HomeMy WebLinkAboutEKLUND #1 BLK 2 LT 5Onsite File Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page / of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OS?/8I 3r! 7 PID Number:05653[/20 Dwelling:(Single Family(SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New WUpgrade Name: A/7c_ es- ABSORPTION FIELD A/A Address /� ❑ Deep Trench ❑ Shallow Trench ❑ Bed 111 Mound /s L7 I/C 7 P,,L}/v77716--/- 2 6R ❑ Other Phone of Bedrooms Soil Rating Total depth from original grade 2/-7/4/— ��r 2 �S 7 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot k4 V'lA1 ) 2. Ft. Ft. U Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. TolSeptic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Fe Ft. Well /0/' .- — — TANK SI Septic El S.T.E.P. ❑Holding EI Other T Manufacturer�J / �) / Capacity Surface Water /DO_ _ — �7 A�( l�(/�/4�� ri/Y�� / 2OO Gal. [ Material Number of compartments Lot Line f// _ --S-7.-g_-:4- 2 Foundation I/6 _ — NA LIFT STATION NA / v Manufacturer Capacity Curtain Drain vnik — — Gal. Remarks 7 , /1 _ ;7e?Z ee - Pump on level at Pump off level at High water alarm at /V /I !� in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Tank to Installer D3a3� drainfield Q3o, //41'� Drainfield� h.)2 CO/MTh j03 f Inspector /I / v.l e, ,' ., 9 BENCH MARK (Assumed elevation) /. 1 n if Inspectiona / `f 1(st ° 7 /d 2- �� �/// Location and description dates: 3 Z& /cf 4th �// rnr/O 8�Or i ` E- . 3'd 7/z COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp.. " j yb Conditional Approval: Date II '�`F� �•,4%.,.4:170� �� ' s of**4l l... _ �' A • 1 6�y c Ir 7'.,'. . 1‘,,,,en I4{;' Approved Date 1© -11 -1 k k` �s�o4°j't,,--- Inspection Report_9-1-12.doc • AS-BUILT MEASUREMENTS A B ST1 9 16 S T 2 11 18 DCO 15 20 Panther Drive 10' Utility asenent 100 5/% Slope Wit 5% Slop. 3 Bairn /, Previous 5% Sl..e QL Tan Sept o SS<2 5. Slope tOo c Slope A.0 Trench Location New 1000 Gallon Septic Tank w/DCO's / No Conflicts N Decommissioned Old Septic Tank PER UPC i 1 1" = 40' NORTHRIM _�P ' .. Vic. . ECKLUND #1 ENGINEERING A*: •' . *•:"9%- 49I1i RECORD SteveEng. com BLOCK 2 LOT 5 PO Box 770724 t tl LAYOUT Eagle River. Alaska 99577 .; .. u-- A•if WASTEWATER UPGRADE 907.694.7028 411 ?a �a i REPLACE SEPTIC TANK I°at10/1/18 12of 3 Foundation Cleanout Elevation @ 100' , / Tank Cleanouts Elevation @ 98' Fin ^amide Opposing Cleanouts Between Septic Tank & Trench - .0'4 2 Foot Cover + 2' Insulation _-Elevation @ 97.5' �"' / 1000 Gallon Steel To Trench Zation @ 98' 'Anchorage Tank' Ele ion @ 97.3' lid Pipe Matched Elevations To Existing FCD & Line NORTHRIM s'P� '' � RECORD ENGINEERING ( 49TIL*\\ SEPTIC TANK PR❑FILE ECKLUND #1 SteveEng. com � PO Box 770724lk w .c : BLOCK 2 LOT 5 Eagle River. Alaska 99577 •S - � 10/1/18 '"" BY: s E i• = sSHEETof 3 907.694.7026 TANK REPLACEMENT °ote: - - - ---------------Sc MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program \`' PO Box 196650 4700 Elmore Road c �� 3 ;1 ' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite ,• I cpartnicnt On-Site Wastewater Disposal System Permit Permit Number: OSP181317 Effective Date: 9/11/2018 Work Type: SepticTank Upgrade Expiration Date: 9/11/2019 Tax Code Number: 05053112000 Site Legal Address: EKLUND#1 BLK 2 LT 5 G:0702 Site Mailing Address: 4407 PANTHER DR, Eagle