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HomeMy WebLinkAboutSPRING FOREST BLK 1 LT 1Spring Forest Block 1 Lot i #015-321-05 Municipality of Anchorage Development Services Department ` Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www d.anchorage.ek.us (907)3437904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW100007 PID Number. 015.321.05 Ran. Kenneth d Denise Konrad Wastewater System: [:1 New ®Upgrade Ado 5800 West Tree Drive Anchorage, AK 99516 ABSORPTION FIELD A+an µ.nor a 9.000m. a D D..o r� m s"ra. Tnrrli D ea o Mara o oxw LEGAL DESCRIPTION SatR.rp T"D.an" "M OVQ.a. 7 .8 GP a Fl Saar 1 Loc 1 Saiaw.an Spring Forest D.an o Pp9 tx p , "om orkrW lF.o. Grn G.a" wwFN pipe 3 Fl, 4 A To.nmp Rrq. a..aart Fa.awe.00.. aprwi V•o• 0r Lrym. 0 Ft. 75 Ft. Well: ❑ New ❑ Upgrade cr..a.w- ).nara aw Owra. •r...nrw 5 Fl. 1 FL CMwnamn (P".. A e. C) TWit DOWL C...o xx Tam.p.xp.on a.. P%.Maria AW WU Water System Fl. FL 750 Fe ASTM D3034 PVC Dwwr D.w 0a suoo war L.ti Mwawr D.w a,Nn.e FL Phillips Construction North 2/3-6!2010 rwia F"saa C­H.y.Aoo. CO TANK GPM Fl. FL SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption I L)ft Holding ublrJPnvro ° 9' Flom Tank Field Station Tank Sa"er Lin. Anchorage Tank 1,250 Cr wo NIA NIA N/A WA WA M. Steel Maar a Carrpron.nu Two (2) SLO"W" >100• >100' NIA N/A LIFT STATION Lau"• >V >10' NIA WA Ga •Pumpa;rwa. •PuWar awn Hgh t. aam r. Faxm"on >S >10' WA WA N h rt CMbn DWI Noted Purry Mao. NopM ENCCxyl nWt.ab V , by Municipality of Anchorage R Existing Septic Tank Pumped, Crushed and Backfilled. BENCH MARK L twt ra D..r"w Existing Absorption Trench Tied In For Future Use. Lower Level Finished Floor wwuart 95.2 FL Inspections performed by: A. Harela Dates: 1" 214/2010 EqgqWL �� OF Q iI� f Qs�9 2nd 2/5/2010 =�Q�f�•••.....0 Development Services Department Approval .: ��• 4918 .*• ;* Conditional Approval Date: 00 s* ••« �:: . .... �..... «.. . .•°^ ;MIQWEI E ANDERSON.�v 81 � Reviewed RReviewedand approved Date: ,;R"sslo Permit Number. SW100007 Municipality of An6horage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report U PID No. 015-321-05 uwzuiu PROFILE AS -BUILT - No Scab 91.6 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 1, SPRING FOREST SUBDIVISION PERFORMED FOR: KENNETH A DENISF KONRAD DATE: 1/31/2010 PROJECT No.: PARCEL ID#: TECIVICLAN: M. ANDERSON DEPTII TEST HOLE 1 ([at) — 4'- 2 y: 3 4 ,.,• 6 ; •, 7 8 w 9 10- 12—T 0 12 13- 14—'-- 17- 18J 3 14 •'.a 15 '' w. 17 18 19 OB/OG SAND WITH SILT SM BOH @ 17' SITE PAN SEE SITE PLAN R WAS GROUND WATER ENCOLWrERFD, No IF YES ® WHAT DEFTH- DEPTHOFWATERAFTER MONITORING: NONE VARIES DATE OF MONlTORLNG: 216110 DATE READING OSS TIME G MINUTES) NET TIME (MINUTES) WATER DEPTH To (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: PERCOLATION RATE;__(MN/INCFI) PERC. HOLE DIA,_UNCHES) TEST RUN BETWEEN_FT. and_FT. COMMENTS: SOILS ENCOUNTERED IDENTICAL TO PREVIOUS TEST HOLES. PERCOLATION TEST TO BE COMPLETED. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 2/19/2010 Performed For. _ Le Oaf soriptlorc A Depth �lS Fee 1- 2 3- 4- 5- 'lr3�e� 15- 16- - 19- 1- 21- 1s- 19- COMMENTS Municipality Municipality of Anchorage Development Services Department Bulking Safety DvWcn On-Ske Water and Wastewater Program 4700 Elmore Road P.O. Bou 198850 Anchorage. AK 99507 www. c[ a n Mara a e. o k. u s (907) 3417904 Hs-Log—PercolationTest _Date Performed: Range. Section: WAS GROUND WATER Date ENCOUNTERED? Net Time Depth to Water S IF YES. AT WENT DEPTH? L Depth to Water After- O P MoMorespf E Dab: 49m 7NNNN ANN * NNNN MIC1{AA ! ANDOW N • CE -4381 d �Qea L -r4—/0 e•�' is �•eeaeueea v Ste Ran Rearing Date ' Grass Tlme Net Time Depth to Water Net Drop 3fl Nltjs 'I.S� 2.25 " 10 IVA$ PERCOLATION RATE Immmsnnchl n PERC HOLE DIAMETER �M TESTRUNSETWEEN FT AND Ll lit/ FT PERFORMED BY: •� I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE x-'3-10 MUNICIPALITY OFANCHORAGE 2 Development Services Department On -Silo Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade L e /0:3Z) Date Issued: Feb 02, 2010 Expiration Date: Feb 02, 2011 Permit Number: SW100007 Parcel ID: 015-321-05 Legal Description: SPRING FOREST BLK 1 LT 1 Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 005800 WEST TREE DR Owner Name: KENNETH & DENISE KONRAD Lot Size: 37525 SQ. FT. Owner Address: 5800 WEST TREE DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-6707 This permit Is for the construction of: Q Disposal Field ❑ 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. -THE ENTIRE SUBSURFACE DISPOSAL FIELD AND/OR ALTERNATE IS NOT WITHIN A 30 FOOT RADIUS OF A PERCOLATION TEST. THE ENGINEER NEEDS TO DO ADDITIONAL PERCOLATION TESTS PRIOR TO THE CONSTRUCTION OF THE SEPTIC FIELD. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL. - CONSTRUCTION MAY PROCEDE AT YOUR OWN RISK BEFORE THE 7 DAY WATER MONITORING IS COMPLETE.PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL. Received By: Date: Z' L — /0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015.321-05 Property owner(s) Kenneth & Denise Konrad Day phone Mailing address 3111 C Street Anchorage, AK Zip Code 99503 Site address 5800 West Tree Drive Zip Code 99516 Legal description (Sub'd., Block & Lot) Lot 1, Block 1, Spring Forest Subdivision Legal description (Township, Range & Section) Lot Size 37.525 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field El Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage Cl Number of Bedrooms Four (4) THIS APPLICATION IS AN: Initial ❑ Upgrade Q Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Pennit/RushFees: -5—;0 Waiver Fees: Date of Payment: Date of Payment: Receipt Number. 07 `i 0 �2,21 Receipt Number. (Rev. 11/05) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX January 18, 2010 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 1, Block 1, Spring Forest Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption system on the subject lot has failed and must be upgraded. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing 1,250 Gallon Septic Tank was placed in 1994 and is barely 15 years old. We are confident it is in good condition and suitable for continued use. The tank will be exposed and inspected to insure it is in good condition and suitable for continued use. The existing absorption trench system will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the adjacent septic systems. The subdivision is served by a Class A Community Water System. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test holes placed on the lot in 1994 indicated poorly graded sand and gravel (SP/GP) with some silt. The percolation rate was determined to be 14 minutes per inch in the area of the new absorption system. Groundwater was not found during the month of May of 1994. We have designed the new trench to be within the 30' radius of the test hole completed in 1994, and to the same application rate of .8 gallons per date per square foot. Additional percolation tests will be performed during construction to verify the soil is consistent throughout the trench area. We are proposing to place a 75' long trench with a 4' effective depth. The total depth of the system will be 9'. A flow diverter valve will be placed to tie in both the old and new absorption systems. The old system will be allowed to dry out and regenerate for possible future use. Lot 1, Block 1, Spring Forest January 18, 2010 Page Two The ground surface on the lot slopes to the southwest at a 14% grade in the area of the new absorption trench. The trench will be constructed parallel with the contours of the ground surface. A minimum of 100' will be maintained between all components of the septic system and any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, VL441 OE Q-C� Michael E. Anderson, P.E. Attachments � !A v :-Ai I. E AN-IISC% { W : •. Ufa •� 17 0 2 0 WEST 4 6, Q 2 � �D D NOTE Subdivision is Served by Class A •��������� Community Water System. g�P "'........... �• M 4p .....49th '•�� .1 AREA MAP ................................ 0 MICHAEL E SOI '% No. CE-4 `� SCALE 1' = 100' 14',,1"�•••� SPRING FOREST SUBDIVISION LOT 1 , BLOCK 1 37.525 S.F. WEST TREE DRIVE ------------------ IF FN yen Out TH — Test Hole MT — Monitor Tube FDV — Flow DMrter -------------- 10105 NOTE No Slopes >25% aro Located Closer Than 50' Dorn Gradient From the Absorption Trench". SITE PLAN SCALE V = 40' 0 1 �. i TartH ®TMA j Payed DrMray I u i P Unly d �. Ci LL o I To Be Placed Prior to Constnlcti FDV o /Four c.o m Bedroom Homs n� I ' 75' L y ■ 5' tads • ♦' Efru. DavN EyfeUnq� 1.250 Absaptlon T"0ollon Jeptic Tank ) ) i M L!J I I I (Expose. Inspect and j VM for Cgatinued a r G � I UM� ) IF FN yen Out TH — Test Hole MT — Monitor Tube FDV — Flow DMrter -------------- 10105 NOTE No Slopes >25% aro Located Closer Than 50' Dorn Gradient From the Absorption Trench". SITE PLAN SCALE V = 40' 0 LOT 1, BLOCK 1, SPRING FOREST SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home 5' Wide Trench System Perc. Rate: 14 Min./Inch Verify Existing 1,250 Gallon Septic Tank Application Rate: .8 GPD/SF 4' Drainfield Rock 4 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 750 SF Absorption Area 750 SF/5 LF (Width)•.5 (Red. Factor) = 75 LF Trench Length THEREFORE: Construct a 75' Long x 5' Wide x 4' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 5' Below Original Ground Surface. Total Depth to be 9' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 10' Separation from Water Services in the Area. 4'0" 5' Drainfield Rock 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. a Minimum 6' Separation From Bedrock. ......, Minimum 4' Separation From Groundwater. 5A Minimum 100' Separation From Wells in the Area. � ..... Minimum 100' Separation From Surface Water or Streams.- �i 49th MR LEM MR8 No. ce+ l D Natural Backfill 4'6" Geotextile Fabric 6" O 4" Perforated PVC (Holes Down) 4'0" 5' Drainfield Rock 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. a Minimum 6' Separation From Bedrock. ......, Minimum 4' Separation From Groundwater. 5A Minimum 100' Separation From Wells in the Area. � ..... Minimum 100' Separation From Surface Water or Streams.- �i 49th MR LEM MR8 No. ce+ l D 4 Av Munlclpallty of Anchorage CO.. • • •• N ; V...... i`, DEPARTMENT OF HEALTH b HUMAN SERVICES 491H 825 -LY Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 0 'am* MICHAEL E ANDERSON t i••. CE -4381 PERFORMED FOR: A4 M C CcjsTz,i t7ind DATE PERFORMU49 ';iih p LEGAL DESCRIPTION:_ LOT%• BI.Ot/L SPM4L Township, Range, Section: 5N-nw. 1Z r1rrT7M Mr SLOPE SITF pt AM 1 2 3 4 5 6 _7 8 9 10 11 12 13 14 15 16 17 18 19 20 FD(LZS r U0 St(xy SANoy &aA%JC7— GP S wry 5"D SM Bo'rroM OF AcP-C 39M WAS GROUND WATER _ /D ENCOUNTERED? /V S IF YES. AT WHAT L DEPTH? 0 P E gep%10 WaterAller/9 OA/E moo1wring? /o WIC Reading Date Groes Time Net Time Depth to Water Net Drop Ift1 /0 l 91 Z: ez •• O IS tf // Z!Vs- 7 I. / 1 Y J*4 3.00 5' Y /YA Y st •' . /S 60 7 'ti' /' " .. _ ..._• . ....+ Y � '- PERCOLATION RATE %� (minNevinch) PERC HOLE DIAMETER e TEST RUN BETWEEN FT AND FT �� J) :OMMENTS /72tr WAS- PnXSOArtiD AA"A' -70 TEST /VO L,wrolL ;J -R1`:-TE7L I b isa. ERFORMED BY: M//� /iAIOEQSO^I I CERTIFY THAT THIS TEST WAS PERFORMED IN CCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: !-008 (Rev. �i&SI I Municipality of Anchorage * 491H< DEPARTMENT OF HEALTH & HUMAN SERVICES .... ' 825'L' Street, Anchorage, Alaska 99502-0650 00OIL A,.. Y:PF 5.. SOILS LOG — PERCOLATION TEST I- AND "J *.CE -4381 MMC ♦ qF••. ^/v •+S PERFORMED FOR:_ WA%STR-V yr/O4 DATE PERFORME o OROr �a LEGAL DESCR pT rog-CFr a o: Br�owa faa�� 2 3 _ 4 • 5 51LTY SANL. Dl 6rZA-JE o- 8 o 9 O. Section: SLOPE SI4, TIZN, 23w n 1101 UNIMUIINnN112 I-Room.MIN RMUNNERIM WAS GROUND WATER ENCOUNTERED? No Depth to Water NEIMMIREMNIFIN MNIMMUMEMBIN Sl L-rY SAJ fj IF YES, AT WHAT C i DEPTH? P 12 •, s.^ E / 13 \ OeptlmWatuAte�O/9 /�DAIE Manlmrinp7 � 0ue :30 • %~ :;/S /Jr :00 / /y YL„ 10 Gross Time WAS GROUND WATER ENCOUNTERED? No Depth to Water 11S Sl L-rY SAJ fj IF YES, AT WHAT C i DEPTH? P 12 •, s.^ E / 13 \ OeptlmWatuAte�O/9 /�DAIE Manlmrinp7 � 0ue :30 • 14 901TOrA c;: 14OL.0 15 16 17 18 19 Reading Dote Gross Time Net Time Depth to Water Not Drop :30 tII// r• %~ :;/S /Jr :00 / /y YL„ 20 PERCOLATION RATE (minuteyncn) PERC HOLE DIAMETER G r // TEST RUN BETWEEN 2- FTAND �FT MMENTS //VLc- cLIAS P/LC co A44<3 7N24012— TD 'T'MT o wATM .1 Monlrr••^^oR— fiFTEfL 7 aA�S. 1FORMED BY. n// () ER.S0�1 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ZORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE-- 05 ATE05 (Ret. 4,85) Munidpality o),Anchorage OW DEPARTMENT OF HEALTH & HUMAN SERVICES 825'L' Street Anchorage. Alaska 99502.0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:— DES)G/JS l.4 (A]OOC DATE :EGAL Wa& e. Section: )FN61,NE):RS SEAL) •� �A L •a q t��'j�• !� 1 'r A381•E two .'''•' 7 f� 13 .4 s 6 7 9 i ) .TENTS &TrorA or low. '• WAS GROUND WATER ENCOUNTERED? /JD S IF YES, AT WHAT L OEPTH7 O E Aapwtawust" O/•)6014& ll°nilxl°p1 Gtt Reading Dan Iium Gross Na Tuna Depth to Water Not Drop *ti S73 S:07 S IZM _ •& I /D qw, 3 e *3 1:27 /O 97 ♦ S W4 1 !0 c/ •• SAlu A* 7 /O 1!l JJA n 3 PERCOLATION RATE (minutas/inchI PERC HOLE DIAMETER 8 ry TEST RUN BETWEEN FTAND T /2•• FT Ira& is 0A160)4G. Al. /$ 44rtuPAT-e:M. 7RMED BY: NAT THIS ES WAS PERFORMED W ROANCE WITH ALL STATEAND MUNICIPAL GUIDELNES W EFFECT ON THIS DATE CATS: 9y IAe .4aS1 ONSITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 1, BLOCK 1, SPRING FOREST SUBDIVISION GENERAL: The scope of this project includes the work to expose, inspect and verify suitable for continued use the existing 1,250 gallon septic tank on the lot. Work will then include the construction of a new absorption trench 75' long by 5' wide by 4' effective depth at the location shown on the Site Plan. The total depth of the trench will be 9' below existing ground and the distribution pipe will be placed at 5' below the surface. All components of the new absorption trench must be constructed a minimum of 10' from any water services in the area and 1 00'from any surface water on this or adjacent lots. A minimum of 4' of cover is required over the septic tank and 3' over the absorption trench. In lieu of cover 2" of direct bury insulation and 2' of cover may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor is also responsible to assure the separation distance from wells and surface water in the area is maintained. The engineer will accept no responsibility for Contractor errors. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division On Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On Site Water and Wastewater Program before beginning system installation. Lot 1, Block 1, Spring Forest January 18, 2010 Page 2 of 4 SEPTIC TANK INSTALLATION — VERIFY EXISTING A new 1,250 -gallon septic tank must be procured from a certified manufacturer if the tank found on site is not acceptable for continued use. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below the distribution pipe must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class Lot 1, Block 1, Spring Forest January 18, 2010 Page 3 of 4 "C" Well or 200' from any community well. The Contractor is solely responsible to assure these separation distances are met. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections must be completed during the construction of the septic system. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not Lot 1, Block 1, Spring Forest January 18, 2010 Page 4 of 4 be backfilled. The Contractor must notify the engineer 4 hours prior to the inspection to prevent delays. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. His measurements must include verification that the proper separation distances have been met. A certified surveyed as -built may also be required to assure the proper separation distances are met from wells in the area. The as -built will also include separation distances from streams or surface water in the area. Municipality of Anchorage Page of 3 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: SW 93035/ PID Number: 015S3Z10S' Name: Wastewater System: (,New ❑ Upgrade Address: ?<' 4ABSORPTION FIELD Phone: No. of Bedrooms: E' i=0OrL_ ❑ Deep Trench '�S a!kt Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating:Q Total Depth from origin at grad e: __ • a GPD/S . Ft. 9. !' i Lot: / Block: / Subdivision: Dapth to pipe hottom from original grade: Gravel depth beneath pipe, 5pizw(a FO/4c$ S, S Ft. `T/ Ft. Township: Range: Section: Fill added above original grade: Gravel length: rt. c liv Ft. WELL: ❑ New ❑ Upgrade Gravel width: 67 Number of lines: Distance between lines: Fl. 7` 1'4. J Ft. Classification (Private, A,B.C): �....._..�/� Pt,r3L,l C_ WA T-C[L Total Depth: Cased To: Total absorption ar``na: Pipe material: ASr'M 103o34, STT "1 Ft. Ft. �(pQ So. Ft. Lr Z Driller: Date Drilled: Static water Level: Installer: D 5 L)ALIM Date installed: 5/7 97 Ft. ITiEt L Yield:Pump Set at: Casing Height Above Ground: GPM Ft. Ft. TANK - SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lilt Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 17 G RCm /,7-50 Well >zoor > ZX, - >zDar Material: S7 Number of Compartments: —mp EC L u10 Surface Water 4 OAIE �ONt: �o�e LIFT STATION Lot/ Line S / Size in gallons: Ma er: i 7' Foundation �5 / Q/ U ' "Pump on" level at: "Pump off' le High water alarm at: -- _ Curtain J Pump Make & Madel EI Inspections performed by: Drain /V Remarks: BENCH MARK Location and Description: Tr'onn a� SIDIN/, S. �. 6AP_A4t= LJAIrC Assumed Elevation: p /Q ? t c i y` ° 7 Inspections performed by: �' %rlDCRSoAI Dates: 1st 2ndS 7 9 h �dio_l E. Ando rsori =9 Department of He and Huma rvices appro al rid iil -e a'<f Reviewed and approved by: Date: Permit No. X930351. Page ---- Z of 3 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: Lor 1, BLO(it 11 SPR-Itae, I OfL6 PID No.: 0163L/057 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930351 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:VASSEN KENDAL & SHEILA OWNER ADDRESS:3911 HENDERSON LOOP ANCHORAGE, ALASKA 99507 PARCEL ID:01532105 LEGAL DESCRIPTION: SPRING FOREST BLK 1 LT 1 LOT SIZE: 37525 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYS'T'EM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 9/07/93 EXPIRATION DATE: 9/07/94 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 343-4744 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: ISSUED BY: /C.S ��n�c,vYr�CC� DATE : DATE: Municipality of Anchorage Department of Health and Human Services rl'1h5 Tom Fink, 825 "L" Street Mayor P.O. Dox 196650 Anchorage, Alaska 99519-6650 343-4744 March 16, 1993 Kendal & Shelia Vassen 3911 Winchester Loop Anchorage, Alaska 99507-3991 Subject: Lot 1 Block 1 Spring Forest Subdivision Permit #SW910353, PID 4015-321-05 The subject permit, issued November 1, 1991 by this office for a single family well and/or on-site wastewater system, has expired as of November 1, 1992. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, 6?hn Smi P.Egram Manager On-site Services enc: Copy of Permit cc: Anderson Engineering MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910353 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:VASSEN KENDAL & SHEILA OWNER ADDRESS:3911 WINCHESTER LP ANCHORAGE, AK 99507 PARCEL ID:01532105 LEGAL DESCRIPTION: SPRING FOREST BLK 1 LT SEC 14, T12N, R3W, SM LOT SIZE: 37525 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1 PAGE 1 OF 1 DATE ISSUED:11/01/91 EXPIRATION DATE:11/01/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: ZZzk DATE: October 21, 1991 Municipality of Anchorage Dept. of Health & Human Services Environmental Services Division 825 "L" Street, Room 502 Anchorage, Alaska 99501 Subject: Lot 1, Block 1, Spring Forest Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: MUNICIPALITY OF ANCHORA(;E ENVIRONMENTAL SERVICES DIVISION OCT 2 2 1951 RECEIVED I have reviewed information available on lots adjacent to the subject property and have conducted an onsite investigation. Systems located on other properties in the neighborhood are more than 200' from the proposed systems on the subject lot. Lots in this subdivision are served by a private water system and no wells are located on individual lots. The terrain of this lot is relatively flat. It sits lower than both Birch Road and West Tree Drive, however, and drainage from these roads will accumulate on the lot. It is essential existing ground be mounded over the drainfield trenches to insure drainage will not accumulate over the system 1. The system, if constructed as designed, will have no adverse impacts on the wells currently in use or to be placed in the future on lots located in the area. Since the subdivision is served by a private water system, it is unlikely individual lots will ever have private wells. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space either surface or subsurface on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. e < o'Ze oIYYYe%Jeioa.,e000 �'o1Y;'/eda ee eo oeo eo oo ao `� t,??a 'CIA Michael E. Andxson °c< 4381 • E <o° 00 a ��®� P 0FCSSt '���v ROCKFORD CORPORATION P.O. Box 111706 ANCHORAGE, ALASKA 99511 (907) 344.4551 FAX (907) 344-2130 JOB _ Go7— I,p C/_ 5 P Ra r 16 F-0 i -.c ST" SHEET NO. +^ / OF ?� CALCULATED BY /✓I L% DATE CHECKED BY DATE ROCKFORD CORPORATION P,O. Box 111706 ANCHORAGE, ALASKA 99511 (907) 344.4551 FAX (907) 344.2130 JOB B L-0 C 4 Z, S PM nJ G SHEET NO.Z OF Z CALCULATED BV In c'A DATE CHECKED BY DATE 5vS7-rM C04 LLU 4,A '77 0 PJ Pap- czL,A-rro,.ti Arm /3 n41Nr/1.4er4 ,; APPLle'v rorJ j1A-C g q 6,DUOrAs x /Sb G. pb, 8 420oM 600 Ca. Pr t�, 5muA ouj T - ('Jckl DE'5161.1 W IrN 3(, 1 6 pAvEL )36WLA) T'r Pc 75-o "'r.z -_S X SB 6ZCDuc770,,3 F7Ac-TD2-) Sl Firzr nr-- TIU,.-rJCirq hu�o LAT C-&AL.S VVI �.JG -- -- /Z50 &ALLOrJ C-rmr � rrc i / `5cPvCr j Mkt -t v,.. . Cr,our Pox r l CA4 c- CT"I o , - — - A r T S r r L ® MON iTo L —U13C i Irl) WL E> Or Ala C !' s�� oa t u0 R.l el" (; y Of c'v ..OuG f0300 000 0 ,O��Ig0000 F. Anderson 14 © e� 4331 - E Municipality of Anchorage �., DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST P� 00% ° d �oyauma:yauSAP 90P 0aoa C Michael E. And-3rson :RFORIAED FOR: �'l,'` 1. C�0nJ 5-ri2vUr/ 014 DATE PERFOR :GAL DESCRIPTION: Lpr� BGUUL SPAu W, Township, Range, Section: S(4 TIZ -P7 (=da --ST SLOPE SITE PLAN 6'0, $ROWS �Rl>JEL- Ill 2 J• � � l� � � t� ,IDENTS <) try S A4Qt y Cgt2-A V El - 15 A L 5A s �✓1 Bo roman 0;- 4(DLf- r, r. IYAS GROUND WATER ENcoun'TERED? ID S IF YES, AT WHAT L DEPTH? 0 ----� P E Depth ID Water Atter Monitoring? Date: z 3 L/J II I PERCOLATION RATE /-') 4;rr (minu:esiinch) PERC HOLE DIAf✓E7ER TEST RUN BETWEEN ? /2- FT AND "_ FT 'ORMED BY: _ /r/ 4 Aj L6:i- o j — r , I tn7TF I�THAT T/HIS 7 ST WAS PERFORMED IN DRDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: %O/Zf le/ 9 (Rev, 4;65) it I I ISI IN � II !I li I til I I i/I III r. 77 til �I�IzI PERCOLATION RATE /-') 4;rr (minu:esiinch) PERC HOLE DIAf✓E7ER TEST RUN BETWEEN ? /2- FT AND "_ FT 'ORMED BY: _ /r/ 4 Aj L6:i- o j — r , I tn7TF I�THAT T/HIS 7 ST WAS PERFORMED IN DRDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: %O/Zf le/ 9 (Rev, 4;65) bMunicipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /✓1 M C 60 "J rj7'�/ Cn Q DATE _EGAL DESCRIPTION: Lor l. <'11h, . I /_ Townchin R..,.... (-FFTIM PT 67l t=o 1 cs r S4NbD Gr2A\JEL �P <)L—Y C /,!, S:: -' 0 AA OF '6,C SLOPE M WAS GROUND WATER ENCOUNTERED? A/0 S IF YES, AT INHAT L DEPTH? 0 P E Depth to Water After /Vp Monitoring? Dale: ^ C 6�3Iy+�?SR'S SEAL) 00 , P �10 F�o 1 -1 * A lr4ichacl E. An&rson 0. 01 0°SIS, I IziJa�jZ31 SITE PLAN PERCOLATION RATE(mi� " nutesiinch) PERC HOLE DIAMETER TEST RUN BETWEEN _4_ FT AND /L FT MMENTS ALC- WAS P&CSOA'� 2n4o/L _-rD "1 '�$T 140 vJA-LL 2QhJ )TQ/?- '-u— B__ C AF7'EtL 7 A lS IFORMED BY: _/=G OamSO"f I '�A F4"d f THAT THIS TEST /AS PERFORMED IN :ORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS GATE. DATE; Q J De (Rev. 4,65) 05/04/94 10:40 S 907 344 2130 ROCKFORD CORP 01 ANDERSON. BOX 240773 ENGINEERING RECEIVED ANCHORAGE, ALASKA 99524 MAY 41994 Munic,palay of Anchorage Dept. Health & Human Services May 4, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "U Street Anchorage, AK 99502-0650 Attention: Robbie Robinson Subject. Lot 1, Block 1, Spring Forrest Subdivision Permit No. SW9303.51 Dear Robbie; The planned location ;For the septic system for the subject lot was covered with it large snow deposit most of the winter. This area is now slowly melting covering the area with surface water, This water is not dissipating because of the frost layer below ground. We are, therefore, required to move the system to a drier area. We have identified a suitable area in the northwest portion of the lot. Soils excavations revealed a silty sand material which percolated at a rate of 14 minutes per inch. No groundwater was noted in the excavation nor is any anticipated during the monitoring period. The attached site plan shows the new location of the system. Also included is the testhole data and design information. We hereby request the original permit be modified to include the new location for the system. Please advise if you have any questions or comments. Sincerely, Michael E. Anderson, RE, 721/&ulG' 1 C-AtJ'r rA41"V -ro b 4y. 'PIC4 s •' a--Dj, 4-`J ..f. (;n(-k- M� ��_ pJ t-MoL, QUEIr16„11 05/04/94 10:40 BIRCH a 907 344 2130 ROCKFORD CORP 02 koAU F Y O 1.1 � 1' 7 �, 11^^ N 0 t A Y i a P 1 m .4 J tp In m L �v " a Ca m i � u po�J a IM k A le. F r 14 = so Y O 1.1 � 1' 7 �, 11^^ N 0 t A Y i a P 1 m .4 J tp In m L �v " a Ca m i � u a IM k A r 14 = so /4' 1.1 � 1' 7 �, / mss•. .. � L r 14 = so 05/04/94 10:41 $ 907 344 2130 IAunWPallly of Anchorage } DEPARTMENT OF: HEALTH & HUMAN SERVICES I E2S "V Street, Anchorage, Alaska 99502-0650 .w SOILS LOG — PERCOLATION' TEST )AMEOPOR: DeSfc,ef$ IN Woo ..`_DATE L 09SCRIPTEON: lfT'', 8`OL.&I _ T_M N & Township, Range, Section: &Tro m or. 140Lti°' ;NTS ROCKFORD CORP WAS OROUNO WATER ENCOUNTERED? "^S 1F YES, AT WHAT L MTN? O E tUplkpWuulllu Cih.1(,OEEJC7 MarwUrinp7 e.__ Wm _�,,,, PEACOLATION RATE -'=- ,,_�r (minwiuiruEf) PFJiC HOLE DIAMETER T98T 14UN BETWEEN FTANp 4 V4 pT .. .. �. . _ _ . i , Imeo BY: `r E C—A EST WAS PERFORMED IN DANCE WITH ALL 5TATEAN0 MUNICIPAL GUIOELIN95IN EPPEGT ON THIS OATS DATE Iew, 41m) 03 05/04/94 10:42 $ 907 344 2130 ROCKFORD CORP Lot 1, Block 1, Spring Forrest Subdivision DESIGN FACTORS: Four Bedroom Home Perc. Rate: 13 Min./Inch Application Rate: .8 GPD/SF Reduction Factor: .5 SYSTEM REQUIREMENTS: Shallow 'french System 1,250 Gallon Septic Tank 4' Drain Rock Under Pipe 4 Bdrms. X 150 GPD / .8 GPD/SF / 5' Width * .5 Red. Factor = 75 LF Therefore: Construct a Wide '/Tench System with Two Laterals Each 38' Long. Place 4' of Drain Rock Under Each Distribution Pipe. 4' Typical Wide Trench Section 04 .1n �..,. r. .. AQ V91 k. FOA13TL.I (!� ��RF'c�nNx� Typical Wide Trench Section 04 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 May 4, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Robbie Robinson Subject: Lot 1, Block 1, Spring Forrest Subdivision Permit No. SW930351 Dear Robbie: MAY 6 1994 :taa e .tGti�l t:v:.e Ali ��. P�i11,i.L1 C"Ot'V Cef> The planned location for the septic system for the subject lot was covered with a large snow deposit most of the winter. This area is now slowly melting covering the area with surface water. This water is not dissipating because of the frost layer below ground. We are, therefore, required to move the system to a drier area. We have identified a suitable area in the northwest portion of the lot. Soils excavations revealed a silty sand material which percolated at a rate of 14 minutes per inch. No groundwater was noted in the excavation nor is any anticipated during the monitoring period. The attached site plan shows the new location of the system. Also included is the testhole data and design information. We hereby request the original permit be modified to include the new location for the system. Please advise if you have any questions or comments. Sincerely, Michael E. Anderson, P.E. BIRCH a w tA Roq p vs; Munlcipallly of Anchorage DEPARTMENT OF HEALTH $ HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 'ERFORMED FOR: ✓CSfGN,S /P4 000,6 /— pp DATE .EGAL OESCRIPTION: 1 004. DW CA 1, SP f2-I,J 4v Township, Range, Sectlon: T I-' 1-0(LaC- Sr SLOPE E , 2 3 4 k .✓'• 7 13 14 15 MENTS &7rOM or- 4O t'c SITE PLAN WAS GROUND WATER ENCOUNTERED? AID PERCOLATION RATE_Q (minulssincn) pEAC HOLE DIAMETER 8 TEST RUN BETWEEN FT AND T /L FT 11n1C, _IS _ ©n1G01tG. / r.i't- r ORMED BY: ,(_�_���� '"CEATTFi"'fHAT THIS EST WAS PERFORMED IN )ROANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:—G�—r—� (Rev. 4,86) Lot 1, Block 1, Spring Forrest Subdivision DESIGN FACTORS: Four Bedroom Home Pere. Rate: 13 Min./Inch Application Rate: .8 GPD/SF Reduction Factor: .5 SYSTEM REQUIREMENTS: Shallow Trench System 1,250 Gallon Septic Tank 4' Drain Rock Under Pipe 4 Bdrms. X 150 GPD / .8 GPD/SF / 5' Width * .5 Red. Factor = 75 LF Therefore: Construct a Wide Trench System with Two Laterals Each 38' Long. Place 4' of Drain Rock Under Each Distribution Pipe. r • � GE QG Municipality of Anchor. e c On-Site Water and Wastewater Pro.am \ v i (907) 343-7904 �, s A T E T Y Certificate of On-Site Systems proval w 015-321-05 .e Parcel I.D. Expira �� I @A S 1. GENERAL INFORMATION Complete legal description Spring Forest, Block 1 , Lot 1 Location (site address) 5800 West Tree Drive Anchorage, AK 99516 Current Property owner(s) Robert & Carla Terrazas Day phone 441-6488 Mailing address 5800 West Tree Drive Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (wlwo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual LI Individual Water Storage ❑ Holding Tank ❑ Community Class A Well Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: '41ADistance: Received by: Date: 5 f l a 117 COSA to be released to the engineer, ut, ss otherwise requested by the engineer. COSA Fee $ 52-4 Waiver Fee $ Date of Payment y 1l0 (1 1 Date of Payment Receipt Number ItutG\ Receipt Number COSA# QGJL« t l (? Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal a ed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlin the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 _ Address PO Box 240773, Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller Date 5/9/2017 4(. f., a,. .'-'','17' , t. t� .. . fi , 6. DSD SIGNATURE 0 '� " '�' .v .....,a System #1 Approved for bedrooms j,; t.-1' { Saltieri 0 System #2 Approved for bedrooms ��w • �° �??92.. °• aDisapproved vei8�' pt,-- Conditional approval for bedrooms, with the following stipulations: . .v,-,;`11 OF ON-SITE c WATER AND IT' =c; WASTEWATER cIN PROGRAM o S Br"-----C7fk':-7-CW2AA---iOriginal Certificate Date: S---12—/ 7 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_E c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Spring Forest, Block 1 , Lot 1 _ Parcel ID 015-321-05 A. WELL DATA Well type A If A, B, or C provide PWSID # 213564 Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft Cased to ft Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 2/5/2010 Tank size 1 ,250 gal Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 4/21/2017 Pumper Isaac's Pumping Service C. ABSORPTION FIELD DATA Date installed 514/94 Soil rating (g.p.d./ft2 or ft2/bdrm) .8 GPD/SF System type 5' Wide Length 2 @ 43 ft. Width 5 ft. Gravel below pipe 4 ft Total depth 9 5 ft. Eff absorption area 860 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/27/2017 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 42/44 in Water added 620 gal. New depth 48148 in. Elapsed Time 1 ,440 min. Final fluid depth 42/44 in Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes. give date A second absorption trench was constructed in 2/3-4/2010. It is 75' Long x 5' Wide with a 4' Effective Depth and a total depth of 7'-8'. The total effective absorption area is 750 square feet. It is accessed with a flow diverter valve. D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >1 001 On adjacent lots >100' Absorption field on lot 100' On adjacent lots 100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line X251 Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas 100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field >5 Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: >10'Property line Building foundation >10Water main 10 >10' >100' Water Service line Surface water Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS The trench constructed in 2010 was not tested. Snow and surface water saturated the trench. Grading will be accomplished in early June to prevent a recurrence. G. ENGINEER'S CERTIFICATION vs� +'w �45k$ I certify that l have determined through field inspections and 4.4%V.1%:** review of Municipal records that the above systems are in C; "� ,..w. •'- •a # conformance with MOA COSA guidelines in effect on this date. +�' * ' ' ' .,T Q of Engineer's Printed Name Benjamin Schiller .. i as 5/9/2017 • , r 1 Date s CE, .� o dr R 4 n R Pqd'' COSA brown sheet 10-10-12.doc ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) MEMORANDUM DATE: May 9, 2017 TO: Tim Ecklund FROM: Michael E. Anderson, P.E. SUBJECT: Lot 1, Block 1, Spring Forest Subdivision Certificate of On Site System Approval (COSA) Minor grading is required near the newer absorption trench on this lot torevent the building up and accumulation of snow and surface water. In addition, septic vents must be raised above grade. This work cannot be accomplished until the road restrictions are off. The buyer of the house has agreed to pay for the work and has contracted with Denali Excavating to complete the grading by the end of May. We request the COSA be issued so the property transfer can occur. Thank you for your consideration. �1ND � 647,0E-4006 ACCEPT 1243(104S a'tatY efts WOK, fill. STAN De", C-1741.- Pn[, 1 ICoe$ MUS 1 BC flccouazct PeA, _ &VILA, 2 , 9E. PLAT NO. 83-7 SPRING FOREST SUBDIVISION LOT 1 , BLOCK 1 37,525 S.F. �rRE N 89'51'03"E 85.00' ''?O zY° 1.94.25. + — _1 Ung MrRaF� d 0 Sod, \ • //oo 1 A.c. revs \ SA C^- ` . ,a� �o V I I ,N. s�0. ti I\ b O I A% Q N SEPTIC Snit-1i �� •` :2. 0 3 ,..1 I ♦ �/ / ilt If ' � / $5 /=o 35 t , / p `44,g/24),V0 / ah �fJ. o •• N / `Y J m 8 J" V Z I J f" , tom V *J•}�h FENCE (APx) /4Ik / ^ 9J- 0.: J �o �r �V g 0 a^ x . A.: X / / "=40' �} 20' ORAJNACE ESVT. / 1 / 10' MI_ ESMT. N 89•51'03"E 139.44' BUILDING D ETA I L SCALE: 1"=20' /AS -B U I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICtt1) ABOVE AND THAT NO �>»� GASTAI.DI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. ♦� + SURVEYING, LLC 1T IS THE RESPONSIBILITY OF THE OWNER TO +' .•O JEFF A. GASTALDI, R.LS. DETERMINE THE EXISTENCE OF ANY EASE�+EYTS, i gyp.•'•• •. -r 2000 E. DOWUNC RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOTCi) 49TH •;* ; ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDMSION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA 1• ••• •t GRID GATE HEREON BE USED FOR CONSTRUCTION OR FOR A o ,kf1•r A. Ga»oldi : ,- ii r ea91 � • 2538 2/17/2010 ESTABLISHING BOUNDARY OR FENCE ONES. .€7's J1)^ .4t��/o•;•cP * ANCHORAGE RECORDING DISTRICT, ALASKA °A •" ° • F.a. JOB NO. . P0le»fonal N-aa�. 93-20 SF511 NOTE: NO CORNERS SET THIS DATE. �4%Walt* � Municipality of Anchorage C .. Development Services Department — Building Safety Division On -She Water and Wastewater Program .. ... --------- —4700 Bragaw Street .---- P.O. --P.O. Box 196650' Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01"21-05 COSA # ! D 0036 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 1, akxk 1. Swing Forest subdivision Location (site address) seooWest Tree Drtve Anchorage.AX99516 Current Property ownerani s) Kenneth a t7se Konrad - — -- Day phone ----- — Mailing address 5600West Tree Drive Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD forpickuA 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-sfte ❑ Public Water System B Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -She Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-familyon-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of OnSRe Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not resdonsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 89524 Engineer's Printed Name Michael E. Anderson, P.E. Date 2/192009 6. DSD SIGNATURE..._._- I +° 1MK Aa E Arroccwa; " • CE -4381 : �` •. Approved for bedrooms. �js��q••.=-t9-ro ; ���� _ - -- Disapproved. B PQOf[SSlB�a� �� Conditional approval for bedrooms, with the following stipulations: Attachments: COSA ChecMist �_ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: d�� � riginal Certificate Date:_ 2 ' - - (w•r. ttos) Municipality of Anchorage Development Services Department Building Safety Division ' Onsite Water & Wastewater Program ------ —.4700 Bragaw Street- --- P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onshe (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 1, eiodc 1, Spring Forest subdivision Parcel ID- 015-321-05 A. WELL DATA Well type _ If A. B, or C provide PWS ID # _ Well Log (YIN) Date completed _ Sanitary seal (YIN) _ Wires properly protected (YM) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level fL R Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: mg/l Date of sample: B. SEPTICIHOLDING TANK DATA Tank Type/Material SeptlHst" Tank size 1,250 gal. Number of Compartments Two Foundation cleanout (YIN) Y Depression over tank (YIN) N Collected by: Date installed 2fd12010 Cleanouts (YIN) _ High water alarm (Y/N) Y P Date of pumping New Constructlon Pumper C. ABSORPTION FIELD DATA Date Installed 2/4.6=10 Soil rating (g.p.d.e or ft!/bdrm).e GForsF System type S YNde Trend, Length 75 fL Width 5 ft. Gravel below pipe 4 R Total depth 1-s fL Eff. absorption area50 ftp Monhodng tube Y Depression over field N Date of adequacy test New const. Results (Pass/Fail) For—bedrooms Fluid depth In absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 moa (Y/N & type) If yes, give date D. UFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at _ in. 'Pump off" level at_ in. High water alarm level at in. Datum Cycles tested Meets alar 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots NIA Absorption field on lot NIA On adjacent lots NIA Public sewer main NIA Public sewer manhole/cleanout NIA Sewer/septic service line NIA Holding tank ruA Animal containment areas None Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: --- ---Building foundation -->S Property line ;S_— Absorption field Water main >10 Water service line >1d' Surface water >10a Wells on adjacent lots >10(r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line >79 Building foundation >70' Watermain 3.1(r Water Service line >1c' Surface water >700' Driveway, parkingArehide storage Curtain drain None Noted Wells on adjacent tots >100' F. COMMENTS: Lot is Served by AWWU Water system. G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name Michael E. Anderson, P.E. Date - 4/19/2009 COSA Fee $ .2 5 D Date of Payment .2- Receipt 2-Receipt Number 15 6 (Rev. 11105) Waiver Fee $ _ Date of Payment Receipt Number CE -4381 3�v FA top ow00 O O z 0 o � .0� 1 Ap x I •' \ 1 x I I g I a •• N I I , — — — •Lvsa'lun .Ot -- - - -- .00'01Z MA9.80.00 N M GVON H02118 I I I I� I� I Ib I I I/ I/ /I / I • �1 n n DD O �/ 000s 0, °':• `rQ`�i : • x e ♦♦� m Y Ikeq � V)U J ui ZUImN to 3 W . r: O O U J w CL V) 3�v FA top ow00 O O z 0 o � .0� 1 Ap x I •' \ 1 x I I g I a •• N I I , — — — •Lvsa'lun .Ot -- - - -- .00'01Z MA9.80.00 N M GVON H02118 I I I I� I� I Ib I I I/ I/ /I / I • �1 n n DD ~� Zd�`` 1W- zog�8ojr�i �c N�N�o9F3W _ 0 4 W m 0 0 ~ xO O W O W W z O O N W U O U O ? M x az o W W U Z p�tZ���0:�78p W F - O F U= Z Oa Z pyUy M W z W- K L10F� E07 V O www n•om�r zd z =iL6L=a !kD=iJ NF $ O - -4 (g J p Y p ipp ¢Q Z, Dn m 2 �F O N O' m Nz �jW W a0 O Q > (� Z r7 N 7d O= a a h F� �,1 = a a �8" N 4 �/ 000s 0, °':• `rQ`�i : • x e ♦♦� f; Ikeq ~� Zd�`` 1W- zog�8ojr�i �c N�N�o9F3W _ 0 4 W m 0 0 ~ xO O W O W W z O O N W U O U O ? M x az o W W U Z p�tZ���0:�78p W F - O F U= Z Oa Z pyUy M W z W- K L10F� E07 V O www n•om�r zd z =iL6L=a !kD=iJ NF $ O - -4 (g J p Y p ipp ¢Q Z, Dn m 2 �F O N O' m Nz �jW W a0 O Q > (� Z r7 N 7d O= a a h F� �,1 = a a �8" N 4 rig walutham CIO REAL ESTATE SUPPORT SVC Day phone 55431 Day phone o�dweZ2 Bavihe�c -Day phone 229 144 ' e 4nchonage,." AK "99503 _Is .. ,iY .2..- . NUMBER OF BEDROOMS 3 TYPE OF WATER SUPPLY. f Individual well _ w;: :Community well XXX P� A a Public water G k � 1n NOTE if community well system, provide written confirmation froniktate AD ttest ing to the legality and status of system.IQ °y _ TYPE OF WASTEWATER DISPOSAL < individual on site <' Holding tank'. „•. ;`: t i" , ur r F,T t t Community on-site rr Public.sewerc }r NOTE If community wastewater system, provide written confirma tion.from State ADEC , attesting to the legality and status of system. 72-025 (Rev. 1/81) Front MOA e21 5. STATEMENT OF INSPECTION BY ENGINEER " As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of`this Health Authority Approvaf 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my invest!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 i S ENGINEERING ; G °I L a � 7g Name of Firm --�7094.E.gls Ktv.r Low Rind NA ' Phone - Address EP09 *IV 2, AIax! 99577 Engineer's signature _ %�.� Date 2111 /2J_ — —� Municipality of Anchorage MUNICIPALITY OF ANCHOKAUE DEPARTMENT OF HEALTH & HUMAN $ARVWi,€> &LSERVICES DIVISION Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907fi�V-41744 1995 RECEIVED Health Authority Approval Checklist c3 Legal Description: Z//. S,�w, Parcel I.D.: � " A. WELL DATA Well type r-omolu.2, 1 z if A, B, or C, attach ADEC letter. ADEC water system number Log present (YIN) /G%/4 Date completed Total depth /L'// -I Cased to /V//V Casing height (above ground) ✓L%/� Sanitary seal (YN /ti -,/y Wires properly protected (YN FROM WELL LOG AT INSPECTION Date of test /t///� Static water level A/c/ %U/// Well production �� /� g.p.m. �%9-P.M. WATER SAMPLE RESULTS: Coliform /y//a Nitrate /y//V Other bacteria Date of sample: /t//� Collected by: /V//'r B SEPTIC iOLDING TANK DATA Date installed s -- Tank size Number of Compartments Cleanouts (YfN) 7 Foundation cleanout (Y/N) /V Depression (Y/N) IV High water alarm (Y/N) Date of Pumping %"y 0/s Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (r) Jit�r felbdrm) Length Width System type 7,1- e", G �i Gravel thickness below pipe G/ Total depth G a 14/Effective absorption area G G�% Monitoring Tube present(Y/I� i Depression over field (Y/N) Date of adequacy test �'- �SJ Results (Pass/Fail) n �tSS For _ bedrooms 0 Fluid depth in absorption field before test (in.); 0 Immediately after gal. water added (in.): a Fluid depth �C) Minutes later: 0 (in.) Absorption rate = /WZ�V 7' g.p.d. Peroxide treatment (past 12 months) (YIN) /(/ If yes, give date /L' D. LIFT STATION Date installed /l//�V Size in gallons Manhole/Access (Y" XJ/ -Z "Pump on" level at* "Pump off' level at* High water alarm level at* A1,1171 /171 *Datum 2611 7 Cycles tested A'/1� E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /��%� ; On adjacent lots "I/// Absorption field on lot On adjacent lots Z61//� Public sewer main Public sewer manhole/cleanout 1wx Sewer /septic service line Lift station /V/f7 SEPARATION DISTANCES FROM EPTIC OLDING TANK ON LOT TO: Foundation 14,�2 �.74 Property line 7"' Absorption field Water main/service line Surface water/drainage ©O yWells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation / e�) /'L Water main/service line /6�2 ///-- Surface water 100 1 /— Curtain drain L// F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots .411111-7 1 certify that I have determined thru field inspections and review of Municipal in conformance wf ith A I guid" es in effect on this date. Signature Engineer's Name t `y � L % �• (-6 ,v fk V fig„ Date HAA Fee $ Date of Payment ?/111/� r7 Receipt Number / 2L Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Ate` ROBERT C. COWAN }�2 �'if' �E • 8801 C7Yl 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. # —0153 Z- 10 t^ HAA # A Q'� Ll ( Q-'- 6 1. GENERAL INFORMATION Complete legal description lT L -o U& S P2ltJ6 ra W57 Location (site address or directions) Property owner Lisu nQ, Ln l i lr.cc Day phone Mailing address (_�:� \ �� �'�ur i S of � �nLh CIA1 S K Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water P60 fZ xxx Day phone Day phone 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 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 021 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that'my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 IJ r)CIZ50 tJ 1'j6 Phone 4 — `ESS Address P(p Rox ZYO773 ►uip �e /�)� R95'Zq Engineer's signature Date Er.1 ZZ Iq t/ 6. DHHS IGNATURE Approved for bedrooms. 0 Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: 4l1TIC 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rw.1/91) Back MOA.Y21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: for �, 9,.,a_ c.gt- (=ulzC-s ALL-5 Parcel I.D. 0 I S.L) 0 A. Well Data j JAT-tvz- Well type Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level If A, B, or C, attach ADEC letter. ADEC water system number P w 5 f U 2--1 -ix4 Date completed Driller Cased to FROM WELL LOG Casing height Wires properly protected (Y/N) Well flow g.p.m. Pump levels SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main AT INSPECTION ; On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Collected by: (viunic,pahly of Anchorage Dept, Health & Human Services Other bacteria Date installed S LI !_Tank size /,Z'; -,O 64L- Compartments �vJ 0 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression MA High water alarm (Y/N) Lt. N/ Alarm tested (Y/N) A Date of pumping A/ c --Lo CotJ s r /W �-z- j iJ Pumper "i % A _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 14 1A __On adjacent lots N 4 Foundation / To property line q I Absorption field / b' Water main/service line Surface water/drainage /V 0 N tom' 72•026(3W)•Front CONTINUED ON BACK PAGE Date installed Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manhole/Access (Y/N) "Pump off" Level at Cycles tested Date installed �i-b A,/ Soil rating (GPD/Ft') Surface water System type w I b L= _T_e_-m a1 i Length Gc r Width S J Gravel thickness Total depth 9 - Total absorption area 8& 0 Cleanout present (Y/N) Y Depression over field (YIN) Date of adequacy test 1l�� CO r S --f— Results (pass/fail)ASS for Water level in absorption field before test Q After test Peroxide treatment (past 12 months) (Y/N) /J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot P4.1A On adjacent lots /\/ )A Property line / To building foundation / To existing or abandoned system on lot _ � On adjacent lots 7/00( /00 Cutbank /J 0 ,1 re- Water main/service line 7/0 4 Bedrooms Surface water ^10 'J C Driveway, parking/vehicle storage area > Z_ Curtain drain &J a nI E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and NAA guidelines in effect on the date of this inspection. Signature G_ - Engineees Name m j tAt AC -L- t�f /-}rJ.D c7ZSo �% 21 r f ��/79K Date HAA Fee $ Date of Payment Receipt Number 72.026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number a I I i I I I I I I , I I I i i I I I I I I I I � I I H I � I t s r "o A/ a; _6 6 n r +o z H 3 0 ..H. rg7 I. O 6 -_ .. O mph / III •'^ I I �r / �,1//(� 6 c it Q Yna h I P GVON HOb18 I I I I via �Yi�oiai• N� a a€ a vi - �3Fu xy n£ N Y o wpm £ bi a cY°5MT a�; Cfi E«am Nr^ UK y. pza 4 o E 4Ei a>g a o Q nm �my a _° amN tiu ac o ,� K UV a I I i I I I I I I , I I I i i I I I I I I I I � I I H I � I t s r "o A/ a; _6 6 n r +o z H 3 0 ..H. rg7 I. O 6 -_ .. O mph / III •'^ I I �r / �,1//(� 5 } I L. 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