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HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 3 LT 5AProsp��+ I�ec9 lu X 1 5 ol (flock Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211289 PID Number: 015-092-05 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ■❑ Upgrade Name Erik & Carrie Sedwick ABSORPTION FIELD Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 9260 Buddy Werner, Anchorage, AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 907-301-5359 4 1.2 GPD/SF JTotal 9.6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 7.1 Ft. Subdivision Block Lot Prospect Heights #1 3 5A Fill added above original grade 3.2 Ft. Gravel length 44 Ft. Township Range Section Gravel width 3.0 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 1 Dist. between trenches N/A From Tank Field Tank Line 616 Ftz Ft. Well >100' >� D0' N/A N/A >25' TANK ❑� Septic ElS.T.E.P. El Holding El Other Manufacturer Capacity Greer 1250 Gal. Surface Water >1 00' > 1 00' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation > 10' > 10' N/A N/A TATION Manufacturer Capacity Gal. Remarks Alarm location Elec stalled by PIPE MATERIAL House to tank D3034 drainfieldTank to D3034 Installer Red Dog Excavation Drainfield D3034 CO/MTD3034 Inspector J.Millette BENCH MARK (Assumed elevation) 100 ft Inspection 151 8/3/21 dates: 2 �a 8/24/21 Location and description Lower Level Door Threshold 3`" 8/24/21 4`n ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp.�1�.�\\ .r~ oF'�gil1 Conditional Approval: Date ��,`Q., •�,f-lt �* •49 *+� s TH r% Benjamiq Schiller �`�r ' Septic System••. Approved Date Z 2u CE 12592 ,• 'srF • 8/11/22.,.V Aw ,pROFESS16 Note: this approval does not include well permit requirements. .+ (Rev 05/02/18) PROSPECT HEIGHTS SUB #1 , BLOCK 3 LOT 5A PERMIT # OSP211289 PI D # 0 15-092-05 j _16'UTILITY EASEMENT N </ J J r LOT 5A/1 NEW 44'LONG x TWIDE, V EFFECTIVE DEPTH ABSORPTION ..TRENCH' N Co tH#j , MT1 col if FD 2C0 NEW,1,250-GALLON, svi t, f SEPTIC TANK w/ EXISTING TRENCH TO REMAIN IN SERVICE m 1 20" MANWAY FCO --- Bm � 166 WELL RADIUS/' \AOO LOT--10A" EXISTING WELL Z GARAGE O/ ro7z.TA cgwmoomm' '*749'—rH Benja i Schiller ja CE 2592 01P 12/18/23 Am PLAN AS -BUILT 0 50 100 ilE ME hIM SM FEET 111=50' A B FCO 2.4 36.1 MH 25.9 54.1 SV 30.4 57.9 2CO 32.9 60.4 FD 34.1 61.7 C01 60.0 1 85.0 IVIT1 63.2 89.2 CO2 87.5 120.4 MT2 82.6 116.1 L LEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE PERMIT # OSP211289 r r O I- 02 98.0 FINISH GRADE P I D # 015-092-05 N N HO 94.8 ORIGINAL GRADE 2 v 92.3 92.3 DRAINFIELD ROCK 85.2 85.2 44' NO GROUNDWATER 8/12/21 - 76.8 FNGINFFRING PROFILE AS -BUILT (NO SCALE) OF Aq' 49 TM •., .' �,---> .....Ben ' ' • ' Schiller • •' • . CE 12592 •�F`�i PROFESSIO�P�,� .61:'S8Z 31100.00oOO N 4% z n O CJ N In �. ® COM J w W 00 MM00 Z �� v ! °` N rn LO 04 z r= V T� 1 � Im 0 CV w Q Ci U) oo3a� I P z CL a O Z W W O Z O z ~ p O - O_ N ��9 0 - _ �—�wWWC~Jo—oWwOcozo 006 C.) 00z ccnr ~mZt zoOZoxmLA- OGC WVx�VWmWpVcn O Q O Z v �0miU.iW O���owoo F- WOUU) CLC3cr- Z dW CC1U4D=Cii O N Lo }aJ O J _Ji Q' to N z to W t j V3 _ pp Q N O d O V' O rn E R z Ljw N > ooaz N Cc 0 o W = a. N N �g04 mN 8 0 MUNICIPALITY OF ANCHORAGE '_ 'L C f1 (. j/ On -Site Water & Wastewater Program �o� 161 PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 __n:,;z ; � �fAl http://www.muni.org/onsite f Dcpartmcnt' NN CH on F1 On -Site Wastewater Disposal System Permit Permit Number: OSP211289 Effective Date: 7/15/2021 Work Type: SepticTank Upgrade Expiration Date: 7/15/2022 Tax Code Number: 01509205000 Site