HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 2i ic��h 1��9s •� � OS\-�3�-38 Municipality of Anchorage Page of 2 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: SV PID Number: os/ X31 39 Name: Wastewater System: ❑ New Z Upgrade Ga./ Address: �� Y3;, ti1r. IafH,j P ABSORPTION FIELD Phone: �$g _ o �3 No. 0Bedrooms: El Deep Trench ❑ Shallow Trench ❑ Bed XIMound ❑ Other LEGAL DESCRIPTION Soil Rating: O� Total Depth from original grade: / GPD/Sq. Ft. 1',�.7 Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 ile/Tlr >w lr 4>131 Ft. �' 7 Ft. Township: Range: Section: Fill added above original grade: Gravel length: / 77_r� Ri W 5 -c -c if 2.0 / Ft. 60 Ft. e` �' _" 7y WELL. ❑Upgrade Gravel width: l s Number of lines: 3 Distance between lines: y S- Z4/0 -rd, -❑New Ft. Ft. Classification (Private. A,B.C): Total Depth: Case er` Total absorption area: Pipe material: 30,�y Pvc Ft. QOO SQ, Ft. I — IV r I vC Sc fr `iO Driller: D rl lied: Static Water Level: Installer: Date installed: Ft. �—;L1—�%� Yield: GPM umSet at. Casing Height Above Ground: TANK FL Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines AWz-H /Z r'p Material: Number of Compartments: Well A Surface --- i LIFT STATION Water �� Lot Line 3v / 10 30 i lS Size in gallons: 17.50 I Manufacturer: Foundation / / z 'p / �� "Pump' level "Pump 0f' vel at: r alarm at: High. te11 I 1Y /O &Model Curtain Pump Make I Electrical Inspections performed by: Drain /✓�.--.._._._____-._--- - SS-os-zo-yNF 4,A Remarks: 7 r'a;/Hc( Sectio( BENCH MARK Location and Description: X/ST/^'G TFN:r Pym•• E /a/Ld LlCA�IOn.N W./.tei `—Q ✓l L/c%t iQ� /.✓ LfJGE �D✓�LI C�+_� �ca/ /'fJu1C Assumed Elevation: Oe. 0-� Pt ENGINEER'S SEAL i OF At ., „ • qE ..•••••.. '� i s y ••�y �R�S �- ••••••• »'•'••••'~••••l Inspections performed by: Dates: 1st �••• 2nd 6—z/-9� �. »----- . » Lo A. But ero :, �j ti.• e"14As 't Department of Health and Human Services approval Department t� Reviewed and approved by: �% Date: -� 2, E'ROfESS���� I ♦ �.. 72-019 (Rev. 9/91) MOA 25 I Permit No. SW980187 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ® Anchorage, Alaska 99519-6650 Teiphone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Northwoods L2 Bilk 3 PID No.: 05173138 { I I i McManus Dr. I SWING TIES 15 UGIRZ Easemen_ —t — " A—C = 86.7' _-- —— — B—C = 73.9' A—D = 79.1' B—D = 91.2' a Bored o0 0 Pbon ° . O .aa o C°7,;4 o8aeo Abandoned PRESSURE PIPE DETAIL Tank 2" PVC Monifold To tank I � 3, 4.5' 3' BED 4.5' 1250 gal D DETAIL Lift Station G Lot 2 a 1-1/4" PVC Sch 40 TH1® Orifoces 29" OC m `x A - TEST HOLE n • - MONITOR TUBE o - SEWER CLEANOUT v - WELL - PROPOSED LEACHFIELD — — - EASEMENT A BI SCALE 1"=40 j 6/23/98 ELEVATIONSQ TOP OF CONC PAD, REAR DECK (NOT TO SCALE) Asp PUMED ELEV = 100.00 ENGINEER'S SEAL A � ORIGINAL m oDO F O�p 4 4 f p ! d ' GROUND 2 ovP'� .••-•....... � LEVEL AT: p 97.8 r 2' ADDED FILL ~m p 49TH -i'O 2"35PSI INSULA➢ON GWT®89.8 .••... •.••••"""::""' OD' TANK 878 W/Lift 94.2 42 97.5 97.5 �O c. Louis A. Butero 96.8 Q S •, CE -6736 Z Q oFESS0\ o 0000 L1_ l Lo - ��1U - - l N �� L,_ _A PAGE 1 OF 1 CLL, -L) n J LIL `k" nv 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:SW980187 DATE ISSUED: 6/18/98 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 6/18/99 OWNER NAME:HETLET LARRY & BARBARA OWNER ADDRESS:22432 MCMANUS DR CHUGIAK, ALASKA 99567 PARCEL ID:05173138 LEGAL DESCRIPTION: NORTH WOODS BLK 3 IT 2 LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: S ISSUED BY: DATE:/(/ / Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax June 11, 1998 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Northwoods Lot 2 Blk 3 Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: The surrounding lots are large, allowing sufficient room for septic sites and there is a community water system. 2. Immediate neighboring septic systems are all +30' distance. 3. Drainage will not be affected and is not a major consideration in our design. This system is to utilize a lift station so that the more permeable upper soil layer may be used for the leachfield design. Sand will be imported to level the bed after the topsoil layer has been removed. The field will have sufficient cover and will be insulated to prevent freezing. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. 11997\98 -035 -NAR McManus Dr. — 15' Utility Easement _ — Properly abandon Existing Tank Lot 1 1 EX�sttng Septic Existing Tank Existing Tie into House existing line with Cleanout 1250 gal Lift Station Lot 2 NO SURFACE WATER NO KNOWN CURTAIN DRAINS 77) TH1® m ,0-2% 0-2% All Septics +30' -11 1 1,1 ,0-'2% " t -,/r cow rvx Cb.00.°o o 00 ..•au °o x.ar .w ° o 0 800 n '• PRESSURE PIPE DETAIL Lot 3 2" PVC Manifold To tank 0 Zq 3' 4.5' 4.5' 3' BED DETAIL WELL/SEPTIC SffE PLAN LEGAL: Northwoods Lot 2 Blk 3 OWNER: Hettllet CONTRACTOR: N/A JOB# 98-035 1 DATE: 6/11/98 SCALE 1" = 30' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-329 ® — TEST HOLE • — MONITOR TUBE o — SEWER CLEANOUT p — WELL — — EASEMENT — PROPOSED LEACHFIELD EXISTING LEACHFIELD ooh OF��opo q ;* 49TH *< .L ............. T.......• �•• LOUIS A. BUTERA �• �;J+ '. CE -6736 2 z- 4:7 ,O PES '•....•.•• <ro 0 O�On�'ESSIONp �o� Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Northwoods Lot 2 Blk 3 6/11/98 A. GENERAL 1. The well & septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK WITH LIFT STATION 1. The septic tank shall be an Anchorage Tank 1250 gallon septic tank with integral OSI lift station pump model OSI-05-20-HHF. 2. A receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all applicable codes. C. BED 1. The bed excavation is to follow the natural land contour and remove the organic layer to underlying sandy soil. Total depth of the bed bottom will vary across the bed. 2. The bottom of the bed should then be leveled utilizing sand material (<5% fines), to plus or minus 1.5". 3. The total thickness of the gravel layer is to be 1.0' . 4. The effluent line is to be a 1-1/4" PVC line with 1/8" holes drilled 29" OC within the leachfield, placed face up with orifice shields placed over holes located mid depth in the 1' gravel layer. 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the bed. Mounded side slopes not to exceed 3:1. Final cover material to be 4" of topsoil and seeded. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: BOTTOM OF GRAVEL LAYER = 1.0' BELOW GRADE' (apporximately) GRAVEL THICKNESS = 6" under pipe, 4-1/2" over pipe BED LENGTH= 60' BED WIDTH= 15' SOIL RATING = 0.5 GPD/ft5 BEDROOM CAPACITY = 3 SEPTIC TANK = 1250 with lift station EFFLUENT PIPE = 1-1/4" PVC with 1/8" holes oriented up with orifice shields spaced at 29" OC. Twenty-four (24) hours notice required for all inspections. 11997198 -035 -spec EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 98-035 Calculated By: LB Date: 6/11/98 Legal: Northwoods Lot 2 Blk 3 Single Family 3 Bedroom Dwelling Bed Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Bed width (VI) = Gravel depth (D) = TEST HOLE 1 450 gallons 14.1 minutes per inch 0.5 gallons per day per square foot 900 square feet 15 feet 1 feet Required length = Required absorption area / Bed width Required length = 900 / 15 Required length = 60 feet Total Excavation Depth = 1.0 feet Import sand for leveling low points Mound and insulate, lift station utilized OF'q�-�gs;p0O *�. 0 49 rH* �'. LOUIS A. BUTERA i J,'• CE -6736 �4G o4�dFoPROFESS10NPo-��4 98-035-cal.xls 2:36 PM6/11/98 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 Job #: 98-035 Legal: Northwoods Lot 2 Blk 3 Date: 6/11/98 Press. Effluent Lateral: Assume T head at orfice 25 GPM flow rate .42 GPM per 1/8" office 25 / .42 = 67 offices Pipe Length 162 Spacing = length/#of offices = 2.42 feet Spacing = 29.0 inches OFq .' 49TH Vn". LOUIS A. BUTERA .- 2" J CE -6736 ��G 004 0 0 PRO...... NPo���� • '��4�7lt s"* �.. .�M_{N{M.N�NN.Npi.• • Municipality of Anchorage - ` 1N04it"46NNNy1 •"" 6#6 M DEPARTMENT OF HEALTH & HUMAN SERVICES Louis A.Btrterd 825 "L" Street, Anchorage, Alaska 99502-0650 �A ' .�' CE4736 SOILS LOG - PERCOLATION TEST $ '+r..__-0.1. o PERFORMED FOR: I-rGTT/1t7— 1 DATE PERFORMED: LEGAL DESCRIPTION: _1V0r%tic✓noaS 4oT� 6/k3 Township, Range, Section: ESLOPE —t SITE PLAN FEET) �OSO// I I I I I 2 SAydy G/AV�i 3 4- 5- 5 6 �vrerws� Gr LHj/ 7/ 7 a- 8 9-- C2 10 11 12 13 X.rn'w yr Til 14 15 l,s P°YC. 16 17 IF YES, AT WHAT DEPTH? Depth to Water After S / Monitoring? ■■■■.■■■■MENOMMMENE■ ■■■■■■.