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HomeMy WebLinkAboutPARK HILLS #2 BLK 3 LT 4Onsite File #017cm 142 32 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181260 PID Number: 017-142-32 Dwelling: ■❑ Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New ❑� Upgrade Name: Susan Rottman ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench El Bed El Mound 14650 Park Hills Drive, Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 .8 GPD/SF 0.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot +0.5 Ft. 0.5 Ft. Park Hills #2 3 4 Fill added above original grade Gravel length Township Range Section 4 Ft. 42 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 18 Ft. 3 6 Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches Tank Field Lift Station Tank Line From 756 Ft2 Ft. Well >100' >100' >100' N/A >25' TANK ❑Septic ❑� S.T.E.P. ❑ Holding ❑Other Manufacturer Capacity Surface Water >100' >100' >100' N/A Anchorage Tank/Orenco 1,500 Gal. Material Number of compartments Lot Line >10' >10' >10' N/A Steel 2 NA Foundation >10' >10' >10' N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted ' Orenco 250 Gal. Pump on level at Pump off level at High water alarm at Remarks 13 in. 25 in. 11 in. Pump make and model Electrical Inspections performed by PF2005 MOA PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Denali Excavation Drainfield D3034 CO/MT D3034 Inspector MEA BENCH MARK (Assumed elevation) 100 ft Inspe ction is 9/17/18 2"tl 9/18/18 Location and description 3fd 9/19/18 4th Bottom of siding at corner of house. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp ��>>�\fit �G of�glll Conditional Approval: Date 'AekQ"�`.•• ; .e•t' Benja.'!ji chiller :� V's •. .,11/21/18,.•, ,. Approved AlHA,C9,_ attg Date 11 x718 �kk A,PROFESSIONP��-= Inspection Report_9-1-12.doc EXISTING WELL 100500 FEET 1"=50' 100' WELL RADI CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE EI - ELECTRICAL INSPECTION PORT CONTOUR INTERVAL - 5' LEGEND MT4 PERMIT # OSP181260 PID # 017-142-32 PARK HILLS #2, BLOCK 3, LOT 4 A B FCO 23.5 2CO 42.2 SV1 43.8 A B SV2 50.1 MH 52.0 MT1 61.8 MT2 99.5 3.5 31.5 33.7 41.3 43.5 52.5 94.0 Nov 26, 2018 PARK HILL D RIVERIVER TON COUR T TR A-1-A LOT 3 20' DRAINAGE EASEMENT 4-BDRM HOME 1500-GALLON S.T.E.P. TANK SECURE FOR FLOTATION. NEW 42' LONG x 18' WIDE x 0.5' EFF. DEPTH ABSORPTION BED TOE OF 3:1 FILL SLOPE.545540MT1 MT2 MT3 MH 2COSV2 WASTE DISPOSAL AREA PLAN AS-BUILT (NO SCALE)10' T&E EASEMENTMT3 MT4 67.667.3 82.983.4 SV1 FCO EI 43.834.1 EI PROFILE AS-BUILT (NO SCALE) 85.5 90.2 95.2 89.8 95.0 FINISH GRADEMTSV1 SV22CO1500 GAL S.T.E.P. TANK TH9/27/18 - GROUNDWATER ENCOUNTERED @ 83.0 90.6 77.0 PERMIT # OSP181260 PID # 017-142-32 PARK HILLS #2, BLOCK 3, LOT 4 MTNov 21, 2018 42' DRAINFIELD ROCK 91.091.5 91.0 91.5 91.0 ORIGINAL GRADE MOA APPROVED SAND MUNICIPALITY OF ANCHORAGE ,%'%',`(GOF \�,,� DEVELOPMENT SERVICES DEPARTMENT 3g�P.•••• ��-•. +� 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 /' ,49TM i' ••*r/ ZE.:CEaLiiiO SOILS LOG AND PERCOLATION TEST �/� -. Michael E.Anderson; ts••, 4831-E (Z-.4.'", i LEGAL DESCRIPTION: PARK HILLS #2, BLOCK 3, LOT 4 i19 ;;Fl:ss.00\-'ter PERFORMED FOR: SUSAN ROTTMAN `\\�����`~ DATE: 9/18/2018 PROJECT No.: Professional Engineers Stamp: PARCEL ID#: 017-142-32 TECHNICIAN: MEA DEPTH TEST HOLE 1 (feet) 1' OB SLOPE SITE PLAN 4 •'!71,;!;•7;.:••:, NEW BED il; 5 ' '.'V.:J : 42 •TH 7 'r ." f.. SANDY SILTY GRAVEL 8 :. :f-: """ MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program ate, PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP181260 Work Type: Septic Upgrade Tax Code Number: 01714232000 Site Legal Address: PARK