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O'MALLEY HEIGHTS LT 4A
Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241055 PID Number: 015-112-43 Dwelling: 00 Single Family (SF) F with ADU 171 Duplex (D) 0 Two Single Family Project: El New 9 Upgrade Name MENEDEZ ABSORPTION FIELD FI Deep Trench ❑ Wide Trench 0 Bed M Mound Site Address 10600 PACER PL 7 Other L Phone Number of Bedrooms Soil Railing Total depth from original grade 5 5 0.7 GPD/SF6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.5 Ft. Gravel depth beneath pipe 0.5 Ft, Subdivision Block Lot O'MALLEY HEIGHTS LT 4A Fill added above original grade 1.0 Ft. Gravel length 58,56 Ft. Township Range Section Gravel width 18,20 Ft. Beds: Number of Lines 3 Distance between lines 6 Ft. SEPARATION DISTANCES To! Septic Absorption Holding Sewer Lift Station Total absorption area Number of trenches Dist, between trenches From i Tank Field Tank Line 1080 Ft2 Ft. Well 100'+ 100' 501+ TANK R Septic El S,T.E.P. 0 Ftolding [3 Other Manufacturer Capacity GREER/ANCH TANK. 1,500 Gal, Surface Water 1001+ 100 Material Number of compartments 7-- Lot Line 10,+ 10,+ 1 1 NA PLASTIC/ DEEP TANK 2 Foundation* i LIFT STATION Manufacturer Capacity i 11 Remarks GREER 10' BRUTAL DEPTH TANK INSTALLED Gal. TANK OUTSIDE FOUNDATION BEARING Alarm location Electrical installed by Installer PIPE MATERIAL House totank 3034Tank to 3034 MIKE MIKE N ANDERSON PE Drainfield 3034 C01MT 3034 BENCH MARK (Assumed elevation) 100 It Inspector MIKE N ANDERSON PE Inspection dates: 2nd 19 5115124 5/17124 Location and description Yd 471 TOP OF MH LID ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's tamp 4 Conditional Approval: Date 49TIJ *too.* ..... X V11 I MICHAEL k ANDERSCN �^ , CE 9 Septic Systeme Approved Date /zy Note, this approval does, t include well permit requirements.4yt l7FFSS4� --� J % EV i Permit No. OSP241055 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: O'MALLEY HEIGHTS LT 4A PID No.: 015-112-43 MARK -2,---8 C \ 5 25 1 NTCCCCCC 20 2 21 16 i CO 25 12 CO3 26 12 VALVE 35 10 \ C05 \ 42 15/ MT3 \ S2 72 60 MT2\ 50 MT165 \ 35 C06 /60 34 C07 _�59 34 C08I 66- X40 C09 69 46 WELL I Wr LL I 0 y II I I � I I \TED MOORE TH \\ 8',S& ARATION BETWEEN �\ I CC09g \ TANK FOUNDATION i \ \ I i C86 7 A B MT _C0 / VALVE TCO1,2 - ---_ --OtD-BED 1 1 L� - - - �J BEN H, TOP OF MH - - - - - 0O2,3 C04,5 i / NEW 1500 GA'LLON PLASTIC \ TANK \\ ASBUILT \ / SCALE: 1"=50' SEPTIC SECTION NO WATER ® MAY 1991 N.T.S. �. �OFq 49 TH MICHAEL N. ANDERSON No. CE 9469 ••'•.• 6-1-24 .•''tom 1���.• Permit No. OSP241055 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: O'MALLEY HEIGHTS LT 4A PID No.: 015-112-43 FOUNDATION WALL GRADE _ 9 FOUNDATI N FOOTING WAS EXPOSED FOR MEASUREMENT VA" \ SEPTIC TANK \ � q \ TANK SECTION ASBUILT NEAR FOUNDATION SCALE: 3/8"=V-0" �. �OF4 �,.• •.-9 i� 49TH'••�� . . ... ... ... . ... . ........ .MICHAEL N. ANDERSON.• ♦ G� •: No. CE 9469 W 1�♦ 7-1-24 .•'' i ANCHORAGE RECORDING DISTRICT, ALASKA AS—BUILT OF: O'MALLEY HEIGHTS SUBDIVISION LOT 4A PLAT 82-288 SURVEY CERTIFICATE: 1, 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 shouli 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, MAY 24, 2024 1 =301 schullerak*gmail.com 24-020 DRAM BY, ICHECKED BY; GRID NUMBER: BOOK /PAGE: JLS SW2536 240158 A%4%4 AMW Sul? ANIF 0 F OAWOW A 0_' 411 49TH FA ?A.„ ........................... -'JOHN L. SCHULLER.-' 0 cp. . LS -10408 1831 Talkeetna Street A 0�\ 6 Anchorage, Alaska 99508 `� Of essi 0 0 (3\ (907) 227-1455 office (907) 274-4992 fax 33 30' 1" 30' 00 Lj_j L -Li < 0 CL 0 00 LLJ CD 0 0 Cf) < 30 33 A%4%4 AMW Sul? ANIF 0 F OAWOW A 0_' 411 49TH FA ?A.„ ........................... -'JOHN L. SCHULLER.