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Home My WebLink AboutBOYD LT 1Boyd LOT 1 #015-521-26 MUNICIPALITY OF ANCHORAGE w 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 E] NEW / Q RQYrnon �( BCi1o2 3L y ryz PGRADE MAILING ADDRESS I/ /Y J- To 4c m O:vac(_. A,,A--c e- A,& '/ ? Y`/G LEGAL DESCRIPTION Ar,tc S L c L2 T /LA/X3"IJ LOCATION NO. OF BEDROOMS 7-0 �CiK►» Well Absorption area Dwelling PERMIT NO. DISTANCE TO: UY CL Q Manufacturer ` teri�al No. of compartments w� t7 y Liq. capacity in gallons IF HOMEMADE: Ln side ength idth Liquid depth �UZ DISTANCE TO: Well Dwelling PERMIT NO. 2 Z F Manufacturer Material Liquid capacity in gallons D LU DISTANCE TO: Well i30 Foundation Nearest lot line /U PERMIT NO. $ �O 22► J LL Z No. of lines Length of each line Total length of lines Trenchwid$h Distance between lines z W S e 50 36 inches N'4 cc Fes- Top of tile to finish grade 8 Material beneath tile Total effective absorption area O 9 f inches Length Width Depth PERMIT NO. LU c7 F Type of crib Crib diameter Crib depth Total effective absorption area oQ Ui N Well Building foundation Nearest lot line DISTANCE TO: J 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 e ri 3 c, 3 y vsC, SOIL TEST RATING /saz?`/� INSTALLER �appe- Ex ifs- 7 ,� REMARKS /LS PCkd Z art MG /1 J"T F S O.2 nn Reder,ped .n Ygx't ✓. Su"/ /--I 4y 46CSS rl7awed C7 07 Cs 2 n„"o !n --kwn O yo c9 Z n ,d Jv j -/rum 8 • J - ft /9•S-- 'The JM lwrns• cube very c/en.? T 'T'his Sp' t;,f ~xed A 6,N, /ooAM /,ire .St*-1 l s Redex (fined J')aA-lh w,"fih,� S'P• I tar � r AI'VKUVEU DATE LEGAL 4 —3-85 — /30yd co is %/ 02. Stc - rz 2-013 (Rev. 3/78) PERM�T NO: DATE ISSUED: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: LOT LOCATION: MAX BEDROOMS: ^ RAYMOND BOND 11145 TOTEM ROAD ANCHORAGE, AK 99516 344�5427 SUBDIVISION: BOYD LO SECTION: 22 TOWNSHIP: 12N *1 -.4f 28000 (SQ.FT. OR ACRES) SYSTEM CROSSES LOT LINE ONTO LOT 2 Listed below are the options available to you in designing your septic -j�� DEPARTMENT OF HEALTH AND ENVIRONMENTAL It I!, PRO�ECTION - 825 L STREET, ANCHORAGE, 264-4720 AK -99501 ' DEPTH TO PIPE BOTTOM (FT.) ~��) �� 4.0 4.O ^ RAYMOND BOND 11145 TOTEM ROAD ANCHORAGE, AK 99516 344�5427 SUBDIVISION: BOYD LO SECTION: 22 TOWNSHIP: 12N *1 -.4f 28000 (SQ.FT. OR ACRES) SYSTEM CROSSES LOT LINE ONTO LOT 2 Listed below are the options available to you in designing your septic -ft Choose the option that best [its your site. It I!, DEPTH TO PIPE BOTTOM (FT.) ~��) �� 4.0 4.O TOTAL �7 DEPTH (FT.) ~8��~°�� GRAVEL WIDTH (FT.) 2.5 31.0 5.0 GRAVEL LENGTH (FT.) 185.0 ** 62.0 179.0 ** GRAVEL VOLUME (CU.YDS.> B5.7 71.2 132.6 TANK SIZE (GALS) 1,250,0 ** 1,250.0 ** 1,25O.0 ** SOIL RATING (SQ.FT./BR) 415 316 415 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH> ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS .... ..... .... _________________________ I certi{y that: {amiliar with the requirements [or on-site sewers and wells as set �orth by the Muni�ipality o{ Anchorage (MOA> and J... In State o� Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in complih the design criteria o{ this permit. 3. I will adhe�e to all MOA and State o{ Alaska requirements [or the set back distances {rom any existing well, wastewaterdisposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid �or a maximum o� 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDIN8 CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-8UILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL W8RK MUST BE DONE�BY A LICENSE ELECTRICIAN. SIGNED DATE: APPLICANT: RAY�OND BOND ISSUED BY DATE: _..... ..... _____..... ___________... ..... ..... _..... _... __..... _______ _______________ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �f uP4 �c�p� DATE PERFORMED: LEGAL DESCRIPTION: 136 /,d Jo -ISI, ,�e c 22 7/2-NK.3Q EqT SLOPE SITE PLAN ( E�T UL pr�4mti gw`� 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 n s r � •►-� su...d .t �I �. c 1 P cicah Sa-4 15 0,01 /b-- v,3vp.a—, oljatan� '1u on �n�l 4 L0 - WAS GROUND WATER S ENCOUNTERED? ✓t 0 L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop TEST RUN BETWEEN FT AND FT COMMENTS •Th ,S -c iS � br'% ` //,+ -frclic4 r'fSelf. 1-71& "frtncfi iS /te,,,— 7%4 dr, -1144 7- N. /Q'1z'Jee4 &,d W�5rT I°99ed &-'t SMAS, 9". A /�{�'2. %%e SM .3 cc--f--f(4 cIreLn SctneL PERFORMED BY: moh ST CERTIFIED BY: DATE: /' • f' J rf .yl, 4 X M - • -r-i-e n c /. r -e C&.f "y M cz er a r cl ' ^y / Vy/J/ 72-008 (6/79) U I I �j PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS •Th ,S -c iS � br'% /64 -Ae u,44—A- //,+ -frclic4 r'fSelf. 