HomeMy WebLinkAboutT12N R3W SEC 22 LT 29 N132'Onsite File
Municipality of Anchorage Page of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S�1 �' 0 3 8 2 PID Number: O f 5— 52.1 ^3 D
Name:
Wastewater System: ❑ New Upgrade
Address:
ABSORPTION FIELD
Phone:
�
No. of Bedrooms:
KDeep Trench ❑ Shallow Trench Deed ❑ Mound D Other
LEGAL DESCRIPTION
$oil Rating: e_
$
Ifrom o-
Total Depth �ginal grade:
• GPD/Sq. Ft.
Lot: 2� Meek. Snb9ivieion:
Depth to pipe bottom from Original grade:
Gravel depth beneath pipe
'
N 13z
4.9 M4x Ft.
6. I Ft.
Township: _+
Range:
Section:
Fill added aboriginal grade:
Gravel length:
rZ
ZIv
P.31VJ
2.Z
(vjoFt.
Ft.
❑ New ❑ Upgrade
Gravel width: f*
2
Numberoflines:
Distance be been lines:
N
Ft.
Ft.
Classification (Priva ,C): Total De
Cased To:
Total absorption a1ea:
Pipe material: x-810
Ft.
Ft.
610 +• SD. Ft.
I -ea++ 4"o Pvc. o3u3¢
Driller: ate Drilled:
Static Water Level:
Installer:
Cavi
Date installe :
6/f 1 97 - 611.3
Ft.
-5
Yield:
Pump Set at:
Casing a ove Ground:
TANK
GPM
Ft.
SEPARATION
DISTANCES
❑ Septic ❑ Holding 4S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer: �[—
Capacity in gallons:
IIZ�
From
Tank
Field
Station
Tank
Sewer Lines
{-w�Gt� r
Well-
10 1±
134 +
I O 1 :t
r i n
/
Glp ±
Material:
S-�._.�.1..
Number of Compartments:
2z
Surface
>I00
>IC1)
>I Op
>IU('
p
r 1FT STATI�wr t=T�1
Water
Lot
Line
=
48
/
E
f
�8�
/
56.t
Size in gallons:
IZS�j
Manufacturer:
oae,.iGOTp,fIL
Foundation
f
q 7 }
f,
132 =
/
7 +
(�
"Pump on" level at:
4-11'
"Pump off" level at:
41 r
High water Orm at:
5
Curtain
0 P
N A
�
�
Pump Make B Model
c
Electrical Inspections pertormetlb: � �° ^
C(�4TCaN0 �U rit
Drain
br2E -o
Remarks:
BENCH MARK
So ISS WEJ�� P��hv-{
Location and Description:
`1 -at' or- S�-T-- f= •vV>
STMT HL SM.aSa
`1�J1L �'1/�`1�wlF L L0
t"�
D t 661 ,.1 Fs . Ni 1,e LA Orta l� ��/
Assumed Elevation:
GtA.'7 7
'_Ca Q� cc N 51 S-rE--, � W l�-k 1-�fzoy ^2�-Lo JP•8 •
EN EERR'S SEAL
® �,�
�®
' l l<T wav� P��v6S��
Sl 2 27a e`i. � ,-
Inspections performed by: Date 1s 6 �
,
a...a . / .... °
2nd 11 /z
. .s:
9 :
Department of Health and Human Services approval
t
Reviewed and approved by: Date: _11Z4197
72-013 (Rev. 9/91) MOA 25
I SV960382 PID #� 01552130
AS -BUILT DRAWING
OF OLD TRENCH
ORIGINAL DESIGN
dAS NOT ACCURATE.
SHOWN ON THIS DWG. /—C/O 'E'
UPON ACTUAL SWING /
FOUNDATION
�C/0. 1.25 INCH PVC
NEW 1250 GALIU S.T.E.P TANK WITH TO OLD TRENCH C/O
DUAL OUTLETS, 1 GAUGE TANK
HOUSE D.
' '� 1.25 INCH PVC
RU .
NS OVER TOP
C/O C OF OLD TRENCH
•e
OLD TH LOCATIO
1
AC = 50,3
BC = 54.5
H' A➢= 112.8
WELL
FG = 19
LOT LINE WAS FLAGGED
NEW SHED—//"
HE "G" BY A SURVEYOR, 2'+ FROM
TRENCH TO LOT LINE.
NEW TRENCH, 50 FEET
LONG, TOTAL DEPTH OF
11 FEET. EFFECTIVE
DEPTH = 6 FEET.+
ooP � �F AC 40
SEPTIC UPGRADE: T12N, R3W, SEC 22, NORTH 132' OF LOT 29
r.. X0°0
PREPARED FOR: ALEXANDER AND LORRA KEENAN
0 ' J f A. me s. o
PREPARED BY+ ALASKA WATER & WASTEWATER SERVICES OQQ°ys '• C -795
04�ai.B ""•'•.....••••, fro
DATE: 6/20/97 DRAWN: GARNESS SCALE: 1- = 30' pr
SID oa"�
SW960382 AS -BUILT DRAWING PID 4, 01552130
GROUND ELEV. = 92.5 (APPROX,)
COVER OVER TANK LID = 9.8 FEET.
1.25 INCH PRESSURES LINE TO
EACH TRENCH.
STEP TANK IS EQUIPPED WITH
DUAL OUTLETS AND PRESSURE
LINES.
GROUND ELEV. OVER
TRENCH IS 94.4+
MINIMUM COVER
= 4.4 FEET.,
TOTAL DEPTH BELOW
ORIGINAL GRADE = 11.1'
2.0+
NEW 1250 GALLON STEP TANK.
ANCHORAGE TANK. 10 GAUGE
INLET ELEVATION = 81.62
TANK SET LEVEL, WITHIN .09 FT.
4 INCH DIA. PVC LINE FROM
HOUSE, INVERT AT FONDATION C/O
= 83.28. DROP FROM C/O TO TANK
= 1.66 FT. OVER 105 FEET (APPROX.),
SLOPE = 1.5% APPROX.
'FOR LOCATION OF M.T SEE PLAN DRAWING
TER FABRIC OVER DRAINROCK
1.25 INCH DIA., SCHEDULE 40 PVC.
3/16 INCH HOLES AT 2 FT U.C.
HOLES FACING DOWN,
A. INVERT OF DRAINPIPE = 89.93+
B. BOTTOM OF TRENCH (AVG.> = 83.8
C. NO GROUNDWATER OR IMPERMEABLE SOIL TO DEPTH OF 18 FEET,
D. TRENCH LENGTH = 50+ FEET
.o E. TOTAL ABSORPTION AREA = 610 SQ. FT.+
BENCHMARK IS TOP OF STEP TANK MH LID.
ASSUMED ELEVATION = 92.77
SEPTIC AS -BUILT: T12N, R3W, SEC 22, N 132' OF LOT 29;��
S...:........
PREPARED FOR: LORRA KEENAN . ...............
O e A. s;
PREPARED BY ALASKA WATER & WASTEWATER Q�°A ., E-7953
po f esslonao\ (000
DATE: 6/20/97 DWN: GARNESS SCALE; NTS �4ppOosloo
INSPECTION
1419 ICIPA[•ITY L'' ANCHORAGE: BOiSiIHG SAFETY 4I ic[ON
350O EAST TUDOR ROAD
NSPECTInyS ?U" 563- gpg NFr,aup_riali' ,?g 'g6-gl'
------------------------------
NANQ• '>EEATbANU :'Luc PERRI'
AOOEES.. .Li6i NITER
PRONE it; 31n -Idl PRONE li: 22i-^+12
:aT. sp_27 i,!;(:F' SURi i. SIC$I 3US n EST
013MMENTS LI ET ST .TitibI:00-IE ?7SS1SLEICALL PiEST
--------------------------------------------------------------------`----N--�----
1: EleC tTlCal S?MCB -.
---------------- --...---- __--__------_---_-__-_-_--_------------------------------
NO NONCOMPLIANCE ONSEE'+''EO 1 1 COR ?E_'iUN..` ,....%NT`Ai. AS E?PLA, LHEU 3E LOW
I I WILL REEXAMINE AT NEXT INSPECTION I J DO NOT CONCEAL UNTIL HINSPECTEO
---------------------------------------------------------------------------------
CONNENTS:
HADE. AL N
Do ycT REgc-VE TN'-, NO'i E
�- k'' g '�
"�Vfy"'
L n,rn
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT
NUMBER:SW960382
DATE ISSUED:12/31/96
DESIGN
ENGINEER:ALASKA WATER & WASTEWATER SERVICES
EXPIRATION DATE:12/31/97
OWNER
NAME:KEENAN ALEXANDER J & LORRA L
OWNER
ADDRESS:11001 TOTEM ROAD
-
ANCHORAGE, ALASKA 99516
PARCEL
ID:-^4-r_� 0
LEGAL
DESCRIPTION:
---
T12N
R3W SEC 22 LT 29 N132'
LOT SIZE: 43560 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
DATE: 11 -2/ .�
DATE:12- 311 4G
o� /Z -?7 7 p 5 A0v/srt) !'1-(19 7' �p 07- /,A. -, 1 .41vF 1�/( L_ 9 E_
11{ (die RvO. {vnu�� (it��KES% Y�onT�gCcs*irK/rvG iib/%7� A5 ,eQ(L(,
11 . Alaska Water & Wastewater
8471 Brookridge Drive — Anchorage — Alaska 99504
(907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
December 30, 1996
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Attn: Dan Roth
Ref: Sewer Upgrade for T12N, R3 W, Sec 22, North 132 feet of Lot 29. 11001 Totem Road,
Anchorage, Alaska.
Dear Mr. Roth:
The existing 3 bedroom house is served by private well and septic system. The drainfield will not
pass an adequacy test (surcharged) at this time, and must be upgraded. As we discussed on
12/30/96, the plan is to obtain a conditional HAA certificate and upgrade the drainfield in the
spring of 1997. The following is the design package for the septic upgrade:
1. SOILS: No soils testing was done as part of this design. The intent is to use the soils data
obtained by Leroy Reid, P.E. in 1989. A percolation test and water monitoring was done at that
time. Attached is a copy of the soils log. The percolation rate, at a depth of 5.5 to 6.0 feet, was
10 min/inch. The log also noted that the soil became more sandy with increasing_ depth. The
system installed on 3/89 utilized the soil profile from 11 feet to 14 feet. During the installation of
the new system, if the soils visually appear to be much different (than Reid's perk test), I will
perform additional perk tests.
Because of the deeper depth for the new septic tank (to obtain 100 foot separation to well), and
the fact that the ground rises towards the east, the new drainfield would have to be at least several
feet deeper if gravity flow is utilized. To avoid such a deep excavation, we are proposing to
install a S.T.E.P tank, and place the drainfield at a shallower depth (strata from depth of 5 feet to
11 feet). Use of the S.T.E.P tank will ensure that flow can be diverted to the old trench
periodically.
2. TRENCH DESIGN:
a. Percolation Rate: 10 minutes/inch
b. Allowable Application: .8 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 562.5 ft2
f. Effective Depth: 6 feet
g. Width: 2 feet minimum
h. Length: 50 feet.
i. Effective absorption area = 600 ft2
We are proposing to use a conventional 1250 gallon lift station (Anchorage Tank), equipped with
dual outlets so that flow can be alternated.
3. SURFACE WATERS: During my site visits (winter conditions) I was unable to find any
surface waters within 100 feet of the proposed septic upgrade. There is a drainage ditch which
runs along the south property line, to collect and channel spring runoff. According to the
homeowners, this ditch only has water in it during spring breakup.
4. TOPOGRAPHY: The lot is generally flat. Attached is a copy of a M.O.A topography map
for this general area. In short, there are no slope concerns.
5. CLOSING: I am unaware of any adverse impacts this installation would have on adjacent
wells or septic systems. If you have any questions, please contact me at 337-6179, or on my
digital pager at 1-800-481-1162. Thank you for your assistance.
Sincerely,
E., M.S.
