The URL can be used to link to this page

Home My WebLink AboutSPRING FOREST BLK 2 LT 14Onsite File Spring Forest Block 2 Lot 14 #015-342-23 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201378 PID Number: 015-342-23 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name RICHARD BENEDETTI ABSORPTION FIELD ❑Deep Trench [J Wide Trench ❑Bed ound Site Address 6141 WEST TREE DRIVE *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-346-1425 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SPRING FOREST; BLOCK 2, LOT 14 Fill added above original gr Ft. Gravel length Ft. Township Range Section ' Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well N/A25'+ TANK MSeptic ElS.T.E.P. ElHolding ElOther Manufacturer Capacity GREER TANK 1250 Gal. Surface Water100'+ Material HDPE Number of compartments 2 Lot Line 5'+ NA V+ I LIFT STATION Foundation 10 I Manufacturer Capacity Gal. Remarks OLD TANK DECOMMISSIONED PER UPC PER CONTRACTOR REQUEST VARIANCE FOR ASBUILT SURVEY UPDATED AFTER INSTALL. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to drainfield D3034 Installer A+ HOME SERVICES Drainfield D3034/EXISTING Co/MTD3034 Inspector TIM ECKLUND AND GEG BENCH MARK (Assumed elevation) 97.16 ft Inspection 1�' 10/27/2020 - Location and description 2 �d -- — t TOP OF MH-_ 3° - 4 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's St#p p co6o�p Conditional Approval: Date COQ O�. / T H Q ........ ...p Gor .J f e E-7953 n •' QUO Septic SystemDO Approved �'� Date —17-20 09sf c�0 Note: this approval does not include well permit requirements. �Df ess[O°oo {tAECC88d (Rev 05/02/18) PERMIT NUMBER: OSP201378 — A B MH 50.0 65.7 ST1 54.1 70.2 DBI -3 55.6 70.8 DB 44 56.1 70.4 SPRING FOREST: BLOCK 2, LOT 13 RECORD DRAWING PARCEL ID 015 34223BER: 10' Tele Esmt GWMT- 00033 —b FD CO A 1 H NEW HDPE C A E ALL PROPERTIES INCLUDING THE SUBJECT PROPERTY IS SERVED BY A CLASS A WATER SYSTEM SPRING FOREST: BLOCK 2, LOT 15 N I = 4U" OF • ............ :� o 'ROUP, Ltd 1 ............... .;..... ® ENGINEERING SALES CONSULTING ® / 3791 E. TUDOR ROAO, SUITE 101 'ANCHORAGE, AK 69597 • PHONE (907) 337-3179 • FAX (S97) 338-3246 • MESSITE: w,w..gam—mg,a mg Cam p . 0 .... ........ . . . ............. ....... PARED FOR: PHONE NUMBER: PAGE NUMBER: dl `�— y A. a et i RICHARD BENEDETTI 907-346-1425 2 OF 3 �a� �; CE -7953 ;'��a LEGAL DESCRIPTION; DRAWN BY: ®�%'• �\Ar SPRING FOREST; BLOCK 2, LOT 14 D.J.G. ®� F'f' �I�w, z• �4W TYPE OF WORK: DATE: LICENSE�411 SEPTIC TANK RECORD DRAWINGS 11/2/2020 uAEccssa kill, o�®® MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO 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: OSP201378 Work Type: SepticTank Upgrade Tax Code Number: 01534223000 Site Legal Address: SPRING FOREST BLK 2 LT 14 G:2538 Site Mailing Address: 6141 WEST TREE DR, Anchorage Owner: BENEDETTI RICHARD & YUKO Effective Date Expiration Date: i»cnt �° Del�art�i�ent 9/22/2020 9/22/2021 Lot Size in Sq Ft: 49393 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: ❑ 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 By: — r y ``' Date: 7 Issued By: h&C-4 Date: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Ethan Berkowitz On -Site Sewer/Well Permit Application _ For A Single Family Dwelling Parcel I.D. �'� :S ` Z — 2 Property owner(s) RICHARD BENEDETTI Day phone 907-346-1425 Mailing address 6131 W. TREE DRIVE *ANCHORAGE, AK 99507 Gill Site address STI -1 W: TREE DRIVE *ANCHORAGE, AK 99507 Legal description (Sub'd, Block & Lot ) SPRING FOREST: BLOCK 2, LOT 14 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (® all that apply) Initial ❑ Absorption Field ❑ Single Family (SF) Upgrade Z (w/wo ADU) 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. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: g 7Sno V Waiver Fees: Date of Payment: 0 Date of Payment: Receipt Number: AO ~%S� Receipt Number: Permit No. �s�2-0137tO Waiver No. (Rev. 01111) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201378, Rebecca Carroll, 09/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201378, Rebecca Carroll, 09/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201378, Rebecca Carroll, 09/22/20 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: I','t~V--- t' ~.I;L h'lOl:)F--'C-~u-/ WastewaterSystem: [] New '~it~Upgrade Address: ~.,3~r"~ L.&,.)(~'-~'T' ~--"(~ O'F--' ABSORPTION FIELD Phone: :'~1-~--'1~-O~2 No. of~rooms: '~DeepTrench rq Shallow Trench DBed DMound DOther LEGAL DESCRIPTION sci, Rating: Total Depth from ori~inal grade: Lot: ~ ~BI°ck: ~¢¢~l~Subdiv~i°n:~~ Depth to pipe~,~/bottom ~om original grade: Ft. iGravel depth b~e~t h. pipe Ft. Township: ~ Range~ Sec~ Fill added abCvei ' O ¢~°riginal~%~grade: Ft. I Gravel length: ~ / Ft. Gravel width: l Number of lines: Distance ~tween lines: Classification (Pr~ ,t~ ~ ~ Total absorption area: Pipe material: ' Odller: ~--~' ~Date Drilled: Static Water Level:Ft. Installer:~o~ Date ,nstal~ed:[G [.~{ /~ SEPARATION DISTANCES ~ septi~ D Holding ~ S.~ Fro~ ~* Tank fi Field Station Tank Sewer Lines Well' ~OO,+ .~'+ ~ ~, ,/~ .~(.ff Material: ~( ~berofCompa.ments: Water~OO/'¢ ioo I oDq- N Lot Line ¢ '* ~"(~ /0['~ Size in gall°nd~turer: Foundation ~!, ~EO/~ ¢ ".ump ~at:. "~ump o~" level at: Cudai~ Drai~ ~/~ ~¢ I ~h ~ke & Model Electrica[ Inspections pedorZd by: ~ Remarks: BENCH MARK .~ ~[~¢~ ~ ~ ~, Location and Description: t ~ ~ ~ 01 ffq C~.M Assumed Elevation: Inspections performed by' ~ ~~ ~ Dates' 1,t /o ¢ Department of Health and Human Services approval ..... '' ' ' ' T 72-013 (Rev. 9/91) MOA 25 NI]RTH PRBPERI'Y LINE ~ / / / ~INSTALLATINN PE~ BHHg SPECIAL ~ B Tm ~ULL RUN = 14 ~ A TO C02 = mg GROUND ELEV, OVER ~ FOR LOCATIDN OF M,T gEE PLAN BRA~ING T~ENCN Ig 95,8 TO 97,~ FEE'F,~_FiLTE~ FABRIC OVER D~AINR~CK :~ A, INVERT OF D~AINPIPE = 9~,18 ~ B, 3DTTOM DF TRENCH = 8%]5 : .,.., DRAINRDCK DEPTH = 5 FEET '~ ? C. ND GRDUNDWATER DR BEDRDCK -FD ELEV, = 78,57 · .~.~,~ D, TRENCH LENGTH = 58 FEET ~ ', E, TDTAL ABgDRP-FIDN AREA = 580+ ~Q. FT, · ',' . BENCHMARK IS TDP DF BULL ~,c~,2 RUN VALVE KEY = 93,~0, _~i _ NAIL IN TREE NEAR TH = 100,00 PREPARED FORt MARK AND BEBBIE MOBEROW .. ~.'~.. PREPARED BY' ALASKA ~/AI'ER & ~ASTE~AI'ER ~, '.. ' ..'.~ BATE~ 10/~9/97 DRA~/N~ GA~NES~ SCALE~ 1' = 30~ PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUNLAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970368 DESIGN ENGINEER:ALASICA WATER & WASTEWATER SERVICES OWNER N/LME:MODEROW MARK R & DEBORAH C OWNER ADDRESS:6141 WEST TREE DRIVE kNCHORAGE, AK 99516 DATE ISSUED:10/14/97 EXPIRATION DATE:10/14/98 PARCEL ID:01534223 LEGAL DESCRIPTION: SPRING FOREST BLK 2 LT 14 LOT SIZE: 49393 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18kAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 1.5 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SA_ME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PRIOR TO INSTALLATION PERFORM ADDITIONAL PERCOLATION TEST TO ENSURE CORRECT APPLICATION RATE IS BEING APPLIED FOR THIS SYSTEM. RECEIVED BY: ISSUED BY: DATE: DATE: 8471 Brookridge Drive N Anchorage N Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers October 7, 1997 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Seetion P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Lot 14, Bk 2, Spring Forest S/D. To whom it may concern: The existing 4 bedroom house is served by a private septic system and a community well. The existing drainfield is surcharged, and must be upgraded prior to the sale of the house. Comments regarding the proposed upgrade are summarized as follows: 1. SOILS: Attached is a log which shows the soil profile, and the percolation test results. At a depth of 7.5 feet