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SOUTH HILLS BLK 2 LT 3
South Hills Block 2 Lot 3 #017-063-04 Municipality of Anchorage Development Services Department Building Safety Division — �• On -Site Water & Wastewater Program, 4700 Bragaw St. — P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO90236 PID Number. 017-063-04 Name: SUSAN JENSEN Wastewater System: ❑ New ■ Upgrade Yas Address: 7100 HILLSIDE WAY is ANCHORAGE, AK is 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 6.32-20550 4 a Deep Trench a Shallow Trench ■ Bed OLlound 13Other LEGAL DESCRIPTION sce Rean9: *0.5 cn/se. rt. Tad D•pth emn •rlpina pod•: 5.9 NORTH/7.4 SOUTH rL Block: Lot: Subdivision: DWh to Wp• b•ttam fwn edpwol pod.: Crow depth swath pp•: 2 3 SOUTH HILLS 4.4 NORTH 5.56 SOUTH rL 0.5' rL Township: Range: Section: — — — N odd•d atwee w4ina pees: aro.a rngth: 2 ® 40' (80 TOTAL) SEE DWG. rL rt WELL: ❑ New ❑ Upgrade Claw ewte. 2 C 15' Numaw a sn«: 6 D.tan•e We 11,w•: **5' R rL Cb ficawn pdeote. A9,C : Cawd To ) Total aboorption em: 1200 plpe mama: D 3034/ F-810/SCH 40 (� Ddder: j\NV ` R so. rL static Waw tww kwt .. A+ HOME SERVICES Oat• tMa•ed: 12/2-3/2009 EX\S r< vwla NOV se At:ea.kw Night Alove &zz TANK ap„ it rL SEPARATION DISTANCES 0Septic 0Holding ■S.T.E.P. ■Other* To Septic Absorption Lift Holding b1k/Pdnale Np1yilo`h"o'' GREER TANK CWocdv in 9A : 1500 cram Tank Field station Tank s•ww lAw• Well 100'+ 100'+ 100'+ — 25'+ STEEL Numew a compo lmw b: 2 Surface water 100'+ 100'+ 1001+ — — LIFT STATION Lot Line 5'+ 10'+ 10'+ — — sre In 0 11 : 1500 � QUANICS GREER Foundation 5'+ 10'+ 10'+ — — p m le.a a: TIMER on le.a a: TIMER "h waw ew.m a: 44" n.np Nose a nada: O.«uwa swwotwn• "'ed br. Curtain Drain NONE KNOWN p—TE-30—PLUS M. M.A. BENCH MARK Remarks: lacoewn and D..adpb. *QUANICS ADVANCED TREATMENT SYSTEM BOTTOM OF VERTICAL 1x4 TRIM ® POINT 8 **5' BETWEEN LINES WITHIN BED. DRAINFIELDS ARE 10'+ FROM EACH OTHER. OLD TANK WAS ABANDONDED IN PLACE, PER CODE. M...wd Er.oewn. 100.00R GEG Ltd. Inspections performed by: Dates: 1st 12/2/2009 ENGINEER'S SEAL oo�oop� 2nd 12/2/2009 ��! OF q��op ,9Srp�0 3rd 12/3/2009 Development Services Department Approval oppP``.•• Conditional approval: Date: po •• esa p Q ° CE-79:O Q r •. SFO o so,' poc�eousos �.O.,{� Reviewed by:, �ate: � and approved l�o W14��� cR«..Iasi ooZof PERMrTNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW0 - SW090236 017-063-04 10 1101 IAS S RES / OLD SEPTIC TANK ABANDONED IN PLACE EXISTING HOUSE P-1 1300 S.T.E.P. RECIRCULATING UNE - GARAGE NEW DRAINf1ELDS /r5 CCpp6 �5/ X20 Co"? BR CO / ,1V C04V EXACT LOCATION OF OLD COULD DRAINFlELD COULD NOT BE ESTABLISHED. EXPLORATORY EXCAVATION DETERMINED OLD FIELD WAS S'+ FROM NEW DRAINFIELDS. ' I 100' WELL RADIUS f A 1 R l ITR1 DBLI 20.97 15.44 COS 140.97 131.27 DBL2 21.83 115.04 1 C06 141.61 131.11 COI 64.69 59.28 C07 141.67 130.40 ST1 66.79 161.29 COB 107.16 104.24 76.99 71.74 C09 105.77 101.99 73.87 88.1{ GD1D 104.49 99.51 76.16 68.58 Coll 143.48137.97 81.24 74.11 0012 142.67136.06 r 100.98 93.66 0013 141.05 134.02107.10 93.58 MTl 10!.88 96.02 104.04 95.83 MT2 138.76127.84 107.48 91.38 MT3 107.53 104.20 103.55 93.34 11 1!1.19 134.01 GARNLSS ENGINEERING GROUP, Ltd. p°C-9 4 y - CONSULTANTS 8 GENERAL CONTRACTORS ----_• -•• Q"""' ' ' "' .. ...... =1 L elOaR e0w. Burt 101 • /IIIA G[. (wl)v " • �vv1R ....,orn�wyrw,mn PREPARED FOR: PHONE NUMBER: PACE NUMBER: •••• •••••••• SUSAN JENSEN 907-632-2050 2 OF 4 .J r Gar es. LEGAL DESCRIPTION: DRAWN BY: 040 a SOUTH HILLS S/D: BLOCK 2, LOT 3 A.J.G. �Q'e. I.Z.IIt� ti�o°o e c TYPE OF WORK: DATE: OQdProfessto�000 AS -BUILT DRAWING OF NEW SEPTIC SYSTEM 12/11/2009 DDOoo��o IR., 01M) PERMITNUMBER: AS—BUILT DRAWING PARCEL ID -0 SWO - SW090236 017-0633-04 FINAL GRADE - JANDY V,LLVE 650 GUANICS 98.50-96.57 � AEROCELE UNIT TOP OF INLET INVERT OF BUNG — — — 88.21 1500 GALLON S.T.E.P TANK (10 GAUGE DEEP BURIAL TANK) THJI T0= RELATIVE ELEVATION OF BOTTOM OF TESTHOLE /1 - 84.90 (DRY) -TOP OF TANK OUTLET - 88.80 SOUTH DRAINFIELD • FINAL GRADE 97.46-99.77 TO DRAINFIELD ORIGINAL GRADE . 98.90 O HIGHEST POINT INVERT OF DISTRIBUTION I UNE - 93.34 BOTTOM OF BED - 91.50 GARNESS ENGINEERING GROUP, Ltd. 4 yelp) CONSULTANTS 3 GENERAL CONTRACTORS --->•�+�^-r-^— --•LL ""' "" """' ' . ... 3MI L , : Ns00VM A< ww, • nc�c cb»� ..„ • r.� 1. .-�.. •.ter .....�.....».. D PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ••••• •• ••••• ••••• SUSAN JENSEN 522-4909 3 OF 4 „ f y A. Gar ess: LEGAL DESCRIPTION: DRAWN BY: QO°y,. CE -79 3 SOUTH HILLS BLOCK 2. LOT 3 A.J.G. �� e *tz jlt jp0(•�o0 TYPE OF WORK: DATE. 44�pp000��0% AS—BUILT DRAWING OF NEW SEPTIC SYSTEM 12/9/2009 s (R. 01N5) PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID _3"— SW090236 017-063-04 TH)I NORTH DRAINFIELD 98.J2-98.41 FF FN 7 7 HRCHEST POINT GRADEIGINAL FINAL GRADE I FILTER FABRIC TOP OF W1D / c �� ��� " �i'a�L+YM '� 1i`'Siw.�•vv` ys ,��•t.�•» �at;y�� _ ..uwi� INVERT OF DISTRIBUTION - 91.39_w�:�t�1`y .,v:..v��µ,, une eeun ni r�o '�'..a.?iwJ'..?Z✓:,{'<ny �`"• LINE - 91.89 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE /1 - 82.29 (DRY) BOTTOM OF BED . 90.39 GARNLSS ENGINEERING GROUP, Ltd. . L CONSULTANTS 3 GENERAL CONTRACTORS»••- •A••---•• Q .. aro( L n Dow. aet 101 • MOORWr. r not (w>)=n I" • rea po»aisaiw •roan[: �..-v�oti.�M� PREPARED FOR: PHONE NUMBER: PACE NUMBER: • ......• ......• SUSAN JENSEN 522-4909 4 OF 4 DO p ';J 1 Y Gar SS.: LEGAL DESCRIPTION: DRAWN BY: Qa CE -7 53 ;'`F� SOUTH HILLS BLOCK 2, LOT 3 A.J.G• �D�e ('2�U•�R9' TYPE OF WORK: GATE•444��0000���0 AS—BUILT DRAWING OF NEW SEPTIC SYSTEM 12/9/2009 (R..0105) 01 0 12/11/2009 13:43 8686770 APLUS ■� T0c85eT74 ■�■ 272 4590 ■� �R1C INC ,rspec�,or Rep rt X09 12:4�P Fr"� � gaEety 0►vislori Irl- - --ane. Bu11dM9i munIcipal1w 0 An4700 ~ INFO tNsmcno '.VOIC_(fin343 1 l µeuro td5 etectAc COMPOAV Address 7Ap3 Hti-LSIDS W AY Grid G)N2939 Suodlvtston SOt1Tt't NILLS Work peseriDtton tnstan stptle lift slant 1 t t MARIA Ind. pertormed,proptf�d PeoKTechnlctan MORISA.r% CommU a^or wrectio^° can to meet on site PAGE 01 (gp71343-e21t munl.ot9 _�' .FAX 1��249 Permit to vo f — ten Dam jti,Qec-2�9 PM 1^+Pei Phone 272.4S9t G. mepecdon'iypt Eloctnc�•AQtro Erec"ncat Comments (tor In,poetor tttt ceyl (�• l N tel✓ C 14 `OT 3 BK2 TR No i Inspector F:Ofz-. Doe Ie MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 25, 2009 Expiration Date: Nov 25, 2010 Permit Number: SWO90236 Parcel ID: 017-063-04 Legal Description: SOUTH HILLS BLK 2 LT 3 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: 007100 HILLSIDE DR Owner Name: SUSAN JENSEN Lot Size: 0 SO. FT. Owner Address: 7100 HILLSIDE WAY Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-0000 This permit is for the construction of. 0 Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. A. Permit Includes waiver WRO90066 alowing a 5 foot separation distance between the proposed and existing drainfields. Received Issued Date: Date: Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 htto:1twww.munl.org1Onsite Development Services Department Onsite Water and Wastewater Program �enr r 0. n n apartment **** VARIANCE/WAIVER REVIEW **** WR#:90 0066 HAM _ Permit#: SWO90236 PID#: 017-063-04 Legal Description: South Hills, Block 2. Lot 3 Engineer. GEG Applicant: Susan Jensen 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 feet. This waiver approval applies to the existing absorption field to Error! Reference source not found. separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver Is Granted: X Waiver Is not Granted, Date: 11/25/2009 Approved b . 