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Home My WebLink AboutT12N R3W SEC 15 LT 124Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 4 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191526 . PID Number: 015-482-04 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑N Upgrade Name Foxstinbaugh Living Trust ABSORPTION FIELD ❑ Deep Trench A Wide Trench ❑ Bed ❑ Mound Site Address 10230 Carlson Rd. Anchorage, AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 242-8117 3 0.6 GPD/SF 9.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.0 Ft. Gravel depth beneath pipe 4.5 Ft. Subdivision Block Lot 124 Fill added above original grade 1.15 Ft. Gravel length 78 Ft. Township Range Section 12N 3W 15 Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 780 Ft i 1 Ft. Well N/A >1 00' N/A N/A >25 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Existing Capacity Gal. Surface Water N/A >100' N/A N/A Material Number of compartments Lot Line N/A > 10' N/A N/A NA Foundation N/A >10' N/A N/A LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank Exist. Tank to drainfield D3034 Installer Denali Excavating Drainfield D3034 CO/MT D3034 Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspection 1s` 12/21/19 Location and description dates: 2�e Threshold of back door. 3rd 4,h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �"OF"'..qS��i ' 49th ♦� 7''v� C �ZZZ"T i i .I............ , �f� ��•.�MICHAEL E. ANDERSON t�e Septic System r— Approve - Date — Zo 2 ♦ �� , N o. CE -4381 �'' _= %.. 1/10/20 Note: this does include ••o°•�c�� 44 ;RO;;Sa;� �•s• approval not well permit requirements. kmuv UDiva i D/ T12N R3W SECTION 15, LOT 124 PERMIT # OSP191526 PID # 015-482-04 EAST 102ND AVENUE EXISTING WELL \1 I w i LOT 125 3-BDRM HOME / VACANT \ / q \ / Q O EXISTING ABSORPTION SYSTEM PARTIALLY EXPOSED TO ENSURE MINIMUM SEPARATION OF 18' TO NEW TRENCH. 78' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH. MAINTAIN 18' FROM / EXISTING TRENCH. —/ / i i EXISTING WELL µ,E`_ ENGINEERING 49th •e. �� '% It MICHAEL E. ANDERSON �,p No. CE -4381 113120 %j°"ROFESS\ �' Coe _ \ H#C�THffit ® MT7 TH- 81 LOT 424,\ 10' UTILITY EASEMENT �— LOT 131 1 PLAN AS -BUILT 0 50 100 ion ME �m FEET V=50' A B FD 44.9 47.5 MT1 LL- EXISTING C01 z SEPTIC TANK MT2 O FD CO2 81.5 91.9 rill 2 , U Coe _ \ H#C�THffit ® MT7 TH- 81 LOT 424,\ 10' UTILITY EASEMENT �— LOT 131 1 PLAN AS -BUILT 0 50 100 ion ME �m FEET V=50' A B FD 44.9 47.5 MT1 102.9 92.65 C01 103.8 92.3 MT2 79.75 90.2 CO2 81.5 91.9 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE T12N R3W SEC 15 LT 124 PERMIT # OSP191526 PID # 015-482-04 97.75 FINISH GRADE Ove 96.6 ORIGINAL GRADE 91.6 DRAINFIE D, ROTSK•. , 87.1 78' 87.1 NO GROUNDWATER 1/2/20 f Trench only replaced under this permit. PROFILE AS -BUILT (NO SCALE) 91.6 SOILS LOG AND PERCOLATION TEST ENGINEER 1 N G LEGAL DESCRIPTION: T 12 N R 3 W SEC 15 L124 PERFORMEDFOR: FOXSTINEBAUGH TRUST DATE: 12/21/19 PROJECT No.: PARCEL ID#: 051-482-04 TECHNICIAN: J. WILLIAMS DEPTH TEST HOLE #1 (feet) 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 OB 1 . SANDY SILTY GRAVEL GM .f .. SLOPE SITE PLAN SEE SITE PLAN figg, �d �' • READING WAS GROUND WATER ENCOUNTERED? NO NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) rs IF YES WHAT DEPTH? — L 1 10:25 2 DEPTH OF WATER AFTER MONITORING: NONE P 116 s DATE OF MONITORING: I/2/20 11:00 01611 E 11:30 COMMENTS: DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) 12/21 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 10:25 016" 2 10:55 30 116 116" 3 11:00 01611 4 11:30 30 116" 116" 5 11:33 0161 6 12:03 30 116" 116" PERCOLATION RATE: 24 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) December 16, 2019 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: T12N R3W Section 15, Lot 124 – 10230 Carlson Road Septic System Design Dear On-Site Services Engineer: The absorption trench on the subject lot has failed and must be replaced before a COSA can be issued for the property. We are submitting this permit application for the construction of a new absorption trench to serve the three-bedroom home. The septic tank was replaced less than two years ago. The attached site plan identifies the location of the home and the existing well and septic system and the proposed trench location. No conflicts exist between this proposed system and any other well or septic system on this lot or adjacent lots. The ground surface on the lot is flat in the area of the proposed absorption trenches. There are no slopes greater than 25% within 50 feet down slope of the proposed absorption trench. Drainage arrows are shown on the site plan indicating the grade and direction of flow. Storm water drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached test hole logs and plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 12/16/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191526, Deb Wockenfuss, 12/18/19 EXISTING WELL 10050 0 FEET 1"=50' 75' LONG x 5' WIDE x 4' EFFECTIVE DEPTH ABSORPTION TRENCH. MAINTAIN 18' FROM EXISTING TRENCH. 3-BDRM HOME NOTE: SLOPES >25% WITHIN 50', BUT ABSORPTION TRENCH CONSTRUCTION MEETS THE DEEP SLOPE PROVISION. NO 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. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND T12N R3W SECTION 15, LOT 124 CARLSON ROAD12/17/19 10' UTILITY EASEMENT EXISTING SEPTIC TANK ALTERNATE SITE COMTEXISTING ABSORPTION SYSTEM. EXACT LOCATION UNKNOWN. LOCATE TRENCH AND MAINTAIN 18' SEPARATION TO NEW TRENCH. PROPOSED TEST HOLE CO FD EAST 102ND AVENUE 0 - 5% 0 - 5% 0 - 5% 0 - 5% EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191526, Deb Wockenfuss, 12/18/19 T12N R3W SECTION 15, LOT 124 DESIGN FACTORS: SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: 16-30 MIN/IN APPLICATION RATE: .6 GPD/SF 5' WIDE TRENCH SYSTEM EXISTING 1,250-GAL SEPTIC TANK TYPICAL TRENCH SECTION (NO SCALE) 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 3.5' 4' NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 8.0' BELOW GRADE FLOW LINE ELEVATION: 4.0' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE 450 GPD / .6 GPD/SF /5' WIDE * .5 (RED. FACTOR) = 75 LF TRENCH REQUIRED (75 LF SPECIFIED) 12/17/19 GEOTEXTILE FABRIC Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191526, Deb Wockenfuss, 12/18/19 Lot 98A _ _ Lot 99A Lot t 00A E. 102nd AVENUE o EAST 164.97' n /^ BLM o / I IF, 13.2'x11.6' S DOG I \12.2'02.0' GREENHOUSE w/ 4' DECK WIRE FENCED GARDEN- \ Z \ e Lot 125 W C4 O Lot 130 & R.O.W. RESERVATION 100' PROTECTIVE RADIU I WELL SEE HOUSE DETAIL SEPTIC PIPES Lot 124 54,455 S.F. WEST 1 0 D M r N O Z Lot 123 ' 2nd STORY ONL — — — 4 -- 50.0' 50.0' Lot 131 I Lot 132 BLM UTILITY & R.O.W. RESERVATIONS I HOUSE DETAIL Scale: 1" = 30' 2nd STORY ONLY 0 14.8' ml C�L_____ DECK 74.2' o 24.0' 2 STORY RESIDENCE 26.0' 16.4' 24.0' 20.0 DECK PLOT PLAN AS BUILT _X_ SCALE _1" __60__ GRID __2k_25_36_ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 0000�ppp (907) 522-4625 Fax oo F A p�4 Professional Land Surveyors kenOlongsurvey.com c Y jonathanOlangsurvey.com 0� gS4�0 I hereby certify that I have surveyed the following described property: QO�:. 49TH COQ BLM LOT 124, SECTION 15, T12N, R3W, SEWARD MERIDIAN, ALASKA O* Q 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 Q'a •.KENN H N premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. F 00 �Fo ..Ls—szoz.•• 5°0� Dated this the __Lc -e--_ Day of __ Lsr� '_�ae� ____, _l_��_, at Anchorage, Alaska 0 a �O 0 4X\4ROFfSSIONAV o� It is the responsibility of the owner to determine the existence of any easements, �pppoo�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171202 PID Number: 015-482-04 ❑ New 0 Upgrade Name: MIKE STINEBAUGH ABSORPTION FIELD ❑ Deep Trench F-1 Shallow Trench F-1 Bed El Mound Address 10320 CARLSON DRIVE El Other Phone Number of Bedrooms Soil Rating depth from original grade 1 4 ITotal GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot 124 Fill added above original grade Ft. Gravel length Ft. Township Range Section 12N 3W 15 Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank I Line Ft' 1 Ft. Well 104.5 NA N/A N/A 25+ TANK Ej Septic 0 S.T.E.P. 171 Holding E] Other Manufacturer Anchorage Tank Capacity 1250Ga1. Surface Water 100+ NA N/A N/A Material Number of compartments Lot Line 28.9 NA N/A N/A STEEL 2 NA Foundation 27.8 na j N/AN/A LIFT STATION Manufacturer TCapacity Curtain Drain 50+ na. N/A N/A Gal. Remarks septic tank upgrade only Pump on level at in, Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank 3034 Tank to 3034 drainfield flinstone ent. Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 365ft Inspection est 9/8/17 dates: 2111 6/5/18 cation and description LAT d 3 4th HOUSE POINT A COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp 0 A�, Conditional Approval: Date even onnome Approved fl�,04 8149 4, 50N Date I I 1byUUL1U[ I muputL—i- i- i/.doc 365 TRUE NOR SCALE 1"= 0' 3 104. BDR SFD 1 A 8 INSTALLED NEW 1250 NI —SEPTIC TANK 126 II , 365 1 DECOMMISSIONED EXISTING 1250g SEPTIC TANK PER MOA I� CODE o _ i O I 00 EXISTING DRAIN FIELD N 124 A B T1 29.7 39.1 T2 36.5 43.2 0 0 z z a Q Lu w J J U OG. FG. U 365 360.4 1250 GAL 360.2 TANK PROFILE SCALE: 1"=10' NOTES: PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 Q'�•'' Date 6/8/18 RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211. .. .... Scale P.I.D. NO T12N R3W SEC15 L124015-482-04 MIKE STINEBAUGH 10230 CARLSON ROADOSP171202 •• even.CpannORe. ` PERMIT NO. DRAWN ACP Sheet SITE PLAN ANCHORAGE, AK 99507 2 OF 2 t4, ",0F MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program od PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 �� http:Uwww.muni.org/onsite cluirtmut)t On-Site Wastewater Disposal System Permit Permit Number: OSP171202 Effective Date: 8/2/2017 Work Type: SepticTank Upgrade Expiration Date: 8/2/2018 Tax Code Number: 01548204000 Site Legal Address: T12N R3W SEC 15 LT 124 G:2536 Site Mailing Address: 10230 CARLSON RD, Anchorage Owner: FOXSTINBAUGH LIVING TRUST Lot Size in Sq Ft: 32200 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing ip Received By: lf el ,4 ,0_, � Date: ! /1 7- Issued By: MIMI ,M1111Wi Date: 0/z..4 7 MUNICIPALITYOF ANCHORAGE ( ii. Community Development Department �rPh• •• •9,, Development Services Division : •9 -o. On-Site Water & Wastewater Program JUL 2 5 2017 ON-SITE SEWER/WELL PERMIT APPLICATION 1- . • ti Parcel I.D. 015-482-04 `i 01 6 8 9 Property owner(s) Foxstinbaugh Living Trust Day phone Mailing address 10230 Carlson Rd. Anchorage, AK 99507 Site address 10230 Carlson Rd. Legal description (Sub'd., Block & Lot) T12N R3W Sec 15 Lot 124 Legal description (Township, Range & Section) Lot Size 32,200 Sq. Ft. Number of Bedrooms'' 9 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 11P II qp (Signature of property owner or authorized agent) Permit/Rush Fees: a1Waiver Fees: Date of Payment: 11 -(e(ti Date of Payment: Receipt Number: Da1016% Receipt Number: Permit No. OS1911 \102— Waiver No. Permit App_ ::...:c Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com July 25, 2017 Subject: T12N R3W Sec 15 Lot 124 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,250g Septic Tank to replace an existing 1,250g Septic tank to be issued for this property. The existing tank has completely failed. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,250g septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property line or building foundation an GI, caay-fc fe( 10'+ from any water line iN/oal CA'elck. WruI 100'+ from any surface water 1,y. P. 