River Owner: HICKS JT Lot Size in Sq Ft: 29597 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 2 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 Special Provisions: Ensure minimum 5 ft separation between septic tank and deck supports. n Received By: Date: ` Issued By: R Cl�2n�� Date: 47/8 • MUNICIPALITY OF ANCHORAGE (b, f �1 Development Services Department tis: +•01—: -343-7904 ti On Site Water & Wastewater Section 9*7-} 43-7997 o SEP 7 Z0 ON-SITE SEPTIC/WELL PERMIT APPLICATI c ; ti <<ozs8L9 y�4, Parcel I.D.OSQ - 53(-/z- Property owner(s) /y/('PS Day phone zqy 27E7 Mailing address L../z/0 7 /%4N771.Eg A rZ Site address c,47,eYI Legal description (Sub'd., Block & Lot) 1C k &v,10 # l ,8 Z L 5- Legal description (Township, Range & Section) Lot Size 2 T. 517 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank /12" Upgrade Holding Tank ❑ Renewal Duplex (D) 1:1 Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 1;--0—Z 6314- (Signature of property owner o horized agent) Permit/Rush Fees: c26 Waiver Fees: Date of Payment: q l?/l' Date of Payment: Receipt Number: 07-7Ott Receipt Number: Permit No. 05Pa X17 Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc • Nk2RTFIM ENGINEERING SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 9/6/18 Number of Pages: To: MOA On-Site Services Subject: Ecklund #1 Block 2 Lot 5 Septic Tank Failure The subject septic tank has failed-a new tank will replace the old one. The existing trench appears to be working OK. Please issue a permit so the tank can be replaced. The existing trench will remain. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks-Stet ' bTF--- IN/ ENGINEERING SteveEng.com Ecklund#1 Block 2 Lot 5 SPECIFICATIONS& DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3-bedroom home. Most of the neighboring lots are developed. The current septic tank has failed-the trench still functions. These lots are near a half-acre to acre and are served by the private water wells.No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2-compartment, 1000 gallon septic tank. Watertight couplings on inlet& outlet. • 5' minimum between the tank and trench. 10' to property lines& foundation. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. Tank&solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment,and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Of 4 .40h ' ;49x- 1 .4400P- S Q� Steven W.E . * -db,% foki 6 53fr • 4reio 9F0O . ,P DESIGN NOTES: 1. Existing Trench Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Tank To Existing Trench. 4. Lots Served by P ' . - e - tells. 5. No Conflict 11ith'n 200'. Mark 100 , ell Radius. 6. Check .ndition of Sewer Service Line— -eplace If Necessary. 7. Add Rouble Cleaneuts Before Tank If No , O. Panther Drive 10' Utility asernent 100 5% Slope / Well 57. Slop= / 41, 3 Bdrrn i, it- Existing / Si sl..e 9 Tan Septic G #ft76\ 5% Slope ��� / o \ 1 to C. ' Slope A000 \ 1 `° Trench Location New 1000 Gallon Septic Tank w/DCO's / No Conflicts Decommission Old Septic Tank PER UPC 1+ ° �� 1" = 40' NORTHRIM P� °F� '!., ECKLUND #1 ENGINEERING 14P:-..' • f BLOCK 2 LOT 5 DESIGN . , PO Box 770724 t . sir LAYOUT Eagle River, Alaska 99577 1,\.. 7 r WASTEWATER UPGRADE 907. 