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Home My WebLink AboutWILLIAMSON BLK 2 LT 2Williamson Block 2 Lot 2 #015-073-23 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211119 PID Number: 015-073-23 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name DONOVAN BAILEY & NATALIE LANDRETH ABSORPTION FIELD -EXISTING [I Deep Trench E:1 Wide Trench E:1 Bed E] Mound Site Address TH 5310 E 98 AVENUE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. WILLIAMSON 2 2 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift LiStation Holding Sewer Total absorption area z Number of trenches Dist. between trenches From Tank Field Tank Line Ft Ft. Well 100'+ -- 25`.+ TANK M Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks EXISTING TANK REMOVED / DECOMMISSIONED. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer MIKE N. ANDERSON dra nfeld Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection V1 5/14/21 nd 5/17/21 Location and description dates:2 3`d 4`h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date ��Q.��•' '•:tQ,¢�� .. - .....:.. " " " " " " " . Curtis Huffman Septic System Appr�kl � �� x`63' CE 128991 Date S ,2� Z� . �� F�•. 5/20/21 .•k� l� FOpROFESSIONW Note: this approval does not include well permit requirements. (Kev U5/U1/l 6) PID: 015-073-23 pERN1|T. OSP211119 .\ \ 3BR HOUSE \ KU A SHED FCO DECOMMISSIONEDREMOVED EXISTING S.T.8c INSTALLED ''—^' 1000—GAL '--- .vv luuu—u*� �upL SEPTIC TANK & RECONNECTED TO EXISTING FIELDS. A—[=2g.4' B—C=10.6' A—D=32.9' B—D=11.5' A—E=37.2' 8—E=14.3' A—F=41.2' B—F=17.9' m*rOP OF MH EXISTING FIELD EXISTING FIELD MISSING CO VV|L[I/\MqON BLOCK 2. LOT 2 PREPARED FOR: DDNOVAN BAILEY 8c NATAUE LANORETH 5310 E 88TH AVENUE ANCHORAGE' AK 98515 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE' AK 99516 907-350-9566 FirstWaterAK@gmoil.com 'TIC SECTION CALE' NTS DATE SURVEY: FRONTIER DRAWN: FWCS nLjMUNICIPALITY 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: OSP211119 Work Type: SepticTank Upgrade Tax Code Number: 01507323000 Site Legal Address: WILLIAMSON BLK 2 LT 2 G:2437 Site Mailing Address: 5310 E 98TH AVE, Anchorage Owner: BAILEY DONOVAN B & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: o`�"lent Ski. n DeI)artment Lot Size in Sq Ft: Total Bedrooms: 5/4/2021 5/4/2022 11406 ❑ 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: Issued By: Date: Date: i? 3 MUNIMPALITY OF ANCHORAGE Development Services Department f` ' # Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-073-23 Property owner(s) DONOVAN BAILEY & NATALIE LANDRETH Day phone Mailing address 5310 E 98TH AVENUE, ANCHORAGE, AK 99516 Site address 5310 E 98TH AVENUE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) WILLIAMSON 132, L2 Legal description (Township, Range & Section) Lot Size 11,406 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: a�2 5 Waiver Fees: Date of Payment: y Z 20 21 Date of Payment: Receipt Number: � 9 2I `i Receipt Number: Permit No. 05Pa2 1M 9 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com April 30, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: WILLIAMSON BLOCK 2, LOT 2 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. 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 OSP211119, Deb Wockenfuss, 05/04/21 FIRST WATER CONSULTING WILLIAMSON BLOCK 2, LOT 2 NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK STAKE WELL RADII PRIOR TO CONST. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211119, Deb Wockenfuss, 05/04/21 ------- -- --- Municipality of Anchorage page __L_ of 7, DEPARTMENTOF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: a7J� ld - PID Number: _ D 1 ':�0_q;?2� ;;5 Name: --rV O"n�l_1 Wastewater System: ❑ New- Upgrade Addregs qci /�✓ 5110-- ABSORPTION FIELD Phone- No of BedjDypms: ❑Deep / — Trench hallow Trench ❑❑❑ Bed Mound Other LEGAL DESCRIPTION Soil Rating /q (� Total Depth from original grade/ S y-U GPD/Sq. Ft. O '" Lot: Block // Subdivision: _ Depth to pipe bottom from original grade: Gravel depth beneath pipe / V✓IL-l�Ii�f��J Or %, Ft. Ft. Township: Range Section: Fill added above original grade:/ D/";J Gravel length: FL Ft. WELL: ❑New O Upgrade _ Gravel width f � FL Number of lines: � _�_ Distance betwaen lines : I Ft. Cmi fication (Private, A,/B,C/)1 �6v�G"/" �✓ Total Depth Cased To: Total absorption area. —� Pii�pe material: I i% -� Fl Ft. SQ. FL 9" S"rI".I Driller: __ Dale Drilled: Static Water Level: Ft. Installer: '�� Date installed: Yield: Pump Setat: Casing Height Above Ground: Imo® TANG — GPM FL Ft. SEPARATION —�To -- DISTANCES — Septic 11Holding ❑S.T.E.P. From septic Absorplion Liu homing Public/Private M.nu�f1acctu1r`err. r��/ 1 Capacity in gallons:/' ��fe1 rank Field Station Tank Sewer Lines o—�1�1 Well �) O 'QZ r ._— N / Material Numbe®of�lCJ'=mpartments: Watere �D"b�- NUaf �e LIFT STATION Lot Line f / � �— Size Size in gallons: Manufacturer, Foundation A gyr 2� f - �_ /— "Pump on" level at: "Pump o(F"I�Hlghel at: water alarm at: Curtain --'GJd/•�� N�( Pump Make&ModElectrical Inspections performed by: Drain Remarks: BENCH LANARK _ Location and Description: Assumed Elevation: Ft ENGINEER'S SEAL S & S ENGINEERING 17034 Eagle River Loop Road, rl?4t 941st � Inspections performed by: Eagle River, ATneka 99377— 2nd_��L�`�� ^ Department of Health-awn U urea !ces appro al ;a, ; Reviewed and approved by: — - Date: 72-013 (Rev. 9/91) MOA 25 Permit No. sw9soogg Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 O Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: WILLIAMSON crI »DMSION, BLOCK 2, IAT z __ PID No.: niRo7a2� CO1 CO2 C010 FINAL GRADE MTI C011 COD MT2 C00 MT3 102' 99' 90.5' 94.8' 94. 1000 GAL SEPTICR 93.0' 93.0' R 91.7' 91.7' 91.7 A 86.7- WATER FO0N0 3/5/03 SCALE 1' - 10' WELL I ON LL fy 100' NFL R U WELL 3 DRIV A B COt 30.5' SW CO2 36.5' 63.5' 3 DRM CO3 38.5' C04 40' 65' 65' HO E C06 69. 6' 78• COO 50.5' 78' MT3 66.5' SO' C07 70.5' BO' A OF- C09 41.5' 63.5' MT2 49.5' COB 59• 64.5' 64• IBM TOP OF CONC. FEP AT C010 26' MT7 40.5' 51• 46.5' FCO ND OF STAIRS C011 52' 52' NE T 1000 GALS PTIC TANK C CO9 33% 7 0 G H COlL04 M2av 00 � v Cos EW DRAINFIELDS Cob � ENGINEER'S SEAL NT3� CO _ I 10' UTIL. ESMT. t i -.... 01; LL4L R r i y a SCALE T m 40'. 