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AUDUBON HILLS #1 BLK 3 LT 9
Audubon Hills lock Lot 9 · ,' 015- 231 -76 Municipality of Anchorage I On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221431 PID Number: 015-231-76 Dwelling: X Single Family (SF) n with ADU n Duplex (D) El Two Single Family Project: n New On Upgrade Name ARLENE CARLE ABSORPTION FIELD ed ound El Deep Trench El Wide Trench E] B>PZ Site Address 6600 DOWNEY FIND DRIVE *ANCHORAGE, AK EJ Other Phone Number of Bedrooms Soil Rating depth —C-original grade 907-345-2137 13 GPDISF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grad Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot AUDUBON HILLS; BLOCK 3, LOT 9 Fill added above original Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To septic Absorption Lift Station Holding Sewer Total rption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 25'+ TANK El Septic E:I S.T.E.P. El Holding [I Other Manufacturer Capacity�� Surface Water '70-6. _0_10 Gal. Material Number of compartments Lot Line 5'+ eo" NA Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks PER CONTRACTOR OLD TANK DECOMMISSIONED PER UPC INFILTRATOR 540 Gal. *SEEPAGE 2/3 Alarm location GARAGE 11 Electrical installed by Installer PIPE MATERIAL House to tank D3034 drainfieIdTankto D1785 ARM SEPTIC SERVICES Drainfield EXISTING CO/MT D3034 Inspector GEG BENCH MARK (Assumed elevation) 101.57 ft Inspdates: ection Is'4/5/2023 Location and description nd 2 th TOP OF MH LID 3rd - 4 ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date �P p 4 T ���0 ... ... .... Septic System f y A orness.- Approved Date ')64 0� ca CE-79�3 UP Note: this approval does not include well permit requirements. Pr of ess"00 :Zzf� #AECC884 mev UDIUZ/ !Cs) 0 Townsend, Curtis L. From: David Garness <David@garnessengineering.com> Sent: Monday, January 8, 2024 12:32 PM To: Townsend, Curtis L. Cc: Jeff Garness; Sonja Blewett Subject: RE: OSP221431 AUDUBON HILLS B3 L9 record drawing comments [EXTERNAL EMAIL] r Perhaps a tank drain pipe is not the correct terminology. It a subsurface drain that will not allow groundwater to exceed the manufacturers specified elevation for the septic tank. From: Sonja Blewett <Sonja@garnessenginee ring.com> Sent: Tuesday, January 2, 2024 12:48 PM To: David Garness <David@garnessengi nee ring.com>; Jeff Garness <Jeff@garnessengineering.com> Subject: FW: OSP221431 AUDUBON HILLS B3 L9 record drawing comments See email below... From: Townsend, Curtis L. <Curtis.Townsend@anchorageal<.gov> Sent: Tuesday, January 2, 2024 11:26 AM To: Sonja Blewett <Sonja@garnessengineering.com> Subject: RE: OSP221431 AUDUBON HILLS B3 L9 record drawing comments What is a 'tank drain pipe'? You draining the tank to a surface discharge? Curtis Townsend, PE Onsite Water and Wastewater Municipality of Anchorage 907-343-7908 From: Sonja Blewett <Sonja@garnessengineering.com> Sent: Thursday, December 28, 2023 2:24 PM To: Townsend, Curtis L. <Curtis.Townsend@anchorageal<.gov> Subject: RE: OSP221431 AUDUBON HILLS B3 L9 record drawing comments Hello, please see attached comments addressed. Thanks! Sonja From: Townsend, Curtis L. <Curtis.Townsend@anchorageal<.gov> Sent: Wednesday, December 27, 2023 11:50 AM To: Sonja Blewett <Sonja _ garnessengineering.corn> Subject: OSP221431 AUDUBON HILLS B3 L9 record drawing comments PERMIT NUMBER: PARCEL ID NUMBER: OSP221431 RECORD DRAWING 015-231-76 DBL1 DBL2 H O wo U OD m z� z ai o 0 O �J33� $w oa z z IL a THERE ARE SURFACE WATERS IN A MAPPED DRAINAGE DITCH TO THE SOUTH AND WEST (ATTACHED). IT IS UNKNOWN IF THERE IS WATER IN THE DITCH THROUGHOUT THE YEAR. HOWEVER, IT APPEARS THAT THERE IS A 100' TRAVEL PATH FROM THE NEW SEPTIC TANK TO THE SURFACE WATER, SEE ATTACHED PHOTOS WHICH SHOWS THE BELIEVED PATH THE EFFLUENT WOULD TRAVEL EXISTING 3 BEDROOM HOUSE / / DE I \) �� BL7&2 �\ EXISTING STEEL SEPTIC TANK O i NEW IM-540 INFILTRATOR SEPTIC TANK UTILIZED AS PUMP VAULT j ASSUMED LOCATION OF TANK DRAIN PIPE; BASED UPON DISCHRAGE POINT AND TANK LOCATION % (j GENERAL AREA OF DISCHARGE FOR TANK DRAIN-, aJ L3 2, o •� " bj.1-7/Z-; AUDUBON HILLS #1; BLOCK 3, LOT 8 GENERAL AREA OF DRAINAGE DITCH PER .DWG PROVIDED BY SURVEYOR / ENGINEERING SALES CONSULTING -, ... �..,, 3701 E. TUDOR ROAD. SUITE 101 ' ANCHORAGE. AK 99507 • PHONE 0071337-6179 -FAX (9071336.324G • WERSITE wnw nvnnvs„nm�nnn�� �„,. PREPARED FOR: ARLENE CARLE LEGAL DESCRIPTION: AUDUBON HILLS; BLOCK 3, LOT 9 TYPE OF WORK: I, SEPTIC TANK RECORD DRAWINGS PHONE NUMBER: 907-345-2137 PAGE NUMBER: 2OF3 DRAWN BY: Q.J.G. DATE: 6/28/2023 APPROXIMATE LOC TION OF EXISTING DRAINFIELD 1 V=40' "-444 .'�P...••• ..,,+i tea;�i r ............. ..................:: ... 10 , �:,• J rey •,• arness ,o�w ♦ i� ' E-795 LICENSE #AECC884 Ik PERMIT NUMBER: RECORD DRAWING V V (N G PARCEL 3 NUMBER: OSP221431 015-231-76 1 UN OF MANHOLE FINAL GRADE TOP OF TANK AT INLET = 97 INVERT OF BUNG AT INLET = 96.67 NEW IM-540 INFILTRATOR SEPTIC TANK - USED AS PUMP VAULT RECOMMENDED FLOAT SETTING (FROM BOTTOM OF TANK): • ON - 31 INCHES • OFF -23INCHES • HIGH LEVEL - 35 INCHES = ENGINEERING z SALES , CONSULTING; 3701 E TUDOR ROAD, SUITE 101 - ANCHORAGE, AK 99507 - PHONE (907) 337-6179 - FAX (907) 336.3246 - WEBSITE: -aamc send nna.ce PREPARED FOR: ARLENE CARLE LEGAL DESCRIPTION: AUDUBON HILLS; BLOCK 3, LOT 9 TYPE OF WORK: SEPTIC SYSTEM RECORD DRAWINGS PHONE NUMBER: 907-345-2137 PAGE NUMBER: 3OF3 DRAWN BY: D.J.G. DATE: 4/26/2023 TOP OF TANK AT OUTLET = 97.26 RAINFIELD � C �1 /j ........ ..... ............. ...0 ...� 0 .•� �ffreyA.•••arness•w LICENS�� �;S�=��•a #AECC884 / �wm -n O 1 -i c — r A O H 1=0X O N p aA O Q� rp fD F+ - m 2 a a � M . rt 3 fD lA �. EF � 5 2 rl O y - rD C� L rD � O S 0 ED s r m m 3 (D W _• CD c O m r- Doi (D `nro3No� (D m n re)y Cr Ts (p y y .O D? r O 0 m r" u+• '� a 0 y m 3y () ? ro CL o<�zD 'O (D tOi o p :3 c _ =r O N N d N 2 '2 o rD ao,ar.' 0 0. N• N LO N O O;q A CD 7 •G O �tn „ OQ w D, Q . n, :=I,-<- y o F as (D goro�� W �' N (p7 r) Z ID O N. O ? ,np O D' (D C D m Vf cn Qw� m O p o 0 a�Nc'c c o FrgQcr m ro c m� w8-0 'm 'o ammw rD 5D o O d 0 W yyyr�w O D <_ = _ Q' N (D D y CT MH�g7! I ' m m o C 0` G p m o r� iSD m * � Q D D x W 1: 0mm tCD o CD �' ° m CC c �3�3y n H ro CM N .N N C ® - y m Nt'C (Dn CL (D N 'a - O C q '9 0 ro 10, ? 3. o =vow ElrtHe� N .0 W O O j _ N tN m T I ID. ID �I�D-0 0 rD IDO O y � fD O rD N p O S. O (D ti m • 0 G N CD o CD N _ G t (DrD <O rD m o C. v T _. — �@ m 0 C� K Co' a r N - M40 / pyG - -7- G / U r Nam_, / / \ 30.0' N00° 02' 26'W 252.02 \K I — — — — — — — _ — — 10' UT1L. ESMT. \2 i .0' %' x to oll '` x50 �_ r O] \05, m I X Ar o V rn co / pJ� / / ti'9L lS' �.1 e3 L toRSO K3 O 00 (l) cn p o ?�,q5 o \ Ch r4�8, A J 15.8 2 � CA qo m- PAVED DRIVEWAY 0 � 4 CT / 01�o-fa 'c' a °n cl) •p N h � .[Z 3 chi -n C) 25.0' co (O N ro ro a co a R- oti S00° 02' 01'E 141.38 — U N N O � ` O i WAXWING CIRCLE =- ( I O a. m 6 M W D H m 13 m m CA ij N V 00 N t0 Ln Ll N V W w Tf 0 m t/f C N r r n A• O !V N Ln r 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: OSP221431 Work Type: SepticTank Upgrade Tax Code Number: 01523176000 Site Legal Address: AUDUBON HILLS #1 BLK 3 LT 9 G:2739 Site Mailing Address: 6600 DOWNEY FINCH DR, Anchorage Owner: CARLE HENRY N & ARLENE Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: .S' X�,.-.c, n llepartmc�lzr 11/2/2022 11/2/2023 43405 ❑ 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 Received By: 4FW0'( t`e'a `f-0 t7 Date: Issued By: "����'� Date: Z'Z I�7UNICIPAUTY OF ANCHORAGE Development Services Department _'� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-231-76 Property owner(s) ARLENE CARLE Day phone 907-345-2137 Mailing address 6600 DOWNEY FINCH DRIVE *ANCHORAGE, AK Site address 6600 DOWNER FINCH DRIVE *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) AUDUBON HILLS; BLOCK 3, LOT 9 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank Upgrade n (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 1 certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: o`{ q Date of Payment: Z- Receipt Number: Q 20 (o L7 Permit No. as C/3 / Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\0n Site Water and Wastewater\Forms\Client FormsTermit Application.doc Z' Municipality of Anchorage On-site Water and Wastewater I MAJI95 ��*yid• OSP221431, Tim Edd md, 11/02/22 -. ._ -7-7-7-7=74M, NESS ENGINESGARU _ , ,'__;0._ �. ' R Cell' ENGINEERING SALES- CONSULTING October 13th, 2022 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: List station replacement for Audubon Hills; Block 3, Lot 9 To whom it may concern: Per MOA records, the existing pump vault is approximately 38 years old (installed in 1984). Per conversations with ARM Septic Services owner Mariah Campbell on 10/6/2022, the existing lift station is taking on water and needs to be replaced. We are proposing to remove the existing pump vault and install a new IM -540 Infiltrator tank to be used as pump vault. See attached design drawings for pump vault location and other MOA requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. A.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.garnessengineering.com THE DEPICTION OF ALL STRUCTURES SHOWN ON ADJACENT PROPERTIES ARE APPROXIMATE IN REGARD TO CONFIGURATION/LOCATION AND MAY BE BASED SOLELY ON PUBLICLY AVAILABLE MOA GIS RECORDS. THE LOCATION OF ALL WELLS AND SEPTIC SYSTEMS SHOWN ARE APPROXIMATE AND MAY BE BASED SOLELY ON INFORMATION OBTAINED FROM PUBLICLY AVAILABLE MOA ONLINE RECORDS AND/OR AS -BUILT SURVEYS AUDUBON HILLS #1; BLOCKI,LOT9A AUDUBON HILLS #1; BLOCK 2, LOT 11 1 LOCATION I N HILLS #1 I GENERA I 2, LOT 10 ALPINE WOODS; BLOCK 6, LOT 11 NO WELL ON PROPERTY PER MOA RECORDS DOWNEY\FINCH DRIVE Municipality of Anchorage On-site Water and Wastewater Tim EcIdund, 'I W I AUDUBON HILLS 41; U I BLOCK 3, LOT 6 JI c) I � I I LOCAT,GN OENE0.AL � I I \ _- AUDUBON HILLS #1; AUDUBON HILLS #1; / BLOCK 3, LOT 7 BLOCK 3, LOT 8 ' 1 GENERAL LOCATION 1 � v ` S LV v = 100' 1-1 40 Off AV �;�' :• o 00 9 ......:...... ......... a ............... 3 TU -��== ENGINEERING SALES -CONSULTING ..-..__s �:.,n _. 0 1 '"ate 0 3701 EAST TU DOR ROAD*SUITE 101 -ANCHORAGE, ALASKA• PHONE (907)337-6179•WEBSITE: w .gamessemmneenng.com o•••^ •••• ••••••• •w., '•••••••..•.••.0 PREPARED FOR PHONE NUMBER: PAGE NUMBER. ` :J J6 rey A.•Garness a ARLENE CARLE 907-345-2137 1 OF 2 #�� CE 79 3 =�: PROJECT/LEGAL DESCRIPTION: DRAWN BY: •# �. f )11 Ar AUDUBON HILLS; BLOCK 3, LOT 9 DATD.J.G. LICENSE 0� e�UFESSI 1 p. vo TYPE OF WORK: 1 rrr�0�� PUMP VAULT DESIGN UPGRADE 10/11/2022 #AECC884 ❑ \1 s� Municipality of Anchorage On-site Water and Wastewater Tim EcIdund, 'I W I AUDUBON HILLS 41; U I BLOCK 3, LOT 6 JI c) I � I I LOCAT,GN OENE0.AL � I I \ _- AUDUBON HILLS #1; AUDUBON HILLS #1; / BLOCK 3, LOT 7 BLOCK 3, LOT 8 ' 1 GENERAL LOCATION 1 � v ` S LV v = 100' 1-1 40 Off AV �;�' :• o 00 9 ......:...... ......... a ............... 3 TU -��== ENGINEERING SALES -CONSULTING ..-..__s �:.,n _. 0 1 '"ate 0 3701 EAST TU DOR ROAD*SUITE 101 -ANCHORAGE, ALASKA• PHONE (907)337-6179•WEBSITE: w .gamessemmneenng.com o•••^ •••• ••••••• •w., '•••••••..•.••.0 PREPARED FOR PHONE NUMBER: PAGE NUMBER. ` :J J6 rey A.•Garness a ARLENE CARLE 907-345-2137 1 OF 2 #�� CE 79 3 =�: PROJECT/LEGAL DESCRIPTION: DRAWN BY: •# �. f )11 Ar AUDUBON HILLS; BLOCK 3, LOT 9 DATD.J.G. LICENSE 0� e�UFESSI 1 p. vo TYPE OF WORK: 1 rrr�0�� PUMP VAULT DESIGN UPGRADE 10/11/2022 #AECC884 \ GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER• THAT PERTAINS TO THIS DESIGN. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO _ ACCEPT THE TERMS AND CONDITIONS OUTLINED. I I I I J p •: v . J 0 ------------ 7-- DOWNEY FINCH DRIVE J/ \ / I Municipality of Anchorage On-site Water and Wastewater OSP221431, Tim Eddund, 1 EXISTING HOUSE EXISTING 1250 GALLON STEEL TANK (INSTALLED IN 2011) TO REMAIN IN PLACE — WSTALL DOUBLE CLEANOUTS— PROPOSED IM -540 INFILTRATOR SEPI TANK TO BE USED AS PUMP VAULT EXISTING PUMP VAULT TO BE DECOMMISSIONED PER COMPONENTS: r14 • GOULDS PE 51M PUMP R EQUIVALENT) SIMTECH EFFLUENT (OR EQUIVALENT) • • DEMAND DOSE CONTROL PANEL WITH AUXILIARY CONTACTS FOR INTERIOR ALARM • MOA APPROVED INTERIOR ALARM COMPONENTS ARE AVAILABLE FROM GARNESS ENGINEERING GROUP, LTD. OR OTHER VENDORS i i / AUDUBON HILLS #1; BLOCK 3, LOT 8 I I / EXACT LOCATION OF EXISTING DRAINFIELD S UNKNOWN; ASSUMED LOCATION BASED UPON PIPE LOCATIONS FROM AS -BUILT SURVEY AND 1984 RECORD DRAWING. IT IS UNKNOWN IF THE DRAINFIELD EXTENDS OFF PROPERTY I I I I I I I I I 1� I I I I I I 9 = 40' `.*,'%\\1j\ "I OF .tti. asY "NESS ENGINF-TRING GRUMP, Ltd e.: �.::�<_ti:.�,�_�>-tiv�_=.::�.,«-.c.:k F_,:.,.,-•�,Sc�_�--�..:.��;,_-�-.3s����.a�.,.�a,�.,_...�.`z .�=s,.s•.-«s�� •....::................... r.. .. & GAR � ENGINEERING00 -SALES-CONSULTING << � _ u 3701 EAST TUDOR ROAD SUITE 101 -ANCHORAGE, ALASKA -PHONE (907) 337-6179' WEBSITE: V � /.games ngnmering.mm •�.� . , ......... . .. .. ; PREPARED FOR. PHONE NUMBER: PAGE NUMBER: J f, Y A. ame Ss •:. W r ARLENE CARLE 907-345-2137 2 OF 2 0���J, = CE -.795• ' �` PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦'0♦ , ••'• I Jl aL AUDUBON HILLS; BLOCK 3, LOT 9 D.J.G. #.......... TYPE OF WORK: DATE: LICENSE 1+%1jAA`S1L%* DESIGN OF SEPTIC TANK UPGRADE 10/12/2022 #AECC884 I \ I \ I \ W U ( 3 W 1,•-t 6 � r I AUDUBON HILLS #1; BLOCK 3, LOT 6 SD%L Ldp 1 t, 0 . 1245L0120 x Q EXISTING HOUSE EXISTING 1250 GALLON STEEL TANK (INSTALLED IN 2011) TO REMAIN IN PLACE — WSTALL DOUBLE CLEANOUTS— PROPOSED IM -540 INFILTRATOR SEPI TANK TO BE USED AS PUMP VAULT EXISTING PUMP VAULT TO BE DECOMMISSIONED PER COMPONENTS: r14 • GOULDS PE 51M PUMP R EQUIVALENT) SIMTECH EFFLUENT (OR EQUIVALENT) • • DEMAND DOSE CONTROL PANEL WITH AUXILIARY CONTACTS FOR INTERIOR ALARM • MOA APPROVED INTERIOR ALARM COMPONENTS ARE AVAILABLE FROM GARNESS ENGINEERING GROUP, LTD. OR OTHER VENDORS i i / AUDUBON HILLS #1; BLOCK 3, LOT 8 I I / EXACT LOCATION OF EXISTING DRAINFIELD S UNKNOWN; ASSUMED LOCATION BASED UPON PIPE LOCATIONS FROM AS -BUILT SURVEY AND 1984 RECORD DRAWING. IT IS UNKNOWN IF THE DRAINFIELD EXTENDS OFF PROPERTY I I I I I I I I I 1� I I I I I I 9 = 40' `.