Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
HOMESTEAD HILLS #1 BLK 3 LT 9
.uv Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211337 PID Number: 015-173-31 Dwelling: 9 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name Ben & Carla Cuaresma ABSORPTION FIELD ❑i Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11401 Bearpaw St, Anchorage, AK 99516 ❑ Other Phone 907-301-6343 Number of Bedrooms 4 Soil Rating Total depth from original grade 0.8 GPD/SF 9.6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.6 Ft. Gravel depth beneath pipe 6.0 Ft. Subdivision Homestead Hills #1 Block Lot 3 9 Fill added above original grade 0.0 Ft. Gravel length 63 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 756 Ft2 1 N/A Ft. Well >100, >100' N/A N/A >25 TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ other Manufacturer Greer Capacity 1250 Gal. Surface Water >1 00' >100' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >10'1 >10' I N/A N/A STATION Manufacture Capacity Remarks Gal. Alarm location Electric ailed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield J R's Septic Drainfield D3034 Co/MT D3034 Inspector L Tidwell BENCH MARK (Assumed elevation) 100 ft Inspection 15' 9/23/21 9/23/21 Location and description 31d 9/25/21 2�d 4'h Bottom of Siding @ NE Corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ®Fl Conditional Approval: Date AwA . '' n'gcS��1� 49 j Septic Syste % �••• Benjam�tr Schiller •:� F� CE 12592 • Approve v►, Date `� �� �`� vw • 9/29/21 . •'�C�� FOPROFESSIONP tl�l�a Note: this approval does not include well permit requirements. .uv HOMESTEAD HILLS #1 SUB, BLOCK 3 LOT PERMIT # OSP211337 92.3 - eNciNeeaiHc PID # 015-173-31 95.9 FINISH/ORIGINAL GRADE NO GROUNDWATER 8/5/21 78.9 PROFILE AS -BUILT (NO SCALE) 92.3 �l .; �. .......... ' • • • • • Benja'n Schiller ' �'F •• CE 12592 •`moi �l��Jl�• snsrt, ��'�o jh`�PROfESSIONP� .d HOMESTEAD HILLS #1 SUB, BLOCK 3 LOT 9 PERMIT # OSP211337 EXISTING 66' LONG x 3' WIDE x 6.5' EFFECTIVE DEPTH TRENCH TO REMAIN IN PLACE FOR FUTURE USE w PID # 015-173-31 BIRCHBARK AVENUE 63' LONG x T WIDE x 6' EFFECTIVE DEPTH ABSORPTION TRENCH 0OTH#1 FD1 MTI SV1 2C0 01 MT MH1 1250 GALLON SEPTIC TANK CO2 W/ 20" MANWAY IrAA WELL RADIUS LOT 10 EXISTING WELL f LOT 9 \ 10'x20' T&E EASEMENT 42� I I ® LOT 8 I LOT 11 I � I NOTE: � I PLAN AS -BUILT 0 50 100 FEET 111=50' A B MH1 26.0 41.5 SV1 30.4 45.6 2C0 32.0 47.2 FD1 35.1 49.5 C01 27.4 31.0 MT1 28.1 31.6 CO2 79.0 67.2 MT2 78.6 66.7 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE 0 N 0 J N 00002'15" W 217.15' i i w W o (� W _! IN W x (n a E va n~z Q 1 It Lq ai co F 0 Z r 00 F W QW bo N -�-- 56.1'��'' W J N v •U3, rL W W W 0 :5i U) Q d U)� 0 m S (� _t - O.N 20 i9� NU cr- m 0) co d. Y_ �- I z 0 V w- �- I N + I z � / ,0£ 1 I _ w w I � I o M N 00006'19" W 217.38' 0 M w W o (� W _! IN W x (n = GJ CO LL • % / / It bo N 0 W M c I- W T- O v 00 O d. cM M 0 V 0 N 00 z C. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211337 Work Type: Septic Upgrade Tax Code Number: 01517331000 Site Legal Address: HOMESTEAD HILLS #1 BLK 3 LT 9 G:2636 Site Mailing Address: 11401 BEARPAW ST, Anchorage Owner: CUARESMA BEN P & CARLA L Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date f„t � n i DeI)arU1 ent Lot Size in Sq Ft Total Bedrooms: 8/12/2021 8/12/2022 41368 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: g / Z /Z_ 4 MUNICIPALITY F Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel 1. D. 015-173-31 Property owner(s) Ben & Carla Cuaresma Day phone 907-301-6343 Mailing address 11401 Bearpaw St, Anchorage, AK 99516 Sita aririrac-, 11401 Bearpaw St Legal description (Sub'd., Block & Lot) Homestead Hills #1 Sub, B3 L9 Legal description (Township, Range & Section) Lot Size 41,368 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑x Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑x Upgrade (D) El Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4-59-6, Date of Payment: $ 13 x021 Receipt Number: 005{ ( p Permit No. O5PZ 1 33% Permit App_:;- : . �. c Waiver Fees: Date of Payment: Receipt Number: Waiver No. August 11, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 8/11/21 Subject: Homestead Hills #1 B3 L9- 11401 Bearpaw St. Septic system design Dear On-Site Services Engineer: The owner of the above property intends to sell their home . However, the existing septic system has reached its end of useful life. We are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home, existing well, existing septic system, and proposed septic system. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water. The new absorption trench will maintain the minimum 13’ separation from the existing trench. Please refer to the attached test hole logs, septic plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211337, Deb Wockenfuss, 08/12/21 / / / / // // // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TH#1 HOMESTEAD HILLS #1 SUB, BLOCK 3 LOT 9 FEET 0 50 100 ≥13' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. BIRCHBARK AVENUE 4-BDRM HOME 8/10/2021BEARPAW STREET10'x20' T&E EASEMENT WELL RADIUS DECOMMISSION EXISTING TANK PER UPC 1250 GALLON SEPTIC TANK W/ 20" MANWAY 63' LONG x 3' WIDE x 6' EFFECTIVE DEPTH ABSORPTION TRENCH MAINTAIN MINIMUM 13' SEPARATION FROM EXISTING TRENCH EXISTING 66' LONG x 3' WIDE x 6.5' EFFECTIVE DEPTH TRENCH TO REMAIN IN PLACE FOR FUTURE USE. MT MT CO CO EXISTING WELL FD MH SV 410 415 420 420 425 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211337, Deb Wockenfuss, 08/12/21 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER3' 6" 6" 3'-6" 6' DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 10.2 MIN/IN APPLICATION RATE: 0.8 GPD/SF DEEP TRENCH SYSTEM 1250-GAL SEPTIC TANK W/ 20" MANWAY BOTTOM OF TRENCH: 10' BELOW GRADE FLOW LINE ELEVATION: 4' BELOW GRADE TOP OF TRENCH: 6" ABOVE GRADE 600 GPD / 0.8 GPD/SF / 6' EFF / 2 SIDES = 62.5 LF TRENCH REQUIRED ( 63 LF SPECIFIED) 8/10/2021 DRAINFIELD ROCK 4" PERFORATED PVC (HOLES DOWN) HOMESTEAD HILLS #1 SUB, BLOCK 3 LOT 9 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211337, Deb Wockenfuss, 08/12/21 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) L. Tidwell DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH?n/a 10.2 6 6 7 7/29 1 2 3 GM (SILTY SANDY GRAVEL) Professional Engineers Stamp: no none 8/05/21 Homestead Hills #1 SUB, Block 3 Lot 9 7/29/21 015-173-31 Ben & Carla Cauresma 11:531 2 3 0 - 3 4 16 12:25 12:55 OB 30 Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER8/10/2021 3 4 16 0 - 3 0 1630 3 0 16 0 - 2 15 1630 2 15 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211337, Deb Wockenfuss, 08/12/21 i — — — — ---- BIRCHBARKAVENUE — — — — — — — 0 m 0 M REBAR N 89057'45" E 190.54' SEPTIC STANDPIPES 30' SEPTIC CLEANOUT (3 Is, 0 f 9)• \�� Z f 2 STORY � Z O \ �0, FRAME . O j O DECK Oo o HOUSE w O O 0 � .� 6 • 6 � d 61.4' � � 06 'O. 19• c� 20• f N U) p' O 47.7" 6 '0, DECK � CJ7 LOT 10 C CP C 0� s PAVERS Lu N ASPHALT N m __j DRIVEWAY 5 Z� v CO �9L S�� / 02 F \ � 30' WELL LOT 9 41,368 sq. ft. 10' X 20' TELEPH. & ELECT. EASEMENT N 89°53'41" E 190.28' I I I LOT 8 OF *: 49 L * ; ..... .. ........ ...; p 20' 40' % • uku Sa ' �o �t % LS-14837 � ��i��4F ' • . 0On'1.. O r .. tttioFES 1�� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE AS-BUILT RECORDED SUBDIVISION PLAT (78-151) ARE NOT SHOWN HEREON.THIS DOCUMENT DOES NOT CONSTITUTE A I HEREBY CERTIFY THAT I HAVE SURVEYED THE BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES FOLLOWING DESCRIBED PROPERTY: THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA LOT 9, BLOCK 3, HOMESTEAD HILLS SUBDIVISION HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT BOUNDARIES. THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY WITHIN THE PROPERTY LINES AND NO VISIBLE PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE ENCROACHMENTS EXIST EXCEPTAS INDICATED. LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY DATED THIS 19th DAY OF JULY, 2021, ATANCHORAGE, TRANSACTION. RE-USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ALASKA. ADDITIONAL USES AT A LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES FIXED HEIGHT LLC COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. f C.O.A. 122554 Land Surveying Services 907.290.8949 JOB # 21135 NO CORNERS SET THIS DATE I SCALE 1" = 40' 225 W 23rd Ave., Anchorage, AK 99503 WWW. FIXEDHEIGHT COM 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 NA \ lPHONE ~NEW '°" LOCATION~. DISTANCE TO: ~ ~ ~'P~]well ~ ? ,~~WAbsorptiy~a, Dwelling~ , PER~NO'OF BED~S L'q' capat~. ~g~°ns IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~_~O Z 4 Manufacturer ~ Material Liquid capacity in gallons ~ DISTANCE TO: Well /dO' Foundation Neares?~li~e PERMIT N~O No.o,l,..sI Length of ~ne Total leng3o~in~ Tronch 5gh~ Distance be~y/~es ~ Total ~ mop of tile to finish grade ~, Material beneath tile 77 ,riches Length Width Depth PERMIT NO. ( N Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line e DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line ~eptic tank Absorption area(s) OTHER REMARKS I '1 ~/' t tv[ DEPF:IRTMENT O¢'%~E:-'FILTH RND EN6'I RONMENTRL P'"-']TIEC:T I ON F4F:PI... I CRNT DON LCE;FfT~ ON BERP. PRN THE REOUIF'.ED F:IZE OF 'THE SOIL RBSORPTION S'?S'TEM t%: THE LF,::NGTH f,) t MENS ! ON IS THE L, EN[]TH (tN F:EET) OF' THE TRENCH OR DRP]INFIEL[X THE DEPTH OF FI TRENCH OR PIT IS THE DIBTRNCE BETWEEN THE SURFSC;E OF THE GROUND RMD THE BOTTOM OF THE E','<CRVFtTION (IN FEET::,, THEF::E: I:E NO 2;ET WIDTH FOR TRENCHES, THE GI?.F:tVEL [~E'F'TH IS THE MINIMUM [:,EPTH OF QRFtVEL BETMEEN THE OUTFSLL PIPE RNf) THE BOTTf.}PI OF THE E?JCIgV~:]TION (IN FEET), PEF:HIT r~r:'PL, IC:F]NT Hr~S THE RESF'ONSZB:fL, ITS' TO INFORM THIS DEP~RTMENT DURINC~ THE INSTF:d.,LF'tTIO~.t :[N%PiEC'/!ONS OF RI'.IY WELLS flD..)'f~CEHT TO 'THIS PROPERTW RND THE hl[~i'~f)~EF;' OF RESIDENCES THFIT THE NELL NILL P!IN!I'.IUM DIS'Tf:~NC,:E BETNEEN F~ NELL. F~ND ~NY ON--.:SITE SEWFtE~E DISPOSF~L :~YSTEM :I. OE' FEET FOR Ft PRIVFC/E NELL. OR f1,58 TO ;208 FEET FROM fl PUBLIC 1.4ELL DEPENDING UPON THE TWPE OF PUBLIC NELL. MINIMUM [:,IfE;TRNCE FROM R PRIVATE NELL TO R PRIVRTE SEP.IER LINE "FO R COMMLINIT¥ SENER LINE I~: 75 FEET. t,4E[,,L LOGS RRE RE(;IUIRED FIND MUST BE RET[.tRFIED' TO THE DEPRRTMENT 14ITHIN 30 OF' THE NELL COMPLETION, OTHER REC~U!REMEN'f'S MR¥ RPPLY, :~[;:'ECZFICRTIONS AND CON:STRUCT~ON :J,: ! P,M Ft~MI[..If~R NITH THE FtEQUIREMENTS; FOR ON""SITE :~EI.4ER~; BNa' NELLS 8S ~;ET FORTtf BY TtiE MUNICiPF:iL,.ITY OF ~NCHORFiSE. 3; t UNDERSTI~f,,tD THAT THE ON-SITE SENER :g?STEM I"'lAb~ REIS]UIRE ENL. RROEMENT IF THE RE:;;I[:,ENCE IS REtflODELED TO iNCLUDE MORE 'I"H~N 4 BEDROOMS, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchm'age; Alaska 99602 276-2224 SOILS LOG-- PERCOLATION TEST [~SOI LS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:, 2 3 4 6 7 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: SLOPE , DATE PERFORMED: SITE PLAN WAS GROUND WATER' ,~) ENCOUNTERED? IF YES, AT WHAT DEPTH? P E Gross Net Depth to Net Readin9 Date · Time Time Water Drop I (minutes/inchJ PERCOLATION RATE TEST RUN BETW~ -- FT AND FT ./] ~/t *, I , DATE 72-008 t7/76) -er. Well Log Date completed.....~...~/..~.. ~D ................................................................................... .............. , MuNiCIPALITY OF ANCHORAGE Depth of well .... .~;.~..q.! ....................................... ~PT. oF ~^~Tt~ ~,, , m~/,(~.6 ~ ~.~q~-.,~:. ~o~O'~.~oN ........... Size of casing .................................................................... ~UL.2.~.i~.8.3. ........... Distance to water .......~.~ ................................................... ~[..C.,[,I..~.'.E,D ............ Distance to water while pumping ............ .~.]..k .................................... at rate of .............. !.%0. ........................ gallons per hour. Formation I from I\\O to ~H %5, \ t\~O DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 Well Date completed .... ~..~.[;..~.0 .................... ~ ............................................................. Dist~ce to water while pumping ........ of ......... %..~ .............................. gallons per hour. Formation from tqo to %\(5 DELTA DRILLING COMPANY SRA BOX 39A* B ANCHORAGE, ALASKA 99507 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. 015-17 3-31 1. GENERAL INFORMATION Expiration Date: I ` / ` 20 ZZ Complete legal description Homestead Hills #1, Block 3 Lot 9 Location (Site address) 11401 Bearpaw St Anchorage AK 99516 Current property owner(s) Mailing address Real estate agent Ben & Carla Cuaresma Day phone 907-301-6343 11401 Bearpaw St, Anchorage, AK 99516 Kea Cuaresma 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907-947-9784 4. TYPE OF WATER SUPPLY: , TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic Q 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 $ 2.T -D -fir) (g9 Date of Payment cl" S D -2-1 Receipt Number ©3 q 0 q 0 COSA # �� (' Z 11 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date ,4L``il '" • q i1 TH ......... 6. DSD SIGNATURE � .��,-��--`. System #1 Approved for bedrooms / Benjam'rv5chiller System #2 Approved for bedrooms �r��29VrFq., 92g%292,� Disapproved 1`l��\\� �-� Conditional approval for bedrooms, with the following stipulations: OFC(r���ii (jON � TER ANO Z o W AsTiw M Br.� � Original Certificate Date: l 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 COSA Checklist Legal Description: Homestead Hills #1, Block 3 Lot 9 Parcel ID: 015-173-31 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA W Well log is filed with Onsite (or attached) Date drilled 6/1/1980 Total depth 249 ft Cased to 249 ft 0 Sanitary seal is functioning correctly 9 Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 9/29/21 Static water level at beginning of test 223 ft. Comments B. TANK DATA Age of tank(s) <1 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank R Standpipes/foundation cleanout per record drawing Date of pumping NeW D. ABSORPTION FIELD DATA Which system tested (date installed) 9/25/21 PC ALL standpipes present per record drawing Total measured depth from grade 9.6 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field 0 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 NSA gallons Comments/Deficiencies: New Installation COSA Checklist yellow sheet Well production at time of test 1.7 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 3.15 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 7/15/21 IFT STATION ❑ Requir aintenance completed Age of lift station years Lift station material Comments: Adequacy test date sults ❑ Pass For bedrooms Fluid de rior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' ED Yes Community Sewer Manhole/Cleanout > 100' ft Q Yes if No ft M Yes if No ft Neighboring Tank > 100' F11 Yes if No ft Private Sewer/Septic Line > 25' ✓M Yes if No ft Absorption Field on Lot > 100' P- Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' 0 Animal Containment > 50' 0✓ Yes if No ft ft 0✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MYes 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 ft Surface Water > 100' M Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F-1 Yes if No ft Private Wells > 100' V Yes if No ft Water Main > 10'✓0 Yes if No ft _ Community Wells > 200' M Yes if No ft Water Service Line > 10' 0✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ED Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' U✓ Yes if No ft Water Service Line > 10' ✓l Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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 49 T H >� j Benjarrt rrySchiller CE /29/212 , •����� ����� pROFESSiONP�AW - 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) pro pe rty ow ne r t-15 ~{,~(~.c~u,4 ~_S ~-~-¢_ Day phone Mailing address . Lending agency ~",~ It%/~- Day phone Mailing address 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: 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 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 MOA #21 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. NameofFirm '"~'~q~-e~.,1 ~,Of~C~ ~ Phone Address ~0'~ ~ / ~- ~ ~ ~ ~. , ~ . Engineers signature ~ ~~~ Date / DHHS SIGNATURE Approved for .,/.~,r/.,~. (2/) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ..... Date The Municipality of Anchorage Department of Health and Human Services (DHH$) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHH$ does this as a ecu rtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type J~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number '/ Date comp,eted ~-- q ~/ Cased to ~. L~ q Casing height Wires properly protected (Y/N) -/ FROM WELL LOG g.p.m. AT INSPECTION MUNIOPAUTY C~F ~,NC. HO ~i~,,,?.ONMENTAL SEP, VK.~-S OIVISlON :,,~.~ 3 3 1993 g.p.m. RECEIV£D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main I'~//~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~/t~,/°e~ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /~- ~C~ Foundation cleanout (Y/N) Compartments ~/ ~ Depression (Y/N) ( Alarm tested (Y/N) J~//~-t-- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots t~ iA~sorption fie,d Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed '~,~ J~'/~' ~ Length ~ ~_~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/F¢) /~- ~ System type Width ~ Gravel thickness ¢ . L,"/ Total depth ~:~'¢7 ~cleanout present (TM) ""_/ Depression over field (Y/N) ~'~C~/~Z-''~ Results(pass/fail) ~ ~ for ~-~ ('7 ii After test ,Z//--~ ~ .If yes, give date /0 Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~ / ~ Property line To existing or abandoned system on lot Cutbank /"~ w .,P.._ Water main/service line Driveway, parking/vehicle storage area iO E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing address. Day phone Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well NOTE: "q 3~qz Day phone Community well Public water 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 /,4, Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 -'~/~,e~ ~~ ~- Phone Address ~,-0 ~ ~ DHHS SIGNATURE /~ Approved for Disapproved.' Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date 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 courtesy to purchasers of homes and their Fending 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. 72~25 (Rev. 1/91) Back MOA~21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LqlE,~'~ '~,.~¢.s~.~ ~[ll~ ParcelI.D. A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Y Date completed ~' /' ~C'C~ Driller ~' ~/~ Casedto ~'-l::~/C~ Casing height [~7 II Wires properly protected (Y/N) Date of test Static water level Well flow FROM WELL LOG Pump level ~e J¢~ ~44 SEPARATION DISTANCES FROM WELL TO: g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION -~ - Z o , ~ ~ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION 1, ,~ g. Plm:' 1992 RECEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout 1',///,,~ Petroleum tank WATER SAMPLE RESULTS: Coliform ¢ Nitrate Date of sample: I~[~ ~L~ I '~ ~).~ ~"-Otherbacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~/"/~ ~/~ ~ Cleanouts (Y/N) ~' High water alarm (Y/N) Date of pumping Tank size J ~)-,~' O Compartments Foundation cleanout (Y/N) /~/ Depression (Y/N) Alarm tested (Y/N) 2.,--L J~ ~j 2-- Pumper To property line ~> Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ?/0-O On adjacent lots Absorption field L~ 0 Foundation Water main/service line 72-026 (Rev. 7/91) Front :::( ' i ~;' /' '~ONTINUEiDON :BACK PAGE C. LIFT STATION ~¥///\ / ~,--~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~' Width Total absorption area ~ Depression over field (Y/N) /"/ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating /~'-~ System type Gravel thickness ~'. Y Total depth Cleanouts present (Y/N) Date of adequacy test .~'/~.o for ~/' If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot .~'/~-¢-~ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ) /o-~ Property line To existing or abandoned system on lot Cutbank /"¢',,/',~- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have cheoked, verified, or conformed to all MOA and HAA guidelines in e.