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HomeMy WebLinkAboutBOREALIS #1 LT 20Borealis Lot ZO #015- 203-14  Municipality of Anchorage "::~ Development Services Department ~'~ Building Safety Division '~ ~' On-Site Water and Wast°water Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page I of www.cLanchorage.ak.us (907) 343-7g04 ON-SITE WASTEWATER DISPOSAL SYSTEM AND]OR WELL INSPECTION REPORT Permit Number: .~U 0.30c~0~ PIDNumber: ~t5'-~,,3 -t~ N,mo ~./.to,~ ~On ~.~(ez WastewaterSystem: [] New [] Upgrade He St o~,e~,~. ~./ A~c6. /F~ 99~-14' ABSORPTION FIELD S~ ~6~: Tot~ Dep~ ft~ origi~l grMe: LEGAL DESCRIPTION O. ~ BI~ Lot Su~ids~ ~p~ ~ ~ ~ ~ ~g~ ~e: Well: ~ New ~ Upgrade *'~ ~'~ Class4fl~ (Private, ~ 8. C); T~ Oepffi; Cal~ to: To~ ~ area: P~pe Matefi~; · ,.,~ P~. s.~,~: c,.~ ~.~ ~ *~ TAN.. GPM F. FL SEPARATION DISTANCES D septic D Holding ~ S.T.E.P. D Othec  M~e~ Capa~t~ To Septic AbsoCtion Lift Holding PuN~Pdvate Tank Field Sta~on Tank Sewer Line ~ ~ ~O~E s~.~w,,,~, ~t~, >~, _ ~/ ~.: ~,,~.,.LIFTSTATION "'~'~r,~t~f r~+, & ~ ~n~ [~~: BENCH MARK Engineer's Stamp Inspections pedormed by: ~~ ~e~. ~uC. Dates: 1" 3/7/~] 2"~ ~ / 7/o3 Dovelopmer :Se~ices Depa~ment Approval Reviewed and approved by: r ¢ ~ Date: .hX Ior ::: "'' ' PERMIT NO: SW030009 PID NO: 015-203-14 SWING TIES: FROM: COR."A" COR."B" COR."C" TO: S.T.C.O. "D" 64.5' 11' STEP M.H. "E" 72.5, 20.5' TR, M.T. "F" 25.5' 39' TR. M.T. "G" 47' 30' TR. M,T. "H" 12.5' 30' TR. M.T. "1" 42' 21' "D" DIA. HDPE 1.25" DIA. SCHED. 40 PVC W. 5/32" HOLES (~ 30" O.C. 49.5' LONG -- TRENCH --~ LOT 20 DRIVE #1 PLAN VIEW SCALE: 1" -- 30' OMEGA CIRCLE GROUND ELEV. 95.1' INV. RIGID IN= INV. 97.5' 98.2' 1500-GALLON STEP TANI CROSS-SECTION NOT TO SCALE ELEV. INV. 92.4' 89.6' T.H. #1 BOT. ELEV. WATER ~ 86.9' 8/7/00 ELEV. 93.2' LOT 20, BOREALIS S/D #1 SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT FLATTOP TECt~IC^[. SERVICES SCALE: AS NOTED 14530 ECHO STREET DRAWN BY TFM ANCIIORAGE, ALASKA 99516 MARCH, 2003 · 01/01/1999 85:44 3491934 WATKIH~, ENGR ~ ',~ '_ _ '~:. ~ t ~. '.: '~r.~ . ...... '~l ~ PAGE Znmpic~oa Report /4 unlclpitlty of Anchorlgm, iulldMg lenity Divlilcm 4700 Iouth Iriglw INIIqClION: V~ZC! 341.LII)0 XNIPECT:C~: .F&X (.~..7)Z4~-7777 Oommm~ ,r I~rectlo~e EO'~ ELECTR3C 4931 OMEGA LT Z0 FOR S~?E MEETe"'*LIFT STATZON INTO: I~.rml! 03-7427 Phone 272-4S9~. lmpetflO. ~ 3/1212003 I~etr~ Electrical ~ INSPE~ON r'l Do NOT CONCEAL UNTIL REIN.qP~cI'ION ~P MUNICIPALITY OF ANCHORAGE Development Serv/ces Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (gO7) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jan 22, 2003 Expiration Date: Jan 22, 2004 Permit Number: SW030009 [~al D~'~-c~ilSti~i~!'iBOREALIS #! LT~20 ii? Design Engineer: 0019 Flattop Technical Services Owner Name: Stephen & Mary Gonzalez Owner Address: 4931 OMEGA CIRCLE ANCHORAGE, AK 99516-2251 Parcel ID: 015-203-14 Site Address: 004931 OMEGA CIR Lot Size: 17395 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field r~ Septic Tank [] Holding Tank ~ Privy Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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: Date:~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number SWO)O00 ~ Property owner(s> ~'31 ~,,¢~,¢t Mailing address (1) ~1~'1 Mailing address (2) Legal description (Lot, Block & Sub'd.)l~.-o~ Legal description (Section, Township & Range) Lot Size / 7 .