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HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 1 BLK 1 LT 6Gl nn View Estates West Block I Lot 6 #05179306 ® Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5� d a©(�'L PID Number: d S I — ��j ?j -�061' Name: J _ ✓©� 4 jet` Wastewater System: `},New ❑ Upgrade ABSORPTION FIELD Phone: �C c) 3 — i Q�� Number of Bedrooms: 4 CC Deep Trench fq;l Shallow Trench ❑ Bed 11 Mound ❑ Other. V LEGAL DESCRIPTION Soil Rating: 0 p ) 2/ GPD,Ft= Total Depth from original grade: ]� ✓h Ft. Block Lot:l,/' Subdivision: -I- ./- / .0 I bL�' Depth to pipe bottom from original grade: Gravel depth beneath pipe: V �i' e5 FL Ft. Township: Range: Sed. n: FII added above original grade: + 03 Ft. Gravel Length: �/ !�/%- r%/ X ' / Fl. Well: ❑ New ❑ Upgrade Gravel width �) Number of lines: Distance betv+een lines: i 5 Ft. Ft. Classification (Private, A,_ B, C): //•• z vmfil K/% / oei Total Depth: Fl. Cased to: /' FL Total absorption area: -75S LJ Ft' Pi a Matefia�l:'^1 �'{7(� Q /� SIJ' / .PJ 0 / EU'V Driller. Date Drill Static Water Levet Installer. F0)�Z � Date Installed: FL TANK Yield: ,A p Set at Casing Height Above -Ground: ' —G Ft FL SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Public/Private Manuf urer. / LVlO.' Capacity., f 06a1. From Tank Field Station Tank Sewer Une �l {/I p�5 Well tt I h I r •'�� '�� t Material' f -tee Nup7)I er cF Compo mems: of(l Surface Water�(� T i�0 t I LIFT STATION 1 Size: Manufacturer. Lot Lire Gal. Foundation I I a �" + 'Pump on level at Iev High water atom at: in. .n. in. Curtain Drain 1 Pump Make Z Mo Electrical InspecUcns performed by. 'CC,, lel Remarks: BENCH MARK Location and Description; &A)m a� std; ,rA Assume'!ew�aticr.: oIn 1'"�( / 1 tl f 0c Ft. R o aa d•�°° °/0O' e IV�Q //pp JAr94 S & S ENGINEERING 17034 Eagle River Loop Road, No. �Q� 1 Inspections performed by: Dates: 15` ���� *Ia5k a°�.'ooi°° i• .e°�ls..eli.ou .roco.ett sae..• -- Eagle River, V-2,4 2nd �._ ^ _> �/�c •ROBERT C. COWAN ,•��� 1�•,p*oa Development Services Department Approval CE -8801 • e���� Reviewed and approved by: Date' i Joe 6J JI ®n x1!(102 PERMIT NO. SW020068 PAGE 2 OF 3 Munibpalit of Anchorage DEPARTMENT OF HEALTH ASI® HUMAN SERWCES EW RONMENTAL SERWICcS DW0500N P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Te'l�ephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR ME WSPL CTIO N REPORT LEGAL LOT 6, BLOCK 1 , GLENN VIEW EST. WEST #1 P.I.D. NO. 051-793-06 LOT 5 10' 17 NEW 1250 GALLON V SEPTIC TANK B DBL1 & DBL2 _� CO3 C01 O C 0 FCO T a1 ST2 ST1 A TBM M X04 MT1 NEW TRENCHES G CO2 RAV e� pRllr f ro i L 0 T 7 ELECTRICTELECOM EASEMENT LOT (, SCALE: I" = 50' j`�J r .ti 1 jL '9 z SEPTIC cAREA .. .,�...�_>:-..... .... A ROEERT C. COWAN• r! CE-8801 r �a;, �',1CrES PERMIT NO. SW020068 PAGE 3 OF 3 Munibpa(ltv of Anchora e DEPARTMENT OF HEALTH ASI® HUMAN SEWCES EWRONMENTAL SEWCES DWI&®N P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tele hone: 343-4744 ®N -SITE WASTEWATER DISPOSAL SYSTEM AND/ORL NSPECTION REPORT LEGAL LOT 6, BLOCK 1, GLENN VIEW EST. WEST #1 P.I.D. NO. 051-793-06 ST1 ST2 98.3' 77 FINAL GRADE 2" INSULATION 94.0' NEW 1250 93 8' GALLON SEPTIC TANK C01 A CO2 MT1 C01 = 94.3' 16.0' CO2 = 93.8' FINAL 15.0' INSULATION 2" INSULATION �lz-j-�C01 = 91.5' SR 15.5' CO2 = 91.5' MT1 = 88.5' CO3 04 MT2�C04 CO3 = 93.9' H II II / = 93.9' A NO WATER FOUND 78.5' B.O.H. MT2 = 87.5' N. T. S. A B C FCO 16.0' - 6.0' ST 1 15.0' - 9.0' ST2 .20.0' - 15.5' DBL1 21.5' - 17.0' DBL2 22.5' - 17.5' C01 44.0' 40.0' - 