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Home My WebLink AboutBEACON HILL ESTATES LT 6beacon Hill Lot 6 #015-092-58 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: osp 161031 PID Number: 01509258 Dwelling: X Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New 9 Upgrade Name: Nhan Tran ABSORPTION FIELD X Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 7501 Beacon Hill Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 230-8928 3 0.8 GPD/SF 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.955 Ft. Gravel depth beneath pipe .05 Ft. Subdivision Block Lot Beacon Hill Estates 6 Fill added above original grade 1.4 Ft. Gravel length 41 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 574 Ft 1 Ft. Well +100 +100 +100 - +100 TANK ❑ Septic 11 S.T.E.P. ❑ Holding ❑ Other Manufacturer fcapacity anchorage tank 11250 _Gal. Material Number of compartments steel 13 Surface Water +100 +100 1 +100 - Let Line _O_ �. 1 4.5 - _ NA Foundation 110 5 LIFT STATION Manufacturer orenco Capacity 250 Gal. Curtain Drain +550 1 +550 +550 RemarksPump old tank was abandoned in place per on level at Pump off level at High water alarm at `££¢ in. ,; tet- in. q-7 in. municipal requirements. 'i $ter W,42VXQ -� �Qi/t'-2'T Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 rank to drainfield �y Installer Scotts services __ Drainfield 507 COIMT3034 Inspector Charles balzarini BENCH MARK (Assumed elevation) 100 ft Inspecttiones: 151 3/25 3/28 Location and description 2° T3/28 -- 0 corner of deck near tank COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp '%'L%%Z F... Conditional Approval: Date pC ...«� sem*# "v= TH ...p `,c :..harles 0. Bal ..........� zarini;'�Q� cj + '��,'.. Approved Date /G. L �' Inspection Report_9-1-12.doc LEGEND �r•�� 0 CLEANOUT • MONITOR TUBE/�(��•`'v,• ••"1�9 �� ® TEST HOLE TH ` `tHARLES G BALZARIN! SWING TIES �t Pic CE -1/3854 o: a oD- 30.1 ��`liF�PROFESSIONP ��r EXISTING WELL E: 48.7 57.6 I LOT 4 X700, (UNDEVELOPED) —�C R EXISTIELD � TO REMAIN. 10 UTILITY EASEMENT SEPTIC AREA LOT 10 \ \nZ DRIVEWAY. 0 Z 3 BR B / D _ DECK NEW 1250 GAL STEP TANK W/ LOT 9 TESTHOLE PF3005 EFFLUENT PUMP \LOCATION. LOT 6 NEW 3'x41' TRENCH W/ 7' EFFECTIVE. DEPTH SEWER ROCK. — T _ OT 8 E 7'TO FENCE L C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: BEACON HILL ESTATES LOT 6 ONITOR TUBE SEPTIC RECORD DRAWING BLUE BOARD INSULATIO +100.0' DECK CORNER FlLTER FABRIC 101'4 NISHED GRADE TESTHOUP C 100' ORIG. GRADE TESIHOLE ELEVATIONS BASED +4' COVER ON TESTHOLE 1. NOTE THAT GROUNDWATER MONITOR REVEALED NO GROUNDWATER DURING CONSTRUCTION. 7.1 INVERT RUNOFF INTO THE TESTICLE EXCAVATION MAY HAVE 0 CONTRIBUTED TO THE OBSERVED GROUNDWATER - 1250 GAL STEP TANK 1.5"0 DISTRIBUTION PIPE IV EFFECTIVE SEWER ROCK .05 TABLE READING IN FEBRUARY. J GROUNDWATER 84.0 B.O.H 82.5 SCHEMATIC ELEVATION - SCALE: NTS C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: BEACON HILL ESTATES LOT 6 OWNER: THOMAS COOPER I DATE: 3/28/16 1 REV: DRAWN: CBJ REF: SEPTIC RECORD DRAWING (�o 1191 nV11 9410r, 74 IT, W. P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV161012 and OSV161034 COSA#: OSC161102 Permit#: OSP161031 PID#: 015-092-58 Legal Description: Beacon Hill Lot 6 Engineer: C&M Engineering Applicant: Thomas Cooper The waiver of the required 5 feet horizontal separation from the S.T.E.P. tank to the property line issued at the time of permit is not required. But, the following waivers have been requested and approved: 1. The trench is approved to be 7' from the property line. 2. The trench is approved to be 9.5' from the trench on lot 8. 3. The tank is approved to be 3.5' from the foundation. This waiver approval applies to the existing S.T.E.P. tank and field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: /Z / Approved by: Name of Review6r ......................................................... .................... **** VARIANCEIWAIVER REVIEW **** C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Septic System for Beacon Hill Lot 6 Dear Reviewer, A new septic system was installed on the above referenced property on 3/28/2016. The leach field was installed within 10' of the neighboring property line. Field measurements indicated the system was installed 7' from fence line, which approximates the property line. Between Lot 6 and Lots 8, 9. As it is shown on the survey asbuilt, the fence is located just within the bounds of lot 6. We are requesting a waiver be granted for a distance of 7' between the leach field and the neighboring lot line(lots 8&9). The survey shows the monitor tube is 7.5' from the lot line. We feel 7.0' is more appropriate, to account for any variations in the leach field excavation and any offset from the monitor to the edge of the trench. As you are aware, these lots are extremely tight, and the subdivision has a history of separation distance issues and waivers. Approval of this waiver would cause no harm to the neighboring lots or general public. The lot line waiver will not adversely impact the adjacent lots 8,9 because: 1. The lots are served by existing wells, and this septic system lies outside their protective radii. 2. Future septic development of lots 8 and 9 would result in systems installed further than the required separation distance from the new system on lot 6. 3. The new leachfield on lot 6 is down gradient from the property line. Were a mishap to occur, any effluent would tend to flow away from lots 8,9. Additionally, it has come to our attention that the neighboring septic system on lot 6 encroaches to within 2.5' of the lot line, not 10' as indicated in municipal records. This puts the separation between the two systems on the order of 9.5 to 10'. We are requesting the separation distance be waived to 9.5' for the following reasons. 1. The new septic trench makes the best use of available space on lot$.a6 2. The 14' required separation distance required by code, necessarily must account for all soil types, surface grades, and other variables. Due to the free draining nature of these, we do not anticipate any significant impact caused by the proximity of the lot 6, 8 septics. As the effluent enters the soil strata, it will to travel downward more readily than it would in slower soils, where there could be more of a tendency for the effluent to migrate laterally. 3. The leachfields meet in a perpendicular arrangement( "T"), minimizing the effects of their proximity to each other. We are also requesting a septic tank to foundation waiver be issued for 3.5' instead of the code required 5'. We do not believe the proximity of the tank to the foundation will adversely impact neither the tank nor the foundation's integrity. A to scale sketch is provided to show the relationship between tank and foundation. A simple 45 degree angle from the toe of the foundation is shown not to intersect with the tank. The exact elevation of the foundation toe was not determined. It is conservatively assumed that it lies just above the top of the pipe as it leaves the house. The elevation is approximately coincident with the top of the tank. The use of the 45 degree angle is a conservative approach to determining if the foundation bearing will have any impact on the tank, or if the tank will reduce the foundation's capacity. The 3.5' separation distance was determined based on a measurement of 5.8' from the house to the standpipes. Attached with this letter is a copy of the inspection report for the new construction, and a current asbuilt survey for lot 8. Thank you for your time in reviewing this request. Please do not hesitate to contact me at 907-854-5558 or by email cgbalzarini(a)gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE l- l� 3 / / On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161031 Tax Code Number: 01509258000 Work Type: Septic Upgrade Permit Effective Dates: March 07, 2016 to March 07, 2017 Design Engineer: C&M ENGINEERING SERVICES Subdivision: BEACON HILL ESTATES Site Legal Address: BEACON HILL ESTATES LT 6 G:2440 Owner/Address: TRAN NHAN T 7501 BEACON HILL DR ANCHORAGE AK 995076014 Site Mailing Address: 7501 BEACON HILL DR, Anchorage Lot Size in Sq Ft: 10000 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued Bt MUNICIPALITY OF Community Development Department" Development Services Division On -Site Water & Wastewater Program • Me Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel 1.D. 0 I S OR 2,5 9 Z30 -892 Property owner(s) 7 µ0M" 5 Loo EZ -1— Day phone 4 cc J Mailing address Site address 7S- H-, J1 A- r Legal description (Sub'd., Block & Lot) geo'(-OA/ 4:11 LOT & Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms_ APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ,�j Initial ❑ Single Family (SF) Septic Tank Q( Upgrade (w/wo ADU) Holding Tank ❑ Renewal ❑ _ Duplex (D) El Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE ! WAIVER REQUEST FOR: or L;ll-C— Distance: L/ I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature property owner or authorized Permit/Rush Fees: CJ(p Date of Payment: Receipt Number: blgq`iG Permit No. (BJP) t01031 Permit App_9-1-12.doc Waiver Fees: Date of Payment: _12 4111 f, Receipt Number: 6-7 ;L 1.4LtC, Waiver No. OM (o102 - CSM ENGINEERING SERVICES Ph: 907.854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Alk 99507 RE: Proposed Septic System for Beacon Hill Lot 6 Dear Reviewer, The above referenced property is currently served by a failing septic system. An adequacy test revealed the system is not capable of accepting effluent from the residence. We are requesting approval to install a replacement septic tank and leachfield. We are proposing to install a new 1250 gallon tank, and a new 3 bedroom deep trench system. The existing deep trench will be retained for a reserve site at the owner's option. The soils are silty gravely sand, and are fairly consistent with depth. Included with this letter is a permit application and design package, including plans, specifications, calculations, and soils logs. We are also requesting a septic tank to lot line waiver from 5' to 4'6" The installation of the proposed septic system will not adversely impact adjacent lots, which are served by existing well and septic systems. Changes to drainage patterns are not anticipated. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzariniOgmail,com with any questions or concerns. Sincerely, Charles Balzarini, PE C&M ENGINEERING SERVICES Ph: 907.8545558 SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER LEGAL: Beacon Hill Lot 6 February, 2016 A. GENERAL 1. The septic design is for a 3 bedroom, single family residence only. 2. The site plan and drawings shall be a part of this specification. 3. The Wastewater system shall be installed by a certified installer in accordance with moa requirements. All materials and workmanship shall meet the Municipality of Anchorage's, and the State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. The engineer shall perform percolation tests and groundwater monitoring prior to finalizing design. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environment of Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. A licensed surveyor should locate all nearby lot lines, easements, exact 100' radius from the existing and neighboring on- site wells, and any nearby surface water. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed, after construction of the Drainfield. 9. The contractor shall provide the engineer with adequate notice to perform inspections. 10. Insulate the sewer line if it passes under the driveway or parking area, with a minimum of 2" extruded board insulation, rated for burial, and on the moa approved lista B. SEPTIC TANK 1. Septic tank shall be a fiberglass or steel, 1250 -gallon tank capacity step tank of MOA approved construction. Installed to meet MOA requirements. The lift pump shall be an orenco PF 3005, or approved equal. 2. Install a foundation cleanout within 5' of the foundation. 3. A combination of soil and 2" minimum of insulation shall be placed over the tank, to prevent ponding and promote drainage. The insulation shall be rated for burial and meet moa requirements. C. DRAINFIELD 1. The Drainfield is to be located as shown on the site plan. Notify Engineer of any changed site conditions. 2. The total depth of the initial drainfield excavation is to be at maximum 10' deep Bottom of excavation shall be level +/- 1.5" max. If bedrock or inconsistent soils are encountered, notify the engineer immediately. 3. In the event of over -excavation, a moa filter sand shall be used to maintain the 6' separation distance from the bottom of each trench to the bottom of the test hole(s).The top of the sand layer shall be level, plus or minus 1.5", and raked, prior to placing sewer rock. Care shall be taken to not compact the sand. 4. A 7 foot effective layer of sewer rock is to be placed in the each trench. The effluent piping is to be set on top of this layer, buried with sewer rock, with 2" of sewer rock cover over the piping. 5. The Distribution pipe shall be 1.5" drilled sch. 40 pvc pipe conforming to ASTM D3034.holes shall be 1/8" at 2'-0" on center. 6. The complete Drainfield gravel and piping is to be covered with a geotextile filter fabric. 7. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the drainfield. Mounded side slopes shall not to exceed 3:1. The minimum insulation thickness shall be 2". Insulation shall be moa approved and rated for burial. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200' to any community well. Design Summary: Excavation Depth: 10' Drainfield Length: 41 Gravel Depth: 7' under distribution pipe, 2" over pipe. Drainfield Width: 3' Soil Rating: 0.8 gpd/sgft System Capacity: 3 Bedrooms N tC ARLES G BALVNj CE-13854i I �s EXISTING WELL LOT 4 100, (UNDEVELOPED)' I � SCC \�b'S EXIST LEACHFIELD \ TO REMAIN. 10' UTILITY EASEMENT \ SEPTIC AREA \� ;•:,r.. .:P:.. - / LOT 10 TIE INTO EXISTING n0-.....;• ,:„. °' LEACHFIELD FOR BACKUP SYSTEM 1 d b r 3 BR P� AT OWNER'S OPTION. ... HOME / V \ ABANDON EXIST DECKTANK PER MOA \ \ i 5 REQUIREMENTS. NEW 1250 GAL / \ LOT 6 STEP TANK W/ LOT 9 TESTHOLE PF3005 EFFLUENT PUMP 0 \LOCATION. 4'-G — — — NEIGHBOR'S NEW 3'x41' \ 100' WELL TRENCH W/ RADIUS i 7' EFFECTIVE. Q- / DEPTH SEWER ROCK. \ �4. 1 SGP LOT 8 10' / \ NOTES:LEGEND \ CLEANOUT / I 1. THE PROPOSED SEPTIC SYSTEM IS GREATER THAN: 100' FROM ANY PRIVATE WELLS • MONITOR TUBE 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER ® TEST HOLE / 50' FROM ANY STEEP SLOPES / *10' TO ANY PROPERTY LINE OR FOUNDATION 0.5%\ SLOPE INDICATOR , 5' TO ANY TEST HOLES C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: BEACON HILL, LOT 6 OWNER: THOMAS COOPER I DATE: 2/19/16 1 REV:O 1 DRAWN: CB REF: SITE PLAN - C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations Residence: Beacon Hill Estates Lot 6 system type: RESJDENCE/Lfl'C INFO numberof bedrooms 3 br Water usage/bedroom 150 gpd/br Water Usage 450 gpd Percolation Rate 4 min/inch Groundwater Depth 16 ft bgs Test Hole Depth 17.5 ft bgs pesspsymmary System type: Conventional Tank: 1250 gal STEP New Drainfield I: 3'x41'x10' W'xUxD' shallowtrench Calc By: CGB Date: 3/4/2016 / TM W :* CHARLES G BALZARINI ' 18.• CE -13854 .V�i +�'�fF9F ��`_ ROFEW6 �� system type: Conventional type: Deep Trench Design Application Rate 0.8 gpd/sgft required absorption area 562.5 sgft trench width (W) 3 ft gravel depth (D) 7 ft below distribution pipe Min Required Length: 41 ft Total Excavation Depth: 10 ft Cover: 3 ft min Insulation: 2" blueboard Use Length: 41 ft Effluent Pipe: 1-1/2" ASTM 3034 Hole Size/Spacing: 1/8" at 2' O.C. pesspsymmary System type: Conventional Tank: 1250 gal STEP New Drainfield I: 3'x41'x10' W'xUxD' shallowtrench Calc By: CGB Date: 3/4/2016 / TM W :* CHARLES G BALZARINI ' 18.• CE -13854 .V�i +�'�fF9F ��`_ ROFEW6 �� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ri.ancharaga.aky� (907)343-7904 f Soils Log - Percolation Test �l / Performed For: THOMAS COOPER Date Performed: 02/12/1 Legal Description: BEACON HILL ESTATES LOT 6 Township, Range, Section: LES G BALZAAANI CE -13854 i Depth TOPSOIL/ORGANICS ,']SM GRAVELY SAND {WITH SOME SILT Site Plan WAS GROUND WATER YES Date ENCOUNTERED? Net Time Depth to Water S IF YES, A r WHAT DEPTH? NONE L Depth to Water After v Monitoring? 16, E Date: 2/19/16 2/18/16 PERC TEST CONDUCTED FOR 1 HOUR MINIMUM Reading Date Gross Time Net Time Depth to Water Net Drop 1 2/18/16 1727 0 6- 0/16" 2 2/18/16 1737 10 3-2116" 2-14/16" 3 2/18/16 1738 0 6-0/16" 4 2/18/16 1748 10 3-3/16" 2-13116" 5 2/18/16 1749 0 6-0/16" 6 2/18116 1759 10 3-2/16" 2-14/16" PERCOLATION RATE 4 Iminutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 4 FT ANDS FT COMMENTS LAST 6 READINGS SHOWN PERFORMED BY: MATTHEW BALZARINI I CHARLES BALZARINI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2/20/16 �0MA MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME'I IAV! �C PHONEEW 3 - ❑ UPGRADE MAI AD R SS LEppGAL DESC P ION Q LOCATION 1.3 T I.2, � IZ `� � � ��'� NO. OF BEDROOMS Well DISTANCE TO: /'Uo Absorption area Dwelling %'1Zn P46_ I �(� PERMIT NO. 8 /� r � v Y r H a CL Manufacturer MaialG No. of compartments ti Liq. ca � gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. 0^4 Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Well { u,ai�r)�;�*� V ..11>�/ N rest lot ne PERMIT NO.1-- Z No. of lines Length of each line Total length c lin es Trench wi tly/ Distance bGtvy� lines wj inches FTop of tile to finish grade i Material beneath tile / t ( Total effective absyio area Length Width Depth PERMIT NO. •w Type of crib Crib diameter Crib depth Total effective absorption area rn DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER od PIPE MATERI—A-L—S� � L _2ILI I a i I -W I 1 -1 44444 r SOIL TEST RATING 150 � o O e) ' r 1 0 i /Q;_ INSTAL„E�;��1� r. REMARKS 0 a bo : • „;` s ea too 110 (ISO '54-60 �� r 4 0� +1f_V)c4l Al L .3; %��s a��C i. - - Al 0 1/' /j /`' APPROVED DATE LEGALLit Cav7 A// 6 _ 72-013 (Rev. 3/78) M1 nicipc ..,..A ' of Anchorage January 9, 1987 P.O. K 196650 ANCHORAGE, ALASKA 99519-6650 (907) 26441-k1x 4 7 4 4 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Will Gay 9601 Hillside Anchorage, Alaska 99516 Subject: Lot 6 Beacon Hills Estates Subdivision On-site Well Permit #860004 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of January 3, 1987. Your permit expired on the date of issue basis by authority of Municipal Ordinance existing at that time. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. The new permit will come under the calendar expiration date as per the new Waste- water Ordinance (effective May 20, 1986). If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as -built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Sinc 1 , R.W. Robinson Program Manager On-site Services RWR/ljw enc: copy of permit / Vol LJ INN 2: C0 1: F:'9 -':N 0. 1 IF* -"V C3 F= �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 850685 10/21/85 ALL GAY 96012 BUDDY WERNER ANCHORAGE, AK 99516 346-2574 � / LEGAL DESCRIP: SUBDIVISION: BEACON HILLS LOT: 6 BLOCK: NA SECTION: 13 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 10000 (SQ.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you in designing your septic system. Choose the option that best {its your site. / ��C,'FA 1=_� EE 13 hO~13 FR 04 31 Adl DEPTH TO PIPE BOTTOM (FT.) 5.0 6.0 5.0 GRAVEL DEPTH (FT.) 5.0 0.5 3.0 TOTAL DEPTH (FT.) 10.0 6.5 8.0 GRAVEL WIDTH (FT.) 2.5 22.0 5.0 GRAVEL LENGTH (FT.) 60.0 41.0 70.0 GRAVEL VOLUME (CU.YDS.) 30.6 33.5 45.4 TANK SIZE (GALS) 1,250.0 ** 1,250.0 ** 1,250.0 ** ' SOIL RATING (SQ.FT./BR) 150 150 150 ** 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 per/nit. 3. I will adhere to all MOA and State of Alaska requirements [or the set back distances from any existing well, wastewater disposal system or public- sewerage ublicsewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement 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 OBTA'NED; (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 DATE: /0^��-- --________ APPLICANT WILL. BY ISSUED ------ _ /V 0-7-1V P 7� leo/+-V q1-0 1,3120 5 0 Municipality of Anchorage U* DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:/ DATE PERFORMED;.. �/ _ LEGAL DESCRIPTION: D' ��.Sr OWrlShlp, Range, Section: DEPTH SLOPE SITE PLAN (FEET) �� c2l&� ICC 1 �\ 4 ✓1� �'�G Ty g A U f' /�c 5 7-0, 6 to 7 8 9 10 11 12 13 M. 14 15 16 17 18 19 WAS GROUND WATER 06) ENCOUNTERED? S IF YES, AT WHAT O L E.'I DEPTH? E �A,) Depth to Water After <4 /77.1� MonitoId A I Date: J l Reading Date Gross Net Depth to Net Time Time Water Drop 5 1--3 '86r 01-) plc c pR 20 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETW4N FT AND FT _ COMMENTS V✓ f 0fLf F8 50, '11,OAJ. PERFORMED BY: P-5 r/��`a% I ` '�/5 �� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 5 r3 �/ C- �U " I I::-- I c--- f=i I I -F V Cl F= F:� N C--: " C-1 FZ n f3 E: DEPARTMENT i HEALTH AND ENVIRONMENTAL ' OTECTION � 825 'L STREET, ANCHORAGE, HK. 99-,a1. 264-4720 WEEL-1 n " C -m I -lr E: W EE F:;?- ��M I _r PERMIT NO. ( 821199 ) APPLICANT DOTTI HARNESS 1732 WEST 12TH 272-7260 LOCATION BEACON HILL LEGAL LOT 6 BEACON HILL SUB LOT SIZE 10000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (5g FT/BR)= 295 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��-lF H - -1 C3 L_ E="" C-3 -F "= �ff* 0 F -C F=l V F= L_ U-- F= F:" -r "= ::L;-2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS 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 IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��U I F...' F= Us ��I I--- -r n " K �I = F=-= -1 C0 C21 Q n L_��"!F. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -rWf--1 < fZ > I "!=- F=* E: I=-- -F I 1=1 " F -'-'I= ��NMI U I F..."U 01 BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLLTION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. 3 04-1 �FF F? r-1 11 -r FE �4 F=' 3: ��E�- F= �::lL.- s4 s_:t W I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. �� SIGNED:_________________________--------------- HPPLICANT DOTTI HARNESS ISSUED BY _____DATE_ �� My�;L_ MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 295 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C3 FZ K "I E= L, Ec-1 E: F-1= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH �M TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND OTHE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIF-'['-.* (1N FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. � ��f"IK_[_I.-A�� THIS DEPARTMENT DURING THELl THIS PROPERTY AND THE ---LL�� I r4 ca F> Ey��0�� E- �� '^ ` _.~. ^ME^"GyrmY SYSTEMWITHOUT FINAL INSPECTION AND APPROVAL BY THIS -- -_...`. .,. WILL H BE SUBJECT TO PROSECUTION. �+ MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR HPRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING ".ONTHE TTYPE OFWELL. �UBLIC ` MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO " COMMUNITY SEWER LINE IS 75 FEET - WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN � OF THE WELL COMPL�TION. ]0 DAYS OTHER REQUIREMENTS MAY APPLY.SPECIFICHTIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION.t`' " 11 r-4 -T '::: -T DEPARTMENT 825 'L' .��I _F '-r� C, F-- ��o::. f ��-'! Fl C3 F:: - HEALTH AND ENV IRONNENTHL �ROTECTION STREET, ANCHORAGE, HK 99501 PERMIT 264-4720 NO �EE L. L. K VA E> ��—��K 00 �� T � ( 821199 ) HPPLICHNTDOTTI LOCHTION'SEPCON.HILL HARNESS 1732 WEST 12TH 272-7260 LEGHL- TYPE OF SOIL ABSORPTION SYSTEM --|l -��.� LOT SIZE 10000 SQUARE IS: TRENCH ** FEET MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 295 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C3 FZ K "I E= L, Ec-1 E: F-1= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH �M TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND OTHE BOTTOM OF THE EXCAVATION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIF-'['-.* (1N FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. � ��f"IK_[_I.-A�� THIS DEPARTMENT DURING THELl THIS PROPERTY AND THE ---LL�� I r4 ca F> Ey��0�� E- �� '^ ` _.~. ^ME^"GyrmY SYSTEMWITHOUT FINAL INSPECTION AND APPROVAL BY THIS -- -_...`. .,. WILL H BE SUBJECT TO PROSECUTION. �+ MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR HPRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING ".ONTHE TTYPE OFWELL. �UBLIC ` MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO " COMMUNITY SEWER LINE IS 75 FEET - WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN � OF THE WELL COMPL�TION. ]0 DAYS OTHER REQUIREMENTS MAY APPLY.SPECIFICHTIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION.t`' _~~ 10 R.J V-4 :1 K0 3C .......... F:� 1,11._ 1: K:) F=7 9=1 FA CD F4 -1 F1 FA C3 Eii`_' DEPHRTMENT . HEHLTH HND ENVIRONMENTAL �OTECTION 825 'L' STREET, ANCHORAGE, HK 99501 264-4720 14E"L.L. F:�! ll,�A 9,�4--- 05 X KIERE �� E,--*: 11-11 11: "T" PERMIT NO. ( 820432 ) APPLICANT DOTTI HARNESS 1732 W 12TH 272-7260 LOCATION BEACON HILL LEGHL L6 BEACON HILL S/D LOT SIZE 10000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 295 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: a.mov umphics-row 00 CaKFA%fEEL. E>E=F"-rFi== �� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS 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 IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). Pit PEE ��X Fm;�.,: IEEE.: f_ fl IF`.:1 :_K C�,:, -11'", F0 0107 K=; 1: �ICE�p E"!q (ED �1L.- L..".�� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- �1.U0 �2 2: -_ . ��A.": II"::::* E.,-.':: o::*_-.:�T- 1: C3 P4 S5 F4 F1 K FZ EE C."� I: qz:.�: . --- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE-_' AVAILABLE TO INSURE PROPER INSTALLATION. �IEEFTft-!X"7- ��F;,'� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE, 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED O INCLUDE MORE THAN ] BEDROOMS. / ./ // ( SIGNED� ___�___�__�_-..... ... .... ..... ..... HPPLICHNT DOTTI HARNESS ISSUED BY__��l_ - ~~=' �^�ac DHTE �� V4 0 �7 ---------- ------- -----�---7- � A, SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION x PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: D� 'ie- }" arntvz6 DATE PERFORMED: �J� 2W LEGAL DESCRIPTION: P A C.by) a1' l,S l7 'S 1 RTP_ s 1— (O R9010P or-c-,sn iC 1 2(GIM)- 5w1tAqrrYdvel 39 4'q 4- 5 6 1 u%s off' c rav e- 7 7 8 9 10 11 12 13 14 15 16 17 18 19 SLOPE (GM)-acca5lton'al gravel I sandLt,��l�- WAS GROUND WATER !� S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? iF.'1 a I inp ri>A le.a have' lral lve, SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop +Hz 6.Z IT: ao,e- 6-:3b 10 -e- r -S1 .oq �:ur ti .qz 03 --T 20 PERCOLATION RATE (minutes/inch) TEST UN BETWEEN ='Sl_ FT AND � FT COMMENTS 2 O PERFORMED BY: e_.v CERTIFIED BY: DATE.��- 72-008 (6/79) GRE ;R ANCHORAGE AREA BO' JGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 E f TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT r/ 1 e//MAILING ADDRESS PHONEr/rY NAME OF APPLICANT y, /VC INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF:� �TANK SEEPAGE PIT DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE. THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. W/ d/ TANK SIZE TYPE MINIMUM DISTANC S, REQUIREMENTS FOUNDATION TO 4/,M%ANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD SEEPAGE AREA SIZE SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPFI-CTANK SEEPAGE PIT DRAIN FIELD _/ / --'* ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT , DRAIN FIELD TANK,_�C>--& SEEPAGE PIT / c- • DRAIN FIELD 1/5-6 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 BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. Kr L." ( v --o- I G.A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM 1 CERTIFY THAT 1 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. DATE APPLICANT'S SIGNATURE FORM NO. EQ -016 GREATER ANCHORAGE ARr=,A E DEPARTMENT OF ENVIRONMENTAL QI 3500 TUDOR ROAD POUCH 6-657 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8586 ,,` SEWAGE DISPOSAL SYSTEM - ICAT NAME OF APPLICANT ff'�faGw� INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED _ FINANCED THROUGH J/7 SOIL TEST RESULTS L/ COMPLETION DATE ANTICIPATED �JNIr/� dR m" Q_GInp�A .c" SEEPAGE TO BE INST G ADDRESS UGH PERMIT NO. / 99 P PH0NC � r `7DRAIN FIELD OTHER P S ERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION. 24 HOUR OTC REQUIR D. B KFIL F ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHO TY V�(1 BE SUB ECT O PROSECUTION. (1w/tf ft SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE b `� fJ, TYPE MINIMUM DISTA C REQUIREM NTS DIAGRAM OF SYSTEM FOUNDATION TO SE TIC NK FOUNDATION TO SEEP GE P DRAIN FIEL J/'D SEPTIC TANK TO SEEPA E PIT ALL � ' SEPTIC TANK SEE AGE PIT DRAIN FIELD TO NEAREST LOT LINE. J, c L. WE L SEPTIC TANK ✓' • SEEPAGE PIT 10, DRA IELD ALSO CONSIDER AREA WELLS. WATER MAI T EPTIC TANK SEEPAGE PIT , DRAIN FI EL SEPTIC TANK, SEEPAG P 1�� r DRAIN FIELD , TO RIVER, LAKE, ST M. CAST IRON INTO AND OUT 0 PTIC T K AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UND IL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOR GH RE ULATIONS REGARDING INSTALLATION. file / " r Gr HEALTH'AUTHORITY OR LICENSED DESIGNER I CERTIFY TVTI M FAMILIAR WITH THE REQUIREMENTS OF GREATER NCA HORA E AREA UGH OR DESCRIBE �SYSTE IS IN ACCORDANCE WITH SAID CODE. DATE .APPLICANT'S SIGN 8 AND THAT THE ABOVE E Z V E 0 U I LZ M • TESTING • EXPLORATION • CHEMICAL • MATERIALS • INSPECTION 503 E. 6TH AVE. PHONE 272.3428 ANCHORAGE, O1ALASKA 99501 AIASNATESTLAB /w\ April 17, 1972 W. 0. 12412 Mr. Frank Hobli tzel l 1523 Ki nni ki nni ck Anchorage, Alaska 99504 SUBJECT: Test Hole/Beacon Hill Estates, Lot 6 Dear Mr. Hoblitzell: Attached are results of test hole exploration of April 14, 1972, No water was encountered. The unified classification of the full 12 -ft. effective depth indicates that 240 sq. ft. of seepage pit side area per bedroom is required, or 20 lineal feet of 12 -ft. deep pit per bedroom. This requirement is per GAAB seepage requirements. With a three bedroom home, you would need 60 lineal feet, or a pit about 15' x15' x 12' deep. I am sure the GAAB Department of Environmental Quality Control will advise you with respect to specific design and additional requirements . Very truly yours , ALASKA TESTLAB hwl James L. Scheffel Staff Engineer JLS:ld GREATER ANCHORAGE AREA BOROUGf HEALTH DEPARTMENT CASE # 327 EAGLE STREET 00 0 ANCHORAGE. ALASKA 99501 Performed For Date Performed Legal Description: Lot- B1ockSubdiv;s:on ( 07177, i This Form Reports a: Sos Log ✓ ercolation Test Depth Feet Sail Characteristics 69A,AyLl sIM Vem SAv�0-4 6ANO/ OAMP L�t2�JtL SIkvJO''1i. M6b� � n^ O�YJS i7`I s Was Ground Water Encountered? If Yes, At Wat Depth Location Sketch 0 Reading :eGross :ire Net Time Depth To H2O Net Drop c ; 0 1 Felrn�u .v. ...., r.:... . P^oposed ."Install.eepage Pit V Drain Field Dep -'Ch Of Inlet %dS�( me, �3 r Depth To Bottom Of P -i -f Or �errCh 9"1 COMMENTS : - �._f f Test Performed By: Data Certified By:�/,},Zj"'t;�.. Date: MUNICIPALITY Or ANCHORAGE • MEMORANDUM \ -= Date 19 0�._. To: From: Re: L -5 , cv Signed ---� CJ/ 91-01�(Rel/ . January 19t 1377 Prank Hoblitzel i titin; }, Subjectx Lot 6 Stacvn mill Rotates Subdivision The subject lot can not support an an -sitar *0war systoul and individual well which is required for single family dwellings. °��he particular configuration of neighborinq wells an4 newer .systems makes protective distanCas impossible to maintain for Utilization as a residential lot. if there are any further questions,, please COntaCt use at 279-2511t extonsion 224. Lost N. Buchholz sanitarian May 15, 1973 Frank Hoblitzell 1523 Kinnikinnick Anchorage, Alaska 99504 Subject: On-site Sewer System Permit Lot 6, Beacon Hills Estate.Subdivision Dear Mr. Hoblitzell: A sewer system permit was obtained for the subject lot on April 17, 1972. A permit of this type is valid for one year from dateoof issuance. This permit, therefore, is null and void. Before constructing a sewer system on this lot, a new permit must be obtained from this office. According to our file, this particular lot is quite small and the soil test revealed that the soil was tight. This indicates that it may be very difficult, if not impossible, to get an on-site sewer and water system on this lot. Sincerely, Lynn Coad Sanitarian II mld �4�v��R P.NONORAOE-gReq�opo 0 f n D9�gNl2ED JAN' \96p GREATER ANCHORAGE AREA BOROUGH 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 December 6, 1972 Frank Hoblitzell 1523 Kinnikinnik Anchorage, Alaska 99504 DEPARTMENT OF ENVIRONMENTAL QUALITY Subject: Permit to install sewer system Dear Sir: A permit was issued to you by this Department for the installation of an on-site sewer system and at this time we have no record of this system having been installed. Please complete this form and return it to this Department at your earliest convenience. yes no 1. The system has been installed. 2. The system will be installed later this year. [] 3. Void my permit; the system will not be installed. 4. The system will be constructed during the next construction season. Your cooperation is requested as we have a great number of outstanding permits for 1,972 and we would like to clear our permit files out as much as possible. an you, & e. Jo hn R. Lee, R.S. vironmental Services Supervisor sjv'09 se Y -4e Tooe.,, F. 7 1,3rA 4zl,o po-P M, 41<1 -', T eq eAoou 7 i SERVICE CONTRACT MULTI-FLO WASTEWATER TREATMENT PLANT 'r{ sr THIS AGREEMENT MADE AND ENTERED into this day o€ '19717, by and between the user of a multi-flo wastewater plant and _ J�..��•..•.�.-,..L_ the servicer, f WITNESS: THIS AGREEMENT is executed concurrently by the user and the dealer service manager at the time of installation. The dealer covenants and agrees to furnish twenty-four (24) months service on the user's waste treatment plant from date of installation. The purchaser-user x! covenants and agrees by the presents to, and does hereby contract with to service the user's waste treatment plant upon expiration of the dealer's aforesaid free service period of twenty-four. (24) months. The user understands by signing this agreement that the user accepts responsibility for the service after the dealer free service period, and also understands the necessity and responsibility for the service requirements that are advised by the dealer. 6 0,a VCil Y1VG \./Vllll Cll. \. - uVllllllUGU Page Two This service guarantees to make two (2) service and inspection calls per year at regular intervals and to respond promptly to any emergency calls for repair service. Unscheduled emergency or service calls not due to malfunction of or defective sewage treatment units shall be paid for by the sewage treatment plant owner. Although the regular service and inspection calls during the first twenty-four (24) months of installation will be free to the sewage treatment plant owners, the sewage treatment plant owner shall be required to pay the Service Contractor's road time for travel on an average scale computed by averaging road time costs for the number of plant ` customers in the area of the service call. Inspection service calls will include the following: 1. An effluent quality inspection consisting of a visual check for color and examination for odors. 2. Adjustment and servicing of any mechanical and electrical components that are out of :. order. 3. Backwashing of filter media or replacement of filter media with previously washed filters. 4. 'Periodic sampling, twice a year if necessary, of the effluent quality, and of the settled solids in the aeration tank. Any additional work necessary will be done upon written authority from the homeowner and at additional charge. Service from "' 7 MONTH - DAY - YEA Service Call Cost $25.00 per call plus travel charges, if any. Customer's Name and Address Gk V AyS K L E V I AJ y R��N.oG, 9y5704-- ��J 1".1 1 :11 F& Ish Q I "W" �F-,", ��J V-1 Cl FR! W'A C3� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 860004 DATE ISSUED: 01/03/86 . APPLICANT: WILL GAY ADDRESS: 9601 HILLSIDE ANCHORAGE, AK 99516 CONTACT PHONE: 346-2574 LEGAL DESCRIP: SUBDIVISION: BEACON HILLS ESTATES LOT: 6 BLOCK: NA SECTION: 13 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 10000 (SQ.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as se` forth by the Municipality of Anchorage (MOA) aid the State of Alaska ^ 2. I will install the system in accordance with all MOA codes and regul^~tions and in compliance with the design criteria o� 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. law � SIGNED ATE: ------------- *_----- ------------------ APPLICANT: __--__----____APPLICANT: WILL GAY ISSUED BY �� ~ DATE �� ' �--- - '`- \ : °~-��~~^m�� _______________ Municipaliey of Anchorage June 23, 1986 P.O. BI- 196650 ANCHORAGE, ALASKA 99519-6650 (907)264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Will Gay 9601 Hillside Anchorage, Alaska 99516 Subject: Lot 6 Beacon Hills Estates Subdivision On-site Well Permit #860004 - Issued January 3, 1986 On May 20, 1986, The Anchorage Assembly approved a new ordinance regulating on-site wastewater disposal systems (septic systems). All septic systems constructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently mold a permit for the installation of a septic system. We strongly urge that you contact this office prior to constructing your system. Any changes in the code that could impact the construction requirements of your septic system will be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/SSM/ljw MILE 50'/4 PARKS HWY 892.7950 WNER OF LAND .....W1QtA.X............... DDRESS ............. JOE CHELAROWSKI DRILLING CO. LIFETIME ALASKAN SERVING ALASKA P O BOX 774847. EAGLE RIVER, ALASKA 49577 'ELL - SITE ......... Lat..b...Deaa An. -"115 - -P-S .►....................... ATE- STARTED ....1 -7 _-A ....... .......................................................... LATEENDED.........!k4-86................................................................. DEPTH OF WELL .... twi L ................... I ............ ........,.. STATIC LEVEL OF WATER FT.. GSti., ir► hole e; DRAWDOWN FT. .9,57 .................................................. 420als.per; hour est. GALS. PER HR...................... KIND OF CASING 200t. sch#40 casing ;.IND OF FORMATION; ................... FT..... Q. TO ..3. FT. ..4.VQ.Tb9rd-1 .-"......... FROM ....................... FT. TO .... FROM ........ ......... FT �Q ......... FT..�.�RGI.,.SxA��.�,. FROM ....................... FT. TO ........................ FT...... . FT. TO FROM .............. ......... FROM....................... FT. TO .......•........,....... FT , ..... FROM ..........6Q...... .... FT. TO ...........• FT..... 11 FROM .. ............ FROM ..........1.Q3..... FT. TO ,......1..40........ FT. . FT. TO . ..... FT...... FROM .................. 140 FT, TO 4 FT.... FROM .......19........... Gravel,sand,water FROM .... FROM ..........194.... FT. TO ......200,....... FT, ................., ........,,.... .FROM TO ..................... FT...... FROM FT. TO .............•.................... ...................... ..................... FROM FT . ................................... FROM ........•.............. FT. TO ........................ F1'....,. ..................... FT. TO ...................... FT. TO FT. ............................... FROM ....................... FT. TO .............,......•... FT..... FROM...................... ........... .... FT. FROM . FT. TO •.... FROM...................... FT. TO ...................,.. FT.................................... ...................... ........................ FT, FR .�.�....•.. FT. TO ,....•....•............ FT, .,. FT. TO ..................................:...................... F FROM ..................... R � V FROM...................... FT. TO ...................... FT.................................... IISCL.INFORMATION' No warrenty ow warranties implied. Hang pump 5 to 10 f t . off bottom. A U Municipality of Anchorage Dept. Health & Human Services i f'l IS w -L It 5jLVVZ3 .. lS (oaf-�- ov% DRILLER'S NAME J4? ...............................•................ T.Q A r z O H oil z O °o w (D cD rt b � O ti O W ry rt �0-h ((D En o El rt N fa. 4 4 O 3 H H H pm 0 Y .b 3 y n r 3 3 3 : O :Qo F., -Ul � z : N :O (o :n ApCI O V -o 0 0 0 0 0 0 3 3 3 3 3 3 Q Ln H 'C) E�-h :n :o :.P, :O im H N• :G i (nn E o H H H H H H 0 0 0 0 0 0 n :O :N• :cn in cC) N (D 90 A4 P� C :(D � xD :►1 n (D tl H H H pm 0 Y .b 3 y n r 3 3 3 : O :Qo F., -Ul � z : N :O (o :n ApCI O V -o y Q Ln H � a H H r tri m r z y v d 4— rpt o o b7 fA �-t v W Ln Ooil Y .b ° y n r 7 0 :O :I -h : rt : O :Qo F., -Ul : N :O (o :n :b y Ln 'C) E�-h :n :o im H N• :G i (nn E o :(D n ct4 r m Ln 000 oM U) r � T b m CD p O m � r A m D ui m ni > < O N n O April 2, 1971 ELECTRIC ASSOCIATION, INC. HTH P. O. BOX 3518 • PHONE 272-4441 (_Anckftage, (_,M ka 995o1 PLEASE REPLY VIA AIRMAIL Mr. Frank Hoblitzell 1523 Kinnil:i.nnick Street Anchorage, Alaska Dear 1,1r. Hoblitzell: Chugach Electric Association, Inc. has no objection to the proposed crater wells you plan to dig within the platted easements on Lots 6 and 7 of the Beacon Hill Estates Subdivision. We feel that we must advise you that letters of non -objection should also be obtained from other utilities that may wish to utilize these easements. The Anchorage Telephone Utility, and possibly the Greater Anchorage Area Borough Department of Public Works, should be contacted. Acceptance and use of this letter of non -objection will constitute agree- ment to the following stipulations: 1. Chugach will be held harmless for any injury or damage to any person or property resulting from this installation. 2. Any Chugach facility damaged or destroyed as a result of this installa- tion will be repaired or replaced at no cost to Chugach. 3. Chugach will in no way be restri-,ted in the use and enjoyment of its rights within the existing easement. 4. All applicable safety code regulations will be observed and maintained. 5. In the interest of public safety, Chugach insists that any work done on these wells, after the installation of Chugach facilities, that involves the installation or removal of casing or pipes, and the operation of mechanical equipment within the proximity of Chugach's lines, will be coordinated with Chugach Electric. 6. Any construction or inspection costs incurred by Chugach as a result of any work done on the wells will be paid by the property owner. 7. This document is to be recorded and made a permanent part of the property documentation relating to said Lots 6 and 7, Beacon Hill Estates Subdivi- sion and is to be recognized by subsequent property owner. Mr. frank Hoblitzell -2- April 2, 1971 8. A tag stating thatCiittgach will be contacted before work is started will be displayed in a prominent place at the well. The tag will be made of a durable material and perm.=znently attached. If you have any questions, or if you need more information, please contact Chugachis Right -of -Jay Agent, Stan Casey. }ie will be happy to assist- you. Very truly yours, 1,. CI)u- ltz General Manager P CU" on A: Ic L; Lai171 . VIOTIE IfflU17 ,j 600 EAST 38th AVENUE: ANCHORAGE ALASKA 99503 TELEPHONE (907) 277-7561 Apr i 1 6, 1971 Telex 090-25-100 Mr. Frank Hoblitzell 1523 Knnikinnick Street Anchorage, Alaska Dear Mr. Hoblitzell: RxMKa .rn4�'F"'F Anchorage Telephone Utility has no objection to the proposed water wells you plan to dig within the platted easements on Lots 6 and 7 of the Beacon Hill Estates Subdivision. We feel that we must advise you that letters of non- objection should also be obtained from other utilities that may wish to uti- lize these easements. Acceptance and use of this letter of non -objection will constitute agreement to the following stipulations: 1. ATU will be held harmless for any injury or damage to any person or property resulting from this installation. 2. ATU facilities damaged or destroyed as a result of this installation will be repaired or replaced at no cost to ATU. 3. ATU will in no way be restricted in the use and enjoyment of its rights within the existing easement. 4. All applicable safety code regulations will be observed and maintained. 5. In the interest of public safety, ATU insists that any work done on these wells, after the installation of ATU facilities, that involves the in- stallation or removal of casing or pipes, and the operation of mechanical equipment within the proximity of ATU's cables, will be coordinated with ATU. 6. Any construction or inspection costs incurred by ATU as a result of any work done on the wells will be paid by the property owner. 7. This document is to be recorded and made a permanent part of the property documentation relating to said Lots 6 and 7, Beacon Hill Estates Subdivi- sion and is to be recognized by subsequent property owner. Very truly yours,, R. L. McBride) Assistant Manager- OutsJ-de Plant Engineering & Construction tom"`. • '� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I. D. 815 "0`1r -58 Expiration Date: 1. GENERAL INFORMATION _ Complete legal description f;Ed(ot/ tf7-t—(— �_5rtlr25 1, ' b Loca ib 6 #(( �°s11, d e. 7j�% �Oico� G I`ll rr�✓� s C rrrbnt Pro erty oJvn@e s& 1 A'A{t/ /� 1{ ^� Day phone c o :MailitAg address....... % Z.Real.Estatgg nt;) . �,�TH CI)?L»]i�5`7 Day phone 2. UPE OF,DWELLING• a� yrtilj (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 19 Individual] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: (acµtx�p 'ro L& 7' �s-•7�< Distance: ,g,iy„., Received bDate: 141/�1� COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � g Waiver Fee $ rah Date of Payment t 31 I S- Date of Payment 3�3i If Receipt Number ��g'1Ci COSA# f�CKo4�dZ- Receipt Number &W5gC. Waiver # ©syi [", 103LA 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 Cf ' ` Address 30 Y'•'fo Pz v fi'd x Engineer's Printed Name Cko4R.25 ;54LFF?f?�� T 6. DSD SIGNATURE System #1 Approved fore bedrooms System #2 Approved for _ bedrooms. Disapproved Phone Date ��P�EatOF _�5��! Conditional approval for bedrooms, with the following f,nar�tes �. $afrarini•'. By'=:::��UM I LCA Original Certificate Date: ! t 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 N Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheel r c If more than 9 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: 6cj4C0A_-5la4S �� 6 Parcel ID: A. WELL DATA Well type �" VRTa If A, B, or C provide PWSID # ` Well Log CYN)!65 Date completed [O f`` O Sanitary seal 6/N) Wires properly protected ON) T5 Total depth ;-60 ft. Cased to dov ft. Casing height (aboveground) Zq_in. FROM WELL LOG AT INSPECTION Date of test. 1NO 017/615/ aolb Static water level } q5 ft. 1 -7q ft. /]�. Well production 7 g:p.m. t 3./ g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate q 7 mg/L Arsenic AIV ug/L Date of sample: 0�/l6/?ab Collected by: C �J ✓ B. SEPTIC/HOLDING TANK DATA Tank Type/Material d'! Date installed 34a811170/b Tank size (,,W gal. Number of Compartments Cleanouts ®/N) i 5 Foundation cleanout (9N) _ Depression over tank (Yo /--10 High water alarm O/N) �� S Date of pumping Pumper ZEA I✓t ?f} `r K C. ABSORPTION FIELD.DATA Date installed ;l Pk Soil rating (g.p.d./ftz of 2bdit) ©• System type ! P"ACff Length(4 1s`'' Width J ft. `Gravel below,pipe 7 ft. Total depth ft 6. absorption area.9 7ff ftZ Monitoring tube v Depression over fieldNO � o,�." .3Z�Sr/(6 Date ofsdequ: test * Results ail) For_3 bedrooms Fluiddi }pth in absorption field before test (0—in. Water added er gal. New depth in. Elapseg;Tirhe nin,• final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treats �argpsf 12 mo.) (Y10 type) �V if yes, give date /,"eA D. LIFT STATION Date installed YoW116 Size in gallons Manhole/Access 6N) )0�5 "Pump on"leve�l � at %1( in. "Pump ofF' level at L in. High water alarm level at 147 in. Q Datum PDQ' iA Cycles tested Meets alarm & circuit requirements? c5 E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot (00 On adjacent lots `t X00 Absorption field on lot 4-tcio- On adjacent lots x/40 r r Public sewer main 4 (W Public sewer manhole/cleanout t loo r Sewer /septic service line 4- tom— Holding tank 75 - Animal containment areas '� Cm© Manure/animal excrete storage areas –41 r SEPTIC/ TANK ON LOT TO: Building foundation. 5 Property line Absorption field Water main i.6j� Water service line t (0 Surface water ` (8� Wells on adjacent lots ABSORPTION FIELD ON LOTTO: 7. , tC Property line Building foundation 4(a Water main k 68 WaterServiceiine iD Surfacewater *"' Driveway, parking/vehiclestorage Curtain drain ^f`54 Wells on adjacent lots f ho F. COMMENTS G. ENGINEER'S CERTIFICATION lk I certify that I have determined through field inspections and „ ,4" OF,a(�t�� review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. • '•• Engineer's Printed Name •••• Date 3/ ?,f�/ ib .,... ...� �, , Charles 6.Batzarini wi ``• CE -1 4 • '��iES I .v.;oma''® COSA yellow sheet_2-6-15.doc - Municipality of Anchorage mA�k Development Services Department ° Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC161102 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 6 of Beacon Hills Estates subdivision. This inspection revealed a nitrate concentration of 6.4 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test', and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. 3 0 I I WELL EBMT.WEST DRIVEWAY ESMT. GRANTED 20' OF THE SOUTH 35' TO LOT 4 LOT 4 BOOK 2421, PG 172 --- ----------------------- ------------------ -------------------- -NOTE- SHED IS ON MOVABLE 1_43.09 SUPPORTS- 10' N UTILITY ESMT .10.2' 89'58'0" E shed --------------- i _ __ ________ __ ____ ______ S RET. WALL ti ary ry /8J EXISTING BUILDING Iry g 34. /2 0 6 G Nom• � \ 14.9' ANN LOT 6 25 _ o _400000 25 . QF A� kkk ooh:' 49TH'• Op p....:.. ............ 4 ......................p QQ 9•�•,. Mark E. Davis .LS -7D38 p4PP. •.3-30-16.-' yJ�O ppop •.........• ado °f es sionot o oOO000�`' EXCLUSION NOTES: It is the owners' responsibilityto determine LEGEND: SET FIND BY: Beth C h d r e s s the existence of any easements, covenants, or restrictions 5/8"R8 W/CAP* 5/8" RB Which do not appear on the recorded subdivision plat. NOTE: 3.25" AL.MON. $MONUMENT 1$ with KW Alaska Group Under no circumstances should any data hereon be used for HUB & TACK EI construction or for establishing property lines. FENCE- —x— x — SURVEY CERTIFICATION: SLANA has conducted a OVERHANc- physical survey of this property as shown on this WOOD DECKS- SLANA SURVEYS INC. drawing and that the improvements situated there ASPHALTH- on are within the property lines and no encroach- ASPHALT- ments exist other than noted. GRAVEL- -BUILT S —BUILT O F: LEGAL DESCRIPTION: SEPTIC STANDPIPES- QS LAND & CONSTRUCTION SURVEYORS WATER weu- 1200 E. 76th Ave., Unit 1226 (fox) 929-3369 ANCHORAGE, ALASKA 99518 (907) 562-6103 LOT 6 WORK ORDER NUMBER: BALE: SLUE PLAT NUMBER: MARCH 30,1999 1"=30' 69-64 BEACON HILLS ESTATES SL16-MISC DRAWN BY: CHECKED GRID NUMBEk BOOK/PAGE MD. t. 2440 39/50 * IN11unicEpaEity Of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road 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 C.Sp)I ) L3 Parcel I.D. 015-092-58 COSA# C)`5c- �� 1. GENERAL INFORMATION 2. 0 r � Expiration Date: a- 16-11 Complete legal description BEACON HILL ESTATES S/D; LOT 6 Location (site address) 7501 BEACON HILL DRIVE * ANCHORAGE AK * 99507 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent CURTIS ORAZEM Day phone 7501 BEACON HILL DRIVE * ANCHORAGE, AK * 99507 Day phone 830-8044 ELIZABETH HOOPER W/ PRUDENTIAL JACK WHITE Day phone 762-3128 x, Mailing address 3801 CENTERPOINT DRVE, #200 * ANCHORAGE, AK * 99503 Unless otherwise; requested, COSA will be held by DSD for pickup. NUMBER OF, BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ 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. fi. STATEMENT OF INSPECTION BY EiJGiNEER 5. As certified by my seal affixed hereto and as of the validation date shown below, l 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 adegu--te for the number of bedrooms and t ype of structure indicated herein. 1 further verify that based on the r ti tai r r",,...,, the Municipality s A ch g fl es 7d f:"om My1 i; lvestigat,'on and ,f-sp' ection, the iin0!`riiauoiiubiaineu riwu uie Oe �i�w O"a^ e - 8 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Phone Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date in conducting this evaluation, GEG, LtD. 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. 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. Conditional approval for Attaci' ments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following stipulations: NrCenic Advisory Maintenance Agreements Supplemental Engineer's Report Other 337-6179 YVASTEWATE'R PROGRAM '111111),P) W? „9 By: Original Certificate Date: S�/��lj c (Rev. 11/05) Municipality of Anchorage ....................... QP • Development Services Department ......... . ............ . .. Building Safety Division S A E T Y On -Site Water & 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 CHECKLIST Legal Description: BEACON HILL ESTATES S/D; LOT 6 Parcel ID: 015-092-58 A. WELL DATA NOTE: WELL IS ON HILLSIDE HEIGHTS S/D; LOT 4. EASEMENT IS ON FILE AT MOA. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/4/1986 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 200 ft. Cased to 200 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/4/1986 5/4/2011 Static water level —155 ft, 180 Well production —7 _g.p.m. 7.0+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 5.39 mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 4/22/2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 11/1985 Tank size -,1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) NA Date of pumping- 4/21/2011 Pumper M.CDONALDS PUMPING C. ABSORPTION FIELD DATA I*BELOW EXISTIN::G�GRAD Date installed 11/1985 Soil rating (g.p.d./fto4EEO 150 System typo TRENCH Length 39 ft. Width 3 _ft. Gravel below pipe **10 ft. Total depth *16.3 ft. Eff. absorption area 450 ft2 Monitoring tub e YES Depression over field NO Date of adequacy test **5/4/2011 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test **75 in. Water added 450 gal. New depth **97 in. Elapsed Time: 165 min. Final fluid depth **93 in. Absorption rate >= 450+ —g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **NOTE: MT ONLY EXTENDS 8.75' INTO EFFECTIVE (10'). TOTAL DEPTH AND LIQUID LEVEL ARE CALCLULATED. D. LIFT STATION Date installed . Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High 'water level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: NOTE: WELL IS ON HILLSIDE HEIGHTS S/D; LOT 4. EASEMENT IS ON FILE AT MOA. Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *5' Property line **UNKNOWN Absorption field 5'+ Water main N/A Water service Fine 10'+ Surface water Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 100'+ Property line **UNKNOWN Building foundation **UNKNOWN Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER PREVIOUS HAA. DISTANCE FROM ST2 TO 2" INSULATION ON FOUNDATION = 7'3". **SEE ATTACHED WAIVER LETTER 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 Print d Na a JEFFREY A. GARNESS Date /r COSA Fee$ qD / . Date of Payment � 5 I / I I Receipt Number ® C 15 (Rev. 11/05) Waiver Fee $ / Date of Payment Receipt Number o� `� Municipality of Anchorage �f & an� reefCommunity Development Department°Development Services Divisionk .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 Nitrate Advisory Certificate of On -Site Systems Approval # 111154 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 6 of Beacon Hill Estates subdivision. This inspection revealed a nitrate concentration of 5.39 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/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. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907)343-7904 • Fax (907) 343-7997 http:/iwww.muni.org/Onsite Development Services Department On -Site Water and Wastewater Program • **** VARIANCE/WAIVER REVIEW **** WR#: OSP111059 PID#: 015-092-58 HA#:OSC111154 Permit#: Legal Description: Beacon Hill Estates Lot 6 Engineer: Garness Engineering Group Applicant: Curtis Orazem 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 1.0 feet. Also approved is tank to property line of 1 foot and absorption field to foundation of 2 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. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 5/16/2011 Approved by: G� viewer ............................................ .. . . ■......................■ Rec#: 074751 Amount: $200.00 Date Paid: -5/1 I /I I **** VARIAN C E/WAIVE R REVIEW **** GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS May 10, 2011 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Beacon Hill Subdivision; Lot 19; Waiver Requests; Mr. Poet, The subject property is served by a private well and septic system. The septic system is located between the foundation and the east lot line. The separation distances were measured during our site visit and we found several deficiencies. Measurements were made from the center of the standpipes to the foundation or lot line: ST1 - Lot Line (per as -built survey) = 6' Trench Cleanout - Foundation = 4.0' Trench Cleanout - Lot Line (per as -built survey) = 7' We assume a tank width of 4.875' and the trench width is stated to be 3' per the original inspection report. Based upon these assumptions, we assume (but cannot precisely verify) the following separation distances: Septic Tank - Lot Line = 3.56'+ Drainfield - Foundation = 2.5'+ Drainfield - Lot Line = 5.5'+ Therefore, we request you waive the following distances: Septic Tank - Lot Line: 1'+ Drainfield - Foundation: 21+ Drainfield - Lot Line: 1'+ The system has been in place for 25 years and (per the owner) wastewater has never infiltrated the foundation or crawlspace. We are unaware of any adverse impact these waivers would have on adjacent wells or septic systegis or�the structural integrity of the house. any/oAftons,l please contact us at 337-6179. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING II�; Parcel I.D. # �t � dn Z -�� HAA # 1. GENERAL INFORMATION Complete legal description L��C /n/ wry '/ye 0- / 3, i 2 Al, lit -3 Location (site address or directions) _ Property owner L(,JArzel L Mailing address -1 b. I �A«L-. _1�1 Day phone 3 Ll r� Lending agency Day phone Mailing address 3� o l 5-�. S,), -r<, 4o 3 Agent J n`'�'' CES Day phone Address Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3 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 C o N Y2C-RS Phone 3 6- 7-00 0 Address i6or C30DD W /Z t; cz, rZ P P_ AAjC., l�- Engineer's signature `' Date �rdVr� Co�� 9 6. DHH6 .SIGNATURE Approved for 3-bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: RECEIVE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES MAR 10 19 Environmental Services Division MUNICIPALITY OF ANC 825 L Street, Room 502 • Anchorage, Alaska 99501 • (904W"74141. SERVICES DIVISION Health Authority Approval Checklist Legal Description: G G 15E,'�CoA) #166, C -S7- Parcel I.D.: ,vw % 5-/3 7-/2 X23 A. WELL DATA Well type P If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed Total depth 20 0 Cased to o D Casing height (above ground) ,3/ Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production 7 g.p.m. 7' g.p.m. WATER SAMPLE RESULTS: dn�P le Coliform ® Nitrate ��'' Other bacteria Date of sample: Z8 9�1 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ��' 8 S Tank size / o G c) Number of Compartments Z' Cleanouts (Y/N) Foundation cleanout (Y/N) _� Depression (Y/N) A) High water alarm (Y/N) Date of Pumping 3 3` 9% Pumper C. ABSORPTION FIELD DATA Date installed �/` �`� Soil rating (gam or ft2/bdrm) /SO System type �ENCt{ Length 3 Width Gravel thickness below pipe /o Total depth 16 Ef�'�it'oA-7 *J-C4wc-T Effective absorption area s Monitoring Tube present (Y/N)tV Depression over field (Y/N) N Date of adequacy test Z T Z7 - 9% Results (Pass/Fail) For 7-/K'ef bedrooms Fluid depth in absorption field before test (in.); 7 Immediately afteL3-] gal. water added (in.): i b Fluid depth -7,7 (ins) Minutes later: Absorption rate = ''� a.p.d. Peroxide treatment (past 12 months) (Y/N) if yes, give date FOES N07- �'� c uv�' A10Rnj1c �f0 115 /t0Z� 72-026 (Rev. 3/96)' D. LIFT STATION woT dsE7�, Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES FRo+� S j,e},tl P! Pis TEC e-5, y — rw EC. L /5 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacent lots ,,o a Public sewer main too Public sewer manhole/cleanout '� �� a Sewer /septic service line �0 a Lift station f'/ D o SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line G Absorption field Water main/service line �a Surface water/drainage '� Wells on adjacent lots f a SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /o Building foundation S Water main/service line �v Surface water d Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots tlo e F ENGINEER'S CERTIFICATION / certify that I have determined thru field inspections and review of Municipal recor ,ahq a'jjrr is are in conformance with MOA HAA guidelines in effect on this date.' Signature x, wk..,� Engineer's Name y� � :ice .• Date .3 —19 _ yy %�``�►'C'.S" HAA Fee $ �� Waiver Fee $ Date of Payment ©�� — o ' � Date of Payment Receipt Number ©` C � / Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # LL)-- HAA # e� 1q L�(-)? -1- , 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Z©l6 13ec-CC)4 11111Z57]5X Sia i /Zn/ If 364J Location (address or directions) 750/ /3e_a.r,o•7 /-/i 14- fir. (b) Property owner _VJ / ►4 67 A� Telephone: (home) 3117 Zg5y Business 2&5 7171 Mailing Address C/o 5Z01 G 57, loo A-iiC' 4, 1C_ g 45o3 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent J K W 1fj = Co - Address 3Z.0 I C S-{ jk 16-6 , &LA c, k, A- !L Telephone 5(.-3 5 5 00 C L'Ar l tt l:, P-*" s (5'l If `t .5-0 (e) Mail the HAA to the following address: (or check here X, if hold for pick up.) List contact person and day phone number below: J A -c -IC Wr+1rc, co - PAr7 ry - 563.5 5 Do 2. TYPE OF RESIDENCE Single -Family R"' Numt 3. WATER SUPPLY %��Vise l��.soti Individual Well Comrr��.� Note: If community well sy, Conservation attesting to thj� 4. SEWAGE DISPOSAL On-site L" Public ❑ Note: If community well sy Conservation attesting to the )egamy arw buatuo, 72-025 (Rev. 7/88) Page 1 of 2 State Department of Environmental State Department of Environmental 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 G ° N'5 T ` Oki G iZ 5 Telephone 34(P-7.000 Address 9 0 nr E3 vD 19� W l� �2. N e �7 � r4r-ti1 c- H r4- I� Date ?'' Z.4 —15 6. DHHS APPROVAL Approved for bedrooms by Approved __ Disapproved Terms of Conditional Approval Conditional L, CAUTION olpwrt� .J �-]�^� �tlR • jy PAM I/1 7y�'pl- „,..ere�wrwafss YrY w Date 9i L 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. 72-025 (Rev. 7/88) Back Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L (, /,5E6jGOA) fi/cG GAJ%" Parcel I.D.: 51.5 A. WELL DATA - IVO7lE; cuELG /S Del//00 1.' LOK RsEMe"7' 6 0coPY O F ,Tcj.<dE9 .47-,*4ag Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (YIN) _ _ _i" Total depth 2,00 Sanitary seal (Y/N) ! Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample: Date completed /0 -- 4f - 8 G Cased to Z d O FROM WELL LOG /0 - V-.? 4 /155 T Nitrate 9.p -m. i _ Casing height (above ground) Wires properly protected (Y/N) r AT INSPECTION n cn /ss M 7, g.p.m. 2'&7 Collected by Other bacteria ffru -- c E 0 B. SEPTIC/HOLDING TANK DATA Date installed //—tS Tank size /O0 Oj Number of Compartments Cleanouts (Y/N)�_ Foundation cleanout (Y" i/ Depression (Y/N) High water alarm (Y/N) �V Date of Pumping 17-75 Pumper IS -4A -CS C. ABSORPTION FIELD DATA Date installed Soil rating ( ft2/bdrm) /50 System type /✓e ic;'A Length 3 % Width .3 Gravel thickness below pipe /0 ' Total depth /4 - / 7 Effective absorption area 1150 t- Monitoring Tube present(YIN) i Depression over field (Y/N) A/ Date of adequacy test 4f- /5T9' Results (Pass/Fail) /04S -S For YfitXEG bedrooms Fluid depth in absorption field before test (in.), /Z- Immediately afterSC agal, water added (in.): 3 00-41 Fluid depth '77-0 Minutes later: 12- (in.) Absorption rate = + �g0 g.p.d. Peroxide treatment (past 12 months) (YM) If yes, give date F" 004 A S Ou'v-c S o l f 3> C ry tTI Cp t0 ch D. LIFT STATION N D % v S Eh, Date installed Manhole/Access (Y/N) _ High water alarm level at* Size in gallons — "Pump on" level at* '— "Pump off' level at* *Datum — Cycles tested — E. SEPARATION DISTANCES So aT i—o r l4m rV o w E t LI 1-30-r 14AS WELL ori Ahp1 1.0Y SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot +/00, ; On adjacent lots Absorption field on lot + /e o � ; On adjacent lots f /00 r Public sewer main /oo . Public sewer manhole/cleanout 4- /00 � r Sewer /septic service line / OO Lift station 4 /Do SEPARATION DISTANCES FROM SEPTIU09S6609 TANK ON LOT TO: /,n.4, Foundation S Property line G Absorption field—9 Water main/service line yD� Surface water/drainage /00 Wells on adjacent lots / 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation r Water main/service line + `f y Surface water t /0 O Driveway, parking/vehicle storage area Curtain drain 4 5-0 ( NONE /oNoanV) Wells on adjacent lots F. ENGINEER'S CERTIFICATION / I certify that 1 have determined thru field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. 7 +r7t '04AAS Signature„o*=k�g�>�� m , w sly €r a� 4 Engineer's Name Date nK .,n.., t:+s xY.WI?°t a.pN�CiLYRy'Y(k fr' v r * J a .tel_ Y r5� aT HAA Fee $ ✓n C) d ,CfZ) Waiver Fee $ Date of Payment ie �.��— 7T Date of Payment Receipt Number 1A q �?— �rh , % Receipt Number Rev. 8/95 OSS: haa.wk.doc �J 4 44 181, � + EASEMENT This easement grant is made between Williford W. Gay and Mary B. Gay, husband and wife ("GRANTOR") and Williford W. Gay and Mary B. Gay, husband and wife ("GRANTEE"). instrument: The following recitals of fact 4re\ a meterial part of this A. The Grantor is the owner of a lot described as follows and referred to as "Parcel 1"i Lot 4, of Hillside Heights Subdivision, Plat No. 79-257, Anchorage Recording District, Third Judicial District, State of Alaska. B. The Grantee is the owner of a lot described as follows and referred to as "Parcel 211: Lot 6, of Beacon Hill Estates Subdivision, Plat No. 69-64, Anchorage Recording District, Third Judicial District, State of Alaska. C. The Grantor wishes to grant and the Grantee wishes to receive and easement over, under and across Parcel 1 described as follows and hereinafter ref rred to as the "The Easement Premises"; A strip of land, the west twenty (20) feet of the south thirty-five (35) feet of Lot 4 Hillside Hieghts Subdivision according to Plat No. 79-257. Now, therefore in consideration of ten and 00/100 dollars ($10.00) and other good and valuable consideration the receipt and sufficiency of which are hereby acknowledged, the following grants, agreements, covenants and restrictions are made: 1. GRANT OF EASEMENT. The Grantor hereby grants to the Grantee, his heirs and assigns, as an easement pertinent to Parcel 2, a perpetual easement for t.hP installation, operation, repair and maintence of a water well, waterline and associated appurtuances over, under and across the easement premises. 2. USE OF THE EASEMENT PREMISES. Exclusive use of the easement premises is not hereby granted. 3. MAINTENCE,OF EASEMENT. Grantee covenants to immediately restore the easement premises to its previous condidtion each time its, use for maintenance and/or repair is required. 2. A. WARRANTIES OF TITLE. Grantor warrants that he has , good and indefeasible fee simple title to The Easement Premises. 5. COVENANT OF LIABILITY. Grantee covenants that he will hold free and harmless, defend and indemnify the Grantor 'AVE 0 6 8 for all liability, penalties, costs, losses, damages, expenses, causes of action, claims or judgements, (including attorney's fee) rusulting from injury or death sustained by any person or damage to property of any kind, which injury, death or damage arises out of or is in any way connected with the use of the Easement Premises for its granted purpose. 6. RUNNING OF BENEFITS AND BURDENS. All provisions of this instrument, including the benefits and burdens, run with the land and are binding upon and enure to the heirs, assigns successors, tenants and personal representatives of the parties hereto. 7. TERMINATION OF COVENANT OF LIABILITY. Whenever a transfer of ownership of either. -.parcel takes place, liability of the transferor for breach -of govenant occuring therafter auto- matically terminates. Dated this !�? day ofy�'/1�i, 1986. GRANTORS: +Willifor4 W. Gay / Mat y B. �; y STATE OF ALASKA ) )ss. THIRD DISTRICT ) GRANTEES: Williford! Gay Mary B. G THIS IS TO CERTIFY, that on this Z % 7`" day of / ct nti G� , 1986 fief -',axe me, the undersigned Notary Public, personally appeared WILLIFORD W. ;q, Y',and MARY B. GAY, known to me and to me known to be the individuals d.esrr.A.ped in and who executed the foregoing instrument; they acknowledged tin iAUT= rj �- JiaFpRse,, therein set forth. wi,rHNESS my hand and official seal. o ary u . is in an or-; My Commission expiry-:,: /�� :lfloii 1 5.4.4ME 068 3. 7 G � •, 17- f W -u95733 c� m Dkc Z9 3 17 IM '86. RE0Ll 1 ADDFFSS 1 GcJ G o � E:- / -) F -F-- r,) (7, CL' Xlt \U S. /f!•V Aor 01 �p G v� I her crrtif that a s. rvey of Lot_ _. Block-_- Subdivision was made on —_. and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. It is the responsibility of the owner to determine the existence of any easements. covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines. / -.1 Dated t ,Qe orage, Alaska, this -_ ___.__. day of JJ /{ CONSTRUCTING ENGINEERS, INC. 9601 Buddy Werner Dr. Anchorage, Alaska 346.2000 694.9098 /7�_ t -C 6ylt+k�84�ttaT� . UP0�9