~ ~) ~ Acre~ Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Zip Code [] Well Only [] [~ Water Storage [] [] Jacuzzi [] [] Water Softening Unit C~' I certify that the above information is correct. I further cedify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of pi~operty owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: TIIEODORE F. MOORE, P.E. PH: (907} 345-1355 . ........... ,OP TECHNICA.LSERVIC q :.. C~ & EN~ON~NT~ ENG~EER~G * ENERGY CONSERVA~ON 14530 ECHO ST, ~CHORAGE, ~KA 99516 Au~st 7, 2000 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 20 of Borealis S/D, located at 4931 Omega Circle. The existing soil absorption trench is no longer able to accept water at an adequate rate for issuance ora HAA certificate. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 2' and 7' below ground level is a silty sandy gravel with a measured perc rate of 9 minutes per inch. Using a slightly conservative soil application rate of 0.6 gpd/sq, ft./day, this 4-bedroom residence requires a total absorption area of(4 x 150)/0.6 = 1000 square feet. The proposed design consisting of 2 parallel 50-foot long trenches with 5 feet of gravel has a total absorption area of 1000 square feet. The topography of the lot in the area of proposed construction is generally level. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any qued!ions on this submittal. Sincerely, Ted Moore, P.E. ~;~...' ~ -...~?~-~ ~ ~. TH~ODO~ F. MOORE ~ ~: ........................................ ~.~ ........ , , LOT 4, BLK. 8 O ~]STINO -- ~ :' : SKY R~CH SEPTIC ~ O~LO. AR~ SE~ ~ANK ~ , o ~ 2 PA~LLEL ~ 5~FOOT LONG ~~ T.H~ ~[~4-BD~ ~ ) : o ~ '~;~ ~,~HOUS'~ ~ ilN SOILABS. TR. ~ ::~ ~ ~ ~~~ , ~ ~ ~ W. 5.3' G~VEL ~[~ :~[~ ~ ~ ~%~ T.H. ' SEPTIC ~~ D~iV~ , .1 ~X 1.2S"Di~ AR~ ......-- ~ ~SCHED. 40 PVC LOT ~9 LOT 20 DIST. PIPE ~ 2'  W. 5/3Z' HOLES o SPACED 30" I OMEGA CIRCLE I ' LOT 11 LOT 12 I i o SEPTIC AR~ SEPTIC AR~ LOT 20, BOR~LIS SlD SEPTIC SYSTEM UPG~DE SffE P~N ~O~ ~C]-~C~ S[[~CES 1 INCH = 50 FEET ~4530 ECHO S~[T D~WN BY TFM ~CHO~O~, ~ ~5 t 6 AUGUST, 2000 NOTE: THIS IS NOTA SURVEYED P~T. ALL LOCATIONS SHOWN ARE APPROXIMATE. 1.25"DIAMETER SCHED. 40PVC FROM 1500 GAL. STEP TANK ~.~ ,, CONSTRUCT (2) 50'-LONG x ?'-DEEP SOIL ABS. TRENCHES '~1 "A WITH 5.0' SEWER GRAVEL BELOW DISTRIBUTION PIPES /// / 1.25" DIA. SCHED 40 PVC / o /~ / ~ w. 5,3~'.OLES~ 30"CTRS. \ ,-/~ / 5O PLAN VIEW SCALE: 1" = 10' / MONITOR TUBE 2' SOIL COVER ~ ~'~ ~----ORIGINAL GROUND ~. ,,., I .', ',Ix ~- 2- RIGID INSULATION "i[' ~-- 1.25" PVC D,ST. PIPE . ·, ~ ' '" ~-- 1/2" - 2 1/2" GRAVEL ~ BOTTOM OF EXCAVATION CROSS-SECTION "A - A" SCALE: 1" = 5' LOT 20, BOREALIS S/D SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATTOP TECHI',IICAL SERVICES I SCALE: AS SHOWN 14530 ECHO STREET I DRAWN BY: TFM ANC!IORAGE, AK, 99516 AUGUST, 2000 q~fattop q~ec~nica£ Services 14530 ~c~o Street, jtnc~orage, iii( 995/6 ~one (907) 345-1355 Lot 20, Borealis S/D 4931 Omega Circle Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope ofthe project consists ofabandoning an existing 1250-gallon septic tank and installation ora new 1500-gallon STEP tank which discharges effluent into two (2) parallel 50-foot long soil absorption trenches containing a total of 5.3' of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement oftopsoil and reseeding all areas disturbed by the construction. 2.0 STEP Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1500-gallon gallon, 2 compartment STEP tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 Ail pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot. A cleanout shall be installed within 5 feet of the building foundation. $.0 Lift station: 3.1 The lift station shall be installed in the second compartment of the STEP tank which has an additional 250 gallon capacity. The lift station package shall be an "Orenco" system as supplied by Anchorage Tank. 3.2 The contractor shall be responsible to obtain the necessary Municipal electric permit and inspection, and shall provide a copy of the electrical inspector's report to the engineer overseeing the construction of the wastewater disposal system. 3.3 The lift station shall be equipped with a watertight, insulated manhole riser and cover extending a minimum of 6" above final grade with positive surface drainage away from the manhole. The contractor shall be responsible for determining the necessary length of the manhole riser. 3.4 The on, off, and alarm floats shall be set at the elevations specified by the lift station supplier, and their proper operations shall be verified by the contractor. 3.5 The discharge line from the lift station to the soil absorption system shall be 1.25" dia. Sched 40 PVC. Ail pipe connections in the distribution system shall be glued, and the ends ofall pipes capped. 4.0 Soil absorption system: 4.1 The soil absorption system shall be constructed by excavating two (2) parallel 50-foot long trenches to a depth of 7 feet below original ground level. The undisturbed soil between the two trenches shall have a minimum width of 10 feet. 4.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. Sand for leveling or serving as filter material shall comply with Municipal specifications. 4.3 A total of 5.3 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 5.0 feet above the bottom ofthe sewer gravel The perforated distribution pipes shall consist of 1.25" diameter Schedule 40 PVC with 5/32" diameter holes drilled in the bottom at a spacing of 2.5 feet. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 4.4 Monitor tubes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 4.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches ofrigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 4.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 4.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 5.0 Inspections: 5. I A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location ofthe system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection alter it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. ITESTHOLE# ] LEGAL DESCRIFq'ION: Lot 20, Borealis SId DATE PERFORMED: 7/31100 PERFORMED FOR: ~a[es DEFq'H (feet) FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST SLOPE Pt. SM Reddish sandy loam GM Silty sandy gravel Dry, loose ML/GM Gray, gravelly sandy silt Dense, moist in pockets of sand Becomes sandier with depth Depth to Groundwater Date No free water 7131100 Water at 13' - 3" 8/~(~0 Water at 12' - 9" 8~3~00 Water at 12"~'-9'' 8~7i00 COMMENTS: ~]eeeeeeeeeeeeeeeeee~leee~ee~ ~,.,~, ,,., '. CE- 3589 .- ~_~ · ~ ...' ~.i;*. ".o .,' SITE PLAN T.H. []~'3 I ~-'#2 --.... -' -- \-~. ,.,.,'I-- ....... '~ I~. OMEGA CIRCLE Date Reading Clock Net Tlrne Percometer Net Drop Time (minutes) Reading (inches) 7131 12" Presoak 31 114 Add water & start 3:13:40 27 #1' 3~3.:40 30 23_1116 3 15116 Add water 3:44 27 118 fY2 4:14 30 23 1/2 3 518 Add water 4:15 27"~4 #3 4:45 30 23 518 3 518 PERCOLATION RATE 9 (minutesYlnch) PERC HOLE DIAMETER TESTRUN BEllNEEN 3.75 FTAND 4.25 FT Recommend using soil application rate of 0.6 gpd/sq, ft. for sb'atum between 2' and 7' below ground level. 7w PERFORMED BY FLATTOPTECHNICALSERVlCES. I '~..~"'~ CERTIFYTHATTHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~' ~'~' O ~ I'rEST HOLE# 2 LEGAL DESCRIPTION: Lot 20, Boreal[s Sld DATE PERFORMED: 7/31/00 PERFORMED FOR: Steve FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG -- PERCOLATION TEST DEPTH -- (feet) GM Silty gravel fill material PT SM Reddish siltyloam ML Gray graveIly silt Dense, variable a. Ho SLOPE SITE PLAN T.H. [] 18 'tOU$~ DRIVE OMEGA CIRCLE Depth to Groundwater Date No fl'ee water 7131100 '~Wa~ at 13' - 3" 81-11-~0 Clock Net Time Percometer Net Drop Date Reading Time (minutes) Reading (inches) 7131 Bottom perc hole -19 1/2 12" Presoak 12:53 -6 3/4 Clean hole & resoak 3:10 -9 114 3.~.7 17 -9 5116 1116 3:45 35 -9~/8 118 4:17 67 -91/2 114 4:47 97 -9 5/8 3/8 PERCOLATION RATE >>60 (minutes/inch) PERC HOLE DIAMETER 7" TEST RUN BE'rWEEN 4.75 FT AND 5 25 FT COMMENTS: Soils encountered in this test hole are too nearly impermeable for a soil absorption bench. No monitor tube installed. PERFORMED BY FLATroP TECHNICAL SERVICES. I ~'".J~_"'~"'~.~-~,,~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:  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 MAI LIN~SS.~ LEGAL DESCRIPTION ') ' We AbsorPtion area Dwelling ~ PERMIT NO, D STANCE TO: I ~ ~ Manufacturer Matorial No. of comoartments I kiq. capacitg in ~allons IF HOMfiMA~fi: Inside length Width kiquid depth DISTANCE TO: O Z ~ Manufacturer Material Liquid capacity in gallons PER O ~ ~ DISTANCE TO: ~mmdni F~ length~ / Trench width._ D~tance between lines ~ No. oflines Le th~f ~line Total ~ Top of tile to finish grade ~,~-- Material beneath tile /Otal ef~ct~ve absCtion 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) OTHERi PIPE MATERIALS ~ pVC , SOIL TEST R~TING I R EM~B KS APPROVED DATE LEGAL 72-013 (Rev. 3/78) PERMIT NO. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 '"L~ STREET~ ANCHORAGE.. FIK. DD50± 264-4?20 8~0~47 ) RPF'LICFINT JOHN MORSELL SRA BO~< 4004-V ANCH ~507 27D-067~ LOCATION LEGAL L20 BORERLIS #± LOT SIZE DDDDDD SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MR::-:: I MLIM NLIME:ER OF BEDROOMS =/' ~' SO I L RAT I NG (SQ F'T/BF.:) = THE REQUIRED SIZE OF THE SOIL RBSORPTION SVSTEM IS: 250 [:,EF' TH= :JL. ~-]~. L F_..[_.-,t L]~i 7E' H ..~: 5 t-:'~ ,'-~ R R'..." E L [:,EF'TH= THE LENGTH [:, I MENS I ON IS THE LENGTH ,::IN FEET:.', OF THE TRENC:H ,'"~F.: DRAINFIELD. THE DEPTH OF FI TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFFICE 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 OLITFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF RN"r' NEI_LS ADJACENT TO THIS PROPERTY FIND THE NUMBER OF RESIDENCES THFIT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEF'RRTMENT WILL BE SUBJEE:T TO PROSECUTION. MINIMUM DISTANCE BETWEEN FI WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ~00 FEET FOR FI PRIVATE WELL OR ±50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM FI PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO FI C:OMMLINIT¥ SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MFI~' APPLY. SF'ECIFICRTIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. P E E." t-1 ][ T E :=-,: F' I E.' E S E:, E ,]: E i-1E-" E E: 3: ::L .. ± "_~ L----: _.~:: I C:ERTIF¥ THAT 't: i AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS AS SET FORTH B'~' THE t'IUNICIPFILIT'~" OF ANCHORAGE. 2: I WILL INSTFILL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3:: I UNDERSTAND THAT THE ON-SITE SEWER Sb'STEM MAY REQUIRE ENLARGEMENT IF THE RES I[:,ENE:E IS REMO[:,ELE[:, TO INCI. LIDE MORE THAN 4 E:EDROOMS. S I ]NE[:: ......... AF' C:RNT .TF~HN I',1ORSELL V4. 0 GRE,' R ANCHORAGE AREA BOI;: 3H O Department of Environmental Quality 3330 C Street t_A3~ (D'~ ~r~- Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Ff~ LOCATION MAILING ADDRESS / ~'--/~ ~ LEGAL DESCRIPTION PHONE 2-77' SEPTIC TANK: DISTANCE FROM WELL )'2~ INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL LIQUID DEPTH __ NUMBER OF COMPARTMENTS __ LIQUID CAPACITYt,~-<j'~O GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL TOTAL LENGTH FOUNDATION ~ NEAREST LOT LINE -- OF LINES__ NUMBER OF LINES I DISTANCE BETWEEN LINES ~ TRENCH WIDTH ,~::::)IN. TOTAL EFFECTIVE ! ABSORPTION AREA ~4~ ~ SQ. FT. LENGTH OF EACH LINE '~'~ I/~,,' DEPTH OF FILTER , (~ DEPTH: TOP OF TILE TO FINISH GRADE ''~ MATERIAL BENEATH TILE ~ 1~. ABOVE TILE IN. WELL: TYPE_~I~II '--¢~- ((-- CONSTRUCTION___ ~"I'D,/J') ["00~ DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE___ SEWER LINE , TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED __ DISAPPROVED __REMARKS DISTANCES: O lC DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE:_ REMARKS: E] GREI :r ANCHORAge AReA BOF Jgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO.. LEGAL DESCR,PT,ON INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS S.EEPAGE PIT . DRAIN FIELD NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 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. SEPTIC /4~ 4 ~- SEEPAGE AREA SIZE [ '*'.~'.i' (~, .,'~., TYPE TANK size TYPE. ~'Y ~ ~.~9:~'5_/ ~=-x~.,' MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK. . SEEPAGE PIT TO RIVER, LAKE, STREAM. DRAIN FIELD , DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE Pit DRAIN FIELD. 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. f' \ // O.A.^.';. ' f } u o. DIAGRAM OF SYSTEM '. ANCHORAGE AREA B(' I H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~'~'O LOCATION MAILING ADDRESS LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL /~)~' INSIDE LENGTH MANUFACTURER F~- ~-~a~ MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF / .~COMPARTMENTS LIQUID CAPACITY /~&~ GALLONS. SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL~:~~ -/~::~af~/,) CRIB SIZE: · BUILDING FOUNDATION ~:)~1¢ DIAMETER __ OR WIDTH DIAMETER NEAREST LOT LINE ADDITIONAL ABSORPTION LENGTH ! ~, t DEPTH /-~ DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE BUILDING FOUNDATION __ CONSTRUCTION NEAREST , LOT LINE , OTHER SOURCES DISAPPROVED. CESSPOOL APPROVED NEAREST SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE , TANK , SYSTEM REMARKS DISTANCES: INSTALLED BY: ~-~-~ PIPE MATERIAL: ~--~ LOT SLOPE: REMARKS: o~ ,~',,e/,e. Form No. LQ-031 DATE ¢-/~- ?'~ 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 INSTALLATION LOCATION LEGAL DESCRIPTION ~/ /~ ZO~ INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS ~ TO BE INSTALLED BY OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 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. SEPT,° TANK SIZE TYPE (/~' E MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TAnK ~ FOUNDATION TO SEEPAGe PIT /S DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ., SEEPAGE PIT TO NEAREST LOT LINE. DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK //'~} SEEPAGE Pit DRAIN FIELD SEPTIC TANK, /~/~O ~ SEEPAGE PIT //L~ © ~ , .. DRAIN FIELD TO RIVER, LAKE. STREAM. , DRAIN FIELD ~:~ JJ/J?¥'~. DIAGRAM OF" SYSI~;:M CAST ~2~_j~NTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCI~ DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED, WITH AIR_~riGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G .A LICENSEZDR~IG NER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAIn CODE. GF iR AHCIiORAGE AREA BOROUGH Depar~,nent of Environmental. Quality 3330 "C" Street Anchorage, Alaska 99503 Performed for J~ ~_.~z~ egal Description: ~,2~- ~m 2~ / his form reports: So'ils log Date performed Percolation test Depth Feet 2- 3- 4- 6- 7- 8- 9- 10- 11 - 12- 13- 14 -.~ Was ground water encountered? 1 If yes, at what depth? 'Reading Percolation rate Date Gross Time Net Time Depth to H20 Net Drop mi nute Proposed installation: Depth cf Inlet C 0 M M E: N T S: Seepage Pit ..... Drain Field Depth to hot:tom r.>'f pit c:' trench 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLIN~ 1. GENERAL INFORMATION Complete legal description Lot 20, Borealis 91 Location (site address or directions) 4931 Omega Dr., Anchorage, AK 99516 Steve Gonzalez~ ~roper[y owner Mailing address ....... Day phone 257-5679 Lending agency Mailing address ,..Ann~r~later/city Mortgage Anchorage Day phone 263-0745 , 12~ Fireweed Lane, Suite 120, Anchorage, AK 99503 :'Ann Slater Day phon~63-0745 Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well xxx Community well Public water If community well system, provide written confirmation from State ADEC attest~ lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide.written confirmation from State ADEc attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA121 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. S & S ENGINEERING Nameof Firm 17034 Ea~lle River Loop RoadNo.204 Phone (~qZ-l- Eagle River, Alaska 99577 Address ,---~ f -/_/ ~ / ..~/~ / / Engineer's signature ¢:~r'"~ 1/- Date DHHS SIGNATURE L'/'' Approved for F'O (,//~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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. 1/91) Back MOA #21 ECEIVED Municipality of Anchorage .... ~ DEPARTMENT OF HEALTH & HUMAN SERVICi~L 2 7 1998 Environmental Services Division MUNICIPALITY OF ANCHORAGE 825 L Street, Room 502 · Anchorage, Alaska 99501~u'(l~g~)~r~J~-~Es Dnf~S~ Health Authority Approval Checklist LegalDescription: L~'r bo /~oR~.~-~ $ ParcelI.D.: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level c. ~. ~ ~ & If A, B, or C, attach ADEC letter. ADEC water system number Date compl;ted ~ /Qa~ height (above ground) Cased to ~~Wires properly protected (Y/N) F~O~ AT INSPECTION g.p.m. Nitrate Other bacteria Collected by: Well production De~ of sample: g.p,m. B. SEPTIC/HOLDING TANK DATA Date installed 7 //~. / '~ ~ Tank size I 3-6-0 Number of Compartments ! Cleanouts {~/N) Foundation c!e.anbu~ ~)/N) ~-.,¥~ ~' Depression (Y/I~ /,,.o High water alarm (Y/~ ~v o ~' 'n '7/~1~ : Date of ~ump~. g , . Pumper ft-~ Ha,,~f. ~/~,~.v,c~ ABSORPTION FIELD DATA Date in~t'e]led (5 / '~ / ~1 Soil rating (g.p.d./ff~ or~ ~. ~--o/ 3. g '/ System type '7,~,-, ~,,'-/ Length '~ ~ '3 ~ · .. Width Effective abs0i~ption area Date of adequacy test ? / Gravel thickness below pipe Total depth I ~/ /~. Monitoring Tube present (~N) ~'~--)' Depression over field (Y~j). ~ o Results(~/Fail) 74 J $ For Fluid depth in absorption field before test (in.); ~ 7 Immediately after ~/,17 gal. water added (in.): Fluid depth ~ 7 (ins) Minutes later: 3 o Absorption rate = ¢ o~ ¥ .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~"'~' /~,-,o~,,~ If yes, give date ~ bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cyc~ E. SEPARATION DISTANCES "Pump on" level Size in gallons .._._......-~------'---- ~off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer manhole/cleanout On adjacent lots ~.,...---- Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ,C' '-/-- Property line ~' /4- Absorption field Water main/service line /0 ~ o 4- Surface water/drainage Wells on adjacent lots '~- ~ ,~ ' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: / Building foundation ~- ~ Property line /o Surface water ) 00 -~- Curtain drain /,~o,,~ ~. k..~o~.,'~,~. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area ~ ,..., Wells on adjacent lots ~, o.~ t~ .~ _ I certify that l have determined thru field inspections and review of Municipal re~.~'~t~;~ 'v~_~ms are in conformance with MOA H_AA guideli, nes in effect on this date. -~'i~/ ~ Signatur HAA Fee $ ~'-~(~ (9, (~) (~) Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 Parcel I.D. # - CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 20~ Borealis Subdiw~sion '¢/ Location (site add'ress or directions) 4931 Omega, Ancno ~a,~c,. A~oaska Property owner Mailing address Lending agency Mailing address · Gr~cn.~rst Mr. and Mrs 2920 Ba.i.b~.idgv.: A~oboaag,* : Day phone A?aa',ca qq~l~ Day phone 345-0640 m Agent Beth Simi~son/SIMPSON REAL ESTATE Address p_o. Bny 11¢342; A~¢[~n~,n3o; AYn4b~ qq~l! Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: ? TYPE OF WASTEWATER DISPOSAL: NOTE: Day phone 345-6644 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. 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 5. STATEMENT OF INSPECTION BY ENGINEER Sm 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 Address Engineer's signature DHHS SIGNATURE ,/'~ Approved for S & S ENGINEERING ;agle River, Alaska 9~5~ Phone bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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. 1/91) Back MOA it21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~;~21 .,~-- Absorption field on lot Wires properly protected (Y/N) g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed "'~"' 1~-'"7~ Tank size \"~'-~ Cleanouts~N) y /~F/~ndation cleanoutg:~i~N) High water alarm (Y/N) Date of pumping I/"'~;:~ ~' I Compartments Depression (Y(~:~j~ Pumper , _ . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ I:~J_~ On adjacent lots '~;> [ "~' Foundation 'TO property line I ~ Surface water/drainage Absorption field Water main/service line tol,..~r- 72-026 (Rev. 7/9t) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Si Manhole/Access (Y/N) Vent (Y/N) ~ "Pump off" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA, ~.~ Date installed (4:~ '" "'7 Length ~¢~ Width Total absorption area Depression over field (Y~;;::~ Results~ail) Peroxide treatment (past 12 months) (Y~) Soil rating Gravel thickness Total depth ~'"~'~t '"- Cleanouts p resent~71~l) ~-/ Date of adequacy test for I/---~ C;'t,J ~ If yes, give date -'""--' bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~',[C)/~ On adjacent lots ~ [--/C' Propertyline To building foundation "~'~'1 g or abandoned system on lot On adjacent lots ~ I,,.~ Cutbank ~,,~°~ Water main/service line Surface water (,c::~:~ ! ~ Driveway, parking/vehicle storage area Curtain drain ~'~ (~ ~-~~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineer's Name Date S & S ENGINEERING 17034 Eagle Rib/er Loop Road N~: ~ !~agle ;~iver, Alaska 99577 of this inspection. HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION / WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 563-6775 November 29,1991 FOR: S & S Engineering PWSID # 210786 My review of the records on file in this office reveals that the Borealis Omega Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Environmental Engineer BR/cf MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ("'~] \ ':5 ~,~(~,..~ - \ L-I HAA # ~-'~ ~ ,¢~-~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~V/l'elephone· (home) (b) Property owner Mailing Address ~ e 'I~ I ~ ~ ~t (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here rq, if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family~ Number of bedrooms WATER SUPPLY [] Community~ Public [] Individual Well Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site'~ Public [] Community [] Holding Tank [] Note: Iffcommunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev, 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 t~.~ Address Engineer's Seal Approved X Disapproved Conditional Date Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 We,, S Well Log Present (Y/N) Total Depth Cased to __ Static Water Level Casing Height Above Ground 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/I,fO~I~ TANK DATA Date Installed ! ~?~'" Size Standpipes (Y/N) O Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Air-tight Caps (Y/N) N Temporary Holding Tank Permit (Y/N) No. of Compartments J Fou ndatio.n..Gteat~'t~i~ (Y~N) ' ~'' Date Last Pumpe(~i~ ~,~.B/,O ~ ~"/'~"X '~,.. ;for .... I~?,',~ .......... To Building Foundation To Disposal Field To Water-Supply Well ,~o.o V- f- To Property Line E> c> + To Water Main/Service Line '7 ~,-~ To Stream, Pond, Lake or Major Drainage Course JO'+ Comments 72-026 (Rev. 7/88)Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 19 8 I Width of Field .~..~. Type of System Design Length of Field Depth of Field Square Feet of Absortion Area ci'~/¢, Depression over Field (Y/N) N Results of Last Adequacy Test '--"~L~_~ ~ ~' SEPARATION DISTANCE FROM ABSORPTION FIELD: TO Water-Supply Well ,'~-~'~> ~ To Building Foundation ¢,~.~ ' Lot 10' ~ To Water Main/Service Line ~ ~5' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,_~O' To Cutback (if present) D. LIFT STATION J~ O t~ L~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. Waiver Fee: $ Date of Payment Engineer's Seal 72-026 (Rev. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION STEVE COWPER, GOVERNOR ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 316 ANCHORAGE, ALASKA 99503 563-6775 FOR: TOLBERT SPURKLAND DATE: March 31, 1989 PWSID: 210786 To Whom It May Concern: According to the records on file in this office, the BOREALIS OMEGA S/D water system is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG Environmental Field Officer APPLI¢ UT FILLS OUT UPPER HA! ONLY Pr°~ertyOwner ~"~[Ab~ W. ~1L AtAII~ J'~/~- ~/'~ (0,'J]",[~ t t Phone ~ /' Phone Realty Co. & A~nt Address/ ~/'fl .ZipCode Type of Resl~nce ~ ~ingla Family : ~ultipla Family No. of Bedrooms : Other Water Supply : Individual A~ACH WELL LOG. A w~l Iog is re'trod for all w~lls drilled since June 1975. Community For w~lls drilled prior to that dale, glw ~11 depth (attach log if availabl~). ~ Public Utility Sewer Disposal ~ Individual Year ,ndiv.ual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ~ b DFPT  ENVIROi&,;:i',,A- ,,q;, 2',.,TION C~"[ 2 '; 1982 BECE! ED (~,,.ow~ ~.oo~ ~' ~,,~/~,~ ( J .co,~mo,s o~ ,,,.ov,u, ._..~ *~ ., . ~~ d' Soils Rating 'Z; /,'~stalled Well To ,bsorptiZrea Well Log Received ~ -- ~ ~ Well to Tank Septic T~k Size 72-023 (3lB?.) LASKA eFIUIROFImeFITAL COFITROL SeRUICe$, II'lC. ~nqineerin§ 8 ~nuironmental Studies MUNICIPALITY OF ANCHORAGE DJ:ol C'": [ :'~ ' °' IFNVIE 31 ~,'. :', ,. ,':,..~P, ANN MORSELL SRA BOX 4004-V ANCHORAGE AK 99507 RECEIVED SELLER - ANN MORSELL BUYER-T & M HAMMER SUBDIVISION-BOREALLIS BLOCK- LOT-20 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AREA OF 594 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 300 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 900 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 4 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON 9/82 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 4 BEDROOM HOUSE. 1250 IS ADEQUATE FOR 1220 J, Uest 25th Auenue · Anchora§¢, Alaska 99503 · (907) 276-1361 Department of Environmental Quality Water and Sewer Questionnaire Subdivision Lot Owner's Name: Mailing Address: Questions: 1. How many bedrooms are now in your house? 2. How many bedrooms were in the house at the time of purchase? 3. Were the basement bedroom walls "roughed in" at the time of purchase? 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? ~r'~~ ~' ~~/ ~/ 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom ? ~ ~ If on a public water supply, do you always have an adequate supply 7. Is the pressure always adequate? OTHER COMMENTS: