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HomeMy WebLinkAboutSST BLK 2 LT 6N c)v c) A -D,3 Municipality of Anchorage Page ofy' 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: Sw 93038 z PID Number: 9,3 Name:Wastewater /ot-j f3 :aowY System: 24New ❑ Upgrade Address: 9(110/ //190Esj,5,¢D ABSORPTION FIELD Phone:54(a// 32 No. V edrooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION SoilRatinA Z Total Depth moriginal grade: GPD/Sq. .Ft. Lot:// Block: Subdivision: /0 Depth to pi/pe bottom from original grade: Gravel depth beneath pipe Z SS /_ '7` Ft.71.5-Ft. Township:J l Z Range: 3 Section: / Z/ Fill added above original grade: 0 Gravel length: Z9/ t `v Ft. Ft. WELL: New 11 Upgrade Gravel width: i Number of lines: / Distance between tines: Ft. Ft. Classification (Private, A,B,C): Total Depth: /ZO Ft. Cased To: /ZO Ft. Total absorption area: /�� SD. Ft. Pipe material: CI 303/ Driller: Date Drilled: AV -93 Static Water Level: 1 -7o Ft. Intaller ?40 4J w L Date in tailed: De, i9 20 p3 Yield: 7 S Pump Serat: Casing Height Above Ground: S TANK GPM //f5 Ft. /f Ft. SEPARATION DISTANCES ®'Septic ❑ Holding ❑ S.T.E.P. To Septic AbsorptionLift Holding � Public/Private Manufacturer: rq 26-6-2 Capacity in gallons: /Z 5_0 From Tank Field talion Tank Sewer Lines I WellSurfac /00 f/UO ></00 Material: r$jEEG Number of Compartments: Z Water f/a 0 t/Do/00 LIFT STATI O N LotSize 416 f �{U f �{O in gallons: Ma Curer: Line FoundationIS ZS — "Pump on" level at: "P p off' leve High water alarm at: Curtain, fi/aO /DD , -/o0 Pump Mak odel Electrical Inspections performed by: Drain Remarks: t5"Y5Ze41 rJSE TvS— BENCH MARK cS'jtf/f ED. 41(f1/45� N4L %NSP, Location and Description: 190 ion/ z2F Se i,2 iiJG NoiC=s Z_06,71 �tE�sfJ v s w Cole /-/s6- Assumed Elevation:0 q.S /00— Inspections performed by: C,�9, OF�E Dates: 1st /�'/�'�-3 �s q "";z v9»S®a rP.9eYA 8 a �A 3x 2nd 1O•ZV'it .61% jone 22, ISS y� e"o' Department of Health anio Hum ri rvices approval�� Date: Reviewed and approved by: f 72-013 (Rev. 9/91) MOA 25 Permit No. SUS Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: PID No.: I I I � I 61- LONP X 7.5" DEEP TREN- / nopt�uba s - ......... I ClecnDut I I 3 o 28 5' I I I - 'cc i ......................._....._. 22.D"i.i' �. ..... o I I I Pipe . ?t 4E BESTORY DROOM FRAME HOEISE I I I GRAPHI SCALE < ' ! j. IPLAN VI W ONLY) i 40 0 20. 40 1 80 f10U 5e I ( IN FEET 1 inch = 40 ft. 72.0' I I€ ._._........._. _. .........-........_ ................ ..............._............_.... __..._.... r.:ilwr ' ........... -.. d... S ) I: I f I: a s I - HOUSE i FINISHED GRAD i2 1' ' ...... .4 t - 97. i5 j - '' HD INSV VLON OVEI TANK L J 90.2 i ° 90.7 ' 91 9 90r 1250 GAL TANK f 6.5 i i M7 MONITOR( U6E AK „,,...„.' t sb CLELJ:9T 9" Y6 CLEANOL4T TUBE FYDOr'eY pq`�y -rr 04. 0y7 Lie O Perforated PIp$i ..... a,. �yPPP •%Y astacaa4e®r34G+4�OC� ts4 li92 19" ' HvQ tri. ti'32•�' :° F: WELL LOG Date Drilled: 10-6-93 Static Water Level 70 feet Draw Down -N/A feet Type Material Drilled: 0 feet to 5 Sandy .Gravel 5 ft. to 8 gravel 8 ft. to 10 gravel & clay Tony Bzowy Lot 6 Blk_ 2 Subd. SST Gallons Per Minute 3h Total Feet of Casing 12n 10 ft. to 12 sandy travel - 12 ft. to 15 sand 15 ft to 20 silty sand w/ 20 ft to 30 silty sand 30 ft. to 35 gravel w/silty clay^_ _ 35 ft. to 40 silty sand 40 ft. 45 sand & gravel 45 ft. 75 gravel 75 ft. 77 wet gravel (a little water) 77 ft. 80 sandy 80 ft. 95 clay HEFTY DRILLING 95 ft. to 110 clay w/ gravel. 3540-AKULA.-DRIVE 110 ft. to 115 gravel ANCHORAGE, -AK ,99516 115 ft. to 120 gravel w/H20 (907) 345-0593 to o: N 1N) 3 I 3- i r •£S/ M,, /s, / o, Ooh/ 1 S yS Z `ti V do a SAPco o N osY 1' v vZ N a h NZ 0 a ZLSf. ^vF zo, oow r o � P°af S'arcloN VA THE INFORMATION N IS FOR TNE_USE OF LENDING INSTITUTION CiF1CALLY TO SHOW ANY CONFLICTS EASEMENTS OF RECORD, OTHER SETWEE !STING STRUCTURES AND PLATTED LOT LINES THAN THOSE SHOWN ON THE SEMENTS AND IS NOT TO BE USED FOR POSITIONING RECORDED PLAT, ARE NOT ADDITIONAL STRUCTURES OR FENCELINES SHOWN HEREON �s OF q� 4 - � 1(� ••1HN... y.17 •• % r :49THip •:,�a� oo 9t • • •• •.•. .•� 0 �a :• Shone A. Holt ,: �o� ••• IS AM : J"O 6.0 9JQodW 1" - AO' AS -BUILT SURVEY (NO CORNERS SET THIS DATE) I hereby certify that I have performed a Mortgagee's inspection of the following described property. ( LOT 6, BLOCK 2, S.S.T. SUB. Anchorage Recording District, Alasks and that the improvements situated thereon are within the property tines and do not overlap or encroach an the property lying adjacent therato,.that no . improvements on property lying adjacent thereto encroach on the promises in question and that there are no roadways, transmission lines, or other visible essments on said property except as Indicated hereon. Dated at Anchorage, Alasks this e3vd day of T Na4 1995. Fp SS -6G HOLT AND ASSOCIATES LAND SURVEYORS ,SG32 NORTHERN TESTING RAT RIES, INC. 941 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645 Report Date: 01/31/95 Constructing Engineers Date Arrived: 01/27/95 9601 Buddy Werner Date Sampled: 01/26/95 Anchorage Ak 99516 Time Sampled: 1800 Collected By: Attn: * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. Our Lab #: A136359 E = Estimated Value Location/Project: Loth Block 2 SST Sbdv. M = Matrix Interference Your Sample ID: Kitchen Sink D = Lost to Dilution Sample Matrix: Water MDL = Method Detection Limit Comments: Lab Date Date Number Method Parameter Units Result * MDL Prepared Analyzed ------------------------------------------------------------------------------------------------ A136359 EPA 353.3 Nitrite/Nitrate-N mg/1 2.09 0.25 01/30/95 Reported By: Anth y J. Lange Chemistry Supervisor MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930382 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. OWNER NAME:BZOWY ANTON L & JENNIFER A OWNER ADDRESS:9420 CHINOOK APT C ANCHORAGE 99506 PARCEL ID:01508223 LEGAL DESCRIPTION: SST BLK 2 LT 6 LOT SIZE: 52114 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 4�J�L✓?Ek_)li DATE ISSUED: 9/22/93 EXPIRATION DATE: 9/22/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVTcrOuc- RECEIVED BY: DATE: ISSUED BY: �,'O(f�► SW'117;� . DATE: 2 Zz SITE PLAN—WATER AND WASTEWATER ABSORPTION SYSTEM I II I I \ I I — - � _POD Psev CL � 1 tzsec-.�. scr,-r 1 e Eggs c oowi P Rpt%A'@7 DFIG �'Votf't I Lg5 P�2Im erZe, J I r I I�uSG T—ovr�R�e+' Q bare wav, WELL I I- � I C7nvw5 zs,00vr-� i � I � � I �-KER AVAtLh'01.e itTZ I W I I kt3S��aN sySret.t W 1111 `T J 1 1 SITE PLAN DETAILS PROPO6r?D WATER AND WASTEWATER ABSORPTION SYSTEM a 4+u3. LOT 6 BLOCK 2 S.S.T. SUBD%V%S ION 753-8377 PREPARED FOR; TONY44WftrFrI (3�0wY �-� 94ZO CHINOONCClYL7C_ w—� ELMENDORF AFB, AK, 99506 a ' DRAWN BY CAL } 3ur Vis^, i}" ,s° `ir<' SCALE: V = 100' . CONSTRUCTING ENGINEERS 346®2000 4 h - JFJfD g3 1,'fj _ 9601 BUDDY WERNER DR 694-9095 ENGINE s€at ,,-:�:..' ANCHORAGE, AK, 99516 9-13-93 DRAWING N 93-51-09-7 01 1 3' T ABSORPTION SYSTEM DESIGN DETAILS --STANDARD TRENCH a� V � OVZ'Z F1[ -VD k �I YRG LAI't?A� tm ONN ISIYZ rue It I ZSO CiSL� Twv-comp 5/Mlr STEE- TnNK TIm In ADC 0 ` J FQom Iio4sE II- C�Za'ND cwerr LESS TWXm 4� (AU_ CArrY»^�t-N4� 3' SCOPE OF PROJECT: New absorption field is designed for a four (4) bedroom system. Lot is to be served by a private well. The system will be a standard gravity absorption system with a deep trench. ABSORPTION AREA CALCULATIONS: Minimum Required: 4 Bedrooms x 150gpd/bedroom = 600 gpd capacity Soils rating, proposed system, 1.2 gpd/sf Minimum sizing: 600 gpd - 1.2 gpd/sf = 500 sf absorption area Use 31W x 381L x 8' D = 608 sf minimum for trench Trench depth: Bottom = 10' Below grade, w/ 2' cover and 2" HD insulation per design drawing IMPACT ON ADJACENT LOTS: There are no private wells within 100' and no public wells within 200' of this absorption system; The proposed absorption system has no impact upon any adjacent lots as shown on attached site diagram. id .V - � 3R si" 6f DESIGN DETAILS PROPOSED WASTEWATER ABSORPTION SYSTEM LOT 61 BLOCK 2 S.S.T. SUBDIVISION PREPARED FOR: TONY $�bwy 753-8377 %4Zo CjAirjooK CIP-1 P,,3fc ELMENDORF AFB, AK, 99506 NOT TO SCALE DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9095 ANCHORAGE, AK, 99516 9-13-93 DRAWING # 93-S2-09-7 in Municipality of Anchorage J ,�"/�[ ,Y. ® DEPARTMENT OF HEALTH & HUMAN SERVICES t 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 45.' rk t(e�a y�py��{� PERFORMED FOR: Toh DATE PERFORMED: ST 5 Township, Range, Section: WE 1/4 S 14 1 !ZN IZ3 W LEGAL DESCRIPTION: S 8 Z $ SLOPE SITE PLAN (FEET) 1 OaY> ' 2- 3- 4- 5- 6- 7- 8- 9 10 11 12 13 14 15 16 17 18 19 sand) gYa��) w rsec I=Lw sand �(-hras,l� WAS GROUND WATER lV O ENCOUNTERED? S L IF YES, AT WHAT - O DEPTH? P E Oepth to Water After �_ 3 Mnniinrinn? itjVr );5- Dale: I Reading Gross Date Time Net Time Depth to Water Net Drop 0 2Y�.. Z ra �• Iv I n In I -L" 1 pyh 6 IZrn r I¢,r Zrn,: '- 14 { S„ Zn 20 PERCOLATION RATE Z (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 4 FT AND FT COMMENTS � t5l f-4bLlr-- 30-93 PERFORMED BY: ' STYLV r GAGS I GJ4`-���kgIt CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) �E• B6 Municipality of Anchorage On -Site Water and Wastewater Program a �L- (907) 343-7904 s n E T Y Certificate of On -Site Systems Approval Parcel 1. D. 015-082-23 1. GENERAL INFORMATION: Complete legal description SST: Block 2, Lot 6 Expiration Date: _12_A -_-711,q Location (site address) 9601 Homestead Trail *Anchorage, AK 99507 Current Property owner(s) Barbara Stillwater Day phone 520-621-7148 Mailing address Real Estate Agent 9601 Homestead Trail *Anchorage, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for. Distance: Received, by:� Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55n// Waiver Fee $ =_ Date of Payment Iq Date of Payment Receipt Number ��g�� Receipt Number, COSA# 9C }Alin Waiver# 91 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: , t 2 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry The 0 �C�,.• "' Q S �Q practices. reported results describe the condition of the system/s on the date/s of the O �,• evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The life -Q i operational of all wells•-' and septic systems depend upon a variety of variables, including but not limited to, soil conditions, .... ... .. • • • . • • • • • • • • • • • • • groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ... . .. ........ ...... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG tt'� ;r. A. - ess, makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system be installed U(1�z < < llnn 9 CSE} 795., c�� can on the property in the event either of the current systems fail to perform adequately inaG the future. The content of this report is for the sole benefit of the person/party that retained GEG to \J\,- P r cco©� perform the evaluation. Reliance upon the information provided in this report by any other person or ess O��O��QOc party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with \G\pP _1TY op(6��#AECC884 J�/yo m.= e9wing ° q�nq: 0= l A1 -V ac By: Original Certificate Date: �% Z7 /�_ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. t 7. ATTACHMENTS: COSA Checklist Nitrate Advi�orX;>- J', Septic System Advisory Arsenic Advisory _ Well Flow Advisory Other h 1 COSA blue sheet 10-10-12.doc F An" aU150Y ---�" - � r COSA Checklist Legal Description: SST; Block 2, Lot 6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Q Well log is filed with Onsite (or attached) Date drilled 10/93 Total depth 120 ft Cased to 120 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 916/19 Static water level at beginning of test 73.9 ft. Comments B. TANK DATA Age of tank(s) 4) years Tank type/material Measured operating operating fluid level in septic tank ❑ Standpipes/foundattiiyon cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 1993 ❑ ALL standpipes present per record drawing. Total measured depth from grade **11.5 ft (max) Measured depth to pipe invert from grade 4.3+ ft (min) ❑ N/A - pressurized field Parcel ID: 015-082-23 Structure served by this system Well production at time of test 6+ gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate ,'3 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L XArsenic less than MRL (ND) Collected by Date of Sample 8/27/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments - Adequacy test date •9/6/19 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 12 in Water added 700 gal New depth 58 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 135 min depth into effective 0 Code -required soil cover over field Final fluid depth 35 in © System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) _ If yes, enter date Gallons introduced 2,000 gallons Comments/Deficiencies: 'Pre-soaked on 9/5/19 COSA Checklist yellow sheet q� E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *5+ Community Sewer Manhole/Cleanout > 100' Surface Water > 100' 0 Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' F-1 Yes if No ft Absorption Field on Lot> 100' E] Yes if No ft Holding Tank > 100' E✓ Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' M Yes Animal Containment > 50' ✓l Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' Q Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' F1 Yes if No ft if absorption field is under driveway comment below Property Line > 10' Q Yes if No It Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS *Met code at time of installation G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet #AECC8&4 :17 A � ..) 1i 3 d j DEVELOPMENT SERVICES DEPARTMENT On -Site water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC191453 Subdivision: SST, Block: 2, Lot: 6 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.31 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. i``"tza",;�7".ti 'amu`,+��z§'.-..�.Csj.s'''r"-i'-. ±e 4 ,Mad�ng{A�d ress P O Box 16650:} Anchorage; Alaska99519-6650* www m0fiJ org y .x.,:�s, s'�.s� F0 a MAIMI 3 s 11 DEVELOPMENT SERVICES DEPARTMENT i On-site Water and Wastewater Section % www.muni.org/onsite v Septic 'Tank advisory Certificate of On -Site Systems Approval # OSC191453 Subdivision: SST Block:2, Lot: 6 w The septic tank for this property is 26 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. it1a� J" 5 s + 965' s age, A as 9 66 ►a� �" MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES��vw b Division of Environmental Services On -Site Services Section. P.O. Box 196650 Anchorage, Alaska 99519-6650 - 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # d r S — y 9- 2 a 3 \f HAA # � 6r`\ C L-1kA 1. GENERAL INFORMATION Complete legal description Lo ' G 3 Lo c_r; a SS' % Location (site address or directions) c 6 0) j t ©"' s A/V CFF d'14 -G. {z Property owner ' ' ' �' S ' "` Day phone Mailing address Go I r4d`��f'��'� i2g �NcN�kA�� .1'C �7y f'tC, Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: y '` 3. 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X 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. "l) Front MOA i21 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 S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address giver. Alaska 99577. Engineer's signature 6. DHHS SIGNATURE �L Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date //a(, / q 1 .r, <<> ; �V bedrooms, with the following stipulations: Date 1-2 7—%7 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 courtesyto purchasers of homes. and their lending institutions in order to satisfy certain federal and state requirements. Employeesof 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. 72025 (Rev. 1/91) Back MOA #21 i RECEIVED Municipality of Anchorage JAN 2 6 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANCH 825 L Street, Room 502 • Anchorage, Alaska 99501 • (9(W�SERVICES D Health Authority Approval Checklist Legal Description: L o 6 i3 L o c 1t S Y l Parcel I.D.: C9 l S' — 0 if A —.2 3 A. WELL DATA Well type iol?'vA"3 "L If A, B, or C, attach ADEC letter. ADEC water system number Log present Q/N) y 5 Date completed / ° / 6 Al 3 Total depth D Cased to 1 a Casing height (above ground) Sanitary seal &N) Y r S Wires properly protected (Y/N) Y S FROM WELL LOG AT INSPECTION Date of test J a G /93 a a R 8 Static water level a 7 a- � ! Well production 3' Sg.p.m. 9•p•m. WATER SAMPLE RESULTS: Coliform t% Nitrate a 3 7 Other bacteria Date of sample: i 0A 5- I °I Collected by: s & c ENGINEERING 17434 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed io / a'0 / Tank size ) a' s 0 Number of Compartments � Cleanouts&/N) yc_y Foundation cleanout&N) Y s Depression (YAP r Q High water alarm (Y/9P ^� Date of Pumping r/X0 gV Pumper A-1-- How E S le -Al)" S C. ABSORPTION FIELD DATA Date installed j° / �L o / 9 -� Soil rating g.p.d./ft2 or ft2/bdrm) System type Length 6 I Width 3 Gravel thickness below pipe i. Total depth Effective absorption area °) i S— P r L Monitoring Tube present (ON) YfS Depression over field (Yo /� O Date of adequacy test S �J °� °j `d ResultsPass Fail) 104-5 S For y bedrooms Fluid depth in absorption field before test (in.); 1 Immediately after? Sygal. water added (in.): �f Fluid depth ' (ins) Minutes later:04�ns A l M,„, Absorption rate = O 0 -f g.p.d. Peroxide treatment (past 12 months) (Y/N) ry 0 `- K �) ° wrJ If. yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed _ Manhole/Access (Y/N) _ High water alarm level at* Cycles tested-' E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic/holding tank on lot 1 o Absorption field on lot /00 /'F Public sewer main P f A -- "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line ( S Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation / t) Property line / 0 / Absorption fie] I , Water main/service line 3'-S t- Surface water/drainage ! o s a - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ' Property line 30 t- Building foundation -ao Surface water /00 r `- Curtain drain N° N t e fJ o F. ENGINEER'S CERTIFICATION / �0 4- Wells on adjacent lots Water main/service line O Driveway, parking/vehicle storage area S /� _ Wells on adjacent lots 00 ! certify that i have determined thru field inspections and review of Municipal AMM t�iat the in conformance with M AYA¢A gjv"deline/s i� effect on this date. > Signature � •' � �• Engineer's Name �� �� �'i T C- - <70 w,q ,v 0) �� ROBERT C COWAN CF -8801 Date HAA Fee $ ?� Waiver Fee $ / c1� Date of Payment / / Date of Payment Receipt Number �` Receipt Number 72-026 (Rev. 3/96)* are 0 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 41111111111151 On -Site Services Section CEM P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # d i S- o S a a 3 1. GENERAL INFORMATION Complete legal description Loft 6; $tock 2 HAA # Q�11 n 0 a SST Subdiv.i,eA.on Location (site address or directions) 9601 Flame Lead TrLai- Anchorage., AK Property owner. _ 1nnidm Lowy Day phone 563-5488 Mailing address 9601 Homestead TnaU Anchaxaae., AK 99516 . y Lending agency Day phone Mailing address 5' Agent C2aiA Ram3eul Jack W i.te Rec,,? i State Day phone 762-3116 Address Unless otherwise requested, HAA will be held for pickup. 2. `NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well "V Community well .; Public water NOTE: If community well system, provide written confirmation from State ApEC attest- ,., ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 1/91) Front MOA X121 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 furtherverify 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 S& S ENGINEERING Phone 6 9Y - a 5 7 �J age River LOOP Road -go. 204 Address Eagle River, Alaska 99577 f Engineer's signature 6. DHHS SIGNATURE - Approved for Disapproved. Conditional approval for i By: Additional Comments bedrooms. Date C / a S` / _2 L .oa �;9 ROBERT C. COWAN f� CE-3E01 t1 ,1 v iY bedrooms, with the following stipulations: 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-M (Rw. 1/91) Back MOA #21 Municipality of Anchorage e DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 MUNICIPALITY OF E fWlgoI. gWALSERWIS DNISION Health Authority Approval Checklist JUN 251996 T -1/0Legal Description: L o T ` 13"GK X S S �0 Parcel I.D.: D 1 V- b g a - a R E r F l V E D A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADE/C water system number _ Log present �'"l y S Date completed I ! 6 /c/ 3 Total depth I d Cased to % OA0 Casing height (above ground) Sanitary seal Date of test Static water level Y e _S FROM WELL LOG Ia/G/c13 70 Well production 3.S- g.p.m. WATER SAMPLE RESULTS: I '4 Wires properly protected d"' YC S' AT INSPECTION 6/X'616 ZO a. y 9— p.m- Coliform O Nitrate -� • S- V Other bacteria O Date of sample: % t `) °/ Collected by: S & S ENGINEERING age River Loop Road No. 204 B. SEPTIC OLDING TANK DATA 1 Eagle River, Alaska 99577 Date installed / 0 /� o / 93 Tank size 13-- S'v Number of Compartments Cleanouts (bm �lE S Foundation cleanout (9N) Y 6-5 Depression (Ya High water alarm (YQ ✓" o Date of Pumping 6 �a j./ q 6 Pumner ✓, c i t C. ABSORPTION FIELD DATA Date installed i o %a o 9 3 Soil rating (g.p.d./fie or ft2/bdrm) ! )L System type .T R S Length G r Width 3 ` Gravel thickness below pipe -7, S Total depth Effective absorption area 9 1 S Monitoring Tube present6/N) Y6 s Depression over field (YO ^' y Date of adequacy test G IX i / 9 (o Results (Pass/Fail) 1"- S s For I/ bedrooms Fluid depth in absorption field before test (in.); G Immediately after_6 IV gal. water added (in.): Fluid depth A N Ya- (ins.) Minutes later: (7 Absorption rate = 6, Q 0 f g.p.d. Peroxide treatment (past 12 months) (Y/N) N 0N j, KaouN If yes, give date — D. LIFT STATION Date installed Manhole/Access (Y/N) _ High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" *Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: eptic r holding tank on lot 1 0 o -�— ; On adjacent lots Absorption field on lot 0 U fi ; On adjacent lots Public sewer main N /A Public sewer manhole/cleanout OV / Sewer /septic service line a S— 4 Lift station w �� SEPARATION DISTANCES FROM SEPTIC OLDING TANK ON LOT TO: r Building foundation / o f Property line /0 1 Absorption field 5` t r r r Water main/service line S Surface water/drainage ° Wells on adjacent lots - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 0 Property Line 0 Water main service line S f J / Surface water / 00 t Driveway, parking/vehicle storage area 4 Curtain drain VI N C Wells on adjacent lots 1 0 0 F. ENGINEER'S CERTIFICATION I certify thatl have determined thru field inspections and review of Municipal in conformance wit O =es't on this date. Signature n Engineer's Name IC a )3 £til` C • Co v4,J Date � �5 Iq'� HAA Fee $ Waiver Fee $ Date of Payment / `� Date of Payment Receipt Number/ q 7 Receipt Number Rev. 8/95 OSS: haa.wk.doc dS.r�Qt Fhq.-aAoVV." P74 re i qo ROBERT C. COWAN ��4p `�e� CE - 8801 / 23-- P 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING d Parcel I.D.# �� —062-23 HAA# 14A95bo3O 1. GENERAL INFORMATION Complete legal description Location/(site address or directions) 1?60 / eslead Tenn i Z l l.5_/ K Property owner 10 42 ,C47 -e-1 C�z Day phone 3 V - l /:3 -3 - Mailing 3 -3 -Mailing address t10 Z orae 9ZZeCA-d te-c_ Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well r Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 1/91) 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 06441 GvI� rS Phone �j�(o`Zd00 Address floc/ 3vck/dv ,�'Wle,VIAC,v Engineers signature'/c /UV"� Date 6. DHHS SIGNATURE Approved for 4L bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with "-t0e,';fgl.lgwng: stipulations: 41 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 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(Ray.1/91) Back MOA821 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L fo 8L 2 Ss% Parcel I.D A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 10-7-3 Driller Total depth Z O r Cased to / 2 y Casing height / Sanitary seal (Y/N) 1 Wires properly protected (Y/N) I`/ FROM WELL LOG Date of test - 6 - g3 Static water level 70 Well flow 9•p•m• Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot -'/00 Absorption field on lot t /DO Public sewer main /0 0 Sewer service line -f /od WATER SAMPLE RESULTS: Coliform 0 Date of sample: /- Z 6 -- 7S" B. SEPTIC/HOLDING TANK DATA AT INSPECTION _; On adjacent lots _; On adjacent lots '` /00 iblic sewer manhole/cleanout— Petroleum tank f /00 Nitrate 2,07 • / Collected by: _Other bacteria //W/Cc /00 Date installed /0- % 3 Tank size /2 5-0 Compartments 2• Cleanouts (Y/N) / Foundation cleanout (Y/N) ! Depression (Y/N) High water alarm (Y/N) N Alarm tested (Y/N) Date of pumping AJC- R) SyS%E/s'l Pumper SEPARATION DISTANCES FROM SEPTIC/HGk@#dQ TANK TO: Well(s) on lot -14-100 On adjacent lots-76'/Od Foundation l5 To property line f 5V0 Absorption field f Water main/service line _ Surface water/drainage f/00 72-026(3/93)• Front CONTINUED ON BACK PAGE 0- c o Z n -o Il prMm 9O D O 0 Z _Other bacteria //W/Cc /00 Date installed /0- % 3 Tank size /2 5-0 Compartments 2• Cleanouts (Y/N) / Foundation cleanout (Y/N) ! Depression (Y/N) High water alarm (Y/N) N Alarm tested (Y/N) Date of pumping AJC- R) SyS%E/s'l Pumper SEPARATION DISTANCES FROM SEPTIC/HGk@#dQ TANK TO: Well(s) on lot -14-100 On adjacent lots-76'/Od Foundation l5 To property line f 5V0 Absorption field f Water main/service line _ Surface water/drainage f/00 72-026(3/93)• Front CONTINUED ON BACK PAGE STATION Date installed Size in gallons Vent (Y/N) "Pump High water alarm level Meets MOA electrical codes (Y/N) _ SEPARATION DIST. Well D. ABSORPTION FIELD DATA LIFT STATION TO: Manufacturer Manhole/Access tested off" Level at On adjacent lots Surface water Date installed /0,79 Soil rating (GPD/Ft2) A Z System type Length 6/ Width 3 Gravel thickness 7's Total depth / Z / Total absorption area lam'/ S_ -Cleanout present (Y/N) Depression over field (Y/N) / v Date of adequacy test /V6: w Results (pass/fail) for Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: After test If yes, give date Well on lot f10 0 On adjacent lots f—/00 Property line f' � 0 To building foundation 05 To existing or abandoned system on lot N�� On adjacent lots -1-30 Cutbank f / 00 Water main/service line Surface water 71-/00 Driveway, parking/vehicle storage area 'G SD Curtain drain f- /0 0 E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineer's Name Date re h HAA Fee $ Waiver Fee $ Date of Payment — 7- % J > Date of Payment Receipt Number 6eln % ��—� / Receipt Number 72-026 (3193)' Back t " PAMpt "fthisinspection. % M1Fq�Y i{L3Y��;;�ss vo.q U n