Lorra Keenan Design Package.wps
LOT 1, KLEMENTSON S/11 -
PRIVATE SEPTIC SYSTEM
AND CLASS 'C' WELL WHICH
SERVES LOT 2, KLEMENTSON
S/D ALSO.
j LOT 2, KLEMENTSUN
S/D. PRIVATE SEPTIC
SYSTEM, SERVED BY
CLASS 'C' WELL ON
LOT 1, KLEMENTSON,
—ZGENRAL AREA
OF SEPTIC
SYSTEM --J 11
i�
fl
I�
i
a GENERAL LOCATD
OF SEPTIC TANK.
s T12N, R3W, C 22, SOUTH
132 FEET, LO
GENERAL LOCATION
OF SEEPAGE PIT.
LOT 3 BOYD S/D,
PRIVATE WELL &
LOT 4, BOB WEST S/D.
UNDEVELOPED AS OF
12/30/96.
\ T12N, R3W, SECTION 22 I
LOT 30, PRIVATE WELL
AND SEPTIC SYSTEM PER
WELL I M,O.A, DHHS .RECORDS. WELL
c IS » 200 FEET FROM THE
PROPOSED SEPTIC UPGRADE.
PVT. WELL
a
SEPTIC UPGRADE, T12N, R3W, SEC 22, NORTH 132' OF LOT 29
PREPARED FEIR, ALEXANDER AND LORRA KEENAN
PREPARED BY, ALASKA WATER & WASTEWATER SERVICES
DATE 12/30/96 DRAWN, GARNESS SCALE; V = 100'
�{E O
�ir ,r rre sera
vv°ae..o.
�.®iPJ,°°a� CE -7953
F` e•
�8�1�� ROFESSI��`Pv
NOTE, THE CONTRACTOR SHALL BE RESPONSIBLE
FOR UTILITY LOCATES. IN ADDITION, THE PROPERTY
LINE IN THE VICINITY OF THE UPGRADES SHALL
BE FLAGGED BY A REGISTERED LAND SURVEYOR,
THE CONTRACTOR SHALL BE RESPONSIBLE FOR
RETAINING THE SURVEYOR,
HOUSE
OLD SEPTIC TANK, INSTALLED
10/72, REMOVE TOP, FILL W
SOIL. �
INSTALL C/O AT 50
FEET FROM FOUNDATION.
4 INCH DIA. PVC 03034)
SLOPED AT 1/4 INCH/FT.
TO THE NEW S.TZR TANK,—
L WELL IS LOCATED IN THE GARAGE,
CUT PIPE BELOW GRADE
AND COVER WITH SOIL -
APPROXIMATE LOCATION OF
OLD TRENCH INSTALLED
3/80. TO BE ABANDONED
IN THE SPRING OF 1997
AS CONDITION OF SEWER
PERMIT.
PLUG
LINE.
EXISTING TRENCH, INSTALLED
3/89. CONNECT TO NEW S.T;E.P
TANK.
TOPSOIL AND RESEEDING SHALL BE THE RESPONSIBILITY OF THE HOMEOWNER,
SEPTIC UPGRADE, T12N, R3W, SEC 22, NORTH 132' OF LOT 29
I PREPARED FOR1 ALEXANDER AND LORRA KEENAN
PREPARED BY, ALASKA WATER & WASTEWATER SERVICES
DATE 12/30/96 DRAWNi GARNESS SCALE 1' = 30'
APPROXIMATE LOCATION
OF OLD CRIB INSTALLED
IN 1972, PREVIOUSLY
ABANDONED,
NEW 1250 GALLON S,T,E,P TANK WITH
DUAL OUTLETS, BURIAL RATING ON
TANK SHALL BE COMPATIBLE WITH
ACTUAL BURIAL DEPTH ENCOUNTERED.
DEEP BURIAL TANK ANTICIPATED,
1.25 INCH PVC.
///---1969 TEST HOLE
30 FOOT RADIUS,
N
v
w
MONITORING TUBE. o
J
N
VO
W TRENCH. 50 FEET
NG. TOTAL DEPTH OF
FEET. EFFECTIVE
PTH = 6 FEET.
TEST HOLE AND PERK, 2/15/89,
LEROY REID, RE. 10 MIN/INCH
AT DEPTH OF 5.5 TO 6.0 FEET,
NO WATER TO 18 FEET.
0
00o eeo o eoe®e �oe•a•on
®• 1 ffreY A.G
Q
�•° CE -7953
4 9FO -.e,. °•oasoo°°•F�Q,��
� p,�PRO FE SS1�Nm`�
TOTAL TRENCH LENGTH
= 50 FEET.
TOTAL ABSORPTION AREA
600 SQUARE FEET (MIN.).
MOUND SOIL OVER TRENCH.
FILTER FABRIC SILT BARRIER.
PROVIDE 2 INCHES OF BOARD INSULATION IF SOIL
COVER IS LESS THAN 3 FEET. INSULA.TION'SHALL
COVER THE ENTIRE WITH OF THE TRENCH.
TRENCH DETAIL: T12N, R3W, SEC 22, NORTH 132, LOT 29
s
PREPARED FOR: ALEX AND LORRA KEENAN
ALASKA WATER & WASTEWATER SERVICES
DATE: 12/30/96 1 DWN: GARNESS I SCALE: NTS
m �c
ses•
Jeffrey ess';
CE -7953 • ; ��t'a
• ee
•eree • F, d.
9PROFESSIO
< a
L25 INCH DIA., PVC PIPE. PROVIDE 3116 INCH
a e 4
DIAMTER HOLES AT 2 FEET ON CENTER.
• °
ONE HOLE NEAR EACH END. 26 HOLES
TOTAL. AT 5 FOOT OF PRESSURE HEAD
a
a °
FLOW IS .94 GPM PER HOLE. TOTAL FLOW
a
EQUALS 24.5 GPM.'
a
• °
MONITORING TUBE (TYP).
, O a
PERFORATED IN DRAINROCK.
NOTE:
• o
0 4
1. TRENCHES SHALL RUN PARALLEL TO THE
SLOPE CONTOURS. SITE IS GENERALLY FLAT.
°
2. FOR LOCATION OF MONITORING TUBE,
a
SEE SITE PLAN.
a
3. CONSTRUCTION PRACTICES, AND MATERIAL
•
< a
SPECIFICATIONS SHALL COMPLLY WITH
ANCHORAGE MUNICIPAL CODE 15.65, -WASTE-
WATER DISPOSAL REGULATIONS".
< °
4. INSTALLATION SHALL 'COMPLY WITH SPECIAL
• , , a
PROVISIONS AS NOTED ON THE SEWER PERMIT.
5. SMEARED BOTTOM AND SIDEWALLS SHALL
BE RAKED.
6. DRAINROCK SHALL BE SCREENED PER M.O.A.
SPECIFICATIONS. DIRTY DRAINROCK WILL BE
REJECTED.
2 FEET IN.
TRENCH DETAIL: T12N, R3W, SEC 22, NORTH 132, LOT 29
s
PREPARED FOR: ALEX AND LORRA KEENAN
ALASKA WATER & WASTEWATER SERVICES
DATE: 12/30/96 1 DWN: GARNESS I SCALE: NTS
m �c
ses•
Jeffrey ess';
CE -7953 • ; ��t'a
• ee
•eree • F, d.
9PROFESSIO
�X T 343-4-70(o
SEWARD
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE,
MUNICIPAUT Y OF F`. mionAGE
DEPT HFAtI & HUMAN SVCS•
DIV. Of ENVIRONIVIENTALSVCS.
ON-SITE 30VIGES SECTION
�irz'o. r �Av arzP, _roc zz, T�v P��
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
DATE+
"Ie/elle
P.O. BOX 196650
ANCH., AK 99519-6650
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
> A --a
204? 7
343- If -7 /
6 • 11
w
5
-y"b QE p6c.:iPo�.�
sP¢r aL�• t5s � ;
3�8o N
ti sin
/ 34
c
AT, vnwE
�4€ / 16 � n
> 1,� /r
I, ip..rK G/O
yw
x,
ti N LA -
(95% 1
A'Qs.1' dO
q7'-* F2o.•r F16a at'
3'r�rzos-, STAQ; op a/o g�84 /,JSP• oR rte'
-IO 57�7r or- 12� IOG wF—w To 728•Jel4
III r Tn oh o�
NFi6uP>o.2S Sf=�.-flnG�
Prt'
ASBUILT-NO CORNERS SET THIS DATE.
SEWARD
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE,
FOLLOWING DESCRIBED PROPERTY:
�irz'o. r �Av arzP, _roc zz, T�v P��
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
DATE+
"Ie/elle
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
204? 7
6 • 11
VISION PLAT :. UNDER NO CIRCUMSTANCES SHOULD
F81
ip
f
'A
bF>� t�Ns=i;; FOR ESTABLISHING BOUND-
DRAWN+
em
�o
w
5
-y"b QE p6c.:iPo�.�
sP¢r aL�• t5s � ;
3�8o N
ti sin
/ 34
c
AT, vnwE
�4€ / 16 � n
> 1,� /r
I, ip..rK G/O
yw
x,
ti N LA -
(95% 1
A'Qs.1' dO
q7'-* F2o.•r F16a at'
3'r�rzos-, STAQ; op a/o g�84 /,JSP• oR rte'
-IO 57�7r or- 12� IOG wF—w To 728•Jel4
III r Tn oh o�
NFi6uP>o.2S Sf=�.-flnG�
Prt'
ASBUILT-NO CORNERS SET THIS DATE.
SEWARD
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE,
FOLLOWING DESCRIBED PROPERTY:
�irz'o. r �Av arzP, _roc zz, T�v P��
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
DATE+
"Ie/elle
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
204? 7
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT :. UNDER NO CIRCUMSTANCES SHOULD
F81
ANY D TA yEREQN :BE US>`D; FOR CONSTRUCTION
'OR
39
bF>� t�Ns=i;; FOR ESTABLISHING BOUND-
DRAWN+
em
r�v>;
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
9/i5g K� TO SEPTIC ABSORPTION WELL
/lent 'ro-re-i
IWO `/_4�/I-
Phones)
36 3/�
Permit No.
�9ooz�
No. of Bedrooms
3
p
LEGAL DESCRIPTION
Lot
29Aet:Qrd
Block—
Subdivision
3y
Township, Range, Section
Tye K36J sem 7-Z
FOUNDATION
TANKS
'K SEPTIC
❑ HOLDING
Manufacturer
EX / AAI
Capacity in gallons
I�z
FROM
TANK
FIELD
WELL
�....
p
LOT LINE
°
FOUNDATION
��
7-7
AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation.
TYPE
TYPE OF SYSTEM
❑ TRENCH ❑ BED 10L W. DRAIN ❑ OTHER C
Depth to pipe bottom from Total depth from original grade
original grade //e 5� FT W FT
Fill added above original grade Gravel depth beneath pipe
FTS' FT
Gravel length C� Gravel width
/ FT .3• 3" 5' FT
Total absorption area Distance between lines
®1� SO FT FT
Number of lines Soil rating Pipe material
SOFT, �'/o
Install% S�
/D
` " — t \ Date Installed
p
��rr// C, l _ 1 3 r
WELLS
PRIVATE ❑ OTHER (Identifv)
Classification (A,B,C) Total Depth Cased to
i FT FT
REMARKS: _1�w/(
uPGt w- 20° A
119 'A7- s d*
'� 7O2�/I
APE ro A, JEW
r6WiTY OV-,
i,< / 1JA79 = 17-6 1 A
337-ff � -
4a T r r 01*6 FRP l l sa. Date:
Municipal and State guidelines in effect on this date: _
Health Department Approval: .9o�C
13(3/65)
7 -
rttG/✓TLY pER 0,1.4 A' A.. ?-/f-
cerlify that this inspection was performed according to all If
Date:-7ILLi-ay
ENGINEER'S SEAL
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
925 L Street, Anchorape� A]aska 43-4720
OM -SITE SEWER ERM[T
�//\0Q/��'!)�
���_�_���/u',��^cx
Permit Number: 890025 L/pgrade
Date Issued: 03/07/8Y Fngineer Des1gnecl
Owne/` mame: PETER M[�RRY
Owner Address: .11.001 TOTFIM RD"
A��CHnRAGE, AK 99516
Day Phone:
346)-3168
Parcel Id: 015-142^13
Lot Legal: Subdivisjon: MM.. Lot: 29-N1329]mc: k: Mftftw-
Section: 22 Township: 12N Range: 314
NORTH 132` OF LOT 29
Lot Size A. A (sq. ft. or acres)
Max Bedrooms: This Permit: 3 Total Capacity: 3
SFPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic
tank must have at least 2 compartments" Depth to top of septic tank(s) < 4.0
fe�i requires insulat1on over tank<s>`
THE INTEGRITY nF THE ExISTING qIN[�iE COMPARTM�NT 1250 RAL^
SEPTICTANK (INIB] !N !972) MUST BE. VER{FIED. THE 8BSORP1IDN FIEL
D TO R[� INSTALLED PER ENGINEERS DESIGN" NOTIFy DHHS PRIO� To ALL
INSPECTIONSPERMIT JSSUED FOR THE EXlSTFlND 3 8R SINHLE
FAMlL� RESIDENCE ONLY, AND EXPIR�S ON 12/31/89.
I CERTIFY THAT:
1. I am �amiliar with the requirements for on, site sewers and wel1s as set
forth by the Municipality of Anchorage (MO(1) and the State of Alaska.
2. I vii]l install +he system in accordance with al1 MOA codes and regulations,
and in comp1ianre with the design criteria o( this permit.
3" I will adhere to all MOA and State of Alaska requirements �or Lhe set ba�k
distances from any existing well, wastewater disposal system or public
sewerage system pn this or any adjacent or nearby lo -F.,
4. I understand that this permii is valid for a maximum of 3 bedrooms. I
also o[ the total system is 3 beJrooms and
any enlar t will rc.,quira, an additional permit.
Signed: DA, CE
--=--^---~^-~'-------------~`-~-----~ -----^~----^^--
(Ovvner} 22-
Tss"ed Ely DATE:
=�~�'=--°--`^~-^~~^~~------� -7--7"--7---�-~
/ /'
EER'S SEAL)
Ala%
o�
e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI825 "L" Street, Anchorage, Alaska 99502-065°•••'� •^• 9
Le REID, JR.°SOILS LOG —PERCOLATION TES2251 `: ��
PERFORMED FOR: /"E/GR %�p�i R� DAT��t(tQit'TS: y I��7
LEGAL DESCRIPTION: LAT z-/ Township, Range, Section: �y f /Q}�7 ffs�G�2-7i
r-_rl 71 SLOPE SITE PLAN
1
2 T- s�/i1"T( SA✓o� 6�'A✓E�
3
rd
5
6 �? L
71111
7-
8 )Z0e14
9
10
11
12
13
14
15-
16-
17
5 1617
18
En(D
19
I I
WAS GROUND WATER
I I I
/o
ENCOUNTERED?
/J
Net
Drop
S
L
IF YES, AT WHAT
O
DEPTH?
P
E
Depth to Water After
DR
3.
Monitoring? r Date:
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
�0 Hl
,b9-,37
gZ
3.
G /lfb
o7 -,4r
,zS
EOC
'ci /�/tE
o fFKEb
20
PERCOLATION RATE �4 (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN FT AND FT
COMMENTS ib/� `� '�, AD 1Y r �IATab AT /6S
PERFORMED BY: /7R� 4, Aj/a I ERTIFY THAT THIS TESTI WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4785)
A
ALASKA RIROnRlMAL COnTROL SCR US, InC.
o engineerinq & 6nuironmenlal Studies
SPECIFICATIONS FOR A FIVE -WIDE WASTEWATER TREATMENT SYSTEM
LEGAL DESCRIPTION: LOT 29, T12N R3W SEC 22
1.0 GENERAL
1.1 The drawings, sheets 1 through 4, shall be a part of this
specification.
1.2 All materials and workmanship shall meet the requirements of the
Municipality of Anchorage, Department of Health & Human Services,
(DHHS), the conditions of the permit, and all applicable rules and
regulations currently in effect.
1.3 All elevations and depths are advisory and are to be verified or
modified in the field by a DHHS approved inspector.
1.4 It is the responsibility of the installer to adhere to approved
designs for installation, maintain the specified separation
distances, and have the appropriate inspections.
1.5 If the installation is not inspected by an AECS engineer, AECS will
not be responsible for the installed system. An engineer at AECS
should be consulted prior to construction, to determine the number of
inspections that will be required and to explain what these
inspections will involve.
2.0 SEPTIC SYSTEM
2.1 The existing septic tank may be used, if it meets the capacity
requirements for the residence and the approval of DHHS. Older
systems may need tank integrity verified. If not, then specifications
2.2 through 2.6 apply.
2.2 The septic tank shall be a UPC approved two-compartment tank,
constructed of 12 -gauge steel with bitumastic coating, set level
on undisturbed soil and insulated with overlying layer of 2 inch
burial type polystyrene.
2.3 The septic tank shall be a minimum of 5 feet from the house
foundation, and a minimum of 5 feet from the absorption area.
2.4 The septic tank and drainfield shall be a minimum of 100 feet from
any private well or body of water, 150 feet from Class C wells, and
200 feet from Class A or B wells, unless otherwise specified. Less
than the required separation distance must have prior approval or
waiver by Alaska Department of Environmental Conservation (ADEC).
2.5 Piping shall be fitted with a mechanical watertight calder coupling
of the inlet and outlet of the septic tank. Piping shall be 4 -inch
ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per foot from
the house to the tank and 1/8 inch per foot from the tank to the
trench.
2.6 Cleanouts shall be installed as designated, capped with air -tight
1412 West 33R6 Avenue 0 AncheRdGe, Alaska 99503 0 (907) 279-5553
rain caps (Jim caps or equivalent), and extend a minimum of 2 feet
above ground level.
2.7 If a lift station is required, it shall be a combination lift station
septic tank per Anchorage Tank and Welding, Inc. design.
Specifications are attached.
3.0 DRAINFIELD SYSTEM
3.1 The gravel for the drainfield shall be 0.5 to 2.5 inch, screened rock
with less than 3% passing the #200 sieve. All substitutes must have
prior DHHS approval.
3.2 The bottom and side of the excavation shall be raked with the backhoe
blade to ensure that it has not been compacted during excavation.
The bottom elevation shall be level.
3.3 Monitor standpipe(s) shall be placed as shown in the drawings, and
shall be rigid PVC ASTM D3034, or 4 -inch cast iron. The section
shown with holes may be drilled 0.5 inch holes on the 6 -inch centers
on opposite sides of the pipe, or a regular section of perforated
sewer pipe, clamped to a solid section, with either a no -hub coupling
or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall
be placed over the top of the pipe.
3.4 The distribution pipe shall be 4 -inch rigid PVC with a minimum crush
strength of 1500 lbs or equal. All distribution pipes shall be laid
level.
3.5 If the final grade of the drainfield is less than 4 feet above the
gravel, insulation is required using burial type polystyrene rigid
board insulation. There shall be 1 inch of insulation for every foot
of soil less than the required 4 feet of cover, but there must be at
least 18 inches of soil cover even though insulation is used. The
solid pipe extending from the septic tank or lift station to the
drainfield shall also have 4 feet of cover or an equivalent layer of
insulation to prevent freezing of the line.
3.6 If insulation is not necessary, the gravel shall be covered with a
layer of nonwoven engineering fabric.
3.7 It is recommended that the area excavated and the area in the
vicinity of the drainfield shall be planted with a white clover, red
fescue mix or Kentucky blue grass.
4.0 INSPECTIONS
4.1 A minimum of three inspections are required for installation of the
trench. The first inspection will be of the excavation to verify
that the installation will be in the proper soil.
4.2 The second inspection will be after placement of the gravel, monitor
standpipe(s) and distribution pipe to verify proper installation
before backfill.
4.3 The third inspection shall be after the drainfield is backfilled and
the ground graded.
4.4 The inspection of the septic tank can be incorporated with any one of
the above listed inspections.
ALASKA ENVIRONMENTAL ,OB Go> Z9 TL-, 'e 31 SEG ZZ
CONTROL SERVICES, INC. ,
1200 West 33rd Avenue, Suite B SHEET NO. OF
ANCHORAGE, ALASKA 99503 CALCULATED BY • " DATE L -27-4V/
(907) 561.5040
CHECKED BY
PAgLL l lie. Ge M 01411.
-ee-a-s1.4 f
\` n
l
3
.330.00
6• c.iAZA( t=erra
3
XE
QED
i Iti2LT
mems si ted thoreon am within the property lilies and do
,:u not overla Or encroach on the property lying adjacentihere-
to, that no 1m rovemeOts on Property lying adjacent thereto
PIP!, r encroach o the premises in question and that there are no
ro/.
roadways, emission lines or other visible easements on
aid prope Y except as indicated hereon.
Dated at chorage, Alasta
ay at--SANt.FARY` _. is B4
Ly f ox
yWA&4 Y. LOITNSBURY & ASSOCIATES
i Engineers Surveyors and Planners
t.RTD 2b3? cuxn nrvw u_ 0�0-r'..,•
S
KIL
i ^
NV'T L'S,: 0%WJP¢ TM0L(-A-TES
wF,.t ZS IxNDER $40W6E.fgkp�
AS -BUILT NO CORNERS SET THIS`DATE
�,•�N es v�d
(L 3
i Iti2LT
mems si ted thoreon am within the property lilies and do
,:u not overla Or encroach on the property lying adjacentihere-
to, that no 1m rovemeOts on Property lying adjacent thereto
PIP!, r encroach o the premises in question and that there are no
ro/.
roadways, emission lines or other visible easements on
aid prope Y except as indicated hereon.
Dated at chorage, Alasta
ay at--SANt.FARY` _. is B4
Ly f ox
yWA&4 Y. LOITNSBURY & ASSOCIATES
i Engineers Surveyors and Planners
t.RTD 2b3? cuxn nrvw u_ 0�0-r'..,•
S
KIL
i ^
NV'T L'S,: 0%WJP¢ TM0L(-A-TES
wF,.t ZS IxNDER $40W6E.fgkp�
AS -BUILT NO CORNERS SET THIS`DATE
�,•�N es v�d
d
W
',:.EPT2L CAEAN OUT
-XS 'ANDER SAGk WOODDEGIC.
'
•
:
I
ASOT LJXPtTED -TNTS
®.'�pp��L
sw.?vFy. 3'
e
s
�
R •'<yiD;
®®�*•
e
_
`'1-
apection_ the following described property::-. --• _--
S
RECi+I'ft7U�����,a*®
•
v
�::o'•.:�;!
;Itr.-ora.
i Iti2LT
mems si ted thoreon am within the property lilies and do
,:u not overla Or encroach on the property lying adjacentihere-
to, that no 1m rovemeOts on Property lying adjacent thereto
PIP!, r encroach o the premises in question and that there are no
ro/.
roadways, emission lines or other visible easements on
aid prope Y except as indicated hereon.
Dated at chorage, Alasta
ay at--SANt.FARY` _. is B4
Ly f ox
yWA&4 Y. LOITNSBURY & ASSOCIATES
i Engineers Surveyors and Planners
t.RTD 2b3? cuxn nrvw u_ 0�0-r'..,•
S
KIL
i ^
NV'T L'S,: 0%WJP¢ TM0L(-A-TES
wF,.t ZS IxNDER $40W6E.fgkp�
AS -BUILT NO CORNERS SET THIS`DATE
�,•�N es v�d
d
W
',:.EPT2L CAEAN OUT
-XS 'ANDER SAGk WOODDEGIC.
'
•
:
I
ASOT LJXPtTED -TNTS
®.'�pp��L
sw.?vFy. 3'
e
I hereby certify that I have performed'' Mortgagee's in-
1 C:. r ,-
R •'<yiD;
®®�*•
e
_
`'1-
apection_ the following described property::-. --• _--
i Iti2LT
mems si ted thoreon am within the property lilies and do
,:u not overla Or encroach on the property lying adjacentihere-
to, that no 1m rovemeOts on Property lying adjacent thereto
PIP!, r encroach o the premises in question and that there are no
ro/.
roadways, emission lines or other visible easements on
aid prope Y except as indicated hereon.
Dated at chorage, Alasta
ay at--SANt.FARY` _. is B4
Ly f ox
yWA&4 Y. LOITNSBURY & ASSOCIATES
i Engineers Surveyors and Planners
t.RTD 2b3? cuxn nrvw u_ 0�0-r'..,•
S
KIL
N I
/r�o'
�,•�N es v�d
33' O
M
Vt.�•
ev . �®
V
i4®
1 C:. r ,-
R •'<yiD;
OTI IFI9 �!"i: °•
t'y r .J.fr"—JI
ON T!IE
S
RECi+I'ft7U�����,a*®
<! .
