DISTURBED PROPERTY OUTSIDE LIMITS OF WORK TO ORIGINAL CONDITIONS. 11 _
I •
SEPTIC NOTES
I 1. EXISTING SEPTIC TANK DECOMMISSIONING MUST BE IN ACCORDANCE WITH THE CURRENT W
ADOPTED VERSION OF THE UNIFORM PLUMBING CODE.
'\ 2. SEPTIC TANK MUST BE PLACED AT BOTTOM OF EXCAVATION,ON UNDISTURBED W
i SUBCRADE AND BACKFILLED WITH CLASSIFIED MATERIAL PLACED IN 12" LIFTS, 1-1-11 C) I— Q
•
COMPACTED TO 90W DENSITY. BACKFILL WITHIN WITHIN SIX INCHES OF TANK MUST NOT � W Y
CONTAIN ANY PARTICLES.SIZED LARGER THAN 1.5-INCHES IN DIAMETER. Q w
J CC Q of
•
3. PROVIDE 1'} SEPARATION BETWEEN DECOMMISSIONED AND PROPOSED SEPTIC TANK. I' J g
0� PROPOSED TANK OUTLET IS TO BE IN LINE WITH EXISTING TANK OUTLET, AS SHOWN. O LL, Q N
R�.--- 4. THERE ARE NO KNOWN WATER WELLS WITHIN 100' OF THE SEPTIC TANK.
5. PVC SEWER PIPE SHALL MEET EITHER ASTM D3034 OR ASTM F789. LL L.LJ m
6. SEPTIC TANK MUST BE FITTED WITH WATERTIGHT COUPLINGS, APPROVED BY THE MOA, —I ` (9 0
• i ...•
AT THE PUMP-OUT ATTACHMENTS AND ON THE INLET AND OUTLET OF THE TANK. ��•
¢ Q w
• LEGEND Z U p zic
i EXISTING NEW DESCRIPTION CC Q p =
------- PROPERTY LINE Q V
r Z J
�;.• DECOMMISSION EXISTING �! EDGE ROF ASPHALT U r-- Q
SEPTIC TANK (NOTE 1)
////7/// BUILDING ��
s - WELL RADIUS Q�
---- I _ o. QQC.o. CLEANOUT W
I I �^
101 LF 4' PVC 00 `----J 4., 101 LF 4" PVC Cr)
® 1.0% MIN ® 2.0% MIN
PROVIDE DOUBLE CLEANOUT PROVIDE DOUBLE CLEANOUT n I
10' MIN FROM INLET 10' MIN FROM OUTLET C1
i .1PROVIDE SEPTIC TANK C1
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- - - - - - - - -- - --- -- - ------t. - -- --- ---- - -'- ----------- - --- �I -- a
EAST 112TH AVENUE t,
eMESIGN: SEAT-`"\\
SITE PLAN4 PVC INSPECTION PIPE _ \
FINISH WATERTIGHT KIM \
• /20MIN
WITH LOCKING CAPS oRAwN. �KIM /��o. '9 07,
41`r H I.„
INSULATION BOARD ..
."CAB: %'•, T... ,,... :'.t.
4" MIN INSULATION /(NOTE 2) �'// aNich �'
o FINISH GRADE NJH (I'`s:,:.WIWI9,•ECE 13655 �fi�`��
„ , A / SCALE:
1� 40FESSA:`
jeS"o;,c,�f- •AS NOTED \\\\�.���
INLET ] OUTLET
w
a
BEFORE DOING al
►, ANY DIGGING ill 4" PBG GRAPHIC SCALE „tnw
45' BEND
w� OR EXCAVATION ` , TO 0 10 20
NOTES 4..'��� I I I SEPTIC TANK
CALL FOR FREE 1. SEPTIC TANK INFORMATION SHOWN IS SCHEMATIC. SEPTIC TANK MUST HAVE MINIMUM LIQUID CAPACITY • REPLACEMENT PLAN
"
UNDERGROUND
OF 1,250 GALLONS, AND BE APPROVED BY THE MOA. • SCALE: 1" = 10'
2. PROVIDE 2" THICK INSULATION BOARD ABOVE SEPTIC TANK IF TANK HAS 4' OR LESS OF COVER. 45' WYE uwe No. o4re�
3. MATCH EXISTING ELEVATION OF INLET AND OUTLET INVERTS. IF SHEET IS LESS THAN C I 09/06/19
Alosko Oigline Inc.
e
Anchorage
Area
800 X78-3121 n SEPTIC TANK DOUBLE CLEANOUT RE = 34" PN-
GRID: SHEET
C1 C1 C1 C1 IT ISA REDUCED PRINT - SW2634
SCALE: 1/2" = 1'-0" SCALE: 3/4' = 1'-0' SCALE REDUCED ACCORDINGLY t 1 of 1 J
O - 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 PHONE ~ ~NEW
MAILING ADDRE~o ~) ~ t ~O ~/~ 5 5
LEGAL DESCRIPTION
DISTANCE TO: I t O0 q ~'~' 3~ ' NO'~oc)
I'- Z Manufacturer t_~ . _ Material No. of cq~partments
~ ~- Liq. c~pacit._~ in_g_allons Inside length Width Liquid depth
~,(~) (~) O IF HOMEMADE: .....
.~__.Z~ ~' DISTANCE T..~.~.~ Well Dwelling PERMIT NO.
0 Well~ F°unOati°~t._- l~ 0 ~ t 0
~ DISTANCE TO: 00 ~ Nearest lot line PERMIT NO.F
~ u. 2 No. of lines Length of each lil~ ~1 Total length of H~.~s__/ T.~nc__h wL~h ~'1- Distance between lines
-;'"o - -, s/ ELon
I- ~ ~. Top of tile to finish grade H' Material beneath tile(.~ ~
~' ;~ Total effective ab r area
Length Width Depth PERMIT NO.
,~ I.- r ~ ective a
u~ ~'DISTANCE TO: Well ~ Building~n N ear e sl*,JJ3.t~qh"~ ~ '
-I"I Clas~:~.~j~_ Depth Driller Distance to Iot.~e~ 0 PERMIT NO.
uJ
Absorpt'on arTIb
~ DISTANCE TO: BuiidingfounOa.~-- Sewerline '~- 7 ~'- Septictank ~ 0 ~)
OTHER
PIPE MATERIALS (~ ~-
SO'L TE~T ~T:N ~.,..- '
· ~(~LL-)' -
R E ~A-R KS
_,~/L~-¢'v
-' )
APPROVED DATE LEGAL
72-013 (Rev~ 1/78) i
F'EF'.M I T
l~-llJl"-.I I _.. - I-IL [ T ..........
[~E'F'F]~'THEI'iT OF HEFtL. TH FIN[:, Ef~',.,'IRnNMENTFIL ~[~'.C'~TEC:TION~
':_--:25 "'[-" STI:;.:EET., AI'.iC:HOF.:FtGE., FIK. 99._,01 ~~..
264-"4?20
2-~.-~---_,~' I-_) I'-.I .... ~S I 1- E
F' 0 E: 0 ::.:: 10-12; 0 4 S'_$ // 2,4:3 1. --': ~: :l /../____
PIF'F'L ! C:FiN T
L L-tC:FtT I ~EIf'l
LECiFtL
C:FINGE & 112TH
L. 4 E:i FtLLEN S,."'[:,
i'¢F'E ElF %F_iIL FIE:SFff:;:E:TIOhl :.TZ.'fE31 ISi' TF:ENC:H
P1Fi:'-:;If'IUI'I f.iI_IHE:EI~: F_iF E:E[.,F::OCH'I'~:: ::
L. 0 T S I Z E
S;L3 I L F.'f:t I '[ ?.IG ,:: 'Si_-..! F T ,.." E: I;: :: ....
q0502 'ECJ!Lff:]F;:E FEET
:12 5
'1 HE FtEC.i!U I fl-:E[> S I SE OF THE ':7, O I L FIE:SOF:F' T' I CIf4 :, ,' ::, I Et I i % '
THE LENGTH [:,IP1ENSICIN IS THE LENGTH ,::IN FEET) OF THE TF:ENC:H i-iF: [:,F:FIir4FIE'L.[.,
I'HE DEPTH OF F~ TRENCH CiA: F'IT I5 THE [:,ISTRNCE E:ETHEEN THE SUF:FtgCE Eft: THF
GF:OLINE, RN[:, THE En3TTOP1 OF THE E::.::C:Ft',/'FtTION ,::IN FEET::,.
