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HomeMy WebLinkAboutFISCHER BLK 1 LT 3A6Fisher Block 1 Lot 3 A6 #015-292-13 Municipality of Anchorage Page 1 of a DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. 4=97031 R PID Number. ni SZ9,.)T i Name: Thomas E. Woods Wastewater System: ❑ New Upgrade Ad`""' 11 APP (6 ABSORPTION FIELD Anchorage, Phone: —117 No. of Bedrooms: eep Trench O Shallow Tranch O Bed O Mound O Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: I•v Po . Ft. O• Lot Block: Subdivision: Dpth to pipe bottom from 0riginal gratic Gravel depth beneath pipe 3 A6 1 Fischer Ft. 4.o Ft. Township: Range: Section: FII added above original grade: Gravel length 1.L37— /. Ft. 4% Ft. WELL: eve (3 Upgrade Gravel width: Numberolana: DlsWpbelwetilim 3. Ft. ( Ft. Classification (PrivetI, A,B.CY• Total Depth: Cased TO. Total absorption area: Pipe materwl•AS7-M D-3oj h• IG 85 FL SO> FL DO so.Ft. —SIo Driller. /—, Date Dralec: Static Watar Level: InstallerDate ltlatalled: 0) �u NV • 5-b.5 Ft. Yield:Pump Set at t:autq Meant Above Ground: TANK S•%/ GPM $ Ft. 'L Ft SEPARATION DISTANCES eSeptIC E3 Holding 0S.T.EP. To From septic Tank AbWnibon Flea Lin station hmtnq Tank Poescortraw se-«t.k... Manufacturer. Awc., f T -.4,`1K Capadty In gallons: 1 LS'o Welt' 13 y' o r f/ A/ 1 f li >140' tonal: 5 fc� Number' Compartments: 1v 'N Waaler ►ov' > /oo' 1A A, > le? LIFT STATION •Lot�15, 3 , > S,, Size m gallons: Manufacturer. Line A/�il' Foundation •' /v � / 'Pump onIevN at ofr' Nvel at Mign water alarm ac curtain / /r / / / Pump Make 6 Electrical Inspections performed by: Drain Remarks: Existing septic tank crushed BENCH MARK and backfilled. Existing Location and Description: L absoreption treniccomp eta y. rNN d Contaminated mater- bujed mor than 100' from all Assumed Elevation: = Weis in tRe area. too F, ENGINEER'S SEAL ��wV.`a�,i � -- j Or A 11 a -- zci.. • %� t •. Inspections by���— Dates:ls `� 77'ff; ��9T�i .. performed Department of Health and Human Services approvalV3Z. 4331E �. Reviewed and approved by: Date: 4 ItxpS�y 72-012 (Rev. Wall MOA 25 I, i Permit No. SW970318 Page of 7 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot 3 A6, Blk. 1. Fischer Subd. MONO.: 01529213 • -. . , r -, . ..I _ , �-'-r' 'r' I • � 1 I I I i I I I - I' � 1 _.I. ...r _ i ---r- ! - • -"---- i I I! well I ( I I I I I I l l I 1 _ H�:: f i I i II f�I�lil � I ii Ilii !I ! I I ! I. — f Vt . I I �L i I T --- - I ------ 21.1 I . G3.3 — - - -- ---- - (3 4129 - 250" P�_.._ _ 2 37 $ C5 MT2. J1(z 2►,�f- SJ oa Septic SP.2 - — — - : Tan C24 CY - — '-- ---- -- ! 1 PLAN AS—BLT - 4MTj -OFAI 11-- i Pq n ', — 9 p�� --1 ! LLEGEND I SPt Septic Pump, compartment 1 —"""-- — --" C �l('�'(')�° i Clean out � f � I • hUC}iAEI E. AW0)ERSDr1 • % I f MT Monitor Tube sill •••'•:moi.•+ ��•= I I 1 _-LL SIE _D_Q_N I f C I R. • i I i f I I i i I Permit No. ewo'7nII a Page of � { Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Lot 3 A6, Blk. 1, Fischer Subd. Legal Description: PID No.:_01 5*)a!71 o IV \0OF —' ��--v\ It- �v j � �^ � vii �\�•\� � �� ^ �w\� � / / /\. gentextil I a� ifabric eRtiCTn b- — i j j KI T\—,4 - I '�i ! ! 77 if It 'v, SP1 I I I SP1 Septic Pump, compartment 1 SPZ « « « Z = • �1 ___ C Clean Out _ MT Monitor Tube Els IT i 11--, �9 � i• i 1 �; ! I j I! I --j— — -- -- -- - 1- -�- -- - — -y Ll • • , _Rock Y I —Septic _i -bid 1 T--_`• _- • — e �•. T•° i_--6—�_t'_-r.__-- dM-- r i 1 __ V ; ` r :MICHAELE ANDERSCtI; %---------------• ELEVATION AS -BLT -c9 . 1 = 10 itl`apRoFESSON-------- — -- - _---- n \� Altinicipa-lilyof Anchorage aw Department of Health and Human Services 825 "L" Street Rick 6lystrom, P.O. Box 196650 6ff_�T.P f4 41aska 99519.6650 Mayor http'7Nrvw.ci, anchorage. ak. us April 3, 1998 Michael E. Anderson, P.E. Anderson Engineering PO Box 240773 Anchorage, Alaska 99524 Subject: Waiver Request for Lot 3A6 Block 1 Fischer Subdivision Waiver Request #WR980008, PID #015-292-13 SW970318 Dear Mr. Anderson: Your request for a waiver of the required 10 foot horizontal separation from the on-site wastewater disposal system to the southern property line has been approved. The approved separation distance is 3 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Darnel J. Roth Civil Engineer On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR980008 PIN 015-292-11 HA# Permit # SW970118 Date Received: March 10, 1998 Legal Description: Lot 3A6 Block I Fischer Subdivision Engineer: Michael E Anderson P E Anderson Engineering PO Box 240773 Anchorage Alaska 99524 Applicant: Thomas'E. Woods Waiver Requested: Lot line waiver of 3 feet from the southern lot line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: *wrr*,e Waiver is Granted: X- Waiver is NOT Granted: List Conditions or Reasons for above: tFr EAG/vEfR�1 Air/3-045D L C iTCIP DF ,rU 3 r1 F/ /iTIDA/ Date: Q -3-28 By: D/9 A/ Name of Reviewer Rec #: 003638/7618 Amount: $ 115.00 Date Paid: 3-10-98 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 March 10, 1998 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 3A6, Block 1, Fischer Subdivision Lot Line Waiver Request Dear On Site Services Engineer: RECEIVED MAR 101998 Municipality of Anchorage Dept. Health & Human Services The attachedSite Plan shows the location of the absorption trench recently constructed on the subject lot. Due to the small size of the lot and the conflicting 100' radii from adjacent wells it was necessary to encroach within 10' of the southern lot line. We are therefore requesting a lot line waiver be issued allowing this encroachment. We originally intended to place the new absorption trench between the old trench and the new tank. During construction it became evident that insufficient area was available to .leave the existing trench in place. We, therefore removed the existing trench in its entirety and placed the new trench near the same location. All contaminated soil was disposed onsite more than 100' from all wells in the area. Soils on the lot are conducive to an onsite system and no groundwater was found during the testhole and design phase of the project. The trench borders on the cul-de-sac serving the neighborhood and is more than 50' away from the nearest septic system. The total area of the the lot is only 11,621 square feet with nearly all of the area taken up by the protective radius from the well to the north. No easements exist along the southern property line. Placing the absorption trench within 3' of the line will have no adverse impact on systems currently in place or to be placed in the future. We therefore recommend a waiver be issued to allow construction of the absorption trench to within 3' of the lot line. Please let me know if you have additional questions. �Sincerely,, , 0 /kj "^`t Michael E. Anderson, P.E. -11 Attachments 0C_4' o3f03F, (-pits t� f' Moo COPi PAGE 1 OF 1 a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 ^L^ STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970318 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:WOODS THOMAS EDWARD & OWNER ADDRESS:5121 SELDON CIRCLE ANCHORAGE, AK 99516 PARCEL ID:01529213 LEGAL DESCRIPTION: FISCHER BLK 1 LT 3A6 LOT SIZE: 11621 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 9/16/97 EXPIRATION DATE: 9/16/98 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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. THE NEW DEEP TRENCH WILL NEED TO MAINTAIN A MINIMUM OF 14 FT SEPARATION FROM SsTHE f EXISTING SEPTIC FIELD: RECEIVED BY: -/aa4"t' DATE: 9Ij�lq% ISSUED BY: DATE: 9/�! wok 041V�3:d ACO _ E;, -AK !V9�24 5:63538 (FSC. August 27, 1997 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 3A6, Block 1, Fischer Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We hereby apply for a permit to install a new septic system on Lot 3A6, Block 1, Fischer Subdivision. The existing system has failed and must be replaced. The attached site plan and backup documentation identify the location, size and components of the new septic system proposed to serve the four bedroom home on the lot. The existing septic tank will be removed and disposed to make room for the new tank. A 10' separation distance will be maintained from the existing trench which will be abandoned in place. The testhole placed in the area of the proposed absorption trench revealed well graded to poorly graded sands with a percolation rate of 5 minutes per inch. No groundwater was noted during excavation nor during the ensuing monitoring period. We are therefore proposing placement of a 37' long by 7' effective depth deep absorption trench for disposal of septic effluent. Wells in the area limit the space available for the septic system, but separation distances are maintained at the location for the new system. The ground surface of the lot slopes and north to south at grades ranging ground in the area of the new trench from east to west at a grade of 2% from 3% to 4%. The surface of the is fairly flat. If the system is constructed as designed the following statements apply: Lot 3A6, Block 1, Fischer August 27, 1997 Page Two 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the area. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained.. Sincerely, C. ,.,,•..�„ s;� Michael E. Anderson, P.E. Attachments AREA MAP SCALE 1" c: 40' ADB Ldj"3hloIr�fZ Sl.�l�b• SHEET NO. I OF CALCULATED BY DATE !� \ CH KED BY GATE f.LLE Kms 6M7 Drano L3A.5 I rt i j j o� 3!;C4—'1-. .–� — Lot i i T —~ I ' 1 i — I ! I I I I Lot 3A6 I i I moo' �s :I. Lot /fit; R • - f I Arir i l i i 1 1 1 1 1 1 I I Kms 6M7 Drano SITE PLAN SCALE 1" = 20' JOB I I I I I I I I I I I I I SHEET NO. or p DATE S Z CALCULATED BY CHECKED BY DATE LE7201 I !CALF 1 1 1 1 1 I.I I I I I I I I I I I I I I I I I I I I I ��- I Ilpo� '—A _ I I 71-j T 'r : ' I � 5 TI I •�. �! IE��I Q�"E'i'?a i I I I � ' •I ' I I I I ' 1� t r F• I1 F-1-11z NmCW ®46� V HN. FOUR BEDROOM HOME REMOVE EXISTING -.J TANK I 1 0 I I o • � I I . NEW 37' LONG X 7' MONITOR EFFECTIVE DEPTH ' TUBE ABSORPTION TRENCH a � M ABANDON EXISTING TRENCH SYSTEM PLAN NO SCALE MAINTAIN 10' SEPARATION FROM EXISTING TRENCH NEW 1,250 GALLON SEPTIC TANK CLEANOUT TRACT 3A6, BLOCK 1 FISCHER SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 5 MinJinch New 1,250 Gallon Septic Tank Application Rate: 1.2 GPD/SF 7'• Drainfield Rock 4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area 500 SF/14 SF/LF (Absorption Area) = 35.7 LF Trench Length Therefore: Construct a Deep Absorption Trench With One Lateral 37' in Length with 7' of Drainfield Rock Beneath the Lateral. Distribution Pipe In Trench Placed at 4.0' Below the Original'Ground Surface. 0 • v /vATLRAL �.. t��/// 1��/i� ny// ��Y/i �w 8nu�lu. ; GearGxrt cc tr 7 O 1 1 s s d '' �na,aFlcW 1 3=0' TYPICAL DEEP TRENCH SECTION (NO SCALE) ;k NOTE: Grade Area Over Trench to Drain Away.I �f L J--W�ft 43SI.T Minimum 3' of Cover over Septic System. .13, 1 aeu , Munfdpality of Anchorage « ,.� +.•..:..• .c. y�•qc ,;' DEPARTMENT OF HEALTH 5 HUMAN SERVICES . HfaYawM••••alM1 �. o�r,7 525 `L' Street. Anchorage. Alaska 99502••06x0 � le.l,z+ L Ae&'we +e i, SOILS LOG — PERCOLATION TEST AZI.2 L PERFORMED FOR: TORI wood DATE LEGAL DESCRIPTION: Lot 3A6, Blk 1 Township, Range. Section: K ey Fischer..• Subd. SLOPE 2 3- 0.v Sir✓/Knvv 4 v 5 • Q. 6 •• 5 / 10 •� 11 1 • 9- 12- 13- 14- is- 16- 17- is- To- 20- COMMENTS 213 14 15161715 To-20 COMMENTS Tll LSV/Y SITE PLAN WAS GROUND WATER K t7 ENCOUNTERED? IF YES. AT WHAT DEPTH? Ns*tratr Rwditt0 Dna Grow TIrm Not Time Depth to Water Not Drop a 77 S 3i r 1 "Z S" 9rZ. it. Le •r3 Ip ISI—O 127. $'t :o r3o i 7.S' i L12.o ?Srs Il.v a•s'o [r3L� s.2y t•3 •'rt PERCOLATION RATE tmwwtmw�ch) PERC HOLE DIAMETER I'�Z 1 TEST RUN BETWEEN �.y FT AND —L�3C FT VV.hS SO/GAJ 1AV0L PeaC0lM'wf PERFORMED BY: � _' 1 / r I•t.l.N.ta-Li yc T r -THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE/ 47 72•MS IRev. 4/651 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: Lot 3A6, FISCHER SUBDIVISION GENERAL: 1. The scope of this project includes the acquisition and placement of a new 1,250 gallon septic tank and the construction of a new 37' long by 7' effective depth absorption trench. The distribution pipe in the trench to be placed 4' below the existing ground surface. It also includes the removal and disposal of the existing septic tank and the abandonment of the existing absorption trench. The new trench must be constructed a minimum of 10' from the existing trench. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan. Lot 3A6, Fischer Subdivision August 27, 1997 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. MUNICtPALITY OF ANCHORAGE • �`�, ALASKA enui nmenTRL COnTROL SM61Z T ��R 88toN o Enginttrinq & Environmental Studies �s RECEIVED 1200 West 33rd Avenue, Suitt B"AnAcrage. Alasko 995034907) 561-5040 TO y p� DATE ek SUBJECT —Z -3 r19-41 Q / Fi.r54v Sof" If _t 7-1 -- Lot 3A6, Fischer Subdivision August 27, 1997 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 3A6, Fischer Subdivision August 27, 1997 Page Four 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be .conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. MUNICIPALITY OF ANCHORAGE HeaJ'�' and 'Environmental Protef '1 n Fourth Floor West ' 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME-N-C�' C'"'ES On MAILING ADDRESS -a( W eJ"'�� GC'�6- PHONE. LOCATION _f._aG(v LEGAL DESCRIPTION �3 A � Ft a✓' SJp SEPTIC TANK: DISTANCE ( NUMBER OF Z FROM WCLL Io C> MANUFACTURER &�~ MATERIAL ( COMPARTMENTS 1 INSIDE LENGTH INSIDE WIDTH _ _.'7"_ LIQUID DEPTH _ LIQUID CAPACITV�•y GALLONS. TILE DRAIN FIELD: P�� I ( TOTAL LENGTH DISTANCE FROM WELL / IOD FOUNOAT ION NE ARCST LOT LINE 0 OF LINE # of Lines 1 7 DISTANCE BETWEEN LINES �J( TRENCHH �WIDTH14_ IN. TOTAL EFFECTIVE ADSORPTION AREA � l SQ. FT. LENGTH OF EACH LINE ` p) 1 � DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE -5 MATERIAL BENEATH TILE 4& IN. ABOVE TILE SEEPAGE PIT: DIAMETER_OR WIDTH_• LENGTH_. DEPTH Log Crib _Rings_ Crib Size: DIAMETER_DEPTH_DISTANCE FROM: WELL • -- ---- -' --' TOTAL EFFECTIVE BUILDING FOUNDATION_ • NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SO. FT. Well Z Class: TA . Depth: Well Distance To: Lot Line to Bldg: -2_o 1 Sewer ,Line: la Pipe Materials: # of Bedrooms: Installer: Self Remarks: —So; 1 4'S DATE APPROVED i 1_L:.: - - - - - - -I-� Jfi- DATE APPROVED i rDEPARTMENT' 'HEALTH AND ENVIRONMENTAL' '.OT CTTIN 825 vc.' STREET, ANCHORAGE, AK. 9y501 3�U --7 WELL_ FiMi:► OPV—SITE SW EEFR F`EF2M T4.S61' D�) - PERMIT NO. < 77400 ) V 1 7-7 7 APPLICANT NO LOTS CONSTRUCTION 3419 NEWCOMB 333-5436 LOCATION DEL CIRCLE LEGAL L3A6 B1 FISCHER SUBD LOT SIZE 11500 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS o 4 SOIL RATING CSO FT/BR)- 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [7EF}TH— 10 ILENC3TH® 43 C3FZF4Vat_ I7EF1THm 4 THE LENGTH DIMENSION IS THE LENGTHICIN 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). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F2EG)U I FZEE> SaEF3T I 0 -rnNFC S I ZE— 1250 C3nL_L_O"S TWO <.2 7 I NS;F:l'ECT I OPUS F iF2E FtEGiU I F2E© 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 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTME14T WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO ;INSURE PROPER INSTALLATION. i 17EFZM I T V1=1L I © F= 0 F OhPE VE:nF Z FROM I'S SUE I CERTIFY THAT 1: I AM FAMILIAR WITH THE P,EQUIREMENTS 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 RESIDENCE I5 REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED ISSUED IF THE GREi.iFR AtICHORAGE AREA BOROUGH I DEPARTMENT OF EtNTROM-IFfITAL QPALITY Case P 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For�IyTwnj bcaTi Ctxxrax-no. I' Dated Performed Legal Description: Lot3AG Block l SubdivisionLen3AA38,Bwcvi.pie" 5u4 This Form Reports Soils Log_ *1 Percolation Test t4R - Soil Test dust Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics / orgaM.C. 3, wast, re $ $rw, St/k I T'n . cl&-f tlet Time Of A/- 1 Depth tAr�•• •• 0p 90 v� Ery, Shlarl loos••da••w Gtr So Ft�rcan ..,.. wet , 16•Y-% �1�i LYNN 1. WAIIACa .,U/ja.{�+w,do..� dry wai.w''d'ti jW �2S So R I8cer. i5b�Q "Neil :; 'v B tl�� 6ey f.1160-1. loose,ote,.0 ',D• c �wrll eluded• IMi(r{7[,I,Ir� CSW 8s'so F+/fta. Was Ground Water Encountered? Se to wcsf •E-- Op q If Yes, At What Depth? F ` _ • i d • 2 i Reading Date Gross Time tlet Time Of A/- 1 Depth tAr�•• •• 0p • LYNN 1. WAIIACa Percolation Rate Minute Proposed lnstallation: Seepage Pit Drain Field �C Depth of Inlet_— 61 __--Depth to Bottom of Pit or Trenc ayfi CDMMUITS: .Pmr ��eo,� so•�r-�s�v�i b/�, 3' Test Performed B %C+ Date Certified BY• Date. L o o`�%�►� ,c,A(� ° (3 r �-e- 3 3-7 — /557` �� T a— L(��� 5-0 -7'cT- L�l11 scj • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval �1 // Parcel I.D. 015-292-13 Expiration Date: - 2- 7=L-4 1. GENERAL INFORMATION Complete legal description FISHER BLK 1 LT 3 A6 Location (site address) 5121 SELDON CIRCLE ANCHORAGE AK 99516 Current Property owner(s) GRANT KLOTZ Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) 1�m ❑ Duplex V j ❑ Multiple Dwellings (Single Family and/or Duplex) MAY o s 2614 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual IN Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: NONE Distance:_ Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: l 4" �� d COSA Fee $ 92 Waiver Fee $ _ Date of Payment / Date of Payment Receipt Number &o 5; t �ipr� U Receipt Number COSA#— 0SUy 11-7 5 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SPURKLAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone 279-3916 Date 4/28/14,x, N N,\\ 47�rii r , �.. 1'...`�. LARSPURKLA,,N / �dj•, �4 `�Fo ••.......••ivy -- Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: Th nici t age Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the resentations 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r i - 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: FISHER BLOCK 1 LOT 3 A6 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #- Date completed LINK Sanitary seal (Y/N) Y Total depth 85 ft. Cased to 50+• ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 7.64 mg/L Arsenic ND ug/L Date of sample: 2/28/14 B. SEPTIC/HOLDING TANK DATA Parcel ID: 015-292-13 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 1/24/14 Is 6.1 ft. :61Ra tl Collected by: LARS SPURKLAND Tank Type/Material SEPTIC/STEEL Date installed 9/24/97 Tank size 1250 gal. Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 9/30/13 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 9/24/97 Soil rating (g.p.d./ftz or ftz/bdrm) 1.2 System type TRENCH Length 42 ft. Width 3.5 ft. Gravel below pipe 6.0 ft. Total depth 10.5 ft Eff. absorption area 500 ftz Monitoring tube Y Depression over field N Date of adequacy test 1/25/14 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 1030 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date 1Dim114C-iCIIV0f0111 Date installed Size in gallons "Pump on" level at in. "Pump off' level at - Datum Cycles tested E. SEPARATION DISTANCES ITA:l11[0LIVON ato] Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50+ Manhole/Access (YIN) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main NA Water service line 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line lI ►` Building foundation 10+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ Wells on adjacent lots 100'+ F. COMMENTS SYSTEM PRESOAKED PRIOR TO ADEQUACY TEST *WELL SCOPED BY WHEATON WATER WELLS 3/29/14 G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date - Engineer's Printed Name LARS SPURKLAND Date 4/28/14 COSA brown sheet_10-10-12.doc Absorption field 5'+ Surface water 100'+ Water main NA Driveway,10'+ parking/vehicle storage OF At s PuaKL�rao:: P {�t�C;N* 11.500 V_ o Municipality of Anchorage s Pw < Community Development Department Development Services Division s A E.: On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 141175 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 3A6 of Fisher subdivision. This inspection revealed a nitrate concentration of 7.64 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. IJ 83 56' 50" Vi 136.73 THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES. IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. A5 -BUILT SURVEY V = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 3A 6, BLOCK 1, FISCHER SUE. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _23RD_ DAY OF MAY , 2014. 11SSB, /B 164-33 HOLT LAND SURVEYING 600 H1GHVIEW DRIVE ANCHORAGE,AK 99515 345-5513 Ns z: u . is SINGLE FAPOILY �h FRAME HOUSE O ,`\�� 00000pppp Qo�P�. �k .. 4 9TH/ �CIF L 447 3- - [% �] ✓`Yl l/ 'SHANEL5--6914oL0 FF J' - ..i'. d4p�ao.ES��H�� `p_o �Opppo�e I'S 53 THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES. IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. A5 -BUILT SURVEY V = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 3A 6, BLOCK 1, FISCHER SUE. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _23RD_ DAY OF MAY , 2014. 11SSB, /B 164-33 HOLT LAND SURVEYING 600 H1GHVIEW DRIVE ANCHORAGE,AK 99515 345-5513 Wheaton Water Well, Inc. 907-376-2041 - Fax: 907-376-2030 - email: cp650wlieaton@gmail.com 1190 Wasilla-Fishhook Road Wasilla, AK 99654 Camera inspection at 5121 Seldon Circle, Anchorage Alaska on March 29,2014. Ran camera down well to a depth of 50 feet. inspected casing and found no leaks or deficiencies. The casing is unperforated for a minimum of 40 feet. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date '{-Z 5- $ 5 (a) Legal Description (include lot, block, subdivision, section, township, range) Loi' 3 A 6 sj crk I sots- 7%2-r.1 C�i w Location (address or directions) (b) Applicants Name Lahnt¢ 1ACV-5VI Telephone - Home " A Business u k Applicants Address �•�.• (c) Applicant is (check one) Lending Institution [= ' O -e /buii#r ; Buyer = ; Other [� (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. b Agent 1/a Lnde•tc;I Address Telephone 562 -"005 (f) Mail the HAA to the following address: 2. Type of Residence Single -Family r:4 tiulti-Family Number of Bedrooms '••f 3. Water Supply' Individual Well 1�1 Community = Other (describe) 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. [Page 1 of 21 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 regula- tions in effect on the date of this inspection. Name of FiTelephone SG ( S'OLfo Address 12oD W 33`1 Avc Date Av.-'I 2S tcl$S J �_-°• %°°° '�'� ;fib .M4• ;N• °..... io `i (ENGINEER SEAL) .. r^ � � f I No. 2251 •E i 6. DREP Approval. ``9(r'J•„• , ,.• Ott Approved for�,� �� bedrooms By soca a+-.+- bat y Approved_ Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOIELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DEEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA)' 1 r -z- u A 3 w HEALTH AUTHORITY APPROVAL (HAA) MtR�IgPAUtt� HEALTH & DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECWN MAY 14 1985 A. WELL DATA Well Classification o.rT If A, B. or C, D.E.C. Approved Y/N) tvA Well Log Present (Y ) Date Completed vnk Yield 6.r6'Prn Total Depth GT Cased to , &5 "a Depth of Grouting *A A Static Water Level �`� b 9 Pump Set At `"WW. $ Z Casing Height Above Ground 6m) Depression Sanitary Seal on Casing 0M) Electrical Wiring in Conduit 6m) Depression Around Wellhead (Y Separation Distances from Well: To Septic/Holding Tank on Lot 126.5 On Adjoining Lots To Nearest Edge of Absorption Field on Lot 11$•S ; On Adjoining Lots C,r t(0"• To Nearest Public Sewer Line N k To Nearest Public Sewer Cleancut/Manhole N11 Water Sample Collected By Water Sample Test Results 5 B. SEPTIC/HOLDING TANK DATA To Nearest Sewer Service Line on Lot uA )o Date y-zy-Yr W ss � 04 Date Installed i/1 Sine I? s-cD No. of Compartments 2 Standpipes %N) Air -tight Caps NN) Foundation Cleanout 6),N) Depression over Tank (yM Date Last Pumped £w T bz 1*1g I Pumpirx /Maintenance Contract on File (YIN) ktk ; for r n Holding Tank High -Water Alarm (Y N Temporary Holding Tank Permit (Y ti Separation Distances from Septic/Holding Tank: To Water -Supply Wall 126 5 4* To Building Foundation 4' 6 To Property Line '* 10' To Disposal Field *--7- • To Water Main1/Service Line N A To Stream, Pond, Lake, or Major Drainage 1'k Ft•ta • U h V� (Page 1 of 21 2-15-84 .4 3W 9 7/5CN£ I-,' Lo f 3 n G gJ� k I C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata `d5 d (k 4 Type of System Design c(s u-�c�•h' Date Installed �ynknewh_T l� Length of Field * tt �• Width of Field k 36' Depth of Field pr's Gravel Bed Thicknessr y Square Feet of Absorption Area 3W4 L? i Standpipes Present 6iM) Depression over Field (YO 1 Date of Last Adequacy Test Seg lot 'Sq Results of Last Adequacy Test S C, 4--,- Separation hSeparation Distance from Absorption Field: To Water -Supply Well fz6•� •'r* To Property Line _(o To Building Foundation '50;* Th Existing or Abandoned System on Lot pi , On Adjoining Lots G T 3o' f,4 To Water Main/Service Line NA To Cutbank(if present) «fA To Stream/Pond/Lake/cr Major Drainage Carse Fr goo' To Driveway, Parking Area, cr Vehicle Storage Area /t""r7' 8 Caments -fes Fan Wto* r.rlc��� .gyp^'* 11�Ur r%st enynnryc�iie_T��urni�r '} F fpr\ Sind ('t��s D. LIFT STATION Date Installed r / A Dimensions )J a Sim in Gallons N n Manhole/Access (Y/N) NA "Pulp Cn" Level at "k "Pup Off" Level at Np High Water Alarm Level at u n Vent (Y/N) EtA Tested for Nu, Pumping Cycles during Adequacy Test. Meets MOA, Electrical Codes(Y/N) Ner Ccmtents ** Check Permitted Bedroan Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed `/ r4!'2 ��. +��' Date _At -2,61-Z;- 1;`q •,.......,,., 9�� . Company c S m0A No. rr rs-ozy 'xr d L. KBl/d5/s Real. Jr. ,• 1 j ��: •c, [Page 2 of 21 2-15-84 r r MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTME14T OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Ilk Application Date /,? 5.tj8 `E (a) Legal Description (include lot, block, subdivision, section, township, range) Li 341. 1p lc 1 F%3 cti a Location (address or directions) 51-1 1 S .a I d on,,c z rccl k (b) Applicants Name Telephone - Home Nn- Business Am - Applicants Address u ulC- <:-•'-�� _(c)'Applicant�ia,, check one) Lending Institution Ownerkbaf j,,n j ; Buyer �Othez (explain); Y Q'; Q ( P ); ' (d) Lendiag-'in tlitti£lon / n -.4 N (^,..f n Telephone (address ; '41;; lr (e) •Real..Esta'te-Co. b Agent VA -1 4Rodtvsa•j I '. Address" ' Telephone 1 Q "2 - 4<* y— (f) Mail the HAA to the following address: -.rel r r fie" . C,f,.Q tir C,t 2. Type of Residence Single -Family 11.zl:zz *I Multi -Family Number of Bedrooms Lf 3. Water Supply Individual Well 11 Community Q Other (describe) Public Q 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. [Page 1 of 21 S. ts, File Search. Data 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 oadequate n - for site nd water supply and/or wastewater disposal system is safe, functional a the number of bedrooms and type of structure indicated herein. I furth based on the information obtained from the Municipality of Anchoragefurther verify that, files and from my -site water supply and/or wastewater disposal investigation and inspection, the on system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Q -ECS Telephone SL/—S-oyO Address I 2 oU W 3 3� V 445 fit\ Date /C SPP +5�(E,.....;+;,QSI�� (ENGINEER SEAL) 6. DHEP Approval ,/ Approved for �e)'7" bedrooms Approved Disapproved Terms of Conditional Approval By Z_- i�.t Clot Gi" CAUTION C. Rad, k. . 2931 - Conditional _/o`=6 _J�y THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF [MUTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH S 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE LUTA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MUIJICIPALITY OF ANCHORAGE ^ CEPT. OF HEALTH & • ' 1 ENVInCND/.ENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) SEP '1-84 HEALTH AUTHORITY APPROVAL ( HAA) R E C E I V E D CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: LT 34 -to 12 1 F%,sct,at Well Classification PV'` If A, B, or C, D.E.C. Approved(Y/N) WA -7 Well Log Present (Y/N)* N o Date Ccmpletsdi u ►+%c Yiel (I • Total Depth +&T 7 f l Cased to ku ftK- Depth of Grouting V - Static Water Level w"19T' Pump Set At V'Ea.W l; Casing Height Above Ground Sanitary Seal on Casing 6D ) Electrical Wiring in Conduit((Y ) y -0S Depression Around Wellhead ( /VO Separation Distances from Wall: i To Septic/HetdiZg-Tar0r on Lot 1 L (, . f On Adjoining Lots Gr ,uuf To Nearest Edge of Absorption Field on Lot I11. ; On Adjoining Lots GTI(JU' To Nearest Public Sewer Line rv/1- To Nearest Public Sewer Clear.cut/Manhole .vis- To Nearest Sewer Service Lire on Lqt w4 Water Sample Collected By 9.GavDeJ Date—2o a4pgy Water Sample Test Results 4 / c- 9 —F y�}4. cc-� �.�-i:-¢ . •r flx-u B. SEPTIC/HOLDING TANK(&t7 A .erzt�_ Date Installed Size �'/2. S'U No. of Ccmpartmerts Standpipes ON) (4o5 Air -tight Caps ) YO,> Foundation Cleanout YY )VP -S Depression over Tank (YQ JVO Date Last Pumped 5 0,:a JqO Pumpirg/Maintenance Contract on File (Y/N) oUt - ; for fV4- Holding Tank High -Water Alarm (Y/N) .A/A- Temporary Holding Tank Permit (Y/N) Separation Distances fran Septic/Holding Tank: To Water -Supply We 11 k'" I Z4 . S pp y To Building Foundation i.(i To Property Line *- /of To Disposal Field **--7 TO!Water�Main/Service Line N4-- To Stream, Fond, lake, Cr Major Drainage . ;Course's • .•.'G',��o' Comment_ + fes.•• PWOA As-�3o 1F "c+ Receipt 1( a9F. Date Paid:Sz Amount: moo (Pa 1 of 21 N QLD _ 2-15-84 L-T'S4(o 610 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata/ ii- 1 0%/Ar--Type of System Design -P Df*,eP ieenc(I Date Installed Length of Field y 3 Width of Field r4- 3L Depth of Field K S Gravel Bed Thickness f` Square Absorption 3 8`f I] r_ qu Feet of orp tio`` AreaStandpipes Present 6N) y=am Depression over Field (Yx^1J Date of Last Adequacy Test _/4 Lap Results of Last Adequacy lost t�w-s Separation Distance from Absorption. Field: To Water -Supply Wall 4,*' 12 &, f 1 To Property Lina -iF /U � To Building Foundation Y' 301 To Existing or Abandoned System cn Lot A) 4, ; On Adjoining Lots CrT /oL), To Water Main/Service Lire PJ 4To Cutbank(if present) N'4 - To Stream/Pond/Lake/o- Major Drainage Course C= T iovI To Driveway, Parking Area, or Vehicle Storage Area t*). 2� Ccia, nts * Fwo•++ As -sS.. I�, sysoq k �K awasyu&J F'"-, s{v. to?.)&A D. LIFT STATION Date Irstalled &)-,�- Dimensions Sias in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MSA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or ocnformed to all M on theto this pection. Signed(W Date fC1 SCP 8 Ccnpary Cc MOA No. Y- U a KBl/d5/s [Page 2 of 21 koqzm& ` A WIL!�4 NV;RILLING CO S P.O. Box 42 I CHl1GIAK, ALASKA 99567 PHONE688-3199 / DATE Z �. NAME ai PIT4 er ADDRESS 112 77 CITY /, c LEGAL DESCRIPTION Z ^ Q A LEGAL OWNERS ' BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST HOMEPHONE WORKPHONE DESCRIPTION OF WORK DEPT., n _ COMMENTS /` (,J YlY / G �. a. a• i✓ f/ Yt % /-) 7-1 SETTING / SERIAL NUMBER MODEL / �" ♦ i7 � /nl L CY /. r% / r� 4 WELL NUMBER / / h / DEPT., n _ COMMENTS /` (,J YlY / G �. a. a• i✓ f/ Yt % /-) PUMPMAKE / HP SETTING / SERIAL NUMBER MODEL OTY- I MATERIALS r All charges shall be paid In full within ten days unless other arrangements are made prior to work. The customer shall pay Interest at the rate of two (2) percent per month on any amount not paid within ten days. Failure to pay may result in a lien against the property. THIS ISA RIGHT TO LIEN SAID PROPERTY DESCRIBED ABOVE UNIT I AMOUNT OTY. MATERIALS PRICE WORKMAN DATE IN �U (TOMER SIGNATURE OUT LABOR HOURS RATE MATE RIALS IFROM ABOVE) r / OTN ERCHARGES �_� PAY THIS AMOUNT % c I ALASKA CI iUmonmenTAL C0nTROL SCRUICCS, InC. Engineerinq 5 Enuironmtntal Studies SEPT 24 1984 LONNIE & KAY JACKSON 5121 SELDON CIRCLE ANCHORAGE AK SELLER — VAL HENDERSON BUYER — SUBDIVISION — FISCHER BLOCK — 1 LOT — 3A6 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 384 SOFT. THE SYSTEM IS CAPABLE OF ACCEPTING 1004 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1004 GALLONS. BASED UPON THE TEST DATA THE SYSTEIS PTABLE FOR A 4 BEDROOM HONE. THE SEPTIC TAMC WAS PUM'ED 0 SEPBd .� FLOW TEST ON WELL 1 THE WELL FLOW RATE WAS 6.16 GPM FOR 3 HOURS. SEPTIC TAMC ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. 1200 West 33rd Auenue. Suitt B • Anchorage. Alaska 99503 • (907) 561-5040 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. • TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY (`1Soo b on D'd' 0is shows this Water SAMPLE to be: WATER SYSTEM: Lp Mo. Satisfactory . ❑ Unsatisfactory ❑ Sample too long In transit; sample should wow sv. 14 n Aro"' No. not be over 30 hours old at examination to Indicate reliable results. Please send new ma;i;,q Ad**w sample via special delivery mail. _ j y chy _Suu Li Cad. SAMPLE DATE �GJ t r Date Received O iS 0 Mo, Day Year .. Time Received SAMPLE TYPE: An1 alytical Method: .'Routine j ❑ Fermentation Tube 0 Check sample (for routine sample t ❑ Treated Water ` P• Membrane Filter 0 SpecW Pu�se' ArUntreated Water I °�110°� Time Collected • . Lab Ref. No. Result' Analyst LOCATIONWkWed By �Cf Baia 6r.L ��sct,c�' I 111joi _ c,cr C ( I m 2 I I I I m 3 m 4 m S COP-*, yeti ` 041210 M BACTERIOLOGICAL WATER ANALYSIS RECORD Ibv. 1001 "i • - •I ' i READ INSTRUCTIONS Membrane Filter. Direct Court ColuomVloomt Verification: LTB BOB BEFORE ~ Final Membrane Filter Results Coliformnooml Date 9 a)- Reported By — Time: �5�;r1 am om COLLECTING SAMPLE TNTC= Too Numerous To Count S. LEGAL DESCRIPTION DATE RECEIVED _ INSPECTION APPOINTMENTS_ 7 TIME TIME TIME DATE DATE DATE ❑ One ❑ Four ❑ Other 6�" SINGLE FAMILY INSPECTOR - INSPECT - OAA INSPECT MUNICIPALITY OF ANCHORAGE MUNI IPALITY OF ANCHORAGE -� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 826 L Street - Anehorage, Alaska 99601 ENVIRONMENTAL PROTECTION • ENVIRONMENTAL SANITATION DIVISION SEP 261990 Telephone 264-1720 pp �(�'' CC CC nn REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEN�FLAAG MED DIRECTIONS: Complete all parts on page t. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE _d. A'C4" I' INDIVIDUAL/ON-SITE" MAILING ADDRESS ❑ PUBLIC UTILITY PROPERTY RESIDENT (If different from above) PHONE !2 I tf(t = 2. BUYER PHONE .3 2 Rr. tU MAILING ADDRESS 2 O Z liDR.S o 3. LENDING INSTITUTION PHONE (w'L' k Miotke- -o" MAILING ADDRESS 0. REALTOR/AGENT PHONE MAILING ADDRESS 2 r L LN f 94 '4� a,�_ /4Jo S. LEGAL DESCRIPTION I AZ aICX- r/Zjq Apr( STREETLOCATION AL 6. TYPE OF RES DENCE NUMBER OF�SEDROOMS ❑ One ❑ Four ❑ Other 6�" SINGLE FAMILY 49r Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY I5 INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM \ I' INDIVIDUAL/ON-SITE" lq'11 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72.O101Ray. /79 =-1114 rA' i 72010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING g ❑SepticTankor ❑Holding Tank Size: f :1-S-D If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER ^' TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank f Go Absorption Area Cjd Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS Pd b---APPROVED FOR i_ BEDROOMS 1:1 CONDITIONAL APPROVAL (letter must accom a cer 'ficate) m/61SAPPROVED Al DATE ,2 •if,'�, Igo I By IP, ic- 72010 (Rev. 6/79) 1 kunicipality ®y Anchoragse .� s�� vcvso 825 "L" STREET ANCHORAGE, ALASKA 99501 (9071264-4111 r /9I;&d GEORGE M. SULLIVAN, /L�[L Lel.✓ . MAYOR DEPARTMENT OF /IFALTH AND ENVIRONMENTAL PROTECTION Williams/Dorman Property October 7, 1980 Kimbrough Owen 8 Marston Real Estate 2804 West Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 3A6 Block 1 Fischer Subdivision (Jack/Judith Williams Property) Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: Ai(1) (2) 'If there are any further questions, please call this department at 264-4720. At the time of the inspection, we were unable to obtain a water sample from the outside faucet. The spigot has no handle on it. Another appointment will need to be set up for the water sample. A well log submitted to this department for our review. The septic tank pumped with a receipt submitted to this department. A four(4) inch cast iron cleanout needs to be installed to the septic tank and the leaching area. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Rainier Mortgage Company 4797 Business Park Boulevard 99583 t Pam �,-7-Jg20 JAI l CF ii,