'ar. .r 72-013 A (Hev. 9/91) MOA 25 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. �V CIVILENGINEERS (907)694-2979 FAX 694-1211 �. May 28,1993 E�� E R,V E R. PtPS�P RECEIVED HEALTH AUTHORITY APPROVALS JUN 1993 Municipat i-ty ob Anehonage D t'l'"C;p,11;Ly 01 Arlcnorape W. Health DEPARTMENT OF HEALTH AND HUMAN SERVICES & HUman Services Attn: Robeht Robinzon SEWER &WATER MAIN EXTENSIONS P. (�, $OX 196650 Anchoaage, AK 99519 REFERENCE: Lot 2; $loch. 2; UlUt iam6on Subdiv.i6ion SEWER & WATER INSPECTION Dean. M,%. Robinson, The worth )cequiRed on .the Bond tiona2 Heatth Autho) i-ty Apphovat dated 3/16/93 had been eompteted. Please .ishue a b.inae HeaC.th Authority ENGINEERING STUDIES AppTcovak. AND REPORTS S.incer y, WELL INSPECTION & PLOW TEST R en -t A. Shaber, P.E. AS/gk SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 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:SW930032 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:TROUTMAN JODY N OWNER ADDRESS:5310 E 98TH AVE ANCHORAGE, AK 99516-6408 PARCEL ID:01507323 LEGAL DESCRIPTION: WILLIAMSON BLK 2 LT LOT SIZE: 11406 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 K THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WI'T'H: fl M 369m DATE ISSUED: 3/19/93 EXPIRATION DATE: 3/19/94 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 343-4329 OR 343-4681 AFTER BUSINESS 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: THE TOTAL DEPTH OF THE DRAINFIELD MUST NOT EXCEEI) 5.0 FT. RECEIVED ISSUED BY: BY : l q DATE: Z Z ��J DATE: > ` _ �- Muni,Apality of Anck,.orage �� ►� Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 991519-6650 343-4744 March 22, 1993 Roger Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 2 Block 2 Williamson Subdivision Waiver Request IfWR930011, PID #015-073-23, HA930110 Dear Mr. Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 foot from the east property line to the leachfield. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Since ly,' l Robert W. Robinson Civil Engineer On-site Services RWR/ljm MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver ReviewWorksheet WR# WR930011 PID# 015-073-23— HA# _HA930110 Permit #__ Date Received: March 15, 1993 Legal Description: Lot 2. Block 2 Williamson Subdivision _ Engineer: Roger Shafer, P. E. S & S EnclineerincB—__—_—_ 17034—Eagle River Loop Road,—Suite-204, Eaqle River 99577 Applicant: Jody Troutman_— --_ — Waiver Requested: Lot line waiver - 5 foot east property line from leachfield Criteria 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation _ TOTAL: 2. Special Conditions: — 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or R sons for above: j�g!'2ec Rec #: 24520/6879 Amount: $ 70.00 Date Paid: 3-15-93 Rim///A R ROBERT SHAFER. P E ROGER SHAFER, P CIVIL ENGINEERS (907)694-2979 FAX G94.1211 SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM 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 y04--'roview, please contact us. A. Shafer, P.E. /LSU/lsu W034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER. ALASKA 99577 Municipality of Anchorage HEALTH AUTHORITY DEPARTMENT OF HEALTH AND HUMAN SERVICES MU�'T"'A'ITv^F AN 140MGB APPROVALS 825 IL' Street �NViE` NM[�PI.L;�k11�..:5;iIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 >1354 SEWER &WATER MAIN EXTENSIONS �Ecc L REFERENCE: Williamson Subdivision, Block 2, LotYt2 SEWER & WATER INSPECTION Request you issue a permit to upgrade the septic system serving the referenced property with a five foot property line waiver and issue a Conditional. Health Authority Approval. ENGINEERING RPORTS STUDIES AND REPORTS An adequacy test was performed on the existingsystem and the `1 Y Y absorption capacity of the system was found to be inadequate for a three bedroom house. Even so, the system is functioning adequately and no health hazards exist or are anticipated by the issuance of a Conditional Health Authority Approval. If WELL NSPECTION RFLOW TEST a Conditional Health Authority Approval is issued, funds will be escrowed and the upgrade will be performed no later than June 15, 1993. JA five foot property line waiver is requested due to the SITE PLANS Ilimited area available for upgrading and to allow construction hof the new system an adequate distance from the existing !system. ROAD DESIGN I,A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM 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 y04--'roview, please contact us. A. Shafer, P.E. /LSU/lsu W034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER. ALASKA 99577 IEEE 0% r o e toZ, / u Y cl LU u w to a OZ rQ) LU cNowoto 3a Uca IZ),U � � "> co N yy O 0PC C :11W W U J 0 O 3 M \Up Z Lt -- t �o �1�(l 4 h� " O uQJ (J �. V, Q) 1 W LU 0:.'(r ti� t ° O� 3pc5M 3 fr7'1 _ M h V O V- V J OIl 5) u1 G\ c7 �'•-� --'7� 31V�5 a 3aVa�dn �—..os�,.i� N a Municipality T Anchorage DEPARTMENT OF HEALTH &HUMAN SERVICES 82.5 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:O CiJ /o _ DATE PER LEGAL. DESCRIPTION:LZ,rJ Z t�t�/LG,/iJMSOtJ Township, Range, Section: 1--�-1 SLOPE 5? - Gp S/w- G M S &S ENCANC—EIZING PERFORMED BY: ACCORDANCEY 72-008 (Rev. 4/85) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT &/ DEPTH? Depth to Water Aller / ,�� Monitoring? g8eYr`— ,!re. 1 :Tier e ��rn Reading Date Gross Time Net Time Depth to Net Water Drop ?_ /; O N. /03 ""33 " /eF//e fo,e 3 3 93 7 ,5�0 � — O(d/N �74 N✓ 71, _ 7 3s,/ ' 3dp /0'0"j 8 fi r. 6 ,( � / , r PERCOLATION RATE (minutes/inch) PERC HOLE DIAM€TER , TEST RUN BETWEEN FT AND 6_ FT ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 2, Block 2, Williamson Subdivision 5310 East 98th GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and three drainfield trenches to serve the 3 bedroom residence located on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned in place. 2. 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. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. 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. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. page 2 Lot 2, Block 2, Williamson Construction Practices 5. 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 ft. 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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. 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 (ruffed - up) before gravel (sewer rock) placement. 2. 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. 3. 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.. 4. 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. 5. 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. page 3 Lot 2, Block 2, Williamson Construction Practices MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 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 F810 (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. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 :sieve. 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. 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: page 4 Lot 2, Block 2, Williamson Construction Practices 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. 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, cleanout -s, and insulation, but before the placement of any other backfill. 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. COM.'N' GREA R ANCHORAGE AREA BOR GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_' G R/� Al 1 A&DRESS y�J /✓�I_'`_� �_—U —_ PHONE �J'/.S bCX' LOCATION �� %�0- ---�L�'�p�.£�/�_ LEGAL DESCRIPTION__"- SEPTIC TANK: DISTANCE 'n NUMBER OF FROM WELL_ MANUFACTURER( MATERIAL. _COMPARTMENT'S COMPARTMENTS INSIDE LENGTH= INSIDE WIDTH__._ LIQUID 0 DEPTH LIQUID CAPACITY D"d4— GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL �� TOTAL LENGTH _FOUNDATION NEAREST LOT LINE_ -,/-.L-_ OF LINES % 11 / NUMBER OF LINES_ DIISSSTANCE BETWEEN LINES TRENCII WIDTH- IN. TOTAL. EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE J MATERIAL BENEATH TILE_ _ IN, ABOVE TILE _- K.? IN. WELL: j7 TYPE __S7" �-S'- f__. _CONSTRUCTION.__ _____DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION , LOT LINE SEWER LINE TANK__ SYSTEM_ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS— DISI ANCES: EMARKS DISTANCES:SYSTEM INSTALLED INSTALLED BY:`"`^�'��'� SEWER LINE DEPTH: PIPE MATERIAL:-(/ G-` � �G"�Al LOT SLOPE: REMARKS: DATE Form EQ -032 DISTANCE FROM: 1-- ED C7REf. R ANCHORAGE AREA BOF JGH x`270" DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 f/ P TELEPHONE 274-4561 / i:'... / /� l - p'� SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED FIELD _, OTHER _— TO BE INSTALL D BY I j_ AR NOTE. THIS PERMIT IS NOT VALID I HOUT 50L TEST FINAL INSPECTION: 24 HOUR NOTICE REOUIREED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE MINIMUM DISTANCES, REQUIREMENTS A / FOUNDATION 'EO SEPTIC TANK _ r'� FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK - SEEPAGE PIT TO NEAREST LOT LINE, DRAIN FIELD DRAIN FIELD WELL TO SEPTIC TANK / SEEPAGE PIT —Z DRAIN FIELD �� / ALSO CONSIDER AREA WELLS, WATER MAIN TO SEPTIC TANK — SEEPAGE PIT DRAIN FIELD SEPTIC TANK, L" Ll SEEPAGE PI'f , 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 SACKFIL / CONFORM TO BOROUGFJ, REGULATIONS REGARDING INSTALL ION. G.A.A.B. OR LICENSED DESIGNER S,�fl �2r.SS�r�,/I 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUI EML'NTS OF GREATER DESCRIBED SV EM IS IN ACCORDANCE WITH SAID CODE. DATE -i 1` � ��C AppLICANT'S SIGNATURE f -ORM NO.I-Q-010 G 2,Lrev. � � a ln: , .IAC AM E) � STE ,.,, , , /�t.....'.,, / I,(/7 CQL/c'LIUI/// O 30RpU' R-omDQq ANCE NO. 28.66 ANe THAT THE ABOVE Y��I xz I J I I ,JI - G1 1 - -- ,.,, , , /�t.....'.,, / I,(/7 CQL/c'LIUI/// O 30RpU' R-omDQq ANCE NO. 28.66 ANe THAT THE ABOVE GRLATLR ANCIIORAGL ARLA 1;0ROUL 61 1„ Department of Environmental Quality } 3330 "C" Street Anchorage, Alaska 99'10:', SOILS LOG - PBROLATION TIiST Performed for -9-AV&p69ti ,&l� -��!� _ Date Perform -d Legal Des cription:__Zfjr�__-_�GpC __�.- - (,�� /fin S__O�!__.SA.t_—_..-_..__.__ �- ----- This form reports: Soils log_ ____ Percolation Lest--,------- Depth est_---Depth !s� *.2. Feet z _ C�R09Vz l 4 - 6 6 S�/VP B - 9 - (.f /YI) (.2 sv) 12 13 14 - - - ---- S/ope r--- Date Gross Time Net Time Depth to Water Net Drop I — T__ 4-4 Was ground water encountered? _ If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate _minute. -Proposed installation: Seepage Pit Drain Field Depth of Inlet—_ ^Depth to_Gottomof pit or trench COMMENTS: .-./ 2�_. s�. _IDA- 7&0 1/��/�.�"�-.� Performed D,y:—_ ,►+z.. l ___ Certified lick 0.90 W/'74) 2 - GREG. :R ANCHORAGE AREA BOF IGH uo(� DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO 3330 "C" STREET ANCHORAGE, ALASKA 99503 ,n TELEPHONE 274-4561 SEWAGE-DISPOfFAt--SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT AE'"t, /J/�'es->//q// �"N2 ��lry1A �•I ADpRE55 � � PHONE LEGAL ✓ /T .X��y INSTALLATION LOCATION �/ �D n/(J�t' LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK - SEEPAGE PIT---, DRAIN FIELD OTHER G,�ezL TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL. TESTRESULTS COMPLETION DATE ANTICIPATED 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 SEEPAGE AREA SIZE DRAIN FIELD SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. // i WELL TO SEPTIC TANK �/�qq �-, SEEPAGE PIT �//¢-� DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK / SEEPAGE PIT DRAIN FIELD 116 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 1 CERTIFY THAT AM FAMILIAR WITH THE REQUIREMENTS OF DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE e&/ �^ APPLICANT'S SIGNATURE FORM NO. EQ -016 TYPE DIAGRAM OF SYSTEM 0 73 S�f ORDINANCE NO. I-8®.AND THAT THE ABOVE MUNICIPALITYPF 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. 015-073-23 Expiration Date: O -1?11 - 2. 1. GENERAL INFORMATION Complete legal description WILLIAMSON BLOCK 2, LOT 2 Location (site address) 5310 E 98TH AVENUE, ANCHORAGE, AK 99516 Current property owner(s) DONOVAN BAILEY & NATALIE LANDRETH Day phone Mailing address Real estate agent 5310 E 98TH AVENUE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_.550 Date of Payment S '/ q -Z� Receipt Number S10 V (0 COSA # OSG Z 1 12 49 Date: Waiver Fee $ Date of Payment Receipt Number 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 5/17/2021 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~S1i� these various and dynamic characteristics and are outside the control of the evaluator of the •�(i well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • • • �9 �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or J discrepancies exist can be given by First Water Consulting & FWS ' *� TH f •'* {r 6. DSD SIGNATURE Curtis Huffman j System #1 Approved for bedrooms ��`%T . ,CE 128991 • FRF 4/17/Z9 `4P System #2 Approved for bedrooms ill PROFESSO Disapproved Conditional approval for bedrooms, with the followin t�k44��i6fm�rf O `g ON-SITE TV WATER AND m �m PROGRAM By' Original Certificate Date: S�� Z7 -2- The 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 Legal Description: WILLIAMSON BLOCK 2 LOT 2 Parcel ID: 015-073-23 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 1975 Total depth 118 ft Cased to 40+ ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 4/21/2021 Static water level at beginning of test 65 ft. Well production at time of test 6 gpm Comments B. TANK DATA Age of tank(s) NA – NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 5/17/1993 ❑ ALL standpipes present per record drawing Total measured depth from grade 7.2 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A – pressurized field Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 5.42 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FWES Collected by Z :- Date of Sample 4/19/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 4/21/2021 Results 0 Pass For 3 bedrooms Fluid depth prior to test 3 in Water added 510 gal New depth 7 in ® Monitor tubes go to bottom of effective. If not, state depth into effective 2'++ ED IR SHOWS 2' Elapsed time 2 min ® Code -required soil cover over field Final fluid depth 1330 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: Eastern CO of middle trench missing – other CO sufficient for servicing.sHORT TRE FS DID SWINGTIES & DUG IN AN ATTEMPT TO LOCATE WITH NO LUCK. HEAVY BRUSH / TREES. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes if No Septic Tank/Lift Station on Lot > 100' Surface Water > 100' ® Yes if No ft Property Line > 5' Community Sewer Manhole/Cleanout > 100' if No ® Yes if No ft ® 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' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *5 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No 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 *MOA WAIVER ISSUED PREVIOUSLY. G. ENGINEER'S CERTIFICATION l certify that l 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. w AWA.t� i ... .... ......�.`... �.• Curtis Huffman �� c��, •. CE 128991 ��+ �� sj��. • 5120/21. - •��v�� Nitrate Advisory Certificate of On -Site Systems Approval # OSC 211249 Subdivision: Williamson Block 2 Lot 2 A water sample revealed a nitrate concentration of 5.42 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. � � Mad�ng Address p� Ox Box 196650 *Anchorage, Alaska 99519 6650 *sww�iv muni org Y {; is s From Northern Testing Laboratories, Inca Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address P� O ;Box 196650 �` Anchorage; Alaska 99519 6650 * www muni org � O M i C7 i IN ' N 0 LV � n rn � I I uj a O T -i 00O \ Ln M � W N O G' IO LO X �•_' X �� X •�. z X 86"L96 M.LO,Lb JON— 1 � X � I O L C I1) o t>s a ' w� i wi!) N 3� m t l / CF, I 1 Z� o 00 Lq 1 O O O m 3 �a T O O O y >• ��`o O (V Ln N ` or c -i Infl Q N C i C O IL O Vl ..�_.. 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E @ U m O @ O = L 3 "@O � �-a:� to � J (n m OC N U C •> 00 tTN y > L @@ O 00 _0 Ma L/1 Ol aZ 3 -°mo� "� r"j o o m O 9mE� y ^1 Y E U `m own Z o 2 Ln "a @ ovnai U- Eo In f- 0 m C `•'T O O a) a- 00 w U<2 > fi3 O u v C ._ w0 U 000n y N u D U QCE W y N Y >. •Vl _I UO m"0 3o16'Es v�N v 0 ?Nov Q@@ N aj C L E v U �- @ O. E N@ T O o OQ l0 i 12 T@ y Vico ++ L 00-1 C '"• @ 07 -a) '_�-o a) y O y zi 1 Ln >' a� QJ Ln O o_>� a m cu y �v0 3 f�j two "= CL �c Ln75 oo C9 Ln O �� 0 Ln 003 a) 4J — LL kom3 LL y m E ao y a y @ oma° Q m Y c, O P* r�,��lrrJ �OJJJ CL o h� J LUC c r V .Ln O a) m UT I Q: CoZ o rnm i �, mN �/ 0 __ N i m o y o / azo w // - O '. LL 0) N y E [A 7 JJ[6' "• = a z ...••moo a o, ro E °yL)iEa m h W Q Q iD N M 7 Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-073-23 1. GENERAL INFORMATION HAA # r) nIg Expiration Date: $ 3 ' D ✓� Complete legal description T.nr 7 - R1 nrk 2 ; 41i 11 i nmann cuhdivi�ion Location (site address or directions) q*31n East, 98th Aire Anchorage, AK 995CUf Current Property owner(s) Paul Upchurch Day phone 351-7551 Mailing address same Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site a Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S S S Engineering Phone 694-2979 Address 17034 N Eagle River Loon Ste 904 Faode River, AK 99577 Engineer's Printed Name Robert C. Cowan Date y �)":1,/05— OF 5. DSD SIGNATURE '�7 R09ERT G tOWAN tf�Z Approved for 3 bedrooms. �I+�.;., CE-8301�'y: Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other BY / Original Certificate Date: S " (R" 01M2) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: !- S T �- d w c. ca w I r -L -e 1.•1 s* N � Parcel Id: I S —a -7 3-13 A. WELL DATA well type PQ�vwrt Date completed ) °t 2 S If A, B, or C provide PWSID # Sanitary seal ON) _Y# -F Total depth )1 8 ft. Cased to No 4 ft. FROM WELL LOG Date of test Static water level v ft. Well production 9 P.M. WATER SAMPLE RESULTS: Well Log (Yf9 'Vo Wires properly prdtectedON) Yf Casing height (above ground) / a i in. AT INSPECTION yVA3 117 ft. S-. N g.p.m. ColiformO colonies/100 ml. Nitrate � mg./l. Other bacteria colonies/100 ml. Arsenic: mg./l. Date of sample: y�14 /Orivollected by: i 5 ENGINEERING g e K1v*FZ55P Iroad No. 204 B. SEPTIC/HOLDING TANK DATA 4;405' &tAfa-'n Eagle River' Alaska 99M Tank TypelMaterial SEP rr c 1 ,STs, E L Date installed 'Irl /7 / 9 3 Tank size 14700 gal. Number of Compartments �L_ Cleanouts&N) %/ E S Foundation cleanout 1r�6 N) YE }3 Depression over tank (Ye Nd 1 High water alarm (Y/ !O N o Date of pumping— Pumper nu C. ABSORPTION FIELD DATA sNA�o � Date installed Sir 7A Soil ratingg.p.d./ft or f12/bdrm) 0_g System type 7-Ai-�a4 1 Length 80 rorq (- ft. Width S ft. Gravel below pipe ft. Total depth 6=/ as ft. Eff. absorption area S7 1 112 Monitoring lube YC J Depression over field N d Date of adequacy test 91;,& /a 3 Results Pa ail) n'f'ss For 3 bedrooms r �• +r- l " -3t- Fluid depth in absorption field before test I!� in. Water added H79gal. New deptha'� in. Elapsed Time:1 "'1 min. Final fluid depth1'Q in.� Absorption rate >= y S 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) !r oN 2 _)�- -If 57-4,0 NOXr-U 7-A(^,c.14 KNOV W If yes, give date D. LIFT STATION Date installed Size in gallons 'Pump on' level at_ in. "Pum Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot //0' Absorption field on lot I Public sewer main N 1,4 r Sewer /septic service lineri i 4 in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots _ 106 On adjacent lots Public sewer manhole/cleanout N 14 Holding tank .V /,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation g r Property line j a r Absorption field r Water main N .4 Water service line / O Surface water I 0 0 -� Wells on adjacent lots in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line S '( Lv rt N 10V I ) Building foundation a3 I Water main N 14 Water Service line 10 "f' Surface water / 0 D �� Driveway, parking/vehicle storage IV 0 1 4 r Curtain drain N Q °'4- K -'G . N Wells on adjacent lots / 0 0 -/ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and r' W i review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. r • . •'+.`.'w �� r /• ROBERT C. COWAN Engineer's Printed Name —RD n 1 /�• C.pr ,fr �� c ;•� CE •8801 Date if /.z +!t!f lel., .r�::i+ _•: HAA Fee $ A4 "l),Ix, Date of Payment yT�05 Receipt Number �LD`a(�1 _ SOM (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 04/27/2005 14:19 FAX 907 242 7997 _ ON SITE la001 APR -29-2005 19100 PH PAUL AND—DRRNDA UPCHURCH 907 968 1751 p_9= 98tri/ .A vE.NtYE X102;x,00 9+um `6 4.06 \ x 1 y AM yew i wc�now �a� p� �A0��1P►ea. Otet O Inr , 107 1 107 7 2 11.406 S.F. ch 1LNrs N o to N r8742'08" E r Lor S NOTE ALL 9fIm1W AO Vt3TMM *No" pM MM, U%Lss Helm CY)OAML EXCU1SI0N N01E: R 5 rAr KEpoMSMtfty or rAE ok%M l0 DETM4wC M COSTANec 9r ANY C40" S wvvtw 1, OR Rfsr"Mol s wwCN eo Not A~ of THE AEC0n7E9 SURMAN" PUJ• uhm No CRCuIRIA ca sww ANT OATH mmoH 09 USED fOR CONSTRM:IIOH pl Poll ESIABUSIINC eOUNOW 08 FDIC[ UNM AS—BUILT EER'[1 CAM I NERE/f CtJIM'f THAT 1 Nk2 sIIINEvm THE fuLovw OEsCAM70 PROPETN'h ,,E02' Z grnr-t p 11/I.Ll.4dl90N Mt THAT NO D/OtONaMUl15 oatiT CMCOT AS PIp1Gli0. f 491th ♦ N a •r is �� s 92 .0.7 02-01 0 o" P. rnSMdd rv. ■. 70-7a roller 1">e30. EPF 'iLN N.7211" Q ANC HORWE Mm.wM 0 w� - COUo 24J7 s—B MILT Municipality of . Anchorage *AC Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-073-23 HAA# O 3 0 5` t / Expiration Date: S' -- © L1- 1. GENERAL INFORMATION Complete legal description L n t 2; R 1 D e k 2 r W i 11 i n m c n n G,i h di v i c i nn Location (site address or directions) 5310 East 98th Ave. Anchorage, AK 99507 Current Property owner(s) Paul Upchurch Day phone 346-1268 Mailing address Lending agency Mailing address Real Estate Agent same Day phone Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site El Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage O • Development Services Department ' Building Safety Division. :"_ On -Site Water and Wastewater Program " 4700 South Bragaw St. ' " s "' P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ` J (907) 343-7904 CERTIFICATE OF HEALTi-1 AU T HORmy, APPROVAL' l=OEt f151NGLE FAMInr DWELLING Parcel I.D. -019-07- HAA# 2)C� -Expiration Date: 1. GENERAL INFORMATION 9 Complete legal description Lot 2 ; Block 2 ; Williamson 1 1 i amson Subd i vi Sinn Lodation (site address or directions) • 5 31 o East -9 8 r h A v a A n i - h n r a gg AK 99507 Current Property owners) Paul Upchurch Day phone 346-1268 Mailing address Lending agency Mailing address Real Estate Agent same Mailing Address Unless 6(1erwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone Day phone - Lam` 10Ito 6-3 3. TYPE OFNATER'BUPPLY: ' TYPE OF WASTEWATER DISPOSAL: r IndividualW611- -' � ( ' Individual On-site] 'Individual Water Stor'age ❑ Individual Holding tank ❑ Community Class >'. Well ❑ Community On-site ❑ Public Waten.System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties servbd by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validaiion'daie'shown below, I verify that my'investigati6n"' based on procedures outlined in the Health Authority 1Guidelinesfor this application, shows that the 6n'P'.': .....y Approva site water supplyis(are) iiifi,"f6n"cii6n4�and adequate for the number and/or wastewater -disposal system bedrooms and type of structure Indicated herein.] f666r v6'ri�'thak based on the information obtained from the Municipality of Anchorage files and from my. Jnvestigatiori;and -'Jn'�'Pidonii, the on' -site water supply and/or system is(are) I and State codes, ordinances wastewater disposal n compliance with h p.:ppp ica and regulations in effect at the time of installation. ". . Name of -Firm S..-_Erig Address 17034' N. &i le River V h t. 99577 % e r t Date' 6 -3 Engineer's Printed Name C' 4C n/. N W! S, 7 Etil'S ".4t. j A DSD SIGNATURE IV Approved for be'drooms.- 7 Disapproved.: Conditional approval for ,.a•:.bedr6oih Aththe follow, in .. - - ". , C., . .". s: 'Sic! 'Y -,J By: Original Certificate Date:_ 91 -03 (Rev. 01M) Additional Comments' :WATER ANL) JAM0 �,TENA J"RAVI 4, - Attachments: HAA Checklist. X Maintenance Agreements Septic System Advisory Supplerfiental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:_ 91 -03 (Rev. 01M) Municipality of Anchorage ( Development Services Department Building Safety Division 1 • = On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: lo i .Z b Lvc�c 2 �✓� LI.�An t e ✓ S�O r'- W� Parcel ID: ©fS 'p -7 3 "a.3 A. WELL DATA Well type If A, B, or C provide PWSID # Well Log (YO /-0 Date completed / Q 7S Sanitary seal JOIN) ItJ Wires properly protected &N) YDS Total depth h I ft. Cased to 'i ID f ft. Casing height (above ground) of in. FROM WELL LOG AT INSPECTION a�/o3 Date of test _ Static water level V ft. 7 ft. Well production g.p.m. -S' y g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Arsenic: mg.h. Nitrate a • 6 mg./l. Date of sample: CJ)__1y1 o3 B. SEPTICIHOLDING TANK DATA Tank Type/Material 50 1 r- l S T& x L - Tank size 0,0 0 gal. Number of Compartments OL Foundation cleanout ON)y4 f Depression over tank (Yd t 0 High water alarm (yo '" y Date of pumping 9 of f �� 3 Pumper (0 L -O k-1 0 C. ABSORPTION FIELD DATA Sty 4 L 1,o W Date installed s—/l71y.3 Soil rating ..d./fe or ftZlbdrm) 0- g System type TK 4Nc-144F- S Len4th 0 7VrdL ft. Width ft. Gravel below pipe a ft. Other bacteria 0 colonies/100 ml. Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 304 Eagle River, Alaska 99577 Date installed S—//7/ .3 CleanoutsON) r Total depth— to ft. Eff. absorption area S ft2 Monitoring tube _xL 1 Depression over field N D Date of adequacy test C1 0 3 Results Pa Fail) pir5s For 3 bedrooms yy A, �• Fluid depth in absorption field before test in. Water added gal. New depths a�� in. Elapsed Time:1� min. Final fluid depth 1i�•� in. Absorption rate >= -YS- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date A_ _rt J 7- 1 0 N c & -r 14 T' 4, C,_, c-,4 D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump off" level at Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL 01� LOT TO: Septic tank/lift station on lot 1/0 Absorption field on lot a Public sewer main %J <f in. Manhole/Access (YIN) High water Meets alarm 8 circuit requirements? On adjacent lots On adjacent lots /00 Public sewer manhole/cleanout �J14 Sewer /septic service line Holding tank N( SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation oZ g Property line - X Absorption field Sr Water main N lA Water service line /0 ,�` Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line S �i�R y 30°r�� Building foundation a 3 / Water main N /A r Water Service line / 0 4- Surface water t7 0 f Driveway, parking/vehicle storage 0 -f-- Curtain f'Curtain drain N DH Wells on adjacent lots �� f F. COMMENTS in. G. ENGINEER'S CERTIFICATION At C, I certify that / have determined through field inspections and review of Municipal records that the above systems are in ✓ _ �'+ conformance with MOA HAA guidelines in effect on this date. qe� ROBERT C. COWAN Engineer's Printed Name �0'aF 2 i C • CoWp,✓ cC� - 880 1 Date �� / D 3 0 HAA Fee $ 3 �- Waiver Fee $ Date of Payment 7 w 3 Date of Payment Receipt Number 0 a d "i \ Receipt Number (Rev. 12/01) LAO,[, RLRLtOR FAX HO. 907t_-163515 40,00 KELL \ ftWr P.H. \ ''r 2 STORY WD. ��- rr 0 t•�o• ,acs �� .•'�'�-/d X 'z �,rl 100' WF;[,(. �� .�• J3 ,r�J � PROT�Gi1CJ: JVLL%(il�j' F' ti r co r 3 Loi' 2 'mss �•.... ...,.,�_ y" LOT t ' • __ peP�r-3 AA✓J4 n 1; 1, 4,06 S. l-; -► ro rH,j 0iZ,4w,W(, ,3y S 4-i 00 ON ,x.16 1 0' • �` FOUND 15 R�� 3 E- EA!;p:w:Nr LOT s NOTE: ,% ALI BEARINGS AND DISTANCES SHOWN ARE RECORD, UNLESS NOTED WHERWISE. ExaUmN NOTE: 1T IS THE RESPONSIBILI'[Y OF THE O%VNER TO bErFRmvgE -rm: FXISiANCI� of ANY COVENANTS, OR RE51MOT1ONS VVI-IICH 00 NOT APPEAR ON THE: RECCRPED SU,M IS1^N PLAT, UNDER No CtRGUMsTANCCS SHOULO ANY DATA HEREON BE USED FOR CCNSrR0CTl0hr or,, FC)ft ESTASUSHING BOUNDARY OR FENCE UNES. 1'. 016 AS --BUILT CERTIFICATE: THEREBY CERTIFY. T�H•AyTryil HAVE rSURVEYED }YTH�r1:rF01,I0WIrN�Gy�DESCRIBED PROPERTY: _-44/.l �. .L�.�,IGiti v�'.r� !/.[�l.l..�..C.r'3 �J 4•'d1' ,t> �Fr��IN...r..s''1"��,��,r' AND THAT No E-NCROACIiIAENTS EXIST EXCEPT AS INGICArED. Y - ---- _ eLocK; 1 ^vsnrnsioN,- � •- sj TY.l.�.�.1.�.�i•1.5 C7N Cr ..4�'U.r�1.7Tt�N 49-E' 1 j y �r�,r y yam ) W10 Cin -w ry K", sorts,3 M%" Ax OW4' V_ f✓rf•✓rC Y_.L a�__7..(_C/_, (977) 374—WM FAX (Wn 573 -WA 15 TOWKSHIP 12 N FutKCE �� DAM ms N� ueW n Eric P. Fuglas tad PLAT No. SEWARD M��ouw �'�~/�3 9 --07.03 92---09.216 703$ - No.7218-5 MICI40RAGE Dls;trccr 1, J0 FP "rL Wr No, `a GRID 2837 �'!`Atkx:+�G�" 'Y,•,rr.;�y 6:.. .'i:»e«a� ',Z,. «,., F. :x �ree . . r a, r. OF E eaS SERVICES Division onofwn Environmental Services c On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE: OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 015-073-23 _ HAA # HA930110 1. GENERAL. INFORMATION Complete legal description Lot 2. Block 2 Wil.Liamson Subdivision Location (site address or directions) 5310 East 98th Avenue Property owner Jody Troutman Day phone 346-3796 Mailing address 5310 East 98th Avenue, Anchorage, Alaska Lending agency Mailing address Agent Neal % Exsell Real Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual well xxxxx Community well Public water Day phone Day phone 276-3333 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxxxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. V01) Front MOA 1121 l3M VOW %Dug (LOA -OH) 990-ZL 'jiom s,Aeauibue leuoissajoAd aqj ul suoissiwo jo sAOAAa Aol opsuodsoA IOU si a6eAogouV jo A(I!Ied!o!unyj oql -ponssi si aleoipim a aaolaq elep azlleue jo suo!Ioadsui lonpuoo IOU op SHHO jo saadoldwg sluawaiinbai alels PUB papa] u!epao A lsges of AapAo u! suo!inl!jsu! 6u!pual A!agl pue sawoqjosAasegoAndofAsajAnooases!glS@Op WHO GLUTMVjo@IBISOLP u!paAajs!6aAAaau!6ualeuo!ssojoid juopuodapu! ue Aq anoge 9 gduibuied ul uan16 suo!jejuasoidw aqj uodn A(luo paseq sojeoippoo lenoAddV Ll!AoglnV gIIBaH sonss! (SHHG) sao!naeS uewnH pue glleaH jo juawlAudoo obeAogouV jo A I!IBd!oiunN aql sluawwo0 leuo!j!ppV suoilelnd!ls bu!anolloj aqj ql!m 'swooApaq Aoj IBnoAdde leuo!l!puo(] ale(] panoAddes!(] •swooapaq aazclq Aoj panoaddV xxxx 3unIVNJIS SHHO '9 ainleu6!s s,Aaau!6u3 LL966 zanig aT PH ltoZ a-4tnS 'ppou dooi .zaATd aT a� a {�C ssaAppV 6L6Z-669 auogd buTaoDuTbUa S 5 S WA!djoaw13N ,uo!loadsui s!ql jo alep aql uo joaljo ui suo!lelnbaA pue 'saoueu!pAo 'sopoo ejejS pue led!own!n! IIB gj!nn eoue!Idwoo un si walsA(s lesods!p AalemalseM jo/pue Alddns Aalem al!s-uo oqj 'uo!loodsui PUB u01je61Is9nu! A w woAl PUB sol!j a6BAogouV jo Aj!led!o!un!N aqj woAj peu!elgo uo!lewAojui all uo paseq jegjAj!AanAagjAnj I •u!aAaq poleo!pul aAnjonAls jo adA(l pue swooApaq jo Aagwnu OglAoj olenbape pue IBuo!lounj'ajes s! wolsA(s Iesods!p AOlernalsemAo/puB A(Iddns Aalem al!s-uo aqj jegj smogs uo!luo!Idde IBnoAddV !j!AogjnV gi!eaH s!ql jo uo!jB6!jsanu! A(w Iegj A(j!Aan I 'rnolaq urnogs alep uo!lBp!len aqj jo se PUB OIOAaq pox!jje Bas A(w !q pailpao sV U33NIONEI A8 N01103dSNI d0 1N31N31V1S 'S 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 Parcell.D.# SL>1_�-• �) l�-1-- HAA If 1. GENERAL GENERAL INFORMATION Complete legal description _Lott 2=B2ock 2; lvitUam6on Subdivision Location (site address or directions) -5310 East 98th Anchohaae. AK Property owner Jody T'Loutman _ Day phone 346-3796 Mailing - I h St. Ancho)tage, :'a t Lending agency — -- Day phone Mailing address --- — Agent Neat - EXSELL REALTY _ _ Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX 276-3333 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site _ Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Ray. 1/91( Front MOA 421 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. S & S ENGINEERING Name of Firm Address Engineer's signature Fundy ane .to be, esgXo in accordance with M. Phone 6?�'- Z? 7 ? Date 3—/S - 9._? r"upgnade the peptic hystem pe)Lmit and S 9 S Eng.ineeni.ng design. Wohlz to be, cwnpteted by June, 15, 1993. 6. DHHS SIGNATURE __ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 0 c CAUTION DateL The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in onierto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025}Rev.V91) Oeck MOAW21 e Municipality of Anchorage Department of Health & Human Services w� + HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ZZBZ �&�aV2ZSJ"-? Parcel I.D. A. WELL DATA Well type — If A, 8, or C, attach ADEC letter. ADEC water system number /\./ . Z Y _ Log present (Y N) _ /J Date completed I9 %S Driller— �� K-,� _ (R� � i Totaldepth ��--Cased to —Casing height X21 Sanitary seal (Y/N) ____ Wires properly protected (Y/N) s hoG�u �Y C. D /itcvrx FROM 1 €Oe0 AT INSPECTION / Date of test /Z I _�! i .� ee i�iir epi Tv i.F nrirNr .y(it Static water level / �/Z / Z16 @NVIKCNMF�of/L:ER`L.:S AVISION _ 7 y Well flow Z '-- 9 -P.M. 3.�y'm1 J 1993 Pump level q � _ I't6 I1nCEIVED SEPARATION DISTANCES FROM WELL TO i Septic/fa8tdittt3 tank on lot �� 7 _ ; On adjacent lots 1,120 / M / ,e Absorption field on lot — Z20 4 _ ; On adjacent lots /60 Public sewer main N A Public sewer manhole/cleanout / Sewer service line /(1b /Petroleum tank /V O WATER SAMPLE RESULTS: Coliform Nitrate �m g� _ Other /bacteria_/ + g D /� Date of sample: Z " / 1 - 93 Collected by: /�LrJL�r�✓ C- & Aail T B. SEPTIC/HOLDING TANK DATA Date installed -Tank size 62 C2 Compartments r Cleanouts (Y/N) � /Foundation cleanout (Y/N) � Depression�()Y//)NN) High water alarm (Y/N) —�_ Alarm tested (Y/N) —/ /—� Date of pumping �� — /l- L%3 Pumper . / f �'QOA E_ � � d! C iFS SEPARATION DISTANCES FROM SEPTIC/FTANK TO: Al I le ! [M WelI(s)onlot— jO 7"—On adja,,.ntlots Foundation Topropertyline /0 �/ Absorptionfie'J S Water main/service line ! Surface water/drainage /VUNC Gr%/ TH/ h./ /00 R 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. �IFT STATION Datei sniiaHed . Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical "Pump Manufacturer Manhole/Access I at ) SEPARATION_DtSTANCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at tested Surface water Date installed Soil rating 1/,57S System type Length Z 8 / K Width 1_? v Gravel thickness 6 Total depth 9 Total absorption area 336 5_111�' Cleanouts present(Y N) Y Depression over field(Y N) Date of adequacy test 2 Z;9 Results (pass/fail) / for 3 bedrooms Peroxide treatment (past 12 months) ( /N) �v If yes, give date --- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: r 2 Well on lot On adjacent lots Property line /0 To building foundation To existing or abandoned system on lot 41"0 A) Onadjacentlots 20 14- Cutbank ND/JE Water main/service line Nb t Surface water �d� A)0�F R Driveway, parking/vehicle storage area Ld � Curtain drain /1V/JF rc AR)�J/J, E. ENGINEER'S CERTIFICATION I certify that I have Signature Engineer's ame Date HAA Fee $ b v� or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ENGINEERING I Eagle River Loop Road e� r, e A _ fas11 A. Chofu, ;Ali Waiver Fee: $ `) D'o Date of Payment �- �' 9'3 Date of Payment Receipt Number �` --b ��fil% Receipt Number 79-099IRn 3/Q11 Rn[k MnA 21 MAR- 5-93 MON 14:43 March 4, 1993 WELL REALTOR V,�AX NO. 9072763515 Howard C. Ixollan, P. s. 4900 Palrnar-Waeilla Highway • Suite 3 Waeiila, Alaska 99654 Mr. Neil'Tysver Exsell Corp. Realtors 3333 Denali Street - Suite 110 Anchorage, Alaska 99503 Ref: on-site engineering inspection for Lot 2 of Block 2, Williarnson Subd. ©ear Mr. Tysver; P, 02 As requested, an on -sits: inspection was performed on F:ebrimry 12, 1993, of the well and waste water disposal systems for the referenced property. MLO -r-5 9PP!YSYstr7r The water supply systr,m proved satisfactM, "f'ne well produced an average of 3.3 gallons per minute cluril id ;I .c; oul-;`lo..; '.c ;:.:, .. d• t?r.lrinc% that period, the well drew down approximately 13 feet. The well recovered to the pre.tr>s', static v ratf r level within 30 minutes of terrninsation of the flow test. The well water was sarnplec ',and tasted for coliform and nitrate content. The test result, were negative. Copies of thr: well flow and water sample tests arp attached for your review. Septic SY�Wem At the time of the test, th(: effective depth of the deep trench drain field was below tho water table, The drain field was found to tiave failed and in need of replacement, The septic tank had more than 4 inches of sludge but was not pumped as it was likely the drain field and possibly other systolI) irnprcverTlef)ts will be ne(cessrary. A survey as -built of the property is also attached for your review. Please call if you have any questions or you require additional information. Sincerely, coward C. hlaltan, P.E. CE -3063 rc: Acumetrix LOCO i i On 1 G `—.--....._._._..___.��__--..............._�... Wrap Depth f+.) caZI inc Aoovo Groand__-;'i _µ,__ $tat fC Wa!en L.Ove, t��'—I(t.) IMoovvrod frau lop of toll Time RKOYERY --- ✓rb s:Ct m �� MFI@f 1 I_ Wr,te, VoIUme f Cum: Recd�nq �* <1 11A Leael gaf.) I Vnlune I 4cpml (Tt ) (gal ) 3�1/se. �. �J �'�.'-. _ C� Jr _—�I .�-- � � ��_(.1 �� 1 ? - __ � -_ .y 1�f�.:.Y� /2z r✓ , C �.�lc� �y Wry a Iii r 'i7 r� k._..i 1 4.0 4.0 3,8 �G I' 3t" 1 iia, __. ..... 1 CF _I �...cann:r $ a RrJE r Ll? i •',+�cv01,00-of time .:1 l MUNICIPALITY OF ANCHORAGE}fid( Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES14 A 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # Q 16 z -az_ HAA # n �Qfl(-tea_ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; BCock 2; WiUi.ambon Subdivision; Location (address or directions) 5310 East 98 tk Sthtet (b) Property owner Robert 9 Banbana 13kitch Telephone: (home) _ Business 276-4302 Mailing Address 5310 Eaht 98th St/ceet, Aneho7cage Ataaka (c) Lending Institution Telephone Mailing Address (d) Real Estate Company. and Agent ._TACK_W UE_C AUy_ATTA(,_Ia4", Y2 EYk�t6n Address -320] S Stegt7nnAehA>fage, A1�,�950�' Telephone 563-5500 (e) Mail the HAA to the following address: (or check herdM, if hold for pick up.) List contact person and day phone number below: _ p S & S ENGINEERING 17034 Eagle Rlytpr L"p-Ro-ad-Na-204 Eagle River, Alaska 9957/ 00 ' 2. TYPE OF: RESIDENCE Single -Family MX Number of bedrooms �3_ 3. WATER SUPPLY Individual Well qX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'7R Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 Z ;o Z a6ed X00e (BOIL 'nae) BZo-ZZ -�aoM s,aaaul6ue leuolssa;oad ay1 ul suo!ss!uao ao saoaaa ao; olq!suodsaa lou s! 96eaogouy;o All!ed!olunn agl ,panss! sl aleolplaao a aao;aq elep az (Ieue ao suopedsu!lonpuoolouopSHHO;o saa(oldw3'sluauaaa!nbaaalelspueIeaapa;u!euao (;sl;esofaapaou!suo!lnl!lsul bu!puol a!agl pue sewog ;o saaseyoand of Asolanoo a se s!gl saop SHHO aql 'e�MV ;o 91elS agl ul paaals16aa aaau!6ue euo!ssa;oad luepuadepu! ueAq anoge g ydea6eaed ul u0Al6 suo!leluasaadaa aql uodn alluo paseq poleo!;!aao len0addVAjpog3nV glleaH sanss! (SHHO) saolAaaS uewnH pue glleaH;oluawiaeda0 96eaogouy;oA1!led!o!unlnl agl NOIlnyo I enoaddV leuolllpuoO 10 suaaal Ieuoll!puoO panoaddeslp— panoaddV 91e (q swooapaq aol panoaddy / r / � -IVAOaddV SHHO '9 alep ZZCAA e4sero'aeAQ101083 ssaappV FOZ'0N peob 0001 A+ Ala a16e31"-- ouogdalal !DNIH33NIJN3 S 8 uaa!d ;o aweN •uo!poadsul s!y;;o alep agl uo 100119 ul suolleln6aa pue'saoueuipao'sapoo alelS pue ledlo!unyi Ile yl!M aoue!ldwoo ui s! wags (s lesods!p aalemalseM ao/pue Alddns aaleM 91!9-uo eql 'uo!loodsul pue uo!le61lsanu! ALUuaoa; PUL' SON 96eaogouy ;o Al!led!o!unN ayl woa; peu!elgo uo!;ewao;ul ayl uo paseq ley( Al!aaA aaylanl I -u!aaay paleo!pul aanlonals;o adAl pue swooapaq;o aagwnu aql ao; a;enbape pue leuo!;oun; 'a;es s! wals/s Iesods!p aaleMalseM ao/pue (lddns aa3eM ails-uo agl leyl sMogs IenoaddV /l!aoylny glleaH s!gl10 u011011sanu! Aw ll (;laaA l'Molaq uMogs alep uo!lep!IeA agl to se pue olaaay paxi;le leas /w !q pa!lllaao sy eg NOIIVVJUOdNI 0NV V1V0 `HOaV3S 3114 `S1S31 `SN01103dSNl DNIOIAOad Wald `JNIa33NIDN3 MUNICIPALITY OF ANCHORAGE (MOA) E ulv of ftpftAuthority Approval (HAA) i _ MENTALS[R,,QKHfflkQKWI$343PR74gUARY1984 wo '\!// C D2 1.9 9 Legal Description: -L=T 2 P�►� Z _ A. WELL DATA R ED I, I V I 1�,� 1 y__ Well Classification P� — If A, B, C, D.E.C. Approved (Y/N) _ �_ Well Log Present (Y/N) [_ Date CompletedK Yield S L• iy1 Total Depth_�/_A_Cased to h Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground /off a '/_ Sanitary Seal on Casing 61 J) __/— Electrical Wiring in Conduit (9N) __ Depression Around Wellhead SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ,_moo I ) On Adjoining Lots J �=,Lc { 1 To Nearest Edge of Absorption Field on Lot —Q� =_ ; On Adjoining Lots _ IZ`L;' To Nearest Public Sewer Line __)71/_&__ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot `u f Water Sample Collected by 5S r� ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /_, Size —1 No. of Compartments Stand pipes(Y/N) —I--- Air-tilght Qaps&/N) Foundation Cleanout (YerD>_t-A_ Depression over Tank (YC?) ate Last Pumped __ (n — /—(0 6°1 Pumping/Maintenance Contact on File (Y/N) ; for �— Holding Tank High -Water Alarm (Y/N) _ Temporary Holding Tank Permit (Y/N)_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 100 ( To Property Line To Water Main/Service Line To Stream, Pond,/ Lake, or M Comments 151+ r Drainage Course To Building Foundation f To Disposal Field La?i 72-028 (Rev. ]/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA �f Soils Rating in Absorption rata —/ Leo Type of System Design DateInstalled 7 Length of Field Width of Field Square Feet of Absortion Area Depression over Field (Yeg Results of Last Adequacy Test Depth of Field Gravel Bed Thickness %� 3 3 U, Statndpipes Presentd>VN) Date of Last Adequacy Test �l 0 Z5 --'D9 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / ad I� To Property Line J S To Building Foundation — To Existinfg or Abandoned System on Lot IliA ; On Adjoining Lots To Water Main/Service Line c 4 To Cutback (if present) 2 ._ I t, To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ____7�__ D. LIFT STATION A Date Installed Size Gallons "Pump On" Lev High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments I. Dimensions Manhole/Access(Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect QR, h�,date of t inspection. Signed &-5 jjNrIn ecRING oop Road No. 204 17034 Eagle River L > Company Date MOA No. C m •. M•A• t�s7 _e'�dri! Receipt No. �� / v J / Receipt No. — Date of Payment /-C d y Waiver Fee: $ — Amount: $ /Zo. Date of Payment 72-026 (Rev 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 5622343 \ FEDERAL TAX ID q 920040440 ANALYSIS REPORT BY SAMPLE for. Work Order # 17831 Date Report Printed: OCT 30 89 a 14:30 Client Sample ID:LOT 2 BLE 2 WILLIAMSON S/D. PWS:ID :UA Collected OCT 25 89 8 hrs. Received OCT 26 89 8 13:15 Inc. Preserved with :AS REQUIRED Analysis Completed :OCT 27 89 Laboratory Supervi or :ST IIEN C�, E/DE By Released C. VCS Special Instruct: Chemlab Rof #: 8253 Lab Smpl ID: 3 Parameter Tested --------------------------------- NITRATE-N Client Name S & S ENGR Client Acct SNSENGP P.O.# NONE RECEIVED Req # Ordered By : S & S ENGINEERS Send Reports to: 1)S & S ENGR 2) Matrix: WATER Rosult/Unite ----------------------- 1.3 mq/l Sample ROUTINE SAMPLE. SAMPLES COLLECTED BY R/P. Remarks: _ =....... ==== ',e=e= o=',e See 1 Tests PerformedSpecial Instructions Above ND- None Detected See Sample Remarks Above NA- Not Analyzed LT=Less Than, GT-Greatex Than Allowable Method Limits ------------------------------ EPA 353.2 10 UA -Unavailable GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received April 13, 1976 Time of Inspection 10:30 a.m` Date of Inspection 4414=76— Wed. REQUEST FOR APPROVAL OF .Les INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Lomas and Nettleton Mailing Address: 4449 Business Park Boulevard ` Phone: 274-7661 2. Property Owner: Bavarian Builders, Inch Phone: 344-5604 Mailing Address: Star Route A Box 78-13, 99507 3. Legal Description: Lot 2 Block 2 Williamson Subdivision (original) 4. Location: East 90th Avenue off of Birch Road 5. Type of facility to be inspected _Single Family No. of bedrooms —2�—_ 6. Well Data: I��nn%diividual - serving one A. Type B. Depth _ _ 118�_� C. Construction D. Bacterial Analysis 7. Sewage Disposal ST e m: on-site system A. Installed _ 1975, 13. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area —�T 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area ^, Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area _ C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages= Re >t for Approval of Individual �r & Water Facilities Legal Description Lot 2 Block 2 Williamson Subdivision (original) Comments Disapproved T Date ApR1-;Valid for one year from date signed Greater Anchora Area 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 subject sewer and water facilities and these facilities are operating satisfactorily. 69191,11911 EQ -034 (1/74) Date KNICIPA111Y UI° ANCHOPA(A DUT. Cf- NPALM 4 MUNICIPALITY OF ANCHORAGE I:NVIaOW;NTA1. N,OUCTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (( *Dl 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 APR ; j MG REQUEST FOR APPROVAL OF"L, 1 f; tl INDIVIDUAL SEWER and WATER FACILITIES ! V 1 1. Type of Inspection: CMRO— VA— FHA_--CONV--- 2. Property Owner: Mailing Address: -__1L1i—. 3'" J) --Day Phone:_ _�- 3. Name of Buyer: Mailing Ad Day Phone: 4. Name of Lending Institution: 5. C 7 I Q Mailing Address: Name of Realtor or Agent: Mailing Address: Phone: Phone:----- Legal hone:_ -- Legel Description: [ '-P �s ds Location: Type of Facility to be Inspected:.— c� Fe 3c. C ---No. Bdrms. Water Supply Type of Supply: Public Utility— Individual_ If Individual, number of dwellings presently served _— /( lLff — If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation— 72 -003(3/76) Individual (on -site) -