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HomeMy WebLinkAboutPRATOR BLK 9 LT 2Prator Block 9 Lot 2 #017-091-33 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231184 Work Type: SepticTank Upgrade Tax Code Number: 01709133000 Site Legal Address: PRATOR BLK 9 LT 2 G:3039 Site Mailing Address: 14540 FERNHILL CIR, Anchorage Owner: QUEBMAN ANDREW & KRISTINA Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: U � O .V Department Lot Size in Sq Ft: Total Bedrooms: 7/14/2023 7/13/2024 49251 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 15 s C/ r- wC Received By: Date: Issued By: (� Date: MUNICIPALITY OF ANCHORAGE 0, Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-091-33 Property owner(s) ANDREW & KRISTINA QUEBMAN Day phone _ Mailing address 14540 FERNHILL CIRCLE, ANCHORAGE, AK 99516 Site address 14540 FERNHILL CIRCLE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) PRATOR BLOCK 9, LOT 2 Legal description (Township, Range & Section) Lot Size 49,251 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade X (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage . ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Z Z Waiver Fees: Date of Payment: Date of Payment: r Receipt Number:(!� Receipt Number: Permit No. t 1 S(n Z 3� t S'i Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 27, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: PRATOR BLOCK 9, LOT 2 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 3 -bedroom residence. A 1500-gallon HDPE tank will be installed for future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The existing septic tank was installed with a required 50’ setback to private wells. The existing service line and septic system (tank / field) will be excavated and adjusted to make elevations and continuation of a gravity-fed system. To do so an Infiltrator with side entrance and exit inverts may be needed or if needed a 1500-gallon STEP tank will be installed. Any tank installed will be constructed per code. The new tank will be of better material than the existing septic tank and per the area data there is silty soils and lower nitrate levels. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231184, Curtis Townsend, 07/14/23 FIRST WATER CONSULTING PRATOR BLOCK 9, LOT 2 DESIGN DETAILS: SERVED BY PRIVATE WATER NO WELLS W/IN 100' OF PROPOSED SEPTIC TANK . STAKE WELL RADII & ANY OTHER REQUIRED SETBACKS PRIOR TO CONSTRUCTION. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231184, Curtis Townsend, 07/14/23 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 NAME I PHONE llct L - -1(4 E] NEW [P- PGRADE MAILINGADgr ES . pp LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Uy DISTANCE TO: W Absorption area Dwelling PERMIT NO. F_ Z aQ WI. - Manufacturer Material No. of compartments (A Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth _j (DZ DISTANCE TO: Well Dwelling PERMIT NO. = Z F Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well ; FoundationNearest 3 lot line ) PERMIT NO. LU J LL Z H Z w No. of lines Length of each line E Total length of lines ) Trench width inches Distance bet en lines ! , HTop of tile to finish grade f Material beneath tile "LZ. inches Total effec ive absor tion area W Length Width Depth PERMIT NO. a aI- W Type of crib Crib diameter Crib depth Total effective absorption area W y DISTANCE TO: Well Building foundation Nearest lot line J J CIDepth Driller Distance to lot line PERMIT NO. WV DISTANCE TO: Buildingfound tion Sewer line Septic tank Absorption area ) OTHER PIPE MATERI LS •- SOIL TEST RATING / J INSTALLER �n � /).41 L REMA ISS D VOIq 4z,, e 5 i t 3- A PRO ED DATE LEGAL (2 9 72-013 (06. 3178) / THE REQUIRED SIZE OF THE SOIL L F=1BSORPTII_N SYSTEM IS: THE LENGTH DIMENSION I THE LENGTH (IN FEET) OF THE: TRENCH OR DRA I NF I EL.. D. THE: DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE CE ►MSF THE. GROUND AND THE:: BOTTOM OF THE: EXCAVATION 0N FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE: MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFAL.L. PIPE AND THE BOTTOM OF THE EXCAVATION 0N FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT T Di. RING THE: INSTALLATION IP•d': PECTIONS OF HP`d'r WELL_' �, ADJACENT TO THIS PROPERTY AND •'l"HE C'di_IMBER OF RESIDENCES THAT THE WELL WILL SERVE. _ -T" 1.4 (3 < ^.._.. _"x :I: PA "...w F " EEn � -ll1: Cor -A' f.•-1 F•Q EV F" E= PCD 0._9 IF. F" EE E:C BACKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION {"•iND APPROVAL BY THIS DEPARTMENT WILL. BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE B TWEEN A WELL AND ANY ON—SITE ITE EWAGE DISPOSAL S YST..EM IS 100 FEET FOR A PRIVATE WELL: OR 150 TO 200 FEET FROM A PUBLIC WELL. DEPENDING UPON THE Ti'f='f OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPL'Y'. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS r• RE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENT: FOR ON—SITE SEWERS AND WELLS AS SET FORTH H B Y' THE: MUNICIPALITY OF HP•dCt-IORAGE:. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE CE WITH THE ta:ODF_'`:;;. . I UNDERSTAND THAT THE ON—SITE ' EWER SYSTEM MAY REQUIRE ENLARGEMENT I F THE RESIDENCE IS REMODELED TO INCLUDE DE t'1ORE THAN 3 BEDROOMS 0 1 u21.1,vi APPL I Q:1 T WA Y NE. ROVi'1AGOU.>, — f �u ��7�% DEPARTMENT Ol -:EAL_TH AND ENV IROY• ME:t•4`fF=1l_ �::T �►t�" % — .. 1.. 5 "L' STREET: ANCHORAGE, AK va°-� t��;j 264-4720 91-1-111 � co bj -_ n= s 3: PERMIT NO. ( 790421 : APPLICANT WAYNE ROUt'1A iOl..► •--; SRA BOX 446M 344 8447 LOCATION UNtk:: LEGAL_ LOT 2 BLK '9 PRATOR SUB LOT SIZE 43560 SQUARE FEET TYPE PE: OF SOIL ABSORBT I ON SYSTEM I S : TRENCH MAXIMUM NUMBER OF BEDROOMS = _ SOIL. RATING (SO FT;' BR) = ::Li r_'; THE REQUIRED SIZE OF THE SOIL L F=1BSORPTII_N SYSTEM IS: THE LENGTH DIMENSION I THE LENGTH (IN FEET) OF THE: TRENCH OR DRA I NF I EL.. D. THE: DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE CE ►MSF THE. GROUND AND THE:: BOTTOM OF THE: EXCAVATION 0N FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE: MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFAL.L. PIPE AND THE BOTTOM OF THE EXCAVATION 0N FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT T Di. RING THE: INSTALLATION IP•d': PECTIONS OF HP`d'r WELL_' �, ADJACENT TO THIS PROPERTY AND •'l"HE C'di_IMBER OF RESIDENCES THAT THE WELL WILL SERVE. _ -T" 1.4 (3 < ^.._.. _"x :I: PA "...w F " EEn � -ll1: Cor -A' f.•-1 F•Q EV F" E= PCD 0._9 IF. F" EE E:C BACKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION {"•iND APPROVAL BY THIS DEPARTMENT WILL. BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE B TWEEN A WELL AND ANY ON—SITE ITE EWAGE DISPOSAL S YST..EM IS 100 FEET FOR A PRIVATE WELL: OR 150 TO 200 FEET FROM A PUBLIC WELL. DEPENDING UPON THE Ti'f='f OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPL'Y'. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS r• RE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENT: FOR ON—SITE SEWERS AND WELLS AS SET FORTH H B Y' THE: MUNICIPALITY OF HP•dCt-IORAGE:. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE CE WITH THE ta:ODF_'`:;;. . I UNDERSTAND THAT THE ON—SITE ' EWER SYSTEM MAY REQUIRE ENLARGEMENT I F THE RESIDENCE IS REMODELED TO INCLUDE DE t'1ORE THAN 3 BEDROOMS 0 1 u21.1,vi APPL I Q:1 T WA Y NE. ROVi'1AGOU.>, �..�GREi' R ANCHORAGE AREA BOF "IGH uult Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ��il/,1�CJ1� ✓� MAILING ADDRESS '�� //�//� %� i� PHONE -2-7 ?? S -C2 Z -5G27 LOCATION��r �i`�� LEGAL DESCRIPTION ��� f�L/lig��T Ste= SEPTIC TANK: ��>.f�i�✓� /��L�����o�i. DISTANCE /��'� NUMBER OF FROM WELL �I /L MANUFACTURER-,- MATERIAL —COMPARTMENTS / INSIDE LENGTHS INSIDE WIDTH LIQUID DEPTH `— LIQUID CAPACITY," �L GALLONS. SEEPAGE PIT: NUMBER OF PITS. DIAMETER OR WIDTH,;, LENGTH _�Z-T DEPTH LINING MATERIAL CRIB SIZE: DIAMETER DEPTH G> DISTANCE FROM: WELL-_� TOTAL EFFECTIVE BUILDING FOUNDATIONc) , NEAREST LOT LINE�5'- . ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION /4'x�_L•— WELL: TYPE CONSTRUCTION CONSTRUCTION � DEPTH lJ�� ` DISTANCE FROM: BUILDING / FOUNDATION/_Z NEAREST NEAREST LOT LINE Z-2/2 SEWER LINEI�-' p7Z�r��J/� I SEPTIC SEEPAGE , TANK �, SYSTEM � CESSPOOL��I/G �'- OTHER SOURCES G�✓Zcl//�/G' �G�i�.G��/tel-�iDt�i✓G�.�G���-� APPROVED DISAPPROVED REMARKS.�Z2/9/�//�/i�� Gds/��•�c'�Si/% �� /r����� DISTANCES: INSTALLED BY:���Gy% PIPE MATERIAL: 2 CWT /' /,-Z'/I/ LOT SLOPE: REMARKS: 17" Form No. EQ -031 DIAGRAM OF SYSTEM DATE ZZ. APPROVED C G.A.A.B. S t t � DATE ZZ. APPROVED C G.A.A.B. ��IMRIpE 5Fp t9i o F 9 p�Mi2 K�• �o� GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 -p„ SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT /o /! / (/-� NAME OF APPLICANT � ^ V 21 MAILING ADDRESS (jam 9 ��� � �, ` PHONE�� INSTALLATION LOCAT LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH CFFPAI_r PIT TO BE INSTALLED BY DRAIN FIELD , OTHER SOIL TEST RESULTS NOTE- THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE le:; TYPE MINIMUM DISTANCES, REQUIREMENTS i FOUNDATION TO SEPTIC TANK 2a FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD 00 Z-11519 - SEPTIC TANK . SEEPAGE PIT DRAIN FIELD TO �N�rEAREST' LOT LI/N WELL TO S1'1/EfPTI TANK . SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD - SEEPAGE PIT % _ f d SEPTIC TANK, S , SEEPAGE PIT /i`' DRAIN FIELD TO RIVER, LAKE, STREAM. E AREA SIZE CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGUL TIONS REGARDING INSTALLATION. G.A.A/ OR LICENSED DESIGNER IGNER TYPE DIAGRAM OF SYSTEM 1 CERTIFY THAT 1 AM FAMILIAR WITH THE R 1REMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDA C ITH SAID CODE. DAT EL' �� �� �� APPLICANT'S SIGNATURE FORM NO. EQ-Oi 6 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY Case # 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For Dated Performed Legal Description : LotB1 o c k o S u b d i vi s i on This Form Reports Soils Log x Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet Soil Characteristics Was 2- -3-4-5-6- 3- 4- 5- 6- 7-8- 7- 8- 9- 9-11 10- 11 12- 2-13-14 13- 14— Was Ground Water Encountered? y/0 If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H2O Net [drop i J Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit or Trench COMMENTS: 49 ``66-4,1.— 711- 'F/, ofioi Test Performed BY Date Certified BY: Date: .r GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY Case 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For e - Dated erformed--6 p/� -� Legal Des cri pt4on : Lot _B1 o c k 67Subdivision 'Pre -o (- This Form Reports Soils Log Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics 1 — 2- 3- 4- 5- 6- 7- 8- 9- 10- 11 - 3- 4- 5- 6 - 7— s -- 9-10- 11— ; 12- 13- 14—,--/ 2-13- 14- a6- 15'at.4� p nxU'Q( Was Ground Water Encountered? no If Yes, At What Depth? MMM ME= mnommmmm Reading Date Gross Time Net Time Depth to H2O Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit or Trench — COMMENTS: :20S- 7�t Test Performed BY Date Certified BY: Date: Parcel I.D. 017-091-33 1 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval GENERAL INFORMATION Expiration Date: & /7// f Complete legal description PRATOR BLOCK 9 LOT 2 Location (site address) 14540 FERNHILL CIRCLE, ANCHORAGE, AK 99516 Current Property owner(s) WILLIAM MORSE Mailing address Real Estate Agent BARBARA MICHELSOHN Day phone Day phone 230-5577 2. TYPE OF DWELLING: ® Single Family (w/woADU) 6{ . ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) MAR 4 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual FXl Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ PUIV yJe ❑ ULJlli ae]eYYel 7_1�arme WaiverNariance request for: NONE Distance: --- I �1 Received by: I✓ �1� 1-- �� Date: i— r COSA to be releaLd4d 1h, err' neer, unless otherwise requested by the engineer. f COSA Fee $ 5d' — Date of Payment 3/ Receipt Number baPio'�5G COSA# 0SCIgio�7 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 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 SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE r/� System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone 279-3916 Date 3/3/14 A � E .. r �fe Am 1 t ` 3�( Conditional approval for bedrooms, with the following stipulations: By:(Z Original Certificate Dater Z2 ZZ The Municipality of Anchorage evelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations give 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r , ,. If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: PRATOR BLOCK 9 LOT 2 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed 1973 Sanitary seal (YIN) Y Total depth LINK ft Cased to >40 ft. FROM WELL LOG Date of test LINK Static water level LINK Well production LINK WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Arsenic ND ug/L Date of sample: 2/19/14 Parcel ID: 017-091-33 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 1/30/2014 ft. 73 ft. g.p.m. 7.1 g.p.m. Nitrate 1.7 mg/L B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments Foundation cleanout (Y/N) Y Date of pumping 10/2/13 Collected by: ANSON MOXNESS Date installed 9/14/73 Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 8/1/79 Soil rating (g.p.d./ftz or fiz/bdrm) 166 System type TRENCH Length 44 ft. Width 3 ft. Gravel below pipe 72 ft. Total depth 11-3 ft. Eff. absorption area 528 ftz Monitoring tube Y Depression over field N Date of adequacy test 1/30/14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added 460 gal. New depth 19 in. Elapsed Time: 15 min. Final fluid depth 14 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date - D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump ofr level at Datum Cycles tested - E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 50+ Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main NA Water service line 10+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10'+ Curtain drain 50+ F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water 100+ Wells on adjacent lots100 + I certify that 1 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 LARS SPURKLAND Date 3/3/14 COSA brown sheet 10-10-12.doc Absorption field 51+ Surface water 100'+ Water main NA Driveway, parking/vehicle storage 10' �OF.A.t 1! !4111! sP00Kv,Nj in. 3 I I I 299.44' N90° 00' 00"E I I I , f � N o LU I W I ! GARAGE W o FI I o W l z o I O I 00 .......:_ .. ......... _.GR.� eo'l I o zU' _ 132.7 42 c I I C. N I I = X I 1 I I las' I 1 W I LL I I I I 20, I N89° 57' 30'VV 299.30' 3 I UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE ONES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. El LOT gmwv SURVEY TYPE SYMBOLS ❑ Fp1ND0kT10N As-euILT - SET REBAR ' DRAINAGE ASPHALT ❑ FNUL SmOCTtNff A5-amr ❑ PUN! AS-BURT LOT SUft1ET TWO RM Y O FOUND REBAR a.�..: �"�$ WOOD FENCE '-..: CONCRETE PLOT ... ... ... ODB ASSUMED ELEV. X X X METAL FENCE ® WOOD DECK T - .. CtlbKBS SET REfFRIIFI(J.IN1N AS-BURT ... NO CORNEASWT PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN, FENCES, WELLS. SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS. TO FINISHED GRADE AND UTIUTY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. suRvEY cER'nnCAn0N �����,, b� Prepared by Robert E. Johns, Jr. & Assoc. PLOT i'LNI m. Nt swi r ..e..a wo. r mr ............ AVP; • ""•j AV _. ' . Professional Land Surveyors ee.. A..r n eretAra a a aw>r m.r. r GJ �••� �� 1700 Fink Drina ANCHORAGE. ALASKA 99504 o-re. rew'.Ar aswea. sew s«. + / =f Rec. Lot S.F. Rec. Plat Re No. FOUNDATION AS-BUILT Rawl a +eN. r. s•+r e.tNT mel i A�we.....a...... am. u r s.t a Yn �•••. •y.. .. ,..: ...= • ........... t..... Scale: 1„ ! 0' 1 — SL Date SUTYB3Sd: 02/18/14 Drown UTc REJ Gheeked nyM K 1 ra,.rlsi a M. - P.� RHR c- Ns• 02!1914 3039 14-43 FINAL STRUCTURE AS-WILT •� a� :,� ¢t iA� .. Legal Description: L Asst C Jdew. r.. YwM WKY met r bw P.�w•r At!/ ...Y r .w e. .. .' Cj� • e, •.............. a Lot 2 Block 9 6nenNmru,tl�.eeve...'m wr"ia ,er'i�' ♦��' �oteasbnot �'���� ��.....•. PRATOR ,�,., a,.eN. 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# ���1—�`�1"� HAA# 1. GENERAL INFORMATION Complete legal description Lot 2: Block 9; P4ato,,. Su.bdivil,on Location (site address or directions) 14540 Fenn Hitt Ci&Cze- Anchon.aci e., Ata.6 ka Property owner At. ,te.d Cotti" Day phone 345-2646 home. 276-7840 wonli Mailing address 14;40 Fea4? Hj�PP 0jhrFe, Ay1Chnaaae, A&Aa Lending agency NSA - ATTENTION: Ruth LaBann Day phone Mailing address Anchokage, Atka Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX_ Community well Public water 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 XXX 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 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 an 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 17034 Eagle River Loop Road No. 204 Address Engineer's signature 6. DHHS SIGNATURE % Approved bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Prior to 1983, there were no code requirements for tank, However, r1ijp_t-n t -hp nrnximi t�7 of this we Ll to the tank,we recommend that the tank be removed. Date By: 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -1 -Il -6,cr 11 l?g�-r-z>L p Parcel I.D. A. WELL DATA 1J Well type ����� If A, B, or C, attach ADEC letter. ADEC water system number SIA Log present (YA tj Date completed 19 -7 3 Driller �< Total depth 220 Cased to '40�+- Casing height 12" } Sanitary seal DN) Date of test Static water level Well flow Pump level Wires properly protected &N) m FROM WELL LOG AT INSPECTION QZZ Z Q M D 3n to 3 e_ N g.p.< Az g.p.m. rn �p �'�- p � < T. SEPARATION DISTANCES FROM WELL TO: 0 7- Septic/holding Septic/holding tank on lot 50++ ; On adjacent lots C) C) �1bOtY Absorption field on lot 11 LOcD { ; On adjacent lots Public sewer main �f Ik Public sewer manhole/cleanout Public sewer service line ~ Petroleum tank U:: �2 S I►.1sc��? �-►� rte- -rz� � � �3 WATER SAMPLE RESULTS: J �•1 �t �+� • Coliform b I (o�+w-Q. Nitrate Other bacteria 1J O iJ S & S ENGINEERING Date of sample: 8 ' S— ` 1 Collected by: 17034 Eagle River LOOP Road No. 2� Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed �' "�i Tank size Al -50 Compartments Cleanouts &1 VN) Foundation cleanout (Ya a Depression (Y& '- High water alarm (Y&) Alarm tested ( fI'dj- ��✓� Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: y , A- Well(s) on lot 1 On adjacent lots loci Foundation a - To property line o Absorption field t Water main/service line 1 n Surface water/drainage -too 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level _ Meets MOA electrical co "Pump on" level at Manufacturer Manhole/Access (Y/N SEPARAIIG-fq-DISTANCE FROM LIFT STATION TO: I on lot D. ABSORPTION FIELD DATA On adjacent lots --- "Pump off" level at Cycles tested Surface water _ Date installed � --79 Soil rating 1 U U k& System type uA Length 4" Width 3� Gravel thickness C.- Total depth Total absorption area _. 243 `a Cleanouts present ON) Depression over field (Y& Date of adequacy test 8 - -7 — 9 ( Results(Qas _ fail) ?PSS for bedrooms Peroxide treatment (past 12 months) (YQ n%o/JE /l,< 0dJ OJ If yes, give date /4/,4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100 On adjacent lots 1 t_C:� Property line } To building foundation 13� To existing or abandoned system on lot ' i I1, � On adjacent lots �� Cutbank "s [�• Water main/service line 1 Surface water 1 d C> Driveway, parking/vehicle storage area 30' 4 - Curtain drain _ ' 1PK E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on_ the date of this inspection. t Signature Engineer's Name 17034 Eagle River L•eR Read No, Z/{ Eagle River, Alaska Date _ �- �� `J/ c1I r,.r nim `Gad `iUFf:S51t}'t� r,, C i HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number LABORATORY CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORRoider# 36913 Date Report Printed: AUG 7 91 @ 16:42 Client Sample ID:L2 B9 PRATOR S/D Client Name :S & S ENGINEERING PWSID :UA Client Acct :SNSENGP Collected AUG 5 91 @ 14:15 his. BPO 4 PO # NONE RECEIVED Received AUG 5 91 @ 16:20 his. Req # Preserved with :AS REQUIRED Ordered By :R. SHAFER Analysis Completed :AUG 7 91 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING Released By 2) Chemlab Ref #: 913906 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N 0.74 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than %" SGS Member of the SGS Group (Societe Generale de Surveillance) Time APPLIC AT FILLS OUT UPPER HAL. .ONLY Property, -Owner Phone Mailing Address j / Zip Code - Buyer Date Date Address Date { (� �} C91 Mtn-, Zip Code Lending Institution Inspector Phone Address Zip Code Realty Co. & Agent �L.G ^} L �. Phone Address Zip Code Field IN ted Legal Description' r_ G- t� — ' % ' l Street Location 4 _ A�; j' Type of Residence Ei? Single Family RECEIVED ❑ Multiple Family No. of Bedrooms ( ) DISAPPROVED ❑ Other (. ) CONDITIONAL APPROVAL` ` '63 Water Supply lel` d- ividual BY: ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community Date Sewer Installed Well To Absorption Area C� For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility 0\,CV Well to Tank Sewer Disposal �� (rYlndividual Year Individual Installed: C ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date { (� �} C91 Mtn-, Date Inspector Inspector Inspector Inspector Field IN ted MUNICIPALITY OF ANCHORAGE T.OF+ ENVIRON1,4'LrNTAL PROTECTION 0� 198 - RECEIVED ( Z4 APPROVED BEDROOMS `CONDITIONS OF APPROVAL ( ) DISAPPROVED (. ) CONDITIONAL APPROVAL` ` '63 DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area C� Well Log Received Septic Tank Size 0\,CV Well to Tank 72023 (3182) U 5. LEGAL DESCRIPTION &wbcl, �310�k DAl E RECEIVED ljr5 D)l 0- INSPECTION APPOINTMENTS �e>eh�`ll �f12C.1C� TIME TIME TIME DATE ❑ One ❑ Four ❑ Other DATE DATE ❑ MULTIPLE FAMILY D4 Three ❑ Six 7. WATER SUPPLY INSPECTOR * ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM S A INDIVIDUAL/ON-SITE** MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF I `EAJH & E] PUBLIC UTILITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION OTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P1; • ENVIRONMENTAL SANITATION DIVISION Sir 1981 Telephone 264-4720 FF r(� � REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER°R�►C'f�41E DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE 3 Lf t-- r G y4 >d oM e C Lk 1112 a -o �2iY- (,63/ WeizlG MAILING ADDRESS t PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS `(3�3 M, lt�,sfar�r'�a �17�z/3 3. LENDING INSTITUTION PHONE ktq J d7L/-35Gf MAILING {- j� SIN b(�A f Lof4'-5 JADDRE�SS t 01 1W 4. REALTOR/AGENT ( PHONE MAILIN ADDRESS Noe ko2ek-4z ©i L,,--) ie-r�co U 5. LEGAL DESCRIPTION &wbcl, �310�k ljr5 D)l 0- STREET LOCATION �e>eh�`ll �f12C.1C� K 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY D4 Three ❑ Six 7. WATER SUPPLY A INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM A INDIVIDUAL/ON-SITE** 1177 YEAR ON-SITE SYSTEM WAS INSTALLED. Credorie �n (11'77) E] PUBLIC UTILITY /-7 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) g i < THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE El SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE E2� THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM I�TINDIVIDUAUON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING f TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA .� MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE Y 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE y MUNICIPALITY OF ANCHORAGE DEPT. OF ;i^:LTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTfRVIRONMENTAL Pi O-lECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 �� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW 1 I DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER \ - �%� ::5-0 VI PHONE I lL��.�C�iij ❑ MULTIPLE FAMILY MAILING ADDRESS IkC-OeAA-L ,� �o�� �w � U�2, 011 PROPERTY RESIDENT (If different from above) PHONE �q-��ry� MAI F ct. rvm A'VG � W A W Q 37Y-10631 Gt1k 2. BUYER U PHONE W1 a e- U3 Q Ls- depth (attach log if available.) MAILING ADDRESS 0 o 4q(.M AIIJ-onase- 3. LENDING INSTITUTION 17('R '7 eGQee-,-1 �AUiv► 5 o�v. 550 �- PHONE MAILINGADDRESS W 1VOR1nL'(Lrl Li K�5 Di�tlL Vft�{ZC! 1{ 4. REALTOR/AGENT PHONE E by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADDRESS 5. LEGAL DESCRIPTION i � 0- a ",-61ac �IZ0. f�� �w� �viSi�in STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS E:1 One E:1 Four El Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three Cl Six 7. WATER SUPPLY INDIVIDUAL* *.ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) `5tirn L'a LL.L&--)L tc�lxLDnl J �-1-�� Un6Y"-tj d alLo 4s 40 lL rcx.-i] c � La as f� � �S-b L,L.�Gr. � 4CD %Q Pu mPF�l. " THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED y3 ! 1 INSTALLER L ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemadeSOILS give dimensions: RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL r 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac mpany certificate) ❑ DISAPPROVED DATE 1�r( r BY (Title) LEGAL DESCRIPTION 72.010 (Rev. 3/78)