HomeMy WebLinkAboutWALTER G PIPPEL #2 BLK 12 LT 2Walter G 0
P IPP el #2
Block 12
Lot 2
#050-092-11
Municipality of Anchorage
o On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-092-11
1. GENERAL INFORMATION
Expiration Date:
6
Complete legal description Walter G Pippel #2 Block 12 Lot 2
Location (site address) 12112 Horseshoe Dr, Eagle River, AK
Current Property owner(s) McCarty Day phone 301-1510
Mailing address same
Real Estate Agent Craig Lightle Day phone 441-4114
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
® Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class C Well
Public Water System
EM
/V5 6 8 9 �0
SEP 22, 2018 b
y �
ILf V
1
/6168L01
Received by: ����' Date: L
COSA to be released to the engineer, unless �thenvise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number
COSA# n6rnIJa
Date:
Date of Payment
Receipt Number,
Waiver #
TYPE OF WASTEWATER DISPOSAL:
❑
Individual
RI
❑
Holding Tank
❑
❑
Community
❑
Public Sewer
❑
Received by: ����' Date: L
COSA to be released to the engineer, unless �thenvise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number
COSA# n6rnIJa
Date:
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.
Name of Firm NorthRim Engineering Phone 694-7028
Address -PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 9/.28/2018 ..
_j:-, , ;@
6. DSD SIGNATURE ;'.. `� :._ .�j�,;, ,`o,. ;:. •=°=:
System #1 Approved for
Y pp � bedrooms.��
System #2 Approved for
Disapproved.
-Conditional approval for
_ bedrooms.
bedrooms, with the following stipulations:
WATER AND
o_.
PPnr,RAM
2.c9
BY: r Ori in i Certificate Date: 10
® i- &\y Q SS
The Municipality of Anchorage Devlopment 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
Septic System Advisory
Well Flow Advisory
COSA blue sheet_9-1-12.dor-
X
Nitrate AdV soli' r' .E
Arsenic Aa ig- _..;
Other- -, 9 ,� -------- ---
� �D
Municipality of Anchorage
On -Site Water and Wastewater Program �
(907) 343-7904
S rr.r.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-092-11 Expiration Date:
tE/
- 2-1- P-0 7-0
1. GENERAL INFORMATION
Complete legal description Walter G Pippel #2 Block 12 Lot 2
Location (site address) 12112 Horseshoe Dr, Eagle River, AK
Current Property owner(s) McCarty Day phone 301-1510
Mailing address , - same
Real Estate Agent Craiq Lightle Day phone 441-4114
9 70 71j
2. TYPE OF DWELLING: �
❑ Single Family (w/wo ADU)
® Duplex SEP 2 2, `1018
❑ Multiple Dwellings (Single Family and/or Duplex) �6 ti
J
0168L0,�' `
3. NUMBER OF BEDROOMS: 8 .
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ® Public Sewer ❑
Received by: 1a�`�"7�j' Date: C�
COSA to be released to the engineer, unless 01herwise requested by the engineer.
COSA Fee $ 115a(e
Date of Payment
Receipt Number Z 0
COSA # (15('13 15113
Date:
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.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Sox 770724, Eagle River
Engineer's Printed Name Steve Eng Date 9/.28/2018 .
6. DSD SIGNATURE
N'
t�C ,'-
r r�
System #1 Approved for bedrooms.
r,
System #2 Approved for bedrooms. /}
Disapproved. c}
-Conditional approval for bedrooms, with the following stipulations:
J� ON-SITE
WATER AND
PROGRAM
Original Certificate Date: 1(9 12- ISP
The Municipality of Anchorage Devlopment 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
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1.12.doc
In
Nitrate Advisory', .4
Arsenic Act-vi9.0T.;,
Other� - - - -
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate f On -Site Systems Approval Checklist
Legal Description: L 1 Z/l°/fl-f% 12 d Z 1-..i Parcel ID: 51�10 Z11
A. WELL DATA
Well, type If A, B, or C provide PWSID # Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m, g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material I�T� A-Z—r= —':cL Date installed _ d>ZZeZZX
Tank size Z500gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) V Nigh water alarm (Y/N)
Date of pumping IAf Pumper�ti/
C. ABSORPTION FIELD DATA
�,6F 10
Date installedg�Soil rating (g.p.d./ft2 or ft2/bdrm) l; System type _ r F,r
Length 4!�'S ft. Width ft. Gravel below pipe_ ft.
