HomeMy WebLinkAboutSPRING FOREST BLK 1 LT 9Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201105 PID Number: 015-321-13
Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
RYAN DANIEL
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
6000 WEST TREE DRIVE *ANCHORAGE, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-748-1140
5
0.8 GPD/SFJ
12 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
8.14 Ft.
Subdivision Block Lot
SPRING FOREST; BLOCK 1, LOT 9
Fill added above original grade
SEE DWG. Ft.
Gravel length
60 Ft.
Township Range Section
N/A
Gravel width
2.5 Ft.
Beds: Number of Lines
Distance between lines
- Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
975+ Ft2
1
_ Ft.
Well
-
_
_
_
_
TANK A Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
INFILTRATOR
Capacity
1530 Gal.
Surface Water
100 +
100 1+
I
Material
Number of compartments
Lot Line
10'+
10'+
-
-
NA
HDPE
2
Foundation
10,
04
_
LIFT STATION
Manufacturer
Capacity
Remarks OLD TANK DECOMMISSIONED PER UPC
NIA
_ Gal.
PER CONTRACTOR
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank D3034 Tankto
D3034
NORTHERN EXCAVATION
Drainfield D3034 CO/MTD3034
Inspector GEG AND TIM ECKLUND
BENCH MARK (Assumed elevation) 100.55 ft
Inspectiones: 1m 7/20/20 god 7/21/20
Location and description
3d 7/21/20 4th _
TOP OF MANHOLE LID
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stam
�Q60001
Conditional Approval: Date
........... ...... ...... ......
�
'.Je carness. �D
E-79
Septic System!�`�
`���
Approved Date
Note: this approval does not include well permit requirements.
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ID
PERMIT
OSP201105 RECORD DRAWING P015-3ARCEL2NUMBER:
21-13
B C
I
I
1
711
1
I
I
1
W
uj00
I
I
NEW DRAINFIELD
SPRING FOREST; BLOCK 1, LOT 10
LINE INSULATED 4'X 4" THICK ON
T1 CENTER UNDER DRIVEWAY
% C
":� �•r: APPROXIMATE LOCATION
OF OLD DRAINFIELD
-'•: + :.-.. LOW DIVERTER
- ` DBL1&2
'• NEW IM 1530 INFILTRATOR
`• �'!.•-'-
SEPTIC TANK
DRIVEWAY SHED/GREENHOUSE - MOA
• s : '- • ' + . ONSITE DURING INSPECTION AND
APPROVED TANK LOCATION
iFENCED GARDEN ATEA
EXISTING 5
BEDROOM HOUSE
11 TI
ENGINEERING SALES CONSULTING
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 'PHONE (907) 337-6179 -FAX (907)338-3246 'WEBSITE—.g.... nglnea g.c
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
RYAN DANIEL 907-148-1140 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SPRING FOREST; BLOCK 1, LOT 9 D.J.G.
TYPE OF WORK: DATE:
SEPTIC TANK AND RECORD DRAWINGS 7/28/2020
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LICENSE 41, ,ROF5`,����•
#AECC884 i
PERMIT NUMBER: PARCEL ID NUMBER:
OSP201105 RECORD DRAWING 015-321-13
TOP OF TANK
AT INLET = 96.04
INVERT OF BUNG
AT INLET = 95.40 J
TH#1
TOP OF MANHOLE = 100.55
FINAL GRADE = 99,7-99.8
MH ST2
2" INSULATION PER
CONTRACTOR
IM -1530 2 -COMPARTMENT
INFILTRATOR SEPTIC TANK
ORIGINAL GRADE AT HIGHEST POINT = 95.04
8.14 FEET
RELATIVE ELEVATION AT BOTTOM OF T.H. = 75.54
(T.H. DRY ON 7/20/2020)
- TOP OF TANK
AT OUTLET = 96.00
INVERT OF BUNG
AT OUTLET = 95.13
MT CO
a a r FINAL GRADE = 94.6-95.6
"ARNEOS EN"INEERING GROUP, td
ENGINEERING SALES CONSULTING
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907)338-3246 ' WEBSITE: -gamrtg'.ri
ring.
m
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
RYAN DANIEL
907-748-1140
3 OF 3
LEGAL DESCRIPTION:
DRAWN BY:
SPRING FOREST; BLOCK 1, LOT 9
D.J.G.