[fect on the date of this inspection. Engineer's Name J Date HAA Fee $ Date of Payment ~-~' Receipt Number Waiver Fee: $ Date of Payment Receipt Number MU.,C,PAL' OF ANC. ORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal DescriptiOn (include lot, block, subdivision, section, towr~6hip, range) Location (address or directions) (b) Property Owner t~.~s~,,~ ~'.~o~. Telephone: Home Business Mailing Address (c) Lending lnstitution ~t1~¢- ¢..¢,~-,~.,~z Telephone Mailing Address '"~v~-0-~'¢ ~ Ol~~ 70 I (d) Real Estate Company and Agent ~ ~ ~¢~ . ~ L Address ~0~0 A ~ ~J~ 10 / Telephone ~(o ~- (e) Mail the HAA to the followin~ address: or; Check here~, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Numbei of Bedrooms WATER SUPPLY Well'S[/ Community [] Public [] Individual Note: If commfJnity/' well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note:/%rf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 fRev 8/861 Front Page 1 of 2 .5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and ~nspection, 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 7 ~ Address Date Telephone lq£7 DHHS APPROVAL Approved for Approved bedrooms by Disapproved Conditional Date '~- ?"~ '~':~ Terms of Conditional Approval CAUTION 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 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. Page 2 of 2 72-025 fRev 8/86) Back MUNICIPALITY OF ANC"HO~IICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 'At 2 ? 1987 WELL DATA RECEIVED Well Classification Well Log Present (Y/N) "'/ Total Depth ~ ~ '~ Cased to Static Water Level ~ '~ Casing Height Above Ground 1"7 ~ f Electrical Wiring in Conduit (Y/N) ~/ If A, B, C, D.E.C. Approved (Y/N) Date Completed ~" '/' ~"O Yield Depth of Grouting NO ~ ~ Pump Set At '~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ;Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size J~ ~ No. of Compartments ! ~ Standpipes (Y/N) ~)~,,1~:- Air-tight Caps (Y/N) Y Foundation Cleanout (Y,/N) , ,~//' Depression Tank (Y/N) ~'//~- ! ~7~7~' over Date Last Pumped Pumping/Maintenance Contract on File (Y/N) J~/~Z~ ;for Holding Tank High-Water Alarm (Y/N) J'~//,z~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line ~' ~ 0 Course To Building Foundation ~'~ To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA · Soils Rating in Absorption Date Installed Width of Field Square Feet of Absorption Area ! Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot I~ 0 I'",/~'- TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots TO Cutbank (if present) Comments D..,F SmAm, O. N Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have~checked~, verified, ..or conformed to all MO,~ and ~-IAA guidelines in effect on the date of this inspection. Signed '~'~ ~ Date / Company MOA No. Receipt No. //~20 / L"~(~ ~ / Date of Payment ff(.~ ~l~"~' Amount: $ /~O O~ Page 2 of 2 72-026 (11/84) Engineer's Seal (b) (c) ~ MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-StTE SEWER AND WATER FACILITY 264-4720 Application Date ~ IG GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name EI~.~ ;. ~ Applicant Address Telephone: Home .~¥& "' l/.~'~ Business Applicant is (check one): Lending Institution []; Owner/builder ~lt~; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family Other Number of Bedrooms ~'~ 3. WATER ~UPPLY Individual Well ~ Community [] Public [] /";t -' " Note: If community well system, must have written'confirmation from the State Department o~ ~nvironmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite]~(¢' Public [] Community [] Holding Tank Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN( ISPECTIONS, TESTS, FILE SEARCH, DA~, ~.ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspec~.~:.Name of Firm ~/, ~~,'~ Telephone Address J' ~0 ~ ~ r~eer's Seal DHEP APPROVAL Approved for ..