HomeMy WebLinkAboutHAMANN LT 22Hamonn
Lot 22
#050-621-09
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211192
Work Type: Septic Upgrade
Tax Code Number: 05062109000
Site Legal Address: HAMANN LT 22 G:0261
Site Mailing Address: 24618 WILMA CIR, Eagle River
Owner: MARGOLIN CATHERINE O &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
�t»cnt
o
Department
Lot Size in Sq Ft
Total Bedrooms:
6/15/2021
6/15/2022
93600
Q Disposal Field ❑ Septic Tank ❑ Holding Tank. ❑ Privy ❑ Private Well ❑ Water Storage
5
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
j 1) A portion of the proposed dralnfield is outside the 30 ft radius of the percolation test. An additional percolation
test is required prior to construction of the drainfield. This additional perk test shall either confirm that water
seeps completely away in first 30 minutes in order to take 10 minute readings or (3) 30 minute readings shall be
taken. If results require a design change, construction shall stop pending Onsite review and approval of a
change order. Please submit results with inspection report (or change order, if required).
Received By: Date:
Issued By: Abfj�la coolrug Date: ZI 5 la 0:2 1
MUNIMPALITY
Community Development Department - " Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-621-09
Property owner(s) Michael & Catherine Tavoliero Day phone (907) 230-1992
Mailing address 24618 Wilma Circle, Eagle River, AK 99577
Site address Same
Legal description (Sub'd., Block & Lot) Hamann Sub, Lot 22
Legal description (Township, Range & Section)
Lot Size 93,600 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank
ElUpgrade
❑X
Duplex ❑
(D)
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: -535 Waiver Fees:
Date of Payment: 613 �2 I Date of Payment:
Receipt Number: 0762910 Receipt Number:
Permit No. D)PZI I IG 2 Waiver No.
Permit App_:- : :-.,:c ;
June 15, 2021
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Hamann Sub, Lot 22 – 24618 Wilma Cir
Septic system design 6/15/21
Dear On-Site Services Engineer:
The owner of the above lot intends to build an additional dwelling unit on the property and will
need to upgrade their septic system, so we are submitting this permit application for the
construction of a new absorption trench. The attached site plan identifies the location of the home
as well as the well, proposed septic location and alternate site. No conflicts exist between this
proposed system and any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot is moderately sloped with grades between 20-30% running to the
southwest. There is one section of slope that was cut out for the construction of a pole barn that is
near 88% down grade from where we are proposing a new septic system. Based on a 46% slope
of effluent influence for soils that perc under 30 MPI, we have concluded that effluent will not
daylight out of the cut bank. Please see attached cross section for justification. The current design
meets all steep slope provisions as stated in 15.65.210.B.4 of the MOA Wastewater Code.
Historical soils tests for this lot show a slower percolation rate than what we encountered in our
test hole, so we are proposing a more conservative application rate for this design. Contour lines
are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not
impact this septic system. The new trench will be constructed parallel to the slope as much as
possible.
The new system will be greater than 100’ from all wells and surface water. The alternate site will
consist of tying into the existing septic with a CAT III system. The proposed septic will be located
greater than 12’ away from the exiting site.
Please refer to the attached plan, cross section, profile page, and test hole log for the septic design.
If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211192, Rebecca Carroll, 06/15/21
1"=50'
80' LONG x 3' WIDE, 6'
EFFECTIVE DEPTH
ABSORPTION TRENCH
4-BDRM HOME
NOTE:
SEE ATTACHED CROSS SECTION DRAWING FOR STEEP SLOPES. NO
SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
DV - DIVERTER VALVE
TH - TEST HOLE
LEGEND
HAMANN SUB, LOT 22
FEET
0 50 100
BALCONY
POLE BARN
2 STORY GARAGE
W/ A.D.U. ABOVE
WILMA CI
R
C
L
E
TH#1
560
550
540
53
0
EXISTING 1500-GAL
TANK & SYSTEM TO
REMAIN IN SERVICE
ALTERNATE SITE FOR 5 BEDROOMS:
UTILIZE EXISTING TRENCH FOR ADVANCED
TREATMENT CAT III SYSTEM
MIN 172 SF OF ABSORPTION AREA REQUIRED
CUT BANK >46%
SLOPES HAVE
BEEN STABILIZED
w/ VEGETATION
≥12'
DVFS
MT
MT CO
CO
6/10/21
Benjamin Schiller
CE 12592R
EGISTEREDPROFES S I O N ALENGINEER EXISTING WELL
100' WELL RADII
CO
CO
FCO
INSULATE PIPE UNDER
DRIVEWAY & MAINTAIN 25' MIN
FROM WELL w/ SEWER LINE
INSTALL CLEANOUTS WHERE
SEPTIC LINES EXCEED 100'
≥25'
CONFIRM
PERCOLATION
RATE PRIOR TO
