The URL can be used to link to this page

Home My WebLink AboutTANAINA VALLEY LT 9 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231101 PID Number: 011-051-83 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade Name Margaret Cikanek ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound ❑ Other Site Address 7104 Lowell Circle, Anchorage, AK 99502 Phone 907-243-3260 Number of Bedrooms 4 Soil Rating GPD/SF Total depth from original grade Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block. Lot Tanaina Valley 9 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Ftz Number of trenches Dist. between trenches Ft. Well N/A N/A N/A N/A >251 TANK ❑E Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water > 100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5, N/A N/A N/A NA Foundation >10, N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Remarks Tank only replaced, with insulation Additional CO added at the end of existing field Alarm location Electrical installed by Installer A. C. E. S. PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Drainfield D3034 Co/MT D3034 Inspector B Schiller BENCH MARK (Assumed elevation) 100 ft Inspectiones: 15` 5/31/23 2-d 3b 4 t Location and description Bottom of siding ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date Engineer's Stamp Septic System !�� Approved Date N : this approval does not include well permit requir ents trtev uoiuln ty Benjamin Schiller CE 12592R E GISTEREDPROFES S I O N A L E N GINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP231101 PID # 011-051-84 TANAINA VALLEY, LOT 9 A B MH 29.3 SV 34.1 2CO 36.0 A B CO1 40.2 MT1 89.6 CO2 95.0 13.7 14.6 15.4 14.5 62.3 68.4 FEET 0 50 100 FCO LO W E L L C I R C L E 4-B D R M H O M E AS-BUILT PLAN 7/13/23 10' T&E EASEMENT 15' WATER EASEMENT MT CO12CO 1,250-GAL SEPTIC TANK WATER LINE ROUTING (ESTIMATED) COMMMUNITY WELL 200' RADIUS 8" DIP W A T E R M A I N CO2 PROFILE AS-BUILT (NO SCALE) 96.5 92.5 97.0 100.1 FC O MH SV 1250 GAL SEPTIC TANK 2C O 96.1 Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N GINEER 7/13/23 PERMIT # OSP231101 PID # 011-051-84 TANAINA VALLEY, LOT 9 INSULATION Tract A Lot 8 15' WATERLINE EASEMENTS 10' T&E EASEMENT r� � $.-5.39 1 NOTE: THIS LOT IS SERVED BY A PUBLIC WATER SYSTEM. PLOT PLAN AS BUILT X SCALE 1" = 50' GRID SW 2122 Prosect No. 23-166/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone amu\ kenOlangsurvey.com .�� Professional Land Surveyors jonathanOlangsurvey.com ~ OF AL, kk travisOlongsurvey.com ' P• , • , I hereby certify that I have surveyed the following described property: LOT 9, TANAINA VALLEY SUBDIVISION (PLAT No. 86-91) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the - iA Day of h�6-0*07 , 7 � , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. *:49TH KENNETH G. LANG o.202 Y ►�_ FESSIONA� �. State of Alaska AECC963 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: OSP231101 Work Type: SepticTank Upgrade Tax Code Number: 01105184000 Site Legal Address: TANAINA VALLEY LT 9 G:2122 Site Mailing Address: 7104 LOWELL CIR, Anchorage Owner: CIKANEK JAMES J & MARGARET ANN Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: \oil»int n �J Depai-tment 5/18/2023 5/17/2024 32206 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 Special Provisions: 1. Locate the beginning of the trench to ensure that the new tank will meet the 5' separation to the field. 