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HomeMy WebLinkAboutOLSON HEIGHTS BLK 1 LT 2 iIIIIIM� Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number- OSP211073 PID Number: 018-231-03 Dwelling: INE Single Family (SF) El with ADU E] Duplex (D) 0 Two Single Family Project: F-I jNew FM Upgrade IName MANDSAGER AB ORPTION FIELD El Deep Trench 171 Wide Trench Bed FJ Mound Site Address 4251 EAST 135TH El Other Phone Number of Bedrooms Soil Rating Total depth torn original grade 4 GPD1SF1 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade, JGravelldepth beneath pipe Subdivision OLSON HEiGHTS BLK i LT 2 Block Lot NJ I Fill added above original grade IGraveilliength Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches i Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 1001+50' + TANK @[Septic [I S.T.E.P. C1 H Iding Other GREER/ANCH TANK. 1250! Gal. I Surface Water 100'+ Material Number �f compartments Lot Line 101+ NA PLASTIC/DEEP BURIAL 2 FoundationLIFT STATION 110,+1 Manufacturer Capacityi Remarks Gal. Alarm location Electrical installed by fttaUr PIPE MATERIAL House to 3034 i Tank to 30 'AA drainfield MIKE N ANDERSON PE Drainfield GOIMT 3034 Inspector MIKE N ANDERSON PE BENCH MARK (Assumed elevation) 100 I ft Inspection 19 4119121 Location and description — 3'd 4m ITOP OF MH LID ON-SITE WATER AND WASTEWATER SECTION APPROVAL En i etr's Stamp Conditional Approval: Date fro 49TH'�A ANDERSON :4-'- ?4619 Septic Syster Approved VIC%*. MICHAEL , CE Date .. 07� 4 2 q . . 1 No this approval does not include well permit requirem nts. ppi of iIIIIIM� Permit No. OSP211073 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: OLSON HEIGHTS BLK 1 LT 2 PID No.: 018-231-03 MARK A B C01 19 48.1 TC01 20.6 49.2 TCO2 24.3 50 CO2 25 50.5 CO3 26.6 50.1 II II MT2 \ NEW 12 0 GALLO PLASTIC TANK \\ HOT TUBI BENCH, P OF MH \\ ,,.------,,\ cap— II i \ � I � I \ / I � 4VELL I I I I I I ® WELL I I I I � I ASBUILT \ / SCALE: 1"=50' / 001 TC01CO2 CO3 ....'** O� '1111 oa 99.8 ♦.�P� .........!.. Air R AV AV i� 49TH 95.6 PLASTIC TANK '3 •••••••• 0 10 :MICHAEL. N. AND ERSON;AW ' No. CE 9469.••,. AV 7-10-25AV ��/••�'.........\••'� SEPTIC SECTION46, �..♦ ♦11';� SSS N.T.S. .��`� Permit Number:OSP211073 Tax Code Number:01823103000 Work Type:SepticTank Upgrade Effective Date: Design Engineer: Site Legal Address:OLSON HEIGHTS BLK 1 LT 2 G:2936 Owner:MANDSAGER RICHARD D & RUTH E Site Mailing Address:4251 E 135TH AVE, Anchorage Lot Size in Sq Ft:49517 Total Bedrooms:4 This permit is for the construction of: Disposal Field 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 3/26/2021 3/26/2022 ANDERSON CONSTRUCTION & ENGINEERING Expiration Date: ¨þ ¨¨¨¨ Received By: Issued By: Date: Date: MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program 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 Deb Wockenfuss 3/26/21 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 018-231-03 Property owner(s) RICHARD & RUTH MANDSAGER Mailing address 4251 E 135TH AVE, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) OLSON HEIGHTS BLK 1 LT 2 Legal description (Township, Range & Section) Lot Size 49,517 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: $225 Waiver Fees: Date of Payment: '"22 -2t Receipt Number: (72 ]� Iia Permit No. OSP211073 Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc March 18, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: OLSON HEIGHTS BLK 1 LT 2 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211073, Deb Wockenfuss, 03/26/21 1"=50' PROPERTY LINE PROPERTY LINE EXISTING WELL 100' RADIUS WELL EXISTING HOUSE SHED -ELMORE ROAD-NEW 1,250 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, 5' FROM ALL DECK SUPPORTS TYP. EXISTING TANK TO BE DECOMMISSIONED PER UPC -E 135TH AVE-DRIVEWAYOLSON HEIGHTS BLOCK 1, LOT 2 SCALE: DJRDRAWN: DATE: OLSON HEIGHTS, BLOCK 1, LOT 2 Anchorage, Alaska RICHARD & RUTH MANDSAGER 2/12/2021 OLSON HEIGHTS BLOCK 1, LOT 3 OLSON HEIGHTS BLOCK 1, LOT 1 MCCABE WEST LOT 4 OLSON HEIGHTS BLOCK 2, LOT 2 WELL DCO DCO VACANT LOT NO EXISTING WELLS WITHIN 100' OF THE SYSTEM EXISTING CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211073, Deb Wockenfuss, 03/26/21 9 N8954'31"E 16500 10' CEA & ATU EASEMENT -------------------------------------------------------------------------------------------------------------------------------- SNE° 3 I� Ig W Q I� IW Iv DECK I �n •_ _ - -a DECK col/ fit6 SINGLE FAMILY HOUSE e 462 399 °ECK _ cOVERED -_ -- _ PLK�Py ti •WFLL A T v N 89 53'E 16500 EAST 135TH OF.'A CO.' 4g TH N SHANE A. HOLT ' • THESURVEYDATA AND MEASUREMENTS HEREONARE PREPARED FOR THE pLS -6914 0`O OWNER OFRECORD AS OF THEDA TE OF THIS SURVEY. �Qa o ANYUSEOF THIS DRAW/NG BYTH/RD PART/ES IS PROHIB/TED UNLESS fessiona% \'Qo WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AVENUE AS-BUILTSURVEY I" =301 NO CORNERS SET THIS DATE 6I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT2, BLOCKI, OLSON HEIGHTS (PLA T79-68) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS -5- DAY OF FEBRUARY ,2021 14933, FB211-10 HOLT LAND SURVEYING 9309 DROVER DRIVE ANCHORAGE,AK 99507 .UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAI.TFI & ENVIRONIVIENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT 1PH°NE UPGRADE LEGAL DESCRIPTION LQCATIQN IF FIOMEMAD E: DISTANCE -FO: Tw%~T7 DISTANCE TO: /''~ ~aT' No, of lines 1Length of each line Top of tile to finish grad~% ( Dwelling Length Width Type of crib :rib diameter Crib depth  Material FoundatioQ~I '[N~ot line _2¢ No Total_~,,..~oJgn~hl..) of~._~ ' 'J¢ lines ¢ .,: '., '~;. ~ll width Mat~d~l beneath tile Depth IN~ OF BEDROOMS BRMIT NO. NF., ~cornpartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. DISTANCE TO: Well Depth Building foundation DISTANCE TO: OTHER PIPE MATERIALS P,V,o, + SOIL TEST RATING ,-) REMARKS Building foundation Driller Sewel line -APPROVE DAZE / LEGAL PERMIT NO. RPPLICANT LOCRTION LEGRL HRNK TRMBLgN E.±]:STH L 2 B & OLSON HTS [:,EF'RRTNENT,OF ' '_TH RN[:, EN',/IRONI"IENTFIL F'r ~ -:TIOF,I///~ .-. ~ ~ 825 ' L" :,] NEET., RNCHORRGE., AK. :~95b~ / /c~. '~ ~} ( 80B248 ) / - P. O. BOX t~-687 RNCH 24~5899 LOT SIZE 49000 SQUARE FEE']' TYPE OF SOIL 8B$ORPTION SM_STEM IS: TRENCH MFI',:.::II"'IUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT,"BR)= ±00 THE REQUIRED SIZE OF THIS SOIL RBSORPTION SYSTEM IS: [:, E F"]- H = 7-' LEN~iTH= 5~-Z~ GRPJ'¢EL [:, E I:"'~ T' H:= ':~ THE LENGTH DIMENSION IS THE: LENGTH (IN F"EET) OF THE TRENCH OR DRRINF'IELD. THE PEPTH OF' R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF' THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR',/EL DEPTH IS THE MINIMUM DEPTH OF GRR',/EL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THIS EXCRVRTION (IN FEET). RED SEF'~T Im'-: F'ERMIT RPPLICRNT HRS THE RFSPONSIBILIT¥ TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF"" RNY WELLS RDJRCEN]' TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TII--IIC~ ( 2 ;) ][ li'-~:E;P'E']C:T I 0l'~$ l-'-t R I}Z F.a. IF_ t;~ I_1 :[ RE-]E.:. BRCKFILLING OF RN¥ SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BV THIS DEPFgRTI',IENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RN"r' ON-SITE SEWRGE DISF'OSRL SVSTEM IS ik90 FEE]' FOR R PRIVRTE WELt. OR i5£'~ TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON 'THE TYPE OF PUBLIC WEt. L. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET FiND TO R COMMUNITV SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO ]'HE DEPRRTMENT WITHIN OF THE WELL COMPLETION. OTHER REQUIREMENTS MR'T' FtPPL"r'. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS FIRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F' E I;.: r.1 I T g ::--: P I R E S F-:, E C: E I"1 B E: R __T_~: 1 .. :1 _c.., 8 ~ I CERTIF9 THRT l: I RM FAMILIRR WITH THE REQUIREMENTS FOR ON--SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITV OF RNCFIORRGE. 2: I WILL INSTRLL THE SVSTEM IN RCCORDRNCE WITH THE COL':,ES. ]¢: I UN[:,ERSTRND THRT THE ON-SITE SEWER S'T'STEM MR'¢ REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS; REMO[:,ELED TO INCLUDE MORE THRN 4 BEDROOMS. ,:.r, I GNED: ............................................... RPPLICRNT HRNK TRMBL'¢N V4. 0 : V4. 01 .i LEGAL DESCRIPTION: 15 16 17 18 19 2O COMMENTS Cc / D~. 5'/ 5'4 CONTRACTING ENGINJ EI S & ASSOC. AN CH©~.,AG E, ALASKA~99502 P~.ON E ~Z,.~ ~ DATE PERFORMED; SLOPE 51 ~A SOILS LOG PERCOLATION TEST SITE PLAN WAS GROUND'WATER ENCOUNTERED? y' G.~ IF YES, ATWHAT DEPTH? /3~'~ Gross Net Oepth to . Net Reading Date Time Time Water ' Drop ~ ~ ~?,~9 F~'SE~9~R CO LATIO N RATE (minutes/inch) T~ST RUN BETWEEN ~ FT AND FT MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251263 Parcel ID 018 -231-03 Expiration Date: Legal description OLSON HEIGHTS BLK 1 LT 2 Site address 4251 E 135TH AVE 7/1/2026 Current property owner(s) MANDSAGER RICHARD D & RUTH E X The On-site system(s) is/are approved for 4 bedrooms 0 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 7/22/2025 This C ficate of On Systems Approval (COSA) is intended to demonstrate the subject sys (s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Pi Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section t Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-231-03 Complete legal description OLSON HEIGHTS BLK 1 LT 2 Location (site address) 4251 EAST 133TH AVE Current property owner(s) MANDSAGER 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: QQ Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: FN� Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 4 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑N Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 00 Date of Payment 7IM2 COSA # 0S(25-1� 3 Waiver Fee $ Date of Payment Waiver # COSA Application_Apr2025.doc COSA Checklist Legal Description: OLSON HEIGHTS BLK 1 LT 2 Parcel ID: 018-231-03 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 10/26/80 Total depth 203 ft Cased to 203 ft Sanitary seal is functioning correctly ❑� Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 7/1/25 Static water level at beginning of test 141 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 50_' Date of pumping 7/1/25 ❑ Required maintenance completed, if AWWTS Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 7/8/80 X ALL standpipes present per record drawing Total measured depth from grade 7.3 ft (max) Measured depth to pipe invert from grade 3.3 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑01 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) _ If yes, enter date Comments/Deficiencies: COSA Check1ist—May2025.d= Well production at time of test 7+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑fi No 0 Coliform bacteria is Negative Nitrate 4.20 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by ROBERT JONES Date 7/1/25 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material — Comments: Adequacy test date 7/1/25 Results ✓❑ Pass Fluid depth prior to test 0 in Water added 600+ gal New fluid depth 3 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 0 in Effective depth remaining 48 in E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' 7✓ Yes if No _ ft Neighboring Tank > 100' Yes if No _ ft Disposal Field on Lot > 100' Q✓ Yes if No _ ft Neighboring Disposal Fields > 100' R✓ Yes if No _ ft Sewer Line/Main > 100' F/1 Yes if No _ It Sewer Manhole/Cleanout > 100' ✓Q Yes if No ft Sewer Service/Septic Line > 25'Q Yes if No ft Holding Tank > 100' r7l Yes if No _ ft Animal Containment > 50' Q✓ Yes if No _ It Manure/Animal Excreta Storage > 100' Q Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' ✓❑ Yes if No _ It Surface Water > 100' Q✓ Yes if No _ It Field to Foundation > 10' Q✓ Yes if No _ It Tank to Property Line > 5' Q Yes if No ft Field to Property Line > 10' QYes if No _ It Water Main/Service Line > 10' ❑✓ Yes if No It F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Wells > 100' Community Wells > 200' ❑✓ Yes if No _ ft 0 Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal ,and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm MIKE ANDERSON PE Engineer's Printed Name SAME COSA Checklist_May2025.docx Phone 727-8864 Date 7/16/25 O r qO.F. AC1 �4,.i /hip'.• �<,�„ I ft . .. ..... MICHAEL N. ANN RSCN rCE - 9469 E X 1" = 50' LOT 1 BLK 1 N89°54'31 "E 165.00' 0 EAST 135TH AVE 0 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: OLSON HEIGHTS SUBDIVISION LUT 2 BLOCK 1 PLAT 79-68 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoulc any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAIL: JUNE 21, 2025 1 "=50' schullerokogmail.com 25-062 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: JLS SW2936 250206 O = FND 5/8" REBAR AMW ANW o F ®® �. .� 0® .�.� ®* 49TH OA ® v 1 .�..:.. ...................:..../ co •.J HN L. SCHULLER.• o 1LS-10408 qj 10 � �® ®® essiona LOT 3 BLK 1 ASD LSUR V o sGj+A' y .t 'f' y r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~;:~"~-~'~ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date A"~IL- ['2...] GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions), (b) Property Owner i~r/""c""c"/t"[~tC-~'''r'p Telephone: Home "~fJc,~-~.________________2~oCf..- Business Mailing AddresslJC'Z.,~~, ~-~-'[- ~'~'~" ~.~ ~¢_~..-~r~J'~/ ~_., (c) Lending Institution~"~~T t""'~u~C/-'T~f~="~--i"~- e'lephone :~----'~( ~.-¢~'"~C2, _ MailingAddressL~t~ ~..4~¢~) ~-.~,..~.~ ~,u.~ ~,,..~~ (d) Real Estate Company and Agent ~f-t~.~ ~L..-~.',,,.( ~ t..~"-~ (._'~.~,.~ \"'~ Address (..o"'Tc.ol ~5~.V,~-~ ~-l~E-~ L~c~~, /~r-*....V-JcJfo,~l¢-.~- ~'~'\(-'-. C~o~S~:~ Telephone '(e) Mail the HAA to the followino address: or: Check here [], if hold for pick up. List contact person and day phone number below, TYPE OF RESIDENCE Single-Family ~i~. Number of Bedrooms 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, SEWAGE DISPOSAL Onsite ]~, 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 z?-025 fRev 8¢86~ Fropl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity 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 inspect[on. Address ~// O~l'~r]'~/ ~~&~/ ~ ~ Date ~1 ~/~ ]~ ~ Approved for / Approved Disapproved Conditional Terms of Conditional Approval Engineer's Seal "~ ~, ....... , ~,?~ . ~", , CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72 025 rRev 8881 8ack MUNICIPALI'TY OF ANCHORAQL ENVIRONMENTAL SERVICES DIVISION APR 2 0.1987 RECE'IVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classification ~''~ [)t~JI O~Rc..-. %.',~'fJ~- If A, B, C, [).E.G. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed '~'4~ (~' ~ Yield Total Depth ,2.~C&sred to Static Water Level I, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depth of Grouting ~ / ~ Pump Set At Sanitary Seal on Casing (Y/N) ""1" Depression Around Wellhead (Y/N) t'~ ~ [ °°¢ ; On Adjoining Lots ~' ~¢::~2~/ To Nearest Edge of Absorption Held on Lot On Adjoining Lots To Nearest Public Sewer Line ~ L/~ To Nearest Public Sewer ~.j - Cleanout/Manhole ~ [¢3~ To Nearest Sewer Service Line on Lot /'~ Water Sample Collected by ~-'~, "~,'W'~.~'~t~--O ;Date q ~.4. b, ~'"'J l .... Water Sample Test Results "~ ~'-.o,--~-~ '~ ~_~f~.~ ~¢...~""~ ~_~- Comments '~,~,(~EJ,(_. %.~,,]~f,~'~ ~-'¢~.~----~_ ~--~'~/T_., r,,.~o'~-' ~.)E..O'~Z~.O¢:;""7¢~' ~ Date Last Pumped '~Pumping/Maintenance Contract on File (Y/N) SEPTIC/HOLDING TANK DATA Date Installed 3~'~'"''( ~'q~ Size'~)'~'~;~ No. of Compartments _b~'~7~"-~-~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) '""~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ; for Holding Tank High-Water Alarm (Y/N) ~,.,.~[/'4 Temporary Holding Tank Permit (Y/N) [~ Separation Distances from Septic/Holding Tank: To Water-Supply Well ~' To Property Line To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 3~,..~ I_,',1' Length of Field Width of Field :;~ I Depth of Field ,z, __ ~',';,~' Gravel Bed Thickness (-Jr- //'-' Square Feet of Absorption Area'~''(~'°?-~ [::~-'~ ~¢-"~t, "¢C::~¢¢lCta~ndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test '~'-/ I'~¢~- Type of System Design T ,~, , 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/" ~/~ ~ ~- '~r'~.¢. To Property Line To Existing or Abandoned System on ; On Adjoining Lots \ ~ To Cutbank (if present) D.- L:FT STAT;ON' 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 chec~4;~ ve~fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sig ned/(~_-~"o~_ ~. ~ ~Date Compa y~ ' MOA No, Receipt No. ~ - ~ © / ~ ~ ~/ ~ Date of Payment ~'~ ~ ~ ~ 7 Amount: $ /~ ?~ Page 2 of 2 72-026 (11/84) cy NORTHERN TE TING LABORATORIES, INC. Drinkin Water Anal sis Re~'ort forff°tal Cohform BaCteria T° BE coMPLE'rF.D BY CUENT PRIVATE WATER SYSTEM ' Purchase Order No. r SAMPLE TYPE: [] Routine [] Special Purpose [] Check Sample (for original contaminated lemple with lab reference no, [] Treated Water ~ Untreated Water Received at: z'~ Anch. [::J Fbke. Date Received Time Received ~ Next Sample Due SATISFACTORY (~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT 2 4 $ 6 ? 8 9 Signature of Represent rm ~olonieg per 100 mil DATE RECEIVED INSPECTION APPOINTMENTS TIME TI M F~-~. ~ TIME . DATE DATE DATE INSPECTOR INSPECTO~ tNSPECTO~ DEPT ~UNIglPALITY OF ANCHOfiAGE  DEPAfiTMENT OF HEALTH ~ ENVl fiON~E~TAL 82~ L Street - A~chorage, Alaska  OCT ~ 7 I980 ( ) ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEwER'¢ACILIT~- DIR[OTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ~..~O~R~VOW~ I .HON~ MAILING ADDRESS PROPERTY RESIDENT (If dJfferen~ from above) PHONE 2, BUYER PHONE MAI LI~ ADDHE88 3. LE~DI~ INSTITUTION ' PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One .1~. Four ~ SINGLE FAMILY [] Two [Z] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975: For wells drilled prior to that date, give well depth (attacli log if availablel) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY '-~ -- .~:~ ~ Connection Verified INSTALLER [~]Septic Tank or [] Holding Tank Size: (~. ~--z~r~ If Tank is homemade SOILS RATING give dimensions: / (~ 0 TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~'~"APP R OV E D FOR ~ BEDR~)OMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (-%,, 79-f}10 ~Rev, 6/79) ANCHORAGE, AK 99501 "~: ' PHONE 34~-3;92 26 C~tobor 19~:0 D R I L L E R'S W E L L L'O G CUSTOMER ~!. ~. H~dk±ns Constn~otion ~,.,"'r' "!}ox 10~6~7 Anohors.~,o~ .,~ 99511 LOCATION ]o't 2, ~S. ock 1, ('[1. s o~ Heights kSubdv SIZE 6. DEPTH 20~' CASING DEPTH 20]' GROUTING DEPTH YIELD ~-lO ~pm STATIC WATER L~EL '~ HOW TEST~ PUMP INSTALL~ 2o ~;~ot ~0 ~PE 75~L-16A~ Ro~ Jaokot FO~TIONS ENCOUNTER~ ~ APPROPRIATE DEPTHS kA l' TO ~'L TO __ 82 TO 9? TO____ 201 TO 203 TO TO TO TO TO TO TO Course sand and cravel 2~own clay 9~_ 5and, black silt Water about !; ~pm -Sand heave(~ in pipe. 201 Gray olay w/gravel Course sand w/small grave], water a'i: ?,~.10 gpm 207 Gray clay