HomeMy WebLinkAboutLOFTY HEIGHTS LT 2Ar Lofty Hei*ghtls Lot 2A #017-411-22 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241238 Work Type: SepticTank Upgrade Tax Code Number: 01741122000 Site Legal Address: LOFTY HEIGHTS LT 2A G:2841 Site Mailing Address: 12611 TOILSOME HILL DR, Anchorage Owner: NEWTON TIMOTHY T & CATHERINE A Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/19/2024 8/19/2025 54450 ❑ 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 Received By: 5`'�'�'g (�- i_' Date: Issued By: �— Date: U ` 2 MUNICIPALITY OF ANCHORAGE r: Community Development Department - Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON -SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-411-22 Property owner(s) Timothy Newton Mailing address PO Box 112902, Anchorage, AK 99511 Site address 12611 Toilsome Hill Drive, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Lofty Heights, Lot 2A Legal description (Township, Range & Section) Lot Size 54,450 Sq. Ft. Number of Bedrooms 4 Day phone APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade RX 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. (Signature of property owner or authorized agent) Permit/Rush Fees: - Date of Payment: ❑ zoo `7 Receipt Number: Permit No. V y/ 2 Waiver Fees: Date of Payment: Receipt Number: Waiver No. Permit App__- : , _.,:c August 1, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Lofty Heights, Lot 2A - 12611 Toilsome Hill Drive Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with a tank designed for 4 bedrooms. The new septic tank will be a minimum of 100’ from all we lls and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241238, Curtis Townsend, 08/19/24 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO LOFTY HEIGHTS, LOT 2A FEET 0 50 100 TOI LSO M E H I LL DR. 4-BDRM HOME SEPTIC PLAN 8/1/24 10' CEA EASEMENT 10' UTILITY EASEMENT EX. TRENCH TO REMAIN IN SERVICE NEW 1250 GAL SEPTIC TANK DECOMMISSION EXISTING STEEL TANK PER UPC FIND FCO OR PROVIDE 2CO BEFORE TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241238, Curtis Townsend, 08/19/24 TOILSOM E H I L L D R LOFTY H E I G H T S SUBD I V I S I O N Taylor L. Dosch No. 189892 R E GISTEREDPROFESSIO N A L L A N D S URVEYOR Municipality of Anchorage Page -I—of 3 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 Permit Number: PID Number: Name: `G K t j v Wastewater System: KNew ❑ Upgrade Address: ' z 45t AL\ t N E b9, ABSORPTION FIELD Phone:No. 3 4,'5 - S 9 4S of Bedrooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: I, �- Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Su divisi`o�n: Lo 5 Depth to pipe bottom from original grade: Gravel depth beneath pipe fL- 6) bhK Z Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: / I Ft. Ft. WEL El New ❑Upgrade Gravel width: Number of lines: Distance lines: Fl Ft. Classification (Private, A. ._ Total Depth: ased To: Total abs rption area: X t A S1 Z Pi a material: Aib / STN 3034 t`1LWR� Fl. Ft. G4 X SQ. Fl. Driller: to Drilled: Static Water Level. Installer: �R�=�vn: Date installed: Ft. Yield: p Set at: Height Above Ground: TANK M Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer /:^/ Capacity in gallons: / 0 From Tank Field Station Tank Sewer lines .5-0 Well Material: ^ Number q�Compartments: Surface LIFT STATION Water Lot�J Line j Size in gallons: Ma urer: Foundation "Pump on level at: "Pum ev High water alarm at: Curtain Pump Make Electrical Inspections performed by: Drain Remarks: No Cl.l. d(Z' N Fi'11t7�1 BENCH MARK �1 C 0' IQ "' em D Location and Description: -r w KT" or oti T t "z1 LINA o r— NAIL IrJ WAS ti Z' Eww C—XcAvA3 TILLi Nt< Assumed Elevatio : 100 a ENGINEER'S SEAL �z�3 W l] gL�vax 5 f ,2 N t�icL- Inspections performed by: F� Dates: 1st 2nd /J Department of Health and Human`�rvices approval ` by: �'� Dater Reviewed and approved 79-n131Rev 9/911 MOA 25 1) Permit No. Page 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 Legal Description: Ld ,yt'+/►Lo FT Y 14 &-1 PON,.: HR)14M44fj Re40 01 72-013 A (Rev. 9/91) MOA 25 60 Ydo 0 4t_ 774NIL Permit No. Page -5 of S 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: TO'r CL r*j37 W 72-013 A (Rev. 9/91) MOA 25 PID No.: 3 I C0vLr'1L, ov&L L t u Lg Co 6 �r �o 11, C04V fAI 8q z °13 3 CA33 act!: �.! �q IN at= Rtxt tr-OJti Qeb E�N�C�I� �;JJ�EAL t� 5p" anaeao oep "'� (i ` r^ 7 � w Vol y Na,c G.i: t•►AtL 1tJ I o f) ! MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920213 DESIGN ENGINEER:ROBERT KNIEFEL, P.E. OWNER NAME:HARDING RICHARD E & OWNER ADDRESS:12456 ALPINE DR ANCHORAGE, AK 99516 PARCEL ID:01741122 LEGAL DESCRIPTION: LOFTY HEIGHTS LT 2A LOT SIZE: 54450 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 PAGE 1 OF 1 DATE ISSUED: 8/07/92 EXPIRATION DATE: 8/07/93 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: I NI IEFEL ENGINEERING 8451 MILES COURT :ANCHORAGE. ALASKA 99504 (907) 339-6560 August 6, 1992 Mr. Dan Bowles On -Site Services Department of Health and Human Services 325 L Street. Anchorage, Alaska 99501 Subject: Lot 2A, Lofty Heights Dear Mr. Bowles: Based upon our previous meeting with you we have performed additional soils tests and re -located the absorption bed to a new area on this lot. The soils at the new location were of adequate usage and bedrock was located at the 12' depth area. We also investigated for bedrock depth at the cut bank in the .iVW corner of the lot. The depth was found to be approximately 2.5' lower than the ground elevation at the toe of the cutbank. Attached is the revised design for the system including the well location. We would sincerely appreciate your expeditious handling of this matter. Please contact us immediately if you have any questions or comments. Respectfully Submitted, 7 Robert. Kniefel, P.E. 6erf C. 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I)oLcr; � t niPic e t,i �l PIo. 4149 -n Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES t 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST J'Oro L. Kniei�l1� No. 4149-ES p, ROSS��C�Z PERFORMED FOR:G �� STs MS DATE PERFORMED it �EGAL DESCRIPT�yy �OT �� j4&jj T' Township, Range, Section: YYYkkk _ V SLOPE SITE PLAN DEPTH � (FEETI I I F7-1 ./" jl� 68 z - KA 3 4 11y7 5 O,P-6.M 6 7 8 9 10 WAS GROUND WATER J' D ENCOUNTERED? _ 11 Q IF YES, AT WHAT 17ev GK. DEPTH? Depth tD Water Aft 13 Mani i WAIF- Date: .0 . 14 15 16 17 18 19 i r+►a t it- t . ",. t^A s L1: l4 '' L[ 'v44- " ross -L � ° >N $ 1 �► u bepth to Nem � T �B r S, 2-r. 7s„ 5. .-./�1 J'Oro L. Kniei�l1� No. 4149-ES p, ROSS��C�Z PERFORMED FOR:G �� STs MS DATE PERFORMED it �EGAL DESCRIPT�yy �OT �� j4&jj T' Township, Range, Section: YYYkkk _ V SLOPE SITE PLAN DEPTH � (FEETI I I F7-1 ./" jl� 68 z - KA 3 4 11y7 5 O,P-6.M 6 7 8 9 10 WAS GROUND WATER J' D ENCOUNTERED? _ 11 Q IF YES, AT WHAT 17ev GK. DEPTH? Depth tD Water Aft 13 Mani i WAIF- Date: .0 . 14 15 16 17 18 19 i r+►a t it- t . ",. t^A s L1: l4 '' L[ 'v44- " ross -L � ° >N $ 1 �► u bepth to Nem � T �B r S, 2-r. 7s„ 20� (10PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER _`� ,� \ TEST RUN BETWEEN 7i FT AND 1_.3 FT COMMENTS Aok-ksec. U�1 IAS6 5wwc'3% RCtu(- Rr4t of �t" l b fM,W = Z. ,N.1wA- kyj t r`�L �I IS jC�, �'1Z.� CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: —Z / �1 Z ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: i� _L TO i Municipality of Anchorage Department of Health and Human Services CJ1�11 U Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 June 25, 1992 Mr. Robert E. Kniefel, P.E. 8451 Miles Ct. Anchorage, AK 99504 'Subject: Lot 2A Lofty Heights, PID #017-411-22 Dear Mr. Kniefel: I have reviewed the on-site sewer and well permit application for the subject lot, and have found it to be deficient in a number of areas. Title 15.65 of the Anchorage Municipal Code is quite specific in determining site selection of wastewater systems on grades in excess of 25% and the mandatory setbacks to such slopes. The site selected, as shown on the site plan, has a slope greater than 30%. The reserve site, as shown on the site plan, lacks the required 50' setback to a nearly vertical drop of over 10'. As bedrock was found at a depth of 12' below the existing grade, and water was found in test hole #2 on 6/19/92, there is a possibility of effluent surfacing. The placement of the septic tank is such that it could not be accessed for mandatory pumping. There is also concern over the gradient of the service line from the house to the septic tank. Separation of water and solids could occur resulting in possible plugging of the line. Therefore, the permit application for the subject lot is hereby denied. If you have questions or wish to discuss the matter further please do not hesitate to contact me at 343-4744. Sincerely, Daniel N. Bolles On -Site Services db/184 ---- 7,0 -p -S-0. 0000 KICK Z%% A ".Ts ori ne4co 10, fA I N, OF At t@ -/ ooaeooa g A 4149. E OFESF,\ Lo A---aA-t -Ty SYSTEM DESIGN/CONSTRUCTION GUIDELINES AND NARRATIVE LOT 2A. LOFTY HEIGHTS SUBDIVISION 1. Svstem Size = 4 bedrooms x 188 sf/bed = 752 sf Recommendation = 5' wide with 3.5'qravel. CF = .54 2~ 5' Wide Trench -- 4 bedrooms x 188 sf/bed /5 *.54 = 83 l/ 3. All materials, construction methods and reouired insoections to follow MOA rules and reoulations. |he contractor i= resoonsible for notifying the Engineer and the MOA at least four hours in advance of all inspection needs. / 4. Contractor will insure no additionanoes have been made to the location of wells and septicot n he adiacent lots prior to the time of constructionthis system. If anv changes to those systems have occurred he enoineer should be immediately notified for review and poss�ble chanoes. 5. The OB/FILL material will bed to the unri de]vno gravelly sand material under any portdon of the bed area. 6. The lot is generally slopim# down to the NW with s1ooes in the 20% range in the SE area latteninq to 8 - 1O% bv the bed area. The installation of th e system will have little or //o effect on the surface dr-ai na around water. or the adiacent systems in the area. / 7. The septic system sho Id be prooerly maintained to include septic tamk inspection, pu pino on an annual basis and no oarbaoe disposal. If a gar -bag isposal is used the tank size should be increased to a minimum 1�50O gal. tank. 8. The well east 105 feet from the nearest point o The bed area must be installed at least 105 feet well on Lot 1A,, directiv west of this lot. OF At g;0 40 Vo PAGE 3/3 �RoberfE. KnIeW � oF NI 07 Li F° F y p qq 0 e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 6 825 "L" Street, Anchorage, Alaska 99502-0650 Robert E. ttnie'rel, SOILS LOG — PERCOLATION TEST ®� s° No. 4149-E ;rte rF9 � 'RUFES51� `:;.tom PERFORMED FOR: �`� c' IZC /k S y S .Z M5 DATE PERFORMED: LEGAL DESCRIPTION: Loi_ �!'1 1�1.—I G-Nr� Township, Range, Section: DEPTH I ..�}••7 SLOPE SITE PLAN (FEET) [•� 2 L 1 r,( ( N 3- ' WAS GROUND WATER N 4 ENCOUNTERED? 5 6 . —IA `Z IF YES, AT WHAT -- 7i I l 8- I ' w 10 ' WAS GROUND WATER N ENCOUNTERED? 11 `Z IF YES, AT WHAT -- i ) DEPTH? 12 13 11e `(ZzL1_ Depth to Water After Monitoring? NIS Date: ZJ 14 51617 15- 16- 17 18 19 20 COMMENTS Imommoommom ■EtES:wrE■ a..■■■■■■■ ■■■■■■■■■■ PERCOLATION RATE -7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN Z_ FT AND 3 FT PERFORMED BY: KN 0�' I �_ 14"�&iza' CERTIFY THAT THIS EST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ����>' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES MEMORANDUM DATE: June 26, 1992 TO: Leslie Jordon, Building Safety FROM: Daniel N. Bolles, On -Site Services 14X�_21 SUBJECT: Permit Revocation Lot 2A Lofty Hts, PID #017-411-22 Please be advised that a wastewater permit, #SW910218, issued on 7/29/92, for the subject lot has been revoked. The revocation is due to slopes which exceed those established under AMC 15.65 for on-site wastewater disposal systems. db/186 Post -If" brand fax transmittal memo 7671 # of Pages . _— To From Co 0 Dept. /�/ J) ( Phone # ` 1 Fax # (, ^ _ G ., Fax # .., " 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 PERMIT PERMIT NUMBER:SW910218 DESIGN ENGINEER:ROBERT KNIEFEL, P.E. OWNER NAME:HARDING RICHARD E & OWNER ADDRESS:12456 ALPINE DRIVE ANCHORAGE, ALASKA 99516 PARCEL ID:01741122 LEGAL DESCRIPTION: LOFTY HEIGHTS LT 2A LOT SIZE: 54450 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 4:'4416✓o PAGE 1 OF 1 DATE ISSUED: 7/29/91 EXPIRATION DATE: 7/29/92 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 PPnlTT9T0M9 - RECEIVED E ISSUED BY: 2--Z7-.?/ DATE: DATE: 712 /"// /ve/z)Ac r E`.? 4 j/1�J W C --t L SYST�r� �tS�l>•N Lo to 1-�-T5 F 4 1,,o000too ins 49 M :4 �..00 I fZC �/-E"� 1'-0i o l� NIT��N1i / • a smog. e rn ; Rob rt E. Kniefel , oe �% No. 4149. E o �✓ 7-/Z —91 A(,gEAGc 3��-�S�o ASF • , �.�. 8® 0 ESS10N4s 5 1 K l Z� FC3) 40,6G _71,-z-lc� -7- /z SYSTEM DESIGN GUIDELINES AND NARRATIVE Lot 2A, Lofty Heights Subdivision SYSTEM DESIGN 1. System Size = 3 bedrooms x188 sf/bed. = 574 sf use 5' wide with 3.5' depth, CF = .54 2. 5' wide trench -- 3 bedrooms x 188 sf/bed /5' x .54 = 61 if 3. All materials, construction methods and required inspections to follow MOA rules and regulations. The contractor is responsible for notifying the Engineer and the MOA at least four hours in advance of all inspection needs. 4. Contractor will insure no additions or changes have been made to the location of wells and septic systems on the adjacent lots prior to the time of construction of this system. If any changes to those systems have occurred, the engineer should be immediately contacted for review and possible changes will be made as necessary. 5. The OB/Fill material will ha ramnvaA tn Fhc 6. The lot is generally sloping down to the NW with slopes in the 20% range at the Se area and flattening to 10% by the bed area. The installation of the system will have little or no effect on the surface drainage, ground water, or the adjacent systems in the area. 7. The septic system should be properly maintained to include septic tank inspection and pumping as necessary on an annual basis and no use of a garbage disposal. If a garbage disposal is used the tank size should be increased to a minimum 1,250 gal tank and the tank pumped regularly on an annual basis. 8. The well must be installed at least 105 feet from the nearest point on the septic tank. The bed area must be installed at least 105 feet from the adjacent well on Lot lA directly west of this lot. age 3/3 703 Municipality of Anchorage 7t 9T14 ', do DEPARTMENT OF HEALTH 8t HUMAN SERVICES ••�•••• ••••'• • 825 "L" Street, Anchorage, Alaska 99502-0650 % ••,•,,,,.,,.. SOILS LOG — PERCOLATION TEST ♦ �` Robert E. Knlefel O •. No. 4149-E PERFORMED FOR: ,—\ L izC !-.CYC S y 511_ MS DATE PERFORF<"PROF 1'jF = y� _ � ) k::" LEGAL DESCRIPTION:_ LQ \ -2-A Township, Range, Section: FIDEPTH ITs� SLOPE SITE PLAN (FEET) 1 U � (? 3 4- 5 6 7 8 9- 10- 12 1012 1 13 14 15 16- 17 18 19 20 COMMENTS 0 WAS GROUND WATER ENCOUNTERED? N S IF YES, AT WHAT L DEPTH? O P E Depth to Water After n Monitoring? /� �A Bate: Reading Date Gross Time Net Time Depth to Water Net Drop & 3 ', p ¢ v v l O...To `S 3 �' (Z 0, -s-D 03 ( PERCOLATION RATE 6 L (minutes/inch) PERC HOLE DIAMETER /� % TEST RUN BETWEEN � FT AND 3 FT K_"��/ �� �` _0 /L.�.'v.4n u _ PERFORMED BY: KN , ;E�� I � _ JC;,, �, ^ ; CERTIFY THAT THIS/JEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ���/ IT/ POUCH 6-650 ANCHORAGE, Al ASK/V J (907) P64-41 11 r('NY K'\,'() V11 MAYOR DEP)WRTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION �.%Li W` January 4, 1982 Shayne G. Tuck 2221 Muldoon Sp. 406 Anchorage, AK 99504 Permit # 811030 Subject: L2A LOFTY HEIGHTS A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. sincerely, Les N. Buchholz R. Program Manager Sewer and Water Program Enclosure: Copy of Permit 'T" Y7 t. a....... ...... ...... � DEPHRTMENT HEHLTH HND ENYIRONMENTH TION STREET, HNCHORHGE' HK99501 ~` ^ 264~4720 �������� ������ PERMIT HPPLICHNT SHHYNE GTUCK 2221 MUL-UH 1 SP406 ]]7~2861 LOCHTION UPPER HUFMHN LEGHL L2H LOFTY HEIGHTS LOT SIZE 4]0 00 -1 k'.1-_- FEET TYPE OF SOIL HBSORPTION SYSTEM IS� TRE�CH MRXIMUM NUMBER OF BEDR�OMS � 4 SOIL RHTI�G THE REQUIRED SIZE OF THE SOlL HBSORPTION SYSTEM IS� `� E> LIE ������ ����������� ��� �������E� ������I� A, THE LENGTH c, THE LENGTH (IN FEET> OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DI5THNCE BETWEEN THE SURFHCE OF THE GROUND HND THE GOTTOM OF THE EXCHYHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTHOF QRHVEL BETWEEN THE QUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET) PERMIT HPPLICHNT HHS THE RE5PONSIBILITY TO INFOR� THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS QF H�Y WELLS HDJHCE-AT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERYE T E--� ��� �������� BHCKFILLIMG GF HNY SYSTEM WITHOUT FINHL INSPECTION HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL HND HNY 8N~SITE SEWHGE DISPO5HL SYSTEM IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FRQM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE F�OM H PRIVHTE WELL TO H PRIVRTE SEWER LINE IS 23 FEE � HND T8 H COMMUNITY SEWER LIN� IS 75 FEET WEHRE REQUIRED HND MUST �E RETURNED TO THE �)EPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION OTHER RE�QUIR�MENTS MHY HPPLYSPECIFICHTIONS H�D �ONSTRUCTION DIHGRHMS HE HVHILHBLE TO INSURE PROPER INSTHLLHTION I CERTIFY THHT 1� I AM NITtH THE FREQU ITTE FORTH B; THE MUNICIPHLITY OF 8NCHQRHGE 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I U�DERST�ND THHT TH� ON�SITE 5EWER SYST�M MHY REQUIR� F"'-11 F' IF T�E RESIDENCE IS REMQDELED TO INCLUDE MORE THHN 4 BEDROOMS ` Sl 1_xx f21 SOILS LOG , r MUNICIPALITY OF ANCHORAGE • +.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: i'1 -F l uCX'\ DATE PERFORMED: `✓ �� LEGAL DESCRIPTION:-'t✓i� fy -� } ��1T I -`��T DEPTH SLOPE SITE PLAN F )�1 o � d 3 �`•. ,. 1 5 ,® ` P 7 8 r c�1 10 ` It ' ` 11 .,.' WAS GROUND WATER �`jC� L r ENCOUNTERED? C O 12 \y . P IF YES, AT WHAT E - 13 DEPTH? 14- 15- 16- 17- 18- 19 - Reading Date - Gross Time Net Time Depth to Water Net Drop 20 1 1 PERCOLATION RATE TEST RUN BETWEEN COMMENTS (� ' �. �j,� `JvYdC PERFORMED BY: �- -C~'j U—lp ( ¢ l�J Y''C_CERTIFIED BY: FT AND (minutes/inch) — FT DATE: /✓ MV unICIPaLl A R E I October 9, 1981 825 "I ' STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE fl, SUI LIVAN, MAYOR DEPARTMENT OF HEAL FH AND ENVIHONMEiNTA L. PROTECTION Shayne G. Tuck 2221 Muldoon Road $406 Anchorage, Alaska 99504 Subject: Lot 2A Lofty heights Subdivision This department has no objection to the garage over hanging the septic system as explained by Mr. Tuck, providing the following: (1) The pilings must not enter the drainfield. (2) Adequate drain lines or gutters to carry rain water of the garage away from the drainfield are provided. If there are any further questions, please call this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist LNB/ljw MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960006 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:HARDING RICHARD E & SHARON A OWNER ADDRESS:12611 TOILSOME HILL DR ANCHORAGE, AK. 99516 PARCEL ID:01741122 LEGAL DESCRIPTION: LOFTY HEIGHTS LT 2A LOT SIZE: 54450 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 1/11/96 EXPIRATION DATE: 1/11/97 1. THE ATTACHED APPROVED DESIGN. 1 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 1 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL P RECEIVED ISSUED BY: ROVISIONS: BY: DATE: r m)NLvxt__'l DATE: O� �� LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MGMT WATER WELL RECORD BOROUGH PUBDI/VI ION, LOT BLOCK SECTION OTRS SECTION TOWNSHIP RANGE MERIDIAN /f°' ` 1 !:"� CJ N ❑ E ho i fr EIS ❑W LOCATION/SKETCH: WELL OWNER: DEPTHS MEASURED FROM:❑Casing top ❑Around surface WELL DEPTH: (DATE OF COMPLETION Depth of hole:it BOREHOLE DATA: Depth _ Depth of easing: it Material Type and Color From To DEPT TO STATIC WATER LEVEL: ! it below S top of casing ❑ ground surface q -11-1a. Alu, EJ+ Date: 40 !i METHOD OF DRILLING:air rotary Elcable tool D" ❑ other USE OF WELL: $,domestic © irrigation ❑ monitor C) public supply ❑ other` _ CASING STICK-UP: ­17....,______tt, Diam: in. to it Casing type:N _ -"' '.... In. to it WELL INTAKE OPENING TYPE: ❑ open end ❑ screened ❑ perforated El, open hole Depths of openings: to — it SCREEN TYPE: - Diam: in. Slot/Mesh Size: Length: it � U GRAVEL PACK TYPE; �� Volume used: Depth to top: JAN 3 �� QGROUT TYPE::•e�<�-+�.•�'-?—� �...,—•-C' Volume: Depth: from ,r -y it to it iviu:I.t:Ipahly Of chorag Seryl s DEVELOPMENT HOD: De t. Health & iiu an Duration: P MPING LEVEL AN IE U: _d 2 it after hrs pumping—gpm PUMP INTAKE DEPTH: _ It Horsepower: WELL DISINFECTED UPON COMPLETION? 0 YES ❑ NO CONTRACTOR INFORMATION: REMARKS: i eglstpred Business a( e PLEASE MAIL WHITE COPY OF LOG T0: _.t....t DNR/DIVISION OF MINING & WATER MGMT Signature o utionze espresentauve ati c;` — PO BOX 907005 ANCHORAGE AK 99590.7005 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munl.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1011 'y 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address mcdci„7roisi COSA# Ole N4151 Expiration Date: i / – �2 19 - or.. LOFTY HEIGHTS SUBDIVISION: LOT 2A, I 12611 TOILSOME HILL DRIVE • ANCHORAGE. AK 99516 i RICHARD HARDING Day phone 12611 TOILSOME HILL DRIVE * ANCHORAGE AK 99516 Day phone ED WALDEN w/REMAX PROPERTIES Day phone 240 20081 110 W. 38TH AVE. • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well )♦ Individual On-site 0 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 ofDnSiteSystems 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 Onsite 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 samples. (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 On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date $ )1d L4 Engineer's Comments: In conducting this evaluation, GEG, Lt D. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational lite of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 5- bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist - --Arsenic-Advisory-Septic System Advisory Maintenance Agreements Well Flow Advisory Nitrate Advisory Supplemental Engineer's Reort Other J .' '•• , �{ WATER AND WASTEWATER PROGRAM By. Original Certificate Date: epr fp_ I'M, Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water b Wastewater Program 47W Bragaw Street P.O. Boot 196650 Anchorage, AK 995198850 www.muni"Wonske (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LOFTY HEIGHTS SUBOMISION: LOT 2A Parcel ID: O 1 7 - 4 L% - 29- A. WELL DATA Well type PRIVATE_ If A. B, or C provide PWSID# N/A Well Log (YIN) i YES Date completed 5/26/1995 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 209 ft. Cased to 24 R. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION i Date of test 5/26/1995 10/25/2005 i Static water level 26 R, 32 R, Well production 6 g.p.m. 2.99 g.p.m. WATER SAMPLE RESULTS: aS,�'� Coliform colonies/100 ml. Nitrate 5A /L. Other bacteria mg. colonies/100 ml. Arsenic:-0—ugJL. Date of sample: 8/11/2006 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA TankType/Matenal SEPTIC/STEEL Date Installed 10/16/1992 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 10/8/2005 Pumper DENALI PUMPING C. ABSORPTION FIELD DATA 1 Data Insta6ed 10/16/1992 Sop rating(k.p.d Rfbdrrn) 1_2 System type DEEP TRENCH Length 64 ft. Width 2 ft. Gravel below pipe 1 4 ft. Total depth 7.79 R. Eff. absorption area512 R' Monitoring tube YES Depression over ir field NO Date of adequacy test 10/25/2005 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 32 In. Water added 750 gal. New depth 43 in. I Elapsed Time: 151 min. Final fluid depth 32_25 in, Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) NONE KNOWN If yes, give date' - I D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons Manhole/Access (YM) "Pump off*leve igh water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknt t station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manundanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Budding foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Weds on adjacent kits 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Weds on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A WNESS Date _8 Lt 2�/o 6 COSA Fee: -7 a _ — Date of Payment g/_4106 Receipt Number�� (Rev. 11105) Waiver Fee $ Data of Payment Receipt Number 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 Nitrate Advisory Certificate of On -Site Systems Approval # 060415 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2A of Lofty Heights subdivision. This inspection revealed a nitrate concentration of 5.21 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. I Oct 26 2005 10:04AM HP LRSERJET FAX i i P.2 UNCONSTRUCTEDT— I r HUFFMAN ROAD n n N 8958'00" W 165.19' ' _--__ 10_OTILITY EASEMENT ----------------- !( a i m ! i 1 t 1 � t 1 1 1 Q N i N 0 � Ol 8 LOT 2A a 1 1 � LOT 1A-1 LOT 1 c; © N � V I i Nil i b i � V CR ' 41 � N i l�llli .Q. The bcoan of ft tuii(s) II I�I 10 ao D BB shown 0n ft mo dr;NWQ II y ~ (894xgn) compks WII I21. AMC. 111 II! v lln E7aSnNC �� ' iI II .��• NDJSE d WALL TAIN NC Date: o - e 2.9' pA S 89'59'30' E 765:19.':c:S t u�6Qi/ OF A��gsne� I ACCESS EASEMENT •/ i • BK 217, PACE 172 lif LS -8202 C LOT 1 E°RU4°N NOR! K N IM w.ri r.wwn•4.hy b .•1•.MN LIGEND: SET rND PAUL M ICHELSOH N°�,I,r:e° °t wy °O�i1°• .1kor r. kkl ble" wjt✓G)' Bir b 0 tat—.: wl .row •n ,r.e ncera.a MOr.M yal. NOTE: J]r ALYOI Q/1p{Ilpt with U104FISOHN ! DAUCHTER. NC, wareYww nlsw01TwN e^Y ••le w{m w ...e ver r•i. { ,� VT "VEY CERA A 4>,: LAN'ECM nM <ena vw . b.(al•NO- BIl® I� �I E°N Ill a{.•r M Ihk 0•W� w1r ro .M_ w . . OLpb- w.w1 a uel tM •.e. ..1. m•a4{ tw ewr[A,rt- LANU � �r• .law u• re•.•IY w•, a� w .wwa- AtI•.Nt- - 1. YM ea.r IM ISIN PAYp_ A�—tlIJILT OF; LEOAI O[M]HI:OI: •o•ec areuM.,F I N U Y0R6-PLANNERS-Eh .NIERS r . A{�+- 440 NEST BENSON BLYD. 0 103 (to-) 55I-6626 ANCHORAGE- ALASKA 99503 (907) 562-5291 LOT 2A LOFTY HEIGHTS SUED. ,e a{ef0 Nra e. Zen AaD t' 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. # C, 17 —a//— z 7 HAA # 1. GENERAL INFORMATION Complete legal description L&- T q Lc ,='T �y Location (site address or directions) 1.2,L I I 1 0 (L So PIE P_CAz�.D Property owner i-i'/IZ I>;1�;IC %E�� Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: �Q Individual well Community well w > � � Q Public water J h NOTE: if community well system, provide written confirmation from StiADEC at- ing to the legality and status of system. 3 4. . TYPE OF WASTEWATER DISPOSAL: 2 Individual on-site V 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 921 5. STATEMENT OF INSPECTION BY ENGINEER 6. 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 �j 0 tjik e u r K 1 �I l Phone �LZ i - S114 Address Engineer's signature DHHS SIGNATURE � Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: 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. 72-025 (Rev. 1191) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LOT,PA Loj=�'�f Ljt-Z166T--,ParcelI.D.: 011 — 4111— Z—Z— A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (YIN) r Date completed b --ems (O Total depth �1 p �� � Cased to F Casing height (above ground) 12 / Sanitary seal (YN Wires properly protected (Y/N) �. r FROM WELL LOG AT INSPECTION ry Date of test Static water level r Cts m Well production &e_g.p.m. WATER SAMPLE RESULTS: / Coliform j Nitrate ! 114 r� jOther bacteria Date of sample: Collected by: 9— p.m- B. SEPTIC/HOLDING TANK DATA Date installed & Tank size / b—V 0 Number of Compartments Cleanouts (Y/N)—Y-- Foundation Y/N)rFoundation cleanout (Y/N) Depression (Y/N) N— High water alarm (Y/N) I Date of Pumping N,,9 y/ e --Pumper N a Vt ,e — H �7a'r--s 1114t ` j, 404! C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) ry System type Length a Width Gravel thickness below pipe _ _ Total depth Effective absorption area 5:1 ;7— Monitoring Tube present(Y/N)—Y-- Depression over field (Y/1) T-4 Date of adequacy test Y A Results (Pass/Fail) N �. For /=� bedrooms Fluid depth in absorption field before test (in.); cl Immediately after gal. water added (in.): N p Fluid depth (ins.) Minutes later: r� Absorption rate = H ✓A g.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date � c Z � n M Z r � en C M T < Z M C 0 Z D. LIFT STATION�VA Date installed Manhole/Access (YIN) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off"level at* Septic/holding tank on lot %jT % ; On adjacent lots t d Absorption field on lot riL('a� ; On adjacent lots l� Public sewer mainPublic sewer manhole/cleanout N Sewer /septic service line %1 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / I Building foundation Property linegyp! Absorption field Water main/service line Surface water/drainage /y/0 Wells on adjacent lots CL SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation . }� // Water mai»<service lineal / Surface water f /0 Driveway, parking/vehicle storage area e , 1 Curtain drain I [� Wells oil adjacent lots PCO Property line 10 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with NIDA IIAA guidelines in effect on this date. Signature a Engineer's Name _ p OCvl � l rkOt��Z.-� engine rtng Seal Here� Date 1� :D HAA Fee $ v , A�o Date of Payment ��p a Receipt Number / Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number --o mmopao - a 3 e m m 2 C 3 • O -4 0 (-0 3 m -0 3 m nm omo - J ymj QJa Z Y. IAiI Z pmDmA A!mOOi -I\NmNDAn NNmNDA\ NAOZ--p_ fCC3233 OADNm-np IOI�llI iDOJNWNXWo NpDrcn- NN-NNNNUO DDy�OOy- r2NCN CNDi ND NW2 _(6O1 NW I r2NN. 'ZmOA -p �i �D:0Np O(NOD9iZp2DOW-A_- Alm Ci - �bOm(mP'i PQiJoGC�tG;mPtH�¢'•1- �jjQ�O_g0 qPOFap\m -QjmtipaN. rO�+m O,ON N O O\ 1 4\ NOO Xc z p�(lmAni_ ll m o m z z p D o �' n N a 2 ti °..T� O .o p �(� � O_ c m m 3 v 39 _ v. 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