TYPE OF WORK:
DATE:
� SEPTIC TANK AND DRAINFIELD PROFILE
7/23/2020
FILTER FABRIC
OF PIPE = 91.18
OF TRENCH = 83.04
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LICENSE 41� ;;;-.,\�
#AECC884
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
STRUCTURES OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.
NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES.
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
in
114:
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ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND THAT NO VISIBLE
ENCROACHMENTS EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE, ALASKA THIS 27 TH_
DAY OF JULY 2020_
HOLT LAND SURVEYING 9643, FB117-27,207-6
TEL. 345-5513
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PC Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www, muni,org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201105
Work Type: Septic Upgrade
Tax Code Number: 01532113000
Site Legal Address: SPRING FOREST BLK 1 LT 9 G:2538
Site Mailing Address: 6000 WEST TREE DR, Anchorage
Owner: DANIEL RYAN & LAUREL
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
De p;ut'ment
5/12/2020
5/12/2021
45471
Z Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received Rt
Issued By:
Date:
Date: a/?�i�
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Ethan Berkowitz
On -Site SewerMell Permit Application
For A Single Family Dwelling
Parcel I.D. 015-321-13
Property owner(s) RYAN AND LAUREL DANIEL
Mailing address 6000 WEST TREE DRIVE *ANCHORAGE, AK 99516
i.
j
Day phone 907-748-1140
Site address 6000 WEST TREE DRIVE *ANCHORAGE, AK 99516
Legal description (Sub'd, Block & Lot) SPRING FOREST; BLOCK 1, LOT 9
Legal description (Township, Section & Range)
Lot Size Sq. Ft. Number of Bedrooms
5
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DEWELLING:
(®all that apply) Initial ❑
Absorption Field ®
Single Family (SF)
Upgrade
(w/wo AD -U)
Septic Tank ® Renewal ❑
Duplex (D)
❑
Holding Tank ❑
Multiple Dwellings
❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
N/A _
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
i
.i
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
-R,*:) Waiver Fees:
Date of Payment: 0 l a l otu atu Date of Payment:
Receipt Number: a1B.L7b Receipt Number:
Permit No. -05P �2 6 l(!05 Waiver No.
(Rev. 01/11)
COVID-19
25% DISCOUNT APPLIED
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201105, Rebecca Carroll, 05/12/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201105, Rebecca Carroll, 05/12/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201105, Rebecca Carroll, 05/12/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201105, Rebecca Carroll, 05/12/20
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEAl. TH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME 'PHONE
MAILING ADDRESS
i'2.00 vJ ~'3'~t¢ ~
LEGAL DESCRIPTION
LOCATION
E, ~ ,~ o' (v~ ¢,i~¢L~ "' N. o..,
Well
- ~ DISTANCE TO: glO't-
I- Z Manufacturer ~
Lq. capacty riga ons
IF HOMEMADE:
1500
DISTANCE TO: Well
Manufacturer
IWell
DISTANCE TO: 1
No. of lines .~=~ J Length~of each line
. I '~,
Top ct t le to rinisn g(aae
~ ~' W/5'le, p6
Length Width
Type of crib Crib diameter
DISTANCE TO: Well
IClass Depth
DISTANCE TO Building foundation
Absorption areA / Dwelling
~'r~ Material I,~ L~-i-
Width
NO, OFBEDROOMS
No. of compartmentS,
Inside length Liquid depth
Dwelling PERMIT NO.