-' 0 cp. . LS -10408 1831 Talkeetna Street A 0�\ 6 Anchorage, Alaska 99508 `� Of essi 0 0 (3\ (907) 227-1455 office (907) 274-4992 fax 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 Permit Number: OSP241055 Work Type: Septic Upgrade Tax Code Number: 01511243000 Site Legal Address: O'MALLEY HEIGHTS LT 4A G:2536 Site Mailing Address: 10600 PACER PL, Anchorage Owner: COJOMA JESUS X APAZA & Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: p,cnt AS, J t)epat-mient 4/23/2024 4/23/2025 26763 Q Disposal Field Z 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 Special Provisions: No waiver required for 18' bed width. Engineer justified to the satisfaction of the department that topography and access will allow construction of this bed without tracking the bottom. Received By: 1 S U�� /y� r 0 S.D/� Issued By: Date: Date: MUNICIPALITY ANCHORAGE %1 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section `— Fax: 907-343-7997 ON -SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 015-112-43 Property owner(s) KAREN MENEDEZ Mailing address 10600 PACER PL ANCH AK Site address 10600 PACER PL Legal description (Sub'd., Block & Lot) O'MALLEY HEIGHTS Legal description (Township, Range & Section) Lot Size 26763 Sq. Ft. Number of Bedrooms 5 Day phone LT 4A APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade 171 Duplex (D) El 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: �'q 5 Waiver Fees: Date of Payment: Zy �� $�7o Z y Date of Payment: Receipt Number: Receipt Number: Permit No. )5P 2.`A 10 55 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc April 15, 2024 Municipality of Anchorage Development Services Dept. On-Site Water & Wastewater Section Anchorage, Alaska 99519 Phone 343-7904 Re: Septic permit and bed width waiver Legal: O'MALLEY HEIGHTS LT 4A To Whom it may concern: This is a request for a septic permit on the above referenced lot. The existing leach field will remain and a new 18 x 60 bed will be added with a new tank, see the site plan. A soil log for the reserve bed was found in the MOA file by Ted Moore P.E. and was used for this design. The perc rate was 2.3 minutes per inch with no water, measured in May of 1991. The new bed has an application rate of 0.7 which is conservative (0.8 is allowed) but the width is 18 feet not the required MOA 15 feet width. This extra width will require a waiver. The wider bed can be excavated without entering the bed system with the excavator which is my justification and the soils are sandy gravels so no smearing can occur. The slopes are flat in the area of the new bed and none of the surrounding properties will be impacted by this new system. 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 OSP241055, Curtis Townsend, 04/23/24 SEPTIC FIELD SECTION DESIGN CRITERIA: 0.5' EFFECTIVE 5 BDRM X 150 = 750 GPD SOILS = 750/0.7 = 1071 GPD 1071 GA/18 = 59.5' 18' WIDE 60' LONG (1) BED 6.0' DEEP 18.0' -6.0 -5.5 FILTER FABRIC 0.5' SEWER ROCK 3,3( GRADE 1"=100' PROPERTY LINE PROPOSED HOUSE PROPOSED DRAINAGE FIELD SCALE: DJRDRAWN: DATE: OMALLEY HEIGHTS LT 4A Anchorage, Alaska KAREN MENEDEZ 4/10/2024 -P A C E R P L - EXISTING WELL & INSULATION SPACED @ 60" -18.5 (TH#3 BY TED MOORE ) -5.5 SP/SM GM -1.0 PT DRY MAY 1991 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241055, Curtis Townsend, 04/23/24 1"=50' EXISTING HOUSE EXISTING BED SCALE: DJRDRAWN: DATE: OMALLEY HEIGHTS LT 4A Anchorage, Alaska KAREN MENEDEZ 4/10/2024 D R I V E W A Y WELL CO/MT CO/MT FLA T N O S L O P E WELL WELL TH#3 BY TED MOORE VALVE W/ DCO BEFORE AND AFTER NEW 1500 GALLON TANK, MAINTAIN 10' TANK TO HOUSE AND 5' FROM TANK TO FIELD WELL MT EACH CORNER TYP W/ CO ON EA. RUN. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241055, Curtis Townsend, 04/23/24 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: O'MALLEY HEIGHTS SUBDIVISION LOT 4A PLAT 82-288 SURVEYCERTIFICATE: 1, 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 shout( 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: DAM SCAM E-MAIL APRIL 4, 2024. 1 =30 schullerokOgmail.com 24020 DRAYM BY. CHECKED BY. MD NUMBER: BOOK AGE: JLS SW2536 240124 33' 30' 1" 30, C6 Li 0 LLJ < 0 0 °� I 00 of 0 LLJ a 0 0 < V) CL 3 01 33 S (IR AW OF 't L A r� N, �1v AW 4 A07N, 0 A*, � 1:� 4 of Z_ 00 elgTH ?A -J N L. SCHULLER.- 0 000 , . LS-10408 A 1831 Talkeetna Street Anchorage, Alaska 99508 OfeSSjon,3� AW (907) 227-1455 office (907) 274--4992 fax Municipality of Anchorage Page / of 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 Wel~ Inspection Report Perrnit Number: .~' v'V ~//0/' ~- PID Number: Numa: Wastewater System: ,~New [] Upgrade Address: ld6oo F/?c~ F~.,~-cE,4~c 4~,YD-~ ABSORPTION FIELD ~ No,~ Bedrooms: Phone: ~ y ~ _ ~ ~ ~ [ ~ Deep Trench ~ Shallow Trench ~Bed D Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: ¢./ 7 GPD/Sq, Ft. ~ /~0 Lot: ~ ~ Block:~, ~ ~ ~.Subdiv~i°n'~' ~[ ~ ~ Depth to pipe.~_~bottom Iromjl original grsds: Ft. Gravel deptho~_~beneathl/pipe Ft~ Fill added ~bove original grade: Gravel length: Township:[ ~- ~ Range: ~ b~ SectiOn:/~-- ~.- ~ "~V~¢- ~¢-d Ft. ~--,~- / FL Number of lines: Distance between lines: WELL: ~ New ~ Upgrade Gravelwidth:¢¢ Ft. .¢ 6i~Ot( Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~ ~ Ft. Ft. /i/00 SQ. Ft. t~ ~ ~¢~ [~ Driller: Date Drilled: StaticWater Level: Installer: Date installed: Yield; Pump Sei at: Casing Height Above Ground: TAN K GPM Ft. Ft. DISTANCES ~s~.tic ~ ,o~in¢ ~ SEPARATION TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Slation Tank SewerLines ~/~ ~ ~- ~[~i1~ /( ,~--~ 0 ~ ~ ,. -- Materiah Number of Compartments: su~c~ ~ LIFT STATION Water ~ ~ ~ LOt ~ . Size in gallons:t Manufacturer: Foundation ~ ~ ,~ ~ ~ ~ "Pump on" level at: "Pump off" level at: High water alarm at: i Curtain ~ .~- ~ ~- ~ Pump Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: Assumed Elevation: [oO~O0 Inspections performed by: Dates: 1st 7-2/~/ - ~ ~ % Marvin E. Browueh ~ ~ % CE 5936 Department of Health and Human Services approval -t;'ea:" ........ Reviewed and approved by: Date: 72-013 (Rev 9/91) MOA 95 Permit No. .¢ W' ~/! ©1 2~ .~ Page 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 LegalDescription: 5¢c. t,F/ -r / 2_, /t,// ¢,.3 ¢~', 5/'1 PIDNo.: O/&-//¢'/.~ _ / / / / / / t / / / J Permit No. 5~/ ~ll o! ~,5~ Page ,_.R of ,~, 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 LegalDescription: 5F-c. 15'/ T-/8,f/¢ I~w~ ,~,,,vl PIDNo.:_OIS'-I/ag.~, £~ CV, ~ I t,Vv. -- | r_.cu, ~ 3.5" (~ ROU,q b gO' 72-013 A (1/93) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910125 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:SAHLFELD JOHN F & DOROTHY S OWNER ADDRE~6--~ SHELBURNE RD ANCHORAGE, AK 99516 DATE ISSUED: 6/03/91 EXPIRATION DATE: 6/03/92 PARCEL ID:01511243 LEGAL DESCRIPTION: 0 MALLEY HEIGHTS LT 4A SEC. 15, T12N, R3W, SM LOT SIZE: 26763 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: ClVfl~ & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345-1355 May 31, 1991 14530 ECHO ST. ANCHORAGE, ALASKA 99516 Dan Bolles M.O.A. DHHS P.O. Box 19-6650 Anchorage,AK 99519 Dear Mr. Bolles: This letter responds to the concerns you expressed regm'ding our permit application to upgrade the wastewater disposal system on lot 4A of O'Malley Heights S/D. (1) The "driveway" overlying the proposed replacement site is really no more than a wide spot where vehicles can be parked adjacent to a secondary driveway access to the house. This can easily be eliminated at the time the replacement site is needed, m~d additional parking area could be created over the then abandoned primary soil.absorption bed, if needed. (2) According to the owner of the property, and as verified by our site inspection, the house is a single family dwelling only. There is only one kitchen, which is located in the upstairs portion of the building, and an interior stairway provides for unimpeded access throughout the house. The garage is accessed only by going through the lower floor of the house. I trust this information will resolve your concerns. cc: John Sahlfeld Sincerely, Ted Moore, P.E. ~ & ~V~O~ ~~ · ~¥ ~0~$~¥~0~ & ~¥S~ TItEODORE F. MOORE, P.E. May 27, 1991 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dem' Sirs: The pm'pose of this letter is to provide the required design narrative to accompany our permit application to upgrade the wastewater disposal system sel, ing Lot 4A O'Malley Heights S/D to a 5 bedi'oom rating. Soils logs, a site plan, design di'awings and specifications m'e enclosed for your review. Since the existing seepage pit ~s failing, the proposed project is for a totally new septic system. Test hole #2 is representative of the conditions in the proposed soil absorption bed. Since the measured percolation rate in the designated absorption stratum is faster than 1 nfinute per inch, a 2' tlfick sand filter is incorporated in the design and the bed area is based on 0.7 gpd/sq, ft. per code. For this 5 bedi'oom residence the required area is (5 x 150)/0.7 = 1072 square feet, which is accomplished with an 18' x 60' soil absorption bed. Due to constraints imposed by tile available space, this is a better configm'ation than would be achieved with a 15' wide bed. The replacement site is designated on the site plan aud the size is based on the measured perc rate of 2.3 minutes per inch in test hole #3, which translates into a requh'ed area of (5 x 150)/0.8 --= 938 square feet. This can be achieved by a bed having a width of 22 feet, and an average length of 43 feet configm'ed as shown on the site plan. The topography in the proposed soil absorption bed site is a shallow depression, which will be largely filled by construction of the proposed bed. Special cm'e will be taken to ensure that there will be no depression remaining over the bed, and that surface di~ainage can make it's way m'ound the end of the bed. The site plan shows tile location of all known wells and septic systems within 200 feet of the proposed project. The proposed project will have no impact on existing or future water and wastewater systems on adjoining lots, or on rese~wed space/surface and subsurface. By filling a small depression, there should be an improvement of surface drainage patterns on the subject lot. Sincerely, Ted Moore, P.E. o ~o o r~ fi% ~)F~PT H OF £~¢cAvATto M ~qECTION A-A sc~L~: Flattop Technical Services 14530 Echo Street Anchorage, Alaskct 99516 LOT q,A O'MALLE",/ 14E~4HT% SOIL ABSOR?T~ON BED PLAN ¢ CRoss ssc-r~oN ScAL~' A~ Uo~r~b Dh/t4 ~y: ~ Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345~1355 Lot 4A O'Malley Heights S/D 10600 Pacer Place Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project includes abandonment of an existing septic tank and seepage pit and installation of a new 1500 gallon septic tank followed by au 18' x 60' soil absorption bed incmporating a sand filter. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations fi'om these drawings may be allowed or requked by the engineer conducting the inspections. All construction procedm'es and material specifications shall conform with Municipal and State requirements. 1.3 All sepm'ation distances shall be in confonnm~ce with Municipal requkements, unless specifically waived. 1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work m'ound any buried utilities. 2.0 Septic Tank: 2,1 The existing leaking 1000 gallon concrete septic tank is to be properly abandoned by pumping, removing, crushing if possible, and burying the remains in the old seepage pit. The seepage pit is to be pumped and then completely filled with clean soil m'ound the remains of the old septic tank. 2.2 The new 1500 gallon septic tank shall be Municipally approved with a minimum of two compartments, and shall be set level on undisturbed soil. Each compm'tment shah be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buffed less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with wate~pr6of mechanical couplings. Tlie waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absmption system shall be constructed by excavating the smiicial soils from the entire 18' x 60' bed area to a depth of approximately 6 feet in the vicinity of test hole #2 to expose a com'se gravelly sand stratum. The bottom of the excavation shall be level, however the native gravelly sand may be graded as necessary to achieve this level surface. A minimum of 2 feet of pit run filter sand shall be placed on the top of the bed bottom to achieve another level sta'face approximately 4 feet below the original ground surface. Sand for leveling or serving as filter material shall comply with Municipal specifications. 3.2 A total of 12 inches of approved sewer gravel shall be placed on top of the filter smad layer. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.3 The 4" diameter perforated and non-perforated distribution pipes shall be buried level in the sewer gravel in the configuration shown on the design drawings such that the inverts of the distribution pipes are no less than 6 inches higher than the bottom of the sewer gravel. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the enth'e top surface of the sewer gravel before backfill with unclassified soil. The cover material shall be mounded an average of 3 feet higher than the original ground. The top surface of the cover material shall be sloped down towm'ds the south fi'om the edge of the existing driveway at approximately 5% across the top of the bed, with a 3:1 fill slope beyond the edge of the bed. The resultant low point south of the bed shall be graded to drain around the east end of the bed. 4.0 Inspections: 4.1 A total of 5 engineering inspections will be required during the course of the project: (1)initial stakeout with the conu'actor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation,.,and conforms with the soil test information, (3) after the sand filter material has been placed, (4) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (5) after final backfill and grading is complete. The septic tank mquh'es one inspection after it is set level m~d the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently fa' in advance to ensure the availability of the engineer. PE"PORMEO PeR= dO,IN LEGAL DESCRIPTION: 1 2 3 4 5 6 P~Rc 7 5k/ 'TE~T 8 g 10 11 12 13 14 15 16 17 18 19, 20- COMMENTS Flcdf'o? Tecta. ri:leal Servlces 14830 Ec:b,o Stz'eet Municipality el Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ¥/t O'I'tALL¢¥ SM/ML SILT"~ UI:=-NSELV C,_. OHPACTE'b WAS GROUND WATER FINE SANb ENCOUNTERED? LIGI-tT CoLoREb IF YES, ATWHAT Township, Range, Section: ~£C I~ SLOPE T ~2 N, SITE PLAN l'{°~) 5[:' [ / ,),// '~.r,'x .sf %)'r.~l, #2 Tdl~1 DEPTH7 ~./~, Deplh tO Waler Allsr 1~/ l~. g,L. Monitoring? DR~ Dale: S/13/~t I Reading Date Gross Time N2o 2~3~:3' ~3 2',37:3 N=O 2;33:0 Net Depth to Net Ti,ne ~,,1~ Water Drop ___ 2"/ 3,/8 __ PERCOLATION RATE I .~ (n,,nums/mch) PERC HOLE DIAMETER '7 ~"L" TEST RUN BETWEEN ~ o FT AND '7.. 5' _ FT .... CLIIIIty 'INA1 ]HIS ]ES'I WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS D/,,;! DATE: ,5'-'/ ~-- ~/'¢/~_ 72-008 (Rev. 4/85) Pla[top Techn~caI Services 14530 Echo Street Anchorage, .Alar.;ka 9951fi Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOII..S LOG -- PERCOLATION TEST T. tt. PERFORMED POR: d0~ LEGAL DESCRIPTION: PT 1 2 3 4 GM 5 6 7 8 9 10 ~,~, 12 13~ 14 15 16 : 17 18 19 20 COMMENT8. ~-/I ~',[ tce~/__~t_o/¢ O'M/iLL£V NT5 BEbDi$Iq ~/INb"/ LottM 'T~'AN S~TIoN lNG TO 1AL SP/6p ¢OARCJE ¢I~AV£LLV SANb Township, Range, Section: ~;EC I~.~ T 12 SLOPE SITE PLAN WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPT~ ~,/~, o ~'6" ~.6,L, Depth to Water AIler 5'/l$/~' / Monitoring? _ ~ Data: Gross Time ;s..; =9 :_30 30:30 g',~l ',oo Net -- Depth to Time Ct.A ,N") Water 22 -- 2'-/ ~,~ .2/ PERCOLATION RATE O.~' -- (mmutes/inch) PERC HOLE DiAMETER Net Drop PERFORMEDB¥: ,~'/¢4~t~¢~__~O// .~0'c -- ' -'¢'"f"'-~ ~ (JkI'IIIY'IHA1 'I HIS 'f ES'I WAS PERFORMEO IN ACCORDANCEWITHALLSfATEANDMLiNiCiPALGUiDELiNESiNEFFECTONTNiSDAfE. DATE: _..~4-~.~--~/'9/ 72-008 (Rev. 4/85) Flattop Technical Services 14530 Echo Street ,~-choraqe, Alaska 99516 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST T.I-f. ~ 3 "ERFO.MED EOR: dOI41q LEGAL DESCRIPTION: LOT LILA O' Mt~ZL£V 1 2 3 4 5 6 7 8 SP/sM REDDISH ~lcT't SA N b'-/ LoAb'~ DR't. ~AN'.t COBBLES ANb 8OuL DEP.~, 9 10 ~o~,~E COBRLE~ 11 12 13 14 15 '~LI~HTL"{ CLEANER h~b Loose. R 16 lZ 18.- 19 -- 20 ,eTC.. Mr Al/ % ~%THEODOR[ ~, MOORE.. DATE PERFORMED: ~/~] Township, Range, Section: SEC I~C., 'T 12 N, tT,~k./ SLOPE SITE PLAN WASGROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth l0 Waler Afler Monitoring? . Reading Date Gross Net Depth to Net Time Time Water Drop I2"FRE¢oA k ~'/2 o~_ II:lz:oo 27y't ..START ti', 2~ Zo 2~ 3/8 +~2© I1~ 2q :Do 2~ ,.. ~2 il: 3q;oo ~ 21 Vq l ~H3o il: 3~', 3o 23 S/~ ~3 II; 39:30 E 2~ ?