HomeMy WebLinkAboutKNIK HEIGHTS BLK C LT 16Knik H ight lock C Lot :[6 ! 7-034 -34 O  Municipality of Anchorage ,¢~ Development Services Department ~~ Building Safety Division "~ ~ On-Site Water and Wastewater Program, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP iOiI]~ PID Number: 0i'~ -03~/- 3¥ Name: d%~ ~m~v Wastewater System: ~ New ~ Upgrade Address: ~¢ t'~ ~( ~ ~ ABSORPTION FIELD Phone: Number of Bedrooms: L~ ~'DeepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other: Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION 0.8 GPD/Ft2 j j Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: Township: Range: Section: Fill added above odginal grade: Gravel Length: Well: ~ ~- ~New ~ Upgrade Gravel width: ~, S Ft. Number of lines:i Distance baleen lines:,~ Ft. Classification (Private, ~ B, C): Total Depth: ; Cased to: Total absorption area: Pipe Matedah Driller: Date Drilled: Static Water Level: Installer: Date Installed; Yield: GPM Pump Set at: Ft. Casing Height Above Ground: ~. TANK SEPARATION DISTANCES ~Septic B Holding B S.T.E.P. B Other: T~ Septic Absorption Lift Holding )ub[iCPrivate Manufacturer: Capacity: Tank Field Station Tank Sewer Line A~O~C&*6 %~ Gal. i M terial: ~ Number of Compadments: ~ ~t ~, A, ~, &, LIFT STATION Lot Line S [+ j 0 :~ ~, A, ~¢, AI~ Size: Gal., Manufacture~ Cu.ain Drain ~ ~* ,~'~, ~.A. / ~ ~ Elect.~, Inspections peffo~ed by: Remarks; Lo~tion and Description: ' ' Engineer's Stamp Inspections performed by: La;5 ~Ouc~l,~ Dates: 1st 01,2J'¢~ I 2.~ Deve,opment Se.ices Depa ment Approva, ' Conditional Approval Date: I :~: ~%~~., Reviewed and approved by: /~, e: ~'2~'/O HUFFMAN RDAD StflNC, TIES C 25.8' ,58.3' D $$.6' 42.7' ~ ~ ~ E 36.2' 44.2'  G 37.9' 45.8' H 85.6' 68.$' I 84.4' 70.2' LENGTH 65 FEEl' ] / ~ -- -- ,lOTH 2.5 FEET -- TOTAL DEPTH 11 FEET ROCK DEPTH 8.2 FEET -- COYER 3.0 FEET NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC _~ ~ / .... ~ -~- DEPARTI~ENT DOCUMENTATION ALL LOCATIONS APPROXIMATE. ' ~. . . [. .. .. '. .~. ~, . . ,~. .~¥. ~.~. . , ~. ~ ..... m ~'. ,., -. No, £E-~1500 SPURKmNO ENmNEEmNC £0~' !#, B£OCE C ENIK I-IBI~E~'$ SEine S~S~E~ ~S~U~ ~0~ ,' ~ S~. ~ VENUE ~NON. ~. ~0~ ~00 HUFFWAN ~0~, ANCNONAG~ AK ~ BA~E: ~UGUS~ ~, ~0~0 (907) 279-a916 JAWES TRO~BLEY SHEET: I/a ~RID: 28a6 PERNIT ~ DSPIOH39 PfB ~ 017-034-34 KnikHei8h~CLlSB~ Standard french: 2.5' Vide 65' Long 11' Deep B,2' Sewer rock 3+' Cover NO SCALE Test Hole E.G. ELEV.=91.6' ELEK =89. 1' ELEK =80.6' /Monitor Cleanouts SiI ~: BarrierS, 3'Cover ~.~ _ . IIII B.~ P~ oF Septic Rock Effectivo J~50 gal septic tank B.O.H. ELEK=74.6' NO SCALE BENCH MARK SLIDING DOOR JAM ELEK =80. 6' SPURKLAND ENGINEERING II 203 W15th Ave Anchorage Ak 99501 ~79-~91~ KNIK HEIGHTS BLOCK C LOT 16 JAMES TROMBLEY 4400 HUF£WAN ROAD, ANCHORAGE, AK 99516 I ] SEPTIC SYSTEM ASBUILT DATE, AUGUST I$, 2010 SHEET~ J/$ GRID, SV£836 PERMIT ~ OSP I O I I Sg PARCEL ID tf 017-054-34 KNIKHEIGHTSBCL I 6D$.DWG On-Site Wastewater Disposal System Permit OSP101139 01703434000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: Tax Code Number: Work Type: Permit Effective Dates: August 10, 2010 to Design Engineer: SPURKLAND ENGINEERING Subdivision: KNIK HEIGHTS Upgrade August 10, 2011 Site Legal Address: KNIK HEIGHTS BLK C LT 16 G:2836 Owner/Address: TROMBLEY JAMES J 3499 FARRIOR DR NORTH POLE AK 997056811 Site Mailing Address: 4400 HUFFMAN RD, Anchorage Lot Size in Sq Ft: 43500 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: ~, ~'o ZolO Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-034-34 Property owner(s) James Trombley Mailing address 4400 Huffman Road, Anchorage, AK Site address Same Legal description (Sub'd., Block & Lot) Knik Heights Block C Lot 16 Legal description (Township, Range & Section) Lot Size Day phone 244-7237 Zip Code 99516 .Zip Code Sq. Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR ([~ all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Sin/gle Family Dwelling and is in accordance with applicable Municipal Codes. (Signature ~p~/operty owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev, 11/05) Waiver Fees: Date of Payment: Receipt Number: Environmental Consulting and Design SEPTIC SYSTEM DESIGN Knik Heights Block C Lot 16 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 July 30, 2010 Subject: Septic System Installation Permit 4400 Huffman Road Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system for the above referenced property. The proposed system will serve a 4-bedroom single-family residence. The existing system is over 32 years old and no longer meets COSA operational requirements. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No Groundwater observed to a depth of l 7feet below ground surface (7/30/2010) Soil Rating: From Testhole 7/20/2010 4.2 rain~in = 1.2 gal per sq.fi/day (TH#0 8. 3 rain~in = O. 8 gal per sq.ft/day (TH#2) 8.0 rain~in: 0.8 gal per sq.ft/day (TH#3) No. of Bedrooms 4 Required Area per Bedroom: 150/0.8 =187.5 sq.ft. Minimum area required: 187.5 x 4 = 750 sq.fi. System: We are proposing a 1250 gallon septic tank, and a deep trench absorption field. The absorption field will be 65 feet long and 2.5 feet wide with 8 feet (1040 sq.ft, effective) of sewer rock. Soils: Three test holes were excavated on July 20, 2010. See the attached soil logs. Silty soils were observed. Ground water was monitored for through July 30, 2010. Ground water was not observed. A percolation tests was conducted at the following depths: 1 foot, 3 feet, & 4 feet. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Environmental Consulting and Design I Surface Water: There are no surface waters within one hundred feet of the proposed septic system upgrade. Topography: The lot slopes to the west. The maximum slope approaches 10%. Waivers: No waivers required. The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Spurkland, P.E. Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net HUFFMAN R£AD N Lo-/; 1 ~Z I I I -~- ~,,~ I I Lo-I; 16 I. I II I Lot ~ :o~ 3- NOTE: THIS IS NOT A SURVEYED PLAT. P/ELL ~ SEPTIC LOCATIONS TAKEN FROM ON-SITE P/ATER AND P/ASTE P/ATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOP/N ARE APPROMt&4TE. 50 100 150 ~00 ~50 SCALE~ 1' = lOO FT, .... · ..... .._ :.-' ,~j~ ...,_.~,~ ~"~. 3o0 ~ .... '"~ .... ~ ~ II SE~r~ S~SrE~ ~ES~ II DATE: JULY 27, 2010 SPURKLAND ENGINEERING 205 I¢ 151'1-1. AVENUE ANCN. AK. 99501 (90Z) lLOr ~e, BLOCK C KNIK HZlGHT$ 4400 HUFFblAN ROAD, ANCHORAGE, AK 99516 JAMES TROklBLEY PERMIT # PID # ~7-034-34 HUFFMAN RflAB ~)- ~rell of: 16 LENGTH 65 FEET PIlDTH 2.5 FEET TOTAL DEPTH II FEET ROCK DEPTH 8 FEET COVER 3.0 FEET Lo? ]5 S S + Well NOTE: ~IIS IS NOT A SURVEYED PLAT. WELL ~ SEPTIC LOCATIONS TAI(EN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIYA TE. · 49~h LARS _ANI) 25 0 25 50 75 100 125 150 SCALE: 1' = 50 FT, II I SPURKLAND ENGINEERING 203 PI 15TH. AVENUE ANCH. AK. 99501 (907) 279-3916 I, OT 16, BLOCK C KNIK HEIGHTS 4400 HUFFMAN ROAD, ANCHORAGE, AK 99516 JAMES [ROklBLEY SEPTIC SYSTEM DESIGN DATE: JULY 27, 2010 SHEET: ~/3 GRID: 2836 PERMIT # PIB # 017-034-34 KnikHeightsBCL16B2 l'es! Hole Stondord Trench: 8,5' ~/ide 65' Lon9 H' JDeep 8' Sewer rock $' Cover --0 0 ND SCALE ND SCALE SPURKLAN9 ENGINEERING 803 ~15th Ave Anchorage Ak 99501 27g-~91~ KNIK HEIGHTS BLOCK C LOT 16 JAMES TROMBLEY 4400 HU~F~&4N ROAD, ANCHORAGE, AK 99516 SEPTIC SYSTEM DESIGN DATEI JULY $0, 2010 SHEETI 3/3 GRIDI $1~£836 PERMIT tit PARCEL ID tit Ol 7-034-34 KNIKHEIGHTSBCL 1603. DWG Performed For: Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoraqe,ak, us (907) 343-7904 Soils Log - Percolation Test James Trombley Knik Heights Block C Lot 16 ~' .:t~'. ..... '"' '~.~ ~ t~ -"' x,.~." A".,¢- u ." 9TH ~ ..Z~ .......... .~~,., .... ~.. ~ ,, .,..,-,. ...... Date Performed: July'~~-- Township, Range, Section: 81ope Sile Plan 7~ 8- 9- 10- 11- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS Pre Soaked WAS GROUNDWATER ENCOUNTERED? NO s iF YES. AT WHAT DEPTH? .......... L O Depth to Water After P Monitoring? i~,,-~ E Date: "~/~0 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE L~ '~::~ {minutes/inch) TEST RUN BETWEEN 1 FT AND PERC HOLE DIAMETER '~.. ft ! PERFORMED BY: Lars Spurkland I /'~ ,_~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEILINES IN E~FECT ON THIS DATE. DATE: 7/27/2010 Performed For: Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoraqe.ak.us (907) 343-7904 Soils Log - Percolation Test James Trombley Knik Heights Block C Lot 16 c .' '..-lz t '49TH : "." ~ ~ LARSE/SPURKLAND.!~,; Date Pedormed: July 20, 2010 Slope Township, Range, Section: Site Plan 1 2 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- ~o COMMENTS Pre Soaked WAS GROUND WATER ENCOUNTERED? NO s IF YES, AT WHAT DEPTH? .......... L O Depth to Water After Monitoring? E Date: Reading Date Gross Time Net Time Depth to Water Net Drop 7/20/2010 2:02 pm 0 min 9" 6.375" 7/20/2010 2:32 pm 30 min 9" :3. ~, 7-5 ~ 5.375" 7/20/2010 3:02 pm 60 min 9" ~., GZ.~~ 5.375" 7/20/2010 3:32 pm 90 min 7_, (~ ~,.~; ~' PERCOLATION RATE 8.3 (minutes/inch) TEST RUN BETWEEN 3 FT AND 4 PERC HOLE DIAMETER 6 FT /,.-- ,, PERFORMED BY: Lars Spurkland I /~,~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPALT. GU~-DI~LINES IN EFFECT ON THIS DATE DATE' 7/27/2010 Municipality of Anchorage ~ .~ ~ Development Services Department ~ '"' ~q-~.s.~..~.,~.~1~! //'____Y____"~ Building Safety Division l/ O~i~;~Ir ,']'"'~ ~\ On-Site Water and Wastewater Program \\~'-.~.f// P.O. Box 496650 Anohorage, AK ~ (907) 343-7904 Soils Log - Percolation Test Pedormed James Trombley For: Date Pedormed: Jul~ Legal Description: Knik Heights Block C Lot 16 Township, Range, Section: Slope Site Plan 2- 3- 4- 6- 7- 8- 9- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS Pre Soaked WAS GROUND WATER ENCOUNTERED? No s IF YES, AT WHAT DEPTH? .......... L O Depth to Water After P Monitoring? E Date: Reading Date Gross Time Net TimeDepth to Water Net Drop ':,--'."/~",, 'z,'~s ~,,.., '.~o ,,;,, i~ '/z." 3%/ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND 5 FT PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL~'I~I~EI~INES IN'~FFECT ON THIS DATE. DATE: 7/27/2010 AME ~-AI LI NG~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT TPHONE UPGRADE LEGAL DESCRIPTION L©CATION I Well -"' DISTANCE TO: I /OD I- ~ Ma~'u factu rer ~ I- Lie capacity in gallons I ,/.~._ ~'~) ~- HOMEMADE: DISTANCE TO: lWell Absorption area NO, OF BEDROOMS PEFIMIT NO. Well DISTANCE TO: /0(.~/ ~ No. of lines / Length of each line Top of tile to finish grade Length Width Type of crib Crib diameter Well DISTANCE TO: Class Depth DISTANCE TO: Building fouodation IDwelling Material~.