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HomeMy WebLinkAboutMULBERRY TR B2
Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site Water& Wastewater Program
4700 Elmore St. •P.O. Box 196650 Anchorage, AK 99519-6650• http://www.muni.org/onsite •(907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 181438 PID Number 018-232-31 ❑ New •Upgrade
Name
TAREE A. WOOD ABSORPTION FIELD
Address: ❑ Deep Trench ❑ Shallow Trench ❑ Bed P ound
4700 E. 135TH AVE. *ANCHORAGE,AK 99516 ❑Other
.of Bedrooms: Soi Rating Total Depth from original;.de
Phone. No
(206) 510-7063 4 GPD/Sq.Ft. Ft
Depth to pipe invert from original grade Gravel-•pth beneath pipe
LEGAL DESCRIPTION G
9,f`\- Ft
Subdivision: Block: Lot Fill added above original grade �.L\ Gravel length.
MULBERRY; TRACT B2 - - V-
Ft. Ft.
I ownship: Range: Section: Gravel width: Beds Number of lanes. Distance between lines.
Ft. Ft
1
SEPARATION DISTANCES Total absorpti• area Number of trenches: Dist between trenches
To Septic Absorption Lift Holding PubliaPnvate
From Tank Field Station Tank Sewer Lines SO.Ft. Ft
Well 1001+ - - 25'+ TANK U Septic ❑ S.T.E.P. ❑Holding LI Other
Manufacturer Capacity
0
Surface Water 1001+ - ANCHORAGE TANK 1250 cal
Material Number of compartments
Lot Line 5'+ - N/A STEEL 2
Foundation *101+ LIFT STATION
Curtain Drain I Nanofacty er C • y
NONE KNOWN -
-
Ga
Remarks: OLD SEPTIC TANK DECOMMISSIONED PER UPC PER CONTRACTOR 'PJmp on'level al: 'Pump off-level at' High water alarm at
•5'+FROM DECK PILES
Pimp Make&Model' Electrical Inspections performed by
PIPE MATERIAL
House to tank EXISTING/D3034 Tank to EXISTING/D3034
drainfield
Installer
WILCO EXCAVATION Drainfield EXISTING CO/MT EXISTING/D3034
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
105.48 Ft
Inspection
Dates: 1st 12/13/2018 2nd - Location and Description
3rd - 4th BOTTOM OF TRIM AT NW CORNER OF HOUSE
ENGINEER'S SEAL
Community Development Department Approval oo�o�
Conditional approval: Date: p` I, ....- -(10
0 4: J i\ ''.-7 00
vA
v . � .
00 ''.•Je' -y A. Gar ess.: g
—7953 • Gop
OQ ki /: .•• .mac O
Approved: - 1------::::-_( Date: t 2 �S LICENSE44eap�ofess;o(o. 6.141q It oo
#AECC884 40\\.�����
Inspection Report_1.1-12.doc
PERMIT NUMBER: PARCEL ID NUMBER: 1
OSP181438 RECORD DRAWING 018-232-31
•
•••:.-• -•..•. EAST 135TH AVENUE
0
A B .�., d
ST1 58.1 44.2 '. EXISTING SUMP Q
ST2 60.1 47.1 '..• W
DBL1 60.7 47.7 W
DBL2 61.1 48.1 0
Z
NEW MT INSTALLED
ALL SWING TIES FROM AS-BUILT W
SURVEY DATED 12/18/2018 W
rt
r' f• 0
'•t `• • •
0
:."••.R••.r.• :••.
CO
NEW 1250 GALLON STEEL SEPTIC TANK; • '_.s•:•'•'�' .•••� `', ` Uf
NO DECK PILES WITHIN 5 FEET OF TANK •••.,.•-•..''
; : ''r•' .•... - !.•• •••;;s
�:•:•;',1�' DRIVEWAY II • ., Q'
4•: r• .-.•.:... j `1 t.•.•
i f '•1�. : .: ii'
��ii• 2 'y" f ' '•
1 -..W.,11•41
EXISTING 4 :.t'�=•�:••:.w. .'. •..:.•._•
...; . .'• • �.''-,,�
BEDROOM HOME / • ,...
itiori f
a
j\k4.
411tr
I100'WELL RADIUS
1 S ALE:
\ li
1"=40'
i ,,ii
4C oF
4.•41,-\\-.. ... 4 10
•
GARNESS ENGINEERING GROUP, Ltd 14`:` 4'/i• t
ENGINFFRING•SALES•CONSULTING + 0
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507'PHONE(907)3374179•FAX(907)338,3246'WEBSITE www 9emessenpmeln9.com •s.( . •• / • ;
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 ill L� y Garne.s .-z--•
41,
/
TAREE A.WOOD 206-510-7063 2 OF 3 •.J'• ••• D g • z-
LEGAL DESCRIPTION: DRAWN BY: •
e•
(Z ' �(�•' �
MULBERRY; TRACT B2 D.J.G. •j •* �py�• •('�r••\, 4�
TYPE OF WORK: DATE: LICENSE•h f E�1 v •
SEPTIC TANK RECORD DRAWING SITE PLAN 12/18/2018 #AECC884 1�li%%Wile*
PERMIT NUMBER: PARCEL ID NUMBER: `
OSP181438 RECORD DRAWING 018-232-31
FINAL GRADE=98.38-98.48
TOP OF TANK ST1 ST2
AT INLET=93.33 > > TOP OF TANK
AT OUTLET=93.37
INVERT OF BUNG NEW 1250 GALLON SEPTIC TANK
AT INLET=92.86 INVERT OF BUNG
1 AT OUTLET=92.72
k \/
,:s*" 1,„
GARNESS ENGINEERING GROUP, Ltd 117/4 r :• 4 �:► 444
� s
• . k k 011 •
3701 E.TUDOR ROAD.SLATE 101•ANCHORAGE.AK 99507•PHONE)907)337.6179•FAX(907)338-3246•WEBSITE'.MAY 9ame•c•npn••ring cool • •• • .
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: O - ' J fr' A.Gam ss
TAREE A.WOOD 206-510-7063 3 OF 3 OA
I CE- 95 . 417m
LEGAL DESCRIPTION: DRAWN BY: •. .. •••
••; •• L iC I.� 4
MULBERRY; TRACT B2 D.J.G. •
DP k••�( I �, •f
TYPE OF WDRK: DATE: LICENSE-.h ;;;• �P.•
SEPTIC TANK PROFILE 12/17/2018 #AECC884
Torn Fink,
Mayor
icipality of nchor ¢
Department of Health and Human Services
825 "L" Street
P,O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
May 1, 1992
B.D. Gilmore
4700 East 135 Avenue
Anchorage, Alaska 99516
Subject: Tract B2 Mulberry Subdivision
Permit ~SW910077, PID ~018-232-31,
The subject permit, issued May 1, 1991 by this office for a
single family well and/or on-site wastewater system, has
expired as of May 1, 1992.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $200.00 for an
on-site wastewater permit; $75.00 for a well permit and
$275.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
n&ger
On-site Services
enc: Copy of Permit
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910077
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:GILMORE B D
OWNER ADDRESS:4700 E 135TH AVE
ANCHORAGE, ALASKA
99516
DATE ISSUED: 5/01/91
EXPIRATION DATE: 5/01/92
PARCEL ID:01823231
LEGAL DESCRIPTION: MULBERRY TR B2
LOT SIZE: 89734 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
t. PROVIDE SECOND TESTHOLE AT WEST END OF TRENCH TO VERIFY
CONSISTENT SOILS. ALL PORTIONS OF THE BED MUST BE
ENCOMPASSED BY SOIL TEST RADIUS.
2. MAINTAIN A MINIMUM OF 10' SEPARATION BETWEEN THE EDGE
OF EXCAVATION OF THE BED AND THE EDGE OF THE TRENCH.
3. VERIFY INTEGRITY OF EXISTING SEPTIC TANK OR REPLACE
WITH 1250 GALLON TANK, INCLUDING TWO POST-TANK CLEAN
OUTS.
ISSUED BY:
/
DATE:
April 26, 1991
ROBERTSHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Tract B-2; M~berry Subdivision;
PERMIT REQUEST NARRATIVE
The lending institution would not accept the recent~y issued Health
Certificate on the referenced property with the note placed on it
predicting the limited life of ~he septic system. Therefore, the
property owner, Mr. Gilmore, is requesting a permi~ to upgrade his
septic system.
Soils encountered during a test hole excavation were GW (sandy gravel)
with a percolation rate less than I MIN/INCH. We have proposed the
installation of an absorption bed with a 2 ft. sand filter.
The area consists of large lots with a low well to septic density. We
anticipate no adverse impact on n~ighboring properties by the
i~tallation of the proposed septic system.
If you have any questions or require additional information for your
review, contact us.
PERCOLATION
TEST
A. SHAFER, P.E.
i/gm
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~' / L-- ~ ~'~,-~
LEGAL DESCRIPTION: '~ '~ ,
1
2
3
4
7
9
10-
11
12
13
14
15
16
17
18
19
2O
Township, Range, Section:
SLOPE
WAS GROUND WATER ~, I
ENCOUNTERED? I'%~ 0
S
L
IF YES, AT WHAT O
DEPTH?
Oeplh to Water~.
Monitoring?
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE __ (minutes/inch) PP-RC HOLE DIAMETER __
TEST RUN BETWEEN ~FTAND /~'-- FT
W.a~ ~* ~,-. ~ ....... ~ ~C ......... THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPALGUIDELIN T ON THIS DATE, DATE:
72-008 (Rev. 4/85)
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
/
[. PHONE [~ NEW
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: lWell ~OO Abs°r~4~,~a"ea ~1 (oq
Manufacturer (~ Material
Liq. capacity in gallons IF HOMEMADE: Inside length ~ Width
DISTANCE TO: Dwelling
Manufacturer
t~Well
DISTANCE TO: ~'~1~ ~~r~
No. of lines ~ Length of e.~ch~line
Top of tile to finish grade~ (~
Length WilthI
Type of crib ~ehCr b d*r~C~.(r/~_~
Depth
Building foundation
DISTANCE TO;
Foundation
T
oral length of li~ees
lute I 33
a ria beneath tile
Depth
Crib depth
Building foundation
Driller
Sewer line
DISTANCE TO:
NO. OF BEDROOMS~,~
IPERMITNO.
