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HomeMy WebLinkAboutWOODHAVEN #1 TR B LT 4Woodhaven #1 Tract B Lot 4 #015-281-59 Municipality of Anchorage .. Development Services Department �;`_' :n='r, Building Safety Division :' On-Site Water & Wastewater Program, 4700 South Bragaw St. `s e , r r r T P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SW060221 PID Number. 015-281-59 Name: LESLIE BRYANT Wastewater System: ❑ New ■ Upgrade Y 4120 LAUREL STREET //106 • ANCHORAGE. AK 99508 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 334-5000 4 0Deep Trench N'Shollow Trench 0Bed 0Mound 0Other LEGAL DESCRIPTION '°' "°"" 1 2 ran D.pth ton X11 0 MAX GKN n rt Tract: Lot: Subdivision: DWh to pow eatom frwn orq:al pad•: Grem depth sanoah pip.: B 4 WOODHAVEN #1 SEE DWG. n 3.71 n Township: Range: Section: rls edd.a ata.e ar4lna wadi arae.l wroth: — — — SEE DWG. n 75 n WELL: ❑ New [I Upgrade Ge" .Wh: 3.0 NumMr aKnow: 1 Dstana. foow, free: rL n Cwnolaann (Pmat-. ARM: Toa Do Cooed io: (o�aat Tobi obwvpu,,,, oroo: Vqe "o": I .,\Cj rt n. 511 so. n D 3034/ F-810 Dnw �X�S��N Da. 0d 1: scan Ma. te.a: i t KING OF DIAMONDS Dae �*Vw,1: 006 Ft vwa: Puny sa M: Ca." Height Above Ground: TANK gp„ n n SEPARATION DISTANCES ■Septic 0Holding 05.T.E.P. t7 Other TO Septic Absorption lilt Holding 4/Private Naralaaluw: ANCHORAGE TANK CapwM o galarn: 1250 from Tank Field station Tank sows tine Well too'+ — — 25'+ Nada: STEEL STEEL NvmDi a oorrwerurwnb: 2 Surface water 100'+ 100'+ — — — LIFT STATION Lot Une 5'+ 10'+ — _ — N gabni teanulwwnr. 5'+ 10'+ uny on I.r.l a: Pump oll Nv.l ol: a •r nom a. Foundation — — — PiHap Mat• t than onpeotiora port«a,od el' Curtain Drain NONE KNOWN Remarks: OLD SEPTIC TANK WAS PUMPED, CRUSHED, BENCH MARK tocotan and D..ogaarn: AND COMPLETELY ABANDONED PER UPC. NORTH END TOP OF GARAGE SLAB 'R.F. = .44 ~ted En.aam 99.50 n GEG ��� Inspections performed by: Dates: 1st 8/30/2006 ENGINEERS aoo� p0� 2nd 9/1/2006 o OF 0 ��C.• �,9s��ll 3rd vv Development Services Department Approval °'?. T •• ........... Reviewed and approved by: Date: D • • ••••••••••••0 DO •.J f y A. O� Gorness: 00 w CE— 95 :p �°� • • � Reviewed and approved by: J / Datel ���°p 0OO�0p00 (R.v. 4/06) IPERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW060221 015-281-59 I A R1 STI 23.9 55.5 ST2 32.4 62.0 DBL1 34.1 63.3 DBL2 35.4 64.4 FD 40.0 64.9 C01 51.4 35.6 MT1 51.7 35.6 CO2 56.3 87.4 111 521 87.9 E.3 41.2 64.5 1 1 I I 1 NEW DRAINFlELD TH/2� COi / /�� NEW 1250 CALLON `��♦ SEPTIC TANK ♦♦♦ III I I THI!I, C<'?., ♦\\ DBL1&2 / \\ f'Oe7 FD \\ I I I EXISTING \ 4 BEDROOM HOUSE \\ III '•' ' • •, r \ Ll'�:: E.., +': ;• .'7;: �: '. UNE UNDER DRIVEWAY ?� 1D0' WELLI INSULATED WITH 4 INCHES OF RADIUS 1 INSULATION 4 FOOT WIDE 1 \ I III/ EXISTING DRAINFlELD \\ / TO BE USED AS A / RESERVE SITE \\ / III / �4 GARNESS ENGINEERING GROUP, Ltd. p T*�0 CONSUL TANTS E GENERAL CONTRACTORS.�.•�..�� �•••••••• •• ••• ........... P, 3n1 C TDe111MD. MIR 101 • M4iM4VX. Mf IgD7 • R (Wr)337-ftn • IM[ (WI)a M" • MUM1L w.po.r.jwrF,Mn. D PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .... •• • ......• ••••••... LESLIE BRYANT 334-5000 1 2 OF 3 Q A ';Je y . Go ess. �O LECAL DESCRIPTION: DRAWN BY: OOc�'• E-79 3 , NAP WOODHAVEN #1.LOT 4. TRACT B B.F.M./J.N.T.�Q�e a t!^I2 06' Fp°o TYPE OF WORK: DATE: 40eO4Op��odc� AS—BUILT OF NEW SEPTIC SYSTEM 9/7/2006 1RTI. V 1M) PERUrTNUMBER: AS -BUILT DRAWING PARCEL 10 NUMBER: SW0 - SW060221 015-281-59 TOP OF TANK AT INLET - 91.70 FINAL GRADE - 97.84-97.91 ST2 - TOP OF TANK AT OUTLET - 91.66 f NEW 1250 GALLON INVERT OF BUNGSEPTIC TANK `INVERT OF BUNG AT INLET 91.05 AT OUTLET 90.82 6' BURIAL RATING FINAL GRADE - 98.08-99.34 ORIGINAL GRADE 98.00 O HIGHEST POINT ftv FILTER FABRIC RELATIVE ELEVATION OF BOTTOME OF TESTHOLE - 81.00 (NO H20). RT OF PIPE - 90.71 )M OF TRENCH 87.00 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE - 82.00 (NO H20). — GARNESS ENGINEERING GROUP, Ltd. p°;'?' 