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Home My WebLink AboutT12N R3W SEC 15 LT 100ATI2N 3W 1 Lot 100A 015-481 -13 Municipality of Anchorage Community Development Department Page ! of 3 On-Site Water and Wastewater Program 4700 Elmore St. · P.O. Box 196650 Anchorage, AK 99519-6650 · http://vvww.muni.org/onsite · (907) 343-7904 ON-SITE VVATER AND VVASTEWATER INSPECTION REPORT Permit Number: OSP111070 PID Number: 015-481-13 Name: WASTEWATER SYSTEM [] New [] Upgrade Susan Merritt ABSORPTION FIELD Address [] Deep Trench [] Shallow Trench [] Bed [] Mound 4411 E. 102nd Ave, Anchorage, AK, 99507 [] Other Phone Number of Bedrooms Soil Rating Total depth from original grade 90%830-7016 3 0.7 GPD/SF 4' Max (to top of sand) Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.41 Max Ft. 0.59 Ft. - - Lot 100A Fill added above original grade Gravel length Township Range Section See Dwg. Ft. 45+ Ft. TI2N R3W 15 Gravel width Beds: Number of Lines Distance between lines ~L (from logs/tests) [] New [] Upgrade~./'" 15 Ft. 3 5 Ft. Classific~3... (Private, A, B, C) Total Depth /C~sed~6'~ Total absorption area Number of trenches Dist. between trenches Existing '~"-~-..:, - ,,.Ft~¢[', - Ft. 675+ Ft2 - - Ft. Dr er ~'%.~ IDate Drilled ~' IStatic Water Level - ~"'¢~, ...,-?" I - Ft. TANK [] Septic [] S.T.E.P. [] Holding [] Other Manufacturer Capacity Yield IPump S¢'a~ '-~....~asing height above ground Anchorage Tank 1250 Gal. - GPMJ,.,~:~: ~ii[" %~ - Ft. Material Number of compartments Water quality testing Coliform - Col/i~ Steel 2 ~TATION ~'~senic- ug/L Nitrates-~mg/~-~ Manufactu~el~,_~ Capacity ~'~' ' SEPARATION DISTANCES ~',,,.~. - Gal. To Septic Absorption Lift Station Holding Sewer Pump on level at Pum~'offJevel a~¢'"' High water alarm at From Tank Field Tank Line Well 100'+ 100'+ - - 25'+ -iD,. 2')'h::-,,, -in. Surface Water 100'+ 100'+ _ Pump make ,aBda~nds'~i Electrical Inspec'tiC~ils-p,gfformed by Lot Line 5'+ 10'+ - NA / ........... - Foundation 5'+ 10'+ - PIPE MATERIAL D3034/F810 Sch 40 Curtain Drain N/A N/A - BENCH MARK Assumed elevation 98.00 Remarks: Location and description Bottom of Siding, NW comer of Barn Installer Wilco Contractors Inspection 1St 6/6/2011 E0~i~,~,r¢~,,~tsmp dates: Inspector GEG, Ltd. 2*~ 6/7/2011 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ¢~'~ ~U~ ~( ~. Conditional Approval: Date Approved , ~ ~,C,x, Date ,,~; -/7~1/ \\Geg 1 \geg ~\TI 2N, R3W~SECTION 15\LOT 100A\Inspection Report Form.doc PERMIT NUMBER: AS BLT];LT DRAW];NG PARCELID NUMBER: OSP111070 - 015-481-13 10' UTILITY EASEMENT C07 C06 .... ~1 ~ ,,,~,k'fF--P, "~ ,¢' 7- ;,';o'5 ,o~ ...... ........ / NEW DRA, N~,E,D CeLL //l/ . :: C02 , CORRAL AREA :: .., ,, ssT; APPROXIMATE LOCATION OF ~ ' DBL1 27.18 47.51 / \ ~ BARN CO1 142.75 155.02 / \ t C02 142.62 155.29 I ~ I ~ r--'l c03 145.30 158.38 I ~ I r- -- '~ .. OLD DRAINFIELD L~J C04 148.40 162.33 I CONNECTED AS MT Io I ........... 1 146.62 160.31 I ~ I t I C05 182.18 189.71 ,,,/.~'~'E,,.;5~Ea'"/,i4D I~ %1 [~. ~.: :'.!-~.% c07 187.14 196.40 [~ I '~- -- -'~ ~.'"'::~'% MT2 183.31 190.77 O~,V. .,'... :.. ~.,..' , , '.. . ~NEW 1250 CA--ON; ST'-~'n' ~'":;"."% SEPTIC TANK ~ ~ ~'"-'":'-"t...~ I I STI~ ~ ~-- '.:".":" :\ ', -' :-'X'. / PAVED DRIVEWAY ~. it` ::':~ I I ".." '." · L_~ ~,~ ;": ':' ;' ' I . ~'.".". ~% '.~ : .:..{.. "; CONSULTANTS & GENERAL CONTRACTORS ] . ' ...... i'''l/' .f't''-Z.,--"~..~ .... '. .... PREPARED ~OR: I P,ONE NUMBER: I PACE NUMBER.' ~'-- X"_--'? .... : A Ggr ess SUSA, .~,,~TT I eo~-~;o-~o~e I z o~ ; k~F'~,~"-,¢¢L~,*~°.y~'...' ,ETA, DESCRiPTiON- DRAWN BY: ~'~%.//.. ¢'hSE.-7~S"Z' ..' ~PE o~ WORK: DATE: '~,*¢ ~,~, AS-BUILT DRAWING OF NEW SEPTIC SYSTEM 6/14/2011 '~..~_%%~.--/ A B ST1 17,45 40.90 ST2 25,85 46.18 DBL1 27.18 47.31 DBL2 27.93 47.73 DtV 28.60 48.51 C01 142.75 155.02 C02 142.62 155.29 C03 145.30 158.38 C04 148.40 162.33 MT1 146.62 160.31 C05 182.18 189.71 C06 184,94 193.34 C07 187.14 196.40 MT2 183.31 190.77 (Rev. 01/05) AS BUILT DRAWING OSP111070 - 015-481-1,3 fFINAL GRADE = 99.05-98.94 ST 1 / ST2 ~ NEW 1250 GALLON ~-~ / I ~ SEPTIC TANK r I 'N INVERT OF BUNG ~ I I {~ ~AII~ ~DDD I ~INVERT OF BUNG AT INL~ = 92.47 I k ......... p. [ [ A~ OUTL~ = 92 18 k/ BURIAL TANK) ~] ' FINAL GRADE 95.80-96.6~ FILTER FABRIC MT CO CO / CO MT ~ ~ ~ / ~ ~ ~ ORIGINAL GRADE 94 10 TH~I [ ~INVERT OF DISTRIBUTION / LINE = 90.69 BOSOM OF BED = 88.10 ~ GROUNDWATER ~ 86.10 (MAY 2011) GA'RNESS ENGINEERING GROUP, Ltd. ~."49~ ":.