HomeMy WebLinkAboutMARIN LT 1Marin
Lot 1
#017-013-67
Municipality of Anchorage
�\
y\ Development Services Department =6,4
Building Safety Division '
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Boz 196650 Anchorage, AK 99519-6650 Page of
www.d.anchorage ak.us (907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWo-40014 PID Number. Of —013-(�-
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Wastewater System: ❑ New 5? Upgrade
Bow rtc{r. Ro1A
ABSORPTION FIELD
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DESCRIPTION
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SEPARATION DISTANCES
❑ septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
utt
Holding
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Tank
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BENCH MARK
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Inspections performed by: I N5 Snrrgand Dates: 10 0 -t 0
Engineer's Stamp
Development Services Department Approval
i c��-�
' 49TH v.1 9
Conditional Approval Date:
cam'. LARS E. SPURKLAYD,•Q.�
Reviewed and approved b : Date: �
P y
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l��gir P�
130TH. AVENUE INSTALLED NEW DRAIN FIELD
_ LENGTH 65 FEET
WIDTH 5 FEET
TOTAL DEPTH 4 FEET
I I ROCK DEPTH 1 FEET
I I INSULATION 2 INCHES
y,G ncs
LOT 1 COVER 3 FEET
I A TO
C 8.51 36'
D 11.5' 37.5'
[ 19' 39' Y Well B
I I f V' 39.3' 7 H
G 14 40
I H 61 45'
I 92 7S5' O
I I I C
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EXIS71MG CRIB t NEW ABSOWWK FIELD
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SPURKLANO ENGINEERING LOT 1 MARIN SID SEPTIC SYSTEM ASBUILT
203 W 151H. AVENUE BOB HARVEY DATE: AUGUST 24, 1007
ANCH. AK. 99501 1300! PATRICK ROAD SHEET 1/3 GRID. 2840
11
907 279-3916
PERMIT # SV070074 PID #017-013-67 MarinLlD2.dwg
0
Existing 1000
gallon concrete
septic tank
2 Mc XSIXA oN
ELEV.= 91.6'
Silt Barrier—
ELEV.= 91.6'1
1 ft or Septic Rock
Effective
1' Sewer roar
2' Cover nin.
Insulate ImcA
Monitor
Cleanout
3' Cover
ELEV.= 95.5'
NO SCALE
Existing 1000 gal. concrete septic tank
EL£V.= 86.5'
NO SCALE
BOTTOM TH ELEV.= 84'
BENCH MARK BOTTOM
*.
49th
SPURKLAND
SE CORNER HOUSE
ENGINEERING
MARIN LOT 1
SEPTIC
DATE
SYSTEMA LT
AUGUST 244,, 2 20007
SPURKLAND
203 W15th
Ave
BOB HARVEY
SHEET-
GRID, 2840
Anchorage
Ak 99501
/JOOI PAIPICX ROAD
.313
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW070074
Legal Description: MARIN LT 1
Design Engineer: 0007 SPURKLAND ENGINEERING
Owner Name: BOB HARVEY
Owner Address: 13001 PATRICK RD
ANCHORAGE. AK 99516-3317
g _7,07 CT .2'60
dA r.., 00
Date Issued: May 24, 2007
Expiration Date: May 23, 2008
Parcel ID: 017-013-67
Site Address: 013001 PATRICK RD
Lot Size: 45725 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field Q 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 notify 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 15, 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.
5. The following special provisions. - SEPTIC TANK INSTALLATION NO LESS
- EMERGENCY TANK FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATIER; AND ONE HUNDRED FEET ON; TENYFE LOCATED EET FROM ANY WATER THAN
PRIVASERVTCE LINE;E WELL;AND THE SEPARATION DISTANCES REQUIRED BY NE HUNDRED FEET FROM ANY SURFACE WAT 8AAC72 FROM WATER SUPP�Y ANY
WELLS.
* QE 17F51ykl SVgM 17 r,60 !/Zv I,,; AND AF,'-Y'V"EQ 0
Received By.
Issued By.
Date: _S12Y 0
Date: 47—T --(o
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. (1il'nl�-(n�
Property owner(s) 13o6 Harvey Day phone
Mailingaddress Boot Zvic\ Zip Code
Site address Boot 4 A Zip Code
Legal description (Sub'd., Block & Lot) lAar%n SIDLA 1
Legal description (Township, Range & Section)
Lot Size Li 5, Ta5 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
❑
Septic Tank
J4
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Number of Bedrooms 3
THIS APPLICATION IS AN:
ZD
Initial
❑
Upgrade
Renewal
❑
certify that the above information is correct. 1 further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of broperty owner or authorized agent)
PermittRush Fees: y60 Waiver Fees:
Date of Payment- Z , 7 Date of Payment:
Receipt Number. q N 9 t_I AVV Receipt Number.
(Rev. t 1ros)
13
SPUTk�M[Md E[Mg n(@B�dnu
Environmental Consulting and Design
M� SEPTIC SYSTEM DESIGN REVISIONS
Marin S/D Lot l
Municipality of Anchorage July 26, 2007
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
Subject: Design Revisions Permit No. SW 070074
13001 Patrick Road
Ladies and Gentlemen:
I am submitting design revision to permit # SW070074. A permit was issued to replace the septic tank a 13001 Patrick
Road. Upon excavation of the septic tank it was determine that the drain field was no longer disposing septic tank
effluent at the house holds level of use and also required upgrading. The excavation of the tank verified its integrity, the
tank baffles were replaced, additional clean outs were installed and the tank was pumped and cleaned.
Soils: A test hole was excavated on July 12`h, 2007. See the attached soil logs. Ground water was monitored through
July 19`h, 2007. Ground water was measured at a depth of 9 feet below ground surface.
Surface Water: There are no surface waters within 100 feet of the proposed drain field.
Topography: The average topography in the area of the septic system slopes to the south east at approximately 10 %.
The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent
lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of
surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
r
Lars Spurkland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
N
s
PHrkIS[Md F[Ma13 iEnvironmental Consulting and Design
SEPTIC SYSTEM DESIGN
Marin Lot 1
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
July 26, 2007
We are submitting an application for the upgrade of septic system for this lot. The submittal consists of three (3)
drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed
improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a
schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed.
The septic system design is based on the following :
Groundwater at 9 Ft.
Soil Rating. From Testhole 07/12/07.
2.4 min/in = 1.2 gal per sq.ft/day
No. of Bedrooms 3
Required Area per Bedroom: 15011.2 =125 sq.ft.
Total area required: 125 x 3 = 375 sqft
Bottom Rock
At 4 feet
Top Rock
At 3 feet
Rock Depth
1 feet
Total Length
375 /5*.87 = 65.25 feet
USE 65 FEET
SYSTEM CONFIGURATION
SHALLOW TRENCH
TOTAL LENGTH
65 FT
TOTAL WIDTH
5 FT
TOTAL DEPTH
4 FT
ROCK DEPTH
1 FT
INSULATION
2IN.
COVER
2 FT (MIN)
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
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SPOWLANU LNUM MiNU LOT 1 MARIN S D SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE BOB HARVEY DA TE. JULY 23, 2007
ANCH. AK, 99501 13001 PATRICK ROAD SHEET.- 1/3 GRID: 2840
907 279-3916
PERMIT # SV070XXX PID # YYY MarinLlDl.dwg
130TH, AVENUE
I I
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INSTALL NEW DRAIN FIELD
LENGTH 65 FEET
WIDTH 5 FEET
TOTAL DEPTH 4 FEET
ROCK DEPTH 1 FEET
INSULATION 2 INCHES
COVER 2 FEET (MIN.)
LOT 1
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SPURKLAND ENGINEERING
LOT I MARIN SID
SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE
ANCH. AK. 99501
BOB HARVEY
DATE: JULY 23, 2007
SHEET. 21J GRID: 2840
907 279-3916
13001 PATRICK ROAD
PERMIT # SWO70074
PID #017-013-67
MarinLlD2.dwg
Existing 1000
gallon concrete
septic tank
INSULAI
Silt Barrier
1 Ft of Septic R
Effective
'- -
1' Sewer rock
2' Co ver rein,
insulate trench
lYU JLMLr
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SPURKLAND ENGINEERING MARIN LOT 1 SEPTIC SYSTEM SCHEMATIC
203 W15th Ave
Anchorage Ak 99501 808 HARVEY DATE: JULY 25, 2007
p7q-Zglr, 13001 PATRICK ROAD SHEET: 3/3 GRID: 2840
PERMIT # SWO70074 PARCEL ID # 017-013-67 151852AJ.DWG
Municipality of Anchorage A% • iP
Development Services Department Gj r
Building Safety Division ; 4Q TN
On -Site Water and Wastewater Program
4700 South B St.
P.O. Box 196650 Anchorage,
AK 99519-6650
4rr�. LARS E, S`PURKLAND: W
,nrrvr.ci.a �choraoe.ak.0s
(907) 343-7904 ��� ' �1_15 0
Soils Lo - Percolation Test
Performed For. -horo J �4 Date Performed:
_
Legal Description: (9*)eV'k1 L4 .1 Township, Range, Section:
Site Plan
WAS GROUND WATER
�j
ENCOUNTERED?
(G5
Depth to Water
S
IF YES, AT WHAT DEPTH?
-j,S1_ L
Depth to Water Atter
P
I P
Monitoring?
E
V, Date: Iti 0I
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
4:K3 n.
0 cam; ;
Z 5/8 I,
t
: 53 PmY„
3/v
3 1lif
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5.13 PM
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15:33 PM
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PERCOLATION RATE 72, (minuteshnch) PERC HOLE DIAMETER (p
So -2,W TEST RUN BETWEEN �FT AND 5 FT
COMMENTS FCe So'i,W
PERFORMED BY: bN J0QLArL)1- I J CERTIFY THAT THIS TEST YVAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELIN S IN EFFECT ON THIS DATE. DATE: 311.110-1
. —
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ON
Environmental Consulting and Design
.✓Single Family On-site Wastewater Disposal System
Construction and Material Specifications
Subject Property: Marin Lot 1
Date: July 26, 2007
General:
1. The owner shall contract with a contractor to perform the work outlined in these
specifications and plans in accordance with the attached MOA permit. There is not
contractual arrangement between the contractor and the Engineer. The Engineer shall
be the owner's representative and will inspect the work to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the MOA.
2. The scope of the project includes the procurement and installation of a 3 -bedroom on-
site wastewater disposal system at the location depicted on the attached site plan
drawings. The location of the drainfield is shown on the attached site plan drawings.
The total depth of the field will be 4.0 feet below the existing ground surface. All
components of the proposed septic system must be constructed a minimum of 100 feet
from any surface water or water wells in the area. A minimum of two feet of cover is
required over the drainfield. In addition to the required earthen cover, 2 -inch thick, 40
psi, direct bury board foam shall be installed directly over all installed piping.
3. Construction shall be in accordance with the approved site plan and design drawings and
any special provisions noted on the Municipal well and/or septic permit. All materials,
components, workmanship and construction practices shall comply with the Municipality
of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA,
Development Services Department, On-site Water and Wastewater Program (DSD)
policies.
4. The contractor is responsible for obtaining all underground utility locates, layout of the
proposed system, and verifying and maintaining all required separation distances to lot
lines, surface water, wells, steep slopes, etc.
5. The property owner shall be responsible for final grading any depressions formed from
settlement of backfill material. The property owner is also responsible for vegetation of
all areas disturbed by septic system installation activities.
6. Contractors installing wastewater disposal systems must be certified to do so by the MOA
DSD, On-site Water Wastewater Program. Property owners installing their own systems
must receive advanced approval from MOA DSD prior to system installation activities.
7. The contractor shall ensure that ALL materials being used are in compliance with the
most current guidelines established by the Municipality of Anchorage. Refer to
"Standards and Specifications for Component Parts and Materials Used in the
Construction of On-site Wastewater Disposal Systems", Dated December 2000, as
provided by MOA DSD, On-site Water and Wastewater Program.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
� Environmental Consulting and Design
Drainfield Construction:
1. The drainfield shall be excavated to the dimensions outlined in the design drawings. If
any discrepancies are noted, contact the engineer immediately for clarification.
2. The drainfield shall be installed parallel to slope contours.
3. The bottom of the drainfield shall be within 2" of level. If the sidewalls or bottom of the
excavation become smeared, they must be raked or scarified prior to the placement of
filter sand or drainrock.
4. The drainfield must be a minimum of 5 feet from the test hole excavation.
S. Distribution pipe is to be installed level with perforations facing downward, atop a level
bed of drainfield rock. Septic rock shall then be placed atop the distribution piping to
provide a minimum of 2" of cover, level across the entire width and length of the trench,
above the piping.
6. A silt barrier must be installed at between the final drainrock and the native soil backfill.
The silt barrier shall cover the entire drainrock surface.
7. Monitor tubes must be 4" in diameter, installed in the locations depicted on the design
drawings, and extend a minimum of 12" above final grade. The portion of the monitoring
tube below the septic rock must be perforated and the portion above the drainrock shall
be solid.
8. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be
installed when the backfill depth is less that 3 feet.
9. Drainfield back fill shall be mounded to prevent depressions from forming due to
subsequent settlement of backfill material.
10. The contractor shall verify that the drainfield is a minimum of 100 feet from any
residential water well, 150' from any class 'C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
Inspections:
1. A minimum of two inspections are required by the Municipality of Anchorage. These
inspections must be conducted under the supervision of a Professional Engineer licensed
to practice in the State of Alaska.
2. The first inspection must be conducted after the excavation of the drainfield and before
the placement of any gravel. The septic tank may be set in place, but may not be
backfilled.
3. The second inspection must be conducted after the placement of the silt barrier, gravel,
distribution lines, stand pipes, cleanouts, and insulation, but before the placement of any
backfill.
4. The contractor shall provide a legible copy of all field notes relating to system layout and
construction to the engineer for the use in preparing the record drawings.
S. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours
notice is required prior to the start of construction. If necessary, a preconstruction
meeting will be held on-site.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
Environmental Consulting and Design
ti
May 23, 2007
Municipality of Anchorage
Development Services Department
Building Services Division
On-site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
Subject: SEPTIC TANK PERMIT APPLICATION
MARIN SUBDIVISION LOT 1
We are submitting an application for the replacement of the septic tank for this lot. The submittal
consists of one (2) drawing showing the present improvements on the lot and the proposed
improvements of the lot, of which only the septic tank is subject to this permit application.
There are no wells within one hundred feet of the proposed replacement site. The installation of
this septic tank will not prevent wells and septic systems from being installed on the adjacent
lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of
the proposed septic tank location. The proposed septic tank will not change the general slope of
the area. Ponding and/or concentration of surface runoff will not result from this installation.
If you have any questions or are in need of additional information please contact me at 279-3916.
Sincerely,
La_ioSt,n��
Lars Spurkland
203 West 15t' Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng@gci.nct
130TH AVENUE
I I
I LOT 1
I I INSTALL NEW
1000 GALLON
I
Well SEPTIC TANK
I ,
I ,
I
I I
I
ABANDON EXISTING
I SEPTIC TANK PER MOA
CODE REOU/REMNETS
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U
L Y I ti \ LOT 2
Well
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25 0 2' 50 75 SCALE! 1' = 50 FT. loo 125 150•,,,�;a::��
WA IL
SPURKLAND ENGINEERING LOT i MARIN SID SEPTIC SYSTEM DES/GN
103 W 15TH. AVENUE BOB HARVEY DATE. MAY 23, 1007
ANCH. AK. 99501 13001 PATRICK ROAD SHEET. 2/3 GRID 2840
907 279-3916
PERMIT # PID # MarinL102.dwg
SEPTIC TANK REPLACEMENT DETAIL
DOUBLE
CLEANOI
4+ FEET COVER
CONNECTED TO
EXIST DRAINFIELD
1000 gal, septic tank
FOUNDATION
CLEANOUT
WC
49th
SPURKLAND ENGINEERING LOT I MARIN S/D SEPTIC SYSTEM DESIGN
203 W15th Ave DATE, X4 23, 2007
Anchorage Ak 99501 BOB HARVEY
9 13001 iA1RKK ROAD SHEET, 2/2 GRIDS 2180
I PERMIT/ PARCEL 1D / MarinLlD3.dwg
spurt almd Elmgormaolflg
Environmental Consulting and Design
Single Family On-site Wastewater Disposal System
Construction and Material Specifications
Subject Property: Marin S/D Lot 1
Date: May 23, 2007
General:
1. The owner shall contract with a contractor to perform the work outlined in these
specifications and plans in accordance with the attached MOA permit. There is not
contractual arrangement between the contractor and the Engineer. The Engineer shall
be the owner's representative and will Inspect the work to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the MOA.
2. The scope of the work includes the installation of a new 1000 gallon septic tank. The
location of the drainfield is shown on the attached site plan drawings. All components of
the proposed septic system must be constructed a minimum of 100 feet from any surface
water or water wells in the area. A minimum of 4 feet of earthen cover is required over
the septic tank. If less than 4 feet of cover is available, 2 -inch thick, 40 psi, direct bury
board foam shall be installed directly over the septic tank and all installed piping.
3. Construction shall be in accordance with the approved site plan and design drawings and
any special provisions noted on the Municipal well and/or septic permit. All materials,
components, workmanship and construction practices shall comply with the Municipality
of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA,
Development Services Department, On-site Water and Wastewater Program (DSD)
policies.
4. The contractor Is responsible for obtaining all underground utility locates, layout of the
proposed system, and verifying and maintaining all required separation distances to lot
lines, surface water, wells, steep slopes, etc.
S. The property owner shall be responsible for final grading any depressions formed from
settlement of backfill material. The property owner is also responsible for vegetation of
all areas disturbed by septic system installation activities.
6. Contractors installing wastewater disposal systems must be certified to do so by the MOA
DSD, On-site Water Wastewater Program. Property owners installing their own systems
must receive advanced approval from MOA DSD prior to system installation activities.
7. The contractor shall ensure that ALL materials being used are in compliance with the
most current guidelines established by the Municipality of Anchorage. Refer to
"Standards and Specifications for Component Parts and Materials Used in the
Construction of On-site Wastewater Disposal Systems", Dated December 2000, as
provided by MOA DSD, On-site Water and Wastewater Program.
203 West 151° Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, LspurklandCaa�gci.net
Environmental Consulting and Design
Septic Tank Installation:
1. A new septic tank, of the size specified In the design drawings, shall be procured from a
qualified manufacture/supplier If the existing septic tank is found to be defective.
Construction shall include two 4" diameter deanouts for pumping access.
2. The burial rating of the tank shall be adequate for the actual burial depth encountered.
3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank.
4. All standpipes on the tank shall extend a minimum of 12inches above the final grade.
5. Tanks installed with less than 4 feet of cover shall be insulated.
6. The sewer service line from the house to the tank shall have a minimum slope of 2%
unless prior approval is obtained from the engineer.
7. The inlet and outlet lines from the tank shalt be bedded in drainrock or the soil shall be
sufficiently compacted to prevent future settlement of the soil.
8. Septic tank inlets, outlets and deanouts shall be fitted with water tight couplings.
9. A cleanout shall be installed 1 to 4 feet from the foundation.
10. Post tank deanouts shall be installed per MOA requirements. Does not apply to
pressurized lines.
11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist
buoyancy forces when there is not adequate soil cover to resist uplift force. The
contractor shall refer to the engineer for direction regarding this matter.
12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the
tank.
13. All holding tank and lift stations shall have an audible and visible alarm inside the
residence being served.
14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform
Electrical Code. A municipal electrical permit and inspections must be obtained where
required by the MOA.
15. The contractor shall verify that the septictank/lift station is a minimum of 100 feet from
any residential water well, 150' from any class'C well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
16. The contractor shall remove or abandon the existing tank In compliance with the Unforn
Plumbing Code.
Inspections:
1. A minimum of one Inspections are required by the Municipality of Anchorage. These
inspections must be conducted under the supervision of a Professional Engineer licensed
to practice in the State of Alaska.
2. The septic tank may be set in place, but may not be backfilled.
3. The contractor shall provide a legible copy of all field notes relating to system layout and
construction to the engineer for the use in preparing the record drawings.
4. The contractor shall coordinate all Inspections with the Engineer. A minimum of 24 hours
notice Is required prior to the start of construction. If necessary, a preconstruction
meeting will be held on-site.
203 West 15'" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
GAaB'14D1 GRE'^:R ANCHORAGE AREA BOROU(^
�+ DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME- ADDRESS h/✓�O!> /i:C i7✓ /�C✓ ! PHONE
;'�:-,"�.= X61:'1/ /(itl. !Jt iii/%cr',i% i7`5/.%,>Fi/�✓ .1(1.'x: -C /�//J "
LOCATION .'-'� Ui �li / '%/j r%SGS'•
LEGAL DESCRIPTION _ •
SEPTIC TANK:
DISTANCE FROM WELL '✓�'y1�� MATERIAL'�x U��� '=�= NUMBER OF
COMPARTMENTS
7 LIQUID
lyj /Gfi ' f7N1J <�i /Jvf `
LIQUID CAPACITY —GALLONS. INSIDE LENGTH INSIDE WIDTH ` DEPTH "
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS ✓
O�UTS$IDE DIAMETER OR WIDTH , LENGTH , DEPTH ,
LINING MATERIAL - - _ ` - . DISTANCE FROM WELL a.�=65�`'d�c-�+' BUILDING FOUNDATION
NEAREST LOT LINE r�1 "^ `��s� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) y SQ. FT
TILE DRAIN FIELD: /v,/jam
DISTANCE FROM WELL , FOUNDATI
NUMBER OF LINES ��- DISTANCE BETWEEN LINES
ABSORPTQt<f AREA SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
NEAREST LOT LINE OF LINES
.TRENCH WIDTH
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH
TOTAL EFFECTIVE
ABOVE TILE
WELL "`'''" ✓yam- "`' ,"J� ✓-' DISTANCE FROM WATER
TYPE DEPTH -,BUILDING FOUNDATION. SAMPLE NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE SEWER LINE TANK " SYSTEM -,CESSPOOL SOURCES_
DISTANCES:
DIAGRAM OF SYSTEM
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
ON-SITE WASTEWATER DISPOSAL SYSTEM INSPECTION
ENGINEER FIELD AUDIT
DATE: 6 - /0 - SR
TIME: 6 -8-88 AT 1:6204,11.
LEGAL DESCRIPTION:
ENGINEER: 0 - S /TE (/SAN Rj
EXCAVATOR:
AUDITOR: 1919N R0TH
COMMENTS:
ZNvF, ?TE P STEEL TAAVK IN PL19CF Of L a6S by 0?/9. L oGS _-
ANP 14f/TER/A TRL-Eil QUE Of QF115 laEIM AADFIFYJ Oa
5� 7-Ej,vO P119F Ong TOP of STEEL 7ANX AS IIEGL 19S 9LL 07A6/?
CoN&Ef Z:/Oa'S INET£ &✓ATE/? T/l HT
Z/✓STf?LL Al/OAI �9l°oEARED TO JTZ 1114AT /�/1'D
SIGNATURE OF
AUDITOR:
GARB -Ho -1 GR,r �ER ANCHORAGE AREA BOROU`
DL. HRTMENT OF ENVIRONMENTAL QUALI'i
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279.8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME �fDDRESS%lJi� �2L`Gy /'G2�s' PHONE
LOCATION ���1��LEGAL DESCRIPTION ��r/d�✓/�sU
SEPTIC TANK:
DISTANCE FROM WELL ��� NUMBER OF
MATERIAL����f� C-,��r/c<���� COMPARTMENTS
LIQUID CAPACITY —GALLONS. INSIDE LENGTH INSIDE WIDTH
J
LIQUID
DEPTH �_
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH LENGTH DEPTH
LINING MATERIAL 0'— �� ��-£� �'. DISTANCE FROM WELL <��✓�lf`BUILDING FOUNDATION��,
NEAREST LOT LINE I��
N®'f� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ->'s� SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM W
NUMBER OF LINES
DEPTH: TOP OF TILE TO FINISH GRADE
FOUNDATIO
ISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
NEAREST LOT LINE OF LINES_
TRENCH WIDTH. TOTAL EFFECTIVE
OF FILTER MATERIAL BENEATH
IN. ABOVE TILE
WELL: rte"" DISTANCE FROM �: WATER
TYPE �'��1�/tf�' DEPTH , BUILDING FOUNDATION. SAMPLE NEAREST
NEARESTSEPTIC SEEPAGE _ OTHER
LOT LINE �r SEWER LINE ` ,TANK `"" SYSTEM , CESSPOOL , SOURCES_
DISTANCES:
DIAGRAM OF SYSTEM
G'�z�131✓r.�'�TG
DATE/�/�
GREA. ER ANCHORAGE AREA BOFivJGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
PERMIT NO. ' 'a` n
NAME OF APPLICANT�"
✓ MAILING ADDRESS `'%�fy"
PHONE x-77
/%�/�
INSTALLATION LOCATION �/ /�
y��y�,-'
��`��
LEGAL DESCRIPTION e- ��_�
�,7x*'lwi
xy/l;lx//t -'f
�f
INSTALLATION OF: SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD
OTHER ,
TYPE AND SIZE OF FACILITY TO BE SERVED
//
FINANCED THROUGH 6� -TBE I 8'r.ALLED BY
SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL
C � �SG'/L 9�ST �6/✓
COMPLETION DATE ANTICIPATED-
TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZEE __ -�
MINIMUM DISTANCES, RE,
FOUNDATION TO SEPTIC TANK
TYPE ��<-�-'— SEEPAGE AREA SIZE 7— TYPE
c�ir/Grr��
5-/
FOUNDATION TO SEEPAGE PIT �� DRAIN FIELD "IV
�+ f
SEPTIC TANK TO SEEPAGE PIT WALL /J
>1
SEPTIC TANK �, SEEPAGE PIT '-"�6 DRAIN FIELD/
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK • SEEPAGE PIT
r"
DRAIN FIELD Z"' ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK �1 / SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, ��-� SEEPAGE PIT �4 G DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
HEALTH AUTH RITY
OR
LICENSED DESIGNER
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE
DIAGRAM OF SYSTEM
GH ORDINANCE NO. 28.68 AND THAT THE ABOVE
00 }
R&M ENGINEERING & GEOLOGICAL CONSULTANTS
229 EAST 51st. AVE. — P.O. BOX 6087 — ANCHORAGE, ALASKA 99503
TELEPHONE 907-279-0483 TELEX 090-35419
Civil Engineers Geologists Land Surveyors
JAMES W. ROONEY, P. E. - RALPH R. MIGLIACCIO
MALCOLM A. MENZIES, P.E., L.S.
Engineering Geologist
JAMES H. WELLMAN, P.E.
June 20, 1972 R & M No. 26531 F,CVJVE79'
Mr. Robert Harvey
4300 Arctic Blvd. Space #491�eF Elv°orGNA iAU0itGH
Anchorage, Alaska 99503
RE: Test Hole and Soil Log Report for Sanitary System
Lot 1, Marin Subdivision
Dear Mr. Harvey:
We are submitting herewith the test boring results and our comments regard-
ing soil conditions encountered at the subject site. This investigation was per-
formed in accordance with your request of June 19, 1972, and those procedures
outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the
Greater Anchorage Area Borough Department of Environmental Quality.
A single test hole was put down within the Lot 1 area for the purpose of de-
fining general subsurface soil conditions for the proposed sanitary system.
Excavation was accomplished with a tractor -mounted backhoe and the test hole
was extended to a total depth of 10 feet below ground surface. One sample
was recovered from the bottom of the test hole and retained for grain size
analysis. The sample will be held in storage, up to approximately one month,
for possible testing before it is discarded. The final log prepared for the
test hole has been included in Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you. Should
you have any questions with regard to the above, please do not hesitate to
contact us.
Very truly yours,
R & M ENGI/NEEEERING & GEOLOGICAL CONSULTANTS.
James W. Rooney
JWR:wb
cc: Greater Anchorage Area Borough
GREASER ANCHORAGE AREA BOROUGH
DEPAR` ;NT OF ENVIRONMENTAL QUAD CASE #
3500 TUDOR ROAD
ANCHORAGE ALASKA 99502
Performed For Re-, 1j il.-I v, Date Performed
I --.
Legal Description: Lot lock Subdivision L49 q r ;L.
This Form Reports Soils-T—og � Percolation Test
Depth
Feet Soil Characteristics
V.
2 Vitt
3
�V/r
10—
Was Ground Water Encountered? J>
06
(9
If Yes, At What Depth?
Reading Date Gross Time
Net Time Depth to H2O Net Drop
—A
PArrnIA inn a+n
Proposed InstalTation.- Seepage Pit Drain Field
Depth Of Inlet Depth ToBottomOf Pit Or Tren
COMMENTS: �-� �, Xi el. - , , , 7 �, - - -7-7.— �-/ // I —
erformeu t5y
ata Cerfified By--
Date:
P. 0. Box 4-1728 0 2311 Dawson
A C 907-279-1741
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Robert i%arvey
Locatior. (address of: Township, Range, Section, if known; or distance main
a
L1, i,iarin SubdivisionQ �y"
Upper DeArmotzn & Patrick Ro#d -17– / K-;7 bi 5M
�J
weQQE N- oro
Cased to 75 feet /.,_ 49 /-/ Q
(below) land surface. Finish of well (check one) open end ( X ) ;
Describe screen or perforation none
Well pumping test at 2 gallons per (minute) for--L-----hours with 100% ft•
of drawdown from static level.
of Well Dom
M'
Size of casing O Depth of Hole P-00 / -Feet
Static water level 70 ft. (above)
Screen ( ); Perforated (
Date of completion 30 April 1973
WELL LOG
1).'.)01 In feet from
ru;;nd surface
Give details of formations penetrated, size of material, color and hardness
3
MUNICIPALITY OF ANCHORAGE
Silty Gravel
DEPT�—TO EALTH &
ENVIRONMENTAL PROTECT ION
7'O�
Sand
VAUG 1984
13 TOS
_Silty Gravel
15RECEIVED
_ TO 32
Viet Sand
_ 'i'O 66
Silty Gravel t andy,-small
06 TO 70
Gravel; small to
t m
C1lulri, sand -y, water -_ .e (',P
?0 TO 200
Bedrock: small
water sears in snarad; c fractures- _
TO
Y
Wayne i. ➢Jestbe ;g
TO
TO
_ 1'O
---'PO
TO
.TO
I CUSTOM=
�� S .� �° "b - � � , iii•.. '`
EPIAIYS
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. 017-013-67 Expiration Date: 7-2-s---/7
1. GENERAL INFORMATION
Complete legal description Marin L1
Location (site address) 13001 Patrick Rd, Anchorage, AK 99516
Current property owner(s) Robert Harvey Day phone
Mailing address 13001 Patrick Rd, Anchorage, AK 99516
Real estate agent Day phone
2. TYPE OF DWELLING:
Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 556 Waiver Fee $
Date of Payment tij141P4 Date of Payment
Receipt Number tiv.73 Receipt Number
COSA# 1611120 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the
time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems
depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by
the system.These conditions are outside the control of the evaluator of this system.All systems eventually fail and satisfactory test results
do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore
we cannot provide any warranty for future performance,nor can we estimate remaining life of the system.The content of this report is for the
sole benefit of the owner listed above.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E. Date 04/18/19
OF
6. DSD SIGNATURE */'gym ' •*
System#1 Approved for J bedrooms
Maven • -annate
CE 8149
System#2 Approved for bedrooms , "
Disapproved •��
Conditional approval for bedrooms, with the following stipulations:
ON ti
O
'SITE %-
,,,WATER
v=
INUVgsT ANp m^
PRS WATER
o G
RAM e
J�11)i�18ERVlCES\\'S `
)n)))),),�
By: v"--- : / Original Certificate Date: L r2S —/
p
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 Checklist blue sheet
COSA Checklist
Legal Description: Marin L1 Parcel ID: 017-013-67
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑� Well log is filed with Onsite (or attached) Well production at time of test 11 gpm
Date drilled 4/30173 Water storage tank volume gallons
Total depth 200 ft Well disinfected for coliform test? ❑Yes ❑No
Cased to 75 ft Coliform bacteria is Negative
0 Sanitary seal is functioning correctly Nitrate 7.18 mg/L ❑ Nitrate less than MRL(ND)
0 Wires are properly protected Arsenic ug/L ID Arsenic less than MRL(ND)
Casing height(above ground) 12 in. Collected by Garness Engineering
Date of flow test for COSA 917/18 Date of Sample g11119
Static water level at beginning of test 31.6 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 47 years ❑ Required maintenance completed
Tank type/material Concrete Age of lift station years
Measured operating fluid level in septic tank 57" Lift station material
ji Standpipes/foundation cleanout per record drawing Comments: N/A
Date of pumping 9/17/18
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/807 Adequacy test date 917/18
D ALL standpipes present per record drawing Results ['Pass For 3 bedrooms
Total measured depth from grade 5.1 ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 2.8 ft(min) Water added 450 gal
❑ N/A—pressurized field New depth 1 in
Monitor tubes go to bottom of effective. If not, state Elapsed time 260 min
depth into effective
❑� Code-required soil cover over field Final fluid depth 0 in
Absorption rate 450+ gpd
❑ System presoaked None
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced gallons If yes, enter date
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' Community Sewer Manhole/Cleanout> 100'
[]✓ Yes if No ft ✓[�]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' 0 Yes if No ft Holding Tank> 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment>50' 0 Yes if No ft
0 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' EI 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' ❑✓ 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' El Yes if No ft
Water Service Line > 10' 0 Yes if No ft Community Wells>200' 0 Yes if No ft
Surface Water> 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
AS—42it r LT (-).-.3'Tt Lt.
G. ENGINEER'S CERTIFICATION 3.OF A�gk,k6
l certify that/have determined through field inspections and review co. '9 4j
of Municipal records that the above systems are in conformance with ,* l *
MOA COSA guidelines in effect on this date. 04/1 8/19
c. , en . rola,, //
Oat;:, .. 8 •
COSA Checklist yellow sheet
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • • 907-343-7904
I
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # 0SC19112O
Subdivision: Marin Lot: 1
A water sample revealed a nitrate concentration of 7.18 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
NOTE:
DRIVEWAY LOCATION APPROXIMATE
DUE TO SNOW COVER.
•
S 1/2 SW 1/4 NE 1/4 SE 1/4 NW 1/4
0
E-1 Nth AVENUE
n ONSTRUCTED)
S 89'32'15"E 308.39'
/ / \ 4 10'MUTC fASEUENT�1
/ Lot 1 (�n1
J 44,914 s.f. ' e \C--q,
77,2'
O I Q. / 9.0'.113'LC0 CABW 0
C§ 12.1'a 14,1' O
CCCC In GRAVEL WR:a1 MN
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9.4'.10.3'04(0
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7/ i0 ' 2.0'CYI
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10.0'.12.0'DECIJ 6 \.
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/ N 89'32'45X 308.44' Lot 1
30 00' J \ 8 I I
I
Lot 2 I
PLOT PLAN — AS BUILT X SCALE 1” = 50' GRID _ SW 2840 Protect No. 19-155/R1
11500 Daryl Avenue, Anchorage. Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 0000Ap0.
(907) 522-4625 Fax oo O F A p0
Professional Land Surveyors kenOlangsurvey.com o ( Q
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I hereby certify that I have surveyed the following described property: o0� j" ''"
Lot 1, MARIN SUBDIVISION (Plat No. 71-173) 0/* 4�� �� �Q
Anchorage Recording District, Alaska, and that the Improvements situated thereon are el 1 V
within the property lines and do not encroach onto the property adjacent thereto, that Q j;" _ (! �y Q
no Improvements on the property lying adjacent thereto encroach on the surveyed i ' T^ �` D
a KENNETH,G. LA • a:
premises and that there are no roadways, transmission lines or other visible pp 0
easements on said property except as indicated hereon. V� a�0,341 p0
Dated this the 't',::.- Day of _ %••"` —, __, at Anchorage, Alaska O00`d,e'•LS-52O .•'OgopO
4 ROPESSi0NAL ' v
It Is the responsibility of the owner to determine the existence of any easements, �140s0g—'
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES M
Division of Environmental Services ~
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel 1.D. # C) —zp i-1 o HAA # 1)
1. GENERAL INFORMATION
Complete legal description Lot 1; MARVIN SUBDIVISION
Location (site address or directions) 15238 Hulka Eag2e Riven, AK
Property owner Henxy and Hitdi Hoe4t Day phone 696-3456
Mailing address P.U. Box 772101 Eaate Riven, AK 99577
Lending agency Norwest Mon;(page Attn: Vick Day phone 694-1144
Mailing address 16635 Centen4.ietd Dn i.ve , Su, to 101 Eag2e Riven, AK 99577
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3 \1
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
NOTE: If community well system, provide written confirmation from State A®EC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: 'If community wastewater system, provide written confirmation from State AVEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA x21
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.
S&S
Name of Firm
Address
Eagle River,
Engineer's signature
6. DHHS SIGNATURE
(
A \ Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
DiI ITIr7
Phone��� �� 7
Date Z c 3
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OR v�. y �
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aegis i+ear. owvsnn a.Gi.9o.•lSae v
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bedrooms, with the following stipulations:
Date 7— 6—f3
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph a 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.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LAT � kAkc� Ik� -<;t 72 Parcel I.D.
A. Well Data
0 /- 3/Z -�/_U
'S`
Well type If A, B, or C, attach ADEC letter. ADEC water system number
JP_
Log �/�_Date completed `5 - \\ ., 1. Driller H -\A
present/N)
Total depth Cased to \ 4'7_ 1 Casing height
l2-�\
Sanitary seal ON) T Wires properly protected C�/N)
FROM WELL LOG AT INSPECTION
-1
Date of test \\ -'� 1.0M
c
Static water level
MrO
N
2m.
Well flow l O -9-P.M. \ g•p•
Z. -
Pump levell JL
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 1 c> C> ; On adjacent lots \ op\ }
Absorption field on lot; On adjacent lots \lCo%�`
Public sewer main NI�� Public sewer manhole/cleanout �`R
Sewer service line 25 \>- Petroleum tank 25-
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria t�)
Date of sample: -\l. -0\3 Collected by: c s c FNGINFFRrNG
17034 Eagle River Loop Read No. 204
B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577
Z
Date installed l I 5 \1'I (A Tank size a Compartments
Cleanouts &N) _Foundation cleanout VN) Depression (Ykajr
High water alarm (Y&N Alarm tested (Y/N)
Date of pumping - - Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot t»� On adjacent lots \tea Foundation ;>S
To property line 1 o t Absorption field '5' Water main/service line 10 `r
Surface water/drainage t oo
CONTINUED ON BACK PAGE
72-026 (3/93)' Front
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O M
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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:
lot
D. ABSORPTION FIELD DATA
Manufacturer
Manhole/Access (Y/N)
"Pump -a
tested
I at
On adjacent lots Surface water
Date installed 1 `tl L. Soil rating (GPD/Ft2) ZC>o �%- I izR System type
Length e d Width _Z,� Gravel thickness r Total depth
Total absorption area to bc>4' Cleanout present(N) Depression over field (YAQ vJ
Date of adequacy test - -1 - 93 Results fail) Fsrss for 3 Bedrooms
Water level in absorption field before test 3 7 After test 3 9 N
Peroxide treatment (past 12 months) (Y& t�,> ^1 -1= KAIa IJ A� If yes, give date /-I//X-
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 00 (� On adjacent lots
\ eo � k- Property line 1 0
To building foundation 1 c>
To existing or abandoned system on lot
On adjacent lots kCutbank
1-�th- Water main/service line
Surface water t>o Driveway, parking/vehicle storage area 5 a
IIt
Curtain drain
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ori MAP ,,4jtinspection.
St0
J .vf fG) )j2 J93 _
Signature
U
e 'ver 0'0P oa o.
Engineers Nam e ver Alask 99577
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2
No. 1457-�
Date
`lt
:t ♦
HAA Fee $ f 2!� «T
Waiver Fee $
Date of Payment 4 -
Date of Payment
Receipt Number I��2 �/� ��
Receipt Number
72-026 (3/93)' Back