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Home My WebLink AboutT12N R3W SEC 33 LT 2248VDMI 1 IAll, I L Municipality of Anchorage JAN On -Site Water and Wastewater Program ° (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP1111176 PID Number: 018-332-10 Dwelling: 9 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ■❑ Upgrade Name: STEVE CONSTENTINO ABSORPTION FIELD Dee ❑ p Trench ❑Shallow Trench El Bed F-1 Mound Address ,� r t S40 Lv� v rf..c+i �Vv?L ❑ Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 4 0.8 GPD/SF 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft. Gravel depth beneath pipe 8.0 Ft. Subdivision Block Lot Fill added above original grade 1-2 Ft. Gravel length 48 Ft. Township Range Section T1 2N, R3W, SEC 33, LOT 224 Gravel width 2.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 768 Ft s 1.0 1 Ft. Well 100'+ 100'+ 100'+ 50'+ TANK X septiAl S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 11250 Gal. Surface Water 100'+ 100'+ 100'+ Material Number of compartments Lot Line 1 10'+ 10'+ 10'+ STEEL 2.0 NA Foundation 51+ 10'+ 10'+ LIFT STATION Manufacturer Capacity Curtain Drain UN UN UN ANCH TANK 500 Gal. Remarks Pump on level atTnP2 30 off level at in. High water alarm at 36 in. Pump make and model PF -20 Electrical Inspections performed by MOA Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield MIKE ANDERSON Drainfield 3034 CO/MT Inspector MIKE ANDERSON, P.E. BENCHMARK (Assumed elevation) 86.4 ft Inspectes: ttions� 12/14/12 12/5/12 Location and description 2M 3rd 4'h GARAGE SLAB COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ErtQioeer s S��amp Conditional Approval: Date`` r e �J eeo•se • o semo•o••oo „�� ° •f� e•e A°o gee ee•e eoa.eee .! P ee MICHAEL N. ANDERSCN 9 69 • ° . o • ccs f Approved Date i Ifo 1��FSa10'e inspection Keport_a-i-iz.aoc Permit No. OSP111176 Page 2 of 2 Municipality of Anchorage 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 Legal Description: T12N, R3W, SEC 33 LOT 224 PID No.: 018-332-10 MARK A 8 c 10 '-20-- CO2 --T� 19 TCO2 16 CO3 19 14 C04 MT1 21 55 1 r C_ -7— YS EM DECOMMISSIONED 500 GALLON STEP TANK #1 SERVE AKt A T1 T BENCH C_ 1250 GALLON STE 1 NK SEPTIC DRIVEWkY__ I --------------- ---- SEPTIC /EXISTING WELL ASBUILT SCALE: 1"=50' 1 -Col f -CO2 irTCO1 IC111 1111 I -CN rMM ja*&'"%ViTAjj 14144 r 7102 VH OF 114 2, 1�2 . .......... T- 1 21,ry 0 1W C '0 ORG 1W __') AV FILTER FABRIC AV 9 TH 4 ......... ..... a 1' 2.50 GALLON BOA jOO GALLON STEP OKI 0 .......... 00 S TEEL TANK STEEL TANK ........ ................... . - ' :;1-0�\ I. , / %A_*-.tA1CHAEL N. ANDERSON.'- 7"' #� 0 -. . 4�1 0, No. CE 9469 SEPTIC SECTIO 84..... . N.T.S. NO WATER 10-29-1 4Z till Soils Log - Percolation Test Performed For: Z� tcv t_') cov, Date Performed: Legal Description: Iq Vz$t"'j Township, Range, Section: Slope 1= 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS lao V 61-OV6% R WAS GROUND WATER ENCOUNTERED? fit Municipality of Anchorage , -k 34NEER,-8,sEA1L),, Development Services Department Z", On -Site Water and Wastewater Section 4 9 7 �ij 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 ju7w www.muni.org/onsite (907) 343-7904 h'dC!-W-zL N. AN"I'l-, CE - 9469 .7 Soils Log - Percolation Test Performed For: Z� tcv t_') cov, Date Performed: Legal Description: Iq Vz$t"'j Township, Range, Section: Slope 1= 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS lao V 61-OV6% R WAS GROUND WATER ENCOUNTERED? fit Gross Time Net Time IF YES, AT WHAT DEPTH? L Depth to Water After Monitoring? 0 P E Date: ju7w Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop & _Z7 tt PERCOLATION RATE (minuteslinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 157 FT PERFORMED BY: NILAL'� - I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: GR~CA~TER ANCHORAGE AREA BOROU,~-.H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~ O~¢~ ~'~' Ji~ LOCATION ~ ~) ~ ~"/-.