Loading...
HomeMy WebLinkAboutHYLEN CREST #3 BLK 4 LT 3JAI .y In n c16 �.3 w 0 o4ii , � o4 " 4w woo) 72-013 (Rev. 9/91) MOA 25 L0 Municipality of Anchorage Page of r DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SIV\)`%<C)C>&C.� PID Number: u4-4-09.7 Name: astewater System: N New ❑ Upgrade Address:Vk i -A I .�.�r �.:�it I -f 11:17 r-_"": +GL� r�,v�i� � ���1 ABSORPTION FIELD Phone: No. of Bedrooms: tqDeep Trench ❑ Shallow Trench ❑ 6ed ❑ Mound ❑ Other 1 LEGAL DESCRIPTION Sail Rating: /, SPD/S.Ft. TotaD�epthfromorigi�(grade: Lot: Block: Subdivision: �- y, �{ (ti/3 'V�i �� ( Pte. T Depth to pip@ bottom from original grade: r% G. I (%kms F,-Stt Gravel depth beneath pipe S Ft. Township: u Range: Section: I Fill added above original grade: Z. L Gravel length: / t� 11� ,_?,4-(V- FL L Ft. WELL: 11 New ❑ Upgrade Gravel width: -� 3,61 Numberoflines: Distance ibetween lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: N !i FL FL _2 SD. Ft. AbTl'I D7 SO.3q -- L. 0WrIC Driller: Date Drilled: Sialic Water Level: Installer:Date installl�ledd��, / FL _CL',�% / 9S Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES (Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Ah) ' fzACLE •TALQ "Z ()- C Well ----- .— ,_ 6i Material: Number of Compartments: Surface -- -- A LIFT STATION Water Water Lot `! i / Size in gallons: Manufacturer: Line L7 NN.NNA I_ Foundation 1 1 ,A ,_ "Pump on" level at: "Pump off' level at: High water alarm at: Curtain _ Pump Make & Model Electrical Inspections performed by: Drain m r Remarks: LOT zseev'E-L,> &I 6!om/1uNlTy BENCH MARK (iJ A-.7LIe_• Location and Description: D(_�O(Z- -SAM 6ACY k>r)vP_ 1 E4 �I-WnUc CNvs. !" C(6 MS V-ING ON 8)�I9S 10 �< (Celt -C a 1 I)t[_ �( cP7H % S S7EAA IS 8 ' 1?EWW Assumed Elevation: '/ 6ffLA-/J� TF_ s7 //cj z Lc A-7/wv - f cmc. ,rnt<, A �i r lle47ieaL ENGINEWS'SEAL, u tP14aA-7f0 Gf2aAJ10 wA-Z6e, I Inspections performed by: LfLTI', KW6, Dates: 1st Z& 2nd '565-19S" rvices approval Department of Healt a�� d 7m� Reviewed % and approved by, Date: 72-013 (Rev. 9/91) MOA 25 L0 Permit No. 6vJ W QQ6,4� Page _ Z of q Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: t-0-1 a tl'i1_-r-M (II?f;e;i PID No.: QL5C)`F 1 ill _7 Elevations: Back Door Jaln 100.00 Septic Tank Inlet 94.63 11 ISeptic Tank Outlet 94.30 '� ^^ Foundation Cleanout 95.86 .............. x).G (1.t:; :..;.;.......1 .........:..... �l.......;..................................................... ........................... Perforated Pipe West End 93.57 Perforated Pipe Central 93.51 Perforated Pipe East End 93.55 Bottom of Monitoring Tube (West) 87.40 Bottom of Monitoring Tube (East) 87.57 Ground Elevations: Over Tank 97.65 West End of Leach Field 99.80 East End of Leach Field 96.17 i E_ .... _ n ......... e ....................... ...................................... :............ ....... t ...................................................... ................... .- ............. .- .... _.................. From: To A: To B: To C: To D: West Cleanout 44.1 18.8 West Monitor Tube 46.5 19.4 Central Monitor Tube 27.3 47.9 "' Central Cleanout WestNGI �'Stil�L Central Cleanout East 33.1 40.9 34.9 39.2 � Tank Cleanout 1 29.2 36.3 Tank Cleanout 2 28.5 37.6 Tank Compartment 1 44.3 21.1 J Tank Compartment 2 30.6 34.8 East Cleanout...... . ....... . ... ... . ..... .. ...... . ..... 30.7 54.7 �D on n. rn�nnnuoonnoo oru�r c� East Monitor Tube 30.8 55.7 King A = NW Comer of House B = SW Corner of House C = SE Corner of House D = NE Corner of House 72-013 A (1/93) - Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 825 "L" Street, Room 502 Anchorage, AK 99519-6650 Re: Construction Report for Lot 3 Block 4 Hylen Crest Subdivision, Unit #3 Dear Sir: Attached is a final construction drawing for the above referenced property. Three construction inspections were performed during the construction of this system. In addition, 3 more site visits were conducted to observe progress and collect measurements. The first inspection was performed the evening of May 2, 1995. During this inspection, I verified the length and depth of the trench, plus all offsets from the building and lot lines. The contractor pointed out that the municipal specifications call for a 5 foot offset from the tank to foundation and tank to trench. During this visit, I changed the construction specification to allow the contractor to move the tank closer to the foundation. The tank was placed 5 feet from the foundation rather than the 10 feet specified in the approved design. The second inspection was performed the evening of May 5, 1995. During this inspection, I verified that the piping was installed level, that monitoring tubes were installed, filter fabric was in place, and that the amount of sewer rock under the perforated pipe was five and on -half feet as specified. The depth of sewer rock was found to be from 5.6 to 5.7 feet. Elevations of the various points on the system were measured and the measurements are included on the attached figure. During this site visit, the contractor requested that the construction specifications be modified to allow less than 3 feet of cover on the western end of the leach field. I made a second field change to the construction specifications and allowed the contractor to place 2" of insulation over the western most 26 feet of trench. The third inspection was performed on May 7, 1995 to verify that the contractor had installed the insulation as specified. A followup visit on 28 May confirmed that 2 feet of soil had been placed over the insulation. The Installation of this system varied from the approved system in that: - The septic tank was placed 5 feet from the house foundation. - The western 26 feet of the trench was covered with 2" of insulation and T of soil rather than 3 feet of soil. If you have any questions, or need additional information, please give me a call at 753- 5520 (wk) or 688-1505 (hm). Sincerely,, vv' /E. �is O0000e o�6opcao 000/c'pcoc cu ov �o o0a vv uoo�ro vvv� vow ,� oo CuYlts A. Wn CE -8691 �� 0 1IN PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE o cn DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 -Q AS _..--°- ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950066 DATE ISSUED: 4/28/95 DESIGN ENGINEER:'�T�"�vrs ­ti^v�NY LA j�°ks�l u� EXPIRATION DATE: 4/28/96 OWNER NAME:EAGLE RIVER VALLEY DEV OWNER ADDRESS:P.O. BOX 141907 ANCHORAGE, ALASKA 99514 PARCEL ID:05047417 LEGAL DESCRIPTION: HYLEN CREST UNIT #3 BLK 4 LT 3 LOT SIZE: 20070 (SQ. FT.) NUMBER OF BEDROOMS: 6 THIS PERMIT: 6 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY 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: RECEIVED ISSUED BY: BY: ��✓ ' DATE: DATE: ,�-- /-9.s- 7.'¢a a.,,. (' k 17'/s /<lk�C/�1LLF_/% 4Atil s,1 IP o� s�tir��y ���. 30 7;;-(,,c- 1104 ;;-(�1104 AE 12- )t�T. L(F_ S�7r/] H TiYouG/*r /$ 601A16 i0 WE CO'.vS7n k cT rrfF 6eOun,12 wry. (S /2 5 — — 9S C urrr�p rn-/o lee [vGLcL/% NF_w DeS/GN Yo rkiJ OFFICE 7WOA16 /,v ,-o .4 «outi 7. ruF w 147-P- n rr�P4E May 3, 1995 Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, AIC 99519-6650 Attn: Mr. Dan Roth REC i V N MAY 519951 Municipality of Anchorage Dept. Health & Human Services Re: Lot 3, Block 4, Hylen Crest Subdivision Wastewater Disposal System Design Change. Dear Sir: Attached is a modified design for the above referenced wastewater disposal system. This design change is the result of unexpected site conditions. In the original design, a trench 13.5 feet deep and 51 feet long, was designed based on a the soils log of a 19' test pit with no groundwater. The groundwater elevation was checked last week and found to be at an elevation of 12 feet below grade. This finding effected these modifications to the approved design. If you have any questions or comments about this modified system, please contact me at 753-5520. Sin erely, / Curtis King �1 no J 1 � 21"11 .