Loading...
HomeMy WebLinkAboutW-A LT 1Lot 1 #018-092-51 Municipality of Anchorage Page · " 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: ',~'0~O ~"]] PIDNumber: ~]~)-- O°/~-- Wastewater System: D New ~pgrade "~'"" ~Ot tH~ A~ ABSORPTION FIELD P~one: lNo. otB~r~ms: ~ Deep Trench ~ShatlowTrench ~ed OMound ~Ot~e~ Total Depth from ~gmal grade LEGAL DESCRIPTION so,,....~: ~ ~"~ Townsh~ ~ Range: { Sechon: F~II add~ a~ve o~glnal grade: Gravel length: 1 I WELL: ~ New ~ Upgrade G~a,.;~iath: Number of lines Onlle ~-- Date Drilled: Stlt~ Wll~ L~; Inltallec ~""' ~ I ...s.,.,: I~.,.,..,;~,.~o,~..: TANK SEPARATION DISTANCES ~s,.ti~ o Holding 0 S.T.E.P. s.~.~. LIFT STATION Lot cu'a'~ Remarks: BENCH MARK ~.. ~.,~ Inspections performed by: ~ 5 Dates: 1st 'tl'e~~ ' ' w ~d "h,l~ .;..~.~ Department of Health and Human Se~ices approval '~'~:~ c~.~ ..~-~ . ~ '.. ....~'~ Reviewed a~a approved by' ~~ ~. ~D~te; ~'~/' ~ / '"~* '~/ d . ~<.~.... %. ££PIACDt£NT $1r£ ~5 \0 \ 5o \ \ SWIN~ I1£$: ~ $~.$ PAN£L I' =50FT. 100 I00 125 150 IOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907) 279-$915 PERMIT # SV000471 II If-A S/D LOT1 4910 EAST I40TH. AVE. LEO AND CANDY RECHNER PID # 018-09£-5I DATE: NOV. 15, 2000 SHEET: 2/5 GRID: 295~ W-AOOOI£.DVG .l'mv ]~ O0 07:57a Maril~n Elsenba~t 3463559 p. 1 INSPECTION REPORT &"~UNICIPAU'f¥ OF ANCHORAGE, BUILDING SAFETY DIVISION 35C0 'EAST TUDOR ROAD ~NSf'~Ctl~ yOICE ~G3-3464 INSP¢~IO~: ~ 1~7~3~3~23~, iNFO: 343~1 *a~s -~ ~ / ~ ,.' ...... ~-,~.. - ~&. _ ~,/v~C~,'~ ~' ~ .... "· '"~' '" ' J CORRE~?IS"e · ., , J , ~.SEN~LAs EXP~,NED ~ELOw RECEIVED NOV 1 6 2000 Mu 1 c~pality ot AnCi3orage Dept. Health & Human Sen/ces MUNICIPALITY OF ANCHORAGE Department of Health and Human Sen/ices On-Site Sen/ices Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 07, 2000 Expiration Date: Nov 07, 2001 Permit Number: SW000471 Legal Description: W-A LT 1 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Leo & Candy Rechner Owner Address: 4901 E. 140th Ave. Anchorage, AK 99516- Parcel ID: 018-092-51 Site Address: 004901 DE ARMOUN RD Lot Size: 45962 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of AJaska 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. I~5. ~l'he following ~l:~cial provisions."' - * · ?.THE SEPTIC TANK SHALL BE M~E TO'B'~ 100 FE~--r' ~OM ':'rHi~ WATE~ ~ELL DuRII~G THE iCONSTRUCTION OF THE PROPOSED WASTEWATER SYSTEM. Date: I1" --'dC) 203 W 15th. Avenue, Suite 203 ANCtlORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 1 W-A S/D LEO AND CANDY RECHNER Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 October 24, 2000 We are submitting an application for the upgrade the waste water disposal system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the waste disposal systems are subject to this permit application, (sheet 2/3), and a schematic of the waste disposal system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Ground Water ~ $ t~ Percolation Rate < I min/inch Use BioCycle Soll Application Rate 4 gal / sq ft No. of Bedrooms 5 Required Area per Bedroom: 150/4 = 37.5 sq.ft. Total area required: 37.5 x 5 = 187.5 sqft Use 10x20 bed Area 200 sq ft SYSTEM CONFIGURATION BIOCYCLE 1250 GAL SEPTIC TANK EXISTING STANDARD BED TOTAL LENGTH 20 Fl' TOTAL WIDTH 10 FT TOTAL DEPTH 3 FT ROCK DEPTH 0.5 FT COVER 3 FT The installation of this waste water disposal system system will not prevent development of the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result from this installation. PERFORMED FOR: MunlclFality of Anchorage DEPARTMENT OF '~EALTH & HUMAN SERVICES 825 "L" Street. Am:horage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 10 It 2O Township, Range. Section: SLOPE WAS GROUND WATER ENCOUNTERED? S SITE PLAN IF YES, AT WHAT OL DEPTH? (~ p E Oeplh to Waler AFter Idoniloring? Cross Net Depth to Net Pead[ng Date Time Time Water Drop PERCOLATION RATE ~ ~ (m,nuteumch) PERC HOLE DIAMETER ~ ~! TEST RUN BETWEEN /1j F? AND ~ F? DISCLAIMKR' Arnundwater cnnd(tions tndtcatmd arm ¢nr the dates show~ only. Past and future presence and/or depth of groundwater can not be predicted trom these observations. PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll ELINES IN EFFECT ON THIS DATE. DATE: 72-~8 (R~. PERFORMED FOR: THUl Munlcll~ality ©! Anchorage DEPARTMENT OF -~EALTH & HUMAN SERVICES 825 'L" Street. A~mhorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: 2 3 4 17- 20- Township. Range, Section: SLOPE WASCROUNDWATER ENCOUNTERED? SITE PLAN IF YES, AT WHAT DEPTH? Cross Net Depth to Net Feeding Date Time Time Water Drol~ PERCOLATION RATE (m~nuleshnch) PERC HOLE DIAMETER TESTRUNBETWEEN FTAND~FT DISCLAIHFR~ ArnundwatPr cnndtttnn~ indicated are for the dates hown 9nly. Past and future presence and/or depth of groundwater can not be predicted trom these observations. PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUlL [LINES IN EFFECT ON 1HIS DATE. DATE: 72-008 (Rev, 4/85) I Ii m % % CREEK OFFSET 5O o I 5o EAST I40TH. AVE. LOT 6 15~ SCALE, 1' = lOO FT. LOT 7 £5~ 300 I *- L >.%. ' ~'""~-"t'r ........ r~' ........ LIOBBEN SPURKLAND P.£ 203 W 15TN. AVENUE ANCH. AA 99501 (90ZI PERMIT # S~OOOXXX II PID # XX 4910 EAST 140TH. AVE. LEO AND CANDY RECHNER SEPDC SYSTE~ OESICN SHEET: I/3 GRID: 2936 W-AOOOII. DWG ££PL4C£~£N[$/r£ 25 \0 50 75 150 [OBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCN. Al(. 99501 279-$916 PERMIT # SWOOOXXX II PID # XX ~r-,4 $/D 4910 EAST 140TH. AVE. lEO AND CANDY RECHNE£ SEP~C SYSTE~ DESICN DATE: OCh 18, 2000 SHEEh 2/3 GR~: 2936 V-AOO~DWG /~ 4-INCH INSULATION 5 ~ AI~CO~P~ESSO~ % ,tK%~.= ............ ~%. mocrctr ,ooo , %., _~7'....~ % =.-.~ ....... = ....... ~.~ t'~t"7~;Wg"~;..~.~ i ~ ~ LEGEND: ~...--...~ 1. PR/MARY TREAT~EN[ SEPTIC TANK ',~/? ........... ~' ~ 2. AERATION rANK '% ~U~ L~ W~** 3. CLARIFICATION TANK ~ ~. D/SCHARCE lANK 5. SOIL ABSORPTION IOBBEN SPURK~ND P.L LOT I J}'-A S/S SEPnC SYSTEW SCHEWATIC 203 W15ih Ave 4901 E 140TH. AVENUE DARE: OCL 24, 2000 Anchoroqe Ak B9S01 77~-~ LEO AND CANDY RRECHNER SHEET: 3/3 GRID: 2936 PERMI[ ~ SWOOOXXX PID ~ XX ... PROPERTY OWNER AGREE1ViENT FOR ~ MA]}fI~NANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM Th,s a~reement, dated'/~)/{D/,,~/)/)0 t99 ,is made between the M~" ' -- c~p~u of Anchorage Depm ~:nt of He~ ~d Hm~ S~ic:s ~HHS) ~d ~ prop:~ o~r(s) of: · This agreement is made for the purpose of rnalnta)n{ng an on-site wastewater disposal system on the subject property. The property ossmers a~ee to th, e following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, tkners, and alarms, md that any deficiencies have been repaired and tha: the system is functioning a~ designed. (Signature) ......... (Pri~idd Name) ............ (l~mted Name) ............................... Notarize Here ................................. - - - - - steo, On th:, day off_e/Oh.' . ~ho la personally kno~ to me ~vhose tdentfcy I proved on the baM.~ of"-- ~hose.tdentf2? I proved on the bath/affirmation ,, a credible ~ness to;~e the signer of the abov~ document, and he/she aek~ule~ed that he/~e signed MUNICIPAUTY OF ANCHORAGE Department of Health & Human Services On-Site Services Waiver Review Worksheet WR#: WR000104 PID~: 018-092-51 Date Received: November 26~ 2000 Legal Description: W-A, Lot I Permit~: Engineer:. Tobben Spurkland~ PE 203 W. 15th Ave.~ #203~ Anchorage~ AK 99501 Applicant: Leo & Candace Reohner Waiver Requested: 9,Iii'foot waiver from well to septic tank on aubjeot property Cdtarla: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2. Special Conditions: 3. Other. Total: Waiver is Granted: ~(. Waiver is not Granted: List Conditions or Reasons for above: ~' Data:l- Reo#: 06463 Amount: $625.00 Name of Reviewer Date Paid: 11-28-00 Municipally' of Anchorage Building Safety Dlxusion ILO. Ih)x 1.~Xi~50 · 47(X)S. Bragaw Slrcct Anchon~gc, Alaska .q9519-C~k'~0 * (907) 343-~)01 h t t I )://~'wxv.cl.m~chor;.~gc.al~.t ~s Public Works 01/02/01 Tobben Spurkland, PE 203 W. 15th Avenue, #203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 1 W - A Subdivision Waiver Request #WR000104 Parcel ID//018-092-51 Dear Mr. Spurkland: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 95.0 feet. This waiver approval applies to the existing septic tank to private well 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, Civil Engineer On-Site Water 8: Wastewater Program - SEPTIC p~TF) '. T I, tE THe. ~Tj, 7-~c b.n~ tJv~t Ij' c]2 FEEl". I /JO ~ ~0~, TS ¢.3 Z.~ T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 Subject: Waiver Re'quest Lot I W-A PID 018-092-51 RECEIVED NOV 28 2000 Mu,,~c,pality of Anchorage Oept. Health & Human Sorvlco9 November 27, 2000 Gentlemen; We are applying for a waiver ofthe separation distance required between the septic lank and the well serving this lot The septic tank stand pipe is located approximately 911 feet from the well. We request a waiver to 95 feet. The submitted siteplan shows the approximate location of the stand pipes of the septic system and the location of the well. Copies of well logs from this lot and from Lots 2, 9, 15, and 16 of Block 2, Elmore S/D can be utilized to evaluate the contamination potential. The static water level in this well was found at 92 feet on October 10, 2000. At a pumping rate ofS gallons per minute the watcr level stabilized at 133. The static lcvels in the other wells are at S0 feet,more orless. Totalwelldepths are l00 feet or more. Well yields are from 6 gpm to l0 gpm. There are several thick layers of hard pan or clay reported. The justifications for granting this waivers are: I. Water samples taken November 16, 2000, show a concentration of 0.769 of Nitrates. This is within expected background levels. No bacterial contamination was detected· 2. The well logs show several impervious layers between the surface and the intakes of the wells. 3. The ground surface is level or slopes away from the well. Overland flow of surface contaminants originating at the septic system location will flow away from the well. Yours 4qo I larO qqsiL £EPLACEIIENT 0 £5 \\ \ 5O 1' = 50 FE eeee 100 1~ 1§0 PERMIT # SW000471 II If-A S/D LOT1 4910 EAST 140TH. AVE. LEO AND CANDY RECHNER PID # 018-09£-51 SEPTIC SYSTEM AS BUILT DATE: NOV. 15, 2000 SHEET: 2/5 GRID: 2956 W-AOODI£.DWG %., :o~mmerv.t.:~ln?~l] :.'71111 "" ""' '"'"-, '. "*f'.~,'4d ,.,,..,, ,,..,. -- hi' ._....~.~7.j ff".-,.h..., i.,,,,; ~c DAILY DRILLING LOG SYREN ggO$. DRILLING, INC 2701 Ea&te Sheet Anchern;~. Ah~ 9~$0,1 27464,17 £1more Subdivision. 81k. 2. Lot 9 I~£LL. SIT£. ............................................................ t)P, AW DOtal FT ........................... ' ..................... · 8-~-81 ~'7. 8-3'8! tz,,nnrr,~'~c 6" A53 Grade "ii" Steel DA1.E · ENDED ................................................ .. ...................................................... ILIND OF n z silt/sand f, gravel F RO~ ......: ........... ~ T. TO ........... ~. ........ f T.....b'./.t~ o.u J d~ rs ....... FROM 6 FT 1o 15 . FTsi t/son,e ravel ~.~. 15 .... 22 ~et silt/so~e gravel KU. ~ ................. rz. ~u ................... ri ....................... F.,~,, 22 r?~,, 78 t~sllt/sc~ gravel ~ , o~ .._.;.a. ....... r T. T o ....... .a..!. ..... n .".?.L.~. J..L V.. ,. .~ ~.d./..9 ~ a v e l ~o~..-.~-I. ........ rT. ~o .... ~ ..... ~.d.'.?....L!.9. /_,.~_~/.~r-'~e l F ~o~._~~_ ....... F~. ~o .... ~.~ ..... rn,..~..ter, l~..~l~r~v.e l F RO.~! ............ FT. TO .............. FT ................. ~ro~ ............ rT.~o ............... -~r .................... ~O~L._ __.FT. TO ......... .rT ............... FKO~. ............ t-T. TO ......... ~ ............... ~c~ ......... :-FT. To ............. ~T ........... I KOM ................... ; 7.10 ............... tT ............................ FROM ...................~1'. TO .................. I:1' .......................... EKO~ ...................FT. TO .............. ~T .................... FROM ............. FT. 10 ............ FT ...................... fROM ................. I-T. TO .............. FT ....................... FROM .................. FT. 1'0 ...............ST. ..................... i RO~ ................. FT. TO ............. FT. ................... tROM ............... FT. TO ........... ..FT. ................. ~'-': FRO~ ............ FT. To .......... rr ............... .,, FR(~! ........ Ff. lO. FT ............. % It is reco~nded tha: the pur~ I~ set at no more than ten (10} gallons per minute, Well 'Owner Hyru= Austin ~Ise 6f Well Location (address of: Township, Range, Section, 1f known; or .distance main Siz~ of casing 6 Depth bf HoI- Static water level 85 ~t. (aVb"oWe) 'Screer~ (. ); Perforated ( 175 ~eet Cased to 171 feet (below) land ~urface. Finish of well (c~e~.k' one! oP.e.n.ena f Eofcel de.~cr~ption'en ]~og -. Describe screen or perforation Well pumping test at .7 'gallons per (~) .(m~ute) for 1 .hours wi~ ' 20 of drawdown from static l~vel. Date of completion .o Ilov ?$ WElL LOG Depth in feet from ~round surface Give details of formations penetrated, size of material, color and hardness 0 .TO' I~' C~!,¥!e ~r?vel w~t.h ~¢~i~one) tcu!der£ X'); · ft. _~Q TO -xO Si~ '., C1 c? f0 TO 7~ '£!!'_y ~:r':e! 7_=. TO !IOTO l 1 _~, ll~TO 15~TO .TO TO TO TO TO :f~,..me ~ ','.'esttl/rg ~ :-- CUsToM~-~ [~-~c-uu ~:z~ FI~OU-CTE EIWIRO~t.~TAL 5615~0' ~ T-844 P.eS/03 F-32T CT&E Environmental Services Inc. Laboratory Divigion Drinking Water Analysis Repo~ for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM ID# y., PRIVATE WATER SYSTEM Sen3 Resull$ SAMPLE DATE: SAMPLE TYPE: /~Routino Repeat Sample (refer to lab no. Special Purpose Location Collected from: 200 W. Po'aer Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: i997) 561-5301 TO,/E COMPLETED BY LABORATORY A~SJS ShOws this Wate¢ SAMPLE to Lab Ret No Time Received: Analysis Began; Analytical Mezhod; Sample tee Ion~ ~n Iran$~t. Sample Should not be over ,.~ Wn,'s c~cl for a'~a!y$is I~ {ndica~ mlia~ e resu;ts. Please se~O a new sampte v.a s~ec~a[ ~eWe~ m~. ' M~,'O-MUO Sent to ADEL:: ANC FBK JUN Date; Time: :-' Treated Water ,~X/~UntreatedWater Client notified of unsatisfactory results: Time CoUec[e(~ Collected: by linitial): Date Time: MMO-MUG Result: Membrane Fdter: Verification: LTB Fecal Coliform Confirmation: Final Membrane Fll~,~sults~.~ BACTERIOLOGICAL WATER ANAYSIS RECORI~ ' Total Coliform E. Coli. D~rect Count ~ ColonlesllOOrnl COLIFORM Fam ColitormllOOml ~S~ Member et tire SOS Group ~,Soc,6te Genre ale de S,~r.~eillencei ~T~. CT&E Environmental Services Inc. 02/03 F-32T Client I'Ot,~ Pre-Paid Coli~JNO3 Prhl.'ed l)atr,"i llllr ! lt21 i2{100 16:56 Colle r :etl [}~ let~'lnle H/I 6/2000 14:30 R~elved Dare.line I './I fii2000 'I uM ',. uh U.769 0.500 m§.'L EPA 300.0 ¢o],'lOOmL SMlg 9222B Limits Date ~. JllJl 10 ma:t 11il6/00 SCL 11116'110 JDT Municipality of Anchorage Page i of r~~)'-' 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 N.me: ~ U.~'Ft h~ ~q ~Cd~ Wastewater System: ~ New ~'Upgrade Address: ~ q 0 ~ )~5/~p¢¢Di~ ABSORPTION FIELD Phone: [No. of B~*oms: D Deep Trench Q Shallow Trench ~Bed ~Mound ~ther_ LEGAL DESCRI PTIO N sos Rating: To,el Depth from original grade: GPD/Sq. Ft. Block: Subd'vision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Ran~ ~ Section: , Fill added above original grade: Gravel length: WELL: ~ New ~ Upgrade Graveldepth: Ft. Number of lines: Dislancebetweenl[nes:Ft. Classification (Private, A,B.C): Total Depth: Cased To: ~otal absorption area: Pipe material: Driller: Date Drilled: Static Water Level: ~nstaller:~/ ~ Date installed: SEPARATION DISTANCES ~sop~*o n Holding ~ S.T.E.P. TO Sap[it Absorption Lift Holding =ubllc/Priwte M~nufacturer: Capacity in gallons: Material: ~ i~.X~ N~mber of Comp~ments: Sur[ace w~te~ ~C~o t LIFT STATION Lot -~- Size in gallons: J Manufacturer: Line I Foundation ~. ~- "Pump °n" level at: [ "Pump ~f'" level at: ]High water alarm at:-- Curtai'Draia ~/~ PumpMake&M°Oel IElectricallnspectionsperformeOb,: Remarks: BENCH MA~K Location and Description: ENG .NEEWS~SEA~ Inspections performed by: x~ ( Dates: lst' e~ ~j,~ ~"d'>~';":~;:l) ~}~4~.~-<¢-{~['n ,,', ........... Department of Hea~and ~luman Sergices approval ~ .... ~ " ReviewedanOapprovedby:~~~ ~ate J~'~'~J %~'~'... ....... 72-013 (1/91) MOA 25 Permi~ No. ~1 LO '~r~") Page ~ of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES BIVlSION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ." ENGINEER'S SEAL 72-013 A (2/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910327 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:AUSTIN HYRUM & MARLENE A OWNER ADDRESS:4901 DEARMOUN RD ANCHORAGE, AK 99516 DATE ISSUED:10/ll/91 EXPIRATION DATE:10/ll/92 PARCEL ID:01809251 LEGAL DESCRIPTION: W-A LT 1 SEC 27, T12N, R3W, SM LOT SIZE: 45962 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: VERIFY SEPARATION~NCE TO WELLS. RECEIVED BY: ~ ~ <.~,~ ISSUED BY: DATE: DATE: ~,~ JR ANCHORAGE AREA BOR DErARTMENT OF ENVIRONMENTAL QUI.~LL. 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: D~STANCE FROM WELL_ :.~.,~.:~:.~.,~:~.n MAIERIAL LIQUID CAPACIIY_ /,,~.- ~)~'2 __GALLONS. NUMBER OF .. ~,~,~z?<~ ,~= LIQUID INSIDE LENGTH .--%__INSIDE WIDTI4 SEEPA©E SYSTEM: SEEPAGE PIT: NUMBER OF PiTS / OUTSIDE DIAMETER "~- OR WIDTH '/"~* / , LENGTH ,,.L~ DEPfFl~g': / LINING MAIERIAL ~' ~' ~,'~j/~7~z~ _. DISTANCE FROM WELL/~7~'~ , BUILDING FOUNDATION~' NeARESt LOT LINE_~.~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: D,STANCE PROM WELL___ NUMBE, -- DISTANCE B,TW EN .NEB_ ABSORPTION AREA____. ~'x~_ NEAREST I.OT LINE fRENCH WID-TH~' SQ, FT. LENGTH OF EACH LINE_ TOTAL LENGTH , OF LINES '--.-~N. TOTAL EFFECTIVE DEPTH: fOP OF TILE fO FINISH GRADE__ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: LOT LINE ~ DISTANCE FROM ,~.~ WATER ,BUILDING FOUNDATION ......... SAMPLE "~-- NEAREST SEPTIC SEEPAGE OTFIER , TANK ~ , SYSTEM_.~_/~-- , CESSPOOL '.~'~ ., SOURCES .... DISTANCES: DIAGRAM OF SYSTEM DATE INSTALLATION OF: SEPTIC TANK GRF,-~IER ANCHORAGE AREA ~',.--,,["~OUGH DEPARTMENT OF ENVIRONMENTAL DUALITY 3.~00 TUDOR ROAD POUCH 6.650 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ~EEPAGE PIT - /Y TO B~ INSTALLE~ By PERMIT NO NOTE; THIS, ~PERMIT IS NOT VALID WITHOUT ~OIL FINAL IN~P~:GTIONI ~,4 HOUR NOTICe' RI~QUIRED. BACKFILLING OF ANY .SY~TFM WITHOUT FINAL IN~P~GTION ~3Y TH~ FOUNDATION TO SEEPAGE PIT .... ~ .... DRAIN FIELD DRAIN FIELD DIAGRAM OF ~YSTEM Municipality of Anchorage Development Services Department : ' · Building Safety Division.. · . - On-Site Water and Wastewater Program . '.. '" 4700 South Bragaw St. . ' P.O. Box 196650 Anchorage. AK 99519-6650 ". www.ci.anchorage.ak.us - ... ' (907) 343-7904 CERTIFICATE OF. HEALTH AUTHORI.TY APPROVAL SINGLE FAMILY DWELLING FoRA ' ..... "~ ' ' Expiration Date: 1. GENERAL INFORMATION Con~p[ei~"16g'~l description Location (si{e address or di?ections) Cu~ent Prope~ o~ner(s)' .Day phone ....... Lending agency address .~- ' "" ?; 2 ~,Ma~hng'.Address B~ ~ ~ ~ ~ ....... ..... ,,~Un/ess other/se requested, H~ w~ll be held by DSD for p~ckup, .. ' 2?:hU~ER OF'BEDROOMS: '-'3;~ ~PE OF WATER SUPPLY: ~PE OF WAST~ATER DISPOSAL: "'" _ Individual Well Individual Water Storage . Community Class Well Public Water System Day phone [~ Ir~lividu.~l Holding tank" Community On-site [~ [] 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 5 by an independent professional civil engineer registered in the State of AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between ~pouses) for prope~es 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 sample results less than 30 days old. (Certificates may be reissued for a period of up t9 one year with valid water samples.) Certificates are valid for one year for properties ~s6rved by Class A or B wells or a public water system. The Municipality of Anchorage is not respons~le for errors or omissions In the professional eng{neer's work. 4. STATEMENT OF INSPEC'~I(~N BY ENGINEER As ce~fied 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 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 t 0[~4 ..... (~pv¢~'-[~.~-.-- --~" ':'_, . . Phon~ -'~-'l~-~,~/If,=. Address ~.o~ I,,~ I ~-/-,~ Engineer's Printed Name .'~J~t~.~4 ~pu(l.4.[~..,,~ i - - -_ .. . . . .~, · ·~: ..... r,.,~ .~..,,.. ;:[~ ENGI~IEER S ., ,. .... ..... -.. ~ ~ A,~,~roved for -~, bedrooms. . - · · .... :--;-- Disapproved. ................. : ~;;.-.- .....2 Conditional approv'~l f~i: ..... · ---bedrooms; with the following stipul~ti~: Additional Comments Attachments: HAA Checklist Septic System Advisory · Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: ol M-nicipality of Anchorage Development Sen/ices Department BuDding Safety DIvision On-Sita Water & Wastewatar Program 4700 South Bragaw St. P.O: Box 196650 Am:ha-age, AK 99519-6650 wv~v/.cLanchorage.ak.us (9O7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Parcel WELL DATA we, ~e" R, Date completed I~/~ Tota~depth 17.5 fi. If A, B, or C provide PWSID .. san~a~ s~ fi/N) Cased ~o I?,~1 ft. Well Log (Y/N) y W~= p=pe~ protected (Y/N) ~ Casing height (above ground) ~O in. Date of test Static water level Well production FROM WELL LOG AT INSPECTION 7' g.p.m. --~ O.p,m. WATER SAMPLE RESULTS: Coliform ~) colonias/100 mi. Date of sample: "/Il 7~ i o I Collected by: Other bacteria colonies/100 mi. B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ ~ L~. ~--(. Tank size ~ gal. Number of Compartments Foundation cteanout (Y/N) 7 Det~ofpUmPtog t'~lt~, ~ <~o Cleanouts (Y/N) ~ Depression over tank (Y/N) ~,~ High water alarm (Y/N) Pumper ~ ABSORPTION FIELD DATA Datelnstalle~ II/llJ,~ Sollratino (g.p.d./ft~ol~)ILl Systemtyp. ' Length ~ Width I t.~ ft. Gravel below pipe O, ~ ft. Total depth 4/-o'-fl. Depression over field Date of adequacy test For ,,~ bedrooms Fluid depth in absorption field before test ~in. Water added v/' gal. New depth ~ in. Elapsed Time: L//min. Final fluid depth i~ in. Absorption rate >= ~" g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) / Eft. absorption area ~ ft= Monitoring tube If yes, give date De LIFT STATION Date installed 'Pump on" level at ~.,S in. Datum L~.~..~ Size in gallons t ~, ~ 'Pump off' level at ~/Vt. in. Cycles tested Manhole/Access (Y/N) ~'/ ,, High water alarm level at //-~- ~/~.- in. Meets alarm & cimutt requirements? ~,~,e.E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lotej f~ t~,~4' ~/~/~lon adjacent lots Absorption field on lot I O 5, Public sewer main 1,4//~, Sewer/septic service line '7.~ '~ On adjacent lots Public sewer manhole/ctaanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ 2. Absorption field ~ o Water main ~A '7 .~ lc Surface water I 617 Wells on adjacent lots /~'O '~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: property line · '~ Water service line Property line L D Building foundation Water Service line '7.~ 't' Surface water / ;.~ Curtain drain i'4~ o Wells on adjacent lots Water main D~veway, paddnghmhicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal recoils that the above systems ara/n conformance with MOA HAA guidelines in effect on this date. Date ~ I HAA Fee $ ~ ~ Date of Payment '"'/~.~-L Receipt Number 7 7,~--~ (Rev. 12~)0) Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL. FOR A SINGLE FAMILY DWELLING 018- ,C3°1~- ,~\ HAA# 1. GENERAL INFORMATION Complete legal description Lot 1~ W-A Subdivision Location (site address or directions) 4901 East 140th Anchorage~ AK Property owner Mailing address Hyr'um Aust in Day phone 344-2915 P.O; Box 110489~ Anchor'age, Alaska 99511 Lending agency NA Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. SI'ATEMENT OF INSP,-CTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that tl:e on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm Gilfilian Engineering~ Inc, Phone 277-2021 Address 255 E. Firewe.~d~_an.e, Suite 102 , Anchoraqe, AK 99503 GEl 93109 DHHS SIGNATURE .X' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~-t.¢,_.,,.~_. ~-¢.~o~ ¢ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AIJTHORITY APPROVAL CHECKLIST Legal Description: Lot 1~ W-A Subdivi si on Parcel I.D. 018-09-251 A. Well Data Well type Private Log present (Y/N) Y Total depth 17,5 f t. Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed 11/9/72 Driller M-W D~-i I I lng Date of test Static water level 85 f t. Well flow 7 Pump level1 Unknov, n Cased to 171 ft. Casing height Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION 11/9/?2 9/7/93 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100 + f t. Absorption field on lot 100 + f t. Public sewer main NA Sewer service line 12,5 + g.p,m, 22 in, 88 ' 4" 7.5 g.p.m. Unknown Z ; On adjacent lots 100 + f t. ; On adjacent lots 100 + ft. Public sewer manhole/cleanout NA Petroleum tank 25 + WATER SAMPLE RESULTS: Coliform __.~/~ Date of sample: 9/7/93 Nitrate ~). ~ ~./Z. Other bacteria Collected by: K, Sheet B. SEPTIC/HOLDING TANK DATA Date installed 10/12/91 Tank size 1250 Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) N Alarm tested (Y/N) N Date of pumping NA Pumper NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ']'O: Well(s) on lot 100 + To property line 10 + Surface water/drainage f t. On adjacent lots f t .Absorption field 100 + ft, 100 + f t. Foundation 25 f t. 15 f t. Water main/service line 50 + f t. 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at On adjacent lots Meets MOA electrical cedes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed 7/3/72 20 ft. Length Total absorption area Date of adequacy test Water level in absorption field before test 1 ?' Peroxide treatment (past 12 months) (Y/N) N Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Width 4:~0 sq. f t .Cleanout present (Y/N) 9/8/93 Results (pass/fail) .Soil rating (GPD/FF) Unl<no__~ System type Log ccib (0,o/ 15 f t. Gravel thickness'''''M~v~ Total depth Y Depression over field (Y/N) N Pass for 4 Bedrooms After test 26 . If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100 + f t. On adjacent lots 100 + f t. Property line To building foundation 25 + f t. To existing or abandoned system on lot On adjacent lots 1 O0 + f t. Cutbank NA Water main/service line Surface water 1 O0 + f t. Driveway, parking/vehicle storage area Curtain drain NA E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Engineers Name Rd}er' E. Gi~'i lan, .E. Date 9/9/93 Waiver Fee $ Date of Payment Receipt Number GEl 93109 HAA Fee $ ¢~)~/'~ · Date of Payment Receipt Number ~"~"~,~,.~ 72-026 (3/93)* Back 20 + ft. None 50 + ft. 30 + ft. Well Owner. Location M-W 'DRILLING, In¢, P. O. Box 4-1728 'e 2811 Dawson' A C 907-279-1741 ANCHORAGE, ALASKA 99509 DRILLING LOG Hyrum Austin Use of Well address of: Township, Range, Section, if known; or distance main road zz S.R. "A" DeArmoun Rd.~ ~ox Size of casing 6 .Depth Of Hole Static water level 89 ft. (a~e) Screen ( ); Perforated ( 17~ feet Cased to 171 feet Describe screen or perforation Well pumping test at ? gallons per of drawdown from static level. (below) land surface. Finish of well (check one) open end ). Nof~e: description on log (minute) for 1 hours with 20 Date of completion__? Nov 72 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness x ); _ft. 0 TO _ 17_TO ~5_TO ~_TO 60 TO 75 TO ll0TO ll~TO 16~ TO TO TO~ TO~ TO_ TO~ TO_ 11~5 ~'~,,~-.~ 2re~wS, th.~sio!jal boulders ' 1 ~', SilYy Saud _ Si!t/ .qrevel: co, reef: ;.l?,terl~earin~ ~13 l~at 10 !d Mills Knife perforations (1}"x]:") from !~E to i6C ft. 1 -- CUSTOMER Gilffiian Engineering, Inc. 1800 E. Parks Hwy., Suite D-100 Wasilla, Alaska 99654 ADEQUACY TEST FORM Location: Lot 1, W-A Subdivision Date: 9/7/93 Inspector: Kent Sheets Septic Tank Size: 1250 Type of S.A.S: Log Crib Project No: 93109 No. of Bedrooms: 4 No. of Bathrooms: 3 Calc. Peak Load*: 300 Calc. Peak Time*: 33.3 Calc. Peak Flow Rate: 9 Meas. Ave. Flow Rate: 7.4 gpm 1215 6.7 -- 50" 1" 17" 1" Ran water into 1225 6.7 67 51" 18" S,L.C.O. 1240 7.5 179.5 51" 19" 1255 7.5 292 51" 21 -- 0" 3" 1315 7.5 442 51" 24" 0" 1" 1330 7.5 554.5 51" 25" 0" -- 1" 1340 7.5 629,5 51" 26" END FLOW 1415 35 min. Rebound 24" 1525 231/2'' 85 7.4 629.5 min totals gal * Peak Load = 75 gallons x (# of bedrooms) · · Peak Time = 25 minutes x (# of bedrooms + # bathrooms) 93109.ADQ KS 116 Gilfilian Eegineering, Inc. 1800 E. Parks Hwy., Suite D-100 Wasilla, Alaska 99654 WEI. L FLOW TEST DATA SHEET From: Well Log X Probing Measurements ADEC Records Well Depth: 175' X Static Level: 88' 4" ® Physical / Sanitary Features: Sanitary Seal ~ / Cap Casing Above Ground Surface: Pump Wire in Conduit __~ Surface Drainage Away from Well: Good ~ Poor 22" Well Pump Specs: Water Supply Line: Size: Type:. Drop Pipe: Size: Type:. Depth to Pitless Adapter: Storage / Pressure Tanks: Time Time Interval Pumping Cumm. Static Comments IViinutes Rate (gpm) Gal. Level 1135 -- 8.5 -- 88'4" 1205 30 8.5 255 138' 5" 1230 25 6.7 422,5 140' 6Yz" 1250 20 7.5 572,5 139' 4" 1320 30 7.5 797,5 139' 6Y2" 1335 15 7.5 910 139' 4" Minutes Average = Gallons /,si 120 TOTALS 7.5 910 51' Time Time Interval Static /,r Comments IViinutes Level 1410 35 95' LOCATION: Lot 1, W-A Subdivision CLIENT: Hyrum Austin PROJECT NO: DATE: 9/7/93 BY: Kent Sheets 93109 WELLFLOW,GEI MAT.-SU 'rEST LAB, INC. Soils - Concrete - Water Field and Laboratory Testing Services 1800 East Parks Highway, Suite D-100, Wasil[a, Alaska 99654 Phone (907) 376-3005 Fax (907) 373-5686 CLIENT: Gilfilian Engineerin.q, Inc. DATE: 9/9/93 ADDRESS: 255E. Fireweed, //102 Anchorage, AK 99503 PHONE# 277-2021 ACCOUNT//: 001 TEST(s): Nitrate COST OF TEST(s):. 822.00 TAX: N/A TOTAL: $22.00 PAYMENT: CHECK // CASH REFERENCE NO: 393119 LEGAL/PROJECT NAME: Lot 1, W-A Subdivision GEl //93109 PRIVATE: ¢' PUBLIC (LIST STATE ID NO.): DATE RECEIVED: 9/7/93 TIME RECEIVED: 1700 DATE SAMPLED: 9/7/93 TIME SAMPLED: 1345 SAMPLED BY GEl/Sheets Analysis Performed: Level Detected MCL Nitrate 0.9 mg/I 10 mg/I mg/I = milligrams per liter ND = none detected MCL = maximum contaminant level NOTF: This analysis was performed by: Mat-Su Test Lab, Inc. If you have any quest(ons concerning the above results, please call me at 376-3005. Cheryl Fultz, Wate age Date " T:;SU'::TEST LAB, INC,.. Soils - Concrete - Water IZield and Laboratory T~tlng Services DRINKING 1800 East Parks Iiighway, Suite D-100, Wasilla, Alaska 99654 Phone (907) 376-3005 Fax (907) 373-5686 WATER ANALYSIS FOR TOTAL GOLIFORM BACTERIA Mailing A, ddress: Phone: PWSlb No: Sample Information Legal Description of Property:__ ~'~ / ~/'~ ~-', Date Collected ~'i-?"q ~ _ Time Collectod: /3 Y~- Collected By: ~' Sample Type: 7>*,/Routine ___Repeat Sample # __Treated Untreated Fecal REFER TO BACK SIDE FOR INSTRUCTIONS