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HomeMy WebLinkAboutPARK HILLS #2 BLK 2 LT 17Park Hills #2 Block 2 Lot 17 #017-142-28 imp Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 P - age 1 , of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211217 PID Number: 017-142-28 ZO�j Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name SCOTT THORSELL ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ound 14730 PARK HILLS CIRCLE *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-830-2791 3 GPD/SF1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. PARK HILLS #2; BLOCK 2, LOT 17 Fill added above original gr Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ftz Ft. Well 100'+ TANK ❑ Septic [9 S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ GREER TANK 1500 Gal. Material Number of compartments Lot Line 51+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC GREER TANK 1500 Gal. PER CONTRACTOR. Alarm location y� Electrical installed by k4 Cid Y t,z �Z`frc� !%J, t�t�o t G..AT STbh/ PIPE MATERIAL House to tank D3034 drainfield Tank to Installer EXISTa A+ HOME SERVICES Drainfield D30341EXIsTING CO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 98.41 ft Inspection ection 151 8/18/21 2 - Location and description nd 3 r _ 41h _ TOP OF M H 1 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stymp op6�O OF Conditional Approval:Date . .. . . . . f �95,�� �.. ... . �.... ... Septic System �� '.J�f A. Garn SS:COD ' �O Approved pp Date Note: this approval does not include well permit requirements. �1. o aAEccaa4�oo 0 (Rev 05/02/18) u dh,-4 eA 0.o -- 6 UA Q t' d+ S wvu' ti X�Lj + -i-im-Q- Goo fl oz, L-kAJU Lyy" . PEF SP NUMBER: RECORD DRAWING PARCEL ID NUMBER: OSP211217 017-142-28 A B 1 M H1 24.1 38.0 MH2 27.9 1 40.4 WE ARE REQUESTING THAT YOUR \ DEPARTMENT WAIVE THE REQUIREMENTFOR AN UPDATED AS -BUILT SURVEY PRIOR TO APPROVAL OF THE RECORD DRAWINGS \ \ \N i / EXISTING HOUSE .' ......... ....... ... .......::..... 1 i 1500 GALLON HDPE GREER TANK / \\\\\\\\gSF�FN< a / \\ GARAGE . V�ELV Rp,O\US �p0 f I S GOO � N P / / SCALE: 1"=40' ENGINEERING - SALES -- CONSULTING 3701 E. TUDOR ROAD. SUITE 101 'ANCHORAGE. AK 99507' PHONE (9071337.6179 -FAX (9071138-324&' WEESITF www.aamescA ninaerin� ��m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: SCOTT THORSELL 907-830-2791 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: PARK HILLS #2; BLOCK 2, LOT 17 D.J.G. TYPE OF WORK: DATE: � SEPTIC TANK RECORD DRAWINGS 9/17/2021 ..+��a��� ■111 %..... * ...... r. ...... ..... ....::..... kr .... .... .............. rey A. Garness s C 795 Zai • LICENSE ,,,i,■ �����'••• #AECC884 / PERMRECORD DRAWING 211 OSP211217 TOP OF MANHOLE = 98.41 TOP OF MANHOLE = 98.60 MH1 MH2 FINAL GRADE = 98.08-98.22 TOP OF TANK AT INTLET = 93.34 INVERT OF BUNG AT INLET = 92.66 NEW 1500 GREER TANK WITH ANCHORAGE TANK COMPONENTS TO BE USED AS LIFT STATION TANK HOLE WAS DRY DURING EXCAVATION - GROUNDWATER WAS NOT ENCOUNTERED PARCEL ID NUMBER: 017-142-28 TOP OF TANK AT OUTLET = 93.33 Ltd ENGINEERING, SALES CONSULTING � 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 33&3246' WEBSITE; w ,gamesse gineenng.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: SCOTT THORSELL 907-830-2791 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: PARK HILLS #2; BLOCK 2, LOT 7 D.J.G. TYPE OF WORK: DATE: �,_ PROFILE OF NEW S.T.E.P. TANK 9/17/2021 V r 4t El %'..w..«.... ... �.........• ......... .. , ## TA t. J rey A. G -a ess Q AF ## CR -7953 ��AV �'pP •........ P� W LICENSE 411 `S`;'�r►�� #AECC884 / David Garness From: Bev <aplus@gci.net> Sent: Friday, September 17, 2021 2:13 PM To: David Garness Subject: Re: Park Hills #2; Block 2, Lot 7 Hi David Capstone does all of our electrical work. Please call Mike directly for the location! Hope you out in this beautiful sunshine! On Sep 17, 2021, at 11:52 AM, David Garness <David@garnessengineering.com> wrote: Bev, I am working to finalize the record drawings for 14730 Park Hills Circle *Anchorage, AK (Park Hills #2; Block 2, Lot 17). 1 was wondering who installed the electrical and where the interior alarm was located. Thank you! Sincerely, David Garness, P.E., M.S. Civil Engineer Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Mobile: (907) 632-4528 Website: www.garnessengineering.com <image001.png> <image002.jpg> <image003 Jpg> MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program poBox 1oOmm 4ronElmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 On -Site Wastewater Disposal System Permit Permit Number: OSP211217 Work Type: SepbcTankUpgrade Tax Code Number: 01714228000 Site Legal Address: PARK HILLS #2BLK 2 L 17 8:3037 Site Mailing Address: 14730PARK HILLS C}R.Anchorage Owner: THORSELL G SCOTT Design Engineer: BARNEBSENGINEERING GROUP LTD This permit isfor the construction of: 11 Disposal Field R1 Septic Tank El Holding Tank 171 Privy Effective Date Expiration Date Lot Size in Sq Ft: 6/17/2021 6/17/2022 [] Private Well ElWater Storage All construction shall beinaccordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC8O) 3. The wastewater code requires inspections during the installation, The engineer shall notify the Development Services Department per AMC 15.85.Provide notification bycalling (007)343-70O4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing C ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-142-28 Property owner(s) SCOTT THORSELL Day phone 907-830-2791. Mailing address 14730 PARK HILLS CIRCLE *ANCHORAGE, AK 99516 Site address 14730 PARK HILLS CIRCLE *ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) PARK HILLS #2; BLOCK 2, LOT 17 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field F-1 Initial El Single Family (SF) Fx_1 (w/wo ADU) Septic Tank 0Upgrade I -XI Duplex (D) D Holding Tank D Renewal ❑ Multiple Dwellings ❑ Privy D (SF and/or D) Private Well R Water Storage D THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: N/A 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: It 9 2 5 Waiver Fees: Date of Payment: — (0/1 � 120:2 f Date of Payment: Receipt Number: 6 L ob' 0 6 Receipt Number: Permit No. 0 S P ),11 Q 1 '7 Waiver No. GAIDevelopment Services\Building Safety\On Site Water and Wastewatefforrns\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211217, Deb Wockenfuss, 06/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211217, Deb Wockenfuss, 06/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211217, Deb Wockenfuss, 06/17/21 Municipality of Anchorage ; '',' '` •, Development Services Department i�:,�'rjt Building Safety