~ 2 3~, *H~O IF, qo :oo 23 S/~ PERCOLATION RATE (minulos/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~.~' FTAND ~, ~' _FT COMMENTS ,fl,,[¢_._ CEllllr Y 'IHA1 1 HIS 1 ESI WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: . 72-008 (Rev. 4/85) GR-"TER ANCHORAGE AREA BOROU";t D,~.~RTMENT OF ENVIRONMENTAL QUALI~ , 3500 TUDOR ROAD ANCHORAGE!, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -/z. J:~, 'S,'??/j/-/ LOCATION ~f~?~-.,c//,~: OL? SEPTIC TANK: MAILING ADDRESS LEGAL D E S C R I P TI O N _/~-' ?'_~-'"/ DISTANCE FROM WELL_. LIQUID CAPACITY _GALLONS. MATERIAL INSIDE LENGTH NUMBER OF /~%.~.)//~.~ '., ;~/~_ C OM P A R TM E N T S / LIQUID INSIDE WIDTH DEPTH ~ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / LINING MATERIAL /~.~/~(-'~ ~'~/-)1('~ NEAREST LOT LINE "~('J ~ O~JTSIDE DIAMETER ..... OR WIDTH /"~ DISIANCE FROM WELl TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH_ /-~z , DEPTH (~ BUILDING FOUNDATION ,2~ ~' ~ ("? SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES___ ABSORPTION AREA.__ DEPTH: TOP OF TILE~E~'F'INISH GRADE , FOUNDATION_ , NEAREST LOT LINE DISTANCE BETWEEN LINES_ _. ~- -~' TRENCH WIDTH SQ.~ FT'. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGIH OF LINES __ IN. TOTAL EFFECTIVE IN. ABOVE TILE WELL: TYPE LOT LINE ,:, 7 I~£///~;/) , DEPTH ') ) c)' DISTANCE FROM . ' WATER ..... , BUILDING FOUNDATION. _~) ~',"~__SAMPLE_ ., NEAREST NEAREST , SEPTIC , SEEPAGE ~ ~ OTHER ,.'L;r: , SEWER LtNE~/6~() _,TANK /().0 , SYSTEM~_ /L/J(;" , CESSPOOL /' r'X.: , SOURCES DISTANCES: /z~/' '1~ ~1~. GREA,ER ANCHORAGE AREA BORuUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT /\ ' INSTALLATION LOCATION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED COMPLETION DATE ANT'CIPATED - ,// PHONE SEEPAGE Pit , DRAIN FIELD , OTHER TO B~ INSTALLED BY "' / ~/'-~ NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TES? FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. ,LING OF ANY SYSTEM WITHOUT FINAL INSPEC, TION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO ~SEC*UTION, MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEEPAGE PIT ~ ~ , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /'~¢ / TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~-'~ DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, . SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIE~ CROSSING GAP OF EXCAVATION 5 FEET INTO UND[STURSED 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. DIAGRAM OF SYSTEM DESCRIBED SYSTEM IS IN, ACCORDANCE WITH SAID CODE. MUNICIPALITY 0-F ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-112-43 Legal description O'MALLEY HEIGHTS LT 4A Site address 10600 PACER PL Expiration Date: 5/17/2025 Current property owner(s) COJOMA JESUS X APAZA &MENENDEZ KAREN L X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: By: lez Lt Original Certificate Date: 7/3/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 Development Services Department On -Site Water & Wastewater Section M01 k 'a` 4 $ r � � w � p 4 G Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-112-43 Complete legal description O'MALLEY HEIGHTS LT 4A Location (site address) 10600 PACER PL Current property owner(s) MENEDEZ 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: FE� Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel Q Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: rN-1 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ q 4 �6' Waiver Fee $ Date of Payment ✓��zT) Date of Payment COSA # DS G 2 `(I Sg Waiver # COSA Application—June 2022 COSA Checklist Legal Description: O' MALLEY HEIGHTS LT 4A Parcel ID: 015-112-43 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 'PRE -72 Total depth 228 ft Cased to 40'+ ft ❑� Sanitary seal is functioning correctly ❑� Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 4/25/24 Static water level at beginning of test 198 ft. Comments " FROM MOA FILE B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW X ALL standpipes present per record drawing Total measured depth from grade 6 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes N No ❑E Coliform bacteria is Negative Nitrate 1.32 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by MNA Date 6/3/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW Results Q Pass Fluid depth prior to test _ in Water added _ gal New fluid depth _ in Elapsed time _ min Final fluid depth _ in Absorption rate _ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' FmFIYes if No _ ft M Yes if No _ ft Neighboring Tank > 100' g Yes if No _ ft Absorption Field on Lot > 100' 0 Yes if No_ ft Neighboring Absorption Fields > 100' 0 Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Holding Tank > 100' [j] Yes if No _ ft Animal Containment > 50' Q Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes f No _ ft �]o Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No :8 ft Surface Water > 100' Q Yes if No _ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Di Yes if No _ ft ❑� Yes if No _ ft [E Yes if No _ ft Wells on Adjacent Lots: Private Wells > 100' Community Wells> 200' EE Yes if No ft ❑� Yes if No _ ft Water Service Line > 10' Yes if No _ ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS " TANK IS OUTSIDE FOUNDATION BEARING AREA SEE CROSS SECTION FIELD IS > 10' FROM FOUNDATION 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. NameofFirm rvilh-C%4 /.4.y4t).,l 1 1Y` Engineer's Printed Name "Airy+ COSA Checklist June 2022 Phone 727-8864 Date -71141 ..`q�• OF 4�,?.�• r h.• :�„rtir l� 17f,! MICHAELL N. ANDERSON 469 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. # (~\z~_ \ \,=~_ L\.~ HAA ff 1. GENERAL INFORMATION Complete legal description ~ 4A O'HALr>:¥ ,HE'TGh~S Location (site address or directlons) 10600 PACER Property owner Mailing address Lending agency Mailing address Agent ,u ,¢~J ~ Address '--'~ DOROTI {Y S AHLFELD 10600 P~CJER PL, ~xlCHOlr~%GE / t951 6 __Day phone 346-3871 [::)ay phone ¢7~- '-/~.'5 o )hone /3~ -- Unless otherwise reques:d, HAA, held for pi 2. NUMBER OF BEDROO/MS: ,~_ 3. TYPE OF WATER SUI:/PLY: ("~ Indivi~al/ well _~_? Com?hunity well _ Puyic water NOTE If comthunity well system, provide~writtell 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 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 inves!i~gation 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 ~ Phone 34,1-1335 Address 800 E. D'Z,~~ORAGE, AE 99515 Engineer's signature~ Date ~'-' /,,7. ,,~.~ DHHS sIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional eng!neer 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. ?2~Y2$(Re~. 1/91) ~ack MOA ~k21 C. LIFT STATION Date installed .... '~-..... Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on Ioi On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested D. ABSORPTION FIELD DATA Date installed 5/91 ~ LenCh 60' ~L~ Total absorption area _ Dale of adequacy lest Water level in absorption field before lest Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) . o.~/ System type BED Width 18' (~ Gravel thickness 1 ' ~ Total depth 75" / c~ ~ O (~ Cleanout present (Y/N) YES (~ Depression over field (Y/N) _ NO 5-10-95 Resulls (pass/fail) PASS for 5 Bedrooms o.,-/' Atler,est NO If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 120' ~ To building foundation On adjacent lots 45' Sudace water N/A Cudain drain. N/A On adjacent Iols 120 '+ © Property line 15' ~ To existing or abandoned system on lot 30 ' ~ Cutbank N/A Water main/service line N/A Driveway, parking/vehicle storage area 7' ® E, ENGINEER'S CERTIFICATION I ce/tify th_~lL~ave checked, verified, or conformed to all MOA and HAA guidelines Enginee¢~ame ~ L~/~- Date -~' /~- ~5 Date of Payment ,.~'- - /~" ~ .~ ...... 'inspection. Waiver Fee $ Date of Payment Receipt Number 72-026 f3,;93)' Back Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ 4A O'MALLEY HEIGHTS Parcel I.D. A. Well Data Well type RS. Log present (Y/N) NO If A, B, or C, attach ADEC letter. ADEC water system number Date completed ?~:. 1972 (~ Driller Total depth 228' Cased to 40'+TM Sanitary seal (Y/N) YES (~ FROM WELL LOG Date of test Static water level N/A Well flow N/A Pump level1 N/A SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot 1 20 Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform 0 Date of sample: 5-1 0-95 B. SEPTIC/HOLDING TANK DATA Date installed 5/91(~ Cleanouts (y/N) YES (~ High water alarm (Y/N) No Date of pumping 8-23-94 /' Pumper // SEPARATION DISTANCES FROM SEPtiC/HOLDING TANK TO: Wires properly protected (Y/N) AT INSPECTION 5-?Iz95,© ~. 'On a0iacent lots 120'+ (D : On adjacent lots 1 20+ (~ Public sewer manho/lle/Cle/anout N/A Petroleum tan~k, N/~ ~e 2.83 ~ Other bacteria ' ~cted by DUSTIN/IGH Tank size / 1500 GA~. / Cor~padmer]tf~.__2 _ Foundationcl/~nout (Y/N) i_z'~S ~,on (Y/N) · / Alarm tested (Y/N) · Well(s) on lot 112' (~ On adjacent lots 110' To property line 4,5' Absorption field 30 Sudace water/drainage 1 DHI ~'%-~?U~D ~ 2~ :3-5 72-026 (3z93)' Fret2 MUNIE P.~CORDS Casing height Y~S g.p.m. No ~> NORTHLAND PUMPING Foundation 8 ' + Water main/service line CONTINUED ON BACK PAGE 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _L. '/ o' 4AL[. _d Location (address or directions) (b) Applicant NameC¢-~i(. ~¢~.¢' __ Telephone: Home 2¥(2 ~ Ck// Business Applicant Address _ (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer [_--]; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address __ Telephone Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family/~ Multi-Family Number of Bedrooms Other WATER SUPPLY Weli,~ Community ~ Public [] Indiv[d, ual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~ Public[] Community[] Holding Tank[] Note: It 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 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this I-{ealth 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 insl~ectio~n. Name of Firm Address Date -~----.¢-4~,f.~ ~-~., ,~ ~'"~ Engineer's Seal Approved for ¢/_Z'J_4~'~__.~-, bedrooms by Date Approved 7~ Disapprove~f Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection ([)HEP) issues Health Authority Approval certificates based solely upon tile 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 institut'ons in order to sabsf car act ons or ..... ' ' Y rain federal and state requirements. Employees of DHEP do not conduct insp ' ~;ieY~oanata~en~llneee1'°re e certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the ,7.~a~L,:~,~?.~:. - - ; fJ er's work MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: 14:T & WELL DATA Well Classification '[~ J]~ Well Log Present (Y/N) _~d~__ Total Depth ¢¢[..~.~. 'K"i'- Cased to Static Water Level ¢~, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge ct Absorption Field on Lot _ To Nearest Public Sewer Line Cleanout/Manhole If A, B, C, D.E.C. ApProved (Y/N) Date Completed "'~',~¢~_ I ~ '7~,. Yield ~ /'¢'~ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~ Water Sample Collected by '-~"' --¢~ .__; Date Water Sample Test Results Comments ~ ~--~ ; On Adjoining Lots 'l I'-~¢ ; On Adjoining Lots ,~, / ~1-4[~, To Nearest Public Sewer To Nearest Sewer Service Line on Lot .~ ~ ~.) B. SEPTIC/HOLDING TANK DATA Bate Installed Standpipes (Y/N) _ Depression over Tank (Y/N) Size /~-~ No. of Compartments ~'~ Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) -[~( Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ Separation Distances from Septic/Holding Tank: To Water-Supply Well _ ~// To Property Line ~ ~;,~ ~ To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) ~/'~ To Building Foundation "7 To Disposal Field ,,'~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /,~ ~ Date Installed 3 tJ ~ ',,/ / ¢ 7 ~ Width of Field /(~ Square Feet of Absorption Area ~t/,,~. 672 Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //~;~ To Building Foundation Lot Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~ O To Existing or Abandoned System on ; On Adjoining Lots ~' '~:~ O To Water Main/Service Line ~ '/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) 1',4 otq NoN -/o 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 ** IsiC~ rntief~ that I~~,,~-~ ~ .,~°r conf~rat?d to ~ac~.d ,.~ A/9~i~.~ es in effect on the date of this inspection. ~~ MOA No. Company Receipt No. Date of Payment Amount: $ L~ ,00 ~'~C~;'" %; ;;' E~i~ ~ Seal Page 2 of 2 ~.~ 72-026 (11184)