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Home My WebLink AboutT15N R1W SEC 8 LT 158Onsite File T15N R1W Section 8 Lot 158 #051-154-15 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221141 PID Number: 051 154 15 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name PAYNE ABSORPTION FIELD E] Deep Trench ❑Wide Trench E] Bed- E] Mound Site Address 19921 Crabtree ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot T15N R1 W SEC 8 LOT 158 Fill added above original grade 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 absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well +100 - _ _ _ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water +100 _ _ Material Number of compartments Lot Line +5 - - NA POLY 2 Foundation +1 0_ _ LIFT STATION Manufacturer Capacity Remarks TANK ONLY — _ Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to UNK drainfield JRS Drainfield UNK CO/MT3034 Inspector C&M ENGINEERING BENCH MARK (Assumed elevation) 100 ft Inspection 15` 6/1/22 Location and description nd 2 3`d 4th BOTTOM OF SIDING NEAR FCO ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 6/5/22 r OF Ak qltf-ll1 Conditional Approval: Date . • �s �r•`Q� •STM i* . Septic System // Approved --7-1 L�....(`_ �$� Date 6O Z CHARLES G BALZARINI ��Gis • CE -13854 �t 1 'lFo ••....••��„r Note: this approval does not include well permit requirements. ll PROFES CO C 37.75 36.15 D 39.8 38.6 E 40.4 39.5 F 40.7 40.3 �O II O NEW 1000 GAL MOA COMPLIANT POLY TANK WITH INSULATED MANWAY RISER AT FIRST CHAMBER GRAVEL DRIVEWAY . GARAGE INSULATION OVER TOP OF O / + \ +� CHAIN-LINK FENCE r.*: -*49 *r� CHARLES G BALZARIHI • . CE -13854 FE �IlF�F�pROSSIONP�'.�~ _ NEW DOUBLE COS -- EXISTING BED SYSTEM PLAN - SCALE: 1" = 30' BM:+100.0' BOTTOM SIDING AT HOUSE 3.8' COVER +2" INSULyjj� 95 7 SEPTIC TANK 5.9 NO WATER ENCOUNTERED IN TANK HOLE SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY. JUnGIVI/1 I I%_ CL -r- VM IIUIV — JI.NLG: IN IJ LEGAL DESCRIPTION: T15N R1 W SEC 8 LOT 159 C&M ENGINEERING SERVICES OWNER: PAYNE DATE' 6/08/22 1 REV: I DRAWN: CBJ REF; 907-854-5558 SEPTIC RECORD DRAWING N -I.- 0 N J � 30.0' 30.0'� I N I T T 0 I o I 0 I I I I I I I I I �I I II �S 00'06'30"E 330.6800'06'30"E 330.68' — — — — — — � U z w z z J Z_ N a W +� 4 a / UU + F= J W / + W ° a + \ + N�bg 93.9 U 0 0 W J p ' W � U W I O _ ,l 0 O � � — iV N G, � W ' J to Z 3 ap J T 0� LO N 00'06'00"W 330.73' I C RABTREE STREET -------------- I I I I I I N I I I �- I I J I I I I I � � w L� I 0 LO vi O O 93.4' J � U z w z z J Z_ N a W +� 4 a / UU + F= J W / + W ° a + \ + N�bg 93.9 U 0 0 W J p ' W � U W I O _ ,l 0 O � � — iV N G, � W ' J to Z 3 ap J T 0� LO N 00'06'00"W 330.73' I C RABTREE STREET -------------- I I I I I I N I I I �- I I J I I I I I � � w L� W U z to LO vi O 93.4' J o to d� �' to Q� O O C.4 QIP T Y =i�� ti�W 0 Q ��. . Z :Y � J Ni N, H ° �p�6�• oQ�O 000 W U W U z c co M 93.4' J — 0 — 0 CC) U- 0 — 0 w 0 0 ----------- ---101 ------ ,o�p4 i co M ' g N'. DA ►� �' Q�I�JTG/w1 :C� � co �': 0V� Im C.4 QIP QLL CD Y =i�� ti�W co r`I Q ��. . Z :Y o Ni N, H ° �p�6�• oQ�O 000 I rn �� 04ao a 0o Z a - v v N ° -e 0 c N L °O O Q m ¢ O X O a o d a. L m CD H�Um m11) m Vl 0 C co Ln > I� c, -4t co � 3 r`iQ tOI c°It c Z I 1 3° Tc in >r-"5 c 0.2 ¢ in > CN1 0NN�p a �. c� cvi 0. O c- 3iOLnLncca mY '.2 a0 Zlonn0o oNc°�m`ooF �� ow ^00 c c-aJ+�..� CJI 1 �.2. aQ m} 7 o 0v • a Q 0 w..- E 1 h m V '^ U D t m •- C L i L I L m W:24 c ms °0— mL _ O 2c LI �` N �Os°mmL I mo c Ili ;a"-�Zy° I -i °3CDyVm ° N "- a ku i �`o I m r I � I/1 �v v- •am ° v L 3 m a a �/ 0 3- c O H O O Q • — -0opo m.00>. c I Lm o VO) U >11 mina• arc cv Z:. 3 1 V— >Z�v m ° '- LLI ror o o cs i o c Q' .r. W a) m '6 .0 a O i �= U �'� y c mLLJ I h N •O Co Q C- m e Q= O m Q L N O x /�^�` W F y O O m a m 0 0 .- N L O a! y m mm°cm�V)EL C 0 U '- 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: OSP221141 Work Type: SepticTank Upgrade Tax Code Number: 05115415000 Site Legal Address: T15N R1 W SEC 8 LT 158 G:1257 Site Mailing Address: 19921 CRABTREE ST, Chugiak Owner: PAYNE DIANA R Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: INA C 11 I r t)epartillent 5/19/2022 5/19/2023 1:•11 ❑ 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: Date: Issued By: �Co✓C1�i� u��z�� (/ Date: 5101, d � 3 MUNICIPALITY OF ANCHORAGE RUSY G A u Development Services Department r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I. D. O 51- 15 y - ( 5 Property owner(s) PAYNE Mailing address 19921 CRABTREE Site address 19921 CRABTREE Day phone Legal description (Sub'd., Block & Lot) T1 5N R1 W SEC8 LOT 158 Legal description (Township, Range & Section) T1 5N R1 W SEC8 LOT 158 Lot Size 108,900 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank El Upgrade Q Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Multiple Dwellings El Privy El and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: _$ a a 5+- A 2 5LRM Date of Payment: 5/17/2022 _5L Receipt Number: Permit No. 05P aa11 `L 1 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for T15N R1W SEC 8 LOT 158 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced immediately. The owner wishes to replace the tank at once. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank will be of MOA approved construction. Groundwater is a concern on this lot. The groundwater at tank location will be determined prior to selecting and setting a tank in accordance with the latest guidance / approvals for tanks installed in groundwater. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 5/15/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221141, Rebecca Carroll, 05/19/22 CHARLES G BALZARINI CE-13854R EGISTEREDPROFE S S IO N ALENGINEER5/15/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221141, Rebecca Carroll, 05/19/22 MUNICIPALITY OF ANCHORAGE ul~ RTMENT OF HEALTH AND HUMAN SER ES ~\ i: Environmental Health Division ~ I 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANC[-'S Address Phone(s) LEGAL DESCRIPTION TANKS E~/SEPTIC [~] HOLDING TYPE OF SYSTEM L~ 'rRENCH [~IED [] W. DRAIN [] OTHER ~ TO SEPTIC ADSORPTION FROM '-'"~ TANK FIELD WELL. WELL /~c)' .4- lc:,o; '/- LOT LINE /o' '''~ /~>' -~ /o'4 FOUN[IATION Wa .T'/,J M~ -F / ~J --_ FT Fill added above Ollglnal grade ~.,.~ j',,,A ) kl. FT .......... ~.'~ ~ F T ~-~ 8Q FT FT (,P · t~ FT /B ~ FT Dale Installed WELLS J~'~RIVATE [] OTHER fl(lenlitv) F1j FT REMARKS: Scale: ,)" =2.C>t Inspection~.~'~,ed by: ENGINEERING ..... ~ ~ cedily that lifts inspection was perlorrned according to all McKay Well Drilling P.O. Box 557 Wasilla, Alaska 99687 Phone :176-5058 Wel Owner-~l' (,/~ Well Location, ~ , ~ ~. Size Casing - ~r~.. ~Depth of Hole _ Static Water Level r , ~ ~ ~feet Well Test_ Date of Completion ..... Date Phone Cased to-~-~.~..---~ ' . feet Gal per Minute for ,' Hours WELL LOG MUN~4P~.Lh~Y OF ,'*,fqCH@RAO[ · DEPT. OF HEAI.I'H & NOV '71986 AUTHORIZATION TO DRILL I hereby authorize McKay Drilling to proceed with the above work. Payment shall be made in the following manner: Rig up Minimum ._ feet. @ Balance due upon completion. ..~ per foot In the event it is necessary to insitute legal proceedings to collect any amounts due on 'this con- tract, I agree to pay an additional sum of fifteen percent (15%) of the original contract price. Plus attorney's fees, and cost for legal proceedings. Name Address - Date _ ~ ; .l,.. U L.CI'I - ' /:{d.,C)CI< ~ :ISN RAfqGE~ :I.W ] C:el t.:i. fy 'Lhal:.: ..d ~cir'tl'l by !'he Iduli:i. cipa],ity of A'lchol'a~::l:.;' (Mi]A) arid t.l~,::, ;:,:t,, I ~:i,:t.:l :i. li~Fi'.a] ]. tl'~0}) ~y~FL(.::)m :J. lr ~'.tf"cc)r"~:tEd~: ~ with ail MOA ~:~::~::1~:>~.~' alld r, egu:t, aL:ions, al'm(:l ~l'i c:oml::)J;i~'~lqE(:~ with 'Lhc.~ dc.~sign cr':iLEH"ia (::if' 'Lhis per, mit,, Z,. I t,~:i.:l. 1 acll'~:~t~ l'..o a.I]. MOA and S'La'Lt~ of Alasl,:a i,c, qu:i. pcun~nts ior' I. he sc~t bat:l:: ]:1::: A I_II::1 S'IA'tI:ON !S II",ISf'AI.I..E)) IN AI',I Al:REA CI'VI~{F :) BY MOA ~':UII-D x ~ CODIES, · .::., (.) ¢, '--::R'(~ ::'ER"I AND 'i x :::'~: ] lJIN MUST BI:. ()BIAINI=D~ (2) 0b {.?):?. I,S , ,., .{::: AN IZI.,ISC;I?ICAI.. :[NSF'EETIUI',I Rh:.FURI; ANJ) (.=,) I1.11=. SCALE' SCALE PERFORMED FOR: LE'GA L DESCRIPTION:_ 1 2 3- 4- 5 6 7 9 10 11 12 13- 14 15 16 17 18 19 20 Municipality of Anchorage DEPA~T~E~NT OF HEALTH & HUMAN SERVICE¢ 825 'L Street, Anchorage, Alaska 99502.-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: ~'1~.~%~,~ SLOPE -- SITE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT Depth Io Water Alter: _: / ' Mogikoring? _ ~/.~ Date: q, Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLA'rlON RATE . ~ (minutes/inch) PERC HOLE DIAMETER -- TEST RUN BETWEEN -- FTAND __FT COMMENTS ~'~' '~"/~'~ -'~)~' ~-,~/.~/~:::1[-~ '~:::~/ ~') '-~/~'~ ~ ,. '~"~O"M~D ~Y: SR B 196X ,~~ _ CERTIFY THAT THIS TEST WAS PERFORMED IN 5 72-008 (Rev. 4/85) U1 H CI L� T 7 OF ' H C H 0R G Development Services Department`:_"` Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 05-11 W1-5 1. GENERAL INFORMATION Expiration Date: '" i -2 Z Complete legal description T1 5N R1 W SEC 8 LOT 158 Location (site address) 19921 Crabtree Current property owner(s) Payne Mailing address Day phone Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: N O N E q Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-50 Waiver Fee $ Date of Payment 5l i i 20 2 2 Date of Payment Receipt Number Q �`� D Receipt Number COSA # 0 S C�2 2 1 2 1 S/ 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. C&M ENGINEERING Phone 8545.558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 5/15/22 OF AlAW gsll 6. DSD SIGNATURE /... . .. A�" ... .. System #1 Approved for 3 bedrooms r CHARLES G BALZARIK( System #2 Approved for bedrooms rr� �F6?*- CE -13854 Disapproved �,i1F�F�pROFE5S10N� r Conditional approval for bedrooms, with the following stipulations: )1 Original Certificate Date: 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 Checklist blue sheet 0(/ o wqT �S�TF � �m�'q M: -o �J q = )1 Original Certificate Date: 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 Checklist blue sheet COSA Checklist Legal Description: T1 5N R1 W SEC8 LOT 158 Parcel ID: 051 154 15 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled -1986 Total depth 73 ft Cased to 73 ft ❑■ Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 5/12/22 Static water level at beginning of test 35 ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material PLASTIC SEPTIC Measured operating fluid level in septic tank NA ❑■ Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA BED Which system tested (date installed) 1986 ❑0 ALL standpipes present per record drawing Total measured depth from grade 5 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth 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 2000 gallons Comments/Deficiencies: NONE COSA Checklist yellow sheet Well production at time of test +3.6 gpm Water storage tank -volume gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate mg/L ❑■ Nitrate less than MRL (ND) Arsenic ug/LArsenic less than MRL (ND) Collected by C.BALZARINI Date of Sample 5/12/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/12/22 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date NA NO 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' 0✓ Yes Community Sewer Manhole/Cleanout > 100' M✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields> 100' Yes if No Animal Containment > 50' ❑✓ Yes if No ft [ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No ft P1 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10'✓❑ Yes if No ft Community Wells > 200' M✓ 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' 0✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS NEW PLASTIC SEPTIC TANK INSTALLED WITH GROUNDWATER MONITORING TUBE. G. ENGINEER'S CERTIFICATION / certify that 1 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. 6/4/22 COSA Checklist yellow sheet �w,ro- • -fes�� r*: 49 TH '•* �� r • • CHARLES BALZARINT . r� ��c •. CE -13854 .•. , �w �w i�F,�•••.....•••��,r l�lFloPROFEGIONP r ft Mil Legal Description:/-o 7' A, WELL DATA Well type '1 ~? ~g ~ r'po i~..~ If A, B, or C, attach ADEC letter, ADEC water system number Municipality of Anchorage DEPARTMENT C)F HEALTH & HUMAN SERVIC ES Environmenta! Services Division 825 L Street Room 502 · Anchorage, Alaska 99501 · I~NVIRONMENTAL SERVICES DIVISION Health Authority Approval Checklist dU~ 2 ~ 1997 /.~'., .~_¢/ PJ/ 7~15'~/ Parcel I.D .r,,.r RECEIVED f-.) Log present~)/N) ____~ Date completed c~ _ 5".. ~ L, Total aeotn "7'~ ' Cased to 7,~ ~ Casing height (stove greund) Wires properly protected~/,N) Sanitary seal ~_JN) FROM WELL LOG AT INSPECTION Date of test Static wamr level ..~(¢ r /Z~ ' Well proauction g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: _ Nitrate ¢. I Other bacteria Collected by:__ ,,~" ¢ ~;-~"J~/~"~ B, SEPTIC/HOLDING TANK DATA DaLe installecl c~_/,/.. 06/¢, Tank size Foundat on cleanout ~Y?N) _ y Date of?umplng. C. ABSORPTION FIFLD DATA Dste'iostalled /~, Depression (YL¢Ti~,) ~-) High water alarm (Y/N) ~/~ _ _ Pumper Sell rating (g.p.d./fF or fF/bdrm). ,,/,¢25- ¢~---System type Length, ' "~ ~ Width _ /~' ' Gravel thickness below pipe /Jr:~ Tots deptn q '/~- Effective absprption area _~5<76'' ¢ _ ~onitoring Tube prese~¢~N)~_ Depression pver field Date of adequacy test ~' ¢/'7- ~ 7 Result~Fail) ~,~;d For. ~ bedrooms Fluid depth in absorption field before test lin.);_ ~ Immediately after ~C~ga~ water added (in.): _ Fluid depth ~ (ins] Minutes later. Absorption rate ~ = g.p,d, Peroxide treatment (past 12 mont,s) (~) ~0,¢~ t4¢~¢~ If yes, give date _ 72-026 (Rev, 3/98)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" ~ High water alarm level at* ......-~ *Datum "Pump off" level at* E. SEPARATION DISTANCES Absorption field on lot Public sewer main SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ ~o o i .~ /~ / On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation c~- / y- Property line /o //- Absorption field ~'- Water main/service line /¢' / Surface water/drainage /PC, Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line / ~ / ']1- Building foundation. /~) / '/-' Surface water /Go / Curtain drain Water main/service line Driveway, parking/vehicle storage area ¢~o Wells on adjacent lots /o o / ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and, review of Municipal recor~,~~s are in conformance with MOA HAA gui~le/ines in effect on this date. Engineer's Name ~¢~*~ ( ~ ~¢¢¢¢~ HAA Fee $.. Date of Payment ~h~/~7 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number .II~, ~ . ~ ~r' 14:25 CT~E ESi ANCHORAGE ,,:]&E Environmont~l ~ervlces Ino. 90?5615301 CT&E Client Narm~ Client Matr)x Ordered I'WSID 973276001 5; & S l~gi~teering L 158, Sec 8, T15N, RIW L 158, Sec 8, T15N, RIW D~i. akiag Water 0 PaL Unlt~ 0.100 mg/t Client I?O# PHnted Date/Time 06~24~97 12:08 Collected Date/Time 06/20/97 14:30 R~celYed Da~e/Time 06/20/97 16:00 Tcclmlcal Dlrecton Steph~n C, Ede Method Llndts Date $H18 9~u MUNIC, IPALITY OF ANCHDRAGE DEPARTMENT Of: HEALTH AND ENVIRONMENTAL RROTECTION DIVISION OF ENVIRONMENTAL HEALTN CERTIFICATE OF INSPECTION FOR HEALTFI AUTHORITY APPROVAL OF ON-SITE SEWER AND WAT[:.R FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal .Description (include lot, block, subdivision, section, township, range) 2- Location (address or directions) £" ¢?¢'£ eusiness (b) ApplicantName,-~c'~~--Teleph°n~e:H~°me ~.4¢0 '/~;~-'.~... /¢~..--?¢_~. Address - (e) Real Estate Company and Agent Address (f)' --tCca~tl;e HAA to the following address: 'TYPE OF RESIDENCE Single-Family ~' MuLti-Family Number of Bedrooms Other WATER SUPPLY Individual Well,~-'~ Community D Public ~ Note: Il community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,~ Public [] Community ['~ Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-o~5 ¢ ~/84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, [ verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate 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 aed inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and Stat(; codes, ordinances, and regulations in effect on the date of this inspection. ,~ & S ENGINEERING .__ Telephone . ~_~'~. -" ~-,~7 Name of Firm Address EAGLE R Date Approved for __ ~ .__ bedrooms by _ ~t~ _~ Approved ~' )~ "__ Disapproved Conditional Terms of Cond~bon? A, pproval Date %', CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72 025 (11/84) MUNICIPAI. ITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL [HAA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTF & ENVIRONMENTAL PROTECTION Nov '7 1986 CHECKLIST- FEBRUARY '1984. Legal Description: ~/'~ A, WELL DATA Well Classification ,~. F Well Log Present Y~4) Total Depth ~ t Cased to Static Water Level Casing Height Above Ground _ Electrical Wiring in Conduit (~/N) Separation Distances'from Well: To Septic/Holding Tank on Lot If A B, C, D,E.C, Approved (Y/N) Date CompJetea _¢-~ -~, Yield _~..~. (=~'~"~ '-/'' Depth of Grouting Pump Set At Sanitary Seal on Casing ~N'~ Depression Around Wellhead (Y/~) On AC oining Lots To Nearest Edge of Absorption Field on Lot __/c~:~ he- . On Adjoining Lots To Nearest Public Sewer Line /J/'/:) To Nearest Public Sewer Cleanout/Manhole ,,L~(~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~'~=" ~f4'~,~,j,.¢. ~l'L.r/~'o, . Date /O -~:,/ Water Sample Teat Results Comments B, SEPTIC/HOLDING TANK DATA Size _ AJr-t~ght Caps ((~) _ / ¢:~ cb o No. of Compartments - _ Fc Jndation Cleanout Date Last Pumped ,N'//~- : for ~ "-- _ Temporary Holding Tank Permit fY/N) _ Date Installed Standpipes (~N) . Depression over Tank Pumping/Maintenance Contract on File ~Y/N) Holding 'rank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _ /¢,O "'~' To Property Line _- To Water Main/Service Line _ Course .To Building :oundauon _ ~'-~ To Disposal Field _ t~/'¢ To Stream Pond. La~e. or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - / / -rC~ Width of Field /{¢ Square Feet of Absorption Area _ Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well _ /0 0 TO Building Foundation Lot ~ / /Z..~ ~/¢/A~_ ./~" Type of System ////- Length of Field Depth of Field / ~' "~ Gravel Bed Thickness ~, ~- Date of Last Adequacy Test To Water Main/Service Line ) Z>/¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ' Design To Property Line. /o To Existing or Abandoned System on ; On Adjoining Lots .~.c.5 To Cutbank (if present) LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th~ ~ a~vJ~(~j~,~tJ~j~, or conformed to all MOA and SRB '196X Signed -F-AGLE RIVER, AK 99577 Company Receipt No. Dateof PaQnt Amount: MOA NO. ~"'"~ '""¢, ~i' FIAA guidelines in effect on the date of this inspection. Page 2 of 2 72-026 (11/84)