HomeMy WebLinkAboutSTEVAHN BLK 2 LT 2Atevahn
Block 2
Lot 2A
#017-422-38
Municipality of Anchorage Page _,Lot'Z—
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: - S w U t OLf '39) PID Number: 0 9L — 'f ZZ — 3
Name:
aVZ & M ofr
Wastewater System: M New upgrade
Address: (? a e(fD'
ABSORPTION FIELD
'
Phone;//�
3 Sl ^ Slo
No. of Bedrooms:
s
n
O Deep Trench = Shallow Trench O Bed [:Mound Other
LEGAL DESCRIPTION
Soil Rating:
2.0
Total Depth from original grade:
GPD/Sq Ft
0
Lot: / BIOck: �$_u/pd,vwon:
Depth to pipe bottom hom original ggae:
Gravel depth peoeatn pipe a, Qre ro
/LII ",I—e VQ
Z.0 Ft
Z.O 5 � � a Ft
Township:
Range:
Section:
Fill added ab v onglnal graae:
Gravel length:
it �� r Ft
/IS Y.2D� Ft
�WEt.• New �.1 Up
Gravel wlat$r r
fgfines:
0 ce mi.een sees:
s:
20 Is" ANumber
v�
O Ft
Classlhca Ion ate. A.B.CI: T spin:
Cased To:
Total absorption area:
Pipe material:
Ft.
Ft
&o so. Ft
Ploc;
Driller: Onlled:
Siaacwaterleroc
install
STfVeer(.
Date inti lea:
Ft
Lb!('
// 3 o
Yield:
Pump Set at: n he,gnt Above Grouna:
TANK
GPM
Ft. Ft.
SEPARATION
DISTANCES
E3 Septic CI Holding P.T.E.P.
To
From
septic
Abaorpuen
Lh
hoioing
Pub,.Wm816
Mahuf tur c
Capacity In gallons:
Tank
F•eip
Subon
—a'+
Tan.
5aw+r Linea
r1 e- O
2(>00
Welt
K
100-14-
/d
� 4
'OrJ /f
Material:
1(
Number 01 Compartments:
> t C
2
Surface
Water
10q
l00 tl�
lN1,¢
/ourlI
LIFT STATION
LotLine
�—
�$,.�
/VQ
5'/
Size in gallons:
Manula urer. rA;O0 ar* i„ri
f
Zro OO
it ria i2K. tFa
Foundation
Foundation
^L $ r,�,
�F
7V /
.L5• a/.
"men' level at:
�r,.,er
'Pumo on-at:
Nign water alarm at:
R
T
32"
2U v
4 It
Curtain
�/�
'/ .
�/
f�
N ,/
pum Masa8Model
Electrical onsp normea Oy:
Drain
/F
/*
r d.
/inspec
I-1 D rrn
Remarks:
BENCH MARK
nn �j
tr IJtFt� A G. tt 7.Z �'O �ii
Location and Descrlpu�on: b OOr`
C ar4S t
.
SI Uev.
/00:00
m G r
b,Af tor zo s, V r /
Assumed Elevabont:
�'•. - ENGINEER'S SEAL
�OF �s¢l•'
•
p ,�•. yAt,
h. t l
2tv
�Q
by: 9
'`
49THInspections
performed Dates: v/
•• �./,s�.. ..:...
2nd a 3°
j��: •'/.r,�.
Aja y
/ A, MICHAEL N. AN
rel
Department of Health and Hum/an Services approval
sof. �E 9
Reviewed by: A/ ' 13 - o '
••;
f tl�,``""�.
and approved • Date:
.ry a lnv. w.i i Wvw 25
eve
Permit No. SWO10458 Page 2 of 2
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: LOT 2A, BLOCK 2, STEVAHN SUBDIVISION PID No.: 017-422-38
\ fYSl
iC
11 kf��
I
I ZS
I
I I
W I O
e / e
J
` N / ARAGE SLAB, BENCH MM . ELEV. 100'
\ I
/ EXISTING HQUSE
NEIGHBORING WELL r
/ AIR LINE W/ PUMP
RADIUS, 100' / A AND INSULATED IN 2 PVC TYP.
P
TANK d 01 �B
� TC T CO2 - - ABANDONED SYSTEM
� I
M11 1 � � 2,000 GALLON
1 \STEP TANK
MT4 I I I L----�----J
MT3 III J \ ^ THI1
I
R10' ; N 89'4'00' E 124.83' R10'
BOTTOMLESS SAND FILTER - B E N J/A M I N ROAD -
18' X 20'
\L----_ A I T
-- \ /SCALE: 1'=50'
roa rtorco! w
": SI: •t OF 41
«� . �.., a. �•! � PSE•.... 4s t l
.. C .. y� • ••..` �r:
:�e•.tiww CAW
I * • is9TH
!rc• Nr. .ala N' d tart. sea ' , • • • • �I1�{4 Ilri!•v '
LLL .. ^ �• MICHAEL N. ANDERSON
j} <' • C 9'
E IM _E� ll� CFi��ii••'1��
SEPTIC
P N. rS. 110N
MARK A B CRND. PIPE.
ELEV. E V.