4S CONSULTANTS 6 GENERAL CONTRACTORS �...... • ... ani c ANDOWL r Door • nw[ (wr}u»in • W (WrW a w • � w. p.rylnww,a.. a PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •••• LESLIE BRYANT 334-5000 3 OF 3:� « LEGAL DESCRIPTION: DRAWN BY: oOOD• WOODHAVEN #1: LOT 4. TRACT B B.F.M. �4'e ey TYPE OF WORK: DATE: QQO PROFILE DRAWING OF SEPTIC SYSTEM UPGRADE 9/6/2006 Rw. OIMS) MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 25, 2006 Expiration Date: Jul 25, 2007 Permit Number: SWO60221 Parcel ID: 015-281-59 Legal Description: WOODHAVEN #1 TR B LT 4 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: 012141 JEROME ST Owner Name: LESLIE BRYANT Lot Size: 47250 SO. FT. Owner Address: 12141 JEROME RD Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-2142 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must 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 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: lfl:\ Date: 7 Date: 7 Z: uG Municipality of Anchorage • Development Services Department i Building Safety Division - Onsite Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property owner(s) LESLIE BRYANT Day phone 334-5000 Mailing address 4120 LAUREL STREET • ANCHORAGE. AK Site address l ai q l-n-RD/Yli✓ Sr Zip Code 99508 Legal description (Sub'd, Block & Lot ) WOODHAVEN SUBDIVISION #11: LOT 4. TRACT B. Legal description (Township, Section & Range) N/A Lot Size Sq.FL THIS APPLICATION IS FOR ( ®all that apply): Absorption Field 19 Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 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. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush FeesJ C -1L 0 C) (� Date of Payment: _7k9 1.1 O C Receipt Number.�- (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS July 18, 2006 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for Woodhaven Subdivision #1; Lot 4, Tract B, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. We are proposing to install a new 1250 gallon septic tank and a deep trench type drainfield. Two test holes were excavated on the property. The drainfield will be designed around the 30 foot radii of these test holes. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAT\FIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography below the drainfield is relatively flat. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any gµestions, please contact us at 337-6179. Thank you for your assistance. Cly, ey P M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design packagefor this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamessengineering.com I I 1 1 It \ SIEFKER S/D /3; \ LOT 8 \ I I I 1 SIEFKER S/D /3; TRACT 8 (NO CONCERN) �1 I / / SIEFKER S/D j3; / TRACT 7C. SIEFKER S/D j3; TRACT 7C. _RAdIK �I IIj / \ U / \ C;EPTc II /%0' wEl�t ,EAE I I II LOT 2. TRACT B; II WOODHAVEN S/D /1 \ 1 \ I LLJI \ LLJ F— LOT D3EN S/D WOOOHAV%1 )SED SEPTIC UPGRADE DESIGN PACE 2 OF 2) EXISTING 4 \ / BEDROOM \ HOUSE \ ti I I EXISTING SEPTIC SYSTEM WOODHAVEN S/D /1; TRACT A r---------------- TRACT D-2: WOODHAVEN S/0 11 TRINITY PRESBYTERIAN CHURCH \ \ WELL ON SOUTH SIDE OF PROPERTY I \ I \ \ —1 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS i GENERAL CONTRACTORS Q•••••••• •• ••••••• trot c noon troto. nFtF tot • rtototwz. w t,lo? . htotC(907)U) tt1 • FM usa2" . trtttatF: �. PREPARED FOR: PHONE NUMBER: PAGE NUMBER:... . .. ........ ......••• LESLIE BRYANT 334-5000 1 OF 2 QQ a r y nese: LEGAL DESCRIPTION: DRAWN 8Y: Q °,�. E-7953 :� WOODHAVEN SUBDIVISION #11, LOT 4, TRACT B J.N.T./B.F.M. 00^ �!l I� t4v� TYPE OF WORK: DATE:4��D00of 003sIll SITE PLAN FOR SEPTIC SYSTEM UPGRADE 7/18/2006 (RFv.01105) ULDIIJN l r%IlLRIM] \ NUMBER OF BEDROOMS:4 \ GALLONS PER DAY (CPD): 600 PERCOLATION RATES: 1.67 ! 1.62 MIN./INCH PROPOSED APPLICATION RATE: 1.2 1 MINIMUM DRANFIELD SO.FT.: 500 DRAINFIELD DESIGN: MAXIMUM DEPTH: 11 FEET WIOTH: 2.5 FEET I LENGTH:65 FEET I M.OA APPROVED SAND FILTER: N/A EFFECTIVE:4 FEET REDUCTION FACTOR: N/A ACTUAL SO.FT.: 520 / SPECIFICATION/ LETTER THAT PERTAINS TO THIS DESIGN. / TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD I WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND ONOMONS OUTLINED. i /PROPOSED DRANFIELD TH#2 FA ' LEXI GUSEO ELD AS BE \\ RESERVE SITE \ EXISTING 4 BEDROOM HOUSE NOTE: THE CONTRACTOR SHALL HAVE THE WEST LOT UNE AND ALL WELL RADII SHOWN FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION FLOW DIVERTER \ iPOSED 1250 GALLON \ SEPTIC TANK \ \ UNE UNDER DRIVEWAY TO BE INSULATED WITH 4 INCHES OF INSULATION 4 FEET WIDE IG SEPTIC TANK TO IPED, CRUSHED AND ETELY ABANDONED. Awl GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS& GENERAL CONTRACTORS iINL AFM 6G0. }AI[ t01 • ,MOEIIME. Mf MSO) •FIC,[ tb"WI�I„ • Igut (10/}1L " • U - w�wwr *--1 . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: LESLIE BRYANT 907-334-5000 2 OF 2 LEGAL DESCRIPTION: DRAWN BY: WOODHAVEN SUBDIVISION #1, LOT 4, TRACT B 1 J.N.T. OF WORK: DESIGN FOR PROPOSED SEPTIC UPGRADE (R".010M) 7/17 m`sig od�0 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS it �' 4 ]701 L 1W WI R . Wn 101 • N4HOR.CG M. 99901 • RIOiL (007)W-4176 • FA 90) -]3.6 • .[DNL 9....... • • • • .• • • D SOIL LOG — PERCOLATION TEST ....... ....... ....:... LEGAL DESCRIPTION: WOODHAVEN SUBDIVISION 1; LOT 4. TRACT B e'•.Je eE � Sa ess: PERFORMED FOR: LESUE BRYANT DATE: 7/7/2006 (feet) as�� 44��00000��6� ORGANICS TEST HOLE 1 1 =San_ :L:.•• SOIL CLASSIFICATIONS •� •.*. •'•••� GP ML 3 '0':'� GM CL 4 .; �•.. GC OL �'::� �•• : SP CH ... 5 •: SM � OH ••�. Sc 6 •.•..• • o•i.• 7 • :•: •: •i i .• 8 •.•.•. Sp 9— •:.•.• . 6*00. 10— .t;:;: .; �.�. 11 "• ••• ....�. 12 •' •••• ....�. �•::� 13 .;� ;• .� �.�. • �.� .• 14 :• i•i• .; •.�. 00 .. •. • .• •. • •• •...•• 16 ••• B.O.II. 17 18 PERCOLATION RATE 1.67 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN 7 FT. AND 7.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: JORDAN TROISI COMMENTS: PERFORMED BY GEC. Ltd. 1. JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: !% 0(. DEPTH TO GROUNDWATER DATE DRY 7/7/2006 R � 16 6 111 1 W - 111 '•� Wfl l RAMUS . CLOCK TIME i 1 WATER LEVEL READING NET DROP (INCHES) 111 1 W - 6" - III 2 �� 111 � 6" 3 9:45 - 6" - 111 111 � � 9:55 X11 � 6" ��� 5 X11 + �`� ;I. �� TH 1 , ExlmNc 4 10:06 � + BEDROOM \ 6" % HOUSE \ 111 - \ - 8 10:17 10 0" 6" 9 10:18 - 1.1 t 10 \ 10 .II \ .II � t' - 900• DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/11/2006 1 9:34 - 6" - 2 9:44 10 0" 6" 3 9:45 - 6" - 4 9:55 10 0" 6" 5 9:56 - 6" - 6 10:06 10 0" 6" 7 10:07 - 6" - 8 10:17 10 0" 6" 9 10:18 - 6" - 10 10:28 10 0" 6" 11 10:29 - 6" - 12 10:39 10 0" 6" iii ...n1 ttanlLK . CLOCK TIME iii a of II. ! 9:32 III 6" — 111 111 111 i � .II i • 3 9:43 GARNESS 6" — ENGINEERING GROUP, Ltd. ,1 `E U TM 1 + CONSULTANTS CONTRACTORS—It 101 • NKAIOM1Y.f. AIL 69!01 • P1tllG 901 7-6179 • FN 901 -O3N • 1YCB5(IL V.^••••N K.�^ .: ......... D BEDROOM \ ]101 E 1100. POM, 6U1E HOUSE \ ,11 6 SOIL LOG — PERCOLATION TEST 11 ...., ...... ....... .....� LEGAL DESCRIPTION: 10:05 WOODHAVEN SUBDMSION 1; LOT 4, TRACT B 6" a fry G rness, 0 \ 8 III \ 0.5" '• E-7953 \ PERFORMED FOR: — LESUE BRYANT DATE• 7/7/2006 ry DEPTH 10:26 10 0.5" 5.5" 444dPr•.....10^o\�oto 11 (feet) — 6" — OOOOo 0 o� 10 ____ ORGANICS ITEST HOLE 2 1 =aan .::..• SOIL CLASSIFICATIONS 2 •; .•.• . 1, •;.•.• ` ; 4-. GP ML 3 ..•.•. •; .•.• GM CL "••'• GC OL 4 •; .•.• L•::• ... °. •°.. SW MH 5 ...10 ��•�:� •: �•.: SP CH TH#2 ;•;• SM J OH ' 0••'• 6 •...• SC 7 �::• • •'•' SP DEPTH TO DATE •.••,• .; GROUNDWATER �.•. •0•�•� 0.. 8 DRY 7/7/2006 ••• ;. DAY •...• 10— 0 •• • •• .; •.�. .e. . 11 �.•.. � S� �: ....�. '' 12 •••• .;00000- •.�. ....,.13— ego 14 •.•.•• �S0 �� •. • •• •0•�.� 15 ;. .; �••. • �. •.• .. �. .00 ••.• 17 8.0.11. 18 PERCOLATION RATE 1.82 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN 7 FT. AND 7.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: JORDAN TROISI COMMENTS: GEG, Ltd. I, JEFFREY A. GARNESS. CERTIFY THAT THIS WAS ER ORMED IN ACCORDANCE PERFORMED BY WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1 L iii ...n1 ttanlLK . CLOCK TIME iii a of II. ! 9:32 III iii ...n1 ttanlLK . CLOCK TIME iii I NET DROP (INCHES) II. ! 9:32 III 6" — 111 111 111 i � .II i V v 3 9:43 — 6" — 4 9:53 10 TM 1 + /--EXISTING 4 ;II ,+ � BEDROOM \ n1 6" HOUSE \ ,11 6 10:04 11 KF�� 1 7 10:05 — 6" ;Ei \ 8 III \ 0.5" .II \ ,• • 100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/11/2006 1 9:32 — 6" — 2 9:42 10 0.5" 5.5" 3 9:43 — 6" — 4 9:53 10 0.5" 5.5" 5 9:54 — 6" — 6 10:04 10 0.5" 5.5" 7 10:05 — 6" — 8 10:15 10 0.5" 5.5" 9 10:16 — 6" — 10 10:26 10 0.5" 5.5" 11 10:27 — 6" — 12 10:37 10 0.5" 5.5" (NO a O j3; A LLI LLI CC in LLI 0 nU2 I POSED SEPTIC DESIGN PAGE D(ISnN� BEDROOM HOUSE 0-144 4' cc?w-F af, (Rw.0L051 •7� /2 J S/D /1 CHURCH PROPERTY GARNESS ENGINEERING GROUP, Ltd. > :` CONSULTANTS & GENERAL CONTRACTORS Igro, N.1[ w1 • w i . PREPARED FOR: PHON UMBER: LESLIE 34— 00 1 OF 2 Q LEGAL D nON: DRAWN BY: �0 DHAVEN UDI SI N1. LO 4. TR T B J.N.T./B.F.M. TE: 4O E OF WORK: SITE PLAN R EPI SYSTEM UP RADE 71WV2006 (Rw.0L051 •7� /2 J S/D /1 CHURCH PROPERTY MUNICIPALITY OF ANCHORAGE 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_ INSP[[CTION REPORT I~¢'~ - ~'/3/ ~ UPGRADE NAME MAILING ADDRESS LEGAL DESCRIPTION ell Absorption area Dwelling Liq. IF HOMEMADE: Insldelength ~ ~.~L~h ~*J Iq DISTANCE TO: Dwelling Manufacturer DISTANCE TO: W,~ ~,~ I Foundation ,~_~ No. oflinesI Lengthofe~h ,~:~ J To,.,~ o,~ Top of tile to finish grade ~ Length Matmial Neares'C~ot line ~ ~ Trench wid~t~ --- inches NO, OF BI--DROOM~.~ PERMIT NO. No, of compartments PERMIT NO. Liquid capacity in gallons PERMIT NO. 'l ~O ~ ~ ~ Distance between lines ~J /~ Total effectiveabsorptio area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line DISTANCE TO: ass Depth Driller Distance to tot line I PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank I Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER DATE 72-013 (Rev. 3/78) LEGAL D'EPFIRTMENT C ...... FIt...TFI FIN"b EN',,,'IROi'..IMENTFIL. ' 82:.'5 '" L.' S'FREET., /al)ICHORF~GE., F:IK. 254-4?20 PERHI'F I".iO. ,:: 78056Z ) FiF'PL I CFIN'F Pi I KE: GRFIE:OL,.ISK I !..OC:I':tT I ON ..TEROHE ST LED'iF:IL L4 TRFICT P,, I,.tO0[:,HFIVEN [_Cl'[' SIZE 4, S)500 SQL.IF:IRE ]"'~"F'E OF SOIL FiDSORL:~I"ION SYSTEH IS: TRENCH MFt)'::IMUM NUHFJER OF BED'ROOH.'S = 4 SOIL RI::FFING (SIt:! F"FZE:R)'-"~' '125 THE REQUIRED SIZE OF' 'T'HE SOIL, FISSORPTION S'~.'SI"EM IS: THE LENGTH DIMENSION IS THE L.ENGI'FI (IN FEEl') OF THE TRENC':H OR [:,I:~'.t':iINFIEL. D. THE DEPTH OF FI TRENCN Oiq: F'IT I:5 'rile DISTFtNC:E..' E:ET!.,J[:':E]'.,I THE SURFFICE OF 'T'HIE: CiROUi'.,ID FIND, THE BOTTOM OF TNE EY:',CFi',/FIT.T.C~N (IN FEET). FHEI-..[:. IS; NO ..,E.I !.,.!I[:,TH F i[. FIL. Ei'.IL. FIE_. . TFIE CiRFI'v'EL D, EF'TH IS THE MIi",IIHLJM E:'EPTH OF .,Ft'I,EL E, E FI. ILEi',I THE OI..rF[q:~II..I. 'F'IPE [qi'..iE:, TFIE E:OTTOH OF' THE E::-:',CFIVF:ITION <Ii'.,I FEiET). PERMIT' FIF'PL. ICFINT Fit:iS 'rlqE RESF'ONSIE:ILIT"r' TO INFORM "[:HI':T, I}EF'FIF.'.TME]'~T' [:,IJRINCi THE !NSTFiLI..FITIOi'.~ INSPECTIONS (.'iF F-li'.,l'~.' !.qEL.LS F~[:.',..'rlaO[Ei'.,II" TO THIS PROPERT'~.' FIND, THE NIJME:ER OF' RE~:;I[)ENC:ES THFI'f' THE WE:L.L I.,.IIL. I_ SERVE, . EIFIC:KFII...LING OF F:IN~Y 'E',9'STEH WII"HI.')U"F FIN61L ZNSPECI'ION F:IND FIPPI;.'.OVFIL [3"'r' THIS DEF'FIRTHEi".IT !.'.1Z Lt.. BE SOEIJECT TO F'ROSECU'F I DIN. ['IlNtMLIM F.:,ISTFINCE E:ETNEEN Ft WELL. 8N[:, FIN's' ON-SITE SEWFtGE [:,ISF'O.SFIL. S'.r'S]-EM IS :'L00 FEE'[' FOR FI F'RI',,,'FITE I.,.IELL..; OR i50 TO 200 I':EE]" FROM FI F:'LIE:L..IC WELL E.',EF'ENDINC-i LIF'Oi'.,I 1'HE '[".?PE OF: F'IJF)L. IC I.,.IEL. L. I.,.IE:LL LOGS FIRE RE[.]LIIRED FIND btLJST BE: RETLIRNE[:' TO THE DE:PFff~:TI"I[~},FI' WITHIN ]:0 D'FI"r'S OF THE WELL. COHFi_.F.:I"ION. OTHER I;.'.EQUZI~:ENENTS MFI"r' FIPF'L.'Y. SPEC:IFICI']TII]NS FINE) COIqSTRUCT!OI",I DIFICiRFIM':S FiRE FI',,,'FIII...F~E,'L.E TO INSURE PF'.OF'EF~: IN'..E;TFII._I_FI]'ION. CERTI F'~" THFIT I FIt'l F'FU'ilLIFIR WITH THE REQI.JIREMEN'FS FOR ON--SITE '.:-:,EI.,.IERS FIND, WELLS FI'.S SET I FOF,'TI'.I BM THE MUNIC:IF'FILIT"r' CII::' FINCHORFIGE. ~:: I [,.lil_[.. INSTI::ILL THE S'Y'ZS,"FE]',I IN F~CC:ORD, F:fi",ICE I.,.IZTH THE COt)ES. ,..]:: I UND'ERSTFiN[:, THt":IT TFIE ON-SITE SEI.qER S'T'S';TI}]M i"lFl'.~.' REQLI[RE EI'.,IL.FiR[~EHENT IF' T'HliZ F:!L":E~I [:,Ei",ICE I'.S REr'I(~.~[)ELEE:, _1.:0 I I'..IL';:[..IJE:,E.~ i',II:]RE THFIN 4 E:E[:,r~'.CIOHS. =: .... , = ...... .............................. -,./- .............................. FIPF'I_, I C:F~NT NIKE GR~]E~OWSK I .................................. ................................... "' PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-950, Anchorage, Alaska 99902 276,222~J SOILS LOG - PERCOLATION TEST DATE PERFORMED; J~ SOILS LOG [] PERCOLATION TEST 1 2 3 4 5 6 7 10- 11 13o 14- 15- 16 17 18 19 20 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) , FT COMMENTS 72-008 (7/76) Municipality of Anchorage Development Services Department Building Safety Division • 4 On -Site Water & Wastewater Program _ rog 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 �� Ob o �s www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. d I- g COSA# d 6 O 1. GENERAL INFORMATION Expiration Date: / O - / EI- O 7 Complete legal description WOODHAVEN # 1 • LOT 4. TRACT 8 Location (site address) 12141 JEROME STREET * ANCHORAGE. AK 99516 Current Property owner(s) LESLIE BRYANT Day phone 334-5000 Mailing address 4120 LAUREL STREET #106 • ANCHORAGE. AK 99508 Lending agency Day phone Mailing address Real Estate Agent VICKY KAAS w/ HOMES UNLIMITED Day phone 727-5555 Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER 5. 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, UD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Idontifmable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 337-6179 Date 8 44 bedrooms, with the fllowing stipulations: Attachments: / COSA Checklist t/ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other . Q ONSITE WATER AND WASTEWATER.: By: Original Certificate Date: (Ray. 11N5) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WOODHAVEN # 1: LOT 4, TRACT 8 Parcel to: D L.S' 2 YZ-S `j A. WELL DATA _ • WELL TEST WAS PERFORMED BY KND ENGINEERING Well type PRIVATE if A. B, or C provide PWSID# N/A Date completed 9/1978 Sanitary seal (Y/N) YES Total depth 67 ft. Cased to 67 ft. FROM WELL LOG Data of test 9/1978 Static water level 57 ft. Well production 10 — 9 -p.m - Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION •6/14/2006 in 1.76 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate O' q0 mg./L. Other bacteria �colonies/100 ml. Arsenic: MD ug./L. Date of sample: 7/3/2007 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Data installed 9/1/2006 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression war tank (Y/N) NO High water alarm (YIN) N/A Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Date installed 9/1/2006 Soil rating .p.d. or ft /bdrm) 1_2 System type SHALLOW TRENCH Length 75 ft. Width 3 ft. Gravel below pipe 3.71 ft. Total depth 12.34 ft. Eff. absorption area 511 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) PASS 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 >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump off" le High water alarm level at in. 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 N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank 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 N/A 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 N/A Water service line 10'+ Surface water 100'+ Driveway, perking/vehicle storage 5' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION Ay� I certify that i have determined through field inspections and * . 4 review of Municipal records that the above systems are in """ .. ' conformance with MOA COSA guidelines in effect on this date. e ass. Engineer's Printed Name JEFFREY A. GARNESS _CE 79 .` Date �(6 /07 COSA Fee S Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11105) Parcell.D. Municipality of Anchorage WOODHAVEN Development Services Department 4, TRACT B Building Safety Division 12141 JEROME Onsite Water & Wastewater Program ANCHORAGE. AK 99516 4700 Bragaw Street P.O. Box 196650 / Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 ���`� CERTIFICATE OF ON-SITE SYSTEMS APPR VAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION COSA# d 6 D t'; D S Expiration Date:,; — —2— R :!O Z Complete legal description WOODHAVEN i 1: LOT 4, TRACT B Location (site address) 12141 JEROME STREET * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LESLIE BRYANT Day phone 334-5000 4120 LAUREL STREET #106 ' ANCHORAGE. AK 99508 Day phone MCKY KAAS w/ HOMES UNLIMITED Day phone 727-5555 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well .0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site .0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated heroin. I further verify that based on the information obtained from the Municipality of Anchorage (les 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 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 x)15/0j• Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines b Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of Me system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will N confer any legal right whatsoever. 5. DSD SIGNATURE v Approved for —It— bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other / By. Q/, Original Certificate Date: (Rev. 11105) � _: ON-SITE c? x : • WATER AND WASTEWATER PROGRAM •' Municipality of Anchorage Development Services Department �J Building Safety Division On -Ste Water b Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 995196650 www.muni.org/onsits (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WOODHAVEN /1; LOT 4, TRACT B Parcel A. WELL DATA • WELL TEST WAS PERFORATED BY KND ENGINEERING Well type PRIVATE If A. B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/1978 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 67 ft. Cased to 67 ft. FROM WELL LOG Date of test 9/1978 Static water level 57 ft. Well production 10 — g -p.m - WATER SAMPLE RESULTS: Casing height (above ground) 12+ In. AT INSPECTION •6/14/2006 29 ft. 1.76 g.p.m. Coliform _Q colonies/1100 ml. Nitrate Q B mg./L. Other bacteria colonies/100 mi. Arsenic: A+'—ug./L. Date of sample: 9/28/2006 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/1/2006 Tank size 1250 gal, Number of Compartments E Cleanouts (Y/N) YES Foundation deanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper – C. ABSORPTION FIELD DATA Date Installed 9/1/2006 Soil rating .p.d r Mbdrm) 1_2 System type SHALLOW TRENCH Legh 75 ft. Width 3 ft. Gravel below pipe 3.71 ft. Total depth 12.34 ft. Eff. absorption area 5111 fe Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass(Fail) PASS 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 >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN 3 type) NONE KNOWN If yes, give date – D. UFT STATION Date installed "Pump on" level at _in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N "Pump ofr Is High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAM station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100,+ On adjacent lots Public sewer main N/A Sewer /septic service line 25'+ 100'+ Public sewer manhole/deanout N/A Holding tank N/A 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 105+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I car* that I have determined through Held 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 JEFFREY A. GARNESS Date It 13dofa COSA Fee I W . 0L Date of Payment j J - (o Receipt Number r a 1 (Rev. I vos) Waiver Fee E Date of Payment Receipt Number 09/26/2008 13:28 FAX9073343001LESLIE BRYA.1'T'S OFFICE / 0002 Kd V D ENGINErRwG, r Tc. 20441 PTARMIGAN BLVD. EAGLE RIVER AK 99577-8736 696-6111/FAX June 16, 2006 Leslie Bryant 4120 Laurel Street Anchorage, AK 99508 RE: WOODHAVEN lfi, TRACT B. LOT 4 Septic tem Adequacy & Well Elow Test (Igne 14 2006 Test Procedure & Results: The well was pumped at a constant rate while an acoustic sounder monitored the draw down. At the beginning of the test, the static water level was measured at 29' below top of casing. At a pumping rate of 1.94 gallons per minute, the water �evel dropped to a range of 48-54' and remained there for the duration of the test. The well recovery was measured at 1.76 GPM. The Municipality of Anchorage requirement for well flow is 150 gallons of water per bedroom per day. This well exceeds this requirement. On May 3, 2006 McDonald's pumping treated the above subject septic field in an attempt to rejuvenate the system. On McDonald's pumping pumped the 1,250 gallonseptictank1ortogortoc riitwasnotedthat water wasleaking from e residence. Interior plumbing shoulbeinvestigated for thecausfssmleak At the beginning of the septic adequacy test, the monitoring tube was dry. A total of 1100 gallons of water was added to the on- site wastewater absorption trench and the fluid levels rose up to the lateral at a depth of 6'. These levels were monitored for the next day, which showed absorption of 483 gallons in 24 hours and another 100 gallons for another additional 24 hours for a total of 583 gallons in a 48-hour period. The Municipality of Anchorage requires fan absorption rate of 150 gallons of water per bedroom per day. This septic system does not meet this requirement and needs to upgraded. Water samples were not taken due to their time -sensitive nature and the failed septic system. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to 09/26/2006 15:29 FAX 9070045001 LESLIE BRYANT'S OFFICE e003 Woodhaven f Tract B, Lot June 76, 2006 Pate 2 of 2 subsurface conditions that may not be observed from the surface, changes in the land use, water usage and other factors. If you have any questions regarding the referenced property's on-site water and wastewater system or testing procedures, please contact me at 696-6111/FAX 696-8111. Respectfully, lEJM Engineering, Inc. Note: The operational life of all septic systems depends on the local soil conditions, groundwaterlevels that may fluctuate during the year and the coater usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. Therefore we can not give any estimate of how long this system will function satisfactory for cturenI or future occupants. All septic systems ultimately fail. Some systems last 15-20 years or longer, while others fail after less thyears. a R_ �fjs NC ii o 2 toW C Q RZr 8 ¢I OP a z°�� :Ella _ $ 09'L9L M„Ot'-LO.00N 1N3w3sv3 unun m — -- ui 4. Ila TO wt �? I I I� I I I ~ S I O _ 0 1 9 I b I I �°off I Mb O t� �ti° `"�� 1 $ II 0 Lis ,r 0.cdoe co 'Ci�i•�, 1Ci wo I — 1N ------meq-- ------- ;.��.r:•Y'�'r ��Z 3W3SV3 ALnLLn of R��� 09'L9 L A&-OtY,LO.00N _ — — M o pph lh co O2 _ g 133Z11S 3VYON3f _ — — h �- ��a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES ,~U~,~y Or'' - D~vm~on of Enwronmental Serwces ENVIR ..... ~'S~VIC~ DIVISION On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 ~-p '~ ,~ 7997 343-4744 CERTIFICAT, OF HEALTH AUTHOR,TY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _ L~/-~' - ~ / - ~-~ GENERAL INFORMATION Complete legal description Location (site address Or dirbCtion~) Property owner Mailing address Lending agency Mailing address Agent ~r~ Day phone Day phone~ Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: V" TYPE OF WATER SUPPLY: Individual well communit?{Well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATE':R DISPOSAL.: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 ' ' : 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/er 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 KND Engineerirlg Phone 20441 Ptarmigan Blvd. Address ~le Rk,~ ~K 9~.77..~ EngineeCs signature 2~/7/~' ~ DHHS SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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. MUNICIPAI. ITY OF ANCHOI,1AGE EN~II~OIG~4ENfAL ~ERVICE$,41~i~oN Municipality of Anchorage DFPARTMENT OF HEALTH & HUMAN SERVICES S£P Environmental Services Division 825L Street, Room 502. Anchorage, Alaska 99501. (907) 343 EIVED Health Authority Approval Checklist A. WELL DATA Well type //')/ Log present (Y/N) Total depth _ ~' Sanitary seal (Y/N) IfA. B, or C, attach ADEC letter. ADEC water system number Date comeleted Cased to _ ~ F / Casing height (above g rou nd) ~ ,,,~,~'~,¢~/ Wires properly protected (Y/N) ~/ FROM WELL LOG Date of test / Static water level ,,~'~ Well production AT INSPECTION g.p.m. WATER SAMPLE RESULTS: / Coliforrn ¢ Nitrate. / Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 7/?/~ Tank size I Foundation cleanout (Y/NJ Y Date of Pumping / / C. ABSORPTION FIELD DATA Date installed Length Z//Z~ Width Effective absorption area Date of adequacy test. ~,~, .¢",~. Other bacteria Depression (Y/I~"~ ,4// Pumper Number of Compartments ~, Cleanouts (Y/N) ¢ Soil rating (g.p.d./fF or fF/bdrm) Gravel thickness below p~pe Monitoring Tube present (Y/N) Y Fluid depth in absorption field before test (in.); Fluid depth /,,~, ~,'.~ (ins) Minutes later: /¢¢~) Peroxide treatment (past 12 months) (Y/N}. High water alarm (Y/N) --'-"' /2 ::~ System type ~/~e,,¢¢¢~ Total depth /~ Depression over field (Y/N) / For_ ~ ~edrooms Immediately after ~/¢ gal. water added (in.): ~7" Absorption rate = ~ ~ g.p.d. If yes, give dats '~ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed //' Size in gallons~ ~off Manhole/Access (Y/N) ~"Pump on" level at* "level at* High water alarm level at* ..~ *Datum ////'/ Cycles tested ./ J E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Sel~tic/holding tank on lot Absorption field on lot On adjacent lots /~)0 On adjacent lots Public sewer main Sewer/septic service line Public sewer manhole/cleanout Lift station --- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /0 ~ Property line /0 q~ Absorption field Water main/service line ~D~ q~ Sudace water/drainage ~OD 4- Wells on adiacent lots 1OO% SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Properly line /O /~L Building foundation ~ ~F Water main/service line ,~' ~-t' Surface water /OO 1- Driveway, parking/vehicle storage area 20o~. ¼ Cto~ss A/~ Curtain drain /OL~ ~ -I- Wells on adjacent lots /cC,'+ ~ 1¼~ F. ENGINEER'S CERTIFICATION I certify that I ha ve determined thru field inspections and review of Municipal re.~. t~th~ ~.~ §J(btems are in conformance w/th MOA HAA gu/defines/n effect on th~s date. Signature ~¢~. ~ HAAFee $ ~, ~ Waiver Fees Date of Payment ?Z~/~ Date of Payment Receipt Number .... /. Receipt Number 72-026 (Rev, 3/96)* MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEO~i~k~CIPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPT. OF [',EALTH & ENVh~ONMENT/~L ENVIRONMENTAL ENGINEERING DIVISION Telepho.e 2E4-4720 FEB 2 1979 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND IIFIECTIDNS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10] days for processing. PROPER ~' WNE - ~ 4 PHONE MAI LI NGr~d~D R ESS __ /W,~~, PROPERTY RESIDENT ~f different from above) PHONE ~ BUYER PHON~ MAI LING ADDR ESS '~, LENDING INSTITUTION ' ~~'~''A~- ' PHONE ~ R~A~OR/AG~NT PHON~ MAILING ADDRESS ~.' lEGAL DESCRIPTION NUMBER OF BEDROOMS One ~J~ Four [] Two [] Five [] Three [] Six [~] Other iTi~EET _ J/z'/x rL 6, TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY [~ INDIVI DUAL* ATTAC./r-t WELL LOG, A-wel log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date. g~ve well [] PUBLIC UTI LITY depth (attach log if available,) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE'* [] PUBLIC UTILITY ''If individual/on-site, give installation date ,,,/(~,~2~, ~ If svstem ia over two (2) years old an aoeduacv test ~s required Dy this Department, NOTE: THE INSPECTION FI=-E MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78t THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TiME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY "~ ~ Connection Verified INSTALLER []Septic Tank or [] Holding Tank ~.,~ Size: I~.,b~'O If Tank is homemade SOILS RATING - give dimensions: Iv ~ ~ TYPE OF TANK MANUFACTURE~ ~.~.._~ TOTAL ABSORPTION AREA M AT E R I A L ~..~_,~.~ 4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accomp/~d~/,~ertif[cate) [] DISAPPROVED LEGAL DESCRIPTION 72-010 (Rev. 3/78)