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DEL'S LT 2
Onsite File Del's Lot 2 #015-492-02 kmev U51uz/l0) Municipality of Anchorage On -Site Water and Wastewater Section " (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201276 PID Number: 015-492-02 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade NameAV Ruth Thomson A RPTION FIELD AV ❑ De Trench ❑ Wide Trench ❑Bed ound Site Address 6300 E 112th Other Phone Number of Bedrooms Soil RatingTotal depth f original grade (907)-230-8488 3 /SF.01 Ft. LEGAL DESCRIPTION Depth to pipe invert from original Gravel depth beneath pipe F . Ft. Subdivision Block Lot Del's 2 Fill added above original Gr length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding ' Sewer Tota orption area Number of trenches Dist. between tr hes From Tank Field I Lift Station Tank Line Ft2 Well 1001+ ; TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water { 1001+ Greer 1000 Gal. Material Number of compartments i Lot Line51+ 1 NA Plastic 2 Foundation 101+ j TAT(ON Manufacture Capacity 1 Remarks Gal. Alarm location Electn ed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Northern Excavation Drainfield COIMT D3034 - Inspector Areterra Consulting BENCH MARK (Assumed elevation) 90 ft Inspection 1S dates: 9/1/20 gra 9/1/20 Location and description 3r' 4th House foundation (north side) ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: NJ t.,+,;+r��. tip Date ��� ,,,•• #LiiMtETt },#. tY4HINi t}4kfitA�, �t��t cMccxtet r'Et rttn ttts ia�. Septic System °�i(iCa int. I,: CE ct� z� ApprovedCa_7(�Z�,.#' pp Date' 1 i �O� 1 r��,, ',;z Note: this approval does not include well permit requirements. �m kmev U51uz/l0) AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP201276 OB -C[11=51.0' DEL'S LOT 2 3B-CD2=51.9' PID# 015-492-02 B -C=44.3' o A -D=57,5' N B -D=49.1' N 9 J OA -001=51.0' g g OB -C[11=51.0' -60-0O2=60.1' A 3B-CD2=51.9' o T m N v HOUSE �. OF AL i 1 PREPARED FDRl 3Atf RUTH & DANIEL THOMSON o ��'`;� 1� 6300 E 112TH o * :49 TH !��- * ANCHORAGE, AK m KE FIELD BOOKS cannuTm: n CE— B W� BOUNDARY. N A DRANH: KSD e m ti STAKING:N A cHECKm: KMD 9/2/ ASBUILT: DATE: m r'ESSION� DM. nle MID: 2638 ACRD n": FILE aDB Nu. 20169 0 4- oti b WELL 0 SCALE, 1' = 40' 1 SCALE- NTS cco�V/!l�t�� ''� R/SFR AK. 99577'6 ` 30 30' Q _ J O z < Q 112TH AVE :�F a BASIS DE BEARING N89'59'00"W 165.00' 40 f MH • SEPTIC VENT N (typ) 67 � N � 1\I � LOT 3 25.5' SHED 2 7 U a o �p LTJ X xW GRAVEL W "'OD .7' JO' 0/W�'26.0'25.6' O CD � Z Z in d r W M = W 23.8' LOT 2 10' T&E ESM T N 89'48' 54" W (N89'58'00"W ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: DEL'S SUBDIVISION LOT 2 PLAT 77-275 SURVEY CERTIFICATE: 1, John L. Schuller. Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements. covenants, or restrictions which do not appear an the recorded subdivision plat. WORK ORDER NUMBER: DAM SCAM, E-uw.: SEPT 15, 2020 1'=40' 20-066 DRAAN sr ICHECKED BY pro Mwera eDM/PAve: JLS SW2638 200208 164.67' 164.00' R) lY LO - ] CD d7 Cil � 25.3' LOT 1 25.0' 25.3' Q = FN❑ 518" REBAR AW AW 49TH �................. ..J HN L. SCHULLIaR.� i GG LS --10408 �► r i aye• rt►.°fessiono� �"� y°ft 40awi Cn n 1831 Talkeetna Street Anchorage, Alaska 98508 (907) 237-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://w .muni.org/onsite Permit Number: OSP201276 Work Type: SepticTank Upgrade Tax Code Number: 01549202000 Site Legal Address: DEL'S LT 2 G2638 Site Wailing Address: 6300 E 112TH AVE, Anchorage Owner: THOMSON DANIEL & RUTH ANNE Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: C 11( Dc-13fli'tlTll'[t{ 8/3/2020 8/3/2021 49421 ❑ Disposal Field M Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: /C" Dater �G Zfl Date: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201276, Rebecca Carroll, 08/03/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201276, Rebecca Carroll, 08/03/20 • Municipality of Anchorage Page I of -2L- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAUSERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: zI J 95 024,�t PID Number: 0/:5-999-0-7, Nam° Wastewater System: • ❑ New KUpgrade Address: Bao E.o-ST i% -r11 A,4cA-IDLk66 qqciL ABSORPTION FIELD Phone• No. of Bedrooms: IK Deep Trench O Shallow Trench O Bed ❑Mound O Other LEGAL DESCRIPTION sdll Rating: o Total Depth from ioriglnal grade: PDB Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe n Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: — — - Cl— Fit Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number of lines: 1 Distance between goes: & Ft. Ft. non (Private, C): Total Depth: Cased To: Total absorption are Pipe material: Ft. Ft. O. Ft. F81b-:Lap-C - 54 Driller. Date Drilled: Static Water Level: installer. Date Install Ft. OW t0G R 4 Yield: Pump Set at: Gasp tAboveGrouM: TANK GPM Ft. 1 I'L1� SEPARATION DISTANCES ❑Septi C3 Holding ❑S.T.E.P. To septic Atnorptioe Lm Marling ubliWrlvat• Manulacturer. Capacity In gallons: From Tank Field Station Tank Sawa, Lines WOW 1+ 1 Material: Number of Comp ts: fop 104'4• Q .45t 2oo'y r'J�M K 0. 2wta LIFT STATION Water Water 2oJ'+ Line fo'+ N1a �f� i Siz Iona: Manufacturer. w'+ Foundation p t 4 IG tH N 6 u A A! A "Pump on" level at: level at: High water alarm at: Curtain Pump Make 9 Model Electrical Inspections performed by. Drain i BENCH MARK Remarks: rte Lobation and Description: 1 'Sp uj " 44� -T-A eN m 1 7 op Assumed Elevation: 102.. '77 Ft ENGINEER'S SEAL �E.OF •At'QS �I S .. oL'..0 •. 1- SQ• KALA �z.t6lNEsrc lst�9�4;�Asti*ar Ar L Inspections performed b . Dates: p p y. lea•• N •Na • a...Ni... so ' F2nd -91I5ky /� It las ........ ..:. w/ V Kenneth M. D �' W �� Department of He ith and j�{' G prices approval PP s'•w CE 7116 �1 � �4 ;9�op Reviewed and approved b �l�` r''^'bate: 'Y r 0 �� ROFESSIb�� 72-017 (Rev. 9/911 MOA 2S AS -BUILT DESIGN DETAILS WASTEWATER DISP❑SAL SYSTEM LOT 2, DEL'S SUBDIVISI❑N nn• 1o/6/9s 10/6/93 d d dd d ❑RIGINAL & FINISHED GRADE UNCLASSIFIED FILL(FROM TRENCH EX) .FILTER FABRIC 1000 GAL x.1--.1 956 8961 10/6/93 10/6/95 S.T. I SEWER ROCK C—s'-6-0 �'a 91—, A *� 10/6/95 10/6/93 A- P.I.D. 015-492-02 Permit SW950264 vMtIES 2.7 1 Notes 10/6/95 Elev. taken from new B.M. The 2nd Bench Mark was on assumed elevation BOTTOM OF TEST HOLE 81.50' from a random temporary bench mark NO WATER OBSERVED 10/6A3 76.00• used to verify previous elevations. OF AL9 �1 i ' TE* E4 KENNETH Y. D S CE -7116 \% ESSIol", Apr RECEIVED OCT 131995 Municipality of Anchorage Dept. Health & Human Services AKL1J F UK: KND ENGINEERING RONALD S CONNIE DIVELEY 20441 PTARMIGAN BLVD 6300 EAST 112 EAGLE RIVER, AK, 99577 ANCHORAGE, AK 99516 (907)696-6111/FAX (907)696-8111 10-12-95DRAVING 9 NOT TO SCALE 9326-32 MD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696.8111 RECEIVED October 12,1995 Jim Cross, P.E. OCT 131995 Manager, On -Site Services Municipality of Anchorage DHHS Oept. Health & Human Services 825 L Street Anchorage, AK 99501 Subject: Lot 2, Del's Subdivision - Sewer System Upgrade Dear Jim: This is to follow-up and confirm that based on our conversation today at about 4:00 p.m. it is now my understanding that if I do not meet your demands by providing the following additional information you will not issue the health authority for the referenced property. 1. An additional certification above and beyond that which is required by code as well as what has been already provided stating that the trench is level. 2. Identify for the record the location of the 2nd Bench Mark used to verify that the information previously submitted was accurate. The other issues that you had initially requested in our conversation were deemed by you after our conversation as inappropriate and/or inaccurate and you would not be including them in your list of demands. While the critical nature of what you have requested does not seem reasonable to delay the issuance of the Health Authority Certificate, based on the above and in an attempt to mitigate any additional damages to my clients, I have attached a note to the as -built drawing that states "The 2nd bench mark was an assumed elevation from a random temporary bench mark used to verify previous elevations." In addition, this letter also serves as my certification that the we inspected the trench and that it was level prior to installation of the gravel. Based on the above, and as discussed with you previously, there is and continues to be no basis for not issuing the Health Authority Approval for this property. On behalf of the owners, I request that you expedite the issuance of the HAA immediately so that we can mitigate any further delays. REF. Lot 2,Del'sSubdivision -Sewer System Upgrade- Health Authority Apppproval October 12, 1995 Page 2 of 2 In addition to the above, it is my understanding that you are also looking into the other projects that have been delayed by Mr. Williams and will be responding to me shortly with your report. If you have any questions or you would