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SHELL #1 LTS 6 & 7
C�eveiapm-;rtt Services Department wilding safety Civisicn 4100 Bragaw Street P.C.Bal. i96c50 a gagich ;rchare .41C 99519-6650 �Nayof : ww.muni.arn/nneire (907) 743-79fJ4 Pump Installation Log ell Drilling permit &umber: SW_. Date of Issue: ' ircel Identification Number:_ ;g31 D {10II (, imp lwtn.ation Date: �� 8 // Imp Intake Depth Below Top of Well Casi_n/g::/JZ feet Imp Manufacturer's Name: Imp Model: I p Size hp itless Adapter Burial Depth: feet ;tless Adapter Manufacturer's `lame: /YlrliC �% �rless Adaprter _nstaller• ocnmeats: ., ump IsPstailer `fame: ra erty Owns�;-J;4j=e & Address: yyal 6'�R/lam O j5-- J'D--H ,ttentio a: The pump installer shall provide a Pump installation log to the DSD witivn 30 days of pump imstallat iom. Municipality of Anchorage ,. Development Services Department Building Safety Division - i Onsite Water 8 Wastewater Program, 4700 South Bregaw St - P.O. Box 196650 Andlorage, AK 99519-6650 www.d.ondlorage.ak.us (907) 343.7904 Page 1 or 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW010387 PID Number. 015-112-11 Name: CARL JAKOSKI Wastewater System: ❑ New ■ Upgrade 4401 O'MALLEY ROAD d ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 346-1228 4 ■Deep Trench OShollow Trench Deed DUound 0Other LEGAL DESCRIPTION =a f 1.2 awa nam 1 O MAX. cn/sM1 rt,Tom n. Lot: Bkxic Subdivision: Wed, to pipe Baan hair, "Ins! erode Qwd dwth ewraolh pipe 6 do 7 - SHELL #1 2.5 MAX. rt 7.5 rt Township: Range: Section: rp odad aeww argarrr ,rade orww wqu: - - - SEE DWG. rL 35+ rt WELL: E)New [IUpgrade Gavel okay 2.5 Nanea of Nrs 1 alslonre b ere - R rt ClaNrrvnm Prhale. AU): Te1al Co..d Ta tow ebeapUan sae: 525 Wot~. D 3034/ F-810 rt so. rt OM1Mr. Pau orr.a stoop eater twrt Vw~.. A+ HOME SERVICES Gate Yrtoeaa: 10/31/01 - 11/1/01 rt �w p set cask's f� ewe Gawp TANK cpu rt rt SEPARATION DISTANCES ■Septic 13Holding aS.T.EP. 0Other To Septic Tank Abi o tion Mid Uft Station Holding Tank see« unse Na,nda:hpen ANCHORAGE TANK copocrw ti sera's 1250 From Well 100'+ 100'+ — — 25'+ STEEL N� of ownpw� 2 Surface Water 100'+ 100'+ — — — LIFT STATION Lot Une 10'+ 10'+ — Foundation 5'+ 10'+ — — — an lwal rt st Hqh eota slam at Curtain Drain NONE KNOW rrnv uot. Eratrtod irr,pacllorr oaeaara eY Remarks: EXISTING SEPTIC SYSTEM ABANDONED BENCH MARK wcalbn end aeaaVeara PER UPC. THRESHOLD OF BACK DOOR CONFIRMATION TEST HOLE EXCAVATED TO 17 E. NO BEDROCK OR GROUNDWATER ENCOUNTERED. d 106.35 n awoetmrs left ov�P�� �0000QS�4 Inspections performed by AWWC, INC. Dates:lst 10/30/01 * ; 4 :y*�QO 2nd 10/31/01 ...:.... .. .... ......� 4th 11/1/011 Q p :J f y am s;' ss h and H man Services pprvalO��t;Op'dp••..• Reviewed and approved by' Dateo �� •o\�o�vop d (Re.. 112/00) 0�40000�� I N 8AS—BUILT DRAWING PARCEL to NUMBER: SWO SW010387 - 015-112-11 I ALTERNATE SITE. WILL REQUIRE A 5 FOOT LOT UNE WAIVER. CONFIRMATION TESTHOLE TO 17' THJ1� / GO DBS sNEo NEW DRAINFIELDI I -k rtmrDz'il7TT171A I EXISTING FOUR BEDROOM HOUSE ZNEW 1250 . ' ' • ' i .'.: •,.` GALLON SEPTIC TANK : ^: O'MALLEY ROAD I A -1 B 1 C I STI 37.89 23.38 — DBL1 149.16 132.29 1 — DBL2 50.54 133.191 — COt — 152.93 1101.74 MT1 — 53.96 101.38 CO2 — 160.99 191.03 DATE 11QCM-1 1 ' ALASKA )WATER & WASTEWATER CONSULTANTS, INC. ODI DFRARR ROAD ONRF M • ANrN RAGF. AK OOSOA • P F (00"W AAO • FA% (007WM-M CARL JAKOSKI K.D.W./C.J.G. I"=30' 346-1228 1 2 OF 3 SHELL SUBDIVISION #1; LOTS 6 do 7 OF WORK AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE WELL A ' fr A es;.- °D C -79 � It wO10387' AS -BUILT DRAWING °osilNUMBER: 1 TOP OF INLET INVERT OF BUNG - AT INLET - 99.61 ORIGINAL GRADE 95.21 (HIGH SIDE) FINAL GRADE 104.3 +/— NEW 1250 GALLON SEPTIC TANK � r c ALASKA WATER & WASTEWATER - CONSULTANTS, INC 6001 DFHA99 POAD. SMTF PO • ANCN AGF. AK 0950E • PNONF (907)317d179 • FAX (907MM-174. 'PREPARED FOR: PHONE NUMBER: CARL JAKOSKI (907) 346-1228 LEGAL DESCRIPTION: SHELL SUBDIVISION #1: LOTS 6 & 7 TYPE OF WORK: AS—BUILT PROFILE OF SEPTIC SYSTEM UPGRADE FINAL. GRADE 96.5 +/- •TOP OF TANK AT OUTLET - 10029 `INVERT OF BUNG AT OUTLET - 99.47 FABRIC INVERT OF PIPE 92.71 (AVG.) ,M OF - 63.21 11/19/2001 0 ?AWN BY: K.D.W./C.J.G. .uF N.T.S. 0 4 ..Y. ..... ... MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Q4)( 5�/8 r SDA A 4- it:u� Date Issued: Sep 24, 2001 Expiration Date: Sep 24, 2002 Permit Number: SWO10387 Parcel ID: 015-112-11 Legal Description: SHELL #1 LT 6 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 004411 O'MALLEY RD Owner Name: CARL JAKOSKI Lot Size: 17255 SO. FT. Owner Address: 4411 O'Malley Road Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE . AK 99516-0000 This permit is for the construction of: Disposal Field Q✓ Septic Tank f-� Holding Tank E) Privy El Private Well El Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by catling (907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions: AT THE TIME THE PROPOSED ABSORPTION FIELD IS BEING CONSTRUCTED THE ENGINEER SHALL VERIFY NO BEDROCK TO A MINIMUM DEPTH OF 16 FEET FROM ORIGINAL GROUND SURFACE. Received By: Issued By: Date:o� fflQl Date: 9 -?-¢ - dZ Municipality of Anchorage Development Services Department l Building Safety Division Onsite Water S Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519650 www.cl.anchorage.akus (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 015-112-11 Permit Number 5WO/0187 Property owner(s) CARL JAKOSKI Day phone 346-1228 Mailing address (1) 4411 OWALLEY ROAD * ANCHORAGE. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) SHELL SUBDMSION 01: LOT 6 & 7. Legal description (Section. Township & Range) N/A Lot Size l -7 9 6t�: A FL t� THIS APPLICATI FOR: Number of Bedrooms 4 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzd ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool •❑ I certify that the above Information is correct I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. (Signalum a! pfoperty owner or authorized agent) Permit Fees: a !:i (PC) . 00 Date of Payment q / / y IQ Receipt Number. Waiver Fees - Date of Payment Receipt Number. ALASKA WATER & WASTEWATER CONSULTANTS, INC. September 10, 2001 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650, Anchorage, Alaska 99519-6650 Ref: Septic Upgrade for Lots 6 & 7, Shell Subdivision #1 To whom it may concern: The existing 2 bedroom house is served by a private well and septic system. The buyers are requesting that the system be upgraded to accomodate 4 bedrooms. The existing septic system is composed of a 1000 gallon concrete septic tank and a crib type drainfield that is surcharged and needs to be upgraded. A test hole was excavated in the area of the proposed septic system. A conformation test hole will need to be dug, prior to construction of the drainfield to confirm no impermeable soils or bedrock are present to a depth of 16 feet. We are proposing that a 1250 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.2 gallons/day/112 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 4.2 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/R2 c. Number of Bedrooms: 4 d. Design Flow: 600+ gallons per day e. Minimum Absorption Area: 500112 f. Total Depth: 10 feet (max.) g. Effective Depth: 7.5 h. Width: 2.5 feet i. Minimum Length: 35 feet long j Effective absorption area = 525 ft2 3. SURFACE WATERS: There is no surface water within 100 feet of the proposed septic system. 6901 Dcbarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the house sits on a flat bench that is higher than the rest of the lot. There is a steep cutbank behind the house that runs down from south to north. The average topography of the north end of this property is a 10 to 15 percent running from approximately north to south back toward the cutbank. The trench is to be installed at the base of a steep cutbank and parallel to slope contours. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179, or 244-9612. Thank you for your assistance. M.S. NOTE. Attached is a site plan drawing, a design drawing, a topography site plan, I soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com , 1 ' % L.1➢D• rnr I 1`\ 0•MALLEY HEIGHTS mELL LOT #0 I SHELL 12 % ,,_�.Lt' 1 ^ ' SHEIL f t i LOT 3A, BLOCK 1 �-sPnc AREA SHELLLf� i LOT 2 ; L--- � -- '----------- 3 EL 1 2 I SHELL 2`\ 1 SHELL il-- -{y SNE71 ftLOT 1 1 LAT \7 LOT' ice!- I- �LDT 3 OOWLLEY2.BLOCK HEIGHTS i 1 I 1 \ W / \ i 1 \ SHELL f2 ' SHELL 12 / EU /1 \\LOT 8 I LOT j LOT It Q' SHELL 11 \ 1 \ , / — — — — -A LOT 4 I ``` I � +T IQ AACANT-) 1I �� 1 150' WELL RADIUS _ Iryj I I w 11 ALTERNA�E klTE 1 PROPOS SEPTIC SYSTEM (UPGRADE (SEE PAGE 2 OF 2) I= i SH /2 �- ) LIQ., / 1 O'MALLEY HEIGHTS / ' SHELL 2``` ��� --� / I LOT 1. BLOCK 1 S ML �ELL 12 IR . / LOT O1 1 T Ir SHELL LOT S� / 1 / I 1 � y, I —_— \ EwsnNc sErrlc — - — - ----% --- / O'MALLEY ROAD ���--- ,�•�------------------- I I I T12N. R3W. SEC 22 2N, R3W, SEC 22 LOT 14, E3N2, PTN IN SEC, LOT 14; T12N, LOT ,15 EC 22 I I �7--I I T72N, LATR3W,1SEC 22 T12N, R3W. SEC 22 LOT 14, PTN N2 / 9/10/2001 c_+ W �i DRAWN BY: ALASKA MATER & WASTENVATER C.J.G. CONSULTANTS, INC. SCALE * �' *� M 6901 DEBARK ROAD. SUITE 28 • ANCHORAGE. AK 99504 • PHONE 07).177-6179 • FAx 907)136-3246 1 = 100 PREPARED FOR PHONE NUMBER: PAGE NUMBER: CARL JAKOSKI (907) 346-1228 1 OF 2 e LEGAL DESCRIPTION: 6�gID 953 SHELL #lI LOT 6 AND 7TYPE OF WORK; �V��s��' •..,,,,,..•'apo' SITE PLAN DRAWING FOR SEPTIC SYSTEM UPGRADE y,4�``"vr°,,.1.essl,ot% NOTE. THE CONTRACTOR roUff HAVE THE WEST LOT LINE. THE 100 FOOT WELL RADIUS, AND THE 150 FOOT RADIUS OF I THE WELL ON LOT B FLAGGED BY A REGISTERED LAND I SURVEYOR PRIOR TO BEGINNING CONSTRUCTION. I_ 15W CLM 'A' WELL RADIUS ALTERIIJATE SITE I . PROPOSED DRAINFIEID: PROPOSED CONFIRMATION I TION EXCAVATE A TRENCH THAT 6 HOLE TO BE O 10 FEET DEEP MAXIMUM), BY PR10f� TO BEGINNING CONSTRUCTION I 2.5 FEET WIDE,.Erf35 FEET LONG ADD 7.5 FEETOF CLEAN, WASHED, SEWER DRNNROCK. TH11 Co \ MT --- -- MT ` WSTA/LL DOUBLE I \ GALLON POSED 1250 \ CLEANOUTS SEPTIC TANK EXISTING SEPTIC TANK TO BE COMPLETELY ABANDONED .+/ \ 1 SHED I e INSTALL \ FOUNDATK)N / I CLEANOUT, / BEDROOM EXISTING HOME I\ \ La �.. •' 1'• . EXISTING SEEPTAGE PR I • ,• •: : • • :: .' •• .• TO BE ABANDONED COMPLETELY • I O-MALLEY ROAD 9/10/2001 o�"dOpO O• '`�!• �oo DRAWN BY: v0 ALASKA WATER & WASTEWATER C.J.G. SC CONSULTANTS, INC. 6901 OEBARP ROAD SUTF 29 • ANCHORAGE AK 99504' PHONE(907)3374179' FAX 07A36-3246 = 30, 0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER:-A CARL JAKOSKI (907) 346-1228 2 OF 2 ...• ..Ga ... Y s; au •, C 953 LEGAL DESCRIPTION:OQ� SHELL SUBDIVISION #1; LOTS 6 do 7 .; „ . 440 vp (eselDO0\ �•'�� 4pppp000�� TYPE OF WORK: DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE N I I I O'MALLEY HE LOT 3�. 8 HIS K 1 S 0 SHELL /2 LOT i OPTIC AREA SHELL /1 SH M 0 72 IUs MELL LOT IfEll 1�2 SHELL SLOT �1 SHELL /1 LOT 3 O'►ULLEY CHTS LOT 2. BL K 1 w 1 SH LOT !2 SHELL LOT 12 �ACANf� LOT 1 RADIUS O yrj S�ETLL4/1 ACANTD w ERNA RE$UM 2) Z Q HEIGHTS LO 1, BLOCK 1 HELLLOT1 YT 5 OALI O'MALLEY ROAD �Q\ \\J) T12N, R3 SEC 22 LOT TAT12N. C NW4NW4N W4 IN SEC. f 14 LOT .EE7N2. LOT 13 7 T12N. R SE 22 T12N, R3W SEC LOT 14, PIN 901 ce R0e0 to • e AX 04 • more co 7//F/(9aue DATE: 01 9/10/20DPAkN oop6o4 `C Re. •• •..� �J . J ..ss..... ss: �JJ OQ °y 7953 OQ ado eoe10^Oo� �440000� BY; C J.G. scALE: 1 — 100 MED R PHON M JAK KI (90 3 1 28 PAGE NUM 1 0 2 LEGAL DESCRIPn SHELL #I LOT 6 (AND 7 TYPE OF WORK:r SITE PLAN RAWING FOR SEPTI YDS EM PGRAD, I i i 150' CLASS A' WELL RADIUS I AT rGaar 5s.: C, tsx+/- � I am. >�`'•'2°� jC�--�Sx+/� tS%+/-� 15�+/- / i fgf0'•PIPOFESSLOW'� \ \ \ TH11 / \ ------ --- -- � CUrBANK 1 E I a \ I / EXISTING 4 BEDROOM \ I HOUSE -+t .• O'MALLEY ROAD DATE: 9/10/2001 DRAWN BY: ,�� Y�"�� ALASKA WATER & WASTEWATERSSE J.W.M. 1" = 30� CONSULTANTS, INC. 6901 DEBARR ROAD, SU7E 2B • ANCHORAGE. AA 0950.' FKNF 907)317-0170 • FAX (907)336-3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CARL JAKOSKI (907) 346-1228 1 OF 1 LEGAL DESCRIPDON: SHELL SUBDIVISION #1: LOTS 6 & 7, TYPE OF WORK: TOPOGRAPHICAL DRAWING Flf"-o*- ALASKA WATER & WASTEWATER CONSULTANTS, INC. LEGAL DESCRIPTION: SHELL S/D LOT 6 PERFORMED FOR: CARL JAKOSKI DATE: 8/30/01 DE (feet EST HOLE 1 1 yyyy ORGANICS 2 �• DRY 8/30/01 3 •• �• •• •-0go •' •o • ., ��1)11)I)��I 6' .• �.go- •• 60. 2 5, .. 9 .; 0..,..0. 2 6 •. .0-00 .; •0-09 .• I.,. 111111111 7 •: .....�. •••• - VZZZ1 .•...�• Illill: SP 000, • ORO 6' — 6 10 .. peg .• ...:.: •..• •. • •• •. 2 11 •:.q.• •-.6.•. •, . 12 ...•. •• ' .; •••• ,.. 8 13 966 • ••'• 2 14 •• 3:30 B.OJL 15 10 3:40 10 16 2 3/8- 11 17 6' 18 12 3:50 10 19 2 3/8' 6i7I����91iC•L•�r(d►I• DATE DRY 8/30/01 DRY $1Ti.•p � ��1)11)I)��I 6' — 2 3:00 %/.pNUN 3 1/2- 2 • 3 3:00 111111111 6' — - VZZZ1 10 Illill: 2 000, • ORO 6' DEPTH TO GROUNDWATER DATE DRY 8/30/01 DRY 9/7/01 2:50 — 6' SEE SITE PLAN DRAWING FOR TEST HOLE LOCATION DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/6/2001 1 2:50 — 6' — 2 3:00 10 3 1/2- 2 1/2- /2'3 3 3:00 — 6' — 4 3:10 10 1 3 1/2- 2 1/2- 5 3:10 6' — 6 3:20 10 3 5/8' 2 3/8' 7 3:20 6' — 8 3:30 10 3 5/8' 2 3/8' 9 3:30 6' — 10 3:40 10 3 5/8' 2 3/8- 11 3:40 6' — 12 3:50 10 3 5/8' 2 3/8' PERCOLATION RATE 4.2 (MIN./INCH) PERC. HOLE DIA. 6' (INCHES) 20 TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. COMMENTS: PERC TEST PERFORMED BY JOE MARCHETTI PERFORMED BY ALASKA WATER do WASTEWATER 1. JEFFREY A. CARNESS. CERTIFY THAT THIS W 1 IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: D D GRE1-'R ANCHORAGE AREA BOP 1HDepartment of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM 9 9.ra -3 NAME C�/12 L_ !,6�-405/C/ MAILING ADDRESS BOX x(,65/ A CIV PHONE _ LOCATION ree)60SkGVl 011'V/2U-4( EV LEGAL DESCRIPTION 1-U J- (p%5 5, G/ SEPTIC TANK: DISTANCEqq NUMBER OF FROM WELL /O9 / MANUFACTURER E=_ S/4i41u_2A MATERIAL ('On/C2GT COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY / �S 0 GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH_, LENGTH_, DEPTH !� / LINING MATERIA ZA166 � / DISTANCE FROM: WELLIB SIZE: DIAMETER _DEPTH )�IOTAL EFFECTIVE BUILDING FOUNDATION �9 / NEAREST LOT LINE / ABSORPTION AREA (WALL AREA) -5 Y SQ. FT. ADDITIONAL ABSORPTIONA/2 SD PPTrvn/ 4z5lt- t c{ /yjrF Fol 4 LSOP�JJ. WE -LL: Dk,l LLEW TYPE rnlO/t/, —_CONSTRUCTION F/r - W/Lc 8C DEPTH {&0 / DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC / SEEPAGE FOUNDATION LOT LINE SEWER LINE —, TANK _ /" , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED ✓ REMARKS INSTALLED BY: SL c -F PIPE MATERIAL: (1,*Sr _2' eeo l AS 1'00u/gcd LOT SLOPE: REMARKS: �it/C (S /-L&-7- 0447" XVAI le,-QU r2 E9 Form No. EQ -031 DIAGRAM OF SYSTEM S / zo 4 � Ln, L,.rE f.3ao.�j 141 Lq 1 _ -4 I ��z----PnovusEn �OMn/r:Cno�/ 1 rpor„J(Ts� � 1 Fon. C�Eitn/oc,T I 1 3 13oem 1 — NO 0V)ev- DATE 6- /9- 7V APPROVED G.A.A.B. GREATER ANCHORAGE AREA BOROUGH 4P ..Y Ff• InI \c DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASI[A 99503 u 555/f TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION PERMIT NO. a,/ GC MAILING ADDRESS ,L - "' f PNVTVr-- INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH _ _ _-- TO BE INSTALLED BY ----- SOIL TEST RESULTS ` 'fit NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED -/-------- FINAL INSPECTION: 7.4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINA1. INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.,^9- s'iJ "� SEPTIC TANK SIZE Ae SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK j -- --- n/ f r FOUNDATION TO SEEPAGE PIT"' - DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL// -- 1 L© / SEPTIC TANK SEEPAGE PIT � DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK / SEEPAGE PIT /�� / ---• DRAIN FIELD _ � ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANIy-. SEEPAGE PIT DRAIN FIELD ..--rJ�--. SEPTIC TANK, /&V- SEEPAGE PIT DC. DRAIN FIELD lee TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL, RACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G,A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. pq • APPLICANT'S SIGNATURE FORM NO. EQ -01 6 GREnIFR ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVTRONMFNTAL QUAL.ITY Case 3330 "C" Street w ANCHORAGE, ALASKA 99503 med For Leo Sawyer (Carl Jakoski) Dated Performed May 14, 1974 Description: Lot 7 Block SUbdivision_Shell #.l _ Form Reports Soils Log X Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - pth ;et Soil Characteristics 1 Small gravel and sand SW v J Medium -to -coarse gravel and sanc 8 — —�— — l 9- 0 0—V Coarse -to -fine sand with occa- 1 2—• sional gravel 13 -- 14 -- h\\� GWSP, 118(' Was Ground Water Encountered? No If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H2O Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit X Drain Field Depth of Inlet Depth to Bottom of—Pit or Trenc 1fi__1_- COMMENTS: We recommend 130 sq ft per bedroom Test Performed BY J. Jameson Date Certified BY: Date: Iv1�1Y 1 1g74 ANI GREATER ANCHORAGE AREA 130ROIJGII Rry DEPARTMENT 01= ENVTRONMENTAI_ QUA.I.II'Y Case 41_� _ WREPTTOf [NVIRMNPIINTAh alu44y) 3 3 3 0 "C" Street ANCHORAGE, ALASKA 99503 Performed For Leo Sawyer (Carl Jakoski) Dated Performed - May 14, 1974 — -. -- � Legal Description: l_ot_ 7- _— _Subdivision _Shell t#1, This Form Reports Soils l_og_ X _-_ _ Percolation Test_= - Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet Soil Characteristics 1 — 2- 3- 4- 5- 6- 7- 8- 9- 12- 13- 14— Small - 3-- 4-a- 5--- 6-8-9--- 12- 1314-- Small gravel and sand Medium -to -coarse gravel and sand Coarse -to -fine sand with occa- sional gravel SW GW -SP SW Was Ground Water Encountered? No If Yes, At What Depth? Reading Date Gross Time Net Time Depth to 1170 ` Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit X Drain Field Depth of Inlet Depth io Bottom of_Pi t or Trench__ 15' COMMENTS: We recommend_ 130 sq. ft. per bedroom . Test Performed BY J. Jameson -i- Date Certified BY; ---------------- D a is e ; • ri Municipality of Anchorage °{a On-Site Water and Wastewater Program I (907) 343-7904 s try CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-112-52 Expiration Date: '--17-( 7 1. GENERAL INFORMATION Complete legal description SHELL#1 LOTS 6 &7 Location (site address) 4401 O'MALLEY ROAD,ANCHORAGE,AK Current Property owner(s) JOHN J. LAU Day phone Mailing address 1332 VIRGINIA CT.#A,ANCHORAGE, AK 99501 Real Estate Agent Day phone 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class —Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: / ' / 7 COSA to be relea -s . th• •ineer, unless otherwise requested by the engineer. COSA Fee $ 62-co — Waiver Fee $ Date of Payment I ' 1 1 Date of Payment Receipt Number C,? Receipt Number COSA# OSC.`--1 \\ n 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, Name of Firm ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 5/15/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ��.\ oencroachments, deficiencies or discrepancies exist. OF Az ,e��� 6. DSD SIGNATURE14. / 'sem,■ System #1 Approved for 1 bedrooms. -P �� r Cj ,01 71 : r System #2 Approved for bedrooms. + °x �s— •, Disapproved. \ WESSI° Conditional approval for bedrooms, with the following stipulations: Q`\�\\_\T Y Op i�Cti wAT..SlrE G r j �/ASr �AND m: AT�R PRWGRA� c By: r Original Certificate Date: S--;-( 7/ 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other coSA blue sheet_1090-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: SHELL#1 LOTS 6 & 7 Parcel ID: 015-112-12 A. WELL DATA* Well type PRVT If A, B, or C provide PWSID # Well Log (YIN) N Date completed CIRCA 1974 Sanitary seal (YIN)Y Wires properly protected (Y/N) Y Total depth 137+ ft. Cased to 43+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test - 5-2-2017 Static water level -- ft. 140 ft. Well production g.p.m. 7+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 4, 92- mg/L Arsenic rV a ug/L Date of sample: 5r3 f t? Collected by: ARCTERRA_ B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL _ Date installed 1111/2001 Tank size 1250_ gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 51212017 Pumper One-Stop C. ABSORPTION FIELD DATA Date installed 111112001 Soil rating .d./fttr ft2/bdrm) 1.2 System type DEEP TRENCH Length 35+ _ft. Width 2.5 ft. Gravel below pipe 7.5 ft. Total depth 10.9 ft. (Measured 5/2/17) Eff. absorption area 525 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5.2-2017 Results (Pass/Fail) PASS For!bedrooms Fluid depth in absorption field before test 0 in. Water added 610 gal. New depth 20 in. Elapsed Time: 70 min. Final fluid depth 0 in. Absorption rate >=4101-g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION 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 WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+&150'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ _ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+&150'+ F. COMMENTS 'Well data per MOA record docs. Vacant system pre-soaked per code prior to testing. ;' Pty.D dd w-6+t4,1 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. � F \ i� � AL41 Engineer's Printed Name KENNETH M.DUFFUS � - Date 511512017 1.4. 9TH 7.411 COSA canary sheet_2-6-15.doc hrNr`Ena Ar rreoPessioN \��_f Municips Ky of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 995i9-6650 .r,.' www.muni.org/onsite // (907) 343-7904 CERTIFICATE FOR A OF ON-SITE SYSTEMS APPROVAL SINGLE FAMILY DWELLING Parcel I.D. 015-112-12 1. GENERAL INFORMATION COSA# O~ /t \t/L~ Expiration Date: ~7¢ ~'- i~ // Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SHELL #1 LOT 7 4401 O'MALLEY ROAD JOHN I_AU *ANCHORAGE, AK 99507 Day phone 44-01 O'MALLEY ROAD *ANCHORAGE, AK 99507 227-2760 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATE,MENT OF !NSPECT!ON BY ENGINEER .... ~ ....... I verify .... my As certified by my seal affixed hereto and as of the validation u~,.e ,u, own ue~ow, investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, ,,,at v~ter su~,/v and/or wastewater disposal system is (are) safe, f, br the number of bed~goms and type of structure indicated heroin, ! fu,~her verify that based on the /nbi}~atJon obis/ned ~'om ~he Mun/cJps/J~y of Anchorage files and ~'um my Jnves~stJon znd /nspect/on, the on-sHe water supp/y and/or wsstewater disposal system is(are) in comp!/ance with afl applicsb/e Municipal and State codes, ordinances, and regulations in effect at t,%e time of bstallation, Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone Date 537-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MQA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being.served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE Approved for Disapproved~ Conditional approval for bedrooms, with the followin~ stipul,tions: COSA ~ Septic System Advisow Well Flow Advisory By: ~ " (Rev. 11/05) Arsenic Adviso~ Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Co CERTIFICATE Legal Description: WELL DATA Well type PRIVATE Date completed PRE Total depth 1.37'+ ft. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 OF 0N-SITE SYSTEMS SHELL #1 LOT 7 *INSPECTED BY APWS-SEE If A, B, or C provide PWSID# N/A 1974 Sanitary seal (Y/N). YES Cased to *4.3+ .ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. SEPTIC/HOLDING TANK DATA FROM WELL LOG NO WELL LOG J g.p.m. Nitrate .3.98 mg./L. Date of sample: 4/8/11 Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Date ofpumping /'7/// 3// · ' / ABSORPTION FIELD DATA Date installed lO/3O/O7-11/1/Ol Length .35+ .ft. 6.19 NO YES 12+ in. APPROVAL CHECKLIST Parcel ID: 015-112-12 ATTACHED EMAIL Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 1.37 ff. g.p.m. Collected by: GEG, Ltd. Date installed 10/50/07-11/1/01 Cleanouts (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A I'BELOW EXISTING GRADEI Soil rating (g.p~.d./~o~ 1.2 System type DEEP TRENCH Width 2,5 ft. Gravel below pipe 7.5 Total depth '10.66 ft. Eft. absorption area 525 ft2 Monitoring tube YES Date of adequacy test 4/13/11 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 1190gal. Elapsed Time: 127 min. Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN ft. Depression over field NO For `3 bedrooms New depth 14 in. 450+ g.p.d. If yes, give date - D. LIFT STATION Date installed "Pump on" level at __,in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump off" leveLa~. Cycles tested 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ Manhole/Access ~ High water alarm level at Meets alarm & circuit requirements~ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main N/A Water service line. 1 Wells on adjacent lots 100'+ PVT/150'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line Curtain drain NONE COMMENTS 10'+ KNOWN Absorption field 5'+ Surface water. 100'+ Building foundation. 10'+ Water main N/A Surface water 100'+ Driveway, parking/vehicle storage Wells on adjacent lots 100'+ PVT/150'+ PUBLIC 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. Page 1 of l Sonja Blewett From: Brian Wille [brian.willel @gmail.com] Sent: Thursday, April ~14, 2011 10:37 AM To: Sonja Blewett Subject: 4401 O'Malley Well camera ran down to 43' at 4401 O'Malley rd. No perforations found with camera. Brian R. Wille Aarow Pump & Well Service 4/14/2011 Municipality of Z Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 •� yep SAFSTT CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-112--341;L HAA y Expiration Date: - /6 1. GENERAL INFORMATION Complete legal description SHELL SEIBDIVISICN #1; L40T 6 & 7 Location'(site address or directions) 4401 O'Malley Road, Anchorage, AK 99516 `Current Property owner(s)David Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Hoffmann & Martha Hutchison Day phone(907)344-7397 ' 4401 O'Malley Road, Anchorage, AIC 99516 Kathi Johnson w/ )rWential Day phone Day phone(907)762-3123 3801 Centerpoint Dr., Ste. 200, Anchorage, AK Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site E Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 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 Environmental Management, Inc. Phone (907)272-9336 Address 206 E. Fireweed Iane, Suite 201. Anchorage, Ax 99503 Engineer's Printed Name Larry A• Helgeson Dat 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory • ni) errC PROGRAM -vIJJJ))11))1)" X Maintenance Agreements Supplemental Engineer's Report Other By: v(/. Original Certificate Date: (Rev. CIM2) Municipality of Anchorage • Development Services Department Building Safety Division 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 • Legal Description: Sial/ Zo t 69-7 Parcel ID: 015-112- A. WELL DATA Well type V If A, B, or C provide PWSID # 10 Well Log (YIN) A10 Date completedrs�l�/ Sanitary seal (YIN) Wires properly protected (YIN) y Total depth (37 ft. Cased to g g ( ground) _r� X/ /0 ft. Casing height above round � in. FROM WELL LOG Date of test Static water level Well production N° g.p.m. WATER SAMPLE ESULTS: Coliform colonies/100 ml. Nitrate3.42. mg.A. Arsenic: �e mg.A. Date of sample: V11/0(, B. SEPTIC/HOLDING TANK DATA Tank Type/Material 51ee'l Tank size I Z -Sc gal. Number of Compartments I AT INSPECTION li/ l y /?o 6G 1 2. 91 ft. lO -Sr g.p.m. Other bacteria colonies/100 mi. Collected by: FAI Z - Date installed 10/30/4 — U /f A / Cleanouts (YIN) y Foundation cleanout (Y%N) bepression over tank (YIN) /V High water alarm (YIN) 11/114 Date of pumping S Pumper TsQQ c rS C. ABSORPTION FIELD DATA Date installed 10-30 _ u-1 01Soil rating g.p..Ift' or ftZ/bdrm) Length 3S 4- ft.* Width 2.S ft. System type 13ear T1Y�c4 Gravel below pipe 7-S ft. Total depth 11.1 ft. Eff. absorption area S2$ ft Monitoring tube _y_ Depression over field W Date of adequacy test /i I Y a(e Results (Pass/Fail) T For —H bedrooms 1 Fluid depth in absorption field before test 13 in. Water added l3Zgal. New depth in. Elapsed Time: 30 min. Final Fluid depth 13 9 in. Absorption rate >= r7aV g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A/ If yes, give date D. LIFT STATION Date installed 'Pump on' level at —in. E. SEPARATION DISTANCES Size in gallons awn level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 10014- Absorption field on lot CDUr -�- Public sewer main 2 $ ' 4 - High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots IOy r +_ On adjacent lots 100, -} Public sewer manhole/cleanout 11114 Sewer /septic service line —AU //-I Holding tank IV14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation j S r +_ Property line 10'4- Absorption field S Water main N114- Water service line 10 t r Surface water IOU I -f' Wells on adjacent lots 100, 4- Pvr. VISO' -Oi�oc SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Id fi Building foundation j0 i' Waler main A� Water Service line 10, t_ Surface water /6 b r'f" Driveway. parkinglvehicle storage Ior ^t Curtain drain Nin& 41101 Wells on adjacent lots j oa�-t""/% 6- 0 "+ P,\a `%C- F. COMMENTS G. ENGINEER'S CERTIFICATION �? I certify that I have determined through field inspections and 49TH review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. A ' 1 ..'UMV A. RELGUI Engineer's Printed Name L A 22Y A. H ELI+ESo�1� sib •..No.CE -8898 �� •..............::: Date S/OG zoFcssi!:;A HAA Fee $ 7c Waiver Fee $ _ Date of Payment �cc//�/D6 Date of Payment Receipt Number Receipt Number, (Rev. 12/01) LOT 4 LOT 8 EAST 95.00' EAST 95.00' 30' z 0 0 0 C B o N z -� C3 LOT 7 LOT 6 o W GO z Ci SHED cn o M 0 0 C M y LOT 5 LOT 5 52.7® J 57.6 J (Jt' HOUSE : cn M 25.7 4.1 26.3 X 79.0 O v rn GRAVEL' NORTH 30' 10.00'\ .. EAST 78.09- 7 8. 0' y EAST EAST EAST 37.00' 00000ppp0 17.00'OF At 58.00' vo �(L ..... PC 49?H ��Op N l p....... ...... p '•;An n P. f On• Qs. LS- yep e o NOTE: BOTH LOT BOUNDARIES ARE PER STATE R.O.W. MAP 76-197. O'MALLEY ROAD ofessionc\ -appppo NOTE: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. -"-%It EXCLUSION NOTES: It Is the owners' responsibility to determine LEGEND: SET FND 0770 ar: the existence of any easements• covenants. or restrictions 5/5'RO W/CAPO* 5/6' RB O K A T H I JOHNSON which do not appear on the recorded subdivision plot. NOTE: 3.25' AL.MON. Q! MONUMENT with PRUDENTIAL JACK WHITE Under no circumstances Mould any data hereon be used for NUB & TACK p K Ita,Nt construction or far establishing property lines. FENCE- —x— x — SURVEY CERTIFICATION: LANTECH hos conducted o OVERHAND- [� I physical survey of Dhe I property as shown on this WOOD DECKS- drowing and Nat lhs knprowmente situated there CONCRETE- 0 On ars withN the r et lines and no encroach— ASPHALT- - menta edst other than noted. GRAVEL- AS—BUILT OF: LEGAL DESCRIPTION: SEPTIC STANDPIPES- 5 LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS WATER "ELL 440 WEST BNSON561-626 ANCHORAGE, ALASKALw 99503 (907fox) 562— 5291 LOTS 6 & 71 WORK ORDER NUMBER: *" Mur: � NUMBER 2006-L-44 MAY 08, 2006 , _40' FP -326A SHELL SUBDIVISION ADDN #1 Awx sc , AP er as K536 61 6— NRB APH 2536 661/36-37 til S Municipality of Anchorage Development Services Department Com: • Building Safety Division ,. .,. Onsite Water 8 Wastewater Program 4700 South Bragaw SL 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. 015-112-11 HAA# //A -y 10 &,?R 1. GENERAL INFORMATION Expiration Date: 3 � / /— OZ Complete legal description 4 SHELL SUBDMSION #1: LOT 6 do 7 ❑ Public Water System ❑ Location (site address or directions) 4401 O'MALLEY ROAD • ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address CARL JAKOSKI Dayphone (907) 346-1228 4401 O'MALLEY ROAD • ANCHORAGE. AK 99516 Day phone Real Estate Agent RAE HALL w/ PRUDENTIAL Day phone Mailing address 16635 CENTERFIELD DRIVE • EAGLE RIVER. AK Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well lit Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 689-1805 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $2,845.00 at, or prior to closing for the engineering services provided. 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 Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for 4- bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing 337-6179 Date IZ SA/ Manitenance Agreements Supplemental Engineer's Reort Other ON-SITE WASTEWATER By:� �� Original Certificate Date: (Re,. tzm) Municipality of Anchorage • Development Services Department ` Seelyowabn ` ..... On•StS WOW a wa�arer Program 47M South SnWW SL P.O. Boot IN= AndWW,AK996194M * W.olAncho".ak us (907) 345.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SHELL SUBDMSIONNI: LOT 6 & 7 Parcel ID: 015-112-11 A. WELL DATA Wen type PRIVATE If A. S. or C provide PWSID# N/A Date completed "1974 Sanitary seal (Y/N) YES TOW depth 137+ ft. Cased to 40+ ft. FROM WELL LOG Date of test Static water level ft. Wen production 9 -p -m- WATER SAMPLE RESULTS: Well Log (YM) NO Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 11/14/2001 137 ft. 7.0 g.p.m. Conform 0 cctoniesm oo ml. Nitrate 3.1 rmgJL. Other bacteria 0 colonlest100 ml. Date of sample: 11/14/2001 Collected by: AWWC. INC. S. SEPTIC/HOLDING TANK DATA Tank Type/Materlal STEEL Date installed 10/30/01-11 /1 /01 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YIN) YES Depression over tank (YM) NO High water alarn (Y/N) N/A Date of pumping NEW Pumper C. ABSORPTION FIELD DATA P8Q.QW M& Date installedlo/ao/o1-11/1/o1Son rating 02or fttbdbdnn) 1_2 System type DEEP TRENCH Length 35+ fL Width 2.5 ft. Gravel below pipe 7.5 ft. Total depth —21,3-11. Eft. absorption area 525 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) - For -A --bedrooms Fluid depth In absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: - min. Final fluid depth = in. Absorption mate >. - g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & Mn) - If yes, give date - D. UFT STATION Date installed Size in gallons "Pump on' level at _in. E. SEPARATION DISTANCES High water alarm level at M. Cycles tested . Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAifi station on lot 100'+ Absorption field on lot t o0'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent kits 100'+ On adjacent kits 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PVT./150'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building foundation 10'+ Water main N/A Water service line 101+ Surface water 100'+ Driveway, pandnglvehlde storage 10'+ Curtain drain NONE KNOWN Wells on adjacent k>ts 100'+ PVr./ 150' PUBLIC F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field Inspections and review of Municipal records that the above systems ate In • ..... ' ' • "' ' ..• """" conformance with MOA HAA guidelines In effect on this date. Engineer's Printed me JEFFREY A GARNESS y 7953 ` Date fL�� DI pro. me o� HAA Fee E .Z00 - Date of Payment ?� D Receipt Number. (Rev. 12M) Waiver Fee $ Date of Payment Receipt Number