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HomeMy WebLinkAboutSILVER CREST BLK 1 LT 8 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201108 PID Number: 01506230 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name HAZEN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 9401 HOMESTEAD TRL ❑ Other Phone Number of Bedrooms Soil Rating JTotal depth from original grade 229-2483 4 GPD/SF Ft_ LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SILVER CREST BLK 1 LT 8 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist, between trenches From Tank Field Lift Station Tank Line Ft'- Ft. Well 100'-+- na na 25'+ TANK ❑■ Septic ❑ S.T_E.P. ❑ Holding ❑ Other Manufacturer ICapacity 11250 Gal. Surface Water 1001+ na naGreer Material INumber of compartments Lot Line 10'+ na na NA Plastic 2 Foundation 10'+ na na LIFT STATION Manufacturer Capacity Gal. Remarks Septic Tank Replacement- Cleanout added before tank Alarm location Electrical installed by PIPE MATERIAL House to tank Tank to D3034 drainfield Installer Dean Drainrield CO/MT D3034 Inspector BENCH MARK (Assumed elevation) 100 ft Inspdection s 6/8120 6/9/20 Location and description 2nd Deck 3rd 4La I ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: DateAr �P�� = off f * : 49Iri fA Stew Eng 4s f Ar ����-82�'Ar 71 6 70 Septic System Approve L` Date Note: this approval does not include well permit requirements. ( Fc." l Iti/11'1I 1 $41 4 �R1z 0iq z0 N k rn m rlZ 00�Nn��' 14 �+�•ap�oa��q� 4�M co �g cD 0 rn. $ Ar oro nj 3rD CD k1k,m Gl(n 3 O' < 0� - �N -9 I rooO � OD n c C+ -o �.0 f7 Q Q O D U :3 O OD < p m 4X -<W r PQ 5- ro Ohf nr0 I> z K -0 F9 70 m m z a `0ro --d -9 m r Q O O C+ :5 SO :3o : Ul �D 0� 4 5 N \ Q (D 00 Ln F- w O7U tdV J r0 H ro Q v 0 a C-) 0 C c On V rrld ro d (� m 3 rorD x P � Q FTI h s H — �- m n LD Q :3 Q n Ci' o S O :3 Qo +> Ln o r n s m r_�.�n:iu����ix�.Yn»iia►rr. L6 Septic NORTHRIM =�P�E.°F'�'4i4���$¢¢ SILVER CREST 1p = so' ate.' `y4 ENGINEERING ¢�.49gL� BL❑CK 1 L❑T 8 RECORD SteveEng.com s """"' Po Box 770724 :.... LAYOUT n 4:JS Eagle River, Alaska 99577 4¢y4 ''•, �- .•' WASTEWATER UPGRADE 907.694.7028 6iigi20 REPLACE SEPTIC TANK °at6/16/20 12 of 3 `Q) Qs '- u cl m m ID m D 0 c o o M t ri7 LO v m m Fn ren 0 CL i El/ LL. { w ELI O 1:0 M 4M WL 1 a) � ED Gx. O LCD r F CP :3 EL m a) 0 N ❑ ur cn m sc trJ p op L 00 f L m 5 C: CC T LU W 4 Vfr LU CO Z m U, Y LIJ < CD =4C � .... C oN V) O +Loo4)o 0-0 CL ID U V d) SIF N F i "J L -CL� L N VI SA {4 L 43 C� dj QS m SA 0 W .0 =-6 Q wE o m D. cr r- —W •� � ��U sc C3 ams Cc � �a/ 0 L L 4f Q7 C ❑ { V l I.L U) SO LL r V5 Yo k/ r ❑ x f CV `Q) Qs '- u cl m m ID m D 0 MUNICIPALITY OF Development Services Department On -Site Water R. Wastewater Section Parcel I.D. 015-062-30 ANCHORAGE ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) Hazen Mailing address 9401 Homestead Trl Site address same Phone: 907-343-7904 Fax: 907-343-7997 5 � ,,; pq� Day phone 229-2483 Legal description (Sub'd., Block & Lot) SILVER CREST BLK 1 LT 8 Legal description (Township, Range & Section) Lot Size 48,007 Sq. Ft. Number of Bedrooms 4 C CUti 6 8 Lg�h APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade Q Duplex (D) ElHolding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 0�= (Signature o property ownbr or authorized agent) Permit/Rush Fees: 01951 %? 176— Date of Payment: ! 5 11 / xj ad Receipt Number: OQ (10_W6 Permit No. Q-5 P 9,0 110 2 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc COVID-19 25% DISCOUNT APPLIED �ThZ ENGINEERING SteveEng.com Date: 5/7/20 To: MOA On -Site Services Subject: Silver Crest Block 1 Lot 8 Septic Tank Failure Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Number of Pages: The subject septic tank has failed- a new tank will replace the old one. The existing trench appears to be working OK. Please issue a permit so the tank can be replaced. The existing trench will remain. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks -Steve C J./ ENGINEERING Silver Crest Block 1 Lot 8 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3 -bedroom home; the existing septic system is sized at 4 -bedrooms. Most of the neighboring lots are developed. The current septic tank has failed- the trench still functions. This lot is over an acre and served by an existing well. No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. No conflicts to neighbor properties. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet. • 5' minimum between the tank and trench. 10' to property lines & house. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Tank & solid pipe must be set on well compacted, stable soil. • No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel. • 4" diameter cleanouts with airtight caps are required F to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • If no foundation cleanout, add double cleanouts prior to tank. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) DESIGN NOTES: 1. Existing Trench Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Tank To Existing Trench. 4. Lots Served by Private Water Wells. 5. No Conflicts Within 200'. 6. Check Condition Of Sewer Service Line— Replace If Necessary. 7. Measure Separation Prior To Construction. 8. Add FCO or DCO Prior To Tank If FCO Absent. 9. MOA Spec For Tank Bedding/Riser. L6 Septic Sand Or Pea Gravel For Plastic/Fiberglass. 1 L6 Well>100' L7 IWell>100' 10' Utility E=serient j —Existing Trench \ Decommission ❑ld eptic Tank 5% Slope PER UPC — New 1250 Gallon Driveway Septic Tank w/DC❑'s = 3 3 Bdrm ro � fco I,iJell on �n� S lo -I' Q ��� Sror Pro�Se� Q. 5% Slope NOR THRIM ENGINEERING SteveEng.com PO Box 770724 Eagle River, Alaska 99577 907.694.7028 R10 0 Well L9 Septic SILVER CREST ... BLOCK 1 LOT 8 DESIGN .. LAYOUT 6 WASTEWATER UPGRADE REPLACE SEPTIC TANK Date: 5/7/20 2 of 3 S U S U N � L U C5 � O Q1 o Y i x Q >naO, O Y LO d d :p F -Ln Q U d X U W Q O� N c N N 3 Qj A Ln -H i. O N L U C5 Qi U !`CL Cl) c Ln O Q n 0 LA `: i. 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C4 01 N Lr) U o o n ON W Q1 o '1; i x Q 0) w W U a ZW��bO � pq W Cell I� wwwwwww�� Ar j4 `#A N W%) 0 C4 01 N U o o n ON W Q1 o '1; LLJ x Q 0) ZW��bO � W � ~UNICIPALITY OF ANCHORAGE Hea and Environmental Prote~ ~n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 ......... INSPECTION ,~.,'Okt ON-.S11;: .,;.WAGE 015POSAL SY,~fxh~ SEPTIC YANK: ]-, ..... ~,,,~ 'TOTAL LENGTH~ / DIS'f/,MCE [ ROM WELL / /~ . FOUNi)ATION ~ . _N~.AREST L Gl / ~EP'rti OF [ILTER 5 E E PA G E. P l"r: DI3MEFER .___Of{ WIDTH .... LENGY!-I DEPI'H Log Crib Rings [3U i LL)I f,h3 ,r:c~LJN DA-! ION .. Crib Size: BI/\ME-I[:.it ..... 