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HomeMy WebLinkAboutALPINE TERRACE BLK 3 LT 5Alpine Terrace lock 3 Lot ! §- 243 -14 MUNICIPALITY OF ANCHORAGE ©� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-243-14 Legal description ALPINE TERRACE BLK 3 LT 5 Site address 11940 CIRCLE DR Expiration Date: $/2/2022 Current property owner(s) MEANS PHILLIP N & SUSAN M XThe On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By:_/O"/ UyirjOriginal Certificate Date: 3/13/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory x Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE o -€ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-243-14 Complete legal description Alpine Terrace Block 3 Lot 5 Location (site address) 11940 Circle Drive, Anchorage, AK 99507 Current property owner(s) Phil & Susan Means 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone (907) 980-1946 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑■ Fiberglass Age 48 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed X Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee Date of Payment COSA # 0 S C Z `y /10 C Z Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Alpine Terrace Sub, Block 3 Lot 5 015-23-14 6.8+ 5/29/1975 52 N/A 50 5.82 24+ 8/2/22 Forge Engineering 34 2/21/24 59" 6/24/75 7.5 2.6 4.9 N/A N/A N/A 8/2/22 2 1147 32 1440 4 >600 72 17.2 54.8 Benjamin Schiller, P.E.3/4/24 (907) 522-7773 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC241052 Subdivision: ALPINE TERRACE, Block: 3, Lot: 5 A water sample revealed a nitrate concentration of 5.82 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Lot 4 10 UTILITY 1 EASEMENTS / Lot 6 ' N 89'58'40"E 205.03' E � CHAIN-LINK CWAI LINK I FENCE DOG RUN 100' PROTECTIVE WELL RADIUS + \PECK SEPTIC PIPES \ 6 + $° RL 1�1 144 Ap Lot 5 35,725 S.F. N N 89.58•00"W 180. O 3. 8.2'00.2' SHED WELL 24.8' 32.2" GARAGE 32.2' .0' CANT GRAVEL DRIVEWAY W 39.8' 10' UTILITY EASEMENT ALPINE AVENUE io In PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 2740 Project No. 22-539/A2 _ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone ��b� 04 44 (907) 522-4625 Fax 4=1 OF O ,y Professional Land Surveyors kenolangaurvey.aam v .. • • • • '9 jonathan4langsurvey.com 4G R,.• .s 4 I hereby certify that I have surveyed the following described property: LOT 5, BLOCK 3, ALPINE TERRACE SUBDIVISION (PLAT No. 64-63-1) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property Eines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the ala Da of Fu�to,n,0(bc 2.J2� Day at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. .... ....-13 - ............ Ar •'•.1P S 4V p U�044 000 �� AECC963 O J In PLOT PLAN AS BUILT X SCALE 1" = 40' GRID SW 2740 Project No. 22-539/A2 _ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone ��b� 04 44 (907) 522-4625 Fax 4=1 OF O ,y Professional Land Surveyors kenolangaurvey.aam v .. • • • • '9 jonathan4langsurvey.com 4G R,.• .s 4 I hereby certify that I have surveyed the following described property: LOT 5, BLOCK 3, ALPINE TERRACE SUBDIVISION (PLAT No. 64-63-1) Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property Eines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the ala Da of Fu�to,n,0(bc 2.J2� Day at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. .... ....-13 - ............ Ar •'•.1P S 4V p U�044 000 �� AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221401 Work Type: SepticTank Upgrade Tax Code Number: 01524314000 Site Legal Address: ALPINE TERRACE BLK 3 LT 5 G:2740 Site Mailing Address: 11940 CIRCLE DR, Anchorage Owner: MEANS PHILLIP N & SUSAN M Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: »cnt off. l�cirn•tment 10/14/2022 10/14/2023 36774 ❑ 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 2022.10.14 Received By:*Wl� 12:38:31 -08'00' Date: Issued By: Date: MUMUPAUTY OF AHC HOR OC 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 Parcel I.D. 015-243-14 Property owner(s) Phillip & Susan Means Mailing address 11940 Circle Dr, Anchorage, AK 99507 Site address 11940 Circle Dr Day phone Legal description (Sub'd., Block & Lot) Alpine Terrace Block 3 Lot 5 Legal description (Township, Range & Section) Lot Size 36,774 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank IRUpgrade ❑X Duplex ❑ (D) Holding Tank ElRenewal El 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 applicable Municipal Codes. Yl (Signature of property owner or authorized agent) Permit/Rush Fees: 02025 Date of Payment: 0ILA 2 Receipt Number: Permit No. is P 12 a / (W Permit App_:;- ::' .. c Waiver Fees: Date of Payment: Receipt Number: Waiver No. October 13, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Alpine Terrace B3 L5 - 11940 Circle Dr Septic system design Dear On-Site Services Engineer: The owner of the above lot has a steel tank that is past its useful life, so we are submitting this permit application for its removal. Records are unclear as to exactly why this tank was installed. The original system was designed for 4 bedrooms, and the inspection report indicates a 1250- gallon fiberglass tank was installed. However, a later report calls the tank a 1000-gallon tank, and at that time the additional 500-gallon steel tank was determined to be necessary. The trench was not extended when the newer tank was installed. The attached site plan identifies the location of the home as well as the wells and septic location. There is no new tank being installed, so there is no concern about separation distances or adverse impacts. The home is currently a 3-bedroom home, so a 1000-gallon tank would be sufficient for the system. There is no adverse impact to removing this steel tank and connecting the original tank directly to the field. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221401, Deb Wockenfuss, 10/14/22 x x x x x x x x x x // x x x x x x Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND ALPINE TERRACE, BLOCK 3 LOT 5 FEET 0 50 100 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. ALPINE AVENUE3-BDRM H O M E 9/30/22 CIRCLE DRIVEDECK GARAGE 10' UTILITY EASEMENT 10' UTILITY EASEMENT EXISTING 43' LONG TRENCH DECOMMISSION EXISTING STEEL 500 GAL TANK PER UPC FCO EXISTING FIBERGLASS TANK RECONNECT SEWER LINE TO EXISTING FIELD Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221401, Deb Wockenfuss, 10/14/22 t Lot 4id o N O 0 O 10' UTILITY EASEMENTS / Lot 6 3 O.p, / N 89'58'40"E 205.03' r8.2'x 10.2 1 SHED LJ WELL A CHAIN-LINK ooc RUN r CHAIN-LINK I FENCE i tR �. 24.8 x x x x 32.2' ( 1c 100' PROTECTIVE WELL RADIUS GARAGE -GRAVEL a a DRIVEWAY \ ` �\/ 32.2' + \DECK O a SEPTIC PIPES + \ 2 OFc N 0 111.0, / 1.0' CANT Lot 5 35,725 S.F. a n N 89'58'00"W 1 T ALPINE AVENUE 10' UTILITY EASEMENT PLOT PLAN AS BUILT X SCALE 1 40__ GRID SW 2740Project No. _____22=5391A1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates i n c . (907) 522-6476 Phone p000p O Professional Land Surveyors (907) 592-46y5 Fax kenOlansurvecom o' OF q��o�4 jonothanOlongsurvey.com S Q I hereby certify that I have surveyed the following described property: LOT 5, BLOCK 3, ALPINE TERRACE SUBDIVISION (PLAT No. 64-63-1) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. 01 Dated this the _?"" - _ Day of ___v_ I�,�t_r , _o,Lat Anchorage, Alaska o TFI� .'fie ............................... �. KQE iff ' LA :R G •.LS -5202.•' SJo 4 aq Nuc %Z. ESS1ONAL't It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchbrage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE ~Oi'J'iJl' [] NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~X DISTANCE TO: ~ ~ Manufacturer Material No. of compartments Liq. capacity in gallons Inside length Width Liquid depth ~ ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer = -- ~ Material Liquid capacity in gallons ~ Well Foundation ~ Nearest lot line PERMIT NO. ~ DISTANCE TO: ~ m ~ No. of lines Length of each line Total length of lines Trench width Distance between lines ~ ~ m inches ~ Top of tile to finish grade Material beneath tile Total effective absorption a~ea Q inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation ~ Sewer line Septic tank Absorption area(s} OTHER PIPE MATERIALS REMARKS /4. ' / APPROVED DATE LEGAL PEF:.M I T Ni-i. l'-lIdl'-.I I r: I Fji~iL I T"r' OF FII",iC:H~,[R:. 