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Home My WebLink AboutBRUIN PARK BLK 1 LT 6Bruin Park Block 1 Lot 6 #016-101-07 Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131286 PID Number: 016-101-07 ❑ New ❑✓ Upgrade Name: ABSORPTION FIELD Roy and Cheryl Martinez ❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound Address 10931 Polar Drive Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPDISF 5.6-6.4 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.2 Ft. Gravel depth beneath pipe 4.0Ft. Subdivision Block Lot Bruin Park - 1 6 Fill added above original grade 1.4-2 Ft, Gravel length 40 Ft. Township - Range Section Gravel width 5FL Beds: Number of Lines Distance between lines Ft. . - - SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 400 Ff Ft. Well >100' >100' N/A N/A >25' TANK ❑ Septic ❑ S.T.EP. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 ,00OGal. Surface Water >100' >100' N/A N/A Material Steel Number of compartments Two Lot Line >5' 5'** N/A N/A NA LIFT STATION Foundation >5' >10' N/A N/A Manufacturer Capacity P Y Gal. Curtain Drain None Noted Pump on level at Pump off level at High water alarm at Remarks **See Lot Line Waiver. in. n. n. Existing Septic Tank Decommissioned in Accordance with Municipal Code. Existing Absorption Trench Pump make and model Electrical Inspections performed by System Abandoned in Place. PIPE MATERIAL Housetotank D3034 Tank to D3034 drainfield Installer G & R Excavating DrainFleld HDPE COlMT D3034 Inspector MEA BENCHMARK (Assumed elevation) 100.Oft Inspectionrt Location and description dates: 1 8/19/13 2M 8/20/13 Front Door Stoop. 3" 8/21113 a'" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL :"` OF A4 It Conditional Approval: Date 49- ; 00.6 .... j...... ....... ...... ... MICHAEL E. ANDERSON° I� ff. CE -4381 \i Date Approved Inspection RepOrt_14r 12lJoc J 1933 � •• %�Jal 0, m: •� •:�ff Z / : Ti a / O ME AV •♦•��,' �. NORTH O .....�� •• �N£ERE 2 '�` .•• VA 18.07' 00 o S I c�i� N O p 4�'g64-�' q n A JPP O A W J J J O« N. Ln N Cn � c0 CIS m A TDT N o C_ to f CA r �n U� x �^N �D0 Z O � rt Q m m" ;c 1 ^N 3,0 D D D •�� 5.0 0rt. r NG) � ? 7 W a N o aa3� g03 _ w ro_ D n o Np z / 30 0�� N N t" (/) 3mo �a aE s� o �� o L F- D / D a0 �a� m o CO (o n N° o m w v / o U) y S u / J Q o X 1 3O W Cm� z coZm ♦—i I z= Som 1 "3 N 0111 r A A r J W A r { V o t0 O _ SOUTH 100.00' x P 3AIda NOYMNIO L4 o o a Z O Q o ol m �iL►�-ti— r o �. o nt O M O 14 W 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: OSP131286 PID No. 016-101-07 i.15 88.3 U) N UU 1,000 Gallon Septic Tank 87.1 v II / 88.5 = U Hn n 86.4 II 2" Insulation 8nd Geoggle Fabric 88.4 84.8 -N Drainfield Rock 11 11 1 _— 84.8 40' (Total Effective Trench Length) 70.4 No Grountlwa[er 8/19/2013 PROFILE AS -BUILT No Scale 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: OSP131286 Tax Code Number: 01610107000 Work Type: Septic Permit Effective Dates: August 23, 2013 to August 23, 2014 Design Engineer: ANDERSON ENGINEERING Subdivision: BRUIN PARK Site Legal Address: BRUIN PARK BLK 1 LT 6 G:2633 Owner/Address: MARTINEZ ROY O SR & CHERYL A 10931 POLAR DRIVE ANCHORAGE AK 995161353 Site Mailing Address: 10931 POLAR DR, Anchorage This permit is for the construction of: Lot Size in Sq Ft: 22945 Total Bedrooms: 3 Y Disposal Field Y 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. Received Issued By Cd.j vst✓j. s 4-,ke dmv,&e/4 ldcotAro,. z-13 Lot Size in Sq Ft: 22945 Total Bedrooms: 3 Y Disposal Field Y 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. Received Issued By Cd.j vst✓j. s 4-,ke dmv,&e/4 ldcotAro,. * Col Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hfti)://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program ftsmtment **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131287 COSA#: Permit#:OSP131286 PID#: 016-101-07 Legal Description: Bruin Park, Block 1. Lot 6 Engineer: Anderson Enclineerintl Applicant: Roy & Cheryl Martinez Your request for a waiver of the required 10 feet horizontal separation from the proposed absorption field to the existing absorption field has been approved. The approved separation distance is 5.0 feet. * S-0044 9:-Ni8id ' 6 14 0yftrVCd . This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ................................................•.............................1 Waiver is Granted: X Waiver is not Granted: Date: ZL Approved 6y' Namrt� 42e fewer .................................................... .......................... Rec#: 00404G Amount: $200.00 Date Paid: 8/20/2013 **** VARIANCEMAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 016-101-07 Property owner(s) Roy & Cheryl Martinez Mailing address 10931 Polar Drive Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Bruin Park, Block 1, Lot 6 Legal description (Township, Range & Section) Number of Bedrooms Three (3) Lot Size 22,945 Sq. Ft. APPLICATION IS FOR: (® all that apply) Day phone APPLICATION IS AN Absorption Field [] Initial Septic Tank ❑ Upgrade Holding Tank ❑ Renewal Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / .Lot Line - TYPE OF DWELLING: ❑ Single Family (SF) ❑ (w/wo ADU) X Duplex (D) El Multiple Dwellings (SF and/or D) /ER REQUEST FOR: x❑ Distance.' 3', % z� S I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 53o Waiver Fees: aoo . Date of Payment: 9.1413 Date of Payment: ELOO113 Receipt Number: Wgtjg6 Receipt Number: Permit No. 3N/131,467 Waiver No. as 1013 a 177 - Permit App_9-1-12.doc C01 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX September 3, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 6, Block 1, Bruin Park Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The surveyor was unable to locate the eastern lot line on the subject property prior to construction of the absorption trench due to problems with existing monumentation. The new absorption trench was placed within 5' of the property line. Placement of the trench in this area does not impact the property to the south or the septic system. We recommend a waiver be issued allowing the trench to be 5' from the south property line. Sincerely, Michael E. Anderson, P.E. WICHAEL E ANOERSCN N0. CE -4381 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 18, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 6, Block 1, Bruin Park Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer The existing absorption trench on the subject lot has failed and must be replaced prior to the issuance of a Certificate of On Site System Approval (COSA). We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the three-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 Septic Tank will be decommissioned in accordance with Municipal Code. The existing absorption trench 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 ground surface contours are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot indicated Silty Sand with Gravel (SM) to a depth of 16'. No groundwater was encountered and none has developed during the monitoring period. The percolation rate in the SM soil lense was determined to be 4.4 minutes per inch. We have designed the new trench with an application rate of 1.2 gallons per day per square foot. We are proposing to place a 38' long by 5' wide absorption trench 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 flow diverter valve will be placed to connect the existing trench to the system for future use. The ground surface on the lot slopes to the west in the area of the absorption trench Lot 6, Block 1, Bruin Park August 18, 2013 Page Two 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, -411cE�a Michael E. Anderson, P.E. Attachments e�49th MICHAEL E. ANDERSON . No. CE -4381 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766(FAX) August 23, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 6, Block 1, Bruin Park Subdivision New Absorption Trench to Existing Trench Dear Onsite Services Engineer: Very little area is available on the subject lot to construct a new absorption system due to the location of the well on the property. The exact location of the existing trench is unknown, but the new absorption trench may be constructed 5' to 6' from the existing trench. In addition, a silt plug will be placed at the end of the new trench to prevent migration toward the old trench. The soil on the lot percolates at rates less than 5 minutes per inch. Little migration of the septic effluent is expected. We therefore recommend the new trench be placed 5' from the existing trench on the lot. Sincerely, C Michael E. Anderson, P.E. 97 �' •49ih � °.� MICHAEL E. ANDERSON No, CE -4381 L t r +i P�oFss.oN��. i j i 4 B / a 10 / \ z O Q F oe; 1 \\ z j E ST 11 TH AVENUE .��•aaata�11. OF � �`' 49th "•�� ....r .............. .......... } ..../ :...................c AREA MAP �'; MICHAEL E. ANDERSON �0, Na CE-4381 �"I �s'•., �.� SCALE 1" = 100' z 0 0 m V / NV L.L Q n z m m C 0 J Gwa I� 1,1 IIII 0b0 0'0v� li x3 a 1W NI 2J0 W dol,OZ > u , M � J /� 0� / ly LLI til h N i C'I 41 O rl w cc 3 w a L,_J Q — � a z J ! ------- -I------ o H zso W � Llj � S Nt,, Q V ''ice �Q��[�Ez WT'�'•% — M O E %LL 00 :vi v N:wl s. � � dd��-''••, `r i = .amu, ; r'�'J i z x 4 w¢ LOT 6, BLOCK 1, BRUIN PARK SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home 5' Wide Trench System Perc. Rate: 4.4 Min./Inch 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 3 Bedrooms ` 150 GPD/Bedroom = 450 SF Absorption Area 450 SF/1.2 GPD/SF/5 SF (Width)�.5(Red. Factor) = 37.5 LF Trench Length THEREFORE: Construct a 38' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 3.0' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over Septic Tank. 5' TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. ..... Minimum 4' Separation From Groundwater. s.....1 Minimum 100' Separation From Private Wells in the Area. Minimum 100' Separation From Surface Water or Streams: 49th MIGHAELE ANDERSON No. GE4381 0 2 3 4 5 6 7 8 9 2 15 I� 17 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 ELMORE ROAD ANCHORAGE, ALASKA 99519-6650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Roy Martinez DATE PERFORMED: 8/11/13 LEGAL DESCRIPTION: Lot 6, Block 1. Bruin Park Subdivision TEST HOLE # 1 SLOPE SITE PLAN OG/OL Silty Sand W/Minor Gravel SM WAS GROUNDWATER ENCOUN-EKED? Clean Sand Gray IF YES, WHAT DEPTH SP DEPTH OF WATER PefC.