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HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS #1 BLK 3 LT 7 Municipality of Anchorage Page / _of ~' DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~'J.J'~,~..)/H PIg Number: ~/~/~1/~ ~e: ~/~ ~ ~M~ Wastewater System: ~ew D Upgrade ~ / ~ /~ ~ '~LV~ ABSORPTION FIELD 'hone: IN° of Bedrooms: ~ ~ eepTrench ~ Shallow Trench ~ Bed ~ Mound ~Other LEGAL DESCRIPTION SoilRating: ~PD/Sq. FI. Total Depth from original grade:~// ~ Lot: ~ ~lock: ~ ~ ~~Subdivision: "~/Depth to pipe bottom from original~/Ft.grade: Gravel depth beneath pipe ~ ~ Ft Townsbip: I Range: ISectiOn: Fib added above odgCgra¢ / Gravel length: ~[ ~ Ft Ft. ~ravel width:~ Number of lines:~ ~ Distance between lines:/~ r Yt, WELL: B New ~ Upgrade ~/Ft. Classification (Private A,~,C): Total Depth: Cased TO: Total absorption area: Pipe materiah ~/~ ~ )riller: ~1~ ¢¢ tll~¢~WaterLevel:Ft ns~b~ Dateinstalled:~/~¢¢~ Yield:OPM I~'m'~"ta': ~, Icasing HeigbtAbOveGr°und:Ft TANK SEPARATION DISTANCES ~eptic Q Holding D S.T.E.P. To Septic Absorption Lift Holding Public/Privet( M nufacturer: Capacity in gallons: Well ~ ~ ~- -- ¢¢~ Mater3~ Numbero~partments: su~¢~c~ I¢~'+ I~'+ ~ ~ ¢ LIFT STATION / Water Lot I~ ,¢l~ -- -- -- Size in gall°ns: IManufacturer~ Line Foundation ¢¢ .Ct ~- ~ ~ ,,~ on" ,~u~ o,," ,~v*, ~h I ~i*b-~'*~'~ ~t: Curtain Drain ~ ¢¢~ q~,~ ~ ~ko&MoOel IElectricailnspectionsporformedby: Remarks: BENCH MARK Location and Description: Inspections performed by: Dates: lst~ ( :~ ': :" Reviewed andapprovedby:~-/~¢¢ E Cd Date: / / '~"'"' 72-013 (Rev 9/91) MOA 25 Permif No. SW950144 Page 2 of 9 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SOUTH LAKEWOOD HILLS //1, BLK 5, LOT 7 01515119 PID No.: CO1 CO ~ --INsuLATION 90.~ N.T.S. CO; 90.5' 97.2' 93.9' % 83' 83' J · 77~ NO WATER FOUND MT2 FILL TO BE ADDED IN SPRING kLONG WITH FINAL GRADING 4 BDEM 30 HOUSE WELL TO BE DRILLED IN SPRING 1994 i00' WELL RADIUS PROP. WELL SCALE t" = 40' ~AB FCO 8 34 CO1 10.5 39.5 C02 22 47 C03 57 7815 C04 29 42.5 C05 59 75,5 MT1 46 68,d MT2 50.5 66.5 N NEW 1250 GAL. SEPTIC TANK TRENCHES ;EAL 72-013 A (2/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930144 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WAGNER MICHAEL S & OWNER ADDRESS:6301 MICHIGAN BLVD ANCHORAGE, ALASKA 99516 PARCEL ID:01515119 DATE ISSUED: 6/08/93 EXPIRATION DATE: 6/08/94 LEGAL DESCRIPTION: SOUTH LAKEWOOD HILLS #1 BLK 3 LT 7 LOT SIZE: 50000 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. May 26, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, AK 99519-6650 REFERENCE: South Lakewood Hills #1, Block 3, Lot 7 We request you issue a permit to drill a well and install a septic system to serve the proposed 4 bedroom house on the referenced property. Two test holes were excavated and percolation tests performed on the referenced property. The approximate location of the test holes are located on the attached site plan. The monitoring tubes within the holes have been checked and found to be dry. This property has enough area for future septic upgrades, which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional for your review, please contact us. A. Shafer, P.E. RAS/JPW/LSU/lsu information ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~-] oo NV'Id qll~ 0 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: South Lakewood Hills #1, Block 3, Lot 7 GENERAL: 1. The scope of this project includes all labor, materials, and equipement to install a 1250 gallon septic tank and construct deep absorption trenches to serve the four bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover Page Two South Lakewood Hills #1, May 26, 1993 Block 3, Lot 7 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page Three South Lakewood Hills #1, Block 3, Lot 7 May 26, 1993 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic tank The following pipe materials septic system installations Anchorage: are approved for use in in the Municipality of Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. Page Three South L&kewood Hills #1, Block 3, May 26, 1993 Lot ? INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2 o The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: /~V/l~.~.~ LO'T ~ LEGAL DESCRIPTION: ~./~ -,~ 1 2 3 4 5 6 7 8 9 10 11 13- 14- 15- 16- 17- 18- 19 2O ~'O, ~¢'/C'F~f/Fddf~ /~¢°~W, ns~i~/P~, Range,SectiOn: SLOPE WAS GROUND WATER ENCOUNTERED? iF YES, AT WHAT DEPTH? Deplh to Water Afte~'..,,,~ t. Monitoring? I..~cf Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop :~:~ io l~ " ~:o> ~0 15~& ~/~" ~ Z~ Io /~ ~8 y~~' ; g[ lo 16" '/~" COMMENTS S & S ENGINEERING 17034 Eagle t(iver ~.~uy ACCORDANCE WlElaldbL~afT~l~l~!~ll~tl~AL GUIDELIN~q~F 72-008 (Rev. 4/85) PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER AND (;~ FT ~ __ ~ CERIlFY THAT THIS TEST WAS PERFORMED IN F ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10- 11 DATE PERFORMED: Township, Range, Section: SLQPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ OL DEPTH? p~ geplh lo Water After~_ 13- MonilorinD? ~L~ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop : ~ S I~ I" ~:o~ ~ ~zy ~/~ " 14- 15 16 17 18 19 20 PERCOLATION RATE TEST RUN~.B~BETWEEN FT AND ~ FT Y 17034 Eagle R~ver Loop Road No. 204~ PERFORMED B : ACCORDANCEWITHALLSTATEANDMUNICIPALGUIDELIN ~EF/T ON THIS DATE. DATE: 72-008 (Rev. 4/85) August 17, 1993 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519-6650 Re: Installation of Septic System Block 3, Lot 7, South Lakewood 6301 Michigan Blvd. To Whom it May Concern: Concerning my property located at 6301 Michigan Blvd., I wish to install our wastewater disposal system which has been designed by S & S Engineering. I am the owner of this property and am in the process of preparing to build a residence for myself and family. Since my background is in carpentry and construction (17 years) I request that you allow me to install the system myself. I also have several hours of experience with a backhoe. Thank you for your consideration -- your response can be sent to me at the address listed below. Sincerely' ~Q~_~ Mike Wagner 8230 Wilcox Street Anchorage, Alaska 99502 LOCATION OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD 8OROUGH SECTION QTRS SECTION ON OS RANGE ~w MERIDIAN LOCATION/SKETCH: DEPTHS MEASURED FROM:~casing top Figround surface 80REHOLE DATA: Material Type and Color Depth From To WELL OWNER: -/ WELL DEPTH: DATE OF COMPLETION Depth of hole: 3c~ ~ ft Depth of casing: ~ ~'~' ft ~' / -~ ~- / ~/~ RECEIV APR 1 DEPTH TO STATIC WATER LEVEL: ? '7~- ft below [~top of casing Date: ..~ /,~.. / ~'¢7/ [] ground surface METHOD OF DRILLING: [~ air rotary [] cable tool [] other USE OF WELL: [~/domestic [] irrigation [] monitor [] public supply [] other CASING STICK-UP: ~---. ft. Diam: ~_~ in. to,~'7?t Casing type: ~., ./~ (~ in. to~.~'2~ft WELL INTAKE OPENING TYPE: ~,open end [] screened ~,perforated [] open hole Depths of openings: ~,~:~ .~2.. toc~ 2~ ft SCREEN TYPE: ~, Diam: in. Slot/Mesh Size: ~Length: ft GRAVEL PACK TYPE: ~ Volume used: ~, Depth to top: GROUT TYPE: ~, Volume: Depth: from ft to ft DEVELOPMENT M~I'HOD: ~,~ Duration: ///--~t . ' Municipality ol Anch( DePt, Health & Human PUMPING LEVEL AND YIELD: c~ /7 ~'ft after t/ hrs pumping --~ gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? [] YES [] NO CONTRACTOR INFORMATION: Registere(f Business Name Signature of AUthOrized Respres~tative Date REMARKS: PLEASE MAIL WHITE COPY OF LOG;TO: DNR/DIVtSION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 �E aCo ® Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 5 A f E T Y Certificate of On -Site Systems Approval Parcel I.D. 015-151-19 1. GENERAL INFORMATION: Expiration Date: 3 — 17 - Zi92-( Complete legal description SOUTH LAKEWOOD HILLS #1; BLOCK 3, LOT 7 Location (site address) 6301 Michigan Blvd. *Anchorage 99516 Current Property owner(s) Virginia Gallus Day phone 947-0608 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well z Individual 19 Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: ma Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ $412.50 (COVID-19) Waiver Fee $_ Date of Payment Date of Payment Receipt Number 06705G Receipt Number COSA 4 OSC201678 Waiver # 1/_JI 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: Garness Engineerinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 / Engineer's Printed Name: Jeffrey A. Garness Date: 12 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE LYL System #1 Approved for _q__ bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fo oaoF °4 4 i ...... .. .. ....... ......... _ . .. ........ ........ fr y"A. Gorn ss.: s� CE 79§ f �G O��rer 124.t!7•,Z��vp �4Pd P� o t z SS �04�000a� #AECC884 lw,<<tctt((rrrrrr G.?NLITY pc Zvi sti� � /``�/T!; M - 4 _ I, -1A Original Certificate Date: Z—j The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other Ssk—le( _CvAtc.-T v,.te Ao(,/fSCu7 „n COSA Checklist Legal Description: SOUTH LAKEWOOD HILLS #1; BLOCK 3, LOT 7 Parcel ID: 015-151-19 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system A. WELL DATA 0 ALL standpipes present per record drawing FE4 Well log is filed with Onsite (or attached) Well production at time of test 2.6+ gpm Date drilled 3122/94 Water storage tank volume N/A gallons Total depth 320 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 279 ft JL -J Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L Nitrate less than MRL (ND) © Wires are properly protected Arsenic 5-05; ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD. Date of flow test for COSA 12/2/20 Date of Sample 1212/20 Static water level at beginning of test 110.8 ft date of test) N/A Gallons introduced gallons Comments Comments/Deficiencies: TESTED NORTH TRENCH ONLY. SOUTH TRENCH HAD T' LIQUID DEPTH THROUGHOUT TEST. COSA Checklist yellow sheet B. TANK DATA C. LIFT STATION Age of tank(s) 27 years ❑ Required maintenance completed Tank type/material SEPMVEE Age of lift station years Measured operating fluid level in septic tank 51 Lift station material F Standpipes/foundation cleanout per record drawing Comments: N/A Date of pumping 12/7/20 D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 7/19/93 Adequacy test date 12/2/20 0 ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 14.33 ft (max) Fluid depth prior to test 8 in Measured depth to pipe invert from grade 7.2 ft (min) Water added 626 Gal ❑ N/A —pressurized field New depth 44 in Q Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective 20 FNCode-requiredsoil cover over field Final fluid depth in ❑ System presoaked Absorption rate. 600+ 9pd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) N/A Gallons introduced gallons If yes, enter date N/A Comments/Deficiencies: TESTED NORTH TRENCH ONLY. SOUTH TRENCH HAD T' LIQUID DEPTH THROUGHOUT TEST. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' M Yes if No Absorption Field on Lot > 100' [Z] Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Water Main > 10' M Animal Containment > 50'[]✓ Yes if No Iv Yes if No ft Water Service Line > 10' M Yes if No ft Manure/Animal Excreta Storage > 100' comment below Community Sewer Main > 75' M Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' Yes if No Property Line > 5'✓[] ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ✓0 Yes if No Water Main > 10' M Yes if No ft Community Wells > 200' M Yes if No_ Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' [✓ Yes if No Water Service Line > 10' FV -1 Yes 'if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in confonnance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ft ft ft ft ft ft ft ft ft ft c::)4 Septic 'Tank Advisory Certificate of On -Site Systems Approval # OSC201678 Subdivision: South Lakewood Hills #1 Block:3, Lot: 7 The septic tank for this property is 27 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org 11 N 89?x'00"W 2 89' . (MEAS) (BASIS) Z5O.00 (REC) IAPO8221 DEL STREET ANCHORAGE, ALASKA 99502 PHONE 243-4890 10/4i95 -AS BUILT - 34-54 DATE�MXTA T� FLD. 8K. of �� C,)AF AV '• 08 a WiitiamlD. Flaming A LS -5773 •: `!r ,®► rTt Oh '. • • • • yJ O r a prO>easional 0 . �. NOTES: Easements not appearing on record subdivision Drn plat are not shown unless description of easement is rnv provided by client. It'is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utilities connections, and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Elevations based' on assumed datum unless otherwise indicated, and bearings and distances are record data. Q MICHIGAN BOULEVARD CLIENT. WAGNER—GALLUS LEGAL DESCRIPTION LOT 7, BLOCK 3 SOUTH LAKEWOOD HILLS V FIRST ADDITION PLAT NO. SCALE GRID P-611 1'•30 2638 N 89050'1 61 249.93' (MEAS) 8 E 250.00 (REC) \— ----0 10 FT. UTILITY EASEMENT J n � �I � � .t1L.. � I 1 , FINAL STRUCTURE AS BUILT 1, William D. Fleming, hereby certify that I have performed an ' I as built survey of the structure on this lot and that all the dimensions and information as shown hereon are' true and that no ' i encroachments exist unless shown otherwise. - i 1 I 1 I o) I 1 � 1 1 Z 1 g ` r 1 r �- 8 wI I tziJ �-u 0t ON .0' /. 0 ° 4' PVC SEPTIC 1 -- I I. 00O sm-PIPEs(TYP) 3 --- . ° 769.5 I�}}F¢ }u�WUJ�� `V 0031 F- 1 tL 109.4 sJ �0 o �s 5 CR Df the :ztruct-jre(s) ° _ r_, th:;a rs4,v,rd drawlU1g 1 apt' - ........";'' s !_ ��� Title 21, MAC, I r / W 1" RECOV. 5/8' t i REBAR (TYP) Well 11 N 89?x'00"W 2 89' . (MEAS) (BASIS) Z5O.00 (REC) IAPO8221 DEL STREET ANCHORAGE, ALASKA 99502 PHONE 243-4890 10/4i95 -AS BUILT - 34-54 DATE�MXTA T� FLD. 8K. of �� C,)AF AV '• 08 a WiitiamlD. Flaming A LS -5773 •: `!r ,®► rTt Oh '. • • • • yJ O r a prO>easional 0 . �. NOTES: Easements not appearing on record subdivision Drn plat are not shown unless description of easement is rnv provided by client. It'is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utilities connections, and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Elevations based' on assumed datum unless otherwise indicated, and bearings and distances are record data. Q MICHIGAN BOULEVARD CLIENT. WAGNER—GALLUS LEGAL DESCRIPTION LOT 7, BLOCK 3 SOUTH LAKEWOOD HILLS V FIRST ADDITION PLAT NO. SCALE GRID P-611 1'•30 2638 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. # ~15-~i$-/-r¢) HAA# ~ ~ ,,( , I(' (~-, 1. GENERAL INFORMATION Complete legal description Lot 7; Block 3; So. Lakewood Hills #I Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Mike Wagner 6301Michiqan Address 6301Mic~qan Blvd. Anchorage, AK Day phone Anchoraqe, AK 99516 Day phone Day phone 248-5680 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State AD~C attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my invest_i_gation 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. S & S ENGINEERING Name of Firm 17'G;4 ;,g;,, ~iYer Leo~ K~ad ~io. 204 A. , ~e River, Alaska 995~ aaress , f . ~ Engin~Fssignature '7~~<~ ~.'~ Phone Date ~ /'' /~Ts- 4 DHHS SIGNATURE ~:,. Approved for / Disapproved. Conditional approval for bedrooms. ROBEr)T C. COWAN /.? ~ CF - 8801 ,/-" ': .~ bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Health Authority Approval Checklist Legal Description: A. WELL DATA Well type pRi Log present i~/N) y 4~ 3' Total depth '5 ;)- 0 Sanitary seal (~}/N) ¥ ~ 5 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to '~ 9 q Casing height (above ground) Wires properly protected FROM WELL LOG Date of test Static water level ] Well production WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: AT INSPECTION , .~t9 ~,ff//~ Other bacteria Collected by: S & S ENGINEERING B. SEPTIC/I~ICOLD~,*C· TANK DATA Dateinstalled~ ~[~q [q3 Tanksize Foundation cleanout ~(/N) Yt' 3 Depression (Y/~) Date of Pumping: ca fA- C. ABSORPTION FIELD DATA Date installed ? t/;t ,./,/q j Pumper 17034 F. mgle River Loop I~oad No, 204 Eagle River, Alaska 99577 Number of Compartments '~k Cleanouts ~x~/N). Y~.3' High water alarm (Y/~) /,t ~2 ~g.p.d./fl3or fl2podrm) ~)- ~' System type Soil rating Length (,, "t Width 3 Gravel thickness below pipe '3 Vv. Total depth fl ~ lq Effective absorption area / O O 5" Monitoring Tube present(~/N)_ ¥ ~-J Depression over field (Y/~ Aa O Date of adequacy test s~ [/t' Results (Pass/Fail) . ,,~For ~ bedrooms --.r Fluid depth in absorption field before test (in.); ,.~ I~~ gal. water added (io.): Fluid depth Minutes later: ~ (in.) Absorption rate = g.p.d. Peroxide tream~ent (p~ If yes, give date Do LII~F STATION Date installed Size in gallons ,./~, Manhole/Access (Y/N) "Pum~ '~Pump off level at* High water alarln level at* ~ *Datum Cycles le ~~ E. SEPARATION DISTANCES Absorptioa field oll lot Pablic sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Scptic/h~d._L.~ tank on lot / t~ 0 -b ; Oil adjacent lots / O d 1' _ ; On adjacent lots A/ [/t Public sewer manhole/cleanout D- ~- r 4-- Lift station SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOT TO: Fonndation '¢~ ! ~ Property linc t 0 t ~, Absorption field &,. Water lnain/service line / d //c Sarfacc water/drainage /Oo t'~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Bnilding foandation /O / Y- Water lnain/service line Sarfacc water ! 0 O f Driveway, parking/vehicle storage area Curtain drain N~; .,, ¢ ~c ,,~ ~ ,~ ,~ Wells oil adjacent lots /O </ ENGINEER'S CERTIFICATION ,. I certiJy that l have determined thrufield inspections and review of Mumci e~st~,s are HAA Fcc $ ~/L). c.47) Waiver Fee $ Date of Payment Date of Paymeat Receipt Nomber /~Ot~(~ ~//) Receipt Nnmber Rev. 8/95 OSS: haa.wk.doc