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HomeMy WebLinkAboutKASILOF HILLS BLK 6 LT 4Kc silof Hills Block 6 Lot 4 #015-132-33 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221356 PID Number: 015-132-33 Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Alan Sears' ORPTION FIELD Exsiting Site Address ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound 10400 Sidorof Ln Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 4 D/SF Ft. LEGAL DESCRIPTION iDepth to pipe invert from original de JGravel depth beneath pipe Subdivision Block Lot Kasilof Hills 6 4 Township Range Section SEPARATION DISTANCES Toj From Septic Tank Absorption Field Lift Station Holding Tank I Sewer Line Well 1100+ Surface Water 100+ Lot Line 5+ NA Foundation 10+ Remarks Ft.l Fill added above original grade JGr I length Ft. Ft. Gravel width Beds: Number of Lines Dista a between lines Ft. Ft. Total absorption area Number of trenches Dist. between tr ches Ft2 TANK 21 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1250Gal. Material Number of compartments Plastic 2 LIFT STATION Vrdnufaclurer ICapacity location led by PIPE MATERIAL House to tankD3034 Tank to Installer drainfield D3034 A+ Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspdeates V 9/22/22 2nd 9/22/22 Location and description 3b 9/26/22 4`" NE house corner, bottom of sidding ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp lConditional Approval: Date Septic System Approved Lo�� Date Ysvzwozz Note: this approval does not include well permit requirements. tKev uoiuzno) AS—BUILT SYSTEM DETAILS/SITE KASIL❑F HILLS BLOCK 6, LOT 4 x pAr PLAN Permit ❑SP221356 PID# 015-132-33 A -C=20.1' B -C=15.5' A -D=24.2' COMPUTED: B -D=19.5' W A -E=25.9' CHECKED: KMD B -E=20 2' DATE: 29 A -F=26.5' & B -F=20,0' 'IDB NO' 22150 A J 0 ti v IM SCALD NTS r • • * - * f � .49 .` CE- wA: Alf hV. ' ' *(ftSS100'� AW" 1 PREPARED FOR: ALAN SEARS 10400 SID❑R❑F LN ANCHORAGE, AK, 99507-5960 FlELD BOOKS COMPUTED: BOUNDARY: N A DRAWN: KS0 STAIGNG: N A CHECKED: KMD AWUILT: BUKU DATE: 29 DWG. FILE: GRID: 2541 ACAD FILE` FILE 'IDB NO' 22150 SCALD 1' = 30' SCALE, NTS MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221356 Work Type: SepticTank Upgrade Tax Code Number: 01513233000 Site Legal Address: KASILOF HILLS BLK 6 LT 4 G:2541 Site Mailing Address: 10400 SIDOROF LN, Anchorage Owner: SEARS ALAN R Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date lel C n t n f r Department Lot Size in Sq Ft: Total Bedrooms: 9/14/2022 9/14/2023 47620 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Locate the start of the trench if there is no cleanout so as to verify 5' separation to the tank 2.Stake the well radius to verify 100' separation Received By: Issued 3 l Date: Date: 91—(V -2z 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 015-132-33 Property owner(s) Alan Randy Sears Day phone Mailing address 10400 Sidorof Ln. Anhorage, AK Site address 10400 Sidorof Ln. Anhorage, AK Legal description (Sub'd., Block & Lot) Kasilof Hills Block 6 Lot 4 Legal description (Township, Range & Section) Lot Size 47.620 Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 APPLICATION IS AN Initial ❑ Upgrade ❑X Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) ❑X (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permi ush Fees: o D Date of Payment: 2 1 a2(' Receipt Number: C2 1-l0(a Permit No. ns Paa l35 � Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Minidpality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE CONIPUANCE OSP221356, Tim Eddund, 09114,22 September 6, 2022 CONSULTING, INC 20441 Ptarmigan Blvd, Eagle River; AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On - Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Tank Replacement Permit — Kasilof Hills Block 6 Lot 4 On August 8, 2022, an inspection was conducted for proceeding with a COSA submittal. While the leachfield and tank passed the test, the home -owner has requested we proceed forward with replacing the aged septic tank. The record information indicates a well to tank waiver of 92 feet was issued in 1988 and with a leachfield to well waiver of 99 feet. We are requesting the waiver to leachfield be maintained for this permit. We propose to replace the existing 1250 -gallon steel tank with an 1250 -gallon HDPE tank. The soil log information on file shows a depth of 18 feet with no groundwater noted. We do not expect there to be any adverse effects to the existing well or this septic system operations in the existing location. If you have any questions, please contact me at 696-6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Attachment On -Site Tank Permit Design 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 Minicipality of Anchorage On-site Water and Wastewater WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAft,3m,Tim amU„d, KASILOF HILLS BLOCK 6, LOT 4 PID# 015-132-33 L 1250 GAL TANK TO BE INSTALLED PER CODE `h EXISTING TANK TO BE REMOVED 10 Y CODE 10' IN EXISTING Fe�CE BUILDING \ DECK .4 Lal .1� .• WELL s� SHED; • , ; R / \ SCALEI 1' = 3 NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. 0_ F AL TH -. KENNETH D FUS CE 71 AW ,� �$W ' t �Fcsslo� 1. DECOMMISSI❑N EXISTING SEPTIC TANK PER CODE. 2, INSTALL NEW 1250 GALLON DEEP BURIAL STEP TANK PER CODE, 3. TANK TO HAVE MIN. 20' MANWAY RISER. 4. MAINTAIN 10'+ FROM FOUNDATION & 51+ EXISTING FIELD. 5. MAINTAIN 1001+ FROM PRIVATE WATER WELLS. NOTES NO WELLS ON ADJOINING LOTS ARE WITHIN 100' OF PROPOSED TANK PLACEMENT, NO SURFACE WATER NOTED WITHIN 100' OF PROPOSED TANK PLACEMENT, CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INT❑ SEPTIC TANK, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR: RANDY SEARS 10400 SIDOROF LN ANCHORAGE, AK FIELD BOOKS BOUNDARY: N /A $TAXING. N_/A AsBU'LT: SA.LIZ DWG. FILE: ACAD FlLE FILE COMPUTm: DRAWN: KSD CHECKED: KMD DATE:- 9/6/ MD: MD: 2541 " N-: 22150 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 MAILING ADDRESS,--- LOCATION I Well i I Absorption area DISTANCE TO: ~6-,,._~.- ] ~ Manufacturer NO, OF BE DRO0~/I/~..~_. PE.M,T NO. 0 / / ,/ No. of comp~a~..~nts [ Dwelling Liq. caf IF HOMEMADE: Inside length ._. /Width Liquid depth,~,,,~ Well Dwelling PERMIT NO. DISTANCE Liquid capacity in gal~ DISTANCE TO: Well No, of lines Length Foundation Nearest lot line of each line Total length of lines 1-rench width Distance between lines inches Top of tile Io finish grade Material beneath tile Total effective absorption area inches Length Depth PERMIT NO. qeter Crib depth Total effective )rich area DISTANCE TO: DISTANCE TO: foundation Nearest lot lin Building found~J. D ri II e~..~ Sewer line Distance to I~.~ lindeO PERMIT NO. '"'~ ~?_~ / Septic tank / ~) '~7 Absorption area(s~/ OTHER PIPE MAT,~RIALS ^ SOl L TEST RATING R EMAR KS Well Log :~0~..~~.~.~ ........................................................................................... ~oo~o~ ~I' ,,~C~/~"/~5'/o },~ ,~' .' ~"k'~t. ,, , :Date co~p]eted..q/. Depth of ~eH...~.~' ................................................................. ~ .......... :.~L~'..,~..?~/~ ........ Size o~ cas~:~..~ .............................................................................. ',...z..¢..V./;-.;-~. ........ ~,~,o~ ~o ~...~.¢.:.~...~..:..~~ .......................................... ~Js~ce o~ ................... ~.Q ...................... ~MZo=s ~e~ 5ou~. Formation from to II '6" 17 Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99507 lIE 1' [",10. i"l!::l;:.:::l~h'ilJH I'd..lh'lE:lli:l:;i: ()1::: I].i'.~i:J)f;~:()(1)l'q:il; ...... Tf"E!. [::,I!!:P'TH Of:: i:::i '/"l;;:l:!i:l",tE:l'! OI;i: P];T ZI;:!?, THE I) :i: :};'I"t::INIT;:I:!:: !3!F/f'I'.!E[!;I",! 'l-Illii; ':!;I..ll:.i:l:::F:l(~:t!i; il)F' FI't!!!; J]f;:EitJl',I!;) I:':lt",i[:' "IHE E',I?!'TCff'! ()F:' THE; [E',:'::E:I'Tv'FIT ;f ON ':; ]; t",! I:=t:'!;li!;T' ). 'f'HE¥;'.l:i; ];;:i!; i',!()::J;f(T I.,.l];l%f'H I:':'(Z:d;;: 'I"HE (;il:~:i:::l'v'Ei;!. I::'IEF;' 'r'!l _1: :!'i; 'I'I.ItZ I"/]; I'.,I ]z i',-I1.11-,1 E)[!:P'I II Ell=. (:il:;;'.l'::l',,,'liilX. F!I'.,![) 'I'I.IEi F?,O1'I'(;¢1 OF 'I"HE E!X:.::CFI'v't:::I'T;I;OI',! (];1'.,I t.=EE-i'). BORING NUMBER Date Completed: 8-29-78 SOIL DESCRIPTION ORGANIC MATERIAL so f t_~ moist SANDY GRAVEL WITH MANY COBBLES (GW) brown, dry, dense _4.5' GRAVEL WITH TRACE SAND (GP) brown, dry, dense 11.5' SANDY GRAVEL W/FEW COBBLES (GW) brovrn, dry, very dense 18.5' No Groundwater Encountered T.D. -LOCATION SKETCH No Scale L~Z' L - 1 ~ 50' : NOTE: DISTANCES SHOWN ARE APPROXIMATE ANO HAVE NOT BEEN MEASUREO BY SURVEYING METHOOS. EXPLANATION ~'~ ORGANIC MATERIAL ' ~:~ '-" LJtfle Visible Ice O;IO' Vx ~Ss 72,5~1% 85.9pcf .5. ~%: I I ~WAr~B CONTENT ~ I ~ ~O~S/FOOT BEDROCK TYPICAL SOILS LOG I L-FROZEN GROUND YID.-WHILEDRILLING ,~.B-AFTER BORING Ss ~ 4 "SPLIT' SPOON WITH 140 LB HAMMER Sz Lq"SPLIT SPOON WITH 340 LB. HAMMER SAMPLER TYPE SYMBOLS I ~-~-~ORCANIC ~GNAVF'L [~7-~ SILT ~ BEDROCK ~ SAND I ICE, MA~IV~ Kasilof Hills Subdivision ORID. Anchorage, Alaska PROJ. NO 851142~ MUNICIPALITY OF ANCHORAGE o Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-132-33 Legal description Kasilof Hills Block 6 Lot 4 Site address 10400 Sidorof Lane Anchorage Current property owner(s) A. Randy Sears Expiration Date: X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: 12/30/2022 bedrooms, with the following stipulations: Original Certificate Date: 9/30/2022 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 I� �1'[))���M��OC PALITY OF AHC��iORAGEU� o�. Development Services Department �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-132-33 Complete legal description Location (site address) Current property owner(s) KASILOF HILLS BILK 6 LOT 4 10400 SIDOROF LANE. ANCHORAGE A. RANDY SEARS 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone __ _ __ _ __ 3._ TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL:FX] Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑x Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: x❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment COSA # Q 5 C vg/L/99 Waiver # COSA Application June 2022 COSA Checklist Legal Description: Kasilof Hills Block 6 Lot 4 Parcel ID: 015-132-33 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system — A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 4/11/79 Total depth 125 ft Cased to 23 ft ✓❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/8/22 Static water level at beginning of test 46 ft Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping New 9/22/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 618179 ❑✓ ALL standpipes present per record drawing Total measured depth from grade 12.6 ft (max) Measured depth to pipe invert from grade 5.6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. F./I 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 Comments/Deficiencies COSA Checklist June 2022 Well production at time of test 2.4 gpm Water storage tank volume - gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 1.32 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by ArcTerra Consulting Date 8/18/22 STATION ❑ Require-a Age of lift station Lift station material Comments: nce completed Adequacy test date S/8122 Results J❑ Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 6 in Elapsed time 2_ min Final fluid depth 0 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 84 in Effective depth used 0 in Effective depth remaining 84 in 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' 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 x99 ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50'✓❑ Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft ✓❑ 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 Surface Water > 100' ❑✓ Yes if No ft Tank to Property Line > 5' /_J Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑J Yes if No ft Private Wells > 100' © Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Fz1 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS * Septic leachfield MOA waiver approved 1988 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 Arcterra Consulting Engineer's Printed Name Kenneth Duffus Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may Fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 Phone (907)-696-6111 Date Z O •1� KENNETH M t1 5 �. GE 711 1 Municipality of.Ancl!orage Development Services Department · ~,; . - ~., . ~. Building Safety Division .~ ·, . On-Site Water and Wastewater Progr.am ..... ' · 4700So[JthBragawSt... P.O. Box 196650 Ar2chorage. AK 99519-6650 .- : · www.ci.anchorage.ak.us (907) 343-7904 · ..... . . .. CERTIFICATE OF HEA,LT,H.AUTHORITYAPPROVAL FOR/~ SINGI'E F,A'I~IL,Y'D~/ELLiN(~' "" ' Parcel I.D. T "O 1 5- '~ ~,2- - :~ .Expiration Date: I~ . i'~k::. (,c, GENERAL INFORMATION Complete.legal description LO'i' Location (cite address or directions) Current Property owner(s) ~, A I:>..T' ~lq Day phone Mailing address Lending agency Mailing address ' Real Estate Agent Mailing Address Day phone -- Day phone Unless otherw!se requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: q 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On-site [] Public Server The Municipality of Anchorage Development Services Depar',ment (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties sewed by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by e private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A er B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) tn compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Address r-~O~ Engineer's Printed .ar~e DSD SIGNATURE Approved for Disapproved. Conditional approval for , bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: .~".-,:~ ~'- O J MnnicipaHty of Anchorage Development Services Department Bul~dlng ,Safety Division On-SEe warm' & Waslawatar Program 4700 South Bragaw St. P.O. B~x 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ak.us (~07) 343-?g04 HEALTH AUTHORITY APPROVAL CHECKLIST LogalOescrlptlon: LOTI-~ _~.L: ~'?.SLLOI~ ~tLL~ PamellD: DIE,- A. WELL DATA Well type Date completed///a'/7 ~ Total depth .L~3_.~.._fl. Date of test Static water level Well production If A, B, or C provide PWSID # '/~, casedto 2'5 fi. FROM WELL LOG ~ fi. I, ~ g.p.m. Log (Y/N) y Well Wires property pmtectad (Y/N) Casing height (above ground) AT INSPECTION .q..~ fl. ~ .' .5' g.p.m. in. WATER SAMPLE RESULTS: Coliform ~ calonies/100 mi. Nitrate _~.~ rog JI. Other bacteria ~ colonies/100 mi. Date of sample: ~/;,,i / o , Collected by: -~, B. EEl=TIC/HOLDING TANK DATA Tank Type/Material ~ Tank size/1~--"~ ~ gal. Number of Compamnenla _ e~- Claanoula (Y/N) Foundation deanout,~//e.../e(Y/N) f)/ Deprassion overA ._.1 ~ /'~/~ ,.,,~,, }lank (Y/N) I~ High water alarm (Y/N) Data of pumping Pump. ~ C. ABSORPTION FIELD DATA Date installed Datainsta,,ed Soil rating (g.p.d)fl Width ~. ft. Lano~ 3/~ fl. Total depth I~.,(.' ~'.H Eft. ab-~:~ption area :~SZ.f~ Monitoring tube Dam of adequacy test ~/~/~,/ol Results (Pus/Fall) Fluid depth in absorption field before test Zj~) in. Water addedSOO gal. Elapsed T~me: ~'Omin. Final fluid deplh J~- in. Absorption rate >= Any rejuvepation treatment (past 12 mo.) (Y/N & type) System type ~.. Grovel below pipe '7 ft. Depression over field For ~ bedrooms New depth~'O in. ~ ~ O g.p.d. If yes, give date D. UFT STATION Data installed 'Pump on' level at Datum E. in. SEPARATION DISTANCES tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tan~llt station on lot Absorption field on lot ~°1 Public sewer main On adjacent lots I On adjacent lots | Public sewer manhole/cteanout Sewer/septic aewice line ,~ ,~ ~'' Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ +' Property line I (~ ~ Absorption field Water main I~ Water sewtce line ~' ,P-~- Surface water Wells on adjacent lots I ~.~ 4- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propert~ line ~O ~' Building foundation ~ o · Water main Watar Service line ,;2.~, ~' Sudacewatar Curtain drain ~ Wells on adjacent lots. ~.~o ~' COMMENTS Driveway, parking/vehicie storage ~ O '*~ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name '~, I Date ~ HAA Fee $ Date of Payment Receipt Numbe~ (~ev. Waiver Fee $ 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, GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner 4~-,,-~ ~ ~,'c,¢~/~,. ,¢'/c g',-~/'~ Day phone Mailing address Lending agency Mailing address Day phone Agent ~ ~-~-,~ / / Address .~¢2¢/ ~ "~'., ~,,¢,'~/c ,,¢_c~,. ,,¢~,~,~,,~ r-~ //,~' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest.. lng 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 MOA #21 5. STATEiV1ENT OF INSPECTION BY ENGINEER As certified by my seal affixed ,ner_to. p and asnf. tbeva~r_ato.~,daleshr)wnbetow, lveritytha!mv w~veshqation._ of this Health Authority Approval apphca/i{x~ shnws~ 'I~ ~,~ .... Hx- o ~ sit,~.., wa!er supply and/or wastewale~ disposal system is safe· function~]t and ad~: quate for the number o~ bedrooms and type of slruclure indicated herein. I further verify that based on the info~matior~ obtained from the Municipality of Anchorage files and from my investigahcm and inspec io~ , the on site waie~ supply and/or wastewater disposal system m u~ c~ ~ 3p!ia ~ce with all M nic oal and S ~te cocles. ordinances, and regulations in effect on the date of 't ,- , ~:$ u~spection ~ND ~ngineerin6 Narne of Firm ' Address .... q~ '~ Engineer's signature DHHS SIGNATURE · / /' Approved fo~ "~- ~ bedroom~. Disapproved Conditional approval for bed ooms wiih thr lolfowlp, o stipulatiorls Additional Cornnqents ] he Mumcipality of Anchorage Department of Health and Iduman Services (D;!HS) issue.", l leallh Author!ty Approval Cefiificates based only upon the representahons given 'rn paragraph 5 above by an independent profess~ona! engineer regfstered in (he Slale o¢ Alaska ! be [)HI tS does Items as n courtesy h) purchasers nt bombs and their lending inslitutions ~r~ order to satisfy certain federal and stale reatmemenh; Employeesof DHHSdo not rsonduct ~nspectlons or analyze data before a certdicate ~s ~ssuod q he Muniopahtv )f Ar~(boraqp ~s no~ lesponsible for errols or ol}l!s51ons Iff the professional engineer s worx Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Stree! Room .502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Log present (Y/N) Total depth Sanitary seal IY/N) Health Authority Approval Checklist If A. B. or C. attach ADEC loiter. ADEC water system nmnber )/ Date completed Cased to /7.6- '!o;-o Casiug height (above ground) __ ./~' ~ Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level ~ ~' ' Well production /, AT INSPECTION g.p.m, cfi, ~' -r' g.p.m. WATER SAMPLE I~ESULTS: Coliforul Date of sample: Nitrate B. SEPTIC/HOLDING TANK DATA Date installed ~.-,.9~ 7~' Tank size Foundation cleanout (Y/N) 7 /. z//57 mq.,~ Other bacteria / Collected by: 0','::9. , ,6~z) %~'r>~'a'r-i>~,g__ /02,--0 Number of Companlneuts ,,2 Cleanouts (Y/N) / Depression (Y/N) /c/ High water alarm (Y/N) ~ C. ABSOR~ION FIRLD DATA ~5 / / Date installed ~-W- 7~ Soil rating (g.p.d./fl2 or ft2&drnl) /~ ~ _ System type Length ~ ' Width ~ ~. Gravel thickness below pipe 7 t Total depth /~ Effective abso~tion area ~-g~ Monitoring Tube preseut(Y~) ~ Depression over field (Y~) Date of adequacy test 7'~- ~ Results (PassWail) ~ For ~ bedrooms Fhfid depth in absorptim~ field before test (in.); ~ hnmediately after//~ gal. water added (in.): /ff '/ Floid depth O (ius.) Minutes later: ~ mr'r) . Absorption rate = ~cyo 4 g.p.d. Peroxide treatment (past 12 months) (Y/N) (,o~,e_,,,~,,,,,,-/. If yes, give date D. LIFT STATION Date installed Size in gallons Maahole/Acccss (Y/N) "Pump on' 1~ "Pump ofF' level at* High water ~ ~m ~d E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tai~k on lot ~..2 ~ /~a,~,o~ /~:o"~: On adjacent lots Absorption field ou lot Public sewer main Sewer/septic service line adjacent lots Public sewer ,nanhole/clcanout Lia station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ ~- Property line /o /-g Absorption field ,a/ / Water main/service line /o ~ff Surface water/drainage /r.~ ¢ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /o ~ Water maitffservice line :.¢~- ¢P Surface water ./~ t~ Driveway, parking/vehicle storage area ~ ~ Cmlam dram .~j ~s~¢ ~ Wells on adjacent lots /~ ~ Property line F. ENG~ER'S CERTIFICATION / ~ :~ ~ ---- "---~0,.,% in co~brmance w~th MOA H/M guidelh~es in effect on th~s &te. ~... ~ Engineer's Name ~,~ ~ ~Aq ~~~,~} rote ~/~/~ ~,~".. c~7~,~* .......................................................... I~;; ~ _ - ............................. .... ................ ,,~:a;~ ~~ ~ Waiver F HAA Fee $ Date of Payment Receipt Number Date of Payment Receipt Nmnber Rev. 8/95 OSS: haa.wk.doc 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Completelegaldescription JoT q ~Lk' (o KASlZ-oF' H~LL5 Location (site address or directions) . IO/.leo Sl b O~ o ¢' ,4,qC/-/, ~'fS/(~ Property owner Mailing address Lending agency Mailing address Agent /',/, ,4-. Address Day phone 35z¢-7o/o Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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 legalify 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 MOA #21 '>HON~ S,J@@U!bU@ leUO!SSejoJd eq~ u! SUO!SS!LUO JO S JO J J@ JOJ elq!suodseJ lou s! @6eJoqou¥ Jo X~iled!o!unlAI eqJ. 'penss! s! @leo!J!~@o e eJojeq elep ezXleUe Jo suo!loedsu! 13npuoo lou op SHHQ jo seeXoldLuB 'slue~ueJ!nbeJ @~els pue leJepej u!eMeo/~s!~es ol J@pJo u! suo!lnlp, su! buipuel J!aql pue seu~oq jo sJeseqoJnd ol Xse~JnOO e se siq~ seop SHHQ eqj. 'e>~SelV jo e~elS eql u! peJels!baJ ~eeu!bue leuo!ssejoJd luepuedepu! ue Xq e^oqe § qdeJSeJed u! ue^!8 suo!le~ueseJd@J eql uodn XlUO peseq se~,eo!J!~Jeo le^oJdd¥ /gJJoq~nv qlleaH senss! (SHHQ) seo!A~eS ueuunH pub q~leeH jo lueLuMedeQ ebeJoqouv jo Xl!ledp!unl~ eqJ. s~uewwoo leUOR!pPV :suoRelnd!~s I~UIMOIIOJ eql q~,!M 'sLuooJpeq Joj le^oJdde leUOpjpuoo 'pe^oJddes!Q Jo¢ pe^oJdd¥ ~- =ll=lnJ.¥NglS ~~, eJn~eub!s s,Jeeu!Su=l ~'_~ I -Sh ~ euoqd ~'DA ~ /¢~3.L dO~.£~'7~ LUJ!~ JO euJeN 'uo!~oedsu! s!q~, jo e~ep eq~ uo ~oejje u! suo!~elnSe~ pue 'seoueu!p~o 'sepoo e~e~S pue ledp!unlAI lie ql!~ eoue!ldUUOO u! s! u~e~s/~s lesods!p ~e~eNte~set~ ~o/pue ~lddns Je~et~ e~!s-uo eq~ 'uo!~oedsu! pue uoi~eSi~se^u! ~u~ LUO~j pue sel!J eSe~oqou¥ Jo X~iledp!unR eq~ LUO~ peu!e~qo UO!~LUJO~U! eq~, uo peseq ~eq~ XH~e^ ~eq~nj I 'uie~eq pe),~o!pu! e~n~on~s jo edX~ pue suJooJpeq jo ~eq~unu eq~ ~oj e~enbepe pue leUO!~ounj 'eces s! Lue~s~s lesods!p ~e~e~e~se/~ ~o/pue ~lddns ~e~,e~ e~!s-uo eq~ ~eq~, s~oqs uo!~eO!ldde le^o~ddv/qHoq~nv q~leeH s!q~ jo uoReB!~se^u! ~u~ ~eq~ ~JHe^ I '/~oleq u~oqs e~ep uoRep!le^ eq~ ~o se pue o~e~eq pex!~e lees Xu~ Xq pe!j!Me3 sV "9 t~BBNI~NB AG NOI.LO:IdSNI JO J. N31AIB.LV.L~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LO'T LI,¢ I~LK ~o ,. 1~/~SILOF HIL~ Parcel I.D. A. WELL DATA Well type PRiV,~TE Log present (Y/N) Total depth Sanitary seal (Y/N) _ Y IfA, B, orC, attach ADEC letter. ADEC water system number Date completed ~'/11/7¢1 Driller D~T~q D~H,/.~N6 Co. Casedto 17,5" pe.. ~E¢5 &#er Casing height I$" Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main >.lOC Sewer service line Wires properly protected (Y/N) "/' ~.._. FROM WELL LOG AT INSPECTION g.p.m. B. I g.p.~ ~,~v~R ¢o~'a,qtEb 2 o ; On adjacent lots '~/oo , k.,'Atv~.~ 6~'/~t4'r£b :~ o ; On adjacent lots ~./oo Public sewer manhole/cleanout >-/co Petroleum tank ~,¢ WATER SAMPLE RESULTS: Coliform ~c¢ ! / foc,~ Z Date of sample: Nitrate '8. / /~ ('--(. Other bacteria Collected by:_ FLR'FT'oP TEd/-/ I~. SFPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size 12 5'0 ~/1~ Compartments :2, _ Foundation cleanout (Y/N) ~' Depression (Y/N) N.zq. Alarm tested (Y/N) N,A. ~?~/25/~/ Pumper 4 * SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~2 On adjacent lots ~/oo To property line ~ fie Absorption field 2.1 Surface water/drainage _> Foundation 5 .Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~8 Width Total absorption area ~ 32 ~' Depression over field (Y/N) t4o~e Results (pass/fail) PC) AS Peroxide treatment (past 12 months) (Y/N) NoNE Soil rating System type T~ENCH IZ Gravel thickness '~ per ?,-~, Total depth Cleanouts present (Y/N) "/ ('.5~ow~ Date of adequacy test for If yes, give date N. ,~ . bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot c~2-~ On adjacent lots To building foundation On adjacent lots Surface water Curtain drain t4¢~4~ ~/oo Property line To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area 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 Engineer's Name Date 199~ HAA Fee $ / Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANC.ORAGE D ¢/7 DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date '/¢/'~' "'~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner /t¢/'/~-~ Mailing Address /~ 'f-' Telephone (c) Lending Institution Mailing Address - (d) Real Estate Company and Agent '"~-',"~ l,d/C/~'-g' ('.~,, Address ~-~ ~-~ ~") / ~-~ ¢ ~'~/---/'- Telephone ~""~ Telephone: Home Business (e) Mail the HAA to the followina address: or: Check here E3, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~, Number of Bedrooms WATER SUPPLY Individual Weli~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~, Public [] Community E] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Fnvironmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev Bz86~ Fronl le^oJddv leUO!l!puoo Io suu.~e/ leUO!:l!puoo pe^o.~ddes!c] y,- pe^oJddv ~) -/-~ -- 5 al~o//~ /,~"~__.~ Aq sLuoolpeq ~-IYAONdd~fJ°l pe^oJddVsHHQ euoqdeje..L LuJ!_4 J.o eUJeN uo lee J/@ u! suo!lelneeJ puc 'seouempJo 'sepo3 e.le:iS pue led!o!unV~ lie ql!M @eue!lduuoo u! s! uJelS.~s lesodsip Je:leMelSeM Jo/pue ,~lddn9 Je:leM al!s-uo egI:l 'uo!l::)edsu! pue uo!:l'eS!lSeAU! /~t.u uJoJ~, pue sel!J aSeJoqguv jo X!.!led!g!unhl @ql u..ioJj peufelqo uo!:leu. JJo,tu! eq:l uo p@seq leq:l ,~j!Je^ Jeqpnj I 'u!e.~aq pe:leo!pu! eJnlonJls jo ed/~l, pue suJoo.~peq ,to JeqLunu al. enbepe pue leUOf:iounj. 'e,tes s! L,UelS~S leSOdSfp JeleMa:iSeM Jo/pue ~ldd ns.~eleM elfs-uo eql leq:l SMOqS leAoJddv/qpoq~.nv qlleeH s!ql ,to uo!le6!l, se^u! ,~LU leql ~J!J6,^ I 'MOleq UMOqS a:lep uo!:lep!le^ eql ,to se pue o~,eJeq pexhge lees Xuu Xq pe!j!peo NOI.LV~I:IO.-INI aNV YJ.'¢CI 'HebI'¢=IS :1'11-.I '$.LS~I/'eNOIJ.9=IdSNI 9Nlal^Ol:ld INbll:l MUNICIPALITY OF ANCHORAGE (MOA) /,h "1 ~'~,:~o'l~-EALTH AUTHORITY APPROVAL (HAA) MUNICIPALIIY (2F ' .'~ ':,'" : ~N\/i~ONt,4ENT/,,L SU..,',.,',:; ~S Di'./iSIOIq CHECKLIST - FEBRUARY 1984 264-4744 Well Classification If A, B, C, D.E.C. Approved (Y/N) ~//,~ Date Completed Cased to ¢ ~,/~',4~'~' Depth of Grouting Pump Set At Sanitary Seal on Casing~N) Depression Around Wellhead (Y~) ; On Adjoining Lots __ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot /~-~"'.~ ~' /Ct. ~,~/' ; Date Well Log PresentCN),, Total Depth Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: / To Septic/Holding Tank on Lot ~ ~,~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments (~) z~l,r~ SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~4) ~ Air-tight Caps~N) Depression over Tank (Ye Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,,~)/,,R Separation Distances from Septic/Holding Tank: ~' ~*~7¢ Size /~-~'O No. of Compartments Foundation Cleanout~(~N) Date Last Pumped ;for__ Temporary Holdin9 Tank Permit (Y/N) c/Z_.'" IO -¢ To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 trey 8¢861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~' "~'-7~ Width of Field Square Feet of Absorption Area Depression over Field (Y~__.~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /-'"/'/~ To Water Main/Service Line Type of System Design Length of Field ,.~'~ Depth of Field (~ /it Gravel Bed Thickness Standpipes Present CN) Date of Last Adequacy Test ~'~ To Property Line ,4J /.~ / To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Commenta2,4-/~l;aft/' ~)o~',< .~/'<~?" $,~,~ D. LIFT STATION ~ .,4, 2//~~ Dimensions Size in Gallons -~'-~ ~..~ ~/~"r Manhole/Access (Y/N) "Pump On" Level at ~'"'---~.~ "Pump Off" Level at High Water Alarm Level at ~ ~ Vent (Y/N) Tested for ____ ~""~'-~Pu pif:kg~C_ ycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** ~'~'"'-~_ I certify that I havevchec, Aed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~---'~-~ ~"///"~-- Date Company ,~r-~_~' MOA No. Receipt No. //O ~ J ~) 0 ~__~/ Date of Payment //'.~/ Amount: $ '{ /~2~o Page 2 of 2 72-026 (Rev 886t Back Iunicipa, tYof Anchorage P.O. BC 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 TON Y KNO WL ES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES February 10, 1988 Alan C. Wien Engineering Technician Alaska Environmental Control Services, Inc. 1200 West 33rd Avenue, Suite B Anchorage, Alaska 99503 Subject: Waiver Request for Lot 4 Block 6 Kasilof Hills Subd. Waiver Request Number WR88-005 Dear Mr. Wien: Your request for waiver of the required separation distance from a residential well to a septic tank and absorption field has been approved. The required 100 foot separation has been waived to 92 feet and 99 feet respectively. Although the well log and the field measurements of the well casing conflict, you verified visually in the field that the casing does indeed seat into the bedrock. You also verified that no water enters the well above the 40 foot depth. This will assure that surface contamination will not likely cause a problem. This approval applies to the existing well to septic system separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-Site Services cc: Gus Andress, P.E., Manager On-Site Services/Water Quality Programs ALASKA [ZFIUIROFImEFITAL COFITROL $ERUI£1 $, Inc. ~nclin~¢rin§ 5 ~nuironmcnlol Sludi~s January 15, ]988 Municipality of Anchorage Department of llealth & thlman Services 825 L Street Anchorage, AK. 99501 Re: Lot 4, Block 6, Kasilof Hills Subdivisioa Waiver Request A Health Authority inspectien shows the separation distance from the well to septic tank and trench to be 92 feet and 99 fee~ respectively. The well was dr[lied 4/11/79 and the sewer system :installed 6/8/79. The sewer system was inspected by Lynn Lindqaist of the MOA and shows the separation distance to be 104 feet to the taak and ~rench. For your waiver evaluation, the well is 125 feet deep with bedrock starting at 21 feet. Static water level is 72.5 feel:. The septic tank is steel. 2 co,lpartment and should have water' tight couplers on the inlet and outlet. Tile trench is installed in GP soil rated at 125 square feet per bedroom. The entire sewer system is downslope from the well with the house located between the two, The slope to 'the west is quite steep, se 'the efflnent frem ~he sewer system will flow away front the well. Water samples taken 1/~3/88 are satisfactory. feel that the well is in no danger of contamination from the sewer system and request that you grant hhe appropriate waiver'. If you have any questions, please cai]. Sincerely, Alan C. Wien Engineering Technician 1200 ~¢sl 33rd ~ucnu¢, $ui1¢ [~ **Pinchoraq¢. /~loska 99503,[907] 561-5040 ALASKA eF1UIROFImeFITAL COI1TROL $ RUtCeS, IF1C. ~nqincerinq $ ~nuironmcnIol $1udies Febraary 4, 1988 Municipality of Anchorage Department of Ileal'th & lluman Services 825 L Street Anchorage, AK. 99501 Attn: Dan Roth Re: Lot 4, Block 6, Kasiloff lfills Sabdlvi,'~ion Dear Dan: On 2/1/88, I accompanied Alpine Drilling to the sabjecL lot to verify the casing depth for your waiver evaluation. There is :18.5 feet of casing with 17.5 fee~ below [he ground surface. The log shows gravelly clay from 17.5 to 21 feet. I~ appears, from visaal inspection, that the casing is to bedrock. It is possible that 'the well log depth measurements are incorrect or, supface soil, label, led overburden, may have been removed which could chexnge ~he depths to match what we now find. Static water level is 22 feet. There is no incoming water above 40 feet. If you have any more quesLions, please call. Alan C, NJ. ell Engiaeering Technician Approved by: / .>/ Le~)~C~}Reld J r.,/~hl), P res i dent PE J~IICIPALITY OF ANCHORAGE DEPT, OF HEALf;,-I & I~IVlIIONMI~NTAL PROTECTION fEB 8 t988 RECEI.V_E 1200 LUesl 33rd Avenue. ~uile ~, Anchorooe Alask. 99503 .f9071 561-5040 ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO CALCULATED BY //~ CHECKEO BY OF DATE MUNICIPALITY OF ANCHORAGE MUI',~JCIPALIW OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ....... C_EPT, OF i::ALTII &  ' ~'~WN~ qMENTAL f'kO [ ECTI~N 825 L Street - A~cborage, A as~a 99501 ' ENVIRONMENTAL ENGINEERING DIVISION JUL 2 ? ]9 ' Telephone 264-4720 DIRECTIONS: Complete all parts on page 1, Incomplete requests wilt not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER J PFIONE PROPERTY RESIDENT (If different from above) PHONE ~, BUYE~ PHONE ~AILI~G ADDRESS ~. LENDING INSTITUTION PHONE 4. REALTOR/AGENT ~ ~ PRONE' MAILING ADDRESS 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE': FAMILY NUMBER OF BEDRODM8 A [] One ~_ Four [] Two '[] Five [] Three [] Six [] Other 7. WATER SUPPLY ~,~ INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY * ATTACH WELL LOG. A well log's required for all wells drilled since June 1975, For wells drilled prior to that date, g~e well ~ depth (attach log if available.) /~/) J~"~. ~.~ findivdua/on-ste, gve nsta atondate ~/./~. If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [~ ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED Eli PUBLIC UTILITY Connection Verified LOG RECEIVED! 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER I~lSepti,~a~.~or []Holding Tank Size: ~ ' If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~;~'~ APPROV ED FOR ~ BEDROOMS E] CONDITIONAL APPROVAL (letter must accompany certificate) E~] DISAPPROVED DATE BY (Title) r LEGAL DESCRIPTION 72-010 (Rev, 3/78) l U) ¢m cli o F- ¢ o ►- Q m 0 ~O �, _ QXui F- �o J ¢ ~ z $ z z ¢ h X cli LL N 89059'00" E 320.16' a: w Q N o �zw w ---------------------------- E- U)W EWo m W — — — — — — — — — — — / /0 J W m w U c, ED a m QO JpEL JLO Ti) / C 2 a 1 = C� m =- m Y LL z O w O E -I U) U) - o `n , = m j -Z o = v a F- - to z > m �- WI } :;, �� / LLU ¢ �zO Cl) mac° w G�' `U'`' F -w cD m2g s� Q �) }/ Of Y WwW NW W �Q �n WI /� / UCS U (�>O� O O HI ^ his mZ �wZ t=-� Z� ZQ `'I \k Y ��Q U J N I w N o O / N o w 0 Q� ti �°' z Q z o C) / I- W W Q w W J \ Zass O / 0zU)W ¢F- W¢ v z3:w= Qw 00 vJ nj O c! 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