to 8.0 feet the percolation rate was slightly greater than 1 minute/inch. No groundwater, bedrock, or impermeable soil was encountered to a depth of 15.67 feet. 2. TRENCH DESIGN: g. h. i. Percolation Rate: 1+ minute/inch Allowable Application Rate: 1.2 gallons/day/fi2 Number of Bedrooms: 4 Design Flow: 600 gallons per day Minimum Absorption Area: 500 ft2 Effective Depth: 5 feet Reduction Factor = N/A Width: 2 feet minimum Minimum Length: 50 feet Effective absorption area = 500 ft2 MUNICIPALITy OF ANCHoRAGi~ F-.NVIRONMENrAL SERVIcEs DIVISION OCT 1997 RECEIVED We are proposing to install a "zabel" flow proport~oner, so that wastewater can be periodically alternated between the old bed, and the new trench system. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic upgrade. 4. TOPOGRAPHY: The lot is generally level from east to west and slopes downward fi'om south to north. The topography at the proposed trench site slopes downward to the existing bed at approximately 20% to 25%. The bed is located in a flat area at the toe of the hill. The slope immediately uphill from the proposed trench site is approximately 75%. Based upon my assessment of the site, there does not appear to be any slopes which would compromise the proposed design. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. SincerelY:l/ ~: Jeff) '>.:[ q~arness, P.E., M.S. Prih ~al ~' TRACT 'B' UNi)EVELOPE~] LAND GENERAL LDCATIDN OF NEIGHt~BRS 1-RENCH SYSTEM~ :XISTING gED ~ ~ ~ LDT 15, BK 2 ~ ~ SPRIN6 FBREST S/~ ~ ~ PRIVATE SEPTIC ~ ~ AN~ COMMUNITY NDTEi ALL DF THE LDI'g SHBWN ARE IN SPRING FI]REST g/]), ALL DF THE LDTg ARE SERVEl) ]]Y A CDHNUNITY WATER SYgTEM, THE WELL IS MUCH GREATE THAN 200 FEET FRDM THE PRDPDSED SEPTIC SYSTEM UPGRADE, IN SHDRI', THERE ARE ND ~EPARATIDN ])ISTANCE C[]NCERNS, SEPTIC UPGRADE~ PREPARED FBR: PREPARED ]~Y~ DAI'E~ 10/4/97 //_XIS TING BED TEST HnLE MT, 1D FOOT UTILITY EASEMENT EXISTING C/D TO DE REPLACED ~/ITH A FLO~/ PR[IPDRTIONER, THIS I~ NOT A FLOW ~PLI'FTER, C/B ~,,. · NEW I'RENCH, 50' LBN c/n NOTE, THE CONTRACTOR SHALL BE RESPONSIBLE F[]R IDENTIFYING THE LOCATITnN DF THE PROPERTY LINES ADJACENT TO THE NEW TRENCH ~YSTEN, ~EWER LINE SEPTIC UPGRADE~ PREPARED FOR: PREPARED DATE~ 10/7/97 LOT 14~ SK a~ SPRING FHREST S/D, MARK AND DEBBIE MODER~W ALASKA WATER & WASTEWATER DRAWN: GARNESS SCALE: 1~ = 30' PERFORMED FOR: LEGAL DESCRIPTION: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED:[~' Township, Range, Section: /"'"J }~r 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S DEPTH?IF YES, AT WHAT ~ pO · E Deplh to Waler After [:>~'"7 Moniloring? Dale: ReadingDate Gi~e~s ~ Be~ Net Time ~ Drop ~. ~/~¢/,~ ~'~,~, ~ ~ ~ ~ ,, ,~. ~ ~o~ ~" PERCOLATION RATE__[' ~) (mmutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN '7"~ FTAND I~°O FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCFtORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Heallh Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Township,~Range, Section TANKS SEPTIC I-] HOLDING DISTANCES WELL SEPTICTANK/ ABSORPTION FIELD /' WELL FOUNDATION ¢~,,f / ; AS-BUILT DIAGRAM IShow locahon el Well, septic system, property lines, loundation~ driveway, water bodies, etc.) Manufacturer Capacdy in gallons ~ T~' NO o' Compart..~ts Material TYPE OF SYSTEM ~tot To~ ~eNbCottH° m'~ BED J~] W. DRAIN ~ el'HER O p h p m fro ~ ~--~- Total depth Item original grade Fill added above original grade Gravel depth beneath pipe ~ ET lie Installed ?~ SI] FT Installer WELLS [] PRIVATE '~OTHER fldentifv~ Classilicmion (A,B,C) Total Depth J Cased to ,,/4- FT FT I Installer Date Installed: I REMARKS: Municipal and State guidelines in ellecl on Ibl~ date: ?""/'~ ~'~'"' Hea[thDepartmenlApprova,; .,~J//~)~t,,~// / "'~ 72-013 (3/85) Inspections Pedorm. ed by:I ~.. Date: cerlily that Ihie inspection was performed according tn all April 8, 1988 I, Rexford L. Turner of Turner Construction Co, Inc. of Alaska, designate Alice A. Smith as my company representative to sign for and pick-up the sewer permit for Lot 14, Block 2, Spring Forest Subdivision. R L. Turner, President Date 4155 Tudor Centre Anchorage, Alaska 99508-4155 (907) 562-5881 P. O. Box 3489 Pahner, Alaska 99645-3489 (907) 745-8334 ALASKA FIUIBOFIm nTAL CONTROL $ BUIC $, IIhC. SPE(;II;If:ATIONS fOR BE]) WAi;TEWATER TRF, ATMEN'r .SYSTI~ I',EGAIL DESCR]:PTION: LOT t4, BYJOCI< 2, SPRING }?0RESt' SUBDIVISION 1.0 1.1 2.0 2.4 2.5 GENEICAI. The dj?swings, s}~eets ] tlirougl~ ,t, sl~il]l be pnrt of this specif.l(:atio~. Ali. mate~'i, al'.~ algol wort<lna~.~hip shall meet the requJ, rement~ of the Ylunicipa]ity of' A~chorage, l)epar'Lment of ttealLt~ & Huma{~ ~;~.~rv:i(;es, (DItHS), pea'mit, a~d a].~ appli~al>le rules al~d ~-egttlatious cu~?rentl$~ in effect. Ail excax~al:io~s a~(t depths ~:re ~dviso~'y, al~d ~re t.o be verified oz~ modified in the fleld I)y the [;~n~J.~teer or j.~specting age~tcl~. Z~ is LI~o respon',.$ibiiity of the owae~' a~d i~sta]ier to adhere to app,:eyed desil'n fo~' the installation, to mai~taJ~ the ~'equired sepa~atio~ dista~ces and to hax~e Lhe appropriate iaspec'tc[ons. If the installation is ~ot inspected I)y an AECS ~;ugineer, AIiCS will not be ~espol~s:~l)]e for Lhe iast~ti~led sys'~em. An en~Jnee? at AECS should be colxsulted prior to construct.ioa, to detormi~e the number of il~spectiolls ttm't w~l] he requi~'ed u~d to expia:tn wha't -these :h~spections will il~volve. Sept J.e 'l'al~k The exJstJllg septic '~.~tI~k may be llsed, if it mcet~-~ -lzh~.~ capacity reqn.iremenL fo~' the res.[dence and him app,'oval of DHHS. Zf eot, then specificatio~s 9 p th~'o~gh 2.6 The; sepi;ic 'tank slmJl ] be a UPC--Approved two -coml:,;~'tmen~: tank, con,,~'tructed of 12--gauge steel with /)itumastic coati~g a~d set ].e~ze] o~ undJ. stu~?/)ed soil. If the t;~nl< i~ bu~'ied at ~ depth of 4 feet et' less, it must be insulated with an over~iying ].ayes' of 2 i.~teh burial type polystyrene rig:id board insu]at:ion. The sep'l:J(; far, l( sha:l.l ~)e ~ mi~iln~nm of 5 feet from the house fotmd~tio~, a~d a Illillil}ll.llll of ~ feet frolll the absorption a~ea. Ti~(~, sepl:ic tanl( al~(/ bed shall l)(.· a mJ~.imum of ].00 feel fpom auy prlva'Le well or bod~, of water, 2,50 feet fr'om Class C ~,ells, and 200 feet f~'om C.lass A or B we]is, unless otheYw.ise specified. Lens than the required sepa~'atioit distance lllust have pl~ioi~ app,)oval or waJ. ve~' by 91{itS of Alasl~a 9eparLment of Envi.r~enmental CousePvatJon (ADEC). Pi. ping shall l)e fitted wi. th a ntecl~aaica] watertight calder eoupJ, ing o~ the outle't and :i~le[ of 'Lhe septic 'taltk. I~let pi. piing shall be 4 inch sol:id PVC AST~I D303,i or c.~ast iron, sloped a mlnlmum of 1/4 i.t~ch pe~' li. neal foot. Outl(~"t: pipi~g shall not be ]ess tha~ ~/8" per foot slope. If 'hl~e p:i. pi~g is buried at a deptt~ of 4 feel: or less, it must I)e it~sulated wi. th an 1200 LUesl 33r8 Aucnu¢. $ui1¢ ~, Anchoroq¢. Alosk~ 99503 ,(907) 561-50/40 2.6 3,0 3.3 3.2 3 , 3 overls~inff layer of 2 inch burial type polystrene rigid hoard insulation, Cleanouts shall be installed as designated and capped with air--tight rain caps (Jim caps or equivalent), and extend a iliJli~iiiHii1 of 1 foot abcx,e ground level. Seepage Bed The sand shall have an effective size of 0.4 to 0.6 MM und a uniformity coefficent of not mope than 4. The gravel for the bed shall be 0,5 to 2.5 :inch, screened rock with less than 3% passing ~200 sieve residual. All substitutes must have prior Dill. IS approval. q'be bottom of the excavat:[on shall be level and raked with the backhoe blade to insure that t:he bottom has not been compacted during excavation. Eqaipment mttst not be driven on the excavated area. 3,4 The distribution pipe shall be perforated 4-Jlleh rigid PVC with a minimam 3.5 3.6 3.7 3.8 crush strength of 1500 pounds and shall meet 'the approval of DtI}IS for use as drainfield pipe. Al.] plpes shall he laid level, and spaced according to the drawings. Monitor standpipes shall be placed as showa in the drawings. They shall be 4-inch rigid PVC AS'DI I3-3034, or cast iron, The section shown with holes may be eikhep drilled 0.5 inch holes on 6 inch een~eps on opposing sides of the pipe, or a section of regular perforated sewer pipe may be clamped to the so]hi section ~vJtll a no--hub coupling or solvent ~eided joint, The perforated section shall be located in gravel oaly. The port. ion of p.ipe abow~ the sewer rock shall be solid. A rubber raincap (Jim Cap or equivalent) shall be placed over the top of the pipe. ff kite final 2'rade ow~.r tbe bed is less 'than 4 fee[ above the grave], insulation is required, using burial type polystene rigid board insulation. There shal] be 1 inch of insu].atJon for every feel of soil ]ess than the required 4 feet of cover, but there must be at least 24 inches of soil even thoagh insulation is used. The solid pipe extending from the septic taak to the drainfield shall also bare 4 feet ef cover or an equivalent layer of insulation combined ~qith so~l. If insulation is not necessary, then the gravel mtst be covered with a layer of a nonwoven filter fabric, The top and sides of the bed shall be planted with a white clover and red lest;ac mix or hhle grass. 4.0 Inspections This bed ~,~J!l ?equ.i~-e a inin:imum of three inspect:ions. The first inspection will be of the open excavation, to a,'-:stlpe that the system installed ~n the propel' soil strata, cerrect depth and atee't m:inimum specified design parameters. 4.2 The seeond inspechion w:il] be performed after sand f:[l] is installed, but prior to p]acement of gravel and distpibutJoi1 pipes. This inspection will w~rify that 't:he filler is properl~ instal]ed, that it meets specifications and that Jt fulfills the intention of the des]gn. 4.3 The third inspection will be afLer p!aceme~t of gravel, monitor standpipes, and distribution pipe, to ve~'ify proper installation and posJLJon o~' p'ipes prior 'to backfill. 4.4 The inspection of the septic tank installation can be incorporated with any one of the above listed inspections. REID, JR, V I HEREBY CERTIF'Y TIIAT ~[ )I~'VE SURVEYED. TIlE FOLLOWING DESCRIBED PROPERTY,: LO'P' ~,4-., BLOCK '~. , '~V~--4~4~ ~_~E~' ~A]~DP'41~,~._~_Q~ .., ~Of~~CORDING' DISTRI~T,'ALAS~, AND TImT TIlE IMPROVE- M~NTS SITUATED Tt~REON ARE WITHIN THE PROPERTY LINES AND DO NOT ENCROACH ONTO THE PROPERTY AQJACENT THERETO, TI~T NO IMPROVEMENTS ON ~HE PROPERTY LYING ADJACENT THERETO ENCROACH ON THE SURVEYED PRF~ISES AND T]IAT THERE ARE NO ROADWAYS~ T~NSMISSION LINES OR OTHER V~SIBLE ~ASF~ENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON. ALAS~. ............ - ~(E2NNE'Pll G LANG, I,.S. 1731 GEORGE BELL CIRCLEt ANCllORAGE, ALASKA 99515 (907) 345-6476 PERFORMED FOR: LEGAL DESCRIPTION :__-~ r ;^~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 I~ :b'treet, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SO bG PERCOLATION TEST 1 2 3 4 5 6 7 9 10 11 12 13 14 15- 16 17 18 ~y C, 1§ No. 2251-E 20 DATE PERFORMED( J'-~%¢ SITE PLAN WAS GROUND WATER S ENCOUNTERED? ~'~O (~ P E IF YES, AT WHAT DEPTH? '~ ~'- 7, ,, '~ Gross Net Depth to Net Reading Dat~- Time Time Water Drop PERCOLATION RATE ,(minutes/inch) TEST RUN BETWEEN - FT AND FT PERFORMED BY: "~,~ ~u CERTIFIED BY: DATE: , ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 CHECKED BY DATE {.GOO ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB SHEET NO. ~7Z OF ~ ___.Z-~-~-~-~ ¢, 3:3 ¢ • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-342-23 1. GENERAL INFORMATION: Complete legal description Spring Forest: Block 2, Lot 14 Location (site address) 6141 W. Tree Drive *Anchorage, AK Expiration Date: �— / r; O Z Z Current Property owner(s) Richard Benedetti Day phone 907-346-1425 Mailing address Real Estate Agent 6141 W. Tree Drive *Anchorage, AK 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: vistdnUe: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 9 17. .50 coo n Waiver Fee $ Date of Payment laoao � Date of Payment Receipt Number 5`� ) ams Receipt Number COSA # O5 G 2 D 1 6 3 2 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: 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: ti 1 7j Zv In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage hnd industry practices. The reported results describe the condition of the system/s on the dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of,the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the. person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _X_ System #1 Approved for _�__ bedrooms IN System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with #AECC884 OFIq C r. ON-SITr WAITS RA r� Fri r p JrGhA1„p JJo�A_ Original Certificate Date: )1—(9-2-0 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 blue sheet 10-10-12,doc Legal Description: Spring Forest; Block 2, Lot 14 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ 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) -'' in. Date of flaw test for COS- ' Static water iev'el t beginning of test ft. Comments Public water B. TANK DATA Age of tank(s) New years Tank type/material "°°"DPE Measured operating fluid level in septic tank New ❑ Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA of Parcel ID: 015-342-23 Structure served by this system Well production at time of test .---, apm Water storage tank vo-1 me gallons Well dif� sinfect� fd coliform test? ❑ Yes ❑ No -ioliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) A"rsenie ug/L, ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station -years,---- ears.---- Lift station material Comments:_ ---- Which system tested (date installed) 1997 Adequacy test date 9/1/20 ❑ ALL standpipes present per record drawing Results [TPass For 4 bedrooms Total measured depth from grade *9.75 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3•.75+ ft (min) Water added 1101 gal ❑ N/A - pressurized field 7 FN Monitor tubes go to bottom of effective. If not, state New depth in 30 depth into effective Ela sed time min p ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date n/a Comments/Deficiencies: Condition of bed wasnotevaluated *AtMT COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' El Yes Community Sewer Manhole/Clea_100' Yes if No ft -- 1`7 Yes if No ft Neighboring Tank > 100' 171 Yes — if No ft Private S er/Septic Line > 25' Ll Yes if No ft Absorption Field on Lot> 100' ❑ Yes if No ft--' Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 10 - Yes �' if No Animal Containment > 50' ❑ Yes if No ft F] if No ft if No ft Manure/Animal Excreta Storage > 100' Cor- i4` -Sewer 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' ['ZYes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ✓lv Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Q✓ 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' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No V y- ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' C]✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS `Met code at time of installation 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 '-.Je r. - s. 1_- 79 e c r0 fes s10 coo #AECC884 Lot 13 o cMO4u u W -Al --------I-----•--- --f' 10' Telephbne Easement O G a O 20' Utility Easement LOT 14 sock vent (tw) o-- ManWa R W W 0 O Lot 15 ,5 Boardwalk �phalt \ =Y 10' Utility Easement no 85.40 -_ SCALE: 1"= 50' OF • qL 11 low ,� `''•' 49th 00 ® • ,7. . 00 79-,'. Elizabeth L. Walatka : so 8036 �s 8036 — LS e'p AM i O �OFESSIONP�-'��'O Z�24.34 R D �vIc Recertified 11-02-20 R�2a 00 ��_ P` Revised 8-24-20 Ad vents ��S"( TR �--, AS -BUILT NO CORNERS SET THIS DATE �-I hereb rti th t I" y— fy a ave performed a Mortgagee s inspection i in accordance with ASPLS Standards of the following described property: LOT 14 BLOCK 2 SPRING FOREST SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying / adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 27th day of JULY ,2020. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors UNLESS OTHERWISE NOTED FB 20-5, pg 5, 6, 8 & 9 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka Is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. deck co 1.0 OR 2.O OH dectc 2.0 OH > `LS •� 30'0 .:';µz0 Story Frame e �3 8 Z IAouse 34.5 24 W ` PcK de1.0 OH o 05.3 R W W 0 O Lot 15 ,5 Boardwalk �phalt \ =Y 10' Utility Easement no 85.40 -_ SCALE: 1"= 50' OF • qL 11 low ,� `''•' 49th 00 ® • ,7. . 00 79-,'. Elizabeth L. Walatka : so 8036 �s 8036 — LS e'p AM i O �OFESSIONP�-'��'O Z�24.34 R D �vIc Recertified 11-02-20 R�2a 00 ��_ P` Revised 8-24-20 Ad vents ��S"( TR �--, AS -BUILT NO CORNERS SET THIS DATE �-I hereb rti th t I" y— fy a ave performed a Mortgagee s inspection i in accordance with ASPLS Standards of the following described property: LOT 14 BLOCK 2 SPRING FOREST SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying / adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 27th day of JULY ,2020. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors UNLESS OTHERWISE NOTED FB 20-5, pg 5, 6, 8 & 9 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka Is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 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. ~ CD ! 1, GENERAL INFORMATION Complete legal description HAA # /¢FC£1p£D Location (site address or directions) ~t 4'"1 Lxj-~g"f- '~"~Y'?~'=JL:2- ~,~vt~- ' Property owner Mailing address Lending agency Mailing address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well 4 ~ Public water NOTE: 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 Cornmunity on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02§ (Rev, 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 .^.?!,:~>t~?: .~_. .J Phone ~-~ Was,~,,,/'~br oecv~es// Address /'/'~71/¢/¢okri~,?/~ ,ngineer'ssignature ~/~: ~ ~ Date /o DHHS SIGNATURE Approved for '~Y~-~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: /'~¢:'~'~---~.-- 0 /o-,"~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-02~ (Rev. 1/91) Back MOAf¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Seduces D~v[s~on 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3~4 Health Author,ty Approval Checkhst ' Legal Description: A. W~~ at oom,, t d Total depth ~~ed tO __~ Casing h~~und) Sanitaw seal (Y/N) FROM WELL LOG ~ AT INSPECTION Well production //¢ . g.p.m. ~ WATER SAMP~g: ~mpleOli~ B, SEPTIC/HOLDING TANK DATA Date installed ~'~ Foundation cleanout (Y/N). Date of Pumping Date installed lo/R. """"~- Soil rating (g.p.d./fF o~), /' '~- Length Width ~-~ Gravel thickness below pipe Effective absorption area _~(~.4- Monitoring Tube present (Y/N) y Date of adequacy test ~-) //~' Results (Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth / (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Systern type 4t~''~ t Total depth . Depression overfield (Y/N) /gE) For -"~¢" bedrooms Immediately after ~gal. water added (in.): Absorption rate = f~ .g.p.d. '~ If yes, give date ~- 72-026 (Rev. 3/96)* Date installed ~ Size in gallons __~ "Pump off" level at* Manhole/Access (Y/N) High water~ *Datum C~ed E. SEPARATION DISTANCES FROM WELL ON LOT TO:' ' ~ '; ir,. ";:: ASbe Pt i~i; gdt:: kl oOt n I ot ~~t~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~'" +' Property line ~' '/4- Absorption field Water main/service line¢t O~4L Surface water/drainage /OO 14' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Surface water Curtain drain Property line lO / Building foundation ¢,~Loo/4- Water main/service line Driveway, parking/vehicle storage area ~L.~O td ~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined ru field inspections and review in conforman~.~-~ ~idelh~es in effect on this date. Signature ~.Jc///¢'~ /j/i/ii . ~._ Engineer's Nam/e L/c~'~ Date / HAA Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Locatiq~. (ad. df'ess or diFe~tions). (b) Prop'}~ty o, wn,er.~'--?--~--'~v/¢?~~w~/.¢7'. Telephone: (home) ~, f': , ,. , ., .' (c) Lending 1'5~it~iSn. :': ' ~ Telephone Business Mailing Address (d) Real Estate Company and Agent Ad dress ~'~ Telephone (e) Mail the HAA to the following address: (or check here ,~'fh(~ldforpickup.) List contact person and day phone number below: 2. TYPE OF RESIDENCE . Single-Family'~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community '~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'1~,, Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFOF{MATION AS certified by my seal affixed hereto and as of the validation date shown below, l ver[fy that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate 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 /¢'~'~ ~ Telephone Address / ¢/Z.- ~) J~ ~'2J~'~/ /'~ Date Approved for/~'-? (/'/)bedrooms by . Approved ../.~_ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdo 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. 7/88) Back Page 2 of 2 MUNICIP&[r¢.,'~ ~E ANCHORAGE (MOA) o~,a~t'~t~t~rity Approval (HAA) ~¢ ~E~LIST- FEBRUARY 1984 ~0~r' ~L' ~ ~7~4 A. WELL DATA Well Classification ~ If A, B, C, D.E.C, Approved~N) resent (Y/N) Date Completed Yield Casedto ~_Depth of Grouting ..... Pump Set At .... Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y~ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WEL~ To Septic/Holding Tank on Lot ~~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~-, ; On Adjoining Lots ~ '1 tM h l To Nearest Public Sewer Line To Nearest PubliB~C eanou / an o e To Nearest Sewer Service Line on Lot '%% Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING I'ANK DA'rA Date Installed 7,/~''¢'¢ Size Standpipes CN) Depression over Tank (Y,~ /¢'-¢~ No, of Compartments Z~ Air-tight Caps ON) Foundation Cleanout ~)/N) Date Last Pumped ,~./~ Pumping/Maintenance Contact on File (Y/N) Holding Tank H gh~Water Alarm (Y/N) SEPARA~J~.I~ DiST.ANC. E:S FROM SEPTIC/HOLDING TANK: To Wat.e~i-?~,up'ply',W¢l~.. , i' Z.4¢~ /4 To Building Foundation 'f'o Pr¢¢er'ty:btne~ ........ /O' -/- To Disposal Field ! To w~l[br Main/Sbrvice Line :~ To Strand1; P~¢ Lake'er Major Drainage Course Comments ' ;,.:.. , ~. ; for '~/~ Temporary Holding Tank Permit (Y/N) ! 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field / Square Feet of Absortion Area ~¢'0 Depression over Field (Y/~ Results of Last Adequacy Test ~J/~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness O, ¢' Statndpipes Present ~N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ! To Property Line /O To Existing or Abandoned System on ; On Adjoining Lots /o / C- To Cutback (if present) ,,¢/~'/ ! Comments D. LIFT STATION ~led Dimensions Gallons~"~~ Manhole/Access (Y/N) Size in "Pump On" Level at ~ "Pump Off" Level at Alarm Level at ,_..__Vent(Y/N)_ High Wate~ Tested for ~Ru~g Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTFRN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: Sm_p~mh~r 8_~. PWSID: 213564 To Whom It May Concern: According to the r-ecords on ¢ile o{' Alaska Drinking Water Regulations. in this o¢¢ice, the comp] iaoce with the State Sincerely, Ronald S. Klein Environmental Field OCficer