Loading...
HomeMy WebLinkAboutMACBETH BLK 2 LT 4Macbeth. Block 2 Lot 4 #015-511-03 a Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Perm(t Number: sw ,A U7,2.+6 PID Number: 015511027 Name: :PAUL- 110 t _ so14/v Wastewater System: New ❑ Upgrade Address: ABSORPTION FIELD Phone: Z43-- - No. of Bedrooms:--� - p Deep Trench Ahallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: • GPD/Sq. Ft. 4-9 Lot: Block: Sub 4 ivisi0n: - Depth to pipe bottom from original grade: Gravel depth beneath pipe `. Ft ?. lyk —!F- Ft. 4 Township: Range: Section: Fill added above original grade: Gravel length: o_y Ft. /7q- Ft. WELL ew C3 Upgrade ' GraveLCyM:W/0714% ` Number of lines: Distance between lines: - .%v S Ft.'21— — /9 Ft. Classification( rivate, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: _ 3 +> 3 F� Orel, Ft. 1Z7-3 Ft. / 714v> 'SQ. Ft. /a— rl' ' !r+ �• 74! Drilla :^ 44�/A/4e Dat% Dr%'�l�eyd: �( Static Water Level: 05 Installer.1 1 b« -7e-, 6—sTG0. Date installed: /91' 1H 54 Ft. P IL2L ?.3 2"10 4cp - Yield: /'-- I Pump Set at: Casing Height Above Ground: Z— TANK GPM Ft. SEPARATION DISTANCES li�leptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ..�'Af6'Q'iCi4�aC r%Q� / srr70 well >IOL' =/Zt /J/,+- gl,– >� Material: s�� Number9 'f Compartments: z Water >�5�' >/pro' ,✓/ r/So' LIFT STATION Lot/ - 3$ Size in gallons: Manufacturer: Line // N/ Foundation _ / r / "Pump on" level at: "P " level at: High water alarm at: Curtain/�, �r` ��� P//,,4— Pump Make el Electrical Inspections performed by: Drain Remarks: 1111CA/{ ;� //KS BENCH MARK 2ar�,,,� Location and Description: Assumed Elevation: o rl oLc u 1 e�, • 16KO ENG T'S SEAL � b r(1eoo / .j.3,-2, .3 ®y�� eU 0Jr�8ssRD ar a9tl0a �. Inspections performed by: "4 Dates: 1Sty F y 2nd / — 1p 99U 0® p oA 0099 O � n Michael L. 1�nrJerson -' Department of He)��H7! Lices approval �4 �;� �•°1 01 � Reviewed and approved by Date: 7 u+_ 72-013 (1/91) MOA 25 Permit No. 5N 941972-'6 Page Z of -3 t Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Ma 6w ► `' &U1 PID No.: G1551103 HT, 11459-1148 V �. ... ..�� w----------.wwwwr wvww a/- 90' UTILITY EASE AV 5- w �fil Qlnw ww w+'v• yKw PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBE SW940226 r DATE ISSUED: 7/08/94 DESIGN ENGINEER-:ANDE SOR N ENGaNEERING EXPIRATION DATE: 7/08/95 OWNER NAME:QUIGLEY ENTERPRISES INC OWNER ADDRESS:6701 E 112TH AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01551103 LEGAL DESCRIPTION: MACBETH BLK 2 'LT :4 ` LOT SIZE: 52176 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: ISSUED BY: ��� f �� DATE: — ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 August 21, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Subject: Lot 4, Block 2, MacBeth Subdivision Revised Site Plan Permit No. SW940226 The owner of the subject property intends to upgrade his proposed home to five bedrooms. The septic system permit was previously issued based on a four bedroom home. The attached site plan has been revised to include the septic system redesigned to accomodate five bedrooms. Soil conditions in the area are satsifactory and the construction of the larger system will present no problems. Our review of the lot and the surrounding area indicates the larger septic system can be placed on this lot