Division -- On-She Water and Wastewater Program, 4700 Elmore Sl. P.O. Box 196650 Anchorage, AK 99519-6650 Page / of 'Z www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ,S 1" 08 O 229 PID Number: Of — /'s 2 — 29 Na""S(a 14 Tl+arI Wastewater System: ElNew R Upgrade Address lye d Pa c'</ Il(/ !I FYIn�h ae 9� / ABSORPTION FIELD Ptwne 26 ? -7D Il' Z Number W aearoane D Deal, Trar O Shailm Trac!, WBad O Mound O o"W.. 5o R'°"0 Tow Da02.6 Wit-" acle LEGAL DESCRIPTION 7 GPDIFt` 2.5r + SA f .a fid FI. Blw LM sum..Von DePM W ppe boomeo. oong," ands C." depth brraN ppe �" .a..F 2 17 Park F{Ilt/ rl2 . Ft. O •Jr Ft Town p Rarga sa Caon FW added above onp,rw grade GravN Lerpm. �y V-7 1.0 Fl. Ft. Well: E'x/s [:]New ElUpgrade GnvN wdh: 1 S Numbers roles 3 Dista, between IMs j Ft. S' FL Cl.sYbobon (Pnvate. A, B. C) Tots DaPm aced m TOW abswpum am MP Wiens 1 •-45 v O 0-4. FI. I Ft 6 'IT FI` S C 1.a✓ y0 P VC Onller Dail DNMd SlabC W MV Larel helaller Dal. MUWIed 7/1 Y/ Z��9 Ft + Y,NO Pump Sal at strop ""MAbove Glwnd. TANK FX1STI ry GPM FL FL SEPARATION DISTANCES ❑ septic []Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding lublicrPrIvale n" atliMifcap.,, From Tank Field Station I Tank Sewer Line Ga+ A4l.net N.m of Conpan"M Wait 107' LIFTSTATION EKfST1NG 15a1.0610%18191 ,foes :e nu eGwer Lot Um F Gal •Pump Of io Y at 'Pump orW" at H,gn Wates arYm It Fwmlabon 77 h h h- Pump Make a Mode El.Mncal hapecbbns penarmad by Cunsn Drrn Romans BENCH MARK i-w, ph'&n bed reen,,-ri-acitr.^ ew Lwow, and Desmpbbn. Per to/g/tis felfp4o,veto/I/tien✓ee-,:ahL . 13, Flom of- •air ll6p 9.67 lir wmW ration l to. on 11 a, h, be Q rI/e� 114n6/ / rr Or /14 M1e /UU. O FL ('a In 1 Gf' 1111/ taw l✓(r 1( 4i Engineer's Stamp Inspections performed by: Flu Hip Toch CL a Dates: 1'r 7 / fe / o9 u7e 2nd 7 / lY /G9 �.4-Sve at :i�+�f,. Or.�Tv, Development Services Department ApprovalvC� �• �,A, : a. ✓, ¢� q' �. STN 1 V Conditional Approval Date: r' * rd..ttF : THEODORE F. OAOORE J. qa,+�,"'•. CE-3589 `2 — q ,;.}' •.. 121 1 /C �j��.;J'••• 3 Reviewed and approved by: ate: (Rev ONad) •' e PERMIT NO: SW 080229 PID NO: 017-142-28 i M`,f ol 44 49m •r*1 ......................... CE If EXISTING SEPTIC TANK A STEP TANK SWING TIES FROM" COR. "A" COR. "B" PT. "X" TO: BED M.T. "C" 81' BED M.T. "D" "' 125" DIA SCHED. 40 PVC w. 3116" HOLES @ 18" O.C. INVERTS @ 108-0- k464 91' 5' 20' WELL 15' PAGE2OF2 \Nq N GEES Nps ------ -- \ RECONSTRUCTED 15' x 43' SOIL ABSORPTION BED ` 1.0'+ AVG. NEW FILTER SAND SAND UNDERLYING PREEXISTING BED CROSS SECTION NOT TO SCALE - 2.0' SOIL COVER - ELEV.110.5' 3 2.5' —� 1 2- RIGID INSL ELEV.107.5' –0.8' SEWER GRAVEL PLAN VIEW .:ALE: 1" = 30' LOT 17, BLOCK 2, PARK HILLS SID *2 SEPTIC SYSTEM UPGRADE AS -BUILT INSPECTION REPORT FLATTOP TECI INICAL SERVICES SCALE AS NOTED 14530 ECIIO CANYON ROAD DRAWN BY TFM ANCI[OR AGE. ALASKA 99516 NOVEMBER. 2009 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW080229 Legal Description: PARK HILLS #2 BLK 2 LT 17 Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Owner Name: SCOTT THORSE If Owner Address: 14730 PARK HILLS CIRCLE ANCHORAGE. AK 99516 - Date Issued: Oct 21, 2008 Expiration Date: Oct 21, 2009 Parcel ID: 017-142-28 Site Address: 014730 PARK HILLS CIR Lot Size: 42069 SQ. Fr. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of. Disposal Field 0 Septic Tank Holding Tank [D Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: I ' 2-.6 le- Municipality of Anchorage Development Services Department Building Safety Division`.+ On -Site Water and Wastewater Program ` 4700 Elmore Road ' ° . , P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. _ 01-7 - 1 H Z - 2 6 Property owner(s)_Scoff- Ttia-,ry/i Day phone 263 _25E Mailing address__��1, Zip Code 9.7 r i Site address Su °n c Zip Code Legal description (Sub'd., Block & Lot) Lot I r r31[r 2 pQ, Legal description (Township, Range & Section) Lot Size q, t)1c Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field ® Initial ❑ Septic Tank ❑ Upgrade Holding Tank ❑ Renewal ❑ Privy 11 Private Well ❑ Water Storage ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5H60 :Z'.'— Waiver Fees: Date of Payment: 10/J7/0,6 Date of Payment: Receipt Number: Receipt Number. (Rev. 11/05) „FLATTOP TEGHNIC_A_ L SERVICES .I �,�. ,, V".,nv+M{JR -Y• ,.A -ll• �`0`� `V�..al ui- .6. ,. •iM .-. CIVIL 6 ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION 8 ANALYSIS TED MOORS, P.E. 14530 ECHO CANYON ROAD PH ail: t moore45-1355 ANCHORAGE. AK 99516 E -Mail: tgmoore�gci.net October 17, 2008 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to reconstruct the existing soil absorption bed on Lot 17, Block 2, Park Hills S/D #2, located at 14730 Park Hills Circle. The present bed has "biomatted up” to the point where it is no longer able to handle the wastewater load generated in the residence without fluid being ponded in the bed to a depth such that effluent flows back into the existing STEP tank between pump cycles. The specific steps proposed to reconstruct the mound are described below in the specifications. A site plan, design plan and cross-section and specifications for the repair are enclosed. Based on extensive soil testing conducted at the time the existing bed was constructed in 1994, the present bed site appears to be the only suitable site on the lot for a soil absorption system. The present bed has an independent monitor tube that extends down into the underlying sand. The regular monitor tube that extends down into the sewer gravel indicates that the sewer gravel is flooded with effluent to a depth of 8 inches, but the deeper monitor tube extending down into the sand is dry. This indicates that the system is not being affected by groundwater, but instead is flooded due to biomat formation at the interface between the sewer gravel and the underlying sand. By removing the top six inches of sand that has "biomatted up" and replacing it with 12 inches of ISF filter sand having less than 2% passing the 4100 sieve and 1% passing the #200 sieve it is hoped that enhanced longevity can be achieved for the rebuilt bed. The location of the present bed is such that it required issuance of a lot line waiver allowing it to be 3 feet from the property line adjacent to Park Hills Circle. I discussed this situation with Dan Roth and he indicated that DSD would honor this existing waiver in granting a permit to reconstruct the bed. We will have a registered land surveyor stake the location of the lot line and drainage easement in the vicinity of the proposed reconstruction so as to prevent possible encroachments. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space - surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal Sincerely, Ted Moore, P.E. T-25ttop 7echnicafServices 14530 Echo Canyon 4Z99 yl nchomge, AX 99516 Thone (90) 34S-1355 Lot 17, Block 2, Park hills S/D, Addn. #2 14730 Park hills Circle Soil Absorption Bed Reconstruction Specifications 1.0 General: 1.1 The scope of the project consists of removing soil cover material and contaminated gravel and sand from the existing "biomatted up" soil absorption bed and reconstructing the bed to an improved design standard with clean sand and gravel. 1.2 Construction shall be as depicted on the approved site plan, plan and cross-section and these specifications. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. Prior to the start of work the owner (or the contractor) shall arrange for a registered land surveyor (such as Shane Noll ph. 34S-5513) to stake the intersection ofthe drainage easement boundary and the property line abutting Park hills Circle, and to place an additional stake on the drainage easement boundary ata distance of approximately 40 feet north west of the intersection stake. T/re survepor should also place hvo stakes on the property line abutting Park Hills Circle at distances of approximately 40 feet and SO feet southwest of the intersection stake. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for retaining wall construction and finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 STEP Tank and Residual Disposal Drainfields 2.1 The existing STEP tank shall be inspected to determine its integrity and that there is no indication of groundwater infiltration. If the tank appears to still be in good condition, it shall be retained in service without modification. 3.0 Bed Reconstruction Procedure: 3.1 The contractor shall remove and stockpile the existing soil cover over the bed. The insulation and filter fabric shall then be removed and disposed of properly. 3.2 The contractor shall remove the existing distribution pipe network, sewer gravel and upper 6 inches of the original filter sand from the entire 15 -foot wide by 43 -foot long bed to create a level surface of uncontaminated original filter sand. If the original sand encountered at this level still shows evidence of biomat contamination additional material shall be removed until uncontaminated sand is encountered. 3.3 A minimum of 12 inches of clean ISF filter sand (with Q% passing the #100 sieve and I% passing the #200 sieve) shall be placed on top of the original sand to create a level surface at approximately 6 inches above the elevation of the top of the original filter sand. 3.4 A total of 9 inches of washed sewer gravel shall be placed on top of the filter sand. The distribution piping network consisting of 1.25' diameter Schedule 40 PVC with 3/16" holes spaced 18" O.C. shall be laid in the sewer gravel with the inverts of the distribution pipe at an elevation not less than 6 inches above the top of the filter sand. 3.5. Next, filter fabric and 2" of new rigid insulation shall be installed over the entire top of the sewer gravel. A minimum of 24 inches of backfill material shall be placed over the top of the insulation. The contaminated material removed during excavation may be used in the lower portions of this backfill. The top surface of the cover material shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.6 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of 5 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the cover material and contaminated gravel and sand has been removed to expose a clean sand infiltrative surface, (3) after the new filter sand is in place, (4) after the sewer has been placed and the distribution pipe network has been installed and connected up to the existing STEP tank, but prior to placement of insulation or filter fabric, and (5) after rough backfill and grading is complete. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. SEPTIC AREA ; ° LOT 6.BLOCK 2 R = 100' PARK HILLS #1 I I I WELL I , REMOVE AND RECONSTRUCT EXISTING 15' x 43' SOIL ABS. BED W. 12" ISF FILTER SAND & 6" WASHED GRAVEL UNDER 1.25" DIA. SCHED 40 PVC DISTRIBUTION ° PIPES W. 3/16" HOLES 18" O.C. SOIL ABS. SYSTEM , HOUSE ------ - o � SEPTIC / ® TANKS 3-BORM DRIVE i' HOUSE -�-Q ----- 10% r RETAIN EXISTING / LOT LOT 16, BLOCK 2 SEPTIC TANK / 1 O PARK HILLS #2 & STEP TANK / SEPTIC WELL AREA R=100' / WELL / R =100' LOT 11, BLOCK 2 PARK HILLS #1 SEPTIC _PARK HILLS CIRCLE AREA _--- -- LOT 12, BLK 2 PARK HILLS #1 -_� �q�• •.,• ------ LOT 17, BLOCK 2, PARK HILLS SID, ADDN. #2 --- " 49 'J �� SEPTIC SYSTEM UPGRADE Tt •• 1 * / • ........ .......... / SEPTIC SITE PLAN / / AREA- ••� •�•••••••....1 /IT •R THEODORE F.MOORE i ,} I FLATTOPTECIINICAL SERVICES IINCH =50 FEET 14530 /�� :• CE -3589 :• ECHO CANYON ROAD DRAWN BYTFM c°r0 x Ar �'a� .,• oli7 , Aw ANCIIORAGE. ALASKA 99516 OCTOBER, 2006 -b' eylo �Nw NOTE: THIS IS NOT A SURVEYED PLAT. 1.25" DIA. SCHED 40 PVC FROM EXISTING STEP TANK 2.5 -a- 5 15 5 i 2.5 3 O'Al' 7 1.25" DIA. SCHED. 40 PVC DIST. PIPES w. 3/16' DIA. HOLES IN BOT. @ 18" O.C. PLAN VIEW SCALE: 1" = 10' 1 2 .8 ruruua rrrrrrtn 2.5 I 5 2.0• SOIL COVER 43 M.T. RECONSTRUCT 15' WIDE x 43' LONG SOIL ABSORPTION BED W. 6" EFF. "Al'Lo:�_WASHED GVL. 812" ISF FILTER SAND UNDER DISTRIBUTION LATERALS MONITOR TUBE FINAL GRADE ORIGINAL GRADE CROSS-SECTION "A - All SCALE: 1" = 5' Q�E.�F•4 N.T-1 * 49m 0 % THEODORE F. MOORE •i �• :, CE -3589 1" , w ��o to ss1o!i�; 2" RIGID INSULATION FILTER FABRIC 1.25" DIA. PVC. w. 3/16" HOLES @ 18" 12" - 2 12" WASHED SEWER GRAVEL ISF FILTER SAND BOTTOM OF EXCAVATION LOT 17, BLOCK 2, PARK HILLS S/D #2 SOIL ABSORPTION BED RECONSTRUCTION PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES SCALE: AS Sl ON%,N 14530 ECI10 CANYON ROAD j DRA%1N BY: TPAI ANCI IORAGE. AK. 99516 OCTOBER, 2008 (oz - C Municipality of Anchorage page 1 0f 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number:SWR4�27 PID Number: )'i2— 76 Name: A Wastewater System: ❑ New Upgrade Address: 30 'P iZY t s c,f 2. ABSORPTION FIELD Phone: No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ' r(Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Oe 7 Depth from original grade: GPD/Sq. . Ft. . Lo[: Block: ^ Subdivision. �!-!2� IL S Depth to pipe bottom from original grade: Gravel depth beneath pipe oC / Ft. Township: Range: Section: Fill added above original gr grade, Gravel length: 1 ecn t L Ft. ! 3 Ft. WELL: El ElUpgrade Gravel width: _ Numberof lines: Distance between lines: Classification (Private, A, B,C): Total Depth: Cased To: eJ Ft. Total absorption area:/[�.t 6 Ft. Pipe material: Ft. Ft. 10 7-J SQ. Ft. !�✓G $ y p Driller: Date Drilled: Static Water Level: Installer: Date in tailed: Ft. Zv - a z/ 1 P g Yield: Pump Set at: Casing Height Above Ground: GPM FL Ft. TANK SEPARATION DISTANCES ❑ Septic ❑ Holding �<S.T E. P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines LI.G TaLk k `;7-5 0 W211 tt O _ I1� Material: Number of Compartments: Surface Water LIFT STATION Line Line 7 _ Size in gallons: ! Manufacturer: `7 /. A! moi` L Foundation 1 ,� 'Pump on" level at: 2 "Pump oft' level at: Flo High wader alarm at: _{y Curtain Drain ..--. Pump Make & Model O ElectricalInspections performed by: • FGl-e LO C;:' L Remarks: BENCH MARK ff / f i t3 �a.L..` �-/-L 1:-c'K n -e/�c. u Location and Description: / t s ems[ P_C k^, c. a �l Qace� e v Assumed Elevation: µA c c Ft /. `I S Ct Lt GbriC 6L ' 'L L J ( r �E +�?.,A!{L S t Inspections performed by: Dates: 1st4�� 2nd L/ Ay'All ` / �A veaVageRea anmen ®ec.. Tohuen Fr,_,tklond a G 4 Department of Healpt and Human Services approval QU�rmem CE .225 �� Reviewed and approved by: Date: 0 -3I - 94 Swing Ties AC 26.5 BC 12.5 AD 294 BD 18 AE 33.8 BE 21.3 AF 44.5 BF 23.5 I I 25 0 25 50 75 100 125 150 SCALE- 1" = 50 Fr. I�sO s rE F � � 43X15�Mloun jop TOBBEN SPURKLAND P.E. LOT 17, BLOCK 2 PARK HILL' ADD. 112 SEPTIC SYSTEM ASBUILT 203 W 15TH. AVENUE ANCH. AK. 99501 14730 PARK HILLS CIRCLE DATE: AUGUST 22, 1,994 (907) 279-3916 11 DANIEL O'TIERNEY SHEET: 2/3 GRID:3037/3137 o- t 15 43 Clean Out A 1 -1/4 PVC with 1/8" holes of 19- A O Monitor into Sand SECTION A -A Per lFilter Sand Perforations tions 106.1 6" Hal/pipe 1-114 PVC Holes Pointing Up 102.514L- 8" Sewer Rock 1-1/4" Distibution Pipe Monitor into Rock O no Existing 1000 gal Septic Tank [Do O F- 1250 Gal STEP / Mirafl 1401250 gal STEP tank 6'" Concrete Sond 6 feet below sur/oce --/// Ground Wafer { BENCH MARKL: � ��� _ SOUTH WEST CORNER OF HOUSE 4' ""F/ller" Sand BOTTOM SIDING ASSUMED ELEVATION 100.00FT 92.9 IUBBLN SP.E. LOT 203 W 15TH. TH. AAVENUE ISEPTIC17 BUCK 2 PARKS HILLS SYSTEM ASBULLT NCH. AK. 99501 DANIEL O'TIERNEY DATE. SEPT. 21, 1994 2Z9 -J916 I 14730 PARKS HILLS CIRCLE SHEET" 3/3 GRID. 3037 FF'UP1 KC: H l a.c k:a TAD/FAX September 2, 1994 TO WHOM IT MAY CONCERN: PHONE HO. : 243 0542 RE: D. O'TIERNEX RESIDENCE PARI{ HILLS CIRCLE — SEPTIC SYSTEM Sep. 05 1594 07:21PM P1 This is to verify that step tante electrical system was connected to rnde on the above new septic system installation, CITY ELLGTRIG Ros irg+/oyne MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 zo(q 4 o «(� ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940274 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:O'TIERNEY DANIEL PATRICK & OWNER ADDRESS:14730 PARK HILLS CIR ANCHORAGE, ALASKA 99516 PARCEL ID:01714228 LEGAL DESCRIPTION: PARK HILLS #2 BLK 2 LT 17 LOT SIZE: 42069 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/02/94 EXPIRATION DATE: 8/02/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ALL SAND USED IN THE FILTER LAYER MUST BE A CLEAN COURSE SAND WITH 40-. OR LESS PASSING THE #100 SIEVE AND 20-. OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE SAND USED OR OBTAINS FROM A PRE -APPROVED SOURCE. RECEIVED BY: &IJDATE: ISSUED BY: DATE: 9- 2 - 94 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 Subject: Septic System Permit Lot 17, Block 2 Park Hills #2 Gentlemen; July 17, 1994 The owner of Lot 17 Block 2 Parks Hills requested our assistance in correcting a mal functioning septic system at the property. In the process of digging testholes we found that the system had been installed too close to observed groundwater levels. The system was 5.5 feet deep with groundwater observed at 6 feet. A note on the soil report used to design the system, reports ground water at 6.7 feet on July 2, 1984. We intend to replace the existing system by removing the existing sewer rock, importing 4.5 feet of filter sand and locate the sewer rock on top of this imported sand. We excavated several testholes on the lot, with the exception of the location of the present system we did not find any suitable soils. A layer of peat overlaying gray and blue silt/clay was the common condition. At the location of the existing system we found clean sand under 5 feet of peat. Gradation of this sand is enclosed. Yours Tobben Spur land P.E. 1 T.SPURKLAND P.E. 203W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 17 BLOCK 2 PARKS HILLS #2 DANIEL O'TIERNEY Ground water at 6 ft Use Pressurized Bed Import filter sand to obtain separation Soil Rating. From test June 30, 1994 <1 min/in On site material is 63% sand See sieve analysis Use .7 gal/ft.sq Required Area per Bedroom: 150/ .7 = 214 sq.ft.. Number of Bedrooms 3 Bed Area 3 x 214 = 642 sq. ft. SYSTEM CONFIGURATION MOUND TOTAL LENGTH 43 FT. TOTAL WIDTH 15 FT. BED AREA 43 X 15 = 645 SQ.FT. SEPTIC TANK 1250 GAL STEP. Remove existing tank, sewerrock and top 6 inches of underlaying sand. Import 4.5 feet of "Valley" Sand from Quality Sand and Gravel Wasilla, or "Lake Otis11.- 6 inches of Concrete Sand 6RAv64 8 inches of sewer rock 3 feet of cover The installation of this septic system will not prevent wells from be installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. PRESSURE CALCULATIONS Total head loss: 45 ft. Pump delivery at 45 ft. From pump curve: Discharge per 1/8" hole at 5 feet of head; Number of holes: 30/0.42 = 72 Spacing of holes: 38xl2x3/72 = 19[inches] Septic System Design Lot 17 Block 2 Parkd Hills 12 pg -1 I I I I I / Lar n 50 100 150 200 SCALE- 1" = 100 Fr, I I I I / I / I I I LOT 8 OT 7 I OS I LOT 9 �� I Well I Lar 67, 8- fj 0r �$ C\1}]�B A3 BCG fdC 3YL 'J f CF. 25 nT ITOBBEN SPURKLAND P.E. I I LOT 17, BLOCK 2 PARK HILLS ADD. 2 SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE 14730 PARK HILLS CIRCLE DATE: JULY 17, 1994 ANCH. AK. 99501 DANIEL O'TI£RNEY SHEET: 1 3 GRID: 3037 3137 19071 279-3916 I I 1250 STS m \ I I 25 0 25 50 75 100 125 150 SCALE, 1®.= 50 FT. I I I (9071 279-3916 ' U°°"V """""'-"V" ` ' .r . LOT 17, BLOCK 2 PARK HILLS ADD. 2 I I SHEET: : J037131-57 /SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE 14730 PARK HILLS CIRCLE DATE: JULY 17, 1994 ANCH. AK. 99501 DANIEL OWERNEY 2 3 GRID 43 mm A 1 -1/4 PVC with 1/8" holes at 19" mm A rK SECTION A -A 6" Hallpipe 1-1/4 PVC Holes Pointing Up Monitor Int Fitter Sand - Monitor No Perforations 3 Fl. of Cover 4" Topsoil 0 0 0 0 0 0 0 on% 0 0 0 0 q � g p q � n 8" Sewer Rock - 1-1/4" Dislibulion Pipe Wall 140 6" Concrete Sand 4yzFilter� Sand 1-1/4" Discharge 9 C Ground Wafer 1250 gal STEP lank 6 feet below surface BENCH MARKL: SOUTH WEST CORNER OF HOUSE BOTTOM SIDING ASSUMED ELEVATION 100.00FT I TOSSEN SPURKLAND P.E. I I LOT 17 BLOCK 2 PARKS HILLS 2 I I SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE NCH. AK. 99501 DANIEL OWERNEY DATE. JULY 14, 1994 9on7) 279—TQ1R 14730 PARKS HILLS CIRCLE SHEET. • 3/3 GRID: 3037 • Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �C T/I U I f ey-0L�J- DATE PERFORMED:` I r l LEGAL DESCRIPTION: LI �7iaK� -park 1-1�i3 MZ- Township, Range, Section: SLOPE SITE PLAN 1 2 3 4 5 6 Rq 7 8 X44, 9 71V 10 Gross Time WAS GROUND WATER Depth to Water Net Drop ENCOUNTERED? S 11 IF YES, AT WHAT p 7 DEPTH? P 12 E Depth to Water After 6 13 Monitoring? Date: - 14- 15- 16- 17 4151617 18- 19- 20- COMMENTS 81920 COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: c —� 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1 I Q i 72-008 (Rev. 4/85) �Iur�ici alis of Anchorage Department of Health and Human Services ®r -is ® 825 " U Street Rick Mystrorn, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor September 22, 1994 Tobben Spurkland 203 West 15th Avenue, Suite 203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 17, Block 2, Park Hills #2 Waiver Request #WR940049 Dear Mr. Spurkland: Your Request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is three (3) feet. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. S' erely, Daniel Roth Civil Engineer On-site Services T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 Subject: Lot Line Waiver Lot 17, Block 2 Park Hills #2 Gentlemen; MUNICIPALITY Of ANCHORAGE ENVIRONMENTAL SERVICES DIVISION S E P 2 1 1994 September 21, 1994 We request the granting of a 3 foot lot line waiver for the drainfield that was installed on this property in August 1994. Due to poorly defined lotlines one corner of the absorption bed was installed to close to the east lot line. This will not create a problem in the future since this lotline is also a street right -of way line. Yours Tobben purklandP.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE NEW NAME ,r7�Lt,$/�-Gt L%1✓+lZ'd�I'hQ�)�`-'� -Sr�I S`�� C� ❑UPGRADE MAILING ADDRESS %) �LJCJ (JV LEGAL DESCRIPTION •� i /1 NO. OF BEDROOMS LOCATION p j_ / � �.� % ! f Well �' Absorption area Dwelling !� PERMIT NO.0 u [ DISTANCE TO: 9b % d � U Y F Z a Q Manufacturer /J ) a /7/t G vl�� Material No.No. of compartments y < Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth poU Well Dwelling PERMIT NO. DISTANCE TO: J a zMaterial Liquid capacity in gallons =Z~ Manufacturer �= Well Foundation ! Nearest lot line— .� fi�P PERMIT NO. 7 LU az DISTANCE TO: % No. of lines Length offeeac lin, '� Total length of Ies Trench idt 2 r inches Distance between lines 2 w —Material /@�� Top of the to finish grade beneath tile Total effective�abssorption area V^^ ¢ F. .¢, �' inches Length Width Depth PERMIT NO. w Q F as Type of crib Crib diameter Crib depth Total effective absorption area W Well Building foundation Nearest lot line rn DISTANCE TO: Depth Driller Distance to lot line PERMIT NO. J Class J Lu Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER trPAL% f fic PIPE MATERIALS PVL L SOIL TEST RATING l�b � INSTALLER .4c, re 6L % -e A2 REMARKS f 6V fDarc ls5e/V, 42 n3 eck e7 Ll m p S T g p M ;7L (rc/ -A44 r fill- ff d Ca j ?$ t. APPROVED DATE LEGAL 0c)e I" 72-01:3 (Hev, JIR:i) k`i 2404 Barrow Street • Anchorage, Alaska 99503 • (907) 279-9597/279-9598 Alaska Environmental Control Services 1200 W. 33rd Avenue Suite #B Anchorage, Alaska 99503 Attn: Carmalita Dear Madam: January 55 1985 This letter is to inform you that Grizzly Electric, Inc. did the electrical installation on a sewage lift station for Wolf Construction. The work was done at lot 17 block 2 Park Hills Subdivision. The installation was done to National Electrical Code standards and Anchorage Municipal Codes, it was also inspected and approved by Anchorage Building Safety inspect -o- . Sincerly, Dave Hallowell Manager f uepartanell l_ RCCi1 l_ll Gita" IJII v w — __ Al 825 ' Street, Anchorage, AK. 4JA01 264-4720�✓� / # # HANDWRITTEN PERMIT # # # Permit # WELL AND/ ON-SITE SEWER PERMIT Applicant: _S T �� - Mailing Address: Mc) > LJ< Location: A /K c/ GCj "3 Phone Number: 5 Co l - 5 o j o /�� > �/ ,,, Lot Size: e/n `%b'y Legal Description: � ,�`�i�c J-�-''� Type of Soil Absorption System Is: Sec 3V %!l� Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) /5-0 The Required Size of the Soil Absorption System Is:' /6 /G '/�> 0"Cs- / G /Vl _DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and - the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = D d GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if • the residence 's cmodeled to include more that�3 bedrooms. � Signed: Issued by: Applica �® �IDate : Jc SWP/024 (1/81) �!/a�C sf�-J���/ /�7��uw /J���� 2<v ��e l S A( /50 LEGAL 1 2 3 4 5 Jo A ION: Par -14 (pt) pmt - (fir^) SLOPE tl V's • IdQ Q' �� WAS GROUND WATER ENCOUNTERED? ® gale r 4 IF DEPTH, AT WHAT Z.Z�.� 14 Date ,: of AC4 ,� ��r•.•.•• Net .15 Net Drop Time Water •• �ea •ice• 17 .•. • •' d o C. Reid.. ;t� s�•. 2251-E t9 DATE PERFORMED: .2 l3 8 1 i�elc J4 3 SITE PLAN zi iteadlr+g Date Gros rime Net Depth to Net Drop Time Water i [4; - i+ i ALASKA ENVIRONII�TAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276.1361 JOB +-� \-' _ SHEET NO. -t OF - - - CALCULATED BY DATE�z-z ,i T CHECKED BY DATE QP,Al F ALASKA ENVIRONM ,jTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276.1361 JOB SHEET NO. ' OF CALCULATED BY DATE CHECKED BY DATE I 4: 9 d IL i. Qo 13 �w p O O .CT E Q�C f- bq L L o a J lb OCO r Lu CD O` m j 0 0 0 O a -'C C H � w•) o 0 w�Of y w Cy I.L.- _ .p W O C a U Kolb w W o ` l l`O 4Q C O 4b �� 0 w �' I 4: 9 d IL i. O 13 O p O O f- bq L L o a J 3 0 r Lu CD m o o a o a) o 0 w Cy v C C w � l`O 4Q C O ti Q �� -21 b �' hQ w c o � J qj Q O d � o oz. I 4: 9 ME d IL i. O a f- �, o J a N r Lu CD h _ � z a o 0 �oLL ME ALASKA ENVIRONW-1AL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO. - -j' OF 5 CALCULATED BY DATE CHECKED BY - DATE SCALE ��� S ADB ALASKA ENVIRONN� jTAL CONTROL SERVICES, INC.' SHEET No. of 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 CALCULATED BY DATE Phone 276-1361 CHECKED BY DATE SCALE N7: .... _ _ .. ................ .._... ... s .. ..... t ... ............ F. e9 ....._.. _- ..... . .. _,...._ _..._. ,.......... . o ' u i _ :. a ._.a x i.... _.... .._ ...... _ 6 L 0 ... .......... Q : ._....... 6f ._ , ............ O 8 R . J Yr��t'M_-'�C 5 _ MUNICIPALITY OF ANCHORAGE Development Services Department t p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-142-2 8 Legal description PARK HILLS#2 BLK 2 LT 17 Site address 14730 PARK HILLS CIR Current property owner(s) THORSELL G SCOTT Expiration Date: X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: By: 8/1/23 bedrooms, with the following stipulations: Original Certificate Date: 5/1/23 This Certificate of. On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 MUNICIPAU TY OF ANCHORAGE ......_. ... .._.._ _-.<.. .... - .... ...-._ . tee, ,.,.. .: .. '^� Development Services Department �� = Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-142-28 Complete legal description PARK HILLS #2; BLOCK 2, LOT 17 Location (site address) 14730 PARK HILLS CIRCLE *ANCHORAGE, AK Current property owner(s) SCOTT THORSELL 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 007-830-2791 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel R Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 550 Date of Payment y 26'z, COSA # 0SG231111 Waiver Fee $ Date of Payment Waiver # COSAApplication_June 2022 nA `4 COSA Checklist Legal Description: PARK HILLS #2; BLOCK 2, LOT 17 Parcel ID: 017-142-28 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system Well log is filed with Onsite (or attached) Date drilled 6/5/1984 Total depth 123 ft Ca,,.gd to �ft ` 12. 3 N Sanitarysea is g—c—orr ectly`— WE Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/7/2023 Static water level at beginning of test 56.2 ft. Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping ` ) c C. 11C 6,r a;" $ t. ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/10-14/09 RN ALL standpipes present per record drawing Total measured depth from grade 3.6 ft (max) Measured depth to pipe invert from grade ft (min) 0 N/A — pressurized field. 0 Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A —IJ113 Well production at time of test 3.1 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ® No Eg/coliform bacteria is Negative Nitrate D' ,3'11mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by uCu Date 4/7/2023 C. LIFT STATION ['Required maintenance completed Age of lift station 2 years Lift station material PLASTIC Comments: Adequacy test date 4/7/2023 Results Fm� Pass Fluid depth prior to test 2 in Water added 606 gal New fluid depth 3 in Elapsed time 120 min Final fluid depth 2 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 2 in Effective depth remaining 4 in Comments/Deficiencies: `BOTTOM OF BOTH MTS SET TO SAME ELEVATION, ASSUMED TO BE AT BOTTOM OF BED COSA Checklist—June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ME Yes if No ft M Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' QYes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' FE� Yes if No ft rm Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ME Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' R Yes if No ** ft Surface Water > 100' 0 Yes if No Tank to Property Line > 5' [E Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No *3ft Private Wells > 100' M Yes if No Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *PER 2009 INSPECTION REPORT IN MOA RECORDS "ASSUMED ft ft li G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gamess Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an aftemative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 o� OF CU�4o 4 T �i Q e y A. Go ess;' CEIF 79 �ce0 LICENSE ��a pro f es ,0" L11 #AECC884 �ODpOO�c' 0 .Z] m m 0 < Ln lz O C- r m o r � r X M. D 3 v Lc D N n E o ° o n o n m S S 0 00 tnpv 00 (p OQ � W N-0 rD °' y ;4kD N Ln �3 tA rD v o to 0 in n 0 0 m D rn n m Z m Z p W p W m Gl D 0 u � L W r, 0 0 A O 00 0 p N W O w W N TO Ln w Ln rn 0 j i Ira a�T0 00 9�' 0 ; SAW of 1tZ� D Z O rn -0 Ln Ln ;a ;10 -10::E -4D0-4 Ln v, nv5D�p�nin�OnC 0�0�� m m m Z C m Mn S* m S Z X S C C 0 xmm p S M S O S S T O in 22 X Z D S _ TOx��Z�w�DmW WZOxminnNm�mmZtmiiGlZ�tntn A O D mmmDZ§Zm nLnAmp�O mmrr0mrZLnCo wo �zmZ���'73 Ooo�G10�-iCm6�'o; OX0 oM,z>>nmvo A O O m m- Z 0 D W O D� p y D p n O m p m D S-OoSoZO00 22Z�r00 < co Oin �Om CtnC7x m�S �m0-nm F S vmi m N r C 0 Z C Z C N� Z 0 Z m m O O T" 0 O vri z>ZL1m Wy=_IOODnpC��D tmiin��SZ�ComLnnD S {����vOZCo�<�,ErK=0 MLnMO r -nm 0-nm� 0 v DDSOZ0>W CZCnLnC7�nN OZ��� X2Sm�tzii A to L, 0, mmAm�mzOC L, 0r z --0SC n W CoODnm--iUl ppmN<<n�Z� ZmCD nmv,p�0� # FZLIDOA�m ZO�DDZOC�M LlD-Zim M 6>-,m1 �2ny25ZKmZ Ln --j mOyzv) M>m= < D D J N ���zm a n -0 N — FAp -< 60 zOmZ G) -1 N PO Ln n Ln mTtnn �_z'='ice S iv p�T mD-i-i O �� vi0 O O� 0� o Co O m N Z D m C r 0 0 r p 0 0 w Ise y �- �r w r N P 1 moo. 0 N 0 Q$, $� $a r Sx O I W oL II, ` 4 m z N G V-0, N 0 p D_ Z D m rn D w m K z v tial.+ r 0 rn --i m r m v S O Z D Z 0 m r m Po Pon m D Ln K z Development Service; Department Phone: 907-34,,3_7904 On -Site Water & Waselawater Section Fax- 907-343-7997 Lift Station/Pump Vault Maintenance Loa Owne 1� Phoni Legal Desc..—.. S012tj Tank: -Sludge level inc lies -Pumping Street Address A13_Q_Az&���//51�G/ (f PID required •Pumping completed y_e-s o Lift slatiao.- 15Z -Pump basket cleanec, -Effluent filter cleaned r" -Control floats cleaner *Proper float settings confirmed AR no -Operation satisfactor) Alarm System: -Dedicated,electrical a arm circuit -Audib,16 and visual alarm inside dwelling -Alarm system operatj(!,n Manhole Fdseer -Ground water intrusio'i at riser to tank cortriection -Ground water intrusio'i around pipe penetrations yga_�a -Weep hole functional 1,!�­ ..n_q -Manhole lid: Furtetional Insulated Properly Secured /y2j$ Lr)j� !the -All manufacturer requi reed inspections and maintenance completed Comments; <--. - , -- -4 .. =6.r:.... ................ .......... _._ ............ ........... ...... ............................ ...... ............. __ ......... ......... ....................... ........... .... ... .. ................................ . ... .......... ­ .............................................................. .............. ­ ............ . ............. _..-.....1.._, ...................... I .............................. -.."'...1- ....... I..", ........... ........... . ........ -1 ...... ........ ......... _ .................. _ ............. ...... . Mainknonce ftyldfij, Technician Date of maintenan Company ),Lll/- �vl�� Signatur*����� I— or Mailinc q A6 'TS Municipality of Anchorage • Development Services Department Building Safety Division = " On -Site Water and Wastewater Program e A L T T a 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01(- 14z - z.B HAA # Expiration Date: 1-31-04 1. GENERAL INFORMATION Complete legal description _ Lo -r %-I, gu. 2, PARK N tL '1Z Location (site address or directions) t 4 130 'PARK 14 ttts c_t Rc.LG Current Property owners) __ DAr1%t P.4T¢« dT„Qe Ht^y Day phone -.21e9- 5153 Mailing address 14'76p PAV-V t-ltt_1_9 LIP_CLC-- Lending agency Day phone Mailing address Real Estate Agent JoD-4 LAµP, I Q.1GHta..w0ayphone Mailing Address 21=1..1 AX Unless otherwise requested, HAA will be held by DSD for pickup. 2.. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY:* TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site [� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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. Name of Firm oWe-M Phone Xlq-3416 Address e20 M, V(/ ►5" )47,61 Engineer's Printed Name Date it)-Zg-03 ci '• C4 5. DSD SIGNATURE _(Z Approved for 3 bedrooms. eevoeeo•a.r• �, 69�ycq. TobL�.^.n Ssutkt�tld v ,�Wuc Disapproved. `©_,,! =• Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory WASTEWATER X Maintenance Agreements Supplemental Engineer's Report Other By:C3o%-� Original Certificate Date: /a - / - 03 (Rev. 01= ....... ..... _..._ _� ..._.. .......... ... ..... Municipality of Anchorage o a • "° Development Services Department Building Safety Division w " On -Site Water & Wastewater Program j 4700 South Bragaw St. P.O.'Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: / n i 1.7 131E 2. IV—V- 141 LI -s Parcel ID: 071- A. ?1-A. WELL DATA Well type If A, B, or C provide PWSID # tit to Well Log (YIN) y Date completed e�,- Ey Sanitary seal (Y/N) Wires properly protected (YIN) Total depth ft. Cased to Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test. t- Irk %-1 q��4 lo-!,, Static water level q?7 ft. !o V ft. Wells production 5 g.p.m. 3: ? g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate tL1->- mg.H. Other bacteria N 0 colonies/100 ml. Arsenic: ✓ mg./I. Date of sample:lir a'N Collected by: B. SEPTIC/HOLDING TANK DATA TankiType/Material S p l^e e� Date installed Tank!size tor u gal Number of Compartments Z Cleanouts (YIN) Foundation cleanout (Y/N) _ Depression over tank (Y/N)_ High water alarm (Y/N) tom) Datelofpumping • K 1i6-10� Pumper 1 .4 ae, C. ABSORPTION FIELD DATA Datehnstalled 5h01i Soil rating (g.p.d./ft2 or ft2/bdrm) D_ System type 114-W Length '~ q3,.. ft. Width I ft. Gravel below pipe l,t:> ft. Total ldepth3. 5 ft. Eff. absorption area G�1� ftz Monitoring tube Depression over field {�f_ Date of adequacy test 91��1 I ti3 Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test � in. Water added Y70 gal: New depth lv in. j Elapsed Time: QD min. Final fluid depth;in. Absorption rate >_ yy g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 7 7 If yes, give date I D. LIFT STATION Date installed $TO Size in gallons 125 V "Pump on' level at qa. in. 'Pump off' level at3_ in. Datum i36 VtOndd l an k Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Manhole/Access (Y/N) �Z High water alarm level atin. Meets alarm & circuit requirements? On adjacent lots �) f U -y Absorption field on lot I V 5 On adjacent lots �Z / &-V l Public sewer main N f i4 Public sewer manhole/cleanout N/A Sewer/septic service line 1y Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7 Property line 3 5 Absorption field q D Water main T-41Pr Water service line 50 * Surface water. 7 +uo Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 Building foundation 6 6 Water main t -41A, Water Service line = 10-o Surface water 7 +u.0 Driveway, parking/vehicle storage to Curtain drain 1 y Wells on adjacent lots +wv F. COMMENTS 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 HAA guidelines in effect on this date. n Engineer's Printed Name I o bbeH �D vrkta wk Date t OlZS 10 5 HAA Fee $ 37J' Date of Payment , 01yd`10 3 Receipt Number (Rev. 12/01) Waiver Fee $ _ Date of Payment Receipt Number FA f'Y+ Jyy LaM To Tobtwn SpV my DWO'1-10'2002 TIn, 11.1402 Nd P,O, 1 ofI jIRYE rOR•4 (Rwlll eT'ON e.ntl. (Enlot 194• I wvt fY4,g, to r9[ iat4fT OC IC41f10 ON fMlt /L4T 411 , o 102"0114410" I41t Nil Yrt4T fNIYt OM 94( 10t 41 12 LEOENO 0 LOT CCRNERS ►CV90ATICN ORAINAGE ARR09V3 . r. D,P ♦Ic t7..�j;/y NOTES$ $• O IN4lL of TNI Rf VONp(ILITT D/ TML fY$Lt E1 04 O-Y(I to yp„ 101E /INt LOC 4f 10- t,e-9 Y(t TL 9ll OV/OI Y17 W9 t0YEY99T1 4,0 e4e1MI,Ctf. T TN4T !. IT If TM[ YC710, III I Ie,IM,D I ( l TY 01 TN( IVILOta TO Y141rr ILL 9L(Y•TI0Y/ 4t/II(7 10 • lL YTILIf:(116 CIGLIN.•CE• I. Toll$LAI Rf,4tft,T1 Tor ,44pfL 01 t4p,(q fY OIICY. 1I f90Y Tot R(CO40(O PLAY DISCM TM41 144C I1. IYOT4JYEY1 4 1 IIIID4 fp04,ITtR 10 / ICO fll0- 14e fN 1.19 Il9Y ( I11Y1 Or T9( (L'04010 PLAT 411 YOT ow% 0 D 4. TN( IM/e4Y 9TI M 1,0-9 OM ULCII$C•LL/ to pyp,. 4iTL4T I( IOR fwE VIt all.OI L1, OIR01MITI7J 110-1 .UTf(p LOT LINIS OR E41(NtYTf TT [`IL4f It`Y 12?14 etTay t 4 PC 11 T(OMlwt 910111CM IL IIYYCYY4 0 Y L7 I•D t1ORfIYC11.O LVI101p, BESSE, EPPS a POTTS 149-9452. 4NCNORa E. 68ih AVE GE ALASKA 89507 149-9 n. »a•a`at GMK t1• Y•I t• /-L Me. 4/� �• �! rLit Is . J MUNICIPALITY OF ANCHORAGE �/ -2, DEPARTMENT OF HEALTH & HUMAN SERVICES 7 `� DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL4.1e OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ` jrd & a3,1 W 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) range) (a) Legal Description (include lot, block, subdivision L/ -/6 y K _AI I Location (address or directions) /¢ rdork/�rls oui (b) Property Owner ��� Telephone: Home Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Lfollowina address: or: day phone number below. 2. 0, if hold for pick up List contact person . 2. TYPE OF RESIDENCE Single-FamilXYff Number of Bedrooms . 3. WATER SUPPLY Business Individual WelF 11� Community ❑ Public ❑ irmation from the State Department of Environmental Conservation Note: If community well system, must have written conf attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite �1 Public 13 Community El Holding Tank U If community well system, must have written confirmation from the State Department of Environmental Conservation Note: / attesting to the legality and status. 72-025 (Rev 8/861 Front Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION M. M As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �ksyE£6G4 �T7S Telephone 3 �9— 6� �J Address 2;71 £K� & A-9 Date `J`� -2- Engineer's Seal c OF A/ *%4/ OFESS10t�Pm1 DHHS APPROVAL Approved for �3 bedrooms by 1"'" `� Date Approved ✓� Disapproved Conditional Terms of Conditional Approval / LOfG /<CCO tis�.wC..�LC CAUTION --7 /- R The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/861 Back MUNICIPALITY OF ANCHORONICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIINALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 zsa ,jum 2 5198 -a�aa Z-1-7 13Z A-4/6 S 1� � RECEIVED Legal Description: A. WELL DATA Well Classification If A. B, C, D.E.C. Approved (Y/N) Of Well Log Present (Y/N) 6�5 Date Completed Juh� Yield ��`� 9� (2—ILt `9-7 Total Depth /Z 5 1�4_ Cased to 123 Depth of Grouting Static Water Level �� A,- Pump Set At Casing Height Above Ground Sof Sanitary Seal on Casing (ON) Electrical Wiring in Conduit (Y/N) y� 5 Depression Around Wellhead (Y/N) �O Separation Distances from Well: To Septic/Holding Tank on Lot %c?¢ ; On Adjoining Lots %dam To Nearest Edge of Absorption Field on Lot 600 ; On Adjoining Lots To Nearest Public Sewer Line A To Nearest Public Sewer Cleanout/Manhole N I4 To Nearest Sewer Service Line on Lot A Water Sample Collected by 4 �0 9 ;Date / ✓�� Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA 8 �O ;e No. of Compartments � Date Installed ��—Size -- �—_C — P Standpipes (Y/N) Air -tight Caps (Y/N) V Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) .4111 Date Last Pumped Aje-- Pumping/Maintenance Contract on File (Y/N) A) ; for Holding Tank High -Water Alarm (Y/N) 01' `'� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /Og To Building Foundation y To Property Line 32/ AlTo Disposal Field � / � To Water Main/Service Line A %�' To Stream, Pond, Lake, or Major Drainage Course Al �0 Comments Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FICLD DATA r Soils Rating in Absorption Strata ��� Type of System Design �' 26 Date Installed of Field Via% r Width of Field 2/ Depth of Field Gravel Bed Thickness i Square Feet of Absorption Area Standpipes Present (Y/N) ` Depression over Field (Y/N) A10 Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: �¢ To Water -Supply Well �O� Property 3v To Pro ert Line '� To Building Foundation To Existing or Abandoned System on Lot IV IA" On Adjoining Lots > -or To Water Main/Service Line SIA To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course A✓%12V m To Driveway, Parking Area, or Vehicle Storage Area 2,� i Comments D. LIFT STATION 014 Date Installed Vq1�4_v Dimensions 3' .6_1At__. y2 _2�e!Fe Size in Gallons � y,/. f/Manhole/Access (Y/N) Y' i "Pump On" Level at 7"-5/ "Pump Off' Level at 0, _,O, I High Water Alarm Level at '31 r Vent (Y/N) y Tested for Al //_� Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company _ MOA No. Receipt No. ('a 00 Date of Payment _ Amount: $ �dy Page 2 of 2 72-026 (Rev 8'86) Back MUNICIPALITY CF ANCHO,PAGE ENVIRONMENTAL SERVICES DIVISION Jun] 2 5 1987 RECEIVED ID:'�,.'°i°ngin�er 4 r-' v ,,."A N Ac Cale . Morrell t, 6n cP� v No. 2055•E ��O�Q"ROFESSOP� MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION i" APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1.: General Information (a) Legal Description (include lot . , ._ .. I., n rs jr (address or directions) (b) Applicants Name Applicants Address Application Date 1J6 block, subdivision, section, township, range) Tel 3chr 7S'7j (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer ; Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: Z. Type of Residence Single-FamilyI Multi -Family Number of Bedrooms 3. Water Supply Individual Well 1�1 Community = Other (describe) 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 E::l Community [71 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] 4 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. Name of Firm92&2W21002+.� Ck{' ' ¢ ® Telephoned Addressf(� Date ��! ���°°°°r°7°' 8��aa or leiE .A * t°iQ (ENGINEER SEAL) `�i o°LVOY C. Reid, Jr, No. 2251- L,o 6. DHEP Approval e �'� °° Approved for 13 bedrooms ByCFaaA c� Approved --Fk— Disapproved Conditional Terms of Conditional Approval 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 ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 y. �,✓ [ VII:�.Jitiidi-dliiw7l0 MUNICIPALITY OF ANCHORAGE (MOA) JAN 1985 HEALTH AU'T'HORITY APPROVAL ( HAA) V-, 7- � E �a k ; CHECKLIST - FEBRUARY 1984 i''!: (`' L- " Legal Description:l�l2 161ocIC- 2- A. DELL DATA f� `t� / n Well Classification n VJ`C_ If A, B. or C, D.E.C. Ap roved(Y/N) iIJ Well Log Present (Y ) Date leted % ' t Yield eta Total Depth . /G j Cased to / Depth of Grouting Static Water Level Y 7 Pump Set At L9i�u� Sanitary Seal on Casing ) Casing Height Above Ground 2 �'Y 9 � Electrical Wiring in Conduit ) Depression Around wellhead (Y Separation Distances from Wall: To Septic/Holding Tank on Lot /y9 ( On Adjoining Lots�oa/ To Nearest Edge of Absorption Field on Lot // j ' ; On Adjoining Lots ;P0 100 To Nearest Public Sewer LineI To Nearest Public Sewer Cleanout/Manhole %A- To Nearest Sewer Service Line on Lot AJIf+ 0 A Water Sample Collected By 4•TwG� -U1�ra ; Date !111e%fes Water Sample Test Results Caments p,P,v 1 •2 O �� 461 - B. SEPTIC/HOLDING TANK DATA V/ Date Installed Size /000 No. of Carpartments 2 Standpipes AN) Air -tight CapsLN) Foundation Cleanout /N) Depression over Tank (Y Date Last Pumped A.71h- Pumping/Maintenance Contract on File (Y/N) Opt-; for +v/st- Holding Tank High -Water Alarm (Y/N) �J�rQ- Temporary Holding. Tank Permit (Y/N) y/4 Separation Distances frau Septic/Holding Tank: To Water -Supply Db11 J/)cl To Building Foundation 1114 To Property Line 32 �� To Disposal Fields To Water Main/Service Line A-)lh To Stream, Pond, Lake, cr Major Drainage Course Nva Comments ta- 0 a, Q6 [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /S"-00 Type of System Design OEJ Date Installed ® Length of Field Width of Field 024� Depth of Field Gravel Bed Thickness CJ,� Square Feet of Absorption Area f"j'g Standpipes Present /�)/N) Depression over Field (YA Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Fbll 114 / To Property Line 32 To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots 30 To Water Main/Service Line f-)1.4 To Cutbank(if present)-w1if To Stream/Pond/Lake/or Major Drainage Course N�,q To Driveway, Parking Area, or Vehicle Storage Area Comments 4pSp- c �Si�9►n. -��E2 �iS-bt D. LIFT STATION Date Installed '%/ �L' Dimensions 2 ckai•..Fr£2. 9 iz,l �ci£�o�fti Size in Gallons _--� T- Manhole/Access rY�N) "Pump On" Level at a,S ` "Pump Off" Level at Q S High Water Alarm Level at 'GO Vent 6/N) Tested for A)1, Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YJN) C�fg�0 aJ .�c.z-ear Comentso ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed n �I45-Date 40�0 �F 4 0,6260,040b 4P No. ROEi 6 14, KB1/d5/s . Reid, Jr. 2251•E ._ (Page 2 of 21 ^^ rig .s '-84