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HomeMy WebLinkAboutWORLD TOP ACRES LT 3Onsite File World Top Acres Lot 3 #015-163-52 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221181 PID Number: 015-163-52 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name WILLIAMS ABSORPTION FIELD ❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11200 HIDEWAY TRAIL, ANCH ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 1.2 GPD/SF JTotal 8.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft. Gravel depth beneath pipe 6.5 Subdivision Block Lot WORLD TOP ACRES LT 3 Ft. Fill added above original grade 5+ Ft. Gravel length 39 Ft. Township Range Section Gravel width 2.0 Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 5507 Ftz 1.0 Ft. Well 100'+ 100'+ 50'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCH TANK Capacity 1250 Gal. Surface Water 100'+ 1001+ Material Number of compartments Lot Line 10'+ 10'+ NA PLASTIC 2 Foundation 0'+ 10'+ ILIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 103 ft Inspectiones: 1st 7/25/22 2"d 7/26/22 Location and description 3rd 4m TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL EniQN`Stamp 4 Conditional Approval: Date � . ,: �`�:•'' • •' e' y' ` g 49TH "` •• �.: • r rr• • • .f �•� MICHAEL N. ANDERSCN •. Septic System Approved ' --t Date CE 94 9 �' • i D ` • ' • V ii0S= Note: this approval does not include well permit requirements. kI\GY VW VG! IUi Permit No. OSP221181 Page 2 of 2 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: WORLD TOP ACRES LOT 3 PID No.: 015-163-52 M�ARK\\ A 1c \ 2n 7 c( 02 4 1 FC C04 C05 44� 4 471 �D 222 M T 7 47 1 06 MT1� E€RVE F1E - -WITH-CLQ S III SYSTEM 1 1 WELL �— // BENCH, TOP OF IMH / I 1250 GA PLASTIC TAN / IVEWAY- Cps, C01 DOC C A � / � ASBU�iLT :ALE: /1"=50' SEPTIC SECTION N.T.S. I°� ;MICHAEL N. ANDERS( ®® No. CE 9469 `0 9-7-22 ® ® NO WATER ®83 MAY 2022 ....'' VIUIRIL EWE 0 0 �s Ln ti 0 0 0 Z N 89 56' 45" E 300.04 OF Ak :' 49 TH 9 O N SHANE A. HOLT �� G �p P LS -6914 0,�°fessional �oo EAST 155.07 THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROV/DED. W O Z THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALL Y TO SHOD/ ANY CONFLICTS BErYEEN EXISTING STRUCTURES AND PLATTED LOT LINES ANDVOR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHO/JN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAUING ARE NOT TO BE USED TO DET£RMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOYN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOU AND/OR ICE. AS-BUILTSURYEY f" =30' NO CORNERS SET THIS DATE /HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT3 WORLD TOPACRES SUB. (PLAT 77-167) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DA TED ATANCHORAGE,ALASKA THIS 12TH DAY OF JUL Y 2022 15419 FB 221-65 224-75 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 MUNICIPALITY OF ANCHORAGE Onsite Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519.6650 Phone: (907) 343-7904 Fax: (907) 3437997 http://w .muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221181 Work Type: Septic Upgrade Tax Code Number: 01516352000 Site Legal Address: WORLD TOP ACRES LT 3 G:2640 Site Mailing Address: 11200 HIDEAWAY TRL, Anchorage Owner: WILLIAMS JANICE E & GLEN V Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: vicnr Sn n "A- Department .I epa 6/21/2022 612112023 Lot Size in Sq Ft: 47500 Total Bedrooms: 4 ❑ 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 Received Is 2Z Zai Date: Date:.Z 2,©22 -01 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 s (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section mcnr r�:�url I�epnrtmcn[ * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221041 COSA#: Permit#:OSP221181 PID#: 015-163-52 Legal Description: World Top Acres Lot 3 Engineer: Mike N. Anderson Applicant: Glen & Janice Williams Your request for a waiver of the required 16.0 feet horizontal separation from the proposed absorption field to the existing absorption field has been approved. The approved separation distance is 13.