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PROSPECT HEIGHTS #1 BLK 3 LT 3
Prospect Heights #1 Block 3 Lot 3 #015-092-03 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141012 PID Number: 015-092-03 Dwelling: Q Single Family (SF) ❑ Duplex (D) []Multiple (SF and/or D) Project: ❑ New X Upgrade Name: KOLOA LLC ABSORPTION FIELD IN Deep Trench ❑Shallow Trench El Bed El Mound Address 930 BUDDY WERNER DR ANCHORAGE AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 9.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.4 Ft. Gravel depth beneath pipe 6.0 Ft. Subdivision Block Lot PROSPECT HEIGHTS #1 3 3 Fill added above original grade 0.5-1.0 Ft, Gravel length 65 Ft. Township Range Section Gravel width 3-4 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 780 Ftp 1 NA Ft. Well >100' >25' TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water -- >100' -- -- Gal. Material Number of compartments Lot Line >10' NA Foundation >10' LIFT STATION Manufacturer Capacity Curtain Drain -- >50' __ __ Gal. Remarks EXISTING DRAIN FIELD CONNECTED VIA Pump on level at -- in. Pump off level at in. High water alarm at -- in. DIVERTER VALVE. BAFFLES INTEGRITY VERIFIED EXISTING CONCRETE TANK INSULATED Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Tankto 3034 drainfield Installer A+ HOME SERVICES Drainfield 3034 CO/MT 3034 Inspector ANSON MOXNESS BENCH MARK (Assumed elevation) 100 R Inspectio 1� 9118/14 9/19/14 Location and description da: 2"d aro 41h BACK DOOR JAM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL EngLLn�.eC�m`� -� ,,.OF A4.1 Conditional Approval: Date %A, S a OW 00 10 E. S, URKLAND. , 11500 n Date l — 1 ' f Approved [�1 � Inspection Report _9-1-12.dbe OSP NOTE.• SLOPES EXCEEDING 25% WERE NOT OBSERVED WITHIN 50 FEET DOWN GRADIENT OF THE PROPOSED ABSORPTION FIELD LOCATION. NOTE: THIS 1S NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 25 0 25 50 75 100 125 150 SCALD 1' = 50 FT 4' contour tines 03 V 15TH, ENGINEtKING' I I PROSPECT HEIGHTS #1 BM 3 LT 3 I I SEPTIC SYSTEM ASBUILT I 203 W TH• AVENUE DATE,, SEP 23 2014 ANCH, AK,K 99501 FRANK IRWIN (907) 279-3916 9230 BUDDY WERNER DR, ANCHORAGE AK 99516 SHEET • 2/3 GRID+ 2441 PERMIT At O9PI41012 PID # 015-092-03 PROSPECTHEIGHTSIB3L3.SC50-ASB•DWG 65' TH E.C. dEY.a4f.8 !HY F6E ftEV-lBd' lKMI FIEWl28' Installed Bull Run Diverter Connected to Existing Seepage Plt Installed Double Cleanouts O Existing 1250 gal Concrete Tank Inspected Baffles Installed 2' Insulation NO SCALE Trench Elevation (TyP) ICleanouts Monitors Silt Barrier ran 6,0 Ft of Septic Rock BENCH MARK BACK DOOR JAM ASSUMED ELEVATION 100 FEET Run Diverter Double Clean outs ISPURKLAND ENGINEERING I I PROSPECT HEIGHTS 11 BLE 3 LT 3 I I SEPTIC SYSTEM ASBUILT I g203CyW I%S AVENUE FRANK IRWIN BA TE., APR 23 20, (907) 279 3916 9230 BUDDY WERNER BR ANCHORAGE AK 99516 SHEET, 3/3 GRID: 2441 PERMIT # OSP141012 PID # 015-092-03 PROSPECTHEIGHTSIML303DWG On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141012 Tax Code Number: 01509203000 Work Type: Septic Upgrade Permit Effective Dates: April 24, 2014 to April 24, 2015 Design Engineer: SPURKLAND ENGINEERING Subdivision: PROSPECT HEIGHTS #1 Site Legal Address: PROSPECT HEIGHTS #1 BLK 3 LT 3 G:2441 Owner/Address: KOLOA LLC 1843 PARKSIDE DR ANCHORAGE AK 995010000 Site Mailing Address: 9230 BUDDY WERNER DR, Anchorage This permit is for the construction of: Lot Size in Sq Ft: 85378 Total Bedrooms: 4 Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcell.D. 015-092-03 Property owner(s) FRANK IRWIN Day phone 244-8051 Mailing address 9230 BUDDY WERNER, ANCHORAGE, AK 99516 Site address SAME Legal description (Sub'd., Block & Lot) PROSPECT HEIGHTS #1 BLK 3 LT 3 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Single Family (SF) El Absorption Field El Initial F] Single ADU) Septic Tank ElUpgrade rX_1 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ SUBMITTAL Water Storage El THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: JAN 2 3 2014 Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or Permit/Rush Fees: 5(c91I — Date of Payment: l p- 311 y (J tiL Receipt Number: DgO(oq G Permit No. 050%4 1V1a Permit App_9-1 -1 2.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. Environmental Consulting and Design SEPTIC SYSTEM DESIGN PROSPECT HEIGHTS #1 BLK 3 LT 3 Municipality of Anchorage November 23, 2013 Development Services Department On Site Water and Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Septic System Installation Permit 9230 Buddy Werner Dr. Ladies and Gentlemen: I am writing to request a septic system installation upgrade permit for the above referenced property. The existing septic system did not meet COSA operational Requirements. The proposed system will serve a 4 -bedroom single-family residence. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No ground water observed after groundwater monitoring. (11/8/13). Soil Rating. From Testhole 11/1/13 1.4 min/in = 1.2 gal per sq.ft/day 2.4 min/in = 1.2 gal per sq.Wday No. of Bedrooms 4 Required Area per Bedroom: 150/ 1.2=125.ft. Total area required: 125 x 4 = 500 sgft System: We are proposing using the existing 1250 gallon concrete tank followed by a deep trench absorption field. The absorption field will be 65 feet long and 2 feet wide and contain 6 feet (780 sq.ft. effective) of sewer rock. Soils: Test holes were excavated on November 1, 2013. See the attached soil logs. An isolated pocket of water was found at 12 feet deep in THI, however after 7 days of ground water monitoring there was no liquid present in the test hole. Ground water monitoring will continue through construction of the septic system. Groundwater was not observed in either test hole after the 7 day ground water monitoring period. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net " lk- SPLITMalmd ERVROBWoNg Environmental Consulting and Design Surface Water: There are no surface waters within one hundred feet of the proposed septic system upgrade. Topography: The ground level slopes down towards the west at less than 10% grade Waivers: None Well: The well is currently located in a pit in the driveway underneath a manhole cover. The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Lars Spurkland, P.E. Spurkland Engineering 203 West 15t" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net FAR NORTH BICENTENNIAL PARK -- — -- -- -- — — — — — — — — ro• urn £as --- — — — — E — — — — — — — — — — I LOT 3 ��. LOT 4 101 n m- BUDDY WERN£R AV BLOCK 3 LOT 2 6 //�-- SPEC7 LOT 8 / // P R O BLOCK 5 LOT 7 1Y NOTE., THIS 1S NOT A SURVEYED PLAT. WELL D SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 50 0 50 100 150 200 250 300 SCALE 1' = 100 FT )z �p0 �vpd� i ISPURKLAND ENGINEERINGI I FROSPECY' HHIUHI S' 11 ELK J LY' 3 ((SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE FRANK IR WIN DATE, APR 23 2014 ANCH. AK. 99501 (907) 279-3916 9230 BUDDY VERNER DR, ANCHORAGE AK 99516 SHEET, 1/3 GRID: 2241 PERMIT # 17SP141012 PID # 015-092-03 PRHSPECTHEIGHTS1B3L3SC100.DWG Spurkland Engineering 203 W.1SthAve. Ste. 202A Anchorage, AK 99501 TEST HOLE / _ I DEPTH 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SOIL LOG AND PERCOLATION TEST 'ZOIC DESCRIPTION DA7E._14L4ZL,L__ mics WAS GROUNDWATER OBSERVED: SEEPS IF YES, AT WHAT DEPTH. 12' Sandy Fill AFTER MONITORING PERIOD: Dom` DATE OBSERVED: 11/13 PERCOLATION TEST.• f W/ gravel les to 12" .O.H. NOTES: PRE-SOAKED FILL DATE I GROSS TIME NET TIME DISTANCE I DROP 6.000" 11 8 11:29 AM 0 min. 6.000 11:37 AM 7 m. 10s. 0.000 6.000 6.000 11:45 AM 8m. Os 0.000 6.000 6.000 1154 AM 8m. 30$ 0.000 6.000 6.000 -FO PM 8m 40s 0.000 6.000 6.000 1:13 PM Bm 45s 0.000 6.000 1:22 PM 8m 45s 0.000 6.000 PERCOLATION RATE: 1.45 minutes/ Inch PERC HOLE DIAMETER: 6 inches TEST RUN BETWEEN __4.5 FT AND _5.5 FT SITE PLAN: LOT 3 rH1 rye PERFORMED BY.• Lars Spurkland, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. SPURKLAND ENGINEERING PROSPECT MGM /1 BW 3 LT 4 SOIL LOG PERCOLATION TEST 203 W 15TH. 4VENUE FRANK IRVIN DATE, APR. 23, 2014 ANCH. AK. 99501 (907) 279-3916 11 9230 BUDDY WERNER BR., ANCHDRAGE, AK 99516 GRIB H1 2241 PERMIT #07141012 PID # 015-092-03 Spurkland Engineering 203 W. 15th Ave. Ste. 202A Anchorage, AK99501 TEST HOLE f 2 DEPTH 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SOIL LOG AND PERCOLATION TEST sn/L DESCRIPTION DATE.• 14(]/13 nks/ RA1 WAS GROUNDWATER OBSERVED: No IF YES, AT WHAT DEPTH. -- AFTER MONITORING PERIOD: dry DATE OBSERVED: 11 /8/13 PERCOLATION TEST.• W/ gravel les to 11' NOTES: PRE-smED FILL DATE I GROSS TIME NET TIME DISTANCE I DROP 6.0000 11 8 11:31 AM 0 m/n. 6—" 11:41 AM f0 min. 0.000 6.000 6.000 11:51 AM 10 min. 0.000 6.000 6000 12.101 pm !0 min. 0.000 6.000 6000 11:11 PM f0 m1n. 0.000 6.000 6.000 11:21 PM /0 min. 0.000 6.000 2:31 PM 10 min. 0.000 6.000 PERCOLATION RATE: 2.4 minutes/ inch PERC HOLE DIAMETER: 6 inches TEST RUN BETWEEN 4.0 FT AND 5.0 IT SITE PLAN: N LOT 3 THI TH2 PERFORMED BY: Lars Spurkland, P.E. l CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. SPURKLAND ENGINEERINGI I PROSPECT AEIGNTS /1 RIX 3 LT 4 I I SOIL LOG PERCOLATION TEST I 203 V 15TH. AVENUE FRANK IRVIN BATE, NOV.. 23, 2013 ANCH. AK. 99501 (907) 279-3916 9230 BUDDY VERNER BR., ANCNImz AK 99516 DRIB #, 2241 PERMIT # PIB It 015-092-03 ' MUNICIPALITY OF ANCHORAGE " DE RTMENT OF HEALTH AND HUMAN SER. eS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name 0�� L! i� DISTANCES Tp FROM SEPTIC ABSORPTION FIELD WELL Address ��L '�U i�D i� ty/2NarL WELL JTANK -(� � �� Phone(s)` �) Permit No. y� �y No. of Bedrooms ✓ � " Y J 9 5P — "'71 CS 7 LOT LINE p 3 0 O V LEGAL DESCRIPTION Lot :�s Block 1 `a Subdivision 1 `PPL0-c�Pi6cT Affl6J,i3" FOUNDATION v�% �/� Township, Range, Section AS -BUILT DIAGRAM (Show location of