HomeMy WebLinkAboutDEARMOUN #2 BLK 1 LT 1DeArmoun #2
Lot 1
Block 1
#018-401-29
Municipality of Anchorage Page 1 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: SW000347 PID Number: 018-401-29
Name:
Wastewater System: ❑ New ■ Upgrade
KAREN BLAIR
Address:
3601 MATTHEWS DRIVE ANCHORAGE, AK 99516
ABSORPTION FIELD
Phone:
(907) 345-9064
No. of Bedrooms:
1
❑Deep Trench ■Shallow Trench ❑Bed El Mound El Other
Soil Rating:
Total Depth from original grade:
LEGAL DESCRIPTION
1.0 GPD/Sq. FL
*1.83-2.02 Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
1 1 DeARMOUN #2
0.83-1.02 FL
0.5
Township:
Range:
—
Section: —
Fill added above original grade:
Gravel length:
30
—
1.34-1.53 Ft.
F.
Gravel width:
Number of line.:
Distance between lines:
WELL: ❑ New ❑ Upgrade
5.0 e,
1
— Ft.
Classification (Private, AS,C):
Total D.
Cased To:
Total absorption area:
150
Pipe matedal:
ASTM D-3034/F-81 o
FL
Fc
SQ. Ft.
Driller. NG
Date Drilled:
Static Water level:
Ft
Installer.
A+ HOME SERVICES
Date installed:
9/5-6/2000
Yield:
Pump Set AL•
Cooing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
■ septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public PLn is
Manufacturer.
ANCHORAGE TANK
Capacity In gallons:
1000
From
Tank
Field
Station
Tank
sewer Ines
Well
a00'+
0100.+
—
—
25'+
Material:
STEEL
Number of compartments:
2
Surface
100'+
100'+
-
-
-
LIFT STATION
Water
Lot
Sze In gallons:
Manufacturer.
5�+
10'+
—
—
—
N
Line
'Pump on' level at
Pump off oU
High water alarm at:
Foundation
5'+
10.+
—
—
—
Curtain
Pump Make s:
Electrical Inspections performed br.
Drain
NONE KNOWN
BENCH MARK
Remarks: *ADDED 0.5 FEET OF M.O.A. APPROVED
laca5on cad Description:
LEVELING SAND.
TOP OF FRONT PORCH
Assumed Elevation:
100.00
F,.
ENGINEER'S SEAL
o6c>o>pp
OF
.A 000
coo ��
.. '
Inspections performed by: AWWC, INC. Dates: 1st 9/5/2000
P
........ ..... ....
2nd 9/6/2000
Q ',J ff Garn
OQ P
Department of Health and Human Services approval
C 953
p401c
Reviewed and approved by: Date: i 3'7- o
��Op°Profasetoo°oma
72-013 (Rev. 9/91) Mao 25
PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
_
SW000347 018-401-29
NEW DRAINFIELD %0 CO2
/
/ /
INSTALLED FLOW
C01�v MT7 DIVERTER (FD)
' DBL2
DBL1
C05 NEW 1000 GALLON
SEPTIC TANK
EXISTING DRAINFIELD
USED AS A RESERVE SITE ry
C040
�1 C B
d g'
EXISTING ONE '4,
d
BEDROOM HOUSE < .d 4
CO3 FCO
A
EXISTING SEPTIC TANK
COMPLETELY ABANDONED
IL— — — — — — — — — — — — — — — — — — — — —
10' UTILITY EASEMENT
DE ARMOUN ROAD
ALASKA WATER & WASTEWATER
CONSULTANTS, INC .
4
�=�
.ori nondoo Donn cmrF 9F • ANCHOBAGF. AK 99504' PHONE (907)337-6179' FAX (907)338-324
9/19/2000
DRAWN BY:
C.J.G.
1 " = 20• I pAt"""
PREPARED FOR: PHUNt NUMHtK:
KAREN BLAIR (907) 345-9064 2 OF 3
LEGAL DESCRIPTION:
DE ARMOUN SUBDIVISION #2; LOT 1, BLOCK 1
TYPE OF WORK:
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
Ld
K
0
V)
Q
Z
PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER:
SW000347 018-401-29
IN5LUAT10H
fm a fmK -
Af INI Ef - 9598
INVERT OP DLNG
AT INLET - 95.93
ORIGINAL 6M - 95.29-95.96
IN& GRADE - 98.0+
511 5f2
n n
NSW 1000 6&U ON
5MC TANK
6OffOM OF TRENCH
93.99(AVGJ-
ALASKA WATER & WASTEWATER
CONSULTANTS, INC. CoQ' __ °°•
6901 DEBARR ROAD. SUITE 28 • ANCHORAGE, M 99504 • PHONE (907)337-6179 • FAX (907)338524
PREPARED FOR: PHONE NUMBER:
KAREN BLAIR (907) 345-9064
(LEGAL DESCRIPTION:
DEARMOUN SUBDIVISION #2; LOT 1, BLOCK 1,
TYPE OF WORK:
PROFILE AS -BUILT OF SEPTIC SYSTEM UPGRADE
fOP a TANK
AT OLnFf - 9599
INV�Rf OF PIPE
AfOM1 f-95.19
GP.ADE - 96.8+
l )v S u w,J'tla,J
`- INVERT OP PIPE
a 99,99 (AVGJ
- fOP OF 5AN9
9399(AVGJ
y/s/w
9/19/00
"'OF
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S�oOo
AWN BY: �����
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ALE:
N.T.S.
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.......:.
GE NUMBER:o.
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3 OF 3
�O P —7953
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MUNICIPALITY OF 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
Upgrade
Permit Number: SW000347
Date Issued: Aug 31, 2000
Expiration Date: Aug 31, 2001
Parcel ID: 018-401-29
Legal Description: De Armoun #2, Lot 1, Block 1
Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 3601 DeArmoun Rd.
Owner Name: Karen Blair Lot Size: 16788 SQ. FT.
Owner Address: 3601 Matthews Dr. Total Bedrooms: 1 Permit Bedrooms: 1
Anchorage , AK 99516 -
This permit is for the construction of:
Z Disposal Field M✓ Septic Tank Holding Tank ❑ Privy ❑ Private Well El 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 By:
Issued By:
Date:
Date: Ll - 3 � --/ '
ALASKA WATER F_� WASTEWATER
CONSULTANTS. INC.
August 22, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Upgrade Design for De Armoun #2 Subdivision; Lot 1, Block 1
To whom it may concern:
The existing one bedroom house is currently served by a community well and a private septic
system. The existing drainfield is in a state of failure and is in need of an upgrade prior to the
sale of the house. One test hole was excavated on the property north of the existing septic
system. The proposed septic system will be designed within this 30 foot radius. We are
proposing that a 1000 gallon septic tank and a five foot wide drainfield be installed. Comments
regarding the proposed design are summarized as follows:
1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and
the percolation test results. The soils below the organic layers are a SW/GW material to a depth
of 4.5 feet and then transistions to a SM/ML material to a depth of 7 feet (bottom of test hole).
Groundwater was encountered during the excavation of the test hole at 6 feet. Seven days later
the groundwater level had dropped to 6.5 feet below grade. A percolation test for this test hole
was performed between the depths of 2.0 feet to 2.5 feet which had a percolation rate of <1
minute/inch. It is our opinion that insitu sandy soils should act as a sand filter and an application
rate of 1.2 gallons/day/82 should be used.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.0 gallons/day/ft2
c. Number of Bedrooms: 1
d. Design Flow: 150 gallons per day
e. Minimum Absorption Area: 150 ft2
f Total Depth: 2 feet (max.)
g. Leveling Sand: 1 foot
h. Effective Depth: 0.5 feet
i. Width: 5 feet
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
j. Reduction Factor: 1
k. Minimum Length: 30 feet long
1 Effective absorption area = 150 ft2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: This property is generally flat; in short, there are no slope concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179, or 244-9612. Thank you for
your assistance. 4
P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, and a 7 page
construction specification letter which are all part of the design package for this septic system.
6901 Debair Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
DE ARMOUN ROAD
DEITZ S/D
LOT 7A,
I i
I I I
DE ARMOUN S/D #2
I I
l
I
i
I (
I i i
I LOT 4, BLOCK 2,
I
I
I
i I I
I I
i
I 1
I
--
I
LOT 4, BLOCK 2, (
1
I I j
pE ARMOUN S/D #2
I I I
I I
I LOT 3, BLOCK 2,
#
i
I
wl
>
I
E I I
IDE
I SERVED BY
ARMOUN S/D #2
�)
# I I
(COMMUNITY WELL
LOT 3, BLOCK 2, 1
(n (
# i I
# I
1
3
w 1
1
¢E ARMOUN S/D #2
€ I
LOT 2, BLOCK 1,
-SERVED BY
# #
#
#[SEPTIC
�) DE ARMOUN S/D #21
COMMUNITY WELL
ARE�D
i LOT 2, BLOCK 2,
jTRACT CiB # I
PROPOSED
I
i
I
(Z -►A I I
WACA�
i
SEPTIC SYSTEM .�SEPTIC
SEE DESIGN AREA I
i i
,
i
PAGE 2 OF 2. `�
1
TH
I i j
I
ARI
i OMMUNITY WELL
I I I
I
I DE ARMOUN S/D #21
LOT 1, BLOCK 2, 1
1
I
L---------
L --------
EXISTING SEPTIC
SYSTEM
EXISTING
ONE
BEDROOM
HOUSE
DEITZ S/D
LOT 6,
DEITZ S/D I
LOT 7B, FIELD VERIFY i
NO CONCERN
8/22/00
ALASKA WATER & WASTEWATER K.D.W. v
CONSULTANTS, INC. _ m SCALE; 4
A ,r : - fc
6901 DEBARR ROAD. SUITE 2B • ANCHORAGE, AK 99504' PHONE (907)337-6179' FAX (907)338-3246
1" = 100' %....... ..... .....
PREPARED FOR PHONE NUMBER: PAGE NUMBER:
KAREN BLAIR (907) 345-9064 1 OF 2 f e arness•-
LEGAL DESCRIPTION: o C 7953
DE ARMOUN SUBDIVISION #2; LOT 1, BLOCK 1,+119610^• c�Lca
TYPE OF WORK: 'Itrof S ,V'VPaprofes(o�o��-=�
SITE PLAN OF SEPTIC SYSTEM UPGRADE '
BEDROOM HOUSE n: Q.
4� a.
i e Q
INSTALL FOUNDATION CLEANOUT IF
EXISTING SEPTIC TANK ABSENT AND RAISE PLUMBING IN THE
TO BE COMPLETELY CRAWL SPACE AS NECESSARY TO OBTAIN
ABANDONED GRAVITY FLOW TO THE NEW TRENCH.
PROPOSED 1000
GALLON SEPTIC TANK
— _ ____ ,_,__ — _
10' UTILITY EASEMENT
DE ARMOUN ROAD
p
ALASIZA WATER & WASTEWATER
CONSULTANTS INC SCALE
.. �....... ....... n re nn. u no�co nr nn[m ounu[ loMlii] AI]O i FAY 1011]liiN39Lfi 1':' - 20
PARED FOR: PHUNE NUMtltlt: rnuc n�mo¢n. W/�Y/
KAREN BLAIR (907) 345-9064 2 OF 2
\L DESCRIPTION:oA y, ' •, 7953
DE ARMOUN SUBDIVISION #2; LOT 1, BLOCK 1 ppOfe ' ••.• OF coo
WORK: OF SEPTIC SYSTEM UPGRADE �"�pr
I;2 ��
DESIGNo�o
i
i
i
PROPOSED DRAINFIELD. EXCAVATE A
TRENCH THAT IS 2 FEET DEEP
MAXIMUM WITH 1 FOOT OF LEVELING
MTo SAND, BY 5 FEET WIDE, BY 30 FEET
SCO
LONG. ADD 0.5 FEET OF CLEAN,
/ WASHED SEWER DRAINROCK.
<O / 7H#1
CO v/MT
f
INSTALL FLOW
DWERTER
INSTALL DOUBLE
EXISTING DRAINRELD CLEANOUTS
TO BE USED AS A
RESERVE SITE. 0
O 0 a
CO
O EXISTING ONE
BEDROOM HOUSE n: Q.
4� a.
i e Q
INSTALL FOUNDATION CLEANOUT IF
EXISTING SEPTIC TANK ABSENT AND RAISE PLUMBING IN THE
TO BE COMPLETELY CRAWL SPACE AS NECESSARY TO OBTAIN
ABANDONED GRAVITY FLOW TO THE NEW TRENCH.
PROPOSED 1000
GALLON SEPTIC TANK
— _ ____ ,_,__ — _
10' UTILITY EASEMENT
DE ARMOUN ROAD
p
ALASIZA WATER & WASTEWATER
CONSULTANTS INC SCALE
.. �....... ....... n re nn. u no�co nr nn[m ounu[ loMlii] AI]O i FAY 1011]liiN39Lfi 1':' - 20
PARED FOR: PHUNE NUMtltlt: rnuc n�mo¢n. W/�Y/
KAREN BLAIR (907) 345-9064 2 OF 2
\L DESCRIPTION:oA y, ' •, 7953
DE ARMOUN SUBDIVISION #2; LOT 1, BLOCK 1 ppOfe ' ••.• OF coo
WORK: OF SEPTIC SYSTEM UPGRADE �"�pr
I;2 ��
DESIGNo�o
00004
ALASKA WATER & WASTEWATER CONSULTANTS, INC. oa�OF Opp
6901 DEBARR ROAD, SURE 2B *ANCHORAGE, AK. 99504 0 ..
PHONE (907) 337-6179 * FAX (907) 338-3246
ISOIL O COT
LEGAL DESCRIPTION: ERMOUN SUBDIVISION #2;
OT 1, BLOCK 1, �.... :. • • •H • •"••.....
PERFORMED FOR: KAREN BLAIR •• ••• •••••�
J fr A. Gar ss
DATE PERFORMED: 8/8/00 @ —7953 mp0
.•' �c�0
DEPTH TEST HOLE #1 ��ae'' .......•
(feet) 4 aProfessio�oa�
ORGANICS pOp���000p
1 _ _
2 5;.~ SOIL CLASSIFICATIONS
GW ORG 3
GP
SW/GW ML
GM CL € f €
prp € w
a �a GC OL € i >_
r . Dq o opo SW MH € j o
5 SM/ML ' mea a SP CH j I +71 31
GROUNDWAI SM ! ! ! OH I I I W
6 Sc El
7 DEPTH TO I i I
DATE
B.O.H. GROUNDWATER
$ 6.0' 8/8/00
6.5' 8/16/00 DeARMOUN ROAD
9-
1011 10-
11
12
13
14
15
16
17
18
19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20 TEST RUN BETWEEN 2.0 FT. AND 2.5 FT.
COMMENTS: PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING.
PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERFOR ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
DATE: W 2 0
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
8/8/00
PgSO�Pp
MUNICIPALITY OF ANCHORAGE
1„ DEISTMENT OF HEALTH AND HUMAN $EROS
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
1216
DISTANCES
TO
FROM
SEPTIC
•
ABSORPTION
FIELD
WELL
Address - -
I 1 W
Phone(s) Permit Na. No. of Bedrooms
WELL C
,(1N /1T,A/NK
%�Fz
},
r ,E.0
xr �
LOT LINE
jr
- LEGAL DESCRIPTION
Lot
Block
Subdivision PF140 UN PX
FOUNDATION
Township, Range, Section
f3
AS -BUILT. DIAGRAM
driveway, water bodies.
(Shaw location of well.
etc.)
septic system, property
lines, foundation.
TANKS
xSEPTIC ❑ HOLDING
ler _
Capacity in gallons
���y
Material
T
No. of Compartments
oD
TYPE OF SYSTEM
❑ TRENCH ❑ BED W. DRAIN ❑ OTHER
Depth to pipe bottom from
original grade
FT
Total depth from original grade -
J..5 FT
.+
fV
Fill added above original grade
"16subAn, FT
Gravel depth beneath pipe
Qo FT
Gravel length -
FTj�
Gravel width -
� FT
Total absorption area
/-5D SQ FT
Distance between lines
FT
�'
,f7
O
Yl
Number of lines
/
Soil rating
/3D SQ FT
Pipe material
licca s% 26®3ti 17g/0
Installer
Q
Da1fI Ls ed p
/L/ O P
WELLS
❑ PRIVATE ❑ OTHER fldentifvl
Classification (A,B,C)
Total Depth
Cased,IpT:h
Installer
Date Installed: y
REMARKS:
-
Scale:a
Inspection_
s Permed
t
by:
* 4
•, ', ,.Y
a: 0. 2225-E
'Q 1UNE125, 4971
-
Date:
�Z
J
ICT/��
I certify that this inspection was purloined according to all
q
Municipal and Slate gui elines in effect on this date:
Health Department Approval: Date: l -Is"
72-013 (3/85) V
P-1 kJ P4 1 (0 T I -I- ne C3 F= lN P4
` . DEPARTMENT�� HEALTH AND ENVIRONMENTAL�@�����
OTECTION
025 L STREET, ANCHORAGE, AK 99501
264`4720
' C3 PA __ E3 I _T_ F-_ E3 E= hJ E= FT FwE=FRVI "r _r
PERMIT NO: 860394 ENGINEERED,DESIGN / �L_
� ,
' =-�� 4_
DATE rSSUED: 10/21/86
APPLICANT: BRIG MORGAN
ADDRESS- 3611 MATTHEW
ANCHORAGE, AK 99516
LEGAL DESCRIP: SUBDIVISION: DEARMDUN LOT: 1 BLOCK: 1
SECTIDN: 28 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 16975 (SQ.FT. OR ACRES)
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2. I will install the system in accordance with all MOA codes and regulations,.
and in compliance with the design criteria of this permit,
3^ I will adhere to -all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MDA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPFCTIONREPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNEDDATE:
&�
--�*^-- ------------.-
-���------����--
APPLICANT:
BRIG MORGA�
ISSUED BY
�
ENGINEER'S SEAL)
• 0unicipalily of Anchorage • 7 t
DEPARTMENT OF HEALTH 8 HUMAN SERVICESOW
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
N I. '
.,a•, JUS.,, ?`.. i>.t
PERFORMED FOR: +t� .n'�l
3i21G Mo2GAt.1 DATE PERF( RMED�.`'..' irif8rj '
LEGAL DESCRIPTION:__Lo-r I t S14 ( ,&A,...Pur'1rfownshlp, Range, Section: '(` j �,N 31,�jk ,s _ Z"
Fffwr.n�
SLOPE SITE LAN
Ij II `�F•�7 �Y rY 1C.�
2
4 SANAy Sf I_T/
5
S f I_TY SAc N D
6
7
8
9
10
11
12
13 �-
. A�
may.
14 A*•9
16-
17-
18-
19-
20-
COMMENTS
6 17 181920COMMENTS _
5.S
:e- a, A A�
rplp.ic
,—OF A1( Xkk'
ffd
M .:
o. 2225-
J
1NE 25. 197147
WAS GROUND WATER , r�
ENCOUNTERED?
S
IF YES, AT WHAT L
DEPTH? O
P
E
Oeplh to Water Aherw� n p
Monitoring? _ O lata: j 9 l7 0
I
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMED BY: k,I _
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN
72-008 (Rev. 4/85)
CERTIFY THAT TWIS TESTAS PERFORMED IN
ON THIS DATE. ATE: (a 47y a/
j40T 4
� i I
/OT 1
Ij
r 1�c••s•••7•"IJ
�sy'�P: 'y '•;1
i *• 49TH,
�• N . 5
222-E
J NE 25.1971
/of38E/�' �ov_K+,4ND
0203
u�i 1 5 �� �7 °C " � i U
SSG B T/o2/
4/v(H /}!� X950 / � %� � I✓/
I
((�y
Jam- ro Po5e.e, I bCclroa
i
z
Q
O�AL TANK
nT
isreKo 2�loC
k-
1/550 > 5 75 0 Ftp
Io'-PO;bE2t-INE
F-ASEaTT.
Ij
r 1�c••s•••7•"IJ
�sy'�P: 'y '•;1
i *• 49TH,
�• N . 5
222-E
J NE 25.1971
/of38E/�' �ov_K+,4ND
0203
u�i 1 5 �� �7 °C " � i U
SSG B T/o2/
4/v(H /}!� X950 / � %� � I✓/
Municipality of Anchorage µ `�
On -Site Water and Wastewater Program a=�
(907) 343-7904 s
Certificate of On -Site Systems Approval
Parcel I.D. 018-401-29
1. GENERAL INFORMATION:
Expiration Date:
Complete legal description DEARMOUN #2; BLOCK 1, LOT I
Location (site address) 3601 Matthews Drive *Anchorage 99516
Current Property owner(s) Greg Matthews Day phone 802-7092
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
V] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
Individual Water Storage ❑
Holding Tank
❑
Community Class Well
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 $ 5-50
Waiver Fee $
Date of Payment 617-5/Z I
11
Date of Payment
Receipt Number 06 2 Z % G
Receipt Number
COSA # O s C 21 1,5,-)-3
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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: ;6) -Zi
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the .system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. .These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
_ System #1 Approved for 21 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
w
bedrooms
bedrooms, with the foll
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#AECC884
�V\TY OFr(
g ON-SITE
WATER AND
't., sWAO ns,ATER z^
�� PROGRAM
9 "v/_ SERV \U"- ,,�`
Original Certificate Date: / Z -2-1
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
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other S-�-a
c
9 e
COSA Checklist
Legal Description: DEARMOUN #2; BLOCK 1, LOT 1 Parcel ID: 018-401-29
If more than ; septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Adequacy test date 8/21/21
❑ Well log is filed with Onsite (or attached)
Well production at time of test gpm
Date drilled
Water storage tank volume gallons
Total depth ft
Well disinfected for coliform test? ❑ Yes F No
Cased to ft
❑ Coliform bacteria is Negative
F,I Sanitary seal is functioning correctly
Nitrate mg/L ❑ Nitrate less than [VIRL (ND)
❑ Wires are properly protected
Arsenic ug/L ❑ Arsenic less than INIRL (ND)
Casing height (above ground) in.
Collected by
Date of flow test for COSA
Date of Sample
Static water level at beginning of test ft.
Any rejuvenation treatment (past 12 months) NONE
Comments CLASS "A' COMMUNITY WELL PWSID #211936
B. TANK DA" A C. LIFT STATION
Age of tank(s) 21 years ❑ Required maintenance completed
Tani: type/material 'EPI-STEE Age of lift station years
Measured operating fluid level in septic tank 51 Lift station material
j Standpipes/foundation cleanout per record drawing Comments: N/A
Date of puiTtping 4/23/21
D. ABSORPTION] FIELD DATA SHALLOW TRENCH
V11hich system tested (date installed) 976/00
Adequacy test date 8/21/21
® ALL standpipes present per record drawing
Results ❑Pass For 2 bedrooms
Total measured depth from grade 3.5 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 2.66 ft (min)
Water added 396 gal
❑ N/A — pressurized field
New depth 3 in
FIN Ivionitor tubes go to bottom of effective. If not, state
255
depth into effective
Elapsed time min
EMI Code -required soil cover over field
Final fluid depth 0 in
❑i System presoaked
Absorption rate 300+ 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 alloys
If yes, enter date N/A
Comm ents/Deficlencle :TESTED 2000 TRENCH ONLY- 1986 TRENCH HAS 3- LIQUID
COSA Checklist yellow sheet
GV
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community we
Septic Tank/Lift Station on Lot > 100'
❑✓
Yes
Community Sewer Manhole/Cleanout > '100'
❑ Yes
if No
ft
❑ Yes
if No
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' ❑ Yes
if No
❑ Yes
if No
ft
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes
if No
ft
❑ Yes
if No
From Septic/l folding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No *5V+ ft Surface Water > 100'
ft
I t
ft
ft
ft
❑2 Yes if No ft
Property Line > 5'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
R✓
Yes
if No
ft
Private Wells > 100' Q Yes if No
Water Main > 10'
✓❑
Yes
if No
ft
Community Wells > 200'✓❑ Yes if No
«dater 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'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓❑
Yes
if No
ft
Private Wells > 100' j] Yes if No
Water Service Line > 10'
0
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No
Surface Water > 100'✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME
OF
INSTALL
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with Ci Al- n H .--'7'
f0OA COSA guidelines in effect on this date. :` .... . l `
Jeff '
ey IGarnr s
Cr N CE i 953
�7r19. I/
l�Sf�r G��i )Z{••. r
COSA Checklist yellow sheet
ofess `"�
#AECC884
ft
ft
ft
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
907-343-7904
On -Site Water and Wastewater Section rt
Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 211513
Subdivision: Dearmoun #2 Block 1 Lot 1
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 21 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
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GACFP.APNTC nP RFC ORD. OTHER THAN
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AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspect
of the following described property: Lo -r f $�r_g. i
�5_ aRmovr•J '1_,.3niyr!5ioe,r /J o. 2 -
Anchorage
Anchorage Recording Precinct, Alaska, and that
improvements situated thereon are within the property lines
do not overlap or encroach on the property lying adjac
thereto, 'that, no improvements on property lying adjacent ther
encroach on the premises in question and that there are
roadways, transmission lines or other visible easements on E
property except as indicated hereon.
Dated at Anchorage, Alaska
—t:=-.; u
this 5 day of 20 _L
FRED VN/ALATKA & ASSOCIAI
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E, E A R I -A--', U [A R. E,
Parcel I.D. 018-401-29
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904 s P
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: -7— 15 —
Complete legal description Dearmoun #2, Block 1, Lot 1
Location (site address) 3601 Matthews Dr.
Current Property owner(s) Lisa Wiley Day phone
Mailing address 3601 Matthews Dr. Anchorage, AK 99516
Real Estate Agent
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class 'A' Well
Public Water System
WaiverNariance
Day phone
2
TYPE
❑
Individual
0
❑
Holding Tank
❑
[K]
Community
❑
LJ
Public Sewer
❑
Received by: LA� Date:
COSA to be released to th a gineer, unless otherwise requested by the engineer.
COSA Fee $ 52-6, '
Date of Payment 3i/�
Receipt Number
COSA #_ CSC !�f 133
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 Pannone Engineering Services LLC
Phone (907)272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
72014
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: 'S o
Thenici aif o 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet ( c
If more than 1 septic system is on the lot:
COSA Checklist # 1 of
Structure served by this system I
Certificate of On -Site Systems Approval Checklist
Legal Description: Dearmoun #2, Block 1, Lot 1 Parcel ID: 018-401-29
A. WELL DATA
Well type Class 'A' If A, B, or C provide PWSID # 211936 Well Log (Y/N)
Date completed Sanitary seal (YIN) _ 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
Tank size 1,000 gal. Number of Compartments 2
Date installed 9/6/2000
Cleanouts (Y/N)
Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping ��j Cr 1 `� Pumper A/c yPr GP
C. ABSORPTION FIELD DATA
10/28186 - 916MO P P 1111R -II I I Shallow Trench
Date installed Soil rating (g.p.d./ft or ft/bdrm) System type
Length 30 - 30 ft. Width 5 - 5 ft. Gravel below pipe 0.5 - 0.5 ft
Total depth 2.2-2.8 ft. Eff. absorption area 300 ft Monitoring tube Y Depression over field N
Date of adequacy test 7/18/2014 Results (Pass/Fail) PASS For 2 bedrooms
Fluid depth in absorption field before test 0 - 12 in. Water added 346 gal. New depth 1 - 12 in.
Elapsed Time: 70 min. Final fluid depth 0 - 12 in. Absorption rate >= 300+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot_
Public sewer main
Size in gallons _
"Pump off"level at
Cycles tested _
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
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 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 200+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 200+
F. COMMENTS
Fields covered with insulation
G. ENGINEER'S CERTIFICATION
/ certify that I 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.
Engineer's Printed Name Steven R. Pannone
Date 7L22?2014
-t-q
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
11
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C TE I have reviewed the as -built sur oy anti it,%ppws to be a true and accurate copy
oaf tht survcy for the ze to rhe test of my knc knowledge,
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(Daw of Inspection)
is
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: PID Number: 015-401-29 ❑ New ❑✓ Upgrade
Name:
LISA WILEY
ABSORPTION FIELD
❑ Deep Trench El Shallow Trench El Bed ❑Mound
Address
3601 MATTHEWS DR
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
2
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
0 Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
ALPINE TERRACE 4 6
Fill added above original grade
Ft.
Gravel length
Fl.
Township Range Section
Gravel widthBeds:
Ft.
Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
Ftp
Number of trenches
Dist, between trenches
I Ft.
Well
200+
200+
N/A
N/A
N/A
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
I
Surface Water
100+
100+
N/A
N/A
Gal.
Material
Number of compartments
Lot Line
10+
10+
N/A
N/A
L
NA
Foundation
10+
10+
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
N/A
N/A
N/A
NIA
Gal.
Remarks FLOW SPLITTER INSTALLED, BOTH FIELDS
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
NOW IN USE FOR 2 BEDROOM HOUSE
Pump make and model
Electrical Inspections performed by
Installer
PIPEMATERIAL Housetotank Tankto
drainfield
A -PLUS HOME SERVICES
Drainield CO/MT
Inspector PANNONE ENGINEERING SERVICES
BENCH MARK (Assumed elevation) ft
Inspection s,
1 d
dates: Orn
3rd
Location and description
HOUSE FINISHED FLOOR
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date
�rP'(..F A.���
fir G�$ TH
.teven annoae
0}�
r,IRPOi�
1\�a�
Approved Date "� /
Inspection Rep*t_1-1-T2.dl590_'
TH1
RESERVE SYSTEM FLOW DIVE ER
1
ASED ON ADVATEX REMOVED AND REPLA ED
WITH NEW FLOW SPLITER—`-
O
V
o g ,)
2 BIR
HOUSE (E)
(TH1
A
EXISTING 12508
SEPTIC TANK
SURROUNDING LOTS SERVED BY PUBLIC
WELLS AND CITY WATER ALL 200'+
NOTES: PANNONE ENG SVC, LLC —` pF AC\`ll D�zs/zo, a
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 .: '�� • ' • q6 jj
PHONE (907) 272-8218 FAX (907) 272-8211 /�g�Q �yj+ Scale
j*:49 .*Fj 1..=20'
......... :S-. P.I.D. NO
DEARMOUN #2 BLOCK 1 LOT 1:' os-ao,-zs
LISA WILEY Ste vecER 8149 no % PERMIT No.
3601 MATTHEWS DR '�j �i .• �r
PLAN ANCHORAGE, AK 99516 jjl��ossioN�= Sh2eoE 3
\
A
B
FS
30.70
40.40
TH1
RESERVE SYSTEM FLOW DIVE ER
1
ASED ON ADVATEX REMOVED AND REPLA ED
WITH NEW FLOW SPLITER—`-
O
V
o g ,)
2 BIR
HOUSE (E)
(TH1
A
EXISTING 12508
SEPTIC TANK
SURROUNDING LOTS SERVED BY PUBLIC
WELLS AND CITY WATER ALL 200'+
NOTES: PANNONE ENG SVC, LLC —` pF AC\`ll D�zs/zo, a
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 .: '�� • ' • q6 jj
PHONE (907) 272-8218 FAX (907) 272-8211 /�g�Q �yj+ Scale
j*:49 .*Fj 1..=20'
......... :S-. P.I.D. NO
DEARMOUN #2 BLOCK 1 LOT 1:' os-ao,-zs
LISA WILEY Ste vecER 8149 no % PERMIT No.
3601 MATTHEWS DR '�j �i .• �r
PLAN ANCHORAGE, AK 99516 jjl��ossioN�= Sh2eoE 3
\
RIGID INSULATION
3 (TYP)
TH-1
-1.5
OR
0>
SW/
Z >
Gw 6.0
>
SM/
QO
ML
�.0
_
—6.5' (8/16/2000)
Z
—
SS — NEW
0>
10 LF X 5.0' WIDE, 0.5' E.D.,
Z >
FC
>
o a
QO
O
CLEAN OUT NO.
Oz
Z
<
RIGID INSULATION
NOTES:
PANNONE
O
w
X
�O
U
J D
NEW 1500g
RIGID INsuLAnoN S.T.E.P. TANK
WIAX20POD
DESIGN PARAMETERS
RESERVE SEPTIC SYSTEM
NO. BEDROOM: 2 (300 gpd)
TANK SIZE: 1500 GAL
PERC RATE = <1 MPI
SOIL RATING: 6 GPD/SF
AREA ROD: 50 SF
SYS. TYPE: 5' WIDE TRENCH
MIN LENGTH: 10 LF
RESERVE
1.25" 6 DRAIN PIPE
W/ 1's" HOLES DRILLED 18" O.C.
FILTER FABRIC
DRAIN ROCK
TOPSOIL AND
VEGETATE (TYP)
=0.52' SAND
SECTION
m
0
0
TRENCH SEE DESIGN
PROFILE
D INSULATION m
TER FABRIC r
RAIN ROCK 6" ABOVE PIPE INV of
1.25" 0 PERF PIPE o
W/Ye" HOLES DRILLED 18" O.C.
LEGEND
W WATER LINE/
WELL RADIUS
USED:
—
SS — NEW
SEPTIC
10 LF X 5.0' WIDE, 0.5' E.D.,
0.5' TO
FC
FOUNDATION CLEAN OUT
TOTAL AREA: 50.0 SF
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R.I.
RIGID INSULATION
NOTES:
PANNONE
ENG SVC,
LLC
RECORD DRAWING
P.O. BOX 100217 ANCHORAGE, AK
99510
RESERVE SYSTEM
PHONE (907) 272-8218
FAX (907)
272-8211
DEARMOUN #2 BLOCK 1 LOT 1
LISA WILEY
3601 MATTHEWS DR
DESIGN DETAILS ANCHORAGE, AK 99516
ABBREVIATIONS
TOPSOIL AND
VEGETATE (Tl
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
BFG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
``OFA�V
Date
r�P•`�..... CAs�I'�
Sc29/2014
NTS
.... .. J .. : '. ....
P.I.D. NO
nnome %
Steven R.Pa-
-1318-401-29
I
6 PF,•.
CE 8149 .•,��
PERMIT NO.
3 O 3
�0
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES p
Division of Environmental Services s
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907)343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel I.D. # 015-401-29 HAA # Q d 0 1/ 7 5'
1. GENERAL INFORMATION
Complete legal description DeARMOUN SUBDIVISION #27 I OT 1 BLOCK 1
Location (site address or directions) 3601 MATTHEWS DRIVE ANCHORAGE, AK 99516
Property owner KAREN BI AIR Day phone
Mailing address c/o MARY COX w/ REMAX PROPERTIES
Lending agency
Mailing address
Day phone
Agent MARY COX w�REMAX PROPERTIES Day phone 257-0112
Address 2600 CORDOVA STREET ANCHORAGE AK 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XXX
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 XXX
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
ing to the legality and status of system.
72-025 (Rev. 1191) Front MOA 921 Computer Version
Note, Alaska Water and Wastewater Consultants, Inc. shall be paid $2,120.00 at,
or prior to, closing for the engineering services provided.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. I 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
mpliance with all Mun> Girl and State codes, ordinances, and regulations in effect
on the date of this inspection.
��
Name of Firm
Address
Phone (907) 337-6179 _
Engineer's Signature`i_ m_� I+t' \.� Date
In conducting this evaluation, AWWC, ine a ted to provide a thorough, conscientious engineering analysis of the
system in accordance with ADEC and M A H Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water oo�opp
usage of the family being served by the system. These conditions are outside the control of o O F
the evaluator of the system. Satisfactory test results do not guarantee future performance o , .. • •. �\p4
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
......... .
�..;,
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or party is not authorized, ... ........ ........:-
....
(7 ,J
nor will it confer anv legal right whatsoever. �, .� ,
ffr A. Gorness,
6. DHHS SIGNATURE
__1Z Approved for I bedrooms
Disapproved
Conditional approval for
Additional
0
E-7953
bedrooms, with the following stipulations:
Date 9 - 7- as
Nil
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of
homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of
DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21 Computer Version
RECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVI@p2 2 2000
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
MUNICIPALITY OF ANCHOR
ENVIRONMENTAL SERVICES DMSION
Health Authority Approval Checklist
Legal Description: DeARMOUN SUBDIVISION; LOT 1, BLOCK 1 Parcell.D.: 018-401-29
A. WELL DATA
/n 21193
Well Type COMMUNITY 1, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) lJ Date completed
Total depth Cas Casing height (above ground)
Sanitary se Wires property protected (Y/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
FRr1M WFI 1. I.OG
Coliform
Date of sample:
AT INSPECTION
Nitrate — Other bacteria —
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 9/5-6/2000 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping NEW Pumper —
C. ABSORPTION FIELD DATA *BELOW FINAL GRADE. 0.5 FEET. OF M.O.A. APPROVED
LEVELING SAND ADDED BELOW TOTAL DEPTH.
Date installed 9/5-6/2000 Soil rating .p.d./ orft2/bdrm) 1.0 System type TRENCH
Length 30' Width 5' Gravel thickness below pipe 0.5' Total depth *2.86'+
Effective absorption area 150 SQ.FT. Monitoring Tube present (YIN) YES Depression over field (Y/N) NO
Date of adequacy test NEW Results (Pass/Fail) — For
Fluid depth in absorption field before test (in.); — Immediately after—
Fluid depth — (ins) Minutes later: — Absorption rate
Peroxide treatment (past 12 months) (YIN) — If yes, give c
72-026 (Rev. 3196Y computer Version
=gal. water added (in.):
Bedrooms
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
"Pump on"
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on
Public sewer main
In
"Pump off"level at*
COMMUNITY WELL
On adjacent lots
adjacent lots
Public sewer manhole/cleanout-
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+`_�
Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots A 00'± _
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main/service line 10=t __
Surface water 100'+ Driveway, parking/vehicle storage area 25'4=
Curtain drain NONE KNOWN Wells on adjacent lots 1100'+
F. ENGINEER'S
1 certify that I I
of Municipal 0
with MOA HA
Signature
Engineer's
HAA Fee $J0_0 � 072
field inspections and review
i systems are in conformance
on this date.
A. GARNESS
Date of Payment 17/z z� 1o,
Receipt NumberO 4 ?-9f (_ 247X�
72.026 (Rev. 3106)* Computer Vefslon
Waiver Fee $
Date of Payment
Receipt Number