*,'%\\1j\ "I OF .tti. asY "NESS ENGINF-TRING GRUMP, Ltd e.: �.::�<_ti:.�,�_�>-tiv�_=.::�.,«-.c.:k F_,:.,.,-•�,Sc�_�--�..:.��;,_-�-.3s����.a�.,.�a,�.,_...�.`z .�=s,.s•.-«s�� •....::................... r.. .. & GAR � ENGINEERING00 -SALES-CONSULTING << � _ u 3701 EAST TUDOR ROAD SUITE 101 -ANCHORAGE, ALASKA -PHONE (907) 337-6179' WEBSITE: V � /.games ngnmering.mm •�.� . , ......... . .. .. ; PREPARED FOR. PHONE NUMBER: PAGE NUMBER: J f, Y A. ame Ss •:. W r ARLENE CARLE 907-345-2137 2 OF 2 0���J, = CE -.795• ' �` PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦'0♦ , ••'• I Jl aL AUDUBON HILLS; BLOCK 3, LOT 9 D.J.G. #.......... TYPE OF WORK: DATE: LICENSE 1+%1jAA`S1L%* DESIGN OF SEPTIC TANK UPGRADE 10/12/2022 #AECC884 Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System 0SPl11352 01523176000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 EImore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: December 14, 2011 to December 13, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: AUDUBON HILLS #1 Site Legal Address: AUDUBON HILLS#1 BLK 3 LT 9 G:2739 Owner/Address: CARLE HENRY N & ARLENE 6600 DOWNEY FINCH DR ANCHORAGE AK 995162413 Permit Site Mailing Address: 6600 DOWNEY FINCH DR, Anchorage Lot Size in Sq Ft: 43405 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y SepticTank 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. Special Provisions: Two wells have been located on this property. Locate both wells prior to placing the tank to ensure that separations are being met. The Final Inspection report is to show both wells. Community Development Department Development Services Division On-Site Water & Wastewater Program [ UNICIPALITY OF ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.OI~"" ~.~51- 7'~ Property owner(s) l~.4,/~'¢ ~--.~,.Z.t.E'zVE C. vC~LC" Day phone Mailing address ~¢..20 ¢;)O¢/I,/E"¢ FI/¢4.~ D~tVb-/ Site address (-~-~,~ ~)E;~)c;'~ ~'I.42E~ Legal description (Sub'd., Block & Lot) ~d~0¢ ~ tYlL/_5 ZZ~l: ~J," ~: Legal description (Township, Range & Section) Lot Size ~/~) f-/¢~'- Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: ([~ all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well THIS APPLICATION IS AN: Initial [] Upgrade '~ Renewal [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single_ Fa~~s in accordance with applicable Municipal Codes. (Signat'~e ~)f ~perty own~'~r authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. ¢i~c~_,~Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com December 13, 2011 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Audubon Hills #1, Block 3, Lot 9 Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1250 gallon septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and will be verified to determine that it is operating adequately for three bedrooms during installation. The existing 1250 gallon septic tank is collapsed and is exposing raw sewage to the environment. The 300 gallon lift station is operating adequately. The existing tank will be filled with clean gravel or concrete and abandoned per code. The surrounding lots are served by private wells, and there are no wells within 100 feet of the proposed septic tank. This lot is served by a private well that is over 100 feet from the existing drain field and proposed tank. PES will verify all required separation distances at time of installation. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 2 slopes from east to west at approximately 8% in the area of the tank replacement. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. Mailing: P.O, Box 1.002t. 7, Anchora{~e, AK 995~.0.O2'].7 Physical: 6'.1.!5 East 82~'~ A,~'e, Cuite B6, Anchorage, At( 9950:5 Telephone: (907) 272-.82;t8 FAX: (907) Page 2 of 2 The proposed installation will not affect the furore development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, OF A7'~%, : ,...: :....~.~-'~¢~.~.~ ........ .,......,, '*;~", ~4~ ...";~ Steven R. P~one, P.E. O~er/CJvil Engineer A~ac~ents: Maiiing: P~O, Box Z002~.7, Anchora6% Al< 995:~.0..02.1.7 Physicak 625 East 82~d Aves Cuite B6~ Anchorage~ AK 99503 Telephone: (907) 272,-8228 FAX: (907) 272,82%[ fAA ~ / DOWNEY FINCH DRIVE ~, , EXISTING 12509 ~~ / / ~ COL~PSED SEPTIC TANK ~ y ~/ M ~_~ ~ ~ ABANDON PER CODE ~' / /-¢~ ~ ~ ~ /¢~ ~--~ ~ 1250gSEPTICT~) ~~ . : WITH DOUBLE CLaN OUT ~ / / : " ~X,ST,~O .,~ ~=.=,o~ ~ ~ / ~ ' ~ co,~CT TO / EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 ~.[~' P.o,E (~o7) zz~-~ F,X (~0Z) ~-~1 ¢~:' ~':%'~ so~.e HENRY & ARLENE CARLE~~ PERMIT NO. ~oo ~ow,~ n~c~ ~v~ ,**~.. ..~¢? xxx,xx~x~ PLAN ANCHORAGE, AK 99516 ~¢~{~A~ Sheet MUNICIPALI'FY OF ANCHORAGE DEPARTMENT OF HEAl TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telel~hone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS ~© ¢~c,,< ti 2 '~q~ 4tCCHorL~(-.C= 4F.. LEGAL DESCRIPTION LOCAT I0 N .D~'~e7 ~ [u~x~ NO. OF BEDROOMS ~~~ I w~;ll I Absorpt, on an:,t Dwell in, PERMIT NO. --__._ ~ufactJFer -~ Material No. of compartmems ~-' IWell Dw~ PERMIT NO. We} ~ ~ gott dar: ~'* "~--- ~Nearest ot ne PERM T NO~ ~ ---- ,~th ~]~ Deoth PERMIT NO. of crib ~'~~eF ........ ]-~;:ib~7~ ~ Total effective absorption rea Well I B~t~n~i~ndalion [ Nearest ot line DISfANCE TO: ! I / ctank IAbsorpt,onar~ Buildinfl foundation Sewer line Septi STANCE TO: ' OTHER $OIL TEST RATtNG INSTALLER R E ?.,!.,\ R KS ! **P~aO= uD I~ DPlE (Rev. 3/78) MUNICIPALITY OF ANCB AGE DEPARTMENT OF HEALTH AND, ENVIRONMENTAL PROTECTION S25 L STREET.. ANC:HORRGE, AK 99501 264-4720 PERMIT NO: PATE ISSUE[..,: RPPLIC:RNT: ADDRESS: CONTRC:T PHONE: LEGAL DESCRIF': LOT SIZE: 840458 UPGRADE 06/i4,'"E4 ~-/~/~ ALMOND, INC P 0 BOX 112247 ANCHORAGE, RK 9951± ~45-3821 SUB[' I SEC: T I ON ±. 258 <SQ. FT. OR ACRES) LOT' 9 BLOCK' _-':: RANGE · I C:ERTIF'T' THAT: ±. I AM FAMILIAF.: HITH THE REQUIREMENTS FOR ON-SITE C]EHEF.:S RN[:, HELLS RS SET FORTH BY THE MUNICIPRLIT'¢ OF ANCHORAGE <MOA) AND THE STATE OF ALASKA. 2. I HILL INSTALL THE SYSTEM IN RCE:ORE:,RNCE HITH ALL MOA CODES RN[:, REGULATIONS., RN[.', IN COMPLIANCE HITH THE DESIGN CRITERIA OF THIS PERMIT. I HILL RD'HERE TO ALL MOA AND STATE OF RLRSKR REC..!UIF.'EMENTS FOR THE SET BRC:K DISTRNC:ES FROM RN'¢ EXISTING HELL., HRSTEHRTER DISPOSAL S'¢STEM OR PUBLIC SEI.4ERRGE S'¢STEM ON THIS OR RN'¢ ADJACENT OR NERRB'¢ LOT. IF R LIFT STATION CO'v'ERE[:, B'T' MOA E:UILE:,ING CO[:,ES THEN ,::i.'., AN EL/ RS-E:UILTS HILL NOT BE ELECTRICAL HO~:~. ,:'] ', THE S I G N E [:, RPPL I CANT · t SSUED, B'¢ IS INSIRL~ .~TF.~_ INSF'EC'TI,-,N MUST E:E OETRINE[, ,'2:, ~-.'TF.:! I,]:AL.. INSF'EIZ:TI OIq REF'OF-:T.' ' FIl"i[."' .'~.:'[ C: I AN. R~/~ND.,I "I-d'.l C: / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Z~% X~XX~'~X6~ZK~XXI~X0(XX G lor i a Bowman PHONE 549-6965 [~ NEW [] UPGRADE MAILING ADDRESS P.O. Box 10-1349 Anchorage, Alaska 99511 LEGAL DESCRIPTION L9 B5 Audubon Hills LOCATION Downey Finch Lane / DISTANCE TO: N/A I- ~ / Manufacturer / Greet ~ [Liq. capac ty n ga onsl ............ i 1250 Ir ~,0~ DISTANCE TO: Well ~0 ~__ ~ Manufacturer - ~ Well . u~ "1' / DISTANCE TO: I N/A ~.~ I No. of lines I Length of each line -~z,,, I- 1 62' I-~n- . . . _ i -- ~ I- hop of tde to finish grade 2 Length Wid1~ ~1- ~-- Crib diamete~ "~ ---- TO: Well _~ lC,ass Depth Absorption6,area Dwelling 14 ' Material Inside length Width Steel Dwellin9 I Material Foundation 32' Nearest lot line 25' Total len~tho~f lines Trench width 62 24 NO. OF BEDROOMS 4 PERMIT NO. 820597 No. of compartments 2 Liquid depth PERMIT NO. Liquid capacity in 9allons PERMIT NO. Distance between lines inches Material beneath tile Total effective absorption area 60 inches 620 sq. ft. Depth PERMIT NO. Crib depth Total effective absorption rea Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area{s} OTHER PIPE MATERIALS PVC, Cast SOl L TEST RATING 150 INSTALLER D & B General, Inc. R E MAR KS APPROVED 8 .F .F. DATE LEGAL 7/10/82 P.E .L.S. 72-013 (Rev. 3/78) ALASKA iUIROFImeFITAL COIITROL Sel dlCe$, Ir'lC. ~nclineerincI $ I~nuironmenlol SPECIFICATIONS FOR ELEVATED BED ALTt~RNATIVE WAST~NATER TREA~T SYSTt94- LOT 9, BLOCK 3, AUDUBON HIT,]..q SUBDIVISION ~ i_ 1.0 G~INIERAL 1.1 ~ DRAWINGS, SHERTS 1 THRU 3, SHAT,I, BE A PART OF THIS SPt~CIFICATION. 1.2 AT,T, MATERIALS AND WORKMANSHIP SHAT,T, M~T THE RS~J~TS OF ANCHORAGE DEPAR~IHENT OF HEALTH AND ENVIRONMENTAL PR~ION PERMIT. 1.3 Ar,]', EXCAVATIONS AND D~ ARE ADVISORY AND ARE TO BE VERIFIED IN THE FIk-~n BY THE CONTRACTOR. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER TO OBTAIN ALL NECESSARY PERMITS OR EASt,INIENTS. 2.0 THE LIFT STATION 2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHAT,r, BE EITHER GALVANIZED S~, (AS~MA-4444-76), OR~INL~CULVERT, CAPABLE OF BURIAL TO10 FT. 2.2 THE 36" DIAMETER PIPE FOR THE LIFT STATION SHA[J, HAVE A WErDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION~ THE CULVERT. 2.3 ATJ, PENETRATIONS OF THE LIFt STATION SHALL BE WRTDED AND WATER TIGHT. A[~,WE~DS SHALL BE~ OF SLAG. W~,~DS ON GALVANIZED ST~RF, WILL BE SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITt~4ASTIC. 2.4 ~HE TOP CAP SHALL BE RAIN TIGHT AND SI~/LIRELY FASTENt]) WITH SCRENS. A TWO INCH LAYER OF POLYURETHANE FOAM SHALL BE GLUED TO THE INSIDE OF THE TOP CAP. 2.5 AT,T, ~ICAL FI~INGS AND CON-fL~-~IONS IN THE LIFT STATION SHA]-,[, MEET THE PdDQUIRSMENTS FOR A WATER TIGHT SERVICE. 2.6 %%~ES~ BE A HIGH LEVEL ALARM, PEABODY BARNES 6147 OR EQUAL SET ATTHE LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHA~, BE LOCAT~DNEAR THE ET,FL~I~RICAL CONTROL PANEL OR IN ALOCATION DESIGNATED BY THE HOMt~IWNER. 2.7 ~ SUMP PLIN1P SHALL BE CAPABLEOF DELIVERING 10 GPM AT AHEAD OF 20 FEET. 2.8 PROVIDE A CAI/)ERCOUPLINGATTHECONNECTION OF THE 4" SOLID PVC INFLUSNT PIPE AND 4" ST~E~, NIPPLE. 1200 LUest 33rd Auenue. Suite [~. Anchoraqe. Alaska 99503,.{907) 561-50z40 ALASKA B iUIROFIFIleFITAL COFITROL SEI dICES, IFIC. ~nqin¢¢rinq 8- I~nuJronmcnlaI $ludics 2.9 THE PL1MP SHALL BE CONTROT. I,ED BY A DIFFERS~TI~ Mt~ICLTRY FLOAT SWITCH, ADJUSTED TO AT,r~]W A RS~O FOOT SPAN BETWEEN 'ON' AbR) 'OFF', AS SHOWN IN THE DRAWING. Ar,T, t~k~,AYS AND RT,FCqlRICAL CONTACTS SHOULD BE LOCATED OUTSIDE THE CHAMBER TO PROTSET THt~4 FROM CORROSION, PP. EF~Y IN A DRY LOCATION WITHIN THE HOME. 2.10 COAT THE INTERIOR OF THE CHAMBER WITH BITUMASIC PAINT OR TAR TO APROXIMATELY 3.5 FEET ABOVE THE BCYI'rflM. 2.11 MOA BUITDING CODES: ~ LIFT STATIONS ARE INSTAT,[,m WITHIN THE MUNICIPALITY, AN RT,~iRICAL PERMIT AND INSPMCTION ARE REQUIRED. IN AREAS NOT COVERED BY MOA BUILDING CODES, THE SYSTtRM SHALL BE INSPMCTED BY A LICt~qSED ELt~-'IIRICIAN TO INSURE THAT THE ELECTRICAL INSTAr,[ATION IS IN ACCORDANCE WITH APPLICABLE CODES AND RMGULATIONS. 3.0 SH~a,T,T~ Tl~d~{5-I 3.1 THE GRAVEL FOR THE BED SHAT,r, BE SCR~.FAT~D TO 0.5 TO 2.5 INCHES. 3.2 THE SAND SHALL HAVE AN EFFECTIVE SIZE OF 0.4 TO 0.6 DiM AND A UNIFORMITY COEFFICIt,lqT OF NOT MORE THAN 4. 3.3 ~ B~IRM AROUND THE SHALLON TRenCH SHALL BE CONSTRUCTED OF IMPERMEABLE MATERIAL, AND ON A SLOPE OF 1 FOOT VERTICAL PER 3 FOOT HORIZONTAL. 3.4 THE B(TFIIIM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE RT,ADE TO INSURE THAT R~HE BfYi'DC~ HAS NOT Bk~N C(IMPACTED DURING EXCAVATION. THE BOT1OM E~r,RVATION SHAT,]', BE PLUS OR MINUS 2". 3.5 OBSERVATION PIPES SHALL BE PLACED AS SHOWN IN THE DRAW~. THEY SHAT,r, BE RIGID PVC, AS~!M 3033 OR D-3034. THE SMCTION SH(TNN WITH HO[.F.q MAY BE EITH~ DRIT,r,RD 0.5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A SECTION OF PERFORATED SMAIER PIPE MAY BE CLAMPED TO THE SOLID SMCTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHA~,L BE PLACED ON THE TOP OF THE PIPE. 3.6 ~ INSULATION REQUIRED SHAT,T, BE DOW EXTRUDED BLUE STYROFOAM INSULATION BOARD OF THE THICKNESS SHOWN ON ~ DRAWINGS. 3.7 THE TOP AND SIDES OF THE TRENCH SHAT,r, BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 1200 LU¢$1 33rd Auenu¢, Suite [~0 Anchoraqe, Alaska 995030[907) 561-50L10 ALASKA ENVIRONMENTAL CONTROL SERVICr- INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO OF CALCULATED I~Y "~"- r/-'~ DATE CHECKED BY DATE SCALE - I...,r j; ALASKA ENVIRONMENTAL CONTROL SERVIC' INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276.1361 SHEET NO CALCULATED BY CHECKED BY SCALE DATE DATE 4 5~___r£ --r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 ._///w . ,,J -- SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~UNICIPALITY (~F ANCHORAGE t)~Hi', ur r~ur~ I=NVIRONMENT~ & PROTECTION ,jrt!! i '1 RECEIVED PERCOLATION RATE (minutes/inch) COMMENTS PERFORMED BY: ~~/'~ ~t~l(~& ~:)~-~ ~/ 72-008 (6/79) TEST RUN BETWEE~I . FT AND CERTIFIED BY:/. -- FT ! SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: (FEET) 1- 2- 3- 4- 5- 6- 7- 8 10 11 12 SLOPE 13 14 15 16 17 18 19 20 DATE PERFORME / SITE PLAN WAS GROUND WATER S L ENCOUNTERED? WO o E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND FT PERFORMED BY: CERTIFIED BY: DATE: 72-008 (6/79) F'ERM I T N 3 ~-lL:r-J I C: I AL I T'T' C~F- Rr-JC:h [:'EPRRTMENT OF HERLTH RN[." ENVIRONMENTSL F'R. OTECTION L--:2'5 '"L'" STREET., RNE:HORRGE.. BK. '~95E~i 264-4720 L~ELL F'EE:rl I T ( :z:.'::'1124 ) RPF'L I E:RNT LOCRT I ON LEGRL STEVE F'ISR L'~ E:2: RUE:'UE:ON HILLS SF.:A BOX '~'R - _ __ 4,-._-z, RNCH AK DD507 27E-4.%--~1 LOT SIZE 'B.~.'B.'~'D'D SQUARE FEET MINIMUM DISTRNCE BETWEEN R WELL RND 8NY ON-SITE SEI.48GE DISPO'_=;RL SYSTEM IS iO0 FEET FOR R PRI'v'RTE WELL OR 15Cd TO 2E~E~ FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNC:E FROM R PRIVRTE WELL TO R PRIVRTE SEHER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRE[.', RN[:, MUST 8E RETURNED TO THE [)EPRRTMENT WITHIN -'-':El DRYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MRY RF'F'LY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE R;,,'RILRBLE TO INSURE PROPER INSTRLLRTION. F'EE:r-11 T E:=-:.'F' I F;~:ES [)EC:EI--1E:EF-: _~:::1__. :1.'_=~- :_--:2 I CEF.:TIFY THRT · 1- I BM FRMILIRF.: WITH THE F.:EL;!UIREMENTS FOR ON-SITE SEHEF.:S RN[:, WELLS RS SET FORTH BY THE MUNICIF'RLITY OF RNCHORRGE. 2' I WILL INSTRLL THE RCCEIRE:,FtNCE HITH THE i_-:I_-i[:,E'---;. S I GNE[) ' ~.,.:_ /_ STEVE FIF'F'L I CRNT F' I SR ISSUE[:, '4. 0 RETURN lC: D~vlston of Geological and ~ical Surveys (DGGS} 3001 Porcupine Drive (Tel~ e: 277-66!5) Anc~rag.e, Alaska 99501 WATER WELL RECORD U.S.G.S. Local Drilling Company NaM V~r~l ~ !)r~ ] ] ~ nC Drll)ing Permit No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES 'i LOCATION OF WELL Please complete eitner Ia, lb. or lc. A.~J.L. ~o. t . . . J j Townsh[p Range Merldlan la. Borough i Subd!vls,on Lot Block lb. Fraction Section No. ~u~ubon 9J 3 / / /j N/s ~ IIills !c. Distance and DTrectJo, From Road Intersect?ohs 3. OWNER OF WELL: ~teve S~r~et Address and Are~ of ~e]i Loc~[~on LOG ~ r~tSurfac~Bel~ ~- ~ELL D~PTH: (co~pl~t~d) SurfBc~ [l~v~tJon~o~p~n/~D~ of 2. WELL 200 Materia~ T/ge j Tog I Bottom siltybrn tillw/cobbles 0 ~ 20 s. ~Cab)e t~) ~Rotary gDKive, ~Dug 'siLty gray/bm clay &~grave! 20 j 3© ~.~,~ ~j~ ~. silty sand & grave.L H~O 30[ 35 -- ~o~ ~,~ ~,~ ~,~ tmg~t gray silty gravel 35 73 ~. hard oan seepage ~ 73 ~ 81 ~,~,~o. ~=,~ ~ ~ 6 ~.. ~o 111 ~. 0~ w~,~ ~/~. IJ j Tyoe: Dia~ter: j J Slot/Mesh Size: Length: J ~ ~ Set bet~en ft. and ft. -- Kitt~ngs: ~ 9. STATIC ~ATER LEVEL: r~ ft. j ~ ~A~ve~ ~Below land surface i j [~z " ' j,_~ '~h: i 10. PUMPING LEVEL below land surface [: JXJ 1~ ~ "? Jj ft. after hrs. pumping ~ 9.p.m. ,~ ) ft. after hrs. pumping __ g.p.m. ~ II. WELL H~D COMPLETION: ~ In Approved Pit ~ ~j: ~' E ~V ~ ,~ ~ ~Pitless Adapter --inches above grade '~ "~' '~ ~ ~ ~ 12. GROUTING: Well Grouted: ~ Yes 13. PUMP: (~f available) HP -- Length of Drop Pipe -- Ft. ca.city -- g.P.~ ~ Type: ~ Sub~rsible ~ Rec i procat ing m ~ Jet ~ Other: ) t4. REMARKS: Pe~o~te~ at 40' to ~1' Water Temperature: 5. WATER WELL CONTRACTOR'S CERTIFICATION: This well ~as ~rilled u~oer my jurisdiction and th;s report ;s tFUe to the best of my knowledge and bellef: Vern's Drilling & ~nt AA 3320 Registered Buslness Name Contract License Number ~.~,,,,, t2~41 Av&o~ Street , J;~A Box 1560 A=cho~ce~ Ak g~O7 Author ~ ze8 Repres~nta t ire Form 32-~R Copy Ulstributton: ~HITE - StaEe DG6S, PINK - 9tiller, CANARY - Customer c�ro�3� ► q or y-5 2-3 LOCATION OF WELL (Ple70 'eee Complete either to, Ib or Ic.) la. Borough [Stu7busjonl Lot Block WATER WELL RECORD STATE OF ALASKA Co DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No, Qfey' A.D.L. No. Ib. 1/agfrs. Section No. Township NO Range r Meridian _o}—of_of S[] WC) 3TS,�9I 5 DISTANCE AND DIRECTION FROM ROAD /INTERSECTIONS Street Address and Area of Well Location 2. WELL LOG Material Type WHOM 3. OWNER O.Fr WELL: Address: F --1; to LAv E7/a"1A-*A a 6T+`l fin►cis N Feet Below 4. WELL DEPTH: (final) 5. DATE OFC YpLET� Surface �,, .y f1 , 7 _ Sir {C[ op Bottom --�— !(p S. KCable tool O Rotary 0 Driven 0 Dug Auger 0 Jetted [3Bored 0 Other : ?.USE:�Domestic 0 Public Supply O Industry Irrigation 0 Recharge C] Commerical Test Well Q Other: S. CASING: 0 Threads §' Welded y diam. _In. to'2. Depth We1ghI Ibs./ft. diam. In. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: s"^�7/ Dlometer: Slot ash Size: Length: Set between ft. and ft. Backfilling Gravel pack 10. 9TA,,T{IC WATER LEVEL:=ter ft. lg l %� A{_J Above or C] Below land surface Dote /Equipment used: I I. PUMPING LEVEL below land surface and Yi ,tea ft. offer ^ hrs. pumping V.P.M. ft. offer—hrs. pumping q.p.m. 12.GROUTING Well Grouted: E] Yee RNo Material: C] Neat Cement 0 Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity q.p Q Subm. C3 Jet E] Centriflcal 0 Other MARKS:14.RE�o V� 16, WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ° O F jhis well was drilled u er my 'u s-Aictioi and port Is true to thekea off my kn.wI +ge and belief; 14t A ! / O 1S /R-e�gist✓✓e��rso Business Nome Contract //License �Nuummber Address: �/• L/•�1�lr /�(i 5�1�V/\ / 1, // Signed: ,.lam _.. Date: ! 114l—ov Authorized/Representative Form 02-WWR (11/8I) Copy Distribution: WHITE -State OGGS, PINK -Driller, CANARY -Customer ME Q r Me - I MUNICIPALITY OF F ANCHORAGE Development Services Departmentlk Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-231-76-000 Leqal description AUDUBON HILLS #1 BLK 3 LT 9 Expiration Date: 9/4/2025 Site address 6600 DOWNEY FINCH DR Anchorage AK 99516 Current property owner(s) CARLE HENRY N 50% &CARLE ARLENE 50% (TOD) X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/10/2024 is 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 Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 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 Application 1. GENERAL INFORMATION Parcel I.D. 015-231-76 Complete legal description AUDUBON HILLS #1 BLOCK 3 LOT 9 Location (site address) 6600 DOWNEY FINCH DRIVE ANCHORAGE, ALASKA 99516 Current property owner(s) HENRY & ARLENE CARLE Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® 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: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 13 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. 1_ COSA Fee $ � 5 Date of Payment WSJ COSA # Z_ Y 3 �\Y Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: AUDUBON HILLS #1 Parcel ID: 015-231-76 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 10/16/84 Total depth 77 ft Cased to 75 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 38 in. Date of flow test for COSA 9/4/24 Static water level at beginning of test 3’ Above Grade Well production at time of test 4 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 5.25 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 9/4/24 Comments Sullivan installed an artesian plug. B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 9/4/24 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station 1 years Lift station material PLASTIC Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7//21/1984 ALL standpipes present per record drawing Total measured depth from existing grade 4.9 ft (max) Measured depth to pipe invert from grade NA ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 9/4/24 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 3 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 6” ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 6 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, MOA records & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *0 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft **Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *WR900027. **Per discussions with MOA, shallow surface topography exists to prevent potential surface effluent flow to the ditch & a berm could be installed in the future if so desired or needed. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/16/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 09/16/24 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Owner Septic Tank: -Sludge level inches Lift Station/Pump Vault Maintenance Log Street Address 46 -Pumping: required es no Lift station: Note �- •Pump basket cleaned es o -Control floats cleaned es no -Operation satisfactory Qes no Alarm System: -Pumping completed e no S �P a��y -Effluent filter cleaned (jRL no -Proper float settings confirmed e no -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling es no -Alarm system operation satisfactor not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es o -Ground water intrusion around pipe penetrations es o Weep hole functionales no -Manhole lid: Functional 6`7e�sl no Insulated e no Properly SecuredQe>_no Other -All manufacturer required inspections and maintenance completed es no Comments: Jvof-& J- 4 , '4., c -I-o rn nn 1rir,. e '-Ci \ nn *P- Y S 1'I Qualified Maintenance Provider: 2 Technician Company Signature Date of maintenance 6 5on 2A Date t -- - -- 3708/0 ONIMXVM-------- I N n 0 ' Ati OO Ot I 3ti. 00 _8f'L►L 3. LO.ZO.00S Sb Vit` b Q � o U) m m ,Rft 0 940 76.4 ,O.9Z\ 1WS3 '7/1/I.OL — — — — — — — I ,0'Of Z075Z MAZ•ZO,OON 0 m g a 0 co c 8 a E o a-� w o Wfq _ o a�oEQ= N Ti^2Cm > icao Z 7 v1 Z ° O s 3 3 a 8_ ao w �°m5= c aZ gg 5a ca on Q 0m LN m m n L)% .E 12 N it �E 0° C = ZN QV To2 t Y n m m g N V Q c E O N V YEm m ao& Eras° o 2 p A� 7 am `w o C $ a Co v h T E awl O c m;_ p a9 o ;Sed- av a_ poi o 3$w O LL t0 m w,'��' .Qac p 3 u °.�° m J.• mN 'fly w v � m y 50 me - �W� ��• �- i vl Na 3, o ! m 0®;30 • s Q /Q. rn•4 Z LL� J o v / ° z I`�La••�%��• � °i mE'E�� l�Q�� i MUNICIPALITY DEVELOPMENT SERVICES DEPARTMEll907-343-7904 On -Site Water and wastewater Section � � Fax: 343-7997 www.muni.org/onsite -- Nitrate Advisory Certificate of On -Site Systems Approval # OSC241358 Subdivision: Audubon Hills #1, Block: 3, Lot: 3 A water sample revealed a nitrate concentration of 5.25 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. 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. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Parcel I.D. # MUNiCIF;ALITY OF ANCHORAGE ~' Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES ~., ,, 343-4744 ,~ , CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location (address or directions) 6'6'00 (b} Property owner y/o.r'/~' ~ Mcr,~- ?lc H- Mailing Address ~'~ 00 (c) Lending Institution (d) Real Estate Company and Agent Address ~ ~00 Telephone E 7K- ~ Telephone' (home) :3'¥5"-5'75'7 Business Telephone (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms ~ '~' 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: f community, well system, must have written confirmation from the State Dep~rtment of Environmental ~COnse~'~ation'a{tre~ti~'g~ th leg~ality and status. :~ ' ' ~:~ '~: : ' :' '~' :i': · ." . , .' 4. SEWAGE DISPOSAL On-site ~ 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. 72-025 (Rev. 7~88) Page 1 of 2 5. 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, funct onal 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 F/~z~-~to, p "/~l,~'c~/ _~,r~;, ¢~./. Telephone '~ q..~-- Address )q~-~O ~-c*~o -~.~ /z)~c~r~c/~)· /4~c Date 6. DHHS APPROVAL Approved for ~ Approved Terms of Conditional Approval bedrooms Disapproved Conditional Date The Municipality of Anchorage Dep,~rtment of Health and Human Services (DHHS) issues HeaLth Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 7/88) Back Page 2 of 2 ~.o~ MUNICIPALITY OF ANCHORAGE (MOA) .~0~,o~:~,~/ Health Authority Approval (HAA) ot F ot.S \~W~li, g4/ CHECKLIST - FEBRUARY 1984 ~ ~ 343-4744 ~~ ~'k %~ Legal Description: ~ ~ ~ A. WELL Well Ol~s~omion ~ ~ ~ If A, B, G, D.E.C Approved (Y/N) Well Log Presem (Y/N) ~ Dste Gomplmed /~ /~ Yield To~l Depth_ ~7 Ossed to 7~ Depth of Grouting ~'~. S~ic Wmer Level ~ ~ ~ ~~ /~ Pump Se~A~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot I I $' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N,,~. To Nearest Sewer Service Line on Lot Water Sample Collected by Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y Water Sample Test Results ; On Adjoining Lots · On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole lOC* ' Tecl~, ~'vc..r, ; Date 7 / l~ / ?O N Comments B. SEPTIC/HOLDING TANK DATA Date Installed 7 /' l(,' /¢' ~' Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) IV, A. Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: i ~5-o Air-tight Caps (Y/N) No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped 7/Z'f't~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water-Supply Well I I To Property Line To Water Main/Service Line ¢O ' To Stream, Pond, Lake or Major Drainage Course lC'O' I/' Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata i 5-'0 Date Installed I0 / ~/ ~,./ Width of Field .5 Square Feet of Absortion Area /'/q,~- Depression over Field (Y/N) /~ Results of Last Adequacy Test ~r/g'~r~ Type of System Design Length of Field ~¢' Depth of Field ,.~O ~' Gravel Bed Thickness ~' ~' Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ! $ ~ ~ ' To Property Line ! To Building Foundation ,.,~d" To Existing or Abandoned System on Lot ~x,~ {~,c~o/, /~, [o,,~er ~,,;~,t ; On Adjoining Lots ~ .~O ' To Water Main/Service Line frS' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) D. LIFT STATION Date Installed IO / Size in Gallons "Pump On" Level at I High Water Alarm Level at I~' '° Tested for 'g ~' Meets MOA Electrical Codes (Y/N) Comments Dimensions 3' ' ~ ,~,,,-~,'" Man hole/Access (Y/N) '(~-.¢ "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g~%e..s in effect on the date of this inspection. ~ ,,,"'"~.- Signed ¢~--~ ~. ~ ,e-~, % ........ Company F/~/~ ~~/ ~~ "~'"' Date ~ ~ ~ /~ ~ .......................... ~ bng~neers ~ea~ MOA No. ~ '..zu:o~o~:~ , ~v~ '- ....... Receipt No. Date of Payment 7 -~ / ~ 0 Waiver Fee: $ Amount: $ / ~ ~ ¢) ~2} Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Tom Fink, Mayor ] unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 1, 1990 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 9 Block 3 Audubon Hills Waiver Request ~WR900027, PID ~015-231-76, HA900311 Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. waived distance is -0- feet. The This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Silly, / Aobert W. Aobinson Civil Engineer On-site Services Co~cur: / Program Manager On-site Services ljw~7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR900027 PID~ 015-231-76 HA~ HA900311 Permit Date Received: July 31, 1990 Legal Description: Lot 9 BLock 3 Audubon Hills=~/ Engineer: Ted Moore~ Flattop Technical Services 14530 Echo Street, Anchoraqe, Alaska Applicant: Mark & Miriam Plett Waiver Requested: Lot line - east lot line trench - 0 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: / 2. Special Conditions: ~/~ 99516 3. Other: Waiver is Granted: Waiver is NOT Granted: t Conditions or Reasons for above: 'Date: Rec #: 22075/2587 Amount: $ 70.00 Date Paid: July 31, 1990 . TItEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 July 30. 1990 M.O.A. Dep't. of Health and Hu man Services P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter I am requesting a waiver down from 10 feet to 0 feet between the existing soil absorption drainfield on Lot 9, Block 3, Audubon Hills S/D and the east property line of this lot where it abuts Waxwing Circle. A copy of the property as-built survey is enclosed. I measured a distance of I foot between the cleanout at the south end of the drainfield and the fence which is indicated by the survey to follow the lot line, so a waiver down to 0 feet will allow for possible underground projection of the drainfield. Since the property line in question separates the subject lot from a dedicated right-of- way, there will be no possible future conflict with a septic system on the other side of the lot line. Accordingly, I believe that you should grant the requested waiver. Please give me a call if you have any questions. Sincerely, Ted Moore, P.E. '! 'ts tl~e' teSPo'ns"~'b~11ty of' the o~ner; to detemlne the existence of any easements, covenant:s. :or re- strictions whtch do not appear on'the recorded sub dtv~sten ~lat. IJnder no ctrct~stances should any ~. 1426 HYDER STREET ................. · ANCHORAGEI ALASKA 99501 " ~CHORAGE RECORDING DISTRICT ~ "~' ' ~'*" data hereon be used for const:ruct~on ot for estab- OF~COeD,. l~sh~ng boundary'or fence l tnes. The. surveyo~ take.~ sHow~ o~z ~.coa~zo ~T, aa~ ~or re~nsq),~lttr for ~e, tntttal transaction only. SHOWN. ~zo... , .. _ .. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Do t,u E V F/MCH (b) Property owner ~'2~,'~ C. Mai,rig Address (c) Lending Institution '~kL/./~l' Mailing Address ~ ?.~ (d) Real Estate Company and Agent Address J(,L ./1,,L'7 "'~' m, Telephone'(home) H/~ Business / Telephone Lt/,4 Telephone (e) Mail the HAA to the following address: (or check here~,'if hold for pick up.) List contact person and day phone number below: Single-Family [2~/ Number of bedroom 3. WATER SUPPLY Individual Well [Z' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORi~ATION 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. NameofFirm ~C'/~'Lt~//d ~? 'AT' ~%~('~ Telephone _5"-~- - / .~ // Address I C. £,C Date Engineer's Seal 6. DHHS APPROVAL Approved for Approved ~ Disapproved / Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth 'i / Cased to Static Water Level Casing Height Above Ground Depth of Grouting f ': t',: ~ &?(* f, L!/,./ Sanitary Seal on Casing (Y/N) If A, B, C, D.E.C. Approved (Y/N) /, '? I Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line / To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Depression Around Wellhead (Y/N) ; On Adjoining Lots ¢ ~ ,' · On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ~ / //"J ~-/--/~/k~t ;Date ~¢~/'~-/~: ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed ?//; i/~Size Standpipes (Y/N) ~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~ / / ~-~ Air-tight Caps (Y/N) No. of Compartments ~// Foundation Cleanout (Y/N) Date Last Pumped ~i/~'t.__. ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line '~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation t,z_ ...; To Disposal Field t '~ Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~,? Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well / / "] ' To Building Foundation Lot ri//~k._ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area %: cid Y To Property Line / To Existing or Abandoned System on · On Adjoining Lots / 4;,'d, ToCutback (if present) ~'t j ~,.._ Comments D. LIFT STATION Date Installed Size in Gallons i "Pump On" Level at High Water Alarm Level at ~'~' (~'" Tested for Meets MOA Electrical Codes (Y/N) Dimensions "~ ~;'' }(' ~ ' C~ Manhole/Access (Y/N) ~' "Pump Off" Level at d~:. '~ Vent (Y/N) 1/ Pumping Cycles during Adequacy Test. ,.'i' A'T! :'.. T: V Comments **Check Permitt~d Bedroom'Rating Against HAA Request** / I certify that,,l/~'~/~.e checkCd:'V--,eCrified, or conformed,to all MOA and inspection./"..~//////./',, //:// Signed /'i': :/~<Z:Z/ :"/~ -- ' Compan;,~'x~ /.i/i/l //jcf_~:,~/ Receipt No. Date of Payment Amount: $ \ "') 72-026 (Rev. 7/88) Back ffect on the date of this ,:3 % ', ~:!%. "' .~:. >¢, .? .., , Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Engineer's Seal FEDERAL TAX ID # 92.0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 14062 Date Report Printed: JUN 19 89 @ 13:57 Client Sample ID:AUDOBON L9 B3 PWSID :UA Collected JUN 15 89 @ 16:00 hfs Received JUN 15 89 @ 16:50 h~s Preserved with :AS REQUIRED Client Name : CORWIN & ASSOC Client Acct: CORWINP P.O.# NONE REC'D Req # Ordered By : Analysis Completed :JUN 16 89 Send Reports to: 1)CORWIN & ASSOC 2) Special Instruct: Chemlab Ref #: 5763 Lab Smpl ID: 1 ~atrix: WATER Allowable Parameter Tested Result/Units ~ethod Limits NITRATE-N 2.8 mg/1 EPA 353.2 lO m~o~z C~/~ II/ Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY K.L. 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE .,"~ / -~:' DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION /MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) Location (address or directions) Property Owner Telephone: Home '~--~-7~?'~ Business ~'~,L./', Z,/~.~ Mailing Address ~,~oo-~P 'i::>C~ I,~F---- "/ ~l l~C/-i- (c) Lending Institution ~c-J~ru'/~' ~"~f' ~/ Telephone Mailing Address ¢'-//~ ~ ~~ (d) Real Estate Company and Agent ~¢f/ '~" ¢ ~~ Address (e) Telephone ~'~ ~" '~'~ Mail the HAA to the followina address: or: Check hereX if hold for pick up. List contact person and day phone number below. I, TYPE OF RESIDENCE Single-Family~ Number of Bedrooms 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 [] 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 IRev 8/86/ Front 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 inspection./-) Name of Firm ~~ Telephone ~)~ '~ Address '~ ~ ~ Date "'"~ 1 ~.~' ,, Engineer's Seal DHHS APPROVAL Approved for ~ bedrooms by Approved ~. Disapproved Terms of Conditional Approval Gonditional CAUTION 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 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. Page 2 of 2 72-025 (Rev 8/86~ Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ~c~O~AGE D,V'$'~uEcKLIST- FEBRUARY 1984 264-4720 WELL DATA J L1L ~ 6 Legal Description: ~ ' -"~ ;":', ; "~' Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground '::'~ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed ..... Yield Depth of Grouting ' ,, , Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) · On Adjoining Lots I ;' · On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot · Date "' ' ~' B. SEPTIC/HOLDING TANK DATA Date Installed ' Standpipes (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 Size .... No. of Compartments , Air-tight Caps (Y/N) Foundation Cleanout (Y/N) ;', Date Last Pumped 7~/_,~'--~:~,''~ ' ; 'for ' ' Temporary Holding Tank Permit (Y/N) To Water Main/Service Line To Building Foundation To Disposal Field ; ' To Stream, Pond, Lake, or Major Drainage Course Page I of 2 72-026il 1/84} C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 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 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~;r Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ' To Existing or Abandoned System on · On Adjoining Lots To Cutbank (if present) ' Comments 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 t ha.~_h~,, or conformed to all MOA~,//.~/~,and.~ HAA guidelines in effect on the date of this inspection. Signed~~ Date Company MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 {11,84) Engineer's Seal CONSULTING ENGINEER 203VV 15thAVE "C SUITE 203 ANCHORAGE ALASKA 99b01 TELEPHONE (907) 279 39i 6 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 9, BLOCK 3, AUDUBON HILLS #1 LOCATION: 6600 DOWNEYFINCH LANE OWNER: JIM LANE RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WELL: PRIVATE, ON SITE SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1250 GAL. ABSORPTION SYSTEM: WIDE TRENCH ABSORPTION AREA: 445 SQ. FT. SOIL RATING: 150 PUMPSTATION INSTALLATION DATE: TANK :JULY 1982 ABSORPTION SYSTEM: OCT. 1984 DATE OF PUMPING: JULY 15, 1987. ANCHORAGE CESSPOOL PUMPING DATE OF TEST: JULY 10, 1987 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 3.5 FEET OF COVER AND 46 INCHES OF LIQUID. ABSORPTION FIELD WAS 2 FEET DEEP AND DRY. 650 GALLONS OF CLEAN WATER WAS ADDED TO THE TRENCH OVER A PERIOD OF 3.5 HOURS. NO ACCUMULATION OF WATER WAS OBSERVED IN THE TRENCH STANDPIPES. TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. ,".'~5 :<,': s-u .' '. ' · :4. ": ~;' ' ~>,:., ',-- , , CONSULTING ENGINEER 203W 15Ih AVE C' ~.~LJlT£ 203 ANCHORAGE, A LA.~KA TE~ EPttON[ {~(.,, RESIDENTIAL WELL INSPECTION LEGAL: LOT 9, BLOCK 3, AUDUBON HILLS #1 LOCATION .- 6600 DOWNEYFINCH LANE OWNER: TYPE OF WELL: WELL LOG AVAILABLE: JIM LANE SINGLE FAMILY YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: PUMP YIELD: DATE OF INSPECTION: 3 GPM 6.5 GPM JULY 10, 1987 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. AT THE BEGINNING OF THE TEST WATER LEVEL WAS 6 FEET BELOW TOP OF CASING. THE WELL WAS PUMPED AT A RATE OF 6.5 GPM FOR 30 MINUTES. WATER LEVEL WAS THEN 54 FEET. AT THAT TIME WATER DELIVERY SLOWED DOWN TO 2.5 GPM AND WATER LEVEL ROSE TO 32 FEET. THE WELL WAS PUMPED FOR AN ADDITIONAL THREE HOURS AT 2.5 GPM WITH THE WATER LEVEL REMAINING AT 32 FEET. TEST FOR COLIFORMS: 2.7mg/1 NITRATES. WATER WAS TESTED FOR COLIFORM BACTERIA AND NITRATES ON JULY 11, 1987. 0 COLIFORMS, TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRO~ENTAL HEALTH DEPARTMENT OF HEALTH AND ENV[ROt~tENTAL PROTECTION APPLICATION FOR ~IEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdJ~vision, section, township, range) Location (address or directions) , ,('~)C~,,L,,,V:C 'xI ~.::: ~:~.,'~. I,~ ~ NA_~'-.i ~ ~,:~ ~d',-- (b) Applicants Name Telephone - Home Business Applicants Address i' c:, t' ~,x t t Z f '4'? "~ ,'' ~,,, ~,. ~ /t S-Ii (c) Applicant is (check one) Lending Institution ~ ; (~rrer/builder ~ ; uyer ; Other i I (e plain ; (d) Lending Insti~ution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. TTpe of Residence Single-Family ~ Number of Bedrooms 3. Water Sup~l~ Individual Well ~ Multi-Family~-~ Other (describe) 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. Sewase Disposal 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] Engineerin8 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 ~astewater disposal system is in compliance ~zith all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm.. Address ~ ~ ~,~ Date (ENGINEER SEAL) DHZP Approval / Approved for ]~) bedrooms By [~' , (~ Approved ~ Disapproved __ Conditional __ Terms of Cond'itional Approval CAUTION THE MUNICIPALITY OF ~2qCHORAGE DEPAR2~MENT OF HEALTH AND EN~'iRONiW~ENTAL PROTECTION (DHEP) ISSUES H~LTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY A2~ INDEPENDEN~ PROFESSIONAL ENGINEER P. EGISTERY~D IN THE STATE OF ALASka. TttE DHEP E~DES %"HIS AS A COURTESY TO PbItCRASERS OF HOMES ~D THEIR IZNDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEP~ ~MD STATE REQUIRE- MENTS. F-x~PLOYEES OF DHEP DO NOT COb~DUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TF~E MUNICIPALITY OF ~NCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL ) RR4/ej/DI8 [Page 2 of 2] 7-19-84 A® MUNICIPALITY OF ANCHORAOE' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HA_A) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification Well Log Present ~VN) Total Depth ¥ ~ ~ c~ ' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line it Cle a no/t/Ma nho le /'U' Water Sample Collected By Water Sample Test Results Conraents ~ f~'~,'~ ~'~ LOC, Cased to ~ /~1 Pump Set At If A, B, or C, D.E.C. Approved(Y/N) fv~ Date Completed ~' / I - / - ~7 ~_ Yield Depth of Grouting. ~ ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ ¥ / ['7 ' ; On Adjoining Lots 6 To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date /u~ ~,' - ~¥ Be Standpipes Depression over Tank (Y/N) Date Last Punlped Ptunping/?4aintenance Contract on File (Y/N)~?.//~' ; =or / Holding Tank High-Water Alarm (Y/N).~/// /Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: Size ,~Air-t ight Caps NO. of Compartments~¥~ Foundation Cleanout ~N) To Water-Supply Well To Property Line --~--....~/ ¢//J To Water Main/Service Line /~/ Course_ TO Building Foundation To Dis sal To Stream, Pond, Lake, or Major Drainage Receipt % Date Paid Amount: [Page 1 cf 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption/Strata Date Installed Width of Field Square Feet of .Absorption Ar~a ~/~/~ ~) Depression over Field (Y~: ~. Date of Last Adequacy Test Results of Last Adequacf Test Separation Distance from Absorptio/Field: To ~Water-Supply Well ///~ / To Property Line /~.~ / Length of Field Depth of Field '~, ~ Gravel Bed Thickness Standpipes Present ~/.~ ) To Building Foundation Lot /~//3 ; On ~djoining Lots ...~/// To Water Main/Service Line /~.,/~L To CutbaDk(if present) TO Stre~ond~ke/~ Major ~aina~ Co~se . ' TO ~iveway, Parki~g ~ea, or Vehicle Stora~ ~eaco~.ts ~7 To Existing or Abandoned System on De LIFT STATION Date Installed Di,~ens ions Size in Gallons Tested for ~/ .' ~ing,Cyc!es ~:in~ Adequa~ Test. Cc~nts ~ets Y~DA Check Permitted Bedroom Rating Against HAA Request certify that I have checked, verified, or conformed to all MOA HAA C~idelines in effect on the date of this ip~pection. Signed KB1/d5/s Date [Page 2 of 2]