Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
MARYLAND LT 5-A
* 0 .. 0 Q, 3LA Municipality of Anchorage Page 1—of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: L tPID Number: C)t 1l Name: iq tix)L - J— Wastewater System: ❑ New 2'6pgrade Address: ABSORPTION FIELD Phone: fNo. of drooms: eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth fWin original grade: Z GPD/Sq. Ft.— Lot:Block: Subdivision: Depth to pipe bottoR from original grade: Gravel depth beneath pipe %i ` Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: ) -C FFF" Ft. Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number of lines: I Distance between lines: I Ft. Ft. Classification (Private, A,B,C): {mfr (/a�'-� Total Depth: � � 4- Ft. Cased To: 2-0 FL Total absorptiop�nnn area: � Z/ � SD. Ft. Pipe material: n Driller:/�r A, Maw Date Dat Drill7 710 Static Water Level: Installer: D e'n2sta�lle Yield: /,.., Pump Set at: J Height Above Ground: TANK C/ GPM Ft. Ft. SEPARATION DISTANCES UKe`ptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: - Capacity in gallons: From Tank Field Station Tank Sewer Lines �(�N-(�/�j � Z Well- rL? L Material: 7-X�L Number of Caifftments: SurfaceQ Water BPj�I ID �f LIFT STATION Lot __ Size in gallons: Manufacturer: Line ho 0 Foundation 2-01 2-0 — _--. "Pump on" level at: -- "Pump off' level eI at: High water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: tr A-5 Assumed �Elev tion�_3 Ft ENG L *49, Tlrl j' 7j Inspections performed by: Dates: 1st 2nd L s'M � • JAMES. WR H'(' � �'•'. CE 88At �'� ' Department of Health and Human Services approval 1� , , t Reviewed by: Date: -2 and approved ® 72-013 (Rev. 9/91) MOA 25 ✓9� Permit No. Page of 41 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report I Legal Description: MA-6YAL/4) ico�bld Lo -r PID No. ----- - --------- --- ----------- ---------------------------- ---- --- 7777777\ ------------------------------------ \------ -------- ----------------------------------- ----- ------------------------- -- ....... -- ------------------- ---------------- ---- ------------------ ------------------------ - ------------------ --- ------------------- \! L I( LO U ------------- 2- 00 -OD 00 00 E. 01) N00'0110301 W W& vMUNN1111 M 25�.14 4 . . ........ . *#%";JAMES M. GHT o. CE a 1 4 ........... - Permit No. Page of .47 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 9 Telephone- 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No. ---------------- ------------------- ------- - -------------------------- ------------------------- -- -- ---- ------------------------------------- ------------ ------ ------------------------------------- ------------------------------------ ------------ - --------------- -- ---------- --------------- ------ -------------------- - -------- -- ------------------------- ------------- --------- 2- 0 'j jVGei I 6--A, L I /< OF ............... 49311 .11 ..... ... .. .. F %.JAMES M. "'ZIF CE I 16 ....... .... Permit No. Page =7'e—of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: � A-/✓® Sdhe1 L or -.5-9- PID No.: 72-013 A (1/93)' Permit No. Page _ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: M,4AX `,q -NO SyJ,a/ PID No.: 72-013 A (1/93)' /r 7----c PAGE 1 OF pm MUNICIPALITY OF ANCHORAGE � DEPARTMENT OF HEALTH AND HUMAN SERVICES L� ry P.O. BOX 196650, 825 "L" STREET, ROOM 502 ZiPrn ANCHORAGE, ALASKA 9 9 519 - 6 6 5 0 1 l a 3 -"lS- ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940447 DATE ISSUED:12/06/94 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:12/06/95 OWNER NAME:SHANE JOHN D & TERRIS N OWNER ADDRESS:6600 JOLLIPAN CT ANCHORAGE, AK 99516 PARCEL ID:01508234 LEGAL DESCRIPTION: MARYLAND LT 5-A LOT SIZE: 53496 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE : / 2- ISSUED BY: DATE: .. 1 Emah Rbw EUSIlD(eadus SOTACDS Louis Butera, P.E. Registered Civil Engineer November 25, 1994 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Maryland, Lot 5A Upgrade Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. 5. The existing trench will be retained through use of a diversion valve. 6. Due to space constraints, proximity of our 20.5' deep test hole, and 11' of gravel in the existing trench, the upgrade will require a variance of the normal 2x gravel depth separation between trenches. Mr. Robbie Robinson verbally approved a 15' separation during a phone call with our Staff Engineer, Mr. Curt Holler, on November 23, 1994. Mr. Robinson requested that we reference that conversation in our narrative. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \C:\WPWIN60\WPDOCS\1994\94-094A.NAR P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Maryland Lot 5A A. GENF.RAT. 1. The septic upgrade plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. SEPTIC TANK 1. Pump and abandon existing tank by crushing and filling, or removing and properly disposing. 2. Replacement tank to be MOA approved, 1,250 gallon standard septic tank. C. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 14.5' at any point. 4. The sewer line is to tie into the existing sewer line, as shown in the detail sketch/site plan. Contractor shall verify minimum 1 % slope of sewer line prior to tank and between tank and fields. The diversion valve shall be a Bull Run brand, available at Alaska Pipe. Contractor shall verify that existing trench invert is met. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 14.5' GRAVEL DEPTH = 5.5' under pipe, 2" over pipe, 6' total TRENCH LENGTH = 46' TRENCH WIDTH = 3' SOIL RATING = 1.2 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallons Twenty-four (24) hours notice required for all inspections. C:\WPWIN60\WPDOCS\1994\94-094A.SPC 1 1 LOT 4A /10.7' x 20' ANCHOR EASEMENT UNDEVELOPED F- I I I I No I ISrq I� ISI ISI r�,2 l a I INf N I W o z m or„ ISI " w `" I s �' oA I < REST WALLS I I D %ST. T ENCH I I I I T c to z r� � �I 57 < I m I- I � rrI tj� ® - TEST HOLE • - MONITOR TUBE o - SEWER CLEANOUT - WELL - PROPOSED LEACHFIELD - EXISTING LEACHFIELD EASEMENT NO SURFACE WATER NO KNOWN CURTAIN DRAINS 2-3%�, 2sj / 1vla LOT 5A 0- —1'U\CD L Lj LOT 6A DETAIL_ `\ 1/8 ELL @ TIE IN NEW 1,250 GAL TANK EXIST TANK TO BE ABANDONED TO CODE ADD BULL C.O./ VALVE UN DIVERSION SEPTIC SITE PLAN LEGAL: MARYLAND LOT 5A OWNER: JOHN SHANE CONTRACTOR: N/A JOB # 94-094 DATE: 11/2,3/941 SCALE 1" = 50' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694-5195 FAX: (907) 694-3297 EXISTING TRENCH NEW TRENCH OF `P ic- `* .49TH i . .. / ..� LOUIS A. BUTERA �� j CE -6736 A_= IIFaFo e +.r Municipality of Anchorage • DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LJ' 'SH tsN1< (EWdINEER'S SEAL)'.- DATE PERFORMED: f 1=-17 -9LI LEGAL DESCRIPTION: t 1A9-yLAIND L01 -5A Township, Range, Section: T�T 6PsJ/13t-K SLOPE SITE PLAN Ili IIT I1�IIT�I� GPGP , vAR1aS -6N PF.Bf3t�y L4o5E 2 4.7 a° .Qo` a Gross Time Net Time Depth to Water Net Drop '50A.r, 5 " -C' 30 {tN. 6 Fill. n P.R 7 — I I 1316:10 8 - VXIG L"/6 1 3 1322=10 Paz- URL10 10- - h 13LVI& —— V t`' 12 -. 13 :oc —C n 14 <� n 15 - 16 tri 17 18 0 19 6111 VARtS-S To Sri aw SH- HL, S11&Lt-6XNP$ of Stt-rlg��SAtvaC� HAT- HF -9 DENSE f u�ttslkStLT Arlo FrNE SAND, Ff•••2ocK�}�" SHr�La-ParolaEs rtt./Bw�u.n.Y/s,,T 5412- LAY/S yr SANP 6eAVMt, MED. DEtls� C�HELtv�� wtLL. FERC WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT N/A DEPTH? to Water After 1 11 firing? DRYZ06 Date: 11-7,y-014 Reading Date Gross Time Net Time Depth to Water Net Drop '50A.r, t1-17-qH t2`- 30 {tN. Fill. n 1,61z:10 — I I 1316:10 6,0 - VXIG L"/6 1 3 1322=10 10.0 FILO- h 13LVI& —— LA 1931110 6.0 '$t%6 Z 6 Zt3 IS3 ;l0 I o 4 -`t Q/6 3q/I F,I-L-- 5A 3'it-33 6,0 -gl'�G 2' 16 3B 1396-9,3 10.0 ��•i,o1y1 OIti 1. 20 - PERCOLATION RATE y, 6 (minutes/inch) PERC HOLE DIAMETER_ — No TEST RUN BETWEEN FT AND 10FT COMMENTS INSTALLI•i�t'S1�1fE111IONItoR TUBF� (o �.St F>: 2JarF-of SAND p�TutEs t 2 1.1`II�N PFZc- 2ATF-540vN M Foe- SILTY LAYF-P-. AV6, PUC?AT - Z.j PERFORMED BY:�S I �� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Fifa �� `f 72-008 (Rev. 4/85) EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694.5195 F. = 45:5' 'NODUCT20.1.1 7' ADB Maryland lot 5A SHEET CALCULATED BY Ch CHECKED BY lb OF. DATE 11/23/94 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 3q_Y-06x_ NEW ❑ UPGRADE MAI LING ADDR[�ESS 88�_I LEGAL DESCRIPTION V LOCATION n� Cie NO. OF B !ROOMS DISTANCE TO: Well / 0� ` Absorption area Dwellin r PERMIT NO. _Y i Q wI Manufacturer Material No. of compartments rn Liqcapacity in gallonsInside ( X-5 IF HOMEMADE: length Width Liquid depth JAZ DISTANCE TO: Well Dwelling PERMIT NO. 2 Z F Manufacturer Material Liquid capacity in gallons 4 w= DISTANCE TO: WellI /00 Foundation �� Nearest t lin 0� PERM O �d&DZ% LL Z FZLU No, of lines ` Length�f a cyline Total ler t f/fines TrenclTwidth inches Distance between lines FTop in of tile to finish grade / Q Material beneath tile/ II ( inches Total effective absorption area LU 0 Length Width Depth PERMIT NO. a F Wa Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J Class . Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER , ` � Rl C' REMARKS APPROVED - DATE LEGAL 6-/-7- -78 72-013 (Rev. 3178) � i'::'��9 �Y» lr 31i�� J•'1� - �lad��ll .5. 