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LOMA ESTATES BLK 1 LT 6A
Loma Estates Block 1 Lot 6A #020-092-22 �t Municipality of Anchorage •:=�� •�� , Development Services Department jj�• . Building Safety Division On•Sfte Water and Wastewater Program, 4700 Bragaw St Page I of 2. P.O. Boz 196650 Anchorage, AK 99519-6650 www ci anchorage.ak us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S W O 9 00 y8 PID Number: O 20 �09 2 — ZZ RNn+ /• _ r J re � Wastewater System: ❑ New Upgrade 0."°°•"(i7 ttot Ge/arofe f}✓e. 99S 11!�' ABSORPTION FIELD N~ N B•atadms Pn"" -7 '145 ^vYSS" 13 O Dw Tn 0 St+Ilo• 71N Sr Bea ❑ tla,nd O Otnsr LEGAL DESCRIPTION sw Ratrp o.7 Grose TNN Dapm tram arplW p+ds 3,0 •t 2.0'X9711 of Ft. ll a LN Sup VWN ES/ufbi DWn b Pp• t Ntan tam NIgn 7•de 24, Ft. Gr"d+pne Stt PW v.S Ft I A on.a. Tor -P RNq• S+Cwn FYl wdsd wdr *VM!11 Pad• — 1.0 GnrN LN'Qin �/ (3 Ft. O•S Ft. Well: F_Y_u77NG0 New ❑ Upgrade Gt" ..mn is fl n N I. , 1 3 D,Nanu Mnra•n Ims Ft Ft. fJn✓,ue+a tPngN AB Ct TNN D•pm C+sW to TNN wswpwn N•+`F,� _ FIY P,wm+I•^N YM D 30 SY 1.�Ni CALQIt YG P✓L Ft. FI O I DrNN DNe Dni" SUIw WNN L"M M61S r A-+' 1&6 S✓'�s DoleInstNNa 6!y/ Zoog Ft t Y,•w Pump SN N Cswq t*,VA Nddra Glo TANK GPM fl. PI SEPARATION DISTANCES ❑ Septic ❑ Holding 1? S.T.E.P. ❑ Other. To I From Septic Tank Absorption Field Lit Station I Holding Tank ItititcrPrivate Sewer Line •alu",�r� uTp Ta(h i* apaary 12 SOGN M+I.tw NN N L.MDN1m 15 ww 1D,s't 109' 1OSr '"> 2,S'' Z' LIFT STATION Sutau Wow fgo' 6•o' &O' — LN L. '4,C' � ys' —. ,ye rn to rO.1 Gat iCl✓N AAcAorYa Tun 4 %OrYt co 'PVapdn erNN 'PJrw Gtr lawN Nigh w+IN wmat PN.aa:wn 1 Zr Zoe 12' —` Ai•f in YO n If 7 ^ ^' Pump MM+ a LYddN os t '/L EI Mii tr,sp+awns pedN^'•a try• M, e. n Cour~ Dan — -. R•t••n'• Wotftllr FttYNt ev/fa.win 60' BENCH MARK G n f /-tin Co..r Ys r u c. Cts. fee qh j'u fG c/ ,t �ro.•rr/ Laa.Iwn Nld asOwlan in r Y e! fl/O swaad .rn,an 0, To! yo sa•lrhhra/e STBr fc.••t %I Ft Y.i rF ttr /+•,jaa /Ton ib GLC�sYt4( oI' ri url /Qy.O L(L,F, ✓tr'1't COV r.Wt*rp. Nn n. 9rpyrLd Y eA41 feylkc n M �t aYGe.dbr, Dates: 1' /0 Performed by: F& Engineer's Stamp �cystiT pQ0 ()F At � E •t 2nd e; / t/o9 ;•••......:i%� Development Services Department Approval y°'*�•: ��tTt :<< Conditional Approval Date: �•••• ••••••'•' l HEODORE F. /dOORe CE -X3] 89 / V. Date: —�3" O �.s7Fil�W�y� tt;�� 7p� ,,,.v; LReviewed and approved by: �;t•' S NU 1.25" SCHED. 40 PVC PAGE 2 OF 2 PERMIT NO: SW090048 410 w 3116" HOLES @ 39' ; SPACED V APART ; PID NO: 020-092-22 ORIGINAL BED • ' " I T.H. .G. " • q #1 NEW 15' x 43' SOIL ABSORPTION BED o� w.2.0'SAND&0.5' z GVL. UNDER PIPES "E" ' NEW 1250 -GALLON "D' :p» STEP TANK ------- --- SWING TIES: C. FROM: COR. "A" COR. "B" 3BDRM TO: HOUSE FDN C.O. "C" 6.5' 28' ; S.T. C.O."D" 17' 28.5' ; S.T. M.H. "E" 24' 30.5' ; BED M.T."F" 20' 45.5' ; BED M.T. "G" 50' 59.51y ; BEDM.T."H" 57' 44.5' - ------' AP `I .� F 60..4r LOT 6A, BLOCK I ; le' LOMA STATES G OPi_ r , THEODORE F.MOORE : / WELL ; CE - 3589 : �i j 1 •.-.q�ryros� .`. PLAN VIEW ' SCALE: 1" = 30' „ „ 2" R�61D 2'+SOIL 2" RIGID 3'+ SOIL ORIGINAL SNS. 2'+SOIL M.H. COVER INSULATION COVER GROUND COVER ELEV. 102.4 ELEV.99'4 INV. 2' 1 FILTER SAND; INV. 1250 -GALLON - ELEV 97.4' , 99.9' 97.6' TEP TANK ; ; 2.5' , 15' „ , 15'x 43' SOIL ABSORPTION BED LOT 6A, BLOCK 1, LOMA ESTATES TEST HOLE #1 SEPTIC SYSTEM UPGRADE PROFILE VIEW WATER @ REL. AS -BUILT INSPECTION REPORT ; ; ELEV.94.9-6rlros NOT TO SCALE BOTTOM 0 FLATTOP TECHNICAL SERVICES SCALE: AS NOTED REL. ELEV. 88.9' 14530 ECI10 CANYON ROAD DRAWN BY TFM ANCIIORAGf ALASKA 99516 JUNE. 2009 Inspection Report Municipality of Anchorage, Building Safety Division 4700 Elmore Road INFO & HELP (907) 343.6211 INSPECTION: VOICE (907) 343-6300 • FAX (907)249.7777 • www.muni.org Name same Permit 1109.8173 Company eds electrical Inspection Date 11 -Jun -2009 AM Address 17101 BELARDE AVE Phone 2724591 1443-u49S• Grid SW3337 Subdivision LOMA ESTATES LOT 6A BK1 TR n/a Work Description RETRO: Septic lift station (2 INSPECTIONS PAID) Permit Technician DAY, JINNY R. Comments or Directions lift station call to meet on site Inspection Type Electrical:Retro Electrical Comments (for inspector use only) aC�P2t=>\jF- 9 Inspector C Date / 7 MUNICIPALITY OF ANCHOR4 GE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 04, 2009 Expiration Date: May 04, 2010 Permit Number: SW090048 Parcel ID: 020-092-22 Legal Description: LOMA ESTATES BLK 1 LT 6A Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Site Address: 017101 BELARDE AVE Owner Name: GARY JOSEPH Lot Size: 42561 SQ. FT. Owner Address: 17101 BELARDE AVENUE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-5324 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. A. This permit includes waiver #WR090018, allowing an 80 foot minimum septic tank and absorption field to surface water separation distance. B. Abandon the existing septic tank in accordance with the code. C. The final surface grade over the proposed drainfield shall drain to the northeast. Received By: Date: 6-1`7 !aq Municipality of Anchorage 01X7 P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water & Wastewater Program Waiver Review Worksheet WR# 090018 PID# 020-092-22 Permit# 090048 Date Received: May 4, 2009 Legal Description: Loma Estates; Block 1; Lot 6A Engineer: Ted Moore, P.E. Applicant: Gary Joseph p�cnr 1, ,o e ^ " Ape .. I I I )epartment Waivers Requested: 80' septic tank and absorption field to surface water separation distance. Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: s......................................................................... Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: 1. Old drainfield had no problems with 51' separation. 2. Final grade shall slope down towards the northeast, which will Increase the surface flow path to surface water to greater than 100'. Date:14/5 09 By: Jay Crewdson Name of Reviewer ........................................................ a ... ............. Rec#: 00501D Amount: $800 Date Paid: 4/29/09 4 i Mali Claman, Acting Magor May 4, 2009 Municipahty of Anchorage P0. Uux 196CN) • Amdhonge, Alaska 9lkiMf)CAO. 37(X) Elmore Rwd O0ire: (!X)7) 343-R91)l • r= (!X)7) 37.9-82X1 Myr.//w���c.munLorX Development Ser vices Dclru-lrneitt Ted Moore, P.E. Flattop Technical Services Subject: Waiver Request for Loma Estates; Block 1; Lot 6A Waiver Request Number: WR090018 Parcel ID: 020-092-22 Permit Number: SW90048 Dear Ted Moore, P.E.: Your request for the waivers listed below; 1. 80 foot septic tank and absorption field to surface water separation distance has been approved. DEPARTMENT This waiver approval applies to the items listed above only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343- 7904. Sindy������(/I.Co v1 amts "Jay Crewdson, P.E. Civil Engineer On -Site Water & Wastewater Program Conzinunity, Security, Prosperity W -v11111kb wft =1wm9w iw -.0 / Gam`%.g" w VV; j IL -- i,.. .S a' (air'?4'V { r, . � •, -•' . ,'t f (.'�'�1'` ri i . .. - `\v.14 i`.ty `'t:. l �' !l 13`<ry � /:1/.v 40j �♦ . >: •., � l /moi- , , � ti YL.n a� !,�� r♦.cv � Mr .r jy•r. / r iA ^�r' .. I: f.. Yom.+�Y /yam a r♦A�r .['Mf.., ; ~ � YC �, ' ♦ ..nod i+ *k' . +v yy��pM'".,ry� � ; -r \a � `j A t�r�. / I R ✓r rM:�«f.� �/t� I ` fr y�Ii 1\ ;'/i' 1Y *�>C�41l -Jx 1a' .r 1 (�.} t, m♦ tt'' f i t J jr`41irr1Y,r \•4�1'T ♦•• ,,..r l'i fi 1 1�tit ( ♦ 'JV '� r}r� y.rt�4'{1 AJ VI/� i\i; f\y'fc `�.� �; { r.I,YI ya ;, +�ti N ll�j{ 19f,'=�'. / � • � � .J_��. f y�:s f / '� '1 � +i�a- >f i` _ `• > ' �'>,.\ •_ f ♦ I= 1 tl{'i > .r it � :• i J �`\ r Irl II ^.., ... f ♦ I 11 ••r ��j;�r�' W"?r! it .�l • >, f A Y. > h. Silt', r•..'al!�_. f';♦ 1 1 J J ,(e ,. • • � S ��Jr��{+Sy=�a. RiJ >Yr p i r t .1. /, J,•_ - r ... j.. I J / fi'nj`\f�t? T'�r^,I { ~•` ' {'\Q If s'1.t7,+ f j,'t � - 4 rte_ � �'/� l/��;A ,�`kslr -.r�i. F i- •�.. :'=k +. �t.:` r '1'v�.,j' \1 ���`�►1 `t+f<�� \ 7G {t irlM�"�'"I �,� r `a Sys {,}tib �. 3tr.+{ e'��y�. A J: -u s hNi L= ! �•,a�r y_s,v�« i YM a♦M/�� J1�• r, �57�Iu wl �"�♦h♦aa�� /� � t f •, �/e � ,.-r }�1 �� ,4. 1•Il lrk l F•� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 02-0 - CA 2- -ZZ Property owner(s)� ER Torah Day phone 7Y& -OY6s- ❑ Privy ❑ Mailing address 1 -?101 Qelarale fNt; /}ne-A Zip Code 9iS1 d_ Site address 1 f Zip Code Legal description (Sub'd., Block & Lot) L oJG A, Rlaek- !, 1_&rnez Er/aNJ Legal description (Township, Range & Section) Lot Size 42, 56 I Sq. Ft. THIS APPLICATION IS FOR (Z all that apply): Absorption Field ER Septic Tank 62 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade 52 Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: SJn Waiver Fees: & oe7 Date of Payment: VjL%9 9'/2-7/09 Receipt Number. 0"75 0 1 I� (Rev. 11105) Date cf Payment: !/ 12 9109 Receipt Number. t FLATTOP TECHNICAL SERVICES . CML E ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION 6 ANALYSIS TED MOORE. P.E. 14530 ECHO CANYON ROAD PHJFAX: (907)3454355 ANCHORAGE, AK 99516 E -Mail: tgmoore@gcl.net April 29, 2009 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal system on Lot 6A, Block 1, Loma Estates, located at 17101 Belarde Avenue. The existing soil absorption bed is operating in a slightly surcharged condition. A soils log, perc test results, a site plan, design drawings and specifications are enclosed for your review. Also, in order to permit the proposed bed to be constructed as designed a waiver will be needed allowing the new tank and soil absorption bed to be located as close as 80 -feet from surface water. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 5 and 9.5 feet below ground level is sandy gravel with a measured perc rate of less than 1 minute per inch. Due to the rapid percolation rate a two -foot thick sand filter will be installed under the absorption bed. Groundwater has been monitored during breakup at a depth of 9.3 feet below ground level, so the bottom of the sewer gravel can be no deeper than 5.3 feet below ground level. The basal area of the bed is sized on the basis of 0.7 gpd/sq. it. as specified for the sand filter. This 3 -bedroom residence requires an absorption rate of 450 gpd, so the required basal area is 450/0.7 = 643 square feet. The proposed 15 -foot wide by 43 -foot long soil absorption bed has a basal area of 645 square feet. As illustrated on the site plan, the topography of the lot in the area of proposed construction features a broad flat ridge of relatively higher ground encompassing and east of the existing soil absorption bed. The topography west of the existing soil absorption bed drops sharply down at a 30% slope to a man- made ditch that carries a small flow of water along the east side of Davis Drive and thence through a culvert. In 1994 a separation distance waiver was issued by the Municipality allowing the existing soil absorption bed to be as close as 51 feet from that surface water. On April 16, 2009 I met with Jay Crewdson and Dan Roth in your office to discuss the issue of granting a new surface water separation distance waiver to allow installation of a conventional soil absorption bed as an upgrade to this failing system. We discussed the fact that the proposed location will allow a horizontal separation distance of 80 feet between the new absorption bed and the surface water in the roadside ditch, which is significantly greater than the presently approved 51 feet for the existing system. By grading the top surface of the finished system to have a slight downwards slope towards the north and east the surface flow path from the new bed to the ditch will exceed 100 feet. In actuality, surface daylighting of the system is virtually impossible due to the fact that septic effluent would have to back up into the residence before this could happen. The new bed will be approximately 35 feet from the break in slope where the terrain starts dropping down towards the roadside ditch. There should be no concern as to effluent daylighting through the side of this slope due to the intervening horizontal ground and the fact that a 25% slope line extending downwards from the proposed bed would not daylight within 50 feet. The present bed, which is located much closer to the steeper slope and is operating in a slightly surcharged condition also shows no evidence of effluent daylighting through the side slope. To maximize the longevity of the system, as suggested by Dan Roth we propose to install a "Bull Run" diverter valve downstream of the septic tank to allow effluent to be periodically rediverted to the original bed as desired so as to allow the new bed to be afforded a resting period. The proposed upgrade will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space - surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, T-C� wle� Ted Moore, P.E. CULVERT D% 4r d EXISTING SOIL ABS. BED 0 EXISTING i -r V A LOT 6A, BLOCK 1 LOMA ESTATES FLAT TOP �, RIOGE OF {HIGHER GRWND 1WlYUALLUN �"�- +nSEPTIC TAW�BDR'HOUS WELL , \ AGF LOT 4, BLOCK 2 \ LOMA ESTATES \ QF -ft AV '0 \ \ 0. ......................CE f / THEODORE F. YOOREi 1 - 3589 Ar e� .....4t; OA \rofesslo \ 1, LR=100' WEL - -------- LOT 5.BLOCK 1 LOMA ESTATES SEPTIC AREA CONSTRUCT NEW 15' x 43' _SOIL ABSORPTION BED w. 2' FILTER SAND & 6" GRAVEL UNDER DIST. PIPES TEST HOLE #1 INSTALL NEW 1000 -GALLON `.SEPTIC TANK -I---------------------------------------- -- ------------------------------------- , , SEPTIC —�� AREA LOT 7, BLOCK 1 LOMA ESTATES dIlW HOUSE LOT 6A, BLOCK 1, LOMA ESTATES PROPOSED SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECI10 CANYON ROAD DRAWN BY TFM ANCIIOP AGE, ALASKA 99516 APRIL. 2009 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. CONSTRUCT 15' -WIDE x 43' -LONG SOIL ABSORPTION BED WITH 0.5' WASHED SEWER GRAVEL 3- 2.0' ISF FILTER SAND UNDER DISTRIBUTION PIPES 4" DIA. TO ORIGINAL D-3034 ABSORPTION BED INSTALL BULL RUN DIVERSION VALVE DBL. C.O. INSTALL NEW 1000 -GALLON SEPTIC TANK WASTE LINE FROM FDN. C.O. 15 �25 5 5 �25 I PLAN VIEW SCALE: 1" =10' 2.5 .5',� 2.0' ISF FILTER_. SAND' � 15 CROSS-SECTION "A -All SCALE: 1" = 5' (TYP.) MONITOR TUBE (FYP) 4" DIA. F-810 PERF. PIPE i Q•OF- 4C ,,,�� *�49mi' *1 ................. .p • THEODORE F. YOORE •• C I �� :, CE - 3589 .� N eAW ,4�1 too d , AV \r.�Ote sS%0 �-� MONITOR TUBE ^LEANOUT (fYP) RAISE FINAL GRADE 6" ORIGINAL GROUND 4" DIA. F-810 PERF. PIPE E7 FILTER FABRIC 12" - 2 12" WASHED GRAVEL 2 2'+ ISF FILTER SAND BOTTOM OF EXCAVATION LOT 6A, BLOCK 1, LOMA ESTATES SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICESFA CALE: AS SIIOWN 14530 ECI10 CANYON ROAD RAWN BY: TFM ANCI IORAGI„ AK 99516 PRIL, 2009 43 u n In i n n -A. 0 i� u n �25 5 5 �25 I PLAN VIEW SCALE: 1" =10' 2.5 .5',� 2.0' ISF FILTER_. SAND' � 15 CROSS-SECTION "A -All SCALE: 1" = 5' (TYP.) MONITOR TUBE (FYP) 4" DIA. F-810 PERF. PIPE i Q•OF- 4C ,,,�� *�49mi' *1 ................. .p • THEODORE F. YOORE •• C I �� :, CE - 3589 .� N eAW ,4�1 too d , AV \r.�Ote sS%0 �-� MONITOR TUBE ^LEANOUT (fYP) RAISE FINAL GRADE 6" ORIGINAL GROUND 4" DIA. F-810 PERF. PIPE E7 FILTER FABRIC 12" - 2 12" WASHED GRAVEL 2 2'+ ISF FILTER SAND BOTTOM OF EXCAVATION LOT 6A, BLOCK 1, LOMA ESTATES SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICESFA CALE: AS SIIOWN 14530 ECI10 CANYON ROAD RAWN BY: TFM ANCI IORAGI„ AK 99516 PRIL, 2009 TEST HOLE 1 FLATTOP TECHNICAL SERVICES 14530 ECHO CANYON ROAD ANCHOR4GE, ALASKA 99516 SOILS LOG - PERCOLATION TEST LEGALDES�RiPTION: Lot 6A, Block 1,. Loma Estates_,_-__,._ DATE PERFORMED: _ April 10. 2009,.. PERFORMED FOR: __ Gary Joseph _._._...—_—_-- -.. . ...._... ...... --._ .. ._.—_._. DEPTH Pt. SLOPE _..._ _.... (feet) 1 EM Reddish sandy loam � I 2- 3- 4- 5- 6- 7 3- 4- 5- 6-7 8 9- 10 it - 12 ' 13- 14 _I 15 16- 117 - is 19 i 20 y GM Somewhat silty sandy gravel i I Dry, non -cohesive j GM/ML Silty gravel lens ■1 { ov �..........................� A : THFOOCRE F. ht0OkE j CE -3589 -. !,5a SITE PLAN .__.._.. _.. -'-10% �x Iola - Ar TEST �t 1 ' 1 N 1 ' 1 , 1 1 1 l 1 \PERC PERCOLATION RATE—<< I(minutestiinch) PERC HOLE DIAMETER TEST RUN EETWEEN 5.5 FT AND 6.0 FT COMMENTS: 2 -foot sand filter will be needed under soil aosorptlon bed. PERFORMED BY FLATTOP TECHNICAL SERVICES. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: TEST f GP/GM Sandy gravel RM I ; 3-13 Loose, dry, sidewalls unstable HOUSE Water seep - Depth to Groundwater Dale ! ! MUGM Gravelly silt Seep@ 9.5' .. ----- f_ i 4/10/C9.. .__ 0% 10°h / Water .�!9.5'.x- ;_.4/15/C9 .__,SLOPE 30% Damp, cohesive Water. at 9.3'._ -__ ,_.4/21/C9. - Clock j Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) , I ;_4/10 i 12" Presoak 12.-_ i I — I ._1'' Resoak - - - :.. _....-•-- _ --_,_27 - -- — .._27 3/4 - — — — _ _.__.;._1""Resoak ......!._. 11:28:30- .. _ ....._._..2712 233/8 #1 - .. 11:29:30._ .. _ .-- 1 _.._ .181/4- -- .. 51/8. ! Add water 3/8 .—...._ - ---._, .. #2._._... _ ....11:29:55 11:30:55 _ -- _ ..._..... .--._ ..1 .... _. _. _23 ---- 181!4.--- _ -- . 51/8..__. , Add water 11:31:35 23 3/8 63 _.��...11:32:35_..._ 1_. _..._ _ _..181/4.---•--5 lie .._.... PERCOLATION RATE—<< I(minutestiinch) PERC HOLE DIAMETER TEST RUN EETWEEN 5.5 FT AND 6.0 FT COMMENTS: 2 -foot sand filter will be needed under soil aosorptlon bed. PERFORMED BY FLATTOP TECHNICAL SERVICES. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: rFfattop TechnicaCServices 14530 Echo Canyon A o9,Xnchorage,,XX99S16 tl fww (907) 345-1355 Lot 6A, Block 1, Loma Estates 17101 Belarde Avenue Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandoning an existing 1000 -gallon septic tank and installing a new 1000 -gallon septic tank that discharges effluent into a 43 -foot long soil by 15 -foot wide soil absorption bed. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. The new tank and soil absorption bed maybe as close as 80 -feet from the water in the roadside ditch beside Davis Drive 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 Unless agreed otherwise, the contractor shall be responsible for any tree clearing and grubbing necessary to complete the project. 1.5 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.6 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing 1000 -gallon steel septic tank shall be properly abandoned per code. 2.2 The new 1000 -gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried 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 waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot. Care shall be taken to adhere to minimum allowable slopes so as to avoid bed encroachment within 4 feet of groundwater. A foundation cleanout shall be within 4 feet of the building foundation and a double cleanout within 5 feet downstream of the septic tank. A "Bull Run" diversion valve shall be installed downstream of the double cleanout and plumbed to allow future reconnection to the original bed. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 43 -foot long by 15 -foot wide excavation to a depth of 7.3 feet below ground level in the vicinity of test hole #1, as illustrated on the site plan and plan view drawing. 3.2 The bottom of the excavation shall be level. A total of 2.0 feet of approved filter sand shall be placed in the bottom of the excavation to create a level top at a depth of 5.3 feet below original ground after being compacted by foot. 3.3 A total of 1.0 feet of sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipe network laid level such that the pipes invert are no less than 0.5 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" washed gravel, with less than 1% passing the #200 sieve. 3.4 The distribution pipes shall be 4" diameter perforated F-810. 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 entire top surface of the sewer gravel before backfill. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. The final surface shall be graded to slope down slightly towards the northeast. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 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 contractor 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 rough backfill and grading is complete. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 0P1GEW V 6/ F: /1rW ��-�/� ❑UPGRADE MAILINGADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS 41 yJ �y / / DISTANCE TO: Well �,q�'T Absorption area 9 Dwelling PERMIT NO. e3/ Ti s� U Y ,ilk /J F Z LU Manufacturer Material,,,,,,,, No. of compartments _ i' F'L. _ 4 Liq. capac gallons I IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. JaZ 0 Z I Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well A;0 Foundation P tI'd3� / / Nearest lot 1' e '�- PERMIT NO. V")/U ) r t W!2 LL z No. of lines Length of each line Total length of Ii Trench width B;y j} Distance between lines F. Z � - �� inches s- ccF Top of the to finish grade � Material beneath tile :J Total effective absorpt;o�area a inches3r F;/ Length Width Depth PERMIT NO. w I,- a w Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RATING ry, _. ,> p6tzW/ j V R�'�r� c D DdsJ�cJ I STALLER EMARKS v9 i J �:� 0 J N4'3,e Co APV f. p' :`1 J , t .r/�, 14 APPROVED - - DATE LEGAL y � 7/ f� �f T; - Q C Z� MUNICIPALITY OF ANCHORAGE = s. • Department --F Health and Environmenta3 ?rotection 825 Street, Anchorage, AK. )501 bI 264-4720 # # # HANDWRITTEN PERMIT Permit #� f�b� WELL ANDS ON-SITE SEWER PERMIT -7 Applicant: F�/!�S eVeto/,O&iUr Mailing Address: X09%/,? 1/ Did dGu+� lxc�j r1��OL Location: �Ph�o"ne Number: .3 l �-�4 Lf/ Legal Description: �@►T �p ,�s+st4"'s Lot Size: Type of Soil Absorption System IIss Trench: Drainfield: ►� _ Seepage Bed: Holding Tank: _ Maximum Number of Bedrooms: Soil Rating(sq.ft/br)�' t The Required Size of the Soil Absorption System Is: DEPTH LENGTH T__ GRAVEL DEPTH iZ / WIDTH 5 r The length d' /„ t -he length(in feet) of the trench or drainfield. The depth of a tj ,,,-face of the ground and the bottom of °0 cv�,�4 �� o� j� �,:� ,. �1 �� � for trenches. The gravel d( 1401 ztfall pipe and the bottom o: w<�-- �f /'- / / � # # OL �X7`�y d'/J4/lfw y'�y„n�iwlfi-- ll/ .�s / // / # # R E loes�e oI or.e cKe� wfiiG�J cid �oefi !re a��.G• SON S Permit applica nt during the installation i D4e/ o/i1�orw/ ,e„e' ooe ,rf,/<ovro�c�fl and the number of residences azx lmer/ , zsc/ou� ' Backfilling of w Fc e� /loco / dr ars by this department �yiGP l �ri�l will be subje< et �w a ,., & 9'jv� b 2 •cenf �,-a- Minimum dista: �1� ", ,XAw- 0L0"/� w� �a/ � r� sO � L system is 100 feet for a private o/is�b1�/oti4 /0" �Z1',oV'e Pr / m` o�75,Z wi// ling upon the type of public wel,hof ivate sewer line is 25 feet ana—L�-�____ � gs are required and must be returned to this dep ment wl--n-i�n--�-�--,,_� well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 # # I certify that: (1.) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha 3 bedroom . Signed:/ i�C'.� r� Issued by: Applicant Date: 6 3 xj SWP/024(1/81) AIVA 1000�&- leve -1 7L6 /,P vo/ — A 4 e c AC/ 613/13 u % . � SOILS LOG MUNICIPALITY OF ANCHORAGE • +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:yetz.- -FU---Atbv- DATE PERFORMED: 4 { -C)2- LEGAL DESCRIPTION: 1®4✓vtc. - b -oma eS - Lot 6 A I. DEFIT11 1 SLOPE SITE PLAN 2.1 L-1-1 7 ( EPT 1 I 2 i 3 4- 5 6 7VP ", 8- 9 9 u l 11 10 ;A 11 IU!v i.A�'f; I_ ii'j"C S r v 1 5crAc (arje rcc r_s WAS GROUND WATERS ENCOUNTERED? \ C5 L O P IF YES, AT WHAT {I E DEPTH? Date Gross Time P, 12 Net Drop f 12: 4r5 13 i 3 z:Ya" 14- 4151617181920 15- 16- 17- 18- 4 19- 20 ii'j"C S r v 1 5crAc (arje rcc r_s WAS GROUND WATERS ENCOUNTERED? \ C5 L O P IF YES, AT WHAT {I E DEPTH? Reading Date Gross Time Net Time Depth to Water r -T Net Drop f 12: 4r5 i 3 z:Ya" t n t 0 4 -79 41: /%j: 15' Tk 13 l A "P' e -P RC ■�s1W01C® ALIINE ■MEMEL EMOMMONESE E101110 EMENSINNERN ENEENNIkIENNI Reading Date Gross Time Net Time Depth to Water r -T Net Drop f 12: 4r5 i 3 z:Ya" t n t 0 4 -79 41: /%j: 15' Tk 13 l A "P' e -P RC PERCOLATION RATE -�_Q (minutes/inch) TEST RUN BETWEEN '41 FT AND 7 _ ? FT COMMENTS ';—'Io 1 � %'Ij J��'%s� 6c Aly0 ll PERFORMED BY: CG o clot- 8c p'c`t S CERTIFIED BY: L<Cd i�ils?F iJtLii'J(,7 c-t�rRVi 12tJL- �i �C —1%C L i kL- DATE: V _� 0 tc.A,• r� b 5 i it = E r Y� 1 (� ANIC. ,oF;AG'-, ALASKA 99501 (yo34-4 1 ; 1 �. i o,; suu_ivAN,VAYOH i3OVMEN FAL Pr MC !ON May 23, 1979 Waterfield and Associates Post Office Box 4 -ii Anchorage, Alaska 99509 Subject: Lot 6A Loma Subdivision Gentlemen: In reviewing the subject, we find that the soil test as submitted are very good (average 125 square feet per bedroom) with a trace of moisture at 7.5 on Test #6 Lot 6A with the test made on January 28, 1976. It would behoove you to make a new test at this time of year, but this department finds by reducing the area to 36,570 square feet, this doesn't reduce the percolation area or increase the density and with good soils throughout the subdivision. The department finds this will meet conditions with which this department is concerned, however, you are aware that a permit and inspections for the proposed system are required from this department prior to final development. If there are any further questions, please contact this office at 264-4720. I ,$incer ly JohnW. ynn Environ,l ntal / JWL/1jw Specialist cc: Jerry Weaver Planning Department i Wateeiieed 46myliteezimy o4ddaciated P. O. BOX 4 -ii - ANCHORAGE, ALASKA 99509 - (907)%>�/�JIW 337-1213 W May 14, 1979 '� 111 �,_ ,•/ /14 2) Municipility of Anchorage Department of Environmental Quality p Q y Re: Loma Subdivision, Lot 6, Grid 3337 Dear Sir: We are in the process of resubdividing the above referenced lot. The only change in the lot is to be the dedication of additional right of way, thereby reducing the area of this lot to 36,570 s. f. This lot is to have on-site sewage and water systems. This dedication of additional right of way allows the owner to leave a very well constructed road where it is rather than reconstruct the road so that it does not encroach upon this lot. The soil in the area is predominantly SW as shown on the attached soils log. Test Hole 1-6 is on this lot as shown. Diminishing the lot area does not diminish the available percolation area. I hereby request your approval for this resubdivision. Sincerely yours Waterf i e I d, P�;E. HW:cd Enclosure ilk Ix Qj 6\UhSi , t: a (tom C, t J _p 6N uE j } 1 f - •__. .. _,.. '�•`sY � �. � w� � 4_ ` i1 __ay_____.__._ �..._�t_� -1 . f\) •:) � d cn Qr_`J C•_ � - � _ _: to n t'r- �> !n n -•' ,', ! +3E 61\ Z •NY�,:_.»,.w` 4 3��ti n J., �- J,.�_. ,�.1 (i '--i � , j,Y. r..I �._ L:•'-+-r�-...1 ..A l� -� :�S - I L, O __ . _ ._,._..�__.___ _....__ � .._. � a � '`• t I'j I t ; 1 •" -_: � � i�+ _, Com' r ,raj fb z 6N �. il Z. Nil c U) .._ ._ tv r 5 96,31,3s.f R F--12.5' 7..0000 � 1 `AI Io°I n 'I zl w NII qlu I 31 10�� Xl�"j 59,394sf.\ - /.364Ac. x 3E h i }��:190.Otl'--—w... J41 i ;i \}vA } f I V u t3 j 3N 4 'F,m 81 I u f J UI 4 i,x Ir 1 �j a �t ' 1 1 89,1�3'7sf. `� r 11 8i 9ev = a .046Ac. } I .o 1 I 41, O96s.f i� =O.943Ac. e% o- per__ 03 iJ86_4g"E 19 s I p1. 9 5 s 71, 9, 10 I Q Ac. �f 4 44,51Us.f. =1.O22Ac. i /p zW �` 59,114 s f 357Ac — ILRoad1"--ZOO 00 Recreational Tn ——------- I \ 2h V-1 L 6 'I =O.977Ac. 2� �o Qom, 45 497989s f =/.O,, _ /.148Ac. �. 29 -84' -------i — — —�— — — N8965426 W,329.81T — OD ..q5 30 30 53,791s.f, =1.235Ac. 26 "' \30 8 U!ili— \Easement 391.45 _ — _ _ ---_ --7iibb \ °C�---------.---- 30.N N89°53 A i.. 7 54,39Os.f. =1.249Ac. n� 8 50,390, =/157A" 3?_g99: eo'rr 0' ----- r 0.1 w W, 1319.45 LOCATION OF WELL (Please complete either Ia, Ib or Ic.) la. Borough Subdivision Lot Block Ib. 1/4 qt re- lr j 3` zI �—of_ot.of— Ic. DISTANCE AND DIRECTION FROM ROAD hNTERSECTIONS Street Address and Area of Well Location WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. A.D.L. No. Section No. Township N❑ Range S❑ 3. OWNER OF WELL: .. Jf ':i[ Address: Feet Below 2. WELL LOG Surface Material Type Top Bottom r, VV OF A GI )N ENVIROVI �' (,1 E[ -I I Merl di an WE]W 4. WELL DEP/jH: ((Incl) 5. DATE OF COMPLETION -6, Cable tool []Rotary ❑ Driven ❑ Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: 7. USE:/E] Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑ Other: 8. CASING ❑ Threaded Welded diam. II in. to _;_❑' ft. Depth Weight .` /` lbs./ft. diam to ft. Depth Stickup ' - ft. �9. FINISH of WELL: Type: r7t.,x.c..wy .o;,- Diameter: f Slot/Mesh Size: Length: "- Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: ft. Above or E] Above � Below -land qurface �� Equipment used: I I . PUMPING LEVEL below land surface and YIELD S ' `ft. after hrs. pumping 9. P. m. ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: ❑ Yes No Material: ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of of Drop Pipe ft. capacity g. p.m ,❑ Subm. ❑ Jet ❑ Centrificol ❑ Other 14. REMARKS 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature This well was drilled unGer my Iutisdlction and this report is true to the best of my knowledge and belief; Registered Business Name ,. _.„,. Con}roct License Number Address: /f / I` vi y ,I _. f� l �. < .r'�s.',. f!i Signed : t,...f - cr_ p;'.;: r ,. Date: r. Authorized Representative Fnrm na-WWP rn/all c°°u nistrlhntinn: WRITF-Stote DGGS. PINK -Driller. CANARY -Customer ❑ F ❑ C November 16, 1983 Helen Morgan Fanner Realty Inc. 6.917 Old Seward Ffwy Anchora.ae, k -K 99502. Dear Ms. Morgan, wW REQ f In regards to the well drilled for Fejes Development on Lot 6A Block 1 Loma.. Estates, the well log is as follows: Total well. dei th; 801 rasing deE;th; 621 Well yield; 3 GPM Static level; 301 below land surface If you need_ any additd oval information, ;.lease feel free to call. Sincerely yours, Patt iar:�er A:lline Drilling and Enterrrises • Municipality of Anchorage Ori -Site Water.and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-092-22 d SAF Expiration, Gate: —2-C 1. GENERAL INFORMATION Complete legal description Loma Estate Block 1 Lot 6A Location (site address) 17101 Belarde Ave. Anchorage, AK Current Property owner(s) Janel Hayden Day phone Mailing address 17101 Bel arde Ave. Anchorage AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer. i❑ Public Water System ❑ y. WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J l-i�a.J� Waiver Fee $ Date of Payment 6-1-7*09b Date of Payment tilReceipt Number 01266 W a Receipt Number COSA# QWaiver# COVID-19 ' 25% DISCOUNT APPLIED i i j 5. STATEMENT OF INSPECTION BY ENGINEER As certified. by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name.of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 F Engineer's Printed Name KENNETH M. DUFFUS Date �G/2J Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water. usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, E ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 0 ` Z �/���(j 10, 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. aFP to r,nE2' ,t;'s rpt System #2 Approved for bedrooms. Disapproved. pal• 3gI0Zr�`� Conditional approval for bedrooms, with the following stip ►`� lOF r/r j1�a� I•IC \NATER PND ST. VUA '.v; o J rr�� yJ a J1J/i ©a OPK-. !VT SE 1...,..( % Original Certificate Date:�'� { The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA).based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the.State of Alaska_ The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10.12.doc Legal Description: e Loma Estates Block 1 Lot 6A If more than 1 septic system on tot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 8/10/83 Total depth 80 ft Cased to 62 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 25 in. Date of flow test for COSA 4/23/20 Static water level at beginning of test 59 ft. Comments B. TANK DATA Age of tank(s) 11 years Tank type/material Step/Steel Measured operating fluid level in septic tank 49" Standpipes/foundation cleanout per record drawing Date of pumping 4/24/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/12/09 ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade ft (min) N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: Structure served by this system 1 020-092-22 Well production at time of test 1.5 qpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes Nc ❑ Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 4/23/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 4/23/20 Results ZPass For 3 bedrooms Fluid depth prior to test . 0 in Water added 450 gal New depth 0 in Elapsed time 1 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'0 Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ❑ Yes if No 80'* ft Property Line > 5' V1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ❑ Yes if No 80'* ft F. ENGINEER'S COMMENTS *Waiver approved 5/4/2009 WR#090018 G. ENGINEER'S CERTIFICATION �� .OF " ! certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with, we4iia aut n�[ai't Htw MOA COSA guidelines in effect on this date. lux.. A C 7116 rN�*' R td COSA Checklist yellow sheet A ^UfNOAnP MUNICIVALI t Y Ur In Phone- ate T-?,4_"'7cI1O4 Deve1opment Services Department On -Site Vqatel & ipastewaterqectfbrl Fax: 907 rCC4 lift Stat o n I p Va L I It Maintenanee Loig Strp-eL Add rpss:_j, *1 tL�_L, owner— egat Desc. PID_ -81ud,ge _LL.inrtje� -ioumping- rN-, uir,,e.o -Pumping corm --urip basket cle�,arwl _Efgvj��nt filter d'eaned -Propprtlba'LsettinCr-$,cogAfirmed ._C7,Gntroj floats r-,Ieaned -ODeratjon sajjisfactory -D ciic r -Audibie and visual alarminside electrical alarm c-.ircui k )Lgll�l /* ,kiarm sy8t,.- L S,t1,,_ -.,m o -pe -ration 1T9 X <z,roLr,d Arater inVUSiOri at risp_r `to "Lank connection Y -e-5 �eq.' erle-Va.- ti A41, Aep hoio function e Tlv� .Gfo,und Water intrusion around -PiPe 'P;R OrIS pro-oerly Secumd -manhole lid: Functior-al 11 Insulated All mquired 7ri5r,,cctiOns and maintenance completed ........... ........... .................... 11 .......... .......... - .......... ........ Ti_ -3h ri ician C, o M P a L -)ate. ofk Municipality of Anchorage 1�1'�pp4E B4/ Development Services Department Building Safety Division z On -Site Water and Wastewater Program a SjA ETI 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. O'ZO -092- 2t COSA # to' (2 Expiration Date: / �1_ 1. GENERAL INFORMATION Complete legal description l.of dA, G lociq A, 1, /w Location (site address) 17101 f3elav'cre A--L,cnue Current Property .owner(s) 11,1<,e t V r ll Roti e 4 Day phone 2 2 2 -1 BD'6 Mailing address 1-710f t3 e lefrcle Aire AnC4.1, All< 995 1'K Lending agency Day phone Mailing address Real Estate Agent DCAle Wir)Aari lie "C'% Day phone 727- 3YG0 - Mailing -Address Unless otherwise requested, COSA will be held by DSD for pickup. P l ~0 &2,0 D a—e yr 2. NU.MBEROFBEDROOMS: 3 e_mc,;j him F wondsor67 1*Jka,net wtien Co -(A ;j re, - -41 J6 0&� cP 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 191 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site 191 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for.the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation, based on procedures outlined in the Certificate of 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 FfuEko Tech n; ec I Se rviri Phone 3 ,YS- 13 CS - Address S - Address J1 -1S34 Fctia Cc,.,�r,., ,Rc(�h . Rk 99s -Id, Engineer's Printed Name _ _ThPodb2' i-. rt oo re Date 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Date: q - % D-' % 2 (Rev. 11105) Municipality of Anchorage 41-111, Development Services DepartmentBuilding Safety DivisionOn-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: il.af 4rh WIT 1, /,em,* l=s 1b /w Parcel ID: 0 20 -4v9 Z - 7- A. A. WELL DATA Well type P vl If A, B, or C provide PWSID # 1, • A, Well Log (Y/N) Y Date completed_* /-16 / 83 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth FSU ft. Cased to-j6 2 ft. Casing height (above ground) ?.'I in. FROM WELL LOG AT INSPECTION Date of test 8110103 a / 19/ 201 / Static water level 30 ft. 59 ft. Well production 3 g.p.m. J. 2 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 40, t mg/L Collected by: rIPA/aP Teti S�-e Arsenic: S' ug/L date of sample: ff/ Zo/ + Z B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP / S/-ee/ Date installed 6 / 2 /G 9 Tank size J ZSO gal. Number of Compartments 2 Cleanouts (YIN) `r Foundation deanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping B/3a/2alZ Pumper A+ A6,"a Sae-g",~ C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) 0.7 4`r System type 660'� Length H3 ft. Width S ft. Gravel below pipe ®+ ft. Total depth 3. S ft. Eff. absorption area�Eft2 Monitoring tube `r Depression over field _I/ Date of adequacy test 911912401 Results (Pass/Fail) 7pFor 43 bedrooms Fluid depth in absorption field before test - in. Water added 1AV gal. New depth '2 in. Elapsed Time: 0 min. Final fluid depth /1- in. Absorption rate >= KJ'l g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) JV If yes, give date D. LIFT STATION (zn h'�'J z'1 in STEP )rtn k� Date installed d12-109 Size in gallons Q 2Sd "Pump on" level at"`J in. "Pump off" level at 't0 in. Datum 130 HOm Cycles tested 2 -)- E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at `t 7 in. Meets alarm & circuit requirements? 7r Septic tank/lift station on lot 105" On adjacent lots > IGG ' Absorption field on lot 1491 ' On adjacent lots 1106 ' Public sewer main V. A. Public sewer manhole/cleanout N �, Sewer /septic service line > 25" Holding tank W A•. Animal containment areas IJOnt -6-0 Manure/animal excrete storage areas Nb^ r / 00 , t�? Ar SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1-4 Property line 415 Absorption field �> C' Water main rJ..4. Water service line '> 10' Surface watery e0 Wells on adjacent lots > 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 23' Building foundation 20 Water main 1✓. A. Water Service line > r o ' Surface water 8 O Driveway, parking/vehicle storage ti '' 6 Curtain drain JV&A& SOOn Wells on adjacent lots� 1001 F. COMMENTS WR o90lir 6 a�/rst�✓vim Pd' se/�arc.f+c :, �'• `CtF AP G. ENGINEER'S CERTIFICATIONR °"_` °•' ! ............ cern.fy that l have determined throughP field inspections and `� raw000s�a review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 1 X ;, , 0 T RODORE F. MOORE Engineer's Printed Name ! ew 4& Pe r'ra C, --ea �4a'" C 3589 Date 6134P / 20 l Z f' y COSA Fee $ 'l9O =a Date of Payment 41 (4 112 Receipt Number (Rev. 4/10) Waiver Fee $ Date of Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 d 1 o lv,55 l 71 eft: Y✓�, �t s s. �.. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O 2O —09 2 ^ 22 COSA # 09 022$ Expiration Date: 1. GENERAL INFORMATION Complete legal description C.of 6'+ S &C-1 ' / Lon+a Erise F+� Community On-site ❑ 1p Location (site address) t'7 10( 3!lar,o,14f /4&-e Current Property owner(s) _(any Z�nPl+ Day phone 7 Y6 ^ 4>VB&— Mailing address Lending agency Mailing address Real Estate Agent f�s•t�f /3eleti-e% Aver �4��g�. A -k 9eSf� Day phone mac; f %�lul7 Mrke RavDay phone 960 — 19 ycf Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. P lit�OYBS- w4en COLA u 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site R3 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of 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 F/aF le4 Tictintcc./ Phone 3 YS*- 17S-S"17S-S"Address _ � x/-530 poke fa-,yc n ��,e�v«y I?-/- �}�rcko�a+yQ / 99s/C Engineer's Printed Name _ �+[�cQo7 7= -+ao.r Date _J.+y 90 2009 5. DSD SI ATURE Approved for bedrooms. Disapproved. .. • Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 7-2-3-09 (Rev 1INS) Municipality of Anchorage y , Development Services Department , Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 4,a t S*A, J3/0CL 1 1.00-8 Emdrl tV Parcel ID: 0 2-0 - 092 -2 Z A. WELL DATA Well type -Lv-#'- If A, B, or C provide PWSID # Datecompleted 8/10/63 Sanitaryseal (YIN) Y Total depth4ill ft. Cased to 62. ft. FROM WELL LOG Date of test F. I r o 163 Static water level 30 ft. Well production 3 9 p m• WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate <o. r mg/L Arsenic: < S ug/L date of sample: 6/2 / 09 B. SEPTICIHOLDING TANK DATA Tank Type/Material STEP / Shit I Tank size 12-541 gal. Number of Compartments 3 Well Log (YIN) Y Wires properly protected (YIN) Casing height (above ground) l F in. AT INSPECTION �/rz/o9 1. $ g.p.m. Other bacteria 0 colonies/100 mL Collected by: Flaf&r Tut+ Date installed 6 IV /4c�9 Cleanouts(Y/N) Foundation cleanout (YIN) Y Depression over tank (YIN) L High water alarm (YIN) Y Date of pumping N.A. C N a w) Pumper N d C. ABSORPTION FIELD DATA Date installed / 0 Soil rating (g.p.dAe or ft2lbdrm) i9-7qz10W'L System type (lea/ Length H 3 ft. Width IS-ft. �s ' Gravel below pipe GS ft. Total depth _!