Total depth T ft. Eff. absorption areaI640 ft Monitoring tube Depression over field
Date of adequacy test/ Results (Pass/Fail)_ For P bedrooms
Fluid depth in absorption field before test 0 in. Water ,added 00 gal. New depth in.
Elapsed Time: _co min. Final fluid depth d' in. Absorption rate >=Z200 _ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _I J If yes, give date
D. LIFT STATION
Date installed ocboflc� Size in gallons ZSQ Q Manhole/Access (Y/N)
"Pump on" level at 7 in. "Pump off° level at �'CJ in. High water alarm level at in.
Datum 1MA4&6(-1r. :rd-/`' Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOTTO: /V,4
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation / f f Property line 'f" Absorption field /aa (?�
Water main f Q Water service line l�) Surface water. 14:�76P
Wells on adjacent lots _- r
ABSORPTION FIELD ON LOT TO:
Property line 0 r Building foundation 4-) !f Water main / /7
/ j l
Water Service line ZQ 4- Surface' water �r Q Driveway, parking/vehicle storage '
Curtain drain U Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l have determined through 'field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.Ayr.
Engineer's Printed Name.-
-^-`yF-^+ Olt—
Date kDate
COSA yellow sheet 2-6-15.doc
W C(
of -4(
MUNICIPALITY OF ANCHORAGE
Development Services Department tt Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Lift Station/Pump Vault
Maintenance Log
l 1
Owner m �U t) r}�� Street Address / � i 1 �_
Septic Tank:
-Sludge level `Linches
Lift station:
-Pumping: required es no -Pumping completed es
�_ 2(-,-/ 9
-Pump basket cleaned nb -Effluent filter cleaned ' no
-Control floats cleaned no -Proper float settings confirme no
-Operation satisfactory no
Alarm System:
-Dedicated electrical alarm circui s no -Audible and visual alarm inside dwelling no
-Alarm system operati satisfact not satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connectio no
-Ground water intrusion around pipe penetrations ves n -Weep hole functional no
-Manhole lid: Functional no Insulated no Properly Secured e no
��R
-All manufacturer required inspections and maintenance completedeV s no
Comments-
Qualified Maintenance Provider:
Technician 1 Date of maintenance" )'GCS' g
Company P S
-- _--_-- ----- i Signature
Septic 'Wank Advisory
Certificate of On -Site Systems Approval #OSC181518
Subdivision: Walter G Pipple #2 B12 lot 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 22 years old. Typical replacement costs range from $8,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
LOT 7A
WEST 201.01'
fy,
8.8'
LIFT STATION
SEPTIC STANDPIPE
- ?43)
alb, e c4ts'" 72HOUSE (o.i'ON LOT 2)
EXISTING •
co
go
-gi
1.0%.1 lii47.2' \
a ,t'''' 25. ' 41(Na 7,9 G Z
co
<V \
eo
..._(), c! \
LOT 1B c
10'
4• .
N63° 34' 00"W I:: .i.:.:.WWI
z. . r7.-
--\
40.00 RETAINING WALL . . .-11 ,...r.i. . . (co z
LOT2 .. . . .. . . ........ ...... . .•
. .. ........ .. .. .. . . .. . . .. . /
Z NOTES:
" • " " ""'••••••••• • •• " " • 1. THIS DRAWING SHALL NOT BE MODIFIED
"6 •• • • • • •• FOR USE AS A PLOT PLAN WITHOUT THE
•c),5, v GRANT OF ACCESS EASEMENTS EXPRESSED WRITTEN CONSENT OF LCG
PER BOOK 3368,PAGES 984-988
/ +
/74:90 • •• • • • •• •
. . . . . .... ....