HILLS #2 BLK 3 LT 4 G:3037 Site Mailing Address: 14650 PARK HILLS DR, Anchorage Owner: ROTTMAN SUSAN J Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 8/20/2018 8/20/2019 2 Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 4 Special Provisions: A test hole shall be done prior to the construction of the drainfield, in location shown on permit site plan. Test hole shall confirm percolation rate, as well as separation to groundwater and impermeables. Construction may proceed at your own risk before the 7 -day water monitoring is complete. If the results require a design change, construction shall stop pending On-site review and approval of a change order. Please submit stamped and signed results with the inspection report. 9 13/) Rel u;t 14 6,X is -kk'� JS hX% as sl1owh Received By: oo � Issued By: 01 Trt e'er 0-;-7 Sj',k- //a-,). Date: 5401 1 (6 Date: g ZO%% MUNICIPALITY OF ANCHORAGE 6l 8-�9 1p\ Community Development Department t:11 1 7 1 I Phoe 907-343-7904 Development Services Division AUG 0 g ZU13 F.• : 907-343-7997 On-Site Water & Wastewater Program ti Cu ON-SITE SEWER/WELL PERMIT ' " CATIO► gyp/ 6 8 9 Parcel I.D. 017-142-32 Property owner(s) Susan Rottman Day phone Mailing address 14650 Park Hills Drive Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Park Hills #2, Block 3, Lot 4 Legal description (Township, Range & Section) Lot Size 48,309 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial LJ Single Family (SF) n (w/wo ADU) Septic Tank I X) Upgrade IX] Duplex (D) ❑ Holding Tank Renewal Multiple Dwellings [l Privy (SF and/or D) Private Well n Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 71/1 .� . (-c;t1Z -Th (Signature of property owner or authorized agent) Permit/Rush Fees: s10 q, 0 0 Waiver Fees: Date of Payment: S/t b J l D Date of Payment: Receipt Numbe( (r� Receipt Number: Permit No. O Sf 1 gJ 24,o Waiver No. Permit App_ c GE ENGINEERING PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) August 9, 2018 MOA Development Services Dept, On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Park Hills#2 Block 3 Lot 4— 14650 Park Hills Drive Septic System Design Dear On-Site Services Engineer: The septic system on the subject lot has failed. The owner is currently unable to stay in the house due to problems with effluent backing into the structure. We are submitting this application for the construction of a new septic system to be constructed as soon as possible. The attached site plan identifies the location of the home as well as the existing well and septic system and the proposed system. No conflicts exist between this proposed system and any other well or septic system,whether on this lot or adjacent lots. The ground surface on the lot slopes toward the west at a shallow grade. Drainage arrows and surface ground contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100' from all wells and surface water, and more than 5' away from the septic tank. A test hole will be completed prior to construction to verify subsurface soil conditions. Groundwater will be monitored to determine the stabilized level. Please refer to the attached test hole log from the system file and the plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE *�49 TH /0\ ...Or#0 � Michael E.Anderson . KA. , 4381-E •/. �/ 819118 •. �yG� pROfESS10N,os'F DEMOLISH E ENTIRI CONTE DISPOSE AT PARK HILLS #2, BLOCK 3, LOT4 /DECOMMISSION EXISTING TANK PER MOA CODE, m I00' WELL RADI - fl PtANK K 'AN P Tlo� U BL E - S BEFORE T-ATION"� )UBLE'--, S BEFORE OV N N 20' DRAINAGE EASEMENT NOTE NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND PROPOSED SEPTIC SYSTEM CO - CLEANOUT ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO - DOUBLE CLEANOUT PROPERTY ARE SHOWN, NO CONFLICTS WITH WELLS OR SEPTIC FCO - FOUNDATION CLEANOUT SYSTEMS. MH - MANHOLE 0 50 100 MT - MONITORING TUBE FEET SV - SEPTIC VENT 1 "=50' TH - TEST HOLE CONTOUR INTERVAL - 5' PARK HILLS #2, BLOCK 3, LOT 4 DESIGN FACTORS- SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW SHALLOW BED SYSTEM PERK RATE: 1-5 MIN/IN 1,500 -GAL STEP TANK APPLICATION RATE:.8 GPD/SF 600 GPD /,8 GPD/SF / 18' WIDE = 41.67 LF BED REQUIRED (42 LF SPECIFIED) BOTTOM OF BED: AT EXISTING GRADE FLOW LINE ELEVATION: .5'ABOVE GRADE 'TOP OF BED: 3' ABOVE GRADE REVEGETATE MOUND TO PREVENT EROSION 2" INSULATION & 2' �z' GEOTEXTILE FABRIC FABRIC 6" 611 OG DRAINFIELD ROCK MOA APPROVED SAND 1,25" PERFORATED PVC (HOLES DOWN) 10-3/16" DIAMETER HOLES PER LATERAL REMOVE ALL CONTAMINATED SOIL 4.2' ON CENTER, AND PLACE IN DISPOSAL AREA. REPLACE WITH MOA APPROVED SAND, 18' t � NOTES: 1, GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY PARK HILLS #2, BLOCK 3, LOT 4 1 4.0 1,500 GALLON SETTLEMENT TANK EYE BOLTS EVERY 2' 2' CABLE W/TURNBUCKLE TIGHTEN OVER TANK • 8' L X 2.5'W x 2.5' D CONCRETE BALLAST a• 1"11 rIII 1 HIM 11-111-111-111-1 I I—III—I I i—III—III—III—III—III—III—III III—I I (— BUOYANCY CALCULATIONS: (NEGLECTING WEIGHT OF TANK) BUOYANCY FORCE ON EMPTY TANK: 1,500 GAL CAPACITY x 8.35 LB/GAL= 12,525 LBS WEIGHT OF CONCRETE BALLASTS: 8' x 2.5' x 2.5' x 150 LB/FT3 x 2 = 37,500 LBS WEIGHT OF SOIL ABOVE TANK: (5' x 12' TANK) 4' x 5' x 12' x 130 LB/FT3= 31,200 LBS WEIGHT OF SOIL» BUOYANCY FORCE-NO BALLAST REQUIRED. SEPTIC TANK BALLAST c:sFikt��-jli (NO SCALE) %*�49 TH f' %•'9*r 4"14d-rj24412 Michael E.Anderson . Y �'F`•• 4831-E ••`fir ft ;;;,..4 kkPROFESs\oo...� � 44 '(E�NGINEE-`S.9AL) `� i? \_-! \._./ • c' • to '' l:' s ' .t '-' %O. SO .,a-d.W -'. a9.)CDt,JW), A y e t� Municipality of Anchorage 5 !` ' / >3 V: DEPARTMENT OF HEALTH & HUMAN SERVICES V" .p g "" c 825"L"Street, Anchorage, Alaska 99502-0650 �0 0; `e J. Corwkid rg (/ S °, No.CE-5283 �� SOILS LOG — PERCOLATION TEST �A�Fe •.1 e0. `', '� PERFORMED FOR: fie/Zell GE . '`)/,,57L--'o1's //Lh.. DATE PERFORMED: 1' 7 ' ,5 a, 2 1=5, LEGAL DESCRIPTION:4.,07- 4 13C-OC/ 3 Township, Range, Section: PARK/,l/LLS AAbXsf, ; .,.... ..1,e, SLOPE SITE PLAN 1 "''moft i` P.,� +, / 3 0 a n 0r - 4 0 5 D 5 w i A - -aii- = z-,.-:,1 \Y\ b 4420 y. h7-SC, mo r 7 8 4 ___________J 9 J v 10 Q 4 WAS GROUND WATER //,�--� ENCOUNTERED? Yf • - 11 0 S IF YES,AT WHAT 6 / L ire d D DEPTH? O 12 d U E .. 13 EzJ b Depth to Water Atter Monitoring? Date: • 14 Reading Date Gross Net Depth to Net Time Time Water Drop 15 16 17 18 19 20 PERCOLATION RATE (minutes/inch)PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS SCS/t'..5 \/1SQkI- . Y / A jEA R coE Al 2 /4 /3' /9.7 /2 c sq,r-T //3NZ,v) PERFORMED BY: TO 7/rEIZ ilq/941 I p� ..r —. _.CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN IN EFFE• •N THIS DATE. DATE: /` 7 ' f 72-008(Rev.4/85) res.,— Hip 6 ttleCrC•,d NGIN.FgR'•.SIN�� 'at ' - 1 L. �= 1't • o e t Municipality of Anchorage !14 aw DEPARTMENT OF HEALTH & HUMAN SERVICES ;• t ce J.Corwin ill,825"L"Street, Anchorage, Alaska 99502-0650 VQ1.‘p % o.CE-5283 �."$f SOILS LOG — PERCOLATION TEST Qp'Fq••o• F�c'� • PERFORMED FOR: 1it P 0 E A&E_'L_ gy$7-E1" Net DATE PERFORMED: I ' / = 8s zs,-) LEGAL DESCRIPTION: Lo T 4 /3tc c-fC 3 Township, Range,Section: pei/71C hi/as 44oNt A SLOPE SITE PLAN 1 - P. 1 ti N 2 - r 3 - 0 o 4O 560 c 4 - d I 5 - d6 N Sc • 6 o v 0 o - • 4 0 4-10 Cf /e 7 "gt'o /az-I!.t` 6, , 8 -' 1 i AT /c7e' 9 -, 10 - WAS GROUND WATER j5 /� ENCOUNTERED? 