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HomeMy WebLinkAboutTHAYERMOORE HEIGHTS BLK 3 LT 4Thayermoore He'D ights Block 3 Lot 4 #015-081-11 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141180 PID Number: 015-081-11 Dwelling: FNI Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Upgrade Name: MALCOM &ELAINE BULL ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 7220 RUSSELL CIRCLE ANCHORAGE AK 99502 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeGravel Ft. depth beneath pipe Ft. Subdivision Block Lot THAYERMORE HEIGHTS 3 4 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 Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' I Ft. well >100' >25' TANK i Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface water >100' Material STEEL Number of compartments 2 Lot Line >5' NA LIFT STATION Foundation >5' Manufacturer Capacity Gal. Curtain Drain >50' Pump on level at Pump off level at High water alarm at Remarks EXISTING SEPTIC TANK ABANDONED in. in. in. PER UPC REQUIREMENTS. MAX BURIAL DEPTH OF TANK 10' Pump make and model Electrical Inspections performed by PIPEMATERIAL Housetotenk3034 Tankto3034 drainfield Installer JOHN'S EXCAVATING Drainfield CO/MT3034 Inspector ANSON MOXNESS BENCH MARK (Assumed elevation)100 ft Inspection 1� 6/12114 Location and description dates: a BACK DOOR JAM 3"' COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp IF Conditional Approval: Date o �P9 fit• i %........ i ... !+ .. . ... � �1 E. SPURKLAND�� 15 �~ �1P Approved Date \��H�E9s� 1� Inspection Report 9-1-1f.doer' CIR ABANDONED EXISTING SEPTIC TANK PER MOA CODE REOUIRfM£NTS I I 3 I — I _ 1 I 5 C A f0' URL NO WELL WITHIN 100' TO THE SO TH 25 0 25 50 75 100 125 150 SCALD I' = 50 FT THA YERMERE HEIGHTS SID BLOCK 3 NOTE • THIS IS NOT A SURVEYED PLAT WELL & SEPTIC LOCATIONS TAKfN FROM ON -517f WATER AND WASTE WATER DEPARTMENT DOCUMENTATION ALL LOCATIONS SHOWN ARE APPROXIMATE. 4+ FEET COVER DQUBLE CLEAN[" SWING TIES A B S.T. C.O. C 14' 38' S. I. C.O. D 21.5' 45.5' DBL. C.O. E 23' 47' 1250 GAL STEEL SEPTIC TANK 2RAINEIELD Y//— 4' CONTOUR LINES CON! EXISTING BRAerrrICLu FLIUNDATIQN CLEANOUT BENCH MARK DOOR JAM ASSUMED ELEVATION 100 FEET SPURKLAND ENGINEERING THAYERMORE HEIGHTS B3 L4 SEPTIC SYSTEM DESIGN 203 W K TH. AVENUE MALCOLM BULL DAT£t JUNE 12 2014 ANCH. AK. 99501 (907) 279-39. 7220 RUSSEL CIR ANCHURAGE AK 99516 SHEEP 1/1 GRID+ SW2439 PERMIT # USP 141180 PID # 015-081-11 ThoyernoreHelDhtsB3L4-49BBV& MUNICIPALITY OF ANCHORAGE e Community Development Department Right of Way Section Development Services Division Phone: 907-343-8240 Mayor Dan Sullivan June 19,2014 Malcolm I. & Elaine M. Bull 7220 Russell Circle Anchorage, AK 99507 Fax: 907-343-8250 RE: Encroachment: Septic System in Utility Easement Thayermoore Heights Subdivision, Block 3, Lot 4, Grid SW2439, 7220 Russell Circle, Anchorage, Alaska The Right of Way Section has reviewed a request for a letter of non -objection to an existing septic tank and the stand pipes, which collectively encroach: 10 feet into the 10'- Utility Easement. On the as -built survey dated 6/13/14 and the septic system design dated 6/12/14, submitted with the request, the petitioner has shown the septic tank and the stand pipes. This letter of non -objection is issued with stipulations, and by using it the petitioner is agreeing to the following: 1: Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachment's. 2. All applicable codes and regulations will be observed and maintained within the easement. 3. This letter of non -objection will in no way preclude MOA from full use and enjoyment of its rights within any portion of the easement. 4. Additional and extraordinary costs incurred during any future required construction, repair or reconstruction of MOA improvements to accommodate any or all of the encroachments shall be paid by the property owner. 5. Maintain letters of non -objection from the following utilities; E Anchorage Water & Wastewater Utility Alaska Communications Systems E Chugach Electric Association, Inc. ❑ Mataim" Telophone Association ❑ Matanuska Electric Association, Inc. Instar Natural Gas Company ❑ Municipal Light & Power E GCI Cable of Alaska ❑ Eyecom (Girdwood Cable TV) , ❑ No letters required All letters of non -objection should be retained in your perniatient files. If you have any questions, please call Daune Wyatt, Right of Way Plan Reviewer at 343-8240. Sincerely, Concur lc Pack L. Frost, Jr. Malcolm I. T3ull, Owner Right of Way Supervisor cf Tz Elaine M. Bull, Owner Mailing Address: P.O. Box 196650 o Anchorage, Alaska 99519-6650 • http://www.muni.org On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141180 Tax Code Number: 01508111000 Work Type: Septic Upgrade Permit Effective Dates: June 12, 2014 to June 12, 2015 Design Engineer: SPURKLAND ENGINEERING Subdivision: THAYERMOORE HEIGHTS Site Legal Address: THAYERMOORE HEIGHTS BLK 3 LT 4 G:2439 Owner/Address: BULL MALCOLM I & ELAINE M 7220 RUSSELL CIR ANCHORAGE AK 995070000 Site Mailing Address: 7220 RUSSELL CIR, Anchorage This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 26800 Total Bedrooms: 4 N Private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing.__ _ Special Provisions: The ROW letter of non -objection is to be submitted to Onsite prior to IR approval. Received Issued By. MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program 06 / Parcell ANCHORAGE Phone: Fax: ON-SITE SEWER/WELL PERMIT APPLICATION D 015-081-11 Property owner(s) MALCOLM BULL Mailing address 7220 RUSSEL CIR ANCHORAGE AK 99516 Site address SAME Day phone Legal description (Sub'd., Block & Lot) THAYERMORE HEIGHTS B3 L4 Legal description (Township, Range & Section) Lot Size Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 907-343-7904 907-343- 9 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) 0 Upgrade R (w/wo ADU) Ren s-1 -Duplex (D) ElLMu(SF Dwellings Elat ,Gj.A (SF and/or D) JUN 0 9 2014 THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized agent) Permit/Rush Fees: D/ cL V6h Waiver Fees: Date of Payment: I d YyDate of Payment: Receipt Number: 61 Receipt Number: Permit No. 0';'j9jLtjl?0 Waiver No. PermH App_9-1-12.doc Spurkland Engineering Environmental Consulting and Design June 6, 2014 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Elmore Rd. Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Thayermore Heights Block 3 Lot 4 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing tank has been compromised and must be replaced. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely,� StSp land, P.E. 203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net 25 0 25 50 75 100 SCALD 1' = 50 FT NOTE., THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. DOUBLE CLEAN 25 150 THA KERMERE HEIGHTS S/D BLOCK 3 4 FEET COVER CONNECT TO EXISTING BRAINFIELD 1250 GALLON SEPTIC TANK FOUNDATION CLEANOUT ISPURKLAND ENGINEERING I I THAYERMORE HEIGHTS B3 L4 I I SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ANCH. AK. 99501 MALCDLM BULL DATEr JUNE 6 2014 (907) 279-3916 7220 RUSSEL CIR ANCHORAGE AK 99516 SHEET, 1/1 GRID: SW2439 PERMIT # OSP 141XXX PID # 015-081-11 ThiyermoreHeight5B3LABW6 l, f", - i Q)0- Tw-,!�- FJL� ;J'U WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE (907) 349-7755 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 RECEIVED April 2, 1993 APR 5 1993 Munic;pahry of Anchorage Ida Vanhouten Dept. Health & Human Services 7220 Russell Circle Anchorage, Alaska 99516 Subject: Lot 4, Block 3, Thayermoore Heights, Anchorage, Alaska, Public Water and Wastewater Disposal Systems, ADEC Project Numbers 9321 -DW -069 and 9321 -WW -056, Review Dear Ms. Vanhouten: I have reviewed your March 12, 1993 submittal regarding the upgrade of your single family home into a Bed and Breakfast. Based on this review, I have the following comments. From the submitted information, it appears that the existing water system met all regulations and guidelines when it was installed. Based on this information and the fact that the demand on the existing water system will not be increased, it appears that the water system will be able to meet the demand without modifications. Therefore, the existing Class C Public Water System serving the two bedroom Bed and Breakfast and two bedroom single family home located on the above -referenced property is approved for the concerns of this Department. A final Operation Certificate, constituting this approval, is enclosed. The Department is assigning Public Water System Identification (PWSID) Numbers to all public water systems in the state. The PWSID Number assigned to your Class C Public Water System is 218093. This number will need to be placed on all analytical results submitted to this Department. At this time, Class C Public Water System, in accordance with the existing State Drinking Water Regulations, are not required to monitor the water provided to the public. However, I recommend that you monitor for nitrate (as nitrogen) once a year and total coliform bacteria twice a year. It appears that the existing wastewater disposal system was also installed in accordance with state and local regulations and guidelines at the time of installation. Also, the existing wastewater disposal system was able to accept the necessary amount of water to pass Ida Vanhouten April 2, 1993 an adequacy test on October 9, 1992. The existing wastewater disposal system was adequate to handle the volume of wastewater from a two bedroom Bed and Breakfast and two bedroom single family residence. Thus, in accordance with the provisions of 18 AAC 72, Wastewater Disposal Regulations and the Department's guidelines, the wastewater disposal system serving the facility on Lot 4, Block 3, Thayermoore Heights is approved for operation. This letter constitutes final operation approval for the existing wastewater disposal system. Thank you for your coordination with this Department. If you have any questions, please do not hesitate to contact me. �JSincerely, Keven K Kleweno, P.E. District Engineer KKK/cf Enclosure: As Stated cc: .;_,, John Smith, MOA/DHHS, w/o Enc. y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & 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 XNEW D0/7'��+'m ❑ UPGRADE MAILING ADDRESS "1, LEGAL DESCRIPTION h1 Lmt .8/ 3 h•� �r�o�-e LOCATION NO. OF BEDDROOMS /f �s DISTANCE TO: Well Absorption area < s Dwelling a PERMIT NO. O Y f e, �Z std h Z Manufacturer Material No. of co+lmpartments N Fa- 'eB V Liq. capacity in gallons Z IF HOMEMADE: Inside length Width Liquid depth OGZ TANCE DISTO: Well Dwelling PERMIT NO. Oz F Manufacturer Material Liquid capacity in gallons OJ= DISTANCE Well `�� Foundation Nearest lot t P�� IT N57 &Wz44r2? zk� �LL No. of lines Length of each ting Total length of lines Trench width Distance between lines 1- Z G - • N inches •--- F Top of rile to finish grade Material beneath rile + Total effective absorption area o /O JZ"ys �� !' inches Cr"3!� tl7` Length Width Depth PERMIT NO. w C7 I H Wd Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO:,. J DISTANCE TO: Building foundation Sewer line Septic tank - Absorpvonarea(s) OTHER - PIPE MATERIALS 1J SOIL TEST RATING INSTALLER - 1 CA GL REMARKS w O•e•H•4••• �®® P Z / JES • a d 2 3• D As x •i �S�d i APPROVED • LEGAL - 2-,i 3 Inev. 3i78i DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET+ ANCHORAGE, AK 9950$' "f 264-4720 ANCHORAGE 594-2131 : EAGLE- RIVER PER111T NO. 831.132 APPLICANT: 'DON THOMAS PHONE: 561-5500 ry ADDRESS: 2818 E 20TH ANCHORAGE, AK 99504 LEGAL DESCRIPTION.- SUBDIVISION: LOT '.SIZE 0 SQ. FT. TOWNSHIP: - RANGE: -. SECTION: - 'mAXIMJM NUMBER OF BEDROOMS = 0 SOIL RATING = 0 0 0"(SQ. FT. ZBR) LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING.YOUR SEPTIC x7 SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE., - - - - - - - - - - - - - - - - - - - - - -- -- -- - -- - - - - -- -- - -- - - i CERTIFY THAT:. - - - 1. I AM FAMILIAR WITH THE.REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SEt FORTH BY THE MUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA. `2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIyED iA'COPY OF THE CODE SUMMARY AND DIAGRAM ATTACHMENTS WHICH IS PART OF THIS PERMIT. :I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE' ENLARGEMENT IF. THE. ,,RESIDENCE IS REMODELED TO INCLUDE MORE THAN, O'BEUROOMS. i, PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DURING 'THE INSTALLATION INSPEC'TION'S OF ANY WELLS ADJACENT TO_THIS:PRaPERTY'AND ' %THE NOMBER OF RESIDENCES THAT THE WELL WILL SERVE. IF A_LIFT STATION IS INSTALLED, AN ELECTRICAL PERMIT AND INSPECTION MUST .j 6E OBTAINED. AS-BUILTS CANNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION'• REPORT. THE ELECTRICAL WORK MUST BE DONE BY A LICBNSED ELECTRICIAN.- ,SIGNED: LECTRICIAN.,SIGNED: 4 ----------------------------------- APPLICANT.: DON THOMAS 'ISSUED BY: DATE:, 12Zi4183 s; 1CY, x+ -•i to , i OF ANCHORAGE Ib-21Departmen#U51aCIPALITY thand Bnvironmenta rotection825Street, Anchorage, AK. 5501 264-4720 Permit # vJ 11� Y # # # HANDWRITTEN PERMIT # # # ON-SITE SEWER PERMIT Applicant:�on-1 Mailing Address/� � U Location: Legal Description: Type of Soil Absorption System Is: Trench: /,, Drainfield:'_, Maximum Number of Bedrooms: Phone Number: _ _ _ _ S tot Size: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) /,Sd The Required Size of the Soil Absorption System Is: DEPTH c (�P / LENGTH SD I �_ GRAVEL DEPTH Yom' WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = j GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a -private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may r uire enlargement if the residence emodeled to include more that 3 edrooms. sign eL� ?= Issued by: pplicant Date: SWP_/024(1/81) JAMES B. ROBERTS, PE, RLS • ENGINEER SURVEY l SOILS LOG • - 1207 EAST 74TH AVEN ANCHORAGE, ALASKA 99502 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 2Di1/7 DATE PERFORMED: LEGAL DESCRIPTION: GOT Q '44 * , -, �Iz/ !-lu�U9 SLYPE SITE N 1 2 3 4 5 v 6 C7� 7 8 � o 9 v o •o. •CSP. 12 o.. 13 14 yz5 3f�/.3/L i5DSr�B.2 WAS GROUND WATER �O ENCOUNTERED? IF YES, AT WHAT DEPTH? 1vZ14 Reading Gross Time Net Time Depth to Net `pate `o Water Drop PSE ..F 4,Lq s� ISI&E r � Sw 20'� 0n>Tv�"s PERCOLATION RATE (minutes/inch) J TEST RUN BETWEEN FT AND FT COMMENTS .PGG O/J'lis7G/?O Ti^G17G`i �7'�7�4JPGi9 %� r Z� 6PO�iGf PERFORMED BY: t/A-Z' CERTIFI 72-008 (6/79) 1, .. a WELL LOG Date Drilleds March 13,1984 Static Water Level9-1,r feet Gallons Per Minute 30 Draw Down_ as NA feet Type Material Drilleds Total Feet of O•asin&131 0 feet to in foot gnYd,n., / �rAvpl 1n foot to AS fact q.,d" rlov 175 foot to to Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 a Lot 4 blk 3 Thavermore Heights F�/,�, 0NT�O OF AN '� aRO�GF OCT 7 ., TecnovP e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 625 'L' STREET; ANCHORAGE, AK. 99501 264-4720 WELL_ F EF;;�M I T PERMIT NO. s 800062 7 APPLICANT BEN KRLYKQWSKI f �j3 1001 BONIFACE PKWY #10F 99504 333-7487 LOCATION RUSSELL CIRCLE ii4 LEGAL LOT SIZE 25000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 1.00 FEET FOR A PRIMATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIMATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET.. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F•EFRM I T E}4F' I FRES LSE EMF3EF2 :3:1:s X5 0 I°CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED APPLICANT BEN KRZYKOWSKI ISSUED BY ------------------------------ DATE -y -a - A_a --- V4.0 'LJ A FARC kuru! M�IIN I C I P FiL I T4' OF 1=1 MCS HaMIZ4 iE DEPARTMENTS(QHEALTH AND ENVIRONMENTAL OTECTION 825 L STREET, ANCHORAGE, AK. 9 1 01'e-0 c, ate-c� 264-4720e WELL- - - F}ERM T'T PERMIT NO. C ) _-a �3 3 2y(J'/ 6n�rrf�t' /OF APPLICANT-�'�- K� LOCATION -�� 4400" 0 6 3 LEGAL L� 1 h fj.y r r 7) Jc " LOT SIZES S-6 Ob SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: _ MAXIMUM NUMBER OF BEDROOMS = - SOIL RATING (SQ FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEF=`H= LEMC3TH- 13RAVEL f7EPTH� THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). RE:Gl J I FZEC} SEPTI C TIRFVK 1510a- r3F4LL0M4Z PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWa C 2 > F1FZM REQU I ME:E} - BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF:ZM I T E}{P I RES L?ECEMaaFZ 3 3.. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. 3Sr?'9 AND WELLS AS SET ENLARGEMENT IF THE Municipality of Anchorage n -Site Water and Wastewater Program r (907) 343-7904 t Certificate of On -Site Systems Approval Parcel I.D. 015-081-11 1. GENERAL INFORMATION Expiration Date: I - 1,�! '7 Complete legal description THAYERMORE HEIGHTS BLK 3 LT 4 Location (site address) 7220 RUSSELL CIRCLE ANCHORAGE AK 99502 Current Property owner(s) MALCOLM BULL Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: x USIVj ® Single Family (w/wo ADU) l J ❑ Duplex JUN Y F] Multiple Dwellings (Single Family and/or Duplex) 7 2014 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: NONE Distance: -- COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $Q_ct/Sh Waiver Fee $ Date of Payment �, �!`1 I �- Date of Payment Receipt Number OReceipt Number COSA# nSclq X24•`{ 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 SPURKLAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE _jZ System #1 Approved for _1i bedrooms System #2 Approved for bedrooms Disapproved Phone 279-3916 Date 6/13/14 4SPURKLA!, OFAt ef i G Z_�� "i D •w j p �r".. �� Conditional approval for bedrooms, with the following By: Original. Certificate Date: The AA icipap Q Anc ge 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue ahem f ., c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: THAYERMORE HEIGHTS BLK 3 LT 4 A. WELL DATA Well type PRIVATE If A, B, or C provide PWS ID #_ Date completed 1984 Sanitary seal (Y/N) Y Total depth 131 ft. Cased to 131 ft. FROM WELL LOG Date of test 3/13/1984 Static water level 90 Well production 30 WATER SAMPLE RESULTS: fid Coliform NEG colonies/100 mL Nitrate 4.82 mg/L Arsenic ND ug/L Date of sample: 6/2/14 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping NEW C. ABSORPTION FIELD DATA Depression over tank (Y/N) N Pumper Parcel ID: 015-081-11 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 5/28/14 88 ft. 132 g. p. m. Collected by: ANSON MOXNESS Date installed 6/12/14 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 10/84 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 System type TRENCH Length 53 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 18 ft. Eff. absorption area 636 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/2/14 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600 9 p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at _ E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 1004 Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Manhole/Access(Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots100+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main NA Water service line 10'+ Wells on adjacent lots100 + ABSORPTION FIELD ON LOT TO: Property line 0* Building foundation 10+ Water Service line 10'+ Curtain drain 50'+ (N.O.) F. COMMENTS *WAIVER ON FILE G. ENGINEER'S CERTIFICATION Surface water 100'+(N.O.) Wells on adjacent lots100 + I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 6/12114 COSA brown sheet -1 0-10-1 2.doc Absorption field 51+ Surface water 100'+ Water main NA Driveway, parking/vehide storage10+ no .. 11 / ..... „ / AR SPURKLAND. 1 00 11, \94 Z A p m a Z o m <,mmm�zm apzmO�� T m—ZWip ICl H (1 Z N C W OO ZOmmu�;--f Z p O H n O m Z 2p=HupZom vZm mv,a HOOmA A H H y o H m ZOa p=�rZ,� Z< m O ZZ N G1 v .. H T T E D > 6l � A a A ZO Cl = X00 mo -1m pzz ()HCC a O � 10 N H= m O T m 3 N i Z D 0 -ai pA m r C7 M m,D aO�z c ; Z C:H m m Z O r,-i� Z OBD zCvZ Op �O m a MN O (n A3:H C Ln Z m O 00(,0 omaz o 0 m yzZ Ln �� m 1 1 p m D C (n Vn p p 70Oa O m p m r p m Z m� r H m -q Zi Z� m n m Z = H N m �mD= Zi^o;E H Ln a Z wa o`= O O r a = Z Q,);5;7D m N 3.0 C? x7 A m M<s c m Z 11 0m1<D r01 --i >xa:�-1Z 0-n M V~1 m H = -1 m u 0 1-0 w 0 4P = ;o c ;a r :;a m m m�Mi ma m M -n< =m rim r0 Z�--i v� 0n rm x1<0n ��� C) < 0 w r -I F -i Dzz30 G)2!-<-n G1 m m " 1 m0�-z1Gz1 Dom= > -i> LIn <LAD Ijr-mz 0 mr) m>0C) Lnr-i poM F' V1 • N V1 3 H H D 0 C a O m= > " M o D 2 < 1-I -mi mm -I ma H In O. =A IN 07 1 D H ma m I— r- G)m 7J I- mz L/) -=i �0 LU mm r. L/) ;10 2 n Z Dm z I o n m 0 D Ln m H = ;a O �2-DI m Ln Fq < z 1 < O m T N 00 02' W 120.00 m N r• z 0 n 0 z z m C0 C0 1n m ti H D m U) 67 C r --I Cl) C < m N 00 02' W 80.00 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. # !` I �,-( 1— 1 \ 1. GENERAL INFORMATION HAA # Q', Cl :) ",7 �4 Complete legal description C o ` `4 alar k 3 TAcAv ei rrGrL ff fy Location (site address or directions) 7,2 20 h'urrell Ccrr! Property ownerL're✓in SnyoCer Dayphone Yo 276-2776 Mailing address Yo ERA P Rear _=r/- Lending shLending agency r^y f7/}C Day phone S6 2-Z161 Mailing address y6O rte. T< ac r Ra. An cbor«mit �4h p9So 3 Agent Bae4cz'a Bowden - ERA Rsrl ESI�16 Day phone 276'2_77 Address 270 2 6:am 6 -ell Sf.. ,¢^chone^ rq-k 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water y ✓ NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ✓ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Ront MllAml 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 Phone 345- - 13SS Address /HS3o Echo S�. /4nchazrge Engineer's signature f ni� Date Z6 /2 6/9 2 $� 0r A4.ht 4 . Tr'cOut 6. DHHS SIGNATURE \' Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M ZILTT[', bedrooms, with the following stipulations: Date _//�4L 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. 72-025 (Rev 1/91) Rack MOA qi Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lor 4 RLK 3 . TdAYeeMoo2e Parcel I.D. A. WELL DATA Well type FRwRTc If A, B, or C, attach ADEC letter. ADEC water system number N. A . Log present (Y/N)Date completed 3113/8Y Driller NEF?Y DRIL(rNG Total depth 13:1 Cased to 13 I / Casing height 2'f ,e Sanitary seal (Y/N) Y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test 3 ) 1312 Li Static water level 90 9 I ✓ Well flow 3o g,p,m. N. ! -r g.p.m. Pump level > 91, SEPARATION DISTANCES FROM WELL TO Septic/holding tank on lot 1 15 , ; On adjacent lots > !00 Absorption field on lot I lS r ; On adjacent lots > /00, Public sewer main N.A. Public sewer manhole/cleanout N.A. Sewer service line 105 Petroleum tank NDNE o 3s ERvE b WATER SAMPLE RESULTS: Coliform O co ( levo." { Nitrate 2• /m a It Other bacteria O co/ lroo M Date of sample: !o /9 /-12 Collected by: FLATTOP TEc if 5✓cs B. SEPTIC/HOLDING TANK DATA Date installed 10123 Z_� Tanksize 125° GAL Compartments 2 / Cleanouts (Y/N) Y Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping to / 2y / 92 i Alarm tested (Y/N) Depression (Y/N) AI N.A, Pumper =sera'_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r , Well(s) on lot1 On adjacent lots > /oo Foundation I Z To property line 6 • Absorption field 3 Water main/service line > eo' Surface water/drainage 72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed 10/ 53 Soil rating ISo 13 / BDRM System type TRENcy Length 53 Width 34 Gravel thickness Total depth i(o1 PER AS -BUILT Total absorption area io36 to Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) Date of adequacy test 101419-4 i for Peroxide treatment (past 12 months) (Y/N) NoNE KNowN If yes, give date N•A bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: otecl sa pJ.� Well on lot IIS On adjacent lots > /1OProperty line O – To building foundation 2S To existing or abandoned system on lot NA On adjacent lots > 3o Cutbank N•A � Water main/service line :> Surface water Curtain drain f{DNE oaSERVEiD E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature f 9R4- -c s *%� d AFH �� e •:.' D.....................i.. Engineer's Name Thec,cPo2 F. Kaa��j �,y Date �Gi�G/ 26� 09 2 :7HEODORE F, MOORE; CE -35E9 % �• f, d Ti N ••.a..••• e4," 4V HAA Fee $ 17b ' 0O Date of Payment /d —Z k —4? L Receipt Number ?=A/,?4 � Sf`�✓ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number • MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL,! OF ON-SITE SEWER AND WATER FACILITY nn 264-4720 Application Date 31-71 / S 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Vcclz 3 /r S /D Location (address or directions) 7Z7 -O R.are tI C r[IG 4nc4or-cty V (b) Applicant Name r=ed,414dka Fidero/ C -U -Telephone: Home Business 276'-101/ Applicant Address Pouch 7-SoS Anr4c/-ago /+k9gslo J � (c) Applicant is (check one): Lending Institution ®; Owner/builder 19; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Cen {raj f' Ma, - 'i t e Telephone e' 9' /- 930 Address hrl1OO 04d S'CUJQrC( *y4wuy _ S�+<,<< 103 Anc.ho.¢yc ¢9so3 v - (e) Real Estate Company and Agent� aam is Rea 11-y - Grncla- /iu !/ Address �f w• Ata ftiun G < kfy 4nckor' �!z 99s-r�3 Telephone 2 79 (f) Mail the HAA to the following address: (N� rd :rT 'o' e 2. TYPE OF RESIDENCE Single -Family S Multi -Family ❑ Other Number of Bedrooms I/ 3. WATER SUPPLY Individual Well R1 Community ❑ Public ❑ Note: If communitywell system, must have written confirmation from the State Departmentof Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 9 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. Page 1 of 2 72-025(11;84) z 10 Z abed Niom s,aaau!6u9 leuo!ssalad a4; ut suo!ss!wo ao sjaja jo; apsuodsaj you si a6eaogouV to Al!ledplunw ag1'panssl si aleo!1!liao e ajolaq elep azAleue jo suo}loodsut lonpuoo lou op d3H4 10 s8aAoldw3'sluewannbaj alels pue leAepal u!eljao /lslles o; Aepio u! suopl!lsu! 6wpual J194l pue sawo4;o siase4omd of (solinoo a se s!4l saop d3H0 a41'e�se1V to 81e1S 941 u! paaals!6@J Jaaul6ua euo!ssaloud luapuadapu! ue ,(q anoge 9 ydei6eied ut uaA16 suo!leluasajdai a41 uodn 6lalos paseq saleog!liao lenoaddV Al!io4lnV 411e9H sanss! (d3H0) uo!loaload leluawu0a1Au3 Pue 411eaH 10 ;uawliedad a6eao4ouV ;o /1!led!ounW a41 NOLLf1V0 euo1l!puo0 !enwddV leuo!1!puo0 to swia1 p9noaddes!4 panojddV ale0 /q swooipaq�i�� 101 panoaddy J C (�/ IVVAOHddV d3H0 '9 J, , POS s,a8au!6u3 f7 !L' UN -�"CCON1 •� ........ . ... :moi* a 'a4 YO Jr! tpwvlf SO rYa 4SAa /v aq-..f r!A/)10)4 4 9 / / f / E ale(] 9/S66 =lig nJoy�vi{ jS °7�� OfShl ssaippv _SS£I — Sh £ auogdalal J-�j /vi+ r, yam .+f f n/ wa!d to aweN 4 'uo!;oodsui s!4l to alep a4; uo loal;a ul suo!;eln6ei pue'saoueulpio'sapoo ale1S pue led!o!unW pe 4l!m aouepdwoo ui s! wals,(s !esods!p Aalemalsem jo/pue A!ddns aalem al!s-uo a41 `uo!loadsul pue u01;e61lsanu1 Rw woll pue sa!g 96eJ040uV to Alped!olunyq a4; wal paum;qo uollewjolul a41 uo paseq 1e41,(l4aAjaglanl ! u!aaa4 pa;eo!pui aAnlonals to ad/1 pue swooapaq to aagwnu a4laol a;enbape pue jumlounl'ales s! walsAs lesodslp jalemalsem ao/pue /lddns aalem alis-uo a413e4; smo4s lenoaddV Al!jo4;nV 411eaH s!41 10 u01je61jsanu! Aw le41 (l4aA 1 'mo!aq UMOl19 alep uogeppeA @4110 se pue 0laaa4 paxg;e leas /.w Aq paipliao sV NOIIVWHOdNI ONV VIVO `H0HV3S 3-11d `S1S31 `SN01103dSN1 `JNIOIAOdd Mid ONIH33NION3 '9 MUNICMPN'1ALOER VICES • ORI ENVIROhM- MUNICIPALITY OF ANCHORAGE (MOA) �� 198 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RECEIVED 264-4720 Lo f '/ Legal Description: Stock 3 TAVeriooere lfetghff S/� A. WELL DATA Well Classification Prrva1-e If A, B, C, D.E.C. Approved (Y/N) M:A. Well Log Present (Y/N) i Date Completed 3113 IS Yield __30 0aer Total Depth 131 Cased to 131 Depth of Grouting X. A• Static Water Level 4Y' Pump Set At G(n /r Casing Height Above Ground 2 `to Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y/N) On Adjoining Lots To Nearest Edge of Absorption Field on Lot Its" ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole — To Nearest Public Sewer To Nearest Sewer Service Line on Lot oI Water Sample Collected by TI t Date 3 /aY / A 7 Water Sample Test Results i4 o#- o%Ae/r bcrc�tric( `� Comments S4ac(y IF H•6 aP" nmxes no snecuaraL/� J �/ �ra t✓ olo wn a f wa Ft !c �t / i4 u e U B. SEPTIC/HOLDING TANK DATA Date Installed 10/63 Size IIS -0 cyal No. of Compartments 2 V Standpipes (Y/N) Y Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 3 /So / 6 7 Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) N• A. Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well tis' To Building Foundation le r Al. To Property Line •G' To Disposal Field 3' To Water Main/Service Line N• 14, To Stream, Pond, Lake, or Major Drainage Course __ > too, Comments Rvaleta anex sfrarah/c9.aC c.a. 46 allow accc-cs 6 Pfrdf cOA.I'q r-AmenF 3/L7(67 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata f SO a' Type of System Design -neem c S Date Installed fa 163 Length of Field r:y Width of Field 3 y" Depth of Field 16 ` 1ee� of - y , r F Gravel Bed Thickness r Square Feet of Absorption Area 6 -76 Standpipes Present(Y/N) Y Depression over Field (Y/N) /V Date of Last Adequacy Test 3127 /87 - 3 / 7o/ a 7 c� Results of Last Adequacy Test A!ft rruafe gar. y 4 ea(�c _r Separation Distance from Absorption Field: To Water -Supply Well tt S ` To Property Line O To Building Foundation 2S ` To Existing or Abandoned System on Lot N. A. On Adjoining Lots ,� 30' To Water Main/Service Line N.A- To Cutbank (if present) Al. A. To Stream/Pond/Lake/or Major Drainage Course > too, To Driveway, Parking Area, or Vehicle Storage Area 160 Comments _-Bepai;�ec( benf� b roh e «nd Lv ed Mon fei- A+ 14er «i wasA f- WerA en 6G a A-c'o � french 1-ten'Aoe li�t6e a/ las/ end e04 foe )4-ene/1 it 04 -t*e 5o"fA Pe re -Ay 1i'ee. D. LIFT STATION N,A, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at — Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certifythat II havechecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '%' Date 3131197 Company F4xAfi% Tech S'ver MOA No. 66 o6Z Receipt No. o? ` O O /--0 O '/ r �® g�9 Date of Payment z �— d 7 .�� OF At�n� 3'1'/ o�C Amount: $ X Z ��}._ a e ® Engineer's Seal Page 2 of 2 �y ..T F•r;o ff `( CE -3589 3; •7 4V ]2-826(11/84) V rP`eel •'••..... •' tip=� Municipatty of Anchorage April 3, 1987 PAX 196650 ANCHORAGE, ALASKA 99519-6650 (907)264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Lot 4 Blk. 3 Thayermore Hts. Subdivision Waiver Request WR87-025 Dear Mr. Moore, Your request for extending the existing property line waiver, for the subject property, has been granted. The separation distance has been waived to zero feet in this case. This waiver is based on the information provided our office and is valid for the existing four bedroom single family dwelling only. Any upgrades or enlargements of the existing system will invalidate this waiver. Sincerely, Z Daniel N. Bolles Engineering Tech. III On-site Services cc: Gus Andress, P.E. Manager, On-site Services/ Water Quality • CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 April 1, 1987 ANCHORAGE, ALASKA 99516 M.O.A. Dept. of Health and Human Services P.O. Box 6-650 Anchorage, AK 99502 RE: Waiver to property line - L4, B3, Thayermoore S/D Dear Sirs: On January 17, 1985 your department issued a waiver allowing the wastewater disposal trench serving the subject property to be within 2 feet of the property line, based on a survey of the position of the monitor tube. At the time of my adequacy test of this system, on March 28, I found the monitor tube to be non- functional due it's having been bent over, and partially filled with soil. I had the tube entirely dug up and replaced, and a new survey done to verify it's new location. This survey showed the tube to be right on the property line. Since this represents the apparent extreme extent of the trench, and the property owners to the south have indicated their non -objection to the granting of a waiver, I request that you extend your waiver to allow a zero foot offset from the property line in this case. Please call me if you have any questions. cc: Linda Ball, Dynamic Realty Dana Burger, FedAlaska Sincerely, Ted Moore, P.E. per�,,®® • O �9 M*VJ e°491H` IY p�•,IY.i.111. ..,� g e T.iEODORE F. MOORE P CE - 3589 ®fie FA ••.... Ii$g, Municippity ®f Anchorage P00 : 6-650 A `JCi iGRAGF, ALASKl:. 9y5!i2-0 50 (907) 264-4111 T ONY KNO b'/LES. F/A YOH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION September 5; 1984 �,,.✓� �� Mr. Don Thomas ? 2818 East 20th Avenue Anchorage, Alaska 99508 Subject: Lot 4 Block 3 Thayer mv=osg Heights Subdivision We have received your engineer's as -built drawing of your sewer installation. The engineer originally had requested a lot line waiver. The as -built, however, shows that the, trench actually crosses the lot line on the south. This Department will not write waivers across lot lines. We are also informed that the system was actually installed in October 1983 without benefit of required inspections. You are now required, within seven(7) days, to obtain a new permit to move the trench. The existing trench will have to be properly abandoned -As part of the permit you must conform to the requirement of two(2) inspections on the new trench. If you have any questions, please call this office at 264-4720. Sincerely, Susan Oswalt Engineering Tech III SO/ljw MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION MR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) F-. I (r • { �L,c-" Via,;- � N r�-F,-t'.�L•[=. d L q--,t�. P� �� `) `=�';=s 14v (b) Applicants Name ( `I �''r l �' Telephone Applicants Address_[ (c) Applicant is (check one) Lending Institution Owner/builder Buyer F�::j ; other (::� (explain); (d) Lending Institution Telephone Address (e) Peal Estate Co. & Agent 1\"� 'f�__-- Address Telephone 2. Type of Residence Single -Family Ezi Multi -Family Other (describe Number of Bedrooms 3. Water Supply Individual well r]7f Community Public Note: If community yell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the Xll adequate for the number of bedrooms specified in this HAA (Y/N) 'err 4. Sewage Disposal Onsite Public Community Holding Tank Is the wastewater disposal system adequate for the number of bedrooms (YIN) ("- [Page 1 of 21 2-15-84 5..Engineering Firm Providing Inspections, Tests, Data and Information I certify that I have checked, verified, or effect on the date of this -inspection. �/ Signed % `%/ fes- �_� 2 l Name of Firm ✓?1': ,=.. s `i>fi= }"y lal„Telephone conformed to all NIDA HAA Guidelines in Date —;.- .'../r'< Address Signed by Via® ®� � Date j ! r.” e . n *.... ® .. .� r-�✓ /4 /.... (ENGINEER SEAL) . •• ••Lir•• v' Q JAMM 8 RODERl9 CE -1516 6. DHEP Approval Approved for bedrooms By Date Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedroom and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address- KB2/d5/s (Page 2 of 21 2-15-84 f A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 JUL 17'0? Legal Description: Lcfi L/ `.� / </< .'z Well Classification -iy2 If A, B, or C, D.E.C. Approved(Y/N) Well Log Present (Y/N) Date Campleted ? - W sy Yield Total Depth iii Cased to I3t Depth of Grouting Static Water Level %'G Pump Set At Casing Height Above Ground Sanitary Seal or. Casing (Y/N) Electrical Wiring in Conduit (Y/N) y c.s Depression Around Wellhead (Y/N) /;n Separation Distances frau Well: To Septic/Holding Tank on Lot /1S / On Adjoining Lots Gc r To Nearest Edge of .Absorption Field on On Adjoining Lots To Nearest Public Sewer Lire Iy 9 To Nearest Public Sewer Cleancut/Manhole /✓ F To Nearest Sewer Service Line on Lot !,,x v - Water Sample Collected By _; Date 1 Water Sample Test Results mu s/ T—, Cam -ants B. SEPTIC/HOLDING TANK DATA Date Installed ',O �� i Size lZf�TGk'�L- No. of Canpartments 2 Standpipes (Y/N) Air -tight Caps (Y/N) `SLS Foundation Cleanout (Y/N) -ice Depression over Tank (Y/N)y_rDate Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (YIN) \; Temporary Holding Tank Permit (Y/N) G Separation Distances fran Septic/Holding Tank: To Water -Supply 1%bllTo Building Foundation i nE s To Property Line lj,tn t <;.. To Disposal Field To Water Main/Service Line Lala To Stream, Pond, Lake, or Major Drainage Course 1s. Commnts [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I -: '] Type of System Design Date Installed Length of Field logr•j` Width of Field _ j '' Depth of Field _ 1061 Gravel Bed Thickness Cf Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test IU4q Separation Distance frcm Absorption. Field: To Water -Supply Wall 1L:7;re To Property Line 7 To Building Foundation 0�- 2 -') To Existing or Abandoned System rn Lot 1LG�iL On Adjoining Lots 15c'+ y To Water Main/Service Line To Cutbank(if present) i// To Stream/Pond/Lake/cr Major, Drainage Carse ivc; To Driveway, Parking Area, or Vehicle Storage Area 7L Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Camments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MDA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA Gu on the date of this ins ior% r Signe jM41- i Company I ' t CE I?LSMOA No. KB1/d5/s [Page 2 of 21 in effect .�............ :..... : JAM!® 8 NOBEWS CE -1516 <i IATN ® 2-1584 October 9, 1984 Municipality of Anchorage Division of Environmental Health Fourth Floor West 825 "L" Street Anchorage, Alaska 99501 Gentlemen: We hereby certify that we are the owners of Lot Four (4), Nettleton Subdivision; that we understand that the absorption trench installed on Lot Four (4), Block Three (3) of THAYERMORE HEIGHTS SUBDIVISION extends across the common line between these respective lots onto our property 0.6 feet as shown on the attached on-site Sewage Disposal System and/or Well Inspection Report prepared by James B. Roberts, P.E., Registered Civil Engineer; and that we voluntarily and of our own free will grant an encroachment easement for this installation to remain. JANI D. SIEFKER