like to discuss this issue further, please call me at 696-6111. Respectfully submitted, Kenneth M. Duffus, .E. KND Engineering attachments: As -built details (rev. 10/12/95) cc Ronald & Connie Diveley Neil Thomas RECEIVED OCT 131995 Municipality of Anchorage Dept. Health $ Human Services r. PAGE 1 OF MUNICIPALITY OF ANCHORAGE ll�� DEPARTMENT OF HEALTH AND HUMAN SERVICES SAM P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950264 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:DIVELEY RONALD R OWNER ADDRESS:6300 E 112TH AVE PARCEL ID:01549202 LEGAL DESCRIPTION: DEL'S LT 2 - 6300 E. 112TH ANCHORAGE, ALASKA 99516 LOT SIZE: 49421 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 9/08/95 EXPIRATION DATE: 9/08/96 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 (16AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVE ISSUED DATE • M Si \\ -A FI �-i -9s September 1995 I Randy Diveley have installed septic systems since 1970. Listed below are qualifications as follows: 1970 to 1977 D and D Excavating Gettysburg, Pa. Installed septic systems 1977 to 1980 Moved to Alaska, worked for Schachles excavating. Installed systems and service line water and sewer. 1980 to 1993 Worked for Marvin Beyer Engineering Service ( which also called Blaines Construction Company) I dug foundations, installed water main and sewer mains, water and sewer service lines, and installed complete septic systems. This system is on my own property for my home. sincerely, Randy DDiiveley KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 1/FAX(907)69&8111 August 23,1995 Municipality of Anchorage Department of Health and Human Services On -Site Services Section P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 2, Del's Subdivision - Sewer System Upgrade Gentlemen: As a result of a failed adequacy test on the above system, the property owner has requested an upgrade to his system so the property can be sold. The original on-site disposal system was installed in 1978 and consisted of a 1,000 gallon septic tank and a 50 foot long deep trench. During my inspection I verified that the trench is full and no longer able to accept at the required rate. On August 14, 1995 a single testpit was excavated adjacent to the existing trench. A copy of the test log is attached, including percolation results. On August 23, 1995 we observed no water to a depth of 17.5 feet. At the same time the owner exposed both ends of the existing septic tank. I could find no breaks in the tank or coating. Therefore I plan to leave the tank in place and begin all new connecting piping at the outlet of the tank. The old trench will be abandoned in place. This lot slopes toward E. 112th Street at about a 2-3% rate; the area behind the dwelling rises more sharply toward the south. The well on the property is located approximately 30 feet from the toe of this southern slope. Lots on either side of the subject lot conform to the same slope pattern. The area proposed for the upgrade is north of the dwelling and parallel to the existing trench. This location is more than 100 feet from adjacent wells and from the well on the subject lot. There is no surface water source within 100 feet of the proposed upgrade location. Subject: Lot $Del'sSubdivision- SewerSystemUgrade August L 1995 Page 2 of 2 I am requesting issuance of a permit for to upgrade this system for a three bedroom single family dwelling. If after reviewing the attached design you have any questions, please feel free to contact me at (907)696-6111/FAX (907)696-8111. Respectfully submitted, Kenneth M. Duffin KND Engineering attachments: On -Site Well and Sewer Application Wastewater Absorption System Details Site Plan Soils Log/Percolation Test SITE PLAN WASTEWATER DISPOSAL SYSTEM LOT 2, DEL'S SUBDIVISION PROPOSED SYSTEM SEPTIC AREA WELL AREA J'I,r IV g k-KiNfirillf K�AM. OFAL9-US/ CF -7116 'r 1 %, S%a3 bS c�~i i. P.I.D. 015-492-02 CONNECT TO EXISTING TANK EXISTING TANK SEPTIC AREA WELL AREA LOT SIZE: 49.421 LESS HOUSE FOOTPRINT: 2.550 LESS EXISTING SYSTEM: 500 TOTAL ARCA AVAIL. 46,371 S.F. RONALD 6 CONNIf DIVEI.EY 6300 EAST ?I? ANCHORA6f, AY 9')',IG KND ENGINEERING 20441 PTARMIGAN BLVD CAGLE RIVER, AK, 99577 <9U7H,96-6111/f AX (507)696-clll "1- 1' • IM' -�._ S=C LI DESIGN DETAILS WASTEWATER DISP❑SAL SYSTEM LOT 2, DEL'S SUBDIVISION CONNECT TO EXISTING TANK I nn n i ORIGINAL & FINISHED GRADE II11 UNCLASSIFIED FILL(FROM TRENCH EX) 2' INSULATION FOR (3' COVER ,FILTER FABRIC 1000 GAL SEWER SEWER ROCK S.T. P.I.D. 015-492-02 Permit BOTTOM OF TRENCH 11.5 63' F BOTTOM OF TEST HOLE 17.5' NO WATER OBSERVED �* 491H */ K NNMI L.VFUS /CE -71 \ �OFESSIGN64 SP/SM GV/GMS 1. 