�_ ft. Eff. absorption area yS fe Monitoring tube Y Depression over field " Date of adequacy lest Nee. Results (Pass/Fail) Poor For 3 bedrooms Fluid depth in absorption field before test d in. Water added_ gal. New depthrL in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= HSIy g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) IJ If yes, give date N. 4 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at_ in. 'Pump off" level at —in. High water alarm level at in. Datum Cycles tested Meets alarm d circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 105' On adjacent lots > too, Absorption field on lot for' Public sewer main N. A. Sewer /septic service line 2 S' On adjacent lots > roo Public sewer manhole/cleanout V. A,. Holding tank N• A, Animal containment areas N. A•. Manure/animal excrete storage areas P -A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 12.0 Property line A167, Absorption field > S ' Water main N - A. Water service line 7!> io' Surface water 60 Welts on adjacent lots ? too SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 123, r Building foundation 2oWater main ". A.. Water Service line �> co ' Surface water 640, Driveway, parking/vehicle storage S 'r Curtain drain _None Sero Wells on adjacent lots > toa F. COMMENTS G. ENGINEER'S CERTIFICATION tritt �•�r•••.............i.« 1 certify 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. T''co�ov: F. ""O,R ` t Engineer's Printed Name T11e�G2vvte r-, r-rdo , . �r.-:��'• Date Su �y 9, Zaa 9 "' nc. COSA Fee $ V90 = Date of Payment r, q 9 G Receipt Number Q9 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ti� rR9c F� •nr "Q F )T 6A Lift Station x d�) _20.2 TGF, 0 HOUSE 'RoC wo. LOT 5 O.i 51.5 OD a i L4 1 1 D ' 1 1 I 1 i > 10' x 30' ANCHOR I- EASEMENT flj VN •, LOT 7 c' i \ l NOTE: THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. Lead Description: Ordered Br. Gary Joseph AS -BUILT Legend: Lot 6A, Block 1, Septic Standpipe QS Asphalt Water Wen Q Concrete Loma Estates Subdivision Fence—X—X— ;ave hang tl;:;: �Wocd Deck— SURVEY C s shown his droN has conducted o Dhyshe survey o/ the Property as eon wn on tale drawing and ines and that cr Improvements situated thereon we within the property lines and no anoroachmenls exist other than noted. EXCLUSIONARY NOTE: It is the owners' responsibility to determine the LAND do CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS existence of any easements, covenants, restrictions or right-of-way 440 West Benson Boulevard, Suite 200 Phone: 562-5291 takings which do not appear on the recorded subdivision plot. Under no circumstances should any data hereon be used for construction, Anchorage, Alaska 99503 Fax: 561-6626 for establishing property Imes, or for plot—pion purposes. Plat: 79-225 cru: 3337 Date: June 18, 2009 Drown Br CB Work Order. 2009—L-84 Ree 98-L-403 scale: 1'-50' Checked By. JMZ SCS RAN Client Name Project Name/# Client Sample ID hlatrix Sample Remarks: 1092360001 Flattop Technical Srv. L.6A,D I,L.oma Estates L.6A,B 1,Loma Estates Drinking Water Printed Dateffime Collected Datclfime Received DatefFime Technical Director 06/12/2009 10:58 06/02/2009 12:30 06/022009 13:50 Stephen G F:de Allowable Prep Analysis Parameter Results PQL Units Mcthod Cbmtaincr ID Limits Date Date [nit Metals by ICP/M3 Arsenic ND 5.00 uF/L L:P200.8 C (<10) 06/08/09 06111/09 NRB Waters Department Total Nitrate(Nitrite-N Microbiology Laboratory Colcmy Count Total Coliform Fecal Coliform 2 of ND 0.100 m8/L SM20450ONO3-F D (<10) 06/10/09 LCE, 0 cot/100mL SM20922211 A (Q00) 06/02109 DLC 0 coU100ml. SM20922211 A (<I) 06/02/09 DLC 0 col/IOOml. SM209222B A (<I) 06/02/09 DLC MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 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. # 0 �� ci } — A �Ly HAA # ^i \A 11.. f_L, `1 1. GENERAL INFORMATION Complete legal description Lot GA; B.Zock 1; Loma Ess Location (site address or directions) 17101 Betarde Anchorage, AK Property owner Matthew Ke Uer Day phone 345-9200 Mailing address 17101 Betarde Anchorage.. AK 99511 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 S & S ENGINEERING 17034 Eagle River Loop Road No. Address Engineer's signature 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments By: al1TIC Phone 6c1+-/ — a)- c, 7 `) Date 3/ .,10/ 9c 34�Cr I r �t n � � T✓ ROBERT C. CO`A'AN r <,''•, CE - 8901 Fj bedrooms, with the following stipulations: Date 4 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 orderto 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 engineers work. 72-025 (Rev. 1/91) Back MOA k21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 MUNICIPAI.IIY 4F AN(;HU GE ENVIR®NMF.N-rAL SFRVICES DIVISION Legal Description: Le .7— 6 4 A. WELL DATA Welltype P00411.r6 Log present (Y)N) i &S r Total depth Y 0 Sanitary seal &N) Y 6s Health Authority Approval Checklist !--A, ,h 2 0 1-996 OL -0 ci- ( L 6 MA- 51A Parcel 1. D.: © a, 0 R E� If A, B, or C. attach ADEC letter. ADEC water system number Date completed g /7C / $3 Cased to FROM WELL LOG Date of test 110 / $ 3 I Static water level '30 Well production WATER SAMPLE RESULTS: 3 g.p.m. Casing height (above ground) Wires properly protected (Y)N) _ AT INSPECTION -3 SG z 1.9 g.p.m. Coliform Q Nitrate 0. 1 Other bacteria U Date of sample: 3 Collected by: S & S ENGINEERING 4 Eagle River Loop Road No. 204 B. EPTIC OLDING TANK DATA Eagle River, Alaska 99577 Date installed 7 1 r)- 3 Tank size Number of Compartments Cleanouts IN) Yf S Foundation cleanout ON y/a S Depression (Yo N 0 High water alarm (Y4 ti � Date of Pumping _311 / 3 i 6 Pumper 4+ 1145, g l ¢ e v` c4' S C. ABSORPTION FIELD DATA Date installed -7 `; .1 Soil rating (g.p.d./ft2 or ft2/bdrm' /co System type Length 30 Width ).S- Gravel thickness below pipe 0 - S— Total depth Effective absorption area �'/ S0 Monitoring Tube present(Y%N) Y -s Depression over field (YO " o Date of adequacy test 3 // 6-/1 6 Results(Pass- ail) Pd YJ For 3 bedrooms Fluid depth in absorption field before test (in.); 1 Immediately after S-63gal. water added (in.):._�? Fluid depth t) a (ins.) Minutes later: 16 Absorption rate = 700 .+ g.p.d. Peroxide treatment (past 12 months) (YIN) tv 0,`c K No w t-' If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level, *Datum "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Se fi holding tank on lot /00 r On adjacent lots Absorption field on lot / U G t a ; On adjacent lots / 0 U Public sewer main !v A Public sewer manhole/cleanout A.1 Sewer /septic service line g 0 4- Lift station V SEPARATION DISTANCES FROM SEP'T`IC HOLDING TANK ON LOT TO: Building foundation Property line zil7 / Absorption field O Water main/servicc line 3 0 Surface water/drainage +� 0 _ Wells on adjacent lots _ w P 41 y Doo 3 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation a V r -f' Water main/service line S U Surface water S-1 Driveway, parking/vehicle storage area S Curtain drain Jyo ✓fit kw o w ,J Wells on adjacent lots / 0 G r -I— Property line l0 F. ENGINEER'S CERTIFICATION / certtJi) that have determined thru field inspections and revie+v of Llunicipai records that (far uinzrt��t�ytems are in con%ormance +vith /OA I��,d guide[i es in effect on this date. Signature Engineer's Name 0 t✓ 9.✓ ;" 1 g a.......... Date 3 / u�-U / � � t� ROBE�Ct CO��,�_ WAN t Q 3p `c '••� CC - 8801 .. HAA Fee $ Date of Payment �/2 oil? 6 Receipt Number / ZD Z— r6 P6 Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH a 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. # HAA # 1. GENERAL INFORMATION Complete legal description Lof �i4v ��� c amu Es /uf�r 2. Location (site address or directions) 17101 gelarore ,4ye17cc.e Property owner l rimes Pr c Ifct r'O< Day phone 5_6/ " Z Z 10 Mailing address 5'08A�chorcrvP Ak 49S03 Lending agency Afa/ITu"" 1-to/ay,0 -- Day phone 26/ -3X00 Mailing address P-19, 612 / 6BS i4ncho�a p Ak 99s-19 Agent _91.ee,f?e,- Ree? /! Day phone 3�W-2S0/ Address 600 ' Dn2o/wC 13Ic.d* i`nc%1cr'arjp /4� 99S 1S Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3,4 3. TYPE OF WATER SUPPLY: 4. Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 5. STATEMENT .OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from -my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. f�a (vee r1e9u uY ai/trcti co{ Name of Firm Flu( -foo TeC%lneca/ SPrv;eei Phone 31gs-- 13s'S Address /yS30 6c ho S)l A-hch0rag2 Alc 99V,5� Engineer's signature Date 99 y �r ' 01,A4%c, 10 THEODORE K AAOORE J aid CE - 3589•�.•� �� •�....•.• O A 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments BY: Date 2 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. 1/91) Beck MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Black 3 Legal Description: LOT 6 A A LpmA ESTATES Parcel I.D. A. Well Data Well type PR) /ATE If A, B, or C, attach ADEC letter. ADEC water system number N.A. Log present (Y/N) , y Date completed A 110 / $3 Driller ALPINE Total depth 20 / Cased to (02 Casing height I Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Wires properly protected (Y/N) FROM WELL LOG 9,643 _S -9-P.M. AT INSPECTION 113/7g RECEIVED 56 I, g.p. M. JAN 121994 Municipality of Anchorage So Wept. f leaith & Human:Services SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I oti' ; On adjacent lots > loo r Absorption field on lot �— 12o` ; On adjacent lots > /oo ` Public sewer main > loo' Public sewer manhole/cleanout Sewer service line g0' Petroleum tank No N E O l35 EP VE D WATER SAMPLE RESULTS: Coliform O ce I //Gam.0 Nitrate G 0. In /-� Other bacteria none r2�or fr 4 Date of sample: i I3Igti Collected by: FIATTOP TECH SVCS. B. SEPTIC/HOLDING TANK DATA Date installed -7183 Tank size /000 GAt Compartments Cleanouts (Y/N) 2 Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) NA Alarm tested (Y/N) N.A. . Date of pumping S/18/93 Pumper OCD MC'DOMAtb5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot JD 14 On adjacent lots 5 100 ` To property line 1 So' Absorption field ` Surface water/drainage Zo ` �c waiver rnc�ut8t a�c%,eoC 72-026 (3/93)' Front Foundation Water main/service line Z 6o CONTINUED ON BACK PAGE C. LIFT STATION N. /I-. Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" Level at Cycles tested foo Fez/aa2n Surface water Date installed -zh 3 Soil rating (GPD/Ft2) 1. S SPD/ F0 System type 13 E D Length 3o Width is- Gravel thickness 11 Total depth If 4 - Total Total absorption area 1450 Ftz Cleanout present (Y/N) Date of adequacy test 1 13 ( q Results (pass/fail) Water level in absorption field before test 6 " v, c• o. Peroxide treatment (past 12 months) (Y/N) No wE XNowN SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Depression over field (Y/N) N Pa..cc for KA r test all ,n e. u, If yes, give date N.A• Well on lot - I20 On adjacent lots ';;, /'Do Property line � So To building foundation 2s To existing or abandoned system on lot N, A, On adjacent lots > /bo ' Cutbank NA • Water main/service line z So Surface water` S/ Driveway, parking/vehicle storage area 3 0 Curtaindrain NouE OQSERvED )4 WC%1vE✓ i^ercterF cYf-/uc6eA< E. ENGINEER'S CERTIFICATION Bedrooms t certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on th6-dategf this inspection. ;4 / Fi v uno Signature Engineer's Name Thcaaeore t= rtaore Date 7 -aa "a r v M HAA Fee $ 30© DCS Waiver Fee $ 98 Oy Date of Payment 1 -12 - Receipt 17 Receipt Number 5-Y Date of Payment -% Receipt Number 7 _T M� Muniipality of Ancii►orage Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 February 2, 1994 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 6A Block 1 Loma Estates Subdivision Waiver Request #WR940003, PID #020-092-221 HA940021 Dear Mr. Moore: Your request for a waiver(s) of the required 100 foot horizontal separation of a septic system to the surface water has been approved. The approved separation distance(s) are an absorption field to the surfa.cA water of 51 feet. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljm:#5 Concur: 'hn Sm th,4P.. rogram Manager On-site Services ' Aw Y't4..�Ti� ♦ 141,1 .` 4, r t- MUNICIPALITY OF ANCHORAGn Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR940003 PID# 020-092-22 HA# HA940021 Permit #_ Date Received: January 12, 1994 Legal Description: Lot 6A Block 1 Loma Estates Subdivision Engineer: Ted Moore, P.E., Flattop Technical Services 14530 Echo Street, Anchoage, Alaska 99516 Applicant: Wes Pickard Waiver Requested: Absorption feild to surface water of 51 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: i\ Waiver is NOT Granted: List Conditions or Reasons for above: Date: Z - �� By Rec #: 25575/1991 Amount: $_920.00 of Reviewer Date Paid: 1-12-94 I G -s I^/�1VFl� i? q UE 57- FGR LOT < I L 014,4 FST wiglvF,:R PiFQttFsr /vu118F-1� wl?9 0403 W41VF-I? >3kQULSsT FOR 27EP rYo'E t9g,SOXRr/a.V M sYsTEi7 Ta Iq n614D P/TC/-/ WITH SuRFRCF Ruovoff OF Sl FEi T. —?GtgFt9-CC- wArFR 0�rR THE Su/7Fft66 I�.FFTFR /AI QVtEST�ov />/?0019eG l' p/a NOT f --Y" r WWW W l I vN TK A PR,4IA, F1 b L 0 I Q u t: S rloA-` f v {ffS C D NS 7'k? H t T/_',D /N T u Y G coo SlTE VIS/ T Otv FEB on 6 T� i%fty OF C�0 � f TE�FER't4Ture�S� IT wrgr aorFr✓J VFR}� v o y�i1� wt�T�R w19S Ru1vv/a& /N Tat•,�1rCH �� TEt/Pau4a rk� J r'Q° CUt-Vt, 1. L wbuLO P/iVF F-kPFCT,=p M kCN ManF_ 61v-rAi 7Th Z W F /9-T'14 E /? C v N 017-1 C S. Er /S tit a t°1 N r o.+- Tt4�1 T 71 -elf 17-6 DOTS A --(p7- C1�RR y was rt y". ff �Routi/�. P/?aQ.�tpt y w►�ir=rQ Awa RJ9-1•dr7-01?.M PRI---t�n1t Y P S F P71C PITA- -- ! !dE SEPT/(SYSrem IS 1} QED % Y1°E rkpT 1 f 3. J` rPt6= 680LANO rui?F1+6F-. %HE DEP ELTIO.-1 19'N>7 fFlo "c Tnlvk djFP7-14 1/-1?F SUCH THOF /F TKr 9FD Folks TKEfl TH6 t"' )9-t rr u.'>3- rF K k. ou L d b?AC e u p / A. T o Ti-r,E )VOtt S E RAt THF THEN pAY4/6H7-11u& 6AI ri-eE 61?ou1,a SoRF19C,E. /- v, l3 SSu/19�L TI-I/¢r Tr/� SurQFr/c� wl�r61? /� l�u�ST1a•v tv1LL NOT QF (0A�TAM IJv/3TEfD SEt°rlc TRI -k ErFLiwAFtiT. P CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345-1355 January 11, 1994 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519-6650 Dear Sirs: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 By means of this letter we are requesting issuance of a waiver allowing the existing soil absorption system serving the 3 bedroom residence on Lot 6A, Block 1, Loma Estates, located at 17101 Belarde Avenue, to remain 51 feet from surface water instead of the normally required 100 feet. The septic tank is 80 feet away from the surface water. A site plan is enclosed to assist you in your evaluation, along with copies of relevant backup documents and a new HAA application. According to the documents on isle at DHHS the wastewater disposal system was installed in July of 1983 and consists of a 1000 gallon septic tank which discharges effluent into a 15' wide x 30' long soil absorption bed containing 6" of sewer gravel beneath the horizontal distribution pipe, and having an effective absorption area of 450 square feet. On January 3 - 4, 1993 we conducted an adequacy test of the wastewater disposal system. We were unable to locate a monitor tube extending to the bottom of the sewer gravel, however there is a cleanout pipe giving access to the horizontal distribution pipe near the downstream end of the bed. At the start of our test the cleanout contained a trace of water in the invert, and the addition of 890 gallons of water into the bed cleanout pipe over a 25.5 hour period never raised the fluid level in the bed above the invert of the horizontal distribution pipe. Based on this relatively large demonstrated surge capacity we concluded that the system continues to function adequately for a three bedroom residence. At the time of our test the discharge pipe from the tank to the soil absorption bed was partially clogged, so we requested the homeowner to have this line replaced. This was done by Carl's Excavating, and included the installation of a double cleanout downstream of the septic tank. The excavator reported that the sewer gravel beneath the horizontal distribution pipe in the soil absorption bed appeared to be clean and dry. During the course of our adequacy test we discovered a small flow (approximately 5 gpm) of surface water flowing in the roadside drainage ditch paralleling the east side of Davis Road, in the location shown on the site plan. At it closest point the surface water is 54 feet from the cleanout in the soil absorption bed, which makes it approximately 51 feet from the corner of the bed. Since this water was observed to be flowing on the surface of the ground in January, it appears to meet the definition of surface water; thus a waiver of the normally required 100 foot separation distance is required. The overall slope of the lot is downwards towards the west at an average of approximately 15 %. The soil absorption bed is constructed on a relatively well drained rise of ground slightly above the general topography. There is a swale beginning a few feet west of the bed which slopes downwards at 30% towards the point where the roadside ditch enters a culvert and passes under Davis Road. We calculated that the elevation of the surface water at this point is approximately 14 feet lower than the bottom of the soil absorption bed, so there is no indication of a problem with the required 4 foot vertical separation requirement from groundwater. We suspect that the surface water in the roadside ditch would not be surface water, were it not for the fact that the ditch was cut into the subsoil to promote better drainage for the road. At the time the bed was installed the inspecting engineer rated the receiving soils directly under the bed at 100 square feet per bedroom (which may account for its continued ability to accept septic tank effluent at an adequate rate). The original soils log prepared in September of 1982 classified the underlying soils down to 13 feet as GM with a measured perc rate of 20 minutes per inch. This material should provide good filtration of the effluent as it passes through the ground. The wastewater disposal system is installed at a shallow depth, with the ground surface over the soil absorption bed being slightly higher than over the septic tank. This means that should the system fail and effluent flow onto the surface of the ground, it would probably do so in the vicinity of the septic tank rather than over the bed. This would increase the length of the surface flow path to the roadside ditch to approximately 80 feet. The yard area over the wastewater disposal system is maintained as lawn, and it is difficult to conceive of a situation wherein the property owner would not be immediately aware of an effluent daylighting problem, or would allow effluent to daylight so close to his residence. Furthermore, it has been our experience that effluent daylighting from failing septic systems is usually reabsorbed within a short distance. Thus, for the above reasons, we feel the requested waiver can be safely granted without undue concern as to contamination of the water in the roadside ditch by surfacing effluent from the subject septic system. Please give me a call if you have any questions on this submittal. Sincerely, Ted Moore, P.E. LOT 6, BLOCK 3 LOT 10, BLOCK 3 / / / / 1 LOT 11, BLOCK 3 LOT 4, BLOCK 1 A "`�pesxaaaaaaa. O / / 1 � �• P Pi t ` � Irt [ a 30% J+PQRa Le PPac Pa.Pe P1.I POc� / Q SOIL ABS.: 3 / 0 ` ED l id PeesP Pea ea asP C.O. ' �� ' e THEODORE F. FAOORE / 10% ' C E 0039 LOT 6A, �s% ; v,'ura e`PPPPPa.e \ / BLOCK 1 0 10o0GAL. LOT 5, �rYPM"z SEPTIC TANK BLOCK 1+�' \\\// H8CDEOOM `�` VACANT \LOT CL + , \\ p - DRIVEWAY i SEPTIC SYSTEM , \ o LOT 4, ' ' 1 L BLOCK \\ F�G� WELL \ LOT 7, \ BLOCK 1 o \ 10% SEPTIC SYSTEM WELL LOT 5, BLOCK 2 HOUSE 20 0 20 40 60 80 100 FEET LOT 6A, BLK 1, LOMA EST. WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH= 60 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 JANUARY, 1994 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES II CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�19 OF ON-SITE SEWER AND WATER FACILITY f1 y3oa - 3aa7a 264-4744 �ZD—O l2�-Z 2 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) (o A 8K! kok- \ P.sTAi � Location (address or directions) 17101 i3,_ 1a4Cfe (b) Property Owner iDalziJI iieDouue(/ Telephone: Home IV,,S-3!1d6 Business 56Y-5-j'O'7 Mailing Address (c) Lending Institution li0'w a F,111—L Telephone Mailing Address (d) Real Estate Company and Agent tau lZo Address I 3 2m )- Telephone`J (' 3 5 u� (e) Mail the HAA to the following address: or: Check here Y if hold for pick up. List contact person and day phone number below. 6_ 2. TYPE OF RESIDENCE Single -Family Number of Bedroomsr_ 3. WATER SUPPLY Individual Well K Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 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 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 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 d b Telephone a �} - 3 07! 6 Address X03 �J Date 2 b q P� o< i� ')Engineer's Seal 6. DHHS APPROVAL p D Approved for TAT bedrooms by Date Approved Z/X/_, Disapproved Conditional Terms of Conditional Approval dhhs 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 theirlending 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 iaev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION ,SLP - 2 1988 RECEIVED Legal Description:LCT GA Ptl-' ) LO Irl A VZST AT E S E A. WELL DATA Well Classification R'GS If A, B, C, D.E.C. Approved (Y/N) N/A Well Log Present (Y/N) _— Date Completed -fid ` 9-S Yield .2. 5 Total Depth A 10 Cased to (a Z Depth of Grouting �d Nd~ Static Water Level S y Pump Set At O Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /o -S ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot __(._10 ; On Adjoining Lots � ! To Nearest Public Sewer Line h(O'Nt-` To Nearest Public Sewer Cleanout/Manhole Q 0ty to To Nearest Sewer Service Line on Lot 7 �a Water Sample Collected by r S ; Date '19A Water Sample Test Results o c CoZI N D Q I �r��2S Comments B. SEPTIC/HOLDING TANK DATA Date Installedwl3 Size �� ® No. of Compartments T ULD Standpipes (Y/N) LY/y Air -tight Caps (Y/N) Foundation Cleanout (Y/N) —7y— Depression Depression over Tank (Y/N) t�l Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N/%A ; for N Holding Tank High -Water Alarm (Y/N) K/A Temporary Holding Tank Permit (Y/N) �A Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation To Property Line > r c� To Disposal Field 511 - To 11 - To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course C> 14C Comments Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1 0'0 Type of System Design 8 F_ b Date InstalledLength of Field C.) m i Width of Field 1 5 Depth of Field Gravel Bed Thickness / 9 - Square Square Feet of Absorption Area Standpipes Present (Y/N) © M Depression over Field (Y/N) Date of Last Adequacy Test 9/.;;.51g; 6 Results of Last Adequacy Test- S Z -:Aa P, Es Z3 14Z lf� A2 00 iKs Separation Distance from Absorption Field: To Water -Supply Well r/ n To Property Line To Building Foundation /f =� To Existing or Abandoned System on A/ Lot ' �` O fYA= On Adjoining Lots > -6 Dn To Water Main/Service Line > /© To Cutbank (if present) r Y o N/4 To Stream/Pond/Lake/or Major Drainage Course (9 N 4E To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION t Y ©rY Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at " Check Permitted Bedroom Rating Against HAA Request " Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all OA/and HAA guidelines in effect on the date of this inspection. Signed � DateIF Company MOA No. Receipt No. 2 Q� - �� �� Date of Payment 2 - Amount: $ 117e 00 Page 2 of 2 72-026 (Rev 8/861 Back Engineer's Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�� OF ON-SITE SEWER AND WATER FACILITY 264-4720 / / Application Date l � 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) i31ac /101-1-4CS7<aAIX , Location (address or directions) �%//^ (b) Applicant Name '%`/� � -f% e�� Telephone: Home '37�fK4 Businesss Y_S j�' Applicant Address •(c) Applicant is (check one):. Lending Institution ❑ ; Owner/builder ❑ ; BuyerZ ; Other ❑ (explain); - (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address 3 ZC/ C 51y-1 o `I `rT 3 Telephone 9__ "? —Sr e C (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms i 3. WATER SUPPLY Individual Well,` Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 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. 72-025 (11/84) Page 1 of 2 (Veil t) geo-ZL Z 10 Z abed ->IaoiA s,aaaui6ua euolssaloid 9y1 uI suolsslwo ao saoaaa aol elglsuodsaa jou sI a6eaogouy to 41lledlolunn a141 panssl si aleo!1luao e aaolaq elep azAieue ao suoiloadsul lonpuoo lou op d3H(] to saa (oldw3 •sluawaimbai ales pue Ieaapal uleuao Alslles of aapio ul suoilnipsul 6ulpual alayl pue sawoy to siaseyoind of Asaunoo a se slyl saop d3Ha ayl T>lsely to alels aq> ul paaalsi6aa Jaaul6ua Ieuolssaload luapuadapul ue Aq anoge g ydeaBeaed uI uaA16 suolleluasaidai ayl uodn Illolos poseq saleollllaao enoaddV AI!Aoylny y11eaH sanssi (d3H(]) uolloaload Ieluawu0J1Au3 pue 141Ie8H to luawlieda(] a6eaoyouy to A1ljedlounw ayl NOIlf1VO lenoaddy IeuolllpuoO to swaal IeuoillpuoO panojddesl(] �x panoaddy f �y ale(] (q swooapaqZ97vWV aol panoaddy �r G Com/ IVAOUddVd3Ha '9 4p Np 9~ �`DJ:' tsaz : •ar H1040com; aye +e OIL'(] a z Aa ssaaPPy J '� _ auoydalal7 5 � a Wald to aweN -uolloadsul sly; to alep aqI uo loalla ul suollelnbai pue 'saoueulpio 'sapoo alelS pue Iediolunw Ile yIIM aouelldwoo uI sl walsAs Iesodslp aalemalsvm ao/pue Alddns aalem ails-uo 0141 'uolloadsul pue u011e611sanu1 AW (uoal pue salll a6ea0140uy to AIlled10lunV1 0141 woJI paulelgo uollewaolul ay1 uo paseq 1ey1 AJ!JOA Aegljnl I -uiejeq paleolpul aanlonils to adAl pue swoojpeq to aagwnu ay1 aol alenbape pue leuollounl'ales sl wags (s Iesodslp aalemalsum Ao/pue Alddns aalum a1ls-u0 ayl leyl sMo14s lenoaddy 11uo141ny y11e9H slyl to u0l1e611sanul,(w 1e141 (1!a9A I 'molaq umoys alep uollep!JUA 9y110 se pue olaaay paxllle leas Aw Aq paillljao sy NOIIVVJHOdNI ONV VIVO `HOHV3S 3lld `S1S31 `SNO11O3dSNl ONIOIAOdd VYHld JNIH33NION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) MUCIP HEALTH AUTHORITY APPROVAL (HAA) FNV/RO 144 AllryOF CHECKLIST - FEBRUARY 1984 fNrAL ANSN� 264-4720 ApR 14 J SERV/ R'S10 Legal Description: A. WELL DATA ce/ V Well Classification fD— If A, B, C, D.E.C. Approved (Y/N)�'g Well Log Present( Y�1) Date Completed 11/ /�VK 3 Yield Z. Total Depth v, Cased to Depth of Grouting -4//4 Static Water Level Pump Set At 6l'r Casing Height Above Ground Electrical Wiring in Conduite,/N) Separation Distances from Well: /�Y/ Sanitary Seal on CasingpYN) — Depression Around Wellhead (Y/6l To Septic/Holding Tank on Lot l n ( ; On Adjoining Lots 160 M"" "z r To Nearest Edge of Absorption Field on Lot 47 a / ; On Adjoining Lots To Nearest Public Sewer Line ,114 To Nearest Public Sewer Cleanout/Manhole AIA- To Nearest Sewer Service Line on Lot �A Water Sample Collected by 46:7-C 5 Date Water Sample Test Results Comments k t-'61( -11"a , 7-6; B. SEPTIC/HOLDING TANK DATA Date Installed 7A Ie Size /Ce.J No. of Compartments Standpipes $Y/N) Air -tight Capsdy'/N) Foundation Cleanout &/N) Depression over Tank (Y/Pl Date Last Pumped 2VF'1A 7 L�-- Pumping/Maintenance Contract on File (Y/N) /U IA ; for A�e 4-1-14=Holding Tank High -Water Alarm (Y/N) �- — Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /05/ To Building Foundation To Property Line /�' 57'_ To Disposal Field I To Water Main/Service Line A�Z_/} To Stream, Pond, Lake, or Major Drainage Course �1A_ Comments - Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata //_�-17 '/1141 ' Date Installed Width of Field !/W,J /j- / _ Type of System Design /Y c Length of Field r Depth of Field Gravel Bed Thickness ©.I Square Feet of Absorption Area �n*'h Standpipes PresentAN) Depression over Field (Y/9I Date of Last Adequacy Test r�/gsl Results of Last Adequacy Test fide Separation Distance from Absorption Field: To Water -Supply Well /Z -Z / To Property Line' i To Building Foundation .2 To Existing or Abandoned System on Lot N,// ; On Adjoining Lots To Water Main/Service Line N/A- To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area, Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments / Dimensions Manhole/Access (Y/N) 'Pump O>�el at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I hav ecke�i, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '�� Date •3 ,r Companycs: MOA No. %- OF A4°n�` T csy 1 d o�3 � �� •• �s��� Receipt No.►� o "• Date of Payment Amount: $ Page 2 of 2 72-026 (1 1184) 9*49 TH •� �ee•se•eee• ueee• ••fix na jA"ee eo• o•o.�' •`wroo eke �e44 V a• IEROY C. ID, JR. ee ` CE 2 51 a J .F ALASKA ENVIRONPENTAL CONTROL SERVIC ; INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907)561-5040 JOB - SHEET NO.� OF r' CALCULATED BY DATE CHECKED BY DATE PCO]1?P i `h�lr2. G�. N 01471 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL VIEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date I 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Dry -1-c- 'SC -td � '~ Telephone: Home 3q,5-ZI Business Applicant Address 171 0a OF -1 AS E 600,AL- ft ArNg,'16IKz (c) Applicant is (check one): Lending Institution ® ; Owner/builder; Buyer ® ; Other 0 (explain); (d) Lending Institution Telephone Address - (e) Real Estate Company and Agent % Address A f fl Telephone — // v ) (f) Mail the HAA to the following4ddress: rl 2. TYNE OF RESIDENCE Single -Family 0 Multi --Family ® Other Number of Bedrooms 3. WATER SUPPLY Individual Well K Community ® Public El 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 K Public Cl 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. 72-025 (11Y84)Page 1 of 2 5. ENGINEERING FIRM PRQVIDINu INSPECTIONS, TENS, PILE SEARCH, DA I A 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 systein 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 f 8�„ Telephones+ Addre Date f��)pf °.000 oo 0000��t'�r �OOfr'N U`00 y"GY,0000000}JFOOo 00a° 3 I_ 6. DHEP APPROVAL- Approved PPROVAL- �� ! Approved for /�l'1� bedrooms by Approved,.i Disapproved Conditional -- Terms of Conditioiial Approval — — CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHOR LTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 �At !nn 8 264-4720 �V0 81996 Legal Descriptio` L6A LdMA �c�f��t✓�� n1N Raw 6E�:3 A. WELL DATA RECEIVED Well Classification ' NDIV i o&'#L If A, B, C, D.E.C. Approved (Y/N) / -4 Well Log Present &N) Date Completed '/93 Yield GP/0 Total Depth Cased to 62— N Depth of Grouting A Static Water Level 301 Pump Set At (�;/V &qWM Casing Height Above Ground — Electrical Wiring in Conduit @N) Sanitary Seal on Casing ((DN) Depression Around Wellhead (Y6 Separation Distances from Well: orf ! To Septic/Holding Tank on Lot 1 Oct; On Adjoining Lots 100 To Nearest Edge of Absorption Field on Lot i�Z f ; On Adjoining Lots /+ To Nearest Public Sewer Line �� To Nearest Public Sewer Cleanout/Manhole /Y��— To Nearest Sewer Service Line on Lot/! Water Sample Collected by QEF/- K#aaG�lacK ; Date 7 31M6 Water Sample Test Results S o & y Comments B. SEPTIC/HOLDING TANK DATA Date Installed 1 Size 1OnC) No. of Compartments 7 - Standpipes Standpipes (Y)N) Air -tight Caps I&N) Foundation Cleanout j/N) Depression over Tank (Y/01 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N ; for N� Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N� Separation Distances from Septic/Holding Tank: ! 7` To Water -Supply Well Icy To Building Foundation To Property Line 100/ To Disposal Field To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage Course 11)0 , Comments Page 1 of 2 Bi _SGA SOV ESMTis._5 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 10o Type of System Design F Q Date Installed 7/ -?-1/8S Length of Field 30 i Width of Field I J i Depth of Field 4 Gravel Bed Thickness 0..7 Square Feet of Absorption Area q,0 Standpipes Present (9/N) Depression over Field (YO Date of Last Adequacy Test Results of Last Adequacy Test-5ft7'13644_ ©R Y Separation Distance from Absorption Field: To Water -Supply Well 12-2, To Property Line e©z i To Building Foundation '23 To Existing or Abandoned System on Lot 6(/4 ; On Adjoining Lots 1 cc) To Water Main/Service Line — IVIA- To Cutbank (if present) 61161 To Stream/Pond/Lake/or Major Drainage Course 00 To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off" Leve ent (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I_ have=,_Z�l ied, or conformed to all MPA ar�d HAA guidelines in effect on the date of this inspection Signed �4� Date 7//J,l//�6 Company 0 AEC3 ilVCr MOA No. OF A4 Receipt No.°"'°°••• -9 0 ®moo° •at�,.Q Date of Payment LlG i of �;� 49TH Ag Amount: $ loS".�O G l 10 - i •°�.,;. 4 1fiT`rkllM�vT I WrLL GOC �° g.•°. ®I LE Y C. REID JR Page 2 of 2 d -*2 414W .Si9-IKPt� # 3 -51 re 72-026 (11/84) 40 .'•• CE - 2251 e ®141. 1. General (a) Legal Dese MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Information Application Date (include lot, block, subdivision, s ctionr township, range) Location (address or directions) (b) Applicants Name eleDoz �f ��r� Telephone a Home Business Applicants Address j%/O11/ ? /%ads , +l c,�6 s/' (c) Applicant is (check brie) Lending Institution ; Owner/builder=; Buyer ; Other.. (explain); (d) Lendiagfl,Institution Telephone Address= (e) Real Estate •Co.'&;Agent i Address Telephone (f) Mail the HAA to the following address: Other (describe)_ Public = >_ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite 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 Z] a 1. General (a) Legal Dese MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE Information Application Date (include lot, block, subdivision, s ctionr township, range) Location (address or directions) (b) Applicants Name eleDoz �f ��r� Telephone a Home Business Applicants Address j%/O11/ ? /%ads , +l c,�6 s/' (c) Applicant is (check brie) Lending Institution ; Owner/builder=; Buyer ; Other.. (explain); (d) Lendiagfl,Institution Telephone Address= (e) Real Estate •Co.'&;Agent i Address Telephone (f) Mail the HAA to the following address: Other (describe)_ Public = >_ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite 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 Z] . 'Engineering Firm Providing Insvections, 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 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 regula- tions in effect on the date of this inspection. Name of eVjl ablffs L- fe7e( d Telephone 50- 5 D D Address I 33 44; 4S DateOF .41 -410 p� (ENGINEER SEAL) 0 * 49 ®° DHEP Approval �^� C. Reid. 9r.: w '006 .22511.g Approved for te6,)%ed rooms B ° °mss• a°° �•` /�� � � Approved Disapproved ondit� Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 A, THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA I-EFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER°S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & FNYIRONMENTAL PROTECTION 5 1985 264-4720 E C E I V Legal Description: "��� r"///j 1?_3 A. WELL DATA Well Classification J/ k l/iF/eIf A, B, C, D.E.C. Approved (Y/N) A Well Log Present(UN) Date Completed // /� "�� Yield Total Depth Cased to 6'Depth of Grouting A �' Static Water Level a4 V Pump Se`t At Casing Height Above Ground Sanitary Seal on Casing yN) Electrical Wiring in Conduit 69/N) Depression Around Wellhead (Y(9 Separation Distances from Well: i To Septic/Holding Tank on Lot 1o`f 16x,On Adjoining Lots To Nearest Edge of Absorption Field on Lot //S On Adjoining Lots To Nearest Public Sewer Line A114 To Nearest Public Sewer Cleanout/Manhole N/ To Nearest Sewer Service Line on Lot Water Sample Collected by 3 i '"f ; Date Water Sample Test Results Comments iJ iiu> i ``'/111�R'i� 11 j...&...N, B. SEPTIC/HOLDING TANK DATA Date Installed 1-7/ 3 Size 7C7JO 611rl- No. of Compartments �— Standpipes NN) Air -tight CapsN) Foundation Cleanout(�N) Depression over Tank (Y(N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A/ for f Holding Tank High -Water Alarm (Y/N) hTemporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well //s To Building Foundation To Property Line /0-0 _a To Disposal Field .Y To Water Main/Service Line _A1 ✓ To Stream, Pond, Lake, or Major Drainage Course 6 Comments Page 1 of 2 o• r / 1_0",la Z T- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ye'o 7�AhRfi Type of System Design Date Installed Length of Field501- / �T Width of Field �> Depth of Field ' l Gravel Bed Thickness Square Feet of Absorption Area `/>-() Standpipes Present(yN) Depression over Field (YO Date of Last Adequacy Test Results of Last Adequacy Test YL-Zs7— y� 15Zi> Separation Distance from Absorption Field To Water -Supply Well 1;7 Z - To Property Line ;5'y To Building Foundation '7_3 / To Existing or Abandoned System on Lot o�I/A ; On Adjoining Lots /,:�,o .-�- To Water Main/Service Line A/A4 To Cutbank (if present) 6 To Stream/Pond/Lake/or Major Drainage Course LIM To Driveway, Parking Area, or Vehicle Storage Area :7 c;' ) Comments D. LIFT STATION Date Instal�erh Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at "" Check Permitted Bedroom Rating Against HAA Request'" Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that I hap ,,z ve ified, or conformed to all MOA and HA guidelines in effect on the date of this inspection. Signed `�' —(f G �� Date Company �" �' MOA No. Receipt No. _- k J - 4- Date of Payment` - c Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal 50570 ALASKA O1IUIR0f1 nTRL COWROL SORUINS, InC. 6ngineerinq & 6nuironmentol Studies 9/10/85 PAT — CASE#200-1073 SELLER—HOME EQUITY CERTIFICATION Wt4KIFR%' LW'TER DEPT. OF FlEALTH CHOR P.O. BOX 8026 ENVIRON1AEN7-A PR & A WALNUT CALIFORNIA TECTIO,VL 94546 5 1985 RECEIVED LEGAL:LOMA LOT 6A ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -9/6/85 THE TYPE OF ABSORPTION SYSTEM IS A BED WITH AN AREA OF 450 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 660 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 9/10/85 . FLOW TEST ON WELL WELL FLOW DATE -9/6/854 A FLOW TEST WAS PERFORMED ON THE WELL. 660 GALLONS OF WATER WAS PUMPED AT A RATE OF 2.5 GPM OVER A DURATION OF 5 HOURS. THE DRAWDOWN WAS 24.9 ' WITH A RECOVERY TIME OF 60 MINUTES AND THE STATIC WATER LEVEL WAS 5,1.4 FEET. THE WELL IS ADEQUATE FOR THIS/BEDROOM HOME. 61% OF Ac Reid, !i 2251.8 , __. III — 111 D n. L_.___ 11_.L_ nnrnc_Inn�) Kci anon APPLIC AT FILLS OUT UPPER HALONLY Property Owf'er .i r Phone Mallin Address f / r ✓Gip Code Buyer` - '- ime Address , _. F-" .� /Ji` .� �--- . 44 - Zip Code Time LendingInstitution _� y� f/?.� �i f �s Vii•, Phone Zip Code 'r'� .��/(J Address4,011, �}r �C�. -.r ,-� .` 1 % ....�✓�s, _ Realty Co. & Agent "J , Phone -1 a�tr.-rerl%.f �f Zip Code ���;;; t J Address �`/� '-f- / •.�'�f! �a r` .s Inspector Legal Description y`7 , } �9�t' f -C' _,. p %C < / Inspector Street Location - / t , / '0& % -� Type of Residence ❑ Single Family ❑ Multiple Family No. of Bedrooms Field Notes: I rLn ❑ Other Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. °Individual �(j` For wells drilled prior to that date, give well depth (attach log if available). Community Pb— ® ENVIRO(V`MLNTAL PROTECTION ❑ Public Utility Sewer Disposal (Individual Year Individual Installed: fj Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. C ^ ' �11Ar-(\ �-4ltlfl U Time ime Time Time Date Date Date i Date Q Inspector Inspector Inspector Inspector RO be Field Notes: I rLn �, �i®• AjO W MUNICIPALITY OF ANCHORAGE OF HEP,LTH t: ( M CEPT. I L6. Pb— ® ENVIRO(V`MLNTAL PROTECTION pakw�j- , 1 H a C ^ ' RECEIVED - APPROVED ( ) BEDROOMS - 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size I t o -) e I (-t 3 Well to Tank e tv e r 14 F 19 8' 3 .4ov� D Pejes, *')L-velo, L xwen L. 6917 Old Seward imcho-ragey A,b 59502 Subject: Lot Ut'., j.,JOCK if Lola 6stjteS U Ap,prov-11 for tile ij,jivi(,ju�,,L sewer an' WAter facilitie�! w- (" -lot' - be granted until. k -he following itens hZ-Ive 1)('e" c0jiltdet"d; ik well log ,;];.nnitteda to this of -ice for our- files Irid -C(! vi Ow. Include dopth of Casilligs. ..A0 The If-ga I for tb,--3 soi Is -and periA B" whi I tile J -his discrepancy. PfAication is for L6, i3l; please cor�-Oct U 13,10,Ase, jj(Dtify t1jis tl)epartment for a reinspection wilc-ni t110 ,joted discrepanCies h -Ave, been corrected. If there are anv further questions, pl"-,;Ase call this office Zlt 9' -4720'. sincere Iv f tory Allisr Al -f-3. ;w.t,-Lng Sevier & 'A'Itz-r Program ixia.-nagor r,� 13 / e j / E I
