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Home My WebLink AboutALPINE TERRACE BLK 1 LT 1Alpi*ne Terrace Lot 1 #015-243-25 Original field constructed in 1975 is undersized, so should not be tested for future COSAs . Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite •(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161332 PID Number: 015-243-25 ❑ New 0Upgrade Name TERRIPAULS ABSORPTION FIELD ■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 11600 HIDEAWAY TRAILS "ANCHORAGE, AK ❑ Other PhoneNo. of Bedrooms' soil aaeng: Total Depth from anginal greae: 632-1464 4 0.6 Goals, FL 10 (MAX.) Ft LEGAL DESCRIPTION Depth to pipe incur tam anginal Wade Grovel occur beneath pipe: SEE DWG. FL 7&7 Ft Subdivision) Block) Lot: Fill added above anginal grade: Gravel length'. ALPINE TERRACE 1 1 SEE DWG. 37.5 & 37.5 FL Ft. awns ip Ful section: - - - Gravel wiffir Same number of lines: Distance between lines: 2.5 & 2.5 FL - - rt. SEPARATION DISTANCES Total mainrydoe area: 1055+ ember of trenches 2 Dist between trenches: 14'+ TO Septic Absorption Lift Holding PublidPrivate From Tank Field Station Tank sewer Lines GG. PL Ft well 100'+ 100'+ 100'+ 25'+ TANK ❑ Septic ■ S.T.E.P. ❑Holding ❑ Other Manufacturer'. capacity: Surface water 100'+ 1004 1004 - ANCHORAGETANK 1500 Gal. Material: Number of comparMdider Lot Line s+ 104 51+ - N/A STEEL 2 Foundation 5'+ 104 51+ _ LIFT STATION Curtain Drain NONE KNOWN Naomacmrer: capaaty'. ANCHORAGE TANK "500 Gat Remarks: OLD SEPTIC TANK DECOMMISSIONED PER UPC PER 'Pump on level at 44 'Pump or level ac 40 nigh water alarm at 46 CONTRACTOR BOTTOM OF SOUTH TRENCH INSPECTED BY MOA Pump Make6 MOEeL Eledrlcal Inspections pertormetl by EMPLOYEE TIM ECKLUND ON 12/1/2016 'SECOND COMPARTMENT OF PF200511 MOA 1500 GALLON STEP TANK PIPE MATERIAL House to tank D3034 Tank to D1778drainfield D3034 Installer WILCO EXCAVATION Drainfield D3034 CO/MT D3034 Inspector GEG,Ltd. BENCHMARK (Assumed elevation) 99.850 Ft Inspection Location and Deveripeon Dates: 1st17/1/7016 2nd 17/7g016 3rd 12/2/2016 4th 12/5/2016 TOP OF MANHOLE ENGINEER'S SEAL Community Development Department Approval 041, Conditional approval: Date: ally �� ..... �j M.....:...... is,.. ............. I i it ...t. A..; ........I .......�. .. Ia tty A.Gar = lness : � Approved: Date:�' �3' EROFESS\_A-`` O LICENSE 1,11kj1l • kAECCB84 Inspecaon Fri yt-tzdoc OSP161332 RECORD DRAWING 015-2 3 -UMBER 015-243-25 ti�til ST1 60.9 37.8 ST2 68.8 45.2 MH 70.5 46.7 C01 73.9 41.8 CO2 111.2 76.5'_ CO3 105.1 75.8 C04 141.6 112.9 MT1 75.7 1 43.0 MT2 107.3 73.2 MT3 107.3 78.8 MT4 139.4 110.0 FS 73.9 43.5 T.HXi TRENCH NEW STEP TANK WAS PLUMBED INTERNALLY WITH DUAL PRESSURES LINES SO THAT FLOW CAN BE DIVERTED PERIODICALLY BETWEEN DRAINFIELDS 10' UTILITY EASEMENT / 1.25" VC CONVERTED TO �4" 30347 FEET BEFORE / ZABEL F.S. EW 1500 GALLON // STEP TANK ,Tr,------- � ST1 I I A FCO EXISTING HOUSE GARNESS ENGINEERING GROUP Ltd OLD SEPTIC TANK - CIVIL & ENVIRONMENTAL ENGINEERS 3701 E TUDOR ROAD, SUITE 101 -ANCHORAGE, AN 99507 -PHONE (907) 337-6179 -FAX (907) 338 3246 ' WEBSITE www Bamessengineenng com DECOMMISSIONED PER UPC PREPARED FOR' T.HX7 WAS DRV PRIOR PAGE NUMBER'. C� PER CONTRACTOR 632-1464 TO CONSTRUCTION ON 11/30/2016 PROJECT/LEGAL DESCRIPTION: DRAWN BY BOTTOM OF SOUTH TRENCH ALPINE TERRACE, BLOCK 1, LOT 1 D.J.G. 1�< INSPECTED BY MOA EMPLOYEE TYPE OF WORK: DATE: TIM ECKLUND ON 12/1/2016 RECORD DRAWING 12/13/2016 #AECC884 ALL ADJACENT WELL RADII, SURFACE WATER, NORTH AND WEST LOT LINE, AND 50 FOOT SETBACKS TO SLOPES >25% WERE FLAGGED BY SHANE HOLT, P.L.S. PRIOR TO CONSTRUCTION NEW DRAINFIELD NEW GRAINFIELD T.HXi TRENCH NEW STEP TANK WAS PLUMBED INTERNALLY WITH DUAL PRESSURES LINES SO THAT FLOW CAN BE DIVERTED PERIODICALLY BETWEEN DRAINFIELDS 10' UTILITY EASEMENT / 1.25" VC CONVERTED TO �4" 30347 FEET BEFORE / ZABEL F.S. EW 1500 GALLON // STEP TANK ,Tr,------- � ST1 I I A FCO EXISTING HOUSE GARNESS ENGINEERING GROUP Ltd - CIVIL & ENVIRONMENTAL ENGINEERS 3701 E TUDOR ROAD, SUITE 101 -ANCHORAGE, AN 99507 -PHONE (907) 337-6179 -FAX (907) 338 3246 ' WEBSITE www Bamessengineenng com % Ay •. PREPARED FOR' PHONE NUMBER. PAGE NUMBER'. C� TERRI PAULS 632-1464 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY ALPINE TERRACE, BLOCK 1, LOT 1 D.J.G. 1�< TYPE OF WORK: DATE: RECORD DRAWING 12/13/2016 #AECC884 A N SCALE: 1"=30' 1 4 . DRIVEWAY r..... ......... .i fi✓e� AN94ness E-7 n P/ OFESS��i��• On -Site Wastewater Disposal System Permit Permit Number: OSP161332 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 11 A 111111" -Q Ucparuncnt Tax Code Number: 01524325000 Work Type: Septic Upgrade Permit Effective Dates: November 17, 2016 to November 17, 2017 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: ALPINE TERRACE Site Legal Address: ALPINE TERRACE BLK 1 LT 1 G:2740 Owner/Address: PAULS TERRI R DECLARATION OF TRUST PAULS TERRI R / TRUSTEE 11600 HIDEAWAY TRL ANCHORAGE AK 995076127 Site Mailing Address: 11600 HIDEAWAY TRL, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank All construction must be in accordance with: Lot Size in Sq Ft: 51600 Total Bedrooms: 4 N Privy N Private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Original field constructed in 1975 is undersized for 4 bedrooms, so should not be tested for future COSAs. Received Issued By: fit u' A &'IyLa II/I7It(,, Municipality ®f Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage. Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://vvww.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161134 COSA#: Permit#:OSP161332 PID#: 015-243-25 Legal Description: Alpine Terrace Block 1 Lot 1 Engineer: Garness Engineering Group Applicant: Terri Pauls Your request for a waiver of the required 5 feet horizontal separation from the absorption field to the test hole has been approved. The approved separation distance is 0.0 feet. See engineer's letter for waiver request. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................ Waiver is Granted: X Waiver is not Granted: Date: 11 1 20 1 to Approved by: Name of Reviewer ............................................................................... **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF A Community Development Department Development Services I N 0 V 0 9 2 0 IS On -Site Water & Wastewater Program \ Mayor Dan Sullivan On -Site Sewer/Well Permit xr; lkatlon For A Single Family Dwelling Parcel I.D. 015-243-25 RAGE 907-343-7904 907- 343-7997 Property owner(s) TERRI PAULS Day phone 632-1464 Mailing address 11600 HIDEAWAY TRAILS *ANCHORAGE, AK Site address 11600 HIDEAWAY TRAILS 'ANCHORAGE, AK Legal description (Sub'd, Block & Lot ) ALPINE TERRACE; BLOCK 1, LOT 1 Legal description (Township, Section & Range) Lot Size Sq.Ft. APPLICATION IS FOR: Initial (gall that appy) Upgrade Absorption Field Renewal Septic Tank Multiple Dwellings Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms APPLICATION IS AN: Initial ❑ Upgrade Date of Payment: Renewal ❑ A THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: DRAINFIELD TO TESTHOLE TYPE OF DEWELLING: Single Family (SF) Waiver Fees: (w/wo ADU) Date of Payment: Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Receipt Number: Distance: 0 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) PermiURush Fees: lo. (16) Waiver Fees: Z5- t- d_( Date of Payment: / l // 0 / I& Date of Payment: ////Q//& Receipt Number: aa)&:tom Receipt Number: Q,5-ff336 �SP ��/�` Permit No. Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS November 9, 2016 Quanics D � Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Alpine Terrace; Block 1, Lot 1 To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The drainfield is in a state of failure and needs to be upgraded. We are proposing to install a new 1500 gallon STEP tank and deep trench type drainfield. The existing septic tank will be decommissioned and the existing drainfield will be connected to with a diverter valve for potential future use. One testhole was excavated on the property and the drainfield is designed around its 30 foot radius. Comments regarding the design are summarized as follows: 1. SOILS: See the attached 2016 logs which show the soil classifications and groundwater monitoring and percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography around the proposed drainfield is 5-10%. There are slopes >25% on the property. However, they are more than 50 feet from the proposed drainfield. 5. WAIVER: We are requesting that your department issue a variance for the required five (5) foot separation distance from a drainfield to a test hole.The test hole was backfilled with native soil, which was uniform throughout the testhole depth. Any "loose' material in the testhole area of the trench will be excavated out, which may result in a localized portion of the trench that is wider than 2.5 -3.0 feet. We are unaware of any adverse impacts this installation or waivers would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. 3701 East Tudor Road, Suite 101 "Anchorage, Alaska 99507-1259 Phone: (907) 337-6179' Fax: (907) 338-3246 . Website: www.garnessengineering.com DESIGN CRITERIA: NUMBER OF BEDROOMS.4 GALLONS PER DAV (GPD): 600 PERCOLATION RATE/S: 21.8 MIN/INCH PROPOSED APPLICATION RATE: 0.6 MINIMUM DRAINFIELD SO.FT.: 1000 FP DRAINFIELD DESIGN: MAXIMUM DEPTH: 10 FEET WIDTH: 2.5 FEET LENGTH: 2 AT 36.5 FEET (73 FEET TOTAL) EFFECTIVE: 7 FEET ACTUAL SO.FT.: 1022 FP ALPINE TERRACE; BLOCK I, LOT DEG, Lid. HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. PROPOSED TRENCHES co #I NOTE: THE CONTRACTOR SHALL HAVE THE NORTH & WEST LOT LINES, ALL WELL RADII, AND 50 FOOT SETBACKS FROM SLOPES >25% FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. THE ALERNATE SITE WILL BE RE-BULDING OR RE -UTILIZING THE EXISTING TRENCH WITH ADVANCED TREATMENT 3130% 5%I 58/01 APPROXIMATE 100 FEET FROM .SURFACE WATER APPROXIMATE LOCATION O SLOPES>25%;PROPOSED DRAINFIELD IS >50 FEET FROM SLOPES 20 FOOT MAINTENANCE EASEMENT 10' UTILITYJ�ZASEMENT 44 5-10% C T__________ _______ 1� ______ l<______-___________ T .. __ — ---- CIVIL & ENVIRONMENTAL ENGINEERS APPROXIMATE LOCATION, 3701 E,TUDOR ROAD, SUITE 101 -ANCHORAGE. AK 99507 ' PHONE (907) 337.8179 • FAX (807) 338-3246 • WEBSITE: www. Bemesse,ginaen,p T.H.#1 O OF EXISTING TRENCH E 5-10%/ / '• '� ' DRIVE WAV MT rf EXISTING SEPTIC TANK TO BE '•,� 632-1464 DECOMMISSIONED PER UPC— ' , 'r PROJECT/LEGAL DESCRIPTION: DRAWN BY �♦♦T�` ALPINE TERRACE; BLOCK 1, LOT 1 D.J.G. 1� < TYPE OF WORK: / • SEPTIC SYSTEM DESIGN UPGRADE 11/11/2016 #AECC884 / / DECOMMISSION EXISTING SEPTIC TANK AND REPLACE WITH A PROPOSED / 1500 GALLON STEP TANK 5% 5%I 5%� 1; EXISTING FCO i 3130% 5%I 58/01 APPROXIMATE 100 FEET FROM .SURFACE WATER APPROXIMATE LOCATION O SLOPES>25%;PROPOSED DRAINFIELD IS >50 FEET FROM SLOPES 20 FOOT MAINTENANCE EASEMENT � APPROXIMATE LOCATION OF CLASS C WETLANDS BORDER lNl I I I I CAL I._4 I ��•„ \\I1 ffq�e� ASG! ess J/ CE -79 3 11�3a��(�: : P�1bFESS1��•�� /w *. GARNESS ENGINEERING GROUP, Ltd " CIVIL & ENVIRONMENTAL ENGINEERS 3701 E,TUDOR ROAD, SUITE 101 -ANCHORAGE. AK 99507 ' PHONE (907) 337.8179 • FAX (807) 338-3246 • WEBSITE: www. Bemesse,ginaen,p PREPARED FOR: PHONE NUMBER: PAGE NUMBER' I C^ TERRI PAULS 632-1464 2 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY �♦♦T�` ALPINE TERRACE; BLOCK 1, LOT 1 D.J.G. 1� < TYPE OF WORK: DATE: • SEPTIC SYSTEM DESIGN UPGRADE 11/11/2016 #AECC884 � APPROXIMATE LOCATION OF CLASS C WETLANDS BORDER lNl I I I I CAL I._4 I ��•„ \\I1 ffq�e� ASG! ess J/ CE -79 3 11�3a��(�: : P�1bFESS1��•�� DESIGN CRITERIA: NUMBER OF BEDROOMS:4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: 21.8 MIN/INCH PROPOSED APPLICATION RATE: 0.6 MINIMUM DRAINFIELD SO. FT.: 1000 FP DRAINFIELD DESIGN: MAXIMUM DEPTH: 10 FEET WIDTH: 2.5 FEET LENGTH: 73 FEET EFFECTIVE: 7 FEET ACTUAL SQ.FT.: 1022 FT' ALPINE TERRACE: BLOCK 1, LOT 2 GEG, Ltd HAS A 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. PROPOSED TRENCH BULL RUN VALVE 5-10� T 11 5% 14 li I I I APPROXIMATE 100 FEET FROM SURFACE WATER . NOTE: THE CONTRACTOR SHALL HAVE THE NORTH & WEST LOT LINES, ALL WELL RADII, AND 50 FOOT SETBACKS FROM SLOPES >25% FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. THE ALERNATE SITE WILL BE RE-BULDING OR RE -UTILIZING THE EXISTING TRENCH WITH ADVANCED TREATMENT // 10' UTILITYk.ASEMENT -'. 's `•..'.. h. 1R% ------- )G------------------ ____ f—APPROXIMATE TERRI PAULS LOCATION '• OF EXISTING TRENCH , •' .:R DRIVEWAY DRAWN BY EXISTING SEPTIC TANK TO BE '•, DECOMMISSIONED PER UPC ' • :.: ••; ` -.'r. / I DATE: SEPTIC SYSTEM DESIGN UPGRADE 11/11/2016 AND REPLACE WITH A PROPOSED 3ALLON STEP TANK I ✓EXISTING FCO r APPROXIMATE LOCATION OF CLASS C WETLANDS BORDER APPROXIMATE LOCATION O SLOPES >25%:PROPOSED DRAINFIELD IS >50 FEET FROM SLOPES FOOT MAINTENANCE EASEMENT GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E TUDOR ROAD, SUITE 101 -ANCHORAGE. AK 99507 -PHONE (907) JJ7-6179 • FA% (90T) JJ9-RIB • K£BSRE: ww'x B+massellpineeny.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER' TERRI PAULS 632-1464 2 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY ALPINE TERRACE, BLOCK 1, LOT 1 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM DESIGN UPGRADE 11/11/2016 m 4 III S / *fyk6y.Q_. Q9mess i 47m ♦♦F,P ��IIIIb •�•F�: ♦♦♦ PROFESS\c LICENSE ,111�"„�� OAECC884 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS 3701 E.TUDOR ROAD, SUITE 101 'ANCHORAGE AKe0e0R- RHONEU107)v7s17e- RAA W7)»,U'vERRIRe.....e.�,�....rv....,.a SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: ALPINE TERRACE; BLOCK 1, LOT 1 PERFORMED FOR: TERRI PAULS DATE: 11/1/2016 DEPTH (feet) ORG TEST HOLE #1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 GM SOIL CLASSIFICATIONS lffwmjyw�.. DATE DRY 0. DRY 11/8/2016 3:15 - 6" II�III,II 2 i//iI 30 4.625 ONi0#1 3 3:45 - • uOR".ROW 4 II"IIII 30 4.625 1.375" 5 4:15 WWRAO 6" " 6 4:45 30 4.625 1.375" DEPTH TO GROUNDWATER DATE DRY 11/1/2016 DRY 11/8/2016 3:15 - 6" DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 11/2/2016 1 3:15 - 6" 2 345 30 4.625 1.375" 3 3:45 - 6" " 4 4:15 30 4.625 1.375" 5 4:15 - 6" " 6 4:45 30 4.625 1.375" 19 PERCOLATION RATE 21.8 (MIN./INCH) PERC. HOLE DIA. _ TEST RUN BETWEEN 5 FT. AND 6 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: ERIK WIDGER COMMENTS: PERCOLATION READINGS ARE WITHIN 1/160F INCH. PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PRF RMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 11 q b 6 (INCHES) GREOWNCHORAGE ,AREA BOR" Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �+f�lo n i/.c/� MAILING ADDRESS SKA—XO.'3�'6-M � PHONE LOCATION /]/GCD.6iL LEGAL DESCRIPTION -Z7 y SEPTIC TANK: DISTANCE J FROM WELL— �� MANUFACTURERS_= ATERIAI NUMBER OF COMPARTMENTS_ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPAC An;p 7,w_ r 6E -or A4N-i+E4_D: J i TOTAL LENGTH / DISTANCE FROM WELLn/_6�0_ FOUNDATION NEAREST LOT LINE OF LINES NUMBER OF LINES 1 DISTANCE BETWEEN LINES TRENCH WIDTH (3/ IN. TOTAL EFFECTIVE �9 1 ABSORPTION AREA Poo � SQ. FT. LENGTH OF EACH LINE /V / DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE ^3 MATERIAL BENEATH TILEIN. ABOVE TILE �LC�IN. WELL: / TYPE �{-//CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE , TANK , SYSTEM_ APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: E'a &4t REMARKS: —/�� r -p" /g005, 10ek_ cZW�uu�++QOi'� Form EQ -032 DIAGRAM OF SYSTEM APPROVED G.A.A.B. CR 3 � F { 0` _ ��$.. �ia I /szol �."�lTT_,� �C�PQ�Ptt� �yI f F /v I aG i APPROVED G.A.A.B. C $ / C<tJ O LV fir( e' Well Log / For -Q]. ............................................. Locationvymlt .....r .................. Date n��h54AdgSb)`1 Sze.a`�,T/ai);�3�iS/% p.......�.. Depth of well..0.....Y<...N-TA ... and-6.17Q,..[.}.Cl...I.q-,Cf..... Sizeof casing.-.I.X.....t.Yi(I.............1.............................................................. Distance to wateri..1.1.`�.1?�.. I ..................................................... Distance to water while pumping ....6 y ....�'N.�rS.0 .Q,.. .at rate ofA.raC... A.UCllrV—J....... gallons per hour. Formation I from I to i Ira 0' Intl ,n a C(ii I q Q I c) c � C n I_C�- ; 43 - q5 y? -4c) i IN nHer DELTA DRILLING COMPANY SRA BOX -,P94 8 _,_ `:4!'OPwnr. ALASKA 99507 '� GREATER ANCHORAGE AREA BOROUGH Y 00--n, DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT � � I - U 1(LING ADDRESS 5 -� / 1 ! o— G PHONE INSTALLATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT D AIN r-FtRT:r--- OTHER y/ N TYPE AND SIZE OF FACILITY TO BE SERVED /'✓! Y✓1 FINANCED THROUGH To BE I/NSTAL ED B SOIL TEST RESULTS _ l / �/%7L1I T — /"'' Z� T / 1• is pERMiT 13 NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE / ` �e�.x TYPE �2 " � Jp SIZE /� MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK J ' / �/n J 2 FOUNDATION TO SEEPAGE PIT Z/7 , DRAIN FiGLA SEPTIC TANK TO SEEPAGE PIT WALL ! nC I SEPTIC TANK , SEEPAGE PIT DRAIN FN!tD TO NEAREST LOT LINE. WELL TO SEPTIC TANK // SEEPAGE PIT DRAIN FIELD Lg// ALSO CONSIDER AREA WEI WATER MAIN TO SEPTIC TANK SCJ SEEPAGE PIT DRAIN FIELD SEPTIC TANK, ( �O / SEEPAGE PIT /✓ DRAIN FIELD L TO RIVER, LAKE, STREAM. - - CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSIN( EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEE FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL SACKFILL - A CONFORM TO BOROUGH RE LATIONS REGARDING INSTALLATION. G.A.A.S. OR LICENSED DESIGNER DIAGRAM OF OF SVSwle ✓ I CERTIFY THAT.I AM FAMILIAR WITH THE REQUIREMENTS OF GREATERw ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE A PLICANT'S BIGNATUR FORM NOFEQ-016 BOROUGH ORDINANCE NO. 28-5°8 AqD THAT THE ABOVE EATER ANCHORAGE AREA BOROU0 6 ` Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99603 SOILS LOG - PEROLATION TEST Performed for _4s�� e Legal Descriptiov This form reports: Soils Depth Feet 2- 4-- 5 - 6 - 8 - 9 - 10 - S/ ope 11 = 12 - 13 - 14 - /''las ground water encountered? /)'1D-- If yes, at what depth? on Date Performed -IlLc / �S test Reading I Date I Gross Time Net Time to Water I Net =t a vercolation rate minute. •Proposed installation: Seepage Pit Drain Field Depth of Inlet _ _ �^ Depth to bottom of pit or trench COMMENTS: rerrormea uy: EQ -040 (6/74) Municipality of Anchorage a On -Site Water &Wastewater Program (907)'343 7904 \. CERTIFICATE OF ON�'/APPROVAL Parcel I.D. 015-243-25 Expiration Date: _� - I 3 1. GENERAL INFORMATION Complete legal description ALPINE TERRACE; BLOCK 1, LOT 1 Location (site address) 11600 HIDEAWAY TRAIL `ANCHORAGE, AK Current Property owner(s) TERRI PAULS Day phone 632-1464 Mailing address 11600 HIDEAWAY TRAILS *ANCHORAGE, AK Real Estate Agent Cox Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 440-9820 WaiverNariance request for. IV/H Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 41q • LQ V Waiver Fee $ Date of Payment 12-I ll b Date of Payment Receipt Number 1 5� Receipt Number COSA # _Osr.I rO 5 g� Waiver # TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ WaiverNariance request for. IV/H Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 41q • LQ V Waiver Fee $ Date of Payment 12-I ll b Date of Payment Receipt Number 1 5� Receipt Number COSA # _Osr.I rO 5 g� Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER 6. 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 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK, 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments - In conducting this evaluation, GEG provided an engineering evaluation of the well andorsepb'c system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industrypract ces The repodea msults describe the condition of the systemis on the deters of the evaluation. Separation d3lances were measured to madilyidentibable features Hidden defects or encroachments may exist that were not identified during the evaluation. The operational the area wells and septic systems depend on a variety of variables including, but not limited to, sod conditions, gmundwaterlevels (that may fluctuate during the year), quality of construction (materials and workmanship), and Me water usage of the family ubfaing the systeMs. These conditions can vary, and are outside the conlml of GEG. Satisfactory test results do not guarantee future performance of the systemls; therefore, GEG makes no warranty (express or implied) regarding the future performance ofthe "Nor septic system. GEG makes no representation whether an alternative well or septic system can be Installed on the pmpen yve the evenf reherofthe current systems fail The content of this report is for the sole benefit of the pencr✓pary who retained GEG Reliance upon the information provided in this report by any other person or party, including but not staged to subsequent properrypumhasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the persoNyarly who paid for this report DSD SIGNATURE System #1 Approved for bedrooms. „ ��xilci{illil with the following stipnions:Wq WASTEWAND m System #2 Approved for Disapproved. Conditional approval for 337-6179 Date I,? � 14 t.- . *.....7491 •IF.I.d...... x................ a VEX \GarnesFE :�� LICEN E44jIft\\S\s' �••• #AECC884 bedrooms bedrooms AAA �o �� T;"RIgtnr.'5 ... Original Certificate Date: 2- 1 S -- The The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. tonvta) /` Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA Well type. PRIVATE Date completed 6/3/1975 Total depth 79.5 ft. Date of test Static water level Well production ALPINE TERRACE, BLOCK 1, LOT 1 -PERFORATED FROM 43-77' If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. Parcel ID: 015-243-25 Sanitary seal (Y/N) YES Cased to `40'+ ft. FROM WELL LOG 6/3/1975 30 WATER SAMPLE RESULTS: B ft. AT INSPECTION 11/2/2016 29.1 ft. g.p.m. 3.0+ g.p.m. Coliform 0 colonies/100 ml. Nitrate 1.43 mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 11/2/2016 B. SEPTIC/HOLDING TANK DATA Tank Type/Material _ STEP/STEEL Tank size 1500 gal Number of Compartments ? Date installed 12/5/2016 Cleanouts (Y/N) Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping NEW Pumper YES C. ABSORPTION FIELD DATA NORTH & SOUTH Date installed 12/1-2/2016 Soil rating p.d./ r ft2/bdrm) 0.6 System type DEEP TRENCH Length 37.5 & 37.5 ft. Width 2.5 & 2.5 ft. 'Gravel below pipe 7&7 ft. Total depth11.5 TO 12.111. Eff. absorption area 1055 ft2 Monitoring tube YES Depression over field No Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in.absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: _ min: Final fluid depth in. Absorption rate>= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date INFORMATION ON 1975 TRENCH IS IN MOA RECORDS `SECOND COMPARTMENT OF STEP TANK "PER MOA ELECTRICAL INSPECTION REPORT - SEE ATTACHED ' D. LIFT STATION Date installed 12/5/2016 Size in gallons '500 "Pump on" level at 44 in. "Pump off" level at 40 in, Datum BOTTOM OF TANK Cycles tested NEW E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) YES High water alarm level at 46 in. Meets alarm & circuit requirements? "YES Septic tank/lift station on lot 100+ On adjacent lots Absorption field on lot 100'+ On adjacent lots Public sewer main 75'+ Public sewer manhole/cleanout 100'+ 100'+ 10l)'+ Sewer%septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 10'+ Water service line 19+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: - Property line 19+ Building foundation 10'+ Water main 10'+ Water service line 19+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain'drain NONE KNOWN Wells on adjacent lots 100'+ F.,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. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 10/12/12) 4V cp p.• ..h..:.._ P� LICENSE •,� ��FESS �� #AECC884 LOT 3, T & T SUB. 10' UTILITY EASEMENT 20 ' MZMTENr1NCE EASEMENT ( PIAT 66-63) W C0.T6[0 ML[ f t LY o SIN FRpjAe OUSE sa? LOT9, BLOCK 4 N 89 58' E 215.BB SOLDOTNA - DRIVE 49 TH7 •.7. S4tft ,SA IIA&L.— u e SHANE A. HOLT..' es 1 e, LS -8814 p�.6v ..... _D c LOT IB, BLOCK 4 /THE INFORMATION HEREONIS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES, EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT. ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. \ ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. FROSTLINE COURT 0 Z AS -BUILT SURVEY 1"' • 30' NO CORNERS SE THIS DATE HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1, BLOCK 1, ALPINE TERRACE SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _7 TH DAY OF _DECEMBER 2816. HOLT LAND SURVEYING 93096ROVER DRIVE ANCHORA6E,Al 9950] 13393. FB 177-74 315.504 �Jo � CPN m Sti �0 0 Z AS -BUILT SURVEY 1"' • 30' NO CORNERS SE THIS DATE HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1, BLOCK 1, ALPINE TERRACE SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _7 TH DAY OF _DECEMBER 2816. HOLT LAND SURVEYING 93096ROVER DRIVE ANCHORA6E,Al 9950] 13393. FB 177-74 315.504 Municipality of Anchorage Development Services Department u e Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www, ci.anchorage. ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. c� 6 J n2 y3— �� HAA#_ /i D/L7�S� 7 Expiration Date: 1. GENERAL INFORMATION Complete legal description LOT 1 E) k 1 AL_P I N L T� Y2.$ -AC Location (site address or directions) l 16 `0_0 / /14l D F—A-�/Aj/ TP_ /-- t L Current Property owner(s) k r LJT-e cP 1,i�'-tdf e{ Day phone 34'.x—%71 � Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Ki 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) 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 less than 30 days old. (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. F 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further 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 Ut:- Phone --2o JI/ Address of n 3 l5 Pic, 020 Engineer's Printed Name x �P✓UAIL` STAMP ti"a ry Tobben Sp,,!4iand _3 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ��w' -.- 6�N �lTG •` Gi Additional Comments = �' WATER AND Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev 12100) X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Municipality of Anchorage • Development Services Department ' Building Safety Division On -Site Water & Wastewater Program S " eT v 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: LOT 1 , Z tL l & UP I t -I t 1 1F__ a to C a Parcel ID: 015- g q3 - 12.5- A. WELL DATA Well type If A, B, or C provide PWSID # � Well Log (YIN) kA Date completed Pre 14 7 6- Sanitary seal (YIN) * Wires properly protected (Y/N) Y Total depth W ft. Date of test Static water level Well production Cased tc $0 ft. Casing height (above ground) 3 0 in. FROM WELL LOG WATER SAMPLE RESULTS: ft. g.p.m. AT INSPECTION -NIS-/01 ft. g.p.m. Coliform O colonies/100 ml. Nitrate I..1101 mg./I. Other bacteria ND colonies/100 ml. 7 Date of sample: Ie/0 t Collected by: �S B. SEPTIC/HOLDING TANK (DATA Tank Type/Material bLG/Q'"4Sep /10544 Date installed L1/75 Tank size 150 gal. Number of Compartments J_ Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression over tank (Y/NII) Highwateralarm (YIN) r� Date of pumping _74010 1 Pumper 2=0 'YO C. ABSORPTION FIELD DATA // Date installed L'/'7 J Soil rating (g.p.d./ft2 or ft2/bdrm) �/ 3fl System type ) 4-444 Gly/ Length 40 ft. Width 3 ft. Gravel below pipe 10 ft. Total depth t3 ft. Eff. absorption area &GU ft' Monitoring tube _- /_ Depression over field ri Date of adequacy test 7 _Z/C-/V 1 Results (Pass/Fail) P_ For 3 bedrooms Fluid depth in absorption field before test JA_ in. Water addedyJOgal. New depth /0 in. Elapsed Time: /80 min. Final fluid depth F in. Absorption rate >= 1/50 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date ✓ D. LIFT STATION Date installed _ "Pump on" level at Datum Size in gallons in. "Pump o eve/ at `in. Cvcl s tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot l Ott 4 Absorption field on lot 10.0 � Public sewer main Ngo+ Sewer /septic service line b O k Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots ) b 0 On adjacent lots _� i c.> Public sewer manhole/cleanout NA Holding tank SIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 4,2 Property line y0 Absorption Feld g Water main N/,io, Water service line 1 A5 Surface water 3 0 + Wells on adjacent lots >! Lf O in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: l/ Property liney Building foundation 7o Water main %-4 Water Service line 5 Surface water i 3D Driveway, parking/vehicle storage too + Curtain drain N/y Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and F'•.2 'SZ:�Yy �� review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name j D ✓1 K tie.`.;,, cfsss5 7 _ Date •,,.•, HAA Fee $ Gid Date of Payment 71z�&Iw ZZ Y8 Number J` g (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number 6 MUNICIPALITY OF ANC14ORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 2/3', �y® 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ��,, �"" i P 41 LD 3 (b) Applicant Name _�_�._ Telephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/ftiftirrikBuyer F-1; Other ❑ (explain); (d) Lending Institution —P—.N r&4Aivtc a S3i WO, Telephone—�6S4011— Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms — :!�!_ 3. WATER SUPPLY Individual Well Community ❑ Public ❑ 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 t{r Public 1:1Community [3Holding Tank ElNote: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025(11/84) 5. ENGINEERING FIRM PROVIDIONSPECTIONS, TESTS, FILE SEARCH, AAND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. �y Name of Firm �� 1 Telephone Address Opa txl) `�P_— Date Z �� f rig Engineer's Seal .�j'. °N 2225.E °`.•,,, {a., =. JUN` 25. J. SDS 'S 6. DHEP APPROVAL �Ld� Approved for bedrooms by _ Date k, Approved � Disapproved Terms of Conditional Approval Conditional The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in'paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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. Page 2 of 2 72-025 (1V84) • •MUNI DEPT.I OFOHEP. TH &RAGc MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA)n , MUNICIPALITY OF ANCHORAGE E HECKLIST- FEBRUARY 1984 , O Z yed�priJt DEPT. OF HEALTH & - ENVIRONMENTAL PROTECTION 264-4720 , 'AN 2 9' Legal Description: LcrrI �r4�,� pra 1 ez. SEC ? W/ A. WELL DATA RECEIVED Well Classification RVS If A, B, C, D.E.C. Approved (Y/N) H%A Well Log Present (Y/N) W Date Completed R+'!. IRTS YieldY_%gm2 Total Depth 80 Cased to 90 Depth of Grouting lY0 n 2 Static Water Level Pump Set At Casing Height Above Ground 3CD Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot > 1a0 ; On Adjoining Lots > 'r d0 To Nearest Edge of Absorption Field on Lot > /80 ; On Adjoining Lots /ClO To Nearest Public Sewer Line NONE-: To Nearest Public Sewer Cleanout/Manhole NON E To Nearest Sewer Service Line on Lot ` Water Sample Collected by %7—C, Date /53 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed *4,117s- Size IA5D No. of Compartments IMN C Standpipes (Y/N) 014a Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped lyjy/a's Pumping/Maintenance Contract on File (Y/N) HIA ; for hiA Holding Tank High -Water Alarm (Y/N) WIA Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well > 1 D J To Building Foundation 1'3 To Property Line 30 To Disposal Field G 7 To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/94) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2tr0 Type of System Design % peH?yC14 Date Installed y/%� Length of Fielder i Width of Field 3 Depth of Field �3 Gravel Bed Thickness Square Feet of Absorption Area Aero Standpipes Present (Y/N) Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Date of Last Adequacy Test l Z/3D 45 To Property Line 3 t> Lot /Y0"l = ; On Adjoining Lots To Existing or Abandoned System on To Water Main/Service Line 7 I D To Cutbank (if present) N ON t. To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N o N 4 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 12./3 14-6 Signed - Date Company MOA No. Receipt No. CI'0�5 y{l Date of Payment N Amount: $ 65' 0o Engineer's Seal *o. i 2225-E ,` JUN: 25, 1971 Page 2 of 2 n',.'p �?u'� 72-026 (11/84) ••. - • MUNICIPALITY OF ANCHORAGE •. UNiCIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC7EIQN OF HEALTH & DIVISION OF ENVIRONMENTAL HEALTH ENVRONNENTAL PROTECTION CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPRQVAL , ,) IM OF ON-SITE SEWER AND WATER FACILITY 264-4720 RE )XID j'J Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _L07- Location (address or directions) (b) Applicant Name .q_ * /4 Telephonner:'Hom�e _A V4Z -7 Business Applicant Address A13bot._t�. (c) Applicant is (check one): Lending Institution ❑ ; Owner/SETA Buyer ❑ ; Other ❑ (explain); (d) Lending Institution P > u b"WOM Telephone a 466 e ZCaf Address (e) Real Estate Company and Agent Address Telephone (f) Mail the MAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 0- 3. WATER SUPPLY Individual Well Community ❑ Public ❑ 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 ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIOINSPECTIONS, 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 regulations in effect on the date of this inspection. Name of Firm 7 _ Telephone __4122!3_T 6 Address Date c D Engineer's Seal ••i°o. 2225-E JUiJr 25. t971 p/ u� 6. DHEP APPROVAL // l Approved for ^l' bedrooms byte Approved — Disapprovew Conditional t Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of 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. Page 2 of 2 72-025 (11/54) Time Wime t Date Date Date Inspector Inspector Inspector Comments l Conditional Approval Date Sewer Installed Permit No. Septic Tank Size 7.2 -77 `— %Y Holding Tank Size Soils Rating Well To Absorption Area j a Well Log Received Well to Tank / (� -\ APPLICANT FILLS OUT LOWER HALF ONLY Property Owner N N �� Phone Mailing Address Buyer f '� Address 1V 1p� Lending Institution !' A.rj A5kA UStl S��G CVJ olNew Phone Address ,7 J-4 P�N!&/ 5/1nA.C� // Realty Co. & Agent Phone Address Legal Description Street Location ° UC o wQ r k>a1 L Typef Residence Single Family 3 ❑ Multiple Family No. of Bedrooms ❑ Other r WatSupply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June Community - 1975. For wells drilled prior to that date, give well depth (attach log if -1Public Utility available. Sewage Disposal to Individual Year Individual Installed: L . Public Utility When Connected to Public Utility: ❑ Holdlnq Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality u 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ++ Date Received 9 -,2 & - 7.5" Time of Inspection 7®;LCAjX- Date of Inspection in REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: �5R,4 Box 346 -/r) Phone: 3qq- 985827y-0(�II 2. Property Owner: Phone: sa +'n e- a s ab o ue� Mailing Address: 3. Legal Description: Lai- ) n lock 1 Al o2 th e. 7"� -r-oLc r- 4. Location: Lp�p O'Malley „° ' s. 5. Type of facility to 4-e inspected 6. Wg11 Data: S A. Type /t7ddi'u;L4 CL/ C. Construction 7. Sewage Disposal, system: o n -s i'4- (5 .i.'7 ngie -r); 1 y No. of bedrooms 3 B. Depth SO D. Bacterial Analysis 4 A. Inst41_ld B. Installer C. Septic Tank: 1. Size /asp 2. Manufacturer 4 D. Seepage Pit: 1. Absorption Area p o 2. Material E. Disposal Field: Total length of lines 8. Distances: I 4 )qC A. Well to: Septic tankAbsorption area; Sewer Lines , Nearest lot line S_, Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line " EQ -034 (1/74) Page 1 of two pages r Page 2 of two pages - Re for Approval of.Individual Water Facilities Legal Description Comments Approved V5aL oLk Disapproved Date Approval,, Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) /a[�� li GREATER ANCHORAGE AP BOROUGH Department of Environ,.cntai Quality \ 3330 9 "C" St., Anchorage, Alaska 99503 - 274-4501 * REQUEST FOR APPROVAL OF INDIVIDUAL SEINER & WATER FACILITIES 2. 3 4. 5 b 7 A 9 Type of inspection: COhdV Property Owner: iiailirig Addres D- gle Name of Buyer: Y-,1— --- }.flailing Address: Day Phone ;game of Lending Institution: Mailing Address: Phone Plane of Realtor or Agent:--- `' Mailing Address: - Phone Legal DescriFtion: Location: . Type of Facility to be inspected:No. Bdrns j= -- Wa%er Supply j Type of Supply: Public Utility Individual If Individual, number of dwellings pr`sently served If Individual, depth of well Sewage Disposal System Type .of System: Public Utility `_ Individual {on-site} �. If Individual, date of installation