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HomeMy WebLinkAboutTHAYERMOORE HEIGHTS BLK 1 LT 3Thoyerrnoore Heights Block Lot #015-081-04 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251050 PID Number: 015-081-04 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name Joseph &Valerie Robideaux ORPTION FIELD Existing g D Trench ❑ Wide Trench ❑ Bed ❑ Mound rR Site Address 9740 Hillside Dr Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 3 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Thayermore Heights I 3 Fill added above original grade Gr I length Ft. Ft. Township Range ,i%G Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES TolSeptic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between cher From Tank Field Tank Line Ft2 Well 84'* 25+ TANK © Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface water 100+ Infultrator 500 Gal. Material Number of compartments Lot Line j 10+ NA Plastic 1 Foundation 10+ L ATION Manufacturer Capacity Remarks *Existing waiver on file. Gal. Field verified 51 separation of tank to trench Alarm location Electric aped by Installer PIPE MATERIAL House to tank Tank to D3034 drainfield Northern excavation Drainfield CO/MT D3034 Inspector Areterra Consulting BENCH MARK (Assumed elevation) 100 It Inspection dates: �3/25/25 2nd 3/26/25 Location and description 3d 4'^ Top of porch foundation post ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp � �,�,rrr►r►®atap# O h4 Conditional Approval: Date .v A * 493H * ♦* i Septic System -'? VKEN N k US 4, i CE 71 Approved -.. ,-° Date �.' -- - 411 % N e: this approval does not include well permit requiremnt . * (Rev 05/02/1 BY AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP251050 THAYERM❑❑RE HEIGHTS BLOCK 1 LOT 3 PID# 015-081-04 _p �7 W 0 \ U DECK / Q 0 \ 0 �� I c) CD \ BM 30 0 O HOUSE HOUSE O \ GF \ DRIVEWAY 0 GAL `SEPTIC TANK 0 0 \ SHED S A—C=17.7' 96.11 .- B—C=14.9' Y A—D=17.0' Eli B—D=15.2' y o = A—E=14.1' _ a m B—E=17.1' 6 A—F=14.2' &on € B—F=19.2' A—G=15.1' A B—G=19.9' y 1500 GAL STEP n 91.58 TANK I I SCALEI NTS OF.. Z4 m * 1 H yf � I �I V1 a 6 KENNETH D o CE -7118 = �� . m AIF E , sstot,AW 92.2 PREPARED FOR: JOSEPH & VALERIE R❑BIDEAUX 9740 HILLSIDE DR ANCHORAGE, AK FIELD BOOKS BOUNDARY: NIA STAIONG N A ASBUILT: ` DWG. FILE: ACAD FILE FILE DRAWM: KSD CHECKED: K M ❑ DATE: 3/27/2 GMD: NW2439 " N° ` 25108 SCALEI 1' = 30' SCALEI NTS • l�!I�1_►1 r� COMPUTED: FA MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251050 Work Type: SepticTank Upgrade Tax Code Number: 01508104000 Site Legal Address: THAYERMOORE HEIGHTS BLK 1 LT 3 G:2439 Site Mailing Address: 9740 HILLSIDE DR, Anchorage Owner: ROBIDEAUX JOSEPH A & VALERIE B Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: 3/17/2025 3/17/2026 24709 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: } ('2 C- t ` `? _° Date: Issued By: L Date: --- Lt � t 3 MUNICIPALITY OF ANCHORAGE Development Services Department �Phone: 907-343-7904 On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-081-04 Property owner(s) Joseph & Valerie Robideaux Day phone Mailing address 9740 Hillside Dr. Anchorage, AK Site address 9740 Hillside Dr. Anchorage, AK Legal description Thayermoore Heights Block 1 Lot 3 Number of Bedrooms 3 Engineering Firm Arcterra Consulting Building Permit Number Not Applicable [NO APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial ❑ Septic Tank x❑ Upgrade X❑ Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: -# �� 5 Date of Payment: ?,,///;/ZS Permit No. 0c5P2 5/05U Waiver Fees: Date of Payment: Waiver No. Distance: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251050, Curtis Townsend, 03/17/25 ` �RCTeRRq e ti y�r rC lti„+J�i� �'L,q'Sha � 111G rya. " ws/r _a March 7, 2025 r �I xc rxx.k CONSULTING, INC 20441 Ptarmigan Bld, Eagle River, AK 99577 Office (907) 696-61 1 1, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Municipality of Anchorage On -site Water and wastewater REVIEWED FOR CODE COMPLIANCE OSP259050, Cwtts TOWM d 03/174 WATER QUALITY TESTING Coliform f`` -G Co1/100mL C, Nitrates mg/L Arsenic 1AVO ug/L 7- f s z -C'.,1. - Subject: New Septic Tank Permit — Thayermoore Block 1 Lot 3 On February 18, 2025 we have inspected the on -site well and wastewater system of the above referenced 3-bedroom property in preparations for a COSA. The system inspected consisted of 3 parts, a concrete septic tank, a 24" CMP culvert with a Zabel filter, and a ]each field. The existing tank and trench both meet MOA requirements but the Zabel filter system does not appear to be functioning properly. Subsequently the owner requests that we proceed forward to obtain a new septic tank permit for the subject lot to replace the Zabel filter system with a 500 Gal septic tank. The proposed system will serve the existing 3-bedroom residence. ° jz - 1 The existing tank was installed on November 6, 1986 with a well to tank waiver issued on November 17, 1986. This new tank will be approximately 84' from the existing well on this lot, which exceeds the minimum separation fort e current waiver on file. The septic system is down gradient from the well. While the concentration levels of nitrates have risen since 2002, the current nitrate levels are below the maximum acceptable limits. 1", 5 Fes- C�_ /q.cl�.o ('V All adjacent lots are developed and are served by private wells and septics. There are no wells within 100 feet of the proposed septic site except as shown on the system design. We do not expect there to be any adverse effect on adjacent lots by the development of this property. If you have any questions, please contact me at 696-6111 /1''AX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. /gin r f r-:- Ken_ Duffus, P.E. Attachments: On -Site Well and Sewer Application Well and Wastewater Absorption System Details/Site Plan iv,a s t "I, `) 1. 3 ` z- Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251050, Curtis Townsend, 03/17/25 FNVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RI=PORT NAME. PHONE BI NEW MAILING ADDRESS LEGAL ~SCRIPTION I LOCAT2Q~ t NO. O~8E BROOMS f ~ Abs~ptio area / Dwelling .~. / PERMIT NO. ~ ~ Manufacturer Material No. of compartments Liq. capa~it in gallons IF HOMEMADE: Inside length~ Width Liquid depth Well Dwelling PERMIT NO. ~ DISTANCE TO: Well '7 ~ / Foundation~' t Nearest lot linle~/ ~ PERMIT NO. ~ ~ Z No. of lines Length of each Ih~e 7oral I~0¢t~ )f li,~es Trenct~}~th Distance~t Nnes ~ T°P °f tile t° finish 9radeg g '~2 ~ ~t, (2~ inches Total effective absorptio[, area Total effective absorption ar ~ ~ Type of crib Crib diam ter Crib ~ Class Depth Driller .... Distance to lot line ~ERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank ~ .~ Absorption area(s} ..... OTHER PIPE MATERIALS REMARKS APPROVED f ' ~ ~ ~ &il~S~)O~¢' ¢'E LEGAL 72-013 (Rev. 3/78) AI:::'I:::'I.. I C AhH :: I'1! i;l-.El',l I=IERGUt.~S[]N · *~I.I.,II.)R-( I., AK //,.]6 f..t::.~',~.t, DI., L I, J,I ,~ll~ D I ¢ I , ~ I I)f h, '1HAYERMORIE I'IE ]:GilTS LEI]:.., BI.,,O[;K~', ]. · :~I:::I,I,t(N:, :1,4 I ]WII,:HII-. 1,,:,N LO I S I ZE: ;,.".q. 6 ')' (SL. F: '1', C}R .,,I d= ) ]: cel'L:i, fy Ll"iat: for"!'h by 'l;hc..: Hu~:i.c;i. pa]:ity c~F Al'lcl'~cH"age (MOA) ali(::l 'Lhe StaLe of' Alaska,, ]: !..!:i].l :Jn!_~;t.a]I 'Ll'it:~ systl..;¢m :i.r"~ aEi;::c:lr'darlc!': ~:J. LIi all IvlE!('~ codl:!s and ,'.¢.1i!::I :irl c:l)ml:)].:L;:'~.l"m:l~.! ~,~:J't'.l'i ti'i,'.? d~;.,s:i, gn cr,:iLer,:i_,a c:!f' th:J.!!; ]: [,:3:L].] adl'm!r'e Lc) ail t't(::JA and S(:a't,.(.:~ (::tf AJ.a~zH.::a i'eql.CLl'(::!menL':~ Fc:)p I:.lm! !ii(:~)t-. b~;.u::l.:: ;:~t(~1 ~t1,I IN~:., A!.I,I:::I I1",1 AI',I AI::;:IF:A CEIVIEF,'.IED !3Y I"IC]A BIJ:U ):)]]',IG II'lIEN (].) AN IEL,I~:CFI::;:ICAL I:::'E]$;H:I: I AND "(:': ' ' W:I:I.I, t"IEYI BE AF'I='FR[]',]I[D I/,I]:TI"II~"¢iN*,EI.~C]'RI(;)Af. ]:NSF'ECYI']:ON RIEI:::'ORI': AND E:t. lEE; [R ICAI. I!](]l::(K I*lt,J~l BE: L)t~NIE BY A' I]%:I:CEI',ISI:~ED !EI..I]:C I]:;'.Ii;; r AN,, ' . ..... / .......... ......... I ql I t I.L,¢.tlI. 11:,1.,t:::1,t Steve Morris Dept. of Health & Human Svcs. Municipality of Anchorage Anchorage, AK. 10/23/1986 Dear Mr. Morris: The following is our proposed septic design for Lot 3 Block 1Thayermore Heights Subd. 11600 CANGE ROAD ' ANCHORAGE, ALASKA ' 99516 ' PH. 345-7008 WHITEWATER ENGINEERING CONSTRUCTOR iZ - ~ ' r' -, ',~ Should there be any questions please contact me at RA~-TnnR / ,Y /'~ / ~ Thom A. Fischer P.E. P.O. B~.)X-196650 ANCt-IORAGE, ALASKA 99519-6650 (907) 264-41 '11 DEPARTMENT OF HEALTH & HUMAN SERVICES Noven~er 17, 1986 Thom Fischer, P.E. Whitewater Engineering Constructor 11600 Cange Road Anchorage, Alaska 99516 Sub)ect. Lot 3 Block 1 Thayermore Heights Subdivision Waiver Request WR86-158 Dear Mr. Fischer: Your request for a waiver of the 100 foot separation required between the septic system and well on the subject property has been granted. This waiver is based on your assessment that soils and hydrogeolegical conditions in the area make contamination of the well very unlikely in this ease. This waiver is valid for the existing three bedroom single family dwelling only. Sincerely, Stephen So Morris civil Engineer On-Site Services Steve Morris 11/6/1986 Dept. of Health & Human Svcs. Municipality of Anchorage Anchorage, AK. SUBJECT: Lot 3 Block i ThC~y~rmore Heights S/D. NOV & 986 Dear Mr. Morris, We are requesting a waiver from the minimum 100' requirement between a single family well and septic system. The distance between the well and leach field would be 78~ and the distance between the well and septic tank would be 82'. The well is existing, drilled in approximately 1965. Two previousely installed leach fields have failed on this lot, both installed downhill from this latest (the .third) leach field. The lot slopes from East to West at approximately 20%. Underneath the top organic layer, the soils are a gravelly silt (GP) overlaying .silt (ML). As you move West downhill the soils get worse; the GP layer gets thinner and the ML layer gets denser to a point at the extreme West lotline where the ML layer will not perk (perk rate in excess of 60 min/in). Clearly the higher uphill on the lot the better the chances of the septic system lasting. Drawn below is a profile of the different soil types based upon four different soils tests. Also the well is on the East property line uphill from the septic system, with a static water level of 140'. On a four hour test the well produced a minimum of 5.6 gpm with a drawdown oI two feet. ,,/ L_J I ; t Thom A. Fischer P WHITEWATER ENGINEERING CONSTRUCTOR 11600 CANGE ROAD · ANCHORAGE, ALASKA · 99516 ' PH. 345-7008 4- Z, L -1 ­-�, ems� VA Pt I mSTAuA----Q Ir OF Af ro Co 49TH L Pao THOM Ar.r;,SC-s E - C 6793 �A "ZIE 7¢ REMOVES SOLIDS utilizing over 198 feet of filtering capacity INCREASES EFFICIENCY over 198 feet of settling capacity in a 1 foot wide space PROTECT DRAINAGE FIELDS solid-reduced effluents drain away faster UTILIZES FLOW the Zabel disc dam concept slows internal velocity but increases effectiveness. INCREASES EFFLUENT QUALITY reducing suspended solids in the effluent discharge. EASY INSTALLATION just slides in any 41/2 inch outlet opening the unique, patented, ZABEL DISC DAM FILTER PLATE almost unbreakable (see spec's.) the series of Zabel disc dams am normally set with 1/16" spac- ing to filter out any biological sludges, water works sludges and light flocculent sludges. the Zabel disc dam assembly easily slides in the sturdy case. You can readily see how influent enters thru the open bottom of the case; is filtered as the liquid passes thru the Zabel disc dams; and suspended solids then fall back to the bottom of the septic or collection tank thru the return holes. The clarified liquid flows on to the next stage (or the drainage field) thru the side-wall effluent opening. For Local Distribution Contact: Easy HAND cleaning-simply pull the Zabel disc dam filter out of the case and flush with water. 1-3/16" .~ 4.762cm T 4-1/2" 5" Q.D. 11.43cm 12.700cm Distance between Zabel Disc Dams (Aperture) 1/16" (.1588cm) Shipping Wt. ea: 17V2 lbs. (6.Skg) 30.004cm ~ 1/4 Specifications - Case-Sewage-Acid Resistant Ethyl 7042 like PVC Disc Dam Plates- 16" High Impact White 40.64cm Styrene Bolts- White H.D. Polyethylene  '~ 28,893cm ' Zab¢l Ilncluslll'ics Inc. Box 1484 · New Albany, IN 47150 · (812) 738-1197 I !,500 ¢;AN~;E' RD, ANCHOI?AGE ~ AK, (907) Edg-'TO0~ PERCOLATION 'FEST P~RFORMEO FOR: !~.~,~i.;,.~ -"~ ......... SLOPE SITE PLAN 2 7 10 11 THOM A. FISCHER CE-6793 13 14 15 16 17 18 19 20 COMMENTS PERFORMEO B Y: .~_. ~ .... ~ ,-..;_~r.~ -- WAS GROJND WATER ENCOUNTERED? IF YES, AT WH/~,T Gross Net Readin!; Date Time Time PERCOLATION RATE TEST RUN BE'FWEEN FT AND ~ SOH_S LOG 6 7 8 9- 10- 11 13 14 15 16 17 18 19 20- SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Date SITE PLAN Reading Time Net ! Depth to Time ! Water , ~,,' ~9TH~-~ --"~,,?," '.'. ~'M.....--:~:..:..,,. ~...~ ~~ PERCOLATION RATE ~ ~__ ~lminuto~/inch) TEST RUN BE'~EEN ...... FT AND ~ FT PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 / I~00 ¢,a.A/EE (~07) SOILS LOG PEIc.'CO LATION __DATEPERFORMED: SI.OPE , ¢SITE PLAN I0 11 13- 14- 15~ 10- 17- 19 20 THOM ^. FISCHER CE - 6793 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Time Net Time PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ........ FT AND FT COMMEN'rS. ')~ t~.'(f~_LL._~_~J~j~;.~[, ?~'~_~ ~['"~'~' ~_~._~_~_____~' _ 'T'O GREt:, R ANCHORAGE AREA BOR GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INS~.PECTION REPC~R,~T/gN-SITE SEWAGE DISPOSAL SYSTEM, -. J,") -_ ./~ SEPTIC TANK: ~/~r'l)~ / ~ ~ INSIDE LENGTH INSIDE WIDTH_ LIQUID DEPTH LIQUID CAPACITY_/,/='~>GALLONS. / / / TOTAL LENGTH __FOUNDATION //C7 4 ._NEAREST LOT LINE /~. OF LINES / DISTANCE BETWEEN LINES _ TRENCH WlDTII~ TOTAL EFFECTIVE ~/ DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE IN. TILE DRAIN FIELD: DISTANCE FROM WELt_ _/~) / NUMBER OF LINES ABSORPTION AREA DEPTI4: TOP OF 'rILE TO FINISH GRADE TWyEpLEL: _ ~-'~.-~ ) ,,~¢ ~' '~_----~ CONSTRUCTION BUILDING / FOUN BATiON/~ "~_, CESSPOOL _ APPROVED --- NEAREST'~ /, /./ NEAREST LOT LINE_~;/--w ,, SEWER LINE OTHER SOURCES DISAPPROVED ______REMARKS SEPTIC TANK <~'{, SEEPAGE SYSTEM FROM: DISTANCES: SEWER LINE DEPTH: PIPE MATERIAL: Form ED-032 DIAGRAM OF SYSTEM /¢1'd GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY  PERMIT NO. SI;WAGE DISPOSAL SYS'I"EM~-- APPp/CAT~ION AND PERMIT / ~ ~SEEPAGE PIT ~ / . DR~ P~ ,] OTHER COMPI.[TION DATE ANTICIPATED FOUNDATION TO SEEPAGE P]T SEPTIC TANK TO S~E.~..AC~P]T WALL f SEPTIC TANK '~-- ' --, SEEPAGE PIT TO NEAREST LOT LINE, DRAIN FIELD WELL TO SEPTIC TANK. /'/~-~"~ DRAIN FIELD_ /,~ '~'~_ / SeEPAge PIT / .~¢~ ~.,//2 · Al. SO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD- SEPTIC TANK, --. SEEPAGE Pit TO RIVER. LAKE, STREAM· -, SEEPAGE PIT · ., DRAIN 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAge PIT FITTED With AIRTIGHT REMOVABLE CAPS, CONFORM TO BOROUGH REG LATIONS REGARDING INSTALLATION. I CERTIFY THAT ( AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH C~iBDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS ]N ACCORDANCE WITH SAID CODE, ~,"~¢,~,, '~ ~ z-~ ' / ........... ',. fill The sediments were loose with a high water I content. ~here was .54s~_oi1 high cobble and boulder ~ 10 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 OSC251106 Parcel ID 015 -081-04 Expiration Date: Legal description THAYERMOORE HEIGHTS BLK 1 LT 3 Site address 9740 HILLSIDE DR 2/3/2026 Current property owner(s) ROBIDEAUX JOSEPH A& VALERIE B X The On-site system(s) is/are approved for 3 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 4/4/2025 Thts Cert ficate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, development 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 X Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE ..A" 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. 015-081-04 Complete legal description Thayermoore Heights Block Lot 3 Location (site address) 9740 Hillside Dr. Anchorage, AK Current property owner(s) Joseph & Valerie Robideaux 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 0/39* - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ *New plastic tank installed 3/25/25 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 $ Waiver Fee $ Date of Payment 3/7-gA-, Date of Payment COSA # 06C? -6006 Waiver # COSA Application—June 2022 COSA Checklist Legal Description: hayyrrnoore Heights Block I Lot 3 , Parcel ID: 015-081-04 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled Unk —Total depth �185***ft Cased to 40+ ft W Sanitary seal is functioning correctly n-/ Wires are properly protected Casing height (above ground) 3o in. Date of flow test for COSA - 2/18/25 Static water level at beginning of test 134 ft. Comments ***Per 1975 Fischer report. B. TANK DATA Measured operating fluid level in septic tank 37"*/New Date of pumping 3/3/25 ❑ Required maintenance completed, if AWWTS Comments: *1000 Gal concrete tank + New 500 Gal . plastic tank D. ABSORPTION FIELD DATA Which system tested (date installed) 11/6/86 W ALL standpipes present per record drawing Total measured depth from grade 9.3 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) F-1 N/A - pressurized field. F-1 Per record drawings, field is insulated. F/-1 Monitor tubes go to bottom of effective. If not, state depth into effective F 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) If yes, enter date Well production at time of test 3.9 _gpm Water storage tank volume, None gallons Well disinfected for coliform test? F] Yes 91 No [21 Coliform bacteria is Negative Nitrate 6.89 mg/L ❑ Nitrate less than MRL (ND) Arsenic_ug/L Arsenic less than MRL (ND) Collected by Garness Engineering Group Ltst Date 2/3/25 STATION E) Require-alrainteriance completed Age of lift station Lift station material Comments: Adequacy test date 2/18/25 Results Fv-1 Pass Fluid depth prior to test 50 in Water added 450 gal New fluid depth 56 in Elapsed time 1200 min Final fluid depth 50 - it Absorption rate 450+ gpd FIELD STATUS - POST RECOVERY Effective depth (per record drawings) 66 in Effective depth used 50 in Effective depth remaining 16 in Comments/Deficiencies, Absorption field is operating in the top 25% of effective. COSA ChecklisL.June 2022 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' Community Sewer Manhole/Cleanout > 100' Yes if No 82** ft n Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' JZ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 77** ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft Q 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 Surface Water> 100' ❑J Yes if No ft Tank to Property Line > 5' ✓Q Yes if No ft Field to Property Line > 10' ❑✓ Yes if No ft Water Main > 10' © Yes if No ft Water Service Line > 10' W Yes if No ft F. ENGINEER'S COMMENTS **Waiver issed 11/17/86 Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' © Yes if No ft Yes if No ft If tank or field is under driveway comment below 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 Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist COSA Checklist June 2022 DEVELOPMENT SERVICES DEPARTMENT-� ��'� 907-343-7904 On -Site water and wastewater Section ° ,. Fax: 343-7997 www.muni.org/onsite --� Nitrate Advisory Certificate of On -Site Systems Approval # OSC251106 Subdivision: Thayermoore Heights, Block: 1, Lot: 3 A water sample revealed a nitrate concentration of 6.89 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. NOTE: GROUND LEVEL IMPROVEMENT LOCATIONS ARE APPROXIMATE DUE TO SNOW COVER. J I Lot 4 I I Lot 2I ] PLOT PLAN --- AS BUILT X SCALE —1" = 40' GRID SW 2439 Project No J25 -022/A2 Lang &Associates, incP.O. Box 210005 tot' ' Anchorage, Alaska 99521-0005 0 000 (907) 522-6476 v� 0 A / �44 Professional Land Surveyors survey@langsurvey.com v�,C ,. • ,qsp� I hereby certify that I have surveyed the following described property: LOT 3, BLOCK 1, THAYERMOORE HEIGHTS (Plat No. P-674) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the -- —416: Day of L � � at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 0 AN C. LANG o �.LS-9944.• ' gJv� o AR ... Npo '�" Frsslow& �a State of Alaska AECC963 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak,us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-0814)4 1. GENERAL INFORMATION Complete legal descdptic~n Location (site address Or directions) Expiration Date: THAYERMOORE HEIGHTS, LOT 3. BLOCK 9740 Hillside Drive. An~hora(~e, AK 99507 Current Property ~wn~r(s) Toni Sparrows Day phone 346-3236 Mailing address same as above Lending agency Dayphone Mailing address Real Es~te Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3, 3. TYPE OF WATER SUPPLY: IndMdual Well Individual Water Storage Community Class Public Water System Well TYPE OF WAS I EWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] 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 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 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 vedfy that based on the information obtained from the Munidpality 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, ordi.nances, and regulations in effect at the time of installation. Name of Firm KND ENGINEERING, INC Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineer s Pdnted Name Kenneth M. Duffus Phone (907) 696-6111 Date 08/29/02 DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with Additional Comments By: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer s Report Other Odginal Certificate Date: ¢/~'/'; ~ 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.ak.ua (907) 343-79O4 HEALTH .AUTHORITY APPROVAL CHECKLIST Legal Description: Thavemoore Hts.. 1.3. BI A. WELL DATA Parcel ID: 015-081.04 Well type I~vate If A, B, or C provide PWSID # Date completed 1965 AnBrox. Sanitary seal (Y/N)_y_ Well Log (Y/N) H Total depth I+T+ ft. Wires pmpady protected (Y/N) y Cased to 4<P ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test Unavailable 08t23R2 Static water level ft. t41 ft. Well production " g.p.m 4.53 g.p.m. WATER SAMPLE RESULTS: Coliform Q coloniss/lO0 mi. Arsenic: gA mgJl. B. SEPTIC/HOLDING TANK DATA Nitrate 3.71 mgJI. Other bacteria _IL colonies/lO0 mi. Date of sample: 8/23/02 Collected by: KND Engineering. Inc. Tank Typa/Matarial seoflc I concrete Date installed tl/06/86 Tank size 1250 gal. Number of Compartments L Clesnouts (Y/N) ~ Foundation cteanout (Y/N) y._Depression over tank (Y/N) gHigh water alarm (Y/N)B Date of pumping 68/23/02 Pumper McDonald's C. ABSORPTION FIELD DATA ' Date installed 1t/06/06 ' "Soil' rating (g.p.d./f~ or ft2/bdrm) :~1!1 System type Trench Length [~ ft, Width ~ fl. Gravel below pipe 5.5 fl. Total depth ~ ft, Eft. absorption area 979 ft2 Monitoring tube Y Depression over field N Date of adequacy test 0~23/02 Results (Pass/Fail) Pass For :} bedrooms Fluid depth in absorption field before test 39in. Water added 453 gal. New depth 44 in. Elapsed Time: 1435 min. Final fluid depth ~1~1 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed HA Pump on level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 82' * Absorption field on lot 77' * Public sewer main ?5'+ Properly line 10.+ Water Service line Curtain drain §0.+ COMMENTS Size in gallons Manhole/Access (Y/N) Pump off level at __ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? Go On adjacent lets t00'* On adjacent lets t00'* Public sewer manhole/cleanout t00.* Sewer/septic service line 25* Holding tank t00'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5,~ Property line ~'+ Absorption field 5' Water main t0'+ Water sewice line t0'e Sudace water t00'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation lQ'* Water main t0",' 10'~' Surface water t00'~ Walls on adjacent lets t00.+ Driveway, paddngNehicie storage 25'+ * MOA separation wai~er for septic I~eld &weti issued 11/17/86. Al~*~on field is operating in the too 40% of elfective. ENGINEER $ CERTIFICATION I certify that I heve determined through field inspections end review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effect on this date. Engineer s Printed Name Kenneth M. Duffu$ Date 08/2912002 HAA Fee $375.00 Date of Payment 8/~;V02 (Rev.Receipt 12/O1) Number Waiver Fee $ Date of Payment Receipt Number in. \ — as� 10IF,VE ~ ~ MUNICIPALITY OF ANCHORAGE . ~ ;, ', *,',...I '~l~t~ I.." DEF ARTMENT OF HEAl.TH & HUMAN SERV CES ,: ..... ~ ~.'~/J _' ' DIv sion of Environmental Services ; "" P.O. Box 196650 Anchorage, Alaska 99519-6650 . , ~..:. · '-,~: · '. -':.~ ,:; :' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMII2Y DWELLING Parcel I.D.'# '~ O 1~--O81-O~ HAA# 1. ".! GENERA[:'IN FORMATION . '.Complete legal,description _ ~3 nl ~'ha'fermore Heiqht~ S/D 9740 'Hillside Drive'- ; ,,~,gocatlon'(slte address or directions) '- "" '- -, ' · ' ' Helen Property owner '- '<'Ma. ng address 9740 Hillside Drive "~,.v. Lending agency ,,. ~,.?. ~. ,, ?,,:;,~/.. . ';:, ';'.Mailin 'address' ': "1' Da h ne 34622]9 ypo ~ ' Anchorage, AK 99516 Day phone _ Da3 3. :.!*TYPE OF WATER StJPPt[~(: '~ ........... STATEMENT OF INSPECTION BY ENGINEER As certifled'.'b~, my se~,l a~i'xe'd h~ret0*~nd as~0f thevalldation date sh0wn.below, I .verify, tha. t my investigatloh"'of' this Health~'~uth0ri'~ A~3P~'&{'ai 'aPPJ¥Cati0n 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 inves.ti, gation 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, ~/ S&S Engineering Phone - 694-2979 Name of Addres~ 17034 North Ea~lg J~ver ~oop Suite 204 Eag].e RivervAK 99577 Engineer's signature Date ~'///'3-~'/,~ 7' .... Approved for *'""~=>'~* .... *-*~.bedrooms~ .......... . ~ ............. ,.. ~nndt~na aoDrova 'for '?'.'~ "~ ~ "~. '~ b~rooms ~wth the.fl o' The Munlclpa ty of Anchorage Department of Health a6d H[iman',$~,,i~e~iD'~) Approval 'ce~i~icates based only upo6 '{he [epresentations given in raph5 abo{;e ~by an Independent istered In the stat~ bf Alaska, The DHHS do6S ~ ,rnes is not Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal DescrJptJon:~.~T "~r' I'~L~ I/ '~¢Pl!/Z~,C~'arcC~e/~ll.l::). A. Well Data Well type ~U~T~__ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y,~ d~rqU,,~l L Date completed ~--=:F'o~,~- ~/':~ Driller Total depth / ~(~ ~ '~ Cased to Z'/'O ' '/- Casing height Sanitary seal ~/N) Wires properly proteoted (~N) /~'"~¢' FROM WELL LOG Date of test C.,¢l~J~f/,,~! C Static water level ~, Well flow Pump level1 AT INSPECTION g.p.m. ~,~ ' On adjacent lots ; On adjacent lots Public sewer manhole/cleanout t .k SEPARATION DISTANCES FROM WFLL 'f'O: ?~Septic/ll~tank on lot ~ ~' ~ct ~'~bsorption field on lot ,~'~¢' -~-o Public sewer main ~J//~ Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~, ~t ). -,~,,~. ~d Other bacteria Collected by: ~% '~ B. SEPTIC/H~[c~IG TANK DATA Date installed ~!/4;/~f~ Tanksize /~X~)~¢/_ C¢r~,~Compartments Cleanouts ~) ~5 ~O~)Foundation cleanout (Y/N) _ /~ Depression (Y~ High water alarm (Y~ ~)/~ Alarm tested (Y/~ ¢/~ Date of pumping SEPARATION DIoTANCES FROM SEPTIC/~ TANK TO: Well(s) onlot ~¢%:O~'{-° .~.f., Onadjacentlots To property line ¢-/~-~/"P Absorption field Surface water/drainage Foundation c~0 Water main/service line 72-026 {3/93)* Front CONTINUED ON BACK PAGE Manufacturer Size in gallons ~ Manhole/A~ Vent (Y/N)_ __"Pum~~ ~ "PL/mp Off" Level at High water alarm level ~ % Cycles tested __ Meets MOA electrical c~ ~ SEP~CE FROM LIFT STATION TO: ~ ~li~n lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length '~' Total absorption area Date of adequacy test Width Water level in absorption field before test Peroxide treatment (past 12 months) fY/l~ Soil rating (GPD/FF) .~ ~ Gravel thickness Cleanout present cN) Results (pass/fail) System type Total depth .Y Depression over field (Y/(~) P/::F~ ~ for After test ~, ~ ~4~r.~-~ ~ If yes, give date /o/~ Jh'f Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ¢/6 '-~ ~ To building foundation On adjacent lots Surface water ~/0~) ~ Curtain drain /"~0,~ ~- E. ENGINEER'S CERTIFICATION ¢ On adjacent lots / 0-~ L~ Property line ?-~(~ ~ To existing or abandoned system on lot ¢:~© '-~ Cutbank /'-///¢~ Water main/service line Driveway, parking/vehicle storage area ~0~ lO 'e I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date // HAA Fee $ Date of Payment Receipt Number 72~026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number CF_ - 880,}, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAl.. HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL"~ (~'?~D- OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~'~ ~~elephone: Home t tG- I '1 Business Applicant Address ~-l~Z~~l I~ ~l~' / ~"~-~ ¢ ~ (c) Applicant is (ch¢:k one): Lending Institution ~; Owner/builde~; Buyer ~; Other ~ (explain); (d) Lending Institution Address 1-elephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: . TYPE OF RESIDENCE ,, Single-Family.,~ Multi-Family [] Number of Bedrooms ~'~ Other WATER SUPPLY, '~ rndividual Well,~ Community [] Public [] Note: If corn munity well system, musl 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 State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11~84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AN[) 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 of this inspection. Name of Firm ('~:~ ¥~' ~TL'~"~ ,Pf~'~'~.~-,- (--'--~'f~-- ~--~O~"~_~1 i:~eere p h o n e _ ~ ~-- '--7 Engineer's Seal DHEP APPROVAL Approved for -/~-'C¢ bedrooms by Approved Disappreved '~¢-~'~'~"~ Date //~/¢- 2 ~ 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 DHEiP 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 DEPT. OF HEALTH & ~NVIRONMENTAL PROTECTION 6 1988 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 28...72o RECEIVED Legal Description: (~ ~- ~ ~-,..~k.¢ WELL DATA Well Classification '~-~ ¢5¢~----_- If A. B, C, D.E,C. Approved (Y/N) . We Log Present fY/N). ~'~%;~ _ Date Completed ~u~_~_ i/'lrP~°,~ Yield Total DeDtr J 7 ~)' ~¢' [b4Cased to ~1;~' ~-J- Static Water Level ~ '1~/ Casing rie~ght Above Ground '~4 Electrical Wiring n Conduit (Y/N) _ Separauon Distances from Well: To Septic/Fielding Tank on Lo~ To Nearest Edge of AbsorDuon Field on Lot _ TO Nearest Public Sewer Line Cleanout/Manhole _.~ Water Sample Collected by Water Sample Test Results Depth of Grouting Pume Set At Sanitary Seal on Casing (Y/N) _~' -'~"~"~ Depression Around Wellhead (Y/N) ~E2) £ : OI1 Ad,olnlng LOtS / : On Adjoining Lots To Nearest Public Sewer I o o (4--- To Nearest Sewer Service Line on~ot . ~'~/¢'~f Oommems 3 SEPTIC~HOLDING TANK DATA Date Installed ~ ~ ~-'~("~" Size I'~''(~ No. of Comoartmems _ J_ Standp. Pes (Y/N) __t~,~-.;L¢, Air-tig ~t CaDs (Y/N) _~ Foundation Cleanout (Y/N) Depress,on over Tank fY/N) ~ Date Last Pumped Pure.lng/Maintenance Contract on File (Y/N) ~ -k~- for Holding Tank Hign.-Wate, Alarm (Y/N) ~_ Temporary Holding Tank Permit (Y/N) . [%l R . Separabon Distances from Septic/Holding Tank To Water-Supply We ~-/ TO Building Foundation 'Z. J To Property Line . /J-~ ~ "J'' To Disposa Field _ '~ To Water Main 'Service une _ ~J /~' To Stream, Pond. LaKe. or Malor Drainage Course ~ ~ Comments Page 1 of 2 72-026 11/841 C. ABSORPTION FIELD DATA Soils Rating in Absorptior) Strat~ ~.~ Date Installed I I /~'~"'/~-% ~-~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well _ "7 ~ · To Building Foundation Lot To Water Main/Service Line Type of System Design ~T""~ Length of Field ~% i .~ ~r-.)--*.~,-~ _: ~ ~'/ · Depth of Field c~ ! Gravel Bed Thickness ,~' i"-- ~ tt Standpipes Present (Y/N) Date of Last Adequacy Test N / To Stream/Pond/Lake/or Major Drainage Course To Driveway; Parking Acea, or Vehicle Storage Area Comments To Property Line r To Existing or Abandoned System on , On Adjoining Eots -:~(- ~ ~ '~ To Cutbank (if present) D. LIFT STATION Date Installed Dimensions ~ ~-~ Size in Gallons ./-~ Manhole/Ac sc~(Y/N) / J "Pump On" Level at/'/~ / ~f" Le;el ~, / ~ High Water ~,~ff Level at / / Vent(Y/N)/ ~ Tested f~ / ~ P~pi~ Cy~ d~ng Adeq~e~. M~t~ MOA Electr~l Codes (Y/N) / / / / ' ** Check Permitted Bedr~.~t_ing Against HAA Request ** Icertifythatlh' vecheck ,verif ,' rconformedtoa OAa dHAAguidelinesineffectonthedateofthisinspection ........ ~ d ~~~A g~d~i~si . Company ~MOA No. ~ _ ~;~ Amount' $ ~ ~) ~ ~"""~.~.. ~ ~Engineer's Seal WHITEYVATER ENGINEERING CONSTRUCTOR HOME SERVICES 15[)OO Francesca l)rivc Anchorage, Alaska 99516 907-345 18.90 NoYember 7, 1986 I, Helen Ferguson, agree to have A+ Home Services pump my septic system on an annual basis. I understand that at that time the Zabel Filter will be cleaned and the housing that it is in will also be vacuumed, The above mentioned services will be done on the anniversary of the Eilter's installation. Helen Ferguson J ing~rd A+ HOME SERVICES Your .'-4c1)I1(, Ces.%)oo[ and I)rOilqfiekl Profcssiolqal '~ v'" . Date [;)ate Date Inspector Inspector Inspector Comrnents Conditional Approval I /7 Date Sewer Installed Permit No, Septic TankSIze / - ,~ (.~_ ~j ~ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~ ~ ~O ~ ~ Phone Buyer Addres~ Address ~ o I~ ~, ~' ( ~x ~-S Realty Co, & Agent Phone Address Street Location (~ ~-~.O U C ~ ~ f~ ~ ~ 2 ~ ~ 4~ Type~Residenoe ~3 Single Family I~ Multiple PamIly No. of Bedrooms. Q Other Watff~pply M Individual L~C.;(~ ~ ~c: r~E~x ~,, ~¢ A~AOH WELL LOG, A well Icg Is required for all wells drilled since June [~ Community%~ _~ "- ' 1975. For wells drilled prior to Ihst date, give well depth (attach Icg If lO Public Utlllty available.} Sewa¢ D posa ~O Individual Year Individual Installed: ~ t ~ Public Utility When Connected to Public Utility; ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Alaska SUBJECT: Lut 3, tl',loot~ l, Thayormoove Subdivtat,~n An in,npceli(m of the ~ul~Ieet lot wa~ made Marel~ 3, 19~5. Tb;~ on,-~ito so;you ~ys'~oro la ton (10) yaa~s old and t~ l~to~nning to Fall. Tim top of tho well oa~in~ will, nell to bo {nsk~llod, A aoil~ tos;t will elao he r~lulred bnfora a p~rmlt te do I:tm repaI,v work (:an be isaued. app~ov<;d. be completed boa)re dun~) 15, 1975. you.have any questlo{ta ~egarding thte, mailer, pleaae ¢.ontaet' ' "~,~' ~;~ ~t R'I4~4501, e~ctensien 133. Lynn S. Coed Sa~ltarl~:n L.qC~/lw GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection //.'m o ~/x)? Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAl. SEWER & WATER FACILITIES FOR ~ \ Mailing Address~~~--~Phone:~ 2. roper y Owner: Phone: X:-:.::/ Mailing Address: .T'. :m. ~, ~, ~: ~ '.',' - /f~c 7 5. Type of facility to be inspected No. of bedrooms Well Data: A. Type C. Construction Sewage Disposal System: A, Installed C. Septic Tank: 1. B. Depth ~_/~/~:~i-l~ D. Bacterial Analysis B. Installer Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank' _ , Absorption area ., Sewer Lines __ Nearest lot 'line B. Foundation to septic tank , Other contamination Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages GREATER ANCttORAGE AREA BOROUGH. Department of Environmental Duality 3330 "C" St., Anchorage, Alaska 99503 274-.456'1 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER I:ACILITIES Type of Inspection: CMRO ] VA FHA 3. Name Mailing Address: =_ _Da__y_ Phone Mailing ~ddress: .~.~l~.~ .~{~.~/ Phone 5. Name of Realtor or Agent: Mailing Address: Phone 7. Type 8. Water Supply Type of Supply: If Individual, Lega~ ~escri,tion: ¢/o~/'< I ,.°cation: ---F/" /-/~ "¢/ ~:-- · of Facility to be inspected: Public Utility number of dwellings If Individual, depth of well ~_~i2_F Sewage Disposal System Type of System: Public Utility If ~ndividual, date of installation Individual presently served EQ-037 (!/74) Page 2 of two pages - Re( for Approval 'of Individual c ~ Water Facilities Legal Description Comments Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in 'this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)