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the proposed absorption field 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: X Waiver is not Granted: Date: L,_20a Approved by: l'u G'C'A Ca -CS Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE rl� C _ Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 015-163-52 Property owner(s) WILLIAMS Mailing address 11200 HIDEAWAY TRAIL, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) WORLD TOP ACRES LT 3 Legal description (Township, Range & Section) Lot Size 47500 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field E Initial ❑ Single Family (SF) El Septic Tank X❑ Upgrade FxJ (w/wo ADU) Holding Tank E]Renewal ElDuplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 3 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: J>- 9 5 Waiver Fees: N 5 Date of Payment: 2 Date of Payment: 6 Na 0 Receipt Number: D `� g °� Receipt Number: 6,24 j y S Permit No. O S p�? �) j I i Waiver No. ©SV -1 a t 0 y 1 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc June 23, 2022 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic permit (CHANGE ORDER) Legal: WORLD TOP ACRES LT 3 To whom it may concern: This is a request for a septic CHANGER ORDER to allow the new trench to be less than the required 16 feet from the old trench but only at the beginning see site plan. The old trench has an effective depth of three feet and will be abandoned in-place because it's a 3 -bedroom design. Total depth for the old system was measured at 8 feet. The new tank is installed as per plan. The change order will not affect any of the neighboring lots. Sincerely /;W, Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 June 4, 2022 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic permit Legal: WORLD TOP ACRES LT 3 To whom it may concern: This is a request for a septic permit on the above referenced lot. A single test hole were excavated and found poorly graded gravels and sands (GP/SP) for the entire depth with no water observed during or after the 7 day monitoring period. The existing 1000 gallon tank will be replaced with a new plastic tank. A deep trench has been designed for the new leach field the same as the old field. The lot slopes to the west very gently at about 1 to 3 percent across the lawn. A slope of greater than 25 percent is located more than 60 feet away from this new proposed system. This new system will not impact any of the surrounding neighbors. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221181, Rebecca Carroll, 06/21/22 SEPTIC FIELD SECTION DESIGN CRITERIA: 8.0' EFFECTIVE 4 BDRM X 150 = 600 GPD SOILS = 600/1.2 = 500 GPD 500 GA/16 = 32' 2.0' WIDE 32' LONG (1) TRENCH 11.0' DEEP 17 (TH#1) 1.0 GP/SP ORG 1.0'2.0' -11.0 -3.0 MOUND OVER FILTER FABRIC SEWER ROCK ‘3,3( GRADE 1"=200' PROPERTY LINE EXISTING DRAINAGE FIELD EXISTING WELL 100' RADIUS EXISTING HOUSE -HILL DRIVE-SCALE: DJRDRAWN: DATE: WORLD TOP ACRES, LOT 3 Anchorage, Alaska GLEN & JANICE WILLIAMS 6/3/2022-HIDEAWAY TRAIL--SNOWLINE DRIVE- Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221181, Rebecca Carroll, 06/21/22 I Atj4— -- --- VACASLOPE > 25% IS 60' AWAY SMALL RUNOFF STREAM LLI ~ / L I I W Q LL / FOO O / I w � W/ � I o- � U I I CD ,,-- 3°/OSI OP J I 1 RESERVE SYSTEM j • I� CLASS III, _ 1 APPLICATION RATE \ CO—UT --; —} 3GPD/SF 2X5X20' G NEW DRAINAGE FIELD DCO 00 9 I IIS EXI TING % I SEP IC / 11 i N 1250 GALLON j I / P TIC TANK W/ 20" RISER, STING TANK ITO BE I I DECOMMISSIONED APPROXIMATE LOCATION OF OLD SYSTEM, PER THE UPC WILL BE DOCUMENTED DURING EXCAVATION TO BE MIN. 16' FROM NEW SYSTEM \ I Septic Design Prepared for GLEN & JANICE WILLIAMS WORLD TOP ACRES, LOT 3 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: SHED HIDEAWAY ACRES LOT 2 WORLD TOP ACRES LOT 3 EXISTING _HOUSE/ EXISTING WELL _ __-- 100' RADIUS TO BE STAKED BY SURVEYOR WORL TOf� RES / LOT 4 \ I r 6/3/2022 DJR 1 "=50' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221181, Rebecca Carroll, 06/21/22 N 89 56'45" E 300.04 OF.A CO 49 R `9 h'Ae�— s SHANE A. HOLT �� G LS -6914 ,\,°fessiona� �-Qo EAST 15507 THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OFRECORD AS OF THEDATE OF THIS SURVEY. ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROV/DED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOD/ ANY CONFLICTS BETNEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO SE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES- EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOYN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAYING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHONN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNON AND/OR ICE. AS -BUILT SURVEY I" =30' NO CORNERS SET THIS DATE /HEREBY CERTIFY THA T / HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY L 0 T 3 WORL D TOP A CRES SUB. (PLAT 77-167) A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENIS SITUATED THEREON ARE WITHIN THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATEDATANCHORAGE,ALASKA THIS 20TH DAYOF APRIL 2022 15419 FB 221-65 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 Il'liE I,.l~}]l"ll(~i'l"l-I I]) ]] I"lI[}~r',l;~; ;I] [;]::1",t :t: S 'I"I'IE I .l:~lr'lllZ~iil I :' ']] [',l I:;: [}~;E~]'I" ) (]]1::: 'l"lll[~}~ 'tlI:;?.[~}~I",[IZ;I"[ 'Z I:;? I]Z;~:I:::I ~[ l"llF ~l~ IEl, l[:,. 'I'f. tE [;,li~Z"IH OF FI II I bl..ll "'t:;'I:;:'];T ils THE I)};S'[FINI]Z~ [?.lE'l"l.,.lli~;[.:;l'.,1 'I'I-IE SLII:;;'.I:;'~:II~];:I}}; (Z;:' TI. lIE (]~il:;:OI..ll'-:ll) I:::iI",ID 't't.IE I~?,[])Tf'OH O1:::'THE · .:. ""r II l[ .[:IL II[ ..... 'I'Ht}~] .1 f I [:'IEP'I'I I ;[ S 't'IIIE I¥1 :I] I",l 3; I¥11..11¥t I)[}}]I~::'TH O1::: []~F;?.I':t'v'EI..r. I ,I. I I41 .[.hi 'I'Hf~}] Ot..I t"t:::'l:;:ll..lr.. I::' ]; I:::'1}~{ I::II'"ID THE [~:OT-I'OI'"I ()F THE IE;:':;(;;:I:qVI:::I"I'];Ot'"! ........ Il Ill l I!:Fll]Z::]:::'.-l;l..I..];i'"!(]!i "'11:::' I:::ll'q"l". I : fI:.i'1 t,.l];"l'll(Zlrl' I:: ]i i'-,ll:::ll.. 3;l",l'_::!;l:::'[iiZ:T]t]l]Z',l I:-:11",11) I [ I _ I [::'~' ' .... I])l!!iT:'l::ll:;i;'l'l'qlii~t",!T l.,.I}]lJ, tli?,111 :!~;ll--II:~"'l}'l!i;l~ylf 'Il(3 FI};''~::::I:]:~I --'l']~;ll'l' .'I.II1~.1..' I:;f1"][)I'l[:''l.'! .... t:;t[iii; :ii;liiii'l' GREATER ANCHORAGE AREA b UGII De partment of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 $OII,S hOG -' I'EROI,ATION TEST Performed for j~_~._d~._J_.~_~_Cp.(~'~ _ Date Perfon~ied ........ '_Z Legal Doscrlp~loll. ~' ~~~-~ ~est ~ This form reports: Soils log ~ 7'/4 Depth Feet 1: .7"~lgLr~ .................. Z~ ....... m 6- 7- 8- 9- lO-- - G ,eger/.'Y 12- 13- Was ground water encountered? Date Reading __~__ If yes, at wh~t depth? Gross Time Net Time Seepage Pit Drain Field _~e?__th__ to water Ilet Drop Percolation rate minute. -Proposed installat-To-W~ Depth of Inlet . . Deptl~ to bottom of l)~t or trench. Well Owner Glen Williams DRILLING LOG [/se of Well Dom. Location (address of: Township, Range, Section, if known; or distance main road Lot 3 World ToD Acres Size of easing_ Static water level 6" Depth of Hole ~03 feet Cased to 100.8 feet Artesian ' ,i ft. (above)'; (b~lb~v) land surface. Finish of well (check one) open end [zix ); (minute) for ]. hours with 1007. Screen ( ); Perforated ( ). Describe screen or perforation ]q/A~' Well pumping test at 2 0 gallgns PerX(,l'I~lr) of drawdown from static level ,,ii ',' Date of completion B/26/78 ': 'i WELL LOG Depth in feet from ·:~ ' : '' ground surface Giv~"~tMls of formations penetrated, size of material, color and hardness TO 1.5 Sii~y' ~avel: cobbly 19 :S~lgy ~ravel: damp 25 ' Silty ,~i~hd: c ].aver 30 "Clayey .gr_avel 42 "C~] ~yay gr~V~l 52 Loose-sil.t:¥ sand &'-graVel 98 }lard pan 103 _ Water 7~rav~], 0 2 15 TO __3.9 TO __23__TO 30 TO 35__TO 42 TO. 52 TO 98 TO TO TO TO TO TO NW\VA Cc:'til:k:d Cm~hactnr 3--CONTRACTOR MUNICIPALITY OF ANCHORAGE 1. 1 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. 015-163-52 Expiration Date: 2- 1. 1. GENERAL INFORMATION Complete legal description WORLD TOP ACRES, LOT 3 Location (site address) 11200 HIDEWAY TRAIL, ANCH, AK Current property owner(s) Mailing address Real estate agent WILLIAMS SAME 2. TYPE OF DWELLING: - 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ qq2- 4' Date of Payment L7 L lag Receipt Number 066-o5%5_ COSA# 615CAgiL1 Waiver Fee $ Date of Payment Receipt Number 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 Onsite 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 MIKE N ANDERSON, P.E. Phone 727'$$64 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 9-2"22 N® : 49TH 6. DSD IGNATURE /......?..... ..........�, System #1 Approved for 4 bedrooms MICHAEL N. Ar:oLascr, • A System #2 Approved for bedrooms f� �••• CE -1.94 9 o Disapproved 1 {{ivy' • • 9'S ?;� �1�FRt�10t�"�4 Conditional approval for bedrooms, with the following stipulati9ll` tiffSS>> oN �T Cyo tvF v m qST' R'1N� c� o Rp " %9TFR 7� WICES O�,�� � CC 2Z By: r--- (p Original Certificate Date: �J 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Cheddist blue sheet z Legal Description: WORLD TOP ACRES LOT 3 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 7126/78 Total depth 103 ft Cased to 100.9 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 44 in. Date of flow test for COSA 815122 Static water level at beginning of test ft. Comments *WELL IS ARTESIAN WITH A PACKER B. TANK DATA Age of tank(S) NEW years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA NEW SYSTEM Which system tested (date installed) 7125122 ❑ ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A— pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-163-52 of Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 4.37 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 815122 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW Results ✓D Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 Community Sewer Manhole/Cleanout > 100' ® Yes if No ft M Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank> 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No ft Water Main > 10'✓Q Animal Containment > 50' Q Yes if No ft 1Q Yes if No ft Yes if No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' dQ Yes if No ft✓U 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' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10'✓Q ft 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-- ots_Water WaterMain > 10'✓0 Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS .4.,� O F A G. ENGINEER'S CERTIFICATION ,`¢•. • • . ,jr, I certify that 1 have determined through field inspections and review f 9.s of Municipal records that the above systems are in conformance with �...... , • , , , • • MOA COSA guidelines in effect on this date. • • • NG • , • + • . + • . e 9 • MIC{-UfiA=�tj "ANDERWt4 ; % �� �•'.• CE 9469 FISS COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DMSION OF ENVfRONMENTAL HEAL'UA DEPA~FME~r OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEAL%~ AURlqORITY APPROVAL CEt~IFICATE 10 Geseral Infornmti_.o_n Application Date __~./I~_~_~_~_~ (a) Legal DescTiption (include lot, block, subdivision, section, township, range) Location (adck~ss or di~ections) (b) Applicants Nan~__~__~.~A/ Applicants Ad¢~ess__//~ 61 O ///E/E~/l&~_?~,~ / (c) Ap)liqant is (check._qo~_~) Lending Institution (d) Imndi~g Institution ____~.~i:; (e) ~al Estate ~. & ~ent _-- Address Te le phone 2. T_/k~_of Pesidence Single-Famil~ N~r of Bsdroc~ 3. Wate= Supp.lji Other (describe.) Individual Well ~ Cc~nity ~/--] Public Note: If c~nity ~11 system, must haw written confir~ntion f~n the State Department of Enviror~ntal Conseuvation attesting to the legality and status. Is the ~11 a¢~equate for the nu~er of bedr(x~s specified in this ~AA (Y/N) Onsite C__~] Public ~ Co~m/nity I~I Holdin~ Tank Is the wastewater disposal system adequate for tile roi. tuber of kedroc~ns (Y/N) [Page 1 of 2] 2-15-84 5. E_~nqinee~ip~ Firm t~ovidi_~ng_~s_pections, 'l%sts,_ Data an__d In__forn%~tto___j] I co~tify that 12 have choekod, ~ified, ~x' ~nfoma~d to all I~)A effoet on the date of this inspection. D te 5 /f .18o The Municipality of Anchorage Depaztm~nt of Health-and Envirorm~.ntal Protection dc~s not guarantee the continued satisfactory pe~:formanee of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validaticn date shown abo~, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply ~nd wastewater' disposal system is safe and func-- tional for the number of bedrccms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the follcwing address: KB2/d5/s [Page 2 of 2] 2-15-84 POU~..~ 6 650 ANCIIORAGE, ALASKA 99502 (907) 264-4111 GEOI~GE M. SULLIVAN, MA May 2, 1978 File No.: EE2.4 Mr. Glen Williams Star Route Box 65 Anchorage, Alaska 99507 Dear Mr. Williams: The Department has reviewed your soil test for Lot 3 of World Top Acres. We find the note on the plat restricting lot #3 to an aerobic system to be unnecessary at the present 'time provided your soil absorption system passes through the location shown for the test hole of the soil test on which it was designed. This Department will issue you a well and on-site sewer permit for lot 3 of World Top Acres provided you initiate the procedure to have the note removed from the plat prior to May 31, 1978. Proof of this action must be provided to the Department by May 31, 1978. Failure to initiate the required action or provide proof of initiation will result in revocation of the well and on-site sewer permit. Hostman . · In~ironmental Engineering JWH: 1 nip cc: William D. Jones ~ Asst. Platting Officer, Planning Dept. MofA A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEAL~ A[YI~ORITY APPROVAL (HAA) CF~CKLIST - FEBRUARY 1984 Well Classification ~.~,,,,0(-~ Well Log P~essnt (Y/N) Total D~pth to~ ' Ca.~d to Static Water Level To, (~r'~ Casing Height Above Ground q~ Eleetazieal Wiring in Conduit (Y/N) Separation Distances f~om Well: To F~ptic/Holding Tank ~n Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line . Nh MUNICIPALITY OF ANCH6)RAGIi DEPT, OF HEALTH & ENVIRONMENTAL PROTECTIOIq MAY 1 4 1984 RECEIVEI] Legal Description: If A, B, ~ C, D.E.C. App~o~d(Y~) ~te ~leted _7/[~ / ~ Yield I~0, ~ ~pth of G~outing ~ ~t At Sanit~y ~a~ on Casing (~) _ ~ession ~ound ~l~ead (Y~) ; O~ Adjoining Lots ; On Adjoining Lots To Nearest l~lblic Sew~ CleanOUt/Manhole '. ~ Nearest Sews= Service Line on Lot Wats= Sample Collected By -r. ~./~¢¢r¢ ; Date Water S~mple Test Results 6(¢ ¢~¢~'aC~'~ Date Installed ~-/~ . _ Size lOo~e4t. No. of Cclapa~,tm~nts Standpipes (Y/N) }' Air-tight Caps (Y/N) ~' Foundation Cleanout .(Y/N) Depression owe'ti Tank _(Y/N) N ])ate LastI PL[~ped Pumping/Maintenance Cont]zact on File (Y/N) ~lJ ; for Holding Tank High-Wats= Al.a~m (Y/N) N/A__ ~%m~Drary Holding Tank :Permit .(.Y/N) Sepeazation Distanoes from Septic/~olding Tank: To Water-Supply Well IOO' To Building Foundation I~ ' To Property Line _ 8~ TO Weter Main/Service Line Course ~/~ To Disposal Field To Stream, Pond, Lake, c~ Major D~ainage [Page 1 of 2] 2-15-.8~- C. A~SORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed_ b-/?¢~ . Width of Field __~' Square Feet of Absorption A~ea Depression ove= Field (Y/N) ~ ;00 ~/&~ro.~Type of System Design Length of Field Depth of Field Gravel Bed Thickness Results of Last Adequacy Test p~$$ ~7,~ 3 Separation Distance from Absorption Field: To Wate=-Supply Well To Building Foundation Lot N~ To Wate~ Main/Service Line TO Existing or Abandoned System cn ; On Adjoining Lots ~ I00' To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Course N~ TO Driveway, Parking Area, or Vehicle Storage A~ea ~O D. LI~f STATION Date Installed Size in Gallons "Iktmp On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dim~r~qions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Co~nents ** Check Permitted Bedroom Rating Against HAA P~quest certify that I have checked, verified, or confomm~d to all MOA on the date of this inspection. Signed KB1/d5/s [Page 2 of 2] HAA Guidelines in effect Date S/, ~-/~ ¢ ~%..~.. ........ Y"' ~ ~THEODORE F. MOORE ** ". ~-[5-8&