THERE !S rio SET WIE:,TH FOR: TRENCHES
THE GF:R'v'EL DEPTH rS THE PI[f.I[IIUH !:,Er'TH OF G~tR'v'EL. E:E'rPlEEN THE OIJTFFd..L. F'[F'E
Rtl!> THE E:OTTOrt OF THE E',:'::CflVRTION ':IN FEET::'·
F'EF:MIT FIF'F'LICFtNT HFtS THE RESF'ONSIE:ILIT'¢ TO INFORrt THIS [:,EF'F~RTMENT [:,I_iR:Ir~G THE
iNSTF~LLRTION INSPEC:TIONL:; FIr RN'Y WELLS Fi[:,JFtF:Er-4T TF~ THIS PRCPEF'TY FIN[:, THE
f4UME:EF: OF fq:ESIE:,EI'-4C:ES THFiT THE HELL WILL SERVE
........ --r i-.-i 131 ,-- :---_*: .*:, I i%1 -_:: F' E i:: T
_.T.-_,TEI,1 14ITHCII_IT FINRL INSF'Ei-:TIf"If'4 FINE:, HFFF.._ ,HL · TI-tiS
E:FtI-:t::F ILL I I'iG L.IF FtN'¢ C' ',- _ _ - I-I' ' - E"T'
[:,EF'FtF'TP1ENT WILt E:E SUE:..TEC:T TO F'RCrE, ECLITION.
1.1IflIMI_.II'I [:,IS.t'FINC:E E:ETIqEEN R WELL FIN!:' RN'T' ON-SITE SEb. IFIGE DISFu_3SFtL S'¢STEM
100 FEE'f FOP. Ft F'RI',?RTE I,IELL.; 0~'.
:15(i TO 200 FEET FROH Ft F'UE=LIC WELL [:,EF'EN[:,ING UF'F~N THE I"T'PE AF F'UE:LIC: WEI. L.
HELL LOGS FiRE F..'EC.!UIRE[:' tint:, HLIST E:E F.'.ETIJF.,'NED TA THE [:,EPIRF'.TMENT HITHIfi 20
OF THE HF-LL C:OMF'LETION
UlttEF: F:EC!IJIF:EMENTS MFt'Y FIF'F'L'¢. SF'ECIFIC'RTIONS fir.ir:, C:Of.iSTI~'.LIC:TIC~N DIFtGF:Ffl'1S
¢Y,,,'F~[LF4E:LE TO !NSUF.:E F'F.'.C~PER INL-STRLLFITZON.
I r_l:EF;:l [ F'r' THFtT
J.' I Ffl'l FRI,1ILIF~F: HITH THE I~rEC!UIF.:Ef'IENTS FAR orI-SITE SEI, IERS FIN[:, WELLS H'_-., :SE7'
F'OFrTH E','T' THE HI_IN I E: I F'Ft[_ I T'T' OF FIi'-~I2HI_-~F.:FIGE.
:,~:,TE!I IN FIC:C:OF;:[:,FIr.4C:E 14IIH 'THE F:O[:,ES
2 I HiLl... II'.iSTRLL. THE '-'"- -'
.~ I IJI'.~[:,EF.:STFII'~[:, THFIT THE CIN-S I TE SEWEr.'. _-, ~ _-_,l EI'I r,lF-r,' F.:EC!U Ir F:E .Er4LFIF:GEI',IEHT [ F 'rile
F:FZSI[:,EI'-4CE IS F:EMO[:,ELE[:, TO I I"iCLLI[:,E !'IFd:;:E THFtI'.4 2: E:EDI;:OIZIHS
'_:: I GNE[:, :, " '
- ' ' -'- E:l_-.l'-r' [',.I r.lt.lFIN
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l S,S[:LIE[: ......... [:,RTE_
·
.............. .
Well Owner
"-"~ M-W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward I-[ighway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Use of WeB
Do r,-"~e ztic
Location (address of: Township, Range, Secti~o,n, if known; or distance main road
Size of casing 6"
Static water leve]
Screen (
Depth of Hole 262 feet Cased to 262 feet
%66 ft.. (~_~_~. (below) land surface. Finish of well (check one)
); Perforated ( ).
open end (.. X -);
Describe screen or perforation None
Well pumping test at 5 gallons per (imur)
of drawdown from static level.
(minute) for I hours with 10,3
Date of completion
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 .TO 2 Ce.~i~ Stick-~.~?
2 .TO roan Si!%? San'l
TO
.TO
TO
TO
TO
.TO
TO.
.... TO.
~__TO
.TO
TO.
TO.
.TO
3O
T~n Silty Ci~'r
Tsn Silty C~"
/
3--CONTRACTOR
PERMIT NO.
r-lLI~-4 I C: I ~LITY CmF R~-IC:H RAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PEOTECTION
825 'L' STREET, ANCHORAGE, AK. 99501
264-4?20
~ELL R~-4[:, E~-4--SITE SE~EF~ F'EF~r'I IT
( 7904~? )
APPLICANT
LOCATION
LEGAL
ROY D. INMAN
CANGE & ll2TH
L4 Bi ALLEN S?D
PO BOX 10-1504SS
LOT SIZE
349 i~6i
40502 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS~ TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:,EPTH= t 2 LE~-JGTH= 24 I]RA'./EL C, EPTH= 8
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL. PIPE
AND THE BOTTOM OF THE EXCAVATION <IN FEET).
~:E~)LI I REE) SEPT I C: TAr-ik-:: S I ZE= l~:-lOF1 13HLLID~-IS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TLqm3 (-~) I f-ISPEC:TICmf~S A~E REL~LmlRE[:,
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR 8 PRIVATE WELD OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'EF-:r.1 I T E~:P I RES [:,EmSEr. IBEF-: _--<1. I -~. 7'_~-
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS 8S SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
S I GNE D' _~~--~:,~___C5~ _ 1-~--~- '~c-~
ISSLIED BY~~~ DATE .... V] 2
(907) 243-7893
KEN JOHNSON
KEN'S COMPANY
WATER WELL DRILLING
PUMP SALES & SERVICE
316:3 LINDEN DRIVE
ANCHORAGE, ALASKA 99502
Roy Inman
P,0. Box 10-1504, S. Station
Anchorage, Alaska 99511
112th and Cange
WATER WELL LOG
June 27, 1980
Phone 343- 1668
6/16/8o
Move onsite...set up.. sound hole.. 185' to top
of casing.. 40' water.. Bail dry.. weldon 6' casing
and drive down.
183' to 200' Glacial till .. course gravel and gray silt ( tight )
200' to 213' Same but weeps water.. 10' head., bails dry
213' to 218' Clay
218' to 231' Glacial till .. weeps some water.. Bails dry
231 '
~asing refusal..
Clean Med. and course sand with some fine gravel
Water bearing
Over night Static 151 Ft. ( 80 ft. )
Test bailed 5 hrs. at 3 GPM
Drawdown to 221 Ft.
Recovers at 1.5 gpm
Bottom stable
Water very clean and clear
Set permenant pump at 230 ft.
WELL LOG
Date Drilled: ~) ~_)L ?~',
Static Water Level
Draw Down ]0t
_~~ feet Gallons Per Minute ~
feet Total Feet of Casing'
T~pe Material
Drilled:
0 feet to
to
tO
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
=
Property owner
Mailing address
Lending agency
Mailing address
Day phone ~' 5/L/- c//~_~
Day phone
Address
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.
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.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my 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.
NameofFirm I O~'¢i"'t ,,,'~ir--t~,'~ P~- Phone ,;2 7~-
Address ~ '5 i.~ / ~'/-~ -"-,
Engineer's signature · ' '~'-- · ~1~c¢.~~ Date
Disapproved.
Conditional approval for
bedrooms.
bedrooms,
with the following stipulations:
Additional Comments
By: .~ . . . _ Date ~_ .
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage ~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: '/--~, ? /3~ il ~ ~'1 ~/L~ Parcel I.D. O1~-- ~'7 ! - ,~ 7
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter.
y Date completed
ADEC water system number
'7///~/~,.,~.. Driller
Cased to ..?..~, '2_ Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
g.p.m.
AT INSPECTION
!
/~ ? / ~'1 N[UNIClPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
DEC 0 5 1991
g.p.m.
RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot i i.~
Absorption field on lot
Public sewer main I~J/
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform /
Date of sample: I ~/;t?/
Nitrate
N~ Other bacteria
Collected by: '~' ~'
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size J ~ Compartments
Foundation cleanout (Y/N) ~ Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot //,-~ On adjacent lots ~//-"¢--~ Foundation
To Property line z:/'~ '/~ Absorption field / ~ Water main/service line
Surface water/drainage h///3~
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~/~O
Length ~--7 Width
Total absorption area ~ ~,,~-
Depression over field (Y/N) ~
Results (pass/fail) ~-~ ~,~
Peroxide treatment (past 12 months) (Y/N)
Soil rating /,2~, System type
Gravel thickness ~ Total depth
Cleanouts present (Y/N) ~/'
Date of adequacy test I
for
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot J
To building foundation
On adjacent lots
Surface water
Curtain drain /'~'/~
On adjacent lots ~ / ~ Property line
To existing or abandoned system on lot
Cutbank F'~//_~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER's CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
HAAFee$ /'~
Oate of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
Department of Health & 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
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
7 ¥ ,g z
Location (address or directions)
///.5-0 C~,~..¢ ~ ~.~,
(b) Property owner Ro,y ~). ~'/w'~,4,,~' Telephone' (home)'~ff¢-~73'? Business
Mailing Address /// .50 ~_____~qa,..~_ ,/~)o 4~ //V.c~/, //(',
(c) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here,~, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family '~ Number of bedrooms
3. WATER SUPPLY
Individual Well ~, Community [] Public []
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~l' Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) 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 end 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 ~-~ ~--~.~" ~-/~o ,~.5' Telephone
Address .2.,~,7..~ ~/~:, ,~oc='~'A /~/V"C/Y". /~/(',
6. DHHS APPROVAL
Approved for ~' bedrooms by
Approved ? Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and 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.
72-025 (Rev. 7/88) Back Page 2 of 2
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description:
1//5'o Cm .5 .
Well Classification
Well Log Present (Y/N) ~' Date Completed ~t J
Total Depth`/' 2G2 ' Cased to X- .?.G2 ' Depth of Grouting /V'//~
Static Water Level /-5~--~' (-~'~' ~'/') PumpSetAt
Casing Height Above Ground '-~ / Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /~ ~ ~'
To Nearest Edge of Absorption Field on Lot /~
To Nearest Public Sewer Line /¥///z~ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot (~.5"
Water Sample Collected by /)~,g ~' F::)o 7/'~--¢ ; Date //-/--~
Water Sample Test Results
Co'mments ;~ ~ ,~..~ L~/'/H~
If A, B, C, D.E.C. Approved (Y/N)
Y
; On Adjoining Lots /434:~
; On Adjoining Lots
Datelnstalled~ Z///¥/'¢0 Size*
Standpipes (Y/N) ,~' Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) /V'
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped ///2_/
Holding Tank High-Water Alarm (Y/N) /7///
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments ~ /~"'o'"" D H/'/J' )~¢ Co, ~1 ~'
;for /)///~
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
35'
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ 7//~'/
Width of Field ~- --~ -
Square Feet of Absortion Area ;~ ~',,~.2,. ~
Depression over Field (Y/N) /~/
Type of System Design
Length of Field ~ ~-.7'
Depth of Field ~ ~' /
Gravel Bed Thickness 'P- P' '
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test /~ ~/c~'~/~ ~..c o~ P~,'3 l~4/'"e~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
I00
To Property Line
/O '4-
.5-0
To Building Foundation
Lot t~//~
To Water Main/Service Line /
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments -~ ~-'~o,m /9~.,"
TO Existing or Abandoned System on
;On Adjoining Lots
TO Cutback (if present)
/D'
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify thatIh~d~conformed to all MOA and HAA guidelines in effect ,o.~ the date of this
inspection. ~~
Signed ~ ~-<~'
Company ~:~.~~ ~. ~ ,
Date //-- 1--~ ~..~~s Seal
Receipt No. ~ ~ Receipt No.
ee:
Amount: $
72-026 (Rev. 7/88) Back
Date of Payment
Page 2 of 2
"~ ' DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
· MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(~IVIRONMENTAL P2OrECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION JUL :[ 5 1980
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPER T,Y~_,~IE R IPHONE
PROPERTY RESlDI~NT (If different from above) PHONE
PHONE
2. BUYE~..~
MAILIN(~ A D D/t~SS
3. LENDING INSTITUTION
MAILING ADDRESS
4. REALTOR/AGENT PHONE
MAI LING~DD~ ESS
DESCRIPTION
STREET LOCATI,~
/,///,,,~ .¢. ¢ ,¢.¢..~.¢.
6. TYPE OF RESIDENCF-~~ NUMBER OF~BEDROOMS
[] One [] Four
[2~ SINGLE FAMILY ~ Two [] Five
[] MULTIPLE FAMILY [] 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.)
8. SEWAGE DISPOSAL SYSTEM
J~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVI DUAL/ON -SITE
r-]PUBLIC UTILITY
Connection Verified
[~'~Ptic Tank or [] Holding Tank
Size: /'Cq¢.~O If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
[] ONE
[] TWO
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank
NUMBER OFBEDROOMS
E~'THREE [] FIVE
[] FOUR [] SlX
IAbsorption Area
lSewer Line
[] OTHER
INearest Lot Line
5. COMMENTS
EZ~PROVED FOR --~ BEDROOMS
[--I CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED ]BY ~
DATE
72-010 (Rev. 6/79)