HomeMy WebLinkAboutAUDUBON HILLS BLK 3 LT 4Audubon Hills
Block 3
Lot 4
#015-231-63
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Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SV/48 D Lit/3_ PID Number:
Name:
Wastewater System: ❑ New Vupgrade
Qui t �.
Address: l 4
ABSORPTION FIELD
Phone:
No. of B trms:
0 Deep Trench 0 Shallow Trench 0 Bed O Mound D Other
LEGAL DESCRIPTION
Soil Rating
Total Depth from original grade:
GPD/S Ft.
Lot: Block:^ Subdivision:
Depth to pipe bosom from original grade:
Gravel depth beneath pipe
F+ a'ti
Ft.
Ft,
Township: Range:
Section:
Fill added above original grade:
Gra le
Ft.
WELL* ❑New ❑Upgrade
Gravel width: �t
umberoflines:
assn behvelnli�n
Ft
Ft.
Classification (Private. A.B,C):
Total Depth:
Cased To:
Total absorption area.
Pipe material:
Ft.
Ft.
SO, Ft.
Duller. • Q
Date Drilled:
Static Water Uvel:
Ft.
Installer.
Date Installed:
Yield: Pump
I
Set at:
I
Cestng height Above Ground:
TANK
l IOC Y C L L
GPM
Ft.
Ft.
SEPARATION
DISTANCES
❑Septic ❑Holding ❑S.T.E.P.
To
sept4
Ataorpuon
I I
lilt
Molding
ubiwPeivaw
Manufacturer.
Capacity in gallons:
0"e7
From
Tank
Field
Station
Tank
Sevrolinaa
Pi 10r—L —
Welt
Material:
Number ofCompartme ts:
�—(
1
tp
110
1
i
Surface
LIFT STATION
Water
H
b
'YLot'
Sr
Size in gattons:
l
Manufacturer.
1310 e_ CLC
Line
rpt
oaf
Foundation
p`
✓
'Pump on' �I at+,
'Pump off' 1 ?
84 q
M19n z z Iarm at
SA:
Curtain
Pump aked lodel
Electrical InspectiMperfor n dby.
DrainVAII
BENCH MARK
Remarks:
Location and Description:
•
A
I1vat.a�c ,
Assumed Elevation: a,,.p
LW _�
ENGINEER'S SEAL
Ir
�S
Inspections performed by: Dates:ls
2n
Department of Health and Hum a Services approval
C 11.19.95
Reviewed and approved by: Date:
r7IM3 (Rev, W) MOA t5
SC4Ef'1' = 50 f
NCH MARK
A
J -WAY VALVE
Well
1203 P/ JYUK EN P.L. I I LOT 4 BK 3 AUDUBON HILLS I I SEPTIC SYSTEM AS,,, I
203 YJ K. AVENUE EUGENE MARINELLA DA TE. NOV. 19, 1998
ANCH. AK. 99501 12200 AUDUBON DRIVE SHEET. • 2/3 GRID: 2739
/oml ��a_xofa
PERMIT k SV980443 PID k 015-231-63 ABH03042.D616
14 -INCH INSULATION
Mw
TO HOLDING TANK
_+ AIRCOMPRESSOR
�I
'VIR
.'.
6" MIN
SAND BACKnLL S'-2' MIN6'-0' MAX'
J'
.......—
BIOCYCLE 6000
49th ! r •:
NO. CE -2225
EXISTING DRAIN TIELD 64 X 54 PT
MT Q
T�7_1—ft--lir 7�I .. II II II
L1 1 w—m—
I-T I I_I I I I-1 I I-1 I I—Ill' 11='1 I I-1 i I=
C
1o!)oCl of�UAVfIV n" A- 1)
PRIMARY TREATMENT, SEPTIC TANK
SILT BARRIER 4 FT
IMPERVIOUS SOIL
NO SCALE I
LEGEND:
1.
PRIMARY TREATMENT, SEPTIC TANK
2.
AERATION TANK
J.
CLARIFICATION TANK
4.
DISCHARGE TANK
5.
SOIL ABSORPTION
1UHULN a"" nc• II TER SYSTEM SCHEMATIC
10.5 V/15th Ave LOT 4 BLOCK 3 AUDUBON HILLSII
DATE. NOV. 19, 1998
Anehoro a Ak 99501 BIOCYCLE WASTE WATER SYSTEM SHEET. 3
779-.3916 /3 GRID: 2739
PERMIT # S V98443 PID k 015-231-63 ABH03043D VG
4
11/20/98 FRI 14:06 FAX 1 907 762 1631 NICO ENGINEERING -PROJECT
. _ _
PROPERTY OWNER AGRE.Ei�IENT
FOR TT1E NIA"NTENANCE OF AN
01N -SITE WASTEWATER DISPOSAL
SYSTEM
This agreement, dated r 0199
Anchorage Dc � $, is made between the Municipality of
8 Department of Health and Human Services (DHHS) and the properly
owners) of:
This agreement is made for the purpose of maintaining an on-site wastewater disposal
system on the subject property.
The property owners agree to the following:
Submit to the %lunicipaliy of Anchorage, on an annual basis,
operation statement from a registered an inspection andprofessional engineer. This inspection and
operation statement shall verify that the This has inspected all effluent and air
pumps, timers. and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed. -
(Signature)
1
(Sigramr
(Printed Name) ne (5/
------------------ (Printed Name)
---------- %otarire Here
-------------- ____ _
SJa _ ------'--------
State of On this � - -
r s 7 _Q?QM day of N Llem be r- �q
CUYi�9f Jit?s.}J:ANn@ S;�p
r jparaonally appealed before me,
wrn is personally known to me
wrkoEe identity 1 Proved on the basis of
whose identity T proved on the oath/affirmation of
to be the signer
of
a credible witness
th
e eE4!;e :.)cument, and he/she
N,y commission expires
d that he/she
ary
2002
P.01
it.
MUNICIPALITY OF ANCHORAGE l l — Lqc
Department of Health and Human Services
On-Sde Services Program
625 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 16, 1998
Expiration Date: Nov 16, 1999
Permit Number: SW980443 Parcel ID: 015-231-63
Legal Description: AUDUBON HILLS BLK 3 LT 4
Design Engineer. 0007 Tobben $purkland, P.E. Site Address: 012200 AUDUBON DR
Owner Name: EUGENE M NELLA Lot Size: 46433 SO. FT.
Owner Address: 12200 AUDUBON DR Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516-2422
This permit Is for the construction of:
❑ Disposal Field ❑? Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: '(ol QO
Date: — (O
7 0
T. SPURKLAND P.E.
203 WEST 15ThL, AVENUE SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fat (907).276x013
Municipality of Anchorage October 12, 1998
Department of Health and Social Services
8201 Street
Anchorage, Alaska 99501
Subject: Septic System
Lot 4, Block 3, Audubon Hills
12200 Audubon,
Eugene and Hughes Marinella
The owners of this property desire to install a BioCycle unit and discharge the effluent to an abandoned drainfield that
was replaced with a holding tank in 1990.
1 have tested and analyzed the existing soil absorption bed on this property and 1 believe the bed can be utilized in
connection with a BioCycle (or similar) pretreatment unit.
This bed was installed in 1983 and failed after two years of use. The original septic system consisted of a septic tank
and a "culvert" liftstation which pumped the septic tank effluent to a 64 feet x 32 feet bed, where the waste was
distributed by gravity. Test hole logs from 1982 indicates that the system was installed in a tight silty material with
a percolation rate of 58 minutes per inch.
The septic system was abandoned in 1990 with the installation of a 3000 gallon holding tank. Additional testholes were
excavated prior to this installation, but suitable soil for a septic system was not found.
Failure of a septic system can be defined two ways: The Municipal Heath Department have established performance
criteria that states that a septic system must be able to disperse 150 gallons of waste water per day per bedroom of the
residence. For a three bedroom house this means 450 gallons per 24 hours.
Most household generates substantial less waste water than 150 gallons per bedroom. A more realistic flow is 40 to
50 gallons per resident. Atypical three bedroom family probably has four individuals living in the house, generating
200 gallons of waste every day on the average. A septic system may fail the Municipal criteria, but may serve a
residence successfully for many years.
Two factors may cause a septic system to fail. The most common one is the formation of a "biomat" which will plug
the soil pores and prevent absorption of the wastewater into the soil. Formation of a biomat will take place if ponding
of the waste water occurs, and if the wastewater is anaerobic.
The second failure factor is intrusion of groundwater into the absorption system. if groundwater intrudes, the waste
water can not get out and backup results.
A groundwater intrusion failure will typically occure during break-up. Rapid snowmelt will cause the groundwater level
to rise substantially, flood a system, and then slowly retreat and after 30 to 60 days the system may begin to perform
satisfactory again. This will happen every break-up, and may be after unusual heavy rains.
A biomat formation failure is progressive and will not temporarily go away. However, excavations of "old" systems
that have not been used for several years fail to find and identify this biomat, though the biomat is easily observable in
active systems. The accepted explanation is that soil microbes will consume the biomat and revitalize the soil. Ilow
long time complete consumption of the biomat requires and how complete it is, is not known. To my knowledge this
explanation has not been documented by actual testing.
This bed has been inactive for more than 8 years and it is assumed that the biomat has been consumed. To verify this
the bed and the underlaying soil was exposed on May 13th. A 3 ft x 6 ft hole was hand dug, exposing both the sewer
rock and the material below the rock. No evidence of the biomat was observed. The sewer rock was clean, the
underlaying material was moist but not wet. The excavation extended 18 inches below the bottom of the sewer rock.
The subsoil encountered consisted of approximately 6 inches of a sandy material that may be natural, but may also be
imported. Below this sand material we found a tight silt. A percolation test on this silt showed a very slow percolation
rate. This percolation test may not be representative of the soil underlaying the bed. A second pert hole was dug
through the sandy material to the top of the silt. This hole was used for the subsequent testing of the bed. This
excavation revealed that groundwater was not a factor in the operation of the bed.
In order to test the operation of the bed a water truck brought 2000 gallons of water on May 14,1998. This water was
distributed throughout the bed through the 4-inch distribution pipes. After discharging the 2000 gallons the water level
was 6.25 inches below the top of the pert pipe. 9.5 hours later the water level had dropped 4 inches.
On May 15th another 1000 gallons of water was added to the system. Prior to adding the water the water level was at
I I inches below top of pipe. After adding the 1000 gallons the water level was at 4.5 inches. 56 hours later the water
was at 10.25 inches.
On May 18, 600 gallons of water was added to the bed. A float was used to measure water levels. The water level
rose from 4.75 inches to 8.25. 16 hours later the water level had dropped to 6.5 inches. This drop represent a
dispersion of 400 gallons. The test was repeated. 610 gallons were added with a resulting rise in the water level of 3.5
inches. 30 hours later the level had dropped 4.25 inches representing a dispersion of more than 600 gallons.
Based on these observation it appears that the bed can absorb the required 450 gallons per day of clean water. If septic
tank effluent is discharged to the bed it will fail within a very short time, 2 years or less. The BioCycle will remove
900/6 or more of the organic material in the waste, and it is possible that a biomat will not form, and if it is forming, it
will form at a substantial slower rate.
There are four arguments in favor of installing a BioCycle:
I. Groundwater is not a factor.
2. Typically the BioCycle will reduce the Total Suspended Solids in the waste from 70 ppm to 7 ppm
and the 5 Day Biological Oxygen Demand from 200 ppm to 10. This amount of reduction is probably sufficient to
prevent a biomat from forming.
3. If a biomat does not form, the system should last 15-20 years or longer.
4. The tests performed indicate that the surrounding soil can absorb 4-500 gallons per day.
1 recommend to leave the 3000 gallon holding tank in place, and connect the BioCycle to this tank. If the bed fails to
absorb the daily flow from the house, the holding tank can be put back in service.
Yours
Tobben urkland P.E.
2
DOWNEY FINCH
50 0 I 50 !00
SCALE• i'
1
tER� / LO1 4
LOT 5 1 \
E
3
LOT 3 B p C K ', H I %.
D \
040
• '•'• , •''• ♦♦♦
0•
49th ff \\
OBBdr� $PURK�91Qb t D OT 9
�C�jt•.• No. CE -2225i/ U \ L \ \ \
title E
TOBB£N SPURKLAND P.E. LOT 4 BK 3 AUDUBON IIILLS SEPTIC SYSTEM DESIGN
103 W 15TH. AVENUE EUGENE MARINELLA DATE. OCT. 6, 1998
(NCH. AK. 99501
(907) 279-3916 12200 AUDUBON DRIVE SHEET. 1/3 GRID. 2739
PERMIT k SV98OXXX PID k 015-231-63 ABHO304LDVG
1Ye11
INSTALL BX
m CON
REMOVE TANK
Well /
/�• Well
25 � 0 25 50 75 100/ 125 /50, �
SCALA i' = 50 FI/ /
j
r\
TO 0 A/NEIELD \
i
/
Wel
1088£N SPURN O P.E. LOT 4 BK3 AUDUBON HILLS SEPTIC SYSTEM DESIGN
203 W 15TH.' AVENUE
ANCH. AK. 99501 EUGENE MARINELLA DATE: OCT. 6, 1998
907 279-3916 11 12200 AUDUBON DRIVE SHEET. • 2/3 GRID: 2739
PERMIT # SV980XXX PID k 015-231-63 ABH03042.DV6
14 -INCH INSULATION
Mw
AIRCOMPRESSOR
AIR UNLT
6" MIN ,
SAND BACKFILL
.9'-4'
• O 3 O
5'-1' YIN • O
6'-D' MAX'
Jj BIOCYCLE 6000
EXISTING DRAIN FIELD 64 X 34 FT
MT Q
LL!— II!J..�'j'jj 1�ll1 1L—
I-11
AOAOAOAVAVAVA"! "A"A-A o
PRIMARY TREATMENT, SEPTIC TANK
SILT BARRIER 4 FT
1MPERWOUS SOIL
NO SCALE I
LECEND.
1.
PRIMARY TREATMENT, SEPTIC TANK
2.
AERATION TANK
J.
CLARIFICATION TANK
4.
DISCHARGE TANK
5.
SOIL ABSORPTION
/0 J W h Averyu t'.L. I I LOT 4 BLOCK 3 AUDUBON HILLS I I WASI£WATER SYSTEM SCHEMATIC
Anchorc203 Y/15/h Ave DATE.- OCT. 6, 1998
;779-39 a Ak 99501 BlOCYCLf WASTE WATER SYSTEM
119_-39 LSE _ SHEET' 3/3 GRID: 2739
PERMIT # sW98xxx PID k 015-231-63 ABH03043DWG
(t.
PERFORMED
LEGAL DESCRII
DEPTH
(FEET)
Munlcirallty of Anchorage
DEPARTMENT OF -iEALTH & HUMAN SERVICES
825 "L" Street,-mchorage, Alaska 99502-0650
SOILS LOG -• PERCOLATION TEST
1 1
INia.L U�,
2 •�s n
3
:r i
A
8 } I3
9
10
11
12
13
14
15
16
17
18
19
20
I-4; 1 l s
(ENGINEER-SSEAL)
1} ._, C J •i
DATE PERFORMED: Irl - Z P. - 7 Fn
S3ctiOn:
WAS GROUNDWATER A' u
ENCOUNTERED? 'r
S
L
O
P
J/ E
IF YES, AT WHAT
DEPTH?
DepIh to Water Alter
Manilurinp? B Date:
J PERCOLATION RATE (mmutemnch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
DISCLAIMFR_` GrmindwatPr rnnrlitians indiratod aro fnr the dates shown only.
Past and future presence and/or depth of groundwater can not be predicted
rom eSe O ervd 1 n -
PERFORMED BY: - IT— S _ I -. r S _ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIC ELINES IN EFFECT ON THIS DATE. DATE: `AJO ✓ tot ( 44p
72-008 (Rev. 4/85)
—�---
J PERCOLATION RATE (mmutemnch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
DISCLAIMFR_` GrmindwatPr rnnrlitians indiratod aro fnr the dates shown only.
Past and future presence and/or depth of groundwater can not be predicted
rom eSe O ervd 1 n -
PERFORMED BY: - IT— S _ I -. r S _ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIC ELINES IN EFFECT ON THIS DATE. DATE: `AJO ✓ tot ( 44p
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES O / `�
Environmental Health Division ✓ 3I
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720p IG11 n
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORTS -JA f
Name DISTANCES
Addre55 FflOM TO SEPTIC WELL
TANK
Pnmret5l Permit No 3701 C_ �XPFF-T�No o Bedrodms WELL I 1
00X I I
LEGALDESCmeTIGM LOT LINEJS 1 r + I
Lot blink SuDdlwS,on
FOUNDATION �s l ZO 1+
r
Township. Rang¢, Section
AS -BUILT DIAGRAM (Show location or wM, septic system. property ones, toundahon,
onvnway. wafer bodies, etc )
TANKS
Ig SEPTIC ❑ HOLDING
Manufacturer Capacity in ganons I 1-
❑ TRENCH
DePln to pipe who;
pngmal grade
'Y E OF SYSTEM
BED Imo] W.DRA
OTHER
nal imus
Pipe
1.
Municipal and Sate guidelines in ellen on Nis
Health Department Approval:
Scale: ENGINEERS SEAL
Ins bons Perform d y. r < 1
_ p '. f///r---:aha /t11,',. r�_'r
gic
t!
Date
a�]a A
L cerlil III I this inspection was performed according to all
..: ;� ... fiw•:vU S
• �. P.- ..p... S
< Dale'
_■■■■■■r■■■■■■e■
■■■■■■■■■■■■■■■■
Municipal and Sate guidelines in ellen on Nis
Health Department Approval:
Scale: ENGINEERS SEAL
Ins bons Perform d y. r < 1
_ p '. f///r---:aha /t11,',. r�_'r
gic
t!
Date
a�]a A
L cerlil III I this inspection was performed according to all
..: ;� ... fiw•:vU S
• �. P.- ..p... S
< Dale'
1.1 U N I C I P A L I T Y 0 F- A N C H O R A G E
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343- lyG�
O N- S I T E H O L D I N G T A N K P E R M I T
Permit Number: 900001 Upgrade
Date Issued: 1/28/89 Engineer Designed
Owner Name: FNMA
Owner Address: 3201 C STREET
ANCHORAGE, AK- 99503
Parcel Id: 015-231-63
Lot Legal: Subdivision:
Section: 23
Lot Size 40000 (sq.ft.
Max Bedrooms: This Permit:
S'u-)99Doo!
AUDODON HILLS Lot: 4 'Block.: 3
Township: 12N Range: 3W
or acres)
4 Total Capacity: 4
Day Phone:
561-0828
HOLDING TAME- Minimum Tank Size: 2,500 gallons. A high water alarm must be
installed on the tank and connected to the residence. Depth to top of holding
tank f 4.0 feet requires insulation over tank.
INSTALL PER ENGINEERS APPROVED PLANS. NOTIFY DHHS PRIOR TO EACH
INSPECTION. VERIFY INTEGRITY OF EXISTING TANK AND FIT -WITH.._.,
WATFiR TIGHT COUPLINGS. MOLDING TANI TO*BE'SECURED'WITH.WEIGHTS
10 PREVENT BUOYANCY. EXCAVATION TO BE COMPLETED IN ONE DAY
UNLES G'OVERED AND HEATED. THIS PERMIT IS ISSUED FOR THE
EXISTING 4 DR. SINGLE FAMILY DWELLING ONLY AND EXPIRES 12/31/90.
1 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 thi- or any adjacent or nearby lot.
4. I understand hat this permit is valid For a maximum of 4 bedrooms. I
also enders aid thatt. parity of the total system is 4 bedrooms and
any enlar.:rm• ill egi.re an additional permit.
Signed: / DATE:
-----.. ._------------------ ---- -� --�<- `-v --
(Owner) FN A
DATE:
Issued By: ��^
Ex.s
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SPPf.r I/ln k
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Alm \ \\ O
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�o ek[Jf - SP�iG fay
ef�lue�+f/o foe , A(s,
lkTb►!( ht�h PV?r{er/
alarm � �i/'ui/�/•
caPa[c.—fi,1 = � 250 �2/•
Bof•1. o'l �/G� %roto- //'-Ow
dr , d awfer@ Sarre
G2,¢x // = 6810,4-,Asr
0 ff 1, 71C196
3� e /�+re
P7arek rdf.� 2504'l Gv/f1 �7u/d=o'Ooo9a�F
/ X 62.q-.
Sei/ _ fJ2.�axizoxGa59/278 �Tefnlc�P.�LP•+t=lo�Fg2 '4JG 2�oz7
NOTE:FS.(� % sE
All Dimensions And Locations Must Be Field Verified Prior To ConStrulglOn
I SEWER SYSTEM LOCATION PLAN I
•t 'N"� _ NORTH
,. aFP s;:� r.r•:
3 1AUDOBQ1.fil.LLS:—_-.__
RANGE
I1. = _ � NOTE.
IOOThe
sursro Location OL waiting
snMd
Proposed property r.. NotL. andseptic
Sona eetol Is Not C.ect. 01. .1... ..JEY.KE55 indicated "eve been DeRecorded my DeeDL Cloth
Tape and/or
N.eletp.l Records, Ana Not or
�eY44
ServeTinq Techniques
PREPARED FOR.
FANNIE MAE
DATE. IZ 0157
ALASKA
SHEET I OF
Corwin
& associates,inc.
Consulting Engineers
1000 E. Dimond Blvd. • Suite 205• Anchorage, Alaska 99515 • (907) 522-1311
December 15, 1989
Mr. Greg Cress
Fannie Mae Alaska
3201 C Street, Suite 505
Anchorage, Alaska 99503
SUBJECT: LOT 4, BLOCK 3, AUDOBON HILLS
12200 AUDOBON
Dear Mr. Cress:
As reported previously, the existing septic system on the
above referenced project has failed. Yesterday we dug two
test holes on the property to see if there was sufficient soil
conditions for installing a new system.
The areas where the test holes
attached sketch. Test hole $1
feet plus. Test hole $2 showed
just below the surface.
were dug are shown on the
revealed peat to a depth of ten
severe groundwater conditions
Based upon these findings we feel the soils on the lot are not
suitable for an on-site absorption system. We recommend that
a holding tank be installed on this lot to handle the
wastewater discharge.
If you have any questions, please contact our office.
Very truly yours,
CORWIN & ASSOCIATES, INC.
J54e��%
Gerard Kress
Engineering Technician
GK/lb
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0� a
10
%
P '
v
I,
h
• '
h
.r
O\�
(LEJ
0� a
10
%
P '
v
I,
/ hereoy cer try that on accurate survey o/ the
/otto,r/np descr/hsd property -
and that the
r. r/IAI. IA.
.r
/ hereoy cer try that on accurate survey o/ the
/otto,r/np descr/hsd property -
and that the
r. r/IAI. IA.
(' Municipality of Anchoral
DEPARTMENT OF HEALTH & HUM,
825 `L' Street, Anchorage, Alaska
TEST HOLE ' SOILS LOG — PERCOLATI
PERFORMED FOR: A LI N I E N16 E AX
LEGAL DESCRIPTION: I nT 4- b( C .7
EPTH
((FEET] A U DO 60 K H I L. LS
1 /%eA'%4.'
2 lt, PENT
3 P-+-- 'j�+--
4
5�
G M ti
7 AA^
8 MMS
9 ivLh� .
10-
11
0 1t END
12-
13-
14-
M
21314
PAM OF ANCHORACK
15 DEPT. OF HEALTH R
El MRONMENTAL PROTECTION
1G
'.".i; -21990
17-
18- RECEIVED
19
20
COMMENTS
PERFORMED BY. I F e P K� FCC
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72-008 (Rev. A/651
WASGROUNDWATER
ENCOUN
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
epte to wAU MIT -
kwitmity?
ip, Range, Section:
SLOPE
Otte
PERCOLATION RATE (m^ute=/w�h) PERC HOLE DIAMETER
TEST RUN BETWEEN ,FT AND FT
ZF11 CAJWAS PERFORMED IN
:FFECT DN THIS OATS
1014 EGATE: _ / /Or!
('� Municipality of Anchorage r */
DEPARTMENT OF HEALTH & HUMAN SErvic "
825 -L" Street, Anchorage. Alaska 99502.
SOILS LOG — PERCOLATION TEAS
TEST NOLE�Z ' r A �/ { v��,.•,�
PERFORMED FOR:._PAU KJ IIE M,AC .ice. F� p �t�i
LEGAL DESCRIPTION: LnT 4 �1 _Lf � Township. Range. Section:
OEVTH A V ��u
FEET) H I LI [LJ'
1 PEAT
2 EW5 Sev+eFe Ground
ErzcL kied
3 �1usr. �dzbw
a C�m.nc/ Level. .
5
6
7
8
9
10
11
12
13
14
is
16
17
18
19
20
COMMENTS
ALny OF ANCHO M
PT. OF HEALTH &
NMENTAL PROTECTION
JAN •2 i990
ZECEIVED
SLOPE
WAS GROUND WATER _YF[
ENCOUNTERED?
,1y IsT Bccctj
WYES.ATWHAT (;2O(1LJD
DEPTH? LFI/F_ I
Bepm to Wax A.w
Antt3ruv? Cate
(ENGINEER'SSEAL)
PERCOLATION RATE (Lminut inchl PERO HOLE DIAMETER
TEST RUN BETWEEN �r 1 AND Fr
n
PERFORMED BY.
ACCORDANCE WITH ALL STATE AND MUNICIPALGUIDELN N
72-006 (Rp .4/631
14�:ERTIFY TH�TH' I� PERFORMED IN
THIS OATS DATE:
1 1 r^ MUNICIPALITY OF ANCHORAGE
1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING
DIVISION
\� 825 L Street - Anchorage, Alaska 99501
Telephone 264-0720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME %�
61or
PHONE
1274_32221
®NEW
G (/O m
❑UPGRADE
MAILING ADDRESS
P.
99'.3-0
a. flVA
z
LEGAL DESCRIPTION
dli
f 4 glocku on Hzffr
Su di b �'fion
LOCATION 1
oft�1 d�
//
NO. OF BEDROOMS
4
f/ u n
GC 4N or1 f
DISTANCE TO:
Well 121, r
Absorption area�7
Dwelling I�r
PERMIT NO.
S 6
O
f✓/
—Y
d ZQ
Manufacturer Gree
Material
No. of compartments
Wf-
V r
Lip. cacity in gallons
s-
paSTANCE
IF HOMEMADE:
Inside length
�
Width
Liquid depth
6 Y
DITO:
Well
Dwelling
PERMIT NO.
Oz
F
Manufacturer
Material
Liquid capacity in gallons
DISTANCE TO:
Well / ♦
Foundation 1 ;
J
Nearest lot line •
PERMIT NOg30169,
UP
u. Z
No. of lines L
Length of each line •
Total length of 'nes
Trench width,
Distance between lines 11
I•' = W
V
inches
Top tile to finish r
Materiel beneat
Total
oH
of grade — ,S r
rile
6
effective are
y
inches
Length
Width
Depth
PERMIT NO.
W
n f
Type of crib
Crib diameter
Crib depth
Total effective absorption area
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
.r
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption steals)
OTHER
PIPE MATERIAL S^
/C
SOILTEST RATING IZ?e C1
320 f�'
M
INSTALLER
X83-0/7
e u xG
REMARKS
T"Iteetzon on t
lot
ja
+t
n it •t %n ti PC/
r
h
APPROVED DATE LEGAL
-v - 9-8 t of 9fl),O(k3
A t,dubo., f/,11 uid
72-013 (Rev. 3/78)
MUtJ I iC I PFIL I TY OF Fft�ICHORFIGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL P20TECTION
825 071 STREET, ANCHORAGE, AK. 95 1
264-4720
Ohl -S I TE SELJER PERM I T
PERMIT N0. C 830169 )
APPLICANT GLORIA BOWMAN PO BOX 6502 99502 274-3222
LOCATION
LEGAL L 4 B 3 AUDUBON HILLS SID LOT SIZE 99999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER. OF BEDROOMS = 4 SOIL RATING (SQ FTIBR)= 320
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
6EPTH= 'r LEtJGTH= 100 GRfivEL. DEPTH=
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 TRENCH W I 17TH I S 5. 0300 FEET_
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
RaQU I RE[7 SEPTIC TnNK S I 2:E= 1.250 GF�ILILONS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY FIND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
T W O C 2] I N S P E C T 101 N S FIR E R E G U I R E E> ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE 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.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXP I RES L?ECEME3ER 31r
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 TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED
APPLICANT GLORIA BOWMAN
ISSUED BY------------------------------
:1-k,---- _ V4. 0
MUNICIPALITY OF ANCHORAGE
DepartmentP*-f Health and Environmenta;"Protection
825 Street, Anchorage, AK. .3501
264-4720
Permit # 3o907 * * * HANDWRITTEN PERMIT
/ WELL A ERMIT p _
Applicant: �L�!% �.�� Mailing Address: •0• k
Location: P'G /Phone N/umber,�:[['�
Legal Description;.. ��`��'� ff-(�_�hOkJ r1Lot Size:
- r
Type -of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:
WIDTH
DEPTH O LENGTH
D . GRAVEL DEPTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS
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.
* *,* TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
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. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
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 insta.11 the —i -accordance with codes..
(3) I and t a on -s' ewer system may re enlargement if
the sid nc a ed to include more th bedrooms.
Signed: Issued by
Appl � ant Date:
SWP/024(1/81)
TYPE OF SOIL ABSORPTION SYSTEM IS: DPAINFIELD
MAXIMUM NUMBER. OF BEDROOMS = 4 SOIL RATING <SO FT/ER)= 320
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
LIEF= TH= r L-E:r4GTH= 1:E:G+ GEF}TH— 21 -
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 TFS Et}ICH W I LATH I S~ S. CD0Ci FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
Ft EL?L� I REL> SEPT I C _Fn"K '� 12: E= 1 ID I[;f�LL4r4S:
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- T W Ci C 2� > I ":F-F}ErT I CANIS F jF?'E RE i_t I Fc EG --
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AP'P'ROVAL 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.
OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM'= ARE
AVAILABLE TO INSURE PAPER INSTALLATION.
F='EF�.*Ul I T E:<F� I RES G�ECEr'1E?EFS ~1, :I_
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOP, 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 TO INCLUDE MORE THAN 4 BEDROOMS.
SIGFJED:- -------------------------------------
PLICANT LOF.'IA BOWMAN
� n p
ISSUED B4__ ZZV4. 0
t�tur-.! I Ir-- I F✓'HL I TY OF= Rr-.ICF F:H1:3E
DEPARTMENT '',HEALTH
AND ENVIRONMENTAL `.OTECTION
825 '� STREET,
ANCHORAGE, AK. 99501
F•ERr9IT
OItA—=ITE
NO. C 820392 )
264-4720
EEWEF<: F=•EFr:t1 I T
/Yvv
r ,
d�
U
APPLICANT
GLORIA BOWMAN
PO BOY, 6502
274-3222
LOCATION
L463 AUDUBON HILLS
LEGAL
L462 AUDUBON HILLS
LOT SIZE 46433
SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DPAINFIELD
MAXIMUM NUMBER. OF BEDROOMS = 4 SOIL RATING <SO FT/ER)= 320
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
LIEF= TH= r L-E:r4GTH= 1:E:G+ GEF}TH— 21 -
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 TFS Et}ICH W I LATH I S~ S. CD0Ci FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
Ft EL?L� I REL> SEPT I C _Fn"K '� 12: E= 1 ID I[;f�LL4r4S:
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- T W Ci C 2� > I ":F-F}ErT I CANIS F jF?'E RE i_t I Fc EG --
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AP'P'ROVAL 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.
OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM'= ARE
AVAILABLE TO INSURE PAPER INSTALLATION.
F='EF�.*Ul I T E:<F� I RES G�ECEr'1E?EFS ~1, :I_
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOP, 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 TO INCLUDE MORE THAN 4 BEDROOMS.
SIGFJED:- -------------------------------------
PLICANT LOF.'IA BOWMAN
� n p
ISSUED B4__ ZZV4. 0
r,._... 1 V1:unicipaii POI y: 6-650
ANCHORAGE. ALASKA 991-01-0650
of 1907, 2641-41 11
�{[]��� yj��(1a�'�j (��1,.., �' `�{,�_y � ^! TONY KN�1.::f `.
l FuEiV.+SLT►JL�!;•i.e `�-".� AIA YOR
DEPARTMENT OF HEALTH AND ENVIRON?.CENTAL PROTECTION
<Permit #: 820392
January 31, 1983
TO: Permit Applicant
Subject: Lot 4 Block 3 Audubon Hills Subdivision
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
SOILS LOG '
MUNICIPALITY OF ANCHORAGE `�,
\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION / \ TESTOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720
//� /� SOILS LOG - PERCOLATION TEST
PERFORMED FOR: n� /Qj-/',q ' /O��n K/f DATE PERFORMED:
LEGAL DESCRIPTION: Al/c1/j,6D17 !7///S c5-aA !J/�r/1 4,34.11
1 -
2-
3-
4-
5.
-3•4•5•
6
s
s
,0
12
13
14
15
,6
17
18
19
20
SLOPE
-orgonit,si�i
M)- sc3nd IS(14-
m txfure
,�M)-9 ravellsanci�si 1+
Owl) IY1l6areS
L)- 5%11+1
Some9rc,vel WASGROUNDWATER _ nvSL
ENCOUNTERED? O
P
IF YES, AT WHAT E
DEPTH?
/-" vr7u
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Hep
5.26
►:os
r O
0.1570
11 O
11:25'
10
0.6lys
O.
H2O
:Zs
o
a
O.
PERCOLATION RATE �+`<C/ (minutes/inch)
TEST RUN BETWEEN 3�•` FT AND FT
•/n 1 __ i
PERFORMED BY: CERTIFIED
72-008 (6/79)
DATE: + ZV--F-Z
n '
LOCATION OF WELL (Plewa complete •liner la, IE or Ic.)
y
TATER WELL'_RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Divlsion of Geological S Geophysical Surveys
Drilling permit No.
A.D.L. No.
la. Borough Subdivision Lot Bloch n. 1/401re.
Section No. Township N0 Range E0 Marldlon
aly-I'd
❑
le. DISTANCE ANp DJSECTIO/NfROM ROAD INTERSECTIONS
S. OWNER OF WELL:
i.i' �% • '< ('7</ /Y«a..
(fit Y �V
Addis..: JPct
,
Street Address and Are. of W41I Location
2. WELL LOG FeetBolo•
Sar foes
d, WELL DEPTH: (final)
S. OATE OF COMPLETION
Material Type Too
Bottom
c 49 <--
-=- —gl')
_
1 ��
��s•.+"� �)
"__
6, pOnbht tool 011tolary ODriven 0Du1
❑Auger 0Jettod ❑Bored ❑other:
7.USE: ❑ DomesNe 0 Public Supply ❑Induaby
(:1 Irrigation O Recharge Cemme•Ical
D Teel Wall 0 Other:
I J'r' /, , .r !JJ fa r.:2-•,. 1 1�
4/�%
// ,
4 //
(l .
��r.,.�ici !t._..��� .. ,w....-..(� r
!•
B, CASING: p D Threaded QW1Id1d
dl.,..�in. to" -5 It. Depth WdgMtoo./ ft.
diem. I.. lo_fI. Depth Slicbup ft.
'/J.
."'.�... ♦Y.�. �� ii 47-1,J
';
•�%.•�.• f- Q
10S
B. FINISH OF WELL: {{,,pp�
Type: w.. L..-.'-r..v.i•/ la , ,/ZV o-0 iii
�J
11
SIot/Mein Site: Lan
Sit bat.eaa ft. and it.
Backfilling Growel pack
10. STATIC WATER LEVEL:Ito• /n
Date
O Above or D 0410 lands/s face
��
Equipment used:
�
11. PUMPING LEVEL below land ..,face and;IELD
[ mn ft. after are. pumping'
It. aft1._nre. pumping_g.p.m.
12.GROUTING Well Ground: O Yes 1' No
Material: ❑ Neat Cement O Other:
13P PUMP: (If available) HP /•- _.
Length of Drop Pipe It, capacity g,p.m.
Subm. O Jet O CeAtrifiCAl O Other
I4.11EMARKIl
_,2,f��'�j
709-71-
16. WATER WELL CONTRACTORS CERTIFICATION:
IS. Water Temperature 1 O F O C
This wsil was drilled ndery /mutlsdlclioa
/hnd tthjs report Is true to the be t,00fff myhnowiadgt and belief;
..I�-C�.Y-.l?A✓
0 R1 g1a1ere0�uNnl ss Name /
Conlrabl License Number
Add,ot:
Signed: CI �,.. _l _. :.:. . l
Don' r/.. r j
Authorized Representotivl
form 02•WWR (11/8I) COPY Distribution: WHITE -310b DOGS. PINK -Driller, CANARY'Cus,omer
Parcel I.D. 015-231-63
�E e�
Municipality of Anchorage =`
On -Site Water and Wastewater Program
(907)343-7904 n
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: � 2! /
AUDUBON HILLS BLOCK 3 LOT 4
12200 AUDUBON HILLS, ANCHORAGE, AK 99516
Current Property owner(s) ADRIAN MCCAA
Mailing address
Real Estate Agent KAREN CISMOSKI
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
Day phone 242-1761
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Fx]
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: NONE
Distance: ---
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the
engineer.
COSA Fee $ 1'-10 Waiver Fee $ 2 CSD
Date of Payment a Jr SI r 3 Ct)e' Date of Payment 2-12-7� z,
Receipt Number 0 (,-755 G Receipt Number 0327756:
COSA # bSC 1 '510 q 5 Waiver # DSP 13 1023
6. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 279-3916
Date 2/12/13,.
OF. !.< AIt
.r ��• • ..
r
r.
Conditional approval for bedrooms, with the following stipulations:
By: Ui/�ri�� Original Certificate Date: Z
The Municipality of Ay6horage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSA blue sheet r � c
Nitrate Advisory
Arsenic Advisdry
Other r
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: AUDUBON HILLS BLOCK 3 LOT 4
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #
Date completed 10/24/83 Sanitary seal (YIN) Y
Total depth 105 ft. Cased to 73 ft.
FROM WELL LOG
Date of test 10/24/83
Static water level 4 ft.
Well production 2 9 -
p.m -WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 1/24/13
B. SEPTIC/HOLDING TANK DATA
Parcel I D: 015-231-63
Well Log (YIN) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
2/5/13
<24 ft
6.6
9 -
p.m -
Collected by: LARS SPURKLAND
SIOCYCLE/ FIBERGLASS/ 11/18/1998&2/21/90
Tank Type/Material HOLDING TANK/ STEEL Date installed
1600/ 411 MANHOLE/ Y
Tank size 3606 gal. Number of Compartments _ Cleanouts (YIN)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y/Y
Date of pumping MAINTENANCE Pumper BIOCYCLE ALASKA
C. ABSORPTION FIELD DATA
Date installed 7/19/83 Soil rating (g.p.d./ft2 or fe/bdrm) 320 System type BED
Length 64 ft. Width 32 ft. Gravel below pipe 0'5 ft.
� a+
Total depth 2'5 ft. Eff. absorption area 2048 fe Monitoring tube Y Depression over field N
Date of adequacy test 215113 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 6 in. Water added 500 gal. New depth 10'5 in.
Elapsed Time: 420 min. Final fluid depth 9. in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 11/11/1998
"Pump on" level at 25
Datum DISCHARGE
Size in gallons 1600
in. "Pump off' level at 44.5
Cycles tested 3+
CHAMBER RIM
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tankilift station on lot '100'
Absorption field on lot '100'
Public sewer main NA
Sewer /septic service line '25
Animal containment areas '50'
Tal
Manhole/Access (Y/N) Y
High water alarm level at 22.5
Meets alarm & circuit requirements? YES
On adjacent lots '100'
On adjacent lots '100'.
Public sewer manhole/cleanout NA
Holding tank '100'
Manurefanimal excrete storage areas '100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 'S Property line f
Water main NA Water service line '10'
Wells on adjacent lots '100'
ABSORPTION FIELD ON LOT TO:
Property line '10 Building foundation '10'
Water Service line '10'
Curtain drain '50' (N.O.)
Surface water '100' (N.O.)
Wells on adjacent lots '100'
Absorption field'S
Surface water '100' (N.O.)
Water main NA
Driveway, parking/vehicle storage 10
F. COMMENTS
3000 GALLON HOLDING TANK CONNECTED TO SYSTEM VIA THREE WAY VALVE. *BED MONITOR
in.
TUBE EXTENDS BELOW DEPTH OF ROCK. LIQUID WAS NOT OBSERVED IN DISTRIBUTION PIPING
xtt Sae WAive, fes:- c,,.... of}n 1s.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through freld inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKAND
Date 10/16/12
COSA brown sheet 10-10-12-doc
CV
0 Biocycle Box
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ch
11160, ohs
O
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8909
170,
7
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Lot 3
IZ
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT
PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH.
49 rH
0
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0
QOh
Legal Description AS -BUILT ordered By. Curtis Sipes
Legend:
Lot 4, Block 3 septic standpipe o A
sphalt
Water well ® Vpl :.Audubon Hills Fence —X—x— ang
D
SURVEY Cs shown
his draw has conducted a physical sumympn:n; of the
Property he shown on this drawing property
nes and that the encroachments
enb
situated t thereon one within the property Ilnes and no enttoochmplta exlat
other than notal
— EXCLUSIONARY NOTE: It la the owners' responsibility to determine the
LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS existence of any easements, covenants, restrictions or right—af—way
440 West Benson Boulevard, Suite 200 Phone: 562-5291 takings which do not appear on the recorded subdhAelon plat under
Anchorage, Alaska 99503 no circumstances should any data hereon be used for construction,
9 Fax: 561-6626 for establishing property lines. or for plot—plan purposes.
Mat: 77-307 Orld: 2739 Date: 2/25/2009 Drawn By. CB
W01* order 2009—L-08 Fb/Pg: 733/43 scale: 1"=40' Checked By. JMZ
44.3 Q
to° /
Existing
L=31.42
House n
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o 5.70
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10' X 30'
Guy Easement
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Lot 3
IZ
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT
PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH.
49 rH
0
.Po
0
QOh
Legal Description AS -BUILT ordered By. Curtis Sipes
Legend:
Lot 4, Block 3 septic standpipe o A
sphalt
Water well ® Vpl :.Audubon Hills Fence —X—x— ang
D
SURVEY Cs shown
his draw has conducted a physical sumympn:n; of the
Property he shown on this drawing property
nes and that the encroachments
enb
situated t thereon one within the property Ilnes and no enttoochmplta exlat
other than notal
— EXCLUSIONARY NOTE: It la the owners' responsibility to determine the
LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS existence of any easements, covenants, restrictions or right—af—way
440 West Benson Boulevard, Suite 200 Phone: 562-5291 takings which do not appear on the recorded subdhAelon plat under
Anchorage, Alaska 99503 no circumstances should any data hereon be used for construction,
9 Fax: 561-6626 for establishing property lines. or for plot—plan purposes.
Mat: 77-307 Orld: 2739 Date: 2/25/2009 Drawn By. CB
W01* order 2009—L-08 Fb/Pg: 733/43 scale: 1"=40' Checked By. JMZ
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage Alaska 99519-6650 0 (907) 343-7904 • Fax (907) 343-7997
http://www.muni.orgi/Onsite
Development Services Division
On -Site Water and Wastewater Program
went
c
n
Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP131023 COSA* OSC131045 Permit#:
PID#: 015.231-63
Legal Description: Audubon Hills Block 3 Lot 4
Engineer: Spurkland Engineering
Applicant: Adrian McCaa
Your request for a waiver of the required 2 feet cover over the field has been approved. The
approved cover is 19 inches with 2 inches of insulation. See the engineer's waiver request.
This waiver approval applies to the existing field only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: Approved by: Lam/
Name of Review
..... 6.s... m.s.ass..................mesa................... .6000.............
Rec#: 03778G Amount: $200.00 Date Paid: 2/27/13
**** VARIANCEMAIVER REVIEW ****
C
Environmental Consulting and Design
MZ6
COSA SUBMITTAL
Audubon Hills Block 3 Lot 4
Municipality of Anchorage February 25, 2013
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: Septic System Adequacy Testing & Waiver Request
12200 Audubon Drive
Ladies and Gentlemen:
I am writing to request a 3 -bedroom approval of the septic system at the above reference
property. The septic system was originally designed as a conventional 4 -bedroom system and
was installed in 1983. It consisted of a 1250 gallon tank, a lift station and a 64 by 32 foot
subsurface absorption bed. This system failed within 2 years of operation. No suitable reserve
sites were identified and a holding tank was installed in 1990. In 1998, approval was granted to
install an AWTS and have it discharge into the abandon bed. At that time the absorption bed
was tested and found adequate for disposal of 450 gallons per day. The inspection report states
that the system is sufficient for 4 -bedrooms.
On February 5s' 2013, I inspected and tested the absorption field. A bed monitor tube and clean
out tube were located. Prior to the test, the bed monitor had a liquid level of 6 inches and the
clean out was dry. Five hundred gallons of clean water was introduced to the discharge chamber
of the BioCycle AWTS, the liquid level in the monitor rose 4.5 inches while the clean out
remained dry. This indicates that the monitor tube extend beneath the depth of sewer rock.
After 7 hours the water level in the monitor had dropped 1.5 inches, indicating that the drain
field is capable of disposing more than 450 gallon per 24 hour period. This is adequate for the
existing residence and within the operational range that was specified for approval in 1998.
We are also applying for a waiver of the amount of cover required over the absorption field. The
inspection report indicates that the entire absorption field was insulated. In the vicinity of the
absorption field monitor and clean out there appears to be 19 to 21 inches of cover. Nineteen
inches of soil cover plus 2 inches of insulation is equivalent to 3.6 feet of soil cover, which is
above the minimum requirement of 3 feet. There is no indication that the system has had
problems with freezing during the 20 plus years it has been in operation. Granting a waiver of
the required soil cover will not adversely impact the operation of the septic system.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
SPUVESfid ENUGHM96AHg
Environmental Consulting and Design
99 1
The holding tank was pumped on February 26th, 2013. Approximately 3000 gallons was collect.
This corresponds well with the documented tank size. No change in the liquid level of the empty
tank was observed over a 24 hour period. The holding tank appears to be sound.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
t4rs
Larkland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND Patrick & Jeri Collins
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
30thDayof January of 201 by and between Patrick & Jeri Collins
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as Biocycle located
at 12200 Audubon Drive _, Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AW WTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of zero dollars
($ o .00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AWWTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations. Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is: annually
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner: Patrick & Jeri Collins
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNER:
By;
Date: 1/31)/LnO
MUNICIPALITY:
By:
Title:
Date:
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this 3o day of �a uriy
20t3 'by
G. � e
NOT Y PUBLI �R ALASKA
My Commissio expires: j„(��6fa2U�Y
J MUNICIPALITY OF ANCHORAGE ARL
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services law
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. # r s
1. GENERAL INFORMATION
HAA# �AOASLLI4)1
Complete legal description Leper' 1i. 3 k 3
AU DUL30N 4�1t1.L-S
Location (site address or directions) 12P -o -o Av no Stat k DK
Property owner f�g4-A ., Day phone
Mailing address 1;- V'•
8ou6:e'
Lending agency �a� ��Day phone
Mailing address ►«°" L2t.twca �i.s.T•
Agent Ol4 Pte K ath t?%lA: Ve Day phone 543" BS & -C:7
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
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
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-M(Rov.1/91) Fm t UOA141
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I Iurtherverifythat 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
Address
Engineer's signature _
i1 .20:3.
6. DHHS SIGNATURE 16
J Approved for bedrooms.
M
Disapproved.
Phone A-75-391 b
'tI laA'
Date ti �
'Ha �1 (atJ r`
``�`ti i�r � ....: .• .moi
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
•
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given In paragraph 5 above by an Independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasersof 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 -MM v. JAI) Beak MOAM
RECEIVED
Municipality of Anchorage NOV 19 1998
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division MUNIOPAUTr OF
825 L Street, Room 502 • Anchorage, Alaska 99501 •
Health Authority Approval Checklist
Legal Description: Lo+ L1, At&te.-6aAa it 16 Parcel I.D.: 015—z31
A. WELL DATA %/
Well type If A B, or C. attach ADEC letter. ADEC water system number N/A
Log present (Y/N) Date completed 10-a*4 -- 93—
Total depth ► O 5 Cased to 73 t Casing height (above ground) f
Sanitary seal (YM) Wires property protected (YM)
FROM WELL LOG AT INSPECTION
Date of teat !o%�tlr� yhki9P.
Static water level Li <1 y '
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform _� Nitrate H Other bacteria bw
Date of sample: t t I'r� 9g Coltected by: - S
B. SEPTICfHOLDING TANK DATA
Date installed 11, L Tank size /&00 Number of Compartments 4— Clearmuts (YM)--�Z—
Foundation cleanout (Y/N) Depression (Y/N) 14 High water alar (Y/N) _
Date of Pumping N • • Pumper
C. ABSORPTION FIELD DATA
Date installed 11 02— Soil rating (g.p.d.V or ftYbdr) 3 2-10 System type h E D
Length ;70 Wldth -5 Z— Gravel thicimess below pipe Total depth I
Effective absorption area 2v 4 F Monitoring Tube present (YIN)Y_ Depression over field (Y/N) !�SL
Date of adequacy test S .v - s - 9 F Results (Pass/Faiq ? For bedrooms
Fluid depth in absorption field before test (In.); Immediately atter. water added pn.): Sc
Fluid depth (ins) Minutes tater. Absorption rate : a.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-028 (Rev. 3Wr
D. LIFT STATION
1
Date installed 1 ijs/9fl Size In gallons iG o -o
Manhole/Access (Y/N) `Pump on" level at* 52.5 rr "Pump ofr level at' y 1
i
High water alarm level at' 2 2 L •Datum, s
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septletholding tank on lot 2 2 a On adjacent lots > I &-0
Absorption field on lot 1 1 D On adjacent lots 7 /c+• -Q
Public sewer main td/p Public sewer manhole/deanout N1/1r
Sewer /septic service line 75-t Lilt station i i D
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Foundation 3 3 Property line !3 t Absorption field i 0 f"
Water main/service line -> o —"Surface water/drainage N I b Wells on adjacent lots >'� /a -a
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I • t Building foundation AO f Water maintservkar line > S D,
Surface water N 10 Driveway, parldnghvehlde storage area > ZS -
Curtain
fCurtain drain Wl O Wells on adjacent lots 1 1 dr•o
F. ENGINEER'S CERTIFICATION
I car* that I have determined thru field Inspections and review of Maddpal records Unit the ebove systems are
in conformance with MOA HAA guidelines in effect on firls date.
Signature
Engineer's Name
Data 2 t I l 4 A
HAA Fee $ Waiver Fee $
Date of Payment 1 1 1 `� - °\ "U Date of Payment
Receipt Number �,•, �s s C 1 a mal Receipt Number
72.028 (Rev. 3196)•
N
APPLIrNT
FILLS OUT UPPER HAr (ONLY
Property Owoer...Iq
14,61 Gd J ti "
Phone
�S X61/
J
Mailing Address
' %
AC
iy it Zip Code
Date
�
Buyer
�l
Address
Inspector
Zip Code
Lending Institution
A bsfa 4411-1
1�4-i
Phone
Address
Zip Code
Realty Co. d Agent
4/eg
//
c. A lY
/
Phone
Address
code
4-- X
Legal Description
�
Ac 7 lie
/
// L ,lziD
3 � (L C4 4760 /Y •'��.5
Street Location
�,re
L
Type o1 esidence
Ingle Family
( ) APPROVED BEDROOMS
❑ Multiple Family No. of Bedrooms
NDI710NS OF APPROVAL
❑ Other
{{q((T )CONDITIONAL APPROVAL' O
DATE
Water S pplY
ndividual
`
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
❑ Community
BY: Cd
For wells drilled prior to that date, give well depth (attach log If available).
-,O Public Utility
Solis Rating
Date Sewer Installed
AreaWell
Log Received
Septic Tank Size / L-
Sewer 'sposal
dividual
`) _ (C �e.9
Year Individual Installed: /�,�3
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PRO ESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
�
_ -�Inspector
�l
Inspector
Inspector,
..- -
Wale_
CT
Field Noted
MUNICIPALITY OF ANCHORAGE
4-- X
DEPT. OF H.`ALTH 1;
ENVIRON1d:NTAL PROTECTION
. .14e
SEP 1 e; 1363
L
RECEIVED
( ) APPROVED BEDROOMS
^� I
NDI710NS OF APPROVAL
O DISAPPROVED
{{q((T )CONDITIONAL APPROVAL' O
DATE
`
BY: Cd
Solis Rating
Date Sewer Installed
AreaWell
Log Received
Septic Tank Size / L-
-3 W
`) _ (C �e.9
rWell,ToAbsorption
to Tank y 'j,. /
71 Wl Uma