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STYMANS LT 2
tymans Lot 2 #015-272-47 Inspection Report _1-1-12.doc PES Municipality of Anchorage V,7I I' Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171244 PID Number: 015-272-47 ❑ New ✓❑ Upgrade Name: RICK CARVER ABSORPTION FIELD ❑ Deep Trench E] Shallow Trench El Bed ❑Mound Address 111 4100 E. �f H AVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot STYMANS 2 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 106.7 N/A N/A N/A N/A TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1500Ga1, Surface Water 100+ N/A 100+ N/A Material STEEL _ems_ P F S Number of compartments 2 Lot Line 49.3 N/A N/A N/A NA Foundation 21.4 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A I N/A N/A Gal. RemarksTANK REPLACE ONLY Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield A+ HOME SERVICES Drainfield CO/MT 3b 3 H Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 382 ft Inspection 15 8/24/17 2nd 11/25/17 Location and description 3rd 4'h W BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date TH .. — ... (0 •�/ / • • even • (Sannor4eAW Approved Date j 0 5 ���p,p�aA , ;"" Inspection Report _1-1-12.doc PES t: ------- - - - - - - - - - - - - — — — — — --- — -- - - - - - - - - - - - - - - - 0�-- --= 112th AveTRUE NORTH SCALE 1"= 50' ,<APPROXIMATE EXISTING MAIN FIELD DRIVEWAY 2 16.2 WELL 106.7 DECOMMISSIONED EXISTING 1000q AND 500 SEPTIC TANKS PER MOA CODE DCO T2 T1 (E) 50R HOUSE A 9.3 INSTALLED 1500q SEPTIC TANK F W/ DCO AFTER Z WATER LINE WELL RADIUS NEW SEPTIC A 8 T1 24.8 30.7 T2 24.2 38.0 DCO 26.6 43.6 F- PAMO�M ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211Scale •8/1/18 ... ... .... M1*e*Ve*n* —pal ope CE 18mi Date RECORD DRAWING LLJ 0 z < z < STYMANS L2...... RICK CARVER 4100 E.112TH AVE. ANCHORAGE, AK 99516 LLJ< D Lj 0 -1 DRAWN ACP OC./FG. SITE PLAN Sheet 2 OF 2 0 u 382 Pn 377.4 1500 GAL 377.2 7- [�\ a NOTES: PAMO�M ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211Scale •8/1/18 ... ... .... M1*e*Ve*n* —pal ope CE 18mi Date RECORD DRAWING REV 1 181102 1" = 50' STYMANS L2...... RICK CARVER 4100 E.112TH AVE. ANCHORAGE, AK 99516 P.I.D. NO --UT5-272-47 - DRAWN ACP �-ERMITNO. OSP171244 SITE PLAN Sheet 2 OF 2 MUNICIPALITY OF ANCHORAGE ,ocnt On-Site Water&Wastewater Program PO Box 196650 4700 Elmore RoadAnchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 1:1:11 "` http:llwww.muni.org/onsite cpai (Inc nt On-Site Wastewater Disposal System Permit Permit Number: OSP171244 Effective Date: 8/23/2017 Work Type: SepticTank Upgrade Expiration Date: / 8/23/2018 Tax Code Number: 01527247000 $ll�// / 7 -retAiL Site Legal Address: STYMANS LT 2 G:2635 Site Mailing Address: 4100 E 112TH AVE, Anchorage Owner: CARVER RICKY W & MARTHA L Lot Size in Sq Ft: 48952 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Received By: .6 t, It -7Ty .L.� IPA Date: li Issued By: A �/ .l�ir_ ,,, Date: 0 2- cijwivat..veit\ MUNIC A !TY OF NC ORALE gT : ' t omunity Development Ph4on �`��� F Wilf/97 On-Site Water & Wastewater Program AUG 22 2011 ON-SITE SEWER/WELL PERMIT APPLICATION drih Parcel I.D. 015-272-47 9 g Property owner(s) Ricky & Martha Carver Day phone Mailing address 4100 E. 112th Avenue, Anchorage, AK 99516 Site address 4100 E. 112th Avenue Legal description (Sub'd., Block & Lot) Stymans, Lot 2 Legal description (Township, Range & Section) Lot Size 48952 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑x Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ 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. 10 WO OP \ (Signature of property owner or authorized agent) Permit/Rush Fees: 4,�16 Waiver Fees: Date of Payment: a 3 1J Date of Payment: Receipt Number: _ 0,03SqlGt Receipt Number: Permit No. OPi12 c '( Waiver No. Permit App_.- _.,c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com August 21, 2017 Subject: Stymans, Lot 2 EMERGENCY Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,500g Septic Tank to replace an existing 1,000g Septic tank and 500g septic tank to be issued for this property. The existing tank has collapsed exposing raw sewage to the environment. Both existing tanks will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,500g Septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property line or building foundation 10'+ from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, PSSS SS OF .