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HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 40Onsite File � � •.y � '° 1, � Y Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191299 PID Number: 011-135-13 Dwelling: 9 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 0 Upgrade Name: Bradley Cunningham ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑t Bed ❑ Mound Address 5411 W. 82nd Avenue Anchorage, AK 99502 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 242-9103 3 0.8 GPD/SF 6.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.2 Ft. Gravel depth beneath pipe 0.6 Ft. Subdivision Block Lot Sand Lake #2 4 40 Fill added above original grade 0.0 Ft. Gravel length 29 Ft. Township Range Section Gravel width 20 Ft. Beds: Number of Lines 4 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 580 FtZ Ft. Well >100' 71' N/A N/A >25' . TANK Fn] Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Tank Capacity 1000 Gal. Surface Water >100' >100' N/A N/A Material Number of compartments Lot Line >5' 3.5' N/A N/A Plastic 2 NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Bed is located 71from well on lot 38 to Pump on level at in. Pump off level at in. High water alarm at in. the South. Bed is >100' from all other wells. Waiver # OSV191056. Tank Serial # 2891 Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank drainfield D3034 Installer Norther Excavation Drainfield D3034 CO/MT Inspector J. Mlllette / J. Williams BENCH MARK (Assumed elevation) 100 ft Inspdection 15' 8/8/19 8/17/19 Location and description 2 n 3`° 4th East lower level door threshold. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ®®®�E DF 44 41® ®�P.••°"'.... � '°••:9S ®® Conditional Approval: Date ® r :° 1 • . 49th W a s �........ ...... . .... 4 ....... e(}�Yj •.°•(x)•..5.....5 00 5 ........................................ ... ��n -.MICHAEL E. ANDERSON e � = �°; NO. CE -4381 �® �F,A°••.° 11/14/19 .••°°•Cc��® Approved Date 6100 6 e� rJ%PRO ES®;®®�®oma® IL inspection mepori_y-i-it.aoc August 11, 2017 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Sand Lake #2, Block 4, Lot 40— 5411 W. 82nd Separation Distance Waiver Septic Tank and Absorption Trench to Lot Line Dear On Site Services Engineer: The subject lot is only 50' wide and surrounded by wells. The septic system has now failed and must be replaced. Very little area is available for the upgrade. The new absorption bed will be placed 3.5' from the south property line. Soil conditions on this lot are composed of clean sand with silt with percolation rates less than 5 minutes per inch. Very little migration of effluent is anticipated. The septic system on the adjacent lot to the north is more than 50' from the common lot line. The south lot line abuts West 82°d Avenue. Placement of the septic system at the location mentioned will not adversely affect neighboring lots. We therefore request a waiver be issued allowing the septic system to be constructed as shown on the Site Plan. Sincerely, Michael E. Anderson, P.E. pnAr m1 I\O :? 'gym ®00TH 9/25/19 , ``®` 0,® �4�sa®®®a ®®®•e // // 100500 FEET 1"=50' 29' LONG x 20' WIDE x 0.5 ABSORPTION BED 3-BDRM HOME CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP191299 PID # 011-135-13 SAND LAKE #2, BLOCK 4 LOT 40 A B FCO 3.9 MH 17.3 SV 22.0 A B 2CO 23.6 MT1 16.9 MT2 33.4 CO1 47.3 20.7 26.4 29.7 30.5 17.9 33.5 30.4 1/15/20 SHED WOODEN FENCE EXISTING WELL WEST 82nd AVENUE SEACLIFF STREETEXISTING DECK REMOVED FOR SEPTIC INSTALLATION. NEW DECK WILL BE LESS THAN 30" ABOVE GRADE. NEW 1,000 GALLON PLASTIC SEPTIC TANK w/20" MANWAY CO2MT1 2CO SVMH 1%1%1%EXISTING WELL EXISTING WELL TEST HOLE FROM MOA FILE. 100' WELL RADIUS CO1MT4 MT3 MT2 ALTERNATE SITE: CATEGORY III SYSTEM w/5' WIDE x 10' LONG x 3' EFF. DEPTH ABSORPTION TRENCH. APP. RATE 6 GPD.SF. TH1 CO4CO3FCO CO2 44.3 CO3 41.4 CO4 39.6 MT3 48.4 MT4 41.9 26.1 21.6 18.4 32.7 19.3 PLAN AS-BUILT 71' WELL RADIUS WAIVER # OSV191056 100' WELL RADIUS NOTE: CLEANOUTS ARE PROVIDED AT THE END OF EACH DISTRIBUTION LINE IN THE BED TO MEET THE INTENT OF THE CODE. LINES CAN BE CLEANED FROM THE SOUTH END TOWARD THE SEPTIC TANK. MONITOR TUBES ARE PROVIDED AT EACH CORNER OF THE BED TO DELINEATE THE LOCATION. 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: OSP191299 Work Type: Septic Upgrade Tax Code Number: 01113513000 Site Legal Address: SAND LAKE #2 BLK 4 LT 40 G:2224 Site Mailing Address: 8148 SEACLIFF ST, Anchorage Owner: CUNNINGHAM BRADLEY S & NIK Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: elll CN e v. 1')epau•till ent 7/29/2019 7/28/2020 6750 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: l J. A percolation test shall be completed prior to construction to verify the percolation rate and associated application rate used to size the drainfield. If results require a design change, construction shall stop pending On-site review and approval of a change order. Please submit results with the inspection report (or change jorder, if required). 2. The well radii for Sand Lake #2 Block 4 Lot 38 (to the south) and Sand Lake #2 Block 3 Lot 11 &12 (to the east) shall be flagged prior to construction to ensure construction stays outside the 100 ft well radii. On the record drawing, the alternate drainfield shall be shown at least 20 ft from the primary drainfield. —see ��;e� oSV1ita5io• Ccs# � g/�� 1 �� � rno��. �. ��► -� � W �� �. � CO Z (8l 13' 1 �� �,u i 5 e dx d eU-+0 0se S D I S. Received By: I I Date: Issued By:61)7_zoR (�_edlvzlylw Date: 7,429/0 2 ! 3 Municipality of Anchorage] P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section x x x x VARIANCE/WAIVER REVIEW x x* x Waiver#: OSV191056 COSA#: Permit#:OSP191299 PID#: 011-135-13 Legal Description: Sand Lake #2 Block 4 Lot 40 Engineer: Forge Engineering Applicant: Bradley Cunningham Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well on Sand Lake 92 Block 4 Lot 38 has been approved. The approved separation distance is 71.0 feet. Your request for a waives- of the required 10 feet horizontal separation from the absorption field to the south property line hase been approved. The approved separation distance is feet. Your request for a waiver of the required 20 feet horizontal separation 3h 5 I,t between the proposed and. existing absorption fields has been approved. The approved �4 ACU separation distance is 5.0 feet. See engineer's waiver requests for justifications. ilf(311q This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ r ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1 Waiver is Granted: X Waiver is not Granted: Date: S�13 h el Approved by: I Name of Reviewer ■ ■ r ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ It ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ I **** VARIAN C EIWAIVE R REVIEW **** MUNICIPALITY OF ANCHORAGE 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. 011-135-13 Property owner(s) Bradley Cunningham Mailing address 5411 W. 82nd Avenue Anchorage, AK 99502 Site address Same Day phone 242-9103 Legal description (Sub'd., Block & Lot) Sand Lake #2, Block 4, Lot 40 Legal description (Township, Range & Section) Lot Size 6,750 Sq. Ft. Number of Bedrooms Three (3) 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 ❑X Upgrade 0 Duplex ElHolding (D) Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: d 4-0 , CoDistance: 7 1 5- 5 I certify that the above information is correct. I further erti tha this is in accordance with — �z applicable Municipal Codes. -- 'k a ai� (Signature of property owner or authorized agent) Permit/Rush Fees: 4!;q. /,. oo Waiver Fees: #_ ? � . 00q + � Q155 Date of Payment: 07 I S !) Date of Payment: �� �.S l 1 �5/1 �( Receipt Number: 240 —1 Receipt Number: 2_062,j 0� 2 O(ob Permit No. 0 Sp 1 q (Zqq Waiver No. x Viq 1 OS4 Permit App_-'- : .'-.,:c August 11, 2019 MOA Development Services Department of On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sand Lake #2, Block 4, Lot 40 — 5411 W. 82" Avenue Septic System Design Dear On -Site Services Engineer: The septic system on the subject lot has failed and must be replaced. We are submitting this permit application for the construction of a new septic tank and absorption bed. The existing septic tank will be decommissioned in accordance with Municipal Code and the absorption trench will be abandoned in place. The new absorption bed will be constructed less than 100' from the private well to the south. A waiver request to allow placement of the trench at this location is attached. In addition, the bed will be 20' wide as opposed to the required 15' width. The additional width is necessary due to the limited amount of space available on the lot. Well drained sandy soils with absorption rates under 5 minutes per inch are found on the lot. The 20' width of the bed will effectively treat and dispose of the septic effluent. We therefore request the bed width be 20'. The alternate site for the septic system will be a Category III System which allows a 50' protective well radius. Sufficient surface area is available in the front of the lot once the 50' radius is applied. The ground surface on the lot is flat in the area of the proposed bed. There are no slopes greater than 25% within 50 feet down slope of the bed. Drainage arrows are shown on the site plan indicating the grade and direction of flow. Storm water drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. A percolation test will be performed to verify the consistency and absorbency of the underlying soils. If the percolation is slower than the assumed 5 minutes per inch a redesign will be required. Test holes from surrounding lots completed to 19' below the surface verify the lack of an impervious layer within 6' of the bottom of the proposed trench. The new system will be a minimum of 100' from surface water, 10' from any water service and more than 5' away from the septic tank. Pleas refer mthe attached test hole log and plan and profile sheets for the septic design. Ithis design 6 followed, there will be no adverseimpa G to a$ a e tplop rte. � Sincerely, n p ( OF 1, 41P .. . /© 49 m ©% Michael £.Anderson, «£ 77 . .. —7 && &c9c E. ANDERSONƒ } CE -4381 . _ ££®$w &I»R:`' % lit % S� August 11, 2019 MOA Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sand Lake #2, Block 4, Lot 40 — 5411 W. 82°d Avenue Well to Absorption Trench Waiver Dear On -Site Services Engineer: Very little surface area is available on this lot for a septic system upgrade. The lot is only 50' in width and 135' long. It is surrounded by wells on nearly every side. We have located an area to place the septic tank outside the 100' well radii, but the absorption trench is only 71' from the well on Lot 38, Block 4, Sand Lake No. 2 Subdivision. A waiver is therefore required before the absorption trench can be constructed at this location. The well on Lot 38 was originally constructed in 1982. It is 312' deep with a measured static water level of 159'. Water samples taken from the well and water system over the years revealed very little nitrate concentration in the water and no presence of coliform. The well is obviously not contaminated from any septic system in the area. The proposed absorption trench is located down slope from the existing well and any effluent that might surface from the trench would flow away from the well. The surface grade is approximately 5% away from the well. Surface effluent contamination of the well is virtually impossible. Underlying soils on the lot are primarily sand with varying amounts of silt based on test holes completed in the past. Absorption rates are typically under 5 minutes per inch. The highest water table in the area appears to be nearly 150' below the surface. Based on all of the aforementioned characteristics and the water quality from the well it is unlikely that contamination from the absorption will occur. ADEC POINT ANALYSIS Bottom of Absorption Trench to Highest Water Table — 130' 7.1 Points Soil Absorption Type — Sand with Silt 2.5 Points Permeability — Fine Sand 1.5 Points Water Table Gradient - +5% Horizontal Separation — 71' TOTAL POINTS 4.5 Points 1.8 Points 17.4 Almost sure to be free from any form of contamination from household sewage. Sincerely, Michael E. Anderson; P.E. ��� °R44RRq RR.Rt gvR1 eq'�J (� 49th p' MICHAEL E. ANDERSON g 4 CE-C38i ������ C0*Z_ August 11, 2019 MOA Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Sand Lake #2, Block 4, Lot 40 — 5411 W. 82nd Avenue Absorption Trench to Absorption Bed Waiver Dear On -Site Services Engineer: Very little surface area is available on this lot for a septic system upgrade. The lot is only 50' in width and 135' long. It is surrounded by wells on nearly every side. We have located an area to place the septic tank outside the 100' well radii; but the absorption bed is only 5' from the existing absorption trench on the lot. A waiver is therefore required since we can't meet the 20' or twice the effective depth of the absorption trench requirement. Underlying soils on the lot are primarily sand with varying amounts of silt based on test holes completed in the past. Absorption rates are typically under 5 minutes per inch. Very little horizontal migration of effluent is expected and absorption should be in a downward direction. Initial excavation on the lot indicates very little migration from the existing absorption trench has occurred. We request a waiver be issued allowing the proposed and alternate absorption trenches to remain at the location shown. Sincerely, Michael E. Anderson, P.E. OF ;•° 49th �. k` MICHAEL E. ANDERSON - i 'h°° NO. CE -4381 ,s°=gr �Fp °•.,,,8.11-19 °°°��,0 F........ ° N EZS\ �� August 11, 2017 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Sand Lake 92, Block 4, Lot 40— 5411 W. 82nd Separation Distance Waiver Septic Tank and Absorption Trench to Lot Line Dear On Site Services Engineer: The subject lot is only 50' wide and surrounded by wells. The septic system has now failed and must be replaced. Very little area is available for the upgrade. The new septic tank will be placed 6' from the north property line and the absorption bed will be placed 5' from the south property line. Soil conditions on this lot are composed of clean sand with silt with percolation rates less than 5 minutes per inch. Very little migration of effluent is anticipated. The septic system on the adjacent lot to the north is more than 50' from the common lot line. The south lot line abuts West 82111 Avenue. Placement of the septic system at the locations mentioned will not adversely affect neighboring lots. We therefore request a waiver be issued allowing the septic system to be constructed as shown on the Site Plan. Sincerely, Michael E. Anderson, P.E. 100' WELL RADIUS NEW 1,000 GALLON SEPT TANK w/20" MANWAY\ - ' DECOMMISSION EXISTING SEPTIC TANK 1 { EXISTING WELL PER MOA CODE. LOT 12 LOT 41 I• 1 ------ " WOODEN FENCE SHELOT 40 3-BDRM HOMYE"T� \ LOT 13 ALTERNT€ SITE: CATEGORY ill SYSTEM w/5' / WIDE x 20' LONG x .5' EFF. DEPTH / ABSORPTION T'CH. APP. RATE 5 GPD.SF WEST 82nd{AVENUE { 100' WELL RADII MICHAEL E. ANDERSON No. CE -4381 fF Bit3/19 ° OZ Ot ESS't. I LOT 38 EXISTING WELL / EXISTING WELL / I � \ Lij \® f1 I W LOT 11 \ : J \ LOT 12 \ Q BLOCK 3 LIJ M LONG x 20' NIDE x 0.5 \ ABSaP�Q_TION BE\D TEST LE FROM MOA FIL�y. COMP ETE-PERCOLATION TEST TO VERIFY ABSORRTIOL! RAt — REDEdIGN MAY BE REQUIRE. I I NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND PROPOSED SEPTIC SYSTEM CO - CLEANOUT ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO - DOUBLE CLEANOUT PROPERTY ARE SHOWN. FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE 0 50 100 MH - MANHOLE FEET MT - MONITORING TUBE SV - SEPTIC VENT 1"=50' TH - TEST HOLE F���l/����[`����' ����T�K8����Ul��NY�0Tc�' `^^_^'.��.".'``�.~^.``�. SYSTEM REQUIREMENTS: 450GPD PEAK FLOW SHALLOW BED SYSTEM PERK RATE: 1-5 MIN/IN 1.ODO-GALLDNSEPTIC TANK APPLICATION RATE: .8(SPD/8F 450 GPD /.8 GPD/SF / 20'WIDE = 28.13 LF TRENCH REQUIRED (29 LF SPECIFIED) BOTTOM DFBED: 7"BELDVVGRADE FLOW LINE ELEVATION: G.5'BELOVVGRADE TOP {}FBEO:.5'ABOVEGRADE 20' TYPICAL TRENCH SECTION NOTES: (NO SCALE) 1. GRADE AREA OVER TRENCH TODRAIN AWAY 2. PROVIDE 3'OFCOVER OVER TRENCHES AND 4'OVERSEPTIC TANK, OR2' WITH 2"OFINSULATION - 3. CHECK GROUNDWATER ATTIME DFCONSTRUCTION. |FLEVEL |SHIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY ES DOWN) SOILS SOILS LOG AND PERCOLATION TEST E N G N EE AI NG LEGAL DESCRIPTION: SAND LAKE #2, BLOCK 4, LOT 40 PERFORMED FOR: NICK CUNNINGHAM DATE: 8/8/19 PROJECT No.: PARCEL ID#: 0 11- 13 5 -13 TECHNICIAN: J. MILLETTE DEPTH TEST HOLE 1 (feet) 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS: •C CLEAN SAND SP/SW SLOPE WAS GROUND WATER ENCOUNTERED? NO IF YES a WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: - DATE OF MONITORING: - P E SITE PLAN SEE SITE PLAN 14 DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) 8/8 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 2:38 30 Sec. 6/0 6" 2 2:39 30 Sec. 6/0 6" 3 2:41 30 Sec. 6/0 6" 4 2:42 30 Sec. 6/0 611 5 2:43 30 Sec. 6/0 611 6 2:46 30 6/0 6" PERCOLATION RATE: <1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 6 FT. and 7 FT. OF A�q�;�p 49 TH* s-/" N SHANE A. HOLT.," LS -6914 1��1°fessional �Qo THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS• ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE• AS BUILT SURVEY I"=20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 40, BCOCK4, SAND CAKE NO. 2 SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT TH VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 17TH DAY OF JUNE , 2019 14273,197-51 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 907-345-5513 ,(E•NG,IVil 'S SEAL) Municipality of Anchorage �s } DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 P, vGa 1 Co viva u SOILS LOG - PERCOLATION TEST PERFORMED FOR: /�� �i/�/% E DATE PERF691MEDc� LEGAL DESCRIPTION: %_ Township, Range, Section: -56 1¢ A4�) Z4 S -11Z A/ t:,/ SLOPE SITE PLAN 2 / 3 Q 4- 5- 6- 7 567 8 o S MEMEMEMENEW 1IEM0I0- 0INNER SUNNI= FL 10 6 jJ/L -��-� WAS GROUND WATER ENCOUNTERED? y 11 s IF YES, AT WHAT L O � � <• DEPTH? p 12 E 17 .. .• 41, 18-- 18 E'Jp A1,4 Depth to Water After Monitoring? Date: e Reading Date Gross Net Depth to Net Time Time Water Drop • 20 { uPERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER / /' / TEST RUN BETWEEN FT AND FT 4� COMMENTS - SG,\r./ n 4J 1 PERFORMED BY: '��j e�� K�E'G.SS• I N'It f J • (-'�T-"1/A10E1TIFY THAT THIS EST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: i /� Z� 72-008 (Rev. 4/85) MEMEMEMENEW 1IEM0I0- 0INNER SUNNI= MENE MEMO e Reading Date Gross Net Depth to Net Time Time Water Drop • 20 { uPERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER / /' / TEST RUN BETWEEN FT AND FT 4� COMMENTS - SG,\r./ n 4J 1 PERFORMED BY: '��j e�� K�E'G.SS• I N'It f J • (-'�T-"1/A10E1TIFY THAT THIS EST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: i /� Z� 72-008 (Rev. 4/85) I ILIA T25e wr, v /o% /3 ZS I moo: yi y I O �Eys�'NG) IESrN . SYS7SM x•87 pJ, Eq moo- do � p�'TpIL /✓A7iyE 6Eo B �.7 Jio 0 6�-_-a eSt e ' �- Tesnlerl SyS75rt I I GlOR/G JO' La„_gA)(/O' DEprj4 Xz) K � :;SEWER: SYSTEM 1' LOCATION PLAN �------- - --- - -._._ - LOT BLOCK / ------ SUBDIVISIONS Z �r0y0 'y S.vOLA/YE 0 cl �''�a- •",,,: y� SECTION/TOWNSHIP/RANGE �I''4 . a . sVIA)1-17 A4 u a+ SCALE* ,, � NOTE - THE ACCURACY OF LOCATION OF EXISTING 9e g / s o ona. PROPERTY CORNERS, WELLS, AND SEPTIC f r / S - DRAWN BY, SYSTEMS INDICATED IS NOT EXACT. NORTH INDICATED HAVE BEEN g3 / u cr _ DETERMINED BY USE OF CLOTH TAPE AND Idn ee 41 C@,I Corwin o w6'® f ti _K ' _ NOT BY SURVEYING TECHNIQUES. of Ci; 283 ��® o Vis( ' >,z✓ z( s� .`>n/s iv _ PREPARED FOR, � 4�7 &;assadaies, iric�" rt�x - AN KJ_TE 14411E 1� ����� Consulfing Englr�eeCs y y< ' :£?:�:.:;3:^::>r:.::�.x�:.::%uidiaaCtFalMkey.%::g:�;.u•?�>"s:rx:£ �>£%! z DATE : SHEET OF { MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE (ANEW S' CUC.' !v',�d}-1�'`_�, (? �' ❑ UPGRADE MAILING ADDRESS a320 P is WAY ANC/46RA(SA- AK 99.6-9`7 LEGAL DESCRIPTION L0-1 40 ALOC-11 4 5' S' I'LL T/?-m Lf k/ S' C LOCATIONj t NO. OF BEDROOMS Id Q -sa C i i I" s•� 2 Well ! DISTANCE TO: Absorption arep 3i -- Dwelling t 6 PER IT NO. ' U Ne � i zz Manufacturer C_ Material ST6L'L. No. of co m rtments W F hi JRA r Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PEPN^'T "'^ zZ Manufacturer Material Q 2—H Liquid capacity in gallons D w= DISTANCE TO: Well I 1.� Foundation I" j,� Nearest lot line I.� PER IT NO. _ �_ J LL z No. of Ines Length of e ch line Total length of lines Trench idtry Distance bet een lines F Z w I inches FTop the to finish Material beneath of grade4'1 tile Total of cc iv,absorption a l dl Length Width Depth PERMIT NO. Lu t7 Q F Type of crib Crib diameter Crib depth Total effective absorption area wa y LU Well Building foundation Nearest lot line DISTANCE TO: JClassn�GLp Depth Driller Distance to lot line PERMIT NO. J !. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER C PIPE MATERIALS CA S-r 71KOAJ A N.0b3C)3 SOILTEST RATING I INSTALLERt A PPE 6X zd gj L REMARKS I SO LA f i-o�ti �A)S' LLEL�V Gue I-A1J A N 7-KE NI C H.l� nj No r_E i7" fo)2 E TR LUiD'T! 00 R 840SEU A4AIVAJ;t L-LL e xw a te Lt,c LL S6A .I F s APPROVED - DATE LEGAL dloasV-ox W S 2 UC T4-0 eL S L "2 -r)ZA) P.4w Sjo 72-013 (Rev. 3178) R �� ` ^ DEPHRTMENT� HEHLTH HND ENVIRONMENTHL �OTECTION � 825`STREET, HNCHORHGE, HK. 94�01 ��^� ` r7:- ` � PERMIT NO� DHTE ISSUED�04/2]/84 HPPLICHNT HDDRESS� CONTHCT PHONE LEGHL DESCRIP LOT SIZE: MHX BEDROOMS T&T CONST 2]20 DENNIS Ni HNCHORHGE/ HK 99517 ]45^2670 SUBDIVISION� SECTION� 10 2670 (SQ.FT 2 SHNDLHKE #2 LOT� 40 TONNSHIP� 12N RHNGE� 4N ORHCRES) LISTED BELOW HRE THE OPTIONS HyHILHBLE TO YOU IN DESIGNING SYSTEMCHOOSE THEOPTION THHT BEST FITS YOUR ... ..... ---- --- ..... SITE ������ L DEPTH TO PIpE BOTTOM (FT� ) 40 4.0 GRHVEL DEPTH /FT ) 100 05 TOTHL DEPTH (FT ) 14 0 45 GRHVEL WIDTH (FT. 15.0 GRHVEL LENGTH (FT ) 150 ]00 GRAVEL VOLUME I.J.(C 4.5 6 THNK SIZE (GHLS) 1/000.0 ** 1/000.0 ** SOrL RHTING (SQFT`/BR) 150 150 BLOCK: 4 YOUR SEPTIC ** THNK MUST HRVE J- ..... ..... ��... .... .... .... ..... ������������^���������� I CERTIFY THHT� 1 I HM FHMILIHR WITH THEREQUIREMENTS FOR ON-SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) HND THE STHTE OF HLHSKFi . I WILL�INSTHLL THE SYSTEM IN HCCORDHNCE WITH -ALL. MOH CODES AND RE6ULHTIONS, HND IN COMPLIHNCE WITH THE DESIGN CRITE�IH OF THIS PERMIT. I I WILL HDAERE TO HLL MOH HND ST H�E �F HLHSKH REQUIREMENTS FOR THE SET BHCK DISTHNCES FROM HNY EXISTING WELL/ NGSTEWHTER DISPOSHL SYSTEM OR PUBLIC SB4ERHGE SYSTEM ON THIS OR HNY HDJRCENT OR NEHRBY LOT. 4 I UNDERSTHND THHT THIS PERMIT IS VHLID FOR H MHXIMUM OF 2 BEDROOMS HND H@Y ENLRRGEMENT WILL REQUIRE HN PERMIT. IF � LIF� STHTION IS INSTHLLED IN HN HRE�i COYERED BY MOH BUILDING CODES. THEN (1) ON ELECTRICHL PERMIT HHD 'T. MUST BE OBTHINED.; (2) HS-BUILTS WILLNOT BE �PPROVED WITHOUT HN ELECTRICHL 1NSPECTION REPORT/ AND (]) THE ELECTRICAL WORK HUST BE DONE BY H LICENSED ELECTRICIHN SIQN-1ED DF-'ITE� HPPLI�HNT� T&TCONST ISSUED BY DHTE� SOILS LOG MUNICIPALITY OF ANCHORAGE er�� ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: / a n F7 7 Cons'i 1 —uC-�J 6n DATE PERFORMED: -/� / j LEGAL DESCRIPTION: ci kn 4/X �C..Z�C���LJ)'c�I�Y) k,1�C/� �f /i SLOPE CJTM Di AniDEPTH-� (FEET) tP141 �rl 2 X, 5 ,�dr� , brows i 6 7 � + t 8 r > � t v 9 r t t r � 101, > r 11 12 13 14 15 16 17 18 19 20 r % WAS GROUND WATER ,J l ' �ar K b roc.�n rCA u(�l I br�l�?n J > % s ` COMMENTS AI ENCOUNTERED? IF YES, AT WHAT DEPTH? No S L 0 P E Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT U_/ --)_j U t PERFORMED BY:&I)( L/1/ —jS1j% STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for A. APPROVAL TO CONSTRUCT PUBLIC WATER SYSTEMS Plans for the construction or modification of WAFER WELL I SUSTE)'1 4- ©a I? L A'SS 4 fTnnTI� ,p , ] It X12 &oc is sA N o L &K F VTc water system located in ( Alaska, submitted in accordance with 18 AAC 80.100 by L KA ENU.T J(Q?IJNE1VTK C26NTRDZ Shave been reviewed and are 9 approved. ❑ conditionally approved (see attached conditions). BY TITLE 6 DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no, or eeecdpt m reference) co 10 & ;t. Approved by Date (.)T c sYSTel Wr H 0 r? rZI ZCW Tif C SGPAR lir� E69 At -s7 -el (2 C. APPROVAL TO OPERATE F W S - ,Z I I &Fyq a,u jwur` o k 10 o w co* uAQ�s11 The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water Is made available to the public. r The construction of the �S).Mj2 S +grEm/LOTS 1y�F 171 %. � ( 1,qZ 0 171-0 Q - *PHU lic water system was completed on -7-5 I- q: tr (date). The system is hereby granted interim approval to operate for 90 days following the completion date. DATE As -built plans submitted during the Interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system Is hereby granted final approval to z C SIJ TDATE BY RS DISTRIBUTION: t. WHITE - ENGINEER (Complete Section CI 2 YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEERIMUNI-BOROUGH (Complete Section C) ALASKA'01ROWnTAL COnTROL S�' RUINS, InC. Engineerinq & Cnuironmenlal $ludies MUNICIPALITY OF ANCHORAGE June 20, 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Department of Health and 1�nvironmental Protection I JUL 2 41984 825 L Ste -et Anchorage, Alaska RECEIVED Attn: K. Bandt Subject: Lots 11, 12, 13, 40, 41 and 42; Block 4 Sand Lake #2 Dear Keith: The above mentioned lots are to be served by a class 'A' well, and separation distances were waivered (attached sheet). The residences and foundation were under construction at the time of installation of the on-site septic. The permits were issued by your department, for single family dwellings. The permits were designed, for the most part, at depths of 10 to 15 feet (total depth). In the soils rated for this area, this presented problems -in that with the depth, the excavations tended to enlarge greatly. In an attempt to circumvent this, the excavator had our office on location during the actual excavation. The lots are extremely small, generally about 6,700 square feet in size. With the class 'A' well restrictions, and the prior establishment of the foundations, the available space for on-site septic was limited. The proximity of neighboring private wells also influenced the establishment of the septic systems. In all cases, the absorption areas and septic tanks adhered to the 100 feet separation from adjacent private wells. Also separation distance (waivered) to the class 'A' well were enforced. Absorptions were confined to 10 feet within the property lines. As the absorption areas were excavated, the trench would widen -due to caving in of the sidewalls. Gravel had to be placed in the trench immediately upon verification of the proper depth. During the excavation, the area separating the septic tank and absorption area also collapsed in. The permits were issued in probably the only configuration that would fit the lots. The only ccmprcmising distances are: 1) Separation distance between septic tank and absorption area. 2) Septic tank distance from lot line. 1200 [LJest 33rd Auenue. Suite E e Anchorage. Alaska 99503 0 (901) 561-5040 The above mentioned compromising distances occurred during the excavation of the septic systems. It was felt that if a compromise had to occur, then the tank would be the exception. If you have any questions please do not hesitate to contact our office at 561-5040. l Sincerely, L 1� Larry Montgomery Environmental Engineer MUNICIPALITY OF ANCHORAGE �1 • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services I On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # D ! 1- 135 - 1 1. GENERAL INFORMATION HAA# Complete legal description 1-t^! SA N T-) )A K >_ Location (site address or directions) A / cc C, Property ownerI "2_ci Day phone �-? 662 ` (`� 712= Mailing address B / G(c, Lendingagency Mailing address "2�" ' 1L��/ / Agent ��crC« Son -c2 -CII '' X'N `f"LLO LL L Address y e Gu Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: S - 3. TYPE OF WATER SUPPLY: r Individual well Community well Public water Day phone A5 -E - 1.5-3 k-% pWne 33° -349 Z a13 14 NOTE: If community well system, provide written confirmation from State AVEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site v Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone G 7c3C1 Z Address Engineer's signature ��� -��"{ Date Ile 6. DHHS SIGNATURE Approved for bedrooms. By: Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 411TIC 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. Employeesof DHHSdo 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(Rw.1/91) Back MOAM21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 3A Z_ _ Legal Description: I. vT YCf U_ gMVD LAK. Parcel I.D. D I` i3J A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number. Log present (Y/N) Date completed Driller Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ti T ; On adjacent lots 1 1 Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank 3d" WATER SAMPLE RES LTS: CoIHorm Nitrate ND Other bacteria Date of sample: a17� Collected by: 4.S B. SEPTIC/HOLDING TANK DATA Date installed —Tank size 1 a 6-&0 Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N)Depression (Y/N) N High water alarm (Y/N) t`I Alarm tested (Y/N) N & Date of pumping 0/pw/q. Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N�A On adjacent lots 1 I q Foundation I q To property line /0 Absorption field 3 Water main/service line Surface water/drainage CONTINUED ON BACK PAGE 72-026 (3193)' Front rn 7v ZO Z (n0 M o W O g.p.m.Cil m z t -r9 Gil m n N ® g O � Vi C O M Z WATER SAMPLE RES LTS: CoIHorm Nitrate ND Other bacteria Date of sample: a17� Collected by: 4.S B. SEPTIC/HOLDING TANK DATA Date installed —Tank size 1 a 6-&0 Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N)Depression (Y/N) N High water alarm (Y/N) t`I Alarm tested (Y/N) N & Date of pumping 0/pw/q. Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N�A On adjacent lots 1 I q Foundation I q To property line /0 Absorption field 3 Water main/service line Surface water/drainage CONTINUED ON BACK PAGE 72-026 (3193)' Front C. LIFT STATION rl� Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) High water alarm level "Pump on" level at "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed LZ `q,) Soil rating (GPD/Ft') Of 50 System type l ;, -t-i C - Length l Width Gravel thickness ! Total depth — Total absorption area //3 oz Cleanout present (Y/N) Depression over field (Y/N) N/ Date of adequacy test 'O/2 -71,2,E Results (pass/fail) for Bedrooms Water level in absorption field before test Aftertest 9744,� X),. Peroxide treatment (past 12 months) (Y/N) 1 V If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ��� On adjacent lots Property line )D To building foundation /7 �To existing or abandoned system on lot Hl/� _ ,�1 On adjacent lots > -0 Cutbank �i 0 ✓I �2 Water main/service line Surface water ISI 0 zL-C- Driveway, parking/vehicle storage area i AO Curtain drain N 0 In. E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect -on Ma-0fteof this inspection. i CSignature Engineer's Name o l> e u ✓ �a �� h (i1 )wU' olWSh Date l 7 T4s. HAA Fee $ . 3 Waiver Fee $ Date of Payment ( �� S! Date of Payment Receipt Number (D O Receipt Number 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ��i $9- (a) Legal Description (include lot, block, subdivision, section, township, range) 4i-qO g641C9- 2&V_a 4AI3:C "2_ 1-1 ZA) R41-4.) 5e, jc Location (address or directions) nac) (b) Applicants NameY Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution Buyer E7 ; Other [::� (explain); = ; Owner/builder ; (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 7- 3. [dater Supply Other (describe) Individual Well Community Public Note: If community well system, must_ have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite �' Public = Community = Holding Tank = Note: I£ community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 9 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 regula- tions in effect on the date of this inspection. Name of Firm /)ED'S Telephone.-1;�6�-p Address Z '3-' `�bjc 1t6xAG 476r �i'SG' So: -tz' Date 9/?AP, 4(- OF A� �` eee ecQo 3or".. fi T. (ENGINEER SEAL) �.®` TH °, n <' 0 eo se eeaas eeo so aoua¢°neo--- eo + ,, �4OeoOe'`edee- 6. DHEP Approval PP Q® TIA�e Lero C. Reid, L: / P o. 2251 F. Approved for -� bedrooms By ��1_✓(-' '��i Dai: e` �;° �`.; _<3'•-, Approved Disapproved Terms of Conditional Approval CAUTION i:i.:.. Conditional THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA.. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 A. i �� ✓ MUNICIPALITY OF F:NCH R=:Ct: DEPT. 02 HEA',TII << MUNICIPALITY OF ANCHORAGE (MOA) INVIRON�btENTP;I •PiCiC�II HEALTH AUTHORITY APPROVAL (HAA) 6EP 14 M4 CHECKLIST - FEBRUARY 1984 ZI P +- Legal Description: D :D +- WELL DATA _5A.l%P�) 4 1, E 74Z Well Classification C`l M(ju,'-rY If A, B. or C, D.E.C. Approvecd/N) Well Log Present (Y/N) ADate Completed 42a: Yield Total Depth�/ Cased to _� Depth of Grouting /Oh -a- static Water Level Pump Set Atm[ Casing Height Above Ground AJ Sanitary Seal on Casing (Y/N),O�l+ Electrical Wiring in Conduit (Y/N) Ndu�,: Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot U )]y On Adjoining Lots >/ob o To Nearest Edge of Absorption Field on LotD /L5. - ; on Adjoining Lots `J/ ' To Nearest Public Sewer Line _A4/4 To Nearest Public Sewer Cleancut/Manhole 441/4- To Nearest Sewer Service Line on Lot Aj& Water Sample Collected By A AA Date �✓�� Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed _sAgg/4 Size 4000 No. of Ccanpartments Standpipes ( N) Air -tight Caps Foundation Cleanout CVM) Depression over Tank (YID Date Last Pumped it—,)/t��- Pumping/Maintenance Contract on File (YIN)A,&__; for AZ Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water -Supply 4 11 p ]lye To Building Foundation 6` To Property Lire c To Disposal Field 3, 91� To Water Main/Service Line 1 To Stream, Pond, Lake, or Major Drainage Course Comments Pg2 moir4 1-i5 av, L Receipt # Date Paid: Amount: 4s , eacl [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ )S�� Type of System Design fief&Yc%4 Date Installed 5_/22/A�- Length of Field /g Width of Field 3 f Depth of Field _)q. Gravel Bed Thickness 101 Square Feet of Absorption Area Standpipes Present /N) Depression over Field (Y( IO - Date of Last Adequacy Test e�L& Results of Last Adequacy 'lest Separation Distance from Absorption Field: To Water -Supply T\bll O ) 14'1- To Property Line )5' To Building Foundation )'7,5 ' To Existing or Abandoned System on Lot _J1 14- ; On Adjoining Lots > 36 -_ To Water Main/Service Line A2&A__ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course —� To Driveway, Parking Area, or Vehicle Storage Area _�_7 ) Comments P,&e Mo6 A s,a4.7- G� nee- &.)A , ue /f -� D. LIFT STATION Date Installed A)IA Dimensions Size in Gallons Manhole/Access (YM) "Pump On" Level at A,,/yT 4 "Pump Off" Level at High Water Alarm Level aty, Vent (YM) Tested for A Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments *� Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guideli.r_es in effect on the date of this inspection. �w Z� V1_ 4, _ 04+`06 y� �-.0 Signed % c! Date i i R4y�4.4�4� 44pmoV640J J0 Yr✓"7` - "y` i Compan CC5 / ur_ MOA No. !;+&-0Z4 *:'�9 '`p`ERS a <. KB1/d5/s Gi '4 h y C. Reid, NJ�°4 No. 2281.E (Page 2 of 21-- 2-15-84