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HomeMy WebLinkAboutBOREALIS LT 1Borealis Lot 1 #015-203-13 Municipality of Anchorage ••=� -y ` Development Services Department Building Safety Division s On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page ( of 7_ www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5 w o 3 0 44 o 'L- PID Number: di S -• 7 0 3—( 3 • Name: nt k Wastewater System: [:]New �ZJ Upgrade L 1�cn t Address: w I 9Do vu VL ABSORPTION FIELD Phone: Number of Bedrooms: 3 L413 'dl 7 Z (�'oeep Trench sl,aeow Trench 0 Bed O Mound ❑Other. LEGAL DESCRIPTION Sod Rating: (9tH S Total Depth from original grade: / 4 3 WWF? Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade 2- Gravel depth beneath pipe: ' 2' 1701 t o I L Fl. Ft. Township: Range: Section: Fill added above original grade: � Gravel Length: 1�/ T � Fl. Fl. Well: El New El Upgrade Gravel width: '2,0 Number of lines: Distance between lines: �-- Ft. Ft. Classification (Private. A. B. C): Total Depth: sed to: Total absorption area: r� I Pipe Matelot: 'J 3 Ft. FL / Ft' fp Driller. ate Drilled: Static Water Level: Installer. // S(hrrr `�TfrlctS Date Installed: ��_ �/-- Ft. - Yield: Pump Set at: Casing Height Above Ground: TANK GPM Fl. FL SEPARATION DISTANCES ❑ Septic ❑ Holding .T.E.P. ❑ Other: To Septic Absorption9(_7 Holding ublic/Private Manufacturer: �t pasty. Sb0 From Tank Field Tank Sewer Line n ;�`tw Gal. Well /0014 Matenal: ' I Number of Compartments: Surface Water /*0 ( Ov t� LIFT STATION Lot Line std Z0 t f- -.o (( ze:an (5 0 p er. rt Foundation /(� L 'Pump on' level at: ����/• lump optr level at: 1 �, / High water alarm at: y�, t7 Curtain cumin orcinV / K/� Pump Make d Model S �WULrdl Electrical Inspections performed by- y I F—(, Remarks: BENCH MARK Location and Description: AssumedElevation: Ft. � 1 S 9 1 0._ 49TH ;* ........� ,/ Hit Dates: 1St'! / U3 Inspections performed by: r�Iacf/%��(n �ts�� .. .... . . . .. ..... ( �/ G.dfl ' I �-0 MICHAEL N. ANDERSON :0 Z ��Id Development Services Department A roU" tr��l , CE 94 9 •:\v► P P PP f.0/v%33.• �.. Reviewed and approved by: . Date: Permit No. SWO30402 Page 2 of V Date: 9/18/03 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 1, BOREALIS SUBDIVISION SyFD NOTE: THIS LOT SERVED COMMUNITY WATER. 1,500 GALLON STEEL STEP TANK OLD SEEPAGE PIT -- FILLED-IN \ — I I L PID No.: 015-203-13 I LINE I I WAY ---- C 01, AC01 EXISTING HOUSE i i i I / C01 O TC01 I Tt`02 H � I 1.25"0 PVC PIPE L-- IAT �'-----\--J MARK A B GRND ELEV. PIPE ELEV. col 29.2 25.1 102.8 99.4 CO2 46.7 21.7 102.0 98.48 TC01 50.9 20.3 102.8 TOC2 57.3 19.2 102.7 MH 60.1 19.3 102.8 \ MT 174.8 119.3 1103.761 1 I � I I TH# 1 I % I ASBUILT / PROPERTY LINE— SCALE: 1"=20' COI CO2 TCO1 TCO2 L •, �tit.�at�``� 3� K. TI .� Q Tv3�3 ry tIANHOLEIV�305 •. At,, T 1 1/4' PVC 76 a-. �� . • . • • .mum 9111FIPIlt S ',, 'tp. • • . �� + OR h.• ,-� r SM/IAL 00 1.300 • • •• • • • •. .060. 0 LIFT STATION 00. 9 • MICHAEL N. ANDERSON : 4 ML SEPTIC SECTION l N.T.S. -„l.a 1 �PR; ESSl0ZO EPS ELECTRIC INC 90: 4-72 4690 10/14,;03 10116am P. 002 .RJ.ghtFax 10/14/2003 5:05 PACE 1/1 RightFax v Inspection Report Municipality of Anchorage, Building Safety Divibi6n 4700 South Bragaw INSPECTION! VOICE 343-8300 INSPECTION! FAX (907)249-7777 INFO: 343-7982 Name EDS ELECTRIC Permit 03-9474 Addresm 11900 OUR RD Phone 272-455??? Legal LT 1 Inspection Date 1011412003, AM Subdlvlaion BOREALIS Comments or Directions AM,***LIFT' STATION*** CALL TO MEET???? Inspection Final Electrical Reinspection N \� NO NONCOMPLIANCE OBSERVED ❑ CORRECTIONS ESSENTIALAS EXPLAINED BELOW ❑ WILL RE-EXAMINE AT NEXT ❑ DO NOT CONCEAL UNTIL REINSPECTION INSPECTION COMMENTS: (for Inspector use only) I . i I j i I I i i i f I I Inspector Date r�> Uv MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW030402 Legal Description: bj0REALIS"LT; Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: Michael Dennis Owner Address: 11900 OUR RD ANCHORAGE, AK 99516-2324 Date Issued: Sep 29, 2003 Expiration Date: Sep 28, 2004 Parcel ID: 015-203-13 Site Address: 011900 OUR RD Lot Size: 17350 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: L Date: Z Date: <7Lz / ©� Municipality of Anchorage o Development Services Department Building Safety Division On -Site Water and Wastewater Program 4 5 A I C .. n 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 - - ON SITE SEWER/WELL-PERAAIT APLI Ch7l-C-" - FOR A SINGLE FAMILY DWELLING Parcel I.D. D S Permit Number SW 6204 04 Property owner(s) 1�`lr- p 'P n S Day phone 3 y s- 2 �1— Mailing address (1 Mailing address (2 lc( 00 0 I Zip Code qsS/G t Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) k _1'3S10 Lot Size Number of Bedrooms Acre S .F THIS APPLICATION IS FOR: ❑ Sewer Only S Well Only Sewer and Well Water Storage EJ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi El Swimming Pool ❑ Water Softening Unit El Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. FIA (Signature of property owner or authorized agent) Permit Fees: �f C�-fl Waiver Fees: Date of Payment:C/ Z S Date of Payment: Receipt Number: �%21 �_ Receipt Number: (Rev. 12/00) Michael N. Anderson, P.E. Civil/Structural Engineering and Excavation 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 September 18, 2003 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 1 Borealis S/D To Whom It May Concern: This is a request for a new septic system upgrade due to the failure of the existing system. The old crib has failed to pass an adequacy test and there needs to be replaced. As the plan shows this subdivision is served by a community well, however the neighbor to the south is not but this is not a concern for this upgrade. The perc was 40 minutes per inch and the test hole log showed a mixed layering of sandy silt SM and silt gravel ML. No water was observed during the design phase. A lift station will be necessary to allow full use of the better soils above 5 feet. The new system design consists of a deep trench with 9 feet of rock starting at elevation -2 feet. The lot slopes gently to the west at about 2 to 5 percent. The lot is bordered by two streets therefore this new system will not encroach any neighboring lots for future development along the east. The existing tank will be demolished and the new tank installed in its place, see the plan. If you have any question please call me at 345-3377 Sincere /J Michael N. AnVn, P.E. MOUND OVER DESIGN CRITERIA: (TH1) GRADE 4 BDRM X 150 = 600 GPD SOILS =• 600/0.45 = 1333 SQ FT REQ'D - ° G FILTER FABRIC 1333/18 = 74.0' DEEP TRENCH SYSTEM SM/ML —2.0 , INSULATION 11.0' DEEP FREQUIRED 9.0'X EFFECTIVE 4"0 PIPE 2.0' WIDE —12.0 SEWER ROCK 74.0,LONG 1 ML —17.5 —11.0 TRENCH SECTION 2'01 N.T.S. I 0 a — O M E G A C I R C L E— 0 0 I EXISTING HOUSE — A LP H A C I R C L E— NEW SEPTIC SYSTEM t ' EXISTING ADJACENT SEPTIC _ <__ i i t I I —TALU St�DR IVE —� EXISTING ADJACENT —� 100' WELL RADIUS Septic Design Prepared For MIKE AND JOYCE DENNIS OF ��jP ,`p'��'••••"4�.'Q LOT 1 BOREALIS SUBDIVISION .... .��T'. ..:...� Prepared By MICHAEL N. ANDERSON, P.E. ��� .� ... ...... 7d I MICHAEL N. ANDERSON 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 i�•. C .9 9 SCALE: 1"=200' SEPTEMBER 18, 2003 TO BE - A L P H A C I R C L E- N4T; SUBJECT LOT IS SURVED BY COMMUNITY WATER. K 'CV) ()-rr T I REPLACE XISTING SEPTIC I TANK ITH NEW 1,500 w GALLON TANK /a ��ti� o= g.0 Z c~i> C.O. x I \-5% i o o --_ w TING CRIB --t- - - - -- ----p- --- ��---� 3ANDONED TH#1 MT � 74.0 � I -5% \2 EXISTING SEPTIC �I ------------ 100' EXISTING WELL RADIUS I 0 a 0 m Septic Design Prepared For MIKE AND JOYCE DENNIS ��• 0F `:t•q0-0 S�+ LOT 1,. y •• � •-.9 t� BOREALIS SUBDIVISION �k"49TN Prepared By �' " • • • • • 1 MICHAEL N. ANDERSON, P.E. •W.- ... ... v0 • MICHAEL N. ANDERSON 4640 SHOSHONI DRIVE ��•C 79"'69 (907) 345-3377 /FAX (907) 345-1391 tj!o� SCALE: 1"=30' SEPTEMBER 18, 2003 1PR` ESS IZ \ = Municipality of Anchorage . K DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "U' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST f. t vm.. .. .... 1 -. MICHAEL N. ANDERSON . C PERFORMED FOR: / ��� �JC n DATE PER FORME F - - 2•�/'%� LEGAL DESCRIPTION: G—U F' l �UY r'QI IS n Township, Range, Section: SLOPE SITE PLAN DEPTH 1 (FEET) CLIC, ante ej rya/!, 1 2 4 6 � lAr 8 LOfeve, 9- 1011 10- 11 12 WAS GROUND WATER /O ENCOUNTERED? 7�( IF YES, AT WHAT DEPTH? Depth to Water After -- 13 Monitoring? � Date: % Z 120n�+n ' 14 N/ A( /» c� 15 r0`h 1,1 r -",go, d+ 14(,C- 19 me� ZIA PERCOLATION RATE %0 (minutes/inch) PERC HOLE DIAMETER j TEST RUN BETWEEN S FT AND FT COMMENTS �I U Y A/ ?'`� "rj or PERFORMED BY: (? ��aT-f- f �f s ✓t — 1 MI ZA0 c' f/!r �L'l�+l+'t CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: z /o /U 72-008 (Rev. 4/85) GREE' _ `R ANCHORAGE AREA BOPGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME � � r�L9 • MAILING ADDRESS?O• 80A ?-ff33 I97S08' PHONE 313 - ?26 7 LOCATION 141-RALEGAL DESCRIPTION 4OT / 80)tM Li .S0Vb . SEPTIC TANK: DISTANCE / NUMBER OF COMPARTMENTS NTSFROM WELL068,eMANUFACTURERI - ! 1L SCe MATERIAL L-L� iM//1� INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 4250 GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH �LENGTH , �• �, DEPTH _ %Q &?e*r e a, 3't i nqs LINING MATERIAL JAW CRIB SIZE: DIAMETER--t-DEPTH ~% DISTANCE FROM: WELL / I TOTAL EFFECTIVE Cy BUILDING FOUNDATION as t NEAREST LOT LINE -P0 ABSORPTION AREA (WALL AREA) O SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE Cfl'i'l'LY�71.L1�?C /�� CONSTRUCTION_ DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE -,TANK -,SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED _ REMARKS DISTANCES: CIS- DIAGRAM DIAGRAM OF SYSTEM INSTALLED BY: &AYTOK) f 211 20 r PIPE MATERIAL: J 3l LOT SLOPE:jry� 1� REMARKS: atto-1- p Lis DATE Form No. EQ -031 APPROVED G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT AME OF APPLICANT -_ 1� r'//MAILING ADDRESS X- a 0 3� � PHONE �-2 iSTALLATION LOCATION / �-� EGAL DESCRIPTION `�- U7- l l 3 iSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER CPE AND SIZE OF FACILITY TO BE SERVED r! / AJ NANCED THROUGH TO BE INSTALLED BY )IL TEST RESULTS / / �`�U NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST )MPLETION DATE ANTICIPATED Sum 7`'� -1 NAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE PARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. :PTIC TANK SIZE /2S TYPE INIMUM DISTANCES, REQUIREMENTS )UNDATION TO SEPTIC TANK �/ o; v fUNDATiON TO SEEPAGE PIT PTIC TANK TO SEEPAGE PIT WALL o 5/ PTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. LL TO SEPTIC TANK 1 _F/ SEEPAGE AREA SIZE ef�NC-✓Ltd .C.Gl.�if�' DRAIN FIELD / 0 / o 'PC , DRAIN FIELD �0 SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. r / ITER MAIN TO SEPTIC TANK C SEEPAGE PIT / DRAIN FIELD 0/ PTIC TANK, SEEPAGE PIT ( DRAIN FIELD TO RIVER, LAKE, STREAM. ST IRON INTO AND OUT OF SEPTIC TANK AND INTO.CRIB CROSSING GAP OF :AVATION 3 FEET INTO UNDISTURBED SOIL. NCH DIAMETER CAST IRON 'SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT TED WITH AIRTIGHT REMOVABLE CAPS. GAVEL BACKFILL NFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM RTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCH031lCC ,2RCA uORCjuGF+ ORDINANCE NO. 28.68 AND THAT THE ABOVE CRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. E APPLICANT'S SIGNATtIRF \ y/ )" IMI'i C" GRLAI I.R ANCHORAGL AM A BOROUGH DEPARTMENT OF ENV IRONMFNI'AI_ QUAI.ITY 3330 "C" Street: ANCHORAGE, ALASKA 99503 Case JI Performed For _ I3orealis_Inc,Dated Performed 8-29-74 Legal Description: Lo 1 B1ock_Subdivision Borealis Sub. This Form Reports Soils Loy _ Percolation Test,- - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet_ Soil Characteristics I Organics surface Roots, bark etc. 2— Yellowish brown fine silty sand (SM) residual soil 3— Course to fine sand SP 4— light gray random pebble and 5— gravel size material low 6— moisture content. 7— - - two L_I II-- fine sand to silty sand 9— (SPASM) light gray, low moisture, 10— Increase in silt fraction with depth. 12— Random gravels 13- 14— Tight sandy silt (ML buff colored Pit depth 14. 5 ft. Was Ground Water Encountered? No If Yes, At What Depth? Reading''—Date ! Gross Time Net Time Depi:h to H2O ` Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit _ Drain Field _ Depth of Inlet Depth to Bottom —of Pit or Trencji COMMENTS:.-- We would recommend using -an, average 180 sq. fuer bedr000m considering the --- -.-- soils column and increase in silt with depth. Test Performed (3 Yyl,d-Greer D a t e Certified BY Date: 72-010 (Rev. 3/7$') THIS SIDE, F -OR OffICIAL USE ONLY - BATE RECEIVED :INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE �INSP15CTOR INSPECTOR INSPECTOR DIRECTIONS: { 1 TYPE OF RESIDENCE NUMBER of BEDROOMS ❑ - SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑" FOUR ❑ SIX 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL. DEPTH OF WELL ❑ COMMUNITY- DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG -RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER INDIVIDUAL/ON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER ❑Septic Tank or L`1 Holding Tank Size:__ if Tank is homemade SOILS RATING give dimensions; TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL - 4: DISTANCES' Septic/Holding Tank Absorption Areq Sewer Line NearestLot-_ ine WELL TO: Absorption Area to nearest Lot Line 6 COMMENTS . I-- APPROVED FOR BEDROOMS O CONDITIONAL APPROVAL (letter -must acc ny certificate) . ~1 DISAPPROVED DATE (� BY (Title) U C� -LEGAL DESCRIPTION 72-010 (Rev. 3/7$') Municipality of • Anchorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION April 25, 1980 Millard/Ruth Owens 637 Wimbledon Road Walnut Creek, California 94598 Subject: Lot 1 Borealis Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (1) The septic tank pumped with a receipt submitted to this office. (2) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. (3) Your application shows the number of bedrooms exceeds the number the sewer system was originally designed for. The system was only designed for a four(4) bedroom single family residence and the request is for five(5). An upgrade of the on-site sewer system will be required. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: United Bank Alaska Mortgage Loan Department 645 G Street 99501 Jim Boudreaux % Dynamic Realty, Inc. ���� REU[� ENVIRONMENTAL ENGINEERINGonu~� �� SRA BOX 1584R Amo*OnAos. ALASKA 99507 (907) 344-1205 276-1361 MAY 13 1988 DYNAMIC REALTY 581 W N0�TN�RN LICHTS BLVD ANCHG�4C[ AK 99503 SELLER S�ME SU��I�ISIOH-BDREALIS BLOCK -ALPHA LOT -1 T�E TYPE QF ABSOR�TIQ� SYSTEM IS A PIT NITH A� A�EA OF 728 SQFT^ THE Q8ANTITY OF NATER ABSO�B�0 QURIN� TH� TEST WAS 682 CALLQNS. THE SOILS RATINC OF THE SYSTEM AT CONSTRdC�IOK HAS 180 AND N8N IS 181 SQv/ BOOh^ THE RE�UI0ED AREA FOR A � BEDROOM HOUSE IS 724 SQFT^ THIS HOME ~'- HAS 728 SQrT^ -- �——� -- ---- - - - u*��o ��U� )M1�6T DATA THE SYSTEM IG ACC�PTABLE FOR A 4 BEDR��� HQME, THE SEPTIC TAN< NAS PUMP�D ON MAY 12 1980 ^ MUNICIPALITY OpANCHORAGE DEPT. OF ENY|RDmwiEoi%,�-..^/u3vOw HAY 13 1980 RECEIVED GSR *9CN0AAGL AA'£A GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received 1Z -A- A y� Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Phone: 2. Property Owner: Phone: Mailing Address: 3r�f D 3. Legal Description: 4. Location: (X,+ 3 5. Type of facility to be inspected No. of bedrooms 6. Well Data: A. Type B. Depth C. ConstructionD. Bacterial Analysis 7. Sewage Disposal System: /� f� A. Installed �Z B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 -of -two' pages - Rei t for Approval of Individual S r & Water Facilities Legal Description Comments Approved Disapproved Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) GREATER ANCHORAGE AREA BOROUGH /1 �-3- Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: VA_ FHA CONV 14 ..fy1- Mailing Address: P& Bo(eq- 83S Day Phone 333 9?(37cr� 3. Name of Buyer :a�-0- Mailing Address : 30f (21a,rr,4. Wuv Day Phone 333`1267 4. Name of LendingInstitution: 1 JJ COr,S � ! o;�T�zt!a e— Mailing Address: Phone 5. Name of Realtor or Agent: Mailing Address: Phone 6 . Legal Description: /" /- / _S0nfot 1,S S4,,d , Location: eoy me y- 7. 7. Type of Facility to be inspected: 4S,dea- e No. Bdrms . 8. Water Supply m Type of Supply: Public Utility �Individual If Individual, number of dwellings presently served -5 If Individual, depth of well %ZS '0' 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation —T 1q.-74 EQ -037 (1/74) \ Municipality of Anchorage Cl A ! • —• Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street r/ P.O. Box 196650 Anchorage, AK 99519519 650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015 -203-13 COSA# 02026 1. GENERAL INFORMATION Expiration Date: Q, — / 0 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BOREALIS SUBDIVISION: LOT 1 11900 OUR ROAD "ANCHORAGE. AK 99516 ALFRED BOHN Day phone 868-1285 11900 OUR ROAD *ANCHORAGE, AK 99516 Day phone MERILYN MOORE Day phone 244-2844 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System N TYPE OF WASTEWATER DISPOSAL: Individual On-site E Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 a ANCHORAGE, AK 99507 r Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date -$I0ri Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and 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 R confor any legal right whatsoever. S. DSD SIGNATURE Approved for _J�' bedrooms. Disapproved. . � 4 v� .1-11 . .................. J f y rness: CE r7953 on+, ' •�� //..Inn . .�►a Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory y Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rw INS) o Profas i ° , oo�� OFAiyr�/%.�. a=�ON SITE ••'��,= WATER AND :1^= WASTEWATER PROGRAM Original Certificate Date: �2_— / 0 - 0 9 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: BOREALIS SUBDIVISION; LOT 1 Parcel ID: O 15'-2 0 3 - /3 A. WELL DATA Well type COMMUNITY Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform COMMUNITY WELL If A. B, or C provide PWSID# 211708 Well Log (Y/N) - Sanitary seal (Y/N)_ Wires properly protected (Y/N� Cased to ft. Casing height (ab round) in. FROM WELL LOG AT colonies/100 ml. ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate mg./L. ft. Other bacteria colonies/100 ml. Date of sample: Collected by: Tank Type/Material S.T.E.P./STEEL Date installed 10/11/2003 Tank size 1500 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) YES Date of pumping 2/4/2009 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA -BELOW EXISTING GwwE o M1 Date installed _ 10/11/2003 Soil rating (g.p.d./ft'o t /bdr 0.45 System type DEEP TRENCH Length 74 ft. Width 2.0 ft. Gravel below pipe 9.2 ft. Total depth • 13.4 ft. EH. absorption area 1361 W Monitoring tube YES Depression over field NO Date of adequacy test - "2/5/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 22 in. Water added 720 gal. New depth 55 in. Elapsed Time: 355 min. Final fluid depth 45 in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - "HOUSE WAS VACANT. PRE-SOAKED ON 2/4/2009 WITH 1000 GALLONS. D. LIFT STATION *MEASUREMENT FROM TOP OF MANHOLE LID Date installed 10/11/2003 Size in gallons 1500 Manhole/Access (YIN) YES "Pump on" level at '64 in. "Pump oft" level at '64 in. High water alarm level at '58 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lot: Absorption field on lot On adjacent lots Public sewer main Sewer /septic service areas COMMUNITY WELL manholelcleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water' 100'+ Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PVT & 200'+ PUBLIC F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certily that 1 have determined through field inspections and review of Municipal records that the above systems are in 0 . . . . . . conformance with MOA COSA guidelines in effect on this „•„r , , • ................. date. QQ A fr Gar ess! ` Engineers Printed Name JEFFREY A. GARNESS Q CEj 7953 ` e� �o �4p4.e.....2 �4.5•'��a� Date Zln'C5 D�piZoresstio^moo COSA Fee S _Z[ n O Date of Paymenta., 9/ J Receipt Number U 4 S� (Rev. 1 1105) Waiver Fee IS Date of Payment Receipt Number Z ALPHA CIRCLE GONG. p{T. w..LL GONG. pm I I (., I• G.N.. EEI I \ LIT /iATION I I I I 1 I I I I I I I --------------------------------------� IO'VWLT GAIGNGNI 139056'35"W 124.76 o7�..OF,q..qb ap. ............................. SHANEAHOLT LSfi9U N� -u u�9w'�•IO�11 ��O i 1L1 NOT TO BE USED STRUCTURES OR FENOFINES. EASELTEA^S OF RECORD. OTHEA THAN THOSE SRO" ON THE RECORDED PLAT. ARE NOT LOCATED APPRO%tlAATELY AND ARE NOT TO BE USED TO DETERMME PROPERTY LINES T, a 0 PPS e � C � O C3 D C N N \ \ O �G N G O \ In \ O \ O \. Z AS BUILT SURVEY (NO CORNERS MT TMS DATE) SCALE I' • 2T M. IhPM1P.S..^,.7 ALASRATMS ISTN_ --� Municipality of Anchorage 00t/4._e., L Development Services Department < Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 wr A,v.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE-FAMILY DWELLING Parcel I.D. HAA # D 3 O -5, 02.. Expiration Date: f D- 3�-�- 1. GENERAL INFORMATION Complete legal description �• ( �'u".0 S SSP Location (site address or directions) (t qo o da Current Property owner(s)* Day phone 3`-r's - Z�'Z Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mafling Address Unless otherwise requested, HAA will be held by DSD for pickup - 2. NUMBER OF BEDROOMS: . -f 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well �/��( ❑ Individual On-site 9 Individual Water Stor e EJIndividual Holding tank El Community Class ell P Community On-site Sewer ❑ ❑ Public Water System ❑ Public The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer or title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of FirmL j ,-r A 04 Address 1-4(,40 Skvs.4vn ,r Engineer's Printed Name M% (e e Al ,. s.n Date ,c,/2 e � �P��• OF. q �•�S� 1 49TH ;* 1 5. DSD SIGNATURE ir,:• MICHAEL N. ANDERSON Approved for �-�' bedrooms. 1 •• CE- 469 r Disapproved. ll�>PROiE�pti�`�� Conditional approval for bedrooms, with the following stipulations: ttt�rurrrri Additional Comments X • WATERWV AND PROGRAM •: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory ;i Maintenance Agreements Supplemental Engineer's Report Other NT bk�4­ -0 111111��-0. By: W � Original Certificate Date:_ /0---70-0-3 (Rev. 01102) Municipality of Ancilorabc • Development Services Department Building Safety Division Deg On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage-ak-us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �> �- ( �yo�a�i5 1510 Parcel lD: 0t'4 -Iva -t'3 A. WELL DATA / �A . -k, 22 (1 74 Well type If A, B, or C provide PWSID # Well Log (YIN) . Date completed __ Total depth ft Date of test Static water level Well production Sanitary seal (YIN) Cased to ft FROM WELL LOG WATER SAMPLE RESULTS: Coliform -,colonies/100 ml. Nitrate Arsenic mg./l. Date of sample: _Z Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Other bacteria '-� colonies/100 ml. Collected by: / B. SEPTIC/HOLDING TANK DATA (-mc�� Date installed /����/U Tank Type/Material Tank size y gal. Number of Compartments Z— Cleanouts (YIN) Foundation cleanout (YIN)j4'1 Depression over tank (YIN) _ High water alarm (YIN) Y Date of pumping cvJ Pumper C. ABSORPTION FIELD DATA Date installed �0 // ✓ Soil rating (g.p.d./ft2 or0bdrm) �,`/S System type O rTp {r*a r4_ Length !`f ! ft, . WidthLLii Z, (9 ft. Gravel below pipe sir Z ft. Total depth It, t ft. Eff. absorption area � �(ft2 Monitoring tube __Y_ Depression over field /- _ Date of adequacy test / Results (Pass/Fail) ��_ For -�(— bedrooms Fluid depth in absorption field before test _ _,---in. Water added-zgal. New depth_ in. Elapsed Time: _Z min. Final fluid depth ,-'_ in. Absorption rate >= g.p-d• Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date �_ D. LIFT STATION ;;Date installed �� /� U?7 Size in allons / Soo g Manhole/Access (Y/N) "Pump on" level at qS• Sjtd "Pump off' level at `l(r,( High water alarm level at s. D Datum t� �_ Cycles tested __ ? Meets alarm &circuit requirements? _ y E. SEPARATION DISTANCES SEPARATION DISTANCES-J�IRMA WELL ON LOT TO: Septic tank/lift station on lot foo Absorption field on lot /an (4 - Public sewer main t" Sewer /septic service line loo 4 On adjacent lots /VV (/- Date /- On adjacent lots 4100 14 Public sewer manhole/cleanout _ Ai Holding tank A, - SEPARATION DISTANCES FROM SEPTIC/ANG TANK ON LOT TO: Building foundation r9 14 - Water main *r Wells on adjacent lots ?.moo Q Property line So '4- Absorption field /c Water service line Zo r4 Surface water 41 o v t4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 'Zu Building foundation 410 I(— Water main41eq0 /-J Water Service line 50 (� Surface water 14 Driveway, parking/vehicle storage 20 r Curtain drain N� Wells on adjacent lots 7se l�- F. COMMENTS G. ENGINEER'S CERTIFICATION y ,`pt.•• .-4j,l) I certify that l have determined through held inspections and * : ,4 9 T H review of Municipal records that the above systems are in /• • •• •01........ conformance with MOA HAA guidelines in effect on this date. �. - • i 7� MICHAEL N. ANDERSON Engineer's Printed Name _ 1141T� a e i /� ,, �rsart P,� . f,� 1 '. CE 9469 '4-60 Date /v�2 3 t+l l'�Fo /0�%3�•���4\�"' i� pROFES SIOtk��- HAA Fee S_ 3� S, ue Waiver Fee $ Date of Payment "o Az 30 3 i' Receipt Number U Li 3 Ct (Rev. 12/01) Date of Payment Receipt Number ALPHA CIRCLE S B9°5B'35"E 104.74' 1:E s a i 0. L/FT STAT/ON ]ALL CONC. RET. I L, CANT. 1 I I � G`�aP�v F I � I O II I \ I \ st4 I L I 9�- I ❑ ---------' CONC. RET. WALL N 10 It O 9 El Z s 1:E s a i 0. L/FT STAT/ON ]ALL CONC. RET. I L, CANT. 1 G`�aP�v F �v� Cc 0 I I I I --------------------------------------J !O' UTILITY EASEMENT N 69°5&35"W 124.76' OF At c 0. 49 TH ................................ ): SHANE A. HOLT p LS -6914 �a o 'of %, d s s °� a c O D b L D y O O O N t in O in O 0 O N AS -BUILT SURVEY (NO CORNERS SET THIS DATE) SCALE: I"= 20' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, BOREALIS SUB. *lion ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN WITHIN THE PROPERTY LINES AS NOTED AND NO VISIBL EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL ENCROACHMENTS EXIST EXCEPT AS NOTED. STRUCTURES OR FENCELINES. D) DATED AT ANCHORAGE, ALASKA THIS _15TH_ EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON.(UNLESS INDICATE DAY L _OCTOBER 2003 NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES HOLT LAND SURVEYING 9144, FB108.16,34 TEL. 345.5513 OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.