HomeMy WebLinkAboutPARADISE VALLEY BLK 8 LT 19Jul 14 22 12:33a Anchorage Well & Pump Ser
9072430742 p.1
r/
MUNICIPALITY OF ANCHORAGE?j
,`
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 020_41339
Date of Issue:
Legal Description
PARADISE VALLEY
Block
8
Lot
19
Property Owner Name & Address:
CROMER, CHRISTOPHER
5911 ROMANIA DRIVE
ANCHORAGE, AK 99516
Pump Installation Date: OE - 30 - 2022
300
Pump Intake Depth Below Top of Well Casing: feet
A.Y.MCDONALD
Pump Manufacturer's Name:
240100V2
Pump Model:
1.0
Pump Size: hp
15
Pitless Adapter Burial Depth: feet
MARTINSON
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
y
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection: PELLETS fir
Comments:
Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
Company: ANCHORAGE, AK 99518
907-243-0740
Mailing Address: -- -
City: State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221102 PID Number: 020-413-39
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
GAVIN L PETERSEON
ABSORPTION FIELD - NONE
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
5911 ROMANIA DR., ANCHORAGE, AK 99516
❑ Other
Phone7Number
of Bedrooms
Soil Rating
Total depth from original grade
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
PARADISE VALLEY 8 19
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
-
*78'+
25'+
TANK ❑ Septic ❑.S:T.E.P...M Holding ❑ Other
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'+
LIFT STATION — HOLDING TANK
Manufacturer
Capacity
Gal.
Remarks Holes cut into baffles. Alarm set in 2nd tank. No buoyance
issue observed at install. Decommissioned existing tanks / system.
Alarm location
LIVING ROOM
Electrical installed by
EXISTING
*Installed berm per permit / waiver **Surface flow.
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer JR$
Drainfield CO/MT 3034.
Inspector FWCS / FWC
BENCH MARK (Assumed elevation) 100 ft
Inspdection V1 5/18/2022 5/19/22
Location and description
2nd
3`d 4'"
TOP OF MANHOLE — FIRST RISER
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
OF At
Conditional Approval: Date
to
*: 497H ....�:*��/
..:
Curtis Huffman
pstem
Septic
Approved
�'�
�� ��c •. CE 128991
Date 5 Z7 ZZ
�� �'jlF�•. 5/20/22 . •����
lliFO
Note: this
PROFESSlONA�
4.+
approval does not include well permit requirements.
tKev uoiuznts/
PID: 020-413-39
LOT 20
VACANT
PERMIT: OSP221102
/ I /1-1
STAKE 100'
WELL RADII
& PL PRIOR TO
CONST.
NO WATER OR SURFACE N
WATER OR PRIVATE
WELLS OBSERVED IN
ALDERS ... .IN ADJ LOT OLD ST
AT CONST. ^OQ
0
TV DISH
DECOMMISSIONED
EXISTING SEPTIC
ADDED BERM TO
MAINTAIN 100'+ RUN
TO EXISTING WELLS & DOWNSLOPE
SURFACE WATER.
SURFACE WATERO�O,,
IN DITCHLINE
VERIFIED AT CONST.
MAY BE SEASONAL.
MOA AINAGE IMPROVEMENTS.
A—C=32,5'
B—C=24,1'
A—D=35.7'
B—D=27,1'
A—E=41.7'
B—E=34,7'
A—F=47,1'
B—F=41,3'
A—G=43.7'
B—G=42,7'
NO WATER OR SURFACE
N WATEROBSERVE IN
jsOs�3T.
� ALLAUTIL PEDESTALS....
0
Y
F SyFO ��SFM J JQ Off,
DCO MH DECOMMISSIONED EXIS FNT
MHHOLDING TANKS & INSTALLED W
1500 -GAL "AX" SEPTIC TANKS
E C WITH BAFFLES CUT AS NOTED
D WITH ALARM & NEW DECO & DC0*-
C�
MAINTAINED 78'+
HT TO WELLS
BM TOP OF
IST RISER - MH
EXISTING
HOUSE
MH
1,500 -GALLON
EPDXY-STEEL
TANK
PARADISE VALLEY BLOCK 8, LOT 19
PREPARED FOR:
GAVIN PETERSON
5911 ROMANIA DRIVE
ANCHORAGE, AK 99516
SEPTIC SECTION
SCALEi NTS
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 FirstWaterAK@gmail.com
LOT 2
UTIL PEDESTALS....
/APPROX. WELL LOC. L18
L18 STREAM ON E PL
1995 GEG COSA SHOWS
TWO 1000 -GAL HTs
30' FROM STREAM.