• f ...... �::.�,
�::o'•.:�;!
;Itr.-ora.
i Iti2LT
mems si ted thoreon am within the property lilies and do
,:u not overla Or encroach on the property lying adjacentihere-
to, that no 1m rovemeOts on Property lying adjacent thereto
PIP!, r encroach o the premises in question and that there are no
ro/.
roadways, emission lines or other visible easements on
aid prope Y except as indicated hereon.
Dated at chorage, Alasta
ay at--SANt.FARY` _. is B4
Ly f ox
yWA&4 Y. LOITNSBURY & ASSOCIATES
i Engineers Surveyors and Planners
t.RTD 2b3? cuxn nrvw u_ 0�0-r'..,•
S
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
rxopx ml ..Gro a aim.
JOe "7'- z9 Tizd Z,?tJ :; Ce—
SHEET NO. 3 OF I`
CALCULATED BY �' �>E.✓ DATE 7--y741
CHECKED BY
SCALE d7-5
w
a o
H H
IL ¢
❑ m
H a
J LL
o m
m z
H
¢
w
w
z
H
L9
z
w
r
0
0
z
Q
w
J
U
w
❑
a
m
m
H
z
H
LL
�IIII QZ t W
JU � N
U
ZHNWmN
--
win m m
Ld
ZU W ;
O I� DOS OH < m 0 CU
\\ Q N
H�-� ❑❑ F
i >W Z
). L -w = Z (n W a)
Q O w a z W W H
r as ¢ �WW J Z 3 Ql
z Ij� HN r QOZ}Q O
a O ((JJQQ (3H z Y m m
U) a❑ H W
° w Q Z m
J U Y a)
m J0U<Hc-
QU fn 0 J
0
O
m
J
w
m
W
0
m
L \
\Q CQ opo
U
E E
� � m OQ
I 1 O
w
zm u
oF-
Xr
-- T
a
H
Y ❑
U P
0
¢ N
¢ I
w
3 In
W O
m
O O O
J
H
Q
W �—
m W
LD ❑
11 ❑
O O
I— Z
H Q
Z W
O J
7- U
W
0 a
H
IL
-- / It
w
10
U a
a a
H
z ❑
w p
IT
r
z
w
w
CL
H
Z
IL
a
r
a ❑
in
zz
❑ J
O
H o
❑
¢
z
m
LL
QQo
U U r
H H a
a
a
H H J
U
War
F
aim
H
En U z
H
W ¢
W O LL
mLLo
w
F-
0
z
w
a o
H H
IL ¢
❑ m
H a
J LL
o m
m z
H
¢
w
w
z
H
L9
z
w
r
0
0
z
Q
w
J
U
w
❑
a
m
m
H
z
H
LL
�IIII QZ t W
JU � N
U
ZHNWmN
--
win m m
Ld
ZU W ;
O I� DOS OH < m 0 CU
\\ Q N
H�-� ❑❑ F
i >W Z
). L -w = Z (n W a)
Q O w a z W W H
r as ¢ �WW J Z 3 Ql
z Ij� HN r QOZ}Q O
a O ((JJQQ (3H z Y m m
U) a❑ H W
° w Q Z m
J U Y a)
m J0U<Hc-
QU fn 0 J
0
O
m
J
w
m
W
0
m
L \
\Q CQ opo
U
E E
� � m OQ
I 1 O
w
zm u
oF-
Xr
-- T
a
H
Y ❑
U P
0
¢ N
¢ I
w
3 In
W O
m
O O O
J
H
Q
W �—
m W
LD ❑
11 ❑
O O
I— Z
H Q
Z W
O J
7- U
W
0 a
H
IL
-- / It
w
10
U a
a a
H
z ❑
w p
IT
r
z
w
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
• # ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99507 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
N? T tv_ Q�`
PHONE
13qUPGRADE
❑ NEW
MAILING ADDRESS (—t
LEGAL DESCRIPTION
-3gC a IU lA/
LOCATION_
16Tw"mEA r7 0
NO. OF BEDROOMS
Uy
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
i Z
wF
Manufacturer
Material
No. of compartments
N
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
�wz
DISTANCE TO:
Well
Dwelling
PERMIT NO.
02 F
Manufacturer
Material
Liquid capacity in gallons
O
m=
DISTANCE TO:
WellldCi (ZL'(j
Foundation
Nearest lot line
PE IT NO.
F z w�No.
of lines
Length of e I" e�
Total len th fines (
g
Trench 4 th
inches
Distance bet lines
G¢
p
Top of the to finish gr[deG D (
Material beneath tile p� /(
J inches
Total a iv bsorption area
�C)6
w
Length Width
Depth
PERMIT NO.
QF
wa
Type of crib Crib diameter
Crib depth
Total effective absorption area
W
Well
DISTANCE TO:
Building foundation
Nearest lot line
J
J
Class Depth
Driller
Distance to lot line
PERMIT NO.
W
Building foundation
DISTANCE TO:
Sewer line
Septic tank
Absorption area(s)
OTFER
PIPE M ERIAALS
SOIL TEST RATING
`
INSTALLER /
C.REMARKS
-b
1
�
l
9J
APPROVED
VED DATE LEGAL
c-3 —c;—,'7—
72-013 ('(=igv!3/78) / ]
` ^ DEPARTMENT -.F HEALTH AND , 825 /L/ STREET/ HNCH
^ 264-4
K
PERMIT NO. ( 800038 )
APPLICANT PETER E. MERRY SRH B
LOCATION TOTEM RD OFF O!M4LLEY RD
LEGAL SEC 22 LOT 29 T12N RiW
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4 S
THE REQUIRED S12E QF THE SOIL ABSORPTION SYSTEM IS:
,-47 L_F=r-417,-r"= 6--:;z �F;�),-FlvF-=L- E>F=F=--r"�
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- -VWID <22> �`��������� nFRIE ���UlFRE=-V--
BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
E:XF='11F;ZE::E; L-tE:IZ�FErIE�[_=F6Z 3-:1.- ::L54 �� 13
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
APPLICANT PETER E. MERRY
ISSUED
'
V4L 0
I
GRE TER ANCHORAGE AREA BO -)UGH
Department of Environmental Quality
YfYY 3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME Jh& ASm;M MAILING ADDRESS 03 16_ G 1,73 �' PHONE
LOCATION TO"l1M 2d- -sd O�m2PQa�-� LEGAL DESCRIPTION /3 y 10j2y `5'e 1?2 T/2/!123 LJ
SEPTIC TANK:
DISTANCE. I .NUMBER OF -
FROM WELL _il-) MANUFACTURER e,09 MATERIAL —COMPARTMENTS /
INSIDE LENGTH INSIDE WIDTH _ LIQUID DEPTH — LIQUID CAPACITY 125O GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER =0R WIDTH/3/, LENGTHZy, DEPTH /0
)��/00
LINING MATERIAL C9t.l,�
� /(J�.J' CRIB SIZE: DIAMETER DEPTH � DISTANCE FROM: WELL
I TOTAL EFFECTIVE
BUILDING FOUNDATION /a0! NEAREST LOT LINE 2/ ABSORPTION AREA (WALL AREA) S SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE /AMIIWIJALL CONSTRUCTION /d'Q(xtµe �//AD DEPTH
DISTANCE FROM:
BUILDING loCn7�n I NEAREST ! NEAREST I SEPTIC ! SEEPAGE i
FOUNDATION 90"e LOT LINE 10 SEWER LINE /O f-, TANK SO ¢ SYSTEM Ano
CESSPOOL �C' OTHER SOURCES (? d5"V)'7
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY: 0 Ii- 191V d&hn
_rct nK by 6a
PIPE MATERIAL: Ca,ST
LOT SLOPE:
REMARKS:
Form PW -026
RAM OF SYSTEM
1 I FIDUSe
LUP.U- o Ot i
1_2a Y
I "5'Ca�sr
�'rr K
3 Carr
`N t ¢pN
la' o 3
"r -
DATE Q& Z6, /97Z APPROVED
G.A.A.B.
N a
�0 GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO._ ---r—
COUCTA 11 650
A'<r-HO^.AGE. ALASKA 99902
279.8166
V SEWAGE DISPOSAL SYSTEM —APPLICATION AND PERMIT
HONE /vbi
NAME OF APPLICANT �'et�_----- MAILING ADDRESS —_—_._ —__-----.--- PHONE
INSTALLATION LOCATION_ U��1�/ ��— ®/L�
LEGAL DESCRIPTION 7—�—���
INSTALLATION OF SEPTIC TANK //JJ SEEPAGE PIT— X DRAIN FIELD _—. OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED _ O�•t
_ TO BE INSTALLED BY
SOIL TEST RESULTS /7/��lJ.2/y NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TMST
COMPLETION DATE ANTICIPATED L r �/ y -
PFRMi�T_�A1.I� NNF YEAR
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANV SYSTEM WITHOUT FINAL INSPECTION SY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO4 .,PROSECUTION.
SEPTIC TANK SIZE /b /�=TYPEG�Pjp DT-CO1l,—rA' —eSEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES. REQUIREMENTS� ��-, , >/, DIAGRAM OF SY°JTGE.1
5 ft.
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT 20 -ft. DRAIN FIELD 10 ft'
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK 5 ft. . SEEPAGE PIT 20 ft. . DRAIN FIELD 10 ft.
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
15-0
0
SEEPAGE PIT /".
ALSO CONSIDER ARCA WELLS.
WATER MAIN TO SEPTIC TANK 10 ft. SEEPAGE PIT
DRAIN FIELD 10 ft. .
SEPTIC TANK, 25 ft., SEEPAGE PIT 100 ftp • DRAIN FIELD 50 ft.
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
9 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
�THOROIT
OR
LICENSED DESIGNER
" CAST IROO SIPIIOH
SEPTIC PIPE HITO AIRTIGHT CRIB
CAST "0
LevJS __
CAST IRON
INTO
UUDi STL'IIOCD SOIL _
^IIUICUi' IR III NuII - S"
yOfBEL Fd IB.
AA- h CRIB. -
C 1 rqui r<A vl:enevcr line dosses T(CRIBABLE A' R!NIY,UP. ABODE' %AiFR-
under Jrire.aY.
TABLE)
111 -II VELI. � Il fll S -R P.L
CCG:II HCLIS
t.
.. A DACE Pit FXCAYLT1011 BASED 04
I11:'J :'!PI!AL 5011. TEST.
In-Tfi':0.- T:n•
10 PIT- 100'
IPS I0 LJro- 10i C.rade: k'.p La•.
1 In, Uc crl/A-p- r0
excep< w' P -ami
11 Tn r0 HOUSE tank A Lna ino IJ
r 1 '. 1)0
P.T eaceee 7.
1 -e 1.1 I; - AO' I 6' per ICO flet
411--P111 O -Au terrefps.
CAS; 12011 SIKft CAST IrOP, d SEPTIC
LIR( I'1."I S IrJH:
1'11RIIC DI$IIIPfED —)
CAST IR011 SIPIIOX PIPE
Olt
i!0 TA".° -`100• ' �.� 5[CRIB PIT
2ar
Tp'OkRVCI UACNTIIL
r..-10^;1/.!:011
S
OfHINIMUR -
I. - REn PEST LOT LIOr---.__`
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26-86 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. I
DATE /O—/�—" �i APPLICANT'S SIGNATURE
A
DF PA p! i HL.N i- PF t, i; f k n r� 1A #
,3500' TUDOR R oildr!
ANCHORACE, ALASKA 99502
Performed For FC.- - S,,Ztvl_ —Oate Performed /Z) ?
Lecial Descrintion: Lot Block. Subdivision—V/31%/
�3C,) Z( 2v.
This Form Renorts Soils Log Percolation Test
Oenth
Feet
I
it Characteristics
2 M -
CT
A 5-'t �
5 —
6 —
7 t,).jt ? Fac e� savjs
10 — I
W_as Ground Water
Encountered?- ho
IfYes, At what Denth?
