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Home My WebLink AboutPARADISE VALLEY BLK 8 LT 17Onsite File Paradise Valley Block 8 Lot 17 #020-413-37 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211439 PID Number: 020-413-37 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name GAYLE KNEPPER & DONALD CASSAS ABSORPTION FIELD - NONE ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5931 ROMANIA DR., ANCHORAGE, AK 99516 ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot PARADISE VALLEY 8 17 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width 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 FtZ Ft. Well __ __ __ 100' 0_°, ° TANK [I Septic ElS.T.E.P. ® Holding El Other �J Manufacturer ANCHORAGE TANK Capacity 2 TANKS OF 1500 Gal. Surface Water -- -- -- 100'+ Material POLY -COATED STEEL Number of compartments 1 Lot Line -- __ -_ 5'+ NA Foundation -- 10'+ I LIFT STATION — HOLDING TANK Manufacturer Capacity Gal. Remarks Holes cut into baffles. Alarm set in 2"d tank. Tanks anchored - no groundwater observed at install. Alarm location LIVING ROOM Electrical installed by EXISTING Installer MIKE ANDERSON PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS & MNA BENCH MARK (Assumed elevation) 100 ft Inspection 1St 12/23/21 2nd 12/27/21 Location and description 3`d 12/27121 41h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL • Conditional Approval: Date .t'�� ' " " "' o " " " • Septic System Approved /�j� • r Curtis Huffman ,a0� �� %�� z� 13120.ZZ �%Date /��jF�• ��• CE128991,+ . 12/30/21 . • AMW �l FQ'°ROFESSIO�� ..� Note: this approval does not include well permit requirements. �� ESSO'�` kRCV uunjz/ 1 O) PID: 020-413-37 PERMIT: OSP211439 -�lz h � ) �A t A—C=58.9' B—C=35,9' A—D=63.2' B—D=42.9' A—E=66.2' B—E=50.1' A—F=72.2' B—F=62.0' 0. G PD�W A !o -A LOT 17 a� BLK 8 �� B 2'X5.5 FP CANT STAKED 100' WELL RADII & SURFACE WATER SETBACK PRIOR TO CONST. r Fa 1,500 -GALLON EPDXY-STEEL TANK D DCO SEPTIC SECTION SCALE: NTS / DECOMMISSIONED EXISTING HOLDING TANKS & INSTALLED 2 NEW 1500 -GAL POLY -COATED ! STEEL SEPTIC TANKS V WITH BAFFLES CUT. �OGj CO tx (*BM) 1,500 -GALLON EPDXY STEEL TANK W/ FLOAT ALARM 'rJ ,70 LOT 16 18' SQUARE HOLES CUT IN BAFFLES & TANKS ANCHORED. USED EXISTING HARING & ALARM. ALARM LOCATED IN LIVING ROMM CLOSET. T PARADISE VALLEY BLOCK 8, LOT 17 SUPPORT, SERVICES: - AV OF AZ PREPARED FOR: AV 4, ' GAYLE KNEPPER & DONALD CASSAS Af TH 5931 ROMANIA DRIVE FW-NCS �* 9 ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 12/30/21 I` rtis Huffman / SURVEY: JLS � CE 128991 `� 13030 SUES WAY DRAWN: FWCS 11 12/21/21G� ANCHORAGE, AK 99516 SCALE: 1" = 30' \ '°�ss>o1zAti 907-350-9566 FirstWaterAK®gmail.com �� F ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: PARADISE VALLEY SUBDIVISION LOT 17 BLOCK 8 PLAT 87-16 SURVEY CERTIFICATE: I, 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 should 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 detennine the existence of any easements, covenants, or restrictions which do not appear on. the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE.—MAIL DEC 29, 2021 1 "=30' schullerOok.net 21-142-2 DRAWN BY: CHECKED BY GRID NWASER: BOOK/PAGE: JLS SW3538 220111 �s ��s 0s oJqj 4/ kk Q = FND 5/8" REBAR. AW F NZ4� � U. AXV AV A. TH 0 AV , ..-LJ FA * #j FAP .............................. ° ••.JQH1V L. SCHULLER.� a / It LS -10408 i .,..ar.' °,. ' • , �� / 1831 'Talkeetna Street 6 'AW Anchorage, ,Alaska 99508 1 Ar oo ° fe Q� L ate. (907) 227 1455 ,office �'�', SSlO�,,''►~` {907) 274--4992 fax Jan 20, 2022 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Hold Tank Testing Legal: PARADISE VALLEY BLK 8 LT 17 To Whom it may concern: This is my report on the testing of the two steel holding tank s installed on the above referenced lot. Both tanks were filled by Around the Clock Pumping to test for leaks. After filling both tanks with more than 3000 gallons of waste, we waited to verify that they held. After a 30 minute test both tanks were pumped out and are now ready for normal operation, no leakage was observed. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 December 9, 2021 Municipality of Anchorage Development Services Division On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99507 Subject: Structural Analysis of 1500 Gallon, 10-Gauge, Holding Tank To: Whom It May Concern, An analysis was performed for a 1,500 gallon, 10-gauge, buried septic holding tank per my own design. This approval allows a maximum 4-ft burial depth with a 2-ft water table (4-ft of soil with 2-ft of water allowed over the top of the tank). The tank dimensions are 64-in diameter, 10-ft long, with one internal baffle. Slight compaction with a granular bedding material is assumed. The tank will be pressure tested in the field by filling the tank two feet above the tank/riser joint to verify the joint is water tight. Bentonite chips will also be placed around the joint to keep the tank watertight. Standard silicon sealant will also on all surfaces during assembly. The tank was analyzed using two approaches. These approaches were compared and the most conservative is used as a limit state. The first approach is based on research conducted by the Steel Tank Institute (STI) reported in a paper titled “Performance Testing of Underground Storage Tank Against Buckling” (attached with calculations). That research confirms a buried steel tank can be analyzed using the AWWA M11 simplified approach for buried pipe. This approach accounts for soil bridging action which tends to reduce force on the tank wall and also confines the tank wall to resist buckling. Maximum allowable loads were developed using the AWWA M11 criteria set forth in chapter 6 based on the STI paper recommendations. The second approach is a finite element model of the tank. The tank was modeled using finite elements with the SAP2000 analysis package to compare the results to the AWW A M11 approach. The model used thin shell elements matching the 10 gage wall thickness and the tank dimensions 64” diameter and 10’-0” long with an internal perforated (18”) baffle, see attached drawing. The baffle was included in the tank analysis. The loading and restraints used were derived from the AWWA M11 methodology. Soil loading was applied to the top quadrant of the tank assuming a heavy granular fill (130 pcf). Restraints were applied to the bottom quadrant of the tank. The restraint assumes a Winkler foundation model with soil springs equivalent to a granular bedding profile (100 pci modulus of subgrade reaction). The analysis assumes the tank is empty with no internal hydrostatic pressure to offset external soil pressure. The limiting load per AWWA M11 is based on buckling pressure and the limiting load from the finite element model is based on yield stress. The lesser of these two with appropriate factors of safety is considered the maximum allowable load. The maximum load per AWWA M11 is 670-psf and the actual load based on the burial depth with water table is 645-psf. The maximum allowable steel stress is 29.9-ksi and the maximum stress from the finite element model based on the 645-psf loading is 24.0-ksi. Each approach confirms the tank is adequate under the burial conditions set forth above. Attached are the calculations, analysis results, and reference materials. If there are any questions, please feel free to contact me. Sincerely, Michael N. Anderson, P.E. 4661 Natrona Street Anchorage, Alaska 99516 (907) 345-3377 DESIGNED:DRAWN:DATE:CHECKED:SHEET1500 GALLON STEEL SEPTIC HOLDING TANK Anchorage, Alaska 4661 NATRONA AVE ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 THE MUNICIPALITY OF ANCHORAGE1 MICHAEL N. ANDERSON, P.E. 1 Carroll, Rebecca M. From:Noffsinger, Ross D. Sent:Friday, December 10, 2021 2:23 PM To:Carroll, Rebecca M. Subject:FW: tank analysis Attachments:1500 Holding Tank Analysis Letter.pdf; HOLD TANK DESIGN.PDF Follow Up Flag:Follow up Flag Status:Flagged I spoke to Mike. He is requesting a one‐time approval for a specific project. I told him this is acceptable for that project. In order for the tank to get a general approval, Greer needs to demonstrate a water tight manway connection. Ross Noffsinger, PE Engineering Services Manager Development Services Department Municipality of Anchorage 343‐8309 From: Mike Anderson <mnanderson58@gmail.com> Sent: Friday, December 10, 2021 11:49 AM To: Carroll, Rebecca M. <rebecca.carroll@anchorageak.gov> Cc: 'Sam Arias' <sam@anchoragetank.com>; Noffsinger, Ross