7 (V S 11 - IF YES,AT WHAT l 0 6 DEPTH? P 12 - E • 13 -«� ��[} Depth to Water After — Monitoring? Date:_ 14 - Reading Date Gross Net Depth to Net Time Time Water Drop 15 - 16 - 17 - I ' 18- 19- 20- PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND . FT / COMMENTS SC>/L,S V!5(/9 Le-y Rt477?0 13 ,E:— , . 2 .0 8/ h`i! ZS set>,Ph- /fir-c PERFORMED BY: 7-OD -SWE/Z/"/ I r - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE ON THIS DATE. DATE: // 7' f'C' 72-008(Rev.4/85) Nill?liciTku.y BUILDINC SAID z:z-� DIVISION \ • ,)(YY_.Y- Y`YY� j w � , TR A— i —A 30 \ ).-.., L1 w2_06- •g ///t,'s- "i. ._. 13 v By —�. _,__—r_- w 1 1, \\ I- r� j2 ry• EXISTING o _ \� fl HOUSE ,v T 0� Z-) i. /3.4 N N 7 :co lf) \j 3 CO Qs- 37 S o O 3T 3g 4 N cs. o `� L0 T 4 `9a 6 46 t. o .. 2a Z 56 Om HOUSE DETAIL S �/�� 1"=25' IIK- � , w �� nkiv1:i i it1,ia�r ' pSir L id,�r '8( )~\LIFT STATION I", L.).:-, - ,-, a 4,1 ,s S / O \ �c� 7 -)z.: o ,, � . O �MONs� F �z, SEO 013 F� � E' . . i wit WilTits 21 , AMC,S' � /,© vF • ,A--'' '` ' ---:1A .13 1010, ... Vc" o� 49mi •�� 3O _.__.. (7 0• •Thomas H. Dreyer: , �,' N 7.18 61 30 OQ�� LS-7625 •-1'.. opt PV<v _ •i O�d�o°fessbnol'�Q�O 4,op �` 4' N' `{ / ��O\�o� -- ROX�E7 / •RPh I � -yx ,10LEGEND: SET FND 5/8 RB W/CAP(] 5/8' RB 3 25 AL MON , MONUMENT AS— BUILT O LEGAL DESCRIPTION: ORDERED 9Y SUE ROTTMAN ,,, „ , „ ❑_. _ HUB & TACK _ FENCE- --- X— X -- ?� /g' with TIMBERLINE HOMES %' r • .. - t•- 1� �— SURVEY CERTIF-ICATION: LANTECH has conducted a physical survey of this OVERHANG- - -___- _ LOT `-, BLOCK 3 property os shown on this drawing and that the improvements situated thereon WOOD DECKS- t-----_ ---1 LAND & CONSTRUCTION SURVEYORS- PLANNERS-ENGINEERS ore within the property lines and no encroachments exist other than noted. CONCRETE- -_ -71 440 WEST BENSON BLVD. # 103 PARK HILLS ADD . N O . 2 EXCLUSION NOTE: It is the owners' responsibility to determine the existence ASPHALT- - ANCHORAGE, ALASKA 99503 562-5291 (fax)561-6626 of any easements, covenants, or restrictions which do not appear on the GRAVEL- I- recorded subdivision plot NOTE: Under no circumstonces should any data WE 9""n1"=50' .� o�ic „a; °,raun w, roo,ywar, SEATPTIC STANDPIPESLL- - t S WO# 93—L-79A 1"=50' MARCH 8, 1993 DMD 3037 KEN 288/50 hereon be used for construction or for establishing property lines WATER M-W DRILLING, Inc. P.O. Box 110378 · 10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 RECEIVED 00T 199 Well Owner Mr. & Mrs. DRILUNG LOG Mark ~ot tman Municipality of Anchorage Oept, Health & Human Services Use of Well Domestic Location (address of: Township, Range, Section, ff known; or distance main road Lot 4 Blk. 3 Park Hille Addition ~2, Anchorage Size of casing 6" Static water leve] Screen ( Depth of Ho)-_,.100 feet Cased to 99.55 feet 50 ft. ~ ~ow)land surface. Finish of well (check one) open end( X ); Per/orated ~( ~ ); Describe screen or Well pumping test .of drawdown from static Depth in feet from gro, m4 surface 0 TO 2 2 8 ,TO 8 TO 43 43 TO 50 50' TO 70 70 75 TO 75 TO. 83 83 TO 100 TO (minute) for WELL LOG 1 hours with 100% ~ ~i~rmations penetrated, size of material, color and hardness SFT ft. TO. TO TO TO TO TO Certificate No's. 814 & 973 1 -- CUSTOMER DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW920110 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:ROTTMAN MARK B & OWNER ADDRESS:277 FAWN COURT ANCHORAGE, ALASKA 99515 PAGE DATE ISSUED: 5/28/92 EXPIRATION DATE: 5/28/913 PARCEL ID:01714232 LEGAL DESCRIPTION: PARK HILLS #2 BLK 3 LT LOT SIZE: 48309 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS ISSUED BY: / ,,gg,¥OoO0 SONIUV38 JO SISV8  ~- 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 MAILING ADDRESS LEGAL DESCRIPTION DISTANCE TO Well __ ~ ~ Absorption area ~ ~ · : I /OO I ~' Dw~ng~o/ PERMITNO. E: n le Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, O Z ~ Manufacturer / Y ~ ~ Material Liquid capacity in gallons ~ ~o. of I,nes~ ~on~th ~h~ino Total Ion~th of~inos Trench~i~ Distance between I,nos -- Z m ': /~& inches ~ t ~ ~ ~ Top of tile to finish gr~de~ ~ ~ ~ Material beneath tile Total effete absorption are~ Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter ~/~ depth Total effective absorption area m Well / ~/ ~uil~ing foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth ~/, ~ler Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation~ '/ ~e~er line Septic tank Absorption area(s} OTHER ~ PIPE MATERIALS SOl L TEST RATING 72-0' F'Er-~H i 'l" IgO; DA'i"E ISSUEDi: AF'P L. :t: C AI".IT = .AD DRE E.~S ~ CON'TAC'T F'HONE; = LEGAL :OE!:SCF;,' I P: LOT' S I ZE = DEF:'AR:H"IENT OF ,'-.-Ir.<ALTH AND IENVIRONMEN]"AL. 825 L. S'T'RE:ET', ANCHORAGE, AK 99501 264 -- 4 '72 () CD P,,4I ........ SE; .% '-F IIEE '.EZ'~ il:Ei: Ip,,[l EE Fq: iF:::" EiE ~,:::>;',: 1i"~"~ % ']I 86002C~ HAND NRI'I"]"IEN 0 1/;P.'7/81'5 J E)l-IIq BERSGREN 1,'.'::"I. 2() ST. JAt~IES ANCHORAGE, AK 99516 :::.~;4.5-.2 122 SUBD:I:VISION~ PARK HILLS SEC'TION: 34 TOWNSHIF:'~ 12N :1.~ i IA (S8, F:'"I'. OR ACRES) LOT: 4 RANGE: 3W BI _OCI.::: ::'; cer't.:i. ,~'y that:' I,, i am Earn:i. liar' w:i.t.h t. he r'equ:i.r'emen1'.s ~:'oi" C)Fl'""~i~i'[.(.}:.) sewer's ancl tweiis as se'L ~'oPth by t.I]e Hunicil:::,a!:i. ty o{' Anchopage (MOA) and the Stat. e o{' Alaska. 2,, t will inst. ail the sys'Lem in accor'clanc:e wit. h all IdOA codes and anti :i.n c::cm'd:)liar~c:e ~.~ith t. he design cr':i, ts:,r'ia o{' 1'.Inis per'm:i.t:. ! will adher'e t.o all MOA and St.a'Le o{ Alaska r~(eqL(ir'~rlent, s ~'op the set. bac:k cl:[st, ances Fr'c:,rn ar]y ex:i.s'L:i.r'lg ~e:l.:l., wast. e~,;a, ter' disposal, sys'Lern op s(.:'..)(*~euage system on t.h:i.s or' .any adjac:e:,nt, or' r'~eal'h,y lot.. .. ~,!~:~IALI....E.O I"',~ AN ~-,..,c.A L. Ow::.,"~c.~., BY MOA BIJII_DII',IG ~J::n4 ( ) AIq :._,: ..... * ...... .- _ ~. * ',_T AND INSF~I:::C;FTdN ........... HU.:: , ~:',:: (..h'.) [A.,.N,::.D. ~.¢,.I...L NOT .,..l:::. AFF,'~..¢vE:..O WI'f'FIE]UT AN '""'~ ........... " ~ ...... L, [I'*..CAI_ I,. :F :.C .t.~.~,4 REF'ORT~ AHD ( :~ ~ ~ r"h:. ~:' ............................. :::p" :::, 'r r'~ WORK ,-tL.,.:::~I BE DSNEH BY A I...ICI::NSI::'D ~:...." ............. :.L.] [, .~. E; I AN,, """"'" AF:'F'I... t E::AN'I'~JOHN }: ~:~(:~ ~...~-] Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: .~ 0 ' 2 3 4 7 8 10 11 12 13 14 15- 16- 17 18 19 2O E/lb DATE PERFORMED: Township, Range, Section: SLOPE r WAS GROUND WATER ENCOUNTERED? yE5 S IF YES, AT WHAT 5 j ~ DEPTH? p E' Depth lo Water After Moniloring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FT AND __FT COMMENTS ~(]C~/L..,~' VI.fUr. tLC ~/ J~ T~P ~ /~t~NE~ ~ ~ /~1 ~ D MUNICIPAL GUIDELIN~ IN EFFE~ON THIS DATE. DATE: /~ ~ ~ '-"' 72-008 (Rev. 4/85) Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ; PERFORMED FOR: '~ LEGAL DESCRIPTION: LO '~' ~ ,/'~LOC/t'~ .~-~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ~W~4~ ]~d, DATE PERFORMED: /' '7~ ~ Township, ~an~e, Section: p~/~ ~/~ ~/)~t. ~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT /t OL DEPTH? __~ p E Deplh to Water After Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE {minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND FT C 0 M M E U T S --...~'~'/~-~ -.-~ ~/[.~U~{-~_.~/~/~-Jr"~-"~ /~.-J~/~-~/~-J ~~/, ~T ACCORDANCE WIT~ ALL STATE AND MUNICIPAL GOIDELINE~ IN EFFE~N THIS DATE DATE' /' 7' ~ 72-008 (Rev. 4/85) 9184 DMXPW22(') PERMIT NUMBER: 84-()9'7t 'T'?l:'liil OFINS'F:'ECT]:ON I N,.S'f' ECTOI.t.