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Home My WebLink AboutBENBECCA BLK 1 LT 4AOnsite File 77, The 00 fieldtested for a future 5 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241047 Work Type: Septic Upgrade Tax Code Number: 05105266000 Site Legal Address: BENBECCA BLK 1 LT 4A G:1561 Site Mailing Address: 22610 LAKE HILL DR, Chugiak Owner: VAJDOS R DAVID JR & MIA G Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: c n rJ; t)epartrnent 4/11/2024 4/11/2025 40116 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 1-�gBy: J�55uej 1-0 Date: Issued By: Date: Development Services Department 3 P p � � �-» _ Phone 907-343-7904 On -Site Water & Wastewater Section -- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-052-66 Property owner(s) DAVID & MIA VAJDOS C/O ARM SEPTIC SERVICES Day phone 907-688-9433 Mailing address 22610 LAKE HILL DRIVE, CHUGIAK, AK 99567 Site address 22610 LAKE HILL DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) BENBECCA; BLOCK 1, LOT 4A Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade nX (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) E] Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5- 9 S Waiver Fees: Date of Payment: I, / / g`� G y Date of Payment: Receipt Number: Permit No. D.S P Z y (.O y Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc — & i -A -)_ L�p Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241047, Deb Wockenfuss, 04/11/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241047, Deb Wockenfuss, 04/11/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241047, Deb Wockenfuss, 04/11/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241047, Deb Wockenfuss, 04/11/24 / ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. ( ) RECORD DATA PER. PLAT #95-123 FOUND .5" BRASS CAP 0 FOUND 5/8" REBAR, NO CAP EDGE OF ASPHALT E OVERHEAD UTILITIES WOOD FENCE (k� WELL @ UTILITY PEDESTAL pp POWER POLE a SEPTIC PIPE DECD ��P�� OF ' ACo s�v'�I ,t: 49TH � '•.,t (/ ?/Vz -,Ryan G. Johnson No. 192159 o LOT 2A I BLOCK 2 LOT 3A I P LAT '— 8 BLOCK 1 1 L L '). c:! I I LOT 35 �- 556 100' WELL RADIUS I I (N 89'52'55" E 14.701 1.u. Is I Aoo T - f � ,.._ w I - GREEN- t 45.5 HOUSE I , Z 10' T&E ESIVIT. If 28.2' �'� LOT ACxa LOT 4 Q, Y xCA BLOCK 1 PLAT#97— ` PLAT#95-123 I -- 06 RESIDENCE 22.0 4' I .. . ' ,4 I I I LOT 36 co COOP CHICKEN SHED 32.6 _. _ _ -- I PLAT, P— 556 0 140 Pps'E 89' 2'03,14.§9') I} 3I � 30 LOT 11 P LA'T; P — �- LOT 1 PLATP-374 / ASPLS MORTGAGE LOCATION SURVEY NOTES: NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. ( ) RECORD DATA PER. PLAT #95-123 FOUND .5" BRASS CAP 0 FOUND 5/8" REBAR, NO CAP EDGE OF ASPHALT E OVERHEAD UTILITIES WOOD FENCE (k� WELL @ UTILITY PEDESTAL pp POWER POLE a SEPTIC PIPE DECD ��P�� OF ' ACo s�v'�I ,t: 49TH � '•.,t (/ ?/Vz -,Ryan G. Johnson No. 192159 o Municipality of AnchOrage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 %" Street Room 502 P.O. Box 196650 Anchorage. AK 99519-6650 Page of www. ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~O(") ,f~ !'z~ d)j PID Number: (~) Name: l,~[ltr~Cj[_{~ ~i~.}A.~[~ Wastewater System: [~[Uew [] Upgrade Address: ~,L~_~,I {2}[~ (~l~-~'f~.J/'~l '} N~umt~ ~ t~ ABSORPTION FIELD Phone: ~4--~ b~ofB~r~ms:.~ ~DeepTr~ ~ShaYr~Tr~ ~8ed OMound Well: ~ New U Upgrade Grave,d,: ~'~ Ft. N.m,er~es: J Ois~.~be,e~10~Ft'lin"' SEPA~TION DISTANCES ~Sepfic D Holding 0 S.T.E.P. To Septic Abso~Uon Li, Ho,d,ng Publi~dvat, ~C~ Foundation t0"~ (0'+ ~ ~k 'Pump.",evo, a,: ~ BENCH MARK Depa~ment of Health and Human Se~ices app~Wl AS-BUILT SYSTEM DETAILS/SITE PLAN Pe.~i~ swoool4s BENBECCA S/D, LnT 4A, BLBCK 1 PID~O51-O5a-66 /V i K ~D ~".~ ~ · , ~ .'~. /.,'.'., ~, IV _--~ ~ -" ~ . .~1: i SEPTIC i SEPTIC i ~ ! · '/ SCALEI 50' I A-c=2o,6, .-.- .~/,~,,,~ ,~.,,,.,.,~ FINAL GRADE ~ I A-D=23,3' ~- I B-D=3a,4' 3~- ~LO00 GAL ~ / A-E=4a'8' ~ TANK X SEWER RBCK ~ A-F=a6,8'B-E=aB'9' ~ ~ ~ TRENCH1 ~ [ A-G=57,a' ~a.=~~ ~ FINAL GRADE ~ ~im~ ~z ~-G=34.1' ~ ~ v~ A-H=38,4' " ~ B-H=68,8' I x ~ ~ SEWER ~BCK ~, ~ TRENCH a ~ ~ I ~ ........................... ~ ~ PREPARE~ FOR, i DISCOVERY TRAVEL ............. EAGLE RIVER, AK. 99577 SCALE~ NTS B~: SEWARD ~: ~G ~_P~sslO~ ~ SEWARD 7/28/00 EAGLE R~R, AK 99577-8736 /LEANOU' /~MDN[TOR ~U~ FINAL GRADE ~- ~LO00 GAL ~ ~ SEPTIC X ~ by SULLIVAN WATER WELLS P.O. BOX 870272, CHU(31AK, ALASKA $956/' · TELEPHONE OWNER Or ADDRESS .)0 ~00 LEGAL DESCRIPTION T PERMIT NUMBERED 0 t ~ ~ Date of Issue T~ ~NDENTIFIC~TION is well located at approved pe~it location? ~ ~ No Method of Drilling: ~ta~ ~ cable tool Depth ofwell: ~ .... Casing Wpe ~Wall Thickness , ~ ~O inches Diameter ~ // .... inches, depth ~,W3 feet Liner Type: ~ ..... Casing 8tlckup Above ~mund', ~ feet Static Water Level (from ground level): , ,] ~ 5~ . feet Pumping level; feet a~er hm. pumping ~gpm Recover Rate: ~ 3~ gpm Method of Testing: Well Intake Opening ~pe: ~n End ~ Open Hole ~ Screened; Sta~ feet Stopped , feet ~ Perorations Sta~ . . . ~et ~pPed ~feet Depth: from ~ ~eet, to ~ feet Pump Intake Depth: ~eet Pump Sl~ ~p Brand Name Well Disinfected Upon MethodofD~sJn~ct{on;, ~ ~'~.~ ~ ~' . ...... Comments: BORE HOLE DATA ,DO ,~-~, DEPTH Drillers Name t p CFI\/FB Au~ '~ ~ ~000 Municipality ct Anchorage Dept, Health & Human Services ATTENTION: It is the responsibility of the property owner to submit a copy of the well Icg to the proper authority, Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation, MetSu Berough: Department of Environmental Conservation, MUNICIPALITY OP ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jun 06, 2000 Expiration Date: Jun 06, 2001 Permit Number: SW000149 Legal Description: BENBECCA BLK 1 LT 4A Design Engineer: 0070 KND Engineering Owner Name: KND Engineering Owner Address: 20441 Ptarmigan Blvd. Eagle River, AK 99577- Parcel ID: 051-052-66 Site Address: 022610 LAKE HILL DR Lot Size: 40116 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15. a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received Date: ~'~ '"' ~---~ Date: EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 May 18, 2000 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: New sewer & well permit - Benbecca Lot 4A, Block 1 Gentlemen: The owner has requested we proceed forward to obtain a well and septic permit on the subject lot. On May 9, 1994 and May 4, 1999 we dug two separate testholes for the proposed system. The results of these tests are attached. The general slope of this lot is from east to west at a grade of approximately 2 - 7%. We have designed our system utilizing the eastern testhole (TH94-4) we excavated for the 3-bedroom house, which is proposed for this lot. The lot will be served by an individual well. We propose to install a 5' shallow trench. Water was not encountered during the excavation or monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, II~I~ Engineering RECEIVED 23 000 MUNICIPAL/f'/OF ANCHL)KAG~ ¥1RONMENTAL $1:RViC~$ DIVI$I attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Logs/Percolation Tests 6/ELL & VACANT ' VACANT 3A (97-8) WASTEWATER BEN]~ECCA ........... Roes; DISPOSAL gl:D, LOT (95-IE3) 1000 GAL, 18 SYSTEH 4A, 3LnCK DETAILS/SITE 1 PLAN ]RACE ]DR, DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPO 450 GPD/0.6 GPD PER SQ. FT. = 750 SQ. FT (750/(5')) X 0.70(RF) (8.0' GRAVEL) = 105 FT. TRENCH USE 2 TRENCHES 52,5'(L) X 5'(¥/> X 2'(D) Totc~l dep'th o? sys't:em Is 4,0' From origin(it gr0,de, Tot:c~l dep'th oF gr~ivet betow dls't:rlbut;Ion pipe Is 2,0' , NOTES: 1. USE 1000 GALLON SEPTIC TANK, IF REQUIRED. INSULATE TANK IF 44' COVER, 2, INSULATE TRENCHES ~/ITH 2' HD BURIAL FRAM.. 3, CONTRACTOR WILL ENSURE MAXIMUM BZ SLOPE INTO SEPTIC TANK. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TB ACHIEVE MIN. 3' COVER IF REQUIRED, 5. CONTRACTOR TD EXCAVATE TANK AND VERIFY INTEGRITY. PREPARED FOR: LINDA FRANK DISCOVERY TRAVEL 11481 OLD GLENN H~Y SUITE 108 EAGLE RIVER, AK. 99577 36 // 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 t907)696-61I~/FAX ACAD FILE 00012A.DW~ A~UIL~ SEWARD ~lNm SEWARD 8~ND~Y:SEWARD RELDBOOKS 00012 OA'm 05/11/00 ~' NW1561 DP, A~N: JAS ~;~D: KMD Sc(ite: 1'= i00' SHEET 1/8 WASTEWATER DISPOSAL SYSTEM ]DETAILS BENBECCA S/D, LOT 4A, BLOCK ! \ / t , .;':' . ...O-.. :','. ~:...'' ' -'/~~~~Z :- T E R ~ ~'~ ~,~,. ....... ~ ......... ~ ~. LIN~A FRANK ~, ...;~ ~ ~ISCDVERY TRAVEL SCQ[e: 1'= ~0' ' · ~ SUITE me SHEET ~/~ FIE~ BOOKS ~Pu~: ENGINEERING ................ ~ ~SSU,LT: SEWARD D*~ 05/11/00 EAG~ R~R, ~ 99577-8736 ~o~ D~. ~ m~D: NW1561 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: · c~ .~ O0012A.DW' ;~ "~': 00012 (907)896-6ttl/FA (907)698-Sttt ~D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Kenneth M. CE 7116 Performed for: Linda Frank Date Performed: Benbecca Lot 4A, Block 1 TEST HOLE 4/ 99-1 2- 3- 4- 5- 6- 7- 8- 9- 10- 12- 13- 16- 18- Depth (Feet) Org- brown SM - med dense, sandy trace of silt Silt & density increasing with depth ML B.O.H. HOLE PRESOAKED PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 5/12/99 Reading Date Gross Net Depth to Net Time Time Water Drop 1 5/4/99 2:00 7" 2 2:30 30min 412/16" 2 4/16" 3 * 2:31 7' 4 3:01 30 rain 4 12/16" 2 4/16" 5 * 3:02 7" 6 3:32 30 mtn 4 12/16' 2 4/16" · Water Added 19- 20- Percolation Rate 12.97 (rain/in) Perc Hole Diameter 6" Test Run Between 2 feet and 3 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelh~es in effect on this date. Munlcipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Bonnie King PERFORMED FOR: LEGAL DESCRIPTION: Prop o .TJX. 4 · BiRo Benbecca S/D i Township, Range, Section: SLOPE ~oL£ E L£ V. 7 8 9 10 11- 12- 13- 14 15 16 17, 18- 19- 20- COMMENTS Hole presoaked. SITE PLAN WAS GROUND WATER ENCOUNTERED;' IF YES, AT WHAT DEPTH? Monl~lng? No/V~ Dale: Reading Date Start i 5./9/c~4 2 4 7 Drop Gross Net Depth to Time Time Water 1055 -- 4 3/4 11oo 5 5 ll05 5 5 5/8 1105 -- *5 111n 5 5 3/8 1115 5 5 7/16 1120 5 6 1120 -- *5 ]125 5 5 3./g 1130 5 5 3/4 I~,~ (m,nutes~mch) PERC HOLE DIAMETER 1/2 3/8 3/8 -- 1/16 5116 3./R *Add ware] 3/8 PERCOLATION RATE ~ 1, TEST RUN BETWEEN 2 FT AND ~ FT PERFORMED BY: ~O / ..I~ID I .~.e. rmetJL_DH ffus _ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MIJN!CIPAL GUIDELINES IN EFFECT ON TFIIS DATE DATE: ~.~,~..q-,L9~L GE~IER~ INFORMATION'~ 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 995'19-6650 www.ci.anchorage.ak.us · "," ' :': ~R?Y Ai~PROvAL. CERTIFICATE~ OF-HEALTH :AUTH, FOR A SINGLE FAMILY DWELLING ' '- ' "-.,-' . · .~. ~: . .~uS- -~ ~,,:: ',' ~. .; Expiration D~te: 'ess' ' ' -~ ""-";""iL?;'.:':" .... ':~ ' "' Real Estate Agent Day phone ' ' ' ' Mailing Address .:~ _,. ~.~'i : . ~'~n/es~'athert/vise requested, HAA wi//~-e held by DHHs for pickup.: HAA picked up ;-" , '."'- '?- ' . ~ ' ' ., .--, / '-. ::i:,3;':~EoF'~V~,T~RSUPPLY:'- ''"" ' :-' :' :~E:0FWASf~ATERDiSP~AE? .:<'- -..-Individual Well ...... ,' ,:~ . ~ '~: :..:.,{ IndiVidual On-site ,' ~'~--' ::~':- ' :",~ ~ ~ ' --~, · : ~,lnd- ,-..-.-..:.vidUal Water storag; ~ ' :' r - I: ' - IndiVidual Holding tahk', ~ msun, ,a %- ' ~" ~: .~Well ". -~ '-~ .' Co~mun~:OnZsite' "2' ' ':~'~ '- Public Wat~'System ?;'-~ .... : -" ~ . Pubhc Sewer · ,.t~, .:~,, ._~. ~ .... ' ~,x-~ - The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Realth Authority Approval (HAA) based onty upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 [ess than 30 days old, 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. (Rev, 11/99) 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further veri~ that based on the information obtained from the Municipality of Anchorage files and fi'om m.y investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations n effect at the time of installation Name of Firm KND Engineering Phone 696-6111. Address 204410Ptarmiban':Eaole River. AK 99577 Engineer's Printed Name K~netrh Dl~ffUS bedrooms. 6, DHHS SIGNATURE . /-~. Approved for -,~ Disappi'oved. C0nditional approval for Date. 8/11/00 , ,,.. KenneiI1 [~. D~ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:. Reissue DateL Legal Description: A. WELL DATA Well type Private Date completed Total depth 243 Dat~ of test Static water level I 8 Well production 2 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Date of sample: 8/9/2000 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel I~CL.E! V EL~ Municipality of Anchorage. AU6 1_4 200{} ~ Department of Health and Human Services ~ Division of Environme,n,t,a,l Services Nt~JNtCIPALIT¥ O[' ANCHOEAGE~ On-Site Services Section 825 L Street Roor~'~0~[ONMENTALSEI~ViCESDIVI$1'%,~_~J~ P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Benbecca B1L4a IfA, B, or C provide PWSID # __ 6/6/2000 Sanitary seal Y ft Cased to 243 ft FROM WELL LOG 6/6/2000 ff g.p.m Parcel I.D.: Well Log ~ Wires properly protected Y Casing height (above ground) 24 AT iNSPECTION in. Nitrate . 0.5 mg/I Other bacteria 0 colonies/100 mi Collected by: KND Enqineerinq Date installed 6/30/2000 Tanksize Cleanouts Y Foundation cleanout Y Date of pumping Pumper c. ABSORPTION FIELD DATA Date installed ~1) 10O Soil rating (g.p.d.lf~ or ~/bdrm) 0.6 Length 54.5 ea. ft Width 5 ea. Total depth 4.95 ft Effective absorption area 750 ft2 Date of adequacy test Results (Pass/Fail) Fluid depth in absorption field before test __ in Elapsed Time: __ min Final fluid depth __ Any rejuvenation treatment (past 12 mo.) (WN & type) (Rev. 11/99) 1,000 gal Number of Compartments2 Depression over tank _N High water alarm NA P Water added in System type Shallow Trench ft Gravel below pipe 2.04/2.09 ft Monitoring tube '1' Depression over field N For ~3 bedrooms __ gal. New depth in. Absorption rate >= __ g.p.d. If yes, give date D, LIFT STATION Date installed / Size in gallons ~ "Pump on~ in "Pump off"le~-'~'~ in E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 100'+ Sewer/septic service line 100'+ Manhole/Access High w_a~el at__ in .,Jvi~CEt~;rnr & circuit requirements? Building foundation 10'+ Water main 25'+ Drainage 100'+ 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line I 0 ' +_ Absorption field Water service line 2 5 ' + Surface water Werls on adjacent lots 1 0 0 ' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water Service line 10'+ Building foundation 10 ' + Surface water I 00 ' + Curtain drain None known Wells on adjacent lots 100'+ F, COMMENTS G. ENGINEER'S CERTIFICATION 10'+ 100'+ I 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. Water main 10'+ Driveway, parking/vehicle storage I 0 ' + Engineer's Printedl~ame Kenneth M. Duffus Date ~.~,~'"~ HAA Fee $ J,¢-~ Date of Payment Receipt Number (Rev. 11/99} Waiver Fee $ Date of Payment Receipt Number