~ Widt~ __ No. of c.~partments Inside length Liquid depth Dwelling PERMIT NO, Material Liquid capacity in gallons Foundation Nearest lot line PERMIT NO, "7 80 Distance between lines Total le~ngth o/f lines l'rench w~.~_ inches Material beneath the Depth Total effective absorption area '~"~RMIT NO, Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank PERMIT NO. A]sorpt on area(s) OTHER PIPE MATERIALS SOIL TEST RATING ~NSTALLER REMARKS /dc) +' , APPROVED DATE LEGAL 77-01.q [R~v 3/7RI £ ~ell yield tested by (pumpinR,~ air)at~ for bouts ~ith_ ~) lt. of dra~do~n from static level. DRILLER'S MATERIAL LOG Depth below land surface in leer Give description of strata penetrated (size of material, color, hardness of drilling, and water content MUNICIPALITY OF ANCI40:~/'f)2 ENVIRONMEN I'AL Pl~OI ECiI~,,~ RECEiVE. O 0[' lien]th :md 1.;Iwiponmentp' 'roteetion 2fi 16 I,~. Tuclor Anchopage, Alrtska 99507 276 2221 l~his form reports: Soils log ~el) th ~ee t 14- Was groum Iteadi ilg ~aLer encountered? ~ If yes, aL whaL ~,~' ~UN'rUIPALITY OF ANCHORAGE ........................................................... t - .,DEP~: -Op.H~ALTH-~ Date Gross [1me Her Time L ~~r._[ Net tJrop ' ...... :'_ .... 1 ......... ZZLz_I ....... 1 ....... ~o ...... 1 ....... ..~ ........ ~-~ ...... Zt ........... /IY.~ ............ /o ............. o~-/ ......... ~-.~ ............ ....... iL .............. !!~_~ .................... ~ ........................................ Municipality of Anchorage ® Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street ® P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite 0iS%A (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01-1- 039- 3q 1. GENEkAL'INFORMATION r Fes: COSA # ()-�'C 16112 V Expiration Date: --a 0 -- / � Complete legaWescription Kni k R6 i<a h4,,5 @k C W 16 Location (site address) ggQ0 Nt, fjmcin oeNA CDrrerit Property owner(s) Jaunt's lror, k 1P V Day phone Mailing address a; 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: q 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ 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-s(ie�water supplyµa d/o4astewater disposal system is(are) in compliance with all applicable Municipal and State codes, odmanbe ,,and regulations in effect at the time of installation. .,r. Name of Firm 30up-f 1CA Enciiiwerir�u Phone V7-3716 Address iti, 151' Ave. 2O2 Anchorage, A k Engineer's Printed Name LARS our�h.�ahc� _ Date 8/0/20/0 _ 5. DSD SIGNATURE Approved for bedrooms. Disapproved. ;.:':. .CARS 9 SPURKLAND. I'/� 11 Q' i Ol®fie S�pNP�4 t� Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory `aze • ON-SITE —WAT K ANN 1A STEWATER e FHKOGRAM ° Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 11105) M:1 Municipality of Anchorage *rIE . G • Development Services Department 4= Building Safety Division =T O"n-Site Water & Wastewater Program S A E T Y 4700 Elmore 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: kn,'k hlybty Qlk C Loi" )6 Parcel ID: 0ld-QM-3y A. WELL DATA Well type LAe' Date completed 45ti Rs Total depth 140 ft. If A, B, or C provide PWSID # = Sanitary seal (Y/N) Cased to NO ft. FROM WELL LOG Date of test 5 15I A Static water level b0 ft. Well production Jr g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate o % mg/L Arsenic: ug/L date of sample: i� j0 IU B. SEPTIC/HOLDING TANK DATA Tank Type/Material t n&DrOL O_ (ANa - 156A- Tank size 12.50 gal. Number of Compartments Well Log (Y/N) 1 Wires properly protected (Y/N) Y Casing height (above ground) �) z in. AT INSPECTION 3 ZOID y y ft. 5.d, g.p.m. Other bacteria -colonies/1100 mL Collected by: f' Qr5 S12urizlcwj Date installed 5512 Zoic) Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N, A , Date of pumping lVew Pumper C. ABSORPTION FIELD DATA Date installed Soil rating 022DOr ft2/bdrm) 0-3 System type 17eeD renc_k Length G5 ft. Width 2.,S ft. Gravel below pipe 6— ft. Total depth 11 ft. Eff. absorption area IDgo ft2 Monitoring tube 'Y Depression over field .A/ Date of adequacy test Ale al Results (Pass/Fail) — For — bedrooms Fluid depth in absorption field before test — in. Elapsed Time: -- min. Final fluid depth — in Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added ~—gal. New depth — in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at Z.in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuitre irements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100 Public sewer main Al'. A I On adjacent lots 10D + On adjacent lots ICC) t Public sewer manhole/cleanout /\/,A, Sewer /septic service line ZvS + Holding tank I% A I i� Animal containment areas 50+" Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: i i i Building foundation 5 +- Property line 5 + Absorption field 5+ Water main IV, A Water service line Pit Surface water 100 Wells on adjacent lots + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: t Property line 10 + Building foundation 101 �- Water main N, A , Water Service line IOF Surface water 1O0 t Driveway, parking/vehicle storage I" Curtain drain Wells on adjacent lots IDQ� + F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and ® 49T review of Municipal records that the above systems are in a ' conformance with MOA COSA guidelines in effect on this date. `:;. : :; .._ ' ' ' / �� �` • : Pt1RKLAND. Engineer's Printed Name G.ti -=`i 3i , AILS •..S��t• �L�4� f� � 1115 �F1Ai3� Date I '7-O 0 1� ��'V l is' COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 1 I 1 I I I I 1 I I I OI �I m m CD I m w Z) <LI `I M U— I Ln ° U— 01 00 =I r t 04 'At ,L `I ATHERTON ROAD zi r- W Q � S Q ♦- 7 U w ao wo wrow irz- Inmv�z � r- w r- t7w�r0- < m z } rn ui Ouyl cr w m wM O� Cl ty'- 0 �w U(9U ¢U¢' iJwsr«u Kms¢ 4 �.n -T >1W- v, UW r -U_ 1-YJ_i z=� <<0111 QI-xiIu C30M- U) W W j F- O I- lli HO O U Q n li. 7_� 111 r � z a C) �u o 00 O n T O �, 1= o� in - J ul w fY. o ¢ m U O 1- o- 30 a O � Z - m n c Oz O j Dn w }- 7 O ~ W S I 1 -W :ern o�s z 1-- Oz lu w b V U ti E; n navS s: z 0I LLI O T (➢ Ow NO CU uiR s WIwz � Lam` LLI j F- Z1- 0u5ti (9LY Z O C9? > w t<> Z—U 5 o< W LLI U D- T 61- I -¢Sm w z0¢ I1 : Tj w m m ZLn bjN Opo s� v1 Ea, o0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range)// (b) (c) Location (address or directio, o,o,o,~s) Applicant Name--C~z/~'---; .~¢.~!~.,4~,¢;'.z...,~-- ~__ Telephone: Hom~ .~a ~/ Business Applicant Address _ . Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other [] (explain); Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-E mily ~] 0 er Number of Bedrooms~ WATER SUPPLY Individual Well~ Community [] Public [] / Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAl. Onsite.~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 5. ENGINEERING FIRM PROVIDINL~ INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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 ins. pection, ' Name of Firr~--:'~'2"~/~'//l/-~' '~' /_~,~o-~:, _~'_~.,-~,c' .