[..,uMi*il::N ........ I'AR~"f FOOTIN(; ROL..3 t Id:.MJV[. AL.L. "PUHI::']:NC.;"x Cl..AY 5,'C)IL & F'I~COV .[ DE: $OL.'[D BIEAF~]:N[; ,S'OII..', '2 t-ROVI.)[:. II (3[ [.1', DRA]:NAC;E F'OF;~ 14AT[EFC ARC)LIND F'OOTIN[;~ S, F'FCOVIDIi': AF'F'ROVli[D F't...OT Pl..AN. F(:)C)TIN(.; I:~E:Ilq k.:)t..,~"'F '" CORRECT]:ON,S' MAD[':, AF'F'F.'.C]VFD F"C)OTIlqG; F;tE.T. lq RC)L.,S' DIC-; OUT S,E: CC)I:~lqE:R & F'RC)VIDE ,~UL.I.I. (;ROUND & F'I~:OF'IL':F~ DI~A.[NA(~.I:. FOI:~ I-ItI_L BE:HIND, PRC)VZDIE APPROVtED F:'LOT PI...~lq, ]E.~C)ND BE:AM ROLS NC)T READY 'i (.): 'I G, Irdi':.-,~Tt:.::lF:l.~ IN F'L.(~CE I::'I...B(; UNDEF;: CONE UN).)I~d~.~t~LIUND WASTE & ¥1::.NT~ APF'I:~O¥1!.:.D., ADD'I.. CHG;~' NA £'UNBURST F'L. BC, OBTAINIi~:D [ [.RH.[ F F'OR f' (:~(~, THC)U BTU) LIMIT I..I[:.'~TIEI;~ AND 2 GAS C)LJTL. E:TS'. . EI_t~C ROU(~:H MERK i, ,... ~'~EFAkAI.[ON I~[:.(~J.[I~I::.D [)lq BACK TO F'"Lllq!!TICIN , f .... D:):5'PL. AY NEXT,PANE:I... - PAGE:: F:'ORWAR,.D, . · F'(JNCI"ION 2 ....F:'(:K~:E )3ACK~ F"UNCTION :3 .... RIiETURN TO CAL. I...IN(; I:'~NEI.. ,F'UlqC-F]:ON 4 -.. HAIN NENIJ~ F:'L.INCT]:ON -- F:'RINT '.?/84 Dl~iXl::'142;2 (~ PERMIT lqUMB[:.I..: 84-(:~9'?~ '¥YF'E OF :[N,S'F'ECT']:ON IN3'F'IECTOF( C, OMHENI~~I:;:Y F' I..B(, RCH-I (,'(]HIE NECH L,.]~E. E1..EC RC]UGH MERR FRAM I NG RC)[ .... BACK F':I:REWAI...L., 2. NA]:L PI...ATE,S' NEEDED, S, RECIEI'"'T I::,'IF:(~LI.T. IRED I:t]:C;HT ,S'IDE: I=]:REPLCE: 4, ,S'E:F'SRATE CABLE:5' I::'I:~CIM DLICT 140RK, 3'I=:FCVZCE ONLY AF'F'ROVt.T.D, TA(:.; ROUC;H F'I...UHB]:lqC; 14A~'TE & VEN'F,~' AF'F'I'"(OVED, C;A,S' P]:F'tN£-; APF'ROV[ED TC) FURNAC[E, 1"t~ I"IEATER, UNIT, IRANC;E & t...0(; t..ITIER, RI'.:"TURN AIR DUCT '¥() UF',S'TA:[I;:£' ,S'(:)I.J')"I"I BEDROOH 14:1:1...1... HAYE: TC) BE: RELC)CATE:]D DUE: 'FO F'I-UHB]:N(; LINE,S' & klA$'¥E I..'.[NE TO TC) ]: I... ['.r. T, ROUC;H-IN ~PF'RC)VED, ~-,S'"fRAF' PR014 CORNER AT F'RONT & BOTTOM ,S:IDE,'~', 2-,S'HFAR NA.'I:L. F'ANEL 'FO R:[.C;I'~T 01=' FRONT DC)OR, 7F"'PF:OVIDE: :.~ ~'TLID C'OI:;.'.NER Al' C;AFtAC4~ 4"'F'RC)V]:DE KIN(:; STUD SOUTH BIEAM FUNCTION ~ D.I:,Sq::'I..AY N[':.'XT F'ANEL '" F'AGIE F:'ORWARD FUNCTION 2 ....PAGE B~C;K; 'FIJNC, TIC)N :.~; ....R['."TURN TO CALI...].'NC; F'ANEL FrUNCTION 4 ....HA]:N HENI. J~ I::UNCTION -.' F'R:I:.NT r9/84 PERMIT NUMBER: 84-097~ TYI::'E OF tN,S'F'ECT]iON 'J:N,S'F'I~.~CTC)R CIDMMIFNTARY I. HXF W ...... DOWN, .:,'...C.)MFLE. 1E BL. OCK]:NC~ AT FAS'T PONY 6-SHE:AR PANEL. I"IIN(;E:D BEARIN(; WALL, 7.".FiRESTOP F'F' F'L. UE AT CEXI_ING., 8-BLOCK TRUS".~E~; AT EAS'T ).EARING 9..-NO ~I..B(, IN kE]JN AIR DUCTS. NAY INS'ULATE AFTER OTHEt~ I.N_,?'.~', ~ ~ .-.S"TF~AF' BEAN TO TOF' t::'LATE: ~A '/E: F'RONT EN"I'RY, I'FEHS ON~ YE.S'TERDAY'S IN,~F' WERE ~.dT CORRECTED~ $55,C~0 RE]:lqSP I::'EE: HLIS'T BE F:'A :[ D, - - ~., .,..,...~.. ,~, ~ ~ ". .~ .... ., CORkI=L.,t i_)N~; H~DE ~t FRJVI=D NECH&KI' ' ROUGH A[' ['"ROVE. L"' "). $~5.~9, ~R,~SS, DEVE~I(ET ~OI..F:E I=b~< 2{~F'ECTION FEE PER CONEU, ~"-2~'"'84,. I ~RECEF'I"hCLE IN IJN).)[;R'"'g I~.[K bLO,.E.I L'.t:GI"IT IS UNGROUlqDED. 25(:p"'74. 2. CONNEC- F'[JNCI"ION t ~" DI,~'I::'LAY NIEX'F I:'ANEI_ PAb[': FORWARD F'UNCTtON 2 "" PAC.;E: BACK~ F:UNCTIC)N :3 RE'FURN TO CAL..1..]:NC; I::'(.li',tEL FUNb'~.[ON 4 "" iAIN MENU; FUNCT:[ON .... F'RtNT !9/84 I" EkN.[ I NUM)~ Ek TYPE OF :[N;~F'E:C'I':F. ON :[N,~'I::'E:CTC)I'~ [l:.Et~ i, INAL DMXt W.... ~:. ¢ 84--(.:)97 t bOMMENTAI~Y ]"HI~!iRMO,S'TAT TO 5,'F"ACI:i~ I..IEiATEI:~ & CH1ECK ,S"I EC,~ F'Of.~ A FU,SI=~ tt(D-L~(B) 3,1..ICH.~I" IN LAUNDRY CI...O,~,'EZT HLJ,~I' BE F"I..C)UI:,'E:,?C1.~i',IT~ 4'i t~".'8,. 4 ~UNABI...IE TO FI:ND PE:I:~MANENT 'AC .... ,E.,~ TO GROUND C:LANP~ AH '5,'FYF'E '['~W 141EI...I- CA~.I...I:: CANNOT BIE BU .... RIED ti~""S(B) 6,S~I...1CE 14E1...L.t.,~t.I..l::.5 F'ROF'ERLY IN BOX,. S7e-7, F'I.,B(; FINAL AF'F'ROVED, UE:(;I-,t t:F:I:ilAL: COMF MECH F]:NAL APPROVED . ._,.~TI.'dJCT r-'.']:N~l., KOI:.,S t'FINAL. GRADE,. '~,...,.-I::'I:~OV]:DE: At_I.. WINDCIW CI:::~NK. 5' :3 .... t::'IRE,.S'TOI::' (;AF.A(:,[:.' ~' .... ['[.N[.1R~] 1C.N ......... AT (;.~..q:~AGE (:)VIER HEAD DOOR~ 4 .... .,,I...I::['VE. ~ , ,,-'"--.., f.?$ I..[::Nl~:.lR!!?IOlq 1N FLIN(iT:[ON ,t :- DI,S'PI..cAY NEX'F ?ANE:L .- F'A(ZE I~'C)RWAR,.D, ." .' ': .... "" : ') .... '1 '" '; "- ........... ;' ' ............ I..UNCT.[ON ,-.. - FA£;[:..~.AC, K~ FUNCi].ON S .... RE.¥UI.,.N ro bAL..Lllqb, FANE. L. FUNCTION 4 ....NAZN MI!:ENU~ F'UlqCTZON - FRIN'¥ .... TYP[.:. OF IN~i~F>ECTION IlqSI:'E:CTC)R c, OMMENTAr.~Y · · · LIOU~E~' & ]i~? AI::'I='ROVED, ' , i ~ STRUCT r.:':[NAL ROt..,S' CONDITIONAL. C,.O~ ApF'I:~C)VIED,F'I.'?DING PO,ST ' & BEAN CONNECTION: F'OR DECK C, CIHPI...ETE: BY ' iSUNCTI(TM t ' D:rSF'i...nY NEX'F F'ANIEi....:, PAGE FORWARD FUNCT]:C)N 2 .... f. Abl::. BRCI(~ FUNCT]:Olq S -RETURN TO L, AL.L.]:N(:; PAlqE:L. I"UNL, .ION 4 H&IN i'tlENU~ I-LINL, :ION .... • • e0 •;'• Municipality of Anchorage On-Site Water and Wastewater Program . mi I (907) 343-7904 Certificate of On-Site Systems Approval Parcel I.D. 017-142-32 Expiration Date: "2-621-191,... 1. GENERAL INFORMATION Complete legal description Park Hills #2 Block 3 Lot 4 Location (site address) 14650 Park Hills Drive Current Property owner(s) Greg & Sue Cress Day phone 907-227-3055 Mailing address 14650 Park Hills Drive, Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex U Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual n Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer.unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 1 L/ t-3 Date of Payment Receipt Number G4LSI 0 Receipt Number COSA# QSC(Y 1[nod Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes. ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 11/14/18 4e 177106 6. DS\DD SIGNATURE a �...• • ice. .. N System #1 Approved for bedrooms / Benja 'n hiller . #,9(`�•. CEn 22592 . ' " System #2 Approved for bedrooms IIk'98°P o••••1.130`. Disapproved u._��"�� Conditional approval for bedrooms, with the following stipulations: #S.? �r y(hl -SI WATONER TEND WASTEWATER r PROGRAM ° SER By: I `^-- Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet.! - If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Park Hills #2 Block 3 Lot 4 Parcel ID:017-142-32 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/8/92 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 100 ft. Cased to 99.55 ft. Casing height(above ground) 34 in. FROM WELL LOG AT INSPECTION Date of test 6/8/92 10/31/18 Static water level 50 ft. 57 ft. Well production 30 g.p.m. 5.5 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.125 mg/L Arsenic ND ug/L Date of sample: 11/09/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/17/18 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date installed 9/19/18 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 GPD/SF System type Bed Length 42 ft. Width 18 ft. Gravel below pipe 0.5 ft. Total depth 4.0 ft. Eff. absorption area 756 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed 9/17/18 Size in gallons 250 Manhole/Access(YIN) Y "Pump on" level at 13 in. "Pump off'level at 25 in. High water alarm level at 11 in. Datum Top of pump cage Cycles tested New Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: 10' >1 >5' Building foundation _ Property line Absorption field Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation > Water main > Water Service line > Surface water > Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION .�t�t\\t\ pF,� t I certify that I have determined through field inspections and Av.- 'gtQki' review of Municipal records that the above systems are in //meg.. `4 i•y-9#6 conformance with MOA COSA guidelines in effect on this date. %*.'49 TH ''.)'1 • *r6 Engineer's Printed Name Benjamin Schiller, PE IlliF \'''""• ' • � :• ": Z Date 11/1 6/18 „ Benja• .hiller • • i • CE 12592 •c`� �Tki4.,• 11116118 ••��vr/ 1kv°PROFESSION' �\\\\���~ COSA brown sheet 10-10-12.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING bra_- -~ '-t- NAA# ~'~ ~0~ O-~C)~ \ ,-'~ ' GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Day phone Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Un/ess otherwise requested, HAA will be held for pickup. NOTE: Individual well ~_ Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature Date DHHS SIGNATURE =g~ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date ,~,,~,~/~,-~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. 72q)25 (Rev. 1/91) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST /_463 ~;,.~.~,'t/~ ¢-z Parcel I.D. A. WELL DATA Well type ?¢~v~-'T~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number OW ~:~-~ 'P~W. S Date completed ..mu~ % t~- Driller I OO~ Cased to ~-E' Casing height "/ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION / MU~,C"~A~ ITv '~F ~_ ~'-- ~"'7_ .'.'~- '~--,_9,~ ~NVIkCNk~E ~xr/L .: ER: k-~S DIVISION 50 49' / "30 ,.p.m. / p, YC E i VE D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ~1- ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank '+lc:,O ' WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size t ~--Oo Compartments ~ Foundation cleanout (Y/N) ~: Depression (Y/N) ~// Alarm tested (Y/N) Y Pumper SEPARATION DISTANCES FROM SEPTIC/HOLD~NG TANK TO~ Well(s) on lot To property line · +-I c::::O On adjacent lots ' Foundation '~ ~g-' Absorption field Water main/service line Surface water/drainage 79_-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) 'Y" Manufacturer /~ ck6,~ Manhole/Access (Y/N) '?' "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 4~tOO' On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed I-~l-~(o Length 40/ ~" _4' Width Z¢ Total absorption area Depression over field (Y/N) hJ Soil rating System type //Aou Gravel thickness ~ ~L~ Total depth ~.~. Cleanouts present (Y/N) Date of adequacy test Results (pass/fail) -- for Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -+~o' To building foundation ;~;~ On adjacent lots '+ Surface water bedrooms If yes, give date .On adjacent lots +~cko' Property line lb ' To existing or abandoned system on lot K) CA Cutbank -bt ~c¢ Water main/service line 4--1%' + -~ ~--' Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~ Engineer's Name ~-~¢~/~--~'~-~- ~/(--~/~----~'~.~' Date HAA Fee $ Date of Payment'--~"/%~'~ Recei pt N u m ber ,~-.~_~.~// 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES MEMORANDUM DATE: March 18, 1993 TO: John Smith, PE, Manager On-Site Services FROM: Daniel N. Bolles, On-Site ServiCes~z//~ SUBJECT: Lot 4, Blk 3, Park Hills #2 Following a comprehensive investigation of this lot and an adjacent property I find that I cannot, in good conscience, sign off on the health approval submitted for the subject lot. Last year I found that the area surrounding the mound and lift station on this lot was subject to seasonal flooding. I further determined that seasonal groundwater levels likely encroach on the separation required under AMC 15.65.040. Therefore, I am, returning HA930113 to you for review.