LOT 18
�urruK IStKVIc;tS:
C * 9 TH
DATE: 5/26/2022 0,
tis Huffman:
SURVEY: LCG
DRAWN: FWCS CE 128991
SCALE: V, = 30' 3�''�/27/22• AOG
A�FESSIOII�'1'
INSULATION
EPDXY STEEL
EPDXY
18" SOUARE HOLES CUT IN
TANK
BAFFLES VATH INSULATION.
W/ FLOAT
USED EXISTING WIRING &
ALARM
ALARM. ALARM LOCATED IN
LIVING ROOM CLOSET.
�urruK IStKVIc;tS:
C * 9 TH
DATE: 5/26/2022 0,
tis Huffman:
SURVEY: LCG
DRAWN: FWCS CE 128991
SCALE: V, = 30' 3�''�/27/22• AOG
A�FESSIOII�'1'
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Pro g ra m
PO BOX 196650 4700 Elmore Road
An&crage, Masks 9951-9-5550 Phone. (947) 343-7604 Fax; [90T) 343-7997
hdp-1 rwN.muni.-Dr&n!le - N
L�Ikll'[IEYtrLC
0n -Site Wastewater Disposal System Permit
Permit Number., OSP221102 Effactivi� Date, &I W2022
Work Type, epticTank Upgrade Expiration Date: Si10V2M
Tax Code Number. 02041339000
Sloe Legal ,address, PARADISrz VALLEY BLK & LT 19 G:3538
Site Mailing Address- 5911 ROMANIA DR, Anchorage
O wn-ar: PETERSON GAVIN L Lot 5izo in Sq Ft: 14498
Des Igrl Engineer: FIRST WATER CONSULTING Total Budroonis� 4
This permit is for the construction of -
Disposal Field Ll Septic Tank Q Hol -Jing Tank ❑ Privy ❑ Private WeIL ❑ Waler Storage
All construction shall be Mn accordance with,
1 _ The attached approved design,
2_ Alf requirements speciFied in Anchorage Municipal code Chapters 15,56 and 15-65 and the Stale of Alaska
Wastewater Di s posal Regu lations (I 8AAQ72) an d 13 rin kf ng Water Reguletlon!a (18A4CJBa)
3- The wnstewater code requl res inspecuons during the installation- The engineer shalt notify the Development
5ervioes Depadment per AMC 15,$6, Provide notification by Calling (90 7) 343-7004 (2417)-
4, f=rom October 15 to April 15, a subsurface sDil nbscrption syslem ander construction during fmve2 ing weather
sharl be either_
a. Opened and Closed on the same days ar
h. Covered, sealed, and hseted to prevent freezing
Received Ey:
Issued Ey,
5} 10122
Date:
Date:
r
"tent
Municipality of Anchorage �..:r
S
�N
P.O. Box 196650 • 4700 Elmore Road
_Anchorage, Alaska 99519-6650 ® (907) 343-7904 s Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Proqram
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV221028 COSA#: Permit#:OSP221102
PID#: 020-413-39
Legal Description: PARADISE VALLEY BILK 8 LT 19
Engineer: First Water Consulting
Your request for a waiver of the required 100 feet horizontal separation from the holding tank to
the private well has been approved. The approved separation distance is 78 feet. This waiver is
for the wells on Lot 18 and 19.
This waiver approval. applies to. the proposed holding tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
■ a 0 N N E 0 ..... t .. ■ Y ...... 0 N N N 0 E ................. K .................. 0 a 0 N E 0 ..... ■ 1
Waiver is Granted: X
Waiver is not Granted:
Date: S/D Z2— Approved by: LaLIIL��
Name of Reviewe
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
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. 020-413-39
Property owner(s) GAVIN L. PETERSON Day phone
Mailing address 5911 ROMANIA DRIVE, ANCHORAGE, AK 99516
Site address 5911 ROMANIA DRIVE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) PARADISE VALLEY BLOCK 8, LOT 19
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms �{
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank
❑
Upgrade Q
Duplex (D) ❑
Holding Tank
Q
Renewal ❑
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: - 2.2 5 Waiver Fees: '� //SD
Date of Payment: t(-ZC/ - 2 Z Date of Payment:
Receipt Number: _(%Z3 Receipt Number:
Permit No. Waiver No. 05 I/ 7 2-147 G
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
April 28, 2022
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: PARADISE VALLEY BLOCK 8, LOT 19
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 epoxy coated 10-gauge Advantex
tanks with 18 holes cut in the baffles in series with an alarm to serve the existing 4-bedroom residence.
