HomeMy WebLinkAboutT15N R1W SEC 8 LT 127T15N RlW
Section 8
Lot 127
#051-154-04
Municipality of Anchorage
On-Site Water and Wastewater Program •(907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181038 PID Number: 051 154 04
Dwelling: ❑■ Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
KIRK BYERS ABSORPTION FIELD
Address
20136 CRABTREE El Deep Trench ❑■ Shallow Trench El Bed 111 Mound
❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 1.2 GPD/SF 2 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 1.5 Ft. 0.5 Ft.
T15N R1W SEC 8 LOT 127 Fill added above original grade Gravel length
Township Range Section 1 Ft. 80 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 5 Ft. -- -- Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From
Tank Field Lift Station Tank Line 480 Ft2 -- -- Ft.
Well +100 +100 -- -- +25 TANK ❑D Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water +100 +100 -- -- ANCHORAGE 1000 Gal.
Material Number of compartments
Lot Line +5 +10 -- -- STEEL 2
41Q. NA
Foundation , +10 -- -- LIFT STATION
Manufacturer Capacity
Curtain Drain +50 +50 -- -- -- -- Gal.
Remarks
OLD TANK DEMOLISHED PER CODE Pump on level at Pump off level at High water alarm at
-- in._ -- in. -- in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034Tank to 3034
Installer drainfield
GUARANTEED SERVICES Drainfield 3034 CO/MT 3034
Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 100 ft
Inspection 15`
4/11/18 20d 4/12/18 Location and description
da
3rd 4/12/18 4th 4/13/18 BOTTOM OF SIDING AT HOUSE CORNER
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date
'. .°... �..`
e.
s
Approved \_IIIMBE Date y Zd 1
Inspection Report_9-1-12.doc
..00616.10400
•
DE CLEANOUT 50' ROW OLD DRAINFIELD REMAINS. _,..0e_,..0eCoP 9,
o `
• MONITOR TUBE DIVERTER NOT INSTALLED / *. 49 TH ��
APPROX. GAS LINE DUE TO GAS LINE AND •• y'•
MAY
® TEST HOLE LOCATION BEO INZEN STALLED IN SOILS. I THETER FUTURE r
• SO THIS SYSTEM CAN BE USED F `'"CHARLES G BALZARINI
AS A BACKUP. \ •/, �c * .CE•13 5 ••`c,
- 5x80 DRAINFIELD lI,;-"PROFESS NP\.__
0.5' EFFECTIVE 7 ~
y DOUBLE CLEANOUTS
/� _0
' NEW 1000 STEEL
SEPTIC TANK LAJ
>
FOLLOW UP `�� N CC Z
TH 1 J PERC 1AC%�1 a0
o � a
\ ------- ----,..,. B •• ♦ 4. •
D
- GARAGE • •.• : ••• • •. • '� w o
SHED / \ \ • •
* •: •• •.DRIVEWAY .•. ;• • 3 Q w
/ INSULATED W/ \ •' ' .i . _ vi
a
4" BLUE BOARD, _ z
SWI NG TIES 4' WIDE. u-i CJ
A B I NEW FCO\ > CL
C 20.99 24.77 FENCE \ I co z ce v
-a
D 50.82 38.26 BM \ p m F m
E 56.71 44.32 rn a
!r Y
/ F 67.19 46.18 3 BR0
w Y
G 116.32 119.24 HOME a
INSPECTION REPORT PLAN - SCALE: 1" = 30• U
o
+100' BOTTOM OF SIDING AT HOUSE
MONITOR TUBE 95.5 4" INSULATION N
+96.6 CLEANOUT W
4" INSULATION IL R FABRIC CJ
TH-1
ir 2' COVERWCOVER 94.5' ORIG. GRADE 94. N 00
ORIG in
GRADE Z In
1000 GAL TANK 93.0 If FE Nt
II)L Wao
92 5 4"0 DISTRIBUTION PIPE 86.5 Z I
0.5' EFFECTIVE SEWER ROCK GROUNDwA t k Z O
94.• 9.3 8 W �
8 O.H M
SCHEMATIC SECTION - NOT TO SCALE cki
C-)
Lf ,n-, g
,��,,,,pAAi,„,,� MUNICIPALITY OF ANCHORAGE ti-r,- (8 �K /rop
On-Site Water 8 Wastewater Program o, r S.
- PO Box 196650 4700 Elmore Road y 3 ..�'. r.
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
i
http://www.muni.org/onsite
),11 tmcnt
4h�NORP(.� I
On-Site Wastewater Disposal System Permit
Permit Number: OSP181038 Effective Date: 4/5/2018
Work Type: Septic Upgrade Expiration Date: 4/5/2019
Tax Code Number: 05115404000
Site Legal Address: T15N R1W SEC 8 LT 127 G:1257
Site Mailing Address: 20136 CRABTREE ST, Chugiak
Owner: BYERS KIRK Lot Size in Sq Ft: 108900
Design Engineer: C & M Engineering Total Bedrooms: 3
This permit is for the construction of:
E Disposal Field C✓( Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
Special Provisions:
The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The
Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit
stamped and signed results with the As-built Inspection Report. If the results require a design change,
construction of the system will stop pending On-Site review and approval. AMC 15.65.060.6.3
.# 4/6i./
/
/
l
C-6
Received By: - Date:
Issued By: i U� Date: 11/;40
au 5 pt.
MUNICIPALITY OF ANCHORAGE
Community Development Department ,,4 Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION I. v
4
Parcel I.D. 651- 15 i-1 -04 GG
Property owner(s) KIRK F YL►25 Day phone 054/` 1016
Mailing address
Site address ad t 3b C+2,A3 T gt & ImE. -
Legal description (Sub'd., Block & Lot)1 15N R I t,,/ it L o% Id.7
Legal description (Township, Range & Section)
Lot Size 10'3/40o Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field [ Initial ❑ Single Family (SF) X
Septic Tank ® Upgrade ® (w/wo ADU)
Holding Tank 11Renewal ❑ Duplex (D) ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
JJ0/1/4.15 Distance:atm
I certify that the above information is correct. I further certify that this is in accordance with
applic to Municipal Codes.
Vi — _._
(Sig .f re of .r..erty owner or authorized agent)
L--'
Permit/Rush Fees: tt' 4 i b Lip Waiver Fees:
Date of Payment: 1413112 Date of Payment:
Receipt Number: OC)in Co Receipt Number:
Permit No. oSPIY103$ Waiver No.
Permit App_:-: :_..:c:
C&M ENGINEERING SERVICES
Ph:907-854-5558
Municipality of Anchorage
Onsite Water&Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System modification for T15N R1W Sec 8 Lot 127
Dear Reviewer,
The above referenced property is currently served by an older, failed 3 bedroom septic system. The
owner would like to replace it with a new septic system.
We are proposing to install a 1000 gallon tank, and a new drain field. The old tank will be
decommissioned per moa requirements. A diverter valve may be used to connect the existing leach field
as an alternate to the new system.
Our review of available documentation and field investigation show that this project will not adversely
impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing
onto and off the subject property.
Included with this letter is a permit application and design package, including plans, specifications,
calculations, and soils logs.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
i
/ ��OF A�qs<<1
JAYHAWK 36,4.. .
.
.*' 1-:,,,,,
• . A • TM * /
� ./.• F i
CHARLES G BALZARIt��/
- 100' 50' ROW 0+ �'F••, •CE-13854 •. ' .
Aye
WENEIGHRADIIII NGIIc/JFq••�/./i(i+••c��C'�
WELL FOR CHESSIK il FD �OFESSI4NP\.`
OLD DRAINFIELD TO REMAIN . LOT 2 k�v.\\1�
+200' FROM
SEPTIC LOCATION
WELL FOR LOT 128 5x75 DRAINFIELD DIVERTER VALVE
+200' 0.5' EFFECTIVE DOUBLE CLEANOUTS
FROM SEPTIC AREA 2' MAX EX. DEPTH
• •
' NEW 1000 STEEL
1l -' ,,` SEPTIC TANK
DEMOLISH OLD TANK
__- - -.11F‘' * PER MOA REQUIREMENTS
1 TH-1 �i 4
FLAG •
' jA/ 100' 1 GARAGE •.': *' � �' •h
RADIUS •' '•:.'
SHED • •• •.• DRIVEW•AY... •,,••."
•
RAISE LINE TO 2'
/ BELOW GRADE/ ��' �'• .' .•
INSULATE W/
4" BLUE BOARD, I (- NEW FCO
4' WIDE. I
u,
0
73
O D
FENCE 3 BR \ * m
HOME A
m
/ \ m
( LOT 127
EXIST
WELL
1 `,700 1 . • .. . 4•, .. 4 ' :DRIVEWAY;. !
\ ,i,
\ \/
100'
NEIGHBORING \ /
WELL RADII
�' NOTES:
LEGEND
CLEANOUT LEANOUT NOTE: INSTALLER SHALL NOTE 1. THE PROPOSED SEPTIC SYSTEM IS GREATER THAN:
100' FROM ANY PRIVATE WELLS
• MONITOR TUBE NEW MOA WASTEWATER CODE 200' FROM ANY PUBLIC WELLS
REQUIREMENTS. NOTIFY ENGINEER 100' FROM ANY SURFACE WATER
X TEST HOLE T LEAST 24 HOURS PRIOR TO 50' FROM ANY STEEP SLOPES
S RTING WORK. 10' TO ANY PROPERTY LINE OR FOUNDATION
n.5%\ SLOPE INDICATOR 5 TO ANY TEST HOLES
SCALE: 1" = 40'
LEGAL DESCRIPTION: T15N R1W SEC 8 LOT 127
C&M ENGINEERING SERVICES OWNER: KIRK BYERS DATE:4/02/18 REV:O DRAWN: CB REF:
907-854-5558
SITE PLAN
CBM ENGINEERING SERVICES
907-854-5558
Septic Design Calculations
Residence: T15N R1W SEC 8 Lot 127
RESIDENCE/LOT INFO
number of bedrooms 3 br
Water usage/bedroom 150 gpd/br
Water Usage 450 gpd
DRAINFIELD
system type: Conventional
type: Shallow Trench
Application Rate 1.2 gpd/sqft
required absorption area 375 sqft
trench width (W) 5 ft
gravel depth (D) 0.5 ft below distribution pipe
Shallow Trench Factor 1
(Shallow trench factor* Required
Min Required Length: 75 ft absorption area/W)
Total Excavation Depth: 2 ft
Cover: 3 ft min
Insulation: 2" blueboard
Use Length: 75 ft
Effluent Pipe: 4"ASTM 3034
Design Summary
System type: Conventional
Tank: 1000 gal
New Drainfield: 5'x75'x0.5' W'xL'xD' shallow trench
Total absorption area: 375 sqft
Calc By: CGB Date: 4/2/2018
.iU�rA11
'
;►' ‘C.•
44 II.
1
,•
•
: es G.Baiza€in1:4s A7�
<cn6''•14'y1 •••'c���r
•d -ROFESSgA:*
C&M ENGINEERING SERVICES
Ph:907-854-5558
SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER
LEGAL: Lot 127
April, 2018
A. GENERAL
1. The septic design is for a 3 bedroom, single family residence only.
2. The site plan and drawings shall be a part of this specification.
3. The Wastewater system shall be installed by a certified installer in accordance All
materials and workmanship shall meet the Anchorage Department of Health and
State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field
by the engineer. The engineer shall perform percolation tests and groundwater
monitoring prior to finalizing design. An additional Test hole and percolation test is
required during construction.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage, Department of Environment of
Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and
to locate any adjacent multi-family wells. A licensed surveyor should locate all
nearby lot lines, easements, exact 100' radius from the existing and neighboring on-
site wells, and any nearby surface water.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. Any remaining open test hole excavations shall be filled and monitor tube removed,
after construction of the Drainfield.
9. The contractor shall familiarize himself with the new code requirements for
inspection notification and notify the engineer at least 24 hours prior to beginning
work.
-4 10.The contractor shall set the grades for the tank and leach field prior to commencing
work to ensure gravity flow is acheived.
B. SEPTIC TANK
1. Septic tank shall be a fiberglass or steel, 1000 gallon tank capacity of MOA
approved construction. Installed to meet MOA requirements.
2. Install a foundation cleanout within 5' of the foundation.
3. Install 2 after tank cleanouts between the tank and drainfield.
4. A diverter valve may be installed after the after tank cleanouts to tie in the old
leachfield.
5. A combination of soil and 4" minimum of insulation shall be placed over the tank, to
prevent ponding and promote drainage. The insulation shall be rated for burial and
meet moa requirements.
C. DRAINFIELD
1. The Drainfield is to be located as shown on the site plan. Notify Engineer of any
changed site conditions.
2. The total depth of the initial drainfield excavation is to be at maximum 2' deep
Bottom of excavation shall be level +/- 1.5" max. If bedrock or inconsistent soils are
encountered, notify the engineer immediately.
3. In the event of over-excavation, a moa filter sand shall be used to maintain the 6'
separation distance from the bottom of each trench to the bottom of the test
hole(s).The top of the sand layer shall be level, plus or minus 0.5", and raked, prior
to placing sewer rock. Care shall be taken to not compact the sand.
4. A 6 inch effective layer of sewer rock is to be placed in the each trench. The 4"
effluent piping is to be buried within the gravel layer with 2" of sewer rock cover over
the piping.
5. The Distribution pipe shall be 4" perforated pvc pipe conforming to ASTM D3034.
6. The complete Drainfield gravel and piping is to be covered with a geotextile filter
fabric.
7. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the drainfields. Mounded side slopes shall not to
exceed 3:1. The minimum insulation thickness shall be 2". Insulation shall be moa
approved and rated for burial.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200' to any community well.
9. The soils at this site may contain fines such as silt and clay. Rake sidewalls and
bottom of trench to remove any smears from excavation.
10. Install drainfield as high as possible in the soil column, while maintaining gravity flow.
There is a relatively narrow band of adequate receiving soils.
Design Summary:
Excavation Depth: 2' Gravel Depth: 0.5' under distribution pipe, 2" over
pipe.
Drainfield Length: (1) 75' Drainfield Width: 5'
Soil Rating: 1.2 gpd/sqft System Capacity: 3 Bedrooms
�o1,%aar1
F 444114.
. ` ** q ��1
%�� •;. harles G.Balzarini ..
o s�,•. •
CE-13854 / '
k pOFESS%O sgo
� ` A 1
Municipality of Anchorage r A\V'lENGIINNEER/ S ff��v
D• evelopment Services Department i�'� "` %I.',I
Building Safety Division • * ' ` 9!-� , 5 .�
0 r 1 r-,...eOn-Site Water and Wastewater Program ""••••••• . •..••
4700 Elmore Road /w• 0
- P.O.Box 196650 Anchorage,AK 99507 0 Sf . ............0
www.ci.anchorage.ak.us 0 0 ; arle$•G•lIali 11( : Q
(907)343-7904 *Th .. CE•1 • �_/
�ntr
Soils LogPercolation Test ?� s�°per ��`.�,,
�,R��Esst�•N�.
Performed For: 1' b\� 5 Date Performed: ,-5l�p?7/ig
Legal Description: 7 I5)1 R I LI .5iC O , to f 1)7 Township,Range,Section:
Slope Site Plan
Depth
. ft) eet
2e. p‘letyv
2- ° /'�
tvp
3- , tr/C0eXC5
4- ' t;
5- 1 , S141
6- . 1),t.vt:42 RAq
7- OF-44E OF-44EFr^'E -
8- U z/tTNF 7
SAivo` ga4.im. WAS GROUND WATER (�
9- r NGT ENCOUNTERED? v
t / s
10- 1t''lt�l°/�i ielAdeIF YES,AT WHAT DEPTH? �/K� L
Depth to Water After * p
11- 8 P
Monitoring? E
12- Date:r 4/+1
13-
RE I� v L
14 Gross Time Net Time Depth to Water Net Drop
15- .-3l /s , 0 Li : 3.2 y ; 0 .
16- ,. (D q ;u 7— VIb 3 - //b
17- xl 0 LIt 4>) 4" 0
18- to L4. 7 -- (/ib 3- O/1(,
19- 7 0 q: 5,-i (,t, 0
3
PERCOLATION RATE 15 (minuteslinch) PERC HOLE DIAMETER (.'
_ TEST RUN BETWEEN 3 FT AND 14 FT
COMMENTS ?GP P✓�1EIT PER, NLw (C9 i. IPA`ji 6l EAD.i'Nb5 Sf(O("IV, 1E57
AAA, Pd HOG R. 4'I'vTLbZAIci 6Y Sr.9L-/ 44 EG._
PERFORMED BY: Cite,,;te$ T�0.I2 i ;1; 1 011,06'S.4.34/29 e;'/1) CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Ydg71K
•
•
pGC e
!_el Municipality of Anchorage
On-Site Water and Wastewater Program
(907)343-7904 T Y
Certificate of On-Site Systems Approval
Parcel I.D. 051 154 04 Expiration Date: 7-x.0
1. GENERAL INFORMATION
Complete legal description T15N R1W Sec8 Lot 127
Location (site address) 20136 Crabtree
Current Property owner(s) Kirk Byers Day phone
Mailing address
Real Estate Agent Sherri Sapp Day phone
2. TYPE OF DWELLING:
O Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for:none
Distance:
f /�
Received by. .�°" c-._. Date: �`1/ ;J7l
COSA to be released to the engieer,unless otherwise requested by the engineer.
COSA Fee $ (c 1 1 ' 11! 4o d Waiver Fee $
Date of Payment quer-l4 Date of Payment
Receipt Number OfloGe5b Receipt Number
COSA# 0s C-i g/(5z Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm C&M Engineering Phone 907-854-5558
Address 30840 prudhoe bay ave
Engineer's Printed Name Charles Balzarini Date 04/16/18
.���®®1►
c.,OF AL,VAk
#* • 49TH :*
6. DSD SIGNATURE f
System #1 Approved for 3 bedrooms a ...... . ..
ARLES G BALZARINI
System #2 Approved for bedrooms •���®
F • IC,,E-13854
Disapproved ��cFgF� 0 • ••.•c.' �
gr
� pR0 �SSION�.�
Conditional approval for bedrooms, with the following s?l ?ittE'y� :,-�t�.
\QP�\cY OFply
O
V
j ON-SITE T
WATEK AND
WASTEWATFR o
PROGRAM
acs
:y: - t/,.__ Original Certificate Date: -2_6 -t
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory 4---
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_i . c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: T15N R1W SEC 8 LOT 127 Parcel ID:051 154 04
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # - Well Log (Y/N) NO
Date completed C.1969 Sanitary seal (Y/N) YES Wires properly protected (Y/N)YES
Total depth +70 ft. Cased to +40 ft. Casing height(above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test UNK 4/13/17
Static water level UNK ft. 55 ft.
Well production UNK g.p.m. +5 g.p.m.
WATER SAMPLE RESULTS:
Coliform ND colonies/100 mL Nitrate 9.85 mg/L
Arsenic ND ug/L Date of sample: 4/2/18* Collected by: C&M ENGINEERING
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material septic/steel Date installed 4/11/18
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) yes
Foundation cleanout(Y/N) yes Depression over tank(Y/N) no High water alarm (Y/N) n0
Date of pumping new Pumper new, N/A
C. ABSORPTION FIELD DATA
Date installed 4/12/18 Soil rating (g.p.d./ft2 orftatiRrrtn) 1.2 System type shallow
Length 80 ft. Width 5 ft. Gravel below pipe 0.5 ft.
Total depth 3 ft. Eff. absorption area 480 ft2 Monitoring tube yes Depression over field n0
Date of adequacy test new Results (Pass/Fail)pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 0 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment(past 12 mo.)(Y/N & type) no If yes, give date n/a
D. LIFT STATION
Date installed -- Size in gallons -- Manhole/Access (Y/N) --
"Pump on" level at-- in. "Pump off'level at -- in. High water alarm level at -- in.
Datum -- Cycles tested -- Meets alarm&circuit requirements? --
E. SEPARATION DISTANCES
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 +100 Public sewer manhole/cleanout +100
Sewer/septic service line +25 Holding tank +100
Animal containment areas +100 Manure/animal excrete storage areas +100
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1-I. + I 0 Property line +5 Absorption field +5
Water main +10 Water service line +10 Surface water +100
Wells on adjacent lots+100
ABSORPTION FIELD ON LOT TO:
Property line +10 Building foundation +10 Water main +10
Water Service line+10 Surface water +100 Driveway, parking/vehicle storage +5
Curtain drain +50 Wells on adjacent lots +100
F. COMMENTS
*bacteria samples re-drawn 4/11 due to lab mixup.
G. ENGINEER'S CERTIFICATIONAMY �c QF Aki,c kk
I certify that I have determined through field inspections and ,� \P•••• • ••�"��
review of Municipal records that the above systems are in �•• TH •• �j
conformance with MOA COSA guidelines in effect on this date. * -4 9 •* ,
Engineer's Printed Name Charles Balzarini (/
Date 4/16/18 ,0.1f1 .(eg,„ LES G BALZARINI• �
CE-1y.54 •
• �`� �'
•
11\e°PROFESS\Oto‘VVwec4
COSA canary sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • ,t["�l 907-343-7904
On-Site Water and Wastewater Section I Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # 0SC181152
Subdivision: T15N R1W Sec 8 , Block: , Lot: 127
A water sample revealed a nitrate concentration of 9.85 milligrams per liter (mg/L).
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. 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.
Mailing Address: P.O. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
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.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
. \
il!esso tSJ=,/
--- !'
I
0N
• �� �1
-41.... _ � �
77 ----_ a
.;a W I ss 94
• Q
.a42 1 ti • A' ; '.o
i
o ^ nes I' 0
`1 j n.
:51 k) .\''
‘i 411*‘hlti
4
11
.v / 1
1
? ffr
V +" ! fit
\\ i! +
S'D W ..s.-;,7-e.
/iii" '9 -9. .r.�:- -r:'"v",<44-'
ASBUILT
SEWARD & ASSOCIATES LAND SURVEYING 694-082(4
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: i
FOLLOWING DESCRIBED PROPERTY "iso ,7+'�'��~ayo
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS p;': ' •
: .. .'..."S
INDICATED. IT IS THE RESPONSIBILITY OF THE /���9 C^ d'-' `
OWNER TO DETERMINE THF. EXISTENCE OF ANY GRID: '`
EASEMENTS, COVENANTS, OR RESTRICTIONS ,-r7�v�>_1 7 f ''.
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- .•
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD � ii
I o„e,L• Mirk. •r
ANY DATA HEREON BE USED FOR CONSTRUCTION _ '? ;•/ ,`P•
a,
OF FENCE LINES, OR FOR ESTABLISHING BOUND- ` •
ARY LINES. DRAWN i1 , fat� � •
G/amu 8c tiw•r
.
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. 051-19U-04 COSA# _02 0L1
Expiration Date: 2��//o
1. GENERAL INFORMATION
Complete legal description Lot 127, Section 8, T15N, R1W, S.M.
Location (site address)
20136 Crabtree Street Chugiak, Alaska 99567
Current Property owner(s) Susan Scearce Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
4200 Scenic View Drive Anchorage, Alaska 99504
Day phone
Brooke Stiltner/Re/Max Dayphone(907) 244-6742
Mailing Address 11525 Old Glenn tlwy Eagle River, Alaska 99577
Unless otherwise requested, COSA will be held by DSD for pickup. t7 k r 1041. 0/11W
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
13
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 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 Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pinard Engineering Phone (907) 232-1347
Address PO Box 871347 Wasilla, Alaska 99687 �Itn Z
Engineer's Printed Name Paul E. Pinard, P.E.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Je_.f9nf+m,.e7f- At-4(47,-79t51i "fU �,XnAf whrA
WATER AND * m?
SVR
PROGRAM
Attachments: '``''•. '•
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date:
(Ra, 11105)
[
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & 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 CHECKLIST
Legal Description: Lot 127, Section 8, T15N, R1 W, S.M. Parcel ID: 051-15LA-OLI
A. WELL DATA
Well type Pyt If A, B, or C provide PWSID # NA
Datecompleted Circa 1 96%anitary seal (Y/N) Y
Total depth 70+ ft. Cased to __i0_+ ft.
FROM WELL LOG
Date of test
Static water level
Well production
n.
WATER SAMPLE RESULTS: Of
Coliform 0 colonies/100 mL Nitrate 40•67-Ymg/L
pml- Fey pep
Arsenic: � ug/L dateofsample:l0 26/09
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Unknown
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
10/27/09
55 ft.
5.3 g.p.m.
Other bacteria 0 colonies/100 mL
Collected by: Pinard Engineering
Date installed 19701
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over lank (Y/N) N High water alarm (Y/N) N
Dateofpumping 10/1/08 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed
1970±
Soil rating (g.p.d./ft2
or 01adrm) Unkn
System type Shallow
Trench
Length
47+ ft.
Width
Unkn ft.
Gravel below pipe
3 ft.
Total depth 100 ft. Eff. absorption area Unk%2 Monitoring tube Y Depression over field N
Date of adequacy test 10/28/09 Results (Pass/Fail) Pass For 3 bedrooms
30 pnv pe: Itr by p�.• —
Fluid depth in absorption field before test in. Water added— 800gal. New depth 39 in.
Elapsed Time: Amin. Final fluid depth 33 in. Absorption rate >= 450 g.p,d.
Any rejuvenation treatment £pVst 12 mo.) (Y/N & type) None Known If yes, give date
D. LIFT STATION NA
Date installed
'Pump on' level at_ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level at_ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 100'+
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm S circuit requirements?
On adjacent lots 100'+
100'+
On adjacent lots
Public sewer manhole/cleanout
100'+
.
Sewer /septic service line 25'+ Holding tank NA
Animal containment areas 100'+ Manure/animal excrete storage areas NA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 10'+ Absorption field 5#+
Water main 10'+ 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 50'+
Water Service line 10'+ Surface water 100'+
Driveway, parking/vehicle storage 25'+
Curtain drain ' NA Wells on adjacent lots 100' +
F. COMMENTS
in.
G. ENGINEER'S CERTIFICATION „'. w� s �. •: Q
I cern that I have determined through field inspections and
lY 9 P �o. :. .� •o favi •! 1
review of Municipal records that the above systems are in e s r
conformance with MOA COSA guidelines in effect on this date.-!' a 1? f;*,.'!_»-+:' _,... • • s •.� of� s
Engineer's Printed Name Paul E. Pinard, P.E. 4TH:- 1f
Date 11 /6/09 r�� raj'•»»...»•', ,
COSA Fee $ ' L cl 0 Waiver Fee $
Date of Payment ' d Date of Payment
Receipt Number ? L Ll Receipt Number
(Rev. 11/05)
NW -5-2009 08:54 FROM:
'>
e��9 'o -w
A
70:18003469931
.r/By •,�i�✓ s�o C
,T,ryis'.awif' ,po/vim
Z
A
r •w
"✓dJp•1'+0vo'- Jlp
AbOVIL:
S$wAlUl &
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
SCALE: t
FOLLOWING DESCRIBED PROPERTY,
�o> ia� sst op'px .rit✓
D THAM NO ENCROACIC�AENTS MST EXCEPT AS
DATE-
INDICATED. IT IS THE RESPONSIGILITY OF THE
OWNER TO DETERMINE THE E:CISTENCE OF ANY
GRID:
EASEMENTS, COVENANTS, OR RESTRICTIONS
�✓wi�s7
WHICH DO NOT APPEAR ON THE RECOkDED SUBDI-
VISION PIAT. UNDER NO CIRCUMSTANCES SHOULD
FB:
ANY DATA HEREON BE USED FOR CONtITRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
DRAWN,
ARY LINES.
f
P.1
Z6t ti'I•��•'p•�.���`e
14
1
r•r
r
- -r%%�`
of A� �.
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
WELL FLOW TEST
LOCATION: Lot 127, Within Section 8, T15N, R1 W, S.M.
DRILLER: Unknown
DATE WELL COMPLETED: Unknown (circa 1989)
WELL DEPTH: Unknown (70'+, by probing)
STATIC WATER LEVEL (lop of casing): 55.0'
JOB NUMBER: 09.254
DATE OF TEST: 10/27/09
FIELD STAFF: PJ Pinard
��J
Time
Elapsed
Time
inures
Static
Water
Level
Flow
Rate
Cumulative
Gallons
Pumped
Remarks
3:10 PM
-
55.0'
5.3
- Start Test - Meter
117090
3:25
15
58.2'
5.3
80
117170
3:40
30
63.1'
5.3
160
117250
3:55
45
65.2'
5.3
240
117330
4:10
60
65.7'
5.3
320
117410
4:25
75
63.9'
5.3
400
117490
4:40
90
65.8'
5.3
480
117570
4:55
105
65.1'
5.3
560
117650
5:10
120
64.2'
5.3
640
117730
5:25
135
67.0'
5.3
720
117810
5:40
150
65.3'
5.3
800
117890
5:55
165
64.0'
5.3
880
117970
6:10
180
65.5'
5.3
960
118050
6:25
195
66.1'
5.3
1040
118130
6:40
210
64.1'
5.3
1120
118210
6:55
225
65.3'
5.3
1200
118290
7:10
240
64.8'
-
1280 Stop Test
118370
RECOVERY
All well protection features are adequate.
7:20 PM 10 57.1'
Average Flow Rate: 5.3 gpm
Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF
PRODUCING 5.3 GPM. THIS TEST DOES NOT CONSTITUTE A Reviewed by: Paul Pinard
WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM
WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Date: 10/30/09
PINARD ENGINEERING
o 1 P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
c�
ADEQUACY TEST -list DAY
LOCATION: Lot 127, Wlthln Section 8, T15N, RiW, S.M.
APPLICANT: SusanScearce
4200 Scenic View Drive
Anchorage, Alaska 99504 -MS
SEPTIC TANK TYPESIZE: Unknown11250 Gallons, per MOA Records
ABSORPTION SYSTEM: Shallow Trench, per MOA Records
DAILY FLOW:
3 BEDROOMS x 150 GALLBR - 450 Gallons
TEST DATA
E"I
JOB NUMBER: 09454
DATE OF TEST: 10/27/09
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 3
SCUM: 0.0' SLUDGE: Minimal
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes No XX
Time
Flow
Rate
Volume
Cumulative
Volume
Septic Tank
Septic
Tank
Soil Absorption System
Comments
pM
(GPM)
(GALS)
(GALS)
Liquid Level
A Level
Monitor
Tube 1'
A SAS
Level
Monitor
Tube 3'
A SAS
Level
3:30
3.3
-
4.0
1.8
Start Flow - Meter 117200
3:45
3.3
80
80
4.1
0.1
1.8
0.0
117280
4:00
3.3
80
160
4.1
0.0
1.9
0.1
117360
4:15
3.3
80
240
4.1
0.0
2.0
0.1
117440
4:45
3.3
160
400
4.1
0.0
2.2
0.2
117600
5:15
3.3
160
560
4.1
0.0
2.3
0.1
117760
5:45
3.3
160
720
4.1
0.0
2.5
0.2
117920
6:15
3.3
160
880
4.1
0.0
2.7
0.2
118080
6:45
-
160
1040
4.1
0.0
2.9
0.2
Stop Test- 118240
RFCnVFRY
Date
Time
ST MT
SAS MT
10!28
5:00
PM
4.07-0.1"
2.57-0.4'
'ALL MEASUREMENTS IN FT.
TEST: PASSED FAILED
COMMENTS: The system has not been in use for several months so SAS was saturated; testing to continue on 102889.
Reviewed by Paul Pinard
Date: 10130/09
PINARD ENGINEERING
P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
ADEQUACY TEST - 2n0 DAY
LOCATION: Lot 127, Within Section 8, T1SN, R1W, S.M.
APPLICANT: Susan Scearce
4200 Scenic View Drive
Anchorage, Alaska 995048805
SEPTIC TANK TYPE7SIZE: UnknowrJ1250 Gallons, per MOA Records
ABSORPTION SYSTEM: Shallow Trench, per MOA Records
DAILY FLOW:
3 BEDROOMS x ISO GALIBR - 450 Gallons
TEST DATA
JOB NUMBER: 09-2S4
DATE OF TEST. 10f2S09
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 3
SCUM: 0.0' SLUDGE: Minimal
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes No XX
Time
Flow
Rate
Volume
Cumulative
Volume
Septic Tank
Septic
Tank
Soil Absorption System
Comments
pM
(GPM)
(GALS)
(GALS)
Liquid Level
•
A Level
Mondor
Tube 1•
A SAS
level
Monitor
Tube 3•
A SAS
Level
5:05
3.3
4.0
-
2.5
-
Start Flow -Meter 118370
5:20
3.3
80
80
4.1
0.1
2.6
0.1
118450
5:35
3.3
80
160
4.1
0.0
2.7
0.1
118530
5:50
3.3
80
240
4.1
0.0
2.7
0.0
118610
6:05
3.3
80
320
4.1
0.0
2.8
0.1
118690
6:20
3.3
80
400
4.1
0.0
2.9
0.1
118770
6:35
3.3
80
480
4.1
0.0
3.0
0.1
118850
7:05
3.3
160
640
4.1
0.0
3.1
0.1
119010
7:35
-
160
8D0
4.1
0.0
3.3
0.2
Stop Test- 119170
RFCr1VFRY
Date
Time
ST MT
SAS MT
10/29
4:30
PM
4.07-0.1'
2.87-0.5'
'ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: This a continuation of the testing begun on 1027/09. The system had been unused for several months,
prompting the extended testing. There was 1.8' of measurable liquid in the SAS MT prior to beginning
the testing. With the addition of 1840 gallons to the system over a period of 28 hours, the level rose 1.5'.
A recovery measurement, taken 21 hours after stopping the flow, showed satisfactory absorption.
Reviewed by: Paul Pinard
Date: 10/311709
MUNICIPALITY OF ANCHORAGE
Mayor Dan Sullivan
November 16, 2009
Ronald L. and Susan M. Scearce
4200 Scenic View Drive
Anchorage, AK 99504 6605
Dear Property Owner:
RE: Encroachment: Septic Pipe in 50' Patcnt ROW Reserve
Section 8 T15N RIR', Lot 127, Grid NW1257, 20136 Crabreet Street
The Right of Way Division has reviewed a request for a letter of nonobjection to an existing septic pipe,
which encroaches into the 50' Patent Right of Way Reserve (Jayhawk Drive (ADOT owned, MOA
maintained). On the as -built survey dated 11/5/09, submitted with the request, the petitioner has shown
the septic pipe.
This letter of nonobjection is issued with stipulations, and by using it the petitioner is agreeing to the
following:
1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or
injury to any person as a result of the encroachments.
2. All applicable codes and regulations will be observed and maintained within the easement.
3. This letter of nonobjection will in no way preclude MOA from full use and enjoyment of its
rights within any portion of the easement.
4. Additional and extraordinary costs incurred during any future required construction, repair or
reconstruction of MOA improvements to accommodate any or all of the encroachments shall be
paid by the property owner.
5. Obtain letters of nonobjection from the following utilities:
❑
Anchorage Water & Wastewater Utility
❑
Alaska Communications Systems
❑
Chugach Electric Association, Inc.
❑
Matanuska Telephone Association
❑
Matanuska Electric Association, Inc.
❑
Enstar Natural Gas Company
❑
Municipal Light & Power
❑
GCI Cable of Alaska
❑
Eyecom (Girdwood Cable TV)
®
No letters required
All letters of nonobjection should be retained in your permanent files. If you have any questions, please
call me at 343-8240.
Sincerely,
,4 —1-h—/--
oro4 Jack L. Frost, Jr.
Right of Way Supervisor
Concur
Property Owner(s)
P.O. Box 196650 o Anchorage, Alaska 99519-6650 o httpi//www.muni.org
G.V)ewlop~nr Semke IROlfwonobjwkmkttmlredlon8. T1JNR1W. 1w 127. Scenree.doe
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENI.'AL 1IFALTEE.
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
(a) Legal Description (include lotblock,
�jrz 60 rA
Loc
s or directions)
Application Date
155 on, section, township, rangf:)
(b) Applicants Name�I[L,jo
�_.�Cel�e
Applicants Address
-- Home
v
(c) Applicant is (check one) Lending Institution Fr ; Owner/ builder
Buyer Other � (explain);
F ---j
(d) Lending Institution /'j 0 A -j /p � � � Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone.
//q.'/ !
(f) Muff the HAA to the following address:
2. 112_e of Residence
Single -Family .
Number of Bedrooms
3. Water SupLly
Multi -Family �4
Other (describe)
Individual Well -,R1
Community �^ `
Public C�.l
Note: If community well
system, must have
written
confirmation from the State
Department of Environmental.
Conservation
attesting
to the legality and status.
4. Sewage Disposal
Onsite'; Public f� ` Community r -T Holding 'rank y
Note: If. community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 21
I
1 ` i n}i�l' FntI
5. . Per..o._v.mdin_I.�n..s Inspections,
Tests �F.... .l_ e Seaswchnµl.eseeryly�a4i 1wnrL1
Y-�1.VA
As certified by my seal affixed hereto and. as of the validait#IIatEtahot4i bh)oRE',l5,
verify that my investigation of this Health Authority Aprov4bl' alUw� tire£ the,st
water supply and/or wastewater disposal system is safe, fun atitinio'i Rifat ttilc?atiRtgt
the number of bedrooms and type of structure indicated herein. :I fuxt6r VaYiiy" t%(it'
based on the information obtained from the Municipality of. Axldholeage jilts and i! bm my
i
investigation and inspection, the on--site wager supply anal/ot' wai3tew.atar.diapuc4rll
system is in compliance with all Municipal. and State codes, ordCitane.es,',and, regt lo-
tions in effect on t:he data of this inspection.
Name of Firm^� y� �} flt �C _ __. _ ...._ Te:lephoneb
t11tt F1IVf;II E1C11 ii.' y!
Address_� �w._ +,ak7.,.:a�'al:.Z`1_.�.__.._ �•.. 'max :_�_ ._�.
Date��^/�/"Nile
41
(ENGINEERSR/.Il)
fc 'Y H,ekxvrt I�. S}1a,6ir iii ��
6. DHEP Approval
Approved for ..S bedrooms B
Approved/ Disapproved Conditional
Terms of Conditional
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF I%ALTH AND FNVSRObhH;NTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASTED SOLELY UF'ON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN 'INDIEPENDENT PROFGSS70NAI. 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 FEDFRAIi ANI) STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE' DATA .BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE,' IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK,,
(DHEP SEAM)
RR4/ej/D18
(Page 2. of 21 7-49-84
IQiI!'SYA.f1M1P4 i4�1R9,.'t51�E'9�Pa'N6. �RkE1FAYT'SfPhn:nN9Nf: 1P9.�JC 3=9Rt �l.aFr wnfM1"�4-'Il rn..'YJiI?iTe�CR^kd'Inteb vF'ktM.VR 84P:]fCt!!'^R!VVt. u'•'+Sfi{ 1hn:.-.:. •.1
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) vDQb17 LSO
CHECKLIST FEBRUARY 1984 NOUD310ad -IV1N3wN0a1AN3
4"41 $$,,F� 3FI Jo 'Id30
A. WELL DATA Legal Description: 1Z)tN� d0 )S1d6INnW
Well Classification T
C lI C _ If A, B, or C, D.E.C. Approved(Y/N)----v'
?L�r«
Well Log Present ( Date Completed _— — Yie.Ld
Total Depth _(�_f= Cased to 4) _ Depth of .Grouting =_
Static Water Level — zz _ Pump Set At
Casing Height Above Ground JC? Sanitary Seal on Casing (Y )
i
Electrical Wiring in ConduitO' --_ Depression Around Wellhead
Separation Distances from Wall:
To Sept ic/HoV�EitJ rank on Lot— On Adjoining Lots_ /c C-)
To Nearest Edge of Absorption Field on Lot1Ze7 Y _; On Adjoining Lots_ C')
To Nearest Public Sewer Line — /-J j�q- To Nearest Public Sewer
Cleanout/Manhole_ J `Vf)- To Nearest Sewer Service Line on Lot
Water Sample Collected By L 2 �1°o'dir; Date_ 2—
Water Sample Test Results w ^- T-� —
Comments----�U—b rf it -
B.
B. SEPTIC &-�ANK DATA
Date Install d ��/ -� Size
Standpipes (Y Air -tight Caps
Depression over. Tank ( s Date Last
Pumping/Maintenance Contract on File (Y N
Holding Tank High -Water Alarm.WyePl_
No. of Compartment=; _
�EV _
Foundation Cleanout I �—
t/xmped — �7��
for _--=__—
Temporary Holding Tank Permit Vim) ' _7ii
Separation Distances from Septic/1Re1d!-ng Tank: /
To Water -Supply 4'11 _ ,U�- To Building Foundation 13-17
To Property Line_ /C� _ To Disposal Fieldf--_—
To Water Main/Service Line G To Stream, Pond, Lake, or Major Drainage
Course ----------4---------- —
Comments tiL) 4j- /
Receipt #9 t' _
Date Paid: \C,
Amount: _JS—�
[Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design 19,elyl/lFlerto
Date Installed /% �7_L-) l S Length of Field`
Width of Field U �� Depth of Field l
Gravel Bed Thickness
Square Feet of Absorption Area — Standpipes Present (Y )
Depression over Field (A—N Date of Last Adequacy Test /C) 2 3 `6
Results of Last Adequacy 'lest
Separation Distance from Absorption Field:
To Water -Supply Db 11 / L? To Property Lire /o
To Building Foundation Z/(5` To Existing or Abandoned System on
Lot Z C) 7/- ; On Adjoining Lots / ,f -u /-
To Water 44niit/Service Line J5D TL To Cutbank(if present)
To Stream/Pond/Lake/or Major Drainage Course /J L9
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons anhole/Access (YM)
"Pump On" Level at ifOff" Level at
High Water Alarm Level at Vent (YM)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes(Y/N)
Comments
** Check Permitted Bedroom Rating Against. HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed $RBQ)9 R R'NQ r. Date Z� d
Company i'Fi.694-2`J7�J J MOA No.
KBl/d5/s
[Page 2 of 21
-15-84
�
N
w
0
TO
,J
l�� Coo�Ct / �� `I J- !� T/S �I U�
SUBJECT DATE
MESSAGEu
r � �
SIGNED
REPLY
r
i h
SIGNED DATE
RECNFORM ®4S 471 SEND PARTS I AND a INTACT . POLY PAK (SO SETS) 4P472
PART 7 WILL RE RETURNED WITH REPLY.
DETACH AND FILE FOR FOLLOW-UP