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ARVESON LT 6
Arveson Lot 6 #015-273-11 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page / of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: d.50P15'13144 PIDNumber: 0/SZ73//aoa Dwelling: ❑ Single Family (SF) Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New XUpgrade Name: L01t1G 45;+Clf 100A7_C,46'F_ ABSORPTION FIELD .60s7_11V6 ❑ Deep Trench E] Shallow Trench F1 Bed El Mound Address If < L t ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade / Z Q— 7603 -/ GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot 4)p VeXaAj Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines I Ft SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist between trenches I From Tank Feld Tank Line Fe Ft. Well /� ® . /� N , /� /V 2.St TANK Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity _C E 9E 1Z SQ Gal. Surface Wateri 1190 Qd NT e114 Material Number of compartments Lot Line d/ /G";C, S% E J614— NA Foundation 5 / / d �A LIFT STATION A Manufacturer Capacity Curtain Drain — Gal. Remarks7;4/✓K n. Pump on level at Pump off level at in. High water alarm at n. F.PL.�FG��tGaU T ��i � Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank Tank to ✓G��drainfield G D � Drainfleld c30 'Tttco/MT Inspector BENCH MARK (Assumed elevation) �� ft Inspection 1�� // S Z,i /O z /�S dates: Location and description TOP U� �� G/t 3° 4m COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin @r4Stamp � ,. , Conditional Approval: Date ' f P y �1 /j Approved Date (a inspection Kepovi-1400C ai}das 00 M cti (� UN ED CU U f— F- A A (/I (4 O� 0 }UaLUasp3 C}iii}n pi �2ED X LLJ0 O= N Ce) O L N -H = U d Q d O Lu LLJ p x O Y 0 Q :vim 0 J ,do �i d O 6 Q V Z � Q N (__) U E 3 a m ( m Z Cf)°� LT LJI <W Ij . CD (U Ce) II L N -H = r d Q d Q Lu LLJ Q > W 0 Q :vim 0 J ,do �i LJ M j Q V Z � Q (__) LLI m LT LJI <W Ij . L � ° N � H O Q 3W (/l W Q IQ Q '3LLI 6 i i auo� Apo4s L,d ai CD (U Ce) II c� r 0 r d Q u7 Q Lu LLJ u > W 0 Q :vim 0 J ,do M j Q V Z � Q (__) LLI m LT LJI <W Ij . V / 0 Q 3W (/l W Q IQ Q '3LLI i i •' � 5 �o •• % - 1*4i/S41 i :� ••� rr^^ V n h N° N �Z ON Q Lu LLJ n O Q X M j (O Z °a m ZW m Oo U 0 N Ci Ln o a 1 o > e d > LJ ajw U • S U C: N L O - N F- L OD Ul J L O di vi do X > U W p L� o w m ~ S U i' _Ul - p d X f W 00 C91 C: O 4' W N O u H o.r Q O Q � Q O 3 C Q E-1 W U i \ W oo� Q io W J r -i o z � w W �z U Z Q Q J W U 0� H V � z W Q F- S p Y N L F- > cc) i Ol O O Ol U W = d d d L 0 p W U oLn dcu c ¢ It O N 00 C91 C: O 4' W N O u H o.r Q O Q � Q O 3 C Q E-1 W U i \ W oo� Q io W J r -i o z � w W �z U Z Q Q J W U 0� H V � z W Q F- On -Site Water and/or Wastewater System Permit Permit Number: OSP151314 Tax Code Number 01527311000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: SepticTank Upgrade Permit Effective Dates: September 22, 2015 to September 21, 2016 Design Engineer: NORTH RIM ENGINEERING Subdivision: ARVESON Site Legal Address: ARVESON LT 6 G:2635 Owner/Address: LONG BEACH MORTGAGE LOAN TRUST 2005-1 ASSET-BCKD CERTIFICATES SERIES 20 3815 SOUTH WEST TEMPLE SALT LAKE CITY UT 841 Site Mailing Address: 3701 E 112TH AVE, APT 000001, Anchorage Lot Size in Sq Ft: 10006 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By By Date: Date: MUNICIPALITY OF s SEP 1 1 2015 Community Development Department6r` P e: 907-343-7904 Development Services Division << 5 ax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. W5- Z73-4� Property owner(s) 40 /J6^ Br'a.n_1-1 iudL?r Day phone -tCl- ?.d O Mailing address 3 7o Site address 5.4.�NoL� Legal description (Sub'd., Block & Lot) _ A Legal description (Township, Range & Section) VOJ Cw t 6'T Lot Size _Z2,_00 ea Sq. Ft. Number of Bedrooms _q APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ Septic Tank � Upgrade (w/wo ADU) `�' Holding Tank ❑ Renewal 0 Duplex (D) /`'" 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. Permit/Rush Fees: �.%���_ Waiver Fees: Date of Payment: qfi1fi!5- Date of Payment: Receipt Number:-�lU�iS.0 Receipt Number: Permit No. �. Pl ��/�% Waiver No. Permit App_9-1-12.doe �IC;RTHI IZ_ ENGINEERING MEMO Date: 9/11/15 To: MOA On -Site Services Subject: Arveson, Lot 6 Septic Tank Failure Steve Eng, PE, PH (907) 694-7028 tel northrimeng@aol.com Number of Pages: 4 The subject septic tank has failed, no cleanouts are present. Please issue a permit so the tank can be replaced. There is a depression at the tank, indicating general tank failure. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks -Steve �CRTh I� M ENGINEERING Arveson, Lot 6 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4 -bedroom, duplex home. Most of the neighboring lots are developed. The current septic tank has failed- the Trench is still useable. These lots are small and are served by private water wells. No adverse impacts are expected from tank replacement. A utility easement is present on the lot. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet. • 5' minimum between the tank and bed. 10' to property lines. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required l' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) i 0.jdaS 3 0> C� d L { L N o d L N 3 [j�- Q1 Q v }uGwGso3 AlMln 01 Li F- LO _ u a e > i D �n w3 L _d L d L auo� /Cpo4S LL c O n h (Y) U N� U) H V) r ) F— N l n O X 'w � U u z o w U. Q €� J �'`�� N Q � 3� Q O� � -J Q 0 O p OLO Ip " U N � U O U 3 a NL O Z (n •m F--- p N •� L O _ L L E E a C: p E O p U c p .E E OO p O N E (U N >_ p L of t) J + U N + N — C U a -p U O W i N = — Z U In •gyp-, N pNU v CD •x ai Q) p O L W U)QYJZU w D � N r7 d U� (D u a e > i D �n w3 L _d L d L auo� /Cpo4S LL c O n h (Y) cu N� N Q H V) r ) F— N II n p O X 'w W L,J u z o w U. 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Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SGc/ 9SS' PID Number: C7/S' 7-311 Name: Wastewater System: ❑ New &'Upgrade G/Qrr55, Vo ',Ce- 7 Address: ABSORPTION FIELD Phone: No. of Bedrooms: 1 4 - weep Trench O Shallow Trench ❑ Bed ❑ Mound 0 Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: �• GPD/Sq. Ft. 1� .S Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe CAMP v • . $` Ft. l0. 4V Ft. Township: Range:,.,, Section: Fill added above original grade: Gravel length: T1 iii 3w Z/ �- Ft. 4 Ft. WELL: EI New ❑Upgrade Gravel depth: Number of lines: Distance between lines: �. S � Ft. 2 TCC Ft. Classification (Private. A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. S Z,6 SQ. Ft. 09 Driller: Date Drilled: Static Water Level: Installer: k4fh 474/Al Date installed: Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ®'Septic&X.,fr.) ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Pub"/Private Manufacturer:: Capacity in gallons: From Tank Field Station Tank Sewer Lines G /Z Et. Z C) Well /D N/ 11 Material: Number of Compartments: Surface e /d/ -4//A A/1 All N/ LIFT STATION NIA LotSize in gallons: Manufacturer: Line /7 /p it1A it/ Z7 �' "Pump on" level at: "Pump off' level at: High water alarm at: Foundation /0 „4 2-0.� Al A/ /A Curtain �1i� / /A A/ A N/� I� Pump Make &Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: Got . ca Svc . pG.�iv ///Eu/ f'D/t GLJGAT/D /✓ Assumed Elevation: /DOFt- ENS`&k S;AL aP� �� 4�:� �s �1 49TH Inspections performed by: Dates: 1st 7111f S' 4 . 2nd 711 APE ��we si,seeC.f... �° • r91E J� Department of Healt d Huma rvices approval �� ••. -d Bales ' �. • 8697 ••••v�� Reviewed and approved by: Date: �t1Z�p�OFESTIO��;�"' 11711/74 % unn 0 Permit No. s/ti Y5"oi3S Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: GoT /'�'�'yESONSy�sO. sFc. Z/ r/zX/23uJ s PID No.: ey/5?-73// eyrT. iJ1% f� i Ii /0C fNa ,h C,p. A10./ c,a,Ala. Z Gd.li/d�3 ��oF/LE zt 1 5EuA2 0" 4� sok \ W W �% S 11 E.L. 99,0 72-013 A (2/9i) MOA 25 O 0 C,O• A/1P•# /-M. T. PL A I/ $CALC 111z7_S' c0 At .t y.. 0%v *: 49TH ;* I �• R. J. Bates �j s •. E 8697Ar �o i '�fo.•.....••.•� PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950135 DESIGN ENGINEER:BATES ENGINEERING OWNER NAME:GOODWIN GLEN C OWNER ADDRESS:7317 MICHELIN PL. NO.1 ANCHORAGE, AK 99518 PARCEL ID:01527311 LEGAL DESCRIPTION: ARVESON LT 6 LOT SIZE: 10005 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: ric' DATE ISSUED: 6/28/95 EXPIRATION DATE: 6/28/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIALPR"t>T�T,,,�� _ RECEIVED B ISSUED BY: DATE. r p I /_� DATE: 4n BATES ENGINEERING 4050 WARWICK PLACE ANCHORAGE, AK 99508 (907) 563-0807 June 19, 1995 MOA DHHS 825 'L' Street Anchorage, AK 99502 Subject: Septic System Upgrade Design for Glen Goodwin. Re: Lot 6, Arveson Subdivision. OF At ,• •,s1 The attached Site Plan shows the proposed septic system upgrade location for the subject lot, the existing well location and the existing wells and septic systems on the adjacent lots. This report also contains the results of an inspection of the existing septic system and adequacy test of both the well and the existing system. WELL TEST & IMPACT The existing well was drilled in May, 1980 by KEN'S COMPANY to a depth of 175' ( see attached well log ). This well was tested on June 14, 1995 for two hours at 5.4 gal/min. ( 325 gal/hour ). The static level at the beginning of the test was 114.0 feet below the top of the casing. The water level dropped to 115.8 in 10 min. and to 116.0 in 30 min. where it stayed to 2 hours. After the well pump was shut off the water recovered to the static level in less than five minutes. The well casing is 1.4' above the ground with a water tight cap, wires in conduit and the drainage slopes away to the south. This test indicates that the water aquifer in this area is strong and the continued use of this well should have little if any impact on the surrounding wells or on the capacity of the aquifer. SEPTIC SYSTEM INSPECTION, TEST, DESIGN & IMPACT The existing 1250 gal septic tank ( installed in 1980 ) was uncovered and inspected for soundness and leaks. The tank was found to be in excellent shape for it's age and without leaks and deemed acceptable to remain in place. A cleanout was installed at the outlet end of the tank to bring it to current standards. The tank was pumped by DENALI SEWER & DRAIN SERVICE on June 12, 1995, and refilled with well water prior to testing the system. BELETTPL.DOC12/94 PAGE I The drainfield is of the deep trench variety, 32 feet long by 6 feet deep for 384 square feet of absorption area, designed for a three bedroom house. An inspection of the piping found three problems: • 1. The 2 facing cleanouts installed between the tank and the field were installed after a 90 degree bend was put in the line. • 2. The drain pipe was not installed level with the end of the line higher then the beginning causing a restriction in the flow and lack of even distribution in the field. • 3. The end of the drain field was approximately 9.2' from the property line. To solve these problems, the owner contracted with Max Bolin (McKINLEY CONSTRUCTION) to uncover the line and repair the pipe. The cleanouts were replaced with one facing toward the tank and one facing toward the field from the 90 degree bend. The perforated pipe was carefully uncovered, the drain rock leveled and the line was shifted to maintain a 10' separation to the property line. The pipe was cleaned laid back level, covered with 2" of drain rock, silt barrier fabric and backfilled. Because the system was not being used during the repair time it was surcharged for over 24 hours with a hose producing approximately 4 to 5 gal/min. The adequacy of the system was then tested by inducing 650 gallons of water in a two hour period on June 14, 1995 into the field. The water level was monitored in a cleanout between the tank and the field. At the end of two hours the water level had risen 0.2' and returned to static level in less than 4 min. after the water was turned off. This test indicates that the system exceeds the absorption rate required for a three bedroom house. The upgrade design adds 12' of trench, 6' deep for 116 S.F. of absorption area. This added to the 384 S.F. in the existing system brings the total to 528 S.F. or 28 S.F. for than the minimum requirement of 500 S.F. for a four bedroom house. All well / septic separation distances were checked and found to be over 100'. The impact of the septic system should be very minimal because no ground water was encountered and the well log indicates that there is a clay strata from 36' to 54' and dense hard pan below that down to 163' where the aquifer starts. DRAINAGE The lot slopes down from the north at approximately 1.0% with no cut banks. BELETTPL.DOC12/94 PAGE 2 BATES ENGINEERING o Design o Construction 0 Resource Development 441 OCEANVIEW DRIVE ANCHORAGE, ALASKA 99515 Telephone (907) 345-0807 Garr !o xewea JOB SCAT/G SySza7'M J �/F�CRAyE SHEET NO. OF 7 CALCULATED BY /�'� 0147 DATE CHECKED BY DATE so+�E tGi��✓T GGCra% 6lOal wig/ I / c,ol . / ca vsT..... i a/-' d!f/ S iTc . —ar 0 .... 