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HomeMy WebLinkAboutLELAND STANFORD LT 4 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 01529134000 Legal description LELAND STANFORD LT 4 Site address 10360 SCHNEITER DRIVE Expiration Date: 2/23/23 Current property owner(s) KEWIN JEFFREY B & EMILY LYNN X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 11/23/22 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUMUFAUT1 Y OF AHC HORAOC Development Services Department ? Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-291-34 Complete legal description LELAND STANFORD LOT 4 Location (site address) 10360 SCHNEITER DRIVE, ANCHORAGE, AK 99507 Current property owner(s) JEFFREY & EMILY KEWIN Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 15J`-0 Date of Payment ) i 1:2- 1 2 2- cam- 51.2093 COSA# ebGZz 1 5a Waiver Fee $ Date of Payment Waiver # COSA Application 2022.doc COSA Checklist 2022.docx COSA Checklist Legal Description: LELAND STANFORD LOT 4 Parcel ID: 015-291-34 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 4/1983 Total depth 101 ft Cased to 101 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/9/2022 Static water level at beginning of test 52 ft. Well production at time of test 2.43 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.92 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 08/09/2022 Comments PER MOA DOCS: PUMP AT 98’. CURRENT FLOW / WATER PRODUCITON RIGHT ABOVE PUMP. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NA – NEW TANK Required maintenance completed, if AWWTS Comments: GOOD MATERIAL AT S.T. INSTALL C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/05/1982 ALL standpipes present per record drawing Total measured depth from grade 12.3 ft (max) Measured depth to pipe invert from grade 6.3 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 08/09/2022 Results Pass Fluid depth prior to test 0 in (DRY) Water added 600 gal New fluid depth 1 in Elapsed time <20 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used 0 in Effective depth remaining 60 in Comments/Deficiencies: MT & DCO MEASURED AT GRADE. ELEVATIONS & VISUAL MEASUREMENTS SHOW 4.9-5.1’ EFFECTIVE DEPTH OF MT & DCO INVERTS & 60” WAS USED. GREEN HOUSE HAS NO FOUNDATION & IS ON THE TOP OF THE 30” DECK. IT APPEARS THAT NO DECK SUPPORTS ARE DIRECTLY OVER OR GO THROUGH THE EXISTING TRENCH. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS LAST PORTION OF TRENCH IS UNDER DECK AND APPEARS TO MEET SEPARATIONS WITH NO KNOWN ISSUES THESE PAST 40 YEARS & PER THE OWNER. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 11/07/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 11/07/22 WMunicipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221330 PID Number: 015-291-34 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New®Up9 rade Name: EMILY LYNN & JEFFREY KEWIN ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 10360 SCHNEITER DR, ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot LELAND STANFORD 4 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width 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 Ftz -- -- Ft. Well 100'+ NA NA NA 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1 1250 Gal. Surface Water 100'+ NA NA NA Material HDPE Number of compartments 2 Lot Line 5'+ NA NA NA NA Foundation 10' NA NA NA LIFT STATION Manufacturer Capacity Curtain Drain NA NA NA NA Gal. RemarksExisting septic tank decommissioned & Pump on level at in. Pump off level at in. High water alarm at in. new HDPE tank installed in same location. Pump make and model Electrical Inspections performed by Installer JRS PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspdates: 1" 11/1/22 2nd 11/2/22 ectionCOMMUNITY cation and description [TOP 3`° a� OF RISER/ MANHOLE DEVELOPMENT DEPARTMENT APPROVAL - Conditional Approval: Date ,,� P. •' • TH *: 49 •.* �.. ............. . Curtis Huffman ��� �'�c�•.CE 128991 '....11/07 .•�`�/ sjF. 11/07 Approved Date Z zZ • tll��ROFESl��.�-� 11 iaNCcuui i Mepui i_a- i- i /_.uoc PID:015-291-34 PERMIT:OSP221330 FIRST WATER CONSULTING LELAND STANFORD LOT 4 SCHNEITER DRIVE SO*01'52"W 135.021 (135.071 R) 11,3' a ' WEIL-L ry PAVED LOT 4 (0 D/W 0 0 0� N0') ry 22 7'CONC <23.7' Ln > LI.! 00 M 0 ff�4 3'< ©° .3' 52.5' LOT 3 0) LOCL C'4 < Crf __1 2 2. 7' r 0) EXISTING _N cr) Cn 12,0' HOUSE C6 C/) < 14, 0' 8.0' 4 4 12.0' LLJ M M 12.0' GRN 0 L0 DECKS X X _ L_ 14.0' ?11C K SS HSE Q0 0 0 M 14.0' 0') co SEPTIC - VENT00 -4 (typ/1 MH 0 � 1 12.0' 5.2' BLOCK 00 .0 C5 FIRE PIT & PATIO MULCH CHICKEN BIN COOP A 110' UTILITY ESMT N00*04'56"E 135-15' (N00°01'1 6"E 135.34) R) ANCHORAGE RECORDING DISTRICT., ALASKA AS -BUILT OF: LELAND STANFORD SUBDIVISION LOT 4 PLAT 80-217 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouh any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE- SCALE: E-MAIL; NOV 3, 2022 1 "=40' schuller@ak.net 22-095-2 DRAW BY. CHECKED BY, GRID NUMBER, 5o5R7P_AM- I JLS SW2537 220358 * — FND 5/8" REBAR 4%401%qj%-' Afti, 01 D Sul? AW 0 F L A V A -W 49TH ....... ............ . ....... ?A �....:.. ........ / ............... •,J HIST L. SCHULLER.: LS -10408 1831 Talkeetna Street 011:11 6 Anchorage, Alaska 99508 \'` �,'/'Ofessionc\ (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:i/wvvw.m u n i , org/onsi to On -Site Wastewater Disposal System Permit Permit Number: OSP221330 Work Type: SepticTank Upgrade Tax Code Number: 01529134900 Site Legal Address: LELAND STANFORD LT 4 13:2537 Site Mailing Address: 10360 SCHNEITER DR, Anchorage Owner: KEWIN JEFFREY B & EMILY LYNN Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: ,ne.ne C J � DLpai-linen t Lot Size in Sq Ft: Total Bedrooms: E-11K:7)"03Ya 8/29/2023 40414 ❑ Disposal Field El Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either_ a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: 8/30/2022 M Development Services Department Phone. 907-343-7904 On -Site Water & Wastewater Section '- Fax- 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-291-34 Property owner(s) JEFFREY & EMILY KEWIN Day phone _ Mailing address 10360 SCHNEITER DRIVE, ANCHORAGE, AK 99507 Site address 10360 SCHNEITER DRIVE, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) LELAND STANFORD LOT 4 Legal description (Township, Range & Section) Lot Size 40,414 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank Q Upgrade FXDuplex (D) ElHolding Tank ❑ Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Signature of property owner or authorized agent) Permit/Rush Fees: 225 Date of Payment: 8�/'O22 Receipt Number: -510) 6 3 Permit No. 05P2_Z133D Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 18, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: LELAND STANFORD LOT 4 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221330, Deb Wockenfuss, 08/29/22 FIRST WATER CONSULTING NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK LELAND STANFORD LOT 4 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221330, Deb Wockenfuss, 08/29/22 SC NEITER DRIVE YE S0°01'52"Vii 135.02' (135.07' R) 11.3' 0 0 w � o i WELL elf '--� PAVED LOT 4 � C0 D /W.. 0 0 c� °' 0 I Of 22 7' CONC WALK W Q 23.7' '�' � I > W o0 � � 4.3 0 M N '� 0 �, 9 0 52.5' LOT 3 Q h " 22.7' _ N EXISTING N C d- _� 12.0' HOUSE N N o Cti 3:.3' o o LL} <C :. X 14.0' 8.0' 4 4 12.0' ^ ^ M 0-) 12.0' 0 o o GRN w DECKS t- HSE X 14. Q' CKS tf? � � m �__--X 14.0' 0 SEPTIC 00 VENT-* (f1 (tya) 12.0' h�` i► 0 BLOCK Eo FIRE PIT �2 & PATIO MULCH CHICKEN BIN COOP 10' UTILITY ESMT NOO"04'56"E 135.15' o f 11 { N 00 01 1 E 135.342 R) 1 I t 'ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: LELAND STANFORD SUBDIVISION LOT 4 PLAT 80-217 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoult any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E-MAIL AUG 14, 2022 1 =40' schuller®ak.net 22-095 DRAWN BY. CHECKED BY GRID NUMBER: BOOK/PAGE: JLS SW2537 220320 Q - FND 5/8" REBAR SUR0 F 4 N 1) i�4L,TH 49 / VA t. ... ....................e ..P : .-JOHN L. SCHULLER: 0 � `s LS -10408 �,r . • ��� ® 1831 Talkeetna Street �� �• . , �� d ® Anchorage, Alaska 99508 tO f � (907) 227-1455 office�lk�eessioa (907) 274--4992 f ax I 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 -~AME IPHONE I~'N EW MAILING ADDRESS LEGAL DESCRIPTION ~OCATION We~ Absorpti~Brea Dwelling PERMIT NO. ~ ~ Manufacturer ~ ~~ M~t.ri~,~~ No. of compar/m.nts ~iq. napaciW in ~allons Inside lenoth ~idth LiquiO depth _ I ~0 IF HOMEMADE:  ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation ~earest ~o~n~ ¢~MIT~ ~ DISTANCE TO: ~lO'r I~ NOT IIq ~:~_~_ N°'°flines / Length ofeac~inA Total lengt~f~es Trenchwidth~ inches Distance between lines ~,~ Top of tile to finish grade ,- r Material beneath tile Total effective absorption area Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~OIL TEST RATING INSTALLER ~PPROVED DATE LEGAL 72-013 (Rev, 3/78) PERMIT NO. DEPBRTMENT OF HERLTH RND ENVIRONMENTRL PROTECTION 825 ~L~ STREET.. RNCHORRGE, FIK. 9950± 264-4?20 ) BPPL I CFINT LOCRT I ON LEGFtL SMRRT EXCRVRTING L4 LELRND STRNFORD 625 LYNNHOOD DR 99582 LOT SIZE 344-8786 999999 S~URRE FEET T'¢PE OF SOIL RBSORPTION S'¢STEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING (SQ FT/BR)= ±25 THE REQUIRE[..' SIZE OF THE SOIL RBSORPTION S'T'STEM IS: [) E F" T ~4 := .~L ,E~ I_ E !'-~ ,._~ T H = 5 £~ ,:-~ R A "..: E L [:, IE F' T t--~ = 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCFI OR DRRINFIEL[:,. THE [:,EPTH OF R TRENCH OR PIT IS 'THE DISTRNCE BETWEEN THE'.' SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOE'. TRENCHES. THE GRR',,,'EL. DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETHEEN THE OUTFRLL PIPE': RND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT RPPLICFINT HRS THE RESPONSIBILIT'¢ TO INFORM THIS [:,EPFtRTMENT DURING THE INSTRLLFITION INSPECTIONS OF"' RN'r' HELLS R[:,JRCENT TO THIS PROF:'ERT"r' RND THE NUMBER OF RESIDENCES THRT THE HELL WILL SERVE. ']-l~4,]N .C ;;' ) I 1"4SPE,]:T I CNl'-,l'_--~ t-]F-:E RI_EL'::!Lfl I E:E[:, BRCK'FtLLING OF' RN'¢ S'¢STEM WITHOUT FINRL INSPECTION RND RPPROVRL B9 THIS DEPRRTMENT WILL BE SUBJFCT TO PROSECUTION. MINIMUM DISTFtNCE BETWEEN R HELL RND FIN"/ ON-SITE SEI.,.IRGE I)ISPOSFIL S'T'STEM IS ±00 FEET FOR Ft PRIVBTE 1.4ELL OR 150 TO 200 FEET FROM R PUBLIC HELL DEPEN[:,ING UPON THE TYPE OF PUBLIC HELL. MINIMUM DISTRNCE FROM R PRIVFtTE HELL TO Fi F'RIVFiTE SEHER LINE IS 2..'5, FEET RND TO R COMMUNIT'¢ SEHER LINE IS 75 FEET. OTHER REf..!UIREMENTS MRY FtPPL'¢. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE FI',,,'FiILRBLE TO INSIJRE PROPER INSTRLLRTION. F"EF:I"I I T E;~-,.'P I RES [:,EE:EI'IBEF-: :-2--::1... I CEF.:TIF'¢ THRT i: I RM FRMILIRR WITH THE REEJ. UIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET FORTH BY THE MUNICIPRLIT'¢ OF RNCHORRGE. 2: I 14ILL INSTRLL. THE SYSTEM IN RCCORDRNCE HITH THE CODES, 3:: I UNDERSTRND THRT THE ON-SITE SEHER SgSTEM MFI'¢ REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. 1%,= _~k. ~,'t ...... -' ------ ~--~.-~.~ ....... ;~.~_~.~--~.-, ~.b ....... ~ --~%-- '--, ;. '~ = PERFORMED FOR: LFGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16 17 18 19 20 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /~ SOILS LOG [] PERCOLATION TEST SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Nc-t,~-"'~-'~'~'"~ ,~h to Net Reading Date Time"~~%-- OF ~ Drop -- ', '.T ', CU:~E 2~ ~ ,' ~o"¢ro I...4 b t'- TEST RUN BETWEEN FT AND FT PERFORMED BY: 72-008 (6/79) RETURN TO: Division of Geological and Ge slcal Surveys (DGGS) 3OO) Porcupine Drlve (Telephone: 277-6615) Anchorage, Alaska 995OI WATER WELL RECORD Please complete either la, lb, or lc. la. Borough Subdlvi sion Lot Block lb, Anch Leland Stanford Sub Drilling Company ttame LOCATION OF WELL ~ 1 III 2, WELL LOG Materla) Type Top O Section No. ~oulder 26 ' - ~8_' sil~ till gpm Feet Below Surface Bottom 14. REMARKS: Water Temf>eratu re: This well was drilled under my jurisdiction and thls report is true to the best of my knowledge and belief: AA 3327 Contract'L~'~se Number 16 Copy Distribution: WHITE - State DGGS, PINK - Driller, CAI(ARY - Customer STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES U.S.G.S. Local No, Drilling Permit No. A.B.L, No, 3. OWNER OF WELL: Nell Ross Address: /~.;'~*~> _~:'4't/,/~lr~-P~ ~ ~. C n 101 ' 6, USE: ~Domestlc [~Public Supply [] Industry ~]Irrlgation []Recharge [~]Commerclal [~Test Well ~Other: ;~' 7, CASING: L~ Threaded ~Welded ~,. to 101 ft. Depth in. to fL. Depth Weight lbs/ft, 8. FINISH OF WELl.: Ty~e: open hole Slot/Mesh Size: Set between Length: fi. and fi, STATIC WATER LEVEL: _~L~I ft. ~]Above ~Selow land surface Type of Measurement: I0. PUMPING LEVEL below land surface 10-12 ~~ fi, after ___ hrs. pumping -- - g,p,m. -~-- ft. after ~ hrs. pumping ~- g,p,m. 11, WELL HEAD COMPLETION: [~Pitless Adapter [~] In Approved Pit inches above grade 12, GROUTING: Well Grouted: [] Yes ~ Ma~erla): []Neat Cerr~nt [] Other: 13, PUMP: (if available) HP bength of Drop Pipe .... fi, capacity -- g,p,n Type: [~]Submerslble [~Reclprocating [~Jet [~]Other: 15. WATER WELL CONTRACTOR'S CERTIFICATION: Alaska Now-Well-Vern's Drilling & Ent Registered ~uslness Name Form O2-~6~R 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 AUTHORIT,Y APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. HAA # 1. GENERAL INFORMATION Complete legal description Leland Stanford, Lot 4 Location (site address or directions) 10360 Schneiter Property owner Neil;.;and Mary Ross Mailing address Day phone 346-2?22 Lending agency Mailing address Day phone Agent Ray Dahl / DYNAMIC PROPERTIES Address 501 w. Northern Liqhts Blvd. Day phone 279-7611 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ¢21 s~uewwoo leUOB!pp¥ :suoBelndp, s bU!MOllOj eq~ LB!M 'suJooJpeq 'SLUOOJpeq JOJ leAoJdde leUOB!puoo 'pe^oJddes!Q ~fo~ pe^oJddv ~]t:INIVNglS SHHO eJn~euS!s sjeeu!Su:l '9 t:I~i~NIIDN~ AG NOIIO~dSNI dO IN~]IN~llYIS '~;  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~©~ ~ ( ~E/-~cJ¢~ ~?'/~¢uD~--'oeP Parcel I.D. A. WELL DATA Well type J~')A.t//F?¢_ Log p resen~,l) Total depth Sanitaw seal If A, B, or C, attach ADEC letter. Date completed ADEC ~ater system number /L_ / 4~-2. '3/ ~--' Driller Cased to /01 / Casing height Wires properly protected f~/N) ~/'~<~' FROM ~/ELL LOG Date of test Static water level Well flow Pump level g,p,m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot lOC .k Absorption field on lot 100 '-I- Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout __ Petroleum tank WATER SAMPLE RESIJLTS: Coliform ('~ Nitrate Date of sample: I )~OIc~~ Collected by: Other bacteria B, SEPTIC/HOLDING TANK DATA Date installed I0/'~ / ~-~ Cleanouts (~N) High water alarm (Y/~_J~ Date of pumping c~L/~/c~ % Tank size 1~.%(.30~L_ Compartments Foundation cleanout (~) ~/~' Depression (Y/¢_.~ /%)//0, Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot , ~00 ~ ~ On adjacent lots To property line [0 Absorption field Surface water/drainage 100 r -? Foundation Water main/service line 72-028 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION "~:~Ke~nstalled ~J //~F Manufacturer Size i Manhole/Access (Y/N) Vent(Y/N) ~at ~ Well on lot ~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length 5?~- Total absorption area Width Depression over field (Y/I~ ~k~o Results (pass/fail) Peroxide treatment (pest 12 months) (Y/~) Soil rating ~:~ ~(~//fSil- System type -T-~ Gravel thickness Total depth Cleanouts present (~N) Date of adequacy test for ~ruo~ r~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water On adjacent lots IOO' ~ Property line I0 t ~ To existing or abandoned system on lot Cutbank I OO ' ~- Water main/service line Curtain drain Driveway, parking/vehicle storage area /(JO/~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, S & SENGINEERING Signature 17034 Eagle River Leop Roa¢{ No, 2{~ ~'-i, ,',~ ~ Engineer's Name p~ Date '~' ~ ~:~ ~ ~ ~ ii~'i HAA Fee $ /7 Date of Payment ~2--'-'~f~" ~ ~- Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HE~;IH D~PAR'I~ERI[' OF ~Ii~HZTH AND ENVIR@~MENTAL PRf/£ECTICN APPLICATION ~RDR HE.~L%YI AUTHORITY APPROVAL CERTIFICATE 1. -General Information (a) Legal Descri?tion <include Icl:, block Cpplication Date ~I~ ¢ '" J , subdivision, section, tcwns~].p, rangt.~] (b) Location (add~,ess or directions) ~.~" ,-/0-/. ' ~'~ ¢ ~-'"~ '~ ~' -"~': ~-'~ J~"~: . .~i' ' ?"~1~',~,~"~" ' z'~,>- >-,'* ./ ~':~'>~..,...~ '- .~,:,.. / . I Applicants N~m ~' ~','Z_ _ ~.~_ ~].ephone Applicants Ad.ess /di:?~:.¢-~ .-::;4¢~¢~¢v?~>:¢ ~>-, ~/~ ~2--:. ..... (d) Lending Institution ___~..~/~_~ Telephono :? -?f~ / / (e) ~al Estate Co, & Agent ...... Address Multi-Family ./ OLn.u (desc.'rib~) Note: If ccm~runity well system, must ha,.e wcitten confJ2}~mntiop. +2r~ the State ~pa~ment of 5~vironnental Conservation attesting to t~m legality and status. Is the ~ell adequate for the ntl~m~: of ~dr~s s~cified in this [{AA (Y~) 4. ,~ wa~qe Is the wastewater dispsal system adequate for the r:mn~r of ~droo~s (Y/N) [PaG~ ]. of 2] 2-15-84 5. En~ineerinq Firm I~ovidinq I__n_ssf~__cJ[.l_o_q~,- l%~_t.s, Data ~d 'r~¢e~' " I oertify that I have checked, verified, or confo~n~d to al. 1 ~,DA HAA Guideli:es i effect on the {~te of ~is inspect].on~ .~// ( ~IGINEER SFA!, ) 6. DHEP Approval Approved fo~_.?_/' ........ bedrocms / conditional Approval Te~nns of TM ' ' ' The Municipality of Anchorage L~p~n¢'t~a~nt of [~alt:h and Enviror~rental Prctection d, nct guarantee the ccntinued satisfactory ~rforfman~ of t]~ wateF supply and/'cnz t; waste~mter disl~sal system. '~is approval indicates that, as of t,~ val].dat]on d; shc~ a~, ~3sed on t:[~ ~ta and information furnished ~f an engi~or registere, the State cf ~aska, ~e v~ter supply and wastewater disposal system ].s safe and tional for the nm~r of ~c~f~ ~d t~ of s~'uct~e indicated. ( DHEP SEtJ~) 7. Mail the HAA to the fo].l~wing address: KB2/d5/s [Page 2 of 2] ae MUNICIPALITY OF ANC}~DRAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WE]',r. DATA Legal Description: Well Classification _~l%//~.~ Well Lcg P~esent (Y/N) .~/~/$ Date Completed TOtal Depth /O/ ' Cased to- Zo~ / Static Water Level ,., ~f f Pump Set At Casing Height Abov~ Grcund Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cle anout/Manhole Water Sample Collected By Water Sample Test Results If A, B, c~ C, D.E.C. Approved(Y/N) / /~ Yield Depth of G~outing ° Sanitary Seal on Casing (.Y/N) \~ Depression A~ound Wellhead (_~/N)~/ ; On Adjoining Lots ~ OlD · }-~C~ ; On Adjoining Lots TO Nearest Public Sewer To Nearest Sewer Service Lira on LOt Comfents Be SEPTIC/HOLDING TANK DATA Date Installed I0{~1~$_ SiT~ I~.~O No. of C~artments '~d~O Standpipes (.Y/N) ~/ Ai~-tight Caps (Y__/N) y Foundation Cleanout !~/N). Y Depression over Tank !Y/N) ~ Date Last P[lmped ,~ Pumping/Maintenance Contract on File (I/N) ; for Holding Tank High-Wate~ AlanTa (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-SupplyWall II,~ To P~operty Line I0 To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, o~ Major D~ainage Counts C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed IO~~ Width of Field ~O ,,~ Square Feet of Absorption A~ea ~ Standpipes P~esent .(.Y/N) Depression over Field (Y/N) ~ Date .of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //~ To P~operty Line ~ O Type of System Design Length of Field Depth of Field Gravel Bed Thickness To Building Foundation ~ d) To Existing or Abandoned System cn Lo~. ; On Adjoining Lots ~ ~ ~' To Water Main/Service Line To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Course To D~iveway, Pa~kirg A~ea, or Vehicle Sto~age A~ea ~ O C~ents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Ala~m~ Level at Tested fo= Electrical' Codes (Y/N) DiFensions Manhole/Access (Y/N) "Pump Off" Level at Vent ( .Y/N ) Pumping Cycles du~ing Adequacy Test. Meets MOA CoF~nts ** Check Permitted Bed~ocm Rating Against HAA Request I certify that I hax~ checked, verified, oF oonfor~ed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~ .Date ~/X~/~ Company~ ~~~MOA No. ~'~ ~-O,~ KB1/d5/s [Page 2 of 2] 2-15-84