as shown on the attached site plan. Please review this information and amend the permit to allow placement of a septic system to serve a five bedroom home. Please call if you have any questions or comments. Sincerely, 0� e--OL� Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 June 17, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 4, Block 2, MacBeth Subdivision Well and Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The terrain of the subject lot slopes gradually from east to west with excellent drainage and no surface water evident. Wide trench systems have been designed for this lot and will be constructed level on the shallower slope. If the systems are placed as designed the following statements can be made: 1. The system, if constructed as designed, will have no adverse impact on the wells currently in use or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 July 6, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Dan Roth Subject: Lot 4, Block 2, MacBeth Subdivision Septic System Design Dear Dan: RECEIVED JUL 6 1994 &tun=c+Panty et Anchorage ()ePt. Health & Human Services Attached is the revised site plan and system design for the subject lot. Following our conversation I modified the system to include a Bull Run Splitter Valve at the intersection point with the header pipe. Hopefully, the placement of the valve will lead to a more even distribution of the effluent and a longer life for the drainage trench. The valve will be placed in the open position to both laterals. Please let me know if you have additional questions or comments. Sincerely, Michael E. Anderson, P.E. ,`, n• Nn:....'Jr'.�+Wtirv4'okNYY.Mn.1pW o �� ;? 6l K • SitLU _� - ♦ � � � W <XJW [� Y I Ip `a �„ �,Z" 2 I°l�,r• cpw �• pp b O •„ l y( 2l h, .-oNv_-...oe•c�xl'__ �«lz;roeaos -- ... .._ _ rvl N0088 _. ° ANOlS rl ,Q U° I9-MI90042 3,♦♦,iD.00N Of Of �. rl/ 0 0 C n / O V \ °- C' - Of 41 O � m t o 0 ° s °0. � err n ` '� 00 e r01 N�� �•'47r to L %P C �0 0. 0 .1 n GoJ 1 n• I I y► 1 It 721.1 s`^ btU♦0 .r_V Q\ e5` r °r AUMts 1 \ N W •° ^ `a p a o 76° yglM E►1M e R ° Siiiw^ n =I 00'2♦L ♦r r , � � N Y' 4L 00092 Off n t UJ CD^ j N 00,008 IW) pp - _ oI ° ` 0 V .1 ^ 1GGS e ` i .: Ir♦3 yifl e01 �• t n i i I i i i d �� Lot 4, Block 2, MacBeth Subdivision DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home Wide Trench System Perc. Rate: 30 Min./Inch 1,500 Gal. Septic Tank (Exist.) Application Rate: .45 GPD/SF 4' Drainfield Rock Reduction Factor = .5 5 Bdrms. X 150 GPD / .45 GPD/SF = 1,667 SF 1,667 SF / 5' Wide = 333' Long X .5 /Red. Factor 167 LF of Trench Therefore: Construct a Wide Trench System with Two Laterals Each 84' in Length. Place 4' of Drainfield Rock Beneath the Lateral. Install Bull Run Splitter Valve with Both Sides Open at the Header Intersection. ._ .: e.. .: \ ..... ... ... .... ........ }aV �a4 as @.@@.a° G .. ar d^ Fil ec,- Q®OR ,0O r. 00 sea a 9B0 TYPICAL WIDE TRENCH SYSTEM ®lY/.... 060.maa® Z (No Scale) �� eMichael E. Anderson a 4v,® . Aar® A381 - E NOTE:9� aa.aaaaaa Maintain 4' Separation from Bottom of�nir--�s3O'�� Groundwater. `'`q°` Grade Area Around Drainfield to Drain Away From Field. (FEET) 2 8 I P 4 11 r"orrtf+osi ti �o 12 e 18 19 20. COMMENTS WAS GROUND WATER ENCOUNTERED? �V S - IF YES, AT WHAT `/ �� OL DEPTH? P E Depth to Water Atter Monitoring? � Date: T Reading Date Gross Time �-- [ENGJN9Efls9 EAL) Depth to Water Net Drop Municipality of Anchorage6.5 /a:yt /S' /0•bAT DEPARTMENT OF HEALTH & HUMAN SERVICES "12' $4. 