0 � W � J ........................................................... o r 8 2, Go,vsT. sN,d�L 30 JOB SCAT/G SySza7'M J �/F�CRAyE SHEET NO. OF 7 CALCULATED BY /�'� 0147 DATE CHECKED BY DATE so+�E tGi��✓T GGCra% 6lOal wig/ ,vorEs: MvsT" NIE6'T TNC' '05TAV,0AW S A Mt7 SPEzrFiGA na�S A"oIC _GoMpdNeiV A'A,O rS d' MA T'C. S I / c,ol . / ca vsT..... i a/-' d!f/ S iTc . —ar 0 .... h ........................................................... o r 8 2, Go,vsT. sN,d�L K o y---IIPft ? o copEb r wit. 1 f+ ,vorEs: MvsT" NIE6'T TNC' '05TAV,0AW S A Mt7 SPEzrFiGA na�S A"oIC _GoMpdNeiV A'A,O rS d' MA T'C. S .off' . k'cA vAT/b oN SSE" k 4414G� G c,ol . / ca vsT..... a/-' d!f/ S iTc . —ar 0 .... h ........................................................... 0 2, Go,vsT. sN,d�L ....... ....... .......................:............ B6/i�A�GoKGA/ ? _T/Z..... ...__.......... ,�eEc�ty �2E�E�.... IfiGA fiauS .off' . k'cA vAT/b oN SSE" k 4414G� G BATES ENGINEERING o Design u Construction o Resource Development 441 OCEANVIEW DRIVE ANCHORAGE, ALASKA 99515 Telephone (907) 345-0807 .►oe SCpi/G S'YSTE.y" Z-1p61ZAE�C SHEET NO. 4 OF 7 W CALCULATED BY 'w V 63- DATE d Y 9;; CHECKED BY DATE !r VT 6 A/Zi/d:X0M/ VV49t7- CC/C- /7- G C.e N V 00,VW/N Q 0 0 0 •ar :d •• � ••' � TA Ta�� s � ,I i Z M +•�Q tw 0_ Z�- � , i 44 i ♦ ASS ; � � Carl, �• I i to Del , • •'..• Z,•fcr.: i e Municipality of Anchorage �O� 7 Aw9TH • ♦r DEPARTMENT OF HEALTH & HUMAN SERVICES �••� ,...•...J •. ' . 825 "L" Street, Anchorage, Alaska 99502-0650 R. SOILS LOG — PERCOLATION TEST ! �o•. • • • •:'� /. �.. R.J. • rio//his' � �,••• • Y • PERFORMED FOR: G�2h `70d�/ Gy�h DATE PERFORMED:�T\`O;p#n��� LEGAL DESCRIPTION:/ Township, Range, Section: T/Z A-1 /L -3A f/XEc Z� Sti9 nF�1 - SLOPE SITE PLAN 7 7 9 S/ �fy 8- 9- 10- 910 L5 11 t% 12 \ , 13- 14- 3 14 , r ' AowliTwz j�ISL 15 1s 17 18- 19- 20- COMMENTS 81920COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Na S L P /✓D &1e E Depth to Water After �✓� (��/ Monitoring? ^/ 0 Date: Reading Date Gross Time (FEET) Depth to Water Net Drop 2- 45 4- " 5 43: Or 2 � ,• OG%LG 6- O 2.-1 fd:5o 31 O©" 7 7 9 S/ �fy 8- 9- 10- 910 L5 11 t% 12 \ , 13- 14- 3 14 , r ' AowliTwz j�ISL 15 1s 17 18- 19- 20- COMMENTS 81920COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Na S L P /✓D &1e E Depth to Water After �✓� (��/ Monitoring? ^/ 0 Date: Reading Date Gross Time Net Time Depth to Water Net Drop r/: 40.3 0 " 43: Or 2 � ,• „ �� O 2.-1 fd:5o 31 O©" v /, 5/-�.7 I aa •I ►. I �47 f% Ale, t 0irJ A A40A /G PERCOLATION RATE _I (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 15- FT AND 6 FT PERFORMED BY: aAT1416- 7UA14 I 11-0e- j e-0 &s CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE 0 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 Q 133-7-936E) PHONE ,� NEW UPGRADE MAI LING ADDRESS `t5 4 o LEGAL DESCRIPTION f0 LOCATION O.13 NO. OF BEDROOMS v Y DISTANCE TO: well 200 Absorption area Dwelling 4 PERMIT NO. 016 L, aQ W� Manufacturer Mater' I No. of compgrtments y Liq. 7Ilons p�city-1dIF HOMEMADE: �� O Inside length Width Liquidsjgpth G Y DISTANCE TO: Well Dwelling PERMIT NO. =0z Z FQ- Manufac Material iquid capacity in gallons D W = DISTANCE TO: Well �Q©� F ndation Nearest lot line PERMIT NOLO Z� J LL Z Z w No. of Jane (J Length of ea h I'ne Total I ngth of lines Trench width (o inches Distance betwee Ijpes �C� 0 H Top of tile to finish grade ( Material beneat therTs Total effective absorpt'on3 area W Length Width Depth( PERMIT N0. Q h- as LU Type of Crib er Cr' th ffective absorption area LU TO: Well Building n Nearest to J s Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Buil ing foundation Sewer line Septic tank too Absorption area(s) 00 OTHER PIPE MATERIALS D SOIL TEST R TI/NG l INSTALLER Z13 4 L'y REMARKS f I( o` P APPROVED r DATE LEGAL 5 36 0 72-013 (Rev. 3178) V MUN 11= X F=*fRL- I -rV (:IF= F4Nr=",0F;_>F=lC3E: DEPARTMENT HEALTH AND ENVIRONMENTAL )TECTION 825 -'L'^ STREET, ANCHORAGE, AK 99501 264-4720 -rl-= �E34E:1;Z F="E:F;ZM I -T- PERMIT NO. ( 800162 ) APPLICANT GLEN GOODWIN LOCATION 0'MALLEY & JEROME LEGAL 4WIA "N"Wr 4540 MT VIEW DR 9 o JB, 337-9360 LOT SIZE 10005 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DE:F::'*-rH- ALO L_f-=N(3-rH- :3,;2 OMIFIVEEL_ DaF=l"-r"= IS THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE 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 OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). M r=- Q U X M E: r> !S E: F=" -r X � -r F=1 " K _S; X 0 E-= �L 0 0 0 03 F=1 L- L- L-) N"-=-, PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- -rWC) < a > I ""_SF:l*E:0-T- I �N55 f=lFRE FZE:QU I Mg=r> - - - BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. Fz*aMM I -r aXF=* I FZa"= E>aCaMOFEM �so:Bo I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. ,J,-:" SIGNED:__4� -a-wz)- ----------- APPLICANT GLEN GOODWIN ISSUED BY - A A. 11r -- ----- DATE V4.0 X SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch 6.650, Anchorage, Alaska 99602 276-2221 SOILS LOG — PERCOLATION TEST PERFORMED FOR: I/1CJ'� �����7( DATE PERFORMED: L21,q j�" LEGAL DESCRIPTION: L_QA A\" v eSC-A S'k o0'tyLS �-% SLOPE SITE PLAN wpfl C) - s IF -'--T—FT 1 2- 345 3- 4- 5 C) 6- 7 17 8 9. G- X10 11 12- 13- C) 213C) 0 14 15- 16- 17 51617 81920 18- 19- 20 COMMENTS PERFORMED BY: 72-008 (7/76) WAS GROUND WATER �S; ENCOUNTERED? L` Oj P - f IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Time Time Water Net Drop �l E 1 WAS GROUND WATER �S; ENCOUNTERED? L` Oj P - f IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Time Time Water Net Drop PERCOLATION RATE fi) fi.11u Q. Talbot TEST RUN BETWEEN T ANQ..,.�._._ CERTIFIED BY: DATE: 26 NE Ce /"A l Cm CL -Y �rl�• pa(bo 2 KEN'S COMPANY WATER WELL DRILLING ` PUMP SALES & SERVICE (907) 243-7893 3163 LINDEN DRIVE �r KEN JOHNSON ANCHORAGE, ALASKA 99502 May MMK;�LV OF ANCHORAGE DEPT. OF i . c< Glen Goodwin ENVIRONMENIAI cr�oN. Lot six Arvenson Subdivision Off Jerome RD, And 0 Malley 'AN 2 Anchorage, Alaska WELL LOG RECEIVED" Of to t Frozen brown silt 1' to 6' Brown silt 6' to 10' Med. gravel with brown silt 10' to 25' Tight course gravel and gray silt 25' to 36' Med, gravel and brown silt 36' to 54' Clay 54' to 78' Compact gravel and gray silt ( very tight ) 78' to 79-6' S.'oulder 79-6' to 98' Hardpan..compact course gravel and cobbles with gray silt binder ( tight ) 98-6 to 104' same but weeps some water 104' to 148' Same but dry 148' to163' Same with trace of clay 163' to 166' Fine sand & fine gravel ... Water bearing.. 20' water came in .. Bailed down to 8' at 5 GPM Slow,recovery ( very dirty ) 166' to 169' Same but -Vater -rose to 40' ( from bottom ) Bails down at 5 GPM.. Slow recovery.. 169' to 171' Fine silty sand with clay texture 171' to 175' Compact gravel ,& brown silt ( dry ) ` 175Glean med. gravel and course sand,,Water bearing.. 40 ft. plus head Test bailed at 7 GPM with no drawdown Clearing rapidly Bottom stable i ����4 if lf--t if 1,����� DEPARTMENT � HEALTH AND ENVIRONMENTA' ROTECTION 825 _' STREET, ANCHORA�E, AK. ���O1 ^~ 264-472O PERMIT NO. ( 8OO141 ) APPLICANT �LEN �O[�WIN 454O MOUNTAIN VIEW DRIVE 995O4 337-936O LOCATION O'MALLEY ROAD LE�AL LOT SIZE 1O5OO SQUARE FEET Mini/n�un distance between a well and any on-site sewage disposal system is 1OO feetfor a private mell or 15O to 2O public well depending upon the type of public well. Mfnimun distance fron a private well to a private sewer line is 25 feet and to a cnmnunitysewer line is 75 feet. Well logs are :i LA and must be returned fo �he dePartment within 3O days of the well completion. Other requirements n/ay apply. Specifications and construction diagrams are available fo insure proper installation. it ji I certify tha� 1: I an faniliar with the requirements fop on-site sewers and wells as set for±h by �he Municipality of Anchorage. 2� I will install the system in acCordance with the codes. SI�NEQ: .... ........................ _________________________ APPLICANT �LEN �OO[WIN ISSUED _____________________............ V4.O MUNI 0lF>nL_l_TV Cjl= DEPARTMENT HEALTH AND ENVIRONMENTAL ulml-11UN �d� A 825 STREET, ANCHORAGE, AK. 9�;..--Ji M -lx- �AA 264-4720 PERMIT NO. < 337- S36 APPLICANT LOCATION LEGAL Z_ CC Ve5O A) .(-/ 's L/ 0 � I- b/I e 6'j -Is /- TYPE OF SOIL. ABSORBTION SYSTEM IS: MAXIMUM NUMBER OF BEDROOMS = 6 LOT SIZE 16 06 SQUARE FEET SOIL RAT 114G <SQ FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE 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 OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F:;?. F" G71 LJ l Fic E: [--*- :S t=- F=• "T" 1E r--.- -F n r-4 K (3f=lL_L_oN:s ;i PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE ;.INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE /&4UMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- -rWC.-) < -=>- > I "'S- F=• E: C_- -r I ID N =--- n FZ E: FZFE 0 Ul I F;?- EE r> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. Fz'f=- FZ M X -r KEE X F=" I FZ a!F- E.-- E_= (-- I -E M Ex a FR :X::L :i_:,= 80 I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES, 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS R MODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED :Zee'_OZ2_ Z_z ------------------- APPLICANT _L� . ISSUED BY ----177L ? --------- --------- DATE- V3 2 I., MUNIMPALITY 0A"s4,': 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. 015-273-11 1. GENERAL INFORMATION Complete legal description ARVESON LOT 6 Expiration Date: 6� — 9 ^ Z I Location (site address) 3701 E 112TH AVENUE, ANCHORAGE, AK 99516 Current property owner(s) RYAN K. RADFORD Mailing address Real estate agent Day phone 3701 E 112TH AVENUE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment 3 Q O 1 Date of Payment Receipt Number a i 02- z Receipt Number COSA # OSC211072 Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 2126121 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWH 6. DSD SIGNATURE System #1 Approved for _!�_ bedrooms System #2 Approved for bedrooms .41 g 49 7H Curtis Huffman �����'cG,/�j. • • •CE 128991 .•��`�`'aw/ pROF SS14NP���� Original Certificate Date 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 Legal Description: ARVESON LOT 6 Parcel ID: 015-273-11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 5/24/1980 Total depth 175 ft Cased to 175 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2/24/2021 Static water level at beginning of test 115 ft. Well production at time of test 5+ gpm Comments Structure served by this system Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 2.07 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW[�5 Date of Sample 2/24/2021 B. TANK DATA C. LIFT STATION Age of tank(s) 5 years ❑ Required maintenance completed Tank type/material SEPTIC / STEEL Age of lift station — years Measured operating fluid level in septic tank 49" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 2/24/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/1/1995 Adequacy test date 2/24/2021 ® ALL standpipes present per record drawing Results N Pass For 4 bedrooms Total measured depth from grade 12.4 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 6.4 ft (min) Water added 600 gal ❑ N/A – pressurized field New depth 0 in ® Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time <1 min ® Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: FW[.S 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' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes — if No ft ®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 Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells >' 100 _ ®Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS DECK SUPPORTS TO BE REMOVED AND DRIVEN OUTSIDE TANK PERIMETER AND TO BOTTOM OF TANK ELEVATION. SEE ATTACHED ESCROW LETTER. G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. .a Aaw" ...-...... .... t:.�.. . . . . Curtis Huffman CE 128991 leA 3/4/202J Amp, �l�F�PROFESS16W low F'fst Water CONSULTING WA Ps R tN f at.c 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 8, 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: ARVESON LOT 6 During the COSA process the deck supports were found to be above the edge of the septic tank which was installed 5 years ago. These supports will be removed and new supports installed to the same elevation or lower as the bottom of the tank and outside the tank perimeter. This work will be completed later this spring due to winter conditions and other factors. We are therefore requesting a Conditional COSA at this time. Granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached is the escrow letter from title for the pending work. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. F�f'pf; ( L i ,4 JF s C �� .Ff Y'481 EfYAiFN "Pi3 EPIANf11NC Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 015- 2 -125 -It Parcel I.D. -051-043-57- 1. GENERAL INFORMATION Complete legal description Arveson Lot 6 Expiration Date: Location (site address) 3701 E 112th Ave, Anchorage, AK 21hLi• ll i Current Property owner(s) Long Beach Mortgage Day phone 261-7603 Mailing address same Real Estate Agent Bob Brock Day phone 261-7603 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ® Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class C Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer Received by: /i Date: AS COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 62-te - Date: Date of Payment 1001'g,11-6- Receipt 61'211SReceipt Number Og"tN Date of Receipt Number, COSA # ()�Cll 151514- 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 10/12/2015 6. DSD SIGNATURE System #1 Approved for "'/ bedrooms. c , System #2 Approved for bedrooms. Disapproved. ('; (o�r g f /3 Conditional approval for bedrooms, with the following stipulations Original Certificate The Municipality of Anchorage Devlopment 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 Wetl Flow Advisory Other COSA blue sheet 9-1-12A c If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: /4z? %P O iii /-a T 6 Parcel ID: O S 10435'7 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed S�Zy Sanitary seal (Y/N) 4 Total depth / 2S ft. Cased to / 7S ft. FROMWELLLOG Date of test, Static water level 375 ft. Well production C g:p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate Z. 8 7mg/L Arsenic A/6 ug/L Date of sample: i B. SEPTIC/HOLDING TANK DATA Tank Type/Material S;�I077e 19455 Z - Tank size 125a gal. Number of Compartments Z Foundation cleanout (YIN) _Y__ Depression over tank (Y/N) Date of pumping fq% Pumper C. ABSORPTION FIELD DATA Well Log (YIN) Y Wires properly protected (Y/N) !KT Casing height (above ground) ^/ in. AT INSPECTION B/ice/i s g.p.m. Collected by: Date installed 44! /IhS Cleanouts (Y/N) Nigh water alarm (Y/N) !t/ .�/�� d 6Cp Date installed, IS Soil rating (g.p.d./ft2 or ftz/bdrm) 2 System type Thr_ hf Length ft Width 2 S ft. Gravel below pipe Total depth S ft.. Eff. absorption area SZ 6 ftz Monitoring tube Depression over field _41 Date of adequacy test / /S Results (Pass/Fail) PFor ! -bedrooms Fluid depth in absorption field before test IJ in. Water added gal New depth Z in. ElapsedTime: 6{6 min. Final fluid depth in. Absorption rate >= 6j�pa 7- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) if yes, give date D. LIFT STATION A//$ Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot /Da rf Absorption field on lot { 0 r t Public sewer main r Sewer /septic service line. Animal containment areas sd 'Y& SEPTIC/HOLDING TANK ON LOT TO: y Manhole/Access(Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots lad On adjacent lots 400 d '14 Public sewer manhole/cleanout 4620 ?`' Holding tank /d f "-f- Manure/animal excrete storage areas /6 d /7 Building foundation J`y"t Property line Absorption field cS -,f- Water main l &I ' f water service line d ' L Surface water Wells on adjacent lots /D Q 't ABSORPTION FIELD ON LOT TO: Property line /D `fi Building foundation 16 `t water main r Water Service line 6 't Surface water Driveway, parking/vehicle storage `+4 Curtain drain Jr� Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION ! certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA gZidefines in effect on this date. Engineer's Print'ed Name Date lo4z, js COSA yellow sheet_2-6-15.doc Steven W. Eno PE 6 S6 F9F °°.+✓� /Z/F � I Lot 710' UTILITY Lot 4 \ EASEMENTS--�� WOODEN FENCE N 90'00'00"E 133.40' .. .. 5.0'x10.2 � ----- CANT N ASPHALT 38.0' W Z " ; DRIVENIAY F, 29-0' SEPTIC to Z o ' 30.9'.' o PIPES 0 Do 34.0'91 o 00 2 STORY N n I 010 0 1.0' CANT a RESIDENCE Lot 5 26.0, F m =o N o DECK I ut 0 2.0' CANT 37.0' o N WELL o ..' ASPHALT ..,... of Lot 6 . • .DRIVEWAY SEPI IC 10,006 s.f. .. PIPE 133.41' cCr1 * 0 I n R4�iUs / -rb — — E 112th AVENU PLOT PLAN AS BUILT X SCALE 1" = 30' GRID SW 2635 Project No. 15-303/A1 Lan & Associates Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang (907) 522-6476 Phone 000p400� Registered Land Surveyors (907) 522-4625 Fax o` 4 kenOlangsurvey.com / jonothanOlongsurvey.com aoPC..OF......... . �o 1 hereby certify that I have surveyed the following described property: Ol< : 0 LOT 6, ARVESON SUBDIVISION (PLAT P-559) �* 49TH -7 00 Anchorage Recording District, Alaska, and that the Improvements situated thereon are ......... :....0 within the property lines and do not encroach onto the property adjacent thereto, that � _ _ y 0 no Improvements on the property lying adjacent thereto encroach on the surveyed �"` �... ..... D premises and that there are no roadways, transmission lines or other visible oo?� .. KENNETH . LANG r� easements on sold property except as Indicated hereon. Q� s /Oi `�! I S : •�O O Dated this the 16 Day of A° -'AS , at Anchorage, �04Fpp'•�-5202.•aoy�0 Alaska 40&,!FESS10NN �o It Is the responsibility of the owner to determine the existence of any easements, env�nnnix. nr raafrte.finne which An nn# nn #h• rennrdnd cuhdivisinn nln#_ 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. 01�i, ;L']3 •- I i HAA #_ a 4j f /1 of 1. GENERAL INFORMATION Expiration Date: Complete legal description _ Location (site address or directions) 3 1Ol E. 1121' Av Current Property owner(s) Miel WjtC0x Day phone Mailing address 3101 E ii2f' Ave, Ao,ck ccaw AK c Lending agency Day phone o-pGE BG x o 5 A EST Y � Mailing address Real Estate Agent T m rz Rgffl Day phone 1-4-4 52z -t Mailing Address i2 fa - Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Q 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water StoragePK ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm aPhone Vq-31t Address Engineer's Printed Name To6ben 5. DSD SIGNATURE _Z/ Approved for __q— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ill ll�� Q �� Original Certificate Date: / (Rev. 01102) M`unicipa�ity of Anchorage Development Services Department ° Bwldmg Safety bmslon " ';: � x" ' "P`��Ob Sou`t�i'�Bragaw St s P O Box`9�6�0 Anchorage AE�'9�51' 6 wm �s •. ni 114orr, I IUN 200y rcft. f2a. tt. 9 P m. g.p.m. ml Nitrate �7 mg./I Other bacteriaA/L colonies/100 Date of sample. �°y ml. Collected by:" C Date installed v30lg0 Number of Compartments � c Cleanouts /N y n- Depression over tank (Y/N) N High water alarm (YIN) h/ q Pumper lil'rating (g.p d./ft2 or ft2/bdrm) System type Deep Ir'ench Y W Idth ft Gravel below pipe �_ ft sor area � ft Monitoring tube l DeQression over field _� _ Results(Pass/Fail) _ For bedrooms ore test :DL In Water "adde'dM gal New,depth )9 in. ..... Rhat fluid depth ©" In. —. Absorption rate >= Co 10 g.p.d. 1Z mo) (57 n., hnn h% if. vA� ni„> ,p=ro D. LIFT STATION Manhole/Access (Y/N) `! Date installed Size in gallons - "Pump on level _ in Pump off" level at in. High water alarm le in. Datum Cycles teste Meets alarm ircuit requirements? E. SEPARATION_ DISTANCES�Y�µ SEPARATION DISTANCES FROM WELL ON LOT TO: 0_t�- 2Dd Septickankllift station on lot �D L S0 j On adjacent lots ?1`00 A ? too Absorption field on lot It3 On adjacent lots Public sewer main N A Public sewer manhole/cjleanout Sewer (septic service line �d Holding tank /1/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:, Building foundation 13 Property line 2 I0 Absorption field _ S Water main ✓\(� Water service line ' a. S Surface water_ Wells on adjacent lots i 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: f A Property line M1 Building foundation a (D Water main N 4,. �. .... _ .. . 1 Water Service Zine 7 Surface water 0 Driveway, parking/vehicle storage Curtain drain on adjacent lots IO( N Wells J F. COMMENTS, G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and £ review of Municipal records that the above systems are in ' conformance with MOA HAA guidelines in effect on this date. aaxt 5r Engineers Printed Name yy Date i —Z p - �✓ ii �r as HAA Fee $ ti 3 -- Waiver Fee $ x. Date of Payment 111% Date of Payment Receipt Number Receipt Number (Rev. 12101) S?G. 20.2UJ04 Z,32PPd REMAX PROPERTIES m M a ,FA *r ,ASPaA4r v e scA.L0 I 3?.:J.o R,z I j4.r 2_ ,roz F R 'Ll F ° DWELLINC;. 24 �0 K: �.. D Y 37,t�o L ' r 0 6 e Ayr !33,41 EA sr No. 4153 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW EASEMENTS OF RECORD OTHER THAN ANY.CONFLICTS BETWEEN EXISTING STRUCTURES THOSE SHOWN ON THE RECORDED AND FLATTED LOT LINES OR EASEMENTS AND IS PIAT, ARE NOT SHOWN HEREON. NOT TO BE USED FOR POSITIONING ADDITIONAL STRUOTURES OR FENCELINES, No corners set I hereby certify Ing! I gave Surveyed the following 00E0rio041 property. Lot 3. BbCK .4�✓CrJ D't � �' t F'7 Andhdrape recording dl$ltidt Alaska, and that the impfOvemeME 33ualed (hereon ere Within the property linea and do not overlap or encroach on the property tying adjacent therelo, tha! no Improvements on property lying adjacent thereto encroach on Ma p7ernISOS in question and that there are n0 roadways, tranamlSSiom Ifni Or Other visible egsenanta on $*;a property except as indicated hereon. i AnOnorage, Aleaka _- Q'7'r Z00¢ Municipality of Anchorage • Department of.Health and Human Services Division of Environmental Services' On -Site Services Section 825 V Street : Room 502 ` P.O. Box 196650 Anchorage; AK 99519-6650 " , www.ci.anchorage.ak.us ' .. ..: (907) 343-4744 . CERTIFICATE OF;HEALTH AUTHORITY;APPROVAL FOR A SINGLE,FAMu: DWELLING Parcel I.D. • O 15—.273 " t ( HAA# D D O f„ 2— Z, Expiration Date: 1. GENERAL INFORMATION Complete legal description LO1 Al2VESo N g to Location (site address or directions) ?x'701 t= 112 Current Property owner(s) K1kT- N t -E EN ALVAQ_FZbay phone Mailing address 3 7a I a l t Z I• Lt Lending agency Day phone Mailing address Real Estate Agent H A i i D t H µ-t l L4. V I S i A Day phone .273 - 7733 Mailing Address LlZ1/l t3 S�' `• Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System -V TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding Tank ❑ Community On-site 0 Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72025 (Rev. 01=)* 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my Investigation . based on procedures'outlined in ihe`Hdalth Authority Approval Guidelines for the H6alth,Authodty' pproGal application show that the on-site water supply and,-. , , ' PP Y � :.. /or wastewater,disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein: 1, 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 applicable Municipal and State codes, ordinances; and regulations in effect at the time of installation. Name of Firm�' %bt'N'r , S' � ;r e; ! }�, _ - t r phone o�-7 Q -3 C? Address 6 3tlel I . '1 lit, Engineer's Printed Name Id bb e rI - 5: j Y-LGI a N X Date _I L'- /,2 0 Fj ................ a...... N.•1.. 1 6. - DHHS SIGNATURE Approved for bedrooms. Disapproved. -- -Conditional approval for - bedrooms; witfi the following stiptilatit o st{ t Additional Comments .. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: O O Expiration Date: 3-1.7-00 Reissue Date: 72.025 (Rev. O1l00)- Municipality of Anchorag �. • Auk Department of Health and Human s�„ eC E I V E D Division of Environmental Services On -Site Services Section 1325 "L" Street Room 5WEC 1 g 2000 P.O. Box 196650 Anchorage, AK 99519.6650 Ut www.ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHOftAOE &MONMENTAL SWCES DMSION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LcT to Aely E s "A Parcel I.D.: (N5-V_*–It A. WELL DATA Well type 1?, If A, B, or C provide PWSID # 'IN- Well Log Date completed i>yo Sanitary seal Wires properly protected _ Total depth /75 ft Cased to /%.S , ft Casing height (above ground) of in. FROM WELL LOG AT INSPECTION Date of test 1!NA0_ Static water level 13 r_> ft Well production % g.p.m WATER SAMPLE RESULTS: Coliform -_0_colonies/100 mi Nitrate N D mg/l Date of sample: '711 " _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sg4L' e S e-1 ft .5 g.p.m Other bacteria_UD_colonies/100 ml Date installed Tank size /A50 gal Number of Compartments Z Cleanouts Foundation cleanout N ogn o Depression over tank t4 High water alarm N Date of pumping /;tom/13 VA( P•r'_�umper A14 C. ABSORPTIONj/FIELD DATA Date installed %� i 7Wer Soil rating (g.pAAM or ft2/bdrm) tg,�" System type Length.S t/L ft Width _ftr e��low pipe F$4Total depth ��ft Effective absorption area ft2 Monitoring tube_ Depression over field _JN Date of adequacy test l %/ o,6 Results (Pass/Fail) T For _V__ bedrooms Fluid depth in absorption field before test in Water added &00 gal. New depths in. Elapsed Time: �k—AI& min Final fluid depth� in Absorption rate >= (:0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) mn If yes, give date 72 025 (Row. 01,00)• D. LIFT STATION Date installed Size in gallons "Pump on" level at in "Pump Datum I E Datum Cycles sled_ E. SEPARATION Manhole/Access at in High water alarm level at in SEPARATION DISTANCES FROM WELL ON LOT TO: Meets alarm & circuit requirements Septic tank/lift station on lot 101 On adjacent lots �t I LYO Absorption field on lot L c ( On adjacent lots 7 l U-0 Public sewer main N/,qr Public sewer manhole/cleanout — `-0a — Sewer /septic service line Q O Holding tank N j'= SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 12- Property line >10 Absorption field Water main W& Water service line �> Surface water Drainage _ hl l Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation 2 (o Water main N/A Water Service line i 7 Surface water - ' t �— Driveway, parking/vehicle storage_ Curtain drain - 1— Wells on adjacent lots >(_PO R COMMENTS I_ G. ENGINEER'S CERTIFICATION • < - '! I certify that I have determined through field inspections and ; r •-,';• . �, ; , �'� • review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date.. Engineer's Printed Name _7e 6,4," }a V rVC iy^ v` N Date 2 3 �`��,'•..,,......••'��-_� HAA Fee $ 0 Waiver Fee $ Date of Payment (2' 13 -da Date of Payment Receipt Number UaLlq. ( ( &7�— Receipt Number. 72-026 (Rev. 01=)' I } WS 1Stft ,r F t N, ad t ifs, ` a 'y x RTME14 H -V . v Yi tg g�r� p, `B sQ+{0 q':°..�A'leaka'�'9951"9=1 =,11 1 , } it I ,� 5iTIFI�A.TEOF HEg4TH AUTHORITYn APPRCII/A O A SI QL 'FAMILY QWELLII (iqRss��v Parcel %SZ F S IKst1, 0 J HAA # 3h,4°{'-t���i ?ALV { ^ $�n�� I��i��i���� �� �AE ^ Agent �� +; y� ;�y�fiak# tts�4r,li" d l;`i7lY, Address ,' Unless otherwise request 2. NUMBBER OF BED_ ROpM 3. ,.TYPE OF WATER SUPPL , „Individual v v 1ua N a C Community ,rola' a�Public Ovate NOTE:4,� if"�olmm�inIty wl ^Ing to the le�y.aill 4, " T fPE OF W STEWATER IndIvid +si'4 ipin NOT; If'cgrrl u� y k m attestlI 1'�. ,I j 72 025 (Rev. 1/91) Ftoni IMOA N21, -v �,, ��r r. • �y� 1 9 •� --ic 1*,,:,-t f l�`� l i$,�, +' ,�;d r A` ,'�1 4 9y{k.n f �� I t„1, !,� ^'� Z.1 •� �' 1 r- 1 . Day phone:G Ill be held for pickup }E at� aF, 1u'd J �y dpi Y j� � ��t!$1��� Gt �s ti"ct' "1 r# p!r ���e''� •• : n�wi 4 �Jt4 r•. twq ,i! 4srw n �� +1 r i �. r>' •ir ,•,ho- ►, F kw Pcii�'bt2}��Gt „ ���^ ,r1G,#�•t �[}��t'4 F'+�Ct4x� i�,, i ' +� rM�f .y+' 1 +ir ,L1IP �oYl le Wrltten'confirrtlatign frQrp:, POW ADEQ atjpsf� .� �r rj•'!i"f'•!Cb 'y�}P tl=: ��� r , ,1 r 1;. 1 r , �, �QI s• I' +.�t� ' Il � t N� �� $. 7t , ! e.dl n,� i r r ,; r ,w!"•� r , } 'M t- �Ft + f � 4� �y j! jIN M � ^�, ri /Ir . / /� 7 "'�{� F 1 ° { /l•'i w i r. p 'b +�a; � I � ! �i + JI f 3t:� ti�i, ��, �I .fire pf sE�T,4� i1,l�r ^f �_, tent prgtre wrjxtepo�Ir to i� R►;Sat� C � � 1i} ^� Y 'r p �,, ��r r. • �y� 1 9 •� --ic 1*,,:,-t f l�`� l i$,�, +' ,�;d r A` ,'�1 4 9y{k.n f �� I t„1, !,� ^'� Z.1 •� �' 1 r- 1 . Day phone:G Ill be held for pickup }E at� aF, 1u'd J �y dpi Y j� � ��t!$1��� Gt �s ti"ct' "1 r# p!r ���e''� •• : n�wi 4 �Jt4 r•. twq ,i! 4srw n �� +1 r i �. r>' •ir ,•,ho- ►, F kw Pcii�'bt2}��Gt „ ���^ ,r1G,#�•t �[}��t'4 F'+�Ct4x� i�,, i ' +� rM�f .y+' 1 +ir ,L1IP �oYl le Wrltten'confirrtlatign frQrp:, POW ADEQ atjpsf� .� �r rj•'!i"f'•!Cb 'y�}P tl=: ��� r , ,1 r 1;. 1 r , �, �QI s• I' +.�t� ' Il � t N� �� $. 7t , ! e.dl n,� i r r ,; r ,w!"•� r , } 'M t- �Ft + f � 4� �y j! jIN M � ^�, ri /Ir . / /� 7 "'�{� F 1 ° { /l•'i w i r. p 'b +�a; � I � ! �i + JI f 3t:� ti�i, ��, �I .fire pf sE�T,4� i1,l�r ^f �_, tent prgtre wrjxtepo�Ir to i� R►;Sat� C � � 1i} i+Y,,,.. itt>} lil ,e �i ,K5 �+ ,'ya i. i 4 y.�;• .y �, .t� t,�t cl' ,�C r ,,, !f i r .I, t v { t Elr 4.. a i ,r A t i4alt;4fi4 t $ c�1j '{, •'I. i !�, fi Eij 1a n ' r SPECTION �� i 41, 1 , 1�f�' ^S ceMfi0 f e Leffixener det sho he1ow i verifyjthat my, f ;investft�oii�isi(��h�' lftl�lit�or1,r�t`i"Y ,. j d ry$ 3. o bws the Ahe,on site Water supply , Si, �9 � F. ,E1 �,i7r: 'ay`. t Iti 7Y1j!$bx ilW 6'Iit., N,'t• fr rp;'�'j2 a4i Y L� fir. 11EF�E {r-' NhF 1r �.� ; f and%r iNastewateriFj osalystems a ute frr the�number of bedrooms ' I ct�rreIH�lcatedhereirtlil+e'd'rithe h,r, tt Y b o iiAation obtained from i' p k, ti' i}`' i 1 i nd:ins� 0 tift the on-site water the 1llluriior flit oi, �►i�i;ir�li d iro r s ,'N 4',"r,Sa • rt i. , - R ; +.t -f75. f" r i , r, s R <# pit �dl!R r �{ G lipply�af d/ i tieetei er ispos `s s rii s n n e vith ali Municipal and.State codes, ; f a 1 ni {tJE'1!i:.i l �' w -t,s „ c otdrnenc�es, and regulation in effect ori th (date: (` tins ifisp�Cti n fix'' p I' All Narne of FirM�`i�phone[S'� 3d , i t i8 r,y, t b p 3S ' �`: r >, t+ t}4! 4 , I � dktl a. "°' �` ` t s �) '! ��� ` ? i• "+ ' la�;� Addre§s', o ri � Iii JAG �. r 0 +� } Z Fi t '.t , n � yt �., 1,1 1 j°�' t a '.y � t tytii�;$t ll tt r N� t q v:-t;•i� r a' j ,ip r . .: �...." r t � .. I P ;, I irz fSd.; t p Srt 81 �. ,� k ki,i�iY�Lt(,x��;5 4� `� • ' i E t=ngrneer's signatureate ��h �4�s'" H t� tYs � •' � ti, �t i �i 4 k� ,: °�� s , s ,t �% �; . . 1, I! `b 1 .� ty kl}i it r , #Gofi >31t." I �t �►��� i t+dKKK y� I``ritka-,3•i �ik+��SE sr t ;�:I�E" � �rj�i ,�y?Nr,�rS���PI�. G, �t ���,F�.wr�,l�l�I��"spl1� r l .,t Aw►���•i• 664,I��`�� tl„ � E t 1 t ft}'+. .i lil �f�1jp f ���•►• +tom. ,''V fat + •••� �� , .- � � 1 ,' ,dt�r��y;°)[ri ��y`�y'�� n t � L{k�f��r�'�•'' ?: 4;�:' � • !.a 1 ; �. tat a w 1 i t'� .• 1 i t° r : r(h ej t p u � � F � ti k �. • �•/ ¢ i 16. E G � t { v �r F.+{a 51 4 i4��� tK rd : � s J • • i ' - �1; ,y� • a , t } � " e k � + 'FIb i '� � E � t R � , y ... t� .I w t {` y � �', bS sp �� .�,� ,y t . �•,1 1 �R, 1 i • • � E , £ •� �. r kyr jj n�f d�3C•V��� `'tl t' {` k k��'I�,• �� J.: Botol iii at rrFit r Y� y'f(. �. �� 4Mi p� + Qui ri: •• S 1 k w ; I r i .N t • • i'1x(`Rr'I'i £. •� �� •1 , r . R rid t rE4i1 f� i {{ l lk t r l' All ;a'' • � �' •• •�• �`..i ,• I �rr.. • i ti `' l1t� 's4 •' &;i*� i jt' ! °'ati�"��� P t#' r 1 OP ��► t�I�;� „ :Ip { ,, , �Y� ttl� RpiESg10M .��+"' DHHS SIGNATUREM-0 �:�,yih�'t a 5r. >.� d t w' �u rAfGFIt", #'trsr 3 Approved for r E d 4 R w bedrooms.. Disapproved ,?F}�'`A !{ Conditional approval for t� # r, ¢bedrooms with the' following i stipulations t e �! , I, t, t° i I •9• (Nt{`1 j t �ll� #"r ri ���i� z� r�l�'� �� '��� r' �# i (i,<.�� �k ��,� r j. n k itr ,'y t� nl� r�fl ,�:• �, t It r t } { fiskN' q -w It'INI' s,Yt syE -�lt� ,A �',dA t >♦ �++aarw) la sgt'� F '. 4 qp. 1{e t1 �4,. • ,J�j r.., s{ f�P } na {. r•� Ft�afi�2f.�t ( S r 9 r i;�r 4t, ,� ;, W a<f r gJ�1pQ. �i t ny r l� r ��$.� Y r '(4 ,4dditidfial Commentsp�t►� ��"'k ' t k�,, r a Y n 1 au t j, fit, i "wc,a \'• +4, > f i. "' } B, 41i id ;. t.. '{':itl� 'ttt(i✓;'p ? f trFd p �' • E 4�ur { r a t f t4 ai�ijd}'4IF;h PNP(lii•WON t#r awf Jl 9 r., EPP11Y .. ., { *_� tFP rI ''bate ♦y`, ti14 ti r { t�k i- aY ON 1r) ��"��rf 6' :���I I "f'ayai "I,'�+�1,; tr The WhicipollCAUTION t f Anchorage DepArtrrtent�oflH alth ikhd.Au i s`�(DF�pp HS issueskHealth Author( :4 L, ,. ' ;Approval Certificates based only upon„the representations olvei n pai�graph5jabove by an,Independent professional engineer,registered ih the State ois Alaska, the DHHS does this as a Courtesy to purchasers of homes . and their lending Ins4itutions In order to satisfyrcertainfsders( and state r k uirements�` �mpldyees of DHHS do not t , r r' . t • t j !, ¢,.: Y , t «t,, Y , , A f,.}+eh 1�' , t it ydPM p �An �: - r , r M � 1, conduct Inspectiorig or analyze data b6fofe'a certificate is.Issued�'The Municipality of Anchorage is not ti k+ad W >FV r�F ' � { as responsible for error or omissions in 4he'proiessiona� ehgihe�r�s JVdriCdji+�( A}f j'I'<sF,�t ; M-026(R6v.1/91)Back MOA 921 Municipality of Anchorage AL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 6 f1Rps—'sON Parcel I.D. 01,5-2 7.3,11 A. Well Data Well type /g2/6M If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed /1,f,4y ! `7ee9 Driller l<E�VS c��,oijNy Total depth 1 7.5' Cased to /7.5� SS�wr Casing height !• Sanitary seal (Y/N) Y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test��Y, i9Ba i ���� /!4 Static water level rrn y Well flow 7 g.p.m. <S" g.p.m. n –� p Pump levels ! Z 9 Ll �o, d /j G, z SEPARATION DISTANCES FROM WELL TO: s o0 N Septic/holding tank on lot »±� ; On adjacent lots 115,0 rn z Absorption field on lot �pO-i ` ; On adjacent lots / 3 S .+ Public sewer main AZ A Public sewer manhole/cleanout A)//A Sewer service line AfA4 Petroleum tank //4. WATER SAMPLE RESULTS: Coliform t,-ev cl c<-" Nitrate 1:7-,-7Z ./Other bacteria -� Date of sample: 71 D /,? SJ Collected by: x/ 1 2 B. SEPTIC/NNNOWTANK DATA Date instaJled l 219v Tank size 12-S O c9i. Compartments Z• Cleanout&.(Y/N)_Foundation cleanout (Y/N) Y Depression (Y/N) cif/ High water alarm (Y/N). Alarm tested (Y/N) Date of pumping v.v� L z� / FVJ- Pumper /2 6,,yA4-/ _T61 SCA �_K 472A/10 e6o&1CC SEPARgTIip,N DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot o.• f .: On adjacent lots _,/474 f Foundation / Z '=` To property line /lam ' ' Absorption field , L,,9' ` } Water main/service line N/A Surface water/drainage IVIA 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION AJ 1A Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Cycles tested On adjacent lots Surface water Date installed 4.v /, /mrSoil rating (GPD/Ft2) 1• z System type 96-C f T/07C41121 Length 4 .5e Width 3 't Gravel thickness Total depth Total absorption area SZ 6' s/7- Cleanout present (Y/N) Depression over field (Y/N) I- 4(Ex<5Y• 3 60AW ry17-CM9 71,/9r "R4n.no6b Tb Date of adequacy test t 1"U.v / t/`?,?r Results (pass/faiq !fA ss for 3 Bedrooms �k• N�CLD, Water level in absorption field before test Ivo Mov�ro� ru3 E i,v 'Aftertest Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /D d - / On adjacent lots // S �=" Property line /t7 To building foundation 2---1 To existing or abandoned system on lot A11A On adjacent lots 3 -7 = Cutbank IVIA Water main/service line_ Surface water XIZ,4 Driveway, parking/vehicle storage area ,5 ��- Curtain drain &ZA E. ENGINEER'S CERTIFICATION I certify Mat I have checked, verified, or conformed to all MOA and HAA guidelines in eff C �f this inspection. , OF �0 0.A 1 •4 Signature •..4•y ilk .... Engineer's Name 8 ,• . J. Bales • r. Date ������ rj.rr��, E "8691 HAA Fee $ 366 / cJZ) Date of Payment -Z– / 7""-1cS— Receipt Number //0 7 rl% JO 72-026 (3190)' Beck Waiver Fee $ Date of Payment Receipt Number 9