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Home My WebLink AboutSEACLIFF BLK 1 LT 11Aacliff lock I Lot I lA , 011-221 -12 Municipality of Anchorage �� a � On-Site Water and Wastewater Section • (907) 343-79 f 1 ON-SITE WASTEWATER INSPECTION REPO Permit Number: OSP181376 MAR 2 8 2019 PID Number: 011-221-12 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex(D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Therese Stokes ABSORPTION FIELD Site Address ❑ Deep Trench El Wide Trench ❑ Bed ❑ Mound 9310 Shorecrest Dr. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-351-1067 4** 1.0 GPD/SF 7.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.5 Ft. 4.0 Ft. Seacliff 1 11A Fill added above original grade Gravel length Township Range Section 0.2 Ft. 63.5 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5 Ft. Ft. ToSeptic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank I Field Tank Line 635 Fe Ft. Well 100+*1 100+* TANK El Septic ❑S.T.E.P. ❑Holding 0 Other I Manufacturer Capacity -I-` Surface Water 100+1 100+1Anchorage Tank 1250 Gal. ; { Material Number of compartments Lot Line 5+ 10+ j NA steel 2 Foundation , LIFT STATION 10+ 10+ 11 Manufacturer Capacity Remarks *subdivision served by public water Gal. **3 bedroom house with a 4 bedroom septic system Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 _ Installer ___ drainfield ___ ARM Services_____ Drainfield 3034 CO/MT 3034 Inspector Crewdson Engineering LLC BENCH MARK (Assumed elevation) 100 ft Inspectio: 151 10-25-18 2" 10-25-18 Location and description da3r° 10-26-18 4'h 11-7-18 top of concrete patio slab (see record drawing) ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date O F q..4 tt I orricylk: 1 / ' / aures A. Crewdson Septic S stem f�., r�, % Approved �-- (%01C: Date C�j g"19 /I . C11527 �� Note: this approval does not include well permit requirements. �\ ADFESSIONP� (Rev 05/02/18) \\\`�"1' /k,(-LC 1 [off } pl SWING TIES(feetl N 89°55'00"E 150.00' Lot 10 A B FC 26.60 37.40 SHED Si 38.40 31.24 I A • J'� S2 44.79 32.21 • DRIVEWAY ••; : DC 46.87 32.88 SHED • • .• Cl 60.65 62.98 ' - C2 69.08 27.92 N)WIDE TRENCH FC -^., w M1 61.80 64.15 M 2 M1 Cl 5'W x 63'L x 4'ED > s w Si iii s o M2 86.71 53.13 3BRSFH wwNjLS# g wM3 69.87 30.20 b :M-TOPOFSLAB . w N)AT-1250 AT PATIO DOOR Lot 1AzSEPTIC TANK C2 B M2 SHED S 89°55'00'W 150.00' ' t nF 1 PLAN SCALE: 1"=30' LEGEND BENCH MARK ELEV ELEV (E)-existing EG 98.8' EG 98.3' (N)-new ASSUMED FG 99.2' FG 98.5' BM-bench mark ELEV 100' TH1 BR-bedroom FC Si S2 DC M1ClM2 M3 C2 EG 98.3' C#-cleanout 1-Illi ED-eouble cldepout - USCS SW ED-effective depth PERC<1 MPI EG-existing ground 4' BGL ELEV-elevation MilFC-foundation cleanout SEPTIC TANK WIDE TRENCH FG-finish grade 2" INSULATION ELEV: BOH 16' BGL INV-invert ELEV: TOP OF ROCK 95.31' ELEV 82.3' M#-monitoring tube SFH-single family home TOT 96.00' PIPE INV 94.81 ' DRY 10-26-2018 S#-septictankcleanout INLET INV 95.47' BOTTOM OF ROCK 90.80' — DRY 11-7-2018 TH#-test hole OUTLET INV 95.25' TOT-top of tank PROFILE NOT TO SCALE Crewdson Engineering, LLC Seacliff, Block 1, Lot 11A �+>�``SAN l ��P��i q•.:40 1k IcLi Septic System Record Drawing j Co ' 4,:..4_ ; •.9*l� Plan and Profile Views �'y Ii ',o Prams A.Crewdson `�TcL ^ #0.0.-. C11527 ��// Civil&Environmental Engineering Prepared for: Therese Stokes Date: 3-26-19 +k i�p'3 -1:1 —" Permit: OSP181376 1 of 1 �k\�PRosswN�� PO Box 671389 Chugiak AK 99587 • ce11c.1@ouUook.comPage: �N�`•�•�1 CollText:907-280-9493 • Fax:907-686-2295 AL INFORMATION SHOWN ON THIS DOCUMENT IS ONE PROPERTY OF CREWDRON ENGINEERING,LLC AND SMALL NOT OE USED FOR ALLC#112279 ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERNG.LLC I I Lot 10 fI I I I CHAIN-LINK FENCE I I N 89'55'00"E 150.00' 12.2'x20.2' _ ., — w I SHED 15-.71 x 66.4' 33.5' a .. 14.2'x20.2' C 8 '•' '•:Co NCRETE:' 1.•:-: T. GREENHOUSE "DRIVEWAY .. •'. • :. .. ••m .• Z 4.� o 70 50.0' \\ oLi, m- ••, o \ I �, ,. 0 0 Tract B o �o ;`�` cin SEPTIC 0 . , 4.0'x20.7' to PIPES m . CONCRETE PORCH o XIn °' 2.7'x7.4' rri XI -4 CONCRETE rn DECK V 1 ri y f--10.2'X7.9' 29.5' Lot 1 1 A —� 4 SHED 14,455 s.f. CHAIN-LINK I Q FENCE Z7 //,, --.4,- S 8 '55 00 9 "W 150.00' 1 Pi .1 IM 1 WOODEN FENCE I 30.0' I Lot 12 I I 10' UTILITY EASEMENT I I PLOT PLAN AS BUILT X SCALE 1" - 30' GRID SW 2424 Project No. 18-564/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone Q000000 (907) 522-4625 Fax oa �� Professional Land Surveyors kenOlangsurvey.com o �F.......A �4 jonathanOlangsurvey.com 0 '• ... .16.A •�s�A I herebycertifythat I have surveyed the followin described property: Oo�P +\ �oo LOT 11A, BLOCK 1, REPLAT OF SEACLIFF SUBDIVISION (PLAT No. 66-31) *• 49TH i�, .9*doo Anchorage Recording District, Alaska, and that the improvements situated thereon are VA within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed a KENN H . • r>♦: premises and that there are no roadways, transmission lines or other visible �, / easements on said property except as indicated hereon. Q l4 ' t(ke lO m 'P�'••.1, -5202.••' SjO Dated this the IL- Day of I`Eu\lkLrlc3t - , =�' , at Anchorage, Alaska 0 ,oR �O� 40O�FESSIONAt-`Aa It is the responsibility of the owner to determine the existence of any easements, �400000� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 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: OSP181376 Work Type: Septic Upgrade Tax Code Number: 01122112000 Site Legal Address: SEACLIFF BLK 1 LT 11A G:2424 Site Mailing Address: 9310 SHORECREST DR, Anchorage Owner: STOKES THERESE M & Design Engineer: CREWDSON ENGINEERING, LLC This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date 10/ZSIjb TCL L f 1)clrn•tmelit 10/19/2018 10/19/2019 Lot Size in Sq Ft: 14456 Total Bedrooms: 'X A - o ❑ 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 drainfield to confirm separation to impermeables and groundwater, as well as confirm the percolation rate of the soil. If results require a design change, construction shall stop pending On-site review and approval of a change order. Please submit results with the inspection report. 10I25I11 C S 1 6 D -A � ., U \ S S -%CPA `6 9-' 2c��rcom. _1 -Le- Received B) Issued By: Date: Date: I ! a D 8 MUNICIPALITY OF ANCHORA X67 8 9 10 OCT 16 2018 3 Development Services Department ne: 907 On -Site Water & Wastewater Section F? - 07 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 011-221-12 Property owner(s) Therese Stokes & Dennis Falldorf Day phone Mailing address 9271 Shorecrest Drive, Anchorage, AK 99502 Site address 9310 Shorecrest Drive Legal description (Sub'd., Block & Lot) Seacliff, Block 1, Lot 11 A Legal description (Township, Range & Section) Lot Size 14,456 Sq. Ft. Number of Bedrooms `-i wc- APPLICATION IS FOR: (M all that apply) Absorption Field Fx I Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) El ( Upgrade Elw/wo ADU) Duplex (D) El EllMultiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify t�t the above information is correct. I further certify that this is in accordance with applicab Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: 5(09 Date of Payment: toll Receipt Number: 0 ya2a{6 Permit No. 03P/g13 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Civil & Environmental Engineering October 25, 2018 Municipality ofAnchorage On-site Water & Wastewater Program 47DOElmore Road Anchorage, AK99519-G65O Attention: On-site Engineer Reference: 5eadUfBlock l,Lot IIA Septic System Upgrade Change Order I Design Narrative James "Jay" Crevvd Email: CELLC.l@outlook.com Cell/Text: (907)280-9493 Fax: (907) 688-2295 The owner of the S-bemomsingle family home would like toupgrade the existing 1971 septic system with a new septic tank and drainfield using conventional treatment to accommodate four (4) bedrooms. The existing septic tank will be decommissioned in place in accordance with the code and the proposed septic tank will be located nearby. The existing drainfield (log crib) will be decommissioned inplace inaccordance with the code. The proposed Wide Trench will belocated along the west and south property lines inanLshape. The ground is Oat in this area and does not pose any problems related to dope orientation. 4test hole will be completed prior to construction to verify the expected sandy soils that were found/documented on the adjacent properties (see attachments) There are no known conflicts with any required separation distances. There are no known private or community well protection radii within SOfeet ofthe septic system. Please feel free tocontact meifyou have any questions. PO Box 671389 o 18368 Amo,nson Road o Chugiak, Alaska 99567 S890 55, 00"W 150.00 ABANDON (E)CRIB BYFILLING WITH SOIL IAVVTHE / CODE S2 S1 F NSTALL (N) AT -1 250 SEPTIC TANK, ABANDON /E\SEPTIC TANK IAW THE CODE 3BRSFH eTH1 (SEE NOTES) |m/ \` � .