1111 yy> P Y ltl ! 1'yy S yi y 1, i i 0 Description of Formation...., from to Sand k- Gray P I `':v Yard 0- 4 Clay, rid'gGrn.vPl.' 45 55 clavi,-Sand&Gravel--MGrev-86ft 55 60. la FinPSar,i.pGran lGr ME>dW 60 65 a dkGraVPI° '">31G P, MPd' 65 100 a lt' Sand&GravtIGre�I,Pc1:tJ id 1Oa%: 115 cla;`Sand&Gravel la Sand&Gravel Grev N;Pd. 1 150 :Clay. Sand&.GravP.l Grav, croft 1 50. -160,1 ave Gro. ..m( -d 160 1 0 a d&Gravel 31Gre' , A ec7 .` 1701: 182 1R2201 and & Gravel= Brei. _, iJatPr' 201 204 ` i 0 WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 WELL OWNER// !'� N VVIi �,[��� (;) �� USE OF WELL k LOCATION 0 t;5, /' 1 a.,r �(t�d 1 _� . ���i 1V L S )',nY1 SIZE OF CASING�DEPTH OF HOLE�PT. CASED TO D� FT. STATIC WATER LEVEL__& FT. YIELD�GAL.PER.MIN. WITH d FEET OF DRAWDOWN. REMARKS h DATE COMPLETED �" �^' / PUMP TO BE SET AT D :2 d gz�'j 2too10 ,�So6,r) AV cro-ovgc4j yr2 s � c Tri V6 �13) Grvv 5a-C- (oto� Cl ��rt�`�ai�n.,j di G(,G�1/�� L-��t-+� �('ov�/ �2�1 r 112 o& yp % 1rwyi) R 1 L V(2rev Al 6 d f so_ �� Ii3✓li. qLY A I "/� t o ��0 W !Y l� C' W Pr (II1.v�0A1 lJ �� l SEL0161) S y eras �l LaOz D erv.Aj �(7t oz.JkA liloq. -S n,» d kv w o��to�04 S nC� y c 0fyyA�1 ��rn . \A//1n.1Gu%i�iY' f/w THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �-��I��.c.��� ���IF-1 L_ EE P-4 Cl _T_ IFA= ,THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR [F?AINFIEL[l THE DEPTH OF A TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCHVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �U 1 Fz*.'F.-. I---- I C. ���9-:1-, ~~~' `t�--1 f =1����� PERMIT Irl 1 F �� �� �� F::l rr-.1 iC- F -p L^ kA� INSTALLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRuTECTION(J-r<-�g hIUI`ll'.','ER OF RESIDENCES THAT -THE WELL WILL 825 /L' STREET, ANCHORAGE/ HK. 99501 - 264�4720 V ` �C" CD ��J - *S.-- 'l 'T', r=- 1�,l I=-- F --l- F-� ��� PERMIT NCI.( 780627 ) HPPLICHNT NOF MHN BUCHHOLZ 8,821 JUPITER ]44 0 ' '~^ LOCATION JOLLIPHN CT LEGAL. L5 L5 MHRYLHND S/D LOT SIZE 46124 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDR081TS SOIL RATING (SQ FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �-��I��.c.��� ���IF-1 L_ EE P-4 Cl _T_ IFA= ,THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR [F?AINFIEL[l THE DEPTH OF A TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCHVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �U 1 Fz*.'F.-. I---- I C. ���9-:1-, F-.'. f =1����� PERMIT / APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY AND THE hIUI`ll'.','ER OF RESIDENCES THAT -THE WELL WILL SERVE. ���I Ca ir-A F-1 F� �����1 FZ. IE_-. E. -j, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS |DEPFIRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS FIRE REQUIRED HND MUST BE RETURNED TO THE DEP��RTMENT WITHIN ]0 D�YS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATION'S HND CONSTRUCTION DIAGRAMS ARE HVHILHBLE TO INSURE PROPER INSTALLATION. ����Irl 1 �4. F-74 1 F.:_u EE ���EE P-11���r I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTHND THAT THE ON --SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:44 !r �-�----- HPPLICHNT � 0 " "• �1 SOILS LOG M .t MUNICIPALITY OF ANCHORAGE • ye DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST Pouch 6650, Anchorage, Alaska 99502. 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: IV V w LEGAL DESCRIPTION: va DEPTH (FEET) 1 2 3 4 GW 5- 67 6- 7 8- 9- 10 9 10 l SU 11 C 12 13- 14- 15- 16- 17 314151617 �G�Z9 18- Vj 19 <I�S� 20 �gs� COMMENTS DATE PERFORMED: rl SLOPE WAS GROUND WATER S ENCOUNTERED? L 0 P I E IF YES, AT WHAT DEPTH? —1 WAS GROUND WATER S ENCOUNTERED? L 0 P I E IF YES, AT WHAT DEPTH? SITE PLAN I Depth to I — —1 -35 sol I Depth to PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT 72-008 (7/76) Depth to PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT 72-008 (7/76) PERFORMED FOR. LEGAL DESCRIPTI DEPTH (FEET) 1 2 3 4 5 6- 7- 9- 10- 11 791011 12 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 3141516-171s1920 COMMENTS ❑ SOILS LOG „MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONIMENTAL PROTECTION ❑ PERCOLATION TEST Pouch 6-650, Anchorage, Alaska 99502 276-222.1 I SOILS LOG - PERCOLATION TEST 4�V G� DATE PERFORMED: / /7_ (f; 1 ,� PERFORMED BY: � S 72008 (7/7G) SLOPE WAS GROUND WATER / L ENCOUNTERED. 