825 Street, Anchorage, Alaska 99502-0650 O. Zi SOILS LOG — PERCOLATION TEST' �oaa�©om�mt�,t� AS l'r ( c Flet yyyy PERFORMED FOR: DATE PERFORTt�1E�` �' �P- • LEGAL DESCRIPTION:, PJ'L /n9� ��r/ Township, Range, Section: DEPTH ,fjf SLOPE SITE PLAN (FEET) 2 8 I P 4 11 r"orrtf+osi ti �o 12 e 18 19 20. COMMENTS WAS GROUND WATER ENCOUNTERED? �V S - IF YES, AT WHAT `/ �� OL DEPTH? P E Depth to Water Atter Monitoring? � Date: T Reading Date Gross Time Net Time Depth to Water Net Drop 2 /a:yt /S' /0•bAT 457 $4. O. Zi -7 -3S o- YS 3 PERCOLATION RATE 3a (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN /0 FT AND /O FT 6 G® ds T" cA7 a n! -71 PERFORMED BY: �Gte� =i` I t " 4GC IFY THAT THIS/JEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LSLii7Z 00 T� DEPTH (FEET) 2 Gd�yi-.�i o�9t- 3 0� 4 6 o d• • 4a 8 'e ' O 9- 10- 11 10 11 e A 12 13- 14- 15 3 14 15 e NEW 18 19 DATE Townshin- Ranaa Rartinn- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? SLOPE t/ N S L O P E Date: tENGINEEKS. SEAL z, y of d �3 , P khacl C. Anderson •® ��'. a.11i.E .- 4 SITE PLAN 20t__] N _- PERCOLATION RATE '2 v (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN y' FT AND S� S FT COMMENTS �h SQ7 421 PA-401L'Tb i_IcSr/A/(� PERFORMED BY /`1' Gam` I 7V i Lt_ ( aoC---ft*TIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 'G17 _ 4it 72-008 (Rev. 4/85) MUNICIPALITY Development Services Department �\ r Phone: 907-343-7904 On -Site Water & Wastewater Section `'`'� Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-511-03 1. GENERAL INFORMATION Complete legal description Macbeth B2 L4 Location (site address) 11121 Briggs Ct Current property owner(s) Mailing address Real estate agent David & Annette Brown same 2. TYPE OF DWELLING: Fx_j Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF c -O• Expiration Date:. I I aC Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic I -XI Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Phone (907) 745-8200 Date •% System #1 Approved for bedrooms �A ' st :�,�= nn� r CF g149 System #2 Approved for bedrooms ��s;•. Disapproved 901 sio','' Conditional approval for bedrooms, with the following stipulations: 01 lt((tt((((( ._ � . W PIER V- o A / j� E T SEK14�\I`- 1) �By: KQjHz ` , �QVLK Original Certificate Date: 5/1 r( 1.2o 2 f 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other ccs ^� � G,�y',�uy- y. Legal Description: Macbeth B2 L4 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1995 Total depth 93 ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 2/23/21 Static water level at beginning of test 176.5 ft. Comments B. TANK DATA Age of tank(s) 26 years Tank type/material 5ept'dsteCl Measured operating fluid level in septic tank OR Standpipes/foundation cleanout per record drawing Date of pumping ,/iCla I D. ABSORPTION FIELD DATA wide trench Which system tested (date installed) 1995 OR ALL standpipes present per record drawing Total measured depth from grade 8.0 ft (max) Measured depth to pipe invert from grade 4.0 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: 