CONSTRUCTION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211192, Rebecca Carroll, 06/15/21
HAMANN SUB, LOT 22
DESIGN FACTORS:SYSTEM REQUIREMENTS:
750 GPD PEAK FLOW
PERK RATE: 6-15 MIN/IN (ADJUSTED)
APPLICATION RATE: 0.8 GPD/SF
6' DEEP TRENCH SYSTEM
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
3'
2' 6"
6'
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 9' 6" BELOW GRADE (FROM HIGHEST ORIGINAL GRADE)
FLOW LINE ELEVATION: 3' 6" BELOW GRADE (FROM HIGHEST ORIGINAL GRADE)
TOP OF TRENCH: 6" ABOVE GRADE
750 GPD / 0.8 GPD/SF / 6' DEEP / 2 SIDES = 78.1 LF TRENCH REQUIRED (80 LF SPECIFIED)
6/1/21
Benjamin Schiller
CE 12592R
EGISTEREDPROFES S I O N ALENGINEER Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211192, Rebecca Carroll, 06/15/21
1"=15'
HAMANN SUB, LOT 22
SLOPE CROSS SECTION
6/8/21FEET
0 15 30
525'
0' 5' 10' 15' 20'
520'
~
8
8%
46
% AN
G
L
E
OF
EFF
L
U
E
N
T INFLUE
NC
E
EXISTING GROUN
D
PROPOSED
ABSORPTION
TRENCH
EXISTING
POLE BARNTH#1Benjamin Schiller
CE 12592R
EGISTEREDPROFES S I O N ALENGINEER~20%
25' 30' 35' 40' 45' 50' 55' 60' 65' 70' 75' 80' 85' 90' 95'
535'
530'
545'
540'
555'
550'
PROPOSED
ALTERNATE
SITE
46
%
ANG
L
E OF
EFFLU
E
N
T
INFL
UEN
C
E
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211192, Rebecca Carroll, 06/15/21
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
HAMANN L22
5/18/21
L. TIDWELL
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?-
3.7 6
3 4
050-621-09
MICHAEL TAVOLIERO
12:05
5/18
1
2
3
4
5
6
0 0
16 / 2 13
16
12:16
12:27
12:38
12:48
1:00
OB
Professional Engineers Stamp:
10
NO
NONE
5/25/21
GM (SILTY SANDY GRAVEL w/
LARGE ROCKS)
10
10
10
10
10
0 0
16 / 2 12
16
0 0
16 / 2 12
16
0 0
16 / 2 11
16
0 0
16 / 2 11
16
0 0
16 / 2 11
16
2 13
16
2 12
16
2 12
16
2 11
16
2 11
16
2 11
16
6/1/21
Benjamin Schiller
CE 12592RE
GISTEREDPROFE S S IO N ALENGINEER Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211192, Rebecca Carroll, 06/15/21
11
L=32.74'(R)
NOTES:
1) DUE TO SNOW & ICE COVER, THE GRAVEL DRIVEWAYS ARE APPROXIMATE.
2) THE DIMENSIONS OF THE LOT DO NOT MATHEMATICALLY CLOSE.
— (C) = COMPUTED
—(R) = RECORD
PLOT PLAN ___ AS BUILT —X_ SCALE 1" —5L— GRID _ SW 0261 Project No. —___ 21=0251R1_
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 0000Q�Opp
(907) 522-4625 Fax o OFA / ppp
Professional Land Surveyors kenOlangsurvey.com O `9
jonathanOlangsurvey.com®�.. A
I hereby certify that I have surveyed the following described property:
LOT 22, HAMANN SUBDIVISION (PLAT No. 73-173)
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this The __'fit '__ Day of ___ tL:, i(� _____. a.4 � _, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49TH ttK�e
KENNETH G. LA o
.LS -5202.. '.•yJ�i
0
ppo�'0f£sS10NP& Uo
pp0000��
AECC963
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System Permit
OSP101228
05062109000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: October 18, 2010 to October 18, 2011
Design Engineer: ANDERSON ENGINEERING
Subdivision: H^MANN
Site Legal Address: HAMANN LT 22 G:0261
Owner/Address: M^RGOLIN CATHERINE O
24618 WILMA CIR EAGLE RIVER AK 995779681
[) e 1. a r t m e ~ t
Site Mailing Address: 24618 WILMA CIR, Eagle River
Lot Size in Sq Ft: 93600
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: I0
Date: /~~//~,(/~_
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. 050-621-09
Property owner(s) Catherine Margolin
Mailing address 24618 Wilma Circle Eagle River, AK
Site address 24618 Wilma Circle Eagle River, AK
Legal description (Sub'd., Block & Lot) Lot 22, Hamann Subdivision
Legal description (Township, Range & Section)
Lot Size 93,600 Sq. Ft. Number of Bedrooms
Day phone
.Zip Code 99577
.Zip Code 99577
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P,O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
September 30, 2010
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 22, Hamann Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The septic tank on Lot 22, Hamann Subdivision is failing and must be replaced. We
are proposing to replace the tank with a new 1,500-gallon steel septic tank to serve the
two-bedroom home on the lot. The existing absorption trench will remain in place for
reuse. We are therefore requesting a permit be issued for the construction of a new
septic tank on the lot. The attached Site Plan and backup documentation identify the
location and configuration of the existing septic system and the location of the new
tank. The existing well is also shown with its 100' protective radius. The wells on the
adjacent lots are also shown and the new tank will be placed at least 100' from these
well and 100' from any surface water. The existing tank on the lot will be disposed in
accordance with Municipal Code. The drainage patterns will be maintained after
construction.
The ground surface on the lot is basically flat in the area of the new tank. The new
septic tank will be constructed near the location of the existing tank and as parallel with
the slope of the land as possible in conformance with Municipal requirements.
If the tank is constructed in accordance with our design the following statements apply:
The tank, if constructed as designed, will have no adverse impact on the wells in
the area or those to be constructed in the future.
The tank, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
Lot 22, Hamann Subdivision
September 30, 2010
Page 2 of 2
The tank, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The tank, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
HAMANN SUBDIVISION
LOT 22
93,600 S.F,
/
Dispose of Existing Tank in -~--/...
Accordance with Municipal Code. /
Place New 1,500 Gallon SeptiB'" /
Tank, and 2 Post Tank Cleanouts. /
/ /
~ ~ Bedroom
ExisUng AbsorptionTrench ~ ~
/ 49' Long x 2.5' Wide ~ ~
/ x 5.5' Effective Depth ~ /
NOTE
No Conflicts With Wells or Septic
Systems in the Area. N~ Breaks
in Grade >25% Within 50 of New -~
Septic Tank.
~ ¢~ / ~~ Vent
~/ - -~ ~ / TH - Test Hole
~.>. ~ / ~o -'~,on c,.~ o~,
-
SITE PLAN
MUNIC;IPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SER¥1CES
Environmental Health Division
825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
DISTANCES
Lot
Township, Ra~qge Section
SEPTIC
TANK
ABSORPTION
FIELD
WELL
WELl_ V'~ c;::> ]
LOT LINE \o /'-~'- ~, ~I-W~ --~
FDUNDATION ")....cs, / ~ / ~
AS-BUILT DIAGRAM {Show Iocahon OI well, septic system property hnos, foundatron,
~-~ SEPTIC [~ HOLDING
TYPE OF SYSTEM
"~rRENCH [] BED [~ W. DRAIN ~ OTHER
Fill added above original grade G[avel depth bonealh p~pe
FT
WELLS
~RIVATE
[] OTHER ¢ldentifv)
REMARKS:
FT
Inspecti~]ed by
$ & S ENGINEERING ~
17034 Eagle River Loop Roa(J No, 204
I ~,lt~Jo~J~cj¥,ejCr~Sk~Lg-,9~L____---_.-.-/~ cerl~y that this inspection was pedormed according to all
lale ~u~d ~~~¢ ~
...... .... , ~, i ii !;ii. :';ii;
{::~..i i;ih:;, ~ '~')': 'c:i :,;ici ~.:.'([. ~ ;::~i;~, ;:i i :,' ,;;,'~ [.~ ,., ~
Municipalily o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG b PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3
4
7
~2
14
15
16
17
18
19
2O
COMMENTS
{ E N G I N E ER'8~'~'~\~ >, ,'~,
DATE PERFORMED: [C~~,,,~;~ ,.[.~,~'~ ~,N ~--,
Township, Range, Soction:~, ~.
SLOPE ' si-rE PLAN
_-y_
WAS GROUND WATER
ENCOUNTERED7
$
L
IF YES, AT WHAT O
DEPTH? p
E
Deplh to Waler After
NIoniloring? ~
Reading Date Gross Net Depth to Net
Time -rime Water Drop
PERCOLATION RATE "~"'"~ (m~nules/,nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND __~:) _FT
S & S ~CNGINEER!N¢_-
17034 Eagle River Loop Road No. 204
E a 9 I~dti ,~r-5,A ~ ¢[',~ 9!/577
PERFORMED BY: ¥'~--__/I/'----~ I CER1 IFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE Ah~D MUNICIPAL GUiDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
(GRE'"ER ANCHORAGE AREA BOP°'UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
/~INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ,/~' ~'- ~¢L-~-~d-,..,,%¢~ MAILING ADDRESS //../~';'",',~/~/'7 ~?../C), PHONE
SEPTIC TANK:
DISTANCE
EROM WELL /~T'¢ '''/-
MANUFACTURER
INSIDE LENGTH _ INSIDE WIDTH
NUMBER OF
COMPARTMENTS /
LIQUID DEPTH__
LIQUID CAPACITY ,/'/J --,7 -~'.,' GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER OR WIDTH /-¢'- /LENGTH /'7, / DEPTH ¢ ¢~ // t
LINING MATERIAL/~,Z';¢./~.~""¢~i:RIB SIZE: DIAMETER___.DEPTH ~ /
DISTANCE FROM: WELL
BUILDING FOUNDATION_ ~'~[) / /
NEAREST LOT LINE -,~20 £'/-' TOTAL EFFECTIVE
ABSORPTION AREA (WALL. AREA)
sq. FT.
