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HomeMy WebLinkAboutMANN BLK 2 LT 4Mann Block 2 Lot 4 #020-041-23 1 Municipality of Anchorage o Development Services Department • • _o,' Building Safety Division y On -Site Water 8 Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.enchorage.ak.us (907) 343-7904 Pogo 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW020089 PID Number. 020-041-23 Name: JOHN McCREA do MOIRA PADDOCK Wastewater System: ■ New O Upgrade Address: 005971 162ND AVE E e ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-3565 3 8 Deep Trench 10 Shallow Trench O Bed 0Mound 0Other so LEGAL DESCRIPTION "�"° 1 0 DPD/sa• R Toa o. 4.5 AX R Block: Lot, Subdivision: Depth to pipe bolbm ham aA.lmt Taft Or" depth beneath ptpt 2 4 MANN SEE DWG. R 2.0 R Township: Range: Section: ra added eba.s enpenel Taft Grmal ImWa SEE DWG. R 64 (2032) R Growl eWaa W,eneer of Met obta b.t...e its WELL: E3 New O Upgrode 5 R 2 10 R Ga -eek -um (prhwle, A&C): 7" Cased it Tote) eeenpom erst Poo mater c R R 457 so, R D 3034/ F-810 Grebr: // Dab palet Meta haler Ueek ewt~ Dab b t~. R A+ HOME SERVICES 5/30/2002 // Lamp Set K 1"o" ,wow Daunt TANK MMR R SEPARATION DISTANCES ■Septic 13HolAmq aS.T.EP. OOther To Septic AD on (NL Holdirtq Pubic/= elgr%o c0 . Copoct0' in gesom From Tank no Station Tank S. /knee ANCHORAGE TANK 1000 Well 100'+ 100'+ — — 25'+ "Oeek STEEL of 2 Surface water 100'+ 100'+ — — — LIFT STATION rt tgefaeture: Lot Une 5'+ 10'+ — — — sae bl T+wI Foundation 5'+ 10'+ — — — 'p p ea tees ft 'pr Der ac Iwo water'""' at Curtain Drain «: NONE KNOWV ►+ev tm otnoa ene� Wpectlo a pwfe Remarks: —EXISTING SEPTIC TANK BENCH MARK Lmat She Deevpuew ABANDONED PER U.P.C. BOTTOM OF SIDING ® POINT "B" Inspections performed by: AKWWC, INC. Dates: 1st 5/30/2002 2nd 5/30/2002 3rd 5/30/2002 Development S rvices Department Approval Reviewed and approved by: Date: i/75/07- (eee. 12/01) IAse.aed EWmd . 108.84 R PERMIT NUMBER: SW020089 O(ISTING DRAINFIELD USED AS A RESERVE SITE STI ST2 DBL1 DBL2 I FD PAP AS -BUILT DRAWING A B 70.22 36.595 73.465 41.84 74.755 43.875 75.20 44.57 119.51 100.72 122.30 103.64 121.54 108.62 122.39 104.51 130.62 107.76 143.24 125.84 147.09 125.84 135.94 122.86 PARCEL ID NUMBER: 020-041-23 \ II II \� i AS -BUILT DRAWING A B 70.22 36.595 73.465 41.84 74.755 43.875 75.20 44.57 119.51 100.72 122.30 103.64 121.54 108.62 122.39 104.51 130.62 107.76 143.24 125.84 147.09 125.84 135.94 122.86 PARCEL ID NUMBER: 020-041-23 L -INSTALLED FLOW .," • • • HOUSI tri..` .. :... •r, E '4 —�--- — — -- DATE* —OATS oo�Soa 6/5/2002 o C— _s,_�r__ �. DRAWN BY --�•_ �,�.. ..._ ._.__.._._..._ ._..._.. : ALASKA WATER & WASTEWATER Z.T.G. CONSULTANTS, INC. 6001 DFBARR ROAD. SUITE 28 • ANCNORACF, AK 00504 • PHONE (007)5174170 • PAX (007)558-5266 1 s - 40, PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN MGCREA do MOIRA PADDOCK (907) 345-3565 2 OF 3 LEGAL DESCRIPTION: MANN SUBDIVISION; LOT TYPE OF WORK: AS—BUILT DRAWING OF \ II II \� I I 11 LI " \ II \ LI \ u \ L -INSTALLED FLOW .," • • • HOUSI tri..` .. :... •r, E '4 —�--- — — -- DATE* —OATS oo�Soa 6/5/2002 o C— _s,_�r__ �. DRAWN BY --�•_ �,�.. ..._ ._.__.._._..._ ._..._.. : ALASKA WATER & WASTEWATER Z.T.G. CONSULTANTS, INC. 6001 DFBARR ROAD. SUITE 28 • ANCNORACF, AK 00504 • PHONE (007)5174170 • PAX (007)558-5266 1 s - 40, PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN MGCREA do MOIRA PADDOCK (907) 345-3565 2 OF 3 LEGAL DESCRIPTION: MANN SUBDIVISION; LOT TYPE OF WORK: AS—BUILT DRAWING OF PERMR NUMBER: SW020089 TOP OF TANK INLET - 100.: AS -BUILT DRAWING t=l__L) INVERT OF BUNC—/ AT INLET — 99.78 O pw Y PARCEL ID NUMBER: 020-041-23 FINAL GRADE RX r. 103.21 (AVG) TOP OF TANK AT OUTLET - 100.22 (13=3 NEW 1000 GALLON SEPTIC TANK INVERT OF BUNG AT OUTLET - 99.54 /WL 00.80[ w7R+ ORAiM1 OMD[ b" tlT gom -..xe- RAW Or PPE - 95.30 (AW) Or TRE)CH 29 (Ac) y,. FLIER B is FRAL �DMu. $7.40 (") oRAsva GRADE MIS-Y0.Y0 K#M Of TE . 9SA2 (AT) T DU or TRa(o( . 9132 (AVC) DATE 6/5/2002 02 DRAWN UY: liio Z.T.G.ALASKA WATER & WAST MATER oc�. r} y CONSULTANTS, INC. SCALE: * _c c -' 40• 1" - ........... ... �. 6001 DFRARR ROAD. &(11TF 29 - ANCHMAGF. AK 005M • FNONF (00))33]-61)0 - FAX (00))338.5T46 — PREPARED FOR: PHONE NUMBER PAGE NUMBER: Q I JOHN McCREA & MOIRA PADDOCK (907) 345-3565 2 OF 3 QO ,J ffre A am s: LEGAL DESCRIPTION: Q E 79 e MANN SUBDIVISION; LOT 4, BLOCK 2 TYPE OF WORK: 44���-rolsealo�a��P AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �= f MUNICIPALITY OFANCHORAGE Development Services Department �� �% Q • ✓h, On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 Permit Number: SW020089 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 02, 2002 Expiration Date: May 02, 2003 Parcel ID: 020-041-23 Legal Description: MANN BLK 2 LT 4 Design Engineer: 0041 AK Water & Wastewater Consultar Site Address: 005971 162ND AVE E Owner Name: Moira Paddock & John McCrea Lot Size: 49458 SO. FT. Owner Address: 5971 E 162ND AVE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-5035 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 DSD at least 2 hours prior to each Inspection. Provide notification by catling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. S 30102 Received By: Issued By: U -ILL Al/F_F_d /i Lor 4-"4"E- c. A1`f:-jCToPoRT1-( G oT Ltyl- Date: 5 a-OQ Date: 3- 17-10 2 Municipality of Anchorage • "` Development Services Department j Building Safely Division — On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Parcel I.D. ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 020-041-23 0 aa„rr Permit Number O Z 008q Property owner(s) MOIRA PADDOCK & JOHN McCREA Day phone Mailing address (1) 5971 EAST 162ND AVENUE ■ ANCHORAGE. AK Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) LOT 4. BLOCK 2. MANN SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size 1-NI/59 Acre ISq.Ft Number of Bedrooms THIS APPLICATION IS FOR: 345-3565 99516 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and Is In accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. (£ignoturc of property owncr or outhorizcd ogcnl) Permit Fees: Date of Payment: Receipt Number: Waiver Fees: Date of Payment: Receipt Number: ALASKA WATER & WASTEWATER CONSULTANTS, INC. April 24, 2002 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 4, Block 2, Mann Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing drainfield is in a surcharged state and needs to be upgraded. A test hole was excavated in the area of the proposed septic system. The septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1000 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.0 gallons/day/R2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 4.4 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/R2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 R2 f. Total Depth: 4.5 feet (max.) g. Effective Depth: 2 feet h. Width: 5 feet i. Reduction Factor: 0.70 j. Minimum Length: 32 feet long each (64 feet total length k Effective absorption area = 457 R2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2D * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPIIY: The area for the proposed septic system is a 5 to 15 percent slope running from approximately east to west; in short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your ncc;c}nn&. P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log, a topography site plan, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2D • Anchorage, AK 99504 Ph: (907) 337-6179' Fax: (907) 335-3246 0 Websitc: akwwc.com MANN S/D LOT 2. BLOCK 2 I ' I I I I v 1 I I I I I 1 SHED❑ I I 1 I MANN S/D `-SEPTIC I I LOT 3. BLOCK 2 ARL -� -1 TrHII 1 1 1 L1oo• wnL 1 1 1 rt 1 I 1 EXIST 1 FAST 164_ NUI;_ MANN S/D LOT 2A, BLOCK 3 AREA ZPROPOSI AND WELL I I ALASKA N'E'ATER & WASTEWATER CONSULTANTS. INC. 6001 DFRARR ROAD. SUITF 2R • ANCNORACF. OK 00504 • P ONF (007)132-0170 • FAK (007)116-3246 PREPARED FOR PHONE NUMBER: JOHN MCCREA & MOIRA PADDOCK (907) 345-3565 LEGAL DESCRIPTION: MANN SUBDIVISION; LOT 4, BLOCK 2 TYPE OF WORK: SITE PLAN FOR THE SEPTIC SYSTEM UPGRADE 1 1 1 I MANN S/D LOT SA, BLOCK 2 DESIGN PACE 2 OF 2) 1 IXISTINO THREE BEDROOM HOUSE —�� 4 YA L' 1 _100• WEIf RADIUS 1 1 1 1 I S/D ` BLOCK 3 1 II / i DATE: 4/24/2002 DRAWN BY: C C.J.G. SCALE: 1"= 100' PAGE NUMBER: 1 OF 2 MANN S/D LOT 2. BLOCK 1 1 \\ 1 MANN S/D j LOT 3, BLOCK I MANN S/D LOT 2A. BLOCK 4 S. •7953-'. .e Alop �` PROPOSED DRAINFIELD. EXCAVATE TWO TRENCHES THAT ARE 4.5 FEET DEEP MAXIMUM BY 5 FEET WIDE BY 32 FEET LONG EACH (04 FEET LONG TOTAL ADD 2 FEET OF CLEAN, WASHED DRAINROCK. INSTALL TRENCHES PARALLEL TO SLOPE CONTOURS. I EXISTING DRAINFIELD TO BE USED AS A RESERVE SITE TH/I / C I I II II u I \ / TANK TO BE ABANDONED STING CPER UPC. I � � I � INSTALL FLOW I PROPOSED 1000 DIVERTER I SEPTIC TM INSTALL DOUBLE CLEANOUTS / I I NOTE: THE CONTRACTOR SHALL HAVE THE NORTH LOT LINE AND THE 100 FOOT WELL _ RADIUS FLAGGED BY A REGISTERED LAND FA SURVEYOR PRIOR TO CONSTRUCTION. \ DATE: 4/24/2002 �.._,.�.�... - ..�....___, .__ _... S_.- .. .. �. _._... _..._�._.__..._..._,.. DRAWN BY: ALASKA «TATER & WASTEWATER SCALE: C.J.G. CONSULTANTS, INC. 1"=40' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN MCCREA do MOIRA PADDOCK (907) 345-3565 2 OF 2 LEGAL DESCRIPTION: MANN SUBDIVISION; LOT 4, BLOCK 2, TYPE OF WORK: DESIGN DRAWING OF SEPTIC SYSTEM UPGRADE -INSTALL FOUNDATION CLEANOUT (FCO) \ EXISTING 3 BEDROOM HOUSE EXISTING WELL r ALASKA. AVATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR AW, SUrlt 29 • ANCHORAGE. AK 99504 • 7HONL (907)331-6179 • FAA (967)178-3216 • WCr4TC SOIL LOG — PERCOLATION TESTI LEGAL DESCRIPTION: MANN S/D; LOT 4, BLOCK 2 PERFORMED FOR: MOIRA PADDOCK & JOHN McCREA 15 — 16 — 17 — 18 — 19 — 20 — TEST HOLE # 11 DATE: 4/16/2002 SOIL CLASSIFICATIONS DATE �. (fPTtj eet = ORGANICS CL GCOL 13.0' o e o o ° SW MH CH LOAM 2— %« sY — SM GP/SP W/ SC 6. SOME SILT — 3 3/4' 2 1/4' 6' 4- ' 2 1/4- /4'6'3 6- 33/4' 2 1/4' PERC. HOLE DIA. 6 (INCHES) ■ 7— GM/SM w/ COBBLES/ • BOULDERS 9— THROUGHOUT 10— '•, . 11— ; 12— ' 13— ' 1 4 15 — 16 — 17 — 18 — 19 — 20 — TEST HOLE # 11 DATE: 4/16/2002 SOIL CLASSIFICATIONS DATE �. ,.+ . GPML DRY GM CL GCOL 13.0' o e o o ° SW MH CH 3/16- SP — SM ;[ OH SC 6. DEPTH TO DATE GROUNDWATER 3 7/16- DRY 4/16/02 DRY 4/17/02 13.0' 4/23/02 DATE 4/17/2002 READING 1 2 3 4 5 6 7 8 9 10 11 12 ... �.......... 4. GDrness. -7953 EXISTING THREE 1Hf1 BEDROOM HOUSE 1 tie ; EXISTING �. SEPTIC j 1Ero' wn1 SYSTEM — 1' / 1 EAST 162 AVENUE i � SITE —PLA—NT' -1 10-100, CLOCK TIME 2:58 3:08 3:09 3:19 3:20 3:30 3:31 3:41 3:42 3:52 3:53 4:03 NET TIME WATER LEVEL NET DROP (MINUTES) READING (INCHES) 10 10 10 10 10 10 PERCOLATION RATE 4.4 (MIN./INCH) 6- 3 7/16- 2 9/16- 6' — 3 13/16' 2 3/16- 6. — 3 13/16' 2 3/16- 6. — 3 3/4' 2 1/4' 6' — 3 3/4- 2 1/4- /4'6'3 6- 33/4' 2 1/4' PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: E YES SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ❑ NO JASON WOOD COMMENTS: PERFORMED BY AKWWC., INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS VJASqERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: -112G/0z Il MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ,/ p/� q� M 01 F/9 pA-0r,>0 iC PHONE 2e-T'/'G"f7I NEW ❑UPGRADE MAI LING ADDRESS' n// L fi'2 50,Y 4A)4�"ti k�F_ ^`-}L�4A qqW4 / LEGAL DESCRIPTION WT 4, 8l/ 154 Z, AWAJ 6013©►U161W LOCATION 1�zM° s-r2Eer «u "6/T � NO. OF BEDROOMS Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. I-_ < Manufacturer ^A��n�F_ r'!7�► Material,,,,-.,,_,�L- No. of compartments LLI 1. u� k- Liq. ca��acity in gallons IF HOMEMADE: Inside length Width Liquid depth ��Z DISTANCE TO: Well Dwelling PERMIT NO. O z Q 2 1� Manufacturer 1 Material Liquid capacity in gallons S DISTANCE TO: Well Foundation Nearest lot line 7 -+ PERMIT NO.��, n' 1�� 50 w r1.2 F ? cc No. of lines Length of each line + I Total length of linesq`� f Trench wid / Distance between lines `L F. Top of the to finish grade/ /� Material beneath tile Total effective absorption arga _--� 31J inches Length Width � Depth m PERMIT NO. LLI U n ts- Type of crib Crib diameter Crib depth Total effective absorption area LLI N DISTANCE T0: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. Liu DISTANCE TO: Building foundation war line Septic tank Absorption area(s) OTHER PIPE MATERIALS PV& 4 z-72 SOIL TEST RATING /36 ® /BPi M - INSTALLER/j�7��],�j'y�fC� d REMARKS _ P C -WITMm OF 86P ek5 baw) Odor, &J?A y' t A 5� ''j�llti�4PI(l Tl -P 3 Or Awa Ty • P P! •• b � Bruucc e J C in v�9 ®� �P•ee No. E a263 e•`i l Yt��'lAD eP•e�re eeani Sia 8 PROF — _ _ - - cj0t,\Z m r .. FFlPP 0 DATE LEGALAl 721`013 (Rev. 3/78) V N WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOU13ES Division of Geological a Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or Ic.) _ A.D.L. No. lo. Borough Subdivision Lot Block Ib. 1/a girt. Section No. Township N ❑ Range E ❑ Meridian Mann 2 4 —of -of —of — sp Wo Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: John McCrea and Moira Piddock Address: Street Address and Area of Well Location 2. WELL LOG Feel Below Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION '[')0 ft. �4 — "0 — 815 Material Type Top Bottom It i,' :al mu F, 6. []Coble tool ❑ Rotary ❑ Driven ❑ Dug ❑ Auger C3 Jetted E] Bored ❑Other: iiltY, k;r&Ve 'Pi 1 ]. ��'�� aYn(� jli.--111 dP.Y! 14 1(i 7. USE: ❑ Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test well ❑ Other: T11-} ',i :LL}1 "O"1C' b":'tCI' 1.6��� Q2mente(i till „'/beul hers 22 1 29 B. CASING: ❑ Threaded E) Welded diam. 6 in. to__ __ ft. Depth Weight Ibs./it. diem. in. to ft. Depth Stickup ft. rock 29 1.20 9. FINISH OF WELL: Type: tlr,Pn Putt -nm Dlameterl .;0�t Jrt Slot/Mesh Size: Length: Set between _ ft. and fl. Bockfllling _ Gravel pack 10. STATIC WATER LEVEL: p ft. /ii) ' ❑ Above or Below land surface Date Equipment used: 11 . PUMPING LEVEL below land surface and YIELD ft, of ter hrs. pumping g. p. m. ft. after hrs. pumping —9 -P.M. +r 12. GROUTING Well Grouted: ❑ Yes ❑ No Material: ❑ Neat Cement ❑ Other: C "It'� _ - 7 V �� 13, PUMP: (if available) HP - Length of Drop Pipe ft. capacity 9 -P.M. ❑ Subm. ❑ Jet ❑ Cenlrifical ❑ Other 14.REMARKS: }'later is corning from a gray nasty. rpcl: het;�reem 78 & S4' at 1-2 gpm w/more Tater coming from the same pasty — rock -nt a dr'nt-h of 116' :1.1.7' 16, WATER WELL CONTRACTORS CERTIFICATION: _ 15. Water Temperature ❑ F ❑ C _° This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; - D' )T P17? i)RIi,T,T'C; C'AEANY A?X512 Registered Business Name Contract License Number Address�r.5—i' 0jr)507 i y ,�I(.-iace. June 1. 8, 1985 Date: k i Authorized Representative Form 02-WWR (11/8I) Copy Distribution: WHITE -Stole DGGS, PINK -Driller, CANARY-Cuslomer PERMlT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCl? IP: LOT SIZE: MAX BEDROOMS I-H.PHAI Hit!; ��AH .. 10 _4 K P 177 1 It 117: 1! 1 1 P� �!: I� DEPARTMENT OF HEALTH AND PROTECTION 825 L STREET: ANCHORAGEAK 79501 ` 264-4720 ~ 850194 05/16/85 MOIRA PADDOCK 6112 PROSPERITY ANCHORAGE; AK 99504 279~8471 ' SUBDIVISION: MANN SECTION: 2 TOWNSHIP: 11N 1'1A (SQ.FT, OR ACRES) 3 LOT: 4 DLOCK: 2 RANSE: 3# Listed below ape the options available to you in designing your sep!.ic syst�m. Choose Lite option that best fits your site" DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT"> 0"5*' 1,0 TOTAL DEPTH (FT^) 4"5,/ 5.0 GRAVEL WIDTH (FT 5 0 . GRAVEL LENGTH (FT.) 35.0��\� 73.0 GRAVEL VOLUME (CU^YDS.) 23,4 2)"3 TANK SIZE (GALS) 1,00^0. 000"0 ** SOIL RATING (SQ.FF. /BR) 138 138 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I p. J. i:hat: J. I am {amiliar with the requirements for on-site sewers and wzlls as uet forth by the Municipality V Anchorage (MOW nnd the State W Alaska. 2. I will install the system in accordance with Al MOA codss and rcgulat. Qui s� and in compliance with the dcxsign criteria w th1s permit. 3, I will adhore to all MOA and lit atc o[ Alaska requirements {or the sct back distances Hunt any existing mull, wastewater disposal system or public sewerage system on thi� or any adjacenL or nearby lot. 4` I understand that this permit is valid [or a maximum 0 3 bedrooms and any enlargement will require an additional permit. � LIFT STATION IS INSTALLED IN AN ARE0 COVERED BY MOA BUILDING CODES' IF A THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINEDY (2) AS-BUILTS WILL NOT BE APPROVE WITHOUT AN ELECTRICAL JNSPECTION REPORT; AND (3) THE ELECTRICAL WORK^ML/d T.."l IMAW BY A L���NSE� ELECTRICIAN, DATE: � I certi�v that: 1" I am {amiliar with the requirements {or on-site sewers and wells as seI- f orth by the Municipality of Anchorage (MOA) and the State of Alaska. 2" I will install the system in acC;ordance with all MOA codes and regulations; and in compliance with the design criteria of this permit. 3. I will MOA and State o[ Alaska requirements �or distances from ny existing well�j system sewerage syst��CYLAhis or any adjacent or nearby lot. the se� back or public SIGNED DATE: ^r�����----_�/__�~`-~_~��~ APPLICANT: JDK� �n& MOIRA/B, MCCRE() & PADDUCK // ' ISSUED BY DATE: � __~ "V w"s 141 AT: I�������� - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTI 825 L STREET ANCHORAGE� AK 995O1 QTT 14 H'^TET T: ^F TE HNOTEK. T~ FOWMR-1 1: 7' PERMIT NO: 850079 DATE ISSUED: 04/01/85 APPLICANT: JOHN E,& MOIRA B^ MCCREA & P0DDOCK ` ADDRESS: 6112 PROSPERITY DR. ANCHORAGE, AK 995O4 CONTACT PHONE: 279-8471 LEGAL DESCRI'Px SUBDIVISION: MANN LOT: 4 8LOCK: 2 SECTION: no TOWNSHIP: 11N RANSE: 31q, LOT SIZE: 1A (SQ^FT. OR (CRES) I certi�v that: 1" I am {amiliar with the requirements {or on-site sewers and wells as seI- f orth by the Municipality of Anchorage (MOA) and the State of Alaska. 2" I will install the system in acC;ordance with all MOA codes and regulations; and in compliance with the design criteria of this permit. 3. I will MOA and State o[ Alaska requirements �or distances from ny existing well�j system sewerage syst��CYLAhis or any adjacent or nearby lot. the se� back or public SIGNED DATE: ^r�����----_�/__�~`-~_~��~ APPLICANT: JDK� �n& MOIRA/B, MCCRE() & PADDUCK // ' ISSUED BY DATE: � __~ MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta Protection 825 Street, Anchorage, AK. -,9501 264-4720 # # # HANDWRITTEN PERMIT # # # Permit # �So( WELL ANDY ON-SITE SEWER PERMIT Applicant: lee-a"t 66. /Mailing Address: Location: Phone Number: Legal Description: L, a �� /�rz�o Size ------ Type of Soil Absorption System Is: Trench: 4,1 Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 16s__ The Required Size of the Soil Absorption System Is: DEPTH LENGTH_ - GRAVEL DEPTH 2 WIDTH 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 SEPT IC�`f#flt-33INf�) 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 departmeni will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel 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 install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if th e,.repidence is remodeled to include more that bedrooms. Signed: / Issued by: Applil ant - — Date: SWP/024 (1/81) � � ✓� �/o�h�c.7��'��c v �.�5~- X -D F 1=1 C"-1 r-:: FA C-9 1 FA DEPAF,MIENT '-IF HEALTH FIND EN',,'I RCINMENTAE F:C i TF.CT I C)N =-'- STREET: ANCHORAGE.. AK.. 6,,1.-4 _,`,GYM 1-5 EE L_ I__ t -1 tl'-A L:. is a 1 d -_ �., Y "X" & = �= l • � Imo- F =_ 5 �� � : I ' 9 :L Y- PE'RM I T NO. C ::c07'335 APDL I CANT SRE%dE F I:=A SRA BOX 41 r'5c.'1-_L"101. LUlC:ATI0N LEGAL L4 B! MANN S,%D LCAT SI?EE 4G_ii 01-`1 SrrUAF.E FEET TYPE OF SC i I L ABS CiF?F'T I C I'J SYSTEM I S : TRENCH NUMBER CIF BEDROCIMS = SC I L RATING "'Si FT, E;R ; = 1.6 TIME REQUIRED SIZE OF THE SCI T L ABS CIRPT I ON SYSTEM I S : E:° E_- F-" -r 1-I = - ; - L_ L:H: r -a r:�j -T-F-1 —. _. _ Ca F;: F -i'": ^ 1:� L-_ C- F-- F -: -r 1-4 =_ _ THE LENGTH DIMENSION 15 THE LENGTH I N FEET) OF THE TRENCH OR DRA I NF I ELD, THE DEPTH OF A TRENCH C)R PIT IS THE CtI';TANC:E BETWEEN THE SURFACE OF THE:: GRCiUND AND THE BOTTOE-1 OF THE EXC:AlvATiorJ -: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 E;�CA%,,ATiON (IN FEET::,, T Fi r-4 F-` : :JL ! --a 0 iD e_a 6-1 E_ 1_ t_i P -q PER11I T APPLICANT HAS THE RES PCINS I B I L I TY 'TO I NFi IRM THIS DEF'ARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY FIND THE NUMBER OF RESIDENCES THAT THE WELL. EJ I LL SERVE. f_:• BACh;F I LL I NG OF ANY SYSTEM N I THOI IT FINAL I N':;PECT I is N AND FiPPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTIOC••I. MINI NUM D I STANCE F+ETWEEN 1-1 WELL AND ANY ON --'SITE SEWAGE DISPOSAL = Y yTEM Is 11710 FEET FOR H PRIVATE WELL OR 150 TO 2(--11-,-' FEET FROM A PUBLIC: WELL DEPENDING UPCiN THE TYPE OF PUBLIC WELL. MINIMUM D I STANCE FRCiM A PRIVATE WELL TO A PRIVATE'. SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE I_+ 75 FEET. WELL LOG'S ARE REQUIRED AND h11_I'ST BE RETURNED TO THE DEPARTMENT WITHIN _30 DAYS OF THE WELL CMIF'I_.ET:EON. OTHER REt)U I REMENTS MAY APPLY. SPEC I F I CAT I ONS AND C :ON S TRUCT I ON DIAGRAM:S' ARE AVAILABLE TO I NSUF:E PRCIPER INSTALLATION. F'U•F-:M I T L: :F' I F-'EE_":3 C: E C EU°1Ir:E'F-: _= -1s 1-:Ei a" I CEF:T I FY 'THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR Ot-1-SITE_ SEWER'S AND WELLS AS SET FORTH BY THE MUN I C I PAL I T'r' OF ANC:Hi 1RAG'E. 2: I WILL INSTALL 'THE SYSTEM 1h--1 AC:CORDANiY:E WITH THE CC DES. t: I I_INDER : TAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF' THE RESIDENCE 'S REMCID.E LED TO INCLUDE MOF:E THAN -Z BEDROOMS. APPLICANT SR VE PISA <}, ISSUED E 4' _ �/�L _c'� --- - ___-DATE__.(/` T�PE OF SOIL HBSORPTION SYSTE� IS� TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RHTING (SQ FT/8R)� 165 THE REQUIRED SIZE OF THE SOIL RBSGRPTION SYSTEM IS: �������� 77 �Q I h! 104 Up- 1 i - 73 �Fit to! �!to 1. if 'P. , !I,=, � THE LENGTH DIMENSION IS THE LENCTH (IN FEET) OF THE TRENCH OR DRHINFfELD, THE IMPTH OF H TRENCH UR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHYHTION (IN FEET) THERE IS HO SET NIDTH FOR TRENCHES THE QRHVEL DEPTH (S THE MINIMUM DEPTH OF GRHVEL BETWEEH THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVR?ION (IN FEET) ��1::�::;; PEI Too -T- I C 1- IS 1: W U J. Kip Go KY I VSHRO 1 A..v A by VY PERMIT HPPLICHNT HHS THE RESPONSlBILITY TO INFORM THIS DEPHRTMENT DURIHG THE INSTHLLHTTON INSPECTIONS OF HMY WHLLS HDJHCENT TO THIS PROPERTY HHD THE NUMBER OF RESlDENCES THRT THE NELL WILL SE�VE ?m 1: b I s" H M 07; - 1- : 0: Q��� BHCKFILLING OF HNY SYSTEM NITHOUT FINHL HPPROVHL 8Y THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTIOH, MINIMUM DISTHMCE BETWEEN H NELL HND MAY ON~SITE SEWHGE DISPU5RL SYSTEM lS 100 FF,�ET FOR H PRIVHTE NEW. OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL MINIMUM DISTHMCE FROM H PRIVRTE NELL TO H PRIVHTE SEWER LINE JS 25 FEET MD TO H COMMUNITY SEWER LINE IS 75 FEET. NELL ME REQUIREC, HND MUS� BE RETURNED TO THE DEPHRTMENT NITHIN ]0 D8YS OF THE NELL COMPLETIOOIL OTHER REQUIREMENTS MY HPPLY SPECIFICHTl0NS HND CONSTRUCTION DIHERPMS HRE HVHILHELE TO INSURE PROPER INSTHLLHTION. 1: -T- WS-30� JE RYER; EN& Q PHI Q A NS? 47� Q ��� �- ISSUED DHTE- �.-- Y40 �/ K �1_1 r-4 1 o� 1_����� Cm F7- ��a:::� I-'`lf�-n F-1 ic-i E::" DEPARTMENT HEALTH AND ENVIRONMENTAL . JTECTION 825 'L' STREET/ ANCHORAGE/ HK. 99501 264~4720 �F=:".' H_ I-- F-0 P-119 ��1 -1", rH_,� 1_1=" I. -A FE"r;? �F?. U-1 1 0 - PERMIT NO. ( 800578 ) APPLICANT SREYE PISA ~� S. R. BOX 475~S �451901 LOCATION OFF GOLDENVIEW~/6 �`�� LEGAL L. -4 B 2 MAMN. /D LOT SIZE 48000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM TRENCH MAXIMUM NOMBER OF BEDROOMS = 3 SOIL RATING, (S8 FT/BR)= 165 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �­F " =-­- ������" =;= ������ �EE'l=%"IF" ==: � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT 15 THE DISTANCE BETWEEN THE SURFACE OF THE ND OTHE EXCH}GROUN� �}. THERE 15 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION (IN FEET). F-':lEE.X7AlU I rl;"E.r-n ��E-:1=47" I C.: �I=M P-4 K, "=F 127 E=_'== �ev C-1 PEN C:i F:l L_ 1__ WD I%I� 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, ___ _r 1 -1 Cfi ���� I I"_4 F -"F—' _y" I co IN -4:F, ��F-- Fr�" F"_-(.'.-! U I FZFEEMN BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THP -5 DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL. SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE NELL TO H PRIVATE SEWER LIME IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MOST BE RETURNED TO THE DEPARTMENT WITH%N ]0 DHYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MHY APPLY. SPECIFICHTI8NS AND CONSTRUCTION DIH8RHMS FIRE HVHILHBLE TO INSURE PROPER INSTALLATION. ���m z "r, ��r-v _r F;?r-_-.'"_-:3' ��(7-: F:-- r-1 UE. F --:'F-.'. :MJ_' I CERTIFY 'THAT 1: I HM FAMILIAR WITH THE REMIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPHLIT9 OF ANCHORAGE. 2: I WILL INSTALL THE IN ACCORDANCE WITH THE CODES. ]� I UNDERSTAND THH ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED/�� INCLUDE MORE THAN ] BEDROOMS. APPLICANT F E E PISA � `�<� /�,.-��� o --:L.n5m::3mCD HND WELLS RS SET ENLARGEMENT IF THE SOILS LOG MUNICIPALITY OF ANCHORAGE / \ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SII TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST Im�+r� t (�cxul- PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION:Many) Cu Y1wsv/) B�!/ -- a�,�— _ SLOPE SITE PLAN 7D COMMENTS E3 lb �-) I WAS GROUND WATER S ENCOUNTERED? L O P — IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop jDnn +- NCO to113 X30 }- N20 t Ot 03 I b_35 1(j ��Jf ( cx) PERCOLATION RATE LJ (minutes/inch) TEST RUN BETtWEEN _ FT AND � FT i� ES PERFORMED BY: Un ! CY h CERTIFIED BY: r 72-008 (6/79) DATE: � 11913 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6660, Anchorage, Alaska 99602 276-2221 SOILS LOG — PERCOLATION TEST ❑ SOILS LOG PERCOLATION TEST 9 10 0' / 11 A IV 12 13 14 15 16 a:®� M11111% v� 17 *6%o�4�- It8 9 18 s 19 �� eao oawra•ab°n o�••a • QwM O. T431 t d W Date Gross Time 20 °o W. AOd9•E a,: go % °m � Net Drop �°.e 0900•p9 p � � PROFE§510�4® COMMENTS PERFORMED BY: (y %CJiC±9 U/V //✓L(/ 72-008 (7/76) WAS GROUND WATER S ENCOUNTERED? YS L O P IF YES, AT WHAT / n, E DEPTH? _( 1 &,�2 5t-, v^; - -- -- li - I Reading Date Gross Time Net Time Depth to Water Net Drop 6 230 1.5- 10 tea- ° ' vo PERCOLATION RATE /t (minutes/inch) r - TEST RUN BETWEEN - FT AND �_ FT _DATEi_ N CERTIFIED B1': � i .moi MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251065 Parcel ID 020 -041-23 Legal description MANN BLK 2 LT 4 Expiration Date: 2/18/2026 Site address 5971 E 162ND AVE Current property owner(s) SULLIVAN JEREMY A X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or conditions: No comments By:: r bedrooms, with the following stipulations: Original Certificate Date: 3/6/2025 This C rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject sysfem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, bevelopment Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-041-23 Complete legal description MANN BLOCK 2 LOT 4 Location (site address) 5971 E 162ND AVENUE ANCHORAGE, ALASKA 99516 Current property owner(s) JEREMY A SULLIVAN Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 550 Date of Payment COSA # Q5 G 2 5106 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: MANN BLOCK 2 LOT 4 Parcel ID: 020-041-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 4/30/85 Total depth 120 ft Cased to 29 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 2/18/25 Static water level at beginning of test 15 ft. Well production at time of test 4+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.849 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 2/18/25 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 51” Date of pumping 2/18/25 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/28/1985 ALL standpipes present per record drawing Total measured depth from existing grade 7.1 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 2/18/25 Results Pass Fluid depth prior to test 0 in Water added 480 gal New fluid depth 1 in Elapsed time 20 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 6” ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 6 in Comments/Deficiencies: Tested the 1985 absorption bed that was currently in use. The untested 2002 shallow trenches were dry and in good condition. Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, MOA records & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MOA WAIVER – WR#050044 G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 2/27/2025 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 02/27/25 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC251065 Subdivision: Mann Block:2, Lot: 4 907-343-7904 Fax: 343-7997 The septic tank for this property is 23 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. 11V[JUHM /\ Il y Y O11 AHCH0RAG , Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020 041 23 Expiration Date: D6 — f%2 02-2 1. GENERAL INFORMATION Complete legal description MANN BLOCK 2 LOT 4 Location (site address) 5971 E 162 Current property owner(s) HANSEN Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FLI Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J; `J U Waiver Fee $ Date of Payment %1GMZZ Date of Payment Receipt Number 006017D Receipt Number COSA # o s c a 213 a� 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 C&M ENGINEERING Phone 8545558 Address 20182 Engineer's Printed Name CHARLES BALZARINI 6. DSD SIGNATURE SIGNATURE >" System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 7/26/22 *: 49 THX. •.* J •L• r CHARLES G 13ALZARINI .% �6' . • CE -13854 ill PROFESSIONA .�. bedrooms, with the following stipulations: 6\PALI TY (�II"i i , � � qrF ATF o J JJJ �iLJ 0�=. jJ9�/�� VICES'ON Original Certificate Date: The Municipality of Anchorage 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 Checklist blue sheet Nitrate Advisory Arsenic Advisory Other S 4- �LV�rSc`d✓`"� � +J_kC(1tR Legal Description: MANN BLOCK 2 LOT 4 Parcel ID: 020 041 23 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA WE Well log is filed with Onsite (or attached) Well production at time of test +5 gpm Date drilled 1985 Water storage tank volume NA gallons ____.m�_..____ Total -depth -1-2Q-- _ �_�_�.�_.____�___.��.r_.______���...__.__WeIF-disinfected-foreoliform-tesfi?_--❑ Yes__._.._❑_.Nov__._�_ Cased to 29 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 0.961 mg/L E]Nitrate less than MRL (ND) 01Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) +18 in. Collected by C&M ENGINEERING Date of flow test for COSA 6/22/22 Date of Sample 6/24/22 Static water level at beginning of test 17 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material STEEL SEPTIC Measured operating fluid level in septic tank 51 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 4/13/22 D. ABSORPTION FIELD DATA (2) SHALLOW TRENCH Which system tested (date installed) 2002 FOR ALL standpipes present per record drawing Total measured depth from grade 5.1 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/22/22 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 0 in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) If yes, enter date y NA Gallons introduced NA gallons Comments/Deficiencies: DIVERTER VALVE CURRENTLY SWITCHED TO 2002 SYSTEM. leachfield depth consistent with previous cosa by GEG COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q✓ Yes Community Sewer Manhole/Cleanout > 100' E✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0✓ Yes if No ft Absorption Field on Lot > 100' 0✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10' Animal Containment > 50' [✓ Yes if No ft [j✓ Yes----if-N o__ � __ _ ft _...______ Yes if No ft Water Service Line > 10' [Z]✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' [Z]✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 5 ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Verified septic standpipes including flow splitter are present per record drawing. There is a diverter valve which allows flow to be directed to the old leachfield. Diverter valve may be used in the event of a leachfield failure or to switch periodically. G. ENGINEER'S CERTIFICATION I certify that l 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. 6/30/22 COSA Checklist yellow sheet TM '• CHARLES G BALZARINI �����. • • CE -13854 ROFE6S14 -®. www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221329 Subdivision: Mann Block 2 Lot 4 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this COSA / property is 20 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org Municipality of Anchorage .. Development Services Department Building Safety Division On -Site Water& Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 020-041-23 HAA# 050.2:76 g 1. GENERAL INFORMATION Expiration Date: 1 —o,. 3 — 0-� Complete legal description MANN SUBDMSION: LOT 4. BLOCK 2 Location (site address or directions) 5971 EAST 162ND AVE. • ANCHORAGE. AK 99516 Current Property owner(s) JOHN MCCREA Day phone 345-3565 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 5971 EAST 162ND AVE. ► ANCHORAGE. AK 99516 LEE Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of tide (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage riles 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for -3 bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date 6f2r105— bedrooms, with the following stipulations: • nr.i erre ! WATER AND PROGRAM Attachments: HAA Checklist Ll--� Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other By: l / /,4 z a,/ Original Certificate Date: 6-2 3 – 026� (R.. 7201( Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.d.anchomge.ak.u9 (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: MANN SUBDIVISION: LOT 4. BLOCK 2. Parcel to: 020-041-23 A. WELL DATA *CASED TO BEDROCK Well type SATE H A, B, or C provide PWSIDN N/A Daft completed 4/30/85 Sanitary seal (Y/N) YES Total depth 120 ft. Cased tD 029 ft. FROM WELL LOG Date of test 4/30/85 Stags water level 9 ft. Web production 1-2 9— p.m- WATER SAMPLE RESULTS: Coliform 0 cdonies/100 ml. Nitrate 0.136 mg./L. Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 6/6/2005 20 ft. 7.D4 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: N/A mgA. Date of sample: 6/6/2005 Collected by: G.E.G. Ltd. S. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date insured 5/30/2002 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Data of pumping 6/9/2005 Pumper ANCHORAGE CESSPOOL C. ABSORPTION FIELD DATA 6/30/2002 / Date instalied 0/2!V1985 Sob rating .p.d 1.0/183 System "DUAL TRENCH / BED 64 (2 O 32)/ 2.0/2.0/ Length 35 It. Width 5/ 5/ 20 ft, Gravel below pipe 0.5 ft. 5.J/ 4.7/ Total depth 17 ft. Eff. absorption area 457 ft' Monitoring tube YES Depression over held NO Date of adequacy test 6/6/21705alta (Pasa/Fatl) PASS For 3 bedrooms 2.75 307/ —7W 7.0/ Fluid depth in absorption field before test 2-5 in. 9f 5.75/ Water added 314 gal. New depth 8.25 in. Elapsed Time: 18 min. Final fluid depth 6.75 In. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 6 type) NO If yes, give date — NOTE: ONLY THE DUAL TRENCH WAS TESTED 1—AS;T ITZ "twNS (N 7W ---1(b° S Cs.WifO 1"0-14E I 8s G& -VW -V1 hh It �, rt 0.79" 2.r,5,6 D. LIFT STATION Date installed "Pump on" level at _in. Datum - E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm b circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 'S' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 25'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0. ENGINEER'S CERTIFICATION I certify that I have determined throWh field Inspections and Z! -,I IIA :YF* review of Munlctpal records that the above systems ere in ......1 conformance with MOA HAA guidelines in effed on this date. omess:• Engineer's Printed Name JEFFREY A. GARNESS Date 6�Zf�o� �P�otessi�d HAA Fee $ q.1) Date of Payment (1 121 I !1 S Receipt Number (Rsv. 1201) Pre ... Waiver Fee S Date of Payment (a 111 �n Receipt Number o? -q 1 �5 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS June 21, 2005 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: AVaiver Request for Diann Subdivision; Lot 4, Block 2, To whom it may concern: We request that your department issue a 5 -foot lot line waiver from the north property line to the existing drainfield. I am unaware of any adverse impacts this waiver would have on adjacent wells or septictems. If you have any questions, please contact us at 337-6179. Thank you for your assistance 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com � Municipality of \ _ �j I P.O. Ik,�cl!N�ILN)-Andtontg,Alaska!C1.i1!F(i6N). 7'ckphow(N)iS:S3:S 301*rnx @Nli1a3:S�R•,INI 47a11!nttvmv Strcct • .lnchontge, Ahlskn SN17117 o%mmitmLorg Mayor D/nrk I3cgicl) Iluilding Safety Dh4sion 23 Jun 05 Garness Engineering Group, Ltd 3701 E. Tudor Road Suite 101 Anchorage, AK 99507 Subject: Waiver Request Mann Block 2 Lot 4 Waiver Request NWRO50044 Parcel ID #020-041-23 Dear Mr. Gamess: Your request for a waiver of the required 10 feet from the Absorption Field to the Property Line is approved. The approved separation distance is 5 feet. This waiver approval applies to the existing Absorption Field to Property Line separations 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 343-7904. Sincerely, Jeff Poet Engineering Tech On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage a4 Development Services Department ~' Building Safety Division On -Site Water and Wastewater Program ` 4700 Bragaw Street P.O. Box 1%650 Anchorage, AK 9951916650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 050044 PID#: 020.041-23 HAM 050270 Permit#: Date Received: 06121/05 Legal Description: Mann Block 2 Lot 4 Engineer. Gamess Engineering Group, Ltd 3701 E. Tudor Rd. Suite 101. Anchorage. AK 99507 Applicant: John McCrea Waiver Requested:_ Separation distance 5 Feet Absogtion Field to Property Line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ............................................................................... Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: _6o - .2 3 - o.7 By: ............................................................................... Rec#: 69765 Amount: $175.00 Date Paid: $123/2005 FOOMOT, I A n Lot 3 m N00003'00"W 164.86 30 10' Utility Easement C) -------------------- I s�� r m� 0 (i y c n = coo T o=ff(� d zm0 O G r W � Spc o o 0) 0d �Irn o :3 W o " o W ff a O O CCD O co O , .9a a so h� fjl i�y3 S C- e y, � r s• deal p 9.7 57 " $.. Z, 3g 60.119dk0` `' y P kR 3 k 34.0 0 ;� 0 T OSL a N •s Ir G, N00°03'00"W 164.86 CO CO "y{S o Elizabeth St. — co 'el MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES My Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # LQO - In L1 \ - al HAA # 4 CAO� Q L- t A- 1. GENERAL INFORMATION Complete legal description Lot -4; Block 2; Mann Subdivision Location (site address or directions) 5971 East 162nd, Anchorage, Alaska Property owner John McCrea and Moira Paddock Day phone 561-1944 wk t, 345-3565 hm Mailing address ' 5971 East 162nd, Anchorage, Alaska 99516 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 S. TYPE OF WATER SUPPLY: w Individual well XXX 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 XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA U21 LEN Vow M099 (L6/L 'AOU) SdRZL ->laom s,aaeuibue leuolssalo.)d agl ui suoisslwo ao saoaaa aol algpsuodsa) IOU si abeaogouV to Aliledioiunyy aql •ponssi si aleollpoo a aaolaq elep ozf%leue ao suoiloadsui lonpuoo lou op SHHa to saaAoldw3 •sluawaalnbei alels pue leaapal uleliao �4siles oliepio ui suoilnlilsul bulpual alagl pue sawog to saasegoand of Asepnoo a se slgl saop SHHa agl .eilsely to elelS ag1 ul paaalslBaa aaauibua leuolssaload luapuadepui ue Aq anoge g gdea6eaed ui u9n16 suolleluasaidaa aql uodn Aluo paseq saleoilgjoa lenoaddy AllaoglnV glleaH sonss! (SHHa) saolna96 uewnH pue glleaH to luawliedea a6eaogouy to AllIediolunN aql NU1111IIJ I algia :suollelndlls 6uimollol eql gllM 'swooapaq Z6-2 - alea sluaww00 Ieu011lppy a01 lenoidde leuolllpuo0 •panoiddes!'a -swooapaq a01 panoaddy 3unIVNJIS SHHa ainleu6ls s,aaau16u3 ssai ppy VOZ'ON psoa dool.+aAlb 01083 b80LL euogd wa13 10 aweN -uolloadsul slgl jo alep agl uo loaga ui suolleln6ai pue 'saoueulpio 'sapoo alelS pUe led!o!unW Ile gllM aouelldwoo ul sl walsAs lesodslp aalemalsem ao/pue AIddns aaleM ails-uo aql 'uo!loodsul pue u011e61ls9nul AW woa; pue sa!!d a6eaogouy to Al!ledlolunW eql woa; paupelgo uollewaolul eql uo paseq legl Aj!J8Aaagpnl 1-ulaaaq poleolpul einlonals;o adAl pue swooapeq;o aagwnu aql aol alenbepe pue leuolloun;'ejus si walsAs lesodslp aalennalsum ao/pue Alcldns aalem alis-uo aql legl smogs uolleolldde lenoaddy AluoglnV glleaH slgl to u01le61lsanul Aw legl Aj!JOA I 'molaq umogs alep uollepplA aql to se pue olaaaq paxl}je leas Aw Aq peilpoo sy EMNIEM AS NO1103dSNl d0 1N3W31tl1S w M .5 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT L/1 L>>Q:�a, 1114,41vN Sump. Parcel I.D. A. WELL DATA Well type (UA -?r✓ If A, B, or C, attach ADEC letter. ADEC water system number /V A Log present &N) ES Date completed y��J'g� Driller tTE/v af(_ ror, leo, Total depth 010 Cased tor= /y0 of Ll"PV(, Casing height 18 tr l al -0 KoaK Sanitary seal &N) _ YFS Wires properly protected (6N) y�S Date of test Static water level Well flow Pump level FROM WELL LOG 4 -3D -8S I - ;), g.p.m. (A K SEPARATION DISTANCES FROM WELL TO: Septic/ham tank on lot Absorption field on lot AT INSPECTION 6-R2 c C- yr S g, m y a l'Q I rT" p � r`t 1 ra � o 0 On adjacent lots —_ /00 �/ N ro O r" ?L ; On adjacent lots 106,1 - Public sewer main — ZQIA Public sewer manhole/cleanout N� Sewer service line A 0 + Petroleum tank /VONF- Kuoni WATER SAMPLE RESULTS: Coliform Nitrate n .%`l 61b,A Other bacteria Date of sample: LAP' 2 2 Collected by: S VS F-N&JrvFrt-zn rJt;_ B. SEPTIC/H; TANK DATA 8$„ Date installed — Tank size /006 Compartments Cleanouts (tel) High water alarm (Y/Ol U Foundation cleanout 6N) y'�S Depression (Y/6l _� Alarm tested (Y/& — NIA Date of pumping (, _;kH-g 2 Pumper i4 I' &64E �Ntvicr� SEPARATION DISTANCES FROM SEPTIC/FFG TANK TO: Well(s) on lot I &0 On adjacent lots /00 "1' Foundation 60 1 f v / r To property line 10 IL Absorption field 5 -h Water main/service line /00 r Surface water/drainage /06 i- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE LIFT STATION Date in ed Size in gallons Vent (Y/N) — N//7 Manufacturer High water alarm level "Pump o " vel at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed 6 - a6 -gs Soil rating SF/&L System type 13F—D Length3� Width / g Gravel thickness 7�i—Total depth �(S Total absorption area 666 SF Cleanouts present &N) 3�TWO M.%S I A/U Depression over field (Y/Q—k01LE([r� Date of adequacy test Ld,3-cQ Results (pass/fail) 'pASS for 3 bedrooms Peroxide treatment (past 12 months) (Y/g) mo -t ""pry If yes, give date 1V I A - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot No On adjacent lots loo ,� Property line X20 /k To building foundation loo r1� To existing or abandoned system on lot WA— On adjacent lots 50 / Cutbank 0//4 Water main/service line /DU .f - Surface waternn t100 � Driveway, parking/vehicle storage area Curtain drain NONE- kryovit� E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect S & S ENGINEERING _' Signature 17034 FadI e River nop Road Na. 204 � �p Eagle River, Alaska 99577 ler Engineer's Name Date HAA Fee $ �l ` 'G �i/ Waiver Fee: $ l Date of Payment o i Date of Payment Receipt Number / ` v Receipt Number 72-026 (Rev. 3/91) Back MOA 21 r� date of this inspection. g9`Rb � ne6ClUa" d Pr JJ 9 %3;t eR 6a�NC JiI bflarz�lD@9 �n AJee® r,��� Y�'�ti�•M PA rf 0FC a1.°o1�eZt MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date �� ?5 — 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name I'nc�l2fi %'/ibDl�C� Telephone: Home �`_7/l Business Applicant Address &-zz_9k `-' -/ -- (c) Applicant is (check one): I -ending Institution D ; Owner/builder 0 ; Buyer D ; Other E] (explain); (JN/off-� (d) Lending Institution 5> \ _ L_)m 11 flf�l� CZIc®t elephone Address _—_--. —-- — (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: ,:5- q11_(x_ 1,6 2 a16 57 , AAJ C // z;' - _`` a 3 - ----- ALh l2 l (k) '; cLI f< 2. TYPE OF RESIDENCE Single -Family K Multi -Family D Other Number of Bedrooms �_:? ___ 3. WATER SUPPLY Individual Well 'A Community ❑ Public D 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 E7 Community 0 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 2 72-025 (11184) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date c Name of I Address Date __! a - C, l N Engineer's Seal G J'von�No. C,-5. E3 r9 frus 6. DHEP APPROV.A - Approved for i��_' bedrooms by/jDate Approved _--— _ Disapproved _._ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL. PROTECTION CHECKLIST -FEBRUARY 1984 284-4720 ULC G5SNfS�� Legal Description: 1_-&'T 46L0CKtkr r C 1\/ E D ,M A1,t1t -015 5 ! VI -616 A/ A. WELL DATA Well Classification _ P/Z I Vol C If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) XES Date Completed 165 Yield 2! PAVE Total Depth 17– FT Cased toAT/Z'Asr 4U Depth of Grouting 6419. Static Water Level q FT Pump Set At 0& i;�tJl9cu/l� Casing Height Above Ground / Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Ca rI r ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 148f- t r ; On Adjoining Lots . 2 CJ To Nearest Nearest Public Sewer Line /� To Nearest Public Sewer Cleanout/Manhole _ To Nearest Sewer Service Line on Lot 2- 5 F 7 Water Sample Collected by !O Q 51WfZM4&1 ; Date — /Z '63 &s Water Sample Test Results 5'f9 / /.SMAC 7 -00r - Comments 0DZ Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size X0(9 C� No. of Compartments — �- " ` �y✓ Foundation Cleanout Standpipes (Y/N) —��? —Air -tight Caps (Y/N) —, (Y/N) j Depression over Tank (Y/N) At o Date Last Pumped AJ Pumping/Maintenance Contract on File (Y/N) 'oy'm ; for Holding Tank High -Water Alarm (Y/N) IL4 Temporary Holding Tank Permit (Y/N) _ Separation Distances from Septic/Holding Tank: To Water -Supply Well — Z 3 0 Tr To Building Foundation 162 To Property Line — ZQ /–T To Disposal Field — _ (9 f= Ti To Water Main/Service Line Course Comments IUM E Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1C7 1 35 IMAM Type of System Design C Date Installed 1L (,.&:5 Length of Field -37 F T 1 Width of Field /6 Fr" Depth of Field 4,oS F T Gravel Bed Thickness 6 //Ue/#FV Square Feet of Absorption Area sgQ�f- Tr Standpipes Present (Y/N) Depression over Field (Y/N) /U U' Date of Last Adequacy Test /vete Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well i4P, f • To Property Line p T' To Building Foundation F! To Existing or Abandoned System on Lot`%/t/1�i ; On Adjoining Lots F Z: To Water Main/Service Line 0 15 F ( To Cutbank (if present) Ajl / / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /0& F 7 Comments D. LIFT STATION Cluo! (=sE4%