~ SUSAN ~ERR 11 907-850-7016 3 OF 5 ~'F3 RSW, (Rev. 01/05) ~EPLY TO ATTENTION OF: Regulatory Division POA-2011-473 DEPARTMENT OF THE ARMY U.S. ARMY ENGINEEI~ DISTRICT, ALASKA REGULATORY DIVISION P.O. BOX 6898 JBER, ALASKA 99506-0898 JUN - 8 201'I Ms. Susan Merritt 4411 E 102nd Ave Anchorage, Alaska 99507 Dear Ms. Merritt: This letter responds to your May 23, 2011, request for a Department of the Army (DA) jurisdictional determination for your proposed septic field replacement. It has been assigned number POA-2011-473, Little Campbell. Creek which should be referred to in all correspondence with us. The project site is located within Section 15, T. 12 N., R. 3 W, Seward Meridian; USGS Quad Map Anchorage A-8; Latitude 61.1289° N., Longitude 149~8000° W.; Lot 100A; in Anchorage, Alaska. Based on our review of the information you provided and our May 25,2011 site visit, we have determined the subject property does not contain waters of the United States (U.S.) under Corps jurisdiction. Therefore, a DA permit is not required. A copy of the Approved Jurisdictional Determination form is available at http://www.poa.usace.army.mil/reg/ApprovedJDs.htm under the above file number. Please contact us if you decide to alter the method, scope, or location of your proposed activity. This approved jurisdictional determination is valid for a period of five (5) years from the date of this letter, unless new information supporting a revision is provided to us before the expiration date. Section 404 of the Clean Water Act requires that a DA permit be obtained for the placement or discharge of dredged and/or fill material into waters of the UoS., including jurisdictional wetlands (33 U.S.C. 1344). The Corps defines wetlands as those areas that are inundated or saturated by surface or groundwater at a frequency and duration sufficient to support, and under normal circumstances do support, a prevalence of vegetation typically adapted for life in saturated soil conditions. Section 10 of the Rivers and Harbors Act of 1899 requires that a DA permit be obtained for structures or work in or affecting navigable waters of the U.S. (33 U.S.Co 403). Section t0 waters are those waters subject to the ebb and flow of the tide shoreward to the mean high water mark, and/or other waters identified by the Alaska District. Nothing in this letter excuses you from compliance with other Federal, State, or local statutes, ordinances,' or regu]_ations. Please contact me via email at joe.d.white@usace.army.mil, by mail at the address above, or by phone at (907) 753-2776, if you have questiens. Sincerely, 'Uoe D. White Project Manager Permit Number: OSPl11070 Tax Code Number: 01548113000 Work Type: Septic Permit Effective Dates: May 26,2011 Design Engineer: Subdivision: On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade to May 25, 2012 GARNESS ENGINEERING GROUP LTD T12N R3W SEC 15 Site Legal Address: T12N R3W SEC 15 LT 100A G:2536 Owner/Address: KAISER SUSAN C 50% & MERRITT SUSAN C 50% 4411 E 102ND AVENUE ANCHORAGE AK 995076581 Site Mailing Address: 4411 E 102ND AVE, Anchorage Lot Size in Sq Ft: 49504 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ; ~-' .* -~-- Date: Date: .