HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 2 LT 5t
swoml
1 1 AL
NOV 0 5 2018
Municipality of Anchorage
Community Development Department Page 1 of 2
On -Site Water and 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: OSP181304 PID Number: 015-133-20 ❑ New ✓❑ Upgrade
Name:
Michael & Heather Grunwald
ABSORPTION FIELD
❑ Deep Trench ❑Shallow Trench El Bed El Mound
Address
8220 Prospect Place
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
7_—`" �E5 X
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade Gravel d beneath pipe
F Ft.
Subdivision Block Lot
Prospect Heights 2 5
Fill added above original grade Gravel length
Ft. Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total orption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Fie
Ft.
Well
136.8
N/A
N/A
N/A
N/A
TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1250Gal.
Surface water
100+
N/A
N/A
N/A
Material
Number of compartments
Lot Line
38.7
N/A
N/A
N/A
STEEL
2
NA
Foundation
13.2
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
N/A
N/A
N/A
Gal.
Remarks TANK REPLACE ONLY
Pump on level at
Pump off level at
in.
igh water alarm at
in.
Pump make odel
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
A+ HOME SERVICES
Drainfield CO/MT 3034
Inspector PANNONE ENGINEERING SERVICES
BENCH MARK (Assumed elevation) 998.0 ft
Inspection„
dates: 10/15/18 2"d 10/30/18
Location and description
31d 4'"
BOTTOM TRIM AT HOUSE POINT B
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Ak. kk
Conditional Approval: DateOF
jlow1
TH'•*
Steven '�annofae'
Approved Z Date 1 1 3 ($
f(d� E 814AW
4
ia�Jcl.uvi � —p- I_ 1- 1- I c. UvI
C
CIO
INSTALLED 1250Q SEPTIC TANK
W/DCO AFTER AND BEFORE
Ti T2
38.7
DC01 DC
REMOVED (2) TREES
—7
A
BDR
ISF
DECOMMISSIONED SEPTIC TANK (E)
40 PER
POWER
-POLE
SHED ` _-!f' 11 6.8
1000
9.95
A/I WELL
�9 0
x 50' PARKiiJG
EASEMENT
E BENEFIT OF LOT
(FOR THE 4)
NOTES:
RECORD DRAWING
I DRAWN I ACIP I
SITE PLAN
/Vo
1100,
CONNECTED TO CENTER OF
EXISTING DRAIN FIELD
02
CIR
I
I
RAILROAD TIE
RETAINING WALL
AY
WALL
1250 g SEPTIC 1\
989.8
TANK
PROFILE SCALE: NTS
PANNONE ENA'KLLCP.O. BOX 102954 ANCHGORAGE, 99510
PHONE (907) 745-8200 FAX (907) 745-8201
PROSPECT HEIGHTS B2 L5
MICHAEL & HEATHER GRUNWALD
8220 PROSPECT PLACE
ANCHORAGE, AK
I A B
DCO 1
28.9
It
T1
0
0
T2
HED
22.3
z
w 0
m 1z
1) L'i
<
LIj
<
Ld
M <
0
u
u OG.
995
D L'J
0 -1
1000
u
0 u
1 nn*
1250 g SEPTIC 1\
989.8
TANK
PROFILE SCALE: NTS
PANNONE ENA'KLLCP.O. BOX 102954 ANCHGORAGE, 99510
PHONE (907) 745-8200 FAX (907) 745-8201
PROSPECT HEIGHTS B2 L5
MICHAEL & HEATHER GRUNWALD
8220 PROSPECT PLACE
ANCHORAGE, AK
I A B
DCO 1
28.9
13.3
T1
0
0
T2
L'J 0
_j zZ
22.3
z
w 0
m 1z
1) L'i
<
LIj
<
Ld
M <
0
u
u OG.
D L'J
0 -1
u
0 u
1250 g SEPTIC 1\
989.8
TANK
PROFILE SCALE: NTS
PANNONE ENA'KLLCP.O. BOX 102954 ANCHGORAGE, 99510
PHONE (907) 745-8200 FAX (907) 745-8201
PROSPECT HEIGHTS B2 L5
MICHAEL & HEATHER GRUNWALD
8220 PROSPECT PLACE
ANCHORAGE, AK
I A B
DCO 1
28.9
13.3
T1
32.2 j
15.5
T2
40.2
22.3
DCO2
42.6
24.4
9
1"40'11 W -1 -A -M
Date
11/1/2018
Scale
1' = 50'
P.I.D. NO
015-133-20
PERMIT NO.
OSPI81304
Sheet
2 OF 2
MUNICIPALITY OF ANCHORAGE mens
On-Site Water&Wastewater Program Nvo Ssr
arc PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ` r,
http://www.muni.org/onsite C %
i)cllartincnt
4NCMORNG'
On-Site Wastewater Disposal System Permit
Permit Number: OSP181304 Effective Date: 9/5/2018
Work Type: SepticTank Upgrade Expiration Date: 9/5/2019
Tax Code Number: 01513320000
Site Legal Address: PROSPECT HEIGHTS BLK 2 LT 5 G:2541
Site Mailing Address: 8220 PROSPECT PL, Anchorage
Owner: GRUNWALD MICHAEL D & HEATHER J Lot Size in Sq Ft: 72090
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field tEl Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
1,0 ► r�
Received By: Al �.�,� Date: Ct v
i
Issued By: "Mr Date: l 170
MUNICIPALITY OF ANCHORAGE
•Community Development Department -T , Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water&Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-133-20
Property owner(s) Michael & Heather Grunwald Day phone
Mailing address 2066 Palm View Road Sarasota FL, 34240
Site address 8220 Prospect Place Anchorage, AK
Legal description(Sub'd., Block& Lot) Prospect Heights B2 L5
Legal description(Township, Range & Section)
Lot Size 72,090 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family(SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑X Duplex(D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
Dis tance:
I 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: oZ(5 Waiver Fees:
Date of Payment: Q 1'41R Date of Payment:
Receipt Number: Receipt Number:
Permit No. 05ert 130 c i Waiver No.
Permit App_..:•. c
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:stevePpanenxak.com
August 30, 2018
Subject: Prospect Heights B2 L5
EMERGENCY Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 1,250g Septic Tank to replace an existing
1,250g Septic tank to be issued for this property. The existing tank has completely failed. It will be
decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement
1,250g septic tank that will be connected to the existing drain field. There are no private wells with in 100'
of the proposed tank.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5'+from any property line
10'+from building foundation
10'+from any water line
100'+ from any surface water
100'+ from any private wells
200'+ from any public wells
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 907.745.8200.
Sincerely
teven R. Pannone, P.E.
Owner/Civil Engineer
cyr
I 1
I \ *- ,
I \ \16 . ,.
.•-•_ , .9F
• .
I II I \ ,,,,1% . -.,
%,: #,*
,„ ,, , ,,,,.
NI { \ _ ,,
...•
4 .... ,
--i, ,,,.., ,',..4.:5-->
TRUE NORTH SCALE : 1 50'
I1 I 11 0 / /��Sq\, , , , i 9 r,
\\� NN
_ a / \T q✓\ <<S
_ // /
W
0o I I /i 1 ice �/00. /
N • /
� / INSTALL 1250g SEPTIC TANK (P) \
N� W/DCO AFTER AND BEFORE IF / • CONNECT TO CENTER OF ,
�k� -/ / / NO FOUNDATION CLEANOUT 41 1 EXISTING DRAIN
FIELD - / /
_ _��� /�/ / / / o ) 11.8 �! � � /
+ / / REMOVE (2) TREES / % / ��
^ / I • /
• CvAll c� JF, RAI R•A t TIE
// // •�\ / / ( I; I BDDR `�Ptil/ PO�� \ RETAINING WALL ( / /
/ /J ! \ / / 01 I yf�� / / / N \ /
Aa� WOODEN WALKWAY
• �Cj DECOMMISSION SEPTIC TANK E M / 5 r \ \
OO i/ PER MOA CODE 1 �� 1 / )
/ 1
\ . / / / POWER POLE /1 ; I / /
% / / / / /� /
ill �- I
• / /SHED 1 \ / 1 CONCRETE R TAINING WALL / /
/ I
/ 985 \ \ 100N 0 / / \ / I //
s< N \ , ' / I
/ N SHED / /
/ 1 N N \ \ •995 ! N / /zi / / /
) _ N M —— N / `h3-S. / / • /
/ �� M / WELL (E) / / / 1 1
i
/ / / ,- / `"_�� , \ 990 / // / / /
�/ //� PA K 1 995 / /
/ /.�� N \ 30' x 50' PARKING EASEMENT 1 / 1000 2/ / /
/ \ �( \ (FOR THE BENEFIT OF LOT 4) / ' • / /
' /
\ / \ \ r // // 1005 / / / /\
. / •_\ \ N I / / 7 1010 1015 U
7 / / / / / Q�
/ / /
\�� N / / / / / / 0 /
/y • . / I / / / /
,.p \ - / / / Q
WELL (E)/
/ / / / /
W '� vel / . ' l
/ \ \ ~ t I /
.„ / / N D N \ / \ , ` � /
/ / „ j N ! /
\ f / / - - - \ \ \\ � \ J /
/ \ _. _
NOTES: PANNONE ENG SVC LLC Dote
FOR MOA REVIEW ONLY P.O. BOX 102954 ANCHORAGE, AK 99510 v4 8/30/2018
PHONE (907) 745-8200 FAX (907) 745-8201 � 1� Scale
*149'Ni i %.* 1- = 50'
"'0•l P.I.D. NO
•
PROSPECT HEIGHTS B2 L5 \:k. 015-133-20
ACP MICHAEL & HEATHER GRUNWALD .. •to 8149�O•R8 PERMIT NO.
DRAWN i^�. CE
8220VPROSPECT PALCE , .,•., 40
SITE PLAN ANCHORAGE, AK v, Sheet
1 OF 1
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
August 30, 2018
Subject: Prospect Heights B2 L5
EMERGENCY Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 1,2508 Septic Tank to replace an existing
1,2508 Septic tank to be issued for this property. The existing tank has completely failed. It will be
decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement
1,250g septic tank that will be connected to the existing drain field. There are no private wells with in 100'
of the proposed tank.
1. Upgrade Tank Design.
A foundation clean out installed if needed.
The tank will be located: 5'+ from any property line
10'+ from building foundation
10'+ from any water line
100'+ from any surface water
100'+ from any private wells
200'+ from any public wells
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 907.745.8200.
Sincerely
teven R. Pannone, P.E.
Owner/Civil Engineer
'I
I I \i I ti A
TRUE NORTH SCALE 1"= 50'
tip
JOO' /
00 1 i / ' ace
i
yah INSTALL 12509 SEPTIC TANK P /
C. W/DCO AFTER AND BEFORE IF CONNECT TO CENTER OF ,
NO FOUNDATION CLEANOUT 41.1 EXISTING DRAIN FIELD
11.8 /
REMOVE (2) TREES
_i
�4 �e JF�P RAILROAD TIE
SFD� � RETAINING WALL /
WOODEN WALKWAY
DECOMMISSION SEPTIC TANK E M M ( 5
PER MOA CODE
I 1
POWER POLE
SHED ` / I CONCRETE RETAINING WALL
/ 985 \ 1000
\ \ \ SHED
/ \ \ 995
EA�WELL
50' PARKING EASEMENT II 995 1000
\ (FOR THE BENEFIT OF LOT 4)
1005
1010 1015 v
/ I
WELL E,�
t
NOTES: PA ONE ENG SVC LLC Date
FOR MOA REVIEW ONLY P.O. BOX 102954 ANCHORAGE, AK 99510�. 8/30/2018
PHONE (907) 745-8200 FAX (907) 745-8201.•'• Scale
:49— 49 ;* 1 " = 50'
.... .. .. ....... P.I.D. NO
PROSPECT HEIGHTS B2 L5 015-133-20
DRAWN
ACP MICHAEL & HEATHER GRUNWALD even
. coin "°"® PERMIT NO.
8220VPROSPECT PALCE
SITE PLAN ANCHORAGE, AK Sheet
1 OF i
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
U/~.~/ IPHONE .. I IZ]NEW
/h
UPGRADE
LOCATION ~ /~ ~ NO, OFBEDBOOMS
Well Absor~oa / ~n~
~-- DISTANOETO: l [t~/~ Dwelling/
~ ~ Manufacturer ~ ~ ~.~ Material~ ~ No. o c
~ Liq' ~agt~mJ°ns ~ ]F HOME.DE: Inside le~~/ ~th O' ~C Liquid depth
O ~ ~ Manufscturer Material kiquid ca0acitg in ~allons
~ DISTANCE TO: Well t~O' ~ Foundation /~ Nearestlotlin?o ~
~ T°p°ftiletGfinishg~r ~g ~O inches ~ .
Material beneath tile -Total effecti a~r~on area
Length Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class~&~,/~,f¢~l,~ Depth Driller Distance to lot line PERMITNO.
~ ' ~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
SOIL TEST RATING/~ ~ ~ ~ ~,~
'NSTALLERo~~ ~- % F
U ~L ~ ~
APP~~ DATE LEGAL
PERHIT NO.
RPF'L ~. CRNT
LOCRT :!: ON
L. EGRL
E:,EF'FIRTHEN-¢' OF I-..IEflL. TH Ft1`-4[)E1`.,P,,,'ZI-';:01`.di';1ENTFIL F'F. fOTECT;[01`.,I E~:EEi '"L." :E;TF,:EET., RNE:HOF~:FIL-:iE., FIK.
4-.-,.-., ?';:.',z, .
,' 790055 :) '~/~(. £/_a-~;c~.'~
TIqo1`,'IFIE; I.,JESTERHOF ~:'Z.':Z.':3: l.,J. :E:E;"FYI-.I FIVE. 2,43: ?"'5'97 '-~ '
PROSPEE:T
L 5 E:2 PROSPECT DR:. LOT SIZE 69000 SLT!LIFIF;:E f::EET
T'¢F'E OF SOIL flBSORB'f'ION '..'.;;'~-'STEI',I tS: TRENCH
i',lR:qli',ILii','l NLli',1E:EF..' OF' BEDROOMS = 4
SOtL RF1TING ,::S6! FT.'E,R. = :I..SE~
"['FIE REQUIRED SIZE OF THE SOIL RBSORPTION S'¢STEH IS:
THE LEi'.,IGTH [.':,It'IENSION IS THE LENGTFI (IN FEET:) OF' THE TRENCH OR [:,RFIINF:[EL.D.
THE DEPTH OF R TRENCH OR PIT IS5 THE DISTRNCE BETI.,.IEEN THE SURFROE OF THE
GROUND RND 7'HE E,'OTTOI"I OF THE E::.:tCR',,,'FITION (:]:N FEET:).
THERE IS NO SET I.,I];DTH FOF.: TRENCHES.
THE GRR'v'EL [:,EPTH IS THE i"!IN.T.t'IUI'I DEPTH OF GRFI',,,'EL BETNEEN 'FYHE OL.Fr'FRL. L. P):PE
RND THE E:O]"TOI','I OF' THE EXCR',/RTION ,::](N F'EET).
F'ERi',IIT RPF'L.i[CR1`.dT HRS ]"FIE RESPONSZB:[LIT'¢ TO tNF'ORi'd THIS [.')EF'RRTFIENT [>UR ]; t',IG THE
INSTRLLRTIO1`4 ].'NSPECTIO1`,!:S; OF R1`,1'¢ PIELL..S RD..TRCE1`-,FF TO THIS PR. OPEF::T'¢ FIND THE
I'.¢Ji',IBER OF' RESI[)ENCES Tf-dFrr 'THE HELL 1.4:[L.L SERVE.
BI:IC:KF.'[LL]:NG OF RN"r' S"d:'EfEI"I NZTHOL.IT FINRL .~i',ISPEE:T.T. O1`4 RN[;" FIPPROVRL.. EFt' TH].'S
I;.':'EF'f::~F. rTi"IE1`dT I.,.IZLL BE SLIELTECT TO PROSECUT.T. ON.
i"lZr, i",l:]:l'"lUl"l D.T.S'f'RNCE BETNEE1`'4 R NELL F:I1`dD R1`',l"r' ON-SITE ':'.'.";ENFIGE DLrSPO~;RL 5'.?STEH .T_S
±O~ FEET FOR R PRJ:VRTE I.,.IEL. L.~ OR
:L50 TO 200 FEET FROi"I R PUBL.:[C NELt_ DEPEND :[1`-,IG UPON THE 'r'¢PE OF PLIBI...1;E: NELl ....
I.dELL. LOG% RRE RE(;!UIREE.', R1`,ID i'"lLIST BE RETLIRNE[.'.', TO THE DEF'F:IRTr, IE1`-4T 1.4.T. THJ:t",I ;:~:(~ [:,Fl"r'~;
(:Il::' THE 1.4ELL COf'IPLETION.
OTHEF?. REO!UIF:Ei'dEN'f'S i"lR'.r' ftF'PL'T'. SPEL";:.l~FICRT.T. O1`',IS FIND CON~;TRUCTION D:r. RGRRI',IS RI:;'.iE
RVR):LRBLE TO INSURE F'ROF'ER IN:~;TFILLRT:I:O1`.4.
I CERTIF"r' THRT
:L: ;[ FIM FFIM!L. IRR NITH TFIE REQUIREi'"IENTS FOR ON--'SITE :SEI.4ER~":; FIN[.'.', NELL..:5 RS SET
:'ORTH B"¢ THE i"IU1`.,IIC'rPFIL..J:T'¢ OF' RNCFIORRGE.
2: ~ I.,JZLL ~NSTRL. L THE
~:: X UN[:,ERSTRNE) '!"HRT 'f'HE ON--SITE .?,El.dER S'¥'%TEi',! NR'.¢ REO!U]:.RE ENL. RRGEi"IENT ;IF THE
;.:ES]:DENCE IS F..:Et,'IEIE:,ELED TCi I1`.dC:L.L.li::,[E 1`,IOF.:E
GNE[;:,: ...... ..¢_~?,~/.~,¢~-~_._.~__....;......._~_.~..~,~_.~...¢.,././.~___¢/~<-~
/
December 29, 1978
~780~86
Thomas Westerhof
3333 West 86th Avenue
Anchorage, Alaska 99502
Subject: Lot 5 Block 2 Prospect Heights Subdivision
A pernlit issued by this department for well and/or
sewer system has expired.
Permits are issued on a calendar year basis~ as stated
on the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be
sent to this department to document the installation
date.
If there are any further questions, please contact
this office at 264-4720.
Sincerely,
Les N. Buchholz, R.S.
Senior Environmental Specialist
LNB/ljw
enc: copy of permit
[ (:;I;!~i:;i:T ]i i';:'"r' THF::i"i'
L; ]; F'ii"i F'i:::d"l;!iL..;i~l:::!i~: I.'I;[TH TI"I~{ t:;;i.~!i;~.'.-:!!..li!;l:;i:li~;i"1,r'E;..,'-,!"!"S; i::'O!:;;:
:'OP. TH [B"~" 'T'I"~IE; !"!I..tI",!);C;I]PFIL;[T"r' OI:::'
~:: ]; I.'.1:~ M... ;i; N'.:~;TF:!!._L THE; S"~"'J'i;Ti::;i"! i!iI",! F:!CCOi;;!DI~:II",iCE; I.'.! ]; TH THE
i:: i~ I..ii",Ii3'~:;P.?I"!::iN[;, 'I"HFXlT T'HE (~iI",I'""S]]TI~;i] SEI4!Ei:;i: S"r':3'T'i~]!"1 I"ii:17
..~..~{.ii;iii~i...E/r,![.~.E:; ;[S :,~::;~'Oi:.,~ I:~[., '~] "!.':: .... [.,~-:. F'!£i;".FZ '"HI;'II". :l I::J',~{!:!::I:;'.O.:';.i'",S.
: '"";:~...~'/{,.!:~i'.rf:'~ .......... ;::i.:"':' r,' i;'~,:: , F":::;"r,:' :",-"::'~:
September 6, 1978 R&M No. 851143
Mr. Thomas Westerhof
333 West 86th
Anchorage, Alaska 99502
Subject: Soil Investigation for Sanitary Sewer System,
Prospect Heights Subdivision, Anchorage, Alaska
Dear Mr. Westerhof:
Lot 5, Block 2,
At your request of August 29, 1978, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the subject
lot. The investigation complied with those procedures required by the
Municipality of Anchorage Department of Health and Environmental Protection.
This investigation, which was accomplished on August 29, 1978, consisted of a
test hole drilled to a depth of 20 feet below the existing ground surface.
The test hole was sited according to your instructions and its location is
shown in attached Drawing A-01. Drilling was accomplished with a rotary
drill rig using continuous flight solid-stem auger with an outside diameter
of 6 inches. A sample was taken taken at the depths shown on the soils log
in Drawing A-01. The sample will be held in storage at our lab for approxi-
mately six months. In addition, ~11 material brought to the surface by the
augers was continuously monitored by an experienced engineering geologist.
The topography at the drilling site is generally horizontal. At the time of
the investigation the site had been stripped for a utility line access road.
The soils encountered in the bore hole are shown in the test hole log in ,
Drawing A-01. This log displays specific conditions encountered at the test
location. However, subsurface conditions may vary in other parts of the lot
without any apparent surficial evidence of the change. Groundwater was
encountered at a depth of 19 feet. Bedrock was not encountered. At the time
the hole was drilled seasonal frost was not present and permafrost was not
encountered.
A percolation test was performed within the bore hole at the depth shown in
the attached Table 1. All depths were measured from the top of the 'hole.
The data in Table 1 show average infiltration from the depths indicated to
the bottom of the hole. The measured percolation rate was 10.0 minutes per
inch.
September 6, 1978
Mr. Thomas Westerhof
Page -2-
We appreciated this opportunity to be of service to you. Please contact us
if you have any questions concerning this letter' or if we can be of addi-
tional service.
Very truly yours,
R&M CONSULTANTS, INC.
Gary/~. Smith
SeniOr Geologist
GS:/kah/12-N
BORING NUMBER
Date Completed: 8-29-78
SOIL DESCRIPTION
GRAVELLY SAND (SW)
red-brown, dry, med. dense
__2.0'
SANDY GRAVEL WITH
TRACE SILT (~W-GM)
LOCATION SKETCH
No Scale
Prospect Place
° 60' ~
SILTY GRAVEL WITH SOME
SAND (GM)
many cobbles, brown, dense,
slightly moist
NOTE: DIsTANcEs SHOWN ARE APPROXIMATE AND HAVE
NOT BEEN MEASURED BY SURVEYING METHODS.
12.0'
SANDY GRAVEL ((~g)
many cobbles, brown,
dry, dense
__17.0'
SAND
brown, dense, moist
20.0
T.D.
EXPLANATION
ORGANIC MATERIAL
Little Visible Ice 0:10' Vx
~-- IC~ D~SC~IPTIDN
~Ss 72,57.1% ,85.gpcf
~8~OWS/FOOr
BEDROCK
TYPICAL SOILS LOG ~ ~.~-~E~80~/~
SAMPLER TYPE SYMBOLS [
~ SILT ~ BFD~OC~
~ SAND ~ IC~ M~IVF
Lot 5, Block 2
R&rvl CONSULTANTS, INC.
SOIL.'::; I hr.
Prospect Heights Subd.
Anchorage, Alaska
h'B. 31
GRID.
PROd. NO. 85114
-~ERCOLATION TEST
TABLE 1~
R&M NO. 851143
9-1-78
TIME
ELAPSED TIME
FEET
DROP IN INCHES
2:15
2:16
2:17
2:18
2:19
2:20
2:30
2:45
2:55
3~05
3:15
3
4
5
15
30
40
50
60
3.25
3.50
3.55
3.60
3.65
3.65
3.90
4.10
4.20
4.28
4.35
3.0
0.6
0.6
0.6
0.0
3.0
2.4
1.2
2.2
0.8
(0.25 ft.3
3°0 inches in 30 minutes
10 minutes per inch
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 015-133-20
Certificate of On -Site Systems Approval
Expiration Date: #C)
Complete legal description Prospect Heights B2 L5
Location (site address) 8220 Prospect Place
Current property owner(,,,' Mike & Heather Grunwald _ Day phone
Mailing address PO Box 112596 Anchorage, AK 99511
Real estate agent
2. TYPE OF DWELLING:
nx Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER • BEDROOTM. A
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
FxJ
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the gineer, unless otherwise requested by the engineer.
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Date
Conditional approval for bedrooms, with the following stipulations:
c��urr
By: a�elcl Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory x
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description:
COSA Checklist
Prospect l2kate 82 L5
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1978
Total depth uk ft
Cased to 40+ ft
❑ Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 519/2018
Static water level at beginning of test 44.7 ft.
Comments
B. TANK DATA
Age of tank(s) 70"51B years
Tank type/material 5`P°Us
Measured operating fluid level in septic tank 48"
0 Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 4/27/79
0 ALL standpipes present per record drawing
Total measured depth from grade 9.7 ft (max)
Measured depth to pipe invert from grade 4.7 ft (min)
❑ N/A — pressurized field
0 Monitor tubes go to bottom of effective. If not, state
depth into effective
0 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-133-20
Structure served by this system 1
Well production at time of test 4.2 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑✓ No
❑ Coliform bacteria is Negative
Nitrate 5.62 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 0 Arsenic less than MRL (ND)
Collected by Pannone Engineering Services
Date of Sample "/'120'9
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/9/2018
Results [-V]Pass For 4 bedrooms
Fluid depth prior to test 33 in
Water added 600 gal
New depth 40 in
Elapsed time 1440 min
Final fluid depth 33 in
Absorption rate >600 gpd
Any rejuvenation treatment (past 12 months) n/a
If yes, enter date
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'
®✓
Yes
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft✓Q
Yes
if No ft
Neighboring Tank > 100' 0✓ Yes
if No
ft
Private Sewer/Septic Line > 25' E✓ Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' P1 Yes
if No ft
Neighboring Absorption Fields > 100'
Q Yes if No ft
Water Main > 10'
Animal Containment > 50' ❑✓ Yes
if No ft
M Yes
if No
ft
Yes if No ft
Water Service Line > 10'
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' 0 Yes
if No
ft
[Z] Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
®✓
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
Yes
Yes
if No
ft
Wells on Adjacent Lots:
✓1
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
Q Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building. Foundation > 10'
0
Yes
if No
ft
If absorption field is.under driveway comment below
Property Line > 10'
F71
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓1
Yes
if No
ft
Private Wells > 100' Yes if No It
Water Service Line > 10'
F71
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
✓M
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that / 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. I q ff
COSA Checklist yellow sheet
����� OF
'�.TH
17 I
Steven R. Panno-,)e
F CE 8140 ? A
Aoi6)
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181329
Subdivision: Prospect Heights, Block: 2, Lot: 5
A water sample revealed a nitrate concentration of 5.62 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
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Parcel I.D. 015-133-20
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Prospect Heights Block 2 Lot 5
Location (site address) 8220 Prospect Place
Current Property owner(s) Michael & Heather Grunwald Day phone _
Mailing address
Real Estate Agent
2066 Palm View Rd. Sarasota, FL 34240
2. TYPE OF DWELLING:
F-7] Single Family (w/wo ADU)
1771 Duplex
1771 Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
E
Individual
0
Individual Water Storage
El
Holding Tank
1771
Community Class Well
R
Community
1771
Public Water System
0
Public Sewer
1_71
WaiverNariance request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being 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
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
s �r
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907) 272-8218
Date 7/10/2018
. S�everi R. annone --
CE-8149
Conditional approval for bedrooms, with the following stipulations:
��T�
WAS-,�ND
PRO- GR.i A
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheet_f '- c
Nitrate Advisory
Arsenic Advisory
Other ViS i`o
Jill lillirl Jill Jiliq
Legal Description: Prospect Heights Block 2kot 5
A.WELL DATA
PrivateVVeUt/pe |fA.B.orCprovide PVVS|D#
Before 12/1978 \/
Date completed Sandaryseal �YN)��_
Total depth []N Kft. Cased to 40+ t.
FROM WELL LOG
Date of test []NK
Static water level UNW
Well production
UNK
WATER SAMPLE RESULTS
Rem
NEG� 1�
Coliformc bm�o�U0mL Nitrate ��mg/L
Arsenic - N[] ug/L Date of sample: 06/15/18
B.SEPTIC/HOLDING TANK DATA
F�8n�r/�t88�+
TanhType/K0obaha| ~ r^'`^~ '
Tanksize 1250gal. Number ofCompartments 2
Foundation cleanout (YYN)YDate of pumping
R/14y)O18
Ifmore than 1septic system iaonthe lot:
COGACheck|ist#1o�__
Structure served bythis system _1____
01��1��\-�O
Parcel |D�~ ' '~~ '-~
Well Log (Y9N)N
Wires properly protected (YYN)Y
Casing height (above ground) 18f in.
AT INSPECTION
5/9U2O18
��7T.
9 -P.M.
Collected by: PES
Date installed "-
v4/'' '~' ~1�7�
Depression over tank (Y/N) N High water alarm (YN/AYN)
__ Pumper '' Services
�+ AO0� F�8 'CeS
C. ABSORPTION
0�t�f��0' / 1��O�h[
Date in�a//eo________ Soil rating z �� f/ System type DEEP TRENCH
��
� 5
Length ""- ft. Widoth ft. Gravel below pipe_ft.
9.7 ft. Y N
Tota|depth_���� Ef[absorptionane��z yNonitoringtube_�__Oepreooionover��|d��__
Date ufadequacy test D��/1��/1 �� Results (Pass/Fail) �\4SS For 4 bedrooms
Fluid depth inabsorption field before test 33in Water added 600 gal. New depth 4O in.
Elapsed Time: 1440 min. Final fluid hW/ n. Absorption rate >= ROOf
�
Any re�manadon�eatnerd(past 12mnj�YN&type) '` |fyes, give date________
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
WELL DNLOT TO:
Size ingallons
"Pump off' level at in.
Cycles tested
Septic tank/lift atadiok
station 100+
Absorption field onlot 100f
+�
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
Manhole/Access (Y/N)_
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
Onadjacent lots 100+
Public sewer manhole/cleanout 100+
Hold1OO+
Holding '~~
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ONLOT TO:
Building foundation 5+ nn Property line 5+
VV
1Of .
Water main '~ Water service 10+
ica|ine '~
Wells cmadjacent lots 100+
ABSORPTION FIELD ONLOT TO:
1Of
Property line '~ Building foundation 10f
Water Service line 10+ Surface water 10Of
er ~~
Curtain ain droin `~ Wells on adjacent lots 100+
Absorption field 5f
Surface1OO+
waar ~~
Water main 1O+
Dhveway, parking/vehicleo�rage10f
F. COMMENTS
*Septic Tank located under cover deck - met code at time of installation.
G. ENGINEER'S CERTIFICATION
/ certify that /have determined through field inspections and
review of Municipal n*oo/du that the above systems are /n
uonfonnenoo with MOA COSA guidelines in effect on this date
Engineer's Printed Name Steven Pannone
Date 7/1D/2D18
COSA canary sheet-2-615.doc
UP
11111
-- waghm-1101MIJ
.. .�,�. .
Awl
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVIC S DEPARTMENT 9€07-343-7904
4
On-Site Water and Wastewater Section F Fax: 343-7997
www.muni.org/onsite
Certificate of On -Site Systems Approval # OSC181329
Subdivision: Prospect Heights, Block: 2, Lot: 5
Advisories are issued for steel septic tanks 20 years of age and older due to a history of extensive corrosion
which eventually results in leaking and structural failure. According to municipal records, the septic tank
serving this property is 39 years old. Due to a thick/firm layer of floating sledge, the tank operating liquid
level could not be accurately determined. Hence it could not be determined if the tank is leaking.
Note there remains a roughly 6 inch thick floating sludge layer even though the tank was reportedly
pumped two times in last 60 days. It is recommended to pump out this floating sludge to prevent
premature failure of the drain field. The purpose of septic tank pumping is to remove the majority of the
scum and sludge to prevent these materials from accumulating in the tank.
This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval.
.MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 0-07-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Certificate of On -Site Systems Approval # OSC181329
Subdivision: Prospect Heights, Block: 2, Lot: 5
A water sample revealed a nitrate concentration of 5.19 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
II
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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. Cf OiQ-
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
/ ~ ,~"~ ~ ~--O HAACf
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
Lending agency
Day phone
Mailing address
Agent ~'/i '~ '.~'.
Address
Dayphone ,L~,~- (~LJ(x"t//'
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
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:
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
o
STATEMENT OF INSPECTION BY ENGINEER
A~ certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority ApprovaJ 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.
Engineer's signature ~~~~ Date.
DHHS SIGNATURE
'~/ Approved for ¢
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Mur~icipality 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 ~Y21
Municipality of Anchorage SgP 09 1997
DEPARTMENT OF HEALTH & HUMAN SERVICE,~--C_
Environmental Services Division ~ "~
825%" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 '
Health Authority Approval Checklist
Legal Description:
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
FROM WELL LOG
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary. seal (Y/N)
Nitrate
Tank size
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~5~
Date of sample: ¢¢/(~/"7 ~
B. SEPTIC/HOLDING TANK DATA
Date installed
/¢'7¢ ?
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
I,b
Other bacteria ,~
Collected by: ~'", -~
Number of Compartments __
Foundation cleanout (Y/N)
DateofPumpi.g
ABSORPTION FIELD DATA
Date installed
Length ~ j~ t Width
Effective absorption area
Date of adequacy test
oq.- Cleanouts (Y/N) .
High water alarm (Y/N) ~x[
?
g.p.m.
Depression (Y/N) Iq
Pumper ] _~ O,x~o c t~
Co
Soil rating (g.p.d./ft2 or ft2flodrm) / ,.~' O
Gravel thickness below pipe ~ t
System type ~T'Ag4,4 c~
Total depth ?.5 ~"~C~
Fluid depth in absorption field before test (in.);
Fluiddepth /~d,d? (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Immediately after ~b'¢O gal. water added (in.):
Absorption rate = ~' /Td~ ~ g.p.d.
If yes, give date
Monitoring Tube present(Y/N) \/ Depression over field (Y/N) ~
Results (Pass/Fail) ?' For 'g// bedrooms