~ _._ Telephone ,-~"~'~'"/ ~ ~/ / ~ ~ ~- ~ .... ~ Address ~/~ ~_~/~.S / ~ ~ ~ , Date /~ - /~' ~ ~ ~ DHEP APPROVAL- Approved /./"' Disapproveo% Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 {11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Descriptio[~: ''~/'¢ / ~ Well Classification ~'/~///~¢ 2'''~ If A, B, C, D.E.C. Approved (Y/N) Total Depth ~/ / Ca' sad to ~ Depth of Grouting ~' Static Water Level ~¢~ / Casing Height Above Ground ~ ~' Electrical Wiring in ConduitS) ~ Separation Distances from Well: Pump Set At ./,.37/ Sanitary Seal on Casing(~) Depression Around Wellhead (~/~1~) To Septic/Holding Tank on Lot /~4) '-/-'-- ; On Adjoining Lots To Nearest Edge of Absorption Fieldon/Lot /-~¢~ '~ ; On Adjoining Lots To Nearest Public Sewer Line _ ~ To Nearest Public Sewer Cleanout/Manhole _ ~ ~ To NearesLSewer Service Line on Lot Water Sample Collected by _~ ~/ ~A~ ; Date /O -- Water Sample 'fast Results ~ ~'~ ~~ Comments ~¢ ~ ~/~ ~¢'~ ~%~ ~ ~'~ B. SEPTIC/HOLDING 'TANK DATA Date Installed "¢J~?~¢ '--~'~¢ Size /,~".~:~ No. of Compartments ~"'- StandpipeiC~l) >/t'¢~--% __ Air-tight Cap/¢ (Y~) ,/b'~.-~ Foundation Cleano~) Depression over Tank (Y/N) /~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N)"~ ;for. './~.~ , Holding Tank High-Water Alarm (Y/N) .~* Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well __ To Property Line / To Wat4~Main/Service Line ~,~ -/-- Co.rse To Building Foundation To Disposal Field ,,'/',~¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72~026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~J~ ,.~z¢' -- Width of Field -~;' // ~~,¢,;,¢-,/ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present~) Square Feet of Absorption Area ~'¢=~,~ / Depression over Field (Y~') -'f//-.'~.._ Date of Last Adequacy Test Resu,ts of 'Last Adequacy Test '* / Separation Distance from Absorption Field: ./ To Water-Supply Well To Building Foundation Lot /t'//~ '¢-" -'~ /'/? ~-~'z¢'/,¢-/¢/ To W.a.te~-.A4ain/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line -'-~¢ To Existing or Abandoned System on ; On Adjoining Lots /z~ To Cutbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Signed/ Compafl~ ~;~'"~¢--~"~'~ MOA No. Receipt No. ___ /~ ~/~ (D~"~ .> Date of Payment Amount: $ ** Check P~.'~ed Bedr~m. Rating.;, Against HAA Request ** I certify th (t I)~a,~,Ch, eck~/¢~fied, or conformed to all MO,5 and HAA guidelines in effect on the date of this inspection. Page 2 of 2 72-026 (11/84) Engineer's Seal : APPLI( NT FILLS OUT UPPER HAl ONLY Pro ~rly Owner , ~,~,,~, ,,j ~.j ~ ,, Phone .¢,i~f :">' 7 / Buyer /~//~ Zip Code Address L~nding Institution /~'~.- ~/~ /~ //'~L~ ('2;;.,,.-~;/,.. / ~JIc~ Address Zip Code Realty co. & Agent Address Zip Code Phone Phone Eega[ Description Street Locatioo Type of Residence ~ Single Family [] Multiple Family ~ Other No. ot Bedrooms /-/ Water Supply ,~ Individual [] Community ~ Public Utgily Sewer Disposal ~ Individual ~ Public Utility 6] Holding Tank ATTACH WELL LOG. A welt log is required for all wells drifted since June 1975. For wells drilled prior to that date, give weg depth (attach log if available). Year Individual Installed:__ ¢/'~ 7~J('~ When Connected to Public Ulility: NOTE: THE INSPECTION FEE ML)ST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Inspector ~rime Date Inspector Time Date Inspector Time Inspector PJeld Notes: ~rCIPALITY OF ANCHORAGE hEP[ Of tf/',L'i]i ¢ ENVIRON,'./,EN I Al_ FPLOTEC [ION N0V ii'];' : ( ) DISAPPROVED ) CQ, NDITIJ~AL APPROVA? ~ 'CONDITIONS OF APPROVAL Dale Sewer Installed Well To AbsorptiOn Area /"~ Well to '~ankY~'?/ /~ Well Log Deceived Septic Tm-~k Size Soils Rating