ADDITIONAL ABSORPTION
~ X~ ~ o,. ....... ~,_ ~,--
WELL.:
TYPE ,~0¢,.-~.~¢.~.~) . _CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED /~-~- DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH / '~' ~ !
DISTANCE FROM:
SEPTIC
TANK /'~'~ /:/- SEEPAGE
SYSTEM .,/~-'Z., / ¢'
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, EQ-031
DIAGRAM OF SYSTEM
DATE V'~ <'~ /''~''1' ''
G.A.A.B,
GRE, .:R ANCHORAGE AREA BOr UGH
PERMIT NO.
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE:, ALASKA 99503
fl, . J {
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PER~[T
INSTALLATION LOCATION
LEGAL
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
C'/] "
SOIL TEST RESULTS / ~- ;/ ~ / ~- /
COMPLETION DATE ANTICIPATED __ '~]~-¢ ¢~ ~'`~;
TO SE INSTALLED NY
NOTE~ THIS PERMIT IS NOT VALID WITHOUT ~OIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE ~ TYPE SEEPAGE AREA SIZE TYPE
DIAGRAM 01" SYSTEM
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTfC TANK
SEPTIC TANK J
TO NEAREST LOT LINE.
WELL. TO SEPTIC TANK
DRAIN FIELD
· DRAIN FIELD
, SEEPAGE PIT .
/
· DRAIN FIELD
//d ",/ /
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK , SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK .... SEEPAGE PIt ,DRAIN FIELD
TO RIVER, LAKE. STREAM.
/
/d/:
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SO]L.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
CAPS.
OR
LICENSED DESIGNER
I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGN ORDINANCE NO. 28-88 AND THAT THE ABOVE
!
Performed for
Legal Description:
This form reports:
GREATER ANCtlORItGE AREA BOROUr''
Department of Environmental
3330 "C" Street
Anchorage, Alaska 99503
SOILS I,OG - I>EROLATION TEST
BOb Hamann
Soils log
Depth
Feet
Dry Reddish Silt
Date Pe rfo rmed____~6./_12~Z2_5
Hamann Subd iv i s_iD_n~
YES .... Percolation test
5 .- Dry Grey Silty Sandy Gravel
6- 150 S.F./B.R.
7 ~ with occasional boulders
12"
( Maximum) ...... -~.
- I -'h ,
13-- t~om ~-es t
Was ground water encountered?
NO
I f yes, at wha'l: depth?
Reading Date Gross Time Net Time _?e_p_t?]_~.~W~te_r_ Net Drop
l~roposed installation: ~eepage Pit ~gS Urain Field
bopth of Inlet Depth to bottom of pit or ~rench
OWNER OF LAND .~,dq ~ e"~r~ ~' T' ~3 ~
ADDRESS ~ /~' ¢;)~ O3-b(a ~ I~ ST.VI'IC LEVEL OF WATER FF. // ~ .
LEGALDESCRI~ION ~ ~ ~q~ ~' DRAW DOWNFT,
DATE-Started ~~ Ended GALS. PERHR ~ ~ OO
. PERMIT NUMBER r~ KIND OF CASING ~
KINDOFFORMATION: ~ ~[~C hC~qS~q' ~ ~ ~ ~/ ~/ ~ ~ ~/(~; ~ ~
From~ Ft. to~Ft. ~/~ C~ y Frmn Fi. to, __Ft.
From __ Ft. to Ft. ~ '~ ~"'4~'t~. From~ Ft. to_. __ Ft.
From/~-'~ Ft. to Ft. ~':'~'b-,~o(../C From__Ft. to __Ft.
From Ft, to Ft. From__ Ft. to. __Fl,
From Ft. to Ft From Ft. lo.__ Et
From____Ft. to Ft. From Ft. to Ft.
From __Ft. to__Ft._ From__Ft. tn. __Ft.
From __ Ft. to Ft. From
From __ Ft. to Ft. From
From __ Ft. to Ft. From
From Ft. to , , Ft From
From Ft. to__Ft. From__
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to Et,
From Ft. to Ft
From__Fi. to Ft.
From__Ft. to___Ft.
From__Fi. to Ft.
From Ft. to Ft.
From__Ft. to Ft,
From Et. to Ft.
Z
o,
0 0 0 0 0 0 0 0
[~ .~.I~ON,"vi~NTALJ P,ROTScHoN .
