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HomeMy WebLinkAboutOLSON HEIGHTS BLK 1 LT 1Olson Heights Block 1 Lot 1 #018-231-02 Original field constructed in 1980 should not be tested for future COSAs . Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161268 PID Number: 018-231-02 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name Carl Bassler ABSORPTION FIELD ® Deep Trench ❑Wide Trench ❑Bed [:1 Mound Site Address 13401 Elmore Rd, Anchorage AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 1.2 GPD/SF 12.13-12.46 , Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.48-5.30 Ft, Gravel depth beneath pipe 6.90-7.16 Ft, Subdivision Block Lot Olson Heights 1 1 Fill added above original grade 0.00-1.66 Ft. Gravel length (2) 25 Ft. Township Range Section Gravel width 2 Ft, Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From_ __.._.. __. Tank Field Tank Line 700Ft2 2 24.2 Ft. Well TANK F11 Septic ElS.T.E.P. [I Holding [I Other Manufacturer Anchorage Tank Capacity 1500Gal. 100+ 100+ NA NA 25+ Surface Water INA 1100+ 100+ NA Material Steel Number of compartments 2 Lot Line s+ 10+ NA NA NA FoundationLIFT STATION Manufacturer Capacity Gal. 10+ i 10+ NA NA Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank drainfield D3034 Installer Beek's Contracting Drainfield F810 CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 106.42 ft Inspecti �� 11/11/16 2 nd 6/11/19 Location and description 3`d 4`h Garage man door frame ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ,40o V, >414tit Conditional Approval: Date AV FUS Septic Systeme Approved (litZ6 Date 1 6 00�2 �^ KENNETH to CE 7116 o�F,p�,zl zv Note: this approval does not include well permit requirements.+� tau (Rev: 05/02/18) _i/ co r4r-a &_ D r ° J -2O. v_p UA -1 lh t2 610 (a Qa) + Eflci Q_0, , sect; (, . co' S St cdu 6,_ �D Li- vd C d pix1 o r Cos R Of fr-D V cJ' , n110[1iq AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP161268 ❑LS❑N HTS, LOT 1, BLOCK 1 PID# 018-231-02 0 �r co 00 0 r7 0 0 N W. J_ Q W In uj F— W W V) i M A -D=19.1' C -D=51.2' A -E=21.9' C -E=61.3' A -I=26.9' B -I=45.4' A -J=27.9' B -J=29.9' A -K=29.8' B -K=29.6' A -L=52.5' B -L=64.8' A -M=56.2' B -M=57.3' A -N=56.5' B -N=57.5' GRAVEL 5'I ti CEU2cl D O ncwnr X: UEARMT X: 0 Of L. o_ 0 A yTTANK 00 GAL tiEPTIC Zr o, SCALE- NTS r ' f * _ TH� CE-7AffI 97. ABANDONED TRENCH L M SPUTTER ic DECK II!I \ a , fi II ill FCa II, IIS I, I, I�+ h>>A. TWO-STORY' BUILDING i i; C Nf lw'_ TUBE OJ 7 FINAL GRADE FD_TER FABRIC _ SEWER ROCK 7.87 TRENCH 1 25' TUBE L FINAL GRADE MTM SEWER ROCK TRENCH 2 25' PREPARED FOR: CARL BASSLER 13401 ELM❑RE RD. ANCHORAGE, AK 907-223-1459 FIELD BOOKS COMPUTED: BOUNDARY: N A DRAW : KS❑ STAKING: N A CHECKED: KVID Amu" KGL DATE 1/12/2- DWG. FILE: GRID: 2936 ACRD FlLE FILE " Nm: 16-213 SCALEi 1' = 30' MONITOR TUBE J o� T 7.•-6" MONITOR TUBE Mn d C EAM3uT N ox us�I•�.sn 1 81.00 Bo„ nRrenww _ Cu ®® c ®/� p� g� r?i EL L ROAD Ld J) o m rr- r z o o ; _ (a i r r m m o m LJ D 00 r C rl v� ;Q ccs G7ARM- I i low im ANW N�m ° ' "280.19'(R) -- — "- r "-- . NO0025W 280 19'(R) o ' o ,. r _ °' (� O `- o m CQ c �0 10' X 160' PUBLICUSE ESMT SERAIL N0' 2003-038877 0 :A1� o��W 15 AG & SC UTIL ESMT.