HomeMy WebLinkAboutTHOMAS L BOYLE BLK 2 LT 6A N2Thornas L 0
Boyle
Block
Lot
6AN2
#015-282-44
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181368 PID Number: 015 282 44
Dwelling:❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 9 Upgrade
Name:
Beth Christensen
ABSORPTION FIELD
❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
❑ Other
Address
12200 Cange
Phone
Number of Bedrooms
4
Soil Rating
0.6 GPD/SF
Total depth from original grade
9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.4 Ft.
Gravel depth beneath pipe
4.6 Ft.
Subdivision Block Lot
Thomas L Boyle 2 6A N2
Fill added above original grade
0.8 Ft.
Gravel length
100 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
--
Distance between lines
-- Ft.
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
1000 Ft2
Number of trenches
1
Dist. between trenches
-- Ft.
Well
+100
+100
--
__
+25
TANK ❑s Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage
Capacity
1250 Gal.
Surface Water
+100
+100
--
__
NA
Material
Steel
Number of compartments
2
Lot Line
5'
10'
--
--
Foundation
+10'
+10'
--
__
LIFT STATION
Manufacturer
__
Capacity
__ Gal.
Curtain Drain
__
+10'
RemarksOld tank disposed ofper code
Pump on level at
-' in.
Pump off level at
-- in.
High water alarm at
-- in.
Pump make and model
Electrical Inspections performed by
Installer
Guaranteed Services
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Drainfield 3034 CO/MT 3034
Inspector Charles Balzarini
BENCH MARK (Assumed elevation) 100 ft
Inspect es: tsc 10/19/18 2nd 10/21/18
3rd 10/25/18 4"
Location and description
garage slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
Engineer's Stamp
Approve l.y, Date 7
inspection Heport_9-1-11.doc
SWINGTIES
A
B
C D
E
F 19.851
9.95
G
H
I
J
K
L
M
N
O
P
QI
33.35 61.05
30.86 54.75
30.56 53.61
30.52 52.35
27.71
26.72
17.68
15.95
45.62
44.06
1 26.991
55.01
26.57
30.47
30.68
30.87
29.12
32.65
Aw
of ALgs���
Gj�•y
4,9 •.
�� • CHARLES G BALZARINI
����Fc�•.
CE -13854 .•��`��'i
FESSIONA��
m
0 SEPTIC RAD1
AREA '� 000_WELL
i
O THOMA
/ BLOCK
NEW 1250
GALLON TANK
+100.0' GARAGE SLAB ,,,[FILTER FAB7-FINISHED
MONITOR TUBE
100.8-\98'6
GRADE TESTHOLE
COVER 4.7'
COVER 97.8' ORIG. GRADE
-�" TESTHOLE ELEVATIONS BASED
ON TESTHOLE EXCAVATED DURING
95.82 1250 GAL TANK 95.65 93.4 INVERT CONSTRUCTION.
88.g NO GWT ON 10/25/18
/4"0 DISTRIBUTION PIPE
4.6' EFFECTIVE SEWER ROCK
91.4
SCHEMATIC ELEVATION -_SCALE. NTS B'O'H 82.8
LEGAL DESCRIPTION: THOMAS L BOYLE BLOCK 2 LOT 6A N2
C&M ENGINEERING SERVICES OWNER: CHRISTENSEN DATE: 10/28/18 REV: I DRAWN: CB REF:
907-854-5558
SEPTIC RECORD DRAWING
K / THOMAS L BOYLE
BLOCK 2 LOT 6AN2
CONCRETE BARRIER_
DRIVEWAY
BM
l \WFC
C�Rypi(/
C
A
GARAGE
T_
LEAN-TO HAS HO E
TEST HOLE IE NO FOUNDATION F'
�-
FCO B
Z
w
o
n LEGEND
w 0 CLEANOUT
SEPTIC
AREA / 700, - MONITOR TUBE
J
`
l wFCC RqO/�S ® TEST HOLE
PLAN SCALE: 1" 30'
- =
+100.0' GARAGE SLAB ,,,[FILTER FAB7-FINISHED
MONITOR TUBE
100.8-\98'6
GRADE TESTHOLE
COVER 4.7'
COVER 97.8' ORIG. GRADE
-�" TESTHOLE ELEVATIONS BASED
ON TESTHOLE EXCAVATED DURING
95.82 1250 GAL TANK 95.65 93.4 INVERT CONSTRUCTION.
88.g NO GWT ON 10/25/18
/4"0 DISTRIBUTION PIPE
4.6' EFFECTIVE SEWER ROCK
91.4
SCHEMATIC ELEVATION -_SCALE. NTS B'O'H 82.8
LEGAL DESCRIPTION: THOMAS L BOYLE BLOCK 2 LOT 6A N2
C&M ENGINEERING SERVICES OWNER: CHRISTENSEN DATE: 10/28/18 REV: I DRAWN: CB REF:
907-854-5558
SEPTIC RECORD DRAWING
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: OSP181368
Work Type: Septic Upgrade
Tax Code Number: 01528244000
Site Legal Address: THOMAS L BOYLE BLK 2 LT 6A N2 G:2734
Site Mailing Address: 12200 CANGE ST, Anchorage
Owner: CHRISTENSEN EDMUND A & KAREN B
Design Engineer: C & M Engineering
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
I
l)clxtrtntent
10/17/2018
10/17/2019
23400
2 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:
1. A test hole is required prior to construction, in location shown on site plan. Test hole shall confirm separations
to bedrock and seasonal high groundwater, as well as 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.
2. Bollards to protect the tank shall be in place prior to final inspection report approval.
ID Z 3/ 18 co:t 1 ; &)(" +r�einck ole 4' f sot 1 s
Received
Issued By
Date: (9
Date:Zf %
4
EPLANS
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015 282 44
Property owner(s) Beth Christensen
Mailing address 12200 Cange
Site address 12200 Cange
Day phone 231-4901
Legal description (Sub'd., Block & Lot) Thomas L Boyle Block 2 Lot 6A N2
Legal description (Township, Range & Section)
Lot Size 23100 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) El
(`N/wo AD U)
Septic Tank
0
Upgrade F]
Duplex (D) ElHolding
Tank
❑
Renewal ElMultiple
Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
none
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Charles Balzarini
(Signature of property owner or authorized agent)
Permit/Rush Fees: 50
Date of Payment: 1611 �lg
Receipt Number: 67Y 8 __M
Permit No. c5p1 g 131v2
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Municipality ofAnchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
5''11 11111 gji�ij III III 111 111 1 1711111 1 1111-11!1�!j
Dear Reviewer,
We are requesting change order approval to alter the leach field design at the above referenced property.
Soils encountered during construction are a silty fine grained sand which are not consistent with the
historic soils log for this property.
Based on our soils explorations during construction, the design must be lengthened as shown on the
updated plans and calcs.
Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558
Charles Balzarini, PE
10/22/18
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 replacement for Thomas L Boyle Block 2 Lot 6AN2
Dear Reviewer,
The above referenced property is currently served by an older, failed 4 bedroom septic system. The
owner would like to replace it with a new septic system.
We are proposing to install a new septic tank, and a new drain field. The old tank will be decommissioned
per moa requirements.
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.
The lot is served by a private well and the proposed septic system will be installed outside of the well’s
100’ protective radius.
Included with this letter is a permit application and design package, including plans, specifications, and
calculations. The design references a soil log completed in 1986 (TH-Spurkland) indicating a percolation
rate of 7 minutes per inch. A test hole will be excavated during construction to verify soil conditions.
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
10/16/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181368, Rebecca Carroll, 10/17/18
0
�j
NVId 311S
S
9999—i7gg—ZO6
S301A?J3S ONIMNION3 VqV3
:332J I eO NMV?JO 10 'A38 19 Vil/O 1:3iV(l N3SN31S18HO :83NMO
ZNV9 iOl Z 713018 31AOG I SVViOHi :NOLLdl83S30 IV03-1
133LlIS 30NVO
ui co
W-- , 1
z
z
< 1
0
m0
MI-- j <
-
w
-j
(n C14
<
<
m
U)
0
U) W
Q0. w
0
0
00
OV
O
0
�
m
oc�—
)
Z
Do
z
w CL CL U) O-Mai�
(n 0
>-
z w
CLWX
z,
0
mz
o z
<
M:mm -i
w
z
n
< 0 CL
0
w
0
er
0 C,)
I--
Lq
0
NG7
o
z U)
<OM <
z
133LlIS 30NVO
ui co
W-- , 1
z
z
< 1
0
m0
MI-- j <
-
0
-j
(n C14
-j
<
< ,
U)
0
U) W
Q0. w
0
0
00
OV
S
0
�
m
oc�—
)
uj
wz Q<<
0
z
Z
LLJ
0
U)
o
m
LIj uj
U)
0
cL
0
z
0
Uj L'i
U) z
W
Z
U) <
U)
0
U) W
Q0. w
0
0
O la -
Z
0
�
oc�—
)
uj
wz Q<<
0
z
w CL CL U) O-Mai�
(n 0
>-
z w
CLWX
z,
0
mz
o z
<
M:mm -i
ZEL
a_ Z>
m000m<z
< 0 CL
Z
LLJ
0
U)
o
m
LIj uj
U)
0
cL
WF: Ww<0bM,EoCqbE.0'R '<wCL
%z=�000x"0 to )
,
w
Z
z
0
Uj L'i
U) z
W
M
LL
U)
0
U) W
Q0. w
Z
w Ix 00i
0
m
0
-j
C,
w CL CL U) O-Mai�
(n 0
>-
z w
CLWX
z,
ou
mz
o z
<
M:mm -i
1:0
a_ Z>
m000m<z
WF: Ww<0bM,EoCqbE.0'R '<wCL
%z=�000x"0 to )
,
w
Z
<
Uj L'i
W
F- 0
0
0
J Fa.<
0
er
0 C,)
I--
Lq
-j <
z U)
<OM <
0 �-
M �-
W - 0
� I.<
W 0
uj
(L LLJ
>
Oaf
<
LLJ
x
A M L,
Z
<
U,
<
0
U,
Ld
uj C�
co <
ui
Lj
Z
C�
mo
J -J
U) ol
z
<
0
:2
0
00
C&M ENGINEERING SERVICES
907-854-5558
Septic •
Residence: Thomas L Boyle Block 2 Lot 6AN2
number of bedrooms
4
br
Water usage/bedroom
150
gpd/br
Water Usage
600
gpd
C►Rllyftll]
system type: Conventional
type: Shallow
Application Rate
2fi.
gpd/sgft
required absorption area
1000
sqft
trench width (W)
5
ft
gravel depth (D)
4
ft below distribution pipe
Shallow trench factor
Min Required Length:
Total Excavation Depth:
Cover:
Insulation:
Length
Effluent Pipe:
0.5
(W+2)/(W+1+2D)
100 ft
8 ft
4 ft
2" blueboard
100 ft
4" ASTM 3034
System type: SHALLOW TRENCH
Tank: 1250 gal
New Drainfield: 5'X100'X4' W'xL'xD'
,bsorption area: 1000 soft
Calc By: CGB Date: 10/4/2018
icp
WY
or
p..
VA
CHARLES G BALZARINI
CE13854Am
;�� 4
C&M ENGINEERING SERVICES
Ph: 907-854-5558
SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER
LEGAL: Thomas L Boyle Block 2 Lot 6A N2
October, 2018
A. GENERAL
1. The septic design is for a 4 bedroom, single family residence only.
2. The site plan and drawings shall be a part of this specification.
3. The Wastewater system shall be installed by a certified installer in accordance All
materials and workmanship shall meet the Anchorage Department of Health and
State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field
by the engineer. The engineer shall perform percolation tests and groundwater
monitoring prior to finalizing design. An additional Test hole and percolation test is
required during construction.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage, Department of Environment of
Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and
to locate any adjacent multi-family wells. A licensed surveyor should locate all
nearby lot lines, easements, exact 100’ radius from the existing and neighboring on-
site wells, and any nearby surface water.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. Any remaining open test hole excavations shall be filled and monitor tube removed,
after construction of the Drainfield.
9. The contractor shall familiarize himself with the new code requirements for
inspection notification and notify the engineer at least 24 hours prior to beginning
work.
10. The contractor shall set the grades for the tank and leach field prior to commencing
work to ensure gravity flow is acheived.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181368, Rebecca Carroll, 10/17/18
B. SEPTIC TANK
1. Septic tank shall be a fiberglass or steel, 1250 GALLON tank capacity of MOA
approved construction. Installed to meet MOA and manufacturer requirements.
2. A combination of soil and 4” minimum of insulation shall be placed over the tank, to
prevent ponding and promote drainage. The insulation shall be rated for burial and
meet moa requirements.
3. Tank shall be bedded per manufacturer recommendations.
C. DRAINFIELD
1. The Drainfield is to be located as shown on the site plan. Notify Engineer of any
changed site conditions.
2. The total depth of the initial drainfield excavation is to be at maximum 8’ deep
Bottom of excavation shall be level +/- 1.5” max. If bedrock or inconsistent soils are
encountered, notify the engineer immediately.
3. In the event of over-excavation, a moa filter sand shall be used to maintain the
required depth.The top of the sand layer shall be level, plus or minus 0.5”, and
raked, prior to placing sewer rock. Care shall be taken to not compact the sand.
4. A 48 inch effective layer of sewer rock is to be placed in the each trench. The 4”
effluent piping is to be buried within the gravel layer with 2” of sewer rock cover over
the piping.
5. The Distribution pipe shall be 4” perforated pvc pipe conforming to ASTM D3034.
6. The complete Drainfield gravel and piping is to be covered with a geotextile filter
fabric.
7. Soil or combination of soil and extruded board insulation to a depth of 3’ or
equivalent is to be placed over the drainfield(s). Mounded side slopes shall not to
exceed 3:1. The minimum insulation thickness shall be 2”. Insulation shall be moa
approved and rated for burial.
8. The septic tank and leachfield must not be closer than 100’ to any existing private
well, or 200’ to any public well.
9. The soils at this site may contain fines such as silt and clay. Rake sidewalls and
bottom of trench to remove any smears from excavation.
G"l NOE ER�
Municipality of Anchorage
Development Services Department
if i nBuild:,ng Safety Division
to
O-Sile'VVate'r and VJas, ewater Pr,cram
d
d
4700 Elmore 'Road
O• Box i 96e5D Anchorage, AK 99507
Xles G. 81-sludro gz ar
(Cr9) 343-7904
i Hca" wu w
Percolation Test
Soils Log
P eCH P,�"5 7 ezv�
rffo I, m e d Far: r: J, Data Perorrned: 0/
110 yic
I cvinship, Range, Section:
Legal Description: T�I-nml-15 13 L 6A
Depth
M
9-
3-
4-
5-
C-
7-
8-
G-
1 0-
-10-
-11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
Slope
VVAS GROUND Vv,ATER
ENCOUNTERED? Li
1FYES, ATV'VHATDEPTH? AIoAjC— L
Depth to Water After 0
114onitoring?
Daie:
Site Plan
Re2dino
Date
Gross Time
Net Time
Depth to Water
Net Drop
0 7
PERCOLATION RATE d, 7 FERC HOLE DIAMETER
TESTNEN FT AND 6 FT
aVII B E I
COMMENTS KR.X* 12—
-7 T
PE'RFORMIE-D BY: ��W!--,101�4-�-��ERTIFY THAT THIS TEST WAS
PERFORMED f—"
�MED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Frontier Surveys, LLC Project No: 18-405 Date: 10/5/2018
Z .,, d I Ordered By: Beth Christensen Plat: P-2448 Grid: N/A
Scale 1" = 50'
--------------------------I
CRINGE STREET - ------------------
d
a
0
SOO' 94'33"E 82.50
I
I
I
7Q0'WELL RpQ1US
f
y
p
�- 6
I
N
a- w
I
1
�:• Ds
6
O
Z
i
/
!
�
r
Q
�
r
6.8
12 4 ` cv
r 12-1 2.1
30.9
29-3
LOT 3B
4-1
LOT 6A S2
LOT 6B
3.2
w L0445aN2,ew�rr2
Thomas L Bayle Subdiw&;
23,100 Sq, H,
12200 Carya Sure!
25fay fYuoR F,anre Nwrse
HTri Affeclietl Z Ca• Ga•rpe
30.0 44.8
O
SHOP
34.7 —
�
L—
f ---1
Q
/ COVERED fiYP.j
].__
— _
S00" 94' 33 "E 82.50
LOT 4B7
y Electric Meter/Outside Power c_� Telephone Pole ❑ Metal Post
Gas Meter ® deck -0- Fence
-3 Light Pole
S; SepticWater Well Me Mailbox Over Hanging Power
0 25 50 100
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. Scale in Feet
3. All measuremenWsetbacks are to the visuallapparent building footprint.
4. All dimensions to property lines are piuslminus 0.1ft.
NN\� 11 t 1
1111
This survey complies with the AS PLS Mortgage Location Standards. The survey represents visible improvements and
OF Al
E
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that boundary It is the the Owner to determine the
�~ t�Q'' • '!r� ►1'
a subsequent survey may reveal. responsibility of
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be for for establishing boundary fence line.
used construction or a or
* : 49TH #
As-Built Survey of:
Lot 6A N21, Block 2 Thomas L Boyle Subdivision
. • - • -
r• '
Frederic W. nor
�� NO. L.S.-9946 •'.5
I, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or
��1•`rA '. 101812018 _=
under my direct supervision on October 5th, 2018.
F
r p�
f 1 f t t'�Surveys,;S`ONJ ` ��.�`
Frontier Surveys, LLC FRONTIER
650 W. 58th Ave. Suite E Anchorage, Alaska 99518 &"��
907.460.1686 - info@frontiersurveys.com
PROFESSIONAL SEAL
www.frontiersurveys.com
/5, MUNICIPALITY OF ANCHORAGE^-
DEI ITMENT OF HEALTH AND HUMAN SER% ES V r A-E)�
Environmental Health Division
1
825 •'L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
72 -013 J3,85)
Name Fit
DISTANCES
TO
FBOM
SEPTIC
TANK
ABSORPTION
FIELD
WELL
Aad,• s
1� %
pnonetsf .eel 6o. No of Bearooms
WELL
I
1
LOT LINE
seeAc bescmeuoN
got � Bloc•
Subdwrsw
FOUNDATION
rownsmp. Rw. •.Section !
C
•%
AS -BUILT DIAGRAM (snow location of well, septic system. p,openy tines. foundation.
Onveway, wale, bodies. etc)
TANKS
K SEPTIC ❑ HOLDING
ManUIdQU.er
aig
Capacity in gallons
O
Malena.
—1
No. of Companmenls
TYPE OF SYSTEM
f"iL
o
;TIG
t.l D
f
Sr
lit
TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom bom
Odgmal glade
FT
local depth hom 0g'nal grade
V/
FT
'
•'�
f
Fill added above: ongmal grade
FT
G.avM dapin bmPath pe
� FT
GrarM leng:n
9 FT
G,~ w,dlh
FT
lotal absorplion area V
SQ FT
Distance between lines
Q FT
r
e
•(/p
Number pl Imes
soli teeny
SO FT
pipe material
VG
'
m5:auer
Lov 15 C-.
Data Installed
WELLS
PRIVATE ❑ OTHER (Identifv)
Uaaubt,deon IA.B.LI
Iola. LlaptnLased
FT
to
FT
mstallel
S j 146
Date Installed
REMARKS:
nu v
-
S7 L' C�11 43 f '. Lyy
Scale: ( z 7,
Inspec s P ormetl by.
Is
9/14 IN
• _ �urtlr�ERssgi
,-� �� (1 �• Y�( T
d.
�J• 2 2 2 5-E ';- �r✓,
s1 ;l'. JN: 2' 1971
+�+,^�,, •, •�,-�
I t�t[.-r _ V -G(/ certify that this Inspection was performed according to all��
�. n
Municipal and Slate guidelines in tiled a i e: d h
Health DepaAmenl Approval: Dare. -
ate.
72-0131385)
V1lJFV I CT I/'1AFL I TY OF= Ah1(7-F-e' -1)FiAC3F=
DEPARTMENT �j HEALTH AND ENVIRONMENTAL ROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
Oh!—S' I _r I-_- SF=WF=R F'EF'-iM I -I-
PERMIT
PERMIT NO: 860267 UPGRADE Cltq//LIeY /K3�T�n
DATE ISSUED: 08/06/86
APPLICANT: RUSSELL WELLS
ADDRESS: 12200 CANGE
ANCHORAGE, AIC 99516
CONTACT PHONE: 345-2812
LEGAL DESCRIP: SUBDIVISION: DOYLE LOT: 6A BLOCK: 2
SECTION: 21 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 23100 (SQ.FT. OR ACRES)
3 c%�izaar
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. 1 will adhere to all, MOA and State of Alaska requirements for the set back:
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES;,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-DUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WYtK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
AF'F'LIC T: ;USSELL WELLS
ISSUED BY - . l / / `C DATE:
/P/- .f I /I dig % �uf�ls:tl.
PERFORMED
r P( SOILS LOG
MUNICIPALITY OF ANCHORAGE p
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION / PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION:_jr LOft'Qc
DEPTH _
(FEET) NGLASs/LrQ �(-L
1
e `-
Gross
Time
.
r
3
r•
4
5
..l O$
6
J /74
I�A
M s
M p
1 QTY S.4 W1
s
�
Cody��5 — J%I
e
y
y /7
10-
11-*
12-
13 J
I
14
15
l..`1t�1
16
r
;yam:•
i�.(�F�A(
*•
,�.J
1 ,
:9TH l.J
17
�..:
18
/,�f�O
o. 2225-E
Q .
UNE 25, 1971
19-
9
20
20
•Z 11 �a��
DATE PERFORMED:
SITE PLAN
WAS GROUND WATER Id/ S
MMINEM'
MEN
' ' . 'L'Gy►ZI
IF YES, AT WHAT E
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
..l O$
M S
J /74
I�A
M s
M p
a %t
3 M s
M
y
y /7
==4
PERCOLATION RATEM// (minutes7ioch)
TEST RUN BETWEEN _L4_ FT AND —7—FT
PERFORMED BY: L -SWW5�5,11 CERTIFIED
72-008 (6/79)
S
LOT 38 A
ItefaL co', wlz
IR NC4 LOC,vo"
wEL'-
Lo�r 6A
MONITORING Fit
co�� /ids (Idr( rW�'
Nbl� '� 6UIlDING W� H q Df( LUNG W�✓�
REqNMTS. 'fM-- j1
Jff1�`'a�o!,/ ,
vUl L�Y14fHNl,fw.l✓_t✓r .ANG! nst()D
\ (n
lQ�
V
WALL.
s Lai m
NJ off s s
I..5x15'(IUG ! r-Pfk�'2W MAY ffsr Ri✓; P 60NIIN�WcN V15L)AL
EXAMINg71oN orooNrflON AND V6fZIrICIA'(I0N aF 517$.
2.M0VXIS(IN6 VCN TA?LI< ANT) UISPJ%-. IFf {� 15
AT CwNEP; cpflo" r(.V�-\Y P. K:5;-rALL6D.AT
c -ND ar
CoMPUiA-nor45 e
,5xKTIN6 1NL,5(INVCPT 3.�' �1;LOy�/ SUPFAC;r
OW Noll 51,GV. Ol
DRor iN nn(yam,FERrT.) 0.5'
PROr IN 'TANK 0.5_
cePTH To FIP); IN 1pNr-H
SOIL RKONG
Ro. op t5Ono6ms
P5mH or'ff?�,t4W
DErPIH 4F P0r-11,bALWjLL
WItV(N OF NGN
L5Nc* o{ ivajcii
140
3
10'
6
30'1
140x3/2x5.5 -38'
'tip:•' % •'f t�
h.49it!
4o. 2225-E
25. 1971 �4;
To3BEN CPUC ILI-ANDi p �. N,i La ro �, dl OG6C 2, gDYI. SUt3q. if
2 05 I n c P�RAO� 7/29/2F
ANcNr n�
AK 995°1 5 21, "(I2N,R3�1� sc11 E 1"w5d-d
( W � ( ¢ ( L4 E L
2
( ( ( ( ( ( ( ( ( L E E
\ ( ( ( \ ( ( / ( ( ( (
3 E w� w L6 w w w a E w
> /
j 3 \
•k•k )|;||!|k;[}|f|ff'
& \ƒ .I
_ ■|to:10 ] |u
moto?�j \!
% @|g / |2 « 7 / !
( ( U. E
�
5
E °
k
§ / / / / / / / / / / / /
2 w w 3 w w w w E w E w
,
§
k
Parcel I.D. 015 282 44
epuMis
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Expiration Date: t I- I j I
1. GENERAL INFORMATION
Complete legal description Thomas L Boyle Block 2 Lot 6A N2
Location (site address)
12200 Cange
Current Property owner(s) Christensen
Mailing address
Real Estate Agent
12200 Cange
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
ED
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariancedequest for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ (Oct •40 +M -L-0
Date of Payment CV jZql � q
Receipt Number (j�--Hb o
COSA # 0 5 C 17/5-0
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 907-854-5558
Date 10/28/18
OWN4
*.49jH
r
t a oya as . a
tHARLES G BALZARit
�CE-13854 40
w��Y NbYlrwnnlrltaQ.�-F��\
Conditional approval for bedrooms, with the following
By:
Original Certificate Date: —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 _ C
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet—f c
Legal Description: Thomas L Boyle B2 L6A N2
A. WELL DATA
Well type private If A, B, or C provide PWSID #
Date completed 3/30/82 Sanitary seal (Y/N)yeS
Total depth 74 ft. Cased to 74 ft.