Legal Address: PROSPECT HEIGHTS #1 BLK 3 LT 5A G:2441 Site Mailing Address: 9260 BUDDY WERNER DR, Anchorage Owner: BJORN-ROLI PER ERIK & Lot Size in Sq Ft: 118483 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: Go-#\ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Veronica Pope "WRGE 2021.07.15 Received By: 10:23:00-08'00' Issued By: .Dr'V/ Date: Date: �✓r Z i MUNICIPALITY F Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-092-05 Property owner(s) Erik & Carrie Sedwick Day phone 301-5359 Mailing address 9260 Buddy Werner Dr, Anchorage, AK 99507 Site address Same Legal description (Sub's., Block & Lot) Prospect Heights Sub #1, Block 3 Lot 5A Legal description (Township, Range & Section) Lot Size 118,483 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: Waiver Fees: (N all that apply) % / Zi g'13 21 Date of Payment: Receipt Number: Absorption Field 055 1q1� Initial ❑ Single Family (SF) ❑X Waiver No. (w/wo AD U) 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: Distance: I certify that the above information is correct. I further certify that this is in accordance with apo`1liccaable Municipal Codes. G/ (Signature of property owner or authorized agent) Permit/Rush Fees: X36<� f 3 70 Waiver Fees: Date of Payment: % / Zi g'13 21 Date of Payment: Receipt Number: V"/ �f9D 055 1q1� Receipt Number: Permit No. �S %� Z I /'� g Waiver No. Permit App__- : :'-.,:c August 11, 2021 Com) PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Prospect Heights #1 B3 L5A — 9260 Buddy Werner Dr Septic tank design Dear On -Site Services Engineer: U� .4. ,4 TH rev . . .......... Sena in Schiller CE 12592 4 8/11/21 ��� pROFES S10HA�-�� After further investigation of the existing septic system, we have determined that the absorption is nearing the end of its life. Therefore, we are submitting this redesign for a change order to the existing septic permit. The ground surface on the lot slopes at or under 20% toward the north of the lot, but near the existing septic the slopes are much milder. It is in that flatter area that the new septic system is located. There are no slopes greater than 25% within 50 feet downslope of the proposed. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100' from all wells and surface water, and more than 14' away from the existing septic field. Please refer to the attached test hole log, plan, and profile pages for the septic design. If this design is followed, there will be no adverse impacts to. adjacent properties. Sincerely, Benjamin Schiller, PE July 13, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 7/13/21 Subject: Prospect Heights #1 B3 L5A – 9260 Buddy Werner Dr Septic tank design Dear On-Site Services Engineer: The owners of the above lot have an existing septic tank is well beyond its 30-year life expectancy. Therefore, we are submitting this permit application for its replacement. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic field. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211289, Deb Wockenfuss, 07/15/21 PROSPECT HEIGHTS SUB #1, BLOCK 3 LOT 5A= EXISTING TRENCH 'I �0' UTILI DECOMMISSION EXISTING —STANK PER UPC, V 36 LONG x 3' WIDE, 7' EFFECTIVE -- DEPTH ABSORPTION TRENCH \ NEW j250 -GAUL SEPTIC TANkC w/ 20",MANWAY TH#1 O 8 MT CC 2C0 .D SHED, 2C0 \ / n \ \ ` 100' WELL RADIUS \ gp M NOME / EXISTING WELL � R GARAGE NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND PROPOSED SEPTIC SYSTEM CO -CLEANOUT ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO - DOUBLE CLEANOUT PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO - FOUNDATION CLEANOUT SYSTEMS. FD - FLOW DIVERTER VALVE 0 50 100 MH - MANHOLE FEET MT - MONITORING TUBE SV - SEPTIC VENT 1"=50' TH - TEST HOLE �'-��� ENGINEERING �l Benja i Schiller ♦■�'c�� • CE 2592 .• �`�i tugusl 11, 2021 1\�_PROFESSIONP � PROSPECT HEIGHTS SUB #1,.BLOC.K 3 LOT 5A �o-I DESIGN FACTORS: 600 GPD PEAK FLOW PERK RATE: 2.7 MIN/IN APPLICATION RATE: 1.2 GPD/SF SYSTEM REQUIREMENTS: 7' DEEP TRENCH SYSTEM 1,250 -GAL SEPTIC TANK 600 GPD / 1.2 GPD/SF / 7 DEEP / 2 SIDES = 35.7 LF TRENCH REQUIRED (36 LF SPECIFIED) BOTTOM OF TRENCH: 10'6" BELOW GRADE FLOW LINE ELEVATION: 3'6" BELOW GRADE TOP OF TRENCH: 6" ABOVE GRADE r' r-= -1 RATED PVC (HOLES DOWN) _D ROCK TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY 4d'V.r .. r *: 49 TH •.* . ��• • • ' .. . • . Benja'n Schiller nC9E5125921. 2•```�i tilj��PROFESSIONP�'�.� r DEPTH (feet) 1- 2 3 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SOILS LOG AND PERCOLATION TEST L'.-� ! ENGINEERING �w LEGAL DESCRIPTION: PROSPECT HEIGHTS #I, B5 L5A PERFORMEDFOR: ERIK 8, CARRIE SEDWICK DATE: 8/4/21 PROJECT No.: PARCELID#: 015-092-05 TECHNICIAN: J. MILLETTE COMMENTS: TEST HOLE 1 1'013 GM (SILTY SANDY GRAVEL) SLOPE WAS GROUND WATER ENCOUNTERED? NO IF YES n WHAT DEPTH? L DEPTH TO WATER AFTER MONITORING: NONE O DATE OF MONITORING: 8/12/21 P E JI It I -LAN DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) 8/4 1 9:15 10 3 -s/7 -s 416 2 9:26 10 3�s/6is 316 3 9:37 10 31s/6is 316 4 9:48 10 31s/6is 316 5 9:59 10 3-s/6L2 3is 6 10:10 10 3-1/6L2 2 3L16 PERCOLATION RATE: 2.7 (MIN/INCH) PERC. MOLE DIA.--6--(INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. 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 INSPECTION REPORT NAME Jh`c PHONE NEW re 9❑ UPGRADE MAILING ADDRESS SR -J 5- ' LEGAL DESCRIPTION `{ i e i LU FTM IL . L 1 1 -. K' LOCATION NO. OF BEDROOMS 4 I A J DISTANCE TO: WellAbsorption area Dwelling PERMIT NO. U _Y P Z Manufacturer ,Y, Material No. of compartments /� Liq. capacity in gallons IF HOMEMADE: Inside length g Width Liquid depth Y Zz STANCE TO: Well Dwelling PER N 2 — Manufacturer Material id capacity in gallons ...1 LU DISTANCE TO: Well 0 Foundation } rD Nearest lot line -i- (� PERMIT NO. _ `� No- - L Z_ of lines Length of each li e Total length of lir Trench Sdt� Distance between lines f � cc � Top of tile to finish grad Material beneath the J Total effectiv—eabZo rption area !� U) Length Width De PERMIT NO. Qa F w °� Type rib Crib diameter Crib depth Tota active absorption area LU N DISTANCE TO: Well Building foundation Nearest lot line J Class - Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS P v C - 4 -'33 . SOIL TEST RATING O'� S -P4 YiVYN INSTALLER L A cl) V hQ REMARKS r ti APPROVED DATE LEGAL � �R-1 PAS I �I �:1 L_ 1 7- CH F`� P-4 C:� PF�" F:l C� E DEPARTMENT k.. HEALTH 8ND ENVIRONMENTAL ..�8TECTION 825 'L' STREET' ANCHORAGE. -HK. 99501 ~ 264~4720 CR P-4 -- F= 1�l E---- FR t-1 F, HZ� F? F -__l E -g E- F-` LE F_�:. _T- PERMIT N(l ( 810825 ) / ' APPLICANT JOHN LOHREY SR BOX 2048.-J 99507 ]44-Z]. f 9 -' LOCATION BUDDY WERNER DRIVE LEGAL L 5H B 3 PROSECT HEIGHTS S/D LOT SIZE 117612 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRHINFIELD MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)­ 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: -,:� ���cEi-vvi­- �4-K:Ev THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELC\ THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET), -F"F= T _�­ 150. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL. PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FZ'iEC�!kJ LE F__"EEC_- l @::� �I -z:r=_=_. PERMIT APPLICANT HAS THE RESPONSIBILITY TQ INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ca ��> I r_-1 _,a-- f` _T' I CP P--1 ES, F=1 F..' FEE F-'! EE-: CA k- E. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL. SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET, OTHER REQUIREMENTS MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ����r-1 I ��F" 3:��E=�, ��� -�Eo fL I CERTIFY THAT 1� I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: _~...... APPLICANT JOHN LOHREY /l } ISSUED BY DHTE.� �-�~_�~~-�~.^__~~_~~�~_��~.^-~�~~ �_��4JV4.0 MUNICIPALITY OF ANCHORAGE Department' _ Health and Environmenta` Irotection 825 L Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # # UP69A-m gate A"'^ ON-SITE SEWER PERMIT Applicant: . o (9In �- f Mailing Address: � � `, 20 L19, -J Location: �� ,� (A)Prnor �r,JE' Phone Number: Legal Description: Lu-rI��,�� Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: �ZSeepage Bed: Holding Tank: Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH'_ LENGTH =�1� pk _ GRAVEL DEPTH =-C WIDTH '3 '4 The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). L x1��"o 6 # # REQUIRED SEPTICku,�G--) TANK SIZE = GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(Z) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 u 1 # # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if t residencess remodeledto include more that 3 bedrooms. Signed: Issued by: plicant 1 Date: V OT 4o SWP/024 (1/81) { P_ e _ °r ?A GAAB-HD I G,V ATER ANCHORAGE AREA BORQT5- zH HEALTH DEPARTMENT 327 EAuLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME c%/7/ /�Q�f�° ADDRESS 06,0' PH0NE��%� LOCATION �l�c _ ,�,� �U LEGAL DESCRIPTION�CL SEPTIC TANK: DISTANCE FROM WELL ��r� MATERIAL G'L��t/C�'�c%`� NUMBER OF COMPARTMENTS LIQUID CAPACITY GALLONS. INSIDE LENGTH �' INSIDE WIDTH �� UID DEPTH - SEEPAGE PTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS f OUTSIDE DIAMETER A_ '�iYOS� G� OR WIDTH ,LENGTH-��, DEPTH , LINING MATERIAI o46 T JX� 6��r DISTANCE FROM WELL �� � - " BUILDING FOUNDATION NEAREST LOT LINE �%. TOTAL EFFECTIVE ABSORPTIONAREA(WALL AREA) 7&4 SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WEL FOUND ION NEAREST LOT TOTAL LENGTHOF LINES NUMBER OF ES DISTANCE BETWEEN INES NCH WIDTH IN. TOTAL FECTIVE ABSORP ON AREA SQ. FT. LENGTH F EACH LINE D H: TOP OF TILE TO FINISH GRADE DEPT ILTER MATERIAL BENEATH TILE: IN. OVE TILE WELL: DISTANCE FROMWATER TYPE1"9//_- � DEPTH Ze,5`� BUILDING FOUNDATION. ©� SAMPLE/ViJ NEAREST LOT LINE a NEAREST r� SEPTIC SEWER LINE TANK a C2� SYSTEME C�� v� OTHER CESSPOOL , SOURCES - DIAGRAM OF SYSTEM DISTANCES: RI DATE , !!��/7� H % 7U F 4 k (A ��r w � t � H k (A ��r VA7"- z �vao :�y1 i � �n1a 1.rr %� _ H GAAB-HD-2 GREATER iNCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 )ROUGH Case o k7 Q/01. 279-2511 ( SEWAGE DISPOSAL SYSTEM o APPLICATION & PERMIT I) NAME OF APPLICANT ` hri Lobre MAILING ADDRESS -1Q 3U I.ojer. RP PHONE NO.349 k33 z� RESIDENCE ADDRESS S/4MF_ LOCATION OF INSTALLATION-�iUS C.1` f f_S Ar)OW't'- I LEGAL DESCRIPTION Z0 % <S A EGDe-k .3 APPLICATION TO INSTALL: SEPTIC TANK I-' SEEPAGE PIT ✓ , DRAIN FIELD , OTHER TO SERVE THE FOLLOWIN o FACILITY 4 B ) R l� FINANCED THROUGH -FTO BE INSTALLED BY PERCOLATION TEST RESULTS` ANTICIPATED DATE OF COMPLETION 24 hf- NOUCE _-F04- BELOW T F¢4- BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT l71/V f)L 1"J5�. THIS IS TO SERVE AS ° ��° /�7/% � PERMIT TO INSTALL A ';��,'rJ/ ex �� ��2%-5;1641 AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED 4ayezeck �% SEPTIC TANK SIZE TYPE Coca ✓SEEPAGE AREA TYPE DISTANCES: Sle e Pa- 'pt -t 4-r-, 110US-0- - 2-o _�r'o Lc RIP-�Ll ?e3 rpt r /nl C -r U f t Woufi SCS/i 7_e,51 Health Authority DIAGRAM OF SYSTEM i I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE 7 APPLICANTS SIGNATURE ATi IREA.TER ANCHORAGE AREA BOROUGH y. HEALTH DEPARTMENT CASs, >t 327 EAGLE STREET ANCHORAGE, ALA(=KA 99501 r i r� .- Date Performed �<> Performed For Legal. Description: Loth lock Subs vision This Form Reports a: Soils LogPercolation Test Depth Feet Soil Char-a�,teris cs Location Sketch s� Was Ground 'Nater Encountered? If Yes, At What Depth Proposed Installat�ion:�Seepage Pit Drain Field Depth Of Inlet Depth To Bottom Of .Pit Or 'French COMMENTS: .� Y Test Performed By: Data Certified By: Date: I Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program s A T 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.usIs aa Z (907)343-7904 1 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OSS - a9 2 - as HAA#�O�t Expiration Date: I I -/P,0 3 1. GENERAL INFORMATION Complete legal description 1--d t r-4, 01oc k j. Pray -pcf� tih ;:P/ Location (site address or directions) 9260 /3uo 161xrner- Dr -&'e Current Property owner(s)„ .i v� n i Ans 1,oAr !v Day phony 3 Y6 - ISy,0 Mailing address P. o. 13Gx / f0 7f / . A-^cAoreMC1,9 A4e 99'r/1 Lending agency GCA Ic. Day phone Mailing address Real Estate Agent FS or) Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Y l eeye Cal( owner cuAen 2. NUMBER OF BEDROOMS:t _ H�� Cer hFrrak u rec+a/r Foy p;e�„�, 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL.: Individual Well to Individual On-site (� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work 4. 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 Health Authority 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 Fletlfop Tccl ni ca ! See-,%« Phone - 3 y s- 1ss5- Address l'1 S 3U E -A& §/. A -n cA v n5 ve A lc 995-1 Engineer's Printed Name Th eoelare F. /'1 Ocie -e Date 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, OF A4ill ZVO 4s•.•••..••0•09000000.•:.fna a..... ......... ' x;%THEODORE F. MOORE �• CE -3589 .-• r' h,� ,,••......••'.�� 4. ,c, with the following stipulations: NOTE: The well for this property meets existing State & Municipal Codes.There are nitrates present. It is suggested that periodic testing be performed to insure rhn vplle nnntinifea c,litahilit.. ".Curregtpjtrat.e concentration is 5.84 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from the On—Site Services Program, at 343-7904. Additional Comments WASTEWATER Attachments: p•• PROGRAM •' HAA Checklist X Maintenance Agreements ��JJ•. •'SO,�� NT Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:_8 - J! - Q3 (Rev. 01J02) e _......_...._..._ ....... .............. _......................._.......... ...__,....__...... _..__....._.. �__.,_.. _...�...._.... . Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program j 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 9951 M650 www.ci.enchorage.ek.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.o f s'A , t? to c k 3, P-Iwl- •ee t Ftlr #i _ Parcel ID:c7lr -a 9 2 -pS A. WELL DATA Well type fm t If A. B, or C provide PWSID # _!. Ac Date completed _I/ z3/10 Sanitary seal (YIN) r Total depth 1__ft. Cased to ft. FROM WELL LOG Date of test 3 123 /70 Static water level 9 S- fL Well production r S g.p.m. WATER SAMPLE RESULTS: Coliform __Q_colonies/100 ml. Nitrate 5:8'/ mg./l. Arsenic: — mg./l. Date of sample: g(,£/ 03 B. SEPTICIHOLDING TANK DATA Tank Type/Material t a H c `Coo cit ld Tank size i 2sa gal. Number of Compartments I Well Log (Y/N) YeS Wires property protected (Y/N) )r _ Casing height (above ground) 2i in. AT INSPECTION 7/B/o7 9-3 ft. -7. S'+ 9— p.m- Other bacteria 2 colonies/100 ml. Collected by: Fla rb, a Teri Ste[ Date installed 9 / I/ 7o Cleanouts (Y/N) Gi Foundation cleanout (YM) P I' Depression over tank (YM) _� High water alarm (Y/N) A/. A: Date of pumping 7 / t6 / 01 Pumper ri c Oona /ds pcTn p, ey C. ABSORPTION FIELD DATA * vsn Fled p rweAee of /A At PA -Z a /etr.► os. F Date installed - - .a Soil rating (g.p.d./fe or ft2/bdrm) e£ o%d System type s' w• oto+., fe I./ Length 014 ft. Width 4- ft. Gravel below pipe 3 ft. Total depth I R Eff. absorption area tv ftp Monitoring tube r Depression over field N rnear s/8/�3 Date of adequacy test -7 / 8 / 02 Results (Pass/Fail) Fery For Y bedrooms Fluid depth in absorption field before test _r in. Water added[ gal. New depth2&Yin. Elapsed Time: lt7 min. Final fluid depth V-9 in. Absorption rate >= 6aG g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NoAe know' If yes, give date A/.6 J n I D. LIFT STATION �/• A- Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off" level at w in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? u E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Iift station on lot 56 16 skr!- tp #A t On adjacent lots > 100 ' Absorption field on lot 110' On adjacent lots > tomo ' Public sewer main N• A: Public sewer manhole/cleanout N• Sewer /septic service line 7 SS' Holding tank ti. A, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation - to Property line -- tSS Absorption field Water main N - A. Water service line �> to Surface water trio Wells on adjacent lots > (emo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 1001 Building foundation 'Or 60 ' Water main —N-.4. Water Service line �> tv, Surface water -> t !xo' Driveway, parkinghrehicle storage '> S , ' Curtain drain None c sen Wells on adjacent lots > tGo F. COMMENTS Ntca j/1 O�tp Cnot'gn f Aan � bi' fta !r t aJ/(o tl ie( a.l�•e.•� sn � �b O�•p�nJ���• ji(a �j�; f,�� W&vhe t/Ae n faAk Az,G�CrYtH IC/d l Ot.% 71/!/0 ;:, '` ,•�S*''�•, r, ..k G. ENGINEER'S CERTIFICATION J 3' ` •''' `' 1 certify that I have determined through field inspections and f t'�e • tY, gt, review of Municipal records that the above systems are in6 conformance with MOA HAA guidelines in effect on this date. ter; • �' ...... •' • • • • • • • •: g V�PE, �rx;cDcRe F. w.00Re; Engineer's Printed Name-7-AeC+ cv rt a�C[ -3589 = r, Datey,a . 4 . HAA Fee $ 3 7s' --`' Waiver Fee $ Date of Payment3 Date of Payment Receipt Number [ Z Receipt Number (Rev. 12101) �� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. "ASBUILT" I I m to W x Leacti,n9 Fie/„� ;% � J� SroR %v — v? o rar,A o r 14 0£ / e a t lase d �, y9 /'2% � G Ag Abe P/N yW THE INFORMATION HEREON IS FOR THE USE OF / L}o- LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES, No corners set Book 87 pg 125- �_������ I hereby certify that I have surveyed the following described property, Lot 514 Block J1�►P��fi �� ALq�y,11 5UgA chorage recording district Alaska, and that the r ��� .•• ••••'f �� improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto • ` ••••••••••••••• • encroach On the premises in question and that there are no roadways, transmission lines or other •9�.��sees 00e....of as* to":0 to visible easements on said property except as Indicated :rani: Hlldon p party phereon. �, o •n • a/ 'u, •. 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