(CR v <� i,o'e) On 0 on/o�/ 07,nnnn o m� Orion ptlpow000000n��nnnn:�u-"�' V j o CUrflo A. King Revised Design for Lot 3, Block 4, Hylen Crest Subdivision Wastewater Disposal System. A site visit was conducted at 11:30 am on April 28th and a second site visit was conducted on April 30th at 5:OOpm to verify the findings of the initial visit. During each of these visits, the depth to groundwater was measured and found to be 12 feet below grade. The groundwater level had neither risen nor fallen during the 50+ hours between monitoring. As a result of these findings, the wastewater system is modified as follows: Total depth to water 12 feet. Usable depth of trench = 8 feet. To minimize trench length, the depth of cover over the sewer rock will be reduced to T with one inch of insulation placed over the filter fabric. This one inch insulation layer may be replaced by an additional foot of soil placed over existing grade. Using the perc rate for zone #1, (see original application), of 8 minutes per inch, translates into an applicaltion rate of .8 gpd/sq ft (table 7.2 of the EPA Design Manual for Onsite Wastwater Disposal Systems). The required square footage per bedroom is (150gpd/bedroom)/(.8 gpd/sq ft) or 187.5 sq ft/ bedroom. Plugging into the Municipality's Deep Trench Design Equation: L = (187.5 sq ft/bedroom)X(6 bedrooms)/((2)X(5.5)) = 102.3' The trench will be 103 feet long. The effluent from the septic tank is to enter the middle of the trench such that approximately 50 feet of perforated pipe extends to either side. (see Section view) The new layout of the trench is shown in the plan view. 4 cleanout pipes are to be install, one at each end of the run. Monitoring tubes are to be installed at each end of the trench. RECEIVED MAY 51995 De;at Healthy& Human Serof vices �> n 1 rZ'1 n1 � GGG/ G. C , l� yyIl............J RECEIVED MAY 51995 Mu{7icipality of Anchorage Dept, Health & Human Services s ,J I I l I I I I I I I 1 V : I - w V5 \n P z 2 0 \ J M U l— April 2, 1995 Municipality of Anchorage Department of Health and Human Services Environmental Services Division P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 3 Block 4 Hylen Crest Subdivision wastewater disposal system permit application. Dear Sir: Enclosed please find the following: - Sewer Permit Application - Application Fee - Site Plan - System Detail - Construction Specifications - Perc Test If you have any questions or comments about this application, please contact me at 753- 5520 (wk) or 688-1505 (msg). I will be out of town till April 26th. Please leave a message for me at my work number as I will be checking in daily while I am out of town. Sincerely, Curtis King, P.E. O f Jou° �O nOJ` n yc�rCIO///'con is n'�'o goOvo oO m�n9pa<uGoo. 4, oc Curils A, Kind � �A goo CF -8597 L Lot 3, Block 4 Hylen Crest Subdivision, Unit #3 A narrative description of the probable impacts to properties adjacent to lot 3, block 4 Hylen Crest Subdivision, Unit #3 is provided below: General Hylen Crest Subdivision is located approximately 3 miles up Eagle River Valley. The subdivision is located in the foothills of the Chugach Mountains on the north side of Eagle River road. A soils investigation was performed in the summer of 1979 by Alaska Testlab. In general, the soils investigation found that the area was "generally suitable for onsite wastewater disposal." A total of 18 test pits were dug in the Hylen Crest Subdivision. The investigation found that the soils were generally sands and gravels with trace to small amounts of silt. In June of 1982, the Municipality of Anchorage rated the soils in this area at 125150 square feet per bedroom. Water Wells There are no water wells within 200' of the proposed septic system. The subdivision is served by public water and a service line from Stewart Drive will supply water for this lot. Wastewater Systems There are 3 septic systems within 200' of the proposed septic system. Snow levels were such that only the riser pipes from one system were visible during the site visit. Another site visit will be conducted once the snow has melted to verify that sufficient room exists on the lot for a primary and secondary septic field. Reserve Space The porposed wastewater disposal system will be located such htat the alternate disposal site for this lot and the alternate disposal sites for adjacent lots will not be compromised. A site visit will be conducted in late April after the snow has had a chance to melt. The purpose of this visit will be to ground truth the location of adjacent septic systems and establish that sufficient reserve space exists. 1� OF 144 0p Op 00000°Opp0 47 .°°° 0 00 ri opo ! 6yi . �0% 0 0 JI , a xt 0 OoeO OcpOuo acpppp00 °0000ro �J L/ 0 0 DO OOOoO0asi.o o0o °o°=a wr o° 0 e curflaA.King ,� Drainage: The northern half of this lot is moderately steep with an elevation loss of up to 26 feet over 70 feet. The lower half of this lot is much flatter with an elevation change of 10 - 12 feet over the remaining 70 feet. The Drainage is from Stewart Drive on the north of the lot to the southwest corner of the lot. The majority of the rainwater and meltwater should enter the groundwater with little or no surface runoff due to the good percolation rates of the soil. The proposed wastewater disposal system should not impact, nor be impacted by the site drainage. �y g'V OOq0OU 0000 000 0000o, ll CC. °gV0°C a°°eee o°e°o®, O JJJJ Q: t Cur* A. KinO �°[oq C'aIIb9l (�J 0000 °°y` y�G7 > n E- ^ 1,750._c�,ftuo�J C%PAGITI� 7 WD Cor-%pk2TmrLt F, Segvc- T4n1K. rtIf)k Ur- Sg-TBaaCA�--;F2Ai`1 Fo�auFtTion1 50'P,L 'SIL PIPE 'IMMCb,k`rr✓L.4 1--)? EeYJ�n)G, I 6EF- IL -FA t-) . CLEANOL/T PjPj^S,S: CLCAt,)QVT PIPr�' T'O BC-rc) FOOT r-2ot1 Four')DRkmoN. O W I cL.6RNcw7 PIPIE�- Tb .?-E 00STAL.O.D Off" (z-.Ac-IA- CLii PAaTM C 1JT o f-- _ Ti-f� SC.P7ic. l`ANK. ' 2 _CLOA0001 PIPa,s TD gp'_ 1 &iSTJLL -cD 1 - 4I (=[sYIDT f �T 7- to SF PTI' TR tJ14, L721e`n��k.� 1 �' aPPoslTr�- Di2,r<GTror.�s; a F I` Z 6-'L-E-4NUuT PIPks) ONTE- PiPI£_ TD& rNsr�+w�� A tf}ctt �rv� of PIPE . : -i m /'85o2PT7oJ Pirr--D: - E u r rn z -n P m PERFORMED FOR: a> AN kk — - -`��- ' \t�'1r,0 Municipality of Anchorage y DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L." Street, Anchorage, Alaska 99502-0650 OILS LOO -- PERCOLATION TEST Q- HENRY li. VYILSON1732-E .4 Q' \ w °�'�.'p�_-rte �� �+-�✓ c�:F1%.li; �AL.G1•AJL''�L`.�C"fiYAE%hJ�' DATE PERFORf . n?`o!•'S�S�ry LEGAL DESCRIPTION: L--•�_Q� DEPTH 1 (FEET) -�'j I lJ �tih 2 3 4 5 6 7 8 9 10 11 12 13 14 '15 16 17 18 19 20 1 len C�_s-)- PF�gO3 'F&R:f4i 'rownship, Range, Section: '5 0 %A ss 2g -I-14 p QI �— SLOPE — SITE PLAN WAS GROUND WATER ENCOUNTERED? If: YES, AT WHAT DEPTH? ° -------�._-... P — – L I Depth to Water After f,1aniloring7 gale: Reading Date Gross Time Net Time Depth to Water Net Drop •7 IC.. Y.1r 1Tv'- 'r i�y�[^9'� ZtC�1�_e.-–�._- LCA WAS GROUND WATER ENCOUNTERED? If: YES, AT WHAT DEPTH? ° -------�._-... P — – L I Depth to Water After f,1aniloring7 gale: Reading Date Gross Time Net Time Depth to Water Net Drop •7 IC.. Y.1r 1Tv'- 'r i�y�[^9'� ZtC�1�_e.-–�._- 1 PERCOLATION RATE TEST RUN BETWEEN Vfv"? iL-:f7c 1:.yJ (rmnulesnnch) PEHC HOLE DIAMETER FT AND __._.—__ FT COMMENTS PERFORMED BY: _.. r \5�Y 1 t S._ �T9) tj�E __ I � C rte_ � —N. CERTIFY THAT THIS TEST WAS PERFORMf=n IN ACCORDANGE WITH ALL STATE AND MUNICIPAL. GUIDELINES IN EFFECT ON I 141 DATE. DATE: 72-008 (Rov, 4185) _ Municipality of Anchorage � a, DEPARTMENT OF HEALTH & HUMAN SERVICES z 14, -,.825 "L" Street, Anchorage, Alaska 99502-0650 JS' " SOILS LOG ® PERCOLATION TEST ur•,NRY N. wlLsoN I —LL• - PERFORMED FOR: vALlXy —DATE PERFORA LEGAL DESCRIPTI -6-- (F E UT E(FEET) 1 2 I 3 4 5 6 I 7 I 8 I 9 10- i 11 - 12 i 13 14 15 16 17 18- 19 3 6 4 Ik-i�n (tea Township, Range, Section: SLOPE WAS GROUND WA"rER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh to Ylaler Alter trlanilorinp? -- SITE PLAN S L_— O E Bale:a— Reading Date Gross Time. 'Ne`T 03 Time Depth f Water ##L2 jet*,3 �rop_ — Ifs r�dz- '0 • u %'q/sPERCOLATION HAr(J; �. � _Xv(minutesnnch) PERC HOLE DIAMETER �. TEST RUN BEI WEEN c' L> U— FT AND � __—e. F -I COMMENTS V�. �Zl1i 1"7- 1r3 C�Iv��t PERFORMED BY. ?->r,f''S"YV«-r"t.__�_.� h ) � _ � ;:a1.` -R1-` �-�.:__.-._._..._._ CERT IFY THAT THISS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE. AND MUNICIPAL_ GUIDELINES IN EFFECT ON THIS DATE. DATE: .._.__--.- 72-ODS (Rov. 4/85) Parcel I.D. 050-474-17 W N Municipality ®f Anchorage <On -Site Water and Wastewater Program o S'16 (907) 343-7904 s . F E „ Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: g— I g, 12 Complete legal description Hylen Crest ##3, Block 4, Lot 3 Location (Site address) 10223 Stewart Drive Eagle River, AK 99577 Current Property owner(s) Bruce & Nancy Steely Day phone 947-3443 Mailing address Real Estate Agent 10223 Stewart Drive Eagle River, AK 99577 2. TYPE OF DWELLING: Fx1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: SIX Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver/Variance request for: Received by: Date: 5_11 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ e Waiver Fee $ Date of Payment f L Date of Payment Receipt Number e b Receipt Number COSA# bel (0 11`�62- 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date4/27_/20116 6. DSD SIGNATURE System #1 Approved for & bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, OF° 47`® aIVVCHAEt$= ,ANDERSON CE -4381 4®® � °ROFESSIO W ®® ®9m®®mom®® with the following stipulations: gy Original Certificate Date: 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 far errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheel5 :- .. c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Hylen Crest #3, Block 4, Lot 3 Parcel ID: 050-474-17 A. WELL DATA Well type AWWU Date completed _ Total depth ft. Date of test Static water level Well production If A, B, or C provide PWS ID # Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. ft. g.p.m. g.p.m. mg/L Collected by: Tank Type/Material Septic/Steel Date installed 5/2/95 Tank size 2,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 4/21/2016 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 5/7/95 Soil rating (g.p.d./flz orfe/bdrm) •8 GPD/SF System type Deep Trench Length 103 ft. Width 3.7 ft. Gravel below pipe 5.5 ft. Total depth 8 ft. Eff. absorption area 1,133ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/18/16 Results (Pass/Fail) PBSS For 6 bedrooms Fluid depth in absorption field before test 0 in. Water added 900 gal. New depth 3 in. Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 900 g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOTTO: NO Well on Lot. AWWU Water Service Septic tank/lift station on lot Absorption field on lot_ Public sewer main Sewer /septic service line _ Animal containment areas On adjacent lots On adjacent lots Public sewer manholelcleanout Holding tank Manure/animal excrete storage areas SEPTICIHOLDING TANK ON LOT TO: Building foundation >5 Pro erty line >5' Water main > 10' Wells on adjacent lots >100' V Absorption field >51 Water service line >10' Surface water >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10 Water main >10' ' Water Service line >10 Surface water >100' Driveway, parking/vehicle storage >10 None Noted >100' Curtain drain Wells on adjacent lots 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. Engineers Printed Name Michael E. Anderson, P.E. Date 4/27/2016 COSA brown sheet 10-10-12.doc in. VO *.MICHAEL E. ANDERSON !i'• CE -4381 ,,IJP\ ESSV�4'a STEk/ART ORfV� � M 0 N78•�9D 1 ^x/,09 R,=3oD400 N89'45'E .l09.00 ` /4 - - N . d ne�/�JI �Y M VA `2• �A { r V 32.G S�Pr ASBUILT-NO CORNER -S SET T1.1- DATE. • SE4IARD & HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE.. 'OLLOWING DESCRIBED PROPERTY"= 30 /YlEnY•GRESTSUBd,, UNiTNp, 3j 4-07- G.C,¢- ,ND THAT NO ENCROACHMENTS EXIST EXCEPT M NDICATED. DATEc 8//9�95 IT IS THE RESPONSIBILITY. OF THE WNER TO DETERMINE THE EXISTENCE OF .ANY GRID, .' ASEMENTS, COVENANTS, OR RESTRICTIONS 'HIGH, DO NOT APPEAR ON THE RECORDED SUBDI- /v4/ 5-7 ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB. ' NY DATA HEREON BE USED FOR CONSTRUCTION F FENCE LINES, OR FOR ESTABLISHING BOUND- RY LINES. DRAWNa- n me V `'' C S:LAND SURVEYING:, -65 .6sanp ~' 4F A(°ot F Fi•,......•q � ./49T—H ;91 WALTER F. ARRZ; 'p •. LS -6943 few-•........ ' seAF4 rtap1�✓a, I'd ZIIL-h69-L06 11891!EJueniS dLb:S09I fj'?K'-A '.MQ, MUNICIPALITY 0FANCHORAGE -Z t'x 1b �W DEPARTMENT OF HEALTH4 HUMAN, -- L7 I SERVICESzji.',� World EhWounnental services­7,4�6. .-Oi V I nbt- J'W I it I OwSRe Services T. 196.650 AnchoragelAlasksm 005f dads "mgm, t 4749 pawl) A7 4 lot 1 CERTIFICATE OF HEALTH AUTHORITY Y10JAPPROVAL FOR A SINGLE FAMILY DWELLING ............. A ss... ................................ lmon................ w R 4?� �fdescriE�tivn/�9T rim^w n :�WW"A on 71, ��'hori rn gl ir Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 6 Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: G.t-)r 3 ?luxeK-- Parcel I.D.: 0L� A. WELL DATA Well type N /A If A. B, or C, attach ADEC letter. Log present (Y/1) Total depth Sanitary seat (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: Date completed Cased to FROM WELL LOG B. SEPTIC/HOLDING TANK DATA Nitrate g.p.nr. ADEC water system number — Casing height (above ground)_ n Wires properly protected (Y/N) cv Collected by: AT INSPECTION Other bacteria 9— p.m- Date installed 51 Z 9S Tank size ;7000%,-,1 Number oAAf 11Compartments Z _ Cleanouts (YIN Foundation cleanout (Y/N) Depression (YIN) IV High water alarm (Y/N) N Date of Pumping NC0 TI}Ni, Pumper C. ABSORPTION FIELD DATA Date installed 4� 17 t 9S Soil rating (g.p.d.H12 or ft'/bdrm) r i) System type DE(%Sp 'iL;)F_4Q("t4 Ib,31t i Length ��-�jWidth 1-4�l a + Gravel thickness below pipe 5" •" Total depth I , Effective absorption area I ) S3? Monitoring Tube present(Y/M "�( Depression over field (Y/1) (Q Date of adequacy test n1E�, Lilts (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): Fluid depth Minutes later: (in.) Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date D. LIIT STATION Date installed Manhole/Access (YM) N/A High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 01A Absorption field on lot N lh Public sewer main 01A Sewer /septic service line O ( A On adjacent lots On adjacent lots "Pump off' level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PI& PiA I t Foundation 1!5 Property line q Absorption field__ wrtTr4- meV,.� APP"K IS' / Abo✓k 6cppc rAN1L Water main/service tine ILLJ Surface water/drainage (Jft Wells on adjacent lots Z)LOPe D4STPFNCC O/A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Wp TK4a APPftX I t 1,C' AUVe Fir",D Building foundation )b Water main/service line %©) SCOPE Di5''CANCE Surface water P 1 N Curtain drain 0 1 N. F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area y 6 Wells on adjacent lots WA R 1 certify that 1 have determined thru field inspections and review of Municipal records that-tlio above -systems are in conformance with MOA HAA gi idelines in effect on this date. ` Signature Engineer's Name t la -as 14. 414-)6� Date r HAA Fee $ Jot) Waiver Fee $ e Date of Payment '(� L� ` ` l Receipt Number —7— Rev. 8/95 OSS: lraa.wk.doc Date of Payment Receipt Number