'f N e of Reviewer ............................................................................... Rec#: 15906 Amount $200.00 Date Paid: 11/18109 **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.r • ♦ V' Property owner(s) SUSAN JENSEN Day phone 632-2050 Mailing address 7100 HILLSIDE WAY a ANCHORAGE. AK a 99516 Site address 7100 HILLSIDE WAY a ANCHORAGE. AK Zip Code 99516 Legal description (Sub'd, Block & Lot ) SOUTH HILLS S/D: BLOCK 2. LOT 3 Legal description (Township, Section & Range) N/A Lot Size Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 1 certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: Date of Payment: / 1 1/9 1 0 Receipt Number: 0 1 5 go L (Rev. 11/05) i Waiver Fees& Date of Payment: Receipt Number: Q 1 S 0 GARN E SS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS - November 25, 2009, Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for South Hills S/D Block 2, Lot 3, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to install a 1500 gallon S.T.E.P. tank with Quanics controWfloats, a 650 Aerocell Unit and dual bed type drainfields. Two test holes were excavated on the property. The drainfield will be designed around the 30 foot radius of test hole #1. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography below the drainficld is a 5-10% percent slope running approximately southeast to northwest. 5. \VAIVER REQUESTED: Due to space constraints, we are requesting a 5 foot waiver from the existing drainfield (to be used as the reserve site) and the proposed drainfield. We are unaware of any adverse impacts granting this waiver would create. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E.I M.S. NOTE: Attached is a sire plan drawing, a design drawing, one soil log, which are all part of die design package for this septic s}stent. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessenginecring.com SOILLS BLOCK H1. HLOT 4 BLOCK ,LOT 2 I 1 \\ ^♦ SOUTH 1. LOT• < BLOCK 5 SOUTH HILLS. BLOCK 1, LOT 6 SOUTH HILLS, BLOCK 1, LOT 7 \ S LTH HILLS. SL \ HILLS. SL E --, r------ - — — — — ------- / ------ //� I 1 OPRK. LOCATION OF DRAINFIELD I I I I TH/1 I I SOUTH HILLS, I BLOCK 2, LOT 4 I I is IO I`\ GARAGE I \ HOUSE 140 AVENUE I I ARuG Y SLEEPY ACRES, LOT 2 \ / I I (FIELD VERIFY) SLEEPY ACRES, LOT i ------------- SOUTH HILLS, BLOCK 2, LOT S T 12N. R3W, SECTION 35, N2, NE4,NE4, NE4, PARCEL 35 GARNESS/i'j�: NGINEL•'RING GROUP, Ltd, CONSULTANTS& GENERAL CONTRACTORS----«•- •» O••••••• •• • • .•••• ••••••••• fAI L TIOM IIdD. Yll[ 101 � Ntld/Cf. N( N'-01 . AOS JI) -SIT • lNf (YOl)J.M-J}b) IRBJIIL w�. O PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •••• •••• ••••; ••• SUSAN JENSEN 522-4909 1 OF 4 OQ p ';� Gar ess: LEGAL DESCRIPTION: DRAWN BY: SOUTH HILLS, BLOCK 2, LOT 3 A.J.G.00� s' •1 .0 00 TYPE OF WORK: DATE: 404O4p�eslo(, SITE PLAN 11/6/09 (Rw. 01105( NUMBER OF BEDROOMS: 4 LETTER THAT PERTAINS TO THIS DESIGN. ""'•""•"""""' '•'""' "'�• GALLONS PER DAY (CPD): 600 TO OBTAIN A COPY OF THE LETTER 100' WELL RADIUS FLAGGED PERCOLATION RATE/S: 080 MIN/IN CONTACT GEG. BY PROCEEDING FORWARD PRIOR TO CONSTRUCTION BY A PROPOSED APPUCATION RATE: 0.5 GPO/ WITH THIS INSTALLATION. THE ENGINEER, REGISTERED LAND SURVEYOR. — MINIMUM DRAINFlELD SO.FT.: 1200 WELL DRILLER. CONTRACTOR AND •OUANICS ADVANCED TREATMENT SYSTEM PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND DRAINFIELD DESIGN: AGREE TO ACCEPT THE TERMS AND MAXIMUM DEPTH: 4' CONDITIONS OUTLINED. WIDTH: 15 / LENGTH: 2 O 40' (80 TOTAL) M.O.A. APPROVED SAND FILTER: 1' EFFECTIVE: 0.5' REDUCTION FACTOR: N/A ACTUAL SO.FT.: 1200 / PROPOSED DRAINFIELDS �O MUST BE '•' INSULATED. `PlOQ \I. APPROXIMATE LOCATION OFEXISTING DRAINFlELD. TO BE / ROW .. USED AS RESERVE SITE. SPUTTER �\ PROPOSED 1500 TH01 GALLON S.T.E.P. 1 TANK DNERTER INSTALL DOUBLE DY VALVE CLEANOUTS I TH%2Av AEROCELL UN R J\'0 I EXISTING SEPTIC TANK TO 5' WAIVER REQUESTED FROM X40 BE ABANDONED PER UPC OLD DRAINFlELD `^ / INSTALL FOUNDATON � AND PROPOSED CLEANOUT o;, DRAINFIELD / j<" o GARAGE NOTE: SMALL SECTION (<51 OF EXISTING HOUSE TRENCH IS TO BE ABANDONED / IN THE IMMEDIATE AREA WHERE / NEW SEWER UNE CROSSES, / .�.. .% AND CLEANOUTS INSTALLED. • : , ! 100' WELL RADIUS ;ALE: 40' GARNGSS ENGINEERING GROUP, Ltd. - - . CONSULTANTS 3 GENERAL CONTRACTORS •••---•••-=•"•mom=••-•• ••• -•• Ml C TR'GI IIG•O. 1UIE 101 • AKIMYL. IR N]O) • AE•[ (YO»1J1-OIT • IAv (•Ol}l,Y-•]3N • SIL �•.�Mwpawn PREPARED FOR: PHONE NUMBER: PAGE NUMBER: SUSAN JENSEN 522-4909 2 OF 4 LEGAL DESCRIPTION: DRAWN BY: SOUTH HILLS BLOCK 2, LOT 3 A.J.G. TYPE OF WORK: DATE: SITE PLAN 11/25/09 (R.. 01M) Garn ss o E- 53 ,FQ 15 (Re 01N5) GARNL•'SS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS • •+-,..,..... •- SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: SOUTH HILLS S/D; BLOCK 2, LOT 3 DRY PERFORMED FOR: SUSAN JENSEN 3:20 DAT DEPTH - Rv •\\ice APPRX. LOCATION OF DRAINFIELD _ (feet) =Z": TEST HOLE 1 1-_ _= ORGANICS 1 I I �==z SOIL CLASSIFICATIONS / J 2 - - - - / • 1 GARAGE 5 5/8- HOUSE 3 a GP ML 6• GM CL 4 GC OL 3/8" °• • o o SW MH 5 • : SP CH SM i OH 6-1 SC 7 0111-11111i® 9 10 11 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE DRY 11/11/09 DRY 11/18/09 3:20 - 6- - 1 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 11/12/2009 1 3:20 - 6- - Rv •\\ice APPRX. LOCATION OF DRAINFIELD ! OTHII I I 1 I I I TN/2• - / J I / • 1 GARAGE 5 5/8- HOUSE 5 I 1 6• - I I t SCALE: 5 5/8" DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 11/12/2009 1 3:20 - 6- - 2 3:50 30 5 5/8' 3/8- 3 3:50 - 6' - 4 4:20 30 5 5/8- 3/8- 5 4:20 - 6• - 6 4:50 30 5 5/8" 3/8" 19� PERCOLATION RATE 80 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 2.0 FT. AND 3.