7a 4.028EET:REPLACE SEPTIC 1Dat9/6/18 of 3 Foundation Cleanout Tank Cleanouts Fin ^amide Opposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal 1000 Gallon Steel To Trench 'Anchorage Tank' Or Equal lid Pipe Match Elevations To DESIGN NOTESExisting FCD & Line 1. Use Existing Trench. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. 4. Water-Tight Couplings. S. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. 7. Decommission Old Septic Tank Per UPC. 8. If No FC❑, Install DCD's. NORTHRIM _••��• �c° ENGINEERING SEPTIC TANK PROFILE ECKLUND #1 SteveEng. com 3•* _4 �` • Po Box 770724 Stove li : t BLOCK 2 LOT 5 fo !. River, Alaska 99577 1 9 907.694.7028 '44'', °l.�i TANK REPLACEMENT °ate:9/6/18 '" By' SE 1, = 5 ' SHR13 of 3 IScc": I SE /~ MUNICIPALITY OF ANCHORAGE /' ~,"J-J-J-J-J-J-J-~J I'~----~ DEPARTMENT OF HEALTH & ENVIRONIVIENTAL PROTECTION ENVIRONiVIEN'rAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ! ~L.NEW MAI LING ADDRESS LEGAL DESCRIPTION LOCATION //~l~ ~0~ &~' ~1~ ~ 0~ ~t~-- ~~ NO. OF BEDROOMS DISTANCE TO: Well Absorption area Dwelling ~ o~ PERMIT NO. ~ Z Manufacturer Material No. of compartments ~ ~ Liq. capacity in gallons Inside lengt~ Width ~. Liquid depth IF HOMEMADE: ~ ~ ~ciW in ~allons 0 ~ ~ Manufacturer ~ell~O~ o~ Foundation~o~ ~earestlotline P~MIT~O. ~ ~o. of lines kenflth of ~ch line Tota' ~h~f H nes Trench ~idth Distanco between Unes Top of tile to_finish grade Material beneath tile Totgl effective absorption area ~ ~ Type of crib Crib diameter Cr~D o~ ~ ~ absorption area ~ ~ ~ Building foundation Nearest lot Une ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PiPE MATERIALS .... : elP~ APPROVED DATE LEGAL DIE!:::'(.W:;'.TMI!.~iNT OF' l."IErrq_'T'H (::}ND IENVIIRONMIEI',IT'~}iL t:::'F;'.O'I"IECTIC~IN 825 L !i!FI"F~:I!.'"':ET', ~qNCHOR~.i(31E, ~l!.( c?750 1 2 A 4.-..q. 7:;:'~ 0 C!C) E: 8.¢ E: E!'qG'G BOB !'3 F:?.B 1 S;&, X E!:A(3!_E R I Vl~ii:l::~'. !~ iq!< ?~75'77 ~:~74.-.2~777 !!ilUBD I V I S i' ON ~; I!![I<L..L!ND [!;Ei:C'T' I O N ~ 3; 2 T' L'] NIx!S I..'I I F::' ',', 4.2 :t. 38 ([EiI:;J ,, F::T ,, OR F~)CF;~Ii!!:!3 ) lEE IL...... ,~ ...... syst ~m. 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["i ~¢¢¢, dc~,~.i6jr; ,::::P :i.t.i¢.:H'~ :i.a elf t!"i:i.~; pe)r'mi+ ::;.;.:[ ~,~:i.].:l.acl'xar'e t.o a].]. l"IChq and St. at.,:.:;) (::),i' [qlasi. l<a r'eqL(z?exnerit..is -l',:::)r' t.h,:.?.~ ~s~:~?i back c:l :i.~iit. atr~c:,:a~B ~' ['(:)[l~ any [~F~>( J.~Bt. iF~]~ ~e)]. 1 ;, ~.~a~iFLi¢~,~4avi:.~¢¢,P d :~.s!:)(::)~sal ~yst. exi (::m pu.l:) 1 :~ (::: ~:i(.~:¢,r.a(:/je) '~!!iy~iir!:.em on t..l~z~iii (::H" any ad.jac:(.~:~nt, c:,P ["~eh:~r'by ].ot. 4.,, ! L.tnc!e:,r's'Lancl t. hat. t. hi~s pst'mit. . s val:i.d ~.of a max:i, mLm"~ c)i' :]; be)clr'oc)ms~ ~.nd any erl].aP6?)~x¥~ex"YL ~,~:i.].]. Pi~.)i::it.t:l.r'~.~:.~ a~u"l adc!:i.t, ic]na]. I F:' (.~ !_ I F:']" STAT t C:)N Z S I N[~?T'~s~d_LED I N (.~N (.g:IESq COVE]:i~E~:D BY HOP BU I I....B i IxlG CODES TI...IE~Iq( ~ ) CHq EL.E:C]"Fi'. ~: C,ql._ c:'tEI:~H ]: ]" (~ihlD I !xl{~iI::'EEC;]" ]: ON ;flUB]" BEC OB'T'~q t I',!E:D ~ (2) ~;.....i.}}',!..I W I L.!. NOT BIZ ~:g:::'F::'F!C)VED N I THCIU"!" ft~lx ELIEC;TF:i: I C(:~I... I NSF:'ECYT' ]: C)N I::;:IE!:::'C]F~T; (::dqD (3;) 'T't-.iE IEL. ECi"r'F~'. :!: Ch~L. I, gORl< !"ILJS'T' BIE DCIIxlE [3Y (::~ L. I C;IE:NSE~D E~:L..I~EC:i'T'F:~ ]: C; Z AN ,, ...... ................. .............. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS PERFORMED BY: ~ ~'r ~,,,~- ...... e 72-008 (6/79) WAS GROUND WATER . I S ENCOUNTERED? P IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 5 ~'~ /o ii PERCOLATION RATE (minutes/inch)/ TEST RUN BETWEEN ~ FT AND r~ , ET MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG PERCOLATION TEST DATE PERFORMED: SLOPE SITE PLAN 10 11 12 13 14--- 15- 16- 17 18 19- 20- ~bert A. Sharer No, 1457-E ~bert A. Shaft I'~. 1457-E COMMENTS PERFORMED BY: 72-008 (6/79) )UND WATER TERED? YES, AT WHAT DEPTH? Reading Gross Date Time Net Depth to Net Th'ne Water Drop /o PERCOLATION RATE TEST RUN BETWEEN ~'~ FT AND (minutes/inch)/ r/ FT OWNER 'OF LAN - DA~E-Stfirted . <:~ Ehoeo PERMIT NUMB~ ;~ '~ ~ND'.OF:FORMATION:" . ~ ~ / Ft. to .Ft. From Ft ~ . Ft--' From From :Ft. to ~Ft. From ' Ft. tO ' Ft.~. From ' Ft. to ' -_Ft.. From ,~t. to Ft. From ..Ft. ~o - .Ft.~ Prom ~ Ft. to. Ft. From Ft. to .Ft. MISCL, INFO~fiTION: DOC' Co. dba WELLS 'Pi 0. B~))~ 272, C~UGIA~;ACA~KA 99567 ? :TE[EPHON.E DEPTH OF WELL GALS. PE~R HR' KIND OF CASING From- -Ft. to , Ft. From Ft. to ' Ft.'__ Ft, to _ .Et. Ft. to Et. ' Ft. to Ft Ft. to Ft. MUNICIPALITY OF ANCH~ ENVIRONMENTAL PROTECTIOM Ft. to Ft. · ' , . From Ft. to' Ft. From ,' ,Ft. to , , Ft. From .. Ft. to F~. .From - ~ Ft. to Ft. ' Fr'om Ft. to .Fr. From _Ft~ to Ft. From .Ft. to , · .Ft, DRILLER'S NAME Municipality of Anchorage • On-Site Water and Wastewater Program (907) 343-7904 nal CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-531-12 Expiration Date: / l/ I ct 1. GENERAL INFORMATION Complete legal description Eklund #1 Block 2 Lot 5 Location (site address) 4407 Panther Dr Current Property owner(s) Hicks Day phone 244-2959 Mailing address same Real Estate Agent Brent Seibert, KW Day phone 360-8655 18970 2. TYPE OF DWELLING: ti Single Family (w/wo ADU) ❑ Duplex 0 T 02 2018 z ❑ Multiple Dwellings (Single Family and/or Duplex) 6 8 Lg�'� 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: , Date: `6/5/P COSA to be released to engineer, unless of ise requested by the engineer. COSA Fee $ 5 A‘, Date: Date of Payment 10l4/'2 Date of Payment Receipt Number Oi 3150 Receipt Number COSA# 03C r57/5-. 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 10/1/2018 . 1k 6. DSD SIGNATURE "-' "`% System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. FE ,`` sy Conditional approval for bedrooms, with the following stipulgtion's o E s,6\0'''„,�= ' KC• I>U ON-SITE "4.0 WATER AND ” WASTEWATER o • cc) PROGRAM• ° 'F V 7 SERI\C - By: � I,U,, ``—d / Original Certificate Date: I V `l i The Municipality of Anchorage Devlopment 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 Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: ,5�L` 4/Z / , '2 £5 Parcel ID: 0_5V 5311 Z A. WELL DATA Well type p If A, B, or C provide PWSID# Well Log (Y/N) y Date completed CAPS Sanitary seal (Y/N) y Wires properly protected (Y/N) yf OTotal depth/ 5ft. Cased tof00. 5ft. Casing height(above ground) < 2fin. FROM WELL LOG AT INSPECTION Date of test O /(r5 7/2 7/4 Static water level 2J� ft. 344 5 ft. Well production l0 g.p.m. � � g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mL Nitrate Nab mg/L Arsenic AM ug/L Date of sample: 'Old' Collected by: 4./ j ��r B. SEPTIC/HOLDING TANK DATA Tank Type/Material _ad S EL. Date installed ?