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HomeMy WebLinkAboutT12N R3W SEC 22 NE4SW4NW4 132' X 330' PTN PARCEL 10T12N R3W CT:EON 22 PAR C L 10 015-171 -03 MUNICIPALITY OF ANCHORAGE , ; '; DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Larry ~-°(c'~ £1tef~ SEPTIC ABSOBPTIO~I ~ddress ~ TANK FIELD WELL Phone{s)~ Y~ -- ~ Per m,t~Noo( O 7 NO o~ B~oom~ WELL f On ~ I 3~t ~ L~A~ O~SCa~.ON LOT LINE ~5'~ ~6-- Township, Range, Section ~ t 2 N/ R 3 ~ ~e~ ~ 2 AS-BUILT DIAGRAM (Show Jocahon ol well, septic system, properly lines. Ioundaho,, TANKS /~ N ~ SEPTIC ~ HOLDING / ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ ~ .~ L '~ original grade ~, 0 FT ~,6-- FT I1~ ~ Number o, I,nes Sod ,ahng Pipe ma edal Fe~ F-g tO / ~ ~ ~ WELLS ~Sr/N~ ~ PRIVATE ~ OTHER (Identifv) FT REMARKS: Municipal and 81al8 guidelines in ellect on Ihis date' ~ ~ I~ v~.~.,, "', CE- 3539 72-013 (3/851 F:' E F( I~1 :!: T Day F:'ar'l::el Id= 0:I. 5--:l. 71--.0:S Lc:rt. I..e(]al: St.tl:.divi~ic:)n: -' LOC,". 10 B].l:}ck: "~ ~'}(.N::lpc~c)/iis~ ThJ.~='; I:::'(.):~pmJ.'La :.:.!; 'l'cH'.al (X;apac:i't,y." .11NFI:Wd'"i [) . H ,, H. S: I:::'R 1t101:~ FI] 1S'T .~ 21q~O 1[ Iq."!ff::'li!I]T ]1 (]NS )}:~Y E:NE~ I IqlEIEI:~ ~, ii F: (~F:"f'IE:R [)FrFI[;E[ HI]LJF(S~, [;13NT(:~[;T :34.:1;.~;'"4~,81 AND I__E[~VE: ~ NIE:SS¢~GIE:. 'TH]:8 F'EH:~HI'I' E~X!:::'NRES :t,['~/:~:I,/8~ hND V(:~L.H) Fill::( ~ SN~GI...[~ F(~WI:[I-,.Y HONE. :f: [][i:!::N':[i:::Y "I'H(YI"I~ .l.~ 1 am t'am:i].:i, ar. ~.~J,'[..l~ 'Ll"l~a r, tz~qLni, p~men'L~ fl:ti" (~n-'[i; :i 'he ~H~)~t:eP~i ar'id ~(al],~i a[~ shat. ;:c:~r't.t'~ by Cl'ie IqLu'J:i.c::i. pa].ity c)F Ant:he)rage (P'I[)¢~) end 2. I ~:i.t]. :Ln~s'La:l. 1 ~:.l"J[~ s'ysi'.~z~m J.n ac:l::c~pdanc:~.] wi'Lb al.]. al'~cJ :iFi c:()mj:)!ianc:~.? ~J.'Lh '[he desi(]l-i c:r.:[teria of t. his S~ :t: ~:i. 1] ac:ll'm)re~ ~_c) a:l. 1 i"l(X]('~ and ~t.a'L~e c){ ¢:~][a~l<a peq~..~,r(~)m~n'ha ~'(:)P Ch~ ~e'L I)ac:k a]sHx~ undergo'Land i. ha'L 'LI'H'~ c:apac::k'Ly (:)~' t.l"/[e 'Lc)'L,~,z:l. ~4ys'{:.~N~l J.~i :!; l:m)c:lrc)om'a and Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 27, 1989 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Waiver Request 9WR890028, Permit ~SW890107, Upgrade T12N R3W Section 22 Parcel l0 PID #015-171-03 Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 foot for the north and west property line. This approval applies to the existing septic system lot ~ine separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljw~7 ~laltop Technical Se~vlces ..... 14530 Echo Street Anchorage, Alaska 99516 "Parcel I0", Section 22, T12N, R3W. S.M. 11250 Lipscomb Street Septic System Upgrade Design Notes and Specifications 1. The design of the soil absorption bed is based on a visual soil rating of 125 square feet per bedroom, which for a three bedroom system requires (125) x (3) x (1.5) = 562.5 square feet. This is accomplished by a 17' by 34' bed. 2. A lot line waiver is needed allowing construction up to the north and west lot lines in order to take advantage of the portion of the lot with the lowest ground elevation and maximum depth of the gravelly sand stratum. This location is necessary to allow installation of a gravity driven soil absorption system. There is no present or forseeable future conflict with wells or septic systems on adjoining lots. 3. The "Parcel 10" designation of the lot has been used in historical DHHS files for this piece of land, but does not appear in the deed to the lot, which uses a metes and bounds description instead. 4. The configuration of the system shall be as shown on the plans, except that minor modifications may be allowed or required by the engineer conducting the inspections. 5. All material specifications and construction practices shall conform to M.0.A. regulations. 