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HomeMy WebLinkAboutWILLIAMSON BLK 2 LT 7 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181102 PID Number: 015-073-18 Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Andrew R. & Kristy M. Naylor ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench El Bed El Mound 5320 Woodcrest Drive, Anchorage, AK 99507 ❑ 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 Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. Williamson 2 7 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25' TANK 0 Septic ❑S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water >100' N/A N/A N/A Anchorage Tank 1,000 Gal. Material Number of compartments Lot Line >5' N/A N/A N/A Steel 2 NA Foundation >10' N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks2" Pump on level at Pump off level at High water alarm at insulation over tank. Existing tank decommissioned in accordance with MOA in. in. in. Code. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Denali Excavating Drainfield CO/MT Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 15' 5/30/18 'n Location and description dates: 2 3rd 41h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ,?'��_(, ,t 0*•49 TH %\ *0 0-711-4-,1,42 r 7 6 % Michael E.Anderson �. lYekl< .' 381E .�.��/ Approved �l - - Date fo'V l til�F9F0p •``•, 11 ROFESSl0 ,`., Inspection Report_9-1-12.doc WILLIAMSON B2 L7 - 5320 WOODCREST CIR PERMIT # OSP181102 PID # 015-073-18 \\ // 00„ �� \\ N \ \ / �� s \ \ N \ \\ / / T \ N \ \ / / / C/� EXISTING WELL \\ \ ` // II \ C.6 y ®� \ 'I1 I EXISTING WELL/-L '�® }�` EXISTING WELL �_r® \\ 1, I Iti 1` I EXI$�'M WELL /' \ / I \ I /1 \\ \\ \ a / I /// \ WOOD RET.WALL \ : ---'/ r / / \ \1 \ 3 BDRM lioUSE / / / LOT N /i3\ t7 / O"iiia �- // N LOT 8 FCO e I _ _ _ -, \ O\' L / _ _ 2C01 - NEW 1000 GA ON SEPTIC ` sTANK WITH IN LATION N 8V2 2CO2 = I — N -- — 10'UTILITY EASEMENT \ RSCHEti SUBD. , ' , II ' LOT 1C LOT 0 A B N NOTE: / 2C01 60.2 60.4 N\ EXISTING SEPTIC TANK DECOMMISSIONED IN / SV1 63.1 62.6 \ ACCORDANCE WITH MUNICIPAL C ODE. \ / SV2 68.1 68.3 / 2CO2 70.2 71.3 1 / I 1111ORGE 1GIN{ICING I NOTE: / -.. \\\x NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND �i�P .Ct44.4`kkh� PROPOSED SEPTIC SYSTEM CO CLEANOUTqa TM j� ';yt+I ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2C0-DOUBLE CLEANOUT yy/ • �..•, PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO FOUNDATION CLEANOUT SYSTEMS. FS FLOW SPLITTER VALVE . Michael E.Anderson . / MH-MANHOLE 0r��'F/`.� 4831-E \4 i 0 50 10ME _OFEET MT-MONITORING TUBE ii F046's:... .�� SV-SEPTIC VENT 1` ROFESSION'. 1"=50'�\���N�� TH TEST HOLE WILLIAMSON BLOCK 2 LOT 7 PERMIT # OSP181102 PID # 015-073-18 ON _ UCNA 0 N > > 0 Cn Cn N - 96.7 - - - • 2" INSULATION 93.3 CJI n' tai 79? 92.7 1000 GAL 92.5 SEPTIC TANK 1L .4. - 88.4 NOTE TANK ONLY PLACED UNDER THIS PERMIT. Of.A/ tSli 4% fi fr 1 i*49TH i\ * , rA PROFILE AS-BUILT •• Michael E.Anderson : i illiiiiiPGE ,r�Fc��F •• 48® ••��•,Al [NGIN[[■INi (NO SCALE) ,Av-PROFESSiO ' 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: OSP181102 Work Type: SepticTank Upgrade Tax Code Number: 01507318000 Site Legal Address: WILLIAMSON BLK 2 LT 7 G:2437 Site Mailing Address: 5320 WOODCREST CIR, Anchorage Owner: NAYLOR ANDREW R & KRISTY M Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: gent , o � _c ^ ,- De partnient Lot Size in Sq Ft: Total Bedrooms: 5/23/2018 5/23/2019 16556 ❑ 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: Z3 3 U" MUNICIPALITY OF ANCH RAGE Community Development Department Phone: 907-343-7904 Development Services Division