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HomeMy WebLinkAboutSHERWOOD HEIGHTS LT 4Onsite File Sherwood Heights Lot 4 #020-042-25 MUNICIPALITY OF ANCHORAGE Q, Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-042-25 1. GENERAL INFORMATION Expiration Date: '-/ - II -ZZ Complete legal description SHERWOOD HEIGHTS LOT 4 Location (site address) 15735 ROBIN HOOD DRIVE, ANCHORAGE. AK 99516 Current property owner(s) ERIC A. SHORT Day phone Mailing address 15735 ROBIN HOOD DRIVE, ANCHORAGE, AK 99516 Reai es aie agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY:. TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment—�.,+�y 2 0 2,1 Receipt Number COSA # (9 C>( Waiver Fee $ Date of Payment Receipt Number Waiver # Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211354 PID Number: 020-042-25 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ERIC SHORT ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 15735 ROBIN HOOD DRIVE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. SHERWOOD HEIGHTS 4 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption LiftStation Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank 3034. Tank to 3034 drainfield Installer MIKE ANDERSON Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1s 8/24/2021 nd 9/8/21 Location and description : 3rd 4'h TOP OF MANHOLE RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date •�,� �� s Co. TH *err "" """""� %j • • Curtis Huffman �. CE 128991 f TF • • Septic System A row V D _J t / Date / i z . ,�i9/2o21, • �� . PROFESS�ONAa Note: this approval does not include well permit requirements.\�����r (Rev 05/02/18) PID: 020-042-25 PERMIT: OSP211354 L 3 SEPTIC OQ AREA DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1000 GAL HDPE SEP11C TANK WITH NEW DCO. GENERATOR LEAN—TO DCO CO VERIFIED & MH co MAINTAINED E 219 5'+ TO D C $ 1 � FIELDLD E "BM TOP FCO tJ� OF MH EXISTING ° 38R HOUSE EXISTING 11 MT FIELD GONG 36 3' O O 0 O W r Lot 4 0 25,383 s.f. M CA 0 GRASS DRIVE f Tt A—C=13.3' B—C=13.3' A—D=17,7' B—D=17.2' A—E=20.7' B—E=20.3' SEPTIC SECTION SCALE] NTS SHERWOOD HEIGHTS LOT 4 PREPARED FOR: ERIC SHORT 15735 ROBIN HOOD DRIVE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmail.com SUPPORT SERVICES: OF .A.L�� F 5 9 TH DATE: 9/9/21 tis Huffman SURVEY. KGLrCE 128991 DRAWN: FWCS 9/9/21 AO SCALE: 1" = 30' Ahbssto��' MUNICIPALITY OF ANCHORAGE Dn,Site Wator & Wastewator Pro oram PQ Boca 198650 4700 :EImare Fuad Anwouag�. Alzsrra 996-1"6M Pham: (W?)*43.4 1 Fac 007) 343-7997 n l! p; f14vu�tix. rn a rY.Oi'q fdi S i l� On -Site Wastewater Disposal System permit Porrnit Number_ OSP211354 Work Type, SapticTank Upgrade 1 ax Qi�dO Nib M15Wt UZUU1�2bUWV ,Site Legal Address: SHERWOOD HEIGHTS LT 4 0-3238 Site Mailing Address: 15735 ROBIN HOOD DR, Anchorage Ovrner: SHORTT ERIE A Design Engineer: FIRST WATER MNSULTING This perm it i !s for the Cin $tru ction of; Effective Date: Expiration Date Lot Size in Sq Ft: Total g wire o ms: 8MM21 8123 O22 253V ❑ D1 -6p$01. Fuld 0 Seplic Teak ❑ Holding Tonle 13 Privy, In Private Well ❑ Water Storage All construction shall be it amordance w1th: 1. Thr? aitaGhed approved design . 2. All Toqu iremen is speciFed 1n Anchorage Municipal Code Chapters 15-55 and 15-65 and the State of Alaska Wastewater Dlspcsal Regulatlons (18AA 72) and Ddn king Water Reg ulatiom, pC� a} I Yrs W�Ol W�tor r"1504 6" uir%ot 10 t otViOrtit dueiOg IhO irltt;� IIN%�n. I lid engineer she II notiiyr the Uevalepme rit Services Department per AMC 15.65. Provide notification by calling (907) X43-7904 (2417), 4. From C Gtcber 15 to Ap ril 15, a su bsurFacxi� soil abscrpti on system, un der construction da ring trogaing weelher Shall be either_ a. Opened sired Closed s r1 the Barrie day, or b. Cuuer$d, sealed, and h-asted to prevent freazlrtig 81231221 13 iv EiY; Dale: Issued By: Oaf: 3 I /�p®�{�, qpj U I I N LIT F Development Services Department On -Site Water & Wastewater Section Parcel I.D. 020-042-25 ON-SITE SEPTICM/ELL PERMIT APPLICATION Property owner(s) ERIC SHORT Day phone Mailing address 15735 ROBIN HOOD DRIVE, ANCHORAGE, AK 99516 Site address 15735 ROBIN HOOD DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SHERWOOD HEIGHTS LOT 4 Legal description (Township, Range & Section) Lot Size 25,383 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade 0 Duplex ElHolding (D) Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: -02-2 S Waiver Fees: Date of Payment: 1 /'202 Date of Payment: Receipt Number: Z5 Receipt Number: Permit No. P 1 13� Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 18, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SHERWOOD HEIGHTS LOT 4 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211354, Rebecca Carroll, 08/23/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211354, Rebecca Carroll, 08/23/21 MUNICIPALITY OF ANCHORAGE k DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I� ENVIRONMENTAL ENGINEERING DIVISION 82.5 LStreet -Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAME _ PHONE NEW , — ❑ UPGRADE — / -- - MAILING ADDRESS I C� LEGAL DESCRIPTIOfyL/ s V LOCATION -F NO. OF BEDROS Vy DISTANCE TO: Well .t Absorption area � Dwelling _�,✓•��tl fi' � PERMIT NO, �Q ~a 2 Q W I- Manufacturer Materi_ �� No. of comp ments Liq. rapacity in gallon s IF HOMEMADE: Inside length Width Liquid depth ell Dwelling PERMIT NO. 2 _ OTANCEO: ctureraterial Lid -Capacity in p L" T DISTANCE TO: ell �,�OIL- Foundation �?jl,�-( ti'UY�__ Nearest lot line -�-1 0 PERMIT NO.��? /` s Cj J Z Lu bZ No. of I}}��n''es (1 f/I-e- Length of each Zine � Total length of lines � _ Trench width � � inches Distance bet en lines -� I.-cc O Top of the to finish grade t Material beneath tile// 6C s Total effe rive abso ion area W Length Width Depth PERMIT NO. < Q N as W Type of c' Crib dia er Crib t Total ective )sorption area toell N DISTANCE TO: Building fo datio Nearest lot line v, _j_ ss Depth Driller Distance to lot line PERMIT NOTlo�� U W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS SOIL TEST RATING IS INS. LER REMARKS t - APPROVED / DATE LEGAL L y 72-013 (FZev. 3/p) ` ` pal 11,11 PA 1 117 :1: Fo, fit C.. 31 W W 12) 0`17 ��1c:7 1-1 v1p 140 f no'C'sE \. DEPHRTMENT OF HEHLTH HND ENVIRONMENTHL PROTECTION 825 'L' STREET/ HNCHORHGE' HK, 99501 '----' 264-4720 / � --:u 'l ��~������ �EU4 Q �0 ������ ///c / PERMIT NO ( 810956 ) /7�/ l HPPLICHNT CHRISTOPHER J. FEJES BOX 640Z HNNEX ]45~107��~'^ LOCHTION ROBINHOOD DRIVE LEGHL 1-4 B1 SHERWOOD HEIGHTS S/D LOT SIZE 28000 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDR0OMS � ] SOIL RHTING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL H85ORPTION SYSTEM IS: ��-1 - � �����" l - P. -I -! :.! �'. � "! A 11 K3 FQ FA "a" RET U FJ ��11-I — 6�7 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE B�TWEEN TH� SURFHCE OF THE GHOUND HND THE BOTTOM OF THE EXCHVHTION (lN FE�T) THERE IS NO SET WIDTH FOR TRENCHES THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEH THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET) ��1: 1 Q lV IN p"I 1<: ���l1F." i -, - - J. Q UP, Ely CAP L.. A .. K3 WA� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE I�STHLLHT�ON INSPECTIONS OF ANP -r' WELLS ADJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL S1 F..: 1E.:. �F J-, BHCKFILLING OF AN? SYSTEM WITHOUT FINN. INSPECTION HND HPPROVHL BY THIS DEPHRTMENT NILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON~SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE NELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEP�NDING UPO@ THEE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TU H PRIVRTE SEWER LINE IS 25 FEET AND TO H COMMUNlTY SEWER LINE IS 7� FEET W[ELL L��� HRE REQUIR'E-1� HND TO THE: DIPMRTMENT WITHIN ]0 DHYS OF THE WELL TION. OTHER REQUIREMENTS MAY APPLY. SPECIF'ICATlONS FRU CONSTRUCTICAI DIHGRHMS HRE: HVHILHBLE TO INSURE PROPER INSTALLATION. Pro, �, R- �������� ����rE I �� I k E.*-� l"', :,J! . .. ... -3 I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SENERS HND KE --J... HS SET FORTH BY THE MUNICIPHLITY OF �NCHORHGE 2� l WILL INSTHLL THE IN HCCORDHNCE NITH THE CODES. ]� I UNDERSTHND TINT THE ON-SITE SEWER SYSTEM MAN' REQUIRE ENLHRGEMENT IF THE RESIMENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOM& HPPLICHNT CHRISTOPHER J FEJW.; ISSUED BY. �'��.y�-'ice L✓h C]?� $� 1 �-� � �_ •��''�S� 5�&�5��'S� •f _.� _ - 5 � ryi_i Et_ ,1,•.,,i=:r=' E' f t cta :�';"_•Tf::f� (': .r.t^ir3 ,�f=}_t � 7:lf. ,t r'•;✓ttf�rt!; {7 �..t. !!, i.' rl. �+: .='r, - - 1 )..3 VIA.}:. 7 -tY J`�I�- �. 4s�_�.._ ;,.•t i. �Y:.:e-.'{..f .y .._a t;—" f ilti"- s_. f171 . I. Si_ r_i�r•ri.k 1 1"t t.�1 t+...l l!':1 t i.ft'f ME: i'#i-_?tot E, i : kq;, g:::Jt A C •.i_ iid) { (i , ! '..'x.Y. 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Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: F� �-S DewePlq p In (?.4j DATE PERFORMED: /G vLEGAL DESCRIPTION: /�-O7 '� 'D��� 0 // / ��Y` DEPTH j / 1 c� n / QJJ'� 2 3 t r/ c r_ 4 U r �- 5 U 6 r x /x/ 7 8 r � 10 4 b 1 SITE PLAN 13 4 't. 14 l+ Gross Time WAS GROUND WATER 11 OF ENCOUNTERED? 0�� 12 l� 0 °©43S f� f 0000 w o0o coo .h 18 D On iJjppn Q IF YES, AT WHAT 7GlI]OC o d4,v °°n t DEPTH? 13 4 't. 14 COMMENTS L 0 P J E Reading Date Gross Time Net Time Depth to Water OF 17 l� 0 °©43S f� f 0000 w o0o coo .h 18 D On iJjppn LC IN-6 �d 7GlI]OC o d4,v °°n 19 No. 4069 - h "� X 20 1 ,[� f'AOF�Sa10Nl' e,., COMMENTS L 0 P J E Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND FT 72-008 (6/79) n®x 13695, SwAla ffzourrjpl� A344-71714 �� p��gAgeA�1IEA 99502 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 200 Te_t DRILLED AT THE RATE OF ,,22.06 PER FOOT. PROPERTY OWNER lr(��, Ch;ti o1ecce� 3 LOCATION OF WELL SITE L.(auL) o P I;C(NwcvbJ DRILLER WELL LOG: 0–__.._.17", urvc,L° 13 to 17 1? --3%'' Calvr�e �/tc-rnzL. Seve�tc�(_ �acctC,L (Ioit.Ldc�c�° ((Jek QLcutP7itCCC)CV�.i• � ,()t]Lea " v-d/toec/, 11,'z am �a <:�Ltelt (a,�adu_cti.vrt. ,�h.dur-u1.n. IuitU 145 -to 160 .'eet: 1/2. 'o ro r_7%;orlt aae '4y ISO Veit, Sane th'za (VI-eax) o'. j)-d,zdu� �tocic, and azo%taco o -tijpe as t.e.,Zi t t to 200 Veit. -- L = ate. -t 11-b?" oV Two C/'li( or-Wi, 1,50 Vee t a C aratPJt otaacLbzct . a CCL4111C1. /-evt.f_'aoa X 150 .Peet: 240 c/cL(.o ,(a ,teAcvwe. �/4 ffavie Submei'(�ibd_e_ /'tua�l. �Itou,(rl .be .1,fti-tcLjtnr!_ 1$ O;' i o-t,,.l Coo -t o )�ztiL(ial.n : , 22.00 pe"tt�-aot X 200 .feet: 11 00.00 C_h1l iA Tec�e.0. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. ------------------ WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF — THANK YOU VERY MUCH. BERNIE: CLAUS OF RAMPART DRILLING WORKS DATE iiolr, /o --V-1981 SERVICE CHARGE OF 1%:°b PER MONTH WILL BE ASSESSED ON PAST UNMWAUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 020-042-25 1. GENERAL INFORMATION Complete legal description SHERWOOD HEIGHTS LOT 4 Expiration Date: 12' I Lf -2/ Location (site address) 15735 ROBIN HOOD DRIVE, ANCHORAGE, AK 99516 Current property owner(s) ERIC A. SHORT Day phone Mailing address Real estate agent 15735 ROBIN HOOD DRIVE. ANCHORAGE. AK 9951 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 555 P I Waiver Fee $ Date of Payment F/2 7/202� % Date of Payment h Receipt Number 1 172 I 0 Receipt Number COSA# QSC-21 1 5-� 3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/25/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to Y OF AJ these various and dynamic characteristics and are outside the control of the evaluator of the •�(i well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q.' • • �„9 ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or J discrepancies exist can be given by First Water Consulting & FWGS *' �9n ,T . .... ... 6. DSD SIGNATURE.✓✓Curtis Huffman System #1 Approved for bedrooms ,�Fc��f . •CE 128991 1 F� q/25/�1 •'F� System #2 Approved for bedrooms �l,F�PROFESS10Nt`� Disapproved Conditional approval for bedrooms, with the following stip Int 6hV((((( �oy OF g ON -St �o WATER AND m z:z_ m PRO'GF.AM EC) S JJI���) SERV11111��\� y: J Original Certificate Date: y �� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: SHERWOOD HEIGHTS LOT 4 Parcel ID: 020-042-25 If more than 1 septic system on lot: COSA Checklist # _of _.__ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 11/1/1981 Total depth 200 ft Cased to 40+ ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/12/2021 Static water level at beginning of test 22 ft. Well production at time of test 2.7+ gpm Comments B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 9/14/1981 ® ALL standpipes present per record drawing Total measured depth from grade 9_7 ft (max) Measured depth to pipe invert from grade *5.9 ft (min) ❑ N/A — pressurized field Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW'[:..; Date of Sample 8/12/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 8/12/2021 Results Z Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 3 in ® Monitor tubes go to bottom of effective. If not, state depth into effective *W/IN 0.1' OF THE 6' ED Elapsed time <20 min ® Code -required soil cover over field Final fluid depth 0 in ® System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced 2,000 gallons If yes, enter date Comments/Deficiencies: PROPERTY VACANT FOR 2 YEARS. *PER ELEVATIONS AT DCO AND BOTTOM OF MT. NE E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and review A �": •' . • • ' • �� of Municipal records that the above systems are in conformance' •:� �¢ with MOA COSA guidelines in effect on this date. TH i . , ..': .. .... .........:. Curtis Huffman CE 128991 PROEM* ft ft ft ft ft ft ft ft U) H z w W U) 6 it - ABERWOO® CIRCLE P. : :&o v, ©°s�oo DO :z °meg p N'. N: 0P0) �� per: -3: N p V)..*.o o Q :zz .'QQ o0 Z Opp :R rn 444do`�c' O acs t E m O / Q 0 X 0 o / v H / Em °m`0 o Cn co mta,n0� s�0 `O EQ ABERWOO® CIRCLE P. : :&o v, ©°s�oo DO :z °meg p N'. N: 0P0) �� per: -3: N p V)..*.o o Q :zz .'QQ o0 Z Opp :R rn 444do`�c' O acs t E m O N a a Q 0 X 0 o v H Em °m`0 o Cn co mta,n0� s�0 `O EQ N> r N QePto0ID M to -4 C 'O C m N C < a 0 tom mtos> (n 6 N N W 0 in 04 O � v0:fi +- a �+•- o.0 NOLO �nh®' O t2. U �' ON 0: Ca in O O c C • BUY �. Q C O O o 0 Oi O .a 00 a1 C n O 0 m C n m o U (n U CO Q. 0 O C C m EL2m m a C n '- 5�:F:o� Ma C0 o. >. C C O a. O V U D J E O J !/1 V 1 0v O O+ U 0 0 61 0. U Q� z cDoo()0>'c " .000N (/�� -4e. "' _ Ui a O m Ol N O O a r .0 �O00>.O C e X v V)2 0 O m a 0 C O p f�� O � Q0�0 to J V J h ~ v -° >. >cai a 0a •- m V)_ 0 w� g m m a = H O to O m L. O p .0 O'—.0+� •0 �w i0 a c a 0 c 0 maim 0-E c o :� q 0 Qz. n, W v" 0 > a t_ J ( �i-- d' a,s 0 to >. O « C 0t-� a m c - +- v O o g�� m��s Em m �,m O_ lJ Z +- m to — < $ C 0. m �- 0 _ > = U MUNICIPALITY OF ANCHORAGE • -� Department of Health & Human Services M}1 DIVISION OF ENVIRONMENTAL SERVICES — 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACLLITY FOR SINGLE FAMILY DWELLING Parcel I.D. #a 2 ® a.4 2 2.3— HAA # A --1 1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) o Location (address or directions) lS '73� Qe'1)k r, �60A /� e (b) Property owner All f6_ Telephone : (home) Business Mailing Address (c) Lending Institution Telephone Mailing Address t� (d) Real Estate Company and Agent �r11fHf ?14 G1rT Address Telephone (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: /�s fie, uP 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3. WATER SUPPLY Individual Welx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. ,.".N 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm id G C 5 Telephone Address Oji Date 12 3J S Y. .�y°�aee°°j God ° ° o 0000°0 100o .Coo.'" 0 0 0004091v0 000a ♦000Y o9'l u LE C. REID, JR, o i8 pr' @gaf2251 ^ ^' 6. DHHS APPROVAL�� 5^ nC � � `/��f� —�– ate p K//'7—��./ � D_ Approved for bedrooms by Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. Page 2 of 2 72-025 (Aev. 7/88) Back 6NICIPALITY OF ANCHORAGE (MOA) il')Asl Health Authority Approval (HAA)CHECKLIST - FEBRUARY 1984 ` 343-4744 Legal Description: /,-07- � '&'e 4/A S'` xtjovs 1)7-5' ­rizn1 z3kJ SEL z -- A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present O'N Date Completed //-/-e/-Yield 316 6 M Total Depth Z -6"V r Cased to ��r'f Depth of Grouting A)/1q` Static Water Level / Pump Set At Casing Height Above Ground G Electrical Wiring in Conduitl&N) SEPARATION DISTANCES FROM WELL: Sanitary Seal on Casing &N) Depression Around Wellhead (Y/© r / To Septic/Holding Tank on Lot /4U -7 ; On Adjoining Lots dao To Nearest Edge of Absorption Field on Lot . fao /� ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole 4114 To Nearest Sewer Service Line on Lot _ 7,5 / fi Water Sample Collected by %i -'r -e 5 Water Sample Test Results IJ/T'&HTE1 --&- Comments GJFU' /Z- TE57- /Z -2-/-8T. B. SEPTIC/HOLDING TANK DATA Date Installed ?'-/ 'f/ Size /o'" No. of Compartments Standpipes(Y)N) Air -tight Caps&N) Date _ 4-C 7- L /Z'-/S'rA Foundation Cleanout(Y N) Depression over Tank (Ye Date Last Pumped /s�4r--5 Pumping/Maintenance Contact on File (Y/N) ^; for 6YA Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply. Well /00 -/ To Building Foundation To Property Line /0 l -f- To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 e_�[ s*ZAA7o1 C. ABSORPTION FIELD DATA �- Soils Rating in Absorption Strata _ �S Type of System Design Date Installed 9_ -V Length of Field Z� Width of Field 3 Depth of Field Gravel Bed Thickness joo Statndpipes Present N) Square Feet of Absortion Area (Y �}I Date of Last Adequacy Test Depression over Field (Y Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: /o, I Well /0 To Property Line To Water -Supply iii ,.r- To Existing or Abandoned System on To Building Foundation �/-t- Lot ----JTZ ; On Adjoining Lots d To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course �Ua To Driveway, Parking Area, or Vehicle Storage Area — Comments D. LIFT STATION Size in Gallons _— "Pump "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) _ "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" I certify tha I have the ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection OF At � ,i ��...__ °° .f,/ Signed —�,� Q.. ,° °,° fb Company I eer's Seal 0491 ; Date °oo °o o e°no p1 O Z7 MOA No. 7 °eeo e ROY C. REID, JR. � ° CF - 22.51 0 �11, , A 1 ° Q 2 l Receipt No. 1 { `� Receipt No. a � �i�v,�..,..-.;,•, Date of Payment Waiver Fee: $ Amount: $ Date of Payment Page 2 of 2 72-026 (Rev. 7/88) Back Time Time ne Date - Date Date e �3-<<)Qe Inspector — Inspector Inspector Comments Conditional Approval — Date Sewer Installed Permit No. Septic Tank Size / e ( 0 � ji W Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner (4111tlS7er i 5 MailingAddressJ��/ LPhe Buyer— Address Lending Institutlo //:�. y // `-A 1/�� Phone Address —r'— Realty Co. & Agent S /yj/ f/F/Z F 9 y P r°i/ �� �� �� Phone 'i Address Legal Description/;— X3 j y beet Location 11)201 /,i1) 1O, li,-1 � Typ@ �f Residence 7 Single Family '. ❑ Multiple Family No. of Bedrooms ❑ Other �e— — ,� Water Supply 'K7 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 ❑ Public Utility available.)— — Sewage Disposal i7 Individual Year Individual Installed: — ❑ Public Utility When Connected to Public Utility:_ ❑ Holding Tank --��--�-- -- NOTE: THE INSPECTION SEE MUST APCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 1 ) o (" f-, I + c r 2« t 1. 9 '.-; L C 11 r 2 " t. W ) 11 k , r P e j u s 6917 Old SQuaiml lliqhwav J ho t. it , sleek L Sherwood 1 N? Q it tw-, l'i, r."! ) j, n ho" -16 j. v t A renal jfQI:' !JI(! 11IMMILIal scyllur, and vahor facilities (;Hjlmqyt be granted a 11 t i 1 Aa k V) 11 all i n c 1 lima Kim muln complOwl A well by a ubmir Inn! tc; Uhn off kct- f ou :w -r, ;ilea Ana review, ;.011w water allellyrml report needs to Oct slonriMal to this (00(scl f1min rhe Chuy 1011), 56:31 5 ntyveE. ;'(w ou-r r1w5tv sultilly thim, dt-"porU�itt ful: a xvinywAinn Wholl LIM noLe"", dlsrtepancieu have be cocrucLed. If UVAL 11M 6Q, 1411:1111011, wwwArms , please will HIS CAAJ.cc at 264-47101. S j n c T" t: -. J. 7 , If' ,ot)c u L E. gra g: 11Nwcizt PO V J, t'u" I a t'll