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, •• l •• •M pi f 's Steven R.Pannone g• •-• :.a8149 Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchora(le, Alaska 99501 Telephone 2B4-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL, INSPECTION REPORT ~]UPGRADE LEGAl. DESCRIPTION Well Absorption area ~--- IF HOMEMADE: DIS fANCE TO: Well DISTANCE FO: No. o1Hnes Foundation ' Nearest lot line Total len§[l~ of lines 'l'mnch width Material beneath tile Depth PERMIT NO. Liquid depth PERMI F NO. Liquid capacity in gallons PERMI- NO. , PERMIT NO. Well DISTANCE FO: Class Driller DISTANCE TO: Building foundation Sewer line OTHER PIPE MATERIALS SOIL TEST RAT,NG~/~ INSTALLER REMARKS APPROVED 72-013 (Rr~v. 3/78) DATE 7-_1: LEGAL PERh'i~ T N0. 9F'F'L. I C:FlNT [::,F:l'v' I £:, I"1. .OC:FtT I ON [:,EHFIF,:T RE:, .EGFIL LOT ±2d.., SEC :tS I_llI1- SIZE ,435~[E~ SQLIFlRE FEET "CF'E: OF SOIL. F:IE:SOF::F'TII3N S'T'SI"EM I'_S: TRENCH f:~',~.::II"ll,..It'l NI_IhlE:ER OF E:E:E)F;:OOP'IS': = d- SOIL RFll'ING ,:iSIS! F'T,."BR>= J. 25 HE F,'EG!LIIF::EB, SIZE[ OF THE SOlE FIBSOF4:PTICli'J E;'T'~'S"I'[.::f'I I'=7: TFIE [...ENGTF.I E:,IMENSIOI'.,I IS THE LENISTH (IN FEE'[':) OF THE TRENCH O1:?. DRFIINFIELE). THE DEF'TH OF R I"re. ENCH OR [:'IT IS:; THE I::,ISTFII',IC:E BETP.IEEN THE LE;IJ[~:FFIL-:E OF THE GF?.OtJND I=¢,IE:, TIDE: BO'f'"f'OH OF THE E::.::C:FFv'FtTICd',I ,::IN FEET). "I'FIEF~:E IfS NO S;ET PlIDTH FOR TRENCHE:S. THE GP. FI',,,'EL E)EF::'TH IS: THE MINIHIJH E:,EF'-FH OF GF,'FI'¢EL E:ETI.,.IEEN 'rile OIJTFFILL PIPE FINE:, THE BOTTOH OF' THE E::.::C:FI'v'FITION (Ii'.,I F'EET>. F'ERHI T FIPF:'LI CFtNT E-IRS TFIE: RESF'ONS]:BIL I T'¢ TO INFOI:RH 'FH ZS DEF'FIRTMENT f::,LIR ING ]'PIE :I:N~;TFILLFITION INSF:'ECTIONS OF FIN"r' F.IELLS RDJFIC£:TNT "rE) THI:B PROPERT'T' FIND, -1.'HE I'.&~P'IBER OF RESIDENC:ES I'HRT THE HELL IqILL SERVE. ................ T' ~.,-~ ~::~ ':: ~:~ ::' :[ I"-~ [='.'~ F> E::: CZ: l" I CZ[ f",~ ::':-:~ F:~ I';~: E: F: ES: G::.~ LI :[ FEI [:_7 [::: ................. E!:RCI<FILLING OF Fii",IV S'¢STEh'I P~ITHCIIJT F'INFIL_ INSF'EI:::TII:.IN I=tN[:, Flf:'F'F'.13'v'f:lL B"2 THIS; DECF'F~I'4~:TMENT I.,.IILL BE SUB..IECT TO PROL::ECUTZON. MINIMLIH E)ZE;'I"F~NC:E E:ETP.IEEiq FI P.IEL. L RND RN"r' ON-SI-FE SEHRGE E)ISPOSI=IL..S;'¢'=:;TEP1 IS :I. EHZ1 FEE'T F'OF:: f:l PRI'v'FtTE NELL 01:~: ±DEl TO 2E:IEi FEET Ff;?.OH Ft F'I.IBLIC NELL [:,EF'ENE:,:[I'.,IL'~ UPON -H-iE T"r'PE OF F'UBLIC HELL. HINIMLIH DISTFINCE FF:OM R F'RI',,,'FI-FE 1.4EI_L TO R PF:'.:['v'FiTE SEIqER LINE tS 25 FEET FINI::, TO Fi COHHLINIT'.¢ '_:iEP.IER LINE IS 7'5 FEET. NELL LOI"_'iS FIRE F:EI~:!I..1.IRED FIND HLIE:T BE RETURNE[:, TO THE DEPRRTHENT 1,1.ITHIN 7.::E~ DFI'T'S OF THE HELL C:CIMPLETICIN. OTHER REC.:!UIREHENTS MFi'T' FiPPL'T'. SF'ECIFII::FiTIONS FIND, iS:ON'="~TRUC:TIFiN DIFll3F?.FIH'.S FiRfE FI',,,'F-/II_F:IBLE TO Ii".~SI..1.F~:E F'I~'.CIF'ER INSTFIL.LFtTIEff. L ]: E:ERTIF'"r' THFI'r :L: I RH FIR1.,llLII~R H ITFi 'THE I;?.EQUIREHENTS FEll;.'. ON-.SITE SEP.IER5 19NE:, NELL.E; IRS SET FORTH B'T' THE HLINIC:I PFILI-F'T' OF F:INCFIORFIC4E. L:.:: I 1.4:[I..L IN'.S, TFILL THE 2;'¢STIZH IN FICCOR[::,FINCE HITH THE CODES. :S: I UNDEFi::STFIN[> THFIT THE ON-.SITE :SEHER S'¢STEH Hl':¢r' REL::!IJIRE IENLFIRGEMENT IF' THE I~?ES I [:,ENCE l S REMO[::,ELE1.> '1-0 I NC:LUDE MORE THF-IN d. BE[:,F'.OI31',IS. PERFORMED FOR: LEGAL DESCRIPTION: THIS FORM REPORTS: CONSTR TEST D~vid M~= 'J"~'~"~'~ ~// ~ ! NCHORAGE, ALASKA 99503 C)~'2'v ~ DATE PERFORMED: Lot 124 & ]_2!5 Block__SW 1ZJ_,_SgQ_,E~J~bdivision_m]2N;~Wi SM Visual Soils Examination ~ Percolnfion Tesl DEPTH FLEET 16' SOIL DESCRIP'I-ION Peat Gravelly, Silt (Brown) Sandy Silt (brown) (Brown) BOTTOM OF HOLE WAS GROUND WATER ENCOUNTERED IF YES, WHAT DEPTH LEd. E__ND ® - Perc zone ®S- Sample token I~ -- Frozen zone ~ -- Water table NOTES Trace of Sand D amp R E ADING DATE PERCOLATION RATE: .__ 5 PROPOSED INSTALLATION COMMENTS: GROSS TiME 30 45 105 Kinney R, Baxter 3656 - E NET TIME 15 min. 15 min, 15 min. GENERAL SiTE SLOPE min/inch E] SEEPAGE PiT ~ [)RAIN DRAINAGE REQUIREMENTS: DEPTH TO H20 NET DRAINAGE i7 i/4" i4 i/4" 28 1/2" ii ~4" 33 1/4" 4 ~/4" 36 " 3" 39 " 3" 125 sf/b_r ................ FIELD ~ OTHER TEST PERFORMED 8~t__ I< R=~ ....... DATA CERTIFIED BY:_ Xinney ?l. Baxter DATE:__~/~Z81 .................. Location ...... ~ t,'~:( !/~ ~ b-r~:' ./.~: ....................................................... ............ : ....... Date completed... Depth of w~ll ~,,;~ z , .f. ........................................... Size of casing ......... Distance to water ............ Ef ~ ............................................................... Distance to water while pumping .......... '~P ~ ............... at rate of ..................... ........................... galloz~s per hour. DELTA D[~ILL,~NG COF¢~PANV P1 MUNICIPALITY OF ANCHORAGE Development Services Department ``. 5�1'�vj Phone: 907-343-7904 On-Site Water & Wastewater Section -u`" Fax: 907-343-7997 Parcel I.D. 015-482-04 Certificate of On -Site Systems Approval Expiration Date: q-9-2-02-0 1. GENERAL INFORMATION Complete legal description T1 2N R3W SECTION 15 LOT 124 Location (site address) 10230 Carlson Road Anchorage, AK Current property owner(s) FOXSTINBAUGH LIVING TRUST Day phone (907) 242-8117 Mailing address 10230 Carlson Road, Anchorage, AK 99507 Real estate agent Jamie Harvey Day phone (907) 227-1059 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic; El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ; ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ o� Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 1/4/2020 r'�11111u1tilh�' Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 49th + 6. DSD SIGNATURE �' r�""•' ,..0 10 System #1 Approved for 3 bedrooms % : MICR :� E. rnDERsoti ; - 4 ♦¢�J%, System #2 Approved for No. CE -4381 •� o�aa bedrooms ,##�F''•..• 1i4/2020 ..••'��'�! Disapproved � to°kRa Sa+ a+®�� Conditional approval for bedrooms, with the following stipulations: r'�11111u1tilh�' Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: T12N R3W SECTION 15 LOT 124 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/3/81 Total depth 237 ft Cased to 237 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 12/10/19 Static water level at beginning of test 175.5 ft. Comments B. TANK DATA Age of tank(s) 2 years Tank type/material Septic/Steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping A+ Home Services - 12/6/19 D. ABSORPTION FIELD DATA 5' Wide Trench Which system tested (date installed) New Constructior ❑ ALL standpipes present per record drawing Total measured depth from grade 10.65 ft (max) Measured depth to pipe invert from grade 5.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Parcel ID: 015-482-04 Structure served by this system Well production at time of test 5.62 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate •313 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 12/4/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 12/22/19 Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date New Trench completed 12/22/2019. Flow Diverter Valve placed and connected to existing trench. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 1✓ Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0✓ Yes if No ft 2] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 1✓ Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' 1771 Yes if No ft F. ENGINEER'S COMMENTS New trench completed on 12/22/19 and placed in service. Existing trench connected to system with flow diverter valve. G. ENGINEER'S CERTIFICATION4 QF � � l certify that l have determined through field inspections and review a°a+aaaaaa+•a•Ra of Municipal records that the above systems are in conformance with �+ ' 4 MOA COSA guidelines in effect on this date. ° 49th 0.—t MICHAEL E. ANDERsar O. CE -4381 1/6/2020 COSA Checklist yellow sheet ............. �� p""'a'+a'aa°, it ft M Lot 98A _ �_ Lot 99A I Lot 100A E. 102nd AVENUE o EAST 164.97' /BLM UTILITY & R.O.W. RESERVATION o o 113.2'x11.6' SHED 100 PROTECTIVE DOG RUN WELL RADIO \12.2'x 12.0' GREENHOUSE L -- w/ 4' DECK 4.7' \ SEE HOUSE DETAIL WIRE FENCED GARDEN 65. L i Z O C) X r 01 o V? Lot 125 ;, C ® z Lot 123 rrTW W 3 I O O - SEPTIC- 4 [n PIPES p > 4 41 I a C Lot 124 54,455 S.F. 2nd STORY ONLY WEST 164.92' I II I 50.0' 50.0' Lot 130 Lot 131 I I Lot 132 I BLM UTILITY & R.O.W. RESERVATIONS HOUSE DETAIL Scale: 1 " = 30' 2nd STORY ONLY 1 14.8' °' I C�L____d DECK 14.2' 24.0' 2 STORY RESIDENCE 26.0___-{ 16.4' 24.0' N 20.0' \- DECK PLOT PLAN ___ AS BUILT _X_ SCALE _?=_= 60=_ GRID _ SW 2536Project No. 19-6991A?_--- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, n C, (907) 522-6476 Phone oQ.�ppp�4 (907) 522-4625 Fax o« Professional Land Surveyors ken0langsurvey.com o O F A jonathan®langsurvey.com �'' I hereby certify that I have surveyed the following described property: BLM LOT 124, SECTION 15, T12N, R3W, SEWARD MERIDIAN, ALASKA 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. . Dated this the _ Day T__ _ °2" y of � ��.�y�_____, ____, at Anchorage, Alaska It is the responsibility of the owner to__dete.r_mine._.the__exi_stence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH y*f .......... KENNETH G. LAN o �444�1 S-5202. 4�%R�F�SSIONA4 �Aa 11301*1461 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL I'IEALTH DEPARTMENT OF ffEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY AI>PROVAL CERTI]?ICA%]~ 1. General Information Application Date ~/ (a) Legal Description (include lot~ block~ snbdivision~ section, Location (address or (c) Applicant is (check one) Landing Institution [--'] ; a.mer/bni~aer ~-- · (d) Lending Institution f~fl'$~ ~'~ ~;C~-h Telephone Address township, range) (e) Real Estate Co. & Agent . _=~__.~/~t ...... 9~94_.. f__~, Telephone ~ ~ · ~ 6 C~ (f) Mail the HAA to the following ~dress: 2. T__yj~e of Residence Single-Family ~ Number of Bedrooms 3. Water _S~j!l_}i Individual Well []'~ Other (describe) Community l~--~ Public Note: If community well system, must have w~itten confir~aation from the State Department: of Environmental Conse~wation attesting to the legality and status° S ewa~e D_i {~ a__l Onsite [_~ Public [~..__~ Community r~-~ Itel. ding 'rank []]~.--~ Note: If c. ommunity well system, must have written confirmation from the State Department: of Envirotnnental Conserw~tion attesting to the legality and status. [Page 1 of 2] _~_~.ineering Firm Providin~ln~ectious__.____~_~'Cesta _File· Search,.__ Data aud Information Aa certified by my seal afflxed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows thai: the on.-site water supply and/or wastewa~er disposal system ia safe, functional and adequate for the number of bedrooms and ~ype of structure indicated herein° I further varify that, based on the information obtained from the Municipality of Anchorage files and from my lnvemtigation and inepection~ the on-si. Ce vra~er supply and/or wastewater dispoeal mystem is in compliance ~ri~h ali Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. (ENGINEER SEAL) DItEP ~roval / ~ ~-, ,,~ ~ Y ..- ~ Approved ~/ Disapproved U Conditional Terms of Cm~ition~ Approval CAUTION THE MUNICIPALITY OF 7~CHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES NEALTH AUTHORITY APPROVAL CERTIFICATF. S BASED SOIgLY UPON THE REPRESEbrf'- ATIONS GIVEN IN FAtLAGILAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTEREI) IN THE STATE OF ~SKAo THE DHEP DOES TI-IlS AS A COURTESY TO PURCHASERS OF HOMES AND TIIEIR LENDING INSTITUTIONS IM ORDER TO SATISFY CERTAIN FEDERAL fuND STATE REQUIRE-- ME}ITSo EI4PLOYEES OF DIiEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSbUiD. q_~IE MUNICIPALITY OF ANCHORAGE IS NOT IIESPONSIBLE FOR ERRORS OR OMISSIONS IN TItE PROFESSIObI~L ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-.19-84 MUNiCIPAU~ OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION /\u0 0 8 t985' RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTFIORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal DeacriptJon: ~.OT Well Classification Well Log Present (Y/N) Total Depth _~ 7 Cased to Static Water Level . J~'~ 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 t~o~ Cleanout/Manhole _ _t~O bi 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 ; On Adjoining Lots _ To Nearest Public Sewer To Nearest Sewer Service Line on Water Sample Collected by '~, ~". Dale __ ~/~,~'" Water Sample Test Results _ -~'~'~'&F c'4/'~ Comments _ ~ ¢~ ~[-/~- ·· . Da~ ~.~t.,e~ ~1/~/ Si~ 1~¢O ~o. of Compa~m.nts Standpipes (Y/N) _ ~O Air-tight Caps (Y/N) _ ~ __ Foundation Cleanout (Y/N). D~pre~ion ow~ T~n~ (Y/N) ~- bate L~t ¢.mp~d Pumping/Maintenance Contract on File (YIN) ~ ; for Holding Tank High-Water Alarm (YIN) _ ~ ' Temporary Holding Tank Permit (Y/N) ~/~ --. Separation Distances from Septic/Hc~dln~Tank: To Water-Supply Well J.O ~ To Building Foundation To Property Line _ _~ ~ ~ To Disposal Field _ To Water Main/Service Line Course Comments To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026tlt/84) 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 . I I To Building Foundation Lot NO/'~ Type of System Design Length of Field 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 Water Main/Service Line :.'~/O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 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, verj, f.~d, or conformed to alI.M O.A and HAA guidelines in effect on the date of this inspection Signed_ ~"%'~'. ~ Date ?'~'_ _,~¢'-~__~ ' Company ~~ MOA NO. Receipt No, _~%~ Date of Payment ~ ~'/~ ~ · A · .~ ~ Engineer's Sea MUNICIPALITY OF ANCHORAGE ' D]]VISICN OF ENVIltOF~.~ENTAL HEAI;H~ DEPARI~MENT OF HFAL~[~{ AND F~NVIRONMENTAL PROI'ECT]]ON APPLICK~IfIN FOR HEALTh! A~$I'HOPdlTY APPROVAl., CEI~TIFI~TE 1~ C~.ne~al Infor~.ation Application Date (a) r~gal Desr~iption (includa lot, block, subdivision, section, township, range) (c) Applicant is (cho~) ~ndlng Institution I-~[ ~ O~r/bull~ ~,.7~ ; Add, ess (e) t~al Estate Co. & ~ent ........... ___ __.~ Address Othe~ ( de scT.,ibe ) 3. ~W~j.t~e._F _ Note: If ccn~aunity ¥~'.~11 system, must: have w~.~itt~n c~nfi~_,~tion f~.~ the State Depat, i~,ent of ~]virorn~ental ~onse~vatzon attesting to the legality and status, Is the well adequate fo~ the nunf0er of bedded]rs specified in this [{AA (Y/N) 4. ~_ej~j.~ Dis~. sal the wastewater disposal s[stsm adequate for the ~r of bedrocms (_Y/N) ................... [Page 1 of 21 2-15-84 5. _E_n~ineering__Fj~_rm_j?~ov_.i~d~i_n.g_I__r~l~gj2tio.ns~,' Tea. tis, I~ata and Infoumation I certify that I have cl~oked, verified, o~ confo~'~d to all MOA HAA Guidelines in effect on the date of this ins~tion. Signed by Da he (ENGINEER SEAL) 6. DHLP Ap_p_r~ova]. Approved for__ ~_~. Appr oved/~__~" Disapproved Temps of Conditional Approval. _ %he Municipality of Anchorage Depa~nt of Ibalth and Environmental Protection dces not guarantee the continued satisfactory p~fo~mn~ of the watel~ supply and/or the wastewater disposal system° 'Enis approval indicates that, as of tl~e validation date shc~vn above, hk3sed on the data and inforn~tion fun_nj, shed by ~] engineer regisi~red in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the pnmber of beck~oc~fl and type of structure indicated° ( [~IEP SEAL) 7. Mail. the HAA to the foil.owing ad(k'ess~' KS2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ae Static Water I~vel ;~7 ~ Casing Height Abo~ Ground i ,I; Electrical Wiz:ing in Conduit ~N) Separation Distances f~cm Well: , ..... W~ e~Sample Test~lllt~-" ~ Pump Set At &3X3 t¢a30 a3/J _ Sanitary Seal on Casing ~)____ Depression A~tound Wellhead _(Y~ To Septic/Holding Tank on Lot IOI ; On Adjoining Lots_-)~.'~O-~'- To Nearest Edge of Absorption Field on Lot~ //0! ; On Adjoining Lots_,~3~ff'~ TO Nearest Public Sew~ Line /(/,~ To Nearest Public Sewe~, Cleancut/Manhole /L~,//4 To k~;a~est Sewer Service Line on Lot Wate~ Sample Colleeted By ~..~,~t-£~ ; gate__ ?//7,/~ Be S_~EPTIC/HOLDING TANK DATA gate Installed -~'~/~//~-r--- - - ~ _ Size /Z~ ~__~)_ ~ No, of Ccmp~n~nt.~___~_~____ Standpipes ~/N) Ai~-tight CaDs _~N) Fo~und_a~9~lolnout. Depression ove~ Tank (Y~ Date Last Pumped ~;~-'_~' i~ File (~N) ; fo~ ' Pumping/Maintenance C~nt~aet Holding Tank High-Wate'~ Alarm (.__Y/%l) ~/~ Tert~l~'ar~y ltolding Tank ~pa~ation Distan~s ~an ~ptie~oldin~ Tank: To Water-Supply Well To P~cpe~ty Line >/(3 ~ To, Wat~.. ~i%i n/Service Line . . To Building Foundation ~0 I -~. To DisPosal Field l lO' To Stream, Pond, Lake, ca, Majb~ D~ainage [Page ~11 of 2,]," 2-].5-..84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y/~ ~_1~~' Type of System Design Length of Field (~3! Depth of Field Gravel Bed Thickness J Standpipes P~esent Date of Last Adaquacy Test Results of Last Adequacy Test ~/%ig/ld'tJR¢ Fd~ z/- Separation Distance from Absorption Field: To Water-Supply Well //Q/ To P~operty Line ~/6 / To Building Foundation &ff~' ~ To Existing or Abandoned System on Lot /b~//~ ; On Adjoiding Lots ~ 30 ' To Water Main/Service Line /~/~ To Cutbank(if present) To Stream/Pond/Lake/o~ Major Drainage Course /LJ/~q To D~iveway, Parking A~ea, or Vehicle Stc~age A~ea ~.~ ~ Comments AV ~%_q .,'W~:^~n,~/~, D. LIFT STATION Date Installed ~2/~ Size in Gallons /13//~ High Wate~Ala~m Level at Tested for ff~;/l~ Electrical Codes(Y/N) ,~ ~ Counts Dime ns ions ./t;//~ Manhole/Access (Y/N) "Pump Off" Level at Pumping Cycles du~ing Adequacy Test. Vent (Y/N) Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~---~ /A ) . ~.~ ~-~ Date ~,//./..~. ~ Cor~pany ~/')~-~-~/ /~[;~ · MOa No. [Page 2 of 2] 2-15-84 ALASKA eI1UIROFImelqTAL COI1TROL $ RUIC S, InC. ~n§ineerinq 6 ~nuironmenlol $ludJes JUNE 7 1984 DAVID MOOP~] 4336 102ND E AVENUE ANCHORAGE AK 9950'7 SELLER - DAVID MOORE BUYER - SUBDIVISION - T12N R3W SECTION 15 ADEQUACY T~T FOR SEWER SYSTEM BDOCK - 0 IDT - 124 THE 'rfPE OF ABSORPTION SYSTf~4 IS A TR[~CH WIrl~ AN AREA OF 1134 SQFT. THE SYSTf~4 IS (IAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF 'IHE SYSTEM lis 9~0-G~NS.---,~-~3/~/~ ~. ,/ /, ,~.~ ...... BASED UPON THE TEST DATA THE SYS%~S4 IS ACCEPTABLE FOR A/. 3 BEDROCM I-IflNIE ......... ~ ~ TEST UN WELL THE WELL F[DW RATE WAS 4.0 GPM FOR 3.5 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK 93LUME OF 1250 IS ADEQUATE FOR THIS ~/BEDROCN HOUSE. 1200 ~Ucs~ 33rd Aucnu¢. $ui1¢ [~, Anchoroq¢. Aloska 99503 o[907) 561-50z10 --~.... )ATP RECEIVED I INSPECTION APPOINTMENTS iNSPeCTOR INSPECr~ ~- INSPECTOI~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY ) DEPARTMENT OF HEALTH & ENV RONMENTALPROTECTION DEPf. ENVIRONMENTAL SANITATION DIVISION ol ,; Telephone 264-4720 ~BUYER ~1 LING ADDRESS E. LEGAL DESCRIPTIDN STREET LOCATION 6, TYPE OF RESIDI-'NCE NUMBER OF,BEDROOMS El One [] Cou¥ [] SINGLE FAMILY [] Two [] Five [~] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL= CC VlMUNITY [] PUBLIC UTi LiTY ATTACH WELL. LOG. A well Io§ is reauired for all well~ drilled s~nce June 1975 =or wells drilled prior to that date, give we1 aepth (attach Io.a if available.) SEWAGE DISPO,~;AL SYSTEM [~ ' ~iDIVI DUAL/ON-SITE" [] PUBLIC UTILITY I cj~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROC-=SSING CAN BE INITIATED. 72-010 {Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS [] ONE' [] THREE [] FIVE [] OTHER [] TWO E; FOUR [] PERMIT NUMBER 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY E~'~NDIvIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM E~DIVIDUAL/oN -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: / ')~-_%'~'~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Ar0a to nearest Lot Line DEPTH OF WELL LOG RECEIVED PERMIT NUMBER DATE INSTALLED MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area / t~.~// ///' ~ Sewer Line INearest Lot Line 5. COMMENTS DATE [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79}