6. The existing soil absorption drainfield shall be abandoned in place. 7. The property owner shall be assume responsibility for location of property corners and any underground utilities. 8. The contractor shall expose the end of the existing septic tank to determine the elevation of the outlet and to allow the engineer to assess the integrity of the tank. Assuming the tank remains in adequate shape, it shall be left in place and an additional 500 gallon tank installed as shown to provide a second compartment. If the tank is badly corroded, it shall be replaced with a new I000 gallon, two compartment, steel septic tank without an additional 500 gallon tank. 9. The bottom of the soil absorption bed shall be excavated level at a depth of 2.5 feet below the septic tank outlet invert. Six inches of approved sewer gravel shall be placed in the excavation before the designated array of perforated and non perforated distribution pipes is constructed. Special care shall be taken to ensure that this entire array is level, An additional 6" of sewer gravel shall be placed around and over the array, which is then covered with filter fabric and a minimum of 3' of soil cover. Cleanouts and monitor tubes shall be installed as shown. 10. Three inspections shall be required during construction: (1) Initial stakeout, (2) after the bed is excavated, but before placement of gravel, and (3) after the gravel is placed, the distribution pipe array is laid and the septic tank is set, with all pipes connected, but prior to backfill. 0 L~ 6 L ~07- $~CT ION ~!attop Technlca! Services 14530 Echo Street ]~nchorage, Alaska 9951R Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~.~rr~ LEGAL DESCRIPTION: 2 3 5 ? $ 10- 14 10 17, 20- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~- DEPTH? pO E Oeplh Io Water Aller Monitoring7 Di'* y Dale', (~'//:2.~/~). -/'leal, SEc SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ ~[~~ ~ , ~,~ .~ 'I ~r'-/~..~'~')'~'~-/' (~'-~'"-~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: ~"~ ~-~ ,~'~ 72-008 (Rev. 4/85) ~!attop Techn[caI Services 14530 Echo Street Anchorage, Alaska 9951R Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOLES LOG -- PERCOLATION TEST P"RPORMED POR= LEGAL DESCRIPTION: 9 10 11 2 3- 4- 5- 6 ? 13- 14- 15 16 17 18 19 20 COMMENTS ~n;~'~r 'h~be q~¢:,.'... C~- 3589 ...-~-~r '~:%. '. ........ · ';.~ I DATE PERFORMED: ~rA,elty Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E Deplh t0 Water After I~onitorin[~? F~r~, Date: SITE PLAN Reading Dare Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER FT AND __ FT PERFORMED BY: ACCORDANCE WITH ALL STATE ANO MUNICIPAL GUIDELINES I~ EFFECT ON THIS DATE. 72-006 (Rev. -- CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: d'/~' GRE--RANCHORAGE AREA BOR¢,gGH Departmen~5;f0 .~_nuV~ro;n~oe:~ Quality Anchorage, Alaska ggS07 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ,~O~l~ "~'~7.-~'~"~ ~-.L~/ MAILING ADDRESS '~ ~---.A ~C)'~ I~ ~4 p.o~.~. ~4 -~7~ LOCATION ~ PS ~mb Ch. LEGAL DESCRIPTION PAneL lo., S¢c. '2z¢~lz~ ~ ~ ~ SEPTIC TANK: DISTANCE FROM WELL ~ C) ~ MANUFACTURER ("~',/2~ ~rrrrrr~p'-- MATERIAL ~'~(~,~g ul.- qpp~ove4 INSIDE LENGTH INSIDE WIDTH. ~ LIQUID DEPTH" NUMBER OF COMPA RTM ENI's LIQUID CAPACITY I'~'~D GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL I|~) / NUMBER OF LINES ~-' ABSORPTION AREA ~ ~, ~'4 DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION '1 ~ .NEAREST LOT LINE 2 ~ !oFTOTALLINEsLENGTHI O~' DISTANCE BETWEEN LINES ~J~/'l~ TRENCHWI~,~ i~. ~O~A~ ~c~,w SQ. FT. LENGTHOF EACH LINE qO~ A~ /qnd MATERIAL BENEATH TILE N. ABOVE TILE IN. WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING OIt NEAREST FOUNDATION I LOT LINE ~ o/fi" CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST t C) ('/'- SEPTIC SEWER LINE TANK ~ O~1 SEEPAGE , . SYSTEM REMARKS IA/ell p;~ I10' DISTANCES: INSTALLED BY: ~ ~ - SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: DIAGRAM OF SYSTEM /®gl , DATE fi, APP.OVED G.A.A.B, Form PW~027 GreaTEr ANCHORAGE AREA BOrOUgH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT ~ {7/4[ '544 - 9~77 INSTALLATION OF: SEPTIC TANK ¢ ~ ~ O SEEPAGE PIT FINANCED THROUGH TO BE INSTALLED BY SO,L TEST RESULTS - /~ ~ PHONE ., DRAIN FIELD ~ , OTHER  ~ '7 ~ ~ NOTE; THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 7 ~ FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. ,EPT'OTANKS'; E T""E SEEPAGEA"EAS''E MINIMUM DISTANCES, REQUIREMENTS fOUNDATION TO SEPTIC TANK ~- / FOUNDATION TO SEEPAGE PIT [ ~ / -. DRAIN F{ELD SEPTIC TANK TO SEEPAGE PIT WALL / ~ / TO NEAREST LOT LINE. WELL TO SEPT,C TaNK DRAIN FIELD WATER MAIN TO SEPTIC TANK · ALSO CONSIDER AREA WELLS. . SEEPAGE Pit CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of EXCAVATION ~ FEET INTO UND]STURBED SO}L. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. GBAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUgh ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRON~ENTA[ QUALITY 3330 "C" Street Performed']~or .~ Legal Description: Lot This Form Reports Soils Log - Soil Test Must Be Logged To ANCHORAGE, B1 oc~' Depth Feet Soil Characteristics 1--- ~l 2-- 4-- 5-- 7-___/ 9-- 13~ 14-- Was Ground Water Encountered? If Yes, At What Depth? Case # ALASKA 99503 Dated Performed Subdivision Percolation Test Below Proposed Seepage System - ]_1 12_ I/-I I _11 I II1_ I I i I I I I I I Reading Date Gross Time I Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit Or Trench .1 BY: Dale: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3830 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For ~o/~ ~r~,~6~/ Dated Performed Legal Description: Lot Block Subdivision l?2/~J~/~/~]. ~ ' ' This Form Reports Soils Log ~ Percolation Test Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet Soil Characteristics 2w 4-- 5-- w 9-- lO- ll- 12-- 14-- Was Ground Water Encountered? ~ ~m. If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop I Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit O~ Trench COMMENTS: ~_~<,// ~o/~ ~SC.~*~ oc~ >x /~u¢l Test Performed BY_ ~/~.~_~. ~m-~/ Date Certified BY: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 7-a -°ct/ Parcel I.D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-171-03 GENERAL INFORMATION Expiration Date: / O "" Complete legaldescription T12N~ R3W~ SECTION 22; Location (site address or directions) 11250 LIPSCOMB Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent BONNIE HOCHSTEIN Mailing address I-o STREET * ANCHORAGE~ AK * 99516 LAWRENCE &: JANET GOLDS'rEIN Day phone (AGENT;) 257-0186 (AGENT) 2600 CORDOVA STREET * ANCHORAGE~ AK * 99503 Day phone W/ REMAX PROPERTIES Day phone 257-0186 2600 CORDOVA STREET * ANCHORAGE, AK * 99503 . Unless otherwise requested, HAA will be held by DSD for pickup. 2Z-NUMBER'OF'BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: IndividUal Well · Individual Water Storage F-] community class Well [-I Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site · Individual Holding tank F-] Community On-site E] Public Sewer E] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system, DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples,) Certificates are valid for one year for properties served by Class A or B wells or a public water system, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I ye#fy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furlher verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date En'gineer'~ Comments: In COnducting this evaluation, GEG, Ltd. attemPted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test,' and separation ' distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may' fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are OutSide the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that .there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for. the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE ~ Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev. 12/01) ..... ; ' ~: WATFRAND -~ .~ ~ WASiEWATER 'j '- .... ., Manitehance Agreements_ ~2~j~ ~)))11) 1' S¢~X.",, ,~ . Supplemental'Engineers Reo~: .. Other Original Certificate Date: · Leg WELL~ D,~TA Well {y~e' PRIVATE Date ~;~m'{pleted al Description: MuniciPality of Anchorage Development Services Department Building Safety Division " On-Site Water & Wastewater Program ; 4700South BragawSt. P.O. Box 196650 Anchorage,' AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 . Total lepth 7.83 ft. Eft. absorptk~n area, 578 ft' ' Monitoring tube, YES .. :. Depression over field Date fa'dequacytest 6/10/2004 i - Results (Pass/Fail~ PASS ' ~ Fluid rlepth in absorption field before t(Jst*8/2.Sin. · : Water added 529 gal · , ! ' :1 '; :l; ~i'' , ~ ~ , ' ;,; ~. ElapS~d'~imel 1336 minl Finallfluid depth*7.2S/Oin. Absorption?ate Any r~juVenati°nl treatment (past :i2: m~.)~, (WN & type)', _', __NONE KNOWN ': ~lf yes, give date 'i'":": *N? WATER IN BED CLEANOUTS i~ F NO For-3 bedrooms *8.25/ New depth 5.0 in. >= 450+ g.p.d. Total klbpth 11 o ft. Cased to '40'+ .ft. · ~.,r, fL -, , ,, FROM WELL LOG " · Dat~ 'Of lest Static W~ter level ft. production ~ ~.p.m. WATER SAMPLE RESULTS: - Coliform 0 colonies/100 mi. "[~"~: ,~[N/A mg./L. Arsenic: SEPTIC/HOLDING TANKDATA [. ' ' ~ ' TankIT~/Material ~EEL/~EEL' .. ,:, .??,'..1250 Tank ~i~e'~' 500gal. Number of C~mpadments .1 ~'~' ~' YE~ Depressi0~ overtank (WN), NO Foundation cleanout (Y/N) uate orp~mp~ng~ ~6/i'0/2004 ~ Pumper ABSORPTION FIELD DATA - - pBELOW ~I~NG ~EI Date installed~ 6/29/1989 Soil ratijng (g.p.d./ff'or~ 125 Leng ~ ~ i~ 34 : ff. Width, '17 ~ ff. Nitr.-4te .. 2.52 mg./L. Date of sample: 6/10/2004 *PER PREVIOUS HAA' .... IFA,: B, Or C provide PWSID# .N/A 1973 ' Sanitary seal (Y/N).YES Well.:L?g (Y/N) Wires properly protected (Y/N) Casing height (above ground) I AT INSPECTION '.6/10/:2004 80: J ff. i 4.78 [ g.p.m. Other baciJria Collected by: Date instaii~d 5/8/,1973 &: 6/29/1989 Clean outS(Y/N) YES gn water/a~arm ~--N/ DENALI '. PUMPING Sy§tem type BED Gravel below pipe 0.5 ft. NO YES 12+ in. 0 colonies/100 mi. GEG, Ltd. .HEALTH AUTHORITY'APPROVAL CHECKUiST T12N, R3W~ iSECTION 22~ ~ ~'~,.~. /,O'Pa¥cellD: 015-171-03 D.' LIFT STATION Date installed !'Pump on'' level at . ,, DatUm ~ Cycles tested E. SEP.~RATION DISTANCES ' ' SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/A~ High water alarm level at ~ , : ', in. Meets alarm & circuit requi;e~m~ eniS? I' ,Septic tanl~/lift station O'n lot, 100'+ · · ,~. Absorption field on lot :' 100'+ Publi(~ sewer main N/A .sewe~-/septic sen/ice line 25'+ ' ~: ,. sEPaRATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: :Buildihg foundation ' 5'+ ' Wate~ main N/A Wells' on adjacent lots 100'+ sEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ,5'+ ' Absorption field Water sen/ice line 10'+ Surface water i',Propertyline *'5' Building foundation ' 10'+ ~ Wate}' sen/ice line . 10'+ Surface water 100'+ i Curtain drain. ~-' NONE KNOWN Wells on adjacent lots..100'+ COMMENTS. ' · **LOT LINE WAIVER REQUESTED ' G'.I(ENGINEER'S CERTIFICATION 'i ... . !) I cerlify that I have determined through field inspections a~d .i,i: reviow of Municipal roco~s that tho above systoms arc in ' ~, , conformance with MOA HAA guidelines in effect on this date. JEFFREY A. GARNESS . On adjacent lots " On adjacent lots" hlO0'+, i; ' Public sewer manhole/cleanout';.: Ii i: ' iN/A. Holding tank ' , Engir~eer's Printed Name 'Datei'.: i ~ !`~5/0 4" ': HAA*Fe'e $, " Date' 6fPayment · Receipt Number Water main" DriveWay, parking/vehicle '~t°r~ge ii.lo'+ . Waiver Fee $ Date of payment Receipt Number cf EASEMENTS OF RECORD, OTHER TH/d~ THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. :GS Ref.# ilient Name ?roject Name/# ;lient Sample ID /latrix 1043250001 G~mess Engineering Group, Ltd. TI2N R3W $e¢22 Lotl0 TI2N R3W See22 Lotl0 Drinking Water ;907 5615301 # 2/ All Dates/Times are Alaskn Standard Time Printed Date/Time 06/14/2004 11:27 Collected Date/Time 06/10/2004 10:06 Received Date/Time 06/10/2004 13:00 Technlc:fl Director, Stephen C. Ede Released~ ~ ,ample Remarks: · Allowable Prep Analysis '~-ameter R~!~ PQL Units Method Container ID Limits Date Date Init ~aters Department Nitrate-N 2.52 0.100 mg/L EPA 300.0 B (<=I 0) 0611O104 J JB ~crobiology Laboratory Total Coliform col/100mL SMI8 9222B A (<=1) 06/10104 DKC 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 10t, block, s.ubdivision, section, township, range) Location (address or directions) (b) Property owner /'~r~'Z~ Mailing Address // '(c) L.er~ding Institution Telephone: (home) ~¥~"~~-¢'~ Business Telephone Mailing Address (d) Real Estate Company and Agent Address -~ ~¢' f ~"-~., · Telephone Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: :. (e) 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3. WATER SUPPLY Individual Well ~ 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 DISPOSA~ 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. 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, 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 FI~/-/~/~ 7"~c/%~¢~[ ..('~r-a,e'r~? Telephone ~' ¢~--- /~ Address / ~,~ ~ ~Ao ~,~ ~n~o~, ~ ~¢5-/~ Date ~*~ ~ I¢~ Engineer's Sea'l~ .~ .,THEODORE F. MOORE...' cE.3589 .. Approved for ,~' bedrooms by . ., Date / ,- _ . Approved ~.~ Disapproved Conditional Terms of Conditiortsl Approval 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 DHFIS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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) eack Page 2 of 2 (]3AI33 GDG o N,qF MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~]©V~OHDNV JO AII1VJIDINnW WELL DATA Well Classification pr' ~'v'~/-,~ Well Log Present (Y/N) ~1 Date Completed Total Depth IlO~ A Cased to ~"~'l¢~" Depth of Grouting Static Water Level 7'? ~ Casing Height Above Ground I ' Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: If A, B, C, D.E.C. Approved (Y/N) Yield '~ '7..3<,~/e~ Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 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 'r'. ~ c.~,. ; On Adjoining Lots ."> too ' ; On Adjoining Lots ~- too ' To Nearest Public Sewer Cleanout/Manhole ? '2¢~ ; Date Water Sample Test Results SEPTIC/HOLDIRG TANK DATA Date Installed, ¢/¢/~ Size Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped Al, ~,, ; for N, ~, Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM sEPTIc/HOLDING TANK: To Water-Supply Well /~O ~ ' To Property Line ,~,-~'. To Water Main/Service Line ~ .'~ ~' ~ To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation ~'~ ~ To Disposal Field ,,,5"0 ' 72-026 (Rev. 7/88) Front Page 1 of.2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed O" / ~-~ /c¢~) Width of Field ! ? ~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test '/¢ ¢(rn~ Type of System Design Length of Field ~ ¥ ~ Depth of Field ~"-¢' ' Gravel Bed Thickness I ,~2 ' Sta~ndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation I I O ' Lot .~ ~'O ' To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area GecK_ To Property Line ,5- To Existing or Abandoned System on ; On Adjoining Lots ;~, ,.3'O ' ~ '~,.¢' To Cutback (if present) ~;> Ioo ' I10 ~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/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 arid HAA g,~i~l~,.effect on the date of this inspection, ....... Signed ~~ ~ ~ ~ ...................... t,,,~ Engineer s Seal MOA No. ~ff -0~' ~ Receipt No. ~ ~ ~a~a ~ ~ Receipt No. Date of Payment ~ ~ -~O -~ Waiver Fee: $ Amount: $ t ~ ~C~ Date of Payment ~-o2~ (R~. ZZ~S) ~.~ Page 2 of 2 ANALYSIS HEPOHT DY SAMPLE foz Work Orde~ ~ 14305 Cate Report P~inted: dUN 26 89 ~ 15:27 Client Sample ID:PARCEL lO SECT 22 T12N RSW-O/S TAP PWSID :UA Collected JUN 23 89 ~ 14:00 ReceiYed 3UN 23 89 @ 13:30 hrs. P~ese~ved with :AS REQUIRED Client Hame : FLATTOP TECHNICAL SRV Client Acct: FLATTOT P.O.# NONE NEC'D ~eq ~ O~de~ed By : Analysis Completed :JUN 23 89 Send Report8 to: Laboratoxy Supar¥i~oz,:STEPHEN C. EDE I)FLATTOP TECHNICAL SRV Special Instruct: Chemlab gel ~: 5924 Lab Smpl ID: 1 Mat~ix~ WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 1,3 mE/1 EPA 353.2 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY T.F. MOORE 1 Tests Performed * See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above NA~ Not Analyzed LT=Less Than, GT=G~eater Than -~-~MUNICIPALITY OF ANCHORAGF~--~ __-DEPARTMEN. OF HEALTH AND ENVIRONMEN'i ! PROTECTION · 825 L Street, Anchorage, Alask~ 99501 279-2511, ext. 224 or 225 Date Received: June 24, 1977 #1: Time 9:30 a.m. #2: Time #3: Time Date 6-27-77 Monday Date Ins Buchholz Insp Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Peoples Mailing Address: Pouch 7-007 99510 Bank and Trust Phone: 2. Property Owner: Anthony Turinsky Phone: 344-3035 Mailing Address: 3. Legal Description: T12N R3W Section 22 Parcel 10 4: Single Family Residence: ( ~ Number of Bedrooms: two Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit # Construction Individual Well (x) Community/Public System ( ) Depth of Well Well Log on File Bacterial Analysis ( ) Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x~ Public Utility ( ) Installed 1973 Installer { ]~____0 Manufacturer Soils Rate Material Distances: Well to Septic to Sewer Line to Nearest Lot Line Tank / 0 ~-- / to Absorption Area ~ / 8 Nearest Lot line ~ Absorption Area Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: T12N R3W Section'22 Parcel 10 Comments: ___~~ ~-{~ ~ __ Affadavit Attached: ( ) Letter Attached: ( ) Approved: Disapproved: Date: Department Worksheet: .... ~ MUNICIPALITY OF ANCHORAGE' ' //~ Department of Health and Environmental Protect,,l~n /[O~// 825 L Street, Anchorage, Alaska 99501  279-2511, ex~. 224, 225 --~L'~ ~equesL Zo~ App~ovaZ oZ Indivi~uaZ Sewe~ and Nate~ Mailing Address: Phone ~/ 2. Name of Buyer: ~~ ~~'~*~ ~ Mailing Address.4~/. ~ /~// P 3. Lending Institution: ~:or/A~' ~ Mailing Address: Phone: o Realtor/Agent: Mailing Address: Legal Description:~, Street Location Phone: Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Water Supply: *Individual Well Number of Bedrooms: (~ Public/Community System ( ) If Individual Well, well depth If Community System, name of system Sewage Disposal System: On-site System (v~ Public System ( ) If On-site System, date of installation: . *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274--4561 Date Received / /9 Time of Inspection ~/ Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected 6. Well Data: A. Type -,..~ /, C. Construction 7. Sewage Disposal System: A, Installed~/~,~.~A C. Septic Tan~: ~/1. Size Phone: Phone: D. Seepage Pit: 1. Absorption Area ~ E. Disposal Field: Total length of lines B. Depth · D. Bacterial Analysis B. Installer /2~~-~ ~.~ 2. Manufacturer 2. Material Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank .~! , Absorption area ~ , Sewer Lines _~, Other contamination .... ' ~ !, Absorption area ~-' C. Absorption area to nearest lot line P.~g~ of two pages - Request for Approval ef Individual Sewer & Water Fac.l,t.e~ i ~ Legal Description Approved Disapproved Date 'Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date