HomeMy WebLinkAboutGREENLAND BLK 6 LT 8 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251140 Work Type: Septic Upgrade Tax Code Number: 01517129000 Site Legal Address: GREENLAND BLK 6 LT 8 G:2636 Site Mailing Address: 4621 Ell5TH AVE, Anchorage Owner: BOSSHART BRADLEY J Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: Delmrtment 5/16/2025 5/16/2026 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Locate existing fields prior to new field construction to verify separation is maintained. K, Received By: ` r =i Date: Issued By:V, I Date: 2 f ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-171-29 -, BradleyBosshart (907) 444-3656 Property owner(,.; Day phone Mailing address4621 E 11 5th Ave, Anchorage, AK 99516 Site address4621 E 11 5th Ave Legal description Greenland Block 6 Lot 8 Number of Bedrooms Engineering Firm Forge Engineering Building Permit Number Not Applicable F] APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field 0 Initial 0 Septic Tank F] Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees:q Soo Waiver Fees: Date of Payment: 1� I �§ Date of Payment: Permit No. n �) R r-12 S / ) L q 0 Waiver No. May 7, 2025 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Greenland Block 6 Lot 8 – E 115th Ave Septic system design Dear On-Site Services Engineer: The septic system on this lot has failed. The old tank has collapsed, the seepage pit must be decommissioned, and upon inspection the existing bed was close to failure, so we are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home as well as the proposed septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot slopes moderately from the east toward the west. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached test hole log, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251140, Curtis Townsend, 05/16/25 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=30' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND GREENLAND, BLOCK 6 LOT 8 FEET 0 30 60 SEPTIC PLAN 5/14/25 20' ALLEY E.115th Avenue 470 465 460 3-BDRM HOME (2) 45' LONG X 5' WIDE, 0.5' EFFECTIVE DEPTH TRENCHES TH#1 1250-GAL STEP TANK EXISTING TANK TO BE DECOMMISSIONED EXISTING SEEPAGE PIT (COMPLETELY EXCAVATE AND BACKFILL WITH NATIVE SOIL) EXISTING BED TO BE DECOMMISSIONED EXISTING WELLS EXISTING WELL NEIGHBORING SEPTIC NEIGHBORING SEPTIC MT MT MT MT FCO WELL TO THE NORTH UNAFFECTED 6.8 MINIMUM SEPARATION 6' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251140, Curtis Townsend, 05/16/25 GREENLAND, BLOCK 6 LOT 8 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER DRAINFIELD ROCK DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: 1.1 MIN/IN APPLICATION RATE: 1.0 GPD/SF 5' WIDE TRENCH SYSTEM 1250-GAL SEPTIC TANK BOTTOM OF TRENCH: 0.5' ABOVE GRADE FLOW LINE ELEVATION: 1' ABOVE GRADE 450 GPD / 1.0 GPD/SF / 5' WIDE * 1.0 RED FACTOR [0.5' DEEP] = 90 LF TRENCH REQUIRED (90LF SPECIFIED) GEOTEXTILE FABRIC AND 2" INSULATION 1 1 4" PVC w/ 1 8" ORIFICES EVENLY SPACED @ 5' OC 5/15/25 PROVIDE ADDITIONAL FILL TO ACCOUNT FOR SETTLEMENT 6" 6" 2' 6" 2' 2.5' MOA APPROVED SAND 5' MAXIMUM 3:1 SLOPE, PROVIDE TOPSOIL AND GRASS SEED Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251140, Curtis Townsend, 05/16/25 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING DEPTH TO WATER AFTER MONITORING 1.075 4/25/25 1 2 3 4 5 6 SM (GRAVEL/SILT/SAND) Professional Engineers Stamp: GREENLAND BLOCK 6 LOT 8 4/25/25 015-171-29 LILY BOSSHART 7 OB 5:00 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER PERC TEST LOCATION TECHNICIAN: JARED EARLS 1 3.5' 5/2/25 COMMENTS: SITE PLAN 6 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED 5/14/25 MOISTURE NOTED AT TIME OF DIGGING?YES SC (SILTY SAND W/SOME CLAY) 6:20 6:27 6:30 6:27 6:27 7 1 6 7 1 6 7 1 6 7 1 6 7 1 6 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251140, Curtis Townsend, 05/16/25  MUNICIPALITY OF ANCHORAGE i~!~) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchora§e, Alaska 99501 Telephone 204-4720 ~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~'AME IPHONE [] NEW ~AI LING ADDRESS LEGAL DESCRIPTION ~CATION NO, OF BEDROOMS LWell Absorption area Dwelling ~1- ~ Manufacturer ~ ~ ~ Material No, of compartments Liq, capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons Well Foundation Nearest lot line PERMIT NO. ~ ~ ~ No, of lines Length of each line Total length of lines Trench width Distance between lines ~ --~ ~ inches ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~ inches Length Width / Depth , PERMI~ NO. Type of crib Crib diameter Crib deptb Total effective absorption area ' tn ~ell Building foundation Nearest lot line ~ DISTANCE TO: y.[O01 .~{~ ~ Class . ~ep~h /, Driller Distance to lot li~e PERMIT NO. ~ DISTANCE TO: Building fom~ation Sewer line ~ Septic tank / Absorption area(s) OTHER - PIPE MATERIALS ~ ~ ~ '~'~'P~ N /, , SOIL TEST RATING / INSTALLER REMARKS I onk' rSt { APPROVED DATE LEGAL 72-013 (Rev. 3~78) MUNICIPALITY OF ANCHORAGE Department Health and Environmental rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~(~(,~3~.l~ WE-EL .:AND/OR 0N-SITE SEWER PERMIT {~/~/o(~ ~So~ Applicant: ~C/~C~ ~~ Mailing Address: _~ ~d~/~ /~ c/ mc3 Location: Phone Number: ~ -3~o~ ~ . Legal Description: ~ ~ ~ ~ ~~ Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Maximum Number of Bedrooms: _ ,~ _ Lot Size: ~ Holding Tank: Soil Rating(sq.ft/br) /~ ~ DEPTH The Required Size of the Soil Absorption System Is: LENGTH /~ "~-~ GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel.depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HEH_-D~NG) TANK SIZE = /~CDC]) GALLONS * * Perm:Et applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a co~uunity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER ~1~ i 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the MunicipalJ. ty of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signe~: ~~ ~ Issued by: ~. ~ <~w-3~ Applicant SWP/024(1/81) / SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 525 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16 17, 18- 19- 20- 8LOPE WAS GROUND WATER ENCOUNTERED? DEPTH? Gross Net Depth to Net Reading Date Time Time Watel D~op i ?: ,fl Lq 0 , TEST RUN BETWEEN PERCOLATION RATE ____ /',~ (minutes/inch) ~' FT AND ~, Va FT ALASKA EIUIROrlmi~nTAL COFITIgOL $~gUlCl~$, InC. ~n§i~rin§ ~, ~nuironm~t~l SNdks PERCOLATION TEST DATA SHEET ADDRESS ZIP CODE TOTAL DEPTH OF HOLE ft. ZONE TESTED (~ I/~ *t TO % ft TH # ~ READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) DATUM FINAL PERCOLATION RATE ALASKA eliUIROIqm FITAL COFII'ROI. SeRUIC $, IFIC. ~nqi~eerin§ 8 ~nuironmenl(~l Slu~ies SPECIFICATIONS FOR SEEPAGE BED TREATMENT SYSTEM - LOT 8, BLOCK 6, GREENLAND SUBDIVISION 1.0 GENERAl, 1.1 THE DRAWINGS, SHEETS 1 THRU 2, SHALL BE A PART OF THIS SPECIFIC ATIONS. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL PROTECTION PERMIT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE ENGINEER. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER TO OBTAIN ALL NECESSARY PERMITS OR EASEMENTS. 2.0 LIFT STATION (NOT USED) 3.0 CURTAIN DRAIN (NOT USED) 4.0 SEEPAGE BED 4.1 THE GRAVEL FOR THE BED SHALL BE SCREENED TO THE SIZES INDICATED; 0.5 TO 2.5 INCHES. 4.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURIi~G EXCAVATION. THE BOTTOM ELEVATION S~{ALL BE PLUS OR MINUS 2~.~ 4.3 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3003 D-3034. THE SECTION SHOWN WITH HOLES MAY BE EITHER DRILLED 0.5" HOLES AT 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A SECTION OF REGULAR PERFORATED SEWER PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL)SHALL BE PLACED ON THE TOP OF THE PIPE. 4.4 THE INSULATION SHALL BE 2~HIGH DENSITY EXTRUDED OR MOLDED BURIAL TY~E, M~ ~ '~ RIGID POLYSTYRENE BOARD INSULATING MATERIAL RATED AT NOT LESS THAN 2.4 #/CU. FT. DENSITY, COMPRESSIVE STRENGTH OF NOT LESS THAN 35 PSI, AND A WATER ABSORPTION OF NOT GREATER THAN 1% BY VOLUME. 4.5THE TOP AND SIDES OF THE BED SHALL BE PLANTED WITH A WHITE CLOVER AN]) RED RESCUE MIX OR BLUE GRASS. 4.6THE SEPTIC TANK OR BED MUST NOT BE CLOSER THAN 100 FT. TO ANY EXISTING WELL OR BODY OF WATER. 4.7 THE DISTRIBUTION ]PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 1200 LUesl 33rd ~uenu¢, $ui1¢ [~ · ~nchoro§¢, Alaska 99503 · [907) 276 1361 ALASKA ENVIRONMENTAL CONTROL SERVICE ~NC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-136]. SHEET NO OF CALCULATED BY ~-! L~', 9 DATE CHECKED BY DATE ! /5' ALASKA ENVIRONMENTAL CONTROL SERVICE,~ NC. 1200 West 33rd Avenue suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO ~ OF CALCULATED BY ~;f' ~ O, ? DATE CHECKED BY-- DATE SCALE / // ~' ~; / QGRE,' ~R ANCHORAGE AREA B0F Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 'JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE -- _~ FROM WELL/[2/--''] INSIDE LENGTH MANUFACTURER ~'"/ INSIDE WIDTH /gL /¢~¢~ -MATERIAL ~/C~ .LIQUID DEPTH____ NUMBER OF / COMPARTMENTS_ _LIQUID CAPACITY GALLONS. SEEPAGE PIt: NUMBER OF PITS } DIAMETER__OR WIDTH~~, LINING MATERIAL &~"2¢ CRIBSIZE: DIAMETER__ / BUILDING FOUNDATION_ ~ , NEAREST LOT LINE '~--7 . ABSORPTION /;7/ ADD,T,ONAL _DEPTH ? DISTANCE FROM: WELL_,// ~'-,.~ --. TOTAL EFFECTIVE ABSORPTION AREA (WALl_ AREA) ./~77~ __SQ. FT. WELt_: TYPE BUILDING POUNDATiON..~ / CESSPOOL APPROVED __ CONSTRUCTION ~Y'~L~.~'Z NEAREST NEAREST LOT LINE SEWER LINE __ OTHER SOURCES DISAPPROVED REMARKS DEPTH ~.~ DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DIAGRAM OF SYSTEM INSTALLED B YC~.. ~'~ ~"~ PiPE MATERIAL: LOT SLOPE: REMARKS: Form No, EO-031 GREATER ANCHORAGE AREA E3OROUGH DEPARTMENT OF ENVIRONMENTAL QUAL. ITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4~61 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PI,'EMIT PERMIT NO, NAME OF APPLICANT ~ ~ LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK ~ -~ SEEPAGE Pit__ ¢ .... [)RAIN FIELD ~__. OTI4ER TYPE AND SIZE OF PACILITY TO BE SERVED_ -~ so,_ T~sT ~ESULTS _~~~¢~ ..... COMRLETION DATE ANTICIPATE; '~':~~__.