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Home My WebLink AboutSECLUDED HILLS BLK 1 LT 1Onsite File Secluded Hills Block 1 Lot 1 #017-343-01 The 1985 drainfield can only be tested for a 3 bedroom conventional septic system approval Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211213 PID Number: 017 343 01 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name STONE ABSORPTION FIELD ❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 13200 BADGER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 0.8 GPD/SF 11.1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.8 Ft. Gravel depth beneath pipe 7.3 Ft. Subdivision Block Lot SECLUDED HILLS L1 131 Fill added above original grade 1.9 Ft. Gravel length 67 Ft. Township Range Section Gravel width 2 Ft. Beds: Number - of Lines Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 938+ Ftz - - Ft. Well +100 +100 - _ +25 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water + 100 +100 _ _ Material Number of compartments Lot Line +5 +10 - - NA PLASTIC 2 Foundation +10 +10 - _ LIFT STATION Manufacturer Capacity Remarks LOT LINE WAIVER NOT NEEDED DUE MORE FAVORABLE — _ Gal. TOPOGRAPHY THAN INDICATED BY MOA CONTOURS Alarm location Electricpl installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer GUARANTEED SERVICES Drainfield CO/MT 3034 Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspection15t 7/2/21 nd 7/3/21 dates:2 Location and description 3`d 7/7/21 41n 7/8/21 top of tank I i d ON-SITE WATER AND WASTEWATER SECTION APPROVAL 7/11/21 Engineer's Stamp OF A`'9& Conditional Approval: Date r f49 — •. ..� .... ..�..rr r •• . Septic System � CHARLES G BALZARINI Approv v-, �, `— Date t7—r��F�i�• CE-13854 .•�� 11�1� PROFESSIONPti� Note: this approval does not include well permit requirements. kmuv uoiuu 1 a) / F 67' DEEP TRENCH W/ TEFF i I TRENCH ALIGNMENT MODIFIED TO _ BETTER MATCH FIELD CONDITONS AFTER CLEARING EXISTING FIELD SUITABLE FOR EMERGENCY USE ONLY. MAY SERVE AS RESERVE SITE W/ AWWTS (ALIGNMENT UPDATED SWING TIES A B C 57.9 11.8 D 48.4 25.7 E 45.8 30.6 F 41.2 35 G 39.7 36.7 HI 28.4 1 37.7 1 14.7 67.2 J 48.3 83.4 KI 50.4 84.9 OF A�,4l � c ,® � .. ... .��... �j CHARLES G BALZAR141 �61CE-13854 • ' \zz AW ��F� pROFESSIONP�'. X00 10' UTILITY EASEMENT BASED ON FIELD DOUBLE CLEANOUTS OBSERVATIONS) (DIVERTER NOT INSTALLED) 1 I � I PERC NEW PVC EXISTING WELL PIPE SECLUDED HILLS L1 B1 4 GF C-F—L-1 I H 1 — TESTHOLE g (—"""_------- A 5 -BEDROOM HOUSE DRIVEWAY NEW 1500 GALLON POLY TANK INSULATED RISER AT FIRST CHAMBER LEGEND INSTALL PER MOA AND MANUF'R \ O CLEANOUT REQUIREMENTS ro MONITOR TUBE ® TEST HOLE PLAN - SCALE: 1" = 30' BM:+100.0' TANK LID MONITOR TUBE FILTER FABRIC 97'9 FINISHED GRADE 5.2' �, COVER ORIG. GRADE 92.2 INVERT 84. 4'0 DISTRIBUTION PIPE 84.9 4' EFFECTIVE SEWER ROCK SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY TESTHOLEI 96 GROUNDWATE NO GWT(7/9121) 78.9 SCHEMATIC ELEVATION - SCALE: NTS LEGAL DESCRIPTION: SECLUDED HILLS LOT 1 BLOCK 1 C&M ENGINEERING SERVICES OWNER: STONE DATE:7/11/21 REV: 1 I DRAWN: CB I REF: 907-854-5558 SEPTIC RECORD DRAWING Performed For: STONE Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Soils Log - Percolation Test Legal Description: SECLUDED HILLS L1 131 ��2, NGINEER' 4001 EA ® CM ' •:9' �*:49TM •. , d CkARLES G BALZARINI �0, CE -13854 ••`� PROFESSIONP� Date Performed: 07/11/21 Township, Range, Section: WAS GROUND WATER ENCOUNTERED? NO 5 IF YES, AT WHAT DEPTH? NA L Depth to Water After P P Monitoring? None E Date: 7/9/21 14- NETTIME READING DATE 15- 3:33 1 7/2/2021 0 0.0 2 7/2/2021 16- 5.5 3 7/2/2021 17 - BOH 4 7/2/2021 18- 4:34 5 7/2/2021 19- 5.6 6 7/2/2021 20- 0.0 7 7/2/2021 5:05 8 7/2/2021 5.5 Site Plan GROSSTIME NETTIME DEPTH TO WATER NET DROP 3:33 0 0.0 4:03 0:30 5.5 5.5 4:04 0.0 0.0 4:34 0:30 5.6 5.6 4:35 0.0 0.0 5:05 0:30 5.5 5.5 5:06 5.0 5.0 5:36 0:30 5.5 5.5 PERCOLATION RATE 6 (minutesfinch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS PERFORMED IN ACCORDANCE WITH MOA REQUIREMENTS NOTE GWT MONITORED TO 15.5, IMPERMEABLE VERIFIED TO 17.1+ PERFORMED BY: C&M ENGINEERING ( CHARLES BALZARINI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 07/01/21 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: OSP211213 Work Type: Septic Upgrade Tax Code Number: 01734301000 Site Legal Address: SECLUDED HILLS BLK 1 LT 1 G:2937 Site Mailing Address: 13200 BADGER LN, Anchorage Owner: STONE GREGORY G & SHERRY A Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: 0 r• �v t) e l) it r C Yi7 ell t Lot Size in Sq Ft: Total Bedrooms: 6/22/2021 6/22/2022 56087 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: A test hole is required prior to construction of the absorption field (in the location shown on the site plan). Test hole shall demonstrate minimum separation to impermeables, seasonal high groundwater and shall confirm percolation rate. Construction may proceed at your own risk prior to taking the 7 -day groundwater reading, but 7 -day reading shall be noted on final soils log. If results require a design change, construction shall stop pending Onsite review and approval of a change order. Please submit results with the record drawings (or change order, if required). Received By: Date: Issued By: Date: �20,') 1 v. t. Municipality of Anchorage v P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section KxxX VARIANCE/WAIVER x* *x Waiver#: OSV211040 COSA#: Permit#:OSP211213 PID#: 017-343-01 Legal Description: Secluded Hills Block 1 Lot 1 Engineer: C&M Engineering Applicant: Gregory & Sherry Stone 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 2.0 feet. See engineer's waiver request for 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. ■aaaaasaaasaaaaaaaaaaaaavavaaaaaaaaaavaaaaaaaaaavaaaaaaaamaaaaaaamasaaaamaa20MI Waiver is Granted: X Waiver is not Granted: Date: to a a Approved by: C9 � � Name of Reviewer ■saavmvaaasaesaaaasaaaaaaaavaaaaasasaeaaaavaaaaaaaseaamaaaaaaaaasasaaavaaaamami Parcel I.D. 017 343 01 Property owner(s) STONE Mailing address ON-SITE SEPTIC/WELL PERMIT APPLICATION Day phone Site address 13200 BADGER ,_ N 10-S Legal description (Sub'd., Block & Lot) SECLUDED BLOCK 1 LOT 1 Legal description (Township, Range & Section) Lot Size 56,087 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: (® all that apply) Absorption Field 0 Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade 0 Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: drainfield to lot line TYPE OF DWELLING: Single Family (SF) El (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: 2 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: & 5% 5 Waiver Fees: 5 Date of Payment: (gill 6a0'� l Date of Payment: Receipt Number: ®Y 7 3 8' 6 Receipt Number: d (04 1) Permit No. U.SPQ %� 13 Waiver No. 0 9j 1d q O GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for Secluded Hills Lot 1 Block 1 Dear Reviewer, The above referenced property is currently served by an older failing and undersized septic system. The owner wishes to install a new 5-bedroom septic system. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. We are requesting a separation distance waiver between the lot line and the proposed drain field of 2’. This will not impact development of adjacent lots due to the large lot size and adequate separation between system locations. A testhole will be excavated during or prior to construction to verify that the soil conditions identified on the historic soils log are accurate. In the event of changed conditions, we will contact the department with an amended design. Contours shown on the drawing are in 1-foot intervals based on data made available by the MOA. The ground slopes downward to the Southwest at the septic location. The existing system may be connected by a diverter valve. It is only sized for 3-bedrooms, so it will not be suitable for long term use or for COSA purposes, but provides an option for emergency use. Included with this letter is a permit application and design package, including plans, specifications, calculations. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211213, Rebecca Carroll, 06/22/21 Residence: number of bedrooms 5 br Water usage/bedroom 150 gpd/br Water Usage 750 gpd system type: CONVENTIONAL type: SHALLOW TRENCH Application Rate 0.8 gpd/sqft required absorption area 937.5 sqft trench width (W) 5 ft gravel depth (D) 7 ft below distribution pipe Min Required Length: 66.9642857 ft Total Excavation Depth: 10 ft Cover 3'+ or 2' min plus insulation Effluent Pipe: Calc By: CGB Date: 6/1/2021 C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations SECLUDED HILLS LOT 1 BLOCK 1 RESIDENCE/LOT INFO DRAINFIELD 4" ASTM 3034 BASED ON SECLUDED HILLS L2 B1 SOILS LOG PERFORMED IN 2020 **DIMENSIONS FOR REFERENCE ONLY. SEE PLANS FOR DIMENSTIONS TO BE USED IN CONSTRUCTION** Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211213, Rebecca Carroll, 06/22/21 &) OSP211� \ j; �49 TF NCHARLE% r �� F� • CE FD PRI CONTOUR ACRES #4 LOT 10 67' DEEP TRENCH W/ 7' EFF MAX EX DEPTH / EXISTING FIELD SUITABLEK'00, \ _ FOREMERGENCV USE q� ONLY. MAY SERVE AS (( "�O 10' UTILITY EASEMENT RESERVE SITE W/ AS WTS _ �1 / \ D � HISTORICAL TESTHOLE \ 0 1' CONTOURS BULL RUN DIVERTER VALVE m DOUBLE CLEANOUTS .Z7 DEMOLISH OLD TANK PER MOA REQUIREMENTS PROPOSED I -- TESTHOLE SECLUDED HILLS L1 B1 EXISTING WELL EX TO 16' 14 _ rZ 1 �EW 1500 GALLON POLY TANK \ W/ INSULATED RISER AT FIRST CHAMBER INSTALL PER MOA AND MANUF'R 5 -BEDROOM HOUSE I DRIVEWAY REQUIREMENTS I �1 i SEE SITEPLAN FOR DETAILS C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: SECLUDED HILLS LOT 1 BLOCK 1 OWNER: STONE DATE: 6/10/21 1 REV: 0 1 DRAWN: CB I REF: AREA PLAN LEGEND r F "`�� """` A Q CLEANOUT 0 MONITOR TUBE I /�Co OSP211213, ' NOTE: *•49 H •••* THE PROPOSED SEPTIC SYSTEM MUST BE INSTALLED GREATER THAN: •-- • •_ 100' FROM ANY PRIVATE WELLS CHARLES G BALZARINI`� 200' FROM ANY PUBLIC WELLS / �+jj�FO, • CE -13854 •�, 2oT0 THE PROPERTY ERTY INE 'FROM ANY SURFACE WATER 1 �J%F� • . , 6/5/21 • • ' �� 14' BETWEEN THE DRAINFIELDS FloPROFESSI*' 5' TO ANY TEST HOLES 10' TO THE HOUSE FOUNDATION CONTOUR ACRES #4 LOT 10 67' DEEP TRENCH W/ 7' EFF 10' MAX EX DEPTH EXISTING FIELD SUITABLE \00" FOR EMERGENCY USE ONLY. MAY SERVE AS \ < ��O 10' UTILITY EASEMENT RESERVE SITE W/ AWWTS _ S,— W HISTORICAL TESTHOLE 1' CONTOURS BULL RUN DIVERTER VALVE m Q� DOUBLE CLEANOUTS �7 \\\ DEMOLISH OLD TANK PER \\ I MOA REQUIREMENTS PROPOSED TESTHOLE SECLUDED HILLS L1 B1 EXISTING WELL 2'- I . EX TO 16' 2 .6' 26.4' NEW 1500 GALLON POLY TANK I W/ INSULATED RISER AT FIRST CHAMBER INSTALL PER MOA AND MANUF'R 5 -BEDROOM HOUSE I DRIVEWAY REQUIREMENTS � I I I \ J C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: SECLUDED HILLS LOT 1 BLOCK 1 OWNER:STONE DATE: 6/10/21 1 REV: 0 1 DRAWN: CB I REF: SITE PLAN 04/_15/1991 21:03 2746427 _......• � , • • ,— l0 � UTI � yiMY ___ Yap)" _..:.......... .IJ ba I. . MUM 161 1,.' :1 DRS DERKSEN STONE O0� .I c iWCLL I�' `� °o U If, .0 A ; N NON495 I Vic IV i„ n iG i I _.._,... :.�............ i EASEMENTS 13:1 OTHER THAN CO�OFIMI nM." •••' i ...... _..:.......... .IJ ba I. . MUM 161 1,.' :1 DRS DERKSEN STONE O0� .I c iWCLL I�' `� °o U If, .0 A ; N NON495 I Vic IV i„ n iG i I PIMA i1,0. 1 ; r Olt1 01 JF V " W. f • t1t' I. • ' ' r PIMA i EASEMENTS OF RECORD, OTHER THAN CO�OFIMI nM." •••' TH64 SHOWN ON :THE. RECOROttb PLAT' ARE NOT SHOWN HEREON, fi'dF.1 b;'-1GR i k'�70,on� G s ZG.7G' PAGE 02 V a J ; AS -BUILT NO CORNERS SETT THIS DATE 1 hereby certify that 1 have performed a Moetageere In spectlon of the following described property: + I _ a6G�UtiET� fl/L'L�r . S•U/✓U/t// �r_�_riL Anchorage Recording Precinct, Alaska, findthatthe Improve not overlap or encroach on hetpiropertyplyingeadjotoent tt er ,to, that no ImProvements on property lying adjacent thereb encroach on the premises In question and that there are It roadways, transmission ilnes or other visible easements In said property except as Indicated hereon, Dated of Anchorage Alaska • ' ' " thio '�%TII day of JULY t9 '� i 1 • ''"M WALATKA dr ASSOCIATE: •^:a and Surveyors I 1,3 I Ve�T 10,0 F, b T AS -BUILT NO CORNERS SET. TI � `N 1t I hereby certify that I have sere ,spectioOn of the Ifollyo�wing describe L % � o �� I � •— Anchorage Recording Precinct, E I v , .o 6t r k, o, &,CAVU1 'ments situated thereon are with &106-r/ 1, euVL- Npd�r vK/V not overlap or encroach on the I to, that no improvements on pre IDII� 4 h��Y.P�.0l vK NI il,i.�h.'I' LIE .,.� encroach on thei premises in qu t' Aa L:! roadways, lines or •-- _ ^� ' �� s�A,je 1�� `,� �P '� T AS -BUILT NO CORNERS SET. TI this ,tel 71 day. of UL EASEMENTSOF RECORD,: OTHER THAN 4Q M04ns -,m THdSE SHOWN Ot THE RECORDED ED : ARE NOT HEREON. PL T i DATE rrormea a w, property: ska, and that the improve - the property linesand do party lying adjacent there- !rty lying adjacent thereto ;ion and that there are no then visible easements on .reon. I 19h 'ILA & ASSOCIATES Surveyors !i � a I hereby certify that I have sere ,spectioOn of the Ifollyo�wing describe L % r, Anchorage Recording Precinct, E 'ments situated thereon are with not overlap or encroach on the I to, that no improvements on pre encroach on thei premises in qu e� Pr �N+8,!5 �' roadways, lines or •-- _ ^� ' �� s�A,je 1�� `,� �P '� said property ert except Date d atAnchorage,apt as indicated Alaska this ,tel 71 day. of UL EASEMENTSOF RECORD,: OTHER THAN 4Q M04ns -,m THdSE SHOWN Ot THE RECORDED ED : ARE NOT HEREON. PL T i DATE rrormea a w, property: ska, and that the improve - the property linesand do party lying adjacent there- !rty lying adjacent thereto ;ion and that there are no then visible easements on .reon. I 19h 'ILA & ASSOCIATES Surveyors !i MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF f-IEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 87.5 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME _ PHONE EW ?e/S_ ,(G.�-, ❑ UPGRADE MAILINGADDRESS LEGAL DESCRIPTION hi, i/ % '-e L4-' rem_ ,51 LOCATION NO. OF BEDROOMS DISTANCE TO: Well lel/ Absorption Dwelling / 7 / PERMIT NO. c� Y 10 F- Z Manufacturer Material No, .of f compartments LU N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth Y J DISTANCE TO: Well Dwelling �s PERMIT NO. 0 H Manufacturer Material Liquid capacity in gallons O � x DISTANCE TO: Well /61/ '- Foundation / � Nearest lot line /0./- PERMIT NO. � �% d ,�"Fj� w � u z No. of lines / Length of each line 'Y Total length of lines Trench width Distance betyy��een lines F Z w / ,j d" inches /✓!6! N Top tile to finish / Material beneath tile Total ¢ of grade LL"" / effective absorption area Length Width Depth PERMIT NO. t7 Q Type of crib Crib diameter Crib depth Total effective absorption area Yw a ,Ljuj Well Building foundation Nearest lot line DISTANCE TO: J ClassDepth ! 6Av Driller Al-� Distance to lot line .-< PERMIT NO. Lu � DISTANCE TO: Building foundation t. Sewer line /O '� Septic tank lGU Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RATI l`jG p= " I 5_ 5p INSTALLER REMARKS /f 1: s L c:. -A /} •i . f' 43 a 4e�l CAfi'r my / /.ZJ @G�f/c1. �[�` orfl' 'k fe- CIO, ./[ �Z e�• Y° V. V l-�r,/�/ �L 1i11i� /i1P.•i 1-h rrlM.11f, ��"� V'C�iY"f/ /l�C N.J%i9 /qf<! !S t (/ yk )j 1 r -Lr, Co PPROVED DPTE LEGAL y�P Cof/ G.a/Ll/ .Sec Aet l //i2Zt 72-013 (Rev. 3/78) ' / / M -W DRILLING, Inc. P.O. Box 10.978 • 10300 Old Seward Highway 84-238 (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner GREGORY S11�NE DDS Use of Welllilnestic _ Location (address of: Township, Range, Section, if known; or distance main road Lot 1 Block 1 Secluded Hills Subdivisim - Anchorage - Size of casing— " Depth of Hole 600 feet Cased to--311L--feet Static water level 177 ft. ) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( X )• Describe screen or perforation Perforate between 198' to 180' 4 sides all the way Well pumping test at gallons per (minute) fox 1 hours with— —l�G% ¢� of drawdown from static level. Date of completion -1st 15,1984 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness _ 0 TO 2 Casing stic 165 TO 2 TO 3 OrganicsMUNICII �� men.- 3 57 Silty sand DEPT. OF HEALTH & PROTECTION + _ TO wtme _ 57 TO 88 Silty sand & gravel —h pQ 1 2 196 88 TO 115 Silty hardpan _ 115 TO 123 _ 123 TO 165 165 TO 180 180 TO 198 198 TO 218 218 TO 223 223 TO 261 261 TO 262 262. TO 290 _ 290 TO 310 310 TO 600 Silty sand Gravelly hardpan — Siltyyhardpan _ Weeping hardpan Boulder Certificate No's. 814 & 073 _ Silty hardpan _ Bedrock - Few water seaps in sproadic fractures 1 —CUSTOMER MUIP4 I C."; I 1--"nL- I -Y'Y DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, Al,*' 99501 264-4720 c3p141---.--!E--; I �E--rvJFFF:Z 31.' "ll-, PERMIT NO: 840564 DATE IS5UED: 07 /11 /84 APPLICANT: GREGORY G1 -ONE ' ADI RESg: 2937 KIMBERLIE ANCHORAGE, AK 99502 CONTACT PHONE: 272-5506 LFEGAL DEgCRIP: SUBDIVISION: SECLUDED LOT. 1 BLOC{:1 SECTION: 27 TOWNSHIP: 12N RANGE: 3R LOT SIZE: 2A (SQ. FT. OR ACRES) MAX BEDROOMS� 3 'Listed below arethe options available to you in designing your septic system. Choose the option that best fits your site. �~FR��V4 C_-,: 11--i jF-1:��X3 K^W][104 DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4,0 GRAVEL DEPTH (�T.) 5^0 0.5 35 TOTAL DEPTH (FT^) � 9"0 4.5 7.5 GRAVEL. WIDTH (FT.) 2.5 17.0 5.0 GRAVEL LENGTH (FT") 3a°0 34^0 41.O GRAVEL. VOLUME (CU.YDS.) 1g.3 21^4 3O.3 TANK SIZE (GALS) 1,000,0 ** 1,000"0 ** 1v000.0 ** SOIL RATING (GQ,FT. /BR) � 125 125 125 ** TANK MUST HAVE ATLEAST TWO COMPARTMENTS I certi{y. that: ^ 1. I am familiar with the requirements for on-site sewers and wells as set ' forth bythe Munici`ality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in ciccordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will, adh*.lrea to all MOA and State of Al�--kska for thci� bark distances from any exiSting well, wastewater disposal system or public sewerage siy5tc.m on this or any adjacent on nearl-,)y lo -L" 4" I understand that this permit is valid for amaximum of 3 bedPooill s 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 PERMIT AND INSPECTION MUST BE OQTAINE8; (2) AS-DUILTS WILL NOT BE Ai -PROVED WITHOUT AN ELECTRICAL'INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY H LICENSED ELECTRICI8N, SIGNED DATE- .. ATEx ` _ APPLICANT: GRE8[]RW STOIE ISSUED BY / DATE: SOILS LOG MUNICIPALITY OF ANCHORAGE +.., DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 'i TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: (,/-L L• G T o1y L DATE PERFORMED: r Ll LEGAL DESCRIPTION: �' (.0 [J L D N DEPTH SLOPE SITE PLAN (FEET) fJ P, 1 2 3 r 4- 5- SA..G�l � 6 - 5 T/ji C� 17 7 8- 9- 10- WAS GROUND WATER FJ 11 ENCOUNTERED? �g -S 12- F1 IF YES, AT WHAT DEPTH? 13- S L 0 P E Reading Date Gross Time Net Time Depth to Water Net Drop 20 r' PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN - FT AND --_ FT COMMENTS T/LOG'fT/J Y'/Jt /L4 a C /-t to /J['/J%!J %O r7 /DEP7N PERFORMED BY: GA A,)' ' l`I L/2 Lt1ll CERTIFIED BY: �`A"-�v DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department ' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 017 343 01 1. GENERAL INFORMATION Expiration Date: % a ` 1-3-z/ Complete legal description SECLUDED HILLS L1 131 Location (site address) 13200 BADGER Current property owner(s) STONE Mailing address Real estate agent 2. TYPE OF DWELLING: F-1 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic FX_1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: N O N E Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 2 4- 1613 Waiver Fee $ Date of Payment 7-1 Z" Z Date of Payment Receipt Number 03 Z(z;,g Receipt Number COSA # 0.x,2 1 15 O' ( Waiver # 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 7/8/21 A P� �F A.�sl�� i co i49 TM / 6. DSD SIGNATURE •• •••• •�•••• I System #1 Approved for � bedrooms r� ' ' ' ' ' ' ' ' / Z;HARLES G BALZARINI / System #2 Approved for bedrooms ��F��. CE -13854 Disapproved (illi PROFESSIONP� Conditional approval for bedrooms, with the following stipulations: /JJ 1))))111 By: 1N.- Original Certificate Date: 3-21 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. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet J ON-SITE `cam' ATER ��nrrn AAlrl , �- m — �� WASTEEVATER z J� PROG(,A /JJ 1))))111 By: 1N.- Original Certificate Date: 3-21 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. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: SECLUDED HILLS LOT 1 BLOCK"I If more than 1 septic system on lot: COSA Checklist # 1 of Parcel ID: Structure served by this system 1 n17 n1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test +5.7 gpm Date drilled 8/15/84 Water storage tank volume NA gallons Total depth 600 ft Well disinfected for coliform test? ❑ Yes ❑ Nc Cased to 314 ft FOR Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 1.25 mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) +18 in. Collected by C&M ENGINEERING Date of flow test for COSA 6/9/21 Date of Sample 6/9/21 Static water level at beginning of test 158 ft. Comments WELL PRODCUTION SIGNIFICANTLY HIGHER THAN NOTED ON ORIGINAL LOG B. TANK DATA Age of tank(s) 0 years Tank type/material SEPTIC PLASTIC Measured operating fluid level in septic tank 0 ❑ Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 2021 ❑ ALL standpipes present per record drawing Total measured depth from grade 13.3 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pig esstt&z-ed-field— ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: NEW LEACHRELD COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: NEW SEPTIC TANK Adequacy test date NA Results ED Pass For 5 bedrooms Fluid depth prior to test NA in Water added NA gal New depth NA in Elapsed time NA min Final fluid depth NA in Absorption rate NA gpd Any rejuvenation treatment (past 12 months) If yes, enter date NA W 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 Community Sewer Manhole/Cleanout > 100' ✓� Yes if No ft Q Yes if No ft Neighboring Tank > 100' 177� Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ft Community Wells > 200' Animal Containment > 50' Fv� Yes if No ft F/71 Yes if No ft if No ft If septic tank is under driveway comment below From Absorption Field on Manure/Animal Excreta Storage > 100' if Community Sewer Main > 75' Q Yes if No ft r,/ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ✓0 Yes if No ft Surface Water > 100' R✓ Yes if No ft Property Line > 5'✓J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 1771 Yes if No ft Community Wells > 200' F✓ Yes if No ft Water Service Line > 10' El 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' F-11 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 1771 Yes if No ft F. ENGINEER'S COMMENTS NEW SEPTIC SYSTEM INSTALLED 7/21 G. ENGINEER'S CERTIFICATION / certify that / 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. 7/11/21 COSA Checklist yellow sheet OF A1,4 : 49 TH '• � .... ;0 CHARLES G BALZARINI �F��,• CE -13854 •.0(�o��,� PROFESStOO -.�,. - BADGER LANE-''�`�� 9L'9e- `\ O N O 0 F 3 J @ U j O c U O` U O- N O O E:fl�c m vii o m � N C > ° C c 3 o c ul N 0 0 Q W O D U N �y N C Sol o Z 0 @ i @ N N a @ Q Qo ° nw Y @ O @ C n O O -0 U °O .0 V) O t0 C O 0 U O C N > .0 � om°�3�n -0 C-. J C E V r N `- O N E N U 5.1 O � 'Op N p U J ~ O @ O d j 7C U Z > N C U o -0 NO v N r .L.. C O a 3`os Es E @ N E oma0 U _ @ O a@ aNi o y N N Z C° m u w n C U N 0 L O @ X L i- U . N v c O V) N no, u U -0 Q) C U7 N 00 Lrlrn rn @ Y E ut @ O Q U ut O a b0 N @ O � t u c U Q C E J W 20 J Ow u Y_ U V O > N y lO + i m V -i c N Ln p O j.,�LO v c ? 3 O o o^ >� U- Lo 0) 3 J W N Q Z O Lo W LL O Q MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ik 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.# %Ljj_C�\ HAA #_ �P2S()Q in 1. GENERAL INFORMATION Complete legal description Lot 1, Block 1 , Secluded Hills Subdivision Anchorage AK Location (site address or directions) 132n0 R@dger ant' Anchorage, AK Property owner Mailing address Greg Stone Day phone 276-5506 Lending agency Ci tv Mortgage °/o(Ki O4n (` )td0tA(_ Day phone 277-0731 Mailing address— 121 W. Fireweed Lane, Suite 120, Anchorage, AK 99503 Agent Errand Scott Day phone 277-0731 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 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. 72025 (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 Gi Ifi I ian Engineering, Inc. Phone 277-2021 Address 1800 E. Fireweed Lane, Suite 102 Anchorage, AK 99503 Engineer's signature Date 5/13/93 O 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments By: Zed E. Bann P•+• NO.CEb0E4 >0 +OFF. 5�otn" bedrooms, with the following stipulations: Date 10 -,aa -91 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 a uependent 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. Back MOA 1121 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 1, B I ock 1 Sec I uded Hi I Is parcel I.D A. Well Data Well type Private Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Y 600 ft. 840564 If A, B, or C, attach ADEC letter. ADEC water system number_ Date completed 8/15/84 Driller Wayne Wat t ey Cased to 314 f t . Casing height 28" above G.S. Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION -o � 5/11/93 m 177 ft. 166 ft. 7 in. w i7,1 12 590 ft g.p.m. 6.8 Unknown SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100+ f t . ; On adjacent lots _ 100+ f t Absorption field on lot 100+ f t . ; On adjacent lots 100+ f t Public sewer main NA Public sewer manhole/cleanout NA Sewer service line 50+ f t . Petroleum tank 50+ f t . WATER SAMPLE RESULTS: Coliform 0 Colonies/100 ml Date of sample: 5/11/93 B. SEPTIC/HOLDING TANK DATA Nitrate NonDet ect ed (less Other bacteria _ None than 1.0 ng/]Kent Sheets Collected by: 376-3aaSF Date installed 9/20/84 Tank size 1500 ga I I on Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N/A Alarm tested (Y/N) N/A Date of pumping Unknown Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 100+ f t . On adjacent lots 100+ f t . To property line 10+ f t . Absorption field _ Surface water/drainage None 10+ ft. _Foundation 15 f Water main/service line 10+ ft. 72-026(3/93)'Front CONTINUED ON BACK PAGE p.m. a: n e� w> w e ca m 0 QJ C7 om m w Nitrate NonDet ect ed (less Other bacteria _ None than 1.0 ng/]Kent Sheets Collected by: 376-3aaSF Date installed 9/20/84 Tank size 1500 ga I I on Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N/A Alarm tested (Y/N) N/A Date of pumping Unknown Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 100+ f t . On adjacent lots 100+ f t . To property line 10+ f t . Absorption field _ Surface water/drainage None 10+ ft. _Foundation 15 f Water main/service line 10+ ft. 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION N/A Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots rer anhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed 9/20/84 Soil rating (GPD/Ftz) 125 sq. f t /BR System type Deep Trench Length 50 f t. Width 3 f t. Gravel thickness 5 f t. Total depth 9 f t. Total absorption area 500 sq . f t .—Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 5/11/93 Results (pass/fail) Pass for 3 Bedrooms Water level in absorption field before test 10 i n . After test 12a i n . Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100+ f t . On adjacent lots 100+ f t .-Property line 10+ f t . To building foundation 20 f t . To existing or abandoned system on lot NA On adjacent lots 100+ f t . Cutbank None Water main/service line 50+ f t . Surface water None Driveway, parking/vehicle storage area 100 f t . Curtain drain None E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in of this inspection. OP Signature 5 my Yoa� ®ocn®eaY�wYaaYa t� Engineer's Name Robert E. Gi I f i I ian, P.E. Neb�rvC c<ititie wb� P Date 5/13/93 g�<-i, "aas;�'°i •, Ess HAA Fee $ 1-`io.ou Date of Payment is" Q Receipt Number DLc- o\ 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number CITY MORTGAGE CORP. P.O. BOX 92810 ANCHORAGE, AK. 99509 DATE: 5/19/93 TO: MUNICIPALITY OF ANCHORAGE FROM: LINDA MELLOR 277-0782 SUBJECT: WELL & SEPTIC APPROVAL PROPERTY: 13200 BADGER LANE ANCHORAGE, AK. BORROWER: GREGORY STONE I HAVE ATTACHED A CHECK FOR $170 AND THE WELL & SEPTIC THAT WAS GIVEN TO US BY THE ENGINEER GILFILIAN ENG. INC. PLEASE ADVISE WHEN READY AND I WILL PICK UP IF POSSIBLE. THANK YOU. CITY MORTGAGE C_ O R P O R A T 1 O N LINDA MELLOR LOAN OFFICER (907)277.0782 121 WEST FIREWEED LANE, SUITE 120 (907) 277.0700 ANCHORAGE, ALASKA 99503 FAk (907) 277.0804 O Gilfilian Engineering, Inc. 1800 E. Parks Hwy., Suite D-100 o Wasilla, Alaska 99654 WELL FLOW TEST DATA SHEET From: Well Log 0 Probing Measurements 0 ADEC Records Well Depth: 600' Static Level: 166' 7" 0 Physical / Sanitary Features: Sanitary Seal ✓ /Cap _ Casing Above Ground Surface: 28" Pump Wire in Conduit ✓ Surface Drainage Away from Well: Good ✓ Poor Well Pump Specs: Water Supply Line: Size: Type: Drop Pipe: Size: Type: Depth to Pitless Adapter:_ Storage / Pressure Tanks: Time Time Interval Minutes Pumping Rate (gpm) Cumm. Gal. Static Level Comments 1055 — 7 — 166' 7" Water clear throughout 1120 25 7 175 190' 5" test. Water level 1 130 10 7.7 252 203' 7" measurements taken while 1 150 20 7 392 194' 5" pump was running. 1215 25 6.5 554.5 199' 6" 12.40 25 6.5 717 199' Noticed 6" well casing 20' away from working well. No cap or conduit. Minutes 105 TOTALS Average = 6.8 Gallons 717 osl Time Time Interval Minutes Static Level or Comments 1255 15 193' 6" LOCATION: Lot 1, Block 1, Secluded Hills Sub. CLIENT: Errand Scott, City Mortaaae PROJECT NO: 9304.1 _ DATE: 5/11/93 BY: Kent Sheets 93041.ADQ KS #5 Giffilian EnEinecring, Inc. 1800 E. Parks Hwy., Suite D-100 Wasilla, Alaska 99654 ADEQUACY TEST FORM Location: Lot 1, Block I Secluded Hills Sub. No. of Bedrooms: 3 Date: 5/11/93 No. of Bathrooms: 3 Inspector: Kent Sheets Cale. Peak Load*: 225 Septic Tank Size: 1500 Gallon Cale. Peak Time"': 25 Type of S.A.S: Deep Trench Cale. Peak Flow Rate: 9 )ZI)m Project No: 93041 Meas. Ave. Flow Rate:. 7 Peak Load = 75 gallons x (# of bedrooms) Peak Time, = 25 minutes x (# of bedrooms —,. # bathrooms) 93041.ADQ KS #5 C........................... ... ............ ......... N�.. 1125 7,7 — 481/2" 1/211 101, 1/2 Ran water into 1145 7.7 154 49" — 10'/2 S. L. C. 0. Oil01, 1205 7 294 491" — 10'/2 1 oil - V, 1225 6.5 424 49"11'/2" oil - III 1235 6.5 489 49" 121/2 END FLOW . .... Reviewed by: .................... .. ........ . ... I.X ....... ........... 70 7 gpin 489 -X ... .... .. .... Xy . ...................... ... ..... ... . . ...... ......... 21/211 min totals ga ............. Peak Load = 75 gallons x (# of bedrooms) Peak Time, = 25 minutes x (# of bedrooms —,. # bathrooms) 93041.ADQ KS #5 EMO-lefter GENGINEERING, INC. Ml 2555 E. E. Fireweed ed Lane, Suite 102 Anchorage, AK 99503 (907) 277-202.1 1800 E. Parks Hwy., Suite D-100 • Wasilla, AK 99651 • (907) 376-3005 �tivnticyy�,C�' � Uin.t/LuxU� Date 4"C4 g ` l Subject WECC AFRVOON/hENI sEGG�t 04F/:)fflu s : 13acrz� r3f�DGE� an •Z 0 4 n ill ;6L 4z �4416� J�V *e- aJ dtv�,4 t- e i lumz Ire aaM, ow•eo,as. m,.,; s52K Dazs FOLD AT (-) TO FIT DRAWING BOARD ENVELOPE #E W 10P 1-;I ,G•OW N , 1H8 A. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _t> (a) Legal Description (include lot, block, subdivision, section, township, range) I M 1 t 1� If 1 0,11_LS `,/0V oe "? Sec_ ? i Location (address or directions) (b) Applicants Name -a (Zp(iONl� Telephone -Home ®Business Applicants Address1 2a L o a/ --t Co) (c) Applicant is (check one) Lending Institution 14 ; Owner/builderl= ; Buyer � ; Other E::l (explain); (d) Lending Institution �('� iPA(,I 1=1 ( Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: I+0 1�s 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3. Water Supply Individual Well Community 1::� Other (describe) 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 1z Public E=j Community = Holding Tank ED Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 1 5. Engineering Firm Providing Inspections, Tests, ]pile 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 J ® GJ�.v� o ✓'/�,1ax A e . Telephone ie, Address_ Date A (ENGINEER SEAL) 'l.' C, r".. .. 6. DHEP Approval oval afi- j; +o� 2225-C= � �� JUNE 20, 13;1 n Approved for -Lf\;l bedrooms By i 6 i L ss i Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY 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/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY Ur DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 APR 1%5 264-4720 D C � �j Legal Description: �� a 5Gtr- L E}'l,4,W H;/11 .5. bolivisra �� /� Ri is 6r" .Ji' c J %' A. WELL DATA Well ClassificationIf A, B, C,/D'.�E.C. Approved (Y/N) �® Well Log Present (Y/N) X Date Completed_ ��' �/ �y/ Yield A'5— G /a," Total. Depth S, 0 _ Cased to 3 / Depth of Grouting —_&A Static Water Level /7? r Pump Set At r. Casing Height Above Ground Ll Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) / Depression Around Wellhead (Y/N) /U Separation Distances from Well: To Septic/Holding Tank on Lot TUU f ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot / bre _ ; On Adjoining Lots To Nearest Public Sewer Line A- To Nearest Public Sewer Cleanout/Manhole 6yoYLc To Nearest Sewer Service Line on Lot t Water Sample Collected by _h ine-e- Date Water Sample Test Results �� ¢G M Comments B. SEPTIC/HOLDING TANK DATA Date Installed 19& Size /S ov Ga/. No. of Compartments Standpipes (Y/N) __ Air -tight Caps (Y/N) Foundation Clearyout (Y/N) f Co Depression over Tank (Y/N) /VDate Last Pumped ,G 1 %dew Pumping/Maintenance Contract on File (Y/N) _ ; for Holding Tank High. -Water Alarm (Y/N) N/i' Temporary Holding Tank Permit (Y/N) 'vim Separation Distances from Septic/Holding Tank: To Water -Supply Well `Oo To Building Foundation _ �D To Property Line %O To Disposal Field _ la f To Water Main/Service Line ��' To Stream, Pond, Lake, or Major Drainage Coursee- Comments <MA> Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed l Sky Length of Field S Width of Field 36 Depth of Field �a Gravel Bed Thickness Square Feet of Absorption Area 0 O Standpipes Present (Y/N) Depression over Field (Y/N) All Date of Last Adequacy Test — �/��°%�Y S Results of Last Adequacy Test Si Separation Distance from Absorption Field: To Water -Supply Well //Uy To Property Line �v To Building Foundation % To Existing or Abandoned System on Lot `vim ; On Adjoining Lots 30 To Water Main/Service Line r Jd l To Cutbank (if present) /vim To Stream/Pond/Lake/or Major Drainage Course al "r c To Driveway, Parking Area, or Vehicle Storage Area tlU Comments �b�e f�*+c r�. ��,P 4--- ?,�/ z„L, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav,Q checked, verifie ,7r conformed to all MOA and HAA guidelines in effect on the date of this inspection. . Signed — Date �// / ,, "2' /�-5 Company & MOA No. Receipt No. 'tlC C. , <, Date of Payment �l - t - Amount: $ �f ��• CSO- r3' Engineer's Seal t 225-E. Page 2of2 tt Ju JF 2a. i9/1 72-026 (11/84) e 1' ---ATO `) F / SUBJECT C. %: % : r I , Ir f .C_ --.L c ( �� £.. _ - ;, !, ,:;: �!n __� DATEC) c� MESSAGE J' — { F?r. .t':.1.4.ti-Ri--f��i._.(/�-c.-.JAL-�C:.-r t_. v� li-.m'.l.i r rte., a.1." -r .;��•-.-(=L .p. t_�-- REPLY REC)TFbRM 9 4S 472 SIGNED f y t tdoC,t. Q-A SIGNED SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP DATE PIXY PAX (50 SETS) 0472