~ ) ,'"/l ,~'uZ? ~'""'/~ SEPTIC TANK: MAILING PHONE DISTANCE FROM WELL //~"~J MATERIAL (~¢-~;~' C/~ LIQUID CAPACITY /~) C~) GALLONS. INSIDE LENGTH NUMBER OF COMPARTMENTS INSIDE WIDTH "~' LIQUID DEPTH~ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS /~ OUTSIDE DIAMETER OR WIDTH NEAREST LOT LINE ~O/ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAI , LENGTH , DEPTH BUILDING FOUNDATION . TILE DRAIN FIELD: DISTANCE FROM WELL , FOUNDATION , NEAREST LOT LINE TOTAL LENGTH ., OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH ABSORPTION AREA .SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILl IN. TOTAL EFFECTIVE IN. ABOVE TILE °,STANCE EROM WELL: TYP~ , DEPTH . BUILDING EOUNDATION NEAREST SEPTIC SEEPAGI~ LOT LINE , SEWER LINF . TANK . SYSTEM WATER SAMPLE , NEAREST OTHER · CESSPOOL . SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED r HEAL[H AUTHORH¥ GREATEL ' ANCHORAGE AREA ROUGH 31% HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT.,/7~¢,~,~ Y-- ~'~- ~'~.~/~.~ A/ MAILING ADDRESS~.z J:)-Y ,'~ RESIDENCE ADDRESS ../mc.~/.,.~.~?.,,.-) ~.~ LOCATION OF INSTALLATION LEGAL DESCRIPTION ~ ~ ~W ~'- ~ -~ '~/~ APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT_ , DRAIN FIELD TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~/.~.'~;"f' PERCOLATION TEST RESULTS TO BE INSTALLED BY ~D ¢',~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT PHONE N0..~//Y/:~D ,OTHER. THIS IS TO SERVE AS , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE TYPE SEEPAGE AREA DIAGRAM OF SYSTEM TYPE DISTANCES: Health Authority I certify that i am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATURE v//)/ GREATER ANCHORAGE; ARea BONoUGH 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 DISPOSAL SYSTE~ APPLICATIOH AHD PER~IT SEWAGE PERMIT NO. TYPE AND SIZE OF FACILITY TO ]BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS,./ SEPTIC TANK TO SEEPAge PiT WALL K/ ~ j WELLTO SEPTIC TA"K "~--~ ' s·efagE PIT WATER MAIN TO SEPTIC~N~ /~ ~ SEEPAGE PIT ~ITTED WITH AIRTIGHT REMOVABL· CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULAT]ONS REGARDING INSTALLATION. HEALTH AUTHOR]TYoR LICENSED DESIGNER TYPE I CERTIFY THAT I AM FAMILIAR WITH THE REQUIR·MENTS O~ GREAT·R ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-§8 AND THAT THE ABOVE GRE/L~LER ANCHORABE AREA 80ROUGH DEPAR ~NT OF ENVIRONMENTAL QUAL]' 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE #,. ~am_uescr]p:lon: LotZZ~Block ~n ~<~ ~ r')-l-'~ ~-~'~ .~erf~r~ed F~r~.b)~.~i~,~ ~' R~-~'~.~ . Date Performed ~o--z7-7/ ln~s ~orm Reports Soils Log~ Percolation Test Depth Feet Soil Characteristics m 3-- 7 Was Ground If Yes, At Water Encountered?~/~ What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop ) ute Proposed Installation: Seepage Pit Drain Field Depth Of Inlet Depth To Bottom Of Pit Or TreQCh Data C~rtified By: Date: i,~ovembe r 2, t',erber t O'Brien P, Ox 3272 ,ncnOrage, Alaska Section Thi~ Deoar~ment ~]as recr=~ived l;he results of a soil ~'-~.'. forl~!ed for you at ~ r~-~sults of tr is soil test an (~f a septic taJik and s~'te~age pit or drainf'[el~ is not feas~ ible on t)ls lot. If uater is to ~)e su?)))l'i()d to tJ)(~ cJ~(~lJinq a holding tank would h~ reout ~ - Ue at,emi, ted to coJ~act yo~l ~)ersonally on t;]is matter and uere u~]ablt~ ~:o do so. If you haw~ any J/or ~oSitat(: to cot~tact Si )cerely~ Carrol Sue ~'icKechnie E~v'~ronmental Control Officer s~ Ruses 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 1. D. 018-332-10 1. GENERAL INFORMATION Expiration Date: (J T Complete legal description T12N, R3W, SEC 33, LOT 224 Location (site address) 15401 LOC LOMAN LN, ANCH, AK Current property owner(s) Mailing address Real estate agent CONSTENTINO SAME 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone _ 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ED 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 $ 6 S 0 Date of Payment E1212--z— Receipt 1212-ZReceipt Number _QQ ZDr iS Waiver Fee $ Date of Payment Receipt Number COSA#_ Q.r.,- GZZ(755_ 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 MIKE N ANDERSON, P.E, phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 6_2_22 6. DSD/SIGNATURE ./ System #1 Approved for 4 - System #2 Approved for Disapproved Conditional approval for O i ij 0 - r •. owl • ` •149TH IF g bedrooms .... . . MICHAEL N. ANDLRSCIN • `'. ', bedrooms G% • CE '469 -f •l�w, ?'z; •'�,G bedrooms, with the following stipulat' �_ 1 r By: f � WATER AND SE` Original Certificate Date: �oa,� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet r. -,V c6J2C1 ©1 (� 1 n n i�9\�`n��'\�Y OF / 1 r By: f � WATER AND SE` Original Certificate Date: �oa,� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet • 1 • Legal Description: T12N, R3W, SEC 33, LOT 224 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UN Total depth *84 ft Cased to' --U N ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 5/13/22 Parcel ID: 018-332-10 Structure served by this system Well production at time of test 4.1+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes IN No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 5/13122 Static water level at beginning of test 65 ft. Comments * PER MOA RECORDS,"GREATER THAN 65' FROM THE STATIC LEVEL B. TANK DATA Age of tank(s) 2012 years Tank type/material s�PrsTE� Measured operating fluid level in septic tank 48" ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/13/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 12/14112 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.2 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet N C. LIFT STATION ❑ Required maintenance completed Age of lift station 2012 years Lift station material STEEL Comments: Adequacy test date 5/13/22 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 8 in Water added 600+ gal New depth 15 in Elapsed time 1440 min Final fluid depth 8 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 5 Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No _ ft ❑� Yes if No It Neighboring Tank > 100' ❑v Yes if No _ ft Private Sewer/Septic Line > 25' ❑✓ Yes if No _ ft Absorption Field on Lot > 100' ✓❑ Yes if No _ ft Holding Tank > 100' ❑✓ Yes if No _ ft Neighboring Absorption Fields > 100' if No _ ft Animal Containment > 50' ❑� Yes if No ft ❑✓ Yes if No ft ft _ comment below _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑� Yes if No _ ft ❑Q Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5 ft Surface Water > 100' ❑✓ Yes if No _ ft Property Line > 5' Q Yes if No _ ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No _ ft Private Wells > 100'✓❑ Yes if No _ ft Water Main > 10' Yes if No _ ft Community Wells > 200'✓❑ Yes if No _ ft 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 _ 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' Q Yes if No _ ft Community Wells > 200' Yes if No _ ft Surface Water > 100' Q Yes if No _ ft F. ENGINEER'S COMMENTS * UNDER OLD MOA CODE G. ENGINEER'S CERTIFICATION t 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. COSA Checklist yellow sheet t r i h~ �4mH ••• r, �I A •, MICHAEL N. ANDERSCN 1+ �l •• CE -9469 r� I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT Off';BLM LOT 2 24 T12N R3W See 33 S.M. AK SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shout( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE- SCALE; E-MAIL JUNE 12, 2022 1 =50' schuller0ok.net 22-054 DRAM BY, CHECKED BY: GRID NUMBER: 8301(/'fA-GE I JLS SW3135 220222 FND ALUMINUM MONUMENT FND 5/8" REBAR A I�Xxxl 'AW 0 F 4 Lslj)?V'�, A AW A � /••' 49TH -z � � � � , K �r ?...................... . ....... A CIO W. 1 A L.