3 BEDROOMS X 150 GAL./DAY/BEDROOM = 450 GPD 2. SOILS RATING- 20 MIN./INCH = 0.6 GPD/SF(TRENCH) 3. 450 GPD/0.6GPD PER SF - 750 SF 4. 750 SF /6'D x 2 - 62.5 L (USE 1 TRENCH 63 L) 5. MINIMUM DESIGN SIZE = 63' L x 3' W x 6' D Trench 6. 2' HD INSULATION REQUIRED OVER FIELD <3' OF COVER 7. 2' HD INSULATION REQUIRED OVER TANK <4' OF COVER 8. CONTRACTOR TO PUMP TANK. 9. ANY ASPHALT, CONCRETE OR APPERTANENCES DAMAGED OR DESTROYED BY THE CONTRACTOR DURING CONSTRUCTION SHALL BE REPLACED BY THE CONTRACTOR AT NO ADDITIONAL COST TO THE OWNER. 10. CONTRACTOR TO VERIFY AND INSURE 2% GRADE FROM EXISTING TANK. ARED FOR: KND ENGINEERING RONALD 6 CONNIE DIVELEY 20441 PTARMIGAN BLVD 6300 EAST 112 EAGLE RIVER, AK, 99577 ANCHORAGE, AK 99516 (907)696-6111/FAX (907)696-8111 8-23-95 BRAVING A NOT TO SCALE 9326-52 [' Municipality of Anchorage 1 r DEPARTMENT OF HEALTH 8. HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 2±ne H /y6 G'�% DATE LEGAL DESCRIPTION: LT Z, -4G, L S S/D Township, Range, Section: r"rw 1 SLOPE SITE PLAN (FEET) 2- 3- 4 3 4 5 6 Y 7- 89 8- 0 Eim Scor, 6"'A' M.444.^ - al r y Gt' Ss-s+w WAS GROUND WATER 10 ENCOUNTERED? ND S 11 IF YES, AT WHAT p 12 DEPTH? E Ikoth to 13 Manilornp?aMer Wt 15 { I' 16 17 18 19 Reading Date Gross Time Net Time Depth to Water Net Drop 6./2. - �, 8" So .S 7 9 A- 6 Zoo ' /I / 2.0 -5 g-� t IAZ a' 20 { I IL_ JI PERCOLATION RATE '10 (mmutevmch) PERC HOLE DIAMETER '/TEST RUN BETWEEN 5 / FT AND / Ff COMMENTS 7 PERFO(NMED DY. Iwai I CV011Y IliAl III ESSI WAS PLHI OIIMED IN ACCOIIUANCE WITH ALL STATE AND MUNICIPAL GUIOLLINLS IN [If LCI 1111S DAIL DATL 5J_..—.._.-.------- 72 Ofie Iiwr Utl51 PERFORMED FOR:_ LEGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Municipality of Anchorage DEPARTMENT OF HEALTH 8, HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST /3 DATE F p Township, Range, Section: e1 nor WASGROUND WATER ENCOUNTERED? S L IF YES, AT WHAT 0 DEPTH? P E Depth b Water After MWITorinp? exit Readlnp Date Gross Time Net Time Depth to Water Net Drop 8-/4-9 — ' / S 6 LI 20j I it lul PERCOLATION RATsim E "Z � Immulechl PCRG HOLE DIAMETER / TEST RUN, BETWEEN ,t FTAND / (y/ Fl COMMENTS 101e4.,--p/'E�4KD5 slri 7' �2, -,2' PERI Or1MED BY. L"falSa I _zAe 1 11111fY THAT1111'TE''7 WAS PE10OHMEDIN ACCONUANCE WITH ALL STATE AND MUNICIPAL GUIDLLINLS IN Eff ECI Ota THIS DATE DATE �4� .------------ 72 -Erin Iftev 41851 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street -Anchorage. Alaska 99501 Telephone 264.4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME SEL TAcm %to PHONE LI -8911 1 NEW ❑ UPGRADE MAILING ADDRESS S FZ A �o1c ie so -I LEGAL DESCRIPTION LOCATION S\\ NO. OF BEDROOMS 3 D Y DISTANCE TO: Well Absorption area Dwelling A —F PERMIT NO. O1 g _ S Q W Manufacturer �f _ Material No. of Compartments w Liq. ca acityy fin gallons IF HOMEMADE: Inside length Width Liquid depth _1 _102V 2 DISTANCE T0: ell Dwelling PERMIT NO. _ f Manufacturer Material Liquid capacity pacify in gallons O W = DISTANCE TO: Well FoundationNearest lot fine PERMIT NO. � Z Z WIA No. of lines Length of each line Total length of lines Trench wi th lOthe3 Distance between lines " M s- p Top of tile to finish grade S Material beneathrile \ %111Total 'S o inches effective absorption area o0 W Length Width Depth PERMIT NO. Q 1— W d Type of crib Cr is a Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J J iassDepth Driller Distance to lot line PERMIT NO. 1 6o \ n o W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(&) OTHER �L 411 PIPE MATERIAO � s n SOIL TEST RATING t50 INSTALLER SeLF III � REMARKS 5 ve CO I u 36R °o s FS OVED ��DATE LEGAL \eLrs`r 72-013 (Rev. 3/78) 3 r p rr� DELTA DRILLING cC_: /lion; d� �{ DRILLING LOG 3C �^f ?S Well Owner.Del Monico Use of Well Dom. Location (address of: Township, Range, Section, if known; or distance main road Lot 2 Block Del's Subd. Size of casing 61, Ttepth of Hole 207 feet Cased to 205.3 Beet Static water levet 120 ft. (WTtGn (below) land surface. Finish of well (check one) open end ( xx ); Screen ( ); Perforated ( ). Describe screen or perforation N/A Well pumping test at 20 gallons per jT0G70 (minute) of drawdown from static level. 6/23/781 Date of completion WELL LOG for-----I—hours with 100% xf[ At r_7 C6/1'074 1-o I 2, / lS sv��� • N S� 1ggqV3.' '16 qN IV ySE v Ntv Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 To 2 Casing stickup Of CEPT• OF HEALTH W —10 PROTEMON 2 TOS_ Organics MAH 6 14RR �2_TO_2Z_Silty gravel: RECEIVED _2LTO�6_ Silty sand: gravelly —i6_TO-62 Gravelly clay 93 Gravelly �rjb�g __62_TO clay 93 TO 110 Silty gravel 110 TO 134.7 Gravelly clay __L34. 7q•O 135.5 Boulder 135.5P0 155 Gravelly clay/ 155 Tp __L80 Gravelly clay V _L8 0 TO 185 Weeping hard pan 185—T0 187 Wet silty sand X87 TO 193 lleavi silty Sandy gavel•water bearing –13 -3 --TO 707 Hard pan 202 207 Water gravel 1—CUSTOMER r•1 a r -a i t- j -/O ►n L- I T o f c l r -z r=i 1:3 E j `- • DEF'AP,TMENJT C r�EALTH AND ENVIRONMENTAL :ECTIOtJ J ..% 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 • 4,IEL-L_ Rr-.!G• ID r-4 I TE SEI-JEF= F-'E�_r'1 I•T ��ts PERMIT NO. 4 780187 ) - APFLICAFJT DFL MrtJlr_.n SPA BOX 26 99507 344 8971 LOC_.ATION 112TH ST LEGAL L2 DEL'S S/D LOT SIZE 39500 SQUARE FEET TYPE OF SOIL ASSORSTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BF:)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EF�TH= 11 L_Er+IGTH= c{..=. 1:3Fi F %.• ELL= L7EF�TH= THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF'THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OP.., PIT JS .THE 'DISTANCE BETWEEN'THE SURFACE OF_ THE.. GROUND AND THE BOTTOM'OFITHE EXCAVATION:CIN FEET): THERE IS NO SET WIDTH FOR. TRENCHES. " * THE GRAVEL DEPTH IS THE MINIMUM DEPTH-OF,GRAVEL BETWEEN THE OUTFALL:•FIPE', AND THE BOTTOM OF THE EXCAVATION CIN FEET)...._ EC -!L_1 I REGti S EF T-�-rn1-4FC :F. I E.- 1t_i►3n rMFiLLvDr-aE PERMIT APPLICANT HAS THE RESPONSIBILITY TO'4INFORM THIS DEPARTMENT`DURING THE INSTALLATION INSPECTIONS OF ANY 'WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TFJiD •C �- 1 I "!s7, f-- -r I o":r, nFRE REG!1_1 S Fz�.EC1 -- BACKFILLING OF ANY SYSTEM WITHOUT FINAL IFSPECTIOtJi-AND,.AFF'ROVNL .BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. ' MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL'SYSTEM ;I5•'' 10=1 FEET FOR A PRIVATE WELL; OR t 151 TO 200 FEET FROM A PUBLIC LJELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL. LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT.IdITHIN 30, DAYS OF THE 14ELL COMPLETION.. OTHER REQUIREMENTS MAY APPLY.° SPECIFICATIONS AND CONSTRUCTION DIAGRAt'S ARE AVAILABLE TO INSURE PROPER INSTALLATION. (QEF-zM I T EXF=' I FEES~ C•Ei--E-=M.'ER = 1: 15 -.7:D I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR, ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE' RESIDENCE IS P,EM DELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED BY PPLIC 4T DEL MONICO ' _-- - - --------DATE _ V3.2 .......... T ou 53 rllv- 4 1 -1 r� � �eu//'�'. ,j. � c ,1 , jqp� dao OurAeA A4� 474M to A41 All' v t( •�- z^"' 13. f. F. • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s E T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-492-02 Expiration Date: �- 2 1. GENERAL INFORMATION Complete legal description Del's Lot 2 Location (site address) 6300 E 112th ,Anchorage, AK Current Property owner(s) Ruth &_Daniel Thomson Day phone Mailing address 6300 E 112th ,Anchorage,_AK 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: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: 3 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: _ _ _ _ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 5-6. Date of Payment Receipt Number -050,35 G COSA# OSG211DZ�d Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AIC 99577 Engineer's Printed Name _KENNETH M. DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future 4'� , occupants or can ArcTerra guarantee that no unseen iOr All encroachments, deficiencies or discrepancies exist. Ar �1l'� 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. 100, T i 1, �t 9 0-NNETH ?t. `ALT :S Conditional approval for bedrooms, with the following sti t��l�lEl�f((�r ```GQPL\iY OF,��/�i ON_s►rFlo lo— ATER AND m B Original Certificate Date: Z r2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory _._ Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: Del's Lot 2 Parcel ID: 015-492-02 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 6/23/78 Total depth 207 ft Cased to 205.3 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 25 in. Date of flow test for COSA 7/15/20 Static water level at beginning of test 5.5 ft. Comments B. TANK DATA Age of tank(s) 9/1/20 years Tank type/material Setic/Plastic Measured operating fluid level in septic tank New Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA Which system tested (date installed) 9/11/95 ALL standpipes present per record drawing Total measured depth from grade 11.4 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 6.1 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0 Nc Coliform bacteria is Negative Nitrate 0.787 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L N Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 12/29/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 7/15/20 Results V,11 Pass For _ Fluid depth prior to test 54 Water added 450 gal New depth b4 in Elapsed time 240 min 3 bedrooms in Code -required soil cover over field Final fluid depth 54 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: 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' Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [0 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®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' ® Yes if No ft Surface Water >' 100 _ ®Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption .Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® 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' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet O iS VI-10NOdW O w Q r N r ,02 r ,9'OL p' (?J ,-VS'66Z Q 3„OZ,•b0.00N) ,69'66Z I _ _ 3„OZ,60.00N LLJw V'1 � Q ,Z' Gtr l -T ti .' co O II ek."ow�` O O iry N G N O •” G O .- o 'e7 N N J w N Ln O r c' .£ 6 r N L't£ i., � 1- 00 O 6 3snoH �® 03HS 00 Qi _ a ONIJSIX3 N uj 3 z ps rn! O �.• S S'LE 0 O C4 y m E) L'04 o (� N G .a y O V .��'” N N030 z Lo ^ G eC ❑ O ami O 3 y r G o m cD Q `— 16 a z Lu ON00 W m ¢���;, cn 0-0 M G .o _j (,0 O fi > p'0 } W O Q U O G Y O m 00 Z Q LLJ .L'Z L n .O'9L o In C1 f0 to N N ,S 6S L (�I 3„OZ,tO.00N) ON ,61�'66Z LZ'66Z 3,,9Z,90.00N ,9'OL p' I Q W I _ _ N LLJw V'1 � Q r. -T ti .' co O II ek."ow�` O O G N O •” G O .- i G J w LLC � 6 a o co 0 b0 Ul O O C%2 O dl -,-, c- r to^.. N - H H Q~'1 .40003 '( d v b (n I _ _ N LLJw al G v U N r. -T ti .' Or ek."ow�` V m0 G N O •” G O .- i G J w N Ln O YO ^ U O i., � 1- 00 O b) In 00 Qi z OD n• O Q z LLC � 6 a o co 0 b0 Ul O O C%2 O dl -,-, c- r to^.. N - H H Q~'1 .40003 '( d v b 0 A' I _ _ 0 0 EO al G v U N 0 J -T ti .' ek."ow�` v b al G v U N C O v.w': V m0 G N O •” G O .- i G J w N O' y •� � YO ^ U O i., � O O 'rJ G c� n• O Q .q V'G y O �.• S O C4 y m E) a� o� NC N G .a y O V .��'” N r ® r ^ G eC ❑ O ami O 3 y r G o m ¢���;, 2 w S M G .o (,0 O fi > p'0 } W O T G• U >+ `� U O G Y O NCj MUNICIPALANCHORAGE IRL DEPARTMENT OF HEALTH S HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # - _ D/5 • z1fg - G7 HAA# GENERAL INFORMATION Complete legal description Zo l Z 7a/s5112 Location (site address or directions) _ G30U E Property owner��»� leue/.sll Day phone 3216 Mailing address Lending agency Mailing address Agent Address .. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well _� Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADECttest- Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: m a Oz Individual on-site rr c lk Z Holding tank c so Community on-site Cn Public sewer u_ c'. NOTE: If community wastewater system, provide written confirmation from Sta?e ADEC attesting to the legality and status of system. 72-025)Rw.1191) Flout MOAF21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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. IGvG Eng :raerin.7 L 96, —6/// Name of Firm Phone Address Eay a River, AK 99577.8736 Engineer's signature - Date 9 96 tE OF AC�� %11. 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. By: yt � i!' •.� C: 711 � awl 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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ?=(P.Int) 9 4 MOAM Municipity of Anchorage w4im DEPARTMENT OF HEALTH & HUMAN 9 ,"tORA 9" Environmental Services Division SUV)CE311"loN 82VV Street, Room 502 • Anchorage, Alaska 99501 • (9071.343-41441996 Health Authority Approval Checklist RECEIVED Legal Description: �oL oe-1 15 .SID Parcel 1.D.: 0/ $- - O�- A. WELL. DATA Well type _,„'H If A. B. or C. attach ADEC letter. ADEC water system number Log present (YM)y Date completed Total depth - ©9 Cased to =off• 3 Casing height (above ground) z 5 Sanitary seal (YM) Y Wires properly protected (YM) FROM WELL LOG AT INSPECTION Date of test (v -.a-> - Static water level a V -7 / Well production g.p.m. G S g.p.m. WATER SAMPLE RESULTS: / Coliform Nitrate Q �•t A-1 L Other bacteria _ Date of sample: - / - g /o Collected by: Z' B. SEPTIC41OLDING TANK DATA Date installed 8 - a9 7k Tank size 10WO Number of Compartments +::' Cleanouts (Y/N)--Y- Foundation cleanout (Y/N) � Depression (Y" AJ High water alarm (Y" - Date of Pumping J -4G Pu.M 'Vu .,I&[ C. ABSORPTION FIELD DATA Date installed 4 9-4S Soil rating (&p.d./(t- or tY/bdrm) 0- (a• Svitem type � 77f- Length ti Length (0 5 r Width 3 J Gravel thickness below pipe to r Total depth Effective absorption area 7 l'D Monitoring Tube present(Y/t)_ Depression over field (Y" /li Date of adequacy test 4AE:EJ Results (Pass/Fad) For 3 bedrooms Fluid depth in absorption feel dote test (in.): % 1 e r_ gal, water added i Fluid depth (ins.) Minutes later: /Absorption rate .p.d. Peroxide treatment (past 12 months) (Y/N) — Al If yes. give date D. LIFT STATION Date installed Manhole/Access (YY High water al el at* Cv ested E. SEPARATION DISTANCES Sire in gallons "Pump on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot �Od : On adjacent lots Absorption field on lot Public sewer main / DO /,4 : On adjacent lots "Pump off' level at• /,go /)P- Public t Public sewer manhole%leanout 1A• Sewer /septic service line 2 s / y Litt station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ©Propem• line / y Absorption field_ i s - Water main/service lineS Surface water/drainage /49d Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain 5r7 f t /Vo/f 1921P 14- F. a F. ENGINEER'S CERTIFICATION Water main/service line ZS/} / O /f Driveway. parkingivehicle storage area Wells on adjacent lots /Oo i,` Propert line I certify that I have determined thru field inspections and review of Municipal records t e in contbrotance with MOA K U guidelines in effect on this date. ; lk ,..�••• Aw Gj .• Signature StC� �r +— /or 9a Engium's Name A;i ort I ell. �,•{ , y � v / 11!Fill • Kene�h M. Date irt/yJ �/� ,� ' `s%' HAA Fee S � , 4;ED A Date of Payment CJ � ql; 6 Receipt Number!5,3e �W2 Rev. 8/95 OSS: haa.wk.doc Waiver Fee S Date of Payment Receipt Number MUNICIPALANCHORAGE • 'r DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. tl (ilk 11 `l •� • (1'J HAA tt 1 I WL C "J I I 1. GENERAL INFORMATION Complete legal description Lha" OWL Location (site address or directions) ( ri ]i '\ L \ P1 h? �t 1 -)1 -r1 -)(N"(, I IV Property owner � 1 l7 E' I E' a Day phone Mailing addresslo X�'�,' ll ) I Z t" 01 \I I I I "•i 1'4 f r 4J( Lending agency r Day phone Mailing address Agent Address ' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 9, 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER 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. 72-023 )M+, 1191) FN % MOA 921 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my invest!qation 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 t, �` ' , �� Phone 'S' Address Engineer's signature Z Date 6. DHHS SIGNATURE L0 1-7 —1F�— Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: 1IITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. nmsm«.�An 9.k Mo•.21 95a/o Municipality of Anchorage (./ DEPARTMENT OF HEALTH & HUMAN SERVICES l Environmental Services Division 8251Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 70 c'r Health Authority Approval Checklist n �o Legal Description:L_�r--jF-1 S SVot,r r,) Parccl I.D.: ao tri A. IVELL DATA t; n C7 0 Well type R-V-� If A, B, or C. attach ADEC letter. ADEC water system number Z Log present (Y/N).`J Date completed %-��-7$® Total depth `c�5J7 tO Cased to ,3r O Casing height (above ground) 0.6,10 Sanitary seal (Y/N) YE;SD Wires properly protected (YIN) Y t Date of test Static water level Well production FROM WELL LOG G -a3- -/-? © ao® 9 - p.m - AT INSPECTION pg -4 - 95 0// Q 6.5 ATER SAMPLE RESULTS: Coliform G Nitrate _C)Za Other bacteria O Date of sample: m(='j - IA -9t) Collected by: Nx� fl tJ N I C„K B. SEPTIC/IIOLDING TANK DATA 9 - p.m -W Date installed 19 %$© Tank size I ox�Gq . umber of Compartments t�© Clcanouts (Y/1� Y6S© Foundation cleanout (Y/N) resp Depression (Y/N) /) High water alarm (Y" Date of Pumping Wal 09-.5 Pumper -?o C. ABSORPTION FIELD DATA t Date installed�4-9-95 0 Soil rating (g.p.d.W or ft'/bdrm) �CD System type Length GO' Width tom— Gravel thickness below pipe �� Q)Graveldepth 114 f �'® Effective absorption arca %`�O Monitoring Tube prescnt(Y/N)_'Jt,!�S Depression over field (YIN) IJOO Date of adcquacy test Ile LJ Results (Pass/Fail) V3rj) For _0(- Q bedrooms Fluid depth in absorption field before test (in.): M- &J Immediately after gal. hater added (in.): Fluid dcpth� Minutes later: (in.) Absorption rate ` e.p.d. Peroxide treatment (past 12 months) (Y/N) {J p If yes, give date \ D. LIFT STA Date installed Manholc/Acccss (Y/N) _ High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons level at* "Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: t Q Septic/ltolding tank on lot _ I� f ; On adjacent lots 1 1 O t I Absorption field on lot 100rfi� ; On adjacent lots 10 t+O Public sewer main Al 1A Public sewer manholcicleanout _/U�A Sewer /septic service line %t "tO Lift station QA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 0 Foundation 1�� t� Property linc'gOr't© Absorption field Z5+ I �tr ) t '� Water main/service lint O t Surface water/drainageo`M t Wells on adjacent lots _� lO 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Buildingfoundation 10 -1- t U Water main/scrvicc lint � t r Surface water �YJt"r ; Driveway, parking/vehicle storage arcapl� -h Curtain drain 01A Wells on adjacent lots 11 O'-% 0 F. ENGINEER'S CERTIFICATION / certifv at 1 have alklermined thru field inspections and review of 1 e4zor systems are in conform ce with A411 fb14 gu del es ' ect on this date. Signature Engineer's Namc r�/cE r'?'; 6 t'CS - 907 5 Date 9/is �%S g�' ...•j�.�.,"o 4 HAA Fee S �/ ' cJV Waiver Fee S Date of Payment ! / `/ `% �S Date of Pavmcnt Receipt Number 43 1,f QID Receipt Number Rev. 8/95 OSS: haa.wk.doc Q DFII RE CnR DS TAKf tJr,) r lrh. AJ>=rUS ASr duKi Dx ® hY rnoA MCO w ^\i �'j•ri�' S U101 `fx 4a 0 - DATE RECEIVED STREET LOCATION From NewSeward g wa go up a ey o Oc r ge oa a ey 1 entag School strep[t). tur>il r gght �nd go sat school ayd aroytnd cure to left 3 INSPECTION APPOINTMENTS e c a et.... st home on r ht a ter mak ng curve 6. TYPE OF RESIDENCE TIME TIME TIME SINGLE FAMILY DATE DATE DATE _ 7. WATER SUPPLY INSPECTOR INSPECTOR INSPECT ❑ COMMUNITY MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ❑ PUBLIC UTILITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI&WT. OF H-ALTH & ENVIRONMENTAL i ZOTE'CTION 8. SEWAGE DISPOSAL SYSTEM 825 L Street - Anchorage, Alaska 98501 • 129 INDIVIDUAL/ON-SITE" ENVIRONMENTAL SANITATION DIVISION ❑ PUBLICUTILITY Telephone 264-4720 NOTE: THE INSPECTION FEE MUST ACCO Dl: ((' V,/ [[ 1 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SElME14 YLWMS 4 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER DelMonico, Kenneth M. & Jori PHONE 344-8971 MAILING ADDRESS SRA Box PROPERTY RESIDENT (If different from above) PH NE n/a 2. BUYER PHONE n/a MAILING ADDRESS 3. LENDING INSTITUTION PHONE undetermined at this time MAILING ADDRESS 4. REALTOR/AGENT PHONE Jack White Company (ATTN: ELLIOT C. LAWSON) 277-1553 MAILING ADDRESS 3201 C Street, Anchorage, AK 99503 5. LEGAL DESCRIPTION Lot 2, Del's Subdivision - STREET LOCATION From NewSeward g wa go up a ey o Oc r ge oa a ey 1 entag School strep[t). tur>il r gght �nd go sat school ayd aroytnd cure to left ect Ice s natura Ceaar s e c a et.... st home on r ht a ter mak ng curve 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS M [3 One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY M Three ❑ Six 7. WATER SUPPLY [29 INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 129 INDIVIDUAL/ON-SITE" Approx. '78 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCO N EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rini. 8/79) I-_ D THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY O MULTIPLE FAMILY NUMBER OF BEDROOMS O ONE ❑ THREE ❑ FIVE ❑ OTHER O TWO O FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED _ g INSTALLER OSepticTankor OHoldingTank Size: If Tank is homemade give dimensions: SOILS RATING / TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank (3 Absorption Area Sewer Line Nearer[ Lot Line Absorption Area to nearest Lot Line 5. COMMENTS M4APPROVED FOR BEDROOMS O CONDITIONAL APPROVAL (letter must accompany certificate) O DISAPPROVED DATE "Yoc 72010 (Rev. 6/79) ria 1kriumicipality 02 Anchorage n 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4,11 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION January 8, 1981 Kenneth M./Jori Del Monico 8 Elliot C. Lawson Jack White Company 3201 C Street Anchorage, Alaska 99503 Subject: Lot 2 Del's Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for 4 our review. (2) The septic tank pumped with a receipt submitted to this office. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw