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HomeMy WebLinkAboutT12N R3W SEC 4 LT 59 W2Onsite File #014-142-08 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191385 PID Number: 014-142-08 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Al Upgrade Name Wilcox Richmond Revocable Trust ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 2827 Lore Road Anchorage, AK 99510 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 229-8208 4 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot 59 W2 Fill added above original grade Ft. Gravel length Ft. Township Range Section 12N 3W 4 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 Ftz Ft. Well >100' N/A N/A N/A >25 TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water > 100- N/A N/A N/A Material PlaStiC Number of compartments 2 Lot Line >5 j N/A N/A N/A NA Foundation >10' N/A N/A N/A LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer Northern Excavation Drainfield Existing CO/MT D3034 Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspdectio 151 10/30/19 Location and description 2 Threshold of door on shed. 3`tl 4`" ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF qL �t�® Conditional Approval: Date®�P,.•°•°°`°°"° °°�5�®� LT "° 49th p!. ° .tp .... .... .t t�fpt.$tt.tt� �• 'fir .. �°7CC°� 0 ® .....:.................................e...... ;•MICHAEL E. ANDERSON S Septic System Approved"vh Date 7 7 x0.20 !J No. CE -4381 ®®'�,p°••.°0 6/9/20 .°•°'<���'® Note: this does approval not include well permit requirements. tKev uoiulrtu/ T12N R3W SEC 4 LOT 59 WEST 1/2 PERMIT # OSP191385 LOT 58 E-T-' GINEERGE LOT 59 W2 NEW 1,500 PLASTIC SEPTIC TANK w/20' MANWAY. (EXISTING TANK REMOVED AND DISPOSED OF PER MOA CODE.) - 4-BDRM HOME EXISTING WELL LORE 0A _ PLAN AS -BUILT 0 50 100 FEET 1"=50' PID # 014-142-08 LOT 59 E2 A B MH 1 19.7 1 25.8 SV 1 20.2 1 28.4 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE PROFILE AS-BUILT (NO SCALE) 1/6/20 95.3 89.5 95.9 99.9FCOMH SV2CO95.1 PERMIT # OSP191385 PID # 014-142-08 T12N R3W SEC 4 LOT 59 WEST 1/2 1500 GAL SEPTIC TANK T12N R3W Section 4Lot 59, West 1/2109,561 Sq. Ft. +/-2827 Lore Road2 Story Wood Frame Housew/Attached 3 Car GarageN00° 08' 23"W 660.00 REC.N00° 09' 39"W 627.93 MEAS.S89° 59' 00"E 164.94 REC.S89° 37' 37"W 166.84 MEAS.N00° 08' 30"W 660.00 REC.S00° 19' 45"E 626.80 MEAS.OHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUWS SSSSSSSSS75.2 5.1 92.636.5 113.3 33.0 R.O.W.100' WELL RADIUSPAVED DRIVEWAYP A V E D D R I V E W A Y RETAINING WALLPAVERSTEPSW A L K W A Y237.1℄ LORE ROADHOUSE DETAILSCALE: 1"=20'SHED8. 2 16.2S89° 59' 00"E 164.92 REC. S89° 59' 00"E 165.00 MEAS.CREEKSS24.723. 3 3.2 5.1 3.46.118 . 7 12.028. 8 33.510. 2 9.85. 9 29. 82.13.2 12. 518.631 . 7 1.4PREPARED BY:FRONTIER SURVEYS, LLC650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518907-460-1686DRAWN BY: CHECKED BY: DATE: SCALE:DRAWING ID: SHEET 1 of 11. Excepting for gross negligence, the liability for this survey shall notexceed the cost of preparing this survey. Dimensions to property linesare plus/minus 0.1ft.General Notes DisclaimerLegend1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visibleimprovements and conditions at the time of the survey. This document does not constitute a boundarysurvey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is theresponsibility of the Owner to determine the existence of any easements, covenants, or restrictionwhich do no appear on the record plat. Under no circumstances should this document be used forconstruction or for establishing a boundary or fence line.SS & KC1" = 50ft06/05/201919-482NBScale 1" = 50'AN AS-BUILT SURVEY OFLOT 59, WEST 1/2T12N, R3W, SECTION 4ANCHORAGE RECORDING DISTRICTSTATE OF ALASKA2827 Lore RoadCONTAINING: 109,561 Sq. Ft. +/-RECORD PLAT: BLM MTP 1918ETEElectric MeterElec. PedestalTel. PedestalFound YPCSepticTelephone PoleSignWater WellLight PoleOHUOver Head UtilitiesSWS T A TEOFALASKA49THROYEVR U SDNALLANOISSEFORPDERETSIGERPierre M. StragierNO. LS-981206/09/2020 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 496650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:#viww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191385 Work Type: SepticTank Upgrade Tax Code Number: 01414208000 Site Legal Address: T1 2N R3W SEC 4 LT 59 W2 G:2134 Site Mailing Address: 2827 LORE RD, Anchorage Owner: WILCOX RICHMOND REV TRUST Design Engineer: FORGE ENGINEERING This permit is for the construction of El Disposal Field 0 Septic Tank. 01 Holding Tank ❑ Privy Effective Date Expiration Date r 1?�I��irtrr�eut 9/412019 9/3/2020 Lot Size in Sq Ft: 103433 Total Bedrooms: 4 ❑ 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 recuires 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 Issued By: L ; Date: p Date: / MUMICIPAUTY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 014-142-08 Property owner(s) Wilcox Richmond Revocable Trust Mailing address P.O. Box 101620 Anchorage, AK 99510 Site address 2827 Lore Road Anchorage, AK Day phone 229-8208 Legal description (Sub'd., Block & Lot) T12N R3W SECTION 4 Lot 59 W2 Legal description (Township, Range & Section) Lot Size 103,433 Sq. Ft. Number of Bedrooms Four APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑x Upgrade pg � (w/wo ADU) ❑ Duplex (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: 13:F, -3D Permit No.(IS Jo%q1,3"Q0 6) Permit App_::- : :'-.,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 30, 2019 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: T12N R3W SECTION 4, Lot 59 W2 – 2827 Lore Road Septic System Design and Permit Application Dear On-Site Services Engineer: The septic tank on the subject lot has exceeded its useful life and must be replaced before a COSA can be issued on the property. The attached site plan identifies the location of the home and the proposed and existing septic tank location. The existing well on the lot is also shown. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The new septic tank will be a minimum of 100’ from all private wells and surface water and more than 10’ from the house foundation and 5’ from deck/stair supports. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 8/30/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191385, Rebecca Carroll, 09/04/19 10050 0 FEET 1"=50' 4-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND CO T12N R3W SEC 4 LOT 59 WEST 1/2 LORE ROAD 8/30/19 EXISTING WELL NEW 1,500 SEPTIC TANK w/20' MANWAY. DECOMMISSION EXISTING SEPTIC TANK PER MOA CODE. EXISTING ABSORPTION SYSTEM TO REMAIN IN SERVICE. MH SV Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191385, Rebecca Carroll, 09/04/19 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: E~'0pgrade ~'~zz:-~c,,~,y /~ ,~-%-~ Wastewater System: u New Address: ~z z.~-'~,:~ ~~.~--~'~--~ ABSORPTION FIELD Phone: INo. o ,~drooms: ~eepTrench ~ Shallow Trench DBed ~Mound DOther Total Depth from original grade: LEGAL DESCRIPTION so" Rating: ~ ¢ GPD/Sq. Ft. Lot:~¢ ~ B~ock: Subdiv~ion: Dap h o p pe bottom f¢om original grade: Gravel depth beneath pipe Township: ¢ / Range: ~/ Section: ~/ Fill added above o~nal grade: Gravel length: /~ ' - Ft. ~/~ ~ ~' ~ Ft. WELL: Q New ~ Upgrade -/ Ft. ~'~ ~/ Ft. Yield:GPM [ Pump Set at: Ft. Icssing Height Ab0ve GrOund:Ft. TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S,T.E.P. TO Septic Absorption Lift Holdia9 ~ub~ic/Pdvate Manufacturer: Cap~city in gallons: su,.c~ ~ .~%/ -- - - LIFT STATION Water Foundation ~P'~/~ ~-~/ _ ~ ~ "Pumpon"levelat:~~levelat:l"- I~Highwateralarmat: Drain , , Remarks: BENCH MARK .ocation and Description: Assumed Elevation: Department of Heal~ and Human Services approval ~:"'"?'~, ~-..>.,,,, ~'~: 72-013 (Rev, 9/91) MOA 25 PermH No. SW960155 Page _ 5 _ of Municipality of Y\nchorage DEPARTMENT OF HEALTH AND HUMAN SF-'RVICES ENVIRONMI-NTAL SERVICES DIVISION P.O. Bo;< 196650 ,, Anchorage, Alaska 99[)19.-6650. Telephone 54.5 4744 On-Site Waatewater Disposal System and/or Well Inspection Report Legal Desc~ pUon:_ 112N, RSW, SEC. 4, LOT 59 W2 .......... N \, \ PID No.: 014 142 08 72 015 A (?/91) MO,a, 25 Perrnit No _!;W960i55__ Pace Legal Descriplion: Municipoli!y of Ancl-~orage DEPARTMENT OF: HEALTH AND HUMAN SERVICES ENVlRONMEN'rAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519 66,50, lelepl'one 5,1,5 4744 On-Site Wastewater Disposal System and/or Well Inspection Report [12N, R3W, SEC 4, LOf 59 W2 PID No.: 014 /42 08 ,OL % 72-0i5 A (2./.,I) MOA 2h Rick Mystrom, Mayor Department of HeaRh and Human Sec'vices 825 "k" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 October 30, 1997 Douglas T. Kenley, P.E. 9960 E Puffin Drive Palmer, Alaska 99645 Subject: Waiver Request for T12N R3W Section 4 Lot 59 W~ Waiver Request #WR960029, PID #014-142-08, SW960153 Dear Mr. Kenley: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 4 feet from the trench to the property line. This waiver is a revised waiver and replaces the waiver issued on June 26, 1996. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer On-site Services ljw #7 Dottglas '1; Kenle)', PE 9960 E. Ptlffin Drive, Painter, Alaska 99645 (907} 740-1076 July 7, 1997 Mr. James Cross Municipality of Anchorage Health & Human Services On-site Services Re: Revision of property line setback waiver request dated June 9, 1996 T12N, R3W, Sec.4, Lot 59 W2, 2827 [~ore Road, Anchorage, AK Owner: Mr. Gregory B. Wilcox Dear Mr. Cross: This letter is to request a change in the distance of 6-1\2 feet granted for the property line wavier to read 4-foot from the mandatory 1 O-foot separation from property line to the septic system foot separation. This reduction would not effect the required separation between water wells or septic systems on the adjacent parcel. Sincerely, D~tlglas T. Kenley, PE (J 'C]5; #8176 Municipality of Anchorage DEPARTMENT OF HEAL'tH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 3 4 7 8 9- ~0- 20- Township, Range, Section: /,,.¢-.A¢.~ SLOPE SITE Pi. AN WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT ~ O DEPTH? p Depth to Waler A, ft Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /'~ (m~nutes/mch) PERC HOLE DIAMETER COMMENTS PERFORMED BY: -~'~ ~",/~*~/Z-~'~/' I ~O~;'/_~.¢' ~ ,?~, ~='-AM.~'.~/IFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: 72-008 (Rev. 4/85) ib, I(j /+ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960153 DESIGN ENGINEER:DOUGLAS T. KENLEY, OWNER NAME:WILCOX GREGORY B OWNER ADDRESS:2827 LORE RD ANCHORAGE, AK 99507 DATE ISSUED: 6/26/96 EXPIRATION DATE: PARCEL ID:01414208 LEGAL DESCRIPTION: T12N R3W SEC 4 LT 59 W2 LOT SIZE: 103433 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 (18AAC80) . 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 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDt~R CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. 1 OF 1 6/26/97 SPECIAL PROVISIONS: ON ASBUILT, PROVIDE TEST HOLE LOCATION AND THE SURFACE SLOPE AT THE UPGRADE AREA. Rick Mystrom. Mayor MtmicipaliW of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 June 26, 1996 Douglas T. Kenley, P.E. HC 01 Box 6034 Palmer, Alaska 99645 Subject: Waiver Request for T12N R3W Section 4 Lot 59 W 1/2 Waiver Request # WR960029, PID #014-142-08, Permit # SW960153 Dear Mr. Kenley: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and lot line has been approved. The waived distance is 6.5 feet from the leachfield and the west property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require ali separations be met or another approval from this department. If there are any questions or concerns regarding this waiver, please call our office at 34% 4744. James P. Williams Civil Engineer On-site Services JPW/ljm:Wilcox Dottglas T. Ke.ley, PE HCOI Box 6034, Pahner, Alaska 99645 (907) 746-1073 June 9 1996 Mr. Jim Williams Municipality of Anchorage Health & Human Services On-site Services Re~ Upgrade of a present three-bedroom septic system to a five-bedroom system. T12N, R3W, Sec.4, Lot 59 W2, 2827 Lore Road, Anchorage, AK Owner: Mr. Gregory B. Wilcox Dear Mi'. Williams: This letter is to request approval to upgrade a three-bedroom septic system to a five-bedroom system on the above-referenced property. The Owner of the property intends to add a fifth bedroom to the home this summer. The original system for the property was an undocumented crib. In 1986, the crib was replaced with a conventional trench. It was later discovered that the trench was inadvertently installed across the property line. As a property line setback waiver could not be obtained from the adjacent property ownei; the present system was designed and installed by S&S Engineering in 1994 and lies entirely within the subject property. This 1994 upgrade was reviewed and approved by Mr. Jim Cross of the On-Site Services Department. The existing septic system appears to meet Municipal standards with the exception of an encroachment on a cut-bank with a slope exceeding 25%. We propose to upgrade the existing system to meet the absorption requirements of a five-bedroom home by adding a new trencb adjacent to the existing one and replacing the existing 1000 gallon tank with a new 1500 gallon steel tank, as shown on the attached site plan. With approval from your Department, the additional trench was sized using the pemolation rate obtained by S&S Engineering during their 1994 upgrade (13.3 minutes per inch). To meet the five-bedroom requirement, a minimum of 26 lineal feet of 7-feet effective trench will be constructed. The new trench will have a 14' separation from the existing trench and will tie in 23' from the north end of the present 41' system. Although the lot size is 103,443 sq. t~., there are limitations as to where the additional footage can be installed, namely, an abandoned crib, the trench that was abandoned in 199~1, two cut-banks, and the well radius. The area where the system is to be installed is relatively flat, with the two cut-banks on the lot exceeding 25% slope, one cut-bank being below the proposed septic systein and the other one above it. The present system encroaches upon the 50' setback requirement; however, tbe newly added trench will be installed outside the 50' setback. Sincerely. Douglas T. Kenley, PE CE #8176 J . ,] 10'1 'P' 'C)3g MgB NZLL N / z IO"1 ~' '~,)~ MBIJ NSL.L ×OO'IlM 'G AJ:lO~l:l~) 'J:l~ ,,9-,0[ % /-/7/ Municipality of Anchorage Page __Lo!_ '"~ DEPARTMENT OF HEALTH AN[) HUMAN SERVICES ENVIRONMENTAl_ SERVICES DIVISION ' P.O. Box 196650 · Anchorage, Alaska 995'19-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Aoo~_ {~ ~ ~'~ ABSORPTION FIEI. D Lot:~/~ O~ Block; ~ Subdiv~ion: DepthtopipeboSomfromodginalgra~e)F,. Gravel depth beneath pipe Township:l~~ Range: ~ ~ Section:~ Fill added above original grade:~ Ft. Oravellength: ~[ J Ft~ Number of lines: Distance bet e n lines: WELL: El New Q Upgrade Gravelwidth: ~' Ft. ~ ~'F~ Pipe materiah ~O ~-~ ~ficatipn (Private. A.B.C): ' ~ Total Depth: Cased To: Total absorplion area: Dril,er: ' Date Drilled: S,a,ic Water Leve,:Ft. ~¢¢~>lnstaller: ~ . D,te i.stalled: ~/~h.~- Yield: Pump Set at: C~sing Height Above Ground: GPM Ft. SEPARATION DISTANCES ¢septic~fi/~-~ Holding ~ S.T.E.P. TO Septic Absorpbon Lift Holding Public/Private Manufacturer: ~ Capacity in gallons: From Tank Field Stat[o~ Tank Sewer Lines Walk J~ I~I ~ / ~{C Material: Number of Compa.ments: su,~ (o~'4 ~ ~ ~ ~ LIFT STATION Water V~3 & t ~ I ~ ~- "Pump on" level at; ~l~p off" level at: High water alarm at: Foundation C~.~,n ~ -..- . --A~ [/,~ ~ ~ ~ Pump I Electrical Inspections peflormoO by: Remarks: BENCH MARK Location and Description: ~ Assumed Elevation: /~ ENGINEER'S SEAL, Inspections performed by: ~ ~ ¢~ st ~ ~ " ...... 2nd Department of Hea Hu~ ervices approval/ Rev ewed and approved by: Date 7P-glR trey 9/91) MOA 25 Permit No.Sw94'021 6 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONIViENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescriptio~!2N, RSw, SEC.4: LOT 59 WEST 1/2 PIDNo,: 01414208 FINAL (]RADIi: 77.2'--',; ' C05 coqso.o I ~,8.0 c021t05.0108.0 [ c031110.0193.5 I co51.~,;!~ I ~2!.,81 160.1' NO WATER ~OUND N lO00 GAg. S~PTIC TANK SCALE 1" = 40' do1 ENGINEER'S SEAL Permit No.SW940216 Page 2 of 2 Municipality of Anchorage DEPAR'rMENT OF HEAL.TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Descriptio~!2N, RSW, S['_-C.4: LOT 59 WEST 1/2 PID No.: 01414208 77.2~ MT C05 FINAL ~]RADE co21to5.o188.o I ,~ ; C031 [10,0193.5 I 661 co41[o7.ol es.o I ; ~1~5.51 i~l.~.l ..... i : MT Itl6.01 !07.5_l SCALE 1" = 40' WELL 604 C02 ' N 1000 GAt. SEPTIC TANK ENGINEER'S SEAL PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940216 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:RUDD SANDRA STARR OWNER ADDRESS:2827 LORE RD ANCHORAGE, AK 99507-3009 DATE ISSUED: 6/30/94 EXPIRATION DATE: PARCEL ID:01414208 LEGAL DESCRIPTION: T12N R3W SEC 4 LT 59 W2 1 OF 6/30/95 LOT SIZE: 103433 (SQ. FT.) NUMBER 0F BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IlS FOR THE CONTRUCTION 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 (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 28, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & PLOW TEST SITE PLANS ROAO DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIQNS ON SIYE WASTE WATER [~ISPOSAL SYSTEM OESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Attn: Jim Cross 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: W% of BLM Lot 59, Section 4, T12N, R3W Request you issue a permit to upgrade the septic s~fstem serving the three bedroom house on the referenced property. Per your conversation with John Blaine, we request you expedite the issuance of this permit due to the circumstances which encumber the property. The existing leachfield is located fifteen feet on the adjacent property and an easement cannot be obtained from the neighbors, therefore, in order for the referenced property to be sold, an upgrade is required before a Health Authority Approval can be issued by your department. A test hole was excavated and a percolation test performed in the area of the proposed u~rade. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been checked and found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, ~c~act us. ~nSU/jk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 o ~ II d II NVld .~IlS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SFRVICES "Alaska 99502-0650 825 "L Street, Anchorage, SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ LEGAL DESCRIPTION: ~ SLOP~ 1 2 3 ~ / (.jr_447 10 11 12 13- 14- 15- 16 18 19 20 WAS GROUND WATER ENCOUNTERED? (ENGINEER'S SEAL) ' SITE PLAN IF YES, AT WHAT DEPTH? I~onitorinn? Gross Net Depth to Not Reading Date Time Time Water Drop PERCOLATION RATE / ,'~'% (minutes/inch) PERC HOLE DIAMETER -- T EST R U N BETWEEN ,~'~D ~:~/~ FT COMMENTS $ &-S-EN6tNEERIN~ ON--SITE WASTE~AT'~ DISPOSAL SYSTE~i CONSg]IUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: W½ of BLM Lot 59, Section 4, T12N, R3W The scope of this project includes the installation of a leachfield trench to serve the three bedroom residence located on the referenced property and excavation of the existing septic tank to verify its integrity. If the integrity of the existing septic tank is poor the existing septic tank is to be excavated, pumped, crushed, and abandoned in place and a new 1000 gallon septic tank installed. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall[ be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. o Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two W½ of BLM Lot 59, Section 4, T12N, R3W June 28, 1994 Septic tanks installed with less than 4' of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABS(ARPTION TRENC~/DRAINFI~D INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared~ they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MAT~IAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three W~ of BLM Lot 59, Section 4, T12N, R3W June 28, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FS10 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any grave].. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four W~ of BLM Lot 59, Section 4, T12N, R3W June 28, 1994 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit° There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DE~ ~,RTMENT OF HEALTH AND HUMAN SERt,~JI'"S Envlronmenlal Health Division 825 "L" Street, Anchorage, Alaska 99502, 1 elephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT TANKS [-I~SEPTI C ~J HOLDING Ioo© TYPE OF SYSTEM [~i~.'i~NCH ['~] BED E~ W. DRAIN [~ OTHER Fl WF. LLS L-~PRIVATE DIS'rANCES ~ WELL WELL SEPTIC ABSORPTION TANK FIELD FOUNDATION / AS-BUlL'r DIAGRAM isiiow Ioc¢l~on of well, sephc system, properly hnes, Ioundatmn, [] OTHER (Identify) FT REMARKS: EERS SEAL I __ ~'L-,L_.C~- ~ , ~ t ~__ cerlily thai this inspection was pedormed according Io all ~l, c poad Stale guidelines in effect on this dalo: FIUNI[]IPAL_iTY JiF NCPiORAGE OEPARTIIEU'f OF HEALiH !lUg EIdVIh..,,ENINL PUDfECTIOU ~25 L NTREZ f, AI~CNOR~I[;E, 61 V9501 26d.4720 EIN-S l i E SEt,'IEF~ PERf'I i T PERHIf ~tO: 860429 UPGRADE APPLICANT: EISA RODS ES[ATE ADORESS: CIO ACREAGE S¥S1EOS CONTACT PHONE: 545"2102 LEGAL uEoCnIP, oUdl'hvh~ZOlt, NA LOf: R I/2 59 SECTION: 4 I'UWNSN1P: 12N RANGE: 5W IO[ SIZG: 5.Off (Sr~.F1. OR O£1iEO) i cortily that: l. Ia¢¢ ia~tiiiar mtb the requirements ior on-site em~er, a and oetl~ as set forth by the Nunicipality oi Anchorage (HOA) and the State o{ Alaska, 2. I ~iit install the s,,stm-~ in accordance ;,dth att 14DA codes and regulations~ and in comp}lance with the design criteria si this per~it. 5. ! wilt adUere to ail MOA and State of Alaska ~equirements ~or the set back distance~ Item any existing ~ell~ ;-~asto,~ater disposal svetem or public ~e~,¢erag~ system on this or any adjacent or nearby lot. IF ~ LIFf SfATiO~ IS INSfAi].ED iN AN AREA COVERED BY I~DA BUILDING CODES~ TIIEU fl) AN ELECTRICAL PERHI~ AND INSPECTION HUNT BE OBIAiNED; i2) AS-BUILTS MIL!. ~OT SE APPIiOVED ~;ITOSUI AN ECECTRICAL INSPECTION REPORT~ AND (5) THE ELEC1RiUAL UORK MUST BiZ DONE ~¥ A LICENSED ELECTR]CIAN. · :,,GNU; DATE: APPLICANT: Lu~A"'RIIDD ESTATE I,~oUE~, DY [ ..... C) -v SEWEFt 8YSTEIVi LOC,ATION PLAN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17- 18 2O 'PJF- hector', orq~r~;e..S DA1 Township, Range, Section: SLOPE IGINE~Ef~S SEAL) SITE PLAN 0 '~' ~'~ LZj-J s L IF YES, AT WHAT O DEPTH? p E Oeplh l0 Water~)[~  Gross Net Depth to Net Date Time Time Water Drop --... -- PERCOLATION RATE (minutes/tach) PERG HOLE DIAMETER 'I'VIUNICIPALITY OF ANCHORAGE C ritt r4 r�V 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. 014-142-08 1. GENERAL INFORMATION Expiration Date: �S'` Z / Complete legal description T1 2N R3W SEC 4 Lot 59 W2 Location (site address) 2827 Lore Rd, Anchorage, AK 99507 Current property owner(s) Mailing address Real estate agent Greg Wilcox Day phone 229-8208 P.O. Box 101620, Anchorage, AK 99510 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Z Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment / 20 Date of Payment Receipt Number 0002 Receipt Number COSA # (0. C— 2,1.1 () - 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Benjamin Schiller Date 2/25/21 o !aC,q h i �'49 P -rH 6. DSD SIGNATURE : " ' . : . ' System #1 Approved for bedrooms % . . . Benjamjr�+ chiller . System #2 Approved for bedrooms �������TF CE 12592 'T�/� Disapproved ,11F�PROFESS10Na Conditional approval for bedrooms, with the following stipulations: f OF AN��n��%; \01 A� z o W PFS 1,fGF� A� FIQ 10.0 1��JJJI�' SEII}1 , BY A -\"o Original Certificate Date:_ C?— 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 � �� Legal Description: T12N R3W SEC 4 Lot 59 W2 Parcel ID: 014-142-08 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UNKNOWN Total depth UNKNOWN ft Cased to UNKNOWN ft ❑ Sanitary seal is functioning correctly OR Wires are properly protected Casing height (above ground) 8* in. Date of flow test for COSA 7/16/19 Well production at time of test 4.9 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/L OR Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 02/22/21 Static water level at beginning of test 74 ft. Comments No well log on file. 'Well casing is in a landscaping feature that is about 30" from grade, but only extends 8" above that. B. TANK DATA Age of tank(s) 1.3 years Tank type/material SEPTIC/Plastic Measured operating fluid level in septic tank 65 OR Standpipes/foundation cleanout per record drawing Date of pumping 3/4/21 A+ D. ABSORPTION FIELD DATA Deep trench Which system tested (date installed) 6-30-94/9-7-96* ❑ ALL standpipes present per record drawing Total measured depth from grade 12.8/9.6 ft (max) Measured depth to pipe invert from grade 6.7/3.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.1 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Adequacy test date 7/16/19 Results QPass For 5 bedrooms Fluid depth prior to test 35.5'0.0 in Water added 990 gal New depth 38.5/2.0 in Elapsed time 1440 min depth 38.5ro.0 in l flude ❑ Code -required soil .cover over field FinaP Absorption rate >750 F-1 System presoaked P gPd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) None date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Original trench installed on 6/30/94 then expanded on 9/7/96 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' Q Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' r✓ Yes if No ft Holding Tank > 100'✓Q Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' F/ Yes if No ft F✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E✓ Yes if No ft 0 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' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 7 Yes if No ft Private Wells > 100' Yes if No Water Main > 10' El Yes if No ft Community Wells > 200' Q Yes if No. Water Service Line > 10' El 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' ❑ Yes if No 4 ft Wells on Adjacent Lots: Water Main > 10' ✓V Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS *Waiver #WR960029 AJ G. ENGINEER'S CERTIFICATION ��� 41, ©������ 1 certify that I have determined through field inspections and review 49 TM of Municipal records that the above systems are in conformance with • • • • . • . • ..-, ..:.. MOA COSA guidelines in effect on this date. ' Benjarri wSchiller s •.CE 12592 02/25//21 .,m�/� �01�,VVke�;s�����` COSA Checklist yellow sheet ft ft ft ft Legend X Electric Meterc0' Telephone Pole LT, Tel. Pedestal h Sign A LE\ Elec. Pedestals Light Pole S; Septic `W; Water Well 4111 Found YPC �s1z Over Head Utilities Cnn" 40' Aa"C ala RA nAFAQ General Notes 1. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. Dimensions to property lines are plus/minus 0.1ft. Disclaimer v / L6 1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. 0 25 50 100 Scale in Feet �E OF At,1111i i 4, " Pierr M. St gier Q; N . LS- 12 S. c�r� 06/09/2020 J�cy 9 t Op O tiii, 0111\ 0NA; VP� N00" 08'23"W 660.00 REC. z<i\� )� N00" 09' 39"W 627.93 MEAS. / \ / ��� Scale 1" = 50' � :5 �5. C5 N o SHED cb. PAVER WALL U 762 STEPSW RETAINING Q ti ti W DRIVEWAY , LU CREEK T1 2N R3 Section 4 PAVED ° ° a OR Lot 59, West 1/2 109,561 Sq. Ft. +/- I ,'"� w W w UJ 3 2827 Lore Road I \ o 0 Q1 o M 2 Story Wood Frame House Cl) ,\" 92.6 w/Attached 3 Car GarageAlCO \ CO mrn °'m Q r� , \� to ° (1) co)o \ N �4 \ 0, 33.0 R.O.W. 237.1 0 N00° 08' 30"W 660.00 REC. Q / Legend X Electric Meterc0' Telephone Pole LT, Tel. Pedestal h Sign A LE\ Elec. Pedestals Light Pole S; Septic `W; Water Well 4111 Found YPC �s1z Over Head Utilities Cnn" 40' Aa"C ala RA nAFAQ General Notes 1. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. Dimensions to property lines are plus/minus 0.1ft. Disclaimer v / L6 1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. 0 25 50 100 Scale in Feet �E OF At,1111i i 4, " Pierr M. St gier Q; N . LS- 12 S. c�r� 06/09/2020 J�cy 9 t Op O tiii, 0111\ 0NA; VP� 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 1. GENERAL INFORMATION Complete legal description TI2N; R3W, See. 4; Lot 59 West½ Location (site address or directions) Property owner Mailing address Lending agency Mailing address 2827 Lore Road Anchoraqe, AK Sandra Rudd 2827 Lore Road Anehora9 e, Day phone AK 99507 Day phone 349-2698 Agent Jehn BZ~J~Q./ COLDWELL BANKER Address 4105 Tudor Centre Drive Anchorage, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ __ TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: Day phone 562-2378 AK 99508 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWA'TER DISPOSAL: NOTE: Individual on-site ~,~x Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fxonl MOA #21 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. Phone ~ Name of Firm Address s & S ENGINEERING ,7u;f4 Eag,e River LOOp R~d"'N~2{~4 Engineer's signature Eagle r.'lver, DHHS SIGNATURE ~/ Approved for bedrooms· Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Additional Comments 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 DH HS 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~)25 (Rev. 1/91) Back MOA#21 MunicipaLity of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description:_~--2~----~%- '~ ,, "'~UT~ [_ A. Well Data Well type"~ Log present (Y~) r-. Total depth Sanitary seFY~' ) FROM WELL LOG Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~' I~'~ Driller Cased to ~ ' '~- Casing height W~res properly protecte N) AT INSPECTION ~ .~ g.p.m. ; On adjacent lots J ¢0 ; On adjacent lots ~ ~' Public sewer manhole/cleanout Petroleum tank I~ ~ g.p.m. / / SEPARATION DISTANCES FROM WELL TO: Septic/t'4~M..~. tank on lot I(~ ' Absorption field on lot I '~£-~ / Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform ~')/ Date of sample: Nitrate ~. I,~ ~,~/L-.-Other bacteria ~>//~ ~ ~. B. SEPTIC/I'{~ TANK DATA Date installed _._~'~¢~ J iq Cleanout~(Y/~) _ High water alarm (Y~ Dato ol pumpin~ Tank sizel ~--~4:~ ~¢:~L-~ Compartments F°u ndati° n clean°u~)N) -V Depression (Y/~_.~ Alarm tested (Y/N) Pumper __/~' SEPARATION DISTANCES FROM SEPTIC/~E~I;;[~Iq~ TANK TO: Well(s) on lot /L~21 On adjacent lots I~2) ~'~ "~ Foundation To property line _ { ~/ Absorption field J E::)'~ Water main/service line Sudace water/drainage ( c:~P ' -,I- 72-026 (3/93)' Feont 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) SEPARATION DIS~ LIFT STATION TO: Well on lot ../" On adjacent lots D. ABSORPT 0~t~ FIELD DATA Manufacturer ~ M a n h/o ~tefA"~e s s (Y/N) ..,/"'" "Pump off" Level at Cycles tested Surface water Date installed ~/~1~¢¢~' Soil rating (GPD/Ft2) ~-~) Systemtype -7~'¢~'h-~-FP~ Leah ~ ~ / Wi~h ~ / Gravel thickness ~ / Total depth ~ ~ / Total ab~tion area ~ Oleanout present) V Depressbn over field (Y,~ ~ Date of adequacy test ~/~ Results (pasCfail) ~ ~ for ~ Bedrooms Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~_~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ~O I On adjacent lots TO building foundation ,5~ On adjacent lots ;,~2<~' ' q-- Cutbank Sudace water After test ~/ ;~' If yes, give date Curtain drain Property line To existing or abandoned system on lot ~'~ ~ ~ Water main/service line Driveway, parking/vehicle storage area ~' % E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, Signature Engineer's Name Date and HAA guidelines in effect on HAA Fee $ ~ Date of Payment Receipt Number Waiver Fee ~ Date of Payment Receipt Number 72-026 (3/93)' Back