QD Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-073-18 Property owner(s) Andrew R. & Kristy M. Naylor Mailing address 5320 Woodcrest Drive Anchorage AK 99507 Site address 5320 Woodcrest Drive Day phone Legal description (Sub'd., Block & Lot) Williamson Block 2 Lot 7 Legal description (Township, Range & Section) Lot Size 16,556 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑x Upgrade ❑X Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Zl5 J Date of Payment: fj7 Ej �g Receipt Number: cga2m Permit No. OSP C � 1162 Permit App_-'-:- , c� Waiver Fees: Date of Payment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) May 19, 2018 Municipality of Anchorage Development Services Dept- On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Williamson Block 2 Lot 7 – Woodcrest Cir Septic system design and permit application Dear On-Site Services Engineer: The owner of the above lot intends to replace existing 1000-gallon septic tank. The attached site plan identifies the location of the home as well as the well and existing septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. Wells on this and adjacent lots are shown. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 10’ away from the house foundation. The existing tank is to be decommissioned on site per MOA code. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE 5/19/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181102, Deb Wockenfuss, 05/23/18 // // // // 10050 0 FEET 1"=50' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGENDWOODCREST CI R C L E WILLIAMSON B2 L7 - 5320 WOODCREST CIR May 19, 2018 SLOPES > 25% SLOPES > 46% SHED WOOD RET. WALL 10' UTILITY EASEMENT INSTALL NEW DOUBLE CLEANOUTS BEFORE AND AFTER TANK INSTALL NEW 1000 GALLON SEPTIC TANK WITH INSULATION EXISTING 1000 GALLON SEPTIC TANK DECOMMISSION ONSITE PER MOA CODE AND REMOVE CLEANOUTS FCO TIE INTO EXISTING 3' WIDE 6' EFFECTIVE 25' LONG TRENCH 3 BDRM HOUSE 2CO SV SV 2CO EXISTING FENCE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181102, Deb Wockenfuss, 05/23/18 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl-TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorafle, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPQSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME LEGAL DESCRIPTION LOCATION Absorption area Dwelling M at e ria,.~- (~ S. L/ NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid depth Dwelling PERMIT NO, Manufacturer Liquid capacity in gallons DISTANCE TO: No. of line~ / Top of tile to finish grade Material Well Foundation ~ Nealest lot line Crib depth PERMIT NO. Distance between lines Totnl effe~iv-e%i)~Oq~tion alea Driller Well DISTANCE TO: DISTANCE TO; Building foundation OTFIER Sewel line PIPE MATERIALS SOIl_ TEST RATING INSTALLER REMARNS Septic tank ( /Absorption area(s) =__=__1 ' 7~ 013 (Rev. ~/78) ~ Cfi DATE LEGAL UPGRADE ~ L,..t tl. I FIF'F:'L i CFI?',IT i,., 0 [i[: F:I "1' I 0 'i',LIE: I...Ei'ql3ll'H [):[ I"ili~:l",l~i~; :[ O1',t :[ S -t"i-i1( !~.i):l".!(~'!'FI THFE !)f~:F'TF! t}F R i"F~:!i~:!".ICI.'.! OF;ir i:::':1-!' IS THE [)I'.E;'!'F:tI".i(S:iL:: i~iL~ET!.,.I1S~:EN "I"III':S ':i~.ll-;i~F:'l'.:![::!~i: ()F: 'iH!i: (:ii~rOI...l!",lD FII",IC, THE t!iI(::rT'T()H(3t::' 't"HI]~:,~:~IE IS NO SET I,.IIf.)TI~I FOF?. T'H,S [t:iI;~rF:I',,,'E:L.. DEP'!"H :('_:5 THE t,IIiYI!',ILII',I FIl'q[) THE: ~ii~O"i'TOt,l OF T!.~!ii: EXCFIYFtTIOt'..I ,::IN FEi'fYi). -i'H I :F~ [::'EF::~FtFi;'II"I!ZHT i::,! IP 'H _ii 't H!i:. TH:I:!:: F:'i~:()P!EF?,]'Y F:It",!D H ;[ I~,11 I"II..IH [:, ! :STFII",!CE: BE'FI,.IE:EN F:I HELl_ RI",I[:, FII",IY ON--'S ! 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E TO IN'ii~;LIRE: F'~:()F'EF: IHSTI::tL.I...FITION. 1 C[!i:F:TIF:'Y 'i'HFtT :;i..: ~ F:II"I FFII'I!L.):FIf~'. HI'I'H TFIEi: F~:E(;!I..IIRE:H~NTS F'Ot~: ON".'SI'I!E SF:I,.!E:FtS FII'.,ID HI:i::L.L.'~':; F'()I~:TH D"*" THE I"ll..It",!~CIF'F!L. iTY O1:: ;~Jt: I I,.t:i:I...L ]:!",!S':TI::II..L. THE: 'i-?'?STEFI II",! F:ICCOI:;i:DFli'-,!C~: I,I!TH THE i!i:: ~ iJI",![:'[:~F:STFII'.,!I::, TFIFIT THE: OF,~"'SITE: S!EI,t~:I'~ S"r%'t'EH I"IF:IY F:Ei)]:!LI!Fi~I_:: [Ei"fl_.f::IR[]iI'~:!'IEH'!' iF: Il'liE F~E'.~!:It:)~fl",!CE!: I:5 ?.EHOt.)I?J.. Et) TO i?,!CL.f..IDE I'"IOF.'.E I'HF!I'! ?~: FI;T/ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Abska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST 4- 5- 6- 7 8 9 SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER S ENCOUNTERED? ~_ I.~ E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time ' Water Drop 't'H?._O (~'8~ 1~',2.c} ,O, 0~r¢ ?"~.H O I I:,,~n lO , . ~c; , ~_ ~ Il:q2: -O .q2 5 ~l:s-z~ ~o ,64 +~z© Ii :S~ '(> PERCOLATION RATE ~?"~' (minutes/inch) CERTIFIED BY: DATE: PERFORMED BY:. 72-008 (6/79) SOILS LOG MUNICIPALITY OF ANCHORAGE [] DEPARTMENT OF HEAL TH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST /: .Z o?'7 SLOPE SITE PLAN 1 2 3 4- 5- 6- 7 8- 9- 10- 11 13 14 15 16 17 18 19 2O ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN , CERTIFIED BY: 72-008 (6/79) M-W DRILLING, Inc. P.O. Box4-1224 o 1310C International Airport Road (907) 274-461] ANCHORAGE, ALASKA 99509 MUnICIPALlY',' OF ANCHORAGE DEPT. OF rqEAETH & ENVIRONMENTAL PROTECTION DRILLING LOG N0V 41986 Location (address of: Town'p, R~ge, Section, if ~own; or dist~ce ma~ road Size of casing~".__~Depth of Hole Static water level Le'q ft. (above) Screen ( ); Perforated ( "L-i'~ '¢~Dfeet Cased to__I-2~'~ ~/~fee[t (below) land surface. Finish of well (check one) open end ( >- ); Describe screen or pdrforation :~o9 Well pumping test a~ .~ gallons per of drawdown from static level. (minute) for__] hours with_ w~_JJ ~,//~ f:J~"i'S~*.f WELL LOG ~u 23- Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness · ~' _TO ~-~o C~;~5ot'~ -", rl.~ ~p. ~ _TO ~ ~7 SiJ tv Hard Pan 130 I~O LA'% IqSVWA C~ied C~'"4-'-'~'~r~' ~ Certificate No's. 814 & ~W2 2 -- STATE ' Row 1Aa9 107 oc• • • Municipality of Anchor: ��;.. � �°� t - On-Site Water and Wastewater Watez. Li](907) 343-7904 1\3015 201$ SAFETY Certificate of On-Site Systems A �9-� I Y P Ii 01 6 Parcel I.D. 015-073-18 Expiration Date: q- 7 _C 1. GENERAL INFORMATION Complete legal description Williamson, Block 2, Lot 7 Location (site address) 5320 Woodcrest Drive Anchorage, AK 99507 Current Property owner(s) Andrew R. & Kristy M. Naylor Day phone 503-881-2195 Mailing address 5320 Woodcrest Drive Anchorage, AK 99507 Real Estate Agent Jamie Harvey Day phone 907-227-1059 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual Individual Water Storage ❑ Holding Tank Cl Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: (/,�6-/Ailkw# Date: (0/Vd COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ cgoktab 4 ?.t.t) 60 Waiver Fee $ Date of Payment (61(01/g Date of Payment Receipt Number O (nc F b Receipt Number COSA# Of),ISla5 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, PE Date 6/5/18 F...• l *: X�49 S�TH ��/ •.* /� 6. DSD SIGNATURE ( / System #1 Approved for bedrooms + Michael E.Anderson ./��' 4381-E •• � System #2 Approved for bedrooms �i F9F°PROFEsstoNP`�`�� Disapproved l�‘\\�N..- Conditional approval for bedrooms, with the following stipulations: F \IPS'(pG• �p,�` inn.Ar,maT c. g t Original Certificate Date: V�h —/ Y� 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. ` (.: '' 1 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory , Septic System Advisory Arsenic Advisory Well Flow Advisory Other r COSA blue sheeti" '• c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Williamson, Block 2, Lot 7 Parcel ID: 015-073-18 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 07/16/82 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 140 ft. Cased to 140 ft. Casing height (above ground) 22 in. FROM WELL LOG AT INSPECTION Date of test 7/16/82 5/03/18 Static water level 108 ft 70.5 ft. Well production 5 g.p.m. 0'9 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1 .6 mg/L Arsenic NDug/L Date of sample: 4/30/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/30/18 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping Pumper New Construction C. ABSORPTION FIELD DATA Date installed 8/20/82 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 SF/BORN System type Trench Length 25 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 300 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/03/18 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 492 gal. New depth 0 in. Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 450 g p d None Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: 10' >5' >5' Building foundation Property line Absorption field 10' >100' Water main > Water service line >10 Surface water 10 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: >10' >10' Property line Building foundation >10' Water main Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and � review of Municipal records that the above systems are in '''' OF At `l conformance with MOA COSA guidelines in effect on this date. /��Q' ' • ;:4.14� Engineer's Printed Name Michael E. Anderson, PE /*•49 TH %\ • •..*# Date 5/31/18 " /r •. Michael E.Anderson : /01 6f tee`'• 4381-E ••�`�1, �` e G - 'S i *<,.A lk -DPROFESSot"= COSA brown sheet 10-10-12.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT f e '�' 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite ` Well Water Advisory' Certificate of On-Site Systems Approval # OSC181255 Subdivision: Williamson, Block: 2, Lot: 7 This well's productivity was determined to be .9 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3-bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org ` ' 8473 0,6 sT IVe<F \ / \ 00 / oo \.,50 onc. ret.wall \ ' bQe 44 \--Well 1g Ent deck NwaN 15.3 22.7 0 6.0 o SCALE: 1"= 30' Wood ret.wall Frame eritNouJ 3.5 OH �Lr N1 Story ent rn O° with Bas em 'o N 44.0 000 Lot 6 1111111111 � LOt 8 co' 1.5 0H ����� deck CO�S�Oh deck __ 7� PD �" /Shed encroaches 3.7'± w Lot 7 CO Iy shed ram Wire fence Septic vent(typ)---! Garden .. 0 10' Utility Easement Lot 1C S89°55'45"W 201 .47 Lot 1D Chain link fen - Fischer I Subd. AS-BUILT NO CORNERS SET THIS DATE , ..%,,V%N. I hereby certify that I have performed a Mortgagee's inspection ` OF 1 of the following described property: LOT 7, BLOCK 2, a. ,`e . , , ,AL I f WILLIAMSON SUBDIVISION ,`P•• S,r l� "1 CO•• 49th )-N ••'9 i Anchorage Recording Precinct,Alaska,and that the / .: . / improvements situated thereon are within the property lines / and do not overlap or encroach on the property lying / / adjacent thereto,that no improvements on the property lying / / adjacent thereto encroach on the premises in question and 0)32,..Elizabeth L. Walatka :1 / that there are no roadways,transmission lines or other f,'sIF. 8036 — LS •,J��= visible easements on said property except as indicated "0.;. y hereon. o• • • .0�� Dated at Anchorage,Alaska EASEMENTS OF RECORD,OTHER THAN ' ` %.%NAL � this 9th day of MAY 2018. THOSE SHOWN ON THE RECORDED \`��` FRED WALATKA&ASSOCIATES,L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors UNLESS OTHERWISE NOTED. Holt, FB 18-2, pg 56 BE 907-248-1666 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _(-~\~ ¢ (~-/ ~)- I?h 1. GENERAL INFORMATION Complete legal description Location (site address or directions ,%.~ 8~, (,~'c,~ ¢_~ ¢ Property owner Mailing address Lending agency Mailing address Agent N. /t,. Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ¢ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Engineer's signature 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 /'=(~f-,~¢, 7-~c,~/~.;c~ f ~'~c~ Phone Address /~ ~c~ ~ ~c~¢ ~ DHHS SIGNATURE ~_ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT '?, ~,M4 2 WII.~.it~I~$eN Parcel I.D. A. WELL DATA Well type f2f(H/A'TE If A, B, or C, attach ADEC letter. ADEC water system number N, ~,, Log present (Y/N) ~' Date completed 'l/1(./82. Driller Totaldepth I~0 ~ Casedto I~'0 ~ ' Casing height Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) 1%1 FROM WELL, LOG AT INSPECTION Date of test 7//~,/~f2 Jo(2'1/cl~- Static water level J o~ ~' ~-~ ~,2'~ ~:~ ~ :.~ Well flow .-¢' g.p.m. I, ~' g.p.m¢,,~ ~ > Pump level ~ I~0 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I o(- ' TO C,o. ; On adjacent lots_ 'Z ICc Absorption field on lot ~-- 115 ~ ; On adjacent lots -? / ~1~' Public sewer main ;:' ~ ~o _ Public sewer manhole/cleanout ;;' / ~o Sewer service line ~ 0¢ Petroleum tank WATER SAMPLE RESULTS: Coliform ~ c~l/~oo.,~.. Date of sample: Ib/.2.',,/c/2 Nitrate Collected by: Other bacteria _ ('2 cc, ( /~'oo~ ,~ ~LA'TToP ']'Et.b' 5Yc.r B. SEPTIC/HOLDING TANK DATA Date installed ~/~2 Cleanouts (Y/N) High water alarm (Y/N) Date of pumping ~'1/ ,~4o/¢/)¢ c., ~' Tank size I O00 Foundation cleanout (Y/N). ~ '~c Compartments % ~' Depression (Y/N) Alarm tested (Y/N) f4. A, Pumper /4 + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IO(~ p~oP. C.O. Onadjacentlots ~ /oo' To propertyJine J0/4' ~ ~t~/~s EC_fAbsorption field Surface water/drainage "~ / ~ ' Foundation ~ Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ Length 2-$¢ Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) To building foundation On adjacent lots > Soil rating jo0 p'/6p~'~ System type Gravel thickness /' * Total depth Cleanouts present (Y/N) Date of adequacy test fo/Z1/ for ~ bedrooms Not4~ KNo~ ~4 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~li~~ Onadjacentlots ~/°°¢ Propertyline I~¢+F¢~ To existing or abandoned system on lot N,/~, Cutbank ~1,/~, Water main/service line Surface water Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date II / ?' HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72 026 (Rev 3/91) Back MOA 21 APPLI(' NT FILLS OUT UPPER HA[ ONLY Property bwner ~-P (< ~ ?r',~ /~) I 7~"'~/' /, t~/ Phone Buyer Address Zip Code Lending Institution Phone Address Zip Code Address Street I_ocatl~ Type of Residence ~' Single Family ~ Multiple Family No. of Bedroom. ,~ ~ Other Water Supply ~ Individual ~ ~ C~ ~ ATTACN WELL LOG. A w¢l log Is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attsch log If available). Sewer Disposal ~"'lndlvidual ~ c~) ~ . Year Individual Installed: ~ Public Utility When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH SE~EST BEFORE ~OC~SSING~ ~BE INITIATED, Inspector Inspirer ~ Insp~tor Field Notes: MUNICIPALFrY OF ANCHORAG~ /~/~. ~DEPT, OF HEALTH ENVIRONM2NI'AL PROTECflON MAN J. 4 :, RECEIVED ( ~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE ~--~ Soi)s Ragng Date ~wer Ins~aUed welm To AbsoCptton Area / /~ ~ welm Log Rece)ved