Municipality of Anchorage _.~.,,
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program ~ "
4700 Bragaw Street
P.O. Box 196650 --
Anchorage. AK 99519-6650
www.muni.org/onsite ~, C.. -- I ~,~,~,0.~1 ( ~.~
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS ,b, PPROVAL
FOR ,b, SINGLE FAMILY DWELLING
Parcel I.D. D~'O- ~1'~
1. GENERAL INFORMATION
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
HAMANN SUBDIVISIONI LOT 22
24618 WILMA CIRCLE
MICHAEL ROY
24618 WILMA CIRCLE
EAGLE RIVER, AK 99577
Day phone
* EAGLE R~ER, AK 99577
Day phone
694-4640
EVA LOKEN w/PRUDENTIAL ~STA Day phone 689-6476
16635 CENTERRELD DR. * EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
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 pedod 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 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 vedfy 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.
NameofFirm CARNESS ENGINEERING CROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUffE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. CARNESS, P.E.
Phone 337-6179
Date L~I oq/O~
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engieeedng analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the pedormance 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
tTuctuata dudng the year, and the water usage of the family being served by the system.
These conditions ara 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 ara no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or futura 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 uae of this report by any
other person or party is not authorized, nor will it confer any legal Eght whatsoever.
5. DSD SIGNATURE
~ Approved for ,~ bedrooms.
Disapproved.
Conditional approval for __
bedrooms, with the fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Roy 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www,rnuni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS .&,PPROVAL CHECKLIST
Legal Description:
HAMANN SUBDIVISION~ LOT 22
Parcel ID: O.~'"O ' ~. ,,~/' OcJ
A. WELL DATA *WELL DEEPENED :,
Well type pRIVATE IfA, B. or C provide PWSID# N/A
6/26/1975
Date completed .7/1985 Sanitary seal (Y/N) YES
Total depth 158 ft. Cased to 158 ft.
Well Log (Y/N) YES (2)
Wires properly protected (Y/N) YES
Casing height (above ground) 12
In.
FROM WELL LOG
Date of test 7/1985
Static water level 115 ft.
Well production 10 g.p.m,
AT INSPECTION
5/22/2007
105
:7
ft.
,g.pm.
WATER SAMPLE RESULTS:
Coliform __
0 colonies/100 mi. Nitrate 0.129 mg./L.
Other bacteria
Date Of sample: 3/28/2008 Collected by:
0 Colonies/lO0 mi.
GEG Ltd.
System type ***CRIB/TRENCH
Gravel be!ow pipe 6/5.5 ft.
Depression over field. NO
Date of adequacy test 5/22/2007 Results(Pass/Fail) PASS · For 2 bedrooms
Fluid depth in absorption field before test 7.5' in. i Water added 385 gal. New depth 21.5in.
Elapsed Time: 360 min. Final fluid d~pth 17 in. Absorption rate >= 300+ g.p.d.
Any rejuyenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes. give date -
· *TESTED THE 1987 ***A DIVERTER VALVE WAS INSTALLED ,-, 8/2000 iTO RECONNECT THE
SYSTEM ON 5/22/2007 CRIB PER THE 8/17/2000 HA~,.
= C. ABSORPTION FIELD DATA: ~BELOW EXISTING GRADEI
6/1975 ' 150
Date installed .'11./7./tg67 Soil rating (g.p.d./ft~0~ 268
Length 15/49 f~. Width 17/2.5 ft.
I , . 384 : .
Totaldepth "8.83 ft. Eft. absorption area 539 ft2 Monitoring tube YES
Date of pumping 5/21/2007 Pumper. ~ JR'S PUMPING
High water alan-n (Y/N)
Arsenic: ND ug./L.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Tank size 1000 ,gal. : i NumberofCompartments 1
Foundation cleanout (Y/N) NO Depression over tank (Y/N) NO
Date installed
Clean0uts (Y/N)
N/A
6/1975
YES
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N) ~
on" level at ~el at ~ .in.
"Pump
~ ~ C~s alarm & circuit requirements?.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorptioh field on lot 100%
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
100%
On adjacent lots, 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation. 10'+
Water service line . 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacentlots 100'+
F. COMMENTS
Absorption field 5'+
Surface water. 100%
Water main N/A
Driveway, parking/vehicle storage
10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer*s Printed Name JEFFREY A. GARNESS
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev, 11/05)
Waiver Fee $.
Date of Payment
Receipt Number.
SG$ Ref.#
Client Name
Project Name/#
Cllenl Sample ID
Matrix
1081257001
Gamcss Englnccrlng Group, Ltd.