D. <ross.noffsinger@anchorageak.gov> Subject: RE: tank analysis [EXTERNAL EMAIL] Ross, See below for my comments and revisions… in red.. M From: Carroll, Rebecca M. [mailto:rebecca.carroll@anchorageak.gov] Sent: Friday, November 19, 2021 12:05 PM To: Mike Anderson Cc: 'Sam Arias'; Noffsinger, Ross D. Subject: RE: tank analysis Mike, We have the following comments: 1. Please provide details for the connection between the tank and manway riser and explain how it will be guaranteed that the connections are water‐tight. Bentonite chips will be added around the tank/riser joint and a water test (fill the tank 24” above the joint) will be done to verify joint is watertight. All of the tanks have bolts connecting the flange to the riser. Silicone glue is also used between all surfaces. 2. In your request letter, you describe the tank as having an internal baffle. Please clarify that the baffle has an 18” diameter hole in it and confirm/state that your structural calculations take the hole into account (or that the calculations assume no baffle). Baffle hole has been revised in both views of the tank, see dwgs. 2 Thank you, Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 From: Mike Anderson <mnanderson58@gmail.com> Sent: Wednesday, November 17, 2021 8:19 AM To: Noffsinger, Ross D. <ross.noffsinger@anchorageak.gov>; Carroll, Rebecca M. <rebecca.carroll@anchorageak.gov> Cc: 'Sam Arias' <sam@anchoragetank.com> Subject: tank analysis [EXTERNAL EMAIL] Ross, Becca, Attached is the 1500 gallon tank analysis for a holding tank installation…we have not modified the tank just checked to see if the baffle can be perforated for a hold tank application… Please call to discuss…Anch tank is aware of this work… M MUNICIPALITY OF ANCHOR -AGE On -Sita water & Wastewater Program P4 Baas 190050 4700 Elrnorr} Rmd Anchorage, AlasKs gMig-GGG9 flwrtie: (907 343-7904 Fara_ M7) 3 997 On -Site Wastewater Disposal System Permit Permit NurnW; O P 1143() Wank Type. SaptirTank Upgrade Tux Codc Nurnbcr; 02041837000 Site Legal Address, PARADISE VALLEY SIX 8 LT 17 G,3538 Site Mailing Address; 5931 ROMANIA DR, Anchorage Owner; KNIEPPER GAYLE DENISE & Dei i g n Eng ineer, FIRST WATE R CONSULTING Th 19 pe rrn 11 is fo r the constru clop of, Effective Date: Expiration nate: Lot Size In Sq Ft, Total Bedrooms, L L ct�;�i'trntn� 10119t2021 10119M22 21014 ❑ Disposal'Field ❑ Septic Tank Q Molding Tank ❑ RNvy ❑ Prlvat-e weir El Water Storage All construction shall be in accordance with, 1, The altached approved design. 2. All requlrernernks specified in Arron ga Muni -Opal Code Chapters 15.65 and 15,55 and the State of Alaska Wastewater Disposal Regulatlons (1$AAC72) and Drinking Water Regulatlons (18AAC80) 3. The wastewater a❑d$ re-quir$e inspoGtiona -during the installation. Thcr engine rr aall nofify tho Uev lGDpmcnt Services Department per AMC 15.65. Provide notification by calling (947) 343-7994 (24f7)_ 4_ From 00*ber 15 to April 15, a subSurFaoe snit :Nb.5erpWn system u rider construction du ring freezing weather shall be eithay. a_ Open ad and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing ReoeNed By; Issued By: 10/1912021 Date: Data, 3 !��/�1UHMPA-UTY OF '\ HCHO AGE r"► Vii; _L�'` Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-413-37 Property owner(s) GAYLE KNEPPER & DONALD CASSAS Day phone Mailing address 5931 ROMANIA DRIVE, ANCHORAGE, AK 99516 Site address 5931 ROMANIA DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) PARADISE VALLEY 138, L17 Legal description (Township, Range & Section) Lot Size 21014 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ❑ Upgrade 17 1 Duplex (D) ElRenewal Holding Tank 0 ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature or property owner or autnorizeci agent) Permit/Rush Fees: $2.Z 5 Waiver Fees: Date of Payment: /0 A I Date of Payment: Receipt Number: Receipt Number: Permit No. 05P Z l 1 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 11, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: HOLDING TANK UPGRADE PERMIT LEGAL: PARADISE VALLEY BLOCK 8, LOT 17 The owner has requested that we obtain a septic permit to upgrade the existing aged steel holding tanks on the above referenced lot. We propose to install two 1500-gallon HDPE tanks in series with an alarm to serve the existing 3-bedroom residence. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211439, Rebecca Carroll, 10/19/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211439, Rebecca Carroll, 10/19/21 DEPARTMENT OF HEALTH AND HUMAN SERVICES ' Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Fannie Mae ~.. ~"~'~--......~ T 0 SEPTIC HOLDING ~ddressrnum ~ TANK TANK WELL 3201 'C' Street, Suite 505 Phone(s)561_0828 Permit880230N°' N o.ool..;, Bedrooms WELL 100 ' 94~ LEGAL DESCRIPTION LDT LINE 24 ' 48¢ 15 Lot J Block Subdivision 17I 8 Parad4 ~ Vnl 1 ~y FOUNDATION 17i 28~ 34 Township, Range, Section - '~ ?~' N; '-'~ :' ~;" ~;' "'~' ~"~" ....... :?:~;4~.? ~-!~: %.-, :.r ~.~:. :;-.-¢, ........... dnveway," Water'':' ~bod,es, .......... etb.)' ' ..... ' ............ ~---t ..... TANKS U ~ SEPTIC ~ HOLDING ~anulacturer Capacity m gallocs Alaska Tank 3,000 Material No. ol Compadments Steel septic-2, holding-1 ~.~ ~TRENCH ~ BED ~ W. DRAIN ~ OTHER u~ ~th ~o p~pe bottom from 7oral depth from origina~ grade /~ onginal grade FT FT / FT FT~ Gravel length FT Gravel width FT / area Distance between lines / Total Sg FT FT - Pipe material/ / ' Numberol, .... Sollrabng ~ ~ ~, ~ g PRIVATE g OTHER (Identify).m~. Classdicat~on (A,B,C) Total Depth Cased to ~ .~ ~ ~ / individual 328 FT ~ ~f ;~. ~ ~ / Inslaltel Date Installed: ~ ~ / REMARKS: % '~ Holding Tank System consists of the ~ exlstin~ 1~000 qallon, 2-compartment I~spectioRs Pedormed by: ~ . ~[,.,~' (~-{~" ~.%...s~'A ~" '%".~ septic tank as well as a 2,000 qallon pa~: ~'-~ tank ' Nov; 30, Dec 1, 198~ steel holdin~ Municipal a~d Slate guidelines in eJlect a~ Ibis date: Health Depa.ment Approvak 4'__ --r ' --~ Ua'~: ~ 72 013 (3/85) L,o'L J,,,.egal: SLd:~d:i,v:i. sicH"l~ PARADIS[ii: VAL,,L,.EY Lot: 17 Sec t i on: I :1. 'J (:t~i"i sh i p: 1 i N Range: Lo'L Size 287~:~() (sq. J"L,, (::)i' att'es) ~"~;.'~;,{ Bedr'ooms:~ ]his Per, mit: :3 'f'o'Lal Capacity: Blocl-::: 8 .... -~..- v' '.. · :i. ze:; "' O()C) Cla].lof'H~, A h:i,c:lh water' a].aPm mLts'J:, be I'-!i;i !).i. NG t~-.,,11'..¢, .i.I ~ Il.un Tartl-:: S ,:::.~ .... '~ ::u~ I,:: .::; .~ ,: 0 ~' ee'L P {~ qL~ :J, 1" (,;,:,s ;i. r)~i~;L.( ]. ~'~., i c)i"'l (3v(~~ !" '~. ~tl'l k. :I:NSTAI..,L PER ENG:i:NEERS A'r'TP, C.:HE.D PI...ANS. F'ERMt'F ISSLJED F(3R "r'PIE LC X ]; ~;'t' ]: l'q~:.J J, i.,.,d:: ¢)ROOM S :1: NGLE FrAM Z L..Y RES I DENCE ON!..Y ~lqD E X F:' :t: RES ;1.2/:S:i./~8. PROVIDE SOILS LOG W!'t"H AS.,.,.BLIII./I". NO'f'~FY DF.IHS F:'RIIJR FEi ,ILN~:iF;'IEC"I"IEIN BY ENG]iNIEEI;:~. Tom Fink, May~r Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 5, 1988 Richard C. Button, P.E. Engineering Evaluation & Investigation Services, Inc. 200 West 34th, Box 267 Anchorage, Alaska 99503 Subject: Lot 17 BLock 8 Paradise Valley Waiver Request Waiver Request 9WR88-070, Permit #880230 Your request for waiver of the required 75 foot separation of a holding tank to surface water, Romania drainage, has been approved. The approved separation distance is 50 feet. This waiver approval applies to the new holding tank to be installed as per Permit #880230. Any future upgrade will require all separation distances be met or another approval from this department° Sincerely, Daniel J.'Roth Civil Engineer On-site Services DJR/ljw ENGINEERING EVALUATION & INVESTIGATION SERVICES, INC. MUNICIPALITY OF ANCHORAGE ENVIRONMEN~L SERVICES DIVISION November 18, 1988 RECEIVED Hr. Ban Roth Hunicipality o¢ Anchorage Department o¢ Health and Human Services Division o¢ Environmental Services 825 "L" Street Anchorage, Alaska 99501 Document No: Subject: 8277HC3o002 Romania Drive A/W/S, Lot 17, 81k 8, Paradise Valley Subdivision - Waiver o¢ Horizontal Bistance between septic tank/proposed holding tank and Romania Drive ditch stream Dear Hr, Roth: We are requesting that you review the attached site plan ¢or consideration in granting a horizontal distance waiver down to a 50-¢oot separation between the proposed holding tank installation on Lot 17 and the ADEC classi¢ied stream at the ditch line o¢ Romania Drive. The holding tank system shall be leak proo¢ and installed in con¢ormance to the Department o¢ Health and Human Services Wasteuater Disposal Regulations. The existing 1,000-gallon septic tank (installed new 11/84) will become part o¢ the holding system. We will veri~y the integrity o¢ the tank by exposing the top and side inlets and top manholes to ensure that all connections are leak proo¢. Calder type couplings and Ram Neck sealant will be used Cot any de¢iciencies. The addition o¢ the 2,000 gallon holding tank is proposed to be linked to the outCall end o¢ the septic tank by an 8-f'oot section o¢ PVC ASTH 3034, 200 West 34th, Box 267 o Anchorage, Alaska 99503 · (907) 274-7611 Dan Roth November 18, Page two 1988 you have any questions, please call. Sincepely, ENGINEERING EVALUATION AND INVESTIGATION SERVICES, INC, A1 an M. Harala Sta¢¢ Engineer' APPROVED: ichar~ C. Button, Principal AMH:lwh 8277HC3,002 attachment 200 West 34th, Box 267 · Anchorage, Alaska 99503 · (907) 274-7611 'ENGINEERING EVALUATION and , INVESTIGATION SERVICES 200 West 3a, th, #267 ANCHORAGE, ALASKA 99503 SCAt~ I/f~ October 10, 1988 Municipality o¢ Anchorage Department o¢ Health and Human Services Environmental Quality Services 825 "L" Street Anchorage, Alaska 99501 Attention: Onsite Environmental Services Document No: Subject: 8203PC.002 Romania Drive A/W/S Dear Sir: Our recent adequacy testing o¢ the on-site wasteuater disposal system existing on Lot 17, 8LK 8, Paradise Valley Subdivision Called due to high ground water and/or impervious soil conditions in the area. The only alternative we see is to resort to a holding tank system. This would require that a 2,000 gallon holding tank be placed in series with the existing 1,000 gallon septic tank to allow ¢ora 3,000 gallon capacity. We are requesting that your department issue a permit, pursuant to Chapter 15.65.090 o¢ the wastewater regulations, so that ~ork may commence on the project. Attached is an as-built of the property and proposed holding tank placement. Sincerel y~~ 8ruce D. Patterson, P.E. BDP:luh attachment ENGINEERING EVALUA1 mON & INVESTIGATION SERVICES, INC. October 6, ~988 Fannie Hoe 3201C Street, Suite 505 Anchorage, Alaska 99503 Attn: Document No: Subject: Nancy Gilbert 8203PC3.001 Romania Drive A/W/S Dear Ms. Gilbert: We ha'~'e per?ormed' an as-Built, a uell and. septic system as-built. on Lot 18, Block 8, Paradise Valley Subdivision. A copy of the as-built is attached. As you can see, the neighbor's (lot 16) ?ence encroaches onto Lot 17. The uell test proved satisfactory. The drain¢ield, houever, does not meet the Municipality of Anchorage requirements. When I visit'ed the site, the drain{ield uas {looded with the water level being.approximately 18 inches belou ground level. The house and drain~'ield are rated ?or three bedrooms. It is my understanding that at the present time, the house is occupied by only two people, (equivalent to 1 bedroom). When I performed the adequacy test, the water level rose to less than 1 ?oot below the ground surface. My' inspection ?ollowed a period of heavy rain. Although the drainfield will accept the_required amount o? uater to support a three bedroom house the drainfield does ~ot meet '']Municipal requirements because the uater level in the ?ie'ld is so high. The effluent does not flou down through the bottom o? the field. Instead, some of it flous horizontally through the' soil, just belou the ground surface. This situation exists with only two people using the system and would be much more severe if the house were occupied by the six people the system was designed for. The only alternative I see is to install a holding tank to hold the wastewater and periodic pumping. A three bedroom house will require 2000 gallons of storage, This wil.1 cost approximately $3,400.00. The existing I000 gallon septic tank can be used as part a? the holding tank. 200 West 34th, Box 267 · Anchorage, Alaska 99503 o (907) 274-7611 Romania Drive A/W/S October 6, 1988 Page 2 As per our conversation this morning, ue uill prepare application ~or a permit and solicit bids ~or a 2000 holding tank installed in series with the septic tank to 3000 gallons o? storage. I? you have questions, please call Allan at 274-7611. Sincerely, Bruce .D. Patterson, P.E. BDP/nb our gallon provide 200 West 34th, Box 267 · Anchorage, Alaska 99503 · (907) 274-7611 ! hereby certify that ! have surveyed the property described on this plat and the improvements situated lhereon are located as shoun on this plat, Dat,d _9_./_¢,_¢-'- ..... LEGEND Lot Corners Foundation 'Drainage Arrous NOTES , i. It shall be the responsibility of the builder or Donor to verify that building location shoun meets all subdivision covenants and zoning ordinances. 2o It is the responsibility of the builder to verify all elevations uith respect to all utilities & drainage. 3. This plat represents the parcel of property described belou taken Crom the recorded plat describing that parcel. Instruments recorded prior tn or after the filing oF the recorded plat are not shuun un this plat. 4.' 'The information on this plat' is far the use of lending institutions specifically to shou any conflicts betueen existing structures and platted lot lines dr easements, the plat is not to be used for positioning additional structures or fences, '-' ~EIS CONSULTING ENGINEERS,.'INC.; 200 West 34th,' Box 267 Anchorage, Alaska 99503 (907) 274-7611 Project ~ 61qO Date ~.~ '~'// WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either la~ lb or Ic.) A.D.L. No. ~'~l[Bordugh Subdivision flat BlockI I~.I I/4qtrs- Section No. TownshiPN0 Range EE~ Meridian Ic.JJDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3, OWNER OF WELL: WELL LOG Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Material Type Top Bottom ' ~' , ,~ ~' ,~ 8, CASING~ ~ Threaded ~ Welded diam. in. fo~ft. Depth Sfickup ~;'* ~ ft. 9. FINISH OF WELL: Backfilling Grovel pack I0, STATIC WATER LEVEL: ~Above or ~ Gelow land surface Date I~. PUMPING LEVEL below land surfooe and YIELD ~ ft. after hrs. pum~ng g.p.m. _. i~ ~~ I~.GROUTING We,' Grouted: ~ YeS ~ No -- ~AN~~ '- Material: ~Ne., Cement ~ Other: ~' h IS, PUMP: (if available) HP ~--- ~,~, ~--~( ~ Length of Drop ,~pe ft. copaclty g.p.m. 15. Woter Temperature ~ ~ F ~ C MUNICIPALITY OF ANCHORAGE Development Services Department `_ &}-r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-413-37 1. GENERAL INFORMATION Expiration Date: 0a 1 I I a N Complete legal description PARADISE VALLEY BLOCK 8, LOT 17 Location (site address) 5931 ROMANIA DRIVE, ANCHORAGE, AK 99516 Current property owner(s) GALE D. KNEPPER & DONALD B. CASSAS Day phone Mailing address Real estate agent 5931 ROMANIA DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic ❑ Water Storage ❑ Holding Tank Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment 12- 8 00,01 Receipt Number �� so 3 3 COSA# 03C a 11701 —re'�ssuJ 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/6/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS 6. DSD/SIGNATURE V System #1 Approved for System #2 Approved for Disapproved Conditional approval for S bedrooms bedrooms . ....•.* .. .. .... .......: Curtis Huffman F CE 128991 . •�`�� ,•0Z/06/2Q2s' \ � 1,PROF iF,ES�� SO bedrooms, with the following stipulations: WATER AND By:/ Original Certificate Date: 1 1 oda 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 is Septic System Advisory Arsenic Advisory Well Flow Advisory X Other COSA Checklist Legal Description: PARADISE VALLEY BLOCK 8, LO 17 Parcel ID: 020-413-37 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 11/8/1984 Total depth 328 ft Cased to 21 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/9/2021 Static water level at beginning of test 41 ft. Well production at time of test 0.67 gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 7.24 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 6/8/22 & 8/30/21 (ARSENIC) Comments B. TANK DATA Age of tank(s) NEW years Tank type/material HOLDING TANKS / STEEL Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade 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 gallons Adequacy test date Results Pass For bedrooms Fluid depth prior 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 Comments/Deficiencies:. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No *75+ ft Absorption Field on Lot > 100’ Yes if No NA ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No NA ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *SURVEYOR MEASURED 107’ TO CLOSEST VISIBLE LOT 18 STANDPIPE TO LOT 17 WELL. WELL IS 75-100’+ TO HOLDING TANKS ON LOT 18 & MET CODE AT TIME OF INSTALLATION. G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 7/6/22 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC211701 Subdivision: Paradise Valley, Block: 8, Lot: 17 A water sample revealed a nitrate concentration of 7.24 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a medi a with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Received Date/Time 06/09/2022 13:41 06/08/2022 15:20Collected Date/Time 1222894001 Matrix SGS Ref.# Client Sample ID Spigot Client Name Project Name/# Printed Date/Time 06/23/2022 13:14First Water Consulting Services (FWCS) Technical Director Stephen C. Ede 5931 Romania Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Waters Department (Provisional Cert for Nitrate-N) EBH06/15/22SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 7.24 0.200 (<10) A Microbiology Laboratory M.A06/09/22SM21 9223B100mLE. Coli Negative 1 B M.A06/09/22SM21 9223B100mLTotal Coliform Negative 1 B 2 of 5 Certificate of On -Site Systems Approval Parcel I.D. 020-413-37 Expiration Date: �T--� 1. GENERAL INFORMATION Complete legal description PARADISE VALLEY BLOCK 8, LOT 17 Location (site address) 5931 ROMANIA DRIVE, ANCHORAGE, AK 99516 Current property owner(s) GALE D. KNEPPER & DONALD B. CASSAS Day phone Mailing address Re�a estate agent 5931 ROMANIA DRIVE, ANCHORAGE AK 99516 fray phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic ❑ Water Storage ❑ Holding Tank Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 5 D Date of Payment 19 8 old Receipt Number 1�00 33 COSA # O S C ).117 01 Date: 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 12/6/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long function ®' •, Aw��': • - a system will satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & NES . e *. T1•I '. 6. �� • • • DSD/ SIGNATURE ' Curtis Huffman �$��`��s '✓ System #1 Approved for 3 bedrooms •- CE 128991 •.c��d � eF ' • .12/6/21 ''tib System #2 Approved for bedrooms ��F�'°ROFESSOW Disapproved _ Conditional approval for bedrooms, with the following stipulations: WATER AND BY Original Certificate Date: 3 as n o 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 cX Other COSA Checklist Legal Description: PARADISE VALLEY BLOCK 8, LO 17 Parcel ID: 020-413-37 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 11/8/1984 Total depth 328 ft Cased to 21 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/9/2021 Static water level at beginning of test 41 ft. Well production at time of test 0.67 gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.43 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 8/3021 Comments B. TANK DATA Age of tank(s) NEW years Tank type/material HOLDING TANKS / STEEL Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade 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 gallons Adequacy test date Results Pass For bedrooms Fluid depth prior 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 Comments/Deficiencies:. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No *75+ ft Absorption Field on Lot > 100’ Yes if No NA ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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 Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No NA ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *SURVEYOR MEASURED 107’ TO CLOSEST VISIBLE LOT 18 STANDPIPE TO LOT 17 WELL. WELL IS 75-100’+ TO HOLDING TANKS ON LOT 18 & MET CODE AT TIME OF INSTALLATION. G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 12/30/2021 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Well Water Advisory Certificate of On‐Site Systems Approval # OSC211701 Subdivision: Paradise Valley, Block: 8, Lot: 17 This well’s productivity was determined to be 0.67 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3‐bedroom residence is 0.31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~ALTH DEPARTMENT OF h~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~oh ~,~ Telephone - Home Business Applicants Address ~F31 ~e$~e~ /~r.J~o,-,~j~ Zq~'A~ ff~-O ~- (C) Applicant is (check one) Lending Institution ~--~ ; Owner/buildgr ~ Buyer ~; Other ~ (explain); ' (d) Lending Institution Telephone Address (e) Real Estate Coo & Agent Address Telephone (f) Mail the HAA to the .following address: 2. T~pe of Residence . Single-Family~ Multi-Family~ · Number of Bedrooms ~ Other (describe) 3. Water Supply- Individual Well ~ Community ~ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 Providing Inspections, Tests~ File Search~ Data and Information e 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 adeqnate 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 regula- tions in effect on the date of this inspection° Name of Firm Address Telephone Date (ENGINEER SEAL) · Approved for~'.~ bedrooms By : Disapproved Approved ' ~/~'~ Terms of C0~ditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY AiPPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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 ~ PROFESSIONAL ENGINEER'S WORK. RR4/ej/D18 [Page 2 of 2] (DHEP SEAL) 7'19-84 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE ~neral Information Application Date / / (a) Legal Description (include lot, block, subdivision, section, township, range) ! Location (address or directions) (b) Applicants Name ~c,~ ~c~ ~.~ Telephone - Home Business (c) Applicant.is (check one) Lending Institution ~ ; Owner/builder~ uyer[ ; Other[222(e×plain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following addreSs: 1~:~'.. z~:~ ~ .... :5~ ~:.--~:-'-->'"~' 2. ~ype of Residence Single-Family~ Number of Bedrooms 3o Water Supply Individual Well~"~ Multi-Family~ Other (describe) Community~--~ Public~ Note: If community well system, must have written confirmation from the State Departmen~ 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 Providing Inspections, Tests~ File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Telephone ,)"-z~l J-o ¥ o e Date ~ 5- /f-'~" ,',~ OF ;~, (ENGI~ER S~) DHEP Approval - Approved for /1I~ bedrooms By CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR A~ALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. RR4/~j/D18 [Page 2 of 2] (DHEP' SEAL ) ,,.; \t i 7-19-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification Well Log P~esent (Y/N) Total Depth 3 2 %~ ~- Cased Static Water Level ~ / Casing Height Above Ground Electrical Wiring in Conduit (Y/~ Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, c~ C, D,E.C. Approved(Y/N) Date C~,pleted {Vov ~ /~yw Yield ~pth of ~outing Sanit~ ~al on Casing ~ession ~ound ~l~ead (Y~ ; On Adjoining Lots ' fu TO Nearest Edge of Absorption Field on Lot /~f?.)~; On Adjoining Lots To Nearest Public Sewer Line tV/~ To Nearest Public Sewer Cleanout/Manhole 1%/~ To Nearest Sewer Service Line on Lot water Sample Collected By ~ ; Date .~/{/ ~ ~/~ Water S~e Tesf'hResults lDO +, f~0 + B o SEPTIC/HOLDING TA~K [i~TA Date Instal~e~:d~t.~ / ~l/g~ Size / O O_ 0 L NO. of Ccmpartments Standpipes ((Y~) ~ ~ Ai=-tight Caps (Y/~ Foun~tion Cleanout ~ession ~~ (Yd~ ~ ~te ~st P~d P~ing~intenan~ ~n~a~ ~ File (Y~) ~" ; for Holding Ta~ High-Water ~a~ (Y~) ~% ~r~ Holdi~ Ta~ ~r~t (Y~ ~p~ation Distan~s ~ ~ptic~lding Ta~: '~'~ TO ~te~-Supply ~11 /0 ~'/ To ~ilding F~ndation To ~o~rty Li~ ~ ~ I ~,/~ TO Dis~sal Field To ~ter ~i~rvi~ Lir~ /O~c" To S~e~, Pond, ~e, ~ ~jor ~aina~ ~ ~~ / Receipt ~ 2-15-84 C. ABSORPTION FIELD DATA Soils Ratin~ in Absorption Strata Date .Installed /l. Width of Field 30 Square Feet of Absorption A~ea Depression over Field (Y~ Results of Last Adequacy Test /5 %3 / ~'~ype of System Design Length of Field ~ ~ ~' Depth of Field /' ~ ~ Gravel Bed Thickness D%~/~/~/~.~3~ ~ StandpiDes P~esent d~N!z Date of Last Adequacy Test Separation Distano~ f~om Absc~ptio.q _F, ie%~ To Water-Supply Well To Building Foundation Lot A To Water Main/Service Line To Stream/Pond/Lake/c~ Majo~ D~ainage CoL~se /00 To D~iveway, Parkin~ A~ea, c~ Vehicle Stc~age A~ea To P~operty Line t Y ~ TO Existing or' Abandoned System cn ; On Adjoining Lots / ~7 ' ~)f'f~cA_,,~ -~'/..~ ~.%..~/t3~.~..~t - /O '-~ '~: TO ~t~(if pre~nt) ~ Comments Do LIFT STATION Date Installed /~.~ Size in Gallons ,/~ "PLaiD 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) ~ing Cycles ~ing Adequa~ ~st. Meets MOA ** Check Permitted Bedroc~ Rating Against HAA Request I ~rtify that I have checked, verified, c~ confom~ed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Company . KB1/d5/s ~__ [Page 2 of 2] 2-15-84