�I� . ••• • co ,r1,• ri -061.040 1,01:\ Steven R.PannoneJ_� Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Mayor Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 wmmuniaro/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Parcel Identification Number: Legal Description s7-yrn ANs Pump Installation Date: I Pump Intake Depth Below Top of Well Casing: J-7$ feet IPump Manufacturer's Name: t2 E D, AC K E -r Pump Model: _75 C cl tt Pump Size 31i hp Pitless Adapter Burial Depth: /61- feet Pitless Adapter Manufacturer's Name: Date of Issue: Properly Owner Name & Address: Pick Clo( evC`ee- ti« E.04 l,g v% Pitless Adapter Installer: / Well Disinfected Upon Completion? %T✓Yes l-1 No Method of Disinfection: 1l VT C{.oal tit f� i Comments: Pump Installer Name: A h Cho eNE. Phone: 907-243-U4 Fax: 907-243.0742 com Attention: The pump installer shall provide a pump installatiln log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 " L" Street, Anchorage, Alaska 99502, Telephone 264-4720 tt P6i9-*01? ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Namech/ !a --d S//raTO DISTANCES 0 /S'— _z7 Z-RVj FROM SEPTIC TANK ABSORPTION FIELD WELL Address y/00 /12 7L4 Are 991—/6 Phone(s) PernyCry �7p No. of Bedrooms �'L tLl WELL /0-1 /� y LOT LINE pO d LEGAL DESCRIPTION Lot V__ BlockSubdivision FOUNDATION oZ�/ g N/g. Township, Range, Section /02 /U .3 W .%Z AS -BUILT DIAGRAM driveway. water bodies, (Show location of well, etc.) septic system, properly lines, foundation, TANKS 2r SEPTIC ❑ HOLDING D/ AF /2 4r ZZ r? y' Manulaclurer GiD /-Z _7 Capacity in gallons S0 49 2AC P fir / _ 1f / ,�,,, Material S'1-elt No. of Compartments TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom trom original grade S—_C FT Total depth from original grade Z 0•� �� r Fill added above original grade O FT Gravel depth beneath pipe FT Gravellength l2'7 FT Gravel width 3 i� / FT i Total absorption area 31;7 50 FT Distance between lines I X//) FT ' -J Number of lines Soil rating /SD SO FT Pipe material f8/0 5',02 if Jr Q Installer y0—/06 Nielson Bros Date Installed A X1 4 AAq[[. C WELLS ❑ PRIVATE ElOTH entifvl Classification(A,B,C) Total FT Cased to FT Installer Date Installed: REMARKS:.` �/� o , 'fz.,� ias f»rnc� o,/ •j'a.rtl a+J �// �7fM /3 C LI�Y�✓e • Fk/s1 Scale: spections Date: Performed by: ENGINEER'S SEAL . & 110, ,.: (y / t dOd co+ C Ai o q t L 7?e, certify that [his inspeclion was performed according to all6�� Municipal and State guidelines in effect on this date: Health Department Approval: i (Yil-Nr2'� Date: s�5 9b 72-013 (3/85) ^ MUN1ClPALITY VF ANCHORADE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 gN-SITF SEWER 10ER1111 Permit Number: 900061 Upgrade `~a� Date issued: 04/02/90 Engineer Designed Owner Name: RICHARD L. SlIRA Day Phone: Owner Address: P.O. BOX 110816 344-9240 ANCHORAGE, AK 99511 Parcel Id: 015-272-47 Lot Legal: Subdivision: STYMAN'S SUBDIVISION Lo+: 2 83ock: - Section: 71 Township: 12N Range: 3W Lot Size 48948 (sg,ft" or acres) Max Bedrooms: This Permit: 2 Total Capacity: 5 SEPTIC TANK: Minimum total septic tank capacity: 1,500 gallons, Each septic tank must have at least 2 compartments" Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s)., INFORM P,MLM^S" PRIOR TO INSPECTIONS BY ENGINEER, IF AFTER OFFICE HOURS, CALL 343-4681 AND LEAVE A MESSAGF, CONSTRUCT PER ENGINEERS ATTACHED DESIGN, THIS PERMIT EXPIRES 12/31/90 AND VALID FOR H SINGLE FAMILY HOME. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MDA) and the State of Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit:, 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewe,age systemon ILI' is or any adjacent or nearby W0.4, r understa d that permit is valid for a maximum of 2 bedrooms. I also und an� thate capacity of the total system is 5 bedrooms and any an additional permit.. on laq,�" Signed: '~ Issued B.�� ' ` ' .1 Slim. ~ DATE: ����_-.... ............. ~' oATE: �� ~ 2 ����J Parcel Id: 015-272-47 Lot Legal: Subdivision: \STYMAN/S SUBDIVISION Lot: 2 Block: -- Section: 21 Township: 12N Range: 3W Lot Size 48948 (sq.fi. or acres) Max 8edrooms: This Permit: 2 Total Capacity: 5 SEPTIC MUNICIPALlTY septic tank OF xNCHgRAGF 1,500 gallons. ^ Department of Health & Human Services Depth to top of septic 825 L Street, Anchorage, Alaska 99501 343-4720 tank(s)" ON - SITE SE W KR & SEPTAC TANK PECMIT �O4/����Y Permit/M Numbers G9�223 Upgrade `u���u Date Issuea: 10/02/89 Engineer Designed Owner Names RICHARD Sl[RA Day Phone: Owner Address: 4100 EAST 112TH AVEMUE 522-13!1 ANCHORAGE, AK 995 P�0 7 ` Parcel Id: 015-272-47 Lot Legal: Subdivision: \STYMAN/S SUBDIVISION Lot: 2 Block: -- Section: 21 Township: 12N Range: 3W Lot Size 48948 (sq.fi. or acres) Max 8edrooms: This Permit: 2 Total Capacity: 5 SEPTIC TANK: Minimum total septic tank capacity: 1,500 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 taut requires insulation over tank(s)" INFORM DJU.H.S. PRIOR TO INSPECTIONS BY ENGINEER, IF AFTER OFFICE HOURS, CALL 343-46B1 AND LEAVE A MESSABF" CONSTRUCT PER FNG[NEERS ATTACHED APPROVED DESIGN. [HIu PERMIT EXPIRES 12/31/89 AND VALID FOR A SINGLE FAMILY HOMi A CERTIFY THAT: 1^ 1 am familia, with the requirements for on-Nite sewers and wells as set vorth by the Municipality of Anchorage (MOA) and the State of Alaska. 2, I will install the system in accordance with all MOA codes and regulations,, and in compliance with the design criteria of this permit` 3. I will adhere to all MOA and State of Alaska requirements for the set bact distances from any existing well, wastewater disposal system or public sewe age stem on this or any adjacent or nearby lot.. 4" I u maximum of 2 bedrooms, l also l system is 5 bedrooms and anypermit. Si9ned:DATE: (Owner� RICHARDc1lKA � L~/ Issued ^/�� DA FE: �//7~^'/`��/��' - - ,/ �/^ '�vv_���� ��L�.-.'... ���-.-.��.�... .... kh, po 20 Oslo 2 �LePP�'ea�ea "/Y9/a(� lsoox5 P�wr2�2l1ew /500�a,%�'e /5o x it o - I/e ed 2 a� 6/T - u2 LOT 2 WELL GOVT LOT 32B -ROP• SYSTEM ty PROP. WELL GOVT LOT 3 ZA WELL AVENUE / G° WELL Zsl i] //lsfir!//tew 3poSe aF tAek aa __�� ��,..,_e�.1f. 3 9&W4b v' r - - t411 25 t A gni. e Lor 2 LoT ! �NS YL L NEW TAFAJr-H — — — — — — — — — — — — — q 4 Per�.p�e ,1 Q o a Gem-�a.6n2. al' Shanm �—'' 66 s 5 JA, SeWer YOd.:. VOD D 0 DL O :SEWER. SYSTEM .. LOCATION PLAN SUBDIVISION �r e0X STYMANS SUED. SECTION/TOWNSHIP/RANGE T12N R3N S21 B SCALE -NOTE, THE ACCURACY OF LOCATION OF EXISTING PROPERTY CORNERS, WELLS, AND SEPTIC DRAWN BY, SYSTEMS INDICATED IS NOT EXACT. t NORTH DIMENSIONS INDICATED HAVE BEEN DETERMINED BY USE OF CLOTH TAPE AND NOT BY SURVEYING TECHNIQUES. 0 �•' , C,EnK2 � � Q i PREPARED FOR, - - RICHARD SIIRA a 's DATE.- SHEET OF Municipality of Anchorage • DEPARTMENT OF HEALTH & HUMAN 825 "L" Street, Anchorage, Alaska 9951 SOILS LOG - P15RRCOLATION PERFORMED FOR:!/��i� LEGAL DESCRIPTION: Lbf 21 5 N�G(F%So''vnship, �F 1 2 b, r 3- 4- 4 5 5 6- 7 7 ' .r 9- to- 101213141516171819 12- 13- 14- 15- 16- 17- is - 19 20 COMMENTS 6ey /S PERFORMED BY: j If 141x_ �r / IVB ACCORDANCE WITH ALL STATE AND MUNICIPAL 72-008 (Rev. 4/85) 9 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water Atter /� Monitoring? Date: v ,v,7rn SITE PLAN 2 PERCOLATION RATE (minuteVinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND _ FT _ 1 �4 RTIFY THAT TIj��ES'4� PERFORMED IN I FFEC/ O/THIS DATE. DATE: / �...� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 0* ENVIRONMENTAL ENGINEERING DIVISION ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW L-1 UPGRADE MAILING ADDRt,%S nr D LEGAL DESCRIPTION _ LOCATION - c� �2 40 w1vu NO. OF BEDROOMS U DISTANCE TO: ell /Absorption - �/'0 7 areas [/ Dwelling /0 .r PERMIT NO. _ �3 `l 0 SZ C7 Y a Q wF Manufacturer Mater' I No. of compartments w Liqcapacity in gallons X00, IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. _Z � F Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well � �o' Foundation r /0 Nearest lot line d PERMIT NO. -7 J w z Z w No. of lines % Length of ac }ne Total length of, lies Gj -\ Trench width// j % inches Distance between lines �V ~ate y.. o Top of rile to finish grade 2 �t Material beneath rile ! G, 1n6i' s Total effective absorption area 300 W Length Width Depth PERMIT NO. a aL- W Type of crib Crib diameter Crib depth Total effective absorption area w N DISTANCE TO: Well Building foundation Nearest lot line J Class /Np Depth Driller Distance to lot line PERMIT NO. w 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MAT 1ALS SOIL TEST RATING y i I INSTALLER REMARKS IU APPROV D DATE LEGAL 72-d413'(Rev. Y178) C7/- - Fi'°'ouoP-S Tf u."'. n Kati. Ifi T 'T_" r cg- E- ,gR-7-3-4. u� Rue LCL. U DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ,I._'' STREET, MN,lC:HCd=`AGE, AK. ^;+' 50-1 /,�U I a, _Ki -A�9 an t t�� �._:C chhs�a, Lar;. APPLICANT JUDY F:ASTL.IOOD PO BOX 3-3763 333 4869 LOCATION _i_1; T -H L.EGAL.. L_2 .-'T'YMFLNd"S 5/1) LOT .;I"ZE 4:=:675 SQUARE: FEET TYPE OF SOIL FiBSORUT I ON :=':'STEM I S : TRENCH MAXIMUM NUMBER OF BEzEiFE;I,TilMS :.: SOIL_ RATING <:<;Q FT/BR)- 100 THE REQUIRED SIZE OF THE _OIL ABSORPTION SYSTEM 15: , --� L,.- EE °-J9 r-2, -T- I -I tu_ r F I FI =,,: ° F-:_ ._.._ _ THE LENGTH DIMENSION 15 THE. LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF FI TRENCH OR PIT 15 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THF... EXCAVATION (IN FEET). THERE IS NO i 'SE:T WIDTH FOR TRENCHES. THE GRAVEL_ DEPTH f._: THE MINIMUM DEPTH OF I:3F>AVEL. BETWEEN THE: OUTFALL- PIPE AND THE. BOTTOM OF THE EXCAVATION (IN FEET) E -r: Nr_.. fi= § B.8 .1! �i'^'" �E.:. �p _;'" e _. Q...." _T" : �._ R-_:: .�-,. �,:.� �..•� �,.-�. :' "r ..�- � �� � '_ __::: :�Q.. fl�_it fi:'i Rv0 u.::1 s=1I E-.._ I.....- fl:� a w..=N "-- PERMIT APPLICANT HAS THE: RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELL_._: ADJACENT TO THIS PROPERTY AND THE: NUMBER OF RESIDENCES THAT THE WE.L.L. WILL. SERVE. -_., .,p - q =..r ems:., ,;. --- a.:." —r :!?_ fi., a L' -=D =_. FI FZ E' . FREE = C s L_6 'K �;•'.� E E __..__..—. � hi C3 a-" � .�. Li"'�„ - ......._...-..._... BACKFILLING OF AN,lr' SYSTEM WITHOUT FINAL IN•1SPEt_TION;! AND APPROVAL BY THIS DEPARTMENT WIL..L BE SUBJECT TO PROSECUTION. MINIMUM DISTRNdC:E BETWEEN A WELL AND ANY ON-SITE SEWAGE DISFOSAL.. SYSTEM Iz, :100 FEET FOR H PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE T'A'PE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION EiIFPGF::FLMS ARE F'VAIL_ABLE. TO INSURE PROPER INSTALLATION. _ .- ...._ .E � ._ FT F=" E-. FR K"^T :�_ "I"' 7:5: � `� E=° :9, F-==" EE vi K:`:x Ei:: fi:':- ems:_ �'^ N N_: k.:. E -- -=' 1- :' t CERTIFY THAI 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE: MUNICIPALITY OF ANCHORAGE. _: I WILL-. INSTAL..L.. THE: SYSTEM IN ACCORDANCE WITH THE: CODES. 3: :E UNDERSTAND THAT THE ON-SITE SEWER _?'':.'STEM MAY REQUIRE RFSTDENdC:E IS REMODELED TO INCLUDE MORE: THAN 3 BEDROOMS. SI I ._s ..."j -" -_ AND WELLS AS SET ENLARGEMENT IF THE: MUNICIPALITY OF ANCHORAGE DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6650, Anchorope, Alwka 99502 276.2221 SOILS LOG - PERCOLATION TEST LEGAL DESCAIPTION: jr 'L "'FIT, O Q C. P.wi 1 C t 1 ' SANDY GQf�vEl 2- 3- 34 4 I Cl so) S P �5 _I 6 7 O 6 e , SI.N py �Q►.1L� �. 9 Sw _QM 10- 012131415 12- 13- 14- 15 S11ip 16 17 16 19 20 0 ❑ PERCOLATION - TEST DATE PERFORMED: __ mre m eN 4— I _I WAS GROUNDWATERS 6 ENCOUNTERED? L 0 P E IF YES. AT WHAT 1S1 DEPTH? PERCOLATION RATE- -'qi` � 11 TEST RUN BETWEEN i _�..•'�'A >.n �'3g• PERFORMED BY: C, 1 41 CERTIFIEp 72-008 (7/76) Ru, J`=:1 aiph okela NO. 1995-E PROFES-W'. Kill I fffidyj T TJ "ll Irl L_' PA I C- .L4_' R— -i fl.._.. -E .d.-. w -e N.-8 F' F u r -A fl_.= p y -Z 0 fl A 7'1 S_ Ji 1-7— DEPARTMENT '-DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 25 'L' STREET, ANCHORAGE: AK ::r3501 264-4720 PERMIT NO. 790493 49r :) APPLICANT JULY EA Tb.00D 1045 MILA ST 333 4869 LOCATION 112TH AVE LEGAL LOT 2 _•TYMFINS SLJE3 LOT SIZE 4::675 SQUARE FEET MINIMUM DISTANCE:. BETWEEN A WELL. AND ANY ON --SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL; OR - 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE: TYPE OF F'UBL.IC L.,.IEL..L. WELL LOG_- ARE REQUIRED FIND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS FIND CONSTRUCTION DIAGRAMS ARE: AVAILABLE TO INSURE PROPER INSTALLATION. 1 -F E X F> :F K E= �:, L=::a E= CC @:= r-1 E J ft. ^_:4 ..tl ^ ^. 'A I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SfTE: _=•EWERS, AND WELL_: AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL IP'STALL. THE SYSTEM IN RCCOYDANCE: WITH THE CODES. ICRNT JUDY ?�jj)L'IING C�n�iRAc"roJL'. 14A('1)C %�k)lUti6 rPIO)Wl DR)t`r-yi-o>t /3RUc1 f_�s'r i�aav l Dc��nto� ; SOT S �y�A✓�� S�1�A>���I�IJ� /�/)rf- dull cp , SPyT"F1o9zR ) 1 % rtA71C G/.:---vrL : 5 tr Ort= 9077oAI G,rM- ,9,th v , /4 t�p /P 6,P44. .DA)CL),1J1 c 1-40e, CI Ay/ -1 `lel-41L 37 C)iAvi4` S�>zo1 SIL T 5-/ /34©Wv C Ay G)z/' gAO144 5- 13/�e�� s .��r-L1k1= ClAy GRAY�L C �7S CAA S Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 TEMS APPROVAL DWELLING nrLnn COSA# v t it�(o� Expiration Date: —a7-07 CERTIFICATE OF ON-SITE SYS FOR A SINGLE FAMILY Parcel I.D. 015-272-47 1. GENERAL INFORMATION Complete legal description Stymans Lot 2 Location (site address) 4100E 112th Ave., Anchorage, AK, 99516 Current Property owner(S) Richard L 6 Robyn R. Siira Day phone Mailing address 4100 E. 112th Ave., Anchorage, AK, 99516 Lending agency Day phone Mailing address Real Estate Agent Lori Hackenberger/ Dynamic Properties Day phone 907-727-4444 Mailing Address 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, COSH w9l be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well r❑ Individual On-site ❑r 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 Onsite Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of OnSfte Systems 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 Certificate of Onsite 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 Watkins Engineering, Inc. Phone 907-349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 49� 6. DSD SIGNATURE ��; Cindy K EIIIs 1� Approved for 5 bedrooms. CE.tosn Disapproved. ',WNW Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory' Well Flow Advisory Nitrate Advisory . X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 3'— a7 — 0-7 rRw nasi Municipality of Anchorage Development Services Department Building Safety DMsion ` OnSite Water & Wastewater Program ° • • * . 47W Bragaw Street P.O. Box 196650 Anchorage, AK 99519850 www.muni.oryonake (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: STYMANS SID Lot 2 Parcel ID: 015.27247 A. WELL DATA Wen type Pri If A, B, or C provide PWSID * WA Wei Log (YIN) YES Data completed 1979 Sanitary seal (YIN) YES Wires Property Protected (YM) YES Total depth 183 R. Cased to 183 R. Casing height (above ground) 20 in. FROM WELL LOG AT INSPECTION Date of teat 911911979 6116/08 Static water level 158 ft. 150 Well production 15 O.P.M. 5.4 9— P.m-WATER SAMPLE RESULTS: Cotton 0 coloniesM00 mL Nitrate 1.73 mg1L Other bacteria 0 colonieaM00 ml- Arsenic: LArsenic: <0_005 n10A Date of sample: 2/28107 Collected by: Rocky Trainor B. SEPTIC/HOLDING TANK DATA Tank Type/Matertal 2 Steel septic tanks Date installed 1013/79.5118!90 Tank size 10W# OW gat. Number of Compartments 22 *,1 Cleanouta (YIN) YES Foundation afeartout (YIN) nS Depression over tank (Y/N) NO High water alarm (YIN) NO Date of pumping 7112106 Pumper A+ Home Services C. ABSORPTION FIELD DATA Data instated t09r79. 6/78A0 Soil rating (g.p.dAe or fi=Ibdmm)10OM50 Length 26+29 R. Width 3.4 R. System type Deep trench Gravel below pipe 6, 5.5 ft. Tofal depth 10AV10.9 R Eff-8b50rPtI0naM8§2—je Monitoring tube YES Depression over field NO Data of adequacy test 6/16/2006 Results (Pass/FsIQ PASS For 5 bedroom$ Fluid depth in absorption field before test 0131.6 in. Water add bed 14.4 gal. Now depth 26.25/40.25 in. Elapsed Time: 120 etin. Final fluid depth 0135 in. Absorption rats >= 750 g.p.d_ Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date D. UFT STATION Date installed NA Size in gallons 'Pump on' level at _ in. 'Pump ofr level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 102 Absorption field on lot 102 Public sewer main 100'* Sewer /septic service line 70* Animal containmentareas 100'+ ManhoWAoeess (Y/N) High water alarm level at Meets alarm 6 circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excreta storage areas 1004 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 20'+ Property We 43 Absorption field 5+ Water main 100'+ Water service line 50'+ Surface water 100'+ in. Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 29* Building foundation 25+ Water main 100'+ Water Service line 60'+ Surface water 100'+ Driveway, perkw9lvehicis storege 40'+ Curtain drain NIA Wells on adjacent lots 100'+ F. COMMENTS: System WBreded 1980 from 3 bedrooms m 5 bedrooms. Two trerrrirea lo perapel. Two sepek ranks In series 0. ENGINEER'S CERTIFICATION I cerdly that 1 have determined through field inspections and review of Municrpal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Cindy W. EIBs Date 3-21?.07 COSA Fee S J Z 3 01 Waiver Fee $ Date of Payment 70 Receipt Number Z �� (Rev. tilt) Date of Payment Receipt Number 49TH MY W. Ellis CE.Jos" io io ui m N 3 �o 0 0 0 t; WELL 20.6' 74-259 STYMANS SUBDIVISION LOT 2 48,965 S.F. EAST 112TH AVENUE /—x--4-1—x—x_x__ S 69°55'11"E 1 A.C. DRIVE EXISTING BUILDING A SATELM o6H SEP11C SYSTEM t J —x—x—x—x—x—x7 z I FENCE (APx) x — I— — — — — — — _ — — — — i 10' UTIL ESMT. S 69.51'46"E 165.01' NOTES I. LIMITS OF A.C. PAVING SHOWN ARE APPROXIMATE DUE TO SNOW COVER AT THE TIME OF THIS SURVEY. 2. SEPTIC SYSTEM LOCATION SHOWN FROM ON—SITE SEWAGE SYSTEM INSPECTION REPORT PROVIDED BY WATKINS ENGINEERING. GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 4726 WEST 88TH AVENUE ANCHORAGE. ALASKA 99502 PHONE 248-5454 GRID DATE 2635 3/21/2007 F.B. JOB NO. 07-02 SSLOT2 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE BUILDING DETAIL SCALE: 111-20' OFr 4 �1 • '� • �; 49IH •• 6. * 0 • .. .................:...1 m I. Je ery A. Gosloldi : N i° l 60//91 A • •�'P°vAr2�Z�(O•i�d6���1 �� oyessionol to �* It#Iari��* 111=40' MUNICIPALITY OF ANCHORAGE 44Pa • DEPARTMENT OF HEALTH & HUMAN SERVICES 1A ri Division of Environmental Services - On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015-272-47 1. GENERAL INFORMATION 2. 3. 4. Complete legal description Lot 2 Styman' s Subd. Sec 21 T12N. R W SM Location (site address or directions) 4100 E 112 A17P Property owner Richard Siira Day phone 263-4943 Mailing address PO Box 110816 • Anchorage AK 99511 Lending agency Day phone Mailingaddress PQ Rox 10702q., An�hnr�qp, AK 99510 Agent _ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water 5 X Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA N21 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 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 Tobben SnnrkIand , P_F_ Phone 779-191(, Address 203 W 15 Ave., Suite 206 Anchorage AK 99501 Engineer's signature Fnr Tobhpn Spnrkland Date 10/20/91 6. DHHS SIGNATURE M xx Approved for Five s l;1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments This is a recertification of the original signed M ITIC Date NovembPr 26, 991 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. 7M25(R.V. 1/91) Bock MOA N1 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# �J�- �%A—U7 HAA# )AC q!a Q'\a� 1. GENERAL INFORMATION Complete legal description f o r a -STY HAN / S S i p Location (site address or directions) Property owner < "r° Day phone Y3 ?' Mailing address I� i2 30)C 11 O 8 1G Lending agency �� rY4 A Day phone Mailing address— Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Day phone Individual well Community well Public water. NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site x Holding tank Community on-site Public sewer NOTE: 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 r , - I r IP�r'j r r f r r -rq'l I r r 1}tt f Nmm sdgE)UI6ue leuoissa;oJd ay; ul suolsslwo Jo stone Jo; elglsuodsaJ IOU sl e6e.10youy;o 4!ledloi6nW syl -panssl'sl eleollpeo a aJo;aq elep az(leue jo suolloodsul lonpuoo lou op SHl 1(1;o sea (oldw3 ,sluaweJlnbaJ alele pue lsaepal uleliao yslles oliepio ul suo!lnlllsul bulpual ileyl pue sewol;osJeseloJndol (salJnooe'seslglsaopSHHQeyl'e�sely;oelelSaylu1paaelsl6aaaaaul6ualeuolssa;oad luapuedepul ue Aq enoge 9 ydeJ6eaed ul u9nl6 suolleluasaJdaJ all uodn Aluo paseq selgol;llJep lenoJddy (3!Jollny l31eeH sanss! (SHHO) seolnaaS uewnH pug Q881-1 ;o luawlJedaa 96eaogouy;o Alllsdlolunw all sluawwoc) leuolllppy :suollelndlls 6ulnnollol ayl lIIM 'swooapaq_ 6 ��u �. ,cpm na ar .tt ap� Jo; lgnoidde leuolllpuoo •panoiddesiC] •swooapaq :0� Jo; panoaddy �- -�- 3un.LVN!DIS SHHO '9 �Z ale4 __4 aanleu6ls s,aaaul6u3 C) cov �1 -,T,v , P" -Y' ssaJPPV �1 I COE — Z74 euold A,� S J4,`7&7`)/ — wal3;o awgN •uolloadsul slyl;o elep eyl uo loage ul suollglnBou pue'seougulpao sapoo alelS pue ledlolunW Ile yl!M aouelIdwoo ul sl walsAs lesodslp aalennalsem Jo/pue Alddns Jolem alls.•uo all 'uolloadsul pue uolle611sanu1 (w woe; pug sell; 96eaolouy;o Allledlolunw all woJ; peulelgo uollewao;ul ayl uo paseq legjA4!JaAaaylan; I -ulaaay paleolpul ainlonJls;o adAl pue swooapaq p Jagwnu all Jo; elenbope pug leuolloun;'ales sl walsAs lesodslp Japamelsem Jo/pue (lddns aalem alls-uo all lell smogs uolleolldde lenoaddy (llaoylny ylleaH slyl;o uolle611sanul Aw leyl l;lJaA 1 'molaq umoys alep uo!lep!IeA ayl;o se pue olaaay pail;;g leas (w !q pel;llJao sy U33NION3 AS N01103dSNl d0 1N3W31VIS i .9 Municipality of Anchorage ' Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �^�' S r104 VILA II s E/U Parcel I.D. 015 272- LZ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 1 1411xLog present (Y/N) J Date completed 1q7 q —Driller ltre-4c lati 1,140 Total depth /� Casedto 493 Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG I_15 .fes SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Wires properly protected (Y/N) r�X/ _ ; On adjacent lots > Absorption field on lot I 1 ; On adjacent lots > ) I, --o Public sewer main (���� Public sewer manhole/cleanout NIA Sewer service line - N/^ Petroleum tank � WATER SAMPLE RESULTS: Coliform &Nitraate 0,"-7-7 Other bacteria Date of sample: 10I� & £ 10 laa1 `f I Collected by: en, B. SEPTIC/HANG TANK �° 'i6�/ �DATA Date installed 10131'M Tank size fxe f Compartments f Cleanouts (Y/N) y Foundation cleanout (Y/N) Depression (Y/N) I` High water alarm (Y/N) NIA Alarm tested (Y/N) N11\ Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 169 On adjacent lots i 11%C> Foundation To property line 30 + Absorptionfield Water main/service line Surface water/drainage H 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE m AT INSPECTION 10 _J ,Jn,. 145 r0 `c c. g.p.m. g'p'? `IJV 0)CID ` ai n o� cu _ ; On adjacent lots > Absorption field on lot I 1 ; On adjacent lots > ) I, --o Public sewer main (���� Public sewer manhole/cleanout NIA Sewer service line - N/^ Petroleum tank � WATER SAMPLE RESULTS: Coliform &Nitraate 0,"-7-7 Other bacteria Date of sample: 10I� & £ 10 laa1 `f I Collected by: en, B. SEPTIC/HANG TANK �° 'i6�/ �DATA Date installed 10131'M Tank size fxe f Compartments f Cleanouts (Y/N) y Foundation cleanout (Y/N) Depression (Y/N) I` High water alarm (Y/N) NIA Alarm tested (Y/N) N11\ Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 169 On adjacent lots i 11%C> Foundation To property line 30 + Absorptionfield Water main/service line Surface water/drainage H 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION jA Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed . /o1/Y% 1 :511819n Soil rating 150 System type Length dh ?41r) Width ) Gravel thickness 61 b, 6 Total depth Total absorption area 6 IC? Cleanouts present (Y/N) L Depression over field (Y/N) N Date of adequacy test t 0Lh I Results (pass/fail) �2�>S `' for t7 Peroxide treatment (past 12 months) (Y/N) I N If yes, give date /0 bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot— I 1 1_I On adjacent lots �! 10-0 Property line To building foundation 19- To existing or abandoned system on lot On adjacent lots �� d Cutbank N� Water mai n/service I i ne Surface water _ N/R Driveway, parking/vehicle storage area 7 Curtain drain _ SIA 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. Signa Engin Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ���IF-CV-8--n- H�JIL> �~.. 203WEST (5TH.AYENUE SUITE 206 ANCHORAGE, ALASKA 97502-3YO4 (907>279-3916 RESIDENTIAL WELL LEGAL: Lot 2 Styman's S/D LOCATION: 4100 W 1`12th" Ave OWNER: Richard Siira TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: Yes WELL YIELD FROM WELL LOSt PUMP YIELD FROM TEST: DATE OF INSPECTION: 10 Gallons per Minute 8 Gallons per Minute Oct. 18, 1991 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 145 feet below top of rasing. At a pumping rate of 8 gallons per minute the water level dropped to 150 feet after 90 minutes of pumping. The water level remained at this level for the duration of the test, 20 more minutes. A total of 830 gallons were pumped. The well recovered to 145 feet within 4 minutes of pump shut off" TEST FOR E^COLI AND TOTAL NITROGEN: Water was tested for E"Coli and total nitrogen on Oct. 18 and Oct 24, 1991 F,Coli 0. Total Nitrogen 0"79 mg/l^ Max, allowable Total Nitrogen 10 mg/l" TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL =PRODUCE MORE TRAIN I-GALLONSPER MINUTE� FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day" This well exceed this requirement" The assessment of the condition of the well applies only to the conditions as of the day tested" The flow rate may change due to subsurface conditions that may not be o face, and changes in the land use and other factors the aquifer feeding the well. �/ F. FE~ 203 WEST 15YH. AYEHUE SUITE 206 ANCH8RAG[,ALASKA YY502-3Y04 (907)279-3Y16 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 2 Styman's S/D LOCATION: 4100 W 112th, Ave OWNER: Richard Siira RESIDENCE: Single Family, 5 Bedrooms WELL: Private, On Site SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 5 Bedroom System TANK: Greer 1000 Anchorage Tank 500., ABSORPTION SYSTEM: Trench ABSORPTION AREA: 619 Sq. Ft. SOIL RATING: 100/150 INSTALLATION DATE: 10/3/79 5/18/90 DATE OF LAST PUMPING: Anch. Cess Pool Oct. 213, 1991 DATE OF TEST: Oct. 18, 1991 TEST PROCEDURE: System was inspected and measured" Tanks were found with 4 feet of cover and with a liquid levels of -_,157 and 49 inches. Trench clean out was 74 inches deep and dry. Trench monitor tube Was 11 deep with 33 inches of water. 830 gallons of clean water was added to the trench while the water levels in the 500 gal tank and the monitor tube were moni- tored, The water level in the tank did not change, while the level in the monitor rose 2 inches" #0 minutes after the water had been added the water level in the monitor was back at the pre test level, indicating that all 83O gallons of water had been absorbed. TEST RESULT: This system meets the code requirements of the Health and Sorial Services Department of the Municipality of Anchorage. NOTE 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 heirig served by the system" These conditions are outside the control of the evaluator of this septic system. We ca i ve any estimate of how long this system will- f or- current or future occupants" { ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 0 %C7 /06 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) �5� F Z� S fv man's S i b Location (address or directions) ly/ C C2 0 1(2- Hr (b) Applicant Name SFevt� %�uiS iY Telephone: Home 109-3Business Applicant Address e-1(yu 12,�on� kl- 9'514• (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 1Z ;Buyer O ;Other[] (explain); (d) Lending Institution Afc Kcvr a'C 3'C—luacei Telephone '6-e z Address l7Ul u.(inecf /'4✓k /{%u<{� /} (e) Real Estate Company and Agent Fa✓ 'te /°+ W ei-1-6eu — Sam A1r e Address 3 000 A S F• Av) C•"1iol7e k l� Q 45.00 Telephone S3 (e — 715-3 (f) Mail the HAA to the following address: l�olc� i7e' Ptclr u� A.A i /Yev"c 2. TYPE OF RESIDENCE Single -Family 99 Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 191 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 _ 72-025 (11,e4) 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 verity that my investigation of this Health Authority Approval shows that the on-site watersupply 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 Jec/t2 ced Set"" Telephone 3y�`-133-5 Address NS 30 Ak Date J '/ l0 / ill ri DHEP APPROVAL( ��') Approved for bedrooms b Approved- Disapproved Conditional Terms of Conditional Approval J-1 hep CAUTION Date//v V 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 I2-025 (11/04( MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUMCIPALITy OF ANCHORAGE CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION Legal Description: L Frl 2, E 1'";*2 j S S /b J v h! 1 1 1986 A. WELL DATA pECEIVED Well Classification -P ✓ (tate If A, B, C, D.E.C. Approved (Y/N) &.4. Well Log Present (Y/N) i Date Completed 9179 Yield'>_ 6.3 Total Depth i (q_?' Cased to f B3 Depth of Grouting Att A. Static Water Level 1'73' Pump Set At 6i12A n Casing Height Above Ground ! ri Sanitary Seal on Casing (Y/N) � Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) K Separation Distances from Well: To Septic/Holding Tank on Lot I LO ;On Adjoining Lots fly V To Nearest Edge of Absorption Field on Lot j -Q5' ; On Adjoining Lots 1 N t To Nearest Public Sewer Line N To Nearest Public Sewer Cleanout/Manhole N. To Nearest Sewer Service Line on Lot N,A• Water Sample Collected by Ic/F'M ; Date Water Sample Test Results .�c7ftS3�C�T-% no b-zc' arta Comments B. SEPTIC/HOLDING TANK DATA Date Installed 16 /3 X 79 Size 1000 cx1 No. of Compartments a Standpipes (Y/N) Y Air -tight Caps (Y/N) r Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 6110 16r Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) N• A. Temporary Holding Tank Permit (Y/N) N• A. Separation Distances from Septic/Holding Tank: To Water -Supply Well f 10 ` To Property Line To Water Main/Service Line Course i 1001 Comments Page 1 of 2 72-026(11/84) III To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _I 00 D /13clnr Type of System Design % .^en c ti Date Installed 10 79 Length of Field 2 6' Width of Field 36 Depth of Field { Gravel Bed Thickness Square Feet of Absorption Area S / G. Standpipes Present(Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test G /9 18! Results of Last Adequacy Test A!Lft cta 6e 3 b_1d PVC),1nf Separation Distance from Absorption Field: To Water -Supply Well Jos r To Building Foundation P.A Lot NA To Water Main/Service Line N, A. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION KA. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for _ Electrical Codes (Y/N) Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Data 0 / !U(_8,( Company 1`reel $e"IC4? MOA No. SS-OS'2- Receipt No.�%� a Date of Payment F ��//��) ©� ° OF A4 ®p ccs �'��,•' °'4�®O Engineer's Seal Amount: $ a . 4 /aThr •• 7 Page 2 of 2 Q • ne000HE r. MOOPL Cr - 3589 tl 72-02en1,e4l/ v 5. LEGY DESCRIPTION I,v Ds RECEIVED INSPECTION APPOINTMENTS - TIME NUMBER OF BEDROOMS TIME TIME e-L�4CA dee D DATE ❑ Two ❑ Five DATE ` � DATE (� 7. WATER� -\\ -O \ _ _ lC INSPECTOR since June 1975. For wells drilled prior to that date, give well INSPECTPIR INSPECTOR 8. SEWAGE DISPOSAL SYSTEM ,,.. INDIVIDUAL/ON-SITE**YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE(DM bIWIPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION AUG 4 I981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEMEI6aFAr,11LY8$ 1(10) DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten days for processing. 1. PR PERTYOWNER %1� I _ CLQ n onaa73 PHONE MAI LI GADDDR , 0 1 PROPERTY RESIDENT lit different from above) PHONE 2. BUYER ( PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE -l9// I'tn a MAILING ADDRG��� 4. ALTO..R/llA''GENT e(, -, k(' n ,n,,, // 0'hn � — p0hr R-e�C PH''O//NE ��+ 3`t r7(0� MAILING ADDRESS 110 (0. 'Ito - f4v� Su,c�2 6 /4K 9�is 6 5. LEGY DESCRIPTION Oi v`' "s(- iv�Gt STREET LOCATMil 1 I a `Lys 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS - - ❑ - One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY C5, Three ❑ Six 7. WATER� 7SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY - depth (attach lag if available.) 8. SEWAGE DISPOSAL SYSTEM ,,.. INDIVIDUAL/ON-SITE**YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 7z -o10 (Rev. ens) 14—p-4�y r ,� "fir- THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE Q SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE El—THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLICUTI LITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING S TYPEOFTANK MANUFACTURER J- ee , TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 'VAPPROVEDFOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 72-010 (Rev. 6/79)