2. Find the missing cleanout at the end of the trench and repair if necessary. Rase: ZSS e tn ra e Issued By: _&� Date: Date: 4 MUNICIPALITY OF ANCHORAGE fx Community Development Department := Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-051-84 Property owner(s) Margaret Cikanek Mailing address 7104 Lowell Circle, Anchorage AK 99502 Site address 7104 Lowell Circle Day phone (907) 243-3260 Legal description (Sub'd., Block & Lot) Tanaina Valley Lot 9 Legal description (Township, Range & Section) Lot Size 32,206 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (`/✓/wo ADU) Septic Tank ❑X Upgrade pg � (D) El Holding Tank r_1 Renewal 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 jMunicipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Z Z S Waiver Fees: _ Date of Payment: 2 Date of Payment: Receipt Number: 032-6 3p Receipt Number: Permit No. 05 PZ 3 11 y 1 Waiver No. Permit App_:- :- :'—._:c May 11, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Tanaina Valley Lot 9 - 7104 Lowell Circle Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with the same size designed for 4 bedrooms. The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231101, Deb Wockenfuss, 05/18/23 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=50' DECOMMISSION EXISTING TANK CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TANAINA VALLEY, LOT 9 FEET 0 50 100 FCO LO W E L L C I R C L E 4-B D R M H O M E SEPTIC PLAN 5/11/23 10' T&E EASEMENT 15' WATER EASEMENT MT CO 2CO NEW 1,250-GAL SEPTIC TANK WATER LINE ROUTING (ESTIMATED) COMMMUNITY WELL 200' RADIUS 8" DIP WATER M A I N Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231101, Deb Wockenfuss, 05/18/23 Tract A Z 15' WATERLINE EASEMENTS Lot 8 S 8 51 8'48" 0. E 785.39' 7 SEPTIC PIPES 2.0'x 12.5' 8.0' DEC 1.5'x10.5' ��nN 60 CANT N N� 8.0x8.0' CANT \\ 1.5 CANT , N Za? Lot 9 32,206 S.F. Lot 10 10' T&E EASEMENT Lot 8 & RAIL FENCE NOTE: THIS LOT IS SERVED BY A PUBLIC WATER SYSTEM. PLOT PLAN ___ AS BUILT _X_ SCALE_1"_= 50__ GRID _ SW 2122__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone kenOlangsurvey.com 09` ' " Professional Land Surveyors jonothanolangsurvey.com ?� o" AL., I t trovisOlangsurvey.com iWQ1 � I hereby certify that I have surveyed the following described property: LOT 8, TANAINA VALLEY SUBDIVISION (PLAT No. 86-91) 0*.' 49TH Anchorage Recording District, Alaska, and that the improvements situated thereon are • • • • • • • • • within the property lines and do not encroach onto the properly adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible / KENNETH G. LANG Q. easements on said property except as Indicated hereon.,+ `P`GJ, • o. 5202 Dated this the __ �_ _ y ____ti_; --"--, at Anchorage, Alaska _ Da of--------- ----- PROFESSION�1��aN� It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 L=20.00' 'J 14J io R=314.35' �! J L=31.33' WU 3 /10 R=50.00' -ASPHALT DRIVEWAY I J U y .,_.26:1 ._ 0�.. 2 p � N a: 1.5'x10.5' ��nN 60 CANT N N� 8.0x8.0' CANT \\ 1.5 CANT , N Za? Lot 9 32,206 S.F. Lot 10 10' T&E EASEMENT Lot 8 & RAIL FENCE NOTE: THIS LOT IS SERVED BY A PUBLIC WATER SYSTEM. PLOT PLAN ___ AS BUILT _X_ SCALE_1"_= 50__ GRID _ SW 2122__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone kenOlangsurvey.com 09` ' " Professional Land Surveyors jonothanolangsurvey.com ?� o" AL., I t trovisOlangsurvey.com iWQ1 � I hereby certify that I have surveyed the following described property: LOT 8, TANAINA VALLEY SUBDIVISION (PLAT No. 86-91) 0*.' 49TH Anchorage Recording District, Alaska, and that the improvements situated thereon are • • • • • • • • • within the property lines and do not encroach onto the properly adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible / KENNETH G. LANG Q. easements on said property except as Indicated hereon.,+ `P`GJ, • o. 5202 Dated this the __ �_ _ y ____ti_; --"--, at Anchorage, Alaska _ Da of--------- ----- PROFESSION�1��aN� It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264.-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORI' Name Address Permil NO. NO oJ Bedrooms LEGAL DE$GRIPTIOB Township, Range, Seclion TANKS SEPTIC [] HOLDING ManuJac[urer Capacity in gallons _ No of Compartmen[s TYPE OF SYSTEM []TRENCH [] BED ~ W. DRAIN [] OTHER Depth to pipe bogofn Irorn Total depth Irom original grade originalgrade */// FI FT Fin added above original grade Gravel depth benealh pipe ~ FT FT / /~ SQ FT WELLS [] PRIVATE [] OTHER {Identify) (A,B,C) Total Depth ET Casedto Installer InsJslled; RFMARKS: DISTANCES SEPTIC TANK WELL ~./0' ABSORPTION FIELD WELL LOT LINE .~ ' Z O' FOUNDATION /..R ~ ~0' .~./.~ ' AS-BUILT GIAGRAM (Show Iocslion ct well, septic system, property lines, Ioundation, driveway, Waler bodies, sic) Scale: Inspections Performed by: Municipal and Slale guidelines In slleU on this date: caddy thai Ibis inopeciion was padormad according Io all /~,4ichclcl t:. Anderson Health Deparlmenl Approval: 72-013 (3/85) Per. m:i'L Ixh..uifl;:H:~P ~ AI',ICHORA'EIIE, Al< ~":75 Day I::~l"lone ,~ 349.....8 () :[ 4 .l:lqt!i'lAl..I.. F:'fii'.R [i:lqG:!:lqEl:'!]::Hii AI::;'F:'F/CIVI!i[D ](:)I~!:S:[(ilN~ NO"I"II::'Y DHHS I::'RIOI:~ EAI]I'I I NSF:'EC, T I OIq BY I"Hli: IEN(:) ]: IqlE[~i:l::/,, '1]"1 ]: S I:::'ERM :1: '[' :1: S I !~ISLIIED FOF:t THE F"'I.AIqNI~)]) 4 B['::DROOM I~:I:IqGLE F:Alfl:[LY DWEI..J.,IIqG ONLY AND E XI::']:IRES ON 12 / 3 :t / 1~19 ,, ]: CEI:;:TIFY THAT: :J.,, :[ ,~'~lfl {am:i,].:i.,~?d' with tile)! I~(~')CIM:i.I"t:)IiI~'~I"i'L~i J'CIl" I:)l"l""'t[ii:J.'[,e Eii::.)v~('.)P~l arid tor,'Lh I::ly 'l'.,he I"lurli, c::i.l:)al:i, ty of Aritho!l-at:lc (MDA) al3d 'Lhc.) Eltate elf A].aska. ?.. :[ ~.~:i:1.3. :i. ns'l',.a].:l thc) sys'l'..efli in al::C:Ol~darlc;c.~ w:i.'Ll'l a:l.:l, MI:lA celtics arid Pel;ju:l,a'L:i, clr'ls~, avid :i.l'l cc)mplJance wJ,'Lh 'L. hl.~, design cpiteP:La c:)t' this pePm~t,, 3~ ]: ~:i.:l,:l adl'i~l".e 'l:.cl ali MOA arid S'La'Le (::)t' Alaska r. 0'.H::lu:i. PemerrLs t'(::H" 'Ll"[e se'l' back (:d:i.~i'~aril:E,~ ['l-.(::)m a',tl'ly t:~i,(~.~'LJ, FI~] kle;~],],~, ~1~:&~'t:,t:~)~'l~'[,~l'~ Cl],~il:]l;:~[~h~lJ, ~:~y!~'~,,~)fll /I.,, :[ i..irll;:l~r'!~'l',4ftl'il:J 'l'.l'h':~'l', ~LHJ, S per, m:i.'L is valid t'(:]l' a max:irm.un i::)t' 4. bedr'ooms,, I arl y ~l'l 1 al. g emerl t ?~ :i ]. 1 i, c,( it,,I ~//~ a n ad d i 'L i or', a I p e r' m :i, t .... ..... ~~/~ ......... ~ ~.,.¢ .................... ((]t,~rl(::,) r' ) DENAL, ~1: SIJ[:'I:;;'I..'Y I NC. ,:...,..,.,,..,.,,~., ,,. ,..., ~~~_- -~ ,:~.:,.,..~,, - I UIH. ¢-[.$W I/~4 4. [AlT 6 ~' [lI~ I 18 ? ~4,550 I,f. 15 /~--~ 31,010 tt ~ooo 5~' ,~A I0 ~1~056L£ 77.?1~ 33,91T Accei~ E~3~ / ', \ ---- -- 2.~,O.OZ' N og°go'40"E - 600.90'(Id) $ 0~098'41 '*W - 6Og. 50'(lq XP68.130) 12 $$,920 &f. Municipality of Anchoraga DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE.PERFO LEGAL DESCRIPTION: / 1 ~,~? 4 5 6 7 9- 11- 13 14 15 16 18 19- 20. [?,,t Township, Range, Section: SLOPE WASGROUND WATER ENCOUNTERED? /~/~ !tlI I PERCOLATION RATE __ Immute~qncJ~) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND _Pr P~FORMED BY: ~ /]/:~ Ob ~'A/ I C~TI~ THAT THIS T~T WAS PERFORMED IN ACCOROANCE WITH ALL STATE AND MUNICIPAL GUInELIN~S IN EFFECT ON THIS OAT[ DAT~ 72q~O8 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Ataska 99502-0650 SOILS LOG -- PERCOLATION 'rEs'r PERFORMED FOR: DATE PERFOR LEGALDE$CRIPTION:. LOT (~ 1 2 4 5 7 8 9- 10- 11 13 14 15 17 18 19 20 I/J ~- L L Township, Range, Section: SLOPE SITE PLAN WAS GROUNO WATER ENCOUNTERED? $ L IF YES, AT WHAT O DEPTH? p E Time Time Water Drop PERCOLATION RATE __ [mmule~,lncn) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND . FT ~ 15 uUIOcLINcS IN EFFE~ OH THIS OAT[ DAT[ ~ -/~¢ WiTH ALL STATE AND MUNICIPAL MUMUPPA UTY OF ANCHORAGE Development Services Department z Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-051-84-000 Expiration Date: Legal description TANAINA VALLEY LT 9 Site address 7104 LOWELL CIR Anchorage AK 99502 Current property owner(s) CIKANEK JAMES J & MARGARET ANN 11/4/2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 8/4/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department `¢ p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 011-051-84 Complete legal description Tanaina Valley Lot 9 Location (site address) 7104 Lowell Circle, Anchorage, AK 99502 Current property owner(s) Margaret Cikanek 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone (907) 243-3260 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑■ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel N Plastic ❑ Concrete ❑ Fiberglass Age < 1 yr - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: akA Expedited review requested: ❑ Distance: 3 By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment -7/2,� -2 r COSA # 0SG2.312 LA7 Waiver Fee $ 72. -5o Date of Payment Waiver # U 5 V?_3 104 1 COSA Application_ June 2022 Tanaina Valley Lot 9 011-051-84 Property is served by city water. N/A N/A New Installation N/A N/A N/A 4/19/23 0 978 22 1440 0 > 600 48 Benjamin Schiller, P.E.7/5/23 (907) 522-7773 July 28, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Tanaina Valley Lot 9 - 7104 Lowell Circle Tank to field waiver request Dear On-Site Services Engineer: During the installation of this new septic tank we found that the buried electrical service ran directly behind the existing tank. The installer set the tank as far as possible from the field, but was unable to achieve 5’ separation, or even shift the tank far enough over because of how close the service was. The new tank is further from the field from the old tank, and does not cause any issues with the trench. We would like to request a waiver be issued for a 3.5’ separation from the tank to the leach field. Sincerely, Benjamin Schiller, PE Municipality of Anchorage _: 1 P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231041 COSA#:OSC231247 Permit#:OSP231101 PID#: 011-051-84 Legal Description: Tanaina Valley Lot 9 Engineer: Forge engineering Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the absorption field has been approved. The approved separation distance is 3.5 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: Waiver is not Granted: Date: ��" Approved ,.-Name 6f Reviewer ■ ............................. ■ 1 **** VARIANCE/WAIVER REVIEW **** 4 t S 00 3 —I i� i� I ; aGpyu�N-CR.`��(3 9Ag'� 1S10N 40 - _ I __J lI/I 3-� /Q �3 /z x %' EXISTING WELL cm I - MA-fCHLIIJE _ -` _ TIKiIJED ON THIS SHEKTD - C� 5TAT101�! FOR MAIM LINE ~ GORPORATInI..I STOPS L-►$ 4- 00, CL STATION FOR MAIN LIIUE =- _ 1 55 L-17 ... Ca.} q0 ..... .....__ = 155 GORPnRATION STDPra L-� et8z 1 -q IZ-1 z8 w L-!-5 6 + 64 C .EXISTING GROUND lL L-117 IZ + 7q L-15 q + 40? ti (pT) J L-11 12 + 81 - - � 5O L-14 - - III (9�� -FINISH Gfzp_.DE N , 9 + 70. __ L).... _ _4 150 L -1Z 14-+48 4-7 10 1 30 �_ - L-13 14+50 tp L-0 10+32 -" 14-5 SL�IINLa TIES. 14 5 5—WIN(a TIES TO KB FROM LOT GORI�IERS - FROM Ce2KwERS L-10/11 L_ ---51(p L-14 ! 15 / __ L -q/10 3 L--5 5% 9q' (G►" 1) L -q' 15 � (10- 14 0 L� = a - ' :....L- 4/15 5 D:48°/' 1�7.0LF ,/ .....__ -57 ` L-10 q86 57 - L II L-=7 53� 77 — -( �- s i 140 2/13 L -ID 6 ML /I L-8 59 85 — _ 1 L-14 7�2 5z �� 1-i '3 : •6�T -- - - ` L -1Z 5% Iq5 1355 5 L-15 85= 59 _ L-13 (off 197 ._ L=Ifo 19 -d- L-17 L=17 19 5 zoz '-L. :..?Q -19 - - Y- P, L=10117 L-17/18) - E_ 13l�.s �� ACL 5ZCT Z (ML) , .. 13Q x-18 u'q� 5. _ _ Soh EL. 1375 ,1� 0 � 13O 0 (5 M) q1 %',, m 1 Z5 V f ... - — 2 $(o I L.F irr— mL. 1.5 ,� _ 5 Dov. _ :.::;:.::.: - I Z 5 — V - S ♦- o W (� M) til Z O w uJ, _ t�f'.EL Iz5,0 w ... ....... ....... 3 - m — �H 2 12O Z� 81 m N �p (9 Q I5 J+ _+ o - - - _ ...._. �9. _:. ........ v., Q + +� w N:- Q - ; z AS -BUILT 5+00 5+50 G*00 (0+50 7+00 �+50 8+00 b*50 9+o0 9+5p 10+09 10+50 11+00 11+5-0 IZ+00 IZ * 50 13+00 1'5+50 14+00 14+50 15+00 W.O. 8716 - 6002 - 0099 SCALE OF.Atgs�♦ MORIZ: I"=50' SNOT In.. CJI DSN BY M J IC. v 4�JTH� • 'F�♦�� VERT --.-. - - — ... •• *Ap •...A - aze� �s_�U LLT - —USS DWG BY ROP -rank Mcdin & WAfi R IMPROVEMENTS NTS ,...a DATE 2 2 8�0 zr es E. Wilson, Jr. a G 51rj FeELDGATEp FIRS IKDRpt.IT F7 WAT1=1? VALV€S RLP Q' CE 6281 y�0 _- 0_424 12 IACp-fE WATER LIME FH STA.,*99 Gv-U.II+Z5 i P eH1 - Associates, Ina LOWELL CIRCLE STA. 5+14 TO STA. 14+24 TAN -SNA► V- _ _ _ _ _ _ i�iSi _ N e�aJl�;,�.. JOB No. �M3�8 A ALLEY SUBDIVISION I BIP 5;-T _ G'uJ_ ENGINEERING o DESIGN • PROJECT MANAGEMENT aPapro�e �� g REV. DATEI DESCRIPTION BY. APPD. AP DAL REVISION NO.G MUNICIPALITY OF:ANCHORAGE • Department of Health & Human Semices DIVISION OF ENVIRONMENTAL, SERVICES — 343 -4744 - CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # �� i " ��-'`� HAA 1. GENERAL INFORMATION (Must be completed prior to submittal),; (a) Legal Description (include lot, block, subdivision, section, township, range) e oT 9 T, 4441,V,1 VACLgy S # T lZ ,J Location (address or directions) LccuEGG D�'/r/�' or'C ki9� BE•t.�y (b) Property owner DEMALL. SuAQL ZAIr- Telephone: (home) - Business 3119-6oiY Mailing Address 704-1 (c) -Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here , if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family;J Number of bedrooms_ 3. WATER SUPPLY Individual Well ❑ Community ( Public ❑ Note: If community well system, must have written confirmation from the State Department of I Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL. On-site P( Public ❑ _ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to.the legailty and,statue. - 72-025 (Rev. 7/88), Page 1 of,2 5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, funct dna .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 rny 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. NameofFirm ~4b~--IZ5~,.4 ~..--'Nb,~J~--L::'r~u~b Telephone ~7- Address P O. box. g,~/O 773 /~NOf--/d,'t.4/~L' Rib Date Engineer's Seal 6. DHHS APPROVAL Approved for y bedrooms by Approved c/'~L Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Oack Page 2 of 2 MUNIcIPALI'TY OF ANCHORAGE £NViP, oNMENTAL SERVICES DIVISION 2 5 1988 RECEIVED MUNICIPALIT~OF A~CHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /- A. WELL DATA Well Classification Well Log Present (Y/N) _ Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) _ Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL.: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line 'Fo Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date No. of Compartments )/ Foundation Cleanout (Y/N) _,V Date Last Pumped l,J¢l,d /V ~-z¢~, ; for Temporary Holding Tank Permit (Y/N) ,4,',~ B. SEPTIC/HOLDING TANK DATA Date Installed ,5,~.~' Size Standpipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ ,~,./-,'¢ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ,~/~ To Property Line ,.5",¢ ' To Water Main/Service Line __ ,3(, ' To Stream. Pond, Lake or Major Drainage Course /v~,4,,~ /,~ ,,~ Comments ~_,¢.;,0~-/~ 7-/¢¢¢/~ /.,.5' To Building Foundation 'Fo Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed .5-' Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test /.~ 5 Type of System Design Length of Field ¢¢ ' '~- Depth of Field ,¢~ ' Gravel Bed Thickness (7" "-" ~,~ ~ Statndpipes Present (Y/N) AJ Date of Last Adequacy Test PAss~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well Z/Z' To Building Foundation ~ ~>' Lot To Water Main/Service Line '// To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Y To Property Line Z To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOp.and H~ inspection. Signed Company ,,Z~ ~ ~:TZ,I'c~,~ Date MOA No. Receipt No. 0 Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~ in effect on the date of this Engineer's Seal