C01 14.2 46.8 98.62 9 .48
CO2 12.5 48.8 98.62 9 .48
TCOI 10.61 51.8 99.08
TCO2 13.1T 61.5 99.62
TANK LID 14.E 64.1 99.58
MT 1 27(6 75.4 98.46
MT2 2$
.7
65.9
98.56
MT3
y0.3
81.1
98.83
MT4
/I9.6
73.4 198.72
\ fYSl
iC
11 kf��
I
I ZS
I
I I
W I O
e / e
J
` N / ARAGE SLAB, BENCH MM . ELEV. 100'
\ I
/ EXISTING HQUSE
NEIGHBORING WELL r
/ AIR LINE W/ PUMP
RADIUS, 100' / A AND INSULATED IN 2 PVC TYP.
P
TANK d 01 �B
� TC T CO2 - - ABANDONED SYSTEM
� I
M11 1 � � 2,000 GALLON
1 \STEP TANK
MT4 I I I L----�----J
MT3 III J \ ^ THI1
I
R10' ; N 89'4'00' E 124.83' R10'
BOTTOMLESS SAND FILTER - B E N J/A M I N ROAD -
18' X 20'
\L----_ A I T
-- \ /SCALE: 1'=50'
roa rtorco! w
": SI: •t OF 41
«� . �.., a. �•! � PSE•.... 4s t l
.. C .. y� • ••..` �r:
:�e•.tiww CAW
I * • is9TH
!rc• Nr. .ala N' d tart. sea ' , • • • • �I1�{4 Ilri!•v '
LLL .. ^ �• MICHAEL N. ANDERSON
j} <' • C 9'
E IM _E� ll� CFi��ii••'1��
SEPTIC
P N. rS. 110N
MARK A B CRND. PIPE.
ELEV. E V.
C01 14.2 46.8 98.62 9 .48
CO2 12.5 48.8 98.62 9 .48
TCOI 10.61 51.8 99.08
TCO2 13.1T 61.5 99.62
TANK LID 14.E 64.1 99.58
MT 1 27(6 75.4 98.46
MT2 2$
IIOX 1369, STAR IZOL'TE A ANcxxoRAGE, Ar.wsxcA 99502
344-7114
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 255•
DRILLED AT THE RATE OF 823.00 PER FOOT. Ph'A e- Pt 250
Sterahrt Sub.
0----16' Sano gAavet mlth 45% met Clay.
16---34' Nandpaa. R cemented gAauet. Sevetat 4matt bouddeu.
34---49' Conq tame4ate. R btakem bedua mater tat. Ca ,?Aq d ttuerc .to -te(lwat at 49 .t t.
49--255' Be&ock. Rye44y hand eedimentaAq. bedtock. VateA ytetd at about 1 1/2 CPR
.atom. 788 .to 194 A to a gAanatat .tope mater beaA.lW mate&,"
D4ttttaq ma4 coni ed and Aca 242 .to 248 .fit, mate -t Atc&cttan. of 4u�t CM .in a
po-tou4 .tripe -tock, dmAtoved the .tatat ptoduetlan .to 5 7/2 �Pi77. 7ht4 melt 4eeM4 .to
hold at .that -tate of. ¢lam and ma{y .tmptove 4onewhat with 4utwm pump.tnq.
The quan tttrf & quaV-4 4 tht4 VetL -to veay. Oat t0 acto4#.
7hte Lle.LL ma4 padd Ito t .ta 7u U liq the RcCauey4 dn. Sep.tembe4, 1984.
�ORppt
NA7� DEPT 0 �µEp OncnON
EhNIRONMEI'nN' �
R�CEIV.ED
COST INCLUDES ALL LABOR AND• MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRIL ING WORKS
DATESeptembe4 20th, 7984
S7SA nn SERVICE CHARGE O F IY&% PER MONTH WILL DE ASSESSE� D ON PAST DUE ACCOUNTS. '
WATERWELL -TEST PUMP REPORT
Conducted by: Aarow nmo
and well sve. Brian Wille
Flow
GPDI
Owner:
Address:
09
Well Location: Lot 2A Block 2 Stevahn subdivision
Well Information:
46
07
Total Depth: 235'
Depth of Casing: 25'
Screen From To
Casing Size: 6^
Screen Diam:
Screen Slot:
Remarks -
06
Pump Information
128
05
Intake Depth:
Pump Size
Air Line Depth:
Static Water Level:
9' Av. Discharge:
GPAI, Max Drawdwn: 157'
Pump On
05
Time: 12:00 Date: 11-05-01 Pump Off.
Time: 4:00 Date: 11-05-01
Time
Water
Level
Flow
GPDI
Remarks
0:00
09
0
10:00
46
07
30:00
71
07
60:00
92
06
120:00
128
05
180:00
157
05
240:00
157
05
Well produces 5 G.P.M. with a drawdown of 157'.
Well exceeds M.O.A. standards.
Brian R. Wille
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 02, 2001
Expiration Date: Nov 02, 2002
Permit Number: SWO10458 Parcel ID: 017-422-38
Legal Description: STEVAHN BLK 2 LT 2A
Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 012441 RIDGE PL
Owner Name: David McCarrey Lot Size: 20869 SQ. FT.
Owner Address: 12441 Ridge Place Total Bedrooms: 5 Permit Bedrooms: 5
Anchorage , AK 99516 -
This permit is for the construction of.
[✓,J Disposal Field Z✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well E] 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
I'The well on this property shall be Inspected to determine if it meets municipal requirements. Any deficiencies shall be
corrected prior to the approval of this wastewater disposal system.
Received By:
Issued By:
Date:
Date:
l V3 /
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
`!
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 02, 2001
Expiration Date: Nov 02, 2002
Permit Number: SWO10458 Parcel ID: 017-422-38
Legal Description: STEVAHN BLK 2 LT 2A
Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 012441 RIDGE PL
Owner Name: David McCarrey Lot Size: 20869 SQ. FT.
Owner Address: 12441 Ridge Place Total Bedrooms: 5 Permit Bedrooms: 5
Anchorage , AK 99516 -
This permit is for the construction of.
[✓,J Disposal Field Z✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well E] 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
I'The well on this property shall be Inspected to determine if it meets municipal requirements. Any deficiencies shall be
corrected prior to the approval of this wastewater disposal system.
Received By:
Issued By:
Date:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.ci.anchorage.akus
(907)343-7904
ON—SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _ 0 1 '/ - It2 2� 'J O Permit Number SWO 10 4S O
Property owner(s)
{,avwZL m r,(L4eyr.
Day phone
3 51 - 5 & (o
Mailing address (1)
1 Z -L49 f (24-r,� .
Nkw e_ �v�� A /F%..
C( 9c:Zl (o
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) • L U• i7 rt Sfn
Legal description (Section, Township & Range)
Lot SizeA�r�bo t> Number of Bedrooms _
THIS APPLICATION IS FOR:
Sewer Only My1K Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade IPA
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
,r
(Signature of property owner or authorized agent)
Permit Fees: Z0' o C-_� Waiver Fees: / / S e p
Date of Payment: Date of Payment: i-06/Zo
Receipt Number. Of 2 D Q - Receipt Number. of 2 o q 5'
(Rev. 72/00)
Michael N. Anderson, P.E.
Civil/Structural Engineering
4640 Shoshoni Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Oct 31, 2001
Department of health and Human Services
P.O. Box 6650
Anchorage, Alaska 99519-6650
Re: Lot 2A Block 2 Stevahn Subd.
To Whom it may concern:
This is a request for a new septic permit at the above referenced location. The perc test hole was
excavated to 12 feet with silty gravel for the entire depth. A bottomless sand filter has been proposed
due to the small area available for the new system. The perc rate was 20 minute per inch with water at
12 feet during the excavation and 10 feet after the 7 day monitoring period. The perc test for the
previous bed system had water at 7 feet which was recorded by Lee Reed, this will be my water table
to account for high spring run off. A new 2000 gallon lift station (1750 not available) will also be
installed with the new sand filter system. The new air pump will be installed in the garage to provide
constant warm air for the system.
We are also requesting a lot line waiver of 5 feet to the south property line to keep the new system
away from the existing bed system, the exact edge of the bed system is unknown.
This new system will not affect the future development of the neighboring properties due to the location
of the wells and septic systems. The general drainage is to the south and east at approximately two
percent.
If you have any question please call me at 345-3377
Since��
Michae N. Anderson, P.E.
- UPPER HUFFMAN ROAO
-
BENJAMIN
0
LOT 2A WELL RADIUS
LOT 2A BLK 2 STEVAHN S/0
TEST HOLE RADIUS TYP
WELL RADIUS TYP.
W
W
I-
1'
O
1
X.
W
C
:.
V
O
LOT 2A WELL RADIUS
LOT 2A BLK 2 STEVAHN S/0
TEST HOLE RADIUS TYP
WELL RADIUS TYP.
W
X.
TALISMAN
R OAD-
-JEANNE
ROAD -
Ef-
17
1
SEPTIC DESIGN PREPARED FOR
DAVE McCARREY
OF At 11
p S�_.'
LOT 2A, BLOCK 2
y�P,.•
STEVAHN SUBDIVISION
v •'
.: 49121
PREPARED BY�•f/J.
...•
MICHAEL N. ANDERSON, P.E.
S •
.MICHAEL
4640 SHOSHONI AVENUE
-t N. ANDERSON
�'
(907)
345-3377 / FAX (907) 345-1391
���}f�:�•�7f19••..:..
r.OrtS..•
�y���'
SCALE: 1"=300' OCT 30, 2001
"s
W vi S
\ D S
20'
TANK C.O.'S
2,000 ST�Pl'
SEPT10'TANK'
_ 5--0' r
/1
/
% EXISTING HOUSE
----------------
AIR LINE W/
CTED IN 2
zr.
I
'I
/ I
/ I
/ I
I
I
I
I
f- TO BE ABANDONED
I I
I ; THIJ RADIUS
I
\-18' X 20' BOTTOMLESS SAND FILTER BE
RIO*--,' IN f
� \ E N
C:)
�s. - B
' rICD
O,
6 20 ,,cropc!s cVvr.�
Go FJILrIHvr5,
DAVE McCARREY
LOT 2A, BLOCK 2
STEVAHN SUBDIVISION
'00- E 124.83'
M I N R 0 A D-
NOTES:
THE AIR COMPRESSOR SHALL BE LOCATED WITHIN THE BASEMENT OR THE
GARAGE. THE CONTRACTOR SHALL PROVIDE A 0-10 PSI PRESSURE GAUGE
AT A LOCATION WHICH IS READILY ACCESSIBLE FROM WITHIN THE HOUSE.
NOTE: TYPICAL 3 PSI READING WHEN STARTING PUMP.
THE AIR COMPRESSOR SHALL BE A THOMAS INDUSTRIES MODEL 5070, AS
SUPPLIED BY ANCHORAGE TANK, INC. THE AIR LINE SHALL BE 1/2.0
HDPE (1 PIECE), INSIDE A 2.0 SCHEDULE 40 PVC JACKET AND INSULATION
INSIDE. THE LINE SHALL BE BURIED TO A MINIMUM DEPTH OF X-0-.
THE CONTROL PANEL FOR THE STEP TANK SHALL BE INSTALLED OUTSIDE
THE RESIDENCE WITH AN AUDIBLE/%UAL INDICATOR INSIDE THE HOUSE.
OR OF A'
PREPARED BY
MICHAEL N. ANDERSON, P.E.
4640 SHOSHONI AVENUE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1"=30' OCT 30, 2001
SP1.,,.... ,,q• ��.
*�49sHts;�" •..
MICHAEL N. ANDERSC.N
CE -fro
f ��; ///2�C9
1 1/4'0 SCHEDULE 40
HDPE DISCHARGE LINE FROM
SEPTIC TANK AND MANIFOLD
�------------------
3/4'0 PVC LATERALS,
SEE ABOVE
I&T- o
0
i
h
6- LAYER OF 3/8' EA GRAVEL
W/ THE PVC LATEFJkLS BURIED
MIDWAY IN T E STRATUM
(GRAVEL BELOW PE = 3'+)
SCALE: NONE
0
MONITORING
TUBE, TYP o
N �' �-FINAL GRADE
18'-0'
SECTION
DAVE McCARREY
LOT 2A, BLOCK 2
STEVAHN SUBDIVISION
PREPARED BY
MICHAEL N. ANDERSON, P.E.
4640 SHOSHONI AVENUE
(907) 345-3377 / FAX (907) 345-1391
AIR LINE COIL SPACED AT APPROX.
12•. ORENCO 'WASTEFLOW' TYPE
PROVIDED BY ANCHORAGE TANK, INC.
3/4.0 SCHEDULE 40 PVC LATERALS
(HOLES, SHIELDS, AND FLUSHING
VALVES PER ORENCO DESING)
18' X 20' BOTTOMLESS ISF.
NO LINER ON BOTTOM. PRESSURE
PIPING DESIGNED BY ORENCO AND
SUPPLIED BY ANCHORAGE TANK, INC.
FLUSHING VALVES W/
PROTECTIVE COVERS, EXTEND
ABOVE GRADE
4'0 MONITORING TUBE AT EACH
CORNER. PERFORATED BETWEEN TOP
OF SAND AND DISTRIBUTION PIPE INVERT.
(DRILL 1/4.0 HOLES)
FILTER FABRIC
OVER PEAC GRAVEL
REOUIRED
\-24* MINIMUM OF
FILTER SAND
AIR LINE 18' BELOW
TOP OF SAND
OCT 30, 2001
.49TH
S:Y.'.'[j...
MICHAEL N. ANDERSCN ;
• CE 9 69
r
PERFORMED
LEGAL DESCR
Municipality of Anchorage .
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
QG
DEPTH
+elan lc 4
1'
2-
3- ~Mild. S.416FT 4fuM
4-
6-
7
6 7
8
9
10
11
12
13
14
15
16
17
18
19
SLOPE
* ' 49711 {^i f
MICHAEL N. ANDCRSCN "h I
CE-�42 10
DATE PERFORMERiF'�/D/-27/
e, Section:
WAS GROUND WATER
ENCOUNTERED? e- S
IF YES, AT WHAT/ �f
f,)dt�eM • DEPTH?
a. I- Jf7f
Od(e. lkpthtoWater After r /l z/o)
Monitoring? /0 pale:
20 -{ I
lul PERCOLATION RATE Z 0 lmmuteym��e//hl PERC MOLE DIAMETER G/f
r TEST RUN BETWEEN 3 FTAND ._L_FT
COMMENTS u�'e' 40^k is "r
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
/ ! e rm•see
r4 Mtn.
eo
/o „"
r.
Y,
rc
b
S•0
' L
PERFORMED BY: P74 a il+nir itiL i To nn ' I CERTIFY THATTHIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE - - / 0( 4 /f0
72-M (Rev. 4185)
Municipality of Anchorage
Development Services Department
v Building Safety Division
On -Site water and wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE
WASTEWATER DISPOSAL SYSTEM
This agreement, dated ) V Z !'J is made between the Municipality of Anchorage
Development Services Dep ent D) and the property owner(s) of:
slrr-Vk'I'-b 5 UA D , kaLV_ z I� ;) A -
This agreement is made for the purpose of maintaining an on-site wastewater disposal system on
the subject property.
The property owners agree to the following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation
statement from a registered professional engineer. This inspection and operation statement shall
verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any
deficiencies have been repaired and that the system is functioning as designed.
` (Signature)
Donr• nA /� 6rrt
(Printed Name)
(Signature)
(Printed Name)
:-:swoJJrtl —to -1 Eu�jrt_ µ9— `{G.;S
Mt @Pdt$r# Here) � n" d(�L lJ ()J bkk,� t �I
0 TA
((�� A
BUC
OF ,I� VJ1�ltiiS�;J� 9x�MS
11/13/2001
Municipality of Anchorage
George P. Wuereh, Mayor Department of
Public Works
Building Safety Ditision
P.O. Box 196650 • 4700 S. Braga«• Street
Anchorage, Alaska 99519.6650 • (907) M-8301
littl)://%�iv.ci.anclioragc.ak.us
Michael N. Anderson, P.E.
Anderson Construction & Engineering
14250 Goldenview Dr.
Anchorage, AK 99516
Subject: Waiver Request for Stevahn Block 2 Lot 2A
Waiver Request # WR010091
Parcel ID #017-422-38
Dear Mr. Anderson:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
5.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely, ,o
Jeffrey W. %Poet
Engineering Technician
On -Site Water & Wastewater Program
Municipality of Anchorage
Development Services Department
� Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchomge.ak.us
(907)343-7904
Waiver Review Worksheet
HAM
Date /0
Legal Description: 1 Stock 2 Lot 2A
Engineer. MIke Anderson
Anderson C•1 fi •14•1tl!
David McCarrev
Waiver Requested
Criteria: Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Permit#:
Points:
Waiver is Granted: Waiver is not Granted:
List Conditions or Reasons for above:
Date: / 12 -IID I v
By /Whe of Reviewer
Rec#: 12096 Amount: $116.44 Date Paid: Qo�
Municipality of Anchor
On -Site Wafer and Wastewater Progra �$
(907) 343-7904
Certificate of On -Site Systems
Parcel I.D. 017-422-38
1. GENERAL INFORMATION
Expiration Date:() 3 -! l0
Complete legal description Stevahn, Block 2, Lot 2A
Location (site address) 12441 Ridge Place Anchorage, AK 99516
Current Property owner(s) Ernest Blanger Day phone 301-1171
Mailing address 6790 Westford Lane Anchorage, AK 99516
Real Estate Agent
2. TYPE OF DWELLING:
rx-1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
Five
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
FX71
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:,
Received by:—&-O-,I`� L Date: _
COSA to be released to the engineer, unless otherwise r quested by the engineer.
COSA Fee $ 5 Waiver Fee $
Date of Payment Date of Payment
Receipt Number �r32�1� Receipt Number
COSA # QbCl1oo3 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
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
i
—�L System #1 Approved for 5 bedrooms
System #2 Approved for bedrooms
Disapproved
522-7773
Date 7/28/2016
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: ' 3
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: X
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheef f '. :: 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: Stevahn, Block 2, Lot 2A
A. WELL DATA
Well type Private If A, B, or C provide PWSID #_
Date completed 9/20/84 Sanitary seal (YIN) Y
Total depth 255 ft. Cased to 49 ft.
FROM WELL LOG
Date of test 9/20/84
Static water level Unknown ft
Well production 5.5 g.p,m.
WATER SAMPLE RESULTS:
Coliform' 0 colonies/100 mL Nitrate 5.95 mg/L
Arsenic ND ug/L Date of sample: 7/8/16
Parcel ID: 017-422-38
Well Log (Y/N)1l4:k
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
2/4/2016
11.2 ft
4.5 g.p.m.
Collected by: And. Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/STEP Date installed 11/3/2001
Tank size 2,000 gal. Number of Compartments 3 Cleanouts (Y/N) Y
Foundation deanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 10/7/2015 Pumper Around the Clock Pumping
C. ABSORPTION FIELD DATA
Date installed 11/3/01 Soil rating (g.p.d./ftZ or if/bdrm) 2.0 GPD/SF System type IDSF Bed
Length 20 ft. Width 18 ft. Gravel below pipe •5 ft.
Total depth 4.0 ft. Eff. absorption area 360 fe Monitoring tube Y Depression over field N
Date of adequacy test 2/4/16 Results (Pass/Fall) Pass For 5 bedrooms
Fluid depth in absorption field before test 0 in. Water added 755 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate , 750 g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFTSTATION
Date installed 11/3/2001 Size in gallons 2,000 Manhole/Access (Y/N) Y
"Pump on" level at 32 in. "Pump off' level at 28 in. High water alarm level at 44 in.
Datum Bottom of Tank Cycles tested 4 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
Wy LIMON LOT TO:
peptic iank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main >75'
Sewer /septic service line >25'
Animal containment areas >50'
On adjacent lots > 100'
On adjacent lots >100'
Public sewer manhole/cleanout >100'
Holding tank >75'
Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >6 Property line >51
Water main >10' Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line 5'** Building foundation >10'
Water Service line >10' Surfacewater >100'
Curtain drain None Noted Wells on adjacent lots >100'
Absorption field >51
Surface water >100'
Water main >10'
Driveway, parking/vehicle storage >10,
F. COMMENTS
Septic system is an Intermittent Dosing Sand Filter (IDSF).
**See Lot Line Waiver No. WR010091.
G. ENGINEER'S CERTIFICATION
I certify that l 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 Michael E. Anderson, P.E.
Date 7/28/2016
COSA brown sheet -1 0-10-1 2.doc
Municipality of Anchorage
Development Services Department
Building Safety Division s,, E.'v
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # osc161326
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 2A
of Stevahn subdivision. This inspection revealed a nitrate concentration of
5.95 milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical'
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test', and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
AND _O ere. Losl? 1G nol
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
2 5 - Day of JA� of 20f int , by and between fle rek k Lcrvelauci ,
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AW WTS), described as
Intermittent Dosing Sand Filter
located at (legal description).
Lot 2A, Block 2. Stevahn Subdivision
2. Definitions.
Alteration. Any change to the design or function of an AW WTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AW WTS that were included
in the original design which would allow the AW WTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AW WTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AW WTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations Installation and Removal of Additional Epuipment Prior to
performing any alterations to an AW WTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AW WTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service sereement with an AW WTS
service and maintenance Provider anaroved by the municipality and the
manufacturer of the AW WTS for the entire term of the AW WTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AW WTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of tide of the property will not occur
without a new Certificate of On -Site Systems Approval.
H. Owner agrees that the AW WTS installation and maintenance requirements as
provided by the AW WTS vendorlinstaller and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AW WTS.
I. Owner agrees to provide and maintain a telephone connection to the AW WTS as
required by the AW WTS approval.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner: Derek K 1.04eland
b. Municipality: Director. Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OW4NER: f%
(signature) Date: Z`b
Derek k Lave•1ca4 (printname)
STATE OF ALASKA )
) as.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this day of ,
201(0, by e.. 6eaxd�tCi�
NOTARY PUB IC FOR ALASKA
My Commission expires: S,3I •SOI ci
MUNICIPALITY•
By: (signature)
Date:
(print name) Title:
Municipality of Anchorage
-� Development Services Department
Building Safety Division
i On -Site Water and Wastewater Program ,,, TV
4700 Elmore Street
P.O. Box 196650
5 • ' Anchorage, AK 99519-6650
ww907) 3.3-790 site
(907) 343-7904 �
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OC7 — 4 027- — 3 COSA # Q !a 0
Expiration Date:
1. GENERAL INFORMATION
Complete legal description L a 1- Z/4 (11,! L-, Z S o a h e) s-10
Location (site address) I ?_44 1 P1, d a � p(ar - -
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Day phone
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
®
Individual On-site
❑
Individual Holding Tank
❑
❑
Community On-site
❑
❑
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 sample results. (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.
4. 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) s fe, 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,M,p�ntcipality of Anchorage files and from my investigation and inspecfion, the on-site water
supply and/or w"Kf ater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, atuTregulations in effect at the time of installation.
Name of Firm Pa.
Address _ 146 fo f 14af.,10na. / we,
Engineer's Printed Name Wit Aae•l n! /41 cr,,oe, P E.
5. DSD SIGNATURE
_IZ Approved for er bedrooms.
Disapproved.
Phone 3'f 5- '33 -7 A
Date GA WO 9
r h •' �••:f' ft
/. N/l!/... .....
A, *. MICHAEL N. ANDERSCN : Q' /
CE -94 9
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory .
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: Q
(R•, CIMS)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lo + Z.. (3(1,r, 2 S � r, u o A ei Parcel ID: DI 7 -1F 2 2 - 3 a,
A. WELL DATA
Well typec_i�f'.Va l -c' If A, B, or C provide PWSID #
Date completed 1Zvle f Sanitary seal (YIN)
Total depth _LS S ft. Cased to
FROM WELL LOG
Date of test I Azo% &f
Static water level P « Lc« ., n ft.
Well production E; '/-z— g.p.m.
WATER SAMPLE RESULTS:
Coliform _colonies/100 mL Nitrate 0.2 mg/L
Arsenic: AL ug/L date of sample: s—hS a9
B. SEPTICIHOLDING TANK DATA
Tank Type/Material S c
Tank size 74co gal INumber of
Well Log (Y/N) Y
Wires properly protected (Y/N) X_
Casing height (above ground) 16 n.
AT INSPECTION
L , c
g.p.m.
Other bacteria 0 colonies/100 mL
Collected by: I'�f,h c d.
Date
Cleanouts(YIN) v
Foundation cleanout (Y/Nepression over tank (YIN) High water alarm (Y/N) Y
Datc�mpingfc'/4 f Pumper A 4-
C. ABSORPTION FIELD DATA /
Date installed Soil rating (g.p.d.lfe or fe/bdrm) 7-0 System type
Length ZO ft. Width /g ft. Gravel below pipe Y� ft.
Total depth Ll ft. Elf. absorption area 3Ga ft' Monitoring tube _y Depression over field ^�(
Date of adequacy test —� Results (Pass/Fail) -� For 5' bedrooms
Fluid depth in absorption field before test! in. Water added i gal. New depth! in.
Elapsed Time: �- min. Final fluid depth / in. Absorption rata >= / g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed r I Size in gallons To vo Manhole/Access (Y/N) V
'Pump ono level at 3 L in. •Pump off" level at -�J in. High water alarm level at `/Y In.
Datum _j -a e ir- beb4or Cycles tested 3 Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /up ' 4 -
Absorption field on lot 100,4 -
Public sewer main
Sewer /septic service line 100 rf
On adjacent lots /001
On adjacent lots /V0 IF
Pd�»tom
Pubk sewer manhole/cleanout iao '
Holding tank X14.
Animal containment areas /V01+- Manure/animal excrete storage areas ruc tG
SEPARATION DISTANCES FROM SEPTIC/HUEONG TANK ON LOT TO:
r
Building foundation & Property line rS a Absorption field S
Water main Water service line too' -1- Surface water /Do' -f-
Wells
Wells on adjacent lots / uo' {-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line S ' Building foundation ZS'' Water main t414.
Water Service line /y0 14- Surface water too r{- Driveway, parking/vehicle storage Zv f f
Curtain drain 1`414. Wells on adjacent lots ryo r+
F. COMMENTS
G. ENGINEER'S CERTIFICATION h`P'' • • • At �+
I certify that I have determined through field inspections end . 9TH • • f��
review of Municipal records that the above systems are in • • •y•/ .. • . • • , , ; , ,
conformance with MOA COSA guidelines in effect on this date. �• /;:'it .
A•
��•; ..... •:•a•c•MIOIAE _ 4 ERSCNEngineers Printed Name CE-99
Date &//7/0 9 �I F�p O��f."`�'N�
COSA Fee $ H90 F Z-gl > 4 fti
Date of Payment 1,11 1 Z&
Receipt Number 1 2 1 99 1 q11 Lk
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
PUBLIC USE
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THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND PUTTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
STRUCTURES OR FENCELINES
EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON (UNLESS INDICAI
NOTE. ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES.
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
LEGEND
S SEWER VENT
AS -BUILT SURVEY
NO CORNERS SET THIS DATE T--30'
1 NFREBY CERTIFY THAT 1 HAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
DESCRIBEO PROPERTY.
LOT 2A. BLOCK 7. STEVAHN SUB.
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 _I2TH_
DIDAY OF JUNE IOD9
HOLT LAND SURVEYING 6429.1`896.9S1S.13641
TEL N5 5513
Municipality of Anchorage
—� Development Services Department <
Building Safety Division '. <i
Onsite Water and Wastewater Program A
CTT
4700 South Bragaw St. ' "
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. C91`9-142 -2--_25S HAA# -!4--b/ D `79
b
Expiration Date: ; - / 3 - 0 /
1. GENERAL INFORMATION
Complete legal description Leo 2_4 R( k7- S� va h n
Location (site address or directions) 17, 4 4 ( (2, k Sc Pia e c,
Current Property owner(s) QcL+fwt V( L -d o r or -e ti Day phone Sc;( -SGC,(
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: S-
3. TYPE OF WATER SUPPLY:
Individual Well
P
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
9
Individual Holding tank
❑
Community On-site
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Public Sewer
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The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 sample results less than 30 days old. (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.
4. 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 Health Authority 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 M<-(ia&I 9Ar?Jr(4 rl �•�• Phone
Address 4f. yo e. A v -,A ni Ane,14k• '19S ft.
Engineer's Printed Name M( r is e( At. 4 der ton P. t=, Date / Poi
-,—OF Ai
......:....•..........
'+ MICHAEL N. AKDERSCN
5. DSD SIGNATURE C�E69
Approved for bedrooms.✓.yl: • ��' >
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional
Additional Comments
eJ.��Y
OF
`� WATER AND
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: /" Original Certificate Date:
(Rev. 12001
Municipality of Anchorage
' Development Services Department
Building Safety Division
On-site Water & Wastewater Program
4700 South Bragew St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.sk.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lof24 66-,'Z, h-�ey&Inrt Parcel ID: 01-9--512-2-3q
A. WELL DATA
Wen type -&vote— If A, B, or C provide PWSID # _
Date completed Sanitary seal (YIN) Y
Total depth 1.1f ft. Cased to eft.
FROM WELL LOG
Date of test 2v
Static water level 4 rL k n o w a ft.
Well production 9-/Z g.p.m.
Well Log (YM) Am.. ire S
Wires party protected (Y/N) X_
Casing height (above ground) �6 in.
AT INSPECTION
/ S o
q•O ft.
S, U g.p.m.
WATER SAMPLE RESULTS:
Coliform —(�—colonies/100 ml. Nitrate 0, Si 6g.A. Other bacteria --0— colonies/100 mi.
Date of sample: Pyo I Collected by: Mr k e �n c(. cr to rl
S. SEPTIC/HOLDING TANK DATA
Tank Typo/Material Date insta11
Tank size gal. Number of Comm dmeM Cleanouts (YM)
Foundation cleano _ Depression over tank (YM) _ High water alarm (Y/N)
Pumper
C. ABSORPTION FIELD DATA I
Date installed /f > / Soil rating (g.p.dJR2 or ft2/bdrm) 2, System type
Length 'Z o ft. Width !8 ft. Gravel below pipe _Y?-- ft.
Total depth 4/6 ft. Eft. absorption area 340 112 Monitoring tube L Depression over field 4
Date of adequacy test -' Results (Pass/Feil) / For 5— bedrooms
Fluid depth in absorption field before test � in. Water added gal. New depthG in.
Elapsed Time: / min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type) If yes, give date
D. LIFT STATION
Date InstallIV // o / Size in gallons 2uv v
T•.,er u
"aump.,W level atp�J2 in. 'Pump oft level at _ in.
Datum N klo n e + t,,,J, Cycles tested 5'vr L
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 1001
Absorption field on lot 10 r f
Public sewer main 1, ZA
Sewer /septic service Ilne /do 1 '-
Manhole(Access (YIN) _ T
High water alarm Igvel at 4Y in.
`F'Crr.cc 0ueeV-4C
Meets alarm 6 circuit requirements?_
On adjacent lots /C>o 14 -
on adjacent lots Ivo 4
Q r"va"
sewer manhole/cleanout Coo'
Holding tank Nzil
SEPARATION DISTANCES FROM SEPTICIMALUM TANK ON LOT TO:
Building foundation ` r{ Property fine r S' f Absorption field
Water main / Water service line IuO 14 Surface water /or) Id
Wells on adjacent lots i vy 4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line S'
Water Service line Coo 1�
Curtain drain
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Building foundation 2--f ' 4
Surface water r u J 1 4�
Wags on adjacent lots 10#
r
I car* that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines In effect on this data
Engineer's Printed Name 141 �"V I AA ns L4-
-Date 0/7 /01
HAA Fee $ 3 0 0. o a
Date of Payment 1//9/'o r
Receipt Number V l 2 47 of - -
t -
(Rev. 12/00)
Water main K f'*
r
Driveway. parkinplvehicle storage
Waiver Fee E
Date of Payment
Receipt Number
TN .... rr
r'
A�MICHAEL N. ANDERSCN
•
CE >9 59
�n�'�'•[//tY>}v!
••.fir
�41. uah (.%\
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ilo,.i'L a
S-`1Lt31
1 1.4 " ct3-13(,
MUNICIPALITY OF ANCHORAGE
ECONOMIC DEVELOPMENT AND PLANNING
P.O. Box 196650
Anchorage, Alaska 99519 -6650': -
PRELIMINARY PLAT APPLICATION
OFFICE USE
RECD BY:
VERIFY OWN:
A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks.
1. Vacation Code 2. Tax Identification No.
3. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34).
S• N
-
4. EXISTING abbreviated legal description I(T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page.
01-tld 6W31
Wod
0
5. Petitioner's Name (Last - First) - - -
6. Petitioner's Representative
CG
Y
SS G
AddressR
iC/q
Address /4T ro.
/K Yr%,z
A
city State -State �C _
City �1�
StateK_
Phone 7
Zip.-
Phone#/37/
Zip 9 94--e
7. Petition Area
8. Proposed 9. Existing
10. Grid Number
11. Zone
-- Acreage-- - -
-Number- - Number
Lots Lots -
-..
12. Fee $�13. Community Council
S. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to subdivide it in
conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. l understand that payment of the basic subofvision fee:
is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the
subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the
basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning,Staff,: Platting
Board, Planning Commission, or the Assembly due to ad istrative reasons.
Date:3
20-003 (Rev 8/89)MOA-2E
must provide written proof or authorization.
S9431�*1993
C. Please check or fill in the following:
1. Comprehensive plan ;Land Use Classification
K Residential Marginal Land Alpine/Slope Affected
Commercial Commercial/Industrial Industrial
Parks/Open _, ....
,pen Space., ,Public Lands/Institutions _Special Study,
,
:.. .
Transportation Related
2. Comprehensive Plan — Land Use Intensity Dwelling Units per Acre _
Special Study Alpine/Slope Affected
3. Environmental Factors (if any):
a. Wetland b. Avalanche
1. Developable
2. Conservation c. Floodplain
3. Preservation
d.; .Seismic Zone (Harding/Lawson) ,<
D. Please indicate below if any of these events have occurred In the last three years on the property.
Rezoning Case Number
Subdivision Case Number
Conditional Use Case Number
ZoningVariance, Case Number
Enforcement Action For
Building/Land Use Permit For 14 x'113 ✓�
Army Corp of Engineers Permit
B. Legal description for advertising.
'scz "
F. Checklist Waiver
y 30 Copies of Plat
-Reduced Copy of Plat (81h z 11)
Certificate to Plat
Fee
/ Topo Map 3 Copies
Soils Report 4 Copies
Aerial Photo..,
`Housing Stock Map
.Zoning Map• .
Water. Private Wells Community Well Public Utility
.Sewer: Private Septic - Community Sys. Public Utility
20.003 Back (Rev. 8/89)MOA-24