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HomeMy WebLinkAboutVALHALLA BLK 4 LT 3Valhalla Block 4 Lot 3 #015-211-04 �.rw�n■ t � N ULU 12220i8 Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171036 PID Number: 015-211-04 ❑ New ❑✓ Upgrade Name: CELLER V R REVOCABLE TRUST ABSORPTION FIELD ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 12305 WILDERNESS ROAD ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.6 GPD/SF 13.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.0 Ft. Gravel depth beneath pipe 7.0 Ft. Subdivision Block Lot VALHALLA 4 3 Fill added above original grade 0.0 Ft_ Gravel length 55 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 770Ft2 1 N/AFt. Well 111.2* 124.8* N/A N/A 73.1 TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1 1000Ga1. Surface Water 100+ 100+ N/A N/A Material Number of compartments Lot Line 35.0 8.4 N/A N/A STEEL 2 NA Foundation 38.4 49.7 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ I 50+ N/A N/A Gal. Remarks* DISTANCE TO WELL ON LOT- SEE Pump on level at in. Pump off level at in. High water alarm at in. WAIVER OSV171029 Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 DEANS CONSTRUCTION Drainfield 3034 CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 540.Oft InspectionLocation dates: 6/9/17 2'w 6/10/17 and descri tion p 3"' 6/10/17 4"' 5/9/18 SE BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp „�, OF AL�tlkl Conditional Approval: Date tteve I5annor,e­� &,4"1_V1 �¢ �c . C 814 iANW,,Approved }� e Date % / PR pt�AL � l��,i�a / �4� DESIGN PARAMEI ERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) ` TANK SIZE: 12508 PERC RATE: 20 MPI SOIL RATING: 0.6 GPD/SF AREA ROD: 750 SF SYS. TYPE: DEEP TRENCH 7.0'ED 'MIN LENGTH: 53.6 LF / i� � ` '• USED: fj Ij \ WELL E) i 75' WELL VdAIV R 55.OLFx2.5'Wx7.0' E.D., 13.0' TD �� ( 67' WELL IWAIVER` TOTAL AREA: 770 SF ' E IAMI `1 N 1 I TK P R ` I AND INSTALLED NEW 10009 SEPTIC TANK A -88 6y v j W1TN DCO _ '1� r MaWELL �T i \ 7 i I � 1 3BR i_SFD LL., z DRIVEWAY B /. / 2 1 � I � Q z A B T 1 44.2 58.6 T2 50.4 61.0 DCO 53.1 62.4 C 1 61.8 I 57.7 M 1 62.2 58.6 i C2 62.0 I 95.5 M2 62.6 95.8 /. / 2 1 � I � Q z m . ` ° _ •. evsn°f.°1�annoe° CE 8149 °" o t- z TER FABRIC a U O � D t- O I Z TH-LAMBE /-4'0 DRAIN PIPE m QO O O > o 0W Q G o OHO v J a- u n In 543.00 n nn 943.0 1000 g SEPTIC TANK 120-01niFs CONNECT TO MIDDLE OF FIELD m 103. 94.6- 75.0 1 I �E TKLIE NORTH SCALE 1"= 50' f 4/ r / 4�i �� l 'INSTALLED DRAIN FIELD P I55LFx2.5'Wx7.0'E.D.,13.0'T.D. W/ DCO BEFORE & COs & MTs AT BOTH ENDS \ I` t 1 � tTH-1 7 I I s I ABANDONE76 DRAIN IFIELD (( �ER MOA CODE`~,! 1i . ITN -PES P i 7 I 1 1 t if I 1 i 75' WELL WAIVER 25AUG2003 ,i; f I i 7.0' DRAIN ROCK -4.0 -5.0- -5.0 -7.0 537 -e.0 sP/1 -10.0 -15.0 -15.0 SP/9 -16.0- -17.0- DATE 16.4-17.0DATE PERFORMED: -1e.0 11L 8/22/79 y.0 -z4.4 -z+.4 TEST HOLE t OR 2 ML/ 3 Su 4- 5-- 6- 7- _.567 SP/ 6 1 sm s -I 10- 11 No WATER 12 13 GATE to PERFOR 6ui ERFO1 15 16 7 1 ML ;a 19 NOTES: m . ` ° _ •. evsn°f.°1�annoe° CE 8149 °" o t- z TER FABRIC a U 50' TRAIN ROCK 6" ABOVE PIPE INV TH-LAMBE /-4'0 DRAIN PIPE 1979 7.0' DRAIN ROCK -4.0 -5.0- -5.0 -7.0 537 -e.0 sP/1 -10.0 -15.0 -15.0 SP/9 -16.0- -17.0- DATE 16.4-17.0DATE PERFORMED: -1e.0 11L 8/22/79 y.0 -z4.4 -z+.4 TEST HOLE t OR 2 ML/ 3 Su 4- 5-- 6- 7- _.567 SP/ 6 1 sm s -I 10- 11 No WATER 12 13 GATE to PERFOR 6ui ERFO1 15 16 7 1 ML ;a 19 NOTES: PANNONE EN,f"+. WC, LC P.O. BOX 102954 ANCHORAGE, AK 995101• PHONE (907) 272-8218 FAX (907) 272-8211"°°°°°°••�Scale . ` ° _ •. evsn°f.°1�annoe° CE 8149 °" Date 11/29/2018 RECORD DRAWING_ 50' VALHALLA B4 L3 CELLER V R REVOCABLE TRUST 12305 WILDERNESS ROAD ANCHORAGE, AK 99516 P.I.D. NO 015-211-04 DRAWN j ACP PERMIT NO. OSP 171036 SITE PLAN Sheet 2 OF 3 1 2 3 4 5 6 7 8 9 df 12 13 14 17 TEST HOLE It SM / ML SM/ SP UL j 19 — BON DATE PERFORMED: 08JUN17 SOILS LOG — PERCOLATION TEST SLOPE I I TEST HOLE O SITE PLAN 4 DATE i WATER NET TIME LEVEL NET DROP READING \ J t 11:05 5.900" 2 11:15 1 5.24" 3 I t 3BR i 5.900" _z f 4 SFD I 11:25 I 5.62" DRIVEWA TH-1Q7 I TH-PESP � 5.900" — 6 11:35 10 MIN 7.647" 1.747" 5.72" 2 ' i I I 1 I 1 it � WAS GROUND MATER ENCOUNTERED? \i IF YES AT WHAT DEPTH? —0—' DEPTH TO WATER AFTER MONITORINGS — DRY — DATE: 15JUN201 7 READING DATE GTIOE� WATER NET TIME LEVEL NET DROP READING (DAPI) 1 08JUN17 11:05 5.900" 2 11:15 10 MIN 7.807" 1.907' 5.24" 3 11:15 5.900" 4 i 11:25 10 MIN 7.678" 1.778" 5.62" 5 11:25 5.900" — 6 11:35 10 MIN 7.647" 1.747" 5.72" •Im SOIL TEST RESULTS/ANALYSIS • PERCOLATION RATE 5.7 (minlinch) (Hydrologic Soils Group: HSG A) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 8 FT AND 9 FT. • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED, COMMENTS: Test hole excavated by DEAN'S CONSTRUCTION. Test Hole was NOT required to be presoaked before Perc due to sandy material (Table 3-8, Para.3, EPA Design Manual), PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE G SVC, LLC Date RECORD DRAWING P.O. BOX 1102954 ANCHORAGE, AK 99510 ^ 11/27/2o1a PHONE (907) 272-8218 FAX (907) 272-8211 Scale NTS • •• •' •• P.I.D. NO VALHALLA B4 L3 —211-041 CELLER V R REVOCABLE TRUST `°f1t18R9a PERMIT NO. I CE 81'49 DRAWN AQP a 12305 WILDERNESS ROAD OSP171036 SOLS LOGS ANCHORAGE, AK 99516 Sheet I ----__ _ 3 OF 3 f MUNICIPALITY OF ANCHORAGE On-Site Water &Wastewater Program a1 PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite `` ' epartment On-Site Wastewater Disposal System Permit �/0/1/ /fi»K Permit Number: OSP171036 Effective Date: 5/26/2017 Work Type: Septic Upgrade Expiration Date: 5/26/2018 Tax Code Number: 01521104000 Site Legal Address: VALHALLA BLK 4 LT 3 G:2736 Site Mailing Address: 12305 WILDERNESS RD, Anchorage Owner: CELLER V R REVOCABLE TRUST Lot Size in Sq Ft: 16855 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: El Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. The location of the 1972 crib is unknown. If, during construction, the crib is located, construction of the system will stop and Onsite shall be contacted. 2. The Engineer needs to do a test hole, including a perk test, prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. • Received By: /�. ��-� � .i _�_` _ _ / Date: (V` /7 Issued By: _�� -� - Date: - Z 6 11f11[ Municipality of Anchorage s P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:llwww.muni.orq/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV171029 COSA#: Permit#: OSP171036 PID#: 015-211-04 Legal Description: Valhalla B4 L3 Engineer: Pannone Engineering Services Applicant: Celler V R Revocable Trust Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distances are: • Absorption field to property line, 8' • Field to well on Lot 2, 94' • Field to well on Lot 4, 85' • Tank to well on Lot 4, 90' This waiver approval applies to the proposed absorption field and septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. D Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: 7 Approved by:/ /61 Name of Revie ,! MUNICIPALITY 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. 015-211-04 Property owner(s) CELLER V R REVOCABLE TRUST Day phone Mailing address 12305 WILDERNESS RD, ANCHORAGE AK 99516 Site address 12305 WILDERNESS RD Legal description (Sub'd., Block & Lot) VALHALLA B4 L3 Legal description (Township, Range & Section) Lot Size 16,855 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (EI all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ❑ Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings 0 Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Separation distances (Field to Well / Tank to Well) Distance: 76 6/75 5 I certify that the above information is correct. I further certify that this is in accordance with applicable Munici..I Codes. 44V (Signature of property owner or authorized agent) Permit/Rush Fees: ..6-6(i Waiver Fees: 1(1 2 Date of Payment: 1 /v.c14 7 Date of Payment: EA47 Receipt Number: D3 241 6 Receipt Number: (")C( G q G Permit No. C7 P l 7/03 6 Waiver No. Q SV 17)0 19 Permit App_,- :...c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com 22 MAY 2017 Subject: VALHALLA B4 L3 Septic System Upgrade Permit Request Design Narrative This is a design narrative for a permit to install an upgrade absorption field to be issued for this property. Currently the lot is developed. This lot and the surrounding lots are served by private wells. There are wells within 100' of the septic system however; separation distance waivers exist between the various wells/systems within the area. The existing system is in failure, it is also currently located within the utility easement on the east end of the property. Further there multiple existing waivers for both well to absorption field and well to tank separation distances around the subject property. L4 has a waiver for well (on L4) to tank (on L3) of 67' and L2 has a waiver for well (on L2) to absorption field (on L3) of 95'. 1. Soils. The subject property is part of a known subdivision. John Lambe(1979) and James Mack(1972) excavated test holes on this lot. The test holes to the east and west of the proposed location both had not encountered groundwater and bedrock was not encountered. Based on the results of the percolation tests performed on this and the surrounding lots, and the overall soils appearance; an application rate of 0.6 gallons/day/square feet was used for a conventional wastewater system for this property. I request that a permit be issued based on this soils information. PES will perform an additional test hole at the time of construction to verify soils at the location of the proposed installation. 2. Surface Water: There is no surface water within 100 feet of the proposed upgrade system. The upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography in the area of the system slopes generally from east to west at approximately 8% in the area of the proposed septic system. 4. Waivers: We would like to request a waiver for separation distance for the proposed drain field to the well located on Lot 2 and Lot 4 and a waiver for the potential new tank location on Lot 3 to the well located on Lot 4 with the details of both specified below. No well logs were located for the wells in the area, all soil profile information was gathered from waivers granted in 2003, 2007 and 2014 between the subject property and the surrounding lots. a. Drain Field (P)to Well (E) on Lot 2: A separation distance waiver between the existing well on Lot 2 and the proposed septic drain field on Lot 3. The distance between the existing well and proposed field is 95.6'±. We are requesting a waiver for the drain field to the existing well for a distance of 94' on Lot 3. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 3 1 DEC Criteria: The well on Lot 2 is a private well and is assumed to have been drilled in '1972 and had a separation waiver applied for and granted in 2003. The data is summarized as follows: The ground water in this area typically flows from the north to the south. The soil cross-sections are similar across the area and a homogenous cross-section was used to calculate the DEC criteria for all components. As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: Lot 3 & Lot 2 Septic System to Well: Distance from sewer system bottom to groundwater 7.19 Soil sorption below sewage system 3.76 Soil permeability below the system 2.23 Water table gradient 4.50 Horizontal separation 2.80 Total Points 20.49 "The sum of the above values could equate to the following conditions: 16-24 Almost sure to be free from any form of contamination from household sewage." In my opinion, this waiver request meets the above criteria for approval and does not constitute risk to health. I hope the above information will assist you in determining that the waiver should be granted. b. Tank (P) (Possible) and Field(P) on Lot 3 to Well (E) on Lot 4: A separation distance waiver is requested between the existing well on Lot 4 and the potential septic tank and new absorption field on Lot 3. The distance between the existing well on Lot 4 to the proposed tank on Lot 3 is 93.3'± and to the proposed field on Lot 3 is 85.0'. We are requesting a waiver for the potential tank and field on Lot 3 to the existing well on Lot 4 for a distance of 85'. i. DEC Criteria: The well on Lot 4 is a private well and is assumed to have been drilled in 1974 and had a separation waiver applied for and granted in 2007. The data is summarized as follows: The ground water in this area typically flows from the north to the south. The soil cross-sections are similar across the area and a homogenous cross-section was used to calculate the DEC criteria for all components. As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: Lot 3 & Lot 4 Septic System to Well: Distance from sewer system bottom to groundwater 7.19 Soil sorption below sewage system 3.76 Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 3 of 3 Soil permeability below the system 2.23 Water table gradient 4.50 Horizontal separation 2.40 Total Points 20.1 "The sum of the above values could equate to the following conditions: 16-24 Almost sure to be free from any form of contamination from household sewage." In my opinion, this waiver request meets the above criteria for approval and does not constitute risk to health. I hope the above information will assist you in determining that the waiver should be granted. c. Lot Line Waiver: As a result of MOA requested changes to the design a septic field to lot line separation distance waiver is now required. We are requesting a waiver of the required separation distance to 8.0'. The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, .•• EOF ' y • ttOWIPP • .. .. • �rI : 1�s* Steven R Pannone i • I��aasaa• Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 • IIIX11 /i i fr' '----,, • J / ill 1 ' . I , / ( 5 /. * / ry ***** M /1 l!, ** , 1 11 -I� I 41 r / +, ; , M /I 1 L WELL (El \ j / : �,'�,.�` M / / TRUE NORTH I SC4LE : 1'- �/ — 1 — ( ��� 11iVif- �- -111 Q 4, L zr / rI (( \%/' / \ / f J / J1 I 1 M s7.o I I \� / I ts` 1 I / / N \ \ \I 1J /� I \91 J l WELL EI / � / � � � V 1// 1 lL 75' WELL WAIVER 28 AR2014 / I/ fl r 67' WELL�WAIVB.R 30 IOp2o0� �/ N 1 \ I I I INS ALL OR�IN FIELD P VERIFY INTEGRITY OF TANK ' \ (E�� & REPLACE OUTSIDE 100' 4 85.0 5.61 55L2.5'Wx 0'E.D.,1\,3,0'T.D. WELL RADIUS IF NEEDED_� z� �/ DA BOTH0 E S COs at- • 93.3 1 �\ D. 1- —7 1 3 / I • • � WELL ( I � 39.9 '►�� ABANDON DR• AIN\FIELD(E) \ 1� _ „� t„� 1vil PER MOA'\CODE la, 3-BR- 1 1 - n 1 (n ! / 1 SFD TH-PESIP) f 1 �I 1 Lu�/ Irl -�-- w N 23.1f 1 1 1 \• II DRIVEWAY • N , h 1 1 L_ I wo ✓ �• \� 101.9a TH tsps / I J // / ` / • \ • A / 1 L I �. - • /1' / 2 , �� I I J 1 , ` 1 ! 75.b 11 11 f �' !1 I--k.k�-+- w �� I M i i Li / 1 1 1 I / M s�� L i 1VQ WELL 1 /M 75' LL WAIVER '5A ' 0e3 \ r ``. _ J ,/ I �, I 1 ! � / I / 1 1 1 !L_ ___ ) . • / ./ J / 1 1 ! 1 \ '. .,,,.,:. / e_2 ) 0 z , N_ J YVFII r %/� iii 11 I /1-1 I I '/ i/ ' t� !1 NOTES; PANNONE ENG SVC, LLC OF`• Date FOR CONSTRUCTION 05/24/2017 P.O. BOX 102954 ANCHORAGE, AK 99510 p' •• PHONE (907) 272-8218 FAX (907) 272-8211 . Scale *; - • 1,. ,t , * 1" = 50' \0� P.I.D. 0 — VALHALLA B4 L3 ' • ���- `�, •15-211-04 CELLER V R REVOCABLE TRUST i ..41°M°^ IR• a Wc.14. PERMIT NO. DRAWN JRL i,,,,•.. CE 8149 OSP171036 12305 WILDERNESS ROAD SITE PLAN ANCHORAGE, AK 99516 ° � ::, Sheet 1 OF 2 4" 0 BRAIN PIP DRAIN RI K A . PIP INV FI T R FA:RI iH-tAMBE 1979 EL. 106 -1.0 06 , Ili - 30 IIIII1III11II11I111=11=�I=11=11=1 -2.0- _ 11�I11- 1-11. 1y4M6.0 -4.0 , 3.0— p0.5 1 -7.0- -8.0— SP/ML -9.0— -10.0— 7.0 -11.0- -12.0- -13.0- -14.0 SP/SM SECTION -15.0 -16.0- -17.0- 85 -18.a— iii. -19.0- -20.0- -21.0- -22.0— DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) TANK SIZE: 1250g PERC RATE: 20 MPI SOIL RATING: 0.6 GPD/SF ABBREVIATIONS AREA ROD: 750 SF w w — WATER LINE / TH TEST HOLE SYS. TYPE: DEEP TRENCH 7.0'ED WELL RADIUS (P) PROPOSED MIN LENGTH: 53.6 LF (E) EXISTING USE: —55 —SS — NEW SEPTIC CO CLEAN OUT NO. 55.DLFx2.5'Wx7.0' E.D., 13.0' TD MT MONITOR TUBE NO. TOTAL AREA: 770 SF TYP TYPICAL �\\ � NOTES: PANNONE ENG SVC, LLC Dote FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 _ `` ••.• 05/05/2017 PHONE (907) 272-8218 FAX (907) 272-8211 _ I �4: Scale IP.I.D. NO VALHALLA B4 L3 ' - ; 015-211-04 DRAWN JRL CELLER V R REVOCABLE TRUST ' CE8 49 - •ERMIT NO. 12305 WILDERNESS ROAD . , osP»1a36 • SECTION ANCHORAGE, AK 99516 Sheet I vv, ... 2 OF 2 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 NAMEPHONE �- ❑NEW 4 is UPGRADE MAI LI NG ADDR ESS LEIIGAL DESCRIPTION {`�` `` A 1 24. L CtATION I \ / NO, OF BEDROOMS k^.i�i''�7C -t:° - �..d � '� �"�. \1i'— + '3 V .fit \OG 'a1 t`�� 7tis� Well / (`�'Cbt DISTANCE TO: Absorption area J Dwelling I PERMIT O `� Uy -��j.� � 7 _ _ H Z Manufacturer Maters Z`7'pe" No, of compartments W 1E�1�. L— w Liq. rapae'ty in Ions ` IF HOMEMADE: _ Inside length Width Liquid depth y' DISTANCE T0: Well Dwelling PERMIT NO. 02< Manufacturer Material Liquid capacity in gallons DISTANCE TO:I +11. Foundation,. Nearest lot line / PERMITPN.�C = r u Z W No. of lines Length of ea Ir eei J Total lengtt 41inps Trench width Distance between lines h Z w C "1_ _ __— ��__ inches F. Top of tile to finish grade 6( Material beneath tile Total effective absorption area O _.FFA l zo inches 110 o Length Width Depth PERMIT NO. W Q Q I- Type of crib Crib diam Crib depth Total effective absorption area W 6 _ W DISTANCE TO: Well - t`ng oun atron Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W ig Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER Oat - PIPE MATERIALS - — -p- SOIL TEST RATING - — -ZtO 26n INSTALLER 14 - - REMARK! L3Vf».11'/� iN �iJ, vt= 52. iy,G hfZf$� 6✓At Q _ i21S1hF TIA It= S kL. J 12—tA^_rt_ .-- !�'tJA 04I-� _ C.N `T1dC✓ t y 01 APPROVED DATE LEGAL 72-013 (Rev. 3/78) 1-111001 1 fl- ir eoul.. v -I"u" C) 171 s11hqKLTH-.'Fit 1�1 KAI &� DEPARTMENT OF ME8LTH HND ENV IRONMENTHL PROTECTION 825 'L' STREET, ANCHORAGE, HK 99501 264-4720 fm 61-40 1: - I - LE 50 FR: U-0 Von 002 17,1147 INUvq if -IT' PERMIT NO. ( 790490 ) HPPLICHNT DON DElTZ LOCATION WILDERNESS LEGHL L_: B4 V8LHHLLH S/D L0T SIZE 25000 SQUARE FEET TYPE OF SOIL HBSOR8TION SYSTEM IS: TRENCH MRXlMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)- 20) THE REQUIRED SIZE OF THE SUlL ABSORPTION SYSTEM IS: PERMIT 8PPL{CHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND TME NUUBER OF RESIDENCES THAT THE WELL WILL SERVE 11 - d , 11 C-11 �i�', if i1i 11-i"'IPA."E. ���ILE_ F�7 Fa I j IF FR F 7 U BHCKFILLlNG OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVRL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ 01,! 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARF. RYHI|'HBLE TO INSURE PROPER INSTALLATION. I�T F? RVI X I - 102 1-1 Vol IL FJ EI 15 ��F,i* IE�: Irl V.-, FE IFT it f L , I CERTIFY THAI 1 l HM FHMlL1HR WITH THE REQUIREMENTS FOR ON-SITE SEWERS F-ORTM BY THE MUNIClPRLITY OF ANCHORAGE. 2: I HlLL IUSTHLL THE SYSTEM IN ACCORDANCE WITH THE CODEA ]: I UNDERSTAND THAT THSEWER SYSTEM MAY REQUIRE RESIDENCE 14 REMODELED DE O DMS �FFLIC8NT DON 0 Z~ - YL f? 17 A:N 0, SOILS LOG MUNICIPALITY OF ANCHORAGE u DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TESTOLATION �l Pouch &650, Anchorage, Alaska 99502 276-2224 SOILS LOG — PERCOLATION TEST PERFORMED FOR: t4 6 l—t'CT LW pPatZ . DATE PERFORMED: Z LEGAL DESCRIPTION: DEPTHSLOPE SITE PLAN \ ~J (FEET) t� ~ 2 I r i S'17p iaf >��y �fZAV��I 3 t�t�1, tynYr�lzr�c� w/ _ ids � 4 -16 v 7 1i l�'t Woo&9i—e +- 10 l� _t ��WAS GROUNDWATER II '' SENCOUNTERED?L 12 p - IF VES, AT WHAT E._._' _ 13 DEPTH? 14- 4 Data Gross Time Net Depth to Time. Water 15 15- 16 16 �G'_'O�*l4y C'7t71„d "/ 17 18 S ,5-Z 34 �-- — �J�tEzt r.1�at��t�sY' 19 _3 1-bLP— 47,c1 Tr, 'Z / 20-1 Reading Data Gross Time Net Depth to Time. Water Net Drop S ,5-Z 34 �-- — _3 Z. - _ a Z-4 �J ' 11r,�tL PERCOLATION RATE y (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: '=1 1tv1� �✓��Y't� �ncr�tl Z7 le 34 It) ;44 4 J C�1_£>Gt�l7. J ZNLESY� t1= hb5$l{3l1'- YDS t_c.%/QST 6�F"71 C_ c2r�c_t< ,_< , I J 1 OCDO SCJUhtzl= F .ivy fii= 61 r7 F- \/ L — cw�y U �v�tzJ�v r� t -I I -C, nt"l - Scrrn L UlN l< (5) Gq- t N S'S7.1c1.L317 tLo'L 4 s�vuor, 1(oo5F' >ti l7 F'c,2 rSgrILrz T2E�ls rMt?�tT 4m�� `tn 'NV_�Xt rtt�t=c t-K.t1 Lt1='�.r t 1311_ITj uI= Soffit=.ac[ 'r�fL pr Izr.. tf-c D It --1 �L1Al-r ,w JJ�N1� b`(IyI�S 'HiltLi PtJ ^ t7-INCI 17C SL LAN C PT1GN 4'�G Sl-tALl-o•-( i`1ZizNLI� ••t t'S'v-� / � �,•rt<2 t�th i tlllZ (eve aLK tit S'-a-IZt[i UTtU �I � G %TER ANCHORAGE AREA LOUGH Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME hF.� I�ZK/�e- RI bRS – MAILING ADDRESS PHONE 1. LOCATION fltkVtUi�;' OF'l= ��(.IY-X=/1')YdN LEGAL DESCRIPTION �D/ �� (3L.K -`/.. V�//�/�/J SSC (-3. SEPTIC TANK: DISTANCEJ NUMBER OF FROM WELL 60 i MANUFACTURERSI710K_ fzf L- CSP',MATERIAL V��- %. � COMPARTMENTS z -- INSIDE LENGTH INSIDE WIDTH—_ LIQUID DEPTH --- >6)66 -- LIQUID CAPACITY GALLONS SEEPAGE PIT NUMBER OF PITS —. DIAMETER OR WIDTH/ jLENGTH 7_2, DEPTH L Co,ra'1r.ie PyFr�lmi� , LINING MATERIAL 6(U(-11-% CRIB SIZE: DIAMETER_DEPTH DISTANCE FROM: WELL r TOTAL EFFECTIVE BUILDING FOUNDATION v` , NEAREST LOT LINE ABSORPTION AREA (WALL AREA) 6-'� SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE?NUDIV. 0�11r�_� __CONSTRUCTION 6 0,(4lNq. DEPTH DISTANCE FROM: BUILDING NEAREST i NEAREST / SEPTIC SEEPAGE FOUNDATION ?0 '- LOT LINE l0 SEWER LINE 1t) 1 TANK jZl _1-, SYSTEM ll.G CESSPOOL \l rlLtLliN OTHER SOURCES —"CNI- I APPROVED_ DISAPPROVED REMARKS DISTANCES: _ DIAGRAM OF SYSTEM INSTALLED BY: 00ko(0ir PIPE MATERIAL: _kAJLLPC(J LOT SLOPE: REMARKS: I-Nn/'k Form PW -026 "rp'nK- I� `7 iI l-ICrh ' (y IYQRA �r i5-tYtu�an i Liv oRU DATE0J, ,3e /9/Z APPROVED „a GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY o O ) 3330 "C” STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT 'TUR.JE- C�;0 ✓LOE/L ^� MAILING ADDRESS INSTALLATION LOCATION 44 ALO E/ZA�E-S S ✓JiZ, LEGAL DESCRIPTION /-07 -3 13 LOCJC- y j�y-t,/�- { 1A - INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED PERMIT NO. '/ 2- % L. 0 ns PHONE SEEPAGE PIT �"� DRAIN FIELD , OTHER TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT. SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD SEEPAGE AREA SIZE TYPE SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS, WATER MAIN TO SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT , DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER DIAGRAM OF SYSTEM ? 68 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2 2B -6B AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE /� / �- /� APPLICANT'S SIGNATURE J I y I �' /1 -�. 141 I 1 I �1�Af/4G 1�1/f+YlEl_ +yl >� I/.({,�l'�l(, ✓�'! 41- ? 68 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2 2B -6B AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE /� / �- /� APPLICANT'S SIGNATURE J GRE:, R ANCHORAGE AR[A 130 JGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. ?5011 T111'Oq ROAD I ,LIC I1 1,-1i51) A 4 110,;AGE ALLS111,.902 TLi.I PI. m,r 279.0606 SEWAGE DISPOSAL SYSTk:Ah - APPLICATION AND PERMIT NAME. OF APPLICANTJ 14L[U�I ��. __ MAILING ADONESS __--._—.. _—_ PHONE NSTALLATION LOCATION __--FGAL DESCRIPT'ON :NSTA ELATION OF SEPTIC TANK —_._--__-- SEEPAGE PIl'--- C' --/r DRAIN FIELD _ OTHER TYPE AND SIZF OF FACILITY TO 11E SERVEO J,._—n/Q6✓1—s/I/C` /'�i7iL �� TO BE INSTALLED BY _.--:;o1L TEST REsu Lrs _�.�,C.:.Z— —_ J�' _ NO"I'h_'I YN13 WEF[P.9IT 15 N07 VALID WITHOUT SOIL TEST /=:JOMPLETION DATE ANTICIPATED _ f � 7 . BTINAL INSPECTION, M HOUR NOTICE_' RVOUIRLD. ISACKFILLING OF ANY SYSTF_eA WITHOUT FINAL INSPECTION "Y'ri 4 "iP_'Al-TH DEPARTMENT AUYNOI:ITY WILL r;,E 3UDJECT TO PnOSFCUTION. � l � i ._ EPTIC TANK SIZE 1 /'-" �l �-•� ___ TYPES. i- F'-LS�LGOYICX..P.iLS:SEEPAGE AREA S12E r ' ^ y' 4A/A'1STYPr.-- r�� 21 X .':;)14i NIMIJF9 DIL"TANCIES, REOLIIREMENTS DIAGRAM OF OYSTEM ` ft. _i .. "'OUNDATION TO SEPTIC TANK _— =OUNDATION TO SEEPAGE PIT _20 ft. ..-�nFPTIC TANK TO SEEPAGE PIT WALT. 15 DRAIN FIELD 0 ft• :SEPTIC TANK 5 fiJ._. SEEPAGE PIT 20 ft=. DRAIN FIELD lO ft. TO NEAREST LOT LINE. _ .. NELL TO SEPTIC TANK �/_�? SEEPAGE PIT DRAIN FIELD _/OAU _, ALSO CONSIDER hfii`A WELLS. ":YATER MAIN TO SEPTIC TANK __ LO ft, .. SEEPAGE PIT DRAIN F'IEL.D_10 ft=`. TANK. —__26 fto, SEEPAGE PIT LOO fte_. DRAIN FICLD TO RIVER. LAKE, STREAM. -ASY IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF .-KCAVATION S FEET INTO UNDISTURBED 601L. =INCH DIAMFI ER CAST IRON SIPHON PIPES ON SEPTIG TANK AND SEEPAGE PIE ---ITTED WITH AIRTIGHT REMOVABLE CAPS. .: 1IRAVEL MACKFILL .CONFORM TO F3OROUGII REGULATIONS REGARDING 114STALLATION HEALTH AUTHORITY OR LICENSED DESIGNER C' CAST IR011 51 PITON APSI[ PIPC NITn h1 P11 GIR (R10 NA 1JU CASs IP.ON - — — — — AIO uNo1STPIBEO $Olt -- !- 5'_11 15.. `IIp1Y. N:j I 11111IY.um C I scQuirr_ r1,r vcr line crosses Nnkr drivex.;y. :I LI": -It ITLL ,IiLI, lJS I :::'I Y r'I I:dL lu -U.it. so - 1 0 0'10 PIT- 100' 40 SELLO LBIL. la 1.1 I:i_POn11C In rACK- nB^ T9 rl r. vn' LO ,-I LCO Tin[- 11111 AB'-Ini' 0'i l! CAS: 1^.fill S,,, 111:1 In ;/:Nc. 200- Cf. 00'CLIPSn SrfFC L:I 1011'. L9 Snl'rlC nF 4".,il:'Il/.11011 Cri!16 HJ&r. Bit S_ SIFVLCE L 1 F% tl%tlm011 CASCO CN SOIL Ii'l. H. PAPiJIIL- '.111 CR.IN. - RINIBill 11'DE AATCA I.LL i• [rade e'.per ;C0' or 1/a" r r exc<i,t l0' [receding not ux Lhu. s Bolo' net <ced .. I 20- uI61mun I4/PES1 LOT L Ulf CERTIFY THAT I AIG FAMILIAR Wll'Lt 111E REOUIRIIIAFNTS Of GREATER ANCHORAGE AREA BOROUGH r RDINANCE NO. 20-68 AND THAT l"HE ABOVE 1J;ESCTRBED SYC)TIA4 IS IN ACCO14DA14CF. WITH SAID CODE. ,. r . �yy ._ _ ;.TE _� �..L__ � ___ APPLICANT'S fiIGNiITUfaC � r' .�Z2-' _a( 6' Per1pl104 on fins V.6T Ir01h ,l SEPTIC LUTa. II'L"E 5' m., I ORII'rC[0 ) Ron; 51PIION PIPE "OltC/.$i �\ SEEPAGE PIT J --,CRN �LNAVCt BACK(ILL 20- uI61mun I4/PES1 LOT L Ulf CERTIFY THAT I AIG FAMILIAR Wll'Lt 111E REOUIRIIIAFNTS Of GREATER ANCHORAGE AREA BOROUGH r RDINANCE NO. 20-68 AND THAT l"HE ABOVE 1J;ESCTRBED SYC)TIA4 IS IN ACCO14DA14CF. WITH SAID CODE. ,. r . �yy ._ _ ;.TE _� �..L__ � ___ APPLICANT'S fiIGNiITUfaC � r' .�Z2-' _a( "Oise test is worth a thousand opinions" 9020 TUDOR ROAD, ANCHORAGE, ALASKA 00907 0 TILe�HONe 333-0472 Performed For Jl��jjj,r i}[�7T,�1�aZ__-�__ nate Performed Lea al DescriP.tion: I_ot_3_ Plock Subdivision Vahalla This corm R(snorts Soiis Inn - Pnrcn1atior fest Itenth FeetSoil r.harecteristics Organic rtlt Overhutden I 1 1I - / i J /P a _ _ a2 I. h,r011'd V!a O„ r -. --_ 1, ells, (I Whai ,._(,n,.�,) Test Performed 11vft7?G�o/� Data Certified BY i Date:.../t- j, Rnariinq Jarc ;,-.ss �ir�e Net TiIII 2ent.h to 11,0 PIet Dron; i r - L- — - - - Percolatior Rate U Pronged Inst:.l1at:i i: Drain Fielrl 13 e I) t h of Inlet Denrh 1u d0ttom 0f Pit 0r 7r nrh i; CnMMFNTS NO. bE«r,oCl(_ 1 tt L1.t _i' t3�i bcs ssi �ti;l0 Fiirei>ifl -pJ scl ft, 0 orpk, ut are.R ce glli reci x }e_ ),: OOYOtl(Aphted avarafie) . Test Performed 11vft7?G�o/� Data Certified BY i Date:.../t- j, MUNICIPALITY OF ANCHORAGE 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. 015-211-04 1. GENERAL INFORMATION Complete legal description VALHALLA BLOCK 4, LOT 3 Expiration Date Location (site address) 12305 WILDERNESS ROAD, ANCHORAGE, AK 99516 - I-- ;�_ 9 - z (9 ?---L- Current property owner(s) VICKI CELLER REVOCABLE TRUST _ Day phone Mailing address Real estate agent 500 DONNA DRIVE, ANCHORAGE, AK 99504 2. TYPE OF DWELLING: M Single Family (w/wo ADU) F-1 Duplex F-1 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well E Water Storage El Community Well El Public Water System El Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic 0 Holding Tank D Community El Public Sewer El Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 575o Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA# 05CQ 11 (oQ5 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/18/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 6. DSD SIGNATURE System #1 Approved for Is bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for oF TH Curtis Huffman ;'0,' CE 128991 AGW bedrooms, with the following stipulat F kQ� e) r)ri_0ZlTP WATER AND -'./)) ) I I V % X \\N)) I I � By: _ ( Lo,_ Original Certificate Date: /0 q - J 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 a ^ I Legal Description: VALHALLA BLOCK 4, LOT 3 Parcel ID: 015-211-04 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA [:1 Well log is filed with Onsite (or attached) Date drilled CIRCA 1972 Total depth 130+ ft (PER ACOUSTIC READINGS) Cased to UNKNOWN ft Z Sanitary seal is functioning correctly Z Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 10/15/2021 Static water level at beginning of test 114ft. Comments B. TANK DATA Age of tank(s) 3 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50" 0 Stand pipes/foundation cleanout per record drawing Date of pumping 10/14/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 6/10/2017 0 ALL standpipes present per record drawing Total measured depth from grade 14.6 ft (max) Measured depth to pipe invert from grade 7.8 ft (min) El N/A — pressurized field Structure served by this system _ Well production at time of test 3.8 gpm Water storage tank volume NA gallons Well disinfected for coliform test? [J Yes No 0 Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic_ug/L Arsenic less than MRL (ND) Collected by Fw!rs Date of Sample 10/1512021 C. LIFT STATION El Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/15/2021 Results N Pass For 3 bedrooms Fluid depth prior to test §4 in (4" PRIOR TO PRESOAK) Water added 600 gal New denth 72 in El Monitor tubes go to bottom of effective. If not, state depth into effective 6.8' OF THE 7ED Elapsed time 1440 min • Code -required soil cover over field Final fluid depth 57 in • System presoaked Absorption rate 450+ god (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced 2000 ciallons Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft N Yes if No Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Surface Water> 100' Yes Animal Containment > 50' Yes if No [M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' N Yes if No ft N Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water> 100' Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' I ft ft ft ft ft 0 Yes if No ft El Yes if No *90+ ft Water Main > 10 129 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' N Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' El Yes if No *8+ ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' El Yes if No *85+ ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water> 100' Yes if No ft F. ENGINEER'S COMMENTS *PER MOA WAIVERS & 2018 INSPECTION REPORT IN MOA RECORD DOCS. G. ENGINEER'S CERTIFICATION / 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. .low, .. .. .... ........... Cudis Huffman �01- CE 128991 �,� ;o' 3 0/29/; 1 - 10ROFiM CL m M a 0- z .Q)- 0 T 4� 0 co U, Q �lu i� LL ul Q) 2 *038 99*89t M,,00,69.69N L + O� C14 C) Nz� LU Q) M () co co LIJ Q \w 7 - C) i co 'o 8, IT, Z:--- ') N 0 C/) Lf) U CU CC) Lo :9 411 c) ('O�� C\i 04 F77777r\-- co 0 r lz� 0 0, 7*t,7 *038 99*89t M,,00,69.69N L .3 LLJ O� 'O'd loc > LU + O� C14 C) . Z (D .; (D 10 E co -0 LL 0 LU Q) M () co co LIJ Q \w 7 - C) i co 'o 8, IT, Z:--- ') N 0 C/) Lf) U CU CC) Lo :9 411 c) ('O�� C\i 04 F77777r\-- .3 LLJ O� 'O'd loc > LU Z3 C,� 0 C) ZC14 LO V) (D 'M co 0 r lz� 0 0, 7*t,7 X -X -X -A '03�J 39'89t M,,00,6.9 .68N X -x x co co co co U uj CO C) LU '4 uj u z: LU C/) LO V) (D 'M E -E zi a) (D E E 0 r a, > R E (D CL (V 0 0 > Q) LL- 0 W, o '� aj ;9 .0) mn :� G�): LO > r- 3: c"I (L) 0 ca (D 0 a) a, C: -2 = :3 o a) Rm LO U) CL 0 C� a) 0 o M 0 CL -0 a) U) m r: OCIL 17 2 :3 0 :5 . R 'o In Co u a) so CL -0 0 0 c 2 0 mn T m 0 tLo 00 T -q 15 'n (>L) 2 0 (1) 3: bb LU .CD a) t 0 CL 0 0 E -j a) :�i Ln CN E 0 mo '-s a) E 0 :E cu 0 < (Z) CL; u a) -0.9 C)o :1 Z: ;-- V- -0 W 0 V) — -0 0 a) a) LL CL 0 o 2 f (0 z; m u 0 t)n (3) m ? 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ALASKA 00007 O T[L[P"0f4E 333.0492 Performed For RL;7,7pAi,L LDERe _ Gate Performed 9-30-'I2 I_enal Oescrintion: I.ot_3__Ploch. 4 Subdivision Vahalla This Form Reoorts Soils Lon „p Percolation Test nenth Feet Soil Characteristics --- --— -------- �1 I ''I --i f 2—t c]lty Gravel M Sati95 r I � 10— it _ad;, `;r,lvr° 0 �IF - --j Il0t –{ISI 1) E5' -RO D I T—. Was r -round Water Fncr- mteled? r/1 /119 If ves, At what Denth� Rea�iinq l I Date j �— Grass Time Net Tirne Denth to H OT 2 Net Drop' Percolation Rate Minute Proilosed Installation: Seenage Pit yes Drain Field Deoth of Inlet _ Denth To Bottom Of Pit Or trench COMMENTS: 190 square feet drainaae area required net bedroom no bedrock or water tabl-e 4 ft. below intended seep e pit �� t Test Performed By,ppes D. Mack _ Data Certified By: CON, r Iab Manager pate; qR .. INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME _ DATE DATE DATE (Vl SINGLE FAMILY ❑ One Four ❑ Other ❑ Two ❑ Five INSPECTOR ❑ Three ❑ Six INSPECTOR n/� INSPECTORmilmir Yll �l IPAI ITV C)K AN('HO ✓? INDIVIDUAL* DEPT. OF 1' Al: iI & MUNICIPALITY OF ANCHORAGE ENVIRONMEPdC,'. I, . IILCTION ❑ COMMUNITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION � 825 L Street - Anchorage, Alaska 99501 rr _ pp .AI o 8. SEWAGE DISPOSAL SYSTEM t��l�1\ 1 �) IJt�O I✓I INDIVIDUAL/ON-SITE** ENVIRONMENTAL SANITATION DIVISION ❑ PUBLICUTILITY Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed, Please allow ten (10) days for processing. 1. PROPERTV OWNER PHONE J" f- -g / MAILING PROPERTY RESIDENT (If di ferent from above) IHONE 2 a5 6odl Z 9 2. BUYER PHONE MA LING ADDS� to 3. LENDING INSTI UTION PHONE , L4X,C MAILING ADDRESS 4. REALTOR/AGENT C e b P� PH[OrNE / p , /✓�� jj G —76 a MAILING ADDRESS l!u/ ,�,1L4 tj n �1��GJ /C, 5. LEGAL DESCRIPTION /� / _ LO C L Z-0 7- STR�/EE.T//LOCATION r 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS (Vl SINGLE FAMILY ❑ One Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATERS I�PPLY ✓? INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM I✓I INDIVIDUAL/ON-SITE** 37? YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY '5z NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72 010 (Re 72-010 (Rev. 6/79) 1a THIS SIDE FOR OFFICIAL USE ONLY - 1. TYPE OF RESIDENCE -- E] SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ TWO -O FOUR ❑ FIVE ❑ OTHER ❑ SIX 2. WATER SUPPLY +i] INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER I U �sYe LV�e Ld7 �� DATEINSTALLED Q--� n 61 d � I�PP±ileYJYI�. INSTALLE -©Septic Tank or ❑Holding Tank Size:_ If Tank is homemade give dimensions: SOILS RATING �Q TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA ID r MATERIAL 4. DISTANCES WELL T0:' Septic/Holding Tank Absorption Area Ipp Sewer Line Nearest Lot Line (o i Absorption Area to nearest Lot Line 5. COMMENTS t/X APPROVED FORL BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE , �_ --A�6 BY C 72-010 (Rev. 6/79) 1a GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received Time of Inspection ?: 1 Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL. SEWER & WATER FACILITIES FOR I. Aopro-al Requested By! Address: 2. Prooertv Owner 9. Legal, Des 4, Location: Phone :3 5. Type of Facility to Number of Bedrooms: spected:�� 6. Well Data: A. Type 1 � B. C. Construction 7. Sewage Disposal System: a-� Installed /°--3i-B. Septic Tank: 1. Size 2. D. Seepage Pit: 1. Size 2. Depth Bacterial Analysis 'Q'A pe- _ per, 3 G_'/'� Installer //� Manufacturer lCe P Material��� z E. Disposal Field: Total Length of Lines 9. Distances: A. Well To: Septic Tank_ -So Absorption Area /z0 Sewer Lines Nearest Lot Line ��i Other Contamination B. Foundation to Septic Tank Absorption Area C. Absorption Area to Nearest Lot Line -c> , Requeet for Approval of vidual Sewer & Water Faciliti Page Two 9. Comments : j�� u j y @C ,c CLC_�o x rrLo Gl eCt �vL e_`e.�Ln.�t+1 Annroved Disapproved�e��.���to�te l%��G173 Approval Valid for One Year From Date Signed Greater Anchorage Arca Borough, Department of Environmental Quality DIAGRAM OF SYSTEM. I certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water facilities located at: Signed Date -- Annroved Disapproved�e��.���to�te l%��G173 Approval Valid for One Year From Date Signed Greater Anchorage Arca Borough, Department of Environmental Quality DIAGRAM OF SYSTEM. I certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water facilities located at: Signed Date