<2 Min./Inch AFTER MONITORING: DATE: S L 0 P E a wrw SEE SITE PLAN READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP 1 8/16 8:10/8:20 10 1.25/3.50" 2.25" 2 8:21/8:31 10 1.50"/3.75" 2.25" 3 8:32/8:42 10 1.25"/3.50" 2.25" 4 8:43/8:53 10 1.50"/3.75" 2.25" 5 8:54/9:04 10 1.25"/3.50" 2.25" 6 9:05/9:15 10 1.25'73.50" 2.25" PERC RATE: 4.4 MIN./INCH PERF. HOLE DIAMETER:8" TEST RUN BETWEEN 4.0 FT. AND 5.0 FT. COMMENTS: PERCOLATION TEST CAVITY PRE SOAKED PRIOR TO TEST. TEST PERFORMED 2Y: MEA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 8/16/2013 Test Hole locations are approximate and have not been located by survey methods. T11-1 3-1B-77 77 T 0.0' ORGANIC SILTY SAND — — — — — 2.0' ., SAND W/TRACE SILT (SM) f. { 10% Silt) — - - — — 4.0' A I".': { I O SAND (SN) (less than 4-5% Silt) Brown, Slightly Moist .•`a -- -----11.0' �'•o; SANDY GRAVEL W/SOME SILT e ees (GM) 1 ° 13.0' TD No Water Table Encountered This log represent subsurface soil conditions within Test Hole 1 on Lot 6, Block 1, Bruin Subdivision, NE�s, Section 20, T12N, R3W, S.M. Anchorage, Alaska FB. CW N- Vee o SANITARY SEWER TEST HOLE CK D JMA Fi s.M CONstJLTANTS,iNC. JIM MARSHALLGRiD 2633 DAT E 3-21-77 ANCHORAGE, ALASKA PROa N0 7511: CC1G. rd O. A-0'. SCALE 1"=3' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION L ENVIRQUWeNTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Tele'�Tione 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME y PHONE NEW ❑ UPGRADE MAILING A ESS tSX /4 /799 LEGAL DESCRIPTION ^ t' (0 � LOCATION NO. OF BEDFjQOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: y,, I-- ZQ Manufacture � Q-- �G-�.d� Mat eri No. of compartments w y Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. G Manufacturer Material Liquid capacity in gallons J = DISTANCE TO: Well 1 �( Foundatio�f' Nearest lot line PERMIT NO. LL Z No. of lines Lengt of a ch li a Total lengtlines Trench width Distance between lines `L 4S 4% IL I a inches HTop of tile to finish grade Material beneath tile Total effective absorl2tion area 1G — 2 s inches 4,40 Length Width Depth PERMIT NO. w Qa F- LU Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RATI NG l �) INSTALLER RE�MAR y /V �U W` .♦^E A 4 .dee a,'7 f e �h she-tc k -Far_ D. �. �•� •••....•.�.�s0' i vj: 9 y :'j7* rc�.�*0-4�- • CA ' • 0 0 / , a ••. CE - 4369 a'` •: Alf Alk,,pr0fess10 �� a 1 APPROVEDDATE LEGAL I elAll,,O 3 1- +7 72-013 (Rev. 3/78) Permit # MUNICIPALITY OF ANCHORAGE Department*;,)f Health and Environmental Protection 825 ".L Street, Anchorage, AK. '99501 264-4720 # # HANDWRITTEN PERMIT # # WELL AND/OR ON-SITE SEWER PERMIT Applicant : Mailing Address: Location: Phone Number:_L-''a� Legal Description: Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br)� The Required Size of the Soil Absorptio System s: DEPTH LENGTH . GRAVE DEPTH �tDT Azr_lelul�) The length dimension is the length(in feet) of the trench or drainfield. The depth of a 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 and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ lc;�- J_U GALLONS * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 %3 # * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that edrooms. Signed. Issued by: �Appicant Date: SWP/024 (1/81) �� j .. - >i L �` e lrze +I�Z -a-' L/ ?1_16 ^mmL�/ �, �� " I (�I F�F��I ��e CA FO FA 44 Cl Vi �FQ �� y' DEPARTMENT HEALTH AND ENVIRONMENTAL !OTECTION 1-01 825 'L' STREET, ANCHORAGE, HK. 99b01 264-4720 �� r�E� ��r4_��F� ��1�� 1 "T PERMIT NO. ( 830O98 ) APPLICANT JIMMIE E MARSHALL SRH BOX 1799 99507 149-8065 LOCATION LEGAL L601 BRUIN PARK LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>E=F"lFFA= "A L_E0VAC3lrVA= AED C3FTF4%AE=L_ ExE0F"1rVA= tff. 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 AND THE BOTTOM OF THE EXCAVATION (IN FEET). F?EE C-74 IJ 1 Fz_"Eo E> ��F::�, 7' 1 C -F n N K I = I=-= ��CA CA �� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -rWC_# <;2 > I F=, FE C_; T' I 0Z) " ISS n F-*_ E=' F,. -"E-= Q U I F. -"E=- C- BHCKFILLING 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 IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �U F --'M I -F FEE F:�' I F-"- U'-=. �U C_: U M 0 U FZ :E%::lL^ -1�� I CERTIFY THAT 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 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS SIGN& ___--- - - �/ �� &~� rHPPLICHNT JIMMIE E MHRSHm-� �^�� ISSUED BY_ ________ Y4.0 NHAWTHORNE-ENGINEERING NHAWTHORNE - ENGINFERIN(" 7127 Old Sc_ � c., a I , Anch, AIS 99w2 344 ., .471 � October 6, 1983 Mr. Robert Robinson Anchorage Department of Health & Environmental Protection 825 L Street Anchorage, Alaska 99501 44-04-.ARGTIc BOULEVARD §4JI E2525 ANC"1&RA6&,, ALASKA 99503 999.271'-4.609 RE: Lot 6, Block 1, Bruin Park Subdivision, NE 4, S 20, T12N, RX SM Owner: Mr. Jimmie Marshall Dear Mr. Robinson, On September 29, 1983 the owner of the above referenced lot contacted me concerning the on-site sewage disposal system that k*s being installed on his property. Apparently Ms. Lynn Lindquist of your office had recently been on the site for inspection and saw water at one end of an excavated trench. That water level apparently had not changed in 16 hours or so, at which time I first saw the excavation. In addition, a hand dug hole in sand at the opposite end of the trench to a depth of 4 feet below the visible water -level had no water in it. I I I ` I had the excavator backfill and compact (with the backhoe bucket) the trench to 4 feet above the water level which gave us 2 feet of usable trench sidewall below the perforated pipe. Material in the sidewalls is about 90% SP/SW with the remainder being SM. At 150 square feet per bedroom we have enough for a 3 bedroom house; about 500 "square feet total absorption area. Extra clean outs and observation pipes were added because of the necessary layout of the leach field. Those pipes will allow access in case the field ever needs rejuvenation. Please see the attached sketch. I was not able to inspect the building outfall or septic tank.installation. However, Ms. Lindquist did observe that portion of the system. Sincerely Neil Hawthorne .. �1 ;•� _,: t v p r Ci December 31, 1979 r i r),,\: Jim Marshall 300 lz East Manor. Anchorage, Alaska 99501 Permit # 790049 Subject: Lot 6 Block .1 Bruin Park Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer has inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz,R.S. Senior Environmental Specii'st LNB/ljw enc: Copy of Permit THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 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 GRHYEL.DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). 1 n3E=FV"-T' 1. C- �I ��f5Gf �� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE, ___ -T- 04 C:) �__.. 3E f4n3F"EEC-F 1. F4FREE FR&C;!f.J:l FlIFE00 --------- __BHCKFILLING s/ � AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. , / «'L � MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR PI LA P -A I C-:: :0. F-* f"l I.. X 7- "r" (3 Fr Fl r4 C! V4 CA F1 F4 C3 E -H. 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ---- THE DEPARTMENT 825 'L' STREET, ANCHORAGE, HK. 99501 mA 264-4720 h DIAGRAMS ARE C4E"_'L_...lL_ �--ipww com_sm x -rE= n3E=L4EHFT F7"F=0;?r'l 1 -T- PERMIT PERMIT NO. ( 790049 A�� APPLICANT JIM MARSHALL 3001/2 EAST MANOR 279 726] LOCATION POLAR DRIVE LEGAL L6 B1 BRUIN PARK S/D LOT SIZE 23000 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 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 GRHYEL.DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). 1 n3E=FV"-T' 1. C- �I ��f5Gf �� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE, ___ -T- 04 C:) �__.. 3E f4n3F"EEC-F 1. F4FREE FR&C;!f.J:l FlIFE00 --------- __BHCKFILLING BACKFILLINGOF 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 WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTHLLHTION, I" En FT P1 3: 1- E= 14 F" 1: F-;;-! ��F,_�* #I:. F-..-- 1* -1 E". f -E: ":i�: A_" A�� I CERTIFY THAT 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 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. ~ SIGNED HP �LlPCHNTwnJIM'MHRSHHLL lism '� TE_��_-_0-00-1_L___ ~ �2 7� 7�7�� ` March 220 1978 #77092 Jim Marshall 300 h East Manor Anchorage, Alaska 99541 Subject: Permit Expiration A permit issued by this department for well and/or on-site sewer installation on Lot G Block 1 Bruin Park Subdivision has expired since the issue date exceeds one(l) year. 2n the event you still pian to install the well and/or on- site sewer system, a new permit is required. The original sail test may be used to obtain a current permit, if the well has been drillers, a wall log should be sent to this department to document the installation elate. If you have any questions regarding the above matter, please contact this office immediately at 259-4724. Sincerely, Les N. Buchholz, E.S. Senior Environmental Specialist T10/1jh TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 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 AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��E� 17A tJ 31 F4 EF EP, ��F=-"-F 1 C-.; �F:l Ir -4 �1 2! FEE= A_ �R TS CA ��CA rA T".; T. L4 irl < :2 > I " F=* I=- c_ I CA " SF " Fe U- �1-3 1 P'_ lE".lL> 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 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS; OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. M I -IF V F=l L_ I U -m ��F?. C -I PA EE '-0 FEE Fi F_! CA t'""l 1 " I.-=_1 kJ E::*.".'. I CERTIFY THAT 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 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:________________________________________ APPLICANT JIM MARSHALL ISSUED BY ------------------------------ DATE _______________ /)v ()�\ {i rl 01O . , r�� ~ ��_ :11�� _ �� DEPARTMENT HEALTH AND ENVIRONMENTAL .JTECTION 825 'L' STREET, ANCHORAGE, HK. 99501 279-2511 14 FEE L_ I- �" [---N Ill Ir -4 —:S3 :1 --f- EF �F. EE L4 IFE- ��1 -T-' PERMIT NO. ( 77092 ) APPLICANT 3001/2 EAST MANOR 279-726] LOCATION POLHR [�IVE LEGAL L6 B1 BRUIN PARK SUBD LOT SIZE 23000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 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 AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��E� 17A tJ 31 F4 EF EP, ��F=-"-F 1 C-.; �F:l Ir -4 �1 2! FEE= A_ �R TS CA ��CA rA T".; T. L4 irl < :2 > I " F=* I=- c_ I CA " SF " Fe U- �1-3 1 P'_ lE".lL> 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 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS; OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. M I -IF V F=l L_ I U -m ��F?. C -I PA EE '-0 FEE Fi F_! CA t'""l 1 " I.-=_1 kJ E::*.".'. I CERTIFY THAT 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 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:________________________________________ APPLICANT JIM MARSHALL ISSUED BY ------------------------------ DATE _______________ /)v GREA -LR ANCHORAGE AREA BOF. jGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT `•' ` • �� MAILING ADDRESS rl' "( An 0 y2^' PHONE 4D9 • f�_G`3 INSTALLATION LOCATION L A t2- ' LEGAL DESCRIPTION 4-7J'`' 3 2(iln OAr2If S/0 MEW Ssk- Jo 91 IV f23 w INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED SEEPAGE PIT_ DRAIN FIELD , OTHER , FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS l ls— r7 -b 17 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE / p4 rb TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK s� sL FOUNDATION TO S,G 6//f(�A'//=��`'JJT�� DRAIN FIELD J:AGi SEPTIC TANK TO S�- WALL �` t SEPTIC TANK �f iT v DRAIN FIELD TO NEAREST LOT LINE. J WELL TO SEPTIC TANK SEE �V DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE AREA SIZE ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, , SEEPAGE PIT , DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL k/). -d_ (I-- CONFORM v CONFORM TO BOROUGH REGULATIONS RE GA ING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED S STEM IS IN ACCORDANCE WITH SAID CODE. DATE �" APPLICANT'S SIGNATUREL�lr4��W" EQ -016(175) I I ... i {{ r 1 , G I ' 1 3 t I PIP 1 i j I � I i _. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED S STEM IS IN ACCORDANCE WITH SAID CODE. DATE �" APPLICANT'S SIGNATUREL�lr4��W" EQ -016(175) R&M CONSULTANTS. INC. 5024 CORDOVA ■ BOX 6067 B ANCHORAGE. ALASKA 99502 ■ PH. 907-279-0453 ■ TLX. 090-25360 ENGINEERS GEOLOGISTS PLANNERS SURVEYORS March 18, 1977 Mr. Jim Marshall 30011 E Manor Anchorage, Alaska 99501 R & M No. 751127 RE: Test Hole and Soil Log Report for Sanitary System Lot 6, Block 1, Bruin Park Subdivision; NE;x, Section 20, T12N, R3W, S.M., Anchorage, Alaska Dear Mr. Marshall: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This in- vestigation was performed in accordance with your request of March 18, 1977, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Municipality of Anchorage, Department of Environmental Quality. A single test hole was put down within the subject site area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 13 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Groundwater was not encountered in the test hole while drilling. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. �t James W. Rooney Vice President JWR/pe xc: Municipality of Anchorage ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILLA W H a Q a a 0 P4 Test Hole locations are approximate and have not been located by survey methods. DW N V,22 CKD JMA _ DATE: 3-21-77 SCALE: 1"-3' TH-1 �3y-18-777 LC w•.I ORGANIC SILTY SAND •m 2.0' SAND W/TRACE SILT (SM) ( 10% Silt) -- -- — — --4.0' O SAND (SW) (less than 4-5% Silt) Brown, Slightly Moist —11.01 b e;e• Q' •o SANDY GRAVEL W/SOME SILT b .b (GM) 13.0' TD No Water Table Encountered This log represent subsurface soil conditions within Tes I1ple 1 on Lot 6, Block 1, Bruin Subdivision, NEld, Section 20, T12N, R3W, S.M. Anchorage, Alaska SA14ITARY SEWER TEST HOLE R&M CON54JLTAIVTS, INC. JIM MARSHALL A ..oA. ANCHORAGE, ALASKA F -B. GRID 2633 PROJ.NO 751127 D�1,0. N0. A-01 �eeala�Y u Test Hole locations are approximate and have not been located by survey methods. DW N VZ2 CKD JMA DATE 3-21-77 a SCAL-: 10_31 4. J TII-1 3-18-77 ORGANIC SILTY SAND M r _r — — ----11.0' 1!446 e' o• SANDY GRAVEL W/SOME SILT o.?v oeD (GM) ro'e 13.0' TD No Water Table Encountered This log represent subsurface soil conditions within Test Hole 1 on Lot 6, Block 1, Bruin Subdivision, NE14, Section 20, T12N, R3W, S.M. Anchorage, Alaska p !..' FB. o SANITARY SEWER TEST HOLE — R&M CONSULTANTS, INCA JIM MARSHALL GRID 2633 .NDIN.... ..G�O.�.*. l'\NN... •V•�• ANCHORAGE, ALASKA PR0J.N0 7511: DWG. NO. A -O' 2.01 SAND W/TRACE SILT (SM) ( 10% Silt) _ -- —4.0' A O SAND ( Sia ) (less than 4-5% Silt) Brown, Slightly Moist r _r — — ----11.0' 1!446 e' o• SANDY GRAVEL W/SOME SILT o.?v oeD (GM) ro'e 13.0' TD No Water Table Encountered This log represent subsurface soil conditions within Test Hole 1 on Lot 6, Block 1, Bruin Subdivision, NE14, Section 20, T12N, R3W, S.M. Anchorage, Alaska p !..' FB. o SANITARY SEWER TEST HOLE — R&M CONSULTANTS, INCA JIM MARSHALL GRID 2633 .NDIN.... ..G�O.�.*. l'\NN... •V•�• ANCHORAGE, ALASKA PR0J.N0 7511: DWG. NO. A -O' M E � 9 >'''� 1 �Ij P �lip ' 0 F 9 "' H 1 i de000.no..aoe ,..n. ,+.e •...i" I : i34•Z r�.F•9 ..-.Yf.. ..........eoe.e.r M4M0HCe P. oiwald r f�ff 613 Ft v" C i r. rl J , h .i > t 70 t LOT SURVEY CERTIFICATION LEGEND: ® Brass Cap Monument O Iron Pipe Lot a , Block E�=t— Area Sq. Ft. i Steel Pin o Survey Hub d Tack Plat File No.____.��:=_Zoning District Anchorage Recording District, Alaska 7 -VISIONS, on► -r_ f;Y D! II -0 MLD -WN_ H' CC:, Residence ofi �� I1 1' €;) 4040 n STREET �'" AHCHORAQV. ALASKA 8T SCO/B.' it f W.UFF 34.n[.M .,.�'..s:M..lYufM:MWAtaW4� • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904+F Ts Certificate of On -Site Systems Approval Parcel I.D. 016-101-07 Expiration Date: 1. GENERAL INFORMATION Complete legal description Bruin Park, Block 1, Lot 6 Location (sae address) 10931 Polar Drive Anchorage, AK 99516 Current Property owner(s) Roy & Cheryl Martinez Day phone _ Mailing address 10931 Polar Drive Anchorage, AK 99516 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY Individual Well it Individual Water Storage ❑ Community Class Well ❑ Public Water Systelm ❑ Waiver/Variance request for: ,i , Received by: ' � �� Day phone TYPE OF WASTEWATER DISPOSAL Individual it Holding Tank ❑ Community ❑ Puhl.ir_. Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date COSA Fee $ C11 SfV Waiver Fee $ Date of Payment �"- 6 - 13 Date of Payment Receipt Number 0 D 3 G� Receipt Number COSA Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE _1z System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Phone 522-7773 Date 9/5/2013 ®a. 49TH 7 ° �A,�nnt�'tca�t"1 -z-oiv p CE -43x;1 ,••��e:� ®®44 ofB.S`x�®®®� with the following stipulatio®UL®®®' By, G/Z,/ • � _ Original Certificate Date: 0 " 13 Thenici alit o horage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet S I- :., c If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description Bruin Park, Block Lot Y �p A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 10/83 Sanitary seal (YIN) Y Total depth 160 ft. Cased to >40 ft. FROM WELL LOG Date of test 9/82 Static water level 70 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic 24.2 ug/L Date of sample: 8/5/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping New Const. Pumper C. ABSORPTION FIELD DATA Parcel 1D: 016-101-07 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 8/5/13 63 ft. 2.66 g.p.m: Collected by: GEG Date installed 8/19/13 Cleanouts(Y/N) Y High water alarm (Y/N) V Date installed 8/20/13 Soil rating (g.p.d./ft2 or ftz/bdrm) 1.2 GPD/SF System type 5' Wide Length 40 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 7-8 ft. Eff. absorption area 400 fe Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons _ "Pump off' level at Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: >I ()nl Manhole/Access (Y/N) in. High water alarm level Meets alarm & circuit requirements? Septic tankilift station on lot On adjacent lots >100' Absorption Feld on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout _ Sewer /septic service line >25 Holding tank N/4 Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >51 Water main >1 O Water service line >10 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: 5'** Property line Building foundation > 10' Water Service line >10' Surface water >1 00' Curtain drain None Noted Wells on adjacent lots >100' N/A F. COMMENTS **See Lot Line Waiver. G. ENGINEER'S CERTIFICATION t certify that t 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 Michael E. Anderson, P.E. Date 9/5/2013 COSA brown sheet 10-10-12.doc Absorption Feld >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage >10, L s° in. ................. `a °. MICHAEL E. ANDERSON ✓j e CE - 4381 4:'�� Municipality of Anchorage IIII P� < Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 131468 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 6 of Bruin Park Subdivision. This inspection revealed an arsenic concentration of 24.2 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site ,Systems Approval -rr-- I— 0 O J N 0 CINNAMON DRIVE ) l H.Lnos 1 _o xor�c � Q . �` m�,i >-WJF U J Z WW1+ -W 0Fn z� � O = W N y of / b'Z9 ^ 1 ,9'Z '97 0 / r M 0 C4 " 0 Cd OQ` PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2633 Project No. 13-170 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone o00IN4Registered Land Surveyors (907) 522-4625 Fax p1h_ kenOlongsurvey.com / jonothanOtangsurvey.com I hereby certify that I have surveyed the following described property: LOT 6, BLOCK 1, BRUIN PARK SUBD. (Plat No. P -222B) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the Day of c Uii`ti , Z. t-t� , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. A, 49TTJ--J � ;y ............., ......... } KENNETH 1G. LANCV �pLS-5202.••05 p 440nR�FfSSIONA� �� Oft w of G�nO• �V OQ` PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2633 Project No. 13-170 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone o00IN4Registered Land Surveyors (907) 522-4625 Fax p1h_ kenOlongsurvey.com / jonothanOtangsurvey.com I hereby certify that I have surveyed the following described property: LOT 6, BLOCK 1, BRUIN PARK SUBD. (Plat No. P -222B) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the Day of c Uii`ti , Z. t-t� , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. A, 49TTJ--J � ;y ............., ......... } KENNETH 1G. LANCV �pLS-5202.••05 p 440nR�FfSSIONA� �� RiAo It WA L_ Municipality of Anchorage Development Services Department oe* 9111%N% Building Safety. DivisionOn-Site Water and Wastewater Program SA ETY 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AU T HORi i , APPROVAL FOR A SINGLE FAMILY OWELUNG R e I Parcel I.D. 016-101-07 1. GENERAL INFORMATION Complete legal description HAA Expiration Date: Lot 6; Block 1; Bruin Park Subdivision Location (site address or directions) 10931 Polar Dr. Anchorage Current Property owner(s) Barbara & Garth Parber Mailing address Lending agency Mailing address Real Estate Agent Day phone Day phone Shannon Parberry Day phone 230-9984___! Mailing Address 3111 'C' St. AnchoragRL, AK a2iD3 Unless otherwise requested, HAA will be held by DSD for pickup. ?41 ? 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Ks Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates 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 processional 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 S & S Engineering NiruF)e 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 995//77 Engineer's Printed Name Robert C. Cowan Date -71aa � V :i3 5. DSD SIGNATURE ,.�` ROBERr C. rfw`@ CE - 880101 r � „ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: f Gl L / /,(, /? Original Certificate Date: 7— 2 03 (Rev. 07/02) 7-21-03; 9:47 ;CT and E S & S Engineering ;5615301 # 2i 2 CT&E Environmental Services Inc. 200 W. Potter Drive A.nchotage', AK 99518-1605 Telephone: (907) 562-2343 Facsimile: (907) 561-5301 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage, AK 99578-1605 ..�... ra rnm.. r>r.mr�,�m ...,.> f. r,imwno nmv nr.+n.�nr. i•.�r r>.�n>.rwr� e. i.�w..... Tel: (907) 562-2343, ❑ PUBLIC WATER SYSTEM I.D. # " PRIVATE WATER SYSTEM Cl send Results )v. .Sendravoice ilV syrtrJn, " fI18p1e • �.. 6 t r►iri41CF_R1NG .. ❑ SQf+dReaults p Sendfnvoicr mp,ny Nume utt nm¢ esa ry sure Code SAMPLE DATE. �• Month SAMPLE TYPB: E3 )RoAtine x 12epp.eat Sample (for ra� }}fiar sa#iiple With1.19b C Special Purpose SAMPI.E,LQCAT1OX 1- 0^i G 13 i.ic. I %frev:n/ PARk .Day DYear ❑ Treated Water Untreated Water Tlrye Collected Collected BY rs x,07 Plcgie Print Analysis shows this Water SAMPLE to be: [7 30 hours old, results may nor'o• „ OlQ 8t C7Carnlr to Its. Please _.. - Date Redil*Wd Tlme iiteceived� Analysis Began J 2 g - j AnalytIC41 Method: < Mpmbrane i?ilter ' Q 1 034375 -1 10 mi. Result* Analyst 11110111 Client notified of unsatisfactory results: PhonnedCl Spoke with Faxed Sent.to A.TbE.C. Ancli Fbks Jun Q Faxed Date: _ Time: Client notified of unsatisfactory results: PhonnedCl Spoke with Faxed Date: Time: BAcCTERIOLOGWAL WATER ANALYSIS UCORI? MNFO-MUG Res#lt:' Total C61iform & Coli Membrane Filter: Direct Count � C6lonles(100 mi •Verification: LTB ZGB COLIFIRM Fecal Coliform Confirmation Final Membra Filter Re ults Coliform/100 mf Reported By i� ., Date zG ' L Time Comments: TNTC -Too Nrohernnr To aunf 03 - Ofher Bu&,to 7-15-03; 3:01PM; ;907 5615301 # 2/ 3 J SGS Ref.# 1034178001 Client Name S & S Engineering Project Name/# Lot 6, Blk 1, Bruin Park Client Sample ID Lot 6, Blk 1, Bruin Park Matrix Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 07/16/2003 15:50 Collected DateMme 07/14/2003 16:00 Received Date/Time 07/14/2003 16:50 Technical Director Stephen Ede Released Parameter Qualifiers Results PQL Units Method Waters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 Microbiology Laboratory Total Coliform W -Q0, Ne46eii- coU100mL SM18 9222B Allowable Prep Analysis Container ID limits n.,. n.,. Init B (<=10) A (<=1) 07/14/03 JS 07/14/03 is Municipality of Anchorage 'co • Development Services Department Building Safety Division " o= On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AR 99519-6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 016-101-07 HAA # 144 (i 5 9 - Expiration Date: - - - O 3 1. GENERAL INFORMATION Complete legal description Lot 6; Block 1; Bruin Park Subdivision Location (site address or directions) 10931 Polar Drive Anchorage Current Property owner(s) 13AA13AAA 9 C- Ail rfi- p,3,13149A y Day phone G%O -,HANI" .� P,1iRd¢,£ALY Mailing address 3 i c ' S - , 14,y:,I4. AK y �1 Sc 3 Lending agency Day phone Mailing address Real Estate Agent Shannon Parberry Day phone 2,30-9984 Mailing Address 1r.f .4t Anrhnraop Au/gg5n' Unless otherwise requested, HAA will be held by DSD for pickup. /�+ 2, 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: B Individual On-site EX ❑ 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 5 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 less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifid'ates 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 encineer'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 S & S Engineering Address 17034 N. Eagle River L000 Ste Engineer's Printed Name Robert C. Cowan 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev. 121no) Phone 694-2979 204 Eagle River, AK 99577 Date I! /) /e a bedrooms, with the following stipulations: OF Jam: ON-SITEWATERAND �Gi= WASTEWATER = rROGRAM 0 iC0F�'IEPJT X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / rr - ), (om= © :2_ o47�4 � � :�� s a •niNGi n�` n -�`. v5. hi � � C 1 ..1d. �.. `: tt aP.*2�}.....�s�nK.lt } '4 ' 'f` 4..'� S� .. .. >. ; V��Y�" P,-P. I certify that I have determined through field inspecticns and review of Municipal records that tho above systems are in conformance with MCA HAA guidelines in efect on this date. Enaineer's Printed Name Waiver Fee.$ . •..4n. .. . cV An f 2 8801 J� C Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: " Septic tank/lift station on lot ` )0.0 f ' . On adjacent lots 0.0+ `. Absorption field on lot 100 On adjacent lots /00. sewer'riiam Public sewer manhole/cleanout-Public Sewer/septic service line 1:S "' Hojding tank !!A SEPARATIONDISTANCES FROM SEPTIC/HOLDING TANIZ'ON LOTTO .::. Building foundation`s Property line /0 ;- Absorption field S y Water main N ��' Water service lineSurPaceWater. /0.4-00 ;f y Wells on adjacent lots l oa .i , SEPARATION, DISTANCE FROM ABSORPTION FIELD ON LOT-TO. Property line Building foundation 3� d . Water main N-, Water Service line 10 + Surface water 10 0. r� Dnveway;'parkmg/vehicle storage 1 -'cu IV. rtam'drarn "• K':" ^�' . Vllells on adjacent lots:' J06,4--1 F. COMMENTS t '' ...J''i G:. ENGINEER'S CERTIFICATION --r C., I certify that I have determined through field inspecticns and review of Municipal records that tho above systems are in conformance with MCA HAA guidelines in efect on this date. Enaineer's Printed Name Waiver Fee.$ . •..4n. .. . cV An f 2 8801 J� C OCT -14-2002 MON 01:24 PM DYNAMIC PROPERTIES EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON, "ASBUILT" FAX N0, 2835019077775681 P. 02 TKef€ tof'o '4 0.04-4 rc rotf f)4.*Wf'C dy iZ's 9' t �rIiYIOL x ��.�eWgd T I F55.00 � I ' N �ws�t o Q o � z•sra:zY 9, '� Q °r12q FRAMC 0 �° floUSE I � 4 Oit/VE � z `• ZG"P. 27.0 > — tr+ V 30,0 WEST 130.17 O , 1 I SCALE 13p THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. No corners set I hereby certify that I have surveyed the following descrloed property. Lal 6 Block J3R u IN PA P% K SU (3, Anchorage recording district Alaska, and that the Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on Inc premisos In question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Anchorage. Alaska 4 U' 77 2002 Book pg FILE OF q *i-49 K 6* �y/A.•W ��I.r-rxaVft�-� s T , renri Hild•n•n (fin �. Ne. 130t•5 ; A •�B • .' J I \2 OFF SSIOWN AL s'g' MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ,S "/ F Z /,P:± (a) Legal Description (include lot, block, subdivision, section, township, rand) L, 6 P! ? r t. X v. 7 k 5" 1 �'. 5 :2,y 'j:!7 N ifs S �' W Location (address or directions) c w f'2 4d ia'r T)r'- (b) Applicants Name Jl hA /-116_Y-5 �' 1 t Telephone Applicants Address �'P /2 :77,a t 'i `? <) �9 _9 S1-2 "7 (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer Other f:::j (explain); (d) Lending Institution-din:x� I� .? i,r '{-�>.�, Telephone 56 .i _- 35�T,. Address '7 (e) Real Estate Co. & Agent Address Telephone 2. Type of Residence Single -Family � Multi -Family Number of Bedrooms .> 3. water Supply Other (describe) Individual well � Community Public Note: If ccmunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA (Y/N) Y 4. Sewage Disposal Onsite Public CAmm.inity Holding Tank Is the wastewater disposal system adequate far the number of bedrooms (Y/N) y [Page 1 of 21 2--15--84 5. Engineering Firm Providing Inspections, Zbsts, Data and Information I certify that I have checked, verified, or conformed to all NDA HAA Guidelines in effect on the date f this inspection. ir�r y + �-� t + ��° +,�v/'wrn "`��ri+✓'�fio t C� Date Signed �.-+��;;:: Name of Firm 7�-1� e" L, Telephone 4-7 1 Address T1,�—.— Signed by IJe-, Date (ENGINEER SEAL) 6.DHEP Approval Approved for bedrooms By" _ Date '� l Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrocros and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: Wed✓ � 'D KB2/d5/s (Page 2 of 2 2-15-84 A. WELL DATA MUNI C 'tYQ k A,NS ( MOA ) HEALTff4A";W, ( HAA) cHECKL MAY 1 49&WpY 1984 % b I JYx-o ),vi k RECEIVED Well Classification kap, If A, B, cr C, D.E.C. Approved(Y/N) P/W Well Log Present (Y/N) y Date Completed /l�/5' �,� ;� Yield 1,2 6,1914 Total Depth Cased to VAk „l ur Depth of Grouting ULn k y„ W h Static Water Level '70 Pump Set At Casing Height Above Ground / t` Sanitary Seal on Casing (Y/N) Ly Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y )fel Separation Distances from Well: To Septic/Holding Tank on Lot /oo� t On Adjoining Lots ? (oo' To Nearest Edge of Absorption Field on Lot 1r2 ; On Adjoining Lots >toe" To Nearest Public Sewer Line JUM To Nearest Public Sewer Cleanout/Manhole /V 1,14 To Nearest Sewer Service Line on Lot �11�4. Water Sample Collected By Date ¢ / ;t /q Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 161,83 Size �2 No. of Compartments .2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Foundation Cleanout (Y/N)_ Depression over Tank (Y/N) N Date Last Pumped A)ew Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) N1,4 Temporary Holding Tank Permit (YM) NIA Separation Distances frcm Septic/Holding Tank: To Water -Supply Well I D1 + To Building Foundation (oo + To Property Line i 5_e.�_ To Disposal Field p6 , To Water Main/Service Line AJ To Stream, Pond, Lake, or Major Drainage CourseF/- Comwnts [ Page 1 of 2 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /5-0 Type of System Design .�,O („) Date Installed ) 6 /9.3 Length of Field /-2 4, 5' Width of Field �0 -- �(d Depth of Field � `t Gravel Bed Thickness -92 Square Feet of Absorption Area „5-0o Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test New Results of Last Adequacy Test Af /, Separation Distance from Absorption Field: To Water -Supply TAbll too' To Property Line /O To Building Foundation 5.0`To Existing or Abandoned System cn Lot JJ /1 On Adjoining Lots To Water Main/Service Line To Cutbank(if present) To Stream/Pond/Take/or Major Drainage Course U/,4 To Driveway, Parking Area, cr Vehicle Storage Area Comments D. LIFT STATION A) /A Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroan Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect on the date oVf, t ' s pecti . Signed 2Cd'�--_' Date � �.� la� Company &-lakeY-ke MOA No. oa� gr' L '. fec.oar,.d aaao A `itl 0 J S S U J, r" U C a U IN KBl/d5/s _..�.._ a 1 u NEIL 1.9AWN ICIriNE % t Cc - 436 o �J [Page 2 of 21 2-15-84