INc. of corrlpartments
Material
Nearest lot line
Tr e r.l,~ ~wiahI
inches
inches
Liquid depth ~ /~
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Total effective absorpdon area
P[BMIT ~0.
Total effective absorption area
Nearest lot line
Distance to lot line
PERMIT NO.
Absorption area(s)
Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATINe
'.5 o 4¢-
INSTAI~LER
REMARKS
72 013 ~'Rev 3/78) ·
DATE LEGAL
PERFI:[ T NO.
FIF'PL I CFINT
LOCAT I ON
LEGRL
g)EF"h~ RTF1EN," "f OF I-JERL'I"H FIIqE:, EN',,,' I RONF'IENTFIL. F'I~:OTE;CI" ;t: ON ~.~..~
,,.
.... ,~ ... ...
B. [:,. Ei I LHF~RE 4. :..]: :L :.t I'.~ORTH ': '"" .....
J.:~STtd STREE"r OFF
T'T'F'E OF' ':'- - c - ¢, ,,- ....
~,UIL F E,_,LFE,~f II3N : ~.:,fEI'I IS: TF:ENCI,.i
I','IFtXINLIH NJHE, ER (:if E:EE:,ROOHS = ~
SE IL RFIT]:NC!i ('L.';Q FT,.-"I3Fd:)= ';'~
THE F~Eg!L.IIId.':ED _.,I~E OF THE '.-qFlIL HB=,EFi. FTIEN :~r.:,FEfl IS'
TIdE LENGTH DIHENSION IS THE I_EI",IGTH ,:: I[4 FEET::' OF:' THE TRENCH OR [:,RFIINFIEI....E:,.
THE DEF'TH OF' FI TRENCH OR PIT IS THE DISTf:INCE; BETI.dEEN THE SURFFIC:E OF' Tl,'il:.':'.
GROUND tINE:, TI,"IE BOTTOI"I OF THE EXCFlVRTI01'4 (II",l FEET).
THERE IS NO SET !.,IIDTI'-I FOR TRENCtdES.
THE GRFIVEI.. DEPI'H IS THE HI. NIfdUf"I DEPTH OF GF~:FIVEL. BETI.,.IEEN 'I.'HE OI..r'f'FI,::IL..I.... F'If::'E
FIN[) THE BOTTOH OF "ride Eh',CRVRTION (If.,I FEET).
PERHIT RPI:Z'LICFINT HRS ]'HE: RESPONSIBIL. IT"r' TO INFOF?.H THIS DEF'RRTHENI' [;'l..rlF;:.'l:["l(~i THE
II"dSTFILL. RTION INSPECTIONS OF FIW'¢ HELLS RD,:I'FICENT TO THIS PROF'EF.:]""r' RI",I[:' THE:
NUHBE:R OF' RESIDENCES THRT THE !.,.IELL. HILL SERVE.
i"t!NIHUH DISTRNE:E D[ETNEEN R FIEI...L FIN[> RN'¢ ON~.SITIE SE!.dflGE
J.01:3 FEET FOR R PR IVRTE !.,.IELL.; OR
J..~50 TO 20~.~ FEET FROP1 F:l PUBLIC 14El_L. DEPENDING UPON THE TYPE OF PL.IBL'!C' 14EL.I_..
!.,.IEL. L LOGS FIRE RELqUIRED RND t',IUST BE RETtJRNED 'FI.-~ "Fide DFPFIRTI"IEI'.KF 14:[THII'.,I ."~:F~ F.:,l":l'T':~J;
OF: THE NELL COI'IF'LETION.
CIT'HER REQUIREFIENT!'; HR¥ RPPL"r'. SPECIF::IC:FITIOI"~S FIi".ID CONSTRUCTION DIFlGP. F:IHS F:II:~'.E
F/'v'RIL.RBLE TO INSURE PROPER INSTFILLRT[OI"~I.
I CERTIF"r' THR"r
t: I RM FRMIL. IFIR HITH THE REQUIREMENTS FOR OI'-,I..-SITI,¢: SEI,,.IE'.RS FIND I,.IEL.LS FIS SET
FORTH B'.,.' THE I',IUI'dIF.::IPRLITY OF RF,ICI--IORFlGE.
2: I HILL INSTFII..L TNE S,N".'STEI','I IN RCCOR[:,RNCE 1.4ITH THE CODES.
:~:: I LINDERSTRND TF.IF. IT THE ON--SITE SEr4ER S'¢SI"EH fqFt'¢ REI;!UIRE ENI.FlF:GEHENT :IF:' THE:
~.b.::,I[..,ENL. E Iz, REI',Iu[..,ELED~ ri.J .INC. LIJ[.,E 1,1OF..E TIdItN ~.. [..,[..[..,F..uOI'I ....