Per MOA record documents of site that has a COSA with these holding tanks and other adjacent sites that
have either have no permit or has holding tanks within 30 of a stream eastward, testholes performed
previously of adjacent lots that show impermeable insitu material with groundwater present.
We have designed and the MOA has permitted a couple of these holding tanks within the past 6 months
and after the MOA tank reversal specifications. It is our understanding after several discussions with
Mike N Anderson that he has done the calculations on the Greer tanks and is in consultation with
Anchorage Tank, Ross Noffsinger, PE, Becca Carroll and other MOA structural employees, etc and
these septic and holding tanks have been tested and are to be approved with more allowable specifications
for the on-site industry. If necessary and per MOA code, the client will request the required waivers to
well and surface water for this existing system.
The existing holding tanks have had no known buoyancy issues for 30+ years. If at construction it
appears there is any possibility of groundwater, each tank will be anchored with 2 3800-pound concrete
blocks, which with tank and a minimum of 2 of soil cover will be 1.5 times greater than the buoyancy
force assuming groundwater at grade. Also and regardless of groundwater observed, indicated or not all
connections, including the connection between the tank and manway riser will be bentonited and prior to
final backfill the tanks filled and observed for leaks to confirm water-tight connections. 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
OSP221102, Deb Wockenfuss, 05/10/22
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
May 7, 2022
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: PARADISE VALLEY BLOCK 8, LOT 19 WITH MOA WAIVER
Per discussions with MOA Onsite staff on May 6, 2022 we propose to install two 1500-gallon
epoxy coated 10-gauge Advantex tanks with 18 holes cut in the baffles in series with an alarm
to serve the existing 4-bedroom residence. Per MOA record documents of the site / adjacent
sites and this design, we hope to proceed immediately with MOA permit approval for this project.
Although we feel the MOA approved this grandfathered system and no MOA waiver fee is
justifiable because the MOA has issued a previous COSA for these holding tanks we have
attached the MOA waiver fee and form. The code separations at that earlier time were met and
approved by the MOA, we are now requesting waivers of 78+ to the well(s) and proposed tanks.
Granting of these waives to install the new improved holding tanks as shown is justifiable with
the improved tanks, a berm will be installed to maintain 100+ surface flow from any wells or
service water to the tanks, the wells are up gradient 10+, wells are on the opposite of the house,
the wells drain away from the proposed tanks, the well logs show clay and bedrock at shallow
depths with little to no possible transference, etc In essence, there is no foreseeable interaction.
For this and other reasons previously submitted and discussed with MOA, we respectfully
request issuance of this permit and waiver so the owner may proceed. 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
OSP221102, Deb Wockenfuss, 05/10/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221102, Deb Wockenfuss, 05/10/22
Feb 18 1910:57a Anchoiage ^fall& Putnp.Sgr 9072430742 P.8
,.- i eve-lopment Services bepcartment
Building Safety Division
"' rr.b=a air Cin _Site Wnter A Wastewater Progr�sixs
4700 Emnre Roar!
f P.C. fax 196650LJLJN
x '
MarkBegich Anchoreae, AK 99507 B A E S Y
Afaror ImlwniJ ..araioyma
(907)343-7904
Pump installation Log
Well Drilling Perwit Number: SW----- Date of Usue: ---
Parcel Identification Mummer: azo - y13--31
Legal Description Propert, Owner Name, Addre s:
po-re"(1 e Va1(e �8 U9
Pump Inst2hation Date:
Pump Intake Depth Belo`- Tit -a Casing::3ul--t'cec
Pursi; Manufacturer's Name: f(ez_,_— --'��-`�C^ ��
Pum} Model: 'rjV S 2-- k
Pump Size C hp
Pitless Adapter Buriai Depth: I,"*( e feet
Pities Adapter Manufac'turer's Name:; tz_1 '7
Pitless Adapter Tustallcr: . J&V�'��
Well Disinfected Upon F
Compietion'' es No
Method of Disinfection:
Comments:" `
Pump Installer harue:
J
Attention: the pump Lastal..er scall orovid a pump instaHatior_ log, to the ;:SSD within 3Q day -;z cf psrnp i;tstallaticn.
DE.~_ ?TMENT OF HEALTH AND HUMAN SER~ .~S
Environmental Health Division ....
825 "L' Street, Anchorage, Alaska 99502, Telephone 204-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
Phone(s) J Permit No. No. of Bedrooms
Lot
Township, Range, Section
TANKS
SEPTIC
~ HOLDING
Capacity m gallons
TYPE OF SYSTEM
FRENCH [] BED [] W. DRAIN [] OTHER
Total depth from origmal grade
original grade
FT F'
Fill added above original ! Gravel depth beneath pipe
Gravel length
FT
Total absorpbon area
SQ FT
Number ot hnes I Soil rating
SQ
Installer
P~pe material
Date Installed
~ t"t'~ ~"'~D I~ ~T~A N C E S
FIELD WELL
WELL ~J /
LOT LINE i ~lj~ / ~
FOUNDATION / ~
TANK
ABSORPTION
AS-BUILT DIAGRAM (Show Ioca on ol well, septic system, property hnes, foundahon,
i driveway, water bodies, etc.)
FT
WELLS
~ PRIVATE
Classification (A,I~,C)
[] OTHER Hdentifv)
Date Installed:
Jnstallel
REiVIARK:
Total Depth..)_~ ~--,~ FT Cased to
Date:
~Umclpal and 8tate,Du~dehries i?effect?J~..l~[i(~te:
Health Depadment Approvak
certify ~al this inspec~lJon was pedormed according to all
72-013 (3/85)
ENGtNEER'S SEAL
Di~i]:'AR'TMENT OF' HEAl_TH AND lii]qV ~F<OIqMEI'~TAL..PF;~OTEC"t"II.]N
82',"5 L STREET, ANC:HOF~AGIiE, AK 995():1.
;;:~64- 472 C,'
PERMIT
DA'fiE tSSI.JIED
APPL :[ CANT:
L..,J~ SIZE:
L. OT I...OCAT t ON.~
BILl... AND MELiNDA DALE
59 :t. i I::~'OMAN I A DR ]: VE
ANCHOiRAGIE, AK 995:1.6
345-'1490
SUBDIVISION: PARADISE vALt..EY
SEC]"]:ON: :1. 1 TOWNSH I F'
14498 (SD.I::'T. OR ACRES)
ROMAN :[ A
LOT',' 19 BLOCK: 8
RANGE;~ 3W
]: ........... .,..,
].. i am {ami.].iai'~ ~,,~iCh the Pectuipements fen'~ on-site set~er.s and ~,~el].s as ~:~:~'i'..
fc:mtl"~ by the t~]un:icil::~a].:i, ty of Arichc,~'~age. (MOA) and ~the State of Alaska.
2. i wi].l ins:l:.a:t. 1 tine sys'l'..(.am :i.n aCCOl"dai"ic:e ~z~J.'Lt"i all M[]A cl:]cles ar'icj pegu].ations,
'and :i.n c:ompliance with the design c:P~ter~ia of ih:i.s pePmi't:..
3,. t will adl'iePe '[.(::i all MOA and St. at(-~ (:)t' Alaska peClU:iP~.:,ments {(:iP the t~i(.:.:~'i:, back
clist, ances-{'r'on~ any (.z. xisting ~,,gell, ~.~ast. e~,~a'Ler' disposal system c,r' I;:H..d::)lic
se,,,-~ePage system on 'l'..l'iis ol" any adjacerrL (:)i'. neal"t;:,y lot.,
it:: A I....IF71' STA'T]:C~N IS INS'I"AI...I...ED IN AN AREA I::(:]VE:I:?E:I:) BY M[]~ BI.JIL..DIIx!G CODIE~,
-!"HEN (J.) AN Et....I~ECTFtlCAL F:'ERMI]" AND ZIqSPtECTZOIxl FIUS]" BE OB]"AIiqED~i
WZL.L NO'T BE AF'PIROVED W:[TFIOUT AN EL. ECTRICAI... INBF:'ECTZi]N REF:'ORT; Alqt} (3) 'YHIE
I~LECTTi::;:Z CA!... WORi< MUS'T' BE Df]NE BY A L.;[CIEIqBED EL.I~[C'T'i::IZC
;:) .t. :m~z:D '_ ...................... :......}
APF'L I ii:ANT ~ B I I...L AND MEL. ! NDA
ISSUED
· ' " \'/ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'rAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME A [PHONE ~7_~ [~NEW
J~L~ i,,.~. ~~ ~%~. ~ ~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION ~
LOCATION ~ - ~ NO. OFBEDROOMS
]~11 Absorption area t Dwelling PERMIT NO.
~ DISTANCE TO: J ~1 j ~ ~0.~ j~ ~
~ ~ Manufacturer .. ~ Material No. of compartments
Liq. capacity in gallons ,~ , ~.~.~ ~ Inside length Width Liquid depth
~ ~ DISTANCE TO Well ~ ~ / Dwelling PERMIT NO.
~z : X ~/,
~ Manufacturer ~ /~ Material Liquid capacity in gallons
Q Well ~ Foundation Nearest lot line PERMIT NO.
~ ~ DISTANCE TO'
~ ~ No. of lines Length of each li~ j ~otal length of lines Trench width Distance between lines
~ ~ /~ inches
~ ~ Top of tile to finish grade ~ z Material beneath tile Total effective absorption area
Q ~ inches
Length ~idth ~ Dept~/ ~ .t ~/ PERMITNO.
< ~ ~ Type of crib Crib diameter .Crib depth Total effective absorption area
~ ~ Well t ~ilding foundatior~ Nearest lot line ~ /
DISTANCE TO: ~ O~ ~0~ ~ ~
~ Class Depth Dril~r Distance to lot Hne PERMIT NO.
~ DISTANCE TO: Building foundation S~er~e ' Septi~ tank Absorption area(s)
OTHER ~ ~~ ~ .....
PIPE MATERIALS ~ '~
SOl L TEST R¢ING*~ .--- ~
REMARKS ~ ~t ~
APPROVED ;~ ~ ~' D~:'~i~ ~-~N~ ~ ~ LEGAL
6 9 zl."'" 2 9 7 9
L..(;)'I" .'.:.!~ ]; ZIiE i;
L..O*i" LCJE:¢::fF ;[ (;]hl ;;
.hi:~:~ X
:l. 4. zF:?Eii(S(:,!,, F'T,, (3F;:
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVI RONMENTA/PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SLOPE
[] SOILS LOG
PERCOLATION
TEST
DATE PERFORMED:
PLAN
10
11
12
13
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED? O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
COMMENTS
Ho. 1457-E
PERCOLATION RATE (minutes/
TEST RUN BETWEEN FT AND ~ FT
PERFORMED BY: '~ '~ ~'' E~'i'GINEERIN~
72-008 {6/79) .
SUBJECT: ~--~-r- I~
COMPUTATION SHEET
DALE:
SHEET
BY,
CKD
OF
No. I,{57-E
:~ 4L~ .~V.,~F!~L[:~fA ,~,~'~,~ COMPUTATION SHEET
SUBJECT: ~ 1~ gtA/x ~ i~,'FZ~-~'~d-~ V'^~-~-~,-/
DATE:
SHEET
BY
CKD
OF
No. 1457.r,
,4" Pe6~ pv'G
Mumcipality of Anchorage
MEMORANDUM
ALASKA eWdlROr/menTAL CONTROL SekdCeS, IllC.
~ngineeHnq 6 I~nuironmenlol Studies
March 18, 1985
Keith Bandt
Department of Health & Environmental Protection
825 L. Street
Anchorage, Alaska 99501
N4.UNiCi?ALITY OF /,'-{Ci;,
DE~:F, 01: "- '
E~ wl~Oix?~':slf/:,L,, ,, , _, i ,
Dear Keith:
This is in regards to Lot 19, Block 8 Paradise Valley. Due to the
small size of the lot and the difficulty we are having in designing a
septic system, we are requesting a waiver of the lot line distance, to
be only 5 feet on the east and west lot lines. Neither the lots east
nor west of lot 19 have been built on yet.
This septic system will be a shallow bed. Naturally we want it to be
on the gentlest slopes possible. The slope to the north is gentlest,
and it becomes steeper to the south. Because it will be a shallow
bed, the lateral zone of influence will be insignificant and it will
not harm adjacent lots.
To keep the bed on the gentlest possible slopes, therefore, we are
requesting a waiver of the lot lines to the east and west only, to be
5 feet.
A diagram of the proposed septic system, along with the soil log, is
attached.
Approved by:
' ~.s Phd.
Sincerely,
Darcy ~fievens
Engineering Geologist
1200 ~s! 33r't{ Auenue, $ui1¢ ~oAnchore§e, ~]aske 99503 -[907) 561-504~0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO~ECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
~_ SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: ~0¢11 s'a./~ ~i~
LEGAL DESCRIPTION: p~.£~ f~'
1
2
3
4
5
6
/ /
DATE PER ORMEO:.
SLOPE SITE PLAN
/
/
/
WAS GROUND WATER S
ENCOUNTERED? ~0 L
0
P
E
IF YES, AT WHAT
-DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERC~OLATION RATE 2~? ~ ¥ ~_ /o · 5'6
(minutes/inch)
TEST RUN BETWEEN ~ FT AND ~ I,~
-- FT
PERFORMED B¥:'"'-'~'~'¢'~Zy ~r~/C~- ,.CT ~ 0 Z~ CERTIFIED BY: DATE:
~ue~ ~ ~'-~G s~v ~h;ll ~ ~ hole ~('~
ALASKA ENVIRONI~'~NTAL
CONTROL SERVII;~.~., INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE. ALASKA 99503
(907) 561-5040
SHEE~' NO OF
CALCULATED BY '"~'~d~'~ DATE '~/'~ / ~ ~
CHECKED BY DATE
SCALE / "'~ ,.~0 ~
SlX INCh Water WEll drilled ........... OUt TO The DEPTh Of .. i ~ 0~
DrilLED at The rate 0f Per fOOT. CJ~ ~o~ 300 /~
PrOPErtY OWNER [/~o B~L~ ~ 34~-23~8 11051 g~ood ~o
LOCATION OF WELL SITE
DRILLER
WELL LOG:
~o,z¢ wa,~ g~ ~&om ~90-296 ~o Se~e,za~ ~ $za~ou.o ~o 7o,to~ ~ p,~ada~r~
400 q~
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PaYable TO rAMPART DRILLING WORKS For THE SUM OF ~/6~O00eO0
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
SERVICE CHARGEOF ~% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
o£
/
] unicip l Yof
Anchorage
P.O. BL~"196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 18, 1986
Mr. & Mrs. Willam Dale
5911 Romania Drive
Anchorage, Alaska 99516
Dear Mr. & Mrs. Dale:
As you know, my staff has been actively pursuing resolutions to the
multiple problems in Paradise Valley Subdivision and as Susan Oswalt
recently told you on the telephone, there still remains much to be
done.
Specifically on Lot 18, you now know that although a Health Authority
request was received on January 10, 1986, it has not been approved.
Receipt of contradictory letters from Alaska DEC temporarily clouded
the stream issue; however, as it was in your situation, the ditch
along Romania has been designated a "stream or surface water" and
appropriate setbacks are required. The owner of Lot 18 must bring his
system into compliance with State and Municipa~ law. Our department
intends to force compliance if we are unable to obtain voluntary
compliance.
Recently we were informed that the State is again looking critically
at the surface flow along Romania. Should their findings differ from
those outlined above I will let you know. In addition, the Municipal
Building Department is investigating your complaint of the lack of a
Certificate of Occupancy on Lot 18.
I appreciate your patience throughout a most difficult time.
Sincerely,
Jewel Jones, Director
Health and Human Services
~J/SEO/ljw
cc: Mayor Knowles
unicipa tYof
Anchorage
OFFICE OF THE MAYOR
May 21, 1986
P.O.~bOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4431
TONY KNOWLES,
MA YOR
William and Melinda Dale
5911 Romania Drive
Anchorage, Alaska 99516
Dear Mr. and Mrs. Dale:
As you're clearly aware, solving drainage and on-site septic
system problems prevalent on the Hillside and north Of the
city will take cooperation between citizens and the
Municipality.
I am asking Jewel Jones, Director of Department of Health
and Human Services, to check into the situation you described
in your letter and contact you directly with her findings.
You can expect to hear from her soon and she will also keep
me informed. Rest assured that we fully intend to tr=at
everyone equally.
Thank you for alerting me to this problem.
Jewel Jones, Department of Health and Human Services
RECE~VE~.'
MAY 0 ! 1986
MAYORS OFFICE
Dear Hayor Knowles:
Last fail, a health emergency was declared for the residents
of Paradise Valley,~ S0bOivision. Th s a~nooncement causeJ
problems for many of os ~ho reside n the area, We had trouble
getting insurance on our. home and closing our. loan at the bank~
The pu~iicii.? ~,il undoub~di.~ resuil in io~er ?ope't? ~ai~es
for some time to come,
We understood that the reason for this dec aration was to
prevent the possibility of pollution to the surface ~azer from
several septic systems which were ~oo close to a "stream" flowing
in a drainage ditch along Romania Drive, We installed a holding
tank to receive a health approval from the Hunic pality. We did
so after three months of wrangling with many Hunicip[al
departments and desperately trying to find another solar on which
wo~id hau~ allowed us to use our S15,000 septic system.
This letter is being written to ask you what p ars you have
to stop the pollution that is still taking place on Roman a
Drive, Zhe house at 5721 Romania Drive has been occupied for six
months, with no C/O or health authorit? appro~ai, We feel it is:
i, detrimental to the future of our subdivision - as you stated
in you~ health emergency dec!aration~ and.2, unfair to those of
os ~,~ho~ at considerable exoense and mental anguish, did comply
~.~ith the law,
~y allowing this. situation to continue, you are n~g~ting any
positive impact That ma>' haue come from ~he ~'hea!tn emergenc?~
your office ~as so concerned about. You are encouraging people
to ignor, e the r. eguiat ohs concerning septic systems which ex st
now and you are discr minating against those of us who ape in
compliance with state and city laws. In view of the fact {hat you
~isb us to have faith in your "strong" stance against future
pollution, we expect ~o hear from you letting us kno~ that the
people living at 592! Romania Drive ha~e been advised to comply
~ith the law or ~ok~e out until they are able to comply. We
reques~ this because we are deeply concerned about the future of
Pmradise Valle>'. We thank you for your. interest and continued
efforts to solq~e our drainage problems,
Sincer-eiy~
Bill and Helinda Dale
5~!I Romania Drive
Anchorage~ AlasKa
?7516
MUNICIPALITYANCHORAGE
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. 020-413-39
1. GENERAL INFORMATION
Expiration Date: g-27— Z 02—> Z
Complete legal description PARADISE VALLEY BLOCK 8, LOT 19
Location (site address) 5911 ROMANIA DRIVE, ANCHORAGE, AK 99516
Current property owner(s) GAVIN L. PETERSON Day phone
Mailing address
Real estate agent
5911 ROMANIA DRIVE, ANCHORAGE, AK 99516
A
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Private Well
Private Septic
Water Storage
❑
Community Well
❑
Public Water System
❑
Waiver request for:
4
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
❑
Holding Tank
Community
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ `fir" 50
Date of Payment rJJ�� aU,2,�
Receipt Number 1 9
COSA # 0 -5C -?-2-122-:5
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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 5/19/2022
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 z�\\\\�\
system and maintenance. The operational life of all well and septic systems are subject to r� �
these various and dynamic characteristics and are outside the control of the evaluator of the •�(i
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��Q: • • • .
for current or future occupants or guarantee that no unseen encroachments, deficiencies or fig•' '.9 �)
discrepancies exist can be given by First Water ConsultingTM
& *: • ....':
Fwrs
6. DSD SIGNATURE Curtis Huffman
System #1 Approved for bedrooms ,'�c%� , CE 128991 ..�g��.��
F�' • .�/19/z2•'F� .r
System #2 Approved for bedrooms ,1��, \0FESSO �
Disapproved
Conditional approval for bedrooms, with the following stipulations:
r
By: Original Certificate Date: 5 --27202
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory_
Arsenic Advisory
Other
Legal Description: PARADISE VALLEY 138 L19 Parcel ID: 017-074-28
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA*
❑ Well log is filed with Onsite (or attached)
Date drilled 6/26/1985
Total depth 305 ft
Cased to 40+ ft (PER MOA DOCS)
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 3/11/22
Static water level at beginning of test 39ft.
Structure served by this system _
Well production at time of test 1.8 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate *9.63 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by_ F�
Date of Sample 4/26/22
Comments *RAW WATER TEST AT SPIGOT & NOT AT TESTING. HOPE TO SEE NITRATE REDUCTION WITH HIGHER USAGE AND
IMPROVED TANKS, ETC... OVERTIME. MAY CONSIDER POU (POINT OF USE) TREATMENT AT SINK AND PERIODIC NITRATE TESTING
B. TANK DATA
Age of tank(s) NEW 0 years
Tank type/material HOLDING TANKS / PDXY STEEL
Measured operating fluid level in septic tank NEW
® Standpipes/foundation cleanout per record drawing
Date of pumping NA - NEW
ABSORPTION FIELD DATA
Which system tested (date installed)
® ALL standpipes present per record drawing
Total measured depth from »gt-ade _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
Comments/Deficiencies:.
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
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 "`yr d
Any rejuvenation treatment`°(Nast 12 months) N
.y —
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'
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
*78+ ft
® Yes
if No
ft
Neighboring Tank > 100'
® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
ft
Absorption Field on Lot > 100'
® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
ft
Neighboring Absorption Fields
> 100'
Animal Containment > 50' ® Yes
if No
ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
®Yes
if No
ft
® 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
_ ®Yes
if No **
ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
NA ft
Private Wells > 100' ❑ Yes
if No *78+
ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes
if No
ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment
below
From'Absorption Field on Lot
to: (Please enter
distances if less than required)
Building Foundation _-n?.0"
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes
if No ft
Water Service Line > 10'
® Yes
if No
ft
Comm nityWe'!..> 200' ® Yes
if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*MOA WAIVER HOLDING TANKS TO WELL ON LOT 18 & 19 WITH **100' RUN TO SURFACE WATER WITH
VEGETATION AND BERM. THE EXISTING SMALLER HOLDING TANK RIGHT NEXT TO PL WAS
DECOMMISSIONED & LEFT IN PLACE.
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 �.' •:Q�)
with MOA COSA guidelines in effect on this date. f TM '.
,/..,/.4 ....fl. .........
...k,. . .....%:.........
Curtis Huffman
CE 128991
$��%slF�•, 5/20/22 ,•,.v
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221223
Subdivision: Paradise Valley Block 8 lot 19
A water sample revealed a nitrate concentration of 9.63 milligrams per liter (mg/Q.
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. 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.
Mad�ng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
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 media 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.
~ ~ftUNICIPALITY~ OF ANCHORAGE , ~/~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name t:~_..~ ¢"~,,,>--t_-~- Telephone: Home '~o¢~-~ I ¢¢t~:~ Business .
Applicant Address ~"~[ ~~ ~E:::~, ~" ,/~..~¢__~4 J ~,,¢Z.~ ~¢:~,'¢'1~'~.~
(c) Applicant is (check one): Lending Institution []; Owner/builder,~ Buyer []; Other [] (explain);
(d) Lending Institution Telephone
Address
(e)
(f)
Real Estate Company and Agent
Address
Telephone
~ t~e HAA to the follo~ving address:
TYPE OF RESIDENCE
Single-Family¢ Multi-Family []
Number of Bedrooms
Other
WATER SUPPLY
Individual Well~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] 'Public [] Community [] Holding Tank~
Note: If community well system, must have written confirmation from the State Department of Environment~d Conservation
attesting to the legality and status,
72-025 (11/84)
Page 1 of 2
ENGINEER'ING FIRM PROVIDING--.-~SPECTIONS, TESTS, FILE SEARCH, DA'i'~-~AND INFORMATION
A's 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 inspection.
Name of Firm
Address
Date
Telephone
DHEP APPROVAL
Approved for /~-('z~Z.~) bedrooms by
Approved ~' Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval ce'~ificates based solely upon the representations given in paragraph 5 above by an independent pr~essional
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
Well Classification
Well Log Present.N)
Total Depth
Static Water Level
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
Cased to
/__~'
Casing Height Above Ground _
Electrical Wiring in Conduit ~.~/N)
Separation Distances from Well:
To ~e,C~'f'c/Holding Tank on Lot
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Lc. ¢ ~ ¢ ,~L~ Yield
Depth of Grouting ~
Pump Set At
Sanitary Seal on Casing ¢~N)
Depression Around Wellhead (Y/....~
; On Adjoining Lots
To Nearest Edge of Absorption Field on I. ot ; On Adjoining Lots ~ ~='~Jc-
t~ lb,, To Nearest Public Sewer ~
To Nearest Public Sewer Line ~ t¢~. ~ .~t¢.
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ¢ ~ ~¢=~¢-~'"'~--~-~¢=¢"~ ; Date ~ ~ ~, ~ - ~
Water Sample Test Results ~1'~ ~ ~ ~
Comments
'~s~Ii!~t~/HOLDING TANK DATA
Date Installed }~.~'7~'1¢-~''~
Standpipes ~/N)
Depression over Tank (Y4~:)
Pumping/Maintenance Contract on File ~/N)
Holding Tank High-Water Alarm~N)
Separation Distances fror~/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
..C,~e z¥,=> ~
Size '¢~-~"O ~ No. of Compartments
Air-tight Caps t~N) Foundation CleanoutCN)
Date Last Pumped
;for
Temporary Holding Tank
To Building Foundation)'~'"'¢~
To Disposal Field ¢~ (~
To Stream,.PerrdT~, or Major Drc, h~cg@
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
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
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments /~'
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)
D. LIFT STATION
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
//'"']/~1 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 M/QA and H~A g ui.._i~delines in effect on the date of this inspection.
Compa~y.,.~,[~.¢)u~,~ ~ ¢~ MOA No. __~ ~ ~ ~
Receipt No. ' .... ~-"~':%'-%.-~ 8 ¢
Date of Payment ~)" ~'~ ~
Amount: $ .~.~- (~ o
Page 2 of 2
72-026 (11/84)
HOME SERVICES
15900 Francesca Drive
Anchorage, Alaska 99516
907-345-1890
MAINTENANCE CONTRACT
Bill Dale
5911 Romania
Anchorage, Alaska 99516
I ~/LL ~A~ _ agree to have ~ Home Services
pump my holding tanks on an as needed basis or a date spec-
flied by me for a period of one year.
Total volume of tanks
Price per pumpingL
customer smgnature
A+ Rome Services -
* Price reflects pumping during normal business hours.
/ / ~ ~- ~
Date
A+ Home Services reserves the right to increase their rates in
accordance with any rate increase incurred from the Municipality
or any other agency.
Your Septic, Cesspool and Drainfield Professional Service ComPany