Loading...
HomeMy WebLinkAboutWOODHAVEN #2 TR C Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241117 PID Number: 015-281-60 Dwelling: Z Single Family (SF) F-1 with ADU El Duplex (D) 1771 Two Single Family Project: 1771 New E Upgrade Name LARRY & LISA MCPHETERS ABSORPTION FIELD E] Deep Trench Z Wide Trench n Bed 0 Mound Site Address 11701 JEROME STREET, ANCHORAGE E] Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1 2 (513R TOTAL) 0.6 GPD/SFI 6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot WOODHAVEN #2 TRACT C Fill added above original grade VARIES 1.1'- 1.52 Ft, Gravel length (2 @ 25) 50 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES ToSeptic lAbsorption! Holding Sewer Lift Station Total absorption area Number of trenches Dist. between trenches From Tank 1 Field Tank Line 500 F t2 2 10 Ft. Well 100'+ 100'+ 100'+ 25'+ TANK 0 Septic El S.T.E.P. 171 Holding 171 Other Manufacturer GREER Capacity 1500 Gal. Surface Water 1 100'+1 100'+ 10 01+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ 5'+ NA Foundation 10'+ 10'+ 10'+ LIFT STATION Manufacturer ORENCO Capacity 75+ Gal. Remarks Augmented 3BR septic with this 5BR system. Decommissioned existing septic tank. 2" insulation. Alarm location Electrical installed by FIRST FLOOR 907 ELECTRIC Installer PCN Tank I d PIPE MATERIAL House to tank 3034 o 3034 Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 It Inspdates: 2ection 1" 6/20/2024 6/21/24 Location and description -- 3`d 6/24/24 4"' 6/25/24 ITOP OF MANHOLE SEPTIC TANK ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date - ----- --------------- A0, 7H --- ---------- Septic System CLIfIls Huffman Approved Date Z16%, CE 128991 2 061"16,24 PROFE06W --0- Note: this a I does not include well permit requirements. (Rev 05i02118) PID:015-281-60PERMIT:OSP241117 FIRST WATER CONSULTING WOODHAVEN #2 TRACT C BAMS OF BEARING I ANCHORAGE RECORDING DISTRICT, ALASKA AS—BUILT OF: � WOODHAVEN SUBD ADD. Nat TRACT C PLAT 71-239 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. tinder no circumstance shoulc any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the .recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAIL: JUNE 28, 2024 1 "=50' schullerak®gmail.com 24-056-2 DRAW BY: CHECKED BY MD NUMBER: BOOK AGE: JLS SW2735 240227 Q = FIND 5/8" REBAR. W 0 LO 0 0 0 U~7 A 4S .S• O F ` �0 L A� 01 L 4 9TH '• ®................... .......� z ?A ... . ...... w. ........., .. ..Rd •.JQH-, N L. SCHULLER.•: ® �• LS--10408�� ��, ' • , 1.831 Talkeetna Street �°cy ::j. 24 a ,� Anchorage, Alaska 99508 Ar 6 'rear esslo� & �. 1~ (907) 22'7--1455 office ��..v (907) 274--4992 fax asp MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241117 Work Type: Septic Upgrade Tax Code Number: 01528160000 Site Legal Address: WOODHAVEN #2 TR C G:2735 Site Mailing Address: 11701 JEROME ST, Anchorage Owner: MCPHETERS LARRY A & LISA M Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 6/13/2024 6/13/2025 99309 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: ( S r w c. Issued By: n , �---- Date: Date: 20 Z 5 Phone- 907-343-7904 Fax- 907-343-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-281-60 Property owner(s) LARRY & LISA MCPHETERS Day phone Mailing address 11701 JEROME STREET, ANCHORAGE, AK 99516 Site address 11701 JEROME STREET, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) WOODHAVEN #2, TRACT C Legal description (Township, Range & Section) (UPGRADING FROM 3BR TO 513R) Lot Size 99,309 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (0 all that apply) Absorption Field � Initial El Single Family (SF) (w/wo ADU) Septic Tank 0 Upgrade M Duplex (D) El Holding Tank ❑ Renewal El Multiple Dwellings ❑ Privy El (SF and/or D) Private Well El Water Storage R THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Permit No. 0 S Receipt Number: Waiver No. GjDeveloprnent Services\Building Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 4, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: WOODHAVE #2, TRACT C The property owner has requested we obtain a permit to upgrade the 3 -bedroom septic system to a 5-bedroom septic system of the above referenced lot. We propose to augment the existing two trenches that passed a 3 -bedroom septic adequacy test and install one shallow trench and one 1500-gallon HDPE Greer 10-foot burial septic tank anchored along with a separate pump basin anchored to serve the existing 5-bedroom residence. The design is based on the recent test hole conducted on May 24, 2024. Groundwater was observed at test hole excavation at 11’ and at 10’ at monitoring. The slopes are moderate at 0-5% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241117, Curtis Townsend, 06/13/24 FIRST WATER CONSULTING WOODHAVEN #2 TRACT C DESIGN CALCS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241117, Curtis Townsend, 06/13/24 FIRST WATER CONSULTING DESIGN DETAILS: WOODHAVEN #2 TRACT C Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241117, Curtis Townsend, 06/13/24 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: WOODHAVEN #2 TRACT C PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/3/2024 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 SM/GM-ml 5 6 7 8 9 10 11 12 SP/SM 13 BOH 14 15 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 5/31/24 30 min 6” 1 7/16” 30 min 6” 1 7/16” 30 min 6” 1 7/16” PERCOLATION RATE 21 (MIN / INCH) TEST RUN BEWTWEEN 3 & 4 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: YES IF YES, AT WHAT DEPTH: 11’ DEPTH TO WATER AT MONITORING: 10’ DATE: 5/31/2024 TESTHOLE # 24-1 DATE PERFORMED: 5/24/24 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: LARRY & LISA MCPHETERS 6/3/2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241117, Curtis Townsend, 06/13/24 BASIS OF BEARING NP0000'00"F ?9,9-49' (��nn_?q' R) I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: WOODHAVEN SURD ADD, Not TRACT C PLAT 71-239 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no cnchroachments exist other than noted. Under no circumstance shouli arty information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any casements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE- SCALE: E—MAJL JUNE 4., 2024 1 =50' schullerak*gmail.com 24-056 DRAWN BY, ICHECKED BYGRID NUMBER: B(W/_PAc E JCS SW2735 240209 00 = F'-%,NTD 5/8" REBAR 1 50' Lij C CCU CD 0 0 SUR L AA,- 01 . 49 1831 Talkeetna IN' )treet Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax [- Municipality of Anchorage Page __I of 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 Permit Number: '~/ ¢/~O°'Q'/"/~ PIDNumber: _;'m":~(Jto~f'¢J ~ ~'¢//Qn ~1~6¢ WastewaterSystem: D New ~Upgrade ~m,,p.~, 50~ 1108~ ~Ehor~.~o ABSORPTION FIELD .,o.~: 3Hd-q175 ~,o.o,,~,~om~ B Deep Trench ~ShallowTrench BRed QMound QOther LEGAL DESCRIPTION soi~.atm:[~, ~ GPD/Sq. Ft, Total Depth f om originalgrade:~ -- ~ h~U~- ~ ~ Depth to pipe bottom from original grade: G ravel depth beneath pipe WELL: E//¢¢h~ New B Upgrade Gravelwidth: ~. / Numberoflines: Bistance~etweenlines: --~'asslficati°nprl ~'h~(Private' A.B.C): TotallocDepth: Ft. CasedlocTo: Ft. Total ab~rea: SQ. Fi. ~7~Pipe material: Date Drilled: Static Water Level: Pump Set at: I Oasing Height A~ve Ground SEPARATION DISTANCES ~ s~,o ~ ~o~,no AS.~.~.,. To Septic Absorption Lift Holding Public/Private M~nufacturer: ~ ~ Capacity in gallons'. From T:~k Field Stat[o. Tan, Sewer Li.e, ~nchor~¢e ~ wm~ /~o'.~ /o¢* /oo + LIFT S'rATION Size in gallons: Manufacture~ ' Pump on level at: "Pump off" level at: High ~t~larm CudainDrain ~O"~ ~0~' ~/ -- P, mpMak,,Uodel Electricallnspectlonsp~or~e~y: Remarks: ¢[~ ~1~ ~¢~5~m ¢~)~dOn6~ BENCH MARl( Inspections pedormed by: ~/¢5~a~-, ~a¢~e~ates: l sL '~ ~/' .~' ~'' ~'~ Depadment of Health and Human Se~ices approval :~~;'~":'~;?O~ESS~;~ ..... Reviewed and approved by' ~/~-~,/ ~, ~Date: ~' ¢' 1 ¢ 72-013 (Rev. 9/91) MOA 25 ~ ,' <' ORIOINAL O~DE FABRIC = gg PROFILE OF S,T.E,P, SYSTEM ~u'n & MI2 V M13 & MT4 N.T.S. = 92.61 = 94.(18 PROFILE OF' DRAINFIELD N.T.S, ~ ~ / FCO~ I I ~ _~ // POINT "A I MFS 56 0 - 50.0 / ~ , '~ 7320 E. CHEWER HEIOHTS CIRCLE. ANCHO~GE, AK gga04 ~.. ...... PHONE: {907) 3~7-617g/FAX: (goT) WOODHAVEN SUBDIVISION ¢2, TRACT O DESIGN OF SEPTIC SYSTE~ UPGRADE PREPARED FOR: PIIONE NUM[IER: J.L.M, 1 = 40' 2 OF 2 ¢"-,-- frO° 0 C~ M~ke Spend[ove MKS Rental & Equipment 2620 Sprucewood St. Anclmrage, AK 99508 Shop 345,.9737 Home 274-7775 ESTINIATE 5018 8/4/98 GI_IEN I' Ed Baker 11701 Jerolue rd. Anch, Ak. !)9516 JOF SITE & INFO Same Loeastion; 345-4175 [)ATE 'fE;,~MS DE.~ICI]IPTION AMOLIN'[' The well caseing was {',tit off bellow gcade flttd filled with ~mad fi'om Lake Otis sand attd gravel. A concrete ping was poored inside the last one foot of caseiag attd allowed to mnshroom ovec thc top. Total so.oo { J ~ORRECTIONB E~N/IAL A~ EXPLAINED BELOW '~ ~.J~' )~" : ~' ": / . DATE' NOTRE~OVE11flS~] CE" ~:~."' .. '~1~ MI3NICIP3~LITY OF ANCHOR3~GE DEPARTMENT OF HEALTH AND HU~ZLAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~.NCHOPg%GE, AI~SIqA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PAGE 1 OF 1 PERMIT PERMIT NUMBER:SW980246 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER ND24E:BAKER EDWARD & LEELLEN OWNER ADDRESS:P.O. BOX 110843 ~NCHORAGE ALASKA 99511 PARCEL ID:01528160 DATE ISSUED: 7/17/98 EXPIPd~TION DATE: 7/17/99 · LEGAL DESCRIPTION: WOODHAVEN ~2 TR C LOT SIZE: 99309 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PER/~IT: 3 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 ANCHOP~AGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) ~D DRINKING WATER REGULATIONS (18D3~C80). 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 UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SED~LED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: Alaska Water & Wastewater June 29,1998 7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers REC. EIVED Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Sgction P.O. Box 196650 Anchorage, Alaska 99519-6650 JUN 3 0 1998 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SlERVIC~S DI¥1$1ON Ref~ Septic Upgrade Design for Tract C, Woodhaven Subdivision #2. To whom it may coJacern: 3 The exigting,-4'bedroom house is served by a private septic system and well. The existing trench is surcharged and must be upgraded. Two test holes were excavated to the east and west of the existing septic system. The test hole to the east will be used for the upgrade design. Comments regarding the proposed upgrade design are sunnnarized as follows: 1. SOILS: Attached are the logs which shows the soil profile, and the percolation test result. In the east test hole (labeled TH#2), the soils below the organics are primarily SM material with light gravel to a depth of 6 feet. At 6 feet the soils than transition to a SM/ML mixture to a depth of 14 feet (bottom of test hole). Groundwater was encountered in test hole #2 ,during the excavation, at depth of 12 feet. One soil percolation test was performed at 6.0 to 6.5 feet which perked at a rate of 20 minute/inch. 2. TRENCtl DESIGN: a. Percolation Rate: 20 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 750 ft2 f. Effective Depth: 4 feet h. Width: 5 feet i. Minimum Length: 80 feet total length (2 @ 40 feet long each) j. Effective absorption area = 800f~T(>750 ft2 OK) k. Maximum depth = 6 feet 3, SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4:' TOPOGRAPHY: The topography of the area for the proposed upgrade is generally a 5% to 7% slope running from northeast to the southwest (see attached drawing). In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems, tf ,ou have ,'my questions, please contact me at 337-6179, or 244-9612. Thank you for your assista~e. Sincerely,/ . Jeff Gamess, P.E., IV[S. Princi Ld~ N 1/2, NW 1/4, NE 1/4, SE 1/4-, SECTION 21, T12N, R:SW _-XISTING SEPTIC SYSTEM TO BE ABANDONED COMPLETELY (ENCROACHING GROUND WATER) OPOSED SEPTIC (SEE DESIGN, PAGE 2 OF TRACT D- 113-A WOODHAVEN S/D _,L--APPROXIMATE LOCATION OF SURFACE WATER. >200' FROM PROPOSED SEPTIC SYSTEM, TRACT D- 1B.-A WOOBHAVEN S/D PREPARED BY: ALASKA WATER & WASTEWATER LEOAL DESCI,~IPTION: WOOl)HAVEN SUBl)IVISION #2; TRACT C, fYPE OF WORK; SITE PLAN PREPARED FOR: PHONE NUMBER: ED BAKER (907)345-417!5 A.C.G. 1 = 100~ 1 OF' NOTE: THERE ARE NO WELLS WITHIN 2OD' OF PROPOSE[') SEPTIC SYSTEM OTHER THAN SI- OWN. I NOTES: 1. THE CONTRACTOR IS REQUIRED 'FO HAVE TIlE NORTH PROPERTY LINE FLAGOED BY A REGISTERED LAND SURVEYOR PRIOR TO CONS'FRUC rlON, 2, THERE ARE NO WELLS wFrNIN 200' OF PROPOSED SEPTIC SYSTEM OTHER THAN SHOWN. EXISTING SEPIlC SYSTEM TO-~ BE ABANDONED COMPLETELY /\ (ENCROACHING GROUND WATER)/\ ~, ~ PROPOSED TRENCHES j ~r ~ ~ //~ 40' LONG BY 5' WIDE BY ~~ '%~ ¢~ ~ '/ ~' ~E~ W/ ~' 0~: S~W~R ~ ~ ~ '~ '~ // DRAINROCK, THIS IS A I '~ ~ ~ ',~/ ¢~ PRESSURIZED TRENCH (SEE I ~ DETAIL, PAGE 3 OF' ~). ~ // ~ EXISTINO I / .,~ 5 BDRM ~ / ~a , HOUSE ] / uJ ~ / , ~ WELL (TO BE ABANDONED I I ~ WITH CURRENT MUNICIPAL I I__ a. WELL ORDINANCE). I I - 2 - J " - WELl I // ': Xx _ / ~ ~ SHED~ ~REP~ED BY: ALAS . WA :R WASTEWA ER DESIGN OF SEPTIC SYSTEM UPeRADE ~ F'EEP~ED FOR: PHONE NUMBER: ~ ". NO 9608 .' BAKER ~45-4175 'v~'.... C.E ..." .,~ . ~;~, · . ........ · I [ L .............. J I I ~ l ALAS~ WATER & WASTEWATER ~ g~.' ....... 7'-.2~ ~ ........ ~.,~,.~ :~ .... DETAIL OF PRESUURIZED TRENCHES , ' j ~JAMES P. WILLIAM~ , ED BAKER J,L.M. N.T.S. [-J~LASKA .WATER ~ WASTEWATER 7320 E. (,ttESTER HIS, CIRCLE A~CH~'~IB-~¥- PHONE (907) 337-6179 * FAX (907) 33B-3246 [SOIL LO(; - PERCOLATION TESTI LEGAL DESCRIPTION: WOODHAVEN SUBDIVISION #2,TRACT C PERFORMED FOR: ED BAKER .... DATE PERFORMED: 6/15/98 ORGANICS ITEST HOLE #2 SM W/ LIGHT GRAVEL SM/ML SILT TO SILTY SAND B.O.H. SOIL CLASSIFICATIONS ORG ML CL OL MH CH OH SC DEPTFI TO DATE GROUNDWATER 12' 6/15/98 12.5' 6/18/98 12.5' 6/26/98 I = O0 DATE READING CLOCK NET TIME WATER LEVEL TIME (MINUTES) READING ./15/96. BECA..PRESOAK . 6/18/98, NET DROP (INCHES) (MIN./INCH) PERCOLATION RATE 20 PERC. HOLE DIA. 6 (INCHES) . TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. COMMENTS. PERFOMED BY ALAS, KA .WATER & WASTEWATER I, ///l~ 1¢ W~J{-~~-~ ,CERTIFY THAT THIS WAS PERFOI~MED J~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: SM/GM ML ML/GM SOIL CLASSIFICATIONS ORG ML CL OL MH CH OH SC DEPTH TO DATE GROUNDWATER 6' 6/15/98 12.5; 6/18/98 12.5' 6/26/98 B.O.H. SITE PLAN i"= ioo J DATE READING! CLOCK , TIME 6/15/98 NO PE ~COLATION NET TIME WATER LEVEL NET DROP (MINUTES) READING (INCHES) '-ST PERFORME[ PERCOLATION RATE N/A (MIN./INCH) PERC. HOLE DIA. -- (INCHES) TEST RUN BETWEEN~ FT. AND FT. PERFOMEB BY ALASKA WATER & WASTEWATER l, //~/J/~,'" ~/F~ , CERTIFY THAT THIS WAS PERFORm'lED/IN ACCORDANCE WITH ALL S~I'~TE AN[) MUNICIPAL GUIDELINES IN EFFECT ON THIS a~u::l L:he !:~ka.i:.c~ c)J ~' II :J !ii~ t:) c,r' Iii :i. 'l:.. (907) 243-2282 KEN JOHNSON KEN'S CO IPANY WATER WELL DRILLING PUMP SALES & SERVICE 35 YEARS ALASKA DRILLING 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 OCTOBER 15, 1987 EDWARD & LeeELLEN BAKER JEROME & KLATT ROAD ANCHORAGE, ALASKA ( 345-4175 ) RE: TRACT C W00DHAVEN NO. TWO WATER WELL LOG MUNICIPALITY OF ANCHOPC'~GJ[ DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION OCT 2 RECEIVED HOLE # ONE, DRILL TO 31 ft hit move over 10 ft. large boulder..bent shoe.. pull out and Hole # two; 0 ft to 2 ft 2 ft to 6 ft '6 ft to 31 ft 31 ft -to 46 ft 46 ft to 51 ft 51 ft to 52 ft 52 ft to 56 ft 56 ft to 61 ft 61 ft to 66 ft 66 ft to 69 ft 69 ft to 70 ft 70 ft to 91 ft 91 ft to 94 ft 94 ft to 96 ft 96 ft to 100 ft 100 ft to 105 ft 105 ft TOP OF CASING 108'-0" (TOC) Sandy to soil Gravel & gray silt Brown silt & fine gray Hardpan..course gray & gray silt Same.. courser gray Medo gray & gray silt.. Weeps.. 15' overnight Course gray & gray silt..dry Same..weeps.. Tight gray formation. H20. 2-3 GP~...10' head Tight cours gray ..dry Over night weep 10' head Course grav..occasional w~eps.o Same..stronger weeps~ Med. gray & lt. brn silt..open Cours gray dry,. Cours gray. H20..tight formation. 3 GP~ 15' head Clean water bearing med. Samd & grav..Tight.. Static water level 57 ft ( TOC ) over night Test bailed one hour at ten GPM Drawdown to 95 ft..TOC Bottom stable & clean Good recovery.. ( See TEST PUMP LOG ) Total easing 108'-0" .~..~ GRE~,,ER ANCHORAGE AREA BOR.,dGH ~:i i~i,?)~) Department of Environmental Quali'ty ~"~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS ~ ,~ (/__,"~-i/.~ ~'~ PHONE LEGAL OESC R I PT ION _'7~/:~ <~ 7 SEPTIC TANK: DmTANCE ~ PROM WELL. ~ INSIDE LENGTH MANUFACl URER _-j~M'~ INSIDE WIDTH MATERIAL ~" ~ NUMBER OF COMPARTMENTS LIQUID DEPTH ~' LIQUID CAPACITY/~-~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL//~) ~ FOUNDATION /'~¢) '~' TOTAL LENGTH ~, t NEAREST LOT LINE ~; Z .OF IINES ~7 NUMBER OF LINES__ / __ DISTANCE BETWEEN LINES _~/~ TRENCH WIDTH~IN. TOTAL EFFECTIVE ABSORPTION AREA ~0 8 SQ. FT. LENGTH OF EACH LINE ~ / MATERIAL. BENEATH 'FLEE ABOVE TILE __ IN. WELL: TYPE BUILDING FOUNDATION CESSPOOl APPROVED ..... .... CONSTRUCTION NEAREST LOT LINE OTNER SOURCES DISAPPROVED__ NEAREST SEWER LINE DEPTH SEPTIC SEEPAGE TANK____. SYSTEM REMARKS DISTANCE FROM: DISTANCES:__ SEWER LINE DEPTH: PIPE MATERIAL: Form EQ-032 I...OT 'l".r'~:::'t~ (])F :~i;i]1Z L. A[3SOF?.I3T ]: ON SYs'r'Ii~;H Z S: 'I"I;i:Ei:I'.,fC;H SOIL. I:(:I::IT]iI",IG ,:iS(i:! F-'I",.."E:F.-:)::: ;].:i~E:J "I'HI;E I:;]:li:~:(.:!L.I]:l:~:liEI]:, S;[;?_'IE (}F:' TI'"IIE :iii;C);[L. I:::II3'i~;OF?.I::'T]:[)I",I SYS'['Ii]I"I ilS: '1"1"11~i! LIEI',I(3TH D :1: I"llEI",IS ]: I]:ll'.,I :[ '.Fi; THE: I..EEI"4GTH ,:: ]: I",1 FEi;ET ) OF:' THE: '['R:EI',IC:I'I O1:;?. I)I:~'.Ft 'I"I'"IE I])Ei]::'TFI I]_~1~;:;' I::1 "l'F::l!~(l'q(;I-I EII:;~: I:::';[-I' ]]S THE] D]]STI:::II",IC:Ii!:i lii!:[ii:"l'l,.llii!:l!ii:l",l THE 'J~;I.JI:;~:FT:::II]]:E I]]]11:::' 'I"HI!E []iF;;'.[]d. Jl"~[) F:IND 'T'HE [3OT'I"EIH O1:::' "I'HIE I.':.:::.::E:FI',,,'FIT]:[]II',I ,::~1',1 F'IiiEET). 'I'HE~N:E ]:'.il; I'.40 SET I,I;1:1~:,"1'1..'1 I:;'O1:;~: 't'I'-IL:~ G~'.FI',,,'EI. I)EPTH ]:S 1"HE h'l]~l",l];I"ll..ll'"l E:,IiEF:'TH OF (3F:'.I:::I'v'IEL. 131E'I*HI!iilEI',I TI.lIE OI...rI'I:::FiI.L. I:::']:l:::'li: FII',I[) 'I"HE I:.:.:(:)T"l"(:)hl (]11:' THE E',:.::{)f:l',,*'l:::l'l']:(}l'.,l (][1'.,I I:::'EE'T'). i'"l]]b,I]:l,'ll..Jl','t I])];'.~i;'I'FIIm.,IC:E BE:I'HEE(I',I I:':l HEI....L. FII'.,II]) FII",IY [:]I",I-S][TE SEHI:::I(~iliE I]) ]] !~I:':'CE:J;F:IL. SY:il;'I"F(H j..l~iil;~l Iz'I!EEET F:(]II:;?. F:I F'I:;;i]:',,,'FI'I"Ei] HI~:I...L O1:(: ;i;i:E)l~) Fli~:IET F;'OF~: I::1 [::'l..ll]!i:l.. ][ I]:: HEI..I .... 'i~;F:'IiJJC: ]; I:;:' ]: C:I:::I"I' ]: [31'qS FIt'~ID C:I31",ISTI:;?.IJ[:]"I'];()I',I I) ;[ Fl[]il:;',FIl'"l:i~; FIF;',I:E F:I',,,'F:I];I...F;Ili31...F;: '1'0 ;[l",l:!:;I.II;~:li}: ]: IH S "l"l':ll..I.J:::ll' ]] CII',I. F" lIEiE; IF;~L" t1"""1t ]tt:] ""IF ".,,,," It::::1t II...... ]tl]~ lIE::. IF::::" ,]iE)l It:;i~:: C)I It"-.11E(!i] '%-" I~E~:i] II::::111F;;i;~ IF:::' I~::;;i;:: eE])l Ih"ll ]E :~ii~ii;; ';i~ii~; IL.il lEi!E; October 26, 1976 R & M NO. 656318 Edward Baker S.R.A. Box 1742A Anchorage, Alaska 99502 RE: Test Hole and Soil Log Report for Sanitary System Woodhaven Subdivision Addition ~2, Tract C, Anchorage, Alaska Dear Mr. Baker: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This in- vestigation was performed in accordance with your request of October 25, 1976 and those procedures outlined in a letter dated July 15, ].975, by Mr. Rolf Strickland of the Muncipality of Anchorage Department of Environmental Quality. A single test hole was put down within the subject site area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 11 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01o Groundwater was not encountered in the test hole while drilling. A percolation test was performed from a depth indicated and reflects average infiltration from that depth to the bottom of the hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Rooney Vice President JWR/ddp xc: Municipality of Anchorage TIME 11:57 li:58 11:59 12:00 12:01 12:02 12:03 12:04 12:05 12:06 12:07 12:12 12:17 12:22 12:27 12:37 12:47 12:57 PERCOLATION TEST EDWAI{D BAKER R & M NO, 656318 ELAPSED TIME 0 1 2 3 4 5 6 7 8 9 10 15 20 25 3O 40 5O 60 INCHES 10'4" 4.0 4.25 4,5 4~5 4,75 4,75 5,0 .5,0 5,0 5,25 5,50 5,75 6.25 7,0 7.25 ]0 ' 7.5" DROP INCtIES 0,0 0,0 ,25 ,25 0,0 .25 0.0 .25 0.0 0.0 ,25 ,25 °25 ,25 ,25 .75 ,25 ,25 3,5 inch TOTAL DROP 17.14 min/inch drop, GAAB-HD-I GRI'~='~,ER ANCHORAGE AREA BOROUr' DE,-mflTIViENT OF ENVIRONMENTAL QUALI'I 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8685 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM :"~ '~' ' "~ .... "' ADDRESS /(~)-'<"/f ~]~!]~ -?,,,>r'//..~/(:~ PHONE~/~' NAME ~/~ ~ / ~' v2~ ~ J MAILING -; ........... ~'?~,//~ ~:/): (?~///~/ LEGAL DESCRIPTION ,~Z(-,~ -SEPTIC TANK: DISTANCE FROM WELL ~¢- / MATERIAL ~=Z~ ~- COMPARTMENTsNUMBER OF LIQUID CAPACITY ~}L~ GAELONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS --' OUTSIDE DIAMETER OR WIDTH LENGTH 'i'H LININg M,~. DISTANCE FROM WELL ................. I~g[L~iNO FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINE.S-' ABSORPTIOF~ AREA ..... F~Q,~DATION , NEAREST LOT LINE DISTANCE BETWEEN LIN'~'BS..,.,.~ TRENCH WIDTH SQ. FT. LENGTH OFEAC~HH DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATE~I.~L-BENEA-TH-TI[E ...... TOTAL LENGTH , OF LINES I N~Tf/TTA L EFFECTIVE IN. ABOVE TILE-- WELL: TYPE /'.),,t ','/~ ~]) . DEPTH LOT LINE ~'! ' " NEAREST ...... SEPTIC /L? fi' ~'g~.//.}, SEWER LINE , TANK DISTANCE FROM · BUILDING FOUNDATION SEEPAGE , SYSTEM WATER SAMPLE ///,:f;/" '4 ]' , NEAREST OTHER CESSPOOL. - .... , SOURCES DISTANCES: DIAGRAM OF SYSTEM ti, DATE G.A.J~".B. GReATEr ANCHORAGE AREA BOROUGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PErM, .0. TYPE AND SIZE OF FACILITY TO BE SERVED DRAIN FIELD FINANCED THROUGH SOIL TEST RESULTS TO BE INSTALLED BY · OTHER NOTE.. THIS PERMIT IS NOT VALID WITHOUT SOIl.,, TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS POUNDATION TO SEPTIC TANK POUNDAT,ONTOSEEPAGEP'T F,ELD SEPTIC TANK TO SEEPAGE PIT WALL /~)~ / TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD _, SEEPAGE PIT . DRAIN FIELD SEPTIC TANK, ., SEEPAGE PIT TO RIVER, LAKE, STREAM. DRAIN FIELD , SEEPAGE Pit ALSO CONSIDER AREA WELLS. SEEPAGE PIT / ./0° ,DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSINGGAP 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. HEALTH AUTHor ~/~' ITY LICENSED DE ER I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREAFROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIbED SYSTEM IS IN ACGORDANCEWITH SAID CODE. ~~/ ~-'~-=~x ~ ~_~u-~ SEWAGE GREATER ANCHORAGE AREA BOROUGh DEPARTMENT OF' ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 27~)-8686 DISPOSAL SYSTEM M APPLICATION AND PERMIT PERM,TNO./ q LEGAL DESCRIPTION MAILING ADDRESS PHONE 317 SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHQM~ SOIL TE~,T COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT-- SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK ., SEEPAGE PIT TO NEAREST LOT LINE. DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, , SEEPAGE PIt TO RIVER· LAKE, STREAM. , DRAIN fielD , DRAIN FIELD , SEEPAGE PIT. j~ ALSO CONSIDER AREA WELLS. /'c~~ · SEEPAGE PIT _, DRAIN FIELD CAST IRONINTO AND OUT OF SEPtiC TANK A~D J~T~ CJ~IB C~OSSING GAP~F EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON P_IPFS c~J ~[~pTl_C TANK AND SEEPAGE Pit ~ITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.  ' ~l HEALTH AUTHORITY Or LICENSED DES[GNER [ CERTIFY THAT IAM FAMILIAR WITH THE rEQUIREMENTS OF GREATER ANCHOrAGe AREA BOROUGH ORDINANCE NO. 2E AND THAT THE ABOVE DATe APPLICANT'S S'GNAT "E '"' _ ~rx Excavating PePfor~med For O~er - Ed Baker ~ ~ ............ Pa~e 8/19771 Legal D ..... · ............ ~ ..... -~- ~ ..................... PerfoPmed Dep'Nh Feet SW. 1/4 NW 1/~-~'I'~F'I'~S%E. 21 T12N R3W --~ ..... Sol I Char~c-,';e?is~ics ...... Location Sketch Brown clayey silt with scattered gravel (CL) Gray silt with sand pockets (ML) Was Ground Water Encountered? Readino- Date Gross Fi me , i Time Depth lc> ,q20 Net DPop Depth Of ?~"~ ~:- ~-,,,.a~ De::,/tj~ To Bbt'tom Of Pit Or il~enc}~ ~ square feet of drazna~e ar~ ~ ...... ~ _ . ~ ~ ' -- ~"~ ..... ~,*~ ~T~ ~ ~Mu~=u per ueuroom except t the ~m as se . . ~; ............. ~, .... the .= ........ . --~_~-~.~~B. by dlrectzve date 8~71 ~nH~~P%~~' ~ z 9~~ required ............ ~ Test Perfor¢~ed By:.,~~l_~l~.' Dote Certified By: National T stin Ser i Date :~'~-~=~ ...... g~p'~er~v~ii~§' Inc. Parcel I.D. 015-281-60 Legal description WOODHAVEN #2 TR C Site address 11701 JEROME ST Expiration Date: Current property owner(s) MCPHETERS LARRY A & LISA M 5/23/2025 X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 7/2/2024 rte, This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) islare in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAG Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-281 Complete legal description WOODHAVEN #2 TRACT C Location (site address) 11701 JEROME STREET, ANCHORAGE, AK 99516 Current property owner(s) LARRY & LISA MCPHETERS — Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well r_1 Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units El Community Well or Public F1 Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic R Private Septic serving 2 dwelling units n Holding Tank n Community Septic or Public Sewer 5. SEPTIC TANK: F] Steel Z Plastic F-1 Concrete F-1 Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: E] AWWTS 0 Bed n Deep Trench H Wide Trench n Seepage Pit Waiver request for: Expedited review requested: Z Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 1'° Date of Payment ZZI L2L� COSA # VS 113 '2 - Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: WOODHAVEN #2 TRACT C Parcel ID: 015-281-60 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 10/15/1987 Total depth 108 ft Cased to 108 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/23/2024 Static water level at beginning of test 55 ft. Well production at time of test 4.5 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 3.86 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/23/2024 Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA – NEW 5BR SEPTIC TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: D. ABSORPTION FIELD DATA – 3BR INSTALLED IN 1998 & NEW 2BR INSTALLED IN 2024 Which system tested (date installed) 7/23/1998 ALL standpipes present per record drawing Total measured depth from grade 7.52 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 4/23/2024 – 3BR Results Pass (EAST / WEST TRENCHES) Fluid depth prior to test 24 / 36 in Water added 650 gal New fluid depth 33 / 41 in Elapsed time 1440 min Final fluid depth 24 / 35 in Absorption rate 450 gpd FIELD STATUS – NEW SYSTEM Effective depth (per record drawings) 48 in (MOA 4’ ED) Effective depth used 24 / 35 in Effective depth (ED) remaining 24 / 13 in New 2BR augmentation has 48” ED, 0” used & 48” remaining. Comments/Deficiencies: Approximate total measured depths from existing grade & ED appears approximate per visual observations & record documents. Only the new 2024 fields insulated – also insulation added from the Lift Station and new pipe was also installed per the inspection report. The shallowest portions of the 1998 trenches are 7.2’ from grade with 3.2’+. with no known freezing issues. These fields are in an undisturbed area where vegetation & snow creates additional insulation cover. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 6/26/2024 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 or NO 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 & 6/26/24 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 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLIr~G ,\ 01528160 ',. HAA# GENERAl. INFORMATION Complete legal description . ?ract~C... Wo_o~von Su~bdl_v_l~ion //2 Location (site address or directions) . 11701 Jerome Street Anchoraq~ AK Property owner __Eq ]3ak~r Day phone 345-41 75 Mailing address P,O. Box 110843 Anchorage, AK 99511 Lending agency Mailing address_. Day phone Agent. Address Day phone _ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XX If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: individual on-site xX Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation frown State ADEC attesting to the legality and status of system. 72-025 (Rev. t/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Alaska Water.~ & Wa,St/ewater, Phone 337-6179 ~ . 99504 EngineeCs signature (/ / ~'/ )-~~ Date ALASKA WATER & WASTEWATER CONSULTANTSt SHALL BE PAID $1375.00 AT CLOSING FOR SERVICES PERFORMED. DHHS SIGNATURE //~ Approved for ~-'~R E~ bedrooms. INC Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By:--~/~..q.,/~ / 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 D H 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 enginee¢s work. 72-025 (Rev. 1/91) I~,ck MOA ¢fZl Municipality of Anchorage DEPARTMFNT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approwd Checklist Legal Description: _ Parcel I.D,:__ A. WELL DATA Well type Log presen(.~.Y.~l) "-/RS Date completed / / Tota depth Sanitary se a(~-/~,l) FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires propeny protected (~N) AT INSPEC'rlOI', Static water level Well production // g.p.m, WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate_ Collected by: __ B. SEPTIC/HOLDING TANK DATA Date installed '-'~/~l - '~'1)-~(%? Tank size /~cJ-3 ' Number of Compartments ~ Cleanouts L~). Foundation cleanout ~?N1 -i~(i%'-(/~C~ Depression (Y/~[~) /~Jo High water alarm ~N) Date of Pumping /~/~ ..-P, rnper- Ne~'~ "~/-JK... C. ABSORPTION FIELD DATA Date installed '~ [~%/~ Soilrating orfF/bdrm). (~),ro _ System type ~' V~lP~-- Length ~ ~'c/©= c~o( Width Gravel thickness below p pe . /"'/~ Total depth Effective absorption ares ___~C.k3 ~- Monitoring Tube present (~q) ~/~.5_ Depression over field (Y/~. Date of adequacy test _J~)/,~ -/~-I,g Results (Pass/Fail) For ~ bedrooms Fluid del)th in absorption field before test (in.); .__~//~ Fluid depth _ ,L,//J-- (ins) Minutes ater: /'-)/~ r Peroxide treatment (past 12 months) (Y/~) ~ .. Immediately after/~'~ gal. water added (in.): ._?/,~- Absorptlon rate = ~/~//~- g.p.d. If yes, give date 72-026 (Rev. 3/96)* AUG 0,5 1998 D. LIFT STATION Date installed Manhole/Access(~N) High water alarm level at* Cycles tested ~V//"~L Size in gallons "Pump on" level at* /3/`'2 ''~ "Pump off" level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /OC~ r./- Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots ( (30 ~ On adjacent lots / (JO '/- Public sewer manhole/cleanout ~u//). Lift station /'~) 6 ',~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ! 6 ~'~ "/' Property line / O Absorption field. Water main/service line ! 0 r./. Sudace water/drainage loc) ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation Water main/service line Driveway, parking/vehicle storage area ~'O ~o~ ~ Wells on adjacent lots / ~ '~ F. ENGINEER'S CERTIFICATION I certify that l ha!de deterrnie/~ thru f, ie~d/inspections and review of Municipal reco#ds ith MOA ~AA g i e n s in effect on this date. Date H~ Fee $ ?~, ~ Waiver Fee $ Date of Payment g l ~ / q 5 Date of Payment_ Reoei)t Number 0~(O3 ('; ? ~ ~) Receipt Number 72-02(~ (Rev, 3/96)*