~_-,~-~ (~/3 bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional 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) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) · CHECKLIST - FEBRUARY 1984 '~_IJNICIPA!.ITY OF ANCHORAG~ DEPT. OF HEALTH & J~NVIRONMEN?AL PROTECTION Well Classification Well Log Present (Y/N) Y Total Depth ~4~ / Cased to Static Water Level ,~"~/ Casing Height Above Ground //7 Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed ~/'~ ~ ,/~,.,~_,/~ Yield Depth of Grouting Pump Set At 'J ' 't,~5,--'/~,~,¢~ . . Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot :>.,/~'_"~ ¢ To Nearest Public Sewer Line ,/V/,z~ To Nearest Public Sewer C eanout/Manho e A,/'~ To Nearest Sewer Service Line on Lot Water Samp e Co ected by ,,~/~' ~,~'-~. ,/Y ; Date Water Sample Test Results Comments ¢t' ~'¢,~,~,,~,~ Y rv' B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Y (/) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) ,A~.,~ Holding Tank High-Water Alarm (Y/N) A/',/~,¢~-// ' ' Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ./~2(~ · To Water Main/Service Line Course Comments Size /25~0 ~ No. of Compartments ~ Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) y ~ Date Last Pumped ~'~'~'~t5 ~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation ~'?~' / To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,v~t/ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field ~ Depth of Field-"//___~ Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot //~/'/~t- / TO Water Main/Service Line ~/C~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Com merits To Property Line /~) To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Bequest ** I certify tha~, ~r confor med ~l~tltlrvl~.OA and HAA guidelines in effect on the date of this inspection. Signed [J. Date ~ 1'7, 1~ - / MOA No.~ ~J Company Date of Payment ~' ~ ~'~ ~ ~.. ~ Amount: $ G~O~ ~:4;?_~ ~" '~ .... ~ '~" ~/; Engineer's Seal ~t,~ · JUNE 25, Page 2 of 2 ~;:';;;-,. ...' 72-026 (11/84) '~ ~'~-%" · CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-391R SEPTIC SYSTEM ADEQUACY TEST LEGAL LOT 9, BLOCK 3, HOMESTEAD HILLS LOCATION: 11401 BEARPAW OWNER .. ELBERT SELPH RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1250 GAL.-~ ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 847 SQ. FT.~ SOIL RATING: 125 ~ INSTALLATION DATE: MAY 1980 DATE OF PUMPING: JUNE 30, 1986, ISAAC'S PUMPING DATE OF TEST: JULY 10, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 3.8 FEET OF COVER .AND WITH A LIQUID DEPTH OF 49 INCHES. CLEAN OU~O ~TRENC~WAS F~ND FIVE FEET DEEP AND DRY. SUMP WAS 8.25 FEET DEEP AND WITH 48 INCHES OF LIQUID. 210 GALLONS OF WATER WAS ADDED TO THE TENCH CLEAN OUT AT A CONSTANT RATE OF 1.5 GALLONS PER MINUTE. THIS CAUSED THE WATER LEVEL IN THE SUMP TO INCREASE 1.6 INCHES. THE INFILTRATION RATXE WAS MONITORED FOR 20 MINUTES. DURING THIS TIME THE LIQUID LEVEL IN THE SUM DECREASED 1 INCH. 7__0 GALLONS OF LIQUID WAS ABSORBED D_~URING THIS PER[Op.~ TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life 'of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- reme,.~...~-~'.t~e Municipality and State. ,~. k.~..' . .<~...;. ¢~,~_ · ~UN~ 25. 1971 .' APPLI '4;"°p~(t~' .Owner , ~ ~ ~ r' t~j Phone Buyer Address /~ ~/~ ) t-~:~ Zip Code Lending Institution /:-//? 5 7~ ~/~ ~O/~//J ~- ~,,~)~ ., ~/~/¢} ~ /~::?~ ~'~ ~'Z~ Phone Address ~ ~:/ ~ ,A~ , , '- ~ - ' Realty Co. & A~nt Phone Address ~ ~ /'~ ~ Zip Code Street Locati~ TYpe of Resi~nce ingte Family ult~plo ~ Other Water Supply cndividual ATTACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ommunity For wells drilled prior to that date. give well depth (attach log if available). ~ Public Utility Sewer Disposal pndividual Year Individual Install,ed: ublic Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time( Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICiPALiTY OF ANCHORAGE /../,,~, ~1 DEPT. OF HEALTH & ,~ ,~ ~,, . ENVIRONMENTAL PROTECTION J U L 1. 8 ' BECEIVED 4 APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ( ) DISAPPROVED ( ) CO N D I',t'l,O N~A/~ PI~VA L * Soils Rating Date Sewer Installed Well To Absorption Area //_-.~-~/' Well Log Received