�Z 7/18 Tank size AO 00 gal. Number of Compartments 2- Cleanouts (Y/N) Foundation cleanout(,Yr//N) y Depression over tank(Y/N) /V High water alarm (Y/N) ,( /v Date of pumping "lam Pumper C. ABSORPTION FIELD DATA PSC p T► ctj Date installed `?/c/4P-5 Soil rating (g.p.d./ft2 or ft2/bdrm) Z 25 System type Length 6-13 ft. Width 2.S ft. Gravel below pipe 6 ft. Total depth/O.5 ft. Eff. absorption area 7.5C ft2 Monitoring tube y epression over field /v Date of adequacy test C� Results (Pass/Fail) /tu_ For 3 bedrooms Fluid depth in absorption field before test 5S in. Water added if 50 gal. New depth '9 in. Elapsed Time: .60 min. Final fluid depth S k in. Absorption rate >= 17SC g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) 1//t/k If yes, give date D. LIFT STATION /VA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /go 4- On adjacent lots / 2O `f" Absorption field on lot /0 0 /1- On adjacent lots /6 O /'t Public sewer main /rJn 'F 0 Public sewer manhole/cleanout /Qd (� Sewer/septic service line a 5 '�' Holding tank ADD 'f � l Animal containment areas 5O -F Manure/animal excrete storage areas /GO 7L' SEPTIC/HOLDING TANK ON LOT TO: Building foundation /0 14- Property line /0 (f Absorption field 5 `1t- Water main AO (i Water service line /0 /ff Surface water /00 r/ 74- Wells on adjacent lots l Q0 k7 ABSORPTION FIELD ON LOT TO: Property line /0 Building foundation /� /O f Water main /0 f Water Service line /Q (74- Surface water /DO (f— Driveway, parking/vehicle storage /0 (1Curtain drain U/ltr k- Wells on adjacent lots_20_6_9- F. 6_ f F. COMMENTS G. ENGINEER'S CERTIFICATION '47�.e>� T.Nof A( � I certify that I have determined through field inspections and .w.:".0, ..,.y '''• .S = review of Municipal records that the above systems are in 'Gj ; • . 'R= ,'/l conformance with MOA COSA guidelines in effect on this date. ICik;'=* It * 14# Engineer's Prin d mey / �� Lam) c� / A; Date ! . / `� ��,: s even W. �,9 itp •f• d 25 ..•.cs t1� PROFESS\` ..? COSA yellow sheet_2-6-15.doc 1 Ute—/l, .� i I 111 0 I �1 SO I / , •/ 4 • � A dA t . .d� kll C . •' /4i7 -.Z.'L, ' • L ` t! li \ .L • Z \elliI '''''' -‘>. kii4‘ -* . •' •‘ • 1 S 1 ' • o . G:.,,,,,,/. H w e i AL ' ,G �/I�i-/ '4.%7 �/By'°-s/"304'.:✓ 9_rsG ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:�, @�� . FOLLOWING DESCRIBED PROPERTY: / 3G 42'.e_ t OF At �a, ��f'��/✓.sl/,y.O,d//4/, 2.O7 4�.�' Z DATE- / .� � ......'•• S t. AND THAT NO ENCROACHMENTS EXIST EXCEPT AS /��.5 -'�.' ,..;A_,: .-.'�,-� INDICATED. IT IS THE RESPONSIBILITY OF THE i..'';' 4' P' OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: °' ' EASEMENTS, COVENANTS, OR RESTRICTIONS SE6dz WHICH DO NOT APPEAR ON THE RECORDED SUBDI- �q • Duane Merk and' . �"4 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD Fs' 3 f A•.. LS- ' ` ANY DATA HEREON BE USED FOR CONSTRUCTION "a' ., •.,' �' � � OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN 13� 'r'�`�'^�' `'�C''�r ARY LINES. la-11.n' %ii J 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 '~ ~.~.'7 ~ ~-~' GENERAL INFORMATION (a) Legat Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~'fz4::~. l"~ ~:,~ Telephone: Home ~:"~:'" '~"~'~"..- Business Applicant Address _~' ~)' ~ l'~'''~'"~' ~_,/'~L..~ [~¢¢J'L~; /~t/~- 015~7~ (C) Applicant is (check one): Lending Institution i-I; Owner/builder,J~, Buyer []; Other E] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone Telephone (f) ~the HAA to the following address: TYPE OF RESIDENCE Single-Family¢~[ Multi-Family [] Number of Bedrooms *~ Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~l~- Public [] Community E] Holding Tank [] Note: If community well system, rnust have written confirmation from the State Department of Environmental Conservatio~ attesting to the legality and status. 724Y',~ ~ Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 ail Municipal and State codes, ordinances, and regulations m effect on the date of this inspection. Name of Firm Address Date __Telephone DHEP APPROVAL , , Approved for '/,~-'2--/~'("~')_,beOrooms by Approved ~x Disapproved Terms o~ Conditional Approval \ Conditional _ Date CAUTION The Muncipality of Anchorage Department of Health and Environmenta Protect on (DHEP) ssues Health Authority . Approval certificates based solely upon the representations given in paragraph 5 above by an independent professionar" engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and the r end ng institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOAI HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 I~UN~"IPALITY OF ANCHORAGE DEPT. O1: HEALTH & E~¥1RONM~NTAL PROTECTION WELL DATA Well Classification ~ ' ~;:~:' Legal Description: Well Log Present (~N) Total Depth t~.='~ ~" Static Water Level casing Height Above Ground Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/Ho!din~Tank on Lot t L To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Man hole If'A, B, C, D.E.C. Approved (Y/N) Date Completed L~/'~' Yield Cased to ~c~=,' ~" ~..~' Depth of Grouting Pump Set At U, I~-, Sanitary Seal on Casing ~N) Depression Around Wellhead (Y/J~_ ; On Adjoining Lots F'z~' ' ; On Adjoining Lots To Nearest Public Sewer · To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ; Date B. SEPTIC/~TANK DATA Date Installed Standpipes (~;~N) Air-tight Caps~[~CYN) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l=t4~tm~ Tank: Size ~ No. of Compartments ~ Foundation Cleanout~N) Date Last Pumped ~ ; for Temporary Holding Tank Permit (Y/N) To Water-supPly Well To Property Line To Water Main/Service Line Course 1~ J~A To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA ' " Soils Rating in Absorption Strata Date Installed ~ 65' Width of Field "~[~ Square Feet of Absorption Area "'] ~ Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: ~.'Z.-,~" ~'1 ~¢~--' Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present~/N) D§te of Last Adequacy Test To Water-Supply Well To Building Foundation ~-'~" Lot ~J/~ To Water Main/Service Line ~.c:~ LF To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line I c> ~ ~- To Existing or Abandoned System on ; On Adjoining Lots '~c~ ~.-~' To Cutbank (if present) ~,~ D. LIFT STATION Date Installed Size in Gallons , "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify !hat I have checked; verified, or conformed to all MOA~nd HA~guidelines in S gned ~,~,lt, ~ I~1~i~jl~Rl~ : Date Compa~t~"~ A~ ~ MOA No. "eceipt.©. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) effect on the date of this inspection.