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TRAILS END BLK 6 LT 10
Treils nd lock 6 Lot 10 015-19 -36 © ~Development M un ic ipality of Services Anchor Department age Building Safety Division ~ ~ On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ©'5)~ ~Oi ~_% PID Number: Oi5- '~- N~m~:L~q¢~ '~q ~O~r~h~ WastewaterSystem: ~Now ~Upgrade Address: ~ ~50 '~r~ S~,~ ~nc~or~, ,~ ~ ABSORPTION FIELD ~edrooms:~-- U DeepTreach ~Shai[ow Trench U Bed U Mound U Other: Phone: Numar of Total Depth from original grade: LEGAL DESCRIPTION sci, Rating: 5, O GPD/Ft2 ~ Ft. Block: Lot: Subdivision: Depth to.pipe bottom from original grade: Gravel depth beneath pipe: Township: Range: Section: Fill added above original grade: Gravel Length: ~ ' )lOft Gravelwidth: Numberoflines: Well: ~X~' ~ New ~ Upgrade ~ Ft. ~ Ft. Classifi~tion (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Drillen Date Drilled: Static Water Level: Installer: Date Installed: Yield:. GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~'Septic B Holding B S.T.E.P. ~Other: T~ To Septic Absorption Lift Holding ~ubliCPrivate Man~a~urer: Capacity: Tank Field Station Tank Sewer Line ,A nC~&C" -~ }~ ~ ~ Gal. /~ i Materia~ ~ ~4;~ ~) Number of Compadments: ~ i~ ~ ,~ LIFT STATION Size: Man~a~urer: ' ~ "Pump on' level at: "Pump o~ level at: [ High water ala~ at: ~ ~/~ Pump Make & Model Electri~l Inspections pedormed by: Cudain Drain 50'~ ~0 ~ 501+ O~ Remarks: Lo~tion and Description: ~ I ' Engineer's Stamp Inspections pedormed by: L~r,5 ¢¢%,¢~.~ Dates: ~s' ,,1.1~*,0 Development Se~ices Depa~ment Approval ff ~¢.' ~}~ Conditional Approval Date: ¢..~ .'.Y..~ ...... , ..... Reviewed and approved by: ~ /:, ~,-~' Date: ]/~O TRAIL STREET II C 36' 46' '.."...:.,.'.'..i..'i'.'..i:....';i...:: i' j'f I I r x~ , ROCK DEPTH 1.5 FEET I --~,-- '~ -~ COVER 2 FEET ~ 5 WELI *DI ~UST RE STA~ED ~Y I~l, ..,4.'-' ...... '~ .... rF"'3~'-'~ ............ NOTE: ~lS IS NOT A SURV~ED P~ WELL k SEPTIC ............ OEPA~T~ENT ~U~ENTATION. ~ LOCADONS SHOWN SCALE,, 1' = 30 F~ SPURK~ND ENG/NEERING 203 · 15TH. AVENUE TRAILS END BLOCK G LOT 10 SEPTIC SYSTEU ASBUILT ANCH. AK. 99501 ~URA VAN NOS[RAND DARE: NOV. 10, 2010 (907) 279-~916 8950 TRAIL STREE~ ANCHORAGE, AK 99~16 SHEED 2/4 GRID: 2641 PERMIT ~ DgP]O]~43 PID~ 015-19~-36 TRAIL$ENDB6LiOD$,DWG A B 36' 46' 42' 53' ~6.$' 42' 53' 61.5' $$' 58' 6~ '~4~AP ADVANTEX 24" ELEK-- +/-99' ~ ~ 6" PUMP-O~ ~ ~~ ..... , ~ ~,~[ ~[c~,o~ ~1~1 ow~ m~s co~[c~o~ s.[[~ ~O~[C~O~- E~END TO BENCH ~RK GAUGE ASSU~ED E~AT/ON I00 SPURKLAND ENGINEERING ~ ~ ~0~ 6 ~0~ ]~ SEPTIC SYSTEM ~ESIGN 203 ~15th Ave Anchorage Ak 99501 ~UN~ V~N NOS~NAND DATE, aCT,18, 2010 e79-~91~ ~BSO ~AIL S~E~ ANONONA~ AK BB51~ SHEET~ 3/4 GRIg, PENWIT ~ OSPIOIXXX PANCEL ID ~ 015-192-~6 ~NAILSENDB6LIOD~.D~G Monitor 5- ~/Ide Trench; ] ]/4' Schedule 48 PV£ ~ 5' ~/ide 3/16' Holes oF 24 inches ~ 35' Long 4' Max Depth : 1,5' Sewer rock ~ 2' ~over To Advan~ex Uni~ 0 Noni~or 2],0' i / / / 2'+ Cover (m/n) ~S/l~ Barrier EH. E.G. ELEK =98.5' , Elev.= 96.0'~.~ . . . ~-~-- To Advon~ex Uni~ 1.5 Effective NE SCALE 8.0.H. ELEK =83.5' ~o 8muNo w~E~ oas~ BENCH WANK GANAGE ~8 ASSUWED ELEVATION 100 SPURKLAND ENGINEERING TRAILS END B~ 6 LOT 10 SEPTIC SYSTEM ASBUILT 203 ~15th Ave Anchocage Ak 99501 ~UR~ VAN NOSTRAND DATE, NflV. 10, ~010 279-391~ 8950 ~AIL S~g~ ANCNONA6~ AK 995~ SHEET, 4/4 GRID, a641 PERMIT ~ 0SP~01245 PARCEL ID ~ 015-192-56 ~RAILSENDB6LIOD4. DW6 On-Site Wastewater Disposal System Permit OSP101243 01519236000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: Tax Code Number: Work Type: Upgrade Permit Effective Dates: November 03, 2010 to Design Engineer: SPURKLAND ENGINEERING Subdivision: TRAILS END November 03, 2011 Site Legal Address: TRAILS END BLK 6 LT 10 G:2641 Owner/Address: VAN NOSTRAND WILLIAM R & LAUREL J 11400 STROGANOF DRIVE ANCHORAGE AK 995076484 Site Mailing Address: 8950 TRAIL ST, Anchorage Lot Size in Sq Ft: 22800 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The maintenance agreement shall be submitted to the department with the inspection report. Special Provisions: The permit includes waiver OSP101261 allowing the drainfield to be a minimum of 5 feet from the south property line and 2 feet from the existing drainfield. Date: Date: Munic a of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 h~p:l~.muni.orglOnsite Development Services DepaRment On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** WR#: OSP101261 HA#: Permit: OSP101243 PID#: 015-192-36 Legal Description: Trails End, Block 6, Lot 10 Engineer: Spurkland En.qineerin.q Applicant: William & Laurel Van Nostrand Your request for a waiver of the required 10 feet horizontal separation from the proposed absorption field to the property line has been approved. The approved separation distance is 5 feet. Your request for a waiver of the required 10 feet horizontal separation from the proposed absorption field to the existing drainfield has been approved. The approved separation distance is 2 feet. This waiver approval applies to the separation distances stated above. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: ____ Approved 'b~-~(~- 1.1_.,~. ~/ Name of Reviewer Rec#: 049906 Amount: $200.00 Date Paid: 11/3/10 **** VARIANCE/WAIVER REVIEW **** Parcel I.D. BuifdiRg Safety D~vision On-S~te Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 ~,&~.m uni.orglonsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Propertyowner(s) ~.~r'~, ~,', ~'~/l'."~,nJ Dayphone Mailing address $~50 'Tr~\ -~¥¢e~; Ar~c~ao¢-~ i At/x' Zip Code Site address --~,'-~m¢_ - .Zip Code Legal description (Sub'd., Block & Lot) T/'qi Legal description (Township, Range & Section) Lot Size Sq. Ft. ~n~ 6ik6 Lo~-IO Number of Bedrooms THIS APPLICATION IS FOR ([~ all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade Renewal [] 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. (Signature of/property owner or authorized agent) Permit/Rush Fees: ~-~L~--~ ¢ Waiver Fees: Date of Payment: /(¢//~ ~'/0 Date of Payment: Receipt Number: ~ ? / 7~'~-- Receipt N umber: (Rev. 11/05) Environmental Consulting and Design SEPTIC SYSTEM DESIGN Trails End Block 6 Lot 10 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 October 14, 2010 Subject: Septic System Installation Permit 8950 Trail Street Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system for the above referenced property. The proposed system will serve a 3-bedroom single-family residence. The existing system was installed in 1984 and is operating in a surcharged state. The existing tank and drain field will be abandoned per MOA code requirements. A Soil log, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Caics: No Ground water observed to a depth of 15 feet below ground surface (10/15/2010) Soil Rating. From Test hole (10/8/2010) 6.7 min./in = Max Application rate 5.0 gal per sq.ft./day w/Cat III advanced treatment No. of Bedrooms 3 Required Area per Bedroom: 150/5 =30 sq.ft. Minimum area required: 30 x 3 = 90 sq.ft. System: We are proposing an Advantex Advanced Treatment System, and a shallow trench drain field. The drain field will consist of 2 17.5 foot long trenches, 5 feet wide with 1.5 feet (225 sq.ft, effective) of sewer rock. Soils: A test hole was excavated on October 8, 2010. See the attached soil logs. Ground water was monitored for through October 15, 2010. Ground water was not observed. Surface Water: A drainage ditch exists along the north edge of the property. It was dry during site visits on Oct 8th& 15th, 2010. Garness Engineering Group observed the ditch during the summer of 2003. It contained water on May 23 (after a recent rainfall) and was dry on 7/7, 27 & 29/2003. Topography: The ground surface slopes to the east at 5 to 10 %. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Waivers: Environmental Consulting and Design I None Required. The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Lars Spurkland, P.E. Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Environmental Consulting and Design SEPTIC SYSTEM DESIGN Trails End Block 6 Lot 10 Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 October 14, 2010 Subject: Septic System Lot Line Waiver; Existing drain field to New drain field waiver 8950 Trail Street Ladies and Gentlemen: Due to the limited area available for the proposed septic system upgrade and the presence of the existing septic system drain field whose exact location is unknown the proposed drain field may have to encroach on the property line off set. The existing 5 foot utility easement has been staked by a registered land surveyor. We are requesting a 5 foot waiver be granted. Granting this waiver will not negatively affect the neighboring property. Since we can not determine the exact location of the existing drain field we would also like to request a 8 foot waiver of the 10 foot drain field to abandoned drain field offset. Both the existing drain field and the proposed drain field are shallow system with a majority of their absorption capacity directed through the bottom area. Granting of this waiver should not effect the operation or safety of the proposed system If you have any questions or are in need of additional information, please contact me at 279-3916. Sincerely, ~ Spurk-Ian~l, P.E. Civil Engineer 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Lot 5 Lot i Lot ~ (¥ACENT) Lot 3 III N II II Lot Lot 6 Lot lO NOTE: THIS IS NOT A SURVEYED PLAT. WELL ~ SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE P/ATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. SCALE; l' = lO0 Fl-, SPURKLAND ENGINEERING 203 lq 15TN. AVENUE ANCH. AK. 99501 (9OX) 27~-3~ TRAILS END BLOCK 6 LOT 10 LAURA VAN NOSTRAND 8950 TRAIL STREET, ANCHORAGE, Al( 99516 SEPTIC SYSTEbl DESIGN DATE: OCTOBER 14, 2010 SHEET: 1/4 GRID: 2641 PERMIT # [ISPiO1XXX PID # 015-192-36 TRAIL SENDB6LIODi, DI,/G TRAIL STREET I I _~.: .' ... .' 'x( ?x.'" . .'... \ / Lo~: Ill ~5 SHOP [~ ~ ........ ~~1 ~ ~'/ 5 ]/ LENGm aS FEET ] ~ ~ .,r: r].~/ ~ ~ ~IDTH 5 FEET ......... ] ~ ~ INSU~ TION 2 INCH - ~ :- -_~:- :- ~o~, ~ , --~ I I srsEu ~ u~c ~rou,~rur~rs ~l L of 9 WELL *OI ~usr BE SUKED BY l j NOTE: TNIS IS NOT A SURVEYED PME WELL * SEPTIC LOCADONS TAKEN F~O~ ON-SITE WATER AND WASTE WATER DEPAR~ENT ~U~ENTATION. ALL LOCATIONS SHO~N ARE APPROXI~A ~. WURK~ND ENGINEERING TRAILS END BLOCK ~ LOT 10 SEPDC SYSTEU DESIGN 205 · 15TH. AVENUE ANCH. AK. ~50~ ~URA VAN NOSTRAND DATE: OCT. ~5, 20~0 (907} 279-~91~ 8950 TRAIL STREE~ ANCHORAGE, AK 995~6 SHEED 2/4 GRID: 2~41 PERMIT ~ DSPIO1XXX PID~ 01~-19~-36 TRAILSENDB6LiOD~.DWG ] 6' '~,.~AP ADVANTEX 24-* / OF s' P,P~ J~ I~ g'"'~ ......... ~';"~7'"";~ ........... ova. T.~S CO..~C~O. ~ ~ ~ .~...~ .... ~~. TO P~OVIDE · .... ~ ......... ?'~'~' , - ES SPUEKLAN~ . B~fD~E EXCAVAT, ON ..... ).~..., .,.Z~ ~.'~ SPU~AN~ E~NEE~N~ ~/~ ~ ~E~ ~ ~ ~ S~T~C ~Y~T~ ~N 803 ~15th Ave AnchorcQe Ak 99501 ~ ~ ~~ DATE: 0CT,18~ 8010 87g-39~ ~ ~E ~ ~~ ~ ~ SHEET: 3/~ GRID: 8641 Non/tom Monhbor 0 0 , I 1/4' Schedule 40 PVC ~,,, 3/1~' Hole~ To Advan~ex Uni~ 5-W[de Trench~ 5' ~/de 1Z5' Long 4' ~ Nax Bep~h 1,5' Se~er rock ~' Cover Momitor , 2' Cover (rain) 1,5 F~ oP Septic Rock Effective ND SCALE SPURKLAN9 ENGINEERING ~~ ~N~ B~K 6 ~0~ 10 SEPTIC SYSTEM DESIGN ~03 ~15~h Ave Amchopage Ak 99501 ~U~A VAN NOS~RAND 9ATE, BCT, 18, 2010 279-39~ ~0 TNAA S~g~ AN~HONA~ AK ~5~6 SHEET~ 4/4 GRIg~ 2641 PERWff ~ OSPIOIXXX PANCEL ID ~ 015-192-~6 ~AILSENDB6LIOD4. DW6 Performed For: Legal Description: 2- 3- 4- 10- 11- 13- 15- 16- 17- 18- 19- 20- T COMME.TS Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 EImore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoraqe,ak.us (907) 343-7904 Soils Log - Percolation Test Slope % ~.. Township, Range, Se~ion: Site Plan WAS GROUND WATER ENCOUNTERED? S ~ L IF YES, AT WHAT DEPTH? · O Depth to Water After 'DC/ EP Monitoring? Date: if~/'"J/ZO,O Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (0 i"J¢' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~.- .5 FT AND ..~;..~ FT PERFORMED BY: L~L%~." ~uc~,,lCtv/c~ I ('¢~'~ CI9~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE V~IITH ALL STATE AND MUNICIPAL ~ID~[I~ES IN EFFECT ON THIS DATE. DATE: JO//yZOib Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and I~laterial Specifications Subject Property: Trails End Block 6 Lot 10 Date: October 14, 2010 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans in accordance with the attached MOA permit. There is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the project includes the procurement and installation of a 3-bedroom on- site wastewater disposal system at the location depicted on the attached site plan drawings. The scope of the work also includes the installation of a Advantex 1250 gallon tank, an AX-20 treatment pod, a lift station, and a drain field comprised of 2 trench, 5- feet wide x 17.5-feet long, a maximum of 4 feet deep, 1.5 feet of septic rock below the distribution piping. The location of the drain field is shown on the attached site plan drawings. The total depth of the field will be 4 feet below the existing ground surface. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water and 100 feet from water wells in the area. A minimum of 2 feet of earthen cover is required over the septic tank and a minimum of two feet of cover is required over the drain field. In addition to the required earthen cover, 2-inch thick, 40 psi, direct bury board foam shall be installed directly over all installed piping. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. 5. The property owner shall be responsible for final grading any depressions formed from settlement of backfill material. The property owner is also responsible for vegetation of all areas disturbed by septic system installation activities. 6. Contractors installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used in the 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net Environmental Consulting and Design i Construction of On-site Wastewater Disposal Systems", Dated December 2000, as provided by IVlOA DSD, On-site Water and Wastewater Program. Septic Tank [nstallation: 3. 4. 5. 6. 9. 10. 11. 12. 13. 14. 15. 16. A new septic tank, of the size specified in the design drawings, shall be procured from a qualified manufacture/supplier if the existing septic tank is found to be defective. The burial rating of the tank shall be adequate for the actual burial depth encountered. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank. All standpipes on the tank shall extend a minimum of 12inches above the final grade. Tanks installed with less than 4 feet of cover shall be insulated. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval is obtained from the engineer. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be sufficiently compacted to prevent future settlement of the soil. Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings. A cleanout shall be installed 1 to 4 feet from the foundation. Post tank cleanouts shall be installed per lVIOA requirements. Does not apply to pressurized lines. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. All lift stations shall be wired in compliance with all IVlOA guidelines and the Uniform Electrical Code. A municipal electrical permit and inspections must be obtained where required by the MOA. The contractor shall verify that the septictank/lift station is a minimum of 100 feet from any residential water well, 150' from any class 'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. The contractor shall remove or abandon the existing tank in compliance with the Unform Plumbing Code. Drain field Construction: 1. The drain field shall be excavated to the dimensions outlined in the design drawings. If any discrepancies are noted, contact the engineer immediately for clarification. 2. The drain field shall be installed parallel to slope contours. 3. The bottom of the drain field shall be within 2" of level. If the sidewalls or bottom of the excavation become smeared, they must be raked or scarified prior to the placement of filter sand or drain rock. 4. The drain field must be a minimum of 5 feet from the test hole excavation. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net 9. 10. Znspections: Environmental Consulting and Design [ J Distribution pipe is to be Jnstalled level with perforations facing downward, atop a level bed of drain field rock. Septic rock shall then be placed atop the distribution piping to provide a minimum of 2" of cover, level across the entire width and length of the trench, above the piping. A silt barrier must be installed at between the final drain rock and the native soil backfill. The silt barrier shall cover the entire drain rock surface. Monitor tubes must be 4" in diameter, installed in the locations depicted on the design drawings, and extend a minimum of 12" above final grade. The portion of the monitoring tube below the septic rock must be perforated and the portion above the drain rock shall be solid. Backfill over the final gravel layer must not be less than 2 feet. Tnsulation must be installed when the backfill depth is less that 3 feet. Drain field back fill shall be mounded to prevent depressions from forming due to subsequent settlement of backfill material. The contractor shall verify that the drain field is a minimum of 100 feet from any residential water well, 150' from any class 'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. A minimum of two inspections are required by the IVlunicipality of Anchorage. These inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. The first inspection must be conducted after the excavation of the drain field and before the placement of any gravel. The septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, stand pipes, cleanouts, and insulation, but before the placement of any backfill. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use in preparing the record drawings. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours notice is required prior to the start of construction. Tf necessary, a preconstruction meeting will be held on-site. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland~gci.net ' ' ' ...JNICIPALITY OF ANCHORAGE e' '~' 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 PHONE I C~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION MO, OF BE~OOMS J Well I ~ Absorption a O~lling PERMIT NO. ~Z Manufacturer ~ ~C~ E Mater~,~ ~ No. of co~artments Liq. capacity in gallons Inside length Width Liquid depth fOOO IF HOME'DE: ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material ~iquid ca~aciW in ~a~lon~ ~ ~ell ~oun~ation ~oare*t lot Iino PE~MII ~ DISTANCE TO: ~ ~ Z No. of lines Length of each line Total length of lines Trench width Distance bergen lines ~ ~~ inches ~ ~ Top of tile to finish grade Material beneath tile Total effecti~ absorption area ~ inches ~ Length ~ , ~idt~ ZO' Depth ~'~ ' PER~tXN~'~OT~ ~--Om ~ Type of~crib Crib diameter~ Crib depth~ Total ef fecti~ absorption area ~ DISTANCE TO: Well ~ ~ ~ J Building found~tion~. Nearest lot line ~ ~ ~ ~lass~0 ~ {.1~~' ~Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line ~/ Septic tan~ ~ Absorption area(s) OTHER PiPE MATERIALS SOIL TEST RATING INSTALLER ~, REMARKS APPROVED DATE LEGAL 72~13 (Rev. 3/78) MUN I C I I :IL I T~r' OF I:~NCH RAGE DEPARTMENT OF'HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE,· AK .q950~ 264-4720 ~3t~--5 ITE 5E~ER L PERrq I T PERMIT NO: DATE ISSUED: 'APPLICANT: ·ADDRESS: ' CONTACT PHONE: 05?29/84 BRUCE,VERGASON SAR BOX l~2-A ANCHORAGE, AK ~502' 248-5000 LEGAL DESCRIP: "~'~DIVIS%ON: TRAILS END .SECTION: 24 TOWNSHIP: ±2N RANGE:'3W LOT SIZE: .58 (SQ. FT. OR ACRES) MAX BEDROOMS: LISTED BELOW 8RE THE OPTIONS AVAILABLE TO VOU I~ DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS VOUR SITE.' DEPTH TO PIPE BOTTOM (FT.> 4.0 4.0 4.0 GRRVEL DEPTH (FT.) 5.0 0.5 3.5.. TOTAL DEPTH (FT.) 9.0 4.5 7.5 GRAVEL WIDTH (FT.) ' 2.5 20.0 5. 0 GRAVEL LENGTH (FT.) 52.0 ~.0.. 56.0 GRAVEL VOLUME (CU. YDS. ) 26.4' 28.8 ~ 41.4 TANK SIZE (GALS) 1,000.0 SOIL RATING (SQ. FT.?BR) TANK MUST HRVE AT LERST TWO COMPARTMENTS I CERTIF~ THAT: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SENERS AND WELLS AS SET FORTH B~ THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL NOR CODES AND REGULRT.IONS~ AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PER~IT. 3. I WILL ADHERE TO ALL MOA AND STATE OF RLRSKR REQUIREMENTS FOR THE SET BACK DISTANCES FROM RN~ EXISTING WELL, WRSTEWRTER DISPO~RL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR RN~ ADJACENT OR NEARB~ LOT. 4. I UNDERSTAND THAT THIS PERMIT. I~ VALID FOR R MAXIMUM OF ~ BEDROOMS AND RNV ENLARGEMENT WILL REQUIRE RN ADDITIONAL PERMIT. IF R LIFT.STRTION I~ INSTALLED IN RN RRER COVERED BY MOA BUILDING CODES, THEN (1) RN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTRINED~ (2) AS-BUILTS .WILL NOT BE APPROVED WITHOUT RN ELECTRICAL INSPECTION REPORT; AND (3) THE EL'ECTRICAL~WeRK--~ BE D, OCE BY A LICENSED ELECTRICIAN.. ___~_ DATE: :APPLICANT: BRUCE VERGASON ISSUED BY Ntu. Jcipality of Ancho ,. e DATE: January 9, 1984 TO: File FROM: Environmental Engineering Manager SUBJECT: LOt 10 Block 6 Trails End Subdivision Bruce Vergason Property - Permit ~ 830525 Does not wish to repay his on-site sewer pemit obtained June 14, 1983, since he has not installed the system to date. Under the old rules/policies and fees: Prior to Octgber lst~. a new permit would have to be obtained after January 1. After October lst: the permit could be renewed without additional fees after January 1. Under the new rules, effective December 13, 1983: A new permit must be re-obtained, with fees to be paid for the new year construction season permit, if the installation was not completed in the previous year. Keith Bandt Environmenmental Engineering Manager KB/ljw 91-010 (4/76) PERHIT I'dLIt~ I I---~ IP'."""~---- I TY I_-,F ANCpr'~RRGE DEPARTMENT OF HEALTH AND ENVIRONHENTAL PROTECTION 825 ~L' STREET, ANCHORAGE, AK. 99501 2G4-472~ I4ELL At-ID ~;~N--S I TE 5EldER PERI',1 I T ( 8~0525 ) APPLICANT BRUCE'VERGRSON 4511FOLKER ST LOCATION LEGAL ;LOT i0 BLK ~ TRRILSEND SUE: LOT SIZE 561-8259 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEF'TH= 8. 5 LFNGTH= 5~ GRRk-'EL DEF'TH= 4. 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOH OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE DilNIMUH DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOH OF THE EXCAVATION (IN FEET). RE _r-!u I RED SFF'T I C TR/~-'. S I ZE= ieee GRLLIDNS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY NELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE NELL WILL SERVE. TI.40 ( 2.', I [~SF'ECT I 0/~$ ARE RE~!U I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT MILL BE SUBJECT TO PROSECUTION. HINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWRGE DISPOSAL SYSTEM IS t0¢.t FEET FOR A PRIVATE HELL OR 150 TO 200 FEET FROM A PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUH DISTANCE FROM A PRIVATE NELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMHUNITY SEWER LINE IS 75 FEET. NELL LOGS ARE REQUIRED AND HUST BE RETURNED TO THE DEPARTMENT WITHIN _~0 DRYS OF THE NELL COMPLETION. OTHER REQUIREHENTS HAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PER~I I T EXF' I RES DECEr-IBEF~ I CERTIFY THAT i: I AH FAHILIRR WITH THE REQUIREHENTS FOR ON-SITE SEWER~ AND NELLS RS SET FORTH BY THE HUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT TH~ ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDE~~'IODELED ~0 INCLUDE MORE THAN 3 BEDROOMS. . z ............ ~PL,~T BRL~ VERGRSON ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION :' . 825 L. Street, Anchorage. Alaska 99501 2644720 '"SOILS LOG - PERCOLATION TEST ~'~ SOILS LOG~ _ PERC:OLATION TEST DATE PERFOR.ED: -- COMMENTS SLOPE SITE PLAN / t4 !. WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? -... L; PERFORMED BY: 72-008 (6~79) Gross Net Depth to Net Reading Date Time Time Water Drop +i~zO ~...tb id;to ~ , O, bO I 10;2.5 I.~ ~1.~ 0,~0 O, ~o +~zu tO;L~ ~ , ~, ~ a I0;~ I1~/~ O, ~' O, I~ +~o /~.'51~"', o, b~ ~ II.'oI I0 ~ o. ~ o~ I~ PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: Box 1369, ~TAR I~OUTE .d~ Ah'CHORA(~E~ .~kLASKA ~9~02 SIX INCH WATER WELL DRILLED A~ID CASED OUT TO THE DEPTH OF DO0 DRILLED AT THE RATE OF $;~.00' PER FOOT. PROPERTY OWNER LOCATION OF WELL SIT~ WELL LOG.' ce,~t o~. ~J.,t,u~: 1~oOO I~. ~ X 2o0 ~.: ~4.~oo. oo COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. " DATE BERNIE CLAUS OF RAMPART DRILLING WORKS ~ERVICE CHARGE[1½% PER MONTH WILL BE A$$F-~$ED ON-PAST ~EACCOU~B. Municipality o.f Anchorage Development Services Department Building Safely Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-7904 Parcel I,D. 1. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o15-192-`36 HAA 0 % O'S bq GENERAL INFORMATION Expiration Date:. //O --,.~ O - ~.~ Complete legal description' TRAILS END SUBDIVISION; LOT 10, BLOCK 6 Location (site address or directions) 11400 STROGANOF DRIVE * ANCHORAGE, AK 99516 current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JUDY KAHN Day phone ,346-3524 11400 STROGANOF DRIVE * ANCHORAGE, AK 99516 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2o NUMBER OF BEDROOMS: ,3 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~] Individual Holding tank r-] Community On-site [] ~ 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 title (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. INote: A/aska Water and Wastewater Consu/tants, Inc. shall be paid $ at, or pdor I to dosing for the engfneedng services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As cedified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authorfty 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 struc'fure indicated herein. I further redly that based on the informaffon 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 ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAOE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough. conscientious engineerfng analysis of the system in accordance with ADEC and MOA . DSD Guidelines & Regulations. The reported results descrfbed ~he 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 tTuctuate 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. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system wilt 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 tfght whatsoever. Date 337-6179 DSD SIGNATURE Approved for '~ Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: ~' WATER AND : m: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other ; WASTEWATER ' PROGRAM ; {Rev, 12~1) Original Certificate Date: Legal, 0escdptton: A. WELL DATA Municipality of Anchorage Development Services Department Building Safety Olvislon On-Site Water & Wastewater Program 4700 Sout~ Bragaw SL P.O. Box 196650 Anchorage, AK g9519-6650 www.ct.anchorage.ak, us (SO7) ~3.7g~ HEALTH AUTHORITY APPROVAL CHECKLIST TRNLS END,,SUBDMSIONi, LOT 10~ BLOCK 6. Parcel ID: 015-192-36 Well type PRNATE If A, B, or C provide PWSID~ N//A Date completed 8/26/1983 Sanitary seal (Y/N) YES Total depth _200. ft. ~40+, fl. Date of test Static water level Well production WATER SAMPLE RESULTS: Collf0rlll ,0 colonies/100 mi. Arsenic: N//A mg./L. SEPTIC/HOLDING TANK DATA Tank Type/Material Cased to ,, , FROM WELL LOG ... 8/28/1983 , 2,5 .... 2.5 g.p.m. Nitrate 0.74. mg./L. Oate of sample: 7//7//2003 Well Log (Y/N) Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION ,7/-//2oo3 69 fl. 1.4.+ ,g.p.m. YES 18+ .in. Other bacteria 0 colonies/100 mi. Collected by: AKWWC, INC. Date installed 8//2//84 Cleanouts (Y/N) YES High water alarm (Y/N). N//A DENAU EXCAVATION & PUMPING SERVICE System type BED Gravel below pipe .0.5 · Depression over field NO For 3 bedrooms New depth 0, in. Absorption rate >= 450+ g.p.d. TERRAUFT ,, If yes, give date 6//4/2003 Tank size ,,,1000,, gal. Number of Compartments .2, Foundation deanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping .... 7//7//2003 Pumper ABSORPTION FIELD DATA P~a.bw~ [x~'~No o~*~E I Date installed . 8/2/83 Soil rating (g.p.d./ff~or(l[~) 172 Length ,, , 39 , It. Width 20 ...... ff. ToiaJ depth .3.7 ff. Eft. absorption area 7.80 fi2 Monitoring tube YES Date of adequacy test 7/7/2003., Results (Pass/Fall) PASS Fluid depth in absorption field before test ,, O, in: Water edded 6~19 gal. Elapsed Time: 0 min. Final fluid depth ~ in. Any rojuvenatlon treatment (past 12 mo.) (Y/N & type) D. LIFT STATION Date installed Size in gallons ~'"'"-' "Pump on' level at .in. "Pump o~ . in. High water alarm level at in. ~ --~ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot. 100'+ On adjacent lots 100'+ Public sewer main N/'A Public sewer manhole/cleanout Sewer/septic service line 25'+ 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 10'+ Building foundation 10'+ . Water main N/'A Water service line 10'+ Surface water '100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Fo DITCH WAS DRY ON 7/7/03. 7/27/03. & 7/29/03. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rev/aw of Municipal records that the above systems are in conformance with MOA I tAA guidelines in effect on this date. Engineer's Printed Namp Date COMMENTS *DRAINAGE DITCH 48' FROM FIELD CONTNNED RUNNING WATER ON 5/,23/03 RNNFALL .... JEFFREY, A. GARNESS .." , Fee$ "- Oate of Payme.t Receipt Number (Rev. 17J01) WaNer Fee $ Date of Payment Receipt Number II I ! ~ III RECEIVED :..:' . - .' ' - ~ ~ ' ----- . . - ~ Dept. Health & Human ~e~es '~ .. TRAIL__ / -- STREE~ ~ / -~ ~ . . . , ~........., - , ,b '" ~..':-e.:.~.. I ~ o , ' :'.:'.:~, ~. ~~:~ %".~..:'.- ~'~' . I I ii'-": '. '~ ~'~,".",,. :~. ~ HOUS~ . .~..., .?,.., ,.: ,..~ ,: ,:... ,: ~ ~ ~ ~ N NLOT I0~'~' : 89'59'30" E ~0,00' ~ ~ ~;~.,. ts.~o~ .."~ ~=~-~,. ~ · . , '~?.,......,..~;' I q~ . ~ ~ .. j ~ .. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. " Expiration Date: GENERAL INFORMATION Complete legal desCription Location (site address) Current Property owner(s) · Mailing address. '/' ~O5¥C~A~ Day phone S(o~~ i333 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. · 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site r-~' Individual Holding Tank [] Community On-site . BI Public SeWer [] The Municipality of Anchorage Development Services Depadment (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional .civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results. (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 theprofessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER .5. 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 disposa system is (are) safe, fun~ti0oa and adequate for the number o~b. edroOms and type of structure indicated herein. I further verify that bas'bd 0nfhe information obtained from~MuniCipality of Anchorage files and from my investigation and inspection, t~"'on-site water supply and~,or~.,,.*.w.' ~S{ewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinance~r~regulations in effect at the time of instal ation. ,_ · Address 103 W, L%'ik Engineer's Printed Name DSD SIGNATURE !/' Approved for ~ Disapproved.. Conditional approval for Phone bedrooms· bedrooms, with the following stipulations: .. . .'~.,,_: ON-SITE . ¢.. WATER AND : m: V?AgTFW.'~.TFR" ~: By: Attachments: COSA Checklist Septic System Advisory Well .Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11IO5) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore ROad P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ~/'iv~3L¢, Date completed Total depth ~.00 ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform TRRti.-5 ~A/'D ~lK.(o ~,OT I0 Parcel ID: · If A, B, or C provide PWSID # ~ Sanitary seal (Y/N). '~ Cased to 'ZoO ft. FROM WELL LOG fto g.p.m. N'~G-~ colonies/100 mL Nitrate LoT mg/L 0(5- iqT.- 3(, Arsenic: A/b ug/L date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material / Tank size | Soo gal.., Number of Compartments Foundation cleanout (Y/N) Date of pumping C. ABsoRpTIoN FIELD DATA '2. .Depression over tank (Y/N) ~ Pumper '-" Date in§tailed [{1~17..0I0 ~o, lrating ~orft2/bdrm) ? Length '~ 3 5 fi; ~ .. ~ Width __~ Total depth ~ ft. Date of adequacy test 5,0 ft. Eft. absorption area .7,Z~ft2 Monitoring tube . Results (Pass/Fail) -- Fluid depth in absorption field before test '-- in. Elapsed Time: '- min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) Date installed Cleanouts (Y/N) '7' High water alarm (Y/N) & ~/ System type Sh~ I~ Gravel below pipe I ,,~ ft. ~ Depression over field For '-' bedrooms Water added "- gal. New depth -" in. in. Absorption rate >= '"'- g.p.d. '" If yes, give date in. Collected by: L4z.~ J~.o,~.~/~.,J Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION lll glZolo ft. g.p.m. LIFT STATION Date installed Ill.j zero Size in gallons ~'~O ! I "Pump on" level at ~'Z,-in. "Pump off" level at I~ in. Datum I~o~ ~)u~) ~'m4~Cycles tested E. SEPARATION DISTANCES Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100 Absorption field on lot Public sewer main /v~A. Sewer/septic service line Animal containment areas On adjacent lots [00 J- On adjacent lots |0~ ~' Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main /VIA Wells on adjacent lots Property line .~' Absorption field Water service line I O~-t' Surface water /oo'+ ('/v,o,.) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain F. COMMENTS Building foundation Surface water 100'+ Wells on adjacent lots G. ENGINEER'S CERTIFICATION Water main Driveway, parking/vehicle storage I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer'sPrintedName LAJ~ ~C~Ctr ~l c~.l~ Date I. lllOI Zot O COSA Fee $ Date of Payment Receipt Number (Rev. 4/10) Waiver Fee $ Date of Payment ! Receipt Number cO0 OC~ ~z m om ~ o zo ~ ~ ~o Z N 0°00'00''E 120,00' -oP · oo / / N 0000'00, 'E 128.88' ~/ONVgO~J$ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. if CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 10; ~.ock 6; Tra~ End Subdivision; Location (site address or directions) 11400 S;~oganoff O~J. ve Property owner Br~zc~ VeAga6ot[ Day phone ..... ..M_~i I~i .n_ g _add r e_~ s_ Lending agency Don~ NORTHLA~rP MORTGAGE CO. Day phone Agent Judy L~5 ]~V LAMB REALTY Day phone Address c/o No~ $46-74~5 ~605 De~ St. Anchorage, Ak;99505 : Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: e TYPE OF WATER SUPPLY: Individual well Community well Public water m NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TyPE OF WASTEWATER DISPOSAL: · Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 121 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ & S ENGINEERING Address Engineer's signature Eagle River, Alaska 9~)577 DHHS SIGNATURE ..~ Approved for ~ bedrooms, Disapproved. Conditional approval for Phone bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. · 72~2s(Rov. I/91) 8a~k MOA~21 Municipality of Anchorage ~1 Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST " Legal Description: t~'l~l~' "~:;z"~L'~Z- ~' ..Parcel I.D.' ' ' ' A. WELL DATA ..... :: :' ..... ' Well type~"~-~-b~;l~' If A;"~, or C, attach ADEC letter. ADEC water system number Wires properly protectecl<~) Log present~;)N) .~ Total depth Sanitary seal.N) ~ Date completed~ ~J~-'Z.~ - ~ Drill~ , Cased to ~Casing height FROM WELL LOG AT INSPECTION Pump level SEPARATION DISTANCES FROM WELL TO: ~. Septic/holding tank on lot I '~' "'~P ; On adjacent lots ~:~;::::>t Absorption field on lot I~'~,'~ ~ ; On adjacent lots Public sewer main ' ~"-~ _~;~---' P;Jblic sewer manhole/cleanout Sewer service line. ~ '¥ Petroleum tank ~ I~ WATER SAMPLE RESULTS: ' Coliform ~ Nitrate E~,~'7 ' Other bacteria Date of sample: ~ ~ '" I'~-'~ I Collected by: ~ B. SEPTIC/HOLDING TANK DATA Date installed ~:~-'~" ~ Tank size~ ~ Compartments Cleanout{,,~/N) ~f F?undation cleanout~N) ~ ~¥'. D(~pressi~n High water alarm (Y/N)" .. ~/~ .... ~ ..... 'i ' ' , Alarm tested (Y/N) ' ~'- - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: C. LIFT STATION ., ...... :Manufacturer '' Date · Size in gallons ~ Manhole/Access (Y/N) High water alarm level, ~~__ ___.~,~___ ' _. MeetsMOAelectricalcodes(Y/N)__ .. ;: :..- SEPARATJONr D,STANCE FROM L]FT STATH~N TQ: ~-'~~-, ' . Well on lot ' ' On adjacent lots' ' 'Surface water ' D, ABSORPTION FIELD DATA Date installed ~ ~ ~ Soil rating ~"7~...,j.w Sysltem type · Width.~..~~Gravelthickness I~, ~c:~.~' Totaldepth ~ Total absorption area· "7 ~)C:>~F' clean°uts pre~ent~~N) "-/ ~. Depression over field (Ydf~ ~'J Date of adequacy test ~, "Results (pass/fail) ~ for '~ bedrooms Peroxide treatment (past 12 months) (Y/N) ~5>~... If yes, give date -- 'SEPARATION DISTANCE FROM ABSORPTION FIELD TO:' Well on let' On adjacent I(~ts ~ (EE::~I~ ' ' . , : ~ Property line To building foundation '~'~' ' To existing or abandone, d sys~e.m on lot ~' on adjacent lots "'~o .,I-- Cutbank ,-.~ Water main/service line Surface water ;' Dri,veway, parking/vehiclestorage area ' ' ~Curtain drain ..... ' · E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA. and HAA guidelines in eff~ct~ _....-..- ....~,. _°n t~e~d~.~._of this inspection. Engineer's, Name. ____~;_~ __ , ~~ HAA Fee $ / 7D .... , Waiver Fee: $ .... _ .... III ~.F~-- IIII IIIIIIIII TRAIL STREE:F RECEIVED Dept. Health & Human Services l LOT 10 E 5' UTIUTY EASEMENT S 89'5@'3O" 44-.5' 190,00' 9 ~UTH Z MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRO,~.tENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include .lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name...~.~(_~ [/~6:O5c~O Telephone - Home '- Business~*~-~'c'c'G Applicants Address (c) Applicant is (check one) Lending Institution ~-~ ; Owner/build~r~-'~ ; Buyer ~--~ ; Other~--~ (explain); (d) Lending Instlt6kion Telephone Address (e) Real Estate Co. & Agent Address' Telephone (f) Hail the ~ to the following address: 2. T~pe of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well.~'~.~ 4~ Multi-Family~--~ Other (describe) Community~--~ Public~---~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage DispOsal Onsite ~ Public ~ Community ~-~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the S~ate Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] e e En~ineerin~ Firm Provtdtn~ Inspectionst Testst File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchoraze files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all M~nicipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm...~ ~--A'?~ /4Jo. Date DHEP Approval Approved for Approved ~' Telephone. ~6 · ~T.t~'%~ ..... '". ~, "~",,.,,,.,..,,,,,,A.;,, ..... . .... Disapproved ~ Condit~on~ ~ V Terms of Conditional Approval CAUTION THE MUNICIPALITY OF kNCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~D THEIR LE:~ING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQUIRE- MENTS. ~PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESFONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIO~%L ENGINEER'S WORK. (DHEP SEAL) RR~/eJ/D18 [Page 2 of 2] 7-19 -84 A. I~LLII%TA Well Classification Well esent Total Dspth Static Water Ls~l Casing Hsight Abo~ G~ound ~, ; ~ Electrical Wiring in Conduit ~N) Separation Distar~s f~cm W~ll~ To Septic/Holding Tank c~ Lot ~ ~_~; 65 To Nearest ~dge of Abso~ption Field c~ Lot To Nearest Public Se~r Line /~7//9 MUNICIPALITY OF ANCHORAGE DEPT. OF ?lEA%TH & ~ ENVJRON,"AENTAL pROTE'CTtON LoTto Ltf If A, B, (X C, D.E.C. App~oved{.Y/N) Date Ccmpleted .' '~/'~,¢,/~ Yield Z. ......... ,.,.;~00/ , _ ~ Dapth of G~cutin~ Pump Set At Sanitany Seal on Casing Da~ession A~ound Wellhead (Y~ Water Sample Collected By Water Sample Test Besults ;Cn ~djoining Lots ~ ; ~ 7 ~; On Adjoining Lots To Nearest Public Sewe~ TO Nearest Se~r Service Lir~ on Lot S. SEPTIC/HOLDING TANK ~kTA ~irg~in~n~ ~n~a~ ~ File (Y~)~/~ ; f~ ~/~ ~ Holdi~ Xa~ Hig~te~ A~ {.Y~) ~a ~~ ~ldi~ Tank ~t (Y~)~, ~ation Dist~s ~ ~ptic,~ldi~ Ta~R: To Water-Supply Wall To P~o~erty nins ~'~0 To Water Main/Service Line To Buildir~] Foundation ~; To Disposal Field ~ 7 To' Stream, Pond, ~ake, c~ Major D~aina9e [Pags 1 of 2] 2-15-84 C. ABSORPTION FIELD ~%TA Soils Rating in Absorption Strata Date ~nstalled Width of Field -~o' Square Feet of Absc~ption A~ea Ds~ession over Field I 7 £ m / Ty~e of System Design ~£~ Length of Field ~q / Depth of Field /~c. {--' Gravel Bed Thickness O. ~ ' m' ./"" Standpipes P~esent ~/N) Date of Last Adequacy Test ~/F) ' Results of Last ;~l~quacy Test D. LIfT S/~TION Date Installed ~/~ Si~s in Gallc~s /L//~ High Nater Alarm Level at Tested fo~ Electrical Codes(Y/N) C~m~ r~ts Mannole/Access fy/N) ~/n "Pump Off" Level at FL;/F~ - ~nt (Y~) A Pumping Cycles. a~ing Adequacy Test. ~//n ** Check Petn~itted ~ Rating Against HAA Bequest I certify that I have checked, verified, c~ o0nfo~,t~d tc all MOA HAA Guidslines in effect on the date of this inspection. Si d [Page 2 of 2] 2-15-84