015-511-03 Structure served by this system 1 Well prcidbbti6`h a# e..of_.test-`- 3 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes Q No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 5/6/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2/23/21 Results ✓❑Pass For 5 bedrooms Fluid depth prior to test 0/0 in Water added 750 gal New depth 8j$ in Elapsed time 200 min Final fluid depth 0/0 in Absorption rate '750 gpd Any rejuvenation treatment (past 12 months) no 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 Community Sewer Manhole/Cleanout > 100' [✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'E] Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' 0✓ Yes if No ft Water Main > 10' Animal Containment > 50' Q Yes if No ft M Yes if No ft V Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' Yes if No ft M 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' Q Yes if No ft Property Line > 5' P/1 Yes if No ft Wells on Adjacent Lots: ✓0 Absorption Field > 5' F/ Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' V 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' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' F71 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I 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. 2to„5"t Z COSA Checklist yellow sheet OF aLQs�� Steven R�'Pannone• Fc CE 8149 IZ7i MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Septic Tank Advisory   Certificate of On‐Site Systems Approval # OSC211233  Subdivision:  Macbeth  Block:2, Lot: 4  The septic tank for this property is 26 years old.  The average life for a steel septic  tank is 20 years. Typical replacement costs range from $7,000 to $11,000.   This advisory must be attached to all copies of the subject Certificate of On‐Site  Systems Approval.               This is an example of what the metal of a 30 year old steel tank MAY look like.      S 00'07'30" E S 00*06'30" E 115.5 220.00' W LO a) w 00 V) ui A 30' Ull Li > < c !—U#� z :E V) X, x Li a. EL li z Ld ix 4 U, . inmu m =, z —i O'gi m x ui U- 0 < U V)7 v 1 1 c IV z EO 0.0 0 OZ 0 0m —V C c C, I L) O*C a 0 o 0 w '&-o-0 . , C r c, C ui C WA.GC E' wo 0 . oo M- CC a'< 20 �12�02 0 Y.0 *0 . -i , - 0 0 �'Q. E 0 r 0:50,4) 000. oc 00 -5-0 1c Upytlm -} v -E :5V > E -C15 0 o a C wo L, I o OW u 0 a 3: > 0 t;,R' �1.2.E �2 U) O. x �, 3, 0 C 00 E , 11 0 SO 0 -,o 'Ej < z C C 0.2 U) tO 2 Lj to UJ to (0 0X C Z 1 r- 0 WE 3: D G Z to Lj LO 6,-, — a 00 X �t V) r" rn W 0 LIJ < 'm Z Z Z C5 "0 0) 0LU x W 11 z 04 >-O bj— > m zgz �w X D W.1 06 W —O > Ir z -i Om< U-) 02 C> F=z v b V) �ir D 0 < -c CL "a z < Dm (A LJ w z Ca 00 <t- 0 LO 5 :_ < z cr- 0 o =o —J t < 9 x U 0)j vo* 67.8 10.2' fl CV Z bi 8's, V) LnD LO XO Ld -r Q0 34.4' °6 S 00*06'30" E 115.5 220.00' W LO a) w 00 V) ui A 30' Ull Li > < c !