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JEWEL LAKE HEIGHTS #1 LT 36A
Onsite File Jewel Lake Heights #1 Lot 36A #011-152-23 �IJUMITTdo1L OCT 13 zozo (Rev ub/U2/18) H 0 uSe i S On Pit i v%,3S, So Code. re%"ty-ec S•e fo_tr••a-{� o h `i t C.o h v eA-H o v10�1 --6 u�txd of '-v ✓1 to No . Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201080 PID Number: 011-152-23 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Ronald & Cheryl Bailey ABSORPTION FIELD ❑ Deep Trench El Wide Trench ❑Bedound Site Address 8749 Emerald St ❑ Other Phone Number of Bedrooms Soil Rating Total depth fr original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Jewel Lake Heights #1 36A Fill added above original grade / Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds.. Number of Lines Distance between lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well n/a TANK ❑ Septic [9 S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water 100'+ Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation n/a Y-7 LIFT STATION Manufacturer Capacity Remarks Orenco 250 Gal. Alarm location House Electrical installed by Solid Ground PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer GLW Drainfield CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 106.0 fl Inspection v 6/16/20 8/10/20 Location and description 3`d 2nd 41" NE Bottom House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ,�� OF AL,q Steven R. Parinore" �� Septic System Approved � 9. Date 11/5bbid �^ c�4Q_ ,o c�c �-� ��OrESS1G���'�.� �41 Note: this approval does not include well permit requirements. (Rev ub/U2/18) H 0 uSe i S On Pit i v%,3S, So Code. re%"ty-ec S•e fo_tr••a-{� o h `i t C.o h v eA-H o v10�1 --6 u�txd of '-v ✓1 to No . un; 'pality of Anchorage On -Site Water and Wastewater Program P.O. Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Review Comments Engineer: PANNONE ENGINEERING SERVICES Legal Description: EPLANS JEWEL LAKE HEIGHTS #1 LT 36A Parcel ID: 01115223000 Permit: OSP201080 SepticTank Report Type: As Built Review �0 �, z l• r, Department 10/22/2020 Completed By: R.Carroll The application has been reviewed and the following comments have been generated. These are to be satisfactorily addressed prior to MOA approval: 1. Special provision to the permit required that the well be decommissioned (since lot is served by public water). A well decommissioning log shall be submitted prior to closing out this permit. 10/a& 120: Dct(\ was F�`-(Scc���Y Lie N c ��.� �nS �� c�� co��. r ��� l v� U Ls AOS :_ c ar-cc or cvti -4 �n�P '/ vz -; Le 26 bn vK-1n-riC7v-O T - Ntrmn0 ` D "" 1, - P�6 OF At '$1 _=��.- !ry , . ... •. Steven R. Ponnono ; " - cE-alas �= f............. ....... .me._ h,� REVISIONS C Z O m Z 0 � CC) U)�p�G CD C) Frl > O JEWEL LAKE HEIGHTS #1 L36A RONALD & CHERYL BAILEY 874-9 EMERALD ST ANCHORAGE, AK -;0 1"=60' $r V x A min O DRAWN ACP zz F5 m F/) � D -_i _— PERMIT No. r> OCzz O=D n t A z O rn o— o m0 JN cm DC+ Z � Co N D z cN„ Lo — n zm O A r- m ' � A D r Cn �0--i� CP n cm C D m 0 N Fs' c� O D m n zr �m O O — -- D I1 \� m 3' SECTION LINE ESM - _ 5' TELEPHONE ESM - -EMERALD STREET — • � r 1 v t f D O _ I m D I mr + A m / D D N� .^m.. m i/-' D ` jl1 jt � o t zo N �6i �cz0m y, o rrrm /t C7 0O --nim oomo - om -mp- �� m OU) Om D'D NOTES: PANNONE ENG SVC LLC (G.I. 1088) P.O. BOX 1,,807 PA:.f`U, AK 99645 PHONE (907) 745-8200 FAX (07) 745--8201 "" 1, - P�6 OF At '$1 _=��.- !ry , . ... •. Steven R. Ponnono ; " - cE-alas �= f............. ....... .me._ h,� REVISIONS C Z O m Z 0 � CC) U)�p�G -D C) Frl > JEWEL LAKE HEIGHTS #1 L36A RONALD & CHERYL BAILEY 874-9 EMERALD ST ANCHORAGE, AK C7 1"=60' N O DRAWN ACP m rm ;0 SITE PLAN _— PERMIT No. SHEET 2 OF 2 u o m N Co N D z cN„ Lo — n D D Cn �0--i� CP NJ CO C D m 0 to —I I c.n U7 N d m cn — -- D I1 \� m 3' SECTION LINE ESM - _ 5' TELEPHONE ESM - -EMERALD STREET — • � r 1 v t f D O _ I m D I mr + A m / D D N� .^m.. m i/-' D ` jl1 jt � o t zo N �6i �cz0m y, o rrrm /t C7 0O --nim oomo - om -mp- �� m OU) Om D'D NOTES: PANNONE ENG SVC LLC (G.I. 1088) P.O. BOX 1,,807 PA:.f`U, AK 99645 PHONE (907) 745-8200 FAX (07) 745--8201 "" 1, - P�6 OF At '$1 _=��.- !ry , . ... •. Steven R. Ponnono ; " - cE-alas �= f............. ....... .me._ h,� REVISIONS DATE 8/12/2020 SCALE RECORD DRAWING JEWEL LAKE HEIGHTS #1 L36A RONALD & CHERYL BAILEY 874-9 EMERALD ST ANCHORAGE, AK 1"=60' POLD' NO52-23 DRAWN ACP SITE PLAN _— PERMIT No. SHEET 2 OF 2 **ILUU FA 31VG SIHI 13S S83NUOD ON :31ON �89CHIr • eor ,n avmsvw 'iowisiaMaNO03M 30VNOH3NV AV ozo;Z/ZL/9 *S3Nn33N3A NO AWaNnosONIHsnevm A I r f t 609-S-1 AV !PIDISDO 'V o 1 110-4 110 NO,,3nlllSNOC) 110A a3sn3ll N03113H 31 AAJ9�19�r �60 viva kw cnnOHS s3owisnnomioON 83aNn *9*9-9*Z 3NOHd my IVId Noiswaens MaHO338 3Hl. NO MUd 11 dV L0966 VASYlV '3!)VNOHONV Co AIF ION 00 HOIHM SNOLL318MM 80 SIMVFN 3AO3 i q 3.uns -am ONnmoa -3 0065, (H),00 - 00Z rn),09-66t N S.LN3R3SV3 AW -40 3DN3.LSIX3 3H.L 3NIV48MCI: SI*N 'ITIVISVO *V AA3P jo 3HIAO AlnlGISNOdS38 3Hi Sl A 311 'DNIAMuns A_, *a3.LvoiaNI SV Ld33X3 ISM S.LN3MH0VOM0N3 aw icnvim a's4. ON IVIU ONV 3AOeV a3l3ld3G AlMdOH& 3RL o3Awns 3AvH I IVHI MLIN33 AB3M3H I 001 O*OL .00*OZ ).6 L$ N (XdV) 33N33 -1riS3 3Nn NOLL03S -2 o/M (N),VS!76Z 3..,VO,9LcL9 N *SS 2WLZ V9 c iol I *ON "N(](]V 'SiH'Z')%13H 3AVI �3M31` QL-21- *ON IVId liK.L2o*9 N (XcIV) 3ON33 In (H),00 - 00Z rn),09-66t N 0 'ONOO ONINM38 XT£ 19,0Z 8 6"cz Z PULLSAs 3® LLd3S -01, > r4 II I 0 rn p . 1: _w8o .,o.v i X: oN O*J, SVIS -0 ZA A I", x rn A.030 o. Z;l NIV80 HON3W DNLLsjX3 lo'zift ZA X oi! .3A08V kvM)q-,VM 00 00 x K) cn 0**L 19.2 6� b 59 rfl PY31SAS 3LL-d3S ONIolins x -n �o DNILSIX3 NIVaCl H3N3& X'J�c 16* LZ CAII 3Mao 0 v co _LAS3 MV A; O*OL .00*OZ ).6 L$ N (XdV) 33N33 -1riS3 3Nn NOLL03S -2 o/M (N),VS!76Z 3..,VO,9LcL9 N *SS 2WLZ V9 c iol I *ON "N(](]V 'SiH'Z')%13H 3AVI �3M31` QL-21- *ON IVId MUNICIPALITY OF ANCHORAGE On -Site Water& Wastewater Program PO Box 196650 4n0Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 Permit Number: OSP201080 Work Type: 8epticTankUpgrade Tax Code Number: 01115223000 Site Legal Address: JEWEL LAKE HEIGHTS #1LT 36/\ G:2325 Site Mailing Address: 874BEMERALD ST, Anchorage Owner: BAILEY RONALD COY & CHERYL ANN Design Engineer: RANNONEENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 5/6/2O20 5/6/2021 21913 1771 Disposal Field 2 Septic Tank 171 Holding Tank' 0 Privy El Private Well 0 Water Storage All construction shall beinaccordance 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 (18AAC8U) 3. The wastewater code requires inspections during the installation. The engineer shall notifvthe Development Services Depa�mentper AK8C 15.65. Provide notification by calling (BO7)343-78O4/24/ '� 4. FronnOok�ber15boApri|15.aoubau��o��oi|obaorptiunsysbamungerconatruciiondurigfreezing weather shall beeither: a. Opened and Closed onthe same day, nr b. Covered, sealed, and heated to prevent freezing � Provisions: The lot is served by public water. The well shown onthe site plan is to be Received By: Issued By: 3 MUNMPAUTY 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. 011-152-23 Property owner(s) Ronald & Cheryl Bailey Day phone Mailing address 350 W. International Airport Road, Anchorage, AK 99518 Site address 8749 Emerald Street Legal description (Sub'd., Block & Lot) Jewel Lake Heights #1, Lotl36A Legal description (Township, Range & Section) ` Lot Size 21,913 Sq. Ft. Number of Bedrooms 3' 1 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ 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) CCV Q Permit/Rush Fees: 125 ' ��B Waiver Fees: Date of Payment: L412-7126 aD Date of Payment: Receipt Number: Receipt Number: Permit No. (3 12 26 1 06 Waiver No. Permit App__- :• :-.,:c COVID-19 25% DISCOUNT APPLIED!:: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201080, Deb Wockenfuss, 05/06/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201080, Deb Wockenfuss, 05/06/20 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 Address LEGAL DESCRiPTiON ~ot I Block JbW- -- Township, Range, Section Subdivision DISTANCES WELL LOT LINE FOUNDATION SEPTICx ABSORPTION FIELD WELL AS-BUiLT DIAGRAM (Show location ol well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS [~ SEPTIC Z_~ ~7z [] HOLDING Manulacturer I Capacily in gallons daterial No. of Comp merits TYPE OF SYSTEM TRENCH [] BED [] W. DRAIN [] OTHER Depth to pipe bottom from Toto[~ep[I depth from original grade originalgrad~_ f__ V r FT ~'~...~ /' FT Fill a~de~ above original gra~e Gravel ~epib beneath pipe / ~ FT ~-J~ ~ FT Gravel length Gravel width ~ ~ ~ ~ ET ~-~ / ET T~ta[ absorption area Distance ~tween IJ~s ~ ~0 SQ ET ~ · ~ FT Number of lines [ Soil rating Pipe material ~ ~c~ [ /~0 SQ ET ~]D/ ~oJ~ ~ ~ WELLS [] PRIVATE [] OTHER~ ,nsta,~ X/"I Date installed: FTI FT REMARKS:.~-~.5'o/~.~., ~,.~,-~s ~.~Z IScale: ~ E that this inspe~ion was pedormed according to all 72-013 (3/85) ENGINEER'S SEAL MUNICIPALITY OF ANCHORAGE MIlleT. OF HEAl, TH & 'DEPARTMENT OF HEALTH AND HUMAN SERVICES ~NVIRONMffNTAI. Environmental Heallh Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 2~4720 FEB ~ 6 1989 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RE~ ?~7 ~/J ~'~ ¢¢~ ~~ SEPTI~ , ABSORPTION ~dd~e~ TAN~ FIELD WELL Phone(s)~_~ [~ ~ II~i& No.~~ Ho. of ~r~ms ~ WELL ~y u~o~sc.,.~o. LOT LINE ' ~ ~+ / 181 ISu~ivision Township,LOtj~ ~nge,~,on ~ ~// Za~ ~F~/r FOUNDATION /p' q TANKS 'IN ~ SEPTIC ~ p~ ~ HOLDING ~ ~ ~ ~.~.~ ~,'/.~ Manufa~urer ~a~W in gairons ' No, of ~mpa~men~ JO0 ]~., TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER FT ~.~/ FT WELLS : .. ; D~ D .mVA?~ D OTH~R~ ~, ~Z ' FTI FT REMARKS: ~ /= ~ ~, ~ ~, ~e; ~ ~ ~P~ ~NGINEER'S ~L Muni~pal and Stm guid~in~ In ~ on ~is ~ ///~/~ ~fy ~at this impeffion w~ pedormed a~rding ~ all Heal~ Depdment ~proval: Date:. - -. - 3500 EAST TUDOR ROAD iNFORMATION (907)786-8211 iNSPECTIONS (907) 563-3464. . LOT / ,-.~ _~,~L6CK/-- SUBDI~PLB . UNDGR. [--I ELEC.~-M~-.. ~ -- E'LEC. SERVI ~(~[]- ELEC- ROUG~ ELEC. FINAL '-~ ~] OTHER -- [] NO NONCOMPLIANCE OBSERVED :COTING _ i'-I PLBG. ROUGH - [] :OUNDATION - [] GAS TEMP. -- [] BOND SEAM - [] GAS -- [] FRAMING [] MECHANICAL - [] ~SULATION - - [] MECH, FINAL [] SHEETROCK - [] [] STRUCT. FINAL [] FIRE FINAL -- [] PLBG. FINAL -- · - [] OTHER [] OTHER -- [] ZONING -- -- [] CORRECTIONS ESSENTIAL AS EXPLAINED BELOW []DOt' COMMENTS-- WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION DO'-~T REMOVE THIS NOTICE 84-002 (Rev. 11/87) PdqCI. ICII'-d:tGE, AK Day l;:'lr]once ~ PaPcel :i:d: O:L L(::rL I. ~:~(.la ].: Sub d :i. v :i. s :i. cx'",: JIEWEL. LAKE I-.I]'S ~, :~ ~. t_.c~t ~ :36A B Ioc k: .... 21913 (sq,~ i't.~ o~'~ a(::~'~es) JlJis Pel',m:i'i'..= ;'.:.!; l'cit, al Capac:Lty= i N~:~I'At..I.... F:'EF:( ENG J: hl!iii[~:Fi:S DES i i).il'~l, i~iL:i:E AT'I A[]"iMIEN'fS. I"..t!::I"I' :i: FY DHHS PR Z Ol:~ i(J li:i:F~[;l"l ]. NSF::'Ii(C I' ]: 8l'~1 ~ELEC I'1::;: I CAI.., PERM I T :1: S I':i'.L:!:I/,!U :i: REX} F:ROM BU J:LD:[I',IG SAF:'!?'I ¥ ,, I'RENC]HS ARE 'Ii:] BE AL't'EF~.NA ['ED ANI'JI. JAL. Y,, '!]"i ]: S [:'EF:;~M :i: T .[ S l SSUliii. D F:'CII:i.' 'I'HE: tEX I S"I' :1: Nt',) :3 BDF;:M ~ .~)W!i']]...L. ! I\IG CINL. Y AND :i; i;i:::.R'['lF'Y THAI: I am i'ami].iar' w:i. th 't. he Pec:tuipl.-:.:,mel]'l.s I'(:H~ (~n.,".sJ. te seweP~i ar'id wells as set i',::)P'i:.h l]y t. he Mur~:i. cii:)atit, y c~i' Ai]cl]ciPage (MOA) ar'id the Stlate ~:)[ Alaska,, 2,, ]: w:i. 1], ins'Lal]. 'Ll']ii~ sys'l:.elii :i. 1'~ ac:ccn~dance w:L'Lh ali. MOA c:(:ides and l"egu].a'L:i, cins~ and i.n comp].ial"ice wi, th the design cr. iter'ia ot' this per. m:i.C. j;. :[ ~.~i].]. aclhe~"e 'L.(::) ali. MOA and State of Alaska pequ:iPemen'Ls fop the se'L bacl< ~i~.~.,.a~"~(:[~ iP(::xii ar~y exis'l:.J,l]g ~.~;e].].~ i,~as~L~wa'Lep cl~.si]cifsa], system c~P pLd,'l:i~c: Sewe:,pagl:~ sys'Li~.ml cli'] 'l:.l']i~i (:)t'~ any ','~].~!~,(:] Llrlcll~l'~sl:,,aF~cl 'LhaL 6) capaci'l:.y of the 'f:(:rLa], sys'l'..e~]l J.s ;3 bedr'c?i:;xil~ arid i~ii]y ~:~.)I] ].EiP gE~iller'i'[, 'wi, U;[ Pe an add i t. ;i.C)l]a ]. p~er'.mit ,, DATE (Own~-:~)P) aOl.lt',l ~ I<AI.;i ....... ~ ...c, ALASKA eFIUIROFImeFITAL COFITROL $1 RUICES, Ir'lc. I~nginceri~q [, ~nuJronrncntel Studies SPECIFICATIONS FOR A TRENCH-TYPE WASTEWATER DISPOSAL SYSTEM - JE~ELL LAKE HEIGHTS, LOT 36A 1.0 GENERAL 1.1 The drawings, sheets i through 4, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All elevations and depths are advisory, and are to be verified or modified in the field by the engineer or inspecting agency. 1.4 It is the responsibility of the owner or installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction to determine the number of inspections that will be required and to explain what these Inspections will involve. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, it may be used if it meets the capacity requirement for the residence and the approval of the MOA. 2.2 The septic tank shall be a UPC-Approved two-compartment tank, constructed of 12-gauge steel with bitumastic coating and set level on undisturbed soil. If the tank is buried at a depth of 4 feet or less, it must be insulated with an overlying layer of 2 inch burial type polystrene rigid board insulation. 2.3 The septic tank and trench shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by ADEC or MOA. 2.4 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of ~ feet from the absorption area. 2.5 Piping shall be fitted with a mechanical watertight calder coupling on the outlet and inlet of the septic tank. Piping shall be 4-inch solid PVC ASTM D3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot. If the piping is buried at a depth of 4 feet or less, 1200 LUr;sl 33rd ~u¢nu¢, Suile I~ · Anchore§¢, ~/~laska 99503 · (907) 276-1361 it must be insulated with an overlying layer of 2 inch burial type polystyrene rigid board insulation, 2.6 Cleanouts shall be installed as designated and capped with air-tight rain caps (Jim caps or equivalent), and extended a minimum of 1 foot above ground level. 2.7 If a lift station is required it shall be a combination lift station septic tank per Anchorage Tank and Welding, Inc. design. Specifications are attached. 8.0 ABSORPTION AREA 8.1 The gravel for the trench shall be 0.5 to 2.5 inch, screened rock with less than 3% passing #200 sieve residual. All substitutes must have prior DHHS approval. 8.2 The bottom and sides of the excavation shall be raked with the backhoe blade to insure that it has not been compacted during excavation. The bottom elevation shall be level. 8.8 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be 4 inch rigid PVC ASTM D3034, or cast iron. The section shown with holes may be 0.§ inch holes drilled on 6-inch centers on opposing sides of the pipe, or a regular section of perforated sewer pipe clamped to a solid section with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be installed over the top of the pipe. 3.4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of 1500 lbs and shall meet the approval of DHHS for use as drainfield pipe. All distribution pipes shall be laid level. 8.5 Trenches may be paralleled, but must have a minimum separation distance between the trenches of 10 feet or 2 times the gravel depth (whichever is greater). 75 feet is the maximum allowed linear length of any trench. 8.6 If the final grade over the trench is less than 4 feet above gravel, insulation is required, using burial type polystyrene rigid board insulation. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 24 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank to the drainfield shall also have 4 feet of cover or an equivalent layer of insulation to prevent freezing of the line. 3.7 If insulation is not necessary, the gravel shall be covered with a layer of nonwoven Geotextile fabric (such as Mirafai, Fibretex 200 grade, Poly Filter X or equivalent). 4.0 INSPECTIONS 4.1 A minimum of two inspections are required for the installation of the trench. The first inspection will be of the open excavation to assure that the system is installed in the proper soil strata, correct depth and meet minimum specified design parameters. 4.2 The second inspection will be after placement of the gravel, monitor standpipe and distribution pipe to verify proper installation and position prior to backfill. 4.8 The inspection of the septic tank installation can be incorporated with any one of the above listed inspections. Anchorage Tank & Welding, Inc. 2700 Porcupine Dr. Anchorage, Alaska 99501 (9O7) 272-3543 1. TANK FOR PRESSURE SYSTEHS SEPTIC TANK SHALL BE A MOIi~IFIED.ANCI-'IOIRA()~:.::. TANK STEEL 'rANK, THE DESIGN OR ANAI...YSIS SHA[.,I~ BE IN ACCORDANCE WITH ACCEPTEI) ENGINEiERING PRACTICE AND LOC~,I.., R[i:GUI.,ATORY AGENCIES. Tt"IE 'IANKS SHALL BE DESIGNED FOR L, OA~JING CONOI'flONS AS RE. QUIId:[ BY i'-~lJN.I. CIl-,.q.., AND STATE REGULATIONS, ALI.., ~U:!,IiING S[.IALJ.., BE IN ACCORDANCE WITH APPLICABI..,E C(l[:.o AND STAN]DARDS COATING SFIAL,L BE TNEME[:: ~.1.6"'q-65 HI-BUIL, I'~ TANI< C[]ATING AN]O ,APP[.,IEf~ AS F'O..,LOI,,ISi SURFACE PREPARATION .... ALL SURF'ACES NUST BI!i: BRY, CLEAN, AND REASONABLY FREE OF RUST AND MIl,I.., SCAL.,E E×CESS RUST, NIL[., SCALE ANI) WEI..,OING SLAG SHALL BE REMOVED BY WIRE BRUSH OR OTHER MEANS AS NECESSARY, 2,. AI::'F'I..,ICATION SI'tALL BI.'". AIRLES,:~ cPRAY TOUCH LiP WITH BRUSH OR 1TlIiqNIN(~i SHALL BE ACCOMI:U.,ISHEI) WItH APPROVED MA'I"E!.f!.I:AL ANI) WII..J~ NOT E:XCE[:'I) 5,%, LI., SURF'ACtE TEMPEP, ATUI:.:IF: SI"IALL. NOT 'BE BELOW OR 5 BE[.,OW DEW POINT WI-tICH Ii!VER )iS L, OWEI~, 5, INTI!!:R]:OR SHALl.. BE: COATED TWO TIMES AN)) SI"IAL, L BE A idININUN OF 20 DRY MIL, I..,S EXTERIOR SHAL, I,,, BE COATED ONE 'lIME AN[~ SHAI.,I., BE A MINIMUM OF 10 DRY MII..,L,S, Anchorage Tank & Welding, Inc. 2700 Porcupine Dr. ~\ Anchorage, Alaska 99501 (907) 272-3543 []ii..,-'flBH'r VISUAL ¢~L. ARi"I WITH PLISI..I..-.'¥[]-S]:I,[:NCE F."EA'f'URE, AUTOi'.,~,.r:~TIC ALIt)]:O-.-ALARI'f RE:SET, :L5 AI~P HO'fOR F(A"FI.ZD TOGGLE SW:[TC, H, SINGLE POL, E, DOLIBI.E-THROIJ I,,I];TH THREE Pf.:I(i;I'TI(3NS; t'.tANU~L (NAN), ~UTOHAT:I:C (.AUT(:)), AND CEN'I"Iii:R (OFF) (H,O,A,), NEHA ~-X--.RAI'ED, FIBERI3LASS, OR EQUAl.,, ENCLOSURE Ill'TH LEVEl.. C(:)NTROI. Fl.,OATS HF'2 CONS'IS'flNG OF 2 HEI:,'.(:;URY FL, OATS ON ADJUSTA][~'~L,E I::'VC STEi"i !,4HICH h'rTACHIES TO VAULT, (:)NE FLOAT S]:(:.)N¢~L.S ALARM; THE OTHER SWITCHES PUMP ON-'OFF, 'I:NS"[AI...I...AT ON, AI..,L PUMPING SYSTEi'/iS ':i;FIAI.,L BE INSI'ALLEI) :I:N ACC,ORI. ANCE WITH THE HANUFAC."ft..RER .S REI;(]MMENDATIONS AND STANI)ARDS, Anchorage Tank & Welding, Inc. 2700 Porcupine Dr. Anchorage, Alaska 99501 (907) 272-3543 E:F'FLUE;NT PUMPING ASSEMBLY A, EI::'I:I.UENT PUMPING ASSEMBLY SHAL, I.., BE ORENCO SYSTEMS (Ti'i) HODEI. OSI WE 4000 SERIES (,ON ~.I. oTTNG OF FOLLOWING', MODEl. 20 OSI 05FIH BY ORi>:NCO SCREE:NEB PUMP YAUbT (U,S, PATENT ~LH4.39;~23) 59" DEEP, 3/16" THICI< HIGH'"DE:NSITY PVC CYCI.INBER HOUSE'S THE PUMP, I.EVE:L CONTROLS - AND SCREEN AND SERVES AS A BAFF'I..,E TO PREVENT I'HE SCRE;EN FROM CI.OGGING, THE F'II::'TEEN 1-:1./2" DIA, HOI..,ES ARE BI~ILI.E:r~ IN THE: VAUL, I' Al' A I.E:VEL, THAT PL, ACE:S TI,.IE:M Al' ABOUT TI.-,S MIl'WAY POINT IN Tt-IE I)E:PTH OF' THE SEE 11C, FL, Al::' CHECK: ALL, OWS THE VAULT TO DRAIN WI.tEN REHOVING f-"ROi"i 'Y'ANKi SCREE:N; 15" IOIA, CYI.INDER OF H]:GH....DENSITY POI.YETHYL, ENE 1/8" HESH CAST INTO I::'IBEI:~GLASS BOTTOM, 3, AL, L, PL.,t.IMBING SHAI.I,., BE PVC OR OTI:'IER NON-- CO F4i:~OD ]:NG MATERIAL, PUMP CONTROI..,S AND AI.ARH SYSTEM - CONTROL SHALl., BE ORENCO SYSTEMS ('f'M) HL""tF CONSISTING OF', :1., AUI)II.~I.,E AL, ARH I:~ANE:I., MOUNI' WITH A MINIMUM OF' 88 DB SOUNI) PRESSURE AT 2q-.-.INCHES, OI:~ERATING I'EHPEI:~ATURE -'.50AC TO &5AC CONI ,.~ OU, oOUN]D RISER Anchorage Tank & Welding, Inc. 2700 Porcupine Dr. Anchorage, Alaska 99501 (9O7) 272-3543 OUTLET RISERS SHALl, BE GAL, VANIZED STEEL CULVERT, AND SHALL, BIS 5k INCHES (MINIM~JM), HIGH, SHA~L HAVE A MINIMUM NOMIHAI.,, DIAMETER OF 2~ INCI-IES~ AND SHALL, BE CAPAB~,E OF' BEING EQUIPPED WITH THE F OLI..,OI,.ZI~ NG ', A, A JUNCTION (NEMA q-X) BOX u"'"" ..... "'r4U¢ L, f~ONl:lE]Em OR A"t 'f'ACHli:.:D TO THE RISER, f{, UL L, ISTED ELEC'f'RICAL, CORD GRIPS, INSTALLED IN "f'14E J-BOX. A L, ID - SHALL BE F'URNISHlii::O WIl'H THE RISER, IT SHALL BE CONSI:RUCTE]O OF FIDERGLASS OR EQUIVAt.,I.T. NT AGGREE;ATE FINISH, RISER ]:NS'f AL, CATION -.. EACH RISER SHALL, BE SEAL, E]EI OR Hlii].,DED TO THE TOP OF' 'rile TANK IN SUCH A MANNER AS TO PREVENT INFIL,'FRATION (IF GROL!ND WATER IJHI:£ RE PRESENT, ]:NStJLATION '- 2" RIGID EXTRUDED POi..,YS'I'YRENE SHALL, BE PLACED IN I"HE RISER DIRECTLY [~EI..,OH ]'FIE LI fl, E, INSULATION - 2" SPRAYED UREIHANE ON CIRCUMFERENCE OF' RI,SER, Municipality of Anchora e 825 'L Street, Anchorage, Alaska 99502-0650 so, s - LEGAL DESCRIPTION: I .T¢ /'f Je~/~//./e~e//e,~Township, Range, Section: 1 2 3 4 5-- 6 7 8 9 10 11 12 13 14- 15- 16- 17- 18- 19- 20- COMMENTS ~>,//e ~_ /J'~) 0'~,'~ - SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT SL DEPT.? Depth tO Water Arie~) Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~- (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~-- FT AND ~" FT PERFORMED BY: ,~. , ~r J I / ' [~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL- GUIDELINES IN EFFECT ON THIS DATE. DATE: ./¢, ,,~ Z.'z.//~-~" 72-008 (Rev. 4/85) .'_;.~.2. .... .':.n~",, /,,.%. ~ ~ . : .T,~.~¢...:.¢.~...: [.. ~ _... ~, /, -,,,. I - i~ / .~ . ~ =4 ~ ~~ [, ~ me .espons,b,t,ly of the builder or owne,, pr,or ,o LEGEND hub ~ to~und D set iron reborn-found 0 set · . COnSf~uCt,~, tO ~e,,fy p,o~sed ~,ld,ng ~rode lo f~n,s~ grade ond uhhty cOn~ct,~s ~d tO defermme iron pipe -found 0 set I~ e~;~lence Of any eosement~, C~enonts ~ resfr~cfion~ ~OS~ cop -found ~ which do ~t o~eor ~ t~ ~ec~ded subd,v~s,on ~l~t . o~um. COp -found set Robert E. ~hns, Jr. ~ Assoc. ~ ~.~y~ ~ ~.. A _ -.~ ~. Professl~ol Lend Surveyors ~.~ ~ %~ S~le. i"=~0' ~Dr~' PEB , ~*'~"~~ :~r~y~ ~5/80 ~ ~: REd ~ ~p~r~ ~ ,~,,,~, ~q~~ Lot 36A, Jewel Lake Heights, Addn. No.I CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. ~ OF CALCULATED BY 2' f~"~' ~1/ DATE CHECKED BY DATE SCALE ~)'l~;l:l~b L-' S ERviC E S, INC. , 1200West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CHECKED BY DATE SCALE *...~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE' ~ ~(¢-~ [~'""N E W MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS ~ Well I Absorption area Dw~l~ng PERMIT NO. DISTANCE TO: ~ ~ Manufacturer ~ ~ Materia]~./~.~ ~Z No. of compartments LiT. capacity in gallons Inside length Width Liquid depth /OO~ IF HOMEMADE: ' DISTANCE TO: Dwelling .~ PERMIT NO. Manufacturer .~ aterial _ gallons ~ DISTANCE TO: Well /~O '-~ ~ Foundati Nearest lot line PERMIT NO~ No. of lines . Length of each line Total length of lines Trench width ~ J U~' ~' ~'* inches Distance betw~ Top of til9 to finish grade . . Material beneath tile Total effective absorption area Tgpe of crib Crib di~r~ Crib depth ~foctive a~orotion area We. DISTANCE TO: _ Nearest lot line ~ C]~s~.~/~i~¢/~l Depth ,~ Driller re '~ Distance to lot line PERMIT NO.,~¢O ~ D~STANCE TO: ~.i~di.~/o..a~tio.~a/¢~ S~w.~ ~i..~ ¢.F s~pti~/poota.* '~' A~orptio* ~(~)/~)O ~ OTHER ~- P,PE MATER,ALS ; ~/~~ SOl L TEST RATING . INSTAELER/ REMARKS ...... t APPROVED DATE LEGAL PERMIT NO. APPLICANT SUN DEVIL CONST. 4905 NEWCASTLE LOCATION EMERALD & 88TH LEGAL L~6A JEWEL LK HTS ADD #1 LOT SIZE TYPE OF SOIL ABSORBTION SYSTEM IS~ TRENCH MAXIMUM NUMBER OF BEDROOMS = ~ t11JNI m2 I P~-~LIT'¢ EmF 8P~m3HE~r~BGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ~L~ STREET, ANCHORRGE~ BK. 99501 264-4720 SOIL RATING THE REQUIRED SI~E OF THE SOIL ABSORPTION SYSTEM IS: [~EPTH= 7 LEr~GTH= 46 GRR%~EI, DEPT: :: 3 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E×CRVRTION (IN FEET). t~.. F I:-"~LI ! F~EI) _'"Z~EP T "ir ,Z: PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PK~PERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO ( 2_ ..-:, I I'-JSF'EC:T I m]l'~t'_~ FIRE REQLI I I~:E[:-, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEHRGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL~ OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIF~ THAT i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. APPLICANT SUN DEVIL CONST. ISSUED 8~_-~---~~_DRTE ~ ~ 2 ff~ ~ V~.2 ~CONST[~UCTION TEST LAB ~ "One Test is worth a Thousand Opinions" 2204 Cleveland Anchorage, Alaska 99503 277-0231 erzormed for Robert Nelson Legal Description: Lot 36A ~Block This Form reports: SOILS TEST yes Date Performed6_23_79 Subdivisi°nJewel Lake Heights #2_ PERCOLATION TEST yes Depth Feet Soil Characteristics ' ~ Brown Sand with otc. Gravel Sandy Silt with occ. Gravel 17~ Bottom of Test Hole Was Ground Water-Encountered -- NO If YES, What depth? Reading / Date i6-23-79 16-24-79 t6-24-79 t -24-7 i6-24-79 !6-24-79 Gross T~ne Net TLme 22hr. 0 4.0 hrs. Depth to H20 5.0" Net Drainage 5" 0 ?" Percolation Rate ]/2" 30_ Minute Proposed Installation: SEEPAGE PIT DRAIN FIELD Depth of Inlet Depth to Bottom of Pit or Trench CO~4ENTS: l~ ~q. ft. drainaqe area per bedroom from minus 6" to 7' and 3013 .qq. t:~. fr~m ~nll~q~ 7' to 17' Test Performed by ~ ,.:,,~ '~ ,) Data Certified By: U i \ \ 35 \ 5erie: l-"(t,, . \ T~¥C / EXHIBIT "A" SITE PLAN t'/£LL ZIT~ ~ 5~?rl~ L OC~ LAM~' ~IGHT5 ~R~ IVO. I PERMIT NO~ I(i~I~'ALIT'~ OF DEPSRTMENT OF HESLTH 8ND ENVIRONMENTSL PROTECTION 825 264-4720 ~-~ELL PERr~ I T 790~05 > APPLICSNT LOCSTION LEGAL SUN DEVIL CONST. CO. 4905 NEWCASTLE 00TH & EMERRLD L268 JEWEL LK HTS S?D 8DD #1 LOT SIZE 22944 SQUSRE FEET MINIMUM DISTANCE BETWEEN 8 WELL AND ANY ON-SITE SEWSGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVSTE WELL~ OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DSYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MSY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS 8RE AVSILABLE TO INSURE PROPER INSTALLSTION. I CERTIFY THAT l: I 8M FSMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS 8S SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTSLL THE SYSTEM IN 8CCORDSNCE WITH THE CODES. ISSUED BY~ ~P~ ___i~ ........ DSTE - V~. 2 rl- PI- C) 0 00 CY) 0) a) X LUp 1 L�1� 0 C cB o LL. V � CL L N Q z LL. -� v lU) i ©v --j cu C FD � D L E P—s■ V — L L c� n. Z a) � 0 U) N s U •L a) 06 U) CU c � E� Q. O tf m 00 O Q Q U) a) U) (D U) C O 0 a) U L N A LO N O N 00 4i N C O cu Q X W O O 0 1 c� N 1 N LO 1 O m U cu a. Q Ln rn CD m cY J Q � Cll U) (6 O _r_r2 V W 2 COW Y 0J Q < JW W �E W W Nt o ti n U) U N N m ca m a) J (n z Q J W U 06 O z L.L W J m U) W c O m Q O Q U CY) 0 m O Q Q CU a) cu E U) C O a) F- X A d 0 •N 0 .N C a) A N CD N C'7 N d' a� cu 0 a) cu U CD U (B C LM 0 m 0 0 0 0 CL L N Q -� 'L) lU) i --j cu C L G N 0 s ami Ecu a) V i co c o 0 0 V a)c = '� N N a ,N m O D o c Q > O N _ WoO 0 Q Q .NN = O LL U U) c 0 0 U)CU 0 N O 3 �, 'N z Q N j C Q. -0 0 OL m a) N O Q Q CL E 0. a) N L N U U = 0 Q x a)cC � .- 0 M L 0- U) O N > U) N E 'a 0 0. < Q o O c Q � > O `� � U N ch 0 >' C-) LL'O d 0 N c 0 c � U C:Q o a) CD v N 0 U) H Q Q` N d Z OU u°) r m L- U E c O c N cu O g Q O a) t 0 t V U)�' t i' v Q "tTI--T VJ At "AA 1_ O O d7 CY) > C/) 00 Z O M � N Lo O LL Z o aLLI o Z v W 0 a T- Q c� O CD O i Y -0 J � a� W (D O OC) L U U U) U m •0 co a) O O Q r- O U 0 .1 Efl LL co J N k a� a_ 0 LL0 CD co 0 Q U) O 0 N U a_ LL W 4� O , In 3 Q N C O O a) U) � to >� N ❑ C:_Q •:.� O U U O N (3) co a, U) E > ❑ Q. U)LL � �- (D W >, U 0 ElO U L O :2 a) co O co o 0 O 0 El m Q Q c co o •h E] L N a) J ❑ > M(a a Q p 'L > fn V O U :F+ Cc N O En a� O 0 a m L LL �❑ 0 J �/ ❑■ i Q El (D c W n. w Ov5 ❑ IL U p U) m to a (n > N w �? W N a) J W (D V � ° N L �w., (� z ,� co >. a a Z O �> L V cn a U 4- LL O LL O a. t F= U a Ua a O �' z n. a� U) O I}- H LU Q CO >_ a M >� x >, N M d L6 CD > W m �O Efl LL co J N k a� a_ 0 LL0 CD co 0 Q U) O 0 N COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ 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. 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 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner iin Street Address q-7 Septic Tank: -Sludge level inches -Pumping: required yes C22 -Pumping completed Qes o Lift station: -Pump basket cleanedAQno -Effluent filter cleaned & no _ -Control floats �cleaned ya no -Proper float settings confirmed (Vs no *Operation satisfactory �Q. no Alarm System, -Dedicated ele �,trical alarm circuit no ,,Audible and visual alarm inside dwellingno -Alarm system operation sat not satisfacto -Groundwater intrusion at riser to tank connection vesQ -Groundwater intrusion around pipe penetrationsyes -Weep hole functional Q no -Manhole lid: Functional Q no Insulated as no Properly Secured no Other -All manufacturer required inspections and maintenance completed no Comments: 6L. jAbA Technician Company Date of maintenance q If I5 Signature i Date / MUNICIPALITY OF ANCHORAGE [~.' ' ' DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 .343-4744 Parcel I.D, # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION ' - complete legai description Lot 36A, Jewel Lake Heiqht$#l Location (site address or directions) ~ '~Z - '. · 8749 herald St. Property owner Mailing address Lending agency Mailing address - Agent Address John & Karen Snead 8749 Emerald St.r Anchoraqe, AK Day phone 344-5040 99502 Day phone Day phone ' -Unless otherwise requested, HAA will be held for pickup.. :- ..... - ~-' " ...... ,- -, 2. NUMBER OF BEDROOMS: . · ............. 3. ~PE OF WATER SUPPLY. Indiwdual well .. Oommumty well ~-- Publio water x . . ' NOTE: If ~ommunity well system, provide wri~en oonfirmation from ~n~ to the legality and ~tatu~ of ~y~tem. 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 ~1 ( ( STATEMENT OF INSPECIION 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 ~hat 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 Environmental M~naqement, Inc. Phone 272-93%6 // Address ?n~;-R,. P~r~w~c] //~.q~A~m ,'~1_ An~k~e A~ qqSN3 Engineers signature ~~ ~~ ..... ~V{~ %, CE-8061 ~.~X~' ,,,,,, ,~, ~ .. · Con,d~tlonal approval for ' ," ' ,Lq .'.:/ .... ~ ~l 'Additidnal Comments DHHS SIGNATURE ~., APPr~)ved fo'r'~ ................ bedrooms, ...,..;... .,.. ' '. Disapproved. : ' ' i- : bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Humar~ 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 courtesyto purchasers °f h°mes and their I~nding institutions in order to s~tisfy 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.C25(Rev. 1/91) Back MOA~21 MUnicipality of Anchorag~'~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 36A, Jewel Lake Heiqhts~l Parcel I.D. 011-t52-23 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) A, Well Data N/A Well type Log present (Y/N) Total depth g.p.m. Sanitary seal (Y/N) ATINSPECTION FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g:p.m, rtl ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 7-2-79 Cleanouts (Y/N) ¥ High water alarm (Y/N) N/A Date of pumping Tank size 1000gal. Compartments 2 Foundation cleanout (Y/N) N Hn,~ Pilin(~s Alarm teste~d (Y/N) N/A Pumper T~anr~q SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N/A On adjacent lots To property line 10'+ Absorption field 2~) Surface water/drainage 1 (*In '+ 1.o ,7~w~] Lake Foundation 1 0 ' +House on Pilings Water main/service line 5(] ' + 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed 11-9-88 Size in gallons 500 Vent (Y/N) ¥ "Pump on" level at 3R" High water alarm level 45" Meets MOA electrical codes (Y/N) ¥ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot N/A On adjacent lots Manufacturer Anchorage Tank./Orenco Manhole/Access (Y/N) Y "Pump off" Level at 23" Cycles tested 2 D. ABSORPTION FIELD DATA Date installed 11-9-88 Length 24' & 26~ Width 2.5' Total absorption area 450sq ft. Date of adequacy test 2-24-95 Soil rating (GPD/FF) 1.0 Gravel thickness Cleanout present (Y/N) ¥ Results (pass/fail) pass Water level in absorption field before test 28" (test~ 26 ' trench) Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N/A (A;'~'~) To building foundation On adjacent lots 50'+ Surface water 100' to Jewel ~ake Curtain drain ~nn~ E. ENGINEER'S CERTIFICATION Surface water 110 ' System type 2 deep trenches Total depth 6. ~ ' -9.0 ' Depression over field (Y/N) N for 3 Bedrooms After test 38,5" If yes, give date On adjacent lots N/A Property line 10 ' (FT~n~¢, ~n ~i ~ ~ ng~ ) To existing or abandoned system on lot '~, Cutbank N/A Water main/service line 50'+ Driveway. parking/vehicle storage area 50'+ I certify that I have checked, verified,/Src¢nformed to all MOA Signature Engineer>s',N~'me ~,7ohn Simpsor~, P.E. HAA Fee $ Date of Payment Receipt Number 72-026 (:3/93)* Back and HAA guidelines in effect ,(> ,. : ~ Waiver Fee $ date of this inspection. Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ['1~\ - \.~1.-~ HAA# ~¢;:~°l_'z) 1. GENERAL INFORMATION Complete legal description Lo'k ~'A; ,,.Te~..,¢l /.,~k¢ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent /~/- ~. Address Day phone ~ q q -5'~' ego Day phone ~ ~- ooE ~ Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ N 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. 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 MOAti21 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 with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Fl~/-/~,/~ 7-er.~,,~cct ! -~¢~'~"¢~/ Phone Address /~/.S-$O Echo .~'/:. ; A~c/~r~¢/ /~ ¢95-1o' Engineer's signature ~'~ ~. ~ Date DHHS SIGNATURE ~._ Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Add~bonal Comments /~,,¢~.,~'~aZ~L '¢/~"Z~-/~'~.'6 ~/~' 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 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~0~ ~'/~; 2'~..,ef'L,~l~e'Hl':.~ ParcelI.D. If A, B, or C, attach ADEC letter. ADEC Water system number Well type Log present (Y/N) Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL,LOG AT INSPECTION Total depth ' Sanitary seal (Y/N) Date of test Static water level Well flow g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: ; On adjacent lots ; On adjacent !ors Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed '7/?-/' 79 Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping Tank size lO°° ~'c~/ Compartments ~ Foundation cleanout (Y/N) ,t/ h~o~¢ ~'~ Depression (Y/N) A. Alarm tested (YIN) N, A Pumper N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage Onadjacentlots h/- A, Absorption field '~O'--+ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed II /'? / Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at y- Manufacturer ,,z).,n c,~. '7'~.p/~ Manhole/Access (Y/N) Y' '7" ~:(~; ¢"( "pump off" level at Cycles tested ¢" t/ 0 t~et~ co SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot N. ,4. On adjacent lots Surface water I1¢'+ -Jr., D. ABSORPTION FIELD DATA Date installed II / ~ / 8 ~' Length '~ ¥1 .¢. ~,~'(.?' Width Total absorption area ~'/~O ~' Depression over field (Y/N) N Results (pass/fail) Gravel Soil rating 1.5'O ~'/~'~r,,.~ System type ~- 'T','-~,~c_.~_~- thickness "/. ~-' Total depth Cleanouts present (Y/N) Date of adequacy test for -~ bedrooms Peroxide treatment (past 12 montj~s) (',Y/N) Nope l,~,~or.~,~ '~-~' tf yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot N.A. (_~IX.~L~rX l'/~.a,~Onadjacent~ots )"/' ~, Propertyline To building foundation On adjacent lots '~ $0' Surface water _100 "¢' .~, ~'...6-' To existing or abandoned system on lot 7> 30 ' Cutbank N. ,4., Water main/service line '~ ~"" (¢/~.~ $/,~,r~ Driveway, parking/vehicle storage area :~¢' Curtain drain 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. Signature Date HAA Fee $ /"~g) ' ¢-:-~:) Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number ~ DAT E,-PrEC-EP¢ ED ..... INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSPE~'O . I NSPEOTOR I ~PEOTO~ MUNICIPALI~ OF ANCHO~GE MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH & DEPARTMENT OF HEALTH ~ E~Vl RONME~TAL PROTEC~ONMENTAL P~OTECTION 825 L Street - Anchorage, Alaska 9950~ BE0.t 9 1979 E~VI RONMENTAL SABITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACi'EiTIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYO~NER I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) ~ PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION I PHONE MAILING ADDRESS 4. REALTOR/AGENT [ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL~ COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [Z~ Two [] Five /~ Three [] Six [] Other *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM I NDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE D SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified f~lSeptic Tank or []Holding Tank Size: I ~)OO If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED ~NSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line [] OTHER Nearest Lot Line 5. COMMENTS [~-'"~/~-I~PRovED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72-010 (Rev. 6/79)