■■■ ■■■■■■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop I,s TEST RUN /3 -?.'SS COMMENTS (WT ��o"'ra/ M/ �I6 FT rr , 7k kl 77, l#1 �1 t —77; /u/G /S / l�T/1n�7<9� T-wo 3o J -G t?> IAeje L4eoF PERFORMED BY: 41e CERTIFY THAT THIS TEST WAS PERFORMED IN I v r6 3o Z3 Z/i 6 Z 2// ' 3o -2.33 Z Z 5 IN,' r-3 3 S Z1/6 3s11& /6 „ 20Q uPERCOLATION I/-{ RATE t (minutes/inch) PERC HOLE DIAMETER I,s TEST RUN /3 Z•S' /y COMMENTS (WT ��o"'ra/ BETWEEN FT AND acs/ >C/av rrcV.*A0 s -77j -r FT rr , 7k kl 77, l#1 �1 t —77; /u/G /S / l�T/1n�7<9� T-wo 3o J -G t?> IAeje L4eoF PERFORMED BY: 41e CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE J ® 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 NAME PHONE �&N EW 0 UPGRADE MAI LING ADDRESP LEGAL DESCRIPTIO LOCATION �.A,tO � ��x R� �/{/O` l' !�/A�bsorptio�nVFa NO. OF B POMS v DISTANCE TO: Well / - Dwelling PER NOe �" 0-5 .Y waz Manufacturer ,> M�F�}' I No. of compartments - l— J Liq. c ciyy gallons IF HOMEMADE: Inside length Width Liquid depth 0 Y DISTANCE TO: Well Dwelling PERMIT NO. JaZ = z H Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. w= J LL Z No. of lines Length of each line Total length of lines Trench width Distance between lines H Z W CC I inches F- Top of tile to finish grade Material beneath tile Total cc effective absorption area 0 inches LU 0 Length `., 5f Width Dep ��G �� p T ,' / i Type of crib Crib diameter Crib depth Total effec ' aiosP,c w y DISTANCE TO: WgJlf /` �i�� 4 Building Smu ti L ��J 7 Nearest lot linef`� J Class -,�/ L Depth Driller Distance to lot line PERMIT NO. J C� v� 7 Lu � DISTANCE TO: Building found ion Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS - SOIL TEST RATING j 6 INSTALLER \ ` v REMARKS S l �, elf S'bNil ;f ncs 4r A. 0 �o p �a APP OV DATE LEGAL WW ;(kf cyq s tnev. of fa) MUN1jCfPALf1-'POF ANCHORAGE_ — e DEPA TR HENT OF HEALTH & ENVIRONMENTALPROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEVVAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME - - PHONE - A NEW. rI ❑ UPGRADE MAILIL1�A, REf LEG/AL DESCRIPTION 4" Z > LOCATION # 4 /,/ t/f//�Y/!/t-.ice �ft?. NO. OF BE OOMS v v Y ISTANCE T0: Well Absorption wa _J Dwelling PERN�.]' NQ<' _03 i _ of compartments LU f 3 Liq. ca achy in gallons IF HOMEMADE: Inside length Width Liquid depth. Z DISTANCIr TO: Well Dwelling PERMIT NO. O. Q Manufacturer - - Material - - Liquid capacity in gallons J= DISTANCE TO. Well - " Foundation Nearest lot line PERMIT NO. w J LL Z No, of lines Length of each line Total length of lines Trench width Distance between lines �R¢ -- - inches - � p. Top of tile to,finish grade Material beneath tile Total effective absorption area - G inches - LU Length t Width Dep P Type of crib Crib diameter Crib depth Total effeciI-' o rga< LU LU rn - DISTANCE TO: W I gU Building undauoy� - - Nlot hn earest !� - Class- �_ , Depth Driller Distance to lot line PERMIT N _ ) _ - - DISTANCE TO: Building founds ion / Sewer line Septic tank Absorption area(s) - OTHER - PIPE MATERIALS- - _ SOILTESTRATING .. r Q /f INSTALLER t 00 REMARKS .:,p.,s, �. f= as..r.,w,.._ r.. ,. r' .0 -inn < .'.. �M4-^-:6• a °s t IA57 J IA5 Oa •a rte. — �7 APPROV bf% DATE LEGAL - 77-0j.,S (Rev. 3/78) Pi 99 PA X L.; IL F `l L_ X I I -T, R—H r— 1`4 a--. 1 t 1 -cc. " K 1~.. DEPARTMENTL_/HEALTH AND ENVIRONMENTAL _..'OTECTION 825 'L' STREET, ANCHORAGE, AK 9-9501 264-4720 PERMIT NO. r (_;10503. APPLICANT PJ&S 600 E BENSON 274-731.5 LOCATION MC MANUS DR LE13AL LOT 2 BLK 3 NORTHWOOD S,, -D LOT SIZE 20000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH /2S_ MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING 45Q FT/SR)=e._ THE REQUIRED SIZF 0 THE SOIL ABSORPTION SYSTEM IS: 0 IE F`T-of;;?nvEFL 6 L_ E THE LENGTH DIMENSION IS THE LENGTH (,IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF 'THE GROUND AND THE BOTTOM OF THE EXCAVATION f'IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FR FE I. -A 11 1 F;'.'E: V -o -*F. FE F=" ".1_ 1 � _r n 1'':11' 1-" "_=5 Ir :::rm EF_ ::L r -N lzi C-3 � FA t- L_ r__l VA E5 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -r 1.4 C -_l PC 2N > I r-4 = F=m E 1 li I f .':11'-.1 :S F-1 F;:" F= FV.0 E: ID tjI F_ rs qF= BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE 15 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE !:--EWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: --- ------------------ 2 APPLICANT PJ,8-S 2 - ISSUED BY- _._.._..._.