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SEAVIEW HEIGHTS BLK 2 LT 6 (LT 7A)
Seaview Heights Block 2 Lot 6 (LT7A ) #011 - 261 - 28 MUNICIPALITY OF ANCHORAGE DE 3TMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825"L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name / _ DISTANCES 1Cc/rr�5 ((til i : 601 1-q(n 1 -D Address o - AL I.- na FROM TO SEPTIC ABSORPTION WELL TANK FIELD 8711 6omer6 Phone(s) PermitrNo. No.of Bedrooms WELL 8 0' _ g&0C 7y I 3 f LEGAL DESCRIPTION LOT LINE 4/0' O LntBlock Subdivision I '7) 8 2 QUfxi.:� x-1113 FOUNDATION / I -- Township.Range,Section /�� P i ( AS-BUILT DIAGRAM 1Show location of well,septic system.property lines.foundation. Z 1 „ , 7 WC driveway.water bodies.etc) TANKS iiiiwENEMEM MEMS\ iii ® SEPTIC ❑ HOLDING ■■' '''4■■■■■ . r.. Manufacturer Capacity in gallons • i ■..'.''■. U. CLnel�[}r'ay•e. /000Niii Material No.of Compartments 3 ( TYPE OF SYSTEM I11TRENCH ❑ BED ❑ W. DRAIN 171OTHER Depth to p pe bottom from I Total depth from original grade original gradeFTillIllillIl FT Fill added above original grade Gravel depth beneath pipe FT FT� Gravel length Gravel width FT FT' 4u Total absorption area f Distance between lines SQ FT( FT Number of lines Soil rating SQ FT Pipe material Installer Date Installed WELLS ❑ PRIVATE ❑ OTHER (Identify)Classif cat on(ABC) Total Depth Case()to !1IIuhI FT FT ■■■.■''' I 1 installei Date Installed. I REMARKS: U ce o . -"MA: 01\a \ `•I I Scale: TNI ilk l 4C_ ! P► Inspectionsby. E-.. -yfi,, .. .NAL Ot^t\ Performed ,.A�''(s•. d C,Q +o SG per. 3• M®r r►s C� ,'O i'�s-',,...pec = '!.••,.. 1' Date C 1 ��''0 1 t.. Go • ';) 0 • at- b E? 3i Marc]) 8� F ., , I J..4-.4 t // certify that this ins ection was performed according to all .•> Municipal and State guidelines in effect of th 3 /1/]date: sict ,-,,,,i,„.. Ia. CL-5283 • ,'.' .<aJ +/t,., A' `77 ` w I b 4468/ / A' Health Department Approval: &e Date `.tbe•-. - ' 72-013(3/85) MUNICIPALITY OF ANCHORAGE Departmenpf Health and Environments Protection Pouch 6-650 , Anchorage , AK 99502 264-4720 On-site Sewers Permit HANDWRITTEN Permit No : 8dv Date Issued : -31/111S46 Applicant : 30--'t a-S. Address : 6-1?2.4 S ' e.I-S n''Q . Legal Description: S/D: '4114...r l ,f"s. Lot : ) 1, & Block: 2-- Section : Section : Township : !2—A4 Range : 41.47- Lot Size : 32" ' (Sq . Ft . or Acres) Lot Location: Max Bedrooms : Listed below are the options available to you in designing your septic system. Choose the option that best fits your site . TRENCH BED W. DRAIN Depth to pipe bottom(ft . ) Gravel depth (ft . ) Total depth (ft . ) Gravel width (ft . ) Gravel length (ft . ) Tank size (gal . ) Soil rating (sq . ft . /br) ** Gravel length 75 feet requires multiple runs (not exceeding 75 feet each) ** Tank must have at least two compartments I certify that : 1 . I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2 . I will install the system in accordance with all MOA codes and regulations , and in compliance with the design criteria of this permit . 3 . I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well , wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4 . I understand that this permit is valid for the maximum number of bedrooms stated above, and any enlargement or modification will require an additional permit . IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES , THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT ; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN . SIGNED: `� _ C DATE : 3-' 7 - 6( Applicant ISSUED B Y : ,s , 0 %°„�`"® DATE : 3 - / -7. SWP/024 rev . l/85 e - 0 11 -7 ! 8-(p 0 MUNICIPALITY OF ANCHORAGE 1. 7� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION l •_ ► r ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /I PHONE LJ NEW J /Yle-S .S/NA/ �J Q ❑UPGRADE MAILING ADDRESS 1 I -�� �-d3 oa g7 •�/ Se ,EreS. � 10 � L • EGAL DESCRIPTION L o T 71- 8 i 2 S.q v/ew // LOCATION NO.OF BEDROOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: I-ZManufacturer Material No.of compartments ti i` FIST NG- Liq.capacity in galloIF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. JCZ I�FQ- Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO.GUO / ,`� w= DISTANCE TO: OO (� 7 J LL Z No.of lines / Length of each liner Total length of lines Trench width Distance betty ��,nn nes -2w 31 Si 3 Cn inches / Top of tile to finish grade i Material beneath tile Total effective at or tion area cc O 9 igeMes (o Length Width Depth PERMIT NO. w <I- Type of crib Crib diameter Crib depth Total effective absorption area o.wa ce wWell Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. rie/MITE w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS A SOIL TEST RATING / .2S '4 . N INSTALLER I \ 3J1 I `+ NEW-70N tXG REMARKS s eiusTnr� °� S eP —. ti1/41) st/ 0 WEll APPROVED DATE LEGAL 42- k aG i z. //—/o — eU 72-013 (Rev.3/78) r 111\11 , r•1 L t-4 I e_: I a -_-�1._ I - "�-'° e�'F FI t-.1 C:t--1 �:iR E3 E ► : U DEPARTMENT 0HEALTH ANC:' EN'V'IRONMENTAL E .BTEC T I ON =25 'L' ATF:EET, ANC:HC,RAGE Hf:. _a 51j1 ` 1 1W. I I 'Lo -V 254-4720 At«h h 1 cit-.1—'=• ITE 7E;EI.•-1Efes: F'EF:t•'1 I -1-- PERMIT PERMIT NO. :: 800649 :t APPLICANT JAMES P. SINNEMA 8 7'21 SOMER_ PLACE : 43-6,1 4 LOCATION SOMER PL LEGAL LOT Th8 ELK 2 SEAtir IEW HTS. LOT SIZE 32670 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH d) 1-a(D i_b 3 Ga bot MAXIMUM NUMBER OF BEDROOMS = = SOIL RATING (SO FT/BE:)= 125 THE REQUIRED _IEE OF THE SOIL ABSORPTION SYSTEM I- : G■E F'T H= 8 L E t-.1'3 T HI= .4-7" I23t--1' E I_.-. [:'E F'-1-I1---1= -- THE LENGTH DIMENSION I S THE LENGTH ( IN FEET) OF THE TRENCH OR DRA I NF I ELD. THE [:DEPTH OF A TRENCH OR P I T I' THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION ( IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I' THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION ( IN FEET). F:E o-:!e_I I F:E E' EFF I '-: T Fi 1•-J I< I . E= . BD ID i i ' II -JE PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSF'ECTICONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TI-•-tc_u ':: I r-a'•F'EeC T I sIt•I_• FORE F:EI !U I IREID --- BACKFILLING -- E:HC_KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL E:E SUBJECT TO F'F:OS EC:UT I C it d. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 1001 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A F'RIVATE SEWER LINE I S 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM_ ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EI:tr1 I T E F- I IFr:E' C_•EC:Et•lE:EF: .71.]:1L, 1..'_„:-:4;1 I CERTIFY THAT 1 : I AM FAMILIAR WITH THE REQUIREMENTS FOR CON-SITE SEWERS AND WELLS AS. SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2 : I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE B=ODE_. 3 : I UNDERSTAND THAT THE ON-'ITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO I NCLUDE MORE THAN 3 BEDROOMS,. S I GNEC__. , 6. .-2s!l'�._._a"`� 4.4,��i �,,, HPPL I C AI' JAMES P. SINNEMA ISSUED B'r'__ - - vi Zk DATEIZt`-Cc"`-_ 'r'4. =1 SOILS LOG • >_:.\ MUNICIPALITY OF ANCHORAGE tos , DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION -- ' 1 Pouch 6-650,Anchorage,Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: J 5,11 n ei 9 DATE PERFORMED: /( -- '4'0 LEGAL DESCRIPTION: Sec:v,a hi 4'e t 9 A-Tr. 8/o e' Z. 4d T 71t$' DEPTH SLO\PE SITE PLAN pimp", D (FEET) 1 1 — i 2 — 5—M ) . I 4 — <----- E I O � f i - _ a 5 I tA+ H 8 N., C r 9 --.—.-- - I 1 _ — 1 — 10 — --- GA) WAS GROUND WATER A, S 11 - ENCOUNTERED? NJ L O PI 12 E IF YES,AT WHAT i-_ - ,- — ,-DEPTH? 13 - 14 — Reading Date Gross Net Depth to Net Time Time Water Drop 15 - 16 - 17 - 18 - 19 - 20— PERCOLATION RATE (minutes/inch) / TEST RUN BETWEEN FT AND FT COMMENTS g2. € /Zr-Q,Q - S - « s, Ven Q 0,P re, y` d/-r. yf / ' tts IOOO / PERFORMED BY: fL &d j / l t • CERTIFIED BY DATE:f f 7 —�d 72-008(7/76) C 0 l , F-1 LI r-J I 17: I F't=i L_ I T '-T' '_'F= Fl r-4 c EA 0 F'Fi' DEPARTMENT OF HEALTH AND EN'v'I RONMENTAL PROTECTION 2510 E. TUDOR RD. : ANCHORAGE: AK. 99501 / /r Ote24-9--- 226-2221 11,I-.IEL L_ F'EF:r1 I T PERMIT Na ( 76299 ) GAYLE SINNEM- 4105 GARF I ELD #'' r "--6309 APPLICANT � LOCATION DI MOND BLVD - ��G_� SQUARE IAF'E FEET LEGAL L 6 7 & = OF SERV I EW HTS LOT IZE _ MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN =:o DAYS OF THE WELL COMPLET I ON. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='E F:1'-1 I T •-.0 IR L. I E. F-0 F: '_'F-J E '•r'E 1=R F`- F-F:'='F'i I =,.E•1_Q E I CERTIFY THAT 1 : I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. : I WILL I NSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE_. • git , SIGNED : ---_ p. ___________ LII :ANT GA;L S I NNEMA - P 1 C--- `I- /.V ISSUED BY r /li ."- eDATE C�T , 72,6---Yir--e,---c--, �-669 t'( /(-• � , e . 02/2 Well Log For 1\10\ --5 cv7 . )Al Le St NNE f Location. 0f \ SoM S et.ALe. 1. 60 Gt' f1 . (A.S.(cf1.... Date completed /7" Depth of well Size of casing.„Ad./. �'�� Q� Distance to water A' . ..`te a .. . ......... .. Distance to water whileg um in D*u � rr�� �� . t r .aate P P /..te-2zdte gallons per hour. Formation from toZr jfe' , moi► -� l � Driller 0\ DELTA DRILLING COMPANY c\ SRA BOX 394 B ANCHORAGE. ALASKA 99507 j\-9 Municipality of Anchorage GE• 4yy • ., Development Services Department oPA. • t _ Building Safety Division a �d On-Site Water and Wastewater Program �'A 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 6'I I -26! - 28 COSA# 0� 0112 Expiration Date: 12- - D ci 1. GENERAL INFORMATION Complete legal description _e -._ (ttit7103/Lc 2., Seas c w /3 Fr S/0 Location (site address) 872-i Sa m e'f Ply c e Current Property owner(s)sTal Jan . .rOnf e'Dein eel Ger, Day phone 229 -9 Lye Mailing address P.0. Max la 2- 0r7 Aon Choc ' +Lc 9'151 Lending agency Day phone Mailing address S" -0 ( 11 Real Estate Agent Mary fox frena. P•z0/2 Day phone 9Yo - 9620 Mailing Address II G W 3 8 '0' A't Supge too) 99So 3 ou Piney Co)c Unless otherwise requested, COSA will be held by DSD for pickup. P 1t owl/ ',7 1'am R `'II"" a 22.9 9 2YB when Cosh v 'rseaary £'-, ►c'e- 2. NUMBER OF BEDROOMS: ,3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Ha Hoe Tcctin tcec 1 Ser s'caf Phone 3 Yc- s- Address ?N,S3e' 5c,ho Canyon Rd.1 CA Of-CMO 4"r 9IS-/c Engineer's Printed Name -Theodore F F. eco Date 5-1 y/ 2 t'O5' 744 • =f• p dP M � : G . "7+�4 5. DSD SIGNATURE � " - • '.2 .L•'' Approved for 3 bedrooms. 419 Disapproved. Conditional approval for bedrooms, with the following stipulations: 1/4,\.to, • • 0N-SITE •- WASTE�rA ND • m_ o . PROORAM ���SoNr ��1° Nk Attachments: COSA Checklist X Arsenic Advisory }� Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other ByJ • .( j/ Original Certificate Date: 0 9 (Rev.11/05) • Municipality of Anchorage • Development Services Department Building Safety Division On-Site Water&Wastewater Program s a r E T Y 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST L.1-- L.7- 7/12 Legal Description:-,at I1 k 2 .SPCC"«w /4)2' Parcel ID: O/ 1 - Zit - Z8 A. WELL DATA Well type P If A, B, or C provide PWSID # 1V•h. Well Log (Y/N) 'r Date completed 7/1Z/76 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth ISF ft. Cased to ISg ft. Casing height (above ground) Z6 in. FROM WELL LOG AT INSPECTION Date of test 7/ 1Z/ 76 12/ 16 / d8 Static water level 1 Z3 ft. 12-2. ft. Well production /6 g.p.m. 6.6 f g.p.m. WATER SAMPLE RESULTS: Coliform D colonies/100 mL Nitrate < 0. 1 mg/L Other bacteria Q colonies/100 mL Arsenic: l7. $ ug/L date of sample: 11/2-7/a 9 Collected by: 1= C 4-c B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sep{-c c / S/-ee ( Date installed 3 / 3i / Sc( Tank size 1000 gal. Number of Compartments 2. Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N. 4 Date of pumping 12./ 9 / 08 Pumper TSaaes C. ABSORPTION FIELD DATA Date installed I /hof 80 Soil rating (g.p.d./ft2 or ft2/bdrm) 12_5 Vero, System type --ren Length 3 I ft. Width 3 ft. Gravel below pipe ft. Total depth 9. 7 ft. Eff. absorption area 372, ft2 Monitoring tube Y Depression over field N Date of adequacy test MI 16/ 08 Results (Pass/Fail) Parr For 3 bedrooms Fluid depth in absorption field before test O in. Water added863 gal. New depth 55 Sin. Elapsed Time: SU min. Final fluid depth 16-%9 in. Absorption rate >= ''/SG g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None 1<fl° '' If yes, give date NJ•/�. D. LIFT STATION N. A•. Date installed Size in gallons Manhole/Access (Y/N) "Pump on' level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 8O ' (wet rt?n ejOn adjacent lots > IC,o Absorption field on lot 96' wet-leer 'z"'kd) On adjacent lots > Zee, ' Public sewer main N• 4. Public sewer manhole/cleanout M• 4. Sewer/septic service line > 24"' Holding tank N• A• Animal containment areas N• Manure/animal excrete storage areas W. A.. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 16 Property line 3S' Absorption field Water main N• As. Water service line > £0 Surface water > t00 ' Wells on adjacent lots > I /0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3' waiverBuilding foundation 2S' Water main N• ran1-0.14-) Water Service line > t0' Surface water !0 o ' Driveway, parking/vehicle storage lo, Curtain drain Petn� Sten Wells on adjacent lots > toe' F. COMMENTS As _ ► /� Surt,c , nrYviriwf/j. S‘44mi1-1-eaC 1-}t, 114i pe, f - 044- wp a"rantc A- G. ENGINEER'S CERTIFICATION 4g!!`"' p= ; ; I certify that I have determined through field inspections and 40 ":`.-' `: t review of Municipal records that the above systems are inAt�,,}} ray-t.1e conformance with MOA COSA guidelines in effect on this date. °( �r ;�rT •j .�.p.,oaeE..+� Engineer's Printed Name lei taalare r /1/41oa.Yr _ "'`, ' v % mWWOORE r. MooitE; I Date 11c.Y Y, 2CCi.9 ?. !•. 89 •r. 5/wog a COSA Fee $ 19 0 Waiver Fee $ Date of Payment 6 / 7/09 Date of Payment Receipt Number 05.5 / Receipt Number (Rev. 11/05) Municipality of Anchorage .GE' 8, •`f r Development Services Department Building Safety Division �.V 1 S A E i Y On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # 090112 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 7A of Lot 6 of Seaview Heights Subdivision. This inspection revealed an arsenic concentration of 17.8 micrograms per liter (ug/L) for the property's well water sample. 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 V Municipality of Anchorage4E• Development Services Department • . - Building Safety Division :_- On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o! I - 26/ - ,$ COSA# 0i(A2g Expiration Date: / - a 3 © 7 1. GENERAL INFORMATION Complete legal description _ _ �f� ER'ck 2, Sacs VI ccA) #& s iJ) ( L* 7A) Location (site address) 9 7 a I So rt c(rS P!u c e Current Property owner(s) Fa f- 4 Terms Day phone (!970) 3,0 -F62...7 Mailing address IS--0 6 S/o ru ce r 'c y �t n i / 1/41.// Co 816.7 Lending agency Day phone Mailing address Real Estate Agent T a y(o ?rz.c der►1led v'.• w. Day phone_ 2 VI( -3Soy Mailing Address 380/ (e/) /-crpain/Dr-� A-'c6 99503 Unless otherwise requested, COSA will be held by DSD for pickup. I'I¢aro Ca I/ 7 ri ; 7 yfoe 3 e ?Y k- 3S�y 4A-0A r/1 (0l/J roc{v 2. NUMBER OF BEDROOMS: r plc _ 44r 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site [� Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 1.0 I- /,i,, u..0, ,er rrqueri-tro( Name of Firm /=1 Flkp S'erete c Phone 24S Address 111.5-20 a_c.47o (?/1rar, Rc�j c.4.0 cy 91,5-1( Engineer's Printed Name leo dofr-e J• i`-(o6 re Date 8/ w / 07 e, e. OF 4443 A Z4fl 4 14 / ; �'.a...s o e...0..•000N�i�i N111• i7i`�49if-- ti •'!8 5. DSD SIGNATURE _ , ,..THEODOREF. MOORE • ali' . CE•3589 Approved for 3 bedrooms. '' -' 9 •.:5/°3. 1 dtz Disapproved. �° , Conditional approval for bedrooms, with the following stipulations: ex ( OF( c ••y° . ON-SITE • i E WATER AND R'= WASTEWATER • PROGRAM • o • fJ- I ' T- SENt 1)�111 1»)1) Attachments: COSA Checklist X Arsenic Advisory X Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: 17LOriginal Certificate Date: -2. 3 ^ O 7 (Rev.11/05) • • Municipality of Anchorage Development Services Department = �E s> Building Safety Division < cal I On-Site Water&Wastewater Program SA ETY 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST �-8 Legal Description:6:0>t 7,4 !-4,f elk 2, Sou vl tw }��� Parcel ID: 0 // - 26/ - A. WELL DATA // Well type put If A, B, or C provide PWSID# N•A-. Well Log (Y/N) I Date completed 7/1 2/7( Sanitary seal (Y/N) Y Wires properly protected (Y/N) ) Total depth ISS ft. Cased to I58 ft. Casing height (above ground) 20 in. FROM WELL LOG AT INSPECTION Date of test 7/l1-/ 76 7 / /O /06 Static water level 12-3 ft. I ft. Well production I O g.p.m. 6.67 1- g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate <O• / mg/L Other bacteria 0 colonies/100 mL Arsenic: !S 9 ppb date of sample: f1/6107 Collected by: F./al-kw r¢ch S t'c B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sepf"c /Skee/ Date installed 3 /7/ /b'6 Tank size I80 gal. Number of Compartments 2 Cleanouts (Y/N) r Foundation cleanout(Y/N) r Depression over tank (Y/N) iv High water alarm (Y/N) N• A-. Date of pumping 9 /3 / 07 Pumper Ar-in-Ino/ the. G{oc ,n5 C. ABSORPTION FIELD DATA Date installed 11 //0 /bC/ Soil rating (g.p.d./ft2 or ft2/bdrm) 17-6- System type T►€"ch Length 3/ ft. Width ft. Gravel below pipe ft. Total depth 9.7 ft. Eff. absorption area 372 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/ 10/ D6 Results (Pass/Fail) P ar./ For 3 bedrooms Fluid depth in absorption field before test 37 in. Water added721 gal. New depth 7/., in. Elapsed Time: /1 min. Final fluid depthS .8 in. Absorption rate >= ySl g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) Nang &car, If yes, give date N. A, D. LIFT STATION Iv A. Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Gi !v' Septic tank/lift station on lot 80 a�lo vI-c�✓ On adjacent lots > WO' Wot�vl Absorption field on lot 90' yrrr�hv" On adjacent lots > l ca' Public sewer main N.AV Public sewer manhole/cleanout N• A-• Sewer/septic service line > ZSR Holding tank N.A, Animal containment areas N• A-. Manure/animal excrete storage areas N• A; SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' Property line 3,5' Absorption field 1" Water main M. 4. Water service line > to ' Surface water > CAC") Wells on adjacent lots J 6 D SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 raper/le,/ Building foundation ZS Water main N. 4, Water Service line > (0' Surface water > too ' Driveway, parking/vehicle storage = YOB Curtain drain None Soar) Wells on adjacent lots > /co' F. COMMENTS 1.,0E (,n0 uda ue r• /revu1'/crc6i'd" tocaner hal 19Urn/ - GT — use a ce, c ,,v/utled or) ki/rAie,2 c,Ak' G. ENGINEER'S CERTIFICATION a:l I certify that I have determined through field inspections and > .•'• : Municipality of Anchorage 0E' • ''�L Development Services Department [ Building Safety Division Ei Jl S 4 ETY On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # 070328 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 6 of Seaview Heights [Lt 7A ] Subdivision. This inspection revealed an arsenic concentration of 15.9 micrograms per liter (ug/L) for the property's well water sample. 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. Municipality of Anchorage ' Development Services Department r"' ' " _. .� Building Safety Division On-Site Water and Wastewater Program °h SAia Id ETY 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. Otl = 26t — O HAA# //4O/0 Expiration Date: 1 Z - !q -0 / 1. GENERAL INFORMATION (104' 4) 4-6-4-74) Complete legal description LollQ/vcZ -Stu v« i w /4 Si Location (site address or directions) 8 7 Z/ Sc,ms <, fin c Current Property owner(s) Tim Mo'-mc. Cray Day phone Z71 —6SY, Mailing address s 72/ S��►mer P/c«cp /'0-,,c4ar7 ,4-u 99Sc� 2 Lending agency G(n knvw„ Day phone✓ s r€_ Mailieg address 12 7V. I SQ A#1 tete T S P Real Estate Agent A/a n wa yd Re/`Tc,), P2,/,. Day phone 2 2:7—99 55' Mailing Address 2600 6o r-cia c S/7 /47,c40,-.75 44, 99Sc Unless otherwise requested, HAA will be held by DSD for pickup. • 2. NUMBER OF BEDROOMS: 3 C 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site k❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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. 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 P/cJ/rl• i con;ca/ S?�'��c r Phone 3 yS- /3.2- Address /yS 3o Echo SY. 4 c 4UryS 4* 9`9,./4' Engineer's Printed Name 0,04:)2 F. Date 9/ ! 9 / G/ OF . kv ,V• •.• '.� .� . s�-EAGf � �.• • - 4 5. DSD SIGNATURE :��...KcOCGRE3.58 oo&:., ;� Approved for 3 bedrooms. 44`,;4,!,v•'.•4J•{•• Disapproved. • ",.. Conditional approval for bedrooms, with the following stipulations: kt��1ytoi(((CF ., i,�i�� • xQ •••• 4 Jam• ON-SITE ; WAItR/A ^.dc:itior al Comments WASTEWATER • •• PROGRAM = •-•S••• •••- s sE\o-,„\) Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: /. 0-411--- Original Certificate Date: " / 9 - 0 (P.ev. .2.00) • Municipality of. Anchorage ���� ¢¢• , Development Services Department - - _ •t_L P P Building Safety Division ` 'e;! I SA STY On-Site 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 fr Legal Description: Lo& 6, , 01 bz. 2 Sec omcw 14 6--Cal Parcel ID:51/ - Z6/- o4( A. WELL DATA Well type / .-/ If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 7/12/ 76 Sanitary seal (Y/N) 7' Wires properly protected (YIN) Y Total depth I 5-8 ft. Cased to I S ft. Casing height (above ground) 2-0 in. FROM WELL LOG AT INSPECTION Date of test 7/12-/ 7 _ S" 2' / Z" J Static water level / 23 ft. _ / 2.? — ft. Well production I a * g.p.m. 7.3 t WATER SAMPLE RESULTS: Coliform U colonies/100 ml. Nitratemg./I. Other bacteria L colonies/100 ml. Date of sample: 9 /10 / G I Collected by: __ F(c /-ky, y A fl- c. _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sen t,'� / S/-'c I Date installed 3 /31 / 66 Tank size I vvU gal. Number of Compartments 2 Cleanouts (Y/N)_ Y Foundation cleanout(Y/N) 'r Depression over tank (Y/N) N _ High water alarm (Y/N) /V• 4 Date of pumping 4-1 29 /of Pumper _1-sc:a es C. ABSORPTION FIELD DATA Date installed 11 / !v /be, Soil rating (g.p.d./ft2 or ft2/bdrm) /25'0 System type 7"re"c y r3v�?rr Length 3) ft. Width .3 ft. Gravel below pipe 6 ft. Total depth 9,3- ft. Eff. absorption area 360 ft2 Monitoring tube_ Y Depression over field A/ mea.c. 6/1/G1 -- Date of adequacy test 6 /1 /0/ Results (Pass/Fail) Parr For 3 bedrooms Fluid depth in absorption field before test O in. Water added 763 gal. New depth3/.9 in. Elapsed Time: 7 min. Final fluid depth 7 _in. Absorption rate >= `1S0 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N & type) Nine If yes, give date N. The du k., 1,uhe,7 /i"e ani t$e 171aA, z, f45e a,e-v Je�.4� / oaf b remo,e cz_ S/ttGQgr c4(1,1-,4/7 on .5-/E9/0( D. LIFT STATION N. A-. Date installed Size in gallons _ Manhole/Access (YIN)_ "Pump on" level at in. "Pump off'level at __in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ve.^ Septic tank/lift station on lot SO' ( yw-�ainkQc On adjacent lots > /0 o ' Absorption field on lot 90' n ) On adjacent lots > /vo ' Public sewer main H. A. Public sewer manhole/cleanout W. ,4. Sewer/septic service line > 2.5 Holding tank 1V. .4, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' Property line 35' Absorption field 5 Water main > Z5' Water service line > ZS' Surface water _> roc. Wells on adjacent lots > /DCS' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 36 * Building foundation 20' Water main > zs ' Water Service line > ZS' Surface water > 16,0' Driveway, parking/vehicle storage 3S' Curtain drain Nene Se et) Wells on adjacent lots > ' F. COMMENTS Trench i1 36 /n .ex/-eriv.- pra79e✓-Fy I/ 1C of Cvr�4incc( rcirce( � f � 3 c--irrorn i n /-ern 4/ Lau')cec.iry ‘-elwrtn /u& 6 't 7 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and .4,ao 4 review of Municipal records that the above systems are in .� conformance with MOA HAA guidelines in effect on this date. ENGINE=4''S�'•;.� Engineer's Printed Name Theo4:1,c,r2 F.' 111$ Date Sty, i.e,+, 4'<f /5 2 GG THEODORE P. MOORE CC-J.1137 i ti HAA Fee $ 300 `-� Waiver Fee $ o'" '' �`. -.� 47, Date of Payment ?I 181 2.0c), Date of Payment Receipt Number l C� Z- / "3�� Receipt Number (Rev. 12;00) FLATTOP TECHNICAL SERVICES CIVIL&ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION&ANALYSIS TED MOORE, P.E. 14530 ECHO CANYON ROAD PH./FAX: (907)345-1355 ANCHORAGE, AK 99516 E-Mail: tgmoore@gci.net August 20, 2007 M.O.A. DSD On-Site Services P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs : By means of this letter I am requesting issuance of a lot line waiver allowing the existing soil absorption trench on Lot 7A of Lot 6,Block 2, Seaview Heights S/D to be approved in its present location approximately 3 feet from the lot line common with Lot 6. The enclosed as-built property survey illustrates the configuration. This system and configuration has been tested and approved numerous times in the past. The only difference is that now Lot 7A is being sold separately from Lot 6,which the present owner plans to sell to the owner of Lot 4A so that it can form a buffer to his property. Because the trench on Lot 7A is approximately perpendicular to the lot line, the impact of the requested waiver on the developability of Lot 6 is extremely minimal. Because of its small lot size and relatively steep slopes down towards the east, Lot 6 would be difficult to develop with on-site utilities in any case. The proximity of the existing soil absorption trench on Lot 7A only means that a lot-line waiver for a similar configuration on Lot 6 could not be readily granted,however a trench could be constructed on that lot as close as 10 feet from the lot line as called for in the wastewater code. Based on the foregoing I believe the requested waiver is justified and should be granted. Please feel free to give me a call if you have any questions on this analysis,and please the Realtor. Tami Taylor, a call at 244-3504 when the waiver has been granted and the COSA certificate is ready for pick- up. Thank you, Ted Moore, P.E. ,II 09/13/2001 11:42 90724%365 JAMES NOPMg CPA IG PAGE 01 3D` WT 4A S s 8 'so 9� ce.3,, l'I 'll .... V GDT <t 6 E... .s. • ,. ‘e lCr O ( v s�nric c743- .o W • 5.A's k � N IQ , •. • o Z 1 ri J I }A CO WT 1 pr; Z'' 7A IV ------I IZi§ strj 11. 0„ tsz 1•9 / 7, DATE 9- ���LJ� 3 , •.5[.OPE ES%NT. /�/� BK../ro7, ic. 344- � e vfi 7A of Lof6 ��~��� _or.�o , Block Z Q ,Q ,� Seaview hf's �`x�d C99-1/5) ' te••Iwht• of r.•«� otM► time IMs/i Nlwh / �! . Aar, 'D �nc�oroge Recording Dlsfrict, Alaskab • — - \ r�. lel •I tri •r• net shone rrrsa l.1- ."'"' 'a.° WMVia l°e not M. f Ar�,, , °I. LEGEND * T - ..... T. IOT SURVEY CERTIFICATION r.. I trey Unfit, tn•t Ina•• ■orw.lA•th..roperty shown and d.scrlb.• 0 woo Armor m ca d me ti1M 1•r•ei. end'bet the I.prog....nt0 •IvVOt.d tri•t.on o.�. •Ithin thy y4P- 0 , tack recovered .sty 11~•••••o rivet ow•i.►...wwroo•ln on oa le�nr Mep.re.sea grist 0 2 i T hub 6 b4 ! this svrvy i `^••w J ,."1. •.MAVt•"11 an*elegem a> t••"er1°'at sn.rowtt a Ms•remises 0 5/8 a 30 _a �� AL n a..1.tlwn or.a trot 7i ore n.geeay.y..Willfy limo, o-°tri aIaIN. MNO•nt.On raid peeing'',1 401e4►1 oa Iw61eOf•/ n.rratl. • Prepared by: R.L. BUTTON Seale /ri o�/ ` Date n / / R�pi��iivd Lone'Sr lrryor i V 09 / / — (907)279-62A0 619 W,fly+►/h Ave_ 4rnc/xs'ap/AfarAlD 9950i Fief. 1 F.B. No. Property of: ' /4" Cmiq232 0/- 076 • Municipality of Anchorage o . tom P.().Box 196650•Anchorage,Alaska 99519-6650•Telephone(907)3!03.8301 •Fax(907)3'13.82(X) < 6 / - lJ' / 4700 Bragaw•Street•Anchorage,Alaska 99507 SA ET www.nnmi.org Mayor Mark Begich Building Safety Division 8/23/2007 Ted Moore Flattop Technical Services 14530 Echo Canyon Rd. Anchorage Ak. 99516 Subject: Waiver Request for Seaview Heights Block 2 Lot 7 [Lt 7A ] Waiver Request#WR070040 Parcel ID #011-261-28 HAA# 070328 Dear Engineer, Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 3.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On-Site Water&Wastewater Program Community, Security, Prosperity Municipality of Anchorage Gk 0 • Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street SAP E TY P.O. Box 196650 Anchorage,AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 070040 PID#: 011-261-28 HA#: 070328 Permit#: Date Received: 8/20/07 Legal Description: Seaview Heights Block 2 Lot 6 {Lt 7A I Engineer: Ted Moore Flattop Technical Services 14530 Echo Canyon Rd. Anchorage Ak. 99516 Applicant: Pat&Teresa Ganie Waiver Requested: 3 feet separation distance absorption field to property line. Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec#: 8/20/07 Amount: $175.00 Date Paid: 8/20/07 Municipality P.O. SG,. 096650 ANCHORAGE, ALASKA 99519-6650 of *At (R (907) 264-4111 Anchorage TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH&HUMAN SERVICES February 27, 1986 Theodore F. Moore Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Lots 7 and 8 Block 2 Seaview Heights Subdivision Waiver Request, WR86-023 Dear Mr. Moore: This Department has considered your request for waivers of the separation distance requirements stipulated in 18 AAC 72.021. You have requested waivers of the well to septic tank and well to absorption field separation distance requirements. Based on analysis of available soils and hydrogeological information your request for waivers have been granted. The 100 foot separation requirement has been waived to 90 feet for the well to absorption field separation and waived to 80 feet for the well to septic tank separation. These waivers shall be considered valid after the following conditions have been met: (1) The total volume of the septic tank must be upgraded to 1,000 gallons or more. This may be accomplished by adding another suitable tank in series with the existing tank or replacing the tank with a new 1,000 gallon tank. (2) If the existing tank remains, the integrity of the tank and fittings must be established and documentation supplied to this Department. If a new tank is used, it must be equipped with watertight couplings and watertight manholes. This waiver is valid for a three bedroom, single family dwelling only. Sincerely, • Stephen S. Morris Civil Engineer On-site Services SSM/ljw FLATTOP TECHNICAL SERVICES CIVIL& ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. February 18 , 1986 14530 ECHO ST. PH: (907) 345-1355 MUNICIPALITY OFESH�E E, ALASKA 99516 CEPT. CF HEALTH & M.O.A . Dept . of Health and Human ServicIRONMENTALPROTECTIOI�I P .O . Box 6-650 Anchorage , AK 99502 ,, �. Attn : Steve Morris I'F-�R 1986 RECEIVED Dear Mr . Morris : By means of this letter I am requesting waivers of the following separation criteria and septic tank size requirements for the existing on-site wastewater disposal system on Lots 7 & 8 , Block 2 , Seaview Heights S/D. This property is located at 8721 Somers Place in the Sand Lake area . Although there are no surviving records on file , we believe that the original system consisting of a concrete septic tank and seepage pit was installed in 1968. The original well location and/or source of drinking water is unknown . In June of 1976 a well permit was issued , and the well was completed on July 12 , 1976 ( See enclosed well log) . The well driller was unable to achieve the required 100 foot separation from the septic tank . As itwas , he drilled the well 1 . 7 feet over the property line into the Dimond Blvd . R.O.W. , and still achieved only an 80 foot separation from the septic tank . The present owner (Jim Craig ) is in the process of securing a R .O.W. encroachment permit for the well , which he will submit to you . In October of 1980, at the time of sale of the property to Mr . Craig , the former owner submitted a "Health Authority Approval" request for a 2 bedroom residence . When the old seepage pit failed to pass the required adequacy test , a new soils test was done , and an on-site sewer permit was issued for a 3 bedroom residence on 11/5/80 . Dr . Lee Reid noted on the soils test report form that he had verified the septic tank size to be greater than 750 gallons but less than 1000 gallons . The new on- site sewer permit specified a 47 foot long absorption trench with a 4 foot gravel depth. The permit also called for a 1000 gallon septic tank , and specified a 100 foot minimum separation between the well and the on-site system . During construction , the length of the trench was shortened to 31 feet , and the gravel depth increased to 6 feet , yielding an equivalent sidewall area properly sized for 3 bedrooms . The original septic tank was not replaced and closest part of the absorption trench is 90 feet from the well . The inspection report approved for 3 bedrooms on 11 /4/80 by Les Buchholz made no a mention of the septic tank size or of separation distance problems . On 11/12/80 R .C. Pratt signed a "Health Authority Approval" on behalf of the city . This document states , however , that the system was approved for 2 rather than three bedrooms . On February 15 , 1986 I performed an adequacy test of the on- site water and wastewater systems . At the start of the test the well had a static water level of 124 feet below the top of the casing , and steady pumping at 5 gpm caused only one foot of additional drawdown. Thus , the well yield is more than adequate for a 3 bedroom residence , and the water sample showed no bacterial contamination (Lab report attached ) . To test the wastewater system I ran 500 gallons of water into the upstream end of the absorption trench and monitored the fluid level at the downstream end . During the test the fluid level rose a maximum of 29 inches in the standpipe , but subsided to the original level within 12 minutes after the water flow was terminated . Thus , the absorption trench functions quite adequately for a three bedroom residence . The ground level at the septic tank is approximately 5 feet lower than at the well casing , and is even lower over the absorption field . The slope is such that any effluent leakage from either the tank or the trench would flow directly away from the well . The well log shows sand and gravel to 18 feet , underlain by two clay strata : the first extending from 18 to 85 feet , and the second from 134 to 148 feet . The water bearing stratum is beneath this second clay layer , and thus should be well protected from surface contamination . All of these factors support the argument that the requested waivers can be granted without risking potential contamination of the well from the on- site wastewater disposal system. Based on the above information we are requesting that you grant the necessary waivers so that you can issue Mr . Craig "Health Authority Approval" for his 3 bedroom residence . Please feel free to give me a call if you have any questions . Sincerely , oF e 7 ....... r . .• ••.•�41. Ted Moore , P. E. *C67' 49TH •:-P cc . Jim Craig THEODORE F. MOORE;• 0CE-3589 wAr . . $, • II I • I . ,' i • 1 , , I , :• ; ,30.0 I•I h ' I 1 . ' ' ' : j : , ; t ili i ( • •.t."1-1—,"--t-i---r-t- i� II ' I' i i , l.1 � _ ._ v . _ ( - � I I . . � I ` I ; , ,Ii , ' 1 I 1 .. .... Ii , 1 jig h • kb . i I • t : : . i i1i i i /sem \ , . '.j 'il �t ii : il � 'W . ) 1 •t o • I ! � oar ' •. I I I i ..N ' 1 .� SEWER • • .: •• I i • I . 1... 11 I :• . • Vi i , . O $7ert . . , ' I • • I 3y 1. ., . . I I p I 30 i ,,�- �' i .: I i 1 I :.., , t„ I I I i L4.t : I i I ! • 1 , ,� „ 4' CO r, I U $GALE [n�30. 1 " 1 .1 I t • 1 • t� ; ' , ' j l ili. l I I 1 1 2-s r,tz. • 1 , IT: . ; 4 - NoUSE N vi ys pd • I • ' i t1 ' 30.0' j .. 'r.r 1 33.1 ;� 24:Z ' ' ' , i. i ; j � ' ' ce ' •• ' \`_• I JI , ' I , I • i I WELL C-7 11-•(0 D�7/: 03 '\i \; t j i i I i ; i i i ( i • NcRe ; pu• 3C, \i�s�'r�\ NOTE ; pUl Lis WoRi 5 DEPT' ��,� : o� `� N RI44IT o;c wAY(BK 1671 P9 344) �•I•I.O ! \`'"� ; ; I I '1 `y' i { II IS AM131qUoc15 �t5 Pe21 R(fJINC <„ I I ! E I 1 i ! i I ; i (Amarta r1(E. cE/•JTIR LINE. Is, 1 � l/� ; � } ' ' I I ; •' • . ; ! • \ rills As&U/LTIs p/1 ED UPON REGENT Su�,VEYs. 7 Q�BUICT" �r/ \ -, Cook No. FSI PeatNo. - �tic Cors --(-7: I hereby certify that I have surveyed the following described property, Lot •f'4 Block Pr"rn'-G ,. w+' Q �+'�z SEA t•'/':t'/ /1E7Mar F i(l,?!) Anchorage recording Precinct, Alaska, and that ' �(�‘:e••''eip••4 ./yZV�t un the improvements situated thereon are within the property lines and do not overlap or ei y2•••' °ee�VV0 encroach on the property lying adjacent thereto, that no improvements on property : (">y� dt �I lying adjacent thereto encroach on the premises in question and that there ere no roadways, d`'~ •z�1 transmission lines or other visible easements on sold property except as indicated hereon. t> ,/, y� t • n l i i 1 it i ; 0 S fronts Hildonen <� /9 ! A/o V, /J • i QQ�sr�,•• No. 13034 .••f. Anchorage, AlaskaS� 1 Q 9F0 •°•••..ow••••O. %l gi • : 4t.4°F�s.^,ions,�‘", w 1 _.-.._.-..-.M_.,--_-,...__.._____.--____._-__-_ .___-.--_______,____ I_...,. .... �V..%.1,,: •4:a�j ' STATE OF ALASKA • DEPARTMENT OF TRANSPORTATION AND PUBLIC FACILITIES AIRSPACE PERMIT THIS AGREEMENT is entered into this 2.4A day of Fe1-tlu47 , 198h , at Anchorage, Alaska, by and between the State of Alaska, Department of Transportation and Public Facilities, acting by and through its Commissioner, hereinafter referred to as the State, and James D. Craig, 8721 Somers Place, Anchorage, Alaska 99502, hereinafter referred to as the Permittee. THAT the Permittee is desirous of constructing, operating, and maintaining a water well occupying the airspace in, on, under or over the highway right of way within the following described area: Approximately 1.7 feet into the right of way adjacent to Lot 8, Block 2, Tract 6, Seaview Heights Subdivision, on State Route 5202, west of the- inter- section of West Dimond Boulevard and Sand Lake Road, in Section 9, T.12 N., R.4 W., S.M., according to Frantz Hildonen as-built drawing dated November 19, 1980 and dated as received February 14, 1986. WITNESSETH that for and in consideration of the mutual benefits to be derived, the State and the Permittee agree as follows: (1) That the airspace shall be occupied for the purpose stated above and for no other purpose or purposes, without the written consent of the State, and that the Permittee will not use the airspace for any purpose in violation of any law, municipal ordinance, or regulation. (2) That any significant revision in the design or construction shall receive prior approval by the Department of . Transportation and Public Facilities. • (3) That the State reserves the right to enter the area at any time as may be necessary for the purpose of inspection, maintenance, or reconstruction of the highway facility. (4) That the Permittee shall not make or suffer any alteration within said airspace without the written consent of the State. (5) It is specifically agreed and understood that the Permittee shall not call on the State to make any improvements or repairs of any nature whatsoever to the facility, but the Permittee hereby specifically covenants and agrees to keep the same in good order and condition and to maintain said facility at its own cost and expense, and that no additional items will be built or permitted within said airspace without written consent of the State. (6) The Permittee agrees to defend and indemnify the State from any injury, loss, claim, or damage to any person or personal property resulting from the use of the highway right of way described hereinabove as permitted by this Agreement except for negligence by the State. The State will not provide any insurance for any facility or use made of the above-referenced right of way under this agreement, and the Permittee will make no claim of any nature against the State by reason of any damage in the event any facility or use made of the right of way is damaged, destroyed, or interfered with by any cause. See Alaska Statute 44.80.070. W. Dimond Blvd. Water Well ASP-520-2-004-1 1 • Nothing L. the transfer of use or any rights granted to the Permittee under the above-mentioned Permit shall be construed to have granted to the Permittee any right to convey, assign or, in ; any way, transfer any rights in said property without prior .. approval by the State. If any provisions or covenants of this Airspace Permit are violated then this Airspace Permit shall be revoked and null and void if said violation is not corrected after the Permittee has received written notification by the State of said violation or noncompliance and has had a reasonable time to correct said violation to conform to this Permit. The Permit will be revocable in the event that the airspace facility ceases to be used or is abandoned, and the provisions of this Permit may be in writing altered, changed, or amended by the mutual consent of the parties hereto. The State, however, reserves the right to terminate this Permit by ninety (90) days written notice to the last known address of the Permittee if said property is needed for highway purposes. IN WITNESS WHEREOF the parties hereto have set their hands and seals the day and year in this Permit first above written. STATE OF ALASKA REC MENDED F APP OVAL: DEPARTMENT OF TRANSPORTATION AND PUBLIC F CILITIES 40-1,v‘ By: Chief Right of Way Agent Director Design and Construction Design and Construction Cent )1 Region Central Region Dctor P ittee CH Maintenance and Operations Central Region INDIVIDUAL ACKNOWLEDGEMENT STATE OF ALASKA )ss. plird JUDICIAL DISTRICT ) BE IT REMEMBERED that on this 2/5+ day of Fc-LrOo..ryy 198 , before me the undersigned, a Notary Public of Alaska, personally appeared 4'2...me5 D. Cv -i� known to me to be the identical person who executed the foregoing Agreement and _he acknowledged to me that _ he_ signed the same as free and voluntary act and deed with full knowledge of its contents, for the uses and purposes therein expressed. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the Seal of my Office the day and year first above written. My Commission rxp{res. 7/94? L-�t�.--- A Notary Public of Alaska W. Dimond Blvd. Water Well ASP-520-2-004-1 2 ACKNOWLEDGEMENT OF DIRECTOR DESIGN AND CONSTRUCTION STATE OF ALASKA ) )ss. THIRD JUDICIAL DISTRICT ) /p/ BE IT REMEMBERED that on this 211A day of /-e,�ovUa,(ry 1986 , before me, the undersigned, a Notary Public of the State of Alaska, personally appeared ro n+n,y ' eoe /!emery r'c-11 Director, Design and . Construction, known to me to be the identical person who executed the foregoing agreement and he acknowledged to me that he executed the same for and on behalf of the State of Alaska, Department of Transportation and Public Facilities, with full authority so to do, and for the uses and purposes therein expressed. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the Seal of my Office the day and year fi7rst above written. My Commission Expires: 3/',/gg /Lp1(Ai ` _ A Notary Public for Alaska W. Dimond Blvd. Water Well ASP-520-2-004-1 3 'MUNICIPALITY OF ANCHORAGE • �T DEPARTMENT OF HEALTH & HUMAN SERVICES Sp , Division of Environmental Services di _ On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # fl,1 l - -f7-V21 • _ HAA# D1l- /- 03 1. GENERAL INFORMATION Complete legal description E-0 7 8, ' el°cc,- 2, Trrcct 6 Se “,( Hete17 S/_o Location (site address or directions) 97 21 Some, P/dce Property owner J a ' '' D. Cra'y Day phone 2 7 - ‘6-17 Mailing address 872( Sarni,er ('lace ` A�choccxf i /9-k 995 o Lending agency un tc Day phone Mailing address Agent Al. A . C RQ Jn nc c_) Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well t • Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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 e21 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 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 F(aFlop Tech nica.( Ser✓•ca- Phone 71/S- / 3S'S Address I f S3O Echo S . A�n/chc,/-7-kv . 99s / Engineer's signature -1' r(IIi Date 9 /8/9 a 1. corz- F:. 40'0'RE. . . 1:04 ~3of39 ••••;.F Ky ••• • 6. DHHS SIGNATURE �7� Approved for /rnZ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 64 - By: , �..� .Lul -.. ! Date CAUTION The Municipality of Anchorage 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 engineer registered in the State of Alaska.The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements.Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0251Rev.1/91) Back MOA#21 • Municipality of Anchorage • Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST •ii Tnucf rs Legal Description: L01-6/74-9 bLK2,A 5EAv!E.i HTs • Parcel I.D. 7/ / "� C A. WELL DATA Well type ?RI✓AT E If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 7/12/76 Driller DELTA DRILL rNG Total depth 159 Cased to 158 Casing height 18 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 7 /12176 cfI 11(12, MUNICIPALITY OF A NC iLYAGE Static water level 12 3 I 20 ENVIRONMENTAL SERVICES DIVISION -o Well flow /0 g.p.m. -7 7 `'' p0 q 199? Pump level ? `22 RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 8y To C.o. ; On adjacent lots >/oo Absorption field on lot 9I ' WAIVER 2127186 ON FILE ; On adjacent lots >foo ' Public sewer main 7 /o0' Public sewer manhole/cleanout 7/°0 Sewer service line ^7o Petroleum tank NoNC o aseR✓E WATER SAMPLE RESULTS: Coliform 0 Ca( //00414 Nitrate -L / ^� / Other bacteria C co/ / Goin Date of sample: 9 11192. Collected by: CHRIS B. SEPTIC/HOLDING TANK DATA Date installed 3)31186 Tank size 1000 Gill- Compartments 2 Cleanouts (Y/N) ) Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N A Alarm tested (Y/N) N A Date of pumping 11 /5 hl Pumper RoTo - RoorER SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)on lot 2'1 FRo n C.o. On adjacent lots > /00 Foundation 12 To property line 40 Absorption field 3 (C.o,H C.o) Water main/service line 7 6o S' per as- Surface water/drainage >/00' 72-026(Rev.7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 1111 °/30 ISoil rating L25 n'/SDRM System type TRENCH Length 31 ' Width 36 Gravel thickness 6 Total depth 10 Total absorption area 372 n' Cleanouts present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 9 i92 Results (pass/fail) PASS for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) NoNE KNowN If yes, give date N .A • SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 91 Cw4(vER off FILE> On adjacent lots > 100 Property line 39 To building foundation 2`f To existing or abandoned system on lot N.A. On adjacent lots > 39 Cutbank N.A• Water main/service line > 70 Surface water > r°o. Driveway, parking/vehicle storage area 3S- Curtain SCurtain drain NO'4( 035E R✓E E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. .6.+4,111%4.4& t '�i6Ga®e•�,.q�,4 SignatureT. ! 0„-- 04.,%:' �'•;'���� • * �+r.-— .• • y f Engineer's Name Th€o cio /=• P-rmc7•� •� Date ' 7L a, /992- • ��� THEODORE E. MOORE;• i e #• e�fi ••. CE-3589 : 0 00 HAA Fee $ /76) Waiver Fee: $ Date of Payment 9- 9- 9 z Date of Payment Receipt Number �� 2� (38_33Receipt Number 72-026(Rev.3/91)BacK MOA 21 MUNICIPALITY OF ANCHORAGE 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 Feb 19, /9t9G 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section,township, range) !vf-r 7 1 6,, 8lac Stav4rw h1 S/.0 Location (address or directions) 4972 / Som€r'.f Drr ere -- SanoQ 4ake are (b) Applicant Name J,m CrayTelephone: Home 2'/3-6365 Business 26"-yss G Applicant Address 872/ Son,emt Drive J And? '/c v , Ak 99..O2. (c) Applicant is (check one): Lending Institution 0 ; Owner/builderE; Buyer 0 ; Other 0 (explain); (d) Lending Institution SEC.02-'*/'Y P (Fac ltoR 6 ar Telephone 4-1(9-ti 33 Address 2SSo ..°C11/41#4.L; 5;- Svr7"E-- 101, llnid/04,44e , 4ie t9S-03 (e) Real Estate Company and Agent Address Telephone (f) Mail rtiAA to the following address: aQQ cOlLt ►J �^� -- a L( 3 -co3 G S a(.o 1 - 2. TYPE OF RESIDENCE Single-Family Multi-Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well g. Community 0 Public 0 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 Si Public 0 Community 0 Holding Tank 0 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 PROVIDINiu 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 regulations in effect on the date of this inspection. - See .be(ow Name of Firm F(af/ir red,/ i Ccs( Servo e' Telephone 3 VS.-/3s,5— Address , y.c30 Cc S/ f A-,,c etoryej Date Feb 19� /986 lea wets reutrec( �. S /'e >ri c 6I et lz S(ze► < few, crf 2. Welt—Cep Sepamrlron = 505/ 3. tlJe(( - Absar,iPon Sera ralfrae = 96' ff Engin 4”A\�yh 4 .�e •• t. r4. "J oTH)'s •. ri241,014--.0 97(14541 0. . THEODORE F. MOORE ; 0 04` % CE-3589 rev s4 O �QA�Pfofentoavo•� 0u0 • 6. DHEP APPROVAL GOND ITiON��. Approved for "0"-e-e"" bedrooms by 4 (/ 4' "9-17� `�`- Date Aped Disoved Conditional ✓ Terms of Conditional Approval (Qs ,M «E.t- � esc4,-�vn.v--12- -+c, ,ITT4a-�i �-p Gt- 1000 r o..l(O w v 5 e I • � 7 r c V m u s f' b- co,-112 le--t-.0e- P,-:,,- 1-0 n"4 e- /s, ,4et.. s(, f,1->1). .�'�� 'IJ► Of a, dhep O* orf ItAA• CAUTION 4,7 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 7^075(1111.1 4 C.) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL(HAA) CHECKLIST-FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE CEPT. CF HEALTH & Legal Description: e Td 7 (iIOCI- 2l ENVIRONMENTAL PROTECTION S ea it ew (i�e[q h/f s7700' /D A. WELL DATA FEB ' i98 j ✓ Well Classification Privet&E C E I V E D If A, B, C, D.E.C. Approved (Y/N) Nr • to(f,n /Per 1a Well Log Present (Y/N) Date Completed 7/ / �6 Yield ' 40y, ',, Ad►•+rri.-,o{ Total Depth 1 Se' Cased to x 1S29 Depth of Grouting N Static Water Level 1 2 '1, Pump Set At 12.r Casing Height Above Ground — 16 Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) �' Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot 90 ; On Adjoining Lots > /Oo To Nearest Edge of Absorption Field on Lot 91 ; On Adjoining Lots 7 loo To Nearest Public Sewer Line N.N- To Nearest Public Sewer Cleanout/Manhole N,4. To Nearest Sewer Service Line on Lot N.A- Water Sample Collected by 1-F("I ; Date 2/iy/96 Water Sample Test Results Sox IJ C1r y Comments we Il ,s located 1.7 .ceef outride erl(y (in a 'ink) °,new! 8/t4! ROW encroachment "er#nil- needed. Waiver nrow/eve to er//vcu we[( —Sep /'c Serat hon cv 6:C�' an€' (/— drips. reed,vi-to,) do 90 ' B. SEPTIC/HOLDING TANK DATA 19(6F 7 7ie9a/ Per Lee Rano( Date Installed anknpu,n Size an known No. of Compartments CIA!coact'', (prole b(y one) Standpipes (Y/N) Y Air-tight Caps (Y/N) ) Foundation Cleanout (Y/N) one Depression over Tank (Y/N) N Date Last Pumped 2/3 /,96- Pumping/Maintenance &(Pumping/Maintenance Contract on File (Y/N) Niit• ; for N',4. Holding Tank High-Water Alarm (Y/N) N./4• Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well 80' To Building Foundation 12 I To Property Line 35' To Disposal Field 5- To To Water Main/Service Line t1 4 . To Stream, Pond, Lake, or Major Drainage Course 7 (cc " Corments Wa(vtr needed I(aw cue(!- spec SerarcU4O/) c ,1 Oa' Waeaer rdy (r.ed /o a//ow Sep kc /an . Joao y ffet/,J Page 1 of 2 72-026(11/84) a C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 123' Type of System Design Date Installed l?t' / (O / 80 Length of Field 3 Width of Field 36r. Depth of Field N r Gravel Bed Thickness ( r Square Feet of Absorption Area 3 72 Standpipes Present (Y/N) r Depression over Field (Y/N) N Date of Last Adequacy Test 2/4r/8( Results of Last Adequacy Test .Sa"c47 tc47 a.krorp A04 parte Separation Distance from Absorption Field: To Water-Supply Well 9/ To Property Line 39' To Building Foundation 2`✓e To Existing or Abandoned System on Lot un k17 awn ; On Adjoining Lots ? 30 To Water Main/Service Line N,4. To Cutbank (if present) N,4 . To Stream/Pond/Lake/or Major Drainage Course > r:0D To Driveway, Parking Area, or Vehicle Storage Area r Comments Wed uern r+irurrec-( 1 cello CO We(/- cc!►.coe`viro4 Seraro1-ra, oks lance of 90 ' D. LIFT STATION N-A . Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked,verified,or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 1--,610d"e .! �'•Y Date 2/O./ed Company Ft'aHap reC/IAt(af.c fMOA No. QS2 Receipt No. S.-.) Co(O62 .1,1 `‘ Date of Payment J — i�4��.A���+ Amount: $ �•- (oS .QCT- ���Q.•'*. • '•. ,��� Engineer's Seal •* 49TH /N e '• * / THEODORE F. MOORS• Page 2 of 2 ®ea„.r CE-3589 •••: ir 4 P2,••'••••••'• Oae` 72-026(11/84) , gprofessiON`�• MUNICIPALITY OF ANCHORAGE • Y 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 4- 8F' 1. GENERAL INFORMATIONoP z-07- (0 (a) Legal Descriptio nclude lot, block, subdivision, section, township, range) Lots 7, 8 Block 2 Seaview Heights Subdivision Location (address or directions) 8721 Somers Drive, Anchorage (b) Applicant Name Jim Craig Telephone: Home 243-6365 Business 261-4550 Applicant Address 8721 Somers Drive, Anchorage, Alaska 99502 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder I Buyer 0 ; Other 0 (explain); (d) Lending Institution Security Pacific Mortgage Telephone 276-1933 Address 2550 Denali Street, Suite 615, Anchorage, Alaska 99503 (e) Real Estate Company and Agent Address -- Telephone — (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family lEtx Multi-Family 0 Other Number of Bedrooms three(3) 3. WATER SUPPLY Individual Well a Community 0 Public 0 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 E X Public 0 Community 0 Holding Tank 0 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 PROVID NISPECTIONS, TESTS, FILE SEARCH, DtIAND INFORMATION , s 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 Telephone Address Date Engineer's Seal This department has received the as—builts for the new on—site sewer system (inspections performed by Corwin & Associates) . This department has reviewed and approved the inspection report. Therefore, this property is now fully approved as per the conditions of the Conditional Approval of February 27, 1986. 6. DHEP APPROVAL Approved for three(3) bedrooms by 4f'" `°�"``� Date April 1, 1986 Approved xxxxxxx Disapproved v Conditional Terms of Conditional Approval dhep 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(11/84) �' LQ 1114A, o LL- `� ' F,c) v LLQ:-' • DATE RECEIVED INSPECTION APPOINTMENTS I C.�-AC� c�c�e. TIME TIME TIME DATE DATE , DATE l - a_4 c- � l A INSPECTOR INSPECT INSPECTO 0 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE •r) DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & ii‘ 825 L Street-Anchorage,Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION OCT 2 0 1980 Telephone 264-4720 '' I �n REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW£R'-F�4ilI IE) DIRECTIONS: Complete all parts on page 1.Incomplete requests will not be processed.Please allow ten (10)days for processing. 1. PROPERTY OWNER , PHONE /9ig/,� S ii. S ///7 e/0/71/7 2Y 6/75/ MAILING ADDRESS ,s 7- / S' cin sn i"g'S fin-. c i= /�I N PROPERTY RESIDENT(If different from above) PHONE '7 y / `7 r /h /17 t �� S thh ( � '2. BUYER , PHONE (' /71 WhI/ MAILING ADDRESS '7/ ' (0 ,0,09C'2/7 2//x/22 `i% 5- c 3. LENDING INSTITUTION ,��ggq�cc PHONE jr/-/Vi 1 7/7e/,-,7/7e/,-, �" MAILING ADDRESS . 2'C / C 5r, 4. REALTOR/AGENTPHONE •L /( r-7) 7, A 6L/1927 (%' S ( 2 MAILING ADDRESS ( � l (�- C L ,% C^, Ao x /2(1 (17,e- ; ./z1 / ,� y5/ /6 /2 5. LEGAL DESCRIPTION A- 7r )i 2 . 5/ "1-/e()/9i /C(' /1 / '`, STREET LOCATION / • c r" rn t" 5 f" /9) /77 C/7/7 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS a, SINGLE FAMILY ❑ One Ell Four ❑ Other ®- Two El Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY Xl. INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date,give well El PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION pF; Yew ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 ev. 6/71)43 I/ v � 4t Q ��ij� xfs