- I �........ ......................JHN L. SCHULLER: 0, LS-10408 Q1r"s C� AW V 40 AWW AM W 0 _4 "':W4 1.831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner Street Address ISV I L b C Na `nos( � Septic Tank: -Sludge level e inches -Pumping: required yes no -Pumping completedev s no Lift station: -Pump basket cleaned ves no -Effluent filter cleaned es no -Control floats cleaned es no -Proper float settings confirmed es no -Operation satisfactorya no Alarm System: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling 4g no -Alarm system operation satisfactory not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection Yes o -Ground water intrusion around pipe penetrations es no -Weep hole functional a no -Manhole lid: Functional (g no Insulated 6EL no Properly Secured (S no Other -All manufacturer required inspections and maintenance completed es no Comments: Qualified Maintenance Provider: Technician 1 Arm v 13� Company S(?_s'V !�5 Signature Date of maintenance L-Svm 22 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # '~"~l ^(~ J~,L[ ~ Location (site address or directions) 15401 Loc Loman Lane Anchorage, AK ~'",-" ' /~ ,"~ Jack ~ Erma Fay ,¢, Eroperty owner/- ~,~-Ma~)ln~laddress. P.O. Box 110491 ~ ~, .., . - ,¥, . ~, Lending agency :t" Mailing address_/ Anchorage, Day phone 345-1230 AK 99511 Day phone Agent - ' Address -. ~'~' Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Ho[ding tank Community on-site If community well system, provide written confirmation from State ADEC attest- ~ng to the legality and status of system. XXX Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA~¢21 = STATEI As certi investig and/or and typ~ the Mur supply ordinan Name c Addres Engine~ DHHS tENT OF INSPECTION BY ENGINEER. led by my seal affixed hereto and as of the validation date shown below, I verify that my ~tion of this Health Authority Approval appiication shows that the on-site water supply ~astewater disposal system is safe, functional and adequate for the number of bedrooms ~ of structure indicated herein. I further verify that based on the information obtained from icipality of Anchorage files and from my investigation and inspection, the on-site water ~nd/or wastewater disposal Sys(em is in compliance with all Municipal and State codes, :es, and regulations in effect on the date of this inspection. Firm S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eaale River. Alaska 99577 / ,¢ssignature , _. Phone Date SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the followin~ stipulations: Additio ~al Comments Th~ Munici Approval pr0f6~i0nal, and ti~elr len~ conduct insl responsible f 724)25 (Rev. 1/91) Date / 2 it,/of An~l~o~age Department of Health and Human Services (DHHS) issues Health Authority only upon the representations given in paragraph 5 above by an independent .~ DHHS does this as a courtesy to purchasers of homes ing ins{i~utions in order to satisfy certain federal and state requirements. Employees of DHHS do not ections or analyze data before a certificate is issued, The Municipality of Anchorage is not ~r errors or omissions in the professional engineer's work. .~ Legal Description: ~a~.Z Z 5// Municipality of Anchorage rL~V/[~'ON~. ,.,, DEPARTMENT OF HEALTH & HUMAN SERVlCE~ Environmental Services Division ' 825 L Street, Room 502 · Anchorage, Alaska 99501 Health Authority Approval Checklist A. WELL DATA Well type Log present (Y/~ ,,/u/C~ Total depth °~ ~7// Sanitary seal. N) If A, S, or C, attach ADEC letter. ADEC water system number Cased to Date of test Static water level FROM WELL LOG WATER SAMPLE RESULTS: Oasing height (above ground) Wires properly protected ~N) AT INSPECTION Coliform Nitrate Other bacteria Date of sample: Collected by: -~ / B. SEPTIC/HOLDINGTANK DATA Date installed ~-,Z o~ Tank Number of Compartments / Cleanout/c/(d~4) Depression (Y/~[~ .'