'UEPllt .... DI%-f'ANCE EP, OM: WEI._L '101 .rtl EF'FECI'IVE NCARE%T LOT LINE ...... ABSORPTION AREA (WAI...L AREA) SQ. FT. Class:__ Depth: Nell Dis'hance To: Lot Line Bldg: Sewer Line: ~ of Bedrooms: ~i~-r~&i_~ Installer: ~u ~"~o¢~1_~2o' ]Remarks: /a~_____~. i..1:3 t ii!:; 1 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 ,/ x ~- . [ TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT ,NSTALLATiONLODAT,GN__ Z r d INSTALLATION OF: SEPTIC TANK SEEPAGE PIT¢ , DRAIN FIELD . FINANCED THROUGH SOIL TEST RESULTS --/~ COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL 13E SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTB FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK , SEEPAGE Pit TO NEAREST LOT L[NE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANKi ., SEEPAGE PIT . TO RIVER, LAKE, STREAM. , DRAIN FIELD ,, DRAIN FIELD SEEPAGE Pit ALSO CONSIDER AREA WELLS. SEEPAGE PIT , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCR, E SYSTEM ,S ,N ACCORDANCE W,TH SA,DOOGE. / .---- ,,: M-W DRILLING, INC. Well Owner DRILLING LOG Use of Well Location (address of: Township, Range, Section, if known; or distance main road Size of casing_ ~ ~: .Depth of Hole Static water level ~0 ft. (~h~i~) Screen ( ); Perforated Describe screen or perforation Well pumping test at ~ gallons per of drawdown from static level. Date of completion i !,i/ !.! /'/] "( feet Cased to ~ ; ' feet (below) land surface. Finish of well (check one) open end (;' ~: ). (minute) for i. hours with .... WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness (i;t~.in.~il ::?~,.,4.. ~ ); ft. .TO. _TO, .TO _TO. _TO. _TO _TO TO TO TO TO TO TO TO. TO 2 -- STATE MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 01506230 Certificate of On -Site Systems Approval Expiration Date: q -2-3^ 2D 1. GENERAL INFORMATION Complete legal description SILVER CREST BLK 1 LT 8 Location (site address) 9401 HOMESTEAD TRL Current property owner(s) Hazen Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 229-2483 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic. 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55�1 - t412 -3--b Waiver Fee $ Date of Payment toP7—/a-O�_6 Date of Payment Receipt Number 60 q 3 0 Receipt Number COSA # Q SC �U ( Waiver # CC?`.l , - 7 2570 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6/16/20 s * •49IH.� ••. 6. DSD SIGNATURE f System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: ```l"Lk T Yto<<(���rf_" /ATE TE m' ASTLPot �vgTER z; J O SEWS*�\�\ Original Certificate Date: �- 2L9 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: SILVER CREST BLK 1 LT 8 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/11/77 Total depth 81 ft Cased to 81 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 36+ in. Date of flow test for COSA 6/8/20 Static water level at beginning of test 45 ft. Comments B. TANK DATA Age of tank(s) new years Tank type/material Plastic Measured operating fluid level in septic tank new ❑ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA 10/77 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 11.5 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 01506230 Structure served by this system Well production at time of test 6+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by NRimEng Date of Sample 6/8/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/8/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 5 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date E. SEFARATION DISTANCES From Prriate Well on Lot to:, (Please erzt&— -Jis1w-*i ff, less than requzed or if oomimurfily Yr -41) Seplic Tank.1ift, Stabun on Lot > 100' El Yes Comm unity Sewer Man ho I e-.'(', I ex-ioul > 100' —1k If absorpCion fuy-eld is under driveAyay comment below Yes iff-No—ft Yes ifft-lo [Z] Yes ff, No ft Neigh ring Tank, > 100' Yes r, No ft Private Se-web'Sep-lic Line > 25' F71 Yes ,Flo ft Absorip-ban F,—, -.Id on Lot _> 100' Yes it No ft Holding Tank > 1,00' 21 Yes -,-f No ft Neighs ring A b s o rpli ort, F59 Ids > 100' Animal Containment > 50' Z Yes -1 No M Yes if No Vanure.;Animai Excrela Sic--7age. —> 1 OU Community Sewer Main > 75' 10 Yes if' No P� Y� ff No ft From ire ptic1VIGIdin g, Tank on Lot to,: l,'Flease enter digin _n" less than reired',j Building Foundations > 10' Yes if' -No Ift S u r', ayce- eater > 10 0' 171 Ye s ff No ft, Property U L- 5' ED Yes ifTNo 'Wells on Ad. poent.Lots: Absoq;A�rurn F=Id;, 55' � Yes if -'No ft Private We > 100' Yes ff No It Vater Main > 10' 0 Y, --s if No ft Corn munifty Wells > 200' 0 `des Jf No ft, ',A' ater Service Line -;� 10' Yes if No I — �ft - If septo tank is under dpvevtay commend benllow From Ali -sorption Field on Lot to: Fbr-ase enter distances if tess,than requirad) Building Foundation > 113' El Yes F, No —1k If absorpCion fuy-eld is under driveAyay comment below Property- Line > 10' ED Yes ifft-lo Vk Wells on Adfacent Lots: Water Main > 10' El Yes if No—tk Private We: > 100' Yes if No W ate r 3 e n 1 i ce Line > 10' El Yes iff No it Communfiy Wells > 200' Yes if No ft, Sur,-`a,ce'Wa.ter>- 100' 7 Yes ilfstalo ft F. ENGINEER'S COMM ENTS G,- ENGINEER'S CERTIFICATION OF 'arc, I ca. rffy Mat I hrave detem, iined tbro ugh field kispections and revi--kv o* -49T—H H if o -,1unfcfpaJreco,%�s fhafth�e above systems are hn confbiwianc:- wilth 0 .... .... ... K R...., fl �- hKOA C,0.3A gu;Veffnezi in effecf on ffifs JaLfe. R ...... W S St � 6 2 Tl - OSA Chemo -st )rAloolt OI -Met LOT 7 LOT 6 LOT 5 12 7-9 N Is" 10, TELEPHONE ELECTRIC EASEMENT CD CP 0- 0 C) O. O SHED X62 2) VENTS LOT 8 REF771 ,RETAKING eco. 0. 1� BLOCK 1 LL 1 1/2 b. STORY FRAME SEPTIC TANK HOUSE DECK MANHOLE 4.8'x6.0' RETAINING• WALL DECK 4.8'x10.0' STAIRS 4,1'x6.9'7.1'x7.2' STAIRS CONCRETE PAD 30.0' 8.4'x124' GREENHOUSE -)3 7, 1'xS.g' WOOD'A STORING STRUCTURE 0 50 100 25 1 50' NOTES 1. Information shown is based on the field survey performed by R&M Consultants, Inc. May 7, 20 & June 10, 2020, record LOT 9 information from the Mortgage as-built performed by R&M Consultants, Inc. dated February 19, 1986, and the plat of Silver Crest Subdivision (Plat 77-176) in the Anchorage Recording District (ARD). 2. Revision date: September 30, 1992 and May 7, 2020, June 1 & 12, 2020. LEGEND 3. Easements of Record other than those shown on the plat of Silver Crest Subdivision (Plat 77-176, ARD) are not shown Found 5/8" Diameter Reba\ hereon. 4. This survey does not constitute a boundary survey, and the Septic Vent information shown on this survey shall not be used to establish any fence, structure, or other improvements. 70, c.o. Septic Tank Cleanout 5. This survey represents a Mortgage Location Survey prepared in ___1 �\`V) Well accordance with ASPILS Mortgage Location Survey Standards. 6. No property corners were set for this survey. [D Diligent Search Not Found 7. It is the responsibility of the owner to determine the existence of any easements, covenants or restrictions which do not appear on OF the recorded subdivision plat. AK - 'I?- AS -BUILT SURVEY LOT 8 BLOCK 1 SILVER CREST SUBDIVISION All CC 0.49TH ANCHORAGE, ALASKA PREPARED BY: .......... 9101 Vanguard Drive, Anchorage, AK, 99507 ......... PH (907) 522-1707 FAX (907) 522-3403 Ij William N. Preston www.rmconsult.com 1W Pie V LIC. No. AECC1 11 LS 11797 '§ 'o 0* 6/12/2020 6 c,)Aw' �'fessjono\ AV DATE SURVEYED: 05-07-20 DRAWING DATE: 06-12-20 DRAWN BY: AJG R&M PROD.: 2835.01 CHECKED BY: WNIP SCALE: 1" = 50' GRID: 2439 SHEET 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONIVlENTAI- PROTECTION DIVISION OF ENVIRONMENTAL NEALTN CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date (;~, GENERA[. I NI'"OR [VIATIO N (a) Legal Description (include lot, block, subdivision, section, townshi.p.