I lam;mn L22
Ilamann L22
Drinking Water
All Dales/Times are Alaska Standard Time
Printed Date/Time 04/09/2008 10:40
Collected Date/Time 03/28/2008 10:30
Received Date/Time 03/28/2008 14:35
Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
Allowable Prep Analysis
parameter Resutts PQL Units Method Container ID Limits Date Dale Init
M~t&ls b~ ICP/MB
Arsenic
ND 5.00 ug/L EP200.8 C (<10)
04/03/08 04/07/08 NRB
Waters Department
Total Nitrat e./Nitri~e-N
0.129 0.100 mg/L SM204500NO3-F B (<101 04/02/08 LCP
Microbioloc~, Laboratory,
Colony Count 0
Total Coliform 0
Fecal Coliform 0
col/100mL SM20 9222B A (<200)
coVl00mL SM20 9222B A (<1)
col/100mL SM20 9222B A {<11
03~8/08 DLC
03~08 DLC
03~8/05 DLC
95/23/2007 12:33 9073~9821
JRSSEPTIC
,IRs Pumpln~
Po Box 773415
F.a~Ie l~J~cr, ~ 99577
(~7) 694~54
~'l~'lllln g Information
Mike &Nena Roy
24618 Wllma Circle
Eagle River, AK 99577
(907) 694-4640
IJob Site Informat on
Mike
24618 Wllma Circle
Job oe,~r~: 20000
P.O. Number:
Terms: Net 30
Sale~re~): Kadia
Map Book:
Eagle River, AK gg577
(907) 694..464 0
786-3g?.5
Additional Location Comments
Brown cedar sided home w/#'s on
post at end of dw.
2bdrm septic behind house, through
gate. Pipes are in dog kennel.
Hamann Road
PAGE Oi
Service Agreement
Number: 022918
Order Date: 16-May-2007
Service Date: 21-May-2007 12:0
Technician: Don
Tax%: 0
Job Ty~e: New
~,,p ~d: 130- -
-ast Serv 12/08/2004 2000g
3umped & Cked Tank
L's all good!
Diagram: ,~a~rams~15528 b,nz~
Service Type Oty Price Each Tax?
Septic Service 2K 1 $0.00 No
Gallons Planned: 1000
Gal. Actual;
Hose Length: 4
Double Tank: i-1 ~
Pump System: ~,
Baffles Inlet: n
Baffles Outlet: [:::]
Extension Actual
SO.OO
NonTlxaldl Total
Estimm. ed Cha'ges' $0.00
Actual Charges:
Custamer a,'j~,~ s to ~e tee'ns l~d co~dltJ~ns ~how,n. TH1S I$ A BINDING AGREEMENT.
Taxable Tot~ Tax TomJ Ol~nd Te~al
$0.00 ~3.00 $0.00
and 1'11~e of Cust~ Repre~entattv~
Accepted by JRs Pumping ~)ate Acc~tm:l
F~' yc~r added convettle~ce we accept; American E.~q~rese, Ok=v~', VI$& and M a.~e~ C~'d p e*/me~t~ ev~' me phoe, e.
Aft~ 30 Day~ a::count will be turned ov~ to COLLECTIONS. $30.00 Fe~ NSg Checks Relumed.
Municipality of Anchorage
Development Services Department
Building Safely Division
On-SiteAnchorage,Waterwww.munl.org/onsite4700P.o.Bragaw &Box Wastewater AK19665099519-6650 Street Program ~-~ ~~)
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEhlS ~,PPEOVAL
FOR ~, SINGLE FAHILY DWELLING
Parcel I.D. ~'):~'~ --~q/- ~ COSA#~[0 ~
,. OE,E ''"FORMAT'O" - / =:O 7 ........
Complete legal description
Location (site address)
Current Property owner(s)
. Mailing address
Lending agency'
Mailing address
Real Estate Agent
Mailing address
HAMANN SUBDIVISIONI LOT 22
24618 WILMA CIRCLE * EAGLE RIVER, AK 99577
MICHAEL ROY Day phone
24618 WILMA CIRCLE * EAGLE RIVER, AK 99577
Day phone
694-4640
EVA LOKEN w/PRUDENTIAL ~STA Day phone 689-6476
16635 CENTER,ELD DR. * EAGLE R~ER, AK 99577
Unless otherwise requested, COSA.will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~
Individual Holding tank
Community On-site ["]
Public Sewer ' []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems
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 ENGINEI~R
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 bedreoms and type of structure indicated heroin. I further vedfy 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.
NameofFirm GARNESS ENGINEERING GROUP. Ltd.
Phone 337-6179
__Add_res_s__ 3701 E. TUDOR ROAD, SUITE 101 * ANCHORACE, AK 99507
--;2 ........
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide e thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered et the time of tho test. and separab'on
distances measured to readi/y identifiable features. The operational life of ali wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, end the water usage of the family being served by the system.
These conditions are outside the control of the eva/uator of the system. Satisfactory test
results do not guarantee futura performance of the system, horde they guarentee that
there ara no hidden defects or encroachments. GEG. LTD. 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. Tho 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 party is not authorized, nor wi//It confer any legal right whatsoever.
5. DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with ihe fllowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
Municipality of Anchorage
Development Services Department
Building Safety Dh'isbn
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/on~ife
(~07) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: HAMANN SUBDIVISION~ LOT 22 Parcel IO:j~_~_~ ....
WELL DATA *WELL DEEPENED
Welltype PI~VAI~ . ffA, B. orCprovidePWSlD~ N/A
6/26/1975
Date completed *7/1985 Saniten/seal (Y/N) YES
Total depth 158 ff. Cased tn 158, ft.
Wall Log (Y/N) YES (2)
Wires properly protected (Y/N) YES
Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test 7/1985 5/22/2007
Static water level 115 ft. 105 fl.