—U#� z :E V) X, x Li a. EL li z Ld ix 4 U, . inmu m =, z —i O'gi m x ui U- 0 < U V)7 v 1 1 c IV z EO 0.0 0 OZ 0 0m —V C c C, I L) O*C a 0 o 0 w '&-o-0 . , C r c, C ui C WA.GC E' wo 0 . oo M- CC a'< 20 �12�02 0 Y.0 *0 . -i , - 0 0 �'Q. E 0 r 0:50,4) 000. oc 00 -5-0 1c Upytlm -} v -E :5V > E -C15 0 o a C wo L, I o OW u 0 a 3: > 0 t;,R' �1.2.E �2 U) O. x �, 3, 0 C 00 E , 11 0 SO 0 -,o 'Ej < z C C 0.2 U) tO 2 Lj to UJ to (0 0X C Z 1 r- 0 WE 3: D G Z to Lj LO 6,-, — a 00 X �t V) r" rn W 0 LIJ < 'm Z Z Z C5 "0 0) 0LU x W 11 z 04 >-O bj— > m zgz �w X D W.1 06 W —O > Ir z -i Om< U-) 02 C> F=z v b V) �ir D 0 < -c CL "a z < Dm (A LJ w z Ca 00 <t- 0 LO 5 :_ < z cr- 0 o =o —J t < 9 x U 0)j �s y�'4 IC Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program ` 4700 South Bragaw St. ' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015 Parcel l.D. ler- 511- o HAA # 05 015 Expiration Date: 7 - Z Co 1. GENERAL INFORMATION Complete legal description Location (site address dr directions) Current Property owner(s) 11060 c:�e�sa�n Day phone '762- 5832 Mailing address -1 '162 51804 Lending agency Day phone Mailing address Real Estate Agent F50B Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site RIndividual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 uest to homeowners. val id or 90 daysDSD fromalso Issues the date of ssue for props upon erties es served by a private ertificates or Class CfHealth well and may be eissuedlare 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 Health Authority 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 To%c6¢ 5�A'�� - P E Phone 2�q'3`t to Address 203 1A1 t5&L 204,4�+AA15o1 Engineer's Printed Name To66c^ $x+n�arc� Datey 200 `l, :ny� T�tM est 5. DSD SIGNATURE V S tt' ^ • "�" �" ✓ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements - Supplemental Engineer's Report Other By: _ (/�, Original Certificate Date: �� — 0 15 (Rev OV07) Municipality of Anchorage Development Services Department m Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 199519-6650 www.ci-anchorage.ak.us (907)343-7904 MHEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel ID: 101 - A. WELL DATA Well type z11LA#_ If A. B, or C provide PWSID # _ Well Log (YIN) y Date completed -!4rA5 Sanitary seal (Y/N) Wiresro rl p pe y protected (Y/N) Total depth 223 ft. Cased to . Casing height (above ground) 19 in. FROM WELL LOG AT INSPECTION Date of test II21 199 s 4 b Z Static water level 115 ft 1440 • ft. Well production l2 g. p.m 5 g.p.m. WATER SAMPLE RESULTS: Coliform _0—colonies/100 ml. Nitrate & -D-_ � m 9 /i• Other bacteria N Q colonies/100 ml. Arsenic: mg./l. Dale of Sample: NV65 Collected by: L.ctr< B. SEPTIC/HOLDING TANK DATA Tank Type/Material_roG lo..}CI S} d Dateinstalled 1430IM4 Tank size ISM gal. Number )_ of CompartmentsCleanouts (YIN) _ y Foundation cleanout (Y/N) 6.51A.Depression over tank (YIN) A/ High water alarm (Y/N) i1/ Date of pumping ��8- pumper _ Dtnal; Pu,,, 4in a � t C. ABSORPTION FIELD DATA Date installed 1 30 4 Soil rating (g.p.d./rye or ft2/bdrm) .QL5 System type .� �y doa ImA Length _la_ ft. Width _ 5 ft. Gravel below pipe —_. / ft 3a ft Total depth . Eff. absorption area 1�ft2 Monitoring tube Y Depression over field /� Date of adequacy test 4fo Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test t in. Water addedal. 9 New depth in. Elapsed Time: 4 min. Final fluid depth �in. Absorption rate >= 9.