FIPPL: I CFINT P.",. D. G I LI,,IOF,:E
CONSUL F~G GEOLOGIST
BOX /176-M, STAR ROUTE A ' ANCHORAGE, ALASKA 99507 " PHONE 344-?071
SOILS LOG
Performed for %,b, 6~/~-~..~ Date C ./~/q
].6
18
Soil Type Water Level
Remarks
b4L_
Total Depth of Excavation
Groundwater
~'ff No t Reached
Depth, if Reached
Classification Method
~Visnal
( ) Sieve Analysis
()
Material at Total Depth ~
Bedrock
~ Reached
Depth, if Reached
Gary F, Player, Consnlting Geologist
979
WELL LOG
C-h ~r~- Gilmore
o 32 £t
32--- 77 ft
77 ........95 ft
95 ~aa rt
~2a ~54 ft
154 .......161 ft
~ 61 ~ 65 £t
Lot ~ Blk # Subdivision
Tract B2 Mulberry Subdivision
Gr ay e ~
Clay % Gravel
Gravel
Brown Sand Clay
Sand %, ,~rav~l
Silt L wet sand
'.'~ater % Gravel
i/!j',x]iC ?-AL 'FY OF ANCHORAGIJ
DF. PT. (DF HEALTH &
I~I,NIRONMENIAL PROTECTION
~,ailed 10 GPH
,','ith 20 ft. water in well.
Municipality of Anchorage rduc.:::J B
- �- On-Site Water and Wastewater Program c, 6 7�8.
(907) 343-7904
ui,'.tom` rat,
Certificate of On-Site Systems Approval
Expiration Date: _ 2- 12
Parcel I.D. 018-232-31 p
Lg
1. GENERAL INFORMATION:
Complete legal description MULBERRY;TRACT B2
Location (site address) 4700 E. 135TH AVE.*ANCHORAGE,AK 99516
Current Property owner(s) TAREE A.WOOD Day phone 206-510-7063
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: M Date: Z
//2/Z6_
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 52(p.00 Waiver Fee $
Date of Payment 111 C 'i$ Date of Payment
Receipt Number 0 5C- cite Receipt Number
COSA# 0 Li/ 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: t 2/lit 8
q�000OpO�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system oOF A
. in accordance with the guidelines and regulations established by the Municipality of Anchorage and d •.r••. �����
industry practices. The reported results describe the condition of the system/s on the date/s of the ' •
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or !' : .0O
encroachments may exist that were not identified during the evaluation. The operational life of all wells 0 . C r * 0
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, VD
groundwater levels (that may fluctuate during the year), quality of construction (materials and i© Q
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and . (I•
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ••J- f - A. Gorr es.:
system/s; therefore, GEG makes no warranty(express or implied)regarding the future performance of (/rA1 _
the well or septic system. GEG makes no representation whether an alternative well or septic system vO s •.�` ••
can be installed on the property in the event either of the current systems fail to perform adequately in VQ •I IJ.1j../S cAo
the future. The content of this report is for the sole benefit of the person/party that retained GEG to eA� ea profession°oo
perform the evaluation. Reliance upon the information provided in this report by any other person or 'O0000Oo
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for 11. bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the follQyving stipulations:
ON-SJTF
WATER
WASTE Ar AND r�•
•
PROGRAIIM R
?SERVIC(..
By." L v`"f`��' Original Certificate Date: 1 a- ) 9 -1g
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 /'' Nitrate Advisory •
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
COSA Checklist
Legal Description: MULBERRY; TRACT B2 Parcel ID: 018-232-31
If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1
A. WELL DATA
■❑ Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm
Date drilled 4128179 Water storage tank volume N(A gallons
Total depth 165 ft Well disinfected for coliform test? ❑ Yes ❑■ No
Cased to UNK ft ❑■ Coliform bacteria is Negative
❑■ Sanitary seal is functioning correctly Nitrate 1.82 mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ND ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) 12+ in. Collected by GEG, LTD.
Date of flow test for COSA 11
'2778 Date of Sample 11`2818
Static water level at beginning of test 143.6 ft.
Comments See attached invoice regarding well cap repair by Wilco Excavation
B. TANK DATA C. LIFT STATION
Age of tank(s) NEW years ❑ Required maintenance completed
Tank type/material STEEL Age of lift station - years
❑■ Standpipes/foundation cleanout per record drawing Lift station material -
Date of pumping N/A Comments: N/A
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8121/78 Adequacy test date 112718
■❑ ALL standpipes present per record drawing Results E Pass For 4 bedrooms
Total measured depth from grade 6.5+ ft (max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 4.5 ft(min) Water added 1373 gal
❑ N/A— pressurized field New depth 13 in
❑ Monitor tubes go to bottom of drainfield. If not, state Elapsed time 70 min
depth into effective 2.0'
Q Code-required soil cover over field Final fluid depth 0 in
Absorption rate 600+ gpd U,��C.