~ range) ~.. '~ Location (address or directions) . _ .... / (b) Applicant Name '~.~//'&L_~_ Telephone: 14orne Y~¢¢ "' ;~¢;"-2 Business _ Applicant Address .... ~ '~ ~- ¢ .... :~-~ .' -' · (c) Applicant is (check one): Lending Institution ~; Owner/b~der ~'; Buyer ~; Other ~ (explain); (d) Lending Institution Telephone Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~,~ Multi-Family [] Number of Bedrooms ___'"zL/' Other WATER SUPPLY Individual Well/~ Community L-] 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 Onsitet't.~ Public [] Community [] Holding Tank [] Note: Ifr''community well system, must have written confirmation from tl~e State Department of Environmental Conservation attesting to the legality and status. 72-025 (11,84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by rny seal affixed hereto and as of the validation date shown below, I verify that rny invesligation of this t tealth 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 _"~'~,~)~.~-~-~'l (~ '/) '?, Telephone ?J'-~ ~:'~ Address ~(P.)~ ~? ] ~-~t Engineer's Seal Approved for '~Z~. ' bedrooms by ~/,~_'~.~,~-f~-,~_'~-r-0~-~',--¢~ ~ ~'~..~¢': Date - Approved ' .".~ Disapproved {.? __ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 WELL DATA Well Classification Well Log Present (Y/N) Total Depth __ ~/ Cased to _ Static Water Level Casing Height Above Ground ~.-~-'~1~ Electrical Wiring in Conduit (Y/N) Y" Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot MUNICIPALITY OF ANCHORAG~ DEPT. OF HEALTH & I~NVIRONMENTAL PROTECTION :'; :l. 'J. ]985' R[¢[IVED Legal Description: LO'~ ¢~ ,'g~ i 5~;. (~e~-tT~ ,/ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ~ Water Sample -Fest Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed if') i(i/'/'7 Yield 80~ ~ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Y ; On Adjoining Lots ; On Adjoining Lots ~'~ro ~l~. To Nearest Public Sewer ~,~ O I',.I IE~ To Nearest Sewer Service Line on Lot _. ; Date B. SEPTIC/HOLDING TANK DATA Datelnstalled O~.~ lq7'/ Size_ Standpipes (Y/N) O ~ ~. __ Air-tight Caps (Y/N) Y' Foundation CleAnout (Y/N) Depression over Tank (Y/N) __~ Date Last Pumped To Property Line To Water Main/Service Line Course Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ l'd/.;cA Separation Distances from Septic/Holding Tank: To Water-Supply Well 1¢ ~ ~/,/A, ;for Temporary Holding Tank Permit (Y/N) To Building Foundation '~'~' '~'~ To Disposal Field J ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11t84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed O C..J~ [ Width of Field }.~ ~.~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line '~ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verifi~, or conformed to all MOA and HAA guidelines n effect on the date of this inspection Signed ~*' '~/ct,'~/~/ Date Company '~- ~ ~~l ,P MOA No. ~ '~9 ,~"-0 *'/ / Receipt No. ~q~ ~ Dateof Payment /~-It~ Amount: $ Z/~ Engineer's Seal ~... Page 2 of 2 CONSULTING ENGINEER _03 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: LOT 8, BLOCK 1, SILVERCREST 9401 HOMESTEAD TRAIL THOMAS TAYLOR SINGLE FAMILY YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 20 GALLONS PER MINUTE PUMP YIELD: DATE OF INSPECTION: OCTOBER 9, 1985 TEST PROCEDURE: 6.5 GALLONS PER MINUTE WELL WAS PUMPED AT A CONSTANT RATE OF 6.5 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 ga[/lons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON OCTOBER 2, 1985. TEST WAS NEGATIVE. WAS PUMPED TILL THE DRAWDOWN STABILIZED. THE STATIC LEVEL WAS FOUND TO BE AT 45 FEET BELOW THE TOP OF CASING. AFTER 90 MINUTES OF PUMPING THE WATER LEVEL WAS 66 FEET BELOW. TOTAL DEPTH OF WELL IS 81 FEET. CONSULTING ENGINEER .03 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 8, BLOCK 1, SILVERCREST LOCATION: 9401 HOMESTEAD TRAIL OWNER: THOMAS TAYLOR RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WATER SYSTEM: ON SITE WELL TEST PROCEDURE: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, STEEL, TWO COMP. 1250 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 400 SOIL RATING: 100 INSTALLATION DATE: OCTOBER 1977 OCTOBER 10,1985, ANCHORAGE CESSPOOL PUMPING OCTOBER 9, 1985 SYSTEM WAS INSPECTED ON OCTOBER 2, 1985. THE SUMP TO THE TRENCH WAS FOUND TO BE 12 FEET TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. ON OCTOBER 9, 1985, 100 GALLONS WAS ADDED TO THE SEPTIC TANK VIA THE HOUSE CLEAN OUT. THE WATER LEVEL IN THE TANK ROSE ONE INCH. WATER COULD BE HEARD RUNNING INTO THE TRENCH. NO WATER SHOWED UP IN THE SUMP. 500 GALLONS OF WATER WAS THEN ADDED TO THE TRENCH CLEAN OUT. THE WATER LEVELS IN BOTH TANK AND SUMP WERE MONITORED. THE TANKLEVEL WENT BACK TO 52 INCHES. THE SUMP REMAINED DRY. DEEP, WITH NO WATER. THE TANK WAS FOUND TO BE 10 FEET DEEP WITH 52 INCHES OF LIQUID. DEPARTM 82b #1: Time Date In s ~~/~/~ MUNICIPALITY OF ANCHORAGF ~~'~ OF HEALT~t AND ENVIRONME~ .L PROTECTION ~____~~ Street, Anchorage. AlasKa 99501 ~ 264-4720 Date Received: #2: Time '~--~ ~ · Date~7 # 3: Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: Property Owner: Mailing Address: Phone Legal Description. · 4: Single Family Residence: (~y- Multiple Family Residence: ( 5. Well Sys-nem: Individual well Permit # Construction Number of Bedrooms: Number of Bedrooms: Community/Publi~__S~l ( ) / Depth of Well _ File ( Bacterial ~~ Sewage Disposal System: On-site System ( ) Public Utility ( ) Permit # 7~1~ Installed ~0/~ 3 Installer ~~ Septic Tank Size _ /~ 6~ Manufacturer ~ ~ / Absorption Area ,~00 Soils Rate /~ Material 7. Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line 0¥% to Absorption Area /~/~/-- Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: ~~ ~ ~- % Comments: Affadavit Attached: ) Letter Attached: Approved: ~~_~_~//~ Disapproved Date: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE ~ ~ ~ Department of Health and Environmental Protection ~/at~SS~(, ~5 L Street, Anchorage, Alaska 99501 ' · ~S~equest ~or Approval ef Individual oewer and Water Pacilihies 2 o Name of Bu y er: ___'_~5__~!~w~_~:%~- Mailing Addr ess: __~_~e~.k %~k t.%~_!nlr~_ Phone: o '7. Lending Institution: Mailing Address: Phone Legal I3escription: Single Family Residence: (~}~-Number of Bedrooms: Multiple Family Residence: ( ) Water Supply: * Ind:i. vidual Well If Individual Well, well depth If Community System, name of system Number of Bedrooms (~[/- Public/Commun{hy System Sewage Disposal System: *'©n-site System If On-site System, date ef installation: ( ) Public System ( ) *NOTE: A well log is required on ALL we]_ls dr:Llled since 6/75.. ** If eh-site sewer system ~_s over two(2) years old, an adequacy host is required by this department. A fee of $25°00 must accompany each request before processing can be Jni'hJahed. 3/77