~-~ High water alarm (Y/~/ Foundatio, n, clean0ut .(Y/~ ¢ .' ping .z~, ..~--,. Date .bf ~um ~ C. ABSOR~TION FIELD DATA Date, installed Z~-~ Le~th O~/:~ ': width? ~/'~ Gravel thickness below pipe.' ~/~Totaldepth EffectiVe absorption area:~ Date of adequacy test ¢-/~-~' Result~ /~ For ~ bedrooms Fluid depth in absorption field before test (in.); ~ ~ Immediately a~er~Z gal. water added (in.): ~ 7 Peroxide treatment (past 12 months) 72-026 (Rev. 3/96)* : Size in gallons .-- (Y/N) ~~R~._.~et'~t'r''-~ "Pump off" level at* level at* ...~-~*-~' *Datum~--'~-'-~'-~-~ ISTANCES STANCES FROM WELL ON LOT TO: nk on lot ./~ //' On adjacent lots /~0 Absorption field lot /~ /~ On adjacent lots /~ Public sewer ma ~- ~ · Public sewer manhole/cJeanout Sewer/septic set vice line ~ ~ / ~ Lift station /~ SEPARATION DI ~TANCES FRO~/HOLDING TANK ON LOT TO: Foundation ~/~ ~ ,~ ' Property line Absorption field Water main/sorvi line ~ '~ .SUVaco watoffdraina~o/~ ~ Wolls on adiacont lots Property line /~0 ~ Building foundation /~ ~ Water main/service line Sudace water _ ~ ¢ / (' ~4~,, ~4r,¢~4¢¢ Driveway, parking/vehicle storage area Curtain drain ~ ~ ~¢~ ~ Wells on adjacent lots /~ F, ENGINEER'S Cl!RTIFICATION I certi~ that I ha ~e determined thru field inspections and review of Municipal mcords~N~.~ in conformance vith MO~ H~ g~elines ~ effect on this date. X' ~ Engineers Nam~ ~,~¢ _ , ¢__ '0~¢~ '~"~ Date installed Manhole/Access High water alarn E. SEPABATION SEPARATION e~ ti~o[ding t8 HAA Fee $ Date of Payment L Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 09/19/96 11:41 CT&E ESI ANCHORAGE a 90?6941211 N0.279 CT&E Environmental Services Inc. Laboratory D;vi;ion 200 W. Potter Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax; (§07) 561-5301 CT&E Ref.# Client Name Project NamoJfl Client Sample ID Matrix Ordered By PWSID 96469.4001 S & S 13~gineering Lot 224 T.12N, R.3W SEC. 33 Lot 224 T. lgN, R.3W SBC. 33 Driuking Water 0 Svanple Remarks: Client PO# Printed Date/Time 09/19/96 09:,51 Collected DMe/Time 09/13/96 ~7:05 Received Date/Time 09/13/96 17:20 Technical Director: Stephen C. Ede Nitrate-N O,tOOU 0,100 mg/L SM 450OF Total cotlform 0 O coi/lOOmt $R18 9ZZ~B Method Limits bate ,, Date Init 09/17/96 ESC 09/17/96 TAV ENVIRONMENTAL FACJUTIES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS. MARYLAND. MICHIGAN, MISSOURi. NEW JI~RSE¥. OHIO, WEST vIRGINIA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~/~'g. ~ ~*'~,~14 ~4~// LEGAL DESCRIPTION: Township, Range, Section: 2 3 4 5- 6- 7- 8- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~ DEPTH? pO E Depth (o Water After D/~ y ,/o/.~/q (~ I'floniloring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE L/ (minutes/inch) PERC HOLE DIAMETER -- TEST RUN BETWEEN (~ '/;t- FT AND 7 'f~,. Fl COMMENTS 'i7034 Eagle River LOOp Read No. 204 '~'" ' ACCORDANCE W~'i~R~/'~'i~I~I~a~9~;~:>AL GUIDEUNES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: lO/lC, / ~:)(~ 2tG ~/M 22~ DORA AVE. 225A ~ 225B~ £LM .BLM 246 247 ACCEPTANCE OF DEDICATION BY THE G.A.A.B. OR CITY OF ANCHORAGE LEGEND TEMPORARY PUB[JC IMPROVEMENTS VARIANCE Z~LM 224 GLO or BLM BC monument existing. DOWL BC monument set this survey, VICINITY MAP MILE CERTIFICATE OF OWNERSHIP 8~ DEDICATION Subscribed amd sworn fo b~{~1 me this DTIO02382 PLAT APPROVAL Plat approved by the Borough Platting Board SEC. LOTS 225A ~Z25B,SEC. 33 CERTIFIGATE OF OWNERSHIP AND DEDICATION THEODORE K SADDLER JR LEGEND NOTARY'S ACKNOWLEDGEMENT NOTES DTI002383 Engh, eer or Su veyo CONTAINING 2.498 ACRES MORE OR LESS LOTS 215A,215B 8~ 215C SUBD)VISION OF ELM LOT LOCATED IN SE.I/:4~ ~EC. 33, T 12 N~ R3W~S.M.