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) _ &Al' kh0 If yes, give date D. LIFT STATION Date installed 'Pump on' le in. D E. SEPARATION DISTANCES Size in gallons 'Pump off lev _ in. Cycl sted SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 710Os Absorption field on lot *p 1001 Public sewer main A/�A r Sewer /septic service line >� Manhole/Access (Y/N) High water alarm le in. Meets ala circuit requirements? On adjacent lots 71001 On adjacent lots %P 100 r Public sewer manhole/cleanout A, Holding tank 4A I t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r 750 Building foundation 710 Property line >10 r Absorption field Water main NIA ' Water service line >'�' Dr Surface water N 0 , Wells on adjacent lots 7 r100 „ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 19, Building foundation ;1`10 Water main N/A r Water Service line � Surface water Driveway, parkin /vehicle storage >5 Curtain drain 1 64 Wells on adjacent lots r F. COMMENTS ��., .r,''..r•.,, - �• G. ENGINEER'S CERTIFICATION ; "�' r r ° , Thave determined through field inspections and r� O 4GpKi�`lCl4•tn I certify that review of Municipal records that the above systems are.in. _, • L, with MOA HAA guidelines in effect on this date: �� w •Z, conformance Vit; � ,f .., {.. Engineer's Printed Namelob6_ e=SPWhL,.A Date F� ZOOS e� y Waiver Fee $ HAA Fee 5 �� �� Date of Payment Date of Payment ! Receipt NNmper Receipt Number (Rev. 12101) 4-20-061 4122PM1 SCS Re(.s 1031794001 Client Name Tobben Spurkland P.E. Project Nam N Macbeth LA B2 Client Sample ID Macbeth LA B2 baht: Drinking Weber SOOT 661670, All Datea/rines are Alaska Standard Time Printed DateMnae M017005 8:01 Collected Datelrlme 04/0617005 17:13 Recdvod DateMme 0"7/2005 11:41 Technical Director Stephen C. Ede .Y.„.2/......:......r . . Sample Remmks: EP300 • Sample rertm outside of bold to cottli ca original eoncenbstloa Copcennadm eontimts Pua111etery Allowable Prep Acalyslf PQL Udu Herkod Coetaiawm Limits Due Date Ink Nwtals by ICP/MS Anenic 5.00 U 5.00 ngn, EP200.8 C 04ro8/O5 04/12.33 SCL Waters Department Nitwe-N 0.100u 0.100 3tlmsobiolooy Laboratory Total CoMorm 0 VIA EPA 300.0 B (0 10) 04MUS CAM COV100121L SM209222B A (0-1) OMIDS TLF M IV 8 lO i - z ZD' > o 0 C: Z > C." 0 noIN, z 0 0 M > U) ;0 -r 0 0::E m M K > V)CD M 00 z a (7) 1 C-) K 0 > cn C)O a) PI mz m M DD- Fp > "I Uj > > z> x o> > 0 c: Cl) z 0 z X --j FTi > 0 G-) ml > Quo r- Z <rg > C/) z L 0 0 0 rn E,4tz;u cn < -M > Fl o— . 0 o (A 0 C4 0 F - 0 N C/) 0 Cl) M (A wc ZOAp JV FT] z 10 0 > z M 00X Fri (D ®°"z-1 -T, �OM -4 x r_n (_n ") -L z � 0) o C::Em g to > ') S z '0 X o- C� C/1) cn cn M M(n c. C-: M Oa M 0 > CO 0 , =, z (n > 3 0 0 -*u c In :3 o— o'0 z 0,2 > :3- . o, 0 < o M 2;ao F— 0 > x o ca o UJ w 6),;;: = , M cD 0 cD -u C) < F— 2'0 �Ko o 0 c-, 3 z CC) F > o Som 2:20 -a 'o(D oo , oo CC) :3 -,w 3& o w, 0 OIZ a > Q =1 CD =0 z—, (,* :0, -co 0 =.—o =ra o- rn on <D .,o = O� > Q. w ca,< v-wo . ::, — 0-0 Q - —,—o (D 0, o o o- Z:,o (D co ooa.0 o . gcnn Q> > an 8 o m < -oz Z M m 0 < m n u ;u mcu o 0 T m (n m M z > 7 m m ? cn 7 . 0 Z m 0 Z 0 m �7 C:: m Fq U) Im m 'N 0 0 '00*0zz C) lO r Q0 ZD' CIO o 00 C: 0 0 M > U) M K M z 0 0 '00*0zz H2 � "0�,90.00 s a ,00'Ztz 7— ,-v*-vc 2M CL< 41 (10 A< M 2 -P� C) 00 C/') Z'O L 3 "02,Z-0.00 s I I I F - 0 w C) r Q0 ZD' 00 Q0 0 O (D H2 � "0�,90.00 s a ,00'Ztz 7— ,-v*-vc 2M CL< 41 (10 A< M 2 -P� C) 00 C/') Z'O L 3 "02,Z-0.00 s I I I F - 0 w Location (site address or directions) Property owner pA U L � 1 C<HC"L $( Moiling address Q5z, Lending agency. ` Meiling address Agent Address Unless otherwise requested, NAA