.... . .... ... LANTECH.
\ O. " " " ' " •
•• •••• •• • 2. LOT 2,BLOCK 12 IS SUBJECT TO A 10'WIDE
/
r '5,
0,ps.6\\1 2.Zi 7
4,
%....<0 s... vds
-4, •• ••• • •• •
•• •••• "
..... . .
• ••• • ••
.... . .
-•-• •
---• LOT 3 MTA UTILITY EASEMENT PER BOOK 3328,
PAGE 936.
3. ACCESS FOR LOT 2,BLOCK 12 TO
HORSESHOE DRIVE IS BY GRANT OF ACCESS
Oz - •• EASEMENTS THRU LOT 3,BLOCK 12 AND IS
Or AL'Np -,-4N, : .•..•I .
"" DESCRIBED IN BOOK 3368,PAGES 984-988
,.../ lqh (0 .•.•.•.•. AND PLOTTED HEREON.
a \,--\.•• .,..1,- .'..1-1,, -••••
.. . . .
Oil\ .• "••
49Th I\ %TY' V LOT 19 \
• •• • •
OA
•
.. .. .
.. ..
AS-BUILT
0 . .. STEVEN 444:91CALLAG AN... ().-,:
ORS' % • e'',,0'
LS-12034 " ••"
•" .
••
••• ••
kirs ..107/2-!?/0 c2s%g \ •• • • ••• LEGAL DESCRIPTION:
••• ••
Wax, • ••• cstl• cl
°„f es siono\ LOT 2, BLOCK 12,
••••••
-,.>.• ,.. .. .., , . . . .
\ .... .- WALTER G. PIPPEL ADDITION NO. 2
250 H Street
ADDRESS: 12112 HORSESHOE DR. PARCEL#:050-092-11-000
Anchorage,Alaska 99501
\ SURVEY CERTIFICATION:LCG LANTECH,INC HAS CONDUCTED A PHYSICAL SURVEY OF THE
:<,? e'' ‘.-.C.;>--:.--6 .) PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS
Survey Department
Phone 562-5291 \ SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST
OTHER THAN NOTED.
anr=rilmi Inc Mainline DRAWN DATE: 10/17/2018 WORK ORDER: 18137 LEGEND: '.......Asphalt : .:::'
aAtialeduite. eiviiieeitin9,.tuutveying Phone 243-8985
DRAWN BY: AP PLAT: 63-81 SEPTIC STANDPIPE 0 •:•• . , EXCLUSIONARY NOTE:IT IS THE OWNERS'RESPONSIBILITY TO DETERMINE THE EXISTENCE
'Concrete • OF ANY EASEMENTS,COVENANTS,RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO
AECC 668
CHECKED BYSC GRID: NW0252 WATER WELL 0 •
IHNI overhang !gm! NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES
:
FENCE —X—X— 3,-- :44. SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION,FOR ESTABLISHING PROPERTY
ORDERED BY: KIM COLLINS SCALE: 1"=40' FB/PG:811/44 REF:05LH321 -..-Wood Deck::---:: LINES,OR FOR PLOT-PLAN PURPOSES.
Sanitary Pumpers JOB
17545 Kahiltna dr Date
Eagle River, AK 99577 09/26/18
907-688-4602 TRUCK
sanitarypumpers@gmail.com
sanitarypumpers.com
Name/Address Ship To
NORTHRIM ENGINEERING
PO BOX 770724
EAGLE RIVER, AK
99577
Contact Phone Alt. Phone Alt. Contact Gallons Pumped
STEVE ENG 694-7028
Hoses Memo Customer Since/pumps
Item Description Cost Total
SEPTIC PUMP 2500g -
other inspect/clean lift station
12112 HORSEDRIVE I I
F] Remove and clean pump basket and effluent filter.