0O2 50.5' 80.5' - 0O3 57.5' 51.5' - 004 63.5' 87.5' - MT1 1 51.0' 1 80.0' 1 - MT2 1 64.5' 1 87.0' 1 - CO3 04 MT2�C04 CO3 = 93.9' H II II / = 93.9' A NO WATER FOUND 78.5' B.O.H. MT2 = 87.5' N. T. S. Municipality of Anchorage " GINEE 0 *�'- 3 Development Services Department A '•�:° ��� Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650ROBERT C. COWAN www.ci.anchorage.ak.us 'i CE - 8801 (907) 343-7904 Ali* `�� r'' t�UApr Soils Log - Percolation Test Performed For: G� y X t'/ -'C I Date Performed: Legal Description: r �j rJ �L��� Y/fL-'� t � &S I— Slope Site Plan Depth (Feet 2- 3- 4- 5- 6- 7-/ 8- 9- 10- 11-• 12- 13- U, 14- 15- 16- 17- 18- 19- 20- COMMENTS 0- s/ t WAS GROUND WATER ENCOUNTERED? Date Gross Time Net Time Depth to Water s IF YES, AT WHAT DEPTH? L Depth to Water After Monitoring? �N� P E Dale: Reading Date Gross Time Net Time Depth to Water Net Drop 3t7 3v " el PERCOLATION RATE _L�� (minulesrncw PERC HOLE DIAMETER (� " TEST RUN BETWEEN _ ' FT AND FT PERFORMED BY: 'd GH-✓kC_-�<<��=��`` _ PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL tW-,,.._ CERTIFY THAT THIS TEST WAS IN EFFECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE j// / q C Lj0n�„� Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial 7 ; -1 , Y - I-) -p Permit Number: SW020068 Legal Description: GLENN VIEW ESTATES WEST PH 1 BLK Design Engineer: 0003 S & S Engineering Owner Name: Leroy Alderman Owner Address: PO Box 670045 Chugiak , AK 99567 - Date Issued: Apr 18, 2002 Expiration Date: Apr 18, 2003 Parcel ID: 051-793-06 1 LT 6 Site Address: Lot Size: 42045 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL SOILS TEST FOR THE RESERVED SITE WITH BEDROCK AND GROUNDWATER MONITORING. Received By: Issued By: Date: llS'roz /9—at,f' + Date: 411,910.2 Municipality of Anchorage *Gf L Development Services Department Building Safety DivisionOn-Site Water and Wastewater ProgramT Y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. G� fir- 701 v0�2 Permit Number SWG2006S Property owner(s)� /�12p�'��-� Day phoned 5 ^ ld5bi�) Mailing address (1) /Pd Mailing address (2) Zip/ Code Legal description (Lot, Block & Sub'd.) L0 G� JIOGk �, lerrr1 V c e E5lafe5 Legal description (Section, Township & Range) Lot Size 4090 OQ Acr s/Sq.Ft THIS APPLICATION IS FOR: Number of Bedrooms `T Sewer Only R Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I 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. 5 & 5 hr4GiiVr.Eir61►G 17034 Eagle River Loop Road No, 21D4 �✓� c_io awar. ,Alaska 99577 - - (Signature of property owner or authorized agent) Permit Fees: 41-f 0 0 --_ _�' 8- D /-s l,, Waiver Fees: Date of Payment: '� - f %— UZ Date of Payment: Receipt Number: v Receipt Number: (Rev. 12/00) HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&S1 Ing ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 April 11, 2002 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 6, Block 1, Glenn View Estates West #1 It is requested that you issue a permit to install a septic system to serve the proposed four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 3/22/02 water was not found. A second test hole is planned at the time of construction (see site plan). We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/bj j Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1 " = 60' DESIGN SITE -PLAN SCALE m � v>w o r7- 00 U1 W Cn C3):_ a. mmti � O O O �ZAp arc � >��� n� r 1Oo �Am,Yf� c �o Om P�4 v0>R V >0-3 Din / D M- ^^ LTJ �O WVO °G l`/J� O l`/J• � �? 00 r lye < O N �7 U) II O II 00 rn •• U,00 D�\� 0 p�0� m® k a n m �=75 J � A m• • zi o 10 10 00 "0 P mw CC) \tee\ \\)o ; No 1 Ja y� n o ✓ st AQp C 1 moo 11 ti00 m 0 DN N m O " Cc D(� >0 Z � O A O> Z = ' Z m 7C �l Z PO m C D Z Qn y o O OC— n m D m v Z= o a r c O rn I a E O m Tl V 1 m o y i t 7,0 N J / y m m m� Dn i i "• • m 1))--- 30' I DESIGN I SITE -PLAN n::E> ^ r o m � 0 0 0 O nyr DOmA D O r- W ITI c ^c r OM F�/ VO>z .OHO � DANA G') m n =2N C7 > o D� O 00 Z O O Co < m >o� o (A:C7 —� O .P 7 �5, Z � Z D = O N Dr_0 Z � O Lf) }}� LTJ O �l r r'l m X 0 T7 o mo N c rm� �Lo `Ceti O p z r O q�\ n o Jn = cn m m �o m O / �L7 ,i TyV J c ( A 0 I ^ � N O tioFo�°sFa �o �sF 0 z 00 y mm r O r- to cn mm C) -� 00 Cn W o m � 0 0 0 Z DOmA D O r- W ITI <� m m r OM F�/ VO>z Z D TI m � DANA G') m n C- o D� O 00 low O CD C/) CA TIO .P 7 �5, m ' Z D OCA i N Dr_0 Z � }}� LTJ O �l U� m X 0 T7 o ny`'o N c rm� �Lo C O p r O m m / �L7 n O C) O 0) Cf) 4�1 o 00 Z m O r- W ITI \o cn I 00 � d CD it C- o D� O 00 V O CD C/) CA TIO 7 �5, m ' Z D OCA i N Dr_0 Z � }}� LTJ O �l CD .. ,.„• ,gip � ^� o m ITI i� I rn I n7 o N goon omo 7 �5, m ' Z D OCA i N Dr_0 Z � }}� LTJ O �l U� m X 0 T7 ny`'o N c rm� �Lo O p O CD .. ,.„• ,gip � ^� ITI i� Municipality of Anchorage bra NGINE �SEAt T,t Development Services Department Building Safety Division ate+ On -Site Water and Wastewater Program 4700 South Bragaw St. _ ®•<_�-•-�" P.O. Box 196650 Anchorage, AK 99519-6650 ROSERT C. COW=' -7 www.ci.anchorage.ak.us CE - 8 i41 e a'�:' jr (907) 343-7904�'J'c `°°•.. Soils Log - Percolation Test Performed For: Az o&YL_F- AJ Date.Performed: /7 U 'Z - Legal Description: f (p , ,IjL NV/I—, ow ��`j%Tnship, Range, Section: _�'"` Depth a (Feet) 1- 2- 3- 4- 5- 6- - 2 -3- 4- 5- 6 - 7- 8- 9- 10- 12- 13- 14- 7- 8- 9 -10 -12 -13 -14 - 15- 16- 17- 18- 19- 20- COMMENTS 15- 16- 17- 18- 19- 20 - COMMENTS ' ^ e WAS GROUND WATER f ENCOUNTERED? S IF YES, AT WHAT DEPTH? L 4A,k �rrar�, o Depth to Water After p P Monitoring? 10�— / E Date: V02— PERCOLATION RATE r=(minuteshnch) PERC HOLE DIAMETER TEST RUN BETWEEN 'tj _FT AND FT r PERFORMED BY:�� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOADANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �% UNA® � PERCOLATION RATE r=(minuteshnch) PERC HOLE DIAMETER TEST RUN BETWEEN 'tj _FT AND FT r PERFORMED BY:�� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOADANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �% E � G • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-193-06 1. GENERAL INFORMATION: Expiration Date: 9A 6 A 2 Complete legal description GLENN VIEW ESTATES WEST PHASE 1; BLOCK 1 LOT 6 Location (site address) 21420 Linda Jo Circle *Anchorage 99567 Current Property owner(s) Tom Ramondetta Day phone 688-4878 Mailing address Real Estate Agent 2. TYKE OF_D.W_ _ELLIUG: ._ — _ --_ ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual p Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ .Public Water System ® Public Sewer 1 WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment V / Date of Payment Receipt Number O bAI9�02 3 G Receipt Number COSA # 0 5 C 11 L/ 9 9 Waiver # q� 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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, — p groundwater levels (that may fluctuate during the year), quality of construction (materials and % T�: 4 t '1 y* v� ....... ......... workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of ;r s - the well or septic system. GEG makes no representation whether an alternative well or septic system i) eyA. ed' can be installed on the property in the event either of the current systems fail to perform adequately in u'l 79 the future. The content of this report is for the sole benefit of the person/party that retained GEG to ilk q perform the evaluation. Reliance up—on the information rovidedin this re ort b an other erson or— ` i� �s� part (including subsequent property purchasers) is not authorized, nor will it confer an legal ri �v profs i° party 9 q P P Y P ) Y 9 `��tlll(l(((((((((� whatsoever. ��\� OF #AECC884 6. DSD SIGNATURE Q G' System #1 Approved for bedrooms System #2 Approved for bedrooms �� �P�ER F SER o co :Z Disapproved Joh W PROc'hP o�� Conditional approval for bedrooms, with th!,Jf wing stipulat����� ��if, MENT SER ���` By: Original Certificate Date: q /6 Z The Municipality, of Anc/iegn Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representationsn 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_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: GLENN VIEW ESTATES WEST PHASE 1; BLOCK 1, LOT 6 parcel ID: 051-793-06 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for C Static wat el at beginning of test ft. C—mments B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC5TEE Measured operating fluid level in septic tank 49" 01 Standpipes/foundation cleanout per record drawing Date of pumping1 f �d D. ABSORPTION FIELD DATA Well production at time of test Water storage tank volume gallons Well disinfects coliform test? ❑ Yes W No ❑ rm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample AWWU WATER C. LIFT STATION ❑ Required maintenance com Age of li>)a" rs Lift stati CommeN/A Which system tested (date installed) 8/15/02 Adequacy test date 614/21 41 ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 6.33 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3.08 ft (min) Water added 606 gal ❑ N/A — pressurized field 9 New depth in n Monitor tubes go to bottom of effective. If not, state 120 depth into effective Elapsed time min © Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: TESTED WEST TRENCH ONLY -EAST TRENCH HAD 9" OF LIQUID UPON ARRIVAL COSA Checklist yellow sheet (4 From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E. SEPARATION DISTANCES Yes if No ft If absorption field is under driveway comment below From Private Well on Lot to: (Please enter distances if less than required or if community well) P71 Yes if No Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Water Main > 10' ✓❑ ❑ Yes if No ft ❑ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft ft Absorption Field on Lot > 100' F-1Yesif No ft Holding Tank > 100' El Yes — if No ft Zi_— �' Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) I `' Building Foundations > 10' ❑✓ Yes / if No 5 f ft 4 A Surface Water > 100' Yes if No ft Property Line > 5' ❑✓ Yes if No ft �'Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft _1� Private Wells > 100'✓❑ Yes if No ft * Water Main > 10'i Yes if No ft +-I Community Wells > 200'✓❑ Yes if No ft Water Service Line > TO'❑✓ 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' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' P71 Yes if No 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' ❑✓ Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **APROXIMATELY 5.5' TO SHED Per Q. , � hofne owner stares thad _%he 56A Sits on railroad -ries. P4,0) G. ENGINEER'S CERTIFICATION o .OF �p04 I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with y MOA COSA guidelines in effect on this date. * .: , q ..... ..... . . .......... ....... f.ey Gorn ss,- Qo49 GEl7 '2,V COSA Checklist yellow sheet �ea °ro f e s sio0°oma #AECC884 8221 DEL STREET ANCHORAGE. ALASKA 99502 PHONE 243-4890 0 CLIENT' WC I INC. LOT 6, BLOCK I p GLENN \P.EW ESTATES WEST, PHASE NO.1 A PLAT 1`40-. SCALE GRID ................. 2000-42 NW 1459 ur`rent 420 ,Lin'da Jo Cir erov.'A1d.erman I :. .�Lenamq;agencV -, uaY Pnone Mailing address Unlessotherwise requested, HAA.witi be held by DSD for pickup. a 2. NUMBER OF BEDROOMS, 3. TYPE OF WATER,SUPPLY., TYPE OF WASTEWATER DISPOSAL itional a bedroo'ms- �B/� ltRT NAS I EWA 1, tK Municipality of Anchorage �£ B Development Services Department =k,_ Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t`. t ( C_'�r,`cvyc a i i Si e-✓'�s;',Parcel ID: / `7 93 —0 6 A. WELL DATA 1' b L -c — x,.1,4 -T IL A ; Well type If A, B, or C provide PWSID # Well Log (Y/N) / Date completed Sanitary seal (Y/N) Wires properly -protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production 9— p.m-WATER SAMPLE RESU QTS: Coliform colonies/100 ml. Nitrate mgA. Arse ' . mg./I. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type%Material Tank size b d gal. Number of Compartments ' rT. Foundation cleanout Depression over tank (Y63 Date.of pumping r���iy - �'dG `• Pumper C. ABSORPTION FIELD DATA Date *'installed �/ / �� . ) Soil rating g.p.d./ft2�br ft2/bdrm) 0 • � Length�� �'- ft. Width S ft. Other bacteria Collected by: 9•p -m. colonies/100 ml. Date installed 4 Cleanouts�F 1) Y S High water alarm (Y/O 'Ohr o System type S114I-i.0c.a 74i.vc,49✓ t Gravel below pipe 3 ft. Total depth v ft. Eff. absorption area 7-1�-ft2 Monitoring tube YgLJ Depression over field ✓� `' Date of adequacy test N/!} —�'�� yJ Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test _jn: Elapsed Time: min. —Final fl iu depth Any rejuvenation tFegt-ment (past 12 mo.) (Y/N & type) Water added gal. New depth in. in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. H' water alarm level at in. Datum Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots - Absorption field on lot On adjacent -lets --- Public sewer main Public sewer manhole/cleanout Sewer /septic sefvic-ein`i a Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line S �7 Absorption field / Water main Water service line % 0 Surface water /'✓ f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / / Building foundation - ` Water main i Water Service line 10 Surface water /00 Driveway, parking/vehicle storage 60 4 - Curtain drain d01,14- Wells on adjacent lots `= F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date.WAN `W Engineer's Printed Name I , V f' °�`�' C Cc�'�;�� �s�� T 801 rs•♦vf w+" Date c� AS A HAA Fee $ Date of Payment i l l C) Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 8221 DEL STREET 400�-:,-ANCHORAGE, ALASKA 99502 PHONE 243-4890 8/30/02 AS BUILT 56-31 3/14/02 PLOT PLAN 54-37 DATE ® ®%1L��p FLD. BK. Willi D. •ming o c ���� '.• LS -57/3 °.' AV . 0 so 8� Arofession81�a % NOTES: Easements not appearing on record subdivision plat are not shown unless description of easement is provided by client. It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grode and utilities connections, and to determine the existence of any easements, covenants, or restricfi,)ns which do not appear on the recorded subdivision plat. Elevations based on assumed datum unless otherwise indicated, and bearings and distances are record data. CLIENT: M2C I INC. LEGAL DESCRIPTION LOT 6, BLOCK I, GLENN VIEW ESTATES WEST, PHASE NO. I PLAT NO. SCALE GRID 2000-42 1"=40 NW 1459