Material Liquid capacity in gallons
Nearest lot line
Trench width
:~ (~ inches
Foundation
Total length of lines
60
Material beneath tile
Distance be~v~en lines
~ O ~ C~ (2 inches
Depth PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
Sewer line Septic tank Absorpt on area(s)
Total effective absorptioo area
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
R EMAR KS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO. ( 82:02ii )
RF'F'L~ I CFINT FIECS
L.OCFIT I ON
L. EGFIL L. 9 E:± SPF.:ING F'OREST
"I"YF'E OF' SOIL.. FIBSORPTION SYSTEM IS: TF:ENCH
[:,EF'RRTMEN]" C FIEFII..TH RND ENVIRONMENTFIL t .OTECTION
825 "' L "' STREET', FII'qE:I.40F..'FIGE., RK. '_:.~950::[
264.-472E~
:'1.2R0 1.4 i..':3:RD SUITE B 99502:': 276-±.]:6±
LOT SIZE La:39'.T.~99 SQURRE FEET
I','IFIXIMUM NUMBER 01.':' E:E[:,ROOh'IS = 5 L:;.,OIL RR'I'II',IG ,::SQ FT,."E:F.:)= :1.25
THE R. Eg!UIRE[:, SIZE OF 'I-HIE SOIL. RBSOI;.:PTION SYSTEM IS:
IE::,, E*% F" T' H .... ::~_ ,4 b. EiE IP...~ ~'_'~ '"F 1t-.~ == ,~:~.. (~) (~ F: IF~ "¢ EEZ b [:, E IF::' -l'- 14
]"HE I_ENGTH [:,IMENSION IS TFIE LENGTFI ,::IN FEET) OF THE TRENCH OF.: DF.:FIII"~FIEL.[:,.
THE [:,EF'TH OF' IR TRENCH OR F'IT I:5 THE D',ISTFtNCE BETWEEN THE SLIRFRCE OF THE
GROLIND, FIND, THE BOTTOH OF' TFIE EXCFIVRTION (IN F:EET).
THEF.'E I.'.5 NO ':;El" HI[:,TH F'OF.: ]"RENCHES.
THE GRFI',,,'EL D, EF'TH IS ]"HE: HINIMUH DEF'TN OF GRR',,,'E:L. BETHEE]'.,I TFIE OUTFRLL PIPE
FIN[:, THE BOTTOM OF THE EXCR',,,'Ft"I"ION (IN FEET::,.
PERMIT FIF'PLIE:FtNT bIFIS THE RESPONSIBILITY TO INFORM TNIS [:,EF'FIF. tTHENT DLtRING TFIE
INSTFIL. LFITION INSPECTIONS OF RNY HELLS RB, JFtCENT TO THIS F'ROF'ERTY RND, THE
NUMBER OF I;.':ESIE:,ENCE'~ THFIT THE HELL HILL SERVE.
'"'IF P,.~ Eb ,:: 2 :::, % l"-~ £-E; IF:" E:
DFIC'KFILLING OF f':INY SY'::';"f'EM t.,.tITHOU]- FINFIL INSPECTION FIN[:, FIF'PROVRL BY THIS
DEF"RR'FI'flENT NILL BE SUBJECT TO PROSECUTION.
MINIHLIH DI'_:';TF'INCE E:ETI.4EEN R klELL FIND RNY ON-SITE -:,EHFIGE E:,ISF'OSI::IL SYc;]-EM I':_:';
t00 FEET FOR FI PRIVRTE t.4ELI_ OR t50 TO 2EIO FEET FF.:OM R PUBLIC 14ELI_ [.',EPENDING
LIF'RN THE ]"YPE OF F'UBL. ZC WELL.
HINIMLIM D, ISTRNCE FROH FI F'RIVFITE 1.4ELL TO Ft F'RZ',,,'RTE SEHEF.: LINE IS 25 FEET FIND,
"FO I:':I COMMLINIT'-r' SEHER LINE IS 75 FEET.
O'I"t4ER RE6!UIREMENTS MFI"r' FIPF.'L.Y. SF'ECIFIC:FtTIONS FINE:' C:ONSTRLICTION DIFIGF.':FtI"IS FIRE
R',,,'FIILFIE:LE TO IN':SUF.:E PROF'ER INSTRLLFI'FION.
I CERTIFY TFIFIT
d.: I FIH F'FIMILIFIR klll"H THE F.'E'~.~_IREI"~ENTS FOR ON-SITE SEHE:F.:S FIND, HELLS FIS SET
FORTH BY TFIE MLINICIF'RLITY OF FINCHOF.:FIGE.
2: I HILL iNSTFILL THE SYSTEM IN FICCORD, FINE:E 1.4ITH THE COB, ES.
]:: I UNI)ER. STRN[:, ]"HR]" THE ON-SITE SEWER SYSTEM MFIY F.:Eg!LIIF.':E ENLFIRGEMENT IF THE
RESID, ENE:E IS R. EMO[:,ELE[~ TO INCLUD, E HOF.:E THFIN E; BE[:,ROOHS..
S I GNED: ...................................
F:IPPL I CFINT FIECS
I '.E '.E; .lEI':, E Y _ ...C.( -'
Y4. El
PERFORMED FOR:.
^LASKA
I IiLIIROrlmEITAL COFITROL $1 RUIC $, I C.
~ncli~¢rinq $ ~nuJronm~ntgl Studies I~to k
SOILS LOG .- PERCOLATION TEST
DATE PERFORMED: I~ /'"~
LEGAL DESCRIPTION:
SLOPE
SITE PLAN
I"q~ I L~J J J
10
11
12
13
~"hl4
16
17
18
19
20
WAS GROUND WATER ~.[
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH;'
Gross Net Depth to Net
Reeding Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN RETWEEN FT AND FT
'_/.., / ,,/1
PERFORMED BY: _.~(LqCAc,~ ,
1200 [[Jesl 33rd Auenue, $ui~¢ B · Anchorgqe. Alaskg 99503 i(90;] 2 -
•
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 S A F E'; Y
Certificate of On -Site Systems Approval
Parcel I.D.015-321-13 Expiration Date:
1. GENERAL INFORMATION:
Complete legal description - Spring _q Forest;- Block 1 1 Lot 9
Location (site address) ...6000 West Tree Drive *Anchorage AK
Current Property owner(s) __Ryan Daniel Day phone .,.907-748-1140
Mailing address
Real I Estate Agent Day phone
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
0 Duplex
Ej Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
5-
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
D
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class —Well
Well
Community
Public Water System
1771
Public Sewer
❑
Waiver/Variance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $2-10 COUID
Date of Payment
Receipt Number_OGu IT6�-
C 0 SA # 0 G C_ W ]z9-1—
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
I
Q0
1,
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 Engineering 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: r
�t
In conducting this evaluation, GEG provided an engineering evaluation of the well andlor 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 o
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, fj
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 0 r
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
G r_e- • .A_G a- ess;
the well or septic system. GEG makes no representation whether an alternative well or septic system / "n • f
can be installed on the property in the event either of the current systems fail to perform adequately in I• CE -7953 3
the future. The content of this report is for the sole benefit of the person/party that retained GEG to vl� �'
perform the evaluation. Reliance upon the information provided in this report by any other person or L�� °api
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �3 rofessla•�c
whatsoever. ���c'�'��
#AECC884
6. DSD SIGNATURE
System #1 Approved for .5 bedrooms `���'(Y OF,4,�,tffffr!
''
System #2 Approved for bedrooms L���\ ON-SITE
Disapproved
WATER AND
Conditional approval for bedrooms, with the fold gW*sVV. ATER 0
PROGRAM "` zl
By: 6Original Certificate Date:
$ o2 GSD
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 _ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist
Legal Description: SPRING FOREST; BLOCK 1, LOT 9
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA COMMUNITY WELL
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground)
Date of flow test for CO
Static water at beginning of test ft.
B. TANK DATA
Age of tank(S) NEW years
�Y
Tank type/material I SEPTIC/HDPE
r4 Measured operating fluid level in septic tank -
k
A Standpipes/foundation cleanout per record drawing
Date of pumping NEW
J D. ABSORPTION FIELD DATA
\,, Which system tested (date installed) '/20.21/20
❑� ALL standpipes present per record drawing
.,� Total measured depth from grade 12.5 ft (max)
Measured depth to pipe invert from grade 3.4 ft (min)
❑ N/A — pressurized field
c
❑E Monitor tubes go to bottom of effective. If not, state
tdepth into effective
! ❑- Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-321-13
Structure served by this system
Well production at time of test gppmm�,,,.�
Water storage tank volume ailons
Well disinfected for m test? ❑ Yes ❑ No
❑ Colif acteria is Negative
i rate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance
Age of lift station
Lift station materia
Adequacy test date N/A
Results P( Pass For 5 bedrooms
Fluid depth prior to test - in
Water added - gal
New depth - in
Elapsed time - min
Final fluid depth - in
Absorption rate 750+ gpd
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date -
E. SEPARATION DISTANCES
❑✓
COMMUNITY WELL
if No
ft
From Private Well on Lot to: (Please enter distances if less than required or if community well)
❑✓ Yes if No ft
Property Line > 5'
Septic Tank/Lift Station on Lot > 100'
Yes
Community Sewer Manhole/Cle,
ft
100'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No
ft Priv er/Septic Line > 25'
❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
Holding Tank > 100'
❑ Yes
if No ft
Neighboring Absorption Fields >
❑✓
Animal Containment > 50'
❑ Yes
if No ft
Yes
if No
ft
Manure/Animal Excreta Storage
> 100'
Co ewer Main > 75' ❑ Yes
if No
ft
❑ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑✓
Yes
if No
ft
Surface Water > 100'
❑✓ Yes if No ft
Property Line > 5'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Q
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
❑✓ Yes if No ft
Water Main > 10'
ft
Yes
if No
ft
Community Wells > 200'
❑✓ Yes if No ft
Water Service Line > 10'
❑✓
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'
Q✓
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'
Q
Yes
if No
ft
Private Wells > 100' [ZI Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
*TANK IS LESS THAN 5' FROM GREENHOUSE/SHED - MOA PRESENT DURING
TANK INSULATION. OLD TRENCH IS LOCATED UNDER DRIVEWAY
G. ENGINEER'S CERTIFICATION
l certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
#AECC884
MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEAL'FH &HUMAN SERVICES
Division of Environmental Services _..
On-Site Services Section
P.O: Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APP.OVAL A S N LE AM L¥
Parcel I.D. # ._~)._~_~X' ~¢~,q HAA #
1. GENERAL INFORMATION
Complete legal description
Lot 9; Bloc[ I; S~ring Forest Subdivision~
Location (site address or directions)
6000 W~t Tree Drive
Prope~y owner Dana ~ Marianne Grann2~l Day phone 346-3555 ~_
6000 We~t Tree Drive, Anchorage, Alaska 99515
Mailing address
Lending agency
Day phone
Mailing address_
AgentMar~j_ Ann Bec~oith FORTUNE PROPERTIES
Address_ f.o_r FRUDEj~L~IA~, K~L0¢AT!0N ~0104732
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ,~F
Day phone 562-7653
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (f~ev. 1/91) Front MOA #21
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 further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
$ & $ ENGINEEEING
17034 Eagle Ri,vet Loop
Eagle River, Alaska 99577
Engineer's signature
DHHS SIGNATURE
Approved for/~_._~/~-
Disapproved.
Conditional approval for
Phone
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Flealth 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.
72-025 (Rev. 1/1~l) Back MOA~21
Municipality of Anchorage ,~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: kr-2-Y ~ ~ /
A. WELL DATA
Well type /~ If A, B, or C, attach ADEC letter.
Date completed
Log present (Y/N)
Total depth Cased to
Sanitary seal (Y/N)
/,:7
ADEC water system number
Driller
FROM WELL LOG
Casing height.
Wires properly protected (Y/N)
,MUNICIPALI'fY OF ANCHORAGE
AT INSPEOTIONENVIRONMENTAL SERVICES DIVISION
Date of test
Static water level
Well flow
Pump level
g.p.m.
OCT' 2 9 199i
g.F CEIVEO
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~ -~ "~'~ Tank size ~ ~:Po Compartments "'-Z---
Cleanouts(¢~) ~( Foundation cleanoutd~2CTN) '"/ Depression (Y,~ ~
High water alarm (Y/N) ~ Alarm tested (Y/N)
Date of pumping /¢--~-¢'~'~1,~ Pumper A?C I~)'~1~---~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot i'~~ ~¢---, On adjacent lots ~
To property line t, ~ _
Surface water/drainage
Absorption field
Foundation (
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installedk'%
Size in gallons ~
Vent (Y/N) "Pump on" level
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Manufacturer
Manhole/Access (Y/N)
_._.__ "Pump off" level at
CyclesD~
Surface water
D. ABSORPTION FIELD DATA
Soil rating t,'¢~==/='~ System type
Date installed
Length I,~;/ ~ /Jr?--' Width "-~
Total absorption area
Depression over field (Y/([~
Results (pass/fail)
Peroxide treatment (past 12 months) (Yi~c
Gravel thickness E~, I ~_ Total depth
Cleanouts present (:~TN)
Date of adequacy test
for
~c>,---~ ~.._to~-~ If yes, give date ~ '
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot h-'~ On adjacent lots ~ l._p Property line.
To building foundation ~ t,..~ To existing or abandoned system on lot
On adjacent lots ~ ~''~ Cutbank ¢~.--~v~ Water main/service line
Surface water \ C:::~)I 5r-
Driveway, parking/vehicle storage area
Curtain drain ~ ~..~I~) ~
bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
$ & S ENGINEERING
17034 Eagle Ri,vet Loop Road
Eagle River, Alaslca 99577
HAA Fee $ //'~d'), ~f
Date of Payment '"/~') ./~ ¢
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
8EN-F BY:ADEO ANOHORASE ;10-28-91 ; 2:58PM ;ANOHORASE/WESTERN DO~S&S EN6ZNEERZN6 ;# 2
~ i'~' ' I~,, "~:'~,:" ;: "' ;" :~ : ,'; ' ' . ," ".-" ' ::,~
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAQE DISTRICT OFFICE
3601 "C" STREET, SUITE $22
ANCHORAGE, ALASKA 99,505
October 28, 1991
WALTER J, HICKI:.'L, GOVERNOR
568-67'75
FOR: 8 & $ Engineering
PWSID # 213564
My review of the records on file in this office reveals that the Spring Forest Subdivision
Class "A" Public Water c,
,)ystem, is In compliance with the routine coliform bacteria samples
requirements listed In Table C, and with the inorganic sampling listed In Table B of
18 AAO 80.200,
Sincerely,
Byron Roys ~"~'"'
Environmental Engineer
BR/of
APPD( NT FILLS OUT UPPER HA[ ONLY
PiopertyOwner J._".Ol~/¥:! ¥c).:,tlll~it,l¥<t'} ,..._ Phone
Address Zip Code
- )<'~ ~: ..... ~ ' '~ Phone
Lending Institution
Address (~]~ x.~y~:,~ ~C:( ~- . ,Zip Code
Type of Residence
/~.~ Single Family
Multiple Family No. of Bedrooms --
[] Other
Water Supply Lq Individum
]~ Community
Public Utility
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Sewer Disposal'
Individual
Public Utility
I~ Holding Tank
Year Individual installed:_' ]Q "~G//~
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
MUNICIPALITY ",;.~ .... ~ *..~ -r,.~,. · ," ~
DEPT. C:F: :-:.,'L': '
ENVIRONMEN','AL p,:...,, ..... q
RECELV_ED
APPROVED BEDROOMS *CONDITIONS OF APPROVAL
DISAPPROVED
CO~.N?/~O N A~, A~EPBOVAL'
Soils Bating
Dste Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
72-023 [3182)