�.► Clean floats and other components, ensure system performance J Q
1 Float controls in compliance with Manfacturer/MOA settings. 4
‘1 ,11 Ensure alarm system is functioning, audible and visual. .\ „0 QQ `C CL \.-\o‘kk $v�
1- Inspect manhole riser to tank connection for ground water intrusion i'J _. t :SicIn
Inspect Manhole lid for functional, insulation and properly secured. \(\ \ G13
'INjr Ensure outlet weep hole is functional to protect from freezing. -6DI1/4-Q___ k;o9-42-1b0\
Two separate circuits for alarm and pump. � -- L �. -o U i
- 9 2 \_)q
Total $450.00.
Directions
Directions 2
Directions 3
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.ci.anchorage.ak.us
(907) 343-7904
ON-SITF SEWFRIWI=LI. SUBMITTAL C,6MhAFNT.HGi=T
To: Bob Cowan
Legal description: Walter G. Pippel #2 Block 12 Lot 2
r 0
ZD
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design.
❑ Additional soils information needed.
❑ Water monitoring results inadequate.
❑ Discrepancy in information submitted.
❑ Topographic information missing or inadequate.
❑ Incomplete; missing _
❑ Incomplete; missing
❑ Additional adequacy test information needed.
❑ Water sample unacceptable.
❑ Measured/proposed distances/dimensions missing.
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils information submitted. _
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field.
® Other. This Is a duplex
Name of reviewer: Jeff Poet Date: 5.20.7• o3
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
Municipality of Anchorage
-- Development Services Department °
Building Safely Division
On -Site Water and Wastewater Program ,
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL 4&4R
FOR A SINGLE FAMILY DWELLING
Parcel I.D. HAA# LIt12/SU�Oo2
Expiration Date:
1. GENERAL INFORMATION �,e<
Complete legal description Lot 2; Block 12; W.G. Pippel Subdivision #2
Location (site address ordireclions) 12112 Horseshoe Dr.
Current Propertyowner(s) Carl Disotell Dayphone 694-5797
Mailing address same
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD forpkkup.
2. NUMBER OF BEDROOMS: 8_
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
U
Individual Water Storage
❑
Individual Holding lank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
U
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 or Health Authority Approval are
valid for 90 days from the dale 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.) Cerlificlates 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 an type of structure Indicated herein. I further verify that based on the information obtained from the
MunicipalitXIMWchorage files and from my Investigation and inspection, the on-site water supply and/or
wastewi%j WA06sal system Is(are) in compliance with ah applicable Municipal and Slate codes, ordinances,
an itiVAa4ons in effect at the time of installation.
r .
%meofFlrm_S & S Eneineerin¢ Phone _594-2979
Address17034 N. Eagle River Loon Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan Dale rbs-/o j
OF
5. DSD SIGNATUREP 4 ROBUT C. COWAN 1
r� s� CE • a 2 0 1 /\
Approved for bedrooms. l ff;;..,
w,
Disapproved. • '�_ ����
Conditional approval for bedrooms, with the following stipulations: `
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Gid
fR«. 02M)
X Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 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: I -v a S L0 CK 1;L WA41," G. P,PP" *11 Parcel ID: OS -0 09x- r/
A. WELL DATA Pva&�#c wArt2
Well type _ If A, B, or C provide PWSID # _ Well Log (Y/N)
Date completed _ Sanitary seal (Y/N)_ Wires properl ected (Y/N)
Total depth ft. Cased to ft. C ' g height (above ground) in.
FROM W ELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. 9.p -m.
WATER SAMPLE ULTS:
Coliform colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 ml.
Arsenic: mg./I. Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA J
Tank Type/Material SEPT z- SrkK L_ Date installed 1Y/4y
Tank size a- S`0 0 gal. Number of Compartments a Cleanouts 6YN) Y E r
Foundation cleanout &N) YL Depression over tank (Y6) AO High water alarm (Y& ^' O
Date of pumping a o31 Pumper
C. ABSORPTION FIELD DATA
Date installed 01 9 8, Soil rating b516 ft2/bdrm) _La System type TR i- c H
Length 63 ft. Width a - S- ft. Gravel below pipe 8 ft.
Total depth I I ft. Eff. absorption area 1008 ftZ Monitoring tube Yf J Depression over field .v 0
Date of adequacy test yhy/ 03 Results Fail) -OASI For S bedrooms
Fluid depth in absorption field before test DAY in. Water added 6 a 0gal. New depth G "in.
Elapsed Time:110 min. Final fluid depth AaY in. Absorption rate >= IX 00 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) *J 0-4 k vyw ✓ If yes, give date —
D. LIFT STATION
Date installed F 1' 8 /9 V Size in gallons a S o 0
"Pump on" level at 70 in. "Pump off" level at 80 in.
Datum 7 cA o f moi Naj, 4 Cycles tested
E. SEPARATION DISTANCES
I�JYS �.L W/iTQ 2
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer
Manhole/Access&N) V f f
High water alarm level at 6 6 in.
Meets alar & circuit requirements? Y# f
On adjacent lots
On
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation a K Property line /d ';- Absorption field /00 ' f
Water main 7 0 Y Water service line 60 4- Surface water /00 -0-
Wells
Wells on adjacent lots /O o 0 -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line O Building foundation )v i Water main ) v 0
Water Service line SO Surface water /00 "+- Driveway, parking/vehicle storage
Curtain drain Hv ,14 '"e -,r Wells on adjacent lots / o O '-A-
F. COMMENTS
OF
G. ENGINEER'S CERTIFICATION
I certify that I have determined through held inspections and r� •-'
review of Municipal records that the above systems are in i e
conformance with MOA HAA guidelines in effect on this date. ?� } ROBERT C. COWAN
Engineer's Printed Name R CO,,4 a
Date !'lis- /0?
HAA Fee S 3'7 S• t / SO. °a (R rJ p l Waiver Fee S
Date of Payment S %rs'lo 3 Date of Payment
Receipt Number O 3.7 't. S Receipt Number
(Rev. 12101)
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Fredae Lx Form 70 L93 PAGE 1 OF 2 tame Lae Fen Toot 49
/enn W2--'F0'A:brYMd7er XWW soOwas by a to mob. OT.— S•t70dUMODE
64 am �f, 7]jJe tr•r rueleipliT• et DxD.t Cam lot F IYss
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Fredae Lx Form 70 L93 PAGE 1 OF 2 tame Lae Fen Toot 49
/enn W2--'F0'A:brYMd7er XWW soOwas by a to mob. OT.— S•t70dUMODE
O' STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICA'T'E S
FOR
DOMESTIC WASTEWATER DISPOSAL SYSTEMS
C -;+- 9821- 111W-734-3-13+
A. APPROVALTOCONSTRUCT
Q1,aG1C:i 2 W A Lr'jtE12 G.
Plans for the construction or modification of
S 11'E domestic wastewater disposal system
'Alaska,
submitted in accordance with IS AAC 72210
located In AQrAA" n C
A _ n _ ns /t ....4 ►1 : have been reviewed and are
by 5 ft r
approved.
conditionally approved (see attached conditions).
c. _ f/ �,�titu� 22p�C, 37
7iTk GVW ,rtr��v'.° 6 DATE
B
If construction bag not started within two years of the approval date, this certificate is void and new plans and specifications must
be submitted for review and approval before construction.
B. APPROVED CHANGE ORDERS
Approved by Date
nmpr number or descrivtive reference) , H
C APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before this system is made available
for use.
The construction of the C �� �1 �gN BE�RA°hl CONDO domestic wastewater disposal system was completed
on f Z 9U (date). The system is hereby granted interim approval to operate for 90 days following the completion date.
195
%AD I ` Y/.I'�✓ ;��W�— , DAA
BY
wastewater
din dawiyss, submitted to the ttm was constructed inpsubstantial conformance with thent, or an Inspection by the e'app�edtplans.
an .as Tth� a system
t m is hereby granted
wastewater disposal syn
final approval to operate.
/`J /oya�+•t% , l I 3 , /t%A!'r/ht''JY.![� '�, ire y DATE...
✓:C✓. `J -J
BY s'
(Rev 41M .. ..
Distribution: 1. WhiwEn;inm (Compiete Section C)
2. Yellow -System File (ComPlcte �p1� �
3. Pink-En&W MunVBarough
.1.0o1dmr0d-MunL130t0u9h (Compicte Section C)
)V,(,: JUNO be sit"d PY a
tu. a ulseosAL Lem` Lot 2
_ ....� � vtem (] Ptduse TmYrtrnt .
SYACIMI
Type soil Abearptka sy"n purrer1i!IrrenchX 2 soil Abe 8.01 C"fd
63 X 2.5 X 8.0 tare•
Perooltion Tet ILOURS Nrtoch Copy offie Sl Paool+tian Tsa by. (No -
mm m Oro" Cover ova Mutimum OeCover over
ion Am -X. 7 r mnd Feet TuJce i
SeWP—Um Wats supply soave m Lot Neeeed YSourcem
Dituroe To: Fen Adiaccng 150e+ I
Carer te/RdowffrwA l
t fRENC A WAS fo,-WWC�' W r7/I d •• l3l irG- !ir'A�'a•
u
i/Traces of Silt 1. a
D.ckfel +eus al used r« 3
a,,.. Ck,,odFip Lr"Wwteaon
No m smy-
La
WaiTcE dO
title, Res/CM No., Out No. ue td/y,9�
�awrf ✓ Cr Yffo /
DEC etga or approved DunerVuiWer
Date In"Ied
(Nome)
-
Fen S is Tuck Fal S ie Tank Yes No
pply sourcecaLot Nceret W ata Supply source m 4wea Dwy of Water We
FMI AdiaceM Lot _ Fen
V.11aiRT C. COWAN
CE 8801
Coof44
INSTRUCTIONS FORDIAGRAM
• 1. in, - C)sq6cTw& 117 d) ;on sysim
6) well b) AD SuAwbxu 2) hvpertyune jT"clM&dlmeojlo"j)
C) wsoe WSW f) sourmorvmurni w;on j) 00" septic unk on m 4—A proptftY
h) Goad well 04164zoent property k) All cleanoub and mookor hlb". -
J) CIO" ar of m absorydam field 00 §4&09d property
2. show lfata wtw dw wen and "& ofdw Ww kCM Used In I-
3. Show &dwbetween won WE" VA MA of dna cow kam lilted in I.
0. wo," mmonewit am dao aw &-pth owarie") of the follwAnr
4. 10 % orm wdko %irw of em "I obwrpt;m w d) mairock D6&xv pip"
&) so cover b) Absorptim MAtaW c) W&WTOAO
91.0
KM
clot
irn - ics-o*
UTZ . 107.0'
UTI . 98.2,
UTZ . 98.3'
UTI
IV Y.1
THA 130H 90.2'
NO WATER FOUND
INSTRUCTIONS FOR DIA
1. In i pten view. beets sed {dcd4 cub of ow fonowinC
S) wen b) An Sbucwr"
d) Surface wets f) Sources ofoordmnbwion
b) posed wen o" adjwd properly
I) Ctowe adds of an atoaptim field on e4+004 properly
2. Show d d,noee between ow "ll mod adf of cue ooree Nem tided In 1.
2. Show Qatantts between wrier bodice end each of or oou"tided H 1 no daw ow depth
d. Ins eros ser-4iao view of oa coil eb era. Mmfiho) weter0W Ta e B
B) Sea covet b) Ab orpt;w
LOT 7
l�Noov-01111
t) Sepwra k : 4) Sal AbwOon SYstem
S) trwedy lJrc (include dlnntnilow)
0 Closed septic tank on en adjacent property
k) An cleanout, NO awniw tuba
e) Disctwv pip"
-'LOT 6
ZNoe17
NEW TRENCH
1
NEW 2500 GAL H >�
S.T.E.P. SYSTEM """ sTz T"' •
8 BEDROOM., //—'EPrIC AREA?
srl Fco DUPLEX
n co) DWELLING '
A k+rz
ALT. �� D
SITE �� 3
'k LOT 2
3 LEL
U qr
APROX. LOCATION 3
OF WATER LINE
M^ t
yob I
LOT 3
LOT 19 .