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HomeMy WebLinkAboutGINAMI HILLS LT 2B inomi Hill Lot 2B #015-461-43 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191153 PID Number: 015-461-43 Dwelling: Al Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name GEORGE CONWAY ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot GINAMI HILLS LOT 2B Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line FtZ Ft. Well 100'+ tJ��+ TANK XSeptic ❑ S.T.E.P. [:1 Holding El Other Manufacturer ANCH TANK Capacity 1250 Gal. Surface Water 100'+ Material STEEL Number of compartments 2.0 Lot Line p'+ ( NA Foundation 1 01-}- LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield CO/MT Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection15t 7/18/19 Location and description GARAGE SLAB 3rd 01 ON-SITE WATER AND WASTEWATER SECTION APPROVAL��� Conditional Approval: Date � 49gH _...._ _._.__.__ _._.__.__.________�_.._. eY . Y. • 0 0 ... . O 0 Y Y �A ............. ...... Y . . moo° MICHAEL N. ANDERSON .� +�,°° CE 99 Y� .'�Y .7 7 ..° '.> Septic System t^ Approves ! i Date ��'��b►�`' Note: this approval does not include well permit requirements. (Kev ublulrn u) Permit No. OSP191153 Page 2 of 2 Municipality of Anchorage 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 Legal Description: GINAMI HILLS LT 2B PID No.: 015-461-43 / EXISTING WELL 0 NEW 1250 GALLON STEEL TANK CO3CO2 TCO2 TCO1 CO1 BENCH, GARAS ----_ i i i i 1 ' J r r t EXISTING I ASBUILT SCALE: 1 "=30' f -col r-Tcoi co`z COC ®®®®1ILTjdVA I / TCO2 I 0®® OF ®® AW MW 1.250 GALLON .Q ........................... . STEEL ranK •• B ®� /-,_1� :.MICHAEL N. ANDERSON. -",-1, # No. E 9A 69 ; �® SEPTIC SECTION �4�F••••.. gy'��* N.T.S. 6 _Sj p®® MARK A B C01 14 20 TCO1 15 21 TCO2 22 28 CO2 23 30 CO3 24 31 PID No.: 015-461-43 / EXISTING WELL 0 NEW 1250 GALLON STEEL TANK CO3CO2 TCO2 TCO1 CO1 BENCH, GARAS ----_ i i i i 1 ' J r r t EXISTING I ASBUILT SCALE: 1 "=30' f -col r-Tcoi co`z COC ®®®®1ILTjdVA I / TCO2 I 0®® OF ®® AW MW 1.250 GALLON .Q ........................... . STEEL ranK •• B ®� /-,_1� :.MICHAEL N. ANDERSON. -",-1, # No. E 9A 69 ; �® SEPTIC SECTION �4�F••••.. gy'��* N.T.S. 6 _Sj p®® 7114/1 �JN/C1P.11.,,r Op MUNICIPALITY OF ANCHORAGE Yn ent / • \ On-Site Water&Wastewater Program ', PO Box 196650 4700 Elmore Roadt. (IAAnchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,�v http://www.muni.orglonsite Department 4NCMOR;VE On-Site Wastewater Disposal System Permit Permit Number: OSP191153 Effective Date: 7/16/2019 Work Type: SepticTank Upgrade Expiration Date: 7/15/2020 Tax Code Number: 01546143000 Site Legal Address: GINAMI HILLS LT 2B G:2741 Site Mailing Address: 12130 GINAMI ST, Anchorage Owner: CONWAY GEORGE A& NANSALMAA Lot Size in Sq Ft: 108166 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 2 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 house and driveway shown on the site plan do not match what MOA aerial mapping shows. An as-built survey is required to close out this permit. Received By: fitlk; Date: �i Issued By: i-C/C.0 , Ccuu -Q9 Date: I 1 6 1 9 • MUNICIPALITY OF ANCHORAGE =' m Development Services Department Phone: 907-343-7904 On-Site Water &Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-461-43 ( GEORGE CONWAY 9.41f ..(pif C(" 22 7(-1 Propertyowner s) Day phone Mailing address 12130 GINAMI ST ANCH AK Site address SAME Legal description (Sub'd., Block & Lot) GINAMI HILLS LT 2B Legal description (Township, Range & Section) Lot Size 108,166 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. '/fl2 (Signature of property owner or authorized agent) Permit/Rush Fees: 3(D 0 Waiver Fees: Date of Payment: y/30I19 Date of Payment: Receipt Number: ^ ft' IO8$O Receipt Number: OS Permit No. P4/153 Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc • April 25,2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage,Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit • Legal: GINAMI HILLS LT 2B To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells,septic or open water issues. Sincerely0/1N)\--- Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 I • ')I 5 TO 6% SLOPE NO WELL OR OPEN WATER WITHIN 100' OF THE NEWr, C.O. TANK AREA. ,'z./ ADI !r , -j /►•; .ED �/,�' 11 3, r„ r ' r, �, � � � , ,, 5 TO 6% SLOPE Q zz ' C.b / REMOVE AND REPLACE rr EXISTING 1250 GALLON \ TANK WITH NEW 1250 \ �. PLASTIC TANK, DECOMMISSIONMT \\ .r ' PER UPC. IN �/ \ r v \ r \ r , R DCO ,'z- TOC CO EXISTING WELL ` 100 RADIUS �� /// EXISTING `\\. HOUSE / / / . . z \ / i/ • 00 \\ r / SCALE: 1"=30' Septic Tank Replacement ...,`�ii,11 GEORGE CCONWAY •'•�� O•• 4� 44* vi GINAMI S/D, LOT 2B A. - • Anchorage, Alaska : v r v v L J L,./ 1 V "...• L'."' pU ! � � � ! --le ___,I Aioo°or 'OG''iv �✓ 329.9¢ • 4 t0` TEL£. comm. k ELEC. ATU. ESM-, t ! Th EXIST. 25' 1~IIDE ROADWAY gSMT, �` lI \\9 \o tE • AL's OFF-STREW PAP*< WIT" S£C PAVED iN ACCAROANCE _ O ' . 21. 45.060.8. N o 1piI„ 1, 0 (/) i b ° L VI co Oe so 7------1—",___—......... ni t nI U� _ r '00.0 9ii m m F. I 25E r0 to fr 3 STI m I c 10,0.0 1 8. 's° B, FC yim 111 > H 0 y n i . >• m i% m 0 0 \/ R th II / �-- 3 N A NN / ------------s----, 1. 109.0 • j `Cc Ai00° 01' 00 " W �✓ 305, 04 o /p 1(.1) i 0 1 tI XI : 'j. f USE ZONE `I' `61.-___. ' ' 01VEa By 4, AIi ' i • J DatTa --_� `� All "1.- -i-i-7.--s. Clrshell i,e l'ro.Nn UI 1x�ot pL�n in 0tIed nlinr.p h�r d on this j or alt shall not he (1,4 ae specifi. j alt without'first , '. d, modified chl�ge order. '��aa>G . r°o fc, 0.- loo ' 25.00 A0O°00'/6, "E tv 0 G/kiAM I STREET Uo8 No.. 50033 ZONED C L1ENT • SCALE: f" •40' PLOT PLAN: X AS-BUILT: GRID: 2?4i DRAWN 8Y: BEM CHECKED BY; - F.Y.P.5. ENGINEERS . INC ANCHHORAGE�'r sr ALASKA 9950I LOT ZB . *1.4..1A1,11 HILLS .5Ue' . ANCHORAGE RECORDING DISTRICT.AK., s:•‘'°. 0. t' 4. • r�,c.,i, o.,,, •.,"'i-:'.•.::;41 i.. - . * DATED THIS (012 DAY OF APRIL. 1985. ANCHORAGE. AL ASKA. +�•I , 1 I IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER. PRIOR TO CONSTRUCTJON, ¢e6 . f/� ` '.•'C TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTILITY y _ 4••••,..I. 1' CONNECTIONS ANO TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS4,..^74,,...Oa',Latld 1 OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. �kT►, uc Q 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: .5, c,o o q._ ~, ~o O PID Number: c)~ ~" _ ~ U ( - ~ "~: ~ ~c.- ~o. w ~ ~ Wastewater System: 3 New ~pgrade Address: ~( ~, GO~ I It~ ~ ? ABSORPTION FIELD Phone: j No.~Bedrooms: ~eep Trench ~ Shallow Trench Q Bed E Mound D Other LEGAL D ESCR I PTI O N so, Rating: Total Deoth from original g~de: Lot: ~ ~ sm~k:~ Img~lSUbdiv~i°n:J~l[[~l ~ ~th to Cm~ ~om from~,~or,g,~l grace: Ft Gravel aeDth beneath WELL: O New ~ Upgrade Gravel width: ~, 0 Ft ( ~GPu ,,. ,,. TAN K SEPARATION DISTANCES = Septic 0 Holding From Tank F,eld Station Tank S~r ~mes Su,aCewater '~0'~ ,~'~ ~ /~ LIFT STATION Line ~ ~ ~ ~ ~ t~ ~ O I~ Size m gallons: Manufacturer: FounQation ~1~ ~0 ~ ~01~ "Pum~ on" level at: ~levelat: High water atarm at: Remarks: BENCH MARK AssumeO Elevation: 72-O13 (Rev. 9/91) MOA 25 Permit No. SW020300 Page 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 34,3-4744 On-Site Wostewoter Disposal System and/or Well Inspection Report of 2 Legal Description: LOT 2B, GINAMI HILLS SUBDIVISION PID No.: 015-461-42 \ C03 C02 // ~V M ..... GRND. PIPE cn~l ANK A U ELEV. ELEV. ~'~-~AL~ TC02 32 22.8 88 9 ~B~ TC02 VAL~ 32.8 24'2 88~g 85.88 _~~ ~ -- C01 133 25.0 88.g 85.88 ~____~A C02 65.7 56.5 83.42 81.1 ~ %~ ~ C03 62.6 47.4 82.62 78.9 ~ C04 119.1 117.3 81.44 79.0 / ASBUILT / SCALE: 1"=50' / / ~_* MICHAEL N. ANDERSON ~ ~ PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3- 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, AJaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: SITE PLAN Gross Net Depth~f'~1~ Net Reading Date Time Time Water Drop I;,..;,.;C ~' {,~" PERCOLATION RATE ~ ~) TEST RUN BETWEEN ~'4/~' ~ (minutes/incl,) PERC HOLE DIAMETER __ FTAND ~* ~'"" FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE; DATE; 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Aug 15, 2002 Expiration Date: Aug 15, 2003 Permit Number: SW020300 Legal Description: GINAMI HILLS LT 2B Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: George Conway Owner Address: PO Box 112275 Anchorage, AK 99511-2275 Parcel ID: 015-461-43 Site Address: Lot Size: 108166 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak,us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number SW 0 ~ O '~ o e Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Day phone '~r' ~-" Zip Code Legal description (Section, Township & Range) Lot Size ~ ~ Io~,/~,~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [~ Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 July 29, 2002 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 ;ils Re: Lot 2B Ginami Subd. To Whom it may concem: This is a request for a new septic permit for the above residence. The peru hole was completed along the north property line with silty gravels for the full 16 foot depth. A total depth of 16 feet was excavated with no water observed during excavation or after the 7day monitoring period. The peru was 26 minute per inch with tight sandy silts for the complete depth. The new deep trench will have 6 feet of septic rock and 84 foot length for the 4 bedroom system. A valve will be installed after the tank to keep the existing system at rest for future use. Ail the ground slopes to the northwest as the plan shows at 5 to 6 percent. This new system will not affect the future development of the neighboring properties or shadow out any neighboring septic replacement areas due to the new well radius. If you have any question please call me at 345-3377 Sincerely ~.~ M~A~nderson, P.E. r ~MOUND OVER DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD -1'__ OR !~ ~ ~,--.FILTER FABRIC SOILS = 600/0.6 = 1,000 SO FT REO'D -r.---~~ . 1,000/12 = 84' TRENCH: ~ ' , 7.5' DEEP cu I I 6' EFFECTIVE 84' LONG Io,X~-~DRAIN ROCK -16' __ =1, 2. ,- EXISTING SEPTIC EXISTING SEPTIC /,PROPOSED SEPTIC · ~-- DIVERTER VALVE '~.2- / ~'"EXISTINC V/ELL ~ -SULTANA DRIVE- Septic Design Prepared For GIN^MI HILLS SUBDIVISION ~49~ ~T '~j~*' MICHAEL N. ANDERSON, P.E. SCALE: 1"=200' AUGUST 15, 2002 76' ADDITIONAL PERC OUTSIDE 30' RADIUS 5 TO 6?. SLOPE TH~ 1 § TO 6~ SLOPE t ~ ~--30' TEST HOLE / ~'~ TANK WILL BE INSPECTEI AND REPLACED IF / ~ / '~ REQUIRED EXISTING HOUSE · .!., .'~ :'.:,".. ... ~... .... , ... :. ,.~... ,?.: .:.~. Septic Design Prepared For GEORGE CONWAY LOT 21] GINAMI HILLS SU1]DIVISION Prepared By MICttAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE (g0?) 345-33?7 / SCALE: I"=30' AUGUST 15, 2002 Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 3 4 5- 6- 7 8 9 10 11 12 13 14 15 16. 17 18 19 2O WAS GROUND WATER ENCOUNTERED? Depth to Water A~er. ~ M~i~ing? ~O~0~ .,Y'/%,t · ~[MImAEL N. AND(R~N ~-~ ~/ DATE PERFORM ~ Town~hip, Barite, Section: SLOPE SITE PLAN Gross Net Depth ~t' o ~ Net Reading Date Time Time Water Drop ~'lq PERCOLATION RATE TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER __ ;TAND '~-- FT PERFORMED BY: /N/It ~'~ d~f/~ ! t/~l,~ ~ Cir~/~ r'l , CERTIFY THAT THIS TEST WAS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: '7/"J-~/O ~ 72-008 (Rev. 4/85) IN "'--~/ MUNICIPALITY OF ANCHORAGE L.~/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE VE £NoN H o UC~K NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer Liq. ca in DISTANCE TO: NO. OF BEDIMS Dwellin gj.~ L IWidth I Abs°r~ti°nf~a PERMIT NO. No. of IF HOMEMADE: Liquid depth PERMIT NO, Manufacturer Liquid capacity in gallons Well DISTANCE TO: J~ i~) T" J/~ No. of lines Length of each line Top of tile to finish grade Length Inside length Dwelling Material Founda~o Nearest Io~J~p~ Total length of lines Trench width ~ O '~(~:m inches Material beneath tile Depth Width PER T¢ )/7 Distance between lines Total effective ~;;;~ption~ area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: ~Jass Depth ~;. Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER 'ERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL / F:'ERFI t 'I" !',IE~ ,~ ).3 A'I" E I S S U E Il) ¢~ APF'L. ;[ CA NJ" ;~ A )i) D F;'. E S S x C[)N'I"A[ZTT' PF'I[]NE '~ L. EGAL.. DESCF;: :1; P ~', VE!;F;,'NON HOUCK c/r.) '1" 2.':):::.; W :[5 T'H A N C H O!::;:A[i')E., Al::; ?950 2 '?' 9 ..... ;5 <",;" :t. ~ c:er 'L i fy t.h~%:,'.'.. ~. foP'LI"~ by !:.he NL~r'l:kc::J.p,':'i].J.'t:.y of ~i"ic::{;'ic)r.;;~(.:.~, '(l~[)~':i) ~2,, :[ v~J.].]. :i. ns'l:..a].]. ~'..I"~,:.)~ sys'Lem :i.n ac:c:c~rc[an,:::,:.:a v,~J.'Lh a].]. hi(iA c:c)c:h-:~s and ~',(.::~.~;~..~:l.a't'..:~.(:)i'":~;~, Ed-id :i.n c::c>mpl:i.~u"u::~;(.:, (.,.~i'k.h C lq ,:.::.:, d(~.~,:s:i.,;:;in c:r'J.'t.e:.~q":[e~ (::)~' 'Lh'J.s :5. :[ 'will ~'~cl!"~(arc-) 'k.c) all P'!(]/:.~ a?,.nd SC.:Fk.~:, (::)f A:i.~:isi<a q.,, ]: und;.;:,rsi:.a.n~J i'..ha'!:. 'k.l";J.~;~. p(ar'mi'k. :i.s va].:[d, for 8. ny er':~]..:'ar'gsn'leF;'k. ~/,¢J.:i.]l. r,~:.;)qL(:Lr',:~;~ .[;;d"~ .a';.ci,::J:k'k.:~.c:)r'~.//~]; I::' A !....:l:F:'l' S'I'ATZ[)N IlS :I:NSTAL..L.E)5 :iN AN AF~E¢:i CE~VE:F;:ED LE,.::%,",k:,:.';Ai ...... ,II. RI.:: ,"~..S; .... ~ZdE BZ.'..E }:~:5.' A .~::.' x' ...... B ELZbZ::'"":~':[T:[AF,&,, - ~... ~... [... ~. ~..,~..~ ~,~ ] .... ...... F:'I~F?.I'fi ]: T N,.C) ~ D(Y'FE!: :[ S!3LI!:E'3 ~ C:~C)N"i',,':'.~C:;"[' [::'F!(3I',[E: i[ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6' 7 8 9 10 11 12 DATE PERFORMED: ~ q .,'T I ~ N : f~ ~ lY-/. %.ic4 SITE PLAN 13 14 15 16 17 18 19 2O COMMENTS FI PERFORMED BY: 4o, 2225-E '¢' JLi;iE 23, L971 .', -,~ : :" ': t' ,¢, :::": ~ SLOPE ; GROUND WATER NTERED? N C) SL O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 1,2¢.o '30 'mo ~ ~/ ~,. Ig~o bo ~o 6~ ~.~ PERCOLATION RATE /~' (minutes/inch) TEST RUN BETWEEN .5 FT AND . FT 72-008 (6/79} & ENGINEERS. INC. 71£5 OLD SEWARD H'W'~.''~/ ANCHORAGE:. ALASKA 9950:5 ,549 -6561 SOILS LOG - PERCOLATION TEST /~ I'EHCOI A TION 7-;4-2. 4 $ 7 8 9 10 12 / 0 / 0 / 0-~" C~D6A~,..IIO..- r-{A,-cgTLIAL. 6"-7' C-f2A'vUL. j vJ WAS GROUNO WATER ENCOUNTERED? IF YES. AT WHAT DEPTH~ / Time Time I'. 35'~ ~,w I : O,J~__ zo " /:4~ '5" bRWHEICHDALIT"'N' OF AmCHORAGE ko � Development Services Department �f� Phone: 907-343-7904 On -Site Water & Wastewater Section `-- Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-461-43 1. GENERAL INFORMATION Complete legal description GINAMI HILLS LT 213 Expiration Date: f © Z© —I Q Location (site address) 12130 GINAMI ST, ANCH AK Current property owner(s) Mailing address Real estate agent GEORGE CONWAY SAME Day phone 5 6 7� iI nfl b 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) `� ��`�J�q❑ Duplex k6. �'❑ Multiple Dwellings (Single Family and/or Duplex)'L��95't4, 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well r] Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: �j, , Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55-0Waiver Fee $ Date of Payment Vas -6// iR Date of Payment Receipt Number 2�D52- ) Receipt Number COSA # o cJ r Iq /33!� Waiver # 21 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-27-19 49TH 6. DSD SIGNATURE �•••"" "°°'°° °� System #1 Approved for 4 bedrooms • ° °; ° ` ° Y pp p° MICHAEL N. ANDERSON System #2 Approved roved for bedrooms P� �.�•• CE 94 9 •�`% Disapproved �QP? 2 Ip. X R FESSl@��ti Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 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 Checklist blue sheet N -SITE i _` =M AIA AND VASTE m PRO,ORAM ,moo J .�. - By: Original Certificate Date: 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 Checklist blue sheet COSA Checklist Legal Description: GINAMI HILLS LT 213 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6115/85 Total depth 245 ft Cased to 57 ft Al Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 6/20119 Static water level at beginning of test 52 ft. Comments B. TANK DATA Age of tank(S) NEW years Tank type/material STEEL Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEWT AN K D. ABSORPTION FIELD DATA Which system tested (date installed) 8/31/02 ❑ ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from gradel •5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-461-43 Structure served by this system Well production at time of test 2+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L Al Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 7/17/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/20/19 Results Q Pass For 4 bedrooms Fluid depth prior to test 15 in Water added 600+ gal New depth 28 in Elapsed time 1440 min Final fluid depth 16 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date L' 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' P� Yes Community Sewer Manhole/Cleanout > 100' M✓ Yes if No ft Q✓ Yes if No Neighboring Tank > 100' F/ Yes if No ft Private Sewer/Septic Line > 25'✓� Yes if No Absorption Field on Lot > 100' F✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50'✓0 Yes if No M Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft E✓ Yes if No ft Property Line > 5' P� Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 21 Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' Q Yes if No ft Community Wells > 200'✓Q Yes if No. Water Service Line > 10' 0 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' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓� Yes if No ft Private Wells > 100' Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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 ft ft 0 Yes if No ft 0 Yes if No ft 4,% 49tH °-;0 °° MICHAEL N. ANDERSON e Q GR. 25 9 ';7 0 0 0 0 0 Ei C14 0 01 0 _P1 N 89*57'26" j)ate 110' T <r I"- L)RAINAGE EASEMENT Legal Description BOBBYF. BURNETT 2941 Carriage Drive Anchorage, Alaska 99507 (907) 350-5541 7/22/2019 111 = 50 LOT 2B GINAMI HILLS SUBDIVISI (D AS -BUILT Drawn by Field Book 0 BFB AS62019 PIAT # 83-244 O C3 C; 0 (Delf Z: 77- 'X� A, 0 0 0 0 9 ';7 0 0 0 0 0 Ei C14 0 01 0 _P1 N 89*57'26" j)ate zscate Legal Description BOBBYF. BURNETT 2941 Carriage Drive Anchorage, Alaska 99507 (907) 350-5541 7/22/2019 111 = 50 LOT 2B GINAMI HILLS SUBDIVISI Grid SW 2741 AS -BUILT Drawn by Field Book BFB AS62019 PIAT # 83-244 MUNICIPALITY OFANCHORAGE 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) /'Z 13l C~tCuAc4t -bC2~¢¢ Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent .%~z,~ ,~.,',~¢ ~ L~-~'[$,~ .~l'¢,cV. Lu~t-r~; co Day phone t ¢ Address ._% c~( C ,_%'~ ~.-(-! ..q~ t'"c-Cr "Z ~ ~ "6 f~ c(~ A lc. 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- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 sTATEMENT iOF' iNSpEcTiON. BY ENGINEER.'' "~:" '_ ~ AS certified by m~, 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'~'~A ~/~t:~~ ~.~c;. ~',4 (: Phone Address 'T'~.~.~ ¢._ l q"?.crz~- A to et~ ~A [C Engineer's signature DHHS SIGNATURE · ~" APproved for /¢ Disapproved. ConditiOnal approval for bedrooms. bedrooms, with the following stipulatiOns: Additional Comments Date~ i;;The MJ~'ic[C/ality of An~c~orage DePartment of Health and Human Services (DHHS) issues Health Authority Approval certificates based only.upon the representations given in paragraph 5 above by an 'independent professional engiheer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage D 12 F' .~ DEPARTMENT OF HEALTH & HUMAN SERVICEI~ I;, ~., E iV [ D Environmental Services Division ]998 825 L ,Street, Room 502 · Anchorage, Alaska 99503 · (907) 3~'4'~4~ Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: A. WELL DATA Well type ¢"~f~ Log present (Y/N) "~ Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ~ / Oasing height (above ground) / ~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION / ? ~ ~ fi.p.m. ~. ~ ~.~.m. Date of sample: -5-/tT/] q~ B. SEPTIC/HOLDING TANK DATA Nitrate I ' 6 ~,~l/ Other bacteria Collected by: ..% ,p .~C~ /L P F Date installed ~/>//~S Foundation cleanout (Y/N) Date of pumping ~'/l~/~ ~ Tank size /'Z~"-~ Numbe~' of Compartments E_ Cleanouts (Y/N) ~ ~ Depression (Y/N) /t_J High water alarm (Y/N) ~ Soil rating (g.p.d,/ft2 or ft2/bdrm) Z. cc.~ Gravel thickness below pipe Monitoring Tube present (Y/N). ~ Results (Pass/Fail) ~i::~ 2~ System type ,.~-'~'~ Total depth C. ABSORPTION FIELD DATA Length ?O Width ' Effective' absorption ,a. rea C~ ¢O Date of adequacy test' "~///b [ ¢~' __ Depression over field (Y/N) ,/~ For '~ bedrooms Fluid depth in absorption field before test (in.); ~$'"//~Y t Immediately after ~ gal. water added (in.): Fluid depth "'~/;~ qt¢ (ins) Minutes later: /qqO Absorption rate = ~,¢c~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed / Size in gallons Manhole/Access (Y/N)~///~ High water alarmleve *~ / /'JJ *Datum E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots On adjacent lots Public sewer main '"'~L/(,A, Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /~-t Property line ~'C~ ~r- Absorption field Water main/service line Public sewer manhole/cleanout ,,4,/(' ~A, Lift station /o~ '~- Surface water/drainage. ICc~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / O '~ Building foundation ·z¢¢ ~ Water main/service line /c~__~ t Surface water /'~O+' Driveway, parking/vehicle storage area '~°~ Curtain drain ~ ('~ ~ t'O c.) --r- Wells on adjacent lots / ~'~'~' ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor~~l~ems in conformance with MOA HAA guidelines in effect on this date. Signatur~ ~ Engineer's Name ~'~ ~ ~~~'~' Date ~/[~ [ ~ ~ are HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Steven R. Pannone, P.E. Consulting Engineer P.O. Box 142025 Anchorage, Alaska 99514 (907) 272-8218 SEPTIC SYSTEM ADEQUACY TEST Legal: Owner: Residence: Lot 2B Ginami Hills S.D 12131 Ginami Drive, Anchorage, AK 99516 Septic System: (from Municipal records) Tank Size: 1250 gallons. Absorption System Size: 3x5x90 Installation Date: 6/7/85 Absorption System Type: Deep Trench Absorption Area: 900 s.f. Soil Rating: 200 sfPor Date of Pumping: 5/18/09 By: A+ Home Service Date of Test: 5/16/98 Test Procedure: System was inspected and measured. Tank was found with 4 feet of cover. Liquid depth was measured to be 12 Inches. The drain field was found to have 3 to 5 feet of cover and a total depth of 8 to 10 feet. There was 25/34 inches of liquid measured in the field's monitor tube. Water was added at a constant rate of 2.2 GPM (which is the production of the well). The water levels in the tank and drain-field monitor tube were monitored. A total of 600 Gallons of water was added. During the test the level rose 4 inches in the field. No rise was noted in the tank. The infiltration rate was monitored for 1440 minutes. During this period, a total of 600 Gallons were absorbed. The observed infiltration rate is 600 Gallons per day. TESTS RESULTS: This system meets the code requirements of the Municipality of Anchorage. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measm'ed to readily identifiable features. The operational life of all wells depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the conn'ol of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. MIINICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL mRALTH DEPIdlTMENT OF ~ALTH ~zND ENVIRONF~NTAL PROTECTION A~PLICATION FOR ~ALTH AUTHORITY APPROV~J~ CERTIFICATE 1. General Information Application Date (a) Legal Descriptiono(incl. ude lot, block, subdivision, section, township, range) L ~?" 2~ (~,,,t,,~c /-~,'lis Location (address or directions) (b) Applicants Name~-J~ ~7. ~_f~fz.. Telephone - Home~g~usiness~&'-It~tO ~ Applicants ~dress Z~ ~ T. Oa~ ~'3 ~ ~00~~ ~' ~50~- (C) Applicant Is (check one) Lending Institution ~ ; ~er/buildgr ~ ; Buyer ~ ; 0ther~ (~plain); (d) Lending Institution Address -f~s~ /~ (e) Real Estate Co. & Agent Telephone ._~ ~ - o~© Address -- Telephone (f) 2. T~pe of Residence Single-Family~ Number of Bedrooms Mail ~he HAA to the following address: C) ~LC~;.',:~ C~q"ac- ~ ~. i-~-~-~' 'c.~.~o Multi-Family Other (describe) 3. Water Supply~ Individual Well Commuuit 7q Fublic f--q 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 0nsite ~--~ Public ~ Community ~-~ Holding Tank ~--~ Note: If community well system, must have written confirmation frgm the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] DHEP Approval Approved for~/,~ . bedrooms Approved /~ Disapproved __ Terms of Conditional Approval 5. Engineering Firm Providing Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of 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 regula- tions in effect on the date of this inspection. Name of Firm Q¢-~q~'~'c ~'v\S ~:~c)~1~-~-~' ~ 'J_~ v~('. Telephone ;~ ~/~' ''~ °~ Address i~~-O( '~l')Y ~ L~I~ -~,~P~'~:~.~.,~ '- ' :~ '.~' .~' .~' 7:: '.'.~~. Condition~ ~ CAUTION THE MIJNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN pARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS ~S A COURTESY TO pURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND 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 OK OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/Di8 [Page 2 of 2] 7-19-84 ae Well Classification Well Log P~esent (Y/N) Total Depth ~ ~ ' ~d to Static Wate~ ~1 /~' Casing ~ight ~ Gr~nd Elec~ical Wi~ing in Conduit (Y~) ~p~ation Distan~s ~ ~11: To ~ptic~olding Ta~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALYS{ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: If A, B, c~ C, D.E.C. Appr Date Completed .~l Depth of G~c Pump Set At Sanitary ~/ Depression ; O~ A~joinin To Nearest Edge of Absorption Field on Lot '~/~ ; On Adjoi To Nearest Public Sewer Line A3/~ To Nearest P Cleancut/Manhole ~i ,~ Water Sample Collected By Water Sample Test Results Comments ~oEC~ ~ B. SEPTIC/HOLDING TANK DATA To Nearest Sewer Service Date Installed ~.._~ __ %c~ Size l~.~0 ~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Dep=ession over Tank (Y/N) tO Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ;J ; for Holding Tank High-Water Alarm (Y/N) A)/% Temporary Holding Separation Distances f~cm Septic/Holding Tank: No. of Ccmp Foundat i~ ~UNICIPALITY OP ANCHO~AG~ DEPT. Ol: HEALTH & ENVIRONMENTAL PROTECTION i'd j~'¢ ':,-,'© ,%' ,~'~/ oved(Y/N) ~al on Casing (.Y/N)Y_ bund Wellhead (Y/N),~'''' Lots '~ / O ning Lots ~- Jbli~ Sewer Line on Lot ~tments Cleanout (Y/N) ~ 2-15-84 [Page 1 of 2] Receipt 9 Date Paid: Amount: To Water-Supply We 11 + I O0 To Progerty Line c~ O' To Water Main/Service Line Course ..k I OO' Comments L ~' ~ t~ i-:~ ( ~( o,~' Major D~ainage To Building Foundaticn To Disposal Field To Stream, Pond, r~ke, T. ink Permit (Y/N) Soils Rating in Absorption Strata Date .Installed L~ - 7 - ~ 5- Width of Field ~3 &~ /~ Square Feet of Absorption A~ea Q~ Depression over Field (y/N) /~) Date of Last Adequacy Test Results of Last Adequacy Test ~/~ Separation Distance from Absorption Field: To ~t~ter-Supply Well +l0o~ To P~operty Line 4~ ~(%' To Building Foundation ~/c~' To Existing or Abandoned System cn ; On Adjoining Lots ~ / ~. o ~- / ~o ~ To Cutbank(if present) ~//~ Type of System Design Length of Field ~/o ~ Depth of Field /.~ '~' /~ ~ Gravel Bed Thickness ~ / Standpipes Present (Y/N) Lot /~ ~ ~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Coarse To Driveway, Parking Area, or Vehicle Storage Area LIFT STATION -- 1~\ Date Dimensions Manhole/Acces~Y~ "tka~ On" Level at ~-~, "Pump~Qff" ~vel at High Water Alarm Level at -~~ Vent (Y/N) Tested for Electrical Codes Comment ~s ~ /~ing Cycle~i~g~dequacy Test. Meets MOA ** Check Permitted Bedrccm Rating A~ainst HAA Request I certify that I have checked, verified, o~ conformed to all MOA on the date of this inspection. a~ ~l~'t ~.~/'~-- Date ~-1 Signed Company <~v.~$-~, ~ ~ ~r ~fi5 ~c~ MOA No. J ~' - ~ - ~-~ KB1/d5/s effect [Page 2 of 2] 2-15-84