will be he 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: I Individual well Community well — Public water; _ NOTE: If community, well system, provide, ing to the legality and status of syc li Mvl!R 4. TYPE OF WASTEWATER DISPOSAL ; )" �f" Individual on-site t = ' l a41 C r Holding Community on site'a°` iB )�' YTV f Us PubI c sewer'�r�Y,:� HC}'�a,6ly�§y �y„If 't6 NOTE. If community,wastewatersystem^� attesting to the legality and sttuS 72-025(Rev.1/91) Front MOAQ21 C, a� Z. A 9u13, ,,, ti Aj - j , , ., , �mtrl 1 t43 -39- Day phone �o } i x _ Day phone 1 r _ Day phone i a ` rr� r r; yrs a..w�� ; i.r r'•M� >� rmation from State-ADEC afiesf .VL ..d� iiFes.' n. Ln i fJni'{ iW td 5: `} STATEMENT OF INSPECTION' As certified by my seal affixed her Investigation of this Health`Autho r, and/or wastewater disposal systen and type of structure indicated hemi the Municipality of Anchorage fUe L 1-1. i supply and/or wastewater dispose Yi L ordinances, -and regulations In effi Eng z { 3Y ENGINEER ' 119,1, i1hv t�o"a d,as of the validation date shown below, I verify that my itylApproval application shows that the on-site water supply i is 9 fe'functional'and adequate for the number of bedrooms ►in; I, urtherverifythat based on the information obtained from r �� s and frommy inYestigation and inspection, the on-site water 1tv3SN rN1rYlrn N r I system, is in'compliance4ith ail Municipal and State codes, ct on theldate of this inspactio '0�l, ir710-1, �G'h► a rJ(, '1'ii !1, `.1,Phonetot ate 1 1 � 1 ct OF 4�1 ago . 1 200, a.1 1 E 3 4I �� t l ^�\ q •v ISO IA 1 I „1. 0.., 0�V4. YYO.YOo p0��• •. 11f 7 i i/ 1 O ••• u i tl•u O • .Y � f l ljl�il r J • �. !� , itlehnel_-E. And•e•rson h.� .• C7 �E'IEi rlt�lr�I�ti' '� �. .. i'., ��'T @�•A04• eca%. 0•)�� � �i1QFl.:iC,l�l��.g0" s ° Sllsl ill ��l t,i1 i bedrooms it 7J bedrooms, with the following stipulations: i1 I The Municipality" of Anchorage Departmant :: Approval Certificates based only upon the'"rl professional engineer registered In State of and their lending institutions In orderto satisfy i conductinspections.or'analyze' daW before responsible for errors or omissions in the prof 72-M(Rev.1/81) Back MOAM21 , I Date C� aaith4nd Human Services (DHHS) issues Health Authority septations given in "paragraph 5 above by an independent ka. The DHHS does this as a courtesy to purchasers of homes in federal and state requirements: Employees of DH HS do not ertificater W. Issued.1The`Municipality of 'Anchorage is not mai' engineer's work:'',1 { 1 41111 ! 15'1 1�: A kPM �Id 1 2r'1A a l t y uyy I , Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: B LDGc. Z. /44G vat Parcel I.D. A. Well Data 'C m 1'�7 co e Well type P21 �)A-7�I= If A, B, or C, attach ADEC letter. ADEC water system number ® `" Log present (Y/N) Y Date completed //Z) 95' Driller A L*4 � Total depth Z Z Cased to Z Z � Casing height Z� Z Sanitary seal (Y/N) y Wires properly protected (Y/N) y FROMWELLLOG AT INSPECTION Date of test 1/ Z 1 AW Static water level 7 4 S Well flow g<p.m: g.p.m. Pump levels U/J I1L^J0 UJ AJ SEPARATION DISTANCES FROM WELL TO: r Septic/holding tank on lot /10 Z ; On adjacent lots 1 Ahcnrntinn fialrf nn Int / Z- % On adjacent lots > /00 1 ? /00, Public sewer main /01 C4.5 Public sewer manhole/cleanout A41 L'C-s Sewer service line 7 2 Petroleum tank O ^lam WATER SAMPLE RESULTS: Coliform DNitrate ! I ® M9 1L, Other, bacteria Date of sample: 7%3f q5 Collected by: A • 4 B. SEPTIC/HOLDING TANK DATA Date installed12I ZZI* 9 4 Tank size 4 5-00 6A -L • Compartments LJ a Cleanouts (Y/N) YFopundation cleanout (Y/N) �c_Depression (Y/N) High water alarm (Y/N)Co f/`� Alarm tested (Y/N) /J1A _ Date of pumping � Co" Sir �­n o M Pumper /`j A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: � / a Well(s) on lot /b� On adjacent lots >100Foundation r To property line 36Absorption field > /0 Water main/service line ? SO' l Surface water/drainage P `" O 1'J (& 72-026(3W)•Front CONTINUED ON BACK PAGE STATION Date installed Size in gallons— Vent (Y/N) allonsVent(Y/N) High water alarm level "Pump on" level (Y/N) "Pump off" Level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /'Z Z Z d q Soil rating (GPD/Ftz) ° System type W 10 L 1 I2 c N u4 Length 174' Width -5 i Gravel thickness `F 1 Total depth &'--ro 96 Total absorption area 1,740 r -T L'Cleanout present (Y/N) Depression over field (Y/N) /J Date of adequacy test /yet—' 6 ^J ST:' Results (pass/fail) JPA s S for Bedrooms Water level in absorption field before test 0 Aftertest Peroxide treatment (past 12 months) (Y/N) /\1 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation Z / On adjacent lots >1001 qZ_ yes, give date Property line 0 ^J A 111 To existing or abandoned system on lot > /p On adjacent lots > /00 ' Cutbank /J co 1,J C Water main/service line 51..0 , Surface water /J 0 �,t C Driveway, parking/vehicle storage area Curtain drain A/0 N 4--- E. ENGINEER'S CERTIFICATION \;� 7-o 1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on,the date of this inspection. t Signature" Engineer's NameA-i 0 ozf o J Date 41 T 10, Y HAA Fee $ 0D0 ,dD Date of Payment 411`".Zl4s 7 Receipt Number � X� < A�. 72-026 (3193)' Back Waiver Fee $ Date of Payment Receipt Number 04/0?/95 09:14 COMMERCIAL TESTING y 90? 344 2130 N0.1?8 D03 I ME Environmental Services Inc. ZtL Laboratory Division CT&E Ref.# 95.1233-1 Laboratory Analysis Report j Matrix WATER Client Sample ID L4 BLK2 MACBETH S/D ' Client Name ANDERSON ENGINEERING WORK Order 13630 Ordered By ALAN Printed Date 04/06/95 Q 15:35 hrs. Project Name Collected Data 04/03/95 c4 16:05 hrs. Project# Received Date 04/03/95 9 16:301 hra. PWSID IIA Technical Director STEPHEN C. SDE Released By�~�^ .►.wu+�.t�, Sample Remarka: SAMPLE COLLECTED BY: A.H. WITNESSED BY J.B QC Allowable $xt. Anal Parameter Results Qual Unita Method Limits Date Date Tnit Nitrate-N 0.10 U ................. mg/L EPA 353.2 ........ ....... -'------------------ 10. 041/05/95 CMR axxxx_aazxxaaxvxxavax�xx===axx�x�axa�axx_x�aaxxxavvav==va=x.==x�avaz=va=a=-ssease=aasax�-xas=aa====aaaxa=aaaavasa zr y See Special Instructions Above UA a Unavailable See Sample Remarks Above NA = Not Analyzed - Undetected, Reported value is the practical quantification limit. LT a Lose Than IZ' = Secondary dilution. GT - Greater Than .y 200 W. Potter Drive, Anchorage, AK 99518.1606 — Tel: (907) 562-2343 Pax: (907) 561-5301 ENVIRnNMENTAL FACILITIES IN ALASKA. CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND. MICHIGAN- MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA