HomeMy WebLinkAboutLILAC PARK BLK 2 LT 6Lilac Park Block 2 Lot 6 #015-21 1-30 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-79D4 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP111286 PID Number: 015-211-30 Name: Jerome scholze Wastewater System: [j New ©Upgrade Address: 12242 Lilac Circle Anchorage, AK 99516 ABSORPTION FIELD Phone: Number of Bedrooms: 351-$596 Q ❑ Deep Trench 16 SM1albw Trench [] Bert ❑Mound ❑ OIM1e[ Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION 1.2 7 GPDul Ft. Block vi 2 Lot: 6 Subdision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: Lilac Park 3 4 Ft. Ft Township: Range: Section: Fill added above original gone: Gravel Length: .5-1 Ft. 50 Ft. Well: ❑ New ❑ Upgrade p9 Gravel Width: Number of lines: Disbnce between lines: s Ft. 1 Ft. Classification (Private, A. B. C): Total Depth: Cased ro: Trial absorption area: Pipe Material Existing - F,. Ft 500 Fp ASTM D3034 PVC Driller Date Ddlled: Static Water Level: Installer Date Installed. Ft PCN, Inc. 10/20.21/2011 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublirJPrivate Mawfacmrer capa�uy: From Tank Field Station Tank Sewer Line Existing Gal, Material: Numbar of Compartments: well >100' >100, >100' N/A >25' Suri Water >100F >100' >100' N/A LIFT STATION Size: Manufacture[ Lot Line >5 >10' >5' N/A Gal. 'Pump on' level at "Pump ofP' level at High water alarm at Foundation >5' >10' >5' NIA in. in. in. Pump Make & Model Electrical Inspections performed by: Curtain Dram None Noted Remarks: BENCH MARK Flow Diverter Valve Placed. Existing Absorption Bed Location and Description: Connected for Future Use. Existing Septic Tank Verified GarageSlab. Assumed Elevation: Suitable for Continued Use. Ft ®�rgit��s S1� Inspections performed by: MEA Dates: jai 10/20/2011 %P��♦!�, •.:; �58�® 2nd 10!21/2011 Development Services Department Approval 49 s: 713 .q• ♦ ♦N N♦ ... u... Conditional Approval Date: .... . i �,........... r„ AUQlAR E ANDERSON: ��Date: f ��I3 J ,011;ROff5510::��s Reviewed and approved by: (Rd, WlOG) , P \ / Permit Number: OSP111286 LILAC CIRCLE \\ \\ \ T — 10' T&E E#MENT /40' PRIVATE PLANTING S VEGETATIVE EASEMENT 0 1z CIS a, TH2®00 / O. M1 A B C5 C5 107.2 90.0 M1 109.7 92.1 C6 155.7 139.3' FDV 82.4' 65.0 FDV N Existing Absorption I Bed O 1 J LOT 6 3 1 74,347 S. F. �- o I Q rs • n I Q I I y I 1 Four Bedroom Home O 1 N _m I .o I w I 0 o 0 1 o I 0 z WELL I I Shed � I Shed O I J I I I 1 I 10' T&E EASEMENT OF N 89'59'00"W 202.51' 49th/V HUFFMAN ROAD .................................... o i MICCHAAEL E. ANDERSON W PLAN AS BUILT i NO. CE -4381 :"'____ SCALE i" = 50' z LOT 7 Page 2 of 3 PID No. 015-211-30 LEGEND SV - Septic Vent C5 - Clean Out M1 - Monitor Tube TH - Test Hole FDV - Flow Diverter Volve Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP111286 PID No. 015-211-30 NOTE: Flow Diverter Valve and Absorption Trench Placed Under This Permit. Existing Septic Tank Verified Suitable for Continued Use. N NDE PROFILE AS -BUILT /... TNICHNO. CEAEL E. p<3aR50N No Scale 80.5 Ly 1 N 0 J 1 \ \\ LILAC p,9 (SEPTIC SE9 Pnc CLEAN WEST 20.00 CIRCLE 31.41' � •50.00' / T&E EASEMENT i 40' PRIVATE PLANTING & VEGETATIVE EASEMENT LOT 6 74,347 S.F. 66.1' 47.1' SEE HOUSE \ DETAILS F WELL- 1, �-10.3'x12.3' SHED 10' T&E EASEMENT I / 122'x20.3' SHED HUFFMAN ROAD HOUSE DETAILS SCALE: 1"=30' LOT 7 ' — — q7- — T --- PLOT PLAN AS BUILT X SCALE 1` = 50' GRID 2736 Project No. 11-184/A7 Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 9 951 5-3049 (907) 522-6476 Phone Registered Land Surveyors (907) 522-4625 Fax kglangla0alaska.net / jclangls0alasko.net c I hereby that I have surveyed9 scribed �P. . BL UaBDIVidS LILAC PLAT 83-484 ON Anchors a Recording Di:rtriotA�that 9 9 the Improvementsdsituated thereon aro .............................. within the property lines and do not encroach onto the ro o, That property thereto, no Improvements on the property lying adjacent thereto encroach on the survey6d ""' "' promises and that there aro no roadways, transmission lines or other visible '. easements on said property except as indicated hereon. KENNETH LAN Dated this the 1'4" Day of t\d"v,NzMf.,, 2tit11 , at Anchorage; Alaska LS -5202 Q �l� �jl•.•'O N is the responsibility of the owner to determine the existence of any easements, A� IONW o covenants, or restrictions which do not appear on the recorded subdivision plat. On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111286 Tax Code Number: 01521130000 Work Type: Septic Upgrade Permit Effective Dates: October 18, 2011 to October 17, 2012 Design Engineer: ANDERSON ENGINEERING Subdivision: LILAC PARK Site Legal Address: LILAC PARK BLK 2 LT 6 G:2736 Owner/Address: SCHOLZE JEROME V & DENISE M 12242 LILAC CIR ANCHORAGE AK 995162258 Site Mailing Address: 12242 LILAC CIR, Anchorage Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: �,ticnr. s_ l)� ��R�rt�r�cz1C 74347 4 Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Prior To Construction: Verify there is no bedrock or impermeable soils within 6 feet of the bottom of the drainfield and verify using 7 -day or greater ground water monitoring that there is no ground water within 4 feet of the bottom of the drainfield. Results shall be submitted with the final inspection report. Note: The engineer may proceed with construction prior to verification at his own risk. Received By: Issued By: /V ^ j_ -// Date: MUNICIPALITY OF ANCHORAGE DevelopmentCommunity -s ♦ 907-343-7904 ProgramDevelopment Services Division Fax: 907-343-7997 On -Site Water & Wastewater Mayor ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. D/5 -Z I I — 3 0 Property owner(s) L5 -c rorne- Day phone 35/ - 0501 Mailing address Z. 2-9 2 L 0e, C,',r Site address If Legal description (Sub'd., Block & Lot) Z, ila G A, k 6 Z L - Legal description (Township, Range & Section) Lot Size 7�y, 3L17 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: (® all that apply) Absorption Field Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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: _ Waiver Fees: Date of Payment: Receipt Number: ,�T-1 Ci C n Permit No. �'`; t `' ',ti4 , � Date of Payment: Receipt Number: Waiver No. GABuilding\On Site\Forms\Client Forms\Permit App_01 041 1.doc (Rev. 1/11) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677--7766 FAX October 9, 2011 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 6, Block 2, Lilac Park Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption system on the subject lot has failed and must be upgraded. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing 1,250 Gallon Septic Tank will be uncovered, inspected and tested and verified sound for continued use. If it is found defective it will be replaced with a new 1,250 Gallon Septic Tank. The existing absorption bed will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Protective radii are shown to the adjacent wells. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot indicated Poorly Graded Sand (SP) underlain by silty gravel. The percolation rate was determined to be less than 5 minutes per inch. We have designed the new trench with an application rate of 1.2 gallons per date per square foot. We are proposing to place a 50' long trench by 5' wide with a 4' effective depth. The total depth of the system will be 7' with the distribution line at 3' below the existing surface. A new test hole will be placed and a percolation test completed to verify the absorption characteristics of the underlying soil. If conditions are found to be different than anticipated a change order will be submitted with a new design for the trench. Lot 6, Block 2, Lilac Park October 9, 2011 Page Two The ground surface on the lot slopes slightly to the north in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area 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 reserve 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. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments LILAC CIRCLE LILAC SUBDIVISION � � 40' Vegetative / / Easement LOT 6, BLOCK 2 74,347 S.F. / CD Construct New 50' Long x /' // TH2 \ 5' Wide x 4' Effective / Depth Absorption Trench. Place Flow Diverter Valve. I ( T ® Y MT Connect Old Bed for Future Use. _ — — — — —I C0 Existing Absorption \ Bed / / I FDV - I I \\ $ I I 01 \ e LOT2, BLOCK 2 I j �� �/ \ �7 o 0 f I o w I Verify Integrity of \Existing N nI 1,250 Gallon Septi Tank SV rn '� I for Continued Use. SV ExWeillg l N a Garage N / I Four Bedroom I I / Home \ / LOT1, BLOCK 2 I \ LOT 7, BLOCK 2 I // zz I I I I Existing i Well O I I I A NOTE: i i vvv No Areas of Excessivel Slope or Surface Water I / are Within 100' of An] Part of the New Septi System. L-= -= ------ ------------ ��v��P .•'' .5�•��I 10' T & E Easement AV :------ : � .x}L�1� — — — — — — — — — — — — — — — — — — — — — — — — — — — - 49th •.......... ................ ..... :. ..... � LEGEND % �................... --jo SV — Septic Vent 00 ; MICHAEL E. ANDERSON SITE PLAN CO — Clean Out No. CE -4381 = MT — Monitor Tube •��� p�� !�:,�- �i FDV SCALE 1" = 50' TH --Test Hole Flow Diverter Clift. FESSi�NP��� Valve LOT 6, BLOCK 2, LILAC PARK SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home 5' Wide Trench System Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank - Verify Existing Application Rate: 1.2 GPD/SF 4' Drainfield Rock 4 Bedrooms " 150 GPD/Bedroom = 600 SF Absorption Area 600 SF/1.2 GPD/SF/5 SF (Width) *.5 (Red. Factor)= 50 LF Trench Length THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over Septic Tank. Place Flow Diverter Valve and Connect Existing Absorption Bed for Future Use. 5' TYPICAL 5' WIDE TRENCH SECTIONOF -- (NO SCALE) •.`P� .............�q�b�i NOTE: Grade Area Over Trench to Drain Away. : t: ;' •: � Minimum 6' Separation From Bedrock. 49th .... ....:... Minimum 4' Separation From Groundwater.1k,:`dr Minimum 100' Separation From Private Wells in the Area. �� MICHAEL E. ANDERSON Minimum 100' Separation From Surface Water or Streams. No. CE_481 z E'c.��.:'���r �4111 ROFESS\ AF MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) 1 - 2- 3- 4- 5- 6- 7- 8- 9- 10- 11 12- 13- 14- 15- 16- 17- 18- 19- 20 - SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 6, BLOCK 2, LILAC PARK SUBDIVISION PERFORMED FOR: JEROME SCHOLZE DATE: 10/17/2011 PROJECT No.: PARCEL ID#: TECHNICIAN: M. ANDERSON TEST HOLE 1 OB/OG d a 4 SILTY GRAVEL a ROOTS, STUMPS AND DEBRIS �d FROM 5'-8' a SLOPE WAS GROUND WATER ENCOUNTERED? No IF YES @ WH DEPTH OF WATER AFTER MON DATE OF MO •`:� ♦� ............. fA' .MICHAEL E. ANDERSON 1 No. CE -4381 _ i Professional Engineers Stamp: SITE PLAN SEE SITE PLAN i AT DEPTH? ITORING: 0 0% NITORING: P E GROSS TIME NET TIME DEPTH To NET DROP (INCHES) DATE READING (MINUTES) (MINUTES) WATER (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: PERCOLATION RATE: (MIN/INCH) PERC. HOLE DIA. (INCHES) TEST RUN BETWEEN: FT. and FT. COMMENTS: ROOTS, STUMPS AND DEBRIS FOUND FROM 5' TO 8'. APPARENT BURY HOLE FROM INITIAL LOT CLEARING. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 10/18/2011 PERCOLATION RATE: (MIN/INCH) PERC. HOLE DIA. (INCHES) TEST RUN BETWEEN: FT. and FT. COMMENTS: ROOTS, STUMPS AND DEBRIS FOUND FROM 5' TO 8'. APPARENT BURY HOLE FROM INITIAL LOT CLEARING. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 10/18/2011 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAVV STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 6, BLOCK 2, LILAC PARK SUBDIVISION PERFORMED FOR: JOE MULCAHY DATE: 10/17/2011 PROJECT No.: PARCEL ID#: TECHNICIAN: M. ANDERSON DEPTH (feet) TEST HOLE 2 1 OB/OG 2 a 3 a SILTY GRAVEL 4 a a 5 6 7 r• 1 11 12 13 14 15 16 17 18 19 SLOPE C� OP 0 OF L571 49th .............. ... MICHAEL E. ANDERSON No. CE -4381 Professional Eneineers StamD: SITE PLAN SEE SITE PLAN Q BOH @ 10.0 WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? S DEPTH OF WATER AFTER MONITORING: O 0% DATE OF MONITORING: P E DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 10/18 1 9:03/9:13 10 1.25"/3.50" 2.25" 2 9:14/9:24 10 1.38"/13.50" 2.12" 3 9:25/9:35 10 1.25"/3.31" 2.06" 4 9:36/9:46 10 1.38"/3.44" 2.06" 5 9:47/9:57 10 1.25"/3.25" 2.00" 6 9:58/10:08 10 1.38"/3.38" 2.00" PERCOLATION RATE: 5 (MIN/INCH) PERC. HOLE DIA. 6n (INCHES) TEST RUN BETWEEN: 4.5 FT. and 5.5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 10/18/2011 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 6, BLOCK 2, LILAC PARK SUBDIVISION GENERAL: The scope of this project includes exposing, testing and verifying for continued use the existing 1,250 -gallon septic tank on the lot. Work also includes the construction of a new 50' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 7' below the existing ground surface. The new absorption trench and septic tank must be placed a minimum of 100' from all private wells and any surface water in the area and 10' from the water service line on the lot. A minimum of 3' of cover is required over the absorption trench and 4' of cover over the septic tank. A flow diverter valve must be placed and the existing absorption bed tied in for possible future use. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Building Safety Division On -Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On -Site Water and Wastewater Program. before beginning system installation. SEPTIC TANK INSTALLATION — VERIFY EXISTING FOR CONTINUED USE 1. A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown if the existing tank is deemed unsuitable for continued use. Lot 6, Block 2, Lilac Park October 9, 2011 Page 2 of 3 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below the distribution line must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. All pockets of unacceptable materials must be removed and replaced. Lot 6, Block 2, Lilac Park October 9, 2011 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated i and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at ',least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 82.5 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name�� DISTANCES L OQVLE' � r, 6r v ^_ TO SEPTIC ABSORPTION WELL Adores" p /04/1P 6 21_ FROM TANK FIELD C7 r c 7 �� Xi Phones) Permit No. No. of Bedrooms WELL !/� 17.3 JAZ �� � 2� ✓-� �' /// �. LEGAL DESCRIPTION LOT LINI: of LBlock �r Subdlv�si��.�l��'C` ('/ / y / �• ' _ �< !/� / ��•t�!nL� FOUNDATION /51 Township, Range. Section _ AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation. TANKS It SEPTIC ❑ HOLDING Mat I urer c 46 � city in gallons 1 Z. c) ENo, Materia. �y / f Compartments �® TYPE OF SYSTEM ❑ TRENCH ^BED ❑ W. DRAIN ❑ OTHER Depth [o pipe bottom from original grade - / C Total depth born original grade �• -5 A9 FT Fill added above original grade Gravel depth beneath pipe Gravel length Gravel width /C> Jr� FT FT Total absorption area Distance between lines 61 SQ FT FT Number of lines Soil rating T /JC� SQ FT Pipe material Installer 7_(IIAAIF rk Date Installs I ?X169 � WELLS PRIVATE �❑ OTHER (Identity) Classification (A,B.C) Total Depth Cased to Pnj `- FT FT Installgi Date Installed. S: a&7711 water Scale: f • a -%4 p hlspgctfons Perlorrpt)d by: Date: I — &2/� ,, e _ cJ C—"t N 11V cert�ily, that this inspection was perlornled according to all Municipal and State guidelines in ellect on this date: of Health Department Approval: �! �, �_ Date: C 72-013 (3/85) N ON /fin. w41 j aNV h�11N� �1.bh12J�J o� PERFo RrsEo For,:_ LEGAL DCSCRIPT(ON:_ 00PTH «Cert 1 2 3- 4 S G < , i . , sP 7- 9 9 10 11 12 13 14 15 16 17 18 19 20 (.Sunieipality. of Anchorage DEPARTMENT OF HEALTH & HUMAN S 625 "L" Street, Anchorage. Alaska 9950 SOILS LOG — PERCOLATION Township, Range, S SLOPE WAS GROUNO WATER ► }O ENCOUNTERED? S n� t_ (F YES, AT WHAT ►VL/ O DEPT"?ce, P ttep�( to iti2ltr 1.rier ((�J{{�,�NNy^n //p l pie ': .i N PERCOLATION RATE PERC HOLE OIAMETEft 1 _ TESTRUN BETWEEN 5' S AND 6's FT COMMENTS Y�(� PERFORMED BY: Yu �� ACCORDANCE WITH ALL STATE AND MUNICIPAL GU(O 72.000 (Rc . u6Sl l r'l-RT(FY THAT THIS TEST WAS PERFORMED (N THIS OATS. DATE: _ 01301 � Mi|NIClPALIlY DF ANCHURAG[ Dn'ant OVA nt 1 vices 8�5 L Street� A/}chorage, Alaska 99501 343-4720 ON�S1l!� SEWER PERMlT Permit Number: 9O(�264 'kh��O\/)/������ DaLe Issued: 08/30/90 Engineer Designed Owner Namex �lOSEPH CAN81:i�:/ LA! Y J. CARR Ownar Address: P.O. ROX 90674 ANCHORA6E:, AK 99509 Day Phone: Parcel Id: 015^211~30 Lot Lega1: Subdivision: LILAC PARK ����, Lot: 6 Blnck: 2 Section: 22 Township: AN Range: 3W L.W. Size 74347 (sq,1t. or acres) Max 8edrooms: This Permit: 4 Total Capacity: 4 SEPTlC lANK: Minimum tcital sep|.ic tank capacity: 1,250 gallons. Each septic tank must have at least 2 compartments, Depth to wry of septic tanN(s) neet requires insulation over iank(s)" [NFORM D"H.H.S. !,RIOR lD lNSP[CT[ONS BY ENGINEER, lF AFTER OF|]C& HOURS 0 CALL 343 4681 AND LEAVE A MESSAGE^ CONS|RUC| PES ENGINEERS AT[ACHED UEASN, !H/C PERMIT EXPIkES 12/31/90 AND) VALID FOR A CINGLE FAMILY HOME` ` (Owner L RY J CARR 7 aso l.___c - - ------ r Bl: ->7 pt'?6oJ 0? k,%. :A!cvu V-n-ek 4 DvvM0PI5- D CIO Lo -r 2. Ini. 2e .0-1 r -6,2e 0 G9 N, 10 112601�gVlakl _kyll _4� L d 1 GL L 5L pr"P "'ej use (I L_17>� EMEMENT NOTE: All Dimensions And Locations Must Be Field Verified Prior To Construction .-SEWER. SYSTEM LOCATION PLAN LOT Stock SUBDIVISION Z I I SECTION/TOWNSHIP/RANGE SCALE, HOTEa Tile Accuracy Of Location Of Exisiting And Proposed Property Corners, Molls, and Septic DRAWN BY& I b-15 Systems Indicated Is -Not Exact. Dixicii,l... NORTH JviAv,1 SCM iLk indicated Have Been Detemined By Use 01' Cloth Tape and/or Municipal Records, And Not By 1.1 "o Surveying Techniques . PREPARED FOR, XV 4 sacl 0 DATES SHEET OF I Q f.`UMCipatity of AnCilora( < DEPARTMENT OF t UkLTH & HUM, �825'L" Street, Anchorage, Alaska SOILS LOG - PERCOLATI PERE-oRmCo For,:^ 1 U�Ae Pjk,� Township, Range. Section: LEGAL DESCRIPTION: l (�"'(" SLOPE SfTE PLAN PERFOR("'co For':, LEGAL DESCRWTU OEPTH (FEET) 1 2 3 4- 6- 7 677 9 10 j �11 i 12- 13 14 15 16 17- is - 19 71819 20 COMMENTS h4unicipa(ity of Anchorage DEPARTMENT OF HEALTH & HUMAN SER 825 "L*' Street, Anchorage, Alaska 99502-0 SOILS LOG — PERCOLATION TE 9 UVti: Township, Range, Section: _ SLOPE WAS GROUNDWATER ENCOUNTERED? tF YES, AT WHAT . DEPT"? Oepth to WzW filter koaftx4np7 02tc S L O P E ,1 'I'll' i 1, Ce win 9 my d�COf#fJCOI v O Z , C7 Jl l L' 1'!_HIV ®1 Z Reading Date Gr= Time Net Time- Depth to Water Net - DroO 0.5 gZ% o 0.34/ p,4,0 M N ana tiA D. 3o O•Zo 5 " 50M IIJ 10 A4 1A1 6 43 O .?-a 5 Z 9D &0A4(Al /0 Mf/J 0,80 .7_0 PERCOLAT(ON RATE t? 3 g (m:rlu(evirlcftl PfRC BOLE OfAMETER - TEST RUN BETWEEN 3_�� FT AND , D FT —1 . , _ / J/ / �_ 7_ / 'K PERFORMED BY:1=�< ACCORDANCE WITH ALL STAit AND MUN(C(PAL 72.008 (Rev. 4/851 i) ��CERTIFY TfiA•f,7 IST WAS PERFORMED (N #1E E THIS DATE. GATE: ' Q F 4- 2 I -QJ---Q RA" 75 - --------- J* Q3 � 1, 2150 v Lo -r 2 T. -44 4 regio of D? LCFT (5 N, Prcro-� ejo 0, L)T IEASEMENT"-Ty EASEMENT" NOTE: All Dimensions And Locations Must Be Field Verified Prior To Construction ..SEWER. SYSTEM LOCATION PLAN IAT BLOCIL SUSOIVISION ?=Yil SECTION/TOWNSHIP/RANGE SCALE, NOTE. f,.4- 1j Ioo, The Accuracy Of Location Of Exisiting And Proposed Property Cornerne.Wells, and Septic DRAWN SYS Systems indicated Za-Hot Exact. Dimensions NORTHJoNIJ �000Z Indicated Have Been Determined By Use Or Cloth 'rape and/or municipal Records, And Hot By -10 Do Surveying Techniques fr. I e 4"'pm4w) PREPARED FOR, %SIP -TL M- An 41 a, y", /8/X4-2/= ;- DATE413 1 Igo SHEET I OF i E.Sunicip Anchorage pEPhh ARTENT OF HEALTH & HUMAN SE 825 "L" Street, Anchorage, Alaska 99502 - SOILS LOG - PERCOLATION T PERF-ORf1E0 EOR- LEGAL OESCRIPTION: (o -I 25 9y Township. Range. Section: |�UNICIPALlTY OF ANCHO�AGE Department o{ Health & Human Services 825 L Street, Anchorage� Alaska 99501 343-4720 ON-S[TE WELL PERMIT �(�\�[l[\���� �ermit Number: 900325 �aLe issue�: �0/02/90 i/w/�er Name: .�UE CAN82 / LARkY CAkR Day Phone: Uwnp/ Address: P.O. DOX 90674 - �)NC!|ORA2�� AK 99509 parcel Id: 015-211-3O Lo�Le�a1: Subdivision: L]LAC PARK L�t: 6 Dlock: 2 Sectinn: 22 Tuwnship: 12N Range: 3W Lot Size 74347 (sq`�t" or ac,es) Hax Dp�ooms: This Permit: O Total Capacity: 4 Log must be submiited to Municipality of Anchorage Depariment o[ Hea]th �nd Human Services within 30 days of wel1 comp1etion. CON9T!�UCT WELL 100 FEEl FROM ALL SOURCES DF CONTAMINATION. LOCATE WB'L AS PER ATTACH GlNEER/S DESIGN" [ ��ERT[FY THAT: 1. I am [amiliar with the requirements �or on~szte sewers and wel1s as set forth by the Municipaiity o< Anchorage (MOA> and the State of Alaska. 2. I will install the system in accordance with all MOA codes and requlations, and in compliance with the design rriteria of this permit. J. I will adhere to all MOA and State o{ Alaska requirements �or ihe seL back distances [rom any existing well, wastewater disposal system or publ�c sewerage systemn thi adja t earby lot^ 4 [ under maximum of 0 bedrooms. i a}so und t al system is 4 bed/ooms and any en| ermit, �iqned� �A|E: '�wner) JifRY CARH L wq��q/oLt i r- �. /'m tc. 16 611 $ED S> CTlot ) -I <3�Gr• 4- /vtc" ri<r /8 C/o Lo -r 1. � I ►, IK � yc�ca M'Aj e bock I UN pvG� i7 y v SEPTI '�' (Ot UTI u77y EA5Er-ISNT NOTE: P All Dimensions And Locations Must Be Field Verified Prior To Construction SEWER. SYSTEM LOCATION PLAN IVT BLOCK SUBDIVISION nNq��4 b uLc �pR y�' CJs •'¢� L�'0� SECTION/TOWNSHIP/RANGE SCALE, tt I NOTE, ry(E ,i 4g 7� The Accuracy Of Location Of Exisiting And DRAWN BY, Proposed Property Corners, wells, and Septic jy �tY. C Syatems indicated Ku Not Exact. Dimensions j NORTH o§AQ ZX'Ao aLy_S Indicated [lave Seen Determined By Use Of Cloth .n oses .Dao .� - Tape and/or municipal Records, And Not By Nlil 9ing Techniques M�_ £ PREPARED FOR DATE, SHEET I OF 'Ala � �. �e, re seo o " . � yc�ca M'Aj e bock I UN pvG� i7 y v SEPTI '�' (Ot UTI u77y EA5Er-ISNT NOTE: P All Dimensions And Locations Must Be Field Verified Prior To Construction SEWER. SYSTEM LOCATION PLAN IVT BLOCK SUBDIVISION nNq��4 b uLc �pR y�' CJs •'¢� L�'0� SECTION/TOWNSHIP/RANGE SCALE, tt I NOTE, ry(E ,i 4g 7� The Accuracy Of Location Of Exisiting And DRAWN BY, Proposed Property Corners, wells, and Septic jy �tY. C Syatems indicated Ku Not Exact. Dimensions j NORTH o§AQ ZX'Ao aLy_S Indicated [lave Seen Determined By Use Of Cloth .n oses .Dao .� - Tape and/or municipal Records, And Not By Nlil 9ing Techniques M�_ £ PREPARED FOR DATE, SHEET I OF Frr_rn LF'ItJE TRILL '+017, X145 020. 1•l0•„ 1 . 15' :J U9:=r Hf9 riJ1 S001AA96 uetunH 18 U1Ie9H Aldep 96eaoq�uy }o Ajjjtvd!o;unVq STATE or AY_j�.SKA DEPATtTt-11�14T O1:' NATLIRAIA RESO 7?CE S 1661 r)"'s'014 Or GEOLOGICAL AND GEOPHYSICAL SURVEY: WATF.'R WELL RECORD GIAMH LOCATION OF W`9LL __ __ 130ROUGH SUBDIVISION GC,< SECTION (?TRSFYA. TOW*7SHIP 11 11GE MERIDIAN UYRECTION$ LOT tiL MASURING P0114T: top of Casing ground surface other: BOREHOLE DATA: Depth ,ater a type an co or FrornT To w -,� 11 C�Lb REMARKS: CONTRACTOR INPORMATION: -Regis red Bu91ness Na Si cmat - ure-of Authorizedkapresontacive Date INLLL OWNER: W -RLL DEPT14 - DEATOF COMPLETION:' Depth of holo: 16 `1 fc ! Depth of casingft. STATIC EATER Date���✓ Y� METHOD OF DRILLING: air rot;ar.y �]GablP. tU01 ot.her ` -17 USE. OF WELL: omE:stic ❑irrigf�- ation 1_1monitor public supply othor: CASING: Stic1:-up; 2_ fr . piam: in WELL INTAKE: Open end ❑ screened perforaLed Elopon hole Depths of openings:` LO ft SCREEN TYPE: Diam: ~ in S1otlMo5h Size: -^ T Length: .� ft Set Between and , ft GRAVEL PACK'1'XI'F volume used: _ --Depth to top: GROUT TYPE: � �Vo I ume 1 Depth: fromT ft tO _ft DEVELOPMENT METHOD:__._.__ Duration: ETHOD:T.___- Duration: PU PING LEVEL AND YIELD: eft after �hrs pumping— —9prn (PUMP INTAKE DEPTHft Horsepower: jl Date Pump Installed WATER CHEMISTRY SAMPLE TAKEN? ❑ yes IJ no Well disinfected upon Completion? des j=]no PLF,ASE M TL WHITE COPY OF LOG WITHIN 4� DAYS TO: DGGS PO BOX 77-2116 EAGLE RIVER, AIC. 99577 -- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES 9144(jtvkDivision of Environmental Services On -Site Services Section Vi O �NA(lTyoF P.O. Box 196650 Anchorage, Alaska 99519-6650 141Ny A( SERV MCH�'�9 343-4744N0 V w�s�oH CERTIFICATE OF HEALTH AUTHORITY A X07 APPROVAL FOR A SINGLE FAMILY DWELLING IC V Parcel l.D.# 01'6 -all —3o HAA#�/u 1. GENERAL INFORMATION Complete legal description I -0 -r ��K�� Llc.4C PMzu_ 'S/0 Location (site address or directions) /2,,� `'fa IfLfFe C (R 11 %gh-t!o 57S16 Property owner �� �� ANN CORK fAN Day phone Mailing address Lending agency Day phone Mailing address Agent '�owN1t Day phone S63-55oo Address e(c WHr7r— Co, 3aw C� , Sunt TROD d/`tty ,4 - yg503 �y�N Unless otherwise requested, HAA will be held for pickup. 1-: 2. NUMBER OF BEDROOMS: - 3. TYPE OF WATER SUPPLY: Individual well _K 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 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. i 72-025 (Rev. 1/91) Front MOA X21 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. Name of Firm jl\-tA-3�_-A SVA --)&L � ��w!�hone ? _? 7-6179 Address �7 3 -10 E Engineer's signature 6. DHHS SIGNATURE X Approved for 4- bedrooms. Disapproved. Conditional approval for Additional Comments Cf02CLe Date It /T/4751- OF A °Ne•o �'Y ��� g • ° °° •.e • n a l 4 til• RY,II�• q•• teff' y kGnrn, "$ CE -7953 �F�°°0s•as a°e°°•P� w RcFi:ssO bedrooms, with the following stipulations: Date %2 --5-77 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.1M) Back MOAD21 CAI (TION 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.1M) Back MOAD21 2 Municipality of Anchorage 'FtiTq�r DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 06- 1A 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3433- Health 43 Health Authority Approval Checklist Legal Description: Li L c_ ?n f (_ S�O� L07 Parcel I.D.: A. WELL DATA Well type RIVM ( If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) YF_S Date completed 1116r, 190 // t i Total depth o Cased to �6� Casing height (above ground) _ /a " Sanitary seal (hN) Y6s _ Wires properly protected ('9/N) /r^S FROM WELL LOG AT INSPECTION Date of test11105 /9D l o ,8 I Static water level 13a lab' Well production 18 g.p.m. .6 MIN, g.p.m. WATER SAMPLE RESULTS: F-0(2- 1b9 n1nVu�g 7�9 hn-�,�s� Coliform Nitrate 9'7 -7 fV14 a Other bacteria Date of sample: /i f A8 /9-�Collected by: 7. P. w B. SEPTIC/HOLDING TANK DATA Date installed Tank size /off 61c Number of Compartments _— Cleanouts &N) (aivOra Foundation cleanouts—dor„ i cmc Depression (Yo M0 High water alarm (Y/IQ I -)IA Date of Pumping '10)d,I l r Pumper /M ` PQNqC0S POM1911V& C. ABSORPTION FIELD DATA Date installed ()f3130190 Soil rating (g.p,d./ft2 o ftz/b ) /5 _ System type /?ED Length 5�-I , _Width �� Gravel thickness below pipe O.5 � _ Total de ,w- f- JEEP MrnJ: h Effective absorption area `1 oZ Sr Monitoring Tube present O)N) r1 Depression over field (Y/10 I �-b Date of adequacy test _ /D aS hr Results (Pass/Fail) _ pftSs For _ Row, Lo bedrooms o Fluid depth in absorption field before test (in.); O Immediately after�ro gal. water added (in.): Fluid depth (ins) Minutes later: 1 Lm /U11r Absorption rate = 00+ g.p.d. Peroxide treatment (past 12 months) (Y/6l NOT KrvOwO If yes, give date N I- 72-026 (Rev. 3/96)* D. LIFT Date installed Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES *Datum Size "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /oC 4 On adjacent lots /do Absorption field on lot loot On adjacent lots / b04 Public sewer main SIA Public sewer manhole/cleanout tJ14 Sewer /septic service line + Lift station NIA - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation S + Property line 5 -f Absorption field lU �- Water main/service line 10 t Surface water/drainage /oo Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 4 - Building foundation /o fi Water main/service line Surface water /00 t Driveway, parking/vehicle storage area Curtain drain F.. ENGINEER'S CERTI l certify that l have in conformarO�elwii Signature oriF_ r1N0WN Wells on adjacent lots field inspections and review of Municipal felines in effect on this date. /OO'4 �� U"��"' p ,7 . . eff y A. Garness Engineer's Name v Date 0��il�7'�'�?��u e pp OP O.v P!109tl0 `�4n.� HAA Fee $ C7"""' qq Date of Payment Receipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number `macsimile Transmittal Alaska Water & Wastewater Consulting Engineers L0 -r- G, Q IL �) / &A <:�, PSK- S% - -- -- - ----- v.tt£ntion: +l+S from: Jeffrey A. Garness, P.E., M.S. C,omment(s): Number of Pages Ft 4 D /'1='' ��— LfUN D ij �-I � t l� go (�► S YF G� 0.J 3/9 i SLAC U 0 J x0Oslia-D . Reply requested: 0 Yes 0 No '1320 East Chester Heights Circle * Anchorage, Alaska 99504 * Phone: (907) 337-6179 a' Pax: (907) 338-3246 - Oct -22-97 O6:58P Bonnie Mehner & Associate (907)762-1855 -- --.,ter l Il fr�ra.rA'tltls • �nt+��r,,ir --"''Y �-'t—'. 1Dr 77t.Ri,PM, #I L44, AAWAMM'rp 49T= I 4 a ILS Prr, of ih0 ,rhs••.�onn7larr^.rLj,'• ,�,� !,�/ I � ,. .meq. 'Ir �i A'6re� i 1 I 'N 6q. L. , r ,e'•TWraai d ` � ,� I LLtN181w►I�I4A \ � e PLOTPLAR - AS SUILT w SCALE. I" -!P' mn l 10H Rn- 711 e Bill riIs4Yisal No {mjj Lola AVA041, AUAVM 0iK (gat) 143.6470 i .6ri" tvtf111 1! Lan lirlgli t1,t trlleM-�l�q{ dlecrfl.J }rtpenti I,tt01,611DT918�0 Clot t i�trA114*60 0 4 A66I ri t0 4 tit hS"7 I ittt tcl tM�lfl NI tfil1t iN,u .d a sor Nm�rL r►N .Lr ts.l.rry � ps baiter t1e5 l6 Im7t P"itt7 11icy NAJNMt illrltl 4MMOb 0i 1111 ft"Ir i rotirra Mrd flitnii+rvrn IF16M11toka Ilber x •tk riHbI III/AMM w Ydd }yyrr4 11t6pt at lidl[iwd hmim. DOM 1611 A4 6 pl? 01 ._ , 10 , .. A•.konye. Mwl. It it %lisnip"Obilliv if Ml tiilr tt 41"Mii6 tht /4111l1,n 6i may 64NattlMr Irflsmap or MfWIMA4 wiltk it an aplw at t4f "Ordli ro0at.ilfia plat, vr ry1� t! 1i N bh I i I I MUNICIPALITY OF ANCHORAGEON • Department of Health & Human Services p - DIVISION OF ENVIRONMENTAL SERVICES 343.4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.# I)l�)- _a\\ - __�L HAA# L4falq\c(»-15k 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lilac Park Subd. Lot 6 Block 2 Location (address or directions) (b) Property owner Turn r on r i on Telephone: (home) —NL Business 562-5881 vlalling •.. • Box 3489,u - (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address _ Telephone Telephone (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: River 2. TYPE OF RESIDENCE Single-Family�fD 3. WATER SUPPLY Services 694-51.95 Number of bedrooms a Individual Wella Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On -situ 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 (Rev. 7/88) Page 1 of 2 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 FirmEagle River FnctinPPrina SPryirp.4 Telephone 694-5195 Address —P.o. Box 773794, FagtP RiYPr_ AK _9gq)77 Date 3 /S –?/ 6. DHHS APPROVAL ZKDate Approved for ? bedrooms by v ApprovedDisapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) it, Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 „, Legal Description:c- �Nv,;. A. WELL DAA' {{ �� G® Well Class;l Ovion If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N)—Date Completed Yield Total Depth 16 7 Cased to 62 Depth of Grouting i /// Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) i Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot //U ; On Adjoining Lots ipd To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line -V l'q To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot j5' Water Sample Collected by Water Sample Test Results Comments ; Date COl,w�if L i//%s li r /V (/ B. SEPTIC/HOLDING TANK DATA Date Installed A .3, 5o Size No. of Compartments Standpipes (Y/N) % Air -tight Caps (Y/N) % Foundation Cleanout (Y/N) Depression over Tank (Y/N) A/ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) Z" ; for "`l��_41 Holding Tank High -Water Alarm (Y/N) 0''14 Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well /'lr' T B 'Id' F d +i To Property Line �U / /a To Water Main/Service Line ' o ui mg oun a on To Disposal Field s /' To Stream, Pond, Lake or Major Drainage Course "1111,4 Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / Type of System Design X Date Installed 'F1,"?. Length of Field `� /- ` Width of Field Depth of Field y ���c�j Gravel Bed Thickness ,,-%uare F�eOA-so ti N Area ��� Statndpipes Present (Y/N) pp, V j✓ w C�wfi. Depre%�'lon or(v r+�h�l Y/N) .� Date of Last Adequacy Test Results &" equacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well le J To Property Line To Building Foundation Lot 117% To Water Main/Service Line �S To Stream, Pond, Lake, or Major Drainage Course On Adjoining Lots 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 Meets MOA Electrical Codes (Y/N) Comments To Existing or Abandoned System on 7-.3ca /' To Cutback (if present) Dimensions Manhole/Access (Y/N) *'Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelinesin .effect on the date of this inspection. Signed Company Eagle River Engineering Seiviees t p Y 0. Box 773294 Date 4/1 j;,/5 Eagle River, AK 99,91-��Engin4er s Seal 694-5195-' MOA No. Receipt No. � -2 5, (,S`, � 'Ll) Date of Payment .-3` /5' %/ Receipt No. Waiver Fee: $ �1 v 0 6 Amount: $ �/ � Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ChemLab Ref. 11 :910943 WORKorder :32578 Client Acct :EAGLERP Collected :MAR 14 91 @ 17:05 hrs. Received :MAR 14 91 @ 17:25 hrs. Promised :MAR 15 91 Analysis Completed : Laboratory Supervisor :STEPHEN C. EDE Released By : � LAB INSTRUCTIONS for WOR:.order # 322578 Date Report Printed: NAR 14 91 @ 18:01 Client Name :EAGLE RIVER ENGINEERING Ordered By :LOU BUTERA Preserved with :AS REQUIRED PWSID :UA Client Sample ID:L6 B2 LILAC PARE: S/D ------------------------------------------------------------------------------------------------------------------ Sample ROUTINE SAMPLE COLLECTED BY: L. BUTERA. Remarks: CfiemDab Extraction Analysis Analyst Sample# Test -Parameter Method Units Result Date Date Signature ----------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- I 80153 -NITRATE -N- - - - - - - -EPA 353.2 - - - mg/l - - - /ilu Co • i 0 ) 3- is End of Sample# I Lab Instructions on WORKorder# 32578 1 Tests for this Sample.