Well production 10 g.p.m. 7 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 1.87 mgJL. Other bacteria 0 colonies/100 mi.
Arsenic: ND ug.lg Date of sample: 5/22/2007 Collected by: GEe Ltd.
B. SEPTIC/NOLDINO TANK DATA, C/O IS THROUGH TOILET IN HOUSE OK. PER DAN ROTH
Tank Type/Material
Tank size 1000 gal.
Foundation cteanout (Y/N~) YES
Date of pumping 5/21/2007
STEEL
Number of Compartments 1
Depression over tank (Y/N) NO
Date installed 6/1975
Cleanoufe (Y/N) YES
High wamr alarm (Y/N) N/A
Pumper
JR'5 PUMPING
C. ABSORPTION FIELD DATA pBELOW EXISTING GRAD~ a/1 $75 150
Date installed *e11/7/lga7 Soil rating (g.p.d./ft~oK~ 268 System type
***CRIB/TRENCH
Length 15/49 ft. Width 17/2,5 ff. Gravel balow pipe 6/5.5 ft.
584
Total depth ,8.83 ft. Eft. absorption area 5,~9 Its Monitoring tuba YES
Date of adequacy test 5/22/2007 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 7..5. in. Water added ,385 gal
Elapsed Time: ,360 min. Final fluid depth 17 in. Absorption rate >= 300+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
(**TESTED THE 1987 (***A DIVERTER VALVE WAS INSTALLED ,-, 8/2000 TO RECONNECT THE
SYSTEM ON CRIB PER THE 8/17/2OO0 HAA).
5/22/2007)
Depression over field. NO
For 2 bedrooms
New depth 21.5 in.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N}
"Pump on" level at ~1 a7
Datum ~
..------- Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenkJlift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic sewice line 2.5'+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line
Water main N/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field 5'+
Surface water. 100'+
Water main N/A
Driveway, perking/vehicle storage
Property line · 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field in~s and
review of MuniCipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
dats.
Engineer's Printed Name JEFFREY A. GARNE. SS
D.te
COSA Fee ~; ~/
Date of Peyment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
SGS Ret'.#
Client Name
Project Name/#
Client Sample ID
M~lrix
107229800 I
Garness Engineering Group, Ltd.
Ilamann Lot 22
Ilamann Lot 22
Drinking Water
All Date-Jl'imes are Alaska Standard Time
Printed Date/Time 06/05/2007 12:31
Collected Date/Time 05/22/2007 11:20
Receh'ed DatdTime 05/22/2007 14:47
Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
Allowable Prep Analysis
Parameler Results I~I. UniL~ Method Container ID Limits Date Date Init
l~ta].s b~, ZCP/MS
Arsenic
ND 5.00 ug/L EP200.8 C (<10) 06/01/07 06/03/07 TK
Waters Department
Total NitratWNitrile-N
1.87 0.100 mg/I.. SM204500NO3-F B (<10) 05/30/07 JDS
MicrobiolocJy Laboratory
Total Coliform 0 col/100mL SM20 9222B A (<1) 05/22/07 DLC
05/23/2007 12:33 9073449821
iRS SEPTIC
rBilllna Information '
Mike & Nena Roy
24618 Wilma Circle
Eagle River. AK 99577
(907) 694-4640
[Job Site Information
Mike
24618 WIIma Circle
jab I:~r~Uo~: 2000g
P.O. Numbe~:
Temns: Net 30
Saeerep: KadJa
Map Boo~
Cr~m Streeh~:
Eagle River. AK 99577
(907) 6944640
786.3925
Additional Location Comments
Brown cedar sided home w/#'s on
post at end of dw.
2bdrm septic behind house, through
gate. Pipes am in dog kennel.
Hamann Rnad
.asr $erv 12~08/2004
~umped & Cked Tank
L's all good!
Service Type Oty Pdce Each Tax?
Septic Service 2K 1 $0.oo No
PAGE 61
Service Agreement
Number; 022918
Order Date: i6-May*2007
Service Date: 21-May-2007 12:0
Technician: Don
Tax%: 0
Job T~*1~e:
Mm O,~d: 130- -
2ooog
Gallons Planned: 1000
Gal. Actual;
Hose Length: 4
Double Tank: f-I ~
Pump System: []
Baffles Inlet: [],
Baffles Outlet: n. ,
Extension Actual
$o.oo
NonTearat~d · Total
Eitimau,d Cha'ges: $0.00
Actual Charges:
Curator' ~s Io the b~ml exl cu~cll~e d~ovm. THIS IS A BINDING AGREEMENT.
Taxab¼ Tz*~d TBx To~ Orm*d To~d
SO.O0 ~.00 $0.00
and Tills of Custom~ Repr~enta~J~m
Acce~l~ by JRa Puml:gng Date Acce~t~l
F~* your m~ed c~ve~e~ce we eccep~ American E.~re~e, ~:x~v~', Visa end M~-~er Crud payments ova' the ph~e.
Aft~ 30 D~y~ ~_--~,~_~JIM Wtll be tum~ over ~o CO[.L£CTIONS. $30.00 F~ N~F Checks Re~Jmed.
06/07/2007 08~29
Description ~c.~, ~o~t
Septic ~ pumped
Sludge ~ ~
Leach ~ca~ent
Bio-mat in leach
Water level ~ leach
Cap on Stud Pipes
Other:
~/~ ~'~
~ ~ ~ ~/~ ~//
Re¢ommen~tions:
To~ ~.~
1.5% into-~ will be charged monthly on unpaid bills until paid,
PAGE
86/88/2887 88:33 907-2~9-3859 ANCH CI-~ISTIAN SQL PAGE 83
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY.'
AND THAT NO FNOROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNID::{ TO DETERMINE TH~ EXISTENCE OF ANY
EA~EI~ENTS, COVENANTS~ OR RE.~;TRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CON~JTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
(;RID:
FB~
"B £WN,
I!
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel.I.D..O ~'~ -(., ~.t -C q
1. GENERAL INFORMATION
Complete legal description
Lot 22, Hamann
HAA#_ ./~',/?L"~'_ .~.'
Expiration Date:
Location (site address or directions)
Current Property owner(s) Bruce & VirRinia
Mailing address % Remax/ Kathi
Lending agency
Mailing address
24618 Wi}~t Circle
Morton
Day phone 694-9112
Day phone
Real Estate Agent Remax g.R/Kathi 01instead Dayphone 694-4200
Mailing Address 16600 Centerfield Dr., Ste 201, EaRle River, AK 99577
Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by: . ~ f. ~
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
2
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authcrity Approval (HAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the Slate of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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 sample results less than 30 days old. Certificates
are valid for one year for properties served by Class A or B wells or a public water system. The Municipality
of Anchorage is not responsible for errors or omissicns in the professional engineer's work.
o
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 the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
S & S ENGIN££RING
Name of Firm 17o.34 F .1 -"~ ~ ~v~r Loop Road No.~.02J
Eag!a i~,ivar, Alaska 99577
Address
Phone
Engineer's Printed Name Rober I: Cowan
Date
DHHS SIGNATURE
Approved for ~ bedrooms.
Disapproved.
Conditional approval for __ bedrooms, with the following stipulations.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: //_......._.3 ~ 0 .c
Original Certificate Date:
Reissue Date:
75 0;5~Rev 01 00F
RECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICI~I~(~
Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501.
Legal Description:
Health Authority Approval Checklist
Z-~; ~(~-v'f~/ ~'/0 Parcel I.D.: 0
A. WELL DATA
Log present (Y/N)
Total depth / ~'~. /
If A, B, or C, attach ADEC letter. ADEC water system number
FROM WELL LOG AT INSPECTION
o.,.o,,..
wamr
Well p~on ]~ g.p.m, g.p,m.
WATER SAMPLE RESULTS:
Coliform -I;;7
Date of sample:
e. SEPTIC/HOLDING TANK DATA
Nitrate /' '~"~-
Collected by:
Other bacteria
Data installed
Foundation c~ear~ut (Y~)
C. AOSOR~ON RE~ DATA*
Len~ / ~ ' w~m
Tank size /lf'~ ~ Number of Compartments / Cleanout~/N) /~'3'
~/0 High water alarm (Y/N) ~ /~f
Depression (Y/~
Pumper ~T~ ',~
Soilrating (g.p.d./ft~or~/bdrm) /'~-'~ ~ Systemtype
Gravel thickness below pipe ~, '
Total depth
Effective ~q~tion area __,~4~" Monitoring Tuba presentfl/N) Y~'d' Depression over field (Yb A.!
Date of adequacy test Results all) ~ For T~6/~ bedrooms
Fluid depth in absarptlon field before test (in.): ~'~ Immediately afte~"gaJ, water added (in.}:
Fluid depth ~ ~. (ins) Minutes later: ~ Absorption rate - "/..~0 0 g.p.d.
Peroxide treatment (past 12 months) (Y/N)-~/AV~- ~W&#A~-~t yes. give date
72-026 (Rev. 3/96)'
D. UFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
/// Size in gallons
"Pump on" level at*
'Datum
"Pump off" level at'
Septic/holding tank on lot
Absorption field on lot
Public sewer main
SEPARATION DISTANCES FROM WELL ON LOT TO:
/0'3
Sewer/septic service line
On adjacent lots
On adjacent lots
Public sewer manhote/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~ t '-/- Property line ~'~ t'*t' Absorption field
Water main/service line /4~ ~ Surface water/drainage ,/~"7 ~-- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line / 0 /.~. Building foundation / c~ /~- Water main/service line
Surface water / ~'~ ~
")- Driveway, parking/vehicle storage area
Curtain
!
/0
/o
/~.A/fl"l,d A/~ Wells 0n adjacent lots t/d...fl r
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal reco~s are
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*