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HomeMy WebLinkAboutPROSPECT HEIGHTS #2 BLK 7 LT 4Prospect Heights #2 Block 7 Lot 4 #015-134-80 The undersized 1984 trench may not be tested for any future COSAs . Municipality of Anchorage " Development Services Department e Building Safety Division }•�_** On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-79D4 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO50458 PID Number: 015-134-80 Name: Gary &Hilda Haas Wastewater System: ❑ New ❑✓ Upgrade Y P9 Aad sae 7800 Schuss Cir. Anchorage, AK 99507 ABSORPTION FIELD Phone: - Number of Bedroom.: 907-677-7217 S mDeap Trench 0 Shallow Trench ❑Bed [3 Mound ❑Omer. LEGAL DESCRIPTION Soil Rating: 0.8 Total Depth from original grade: 13.02 GPDfFt' Ft. Black: Lot: Subdivision: Depth to pipe bottom from original gmda: Gravel depth beneath pipe: 7 4 Prospect Heights #2 6.02 Ft. 7 FL Townshlp: Range: Section: 12N 03W 13 Fill added above original grade: Gravel Length: o Ft. 17 (new) 71 (totag Ft We ❑ New ❑ Upgra Gravel width: 3 Numberoflines: Distance between lines: Ft. i N/A Fl. classification (Rivera, A, Total Depth: Cased to: Total absorption area: Pipe Material: Ft. Ft 238 (now) 984 (rota) FF ASTM D3034 PVC Driller: Data . d: Static Water Level: Installer. - Date Installed: Ft Beek's Contracting, Inc. 7/27/06 Yield: Pump Set at: Casing Hdlg ve Grountl: TANK GPM Fl. SEPARATION DISTANCES )Septic ❑Holding ❑S.T.E.P. ❑Other: To Septic Absorption lift Holding ublic1private Manufacturer - Capacity: From Tank Field Station Tank Sawar Line Anchorage 1500 Gal. Material: Number ot CompaNnents: Wei 146.9 133.4 N/A N/A +100.0 Steel 2 SurfaceWater +100 +100 N/A - NIA - LIFT STATION - - ¢e: I en eciurer: Lot Line 119.4 123.1 N/A N/A out. _ 'Pump an' level at "Pump at High water alarm at: Foundation 70 14.5 N/A N/A in. in. Pump Make Electrical Inspections performed by: Curtain Drain N/A N/A N/A N/A Remarks: BENCH MARK Location and Description: The water source - Individual well is not located in the BM#1 - NW Comer of Slab at bottom of stairs - 1.85 Assumed Bowdon: driveway to the house BIWtZ "" «ro` 1 `1vu,n a ;nYn tenk and fimphn, .3 A Fl. kq 14 ` mvcli% 'no-ir -ko b2 Cos �09d-- "'rit cos/A-5, Engineer's Stamp Inspections performed by: ANTHC Dates: 1.17/27/06 t 4# 2nd 7127106 '....#P Development Services Department Approval ♦ DANIEL H. MUTA115 ;' M Conditional Approval by: Date: CE 10031 *t+tf,;(�` Approved by: /Z S Reviewed and z. Date: / YtE� ►� (Rer. 12m) / flod 4M [Nc,tes:ate of Survey 7 -OH -DS Ref. Field Book: ANG -02-C6 Ref. Plat 76-158 ANCHORAGE R.D. LEGEND ---_ Property Line -- -- — Edge of Gravel Road — — — Gravel Driveway — OHE — Overhead Electrical — UGE — Underground Electrical — S — Sewer Service Lines W — Water Service Lines C—� Structures ® Wells (Existing & Proposed) ca.I Power Poles 7P 0 Soils Test Location 0 LOT 1 OF q�q tt s' C)' 4913' * f .0 DANIEL H. WILLIAM AW It CE 10031 f , ZRirE�\I p\�� ♦' +200' TO SEPTIC AND WELL SYSTEMS N89°56'48"E 236.36' EXISTING RESERVE AREA EXISTING DIVERTER VALVE LOT 4 BLOCK 7 SEPTIC UPGRADE: REPLACED EXISTING SEPTIC TANK WITH 1500 GALLON SEPTIC TANK + POINT CED N a o co? EXISTING DEEP TRENCH w 54' LONG (NEWER) J NEW UPGRADE: EXTENDED DEEP y TRENCH 17' z 0 POINT A SHED r Wes'. r� See SlAruey \OL1 Fret W G Z) C x:s+„ny neserlic -ferr h wllll, be wr (� a nn ad W�iSia WG{Q(er ' s„IS7•erin h o,me_ -AM EXISTING WELL XISTING DEEP TRENCH PUBLIC LA 66-12I R o CT DRAWN BY: M.rt' DAIS: 3/7/05 No 41' LONG (OLDER) TalAl SHEETS o_ ABANDONED SEPTIC TANK+iA # SW030019 (2/2/03) 3 k\HOUSE I � ALASKA NATIVE TRIBAL HEALTH CONSORTIUM BM1 CONC. SLAB=1.35 LOT 7 \—POINT B Stc'�S LOT 6 OS LOT 5 \ Haas '.. I I AN -oz -M4 L. 4, B. 7, Prosect Hel its Subd. #2 BEET 5 PUBLIC LA 66-12I R o CT DRAWN BY: M.rt' DAIS: 3/7/05 - � 2 RLE NAME: HAAS SCALE: —I&D— TalAl SHEETS aa,a57 : CROSS SECTION QU-5- ,,, }96:93' Original grade Filter Fabric 4" Perforated Pipe SWING TIES A B C ST1 145.6 N/A 59.5 ST2 148.2 N/A 60.0 MT1 122.1 71.5 62.5 C01 122.9 69.4 65.0 MT2 109.8 N/A 58.0 CO2 104.0 N/A 52.5 6.02' Native Soil Cover g3,a3 7' of 1/2" to 2 1/2" Sewer Rock Bottom of Trench Bev.= 1e9.92- mva3 U2,11 - Bottom of Test--'VAYA Hole Elev. }�3-f10 �P��...OF„.glg21I� 49m ti. 0 No Ground Water, Bedrock, ....0 or Permafrost Encountered 0 DANIEL H. WILLIAMS 4Z AW ♦ c'� . CE 10031 : 2`�Aw — 4” Sewer Pipe�! IlR`;ESSI` qS•O 2" Blueboard Insulation 6KS' /—Top of Tank Elev.--.Frr Cieanou II it I %, 9a by C.IQQnP.A+S 1T EXISTING DLA&TRENCH New 1500 Gallon Septic Tank a ,fig / 2-1 2" j — Sewer Rock 17.00 54.00' PROFILE ., j4A Filter Fabric ADDITIONAL TRENCH 1/2" to 2_1/2" Sewer Rock 17.00' Monitor Tube DATE REVISIONS €NnEAL$ 9 Mt ALASKA NATIVE PROJECT NO. e r Anchorage Alaska e ra TRIBAL HEALTH CONSORTIUM Homestte: HItDA HAAS aN-02-C94 DEPARTMENT OF Septic System Profile K ie ENVIRONMENTALHEALTHL. 4, B.7, Prospects Hei hts Subd. #2 SHEET ,g - AND ENGINEERING PUBLIC LAW 86-121 OJECT 22 12 2 REMI51 FOR ROVAL M % "'t a4' 1901 SOUTH BRAGAW, SUITE 2130 DRAWN BV: ADK DATE; 11/04105 OF T FOR NFORMA MJF d8<LTe Ca�9 ECHO 9d7 728 380008-5997 FILE NAME: ybWG SCALE: NTS 707AL SHEEiS ZOO t? sk 1-10 OF 4� 14 AV 49i MunlcipalityofAnchorage ""' ' ' "' "" ...... i DeYelopmerrt Services i3ePBTtTT1eRt % �: DAN EL . WlLLIAMS .: ¢� i BWming SatelY dvtabn G'+ . �� .: Dn`ghe "^d� gram ♦ CE 10031 _ 4700 SOA SragaW St `'�'�'•. -_ J ��i P.O..Box 19WMAnchorage. AKMig-Sew ` ie • j-7, , . •'' F4 • (907)3 7904III VuL% /� Soils Log - Percolation Test Pertonned For. ri �dQ42rData Pedoma:d:�/�'/ p7 Lagar Oeacriptlpn; y B/a4 Piatf /i4J Ajlrovmshr - - —•' Depth { ORI&marcs 2- 3- 10- 12-- 13---- 14-- 16. -3- 10- 12- 13-- 14- 16. rTr/�y n7 17- 20--- 3w 7- 20 -3c E �ofka»r ar° —ra PERFORMED BY: W PERFORMED IN ACCORDANCE YMTI4 A WAS GROUND MT ER ` f^ ENCOUNTERED? B IF YES. AT WHAT DEPTH? 4 GapffiWWat*rATbr O Moniewingt P DaM: Reading Data Grose Time Net Time Depth to PERODIATION RATE (redrww 'u* PERO TEST RUN BETWEEN FT. AND Pr YE .L STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DIAMETER - Net Drop CERTIFY THAT THIS TEST YPA IIS DATE, DATE: G7 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program` 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW050458 Legal Description: PROSPECT HEIGHTS #2 BLK 7 LT 4 Design Engineer: 0870 ALASKA NATIVE TRIBAL HEATLT Owner Name: HILDA HAAS Owner Address: 7800 SCHUSS CIR ANCHORAGE, AK 99507 - Date Issued: Dec 28, 2005 Expiration Date: Dec 28, 2006 Parcel ID: 015-134-80 Site Address: 007800 SCHUSS CIR Lot Size: 106704 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. a.) An additional test hole and percolation test shall be conducted at time of construction. The test hole shall be located near the northwest end of the 1984 trench. The soil log with 7 -day groundwater monitoring and percolation results shall be submitted with the Inspection Report. Received By: Issued By: Date: 2 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FORA SINGLE FAMILY DWELLING Parcel I.D. C) (S 13 1/ & U Number SW Property owner(s) Day phone Mailing address_Zip Code _ Site address %to- S cl ,, 55 Cr _ , AvL�sc , ?y Zip Code _ Z(DS -'IIoZ_ 7 yr-7- Legal description (Lot, Block & Sub'd.) ( ti i g • i� �s n��+S� Legal description (Section, Township & Range) 1'3 1 Z o gni S . M . Lot Size 2"t S / Io Io,10ff Acre !.Ft Number of Bedrooms S THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ✓❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwg and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Date of Payment: Receipt Number: 14LI IA I q Receipt Number: (Rev. 09104) Iv Alaska Native Tribal Health Consortium e Division of Environmental Health & Engineering o 1901 South Bragaw, Suite 200 Anchorage, Alaska 99508-3440 0 o phone: 907-729-3600 Fax: 907-729-4090 a www.anthc.org November 10, 2005 Municipality of Anchorage Attn: Onsite Department P.O. Box 196650 Anchorage, AK 99519 RE: Hilda Haas septic system upgrade. To Whom It May Concern: ANTHC received a request from Hilda Haas on 12/09/04 to upgrade her existing 4 bedroom septic system as constructed under permit #SW030019 to a system capable of handling a fifth bedroom. The design calls for a 1500 gallon septic tank to replace the existing 1300 gallon septic tank and also an extension on an existing deep trench from 54' to 67'. The improved septic system is located well over 200' from adjacent properties septic and well systems and should not impact their systems or property. Reserve space on the property is adequate for another septic system. Soils and terrain are sufficient for proper drainage. No probable impacts to nearby properties are foreseen. Sincerely, Daniel H. Williams, P.E. Regional Manager Cc: Project File, ANTHC, (AN-04-CD6), Anchorage Votes: I. Date of Survey. 7-08-05 \\\\TA Ik 2. Ref. Field Book: ANC -02-08 3. Ref. Plat, 76-158 ANCHORAGE R.D. �. LESEdp �P 49TH Property Line ,w Ed a of Gravel Rood 10 — — Gravel Driveway — OHE — Overhead Electrical UGE — Underground Electrical — S Sewer Service Lines W — Water Service Lines 0 Structures ® Wells (Existing & Proposed) Power Poles Soils Test Location REPLACE WITH 1500 LOT 1 DANIEL H. WILLIAMS ;o,- ♦ �r C� 10031 A f i `RhEESSI p 4" LOT 3 +200' TO SEPTIC AND WELL SYSTEMS LOT 4 \ BLOCK 7 � EXISTING ' DIVERTER VALVE WELL LOT 7 RESERVE AREA EXISTING OLDER NG TRENCH 1' \ \ � A o i ABANDONED EPTIC TANK PERMIT # SWO30019 (2/2/03) ¢ n ED UPGRADE: S SEPTIC TANK OUSE / SEPTIC TANK Sth 6 EXISTING DEEP TREN H PROPOSED UPGRADE: 54' LONG (NE ) EXTEND DEEP TRENCH 13' / �a5 Ste' yl y LOT 6 Q.\G !G �O LOT 5 AN -D4-006 L. 4, B. 7,Prosect HdWIS Subd. #2 SHEET PUBLIC LA 86-121 .ECT 1 DRANK BY: MJF DATE: 3/1/0.5 CF RLE NAME: HAAS SCALE: 1,602 T TAI WFFTC 2" Blueboard Insulation Filter Fabric 4" Perforated Pipe 48" Native Soil Cover 84" of 1/2" to 2-1/2" Sewer Rods No Ground Water, Bedrock, or Permafrost Encountered CROSS SECTION 4" Sewer Pipe 2" Blueboord Insulation ��,..OF,. Z : 49m *A DANIEL H. WIWAMS :P 10031 $�. 2%.� Cleanout/ II j \ Filter Fabric. (,Monitor Tube EXISTING PROPOSED TRENCH TRENCH 1/2" to 1/2" to 84" New 1500 Gallon Septic Tank 2_1/2" 2_1/2" Sewer Rock Sewer Rock 10.00 54.00' 13.00' PROFILE HomeaitOHILDA HAAS AN -Oa CDB Septic System Profile L 4. 8.7, Proiects HeillTts Subd. /2 SHAT PUBUC W 88-121 MCT 2 DRAWN BY: ADKOATS: 11/04/05 OF FlLE NAME: HAAS.i n SCALE: 2 TOTAL 8HEE75 :RIBAL HEALTH CONSORTIUM Project: U'e, Pg X of Z-- ALASKA NATIV�SubecC �i'=-i:n�� iC5�2.6n ' Date t��2S �t•S Division of Environmental Health and Engineering J • � .- 1901 South Bmgaw Street, Suite 200 Detail: Anchorage. Alaska 99508-3440 Prepared By: nor° 657;V't T? -aiV" � r• 4-i'U-S 45 S 4 ��r�?��_ ADS L..iJl_ 'Sn.�-.Q.cc'i My 12-e�oY 'f - �UP��2s7 Ca r ae � �� - �4 t Z = ��• • � F, ��P� • --. e 1F4 ,:• DANIEL H. WRLLIAYS ��•_ CE 10031 . PHONE: (907) 729-3600 Toll Free: 1-500-560-8637 FAX: (907) 729-4090 ALASKA NATIVc TRIBAL HEALTH CONSORTIUM ��...` Division of Environmental Health and Engineering Subject:_ 6'tf 1901 South Bragaw Street, Suite 200 Detail:_ tTl,c Anchorage, Alaska 99508-3440 Prepared 'E-A P9_oi Date PHONE: (907) 729-3600 _ Toll Free: 1-800-560-8637 FAX: (907) 729-4090 Municipality of Anchorage Development Services Department Buitding Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P -O. Box 196650 Anchorage, AK 99519-6650 www.munLorg/ans" (907) 343-7904 Soils Log - Percolation Test perfonned For. Hilda Haas v c Y°' COMMENTS jP: DANIEL H. WILLIAMS CE 10031 `g Date Petfomred: 7/8105 TovrttstNP' n......., ce..r.."- TI 2N- R03W. S.M. Sec. 13 iiNaPPEORM Reading -' WAS GROUND WATER S \A-, ENcouNrERED7 NO 5".5 IF YES, AT WHAT DEPTH? _ 1 Depth to Water After 2:OOPM Monttortng? jP: DANIEL H. WILLIAMS CE 10031 `g Date Petfomred: 7/8105 TovrttstNP' n......., ce..r.."- TI 2N- R03W. S.M. Sec. 13 iiNaPPEORM Reading Date Gross rune Net Tana Depth to Water Net Drop 1 7/$/05 2:OOPM - 10" " 2:08PM 8 Minutes 0" 10" 2 2:09PM - 10" " 2:19PM 10 Minutes 0" 10" 3 2:20PM - 10" " 2:30PM 10 Minutes 10" 10" PERCOLATION RATE t PERC MULE umommm a TEST RUN BETWEEN eb' FT AND 7.5' Fr PERFORMED BY: Dan WiYtans CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE- DATE )C1 Lila Municipality of Anchorage=, Development Services Department i i:.,.,, Building Safety Division Onsite Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 995IM650 Page ` of www.ci.anchofage.akus (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECCTION REPORT Permit Number: 5 00,300 19 PID Number: o1 — 13� -600) Name. .�q i'G Sfq Wastewater System: ❑New Upgrade Address: '7900.44 L,r-,IS �9�16'ri ABSORPTION FIELD Phone: — 3lI j � a NumberT of Bedrooms:) L Deep Trench 0 shallow Trench p Bed ❑ Mound ❑ Other. LEGAL DESCRIPTION Sad Ratify: D��GPDIFt= Told Depth from original grade: 1-3, FI. Black: Lot: Subdivision //(j ro [t f7(r/C Dept to pipe bodam from wig' grade' • Ft. Gravel depth beneath pipe: -7 — 7 / Ft. �J Township: Range: Section 4{'•] r,0• Fid added above oiginal grade: <0,7, Gravel Length: Ft. Well: [I New E]Upgrade Gravel width°� Numberoflines: ( Distance between lines: Ft. Ft. CCl^assifcalton(Pmate, AB, CI: Told Dept: Cased to: Eje n Pr Va Fl. FL Total absorption area s/7 /,j / V Fts ��Pftip/ppee�Moj^u�n(d.�: qq A 5 j M q ! V Grille[ Date Dolled: cWaler Levet Installer. �` Date Installed. z Fl 1 Lr Yield: et at ova Ground TANK GPM Ft. FL SEPARATION DISTANCES %(Septic ❑ Holding ❑ S.T.E.P. ❑ Other: TogSeAbsorption From Field Lift Station Holding Tank PubliUPrivat sewer Line Manuldtlurer. t // ('eMl�i- !A$" /GS Capacity: _ 3 cal. Well 13� % aMaterial: : j 0 ^ 1(.!Surface Nu f Compartments: Water /�/�.��N�.Ij / r I/ \ LIFT STATION Lot Line 1 ` + +'Pump ( Size: Manufacturer. Gal. Foundation 7Lf L qC ` 16 V^ on I Pump of level aC High water alarm at in. in. in. Pump Make 8 Ma Electrical Inspections perfanned by. Curtain Grain p t/j// vl Remarks: BENCH MARK Location and Description: f - LOVI Grp Assumed Elevation: o, t Do Ft. S&SENGINUEER—ING 17034 Eagle River Loop Road, No. 204 at } Dates: 1 �'� -G3 ,•ROBERT • J Inspections performed by:Eag , 2nd C. COWAN� Developmen Services Department Approval r� r2 vd��� •. CE -8801 1a� Reviewed Date: S G o3 p�tT\",`•;............:..:. `�`c'= and approved by: L.i PERMIT N0. SW03001 9 PAGE 2 OF 3 Municipatit of Anchora e DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tete hone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 7, PROSPECT HEIGHTS #2 P.I.D. NO. 015-134-80 I I I I I I I I I (100w WELL RADIUS I I °A I DBL1 & DBL2r^4 NEW 1300 GALLON y< HDPE SEPTIC TANK A DV (DIVERTER VALVE) T2 T ®o T1 TMT =� p CO2 CO Q0' N� TH TB }O�OC) rq FC a a z NCN Wl-, [[� W 9VPIE0 EL[L.flIC LINE MTN Q DRIVEWAY/WI\I wl :I :JI �I �I of '� SCALE: 1 i� 50' d P E A�}s•ROBERT C. COWAN i / �\� / fP c •` CE -8801 PERMIT NO. SWO3001 9 PAGE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH AND HUKAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 7, PROSPECT HEIGHTS #p2 P.I.D. N0. 015-134 FINAL GI Mi i =aU.1r ST1 ST2 96.9' FINAL GRADE 2" INSULATION NEW 94 3 1300 GALLON POLYETHYLENE 94.0' SEPTIC TANK C01=100.6' ?=97.0' �_01=93.5' 102=933' A NO WATER FOUND 80.4' B.O.H. N. T. S. MUNICIPALITY OF ANCHORA GE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030019 Design Engineer: 0003 S & S Engineering Owner Name: Marcy Stauffer Owner Address: 7800 SCHUSS CIR ANCHORAGE , AK 99516-1142 Date Issued: Feb 10, 2003 Expiration Date: Feb 10, 2004 Parcel ID: 015-134-80 Site Address: 007800 SCHUSS CIR Lot Size: 106704 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: z Date: 2 /%/,, -3— Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.ancharage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 C S 13 y— it u Permit Number SWD$DO/`j' 416 Property owner(s) I l A G Y S i g v F F/ Day phone 3- 3 // O Mailing address (1) '7 `d O '0 S UN v Si C r te&I-t: Mailing address (2) 1+N CNo R9 U f , 4 Kp Zip Code 61 1 J- / (oLegal description (Lot, Block & Sub'd.) Lo"IL D '7, � O6k2 Prospe ct Ile, IQ h-�5 Legal description (Section, Township & Range) Lot Size 106 AcresED /e lo, -7© THIS APPLICATION IS FOR: Number of Bedrooms T Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade W THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. S & S ENGINEERING /� % 17034 Eagle River Loop Road No. 204 C /� Eaaie Rive_ Al..&. (Signature of property owner or authorized agent) Permit Fees: -V q 00. vo Waiver Fees: Date of Payment: a/3'`o 3 Date of Payment: Receipt Number: O 36' 5,7 Receipt Number: (Rev. 12/00) S& January 28, 2003 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)6942979 FAX(907)6941211 HEALTHAUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 SEWER&WATER Anchorage, AK 99519 MAIN E(TENSIONS REFERENCE: Lot 4, Block 7, Prospect Heights Subdivision #2 SEWER& WATER INSPECTION It is requested that you issue a permit to replace the septic tank and install a new trench to serving the existing four bedroom dwelling on the referenced property. ENGINEERING STUDIES A test hole was excavated, and a percolation test performed. The approximate location of AND REPORTS the test hole is located on the attached site plan. At the time of excavation 1/25/03 no water was found. After monitoring, ground water was not found. WELL INSPECTION We do not anticipate any adverse effects on neighboring wells, septic systems, reserve &FLOWTEST areas or drainage patterns by the installation of the proposed septic tank. The installation of this septic tank will not prevent any future development on any of the adjacent properties. SITE PLANS If you require additional information, please contact us. Sincerely, RoADDESIGN Voe� �7 e... Cowan, P.E. SOIL TEST RCC/bjj Enclosure PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 1" = 50' DESIGN SITE -PLAN '7 777 oqr 0 W V -' \ a10 'P O O �m \ \ CnW \ v0 rO r p`°o m W ctiz M Z TI O rg d i � fml M L / �e N m r - — — — — — — — — — — — — — — — — — — — — -z — — — — — — — — — — — — — — — 0-00 7J m 10' UTILITY EASEMENT pp�V� L'J -------- ------------ -- — — — — — — — — — — — — — — — — — — — s ro <z hi-- - DOO \ zm0 00 oFm �m \ \ mi OL \ v0 \ r 0 u ~ W II n � O L Ky4� N LnC) O1� D 0-00 7J m pp�V� L'J s ro <z i I O (14 �y -4 I } A =D y - DOO \ zm0 00 oFm 0 z \ \ mi OL \ v0 \ r 0 u ~ W II n � O I o �a, N LnC) O1� D 0-00 7J m pp�V� L'J V �] I O (14 �y -4 - r 2 00 oFm CrJ o r � � H m' r 0 u ~ W II n � O I o �a, N LnC) O1� D 0-00 7J m I ) � ~ JCD a Wo r 2 Tlp l J n o N � H m' m � � n � O (7 N O1� D m pp�V� L'J V �] I O (14 �y -4 A z 022-0 R O � � N W TAZA � D O y y l! V1 y F0 Z r A O T lV 0 r) c+: M 0 iaaaA�'�F£R •¢ A Municipality of Anchorage �� r�tAK tNttK'J�v•..=F r� Development Services Departmento_• �, .. Building safety Division,•...•°�"°� On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 • :o ° ROBERT C. COWAN www ci anchoraoe.ak.us CF (907) 343-7904 - Z ��• `.' ,,r. Soils Log - Percolation Test Performed For: M A 2 GY 5 74 VP F& f2- # Z Date Performed: f/ as—/O,3 L.. Legal Description! )_07 � )3LX 7 I3j2ijp&`cr '%'S Township, Range, Section: n ^ Depth i-eet) (J 2G,grrcS 7t fLL rJ SI L7/ S4N0 V -a d � WAS GP.OUND WATER ( G 2 ll ENCOUNTE=V'D? N a B IF YES, AT WHAT DEPTH? '— 0 Depth to Water After p Monitoring? of) -Y E Dale: a � 17- J 18- d JtG 1a 4.0,# . 20- t L Reading Date Gross TimeNet me Depth to Water Net Drop �'Rizl oAK /�as�o3) C9 3D 3 a r r I g r/� r, a 1/y- 30 6 ° 130 60 — I 6 ,. q0 30rn,,i g'�y a- 1/y I, PERCOLATION RATE -5 (minuteslnci) YtK. NULt UTANlt i tK ip TEST RUN BETWEEN _FT AND —_FT - COMMENTS S & S ENGINEERING CERT IFY THAT THIS TEST SVA.$ PERFORMED BY: 17Q�{��� 7-� Z PERFORMED IN FE a 20EA'Ll! __ a -! " 1204'PA GUIDELINES IN EFFECT OPI TriIS DATE DATE: 01- J MUNICIPALITY OF ANCHORAGE D DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME- ^ 'Ti V7/) P. S�'a.� Pr PHONE �U l /f j S_ D NEW ❑ UPGRADE MAILING ADDRESS s-,,4 T>3ux Ss •� 9� a/ �fr'e, ,4„ck 49Sog- LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS a Y DISTANCE TO: Well /p Absorption area �. Dwelling pf— %/ PERMIT NO. 1- ZManufacturer W F 4 re er Material /I .Tec r No. of compartments -- w Liq. capacity in gallons d_ O IF HOMEMADE: Inside length Width Liquid depth d x JV'Z DISTANCE TO: well Dwelling PERMIT NO. `SAF Manufacturer Material Liquid capacity in gallori5 O m= DISTANCE TO: Well / ©9 Foundation 10 f /n Nearest lot line /0 4 PERMIT NO. J w Z '_Z w No. of lines- Length of each line Total length of lines ell Trench width ?/ inches Distance between lines < F p Top of file to finish grade Material beneath rile � inches Total effective absorp area s- 57 w Length Width Depth MUNI PERMIT NO. IPALITY OF ANCHORAGE Q F w aFNVIRONMENTAL Type of crib Crib diameter Crib depth - Total effective absorption DEBT. OF HEALTH PROTECTION; w DISTANCE.TO: Well Building foundation Nearest lot line - J J Class Depth Driller Distance to lot line PMR NO71n w � DISTANCE TO: Building foundation Sewer line Septic tank - s r (s OTHER — — PIPE MATERIALS r� /VG GI s vs- SOILTESTRATING INSTALLER- �/tn fon REMARKS r`ce Wcr%<• Wei t OJ. e APPROVED �uqe DATE LEGAL 72-013 (Rev. 3/78) /I 4s t 3F • 0 x SOILS LOG MUNICIPALITY OF ANCHORAGE -. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION • TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: IZOS AR'tMHObl C��oDAATT•E PERFORMED: �y �r Be. I LEGAL DESCRIPTION: Lc7i# BK ( -PRosD ec�+ 11r+1df'.icc13r7-11f . RAL01 DEPTH SLOPE SITE PLAN 0126ANICS 4ND F 1 � LOAM 2 311111111 SILT ML 4 • ' ' SAND V-.-'ITH SILT 5 �.nwvm. LENS C— S U fb To • r • 6- 7 8 15o A 9 . .. " e�`sutp- 10 O 11 12 13 14 15 16 17 18 19 20 +Y• Wa t.L rZaAwB 15 WAS GROUND WATER O ENCOUNTERED? s� e GAAVa ` IF YES, AT WHAT 8 b DEPTH? n 1 sn r M ` OFA `L\ 1t�4 TFI • .......* 2225-E `4 f J NE 25, 1971 1 COMMENTS No■■■M©E■ ■■■■■■■■■■ Reading Date GrossNet Time Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND - FT PERFORMED BY: "r, Se SF as -oil CERTIFIED BY: ' % DATE: IO'{ V41r.3 72-008 (6/79)' M-~/V DR]LUNG, Inc. P.O. Box 10.378 · 10300 Old Seward Highway (~07) 349-8636 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner Al. ~auffer .Use of Well Domestic Locatlon (address of: Township, Range, Section, If known; or distance mafi~ reed Lot ~ lltock 7 P~ocpect Ilei~hts #2 - Anchorage Size or,casing 6" Static water level Screen ( ); Perforated ( ; ,,.).~. · Describe screen or perfora{~on t;one ". Well pumping test at 2+ gallgns per of drawdown from static levbl; "; i;' '" Date of completion June 8, 198[ ~-.',. ', ." Dep~lnfeet~om ground surface 0 ~O 2 2 TO 16 TO 19 19 TO 75 TO, ~8o 280 TO ~0~ ~O ~O. ~O --~TO ~O TO ~O Depth of Hole l/Ot~ feet . Cased to 80.7e feet ft. (ahoy/e) '. (below) land surface. Finish of well .(check one) (minute) for 1 hours wit~, o WELL LOG open end( X ); 100~ ~ 6' of extra c~sln~ welded on after yell was drilled. Gi~'d;,tail~ ~f formations penetrated, size of material, color and hardness Silty,Gravel -,-~:?'<LC' :".',.; l~d~0ck"'.":.:.: Certificate No's. 8/,i & 9T3 .'TO 3--CONTRACTOR MUNICIPALITY OF ANCHORAGE *C6: Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-134-80 1. GENERAL INFORMATION Expiration Date: /— (,— 2_6zS Complete legal description PROSPECT HEIGHTS #2 BLK 7 LT 4 Location (site address) 7800 SCHUSS CIR, ANCH AK Current property owner(s) Mailing address Real estate agent TODD SAME 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic [Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for. Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 19-b Date of Payment Receipt Number COSA # e7- 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, 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. 6. DSD SIGNATURE 4 System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved Date 9-22-2�.•����0. 4 tr• All AN b 49TH MICHAEL N. ANDLRSCN ell C 94 9� • •\` - 40 � y�ti Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: Za Z 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other Legal Description: PROSPECT HEIGHTS #2 BLK 7 LT 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/8/84 Total depth 404 ft Cased to 80.7 ft OR Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9/13122 Static water level at beginning of test 77 ft. Comments B. TANK DATA Age of tank(s) 16 years Tank type/material "" Measured operating fluid level in septic tank 48 AN Standpipes/foundation cleanout per record drawing Date of pumping 9/13121 D. ABSORPTION FIELD DATA tested 2006 trench Parcel ID: 015-134-80 Structure served by this system Well production at time of test 2+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ Ne ❑ Coliform bacteria is Negative Nitrate 6.4 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 9/13/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 7127106 Adequacy test date 9113/22 ❑ ALL standpipes present per record drawing Results ED Pass For 5 bedrooms Total measured depth from grade 14 ft (max) Fluid depth prior to test 28 in Measured depth to pipe invert from grade 7 ft (min) Water added 750+ gal ❑ N/A — pressurized field New depth 33 in ❑ Monitor tubes go to bottom of effective. If not, state 1440 Elapsed time min depth into effective OR Code -required soil cover over field Final fluid depth 28 in El System presoaked Absorption rate 750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test)0 Gallons introduced gallons If yes, enter date CommentslDeficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q Yes Community Sewer Manhole/Cleanout > 100' E Yes if No ft M Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' 2✓ Yes if No ft Water Main > 10' Animal Containment > 50' El Yes if No ft M Yes if No ft r7l Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100'Q If septic tank is under driveway comment below Community Sewer Main > 75' Q Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required Building Foundations > 10' Q Yes if No ft Surface Water > 100' [Z] Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5'�j✓ if No Yes if No ft Private Wells > 100' 2✓ Yes if No ft Water Main > 10' ✓1 Yes if No ft Community Wells > 200' r7l Yes if No ft Water Service Line > 10' 0 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' R Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF li� �•' 111 y7 i 491 M1 ERSON oj•, CE-` b 1*-Iitrate Advisory Certificate of On -Site Systems Approval # OSC 221481 Subdivision: Prospect Heights #2 Block 7 lot 4 A water sample revealed a nitrate concentration of 6.4 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. 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. Received by:i COSA to be released to the engineer, unless otherwise requested by the engineer. C Date of Payment Date: i Waiver Fee $ Date of Payment Receipt Number C); t43q(5\ Receipt Number COSA# osc(GI(P-31 Waiver# yl a 9 70 yr Municipality of Anchorage R<a On -Site Water & Wastewater Program a 1`40V 21 20'15 (907)343-7904 S, e*• 6 `lei 9 y� 01 6 ;g L CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcel.I.D. 015-134-80' Expiration Date: l �6 1. GENERAL INFORMATION Complete legal description PROSPECT HEIGHTS #2; BLOCK 7, LOT 4 Location (site address) 7800 SCHUSS CIRCLE *ANCHORAGE 99507 Current Property owner(s) GARY HAAS Day phone 632-2333 Mailing address 7800 SCHUSS CIRCLE *ANCHORAGE 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑, Community Class Wells ❑ Community On-site ❑: Public Water System ❑ Public Sewer ❑ WaiverNariance request for: N/A - - Distance: - — Received by:i COSA to be released to the engineer, unless otherwise requested by the engineer. C Date of Payment Date: i Waiver Fee $ Date of Payment Receipt Number C); t43q(5\ Receipt Number COSA# osc(GI(P-31 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, ( 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 wafer supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the. Municipality of Anchorage files and from myinvestigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD,SUITE 101 *ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date l! 20 l Engineer's Comments:.. - In conducting this evaluation,GEG.providedan engineering evaluation ofthe wag anOrsepticsystem in accordance with the - ♦+,�„�»,I, guidelines and regulations established by the MunidpolilyofAnchorege andfadusfryprdcdoes. The reportedresulls describe the ♦♦�� OF, ^� fl+♦ condition of the systems on the dates of (he evaluation. Separation distances were measured to readgyidenfifiable features - *♦ A ... �♦ Hidden defects or encroachments may exist that were not identified during the evaluotion.The operalionallile of all wells andsepfic v'1 fYY', systems depend on a vadelyofvadablesinduding, bufnof limitedio, soil iondib'ons, groundwalerlevels(that may fluctuate during ��' ♦# fheyearl qualifyolconsirudion(materialsond workmanship), andlhe waterusage ofthe family uhfizmgthe sysfeMs. These conditionscan vary, andareoutside the controlofGEG. Satisfactory test results do not guarantee future performance ofthe , sysfervo therefore, GEG makesno warranty(expressorimplrediregardingthe futureperformance of the wellorsepficsystem. "".. "" 00 GEG makes no representation whetheran alternative well orseptic system can be installedon the properlyin the event effherofthe 4/t 0 current systems fail. The content ofthis report isforthe sole benefit of the p0mvilady who retained GEG. Reliance uponthe................+ information rovidedin thisreport b an other arson or ad, including but notlimded to subse uent ro ert urchasers, is not �^ °. ffrey`A. Ga ass PY Y P P Y n9. 4 P p YP � G'r 41+ authorized. lnshort, GEG disavows any legal duty to anyone otherthan the pononlparty who paid for this report CE -7953 •♦�1 F r> Itl2cq 6. DSD SIGNATURE �1� pROFESS��A+♦ System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for , a1Ull l l i(11 rR \Q��\�Y OFgN0yo ` bedrooms, with the following stipulations _ J ON-SITE. WATER AND. WASTEWATER oz rPROGRAM�= Jam= c0b 0�= By: Original Certificate Date: The Municipality or Anchorage evelop,emt Services Division (DSD) issues Certificates of On -Site Systems, Approval (COSA) based only ,upon the represenatationsgi en 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. ATTCHMENTS: COSA Checklist Nitrate Advisory l� Septic System Advisory Arsenic Advisory Well Flow Advisory Other _(Rev. 10112112) - • it.�.rt s If more than I septic system is on the lot: COSA Checklist # _of_ Structure served by this system_ Certificate of On -Site Systems Approval Checklist Legal Description: PROSPECT HEIGHTS #2; BLOCK 7, LOT 4 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 6/8/84 Sanitary seal (Y/N) YES Total depth 404 ft. Cased to 80.7 ft. FROM WELL LOG Date of test 6/8/84 Static water level UNK ft. Parcel ID:_ 015-134-80 Well Log (YIN) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 10/30/15 80.8 ft. Well production UNK g,p,m, 2.0+ g,p,m, WATER SAMPLE RESULTS: Coliform MW colonies/100 ml. Nitrate OW mg./L. Collected by: GEG. Ltd. Arsenic: HIN ug./L. Date of sample: 10/30/15 B. SEPTIC/HOLDING TANK DATA ISEE ATTACHED RECORD DRAWING OF 2006 UPGRADE Tank Type/Material SEPTIC/STEEL Date installed 7/27/06 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping ARNOW Pumper MMMMY C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 2/13/03 & 7/27/06 Soil rating OErift/bdrm) 0.8 & 0.8 System type DEEP TRENCH Length (5 i Width 3 & 3 ft. Gravel below pipe 7 & 7 ft. Total depth *14.25 ft..4 Eff. absorption area 994 ft' Monitoring tube YES Depression over field NO Date of adequacy test. i*'10/30/15 Results (Pass/Fail) **PASS For **5 bedrooms Fluid depth in`bsorption :field before test **32 in. Water added **834 gal. New depth ***36 in. Elapsed Time: **120min. Final fluid depth ***32 in. Absorption rate >= 750+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE ifyes, give date 2006 EXTENSION ONLY. CAUSING A RISE OF 2" IN MT IN 17 FOOT EXTENSION. FOR THIS REASON WE BELIEVE THERE TO BE A DISCONTINUITY BETWEEN THE 2003 TRENCH AND THE 2006 EXTENSION. 1984 TRENCH WAS DRY UPON ARRIVAL; INFORMATION REGARDING 1984 TRENCH IS IN MOA RECORDS D. LIFT STATION Date installed Size in gallons Manhole/Acoess (1f/N "Pump on" level at in. "Pump off level High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100,+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field *5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'.+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parkinglvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *ASSUMED G. ENGINEER'S CERTIFICATION / certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effeci on this date. Engineer's Printed Name JEFFREY A. GARNESS Date fI t 3obi (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC151637 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 7, Lot 4 of Prospect Heights #2 subdivision. This inspection revealed a nitrate concentration of 6.65 milligrams per liter (mg/L) was reported for the property's well water sample. 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. 04 04 qt 2 N M O 0 O I I I I I I I I I I I I I I I I I I I I aI EI NI wl �I �I of �I I I I I I I Lot 4 Lot 3 N89°56'48"E 236.36 deck ;0 Tree hous Chain link fence She6,,,, �V 8428K C �J C R'30 / ' 00 08 Lot 7 05 �•. �� a ire pit Ne o LO 44 ` O O 0 .a: aj oro �S ° C h�Em o ono ret.wal � Tom. o`* 3 U p G n 55y ]anter1160, +eH. Boardwalk Q P phaK Conc,. ret. wall'�j���\\\{\\\\ YY Storeg i i (tYp i Lot 6 i i SCALE: 1 "= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. � Q25.p �� 21 2 X61° 1 OF , A4,I 49th I� 00. *!I 00 00 ,.. #, %Fred Wal atka: f / s'\� • 3255 - S o. • oy ,1 1 ���ssio PIS �`� Redbird, FB 15-12, pg 37 Lot 5 BE REVISED 11-30-15 //- f/�V� AS -BUILT NO (f�(jjRNERS SET THIS DATE Municipality of Anchorage ° e • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING RG I SSV Parcel I.D. 015-134-80 HAA # 144 d 3 0 19 ,;)- Expiration Date: 1. GENERAL INFORMATION ?.. V Complete legal description Lot 4•,•�Block 7.'Prospect :Heights #2 Location (site address ordirections)r7 :7800.'5chuss 'Circle, Anchorage, Ak. 99.516-1142 r .. Current Property owner(s), 11arcy Stauffer • - Day phone 346-3110 Mailing address same Lending agency - Day phone Mailing address Real Estate Agent Kathy Fernandez Day phone 562-6464 Mailing Address Prudential Vista - 4241 'B' St. Anchorage, Alt. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. �i� Z � _ /° A 3 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 9 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ' ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Anchoreae 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 Health Authority 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 S & S Engineering_ Phone 694-2979 Address 17034 Eagle River LD. Rd. -Eagle River, Ak. 99577 Date /017 13 . Engineer's Printed Name Robert C. Cowan OF 0Fq�y s'l ON-SITE • i WATER AND 5. DSD SIGNATUREWASTEWATER �, �r C. COWAN . PROGRAM Ox CE-SZat t/ Approved for _ bedroor>3s. O'•, �lFn ��••••.........•i,.'''•�;= Disapproved. �i�J�'�,T�`` • t t�►iLa``.. Conditional approval for bedroo)ftJWith`G following stipulations: Additional Comments No • ThP wP11 for the r. property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed t to insure the wells continued suitability_- C»rrPnt nitrate rnnrPntratinn is A_.19 mg/1. EPA maximum egneentratinn iq in n Move infermatien on nitFates is avai able from the On—Site Services Program, at 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:—/O- 03 (Rev 01102) 10- 6-03;11:56AM; SGS Ref.# 1036311001 Client Name S & S Engineering Project Name/# L4, B7, Prospect Hts #2 Client Sample ID IA, B7, Prospect Hts #2 Matrix Drinking Water Sample Remarks: ;907 5615301 # 2/ 3 All Dates/Times are Alaska Standard Time Printed Date/Time 10/03/2003 10:11 Collected Date/Time 09/29/2003 20:30 Received Date/Time 09/30/2003 12:45 Technical Director `Lu'+S It de Released B ,� Parameter Qualifiers Results PQL Units Method Container AllLimit, a Prep MaDate Datete Init Waters Department Nitrate -N 6.19 0.100 Microbiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<=10) 09/30/03 JJB coVlOOmL SM18 9222B A (<=1) 09/30/03. DKC Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program T Y 4700 South Bragaw St. s . E T Y P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-134-80 HAA# HP 0:30 / 9 2 Expiration Date: $ - % 3 - C9-3 1. GENERAL INFORMATION Complete legal description Lot 4: Block 7• Prospect Heights Ill Location (site address or directions) 7800 Schuss Cir- Anrhnragp Current Propertyowner(s) Marcy Stauffer Dayphone 346-3110 Mailing address Lending agency Mailing address same Day phone Real Estate Agent Kathy Fernandez Day phone_ 562-h464 Mailing Address Prudential Vista 4241 'B, St Anrhnranp� AK gg5n3 Unless otherwise requested, NAA will be held by DSD for pickup. S -It 3 /p 3 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well U Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifid'a(ps 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 Health Authority 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 S & S Engineering _ Phone 6g4_2 7o Address17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date S—Z $/0 3 5. DSD SIGNATURE aoaea� C. COWAN.�e / C,. - SEC I , Approved for —T bedrooms. tt Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. it is suggested that puz iudic testing be pet f4i med to insut e the wells continued suit itip Current nitrate concentration is 5.72 mg/1. EPA maximum concentration is 10.0 mg/l. More information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �, �. ! — Original Certificate Date: 6--13- 03 (Rev. 121001 Municipality of Anchorage p of • �` Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo;" 9 ,lLOCK 7 PROS Nec,Ht j(G I/ >S # r�L Parcel ID: a1 S - 13'/ —$C) A. WELL DATA Well type RN1FT1 Date completed 6/ '3/ $y If A, B, or C provide PWSID #`'- Sanitary seal &N) XC% Total depth ft. Cased to g0.7 ft. FROM WELL LOG Date of test e, / $/ S '/ Static water level V �, K ft. Well production a• + g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate f 7a mg./I. Arsenic: mg.11. Date of sample:��l'0 3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material 56P7Q, / m D PE Tank size ) 3 0o gal. Number of Compartments z Foundation cleanout (&N) Yf-5 Depression over tank (Y/16 e''0 Date of pumping N/R — "0 a/ Pumper C. ABSORPTION FIELD DATA Date installed a/1 i/03 Soil ratingg.p.d./ r ftZ/bdrm) �p_g Length S'f ft. Width Total depth 133=5 ft. 3 Eff. absorption area 7+ 6'i, ftZ Date of adequacy test N/4 - r' C'4 Fluid depth in absorption field before test Elapsed Time: _ min. Results depth Any rejuvenation trent (past 12 mo.) (YIN &type) Well Log&N) Y6- Wires properly protected &N) YC 5 Casing height (above ground) I X4 in. AT INSPECTION x,/13/03 J e3 ft. Other bacteria O colonies/100 ml. Collected bys 17034 Eagle River Loop Road IQo, 2tk_ eagle River, Alaska 9.9577 Date installed a I1 3 / 0-3 Cleanouts &UN) Y IF J High water alarm (YIQ >ro System type 7-0 err 1-H ft. Gravel below pipe -7 ft. Monitoring tube Ycs Depression over field°V ti For I/ bedrooms Water added_ gal. New depth_ in. in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. E. SEPARATION DISTANCES Size in gallons 'Pump off' level at SEPARATION DISTANCES FROM WELL ON LOT TO High water alarm level at in. Meets alarm & circuit requirements? Septic tank/lift station on lot ` ) y 6 On adjacent lots 1 00 '-J-- Absorption J-Absorption field on lot 1 3 y On adjacent lots 100 1 -,- Public Public sewer main Id �q Public sewer manhole/cleanout I) i Sewer /septic service line 4 Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 1% `� Property line 1) 33 Absorption field S Water main ),)14 4 Water service line 1 0 Surface water 100 Wells on adjacent lots 100 r't SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 11 B Building foundation 6 Water main J01-4 Water Service line / O + Surface water /00 / Driveway, parking/vehicle storage 2% O Curtain drain Wells on adjacent lots 1O0 -4- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Ro Un-, C• CowgtJ Date r l S 10 3 HAA Fee $ 3 7 5. ' Date of Payment J / g r a7 J Receipt Number 6 3 S' o S g (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number ROUWMPOWAN C.-8801 n MUNICIPALITY OF ANCHORAGEo Q S D 3� DEPARTMENT OF HEALTH AND LNVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL !W 5 7-, /�, J OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) e__- <c1/.44�-- G� .S<<_ / 3 7-/ 2 /Cr /2 Location (address,or directions) (b) Applicant Name'•? r °/•/ •S Telephone: Home A��� ? �� Business Applicant Address %�'bi1 Sob •mac' C''��c' �T7)C-lx oras¢, �lC l,f-/. (c) Applicant is (check bne)%ending Institution ❑ ; Owner/builder)R(; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution-Aa��- 'Q,s L^"3L uco* Telephone Address 1001 CJ S "V%SIVA A r (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the follo ing address: rrt�. �Q 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well CT 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 m Public ❑ Community ❑ Holding Tank ❑ Note: If community wel I system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11i84) 5. ENGINEERING FIRM PROVIDI ASPECTIONS, TESTS, FILE SEARCH, DO AND INFORMATION • P„ 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 &e-c_S Telephone �'� z�— BYO Address /�200 40 Date 6. DHEP APPROVAL r � Approved for % bedrooms by Date Approved A::_- Disapproved Terms of Conditional Approval Conditional CAUTION CE -2451 .' ��• 4W4%,Ywenlonal The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025h1/84) C ifi�IICL�ALITi'OF gidCFiORAGE 'VI;fON MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) 6'" 1 7 CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: pecSp­ r.� s #z S S"P. A. WELL DATA Well Classification /1rr°L If A, B, C, D.E.C. Approved (Y/N) Well Log Present(YiN) Date Completed ��4 9"% Yield Total Depth 40 ( Cased to Depth of Grouting — Static Water Level Pump Set At Casing Height Above Ground Electrical Wiring in Conduit /N) Separation Distances from Well: 7_ Sanitary Seal on CasingdY/N) Depression Around Wellhead (YA To Septic/Holding Tank on Lot /C � ; On Adjoining Lots _>10e) To Nearest Edge of Absorption Field on Lot /Dg/- On Adjoining Lots > A0 V To Nearest Public Sewer Line A/,¢ To Nearest Public Sewers Cleanout/Manhole /U Lx To Nearest Sewer Service Line on Lot Water Sample Collected by <- - pl' Ir/ ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 1�' !7 S Size /7- �- Standpipes fY/N) Air -tight Caps6VN) Depression over Tank (Y& Pumping/Maintenance Contract on File (Y/N) No. of Compartments Foundation Cleanout Y/N) Date Last Pumped 3 aq- f(,j 54Ctt'� for Holding Tank High -Water Alarm (Y/N) /4'/A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well l To Property Line / r To Water Main/Service Line — Course Comments Page 1 of 2 72-026(l V84) To Building Foundation r To Disposal Field To Stream, Pond, Lake, or Major Drainage M C. ABSORPTION FIELD DATA M Soils Rating in Absorption Strata C Type of System Design _ Date Installed Length of Field i Width of Field r Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (YR— Results Results of Last Adequacy Test 5-,2,v -a I Separation Distance from Absorption Field: To Water -Supply Well /e 5 To Building Foundation Lot A-/ 1fP To Water Main/Service Line 7 /c To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments ('0 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for U r° Electrical Codes (Y/N) Comments Standpipes Present) Date of Last Adequacy Test To Property Line Al To Existing or Abandoned System on On Adjoining Lots el d- To Cutbank (if present) C% rs r Dimensions Manhole/Access (Y/N) ay� Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h h cked,ver'Pied, or conformed to all MOAand HAA guidelines in effect on the date of this inspection. Signed �� ' DateGA �� Y p Company ' CS .yc, c MOA No. d � m� OF QF A`� @� /� / o o''�••••• Receipt No. 0, ONQ•c�• Date of Payment // * : • H ••�9itS, Amount:$ �C�y� /•• ' ngf2's'Sc�•••f e � WC. RECD, 3R/ � ` / CE - 2251 ,' jtE Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL, — OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Z3 2- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) .5"P 3.�Z ra rlir 2 R 1-6cMion (address or directions) t r. reo _ (b) Applicant Name M ` v Sf �« Telephone: Home 3'16 3 // O Business 3 6/ �r S ,A ppli can.t Address � ° � O O /i A' 9 9,Y -A/ (c) Applicant is (check one): Lending Institution` 6 ner/builder; Buyer ❑ ; Other ❑ (explain); r (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following d6 2. TYPE OF RESIDENCE Single-Family�uITi-F i{ -❑ Other Number of Bedrooms 3. WATER SUP Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Departmentof Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 4 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 n 11841 "iz_._% 5. ENGINEERING FIRM PROVIOG INSPECTIONS, TESTS, FILE SEARCH,QTA 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 r S Telephone -3"15 of P- 'C_ Address / o ' 3 - - Ai c l o- y C /3 3-o 3 Date 7-"2 3 `86 6. DHEP APPROVAL 6)4 Approved for �bY12.1 bedrooms by Approved � Disapprove Terms of Conditional Approval Conditional CAUTION 00 C. RED, JR. r si The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) 7 Of• 00N0? ,GE N1 � POL RO1K104 00 (301 0Z� 1 A. WELL DA'I?%tCtI • `O MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 284-4720 �z Posy f{e,�ti f3 c /3 3u Legal Description Well Classification d°�f r - If A, B, C, D.E.C. Approved (Y/N) /' A Well Log PresentA Date Completed 1K^° 8) /f9y Yield 2 C '1-!2 Total Depth y /) V Cased to 80 Depth of Grouting Static Water Level kv� 'f 1-, Pump Set At Casing Height Above Ground 6 J Sanitary Seal on Casing til) in Electrical WiringConduit ) Depression Around Wellhead (Y/�' Separation Distances from Well: To Septic/Holding Tank on Lot /0'7 ; On Adjoining Lots C T /00 To Nearest Edge of Absorption Field on Lot /U `/ + ; On Adjoining Lots t /00 To Nearest Public Sewer Line ,vA To Nearest Public Sewer Cleanout/Manhole AIA To Nearest Sewer Service Line on Lot 6,7 r Z 3 - Water Sample Collected by Water Sample Test Results Comments B. B. SEPTIC/HOLDING TANK DATA Date Installed JVAe13) y Size / Z sZ�) Standpipes tl) Air -tight Capsfy N) Date --2!-: z z —P 0- No. of Compartments 2 Foundation CleanoutV' N) Depression over Tank (Y29 Date Last Pumped N� Pumping/Maintenance Contract on File (Y/N) /UIq ; for Holding Tank High -Water Alarm (Y/N) 'q Temporary Holding Tank Permit (Y/N) iV Separation Distances from Septic/Holding Tank: To Water -Supply Well / v % To Building Foundation To Property Line 6-7- &6 To Disposal Field To Water Main/Service Line l T Z 5- To Stream, Pond, Lake, or Major Drainage Course, n�7 I- /00 Comments rt� at t' Page 1 of 2 72-026(11/84) 0 C. ABSORPTION FIELD DATA C� f„�sP2c Soils Rating in Absorption Strata wU Type of System Design T' Date Installed -1u^e /3, /4kl� Length of Field Width of Field •D Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 5 Standpipes Present / Depression over Field (Y/I` Date of Last Adequacy Test NA Results of Last Adequacy Test N)1 Separation Distance from Absorption Field: r To Water -Supply Well /0 7 To Property Line % la To Building Foundation I To Existing or Abandoned System on Lot N4 On Adjoining Lots (9 r 3 O To Water Main/Service Line G T D To Cutbank (if present) N H— To Stream/Pond/Lake/or Major Drainage Course C r I o O To Driveway, Parking Area, or Vehicle Storage Area C` Sv -'b Comments D. LIFT ST ICON Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments % — Dimensions Manhole/Access Off' Level at _ Pumping Cycles **,Check Permitted Bedroom Rating Against HAA Request ** Test. Meets MOA I certify that I have cl ecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date �1231r6 Company AEGC MCA No:,rr �p2. Receipt No. U J 0 0 Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)