HomeMy WebLinkAboutTRAILS END BLK 5 LT 8Trails End Block 5 WOTE 11081 1 If lei #015-192-33 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221299 PID Number: 015-192-33 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Van Tuyn A ORPTION FIELD EE]D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11240 Stroganof Dr, Anchorage, AK Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 DIS F Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Trails End 5 8 Fill added above original grade Gr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between t ches From Tank Field Tank Line Ftz Well 100+ TANK © Septic ❑ S.T_E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1250 Gal. Surface water 100+ I Material Steel Number of compartments 2 Lot Line 5+ I NA Foundation 12' UFTTATION Manufacturer Capacity Remarks Moved tank location to meet separation of tank Gal. and garage foundation. Alarm location Electri lied by Installer PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 JR's Drainfield CO/MT D3034 Inspector Areterra Consulting BENCH MARK (Assumed elevation) 100ft Inspection1� Location and description dates: 8/2/22 2nd 8/2/22 3rd 4'h Garage roof ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF 4r�t 49111 * �, ■ Septic S st Approved "'-J �^- (" Date -2 f �► KENNETH M. D ��:�s� c �»a • 441111iiiiiis Note: this approval does not include well permit requirements. (Rev 05/02/18) u SEPTIC VENT (typ) A -C=35,3' B -C=30.7' A -D=35,9' B -D=32,0' A -E=38,2' B -E=34.4' A -F=45.8' B -F=41.9' A -G=47.6' B -G=44.2' A -H=47,1` B -H=44.4' AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221299 TRAILS END BLOCK 5 LOT 8 PID# 015-192-33 125 TAP F C VES PAVED EXISTING\ DEW GARAGE W v� 55 COMPUTED: 5 DRAW KSD. STMNG N/A 'Eq®: KMD ASBUILT: JLS DATE ,8/15/22 WJ JJ (J.IW J JOB NO•: 22144 0 U. —IaN P125 0 GCAL l EPTI SCALES NTS {� OF•.AL Aar Y. •1 Ao 4 TH KENNETH 4 D S ' ` CE- ,. 0 FESSIC�' PREPARED FOR: VAN TUYN 11240 STR❑GAN❑F ANCHORAGE, AK RELD BOOKS COMPUTED: BOUNDARY:..N A DRAW KSD. STMNG N/A 'Eq®: KMD ASBUILT: JLS DATE ,8/15/22 DWG. Fly: GMD: SW2641 ACRD FRE'FILE JOB NO•: 22144 I SCALES 1' = SCALES 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: OSP221299 Work Type: SepticTank Upgrade Tax Code Number: 01519233000 Site Legal Address: TRAILS END BLK 5 LT 8 G:2641 Site Mailing Address: 11240 STROGANOF DR, Anchorage Owner: VAN TUYN PETER H & Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: nt '0 S�• G V Department 8/8/2022 8/8/2023 22800 ❑ 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 Received By: Date: Issued By: (/(/ Date: 2 4 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 015-192-33 ANCHORAGE ON-SITE SEPTICIWELL PERMIT APPLICATION Property owner(s) Peter VanTuyn Mailing address 11240 Stroganof Dr, Anchorage Site address 11240Stroganof Dr, Anchorage Day phone Legal description (Sub'd., Block & Lot) Trails End Blk 5 Lot 8 Legal description (Township, Range & Section) Lot Size 22,800 Sq. Ft. Number of Bedrooms 4 Phone: 907-343-7904 Fax: 907-343-7997 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 ElUpgrade FX]Duplex (D) ElHolding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: f 13 5 Date of Payment: �Ia&���� 72a Receipt Number: �'�' % 1 i 008141G Permit No. 0 S pad o 9 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221299, Deb Wockenfuss, 08/08/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221299, Deb Wockenfuss, 08/08/22 Mayor 08veloWnent Services, Department all"d'ng Safety NVISiOrl On-Si,te 'Fater & W'Osfew!3ter Proc -11-00 E:�.more Pioad gram P-0, aox 196650 Arichcroge, AK 99507 (907) 343-7904 Pump Installation Log WeU Drilling Permit N-a-mber:8-W Parcel Identification 'Number: -2- 5-- 19 2 33 Legal Deger—,Pti(Z--� 7rccjo &,:3/ -— Puy -"P Itlit if lat-1—OnDat'e: Date of issue.. e Name —,& :address: 5 L S F -PumP IP-tftke Depth below Top of Vvell `asin feet� Pul"P Manufacturer's Nalve.. 14-(,� Pmrap Model: pump $17e 1 I f- - 4 — hp Pit[6ss,A,dapterBtiria!Deptil.iq feet Pitless Adrlpter Manufacturer,, N..., Rffless Adapter Justailer. Well Disinfected (!po, CampletiD -O !etlta of Disinf.t- ,- N. iton: ,D-ffimerts! temp Installer N a m e: 'tention.- Th, pL:rlp irstalj. ; sail prop de a Pulq, rs�ftll n log t th atia L -d i P, t,,, d _ u n� r, 1! e,,V, 9 0 P-. i o Li o u V d u) p ,:71D6 i 1 1 97, r -IL 8 Municipality of Anchorage Development Services Department=' Building Safety Division On -Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 2 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW050098 PID Number. 015-192-33 Nome: PETER VAN TUYN Wastewater System: O New ■ upgrade Address: 11240 STROGANOFF DRIVE, ANCH AK 99507 *EXISTING* ABSORPTION FIELD *EXISTING* Phone: No. of Bedrooms:17 (907) 346-2864 4 O Deep Trench O Shallow Trench ■ Bed Cl Mound ODther* LEGAL DESCRIPTION $a"°"" Tata p.wh ham vpnayaa: CPD/Sa. M1 M1 Block: Lot: Subdivision: depth te Pipe tHtt. ha„ oASNat Peds: rdawl depth beneath pipe: 5 8 TRAILS END ft.( M1 Township: — Range: — Section: — M odded neo,. arlslnol Pale: R WELL: ❑ New p Upgrode GpeN .oft N„mD.r W tine.: Uelanw Mown Noce: M1 M1 Cbwlcaeon Pmet., A.D.Q. Tad Deo Cwed To (OU)NOCK) ToW absomtkon ono: Fee m dcl: rt (NFt So. rt Static water LwN: Maven *GLW W. kwi~ Da . J\S\\• We pN4d: / M1 held:Pump Ser At: Ceei g Height Avow Wowk: TANK *INSTALLED 8-9/2005* cepa M1 M1 SEPARATION DISTANCES ■septic OHolding OS.T.E.P. C) Others To Septic Tank Absorption Field Lift Station Holding Tank /Prlrole sewer unwe Yawt ctu . ANCHORAGE. TANK Copoc'b In 90 : 1250 rrom Well 100'+ — — — 25'+ STEEL aw ''2 Surface Water 100'+ — — — — LIFT STATION Lot Line 5'+ — — — — Size In 9.0":rdanaocta.r. Foundation 5'+ 'Pwnp M Riva a: amp ell oL Hph .oter abm OL — — — — Pump tdote t EMatika Nwv.ntieiie prfomied lr Curtain Drain NONE KNOWN BENCH MARK Remarks: Locobon ono 0 ..ripeon: *TANK INSTALLED WITHOUT INSPECTIONS BY GLW BOTTOM OF SIDE DOOR THRESHOLD. ENTERPRISES IN AUGUST SEPTEMBER OF 2005. Awwrwd EM.atwn. 100.00 M1 ENGINEER'S ll A PER HOMEOWNER, OLD TANK WAS REMOVED AND DISPOSED OFF o006o p�D gC'9sd0o PROPERTY. NEW TANK IN SAME LOCATION AS OLD. o �.• Inspections performed by: GEG, Ltd. Dates: 1st a/is/os .:......-.............:.°.. � 2nd p 3rdQQ '. A Gorness. Development Se ices Department Approval O O l 0 c —7 s3 .• .v '' Reviewed and approved by: Dote:,11 I� i]� e� 6 }� x • •' PAdO �4p0 roressl000� 400000 PERMTTNUMBER: AS -BUILT DRAWN \ G PARCEL NUMBER: SW0 SW050098 015-11 92-3333 ST1 ST2 DBL1 DBL2 EXISTING I •T DRAINFlELD r —ico I \ NEW 1 BDRM I ETHREEO I I 1 ADDITION r BEDROOM I \ IA I HOUSE e 46.3 33.6 44.8 40.2 1 ♦0� 43.3 41.9 TH# 1 Fcb :.: • ; SCALE: 44.5 41.5 \ I • 1• - J0• DB I DBL NEW 1250 GALLON ' . , •. • ; CSEPTIC TANK \ ".•'� ¢NLS END S/D; LOT 7, BLOCK 5 WELL 100'+ FROM S. LOT UNE TOP OF TANK AT INLET - 95.26. u NEW 1250 GALLON CALCULATED INVERTSEPTIC TANK OF BUNG AT INLET 94.68 610: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS i3"' L TAW IG,D. fWC 101 • MKM01„L(. Ml eem . 11eYlC (e0n}l)41>♦ . F" 007)OM " e ' eee.pneewyiwwyaaw PREPARED FOR: PHONE NUMBER: PAGE NUMBER: PETER VAN TUYN (907) 346-2864 2 OF 2 LEGAL DESCRIPTION: DRAWN BY: TRAILS END SUBDIVISION: LOT 8, BLOCK 5 K.D.W. TYPE OF WORK: DATE: AS—BUILT OF SEPTIC TANK UPGRADE 4/20/06 (Rev. 01105) GRADE - 98.02-98.51 TOP OF TANK AT OUTLET - 95.22 LiJ 0 O Q 0 O Of N CALCULATED INVERT OF BUNG AT OUTLET - 94.47 _ 4 .I ... .. .. ..... ........... p f ey mess. E-7 53 •.1t I ..•' w MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 26, 2005 Expiration Date: Apr 26, 2006 Permit Number: SWO50098 Parcel ID: 015-192-33 Legal Description: TRAILS END BLK 5 LT 8 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 011240 STROGANOF DR Owner Name: PETER VAN TUYN Lot Size: 22800 SO. FT. Owner Address: 11240 STROGANOFF DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99507 - This permit Is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: �&ZJ:—UaS" k� V�—sd✓1 lsd ' 0, Date: Cap Municipality of Anchorage •"' '' '11i'•, Development Services Department Building Safety Division On -Site Water & Wastewater Program ' • " 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. Ols - (ga.- 33 Permit Number Property owners) — PETER VAN T YN Day phone 346-7664 Mailing address (1) 11240 STROGANOFF DRIVE • ANCHORAGE. eu Mailing address (2) Zip Code 99507 Legal description (Lot, Block & Sub'd.) LOT B. BLOCK 51 TRAILS NO S BOM ION Legal description (Section, Township & Range) N/A Lot Size 22 M0 Acres6D Number of Bedrooms 4 THIS APPLICATION IS FOR: Sewer Only 0 Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. (Signature efpfopeFty owner Permit Fees:_ t'/ ) Date of Payment: y -,?)-05 `� fR Receipt Number. o Waiver Fees: Date of Payment: Receipt Number. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS April 12, 2005 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Tank Upgrade for Lot 8, Block 5, Trails End Subdivision To whom it may concern: A 1000 -gallon septic tank currently serves the existing 3 -bedroom house. The owner is adding one bedroom to the house making it a total of 4 bedrooms. The drainfield was originally sized for 4 bedrooms. We are proposing that the existing 1000 -gallon septic tank be replaced with a new 1250 -gallon septic tank. There are no surface waters within 100 feet of the proposed upgrade. We have identified a reserve site for a 4 bedroom system. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your ACCICtAnrP V.S. NOTE: Attached is a site plan drawing, a design drawing, and two soil logs which are all part of the design package for this septic system. (Contact C.E.G. Ltd. for 7 page construction specification letter.) 3701 E Tudor Road, Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246Website: garnessengineering.com I I _ SHEBANOF AVENUE `\ / \ \ 1 W1 �I Z LLI QI \ I \ W \ '^ \ \ ^I \\ \ tOJI \ j Y DI / I < i I 1 OL / Ir /1 W / I / / / N \ I _ \ 1 U \ Q w \ > \ LL \ / Y I 1 Z I I %p N 1 N / TRAIL STREET / V. 100' I OF GARNESS ENGINEERING GROUP Ltd. CONSULTANTS t GENERAL CONTRACTORS��� . � 4 �........ .. .... .............D Al L NOM IpfO, MIC 101 , fIL1MIGL Nf N.OI . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ... ........ Q PETER VAN TUYN (907) 346-2864 1 OF 2 ''.J f e . G mess.:O LEGAL DESCRIPTION: DRAWN BY: 00 °o; TRAILS END SUBDIVISION; LOT 8, BLOCK 5, C.J.G. ��0�, lfllj oS�Aov TYPE OF WORK: DATE %- pr -f- SITE PLAN FOR SEPTIC TANK UPGRADE 4/12/2005 ���O000�c ff)w IIIIX. LIDO, r-- � II 1 �— �"�=`� I I I .�„' WF71 RADIUS_1 TRAILS END 5/D; �7R1.ULS END 5 LOT 1, BLOCK S, I II �+/-D' \\\ L\\ I I I LOT 10. BL �-SEPTIC AREA `-SEAR LOST 2 BLOCK, I I // TRMlS END S/D; C� I I l�T 9, BLOCK S. I IXlsmNc I —,----- ISEPfIC SYTE _ _ \� TRAMS END 5/D; LOT 3. BLOCK S. u III � I f +• �1 IV6Et II I TMJ1 II Jn0' I enl le 1/ I IXISfiNC /� III � ous�M � �TRAIL/S END s/D: p.�� LOT t, BLOCK S, III ,6- SLS END S/D;-- / (1` LOT 7. BLOCK S, – � / III 1102!' wn 1 I I TRAILS END 5/D; TRAILS END S/D; LOT S. BLOCK S, I I LOT G. BLOCK S.� II \ I TRAILS END S/D; LOT 3, BLOCK S, � II � II � II I II TRAILS END S/D; LOT 4, BLOCK 3, II HAI PERTAINS TO THIS DESIGN. FAIN A COPY OF THE LETTER \ \ DEC. BY PROCEEDING FORWARD Eiii.l TRAILS END 5/D; � LOT 9, BLOCK S. / �I _ 100• WELL RADIUS Ion, WELL RADIUS I � � I I 1 I 1 1 1 1 1 1 \ g 1 1 � _EXNG 1000 &� 1 I 1 I 1 CALLON TANK WILLm� I I 1 1 BE CRUSHED AND 1 ITM+A BURIED TO MOA 1 I I I I I 1 I 19 Gt 1 (CATIONS AND TERMS AND II \ iNED. \ DOSED \\\ '. i'R:Y:�'•�!�!, /// C1� 07.J / '— INSTALL DOUBLE DOUBLE CLEANOUT CLEANOUTS TRAILS END S/D; / LOT 7, BLOCK S. GARNESS ENGINEER CONSULTANTS & GENERALING4�GROUPe_ ,Ltd. ppm?:' Rol L 7110M I A r.lc lel • roawcc M N 7 . • • • !�Y/( (�01).1T)�17♦ . M7 (,Ol)17F]7N .w.q..�pwrny�w PREPARED fOR: PHONE NUMBER: PACE NUMBER: PETER VAN TUYN (907) 346-2864 2 OF 2 LEGAL DESCRIPTION: DRAWN BY: SOD L. • . TRAILS END SUBDIVISION, LOT 8, BLOCK 5, R.A.L. TYPE OF WORK. DATE: DOC SITE PLAN FOR SEPTIC TANK UPGRADE 4/12/2005 (R". 0IM5) Munlclpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 OV Street, Anchorage. Alaska 99502 -MO SOILS LOG — PERCOLATION TEST PERFORMED FOR:�Gye /J I �SO n DATE LEGAL DESCRIPTION: Z-'8 4jr T.II It Township. Flange. Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 16 17 16 19 20 WAS GROUND WATER ENCOUNTERED) S IF YES. AT WHAT / / L 0 DEPTH? (0 E BePb b Water Mer IIatl"? otu T/dN P-3-97 say UPERCOLATION RATE lmmulevmh) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: ' 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 IRev. 415) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825'L7 Street, Anchorage. Alaska 99502.0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: SGO // Aj/ I SO/f DATE LEGAL DESCRIPTION: 17 Of: t• 71Zs /lt ,%./ S✓j Township. Range. Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 16 19 20 COMMENTS Gr.2✓a Ja.,d Coarse CGP/vP) SI.•� frAv+/• SLOPE IF YES. AT WHAT DEPTH? MewrYl? �� tlNc R�oiiiiffii�■ 1N . PERCOLATION RATE /7- (mmuteymcb) FERC HOLE DIAMETER �2'Y TEST RUN BETWEEN is FT AND 3FT PERFORMED BT: �G=,u w t - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE*��90 72-008 (A". 4M) _V"AGZKR= �a��Q3'�� s� �ram0; mLi � PERCOLATION RATE /7- (mmuteymcb) FERC HOLE DIAMETER �2'Y TEST RUN BETWEEN is FT AND 3FT PERFORMED BT: �G=,u w t - CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE*��90 72-008 (A". 4M) nes /91-33 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES EnvironmenW Health DivWon 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ten» t' SOON r �SO n DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL _ //o?�D rS/ ro n dFF 991/6 GMrle(S) MTn NO. NO. OI BeOrOOms c3 Y4-3/Jd' 000T.T 3LOT WELL !Od //0 LINE 1.113M. DESCRIPTION Lot Black � $ODa�On r.�iIr .Enc/ FOUNDATION Township. Range. section /AA..) A3 AS -BUILT DIAGRAM on.wway.wateodIM. Snow buuon of well. CC,) septic system. p opany Imes bunauon,T TANKS o y $t SEPTIC ❑ HOLDING MM�Ig�IOHr ` xd'0rz'e Capacity In gallons /000 Mate" l No. of Companments TYPE OF SYSTEM ❑ TRENCH ;9 BED ❑ W. DRAIN ❑ OTHER Depth 10 pipe W10m 190m Orgmal grade 0.7 FT low beptn Iran •prow grade /,;z FT FIII •odea aoove al9mel 91800 FT Gravel depth beneath Ppe O •S FT D y Gravel "in FT Gravel width FT Tow absorption aha 9/0 SO FT Distance between ves S FT jr Jf Number of lines Z Sal rating 1 :ZO/ SOFT Pipe materw e Insleller 014 N t o N(V Bros Dale Inawleo WELLS Rip 7 r,D 1 ' i ❑ PRIVATE ❑ OTHER (Iden9ty) classification fAB.C) ii Installer ` Taal DepthCases to FT FT Date Installed. //1 P1 T vd REMARKS::jyl alz-io.r OY2r pec 7a,L a! 1ome^ffv� 4a•tC;) bed.8ec(%tu avve. �' 2 - , e/� / ZA G Scars: Inspections Data. Performed by: _ENGINEER'SSEAL - ... . i f' " cpe 3oweo+e h, if e • veruty that INs htapedion wu performed Kwding to all IAunidpat and State Suldsinea N sled on thtadale '2 Health DepaAment Approval: _,& Date: 4 Aee 72-019 (9/95) / frivlA�T, ¢:OOp.N. M U N I C I F' A L I T Y O F A N C H O R A G E Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-43?4- MY- yGg/ O N- S I T E S E W E Rif P E R M I T Permit Number: 900003 Upgrade �'LJ:)9[�(�i8'd Date Issued: 04/27/90 Engineer Designed Owner tame: SCOTT WILSON Day Phone: Owner Address: 11280 STROGANOFF DR. 346-2679 ANCHORAGE, AK 99516 Parcel Id: 015-192-33 Lot Legal: Subdivision: TRAILS END Section: 24 Township: Lot Size 22800 (sq.ft. or acres) Max bedrooms: This Permit: 3 Total SEPTIC TANK: Minimum total septic tank: tank must have at least 2 compartments feet requires insulation over tank(s). Lot.: 8 block:: 5 12N Range: 3W Capacity: 3 capacity: 1,000 gallons. Each septic Depth to top of septic tank(s) < 4.0 TO BE INSTALLED PER ENGINEERS DESIGN WITH THE FOLLOWING CHANGES 1. DRAINAGE SWALE FROM DRIVEWAY IS TO BE GRADED AWAY FROM SEPTIC AREA. 2. ABSORPTION BED MUST BE CONTOURED TO SLOPE SO AS TO MINIMIZE THE NEED FOR ADDED FILL. 3. NOTIFY DHHS OF ANY DESIGN CHANGES AND PRIOR TO EACH INSPECTION. THIS PERMIT IS ISSUED FOR THE EXISTING 3 DDRM. DWELLING AND EXPIRES ON 12/31/90. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid bor a maximum of 3 bedrooms. I also understand that the capacity of the total system is 3 bedrooms and any enlargement wQ15hequire an additional permit. Signed: ------------ DATE: u " (Owner) SCOTT WILSOr Issued By: '/G l__ & _--------- DATE: - f!= LLQ---- -�--- .-- . I •• A ALASKA CIIUnonmenTAL COIITIIOL SCRUICCS, inc. Enginccrinq 6 Enuironmcmal StAcs MUNICIPALITY OF ANp W DEPT. or MEA ENVIRONMENTAL PROTECTION P. 0. Box 240668 Anchorage, AK 99524-0668 APR 2 51,030 (907) 279-5553 •** FAX (907) 276-8706 RECEIVED April 24, 1990 Department of Health & Social Services Municipality of Anchorage 825 L Street, Fifth Floor Anchorage, AK 99501 ATTN: John Smith RE: Lot 8, Block 5, Trails End Subdivision 015-92-33 Dear John: Under the provision AMC 15.65.040C, I would like to apply for a waiver of the length of the bed for this lot. AMC 15.65.075D requires a length to width ratio of not more than 4. This lot has a shallow groundwater table and an increasing slope which precludes installing a conventional bed. Two percolation tests were performed. The one used for design is 17 minutes per inch. The second one is 6 minutes per inch. However. I feel that the entire system should show the most conservative design. During the development of the proposed ordinance the technical committee contacted personnel of national stature on wastewater systems. The concensus was that the length of a system is irrelevant to its ability to properly function. As a professional engineer. I submit the design as based on accepted scientific facts. Any future work on this lot will require a curtain drain to control groundwater. If the groundwater table is lowered then the original system will again be functional. Also, quoted in the review as a reason for disapproval was AMC 15.65.060 A4. There is no bedrock within 6 feet of the bottom of the system. The symbols shown, the Unified Soils Classification System. are to signify a GM soil, not a fractured bedrock. A second soils test hole was done the same day as the original soils test. I did not send it forward. However. at this time. I am submitting it along with the first percolation test data. I therefore request that a permit be issued for this lot. Sincerely yours, Ler C. Reid, PhD, PE, DEE LCR/sr i�•4 T e V Municipality of Anchorage e•* • •• DEPARTMENT OF HEALTH & HUMAN SERVICES 0 825 "L" Street, Anchorage, Alaska 99502-0650 �• ; ••••• •• SOILS LOG — PERCOLATION TEST 0 1, c SBD, u. :_ E-2251 ,, a p���y o PERFORMED FOR: SCOft / �SO DATE PERFORARiib� LEGAL DESCRIPTION: 7&11 /S k)•d JvZ Township, Range, Section: 7-/6LIV -P-3'co ray SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER �jlf ENCOUNTERED? S IF YES, AT WHAT /_ I L DEPTH? (O P E Depth to Water Alter Monitoring] Date: PERCOLATION RATE )minutesnncn) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: • 1 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: !l'? Zkc> 72-008 (Rev. 4185) I e V Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: SG" /j.46O-, I LEGAL DESCRIPTIONJ a Qjr T!'�//C A -hot S.Z Township, Range, Section: 7 1,2 N /L pN S'.Z/ of eP1 SLOPE SITE PLAN 1 2- 34567 3- 4- 5- 6- 7 8- 91011 9- 10- 11 12- 13- 14- 15- 16- 17- 118- 19- 20 213141516171a1920 COMMENTS WAS GROUND WATER IJO ENCOUNTERED] S IF YES, AT WHAT L O DEPTH? P E Depth to Water Alter Monitoring] gate: ®®mmm —©®EERM.01"t"fic RICO 2-2® —� —00970— E��' GG.. PERCOLATION RATE (minutest mh) PERC HOLE DIAMETER ...1� TEST RUN BETWEEN FT AND /• I FT PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) `C , ALASKA EIIUInfIwTRL COnTROL SWICCS, IX Engmttrinq 6 Enuironmtnlnl StAts SPEC FICATIONS FOR nFn WASTEWATER TRFATMFNT SYSTEM LEGAL DESCRIPTION: LOT 8, BLOCK 5, TRAILS END SUBDIVISION 1.0 GENERAL 1.1 The Drawings, sheets 1 through 3, shall be part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of health & Human Services (D111IS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 All excavations 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 property owner or installer to adhere to approved design for the Installation. to maintain the specified separation distances and to have the appropriate inspections. 1.5 It is the responsibility.of the property owner or installer to report to the engineer any observed conditions which would put the system in violation of state or Municipal regulations. 1.6 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. The structural integrity of the tank must be verified. 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 polystyrene rigid board insulation. 3.0 2.3 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.4 The septic tank and bed 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 DIMS or Alaska Department of Environmental Conservation (ADEC). 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 D-3034 or cast iron, sloped a minimum of 1/4 inch per lineal foot on the inlet side and 1/8 Inch per foot on the outlet side. If the piping Is buried at a depth of 4 feet or less, 1t 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 extend 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 and design drawings are on file with the municipality and the engineer. SEEPAGE BED 3.1 The gravel for the bed shall be 0.5 to 2.5 inch, screened rock with less than 3 percent passing the No. 200 sieve. All substitutes must have prior DHHS approval. 3.2 The bottom of the excavation shall be level and raked with the backhoe blade to ensure that the bottom has not been compacted during excavation. 3.3 Sand, for leveling, shall have a size distribution which meets the requirements of MOA code 15.65.077. 3.4 The distribution pipe shall be perforated 4 inch rigid PVC with a minimum crush strength of 1500 pounds and shall meet the approval of DIIHS for use as drainfield pipe. All pipes shall be laid level, and spaced according to the drawings. 3.5 Monitor standpipes shall be placed as shown in the drawings. They shall be 4 inch rigid PVC ASTM D-3034, or cast iron. The section shown with holes may be either drilled 0.5 inch holes on 6 inch centers on opposing sides of the pipe, or a section of regular perforated sewer pipe may be clamped to the solid section with a no -hub coupling or solvent joint. The perforated section of the monitor tube shall be located in gravel only. The portion of pipe above the sewer rock shall be solid. A rubber raincap (Jim Cap or equivalent) shall be placed over the top of the pipe. 3.6 Filter fabric is required. 3.7 The side slope of the mound shall be slope 1 foot vertical to 3 feet horizontal. 3.8 The bed shall be planted with a white clover and red fescue mix, or with Kentucky bluegrass. 4.0 INSPECTIONS 4.1 This bed will require a minimum of three Inspections. 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 gravel, monitor standpipes, and distribution pipe, to verify proper installation and position of pipes prior to backfill. 4.3 The third inspection will be after final backfill grading and seeding to ensure that adequate soil cover has been provided over the bed. 4.4 The inspection of the septic tank or lift station Installation can be incorporated with any one of the above listed inspections. 4.5 The lift station will electrical inspection licensed electrician building code applies require either an MOA or certification by a depending on whether the to this part of the city. ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE. ALASKA 99503 (907) 561-5040 aod0/) ;L$ 6r iii,/r <7�J sa1 SHEET NO. / OFJ? CALCULATED BY 1 • ^' DATE CHECKED BY SCALE DATE N% I_ _t.—T M N Q Q` w o � � w 4'1 A$ n ZJ bi Ln x j :� I I I =`� ►� ��I I I • ' L Z �� •I -� �,1 =� a 40 O; I� • � bis .:- ••• _i0� OF At OF A4 c3 eo' *, .Jam.. Carl DowC % / c .�• err'.• 15645 4 AV * .A•: IEROY C. REID JR. F ., .• gJ4' i }� •E -2251 5/ Sek••ar a 6 •_-" - 9 --t-? f Vii;�fiNtd ViV.Ik.s. OevcY 04 -sere— Sys 591,5o 1,1,4E /90.00 s. /L • Es —7 -- —..IJ 8 Yz- s -r It- / 2 VRI OF 1 sip. LT WIC. ,y. • - 7--: fiamiBul .. Sir. Itlis the responsibility of the Own& -to determine the existence of any easements. covenants, or re- '7 •.I ~ - strictions which do.not appear on•the'recorded sub division plat. Under no circumstances 'should any NOTE -• - data hereon be used for construction or for estab- EASEMENTS OF RECORD OTHER-THANTHOSE lishing boundary or fence lines. The surveyor takes SHOWN ON THE RECORDED PLAT, ARE NOT responsibility for the initial transaction only. SHOWN HEREON. LEGEND , LOTBLOCK 5 ® BRASS CAP MONUMENT _ 71A lGS Z:W- ,b VO,(PLAT No.—. -IRON PIPE _ 00 REBAR rotor. COR.IND - ANCHORAGE RECORDING DISTRICT ❑ NUB B TACK -• 1426 HYDE(? STREET ANCHORAGE, ALASKA 99501 REVISION I DATE '•BY DATE:,e8 ^ P2 87 BY: 1/ SCALE: I //��/ W08!{OrJROE�R3 1'11pl '.SS GRID: 2041 • -' p♦F A • e � P •••' 1ENG EC 1 •7'�;V Municipality Of Anchorage 0.0 •• ••••••Y DEPARTMENT OF HEALTH &HUMAN SERVICES ...... .. .. •..ffyl 825 "L" Street, Anchorage, Alaska 99502-0650 _ Itm iii' '� SOILS LOG — PERCOLATION TEST ��+ �G� �,.'� i • kilk • PERFORMED FOR: SGO // A) /sort DATE PERFORMED: !vi�' LEGAL DESCRIPTION: 4 4 dkS T:tlt nlj 5%,j Township, Range, Section: 7-j2 N ),yW S.? y! SLOPE SITE PLAN % 1 (54-47 2 (S5w "�) N 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS Gra u'd .746%jy a•.d Cp.xrsc Co P/Se H r,/1(7 WAS GROUND WATER ENCOUNTERED? Cf 'IF YES, AT WHAT 0 DEPTH? Depth to Waur Mier monitoring? C.6 rt• Date: Y 90 PERCOLATION RATE (minutestinch) PERC HOLE DIAMETER TEST RUN BETWEEN Z FT AND 3 FT ". '/ etC`4�tl•"P S Q& PERFORMED BY: /. ` is"G? ^ 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:��9� 72-008 (Rev. 4/95) _ ... RF�--��,� gra �r- �� � �1111WOMEN- --- PERCOLATION RATE (minutestinch) PERC HOLE DIAMETER TEST RUN BETWEEN Z FT AND 3 FT ". '/ etC`4�tl•"P S Q& PERFORMED BY: /. ` is"G? ^ 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:��9� 72-008 (Rev. 4/95) _ ... \ r MUNICIPALITY OF ANCHORAGE rS, s \\I 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 Morgan Keitph Fu ate, -person who took out permit C,12 ONx CR I PHONE NEW UPGRADE MAILING ADDRESS Sik,A, GQX07 LEGAL DESCRIPTION L�LOT T12MI-S END LOCATION S O 6- u NO. OF BEDROOMS :3 U DISTANCE TO: Well 0% N Absorption area / Dwelling 49 PERMIT NO. 630/91 Y Q WF ManufacturerG F ^ /z Materiel No. of Compartments to Liq. capacity in gallons L IF HOMEMADE: Inside length Width Liquid depth lj Y J t72 DISTANCE TO: Well Dwelling PERMIT NO. _? F Manufacturer Materiel Liquid capacity in gallons O w= DISTANCETO: Well IJOZ 1AJ Foundation Nearest lot line PERMIT NO. / 9 .W.1 W E Z suI No. of lines Length of each line C1 Total length of lines Trench width u Inches Distance between lin F F¢.. p Top of tile tp finish grade 3 /A,140L. Material beneath tile inches Total effective alAorption area OO W Length Width Depth PERMIT NO. di- W d Type of crib Crib diameter Crib depth Total effective absorption area W rn DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W �+ DISTANCE T0: Building foundation Sewer line Septic tank Absorption area (s) OTHER f Aa PIPE MATERIALS P,, Vie SOIL TEST RATING Q I I 1 Q) INSTALLER 0 G REMARKS -S 4" k OvErl, T1mJn1t-. 1 12 SR O — ELL V APPHOVED DATE LEGAL 8 t,s CAM 72-013 (Rev. 3/78) r � MI.JN I C IaFl_ I T4' C7F= FINC3F fJCPFdFiGE ' DEPARTMENT 'hCALTH AND ENVIRONMENTAL'' ".OTECTION 825 'L- STREET. ANCHORAGE, AK. 99oOl 264-4720 WELL nNO CSN -S I TE SEWER F='ERM I T PERMIT NO. C 830119 ) APPLICANT MORGAN KEITH FUGATE 1001 SONIFACE SP3J 99504 264-4441 LOCATION LEGAL L8B5 TRAILS END LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAI14FIELD MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSO FT/BR)= 166 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEF'TH= S LENGTH= S+3 C3 FR n VE:L_ [7EF=l TH= 2 THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN FEET). THE TREtJGH W I GTH I SS 5. ODEC-+ FEET_ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REGI) I REL7 SEPTI (-- TFiNFC S I 2E:E= :1-22!5C71 13nL_L_i3t4S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TIJC} C 2 ] I NSP'EC3T I C7tJ5 FIRE REGI) I REG --- 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 SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. i WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F7ER11I T aXF=' I RES OEC3EMEBER 31.. �LE3:03 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED Tq INCLUDE MORE THAN 4 BEDROOMS. SIGNED ISSUED BY TH FUGATE 3 8J rM Optic% L- 70' road 7IV= S • & r) -a Cdr SOILS LOG 1 MUNICIPALITY OF ANCHORAGE 0.1-' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 'ERCOLATION TEST 825 L. Stra t, Ambwa9s. Alnke 89501 2644720 SOILS LOG = PERCOLATION TEST PERFORMEDFOR: t)(`. DATE PERFORMED: (0-0% LEGAL DESCRIPTION: I.tx R 0\K am'IA Pt`s • c 77008 16/79) - 1 C� Cl, / • ', �7U l?� Certificate of On -Site Systems Approval Parcel I.O-. 015-192-33 Expiration Date: Legal description Trails End Block 5 Lot 8 Site address 11240 Stroganof Dr. Anchorage Ak Current property owner(s) Van Tuyn 12-23-22 X The On-site system(s) is/are approved fsf 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: Y' 21 _ Z. Z,.. 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 Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approval_June 2022 oma;: Development Services Department 4 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. 015-192-33 Complete legal description Trails End Block5 Lot 8 Location (site address) 11240 Stroganof Dr, Anchorage, AK Current property owner(s) Van Tuyn Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS ___.3.— T_Y_PE_OF WATER SUPPLY: © Private Well –O -Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: © Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 16 = See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ 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 $ 55-b Waiver Fee $ _ Date of Payment ���%2 ri'o, 0�ft� Date of Payment COSA # ��7i2-i �S°�l Waiver # COSA Application June 2022 i Legal Description: Trails End Block 5 Lot 8 Parcel ID 015-192-33 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) Well production at time of test 5.5+** gpm Date drilled 1983 _Total depth 166* ft Water storage tank volume - gallons Cased to 49* ft Well disinfected for coliform test? ❑ Yes Q No ✓❑ Sanitary seal is functioning correctly ✓❑ Coliform bacteria is Negative Wires are properly protected Nitrate 3.58 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 12+** in. Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Date of flow test for COSA 6/1.6/22** Collected by GEG Ltd. Static water level at beginning of test 24.5** ft. Date 6/13/22 Comments *Per Alpine Drilling log in MOA records. **Information provided by GEG, Ltd B. TANK DATA Measured operating fluid -level -in septic tank rl Date of pumping 5/2/22 tenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1990 R ALL standpipes present per record drawing 'Total measured depth from grade 5.75 ft (max) Measured depth to pipe invert from grade 5.25 ft (min) ❑ N/A — pressurized field. F/_1 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 Comments/Deficiencies: *'Information provided by GEG. Ltd COSA Checklist June 2022 C. LIFT STATION 7of maintenance-completed atic yearsmaterial Adequacy test date 6/16/22 Results Q Pass Fluid depth prior to test 0** in Water added 1607**gal New fluid depth 0** in Elapsed time 0** min Final fluid depth 0** in Absorption rate 450+** gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 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' ✓❑ Yes if No Community Sewer Manhole/Cleanout > 100' n Yes if No ft n Yes if No ft Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' ✓❑ Yes if No ft Absorption Field on Lot > 100' ✓❑ Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ✓❑ Yes if No ft Yes if No ft ft If tank or field is under driveway comment below 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' Fv� Yes if No ft Wells on Adjacent Lots_ Field to Property Line > 10' ./❑ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' © Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10' ❑✓ 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 Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date' Engineer's Comments: This investigation was completed in compliance with ADEC and i90A regulations. �4ylp A�,��� The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The tq �L ,t flow and absorption rates may change due to subsurface conditions that may not be observed from the.';.' «.y ♦�� 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 'l9 systems are subject to these various and dynamic characteristics and are outside the control of the evaluator or of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will 0 function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. ata KENNETHWIFtJSIi 4 G� R COSA Checklist—June 2022 ��p� n�'ati ��o I-. O 0 N N LJ o - � r'J I O O t— O Z 0 10 z i U N89'59'14"E 189.86' (N89°59'30"E 190.00' R) 5' UTILITY ESMT7.81 _ M SHED "? a - U o U 36.0' LOT 8 SEPTIC ® BLK 5 VENT (typ) 8® 0% EXISTING HOUSE 2.0' o - 12. 2.0' o20.0' r---=---- --- i I EAVES I o EXISTING o PAVED p/w N GARAGE a 1 30.0' 1 1 / N89'59'30"E 190.12' (190.00' R) BASIS OF BEARING ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: TRAILS END SUBDIVISION LOT 8 BLOCK 5 PLAT P-604 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoulK any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines, EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DKM sCAl.E E-MAIL, AUG 10, 2022 1 "=30' schuller0ek.net 22•-089 DRAM BY: CHECKED BY (MD NUMBER: —B0—% AGE: JLS SW2641 220304 O = FND 5/8" REBAR AW '...49TH........ F €. I 1, / f I-.JOHN L. SCHULLER.: 'Kn� ••.: OL - LS -10408 4r OOH °fessionot 52.3' WELL 33' w� `0 -7P 1831 RL 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Ld CY O z c� O MUNICIPALITY OF ANCHORAGE `L • .. DEPARTMENT OF HEALTH b HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# OI'�— 192.— 33 HAA If .11ZgLjryjln� 1. GENERAL INFORMATION Complete legal description I O- 8 ak's I PAILS eN17 Location (site address or directions) n;t4o STRACIANDt= Property owner wcs 40-4 Dayphone 5(e4—_76µ5 Maiiinq address I IA4 D S a tno Lending agency Mailing ad qJ ( 12 tQ'_%" Day phone Agent Cly✓ P-'otw.. i c `!6 Fnc e� • Day phone 563 -5 5 vel Address C S tem Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: _'t� 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- . ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ✓ f. . ti- Holding tank - - v 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(A".1/91) Front MOAF21 S. STATEMENT OF INSPECTION BY ENGINEER r 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 –T -6 /0"u, Sp +r1iC la.�Q 1� E Phone 972'3416 Address O 3 ui l S d [, 20 a Engineers signature Date Z/L//l 4 q . a r ..... CC -2225 ?� 6.• DHHS SIGNATURE C`�C` 7CF[8;10�y4w Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 7 CAUTION 'The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates'base'd 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 MW.. 1A1) 8xk MOA 121 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Le+813Ks TQAILS MND Parcell.D. O(5— (41-3'S A. Well Data 1* 41 type Q If A, B, or C, attach ADEC letter. ADEC water system number �� Log present (YM) (`i Date completed 19813 Driller Total depth I t, 6 Cased to 'r Lelvee 4 (2o� Casing height 7 it Sanitary seal (Y/N) 7i Wires properly protected (YM) FROM WELL LOG AT INSPECTION Z�Z/9'y Date of test M rn Static water level C7 w 0 c/ M Well flow g.p.m. g.p.m. .-- Pump level 4 6 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot tot ; On adjacent lots 7 t o'.0 Absorption field on lot 10:2 ; On adjacent lots > (c.e7 Public sewer main _(VAPublic sewer manhole/cleanout N/Al Sewer service line > 50 Petroleum tank NO N E WATER SAMPLE RESULTS: Coliform 2� Nitrate C2_i, 4 _Other bacteria Q ND Date of sample: ;/ 2/q Lt Collected by: B. SEPTIC/HOLDING TANK DATA �es�-f��-� Date installed >114 90 Tank size I Ly a Compartments Cleanouts (Y/N) / / Foundation cleanout (Y/N) N Depression (Y/N) nl High water alarm (YM) N!A Alarm tested (Y/N) K�/t Date of pumping D,�_, I g93 Pumper L Ra C! SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1,0 P_ On adjacent lots '> 100 Foundation 32 To property line > 1 O Absorption field 1 A Water main/service line ' S0 Surface water/drainage N 1a CONTINUED ON BACK PAGE 72-028 ("3)- FroM C. LIFT STATION N0Nt Date Installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at 'Pump off" Level at High water alarm level 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 SlAlIq o Soil rating (GPD/Ftz) Z c-1 System type 345;0 Length 91 Width I D Gravel thickness G s� Total depth U Total absorption area G i o Cleanout present (Y/N) �Z Depression over field (Y/N) 1\1 Date of adequacy test 21411 Y Results (pass/fail) _ 'lam for 3 Bedrooms Water level In absorption field before test 1'2— After test 3 Peroxide treatment (past 12 months) (YIN) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 10 7 On adjacent lots > I u -o Property line 7 I'D To building foundation G8 To existing or abandoned system on lot 10 On adjacent lots > ?-o Cutbank tJ a ti t Water main/service line 5 c� Surface water N-14 A -Driveway, parking/vehicle storage area > S-0 Curtain drain N/n E. ENGINEER'S CERTIFICATION I certify that I have checked, vedfied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature , r Engineer's Name tO�iFlfN/�K Date HAA Fee $ t,bD .CJ -0 Waiver Fee $ Date of Payment Date of Payment Receipt Number °�s�j1 �.7�P�% Receipt Number. 72-026 (399)• Back MUNICIPALITY OF ANCHORAGE • - Department of Health & Human Services t� DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # of S -1902 - J 3 HAA t► 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 11 4 %fk 'u •�' ocaf�o�► a8tlross or dir6ctio.ns) a (b) Propertyowmer•-- •SG'+ • Jtj.jro .. Telephone: (home) ?VC -•3L7f' Business Mailing addreP: 40 f (c) Lend ing'Institutioii . y. Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check hereg, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE 3 Single-Family'KI Number of bedrooms 3. WATER SUPPLY Individual Well 7, Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On -sited Public ❑ Community O Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72425(Ro.. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by myseal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional ,and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone X79 —XX7r `I Address 190 As,u(dr<G r.Z K-04fP Date Re.wo,.e C.0 4S..,z/. ve-i tyf,4k, itir�/,41 A jo4-ca f�? c4acl e /J .2251 pl01CS51�� 6. DHHS APPROVAL—jl`� Approved for ? bedrooms by Date P�l Approved -2CDisapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors oromissions in the professional engineer's work. 72-025 )R.v. 7/08) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health &Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. fi nl f ci ' ' HAA # Clf�Qf]I1aA-2Z 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Leg/al Description (include lot, block, subdivision, section, township, range) T>' h 2a. e1 /2.0 2?v S.25� Y Location (address 6T directions} �e/aYo " s' .g2 0� A,•P (b) Property owner's Telephone: (home) zD1! ^ Business Mailing Address, (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check hereZ, if hold for pick up.) List contact person and day phone number below: tz S G CK 2. TYPE OF RESIDENCE 3 Single -Family Number of bedrooms 3. WATER SUPPLY Individual Well p Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteg Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 22-025(R". 7/881 Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm X2ec -"S h c Telephone 279 -17 -ST Address le) 607, 02yo -c Q- //rrCZ,1/?14- 94r -7Y o6tr DateW20147c_� Iw I ,~_ %f4.o •.•....... Q Y G 0E1D, JA. 1oa p�pmPesstctr��: 6. DHH APPROVAL CuriTtjcal/y f Approved for 3 bedrooms by � Date� APPrOvOd . 8isappraved Conditional Terms of Conditional Approval frereu A= _.� n �/lov��/ s> . i—/ �0,��,2avw7iT �stJ fOD U83 • SpT� r�7lc lnaaT �7p.tc.�,,r/2r�C tz- cZ /W1J1 /a7uM GuCvq /Q�yJ Wn�rl�S/��G sy6Tsrrt !J <r�Yt/G/ lO�i�S �/ TLi2 ��i+�� iltq ht/UDlC2S �cJr'Gl �QOMrJtG'�/4�v- �2o�Csorc.n/�'/%�y/f r,o 7'/ie �jOartt+/.�7= `x�nr/G S�STi�nL.d9/�iCa rtaST�Gors�/� /Y� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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 (8...7/88) Sock Page 2 of 2 MUNIc"Aur/ of �2AGE MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONmENTAL5 av ISION Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 APR 2 0 3343-4744 Legal Description: l of B. B(ac k S. RECEIVED 'inallt EAd SID A. WELL DATA Well Classification P rt ✓ak If A. B, C, D.E.C. Approved (Y/N) Ali Well Log Present (Y/N) —Date Completed i9S3 Yield '"ew• 3177/90 cnlo bedrock Total Depth _1 —Cased to ?0 A Depth of Grouting Nth. Static Water Level 5r0' Pump Set At lSS' Casing Height Above Ground n Sanitary Seat on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y - - Depression Around Wellhead (Y/N) IV SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 10Z, On Adjoining Lots > 100 " To Nearest Edge of Absorption Field on Lot 10 2' •kr c-7, ; On Adjoining Lots > 100 1 To Nearest Public Sewer Line N, A. To Nearest Public Sewer Cleanout/Manhole N/A. To Nearest Sewer Service Line on Lot =�t 2-7 Water Sample Collected by F(a / fob TccA S au ;Date S11-9190 Water Sample Test Results Sceluw4acLrIX - o Co(cf-02" /loom-? 2.2 !;ee1-e ol11m6e-/y Comments Wc(( oI�FM f ccrl�-"r odap�of?.er ff4oet &„ AF�Ine Drc/%oq. Wtt( r wt tx(-tnd( I2" dr,So�e grow,d Icvel .end- 6e =We C -lo a1 r-94 0%7 awur IV C&'"17 1Y CA'fA coact_. B. SEPTIC/HOLDING TANK DATA No /- Pccrf OF fA3f t-ec / o r- cer Ari c t fiGn Size Standpipes Depression over Tan No. of Compartments Air -tight Caps (Y/N) Pumping/Maintenance Contac File (Y/N) Holding Tank.High-Water Alarm (Y/N) �C SEPARATION DISTANCES FROM SEPTICA To Water -Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Comments 72-028 (Rw. 7/88) Front Foundation Cleanout Date Last Pumped _Temporary Holding Tank Permit (Y/N) _ TANK:--'� "tiding Foundation � • To I r Drainage Course Page 1 of 2 C. ABSORPTION FIELD DATA not ../oa'—f Date In lied Width of Fiel of fhet :�e✓f. of cep h/�7iahe., i ype or bystem L)esign Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion A Statndpipes Present (Y Depression over Field (Y/N) Date of Last Ade cv Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTIO To Water -Supply Well To Building Foundation Lot I; On Adjoining Lots To Water Main/Service Line To Cutback (if pr nq To Stream, Pond, Lak r Major Drainage Course To Driveway, P (ng Area, or Vehicle Storage Area Property Line To Existing or Abandoned System on D. LIFT STATION NIA. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) 'Comments - Dimensions _ Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request' certify that I have checked, verified, or conformed to all MOA and HAAguidelinesIn effect on the date of this Inspection. Signed OF A���® Company r�a��� %eAniea/ ...... Strrei�/ .,4 .•vr ' i�Cj: LJ C�TH 7 Mae -ch 2B /990 Date.......................... * : e .............. ........ 00 5r 90 — /9 MOA No. o p ...............m°: _ d0�..7HEOD09E F. MOORE - 1 '' ,L• CE -35.02 . : O Recei tN •,.V �Q�P�, �.....•`�EA°moo �oaprofessic�a_m� P o• — Date of Payment Amount: $ 72-M (Bt. 7/88) Back Receipt No. — Waiver Fee: $ - - Date of Payment Page 2 of 2 Engineer's Seat MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Legal Description: to l 7 91,ck s- Tz,l .Sal, /a no Q Jt'l s: -zY Date Completed Depth of Grouting Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: oci To Septic/Holding Tank on Lot 4 To Nearest Edge of Absorp' To Nearest Public Sewer L' To NearesZtResults Water Sample C Water Sample T Line on Lot If A, B, C, D.E.C. Aproved (Y/N) Pump Seal on Casing (Y/N) Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed, Size /2J-0 No. of Compartments Z Standpipes/N) Air -tight Caps&I?N) Foundation Cleanou{(Y/� Depression over Tank (Y& Date Last Pumped VI O0 lr azC r Pumping/Maintenance Contact on File (Y/N) � ; for Holding Tank' iigh-' Gr•Alarm (Y/N) / Temporary Holding Tank Permit (Y/N /2 SEPARATION DISTANCES F'Wy1 SEPTIC/HOLDING TANK: To Water -Supply„ e I l! T To Building Foundation 3 Y r ' To Property Line rO1 r To Disposal Field To Water lin/Service Line To Stream, Pona, Lake or MajoeDrainage Course _Z Comments n -M (Rw.7/08) Front Page t of 2 C. ABSORPTION FIELD DATA Soils Rating In Absorption Strata Type of System Design Date Installed A,3 Length of Field ?� r Width of Field ? Depth of Field r Gravel Bed Thickness 33 " Square Feet of Absortion Area 57)0 Statndpipes Present&/N) Depression over Field (Y/&3 Date of Last Adequacy Test Results of Last Adequacy Test Com, led — T ✓ 1,6- re E is 7e ,A,,4./. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /oZ To Property Line /0 To Building Foundation ^ Lot A1/.4 : On Adjoining Lots To Existing or Abandoned System on /Or To Water Main/Service Line To Cutback (if present) W,le To Stream, Pond, Lake, or Major Drainage Course , /o n To Driveway, Parking Area, or Vehicle Storage Area > io , Comments .5d SA, te 4--r,,x... J �12 r, b, c%y.,e /f iiro D. LIFT STATION Date Installed Size in Gallons — Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' L at High Water Alarm Level at ent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "Check P rmitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelinesia inspection: xt(in the date of this QA�,' ....0. 4 .• Signed ^ i�Q. ••• ••••s'�'' Company— Date ompany_Date �•"'• •••• gtneer's Seal �E�O—oi L ... MOA No. .... ....� or G Rem, Receipt No. .��82z ///7 b Date of Payment Amount: $ 72-M (R". 7M) Beck 1� CE -2251 i A Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 FLATTOP TECHNICAL SERVICES 14530 Echo St., Anchorage, AK 99516 Ph. (907) 345-1355 ADEQUACY TEST DATA SHEET Legal Description: (of 8 [j/uc/TS i+a�11 En.0 .f/p Street Address:_ _►1 2y o S�ro 2,iof Di'• Client Name: Scoff 4111roo `/o Taoe/(e P.F/etvtl-- ReHax 0 Test Date: !?/?-7 Tested By: %F. Huor[ Initial Conditions: Float 11 in_ct C Atl Set 5a b.t.o. 2 " pipe v. S[�" fluid lou T.f,. Float $2 in�nct #2 set 13 " b.t.o._�" pipe v. 6/ " fluid toy 7-oA Float #3.in_S"fA TrenchuVset 7s_" b.t.o.. 35-" pipe w. S2 " fluid[27 T/F Float $4 in_J�ar{d Te[Ao'iCaset 67^" b.t.o.I S-" pipe w.::.fluid fluid 119 lofty Water added through:_ S[it c T-ank c.o. 11t2 ACTION TAKEN TIME H2O METER NET. GAL WELL LEVEL Seohe # 1 Sa.fti Tr. CG T N• r�r c. o: r 10:26• if3 SIya O 110 ep I 0 C5 to: 29 '13 6Eo 20 ?. 2 V? - i10:31 10:31 U:3 3 7oS' 6S s9 6 I2'[y /2'/Y 14.'"11 1U :,YS J{; 77Y 83 13/O f 2 2 y',6 22`j 2y'/r zy V (:0 3880 2y 0 0 9 113931 291 ISS 2s"'Y oFf :Iz N3 yo IS3i 1:16 1113 ' • [I: 133 1: ZY 123 6 1I*q9 1 63 12 : 2 y/ Vz 3'/z 3 Va. Measured Well Yield 90'(f.y6�)c3XD?,o , Adequate for 3-f• Bdrms • 37•+�� Unit Absorption Capacity Average Absorption Rate .. Pum/s;�� Raf e = z9/baa/ _ 6 7 N3:n,1t tpv," Surge Capacity . Adequate for Bdrms a„e11 At re ca'a. Hosv• V(e'v l MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH T n 2 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�f 7s �I OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L47'r}'' %neat/l :5, ".5 /0 7-/1.J P)& Sc'e..7 y/ Location (address or directions) ./yso sT,PaS.iS•./o� �P. (b) Applicant Name ��'rf/��� Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution 4 -pe, 1fw77ofI- Telephone (e) Address Real Estate Company and Agent Address yb`uY A/,Z7/ 7Zi/ X71. Biu' Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. T2-025(11,84) Page 1 of 2 l --J ds Tridi/1 r -AO — 5. ENGINEERING FIRM PROVIDI. . INSPECTIONS, TESTS, FILE SEARCH, L A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ^ Name of Firm Telephone�--c, " Address 11-e,7 i1/ 33'� lh e-, Xol72r- a /Y�� Ile 195rz, Date 4-2.1-57 Q..• �•. * CO- 49T D UR•• G REID, JR. J! ' -2251 •• a i�'Prfesjo�� 6. DHEP APPROVAL 11 " 11 Approved for -bedrooms by Date Q -24 -97 Approved x Disapproved Conditional Terms of Conditional Approval W\ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 engineers work. Page 2 of 2 72.025(11184) n n, MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORL%CKLIST - FEBRUARY 1994 ENVIRONMENTAL SERVICES DIVISION 264_4720 Legal Description: �T� a«ts ����GS E✓D APR 221987 7/Z j zji-i s� z A. WELL DATA RECEIVED Q Well Classification ;'t/o+T� If A. B. C. D.E.C. Approved (Y/N) 'J/A Well Log Present (Yo Date Completed e1A1Xtt^_J-1 Yield 2 huh i Total Depth n /Ge' 'CLased to � � Depth of Grouting �A 7 Static Water Level (X2 7• `f Pump Set At Q /� Casing Height Above Ground j's Sanitary Seal on Casing&) Electrical Wiring in Conduit&N) Depression Around Wellhead (Y& Separation Distances from Well: f , To Septic/Holding Tank on Lot /07- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /0 Z- ; On Adjoining Lots /� •� To Nearest Public Sewer Line W-14 To Nearest Public Sewer , Cleanout/Manhole A)�fh To Nearest Sewer Service Line on Lot Z S f Water Sample Collected by hCS A. ��/�f ; Date tl_ /4-& 7 Water Sample Test Results sArjy),te-Toz1 Comments/JzL hc.j 7E57 y-/7-87• A�F4'uE. (� [ceu �Pie[eRs Ce%Rr '� Zo-Si Her1Pi/� ,R7- /Z loll 7457 G -/o 8/ SEPTIC/HOLDING TANK DATA Date Installed �Size /L So No. of Compartments y Standpipes lj N) Air -light Caps &N) Foundation Cleanout (Y© Depression over Tank (Y© Date Last Pumped if -7 17 Pumping/Maintenance Contract on File (Y/N) for '�c --- Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) 'LJ A Separation Distances from Septic/Holding Tank: To Water -Supply Well 10Z -'To Building Foundation jT To Property Line To Disposal Field i To Water Main/Service Line ys To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/04) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /GG T Dfi11 r/fi6cA el -I of System Design Date Installed e-IJF-S-3 Length of Field r � Width of Field 3 Depth of FieldAf (, Gravel Bed Thickness 33 Square Feet of Absorption Area SD Standpipes Presen6) Depression over Field (Y6 Date of Last Adequacy Test Results of Last Adequacy Test Aeptoffir Separation Distance from Absorption Field: To Water -Supply Well /a 2 To Property Line To Building Foundation ^i `{� To Existing or Abandoned System on Lot '�,�� ; On Adjoining Lots /� t To Water Main/Service Line ys�> To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /tea , -A- To Driveway, Parking Area, or Vehicle Storage Area /o It - Comments D. LIFT STATION Date I Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access (Y/N) "Pump OM" Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that I have /�c�cJJhtte�c ed, v rifted, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /oLe wig Date -z-/-8'7 Company MOA No. f!G-OZ- Receipt No. toc> I - COQ .ZE, OF A4 Ar Date of Pa ment Lk . aa. S1 �,tQ.• Paytq.• H .y Amount: $ 1C Oo GCX�t _•• 6ee1• . IWNy Yta/7T- /• tVeZJ )Bruck! /etf0,e7- i... ....... .... LER C. REM, JR. Z-• /�a I.NitE le7pcJT I`�•.�� r-2251• AF Page 2 of 2"''JJ�� ••�� 72-026 (11,84) id Alpine Drilling & Enterprises INVOICE Domestic — Commercial No 2122 Pump & Water Systems P.O Box 110496 bib rloceuo Anchorage, Alaska 99511 �f (9017 345-0202 DAT ZOO- _,& Thank You SIGNATURE Q Hereby Acknowledge the Satisfactory Completion of Vie Above Described WOrk.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.6% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. DESCRIPTION PAY THIS AMOUNT Thank You SIGNATURE Q Hereby Acknowledge the Satisfactory Completion of Vie Above Described WOrk.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.6% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. APPLIC*—T FILLS OUT UPPER HAL" 'ONLY Property Owrer, //,,i Phone p [! -- pp Mailing Address %(JO L`� w/ r �.� C F J 21P Code P Buyer Coda Address 1Zip m MU 1 V�: L Fl AJ � Lending sututton LAS KA Phone D f�11 / q Address / 5 c' U W .<' AJS O!J t'L V cl zip Code / co n Phone Realty Co. & Agent Date Address Zip Code Date Legal Description �/0-7- O Q� OL� ,s—%�/1;L s &AIC11 S U 6 J Street Location .SS7'r o(,�A o(,Aj a Date _ Type of Residence 6icSingle Family ❑ Multiple Family No. of Bedrooms ❑ Other L - Water Supply �IndiVldual ATTACH WELL LOG. A well lop Is required for all wells drilled idiots June 7975. Inspector For wells trilled prior to that date, give well depth (attach log If available). ❑ Community ❑ Public Utility Sewer Disposal y� TwAndividual Year Individual Installed: • Public Utility When Connected to Public Utility: ❑ Holding Tank ' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. ifya-i Timid Time Time P Time n Dale Date Date Date _ L - Inspector Inspector Inspect o Inspector aQ Field Notes: / I MUNICIPALITY OF CHORAGE CEPT. OF H`ALTH & ENVIRO.`.','d'cNTAL PROTECTION c AUG 17 1933 -� RECEIVED ( APPROVED BEDROOMS •r :nunrrlONS OF APPROVAL ( ) DISAPPROVED I, y T- d 3 CONDITIONAL APPROVAL - DATE BY: Solis Rating Date Sewer Installed Well To Absorption Area ('60 y� Well Log Received Septic Tank Size j Z d G 1 1 Welt to Tank d z zzozs iron