HomeMy WebLinkAboutBOWLBY LT 1wtlm"�-
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181186 PID Number: 051 153 55
Dwelling: ❑� Single Family(SF) ❑with ADU ❑ Duplex(D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Twins Homes ABSORPTION FIELD
Site Address
20506 Jayhawk [' Deep Trench ❑Wide Trench MBed El Mound
El Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3109938 3 0.8 GPD/SF 3.45 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 2.65 Ft. 0.8 Ft.
Bowlby Lot 1 Fill added above original grade Gravel length
Township Range Section 3.35 +/- Ft. 40 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 15 Ft. 3 5 Ft.
ToSeptic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
' Tank Field Lift Station Tank Line 2 1
From 600 Ft - Ft.
Well +100 +100 - - +25 TANK ❑l Septic CIS.T.E.P. ❑ Holding IDOther
Manufacturer Capacity
100 +1 00 Anchorage 1250 Gal.
Surface Water + - -
•
Material Number of compartments
Lot Line +10 6 - - NA Steel 2
Foundation +10 ' +1 0 - - LIFT STATION
Manufacturer Capacity
Remarks Old tank disposed of per code Gal.
Alarm location Electrical installed by
PIPE MATERIAL House to tank 30034Tank to 3034
Installer drainfield
Guaranteed Services Drainfield 3034 CO/MT3034
Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 100 ft
Inspection 11 Location and description
dates: 2nd
3rd 4°i bottom of siding
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp
Conditional Approval: Date
. OF A�gskl
,*�49] %' '�*�l
Septic Sys �r. HARLES G• BALZARII ••j
CE 13854 ...
``�
Note: this approval does not include well permit requirements. i1�.;rROFESSIO�' —
(Rev 05/02/18)
2/17/19
•
of a�gslll
a
GARAGE PAD
tAiwc:.
, • 11-I 1\ •÷-91 10
/ 4 /Of
SWINGTIES I CHARLES G BALZARINT j
A 8 4ft�'(K''• CE-13854 •••K�c�/
C 3.5 158 a° � r 1 j�FA'.,��y./1q,•'��V\-�
D 14.12 242 '/
E 19.9 268 ,1 ROFESS\C)N�'�'-r
F 24.4 266 '° ~
6 25.3 301
N 29 327 / 4 r
i 25 8 27.8 e /
1 20 1 20 7 /
K 30 307 BOWLBY BOWLBY
T15N R1W SEC 8 M 616 445 a LOT 1 LOT 2
LOT 132 N 59 4 49.4
(UNDEVELOPED) 0 579 46.3 e
• ° \
• 1
'M 3BR. HOME 1
,.--____
FOUNDATI EXISTING
F•�e I B� CLEANOUT WELL
° ' NEW 1250
GALLON TANK \
/ /
TH
NEW 15x40 BED _
T M N " SYSTEM
10
T15N R1 W SEC 8 \T 1kN R1 W SEC 8 LOT 142 (UNDEVELOP
LOT 141 / LEGEND
WELL AND SEPTIC CLEANOUT
+200' FROM — — • MONITOR TUBE
PROPOSED SYSTEM ® TEST HOLE
PLAN-SCALE: 1"=40'
+100.0'BOTTOM OF SIDING FILTER FABRIC MONITOR TUBE
98.3 100.25�lFINISHED GRADE
I rORIG GRADE/TESTHOLE t
4.5'COVER 569' l 969,
COVER ORIG.GRADE
— — 4 .
!;1-1
1250 GAL TANK 94.37 I;I;•'-�'-•
94.54Y ►-•'IP P1/• 94.25 INVERT
93.45 88.4'HIGHEST GWT 6/24/18
4"0 DISTRIBUTION PIPE
90.127 0.78'EFFECTIVE SEWER ROCK
SCHEMATIC ELEVATION-SCALE:NTS B.O.H 84.9'
LEGAL DESCRIPTION:BOWLBY LOT 1
C&M ENGINEERING SERVICES OWNER:TWINS HOMES I DATE:02/15/19 I REV: 1 I DRAWN:CB REF:
907-854-5558
SEPTIC RECORD DRAWING
"°A"' MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program 5,
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
j' http://www.muni.org/onsite
I)cI,artntcnt
;C-N-0.-Ft PGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP181186 Effective Date: '7/ 11/20 1E
Work Type: Septic Upgrade Expiration Date: +
Tax Code Number: 05115355000 I/1 7/200
Site Legal Address: BOWLBY LT 1 G:1256
Site Mailing Address: 20506 JAYHAWK DR, Chugiak
Owner: JOHNSON CYNTHIA E LLC Lot Size in Sq Ft: 44344
Design Engineer: C & M Engineering Total Bedrooms: 3
This permit is for the construction of:
Q Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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 (24/7).
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
71x7Received By: 16,,t4,41,, Date: N
Issued By: CLJt Date: 1 U
Municipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
htt12://www.muni.org/Onsite
QDgeyvellopment Services ggpIrtment
On -Site Water and Wastewater Section
Waiver#: OSVI 81043 COSA#:
PID#: 051-153-55
Legal Description: Bowlby Lot I
Engineer: C&M Engineering
Applicant: Cynthia Johnson
Permit#: OSPI81186
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 8.0 feet. See
engineer's waiver request for justifications.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
I
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
M a M a Is a 8 0 z M M a a M a a a a a a a a a 2 a M a a a a 2 2 0 a a is a a a a a ff n a M a a 0 2 a 0 z a a M U a a a 2 M a 13 a M 0 M 0 M a a x a 0 0 a M 0 1
Waiver is Granted: x Waiver is not Granted:
Date: _-0-7/a Approved by:
�z 6vL
Name of Reviewer
2 a a a M M a a a a a a 0 0 M a a M a a 2 a a M 2 a 0 a U 8 a M M a M a a a a a M a a x a a a a z z 0 a a a 2 a M 2 M a a a a a a M a M M a a a I
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTICM/ELL PERMIT APPLICATION
Parcel I.D. 051 153 55
Property owner(s) CYNTHIA JOHNSON LLC
Mailing address 3842 CARAVELLE
Site address 20506 JAYHAWK
Legal description (Sub'd., Block & Lot) BOWLBY LOT 1
Day phone 310-9938
Legal description (Township, Range & Section)
Lot Size 44,344 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(E all that apply)
Absorption Field 0 Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank El Upgrade Q
Duplex (D) ElHolding
Tank ElRenewal ElMultiple
Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
LOT LINE TO LEACHFIELD
Distance:8
I certify that the above information is correct
applicable Municipal Codes.
I further certify that this is in accordance with
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5G9 Waiver Fees: #2 I'S
Date of Payment: :Wi�] Date of Payment: '71 D f
Receipt Number: b `{ 2 Receipt Number: O q O3'--(
Permit No. 0 SP I � 1 A Waiver No. 6s V 1 d' 1 0H :�
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
)%�' E PLli N's A-
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System replacement for Bowlby Lot 1
Dear Reviewer,
The above referenced property is currently served by an older, failed 3 bedroom septic system. The
owner would like to replace it with a new septic system.
We are proposing to install a new septic tank, and a new drain field. The old tank will be decommissioned
per moa requirements.
The proposed system is gravity flow, however if during construction it is determined that a lift station is
required, we will submit a change order request.
Our review of available documentation and field investigation show that this project will not adversely
impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing
onto and off of the subject property.
The lot is served by a private well and the proposed septic system will be installed outside of the well’s
100’ protective radius.
Due to the placement of the well and subsurface conditions, the proposed system will encroach slightly
on the west lot line. We are requesting separation distance requirements be waived to a distance of 8.0’
between the leach field and the lot line. Due to the large size of the adjacent lot, approval of the
separation distance waiver is not anticipated to have any meaningful impacts on that lot’s development
Included with this letter is a permit application and design package, including plans, specifications,
calculations, and a soil log.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181186, Rebecca Carroll, 07/17/18
T15N R1W SEC 8 LOT 142 (UNDEVELOPED)
3BR. HOME
EXISTING
WELL
TH-1
LOCATE
AND DEMOLISH
OLD TANK PER
MOA REQUIREMENTS
NEW 1250
GALLON TANK
NEW 15x40 BED
SYSTEM
8'
10'
10'
GARAGE PAD
15' T&E EASEMENT
DRIVEWAYBOWLBY
LOT 1
BOWLBY
LOT 2
SEPTIC AREA
T15N R1W SEC 8
LOT 132
(UNDEVELOPED)
T15N R1W SEC 8
LOT 141
WELL AND SEPTIC
+200' FROM
PROPOSED SYSTEM
JAYHAWK
FOUNDATION
CLEANOUT
100' NEIGHBORING
WELL RADIUS
(APPROX)
5'
1' MOA CONTOURS
229228
C&M ENGINEERING SERVICES
907-854-5558
SITE PLAN
LEGAL DESCRIPTION: BOWLBY LOT 1
OWNER: CHRIS HAYNES DATE: 07/02/18 REV: 0 DRAWN: CB REF:
SCALE: 1" = 40'
CHARLES G BALZARINI
CE-13854R
EGISTEREDPROFESSIONALENGINEERLEGEND
CLEANOUT
MONITOR TUBE
TEST HOLE
SLOPE INDICATOR
NOTE:
1. THE PROPOSED SEPTIC SYSTEM IS
GREATER THAN:
100' FROM ANY PRIVATE WELLS
200' FROM ANY PUBLIC WELLS
100' FROM ANY SURFACE WATER
50' FROM ANY STEEP SLOPES
10' TO ANY PROPERTY LINE OR FOUNDATION
5' TO ANY TEST HOLES
EXCEPT WHERE SHOWN
0.5%
7/15/18
THE LEACHFIELD MAX EXCAVATION DEPTH IS 3.5'.
CONTRACTOR SHALL RE-CONFIGURE PLUMBING INSIDE CRAWL SPACE
TO EXIT THE FOUNDATION AT 2.5' BELOW GRADE.
IF PLUMBING CAN NOT BE RE-CONFIGURED, OR LINE GRADES CAN
NOT BE MAINTAINED, A LIFT STATION WILL BE REQUIRED.
FILL AND/OR INSULATION SHALL BE PLACED OVER ALL LINES.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181186, Rebecca Carroll, 07/17/18
Residence:
number of bedrooms 3 br
Water usage/bedroom 150 gpd/br
Water Usage 450 gpd
system type: Conventional
type: BED
Application Rate 0.8 gpd/sqft
required absorption area 562.5 sqft
trench width (W) 15 ft
gravel depth (D) 0.5 ft below distribution pipe
Min Required Length: 37.5 ft
Total Excavation Depth: 3.5 ft
Cover: 2 ft
Insulation: 2" blueboard
Use Length: 40 ft
Effluent Pipe:
System type: BED
Tank: 1250 gal
New Drainfield: 15'x40'x0.5' W'xL'xD' BED
Absorption area: 600 sqft
Calc By: CGB Date: 7/17/2018
C&M ENGINEERING SERVICES
907-854-5558
Septic Design Calculations
BOWLBY LOT 1
RESIDENCE/LOT INFO
DRAINFIELD
4" ASTM 3034
Design Summary
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181186, Rebecca Carroll, 07/17/18
C&M ENGINEERING SERVICES
Ph: 907-854-5558
SPECIFICATIONS FOR ONSITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER
LEGAL: BOWLBY LOT 1
JULY, 2018
A. GENERAL
1. The septic design is for a 3 bedroom, single family residence only.
2. The site plan and drawings shall be a part of this specification.
3. The Wastewater system shall be installed by a certified installer in accordance All
materials and workmanship shall meet the Anchorage Department of Health and
State Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field
by the engineer. The engineer shall perform percolation tests and groundwater
monitoring prior to finalizing design. An additional Test hole and percolation test is
required during construction.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage, Department of Environment of
Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and
to locate any adjacent multi-family wells. A licensed surveyor should locate all
nearby lot lines, easements, exact 100’ radius from the existing and neighboring on-
site wells, and any nearby surface water.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. Any remaining open test hole excavations shall be filled and monitor tube removed,
after construction of the Drainfield.
9. The contractor shall familiarize himself with the new code requirements for
inspection notification and notify the engineer at least 24 hours prior to beginning
work.
10. The contractor shall set the grades for the tank and leach field prior to commencing
work to ensure gravity flow is acheived.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181186, Rebecca Carroll, 07/17/18
B. SEPTIC TANK
1. Septic tank shall be a fiberglass or steel, 1250 GALLON tank capacity of MOA
approved construction. Installed to meet MOA and manufacturer requirements.
2. A combination of soil and 4” minimum of insulation shall be placed over the tank, to
prevent ponding and promote drainage. The insulation shall be rated for burial and
meet moa requirements.
3. Tank shall be bedded per manufacturer recommendations.
C. DRAINFIELD
1. The Drainfield is to be located as shown on the site plan. Notify Engineer of any
changed site conditions.
2. The total depth of the initial drainfield excavation is to be at maximum 3.5’ deep
Bottom of excavation shall be level +/- 1.5” max. If bedrock or inconsistent soils are
encountered, notify the engineer immediately.
3. In the event of over-excavation, a moa filter sand shall be used to maintain the
required depthThe top of the sand layer shall be level, plus or minus 0.5”, and raked,
prior to placing sewer rock. Care shall be taken to not compact the sand.
4. A 6 inch effective layer of sewer rock is to be placed in the each trench. The 4”
effluent piping is to be buried within the gravel layer with 2” of sewer rock cover over
the piping.
5. The Distribution pipe shall be 4” perforated pvc pipe conforming to ASTM D3034.
6. The complete Drainfield gravel and piping is to be covered with a geotextile filter
fabric.
7. Soil or combination of soil and extruded board insulation to a depth of 3’ or
equivalent is to be placed over the drainfields. Mounded side slopes shall not to
exceed 3:1. The minimum insulation thickness shall be 2”. Insulation shall be moa
approved and rated for burial.
8. The septic tank and leachfield must not be closer than 100’ to any existing private
well, or 200’ to any public well.
9. The soils at this site may contain fines such as silt and clay. Rake sidewalls and
bottom of trench to remove any smears from excavation.
Design Summary:
Excavation Depth: 3.5’ Gravel Depth: 0.5’ under distribution pipe, 2” over pipe.
Drainfield Length: (1) 40’ Drainfield Width: 15’
Soil Rating: 0.8 gpd/sqft System Capacity: 3 Bedrooms
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Section
47OVElmore St.
PD.Box 18o650Anchorage, AK 99519-6650
(907)343-7904
Soils Log - Percolation Test
Performed For: CHmSHAYweo
Legal Description: BOWLBY LOT 1
�unicipality of Anchorage
"k r and Wastewater
qter
07/17/1
49 TH
6� CE -13854
Date �1�1a
Township, Range, Section:
Site Plan
SW, SAND WITH SOME
GRAVEL
SM, WAS GROUND WATER
Date
Gross Time
FINE SILTY
nwE3|-�TY�—�mo ewoouwTenso,
Y2ESL___
Net Drop
1
6/24/18
7:35
IF YES, «rvvx^�oeprnr
'
��-----
L
Depth mWater After
6124/18
o
p
mvono,mor
8.5
e
BOH Date:
0/24/1e
7:46
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
1
6/24/18
7:35
0
011
011
2
6124/18
7:45
10
3-6/16"
3-6/16"
3
1 6/24/18
7:46
0
011
01
4
6124/18
7:56
10
3-6/16"
3-6/16"
5
6/24/18
7:57
0
011
011
6
6/24/18
8:07
10
3-5/16"
3-5/16"
I'LHUOLAHON RATE 3 (minutesfinch)
-3-4-
5-6-7-8-9-10-11-
12-
13-14-
15-
1S-
17-
18-
ig-
2O-
n=HuuLmHmwx*rs3(min"tesfi"ch) pencHOLE DIAMETER 6"�__
TEST RUN asresEwrr mvo
—�_£FT
COMMENTS LAST sREADINGS SHOWN. PERFORMED FOR 1HOUR.
PERFORMED BY: CHARLES BALZARINI | CHARLES BALZARINI CERTIFY THAT THIS TEST WAS
0 20-, 40
OF
49TH
;REDFRIC W, %A�XAeN EA
6/28/2018
SlONN-
W,1 Water Well Concrete
Septic Found Rebar
A
4_,rum,Cap
Tel. Pedestal Found Al
z��
cc," Utility Pole Found Hub & Tack
(RFC,} - Record Data Per Plat No. 86-7 Palmer Recording District
(MEAS.) - Measured Data on June 20th, 2018
(PRM) - PrDpOrtiOnWed
General Notes
---- ---- - -----
1, Excepting for gross negligence, the liability for this survey shall not
exceed the cost of preparing this survey. Dimensions to property lines
are plus/minus 0.1ft,
2. This document is created by Frontier Surveys for the purpose of a plot
plan for Twins Home Improvement only.
3, This document is based on Plat No. 1986-7, Anchorage Recording
District,
4, All lot corners Shown in the drawing have been located and marked,
PRf131
FRONIIER SURVEYS, LLC
I l)RA,', N Ry S', I DATH: 20180, 21 1 D,?AV;I!X10 B237 I
AN -IS BURT I PLOD PLAN SURVEY OF
This survey complies with ASPLS Mortgage Location Standards. The survey represents visible improvements and
is
conditions at the time of the survey. This document does not constitute a boundary survey and subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine
the existence of any easements, covenants, or restrictions which do not appear on the record plat. Under no
circumstances should t1his document be used for construction or for establishing a boundary or fence line.o.
LOT I BO LBB SUBDIVISION
AM yar r RLQ Rrl c DIVMC, JUDIOAL Di>',RICT
'7AJk: M AtAW,
'0 J AYHfi,VN'X. 3R CHUG IAK- A9
,.E "a.I(.
PRf131
FRONIIER SURVEYS, LLC
I l)RA,', N Ry S', I DATH: 20180, 21 1 D,?AV;I!X10 B237 I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION L~.~,.~
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
~ ~ON-SlTE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ,~/ ~ . ~ ~ ~ ] PHONE I ~NEW
MAILINGAD~SS. ~ -- ~ ~ ~, ~ i /) , ,
LEGAL ESc~aT~' ~~ ~~ ~' ~ ' ~4 ] ~~/~
LOCATIO ~ ~ ~ ~ I NO, OF BEDROOMS
] Well ~ _ ' .I Absorption area. ~ v Dwelling ~ ~ PERM~'O. .~
~Z I Manufacture~ ~t - M~~ No. ofco~partments
~ I L'q. capac'ty ;n gallon~ Inside length Width L~qu~d dept~- h
I ~ IF HOMEMADE:
--~Z ~ capacity in gallons
0 Z ~ Man ufacturer Material
~ ~ ~ No. oflines Length,~ine Total ~ines Trenc~i~ 7~
is~7~een lines
~ ~ ~ Top of'tile to finish grade ~ Material beneath tile ~ '-
area
Length Width Depth
~ W Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
CJass Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MAT~IALS ~~ .% ', ,',
SOILTESTRATING ~b~ a ~ ~t) C'
INSTALLER ~ ~'
., ,,,.,.,,,,.,.,
72-013 3/78)
t""1 IJ ~-~ % C: ].] F" R L_ l'. T' "'r"
DEF'RRTMENT Or.. HERLTH RND
:,TF.EET., FINCHOF.:FIGE., FtK. .,:1
.-."~:, 4- 4 ,.
Cn [-~ ..... ~5 Z ~- E: 2; E 1.,.! E F..: F' E-. F: P1 I' '1"
PERMIT NO: ,:: 8±0452 )
RIC:HRRD D. BOI.4L. BY
DIRC:HWO0[:, L..00~
LIT i]:i SEC: 8-TZ5N Rlt,.I
RPPL. I CRN'r
LOCRT I ON
L. EGRL.
PO BOXY45 ERGLE RIVER
C, F: F-I I%1,2: H C, IF~: Fl ,;::ii E ¢;~/'Z- ?. -- / [; / ~--
Lt-.IT E;IZE ::I.I-__"IE:O00 L:.;F.:!UFIF.:E FEET
TYPE OF SOIL. RBSORPTION SYSTEM IS: DRAINFIELD
I'dRXIMUM NUMBER OF-- BEDROOM:_=;
SO I L. RRT I NG < SQ F'T',-"BR) = ±25
THE REQUIRE[) "SIZE OF THE SOIL. RBSORPTION SYSTEM IS:
[:, E: F" ]' H == 5 L E ~-~ C-] T' 1'4 = 5 _-3_=: ~3 F-: R %.' E2 L_ [:, E F' "T H == 2:-2
THE LENGTH DIMENSION IS THE LENGTH (IN FEET:) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND FiND THE BOTTOM OF THE EXCR'.?RTION (IN FEET).
THE GRFI',,,'EL DEPTH IS THE MINIMUM DEP'FH OF GRR',/EL BETWEEN THE OUTFFILL PIF'E
FIN[:, THE BOTTOM OF THE E,'-'.::CFI',/RTION (IN FEET).
F:'.'. ES: ~'S'.'~ I_1 I F: E E:, :~; E F" T I C: T F! f-~ I-::.' S ! Z E = Z 0 LZ-i Lit iS F4 L_ i._ El ~-~
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF' RNY WELLS RD..!RCENT TO THIS PROPERTY RND 'THE
NUMBER OF RESIDENCES THefT THE WELL WILL SERVE.
......... T 1..-II C:~ < ;,2 ::, ][ f-.1:5 F' E ~3 '-Ir- ]: C~ !'-,i L-re.' R F: E F: F-_: ~;:! LI I I--~: EE IR:,
BFIC:KFILLING OF FINY SYSTEM WITHOUT FINFIL INSPECTION FINE:, RF'PF.'.O',/RL BY THIS;
[:,EPRF,:THENT HILL BE SUBJEC]" TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL. RND RNY ON-SITE SEWBGE DISPOSRL S'.r'STEM IS
:200 FEET FOR R PR I'v'RTE WEL. L OR t50 TO 200 FEET FROM R PUBLIC NELL [:,EF'ENDING
UPON THE TYPE OF PUBLIC WELL
MINIML1M DI?STRNC:E FROM R PRIVRTE WELL TO R PR I ',,,'RTE SEHER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTFIER REQUIREMENTS MRY RF'PLY. SPECIFICRTIONS RND CONSTRUCTION [:,IRGRRM':.-., F~RE
R',,,'RILRBLE TO INSURE PROPER INSTRLL. RTION.
I CERTIF"r' 'THRT
:1..: I RM FRMILIRR HITH THE REQUIREMENTS FOR ON-SITE SEHERS 8ND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF 8NCHORRGE.
2: I [4ILL INSTRL. I_ THE SYSTEM IN 8CCORDRNC:E WITH THE
]'.':: I UN[:,ERSTRND THRT THE ON-SITE SEWER S"r'STEH MR"¢ F.:EC-.!UIRE ENLRRGEMENT IF THE
RESIDENCE IS F.:EMODELED TO INCLUDE MOF.:E THRN 3 BE[:'ROOMS.
S I GNED: ...........................................................
FIF'F'L I I]:FINT R I CFII=IRD E:, E:OL,JLE:Y
I"-" S_ ED E, ¢~__~ .... .~~_ E. H T E_._~/_/_~__~/
-,,,
',,,'4. 0
[] SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
.>
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
:~ ,~/'/i~ DATE PERFORMED:
SLOPE
[] PERCOLATION
TEST
Robert A.
No. 1457-E
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
O
P
E
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
:... RUN BETWEEN/ FT AND
COMMENTS '¢ L~/'~ 6t'/,/~ / ,~/,~EST ~'"¢'~"~ ~ ,F ~ ~
PERFORMED BY: ,~--~'S~-¢~~ CERTIFIED
/ FT
DATE:
72-008 (6/79)
LOCATION OF WELL
(Please complete either ID, lb or lc.)
WATER WELL RECORD
STATE Of ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ Geophysical Surveys
Drilling Permit No.
A.D.L. No.
Meridian
,division Lot Block~l '/4qtre. Section No. TownshiPN[~_. Range
__.j~ _o,_o,_of_ ~ '.," /
)IRECTION.FROM ROAD INTERSECTIONS ~. OWNER OF WELL:
Address: ,
F~I ~1~ 4. WELL DEPTH: (fi~1) ~. D~T~ OF COtpL~IO~
Surface
~Materlal Type Top Bottom
~ ~detted ~ Bored
Z/ ~. 7. USE:,~ Oomeatio 0 Public Supply 0 Industry
. ~-~-r />. ~ ~ 0 Irrigetlon 0 Recherge 0 Commericol
~/~ ~'~ ~ TeEt Well ~ Other:
~ ~ ~ ~/ 8. CASING: ~ Threaded ~ Welded
-~~' J - "Z~ /~ ,~ diam. in. to__ ft. Depth Stickup ~',. ft.
~L~*~S ..... Slot/MeSh Size: Lan,th:
Set bet ween ft.
Buckfillin~ Gravel pock
--'~ ..... ~ ~ I0, STATIC WATER LEVEL: ft.
'-~ ~ ~ Above or ~'Below land surface Date
Equipment used:
A~O~~_ I1. PUMPING LEVEL below land surface end YIELD
...~A~ ~ fi. after hrs. pumping -- ~.p.m.
....... ~1~'- ~n97 I~.OROUTIN6 Well Grouted: ~ Yes ~ No
~1 ~1 IS. PUMP: (" available) H,
............. g~, · --~¢ ~ Length of Drop Pipe __ft. capacity __g.p.m.
...................... i~.L 0 Subm. ~ ~.t ~ Centrifical 0 Other
~ ~ . ~ O~ . ,i ~ 14. REMARKS:
............................ "
:ONTRACTOR'S CERTIFICATION:
15. Wofer Temperolure ~o ~ F ~ C
Irilled u~er my ~r~dlction and this seport is true to the best of m~ knowledge ond
teled Business Nome
, ~ Contract Li.~nse Number
Authorized
Copy Distribution: WHITE-State DGGS~ PINK-Driller~ CANARY-Customer
-__1-'-~} DIS TAN C E AND
S~reot Address
2. WELL LOG
............... :~_~_
................
..........
..............
Form O~-WWR
16, WATER WELL
T h i~[e II wos._
Sigl~ed ,
DEF ARTMEN1 OF HEAL'I"H AND ENVIRONMENTAL.. FRI.]l E. CT ION
825 L ST'REET, ANCHORAGE., AK 99501
~64'-47~L
0N'--'..c32 I 'T"E] WEI_.i_ F'ERM I T
PERMIT NO:
DATE ISSUED.
8.~U461
0'7 / ... L / 8 o
AF"F:'L I CANT:
ADDRESS:
(..,ON7 AC r F HONE.
RICHARD B BOWLBY
P O BOX 545
EAGLE RIVER, AK
688-2229
99577
I...EGAL DESCRIP:
LOT' SIZE:
I....O'F LOCATION:
SUBDIVISION: NA
SECTION: 8 TOWNSHIP: 15N
40000 (SQ.FT. (3R ACRES)
JAYHAWK DRIVE
LOT: W1/2-151 BLOCK: NA
RANGE: 1W
]: certi£y that:
:1.. I afn familiar with the requirements for on-site sewers and wells as set,
for'th by the Municipality of Anchorage (MOA) and the State oF Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance wit. h the design criteria o¢ this permit.
3. I will adhere to all MOA and State o~ Alaska ~equirements Cot the set bac:l<
distances fro~ any existing well~ wastewaler disposal system or public
sewerage system on this or any adjacent or nearby lot.
SIGNIED ~~_~~_~____~ DATED ___-_-'--~O--~ ~
APPLICANT: RICHARD B BOWLBY
ISSUED BY ' ~ ~~:~--'~' DATE:
EPLANS
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. 051 153 55 Expiration Date: (9-71
1. GENERAL INFORMATION
Complete legal description Bowlby Lot 1
Location (site address) 20506 Jayhawk
Current property owner(s) twins homes Day phone
Mailing address
Real estate agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Q Private Septic 0
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for none, drain field to lot line waiver on file Distance:6'
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment 3/1-1 /0 Date of Payment
Receipt Number !J 7da"LUReceipt Number
COSA# 05C /q /060/ Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation.
Name of Firm C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 1/2/2019
Atr. lk'
elsA•
meg.• ••4 9
i*: 49TH �* /
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms d • "' r" •''.xY•.t.• ._•..
kARLES G BALZARINI
System #2 Approved for bedrooms /��+�����.• CE-13854 • . �w�/�
Disapproved gl‘iF.�PAcir
ROfESS10�a�-air
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
WATER AND r"
WASTEWATER o
PROGRAM
:y: A Original Certificate Date: -' 7 ?
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval(COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Check/st blue sheet
COSA Checklist
Legal Description: BOWLBY LOT 1 Parcel ID: 051 153 55
If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1
A. WELL DATA
• Well log is filed with Onsite (or attached) Well production at time of test +5 gpm
Date drilled 9/15/85 Water storage tank volume NA gallons
Total depth 173 ft Well disinfected for coliform test? ❑ Yes ❑ No
Cased to 128 ft ❑■ Coliform bacteria is Negative
■❑ Sanitary seal is functioning correctly Nitrate mg/L El Nitrate less than MRL (ND)
❑■ Wires are properly protected Arsenic ug/L ❑■ Arsenic less than MRL(ND)
Casing height(above ground) +12 in. Collected by C.BALZARINI
Date of flow test for COSA 218/19 Date of Sample 2118/19
Static water level at beginning of test 61 ft.
Comments Well production may be higher than reported, limited by testing equipment and plumbing.
B. TANK DATA C. LIFT STATION
Age of tank(s) <1 years ❑ Required maintenance completed
Tank type/material steel Age of lift station na years
❑■ Standpipes/foundation cleanout per record drawing Lift station material na
Date of pumping na Comments: na
na
D. ABSORPTION FIELD DATA bed
Which system tested (date installed) /2018 Adequacy test date na
0 ALL standpipes present per record drawing Results E Pass For 3 bedrooms
Total measured depth from grade 6.8 ft(max) Fluid depth prior to test na in
Measured depth to pipe invert from grade 6 ft(min) Water added na gal
❑ N/A—pressurized field New depth na in
O Monitor tubes go to bottom of drainfield. If not, state Elapsed time na min
depth into effective
0 Code-required soil cover over field Final fluid depth na in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) na
date of test)
Gallons introduced na gallons If yes, enter date na
Comments/Deficiencies: new system,adequacy test not necesary.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100'
❑✓ Yes if No ft ✓0 Yes if No ft
Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line>25' Z Yes if No ft
Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank> 100' Q✓ Yes if No ft
Neighboring Absorption Fields> 100' Animal Containment> 50' E Yes if No ft
✓❑Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ✓0 Yes if No ft E Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' ❑✓ Yes if No ft Surface Water> 100' ❑✓ Yes if No ft
Property Line > 5' ✓❑Yes if No ft Driveway/Parking > 0' ✓❑Yes if No, comment
Absorption Field > 5' Z Yes if No ft Wells on Adjacent Lots:
Water Main > 10' ✓❑Yes if No ft Private Wells > 100' Z Yes if No ft
Water Service Line> 10' E✓ Yes if No ft Community Wells>200' ✓❑Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑✓ Yes if No ft Driveway/Parking > 0' ❑✓ Yes if No, comment
Property Line> 10' ❑ Yes if No 6 ft Wells on Adjacent Lots:
Water Main > 10' ✓l Yes if No ft Private Wells > 100' E✓ Yes if No ft
Water Service Line > 10' ✓❑Yes if No ft Community Wells >200' ✓❑Yes if No ft
Surface Water> 100' p✓ Yes if No ft
F. ENGINEER'S COMMENTS
septic to lot line separation distance waiver on file.
All Standpipes present at time of COSA inspection
G. ENGINEER'S CERTIFICATION `+ cF. L,trki
I certify that 1 have determined through field inspections and review ��'�P' •.904
of Municipal records that the above systems are in conformance with j*:'49 TH '•*I,
MOA COSA guidelines in effect on this date. 2/20/2019 • d
CHARLES G BALZARINI
�4� �e .. •CE-13854 . c`v%/�
f� <`)P•.. ••��V,i
COSA Checklist yellow sheet k�`��`Fisi`i.`—
PRODUCED BY AN AUTODESK STUDENT VERSION
W N
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a
"I 0.1 LOT 130
M ...."1 3 W
a
▪ �� / k .n
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F Y N �I / i
Z ``_ I Q n 500'06'13"E 295.70 REC. / \
W 4t1 I 500'20'39"W 296.26 CALC. /
` t f 1vi 1 \
Z I 0 20 c 8I I 2 �'' Z 1 700 w�<<RAD%c, " g a 11 .Zl
N Scale in Feel I w , _ 0
4 d W forir_ , 104.5 r !.. 0
W J a „ w Bowlby Subdivision \ e
D Lu ,°D I SHED/PLAYHOUSE 6 4' 1 0
I— "....,%%1t1,l o = w Lot 1 , \
LU '�p��• OF' A�9pf+L+ I 3 .5 44,344 sq.ft. +/- \\ 1 03
v l D
h 4- //, i Cj 20506 Jayhawk Drive \ ¢ /
I"" - �'� •'• /i/ W J 2 Sfory Wood Framed House \ \ W Z
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'i,42.1„'•. 3/7/2019 -------- ----- \ _____
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.1
N00'06'27"W 295.67 REC.
¢ N00'09'00'W 294.72 MEAS. } } s
I
I LOT 132
I
Legend General Notes Disclaimer
M Will/PLOT PLAN WWI YM
W; water well 0 Concrete 1. Excepting for gross negligence,the liability for this survey shall not This survey complies with ASPLS Mortgage Location Standards.The survey represents visible improvements and LOT 1 BOWLBY SUBDIVISION
exceed the cost of preparing this survey.Dimensions to property lines conditions at the time of the survey.This document does not constitute a boundary survey and is subject to any PNt�gNP41µ10,O,,i V61ell.iveoivocat OnttKr
,.5.; Septic 0 Found Rebar inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine sraii05usrn
^ are plus/minus is the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no
LT) Tel.Pedestal A found Alum.Cap "2. This document is created by Frontier Surveys for the purpose of a plot circumstances should this document be used torr construction or for establishing a boundary or fence hoer. t �,rNAVAµs �''r
0::>. Utility Pole ii Found Hub&Tack plan for Twins Home Improvement only. Mr9m1,41'.L..74.414..,1 SKOPP.cx,R.C.
3. This document is based on Plat No.1986-7,Anchorage Recording Per9uxom.
(REC.)-Record Data Per Plat No.86-7 Palmer Recording District District. Ptrxrrra wtvtvs.uc
MEAS. -Measured Data on lune 20th,20186sow nv uxt.sum 1..nopwwt.s,9%IP
(MEAS.) 4. All lot corners shown in the drawing have been located and marked.
(PROP.)-Proportionated woeY ss
01.40 ev rest mit HALL.f'-Kit S.(t'LN:
NOIS213A IN30l1S>iS300111b NV A9 43DfGO2ld
Parcel I.D. #
1.
t.- / 5-5--5'5"
GENERAL INFORMATION
Complete legal description
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage,'Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
:~'APPROVAL FOR A SINGLE FAMILY DWELLING
C~g~k, AK
Location (site address or directions)
20506 Jayhawk Driv~
Property owner
Mailing address
Lending agency
Mailing 'address
Agent
Address "
Joh~
Day phone 688-5164
Chuqiak, AK 99567
Day phone
Day phOne
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: 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
xxx
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
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 S & S ENGINEERING
! 7034 Eagle River Loop Road
Address ~-,1~ mw, *J~,~ ~ ~'
Engineer's signature "~/~ ~_~-'
Phone
6. DHHS SIGNATURE
.... / Approved for , ~2_,)
Disapproved.
Conditional approval for
bedrooms.
bedrooms,
with the following stipulations:
· ': Additional Comments
By:
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 issu.,ed. The Municip,ality 'of Anchorage is not
'.:/:'(responsible for errors or omissions in the professional engineer's work.?\ ? ~:,.-.~:;
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type '~..~\J lx.-'~_ ~
Log present (~)
Total depth \"~ ~
Sanitary seal ~kl)
Date of test
Static water level
Well flow
Pump level1
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed c~ ~ \ ~ ~ ,~ ~-- Driller
Cased to \ '~ ~ -Casing height
q Wires properly protected (~TN)
PROM WELL LOG AT INSPECTION
7, ~ g.p.m. /'J(,
!
SEPARATION DISTANCES FROM WELL TO:
; On adjacent lots
; On adjacent lots
Septic/holding tank on lot ~ o"~ ~
Absorption field on lot \ o ~
Public sewer main ~\/~
Sewer service line ,~. iA"-
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform C) Nitrate O, ~ ~
Date of sample: \ ~ ~ L~ ~ ~ A Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed \~ -'5 r ~ ~ Tank size ~' I ~'~. ~ Compartments
Cleanouts {~N) ,,J Foundation cleanout (Y/_~ ~ ,Depression, (Y~)
High water alarm (Y~) r( Alarm tested (Y/N)
Date of pumping ~ I o"- 'l,,-'- c/ ~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ o'~' On adjacent lots
To property line I c~ Absorption field
Surface water/drainage \ t~ c,
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer
Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at "Pum?.~.~~at
water alarm level
High
Meets MOA electrical codes (Y/N) _
SEPARATION TO:
WelFon lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed \ o .~ ~ - ~ ~.
I
Length ~' Width
Total absorption area 3~/2. ~
Date of adequacy test / ~ - 7- '~/7/
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~
Soil rating (GPD/FF) \l--5''~/~ f,-- System type
~__k~,~'. Gravel thickness .~ ~ Total depth
Cleanout present ~) ~ Depress~n over field (Y~
Resu~s ~il) ~ for
/ ~ ' / After test
J o~(~ /~o ~ If yes, g~e date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot \ c:,~ ~
To building foundation
On adjacent lots
Surface water \
Curtain drain
On adjacent lots \ c~ b x ~ Property line
T~elisting or abandoned system on lot
Cutbank %~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
/ certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff.?~q~d, ate of this inspect'on.
Signature '.~ ...... ~.~~. ,~ .~.~.,,,~ ,:,
Engineer's Name J~0/~gA~-- · CO~'~/ ~1[..~...~ ROBERTC. COWAN
Date /0 ~///~ ~ ,~ ~,,.. ...~
H~ Fee $ ~ 0~ , ~ Waiver Fee,
Date of Payme~ [ ~ ~/~ ~ ~ Date ot Payme~
Recei~ numar ~ ~? ~ >~ Receipt numar
72-026 (~)* ~ck
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
..... 264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name /l~//~('~' ~~y Telephone:Home ~)'~2-"~'~ Business --
Applicant Address I,~ O, {~0~ '"~Llt'~5~" ,~PrE--/.,E /~U~,'~; j4///,~,~
(c) Applicant is (check one): Lending Institution []; Owner/builder~2~; Buyer []; Other [] (explain);
/
(d) Lending Institution Telephane
· , ,"~'": Address
~ '::.;~;':,;;w~* (e) ': Real Estate Company and Agent
Telephone
the HAA to tl~/ou~.~ia~dress:
17034
...... ~ Eagle River, Alaska ~5~
OF RESIDENCE
!Multi-Famil
SUPPLY
)nfirmation from the~ :)artr ,nme
On SiteX :~ pub iic [] : Community [] .: ..H~)lding Tank 1-1 :.i ;: :: ..L : : : .'1: ' ~ : ':'' .'~. ' ' , . ' ' '; . ' '
Note: If community Well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2 .
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eq~, u! suo!ss!mo ~o sJOJJa JO,~ elq!suodseJ ~ou s! e§eJoqou¥ jo ,~l!led!o!unv~ aq.L 'penss! s! eleO!J!l~eo e eJoieq e~,ep eZXleUe
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,~Hoqln'v' q~leeH senss! (d:IHQ) uo!loelOJd I~lUeLUUOJ!^U=I pu~ q31EeH lo ~,uamlJ~deQ e~Joqou¥ ~o ~!led!ounl~/ eq.L
NOI.LFIVO
t~UO!l!puoo
,g
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPALITY OF Ai~''~'~'~EAUTHORITY
APPROVAL
(HAA)
ENViP. oNUF-NTAL SEP, VlCF-S i::~,,III~,~LIST- FEBRUARY 1984
264-4720
DEC 4 !987 Legal Description:
RECEIVED
Well Classification
Well Log Present. N)
Total Depth \'1 ~
Static Water Level
\~.5~-"~\,J ~ ~-..~/"~.-'u..- If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ -- \ ~ ~ ~ Yield
Cased to \'7...-'~:~ / De pth of Grouting
~ ~ ' Pump Set At
I
Casing Height Above Ground
Electrical Wiring in Conduit~N)
Separation Distances from Well:
To Septic/I,letdmg Tank on Lot
Sanitary Seal on Casing::~N)
Depression Around Wellhead (Y/~:~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments _~ '~' )~-, -
· On Adjoining Lots
I
On Adjoining Lots
To Nearest Public Sewer !
/J/,A TO Nearest Sewer Service Line on Lot ~ Jr'
B. SEPTIC/'HOLIDfRG TANK DATA
Date Installed
Standpipes ~N) ~/ Air-tight Caps ([~7/N)
Depression over Tank (Y~[~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/HoMh:,g Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course ~
Comments '~';¢" ~
Page 1 of 2
No. of Compartments
'-/ Foundation Cleanout (Y~
Date Last Pumped L~, / ~/~"7
r~ ~, ;for
Temporary Holding Tank Permit (Y/N)
I
To Building Foundation \ 0
To Disposal Field
To Stream, Pond, 'Lake, or. Ma)or Drainage
72-026(11/84)
C. ABSORPTION FIELD DATA
To Water-Supply Well
To Building Foundation
Lot
Soils Rating in Absorption Strata
Date Installed \~ -" '~ J ~-~ Length of Field
Width of Field ~
,:~1,-I l~J~. Depth of Field
~,rave Bed Thickness '2....
Square Feet of Absorption Area~ "~P~ "L- ¢ (~' .W,¢6.') Standpipes Present(~N)
Depression over Field (Y~[~ t-J Date of Last Adequacy Test
Results of Last Adequacy Test ~---2~\~
Separation Distance from Absorption Field:
/
~ (~:2~' To Property Line
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
Type of System Design
To Driveway, Parking Area, or Vehicle Storage Area
Comments ''~ ~¢---~-~O~,-'~f¢, ~" r V-J ~¢~. ~
LIFT STATION
Size in Gallons~
"Pump On" Level at
To Existing or Abandoned System on
· On Adjoining Lots
!
To Cutbank (if present) ~//~'
Dimensions
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumplftcj-Cy.c_~e_.~s during Adequacy Test. Meets MOA
** 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.
Sig 8(&l $ ENGINEERING Date
170~4 Eagle RI,er L~I~ Read No. 204
C o ~l~;lal~ y~i~,7~l~atka~ MOA No.
Date of Payment
Amount: $
Page 2 of 2
72-026 [11/84)
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
;~;~-~" X 5633 B STREE'T ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
/ --'~'.-"~_-/,E'~... X FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE
Client Smpl iD: LOT i BOWLB¥ it-23-87 1730
Sample ~ec'~ : NOV 24 87
Reports
Work Order No, : 4076
Client Account : SNSENGP
~ate ~eport Printed: ~0v 30 87
Reports Address
Speciai
instruct:
Chemlab ~ei ~: 844i Lab S~pl I0: i ~atrix: Water
Ailousble
Parameter Tested Result/Units ~ethod Limits
NITRATE-N ND(0.10) mg/}
Ren~arks: ANALYSIS COMPLETED: 11-25-87,
~A~ORA?OR¥ SUPERVISOR: STEPHEN C, ~DE, ~4~~-
i Tests Performed , See Special instructions Above
ND= None Detect¢ *~ See S~mpte Remarks Above
NA= ~ot Analy~ed LT=Less Than. GT=Greater Than