—------- -- rn�-- --�— \ o _ _ r" �/� _ 'o`- -------------1-------------------- --------� \ "Cof� 00 ' i I171 F- — —� r z �� __ --- _._. :f Cn [> � –{ GAO A tr= �l C f Ci co d C- m z �' ) CP 6� oo cr s o 133.9> -(� 3 r- >< cD �� 87.7 o p o C;4 W O aj No= I -q c ;� J o cn m w m v O zc� mz / c '' �° zo a� - 8.2'A'ti o r — NCan � i i x ami oa m fT e , c z 1�. �� "�.,� rn DED m `V a ! Cp Q o 03 o m n o -G ; O Lu INS is QCv N O` �o aoil30' o0 (n � N m Z c, \ N00°04'30"W 300.14'(R) m a \ QAC O D oil m i0m co 61 c4 4, o `c1 r cam..z. �. T Cori z C-7 C7 = Cn (ZD z �7 CD OW ���:� y o 0 o c c„ o J� cn r s r -C p O- rr o ° �• �. n o c c O a o m d rn n o oz Cn C!l - � z O °' °• z oma° ?� D rrn m y cfl z i I cn i o y z 9 m 1� - I cn O -U r G7 M n -q CD -0 -o M a J m m p N x co Q m * r- = N m r z - Oo � n z ° °Or Z n _, — N D n z D � -0 m z m a M J .��7 O a �° � c z o z = o xr z m a m ° ° s c n I l tl z rm a ac m z- o M m z m o -a a� m , o m y r 'v m m m � o cn m o �- n n a O *i o z N m n o cn rn A Z d7C= (n tt= a r p G7 rn o v' o Q D .a -p c m cn o r ;;o m m On -Site Wastewater Disposal System Permit Permit Number: OSP161268 Tax Code Number• 01823102000 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 Work Type: Septic Upgrade Permit Effective Dates: October 13, 2016 to October 13, 2017 Design Engineer: ARC TERRA CONSULTING INC Subdivision: OLSON HEIGHTS Site Legal Address: OLSON HEIGHTS BILK 1 LT 1 G:2936 Owner/Address: BASSLER CARL A & CARIN J 13401 ELMORE RD ANCHORAGE AK 995163608 Site Mailing Address: 13401 ELMORE RD, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank All construction must be in accordance with: Lot Size in Sq Ft: 39129 Total Bedrooms: 5 N Privy N Private Well N Water Storage 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. Special Provisions: Original field constructed in 1980 should not be tested for future COSAs. Received Issued By By: Date: Date: �� 13 07010 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 018-231-02 Property owner(s) CARL & CARIN BASSLER Day phone 907-223-1459 Mailing address 13401 ELMORE ROAD, ANCHORAGE, AK 99516 Site address 13401 ELMORE ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) OLSON HEIGHTS BLOCK 1, LOT 1 Legal description (Township, Range & Section) Lot Size 39129 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) In Septic Tank [Xj Upgrade ❑k (w/wo ADU) Duplex (D) ElHolding Tank El. Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Siqnature'*I§'r6perty owner or authorized agent) Permit/Rush Fees: 5 A Date of Payment: 0(ll ot I I (o Receipt Number: on-1,5'rc Permit No. 05f1(/ flu: Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. a �EtCTERRy F S4 aBsn-�N6 September 16, 2016 ARC 1 ERRA CONSULTING, INC 212 E. 51"Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: SEPTIC UPGRADE PERMIT— OLSON HEIGHTS BLOCK 1, LOT 1 The owner has requested we proceed forward to obtain a septic permit to upgrade the septic system from a 4 -bedroom system to a 5 -bedroom system. The existing 4 -bedroom system will be left in place for additional capacity. The general slope of this lot is from south to north at a grade of approximately 2- 5% over the septic area. On September 9, 2016 testholes were performed to investigate soils and groundwater for the primary and reserve fields. The results of these tests are attached for your review. The proposed upgrade will serve the proposed 5 -bedroom single-family residence. We propose to install 2 deep trenches. Groundwater was not encountered at excavation or at monitoring. The property and adjacent lots are served by private water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan Soils Log/Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA Tau FLAG WELL PRI❑R PR❑PERTY L-11VLJ RADII & EASEMENTS TO C❑NSTRUCTI❑N ❑LS❑N HEIGHTS BLOCK 1, LOT 1 NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200. OF PROPOSED WELL EXCEPT AS NOTED. idw, OF A44 141 TH M. 18 � j100 i SUg�. ANTS Scale: 1'= 100' DESIGN DETAILS PAGE 1 OF 2 5 BDRM X 150 GPD = 750 GPD 750 GPD/1.2 GPD PER SQ. FT. (2 MIN/IN.)= 625 SQ. FT (625 / 2 x <7' GRAVEL) = 45 FT. TRENCH USE 2 TRENCH - 25' (L) X 2' (W) X 7' (ED) Total depth of system Is 13' max from original grade. Total depth of gravel below distribution pipe is 7' NOTES: 1. INSTALL 1500 GAL & INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ, 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK, 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FORT CARL & CARIN BASSLER 13401 ELMORE RD, ANCHORAGE, AK 99516 907-223-1459 FIELD BOOKS BOUNDARY. N/A STAKING: N/A ASBUILT. CAB DNC. FILE: ADA° FILE: FILE COMPUTED: DRAM:` BMW mm'ED* KMD DATE` 9/16/1 GRID: 2936 " No.: 16-213 WASTEWATER DISPOSAL SYSTEM DETAILS OLSON HEIGHTS BLOCK 1, LOT 1 IV 200'+ W- 20' N89'54'31 "E 130.44'(130.44') Aw OF AL� �1 � 9TH* \ '•�Es910 � NO SLOPES >25% W/IN 100' OF SYSTEM NO WELLS W/IN 200' OF PROP. SYSTEMS Scale, 1'= 30' UNLESS NOTED PAGE 2 OF 2 PREPARED FORT CARL & CARIN BASSLER 13401 ELMORE RD. ANCHORAGE, AK 99516 907-223-1459 FIELD BOOKS D puTm: BOUNDAR1-N A DRAWN: BMW STAKING: N A 10' EL & ELEC ESMT KMD A u. CAB DATE 9/16/16 DWG. FlLE: LAID: 2936 ACRD "F11 .pe"°°i6-213 JFP. 10 C _-��, i N ^ O \ ?Y TH16-2 J7 0) O O °jN4 rn RESERVE U ag u O •! O, W I•�j MT CO -W- fi�l� O J I '0 . GO 1+1T O Z / CO SPLITTER / INSTAU DBL. COs & DIVERTER 0 G w � Q TH16-1 CO CO I/ Q / U o _DECOM PER C ISSIO DE & EXISTING 1250 -CAL TANK INSTALL NEW 1500 -GAL S.T. U - ,n �/ CO •iY1 •T'C FILLbd rn i C .FCO INSTALL EW P J. LINE & FCO xz� 5"BR X o FLAG G PR❑P TY LINES WELL R II & ASEMENTS 28,0' PRIOR ❑ CONS UCTI❑N Aw OF AL� �1 � 9TH* \ '•�Es910 � NO SLOPES >25% W/IN 100' OF SYSTEM NO WELLS W/IN 200' OF PROP. SYSTEMS Scale, 1'= 30' UNLESS NOTED PAGE 2 OF 2 PREPARED FORT CARL & CARIN BASSLER 13401 ELMORE RD. ANCHORAGE, AK 99516 907-223-1459 FIELD BOOKS D puTm: BOUNDAR1-N A DRAWN: BMW STAKING: N A CNmKm. KMD A u. CAB DATE 9/16/16 DWG. FlLE: LAID: 2936 ACRD "F11 .pe"°°i6-213 ARC1m ERRA CONSULTING, INC 212 E. 51" Ave, Anchorage, AK. 99503 P." Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Carl Bassler Date Performed: 09/09/2016 Project: OLSON HTS. Bl, LI TEST HOLE # TH 16-1 Depth 20- OF ALS �4 9 TT H ^�* KEINNOT FIBS 1 w / SEE ATTACHED SITE PLAN Org/OL- top 1.5' FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 9/16/16 SM — to 5.5' SW/SP-gp trace of silt/fines, HOLEPRE-SOAKED PRIOR TO TEST ftX01:11 Reading Date Gross Time Net Time Depth of Water Net Drop 1 9/9/16 1:00 6" - 2 1:10 10 min 11/16" 5 5/16" 3 * 1:11 6" 4 1:21 10 min 14/16" 1 5 2/16" 5 * 1:22 6" 6 1:32 1 10 min 14/16" 5 2/16" 7 * 1:33 6" - 8 1:43 10 min 15/16" 5 1/16" 9 * 1:44 6" 10 1:54 10 min 15/16" 5 1/16" 11 * 1:55 6" - 12 2:05 10 min 14/16" 5 2116" * Water Added Percolation Rate 195 (min/in) Pere Hole Diameter 6" Test Run Between 6 feet and 7 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. V °" p.RCTER,Qq ¢ ARC 1m ERRA CONSUL'T`ING, INC z 212 E. 51"Ave, Anchorage, AK. 99503 . " ,.k Office (907) 868-3791, Fax (907) 868-3793 m° SOILS PERCOLATION TEST Performed for: Carl Bassler Date Performed: 09 09 2016 Project: OLSON HTS. Bl, Ll TEST HOLE # TH 16-2 Depth 20- Org/OL- top 2' SM —to 6' SW/SP-gp trace of silt / fines, HOLE PRE-SOAKED PRIOR TO TEST B.O.H. rAO OF AZ "k/. u SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 9/16/16 Reading Date Gross Time Net Time Depth of Water Net Drop 1 9/9/16 1:00 6" - 2 1:10 10 min 9/16" 5 7/16" 3 * 1:11 - 6" - 4 1:21 10 min 9/16" 5 7/16" 5 * 1:22 6" 6 1:32 10 min 10/16" 5 6/16" 7 * 1:33 6" 8 1:43 10 min 10/16" 5 6/16" 9 * 1:44 6" 10 1:54 10 min 11/16" 5 5/16" 11 * 1:55 6" 12 2:05 10 min 10/16" 5 6/16" * I Water Added Percolation Rate 1.86 (min/in) Pere Hole Diameter 6" Test Run Between 6 feet and 7 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. MUNICIPALITY OF ANCHORAGE -�DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION !�® Il conn onni nnenn nr enrrrnrzrerainrn ni%rreinni 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAME � + �— Ir�� �,— -----�.-__"�.-_a�'�ss PHONE NEW UUPGRADE MAIIcLAI[f�DpESS � � —6L — LEGAL DESCRIPTION Or 91/r I-ey'046 / LOCATION Well Absorpti n are Dwelling j U DISTANCE TO: ✓"(1 �Ejp ! Y a NO. OF BEDROOMS PER NO. Z Manufacturer %1 C LU Q rG f-vC —?� Mate I y No. of comfa�rtments Liq. rapacity h g Ilons .. IF FIOMEMADE: Inside length Width Liquid depth !j U DISTANCE TO: Well _ Dwelling v PERMIT NO. O z F-- Manufacturer Material Liquid capacity in gallons O w = U We DISTANCE TO: ��� *'_� Foundation Nearest I li e y% PERAAIT NO. �� j.� w a IJ z No. of lines f Len th o aph line [ ( Total len t 9f lines Trencl ih c inches Distance bet wy�q In Q b- .1 Top Top of tile to finish grad -_4 Material -- beneath tile % — Total effect ve abs rption area -7.�.�_�� I cw inches �) w Length Width — Depth PERMIT O. Q r a0. W Type of crib Crib diameter Crib depth dotal effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line J Class Depths Driller - Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation — Sewer line Septic tank -- Absorption areas) OTHER — - PIPE MATERIAnnLSS S i// SOILTESTRATING ff /J INSTALLER REMARKS p ti LEGA/L)/�//rs LU AP VED DATE`} Type of soil absorption synit em isI TRENCH 1% X AM"An nunher OF bedrnons - 4 Soil rating (SQ F|/Bi 119 The required size o vhe soil absorption Sywhefil is� M aw go. k: Of = I I U. *a r-4 Ig 9 -1! .41 v_: 'o '�!1 , " 4", F, 17 A is. The length dimension is the length Al(feet) of the trench or drainfield. The depth of a trench or pit is the distanne be Ween the surface of the ground and the bottom of the excavation (in feet). T! rc is no set width for trenches. The depth is the minimum depth of gravel botween the outfall pipe and the bntfon of the lox ,avativin (in f('et)` :ii. �nll ��4 �Q. ii Y::::� '4 ikf: :A. J_ A. � ic�).m^� FDermit a;pliicant has the responsiA.lJ.ty to info'In this department duriny the installation ii ctions of any wells adjacent to t1 property and the number of residences that the well will servo. �4 ago cl {his} 14����00�C 1f: J, 1". �%A: --- ii� Backfilling of any system wifhnut final inspection and approval by this de�artmpnt will be subject to prusccution. |�inimun distancc between a well and any 011-5ite sewage disposal systen8 is 1O0 feet for a Private well or 1to 200 feet fron a public well dgpending upon the type of public well. Minimum disfance from a private well to a private sewer line is 25 feet and to a comnunity sewer, line is 75 feef, Well lVgs are requi/`pd and must he returned to the department wifhin 3D days nf fhe well completi,on, Other re�u�rements may ayyly, Specifications and construction diagrams are available fu insure prnper installation. � if- �Eol WWI to on, � �� � � X. I certify that 1!� T an {aniliar with fhe requirements for on~site sewers and wells as set �orth by the MUM cipalify of Anchnraqe. 2 I will install the system in accordance with the codes. 3:� I understand that the on -sit- swwer system may require enlargement if the residence is remodeled tn include 010re than 4 bedronms^ t7Ur-4 I C I F -'"L I T`e Li F-; ""t:.E-6c?W."kiEz: DEPARTMENT 07 iEALTH AND ENVIRONMENTAL f 1TECTION 025 'L STREET, ANCHORAGE, AK. 99 L 264-47'0 WELL- F4r4C> 0"—:S T Ta SSaWEEF} F 9EF::M I T PERMIT NO. APPLICANT ✓�, r / /� �c /� s -sem .. 5 n i ,� r= LOCATION LEGAL L_l �j���,��1 c LOT SIZE 3 ���� SQUARE FEET TYPE OF SOIL ABSORSTION SYSTEM IS: MAXIMUM NUMBER OF BEDROOMS = SOIL RATING (SQ FT,'BR) = 9 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C>EF?THS W LE :Nc-aTH— y D oRF:ivE:L. C>r=-F�-TH= THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). RE= SCRU I FREC:, '_=;[= f=T I C3 TF4NK Sy I ZE= J ,S C3RL-LL IDN PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -rWCDi < :2 > 1N_'15PEa(=T 10 N:5 AF;ZE R'E=0U I FR. EC? BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON --SITE SE14AGE DISPOSAL SYSTEM IS 100 FEET FOR. A PRIVATE WELLS OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEEF;,>M I T E: X FD' I FaEn5 Lse0F=M0aFR : M-3 . :��,-4 r I CERTIFY THAT 1: 1 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. _s: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:- APPLICANT I +UED -----•----- - ----------DATE__ L __ 4--_ V3. t SOILS LOG - MUNICIPALLY OF ANCHORAGE f\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION 711 TEST I\ Pouch 6.650, Anchorage, Alaska 99502 276-2221 \— SOILS LOG — PERCOLATION TEST 9- Date Gross Time Net Time Depth to Water �G 10 - -- 12- 13 14 15- CA Of.. x'• 5 16- 17 c�� o 01�oc_ 18 19 20 COMMENTS WAS GROUND WATER i.. .( S ENCOUNTERED? L O ` P /J IF YES, AT WHAT E ...... _ DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop CA Of.. x'• 5 c�� o 01�oc_ y 1 1 C:5 It, , PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: L %LJ\-I�-�X_1 % CERTIFIED 8Y: 72-008 (7/76) <Q a R I <�d-(-- (-- 61 FCIC&ND). No. 4069 - DATE:/ e4 WAT_?R W' -;LL LOG FOSS DRILLING ASSOCIATED 909 CHUGACH DR. #37 ANCHORAGE, ALASKA 99503 WELL OWNER Merle 13eeter USE OF WELL Domestic WELL LOCATION_ Lot 1, Block 1 Olson Heights Subdivision SIZE OF CASING 6" DEPTH OF HOLE 24 -FT. CASED T0� 74 FT. STATIC WATER LEVEL L�2 FT. G. P. M. 6 WITH 30 JT. OF DRAWDOWN. REMARKS DATE COMPLETED L 2t. 80 PUMP TO BE SET AT� 46' _.Q_to15 Alluvium: grey color, medium hardness .dto-L0 Sand and Silt: green color and. soft ®0,� -ZQto 50 Till: grey and hard �QtojEa Alluvium: blue -grey color, medium hardness ,oto -,0 Alluvium:_-xey color, medium hardness -2-Qto7Li Sand and GRavel: grey, with water to to to Mrs i01 i7e: —to__._ NUNICIINPCGJ: DEPT. to ENvIROt:., to I �. to to MUNICIPALITY OF ANCHORAGE Department of Health & Human Services, DIVISION OF ENVIRONMENTAL SERVICES,; 343 -4744 -;-,%:-,: CERTIFICATE OF; INSPECTION FOR HEALTH AUTHORITY APPROVAL OF;; ON-SITE SEWER, AND WATER FACILITY FOR SINGLE FAMILY DWELLING;; Parcel I.D.,# HAA#' 1. GENERAL INFORMATION (Must be complet'ed'prior.to submittal)1 (a) Legal, Description (include lof, block, subdivision,.section, township, range) ��f s 13/Gcty -1 0Qo4 HSI hkr Location (address or directions) 13 YO! r3rccyaw Sf (b) Property owner 6Y (017 Telephone: (home)' Business Mailing Address _r�0 / (3ra7 r4nCh� rar _ f}Gt 9�'S!G _ (c) Lending Institution C_lkffV e Telephone _ r 6 3 �o��C3 Mailing Address w. 9q5 -0y (d) Real Estate Company and Agent Non e _ Address Telephone (e) Mail the HAA to the following address: (or check here ®, if hold for pickup) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family ® Number of bedrooms a, 3. WATER SUPPLY. Individual Well ® Community ❑ Public ❑ i.Note: If, community. weili,system, must,have written Fconfirmation from the En State Department of vironmental: Conservation'•attesting'to th'legality'and"status: 4 SEWAGE DISPOSAL a.On-site ®s Public E7 . Community ❑;'r:' Holding Tank ❑... Note: If community well system, must have'writtenconfirmation from the State Department of Environmental, Conservation attesting to the legality and status' "' 72-025 (Rev. 7/88) Page 1 of 2 Z to Z abed MOUG (09/1'AOH) szo-zc -�joM s,aaauibua leuolssaload eqJ ul suoissiwo ao saoaaaaol aIgsuodsaa lou sl abujogouy loAl! ledlolunW aqi •penssi si eleolllliao a ajoleq elsp azAIeueao suoiloedsul Ion puoo lou op SHHQ to saeAoIdw3 •sluawaalnbaa alels pus leaapal uielaao Alslles olaapao ui suo lnipsul buipual alagl pue sawoq to siesegoind of Aselinoo a se slgl scop SHHQ E)U Te Suzy to Olds ayl ul p9a8ls160a Jeoulbue 1euoiss9loid luapuedapul us Aq anoge g ydwBeaed ul u9nl6 suolleluesaidaa aul uodn Rluo paseq paleolllaao lenoaddV Al!ao4lnV 411eaH senssi (SHHQ) saolnaaS uewnH pus gIIEaH to luawlaedaa abeaogouy to Ailledlolunyq ayl !f r 1 � lenoaddy leuoll!puoQ to swaai leuoll!puoO panoaddesiC] panoaddy ale(]�� f`q swooapaq � aol panoaddy b IVAOdddV SHHO '9 1, 4rya� '• 'cess 9D '°•.' leas s,aaaul6u3 J 3L00V 'A asoco Hi , 44 9 �tzi •es � •e• a� Li Ntj 4 F /661 oZ . y �lJ alsa it S66 yli� �aoy7uF/ 7�5 �`l�� O� h/ ssaapp'd euogdelal 1.n /»7i uy"0 Of4V wal3lo awsN - •uolloadsui sigl to alep aUl uo lo.elle ul suolleln6ai pue'seoueulpio 'sapoo @leis pus lsdlolunw Ile ql!M souelldwoo ul sl walsAs lesodslp aalumalseM ao/pue Alddns aeleM al!s-uo ayl'uolloadsul pue u01le61is9nu1 AW woal pus sa!!l a6saoyouy to AI!ledlolunW a4l woal peulelgo uollewaolul aql uo paseq le4l Al!aan jegljnl ! -ulaaaq peleolpul ainlowls to ad�(l pue.swooapoq to aagwnu aql aol alenbepe pue leuollounl 'ales si wels�(s lesodslp aalemelseM ao/pus �(lddns aalum-.alls-uo 91-11 lsyl sMoys.lenoaddy Al!aoglny 4llsaH slyl to uolle61ls9nuI �(w leul Al!Jan I'MO laq uMoys alsp uollep!ILIA aul to ss pus olaaaq pax!lle. leas Aw Aq pallllaao sy NOI.LVWEIOdNl dNV V1VQ `HOliV3S 3'11d `S1S3.L `SNOI.LO3dSNl JNIOIAOdd Wail ONIl133NION3 '9 v' n -r �. A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) `fid Health Authority Approval (HAA) CHECKLIST - FEBRUARY 19841 343-4744 Pr'+va. !-e Legal Description:� p , 6/0c Ir 1 OISon l�e(gh% 5' /D If A, B, C, D.E.C. Approved (Y/N) N A Well Log Present (Y/N) Y _ Date Completed Y /2 y /&O -Yield —��p 10� Total Depth ?`Cased to 7 Y Depth of Grouting Static Water Level — 3 2 1 Pump Set At .::,- 5 2 7 Casing Height Above Ground f 8 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) — Y Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 112, c. To Nearest Edge of Absorption Field on Lot 130 ' ; On Adjoining Lots > i0o ; On Adjoining Lots e00 To Nearest Public Sewer Line •;-,- (GD To Nearest Public Sewer Cleanout/Manhole > ICO To Nearest Sewer Service Line on Lot a ZS- f Water Sample Collected by I=laf*.�e Tech S vc. ; Date — / /y /q/ Water Sample Test Results C9 colr{or- /rapr"_a,, 12,7r?iq nifir,/e--N Comments Durtny well �le.vr �Cs� on /ly/9/ um i 0S i; 'Wallons of weer ccrwea fAe ce.,afer level 7nf704,,4 7"O+e w -ell eeeJ6,)J be draus� r;Cawn �o S�` , hu1 no %r bier Y B. SEPTIC/MOLDING TANK DATA Date Installed H/21/60-SizeINo. of Compartments Standpipes (Y/N) i --Air-tight Caps (Y/N) — Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped )N/ 4y Isaac—' Pumping/Maintenance Contact on File (Y/N) Nri4. • for N.74 Holding Tank High -Water Alarm (Y/N) Al, h, 'Temporary Holding Tank Permit (Y/N) N' > • SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 112' -6rO7^ C-0, To Building Foundation To Property Line % to t To Water Main/Service Line "?' 25' To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field 00 J 72-026 (Rev. 7/88) Front Page 1 of 2 /27 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 119 Type of System Design Ty'ench Date Installed IV / 2/ /moo Length of Field H/ I Width of Field Square Feet of Absortion Area ._92 Depth of Field 0 Gravel Bed Thickness 6 Statndpipes Present(Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test 31 y / 9/ Results of Last Adequacy Test A6SarPh-oo cot ho c;tdeafuafl Aor 4/ h�drera SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well I To Property Line To Building Foundation 45 To Existing or Abandoned System on Lot M4 ; On Adjoining Lots 7 30 To Water Main/Service Line ZS'� To Cutback (if present) N(A, To Stream, Pond, Lake, or Major Drainage Course 10c, To Driveway, Parking Area, or Vehicle Storage Area 15`a Comments Mon4or fctbe oaf enc/ o,Jr /-"/7c6 near NE: corh-el- at' ga.ro<<o ;ulf rnslcta gau-e, locaFeo( 67' from NW cor of an� &C-S"m NUav: D. LIFT STATION NIA. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidetirre$,in effect on the date of this inspection. ' h Signed Company Flu4vO 7';-- r cu i �2c'dcc Engineer's Seal Date /`-tcareh ��, /99/ MOA No. X70 —0i9 s a°<°•, °,:° Receipt No. 2� Receipt No. Date of Payment — G! Waiver Fee: $ Amount: $ ? ��. �� C) Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services `e DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING /� Parcel I.D. # y /9 z� �f HAA # 4A 9S ,_rte L- � S 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Telephone : (home) 3¢5-2ZZI Business 0 Mailing Address (c) Lending Institution Telephone �> Mailing Address N/ (d) Real Estate Company and Agent AP/2 Z�/ ?7 %G 11 -le r'T/7 /C :, Address ��iQ IJICGC r`1 f11�i�<�G7 Telephone 344 5- -'/1-4t1- (e) Mail the HAA to the following address: (or check here Wilf hold for pick up.) List contact person and day phone number below: 2--7 G> - Z'_10 (::� 2. TYPE OF RESIDENC Single -Family 7I Number of bedrooms 3. WATER SUPPLY f Individual Well Q/ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAG:��Public DI SAL On-site ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) 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 Authority 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 codes, ordinances, and reg lations in effect on the date of this inspection. /7 Name of Firm C On'%Mt- /UC'/ Telephone /��� A _2 Z -1311 Address /Oc'�Ca �iG��i2cl(lG'li /iCIZG'Ii ���5 �f Date n e� ooea oo�oe oo uc Engineer's Seal U-063 v vlt��Q 6. DHHS APPROVAL Approved for bedrooms by� /?i% Date -g8 ApprovedDisapprovedConditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88) Back Page 2 of 2 C. ABSORPTION FIELD DATA ���� �'/�j, wldam.' Soils Rating in Absorption Strata i uca l VT"in / 7/�f Type of System Desiggn, Date Installed Gf�? %� ("? / Length of Field _ Width of Field Depth of Field I� Gravel Bed Thickness �v Square Feet of Absortion Area Statndpipes Present,(Y/N) Depression over Field (Y/N) &/ Date of Last Adequacy Test c� Results of Last Adequacy Test � SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well // To Building Foundation >` ! To Existing or Abandoned System on Lot /�-��L-i- ; On Adjoining Lots _ /U��`I To Water Main/Service Line%C� To Cutback (if present) To Property Line To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area ::>/U i Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Code Comments / *'Check Perm I certify that I inspection. / Signed Company Date i MOA No. Dimensions Manhole/Access (Y. Bedroom Dating Against HAA Request" "Pume.9fff' Level at Vent(Y/N) ified, or conformed to all MOA and Receipt No. Win" Date of Payment II� Amount: $ 72-026 (Rev. 7/88) Back Pumping Cycles during Adequacy Test. in effect on the date of this ra. i uca l VT"in Receipt No. Waiver fee: $ Date of Payment Page 2 of 2 Engineer's Seal 1v1UNIC:IPALIIY OF ANCHORAGE ENVIRONMENTAI. SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) 1..31)8 Health Authority Approval (HAA) r CHECKLIST - FEBRUARY 1984 343-4744 (.. 6 q, / Le//gal Description: /34& A. WELL DATA P' Well Classification 11 P� I V A If A, B, C, D.E.C. Approved (Y/N) N/A' Well Log Present (Y/N) I 1 Date Completed 1� '�' � Pt Yield (0 - Total Depth_74- 1Cased to -7 Depth of Grouting Static Water Level'' Pump Set At UVlrlCwvl II Y Casing Height Above Ground ''12- Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL t �r r To Septic/Holding Tank on Lot Gc' ; On Adjoining Lots I 0�' To Nearest Edge of Absorption Field on Lot (� ; On Adjoining Lots To Nearest Public Sewer Line �j_� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot cot f/— / Water Sample Collected by e == i �`� Date A -,7/&" &" Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed %( k�Size 1 2 No. of Compartments �- Standpipes (Y/N) Air -tight Caps (Y/N) l Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) N �� ; for Holding Tank High -Water Alarm (Y/N)_ 'v /L Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: l ( To Water -Supply Well �� To Building Foundation To Property Line C'' '�" To Disposal Field To Water Main/Service Line ( Cl To Stream, Pond, Lake or Major Drainage Course tJ /A - Comments 72-026 (Rev. 7/88) Front Page 1 of 2 5. LEGAL DESCRIPTION � ,.� L( i DATE RECEIVED INSPECTION APPOINTMENTS ,� TIME TIME TIMI`�l�J 6. TYPE OF RESIDENCE NUMBER OF\BEDROOMS - DATE DATE DATE _ ❑ Two Cl Five ❑ MULTIPLE FAMILY 10- rn INSPECTOR INS INSPECTOR * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY )u ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OP l!—l.T I "-. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE(EHOIRONUEf l ;L ,.:' XTION 825 L Street - Anchorage, Alaska 99501 • 11"I'AY 2 9 19180 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RE CE I VE D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE tai ltii C C> ca 1\ 2. BUYER I ale ' N i IZ PHONE MAILING ADDRESS 3. LENDING INSTITUTION e A ^^ PHONE 1�_. 1� L I<\l L:— yL 7 MAILING ADDRESS fC 4. REALTOR/AGENT - PHONE C 2r- Wire,, %C�ur�C1 2l} MAILINGADDRESS \ � — 2---d04 5. LEGAL DESCRIPTION � ,.� L( i L. L irJ STREET LOCATION � - t --I . t,.:N 2 c� fa •� 6. TYPE OF RESIDENCE NUMBER OF\BEDROOMS - ❑ One ❑ Four ❑ Other SINGLE FAMILY _ ❑ Two Cl Five ❑ MULTIPLE FAMILY ®. Three ❑ Six 7. WATER SUPPLY 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.) B. SEWAGE DISPOSAL SYSTEM $41- INDIVIDUAL/ON-SITE** C)—YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. A 72-010 (Rev. 6/79)/1 79-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ 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 INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Q APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE iv BY � ,,• 79-010 (Rev. 6/79)