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HomeMy WebLinkAboutTRAILS END BLK 5 LT 7T ails End Block 5 Lot 7 #015-192-34 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221299 PID Number: 015-192-33 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Van Tuyn A ORPTION FIELD EE]D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11240 Stroganof Dr, Anchorage, AK Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 DIS F Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Trails End 5 8 Fill added above original grade Gr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between t ches From Tank Field Tank Line Ftz Well 100+ TANK © Septic ❑ S.T_E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1250 Gal. Surface water 100+ I Material Steel Number of compartments 2 Lot Line 5+ I NA Foundation 12' UFTTATION Manufacturer Capacity Remarks Moved tank location to meet separation of tank Gal. and garage foundation. Alarm location Electri lied by Installer PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 JR's Drainfield CO/MT D3034 Inspector Areterra Consulting BENCH MARK (Assumed elevation) 100ft Inspection1� Location and description dates: 8/2/22 2nd 8/2/22 3rd 4'h Garage roof ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF 4r�t 49111 * �, ■ Septic S st Approved "'-J �^- (" Date -2 f �► KENNETH M. D ��:�s� c �»a • 441111iiiiiis Note: this approval does not include well permit requirements. (Rev 05/02/18) u SEPTIC VENT (typ) A -C=35,3' B -C=30.7' A -D=35,9' B -D=32,0' A -E=38,2' B -E=34.4' A -F=45.8' B -F=41.9' A -G=47.6' B -G=44.2' A -H=47,1` B -H=44.4' AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221299 TRAILS END BLOCK 5 LOT 8 PID# 015-192-33 125 TAP F C VES PAVED EXISTING\ DEW GARAGE W v� 55 COMPUTED: 5 DRAW KSD. STMNG N/A 'Eq®: KMD ASBUILT: JLS DATE ,8/15/22 WJ JJ (J.IW J JOB NO•: 22144 0 U. —IaN P125 0 GCAL l EPTI SCALES NTS {� OF•.AL Aar Y. •1 Ao 4 TH KENNETH 4 D S ' ` CE- ,. 0 FESSIC�' PREPARED FOR: VAN TUYN 11240 STR❑GAN❑F ANCHORAGE, AK RELD BOOKS COMPUTED: BOUNDARY:..N A DRAW KSD. STMNG N/A 'Eq®: KMD ASBUILT: JLS DATE ,8/15/22 DWG. Fly: GMD: SW2641 ACRD FRE'FILE JOB NO•: 22144 I SCALES 1' = SCALES NTS Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~[-~ ~OI2~O PID Number: C>I~'--/ .a~:Wastewater System: ~ New ~ Upgrade /t~ ~~ ~/~ ABSORPTION FIELD To.ship: I Range: I ~tion: Fill a~d~ a~7 Off,al grade: Fl G~.I. Z ~" ~'length' Ft WELL: ~New D Upgrade / , ~ ~ ~~ /~/ ~. SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. Suflace Water l~~ i~ LI~ STATION Remarks: BENCH MARK %:Z;.,'¢ENGINEER~ Depadment of Heal~ and ~~ces approval PERMIT NO. SV980130 ;,?ASTE;/ATER ABSI]RPTIDN SYS NEY P,I.D, ND. 015-19~4. EXIST SEPTIC SYST£M C3 ' -~ .............. NEV'"DRAINFIE~D ~ 2 TRENCHE~ ~ 42 & 43 LFxl.5 EFFCTIVE 190.00 I cd C~\;/or k\7-5 TRA IL,D;/c, c T~ 27.B 21.6 ~ 35.3 29.3 46,8 41.8 J Cl 46.4 41,6 Hi 40.6 56.0 C2 41.8 59.2 C3 63.6 60.2 ~2 59.6 70.9 C4 59.5 72.3 A-VELL - 92.7' B-VELL = 55,2° NEV 4 HDUS NEY VELL Pert R=~e, ~4"'Mln/In'e~n/ Solt Ra'tlng, 0.6 gpd/s? 4 B.R. 1000 SF Requ~ed ~eep Tpench 6' EFFective, 2-3' ~lde~ 9' Tot~[ ~ep~h, 84' Long 1008 ~F To~t PREPARED FfR' Je?? L JuUe ~pyr 11300 Strogeno?? Drive Ancghorage, AK, 99516 PANNDNE ENG. SVC P. 0. BDX 14~0~5 ANCHDRAGE, ALASKA ~72-8~1B 99514 DATE, 1e-5-98 AS-BUILT ~CALE, 1°=~0' PERMIT ND. S~98n13n AS-BUILT DETAILS ~ASTE~/ATER ABSORPTION SYSTEM LnT 7, BLOCK 5 TRAILS END S/n .P,I,D, NO, 015-192-34 6,1 Z W PANNDNE ENG, SVC. P. 0, BOX 142025 ANCHDRAGE, ALASKA /99514 E~74-O30B~ 272-B21B FAX I]ATE, 1~-5-9B I N[2T TO ~:ALE~ AS-BUILT · 12/10/1~8 10:~9 34§32B? ~ W I~ILLING, INO PAGE M.~N~ DRILUNG, Inc. P.O. Box 110378 · 10330 OkJ ~)wwd H~m~f ANCHO~a. AG£, ALASKA ~9~ 1 PERMIT# :SW980130 PARCEL ID#: 01519234 Well Ownm- HILDA PAULINE ANDF_~SON: BELL BUILDERS Hm o~ W.mDOMESTIC L_-~_'_Uc~ (n~'em o~: Tow~p. 1~ Sacral, ff known; or dl~nnce ~ ~ ~0T 7, B~OCK 5, TRAILS END : 11300 STRQGANOF DR n~ten ( ); Pex~ra~4d ( . .~ ~L. et Cased tn 95.09 land mufm. Finish of well (ehe~k m~) open end ( X ); · I~..:?t;~ '~ NOTES:l) AZR ROTARY DRXLLED. D, tao~com ' i:.J .:~, ' 2) DRYBENTONiTEGROUTEDcHIpsW/2 SACKS OF DATE OF START: 15 S~G~ 1998 3} =ELORINATED W/ 2 CUPS OF .... .wm. mo Del)thlnfeeth'om .j4, ..:: .. : ~oumi .u~.ce ~ ~, .~tion~ pene~ated. .. o up 4 TO 11 ~[~ll~ k ~IROWN, GRAVELLY 11 ~ 19 ~ ~0~, SZLTY . 19, ~ .40 ~~ , , 60 60 ~ 159 '~~:~?~' 159 ~ 169 ~.~-~ . ....--.-~- -. 169 ~~ A/A~ ~LACK WITH ~CASTONA~ OU~TZ 204 ~ 209 A/A: BLACK WITH OCCASIONAL WATER SEAPS l -- CUSTOMER PA~E MUNICIPALITY OF ANC]qORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 AI~CHORAGE, $J.~ KA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER: SW980130 DESIGN ENGINEER:STEVEN R. FANNONE OWNER NAME:A~DERSON HILDA PAULINE OWNER ADDRESS:Il300 STROGANOF DR A~CHORAGE, ~J.~KA 99516 DATE ISSUED: 5[22/98 EXPIRATION DATE: 5/22/99 PARCEL ID:01519234 LEGAL DESCRIPTION: ,,TRAILS END BLK 5 LT 7 LOT SIZE: 22800 (SQ. FT.) ~rJMBER OF BEDROOMS: 4 THIS PEP, MIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TA~K / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. T~E ATTAC$qEDAPPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE C]{APTERS 15.55 AND 15.65 AND T]qE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) ~ DRINKING WATER PO~Gu~ATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY D}{~S AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROV'/DE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ISSUED BY:~~~~/~~ Steven R. Pannone, P.E. Consulting Engineer (007~ 272-8218 P.O. Box 142025 Anchorage, Alaska, 99514 (907)272-8218 Fax April 29, 1998 Municipality of Anchorage Dept. ofHealth & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 7 Block 5 Trails End Subdivision Well and Septic System Permit Gentlemen: My firm was contacted to investigate the possibility of installing a new septic system on the referenced lot to serve a five bedroom house. A single test hole was excavated on April 20, 1998. The soil report and percolation test results are attached. Ground ~,ter was monitored for seven days. No ground water was encountered or monitored. No bedrock was encountered in the test hole. The lot is approximately 0.5 acres in size. Lot 7 slopes to the southwest at a rate of approximately 3 to 5 percent The proposed installation will be located on the western portion ofthe lot. The proposed location xvill be greater than 100 feet away from proposed well serving this property and 25 feet from the water service lines. The surrounding well are located greater than 100 feet from the proposed installation. The proposed installation shall not impact the future development ofthe surrounding or existing lots. See attached design. The new system will maintain over six feet vertical separation to the bedrock, over four feet vertically to the ground water and over I00 feet to surface water. Ifyou have any questions about the proposed installation, please contact me at 272-8218 Sincerely, ~one, P.E.- Attachments: C:IV,'ORKW.5~ai[~-'~I.O0 ! .~pd PERMIT ND. \ EXIST EXIST SYSTEH RIMARY / / txxsr :~ ,I, I I ~ C,\WorR\7-STRAIL.11VG DESIGN SXS Tr ND. ~/ASTEWATER A]~SDRPTIDN M LRT 7~ ~LOCK 5 TRAILS E~I]~ 49~ Pet'c Sole R~%lng, O.G Dpd/s~ 4 ]~.R. 1000 SF Requl?'ed Deep Trench 6' EF~eci;Ive, 2-3' Vide, 9' To~x[ Depth, B4' Long 1008 SF Tot:t Steven R. Pennone.~ Nc. CE 8149 PREPARED FOR, Mr. &Mrs, JeFF & Jutle Spyr Anchorm§e, AK 995 PANNDNE ENG. SVC P. D, BOX 142025 ANCHORAGE, ALASKA 272-8218 99514 DATE, 4-e7-98 DESIGN SCALE' 1'=60' ,PERMIT NO. 'DES'IGN DETAILS WA~TEWATFR At)SI1RPTIrlN SYSTEM LOT 7, BLrlCK 5 TRAILS ENB Z ~ '- 3ZZZZZZZZ_-~2ZZ-ZZZ ?-,\Work\7-STRAIL.I)'w/G PREPARED FDR, Mr, &Mrs, JeFF & Jutle Spyr Anchorage, AK 995 PANNDNE ENG. SVC, P. ri. BOX 142025 ANCHORAGE0 ALASKA 99514 ~74-0308~ 272-B21B FAX NOT TO SGAL~I u:~ium Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE CEGA, DESCRiPTiON= L.'~ ,'~ ~ 'T~r~,C5 ~ 1 2 3- 4- 5- 6 7 8- 9- 10- 11 13- 14- 15- 16- 19- 2O Township. Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT SITE PLAN IIIIIII1.11 I S DEPTH? E ~el~h t~ Wa~' ~tef Reading Date Gross Net Depth to Net Time Time Water Drop ,,, *~: ~- ~ ~ '/,~ PERCOLATION RATE . TEST RUN BETWEEN ~* ~*~ (mmutes~,nch) PERC HOLE DIAMETER ~ FTAND ~' FT PERFORMED BY; ~ ~'/~-)i~-/O ~-~ I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCEWITHALLSTATEANDMUNICIPALGUIDELINESINEFFECTONTHISDATE. DATE: '~'3~'~L~} 72-008 (Rev. 4/85) Certificate of On -Site Systems Approval Parcel I.O-. 015-192-33 Expiration Date: Legal description Trails End Block 5 Lot 8 Site address 11240 Stroganof Dr. Anchorage Ak Current property owner(s) Van Tuyn 12-23-22 X The On-site system(s) is/are approved fsf 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: Y' 21 _ Z. Z,.. This Certificate 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 Services 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 work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approval_June 2022 oma;: Development Services Department 4 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. 015-192-33 Complete legal description Trails End Block5 Lot 8 Location (site address) 11240 Stroganof Dr, Anchorage, AK Current property owner(s) Van Tuyn Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS ___.3.— T_Y_PE_OF WATER SUPPLY: © Private Well –O -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 16 = See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 55-b Waiver Fee $ _ Date of Payment ���%2 ri'o, 0�ft� Date of Payment COSA # ��7i2-i �S°�l Waiver # COSA Application June 2022 i Legal Description: Trails End Block 5 Lot 8 Parcel ID 015-192-33 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 5.5+** gpm Date drilled 1983 _Total depth 166* ft Water storage tank volume - gallons Cased to 49* ft Well disinfected for coliform test? ❑ Yes Q No ✓❑ Sanitary seal is functioning correctly ✓❑ Coliform bacteria is Negative Wires are properly protected Nitrate 3.58 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 12+** in. Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Date of flow test for COSA 6/1.6/22** Collected by GEG Ltd. Static water level at beginning of test 24.5** ft. Date 6/13/22 Comments *Per Alpine Drilling log in MOA records. **Information provided by GEG, Ltd B. TANK DATA Measured operating fluid -level -in septic tank rl Date of pumping 5/2/22 tenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1990 R ALL standpipes present per record drawing 'Total measured depth from grade 5.75 ft (max) Measured depth to pipe invert from grade 5.25 ft (min) ❑ N/A — pressurized field. F/_1 Per record drawings, field is insulated. © Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: *'Information provided by GEG. Ltd COSA Checklist June 2022 C. LIFT STATION 7of maintenance-completed atic yearsmaterial Adequacy test date 6/16/22 Results Q Pass Fluid depth prior to test 0** in Water added 1607**gal New fluid depth 0** in Elapsed time 0** min Final fluid depth 0** in Absorption rate 450+** gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ✓❑ Yes if No Community Sewer Manhole/Cleanout > 100' n Yes if No ft n Yes if No ft Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' ✓❑ Yes if No ft Absorption Field on Lot > 100' ✓❑ Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ✓❑ Yes if No ft Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' © Yes if No ft © 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' Yes if No ft Tank to Property Line > 5' Fv� Yes if No ft Wells on Adjacent Lots_ Field to Property Line > 10' ./❑ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' © Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS 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 Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date' Engineer's Comments: This investigation was completed in compliance with ADEC and i90A regulations. �4ylp A�,��� The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The tq �L ,t flow and absorption rates may change due to subsurface conditions that may not be observed from the.';.' «.y ♦�� 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 'l9 systems are subject to these various and dynamic characteristics and are outside the control of the evaluator or of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will 0 function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. ata KENNETHWIFtJSIi 4 G� R COSA Checklist—June 2022 ��p� n�'ati ��o I-. O 0 N N LJ o - � r'J I O O t— O Z 0 10 z i U N89'59'14"E 189.86' (N89°59'30"E 190.00' R) 5' UTILITY ESMT7.81 _ M SHED "? a - U o U 36.0' LOT 8 SEPTIC ® BLK 5 VENT (typ) 8® 0% EXISTING HOUSE 2.0' o - 12. 2.0' o20.0' r---=---- --- i I EAVES I o EXISTING o PAVED p/w N GARAGE a 1 30.0' 1 1 / N89'59'30"E 190.12' (190.00' R) BASIS OF BEARING ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: TRAILS END SUBDIVISION LOT 8 BLOCK 5 PLAT P-604 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoulK any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines, EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DKM sCAl.E E-MAIL, AUG 10, 2022 1 "=30' schuller0ek.net 22•-089 DRAM BY: CHECKED BY (MD NUMBER: —B0—% AGE: JLS SW2641 220304 O = FND 5/8" REBAR AW '...49TH........ F €. I 1, / f I-.JOHN L. SCHULLER.: 'Kn� ••.: OL - LS -10408 4r OOH °fessionot 52.3' WELL 33' w� `0 -7P 1831 RL 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Ld CY O z c� O Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street 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. 015-192-34 GENERAL INFORMATION Complete legal description Location (site address or directions) Expiration Date: Lot 7 Block 5 Trails End O 11300 Stroganof Drive, Anchora.~e, AK 99516 Current Property owner(s) Jeff & Julie Sl~¥r Day phone 522-5287 11300 Stro~anof Drive, Anchorage, AK 99516 Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Susan Peacock/Dynamic Prop. Day phone 261-7566 3111 C Street, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Well The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. 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 less than 30 days old. 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. (Rev. 11/99) 5. STATEMENT OFINSPECTION 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 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 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Pdnted Name Steven R. Pannone, P.E. Date Engineers Commen~' ~ conduc~g ~ ad~cy tes~ I a~pt to pro.de a ~orou~ con~z~bous ~oned re.ts desm~ ~e p~om~ of ~e systm ma~ ~e ~n~hons ~co~t~ at ~e me of ~c~ · e test, ~d s~fion di~s m~ to r~y id~able f~es. ~e o~mfion~ hfe of~ ~ we~s ~d ~p~c syst~s d~nd on ~e 1~ ~ con~o~ ~o~d wat~ levels ~t may fluc~m ~ ~ outside ~e ~n~ol of ~e eye,tm of ~s ~em. ~I ~st~s ev~ly f~ ~d ~fishcto, tern ream do not ~ ~e ~omce of ~e ~st~ nor do ~ey ~t~ ~t ~e ~e no ~..~.~ ~dd~ def~B or m~c~ts. PES ~ ~efore not prohde my w~ for h~ ~omm ~*~ nor ~ve ~y emte of how long ~e ~mm ~ ~n~ue to m~t ~e o~fioml r~m~ of ~e ~?~ ~EC orMOADSD ~e contmt of~sr~is for~e mle~efit of~e o~list~above ~y reU~ u~ or ~ of ~s r~ by ~y o~ ~ or ~ zs not au~o~ nor mQ zt m~ ~y 6. DSD SIGNATURE ~ Approved for ~ / bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Expiration Date: (Rev. 11/99) X · L~.'. k.~ "~[ ....... . ~ ~ WASTEWATER : ~ PROG~M .' . .... . Maintenance Agreements Supplemental Engineeffs Repo~ Other Odginal Certificate Date: Reissue Date: (907) $43-7904 Date of test Date C. ABSORPTION FIELD DATA Date installed Date of adequacy test 11114/2602 g,p.m ff g~P.m, : Isaacs tank N N/A Gravel below pipe ,6.1 ft DePression over fie d N Results(Pass/Fail) P* ~ Final fluid depth 66.5 &6i (pan 12 mo.) (YIN & type) N AbSOrption rote >= 600 g;p.d. If;yes; ,give date Size in, gall0qS "Pump on" level at in"PumRoff".tevel at Datum Cycles te~ed~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 122 Absorption field on lot t35 Public sewer main N/A?~ ':' Building foundation 20' Water main 68' Drainage 100+ Manhole/Access ,, ;',High water alarm level at Meets alarm-& circuit requirements? On adjacent lots/100~ On adjace~ lots t00+ Publicsewer manhbi~]cieanout NIA Holding tanl( SEPARATION DISTANCES FROM~SEPTIC/HOLDING TANK ONLOT TO: Property line 38' AbsorptiOn,field 10' Water service, line .68' . :::Surface water- 100+ . ~ Wells on adjacent 10ts.~'100+~ SEPARATION DISTANCE FROMABSORPTION FIELD'ON LOT TO; Property line 30' Water service line Curtain drain 100+ COMMENTS *This Deep Trench is 90% full. Building foundation 37' Surface water 100+ Weils~;6n adjacentlots ~100+ G: ENGINEER'S CERTIFICATION I certify that'[have~ determined f~rot~gh field inspections and review of M~micipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date.-~' Engineer's Pdnted Name Steven R. Pannone, P.E. Water main 80' Driveway, parking/vehicle storage :80' HA,& Fee $ ,3 Date of Payment Receipt Numbel~ ~ (Rev. 11~) Waiver Fee $ Date Of Payment ,d~k~ CT&E Environmental $ervices Inc. CT&E Ref~ Client N~me ProJeet Nan~e/~ CHen! Sample ID Matrix 1027857001 Pannone Bag, Lot 7, Bk $ Trails End Lot 7, Bk 5 Trails End Drinking Water 0 Remarks: All Dat~sffimas are .Maska Standard Tin~ ~ed Dat~ime I 1/19~002 15:03 Collected Da~l~ 1 t/14/2002 13:30 Reeei~ D~I~ 11/14/2002 14:30 Ni~rate-N P,~sul~ 1 Method Limits Dat~ Date 0.600 mg/L EPA 300.0 (<=I0) 11/15/02 irs To=! Coliform. col/lOOmL SM18 9222B ~<=I) 11/14/02 P-604 TRAILS END SUBDIVISION LOT 7, BLOCK 5 22,600 S.F. N 89'59'30"E 190.00' 1 "=30'' - LOT 7 · 5' UTIL ESldT. T,,--~NC~ (~Px) The location of the otruc~ure(s} a~ shown on ~ls record drawing (8~buflt) complies with Title 21, AMC By:'-~ .-~ c ~,,~ x~x go.o0' FINN. SIRUCTURE AS-BUILT I hereby oortlfy that I hove lUrVOyod the proport/ depleted above and that ~o ANCHORAGE R£CORDINO DIS1RICT, ALASKA NOTE: NO CORNERS SET 'ntis DATE. MUNICIPALITY OF ANCHOR~,GE 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing address Day phone Agent Add'ress Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF. WATER SUPPLY: Individual well Community well Public water 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. 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 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."'~3 ~.,~o,,~c..~ ~_~ C, ~',4r..._ Address ~q:~-~.'~o~ /c~'~'~-q , /~/uc~/ Engineer's signatur~ Phone '~---~%'~/~ Date Se DHHS SIGNATURE Approved for z~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ./2 -/~ - 78 The Municipality of Anchorage Department of Health and Human Sen/ices (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. ·" RECEIVED, , ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES DEC 07 1998 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · ( Health Authority Approval Checklist Legal Description: C~z' ~ -'T"~,t£.S ~- ~ Parcel I.D.: Ol~'"-Iq~ --~ · A. WELL DATA Well b/pe ~ f?t U.A't'-G. Log present (Y/N) ~' Total depth '~ <:~ ~ San~ ss~ ~) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ J { ~ J 4[ ~ Cased to ~ ~.L c Casing height (above ground) "~ Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform ~ C>. - Date of sample: ///?~//~' Nitrate I./q Om,r b, ri. - / - Collected by: B. SEPTIC/HOLDING TANK DATA Dateinstallad ~[/~?-~?~ Tankeize /~',5'C> Number of Compertments ~-- Gleanouts(Y/N) Foundation cieano~ (Y/N) Depression (Y/N) "~ High water alarm (Y/N) "-'- Date of Pumping ' ./t~/.,~- C. ABSORPTION FIt~LD DATA Date Installed '~;'"~/~ / Length '~l'Z/'~, width /-,~' Effective ~mtion m;ea/ ~"3 *:7 Da~e of adequacy test/t~ Fluid depth In abeoq~flon field before test (in.); Gravel thickness below pipe Monitoring Tube pmssm (Y/N) ~ Results (Pass/Fail)--l~ ~ Soil rating ~ .p.d(g,L~r~ fPfodrm) c::,. (=, System type -T-* Tot depth Depression over field (Y/N) For ~ bedrooms Immediately after ~ gal. water added (in.): Fluid depth ~ (ins) Minutes later:.. Peroxide treatment (past 12 months) (Y/N) Absorption rate = ~ g.p.d. If yes, give date '-'---- 72-o26 (Rev. D, UFT STATION Date installed Size' in gallons Manhole/Access (Y/N) 'Pu~'l'%a~'~:~t* 'Pump off' level at' High wa~__ 'Datum C.,,.~cles'~st ed E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /?--~/ . ,On adjacent lots / ~'~'~' Absorption field on lot (' ~'-~'! On adjacent lots ,/e, Public sewer main .,,c,(' (A. Public sewer manhole/cleanout ~ Sewer/septic service line / ~ t Lift station ,/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ o & Property line "~ (~, t Abserpti6n field / C:~ Water main/sewice line ~ ~ Surface water/drainage /~°"t Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~C~ t Building foundation ~ ~ t Water main/sswice line Surface water ~' c=c'+ Driveway, parking/vehicle storage ama Curtain drain / ~ -,r- Wells on adjacent lots £ ENGINEER'S CERTIFICATION * '*' *' * ' ' ...... : I certify that I have determined thru field inspec~ons and rmSew of Municipal reco~ are in confommnce with MOA HAA guidelines in effect on this date. /2~ : Date /,~/;, / ~ ~ Waiver Fee $ Date of Payment Receipt Number