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Home My WebLink AboutTANAINA VALLEY LT 3Tanaina Valley Lot 3 #011-051-78 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191435 PID Number: 011-051-78 Dwelling: ❑Q Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade Name: Gregory & Wendy Gursey ABSORPTION FIELD ❑ Deep Trench El Shallow Trench E] Bed E] Mound Address 6908 Lowell Cir. Anchorage, AK 99502 ❑ Other Phone_ _Number -of Bedrooms —_ 4 Soil_R_ ating_ _ Existing GPD/SF Total_depth_from_o_riginal_grade _ Ft. _ 830-3199 LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Tana -in a a ey 3Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well N/A N/A N/A N/A >25' TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water >100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >10' N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Tank Serial #: 1786 Pump on level at in. Pump off level at in. High water alarm at in. Tank only permit. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer Denali Excavating Drainfield Existlnq CO/MT Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspeect sn 151 10/3/19 ntl Location and description z dat:3r 4'h Bottom of siding @ point A COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF 114 <i tilt \,..."".' Conditional Approval: Date ••,S�e f� 49th .... ....... .. lb ...... qg s.�(yJ.. .... ..................... .......................... e fi % MICHAEL E. ANDERSON Qj fir ��®��j�'�•sFe k4e,(�,/Rarlif No. CE—.4381 Fs/9%Approved Date 1013 i l 4/pROEc6�4.w inspection Keport_a--i-iz.aoc TANAI NA VALLEY, LOT 3 PERMIT # OSP191435 PID # 011-051-78 �O LOT 3 h 6ry�C � Z A � DV SV MH •2C0 ® 14 B NEW 1,500 GALLON SEPTIC TANK w/20" MANWAY. EXISTING ABSORPTION SYSTEM TO REMAIN IN SERVICE. ALL \,y 1 CLEANOUTS AND MONITOR TUBES LOCATED. l ENGINECRING y®'i U_ C •49th •`�� .E 0 5 MICHAEL E. ANDERSON No, CE -4381 •` 10/11/19ESS\ 4014" •°''F�� PLAR AS -BUILT 050 100 A B MH 14.3 14.7 SV 17.2 18.5 DV 19.0 22.1 2CO 19.9 22.1 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE TANAINA VALLEY, LOT 3 PERMIT # OSP191435 ENGIN EE0.iNG PROFILE AS -BUILT (NO SCALE) 049th MICHAEL E� � ANOERSON; 4 t4 � N. CE -4381 'PGFESS9C! ®" � 26a 3� 31�aE N6�D co N w W O"� I O L4 00 z � O CO.: 49 TH � SHANE A. HOLT.. m i �4e LS -6914 yo`o0� 44��°Jes sionel �'ocao A 2K 11KDt v Io — ic S� �O \z N ASPHALT DRNEWAV 10 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS BUIL T SURVEY 7 " = 40' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 3, TANAINA VALLEY SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 10 TH DAV OF OCTOBER , 2019 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE.AK 99507 Municicpal ClezleoDffice Submitted by: Chair bfthe Assembly at the Approved Request of the Mayo[ Date: 11/10/2015 prepared by: Anchorage Water &Wastewater Utility For reading: October 13,2U15 ANCHORAGE, ALASKA AR No. 2015-277 I A RESOLUTION APPROVING AN AMENDMENT OF THE CERTIFICATED 2 SERVICE AREA OFTHE ANCHORAGE WATER UTILITY (AWU)RESULTING 3 FROM THE ACQUISITION OFSOUTHCENTRALUTILITIES, INC. 4 5 6 WHEREAS, in accordance with AS 42.05.221, e public utility must operate with a 7 Certificate Of Public Convenience and Necessity (CPCN) that includes 8 8 description ofthe authorized area served. /YWUoperates under CPCN122; and 9 lO WHEREAS, in 8ccondoOCG with 3 A\C 48.300(a) and (c)' the Tariff 0fAVVU lI includes @vVhtteD description of the service area matching the area approved by 12 the Regulatory Commission of Alaska and a map depicting the areas under which 13 the Utility will provide service tOcustomers; and 14 15 WHEREAS, /YWU has negotiated to acquire the assets ofGoVthoantrai Utilities, 16 Inc. /SU|\, used to provide water services, see Assembly K8ernOD3DdUDl' App[OV@| 17 of Acquisition Ofthe Water Utility Assets of8DUthC8Otn8| Ud|iU8S. Inc.; and 18 lS VVHEREAS, as a result of the acquisition and in accordance with Alaska Statutes 20 and Alaska /\dDliOiStn]tima Code, AWLJ will Update its CPCN to orDeOd the 21 certificated service area to include the area served bvGOUthD8Ot[2| Utilities, Inc. 22 23 THE ANCHORAGE ASSEMBLY RESOLVES: 24 25 Section 1. The amendment to the written legal description and service area 26 rn@po for Anchorage Water Utility CpCN 122, referenced in the corresponding 27 /\SS8rDb|y MeOloC@DdUrO and incorporated herein by reference, is hgn8bY 28 approved. 29 30 Section 2. This resolution aho|| be effective immediately upon passage and 31 approval bythe Assembly. 32 33 PASSED AND APPROVED by the Anchorage Assembly this 1Om day of 34 November, 2015. 35 36 37 38 Chair Ofthe Assembly 39 40 ATTEST - 41 42 43 Municipal Clerk i No. AM 590-2015 Meeting Date: October 13, 2015 1 From: MAYOR 2 3 Subject: A RESOLUTION APPROVING AN AMENDMENT OF THE 4 CERTIFICATED SERVICE AREA OF THE ANCHORAGE WATER 5 UTILITY (AWU) RESULTING FROM THE ACQUISITION OF 6 SOUTHCENTRAL UTILITIES, INC. 7 8 The Administration seeks approval to amend the certificated service area of the 9 Anchorage Water Utility Certificate of Public Convenience and Necessity (CPCN) 10 122. 11 12 In accordance with Alaska Statute, Anchorage Water and Wastewater Utility 13 (AWWU) is required to amend AWU's CPCN certificated service area to 14 incorporate the service area boundary of Southcentral Utilities, Inc. (SUI). The 15 CPCN amendment is a result of the acquisition of SUI referred to in 16 AM 591-2015, Approval of Acquisition of the Water Utility Assets of Southcentral 17 Utilities, Inc. 18 19 The intent of the amendment is to incorporate the area served by SUI into AWU's 20 CPCN certificated service area and Tariff, but not to terminate service or remove 21 existing customers. In accordance with Alaska Administrative Code, AWWU is 22 required to update AWU's Tariff written legal description and maps of the service 23 area. The Tariff amendment is a result of the acquisition. The area served by 24 SUI is described and illustrated in AO 2015-114. 25 26 The service area description for the amendment has been reviewed by a 27 registered professional land surveyor at Hattenburg Dilley and Linnell, LLC, and 28 determined adequate. 29 30 During the acquisition process, AWU has contacted the property owners and 31 resolved questions and concerns related to the acquisition and service area 32 revisions. 33 34 Upon Assembly approval, AWWU will submit to the Regulatory Commission of 35 Alaska (RCA) a certificate amendment and tariff revision for AWU to incorporate 36 the area formerly served by SUI. The RCA will notice the filing to the public and 37 allow a thirty -day comment period. The RCA will render a decision within one - 38 hundred eighty days to either approve the filing, suspend the filing for further 39 investigation, or reject the filing. The proposed revisions will not go into effect 40 until the date approved by the RCA. 41 42 1 2 3 4 5 6 7 Amendment of the Certificated Service Area Page 2 of 2 THE ADMINISTRATION RECOMMENDS APPROVAL. Prepared by: Anchorage Water and Wastewater Utility Approved by: J. Brett Jokela P.E., General Manager, AWWU Concur: William D. Falsey, Municipal Attorney Concur: Michael K. Abbott, Municipal Manager Respectfully submitted: Ethan A. Berkowitz, Mayor 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 ht;p:/Iwmv.muni.org!onsi to On -Site Wastewater Disposal System Permit Permit Number: OSP191435 Work Type: SepticTank Upgrade Tax Code Number: 01105178000 Site Legal Address: TANAINA VALLEY LT 3 G2122 Site Mailing Address: 6908 LOWELL CER, Anchorage Owner: GURSEY GREGORY J & WENDY J Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: 0��.enr'S ti • �n c� ihh�trtrntur 10/1/2019 9/30/2020 37988 ❑ Disposal Field Ill Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 0 C pLI-4&S' MUNICIPALITY OF ANCHORAGE Community Development Department ` Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-051-78 Property owner(s) Gregory and Wendy Gursey Mailing address 6908 Lowell Circle Anchorage, AK 99502 Site address Same Legal description (Sub'd. Block & Lot) Tanaina Valley, Lot 3 Day phone 830-3199 Legal description (Township, Range & Section) Lot Size 37,988 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑ (w/wo ADU) (D) E]❑ Holding Tank ❑ RenewalDuplex Multiple 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: 9:R Waiver Fees: Date of Payment: 9Z,36&9 Date of Payment: Receipt Number: 6'86CI& b Receipt Number: Permit No. x/91405- Waiver No. Permit App__- : , �. c PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 30, 2019 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Tanaina Valley, Lot 3 – 6908 Lowell Circle Septic System Design Dear On-Site Services Engineer: The septic tank on the subject lot has failed and must be replaced. We are submitting this design and permit application for the construction and placement of a new 1,250-gallon septic tank. The attached site plan identifies the location of the home and the septic system along with the new tank location. The lot is served by a community water system. No conflicts exist between this proposed tank and any other well or septic system or the water service line on this lot. The new tank will be constructed a minimum of 100’ from any existing wells. It will also be 100’ from surface water and more than 5’ from the existing absorption trench. It is not possible to place the new tank 10’ from the house foundation as the location of the existing absorption trenches limit the location. The new tank will be 6.5’ from the house foundation and out of the 1:1 angle of repose. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 9/30/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191435, Rebecca Carroll, 10/01/19 MH 10050 0 FEET 1"=50' EXISTING ABSORPTION SYSTEM TO REMAIN IN SERVICE. ALL CLEANOUTS AND MONITOR TUBES TO BE FOUND OR REPLACED PER MOA FILES. LOCATION SHOWN NOT EXACT. 4-BDRM HOME NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM SUBDIVISION IS SERVED BY COMMUNITY WATER SYSTEM. NO CONFLICTS WITH WATER SERVICE LINES 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 LEGEND TANAINA VALLEY, LOT 3 Michael E. Anderson 4831-ER EGISTEREDPROFES S I O N ALENGINEER10' T&E EAS EMEN T S H E D LOWELL CI RCLEDECOMMISSION EXISTING 1,250 GALLON SEPTIC TANK PER MOA CODE. PLACE NEW 1,250 GALLON SEPTIC TANK w/20" MANWAY. SV 2CO NOTE: CONNECT DISTRIBUTION LINE FROM NEW TANK TO EXISTING FLOW DIVERTER VALVE. 9/30/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191435, Rebecca Carroll, 10/01/19 1 1I n f l u e n c e Li n e 6.5' 4.0' LOT 3 TANAINA VALLEY SUBDIVISION FOUNDATION TO SEPTIC TANK WAIVER SCALE 1" = 3' 96.5 100.0 10/1/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191435, Rebecca Carroll, 10/01/19 Municipality of Anchorage • •.. �;' ��• 4'15': Development Services Department - Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 2 www.ci.anchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S w 0 9 O r 3S_ PID Number. 01 r - OSr -•79 Name Mark � Ncinc Mum,n Wastewater System: ❑ New ® Y Upgrade Address 6.908 l-oeverl Gr, f}'ICA• hk99s-VZ ABSORPTION FIELD Phoney — 7!J Number ofBeoroans: jj Deep Trench O Shallow Trench O Bed O Mout O Other. LEGAL DESCRIPTION Soil Rating:Total O.8 Depth from original grade. r3•S Pad Max Ft Block. Lot: Subdivision: /, UCtlkl Depth to pipe bottom from original grade: Gravel depth beneath pipe: — 3 Tan Gtlnet MOLA S• y Ft. 8• Ft Townsrup. Range: Section: Fill added above anginal grade: Gravel Length: o —1 Ft. J S' S Ft. Well: ❑ New ❑ Upgrade Gravel widthh: 2.S -8 Number of lines: / Distance between lines: — le Ft. Classification (Pnvale. S. C): Total Depth: Cased to: Total abforpum Visa, Pipe Material: Per.11" G VA ils �A1 /7 Ft. Ft. 9 % Fts D- 30 r N /h(on- Perf Driller Oslo Dnlled. Static Water Level: Installer WoadN(3orS Dale Installed: 5-/ao/03 FI. Yield Pump Set at: Casing Height Above Grand: TANK xrs TiN( GPM Ft. FL ,E SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding PublidPrivate MarsAactixer. Capacity From Tank Field Station Tank Sewer Line Gal. Material: Number of compartments Well > 200 7 Sudan Water > l60 LIFT STATION N i} Sue. Manulacturw Lot Line- �s 1 5 3 Z •- Gel. 'Pump on' level at. -Pump otr level at: High water Gann at Founoatron •7 'L 7 ^ In, n. in. Pump Make d Model Elecbieal Inspections performed by Curan Dram — -- — .. Ronne" E Xy ILIn p he tu'o h In �c ]YoC � BENCH MARK rust- O4Se,-woof cdo^ cooler Ime Loratron and De impuon: Porch Surr'rtre ert JUcafTon S%iUCe.ij Assumea Elevation. O r_t'l7n %rokrn/aineel In on sheef 2 l�jO Ft. (Po r-f,&A! d( tiortee,4r of 71-rm ac slaw A&( � dctrin excuvcc!(Uq So aFk'/ ✓'C �xtCLUafzU� frc�[! Engineer's Stamp f Ge f,d/A it u P /o 0 rn tevQ% eat/ Ran CAez, valve ;,7xi. r..r�✓ Or A4��% Ar c •••• 1••••. LN /l& w lln �u fure rr eo;,P eclzcrt y6 reelicvz- c(rriin cte(c4% Inspectio�fs performed by: 1—luffePi 'T"tcA Svc Dates: 1a'_ S 3 /(9 (a J"'* �; 0kC1TtI t r 0 f...: 2nd S / r9 ................a.:. y'�'' r••• a Development Services Department Approval •��•••••e••• Date: S 30' 03 41 • • THEODORE F. ASOORE ; Jrr i;" '' •' Cc" 3589 ~ rr Reviewed and approved by: (Re, 12001 4r,, 1; ••••••.••• t;:�'G•"Y PERMIT NO: SW030135 PID NO: 011-051-78 "BULL RUN" DIVERTER PAGE 2OF2 ORIGINAL 1988 & 1993 DBL SOIL ABS. DRAINFIELDS C.O. .• SWING TIES: �.,.: 49TH!`v :T�6� PLAN VIEW E: •• .:.................::...p SCALE: 1" = 30' s � �THi OD02E F. CL -3569 ii TBM1 FROM: COR. "A" COR. "C" COR. "D" ..•'��• . ..X.. ' I I I 1 • 55.5' TO: 3'+ SOIL COVER y*> S.T. #1 42' 14.5' • ..iy.,. moi' • �'" S.T.#2 45.5' 20' DIV. VALVE 47.5' 22' ••• -. - •y DBL. C.O. 48' 21.5' Z T.H. TR. C.O. "X" 73' 45.5' #1 T.H. -' TR. M.T. "Y" 113.5' 92' #2 NEW 55.5 -FOOT LONG SOIL ABS. TRENCH TR. C.O. "Z" 117.5' 97' W. 8.1' GRAVEL BELOW DIST. PIPE "'(ii:f iiii;iiiii;iiiiiii OF A4 �.,.: 49TH!`v :T�6� PLAN VIEW E: •• .:.................::...p SCALE: 1" = 30' s � �THi OD02E F. CL -3569 ii I 1 I I I 1 3'+ SOIL COVER I 1 I I I 1 I 1 I 1 Y :INV INV. 1SEPTIC TANK, 931 I 1 "'(ii:f iiii;iiiii;iiiiiii ii ii:::::i:::::isisisisisisisisf:>55:::isis5'Y.•GSY::y$>:.......:..:::.:...........�......: NEW 55.5 -FOOT LONG i;€;SOIL ABS. TRENCH 8.1 EFF. SEWER GRAVEL'` ' 1 � LOT 3, TANAINA VALLEY SID SEPTIC SYSTEM UPGRADE BOTTOM OF TRENCH ELEV. 84.4' AS -BUILT INSPECTION REPORT I 1 BOTTOM T.H.#1 f-ELEV 78.4 PROFILE VIEW FLATTOP TECHNICAL SERVICES SCALE: AS NOTED !/ M.T. DRY 5/9/03 NOT TO SCALE 14530 ECHO STREET DRAWN BYTFM y ANCI IORAGE, ALASKA 99516 MAY, 2003 MUNICIPALITY OF ANCHORAGE p a Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 15, 2003 Expiration Date: May 14, 2004 Permit Number: SW030135 Parcel ID: 011-051-78 Legal Description: TANAINA VALLEY LT 3 Design Engineer: 0019 Flattop Technical Services Site Address: Owner Name: Mark & Nancy Mumm Owner Address: 6908 Lowell Cir. Anchorage , AK 99502 - Lot Size: 37988 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. Received By: ✓� -- Date: S l / ' /42? Issued By: Date: �•�` �� Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Ot f - OS-/ - 7 6 Permit Number SW 030133 - Property owner(s) f" tack � Nc(n c ct #" en Day phone Mailing address (1) 1<9 y8 Cc. --c% Mailing address (2) 1411cAo,, ciao A -k Zip Code 99So z 10 Legal description (Lot, Block & Sub'd.) I- 3,. %-Grn ct rney 14( Legal description (Section, Township & Range) Lot Sized %9(Vr' Acres Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms y Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ? 9n� (Signature of property owner or authorized agent) Permit Fees: ' "Aloo " Waiver Fees: Date of Payment: 0'3/ Date of Payment: Receipt Number: �� Receipt Number: (Rev. 12100) CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. PH: (907) 345-1355 May 12, 2003 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: 14530 ECHO ST. ANCHORAGE, ALASKA 99516 The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 3 of Tanaina Valley S/D, located at 6908 Lowell Circle. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. Despite seemingly excellent soil conditions the existing septic system failed a recent adequacy test. The proposed upgrade trench will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material below 6 feet is a somewhat silty sand with a measured perc rate of 1 minute per inch. Partly because of past problems with the existing system we have used a conservative soil application rate of 0.8 gpd/sq. f%. in our design. Thus, this 4 -bedroom residence requires a total absorption area of (4 x 150)/0.8 = 750 square feet. The proposed 54 -foot long design with 8 feet of sewer gravel (7 feet effective below 6 feet) has a total effective absorption area of 756 square feet. We are also incorporating a "Bull Run" diverter valve to allow future reconnection to the original system. The topography of the lot in the area of proposed construction slopes down towards the west at approximately 2%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. Q,_.. _ -- -• ., G SEPTIC %AREA �•.•'i�iH •rk . H•... •.••••••H.N•i•r. J..........r(.:.:..�t� HOUSE -rHEODCRE F. IdOORE� t t .V ••, CE -3589 °tel. "`. �` +.'.,_.e..�•h, qr. LOT 2 / TANAINA VALLEY _l 1 ABANDON EXISTING SEPTIC TANK- 1 RETAIN EXISTING 5 -WIDE DRAINFIELDS (ASSUMED CONFIG. 1 ' 1 5Till TH LOT 5 ' TANAINA VALLEY 1"- 1 .' '' �1`HOUSE SEPTIC 1 AREA - NOTE: LOTS IN TANAINA VALLEY S/D ARE SERVED BY A COMMUNITY WATER SYSTEM AND PRIVATE SEPTIC SYSTEMS. LOTS IN COUNTRY LANE ESTATES ARE SERVED BY AWWU WATER & SEWER ILI 1 1 1 1 1 1 1 L_ 1 1 1 1 / LOT 3 \ TANAINA VALLEY 5' DRIVE INSTALL NEW 1250 -GALLON SEPTIC TANK BULL RUN DIVERTER VALVE CONSTRUCT NEW 54 -FOOT LONG SOIL ABS. TRENCH W. 8' SEWER GRAVEL LOT 4 TANAINA VALLEY LOT 3, TANAINA VALLEY SID SEPTIC SYSTEM UPGRADE SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 MAY, 2003 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. TO EXISTING FROM DRAINFIELDS FDN. C.O. "BULL RUN" DIV. VALVE 4" DIA. D-3034 4" DIA. F-810 NON -PERF PIPE 1250 -GALLON PERF. PIPE �•A�� DBL. C.O. SEPTIC TANK 54 ------------ - C.O. M. T. C.O. "All 1 -000- 54 -FOOT LONG SOIL ABSORPTION TRENCH WITH 8.0' EFFECTIVE SEWER GRAVEL MONITOR TUBE - CLEANOUT MOUND BACKFILL E 1 r3 13 8.5 18 PLAN VIEW SCALE: 1" =10' INAL GROUND .TER FABRIC �" DIA. F-810 PERF. DIST. PIPE X1/2" - 21/2" SEWER GRAVEL BOTTOM OF EXCAVATION CROSS-SECTION "A - All SCALE: 1" = 5' it 49TH 1i t: rte: TKODCRE F. IdOCRE CE -3589 : % = i, LOT 3, TANAINA VALLEY S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECIFNICAL SERVICES SCALE: AS SHOWN 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK, 99516 MAY, 2003 FLATTOP TECHNICAL SERVICES 14530 ECHO ST. rr C:;; ; f '' • ,= y,. r,. ANCHORAGE, ALASKA 99516 ; r..........................�, TEST HOLE # 1 SOILS LOG -- PERCOLATION TEST �•. ViEGDORE F. L]OORE ; r {'...� CE - 3599 , ' �9 LEGAL DESCRIPTION: 3 Tanaina Valley S/D , �,v DATE PERFORMED: May2L2003 PERFORMED FOR: ____uiark and�Jancy Mumm DEPTH SLOPE SITE PLAN (feet) Date Pt. 1 Net Drop (inches) 5/2 12" Presoak 12" resoak and lighter color and 15 SM Reddish sandy loam 2 densely consolidated GP/SM Silty sandy gravel 3— below 13.5 feet 4— 5 MUSM Gray sandy silt 5— 17- 11:�g:55 Predominantly on S side of T.H. 6 18- Add water 11;20:25 19— 7- #3 11:25:25 5. 8- 8SP/SM 4.3/4 B.H. SP/SM Somewhat silty brown medium sand g Dry, with clumps/lenses of damp ML 10- 11- 12- 13-1 0111213 14 Date o groundwater M.T. dry Sand becomes finer Net Drop (inches) 5/2 12" Presoak 12" resoak and lighter color and 15 Add water & s art densely consolidated 23 3/8 below 13.5 feet is- 6171819B.H. 5 18 3/8 5 17- 11:�g:55 5 18.5/8 18- Add water 11;20:25 19— #3 11:25:25 5. 8.5/8 4.3/4 B.H. Depth to Groundwater Date o groundwater M.T. dry May 22003. May 92003_ Net Drop (inches) 5/2 12" Presoak 12" resoak 271/2 271/2 66� T•H. T•HJ #2� Date Reading Clock Time Net Time (minutes) Percometer Reading Net Drop (inches) 5/2 12" Presoak 12" resoak 271/2 271/2 Add water & s art 11:0935 23 3/8 —1_ _— — 11:14:35 5 18 3/8 5 _dd_#2ter 11:�g:55 5 18.5/8 4_3/4 Add water 11;20:25 23 3/8 #3 11:25:25 5. 8.5/8 4.3/4 20 PERCOLATION RATE 1 (minutesAnch) PERC HOLE DIAMETER-6— TEST IAMETER6TEST RUN BETWEEN 7.5_ FTAND_$,p_ FT COMMENTS: PERFORMED BY FLATTOP TECHNICAL SERVICES. I �-r, �_ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6 // 2 / za4:'3 • FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE 027 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot-3Tanaina, Valley S/D DATE PERFORMED: May 2.2003 PERFORMED FOR: Mark and_Nancy Mumm DEPTH SLOPE (feet) Date No groundwater _M.T. dry Pt. 1 7j/2 SM Reddish sandy loam 2 7_1!2 GM Silty sandy gravel 3 11_38.95 23 3/8 4- 11:40:25 2 195/8 3 314 5- 567 11_40.50. 3 3%8 6- 11:42;50 _1 9 7/8—.-3-5/8. 7— 11:43:20 233/8 SP/SM Light gray fine sand #3 11:45:20 9718 Dry, no silt lenses 8 Uniform consistency throughout 9- to- 11- 12 - 13 -1 10111213 14J 16 18 19 20 B.H. Depth to Groundwater Date No groundwater _M.T. dry May 2`2003 May 92003_ 5/2 J.2'_Presoak 7j/2 2'_Resoak fir 6"1 TH d .......................... �. ...• �' :.��t.:. THCCDCPc F. A700R£ j; CC - 3589 r SITE PLAN lA Q N / 7. 145 145 • 66.5 T.H. T.H. #2 #1 Date Reading 2% Percometer Reading Net Drop (inches) Date Reading Clock Net Time Time (minutes) Percometer Reading Net Drop (inches) 5/2 J.2'_Presoak 7j/2 2'_Resoak 7_1!2 Stag 11_38.95 23 3/8 #1 11:40:25 2 195/8 3 314 ddwater. 11_40.50. 3 3%8 #2 11:42;50 _1 9 7/8—.-3-5/8. _dd water 11:43:20 233/8 #3 11:45:20 9718 3 518. PERCOLATION RATE <1 (minutes/inch) PERC HOLE DIAMETER_g_ TEST RUN BETWEEN 5.25 FT AND 5.75 FT PERFORMED BY FLATTOP TECHNICAL SERVICES. 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S // 2 / 2 C'C 3 i t-FYattop 7echnicafSen*es 14530 Echo Strret,.Anchorage, A?C 99516 (Phone (90) 345-1355 Lot 3, Tanaina Valley S/D 6908 Lowell Circle Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of abandoning an existing septic tank and installing a new 1250 -gallon septic tank that discharges into a new 54 -foot long soil absorption trench containing a total of 8.5 feet of sewer gravel. The design also includes installation of a "Bull Run" diverter valve. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250 -gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 54 -foot long trench to a depth of 13 feet below ground level. If the original ground is higher at one end than at the other, the maximum depth of excavation shall not exceed 13.5 feet at the higher end. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. Sand for leveling or serving as filter material shall comply with Municipal specifications. 3.3 A total of 8.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 8.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. f-- Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: J�( s l0) Y—) "49" 3A PID Number: (,r)\ Name: 80550 Wastewater System: stem: ❑ New Y �(UPgrade Address: na C6C 690 a �ocsl6t.L ABSORPTION FIELD Phone: No. I! p Deep Trench XShallow Trench []Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: z GPD/Sq. Ft. ` /Z Lot: Block: s Subdivision: Depth to pipe boltomfrom originalyrade: Gravel depth beneath pipe T vnlA Q D Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. 3f Ft. WELL: ❑ New ❑ Upgrade Gravel depth:f VL Numberofloos: Dislzncebetweenlines: q Ff. O Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: �� M rL Ft. Ft. .51D SD. Ff. Driller: Date Drilled: Static Water Level: Installer:�� /� Date installed, s' zz 93 Ft. Yield:Pump Sotat: Casing Height Above Ground: TANK" / GPM Ft. Ff. N T S Q�� 12 -Ig SEPARATION DISTANCES D<Septio ❑ Holding ❑ S.T.E.P. To From Septic Absorption Lift Holding Public/Privele Manufacturer:n rL Capacity in gallons. Tank Field Station Tank Sewer Lines g Well A _.� Material: GE -L Number of Compartments: surface�// Water /Yba/A LIFT STATION Lot/ Q r AIA A] A •' Size in gallons: M enu er: Line T/ O /V Foundation 8 s y I r AA N A z zl NJ . ,J A "Pump on" level at: "P lev!!I"-.High water alarm at: Curtain/ Pump Meke a Electrical Inspections performed by: Drain 1`/Oqc Remarks: BENCH MARK -TRA L AtS5o2.r''T"jOrJ /QR-�,. Location and Description: b �•EkYR cGL is CL. j"(. UPG DC /,S IZ16 F7 -L Assumed Elevation: I FW, EAL < Z Y' iip o n < f o0 o`y' Inspections performed by: Dates: 1s 5 z i q! 2ndLL .iv. is /L L% f haol I FnJ--rson "d Department of Healtft� Hume ices approval Reviewed `I�`'� `�~ by< and approved - Date: ]2-013(1/-1) MOA 25 ,14,Z7_U 6r ! Permit No. Page 2 of 9 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report i--- - --7-- . 14 uescriptlon: A t.( -n Y PID No.: 8a 4 ------- L,/JEtJ (A7.75r&yCr/07L1��11 04 Co'i'muerioA! -5/?j9J /488 5cAW i" - zo' 72-013 A (2/01) MOA 25 6-Z YZ , 5I%, pac'f-�J Gwv. . ,loos M,icLael F. Anderson SEAL Permit No, Pepe 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone; 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930284 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:BOSSE PETER J & ELLA W OWNER ADDRESS:6908 LOWELL CIRCLE ANCHORAGE, AK 99502 PARCEL ID:01105178 LEGAL DESCRIPTION: TANAINA VALLEY LT 3 LOT SIZE: 37988 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/10/93 EXPIRATION DATE: 8/10/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION, PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS SYSTEM WAS INSTALLED BEFORE THE PERMIT WAS ISSUED, AND A CITATION WAS ISSUED ACCORDINGLY TO HARTEN CONSTRUCTION. RECEIVED BY: ISSUED DATE: DATE: �J ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 May 21, 1993 349^-3377 Municipality of Anchorage Department of Heath & Human Services 825 "U Street Anchorage, AK 99502-0650 Subject: Lot 3, Tanaina Valley Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: During a recent adequacy test of the septic determined incapable of absorbing 600 gallons Probing and excavations into the system revealed kind. Percolation tests were performed at the indicated the system was underconstructed. system had not been constructed fully in actor; have, therefore, designed an extension to the sy 600 gallons per day. system on the subject lot it was of water over a 24 hour period. no sludge buildup or biomat of any bottom of the drainage trench and Further investigation revealed the .ante with the original design. We ;tem so it will absorb the necessary This design utilizes information from the original design and testholes and percolation tests recently obtained. Lots in this subdivision are served by a community water System and adjacent septic systems are more than 50' away. The ground surface in the vicinity of the system is flat, but slopes rapidly on the eastern boundary. If the extension to the system is constructed as designed the following conclusions may be drawn: 1. The system, if constructed as designed, will have no adverse impact on the wells currently in use or to be placed in the future on lots in the area because the subdivision is served by a community water system. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4.'The system, if constructed as designed, will have no adve}sp`?iYtSpae>�, n drainage patterns in the area. Fs,, �fl 9A Sincerely, r, yyy L J 3 G UU Vl'J a (�q ,mad,ad H.. Anderson 4381 • E Michael E. Anderson, P.E. ?>;w F ',: PPOaKrtL�� IWgi Grsul EW'I Ifrm�al Ua�nc, Gram. Wu.G101. raaAr%gNEIOLLfAEf idtaQMVJ JOB �vr �, A. AWA J14 l=4 SHEET NO. OF CALCULATED BY Mk -A DATE CHECKED BY DATE tiarE, SuDDI'v151 om 15 St ual By A Cx m rA U Ai l ry VJ vatL S/ $7t;O . /SID SEPTIC. SySrems Wrr-A)0 of of rNt$ SySTEWI. 51-rc -R-AJ /" = /oo' JOB Lpr 3� %Ai.IAINA yAL!&;y SHEET NO. OF Ex1.ST-fn,G 57Y S5 -t- " %l c-PLAxlo .l CALCULATED BY ' • I •"�' DATE r J /93 So T r ? P,06 . f-7,+(ro4- 900 r-7- y DAAA , IJ AACA .� CHECKED BY r -r. L = y05 Gauo,�s DATE Gbb 6s4Go.js Cx1s7d6 Sy STt�'1 S I ZL Cl-�L W LA 7-10 Ex1.ST-fn,G 57Y S5 -t- " %l c-PLAxlo .l Rwrur M l nl. / /mw •'• ._.4�P�tG9r,o,� �2arc r`oa-. 5�, WYor $rhavL9�.1 Tn.e,,Itt1 � , S�5' tJ _ `SSD TT, z O1-4. 4' &W& -L. a0JGAri+ PIPE So T r ? P,06 . f-7,+(ro4- 900 r-7- y DAAA , IJ AACA 900 fir. X 5�5' z' -'OL -S. /D All r -r. L = y05 Gauo,�s [� 6.L--:4ri-oorv) �)omzr 77-c4U12ES Gbb 6s4Go.js Cx1s7d6 sy 57 -cm. IS _ /NA DC0U,QTCC UQ_6ILAriC' S/STL-M 190'L A-14 4bb1rn.JAL. ZOD 6mf.lea% PE%i-U "4-17./ D J 24471E tL _ A)4 0 COOS+AAJ tnj) J 8.5- M /N , htj W •'• �P>?UC,+� TI.4^I %�q-i L= : >`b 2_: 5 � �IA�� , S�iAGG9W-%2GN(M = $ G,,ALS• �3 GALS Ir -l- L 2�D rT. L l a uIA.el 5 CT• S-0 fir, LI-►yL77 I,J rl+ -1 I D2A rJ' oul, vN b6ll PIPs- P4,t9. F,RLroIL = 5 SD r=r. x 5- 2 1=3n 4;w Euro 5,).o GJ /u _ $� ZS L X 5 / L� w IrN 4q I RoU4- 0 YIN ]] U 6jj� ooa b�o� �a �; 1 zb'ad b� �`) IJI�lI1lYCI L. /%114CY5011 v / j. PNTM r jSrJe SWilM1(YMEN)®aR4.Gr".Wu. 01411. To k21 GMOM1E IOU ME ILDY6d1W mn<nfmr nrrnni rvu�rnnoi irnn nen uum fYSn lrm,I�wlwe�Aai�w �r 31tl4 AB 03No3n Bivc] / A803ivinoivo 2 30 'ON 133HS � d BOf d� b r N� �' J-% PERFOAMED LEGAL DESCR 5 •�:J'� 6 7 �'• 8 9 , 10 12 13 V 14 15 •�,�,; j('E'NGINEER'S SEAL) Municipality of Anchorage ' G% DEPARTMENT OF HEALTH & HUMAN SERVICES rl', 825 "L" Street, Anchorage, Alaska 99502-0650 ae SOILS LOG - PERCOLATION TEST 16. 1�" 17 6 19 m SLOPE E. Andorson DATE Section: WAS GROUND WATER 1 I 5 ENCOUNTERED? IV IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? m Dat: al �®mmmm 20 I ) ILII PERCOLATION RATE 8'7 (minutesrinc�h)��PERC HOLE DIAMETER TEST RUN BETWEEN OIL / FT AND I I Iti FT COMMENTS a 419LI- %&2 Pkl; .�19A 6f� h MIA TO I' q,- 7G1�1�tJG�. PERFORMED BY:,G/ I • "'e+�r°�� "CERTIFY THATT IS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: .gy 72-008 (Rev. 4)85) 20 I ) ILII PERCOLATION RATE 8'7 (minutesrinc�h)��PERC HOLE DIAMETER TEST RUN BETWEEN OIL / FT AND I I Iti FT COMMENTS a 419LI- %&2 Pkl; .�19A 6f� h MIA TO I' q,- 7G1�1�tJG�. PERFORMED BY:,G/ I • "'e+�r°�� "CERTIFY THATT IS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: .gy 72-008 (Rev. 4)85) IY:1:1Y111T:7T'1xP, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: WI E ,9 1 2 3 ; • �' . 4 6 7 8 17 SH 1 SLOPE 'D� N/q\• "u ✓� b / ��rsaJL �� SEAL) _ DATE 0,,ERP,Q'hMSD' ..,, Section: (121 WAS GROUND WATER / I r / ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? E Depth to Water After MonbrinD? Date: 18— I fl 1GL 19 20 u PERCOLATION RATE '36 (minutes/inch) -PERC HOLE DIAMETER r y �,,�L� TEST RUN BETWEEN I HAND FT �r COMMENTS [6M 6 YIZ'r/� EV MCM V 11W,1 PERFORMED BY: .� Ir �ERTIF HAI THIS?EST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/115) Wi ARM_WM'0�. � 20 u PERCOLATION RATE '36 (minutes/inch) -PERC HOLE DIAMETER r y �,,�L� TEST RUN BETWEEN I HAND FT �r COMMENTS [6M 6 YIZ'r/� EV MCM V 11W,1 PERFORMED BY: .� Ir �ERTIF HAI THIS?EST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/115) DEPARTMENT OF HEATH A HUMANI SERVICES 8Z -V SU"t Amhawge, Alaska OM46M SOILS LOG — PERCOLATION TEST MHfoNMilopon:. rWrs/40,41s is ui!_.nv DATlfell UMAL oI/d1Wn M 147'-f Tow+W*RwV% Soc§m S 1/ '` /2R/ & �vr� M Slop! We ►LAN OSITI 1 N 2. SM e ` s GA EI ED Mlchacl tL P.ndcrsmr t' `(� /'170 P'' "�� ^ �'• S'3s S.•60 G�oS �: aG WAS OHOUNO WATIA ♦iw MM'A ATWN NATI IWAOMO Al MC NOLE MAMITIA TUT MMUTWIIN — FT AND r_fT COMMINTI 7-///5 /Z A✓$/Yl tYIATE/A- F#eo�2 --- 16-9.1 Ave-. DES,GA! roe Aoru 0-p6g LS i s - 20 mA:-.y 6i - 125 M74C -- MAfo11MIo Oy; IA) . Iyl FA AA f u I a/ACZ E .4ve-y4mi" THAT' T TUT WAS PUM MID IN ACCOMMNCI WITN ALL STAT! AND MUIMCIPAL OUOIUNIS W IIf&= ON THIS DATL DATL 7240 pum. 4064 � is i �■�.'�;law ■ENNEN ■ ©�r,�■� ■mom � ��a i■wra� MM'A ATWN NATI IWAOMO Al MC NOLE MAMITIA TUT MMUTWIIN — FT AND r_fT COMMINTI 7-///5 /Z A✓$/Yl tYIATE/A- F#eo�2 --- 16-9.1 Ave-. DES,GA! roe Aoru 0-p6g LS i s - 20 mA:-.y 6i - 125 M74C -- MAfo11MIo Oy; IA) . Iyl FA AA f u I a/ACZ E .4ve-y4mi" THAT' T TUT WAS PUM MID IN ACCOMMNCI WITN ALL STAT! AND MUIMCIPAL OUOIUNIS W IIf&= ON THIS DATL DATL 7240 pum. 4064 � is i MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST B26 L Mewl. At*bw"16 Ails" "601 2S4720 SOILS LOG — PERCOLATION TEST / DATEPERFORMED! P[RF011M[O PORI / LBOA{ D[BCIIit nlNl; ELOPE 61TE PLAN remwe SM Sart/ SA ►rti"� s I 8 2� MkMA ! AntblMll . J r 10 WAS GROUND WATER ENCOUNTERED? rd t ,EtrRAO�Q,,1 li ` �JAND^� IPVEB,ATWHAT '£ f t •7 � DEPTH? -- N RwdME Dow Groot Time Not Tlnw 14 b`1o t' i I !' 16 � A E i�rt ciCY.501� �9 i Ili1Ol3�. �It / h�61 ,a° z)IiiU \0\L :l Of t 11 3:ro 19 RwdME Dow Groot Time Not Tlnw Mpth to water Not .nmp Of PERCOLATION RATE J{ �Im�lnulwllnehl TEST RUN BETWEEN ._..9 FT AND _..LQ.. FT COMMENTS raAe SSAvFv DpN Fi�G^0 A/�1 9�I�I I�FSidN-�nR - PERFORMED BY:,,,yyily� FSA ' �"�� l CERTIFIED BY:GNAGI. f�hlQroATE: 9 d 72-006 fwli) 05/19/93 09:43 $907 344 2130 ROCKFORD CORP �1 FAX MEMORANDUM / TO: Dan Harten �r WITH: Harten Construction FROM: Mike Anderson DATE: May 19, 1993 SUBJECT: Lot 3, Tanaina Valley Septic System Upgrade MESSAGE: The attached drawing shows what has to be done to bring the septic system into compliance with the Municipality. Please let me know when you think you can get this done. I appreciate your help in taking care of this mess. Thanks. 2 Pages Being Transmitted Including This Sheet 01 Z♦ /✓)o,�♦roa. TEE C/.EA*,+vu-r / � N1ON I-rb2 TEC C�COTS''XT! LE Fi�73Ric. A� �O ZS � D fI 146 /Jed } CO♦+SrfLuv/pa / Exrt�+a 5f G.JjDC biMi r T�LN ZS ��ertGN /Z I BEto�j O.G. S. PCA E Li f OF L7. �2Aea IzotiL- Uj ocp PtPE �l_ I SCT /✓IoNrr02 TvBE o� Ex+;rmJ4, T racy S R-c'0404C PCfLF=O"rt-t niAC FRor+'m C4,C.4-JOVT- ON ExsSnAG SOU714 LEGr" A+ab P�CnGAcC W m*4 Sana P�AE, (Ija s��) MAY -18-93 TUE 10:46 AUTOGENESIS INC 9072483174 F.01 May 17, 1993 TO: Dan Harten 111r:Haten Construction & Landscaping VIA FAX: 344-8732 FROM: Tom Windisch 4721 E. 113th Anchorage, Alaska 99517 346-1967 RE: Final Grade of Drain fteld/Holdi'ng Tank Per our conversation on Friday May 14, 1993, please schedule the above listed work into your schedule as soon as, possible. The yard condition renders i't unusable and it is UGLY. We want to schedule hydroseedi'ng as soon as possible, Please call and leave a message on the message machine at 346=1967, the day before you intend to come so we can have the dog tied up, Thanks so much for working us in. �. Thomas Windisch J V/// c �✓ P I I j .^P </ /r7r Jam! G PY.//Irl a'll✓I �� / !C��4� _. 2 —Ile /'J-�t-f 6.-�/ ,�rc I C✓.o-ci, �� ,1.�_ � i' ',. ✓-4'� !j -i 'I ,fD. , cPl�i l(,��z �� ': ✓J7n'/Jle.-�,�e�y/'�D �� f : / cG�' / / I L_. `'f,-� ✓G'9�.j Ckl i �4 (7 `�'C/ -cG � �d v%.'�i�J�/✓{c� . / r aux) s cJ'!'('/�irj/'/77 %, !� � jvlJ�2s��tJ �`j�s�J� l��f.�j�J ✓� �<—�J,/2F MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name L/L S IAA DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address P4P1Ar7_1etz60A /,;;16 Phonefs) Permit No. No. of Bedrooms E/?- Cil �I 1,980/p.3 � WELL D C7 8 i '90c), + LOT LINE i C7 f,1 1 LEGAL DESCFIPTION Lot Block `— Subdivision %AAIAIit FOUNDATION8t Z4gfooI Y„ Township, Range, Section 7- AS -BUILT DIAGRAM driveway, water bodies, (Show location of well, etc.) septic system, property lines, foundation, TANKS SEPTIC ❑ HOLDING Manufacturer A:�.,_ )e I Capacity in gallons /?_ tJe) Material No. of Compartments TYPE OF SYSTEM ❑ TRENCH ❑ BED W. DRAIN ❑ OTHER Depth to pipe bottom from original grade -1 FT Total depth from original grade L I I FT i �( T Fill added above original grade b FT Gravel depth beneath pipe L� FT oo, ._r Gravel length � q0 FT Gravel width !r � FT s" ds, tl-t-t ---- Total absorption area pp SQ FT Distance between lines iFT �O FT Number of lines Z Soil rating IZS SQ FT Pipe material P\IG Installer Date Installed WELLS ❑ PRIVATE [ OTHER (ldenti(v) Classification (A,B,C) SEE A-VTAcNED Total Depth FT Cased to FT Installer Date Installed: REMARKS: �,UII.S U�:C:AM� k�)>`1-)•5\e, mere rS�IE� Inspections Dale: JAI,A)� Performed by: Wzx)rAl r..t ,r° .5 •^v r,, by �J y� 6 »��C `ey°uea°oaa1 e.•e@eoyyg �i� 9R? p e �t 1 e Y e ,T s,P e 1 4av pep pe0c e4 - L`OUb pe al 4Pa4 �, aaOeeo, E. A �'n �, N�ichael [. Anderson g ` oe 0 z9/uQ (J O jf /Y{lCldA CL /tNDr 1Lfy J I lctertily [hal this inspection was performed according to all - Municipal and Slate guidelines in ellect on this date: � Heellh Department Approval: �b /t^ '�'"�� Date:"Z'�'•�.-+B'�W 72-013 (3/85) Department EM |<ea]th & Muman Hervzces W5 L StreeL, rmchoraqe, Alaska 97501 343-472O U1! E SEWER & WEP|1C |ANk PERMIT uuoflber|83 yaL'\ssuud: 09/O8/88 tnginee|` Designed Name: DENAL1 SUR,LY INC" Day Phone: 7021 DRlFTWOOD 349-8014 ANCHORAGE, AK 99518 Parcel 1d: 011-051-78 ' Lot Legal: Subdivision: TANA[NA VALLEY Lot: 3 81ock: -- Section: 4 Townships 12N Range; Section; 4W' lot Size 37968 (sq.ft. or acres) %.' »odrooms: This Permit-: 4 Total Capacity: 4 S[|.;C TANK: Minimum Lota1 septic Van capacity: 1,250 gallons" Each septic 1 ufl: ~/.st have at least 2 compartments, Depth to top of septic tank(a) < 4.0 ;c`! 'equires insulation over tank(s). |N�i[A!L PER ENO INEMS A|WHEU DESIGN, |l1[S PERMIT IS 195UED |//K �) FAM1LY RESlUENCE ONLY AND EXPIRES 12/31/89. NOl1|� o||HS Pk'lOR TO EACH lNSPECT1UN^ 1 CLRllFY (UA|: L. l am fami1iar with the ,oquirements for on-site sewers and wells as set nu,Lh by the Municipality of Anchorage (MOA) and the State of Alaska, �l will install Me system in accordance with all MDA codes and regulations, and in c.01111)1 !anus with the design criteria of this permit. 0" 1 wi]i adhere to a!l MOH and Mate of Alaska requirements for the set back dista/^es |rom any exisiino well, wastewater disposal sysLem or public sewerage system cm this or any adjacenL or nearby lot, 1^ I that this permit is valid for a maximum of 4 bedrooms. I Moo undorsLand Lhnk the capacity oi We total system is 4 bedrooms and any enla L ill require an additional permit. --------��-�--'-7--~�---'-�--------- DHTE: --`�-7-------- NALI StjPPLY lNC Issued --r.~-~--^--------'-----------^----- --~-r-v'-~------ 21 33, 516 cf. CIPALITI' OF ANCHORAGE DEPT. OF HEALTH & ; 36 . 'Y i `R E 's". A *co..w Cswls_ 4. 33,117 af. • CAST I 210.45 ' n 6 0� 32,341 ai F t1 ::I - /„l x 14 34,o .: 15 36,297 tt AL PROTNCE7'tt9 n Y� I 88 �9 I �IVED20 33,Su{.f• 0 o N f Ja, N i moo♦ a e6°sYQ1(' — ��17.11 T{NM.�wC{n�I{ a 18 O ; 34, 330 tf - 1 fJw l Sw Ar 1 �I H :)F r I eo„�OVVe e1l.V /• . Anderson S ly N w � r- • y • , s' • `i•'�' nl r- ►o.0 )�'E5S10r1 �rj9 I • S I 13 � e Municipality of Anchorage DEPARTMENT OF HEALTH 8, HUMAN SERVICES 825 "1:' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST I PERFORMED FOR: JJES /l.c/ 5 /A/ (ir/Uop DATE PER LEGAL DESCRIPTION: Z67-2 %////!//e/-9 VA",—v TOWnshlp, Range, Section: r�T SLOPE SITE PLAN (FEET) 1 2- 3 3- 4- 6- 7 46 Date Grom Time Net Time Depth to Water Net Drop / 8 -se 8 O 9 o' 2 G' 10- 5 11 TIFY THAT THIS TEST WAS PERFORMED IN 12 13 14- ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS 15 DATE MUNVKH ry OF A DEPT. OF HEA ENVI!ZqyM zNTAL P. 16 P 9 SIA/ IAI�=G� (,P-ADFD ,A /.1 b EIWED WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 040 U wrier After Mautorilp7 04te //0 ■■■■■■■R■■ Date Grom Time Net Time Depth to Water Net Drop / 8 -se v O ■■■■■■■N■■ o' 2 9-a-ae S 5 0 TIFY THAT THIS TEST WAS PERFORMED IN ■■■■■.�■m.■ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE t5 15 ■■■,MIMM■„■ ■■/■■■■■E■ ■11■iii■®■_ �■ ■Iii��■I■I■■ ■„N•N■■■■■ ■o■■■■■■ ■■■■■■■■■■ ■■■■■■■ ■■■■■■■■ S L 0 P E Reading Date Grom Time Net Time Depth to Water Net Drop / 8 -se v O /Z. s7 o' 2 9-a-ae S 5 0 TIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE t5 15 ZO I �I PERCOLATION RATI(, 3 D (minutea/mch) PERC HOLE DIAMETER - TEST RUN BETWEEN L FT AND FT COMMENTS /-Y/5 /5 -22V )/>U/% -/v ./_4l 7F".,7" i✓> >r ✓'J E= SIrI I�.9Tt"-.�/A-G F/l C�✓�-J 10-2., Avr, Poo -r1-1 z-olz.n 2 PERFORMED BY: W, r F/1 PDf='Ar 114,a Lt C n's Alude TIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE 72-008 IRev. 4/85) -B_ SOILS LOG MUNICIPALITY OF ANCHORAGE +.a DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 025 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Qk- /GiAI> /AI /A/Z21247 DATE PERFORMED: LEGAL DESCRIPTION: Z,07_,-? MA1A/N,4 UA/1`4 TY1,1 DEPTH SLOPE SITE PLAN (FEET) 1 SM z 3 s/i a ejja , .._oFA��e .. .� 4 9 ��, n: JI(9 �•.�au sajh�a�)e.�/.�/'�aaru/.//{eu.� Michael E, Anderson W W 7 DACp'., 4361 • E e� 9 " /lei 10 jiA/" /n 11 1 I/IE L.L. 6�I? b v 7 12 Sntily 13 14 15 16 17 18 19 ,0" 3'ofp WAS GROUND WATER S ENCOUNTERED? Al L O U o P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop IZ, 561, -- 20 I PERCOLATION RATE S (minutes/inch) I_I TEST RUN BETWEEN FT AND FT COMMENTS /%70q 7'!lA?!'- _9S7/J -`!.' r� /3 i' : `-'r'e, n? ef�/S,.Frfij.4> .."• .7� zi;,f`fi`.P�l �/��t/ F"!�/'. PERFORMED BY: Gdi �� `�� ,', ,- �-'�r ,% CERTIFIED BY: 41WAe2. C- ; FhVOs:3LJ0edATE: / BG 72-008 (6/79) -h— 12 Bike 'roll Ls• 30Y -:)o co w; W —139.00 _--_19500'---F$ 88w------ ——_--_ —T .. 5000 50co w 1 0 21 ..:.:. .Y i m v. 33,50 Lt. M�oFI,, c; 4c dr g�P p 5.00 2 l 32, t� 11 67-,4)1 I a +tea SOTILL T 10'Ebt. a Tsltceaw [stws. 4. 33,11nit ' CAST 210.44' 32,345 f : 0OH, 4 o � N6T I q?� 05 I 20 W I - 088 , JQ, N n I \� ra _ �• �2d S n --- A7.14 •ee. 34,660 tf. I Jeh 0 8 j T.Ntoww�,[IM I U+H. E%wtk $3, 2" $A sr•w Elft. & ' ooicttm. E*wA 1 �• s � 10'Ebt. a Tsltceaw [stws. 4. 33,11nit ' CAST 210.44' 32,345 f : 0OH, 4 o � N6T I q?� 05 I 20 ' - N , JQ, N �• �2d S n --- A7.14 10 [Iss. f[ I 34, 330 at Ir 0 ..�, C , I ,— C 1 O %' O M .F Ai. es u � eea,. •Hp Z e I °qF'% Michael E. Andett��, ee�,•� A387•E3f, b� •�� QIV N 15 +dE1tc. : 14 31,000.a �� , 13 8 ss,s4e..e N Fr AqK F f' r' S_ , $G • Municipality of Anchorage .'°Q, On -Site Water and Wastewater Program (907) 343-7904 s A f E T Y Certificate of On -Site Systems Approval Parcel I.D. 011-051-78 Expiration Date: l) o\4 + «d 1. GENERAL INFORMATION Complete legal description Tanaina Valley, Lot 3 Location (site address) 6908 Lowell Circle Anchorage, AK Current Property owner(s) Gregory J. & Wendy J. Gursey Day phone 830-3199 Mailing address 6908 Lowell Circle Anchorage, AK 99502 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ED Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5� 60 Date of Payment 10/19 1 Receipt Number 03� 99 J COSA# 011sC i 81559 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. Name of Firm Forge Engineering Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 522-7773 Date 11/20/19 Conditional approval for bedrooms, with the following stipulations: 1 By: -1,114mw1l,- Original Certificate Date: f ,o The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet � Legal Description: Tanaina Valley, Lot 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Lot is served by public water system. Parcel I D: 011-051-78 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample B. TANK DATA C. LIFT STATION Age of tank(s) <1 years ❑ Required maintenance completed Tank type/material Septic/Plastic Age of lift station years Measured operating fluid level in septic tank Lift station material ❑ Standpipes/foundation cleanout per record drawing Comments: Date of pumping New Construction - 10/3/19 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 05/20/03 Adequacy test date 8/31/18 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 12.5 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.5 ft (min) Water added 703 gal ❑ N/A — pressurized field New depth 17 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 60 min depth into effective FECode-requiredsoil cover over field Final fluid depth 7 in ❑ System presoaked Absorption rate >600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) None date of test) Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) - Community Water System Septic Tank/Lift Station on Lot > 100' NA Community Sewer Manhole/Cleanout > 100' NA ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No NA ft Private Sewer/Septic Line > 25' ❑ Yes if No NA ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ❑ Yes if No NA ft Neighboring Absorption Fields > 100' NA Animal Containment > 50' ❑ Yes if No NA ft ❑ Yes if No _ _ ft Yes if No NA Manure/Animal Excreta Storage > 100' NA Community Sewer Main > 75' F_] Yes if No ft E] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10'✓❑ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5'✓❑ Yes Yes if No ft Wells on Adjacent Lots: ❑✓ Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓❑ Yes if No ft Water Main > 10'✓❑ ft Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS Septic tank replaced 10/3/19. G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ❑✓ Yes if No ft ✓❑ Yes if No ft 11/20/19y°°°°°°�C�� °.......°.°C p� "ROOF ESS EPuNS Municipality of Anchorage ?!* E On-Site Water and Wastewater Program (907) 343-7904 S.T E T T Certificate of On-Site Systems Approval Parcel I.D. 011-051-78 Expiration Date: 1 '2%7—tie 1. GENERAL INFORMATION Complete legal description Tanaina Valley, Lot 3 Location (site address) 6908 Lowell Cir Lot Current Property owner(s) Gregory J. & Wendy J. Gursey Day phone 830-3199 Mailing address 6908 Lowell Circle Anchorage, AK 99502 Real Estate Agent Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment /OOP? Date of Payment Receipt Number O6.7-ict D Receipt Number COSA# 6 6(/VV5559 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 Benjamin Schiller, PE Date 10/17/18 4�>>OL1\\ OF Ai j, '49 TM %\ *fir, 6. DSD SIGNATURE ---- ., , . • i System#1 Approved for bedrooms ?Ai '._ Benja •a/Schiller ,:�j V.• CE 12592 ••4- System#2 Approved for bedrooms ,6 4...10/1 /18 •• .� Disapproved \\tx`e�4 Conditional approval for bedrooms, with the folio ing stipulations: �S �� '- J scfatG `C its 3 0 S S�`�''�-� �' °1-eif t c--27—(g d r C a 4.0 . % ., d (vim e v tri r `c-o `k s' ,(-Av.0(ritite ci or d'`•- f 6 rkier(e-c-ka A e` I G - C 0 P�„, U►-AIVC;#70 �� -SVVt �`'; 0 D WPB AWP ER Z. ,off W QROG1*% c.. ---.07: - Li s<0 By: Original Certificate Date: j "` f41'6GE (� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 6 ( a,r ilvd( .S i"OV` COSA blue sheet_ '• 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: Tanaina Valley L3 011-051-78 Parcel ID: A. WELL DATA Well type A If A, B, or C provide PWSID# 214706 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 12/88** Tank size 1250 gal Number of Compartments 2 Y P Cleanouts (Y/N) Foundation cleanout(Y/N) Y Depression over tank Y/N ( ) High water alarm (Y/N) Date of pumping 5/29/18 Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed 5/20/03 Soil rating2 2 0.8 System type 5 (g.p.d./ft or ft2/bdrm) Deep Trench Length 5 5 ft. Width 2.5* ft. Gravel below pipe 8.1 ft. Total depth 12.5 ft. Eff. absorption area 899 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/31/18 Results (Pass/Fail) Pass q For bedrooms Fluid depth in absorption field before test 0 in. Water added 703 17 gal. New depth in. Elapsed Time: 60 min. Final fluid depth 7 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) None If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "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 On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation >1 1 0' Property line >5' Absorption field >5 >10' >10' >100' Water main Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10 Surface water >100' >10' Driveway, parking/vehicle storage None Noted Wells on adjacent lots >100' Curtain drain F. COMMENTS *Inspection report notes that the trench sloughed during install and is 8' wide in areas. **Water level was measured at 50.5" w/ home unoccupied, indicating no leaking. G. ENGINEER'S CERTIFICATION _'_ OF �� I certify that ! have determined through field inspections and �it'� t!Qsi-,� review of Municipal records that the above systems are in ��fj •...m— .1'& conformance with MOA COSA guidelines in effect on this date. ® *. 49 T H )` ro Benjamin Schiller, PE ',' ,' fir. Engineer's Printed Name •, ..��,`;-;/e =�✓,./ fr 10/17/18 6 . ... .. _ .. • i Benjamin Schiller Date V..* C ,?592 • 1A •. 10/ /18 •.klk,g pROFESSI(N�' COSA brown sheet_10-10-12.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ` • , .......e\, 907-343-7904 On-Site Water and Wastewater Section \ jtl Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181559 Subdivision: Tanaina Valley, Lot: 3 The septic tank for this property is 29yrs 11. Months years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. 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 30 year old steel tank MAY look like. d•. h- , ,.. t ' om 43. * G k i 4, -6 Yew'40, �4Z� � �`�Iy-+�;�. Sono°°°'''''' y. • 4f ("'._ ' - ......„. r„ .ice i w. , :, - 0 �,ros: _•.1� ggam' �: u � ^ '�i'.�.. -.. w •1 3 -4, _ Jp,• F it ® u. Mailing Address: P.0. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org �Ar * -4- , aE 'l 63°31 ys AA 0 'moi ,r -00. \e) hSFW. ,. -. ov* c`',1,5, .._. ‘.. cp E11 L t W :41111 O M o m z f 4 • V • }• • •,\ • \\\ ; O oAN CD � �W 0 Cn !tBL2Ear" o r c -r s eve . O Z ��(��E AS BUILT SURVEY 1" = 40' �F .\ NO C09YFAS SIT THIS DATE ,\ A ` 1 ' I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY �P'. �1F'J, OF THE FOLLOWING DESCRIBED PROPERTY 49TH •,, ' LOT 3. TATIAITLA VALLEY 5U8. 5 S'^ ,ii J ' THE 1NFONEETION HEREON IS FOR THE USF OF LFIDING INSTITUTIONS SPECIFICALLY TO SEON ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AEA THAT THE .1, CONFLICTS BETWEEN EXISTING STRUCTURES NC PLATTED LOT LINES AND/OR EASEMENTS;AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT 10 BE USED FOR POSITIONING AOOTTId6AL STRUCTURES, IMPROVEMENTS,OR FENCFLIFES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS 'I? EASEMENTS OF RECORD, OTHER THAN 1105E APPEARING ON THE RECORD PLAT ,ARE NOT SINN •'., SHANEA HOLT•• HEREON(UNLESS INDICATED) EXIST OTHER THAN NOTED. 1i • IS-6914 NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT 70 BE USED TO DETERMNE DATED AT ANCHORAGE,ALASKA THIS 25 TH DAY OF •o'c, • . e'''.. PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. , 2018 II °Te 3 5'•°- ANY PAVING SNOW HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. EOLT LAM)SURVEYING \\\\\�o\s 600 ORAGE AY DRIVE °.r)�'. 3 EI9-J:.. 193-6 AKHOMGE.AX 99515 3{S•5513 Municipality of Anchorage Ali 'Bto Development Services Department Building Safety DivisionOn-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING - Parcel I.D. O 11 - os -1 - 7e HAA # I l�b Z ( q Expiration Date: S- SO - O4 1. GENERAL INFORMATION Complete legal description /.of 3 'Tczn a��cs Ua/ley S�� Location (site address or directions) 69 O& 4or-v er/ Ctrcte Current Property owner(s) Mark >r Alq >, 11","m Day phone '2v,6 -7>67 Mailing address 69 a6 4&cu,ell 6(�-We �4�s4 A4- 99S-02 Lending agency weltr Fa;90 Day phone 2.57 -36op Mailing address o f?a4S'6n l3wd.� �1i+c�o�ay� /}lc 99s+5�_7 Real Estate Agent Day phone S7 -T -7? -Z-? Mailing Address H2 y/ °/3" S4�a�ee if k' 99Sa� Unless otherwise requested, HAA will be held by DSD for pickup. Pl e& -r e ca l/ R ea l An,.- _4:�, r 1w c le 2. NUMBER OF BEDROOMS: I 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Water Storage ❑ Community Class , A Well Public Water System ❑ Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm F(uFfce T.rcAo teat Servs ct_r-Phone 3 YS-- IT .Cr Address 1 yS3o EcAo SI., hnchvi-aoP , A -k' 99516 Engineer's Printed Name �7 Aeodo e F Mao? Date _ at, z3_ Zr✓�3 5. DSD SIGNATURE 1/ Approved for _h bedrooms. Disapproved, 4 �}i • ,,,.p . si. rg� q `� �G ORE F. 4600d£ r CE -3,589 , rS Conditional approval for bedrooms, with the following stipulations::., Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory 0 (Rev. 01102) Maintenance Agreements — Supplemental Engineer's Report Other "-'30-03 I Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description: 1-40 f 3, 72Z.9 a;AOL 44M110v S/ -b Parcel ID: 4// - OS / - 76 A. WELL DATA Well type �4 Date completed Total depth ft. if A, B, or C provide PWSID # ?1Y701; Well Log (Y/N) Sanitary seal (YM) _ Wires property protected (Y/N) Cased to ft. Casing height (above ground) in. . FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg.A. Other bacteria colonies/100 ml. Arsenic: mg./1. Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material SV A C /S/4 i / Date installed 12 / &6- Tank 8Tank size I ?J_ gal. Number of Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y/N) r Depression over tank (Y/N) 14 High water alarm (Y/N) N• * Date of pumping 5"/ 23 / O 3 Pumper No r A /4,., cO Pa!!!e C. ABSORPTION FIELD DATA Date installed 5 -/OJ Soil rating (g.p.d.M2 or fts/bdrm) !E. .p System type 7,,-enci Length 6S. S ft. Width 2.5- - 6 ft. Gravel below pipe ft. Total depth 13-1 ft. Eff. absorption area 8 .fe Monitoring tube i" Depression over field N Date of adequacy test N.A. C 6tow) Results (Pass/Fail) P.. For Y bedrooms Fluid depth in absorption field before test _g2_ in. Water added d gal. New depth_ in. Elapsed Time: ^ min. Final fluid depth _ in. Any rejuvenation treatment (past 12 mo.) (YIN & type) Absorption rate >= GGG g.p.d. 1✓ If yes, give date N. 4. I D. LIFT STATION N • /}• Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level at,_ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: U. k Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Manhole/Access (Y/N) High water alarm levet at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7 Property line I_ Absorption field '20 Water main > t v ' Water service line > to ' Surface water —'> t GO ' Wells on adjacent lots > 200 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 2 Building foundation 27' Water main > Ia ' Water Service line > t0' Surface water > t cArl Driveway, parkinghrehide storage >5t:)' Curtain drain N• A F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots > ?CIO 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 7_AeaaG1-e F M�'r {�.' 6•.. ••�•.• •••H••.•• 1 �• w •�,�ir�)P1.00RC . I Date 1` eA X 23 ZC.Y� 3 HAA Fee $ 3?S Waiver Fee $ Date of Payment b`/ 23/D3 Date of Payment Receipt Number X5`1 Receipt Number (Rev. 12/01) �± k� � CP0 & . cn� � « <2 f r,. By: Original Certificate Date: 7 —A-7 — c3 p Expiration Date, 7 — 2 7" O / Reissue Date• (Rev. 11m) Municipality of Anchorage •'i Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Tanaina Valles Lot 3 Parcel I.D.:'9 x51 " 78 A. WELL DATA Well type Comm If A, B, or C provide PWSID # 214706 Well Log Date completed Sanitary seal Wires properly protected Total depth ft Cased to ft Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft Well production 9 P m WATER SAMPLE RESULTS: ft g. p. m Coliform colonies/10 ml Nitrate mg/I Other acteria colonies/100 ml Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed 12/1/1988 Tanksize 1250 gal Number of Compartments 2 Cleanouts yes Foundation cleanout yes Depression over tank no High water alarm n/a Date of pumping 6/14/2000 Pumper McDonald C. ABSORPTION FIELD DATA /.2/go Date installed -5'/9:3 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type Deep Trench Length 121 0431 ft Width 5 ft Gravel below pipe 4 ft Total depth 12 ft Effective absorption area 710 ft2 Monitoring tube yes Depression over field no Date of adequacy test 725 00 Results (Pass/Fail) pass For 4 bedrooms Fluid depth in absorption field before test 0 in Water added623 gal. New depthl4 in. Elapsed Time: 1440 min Final fluid depth 0 in Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) yes If yes, give date (Rev. 11/99) D. LIFT STATION Date installed "Pump on" level at n Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at n Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot On adjacent h Absorption field on lot On adjacent h Public sewer main Public sewer Sewer /septic service line Holding tank Manhole/Access High water ala/uit at at in Meets alarm & cequirements? _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 1 0 ' + Absorption field 1 0 + Water main 25'+ Water service line 2 5 ' + _ Surface water 1 0 0 + Drainage 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 1 0 ' + Water main 2 5 ' + Water Service line 25'+ Surface water 1 0 0 ' + Driveway, parking/vehicle storage 2 5 ' + Curtain drain 100'+ Wells on adjacent lots 2 0 0' + F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and0.1 ... . �:..,. °..a... review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. 7 °sK01101 1, I'l ° cc i t a Engineer's Printed Name Kenneth M. Duffus 0�0 /ROfESS10N� Date 7/25 HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/99) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES On -Site Services Transmittal Sheet TO: ��n D v 77' „s LEGAL: The attached paperwork has been reviewed and is being returned for the following reason(s): Discrepancy in legal description and/or owner name. Discrepancy in number of bedrooms. Signature and/or stamp missing on Show measured distances to sewers/wells, curtain drains and streams within 200 feet of proposed system. Replacement disposal site not shown and/or tested. Calculation error in design. Show locations of all soils, percolation or water table tests. Proposed system too deep for soil test submitted. Topographic information missing or inadequate. Narrative missing or inadequate. Additional soil/perc test needed. Sand filter requirements not satisfied. Water monitoring results missing or inadequate because C /G/Lln- oL21 /n., ir0✓ /v e7- r �. Incomplete; missing - - ' S 17 s fo-n /KJ tva /er f'f'v 7'� k. uv h„ ? Well log required. �I Water, sample unacceptable becauseop _"4 Other V. C4- L0(ze "o !� OT 4A e, [I.�r 11/�ti �/oma,. Please supply the necessary information and re -submit your request. Your cooperation is appreciated. Reviewer r i P 7— Date LEAVE THIS FORM ATTACHED TO PAPERWORK /203 -rev. 4/93 0,4N wgLF 23-7-0114 W 14 D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-8111 July 24, 2000 Municipality of Anchorage Dept. of Health & Human Services On-site Services Section P.O. Box 196650 Anchorage, AK 99519-6650 RE: Taniana Valley Lot 3 HAA request- Adequacy test procedures Gentlemen: During the septic adequacy test process we encountered variations in the field elevations versus the as -built information on file at DHHS. No time during our testing procedures did the water level rise above the lateral lines in the field nor did any water run back to the septic tank. After discussing the concerns with the owner he stated that additional fill was placed over the area in the past but the septic pipes were not distributed. If you have any questions, please contact me at 696-6111 /FAX 696-8111. Respectfully submitted, KND Engineering KeuEheth M. Duffus, P.E. K�e eth Attachments: Health Authority Approval Checklist Permit No. Page S —Of S Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: zo, 31 1 Amt 4 W A JA Lt -E / PID No.: m w z 95 — N 9r 87 ? N I Oco CoNSrn !z/8B Kld - 6>ftk-_ Jot 6 k 5Tck ' G 6 l % 2 lo— - Cys Al r"13 A (201) UGA 25 9/ y kichcei E. Anderson 43E7 -E P% o Permit No. Page 2 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519=6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 1.0'3 -7- Legal VALLEY PID No.: OI/- 051 - 78 411 92" 0 GLi' 0 0 Co SZ%' ov 5 5 -0 cob lob � _.._ 10. AICD 6"5T2UC.T'7 O,TL 1r1cT �. if9^ is..uwe......eo•® s CE 71 i6 C.E1W / ZOO ��4gORpFESs1� +�" uac ��f %�aSDD peptti o�wa+er Meter Read Cum Gallons MT9 C08 MT7 C06 C05 MT4 CO3 water drop 44740 0 0 0 1 0 0 4" 44800 60 0 0 0 0 0 4" 44860 120 0 0 0 0 0 4" 44940 200 0 0 0 0 0 4" 45100 360 14" 10" 0 0 0 4" 45130 390 14" 10" 0 0 0 0 4" waterdro 45180 440 14" 12.5" 0 0 0 4" 45250 510 14" 10.5" 0 0 0 4" 45363 623 13" 9" 0 0 4" 0 5.5" 20 minutes 1 13" 8" 0 10 4" 0 4" 72-013 A (2/81) MOA 25 Permit No. Page 2 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Z4r- 3 7;";4MIA VALL-eV PID No.: SD, 41::' 1 / 1 \ SZ%' y 96 1" 3 s % 9 _ DGrue- o v oo- L AZCiJ Co" 5TeVCXj ' i DLO INN Mz'UCT7p^1 5 93 �I 1486 fps; YJ��vw✓ 72-013 A (2/81) MOA 25 -�-EefciNic�A Michael E. Anderson 4381-E Ktk-tIVtU Municipality of Anchorage JUL 18 2009 Department of Health and Human SeMbLdSOOFANCHURAGE I Division of Environmental Services I-r)NMENTALSERVICES DIVVFIfi On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage .ak. us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Tanaina Valley Lot 3 Parcel I.D.: A. WELL DATA Well type Comm If A, B. or C provide PWSID # 214706 Well Log Date completed Sanitary seal Wires properly protected Total depth ft Cased to ft Casing height (above ground) in. FROM WELL,LOq AT INSPECTION Date of test Static water level ft ft Well production Z 9 -p -m Z 9 -p.m WATER SAMPLE RES LTS: Coliform colonies/100 ml Nitrate mg/I Other bacteria colonies/100 ml Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed /A88 Tank size 1250 gal Number of Compartments -Z Cleanouts yes Foundation cleanout _yes Depression over tank no High water alarm n/a Date of pumping 6/14/2000 Pumper McDonald C. ABSORPTION FIELD DATA Date installed 17— /69 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type Deep Trench Length 90 ft Width 5 ft Gravel below pipe 4 ft Total depth 11 ft Effective absorption area 900 ft2 Monitoring tube ves Depression over field no Date of adequacy test 7 /y 00 Results (Pass/Fail) pass For 4 bedrooms Fluid depth in absorption field before test 5.2 in Water added600 gal. New depth59.5 in. Elapsed Time: 1440 min Final fluid depth 5 in Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) yes If yes, give date 4 / l _'o (Rev. 11/99) D. LIFT Date installed "Pump on" lev Datum E. SEPARATIC SEPARATION Septic tank/lift Absorption fief Public sewer n Sewer /septic SEPARATION Size in gallons Manhole/Access atin "Pump off' level at in High water alarm I el at in Cycles tested Meets alarm ircuit requirements? _ DISTANCES iISTANCES FROM WELL ON LOT TO: lation on lot On adjacent lots on lot On adjacent lots in Public sewer manhole leanou �rvice li Holding tank IISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 1 0 + Absorption field 1 0 ' + Water main 5'+ Water service line 2 5 ' + Surface water 1 0 0 ' + Drainage 1 Q 0'+ Wells on adjacent lots 2 0 0' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property lineal 10'+ Building foundation 10'+ Water main 25'+ Water Service line 25'+ Surface water 1 0 0 '+ Driveway, parking/vehicle storage 2 5 ' + Curtain drain_ 100'+ Wells on adjacent lots 2 0 0' + F. COMMENTS G. ENGINEER" CERTIFICATION �sC,N 1 � •"��c�errs`''; 1 certify that I t ave determined through field inspections and �,•,o,,�; review of Mum ipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. 4" •••••••••• Engineer's Printed Name �e-s'Ji7GG�/ / ,72tf /uS I yr'ia pI - F Date 7 O\a FESSIOON HAA Fee $ Date of Payment Receipt Number. (Rev. 11/99) r 0 7-/ P Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Tanaina Valley Lot 3 Parcel I.D.: A. WELL DATA Well type Comm If A, B, or C provide PWSID # 214706 Well Log Date completed Sanitary seal Wires properly protected Total depth ft Cased to ft Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RE: ft ft g. p. m Coliform colonies/100 ml Nitrate mg/I Other bacteria colonies/100 ml Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed'` -Y-=-"' Tank size 1250 gal Number of Compartments 2 Cleanouts yes Foundation cleanout yes Depression over tank no High water alarm n/a Date of pumping_ 6/14/2000 Pumper McDonald C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type Deep Trench Length 90 ft Width 5 ft Gravel below pipe 4 ft Total depth 11 ft Effective absorption area 900 ft2 Monitoring tube yes Depression over field no Date of adequacy test 7 /y OD Results (Pass/Fail) pass For 4 bedrooms Fluid depth in absorption field before test 5.2 in Water added600 gal. New depth48 in. Elapsed Time: 1440 min Final fluid depth 5 in Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) fires If yes, give date (Rev. 11/99) D. LIFT STA Date instal "Pump on" Datum — E. SEPARAI SEPARATI Septic tank/li Absorption fii Public sewer Sewer /septic SEPARATIOI' Building Water main Drainage 1 SEPARATIOt Property line Water Servic Curtain drain F. COMMENTS at_Z in DISTANCES Size in gallons "Pump off' level at in Cycles tested DISTANCES FROM WELL ON LOT TO Manhole/Acces/requirements? High water alarin Meets alarm & c' cuit station on lot On adjacent lots I on lot On adjacent lots ain Public sewer manhole/c anou ervice line Holding tank DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 10'+ Property line 10 ' + Absorption field 1 0 ' Water service line 2 5 ' + Surface water 1 0 0 '+ )0'+ Wells on adjacent lots 2 0 0 '+ DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 1 0 ' + Water main 25'+ line 25'+ Surface water 1 0 0 '+ Driveway, parking/vehicle storage 2 5 ' + Wells on adjacent lots 2 0 0 ' + G. ENGINEER' CERTIFICATION I certify that I have determined through field inspections and review of Mu l icipal records that the above systems are in conformance with MOA HAA uidelines in effect on t date. Engineer' P Date Zf HAA Fee Date of F Receipt Number (Rev. 11/99) Waiver Fee $ F.. 4L.. fry � .... . IU-711 :;' ,�j ,00 4 Date of Payment Receipt Number GE p MUNICIPALITYHEALTH & HUMAN ' • '� 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 l.D.# 00Lk-i�i HAA# �\'n'\'-)r) �� 1� 1. GENERAL INFORMATION Complete legal description Location (site address or directions) In gd a Z.0Lj LL Ci,Z (;tc Property owner Mailing address Lending agency Day phone Day phone Mailing address Agent 120 A,% Ax 4=2--n tZS - f/HL)3AXA /s,AAnYCcrgay phone Z7G - 270 Address 7-601)/go Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. 1/91) Front MOA n21 Lznvow 9OU8 Q6Al OH)M-ZL •�aorn sdaou!6uo leuo!ssaloid all ui suo!ss!wo ao saoaaa aol agsuodsaa IOU si a6eaogouy jo (j!Ied!o!unw oql ponssi si ojeoilpoo a aaojaq elep az(leue ao suo!loodsui jonpuoo IOU oP SHHO to soa (oldw3 •sluawaa!nbei alels pue leaapal u!el)ao /ls!les oliepio u! suo!lnlllsui 6uipue a!all pue sawol to saaseloind of Aselinoo a se s!ql saop SHHo all •eNsely jo alelS aql u! paaals!6ai aaau!6ua leuo!ssajoid luapuodopu! ue (q anoge g ldeibeied ul UOA16 suo!leluasaadaa all uodn lluo paseq sojeo!lpoo lenoaddy Al!aoglny llleaH sonss! (SHHO) sao!ruaS uewnH pue 111eaH jo juawlaedao a6ejogouy jo (l!led!o!unw aql mo!jelnd!ls bu!Mollol all qj!m 'swooapaq 1' im, .I uovnsuk!'"l 100433 �p � Op }••, � 0 � ��' P�4�iil l Ayf i J C acf:9� O Al sjuawwoo leuo!j!ppy aol lenoidde leuo!l!puo0 •panoaddes!Q swooapaq aol panoaddy 3unIVNDIS SHHO ale0 ty) � � aanleu6!s s,aaau!6u3 �b NH C1i nA-7 xoO na ssaappd auogd 9pil�N» N� NOS Zia . N wa!A to aweN •uo!joadsui sill jo alep all uo joalla ui suo!jelnl5w pue 'seoueu!pio 'sapoo ajejS pue led!o!unw Ile qj!m aouelldwoo ui s! wals (s lesodslp aajemalseM ao/pue /lddns aalern ails-uo agl 'uolloodsu! pue uo1je61jsanu! (w woal pue sag a6eaogouy to /llledlolunIN all woal pou!elgo uo!lewaolui all uo paseq jell (l!aanaaglanl I -u!aaaq paleolpui ounjonals jo ad (j pue swooapaq jo aagwnu all Aol alenbape pue Ieuo!jounj'ajes s1 wals/s lesodslp aalumalseM jo/pue lddns aalem alis-uo all jell smogs uo!leo!ldde Ienoaddy Al!aogln`d g11e9H sill to uo!je61lsanu1 (w legj AjIJGA I 'molaq umogs ajep uo!lep!Ien all to se pue ojaaag pax!lle leas Aw Aq pa!jpno sy H33NION3 A9 N01103dSNl d0 LN3W31VIS m p7 .5 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST It Legal Description:10r'j 4;n AIJM.A �%Lt y Parcel LD A. WELL DATA COM Ml/nt1:hy JA)A>re-72_ .S/5 -6--M PWS ib Z -14,76b Well type Log present(Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Total depth Cased to Driller Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) m c FROM WELL LOG AT INSPECTION .y.�ry7 o n Date of test 'v n m y Static water level rT1 �> .�- 7 N Well flow g.p.m. 4 T �c Pump level � in m O Z SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate On adjacent lots On adjacent lots Public sewer manhole/cleanout tank Collected by: Other bacteria Date installed lZl fib' Tank size /,7-6-0 6/1"�Lu.J Compartments 1—TV, o Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression (Y/N/I) fQ High water alarm (Y/N) AVA Alarm tested (Y/N) AI)A Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 0 ^t41 On adjacent lots A0 0 t` Foundation i I To property line -t-- Absorption field J& Surface water/drainage /\/0t4o Water main/service line 9 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 SIA "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access(Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA "Pump off' level at Cycles tested Surface water _ a GPp/1rL Date installed �Z ISP&✓fv1DL 5 ��Soil rating Length NO Width Gravel thickness • ®LD SylS. uv1 System type SµA L(o1J I /LrTJt."1 Total absorption area /, 2/0 t=%" Z" Cleanouts present (Y/N) Total depth . v IV— P612 -4,0L Depression over field (Y/N) N Date of adequacy test �`f L� uP (,&Am� Results (pass/fail) 7A SS for / / bedrooms Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Alo t,1 Ce To building foundation On adjacent lots If yes, give date NIA On adjacent lots 1q0 ^i C' Property line Z4f To existing or abandoned system on lot 4A /Vo �.(L Cutbank /VOL Water main/service line 7Sd Surface water AJO ^Jf Driveway, parking/vehicle storage area y�0 Curtain drain Ah, a�--- 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. �j�� XLH X ✓Lf "+ >°uc`.3a`�®�n Signature ¢ C C� f r o 'V p• An S /Y Engineer's Name 1 Ce ,4L-. ,)oo2SOJ r " Date �� f✓, J,acl �. Andr rsun HAA Fee $ ( 101 t _U Waiver Fee: $ — Date of Payment " ?,O r"t 3 Date of Payment Receipt Number / ' S Receipt Number 72-026 (Rev. 3/91)Back MOA 21 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 June 29, 1993 ReMax Properties, Inc. 2600 Cordova, Suite 100 Anchorage, AIS 99503 Attention: Barbara Granger MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION 1993 RECEIVED Subject: Lot 3, Tanaina Valley Subdivision Septic System As -Built Health Authority Approval Certification Dear Ms. Granger: Transmitted is the certified As -Built as well as the Health Authority Approval Certification for the subject property. This information along with the documentation showing the septic tank was pumped within the last year must now be submitted to the Municipality along with $170.00. The submittal location is the Department of Health and Human Services, Division of Onsite Services, 825 "L" Street, Fifth Floor. The Municipality may take up to 14 days to issue the certificate, but have provided much better service in the past. Please advise if you need additional information. Sincerely, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE • Department of 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 l.D.# r7�\-Q�)k--�� HAA# 0qR-Q�iZ), 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L07- 3 7,4AI4IAI.4 VALLr_ y S q T I?- AJ Location (address or directions) L6lA1AELL- 02/VE or=F 2ASpl3�l�Ry (b) Property owner DE5I6US lu IAI60D Telephone: (home) Business 347-8o1y Mailing Address 70Zl O21A- WOOD T=CAcE (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here 81 hold for pick up.) List contact person andday phone number below: PlEASc 0,411 P 5/6W.S IAI fA100O Fat alcleup 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY Number of bedrooms —4 -- 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'] 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.7/881 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/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 41J4L-72SOAJ L v 1A)Laa4nr6 Telephone X37— S.3G 7 Address Date 6. DHHS APPROVAL 130x ZVo7-13 Approved for bedrooms by Approved Disapproved Terms of Conditional Approval Arj w Engineer's Seal Michael E. Anderson s- 4381 - E Date Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze 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. 7/88) Beck Page 2 of 2 DE* MUNICIPALITY OF ANCHORAGE (MOA) fi Health Authority Approval (HAA) MUNICI ANCHORAWHECKLIST - FEBRUARY 1984 1 DEP. EALTH & 343-4744 ENVIRONMENTAL PROTECTION r 51988 Legal Description: 7-AA/A/AIA VAILau DI_U A. WELL DATA RECEIVED Well Classification e6M1n V Al / r'LV If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Cased to Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Date Water Sample Test Results Comments SfEE ATTA c H F-7 B. SEPTIC/HOLDING TANK DATA Date Installed // Z Size f Z !�O No. of Compartments Standpipes (Y/N) y_Air-tight Caps (Y/N) _Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped _MOW ChN 6-.77 Pumping/Maintenance Contact on File (Y/N) tAF_ W C bkiST ; for Holding Tank High -Water Alarm (Y/N) N 1A Temporary Holding Tank Permit (Y/N) A(1,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well P UCD( + To Building Foundation To Property Line y 9 To Disposal Field q 2 To Water Main/Service Line 53 To Stream, Pond, Lake or Major Drainage Course NDN E /AI ft R-- c=,4 Comments S CFrIC T, b4 V IS AAt=C:uA'V- 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata f 1 '1 Type of System Design itil, L�fzA / N Date Installed Length of Field 90 / Width of Field Depth of Field f� Gravel Bed Thickness Square Feet of Absortion Area yoo Statndpipes Present (Y/N) ,/ Depression over Field (Y/N) N Date of Last Adequacy Test � o/ ! o Al157T Results of Last Adequacy Test PA LD SEPARATION DISTANCE FROM ABSORPTION FIELD To Water -Supply Well e9 010' + To Property Line Z8 To Building Foundation z y/ To Existing or Abandoned System on Lot nloX/E eni Lor ; On Adjoining Lots /4/0 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course - To Cutback (if present) MOAJF PZ5E rL/T To Driveway, Parking Area, or Vehicle Storage Area Z Comments AsSoRpnonr F(EGo is AnEyuAre_ Tat STATION Date Inst 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 arid' inspection. � ///� Signed ad, Company 4001.9©/J C_1iG// C7_17"vL ®' Date MOA No. Receipt No. 6 F-3 a C Z"/� / Date of Payment 2r�= _4�_ k Amount: $ /,7 0 72-026 (Rev. 7/88) Back Receipt No Waiver Fee: $ auyc4g4*n effeet'on the date of this a�nvoe vv,� A v° V Ap j „ ayoat.,eea,a.E 0 Engineer's Seal Michael E. Anderson 'v 4307-L f vva ° 0 0 Date of Payment Page 2 of 2 STEVE COWPER, GOVERNOR D\w\EPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3:601 C STREET. SUITE 1334 ANCHORAGE, ALASKA 99503 DATE:-- PWSID #: To ldhom It May Concern: Accordinq to the records on file in this office. the System is in compliance with the State of Alaska Drinkinq Idater Requlations. RSK:sa Sincerely. Ronald S.4;-oin Environmental Field Officer