~_ FINAL INSPECTION: 2,4 HOUR NOTICE REQtJIRIED. EIACKFILL. ING OF' ANY' SYSTEM WITIIOUT FINAl. INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL 13E SUB.JECT TO PROSECUTION. g~ ~ / DIAGRAM OF i~IINIMUt'¢! DISTANCES, REQUIF~EMEI~I'~ FOUNDATION TO SEPTIC TANK ~'"'~" FOUNDATION TO SEEPAGE Pit .. DRAIN FIELD SEP'DC I'AN,( TO SEEPAGE Pit WALL ~EPTIC TANK SEEPAGE PiT TO NEAREST LOT LINE. --, DRAIN FIELD ./ ALSO CONSIDER AREA WELLS. _, SEEPAGE PIT --/l~ / /¢JO_, ~RA,N FIELD GRAVEL BACt{FILL CONFORM TO [~OROUGH REGULATIONS REGARDING INSTALLATION. OR R&M Civi! £~gineers ENC .v4EERING & GEOLOGIC. ,L CONSULTANTS 229 EAST 51st. AVE. - P,O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907--279--0483 TELEX 090--35419 Geologists Land Surveyors JAMES W. ROONEY, P. E. MALCOLM A. MENZ[ES, P.E., L.S. JAMES H. WELLMAN, P.E. RALPH R. MIGLIACClO Engineering Geologist April 17, 1974 R & M No. 462010 Mr. William Siemens SRA Box 1721 G Anchorage, Alaska 99507 Re: Test Hole and Soil Log Report for Sanitary System Lot 8, Block 6, Greenland Subdivision Dear Mr. Siemens: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of April 17, 1974, and those precedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 8 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended tO a total depth of 13 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, %. R & M ENGINEERING & GEOLOGICAL CONSULTANTJ;~'' James W. Rooney . rb xc: GAAB ANCHORAGE FAIRBANKS JUNEAU T.H. I 4-17-74 ORGANICS SILT, Some Sand and Organic~ (MCzSM! GRAVELLY SAND, Trace silt SAND, Some silt and Gravel (SP-SM) NO WATER TABLE 0.0~ 0.5' ] .5f 3.5I 13:0' T.D. NOTE: Test hole excavated with tractor mounted backhoe. I~ Engineering E~ Geologlcol Consultants Inc. V[ ANCHORAOE FAIRBANKS ALASKA JUNEAU OA~E 4-17-74 ,IS~A,L~ 1,"=5' '~042~7~ WILLIAM SIEMENS PROPERTY LOG OF TEST HOLE Anchorage Alaska PF~OJ. NO DWO NO.i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL.TIt & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 34:3-4744 Parcel I.D. # O/g- CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location Day phone Property owner Mailing address Lending agency'" -P/PcC~C~:L ~-~ '~O~g~ ~ Day phone Mailing address ~OO Agent ~ Day phone_ ~' Address ~/~ Unless otherwise requested, HAA will be held for pickup. NUNiBER OF BEDROOIVtS: '~ TYPE OF WATER SUPPLY: Individual welt Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATFR DISPOSAL: Individual on-site 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. 1191) Front MOA ~21 s~uawwoo leUO!~!PPV :suo!telnd!ls 6u!~OllO~ emi q~!~ 'stuooJpaq ]o~ I~AoJdde leuo!~!puoo 'pe^o]ddes!c] · stuoo~peq .... ,,., ~o~ p@^o]ddv ,, '9 bl.;I~NIE)N:-I Aa NOIJ. O:tdSNI .40 J.N=ll/~2J.",f.LS '(:j Municipality of Anchorage R E C E i V E D DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JUN 1 6 1998 825 L Street, Room 502 · Anchorage, Alaska 99501 ~9,9-7';)AAASCT:~8,40~AOE H'qVIRONMEN'fAL ,SERVICES DIVISION Health Authority Approval CheCklist Legal Description: A. WI-'LL DATA Welt type 'J~\U Pt--"~ ~_ Log present (Y/N) Total depth Sanitary seal (Y/N) IfA, B, or C, attach ADEC letter. ADEC water system number Date completed .~ //8 / ~ V Cased to Casing height (above ground) Wires proPerly protected (Y/N) /V/~_.~- Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK:~DATA Date installed ~¢:C,r¢¥ P~'f Tank size Foundation cleanout Date of Pumping FROM WELL LOG AT INSPECTION ~© g.p.m. 6,~ Nitrate ~ ~ '~ ~ Other bacteria_ Collected by: %, ~. ~, IO00C,4c Depression (Y~I~ Pumper /~C g.p.nl. Number of Compartments ,;.3.. Cleanouts ((~N) ~L. _ High water alarm (Y/~ C, ABSORPTION FIELD DATA-- '~-~.S-¢er~ /~'~_~ t~EO ~'-STE'x'~ O~F /f~l~ ~PP~ Date installed 71~ Soilrating (g.p.d,/*'or~F/b%~ /~% Systemtype Length ~¢ ' Width 1% r - Gravel thickness below pipe O, % Total depth Effective absorption area E~rbrO S~ Monitoring Tube present ~ ) I Ye; Depression over field (Y/~/.)/ /'Jo Date of adequacy test ~- ~- ~'~ Results (Pass/Fail) '~¢S~ For ~ bedrooms Fluid depth in absorption field before test (in.); '~?~fV' Immediately after(~CJ2, gal. water added (in.): Fluid depth hJ/R (ins) Minutes later: ~J/,q Absorption rate = L/SO '¢ _g.p.d. Peroxide treatment (past 12 months) (Y/~ ~'k)~ ~t r.:.6~,,v If yes, give date ha/,4 72-026 (Rev. 3/96)* Date installed -~-., Size in gal Manhole/Access (Y/N) __~__ __ "Pump off" level at* High water alarm level at* ....-----~ *Datum---'"'"""----.~. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots /00 -/: On adjacent lots Public sewer manhole/cleanout /'J//] Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation [0 "/ Property line /d '¢ Absorption field Water main/service line o~ ~ Surface water/drainage /00"f Wells on adjacent lots /0o ~/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ 0 ~-/- Building foundation ,/0'-J- Water main/service line /o './- Surface water /00 '4- Driveway, parking/vehicle storage area /d Curtain drain ~,..~o~_ ~-4,~..,w Wells on adjacent lots ENGINEE R'S CERTIFIC ~ATI~ON ~/! I cedi& that I hav¢.~eteOided ~g/~eldtinspections and review of Municipal mc¢~¢?~a¢fE&~y~ms ~n conformance with ~M¢~/HA¢ ¢¢~elin~s in effect on this date. ( .¢¢~;: ,~v ~ ",?, ~ ~(~ Signature J. .... .~~L~ . . HAA Fee $ C~C~(~)-O 0 Date of Payment Receipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number Facsimile Transmi,tal Alaska Water & Wastewater Consulting Engineers Date: (~/~ g/~/~ Number of Pages Including Cover: Attention: p% o ~ ~ ~ ~ From: Jeffrey A. ~arness, P.E., M.S. Comment(s): Reply requested: [] Yes [] No 7320 East Chester Heights Circle * Andlorage, Alaska 99504 * Phone: (907) 337-6179 * Fax: (907) 338-3246 Water & Wastewate]r Apdl 16, 1996 8471 Brookridge Drive ~ Anchorage ~ Alaska Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers Municipality of Anchorage Dept. Health & Human Services Division of Environmental Services On-Site Services Section P.O Box 196650 Anchorage, Alaska 9951%6650 Ref: Health Authority Approval (HAA). Lot 8, Bk 6, Greenland S/D. To whom it may concern: The subject lot is served by a private well and septic system. I inspected and tested the well/septic on 4/13/96. The results are summarized as follows: WELL: The static level was 23 below the top of the casing. Water was pumped from the well at a rate of 6.34 gpm for a total of 180 minutes (1142 gallons). There was essentially no drawdown. Based upon this data it is clear that the well is adequate for a 3 bedroom house (450 gpd). SEPTIC TANK: The septic tank was installed in 1974 and is now 22 years old. Given that it is a steel tank (Greet) it is undoubtedly approaching the end of its useful life. The next homeowner should anticipate replacing it in the near future. The existing septic tank is buried only about 15-18 inches deep. I don't know whether it is insulated. The homeowner didn't indicate there were any problems with the tank freezing. DRAINFIELDS & ADEQUACY TEST: The septic system cons~ts ora !000 gallon septic tank (installed 6/74), a 574 ft2 log crib (installed 6/74), and a 570 f~ bed (installed 7/83). Based upon my observations, it appears that the system is constructed so that wastewater first flows to the crib and,then overflows to the bed once the crib is full. The sewer lines from the house to the tank, from the tank to the crib, and the clean-outs on the septic tank were replaced ~PVC pipe) in August of 1995 by Carl's Excavating. According to the as-built records, the log crib has an effective depth of 84 inches (7 feet). On 4/13/96 the crib only had 35 inches of liquid in it. The monitoring tube in the bed was completely dry. The adequacy test was performed on the bed .system The results are summarized as follows: Water was introduced into the bed monitoring tube, at a rate of 6.54 gpm, for a total of 307 minutes (2008 gallons). The original intent was to presoak the bed and then retest it 24 hours · later; however, at no time during the test, was there any standing water in the monitoring tube. In short, it appeared that the water was being absorbed as fast as it was introduced. My initial concern was that the monitoring tube didn't extend to the bottom of the bed, and therefore, I was getting erroneous readings. However, according to the as-built records, the total depth of the bed is 3feet, and I determined the bottom of the M. 7~ to be 35 inches below grade(essentially 3feeO. In addition, I shot the elevation of the pipe invert, at the c/o just past the septic tank, and the bottom of the M.T., and detet~nined the difference to be 4.3 inches. If the pipe from the c/o to the bed is generally flat (assumption), then the elevation difference between the pipe invert in the bed, and the bottom of the M.T. is approximately 4 inches. Ideally, the difference between these two elevations should be 6 inches, but the only purpose of this exercise was to ensure that the bottom of the monitoring tube was at least below the elevation of the clean-out past the septic tm~k. When looking down the M.T. I could see that it was n6t resting on ~s921, but at least several .inches of drainrock. In addition, it was noted that the M.'i' did not appear to have any perforations (open ended oniy?). Perhaps the cast iron monitoring tube has "jacked" out of the .ground (freeze/thaw cycle) several inches? In short, without excavating, and determining the elevation of the drainpipe itt the bed, it is not possible to verify for certain that X~he monitoring tube extends all the way to the bottom of the drainrock. Given the fact that I introduced 2008 gallons into the bed without detecting water in the M.T., nor noting any water backing up into the crib, or the septic tank, it is reasonable .to assume that it is adequate for a 3 bedroom house (450 gpd). .NOTE: The adequacy cfa septid aystem ia' influenced by numerous factora', including, but not limited to, seasonal surface water i~ltralion, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives.), condition of drain pipe and pipe joints Ovhich can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic aystem (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. STRUCTURAL INTEGRITY OF LOG CRIB: Given the age of the crib it is reasonable to assume that it is approaching the end of its useful life. The next homeowner should anticipate having to fill the depression once it caves in. If you have any questions, please contact me at 337..6179, or on.my digital pager at 1-800-481-1162. Thank you. Sincerely, Jeffrey A. Garness, P.E., M.S. Owner/Consultant Vicki Hartmanl .wps c.c. Vicki Hartman Parcel I.D. # 1.  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 GENERAl. INFORMATION Complete legal description /,--~-i- ~ I~}.~(~. _~:~i~jC~.,j0 ~'/~ Location (site address or directions) .~_ ~.~.~-~ Property owner Mailing address Agent ~ Address ~~_ ~ Unless otherwise requested, HAA Will be held for pickup. NUMBER OF BEDROOMs: ~ TYPE OF WATER SUPPLy: Individual Well ~ Community well HAA # ~ Day phone Day phone Day Phone~ Public water NOTE: If community Well System, provide written confirmation from State ADEC attest- mg to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ~ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written attesting to the legality and status of system. 72-025 {Rev. 1/91) Front MOA/121 confirmation from State ADEC 5. STATEMENT OF INSPECTION BY ENGINEER ordinances, and regulations in effect on the date of th Name of Firm Address Engineer's signature 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 furtherverify 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 com 31iance with all Municipal and State codes, Is inspection. W6stewater Se, f vices Phone 847'1'~root~tirg~o Ut. // 6, DHHS SIGNATURE ~ Approved for ---.~'~ bedrooms. DisaPproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Mtin!cipality 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 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 engineeYs work. 72~25 (Rev 1/91) Back MOAI121 Municipality of Anchorage /';!q:( I B 1996 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ,~,4~.4{~ E 825"L" Street, Room 502e Anchorage, Alaska 99501e (907)34 -1V E D Health Authority Approval Checklist Legal Description: A. WELL DATA Well type Log present (Y/N) '~//~--- ~ Date completed Total depth ~ f~) / Cased to ~ ~ / Sanita~ seal (Y~) If A, B. or C. attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) kf F_-_~,.~ FROM WELL LOG Date of test Static water level . AT INSPECTION ! Well production WATER SAMPLE RESULTS: Ccitt'erin 4 Oateo[samCe: 4ho/q6 Nitrate fB. SEPTIC~[I~ TANK DATA "'CCoaV--- t% '2Z '"'/'i--...~-~ OL~2~ C(,-.~(p'i~. Datemstalled ~/7~-- .Tamksize lCD2 Nmnber of Compartments I Clcmiouts(Y/N) y Foundation cleanout (Y/N) NC Depression (Y/N) N~ High water alarm (Y/N) ~ Dateofmumping..¢l///~" Pumper X,_.%~,-,~ ~ Co .~"~Fluid depth iii absorption field before test (in.); "T<r2 %~'6~'J;> /Fluid depth ,0~ (ins.) Minutes later: CPcroxide treatment (past 12 months) (Y/N) ABSORPTION FIEI~D DATA Date installed '7,~-~.~-'- Soil rating ~ or ft2/bdrm) i z ff _ System type ~--f 7_.0 / Length ~ Width -~-~q-,- Gravel thickness below piper ) Total depth Effective absorptiou area. ~-';'~ -t:~ 2 ~otfitoring Tube present(Y/N) ~ _ Depression over field (Y/N) Date of adequacy test ¢r/IA/q/¢ Results (Pass/Fail) ?A-%~ Fo,' .~ bedrooms hmnediatelv after~O°Ogal, water added (in.): ¢ Absorption rate = '~' 6045) g.p.d. If yes, give date to//0. ~ Size in gallons Manhole/Access (Y/N) ~f lcvel at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tao_k on lot I DO On adjacent lots Absorption field on lot i.g4)t.. ~ O2.aB ~ ~' .... , ...,~ -va ; On adjacent lots Public sewer main [,.J/lA-- ....... g'~> Sewer/septic service line Public sewer manhole/cleanout Lift station /'~ SEPARATION DISTANCES FROM SEPTIC~ ON LOT TO: Building foundatiou ~ 7_.. t ~ Property line 4' ~" t ± Absorption field I~/~ Water main/service line ~ Iat Surface water/drainage ~ l O~! Wells on adjacent lots "~ lOOt' SEPARATION DISTANCE FROM ABSoRPTIoN FIELD ON LOT TO: Building fofindation ,~O ~ Water i~ain/service tine ~" ~0 Surface ~vater ~ ~o0 t Driveway, parking/vehicle storage area Curtain drain at:=: Wells on adjacent lots ProperW line F. ENGINEER'S CERTIFICATION h I. ce, try' ~ that 1 have detert?rtn'med thru ,~,,,tms' peet, OhS' and review' ofMunicipal reco~o(~,~tns, "' ;"' ~V"'e~f} are m confo.,,ancp~a;/~~eli~s' in' e/Sect on this date. Engineer/Name q~~ '~" ~~ , ~-7%3 . ~.~'~ ............................................................................................................ ~v~:z.~ ................ Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc April 16, 1996 Municipality of Anchorage Dept. Health & Human Se~Mces Division of Environmental Services On-Site Services Section P.O Box 196650 Anchorage, Alaska 99519-6650 8471 Brookridge Drive - Anchorage ~ Alaska Phoue (907) 337-6179 ~ Fax (907) 338-3246 Cousultiug Engineers Ref: Health Authority Approval (HAA). Lot 8, Bk 6, Greenlaud S/D. To whom it may concern: The subject tot is served by a private well and septic system. I inspected and tested the well/septic on 4/13/96. The results are summarized as follows: WELL: The static level was 23 below the top of the casing. Water was pumped from the well at a rate of 6~34 gpm for a total of 180 minutes (1142 gallons). There was essentially no drawdown. Based upon this data it is clear that the well is adequate for a 3 bedroom house (450 gpd). SEPTIC TANK: The septic tank was installed in 1974 and is now 22 years old. Given that it is a steel tank (Greet) it is undoubtedly approaching the end of its useful life. The next homeowner should anticipate replacing it in the near future. The existing septic tank is buried only about 15-18 inches deep. I don't know whether it is insulated. The homeowner didn't indicate there were any problems with the tank freezing. DRA1NFIELDS & ADEQUACY TEST: The septic system consists ora 1000 gallon septic tank (installed 6/74), a 574 ft2 log crib (installed 6/74), and a 570 ft2 bed (installed 7/83). Based upon my observations, it appears that the system is constructed so that wastewater first flows to the crib and then overflows to the bed once the crib is full. The sewer lines fi'om the house to the tank, from the tank to the crib, and the clean-outs on the septic tank were replaced (PVC pipe) in August of 1995 by Carl's Excavating. According to the as-built records, the log crib has an effective depth of 84 inches (7 feet). On 4/13/96 the crib only had 35 inches of liquid in it. The monitoring tube in the bed was completely dry. The adequacy lest was petlfo~w~ed on the bed ,Ua'tern. The results are summarized as follows: Water was introduced into the bed monitoring tube, at a rate of 6.54 gpm, for a total of 307 minutes (2008 gallons). The original intent was to presoak the bed and then retest it 24 hours later; however, at no time during the test, was there any standing water in the monitoring tube. In short, it appeared that the water was being absorbed as fast as it was introduced. My initial concern was that the monitoring tube didn't extend to the bottom of the bed, and therefore, i was getting erroneous readings. However; according to the ets-built records, the total depth of the bed is 3feet, and I deterrnined the bottorn of the M. Z to be 35 h~ches below grade (essentially 3feeO. In addition, I shot the elevation of the pipe invert, at the c/o just past the septic tank, and the bottom of the M.T., and determined the difference to be 4.3 inches. If the pipe from the c/o to the bed is generally flat (assumption), then the elevation difference between the pipe invert in the bed, and the bottom of the M.T. is approximately 4 inches. Ideally, the difference between these two elevations should be 6 inches, but the only purpose of this exercise was to ensure that the bottom of the monitoring tube was at least below the elevation of the clean-out past the septic tank. When looking down the M.T. I could see that it was not resting on soil, but at least several inches of draim'ock. In addition, it was noted that the M.T did not appear to have any perforations (open ended only?). Perhaps the cast iron monitoring tube has "jacked" out of the ground (freeze/thaw cycle) several inches? In short, without excm,ating, and determining the elevation of the drainpipe in the bed, it is not possible to verify for certain that the monitoring tube extends all the way to the bottom of the drainroclc Given the fact that I introduced 2008 gallons into the bed without detecting water in the M.T., nor noting any water backing up into the crib, or the septic tank, it is reasonable to assume that it is adequate for a 3 bedroom house (450 gpd). .NOTE: The adequacy of a septic 6ystem is influenced by nurnerous facWrs, including, but not lirniled lo, seasonal stttface waler it~liration, groundwater variations, xeptic ,system rnaintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seisrnic activity and deteriorate with age), type of substances deposited in septic ,ystern (cigarette butts, sanitary napkins, rnisc, objects), and the ctrnount of water being inO'oduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. STRUCTURAL INTEGRITY OF LOG CRIB: Given the age of the crib it is reasonable to assume that it is approaching the end of its useful life. The next homeowner should anticipate having to fill the depression once it caves in. If you have any questions, please contact me at 33%6179, or on my digital pager at 1-800-481-1162. Thank 'ou. Sincerely, OWl3 ~ ultant Vicki Hartman 1.wps c.c. Vicki Hartman Z7~- EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED~,~. R¢cerfiOe~J AS-BUILT NO O0~NER$ SET THIS DATE hereby cez~tify that I have pmfformed a Mortgagee's ~.- spection of the following described property: Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap o~ encroach on the property 1}'rog adjacent.there- to, that no improvements on property lyung adjacent thereto encroach on the premises in question an.d..t~hat there a.re nc roadways, transmission lines or other VlSlDle easements on said property except as indicated hereon. Dated at A~ehorage, Alaska this /~:P~' day oL-~2~--'7''~::2'~4~-~ ~ 19 7TM FRED WALATKA & ASSOCIATES Engineers and Surveyors Z7a EASEMENTS OF RECORD, OTHER THAN AS-BUILT NO OORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's in- spection of the following described property: Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap c~r encroach on the property 1Flng adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easementS on said property except as indicated hereon. Dated at Anchorage, Alaska this /~--'~ day of (5P~_.7-~5~.~ , 19_-77_ FRED WALATKA & ASSOCIATES MUNICIPALITY OF ANCHORAGE Department o! Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~-\ ~"~°1 (~f '"¢% t~z-k~ HAA# ~'~, ~ ~ ~ ~ "~ \ -c'~Cl~' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 4621 East ll5th Avenue (b) Property owner Mailing Address (c) Lending Institution Mailing Address David M.Karen L. LandfTeT~phone~mr: (home) PO Box 112534 Anchorage, Alaska 99511 Telephone Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here El, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms //¥/~: 3. WATER SUPPLY Individual Well'~ 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,l~ 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 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/er 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 wi'th all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~9~/d5/-T, ~/,.2/_.;>, ~"A2C. Telephone Address ~ (¢ o~ I'~'OO.~ ~U'~-/o~/I~'L~--/'~ /-~I~I L/S t~t~C/~I/ ,Y~-//__.., ~ ~-/~, 6. DHHS APPROVAL. Approved'for ~ _ bedrooms by Approved ~ ~ Terms of Conditicnal Approval Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph § 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 ordertosatisfycertain federal and state requirements. Employees of DHHSdo 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 (Re,/. 7/88)8ack Page 2 of 2 A. WELL DATA Well Classification Well Log Pr.es, ent (Y/N/ /k.) Date. Completed ,~//i{//? 7 ~/ Total Depth..-~ ~ Cased to¢'~ ~' Depth of Grouting Static Water Level Z ~' / Casing Height Above Ground / ~'' Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding TankonLot /0/ / ~ /O-LP~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '-/'/~" To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot '¢ ~-~.~" Water Sample Collected by /.//.o~/ ~'~c~-- ~. ; Date / Water Sample Test Results 3/-? 2'75/~R4 ~ MUNICIPALITY OF ANCHORAGE (MOA) (~,f~J~U~Y OF/,~dela"l~thorily Approval (HAA) E~NTAL SE~Vt(~FII~iI~J~L)~T- FEBRUARY 1984 '"~' 343-4744 JAN ~ -' 1_990 Legal Description: l,~ RECEIVED t:)/4'/(//'/- Yield If A, B, C, D.E.C. Approved (Y/N) __ / /., ,-. Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ;OnAdjoiningLots I0~- ; On Adjoining Lots Comments B. SI=PTIC/i#~TANK DATA Date Installed _~-,~,-.7 ~ Size Standpipes (Y/N) ~/' Depression over Tank (Y/N) j¢0 ~ NO. of Compartments / Air-tight Caps (Y/N) __)/ Foundation Cleanout (Y/N) /~ Date Last Pumped X/¢/¢6) ~ Pumping/Maintenance Contact on File (Y/N) IV' ; for Holding Tank High-Water Alarm (Y/N) A.?Pt Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: .¢- Z..%/ To Building Foundation To Disposal Field c~-~' t To Water-Supply Well /0/ To Property Line -k ~Z.O / To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~ u-~/J ~KZ. /---~¢ ~'d ~ ~P 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7-/~/- ~ -~ Width of Field /5- ~ Type of System Design Length of Field ,75~ ' Depth of Field ~'~ / Gravel Bed Thickness / / Square Feet of Absortion Area _'5 70 Statndpipes Present (Y/N) Depression over Field (Y/N) /'¢/ Date of Last Adequacy Test Results of Last Adequacy Test /~¢~~''''~'-7z¢- ~" ~ '¢~¢~:~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot /-/OO/ -¢- ?0 ' To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments v'-/ To Property Line To E~'~ Abandoned System on ; On Adjoining Lots -/- .'~O ' To Cutback (if present) -/-/¢~'~ ' D. LIFT STATION -- Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in'effect, inspection. ,~. ,/.~. ,~,~_.¢ ,~*--. Signed Company (:[2~U5)~, E.:./.~6)/').~5 L~ /¢C. ,:,?"'"~ - Date / ~- Z-~ -$~,) MOA No. ¢L'~7 S"~ - ¢ ~ ~) this - Receipt No. Date of Payment Amount: $ 72 026 (Rev. 7t88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAl- OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -I ~ GENERAL INFORMATION (a) Legal~,,,.~DesC~t~n. (,n.~e~/~.j~C.~~.&.,fj~jIot, bl~ck, sub~ivi~_.9~seftion, township, range) Location (address or directions) (b) AppliCant Name~~/~~Telephone: Home ~--I 'S~ Business Applicant Address ~ J~ [ ( ~ (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the 14AA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms. ~ Other WATER ,~;UPPLY Individual Well 1~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~J Public r'q 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. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA~A AND INFORMATION 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 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 tile date of this ins[~ection. Address ~ ~. DHEP APPROVAL Approved for J Approved ~"- '' , Disapproved Terms of Conditi'onal App,r~val Engineer's Seal ,., ..? ,-.. .. ~:? " :"" lz " " : ., . [,, ., ~ ,; %'_ .':: ;h, ' ; '~.,,'.! . ·. .,? Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. Tile DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DI--IEP 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. Page 2 of 2 72-025 (11/84) WELL DATA Woll Classification ~- Well Log Present (Y/N) ~ . Total Depth ~ ~ I Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Date Completed I ~M,¢4,~ '~'[/- Yield 30 ~r E~tvl Depth of Grouting ~.~/ Pump Set At ~../ Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) t To Septic/Holding Tank on Lot .......... ,L(..Z_ t TO Nearest Edge of Absorption Field on Lot .... ; On Adioining Lots _ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots ~(¥¢'-0~. W-',~'," 10b ¢~ / ~ TO Nearest Public Sewer To Nearest Sewer Se~ice Line on Lot B. SEPTIC/HOLDING TANK DATA I nstalled~ ~,~,_¢ / Date Size No. o, Compa ments __O* Standpipes (Y/N) _~ ~ ~ Ab-tight Gaps (Y/N) N~' Foundation Cleanout (Y/N) Depression over ~ank (Y/N) ~_ Date Last Pumped Pumping/Mainter, ance Contract on Fde (Y/N) ~J/A ; for Holding 'Fank High-Water Alarm (Y./N) ~_, Temporary Holding Tank Permit (Y/N) - ~ .... Separation Dis'mnces from Sephc/Ho..,ing Tank: To Water-Supply Well ...... 'Fo Property Line To Water Maip.,'Ser~ice Line ....... Course /~V///~ To Building Foundation __ To Disposal Field To Stream, Pond, Lake, or Major Drainage Cornments Page 1 of 2 72-026 trey 8 861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area I/ ~_~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness ' Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line "'Z I To ...... Existing or~~J ystem on ; On Adjoining Lots To Cutbank (if present) Comments Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed __ Date Company MOA No. ReceiptNo. ~ 02¢/ (~2~ ~ Dateof Payment [,~L~ /~ --~r Amount: $ ~:) ~'~ Page 2 of 2 72-0261Rev 8¢86~ Bac~ · LO~ tion: Client's Nan.: Address: BESSE, EPP$ & POTI'S 2220 EAST 88 AV~3E ANCHORA~, AK 99507 (907) 3~9-6451 W~ ~LT~ Subdivision: Lot.' · Block: -t ~,..,/,* 4 ,.4 ,.,~,,' ,-,'.¢: 4 ,, ,", ¢S!~ '~' ?,;4-, Pr~luction Rate: 7,~ GPM 24-Hour Ca[x~city_____Cel]c~a APPLI( NT FILLS OUT UPPER HAl ONLY Address Realty Co. & Agent Address Zip (;ode zip (;ode Zip (:.ode Zip ()ode Phone Type of Residence [~'/'Sin gle Family [] Multiple Family No. of Bedrooms EJ Other W a~t e r/~p p I y Individual Community Public Utility Sew__er/pi~posal ¢L¢ Individual [] Public Utility [] Holding Tank [-~'T'C~CH WELL LOG'. A well Icg is reqmred for all wells drilled since June 1975. IFor wells drilled prior to that date, give well depth (attach Icg if available). Year Individual Installed: When Connected Io Public Utility: NOTE: THE INSPECTION EEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspeclor Field Notes: MUNICIPALITY OF ANCHORAGE DEPT, OF IJF/,L£11 ~: [NVIRoNM~NI'AL P~OTEC/ION APPROVED BEDROOMS DISAPPROVED CON DITIOJ~f~L APPROVAL* 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank iWell Log Received Septic Tank Size ALASKA elIUIRODmE DTAL COIqTROL SE IquICE S, IIqC. ~n§in¢¢rin§ $ ~nuironrn~nlol $1udics December 13, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On December 8, 1983 our company collected a water sample from the house located on Lot 8 Block 6 Greenland Subdivision. The property owner is Dennis Wirt. The water analysis was satisfactory. A copy of the report is attached. The well is located 101 feet from the septic tank and 101 feet from the leach field. The electrical wires are encased in conduit. All the standpipes are capped. The well casing stands 3 feet above ground and has a sanitary seal. 1200 LUest 33cd Aoenue. ~uile [1., J~nchocoqe. J~l,~ska 99503 · (907) 276-1361 ~-~ HUN I C ! PAL I TY o~ ANCltu~/, EJme~ ~i]° ' ~2' 7i~ ~ '~ DaCe REQUEST FOR F INI ~ROTECTION 99501 September 28, 1977 FACILITIES 1. Lending Institutior Mailing Address Phon 2. Property O~ Mai~ing Ad( tar P%o~te A 3. Legal DescrJ_pi 8 BI 4: Single Family .'~(x)~ Multiple Family Residence: ( ) Numbe~ o Number of Three Well System: Permit # Construc-tion Individual Well (x) Conm]unity/Public System ( ) Depth of Well 66' Well Log on Pile ( Bacterial Analysms Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Installed 1974 Public Utility ( ) Installer ~36~ Manufacuurer~ ~)~ 7. Distances: Well to Sep'hic Tank ~o Absorption Area ho Sewer Line Nearest Lot lJ_ne Absorption Area · to Nearest Lot Line , , UNICIPALITY OF ANCHORAGE //[~[~ ~ Department of Healhh and Environmenhal Pro:h'eCti'On- //~[~)i~/ 825 L Street, Anchorage, Alaska 99501 "~=:~equest for Approval of Individual Sewer ane Water. 1 Property Owner: . , Phone: Name of Buyer: Mailing Address: Phone: Lending Inshitution: Mailing Address: Phone: Realtor/Agen-t: ~' /~.~6L~,{_~ Mailing Address: ~/ ~. ~~~~.. Phone: Street Location: ~, Single Family :esidence: ~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: * Individual Well ~ If Individual Well, well depth , ~ If Co~mnunihy System~ name of system Public/Community System ( ) 8 o Sewage Disposal System: On-site System If On-site System, date of installation: Public System ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 I we Page ' } Deparhment of Healhh and Envlronmen'~al Pro'hectlon Reques~ for Approval of Individual Sewer_ and Water Faci]..~iies Legal Descriphion: Lot. 8 Block 6 Greenland Subdivision Coml-~en't s: Affadavi..% Attached: ) ]-,etker Attached: ( ) Department Worksheet: