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HomeMy WebLinkAboutMANN BLK 1 LT 2Onsite File Mann Block 1 Lot 2 #020-041-20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N,�Mlz PHONE pijqcr, -ONVV UPGRADE MAILING ADDRESS c2'1071�� zi�/_V. LEGAL DESCRIPTION kot'2' 9/oai� I P&Ivyy 7_141 S�r­D- LOCATION S, NO. OF BEDROOMS LJ �4 DISTANCE TO: — Well. Absorption area D PERMIT NO 86 -0303 1- 2 a. < Manufacturer No. of compartments Licl. capac in gallons IF HMEM"ADE: - Inside length Width Liquid depth 6 �4 DISTANCE TO: PERMIT NO. 10 2 0 �: X Manufacturer -M—aterial—_ Liquid capacity in gallons DISTANCE To: —lines Well Foundation Nearest lot line PERMIT NO. w No. of Length of each line Total length of lines Trench width Distance between lines CFC ____UFaterjaI inches C�2( Top of tile to finish grade —I)eneatil tile Total effective absorption area 0 __ inches Lengt �_5_ Width Depth PERMIT NO. a's,- I L9-520,1(23 < r. 11 Type of Crib AJI& Crib dia Crib depth Aj/4 Total effective absorption area uj U1 U) DISTANCE TO: Well Building foundation Peo <�q s4_ Nearest lot line /145- 1— Class Depth Driller `­ Distance to lot line LU DISTANCE TO: Building foundation Sewer line Septic tank !s) OTHER PIPE MATERIALS CA6+- SOILTEST ATING INSTALLER 2 REMARKS FIT a-cm-P&Q, .6-M A'14 1� Il-. 'Z� T noL kc vlaa Nd oll�_&S aom' ZeP4�c� R4 43' APPROVED DATE LEGAL �-v I, �Muv. 0!/0) WELL LOG Date Drilleds 5-30-8a' Static Water Levelo feet Draw Down N/A feet TyE2 Material Drilledt 0 feet to 2 Peat 2 feet to 19 Gravel w/water 19 feet to 129 Bedrock to to to Hefty Drilling S.R.A. Box 1553 H Anchorage OA laska 9950? L,., 2 Blk. I Mafln Subd. Gallons Per Minute 40 Total Feet of Nksing_ �22 0 0 0 -po 0 PERMIT NO: DATEll IGS"),IF. D: APPLICANT: AD�REgS: ���fi I "h 0 JL IE K :4 ll���� DEPARTMENT Lx HEALTH AND ENVIRONMENTAL �OTECTION ^^ 825 L STREET, ANCHORAGE,l AK 99501 264~4720 ��-11. 11-11- �k, �, p EE �, F �ll,-. 11 \ �� A50303 ENGINEER2D DESI8N ' 06/14/85 CONTACT PHONE: LEGAL DESCRIP: LOT SIzE: NORTH BANK CONTRACT, 2726 TELEQUANA ANCHORAGE -9 AK 99503 268~6850 �UBDIVISION: MANN LQT: 2 SECTION. 2 TOWNSHIP: 11N RANGE: 3W 87120 (SU.FT" OR HCRUS> I certify that: 1" I am f'amiliar with the requirements f'or on-site sewers and wells as set forth by the oA, Anchorage (MOA) aQd the State of' Alaska. 2" I will inst�ll the systexo in accord�nc� with all M0A codes and regulations, and in compliance with the design criteria of' this permit. 3. I will adhere to all MOA and State o Alaska requirntiii for the i7i;et back distancesi� f,rom any elxisting we1l, Wilk stewater diSir.:)os�Al sy5tCM) or public seweragc-1 system on this or aOy adjacent or nearby lot" 711i: A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN CO AN ELECTRICAL PERMIT BE OBTAINED; (2) AS.BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INGPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST D ELECTRICIAN. SIGNED ;nr�----------�-~�-~~-�~��~�~~ --�-~-~ APPLICAN O ISSUED B DATE: -���~�-~-�-~-~~~~---�-----�- � ' C JL L �t�, L�D��\[��� {�����\ �-t \ 1 -� JOB ALASKA ENVIROV 'ENTAL SHEET NO. 0 F CONTROL SERVlk,�S, INC. 1200 West 33rd Avenue, Suite B CALCULATED BY— DATE ANCHORAGE, ALASKA 99503 CHECKED BY DATE (907) 561-5040 /1 , SCALE . .. I S, 6'( A F" s— ILI 41-1 eF "t'A' rk (2 jo,3—. Lc)l- ;� (f Ine.(- ( ALASKA ENVIROt' 7NTAL SHEET NO. OF 41 CONTROL SERVIL�j, INC. CALCULATED BY— w� t 1200 West 33rd Avenue, Suite B DATE ANCHORAGE, ALASKA 99503 CHECKED BY DATE (907) 561-5040 r SCALE PROW 20�1 CAI�tb W 1,�. G,�o M. 01471 JOB 4- -/ �� 4- / "2 /; ALASKA ENVIROP' ':NTAL SHEET NO. - 3 OF CONTROL SERVIGri, INC. CALCVLATED BY- 12 1200 West 33rd Avenue, Suite B — - 42/� DATE ANCHORAGE, ALASKA 99503 CHECKED BY DATE (907) 561-5040 c SCALE-- - 1V7 � PRM ml lk wm M'. 01411 ALASKA ENVIRONMENTAL CONTROL SEM S, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 v; SHEET NO. - < / OF CALCULATED BY ---Z DATE CHECKED BY DATE SCALE PRWM ml 1� G'M� M� mv! ALASKA RIUMPTAL COnTROL �nqineerinq & Cnuironmenlal Studies SeRUIUS, InC SPECIFICATIONS FOR ELEVATED BED—DRAINFIELD SYSTEM — LOT 2 BLK 1, MANN SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS SHEETS I THRU 4 SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, THE CONDITIONS OF THE PERMIT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE CONTRACTOR. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR INSTALLER TO OBTAIN ALL NECESSARY PERMITS, EASEMENTS, OR WAIVERS REQUIRED FOR INSTALLATION OF THE SYSTEM. 2.0 SEPTIC SYSTEM 2.1 THE SEPTIC TANK SHALL BE A UPC APPROVED TWO COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN OVERLYING LAYER OF 2 INCH BURIAL TYPE POLYSTYRENE. THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL. 2.2 INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER— TIGHT CALDER COUPLINGS. PIPING SHALL BE 4 INCH SOLID PVC SLOPED A MINIMUM OF 1/4 INCH PER FOOT, WITH A MINIMUM OF 4 FEET OF COVER. IF LESS THAN 4 FEET, USE I INCH OF POLYSTYRENE FOR EACH FOOT OF COVER LESS THAN 4 FEET. 2.3 CLEANOUTS SHALL BE INSTALLED WITH CALDER COUPLINGS, CAPPED WITH AIR—TIGHT JIM—CAPS (OR EQUIVALENT), AND EXTEND A MINIMUM OF 3 FEET ABOVE GROUND LEVEL. 2.4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE HOUSE FOUNDATION, AND A MINIMUM OF 5 FEET FROM THE DRAINFIELD. 3.0 ABSORPTION AREA 3.1 THE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 2.5 INCH AND FREE FROM SILT OR SAND. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2 INCHES WITHIN LEVEL. 3.3 THE NSF SAND FILL SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 MM AND A UNIFORMITY COEFFICIENT OF NOT MORE THAN 4. 3.4 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR 1200 West 33rd Avenue, Suoe B * Anchoraqe, Alasko 99503 * (907) 561-5040 POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 3.5 TWO OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM D-3034. THE SECTION BELOW GROUND LEVEL MAY BE EITHER DRILLED 0.5 INCH HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN -CAP (JIM -CAP OR EQUAL) SHALL BE PLACED ON THE TOP OF THE PIPE. 3.6 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER OR A NONWOVEN FABRIC (SUCH AS MIRAFAR FIBRETEX 200 GRADE, POLY -FILTER X, OR EQUAL.) 3.7 IF INSULATION IS USED RATHER THAN MOUNDED BACKFILL, THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT INSULATION BOARD OF THE REQUIRED THICKNESS (I INCH PER FOOT OF SOIL LESS THAN 4 FEET OVERLYING THE BED). 3.8 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX, OR BLUEGRASS. 3.9 IT IS CRUCIAL THAT CARE BE TAKEN IN CONSTRUCTION OF THE BED TO ENSURE PLACEMENT INTO THE PROPER SOIL STRATUM FOR PROPER OPERATION OF THE SYSTEM. 4.0 INSPECTIONS 4.1 A MINIMUM OF THREE INSPECTIONS SHALL BE REQUIRED; THE FIRST INSPECTION SHALL BE OF THE EXCAVATION PRIOR TO THE PLACEMENT OF THE NSF SAND FILLER. 4.2 THE SECOND INSPECTION SHALL VERIFY THE INSTALLATION OF THE NSF SAND FILL� BEFORE GRAVEL AND PIPES ARE POSITIONED. 4.3 THE THIRD INSPECTION SHALL INCLUDE THE GRAVEL, PIPES ALL CONNECTIONS AND BARRIER MATERIAL/INSULATION� PRIOR TO BACKFILL. 4.4 IF AECS DOES NOT INSPECT THE INSTALLATION, AS DESCRIBED IN SECTION 4.0, THEN AECS IS NOT RESPONSIBLE FOR DESIGN OR INSTALLATION OF THE SYSTEM. Q -'SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TE�Tr) 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: A)(2V- &11� 00014c4JOCIS DATE PERFORMED: �E5�/ L /- T 11 Pi J�'-5 wi ��, -1, LEGAL DESCRIPTION: 5-E §:-� j (FEETI Lrp L 'SILT�- 440 oti S�4 t4 SLOPE SITE PLAN v 11 ��M F-�o 10- 2 - k . . N . I 3 -- PEA T P+ M�. ifA.1,�I. A4 e90-"7"6;6HA( C0664 -,A'r&6 A7- 125Q.2AA -71 K4,fd. e 9 Date Tim Net Time Depth to Water Net Drop 10- 11 - 12 - 13 - 14 - 15- 16 - 17 - 18- 19 - 20 - COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? -70 5--o-str 9- 1 4�- --2v - , oil Reading Date Tim Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: N-cf";�5 �C* CERTIFIED BY: 72-008 (6 /79) ----(rninutes/inch) FT AND -- FT I DATE: 9--��OILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATZION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 1v1')y-4L �Okl com S �v to DATEPERFORMED: T- it V, le3 (t) 5rc. LEGAL DESCRIPTION:. 6(0�4 SLOPE SITE PLAN I A , � - 2:q qf'� F+ ec C 3 4 6 7 8 v w 10 11 WAS GROUND WATER S ENCOUNTERED? 5 L -0 12 P IF YES, AT WHAT E 13 DEPTH? -'5-1-3-6 5- 14 15 16 17 18 19 I I /U 0 Reading Da te G N� �t Depth to Net Time Time Water Drop '71 10 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN F T A N D F T COMMENTS ke,,�-ej )Q!j 0Zt"It? S-ro 1� 0, eq k(oc"' � 4&.( L &Z" "I �n -2:i� 10� j PERFORMED BY: 7 2-008 (6/7 9) cov CERTIFIED BY: DATE: Parcel l.D 020-041-20 Municipality of Anc On -Site Water and Wastewater (907) 343-7904 Certificate of On -Site Systems 1. GENERAL INFORMATION Complete legal description Location (site address) Mann, Block 1 1 Lot 2 16001 Elizabeth St. JUN 0 8 20116 Expiration Date: 01-aq. I (Q Current Property owner(s) Gregory & Janice Clayton — Day phone Mailing address Real Estate Agent 351 E International Airport Rd. Anchorage, AK 99518 2. TYPE OF DWELLING: Rx Single Family (w/wo ADU) El Duplex R Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well FX Individual El Individual Water Storage El Holding Tank Community Class Well El Community Public Water System El Public Sewer El WaiverNariance request for: Received by: Date: 4�'/Q_9 L,�-01_ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _572,6-oo Q-10 Waiver Fee $ 59 Date of Payment Date of Payment (Q Z2,5_'? //(9 Receipt Number 0 Receipt Number 0-3o? F� &- COSA# QXe"(,ot 2d S' Waiver# OSV/6'/074 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal aPj ed.ti and as of the validation date shown below, I verify that my investigation, based on procedures outlined 11 s Approval Guidelines for this application, shows that the on-site water supply and/or wastewater in the CertiflcE V% disposal system is (are) safe, , f6iiclional and adequate for the number of bedrooms and type of structure indicated herein. 4 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being sewed by the system. These condifibns are outside the control of [he evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above, Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 En . gineer's Printed Name Steven R Pannone Date 6/7/2016 6. DSD SIGNATURE .. .... System #1 Approved for bedrooms -Sl- vein w. CE -8149 System #2 Approved for bedrooms AW Disapproved Conditional approval for bedrooms, with the following stipulations: KA -L By Original Certificate Date:L-2—q -16,-�. The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbl.eshee[S - ., c If more than I septic system is on the -lot: COSA Checklist# '_- of Structure smed by this systehi 1 Certificate of On -Site Systems Approval Checklist Mann, Block 1, Lot 2 02-0--0,420 - Legal Description., Parcel,'ID: A. WELLDATA Well type PrivaI;e If A, B, or C p.Fovide PWSID # Well Log (YIN) Y 5130/ 5 Y ed (Y/N) Y 198 , Sanitary seal (Y/N Wires properlyprotect Date completed Total'ideptfl 22 12+ ft. Cased to t Casjng height (above ground) n. FROM WELL LOG AT INSPECTION 5/30/1985 5/17-12016 Date of test 0 Unknown* Static water level ft. 4o,- &0+' Well production 9 -p -m - WATER SAMPLE RESULTS: Coliform es/100 mL Nitrate mg/L _��eg_coloni� ND N D ug/L Date of s�ample: 5/1'7[2016 toile PES Arsenic cted by: B. SEPTICIH'OLDING TANK DATA Tank TypefMaterialSeptic/Steel lN18/1985 Date installed Tanksize 1,500 gal. Number of Compartments 2 Cleanouts (Y/.N) Y Foundati6n6Ieanput(Y/N)_K_ Depression. over tank (Y/N) N. Highwater alarm (Y/N) N Date of pumping 5/4/2016 Pumper Isaacs- Rumping - C. ABSORPTION FISID DATA 6118/1985 5 SF/8,R -Bed Date installed Soil rating (g.p,dM orfl:21bdrm), System Itype Length45� 0-5 ft. Width ft._ Gravel below pipe ft. T 4tft-,4 3 o6ion 6 re6(11'25%1 be Y Al IdN, btal 4 Yt. tff. abs Monitoring tu Deoressiorn over flei Oass of ad 6 Re For bedroomS Date equoytesi 51171,201 - i ,suits (Pass/Fel!) __ -I , I . . �0 FI d dio'th In absfttibn field befdr6 te6t, 0 in. Water addeJL�_ gaL New dept _.In. 90 750+ Elap.s#d Time: mh�% "Final flulddepth 0' In. Absorption rate >= g.p.d. No Any.rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Si,ze in gallons Manhole/Access (Y/N) 'Pump on" level at in. "Pump off" level at in. High water alarm4evel at in. Datum Cycles tested Meets alarm &-circuit requirements? E.- SEPARATION DISTANCES WELL ON LOT Td: Septic tank/lift station ory lot 100+ — On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 1 004M Public sewer me I i:n 75+' Public sewer manhole/cleano 100+' ut Sewer /septic service line 25+ Holding ta, 100+ . nk Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTICIHOLDING TANK ON LOT -TO: Building-fo6ndation 5+ Property line 5+ Absorption field 5+. 10+ line Water main Water service 10+ Surface water 100+* Wells on adjacent lots 100+� ABSORPTION FIELD ON -LOT TO: Property line lot Building foundation 10+ Water main 10+ -10+ 1 OQt** '1()+ Water Service line Surface water Driveway, parldrigi.vehicle storage 50+ Curtain drain Wells on adjacent lots 100+ F. COMMENTS -**Pond is no Ion -er g xisting G. ENGINEEFSPERTIFICATION I certifyffiat I have determined through field irispections and review of Municipal records that the, above. system�� are in, conformance with MOA COSA guidelines in effect on this d�ite, ii Steven Panis Engineer's Printed Name Date 6/7/26 16 COSA canary sheet-2-6-15.doc V r. " . iiioQr. ­�, t Municipality of Anchorage P.O. Box 196650 * 4700 Elmore Road Anchorage, Alaska 99519-6650 * (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.orglOnsite Development Services Division On -Site Water and Wastewater Program t X * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV161070 PID#: 020-041-20 COSA#: OSC1 61218 Permit#: Legal Description: Mann, Block 1, Lot 2 Engineer: Pannone Enaineering Services Applicant: Gregory & Janice Clayton The following separation distances are approved. 1. 55 feet between the existing onsite septic tank and surface water. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. 7 The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. X Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: f Date: /a Approved by: ....... / I oTeviewer 4 ...................................... V.a!T� ....................... Pannone Engineering ServiceS LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveC@Panengak.com June 20, 2016 Subject: Mann S/D Block 1 Lot 2 Septic system to Surface Water Waiver Request I am writing to request a waiver of the separation distance from the existing septic system to a newly constructed pond on the property. When the septic system was installed in 1985, it met all the separation distance requirements. The owners of the property constructed a small pond on the property 59 feet away from the septic. This pond was recently mapped as a small intermittent open channel drainage by the MoA WSM. When FES conducted our COSA investigation we searched for surface water due to the Note on the file. This intermittent drainage was dry on May 17, 2016 as was the pond located approximately 55 feet northeast of the drain field. The owners recently constructed a small wedge-shaped berm between the pond and the septic tank. The berm is constructed at a 6% cross -grade towards the tank and a 6% longitudinal grade to the west such that any spilled sewage will overland flow in excess of 100 feet before it enters the drain channel. 1. Surface Water: There is an intermittent drainage within 100 feet of the existing septic tank (PES measured 59 feet to the nearest point.) Using an earthen berm system (see attached picture) the existing septic tank will maintain an overland sheet flow of at least 100 feet from all surface water and drainage. 2. Topography: The existing overall topography slopes to the west at approximately two to six percent. 3. Waiver: We are requesting a waiver for the separation distance from the septic tank to surface water of 55'. The surface water is approximately 59'± from the septic tank. Construction of the earthen berm system extended the overland sheet flow distance to greater than 100' from the existing system to the surface water. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 Approving this waiver will not affect public health nor wil I it pollute the groundwater. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 u FLI�l NU, bb—lUb MANN SUBDIVISION LOT 2, BLOCK 1 95o919 S.F, BUILDING DETAIL SCALEb III -20' AS -BU I LT I HEREBY CEFMFY THAT I HAVE $UR\'MD THE GASTALDI LAND, PROPERIY DEPI=D A$OVE AND THAT NO SURVEYING, LLC ENCROACHMENTS EXIST EXCEPT AS INDICATED, 7 IS THE RESPON$IBILITY or THE OWNER TO JErr A. GASIALDIP R.LS. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E� DOWUND RD,, SUIIIE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAOE, ALASO 99607 APPEAR ON THE RECORDED SUBDIVISION PLAT, PHONE 248—U454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON IRE USED FOR CONSTRUCTION OR FOR SW323� 6/24/2010 ESTABLISHING BOUNDARY OR FIENCE UNES, ANCHORAOt REOORDING I)IMICT, ALASM F.131 JOB No. MV NOTE: NO CORNERS $E7 THI$ DATE OF )RIVEWAY CON71NUF$ To LOT i miory & youtom e "50" MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date — le) - � -y< 1. GENERAL INFORMATION (a) Legal Description (include lot, block, sul�clivision, section, township, range) "7- 7, �IdALJ -5-oon' —///A) SJ PJ J Fe- 0, Location (address or directions) (b) Applicant Name Telephone: Home --- Business Applicant Address 5�1-�Iw�A14 4Veell 1k. ��5—oj (c) Applicant is (check one): Lending Institution Owner/builderX; Buyer 1:1 ; Other El (explain); (d) Lending Institution Telephone Address (0) Real Estate Company and Agent N /A Address Telephone (f) Mail the HAA to the following address: - V 1 �4 (� / L / ,, �'-' -1i 1,Y) �2 C, �� - - b 1� '�: Z � 10 � 2. TYPE OF RESIDENCE Single-FamilyX MUlti-Farmly Other Number of Bedrooms 3. WATER SUPPLY Individual WeIlX Community El Public El Note: If communitywell system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteK Public EJ Community 0 Holding Tank EJ Note: If communitywoll system, must have written confirmation from the State Departmentof Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 0 1184) /_ Z"61 5. ENGINEERING FIRM PROVIDIN-, iNSPECTIONS, TESTS, FILE SEARCH, 0), ANDINFORMATION e 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 regulations in effect on the date of this insoection. Name of Firm Address 17 -eV 4) Date 6,WWae- 44172- �'4,1 r-, Telephone ngin al % 9 10 Qp ro 00' 30r� 302,JaM Lr)roy 1, 1 F, NO. r_3 6. DHEP APPROVAL y Approved for bedrooms b ate Disapprove Conditional Approved Terms of Conditional Approval � r1a CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DFIEP 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 not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: 1-67- Z- 23eoa/ A. WELL DATA Well Classification If A, 6, C, D.E.C. Approved (Y/N) Well Log Present (()YN) —Date Comple�� ---Yield Total Depth Cased to Depth of Grouting Static Water Level 0 Pump Set At Casing Height Above Ground -_ Electrical Wiring in Conduit& Separation Distances from Well: Sanitary Seal on Casing6N) Depression Around Wellhead (Y( No To Septic/Holding Tank on Lot //-<, --t- On Adjoining Lots Z�71 4'r 7� To Nearest Edge of Absorption Field on Lot On Adjoining Lots 7 To Nearest Public Sewer Line Al�,4 To Nearest Public Sewer Cleanout/Man hole To Nearest Sewer Service Line on Lot Wate r Sample Collected by Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes& Air -tight Caps&N) Foundation CleanOUt 6(Y N) Depression over Tank ( 6/N Date Last Pumped y Pumping/Maintenance Contract on File (Y/N) for W Temporary Holding -rank Permit (Y/N Holding Tank High -Water Alarm (Y/N) o� L,4 Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation /_3 To Property Line e? j To Disposal Field _tr To Water Main/Service Line — 0 Course WIA Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage /_ �, 6 / �Wv C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field Width of Field Depth of Field Square Feet of Absorption Area Depression over Field ( )(9— Results of Last Adequacy Test Gravel Bed Thickness I — Standpipes Presen 6Y N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 5� / 5 _10 — To Property Line 0 '7� M� To Building Foundation Lot ; On Adjoining Lots To Existing or Abandoned System on __� 0 " -�- To Water Main/Service Line wi-A To Cutbank (if present) AV -d To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Are, Comments D. LIFT STATION Date rn-S� Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Cycles during Adequacy Test. Meets MOA I certify that I ch4ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. P0Pee7Z';6 -7 S1�31 l�� Y/ 11f7ee'l Date 'C', 1�bFe'.5 Company MOA No. Receipt No. 15(o 6c) Date of Payment .-S -<95 Amount: $ 60,C) Page 2 of 2 72-026 (11/84) oom ofa 02 800efla "%W$ ago no �r rz- Hoy C. Reid, Jr. 4W, No. 2251-H