__...DAT E .......DATE--- L723�1 V4.0 DEPARTMENT �;, HEALTH AND ENVIRONMENTAL i TEC T I ON 1h ,unS L i rr ''L' : TF T', hit•dC=:Hr::jR.AGE. N!'::. 1!'=i=+0 bul ` — 264-4720 ^a PERMIT NO. 8105w_i'3 APPLICANT F',T.g.- 600 E BENSON 2 'i._- i :15 L OCAT I ON MC MANdt-i�' DR - � :_��€�_io6 ;QUARE FEET LL i tT �: E,L.t': � N�d� �F�:7tiWCu�iC:F •.'C:` LOT_, I •:,.E TYPE OF =COIL ABSORPTION ION'd 'SY'STEM IS: TRENCH �i `OIL RATING F-T,'E:R',= MAXIMUM NUMBER OFE�EE:"F:��i�:�ti:=• - - - THE REQUIRED SIZE OF THE ::OIL ABSORPTION SYSTEM IS: J� THE LENGTH D I MEN S I C iNd IS THE LENGTH I Fd FEET OF THE TRENCH OR. DRA i N�?F I EL r). THE DEPTH OF4A TRENCH OR PIT IS THE DISTANCE BETWEEtd THE 'SURFACIE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (INS FEET). THERE IS t•.10 SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I'S THE MINIMUM DEPTH CSF' GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE C t-!`• ATI ON•d (IN FEET). F_p ry CA u 3!t- 6,-- u-- C. f:-; L= 1=" .�- I c: ""R-_" = 1 `"-v F_- =: :2L 071 f3 9- fl"'_; F= 9 E_ . 4__ R3 !' Jl PERMIT APPLICANT Ht=!'• TFi�f:E�F'�F uj ILI7`r' TO INFORM THIS DEPARTMENT DURING THE INd'=l"ALLfTFIONd INSPECT -F •d`,' WEt_C._'; T.ACENdT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES C E'NdC:/T"_TEM HE WELL LL SERVE. :''tE. __ r-4 5 -� = 1F : �: fl. a fl_._�1 �a'F 'a "E,Ii�`f FIL C_:CNd�3 QF'. t-1Nd'rdITH� I,i 1T 1•lld=yFE�{ IiiNd tdC` !if'F'F:�_�'Y`AL. k:'r' 7HI: C:`EF'Fif=:`!t1E:NdT Cdl:LC_ E:F_Ti PROSE C:!_IT IONd. MINIMUM D I'STAr.-IC:E BETWEEN A klELi_ AND ANY Ohl --SITE EWA13E DISPOSAL `STEM IS 11:0 FEET FOR A F•RI`v'ATE WELL OR J.50 TO 200 FEET FROM A PUBLIC: WELL DEPENdDINdi3 UPON THE TYPE OF PUBLIC. WELL. m I N+1 I hium D I E, T AN•dCE FROM A PRIVATE WELL TO A PRIVATE :=•EWER LINE I := 25 FEET AND 'Tp A COMMUNITY SEWER LINE .I' 5 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE F'F:?: PER INSTALLATION. C -0E : Ems: f"I �� E - I CERTIFY THAT 1: I AM FAMILIAR WITH FORTH FOR ON-SITE _,EbIEF:' AND WELLS AS SET FORTH B THE MUNICIPALITY OF ANCHORAGE. : I WILL INduTAE_E_ THE 'SYSTEM IN ACCORDANCE w I TH THE CODES. T UNDERSTAND THAT THE Or -4 ---SITE SEWER 'SY'STEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3: BEDROOMS. SIGNED APPLICANT PJ8, ISSUED BY- b=3 L__- 6- D =G -D f' �• r� PERFORMED LEGAL DESCRIPTION l ! J ❑ SOILS LOG -MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 I ` -/ SOILS LOG — PERCOLATION TEST `✓ 1 �d� '� C ' DATE PERFORMED: �� f�IJGJ i L DEPTH Ej 2 v ' -5 S" yummy gla�i� 3- Date Gross Time 4 4- Depth to Water Net Drop 6- 6 ( Z2�e d i S%s� Ohl ` r 7 8 9 10 11 12 �o a I 41- 13 14 U AY- XL 11 15 16 9Y Pc" r ` y� d 17 18- 8 .e a 20 20 COMMENTS RA3art A. Shc • 5P 4', ;,. 1457 c SLOPE SlfE PLAN WAS GROUND WATER S ENCOUNTERED? L O P E IF YES, AT WHAT <� DEPTH? (� Reading Date Gross Time Net Time Depth to Water Net Drop p l ( Z2�e d i S%s� C Glia �o a I 41- 3 y S-0 U AY- XL 11 3 !r PERCOLATION RATE �� (minutes/inch) 'L TEST .RUN BETWEEN FT AND FT T,.. PERFORMED BY: 7�%='i'l�ix" CERTIFIED 72-008 (6/79) DA bbl X (--)-Z 0 SOILS LOG MUKIFICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: -2- Z- fe,,f-1 LEGAL DESCRIPTION: DEPTH SLOPE SlYE PLAN (aF E W) � %Sp /�� 1 al All 4,— • 3- 4- vW 5 v?. I -71 6- 7- 9- 10- 11 Date Gross Time WAS GROUND WATER :e s Net Drop 2 Z6 ;e ENCOUNTERED? LO E 16- 3 P 12 Iq 0 E IF YES, AT WHAT C4 18— DEPTH? 13 ort A. Sh 4'j 14- Date Gross Time Net Time 15- Net Drop 2 Z6 ;e E 16- 3 Iq 0 17- C4 18— ort A. Sh 4'j 14S7. 19— u 20 COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop 2 Z6 ;e E 1-3, 3 Iq C4 PERCOLATION RATE TESTF!UN BETWEEN PERFORMED BY: CERTIFIED 72.008 (6/79) (minutes/inch) FT AND FT u?' SOILS LOG MUNICIPALITY OFANG�IW� °; OF ANCHORAGE �Y( F H-A.LT'H & . DEPARTMENT OF HEALTH AND ENV[ RONW*T&L�RROTE�'F O TEST OLanON 825 L. Street, Anchorage, Alaska 99501 264-4720 \\ r SOILS LOG — PERCOLATION fis;f2 8 PERFORMED FOR: PJ & S R E CEIVTE PEED MED: April 23, 1981 LEGAL DESCRIPTION: Lot 2, Block -3, Northwood Subdivision .�H Organics and organic silt, dark SLOPE SITE PLAN brown, wet, soft, tree debris. 1 -- (Pt -OL) Gravelly -sandy -silt, light z brown, stiff, moist, with some organics. Silty -gravelly -sand, gray, moist, compact, rounded to sub - rounded particles to cobble size. (GM -SM) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? EMMEMMONN Date Gross Time Net Time Depth to Water Net Drop NNEEMENEEN 4-23-81 3:55 PM 20 Min. 19 3/4 2 3/4 EMENEMMME ■■NE■■L'■■■ 0111"EpM11 EMIIMMEM 4:05 PM 30 Min. 21 3/4 no 4 4-23-81 REEMENNEE 40 Min. 23 1/4 1 1/2 5 4-23-81 MEM IMMOM■MEMENMEMN, 24 1/2 1 1/4 6 4-23-81 4:35 PM 60 Min. 25 1/4 3/4 .MENMEM■ NEENEENEEN Reading Date Gross Time Net Time Depth to Water Net Drop 2 4-23-81 3:55 PM 20 Min. 19 3/4 2 3/4 3 4-23-81 4:05 PM 30 Min. 21 3/4 2 4 4-23-81 4:15 PM 40 Min. 23 1/4 1 1/2 5 4-23-81 4:25 PM 50 Min. 24 1/2 1 1/4 6 4-23-81 4:35 PM 60 Min. 25 1/4 3/4 PERCOLATION RATE TEST RUN BETWEEN COMMENTS PERFORMED BY: Howard Grey & Assoc., Inc. 72.008 (6/79) TE:April 27, 1981 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L Street, Anchorage, Alaska 99501 2644720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: PJ & S DATE PERFORMED: April 23, 1981 LEGAL DESCRIPTION: Lot 2, Block - 3, Northwood Subdivision Organics and organic silt, dark SLOPE SITE PLAN 2 Date brown, wet, soft, tree debris. (Pt -OL) Gravelly -sandy -silt, light brown, stiff, moist, with some Net TimeDrop Net 2 __a 6_; 3:55 PM 20 Min. ' organics. 2 3/4 3 4-23-81 4:05 PM 3�- . (GM -ML) 4 4-23-81 4:15 PM 40 Min.F251/4 1 1/2 5 4-23-81 4:25 PM 50 Min. Silty -gravelly -sand, gray, 4 6 moist, compact, rounded to sub - 4:35 PM 60 Min. 3J4 rounded particles to cobble 5 N size. (GM -SM) 14 15 1s 17 18 1s 20 e V15 Gr y' WAS GROUND WATER S ENCOUNTERED? Yes L O P IF YES, AT WHAT 13' E DEPTH? Reading Date Gross Time Net TimeDrop Net 2 4-23-81 3:55 PM 20 Min. lei 2 3/4 3 4-23-81 4:05 PM 30 Min. 2 4 4-23-81 4:15 PM 40 Min.F251/4 1 1/2 5 4-23-81 4:25 PM 50 Min. 1/4 El 6 4-23-81 4:35 PM 60 Min. 3J4 N Reading Date Gross Time Net TimeDrop Net 2 4-23-81 3:55 PM 20 Min. FDepth 2 3/4 3 4-23-81 4:05 PM 30 Min. 2 4 4-23-81 4:15 PM 40 Min.F251/4 1 1/2 5 4-23-81 4:25 PM 50 Min. 1/4 El 6 4-23-81 4:35 PM 60 Min. 3J4 PERCOLATION RATE 15 , ®`%% mutes/in TEST RUN BETWEEN _4�s,�,, COMMENTS 0 P •• s•� + Howard Grey & Assoc., Inc. PERFORMED BY: y CERTIFIED B e I •eae•s,e• e.ee. ee •ee ee a•e •• ca Richard A. Lowman or April 27, 1981 x 5, �o Gp °moo 190 K 8 Parcel I.D. 051-731-38 Municipality of Anchorage z u ... On -Site Water and Wastewater Program (907)343-7904 saeery. Certificate of On -Site Systems Approval Expiration Date: -6 - 6 — 1. GENERAL INFORMATION Complete legal description North Woods, Block 3, Lot 2 Location (site address) 22432 McManus Dr Current Property owner(s) Robert and Regena Evans Day phone Mailing address 22432 McManus Dr. Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System El Public Sewer ❑ WaiverNariance Received by: Date:I3 Z6i S COSA to be released to the ng' eer, unless otherwise requested by the engineer. COSA Fee $ 622:k '/ Date of Payment '?1a-76 5 Receipt Number 000M COSA #_ ©5CIS�5?— Waiver Fee $ Date of Payment. Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation dateetiown 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. In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907)272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone Date 7/21/2015 6. DSD SIGNATURE r _kz System #1 Approved for bedrooms "t$iever i2. am CE -8149 System #2 Approved for bedrooms - Disapproved �ES9 Conditional approval for bedrooms, with the following stipulations: uy, L f 10s LYJ s� - viiyntal ueiflflCatc Date:_ Th4 n f ®rage 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. ATTACHMENTS: COSA Checklist X• Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA We sheet t. -, c If more than 1 septic system is on the lot: COSAChecklist# ± of 1 Structure served by this system 1 T Certificate of On -Site Systems Approval Checklist Legal Description: North Woods, Block 3, 4ot 2 Parcel ID: 051-731-38 A. WELL DATA Well type Public If A, B, or C provide PWSID # AWiR%fJ' Well Log (Y/N) Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth % Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./Steel Date installed 06/21/1998 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over(t�ank (Y/N) N High water alarm (Y/N) Y Date of pumping 29 6r5 -Pumper_�6 IT�(^� PUMpegs C. ASSORPTIONTMLD DATA Date installed 06/21/1998 Soil rating (g.p.d./fiz or ft2/bdrm) 0.5 GPD/SF System type Mound/Bed Length 60 ft. Width 15 ft. Gravel below pipe 0.7 ft. >F Total depth 4.4 .fl. Eff. absorption area 900 ftZ Monitoring tube Y Depression over field N Date of adequacy test 05/06/2015 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added 498 gal. New depth 8. in. Elapsed Time: 140 min. Final fluid depth 3 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes; give date D. LIFT STATION Date installed 06/21/1998, "Pump on" level at 42 in. Datum Bottom of Tank Size in gallons 250 Manhole/Access (YM) Y "Pump off"level at 40 in.' High water alarm level at 44 in. Cycles tested -_ Meets alarm 8 circuit Meldirerrnts? E. SEP*RATiON DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septid-service line 25± Animal containment areas 50+ On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 1(}0+ Holding tank 100+ Manure/animal excrete storage areas 100+ - - -SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main .10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+` Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS System is at 90% Capacity *Added 28-�of insulation over entire field G. "ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the- above systems are in conformance with MOA COSA guidelines in eSect on this date. Engineer's Printed Name Steven R. Pannone Date 7/21/2015 . COSA canary sheet 2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 1.0+ McMANUS DRIVE LO io N N Valve 1 Elec. Pedestal--`� 15 Utility Easement Tele. Pedestal a N N IFlag Pole m Asphalt Drive SCALE 1 " = 20' Steps -I & Landing 0' 10' 20' 40' PCC LOT 2 BLOCK 3 Wood Shed (No Foundation) in 0 E Chain Link Fence LOT 42 1 LOT 41 LOT 40 1 hereby certify that an accurate survey of the following described PREPARED FOR: `.++tIk1kjkyt property: ..OF.A1q+t+ NORTH WOODS SUBDIVISION (79-195) PANNONE EN( p ; •• J �I LOT 2, BLOCK 3 r TH �c,� was made on June 17, 2015 and that the improvements 49 ;,,,, ,,, I situated thereon are within the property lines and do not overlap or —B AS encroach on the property lying adjacent thereto, that no 2••••••••• • improvements on the property lying adjacent thereto encroach on 0W' DATE Lee lnikoff: the premises in question and that there are no roadways, JSP 6/24/201 No.. 314 3143-S transmission lines or other visible easements on said property except FltF N0. F.B. 2015 �D�•dtZyp +' as indicated hereon. Easements other than those shown on the 1530 PG. 21 +� SSONa +�� �i��+� KARABELn record plat may not appear on this drawing. li Anchorage Alaska, this 24th day of June 2015. C/ /9)1/f:-VIAII Bi—Level Wood Frame 1 ro Residence on Concrete ° Block Foundation n o LOT 1 ro LOT 3 z 19.7' Upper Floor o o Wall Line 0.8' x 1.1' .7 0 Cantilever N `v 42.6' Wood Deck Upper 15.2' Floor Level Wood Steps & Landing Storage Under PCC Pad Woad Deck ° Lift Station Man Hole `Clean Out (Typical) LOT 2 BLOCK 3 Wood Shed (No Foundation) in 0 E Chain Link Fence LOT 42 1 LOT 41 LOT 40 1 hereby certify that an accurate survey of the following described PREPARED FOR: `.++tIk1kjkyt property: ..OF.A1q+t+ NORTH WOODS SUBDIVISION (79-195) PANNONE EN( p ; •• J �I LOT 2, BLOCK 3 r TH �c,� was made on June 17, 2015 and that the improvements 49 ;,,,, ,,, I situated thereon are within the property lines and do not overlap or —B AS encroach on the property lying adjacent thereto, that no 2••••••••• • improvements on the property lying adjacent thereto encroach on 0W' DATE Lee lnikoff: the premises in question and that there are no roadways, JSP 6/24/201 No.. 314 3143-S transmission lines or other visible easements on said property except FltF N0. F.B. 2015 �D�•dtZyp +' as indicated hereon. Easements other than those shown on the 1530 PG. 21 +� SSONa +�� �i��+� KARABELn record plat may not appear on this drawing. li Anchorage Alaska, this 24th day of June 2015. C/ /9)1/f:-VIAII MUNICIPALITY OF ANCHORAGE RECEIVED DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services JUN 2 4 1998 On -Site Services Section P.O. BOX 196650 Anchorage, Alaska 99519-6650 MUNluPHUTY OF ANCHORAGE NVIRONMENTAL SERVICES DIVISION 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 05 -/ 7 313 S HAA # V\M9\n\,4E1 1. GENERAL INFORMATION Complete legal descriptionVvi TkW-'ae-4 1,4'! '), Woc-k Location (site address or directions) Li 3 2 A'&- •N%r7rAs per, C A uQ i•C1 k 14k vets -d k .Property owner`'C.Fjrr f �� �6�,f« zT/,- 7- Day phone Mailing address 2'x:,`/32 /1l�NL,>�,S b.- CLQ 2,•uk Ak qC/ Lending agency Day phone Mailing address Agent , 11 %i Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water LSC NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public`sewer NOTE: 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 F;. STATEMENT NT OF INSPIFCTICN CSV 1ENGINEER 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. Name of Firm Phone Address Engineers signature — r_'� Date 1064 -T 0 a Golfo �0°ege�oL3ueegdo ooa'oopio n»�sra _,o ° Louis %° 6. DHHS SIGNATURE ��A ��°"e5®����• Approved for E bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: i% 1r/ J ot-� Date �- 9 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. 1/91) Back MOA P21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERvR C i V D Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (9Qj)PZ@44T Health AuthorityApproval Chec Municipality of Anchorage pp ld . Health & Human Services Legal Description: /V-11714 w +r° Ler 2n 131 � - Parcel I.D.: O5-/ `7 3 f 3� 8 A. WELL DATA ewm'71 WaTer Well type Log presen /N) _ Total depth Sanitary seal (Y/N) _ Date of test Static water level Well production WATER SAMPLE R Coliform Da of sample: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Casing h FROM WELL LOG B. SEPTIC/HOLDING TANK DATA Date installed '%' Tank size Foundation cleanout (Y/N) 9 -P.M. Nitrate Collected by: ground) protected (Y/N) AT INSPECTION Other bacteria Number of Compartments Cleanouts (Y/N) Depression (Y/N) High water alarm (Y/N) Date of Pumping Pumper C. ABSORPTION FIELD DATA Date installed �` �� ` �� Soil rating (g.p.d./W or ft2/bdrm) System type w` oClk4e7l� Length �� Width /� Gravel thickness below pipe s~ Total depth % d Effective absorption area Monitoring Tube present (Y/N)--Y— Depression over field (Y/N) ✓V Date of adequacy test iVA Nuy Results (Pass/Fail) l�t=� For 3 bedrooms .NA Flu -id -depth -in -absorption field before test (in.); Immediately after_ gal. water added-(im): Fluid depth (ins) Minutes later:----'rption rate = g.p.d. Peroxide treatme,nt-(pn-s`t- 2 onths)(Y/N) r If yes, give date ---•- 72-026 (Rev. 3/96)' D. LIFT STATION Date installed K__ '162— 6M Manhole/Access (Y/N) High water alarm level at* Cycles tested /f/ tw E. SEPARATION DISTANCES `1 y JUN 2 4 1998 Ari. if P._JPALI I Y OF ANCHORAGE 1RONAhENTAL. SERVICES DIVISION Size in gallons yA///dD>S "Pump on" level at* Lid "Pump off' level at* `7J� *Datum T4-tik. SEPARATION DISTANCES FROM WELL ON LOT TO: /VAS w"`r`=r +/v 75 1411 Septic/holding tank on lot Absorption field on lot Public sewer main Sewerls c service line On adlacen ts— On adjacent lots manhole/cleanout Lift station ' A/u tea r v„ 7cr �I f.,' �-r S 7 liG✓/ `\ SEPARATION DISTANCES FROM SE-Pi10/I#@tDIN&T*W ON LOTTO: Foundation to r Property line 30 / Absorption field 19 Water main/service line f s a Surface water/drainage IVA Wells on adjacent lots f 2 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: r � Property line to Building foundation /0 Surface water /V4 Water main/service line r -moo Driveway, parking/vehicle storage area 12 C� Curtain drain oktioow� Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that l have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature) Engineer'sName Date G1� e &irf HAA Fee $ :� (j() , Date of Payment (-�r� 1 Receipt Number �7i 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number +- -Z0e_j "' ."Goes CE -6736 are 13DIV11)E-I N0002'44'W r I I I 889059?dW 231.32 � w 30.00 -- 181.30 O of fl s — -- N w 1 y ^J Its 1» NORTH I 201.30 N 0 _ 1 I 0 I O In w <I ___201.29 _. 0 I I N .40 Io O16 O N IO co dpl N NORTH i p N 1 0 O 4s 10 1© 4 ry 1 � I 1 ! 201.26 O Ln IO O IO it 201.24 O Q10 0 10 O A 10 I o� ® O N 0 (] I� 10 1 U O N O N 10 IO I Rad NORTH a Ip _ 201.?_! N (X) 1 I w 1f0 N (f1 � c0 OD �/ cn O�iiO�f%ta Qo>� w w 0 (p O A � N �Q 200.00 w CJ -W t 200.001 i QO � ulro Ch n 3d 1 3C 30, 1 30' w CL O &I -`t9- N 1 GNi gp21 6'i ONS; 0 09 MA w r 0 N v 180 25 2e i i ID 01 0 NOR �I 200 c] o OD 0 U1 200. OI N OO O) � n tD C O b -- O of fl 179.98 — -- 01 0 v p U N 0 _ 1 ' to NORI 20A.( w ro 0 O 'm �- N NORTH dpl N NORTH (D N 2o0.A0 O 200.00 U I o� ® ro a Ip aI o 1f0 200.00 _ 200.001 ulro n a i0 O� O W iq I cn 200.00 200.00 W 0 10 ri, 10 1 200.00 2ao.®n OI N na p 0 10 o 01 0 00 O O cn I I0 I ®I � iN7 ON 070 I O 10 b 0 e 0) 10 r /~ NORTH 1 1 -I 20]8.00 200.00 h N P I N 0) w m NORTH Rad N — 2c70.00 s M,( 0O� L n O &I -`t9- N 1 GNi gp21 6'i ONS; 0 09 MA w r 0 N v 180 25 2e i i ID 01 0 NOR �I 200 c] o OD 0 U1 200. OI N OO O) � n tD C O b O of fl V 01 0 v U1 �w NORI 20A.( ro oyV O ' N w dpl N (D N � O o ® V '•5 W oyV N O � O o J MUNICIPALITY OF ANCHORAGE U Y DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -94 /W el 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) A ff (b) Applicant Name �6 41 l,--rVephone: Home 0 Business Applicant Address 17-e fe- "7 0 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institution��� Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING SR B 196X EAGLE RIMER, 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well 11Community 11 Public /I U �U4,0-o"o-e'l� Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 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 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDINU41NISPECTIONS, TESTS, FILE SEARCH, DA -s -A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm RMICCK d Telephone � Address Date E®Z9 ERftMRA V OOr.� . 4S�! OF A <.4 _„an®0000.. ^se�AA< i 8 A. S11 o< IV.. o t� Doe Q Pn Ce owe ao oo®..a1Q�..e� . 6. DHEP APPROVAL Approved for bedrooms by nn. Date 2/f 7) Approved il/ Disapprov Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. AGE �OOff 0' MUNICIPALITY OF ANCHORAGE (MOA)J HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: L2– BLiC-3 NoR.T-H W aj> VO WELL DATA �� �t-i PAt If A, B, C, D.E.C. Approved Y/N Well Classification PP ( ) Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Depth of Grouting — Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Water Sample Test Results Comments (r�RTHyyoob w_AATc'Z 5Y576A B. SEPTIC/HOLDING TANK DATA Date Installed Size 1000 No. of Compartments Foundation Cleanout ((YQ} / / Date Last Pumped VI 8-(P Pumping/Maintenance Contract on File (Y/N) "( ; for Holding Tank High -Water Alarm (Y/N) tjA Temporary Holding Tank Permit (Y/N) Z' Standpipes (&N) Depression over Tank (YJ& Air -tight Caps (CIN) +h Separation Distances from Septic/Holding Tank: To Water -Supply Well Z oo' f To Property Line To Water Main/Service Line N/ N l o`4 10? 4, To Building Foundation To Disposal Field5,�4., To Stream, Pond, Lake, or Major Drainage Course Comments/ c a cenlcyl%.P�zo i9+✓!9 Ex T/=k/d�cr% Page 1 of 2 72-026( 11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata5/Type of System Design 3 Date Installed Lelt13 S(P Length of Field - 3Its � Width of Field Z 1 Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 7%B 9 Standpipes Present O/N) Depression over Field (Y6 Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Date of Last Adequacy Test�/A& To Property Line To Existing or Abandoned System on Lot N/ A- ; On Adjoining Lots -16 i To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 5 Comments &FG✓ A4 7: W A-$' /NS 74 cc r - g i tiJ 0S'.J ez e- ,geb D. LIFT STATION Date Installed Dimensions Size in Gallons A Manhole/Access (Y/N) "Pump On" Level at 'Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify t�lgj��d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed SR B 19AX Date �I /igG Compar AGIE WER AK9967i7 MOA No 010-_r Receipt No. .2 !� Date of Payment Amount: $ Zli Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGENESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: l�� PWS I.D.# /331a To Whom it May Concern: BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 According to records on file in this office the In 64 Ak wl ,a d we, % Water System is in compliance with the State Drinking Water Regulations Sincerely,