1-71& "frtncfi iS /te,,,— 7%4 dr, -1144 7- N. /Q'1z'Jee4 &,d W�5rT I°99ed &-'t SMAS, 9". A /�{�'2. %%e SM .3 cc--f--f(4 cIreLn SctneL PERFORMED BY: moh ST CERTIFIED BY: DATE: /' • f' J .,_ .yl, 4 X M - • -r-i-e n c /. r -e C&.f "y M cz er a r cl ' ^y / Vy/J/ 72-008 (6/79) Dc 11 tC R, DEPA Ii 1 il N f 01 1i[ U -II I AN F), N1I i Al, f'lM I I i _ <Permit #: 820696 January 31, 1983 TO: Permit Applicant Subject: Lot 1 Boyd Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerely �'-D "d— Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 111 FOE F"" 7- bil= ;lL -44 - H wl k.A 01 :1 K0 1 "-" 1011.. 1: 1- "i" 1:) F" FA PAI Cl h FK FA C3 !E.`.-:: DEPARTMENT HEALTH AND ENVIRONMENTAL . OTECTION OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF 825 'L' STREET, ANCHORAGE, HK 99501 THERE IS NO SET 264-4720 FOR TRENCHES. K:T 144 --- YET 10- FEE 00 FEE !A.# E":._"F;�,.. T-:::" EE.: 1:-� PERMIT NO. ( 820696 ) ��E::::n ��F-" APPLICANT RAYMOND BOND 54 0*, SRH 1704 TOTEM 99507 344-5427 LOCATION LEGHL L1 BOYD S/D LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 305 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 111 FOE F"" 7- bil= ;lL -44 - IL- ��4 IC.i —7-4 A F& K NI EE L. E> EE FA w Fi= 11L 1121�11 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD, THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION (IN FEET). ��E::::n ��F-" 'T" I ��r-14 11-f, 1: .2-f CA C3 FA L_�CD 54 0*, PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE. - 1,41 HENUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -I- JAI C) ��:::Iu 1. 1 �#F;"FE._ III-! IEE (_� #-.I ]E FZ.-', EEE E';� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE 15 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. KEEEK!"ll 1: K FEE43" 11 E_`.nEEC1EwII7lE3EE:r-P, ��" 1. _. : [. �� I CERTIFY THA"I" 1: I HM 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 THE CODES. ]: I UN E S R SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS|MMN 4 BEDROOMS. SIGNED:__ 94.-�� -------- (6L/9) 800-ZL :31V0 :AS 0313111330 Aomuv� :A8 O3Wa03133d i^17/ S1N3WW00 v 4� O , / .r (INV 13 L N33M138 NnH 1S31 (youl/sajnulw) 31VU N011VIODH3d 0z +0, 6 L' 1 g4 : d1 -- `t PJ• o gz:1 L2N t 0i in I I b9 O c)p ; I ° oq 0 O 55 -• Z i �� -4 L°) p1 .yy'•Z� 2 o, o �14:ZIH doa0aaleM (%A%,I) awll awll Ole(]6ulpeaa ION of yida0 ION ssoa0 6L SpllQS'l�}I�c 8L LL 9L 9L tit tHld30 1VHM 1V 'S3A 31 3 ZL d O L03831Nf)03N3 L L S ©N H31VM 0Nnoug SVM OL 1 6 8 L 9 b Z L Q NV -1d 311S 3dO IS vi c; p hO9 :N0I1d1130S30 �V�J3l L :03W130JH3d 31V0 p,noe� \7uoww,,-� :1303 (13W1303133d 1S31 NOUVIO383d — OOI SIIOS OZLV-V9Z 10966 e)lseld 'eBe.wyouV '180JlS -1 9Z8 1S31 � NOI1V�003d ® N01133108d Ib'1N3WNOHIAN3 UNV H11V3H 301N3W1HVd3o / 3E)VHOHDMd :J0 A11I 'd13INnw 901 silos 9. GPcATER ANCHORAGE AREA BOR011 .H HEALTH DEPARTMENT NO 30` 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME 'T® ,M&jeZV i� ADDRESS 2�e ,L2L-:�4 .d�HONE LOCATION Tr%�� ! SU. 0 .� e� 4IrYDESCRIPTION SEPTIC TANK: NUMBER OF DISTANCE FROM WELI-AeAft�% �d MATERIAL - COMPARTMENTS_ LIQUID CAPACITY 1�'2-52 GALLONS. INSIDE LENGTH INSIDE WIDTH SEEPAGE SYSTEM: SEEPAGE PIT: LIQUID `_ DEPTH i i NUMBER OF PITS H / OUTSIDE DIAMETER �! OR WIDTH LENGTH DEPTH, LINING MATERIAL ��1 �� ✓/ DISTANCE FROM WELI_,O , l�� / BUILDING FOUNDATIONe !z NEAREST LOT LINE �2 `T TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) �e SQ. FT. TILE DRAIN FIELD: TOTAL LE GTH DISTANCE FROM WE FOUNDATIO NEAREST LOT LI 7OF LINES NUMBER OF ES DISTANCE BETWEEN LI S TR CH WIDTH IN. T TAL EFFECTIVE ABSO TION AREA SQ. FT. LENGTH O EACH LINE PTH: TOP OF TILE TO FINISH GRADE DEPT TER MATERIAL BENEATH TILE IN. ABOVE TILE WELL:/ DISTANCE FROM ! WATER TYPE �/�0�-ism DEPTH/4V BUILDING FOUNDATION. ✓� SAMPLE, NEAREST ! NEAREST SEPTIC�� v SEEPAGE 41< ! OTHER LOT LINE �d SEWER LINE �� TANK 71 SYSTEM 240 CESSPOOL SOURCES ` DIAGRAM OF SYSTEM DISTANCES: DATE / APPROVED HEALTH AUTHORITY GAAS-HD-2 GREATET 'ANCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 ')ROUGH Case No. 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT IOWA A4U!e Too MAILING ADDRESSTo> 1-204 PHONE N RESIDENCE ADDRESS70f4etll Q ��F' O'/4*1AAOCATION OF INSTALLATION IY M/' IAI QX) a�OPM LEGAL DESCRIPTION .�OT� ' / e"�&=2 0;�ZAQ 44/CP APPLICATION TO INSTALL: SEPTIC TANK Poll, SEEPAGE PIT , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY EDRM 400 S �- FINANCED THROUGH TO BE INSTALLED BY 4ZJ %2 / PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION_ )-Z' Ar iyornc6 BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS 41e, NOR �V , PERMIT TO INSTALL A AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED 4` eiyn SEPTIC TANK SIZE 1 TYPE % —7'SEEPAGE AREA TYPE de4.5 Se�.Q DIAGRAM OF SYSTEM DISTANCES: HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that.the above described ystem is in accordance with said code. DATE '/ APPLICANTS SIGNATURE Q Z- 3 4 GREAT P ANCI )R_A"-T ARY;A 11,0 ROUr", MAJA H ': LEE! i T CASE V 327 1,AGL1: �'I'RFET .� ANCHORAGE, ALA5KA 99501 performed For .` - A/ i` c'y . _ Date Performed e Legal Descriptions Lot e BlockSubc'.iv'sion Logue -Pem �y�.��'��> 'res't This T'crm Reports a'. �o1].s 1�/ atinn, Depth .'ee% Soil Characteristics Location Sketch Proposed Installat�' ; ~Seepage Pit l Brain "io].d Depth Of Inlet '% Uei�ih TO Bottom Of Pit Or T }. �,:...�ra.,........ COMh1EW."S : r�nc.h �. _...._._ Test Performed By, ---.L Data Certified By: Date : , / Ly ._ .FROM : ALPINE DRILLING FAX N0. : 907 345 0202 Jul. 07 2004 11:31RM P^. Municipality of Anchorage ACUL Department of Health and Human Services $25 "L" Street P.O. Box 196550 Anchorage, Alaska 99519-6650 Rick Mystrom tntp:jN~.ci.ancnorepe.ak. us Mayor Permit Number: #SW _ Date of Issue: _ Parcel Identification Number.____ Date Started: &1_02 Date Completed: 8-2-02 is well located at approved permit location? ® Yes ®No Legal Description: 6oyd Lot 1 Property Owner Name & Address: Raymond & Lela Bond 11145 Totem Road Borehole Data: nrv„v,w DeptL r(ft) Method of Drilling® air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing. stoof riPe� — ehisting well 0 115 Wall Thickness: .250 inches silt 115 125 Diameter: 6 inches Depth: 115 feet gr~dvehy silt wet gravelty silt 125 156 i56 170 Liner Type: A101 Diameter: flinches Depth: 10'to 173'feet Casing stickup above ground: 9 feet water sand & gravel 170 173 Static water level (from ground level): feet Pumping level: feet after 2 hours Pumping 2Q gpm Recovery Rate: 20+ gpm Mcthod of Testing: gLr Well Intake Opening Type: ® Open End ❑ Open Hole Screened Start _ feet Stopped — feet Perforations Start feet Stopped feet Grout Type: — Volume., _,_,_ Depth: Start feet Stopped ^ feet Pump: Intake Depth — feet Pump size hp Brand Name Wei] Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: chlorine tablets Comments: Well Driller. Alpine Drilling & Enterprises PO Box 110496 Anchorago Alaska 99511 Attention: The well driller shall provide awell log to the property owner within 30 days of completion and the property MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section J� Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-521-26 Legal description BOYD LT 1 Site address 11145 TOTEM RD Anchorage AK Current property owner(s) STRICK Expiration Date: 6/23/2025 X The On -site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 7/30/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE A" Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcell.D. 015-521-26 Complete legal description Boyd Lot 1 A- Lo -r ?_ Location (site address) 11145 Totem Road, Anchorage, AK 99516 Current property owners) Gerald & Dorothy Strick Day phone 2. ON -SITE SYSTEMS SIZED FOR BEDROOMS 3. TYPE OF WATER SUPPLY: RN Private Well R Private Well serving 2 dwelling units M Private Well serving 3+ dwelling units R Community Well or Public n Water Storage 4. TYPE OF WASTEWATER DISPOSAL: FE-1 Private Septic 0 Private Septic serving 2 dwelling units El Holding Tank F-1 Community Septic or Public Sewer 5. SEPTIC TANK: F-1 Steel R Plastic OR Concrete R Fiberglass Age 53 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: E] AWWTS Fj Bed FE] Deep Trench E] Wide Trench RN Seepage Pit Waiver request for: Expedited review requested: F Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $__5�Q Date of Payment 617- L I COSA # 00 C, 2-H I 110 Waiver Fee $ Date of Payment Waiver # COSA Application —June 2022 COSA Checklist Legal Description: Boyd Lot 1 & Lot 2 Parcel ID: 015-521-26 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA � Well log is filed with Onsite (or attached) Date drilled *1970 Total depth 173 ft Cased to 173 ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) +18 in. Date of flow test for COSA 6/17/24 Static water level at beginning of test 53 ft. Comments *Well deepened 8/2/2002 B. TANK DATA Measured operating fluid level in septic tank *--52" Date of pumping 7/11/24 (Northland) ❑ Required maintenance completed, if AWWTS Comments: *tank visibly full, measuring stick bent D. ABSORPTION FIELD DATA Which system tested (date installed) 1970/1985 FE-1 ALL standpipes present per record drawing Total measured depth from grade 12.4113.7 ft (max) Measured depth to pipe invert from grade *None ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 6.2 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes [11-1 No A Coliform bacteria is Negative Nitrate 1.16 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L FE-1 Arsenic less than MRL (ND) Collected by Forge Engineering Date 6/23/24 C. LIFT STATION M-R,,ired maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results Q Pass 6/17/24 Fluid depth prior to test 30/0 in Water added 797 gal New fluid depth 43/0 in Elapsed time 1440 min Final fluid depth 36/0 in Absorption rate *''600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72/84 in Effective depth used 36/0 in Effective depth remaining 36/84 in Comments/Deficiencies: (Measurements listed Crib/Trench) *Absorption systems have no COS **Unsure percentage of flow between systems, but assuming at least 100 gallons went to trench COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' *72 Community Sewer Manhole/Cleanout > 100' Yes if No ft 0 Yes if No ft Neighboring Tank > 100' g Yes if No ft Private Sewer/Septic Line > 25' Fil Yes if No ft Absorption Field on Lot > 100' 50-1 Yes if No ft Holding Tank > 100' R Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft Ro Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' FN� Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fm� Yes if No ft Surface Water > 100' R Yes if No ft Tank to Property Line > 5' R Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' © Yes if No ft Private Wells > 100' F' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 9 Yes if No ft Water Service Line > 10' FEI Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *Met code at time of 1970 construction. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Forge Engineering Engineer's Printed Name Benjamin Schuller, P.E. Phone (907) 522-7773 Date 6/19/24 OF At, fj BenjarrrSchiller CE 12592 ��lidpROFESSt4Nt`�'F..,o,..- COSA Checklist June 2022 Municipality of Anchorage • Development Services Department iBuilding Safety Division . V. On -Site Water and Wastewater Program " 4700 Bragaw 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 I.D. 019;-1;21-26 COSA# 1 J6641 Expiration Date: r- 2 Ste- / O 1. GENERAL INFORMATION Complete legal description _ Boyd SID Lots 1 & 2 Location (site address) _11145 Totem Road, Anchorage. AK 99x16 Current Property owner(s) Matthew & lanell Kurchinski Day phone _267-1414 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 11145 Totem Road Anchorage AK 49516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 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. c based on procedures outlined in the Certificate of Onsite 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 Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 1002-17. Anchorage AK ggao Engineer's Printed Name Steven R. Pannone P.E. Date g/10/10 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. '��p��aa as The operational life of all wells and septic systems depend on the local soil condition, ground water �. �� (� q� 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 ; + a9'" •�� satisfactory test results do not guarantee future performance of the system, nor do they guarantee that ; there are no hidden defects or encroachments. IGS can therefore not provide any warranty for future $ performance nor give any estimate of how long the system will continue to meet the operational ... _._. f �y requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed # c Ste Na CE a e3 �! r�� above. Any reliance upon or use of this report by any other person or party is not authorized nor will it #i}`,r confer any legal right whatsoever. 4: 5. DSD SIGNATURE ••••,aaaF; :::::Q'•••• !/ Approved for _�_' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic huvwut y Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: 3 O (It" „ Municipality of Anchorage ' Development Services Department Building Safety Division n On -Site Water & Wastewater Program '" `•' 4700 Bragaw 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: -Boyd SID Lou 2 & z A WELL DATA Well type p a (yinull� Pbri(¢ct(YIfA, ,provideWSID # 70 Date omple ed8 2 2002 Sanitary seat (YIN)y Dee_pe+tect Total depth _U3_ft. Cased to 172 ft. FROM WELL LOG Date of test SW2002 Static water level ft. Well production 20+ g.p,m• WATER SAMPLE RESULTS: Coliform �colonies/100 mL Nitrate ' mg/L Arsenic: g-1,71 ugll Date of sample: 0 0 o B. SEPTIC/HOLDING TANK DATA Parcel ID: oic-S22-26 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 22+ in. AT INSPECTION alio/2020 '6o ft. 6.o+ g.p.m. Other bacteria-9fcolonies/100 mL Collected by: Laura Pannone Tank Type/Material _AS&G Concrete Date Installed 9/aho7o Tank size 22S0 gal Number of Compartments 1 Cleanouts (YM) Y Foundation cleanout (Y/N) y Depression over tank (YM) N High water alarm (YIN) NIA Date of pumping _7h612009 Pumper Isaac's Pumping C. ABSORPTION 1�,DLDATA Cr t `i 0 — Date installed 6 _IS Soil I rating (g.p.dA? or fti/bdrm);So System type Cribfrrench v'28, Crib pl ci, r 6 6 0 Cr -r b Length go ft. Width Scr��8� or I ft. Gravel below pipe '' Taft. /a.% y Total depth }ter ft. EH, absorption area Lfti Monitoring tubel' Depression over field N Date of adequacy test 3 io/2o2o Results Pas /Fail) Pasi For r bedrooms (3�4 Fluid depth in absorption field before test in. Water added600 gala New depthi6/Dry ln. Elapsed Time: 3o min. Final fluid depth Iron In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ N If yes, give date D. LIFT STATION Date Installed Size I al Llein. Manhole/Access (YIN) "Pump on" level at _ in. 'Pump off" High water alarm level at in. Datum CyclesMeets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 72'* Absorption field on lot zoo+ Public sewer main N/A Sewer /septic service line 15+ Animal containment areas soo+ On adjacent lots zoo+ On adjacent lots zoo+ Public sewer manhole/cleanout NIA Holding tank zoo+ Manure/animal excrete storage areas zoo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation moo+ Property line so+ Absorption field io+ Water main NIA Water service line zc+ Surface water zoo+ Wells on adjacent lots ioo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo+ Building foundation zo+ Water main N/A Water Service line zs+ Surface water zoo+ Driveway. parking/vehicle storage o Curtain drain None Known Wells on adjacent lots zoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION � Under' I certify that / have determined through field Inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. DateI/ /ObS COSA Fee $ 'T q 0 Waiver Fee $ Date of Payment .7?—.�Gr�o`� Receipt Number 2 -/ O 9 7 (Rev. 11/05) Date of Payment Receipt Number ••�OF �� QgJf n'NtO�tf"`� 40L- iN0 � f' No. CE 8.14: •��Zj'`•. ........ W i Roo ma.®.earn m.a1 mart �Aa{- eITMa sa e.n.o ><Tuol ArM euuR lArIX I I 33' 3 I mSNE ,/0.77 ,.9.97 K :::::::::: 71.3 789 ..................... GARAGE ......r ......:•rr EMWSEG O I (4 g o e e r. I pb al I m m O 10 5 713 y I f0• SE W 8 TELE ESMT to SEW 8 TELE ESMT I N99. 50' 10'YI 796.67 - 112th AVENUEL — - — - — ` - - — UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT=LVET SURVEY TYPE SYMBOLS FOUNDAT" AS -soar MAL STRUCTURE A9-BuaT ,,,a® a SET REBAR y DRAINAGE ASPHALT PIAT PLM ... AS-aXT ... LOT wRl[Y ... TDPOORA y o FOUND REBAR WOW FENCE CONCRETE AS-DATSETREOMWXATION AS-PATtooCOWIMS SET® ASSUMED ELEV. .11—,I. -.,I- METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBIUTY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION Prepared by PLOT PLAN ••••",%,,• oF, •y Robert E. Johns, Jr. &Assoc. •oP�E 4 Professional Land Surveyors e•� a C.w �. E. 2 AVE. TALASKA r r w642 AV kt ANCHORAGE. 99501 Scale:R Rec. Lot S.F. Rea. Plot Fie No. Yj• h •• FOUNDATION AS -BUILT y•••• ••• •••••• •• •••••• •• • •/ - , 1 - 50 r r.A•... w ...e,A, r.•rr,. e. Sur ied Date : Ora" by Checked by. u•o• o:•• ••1o••u 10 REJ JMK OBERTJR .• o Data oe: Grid: W.O. P•• 4 -S 3/10/10 2637 152 FINAL STRUCTURE AS -BUILT �•.. •• Legal Diption;.i a rarA.+F 1 � 'm� •:••••• Lot 1 & 2�� .-, BOYD 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 i 52,1- W(e Parcel 1. D. O 16 -- GENERAL INFORMATION INFORMATION HAA # 04 030� Expiration Date: /_064? 5 L. S -T_Z�" Complete legal description $0 `I D -"-I[> L -OT 1 R4!� 1 Location (site address or directions) 1l l b T6-1 E 't -k 0A Q Current Property owner(s) L-A& 3©vi eI Day phone -346- 027° 7 Mailing address t t 1 4 5 Tot t= M Z0 A, C� cAg5l(, Lending agency Mailing address Day phone Real Estate Agent 3066'1 C'ar pzu TN' 1 IYr Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 14_ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well " ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ 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 supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority 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 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 vt l,clavt_ 7L Phone 97q-39'16 Address__ 203 iXi lsLr� �'2n3 Engineer's Printed Name 5. DSD SIGNATURE �/ Approved for Disapproved. bedrooms. Date to o Y 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: � Z o UU (Rev. 01102) Nunicipality of Anchorage B , Development Services Department' Building Safety Division ` $qF CTY On -Site WaCer:& V�(astewater Program d76�South Bragaw St O Anchoo rageAK 9J51g=6650 2ncnorageak us ,. ,...,. �..... , .. � , EALTH 11THORITYAPPROVAC CHECKLIST °c.IPIR .r..::».m ....: w,n t �5, �' L scrip ion: of e "'Parcel ID: -- 7 A WO } . _ �w k� ..�" � � �� fir' •'��: " •.� .� .., .;. ,. ,,.. �- If A B or C provitle PWSID # w Well Log(1�JN) Sanitary seal (Y/N) Wires properly protected (Y/N) �� i I ft. �bCased to l3 ft. Casingfieight (above ground) fq in ,�9`�F 3nk� `Jek%�*>'�4"�j { '�f W..iwriN'"•"e�'w. is i' ms rr ;4 la er eve , colonies(1A0 ml" Nitrake 4 1 . ` mg./I. Other bacteria iv colonies/100 ml mg./I. Dake of sample: `b/.2�%(Dy Collected by h . ��vvY 1 alta L � d ,h��. u- Fa$ ✓eM�"3�°^�IM�w��"t«,�i��Ys°F +�a' .;v. zslf pe akena , re S� r Date installed 9 3 DC7 e5D gal Number of Compartments l Cleanouts (Y/N) ' ANai+w :'�."+'�+a;�Ymtl ,�„��tGr�+zaviz ;..s ,sc.,u> �s=,�,.. .�a�...�•t� �, ,N/ ion cleanout„(” Depression 9verta„nk (Y/N) /�% High water alarm (Y/N) pnrripiny iDN Pumper �Uua.e,3 a e Soil rating (g p d:/ft2 or ftz/bdrm) System type I rent h ft. Width ' ft. Gravel below pipe_ ft. p z ' pth f0 ft. Effqq absorption area' ftz Monttoring tube _ Deprassion over field _ guac�r es � � F2esults (Pa'ss/Fail) � For bedrooms p , in a so"rp ion' ie dbe ores New depthO in 4 imer'&-;VMrT-� Final fluid depth 10 in Absorption rate >= Cw g.p.d %9•.: -. .. ,. w. ... . ,-. �: mid=•'aY'..9`f?�.,.h'+u3F'�YY`@4,aS.'.'i:��1A�t"X:.fi "X;,, �+: 'K':�. _ in. "Pump off' level a _ in. High water alarm ley n. requirements? d through field inspections' and fiat the above systems are in guidelines in effect on this date. 08/23/04 WED 12:( 'SENT ;BY STEWART TIT t . d r: es/V6 / 2 1 FAX 1 907 782 3189 Jack White Estate .E OF AK ;11-18-83 2:3B N TIT1x1AbNIN-STEWART TITLE I Af-1 17 AO VA" U4K w�¢t•LS Cs.w•• e•µ+ \ � ,� �r•HO FIRES a 0 Q A( Booz ;112/2 7.1 F C AS -B IIS f A4 CA 49 t.S. .... ••N1 t.. • 0. ]INr•• N to 'j.\ a �+ 6185 y of u* der or e 1fWi�t 00 nn. �t'.{FG ST F� a, N tl LDT SUR y C k 1 N • stNl ►In Lot If , Block -o surest Hub • took am iar p Rtsord n Precinct, Alaska y ti- D/cir/A40-OSWALD 6 AARrx Residenes of; OW Cordaroheel PR, pr7-1686 ro.o To 2 > D m 0 mm mc,m m=z Z O m 0:O Z m xOD o Z Z m O mm mmo M M09 002 zom mp om r; n p Z � c � I r ,U fit I ° s N _ � b \ 411°° ry�00pn Na O N C F 61 O O O I� o Q 3� O� "y 4 , (� n on w > R I` i m �' g 9 3 to 'a z0 -'' m 3 g 3 Er p w. y N 21 O O O ry a 0 >__53m n5 _ > z wm],�3- rn p1 � m N 7 0 O �. m -nO � S pm° m o a o EF ° m _ dy IR> o. V' D vgy N L7 w C\� O oD w25" m > m p1 oi vp 3��'�a n J N b N 08 5 m� m.�N w m sas_FLC Io' Vfl1. Fsmf, S0003'30 E 99.nn z Totem Rai. 8261? U y w SO 004'Oo"E 9 9, 00 fit I ° 03 Co � b \ 411°° N I� o 9 3 to / -' 68 f n n fit I ° 03 Co O S y f n m � _ V' C\� I W I Io' Vfl1. Fsmf, S0003'30 E 99.nn 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 2'2— 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) LOTS 14.2- (30Y10 61D Location (address or directions) I 11g5 TOTEM RD (b) Applicant Name Ra Telephone: Home 3416-2707 Business 3gy'S�2Z Applicant Address _iII q TOTEM R1b, ANG H. AN g9�/6 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Eff ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent — Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Z Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well I9 Community ❑ Public ❑ Telephone 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 0 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 I- OTS ► q-2 80L 0 61L 5. ENGINEERING FIRM PROVIDING wiSPECTIONS, TESTS, FILE SEARCH, DATk ,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 h EG5aycl Telephone 61 `6705/0 Address 2 0 G10,,�3 A-UE� .5 y l TE ,Q 41VC 14-,-.. `?Q_83 Date REMOVE COMDI •Tr ON14L A/SPEC rE0 S-12-1196 43Y JEFF K/}/Tcravcl� S fiPTlc. T iNK cl- CR ib S rAIVD PiPas &OC-/4TCD I— C61P aD Ar •° �- Vn • Y C. REID, JR. AV 1! n ?Js E - 2251 !43,g Prote 6. DHEP APPROVAL Approved for bedrooms byOC i -Q Date�� ` Approved Disapproved Conditional Terms of Conditional 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 72-025 (11/84) ALASKA ENVIRONMENTAL CONTROL SERVIC INC. 1200 West 33rd Avenu,., Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 ,oB 1-01-5 1 *-Z 6 LOCK e Q s SHEET NO. OF {{ y CALCULATED BY �^ DATE CHECKEDBY DATE SCALE MUNICIPALITY OF ANCHORAGE ',,PAH f qQE', V I- OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH 10i iF!'"Ai E OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date �//// 1. t f'::' HAL INf'QItiVATION ion (include lot, block, subdivision, section, township, range) Location (address or directions) (t�1 applicant Name------ Telephone: Home i' Business Applicant Address ll/%'a/. ' lWell, 14, (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder, ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution_tsG�S�c:c`) cn i Telephone Address a � Ai"� PDfoilK:-,)C_ It . (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other ►[111-3974"Sw0 • • u 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. Page 1 of 2 72-025 )11,84) z INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMA110N Aa t,t)rti rr.=,A by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health o,uti tot ih.f Appi oval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedroorns and type of structure indicated herein. I further verify that based on the information obtained iron, the Murricipaiity of Anchorage files and from my investigation and inspection, the on-site water supply and/or wash wa.tei disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the gate of this inspection. �1.�- / i�arnt; oI 1 it rri .- - ---- —!( `- �p 5 Telephone 5'�'/ r C16 ---------------- — t_3atc Ci`�t';s ere'` ��P'Tic 7i#r%r 5?��Pri'E �� ,•..«..,®,.'QS"� CO )TIj* 0• nZn hw A.j •cea.:, rye' AY. C. REI n ne peal®° �W 6. DHEP APPROVAL Approved for /—CXIP,, bedrooms by c- at, V/vv X6 Approved Disapproved Conditional >/1 T rms of Conditional Approval GfL-t _/r(� ( -r�-�� c�-e— Ce �c c.,_s 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 MUNICgg,&Y OF ANCHORAGE (MOA) MUNICIPALITY (a N DEPT. OF 1'I�hT AAUTUT HORITY APPROVAL (HAA) ' EwiRoNMENTAL PIR IST FEBRUARY 1984 264-4720 APR 1 i R ,Goffs / 1301 s/h Legal Description: A. WELL DATA RECEIVED Well Classification ��IS_ If A, B, C, D.E.C. Approved (Y/N) 0 Well Log Present (Y ) Date Completed PRC / 9 7-5' Yield %•y 'om Total Depth G Cased to'� 't Depth of Grouting it /�" Static Water Level ,to 61.3 Pump Set At W Casing Height Above Ground Sanitary Seal on Casing Y/ ) Electrical Wiring in Condui (Y N) Depression Around Wellhead (Y19 Separation Distances from Well: To Septic/Holding Tank on Lot % ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot X30 / ; On Adjoining Lots �� f To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole dTo Nearest Sewer Service Line on Lot Water Sample Collected by ECS /��N ; Date 41-r- r& Water Sample Test Results SST�2� Comments i' 11 W&u' ftp 'QST _�-144 • 1Ar COHPA-0M w10WA1 ,,Isa B. SEPTIC/HOLDING TANK DATA j Date Installed %3 �7� Giz �y �gL No. of Compartments Standpipes (Y/N) ?6':CdN 6'/73 Air -tight Caps (YIN)AW ci?!HK^lTs Foundation Cleanout ((Y V� Depression over Tank (Ye1 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A,,1;for Holding Tank High -Water Alarm (Y/N) r Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: i To Water -Supply Well 7ZTo Building Foundation i To Property Line To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments eo*4 ,wr- A44ppe _-rr*APIPE. $a,elA 4,wbo E' lee- 4 s.✓hJ. Cai✓biTi�ifz ?o ZOM'id' /AI' SP&1A1#. -)4 ?��s7,wl�o id 6WZ14140 AWsAI Page 1 of 2 72-026(11/84) L / # Z_ $oy/b SO) C. ABSORPTION FIELD DATA Separation Distance from Absorption Field: " / To Water -Supply Well 130 To Property Line A0 To Building Foundation To Existing or Abandoned System on i r Lot * ZS ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway,Parking Area, or Vehicle Storage Area T" Comments -i�`,' G'R/B / ,bCVW -,056-b M-6VOrGftJ 109W-a,*006C . 4Wd-b A/c7 Aoc'/fe- , 57*01?g- $gytA #W&R /Cgr 41.S.e%x). c'.A✓DiysWhg. T Goayr /,% 5NIA14. D. LIFT STATION DateInstalled 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) Pumycles during Adequacy Test. Meets MOA I certify that I hav ecc d,,�ve0ified, or conformed to all �MjOA and HAA guidelines in effect on the date of this inspection. Signed G --i - G'�L"" Date Company MOA No. rl-- Ovr •�+~'�`,� Receipt No. .3'1 Cl 3013 Date of Payment L� ' \- S(D Amount: $ (0S,CX::>' Page 2 of 2 72-026 (11/84) .. Q•; .• •• ;s,�.�� .�. i y:49zH •9*♦� 100 0.• •►•• • • w • �••e� • UR C. REID, JR� CE - 2251 f , AF � It Wk V"lk d / 5 Soils Rating in Absorption Strata Type of System Design Date Installed G - S �� D1�b P�96E P Length of Field �V r Width of Field / Depth of Field Gravel Bed Thickness 7� Square Feet of Absorption Area %&V Standpipes Presen (Y ) Depression over Field (Y(9 Date of Last Adequacy Test Results of Last Adequacy Test AJIX Separation Distance from Absorption Field: " / To Water -Supply Well 130 To Property Line A0 To Building Foundation To Existing or Abandoned System on i r Lot * ZS ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway,Parking Area, or Vehicle Storage Area T" Comments -i�`,' G'R/B / ,bCVW -,056-b M-6VOrGftJ 109W-a,*006C . 4Wd-b A/c7 Aoc'/fe- , 57*01?g- $gytA #W&R /Cgr 41.S.e%x). c'.A✓DiysWhg. T Goayr /,% 5NIA14. D. LIFT STATION DateInstalled 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) Pumycles during Adequacy Test. Meets MOA I certify that I hav ecc d,,�ve0ified, or conformed to all �MjOA and HAA guidelines in effect on the date of this inspection. Signed G --i - G'�L"" Date Company MOA No. rl-- Ovr •�+~'�`,� Receipt No. .3'1 Cl 3013 Date of Payment L� ' \- S(D Amount: $ (0S,CX::>' Page 2 of 2 72-026 (11/84) .. Q•; .• •• ;s,�.�� .�. i y:49zH •9*♦� 100 0.• •►•• • • w • �••e� • UR C. REID, JR� CE - 2251 f , AF � It Wk V"lk 60141 ALASKA �,idlRO MenTAL COnTROL SCI 1US, InC. Engineerinq & 6nuironmental Studies RAY POND SELLER—RAY POND 11145 TOTEM ANS ALASKA 99516 LECAL:BOYD SUBDIVISION LOT 1 & 2 FLCW TEST ON WELL WELL FLOW DATE -04/08/86 04/10/86 RAY POND 11145 TOTEM ANCHCR40E ALASKA 99516 A FLOW TEST WAS PERFCRIVED ON THE WELL. 750 CALLONS OF WATER WAS PUMPED AT A RATE OF 6.2 GPM OVER A DURATION OF 2 HOURS. THE DRAWDOWN WAS 28.8 ' WITH A RECOVERY TINE OF 60 MINUTES AND THE STATIC WATER LEVEL WAS 61.3 FEET. THE WELL IS ADEQUATE FCR THIS 4 BEDROOM HYVE. 1200 West 33rd Auenue, Suite B • Anchoraqe, Alaska 99503 • (907) 561-5040 ALASKA ENVIRONMENTAL CONTROL SERVIrcS, INC. 1200 Woc+ ,", , . E ALASKA PUM PING AND LINE CLEANING Box 10232, Klatt ANCHORAGE, ALASKA 99502 Phone 344-7732 ,oB 407-5 / f A ZY-deK 0 boYa '/fit SHEET NO. CALCULATED BY CHECKED BY— —O F L{/ / ' lo/� DATE /y -f6 ./Q DATE All claims and returned 0000. -�UU anted by this bill. ci'i. a,comp �� // 808 29 O n SERIES Qui _.. elww ml ® Im. Galen. Mm 01471 THIS:-SIDE FOR OFFICIA USE'ONLY - INSPECTION.APPOINTMFNTS 71ME TIME= TINTS DATE bAtE DA'I`S INSPECTOR - - 1-NSPEGTOR INSPECT R = - DIRECTIONS, 1. TYpt OF`ItE9lD1=NCE NUMBER OF 9EDROOM& ❑ SiN.GLE FAMILY I7 ONE ❑ THREE ❑ OIVE ❑ Ol`HER ❑ MU1.TIPLEFAMILY ❑ TWO ❑ FOUR ❑ SIX 2: VIfiA� ER SUPPLY PERMIT NUMBER ❑ 1NDWIDUAL DEPTH OF WELL - - ❑ COMMUNITY `_ DATE DRILLED ❑ PUBttlC UTILITY - --Connection Verified LOG RECEIVED - 31. 'SEWAGE,[SPOSAL SYSTEM PERMIT NUMBER INDIVIDUAL/ON SITE - DATE INSTALLED C`]PUB IC{JTILITY l q 7 0 Connction'Verified` INSTALLER, l3 septie_fankc or ❑Hold ing- Tank Size. ,� If Tank is homemade SOILS RATING give dim�nslons: '"r'f�1aw►S - TYPEOTANK-- - MANUFACTURER - - - _ TOTAL.ABSORPTION AREA MATERIAL = 4: DISTI4NCES Septic/Holding Tahk absorption Area = Sewer Line UT Lot= ane . WELL T0: Absorp4i7 Area to nearest -Lot Line COMMOT_-S lam' APPROVED FOR S BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) - LEGAL-D-ESC LPTION =` 7Z 010 (Rev. 3/751. - ALASKA DEVELOPMENT CONSULTANTS ENGINEERS SURVEYORS PLANNERS 5905 OLD SEWARD HIGHWAY ANCHORAGE. ALASKA 99502 OFFICE: (907) 344-0313 October 24, 1978 ADC No. 78109 Mrs. Sheryl Davis SRA 1704 Anchorage, Alaska 99507 Re: Adequacy Test on Existing Septic System, Lots 1 & 2, Boyd Subdivision. Dear Mrs. Davis: At your request, we have performed an adequacy test on your existing septic system at the above referenced location on October 23, 1978. You reported that the septic system is comprised of 2 septic tanks and a drain field. The following table represents the depth of liquid in the septic tanks as measured from the top of the 4 -inch stand pipes. The initial liquid level in the tanks was determined to be 6.0 feet in the tank near the house and 9.3 feet in the second tank. Since the addition of approximately 65 gallons did not raise the level in the tanks, the septic tanks were assumed to be full and at their liquid capacity. Summary of Measurements Time Liquid Level from Top Stand Pipe Meter Reading Remarks Tank ## 1 Tank ## 2 Gallons 1:43PM 6.0' 9.3' 00.0 Add 50 gal. 1:56 6.o' 9.3' 50.6 No RISE 1:58 Adjust Flow 2:05 65.3 Begin Test 2:10 73.0 (7.7 gal/5min=1.59pm, 2:15 6.0' 9.3' 79.3 (14.0 gal/lOmin=1.49pm 3:43 6.1' 9.0' 205.0 (139.7 gal/98min=1.4gpm 4:02 231.0 Adjust Flow 4:07 238.9 (7.9 gal/5min=1.6gpm 6.05 6.0' 9.0' 419.2 End Test 353.9 gal/240min=1.5gpi Meter used during the test was a standard 5/811 Neptune water meter borrowed from the Anchorage Water Utility. October 24, 1978 Mrs. Sheryl Davis ADC No. 78109 Page -2- Since your 5 -bedroom residence was occupied, it is assumed that the drain field is at its normal degree of saturation. To further insure normal saturation and to fill any possible storage in the system, approximately 65 gallons of water was added to the septic tank prior to beginning the four hour percolation test. If it is assumed that this 5 -bedroom house can house 10 people, the average daily load on the disposal system can be expected to be about 750 gallons per day. The maximum hourly load on the system, then, can be expected to be about 1.5 gallons per minute (gpm)• Since your existing disposal system accepted 1,5gpm for 4 hours, slightly more than half the average daily load, with no significant change in level in the tanks, it can be concluded that the system is presently performing in a satisfactory manner for a private residence. If you have any questions concerning this test, please do not hesitate to contact this office. Very tbuly yours, ALASKA DEVELOPMENT CONSULTANTS N. Step en D. Shrader, P.E. Project Manager