0 P IF YES, AT WHAT E DEPTH? SITE PLAN r Reading Date . Gross Time Net Time Depth to Water j 1/ 01" 7 77 _-I--T- T i ay� 1, p; I r �Q V\ �, � y 1 rP 7,S-„ :a© =p 30 rI �S i r Reading Date . Gross Time Net Time Depth to Water j 1/ 01" 7 77 _-I--T- T r Reading Date . Gross Time Net Time Depth to Water Net Drop 1/ 01" 7 77 ay� 1, p; I r �Q V\ �, � y 1 rP 7,S-„ :a© =p 30 rI �S PERCOLATION RATE (minutes inch)'-� J TEST RUN BE"%IECN FT AND -- FT �r CERTIFIED BY: DATE:_----------.. c�1 v; �. ❑ SOILS LOG i MUNICIPALITY OF ANCHORAGE PERCOLATION 67 �`.; DEPARTMENT OF I-iEALTIi AND ENVIRONMENTAL PROTECTION ❑ TEST Pouch 6,650, Anchorage, Alaska 99502 2/6-2221 v� 1 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTI DEPT H (FEET) 1 2 3 4 5 6 7 8 9 10 11 12 13 .14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72 008 17/75) l PERCOLATION RATE TEST RUN BETWEEN FT AND FT SLOPE WAS GROUND WATER S ENCOUNTERED? L P IF YES, AT WHAT E DEPTH? SITE PLAN Reading I Gross Time Net Time PERFORMED FOR: Net Drop C`, I_ t ��-1l �� DATE PERFORMED: 3 a ,, LEGAL DESCRIPTI DEPT H (FEET) 1 2 3 4 5 6 7 8 9 10 11 12 13 .14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72 008 17/75) l PERCOLATION RATE TEST RUN BETWEEN FT AND FT SLOPE WAS GROUND WATER S ENCOUNTERED? L P IF YES, AT WHAT E DEPTH? SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop 3�)' i-/-77 3 a ,, 0„ 0 /0 7 6 `' X13 CERTIFIED BY: DATE:—., ------- �vAL Test [dole Field Log Client/' ��n1� W. 0. No. Project /� f" �� ��� �, (,1=� Date m Hole No. Water Level While Drilling -f:7-7— Logged By Location_S� ^'� )��'� Water Level Atter Drilling Driller �,L^. ,;?�"-i•�! Frost Drill,`^IVWeather �eR — Ill Milli ::Ill T �C \'/� �� �! O OJ QIP O O ", �✓ OF' O O�,,P PP O L Standard Penetration F`�PP G,F O'v OO �O,;�C JG O. Op E 9� F. 9� �� �O ♦ � ,—y�j��" /� BLOWS/6� . _ � O° °PP O � /P OPV \�l\ .b°\ f� c�°`' \"l . °P Or-'.,�. � PP h �•P !� t Al_O- CD i g f�a (� D (/ R /✓ ! t /Vl /� D12- Y Br , i , fry �n;l rJ ul, v Jt, 4 r-szt�cx � ^sasx�ae unsTlEr:w� sn�- e�-_n�Ss:.+zau� mai .ii. y�..:r�o. �.�• acxtti _... ei `� 1 ,i s• 1 LES SK -✓ 9 Test Hole Heid Log Client_ ;ie 5` /'A -f// W. 0. No. Project— / !., ,-c., /n r� cr <` ./- Date 3 Hole No. ` Water Level While Drilling ^ Logged By % !� Location Water Level After Drilling Driller P-1-7/ _ r ---- Frost_Drily % Weather C ' O� Q• O OF' v OP y1 v �` p p�` r y� \ >• �`� Q -Q OJ Q'S O �< Standard �� r 1 oP Q OJ oaP O o Ax I<° Q Penetration / " O 5 .,Y F „ r O .> 0 a �� r �� 0 4J •f` " -11 9� Q f>' G OQ' �o BLOWS/6 F 'C Q5 O O ti r� i f ti Y '�: ' `�f d3r.: S4Yg�3'�'.CM1�. �`..1�••-31�`S �w"'�"' .-P'v"a'dt� -.{'YS�R9d:N6': I .�'S.4+ETF�F}^.y'A•J`.-:n2�5� 14 +�-nxtc e� err-rr.�• ,a;-r.�c«� vcx, �._s. aac :c ;y q �f.+;.»y�xc4a,�.v,:-.;:avr.�.��> s ` l %/s�''J • IJ I a `y i ��r.cm^.Jssn.�tr.% 3:£�n:��L;r��rs.-yaw.r,.✓:SG2v-E.¢c-.Ice R+�..w3�uv c__ _.saesa�. �ws.•uv�lemuurn�zsm.....�.axvwoa:.mw.ess...mn.:aw..rrc..nu'�_•r..n-�+.r.s�sa�-usi:�arnfa _-....,i.=J DICKINSON-OSWALD-WP "H -LEE ENGINEERS 1P 4040 "B" Street ANCHORAGE, ALASKA 99503 Phone (907) 278.1551 TO GENTLEMEN: WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ATE t/`' ATTENTI dN RE:I /DATE ' // 17— i�� —' �. "� (� <_L lap, (Attached ❑ Under separate cover via h it e.914,e,�Z the following items: V Prints W Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES NO. DESCRIPTION / /DATE ' // 17— i�� —' �. "� (� <_L lap, oe 04 THESE ARE TRANSMITTED as checked below: Cx For approval ❑ Approved as u mitted O(For your use ❑ Approved as noted xi As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE l/ JResubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 77jr—_- T 0 / 12 e} 7—A )2 ;FE avr=Gjc0 �aW T/t,65Fi2 n !�_22C7.JT46AJ` L- _f i% 77j—s7s iG�F- r�/moi Ott 5 /^" 777 COPY TO /i �T71/��ZN SIGNED: FORM 240-3 _ Available from Townsend, Mass. 01469 If enclosures are not as noted, kindly notify us at once. Municipality of Anchorage °•00 • �` Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ok.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-082-34 , HAA# 6-2, 6 �� V 1. GENERAL INFORMATION Expiration Date: / 0— IG — 0 3 Complete legal description MARYLAND SUBDIVISION; LOT 5A Location (site address or directions) 6600 JOLUPAN CT. Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LESLEY do NGA NYMAN Day phone 346-3375 6600 JOLLIPAN CT. • ANCHORAGE AK. 99516 Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ —_ Public Water System ❑ Public Sewer ❑ — The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4. 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 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 riles 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 ALASKA WATER do WASTEWATER. CONSULTANTS, INC. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or pally is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _V bedrooms. Disapproved. Phone 337-6179 fey �ss.� C 7953 `�vQ ,Ol�.�.�'ro f e s slopo400 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other WASTEWATER By: / - Original Certificate Date: %' IG -09 _ (Rev. 12!01) Municipality of Anchorage a Development Services Department Building Safety Division " On -Site Water & Wastewater Program ' ` ` 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MARYLAND SUBDIVISION; IAT SA Parcel ID: 015-082-34 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 11978 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 204 ft. Cased to 204 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/7/1978 .6/16/2003 Static water level 67 ft. 96 ft. Well production 6 g,p.m• 1.8+ 9.p,m- WATER SAMPLE RESULTS: Coliform **0 colonies/100 ml. Nitrate 40.1 mgJL. Other bacteria "'0 coloniesh00 ml. •6/16/2003 Arsenic: N/A mg./L. Date of sample"•6/26/2003 Collected by: AKWWC, INC. B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 4/23/1995 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping - Pumper McDONALDS PUMPING C. ABSORPTION FIELD DATA 8/17/1978_ 145 Date installed 4/23/1995 Soil rating .p.d. r bdnn 1^ System type DEEP TRENCH Length 33/49 ft. Width 3 R Gravel below pipe 1116 ft. 726/ — Total depth •i6 4/ ft. Eff. absorption area 5888 ft' Monitoring tube YES Depression over field NO Date of adequacy test 0*6/2/2003 Results (Pass/Fall) P_ ASSN . For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 2.�Ogal. New depth 44 in. Elapsed Time: 62 min. Final fluid depth 32 in. Absorption rate >= 600+ g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — +� TESTED 1978 DRAINFlELD. 1995 DRAINFIELD SURCHARGED. •#� MT ONLY EXTENDS 62' BELOW INVERT D. LIFT STATION Date installed _ "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1008+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 1000+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 6'+* Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 25'+ Curtain drain NONE KNOWN Wells on adjacent lots 1001+ F. COMMENTS * crr errai G. ENGINEER'S CERTIFICATION v! -14% i certify that / have determined through field inspections and �� 9 review of Municipal records that the above systems are in conforrnance with MOA HAA guidelines in effect on this date. r (. A Garne ; .. EngineersPrint d N me JEFFREY A GARNESS —79 .� VQ .� Date % ff o3' 4�edp fogs ......��c4 HAA Fee $ 3 `S Waiver Fee $ Date of Payment -1'4 ' 03 Date of Payment Receipt Number e-? 04 ZI Receipt Number 3 53 !�4 .Z q (Rev. 12101) — :907 5615301 0 1/ t 7- 1-03; 9:27AM: CT&E Environmental Services Inc. Laboratory Division riioiiissiai�►ic�o��•��►��r����•►a�����y'i"�r 200 W. Potter Drive Anchorage, AK 98618.1608 • inking Water Analysis Report for Total Coliform Bacteria Tel: t»o„ 56:-2343 . REMINSTRUCTIONSONREVER.SESIDDBaEFORD1��ING pLE Fax: B OMPLM Analysis shows this Watei SAMPLE to be: 10< • Satisfactory : p Unsatisfactory p Sample over 30 ho •urs old, results may be unteiiabie p Sample too long in transit: sample should not be over3l Vmuts old at examination to indican reliable results: Please and new sample via special delivery mail. Date peecived 4- TI me Received Z� t 4 Analysis Began rvtuall...--: -- p PUBLIC WATER SYSTEM I.D,11 'PRIVATE WATER SYSTEM p Send Resum p Siad lxwf Nr Y M Seal joroke TNS a r- ...�..+ MID jD • SAMPLE DATE: M ontls Day Ire SAMPLETYP.E: cl Treated Water Routine " ) Untreated Water p Repeat Sample (for routine sample / with lab refGO- (3 Special Purpose Time WLE ATI N / Collected jell IWjl BACTERIOLOGICAL W. Analytical Metbod: ,? Membrane Filter 13 MMOI - I ..,�._ .."oml. Result* Analyst -- 1033798--1 M� Tel TS It beat a A.U.:Anct Fbks Joe ❑ Fazed Collected - B/y tle"hw _ Dam; Time: -- Client notified of unsatisfactory results: ❑ ❑ Spoke with Fazed Pbooed YSIS RECORD 1 C -u MMG-MUG Resdts Total Coliform _ Colooleslloo ed • Meinbraao Filter. Direct Count O COL,flRMJ--- Verification: LTB BGB Fecal Coliform Confirmation l Cotlformfloo ml q ♦ T4G Tei Final Membrane Filter Results brs Time Date / �7 Reported By Comments: Time: TNTC. roe NNwnN re 6+.1 or-odwsmWis r� Member of the iG3 Grout (Soeiit4 G6rA,*I ds Survetl1`) 06-24-03 03:37PM FROM -CUE ENVIRONMENTAL SRV _SG9. SGS Ref.0 1033540001 Client Name AK Water & Wastewater Consultants Inc. Project Name/# Maryland S/D Lot SA Client Sample 1D Maryland SID Lot 5A Matrix Drinking Water PWSID 0 Sample Remarks: 9075615301 T-181 P.02/02 F-501 All Dates/Times are Alaska Standard Time Printed Date/Time 0612312003 14:12 Collected Date/Time 06/16/2003 14:30 Received Date/rime 06/17/2003 11:15 Technical Director SS/tephen .1~de Released✓? Paramettt Results PQL Units Method Container ID Allowable lc Prep Analysis Init Limits Date Date Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform TNTC OB mg/L. EPA 300.0 B (<=10) 06/17/03 JIB col/100mL SM189222B A (<=1) 06/17/03 KAP 6-22-03;19:12 ;CT an'd E AWWC ;5615301 fe 2/ 2 :. HQid f=or • drifirmaU00 ME Environmental ServicesInc, fi Laboratory Division 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria ApchonW. AK 99618.1606 2-2343 RFADIIVSTRUCTIONSONREYERSESIDEBEFORE COLLECT7NGSAMPLE to.. aam ec, Cl PUBLIC WATER SYSTEM I.D. 8' }.'PRIVATE WATER SYSTEM O Ssa^d R-a-n�� /n O ' S • "tet/( ALASKA WATERS _WASTEWATCR ��• '"" INIM 337.6170 FM 23&3246 01 L Tudor Rad, $dft 101 mg w a 5"1 Ramo a S 4 ,E} } `. PN NIt 337.61rf PAX! 330.32•{6 tom,.— 3701 L Taft Road, fdN 101 M sw SAMPLE DATE: Month SAMPLE TYPE: O Routine O' Repeat Sampie (for routine sample with lab ref. no. ) D Special Purpose SAMPLE LOCATION i''1 gft44D S/D (41r S R c:M n� 1 O Treated Water 0 Untreated Water Time Collected Collected By . 0 . `a,^ IQ M -S•0f'5 Pkm hw Analysis shows this Water SAMPLE to be:' a • 'Satisfactory Unsatisfactory O Sample over 30 hours old, results may be unreliable O Sample too long in transit; sample should not be over3ftours old at examination to indicate reliable results. Please send new sample vis special delivery maii. Date Received Time Received . Analysis Begin. Analytical Method: -t�-Membrane Fiha C3 MMO-MUG - 10335W* b ml. Rault• Analyst Seatto A.D.E.C. ' Ana Fbla Jun ❑ Fated Date. Time: Client notified of.umatisfactory results: Pboead Spebe 1vItA aced Date:*yTlate ' BACTERIOLOGICAL WATER ANALYSIS RECORD. MMO-MUG Rank: Total CeUform ' Y p E C&/i Membrane Fl6n Dlreet Cornt ?'AJ C• [X17 Coloaial100 ml Verit{cattoo: LTB /Aj_ _ BGS _A-? Gy_ _ _ _COLIFIAM Fetal Collkro Confirmation /u Float Fleal Membrane Filter Results a. S q Colifoim/100 tai Reported By L-- Date (D Z cis Time _ t 1 (yu. _, Ars Comments: rev NrvNrr ri b+s(' i3 Member of tM SG$ Group (Soeieti G61Nalo do Surwillsmel :_cuutoouucwTu_ cArai MES_ ALASKA _G►UFORHIA, FLORIDA IL.UNOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO, WEST VIRGINIA i S 0'04'40"E 253.14' •l.ws3 •J313 1 3131 oa s r — " � S i VVVOIII C � " N -O:O,j; �ax o� tri• a+ o�ls� Ul $ OD zm � w ' 1�•11 �� b co c � � '2 9A, 1 1 L �of � 8� oov0000ppp� 9� rnm tj to D N -1 - f [7 -t O ow ri%Jr� i C D i�O _ CSd �� Q' .. �AS: o• � v� o D - � e to � � H ALASKA WATER F� WASTEWATER CONSULTANTS, INC.� July 8,2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Lot 5A, Maryland Subdivision. To whom it may concern: We request that your department issue a 6 foot lot line waiver from the south property line to the existing drainfield. Iunaware of any adverse impacts this waiver would have on adjacent wells or septic systet�� If you have any questions, please contact us at 337-6179. Thank you for your assistapcpy Jeffery/A. 0#*els, P. E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com Gcoryc P. ❑ itercA, Mayor 7/16/2003 Anchorage Municipality of A nehorage � All -America City Building Safety Dix•ision 2002 Jeff Gamess Alaska Water & Wastewater Subject: Waiver Request for Maryland Subdivision Lot 5A Waiver Request #WR030054 Parcel ID #015.082-34 HAA030330 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 6 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, h;14� Jeffrey W, oet Engineering Technician On -Site Water & Wastewater Program P.O. Box 19W)50 • Anchonge, Alaska f]<J519-6650 • Telephone: (907) 343-£3301 • FIM: (907) 343-8200 4700 Smith I3ragaw Strcet • Anchorage, Alaska 99507 l ittp://tt,%tlt-.ci.ancliorat;c.alc.us Municipality of Anchorage Development Services Department • '� Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: 030054 PID#:015-082-34 HA#:30 0330 Permit#: Date Received: 7/16/03 Legal Description: Maryland Lot 5A Engineer: Alaska Water & Wastewater Consultants. Inc. 3701 E. Tudor Road Suite 101 Applicant: Lesley & NGA Nyman Waiver Requested: 6 foot lot line waiver from south Property line to the existing drainfield Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: ............................................................................... Waiver is Granted: _� Waiver is not Granted. List Conditions or Reasons for above: Date: �% - / G, - 0 3 By ...................................... t of Reviewer Rec#: 38429 Amount: $375.00 Date Paid: 7/1612003 72-025(Rw. 1/91) Front MOA #21 = 5. STATEMENT OF INSPECTION BY ENGINEER 7. As certified.—by—.m affixed hereto and'as-of the Validation -date shown below, I verify that my r investigation of this Health Authority Approval application shows that the on site water sup4ply` and/or wastewaterdisposal system is safe,. functional and adequate for the number of bed rooms"Me :" and type of structure, indicated. herein If u rther-verify that based on the information obtained from the Municipality ofYAnchorage files and from my investation and inspection, the on-site water's -_ supply and/or wastewaterdlsposal system is in compliance with ail Municipal and State codes, ordinances, and regulationsliri effecton the dateof this inspection 1 Name of Firm ,M-41 i5� (•l)i� ,�`it Phone 'Zk43—'`f 3� ! h„ Address. ° YGi>� =sem Engineers signature Date Z, z. 3 t 1 - -/�•- -•�_ ,_ I • w .r,: . f_. r , %' .. _amu-,;.fi2..,., .. _ t kdditional Comments._ )prove l_Certificates basedonly upon>the representations given in•paragrap ofessional engineer registered in'the State ofAlaska. The DHHS doesthis as a c d their lending institutions in orderto satisfy certain federal and state requireme '�._- ��:-<m+.v , :: .a•-� v.r�, .: .t�,lR#'�4` ! �r-{_xx u4 'Sd.1=^„a ., �, responsible for errors or omissions in thepi ofessionalengineer's work. _. 72-025(Rw.1/91) Back MOAa21 April 24, 1995 Department of Health and Human Services Anchorage Alaska James Mark Wright P.E. 2900 West 33rd Ave. Anchorage Alaska 99517 (907) 243-4361 RE: Health authority certificate request for Lot 5A of Maryland Subdivision. Dear DHHS, This is a request for a health authority certificate. S & S engineering performed a well flow test and water sample tests in november 1994. No additional water supply system testing was deemed necessary. No impacts to the surrounding properties are foreseen. Sin erely, James Mark Wright P.E. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MAAy /,4/✓Q S,Jft Parcel I.D. A. Well Data Well type rr 1(/G(f e— if A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) V Date completed Driller VALE Fc) SS Z / Total depth Cased to 2,64 Casing height Sanitary seal (YIN) Wires properly protected (Y/N) 1 FROM WELL LOG Date of test Static water level J Well flow 3 & CLQ Ao g.p.m. Pump levell / j 7 SEPARATION DISTANCES FROM WELL TO: AT INSPECTION m 73j rri n z ,� g.p.m. N N O / �hJ c.0 Pin p 0 < G) O m Septic/holding tank on lot TI ,/ � ; On adjacent lots i Absorption field on lot 2- ; On adjacent lots Public sewer main 94 Public sewer manhole/cleanout Sewer service line i�/i Petroleum tank WATER SAMPLE RESULTS: Collform "`` Nitrate 0 Other bacteria Date of sample: A100 vy l gal: Collected by:�> Win/ 6r//V L F- ,(qt IV 6:: B. SEPTIC/HOLDING TANK DATA Date installed L 2— Tank size S-0 "I- Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) ,AZ High water alarm (Y/N) Alarm tested (Y/N) Date of pumping IVE- td 7%j -l//<{ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot i On adjacent lots f` _Foundation 2 To property line D Absorption field _Water main/service line T�iT i Surface water/drainage CO 4- 72-026(3M)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed YA Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Manhole/Access (Y/N) "Pump off" Level at Cycles tested On adjacent lots Surface water Prz'c P /4-13S0/li"Mv4l Date installed Soil rating (GPD/Ft2) 2.. System type T-FIVC0 Length +q Width Gravel thickness Total depth j Total absorption area 4y -,2 -Cleanout present (Y/N) Depression over field (Y/N) Date of adequacy test�Resufts (pass/fail) A— for Bedrooms Water level in absorption field before test _ >/ /P, After test A/ I -• Peroxide treatment (past 12 months) (Y/N) I/S i6F 64 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots %&V I,— Property line l O r r i To building foundation _To existing or abandoned system on lot 2, On adjacent lots L Oo 4- Cutbank_ l OP f Water main/service line I Surface water f yo -f- Driveway, parking/vehicle storage area 3 Curtain drain r C&2 /- E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in NAa of this inspection. TH r4 Signature Engine Name �� /?'/ e5 /a.w Gy/'i 1 c6-67�T T . <'b u I; r „ °'`;•!' Date �� `f Sf~ fid' �,'• GF 1 CJI i HAA Fee $ %A06 ,a Date of Payment 1 2-&- Receipt Number L410 l o'�,/ 5/ 72.026 (3193)' Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # e0l.�_ Q82`-3�y HAA # VA 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) � io IAA (b) Property owner Mailing Address (c) Lending Institution _ Mailing Address (d) Real Estate Company and Agent Telephone: (home) �d4 Business Telephone Address Telephone�� (e) Mail the HAA to the following address: (or check hereAif hold for pick up.) List contact person and day phone number below: 17q- SM 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3. WATER SUPPLY Individual Well 1 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 -sit ¢� Public ❑ Community ❑ Holding Tank ❑ Note: t/co`mmunity 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 .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 66b.e-'�1 �DU f V, ETleIephone i'6 Address Date Z6 ;�, • - •��%kms`: ` �• .'ngineer's Seal �= 7 6. DHHS APPROVAL Approved for bedrooms by Date1��,L� Approved_ Disapproved —Conditional Terms of Conditional Approval CAUTION..... ,. 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) MUNICIPALITY RWKJdSrV- FEBRUARY 1984 MrNTAL SE VICcS DIV34-3(4744 ENVIRON Legal Description: L -o% 5 1—lA�Y AHD STT i r), N1 W1 A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N)_Date Completed �/��%� Yield 6 Total Depths Cased to 0-0 ` _ Depth of Grouting:p._ Static Water Level % Pump Set At Bn 7-0 Ay Casing Height Above Ground f�'� 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 loZO ; On Adjoining Lots Ptotic To Nearest Edge of Absorption Field on Lot I d ; On Adjoining Lots NoN16 To Nearest Public Sewer Line hZAc To Nearest Public Sewer Cleanout/Manhole L`1jA To Nearest Sewer Service Line on Lot 9 io Water Sample Collected by - S ; Date Water Sample Test Results 4e� d4l% 4 N L>�r1y�^e S Comments B. SEPTIC/HTANK DATA Date Installed A() 6r 78 Size 1d25cv No. of Compartments Ttwc Standpipes (Y/N) ONa Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped 7/8 0- Aotae�s Pumping/Maintenance Contact on File (Y/N) Nf�l ; for Holding Tank High -Water Alarm (Y/N) �"X/4 Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well lao * To Building Foundation To Property Line > r To Water Main/Service Line > �a To Stream, Pond, Lake or`Major Drainage Course ._ Comments 72-026 (Rev. 7/88) Front To Disposal Field dZ Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 14s- Type of System Design TAGNC4 Date Installed A u_,e, /2-7(3 Length of Field 33 Width of Field 3c� i- Depth of Field 12 y Gravel Bed Thickness Square Feet of Absortion Area %ah Statndpipes Present (Y/N) o>// Depression over Field (Y/,N) N Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Selo To Property Line 2 - To To Building Foundation To Existing or Abandoned System on Lot 1_//0eAr On Adjoining Lots 7- o/V�E To Water Main/Service Line� To Cutback (if present) NO ndc To Stream, Pond, Lake, or Major Drainage Course No t4tz To Driveway, Parking Area, or Vehicle; Storage Area Comments D. LIFT STATION N n !V� 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 that I have checked, verified r conformed to all MOA and HAA guidelines in effect on the date of this inspection. i �; os Signed Company b �' r a,ca? • h a E 1 Engineer's Se �� ngin er's al Date a E ' MOA No. r Receipt No. --i S -, O�Ca� _>>- �J . - Receipt No. Date of Payment.-._ _ g l Z b' g Waiver Fee: $. Amount: $ pate of Payment 72-026 (Rev. 7/88) Back Page 2 -df 2 - ' MUNICIPALITY OF ANCHORAGE /�Q /� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC7<'IL(iFP��P�'+ 'W' 825 L Street - Anchorage, Alaska 99501 - DEPT. OF I IEALTf9 & ENVIRONMENTAL F&OECTION 0* ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 JAN 1 ���� STREET LOCA REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWft'0 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNERPHONE No v -yr c) Y) d 16ke-vie e- 13df tA4 o MAILING ADDRESS Y 9� / �ec i /) 9 `l1 7 r vHac PROPERTY RESIDENT (If different from above) PHONE 2. BUYER - PHONE �ezw WC° /n 'U I MAI LI NG ADDRESS * ATTACH WELL LOG. A well log is required for all wells drilled 3. LENDING INSTITUTION - _ PHONE ❑ PUBLIC UTILITY depth (attach log if available.) MAILING ADDRESS 90 `I **If individual/on-site, installation date_. INDIVIDUAL/ON-SITE** 4. REALTOR/AGENT PHONE If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY MAI LING ADDRESS NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 5. LEGAL DESCRIPTION IL974- STREET LOCA ON 6. TYPE OFR IDENCE - NUMBER OF BEDROOMS SINGLE FAMILY ❑ One �4 Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY - I INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, installation date_. INDIVIDUAL/ON-SITE** give If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) CIS a THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED - TIME - TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank -Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LtYAPPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)