wen, driveway. water bodies, etc.) septic system, property lines, foundation, TANKS NT SEPTIC ❑ HOLDING Manufacturer E55P//p� C)Z. Capacityingallons �ca= 52' 0 Material 6entct?T6 No. of Compartments a"fi�_ I Hc u 'E --- TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade '-/ V FT Total depth from original grade e� -! FT�,/y" Fill added above original grade _ r0 FT Gravel depth beneath pipe FT Gravel length FT Gravel width FT � I r Total absorption area -333p 7SQ FT Distance between lines FT So e t to % Number of lines fJ� Soil rating SOFT Pipe material Installer Date Installed WELLS PRIVATE ❑ OTHER (Identifv) x h (� Classification (A,B.C) Total Depth aV FT Cased to aa FT Installer Date Installed. `% •q/ f G`� Put vt% REMARKS: AN�r� Sc3 t> i�il +` _ fi� V P eAc D E_ Scale: Inspections Performed by. ENGINEER S SEAL :. K.. t (hf JUN. 1.5, 19 1 qa 0 �o Date. I that this inspection was perlortned according to all -certify Municipal and State guidelines in effect on this date: Health Department Approval: ' " - yam_ — " " "- - " - / �`� Date: PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: ~� ~`\ �����������...... ]'� ��w� ���� Par-!! VAR [Il,:]t !1!!rr)l IER�P'� DEPARTMENT OF HEALTH AND ENVIR8NMENTAL PROTECTION 825 L STREET� ANCHORAGE, AK 99501 264`4720 850718 11/19/85 OM MCLAUGHLIN 9230 BUDDY WERNER ANCHORAGE, AK 99516 563-4431 LEGAL DESCRIP: SUBDIVISION: PROSPECT HEIGHTS #1 LOT: 3 SECTION: 13 TOWNSHIP: 13N RANGE: 31W LOT SIZE: 2,511 (SW,FT^ OR ACRES) . MAX BEDROOMS: 4 ` (.A� PQAZ.4 D E BLOCK: 3 ` Listed below are the options available to you in designing your septic system, Choose the option that best fitsyour'site. �~..... ..... ..... ^-~__^`-~_..... .... ... _�~~~-~� W�T ERE Nil Ell 11-111 13 IITHT Mob �T ;b F:�! A!!D1,][�� DEPTH TO PIPE BOTTOM (FT") 4^0 4"0 4.0 GRAVEL DEPTH (FT") 5.0 0"5 3"5 TOTAL DEPTH (FT.) 9"0 4"5 7.5 GRAVEL WIDTH (FT.\ 2.5 16.0 5^0 ` GRAVEL LENGTH (FT") 34.0 32"0 37.0 GRAVEL VOLUME (CU.YDS.) 17"4 19"0 27.5 TANK SIZE (GALS) J. 250.0 ** 1v250,0 * 1,250.O ** SOIL RATING (SQ,FT./BR) 85 85 85 ** TANK MUST HAVE Al LEAST TWO COMPARTMENTS , I certi;y that: 1^ I am familiar with the requirements for on-sitesewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" it. I will install the �ystem in accordance with all MOA codes and regulations,, and in comp1iance with the design criteria of this permit" 3^ I will adhere to all MOA and State of Alaska requirements /or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4^ I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS~BUILTS WILL NOT BE APPROVED WITHOUT A ELECTRICAL INSPECTION REPORT; AND (3) THE AECTRICOAL. A LICENSED ELECTRICIAN, SIGNED ` `DATE: ------ ... ..... .... .... ----... T ....... .... ~�~~~.... ��.... ... ..... ..... ...... -..... ���-.... .... ..... APPLICANT: TOM MD�AUGHLIN � ISSUED BY E: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: IoM 1"y `LAtru r7 ut i -a DATE PERFORMED: 4'DQ'4! LEGAL DESCRIPTION: Lc1 �5—�OSp1Et.T 4k EIQLWt- $ SP. C� IS T 12N. R31J(� DEPTH 1 SLOPE SITE PLAN (FEET) 1 Ca• o i14 2- 3- 4 3 4 G V//Sv/ b o 5 VIELL G9Ae-PED 6 • ° ` rt�D G RA V a L- 8- 9- 10- 11 - 8 13 MOTTO V4 O Ir 14 +�©LE 15- 16- 17 51617 18 ... ., y9 19 lo. 2225-E ` 25, 1971 20- COMMENTS 0 COMMENTS WAS GROUND WATER ♦ 1 b L ENCOUNTERED? 1�4 O P IF YES, AT WHAT E DEPTH? .■■■■■■■■■ Date Gross Time Net Time NEEMEMMOME Net Drop ■■■■■N■■■s ■■■■■■.■ ■. ■NON■■■N 11 ■■E■N■.■ N.' wouvra ENS MEEMEMNEE WENNEEMEN A■■■■■■■■■ 171 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE tASVAOrl. RS TEST RUN BETWEEN FT AND FT PERFORMED BY: > CERTIFIED BY: (� DATE: cA;Bh'D-I, Gf \ ER ANCHORAGE AREA BOROI ",H OL,ARTMENT OF ENVIRONMENTAL QUALI. 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �1-d/41 46,*s MAILING//� OT /�/D7v?-� % ADDRESS � PHONE C 777;ro#�9 LOCATION �� '���' �/ ��� LEGAL DESCRIPTION�e -✓r. �' `���� //'-s'57041-4,' SEPTIC TANK: DISTANCE FROM WELL /NUMBER NUMBER OF / COMPARTMENTS � 49 LIQUID CAPACITY / GALLONS. INSIDE LENGTH INSIDE UID PTH WIDTH DEQ SEEPAGE SYSTEM: SEEPAGE PIT: / / f ��' 6 NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH—// LENGTH DEPTH , '�G E%� /e'5 6 LINING MATERIAL /e/X/4aSf . DISTANCE FROM WELL BUILDING FOUNDATION , Zo f� �9 / NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TI AIN FIELD: TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES , NUMBER OF LINES DISTANCE BETWE TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACHLINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABO WL: �T�/N�DISTANCE FROM / EL �� / %/""�, TYPE//&Wf , DEPTH BUILDING FOUNDATION. SAMPLE NEAREST / NEAREST SEPTIC / SEEPAGE LOT LINE SEWER LINE TANK 4 a SYSTEM OTHER CESSPOOL SOURCES_ DIAGRAM OF SYSTEM DISTANCES: �+ yti s' G/3�T fi� .t1� y l W/ r.-'v-'AA1sfr` �fl✓�"G g/f- I .. , /�!/�TifLLED 4V jj �EPi'iG TAy� 10116)eturl/G 6(/zlv �eN�sT � o � Niers IV IREA'ER ANCHORAGE AREA Rr)r. UGH /%� JV.V' DEPARTMENT OF ENVIRONMENTAL QUALITY - n PERMIT NO. L/� I' 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 '^y TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT - ���1�`,Iw c<�.UL-�- ��-/7.� MAILING ADDRESS'K PHONE Gl%%hr INSTALLATION LOCATION /�-��_ld/ �A ���s`I f ��//tea; arf/✓". LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD z_ OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED `>` �^ �f''-a`s" �'F6'�P/" �'- �'s.d' �'✓may %A,/% FINANCED THROUGH �-_ TO BE INSTALLED BY solL TEST RESULTS fid �✓/�i'� ���O��e �1y�y NOTE: THIS PER NOT VALID WITHOUT SOIL TEST J GUJG .TO/G. CUI`/if�/7�¢U�/✓J COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTE ITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT/0 DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. i WELL TO SEPTIC TANKjLt SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD , J SEPTIC TANK, �`---SEEPAGE PIT J/' DRAIN FIELD , TO RIVER, LAKE, STREAM. 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 REGULATIONS REGARDING INSTALLATION. 1, HEALTH AUTHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GRERAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYY/STTTE/M/ IS IN ACCORDANCE WITH SAID CODE. .. / DATE ��% J �� APPLICANT'S SIGNATURE J/// • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 F�fEe seta,"` Certificate of On -Site Systems Approval Parcel I.D. 015-092-03 Expiration Date: J 1. GENERAL INFORMATION Complete legal description PROSPECT HEIGHTS #1 BLK 3 LT 3 Location (site address) 9230 BUDDY WERNER DR Current Property owner(s) KOLOA LLC Day phone Mailing address 1843 PARKSIDE DR ANCHORAGE AK 99501 Real Estate Agent Day phone 2. TYPE OF DWELLING: x❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual E Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ - Public Sewer ❑ WaiverNariance request for: NONE Distance: Received by: Z Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ e f?&y•56 Waiver Fee $ Date of Payment 1 &3115 Date of Payment Receipt Number G yzaf 5 Receipt Number COSA# (1305-160� 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. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE _,::' System #1 Approved for __t bedrooms System #2 Approved for bedrooms Disapproved Phone 278-3916 Date 10/27/14 OFrt/iCntgt r � lot Conditional approval for bedrooms, with the following stil3t1tl1 ., -s'_"" :." By: t /i%�i�/ %/ �i �d Original Certificate Date: Theunici� alit o-chorage 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 ofAlaska. The Municipality of Anchorage is not responsible far 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 E , - If more than I 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: PROSPECT HEIGHTS #1 BLK 3 LT 3 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Date completed 1972 Sanitary seal (YIN) Y Total depth 120 ft. Cased to 120 ft. FROM WELL LOG Date oYtest Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 3.31 Z. � mg/L Arsenic ND D ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Parcel I D: 015-092-03 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 0-z ib in. AT INSPECTION 12/19/13 62 4.7 ft. g.p.m. Collected by: ANSON MOXNESS Tank Type/Material CONCRETE Date installed $/7/1972 Tank size 1350 gal. Number of Compartments 1 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 9/24/14 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 9/19/14 Soil rating (g.p.d./ft z 1.2 TRENCH orft�lbdrm) System type Length 65 ft. Width 3 ft. Gravel below pipe 6.0 ft. Total depth 9 ft. Eff. absorption area 760 if tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on' level at Datum Size in gallons in. "Pump off" level at - E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 60' Absorption field on lot 1001+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Cycles tested _ 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 areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ 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+ Suriacewater 100'+(N.O.) Curtain drain 50'+ (N.O.) Wells on adjacent lots 100'+ F. COMMENTS `EXISTING WAIVER FOR WELL VAULT ;n{ 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 effect on this date. Engineer's Printed Name LARS SPURKLAND Date 10/27/14 COSA brown sheet 10.10-12.doc Absorption field 5-+ Surface water 100+ Water main NA Driveway, parking/vehicle storage 10' in. "_ -y} s= r�i¢� }I zz n:w I n MUNICIPALITY OF ANCHORAGE �} • '� DEPARTMENT OF HEALTH & HUMAN SERVICES M i 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 Parcel I.D. # cn'. - HC -32i 1. GENERAL INFORMATION HAA # Complete legal descriptioni-- o'er 3 P KS V- -CO 441 Location (site address or directions) Ln16 3 Q Y, '71 9z342 L Z-0 ,d-r.v Property owner Day phone S63 — 7d 7B _ Mailing address " P - .d c .23 (Q.7 Lending agency �r rpt It-io,. r 9. Day phone Mailing address. Agent 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 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm l obla-e h !Rb U0 Y. LV&41C� P. E Phone �-Zg��4C� Address Engineer' .OF A4. + or ` { - � ONl�a� est�iaae dp,�°eo°c .. .. �•H� e_ a •a N•a a`: it bben 2urkinadCL -2225i1A,CE A;' e J _. �i� 170 FrESG% :'fr 6. DHHS SIGNATURE Approved for I` bedrooms. Disapproved. Conditional approval for Additional Comments . 0 bedrooms, with the following stipulations: Date 7-29-72 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 orderto 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 7121 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: cJ Parcel I.D. A. WELL DATA Well type `zl If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed ►4 7�1- Driller I '.p Casedto ► a -o Casing height g Sia, lY�ac, uo.>r FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot f Wires properly protected (Y/N) y AT INSPECTION `z i0 f11 -M m �O t m. ✓?1ewe 7 9 p mm ^' r g'P' ®/ �j m o X67 'O onZ rn r.0 ro nn ® 0 < D N G) m On adjacent lots / Otb z Absorption field on lot 3 E 15'5 ; On adjacent lots ro 0 Public sewer main N/A Public sewer manhole/cleanout Sewer service line -Petroleum tank N 16 WATER SAMPLE RESULTS: Coliform Nitrate r `t� Other bacteria Date of sample: ot2— Collected by: S B. SEPTIC/HOLDING TANK DATA Date installed 0-7- 7X- Tank size J3by Compartments Cleanouts (Y/N) ___y? Foundation cleanout (Y/N) N Depression (Y/N) K/ High water alarm (Y/N) tN.ZA Alarm tested (Y/N) N1%a Date of pumping ���4 Q Z Pumper 06,4K SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wel I(s)onlot b(J f Onadjacentlots Foundation To property line 5 Absorption field 3 Water main/service line >75 Surface water/drainage X47 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed . Size in gallons Vent(Y/N) N 0 N I_ High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed 577172. t tl 2( /e -.S Soil rating 5 System type lA-uACA Length __ 3 y Width Gravel thickness Total absorption area 3qc Cleanouts present (Y/N) Total depth Depression over field (Y/N) N Date of adequacy test 744r/13 Z Results (pass/fail) T for Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 7 f 13 On adjacent lots J f0-0 Property line i 30 To building foundation 12 O To existing or abandoned system on lot (40 On adjacent lots >l0-0 Cutbank No "2 Water main/service line > /6.0 Surface water No is R - Driveway, parking/vehicle storage area > U-0 Curtain drain t� E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on 1herdate of this inspection. t A. Signature J. a, + Engineer's Name Ls2L✓�-'I ��� ��1 ar�ttiGJ� t� L- T,� Date Ef: c,T,., r r HAA Fee $ �_ Date of Payment 7 - �- 3 —17 Z- \ Receipt Number -3? �� /7 1 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3 Block 3 Prospect Heights Subdivision 411 Location (address or directions) 9230 Buddy Werner (b) Applicant Name Tom McLaughlin Telephone: Home 346-2450 Business 563-4431 Applicant Address 9230 Buddy Werner (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ®X Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Clair Ramsey, Jack White Company Address 3201 C Street Suite 200, Anchorage 99503 Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family axMulti-Family ❑ Other Number of Bedrooms four (4) 3. WATER SUPPLY Individual Well ®x Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Cox 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. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING w4SPECTIONS, TESTS, FILE SEARCH, DATP,,iND 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 Tobben Spurkland, P.E. Telephone Address Date Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of November 27, 1985. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. 6. DHEP APPROVAL Approved for four(4) bedrooms by <x` X2 Date June 25, 1986 Approved XXXXXXXXXXXXXDisapproved Conditional Terms of Conditional Approval c�hep 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 Poi® CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 MUNICIPALITY OF ANCHORAGE JUNE 23, 1986 DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Re: Conditional Health Authority Approval, Lot 3,Block 3, Prospect Heights Gentlemen; On November 27, 1985, a conditional approval was given for subject lot. The conditions for the approval have been met. The wellpit has been abandoned, the well casing raised, and the pavement repaired. Please furnish the owner with an unconditioned approval. Yours Tobbe Spurkland Clai Ramsey, Jack W ite Co. ✓UNICIPALITY OP %CHORAr LNVIO\M=T0' hEALTH & n,/,L r;zOTECTION Z=1986 RECEIVED to e MUNICIPALITY OF ANCHORAGE 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, a township, range) //q /p/ 9 � R 72 1® � m)_ n w M —- -1 Ll n. s I� Jif LSY.f7N I S G C' Location (address or directions) C? z 3 (b) Applicant Name 100,4 gAmj tj Telephone: Home 3 ®9L1a7® Business �y �mdJbl� f Applicant Address 9'mab® (c) Applicant is (check one): Lending Institution D ; Owner&Imi"ePIR; Buyer D ; Other D (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Z2,01 pie, Telephone 916 3, 15 (f) Mail the HAA to the following address: Z> 2. TYPE OF RESIDENCE Single -Family Multi -Family D Other Number of Bedrooms 3. WATER'SUPPLY Individual Well Community ❑ Public D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL I Onsite Public ❑ Community ® Holding Tank D Note: f 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 O 5. ENGINEERING FIRER PROVIDING „dSPECTIONS, TESTS, FILE SEARCH, DAI,. 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 Telephone'74 Address / �� �✓ Date UW i. •fiR.T. r' N° sn °e ev • •° • .. • ° . �i`• to. •2225-E°• Engineer's Seal JUJr 25. 1971 r 4S/VL 6. DHEP APPROVAL Approved for `� bedrooms by Date Ap oved Disaved Con onal Terms of Conditional Approval , /7 (�,'�- cam[ � bxc.c2S � � �. Ga-� : • �1G Ccr.$S, l� C�m aQ_ v�e*�'®rte i't a s��- /�.) I q 8 6 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 An6horage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Description: $%X/ A. WELL DATA Well Classification 1Z E rz3i If A, B, C, D.E.C. Approved (Y/N) Nim► Well Log Present (Y/N) N Date Completed ii -74 Yield ..J5�159 A# CZ JV Total Depth /�zo Cased to Depth of Grouting W Static Water Level A O Pump Set At 90 Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) X Depression Around Wellhead (Y/N) Separation Distances from Well To Septic/Holding Tank on Lot -0 ; On Adjoining Lots > ZO-0 To Nearest Edge of Absorption Field on Lot I On Adjoining Lots To Nearest Public Sewer Line tv © HLF To Nearest Public Sewer Cleanout/Manhole NONE To Nearest Sewer Service Line on Lot /o Water Sample Collected by -;�:- ; Date Water Sample Test Results —SAT _S JCAC 10ey Comments * "At, /N c:yACC&,r=TC T_/! IN PR_I 4 tr`✓� B. SEPTIC/HOLDING TANK DATA Date Installed e''7' U- Size 190 No. of Compartments Standpipes (Y/N) 7 f1i 0 Air -tight Caps (Y/N) )0� Foundation Cleanout (Y/N) N Depression over Tank (Y/N) Date Last Pumped Ha -Zo '21 Pumping/Maintenance Contract on File (Y/N) NIA ; for N/^ Holding Tank High -Water Alarm (Y/N) NXA Temporary Holding Tank Permit (Y/N) "% Separation Distances from Septic/Holding Tank: To Water -Supply Well 35 To Building Foundation To Property Line > To Disposal Field 75 % To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course fV n Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata a `; Type of System Design ce-f m Date Installed / 1 7A g 19-A Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area '5440 Standpipes Present (Y/N) Z�p J Depression over Field (Y/N) Date of Last Adequacy Test Nous- ~5 Results of Last Adequacy Test 11_11AV N a J/,/ e'0 N S 1 Separation Distance from Absorption Field: To Water -Supply Well /Qct, %j�G-_) To Property Line To Building Foundation 742, 1142 To Existing or Abandoned System on Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION IV0 N L�j Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ; On Adjoining Lots > X00 To Cutbank (if present) NO N 1= Dimensions Manhole/Access (Y/N) ,,Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I that I have checked, verifi d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. certify �� g SM Signed Date s Company MOA No.hSr—mil Receipt No. Date of Payment Engineer's Seal Amount: $ y ' €_t � C_�jVlJa ,{ p N:. �� 9„f Page 2 of 2 (�'. 1UN� 2s• Nil 72-026(11/84) December 5, 1985 P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Tobben Spurkland, P.E. 203 West 15th Avenue Anchorage, Alaska 99501 Subject: Lot 3 Block 3 Prospect Heights Subdivision Conditional Health Authority Approval Dear Mr. Spurkland: Please consider this letter written confirmation of the Department's intention to approve a well casing upgrade on the subject property. A Health Authority Approval was recently issued from this Department with the stipulation that the existing pit well be improved by extending the well casing approximately two inches above the grade of the driveway. The driveway surface will be mounded so that the surface slopes away from the well casing. This improvement shall be completed prior to June 15, 1986. The requirement that the well casing extend at least twelve inches above ground will be waived in this case. Sincerely, ,� 4. _27%' Stephen S. Morris Civil Engineer On-site Services SSM/ljw ALASKA cnUIROnmcnTAL C0I1TROL 1' engineerinq & Enuironmental Studies q-^ ScRUlccsr Inc. -June 7, 1982 Caroline Szymanski C 21 Heritage Homes & Investments, Inc. 207 E. Northern Lights Blvd. Anchorage, Ak. 99503 On June 5, 198241 performed a well flow test on the well located on lot I Block 3 Prospect Heights. At the start of the test the static water level was 59 feet. After pumping for 25 minutes it had dropped to 90 feet. It remained at this level for the next 100'.minutes. The long term flow rate was 3:2 gallons per minute (gpm). After 140 minutes the pump was turned off and the recovery rate measured. The' -well recovered 30 feet in 17 minutes for a rate of 3.2 gallons per minute. There appears to be water entering the well at a depth of approximately 61 feet. The conclusions are that this well will yield slightly over 3 gpm for a long term yield. If you have any questions please let me know. y_ 7 a'rG S inc-c-0 OF �C,�,•a. t9 a}• • ti. c Leroy C. Raid, Jr. `��i �F� •. No. 251-E •,� C5\ -,a eilr �'•. .•• C6��s� Q.t� lnu u 4 b OF S1 hD s �ic�rtJ �. �— VVU Id o ' ��r 1L((I� yJ � Li2-� 1 }YS'S�CtI"Ybl% � iii � /( 0./YL-� � J � <ir[L' iQ. C,J Q..� `: i. �..Q-':: [_�i"• a� 1220 West 25t Auenue 9 Anchorage, Alaska 99503 • (907) 276-1361 - DATE RECEIVED INSPECTION APPOINTMENTS #1 TIME rTIME TIME L_f 6. TYPE OF RESIDENCE ��\ CSL i� l_GY Di DATE DATE DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY _��„r ❑ Six INSPECTOR INSPECTOR INSPECT R * 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.) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTloIQEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION • ENVIRONMENTAL SANITATION DIVISION JUIN" 981 Telephone 264-4720 (' CC nn REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEi UJIMI 4EQ. DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE A. Virginia Liskow (G. W. Liskow) 349-4196 MNG ADDRESS AILI SRA Box 34M, Anchorage, AK 99507 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Unknown at this time. MAILING ADDRESS 3. LENDING INSTITUTION PHONE Unknown at this time MAILING ADDRESS 4. REALTOR/AGENT PHONE Elliot C. Lawson, Jack White Company 277-1553 MAILING ADDRESS - 3201 "C" St., Suite 100, Anchorage, AK 99503 NOTE: Send all information & reports to Elliot Lawson at above address. 5. LEGAL DESCRIPTION Lot 3, Block 3, Prospect Heights #1 STREET LOCATION NHN Buddy Werner Dr. L_f 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS Lyl SINGLE FAMILY ❑ One X7 Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY _��„r ❑ Six 7. WATER SUPPLY CA 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 CSI INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) I I� —N�a�—�—�}_.----- 1. TYPE OF RESIDENCE THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS VE El SINGLE FAMILY ❑ ONE ❑ THREE ❑ FI E FAMILY E:1TWO ❑ FOUR El six ❑ MULTIPL PERMIT NUMBER 2. WATER SUPPLY ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED PERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Septic Tank or ❑ Holding Tank Size: ) 3S�5 If Tank is homemade SOILS RATING give dimensions: MANUFACTURER TYPE OF TANK MATERIAL TOTAL ABSORPTION AREA Septic/Holding Tank Absorption i 4. DISTANCES WELL TO: Absorotion Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED ❑ OTHER ' - INSPECTION APPOINTMENTS DATE RECEIVED �. TIME TIME TIME DATE DATE DATE ❑ One � Four ❑ Other SINGLE FAMILY ie'' INSPECTOR ❑ Three ❑ Six INSPECTOR INSPECTOR `Ff INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled MUNICIPALITY OF ANCHORAGE since June 1975. For wells drilled prior to that date, give well MUNICIPALITY OF ANCHORAGE DEPT. OF ;'.':" _T'' « DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTWJW Vdiv1ENT.�L F .0%icCTION 825 L Street - Anchorage, Alaska 99501 C 7 INDIVIDUAL/ON-SITE** 1 YEAR ON-SITE SYSTEM WAS INSTALLED. juNi 10 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE MAILING ADDRESS ._ PROPERTY RESIDENT (If differen from above) PHONE ti�/-3 2. BUYER / --� PHONE MAILING ADDRESS - - 3. LENDING INSTITUTION- PHONE MAILING ADD ESS 4. REALTOR/AGENT ,-- PHONE MAIL IINGA%DRESS 5. LEGAL DESCRIPTION i STREET LOCATION' i, / 6. TYPE OF RESIDENCE / NUMBER OF,BEDROOMS ❑ One � Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY G-� -L a<: 7[ /' `Ff 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 C 7 INDIVIDUAL/ON-SITE** 1 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)_ THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX PERMIT NUMBER 2. WATER SUPPLY ❑ INDIVIDUAL DEPTH OF WELL ❑ COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY LOG RECEIVED Connection Verified 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER DATE INSTALLED ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY INSTALLER Connection Verified ❑SepticTankor ❑Holding Tank Size:_. e D If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER MATERIAL TOTAL ABSORPTION AREA Septic/Holding Tank Absorption Area hewer Line Nearest Lot Line 4. DISTANCES WELL TO: C9 Absorption Area to nearest Lot Line 5. COMMENTS tl/APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompan certificate) ❑ DISAPPROVED DATE BY A41unicipality o Anchorage June 11, 1980 171L�! 825 "L" STREET ANCHORAGE, ALASKA99501 (907)264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Toni Brown % Jack White Company 3201 C Street Anchorage, Alaska 99501 Subject: Lot 3 Block 3 Propect Heights Subdivision Terry J. Miller Property Approval for the individual sewer and water facilities can not be granted until the following items have been completed: (3) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. Expose the well for our inspection and to insure til���F,>� proper distance requirements between the well and the sewer system. -I- (c -, A - ,.s .,. n _ Ci - Cn -,,,2 i,,�C�cov ill ovr/t ir; . The septic tank be pumped with a receipt subMitted to this office. (4) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing this test is enclosed. This report needs to be submitted to this department for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Assoicate Specialist RCP/ljw cc: Alaska Mutual Savings S Y R6M CONSULTANTS, INC. 5024 CORDOVA ■ BOX 6087 ■ ANCHORAGE, ALASKA 99502 ■ PH. 907-279-0483 ■ TLX. 090-25360 ENGINEERS GEOLOGISTS PLANNERS SURVEYORS N uv June 17, 1980 R&M No. 0MU Mg-,1 ' OF ANCHORAGE Mg -, 16-Y OF 1! ALTH u ENVIRONMENTAL f --,',;•ACTION Jack White Company 3201 C Street Anchorage, Alaska 99503 Attention: Toni Brown "IV 1 9 's9ti0 RECEIVED Re: Adequacy Test on Existing Sanitary Sewer System; Lot 3, Block 3, Prospect Heights Subdivision, Anchorage, Alaska Dear Mrs. Brown: Per your request of June 10, 1980, we conducted a test of the sanitary sewer system on the above described property. The septic tank was pumped prior to the performance of the test on the seepage pit. During the test the liquid level in the seepage pit was measured before and after the addition of 1,100 gallons of water. The total depth of the pit was 10.4 feet. All liquid levels were measured below the top of the standpipe and are shown in the following table: Initial Water Second 24 hour Total Reading Added Reading Reading Drop (gallons) 9.2' 1100 4.15' 7.4' 3.25' The water level rose 60.6 inches with the addition of 1,100 gallons of water, indicating a capacity of 18 gallons per inch. Twenty-four hours later the ANCHORAGE FAIRBANKS JUNEAU VALUEZ WASILLA r R&M No. 051001-40 Page -2- liquid level was again measured and found to be 7.4 feet. It had dropped 3.25 feet or 39 inches. This indicates an average effluent acceptance rate of 702 gallons per day for the surrounding soils. If the 4 bedroom residence on the property is to house 8 people, the average load on the system can be expected to be 600 gallons per day. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 4 bedroom residence. We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or if we can be of additional service to you. Very truly yours, R&M CONSULTANTS, INC. Jane Cecere Project Manager JC/jh/AT&SI-Z spa 7yjSl 340 + ra CIPALITY OF ANCHORAGE L UAR i tr \ � i l [a. k DEPT Ui ALT'+ & L t NVI�ON:t FVT.'.'_ CTION F EB 2 i .5.....t.-_ - ., �? r L ... r. �:f4i r_ :r�..4i./..ri_.._ %:V.• s..i i .I .ymp a& naqs on 1.;.ya ?, mon :,} Via .mums ,vii: r.c4 tr }'-"o 'a%d. pyome ailov. t2^ ,"C; Avs for )noon an. -- - - --- - c2 i T.o. o 5, 1 MAL DMIATI Kul S r �. r 1..RLCR 0F�L'CDi v0ms One Pouf Two E: GBier ' A LOG', A vol ; )o is reml e } f }I all Vv 11 C!1 iPC^:i si no., ,(..inc- .(df 5. For l\e11s d -i1 kii ri i or to a ic, gIN, v: death (anach log if aVAIN !W ind i vi 0i jo 0 s A e (ivc i t:ulaIion ba', o, . if sysunn v over woo (2I yem old 3. i c� (•f u 'tt&i r �.a;l tie:.! 1,y i1:5 ii Ej:7�: fit!•',}i. i i ! t 1Jit THE iS.P C 01 FEE MUST At0 -'FeEACH BEFORE I pf_y r- 9 J/27/79 �N _ I. e D 1\1; L l I _ f r—. P.' 2 L 1 C UF1UTV' . �._[_i n.C�..._• _J�, E_.�, �: c(v""_v_.... _dee..,_ iV !I pica /1 )JP.' -;(iii { PUBLIC UT ILITY E: GBier ' A LOG', A vol ; )o is reml e } f }I all Vv 11 C!1 iPC^:i si no., ,(..inc- .(df 5. For l\e11s d -i1 kii ri i or to a ic, gIN, v: death (anach log if aVAIN !W ind i vi 0i jo 0 s A e (ivc i t:ulaIion ba', o, . if sysunn v over woo (2I yem old 3. i c� (•f u 'tt&i r �.a;l tie:.! 1,y i1:5 ii Ej:7�: fit!•',}i. i i ! t 1Jit THE iS.P C 01 FEE MUST At0 -'FeEACH BEFORE I pf_y r- 9 J/27/79 USE ONILY ,,SF( UA -1 [ I DAT . -- - -- 0 i - — -- — I%SPf:CTOR O! "r• cCllOi�iS: O� tt t_S�!�� \!(:!-.___ -- -- —�— NUMBER OF B3 DROOM. --- -- -- I W,,j.�L', FFA ,iH_Y Or\E C� ?REE ❑ FIVE ❑ OTHER ^ei LTIPI_E Aiv',IL.Y I L_J Tir10 ❑ FOUR SIX _.PFRivi! (ivUiv13ERSi ----—— --- nr — j INPW1,11DUAL DEPTH OP I'dELI_ — —� C7 CC'1 iU N! Ty ---- 1�d�`---------------- ---- DATE Dftl!_LED !" i P L B i_ IC U I L I T Y __--_------- LOG - - Cu lr�e�i � l Jr:lfrd _-- j PERMIT NMAiBER .,I.=1 15pt" vYSl [.Ml IA/Iji:;Livi'.i DATE H,jSTALLED _ �,. ��-6nfU � rl ': i�OrIT. Ci .- -'I INSTALLER li E"?S2F-iiC Tr.nIC GI !.—i Ii 0!dinq Ta If Tank .s ^on-,emad- I SOILS RATING _ - r,,v tEI T ((r_ OF )T! - _----- ----- MANICFACTURER ! Lg1Y� 0—/U -- --- �S aLUt l �i ------ ------ -- NIV I ScN.I�?Flc-Gine lank �Ab_ol Ptwn rt.rea IScr acr 1_inc Lot Lr:e !-FSG I;O !I r FOR — c�r;OOn�ls k- -AL t`I!\?_ i;;=!'?' muz: accon P>E y I Ccc^f'[iilC2i@)