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T13N R3W SEC 33 LT 6 W3 OF SE4 M&B
T13N R3W Section 33 Lot 6 W3 of SE4 M&B #008-042-16 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201414 PID Number: 008-042-16 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New EZ Upgrade Name Kaela Parks A ORPTION FIELD ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 4432 Wright st. Anchorage. AK Other Phone Number of Bedrooms Soil Rating depth from original grade 2 ISF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original e Gravel depth beneath pipe Subdivision Block Lot W3 of SE4 6 141- Ft, Fill added above original grade G7%.,I length Ft. NS, Ft. Township Range Section 13 �A 3W 33 Gravel width Ft. Beds: Number of Lines Dist e between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between t hes From Tank Field Tank Line Ftz Well 57, j TANK ® Septic i] S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 1001+ Greer 1000 Gal. Material Number of compartments Lot Line 51+ NA Plastic 2 Foundation 101+ i TATION Manufacture Capacity i t Remarks Inlet and outlet of tank sealed with SikaFlex Gal. per design criteria. Alarm location Electn Iled by i Installer PIPE MATERIAL House to tank Tankto D3034 drainfield D3034 Northern Excavation Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft InspectionAsa dates: 10/30/20 2°° 10/30/20 Location and description 311 11/2/20 4th Back door frame ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp �Y..rt44 . � # Conditional Approval: Date,�,'•,,� ,, ... k<Fit} SY � 39Xii trt r 0 -t�MiY fXt:IXi[.it7%Xt XIWifRSi XG� ' ' , ; > z�t••`� Septic S sterntKIENN Approved C1U� e Date a3 �20Q0 Note: this approval does not include well permit requirements..` foe ncfnni4of AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP201414 T13NR3W SEC 33 LOT 6 W3 SE4 PID# 008-042-16 / / / I SEPTIC PIPE l l / NEW 1000 GAL l PLASTIC TANK of E l / ! y / l / I ❑rc l ll/ / i J W LL; DECK I 1 1 I r \ i $ B rJ l BUILDINGEBRODM 7 V l � 1 I l i T ,l A -C=57.6' B -C=59.4' 99,73 99.6 A -D=58,6' B -D=60.5' A -E=60.8' o< B -E=63.1' A -F=64.9' f B -F=67.5' A -G=67.6' 1000 GAL B -G=70.3' ti A -H=68,7' a 96,41 TANKSEPTIC B -H=71.6' .40 'a, low AArr ()F'"L i PREPARED F❑R: KAELA PARKS 4432 WRIGHT ST. * ; 4p lH. j7 * ANCHORAGE, AK ' KE "US / FlELD BOOKS CDMPUM: ` CE 6 ,w� BOUNDARY:N A oRAwTa: KSD 1 ti sTacwc: N/A cxECKm: KMD 1 \ . Z4 I ASOUILT. DATE: 11/14 5S1Oi1- DWG. FIM GRID: Syy183 ACA[) Flu:: FILE NO'` 20195 A I SCALE, NTS N 1/2 LOT 6 DEEDED PARCEL ADJACENT COMMERCWL BUILDING - S 89'57'38"W 48.42' SEPTC PIPES WIRE FENCE SEPTIC MANHOLE DEEDED PARCEL x 10.3' SHED LOI I WOODEN FENCE��I CHAIN-LINK x 8.3' SHED 41-b o DECK o I ONE STORY iO .I HOUSE ':...1 N 89'57'19"E.. ..I.. Lot 21A FENCE DEEDED PARCEL ADJACENT HOUSE :HAIN-LINK FENCE 'OODEN WALKWAY x 8.1' WOODEN DECK NOTE THIS DRAWING IS BASED ON A CORRECTIVE DEED RECORDED JULY 25, 1985 IN BOOK 1462 AT PAGES 412 THRU 416 PLOT PLAN AS BUILT —2L SCALE 1" 330' GRID SW 1834 Project No. 20-713/W1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 000ppppp (907) 522-4625 Fax oo p�4 Professional Land Surveyors kenOlangsurvey.com o F A 9 tonothanOlonasurvev.com 0 .•'' s Q I hereby certify that I have surveyed the following described property: DEEDED PARCEL WITHIN BLM LOT 6, SECTION 33, T13N R3W SEWARD MERIDIAN, ALASKA 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 i-Lrt' Day of Nnyswf t —1 'LoY'o , 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. 49TH ........ ?0 KENN H-6. • G '.o Ic tt�n��o.-' i 0040Z mss ONXL MUNICIPALITY OF ANCHORAGE Hent S' On -Site Water & Wastewater Program_•- PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 1 http://�.muni.org/onsite r m y DepziT C3lieRt. On -Site Wastewater Disposal System Permit Permit Number: OSP201414 Effective Date: 10/13/2020 Work Type; SepticTank Upgrade Expiration Date: 10/1312021 Tax Code Number: 00804216000 1 Site Legal Address: J r?,m (3,3ci 3-5 �^� b u)3 o,�- 5;5y ti -p i Site Mailing Address: LJ LA`32 (Jrt'l -t Gi- Owner: PARKS KAELA Lot Size in Sq Ft: Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy El 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 (I8AAC72) 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, seated, and heated to prevent freezing Received B, Issued By: Date: [late: jVZ f�' puvlt Mun*dpaflty of Anchorage i� Ur.partmenr P.O. Box 196650 a 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program x* x x VARIANCE/WAIVER REVIEW x x x x Waiver#: OSV201062 COSA#: Permit#:OSP201414 PID#: 008-042-16 Legal Description: T13N RM SEC 33 LT 6 W3 SE4 Engineer: ArcTerra Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 55.0 feet. See the Wastewater Disposal System Details for spection construction requirements. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: Ma&C) Approved by: &A rpt/ Name of Reviewpf **** VARIAN C E/WAIVER REVIEW **** ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 008-042-16 Property owner(s) Kaela Parks Day phone Mailing address 4432 Wright St. Anchorage AK Site address 4432 Wright St. Anchorage, AK Legal description (Sub'd., Block & Lot) Lot 6 W3 SE4 Legal description (Township, Range & Section) TI3N R3W Sec 33 Lot Size 8,262 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Single Family (SF) Absorption Field ❑ Initial ❑ Septic Tank Upgrade (w/wo AD U) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Well to Tank Distance: 50' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: � 16 g 7 I Date of Payment: ��1�� o7y� 0 Receipt Number: Permit No. Waiver Fees: It Es 5 60 V I fl- 19 Date of Payment: 101L �O_-) 0 Receipt Number: 001,6 76 Waiver No. 0 Sy '�" 01 O (0 'Z12 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201414, Deb Wockenfuss, 10/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201414, Deb Wockenfuss, 10/13/20 un'c* alaiy of Anchorage On -Site Water and Wastewater Program 2" (907) 343-7904 s A .F E Y CERTIFICATE OF ON-SITE SYSTEMS ,APPROVAL Parcel I.D. 008-042-16 1. GENERAL INFORMATION Expiration Date: Complete legal description T13NR3W Sec 33 Lot 6 W3 of SE4 ,-S Location (site address) 4432 Wright St. Anchorage AK Current Property owner(s) Kaela Parks Day phone Mailing address Real Estate Agent 4432 Wright St. Anchorage _AK 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 2 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ Waiver/Variance request for: Well to tank. Distance: 55 ft. Received by: _ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSAFee $ 91�.50((M ()-I� Date of Payment Receipt Number o�a9aG COSA # 0 S C 10 1 � � Waiver Fee $ Date of Payment Receipt Number Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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 ARCTERRA CONSULTING INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 / Engineer's Printed Name KENNETH M. DUFFUS DateD E-ngineer'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 OF 4 j encroachments, deficiencies or discrepancies exist. rIS� '1 */49 M ,*$ 6. DSD SIGNATURE System #1 Approved for bedrooms. KENNETH °'j� System #2 Approved for bedrooms. �'1-rEsslor•�� Disapproved. Conditional approval for _ bedrooms, with the following stipulations: ON_- INATER ANS WASSTj;�_iV' 'ATER ^ J H 1" U G r� c;;z SEVV�rGr� By: ( � �X Original Certificate Date: AW.? 3 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 Septic System Advisory Arsenic Advisory Well Flow Advisory Other___-- COSA blue sheet 10-10A2.doc COSA Checklist J Legal Description: T13NR3W Sec 33 Lot 6 WAE4 lYl+ 6 Parcel ID: 008-042-16 If more than I septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 5* gpm Date drilled UNK Water storage tank volume gallons Total depth 68.4* ft Well disinfected for coliform test? ❑ Yes M No Cased to UNK ft Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate mg/L N Nitrate less than MRL (ND) Wires are properly protected Arsenic 17.0 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 10** in. Collected by Areterra Consulting Date of flow test for COSA 9/28/20 Date of Sample 9/16/20 Static water level at beginning of test 16.4 ft. Comments *Well flow information provided by Sullivan water wells **Well located under building foundation B. TANK DATA Age of tank(s) 0 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping New tank 10/30/20 D. ABSORPTION FIELD DATA FT STATION F-1Requir aintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 1959* Adequacy test date 9/22/20 ALL standpipes present per record drawing Results Q Pass For 2 bedrooms Total measured depth from grade 4.83 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade NA** ft (min) Water added 400 gal ❑ N/A — pressurized field New depth 11 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective UNK Elapsed time 5 min p Code -required soil cover over field Final fluid depth 0 in System presoaked . Absorption rate 300+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies:_ *Per previous COSA **Septic crib no pipe invert COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes. if No Community Sewer Manhole/Cleanout > 100' Surface Water? 100' ❑ Yes if No 57 ft 0 Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'21 Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to. (Please enter distances if less than required) Building Foundations >.10' Yes. if No ft Surface Water? 100' Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 3 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC201637 Subdivision: T13N R3W Section 33, Lot: 6 W3 of SE4 M&B A water sample revealed an arsenic concentration of 17.0 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On‐Site Water and Wastewater Program website (www.muni.org/onsite) or at 343‐7904. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. i Municipality of Anchorage lJ Development Services Department Building Safety Division On -Site Water &Wastewaterprogram 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us " ` (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING� Parcel I.D. �g' W�4 HAA# ( / q 1. GENERAL INFORMATION Expiration Date: — / d — O Complete legal description T13N. R3W. SECTION 33: LOT 6 E3 SE4. 13 Location (site address or directions) 4424 WRIGHT STREET * ANCHORAGE AK 99508 Current Property owner(s) FLOYD do MARILYN THOM Day phone _(907) 563-6383 Mailing address 4424 WRIGHT ROAD * ANCHORAGE AK 99508 Lending agency Day phone Mailing address Real Estate Agent MARS' COX W/ RE—MAX PROPERTIES Day phone 275-8194 Mailing address 110 W. 38TH SUITE 100 * ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class_Well Public Water System 3 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3707 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 14® D tf— Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSO Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for Me sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. 'DSD SIGNATURE _ Approved for �3 bedrooms. Disapproved. Conditional approval for Attachments: f/ HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: Manitenance Agreements Supplemental Engineer's Reort Other By: Original Certificate Date: I I — l D — D 4% (Rev. 17/01) I Municipality of Anchorage I ' Development Services Department } .tea i Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST ( Legal Description: T13N,• R3W SEC 33• LOT 6 E3 SE4 /}jat%( parcel ID: 0 D S0 N Z.- I Y A. WELL DATA *HOUSE BUILT IN 1968 #*ONLY 30' REQUIRED IN 1968 Well type PRIVATE If A, B, or Cprovide PWSID# N/A Well Log (Y/N) NO I Date completed *1968 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth —937+-- ft. Cased to **30'+ ft, Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test ..10/21/2004 's ' Static water level ft. 25 ft, Well production g.p,m. 4.55 t g:p.m. r WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.10 mg /L Other bacteria 0 colonies/100 ml. Arsenic: N A mg./L. Date of sample: 1010/2/281/2004/200 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER p Tank Type/Material Date installed Tank size gal Number of Compartments _ C (i7 Foundation cleanout (Y/N) _ rsesi ver tank (Y/N) High water alarm (Y/N) Dale mping Pumper C. ABSORPTION FIELD DATA t Date installed Soil rating (g.p.d./ft'or ft'/bdrm)_ System type Length ft. Width ft. Gravel below ft. Total depth ft. Eff. absorption area— ft' Monitoring tube Depression over field Date of adequacy test Results all) For—bedrooms f Fluid depth in absorption field befor _ in. Water added —gal. New depth _in. rs Elapsed Time: n. Final fluid depth _ in. Absorption rate >= g.p.d rejuvenation treatment (past 12 mo.) (Y/N & e tyP) if yes, give date I, s 1' Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons Manhole/A tl— 'Pumo offJeual a —in. High water alarm level at Cycles tested Meets alarm & circuit requirements?, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main *50'+ Sewer /septic service line 25'+ *ONLY 50' REQUIRED IN 1968 On adjacent lots *50'+ On adjacent lots *50'+ Public sewer manhole/cleanout *50'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC S EW E R Building foundation Water main Property line Absorption field Water service I' u ace water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Water service line F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundation Water Surface Wells on adjacent lots parking/vehicle storage m! I certify that 1 have determined through field inspections and 4 ��` • • _ '•'*, review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. ..... ........ Jet a ess•, Engineers Printed Name JEFFREY A. GARNESS 000 a C 7953 .•' •. • • ......... Date tl 8 otF 10 "�oresslo�o\� .r HAA Fee $ q3) Waiver Fee $ Date of Payment ii I t7� Date of Payment Receipt Number �)ron57 Receipt Number (Rev. 12101) MARY COX 2681300 10/ y 7? d" N &-r ,W 33' ry °t it, a f �E Acs - sfoQEu FRS a #ROSE n - � .26 � r3= •O _ Io L — W ,V 87's7'w Y7.40 1611 r68pm P. 002 $FN SURVEY TYPE SYMBOLS "" *0 ' AS -BUILT— NO. CORNERS SET oast ASSUMED ELEV.. ® DRAINAGE' WOOD DECK ❑ PLOT PLAN - AS -BUILT -LOT SURVEY -TOPOGRAPHY ' MOOD FENCE, "c" f�'•_:3 °'s��Oca�b s•°e•e aabega•° fl.. fes , ASPHALT e.brd�(7•'f^ 'l:.''a .a.f ` CHAIN LINK FENCE D:• a CONCRETE ❑ LOT SURVEY NOTE: Fences are shown in their approximate ❑ RECERTIFICATION AS -BUILT — NO CORNERS SET Jocations only. are not shown hereon. It is the responsibility of the builder or owner; prior to .LEGEND hub 8 tock -found ❑ set_ !W construction, to verify proposed building grade relative iron rebor -found 0 set • to finished grade and utility connections and to determine iron pipe -found-C� set O the existence of any easements, covenants or restrictions brass cop -found ® set which do not appear on the recorded subdivision plot• alum, cap -found. e set 1 hereby certify that I have. � (,� OF Arty, V&,, surveyed the property shown � ,°••jO°'••o,�dn 1 and described hereon, and the improvements situated thereon I01.. :<y„•. are within the property lines and do not "c" f�'•_:3 °'s��Oca�b s•°e•e aabega•° fl.. fes overtop or encroach on e.brd�(7•'f^ 'l:.''a .a.f adjacent property, except ,,,JJJ /S '•F <' ouala, G. IAIntod as indicated hereon. Easements of record, " k '•; �r a. other than those shown F''�•OOpe. °.^°LO•' ° on V.e recorded plat, are not shown hereon. Pre ar d by BENCH IARK.. INC. Professional Land Surveyors Scale, 1 "=40 t Drawn by:.. wAH Dole Surveyedr Decked by: 3-27-86 DGN Date Drown; Grid W.O. 3-27-86 1834 1 86-037 Legal Descriptionz SEE BACK OF THIS SHEET Municipality of Anchorage , Development Services.Department building Safety Division .: �'--'� "•:: a On-Site Water and Wastewater Program ' • t r " 4700 South•Bragaw St. P.O. Box 196650 Anchorage, AK' 99519-6650 wmn.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING/ Parcel I.D. ' 008-042-1.6 HAA # �`•/T ����� - Expiration Date: 1. GENERAL INFORMATION 1 Complete legal 'description T13N R3W SEC 33, LOT 6 W3 OF SE4 M&I3 Location (site address or directions) 4432 Wright St., Anchorage, AK 99507 Current Property owner(s) Giorge & Jean Angus Day phone343-4619 Mailing address .,,,,.4432 Wright St., Anchorage,_AK 99507.•::::::.a•s:..; ;i_;,�.,.. , Lending' agency-'`. y,>" Day phone'' Mailing address Real Estate Agent Les Bailey Dayphone_689-6451 Mailing Address 16635 Centerfield Dr., Ste• 103, Engle River, AK 99577 , Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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 engineers work. TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ' ❑ Individual Holding tank Q' ❑ Community On-site ❑ Public Sewer 0 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 engineers work. 4. STATEMENT OF INSPECTION SY ENGINEER As certified by my seal affixed hereto and as of the val'.da:icn dzte shown below, I verify that my investigation, based on procedures outlined in the Hea!tn Aut; erity Approval Guidelines for this application, shows that the cn-site viater supply ander vrastevrater disposal system is(are) safe, functional ' . and adequate for the. number of bedrooms end type of structure' indicated herein. I further verify that basad on the information'obtainec from the•Municpafity o' Anchorage, files and from my investigation and inspection, the on-site water supply andlor 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 KND ENGINEERING- Inc. Phone -(907) 696-6111 Address ?2 I�L2tarmi gin_' fld.� ��^l _-. �r,---.A'�.._°.g;7, Engineers Printed Name Kenneth i1jDuff LIS Date 04/08/03 1 4 �E OF ALg%,a� ���P;,je•... V* Fel N:�e ei.i.. •.••u.• :••.�•.•�� Additional Comments WASTEWATER Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other By: Original Certificate Date: (Rev 01,02f/ ••N•• •q•••u 5. DSD SIGNATURE �� iS:e Kon CE 711500' 'i r/ • 3a4�Fq'•:.;�•���,�..�� Approved for bedrooms. `„"•; Disapproved. �414p\a�-i�t6'`' , Conditional approval for bedrooms, with the following stipulations: Additional Comments WASTEWATER Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other By: Original Certificate Date: (Rev 01,02f/ .,...._.___..., ,.,_,.__...._ .....,...... _........._ .... ._....... Municipality of Anchorage Development Services Department Building Safety Division t On -Site Water & Wastewater Program • • 0 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T13N R3W SEC 33. Lot 6 W3 of SE�4 M&S Parcel ID:008-042-16 A. WELL DATA Well typerte vate If A, B, or C provide PWSID # Well Log (Y/N) N Date completed 1959• Sanitary seal (Y/NLY_ Wires properly protected (YM) Y Total depth-jr-ft. Cased to 40+' ft. Casing height (above ground) 12 " FROM WELL LOG AT INSPECTION Date of test 3/11/03 Static water level ft. 1 5 ft. Well production 9 -p.m 2.44_ m. 9•P• WATER SAMPLE RESULTS: Coliform 0 olonies/100 mi. Nitrate 0.200 gig./l. Other bacteria _J_colonies/100 ml. Arsenic: NA mg./1.Date of sample: 3/11/03 Collected by: KNQ Engineering, Inc. B. SEPTIC/HOLDING TANK DATA Tank Type/Material unknown Date installed 19 6 9 • Tank size 1.000 est. gal. Number of Cpmpartments_j.Cleanouts (YIN)3L-Foundation cleanout (Y/NO Y (w/in foundation) Depression over -tank (Y/Nj.0 High water alarm (YIN) N Date of pumping; 3/4[02; Pumper _McDonalds C. ABSORPTION FIELD DATA Date installed 1959` Soil rating (g.p.d./ftp or ft2/bdrm) unkagy System type c r i k Length unknown ft. Width unlMown ft. Gravel below pipe _unknown ft. Total depth 4.83" ft. Eff. absorption area unknown ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/11103 Results (Pass/Fail) Pass For2. bedrooms Fluid depth in absorption field before tegt 0 (Dry) in.Water added 300+ gal. New depth_U in. Elapsed Time:S& min. Final fluid depth 0 (Drvl in. Absorption rate >= 300 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed NA 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 50'+ Absorption field on lot 50'+ Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 50'+ On adjacent lots 50'+ Public sewer manhole/cleanout 100'+ Holding tank 50'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5 ' + Absorption field 5 ' + Water main 10'+ Water service line 10 ' + Surface water 100'+ Wells on adjacent lots 50'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3' Building foundation 10' + Water main 10 ' + Water Service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 25'+ Curtain drain 50'+ Wells on adjacent lots 60'+ F. COMMENTS A� G. ENGINEERS CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in • "K"s « »•••«. conformance with MOA HAA guidelines in effect on this date. ' 7K.Ir' Me• Engineers Printed Name Kenneth M. Duffus Date 4/08/03 HAA Fee $375.00 Date of Payment 4/09/03 Receipt Number o 33 '�' 8? (Rev. 12101) Waiver Fee $ 150.00 Date of Payment 4/09/03 Receipt Number �ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 April 8, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Undocumented Well & Septic — T13N R3W Sec 33, Lot 6, W3, SE4 Gentlemen: The well and septic system of the above subject property were undocumented. The 2 - bedroom house was built pre 1960 and the well and septic conformed to the applicable separation requirements of that year. On March 10, 2003 we excavated one testhole within 20' of the existing septic field for verification of ground water and bedrock or impermeable barrier. No bedrock or impermeable barrier was discovered and ground water was encountered at 9'. Attached is the soils log of the testhole. The septic tank is approximately 1,000 gallons and outfalls into a crib with an approximate depth of 4.83 feet. As shown on the attached as -built survey, the on-site well serving the lot is located within the house. The six-inch casing extends 12" above grade and 40'+ below grade. The well was probed to a total depth of 65' TOC. The crib standpipe is 3.5' from property line and we are therefore requesting a lot -line waiver. We do not expect there to be any adverse effect on adjacent lots by the location of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, IKVI D Engineering, Inc. Attachments: MOA HAA As -built Survey Water Analysis Soils Log 04/09/03 09s53am P. 001 N lit ADJACENT COMMERCIAL OULDINO 89057'38"W 48.42' SEPTIC CLEAN -OUTS TEST HOLE PIPE a 22' FENCE ENCROACHMENT A m ADJACENT SEPTIC CLEAN-OUT fA Z 8 8 . SHED e A �i O 21.6' O DEEDED PARCEL m DECK a DEEDED PARCEL 12.9' - o 4A' 19.5' 10.4' ,gyp &1' ONE STORY ,-.:: ADJACENT a.r HOUSE HOUSE n 4.1 8.1• .i• Isa• � d' G.L. FL•wc ' >D . LADJACENT WELL JN 89°57' IVE 2'• + . _ _` FOUND 5/80 REBAR NOTE POWER POLE THIS DRAWING IS BASED ON A CORRECTIVE Lot 21A DEED RECORDED JULY 25. 1985 IN BOOK 1462 AT PAGES 412 THRU 416 PLOT PLAN _ ASSUILT `f- SCALE I' _-30' GRID 1834 Project No. 03-M/A3 Lang do Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515 907 522-6476 Phone Registered Land Surveyors 9073 522-4625 Fax 1 herby certify that I have surveyed the following described property. '``. •"""'• . qs DEEDED PARCEL WITHIN BLM Lot 6, Section 33. T13N, R3W, S.M., Alaska .�- Anchorage Recording District, Alaska, and that the improwmeMs situated Cij.• 49T '•-� thereon are within the property lines and do not encroach onto the properly * ; adjacent thereto, that no Improvements on the property lying adjacent thereto �•• ••. .••?•* encroach on the surveyed premises and that then are no roadways, transmission Ones or other visible easements on said property except as Indicated heron. • •• .:•••• :KENNETH G. •LAt Dated thin the Fft Day of 449(L 2003 _ at Anchorage, Alaska Q° '• LS -5202 It Is the responsibility of the owner to determine the existence of any easements, 'ON "•••"' covenants, or restrictions which appy to this lot.°sslonAi I �-ADJACENT WELL FOUND 5/8" RE8 NOTE POWER POLE THIS DRAWING IS BASED ON A CORRECTIVE Lot 21A DEED RECORDED JULY 25, 1985 IN BOOK 1462 AT PAGES 412 THRU 416 PLOT PLAN __ ASBUILT SCALE 30' MD Prole& -A68/A Lang & Associates, inc 11500 Daryl Avenue, Anchorage, Alaska 99515 907 522-6476 Phone �000ppp� Registered Land Surveyors 907 522-4625 Fax o pF A k>k I hereby certify that I have surveyed the following described property:s��o DEEDED PARCEL WITHIN BLM Lot 6, Section 33, T13N, R3W, S.M., Alaska 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, tronsmission0 lines or other visible easements on said property except as indicated hereon. V0'y; """""""""""""'4 a O KENNETH G. LANG Dated this the Day of at Anchorage, 115 Dated LS -5202 -A It Is the responsibility of the owner to determine the existence of any easements. a�0� ORp�SSIONA��o covenants, or restrictions which apply to this lot. ADJACENT COMMERCIAL BUILDING N 1/2 89'57'38V 48.42' SEPTICCLEAN-OUTS TEST HOLE PIPE a 2.2' FENCE ENCROACHMENT r OIL ADJACENT SEPTIC CLEAN -OL? V1 Z O 8.3' x 8.3' O 4 SHED p r y W 21.8' O O ID DEEDED PARCEL m DECK o DEEDED PARCEL 12.9' ...? m 4.4' 19.3' 10.4'.. .. .......__...__... ._ .... . ' v re.10 ONE m STORY ADJACENT 5 7' y HOUSE HOUSE 8.1' 18.5' I �-ADJACENT WELL FOUND 5/8" RE8 NOTE POWER POLE THIS DRAWING IS BASED ON A CORRECTIVE Lot 21A DEED RECORDED JULY 25, 1985 IN BOOK 1462 AT PAGES 412 THRU 416 PLOT PLAN __ ASBUILT SCALE 30' MD Prole& -A68/A Lang & Associates, inc 11500 Daryl Avenue, Anchorage, Alaska 99515 907 522-6476 Phone �000ppp� Registered Land Surveyors 907 522-4625 Fax o pF A k>k I hereby certify that I have surveyed the following described property:s��o DEEDED PARCEL WITHIN BLM Lot 6, Section 33, T13N, R3W, S.M., Alaska 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, tronsmission0 lines or other visible easements on said property except as indicated hereon. V0'y; """""""""""""'4 a O KENNETH G. LANG Dated this the Day of at Anchorage, 115 Dated LS -5202 -A It Is the responsibility of the owner to determine the existence of any easements. a�0� ORp�SSIONA��o covenants, or restrictions which apply to this lot. `t OF Al %%a KT1 D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for: George Angus Date Performed: 03/11/03 Project: T13N R3W Sec 33, Lot 6 W3 of SE4 TEST HOLE # 2003-1 Depth 12- 13- 14- 15- 16- 17- 18- 19- 20- ORG/OL SEE ATTACHED SITE PLAN FOR HOLE LOCATION GP/SP— sandy gravel mod.dense, gray. w/ cobbles to 8" Visual perc rate 1 min/" B.O.H. {Vas Groundwater encountered? YES What depth? 9' Depth to water after monitoring? Date? Reading Date Gross Time Net Time Depth to Water Net Drop 1 2 3 4 5 6 7 8 9 10 11 12 Water Added Percolation Rate _ (min/in) Pere Hole Diameter_ Test Run Between feet and feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date.