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HomeMy WebLinkAboutT12N R3W SEC 15 LT 45AT12N, R3W, Section 15 Lot 45A #015-052-52 Municipality of Anchorage Page 1 of. 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 54,7,-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990595 PID Number: 015-052-~t~J~'c~. N°m":MIKE THOMAS Wastewater System: · New [] Upgrade Address: PO BOX 770110, EAGLE RIVER, AK 99577 ABSORPTION FIELD No, of Bedrooms: Ph°ne:(907~ 441--2664 mDeep Trench DShe]low Trench DBed DMound DOther LEGAL DESCRIPTION 0.6 o.D/~.. ~ 9.2 - 9.6 45/~ 2.06 - 2.46 F~ 7.14 rownship: 12N Range: 5W Saetia,= 15 fill added above odglnal grade=Gravel length: 1.25 - 2.5 F~ 61 WELL: · New [] Upgrade 2.5 F~ 1 , PRIVATE 165 ~ 165 Ft 871 s~.r~ ASTM D-5054/F-810 SANDERS AND SANDERS 12/6/99 ALPINE BRILLING & ENT. 2/12/00 151 .e,d: 8 a.u 165 r,. 2 ~ TANK SEPARATION DISTANCES. · Septic [] Holding [] S.T.E,P, To Septic AbsorpUon Lift Holding =ubllc/Pdvofl --rom Tank Reid Station Tank Sewer Unes ANCHORAGE TANK 1000 Wel] 100'+ 100'+ - 25'+ STEEL 2 ~00'+ ~oo'+ - - LIFT STATION Sun'ace Water Size Tn galron=: I I h Lot 5'+ 10'+ - - · LTne "Pump on' rev~~ Foundation 5'+ 10'+ -- - Curtain ~' =L~c=I Ins ep titian= p~rferrned ~ Drain ~ NCI~IE I KNOWN ~emarks: BENCH MARK TOP OF FOUNDATION WALL 104.97 Inspections performed by: AWWC, INC. Dates: 1st 12/6/99 .... ;";"r" · ~ ........ : .... 2nd 12/6/99 [, (,, (.~,4.,.,.,~..~ 3rd 12/21/99 )~ ¢~J~ ................~_ :'"1 Department of Health and Human Services approval ~h;"~ '-- .." ..... Reviewed and approved b /--f,/. ~Date: ~~ ~ '0 o q fesslO PERMIT NUMBER: PARCEL ID NUMBER: wgBo393 AS-BUILT DRAWING o,~-o~2-49 1 co,., ~ o %&A_¢4~I~ NEW~ I~o~/ .~.~ I ~.~ I ~%.¢- I HOUSE ALTERNA~ S~~ N~ GARAGE Af I~f- ¢8,70 / ~f2 'Ot~f - ~8,76 - ¢/.42 (AVd.) Af IhlJ~f - NgW I000 5~LON Af O'dfl.~f - ~8,0~ - ¢0,2~ (^Vd,) A1 ASKA WATER & XVASTEWATER .......... CONSULTANTS, INC, DATE: 3/24/2000 DRAWN BY: J.L.M. 1" = 40' MIKE THOMAS w/ THE THOMAS CO. .EOAL DESCRIFIION: BLM LOT 45, SECTION 15, T12N, RSW PHONE NUMBER: 441-2664 PAGE NUMBER: 20F2 WORK: AS-BUILT OF WELL LOCATION AND SEPTIC SYSTEM ,22-00 08:39A THE THOMAS CO. INC. 6~4-5202 P.02 o¥ (PLA'r NO.: ANCHORAGE RECORDING DISTRICT I PREPARED BY: ~ P.O. BOX 110029 ANCHORACiE, AK 9q511-0029 ' REVISIONS -- ITASEMENT,R OF III~C:ORI), OTI [~R 'rlJAN THOSE s HOW.,N ON Tt IE I~I~CORDED PLAT, ARE NOT SHOWN HEREON. (JAP MONUMENT · IRON PIPE O RE[tAR COI{NER FOUND ri FIUB AND Mar-22-O0 09:04A THE THOMAS CO. INC. 694-5202 P.01 Mumcipality of Anchbr. age Department of Health and Human Serwces 825 "L" Street P.O. Box $96650 Anchorage, Alaska 99519-6650 RicR Mystrom htlp:/twww.ci,a nchora ge.ak, us Mayor Permit Number: #SW 990393 Datcoflssue: ,'10-19-99 Parcel ldcntificatlan Number: 015-052-49 Date Started: 2.~-00 Date Completed: 2-12-00 Is well located at approved permit location'? [] Ye~ [] No Legal Description~ T12N R3W Sec 15c Lt 46 Property Owner Name & Address: The Thomas Co PO Box 770110 Eagle ~i~e~, AA Borehole Da~'a': · Depth (ft) Soil 'l'ypc, Thictmcss & Water Strata From To sticg-up 0 2 organic & silt 2 5 gravelly silt 5 15 silty coblly gravel 15 89 silty sand 89 112 gravelly cobblly silt 112 145 silt '145 155 sandy silty water & gravel 155 163 water sand & grovel 163 165 RECEIVED MAP, 29 2000 Municipality of Anchoreo~ Dept, Health & Human ~rVic~b 0.577 Method of Drilling [] air rotary [] cable tool Casing type: steel Wall Thickness: .025 inches Diameter: _6 inches D~th: .~6__~ feet Liner Type: Diameter: __ inches Depth: __ Casing stickup above ground: _2 feet feet Static water level (from ground level): 131 feet Pumping level: 165 t~et alter _2 hours pumping _0 gpm Recovery Rate: ~ gpm Method of Testing: air lift Well Intake Opening Type: [] Open End [] Open Ilole [] Screened Start__ feet Stopped [] Peri'orations Start__ feet Stopp~d Grout Type: bentonite # 8: Volume: 2 bgs Depth: Start . feet Slopped feet Pump: Intake Depth ...... feet Pump size ~ hp Brand Name WellDisinfeeted Upon Completion? [] Yes [] No Method of Disinfectlun: clodne, tablets Comments: · Well Driller:, Alpine Drilling& Enterprises P 0 Box 110496 Anchorage AK 99511 Attention: Thc we~'~-~r~ lnovide a well log to thc property owner within 30 days ofcomplcli0n and thc property MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street. Room 502 P.O. Box 196650, Anchorage, AK 995'19-6650 (907) 343-4744 .~d ~.~ Initial Date Issued: Oct 19, 1999 Expiration Date: Oct 18, 2000 Permit Number: SW990393 Legal Description: T12N R3W SEC 15 LT 45A Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: The Thomas Company Owner Address: PO Box 770110 Eagle River, AK 99577- Parcel ID: 015-052-.~'c',~'' Site Address: Lot Size: 54450 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Issued By: ~ Date: /~ '"2/- ~'(~' Date: /O - 2~ --~:~ Alaska Water & Wastewater Consultants, Inc. 6901 DeBarr Road, Suite 2B ~ Anchorage, AK (907) 33%6179 ~ Fax (907) 338-3246 Consulting Engineers ~ 99504 October 15, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well and Sewer Design for Township 12151, Range 3W, Section 15, BLM Lot 45 To whom it may concern: The reference property is currently undeveloped. The owner wishes to build a 3 bedroom house with an on-site septic system and well. Two test holes were performed on the property and the soils are summarized as follows: 1. SOILS: Test hole 4/1 and #2 were excavated on 6/29/99 and no groundwater was found in either test hole. Below the organics in test hole #1 was a SM material to a depth of 11.5 to 12 feet followed by a SM/ML mixture to the bottom of the test hole (16 feet). One perk test was performed at a depth of 7.0 to 7.5 feet and the soils perked at a rate of 30 minutes/inch. Test hole //2 had approximately 1 foot of organics at the surface followed by a SM/ML material to a depth of 16.5 feet (bottom of test hole). The bottom 1.5 feet were very hard digging. One perk test was performed at a depth of 7.0 to 7.5 feet and the soils perked at a rate of 11.4 minutes/inch. 2. TRENCH DESIGN: a. Pemolation Rate: 30, 11.4 minutes/inch b. Allowable Application Rate: .6 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 750 ft2 f. Total depth: 9.5 feet g. Effective Depth: 7 feet h. Reduction Factor = N/A i. Width: 2.5 feet j. Length: 60 feet k. Effective absorption area = 840 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The entire lot has a gradual slope from east to west at approximately 5% to 10%. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistan~ Sincerely~t /fir, I Presi ent ' BLM LOT 35 T12N, R3W, SEC15 R3W, SEC15 ALTERNATE BLM LOT 33A T12N, R3W, SEC15 BLM LOT 44 T12N, RSW, SEC15 SEPTIC SYSTEM (SEE DESIGN, PAGE 2 Of 2) PROPOSED LILLESTON STREET INOTE: THE WELL DRILLER SHALL FIELD VERIFY THAT THE 100' SEPARATION DISTANCE TO ANY ADdACENT SEPTIC SYSTEMS CAN BE MET PRIOR TO DRILLING THE WELL. BLM LOT 51 T12N, R3W, SEC15 BLM LOT 52 T12N, R3W, SEC15 ~SEPTIC LOT 1 BLM LOT 54 II LOT 2 \ T12N, RSW, SEC15 h HAMILTON EST.~ HAMILTON EST. ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK, 99504 PHONE: (907) 537-617g/FAX: (907) 358-3246 LEGAL DESCRIPTION: T12N, R3W, SEC 15; BLM LOT 45 ]'¢PE OF WORK: SITE PLAN PREPARED FOR: PHONE NUMBER: THE THOMAS COMPANY 441-2664 DRAWN BY: I SCALE: I PAGE: DATE:lo/18/99 K.D.W./A.C.G. 1 = 100' 1 OF 2 NOTE: THE WELL DRILLER SHALL FIELD VERIF~ ADJACENT SEPTIC SYSTEMS CAN BE MET PRIOR ,' · TO DRILLING THE WELL. 9.5 DEEP. ADD 7 OF' CLEAN, WASHED SEWER DRAINROCK. INSTALL TRENCH pARALLEL TO THE SLOPE CONTOURS. : PROPOSEO 1000 ALLON SEPTIC TANK /INSTALL FOUNDATION CLEAN-OUT CO MT / / LILLESTON STREET 6901 DEDARR ROAD, SUIT~ 2B. ANCHO~GE, ~, 99504 , ,, .EGAL DESCRIP~ON: I T12N, R~W, SEC. 15, BL~ LOT 45 YPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~_ .Ch..F-. ~- .~ }~1 PHONE (907) 337-6179 * FAX (907) 33§-324fi [SOIL LOG - PERCOLATION TEST] TBDMAS 0GM,AN','' """"" PERFORMED FOR: DEPIH ~ SOIl_ CLASSIFICATIONS GC OL ~m#'l ~ SW ~ MH ~ ~ SP~ CH ~ ~ PRoposeD SM ~ OH TH~ OR~V~AY SM SC DEPTH TO DATE 3ROUNDWATER ~ LILLESTON STRE~ ....... DR_....Z.. .. ~/29/99 ~ ......................................... ..__ DR._.~. 9/30/99" DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (iNCHES) 6/30/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING ................. -C ........ --g:q'~ ........................... "~"~ .... 2 5:47 30 ~ 3/~" 1 1/~" SM/ML 3 5:47 6" 4 6:]7 30 4 15/~6" 1 ]/~6" 5 6:]8 ...... 6" ......... 6 6:48 30 5" ]" PERCOLATION RATE 30 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) : TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. COMMENTS: PERFORMED BY A~SKA WATER & WASTEWATER. i, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PERFORMED/IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: / DEPTH TO DATE ;ROUNDWATER DRY 6/29/99 DRY 9/30/99 ALASKA WATER & WASTEWATER CONSULTANTS, INC. I SOil LOG - PERCOLATION TEST] LEGAL DESCRIPTION: T~2N, R3W, SEC. lS, BLM LOT 45 PERPORMED FOR: THE THOMAS COMPANY ,..~. ~ ". .... DATE PERPORMED: ~,29,99 ITEST HOLE ~2 DEPIH ~ ] (feet) ~:~: O~G~IC 2 SOIL C~SSIFICATIONS GC OL .TH~I ~ SW MH SP I CH .~s[ SH ~ OH *~ o~vm*~ SC DEPTH TO DATE 3ROUNDWAT~ ULLESTON ST~E~ SH/HL DRY ~/30/~ HODERATffkY BONDED DATE READING CLOCK NET TIHE WATER ~EVEE NET DROP TI~ (~INUTES) ~EADING (INCHES) B_~.JO/~ PERO. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO IESIING ................. ~............ 5:20 ............ 6" --"- - -'~ 2 5:50 30 3 9/16" 2 7/16" ............ ~ .......... 5:52 ~ 6" ............. ~ '"' 6:22 30 3 3/8" 2 5/8" BOSOM FOOT *~--- 5 6>23 -- 6" VERY HARD 6 6:53 30 TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. COHNENTS: PERFORMED BY A~SKA WATER & WASTEWATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS WAS PERFO~M~ IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: /~ DEPTH TO DATE SROUNDWATER DRY 6/29/99 DRY 9/30/99 MUNICIPALITY OF AN 1 CHORALE ; Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 0150-52-52 1 Certificate of On -Site Systems Approval Expiration Date: _2 D 2 C7 GENERAL INFORMATION Complete legal description T1 2N R3W SEC 15 LT 45A Location (site address) 9330 JUPITER DR, ANCH AK Current property owner(s) ROBERT BALAZS Mailing address SAME Day phone Real estate agent Day phone 2. TYPE OF DWELLING: f ❑ 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: Private Well Q Private Septic Fx_1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6 l 1 b -19 Date of Payment C)2 0 Receipt Number 06� 1 Z COSA# 4SL���`i 1 Z 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 9-2-20 OFA a�1 � * �- 49T!�� • �- � 6. DSD SIGNATURE /.... ... • . • . i .. ...� System #1 Approved for 3 bedrooms r • • •. • + - - • � 9 • MICHAEL N. ANDERSON •: `� System #2 Approved for bedrooms CE 9 9 � Disapproved 19 �'7..•�.�`���� tt PRO ESS*1VX Conditional approval for bedrooms, with the following stipulation��t����'` «wtiuurrr� Original Certificate Date: 0—( -3-2 ©Z0 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Adviso Other `Z ✓� Legal Description: T12N R3W SEC 15 LT 45A If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 2112/00 Total depth 165 ft Cased to 165 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24"+ in. Date of flow test for COSA 5128120 Static water level at beginning of test 144.8 ft. Comments B. TANK DATA Age of tank(s) 21 years Tank type/material 9epV`%`�" Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/28/20 D. ABSORPTION FIELD DATA Parcel ID: 015-052-52 of Structure served by this system Which system tested (date installed) 12/6/99 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.4 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced0 gallon�"���_ COmmentS/DefICIEnCI ;;A11eptic pipes were found per the asbuilt survey. COSA Checklist yellow sheet Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.815 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 6/4/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/28/20 Results F, -/]Pass For 3 bedrooms Fluid depth prior to test 61 in Water added 500+ gal New depth 68 in Elapsed time 1440 min Final fluid depth 61 in Absorption rate 500+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft �j✓ Yes if No Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' �71 Yes if No Animal Containment > 50' M Yes if No Yes if No ft if No ft F. ENGINEER'S COIVIJENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft Q Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ft ft ft ft ft 0 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' 0 Yes if No. Water Main > 10' 0 Yes if No ft Community Wells > 200' M Yes if No Water Service Line > 10' 0 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' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Rl Yes if No ft Wells on Adjacent Lots: Water Main > 10' 21 Yes if No ft Private Wells > 100' (❑✓ Yes if No Water Service Line > 10' 71 Yes if No ft Community Wells > 200' El Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COIVIJENTS r P � •-Jv ft ft 10 ft ` " 't " E G. ENGINEER'S CERTIFICATION " J' 1 certify that 1 have determined through field inspections and review ,• i. '•' ; ?� ••, of Municipal records that the above systems are in conformance with /49TH , ; MOA COSA guidelines in effect on this date. j.. NG} ^ • ^ • • • • ° ° " J a✓ ... r c • MICHAEL N. ANDCRSGN: 46 YRF � �SI� %.` COSAChecklist yellow sheet ft ft 10 ft r -22-00 08:39A THE THOMAS CO_ INC. 694-5GUG r_vc . '41" / 'A1'69 to y� AAb , oSQn Q� / 4 � n 5TvR.Y h �i. fi+2r4,r� yLe p 0 or N Ln T- s -F - It il�; 111c respnnsibility of Iite owner to detcrminc the existence of any ensemenls, eovennnts or restrictions which tto not appear on the retarded subdivision plat.1AASB 11141 Under no circumstances should any data hereon be c� used tier construction or for estahlishing hodndury orJ fence lints. The surveyor hikes responsibility for the initial transaction only, 1 LOT BLOCK (PI.A•r NO.: a ANd' ORAGE RCCORDING DISTRICT ^� OF A O �4� OD4rp)Oq))D)p1bDt0)fy�rr. ,lanlai Karl Dowling OFFSSIONIAL�A I;ASr:Mi;NTi OF RIiCa:)RI), OTI M -K THAN *rHOSG SHOWN ON Tr IC RECORDIm PLAT, ARG NOT sl ibWN HliREON. I&CE, m BRA.S.J CTAP MONUMENT Irto N PiPc O RrIiAR COHNCR MOND Q MLIB AND TACK DATC: F3Y: SCALE: WORK ORDER: I IFLD 30OK: GRID NO.; ire W_ moo' oo v i p��r� �z• PREPARED BY: DOWLING R: ASSOCIATES — - — P.O. 130Y 110029 ANCHORAGE, AK 9()$11.0029lREVt510NS+ - I7A'rr BY v Q, n Ln T- s -F - It il�; 111c respnnsibility of Iite owner to detcrminc the existence of any ensemenls, eovennnts or restrictions which tto not appear on the retarded subdivision plat.1AASB 11141 Under no circumstances should any data hereon be c� used tier construction or for estahlishing hodndury orJ fence lints. The surveyor hikes responsibility for the initial transaction only, 1 LOT BLOCK (PI.A•r NO.: a ANd' ORAGE RCCORDING DISTRICT ^� OF A O �4� OD4rp)Oq))D)p1bDt0)fy�rr. ,lanlai Karl Dowling OFFSSIONIAL�A I;ASr:Mi;NTi OF RIiCa:)RI), OTI M -K THAN *rHOSG SHOWN ON Tr IC RECORDIm PLAT, ARG NOT sl ibWN HliREON. I&CE, m BRA.S.J CTAP MONUMENT Irto N PiPc O RrIiAR COHNCR MOND Q MLIB AND TACK DATC: F3Y: SCALE: WORK ORDER: I IFLD 30OK: GRID NO.; ire W_ moo' oo v i p��r� �z• PREPARED BY: DOWLING R: ASSOCIATES — - — P.O. 130Y 110029 ANCHORAGE, AK 9()$11.0029lREVt510NS+ - I7A'rr BY Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 201412 Subdivision: T12N R3W Sec 15 lot 45A Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. ��� � � Mailing Address PCO Box N196650 gnchorage;glaska 99519h 6650 �` www4m�m�org� ��N' � ,� ��, Parcet I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sita Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 1. GENERAL INFORMATION & Complete legal description BLM LOT 45,P'SECTION 15. T12N, R3W Location (site address or directions) JUPITER ROAD ANCHORAGE. AK Property owner Mailing address Lending agency Mailing address MIKE THOMAS w./ THE THOMAS COMPANY Day phone P.O. BOX 770110 EAGLE RIVER. AK 99577 Day phone (907) 441-2664 Agent Day phone Address Un/ess otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: .3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: ff 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: /f community wastewater system, provide written confirmafion from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version 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 fudher redly 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 an,¢ State codes, ordinances, and regulations in effect on the date of this inspection ,, /I · ,/ // Name of Firm ALASKAWA'F~W~8~,EZ~,~EF~ CONSULTANTS, INC. Phone (907) 337-6179 ../. /.// ..~,/~. ~/I ! 7 504 Address 6901 DEBARR R~,~D, SU~.,,/E ~,~(.~CH?r RAGE, ALASKA 99 / // Engineer's Signature ~.. ' b/ -- Date~ and septlc s~tems decnd on ~e I~l solls ~nd~on, ground ~ter le~ls ~at may flu~ate dudng y~6 and ~e ~ter usage of ~e ~mi~ ~lng se~ by ~e s~tem. ~ ~ndi~ons are o~ld¢ the ~nt~l of the e~luator of ~e s~tem. ~1 s~tems e~n~al~ fail and ~Esfacto~ t~t msults do not guamnt~ ~, ,~an~ of ,e ,,t~, nor do ,ey guarant~ that ,~e are no hidd~n def~ts ,r en~chmen~. A~C, Inc. ~n ~erefore not p~de any ~n~ for ~ ~do~an~ nor g~ any 5-7953 · .J //2 DHHS. ~e cntant of this re¢~ is for the sole ~ne~ of the o~er llst~ a~. ~y ~llan~ u~n or use of ~ls ~R by any other ~on or ~ Is not a~odz~, nor ~11 ~ ~nfer any I~al dght whacker. .. 6. DHHS SIGNATURE L'/" Approved for ~ Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments By: 0,.~?/'..'~.'/ ~/(.,/ ~o--~ Date L./-'~-O O The Municipalify 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 engineer's work. 72-025 (Rev. 1/91) Back MOA ¢Y21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICLY Environmental Services Division MUNiCh,^Lb 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343~47,,~,T^L S~RVIC~ Health Authority Approval Checklist Legal Description: BLM LOT 45. SECTION 15, T12N, R3W Parcel I.D.: 015-052-49 A. WELL DATA Well Type Log present (Y/N) Total depth Sanitary seal (Y/N) PRIVATE YES Date completed 165' Cased to 165' YES If A, B, or C, attach ADEC letter. ADEC water system number N/A 2/12/2000 Casing height (above ground) 2' Wires properly protected (Y/N) YES Date of test Static water level Well production FROM WELL LOG AT INSPECTION 2/12/2000 131' 8.0 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: 5/22/2000 B. SEPTIC/HOLDING TANK DATA Date installed 12/6/99 Foundation cleanout (y/N) Date of Pumping NEW C. ABSORPTION FIELD DATA Date installed 12/6/99 Length 61' Width Nitrate o r'/ ~w,~/~ Other bacteria. Collected by: A.W.W.C.. INC. Tank size 1000 Number of Compartments 2 Cleanouts [Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Pumper Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 2.5' Gravel thickness below pipe YES Effective absorption area 871 SQ.FT. Monitoring Tube present (y/N) YES Depression over field (Y/N) Date of adequacy test NEW Results (Pass/Fail) For 3 Fluid depth in absorption field before test (in.); - Immediately after - gal. water added (in.): __ System type DEEP TRENCH 7.14' Totaldepth 10.5'-12.2' NO Bedrooms Fluid depth (ins) Minutes later: Peroxide treatment [past 12 months) (Y/N) 72-026 (Rev. 3/96)* Computer Version Absorption rate = If yes, give date D. LIFT STATION . ~ Date installed ~ Manhole/Access (Y/N) ~ a*t "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ 100'+ N/^ 25'+ SEPARATION DISTANOE8 FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5"+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: 10'+ Building foundation 10% 100'+ Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service llne Property line Surface water Curtain drain F, ENGINEER'S CERTIFICAT],O~ I certify thatl.~a1~et~rr~/ne/~J of Municipal/fecerd~ t~a~he[/~b with MOA ~AA gu!fe~nf~ Signature ~/v r'~ ' Englneer,s Name~/ I~JU Date ~/~'/oo NONE KNOWN On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout. Lift station N/A Absorption field Wells on adjacent lots 5'+ 100'+ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots 100% field inspections and rev/ow systems are in conformance on this date. JEFFREY A, GARNESS HAA Fee $ ~_~ m. '- Date of Payment ./ Receipt Number C2~-~P ~2,,~'-/ 7~) 72-o26 (Rev, ~196)* Computer Vemlon Waiver Fee $ Date of Payment Receipt Number