�I ' `4N8TALL(N)VNOETRENCH ` | "~ (SEENOTEG) G8S"S5.DO"VV 15000 DRIVEWAY NOTES LEGEND t ALL CONSTRUCTION SHALL asuHWTHE GOVERNING CODE 2. LOCATIONS OFEXISTING SEPTIC TANK AND CRIB ARE APPROXIMATE (N) - new 3. TH1SHALL BECOMPLETED PRIOR TOCONSTRUCTION TOVERIFY THE eR'bedroom nnA|mr|ELODESIGN APPLICATION RATE CO'cleanout 1. oRA|wF|ELDDE8|Sw oC'double cleanout APPLICATION RATE: 18GPcxSp Eo'effective depth REQUIRED AREA FOR 1BEDROOMS: 0OnGp EG-exiebnggmund USE: 4'EDWIDE TRENCH: o'WxOO'L8'TOTALDEPTH pC'foundation cleanout u. SOLID (m0N-PERFORATED) SEWAGE CONVEYANCE PIPES AND THE SEPTIC TANK rG'finish grade SHALL osINSULATED WITH 2^THICK 4nPSI FOAM BOARDS Seacliff, Block 1, Lot 1 1A Septic Systern Design Prepared for: Civil & Environmental Engineering Therese Stokes rua=n,`anoo^"n/ax«xeyavr~=°/icugommo.com Permit: OSP181376 oeone*.mnen0-oou . Fax: 907-688-2295 | =°~RMAT. ON SHO%�N ON THIS DOCUMENT IS THE PROPERTY OF CRE=SCN ENG ENGINEERING OR CONSTRUCTION PURPOSES WTHOUT VMITTEN PERMISSION [l8t8: 10-�5-18 Page: 1Of1 PING, LLC AND S�L NOT BE USED FOR MM IAW'inaccordance with KT-munitormbe Gw'septic tank cleanout Sp'square foot 8r* - single family home ST'septic tank ro'total depth ALLC #112279 GAAB-HO-I Gt TER ANCHORAGE AREA BOROI, :,d D~ARTMENT OF ENVIRONMENTAL QUALi'r~ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL UQU~D CAPACITY ~' ?~' GALLONS. · ' NUMBER OF MATERIAL ~ 0 F-" O ~,.: d*t',~: i~ If ~ ~'~ COMPARTMENTS INSIDE LENGTH ~ z; ' -d ~ INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER NEAREST LOT LINE z~'-~--fi' / ~; /~ ' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) __., LENGTH / ''~ ' , DEPTH OR WIDTH DISTANCE FROM WELL (' (Vz/,,/z,',) BUILDING FOUNDATION. SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NUMBER OF LINES '~ DISTANCE BETWEEN LII',JE~''''~ ABSORPTION AREA SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE . NEAREST LOT LINE TOTAL LENGTH OF LINES TRENCH WIDTH LENGTH OF EACH LINE -'-~-~ DEPTH OF FILTER MATERIAL BENEATH TILE IN. TOTAL EFFECTIVE IN. ABOVE TILE WELL: TYPE./ --L'L'~'~4. DEPTH NEAREST _. SEPTIC LOT LINE , SEWER LINE· ., TANK DISTANCE FROM WATER , BUILDING FOUNDATION. ' SAMPLE_ ~ ., NEAREST SEEPAGE = ~ OTHER ~ , SYSTEM. , CESSPOOL , SOURCES DISTANCES: 6 i.:~~ ~ / DIAGRAM OF SYSTEM NAME OF aPPLICANT INSTALLATION Of: SEPTIC TANK SEEPAGE PIT ., DRAIN fIELD fINANCED thrOUgH TO be INSTALLED bY 6~ ~t COMPLETION DATE ANTICIPATED GreaTEr ANchorage Area BO~Ugh DEPARTMENTOFENV,RONMENTALOUAL' PERM,TNO, 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-S686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT , OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE j MINIMUM DISTANCES, REQUIREMEN.~TTTS/ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPagE PIT ~-- ~// , DRAIN FIELD SEPT[C TaNK TO SEEPage Pit Wall / SEPTIC TANK /~/' , SEePaGE Pit ~ . ,, DRAIN FIELD WELL TO SEPTIC TANK SEEPAE--~IT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK . DRAIN FIELD SEPTIC TANK, , SEEPage PIT TO RIver, LAKE STREAM. SEEPAGE PIT . , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIBgROSSING gAP OF EXCAVATION 5 FEET iNTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AirtigHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING iNSTALLATION. LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA bOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED YSTEM IS IN ACCORDANCE WITH SAID CODE. ~J~/l EPtAAIS 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 I.D. 011-221-12 Expiration Date: lr7 - 2_0Z 0 1. GENERAL INFORMATION Complete legal description Seacliff, Block 1 , Lot 11A Location (site address) 9310 Shorecrest Dr., Anchorage, AK 99502 Current property owner(s) Therese Stokes & Dennis Falldorf Day phone 907-351-1067 Mailing address same Real estate agent Day phone 2. TYPE OF DWELLING: I" Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System El Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 0120/ Waiver Fee $ Date of Payment Co//3 [f' Date of Payment 1 Receipt Number Q `l q a 1 6 Receipt Number COSA# G 5C1 R1�3 J 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm Crewdson Engineering, LLC Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 6/12/2019 OF A4 11 0"Ce•.. l -•►' �y+iI 6. DSD SIGNATURE /A,: 'a! TM r� '•1k �/ fER'S' •• • • • / V System #1 Approved for 7 bedrooms 4 . /••• A#i.P ' 11 �7• James A. Crewdson i, System #2 Approved for bedrooms / • C11527 / Disapproved 1 '�;la_ �,q.•X03 t\��90FESS\ - Conditional approval for bedrooms, with the following stipule lamsz .. A LLC t t aaq .� "\JTYtOp/'((((. 4- 0�_ �0�i o ATE r WgTERA c ^ =m /IT 0 PROD ER ,a SAM c) vs <iji SEt )C* \ �y `^^� ' Original Certificate Date: G-(s7---i? 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 bice sheet CASA Checklist Legal Description: Seacliff, Block 1, Lot 11A Parcel ID: 011-221-12 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑Well log is filed with Onsite(or attached) W I pr du n a ti . f - gpm Date drilled \..... c....;Wat e -- volume gallons Total depth ft ell .' ected for coliform test? ❑ Yes ❑ No Cased to ftIIIColiform bacteria is Negative ❑ Sanitary seal is functioning c c Nitrate mg/L 0 Nitrate less than MRL (ND) ❑Wires are properly protected Arsenic ug/L ❑Arsenic less than MRL(ND) Casing height(above groun. in. Collected by Date of flow test f. 'e SA Date of Sample Static w- - evel at beginning of test ft. '.mments B. TANK DATA C. LIFT STATION Age of tank(s) 0.8 years ❑ Required maintenance completed Tank type/material S' Age of lift station years Measured operating fluid level in septic tank 49 Lift station material 0 Standpipes/foundation cleanout per record drawing Comments: Date of pumping not required D. ABSORPTION FIELD DATA Which system tested (date installed) ""n018 Adequacy test date NA 0 ALL standpipes present per record drawing Results ❑Pass For bedrooms Total measured depth from grade 7.7 ft(max) Fluid depth prior to test in Measured depth to pipe invert from grade 3.7 ft(min) Water added gal ❑ N/A—pressurized field New depth in 0 Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective ❑ Code-required soil cover over field Final fluid depth in ElSystem presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) No date of test) Gallons introduced gallons *If yes, enter date Comments/Deficiencies:Field is less than 1 year old,adequacy test not required 1F COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if communis II) Septic Tank/Lift Station on Lot> 100' omm nit &wer ' yi ole/Cleanout > 100' ID Yes if No ft El Y- ' ,• ft Neighboring Tank> 100' Y if No rivate S wer/ _- me>25'❑Yes if No ft A•.• •ti 1 Id 0 of 100' Ye if o 'olding Tank > 100' El Yes if No ft Ne ori A or. •• F s> 6 Animal Containment> 50' ❑Yes if No ft ■ Yes if No ft Manure/Animal Excreta Storage> 100' . munity 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' El Yes if No ft Surface Water> 100' ['Yes if No ft Property Line > 5' El Yes if No ft Wells on Adjacent Lots: Absorption Field> 5' Cl Yes if No ft Private Wells> 100' Ei Yes if No ft Water Main > 10' El Yes if No ft Community Wells>200' Q Yes if No ft Water Service Line> 10' ❑✓ 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' El Yes if No ft Private Wells > 100' ElYes if No ft Water Service Line> 10' ElYes if No ft Community Wells> 200' ❑✓ Yes if No ft Surface Water> 100' El Yes if No ft F. ENGINEER'S COMMENTS Subdivision is on public water. OF A4 �1 G. ENGINEER'S CERTIFICATION �.:�P� .•.....•..'4s►1ii I certify that I have determined through field inspections and review 1 6•,/• rH t9 �/i of Municipal records that the above systems are in conformance with /,, .. •>� MOA COSA guidelines in effect on this date. / • ,EER'S / 1;Wt. Jam: . .',- dson e bC11527 .•� i0 �1��o�s's�o�P-- COSA Checklist yellow sheet %'1( LC 1� �-l� Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011- ~-~-I-17_ GENERAL INFORMATION Complete legal description ..~---./)[_-.J-.I FF S/IO Location (site address) Expiration Date: /'-/' /-' i aL Current Property owner(s) Mailing address Lending agency Mailing address Day phone ~C/'Z- ~,3 7 Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: .~ 3. '~ TYPE OF WATER ~UPPLY: Individual Well Individual Water Storage Community Class, /2/ Public Water System Well TYpE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [~ Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Pannone Engineering Services, LLC Phone 272-823_8 Address P.O. Box 100217, Anchorage, AK 995~L0 Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~JApproved for 3 bedrooms. Disapproved. Conditional approval for ~r-.x ." bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ..~/~. (..J-I?F ...q//::) ~Loa/< ~ ,] /~o T II/}- Parcel ID: (b(I- 7.7_1- J?_.. A. WELL DATA Well type CO,~/O~ln'l/ Date completed __ Total depth ft. IfA, B, or C provide PWSID # Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION in. Date~a~.~....~ Static water level -~_ ft. ft. Well production .m. g.p.m. WATER SAMPLE RESULTS: ~_~.~~.e Coliform colonies/100 mL Nitrate mg/L si100 mL Arsenic: ~ ug/I Date of sample: ~ Collected by: ~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material/.-~4/(_l~E'r'~ Tank size ~7'°o gal. Number of Compartments Foundation cleanout (Y/N) Date of pumping ~/1~"//~-o II C. ABSORPTION FIELD DATA Date installed E/7.~/197'1 Soil rating Length ~ Z~ ff. Width Total depth ~ ft. Eft. absorption area 2--~;~ ft2 Date of adequacy test,~/1"/'/~1 ) Results (Pass/Fail) Fluid depth in absorption field before test ~-O in. Date installed Depression over tank (Y/N) ,4/ High water alarm (Y/N) /// Pumper ,~.+ (g.p.d./ff2 or ft2/bdrm) ~ ff. Monitoring tube . Water added ~'O gal. Elapsed Time: IZ-~ min. Final fluid depth'Z-O in. Any rejuvenation treatment (past 12 mo.) (Y/N & type)/[/' System type ~.,c~ d--Ell5 Gravel below pipe ~:, ft. ~ Depression over field ~ For ~ 'bedrooms New depth 2--'~'-in. Absorption rate >= /---J'~'C,~- g.p.d. If yes, give date D. LIFT STATION "Pump on" level at ~ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump o~a~~-~~gh water alarm level at in. Cycles tested Meets alarm & circuit requiremen-'~~ SEPARATION DISTANCES FROM WELL ON LOT TO: Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas On adjacent lots On adjacent lots ~ manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line JO-/- Absorption field ~'-~ Water main 10¢- Water service line Surface water Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10-/- Building foundation lO Water Service line ?--~'~' Surface water loc ¢- Curtain drain ~'-4>/L Wells on adjacent lots Water main Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Steven R. Pannone, P.E. Date /-~ /~ ~"-/~::::q I COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number From: $. HOLT To: NORTHERN PACIFIC O~l,': 10/26/9a ~r~me: 4:07:42 ,OM P~ 2 ol 3 Z ,S 0°0~'CXT'E 9(~,37' N 0°05'00"W 9637' z MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 011 -221 -1 2 '~ NAA# g-~. (~-"~,G~ -C~'" L\.'-h .('~'' 1. GENERAL INFORMATION Complete legal description Lot 11A; Block 1; Seacliff Subdivision Location (site address or directions 9310 Shorecrest Drive Anchorage, AK Prope~yowner David & Patricia Hughes Day phone Mailing address 13380 Dunn Drive Caldwell, Idaho Lending agency Mailing address Day phone. Agent Lynne Mills/Prudential Vista R.E. Dayphone Address 244-7624 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 , TYPE OF WATER SUPPLY: Individual well Community well xx Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xx 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 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. Engineer'S signature ~.~/~7~/~~~ Date m ~'7o0~/-/CJV ' . -- '~~11 ALASKA WATER & WA~EWATER CONSULTANTS INC ~X~..~..~4~ is TO B~ PAID $~ AT CLOSIXS FOra ' RFORM . ' 6 DHHS SIGNATURE ~ ?~;~.%.. .... Approved fo edrooms. ~.. ~~ Disapproved. Conditional approval for bedrooms, with th% following stipulations: Additional Comments Date ~:9,111[fli The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cortificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91} Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI~P^LiT~ Environmental Services Division ENW~O~,U~NT^~S~V~CES D~VI~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegaIDescription: ~--,,~C,L..,iI::~ {,.,c~"~"- 1///~ ! I~./ ParcelI.D.: O //- z.2./-/~ A. WELL DATA Well type Lo~(Y/N) Date completed Total depth ~ Cased to ___ Casing height (above ground~..-~ Sanitary seal (Y/N)~~ Wires pro-perly-pro~' -- F~ ~ON .... ;;~,'ec°~ 'al: tr level Well production ~ g.p.m. WATER SAMP~ ' Coliform ~mpie: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~::~/2~,/-7! Tanksize ~-7~ Number of Compartments ,I Cleanouts(Y/N Foundation cieanout (Y/N) Date of Pumping /d-g~-~ Pumper ABSORPTION FIELD/DAT/~ Date installed ~/7~/'7/ Length ] 7_. .Width { ~ Effective absorption area 7-- / Date of adequacy test ,[ 2.~-/~'~ Fluid depth in absorption field before test (in.); Fluid depth ~7.._~ (ins) Minutes later: ~-~ Peroxide treatment (past 12 months) (Y/N) X/~=___ 72-026 (Rev. 3/96)* -,~-~T' ~ L,~,fll~-J~ Soil rating (g.~d~/ft~ or fF/bdrm) Gravel thickness below pipe Monitoring Tube present (Y/N) Results(Pass/Fail) Immediately after ~r'~';~al. water added (in.): Absorption rate = z~ ~. g.p.d. If yes, give date ~"~System type ~ / Total depth ~ Depression over field (Y/N) ~ For .~ bedrooms CJ Date installed ~ _ Size in gallons ...... ~vel at* Manhole/Access [Y/nU ~-- ' ~ ' H~gh water alarm level at* .-----'-- ~ "u~[urH E, sEPARATION DISTANCES ~N,C~S FROM WELL ON LOT TO: Septic/holding tank ~ ~ On adjacent lots Absorption field on lot_ ~ Public sewer main ~ ~ S~ Lift station _.....~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~'/~- ~"/~- Property line Absorption field / Water main/service line /0 '~ Sudace water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I C) ('~ Building foundation I o/-¢- Wells on adjacent lots "J..Oo /~- Water main/service line /O /OO ~' Driveway, parking/vehicle storage area Surface water Curtain drain ~o~J~?-- .~0o~.~J,,,/ ~ Wells on adjacent lots F. ENGINEER'S CERTIFICATION /// .... ~' ~ s are ce,iNthatlha~ete~ed~;d~pect/onsandrev/ewofMumc/palr"~" '~~ ..... ~; con~o~anp~wit~ ~EH~delin~s in effect on this date. Signature ~N/~ ~~ ~ ' ~nglneer s Name ~ ~ ' · Date ~/~ /~ ~ HAAFee $ ~ ' ' Date-ofPayment /~ /' Receipt Number ¢~/L~¢~,~ L Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~ Anchorage ~ Alaska 99504 Phone (907) 33%6179 - Fax (907) 338-3246 Consulting Engineers November 28, 1998 David and Patricia Hughes C/O Prudential Vista Real Estate 424 t B Street Anchorage, Alaska 99503 NOV 2 B 199f ~ Attn: Lynne Mills Subject: Seacliff, Lot 11 A, Bk 1. 9310 Shorecrest Drive. Dear Mr. & Mrs. Hughes and Ms. Mills: Per your request, we performed an adequacy test on the septic system serving the subject property, 30 days after it was chemically treated. Prior to the start of the test the liquid level in the seepage pit was 44.5 inches. Over a period of 74 minutes, 453 gallons was introduced, causing the liquid level to rise 19.75 inches. At this level it backed-up into the septic tank. The recovery was monitored for 253 minutes, during which time the level dropped 11.75 inches, indicating that approximately 269 gallons had been absorbed. Based upon this data it was concluded that the absorption capacity of the system exceeds 450 gallons per day, as required by the MOA for a 3 bedroom~ouse. If you have any questions, please contact me at 337-6179. ~ ~Sincerely' i Je: Jess, P.E~M4S. Pre~ NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives'), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected No warrantee is made regarding the future performance of this septic system J MUNICIPALITY 0FANCHORAGE :' ;- ?~? DEPARTMENT OF HEALTH & HUMAN SERVICES · Division of Environmental Services .' On-Site Services Section ....... P.O. Box 196650 Anchorage,Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY - APPROVAL FOR A SING LE FAMILY DWELLING ~)//- ,~-~/- /~- NAA# ~-~1~ 1. GENERAL INFORMATION "' con~plete legal description Location (site address or directions) Lending agency ~Mailing address Day phone Day phone 'r i'::-:~?-i' '~!i~:'' Unie~S'Otherwise requested, HAA Will be'held for pickup..;;:i;~-'.i-?-i.::!~:~i:_:ii :: '-:-':' _ C":. 2.~ii- NUM;;ER OF BEDROOMS:' '~??.~::~?v::;~ ..~,:_:?:-::-::.ff~:;?:'_:::~.:::;'t-:~-~-::.?:~t~-:'"::" ':" '- :' -:.: ?:?:': -' . 3. ',' ~PE OF WATER SUPPLY: '. · ..... . .- '~. -':,.-':'. ~. L':" Individual well., ' .-':: :'.' ..... ' ...... r""'"~- ........ '~"'~'-'.':::: : ' ' '- - :~. -: '-: ?,'~:-"':' ' :.'- Community well ~/~ -'" ' '" .... ·" ' ". .... ":'~ -:~,- : .' ~Y:ZL:. : :" '' - - ' ' ' ' ' ~ ' ' .... '- ~''' '"' '-' -. - '%~:;:"::' ':'~ .'::'..:' ' Public water '"" ' :'-:-' ' ' --~ : ": "?~. ?"'::' ~'.':::"":"~ '-:?' '-::' --: ':" ' T'"NofE: '/~ ~o~ity %. ~.~ p~o~de ~/~ oo~fi~at~O~'fro~"st~te ~D~c-~t- .... '": ' "- ........ ing to the/egali~ and status of system. - ~-~ ..... .- , - ,- 4, TYPE OF WASTEWATER DISPOSAL: Individual on-site ~ ' :-: :~: c0mmun~t~-0n_sit~'-' .'.' '. :~ '.:"--- ~-: ~ :-."-.---:-.. _ --,-..:. Pub,~wer ~-':-',: -""" -'..::: .- NOTE: If community wastewater system, provide wri~en confirmation from State ADEC a~esting fo fhe lega/i~ and status of system." - ·. : ' 72-025 [Rev. 1/91) Front ~1OA#21 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. STATEMENT OF INSPECTION BY ENGINEER As certifi~d bYm~ Seal affi;e~ herei0 and' aS of ~he ~,alidation date shown below, I verify that my Phone Address Ce $ ~/~/--'~/ /~' ~ ~ Engineer's signature -'6~' "."DHHs" SIGNATURE" "-' ': ........ · ''~ ":' '- ' , _:-~_,: .... _ '- .Appr°ved for '~?'~:~. _. bedrooms. · , :-( '- . ~:.':,,-':-~:.~., ,, .... .... '/: :~. -- ?. . ..'i-:- (:- :--"" : -, Disapproved. '_i:,¢?/?i'.~' 7 ::.(:.~:.,-.i~ .!:'-:_: ::" :L :' : ,'::_ ?i~' -:.: .~/-,i~.~,· ~:-,.~'i. ~;~;?~i!i:~:;¢~:~.~:i-;,'-:~,!~):,::~'?:: :. ':/.> "~.), .~' ...... Conditional' aPprOval "for bedrooms, with the following.~tiPU'la?ns:"...!?~:Z:',:,~ I~,.~lj I[I] ] ' _- The Municipality of Anchorage Department of Health and Human Services (DHH$) issues Health AuthoritY .... Approval Oertificates based only upon the representations given'in paragraph ,5 above by an independent professional engineer registered in the 8tare of Alaska. The DHH$ does this as a courtesyto purchasers of homes - ' . and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ do not ~ conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not '/ : responsible for errors or omissions in the professional engineer's work. · ~ . .' ' ' · . 72-025 (Rev, 1/91) Back MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type ~," Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION g.p.m, g.p.m. Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~) ~g. pC) Absorption field on lot ~- ~c~.~ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed ~/~-~/~'7/ Cleanouts (Y/N) '~/ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Tank size ~ ~/7 ~ Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping ~/,~--//~ ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I"-///~ On adjacent lots To property line ? ,,~ ~' Absorption field j Surface water/drainage /~ O ~ Other bacteria Compartments J",J Depression (Y/N) Alarm tested (Y/N) Foundation Water main/service line 72026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Welt on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Su dace water o % D. ABSORPTION FIELD DATA Date installed c~/~. ~ / 7/ Length '1% Total absorption area Date of adequacy test Width Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) ~ Gravel thickness Cleanout present (Y/N) ~ Results (pass/fail) '"'Y~ System type Lo o{ Total depth Depression over field (Y/N) . for ,.~'~ Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation ,~,'~ On adjacent lots Surface water Curtain drain /~',,/~ ~ CL_ On adjacent lots 1,-.1//~ Property line ,'~ Z 0 To existing or abandoned system on lot '~ ,'//'~ Cutbank ~ o ~ ¢ Water main/service line "7 ,2 ~ Driveway, parking/vehicle storage area ~ ~ E. ENGINEER'S CERTIFICATION I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effe..~!.On' th~date ~f this inspection. Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)° Back Waiver Fee $ Date of Payment Receipt Number DEPARTMENT OF HEAL;TH & HUMAN SERVICES Oivision 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.# GENERAL INFORMATION Complete legal description - L~'r Location (site address or directions) Property owner _B~A~4 ~ JuL~e Mailing address _¢~A~e Lending agency --~n l~ocu,~ Day phone Day phone Mailing address Agent _ NoNE Day phone. 4 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site NOTE: / Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Holding tank Community on-site Public sewer 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 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 FLATTOP T£Cf/ ~C£ Phone 3'q~'- Address I q-S3o ECl.lo AT ANc~I. ,4t< Engineer's signature ~~ '~. ~ Date oE e.~HEODORE ~. MOORE .~ DHHS SIGNATURE DisapprovoO. Conditional approval for bodr~oms, with the followin~ stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST /OT IIA,~ BLKI) 5EACLIFF ParcelI.D. '(~//-~P"P-/--/P-' A. WELL DATA Well type ~'LA~,.( Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to ADEC water syStem number Driller Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ 200 Absorption field on lot '~' 2. OD Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum t~nk Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/NI High water alarm (Y/N) Date of pumping Tank size 870° ¢~z PEn IO/~1 J'L,~.ACompartments I Foundation cleanout (Y/N) H Depression (Y/N) Alarm tested (Y/N) Pumper I SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot NI;A. To property line /~ 5o Surface water/drainage Onadjacent lots ~'2oO ' Foundation 12. Absorption field I~1 ¢,o. ~o ¢.o. Watermain/servJceline '? 30 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 9/7/ Length 12 ' Width Total absorption area Depression over field (Y/N) h~ Results (pass/fail) ~/] SS Peroxide treatment (past 12 months) (Y/N) NO~4E Soil rating $.5' z~'/SDR'/~ System type 5££P4o~ Gravel thickness (o Total depth Cleanouts present (Y/N) Date of adequacy test 8 //~z/4 ~ for _ -~ bedrooms Kt~ow,',/ oF If yes, give date N,,fl. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot lq.~. To building foundation ;~0' On adjacent lots >' ~/o' Surface water ~/o9' Curtain drain On adjacent lots '-~ :20o Propertyline F¢~)~ C.O. To existing or abandoned system on lot Cutbank N.,4. Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION HAA Fee $ /7 Date of Payment Receipt Number I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 DEPT. OF ENVIRONMENT~kL CONSER¥~kTION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 '(907) 349-7755 August18,1992 Mr. Ted Moore, P.E. Fiat Top Technical SUBJECT: Majestic View Subdivision (Seacliff Subdivision) Class "A" Public Water System, PWSlD 210485 Dear Mr. Moore; I have completed a review of this office's files concerning the status on the above- referenced Class."A" Public Water System. and found following:. Inorganic Chemical Contaminants: Date of last samples on record: 18AAC 80.2O0 07/07/92 Organic Chemical Contaminants: Date of last samples on record: 18AAC 80.200 05/27/92 Volatile Organic Chemicals (VOC's): Date of last sample on record: 18 AAC 80.400 Completed composite sampling program 05/27/92 Radioactive Contaminants: Date of last sample on record: 18 AAC 80.200 Composite sampling program arranged with Chem. & Geo. Total Coliform Bacteria: Date of last sample on record: 18 AAC 80.200 - Satisfactory 07/15/92 Final Operation Certificate: 90 Day interim approval until operational certificate by health authority is found Outstanding Violations: No August 18, 1992 Page 2 Based on the above information, this Public Water System is in compliance with State Drinking Water Regulations (18 AAC 80). If you have any questions on the above comments, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II ML/pf INSPECTION APPOINTMENTS TIME ^ x/~/ TIME DATE DATE DATE NSPECTOR INSPECTOR ; INSPECTOR 0 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAG~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~-vT. OF 825 L Street - Anchorage, Alaska 99501 ENVIRONMEN],:,L ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 )iRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. PHONE I. PROPERTY OWNER MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER MAILING ADDRESS 3, LE~DING INSTITUTION ~AILING ADDRESS 4. ~EALTO~/AGENT ' / [ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ,,~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ,[~ Three [] Six [] Other~ 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for ail wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM ,/~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM ~INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING [~Septic. Tagk or E~Holding Tank Size:~ O~"~ ~ If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line OTHER Septic/Holding Tank IAbsorption Area ISewer Line I Nearest Lot Line 5. COMMENTS DATE C/ PPROVED POR BEDROOMS [] CONDITIONAL APPROVAL (letter must acpo~pany certificate} / [~] DISAPPROVED 72-010 {Rev. 6/79) ALASKA eFIUIROFIm[ rlTAL COFITROL SeRUlCeS, IIIC. ~nqi~eerJnq ~- ~noi~'onmental Studies 10/3/81 ELSIE HRUBES 184 E 53RD ANCHORAGE AK 99502 SELLER - DWANE HRUBES SUBDIVISION-SEACLIFF BLOCK-1 LOT-11-A ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 288 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 464 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 96 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 8/11/81 SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 878 IS ADEQUATE FOR 1220 LUest 25th ~uenue · )~nchora§e, Alaska 99503., (907) 276-1361