Loading...
HomeMy WebLinkAboutSAMPSON ESTATES BLK 1 LT 15 ���" - .Y o, MUNICIPALITY OF ANCHORAGE cnr On-Site Water&Wastewater Program .r-ore` PO Box 196650 4700 Elmore Road r. 1 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 t httpalwww.muni.org/onsite 1),T,111111,'111 'xcHox' y. On-Site Wastewater Disposal System Permit Permit Number: OSP171057 Effective Date: 5/9/2017 Work Type: Septic Upgrade Expiration Date: 5/9/2018 Tax Code Number: 05105363000 5---13"-J 7 Site Legal Address: SAMPSON ESTATES BLK 1 LT 15 G:1561 Site Mailing Address: 22120 SAMPSON DR, Chugiak Owner: NOVY MICHAEL EDWARD Lot Size in Sq Ft: 45712 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: D Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: Ensure that final cover over field, shown on profile drawing (Sheet 4 of 4), does not extend over property line. Received By: Date: c. A6 r 7 Issued By: R_QA4,:0_,, Date: 5/7/001 7 S Municipality 01 Allo Drage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:llwww.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV171024 COSA#: Permit#: OSP171057 PID#: 051-053-63 Legal Description: Sampson Estates Block 1 Lot 15 Engineer: North Rim Engineering Applicant: Mike Novy Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 feet. In addition, your request for a waiver of the requirement that the absorption field be installed parallel to the contour lines of the slope has been approved. See engineer's letter and profile drawing for waiver justifications. 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. VI The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: 5/ / 1 -I Approved by: �)- cA rName of Reviewer **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department o + a Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel LD. a5! 053-3 Property owner(s) Navy Day phone Ca4?'5Z5/ Mailing address 0 2120 SAAA's Site address .54-�E Legal description (Sub'd., Block & Lot) Citi.,'SQaLr CS% -s $''/ t,/5 Legal description (Township, Range & Section) Lot Size 1-7(5 7/i. Sq. Ft. Number of Bedrooms 17 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (El all that apply) Absorption Field 254A Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank �Q Upgrade me/ // Duplex (D) Holding Tank ❑ ❑ Renew., 61 S • W 7i '-A Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ ApR 18 2017 Water Storage ❑ ° ti 46 c, THIS APPLICATION INCLUDES A VARIAN a4PIAlyE: QUEST FOR: ke id \\ \e c� t.n;a, c.:,AD-4( }v C.Lv, ,--( Distance: 1 bt k, r QY cv I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property own r or authorized agent) Permit/Rush Fees: 5629 Waiver Fees: 41. d Date of Payment: Date of Payment: 5/ S/ I 1 Receipt Number: OReceipt Number: 035' o 1 Permit No. O5)017165F Waiver No. c - .V ti i O L`1 Permit App_9-1-12.doc C T H I M SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 4/18/17 Number of Pages: c To: MOA On-Site Services Subject: Sampson Estates Block 1 Lot 15 Septic System Upgrade An existing bed is failing on the subject lot. A number of soil tests in the area reveal silty sandy gravel soil and no groundwater. The design calls for a new deep trench and a new septic tank. The old bed will be connected via diverter valve. A new soil test will be completed prior to construction to verify the soil; soil tests on neighboring lots reveal no bedrock or groundwater at depth. The entire subdivision is on private water wells and septic systems. The terrain slopes southeast slightly at the trench site. The system size is a single family at 4 bedrooms. A previous soil test is being used for design. Although the design test hole is not quite deep enough, there is a 17'-deep test hole to the south with no groundwater. The well logs in the area show no bedrock. Well logs reveal a deep static water table over 100'-deep. Please review the wastewater system design for the existing 3 bedroom home. I have included design plans & specs,design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks-Stev \CRTFFI M ENGINEERING SteveEng.coin Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 4/27/17 Number of Pages: 4 To: R. Carroll,MOA On-Site Services Subject: Sampson Estates Block 1 Lot 15 Septic System Upgrade Your Comments 4/21/17 A new soil test was conducted on a flat bench on the south lot line. Superior soil was discovered at this location. A trench design has been revised. The trench will follow the lot line; a 1'-lot line waiver is requested. Slopes were checked and reported on the drawing. Please review the wastewater system design for the existing 4 bedroom home. I have included design plans& specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks-Ste�� • 11. � OF1. � • t 10. ..... Arte ork. ENGINEERINGa SteveEng.com Sampson Estates Ick I itatnINS. Eng yf 1• �• p6256. t SPECIFICATIONS & DESIGN GUIDELINES If$4 4,'°" J Wastewater System Sizing: This is an existing 4-bedroom, single family home. This is a developed subdivision. These lots are large and are served by private water wells. No adverse impacts are expected from trench/tank upgrade. No conflicts to the other lots will take place by this septic system construction. The easements are located on the drawing and are not encroached upon. A new test hole revealed silty sandy soil, no groundwater or bedrock. An application rate of 1.2 GPD/FT2. Trench Length= 500 FT2/5'x 2 = 50' trench, 5' effective. A new 1250 gallon septic tank will be installed; Decommission old tank per UPC. New Diverter Valve to be installed. Slight slope in line with trench as depicted in trench profile. Cover& insulation will be added. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment,New 1250 gallon septic tank. Install Double Cleanouts. • Install Diverter Valve, Connect to both trenches; "ON" to new trench. • Decommission old tank per UPC. • 5' minimum between the tank and trenches. 10' to property lines, 14' between trenches. • 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation can substitute for l' cover. • Tank& solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock. • Drain rock to be V2 inch to 2 '/2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier(filter fabric) to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) DESIGN NOTES: s e Pt' ' 1. Total Depth of Trench is 8.5'. 2. Sewer Service Line minimum 2% slope. 3. Private Water Wells. 4. Decommission Old Tank Per UPC. 5. Lot Line Waiver To 1'. _ 6. Connect Old Bed Via Diverter V• ve. 7. Check Well Separation Prior T. Constructi. . rl d h No Neighbor j o Vu Conflicts o l- Well '100 ic o il Well '100 N 37. Slope F Q� `o N oi 4 Bdrr� ��` Slope Decommission Old Septic Tank/Crib C❑2 Cu PER UPC & Replace w/ 1250 Gallon Q Septic Tank w/ Double Cleanouts 37. Slope r a E d 0 New Diverter Existing Be l Valve i C❑1/MT 4% $lope e C❑2 ~ a 0 1 No Neighbor N TH1 s Conflicts 'c-:i / N / C-.°Fv,„,,,,,,, °'qty SAMPSON ESTATES 1" = 40 NORTHRIM *;49Ti • PLAN ENGINEERING BLOCK 1 LOT 15 ' LAYOUT Po Box 770724 • St•••� 101 WASTEWATER DESIGN Eagle River Alaska 99577 ., ce-use• 1/ r/ 907. 694. 7028 3 t7 • I UPGRADE SEPTIC 1� 5/3/17 of 3 Foundation Cleanout 7 Tank Cleanouts Fin ^amide Opposing Cleanouts Between Septic Tank & Trenches _ pd 4 Foot Cover or Equal To Diverter Valve 1250 Gallon Steel 'Anchorage Tank' Mounded Cover To Match Terrain Or Equal Monitor Tube Solid Pipe /leanout DESIGN NOTES: 1. Depth of New Trenche is 8.5'. �! 2. Septic Tank & Solid Pipe to be Placed on Compacted, 3 Stable Soil, Free from Boulders, Filter Fabric —_ 3. Sewer Service Line is Minimum 2/. Slope 8. 3' Cover. 4, Water-Tight Couplings. ft- PAWiii0 5. See Specification Sheet. ` .. .. .. .. 6. All Work To Conform to Municipality of Anchorage (AMC) ,f. touktPjea-Oj!'!'!" P Y 9 �: r`�:��'i"i' Requirements & Specifications. 5' - •.••-•_` 8.5' P= �ci=�.��: 7. Maintain 3' Cover Over Trench Or Insulate. = �'!`�''�'!`�' Drain Rock -. Pat:W I:ft 8. Lot Line Waiver To 1'. .' .:.:. .:•. 9. Install Diverter Valve To Old & New Trench. Pa !=P=!aea!=e= !.ltal:ll:l: I •. ss:•:•:•: -,_____ __.- 25 =�Pc� OF TRENCH END VIEW SAMPSON ESTATES •NORTHRIM *.49m ENGINEERING , a, SEPTIC TANK PROFILE BLOCK 1 LOT 15 77237 Bear Pow Circle $ su» e Eagle River. Alaska 99577 ‘46%-.s73-42,1(7 . s 3( .4 SEPTIC SYSTEM 907.694.7028 UPGRADE Dote: w"' �' SE r°k' i• = 5 3 of 3 5/3/17 �°'° T « DESIGN NOTES: ' 1. Total Trench Depth is 8.5'. 2. 3' Minimum Cover Material or Insulate. 3. Trench to be Level w/ washed/screened Drain Rock 1/2' to 2 1/2'. 4. 5' Minimum Undisturbed Soil Between Septic Tank & Trench. 50' - 4' Perforated Pipe CD Cleanout Plan Cleanout Monitoring Tube / olid Pipe to Septic Tank leanout Filter Fabric Perforated Pipe Level, Holes Down Final Cover Exis it GroldnQj \r---- i - . ______ 1:� ����*r�•�r��C,Ar.'•r.'•reAr��r�.r�•_r�•�re•�r�•Ar�••:-�T-�Z��r..r.yreer.„.r�•r�'�r�'yrn•er�er-w-T erT•er,'�rT•erT•er.•irw�T..ierT r`' .1.1..• 5.f ��1��1��1 � 1��1��������1��1�_1��1��1��1��1��19�1p�1p�1A�1��1��1��1��1��1��1��1��1��1�*1��1 �1��1��1��1��1��1��1: c1. ,. L. +. ,ii ce. o. cL. r1, .,i cLr 1. 1. cL. C4. i cL, ti. A. .�. �, A L. L. L L L �, L L ., 1. 1 it. ei`tair ittair-:7-it irreiaiteierirtareirei`ei` eitelic first`ei`rii`.'-� trii riatrizeittieit iYlit i it i+ZiYri[ ie ie i,,: iMinimum 6' to Bedrock, 4' to Groundwater +.."`4/.4 SAMPSON ESTATES :'`c` �` TRENCH UPGRADE IVORTNRIM =��P . ; '+++ BLOCK 1 SGT 15 ENGINEERING •* '49 �' '' '�• 77237 Pow c;��,s s PLAN & PROFILE Eagle River, Alaska 99577 -, fX 907.694.7626 441 Sy ` ( Dot. !Drown y cae: 5/3/17 IDBISli. = 5 ' SHEET:4 of 4 SF A n S❑ILS LOG - PERC❑LATI❑N TEST TFRIIVI Date Performed: 4/25/17 ENGINEERING Performed For: Mike Novy Legal Description: Sampson Estates Block 1 Lot 15 DEPTH (FEET) Organic T.H, Location: See Attached Design MR.2 - a 3 - 4 - . SM Silty Sand 5 _ w/ Gravel 6 - Groundwater? No 7 - Depth -- 8 - ::.0..±:.:. Water Depth After Monitoring.None Date: 4/27/17 + 5/3/ 11 10 - # Date Gross Time Net Time Depth Net Drop 11 - _ 1 4/25 0 -- 7' -- 12 - :. •..0. .' 2 4/25 10 10 min. 10.5' 3.5" 13 - 3 4/25 12 -- 7' -- 14 - ..%- ' 4 4/25 22 10 min. 10.5' 3.5' 15 - 5 4/25 25 -- 7' -- 16 - 6 4/25 35 10 min. 10.5' 3.5' 17 - 7 4/25 37 -- 7' -- 18 - 8 4/25 47 10 min. 10.5' 3.5' 19 - 9 4/25 S0 -- 7' -- 20 - 10 4/25 60 10 min. 10.5' 3.5' 21 - Percolation Rate 3 min./inch Perc Hole Diameter 6" Test Run Between 3' and 4' Comments: Presoaked. Measurecl to nears . • a a Performed By NorthRirm Frig. I CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect DN THIS DATE. DATE: 4/25/17 tc.77 i NORTHRIM ~4 TESTHOLE LOG I TH1 ENGINEERING ••• • PO Box 770724 .• see 't dif Eagle River. Alaska 99577 907.694.7028 GE❑TECHNICAL Ot*. EU: 4/27/17 1 MUNICIPALITY OF ANCHORAGE p 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 NEW 'Alent5 3/1 UPGRADE MAILING ADDRESS+ Y/01 (Ael- N C�I�CG tF '• j%siU LEGAL DESCRIPTION "�l ii 3L -�� j irtl�Son� Sir 5 %!Sr✓ i�'ib� �(� 3 LOCATION NO. OF BEDROOMS % f/L ez v (74i=i✓ Wellv � f Absorption area f Dwelling / PERMIT NO. !dI Y DISTANCE TO: j/ � rj >U i¢ w I- Manufacturer �3r��ffuf,'i:�yC `T�'i✓iC Material S'% �e:L No. of compartments i2. y Liq. capacity in gallons /7 ® IF HOMEMADE: Inside length Width Liquid depth ❑ Y DISTANCE TO: Well Dwelling PERMIT NO. J � Z O Z a 2 — F- Manufacturer Material Liquid capacity in gallons ❑ DISTANCE TO: Well �j.j Foundation s - �n Nearest lot line , % C1 PERMIT NO. :?C) w 2 J LL Z No. of lines(_ nth of each ine Tgtal length of lines Trench width r Distance between lines F Z Lu / 7 7 � jf� 3@ inches ccp Top of tile to finish grPd _- -- Material beneath tile // Total effective absorption area • ® �3•,S 'r %''fes `'�" �J inches `� 0 Length Width Depth PERMIT NO. w Q I•- Type of crib Crib diameter Crib depth Total effective absorption area as w y Well Building foundation Nearest lot line DISTANCE TO: J Class L Depth Driller Distance to lot line PERMIT NO. J Lu 3:DISTANCE TO: Building foundation Sewer line Septic tank; Absorptionarea(s)ii OTHER ELL PIPE MATERIALS Pb* WAA Od ' o City1 /tZc l 4 iii✓[ � ! 7J Y SOIL TEST RATING INSTALLER REMARKS .� ��� IN�jl9l-ii / /C;sl L7✓ '/l%i�/C M i , Ci9zu� Crrafi:iJC�s exl ;Nlzz� a�r'r� r %� _ r or i a a' 2 Ali _ &/ Bo APPROVED DATE LEGAL LJLOC'K' j _5IH-11°S6 4 �9,%� 1 1 C- :1 9,:­� #E4 L__ *.1, -y' *4,e' C11 F:,-- �������Fz:z e-:4 t -3 ff=.-- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 C-3 N1 ����� ���%���� � W IFEE L_ L_ F F:Z M I "'T" ' PERMIT NO: DATE ISSUED: 'APPLICANT: ADDRESS: CONTACT PHONE - 8504O9 07/12/85 LARRY H NEAS 4901 CARLYN CIRCLE ANCHORAGE, AK 99516 346-2471 ' M LEGAL DESCRIP: SUBDIVISION.- SAMPSON ESTATES LOT: 15 BLOCK: 1 SECTION: 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 45712 (SQ.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you in designing your septic system. Choose the option that'best fits your site. -F FR FE M C7_ I -A E� F-7 n W 13 FR dc� I M DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 5.5 0.5 3°5 TOTAL 'DEPTH (FT. > 9.5 4.5 7.5 GRAVEL WIDTH (FT.) 2"5 ^ 30"0 5°0 GRAVEL LENGTH (FT.) 130.0 ** 50,0 153"0 ** GRAVEL VOLUME (CU. YDS. 72.3 64"5 113.4 TANK SIZE (GALS) 19250^0 ** 1,250"0 ** 1,250,O ** SOIL RATING (S("?"FT. /BR) 355 287 ` 355 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT" EACH) *� TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of' Alaska. _ 2. I will install the system in accordance with all MQA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MO� and State o� Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4. I understand that this permit is valid for a maximum of' 4 bedrooms and any enlargement will require an additional permit. ' IF A LIFTSTATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES�� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APWITHOUT INSPECTION REPORT; AND (3) THE ELECTRICAL WO ED ELECTRICIAN. SIGNED � DATE APPLICANT: LARRY 11 NEAS ISSUED BY DATE: POUuH 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 F 56, L� 0 TONY KNOW1 F.S. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840854 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 15 Block 1 Sampson Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, h E Bandt S�sor Keit p Environmental Engineering Program KEB/ljw enc: Copy of Permit SwP/057 ^' - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, � 99501 264~4720 ��i-.:; :.tr- --H­� ����EE 11:�-< §n!--� ���.... L_ ����X '-IF' PERMIT NO: 840854 DATE ISSUED: 10/05/84 � APPLICANT: LARRY H NEAS ADDRESS: SRA 1727AA ANCHORAGE,, AK 99516 CONTACT PHONE: 346�2471 LEGAL )Dr -.-.SCRIP- SUBDIVISION: SAMPSON ESTATES LOT: 15 BLOCK: 1 SECTION: 3 TOWNSHIP: 151\1 RANGE: 1W LOT SIZE: 45712 (SQ.FT. OR ACRES) MAX BEDROOMS: 4 ` Listed below are the available to you in designing your septic system" Choose the option that best �its your ,��������������������^ site" ��[F�. EE V-41 IFE-'; P. -I �D: 1E Uy, LIAT= liEPTH TO PIPE BOTTOM (FT. > 4.qV ~,0 4.0 4"0 GRAVEL DEPTH (FT.) 5"5 6^��, 0.5 3,5 TOTAL DEPTH (FT') 9^5 61; /' 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 2.�^ 30.O 5.0 GRAVEL LENGTH (FT") 130"0 **//0.0� 58"0 153"0 ** GRAVEL VOLUME (CU"YDS.) 72.3 ~~- 64.5 113.4 TANK SIZE (8ALS) 1,250.0 **0��/ 1,250.0 ** �1,250.0 ** SOIL RATING (SQ.' T./BR) 355 J�fo 287 355 ** GRAVEL LENGTH > 75 FT" REQUIRES MULTIPLE RUNS(NOT EXCEEDING 75 FT" EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS .... .... ... __�~��� I certify that: I. -I am 1'amiliar with the requirements for on­­�ite sewers and wells as set ^ �orth by the Munictpality�o� Anchorage (MOA)` and the State of Alaska. 2" I will installthe system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permi-L. , 3" I will /adhere to all MOA andState of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on thi� or any adjacent or nearby lot. 4" I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES� THEN (1) AN ELECTRICAL BE OBTAINED; (2) AS~BUILTS wI[ILL. NOT BE ION REPORT; AND (3) THE ELECTRIC ECTRICIAN" SIGNED ` ^�~ DATE: ----- M � _ /.�� �� --�--`---�-~ APPLICANTn LARRYH NEA��/ ISSUED BY DATE; ....... ... ... ... ~�...... ��_~~~^~����~,�~ r SOILS LOG MUNICIPALITY OF ANCHORAGE ` "� ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION L� PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: I—CAr'ry NC�aS DATE PERFORMED: apt 2,6 t -j LEGAL DESCRIPTION: Ek f-zkS B. 1 `c `t' 15 TH —I E T SLOPE SITE PLAN 1 F I I E) fi� vrq U.411c Stn t q C 2 e71Y1 z; 14%,j sc"J`t Irnvel 3- 4 - `n - je-�s' o� cvbt+ie51 (�o.,ic�efx 5 � � iZclfEo �►"} 23©qz%� 4 T 6 7 f 8 ti M c 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER S ENCOUNTERED? 00 L O P IF YES, AT WHAT E DEPTH? cJeej a ICVTCc 4 \- t- 5-10°/0 .V I' fi so/, Reading Date Gross Time Net Time Depth to Water Net Drop j -Z� 1 a1 t 3 t125` 11 .137 ©� 11 Loy _ r TS GG z t [ Y -2-n,meq 3 ."-9-G •03 /zt fr 10 PERCOLATION RATE !t (minutes/inch) TEST RUN BETWEEN FT AND '� 5 FT -7,0/3-s- , sq 'tecl g z 6C>L7 'IL ��PERFORMED BY: �orc �• (%�} ST£3 `-r CERTIFIED BY: 4(/1 72-008 (6/79) DATE:10,41 sk/. 5 J J kr 7 r O a w J 0 0 0 0 0 w w ri w w / /p 0 yV/�i of 00 w w w ri. w 0 0 0 0�• o a a a z oa w w w w w I MUNICIPALITY OF ANCHORAGE ' •DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date �L 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or d r (b) Applicant Name 1_ hth y Akx) t Telephone: Home_ 13�� -/-e/7/- Business Applicant Address ll; 0/ 6WI- `AI elk- ®m'elf`l // ' 9� (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,; Buyer ❑ ; Other ❑ (explain); (d) Lendinglnstitution e ���// //��-r..Telephone Address (e) Real Estate Company and Agent Address Telephone - 1 1f 7 (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY 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: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11184) Page 1 of 2 C}� 5. ENGINEERING FIRM PROVIDING-ASPECTIONS, "PESTS, FILE SEARCH, DAI AND IP1FpRMA7i(3" � As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investic7aunr, 6i tt Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional for the number of bedrooms and type of structure indicated herein. I further verify that based on the informa001, c lnl. from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supt;(y , { wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in the date of this inspection. ` / s /a�ct��/ - � V7Z'?L kle. Telephone goS�O Name of Firm � 2. Address /?r77 G:.% -- Date 01 1�4,RLID 0 0r 6. DHEP APPROVAL IZZ Approved for bedrooms by � Approved Disapproved Terms of Conditional Approval v ,roy ineer's Seal °d/ No. 2251 -IE g FESSIO�-�`4 Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. 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. Page 2 of 2 72-025 (11/84) (� ni MUNICIPALITY OF AN MUNICIPALITY OF ANCHORAGE (MOA) ENVIROPTy A OFALIN& HEALTH AUTHORITY APPROVAL (HAA) ION CHECKLIST - FEBRUARY 1984 utC 0 2 two 264-4720 ,gyp Legal Description: 1—% 5� 15/ rr n 775-4/ ZI /t/J SSC A. WELL DATA %If A, B, C, Well Classification D.E.C. Approved (Y/N) Well Log Present(Y N) Date Completed T `5 Yield Total Depth 1 ' / Cased to X37 / Depth of Grouting Static Water Level Pump Set At .✓ .�9 i Casing Height Above Ground Z �� Sanitary Seal on Casing N) (Y Electrical Wiring in Conduit) Separation Distances from Well: T Se tic/Holdin Tank on Lot Depression Around Wellhead (Y(9 T- On Adjoining Lots 33 To Nearest Edge of Absorption Field on Lot �; On Adjoining Lots To Nearest Public Sewer Line )�� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by fT€CS / R ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed %-/%-��� Size )7-5C) 61�tNo. of Compartments Standpipe (Y ) Air -tight Caps(q) Foundation Cleanout(ON) Depression over Tank (Y& ` Date Last Pumped — --�/� Pumping/Maintenance Contract on File (Y/N) �!/� for N Holding Tank High -Water Alarm (Y/N) /�IA Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i To Water -Supply Well —%/J! To Building Foundation To Property Line Z-6 To Disposal Field To Water Main/Service Line W114 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) `rSbi,5maJ��`%- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 287 Type of System Design CEJ Length of Field J 4 Depth of FieldC / ll ✓ / Gravel Bed Thickness U• Square Feet of Absorption Area Standpipes Present (Y/ ) Depression over Field (Y N) Date of Last Adequacy Test Results of Last Adequacy Test �✓� Separation Distance from Absorption Field: To Water -Supply Well / 33 / To Property Line / To Building Foundation 50 To Existing or Abandoned System on Lot ��/ir / ; On Adjoining Lots�— To Water Main/Service Line Nf To Cutbank (if present) •✓% To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 30 Comments 0) W71� a>' 2W Y*040 bVC -737 Of 4e7—. D. LIFT STATION A ®v Date Installe Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pum Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hh ked, v rifled, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 0--Z- C�s 7 -Company's S MOA No.� Receipt No.�! ,5�� �5--°{{{{{aso{e{o°eee�fiD Date of Payment r� + °° �� �' Amount: $ S ®fir; �qy $ °° ,,Engineer's Seal A •ems }, Y {0{0090{ OZ{{e 0000 • • ° { 6� r7 r �® oy C. Rei Page 2 of 2 a .A �cP�(o_ No. 2251-E °a•,6y ' 72-026(11/84) CHEMICAL & GLJLOGICAL LABORATORIES %,Y%ALASKA, INC. l , TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 • :% ...ow�mmu Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D.# PRIVATE WATER SYSTEM. Name Phone No. Mailing Address tlwC4 - - I I Saj City State Zip Zip Code SAMPLE DATE: 2 11 7 I Mo. Day Year SAMPLE TYPE: 'M Routine ❑ Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water ❑ Special P-urpose-- - - ---- - Y�l Untreated- Water - SAMPLE Time Collected NO. LOCATION Collected 1 1/- 15- a / 2 3 1 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water.S-A-MPLE-to-be: A'Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. Result* Analyst �B-- 11309 -SIII DA LJ m U m - -J m U m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: LTB Final Membrane Filter Res)ts. Reported By TNTC = Too Numberous To Count OB = Other Bacteria Collforml100ml BGB Collfo 1100ml Date r 0 77 Time: a.m. p.m.