-~/~/" Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERHIT APPLICATION FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-481-1,5 Day phone Property owner(s) SUSAN KAISER Mailing address 4411 E. 102ND AVENUE * ANCHORAGE, AK * 99507 Site address 4411 E. 102ND AVENUE * ANCHORAGE, AK Zip Code Legal description (Sub'd, Block & Lot ) T1 2N, Legal description (Township, Section & Range) Lot Size *'f~, ~0C[ Sq. Ft. 850-701 6 99507 R3W, N/A SECTION 15; LOT IOOA Number of Bedrooms 3 THIS APPLICATION IS FOR ( [~all that apply): THIS APPLICATION IS AN: Absorption Field [] Initial Septic Tank [] Upgrade Holding Tank [] Renewal Privy [] Private Well [] Water Storage [] 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. ., ~Permi~Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) ,, ~ /~ Waiver Fees: Date of Payment: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS May 16, 2011 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 System Upgrade for T12N, R3W, Section 15; Lot 100A, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The drainfield is in a state of failure and must be upgraded. We are proposing to install a 1000 gallon septic tank and a bed type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of the test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached site plan, the average topography in the area of the drainfield is relatively flat. In short, there are no slope concerns. We are unaware of any a~tverse impacts this installation would have on adjacent wells or septic systems. you have any questions, please contact us at 337-6179. Thank you for your assistance. Si~erel~, ieffrey A-~arneg~S, P.E., M.S. President NOTE: ~Attacfied is a site plan drawing, a design drawing and one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7page construction specification letter.) If 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Wockenfuss, Deborah M. From: Sent: To: Subject: Rob Campbell [Rob@garnessengineering.com] Wednesday, May 25, 2011 3:18 PM Jeff Garness; Wockenfuss, Deborah M. FW: Susan Merritt Property (UNCLASSIFIED) ..... Original Message ..... From: White, Joe D POA [mailto:Joe. D.White@usace.army.mil] Sent: Wednesday, May 25, 2011 3:15 PM To: Rob Campbell Subject: FW: Susan Merritt Property (UNCLASSIFIED) Classification: UNCLASSIFIED Caveats: NONE Typo in your address on the first one. Joe ..... Original Message ..... From: White, Joe D POA Sent: Wednesday, May 25, 2011 3:13 PM To: ~rob@garnessingineering.com' Cc: ~Keesecker, Karen M.' Subject: Susan Merritt Property (UNCLASSIFIED) Classification: UNCLASSIFIED Caveats: NONE Karen, Rob Campbell and I met on the Merritt property this morning. The MOA Wetlands Atlas shows some class C wetlands mapped in the location of a proposed septic system drain field. I did a JD on-site and found no wetlands on the site. The area of class C wetlands is questionable but I did not go off the property to confirm. I will be out of the office starting tomorrow afternoon and don't know if I will be able to provide the JD letter before I return on June 2. Joe White Classification: UNCLASSIFIED Caveats: NONE Classification: UNCLASSIFIED Caveats: NONE T15N, RIW, SEC 15, LOT 96 T15N, RlW, SEC 15, N2NE4NW4SW4 SEPTIC X SYSTEM ~ [] I I t ] \ / It , \ / \ / "'-' \ \ / \ [ \ / ' ~ / EAST 102N ~ T15N, RlW, SEC T15N, RlW, SEC ] 0 15, LOT 123 15, LOT 122 SCALE: I I ~"= ~oo i ~ G~{~NESS E'N'GINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS ~701 E. ~R RO~ SU~ 101 * ~CH0~GE ~ 99~7 * PHONE (907)~7-6179 * F~ (907)~-~246 * WE~ ~,~:mn~n~in~dn~.com PREPARED FOR: PHONE NUMBER: ~ PAGE NUMBER: t SUSAN KASER 907-830-7016 [ 1 OF 2 % T12N R3W SECTION 15; LOT 100A A.J.G. N'~ '.~: ~./:' ~'/ .... ~.'~A~ ~ -, ..... ~ ~/ SITE P~N 5/25/2011 / MT 10' UTILITY EASEMENT CO CO CO PROPOSED DRAINFIELD ~ I I _, ~ ~IA'T '~, I-~-TH#I ~ I I MT :: CORraL AR~ DESIGN CRITERIA: :: / ~ NUMBER OF BEDROOMS: '~ ~ ~ GALLONS PeR DAY (GPD): 450 ~ / ~ / ~ ~ PERCO~TION RATE/S: <IMIN/IN :: x ~' ~ PROPOSED APPLICATION RATE: 0,7 APPROXIMATE LOCATION OF ~ MINIMUM D~INFIELD SQ.~.: 643 FENCED CORRAL AR~ ~ ~ ~ ' DRAINFIELD DESIGN~ / ~ ~ BARN WIDTH: 15' / ~ ~ ~ LENGTH: 45' ' ~ ~ _ ~ M.O.A. APPROVED SAND FILTER: 2' I ~ I * ACTUAL SQ.~.: 675 co~Ec~Eo AS ~ESE~W S~ ~ ~~.~ ~ S~EC~CA~[O. L~. ~AT I ~ ~ ~~,.~ ~ PERTAINS TO THIS DESIGN. TO ~ ~~:~ ~ ~ OBTAIN A COPY OF THE L~ER I I / ~ '~~._~'~ ~ CONTACT GEG. BY PROCEEDING PROPOSED DIVERTER VALVE ~ ~ ~ ~ ~ ~[?'~ FORWARD WITH THIS INSTAL~TION I I I',' '.~.'-'.'.".'.. ,~. · ·" ~.o~o~ ~o~ c~.o~s~ ~ ~ ~:.':.~..'.~ ~ ~ / r~ ~ . ~ ~ ~ ~ ~ '/':'-L-/. ~:~ ~OR~ AND WES~ :0~ U~ES , v ~F~2.-,; :~ *NO ~00' S~.~M O~S~ , l I /I /~':.':.~ )~.~ F~GGED BY A REGISTERED ~ ~ ~ ~~:/.:"~ ~RO.ESS~ON*: ~D SURWOR ',. = ,o. ' I ~s.~..~ ~ /'~.":;:'. :'~ ~ / ~.~~~ /~.. ....... ,}...:?,.. .... :..,.. ..... : .... .,~. susA. XA~S~. gOZ-a~O-ZO~ I ~ O~ ~ T12N, RSW, SECTION 15; LOT IOOA A.J.G. ~PE OF WORK: DATE: ~~o DESIGN DRAWING OF PROPOSED SEPTIC SYSTEM 5/25/2011 Rev. 01/05) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK. 99507 * PHONE: (907)337-6179 * FAX: (907)3~8-5246 * WEBSiTE gamessengineerlng.com ISOIL LOG - PERCOLATION TESTI T12N, RSW, SECTION 15, LOT I OOA SUSAN KAISER DATE: 5/9/2011 LEGAL DESCRIPTION: PERFORMED FOR: ORGANICS GM SP TO SM H20 @ 8' SOILS LOGGED BY: TEST HOLE //1I SOIL CLASSIFICATIONS GW ~ ORG GP hIL Ghl CL GC OL SW NH SP CH SM OH SC DEPTH TO DATE GROUNDWATER 8' 5/9/2011 8' 5/17/2011 /-TH#1 /? SCALE: I" = 100' DATE READING CLOCK NET TINE WATER LEVEL NET DROP TINE (MINUTES) READING (INCHES) 5/9/2011 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (iNCHES) TEST RUN BETWEEN 4.0 FT. AND 5.0 FT. A FOUR HOUR PRESOAK WAS PERFORMED: i'll YES . NO ANDREW GRAY PERCOLATION TEST PERFORMED BY: ANDREW GRAY CONNENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: '~"'- f'; '?"'. ~!EPLY TO ATTENTION OF: Regulatory Division POA-2011-473 DEPARTMENT OF THE ARMY U.S. ARMY ENGINEER DISTRICT, ALASKA REGULATORY DIVISION P.O. BOX 6898 JBER, ALASKA 99506-0898 JUN - 8 Ms. Susan Merritt 4411 E 102nd Ave Anchorage, Alaska 99507 Dear Ms. Merritt: This letter responds to your May 23, 2011, request for a Department of the Army (DA) jurisdictional determination for your proposed septic field replacement. It has been assigned number POA-2011-473, Little Campbell Creek which should be referred to in all correspondence with us. The project site is located within Section 15, T. 12 N., R. 3 W, Seward Meridian; USGS Quad Map Anchorage A-8; Latitude 61.1289° N., Longitude 149.8000° W.; Lot 100A; in Anchorage, Alaska. Based on our review of the information you provided and our May 25,2011 site visit, we have determihed the subject property does not contain waters of the United States (U.S.) under Corps jurisdiction. Therefore, a DA permit is not required. A copy of the Approved Jurisdictional Determination form is available at http://www.poa.usace.army.mil/reg/ApprovedJDs.htm under the above file number. Please contact us if you decide to alter the method, scope, or location of your proposed activity. This approved jurisdictional determination is valid for a period of five (5) years from the date of this letter, unless new information supporting a revision is provided to us before the expiration date. Section 404 of the Clean Water Act requires that a DA permit be obtained for the placement or discharge of dredged and/or fill material into waters of the U.S., including jurisdictional wetlands (33 U.S.C. 1344). The Corps defines wetlands as those areas that are inundated or saturated by surface or groundwater at a frequency and duration sufficient to support, and under normal circumstances do support, a prevalence of vegetation typically adapted for life in saturated soil conditions. Section 10 of the Rivers and Harbors Act of 1899 requires that a DA permit be obtained for structures or work in or affecting navigable waters of the U.S. (33 U.S.C. 403). Section 10 waters are those waters subject to the ebb and flow of the tide shoreward to the mean high water mark, and/or other waters identified by the Alaska District. Nothing in this letter excuses you from compliance with other Federal, State, or local statutes, ordinances,' or regulations. -2- Please contact me via email at joe.d.white@usace.army.mil, by mail at the address above, or by phone at (907) 753-2776, if you have questions. Sincerely, Project Manager MUNICIPALITY OF ANCHORAGE D," \RTMENT OF HEALTH AND HUMAN SI;Ir ;ES Environmenlal Health [)ivision 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTr-"M AND/OR WELL INSPECTION REPORT Address AK ??:6? IS- 7 /z r,J /2. 3 TANKS SEPTIC ~ HOLDING TYPE OF SYSTEM [~ TRENCN ~' BED [] W. DRAIN OTHER (~) FT ,' /00 s0e j WELLS Fl PRIVATE OTHER fldentJfv') FT DISTANCES ~l'fl SEPTIC ABSORPTION FR0~ .~ TANK FIELD WELL WELL r~oT' ,q ~,~/'/,~ LOTLINE ~,,'T ,S-O ~T ~'0 .~ FOUNDATION /.:f- ;,~ ~,o'~ , .-~ - D&te /o ~unicipal and 8la~idflmes in oll~c[ o~ this ENGINEER'S SEAL 72 013 (3/85) 0 o o o o o o o o o oo o ANCHORAGE, AL,C, SKA 99502-0850 DEPARTMENT OF HEALTH & HUMAN SERVICES January 10, 1986 TO: Permit Applicant Subject: Permit # 850469 T12N R3W SEction 15 Lot 100 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the onvsite sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit DEPAI:tTIflENT OF I.-tEAL. Ttrl AND ENVIRONMEIqTAL F'Fd]TECTIOI~ I~ll;:'.~,:i k !~i"I'rRIEI~[-I' :, ANCHORAGE, AK 991~i0 :L I::'IEF/II I T NO: 850469 DATIE ISSUED: 08/02/85. AI:;:'I:;'L.. I CAr, IT ADDREEiS: I]ONTAI3'T' F'IqONE: GUST I... I_ARSON 3795 []OVENTRY DRIVE ANCI"4[IFd~GIE, AK 99507 I_EI]iAl.,. DE!~II]F:I I F:': LO'I" IS I ZE: MAX BI!~])ROOMS: SLIBDIViSI[IN~ NA LOT: 100 SE[;T II]N: :1.5 TOWNSI41F': 12N RANGE: 3W 1.25A (SQ,. F"I',, I]F(ACRES) 3 BM]CI:::: NA I..i!~4t{<qd I]{,~],o~J ape the options available to you in designing youP st:0p'lLi(; system. Choose thr2.option that best f:Lts your' site. DEPTH TO I:::'IPE BO'f'TI]M-.(F:'T,,> Zl.,,',:~ 4.0 I;~RAVEL. DEPTH (F'l'.) 0.5 t. 0 TOTAl... DIEF'TH iF'T,, > 5. () 5,, 0 I31:IAVIEI_ WIDTH (FT.) 15,,0 5.0 GRAVEL,, I_.E]qGTH (F'T.) 30.0 53.() EIRAVEL. VCILUMIE (CLI. YDS.) 16,,7 ~4. ~1 'TANI< S I ZE (13A[..S) i ~, ()00.0 '~'~ :1., ()00.0 '~"~ EiCI3:I.. RAT'IN[~ (SI;I. FT,, /BR) ;I.()0 ;LO0 ~{-.1~ 'f'ANI< MI]ST HAVE A'T L,,EAST "FWO {]{]IIF'AF/TMENT,C3 ]~ cePtify that: :1,, I am t'am:Lliar' wi'Lb the i"~¢qLtiPelfler]'L¢;i fop on'-"Sit~:~ sewer!~ ancl t'oP'Lh I::)y the Munic:il:~a].:i. ty of Anchonage (MOA) and the S'[.at.e 2. I will inst. a].l the system in acc:c)}-danc6=~ wi'Lb all MOA codes ~ll'IC,J iFI C;Omp].i¢iriE6! ~i'(.J'l t, he (:J(o~iil,~f'l C:l-i~'.~2pia c3f th;L~ I:)epmi'L. 3,. I w;J. ll adhepe to ali. M[IA arid State of ~]aska I'I.BqUiP6ilII[~I~'LE~ wells as; set and Pegulat ions, l'oP the !~ie'[. {;;)ac:l.:: distances Fr, om any e~li.~!itir3g well, wasi.¢water' disposal system of public ]', I.lr](]Ji~)J'~[c/~.d3J"Jd '[,hd3'[. t.h:J, liS pl:~Pllii'{; ;lis Vd'~].:J.d ~IDI' d~ maximum of 3 Jl3(i)f;:Jl"lz)(::)rfl~3 ¢'ind ]:1:':' A t...IFT STATION IS ];blS'I"AI,..L.ED ]:lq AN AREA COVERED BY MOA BI]II.~,DING [;ODES, THr!ilq (1) AN I]g.Jg.:CTRICAL. I='ERMIT AND INSPIE[FrION MUf.3T BE [IBTAINED; C..~) A,S-BUIL'I"S WII.I, NI]T BE AI::'F'ROVED WITIqOLJT AN EI..E[YI'RICAL iIqSF'E[:TI[IIq REPOR'T; AND (3) THE EI...EC'I'I~ICAI.. WORK MUST BE DONE ~Y A [..ICEIqSED [ELIECTR ICIAN. APPI,.ICAIxI'f':: GUST L I.~ARSOIq Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: (ENGINE6 q'S SEAL) DATE PERFORMED: 3 4 ..~-.,,-~=,,,.,. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: SLOPE SITE PLAN WASGRO~D ~A~E~ ~/t 0 ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? p E Depth to Water Altar Monitoring? Dele: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (mmule$,mchl PERC HOLE DIAMETER TES~ RUN BETWEEN __ FTAND __ FT COM.~.,~ _.~; I-G,. t -I~ .s .4 ,-.../~,~ ~ ~',~-,~' /,, .~,7,~,,, v '~ ? ,-47J C~ / Municipality of AnchoraGe Development Services Department 9uilding Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEHS FOR APPROVAL A SINGLE FAHILY DWELLING Parcel I.D. 015-481-15 1. GENERAL INFORMATION cos^# Expiration Date: Ii Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address T12N, RSW, SECTION 15; LOT 100A 44-11 E. 102ND AVENUE * ANCHORAGE, AK * 99507 SUSAN MERRITT Day phone 850-7016 4411 E. 102ND AVENUE * ANCHORAGE~ AK * 99507 Day phone Day phone Unlesso~erwiSerequeste~ COSA willbeheldbyDSD ~rpick~. NUMBER'OFBEDROOMS: 5 3. TYPE OFWATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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. STATEMENT OF ~NSPECT]ON BY ENG!NEER As certified by my seal affixed hereto and as of the validation o~L~ showu u~/ow, I v~n,y ,~, ,(¢ investigation, based on procedures outlined in the Certificate of Qn-Site Systems Approval Guidelines for this appiication, shows that the on-site water supply and/or wastewater disposal s~tem is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein· I furt,ffer verify that based on the #/on-nation obtained from t,~e Municips;ity of Anchorsge Nos and from ,my investigation and ?,spection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all appficable 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 dEFFREY A. GARNESS, P,E. Date ~ // Engineer's 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 & 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 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 dhow 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 it confer any legal right w,~atsoever. DSD SIGNATURE ~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (/¢ - / 7 ~--// Municipality of Anchorage Development Services Department Legal Description: WELL DATA Well type PRIVATE Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST T12N, R3W, SECTION 15; LOT I OOA Parcel ID: *ASSUMED BASED UPON SURROUNDING WELL. LOGS. SEE A'I-rACHED. If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed 11/li/1985 Total depth 220 ft. Sanitary seal (Y/N)YES Cased to *40+ .ft. FROM WELL LOG 1 / / 985 180 .ff. g.p.m. Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 5/4./2011 137 ft. 3.2+ g.p.m. Nitrate ND mg./L. Collected by: Date of sample: 5/4/2011 2 SEPTIC/STEEL Number of Compartments 015-481-1,3 Date installed 6/6-10/2011 Cleanouts (Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A Pumper. - I'BELOW FINAL GRADE TO TOP OF SANDI Soil rating ~r ft2/bdrm) 0.7 System type Length 45 ft. Width 15 .ft. Gravel below pipe .ft. Total depth *5.7-6.5 ft: Eft. absorption area 675 ft2 Monitoring tube YES NO Date of adequacy test NEW Results (Pass/Fail) - For - bedrooms Fluid depth in absorption field before test - in. Wate~ added - gal. New depth - in. Elapsed Time: - min. Final fluid depth - in. - g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) - NOTE: OLD DRAINFIELD WAS CONNECTED AS RESERVE SITE. Foundation cleanout (Y/N) YES Date of pumping NEW ABSORPTION FIELDi DATA Date installed 6/6-10/2011 BED 0.59 Depression over field~ Absorption rate >= - If yes, give date SEE MOA DOCUMENTATION. Date of test Static water level Well production 10 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1250 gal. GEG, Ltd. YES 12+ in. YES D= LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access (Y..~.~ _ "Pump off" level__~. High water alarm level at in. Bantam f E. SEPARATION DISTANCES Cycles tested, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ 100'+ Meets alarm & circuit requirements? On adjacent lots. 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout, N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main :N/A Water service line 10'+ Wells on adjacent lots 100'+ Absorption field 5'+ Surface water. 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundation. 10'+ Water main N/A Surface water 100'+ Driveway, parking/vehicle storage Wells on adjacent lots 100'+ 10'+ F. 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. Engineer's Printed Name JEFFREY A. GARNESS Date Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number FOUND ALUM, MONUMENT N 89 56' 54" E 164.81 FOUND NO. 5 REBAR ¥9'/FIJ',5 TlC CAP o oo . °o o oO BARN 30.1 75.3 20' TELE. & ELECTRIC FASEMENT ASP~LT FRAME HOUSE 32.1 N 89 57' 57" E 164.98 WELL FOUND NO. 5 REBAR LOCATION TAKEN FROM DATA ON PL~T 98-74, NOT VERIFIED THiS SURVEY FOUND NO. 5 REP, AR EAST 102ND AVENUE THE 'rNFORMAT~ON HEREON Z5 FOR THE USE OF LENDZ~I$ 'rNS'I'ZTU'~ON5 SPECIFICALLY TO SHOW ANY CONFITCTS BET'WEEN EXZST'r~ STRUCTURES AND PLATTED LOT ITNES AND/OR EASEMENTS; AND 'rS NOT TO BE USED FOR POS~'I"~ON~N~ ADDITIONAL STRUCTURES,'rMPROVEMENTS, OR FENCELZNES. EASEMENTS OF: RECORD, OTHER THAN THOSE APPEARTNG ON THE I~ECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELTNES THAT MAY APPEAR ON THIS DRAW~ENG ARE NOT TO BE USED TO DETERMNE PROPERTY LTNES OR POS*~T.[ON AbD'rT':ONAL IMPROVEMENTS, ANY PAV'.EN~ SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESS/VE SNOW AND/OR 'rCE. AS-BUILT SURVEY 1" = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT Z HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY BLM LOT 100A, SECTION 15, T12N, R3W, S.M. (PLAT 98-74) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _10TH DAY OF _DUNE ., 2011. HOLT LAND SURVEYINg, 600 I.E.6HV'[EW bP-~VE [ 11574, FB 145-72,146-27 ] ANCHORAGE,AK 99515 345-5513 SGS ReL# 1111698001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 05/13/2011 8:13 Project Name/# WATER SAMPLE Collected Date/Time 05/04/2011 13:10 Client Sample ID T12N, R3W, SEC 15, L100,~, Received Date/Time 05/04/2011 16:40 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/05/11 05/09/11 NRB Waters Department TotalNitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 05/05/11 AYC Microbiology Laboratory E. Coli Negative I 100mL SM20 9223B A 05/04/11 SDP Total Coliform Negative 1 100mL SM20 9223B A 05/04/11 SDP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchoraoe, Alaska 99519-6650 343-4744 Parcel I.D. # ~/,~'- CERTIFICATI-' OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWFLLING q~/ ~ ~ ~ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ~"~//I[~ I 0 I Property owner U)z~u~ ~ ~ m¢~e-.~'" Mailing address Lending agency Mailing address Agent Day phone Address Day phone.~'~---?/¢'~ _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community 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 WASTEWATI-'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-O25(Rev, 1/91) Fronl MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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, t 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. Address 0 '5 ~ /~-tL~ /~ ~P ~ Engineer's signature f~HHS SIGNATURE ,~ Approved for Disapproved. Conditional approval for bedrooms. C152225 J ~'¢~ bedroorns, with the following stipulations: Additional Comments · Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Healtll Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independeh; 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. I=-mployees 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. Municipality of Anchorage Department of Health and Human Services HEAl. TH AUTHORITY APPROVAl. CHECKLIST Legal Description: A, Well Data Well type Log present (Y/N) Total depth r"~ ~ Cased to seal (Y/N) Sanitary FROM WELL LOG II,I. Date of test Static water level Well flow Pump level1 ~.. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '~ I I O Absorption field on lot Public sewer main Sewer service line If A, B, or C, attach ADEC letter. ADEC water system number Date completed It Il/~'* Driller '~..~ ,.¢ ~ Casing height Wires properly protected (Y/N) g.p.m AT INSPECTION '7 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate _ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed It.) , ,~o , ':~ _6 Tanksize Cleanouts (Y/N) ~ I Foundation cleanout (Y/N) High water alarm (Y/N) ~'~ ~',,~ Alarm tested (Y/N) Date of pumping '7/,~7/qr~ Pumper Other bacteria L,~9~partments Depression (Y/N) A SEPARATION DISTANCES FROM SE-'PTIC/HOLDING TANK TO: Well(s) on lot ~ To property line _ Surface water/drainage On adjacent lots '~ / lid Absorption field j 0 Foundation ~' Water main/service line 72-026(3/93). Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed L 0 /,;;L '1, / ~ ~' Length L'~, O Total absorption area Date of adequaoy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) I ¢J-~ System type ~ J-~ I'~ Width I ~ Gravel thickness ~ ~/ Total depth L~ ~- /'//~^ C) Cleanout present (Y/N) "/' Depression over field (Y/N) ~'/ "~/,* D / ~/~ Results(pass/fail) / ~ for ~ Bedrooms ~ After test I ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~> ! Surface water ~ /0'-' Curtain drain ~'/ On adjacent lots ~ //O Property line To existing or abandoned system on lot Cutbank N ¢ /,¢ f~, Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff¢~t On-the,date of this inspection Engineers Name Date ~-~ HAA Fee $ ~/ ~L~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAl.- PROTECTION DIVISION OF ENV{RONMEN'rAL HEALTH CERTIFICATE OF INSPECTION FOR HEAL-FH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER I:ACILITY 264-4720 Applicatioa Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ¢,/? (b) Applicant Name ~¢'~ ,~~'A''/ Telephone: Home ~¢¢ ~'~¢¢~' Business Applicant Address ~ ~¢,-5'/ ~,¢j/,E-"~/'.r'~$/ ,~,~. /'¢-AJ~.rhh/./___/~. ~'¢.';'~ 7 (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer ["]; Other E] (explain); ~__ Lending Institution ~O-~ ~-~r:'-J'-'-t--~,~-- ~L~cck~'-r3'~C~(Telep ~one (d) (~(_~r~( C¢V~ l~- Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to Ihe iollowing address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms "":'? Other WATER SUPPLY Individual Well~ Community [] Public [] Note: I1 community well system, must have written confirmation from the State Department of Environmental Conservation attesting to tire legality and status. 4. SEWAGE DISPOSAl. Onsite~ Public [] Community [3 Holding Tank Note: Il community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authorily Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State cedes, ordinances, and regulations in effecl on the date of this inspection. Name of Firm Address i~¢.~ ~t ].~t~~ ~/tt'T¢ ~ ~, I~ ~.~ DHEP APPROV~[~..~. ' ~-..,...,:,k/~/ ! /' // Approv~dfor ~-~O-"nedrooms by~~.~--'~i ~Date--~i¢' Approved __ ~ Disapproved . Condit'onal ~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and EnvironmeDtal Protection ([)HEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph Ii above by an indepandent professional engiDeer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is rrol ~esponsil Ior errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA Well Classification Well Log Present~) Total Depth _ Statio Water Level .......... MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF~~ORITY APHHU A ~ ~ E~IRDNMENTAL PRO~E~IST - FEBRUARY 1984 264-4720 MAY 5 1986 Legal Description: ~'~ RECEIVED '~"~/¢//¢"~'~" If A, B, C, D.E.C. Approved (Y/N) __ Date Completed //~ / ' ~''5¢'' Yield Cased to ~Z~Z~/ Depth of Grouting ~ .W// ./~'~ / Pump Set At Casing Height Above Ground Electrical Wiring in Conduit(~N) Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on Casing (~'~N) Depression Around Wellhead (YN~. ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /'~O · ___ ; On Adjoining Lots To Nearest Public Sewer Line .W//,/~_ To Nearest Public Sewer Cleanout/Manbole z~/_~/ __ To Nearest Sewer Service Lin~ on. Lot Water Semple Collected by ,~'~'~' /~', Z'/~')/~c'/v/ ; Date Water Sample Test Results ¢-~',/~/ Comments B. SEPTIC/HOLDING TANK DATA Date Installed /¢ "~'¢~¢,~_ Size /~".~g ~2',~¢¢. No. of Compartments Standpipes~')N) ___ __ Air-tight Caps~)N) Foundation Cleanout~N) Depression over Tank (Y~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~.,~/,g ;for Holding Tank High-Water Alarm (Y/N) _~. Temporary Holding Tank Permit (Y/N) _ Separation Distances from Septic/Holding Tank: To Water-Supply Well .//~'"' / To Building Foundation ' ''~'~ To Property Line ¢" To Disposal Field To Water Maie/Service Line _ Course Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(H/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ? ~ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Type of System Design Length of Field .~ / Depth of Field .~ · Gravel Bed Thickness ~o ~'' / Standpipes Present Y(~N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~ / Lot ~/~ ' To Water Main/Service Line ,4/b To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or V~hi~le Storage Area Commer~ts' ~2~/.¢~2¢'~/,,~ ~¢ V'//,~'~ TO Property Line To Existing or Abandoned System on ; On Adjoining Lots .~ / ./ To Cutbank (if present) LIFT STATION Wb D~ 2~/'/ Dimensions Size in ?,,1,o7 -- %~Manhole/Access (Y/N) "Pump On Level at _ ~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ~ycles during Adequacy Test. Meets MOA EcI;Cmt rimCtl t~ o d es (Y/N) ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hay~e/¢hec~l~ed, veCt!.ed, or conformed to all MOA and HAA guidelines in Signed ~--(" f /L.~/ Date ~'~ Company ,,~¢'~"~ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-028 (11/84) effect on the date of this inspection. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 12o0 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 56:[-5040 SHEET NO. CALCULATEDSY CHECKED BY_. SCALE OF A, ~1,~/ DATE DATE