❑ System presoaked
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) IN
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: MT was installed during tank install;All testing was performed through sump on north end of trench;sump only extends 2'below invert
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑✓ Yes if No ft ✓❑Yes if No ft
Neighboring Tank > 100' JYes if No ft Private Sewer/Septic Line > 25' E Yes if No ft
Absorption Field on Lot > 100' EYes if No ft Holding Tank > 100' E Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' 2 Yes if No ft
❑✓ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 2Yes if No ft 0Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' E✓ Yes if No ft Surface Water > 100' E Yes if No ft
Property Line > 5' E Yes if No ft Driveway/Parking > 0' 2 Yes if No, comment
Absorption Field > 5' 0✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓Q Yes if No ft Private Wells > 100' OYes if No ft
Water Service Line > 10' Q Yes if No ft Community Wells > 200' 0 Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑✓ Yes if No ft Driveway/Parking > 0' E Yes if No, comment
Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' Q Yes if No ft Private Wells > 100' 0 Yes if No ft
Water Service Line > 10' Q✓ Yes if No ft Community Wells > 200' 0 Yes if No ft
Surface Water> 100' ❑✓ Yes if No ft
F. ENGINEER'S COMMENTS
Septic tank is 5'+ from deck post during inspection on 12/13/2018; See attached email
from agent (Lew Ulmer) regarding vacancy of home prior to septic test (approximately 3 weeks).
The first 319 gallons introduced through the sump caused a 7" rise in the sump.
�00�00..,‘0
G. ENGINEER'S CERTIFICATION o� �F.. ' ��sn
•
1 certify that I have determined through field inspections and review �f. ��\ ..�QO
of Municipal records that the above systems are in conformance with Q,* 't �I I • * O
MOA COSA guidelines in effect on this date. vVA
4 1-,
D► 13 •,J:;fA. or -ss:'
QO 9. '• , CE— 95 •• e,O�
o4 %1%,-a.*•Igtq f`6 00
COSA Checklist yellow sheet
400 l'rofesslo�°a
y #AECC884 ��0000��
N Frontier Surveys, LLC Project No: 18-453 Date: 12/18/2018
4 Ordered By: Lew Ulmer Plat: 74-238 Grid: N/A
Scale 1"=50' I
1
-----t E. 135TH AVENUE ---- -- - - I
EDGE OF GRA VELI A I
Oo
o i
S89°54'26'W 280.16 i 4-
12....-*,27
a 1
*c.t
0
Tract 8-2 I
Mulberry Subdivision
89,878 Sq.Ft. +1-
4701 E.135th Avenue t 1
2 Story Wood Frame House W
W/Daylight Basement W
With Attached 3 Car Garage ^ �y
oi PC
C-)1 N Ci)0 3
0
0
K. 0
CO
of a)
i a UJ
N
CO
V
PAVED DRIVEWAY —SHED 0
0
s
c s 6.0I
I.... $ 3'X 6' , Ac). OVER
0 BASEMENT �S� P.L. �+
I
, EGRESS(TYP) ,Mrye. ag /iri�ii1��- \ \
,irah • 82.9 ?7.> - `p 9 ^0 ���
• 16.7 "• "
.-7,, i 1 W
86 ` 1
• Nbit a s -�• 145.7 • I
/ 02
•
• • 1
• a -..-30.0
I • �0)SHEDS vi R.O.W.
• ♦ 95.8 1
82.9 •I
1p3 tw��
ICOI
1�%� RuS w
\ g21a, •
/ v 1
- - - - - N89°53'00"E 299.94
50'R.O.W. EASEMENT
Legend:
Z Electric Meter/Outside Power rQ, Telephone Pole a Sat.Dish
Xy Gas Meter :moi Deck -0- Fence -XE- Light Pole
:S) Septic OW) Water Well a Concrete —au—Overhead Utility
General Notes: 0 25 50 100
1.This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. im.•Imm�
2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey. Scale in Feet
3.All measurements/setbacks are to the visuaVapparent building footprint.
4.All dimensions to property lines are plus/minus 0.1ft.
``‘���N.�1A11j t� I This survey complies with the ASPLS Mortgage Location Standards.The survey represents visible improvements and
conditions at the time
the survey.
s
ment
s not
subject to any
�``�(t O F q IqS il�� inaccuracies that a subsequent boundary survey may oreveal.constitute
the tesponsibility of the Owners to determine the
�P.'•• ' •• • -,9�7existence of any easements,covenants,or restriction which do no appear on the record plat.Under no circumstances
Gj .' `' /i' should this document be used for construction or for establishing a boundary or fence line.
*: *
49T"ilk '
. /, As-Built Survey of:
'
Tract B-2, Mulberry Subdivision
1p • FredericWI,FredericWagner, r i
e cl, ••, NO.L5.-9946 .g� h e eby certify that this Mortgage Inspection Survey was performed by me,or
/ liA 12/18/2018 • = under my direct supervision on December 18th,2018.
•
rtttOph�ESSIONAt �'P.,o' Frontier Surveys, LLC FRONTIER•
tlt1,""`•••- 650 W.58th Ave.Suite E Anchorage,Alaska 99518 ASurve
907.460.1686-info@frontiersurveys.com i► .
PROFESSIONAL SEAL www.frontiersurveys.com
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVl CES
Division of Environmental Services
On-Site Ser¥ices Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ¢'~ l~- ~'~ t ~'
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) /----/~¢c;, ~-- /3~-'~)
,Lending agency
Mailing address .'
.... Day phone ~/D ~ 2~cf~ ]
Day phone
Agent kJ'l o ~ I ¢- _'~ L o'b ~ ~.'T- ·
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Cdmmunity well
Public water
MUNICIPALITY OF ANCHORAGE
6NVIRONMENIAL 8EI~VICE$ DIVISION
MAY 1 2 1997
RECEIVED.
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
IndivMual on-site
hloldi~g tank
Community on'site
Public sewer
RECEIVED ' _
MAY ] ~ 'B,977:: ' ~..,~-
MuniciOality of Ahchorage,:~,: :
Dept. Neal'th & NUm~n 8ervice~:
NOTE: If community WaSteWater SYstem, provide written C ohfirmation from State ADEC
attestisg to the legality and status o! system, -
72-025 (Rev. 1/91} Fronl MOA#21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. 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 inspection.
Phone
Date -5-//t! lq :F-
DHHS SIGNATURE
.X
Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Mu~iciP~[ity of AnCOt)rage Department of Health and Human ServiCes (DHHS) issues Health Authority
ApPrOVal certificate~s!'b~.sed OnlY'up°n the repreSentations given in paragraph 5 above by an independent
professional engIneer registered ~n the State of Alaska. The DHHS does th~s as a courtesy to purchasers of homes
and th-eir 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. 1/91) Back MOA ¢r21
RECEIVED
Municipality of Anchorage MAY '~ 2. ~997
DEPARTMENT OF HEALTH & HUMAN SERVl~c~cipelity of Anchora
Environmenta Services Division 0~t Health&HumanServ~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description: ~
A. WELL DATA
Well type ~::~re t,j,,,( --re . If A, B, or C, attach ADEC letter, ADEC water system number
Health Authority Approval Checklist
~j/_'~ r¢~"2¢~'¢ ~,/',/~' Parcel I.D.:_(~I~ ~---/_~'~_~2 [
Log present (Y/N) ~" Date completed
Total depth / f¢,5- Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Casing height (above groundl
Wires properly protected (Y/NI
AT IN SPECTION
Date of test
Static water level /
Well production
WATER SAMPLE RESULTS:
Coliform
g.p.m.
Nitrate C) ,, (~--
t
g.p.m.
Other bacteria
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Date installed c,W ['~tl
Foundation cleanout (Y/N)
Date of Pumping
C. ABSORPTION FIELD DATA
Date installed ~
Length ~,..~
Collected by: ~ ,~"7"iDA ,,u~uu~,, ~
Number of Compartments ~ Cleanouts (Y/N)
Depression (Y/N) ~ High water alarm (Y/N) ,,'~'('~
Pumper
Soil rating (~.._E_.¢_~.~ or fF/bdrm) ~'~- _ System type '-t'--~
Width ~.<~, C) Gravel thickness below pipe ..:'~ ~' Total depth
Effective absorption area ~ ~ ~
Date of adequacy test
Fluid depth in absorption field before test (in.);
Fluid depth ~ (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Monitoring Tube present (Y/N).~ Depression over field (Y/N)
Results (Pass/Fail) ~:~,._q,~ FOr ~ bedrooms
Immediately after ~ gal. water added (in.):
AbsorPtion rate = ~,~o .g.p.d.
If yes, give date '
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons
"Pump o~mp off" level at*
~'~Datum
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
RECEIVED
Municipality of Anchorage
Dept, Health & Human Services
On adjacent ots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation / O ¢ Property line / C, d- Absorption field
Water main/service line ~- ¢ Surface water/drainage
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation ~-~',-.~ Water main/service line
Driveway, parking/vehicle storage area ~-',~-!
Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that/have determined thru field inspections and review of Municipal recorc ~_~~s~tems
are
in conformance with MOA HAA guidelines in effect on this date,
Signature ~" ------~
Engineer's Name ~~ ~~0~,~¢'
H~Fee $ ~ · ~ Waiver FeeS
Date of Payment ~¢/*¢ Date of Payment
Receipt Number ~ ~~/~ .oc~ipt ~umB~r
72-026 (Rev. 3/96)*
J
~ ~ ~ Oereld V. Randall Jr, ~ ~ no okoul~tnnce~ should any
/of IOur~dB~lOn In relltlon to UB & TAC~ ~ ~ on~~ ~a~ ..........
'WEST BENSON BLVD. 272-9231 ~llnllll grldl end building Ill- MONUMENT ~ ~ ....
HORAGE, ALASKA 99503 562,5281 J..,~ ......... ~,cn, ~ G ~ ~
' ~- ? ..... ~K NAil, X .~~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P,O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
018-232-31 HAA# HA910098
1, GENERAL INFORMATION
Complete legal description Tract B2 Mulberry Subdivision
Location isiteaddressordirections) 4700 East 135th Avenue, Anchorage
Property owner Charles & Marilyn Gilmore Day phone 345-2046
Mailing address 4700 East 135th Avenue, Anchorage, Alaska. 99516
Lending agency N.B.A.
Mailing address
Day phone
Agent Ray Dahl % Dynamic Properties
Address 501 West Northern Lights Boulevard~
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: four (4)
TYPE OF WATER SUPPLY:
Individual well xxxxxxx
Community well
Public water
NOTE:
Day phone
Anchorage, Alaska 99503
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
XXXXXXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA ~21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage flies and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
NameofFirm S & S Engineering Phone 694-2979
Address 17034 Eagle River Loop Road, Suite 204, Eagle River 99577
Engineer's signature Date
DHHS SIGNATURE
~/X/"_ Approved for ~7/
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
Additional Comments ~ g.~/~"/?~,~, ~<~Tk 3~~ ~
~/~~ .~ ~/ Date
72~)25 (Rev. 1/91) Back MOA ~21
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 FAMIL. Y DWELLING
Parcel I.D.# (~3~O~ _o~,__2-j~_~.~ I HAA# {-~-~ / ('1(%0~0~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
TRACT B-2; Mulberry Subdivision;
Location (address or directions)
4700 East 135~Jt Avenue, Anch0ra,qe
(b) Property owner Charles & Maril~fn G,O?,more
Mailing Address 4700 East 135t& Aven.
(c) Lending Institution N.B,A.
Telephone : (home) 345-2046 Business
Anchorage, Alaska 99516
'relephone
Mailing Address
(d) RealEstate Company and Agent DYNAMIC PROPERTIES ATTN: Ray Dahl
Address 501 West Northern Lights Blvd. Anchorage, Ak. 99503
Telephone 279-7611
(e) Mail the HAA to the following address: (or check here r~if hold for pick up.)
List contact person and day phone num. ber below:
S & S ENGINEERING
17034 Eagle Ri.vet LoOp Road
Eagle River, Alaska
2. TYPE OF RESIDENCE
Single-Family [~X Number of bedrooms
3. WATER SUPPLY
Individual Well,C[ 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. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
Address
Date
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATIOI~
As certified by my seal affixed hereto and as of thevalidationdateshown below, Iverifythat 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 inspection.
Name of Firm Telephone ,~'~'Z.~'~ ¢
5 & S ENGINEEriNG
Eagle River, Alaska 99577
6, DHHS APPROVAL 4/~//~'''~
Approved for ~'/ bedrooms by _ Date
Approved ~'~_..~ Disapproved Conditional
The MunicipalityofAnchorage 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 DHHSdonotconductinspections
or analyze data beforeacertificateisissued. 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
A. WELL DATA
Well Classification
~ MUNICIPALITY OF ANCHORAGE (MOA)
~,.~T~[~¢,~ Health Authority Approval (HAA)
FNV~k~....~',L 5,!x ,",.-JcC.~E'~-KLIST - FEBRUARY 1984
343-4744
MAR 2 7 1991 Legal Description: .-"~.~(*--'~ ~ - ,~}_
RECEIVED . ,
.~:~1 ~J ~ fc'~ I--'---~ /',A ,. J'"l If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) L1 Date Completed /7/ -~' ~ - '-¢' ~' Yield
Total Depth~J~'Cased to ,~.o '~r Depth of Grouting --
Static Water Level / ._~ ~ '
Casing Height Above Ground I ~--- 'f-
Electrical Wiring in Conduit (Y/N) L~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot / I O
To Nearest Edge of Absorption Field on Lot
/oo t
Pump Set At LP l'~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots [ O© '/
To Nearest Public Sewer Line /v////~ To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~ ~ /''/~
Water Sample Collected by ~ ~ ~. -/-~ -----~-'~? },~.e'~r'},'~i ; Date
Water Sample Test Results ~ F~ .~ ~ .-/-,/~ c3~ .~ ¢' ~ -d
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~2~_~/~~¢ Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/',,,.,,_~,,'NG ..... TANK.
To Water-Supply Well t
To Property Line
To Water Main/Service Line
/ ~ _.~O¢R INc. of Compartments
Air-tight Caps (Y/N)
(1 Foundation Cleanout (Y/N) ~
Date Last Pumped ~, - ,,~ '~ - ~'/
A.,)/* ;for --A~/~1
Temporary Holding Tank Permit (Y/N) /',-)/~
To Stream, Pond, Lake or Major Drainage Course
Comments .-~ ,0 '~t"~_ ~0 C)//A,O (~ d
To Building Foundation _
To Disposal Field
/oo ff-
I
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~J- ~ / --
Width of Field ~
Square Feet of Absortion Area
Depression over Field (Y/N)
~'-'~ 4z~/.~;~, Type of System Design ~¢~c~
Length of Field
Depth of Field {
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
-q
To Property Line f O "~
To Existing or Abandoned System on
; On Adjoining Lots ~ O 7
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~;--
D. LIFT STATION
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)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA gu de nes n effec&,o,,q,,lb~ date of this
D
ins.ection. ,. ~.: ~,.~.~:-;~ri~:, :,, ..... ~ .4
Company - _ __~ ~, .... .,, ,... % .~, ¢/~
Date ~--~/ ~~ )~
Receipt No, ~ ~ Receipt No. "-"~".,::~:~'<""
Bate of Payment ~ ~)~%~ Waiver Fee: $
Amount: $ ~C~ Dato of ~ayment
72-026 (Rev. 7/88) Back Page 2 of 2
I
I
': '"" ' i ~,' · ~.~ '. ~' .... ' .... · ' '-'., "' - , ' ~ ~ ~ ~ -
· , ~ . ..?,, .~ , , ~ , ... ,~ ~...,]j..~ .,f ;. ~....,,..; .,,..~.,.,..'.,",:'~...,.:. ,~.. ..... ~ .
' ~ . :, ,- ~...-: ... ~'" .,.:: · 'h: ........ '{':'?.: ,.~:.'.. : CK ~ ~"-' :": ' ' ." · '..~ ' :.,
~ .. ~ .......... . . ...... ~ ........
, ',', ~ . ' ' ;~: ,-".".- .,,, -- . ,,~ ~- ' .~,T-, .. ........ .... ~ - '
' - · ' '. , ;...' - .~.~;,~;"..,.¥...:..'..'~.m....... '.. ; .~ .. ~~- -~
~ , .. , ~ ~ ../~.. ~ ~.'.. ~.~ .- . ., -. .
'.' '..~:-,' .. ..--. ~= ~ ~ .............. :.....~
... ..... ,
Apr~ 18, 1991
ROBERT SHAFER, P,E,
ROGER SHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
/
SOIL TEST
Dan Boll~s
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Tract B-2; Mulberry Subdivision;
4700 East 135th Avenue
Dear Dan,
Per your conversation with this firm on Ap~l 3, 1991 a groundwater
monitoring tube was insta~ed on the referenced property on Apri~ 11,
1991. The tube was installed 15 ft. deep (more than 4 ft. below the
bottom of the leachfield .trench) and approximately 15 fi. northwest of
the existing leachfield monitoring tube.
After a seven day monitoring period we did not find groundwater present
within the monitoring tube. Therefore, there does not exist a
groundwater encroachment at this time.
If you require additional information for the issuance of a H~h
Certificate on the referenced property, please contact us.
RT A. SHAFER, P.E.
RECEIVED
PERCOLATION
TEST
APR 1 9 1991
Oept, Health & Human Services
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
HEALTH AUTHORITY
APPROVALS
SEWER &WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
S~TE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
iNSPECTIONS
ON SITE
WASTE WATER
DisPOSAL SYSTEM
DESIGN
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
S~pt~mber 12, .1991
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Ms. Donna Barr~t
NATIONAL BANK OF ALASKA
P. O. Box 107025
Anchorage, Alaska 99510-7025
REFERENCE: Tra~ B~2; Mulberry Subdivision;
4700 East 135th Avenue
Gilmore to Dunbar Loan #415833
SEP 1 5 1991
Dept. Health & Human Services
D~ar Ms. Barr~t,
At your requ~t the septic system serving the referenced property has
be~n treated with hydrogen peroxide in an effort to increase the life
of the system.
As you know, due to a comment placed on a H~alth Certificat¢issued on
the referenced property April 19, 1991, money has been escrowed "to
have a peroxide and clean-up procedure and a n~w adequacy test
p~rformed on the (septic) system." The comment on the Health
C~tificate expressed concern of the life expectancy of the septic
system due to the "absorption trench currently fun~ion(ing) with 90%
of its effective depth full of water."
On September 3, 1991 at 3 p.m. we meas~£ed the wate~ level within the
l~achfield monitoring t~be at 62.5 inch,. At 4 p.m. on the same day
we observed the addition of approximately I00 gallons of hydrogen
p~roxide to the l~achfi~ld. On Setpember 5, 1991 at 3 p.m. we r~turned
to the site and measured the liquid level within the leachfield
monitoring tube at 4 inch~s.
On September 10, 1991 we r~t~rned and once again measured the liquid
level within the l~achfield monitoring tube at 4 ineh~s. At th~ time
an adequacy t~st was performed on the l~achfield. From this t~st we
found the l~achfield ~apable of absorbing in excess of 600 gallons per
day as required for a 4 bedroom house. The system, however, is not
guaranteed against subsequent failure.
It should be noted that'- during this period neith~ the septic tank nor
the l~achfield was pumped. It appears the system is now functioning
with only approxlmately 6% of its effectiv~ depth full of water.
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
Pag~ Two
Tract B~2; Mu2b~rry Subdivision;
4700 East 13Eth Av~nu~
Gilmore to Dunbar Loan #415833
S~pt~mb~r 12, 1991
If you hav~ any questions or if w~ may be of further services, pl~as~ contact
Sincerely,
ROGER J. SHAFER, P.E.
RJS/gm
cc: MUNICIPALITY OF ANCHORAGE
DHHS (R~f. P~rmit #SW910077)