FROM WELL LOG
Date of test 3/30/82
Static water level 40 ft.
Well production 5 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 7.94 mg/L
Arsenic ND ug/L Date of sample: 10/28/2018
B. SEPTIC/HOLDING TANK DATA
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Parcel ID: 015 282 44
Well Log (Y/N) Yes
Wires properly protected (Y/N)yes
Casing height (above ground) +12 in.
AT INSPECTION
9/20/18
38 ft.
+4.4 g.p.m.
l
Collected by: C&M Engineering
Tank Type/Material SEPTIC/ STEEL Date installed 10/25/18
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) yes
Foundation cleanout (Y/N)yes Depression over tank (Y/N) no High water alarm (Y/N) no
Date of pumping NA/New PumperNA
C. ABSORPTION FIELD DATA
Date installed 10/25/1 Soil rating (g.p.d./ft2 oro rr +) 0.6 System typeshallow
Length 100 ft. Width 5 ft. Gravel below pipe 4.6 ft.
Total depth 10 ft. Eff. absorption area 1000 ft2 Monitoring tube yes Depression over field no
Date of adequacy test na/new Results (Pass/Fail)ap ss For 4 bedrooms
Fluid depth in absorption field before test -- in. Water added -- gal. New depth -- in.
Elapsed Time: -- min. Final fluid depth -- in. Absorption rate >_ -- g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) no If yes, give date na
D. LIFT STATION
Date installed --
"Pump on" level at --
Datum
Datum --
Size in gallons
in. "Pump off' level at -- in
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tank/lift station on lot +100
Absorption field on lot +100
Public sewer main +100
Sewer /septic service line +25
Animal containment areas •+100
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (Y/N) --
High water alarm level at --
Meets
Meets alarm & circuit requirements?
On adjacent lots +100
On adjacent lots +100
Public sewer manhole/cleanout +100
Holding tank +100
Manure/animal excrete storage areas+100
Building foundation +10 Property line 5 Absorption field +5
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots +100
ABSORPTION FIELD ON LOT TO:
Property line 10 Building foundation +10 Water main +10
Water Service line +10 Surface water +100 Driveway, parking/vehicle• storage +5
Curtain drain +50 Wells on adjacent lots +100
F. COMMENTS
new septic install
G. ENGINEER'S CERTIFICATION
l certify that l 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 Charles Balzarini
Date 10/28/18
COSA canary sheet_2-6-15.doc
in.
ESQ G BALZAREW
CE -13854 �c
It Ja`'
DEVELOPMENT SERVICES DEPARTMENT � � «�rd
On -Site Water and Wastewater Section
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC181569
Subdivision: Thomas L Boyle , Block: 2, Lot: 6A N2
A water sample revealed a nitrate concentration of 7.94 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
cht�d1�k��1' �,
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby' disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
lith 5 910,�$O { r �� .Sas Wlil� 1
R22 x� E N. ,r ,:
Frontier Surveys, LLC Project No: 19-278 Date: 7/19/2019
Ordered By: Beth Christensen Plat: P-2448 I Grid: N/A
--------------------@ CANGE STREET
( COVERED(TYP.J �
S00°14'33"E 82.501
LOT 481
Le It
Electric Meter/Outside Power `0.1 Telephone Pole O Metal Post
Gas Meter ® Deck o Fence E Light Pole
S; Septic 0 Water Well na Mailbox —uP— Over Hanging Power
3
0
h
9
LOT 6A S2 I LOT 68
General Notes:
0 25 50 100
/
r S00° 14'33"E 82.50
I
2. Excepting for gross negligence, the liability for this
----
;100' WELL RADIUS
I
I
4. All dimensions to property lines are plusiminus 0.1
ft.
t
l
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
o
> o
3
\
-W
m
N
\
plat.
should this document be used for construction or for establishing a boundary or fence line.
J
.. 4 TH
0; W
' o
:
Lot 6A N2, Block 2 Thomas L Boyle Subdivision
Id
1, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or
7/24/2019 �J�X
under my direct supervision on July 19th, 2019.
\0
2
0
N
\
79.
W
www.frontiersurveys.com
4
u1 to ,y^
9.6
_
12.7—
w
30.9 12.1 2.1 H
2
29.
LOT 38
' 1
3.2
I Lot 6A N?, Brock 2
Thortms L Boyio Subd;,isio,r
23,100 Sp. Ff.
�cwF
f .�cnt
14.9
30.0
o
o SNOP
( COVERED(TYP.J �
S00°14'33"E 82.501
LOT 481
Le It
Electric Meter/Outside Power `0.1 Telephone Pole O Metal Post
Gas Meter ® Deck o Fence E Light Pole
S; Septic 0 Water Well na Mailbox —uP— Over Hanging Power
3
0
h
9
LOT 6A S2 I LOT 68
General Notes:
0 25 50 100
1. This document is created for the purpose of a single
property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this
survey shall not exceed the cost of preparing this survey. Scale Feet
3. All measurementsisetbacks are to the visual/apparent building footprint. In
4. All dimensions to property lines are plusiminus 0.1
ft.
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
'.� 0 F• A C ��/
'( • • /!
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies
r ,`Q' •' • • • , • .q
' •;
that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record Under no circumstances
'.•9 /j/
plat.
should this document be used for construction or for establishing a boundary or fence line.
//
.. 4 TH
As -Built Survey of.
:
Lot 6A N2, Block 2 Thomas L Boyle Subdivision
..... ........r ... ....5
�1 •Frederic W. e •� ar i
/ NO. LS: 9946 �0 ..
1, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or
7/24/2019 �J�X
under my direct supervision on July 19th, 2019.
!t pRt �,�;Y��� ~
Frontier Surveys, LLC
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
13W
907.460.1686 - info@frontiersurveys.com
PROFESSIONAL SEAL
www.frontiersurveys.com
r.
f1�1ENp�
n
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date t `N\ \ Q f,
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property Ownerl;�!Nkg & A?Ak :� Telephone: Home-7,TS'2 gX? Business
Mailing Address 72 �� ` A--+- �1—
(c) Lending Institution _30n LE
r\nNTelephone
Mailing Address4�:iLLS\ Ye
OtC( 90
(d) Real Estate Company and Agent NOIJ C
Address
Telephone
(e) Mail the HAA to the following address: or. Check here K if hold for pick up.
List contact person and day phone number below.
X74_ z9 /fes
.2. TYPE OF RESIDENCE � APP/j>�ED FaR fOuR DED�poor�J PE/� AVEQuyrE
Single-FamilyL ADSOr�PTrov AREA
Number ofBearooms OfS/GN 1,✓ D. y.y,s F/LE.
3. WATER SUPPLY
Individual Well F, Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Q Public[3 Community E3 Holding Tank ❑
Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 77.075 Inn. 8.861 r.M1
r`
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, l 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 regulations in effect on
the date of this inspection.(1
Name of Firm �+I. cv/�.tucr� Telephone 6171-391(,
Address p 3 I V!f" r�
Date ? &��
tea:; •�� �:
� may: - :•7
Ps1' • ���`T�W �. J
/... .. ...... ••�
t 2225_E &I_Engineer'sSeal
i
APMOUEQ FOR ¢ gEv/loorlf PfR ROfq.,ATE ADSOrrP7.10, fT/7Es} OEs/Ga IN
P.H.H.1 Fic E.
6. DHHS APPROVAL_ t�
Approved for bedrooms
Date
ApprovedDisapproved Conditional
Terms of Conditional Approval
CAUTION
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
engineers work.
Page 2 of 2
72.075 IR" 8 261 e+.rk
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL Ij glo _ lama
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date I `fit, N Q Le
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot block, subdivision, section, township, range)
Location (addrrss or directions)
(b) Property Owner'2�u!aR\l 0&S Telephone: Home—jaS'z giZ Business
Mailing Address 2 D b 0 V- .
(c) Lending Institution Telephone G2— 5 ,•G (F
Mailing Address G --rlA�\ Y.PSS n..14 Rltl N nn.�� �'1lP Otcl19
t (d) Real Estate Company and Agent Noll C
Address
Telephone
(e) Mail the HAA to the fotlowina address: or. Check here if hold for pick up.
List contact person and day phone number below.
-- y_ ��vtz��Aue
874
2. TYPE OF RESIDENCE
Single-Familyl�
Number of Bedrooms r
3. WATER SUPPLY
Individual Well Community0l Public[3
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
Onsite4 Public 0 Community ❑ Holding Tank O
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 nms law 81861 Fra.1
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection• the on-site water supply and/or
wastewater disposal system Is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this Inspection.(
Name of Firm Telephone 979-3116
Address 020 3 t.ke�'
Date — No ✓ ti r / 9 d'6
OF A j(j Rl
•'/000
dt
04.
. •T..
'222
� _�ngineer'sSeal
S971. 1
ANE,vOeD FOR ¢ RePgoonS PER ADEqu.47_E /I ORPTICA, ATEA Pcr1011 Z.
OH•H.S, faE ���
2 3-87
6. DHHS APPROVAL ilbedrooms
ApprovedforDate 6
Approved __7'�— Disapproved Conditional
Terms of Conditional Approval
CAUTION
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.
Page 2 of 2
77-875 IRw 8161 awk
r'1
G' MUNICIPALITY OF ANCHORAGE (MOA)
!I►ArPOfR ION HEALTH AUTHORITY APPROVAL (HAA)
pESt� pRpTEC1
gplt*#�CHECKLIST -FEBRUARY 1984
284-4720
%Adv 5 N'/2 L e) i 6A t- p iG 2
R Ep Legal Description: A.
4 aI
A. WELL DATA ■����1yL r TIar4, P-5wl
Well Classification R If A, B, C./p.EC. Approved (Y/N) N�Ar
Well Log Present (Y/N) _� Date Completed 3/x162 Yield In 710
+1 FIC, ui 7—e r
Total Depth -7 Cased to 7y Depth of Grouting No NL
Static Water Level I/A Pump Set At 41's
d
Casing Height Above Ground Sanitary Seal on Casing (Y/N) y
Electrical Wiring in Conduit (Y/N) 1' Depression Around Wellhead (Y/N)
Separation Distances from Well
To Septic/Holding Tank on Lot lDd f ; On Adjoining Lots fJ0 -i
To Nearest Edge of Absorption Field on Lot 10.0 f ; On Adjoining Lots I Bo +
To Nearest Public Sewer Line N o N_t= To Nearest Public Sewer
Cleanout/Manhole N 0NTo Nearest Sewer Service Line on Lot >
Water Sample Collected by !_• S ; Date
Water Sample Test Results S 0- It% f
Comments
B. SEPTIC/HOLDIN TANK DATA
Date InstalledE t F1
h� Size 10- ;:o No. of bompartments T t)r/ D
Standpipes (Y/N) T cYi Air -tight Caps (Y/N) y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) fq Date Last Pumped (%A
Pumping/Maintenance Contract on File (Y/N) IA ;for W'/-41
Holding Tank High -Water Alarm (Y/N) Nl^ Temporary Holding Tank Permit (Y/N) NSA
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 16,04 To Building Foundation
To Property Line ! (v To Disposal Field / Z7
To Water Main/Service Line i
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type Design
YPe Y 9
Date Installed e/y/d 6 Length of Field 159
Width of Field 3p / / Depth of Field �Z
Gravel Bed Thickness � /Z
Square feet of Absorption Area X29 Standpipes Present (Y/N)
Depression over Field (Y/N) N/ Date of Last Adequacy Test '//A
Results of Last Adequacy Test�.4
Separation Distance from Absorption Field:
To Water -Supply Well /oO f To Property Line /6
To Building Foundation .;- o To Existing or Abandoned System on
Lot NONE ; On Adjoining Lots i go
To Water Main/Service Line > io To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course tv O N L
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION NONE✓
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
•• Check Permitted Bedroom Rating Against HAA Request •'
Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Icertify th I1hav(e�checked,vented r conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date No ✓ S , q 6
Company MOA No.
Receipt No.
/6 0/000 2—
Date of Payment
Amount: $ Ic SyV
Page 2 of 2
72-026 111,84)
0F At
&;
*.A9TH y +
�•n: rN •2225-L. .•^.�
�•a` J.I; 2S• t9'l
Engineer's Seal
C�ASUITE O �P"�ELAND9 PQ(ga HoRALASK50
CONSULTING ENGINEER TELEPHONE: 1907) 279.3916
R E S I D E N T I A L W E L L I N S P E C T I O N
LEGAL: N1/2 LOT 6, BLOCK 2, BOYLE
LOCATION: 12200 CANGE STREET
OWNER: RUSSELL WELLS
TYPE OF WELL: SINGLE FAMILY
WELL LOG AVAILABLE: YES
INSTALLATION REQUIREMENTS MET: YES
WELL YIELD FROM WELL LOG: 5 GPM.,
PUMP YIELD: 5 GPM.
DATE OF INSPECTION:
NOVEMBER 4;1986
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE. OF 5
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE., -AT THE BEGINNING OF THE. -TEST
WATER LEVEL WAS FOUND AT 48 FEET.BELOW TOP OF CASING. AFTER._ 10.
MINUTES OF PUMPING THE WATER LEVEL WAS AT 67 FEET. THE WELL WAS
WAS PUMPED FOR 30 MORE MINUTES WITHOUT ANY FURTHER DROP IN. WATER
LEVEL.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA' ON
NOVEMBER 5, 1986. TEST WAS NEGATIVE.
TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is 150 gallons of "water
per bedroom per 24 hours.This well surpasses this requirement.
The assessment of the condition of this well applies only to the
conditions as of this date. The --flow rate of the well may change
due to subsurface conditions that may not be observed from the
surface, and changes in land use and other factors that may
impact the conditions of the aquifer feeding the well.
4.
•: •i
V, 0 2225-E ^rte
P ,�i UNE 2b, 1971 ,. -
03 W. 15th AVE "C" SUITE 203
Po2U 2 ANCHORAGE, ALASKA 99501
CONSULTING ENGINEER TELEPHONE: (907) 279
MUNICIPALITY OF ANCHORAGE FEBRUARY 3, 1987
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O.BOX 6-6650
ANCHORAGE, ALASKA 99502-0650
SUBJECT: HAA for N1/2 6A Block 2, Boyle
Russel Wells
Gentlemen;
A HAA was issued to Russel Wells for the above ref. lot in
November of 1986. This certificate was for a three bedroom
house. The appraiser has determined that this is a four bedroom
house and in order to finalize the financing for this property
the certificate must be changed to show a four bedroom approval.
The tank that was installed is a 1250 gallons tank. In addition
to the specified trench with a total absorption area of 429 sq.
ft. a 900 gallon steel leaching tank was added to the end of the
trench. The added absorption capacity of this tank was not
included when the HAA was prepared. This tank is 5 feet in
diameter and 6 feet high. The installation of this tank was not
witnessed by me, but the cleanout to the tank is 16 feet distant
from the end of the trench and the contractor installing the
system made the statement that the excavation for the tank was at
least 8x 8 feet and that this excavation was backfilled with
sewer rock. An excavation of this size will result in an
additional absorption area of 192 sq. ft. giving a total area of
621 sq.ft., which is sufficient for a four bedroom house and a
soilrating of 140. ( 4 x 140 = 560 )
Yours
D_
Tobbe Spurkland P.E.