1461., o(j s11 e dn a I En� s t DT—a —tif
—o-1 e. Pit r ;1`! n r; r'l d
Depth of inlet
Cr'MMENTS th To Botto!n Cf Pit Or
Test Performed v
B
IVPa `:aIa ert j f 1 el! pv
--
rent
_'--
IL— iii
I�
1461., o(j s11 e dn a I En� s t DT—a —tif
—o-1 e. Pit r ;1`! n r; r'l d
Depth of inlet
Cr'MMENTS th To Botto!n Cf Pit Or
Test Performed v
B
IVPa `:aIa ert j f 1 el! pv
--
rent
6 PLANS
MUNICIPALITY OF ANCHORAGE
Development Services Department/ Phone: 907-343-7904
On -Site Water & Wastewater Section \ �� Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-521-30
1. GENERAL INFORMATION
Complete legal description T12N R3W SEC 22 LOT 29 N132'
Expiration Date: _q— I 2 02,0
Location (site address) 11001 TOTEM ROAD, ANCHORAGE, AK 99516
Current property owner(s) GAVIN & DAWN CARMICHAEL
Mailing address
Real estate agent
11001 TOTEM ROAD, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER
DISPOSAL:
Private Well ®
Private Septic
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 $ �JrD
Waiver Fee $
Date of Payment IaIg4p g
Date of Payment
Receipt Number 0;1g39b
Receipt Number
COSA # O15C (q ((o (l
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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 12/26/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices I 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
OF�/
��� '' `.YS
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 estimate of how long a system will function satisfactory
/ ylt :"49 TH
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
I
discrepancies exist can be given by and Anderson Construction & Engineering.
Firs
MICHAEL N. ANDERSON. -
6. DSD SIGNATURE
No. CE 9469 �� �
1'..12/2.... ' AW
System #1 Approved for , bedrooms
�\ nssioN=
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
C.1
y: � lig•.- (i� .
"M►ft►rt1
Original Certificate Date: I— 3 - ZD 7. (7
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other ! O
Legal Description: T12N R3W SEC 22 LOT 29 N132' Parcel ID: 015-521-30
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled UKNOWN
Total depth * 110 ft
Cased to * 40+ ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 12/13/2019
Static water level at beginning of test 63 ft.
Well production at time of test 4.4 gpm
Comments *Per MOA data.
B. TANK DATA
Age of tank(s) 22 years
Tank type/material STEP / STEEL
Measured operating fluid level in septic tank 48
® Standpipes/foundation cleanout per record drawing
Date of pumping 11/25/2019 f
D. ABSORPTION FIELD DATA — Both fields tested
Which system tested (date installed) 3/11/89 & 6/12/97
® ALL standpipes present per record drawing
Total measured depth from grade 17.3 / 11.6 ft (max)
Measured depth to pipe invert from grade 15.3 ft (min)
® N/A — pressurized field 1997 SYSTEM PRESS.
® Monitor tubes go to bottom of effective. If not, state
depth into effective 2' +1- into 2.5' ED (1989 FIELD)
® 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:
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® Nc
® Coliform bacteria is Negative
Nitrate mg/L ® Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by
Date of Sample 12/13/2019
C. LIFT STATION
® Required maintenance completed
Age of lift station 22 years
Lift station material STEEL
Comments: See attached maintenance by L&S
Adequacy test date 12/13/2019
Results 2 Pass For 3 bedrooms
Fluid depth prior to test 0 / 0 in
Water added 460 / 490 gal
New depth 6 / 24 in
Elapsed time 1310 min
Final fluid depth 0 / 0 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
41
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'
® Yes
if No ft
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
® Yes if No ft
Property Line > 5'
® Yes
if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No ft
Private Wells > 100' ®Yes if No _
Water Main > 10'
® Yes
if No ft
Community Wells > 200' ® Yes if No _
Water Service Line > 10'
® 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 *3 ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No _ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No ft
F. ENGINEER'S COMMENTS
`1989 FIELD TO SHOP FOUNDATION — WAIVER REQUESTED.
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
12/27/19
ft
ft
Municipalityof Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 ® (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
11,ent S
C+
J �.
Department
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#:
PID#: 015-521-30
COSA#:OSC191611 Permit#:
Legal Description: T12N RM Sec.22 Lot 19 N132
Engineer: MNA
Applicant: Carmichael
Your request for a waiver of the required 10 feet horizontal separation from the absorption field to
the foundation has been approved. The approved separation distance is 3 feet.
This waiver approval applies to the Existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
[d Adjacent properties are not affected by this waiver.
Waiver is Granted: X
Waiver is not Granted:
Date: Approvedb C
N me of Reviewer
............................................... ■ ........ t t .................. 9 ■ 1
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345-3377 /Fax 345-1391
December 27, 2019
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: FOUNDATION TO FIELD WAIVER - COSA
LEGAL: T12N R3W SEC 22 LOT 29 N132'
During a recent COSA inspection of this property it was discovered that the
absorption field constructed in 1989 is within 10' of the recently constructed shop
foundation. We are therefore requesting, a foundation to field waiver of 3' be
granted.
The invert of the encroaching field is 70"+ below the shop footer with no potential of
effluent infiltration into the foundation. We believe the 3' separation is adequate to
prevent damage to the building or to the drain field. There have been no known
issues and there are no adverse effects on the subject or adjacent lots by granting
this waiver. Please contact Brent M. Western or me if you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Support Services ,
Brent M. Western
907-440-4601 t" cr rrs
Y ZU 3XO. ,0.0 S
rl All
,00'ZU 31,00,t,0o0 s
Iz
¢tits Qo"'
--I
W
ui
u-
O
a s P e
�i7N
1 LL
w
�Nw
i �
www aim
0-)
•—
N
Gw>
>6i
«�
=m° Naz x
n
0 z w
Or�ry
Nz�n2wm
Lj-
50� K>KZ
rn •
to
w u'o�ma w
o
N1�ow`
= rU
M
i
o . W
o H
S
O
o a
SWOQ
C
nzwa wd
w
•
teals
n
O
O
M
M
iow2 x
W
W
.N
-- ---
N
O
rye
O)
LOW
ti w a
��Siq
v
on
rn00
rn
^Q
,
co
c r
SE
z
�
fj
FAMILYU
n o
2J.8
33.F 27.2
°a
��'Wa•'~i=
w
W W
g moo inti
3
- -- -- - ---
o (L
W a
a4
F- Y
}WO
i Q
\
MDQ
I
' i
Y ZU 3XO. ,0.0 S
rl All
Iz
MUNICIPALITY
Ain!�;_�_
Development Services Department-_ x= Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Lift Station/Pump Vault
Owner_Cavin I#�c, o , Street Address1.100 � Tot ern
Septic Tank:
-Sludge level inches -Pumping: required es n -Pumping completed (@ no
Lift station: Nov �ot5
-Pump basket cleaned es no -Effluent filter cleaned es no
-Control floats cleaned e no -Proper float settings confirmed es no
•Operation satisfactory es no
Alarm System:
-Dedicated electrical alarm circuit yes no -Audible and visual alarm inside dwelling e no
-Alarm system operation Csatisfactonot satisfactory
Manhole Riser
-Ground water intrusion at riser to tank connection yes
Ground water intrusion around pipe penetrations es no -Weep hole functional 6 ges no
-Manhole lid: Functional es no insulated e no Properly Secured es no
Other
-All manufacturer required inspections and maintenance completed yes no
Comments:
Qualified Maintenance Provider:
Technician -\-\5
Company
Signature
Date of maintenances i
Dateh Q,i c. M
www.muni.org%onsite
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSCOSC191611
Subdivision: T12N R3W Sec 22 Lot 29 N 132'
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 22 years old. Typical replacement costs range from $8,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
Municipality of Anchorage
*AE
Development Services DepartmentBuilding Safety DivisionOn-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. i" 2l e .-4 COSA #L
Expiration Date:
1. GENERAL INFORMATION.,
Qomplete legal description Vz R,3 tv' 3 U_ 2-Z
Location (site address) t
i
Current Property ownors) 4 dt t� �cc. Day phone 5 {- - CS(- -
Mailing address S Ai -n -
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing,Address
Unless otherwise requested, COSA will
be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER.8UPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual. Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 sample results. (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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm 3az�.�a,
i
Address 2-o3 UJ. s�, ;,vE %. ,-LZ A,(L110:_4:4 AK 91 50
Engineer's Printed Name L AQL&o'uc_VV _m
5. DSD SIGNATURE
I —Z Approved for
Disapproved.
_ bedrooms:
Phone
Date
At
� - I
10
. ..........
S E. SPURKLAND;8
rtf�, 1.1500��/`
Conditional approval for bedrooms, with the following stipulations:
�� r1h1 QITC
WATER AND
PROGRAM
i�l�IJ�NT1�� }`}1•�
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date:
0
P'
(Rev. 11105)
Municipality of Anchorage *og �4,
Devetopment Services Department
Building Safety Division
On -Site Water & Wastewater Program Y
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343=7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: TI7—A( R3W SEC 22 LOT 211 _ N 13Z ' Parcel ID: 015- 5ZI- 30
A. WELL DATA
Well type PRwq- L- If A, B, or C provide PWSID #
Date completed unknown Sanitaryseal (Y/N) Y
Total depth l 10 ft. Cased to ft.#
FROM WELL LOG
Date of test unknown
Static water level \A n k►ac%,"n ft.
Well Log (Y/N)
Wires properly protected (Y/N) Y—
Casing height (above ground) 30 in.
AT INSPECTION
—F/ -f, III
5 9 ft.
Well production u nkn oW rg�.p.m. 1 ` 5, I g/.p.m`. 1
W,01 (a6 i n¢ Zv,S(xJA Id/ ca-e,w No I�Etsro� m.l i`an W-,& AJACA i" 6p.
WATER SAMPLE RESULTS: I
Coliform s c- colonles/100 mL Nitrate AQ mg/L Collected by:
Arsenic: Nil _ ug/L date of sample: U11I I
B. SEPTIC(HOLDING TANK DATA `
Tank Type/Material nck►or T S� earl Date installed
Tank size " Jiso gal. Number of Compartments ?- Cleanouts (YIN)
Foundation cleanout (YM). Y Depression over tank (Y/N) A/ High water alarm (Y/N)- y
Date of pumpingAd 'Lc�l1,:, Pumper /VorAGnb Cun,Azn�
C. ABSORPTIOht .FIELD IQ-, 3/tr�'t98q 115/ S�+a.lbw TRErocM,/
Date -installed Sollrating (g.p.d./fe or ft2/bdrm) IBT,S System type D Trend,,
I
Length.16150 ..ft. Width 35-S` 2 f ft. Gravel below -pipe ft.
15,2 so
Total depth ,LI io ` ft. Eff. absorption area In ft Monitoring tube y Depression over field
Date of adequacy test -=tglll Results (Pass/Fail) PA56 For 3 bedrooms
Fluid depth in absorption field before test (o in. Water added 1160 gala New depth 2-Y in.
Elapsed Time: Ift min. Final fluid depth 1_ in. Absorption rate >= LI54 g.p.d.
Any rejuvenation treatment(past'12 mo.) (Y/N & type) /done /' now'n If yes, give date
** The,AdtQuncy T643A was pe L�rme o n A 195j Drat, QQ\, w> id, w0.i'l'
s pre S&AJ we
U
2 Go.11ons (}zo. Ytie I99 -f Trend Was Su��l�any e�y�ing 9n 1h5peA,,1 on
D. LIFT STATION
Date installed (-b2-111
"Pump on" level at Li I_ in.
Size in gallons 1'260 Manhole/Access (Y/N) _
"Pump off" level at 41 in. High water alarm level at
Datum 64o, I. ,,%K Cycles tested
E. SEPARATION DISTANCES
3+
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on 'lot 1001---
Absorption field on lot IOD
Public sewer main IV. A,
Sewer /septic service line Z5 +
Y
y5 in.
Meets alarm & circuit requirements? Yet S�
On adjacent lots
On adjacent lots
100
(00'+
Public sewer manholelcleanout N, A.
Holding tank N, A,
Animal containment areas 50't Manurelanimal excrete storage areas !00 +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 tt Property line It Absorption field S +
Water main MA, Water service line 10'f Surface water
Wells on adjacent lots 100 �4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
/Do `f
Property line 10`+- Building foundation Ia�t Water main N A,
Water Service line [ D rt Surface water 00 '1- Driveway, parking/vehicle storage 5D I+
I
Curtain drain 50 t (A/ 01AWells on adjacent lots 100 J
F. COMMENTS R
G.
ENGINEER'S CERTIFICATION r OF
q5
A.0�1 t
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
r t
Engineer's Printed Name LAz SDur�L 4 ��t .. E1S5URKLAND���
Date _ �28' I l tl 1J , ' 'p'�?;ti �JJt1r1R�'` ~
Date of Payment
Date of Payment
Receipt Number 0 )1 a" �o t Receipt Number
(Rev. 4/10)
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
I ran a camera 40' down the well at 11001 Totem Rd and did not find
any holes/ cracks in the casing or leaking around the pitless.
Beau Maxim
i
GROH I
SUB.
-
O
rF- N
CD M_
3 w
0
p
0
M O
O^'
2)
CL
cl
N SHANE A. HOLT.,,` r G
LS -0974 u O
KLEMETSON SUB.
S 89059'25"E 330.10'
WELL
S 89059'25"E 330.10'
33' RIGHT OF WAY
( FROM U.S. PATENT RECORDED
APRIL 9, 1965, BOOK 299, PAGE 159)
e
OLIFT
STATION
syFo a
b
O
N
M_
W
O
p
lqt0
O
m
AS -BUILT SURVEY 1" = 40'
r
NO CORNERS SET THIS DATE
Y
/
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
NORTH 132' OF LOT 29, SECTION 22, T12N,R3W, S.M.
D r
�m
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
m0.
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
EXIST OTHER THAN NOTED.
z�
DATED AT ANCHORAGE,ALASKA THIS 18TH_ DAY OF
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
—
—3ULV , 2011. HOLT LAND SURVEYING
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
IGS FB /77-15. 195-GO,G 11 600 HIGHVIEW DRIVE
ANCHORAGE,AK 99515
6
ASPHALT 'Ri'✓EV✓Av
IT1
700j
WELL
S 89059'25"E 330.10'
33' RIGHT OF WAY
( FROM U.S. PATENT RECORDED
APRIL 9, 1965, BOOK 299, PAGE 159)
e
OLIFT
STATION
syFo a
b
O
N
M_
W
O
p
lqt0
O
m
AS -BUILT SURVEY 1" = 40'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
NORTH 132' OF LOT 29, SECTION 22, T12N,R3W, S.M.
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
EXIST OTHER THAN NOTED.
HEREON (UNLESS INDICATED)
DATED AT ANCHORAGE,ALASKA THIS 18TH_ DAY OF
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
—
—3ULV , 2011. HOLT LAND SURVEYING
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
IGS FB /77-15. 195-GO,G 11 600 HIGHVIEW DRIVE
ANCHORAGE,AK 99515
345-5513
J'/ 6-107
- Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D. 01 S- S Z t - 3 o COSA # M[Y)58
Expiration Date: (o -- Q 1- C4 :z
1. GENERAL INFORMATION
Complete legal description N I T Z' L o f 29, Sa � hof. 22, T l z NO R 7 w t. m.
Location (site address) 11 oar o hew+ R o exd
Current Property owner(s) -M.A., fit e 1c/en Day phone 930 -
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
11601' 'T'of-e� RoC Ein_ AoraFv !}I -e 94Vtr-16:fS—
PuC(/•C_ "W 7-0f/e Day phone
pe Per L&4, -%e la , e-"to6*f Snu. S'-cr. Day phone 317 —
Ken at i. A fav ka
Unless otherwise requested, COSA will be held by DSD for pickup. P) care cc.// Rea/Ac' Pefe - l wmetfl*
2. NUMBER OF BEDROOMS: 3 &0 317 -SYS atw/e.. COVA rrlao1. A'//uk-.r+
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Individual On-site
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of Onsite Systems 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 sample results. (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.
4. 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. 7,Ae r yJo HOA 12Meevrie7 Fee
r+l vt f 6 n 19 al ct !a int el•,g i9 ece o•.f od' elwry.
Name of Firm F/af&4 r&cti,,;,c«/ Svc- Phone 3 y.S- 1.TSS
Address IN_f3o Ectio Canyy� If-'cti reqs Ak 994-16
Engineer's Printed Name Thabdore F. r+ocrP Date 3/1-9/07
5. DSD SIGNATURE „,-: KODORE F. uoorte.•r
$.. Via:•
CE -3589 i
._1/ Approved for � bedrooms. 'E,'••.!�?••'µy
Disapproved.-'"?F,� �' z
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By. LV Original Certificate Date: 3 2 �— 07
)Rw. 11AS)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: N 13t! Lei 29- S. c 22, T/'tN, 83 !✓, S. r. Parcel ID: 0i4 -S'2- r -30
A. WELL DATA
Well type If A, B, or C provide PWSID # P. A.
Date completedA-v raun2- Sanitary seal (Y/N) Y
Total depth J-!0 ft.
Date of test
Static water level
Well production
Cased to>Yy ft.
FROM WELL LOG
ft.
Well Log (YIN) N
Wires properly protected (Y/N) Y
Casing height (above ground) 30 in.
AT INSPECTION
S 7 ft.
g.p.m. 5.6 * g. P.M.
WATER SAMPLE RESULTS:
Coliform O colonies/100 mL Nitrate .461.1 mg/L
Arsenic: .4 5' ppb date of sample: 2/2-6/07
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP / S
Tank size /'ZSO gal. Number of Compartments 'Z
Other bacteria e!5—colonies/100 mL
Collected by: 1= lartA` TWol+ X-C
Date installed 6 / 13 /97
Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 3/19/0'a Pumper Nor*A14wd
C. ABSORPTION FIELD DATA
Date installed d / r3/ 97 Soil rating (g.p.d.M2 or ft2/bdrm) 0. 8�i System type 'Tre'eA
Length SU ft. Width Z+ ft. Gravel below pipe 01.1 ft.
Total depth If. I ft. Eff. absorption area 6.!p ftZ Monitoring tubeY Depression over field _M
Date of adequacy test S / r2-/ 07 Results (Pass/Fail)r.4 For 3 bedrooms
Fluid depth in absorption field before test min. Water added.Vi gal. New depth 6Y. 22 in.
Elapsed Time:Z?4min. Final fluid depth S7•7in. Absorption rate >= 'Y 5"6 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NGAL Icncrr^ If yes, give date N. A.
D. LIFT STATION
Date installed 6113197
`Pump on' level at " in.
Datum & flpm
E. SEPARATION DISTANCES
Size in gallons XnAerlral
"Pump off" level at 37 in.
Cycles tested _> to
Manhole/Access (Y/N) Y
High water alarm level at Y S in.
Meets alarm ti circuit requirements? Y
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 101' On adjacent lots10& gr � (rae�.w o4VIn
Absorption field on lot 13Y' On adjacent lots > 144v-
Public
uOPublic sewer main V. A Public sewer manhole/cleanout N. A.
Sewer /septic service line > 4S' Holding tank W. A.
Animal containment areas N. A. Manure/animal excrete storage areas N• A.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 9 7 Property line H4' Absorption field 3G'
Water main N. A. Water service line >1471 Surface water _> tcXi'
Wells on adjacent lots > too '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 2 Building foundation 13 2' Water main N• A•.
Water Service line 1 r6' Surface water > tuo' Driveway, parkingtvehicle storage
Curtain drain sees. Wells on adjacent lots > ICAO'
F. COMMENTS
'1F Lof floe 4+Giva� .1lut0( e!+:• {jr• �: bt,.
G. ENGINEER'S CERTIFICATION r '
I certify that I have determined through held inspections and ;*"'•'••'••'•••••••••••T•••�
review of Municipal records that the above systems are in,*�.'....�...
conformance with MOA COSA guidelines in effect on this date. s, •, Irsct 61L r. uDOR E .. it
Engineer's Printed Name 'rAeaofore !F t-••aorr '�,•,, ••,/0�,d,<. r.
Date Mscwy-A 19, 2007
COSA Fee $ Lov Waiver Fee $
Date of Payment 31/2! 1 Date of Payment
Receipt NumberReceipt Number
(Rev. 11105)
i I i i
GROH KLEMETSON SUB.
SUB.
I— S 89D59'25'E 3313.113'
O �
O
of N
yr .e
W
O I °u Z; W
73 7 (cQI O
O I ASPHALT DRIVEWAY u • V
O o OL." 0
STATION D
0 O
ns.a
N
J
WELL J
•y�D e
I
S B9059'25'E 330.113' '
`—_
31NIGHT OF WAY f
I FROMYJ. PATENT RECORDED I
' APRIL°.IYIS.°OOE 299. PACE IEEI •F 0.... ,
o ICF!•" �,9 �
*� 49TH* oY�
•p sA3-0UCJLLEE.1 ;BEY
O PSHANEA. HOLT. O
oa�iP'.•.• LS -6914 .•'.•,41f,
OQ LgRT •OAOEETIfEPEttgN OF 111E FOLOWND
N�IIRWW. Y°DFPROU; EER,ON Ta.t,>II,
FORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SNOW ANY CONFLICTS BETWEEN
NO STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
ANOIORA(iE PECatE>wR pSTRItt. ALASKA AND IIMT
TURESORFENCELNES,
THE MWSE SIPRWEYENT3 SINATED THIiREDNARE
WONW THFPROPERTYT
8:N15O HEl:U1U. 01NLN INAN INOSE SNUWNON iNE HEOAB)EUFUI.AHE tiVl SI1UYYN NLNEUN
OTHER THANNOTED
ENCROAQREM9E%IST OTIER1wW NOTED.
D.TEMA .ANCNOMGE.AWNA 9_NTI(_
ANY FFWfiINFRII AIN ARF I IVATFO APPRO%IMATFI Y AND ARF MDT TO Be I ISFO TOf1FTFRMNF PROPFRTYINFR
;ATE STRUCTURES. I
HOLT LARD SUBVEYNG 10108. FB 47-15
I~; EW1W1 Y.Y BF 11PPR(11IY.TF N C T/1 IYYIW IYYIM11VYI4
-. ... .
� q I&SC�D'
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# b Ig -9 9-/, 30 HAA# 14Q211r
1. GENERAL INFORMATION
Complete legal description / Z N
NO)v—n- ria
Location (site address or directions)
23LL1, ScG Z2, Co f
a L��cA�+D� %rza� j��� �N-I�--
Property owner Day phone
Mailing address
Lending agency N Day phone AJ
Mailing address
Agent fJ %a
Day phone
//
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
F -ZZ
Individual well X
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES
X
DIVISION
Individual on-site
JUN 30 1997
Holding tank
Community on-site
RECEIVED
Public sewer
NOTE: It community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev.1/91) Front MOAM21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
6. DHHS SIGNATURE
Ales ca WaV;,. u
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
UITln
Phone 3^�
Date �20
4 CE -7953 zi
bedrooms, with the following stipulations:
Date 7 z 9 9 q
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 cou rtesy to pu rchasers 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-M(Rw.1/91) Back MOAM
Municipality of Anchorage MUNIcjpnLIryoF
DEPARTMENT OF HEALTH & HUMAN SER\'EC&MeNrA,seavicesofP4
Environmental Services Division
825 L Street, Room 502 • Anchorage, Alaska 99501 • (9071'*6197
Health Authority Approval Checklist RECEIVED-
Legal
ECEI 973
Legal Description: T12n1A ( S� z2J Parcel I.D.: E
�
(v'T 2c1J nJc>rL� f39,/
A. WELL DATA
Well type P V 7 If A, B, or C, attach ADEC letter. ADEC water system number �/,'
Log present (Y/N) NO Date completed Pt 2-iAq, 7TH
r Pry 3/15189 r n
Total depth %/d /�At Cased to 4 D Casing height (above ground) �� Z
Sanitary seal (Y/N) Y�� ' Wires properly protected (Y/N) Y
FROM I WELL LOG
Date of test � IA -
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
4 Nitrate N D
AT INSPECTION /
/2 /cid/7
56.5-1
Q -•V 6 g.p.m.
r—olL +-70 d" 10r v-rt:S. / �/ )-o 6'--tt'01J
D�,4-W pOWN -M -70' r o^�Pl r TE 2ElA
Other bacteria
Date of sample: f zls/�d Collected by:
B. SEPTIC/HOLDING TAN DATA N
Date installed ''b //3 14- Tank size Number of Compartments a Cleanouts (Y/N)--YJE-s
Foundation cleanout (Y/N) 'Yr -i Depression (YIN) NC) High water alarm (Y/N)L/�S
Date of Pumping QIP- Pumper
C. ABSORPTION FIELD DATA �
Date installed 4 // z gT- Soil rating (g.p.d./W or ft2/bdrm) System type —TV -0,J C44
Length r Width aZ Gravel thickness below pipe 6 • I Total depth
Effective absorption area Monitoring Tube present (Y/N)-Y— Depression over field (Y/N) N�
Bat adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorp i before test (in.); Immediately after_ gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION N
Date installed 6 �/3 �� Size in gallons
Manhole/Access (Y/N) "Pump on" level at* +I "Pump off" level at* 4 1 u
Q
High water alarm level at* *Datum
Cycles tested N
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
I
Septic/holding tank on lot
Absorption field on lot
Public sewer main
�J IA -
Sewer /septic service line +01.4-
On adjacent lots
> 100 /
On adjacent lots 7 too f
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
l�,
7
Q� r
Foundation I .F Property line 4-V, 4- Absorption field ;2 `V Nsw
f / r
Water main/service line 1 O Surface water/drainage X100 Wells on adjacent lots /OD
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line ;2 Building foundation / 3�1 t± Water main/service line
Surface water > IOD I Driveway, parking/vehicle storage area -�- I00
Curtain drain t4JUWr✓ Wells on adjacent lots fOD
F. ENGINEER'S CERTIFICATION
I certify that t have
in conformance wl
Signature
Engineer's Name
X , WOvrvUL r 4�6STF�
inspections and review of Municipal
,s in effect on this date.
Date h /at V/ H fi
HAA Fee
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section Ciro
P.O. Box 196650 Anchorage, Alaska 99519-6650
_ 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 015— 5Q_\ - "'So HAA # l n Q. IN
(hum
1. GENERAL INFORMATION
Complete legal description _T17- (23 Li)SSG, 7-2 Norc.,� 132
c9 i=' l�cJ-r 29.
Location (site address or directions) �j DO I F� + 1zoAA
i95/6
Propertyowner LoRAA Day phone 3`�—�7dg
Mailing address SPnn F_- PS. 490 vf—::-
Lending agency I`% k Day phone N ��-
Mailing address f'j Ip, -
Agent FyM,-Jr i a gV S�1 p y phone 34� /6SS
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
W�u�-9 L1ic� -r-o
3. TYPE OF WATER SUPPLY: gypv. GwSF o rJ
Individual well iz% 3v/96 • PL5�av�
!", A-C� F6/L-
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. -..TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site /� s
Holding tank
Community, on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025)Rev.1/91) Front MOAt21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verifythat 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.
Alaska Water &
Name of Firm Wastewater Ssvlces Phone 337-617
Address Anc , K 04
Engineer's signature Dafe Iz s7 y(,
— tvPil.l� INICLF�3 NFGr �� °U� (nl CoND�w,'7-'
No=n n)EvJ S�t�c tl� flP� •)P(E�P mm®0e®�8%
OF
CwS1r�Cs 4 AgD
VO Off' /. P�Ff ey A. Garness
6. DHHS SIGNATURE 6t���9 aY :7953 e •s
Approved for bedrooms. 6®®�ReFEss;o�P
Disapproved.
X Conditional approval for 3 bedrooms, with the following stipulations:
Money shall be put in escrow to construct a new wastewater system to serve
the home on this property pursuant to permit number SW960382. This shall
be accomplished by no later than June 15, 1997. Money put in escrow
.shall not be released until this office has given final approval.
Additional Comments
- By:
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificate`s based only upon the representations given in paragraph 5 above by an independent
professional eng i neer registered in the State of Alaska. The DH HS 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.
Date /z —31 - W
72-025(RV.1/91) Back MOAM -
Municipality of Anchorage
0* DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division dhrl5
825 L Street, Room 502 9 Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: N 13Zr Uolr 29) TIZN) Parcel I.D.- O/5 --(4Z—/3
23w� SEc z2
A. WELL DATA
Well type If A, B, or C, attach ADEC letter. ADEC water system number N
Log present (Y/N) N0 Date completed f Viae- TTS io�z6/72
!PE2- 3�" 19 r
Total depth 110 A" Cased to >4-0 Casing height (above ground) /
Sanitary seal (Y/N) Wires properly protected (Y/N)NQ Q.
C'r �
FROM WELL LOG AT INSPECTION G
Date of test NIA 127/96
Static water level
,O
Well production 9 -P.M.. a
m.
FZ4- 470 MlN `1920 6A towoo
WATER SAMPLE RESULTS: APavrop--w -no -7 - ^Qb'E RC�J—
•
Coliform Nitrate Other bacteria 9J
Date of sample: tZ�s� L Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed t0/2J72 Tanksize 17-50 Number of Compartments I Cleanouts (Y/N)—�—
Foundation cleanout (YIN) Na Depression (Y/N) High water alarm (Y/N) tA
Date of Pumping 14 7/16 Pumper �� "o^6 SF�vrcEs
ik SrJOw/ o,,J (�(1-oJ,JO
C. ABSORPTION FIELD DATA
Date installed SGI - Soil rating (g.p.d./ft2 or ft2/bdrm) %6 System type`s
r r /
Q Length 69 Width 31 To 5 Gravel thickness below pipe '° 1 Total depth Iq
Effective absorption area 502 Monitoring Tube present (Y/N) Y Depression over field (Y/N) �a
Date of adequacy test ly 14 9g Results (Pass/Fail) For 3 bedrooms
�n rr
Fluid depth in absorption field before test (in.); 3(o Immediately aftwr gal, water added (in.):
Fluid depth (ins) Minutes later: l Absorption.rate g.p.d.
Peroxide treatment (past 12 months) (Y/N) nroNC-- bQowo If yes, give date N�
72-026 (Rev. 3/96)* 4 G,•QII j o�j 6fwUrjv'
D. LIFT
Date installed
Manhole/Access (Y/N)
Size in gallons
High water alarm level at* *Datum _
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot �0
P� 1`I4F7
Absorption field on lot 1 Ai 4 til c7
"Pump off" level at*
i SOKt µ Ie.7'� e- 912. C,_�T ON (AT _�
On adjacent lots > ion' -ry seov�c `^ 04 "-r r"
No2T71'
> Ivu' PVT'
On adjacent lots > ISS C(oSS"O
Public sewer main N 1 Public sewer manhole/cleanout
Sewer /septic service line V N V_NO W rJ Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
/
T Foundation 51 As -3u "'r Property line � Absorption field 0a1Cruuw
N Water main/service line tot Surface water/drainage > too + Wells on adjacent lots > So / t°vT,
> go, rn CUAA 5 C
6- we u Nun,f -4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r r r 1 , Ices, rrSOJ
A PES 1988
�— Property line 2'0 /± Building foundation ps�8u"Water main/service line .'iO
Surface water a ioo * oppf�oSl E moos of
Driveway, parking/vehicle storage area (� Z PEX7�T-�f
Curtain drain NoNr= "'>wQ Wells on adjacent lots �tCJ 1? ��
F. ENGINEER'S CERTIFICATION �✓UDIJ ort 62oUND >r RFs+Ei rSOrJ
i certify that i have dete ine"yd,+�tyhhrt1dinspections and review of Municipal records tla 4}�e�abovea Aare
in conformance H�effect on this date. i0oL',^" °° orV 9D
AV
Signature
A
e®°°od•o. • s • °
Engineer's Name t `
Date 12/ a 7
HAA Fee $
Date of Payment l�
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
�RorFis�oe .:'°
Alaska Waiter & Wrist :waltzer
8471 Brookridge Drive — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
December 22, 1996
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
�Z
Subject: Conditional Health Authority Approval. T12N, R3W, Sec 22, North 132 feet of
Lot 29. Alexander and Laura Keenan Property. 11001 Totem Road.
To whom it may concern:
I inspected the well and septic system which serve the subject property, and found the well to be
adequate, but the septic system to be operating in a surcharged condition (technically failed).
Attached is a copy of the report which summarizes my findings. The property is currently being
sold, and the parties involved would like to get a conditional HAA, so that the transaction can
close now, and the septic system be upgraded next spring (prior to 6/15/97). Monies will be
escrowed ($15,000) to cover the engineering, and installation of the new septic tank, and
drainf►eld.
The septic system, although surcharged, appears to be functioning adequately for the current
homeowner. In order to minimize the potential for a back-up, we installed an alternator valve
and have diverted flow to the old trench (installed 1980). The newer trench (installed 1989) will
be rested and the flow diverted to it only if necessary. The old trench, which extends several feet
on to the lot immediately to the north, will be abandoned when the upgrade is completed in the
spring of 1997.
Because of the burial depth, it is not possible for the drainfields, or the tank, to overflow onto
the ground without first backing up into the basement. If a back-up occurs, the homeowner (the
buyer) would have the following options:
1. Switch the flow to the other trench, using the alternator valve
2. Use the septic tank as a holding tank until spring
3. Proceed immediately with the septic upgrade.
If there are basement floor drains, the buyer may want to plug them, so that in the unlikely event
there is a "back-up", it will first be noticed in a basement sink, tub, or toilet, and not on the floor.
Based upon the facts presented, it is my recommendation that the conditional HAA be issued. If
you have any questions, please contact me at (907) 337-6179, or on my digital pager at
1-800-481-1162. Thank you for your assistance.
Sincerely,
P.E., M.S.
Laura Keenan HAA Letter. wps
N4.0,4 ovpr
Alaska Water & Wastewater
8471 Brookridge Drive — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
r OF
� �
a
December 15, 1996 '�F
.y a•. oa, ao
t a®ee-e •=
Lorra Keenan
11001 Totem Road
Anchorage, Alaska 99516
ey A. Garners
CE -7953
F%'OFESSON�s
Subject: Well & Septic System Evaluation. T12N, R3W, Sec 22, North 132 feet of Lot 29.
Alexander and Laura Keenan Property. 11001 Totem Road.
Dear Ms. Keenan:
Per your request I performed an inspection of the subject well & septic system. My findings are
summarized as follows:
A. WELL TEST (12/7/96): I was unable to find a well log on file at the municipality, however,
according to M.O.A. records (3/15/89), it is 110 feet deep. On the day of my inspection the static
level was 56.5 feet below the top of the casing. Water was pumped from the well at a rate of 4.08
gpm for 470 minutes (1920 gallons). The water level dropped a total of 13.5 feet to
approximately 70 feet. At the end of the pumping period the recovery of the well was monitored
for 45 minutes. During that period the level in the well recovered completely (to 57 feet). Based
upon this data it was determined that the capacity of the well exceeds 4.08 gpm, which meets the
Municipal requirements for a 3 bedroom house (450 gallons per day).
As mentioned previously, there is no well log on file, consequently, it is not possible to determine
the total depth of the casing. Based upon my knowledge of other wells in the area, it is
reasonable to assume that it is cased to at least 40 feet, as required by the Municipality; however,
the only way to be certain would be to have it verified by a well driller. As required by code, the
casing extends greater than 12 inches above the ground, and has a sanitary seal.
B: SEPTIC TANK: The existing septic tank was installed in October of 1972. According to
the M.O.A records, it is 1250 gallons, has two compartments and is made of steel. It is only 51
feet from the well, however the separation distance required at that time was only 50 feet. Given
the tank age (24+ years), it is reasonable to assume that it is approaching the end of its useful life.
The homeowner should anticipate replacing it within the next several years. The tank was
pumped on 12/7/96 by A+ Home Services.
C: INSPECTION OF "NEWER" TRENCH SYSTEM (INSTALLED ON 3/11/89): This
drainfield is a shallow trench type system, 3.5 to 5 feet wide, 69 feet long, and has an effective
depth of 30 inches. On 12/6/96 I measured the water level in the monitoring tube and determined
it to be approximately 36 inches deep (there was standing water in the clean -outs). Based upon
this observation, it is clear that the system is surcharged, and technically failed. I then
recommended that we test the old trench system (installed 3/27/80).
D. PRESOAK OF "OLD" TRENCH SYSTEM (INSTALLED ON 3/27/80): The drainfield
is a deep trench type system, 3 feet wide, 87 feet long, and has an effective depth of 4 feet. The
sump was completely dry on 12/6/96, indicating that it has been inactive (probably since 1989
when the new trench was installed). Based upon the volume of the drainrock (87' X 3' X 4' =
1044 ft3), and an assumed porosity of 33%, the pore space in the drainrock should be
approximately 2600 gallons. Immediately prior to the presoak I had the 1250 gallon septic tank
pumped.
Water was introduced into the c/o at the beginning of the trench, at a rate of 4.08 gpm, for 470
minutes (1920 gallons). When I checked the liquid level I found that there was 12 inches standing
in the c/o and sump, and that water had backed up into the other trench, raising it's level 12
inches. In addition, the septic tank level rose from 16.5 inches to 27.25 inches. Clearly, the
porosity of the drainrock is significantly less that 2600 gallons!
Further investigation (shot elevations in pipes) revealed that the sump (old trench) did not extend
all the way to the bottom of the drainrock, but only appeared to go down to the drainpipe. I
recommended that an alternator valve and new monitoring tube be installed, after which the
system could be tested.
E. ADEQUACY TEST ON OLD TRENCH: Prior to starting the adequacy test on 12/14/96,
it was noted that the liquid level in the monitoring tube was 17 inches. Water was added into
trench c/o at a rate of 4.03 gpm for a total of 116.5 minutes (470 gallons). During the first 60
minutes (250 gallons approx.) the liquid level rose 30 inches in the monitoring tube. The water
level stabilized shortly thereafter at a total depth of 49 inches (could see standing water in c/o).
Throughout the rest of the test the liquid level remained unchanged (alternator valve would not
allow it to flow back to other trench). Twenty-five hours later the liquid level had dropped only
4.5 inches (to 44.5 inches), a very minimal recovery.
The test results generated more questions, than answers. Why did the liquid level rise so rapidly
(250 gallons caused a 30 inch rise!)? Perhaps the drainrock is not continuous throughout the
trench length, or the drainrock has a considerable quantity of fines in it (reducing pore space)??
Why did the liquid level rise so quickly, and then stabilize throughout the rest of the test (It did
not back-up into the tank, or the other field)? In short, without further investigation, it is not
possible to determine whether the subject trench is adequate or not. It may be helpful to install
one or two monitoring tubes along the trench to see if the liquid level in the drainrock is
consistent throughout the entire length.
F. SUMMARY: The well is adequate and the water quality is good. The options with the
septic system are as follows:
a. Install additional monitoring tubes in the old trench and do further testing, or
b. Jet clean and chemically try to regenerate the newer trench, or
c. Install a new septic system.
If you have any questions, please contact me at (907) 337-6179, or on my digital pager at
1-800-481-1162. Thank you for your business.
Owner/Consultant
Laura Keenan Initial Report. wps
l
-Ta BE ASa.+oO•J�
SPw atr 1y'�? 7 ,
� A
r
.F�3'%. J10• p
• � +Sunt
!• p�-r. VANE G1P \ .• I�S
X iE ✓IL
fir. •� �� � pdK c/P -
G��. y_e
I 6 C
-3/0 q
ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIA_TSS_ LAND SURVEYING 60
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE,
FOLLOWING DESCRIBED PROPERTY: �� 0 At 1%
CorZ9 f" zz �zti �.�t.� . .r '�4...... .. ►
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATP�y�f Sb�
INDICATED. IT IS THE RESPONSIBILITY OF THE r * A� rti v`
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID pf'"'
EASEMENTS, COVENANTS, OR RESTRICTIONS 21 a+ -
WHICH DO NOT APPEAR ON THE RECORDED SUSQI- j
. Puene Merk.5ewer6
VISION PIAT, UNDER NO CIRCUMSTANCES SHOULD F8' �y
ANY DATA.MEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING SOUND- DRAWN,
Igh�phssk>t+a�»�"��
ARY LINES. �lr�f ��*v►F
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR#r A.N C11G V!� PID# 015-521-30 HA# �(�°1lnC1SLf.X Permit
Date Received: June 30, 1997
Legal Description: T12N R3W Section 22 Lot 29 N132'
Engineer: Jeff Garness,P.E., Alaska Water & Wastewater
8471 Brookridge, Anchorage, Alaska 99504
Applicant: Alexander Keenan
Waiver Requested: Lot line waiver of 2 feet from the absorption trench to
the south property line.
Criteria: 1. Geology: Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
see Pnept 3 QIQ' V- (e'4er
3. Other:
Waiver is Granted: V Waiver is NOT Granted:
List Conditions or Reasons for above:
Date: 4"1 BY: __/_4
Name o
Rec #: 02790/0370 Amount: $ 115.00 Date Paid: June 30. 1997
Alaska Waltelr & Wastewater
8471 Brookridge Drive — Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
June 20, 1997
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
I
Subject: Septic System Lot Line Waiver for T12N, R3W, Sec 22, Lot 29, North 132 feet.
To whom it may concern:
During construction of the septic system upgrade for the subject property, it became clear (after
the lot lines were flagged by a land surveyor) that, in order to stay 12 feet from the existing
trench, and within a reasonable distance from the TH, it would be beneficial to move the trench as
far to the south as possible. DHHS was contacted (6/12/97, 8:50 AM) and verbal approval was
granted by Dan Roth to place the trench within 2 feet of the lot line. Attached is a copy of the
100 scale site plan that was submitted with the original design package. Upon looking at the
drawing, it can be seen that there are no existing wells or septic systeniwhich will be affected.
Furthermore, the encroachment does not appear to restrict the potential for future septic upgrades
on the adjoining properties. In short, I am unaware of any adverse impacts associated with this
waiver. It is my recommendation that the subject separation distance (absorption field to lot line)
be waived to 2 feet.
If you have any questions, please contact me at 337-6179, or on my digital pager at
1-800-481-1162. Thank you for your assistance.
Sincerely,
P.E., M.S.
Principal
O MUNICIPALITY OF ANCHORAGE AN
Department of Health &Human Services �ti�p�t
DIVISION OF ENVIRONMENTAL SERVICES RNFN
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
HAA# 1Ji+k"\ c)C�-1
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
J37-' �cT,rz ,- W e3wl SEL LZ
Location (address or directions).
//oal TTch
(b) Propertyo`Wn2 'a�«P :p>Telephone: (home) 37�'J/Business_
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
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:
AECS A162 yy
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms 3
3. WATER SUPPLY
Individual Wel 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 legality and status.
72-025 (Rev. 7/88) Page 1 of 2
Z to Z abed
NOVO WBIL "H) 960-ZL
laoM s.jeouibuo leuoissaloid aql ui
suoisslwoao sionalol alglsuodsaa lou sl a6eaogouyloL(liledpiunW egl'ponssl si eleopllaao eaaolaq elep azlleueao
suoiloadsui lonpuoolou oPSHHOIosaaloldw3 -sluawaiinbaa alels pus leaapal uielaao%lsilesolaapao ui suoilnlllsui
bulpual alagl pue sawoq to siesegoand of Aselinoo a se slgl saop SHHO aql T�seIy to alelS aql ui paaalsi69!
aaaul6uo leuolssaloid luepuedepui ue Aq anoge 9 gdea6ejed ui uan16 suolleluasaidaa agl uodn Aluo paseq paleoppeD
enoaddy /Iluoglny glleaH sonss! (SHH(l) saolAaaS uewnH pue glleaH to luewliedaO a6eaogouyloAl!IedlolunlN aql
lenoaddy leuolllpuoO to swiel
IeuollipuoO panoadduspanoaddy
•r'.�:1QFISS3aJi�
A1 � �foaer re
fl � r•
f et
a /-f/i,„ pi?
keit nee4D.�e 0e'e`��• o ,`{ 1
....fry c• °° T
s
;fib
Aq swooapaq - aol panoaddy
lVAOHddV SHHO '9
aleO
�✓17 , �F ' r4 2/ / ssaaPPV
ouogdo al wild to aweN
uoiloodsui sigl to elep aql uo loalla ui suollelnbei pus 'seoueulpao 'sepoo alelS
pue lediolunw Ile gllM eouelldwoo ui sl wals/s lesodsip aalumalseM ao/pue Aiddns aaleM alis-uo egl'uolloedsul
pue uollebilsanui (w woal pue salll a6ejogouy to AllledlolunW eql woal pauielgo uoilewaolui aql uo paseq
legl Al!jaA aaglanl I-ulaaaq peleolpul ainlonals to ad/�1 pue swoapaq to aagwnu eql aol alenbeps pue �euollounl
'ales sl walsAs lesodslp aaleMalseM ao/pue llddns AeleM ails-uo eqi legl sMogs lenoaddy Al!aoglnV glleaH
slgl to u01le61lsanul lw legl AllaaA l 'Molaq uMogs alep uo!lep!IeA aql to se pue olaJaq paxllle leas (w Aq paiplaao Sy
NOIIVWHOdNI ONV VIVO `H0HV3S 311:1 `S1S31 `SNOI1O3dSN1 ONIOIAOHd WHId ONIH33NIEM '9
., OF ANCNORp6E
MUN`CtPA�1 P� �100"'�IUNICIPALITY OF ANCHORAGE (MOA)
MEN Health Authority Approval (HAA)
ENVtROt� CHECKLIST - FEBRUARY 1984
R 1 343-4744 /
MP Legal Description:
A. WELL DATA
Well Classification If A, B, C, D.E.C. Approved (Y/N) ' _
Well Log Present (Yo Date Completed ali'mYield el S 6AA1
Total DepthP 61 Cased to � Depth of Grouting Nl_),
Static Water Level _57 Pump Set At
Casing Height Above Ground / / t Sanitary Seal on Casing (ON)
Electrical Wiring in ConduitON)
Depression Around Wellhead (yo
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 67 7 ; On Adjoining Lots /e -/—
To Nearest Edge of Absorption Field on Lot - ; On Adjoining Lots /07)
To Nearest Public Sewer Line /J L4 To Nearest Public Sewer Cleanout/Manhole 11J,4
To Nearest Sewer Service Line on Lot ZS
Water Sample Collected by 4ee_5 14` /��E� ; Date 3'
Water Sample Test Results B/�d T
Comments WEw `�
AkZ,1 /AI 4A1e14V_-
B. SEPTIC/HOLDING TANK DATA
Date Installed Size LUSO No. of Compartments
Standpipe (Y )
Depression over Tank (yo
Air -tight Cap (Y N)
Foundation Cleanout (Y No
Date Last Pumped j % 8 /SAlfGS
Pumping/Maintenance Contact on File (Y/N) %/ ; for ILI
Holding Tari jrm (Y/N) A�A Temporary Holding Tank Permit (Y/N) 4 A
To W+ZEpl:
q •a.,s
To Property L
To Water
To Streahj RP4
Comments
SEPTIC/HOLDING TANK:
aP
Course
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
Z_ ?_9 'TzJ 230 src ?-2-
C.
Z
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 3-11-6
Width of Field 3.5
Square Feet of Absortion Area
Depression over Field (YA
Results of Last Adequacy Test
165,
Type of System Design >Z41�01flrl-�
I ennth of Field (1c/ r
Depth of Field
Gravel Bed Thickness
y Statndpipes PresentON)
Date of Last Adequacy Test
SEPARATION DISTANCE I -ROM ABSORPTION FIELD:
To Water -Supply Well /0 / To Property Line Zo '
i
To Building Foundation 97 To Existing or Abandoned System on
Lot On Adjoining Lots
To Water Main/Service Line /o + To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course «� f
To Driveway, Parking Area, or Vehicle Storage Area /6 t
Comments
TSTATION
Date Insta d� Dimensions
Size in Gallons\ \ Manhole/Access (Y/N)
"Pump On" Level at `� "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for \� Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
Comments \_
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection. /�D
Signed �"'�` ` 1 --
Company �CS
Date 3-13 b'! 0`
MOA No �� f POVO
Receipt No. C;- 01 /U/ 6��� C /
Date of Payment '3 � /-
Amount: $ ,� r✓ - 0a
_
Receipt No. _
Waiver Fee: $
Date of Payment
72-026 (Rev. ]/88) Back Page 2 of 2
n the date of this
Seal