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HomeMy WebLinkAboutMARIE ACRES LT 21 � 1 NUJ 9Led U L U � LJ DEC 212018 inspecuon meporn_i- i - it.aoc Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171247 PID Number: 018-181-23 ❑ New ❑✓ Upgrade Name: VERNON & MARY OSBORN ABSORPTION FIELD ✓❑ Deep Trench F1 Shallow Trench El Bed ❑Mound Address 14041 THUNDER ROAD ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 13 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 7.5 Ft. Gravel depth beneath pipe 5.5 Ft. Subdivision MARIE ACRES Block Lot 2 Fill added above original grade 0.0 Ft. Gravel length 70 Ft. Township Range Section Gravel width 2.5 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Stationine �Holdinqwer Total absorption area 770 Ft2 Number of trenches 1 Dist. between trenches Ft. Well 118.6 159.3 N/A ( N/A 108.5 TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1250Gal. Surface Water 100+ 100+ N/A N/A Material Number of compartments Lot Line 33.8 23.9 N/A N/A NA STEEL 2 Foundation 10.6 10.9 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ N/A N/A Gal. Remarks Pump on level at in. Pump off] vel at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield ISAAC'S Drainfield 3034 CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 103.0ft Inspection5i dates: 9/25/17 2 a Sd 10/3/17 4'h 9/26/17 12/4/18 Location and description BOTTOM TRIM AT GARAGE POINT C COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date,� OF At,, Skhk t'te'ven 'f�. 0ann6rae' 8149 ® �� 0r�',. Approved I Date inspecuon meporn_i- i - it.aoc IWELL (E) { INSTALLED 1250a SEPTIC TANK 17, W/ DCO AND DV AFTER CONNECTED TO MIDDLE OF 1 10'!7, DRAIN FIELD \\ DECOMMISSIONED 1250g SEPTIC- Qz TANK (E) PER MOA CODE /y z ' / DRAIN FIELD (E) IN FAILURE R �RE-USE AS RESERVE t zui 1 GARAGE Tu -1 1 M1„ /-- INSTALLED DRAIN FIELD o 70LF x 2.5'W x 5.5ED x 13.0'TD ( 1 INSTALLED MT AND CO AT EACH END A DESIGN PARAMETERS C D E UPGRADE SEPTIC SYSTEM l NO. BEDROOM: 4 (600 gpd) 0 TANK SIZE: 1,250g L ,- 105 PERC RATE: 14.3MP1 SOIL RATING: 0.8 GPD/SF _ AREA RQD: 750 SF JZ Z o FILTER FA RI SYS. TYPE: DEEP TRENCH: 7.0'ED 2i MIN LENGTH: 53.6 LF 0 DV 1 , USED: 70LFx2.5'Wx5.5' E.D., 13.0' TO 4BR TOTAL AREA: 770 SF HOUSE i / (E) IWELL (E) { INSTALLED 1250a SEPTIC TANK 17, W/ DCO AND DV AFTER CONNECTED TO MIDDLE OF 1 10'!7, DRAIN FIELD \\ DECOMMISSIONED 1250g SEPTIC- Qz TANK (E) PER MOA CODE /y z ' / DRAIN FIELD (E) IN FAILURE R �RE-USE AS RESERVE t zui 1 GARAGE Tu -1 1 M1„ /-- INSTALLED DRAIN FIELD o 70LF x 2.5'W x 5.5ED x 13.0'TD ( 1 INSTALLED MT AND CO AT EACH END \M1, TH-2 / z C A B C D E DCO 1 8.8 o� ~0 0 T1 14.1 24.0 T2 20.4 30.9 JZ Z o FILTER FA RI DCO2 22.7 33.3 0 DV 24.3 34.7 C1 O.G./F.G. 103.0 31.6 12-5 M1 - 31.4 11.7 C2 _ TH-i 69.6 89.0 Mit 69.4 88.60 \M1, TH-2 / z C o� ~0 0 0 m m 0 Zw w wW w JZ Z o FILTER FA RI oQ LIU U 0 "5 z OU >Q cJ RAiNR K "A z PP INV M V O.G./F.G. 103.0 O.G./F.G. 4"0 DRAIN PIP 103.0 - _ TH-i I OR 2 OL 3 GP 4- 1250 g SEPTIC 5 TANK 7 CONNECTED TO MIDDLE OF 6 7 DRAIN FIELD g DRY: PROFILE 5 5.5* DRAIN ROCK SCALE: NTS 9 GM 10 - 11- 1i1 8/22/17 12- 1 19 80H DATE PERFORMED: 8/15/17 NOTES: PANNONE ENG SVC LLC P.O. BOX 100217 ANCHORAGE, AK 9951002/14/19 ••• Dote RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211 �••• •� •••• •• •• ••••••• ••even t�. annaAe Scale 1"=50' DRAWN BY: MARIE ACRES, LOT 2•••• VERNON & MARY OSBORN ACP P.I.D. NO 018-181-23 PERMIT N0. 14041 THUNDER ROAD CE 824$ OSP171247 PLAN ANCHORAGE, AK 99516 Sheet 2OF2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST HOLE 2 OR ORGANICS OL ORGANIC SILT POORLY GP GRADED GRAVEL GM I SILTY GRAVEL 80H DATE PERFORMED: 10/3/17 SOILS LOG - PERCOLATION TEST SLOPE X TH WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DF DEPTH TO WATER AF' MONITORING? '#fit DATE: /v l f!e READING DATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 1013/17 11:25 --- 6.70 --- 2 11:35 10 MIN 8.50 1.80 3 11:35 --- 6.70 --- 4 11:45 1 10 MIN 8.45 1.75 5 11:45 --- 6.70 --- 6 11:55 10 MIN 8.42 1.72 PEROLATION RATE 5.8 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 13 FT AND 14 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST PAMOM EN SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510�� PHONE (907) 272-8218 FAX (907) 272-8211 � -o®�� ,�� meq) - y�t ;,o'*.- 49 TH > / ....... S'te'ven R. Po one' d CE 8149��®r t�,® \\ -®� Date 12/20/1 s RECORD DRAWINGNOTES. Scale NTS MARIE ACRES, LOT 2 VERNON & MARY OSBORN 14041 THUNDER ROAD ANCHORAGE, AK 99516 P.I.D. NO 018-181-23 PERMIT N0. osPt71247 SOILS LOG Sh3e0F 3 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP171247 Work Type: Septic Upgrade Tax Code Number: 01818123000 Site Legal Address: MARIE ACRES LT 2 G:3035 Site Mailing Address: 14041 THUNDER RD, Anchorage Owner: OSBORN VERNON H & MARY Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: �IlIent J i)l'I)HI'Clll@ll[ 9/5/2017 9/5/2018 16/1-7 B °i4 {(a 49459 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (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 If9ihu� 19 3.' lvc co� r 1""fo V. : A(�q � l Ql! k 40 b.—(�Ov)B � fi rrie a� COYIS lru��10►� . Received B) Issued By: Date: / 7 - Date: L�L 4 MUNICIPALITY OF ANCHORAGE Illni Community Development Department \ " 45r,j Phon-, 9, - '701• Development Services Division . - •- • On-Site Water& Wastewater Program �� ON-SITE SEWER/WELL PERMIT APPLICATION a AUG 23 2017 1 4• - -i * S f Parcel I.D. 018-181-23 << aMaryOsborn 6 a c °° Property owner(s) Vernonernon Day phone Mailing address 14041 Thunder Road, Anchorage, AK 99516 Site address 14041 Thunder Road Legal description (Sub'd., Block & Lot) Marie Acres, Lot 2 Legal description (Township, Range & Section) Lot Size 49,459 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑Q Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. AP \ N (Signature of property owner or authorized agent) Permit/Rush Fees: S 1 — Waiver Fees: Date of Payment: ? 3-7,11-7 Date of Payment: Receipt Number: 091341 G Receipt Number: Permit No. nen 1Z`f Waiver No. Permit App_ - .:..c: Pannone Engineering Services LIC Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com August 22, 2017 Subject: Marie Acres, Lot 2 Upgrade Septic System Permit Request Design Narrative This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed system will serve an existing four (4) bedroom house. The existing drain field is in failure and will be re-used as a reserve. The system will utilize a replacement 1250g septic tank and conventional drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100' of the proposed septic system. 1. Soils. One test hole was performed in the vicinity of this system by PES in August 2017, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 19' below the surface in the test hole monitor tube in August of 2017. Bedrock was not encountered in the test hole to 19'. Based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 gallons/day/square was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography on the lot generally slopes from northeast to southwest, with a slope of approximately 3% in the area of the drain field. There are no steep slopes in the vicinity of this system. The proposed drain field will maintain 50' separation all steep slopes. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 lJ SEPTIC AREA (E) t i / 1250g SEPTIC TANK � DECOMMISSION PER CO AND INSTALL _4,1 ,1_,,,R/ P) DO BLE CLEAN OUT,SEPTIC TANK AND ERTER VALVE � � R T ,,......,..__ ,k, ,, ,,,,,,_:___ , ., "' DRAIN FIELD (E) IN FAILURE 4HOUSE R = V RE-USE AS RESERVE (E) o IH-1 1 � . -. WELL (E)—\ NO l, `� GARAGE ,s. k w• l w / ` p a UPGRADE DRAIN FIELD (P) 1 6OLF x 2.5'W x 7.0'ED x 13.0.-IDTIE INTO MIDPOINT OF FIELD INSTALL MT AND CO AT EACH END I I 2.2_ 1 iM N I I DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) LEGEND TANK SIZE: 1,2508 w WATER LINE/ PERC RATE: 14.3MPI WELL RADIUS ABBREVIATIONS SOIL RATING: 0.8 GPD/SF AREA RQD: 750 SF TH TEST HOLE SS NEW SEPTIC SYS. TYPE: DEEP TRENCH: 7.O'ED (P) PROPOSED MIN LENGTH: 53.6 LF (E) EXISTING GB- - - GRADE BREAK CO CLEAN OUT NO. USE: 6OLFx2.5'Wx7,0' E.D., 13.0' TD 0 0 RETAINING WALL MT MONITOR TUBE NO. TOTAL AREA: 840 SF TYP TYPICAL NOTES: s,��....ku Date FOR CONSTRUCTION PANNONE ENG SVC, LLC OF A� 11 8/30/2017 P.O. BOX 100217 ANCHORAGE, AK 99510 '� 'q , SAY:.' ' 2.4-‘1' . Scale PHONE (907) 272-8218 FAX (907) 272-8211 meg,• �4,, •77 # /*: . . �� • *() 1"=50' DRAWN BY: — / • DRM /••"••' 0 P.I.D. NO MARIE ACRES, LOT 2 ' �� �. 018-181-23 VERNON & MARY OSBORN i Steven V. annorae / PERMIT NO. 14041 THUNDER ROAD %I..,�+ . CE 8149R�� 0SP171247 kg PLAN ANCHORAGE, AK 99516 �I, •.....•P\7= Sheet ��N��`_�� 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: REPLACE SEPTIC TANK. INSTALL NEW DRAIN FIELD. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 19 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS TO THE ENGINEER. THE RED-LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN-OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS-BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: . TITLE: DATE: NOTES: PANNONE ENG SVC, LLC _-�� `�� Dote pF AL sl + FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, A 99510 8/30/2017 r'��• q 1 PHONE (907) 272-8218 FAX (907) 272-8211 fty, �4 •�y�; Scale DRAWN BY: — #; . • TH /�\ *`` NTS DRM ' fp foo; fr ••' P.I.D. NO MARIE ACRES, LOT 2 - ., .. 018-181-23 VERNON & MARY OSBORN Steven Po e NO. CE 8149 OSP171247 14041 THUNDER DESIGN DETAILS ANCHORAGE, AK 99516 +Nil -4> •OFES510Np��` r Sheet i��ww���—� 3 OF 3 SOILS LOG - PERCOLATION TEST TEST HOLE 1 SLOPE %7`\ SITE PLAN OR ORGANICS -*7 2 OL ORGANIC SILT \ i\* ' POORLY 3 GP GRADED GRAVEL /7 4 4BR z I 5 HOUSE 6 x (E) 11 (E) 6 \ TH • Z GARAGE 1 • e w• W 9 l GM SILTY GRAVEL / 10 ---..\\ 1 ) —. 11 12 . 13 • WAS GROUND WATER SLOPE 14 ENCOUNTERED? N 15 IF YES,AT WHAT TH DEPTH? -DRY x 16 17 DEPTH TO WATER AFTER MONITORING? -DRY 16 DATE: 8/22/17 WATER 19 BOH READING DATE CLOCKTIMENET TIME LEVEL NET DROP READING 20 1 8/15/17 12:40 -- 6.39 -- 2 1:10 30 MIN 8.52 2.13 DATE PERFORMED:8115117 3 1:10 -- 6.39 -- 4 1:40 30 MIN 8.50 2.11 5 1:40 --- 6.39 ------ 6 2:10 30 MIN 8.49 2.10 PEROLATION RATE 14.3(min/inch)PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS:Test hole excavated by A+ HOME SERVICES PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: ..-----,INN,‘,‘‘‘, Dat,: FOR CONSTRUCTION PANNONE ENG SVC, LLC � :11,:,46,44 . 6/30/2011 P.O. BOX 102954 ANCHORAGE, AK 99510 .r :. PHONE (907) 272-8218 FAX (907) 272-8211 ,.OS:. �4 1:41 Scale DRAWN BY: Of*: *:' TH )\ ..id/ NTS DRM Al "" "' 0 P,I,D. NO MARIE ACRES, LOT 2 ,�.�/ 018-181-23 VERNON & MARY OSBORNteveCE 8149 no PERMIT NO. 14041 THUNDER ROAD 111 �s• OSP17124/ SOILS LOG ANCHORAGE, AK 99516 6/• 30/Sheet `���\\���� 2 OF 3 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4 _' o , 4700 Elmore Road ��" P.O. Box 196650 < MarkBegich Anchorage, AK 99507 $" r c r r Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: VW -18123 Legal Description Property Owner Name & Address: YA n i'e a MA(ty W 60A,w1 1 y o"l1 -rm t4 Z &Q- (U. L + z NC"0 A(;C AK 9 951(- yo-qa Pump Installation Date: !{ S Pump Intake Depth Below Top of Well Casing: Yh1 feet Pump Manufacturer's Name: P Y /U16 (j o :+.a J Pump Model: 2-5OGUU3L5 Pump Size V hp �y Pitless Adapter Burial Depth: D feet Pitless Adapter Manufacturer's Name: 4/,,/p Pitless Adapter Installer: - V/ Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Comments: Pump Installer Name:�,� in Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME _ A PHONE ,J Efry )E MAI LI 'ADDRESS/ 611 E�/"1 Q f f LEGAL DESCRIPTION LOCATION Int `" NO. OF BEDROOMS L) Y DISTANCE TO: We Absorption CC11 Dwelling V V PER Np 6 I__ Q w F Manufacturer/1 ' �-�j�J J Materi ONo. of corn artments �� N Liq. capaF '!jlions IF HOMEMADE: Inside length Width Liquid depth Y J02 DISTANCE TO: Well Dwelling PERMIT NO. O z 4 x-- Manufacturer Material Liquid capacity in gallons O LU DISTANCE TO: Well '7- ®1 Foundationq3i 1 Nearesto Iirpe�. (� PERMIT NO. J LL Z ? ¢ No. of lines, �7 pG� Lengl{ of etc I'ne� pG v Total length of lirvs f© Trench wid �. inches Distance e e Ines cc I.- p Top of tile to finish grade Material be eath tile 7 - inches Total fec 've sorption area LU 0 Length Width Depth PERMIT NO. 41­- as LU Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. LU � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS CAT SOIL TEST RATING INSTALLER / - F6 /1? l � � Y REMARKS APPROV DATE LEGAL 72-013 (Rev. 3/78) 1// i A 'Cn— —/ DEPARTMENT OF HEAL. E'H AND ENVIRONMENTAL PROTECTION cl 825 'L.• STREET'. HtICHOf::AGE: FIK. 99501 / to 26.4-4-7120 R -A E= Fl_ L_. 1=1E F "y AEwA R "� - =- 1 T E.: °E _ - E? -•-Q EZ" Fz. F=- P7 € -° fi°-9 1 ;h APPLICANT LT_LINt1 _. HIGGINS PO FOX 10-1463 99511 ! 349-3 31 LOCATION Ml DEFlF:MO N1df LEGAL T1'2NF?.31,.lS. w = L 4 LOT SIZE :I0::;':L,16_ 0 :_Y�!_ ARE F-llS4. TYPE OF ':OIL ABSORPTION SYSTEM IS: TRENCH t'iF1<:ItlUh1 NUMBER OF BEDROOMS 4 SOIL. RATING =Q FT,°'BR.`1. 2 C -aLo THE =EC_IFE;SIZE OF THE SOIL ABSORPTION -rSf_r IS: �l E..: ' i� - "'_� _.::� K �'A .-. �''° A_3 _- F' -•F ^ =- A.M.* a — A i �: fzi %. ° '.Y. �_.. E:a E- r`"" -T- &_,° L7,00 TE'Ir_ LEN13TH DIMENSION I S THE LENGTH ','IN FEET> OF THE TRENCH OR f; RA I NFI ELC). THE DEPTH OF y TRENCH OF, PIT IS THE DISTANCE BETWEEN THE SURFACE OF 'THE IGROI_IND FIND THE BOTTOM OF THE EXCAVATION (IN FEET?. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DDEPTH OF GRAVEL. BETWEEN THE OUTFALL F'IF'E AND D THE BOTTOM OF THE EXCAVATION ( I N FEET). F''ERM I T APF'L I CANT HAS THE RESPONS I B I L. I TY TO INFORM THIS, DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF I=1C•Y WELLS F3DJAC:EhlT TCS THIS PROPERTY AND THE t••ILIMID'EF? OF RESIDENCES THAT 'THE WELL WILL. SERVE. i- F -"-F A,••_b < ;2 "_q I P-4— IDPAS_-- �" a �'••'° �^.' �='° f� Aw: ®�_..� _F: F 4 EEE-?' _.._. -..._ __- E.E3C:`"FI LL I NG OF ANY SYSTEM WITHOUT FINAL INSPECTION AND FIF'FF:O'Y`AL BY F H I E DEF`FiRTMEt• T E:lILL. BE SUBJECT TO PROSECUTION. t'I I N I C1€ M DISTANCE BETWEEN-{ F! WELL FIND ANY ON --SITE 'SE=='1AGE DISPOSAL SYS TEM I 1.010 FEE`!- FOR A PRIVATE WELL �: R 150 TO 200 FEET FROM t � PUBLIC 14ELL DEPENDING I_!PON THE T` -PE OF PUBLIC: WELL. MINIMUM DISTANCE FROM A PRIVATE 14EL.L. TO N PRIVATE =EWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FE=ET. WELL L.OG:_, ARE REQUIRED t N[) MUST BE RETURNED TO THE DEPARTMENT WITHIN -7-:0 DAY OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SF'E C-: I FI C Fi T I OE'•dS AND CONS TR CJ' I ON DIAGRAMS ARE AVAILABLE TO INSURE PROPER INI:=TALLATION. I CERTIFY THAT 1: I AN FAMILIAR 14ITH THE REQUIREMENTS FOR ON-SITE SE[4EF:S AND WELLS, A =ET FORTH BY THE MUNICIPALITY OF' ANCHORAGE. _.: I WILL I Pd'._.THL.L. THE `_ 'T'' 'f Et'1 I N ACCORDANCE WITH THE CODES. DES. 3: i UNDERSTAND T'Fit'dG I hIFIZ' THE Citk -w I TE SEWER : E `v'F TEt'1 t'1; 1'- REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. APPLICFlNIT WILLIAM C. HIGGIN'S \ , SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: — DATE PERFORMED: �z LEGAL DESCRIPTION: r @ /Z" 4 r� SLOPE DEPTH (FEET) 1 2 3 \ f -4 5 6 7 8 9 10 11 12 13 14 15 16 17 1s 19 20 COMMENTS WAS GROUND WATER L ENCOUNTERED? O _Sa� d (SP) e IF YES, AT WHAT M_/ f'dg DEPTH? -7-74-131 Reading Date Gross Time Net Time Depth to Net Drop eWaatedr/ 0,17 lz 3 01 73 d,_'�rz 3� z-_ . 4� z © . PERCOLATION RATE � 15 (minutes/inch) TEST RUN BETWEEN FT AND FT G—so 'r__ -k PERFORMED BY:CERTIFIED BY: 72-008 (6/79) s DATE: e Idl ra 0 0 0 0 0 w w a' ON . o 0 w w w w rn: 0 rl O O O O O N 4' 'C7 T5 O: CO : 3 O: �E : o: 0 4-C v-4: Ul ; .-i : O : .-i: r -i : O: I co: CO o SS : PA: 1 IH: w o �S A • : 4' i ei ro : Z z o: o: w co : \.O : 3 w ® U : ri u cd w Ln z w Z� x FG ® U A y d@ F z F F F F F F [• F+ F F ra 0 0 0 0 0 w w w ON . o 0 w w w w rn: 0 rl O O O O O N 4' T5 CO : 3 •rl : C''1 : N v-4: Ul ; .-i : O : .-i: r -i : O: I co: CO SS : PA: 1 o A • : 4' i ei ro : Z z o: o: w a P1 w q O w ® U : ri u cd Ln w O FG in aO A 3 A w d@ F z F F F F F F us 0 0 0 0 0 w w w 1 0 0 w w w w w 0 rl O O O O O N 4' us w w w w w w 1 0 0 0 0 0 0 rl r-� rl N 4' CO : 3 us rl r-� rl N 4' CO : 3 cd: ro : Cd cd : rI: o : r•i ; U : ri Zi : • ri : cd Clo: Tn : in aO F F F F F F F F [• F+ F F c1�N Ln Ln o C`: 0' O 0 O O O O O O O O O O E-+ H E -F H F+ F F F F F F F w w w w w w w w w w w w O \r \ O O O O 010 O O O O O O a V. 9 cd r4 lnA x W c4 us MUNICIPALITY OF ANCHORAGE fi • '� DEPARTMENT OF HEALTH & HUMAN SERVICES M� 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 Parcel 1. D. # 01 83 - 18 1 -Z-_S 1. GENERAL INFORMATION \Agjj`t Complete legal description oT 2 �^') 2�C A _s/71 a CLor eq T i -LN, mow; S z1 Location (site address or directions) /,1/oq f Property owner Day phone Mailing address R- o Qou. /// e/63 , 10.v c A F. . � K 9 C .C7 -//–/d 63 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: q 3. TYPE OF WATER SUPPLY: Individual well X 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: Individual on-site — Holding tank Community on-site Public sewer 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 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm G SV Phone -7-1F _ 'z� 93 Address �oyc /k2 oz c ry O(; ra t< q J) S/4( Engineer's signature___ Date 6. DHHS SIGNATURE , J Approved for ul `4 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Note • The well for this property meets existing State and Municipal Codes. There are nitrates present. It is „co tinued su By: trate concentration is 7.07 mg/1 Date EPA 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 engineers work. 72-026(Rev.1/91) Back MOAR21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIREC E I V E Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 JAN 13 1997 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: LZ, m Ay i Ls._ SIL L Parcel I.D.: 0 A. WELL DATA Well type GPak V Airs_ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) lel Date completed D� gra Ctz) Total depth Cased to .; 40+ Casing height (above ground) / Z Sanitary seal (Y/N) Date of test Static water level FROM WELL LOG 3yl Well production 9 G{Pl) g.p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) T AT INSPECTION . O g.p.m. Coliform © Nitrate . t? Other bacteria " C� Date of sample: I — 12 Collected by: 1� •P�Q'/an1NON B. SEPTIC/HOLDING TANK DATA Date installed 1i' $`8 [ Tank size LNumber of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression (Y/N) t -l. High water alarm (Y/N) Date of Pumping 1—{O-1jV, Pumper .j -F C. ABSORPTION FIELD DATA {( R'z_nN Date installed ( Soil rating (g.p.d./ft2 o ft2/bdrm) System type a --T- -;, q TZ4 +410 � Length 6 Z4 Width s [ Gravel thickness below pipe � 1 Total depth (1. B t Effective absorption area 760 &2) Monitoring Tube present(Y/N) �C Depression over field (Y/N) Date of adequacy test 1 Results (Pass/Fail) s For '?�_ bedrooms i•4 Fluid depth in absorption field before test (in.); 36 Immediately after /oct5gal. water added (in.): `/O Fluid depth3�(ins.) Minutes later: /c!" Absorption rate = /, 6, 0o g.p.d. Peroxide treatment (past 12 months) (Y/N) ,u p If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES Size in gallons *Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/bolding tank on lot /0C) --t- : On adjacent lots / b© Absorption field on lot / pp'+ : On adjacent lots / Oc9 + Public sewer main 'v /(\' Public sewer manhole/cleanout N Sewer /septic service line ci * Lift station ! pct i— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation 33 t Property line -5O Absorption field /0 t Water main/service line dO' Surface water/drainage / Oc�,4 Wells on adjacent lots / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water / t Curtain drain 6 V U-�- F. ENGINEER'S CERTIFICATION Water main/service line / C?c9-I•- Driveway, parking/vehicle storage area 5 o F Wells on adjacent lots Oc7 4- Property line 2� 1 certify that 1 have determined thru field inspections and review of Municipal records that the above systents'are in conformance with A1100A- HIAA guidelines in effect on this date. Signatttr� Engineer's Name 'ka.< , Cjory c�- ?. Flnpmcoiiii& $ea!"HerR Date (-7'Z-°7'7 HAA Fee $ ��Du ,.CSO Waiver Fee S Date of Payment Date of Payment Receipt Number �S 15 f ev Receipt Number Rev. 8/95 OSS: haa.wk.doc · . AppLI¢" NT FILLS OUT UPPER HAl* 'ONLY .... ' ~, ~_~ ! ¢,~ /- -: Phone Property Ow~..~er iX..)i ~i . c :. '~ , . , Mailing Address \. , ~.. ~ ~ I ~J ~,~ ' ~,~ ~,..~ ;: ;(' . Zip Code Buyer Address Zip Code Lending Institution Phone Address Zip Code Phone. Type of Resi~nce Single Family ~ Mu~tipl~ Family No. o~ Bodroo~ D Other Water Supply  Individual A~ACH WELL LOG A w~l Icg is required for all wells drilled since Juno 1975. Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ individual Year Individual Installed: J ?~ / ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION ~EE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. \-~ Time Time Time Time Date Date Date Date,~.. Inspector Inspector Insp~tor Insp~to~ Field Notes: ( ~ ) DISAPPROVED ( ) CONDITIONAL APPROVAL; 8oils Rating Date ~wer Installed Well To Absorption Area Well Log RebeJved Well to Tank Septic T~k Size 72-023 (3/82} ---„ - DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE � DATE 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled �1 1 C)_ of - 2S� INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P8O f ECTION • ENVIRONMENTAL SANITATION DIVISION `w -r 2 0 1981 Telephone 264.4720 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE 66f ilk. -D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER _ PHONE M NG ADDRESS AL 8. ?t� ��� i OcGID`a fY - INJ7 PROPERTY RESIDENT (If different from above) �/ l / e/t, tr�6r�v7 GCf� wd"eheo-a C �i K� PHONE .44S—t 0 2. BUYER ' �\ U1 yl '£'E''G ri l�, r �J ills PHONE (J(/Gf� (�^�ifW /J�� MA V ! 0, c� k `�' `�� (o cko Pea, / / /K / i 3. L I NSTLI'`UTI Maq 5, PHONE MAILING ADDRESS X301 �I`'Vii�l �� U✓f�fvv� vICY%o�e e 4. REALTOR/AGENT - PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION 1,04- _ av01/ 1 2 no Qdr7 ecf ee ,00l 33 �eklare wLoy-A STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDRQQMS - P SINGLE FAMILY ❑ One S— Four ❑ Other ❑ ' Two ❑ Five EDMULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** /°I!�,l YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) i6t jfj THIS SIDE FOR OFFICIAL USE ONLY 1 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX Z. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE E] PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED _ �( INSTALLER ❑Septic Tannkrlor ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING - TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL r_ i 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS V --"APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 49 BY 72-010 (Rev. 6/79)