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ANDREW GRAY COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: it c GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS ••�• ^••-- •-- •-••-•7 >I c . wlrL IOI • NoCHM at AM. 99W? • h 07)331-179 • fu coy a " • Ircesrt -pip. 1 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: SOUTH MILLS S/U: ULUOK Y, LUI o PERFORMED FOR: SUSAN JENSEN DATI DEPTH (feet TEST HOLE #21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 FILL AND ORGANICS GM/ML DATE 1 I ,I i. OF DRAINFlELD `2` !MPR%. LOCATIONI \ .TH/t I I \ I TH/2♦ ------. i 1 � 1911 / I GARAGE / HOUSE � i , I I I , t SCALE: \ t' .too' DATE 1 I ,I i. OF DRAINFlELD `2` !MPR%. LOCATIONI \ .TH/t I I \ I TH/2♦ ------. i 1 � I / I GARAGE / HOUSE � i , I I I , t SCALE: \ t' .too' 19� PERCOLATION RATE _ (MIN./INCH) PERC. HOLE DIA. — (INCHES) TEST RUN BETWEEN FT. AND FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Is fi-lb 9 IT ally, lip : - 11/17/2009 DRAWN K.DBr.M. ��!/ DESCRIPTION: SOUTH HILLS S/D; BLOCK 2, LOT 3 GARNESS ENGINEERING GROUP, Ltd. OF WORK: CCNSULTANTS 6 GENERALCONTFACfOFS DESIGN OF QUANICS AEROCELL SYSTEM ,,,,,m m.,, .,..�.-.«.e�� ..+.�n.,�...•�— —+—• ARLD FOR: PHONE NUMBER: IPACE: SUSAN JENSEN 1 632-2050 4 OF 4 VeA .••Gorne/ls.�•••• . •••r�.l� 11/19/2003 12:30 4247739 NVEYAKVILLAGE PAGE 02/06 ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN CH'ALITY OF ANCHORAGE AND , S[n ,., LTCn .S s ✓L THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this LDay of/llOUtrn%',Cof2009,byand between 5&5cI jee7seAl herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY:" In eons:derstion of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Trtatment System (AW WTS), described as a L n n i C S Arice I (located At 5,i , A -k Al L 3 , Anchorage, Alaska. 2. Definitions A. Alteration. Any change to the design or function of an AW WTS that Includes the installation or removal of any parts, components or pieces not Included in the original construction permit and design Prior to performing any alterations to an AW WTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter. "AMC") 15.63. B. Certificate of Onsite Systems Approval An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. 11/19/2009 12:30 4247739 NVEYAKVILLAGE PAGE 03/06 These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of .system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, campomnts and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Constraetion) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the rcquiromentc of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of O (S„(�L_.00). payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. J=. The tern of this Memorandum of Understanding shall be for the life of the AWWTS. 11/19/2009 12:30 4247739 NVEYAKVILLAGE PAGE 04/06 The term begins on the date of approval by the Municipality of the installed ". ern and shall continue while the A WVITS system Is in use or operational or until the property is sold or title is transferred by owner and a new toff ate of On -Site approval is issued to the new owner or transferee Or the property. S. Alterations, Installation smd Removal of AildtionaLEARament. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. 1M2intenance and Rennin A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. in addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (I) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws. regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the arras and conditions contained in the Owner's AWWTS Operating Permit This schedule shall be submitted to the Municipality annually upon the renewal of the permit The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: J f. j i e e %l Pz. r C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified In AMC 14.60. 11/19/2009 12:30 4247739 NVEYAKVILLAGE PAGE 05/06 O. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system_ E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours vritten notice. F. Owner agrees that any salt or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the goveming professional guidelines for the construction, maintenance and repair of the Owner's AW WTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, not in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. g. Amendment A. This Memorandum orUndersraMing shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: 11/19/2009 12:30 4247739 NVEYAKVILLAGE PAGE 06/06 Owner. tl SGl t I C/! S Anchorage: purchasingOfti C. Any attempt to amend. modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. zSeverabilitY. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. renlia 31 STATE OF ALASKA THIRD JUDICIAL DISTRICT The foregoing instrument 20.[ L-\ by ftMa My Commission expires: MUNICIPALITY: By: Title: Date: ) as. before me this L day of d DVr�cclhPC MUNICIPALITY OF ANCHORAGE j DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION .y. ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 0* 0* ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPHONE(j 5�, % lE✓fi� 8 _ -NEW ❑'UPGRADE MAILING D®SS Ll\ y�� LEGAL pESCRIPT10f�, _ ^�c LOCATION NO. OF BEDROOMS Uy DISTANCE TO: Well �. 160 Absorp ion�rea � Dwelling, r �4 Z PERM O. / a Q LU < Manufacturer %��% �'�w �/ �/ Wvwr� Mater" .+( No. of co partments rn Liq. c pa ity -n alions IF HOMEMADE: Inside length Width Liquid depth 6 y Jt7Z DISTANCE TO: Well Dwelling PERMIT NO. = Z F Manufacturer Material Liquid capacity in gallons O J = w DISTANCE TO: Well �� Foundation ! Nearest I line PERMIT In oz - J u- Z Zw ~ No. of lines Length of each line , c5 d Total len hof liras EI[ Trench v tb� c3CG� inches Distanc�,be en lines FTop of tile to finish grade / Material beneath tile inches Total of �ctive orp ion area w Length Width Depth PERMIT NO. U 4I— wa Type of crib Crib diameter Crib depth Total effective absorption area w y DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER IlLt_L PIPE MATERIALS, Llg2't SOIL TEST RATINGs�� s, V r L4 wAf INSTALLER` y y _ b REMARKS MT_" Trmn 0 , DATE LEGAL APPR54,q /®/g r/ 72-013 (Rev. 3/78) L_j 071 77 77 77 :F, : FA 1O -tr : -p- :O\ :rn :o : 11 Oil �n H H H O O O :FA ;co :O ON :O 61, :m m: :(D : O:(D :Pt E�o:ly K K (D K 0 wao 0 cF 0 PV no x 0 Y H H H H O O co @o H H zn (n : (o Q cF: cF � m:a N. ' IZ ql �.� 071 0 0 0 0 0 0 0 0 0 0 0 . : o ii z v O 0 H O z C+ O 417 co In d a o v co : co 1 E 1 :Cb :--j 1 I CO ; CO tv r v r o 'OD r 'r :w z :O :o v.. W :O :(D N :(n iH.:ti' :(D i(v :• 43 :0 : � :5 :co :N : to x x x m x m m :o : w:o :ou No;w H H H H H H H O O O O O O O :\o \O rn :lA rn :- : o :Co. :o : w -No H H ;-3 H H H H H :[A Fhi io" C3!R-cn!w :p K i CD 5 K : (D : (D: P-: i. op :0 i(Di :5'` m:�3' !ii5N:�Y iA1Y :F-'m:Pt Bou:W EsIz:A) :c+ : A):ci- :h ;K :c+ ;K :(D CO! .:(D :• K:a :• K:a o: O: (D CD K K K K H H H H O O co @o H H zn (n : (o Q cF: cF � m:a N. ' IZ ql �.� 071 0 0 0 0 0 0 0 0 0 0 0 . : o ii z v O 0 H O z C+ O 417 co In d a o v co : co 1 E 1 :Cb :--j 1 I CO ; CO tv r v r o 'OD r 'r :w z :O :o v.. W :O :(D N :(n iH.:ti' :(D i(v :• 43 :0 : � :5 :co :N : to THE REQUIRE[.,- SIZE OF THE SOIL ABSORPTION SYSTEM IS: 19P__ EE �_' _E 6-� —• fii E,:° e;=•=1 a Er E.-_ THE LENGTH DIMENSION I S THE LENGTH (IN FEET? OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF FI 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 €. RAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION < I N FEET). -jF 11=o P-4 j-= - T = E= - fL 2_4 o a: --n ea n E _ L_. f=n r -,J ^_.. PERMIT APPLICANT HAS THE RESPONSIBILITY 'TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPE€_TIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE P•dl_1MBER OF RESIDENCES THAT THE WELL WILL SERVE. _ _ -rj °-I v_& < :2 > I PA '_^ F- E - Qv -T- ..I.. n F' EL. F-_-" E_. i- ®U I BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPE€::TION AND AF`F'K:C€VAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL Yri T•EM 1,5 100 FEET FOR A PRIVATE WELL OR 1.50 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPN 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 THE DEPARTMENT WITHIN _0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENT'S MAY APPLY. `PEC: I FI CAT IONS FIND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-`' a ER M I -IF a e--2 E='' I Ff C: CA EE 0 EE= d'n"6 E_= a Fi° w1. _L =� I CERTIFY THAT 1: I AM FAMILIAR WITH THE' REQUIREMENT_=. FOR ON-SITE SE14ERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. -:I UNDERSTAND HAT THE ON --SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMOE:l9-jI5Cl TO INCLUDE MORE THAN 4 BEDRC€€�€MS. -,n�d �,. �` SI€ NED ADPL I r'='= I IEry r..,r i �-_ ___ MR1 -Y.. aT 'F" d Ss r"1 k—A r -s9 I i._ .I= V- L_ I c CP F::l l'-4 C" F-4 r-- F.? t=l 1:3 E= DEPARTMENT G. Ar' D Er'?�.' IRC €NMENTAL i,_.,0TEC:TIOlN i� 6n in �91 -,,HEALTH - .�•••� 'L.' STREET, ,,F-fPAC9 ANCHORAGE: ALS:. 995101. �� L dia 26-4-4720 Q4E::-E_9 f_wrA- _:= _-F-- oF=1- 1E_F--"E-7-f_=' JFJ /tom •�L� 3. -IfPERMIT NO. 810442 APPLICANT JES I E THOMAS PO. BOX �-€ €- _ 94 `:4--•8 t•8 L) LOCATION HILLSIDE LEGAL LOT 3 BL E': 'u SOUTHH I LL SLIE; LOT SIZE r,=: 340 SQUARE FEET :]S' TYPE OF SOIL. ABSORPTION SYSTEM I E• : TRENCH j 3D -o in MAXIMUM NUMBER OF BEDROw€pi'_, _ 4 SOIL RATING SO F'T.-'E,R'., = .j IZ'y c, qtr L( THE REQUIRE[.,- SIZE OF THE SOIL ABSORPTION SYSTEM IS: 19P__ EE �_' _E 6-� —• fii E,:° e;=•=1 a Er E.-_ THE LENGTH DIMENSION I S THE LENGTH (IN FEET? OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF FI 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 €. RAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION < I N FEET). -jF 11=o P-4 j-= - T = E= - fL 2_4 o a: --n ea n E _ L_. f=n r -,J ^_.. PERMIT APPLICANT HAS THE RESPONSIBILITY 'TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPE€_TIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE P•dl_1MBER OF RESIDENCES THAT THE WELL WILL SERVE. _ _ -rj °-I v_& < :2 > I PA '_^ F- E - Qv -T- ..I.. n F' EL. F-_-" E_. i- ®U I BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPE€::TION AND AF`F'K:C€VAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL Yri T•EM 1,5 100 FEET FOR A PRIVATE WELL OR 1.50 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPN 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 THE DEPARTMENT WITHIN _0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENT'S MAY APPLY. `PEC: I FI CAT IONS FIND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-`' a ER M I -IF a e--2 E='' I Ff C: CA EE 0 EE= d'n"6 E_= a Fi° w1. _L =� I CERTIFY THAT 1: I AM FAMILIAR WITH THE' REQUIREMENT_=. FOR ON-SITE SE14ERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. -:I UNDERSTAND HAT THE ON --SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMOE:l9-jI5Cl TO INCLUDE MORE THAN 4 BEDRC€€�€MS. -,n�d �,. �` SI€ NED ADPL I r'='= I IEry r..,r i �-_ ___ MR1 Plus" r LIEF-FIRYPE14T+� �EiIRPittl�id]TTI� < �3104412? 3 uloAilaN Illu-sIckEPa. Box 110-51-34 Lcrs'l- LOT sGLK aaJTHtiIAjq - ♦� 24-13349 . ; �1y " 5','�. i2"i Si't��i� f 7; �� ��' 1, i� V�,a �• � .5+3 ��_ { iS+i+s E.�t� a��a'x$7i4'.k= ASF@ 3g+`.a y.I am -rte: TfC tXtl'am DumisI9-w I'-- TW LEWTH (In Fa:-IT3 (A= T :' Pjj�N �p I3�iIF�; s THE CEPTIM 13' A T MEW -M OR PLY I'a THE &,F T1,1EEN T# -JE _fiFITr�E 131= Tim t IM-4-P-JAf r'?AT4 s! Tf ViiTION IN FSED3 TFIE'GRRVEL CtER T 4 IS T -r- M M Ji M DEprHjF saRRVEL BETIWErf THE t 311TH iv F' Iii -Pv,Rmir f'#'? Icmr H% 3IR-En Iry Oh3SIOrLITY TO fWtlqil Yi�I'� 0 r it I��i'im T F I T # mspEcriclm oF my m 1_ s noj T T13 rm r PR y)5ZR ? AND Tim RNV3 f�� T W I TI+--djr F FPS,. i SPECT I oT# MID 8PPRIT-549L 8y THIS F -FRT;' T€ ri L aE -sa to jei-, ToPRo-swurpoK ti 3i I inn ] o I s rf-si-P� s rwout 13 wvi. L 1 -m -M 8:t 1:)m -s I TE '.Fz4p,3F olspfK - 1-1 IFLa==T FOR A PRIVRTF WOLL GIZ i TO 2QV FEZT PP•.#t$ A PLJLLtc wu_ mF>swr MINIPrPM OIsT}ate FROtj A PREYATE WDLL_ T1# A-PRIVAPE SO4 UM is 2a FFAI tv#t) TO H COMPPsi`LITY w W -R L_INC IS_ FEEL L.. i �' REQUIRED SHO t�t�I cl i3# NED TO THE DEPARTMENT L)Lrl4tM 30 Wes 13F TWE WaLL CoWt-F-TILK OTHER MAAXJfPFJ4ENTS PAY FLY CIF ICATI0?6 AMD M. ,r5TRlxrStm o[RORAm A 19 1TL- 4P- To IN5K PROPER IN`sT .LAT I CDEPIrIFY THAT . : I 13H FAWLERR LSM, T RAEQUIREMiTS Trap, on -•alis ;it-jo lil:1.. s is = T _ i UfU- MST -`s_ TWE S SMEM WITH T1 -E s��x 3: I UASCE TAM LI -VAT T L M --5I SEI' Y% ----F RRY� -,ext*}€ IF T . r ❑ SOILS LOG r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION K PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:f-`�f{i"�I�iC.- DATE PERFORMED: LEGAL DESCRIPTION: ,3 BZ, ' / 10 SLOPE AI SITE PLAN 1 / 2 v F, 3 4 '.IG 5 6 7 8 9 10 11 f i 12 13 14- 15- 16- 17- 18- 19 41516171a19 20 COMMENTS Cw !) (1 e rc v i . t'ri L',I,.,) !6!6 WAS GROUND WATER ENCOUNTERED? At Robert A. ofer 7•E �= IF YES, AT WHAT DEPTH? S L O P E V Reading Date Gross Time Net Time Depth to Water Net Drop i���� -� 123, ryvI{- JO I yJ PERCOLATION RATE (minutes/inch) " TEST RUN BETWEEN FT AND FT PERFORMED BY: .S S Engineering' CERTIFIED BY: �. - -- 72-068 (6/79) DA 11 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # X1`1 - C�—\ HAA # Q "9 "QIl:Q �)-) 1. GENERAL INFORMATION Complete legal description LOT 3 , $LOCI- 7- 5ou.74 1 L , sta&D IV 1511) t -j Location (site address or directions) —1 100 "ILLSIDE! WA}-/.) �C Property.owner �SSt E `l–I-kOl"1�!-S Day phone �� "' 4 Z' �S ZSR Mailing address , 1P So% 110594 1 A•k • CM511 Lend'igg agency �� Day phone N �p <, Mailing addr'S, 4 Agent Address Day phone µ L4 Unless otherwise requested, HAA will be held for pickup. PSE t"14i L 7-0 }4D.m S OvvNJIER 2. NUMBER OF BEDROOMS' Fou2ti 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA»21 5. STATEMENT OF INSPECTION BY ENGINEER t As certified by my seal affixed hereto and as o oaltshows tha the otion date shown nsitevwater supply erify that MY investigation of this Health Authority App application and/or wastewater disposal system is safe, dicated he ein. I further verriify that based onnal and tthe nfoe for rMation obtained from and type of structure the Municipality s Ancewaterdis diles and from my investigation and sposal system s n compliance with all Mpunicipal and State codes, supply and/or wastewater p ordinances, and regulations in effect on the date of this inspection. 3376,79 nr �YA wa"�E� u'�'��� Svcs. Phone Name of Firm '� �G� . �99 5'04- —1 Beoo E' R. Address Date Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. bedrooms, with the following stipulations: Conditional approval for Additional Comments -- The Municipality of Anchorage Deparrmem ui ara raph 5 above by an (naepenuu Approval Certificates based only upon the representations given in p 9 professional engineer registered n order to satisfy th celrtain federaall and HHSsta esrequis rements. Emplos a courtesy to yees of DHHS do not and their lending institutions conduct inspections or amiss ons In the oreprofacerti sional(cate is issued. engineer's work. Municipality of Anchorage is no responsible for errors or o 72-025 (Rev. 1/91) Sack MOA 1Y21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.oT' 3-I %Locy�2• Parcel I.D. 450wr 1t.t_ SQgDIVtStoW A. WELL DATA A Well type KIVA-T6 If A, B, or C, attach ADEC letter. ADEC water system number / Log present (Y/N) X1;5 Date completed Ind 91 Driller SYIS�'J 3RUS. Total depth 2D 4 r -T• Cased to 44B 4 Casing height I ns — Sanitary seal (Y/N) ��'S Wires properly protected (Y/N)«S v FROM WELL LOG AT INSPECTION a c Date of test S�!?���I 4-/I©/9'2 X (D 2. t ti Static water level / 50 F44n -roe �'.. w& 44#i 90 11<1 MC) Well flow 2 3 g.p.m. b, '2S0 9.@ - sdou . -"wet. m WI: VZOP 6A -Loos Pump level NoT �Sl"ATED 0040 UNKN�W►J �� r., %"r=%A.: 1.0 G -r 5AD SEPARATION DISTANCES FROM WELL TO: m o� Z Septic/holding tank on lot IZ I FT. ; On, adjacent lots F(ELD Vol � tOo F+T. Absorption field on lot y$ F'T` ;On adjacent lots Ft>vt.D vERtPtED > Ice) FT. z Public sewer main �a Public sewer manhole/cleanout NLA Sewer service line I Z'g" Fr. 2 Petroleum tank NONE D BSEk V�Q WATER SAMPLE REPULTS: Coliform Nitrate �® Other bacteria Date of sample: 492 Collected by: ESS B. SEPTIC/HOLDING TANK DATA © O Date installed ��'� / $ Tank size 12 Sa 6'L . • Compartments 2 ©, NO Cleanouts (Y/N)". yEs ' "Foundation cleanout (Y/N) 146 Depression (Y/N) High water; alarm (Y/N) -Alarm tested (Y/N) P4/A Date ofpumping �4 Pumper A+ 1. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: O Well(s) on lot 'IZ�, `O ` On adjacent lots �I e) V: -r. Foundation 15 �T' To TM�th C/O Topropertyline Absorption field la PT' Water main/service line �rJlGaown! 5ouTk .L Surface water/drainage > too FT. 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date in d Size in gallons Vent(Y/N) High water alarm level "Pump on ,I at Meets MOA electrical codes (Y — Manufacturer Manhole/Access (Y/N) ump off" level at Cycles tested SEPARATIONCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacentlots Surface water Date installed 1O /e / & Soil rating 3 Zp System type TREACA4 Length 2400 PTG) Width 317 0 n 0' Gravel thickness 4 Loft OI( O Total depth 9 L0,V Y� S Total absorption area t 53'ip FTI T Cleanouts present (Y/N) Depression over field (Y/N) NO Date of adequacy test Results (pass/fail) PASS for T--ouIp. bedrooms Peroxide treatment (past 12 months) (Y/N) N /i4 If yes, give date SEPARATION DISTANCEF OM ABSORPTION FIELD TO: 8I• (=)6lp VE?,IF(10 SEE. co4ER Well on lot 9S FT Onladjacent lots �> 100 F'' Property line To building foundation To existing or abandoned system on lot 46, >� l0 FT.covFlL On adjacent lots £E Cutbank N 1A —Water main/service line UN1GNow1�! t�'rt�rz FIELD V1Jtif-1S0 Surface water —> FOO' Driveway,34 FT,� parking/vehicle storage area — Curtain drain NnNf_INSP U" -r"113 5D /8/ F,F-S4•• I I N t Tld{. F�� t�orJ Y�PoR t 0/6 /81 ENGINEER'S CERTIFICATION 2, f'tELD INSPEc;1on1`. (9N 4-1lo/`i2 1 certify that 1 have checked, vgfified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's NamA • 6AQ-,J6,sS Date t►' L �a�2?OLZ, HAA Fee $ \iL3,C>(�' Date of Payment Receipt Number 72-026 (Rev. 3/91)Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number OF. ^f"x ' ••i..,.'1' iy A. Ga CE -7453 Alaska Water 8c Wastewater Services "Preserving the Last Frontier" May 22. 1992 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section P.Q. Box 196650 Anchorage, Alaska 99516-6650 RECEIVED fAAY 2 2 19 `2 Municipality of Anchorage Dept. Health & Human Services Ref: Health Authority Approval (HAA) Application for Lot 3, Block 2, South Hills Subdivision. To whom it may concern: 1. WELL ADEQUACY TEST: Attached is the HAA application for the subject lot. An adequacy test was run on the well by pumping 0.8 GPM (average flow rate) for a total of 25 hours. The total volume pumped was 1200 gallons. The static water level, at the beginning of the test, was 50 feet from the top of the well casing. The static water level in the well was measured, 18 hours after pumping was discontinued, at 52 feet. This is essentially a 100% recovery. In short, the well is capable of producing 600 GPD. The home has been occupied by the new owner (family of six) for the last month. 2. SEPTIC SYSTEM ADEQUACY TEST: The septic system was tested for adequacy by introducing water into the clean-out located immediately downstream from the septic tank. Water was introduced into the clean --out at a rate of 0.8 gpm for a total of 25 hours (1200 gallons). The system absorbed the entire volume without backing up into the septic tank. Consequently, the system was deemed to be adequate for a four bedroom home (600 gpd). The existing sump was not used as a monitoring tube because it was previously fouled/plugged (See attached HAA report from Buxdor Engineering). 300 gallons was pumped out of the drainfield, through the sump, by "A+ Home Services" on 4/3/92. Again, for this reason, I did not feel comfortable using the sump as a monitoring tube. As mentioned previously, the home has been occupied for the last month, by the new owner (family of six), and they have not indicated that there are any problems. 3. FOUNDATION CLEAN-OUT: I was unable to find an exterior foundation clean-out. The initial inspection report, dated 10/8/81, did not show a foundation clean-out either. Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504 4. SEPARATION DISTANCE FROM WELL TO SEPTIC TANK: The initial inspection report, dated 10/8/81, states that the well is located 98 feet from the absorption trench. Since the trench is buried, the separation distance cannot be verified. A waiver has been approved by DHHS„ 5. LOCATION OF WATER SERVICE LINE: The location of the water service line was never documented. However, the homeowner, whom also built the house, indicated to me that the water line runs directly from the well to the middle of the eastern foundation wall. If this description is accurate, the water line is approximately 30 feet from the septic tank, and some unknown, but farther distance from the absorption trenches. 6. ABSORPTION FIELD - GENERAL: Due to the fact that the drain field was not located with swing ties, and noted on the initial inspection report, the actual location of it on the property is unknown. Consequently, it is not possible to accurately measure the separation distance to the property line. According to the inspection report, the separation distance to the property line is 20 ft.+. Short of exposing the absorption trench, it must be assumed that this is correct. 7. GENERAL: Due to the large lot sizes, I only verified that well/septic system separation distances were greater than 100 feet, and did not attempt to actually measure separation distances which were, in some cases, more than several hundred feet. If you have any questions, please call me at 337-6179. if all goes well, please contact the homeowner for pick-up. Thank you. Vr/ionsultantss' , . rneP.E. JAG/Jag Thomasl.wps A+ HOME SERVICES, INC 15900 Francesca Drive Anchorage, Alaska 99516 345-1890 or 345-2444 CUSTOMER R Block. Lot INVOICE # `6.249 DATE DESCRIPTION AMOUNT U TOTAL cf REMARKS r` 5-u✓ t iI - -� Ian Gallons �L Septic / Leach Area Holding Tank _Standpipes Time ❑ PROBLEM AREA -CALL FOR MORE INFORMATION ❑ NEEDS -TO BE;DONE AGAIN IN B MONTHS ❑ Good.Shape• ❑ Sludge buildup on bottom ❑. Floater on top ❑ Jim cap missing or❑ Cut standpipe to 1' above ground ❑Needs Septictrine needs replacing CUSTOMER COPY - KEEP FOR YOUR RECORDS -PLEASE PAY FROM. THIS INVOICE— HEALTH AUTHORITY APPROVAL RESULTS AND ANALYSIS AS OF TEST.OATE ONLY LEGAL DESCRIPTION: LOT _ D7LOGt ----------- ADDRESS___ 0 _ �Il S ! Q«2� W--- ------------------- WATER TEST RESULTS: �.v� �-r.�,��. 1_,�tT i� cy�,.`,�'��•'= a ) � Ga �i 2•ed @'y' I�i'�t � i t�-e.- � v 5 •) �'-�-� . j S`� '' G) tom? j r�� � v�. `�•t. �a �,S '�-- i� i �S�S.o vt�,o� c� i .�•,� a�. C� �0-es w�-I- wl.�.�-i- �{u� � G��_ I r�a� u �xx��u-) TESTED 9Y l .. p�s•�' is 1.�.•' IC� ��t _ _...r...,. • b ~I Ir,,11 n�q •• �AC � _ ��Sl1� �JGt�ruuG ��M :N •(/l I...1l..:::�.NIIINIM��� •... ..Nw.. �'Ill 1"11 _ a 5 �o;•,ri ��r k ,Q•�i _ _ CC J l0 3 a� fi .we'll -� l�•� Y L`POf �. ....� � lam'--�•:•1.;.- �.,�, 49,r ���'1 Y'%� �,�'!'�j SEPTIC TEST RESULTS: c�t U 2Y �ILLU • Cd- �.v� �-r.�,��. 1_,�tT i� cy�,.`,�'��•'= a ) � Ga �i 2•ed @'y' I�i'�t � i t�-e.- � v 5 •) �'-�-� . j S`� '' G) tom? j r�� � v�. `�•t. �a �,S '�-- i� i �S�S.o vt�,o� c� i .�•,� a�. C� �0-es w�-I- wl.�.�-i- �{u� � G��_ I r�a� u �xx��u-) TESTED 9Y l .. p�s•�' is 1.�.•' IC� ��t _ _...r...,. • b ~I Ir,,11 n�q •• �AC � _ ��Sl1� �JGt�ruuG ��M :N •(/l I...1l..:::�.NIIINIM��� •... ..Nw.. �'Ill 1"11 _ a 5 �o;•,ri ��r k ,Q•�i _ _ CC J Municipality of Anchorage Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 27, 1992 Jeff Garness, P. E. Alaska Water & Wastewater Services 8471 Brookridge Drive Anchorage, Alaska 99504 Subject: Waiver Request for Lot 3 Block 2 South Hills SD Waiver Request #WR920022, PID #017-063704, HA920252 Dear Mr. Garness: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are 98 feet from the private well to the leachfield. This waiver approval applies to the existing septic well separation only. Any future upgrade to either require all separation distances be met or another from this department. Sinc rely, Robert W. Robinson Civil Engineer On-site Services RWR/ljm system to will approval MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#:jy��PI D# 017-063-04 Date Received: May 5, 1992 HA# IIA920252 Permit # Legal Description: Lot 3 Block 2 South Hills Subdivision Engineer: Jeff Garness, P. E., Alaska Water & Wastewater Services 8471 Brookridge Drive, Anchorage, Alaska 99504 Applicant: Susan E. Green (Jessie Thomas) Waiver Requested: Well to leachfield - 98 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability �3 , D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or R asons for above: / zv_ _ / e %lam/' _ ... -- .,.e// �s r,c%s a ii4 Rec #: 23665 Amount: $590.00 Date Paid: 5-5-92 W4 WIL D o Z Lo 3 (?lei�J�!-�/ s B a f/��li V�� v D` ' /�00 p�l B•y� vtpP/�� C140 a4v, � 0�/t-�� l�ri28fGN, �/� L�it�C� cl�Vi-p�S�t J'G9�J 4f ¢�!O/fz VX04r,-W D 4J.°�� o� orifi Z0^1 C, PC/dPFill ic�i J • w,+r v(c. 1 �4i� Lz G cci" Alaska Water 8c Wastewater Services "Preserving the Last Frontier" 11- LLD S --(YL-\ May 4, 1992 Municipality of Anchorage Department of Health and Human Services rTI Division of Environmental Services On -Site Services Section t®ii P.O. Box 196650 Anchorage, Alaska 99516-6650 Ref: Waiver of Separation Distance from Well to Drainfield on Lot 3, Block 2, South Hills Subdivision. To whom it may concern: While performing records research (for an HAA) on the subject lot I noted that, according to the initial inspection report, the trench was located only 98 feet from the lot's private well. This distance was approved at the time by a DHHS employee, John Kennedy. Since the trench is buried, the separation distance cannot be verified. Upon submitting the HAA package for review I was informed that a "Separation Waiver" would be required„ The following is an item by item evaluation of the criteria outlined in the "Separation Distance Waiver Guidelines for SCRO", prepared by the Alaska Department of Environmental Conservation (ADEC), January S. 1985. As per the instructions of this guideline, since the well penetrated bedrock (according to the attached well log), I will only consider the separation distance from the bottom of the trench, to bedrock, rather than the separation distance to the water table, which in this case is a confined aquifer accessed through fissures in the bedrock. 1. GEOLOGICAL: a. There are no well logs for Block 1, Lots 5, 6, & 8, South Hill Subdivision, and Block 2, Lots 2, & 4, South Hill Subdivision. There is a well log for Block 1, Lot 7, South Hill Subdivision, and my clients lot (Block 2, Lot 3, South Hill S/D). In addition, there is a well log for the community well which serves the subdivision directly to the south of my clients lot, Sleepy Acres Subdivision. All of the subject well logs are attached with this letter, and are also on file at DHHS. By looking at the well logs, it can be seen that all of the wells are tapped deeply (several hundred feet) into a confined aquifer in fractured bedrock. Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504 0 Cn N With this limited information it is difficult to accurately define the bedrock profile, but it is clear (upon visual observation of the topography) that it slopes (at approximately -125%) to the northwest from my clients well and drops off rather rapidly, at Hillside Dr., down to Rabbit Creek. In short, it slopes away from my clients well. It is apparent that my client's well is not supplied directly by water from above the bedrock, since the well is cased into the bedrock. My field investigation on 4/10/92 confirmed that there was no water entering the well from above the bedrock elevation (-48.0 feet). This was determined by listening for incoming water, and visual observation with a flashlight. b. The depth from the bottom of the trench, to bedrock, is estimated to be 33 feet (see the attached drawing). This separation distance corresponds to a point value of 4.33. The soil sorbtion below the trench, assuming 33 feet of coarse clean sand (a conservative assumption), is estimated to be 1.5. The water table gradient is not applicable since the well is supplied from a confined aquifer and does not induce a hydraulic gradient from the trench to the well. The point value for this is unclear (I assume it would be 7.0). The horizontal separation distance is 98 feet, which corresponds to a point value of 3.0. 2. SPECIAL CONSIDERATIONS: There are no special materials or construction techniques used to mitigate geological concerns. 3. OTHER CONSIDERATIONS: a. Only 2% of the separation distance needs to be waived. b. There is over 10,000 ft2 of property per bedroom. C There are no aspects about the lot shape or structure which would have an impact on the decision to grant, or not grant the subject waiver. d. The well is privately used for a four bedroom house. In addition to the above, it is important to note that the well was tested for bacteria and nitrates on April 10, 1992, It tested "non-detected" for both nitrates and bacteria. In short, it appears that the septic system is not contaminating the well. If you have any questions, please call me at 337-6179. if all goes well, please contact the homeowner (Jessie Thomas at 279-4422) for pick-up of the waiver. Thank you. Sincerely: J e A, Owner Consultant JAG/Jag Thomas3.wps - - —_ sweet i L a4 0 vi. o I r P o 0 -�•. >xe a9.-..- -—..__—• %�o"5nC't PPz.es co Sev'<zr <n a. u . � � �• ' o n a) arwrvuvn ava.J 4E o o9a9, .�woaBr, �Ae a - ar�J _ _, r100'Ot )DY 3 e 1PiaP <5>.9B va � Im c F, in r � a sO JJ r wk �i 7 `i �h � � ,l`•n Th e O'NEILL O`NEILL Sao -A N t :II I �f tY'f l i DAILY DRILLING LOG €€, ' SYREtN PROS. DRILLING, INC f 4z x I?=H II f1 �'a�sl a•:; r.1r 9.'f It• IXrltt faal!; .! %n:h..ngt. Al2%ka 904003 t ?S'h_NTR(j�l.ANb. e�fie ,....... ho a.. ......... ....................... DEPTIIOF'AELL .............._......_.. c I,•.�p D;blovin AnchoraPe .;:, c9i�7 5' Ri'�g2r ,AI7h�................................_..... .... ................. ST DTICLt.%ELOFWATER FT_.� _.-.. +.«.. 6 s' o� Eli . 2 Sort': i:il Sub. ........ ..... OR VA 00%N FT...... _................ r I + s.*a t I)ATF STA 7EO. �,.17 .3t G%LC PER H (� 1 2..3... p .. .......... . ..... `.! R (� ..6'/A. /Grd. =B st 3)AT6 • E,�iUE3)» :«. ....... ` .... . KIND OF CASItiG.............. S3 ,-.K1 DOF;FOX ATIO%to 48' 9" I '. ' «+ FT'. TO ..... _ F T..` ilt c�:�.^.d gravel FROM..... 1.8D..........FT. Ta. ._. it w%` -i^.311 annt• Ifs i!" I ROgt ,' id T. TO „SF . ............. FROM ........ ............ FT. «, FT. To....3G.............. FT. .2 .gr. i water `t +a I 4g 5�it w �:'3^d FROM........_......._.._FT.TO.. »»FT TO.......................FT.&...cxsa''e= small FROM.........._».. »_FT.TO........... FT € `` s F7 TO. 50......_.._..FT.� r Crc.'.<.. d rock FROM........_.._.. .....FT. TO....__..__ »- .FT s F'R tt 14� I.......__.. . - `. ;ter `» 0 ' 9 ediun 1'.10' M ...,5 .. FT TO. ..FT.. .._... FROM TO -------- - FT 81 00 fractured rockT f'310)I.._. --------- FT. TO ......... __..__ FT.a^., FROM ......... ........... _.-.FT. TO.__.._____ __ FT.. K t F'FxO►l. FT.TO..... hard rock FRO%1. __.._.._--_- _fT. 96 i Fi2Oil,�' ' I 1_FLTO.. _..._..... FT_= 1'._''.•"•t.. ^a.er FROM.........._.._..__..FT.TO...... _. Mediu- Yard roc;c r. Iit�klt 6� !.FT. TO..... ..C.. FT.' FROM...... ... .__.._. _.FT. TO...- _ FT »a so.' fractured rock. »FT.TO__1J............FT.`:-: i .a -'?.=..._water FROM.....-. __-__....FT.TO.._._.....----FT .«. R ' i'a6 FT_ TO.. = � C p d t' � * ;= d `` O C k FROM ----. _ ---_ ___FT. TO.___- ----- FT.,l_' - „ s �33�t:i.,i`cFU�2.�tATiQV: �t I . y ` II , I, r , , II DRILLER"; Kermit D. Sy ren s T d ,. - 4 -. v t i• 1 I, Y if liPl t if f 1 t4 I a � F I , I ,t { 1 t - I� i 'Ma i If if i ( I 5; Y 3D0) Pofaupine Dt ,,..uphonr, 2JJ•66f5) A a, Alts 1 WATCA WELL RECORD Drilling COM4My NEU [LOCATION OF WELL Please complete tither la, lb, at It. I - - Ia. Borough Subdlvlslon Lot Alock Ib, Fraction Section No. i .�k- ,l u- Arc --s /I , , I It. Distance and Direction from Road Interseetigns Street Address and Arte of Well Location WELL LOG Msterlal type e J� � e 1 - , Fest Below uefate op Botta � i y #rots ear RLA4FA DEPARTMENT OF NATURAL REE0VA6ES U.S.M. Local NB. Drilling Permit No, — M.L. No. _ Township Range Maridlert M/S E/W 3. OWHRR OF WELLI �J ! at7Sfr,�i%i fla'J Address: 4, WELL DEPTH: (OOnplttt4) Surfers Elevation Date of Completion !. clews tool [�tRot■rY ED Driven ❑ Dug ❑ Auger ❑ Jetted ❑ Be red ❑ Other: 6. USE ❑ Oomeattc [3PubIIC- Supp1Y Cr] Industry ❑ Irrigation Q o Recharge toenwrelal []test Wali ❑ Other, C e �r 7. MING; 0 Threaded RWatded In, to ,Q,ft. Depth Walsh% —LZ-Iba/ft. In. to ft, Depth S. FINISH DP WELL: Tvoet /h P'-/n/t, l /ld'CGOI■�me to r t Slot/Meth $1261 Length: Set between ft. and ft. Fittings; 9, STATIC WATER LEYM t, � ❑ Above (4Belew lend surfaca Typt of Measur~It �,�•_.. t� 10. FUMPINO LEVEL below land surfaaa 5 ft. after hrs. o4mping g,p.ro, It. efttr` hr5. pumping _ g.p.m. It. WELL MEAD COMPLETIONt In Approved Pit ❑ Pitless Adapter 1± Inches etova grads 12. DROUTING: Well Grouted: ❑ Yes �so Mottrlal: ❑ Mtet Gement ❑ Othdri 13. PUMP, (1f available) MP = Length of Drop Pip* 3 40 _ ft, oepaclty Type: submersible ❑ Roe 1proeatIng © Jet ❑ 0cherz� Ib, WARM Water Temperature; 15, WATER WELL CONTRACTOR'S CERTIFICATIONt This wall was o'rllled under myjurisdictionand this report Is true to the best of my Nnowiadge and beliefs 1ftgTatsred us nese Nanw �y �+ '" �ontraet Ctnu Nu er/� Address: 1 Li! -� n �S/+ �7 / 1 ;�1 r rY Sign►d: �'�nt..-.'J. �. .Ti, �, �r..1f'" .. _._ __ Data: 7V� 1-/4 GOT ,8L0 U2 C�UTN f7r/C C V B,Fld 419111a� cSeilJ�Pfi cXitJ�� ��st tfi� r-reGJ 4�0� Udsa��i� OlJ 4074 Et J!rhr 244 jr, r/ I�Av W, J �/ /Jlpi,�s Gicf 04e io / /) o� 60 401 1/aA-,D vs VA,� 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ZOT- 3 BCoCA- Z 5601-1+ 07/IS 5U,90 SECTioni 3S TIZA/ 1, SW Location (address or directions) 7i00 Neffsib WAV (b) Applicant Name - ESSIF T"MAS Telephone: Home 346--77--7q Business Z74- yyZZ Applicant Address P O Bo K io - 59e! 1gAfC90RAi' E7 I4 K 995-14, (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address /—t// / /t-- 4 6. (e) Real Estate Company and Agent Address Telephone Telephone :�7_7l% — 4L, .10 L% (f) Mail the HAA to the following address: -11, ) t1 1 / '/' /f '?s e, P 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 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 72-025111/841 i' .�,_j) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forth e 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 ('2VROMi E _Iv L //JGZ=124A)1i Telephone Z7b-; S 770 Addre Date 9ng;Mfchuel E. Anderson n' i• /''80FE5S10.\1.� Engineer's Seal 6. DHEP APPROVAL Approved forG'6-` iI bedrooms by 2�. �� ` Date Approved Disapproved Conditional Terms of Conditional Approval dhep CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION � Legal Description: coT3 eeotd1� C E 1 V E D soo Tt4 N r t!s 5 vBD. A. WELL DATA Well Classification PRIVAT -a If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N)— Date Completed Yield 4 t Total Depth 2041 Cased to 49 � % Depth of Grouting NDAt,E Static Water Level 69' Pump Set At /a Casing Height Above Ground 2 / Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 12D ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot !OD' ; On Adjoining Lots /DOS t - To Nearest Public Sewer Line A10A16 iAt ArLeA To Nearest Public Sewer Cleanout/Manhole NOMI IM AMA To Nearest Sewer Service Line on Lot i20 Water Sample Collected by 00AJrrA — MIFAr5DE,,( ; Date Water Sample Test Results 5AT'15 rACT'ORI Comments %1%OU /5 A04K'PuATE — 51 ` 101"W06c A' P 4 CPM B. SEPTIC/HOLDING TANK DATA Date Installed 1981 Size JZSD COAL. No. of Compartments Z Standpipes (Y/N) Y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) A/ Date Last Pumped 9�+gLBle Pumping/Maintenance Contract on File (Y/N) for 1986. Holding Tank High -Water Alarm (Y/N) A1114 Temporary Holding Tank Permit (Y/N) NelY Separation Distances from Septic/Holding Tank: To Water -Supply Well /ZOO To Building Foundation ZZ. � To Property Line 7 t 5 To Disposal Field 40 To Water Main/Service Line i�d� To Stream, Pond, Lake, or Major Drainage Course f�00A' Comments c�E�DTtc TANK t5 R+O�QtJ,9TlG Page 1 of 2 72-026(1 1184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed /9& Length of Field Zoo' Width of Field J' Depth of Field 6' Gravel Bed Thickness `17 Square Feet of Absorption Area /S3L Standpipes Present (Y/N) )' Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test f AsSED _ Separation Distance from Absorption Field: To Water -Supply Well 100 To Property Line 2 S To Building Foundation go' To Existing or Abandoned System on Lot On Adjoining Lots To Water Main/Service Line 5� To Cutbank (if present) NONE To Stream/Pond/Lake/or Major Drainage Course /0001 To Driveway, Parking Area, or Vehicle Storage Area Comments A85012PTIOM IS EXCELLEn[T _ D. LIFT STATION It/1 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at — Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I havechecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed.� //''GS "�wDate Company 0VUWM GM61 dGtl2.W6 MOA No. 31 R 3 `i � Receipt No. � ��o0 a°...ea��Po�•J Date of Payment Amount: $ �� 5 a��) abs Engineer's Seal �J aFa00 Bo aoo Op:aeu�acop. pae.ub uo c �j Page 2 of 2 72-026 (11/84) c 09a°po�e as o'e e�"a•'M'ati n i a ;'Michas) F., Andumv, 9 (;= .: °e 4381 - E *p, •i�, i� ?�� -/°909. rnha a�V H.,v f3hpR6 GF SS1U 1ti , APPLI ,NT FILLS OUT UPPER HA ' ONLY Property -Owner --E, _:_- .,�_ t �;. ,r / ).2/ - `� i�/'i F";�( 1a Phoney` Mailing Address Zip Cole Date Buyer Address - - Zip Code Lending Institution /1 �JJ j /_' j-/ /,/n a/ �i �- r^. _ _ - Phone Address/ Zip Code Realty Co. & Agent Phone Address Zip Code Legal Description �L T-.. ty✓� .h.� ;.., ",- /.. i , / r.' , -!. _, , ,`--; / ,- /; f� t<J c7 ✓ - fir Street Location // •, /� r. ! j _ i! l �- t'_ / �/ rj_-ti Type of Residence. ,p' Single Family ' ❑ .Multiple Family No. of Bedrooms_ ❑ Other Water Supply ( PPROVED BEDRO S 'CONDITIONS OF APPROVAL -individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. .0 ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal DATE '� 5 Year Individual Installed: _P-1hdividual ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Kr�, T Time Time Time Time Date Date Date Date cn, —tDv6 Inspector Inspector Inspector Inspector Field Notes: ( PPROVED BEDRO S 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE '� 5 B' Soils Rating Date Sewer Installed Well To Absorption Area �'� Well Log Received Septic Tank Size f j 7iD Q Well to Tank l __0 72.023131a21 -; o, -7; � -.otear)ei, - 1:�v3 Jusyde anci 4-4arion Tho.�Ow its U. Box 1 .}.OSSU-1 -30, 995ii 13 a :}J to L: LCA 3y SIO €.:`s Q ti OLUtIl iii-il-s Subu.,Lvision 7" 3 6r - 9- � ispproval kor the individual Eumm uad watec Laciii-'UiQi carmoL until. Me fallowinal imms havo .,o,-aolwtcidi kdUlj. Wyl MINIMUM Q) WAS offico ;.Of: au.: arld off/ iil� ..),, (A the wall cons ing should be sualed so UmL its is a a or ,';I L ztro,-t I at -I t n (I wc 1 i c a nuoOs -to De 3,I i.J . od wilm iwj?wrv':.Lot:.s tyL�u suil so tweit. its Molles avay trasi vvel-i casinl,3. Tw4. �;teRnu j -,pc Lo trio 6ystu.,ti -need capu tin them. Plume mcify this Depact.,Iujnt kka�.- a reiri.-ape�t;i:itia whc--a t11--.. wave 1,,een �.Iori:ucLed. jif, there allo ally e2l"-,03c-, cail this otlic;AL 4 �Slncerely, jila Rooerts J RJ j/€ ,/E'2 ' CHEMICAL & Gi , ,LOGICAL LABORATORIES'.,.F ALASKA, INC, TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER q, 5633 B Street a ueon�roa,ee Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER' - WATER SYSTEM: f� %J I.D. NO. water System Name ,Phone No. _ Mailing Address City J State Zip Code �Y SAMPLE DATE: C Mo. Day Year SAMPLE TYPE: Or outlne O�heck Sample (for routine sample ❑Treated Water with lab ref. t, ElUntreated Water ❑ Special Purposea SAMPLE Time Collected NO. LOCATION Collected By i 13 i 3 a 5 TO BE COMPLETED BY LABORATORY /jnalysis shows this Water SAMPLE to be: r Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit: sample should not be over 48„ hours old at examination to ifidicate re0able results. Please send Date Received e,) I Time Received Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. �j-LO q I Result' Analyst ELI *No. of colonies/ 100 ml or No. of Pos,lwe portions, 06-1220(6) BACTERIOLOGICAL WATER`ANALYSIS RECORD Rev. 1978 Data Collected READ INSTRUCTIONS to Received BEFORE Time Source a.m. p.m. Lab. No. — 10m1 I loml I loml 1.11ml I 0.1m1 EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Posltive/Total loml Portions Membrane Filter: Direct Count collform/loorrl Verification: LTB BGS Final Membrane Filter RespIts Collform/100ml Reported Bye, - ��'- ^J DateTime- ,4!;24�) A.M. p.m. DENALI SEWED 1.- a u 4;F 8404 2900 BONIFACL P ml - ANCHORAGE, ALAR 99. PHONE 333-57S-4 cGt.r CUSTOMER'S ORDER NO. DEPT. DATE NAME ADDRESS SOLO BY CASH C.O.O. CHARGE OH ACCT. MOSEAEIO. PAID OUT 7— DESCRIPTION RZIM . 1 2 �, 3 4 5 V x�\ 6 7 8 9 ............ 10 11 12 13 14 15 >' 16 17 18 M RECD BY rdMFORM. KEEP THIS SLIP 5020/01320 FOR REFERENCE CARBONLESS