'FICHE . ': ;~ DEPFIRTMEI'.,IT C~t~I_ERLTH RND ENVIF.:0NMEI'-,ITFIL ITECTIIDN ;1 825 "L" STREET., FII",ICHORRGE, Rk.'.'. ~5L'~'.1~ C~l'-.I--"-: I TE SEI.--IEF-." L~F't.~F-'R[:,E F'EF-."I'.I :;[ T ,:: 82:006i ;, ' F F L I _.HNT LOC:RT I ON LEGFIL CFIRL" S Er,_.H,~ HTIN~ .... F'-' ~- I-' FILRTNR SRR E,J,.--, 1724M q.'~..=;F~7 LOT SIZE TYPE OF SOIL FIBSORF'TION S'T'STEI"I I5' DRFIINFIELD 2:4-4-(1044 SQLIFtRE FEET t"IRX I MUM NUMBER OF E:E[:,ROOMS = 4 501L RFIT I NG ,' S_.':' FT,/E:R) = ~ THE REQUIRED SIZE OF THE SOIL FIBSORPTION SYSTEM IS: E:'EF"TH= J LEI"4~STH= Et "3 F~: FI"..." E L [:'EF'TH= ~ THE LENGTH DIMENSION IS THE LENGTH '::IN FEET::, OF THE TREN_.H' P nF.'_ . DRRINFIEL[:,. THE DEPTH OF 1=1 TRENCH OR F'IT IS THE [.I=,THNuE" '- - -' BETNEEN THE SLIRFRCE F~F THE GF.:r~UND FIND THE BOTTOM OF THE EXr:R',/FITION (IN FEET;,. THE GRFI',,,'EL DEPTH IS THE MINIMUM DEPTH OF ~ ..... -","-' .~.n,,,-~_ BETWEEN THE OLITFFILL PIPE 1=11'4[:' THE BOTTOM OF THE EXCFIVFITION ,.':IN FEET:). F=:EL-::!IJ I: F-:E[:, '_-~EF'T [ C: T Rt'-.II-=:-.' ---; T ZE= 5£1~._---1 t-aRLLC, I'-.I$ F'ERMIT FIPPLICRNT HR'--', THE RESPONSIBILITY TO INFCRM THIS DEF'FIRTMENT DURING THE iNSTFILLFITION INSPECTIONS OF FINY WELLS R[:'JFIf':EI",IT TO THIS F'RF;PERT'¢ 1=11'.,1[:, THE NUMBEF.: OF RESIDENCES THFIT. THE WELL WILL SERVE. TI.4C' ,:: '--:._: ::, l' I'-.IE..F'EF:T I !:,1'-.i$ ARE F.:EL-:'~Li l' REE:, BH_.k. FILLING F~F FINY SYSTEM WITHOUT FINFIL INSPECTION FIND FIF'PRF¢,/FIL B'¢ THIS DEPFIRTMENT WILL BE SUBJECT TO PR~3'--,EF:IITION. MINIMUM DISTRNCE BETWEEN 1=1 WELL FIND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS ±00 FEET FOR 1=1 PRIVRTE WELL OR ±50 TO 200 FEET FROM 1=1 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTFINCE FROM 1=1 PRIVFITE WELL TO R PRIVFITE SEWER LINE IS 25 FEET FIND TO 1=1 COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY FIPPLY. SPECIFICRTIONS FIND CONSTRUCTION DIFIGRFIMS FIRE FIVRILFIBLE TO INSURE PROPER INSTFILLFITION. F"EF-:I'-I I T E::-::F' I F-:ES [:,EE:Ei'-IE:EI~: _---=:1.. 19.'-2::2: I CERTIFY THFIT ±: I FIM FFIMILiFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FIS SET FORTH BY THE MUNICIPRLITY OF RNCHORFIGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTFIND THFIT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. S I GI",IED · _. __ _ · FIPPL I C:FINT LC'_:FIF.:L'" S EXCFI',,,'FIT I NG ISSUE[:, BY ..... L __DRTE .... GREA' tR ANCHORAGE AREA BORtJuGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -~~ LOCATION MAILING ADDRESS LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER /~'/~ INSIDE WIDTH NUMBER OF COMPARTMENTS LIQUID DEPTH __.LIQUID CAPACITY t~,~O GALLONS. SEEPAGE ~ F~/U~ NUMBER OF PITS __, L)NING MATERIAL BUILDING FOUNDATION__ ADDITIONAL ABSORPTION DIAMETER OR WIDTH__, CRIB SIZE: DIAMETER__ , NEAREST LOT LINE__ LENGTH , DEPTH DEPTH__ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE ~)j'~'~ ~ CONSTRUCTION BUILDING NEAREST FOUNDATION __ , LOT LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED ~ DEPTH NEAREST SEPT lC , SEWER LINE , TANK__ REMARKS. DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: (~ ~' INSTALLED BY:~L ~ PiPE MATERIAL: ~) LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM APPROVED ~¢~ ~)~C- G.A.A.B. 39953 GreA :~ ANCHORAGe ARea BOR ~h DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. ,.ST ALLAT,ONLOCAT'ON real DESCR,PT,ON /-¢ ,d'.Y' INSTALLATION OF'. SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED SEEPAGE Pit V' ,DRAIN FIELD. ~ OTHER ._ NOTE~-'~rRI'~-I~"i'~"~iOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /~'~"~/"~ TYPE /./'"/f~ SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE ~ / ~ . DRAIN FIELD SEPTIC TANK TO SEEPAGE P~ WALL SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE Pt"T, ./ ~:~"~ ALSO CONSIDER AREA WELLS. 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. G .A .A .B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GRE,~.T~R DESCRIBED SYSTEM ISIN ACCORDANCE WITH SAID CODE..~ DATE I APPLICANTS SIGNATU~ FORM NO, EL-01 6 ' ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE This form reports' Soils log 2< GREATER ANCtlOt<t\GL AREA BOROUGh, Department of LnvironmenLal Quality 3330 "C" Street Anchorage, A1 aska 995(}3 $OII~S I,O(; ~ PEROI,ATION TEST Percolation 'kest Depth Feet 11 - 12- 13- Was ground water encountered? If yes, at wi:a't depth? Reading Date Gross Time Net Time Depth to Water Net Urop Pe rcol a ti on 'r-~ t--e- ................. ~i~i-n-a-~-.' ............................ .,Proposed 'installa't-F~h--:- Seepa'ge Pit Drain Field Depth of Inlet DeptI-~-t'6'-IJ~t~i--O'f-l~it or trenci~ COMMENTS: EQ-.040 (6/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services SeCtion P,O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 5 Block 3 Alpine Terrace Location (site address or directions) 11940 Circle Drive, Anchorage, Alaska Property owner Art & Janet Garrod Day phone 345-6484 Mailing address 11940 Circle Drive, Anchorage, Alaska 99516 Lending agency NOR~ST Mailing address Denali Towers Day phone Agent Mary Reardon Day phone 274-6142 Address 445 E. 23rd, Anchorage, Alaska 99503 e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~ TYPE OF WATER SUPPLY: Individual well × Community well Public' water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X 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 investigatio.n 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 Gilfilian Engineering, Inc. Phone 376-3005 Address 1800 E. Parks Hiqhway, Suite D-100, Engineer's signature~/~ ~' .'~~-:- DHHS SIGNATURE ~, Approved for ~'-- -(/~2 bedrooms. Wasilla, Alaska Date 99654 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 abo¥~ by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is 'not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91~ Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 5 Block 3 Alpine Terrace Parcel I.D. ~/~-- 2, y' ~ ~ / ,,7/ A. Well Data Well type Private Log present (Y/N) N Total depth Unk~ow~ Cased to ~ow~'"~ Casing height Sanitary seal (Y/N) Y - ,, ,cC~ (~ ~/ wires properly protected (Y/N) Y Date of test Unknown 7/7/93 If A, B, or C, attach ADEC letter. ADEC water system number l q T~ _1~'~'~- ~,.~a~. Date completed UnY, nown Driller Unknown Static water level U~own 30 ' 7" Well flow Unknown g.p.m. 8 Pump level1 Unknown 40 '+ SEPARATION DISTANCES FROM WELL TO: 21" g.p.m.r-r-I Septic/holding tank on lot 100'+ Absorption field on lot .-LO0 ' + Public sewer main N/A Sewer service line 50 ' + ; On adjacent lots 100'+ ; On adjacent lots 100'+ Public sewer manhole/cleanout Petroleum tank 50 ' + N/A WATER SAMPLE RESULTS: Coliform Absent Date of sample: 7/7/93 B. SEPTIC/HOLDING TANK DATA Date installed 1975 Nitrate Tank size 2.6 Collected by: Kent 1250 gallons Otherbacteria N Sheets Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping 7/9/93 Foundation cleanout (Y/N) Compartments 2 N Y Depression (Y/N) Alarm tested (Y/N) N Pumper At. Home Services SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: N On adjacent lots 100' + Absorption field 10 ' Foundation 10 ' Water main/service line 2,5 ' + Well(s) on lot 100'+ To property line 25'+ Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed 1975 Length 43 ' Width Total absorption'area 516 sqoft. Date of adequacy test 7/7/93 Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Soil rating (GPD/Ft2) 125 sq.ft. 36" Gravel thickness 72" Surface water Cleanout present (Y/N) Y Results (pass/fail) Pass 25" N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100' 4- On adjacent lots 100' + System type Trench Total depth 94½" Depression over field (Y/N) N for 4 Bedrooms After test 30" If yes, give date Property line 10' + To building foundation On adjacent lots lO0' + Surface water None Curtain drain None 25'+ To existing or abandoned system on lot 25 ' + Cutbank N/A Water main/service line 25 ' + Driveway, parking/vehicle storage area 45 ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in,c&~~.~ ~ate of this inspection. Engineer's Name Date ~//fl/ H~ Fee $ ~ ~ Waiver Fee $ Date of Payment 7--/?~ Date of Payment Receipt Number _ _ ~ Receipt Number 72-026 (8/93)* Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ¢~//~..~~ j/ OF ON-SITE SEWER AND WATER FACILITY ,.---- '"~ 264-4720 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name 2',~,6'~'~'2- ,~',~',4,,4/~ Telephone: Home Business Applicant Address c~ ~"x/7"~$~- /~,~'z-'~'.,.~¢~' ~.~:~. Applicant is (check one): Lending Institution []; Owner/builder'S; Buyer []; Other ~ (explain); (d) Lending Institution ~EN-ri~¢~T ~Oiff. T~,4¢~. ~_.o~..,c,. Address Telephone (e) Real Estate Company and Agent Address ~ q~O /.-}AETZ~'L_ Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'[fil~ Multi-Family [] Number of Bedrooms ~/' Other WATER SUPPLY Individual Well'J~, 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 ~ 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 I of 2 72-025 (11/84) 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this insp_ection. Name of Firm ~//'~.O~/~ ~'"~#*J~-'G-'/~i~Jb Address ~ / ~ ~~ ~ ~-- Date ~ ~ ~--~ ~t i~ Telephone Engineer's Seal DHEP APPROVAL Approved for ~ bedrooms by Approved ,~ Disapproved Terms of Conditional Approval Conditional 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 an:alyze 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 cKVlCEs OI¥1$10N RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LOT 5' 2~ f_O C,,~ ;~ Welt Classification /c=',~/V~X"~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) A/ Date Completed /_.~F~_~M'_ ,~'z · Yield Total Depth {~"'----~ased t~ ~)epth of Grouting Static Water ~' '5'" Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation .Distances from Well: Y To Septic/Holding Tank on Lot /O ~' To Nearest Edge of Absorption Field on Lot /d~" To Nearest Public Sewer Line Mo'r' /N AgE,A. Sanitary Seal on Casing (Y/N) y Depression Around Wellhead (Y/N) /~J · On.Adjoining Lots /..~-O' ; On Adjoining Lots /:5"'~' To Nearest Public Sewer Cleanout/Manhole ,VDT IN Am,~ ,A To Nearest Sewer ServicE~ Water Sample Collected by ~I~.¢Fr*AC~I='I~'Id ,~u,4~ ~ ; Date Water Sample Test Results ~AT~5~A~ Comments ~L~ I~ A~A~ /~ ~t~~._~,~,~/~~ SEPTIC/HOLDING TANK DATA Date Installed / ~' 7~' Size' Standpipes (y/N) y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~ To Property Line ~ ~' ' To Water Main/Service Line No. of Compartments Foundation Cleanout (Y/N) y Date Last Pumped /Z/Z./f'& , for Temporary Holding Tank Permit (Y/N) To Building Foundation ,~' ' To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~75>' Width of Field ~" Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /'~' To Building Foundation /~, Lot To Water Main/Service Line ~3_~' Type of System Design Length of Field 5/5 ' Depth of Field 7 E °' _ ~_C~L~el Bed Thickness 7Z" Standpipes Present (Y/N) Date of Last Adequacy Test T° Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Y / To Property Line // To Existing or Abandoned System on On Adjoining Lots /0~' 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 that I have checked, verified, or conformed to all MO/A a~nd HAA guidelines in effect on the date of this inspection. Signed ~ate / ~/~/~ ~ Company/~l/A41X,~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal APPLI( T FILLS OUT UPPER HAI ONLY Phone --~ Maiiing'Address(~/~) / ,~-~t .... 7'7,'C3 ! / Address Zip Code Lendinglnstitution ~-)//~.~/~ T~'~'~"; /'~-~L" '-~"~/""~ rD'~)/~' '~;'J-~'~2. Phone Address /0/ ~/~-/, ~.~Z~,.~ ~ Realty Co. & Agent /~,./g,~/~/~----- Phone Address Zip Code Legal Description Type of Residence ~ Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply I ,,~lndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility /~.r~.~/ .-- ~.~ / Sewer Disposal ,~ Individual Year Individual Installed: Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: _...~..._..~:. MUNICIPALITY OF ANCHORAGE' ( "~ APPROVED BEDRoC~ *CONDITIONS' OF APPROVAL J~ r" ~ r" ( ) DISAPPROVED /"'~ Soils Rating Date Sewer Installed Well To Absorption Area / ~ Well Log Received 72-023 (3182)